Abstract Cutaneous metastases from solid tumors are uncommon events in clinical practice. Most of the time, the patient already has the diagnosis of a malignant neoplasm when the cutaneous metastasis is detected. However, in up to one-third of cases, cutaneous metastasis is identified before the primary tumor. Therefore, its identification may be essential for starting treatment, although it is usually indicative of poor prognosis. The diagnosis will depend on clinical, histopathological, and immunohistochemical analysis. Sometimes the identification of the primary site is difficult; however, a thorough analysis using imaging tests and constant surveillance is important.

RESUMO Este trabalho apresentou estudos de custos de operação e manutenção (O&M) na estação de tratamento de esgotos (ETE) de nível terciário, intitulada ETE do Baldo, localizada na cidade de Natal, Rio Grande do Norte. Teve como objetivo avaliar a eficiência econômico-ambiental da ETE através da determinação de indicador de desempenho, calculado via identificação e quantificação de todos os custos operacionais e de manutenção envolvidos nos seus processos internos de tratamento. Na pesquisa, foram identificados os diversos componentes dos custos de O&M responsáveis pelas atividades necessárias ao funcionamento da ETE de julho de 2016 a dezembro de 2018, reunidos em quatro grupos de custos. Os custos mensais foram correlacionados com os dados de vazões do período, e os de O&M por metro cúbico de esgoto tratado ao longo dos anos de 2016, 2017 e 2018 assumiram valores médios de R$ 0,32, R$ 0,30 e R$ 0,38·m−3, respectivamente. Os custos referentes ao pessoal e ao consumo energético exerceram, em todos os meses analisados, o primeiro e o segundo componentes de maior representatividade no custo total, assumindo as seguintes composições percentuais: 56,72 e 26,75% no segundo semestre do ano de 2016; 46,69 e 28,73% no ano de 2017; e 52,44 e 27,56% no ano 2018. Por fim, recomendam-se estudos na implementação de melhorias nos grupos pessoal e energia, tendo em vista que são responsáveis por cerca de 75% de todos os custos de O&M da ETE.

ABSTRACT This study presented operational and maintenance costs (O&M) at the tertiary wastewater treatment plant (WWTP) entitled Baldo's ETE, located in the city of Natal, Rio Grande do Norte. Its aim was to evaluate the economic and environmental efficiency of the WWTP through the determination of a performance indicator, calculated from the identification and quantification of all the operational and maintenance costs involved in its internal processes of treatment. The research identified the various components of O&M costs responsible for the activities necessary for the operation of the WWTP from July 2016 to December 2018, assembled into 4 cost groups. The monthly costs were correlated with the flow data of the period. O&M costs per cubic meter of sewage treated over the years 2016, 2017, and 2018 assumed average values of R$ 0.32, R$ 0.30, and R$ 0.38·m−3, respectively. Personnel and energy consumption costs accounted for the first and second most representative components of the total cost in all the months analyzed, with the following percentage compositions: 56.72 and 26.75% in the second half of 2016; 46.69 and 28.73% in 2017; and 52.44 and 27.56% in the year 2018. Finally, studies on the implementation of improvements in the personal and energy groups are recommended, as they account for about 75% of all O&M costs of the WWTP.

Abstract Systemic amyloidosis secondary to psoriatic arthritis is rare, and published data are based mainly on case reports and are associated with increased mortality. This is the report of a patient with long-term psoriatic arthritis and chronic sialadenitis, who showed an inadequate response to therapy. The diagnosis of secondary amyloidosis was attained through biopsies of genital skin lesions. Although very rare, it is important that dermatologists and general practitioners consider the possibility of amyloidosis in patients with chronic inflammatory diseases, since an early intervention can be implemented, and thus, the prognosis of this condition can be improved.

RESUMO OBJETIVO: Analisar e traçar uma relação entre as características clinicopatológicas e sociodemográficas dos melanomas acrais diagnosticados no Hospital do Servidor Público Estadual de São Paulo. MÉTODOS: Fez-se um estudo observacional, descritivo e retrospectivo de pacientes diagnosticados com melanoma em sítio acral entre 1997 e 2016 no Hospital do Servidor Público Estadual de São Paulo. Características sociodemográficas e clinicopatológicas foram coletadas e analisadas. RESULTADOS: Foram encontrados 45 pacientes com melanoma acral no período avaliado. Trinta e um eram do sexo feminino (68,89%) e 14 masculino (31,11%). A maioria dos casos diagnosticados eram invasivos (88,37%) e o subtipo histológico predominante foi o lentiginoso acral (91,11%). A região plantar foi a mais prevalente (64,44%). A mediana do índice de Breslow foi de 3 mm. Houve uma tendência a maior gravidade nos pacientes do sexo masculino. CONCLUSÕES: Os melanomas de sítio acral são diagnosticados em fases mais avançadas o que acarreta pior prognóstico dos pacientes. Assume ainda maior importância em populações altamente miscigenadas e negras como a brasileira.

SUMMARY OBJECTIVE: The relationship between the clinicopathological and sociodemographics characteristics of acral melanomas diagnosed at the Hospital do Servidor Público Estadual de São Paulo was analyzed and traced between 1997 and 2016. METHODS: An observational, descriptive, and retrospective study of patients diagnosed with acral melanoma was performed at Hospital do Servidor Público Estadual de São Paulo. Sociodemographic and clinicopathological characteristics were collected and analyzed. RESULTS: Forty-five patients with acral melanomas were found during the evaluation period. Thirty-one were females, and 14 were males (68.89% and 31.3%, respectively). Most of the cases were invasive (88.37%), and the predominant histological subtype was the acral lentiginous (91.11%). The plantar region was the most prevalent (64.44%). The median Breslow index was 3 mm, and there was a tendency towards greater severity in male patients. CONCLUSIONS: Acral site melanomas are detected diagnosed when they reach more advanced stages, which leads to a worse prognosis for patients. Late detection assumes even greater importance in highly mixed and black populations, such as the Brazilian population.

Abstract Sporotrichosis is a deep mycosis of subacute or chronic evolution, caused by the dimorphic fungus of the genus Sporothrix. The treatment is carried out with antifungal orally or intravenously. Therapeutic success can be affected by several factors, such as altered gastrointestinal physiology by surgery. More and more patients are submitted to bariatric surgeries and the literature for the alterations of the absorption of medications in this context is very scarce. We intend to contribute to a better understanding with this case report of cutaneous-lymphatic sporotrichosis in a patient after bariatric surgery without response to itraconazole treatment, even at high doses.

Abstract The Borst-Jadassohn phenomenon is a morphological finding that consists of the presence of well-defined nests of cells located in the spiny stratum of an acanthotic epidermis. One of the neoplasms where this phenomenon is found is hidroacanthoma simplex. This neoplasm is considered the intraepidermal form of the eccrine poroma. Despite its benign nature, malignant transformations are reported. The present article reports a case of hidroacanthoma simplex and discusses the dermoscopy of this phenomenon.

Abstract Beekeeping is affected by adverse climatic conditions and availability of floral resources. This study aimed to survey and characterize the flora in São João do Piauí, a semi-arid region in Piauí, Brazil, and to identify species providing resources to bees. Flowering plants were observed for 18 months, and records were taken of flowering date, growth habit, visitation and resources collected by bees. Melissopalinological analysis of honey produced in the area was performed. A total of 67 flowering plant species were recorded, of which 49 were considered as bee plants, with a predominance of herbs and shrubs. The low rainfall reduces the number of flowering species, which makes important the conservation and multiplication of species which bloom in dry season, such as Ipomoea glabra, Myracrodruon urundeuva, Sida cordifolia and Ziziphus joazeiro, as well as species that contribute to honey production such as Mimosa tenuiflora, Mesosphaerum suaveolens and Croton sonderianus.

Abstract: Squamoid eccrine ductal carcinoma is a cutaneous malignancy that originates from the eccrine sweat gland. A 76-year-old woman presented with an asymptomatic papule on her nose that had been present for one year. Dermoscopy showed pseudocysts, irregular linear crown vessels, and yellowish-brown globules surrounded by white halos. This is the first dermoscopic description of squamoid eccrine ductal carcinoma. Studies with more cases are needed to confirm the dermoscopic characterization of this tumor.

RESUMO Entre os padrões de osteólise acetabular associados às solturas acetabulares, os autores destacam como de maior gravidade a dissociação pélvica e as perdas segmentares mediais nas quais a lâmina quadrilátera está gravemente acometida. Tais lesões são potencialmente letais em casos de lesão vascular de grande porte. O objetivo desta nota foi descrever um acesso iliofemoral modificado quando há migração intrapélvica maciça do componente acetabular em pacientes com proximidade total do feixe vascular ilíaco e ausência de plano demarcatório anatômico entre o conteúdo migrado e o feixe ilíaco. Esse acesso foi feito em 12 pacientes de 21 que apresentavam tais critérios.

ABSTRACT Among the patterns of acetabular osteolysis associated with acetabular loosening, the authors emphasize the severity of pelvic dissociation and medial segmental losses in which the quadrilateral lamina is severely affected. Such lesions are potentially lethal in cases of large vascular injury. This note aimed to describe a modified iliofemoral approach in cases of massive intrapelvic migration of the acetabular component in patients with total proximity of the iliac vascular bundle and absence of an anatomical demarcation plane between the migrated contents and the iliac bundle. This approach was performed in 12 of 21 patients who had these criteria.

Resumo Mesmo com a evolução considerável das técnicas de pintura automotiva nas últimas décadas, o para-choque é uma autopeça que ainda tem diversos problemas relacionados ao aspecto da sua superfície pintada. O objetivo deste artigo foi identificar os fatores de aplicação do verniz que interferem na intensidade do aspecto de casca de laranja em superfícies de para-choques pintados e propor uma combinação ótima dos fatores através da metodologia do projeto robusto. Na pesquisa realizada no setor de pintura automatizada de uma empresa de para-choques, o projeto robusto auxiliou na identificação das formas de variabilidade do processo de produção através da aplicação de um experimento e de técnicas estatísticas, de forma ágil e com pouco desperdício de material. O experimento testou várias combinações dos níveis dos fatores de aplicação do verniz (velocidade, vazão, rotação por minuto, alta tensão, ar modelador) em amostras de para-choques. A intensidade da casca de laranja em superfícies pintadas de verniz das amostras foi medida pelo equipamento Wave Scan, o qual fornece a leitura do comprimento de onda em função de duas medidas: Short Wave e Long Wave. Os principais resultados obtidos através da análise da variância da razão sinal ruído revelaram que os fatores que têm efeitos significativos no valor resposta do comprimento de onda Short Wave são: rotação por minuto, alta tensão além das interações vazão*alta tensão e velocidade*alta tensão. Já os fatores que afetaram significativamente o valor resposta do comprimento de onda Long Wave são: vazão, ar modelador, rotação por minuto, alta tensão e a interação velocidade*alta tensão. Como resultado da análise das médias do sinal ruído, foi apresentada neste trabalho a combinação ótima dos fatores: velocidade = 920 m/s; vazão = 160 mililitros/minuto; ar modelador = 180 bar; rotação = 90 rotações/minuto; alta tensão = 180 quilovolts.

Abstract Even with the considerable development of techniques for automotive paint in recent decades, the bumper is a car part that still has many problems related to the aspect of its painted surface. This study aimed to identify the clear coat application factors that affect on the intensity of orange peel appearance on painted bumpers surfaces and offer an optimum design of factors through the robust design methodology. In this research conducted in automated paint sector of a bumper company, the robust design helped in the identification of variability cause in a production process by applying an experiment and statistical techniques, in an agile and with little waste material way. The experiment tested various combinations of levels of the clear coat application factors (speed, flow, revolution per minute, operation voltage, atomizing air pressure) in the bumper samples. The intensity of the orange peel on coated surfaces samples was measured by a Wave Scan device that provides the wavelength reading as a function of two measures: Long Wave and Short Wave. The main results obtained by variance analysis of noise signal ratio showed that the factors that have significant effects on the value of the Short Wave response wavelength are: revolution per minute, operation voltage and the interactions flow*operation voltage and speed*operation voltage. The factors that significantly affected the response value of the Long Wave wavelength are: flow, atomizing air pressure, revolution per minute, operation voltage and the interaction speed*operation voltage. As a result of analysis of the noise signal mean, it is presented the factors optimum design: speed = 920 m / s; flow = 160 ml/min; atomizing air pressure = 180 bar; revolution per minute = 90 revolutions / minute; operation voltage = 180 kilovolts.