Lipase hypersecretion syndrome (LHS) is a rare paraneoplastic syndrome, associated with acinar cell carcinoma of the pancreas (ACCP) in 10% to 15% of patients. Clinically, LHS manifests itself with the appearance of subcutaneous fibrocystic nodules, associated with trophic changes in the overlying skin, such as ulcers or fistulas that are difficult to manage, mainly affecting the lower extremities. Additionally, lipolysis near the joints and in the intraosseous adipose tissue can cause bilateral arthralgias, especially of the knees and ankles. We report a 57-year-old man, with a history of insulin resistance and allergic rhinitis, who presented in June 2019 with multiple subcutaneous nodules in the lower extremities, predominantly in both ankles, associated with arthralgia in that region. Additionally, a CT scan of the abdomen revealed a significant abdominal mass, measuring approximately 17 cm and in contact with the body and tail of the pancreas, pathologically compatible with an ACCP. Treatment with capecitabine was started with a favorable progression. The patient currently presents a small left lateral retro malleolar fistula, which, given the analyzes, studies and reviewed literature is concluded to be a lesion in the context of LHS.

OBJETIVO: Avaliar o impacto do sistema de autotransfusão com hemoconcentração (SAH) no uso de concentrado de hemácias (CH) em cirurgias de revascularização do miocárdio (CRM). MÉTODOS: Foi desenvolvido um estudo transversal, que incluiu 87 pacientes submetidos a CRM eletiva primária com miniCEC, sendo 44 sem uso do SAH e 43 pacientes com uso do SAH. Foi investigada a necessidade de uso e o volume de CH em cada grupo, bem como fatores de risco cardiovascular, variáveis pré-operatórias e parâmetros cirúrgicos transoperatórios por meio de coleta de dados em prontuários. Não houve randomização ou intervenção na seleção dos grupos. Na análise estatística foram utilizados os testes t de Student, teste U de Mann-Whitney, teste do qui-quadrado, com um nível de significância de 5%. RESULTADOS: Em relação a fatores de risco cardiovascular e variáveis pré e transoperatórias, não houve diferença estatística significativa entre os dois grupos. Quando se avaliou o uso absoluto de CH no transoperatório, houve diferença estatística significativa (P=0,00008) entre os grupos sem-SAH (21/44 casos; 47,7%) e com-SAH (4/43 casos; 9,3%). Na análise dos volumes de CH utilizado no transoperatório, também houve diferença significativa (P=0,000117) entre os volumes utilizados no grupo sem-SAH (198,651258,65 ml) e com-SAH (35,061125,67 ml). Já no pós-operatório imediato (até 24 horas), não houve diferença tanto no uso absoluto como nos volumes de CH entre os grupos que usaram ou não o SAH. CONCLUSÃO: A autotransfusão de hemácias possibilitada pelo uso do SAH determina menor uso de CH homólogo no transoperatório de CRM com uso de miniCEC.

OBJECTIVE: To evaluate the impact of Cell Saver autologous blood transfusion system (CS) on the use of packed red blood cells (pRBC) in coronary artery bypass grafting (CABG) surgery. METHODS: We carried out a retrospective cross-sectional study in 87 patients undergoing primary elective CABG with miniaturized cardiopulmonary bypass (miniCPB), divided in two groups: 44 without-CS and 43 with-CS. We investigated the necessity of absolute use and the volume of packed red blood cells (pRBC) in each group, as well as cardiovascular risk factors, presurgical variables and intraoperative surgical parameters. All data were collected from medical records and there was no randomization or intervention on group selection. Statistical analysis was performed with Student t-test, Mann-Whitney U-test and χ² test, with a 5% significance level. RESULTS: There were no significant differences between the two groups in terms of cardiovascular risk factors and pre and intraoperative variables. Evaluating the absolute use of pRBC during surgery, there was a statistically significant difference (P=0.00008) between the groups without-CS (21/44 cases; 47.7%) and with-CS (4/43 cases; 9.3%). There was also a statistically significant difference (P=0.000117) in the volumes of pRBC between the groups without-CS (198.651258.65ml) and with-CS (35.061125.67ml). On the other hand, in the early postoperative period (up to 24h) there was no difference regarding either the absolute use or the volumes of pRBC between both studied groups. CONCLUSION: Autologous erythrocyte transfusion with CS use reduces the use of intraoperative homologous pRBC in coronary artery bypass grafting surgeries associated with miniCPB.

Background: Exposure to solar activity may be associated with incidence of depressive and manic disorders. Aim: To assess the link between solar activity and appearance of affective disorders. Material and Methods: We examined 1862 clinical records of a psychiatric clinic located in Santiago, Chile. Patients with major depression and manic disorders were included in the study, only when they were admitted at the clinic for the first time. Solar activity was calculated using the Wolf number, which is given by the formula R= K(10g+f), where “g” stands for the groups of sunspots and “f ” is the total number of sunspots. We examined the correlation between annual incidence of hospital admissions and average Wolf numbers for the period 1990-2005, which corresponds to approximately one and half solar cycles of 16 years. Results: A total of 450 medical records corresponding to 299 patients (199 women) with depressive symptoms and 151 patients (73 women) with mania, were analyzed. There was a higher number of admissions for depression during the years with lower solar activity. Admissions due to mania tended to increase in the years with high solar activity. There was a negative correlation between the number of hospital admissions due to depression and solar activity (Spearman r =-0.812, p < 0.01). The association between the latter parameter and admissions due to mania did not reach statistical significance. Conclusions: There is a significant negative association between the rate of hospital admissions due to depressive disorders and solar activity.

Os países da América Latina tomaram a decisão política de eliminar a raiva humana transmitida por cão até 2005, e o objetivo deste estudo é analisar o cumprimento desta meta. A situação epidemiológica e as ações de controle foram analisadas de forma desagregada dentro dos países, utilizando-se georreferenciamento da informação. Os 27 casos humanos relatados em 2003 ocorreram em cerca de 0,2% das unidades de segundo nível geopolítico (municípios) da região. Esse dado sugere que a doença atualmente é muito localizada. Vários países não reportam mais transmissão de raiva em cães. Cerca de 1 milhão de pessoas são potencialmente expostas ao risco da raiva e recebem atendimento médico. Existem em média 34.383 (classe: 4.300-148.043) habitantes por posto de saúde com tratamento anti-rábico. São vacinados cerca de 42 milhões de cães anualmente, 70% deles no Brasil e México. A vigilância epidemiológica para a raiva foi considerada média pelos critérios estabelecidos no estudo, sendo enviada 0,05% da população canina estimada de amostras para diagnostico de raiva. Foi considerado que os países estão muito próximos de alcançar a meta.

Latin American countries made the political decision to eliminate human rabies transmitted by dogs by the year 2005. The purpose of the current study is to evaluate to what extent this goal has been reached. The epidemiological situation and control measures were analyzed and broken down within the countries by georeferencing. The 27 human cases reported in 2003 occurred in some 0.2% of the second-level geopolitical units (municipalities or counties) in the region, suggesting that the disease is a local problem. Several areas within the countries reported no more transmission of rabies in dogs. Nearly 1 million people potentially exposed to rabies received treatment. On average, 34,383 inhabitants per health post receive anti-rabies treatment (range: 4,300-148,043). Nearly 42 million dogs are vaccinated annually. Surveillance is considered fair according to the epidemiological criteria adopted by the study. Samples sent for rabies testing represent 0.05% of the estimated canine population (range: 0.001 to 0.2%). The countries are quite close to achieving the goal.

Os países da América Latina tomaram a decisão política de eliminar a raiva humana transmitida por cão até 2005, e o objetivo deste estudo é analisar o cumprimento desta meta. A situação epidemiológica e as ações de controle foram analisadas de forma desagregada dentro dos países, utilizando-se georreferenciamento da informação. Os 27 casos humanos relatados em 2003 ocorreram em cerca de 0,2% das unidades de segundo nível geopolítico (municípios) da região. Esse dado sugere que a doença atualmente é muito localizada. Vários países não reportam mais transmissão de raiva em cães. Cerca de 1 milhão de pessoas são potencialmente expostas ao risco da raiva e recebem atendimento médico. Existem em média 34.383 (classe: 4.300-148.043) habitantes por posto de saúde com tratamento anti-rábico. São vacinados cerca de 42 milhões de cães anualmente, 70% deles no Brasil e México. A vigilância epidemiológica para a raiva foi considerada média pelos critérios estabelecidos no estudo, sendo enviada 0,05% da população canina estimada de amostras para diagnostico de raiva. Foi considerado que os países estão muito próximos de alcançar a meta.

Latin American countries made the political decision to eliminate human rabies transmitted by dogs by the year 2005. The purpose of the current study is to evaluate to what extent this goal has been reached. The epidemiological situation and control measures were analyzed and broken down within the countries by georeferencing. The 27 human cases reported in 2003 occurred in some 0.2% of the second-level geopolitical units (municipalities or counties) in the region, suggesting that the disease is a local problem. Several areas within the countries reported no more transmission of rabies in dogs. Nearly 1 million people potentially exposed to rabies received treatment. On average, 34,383 inhabitants per health post receive anti-rabies treatment (range: 4,300-148,043). Nearly 42 million dogs are vaccinated annually. Surveillance is considered fair according to the epidemiological criteria adopted by the study. Samples sent for rabies testing represent 0.05% of the estimated canine population (range: 0.001 to 0.2%). The countries are quite close to achieving the goal.

Avaliou-se, durante quatro estações de monta (1/11 a 31/1 do ano seguinte), o efeito da ordem de parto (OP) e da condição corporal (CC), segundo escala de 1 (magra) a 5 (gorda), sobre o desempenho reprodutivo de 468 fêmeas Nelore, sendo 391 vacas multíparas e 77 primíparas, em pastagem de Brachiaria decumbens Stapf, na região dos Cerrados, no Brasil Central. A OP teve efeito quadrático na taxa de prenhez (TP). Vacas OP1 apresentaram TP de 69%, OP5 a OP8 de 90%, com declínio gradual até 80% de prenhez na OP12. A CC à desmama afetou a TP. Pela análise de regressão, vacas OP1 com CC 2,0 e 3,5 tiveram TP de 52,7 e 82,5%, respectivamente. Observou-se TP DE 96% em vacas com OP4 e OP8 e CC 3,5. A TP de vacas OP1 com parição tardia foi de 37,7%, mas, independentemente da OP, vacas que pariram no início da temporada tiveram TP superiores a 80%. Vacas OP1 pariram 350,12 dias após o início da monta, enquanto aquelas com OP superiores, necessitaram de 328,32 dias. Vacas OP1 apresentaram o mais longo intervalo de partos (IP), com 392,10 dias, ao passo que o IP das OP5 a OP9 foi de 365 dias. O IP foi afetado pelo ano, pela OP, pelo número de dias necessários para parir na estação de parição e pela variação de peso na estação de cobrição. O peso vivo e a CC das vacas à desmama foram afetados pela OP e pelo ano. O peso à desmama (PD) do bezerro aumentou da OP1 até a OP4/OP5, de modo que as vacas OP1 proporcionaram PD de 159 kg e a média dos PD das OP foi de 169 kg. Altos índices produtivos e reprodutivos são obtidos entre OP3 e OP8 com CC acima de 3,0 e 3,5 em vacas Nelore multíparas e prímaparas, respectivamente.

The objective of this trial was to evaluate the effects of calving order (CO) and body condition score (BCS), scale 1(thin) to 5 (fat), on reproductive performance of 468 Nellore cows (391 multiparous and 77 primiparous) grazing Brachiaria decumbens Stapf at Brazilian Central West (Cerrados region) during four breeding seasons (from 11/1 to 1/31 of the following year). Calving order quadratically affected pregnancy rate (PR) in this trial; PR of CO1 cows was 69% while that of cows from CO5 to CO8 was 90% followed by a gradual decline until 80% PR in C012 cows. Body condition score at weaning also affected PR. For instance, CO1 cows with BCS of 2.0 and 3.5 had 52.7 and 82.5% of PR, respectively. Cows from CO4 to CO8 and BCS of 3.5 showed 96% of PR. CO1 cows that calved late in the season had 37.7% of PR but independent of CO, cows that calved earlier in the calving season had PR greater than 80%. CO1 cows calved 350.12 days after the start of the mating season while multiparous cows calved earlier (328.32 days). CO1 had the longest calving interval (CI) averaging 392.10 days whereas that from CO5 to CO9 cows averaged 365 days. Calving interval was affected by year, CO, number of days spent to calve in the calving season, and body weight change in the mating season. In addition, cows body weight (BWW) and BC at weaning (BCW) were both affected by CO and year. Body weight of calves at weaning increased from CO1 to CO4/CO5 averaging 159 kg for calves from CO1 cows and 169 kg when all CO levels were included. High production and reproductive performance are obtained from CO3 to CO8 and BCS above 3.0 and 3.5 for multiparous and primiparous Nellore cows, respectively.

Foi avaliado, durante três anos, o desempenho de 103 bezerros Nelore criados a pasto, recriados com suplementação na primeira seca pós-desmama, com o objetivo de se obterem animais com desenvolvimento suficiente para serem confinados aos 20/21 meses de idade. Os animais apresentaram, início da suplementação, 189,51 ± 21,08 kg de peso vivo e 254 ± 29,22 dias de idade e, ao final, de 242,38 ± 29,22 kg e 400 ± 31,08 dias de idade e consumo médio diário de ração de 1,52 kg. Durante a suplementação, o ganho de peso médio diário foi de 0,377 kg e, nas águas, de 0,534 kg. A correlação do peso vivo do início ao final da suplementação foi de 0,78 e, ao final do período das águas, de 0,65. As maiores correlações entre pesos vivos foram: peso no final da seca e nas águas (0,86), peso e ganho de peso no final da águas (0,62), peso no final e ganho de peso das águas e ganho total (0,75 e 0,71, respectivamente), ganho na seca e ganho total (0,80). Após a desmama, os animais foram estratificados em três classes: inferior (140 ± 11,37 kg), média (187 ± 11,09 kg) e superior (219 ± 8,51 kg). Os pesos no final do período das águas foram de 271 ± 9,56 kg, 362 ± 22,75 kg e 425 ± 15,32 kg, respectivamente. Pelo menos 54% dos animais permaneceram como inferiores, 60% como médios e 54% como superiores no final do período das águas. Somente 4% dos animais inferiores atingiram a classe superior no final do período avaliado. Aos 20/21 meses de idade, os novilhos apresentaram, em média, de 366 ± 39,04 kg e condições para terminação em confinamento. Entretanto, existem bezerros com peso inferior a 150 kg aos seis/sete meses de idade à desmama, mesmo criados em boas condições de manejo, com baixo potencial de ganho de peso e menores condições de serem terminados precocemente quando suplementados previamente.

Body weight gain of 103 Nelore calves until 20/21 months old when weaned on cultivated pasture and supplemented during the dry period was evaluated during three years to obtain steers with body weight to be finished immediately at fedlot. At the beginning and end of supplementation period, the animals averaged body weight and age of 189.51± 21.08 kg and 254 ± 29.22 days and 242.38 ± 29.22 kg and 400 ± 31.08 days, respectively. The mean daily feed intake was 1.52 kg/head. The mean daily body weight gain in this period was of 0.377 kg and in the next rainfall season was of 0.534 kg. The correlation of body weight from the beginning to the end of supplementation and to the end of rainfall season was of 0.78 and 0.65, respectively. The highest correlations found among body weights were: at the end of the dry and rainfall period (r = 0.86); body weight and gain at the end of rainfall period (r = 0.62); body weight and gain at the end of rainfall period and total gain (0.75 and 0.71, repectively), gain at dry season and total gain (0.80). After weaning, the calves were classified into three classes: inferior (140 ± 11.37 kg), medium (187 ± 11.09 kg) and superior (219 ± 8.51 kg). The body weights at the end of rainfall season were of 271 ± 9.56 kg, 362 ± 22.75 kg and 425 ± 15.32 kg. At least 54% of the animals remained as inferior, 60% as medium and 54% as superior at the end of rainfall season. At 20/21 months old, the steers averaged body weight of 366 ± 39.04 kg and conditions to be finished in fedlot. However, there are calves weaned at six/seven months old with less than 150 kg of body weight, with lower potential to body weight gain and less conditions to be finished in fedlot even when supplemented previously.

A produtividade de vacas Nelore foi estimada durante quatro anos em pastagem de Brachiaria decumbens Stapf, com correção inicial da acidez e da fertilidade do solo e livre acesso a uma mistura mineral. Foram determinadas as taxas de prenhez (TP), de natalidade (TN) e de desmama (TD), o peso à desmama dos bezerros (PD), a produção de quilos de bezerros por vaca (P) e a eficiência de produção de bezerro por vaca (E) e por área (EA), bem como o peso e a condição corporal (CC) das vacas antes da estação de parição (PAP e CCP), durante o acasalamento (PMA e CCM) e à desmama (PVD e CCD). A TP média foi de 87,5%, enquanto a TN e a TD foram de 81,7 e 77,2%, respectivamente, considerando-se todas as vacas expostas a touros. O PD médio foi de 170 ± 21,89 kg, com a média de 202 ± 16,48 dias de idade à desmama. A ordem de parto (OP) influenciou o peso dos bezerros à desmama. Bezerros mais pesados foram produzidos pelas vacas entre a OP3 e a OP9. A P e E por vaca exposta a touro foram de 130 e 32,19 kg, respectivamente, e a EA foi de 192 kg/ha. Nos períodos PAP, PMA e PVD, os pesos vivos foram de 471 ± 19,67 kg, 405 ± 21,48 kg, 410 ± 9,35 kg e as condições corporais 4,45 ± 0,30, 3,32 ± 0,44, 3,54 ± 0,19, respectivamente. A correlação entre peso vivo e condição corporal foi de 0,66. Vacas Nelore, em pastagem de Brachiaria decumbens Stapf com correção inicial da acidez e fertilidade do solo, apresentaram altos índices reprodutivos e produtivos. Vacas em ordens de parto intermediárias foram mais produtivas que as vacas no início e no final da vida reprodutiva.

The productivity of Nelore cows on Brachiaria decumbens Stapf pasture was measured during four years, in a soil initially improved with limestone and fertilizer and with free access to a mineral mixture. Pregnancy rate (PR), calving rate (CR), weaning rate (WR), calves weaning body weight (BWC), productivity (P = kg of calf/cow) and efficiency (E= P/100 kg of cow) per cow, productivity per area (AP = calves kg/ha), as well as cow body weight and body condition before the calving season (CLW and CBC), at the middle of the mating season (MLW and MBC) and at weaning (WLW and WBC) were evaluated. Mean PR, CR and WR of 87.5, 81.7 and 77.2%, respectively, were observed. Mean LWC of 170 ± 21.89 kg and mean weaning age of 202 ± 16.48 days were observed. Significant effect of calving order (CO) on LWC was detected. Cows between CO3 and CO9 weaned the heaviest calves. Values of 130 kg and 32.19 kg were observed for P and E, respectively, with AP of 192 kg/ha. The CLW and CBC, MLW and MBC, and WLW and WBC were of 471 + 19.67 kg and 4.45 + 0.30; 405 + 21.48 kg and 3.32 + 0.44; 410 + 9.35 and 3.54 + 0.19, respectively. The correlation between body weight and body condition was of 0.66. Nelore cows maintained on a tropical pastures of Brachiaria decumbens Stapf, in an initial fertilized soil, had high reproduction level and productivity. Cows with medium calving order had higher productivity than primiparous and older cows.

Medical literature is paying increasing attention to conflicts of interest, mainly although not exclusively from the perspective of the physician-pharmaceutical industry relationship. When interests compete, the possibility of medical judgment being distorted is often not visible at first sight. The likelihood of an unconscious and unintentional self-serving bias, as well as the effects that professional judgment would appear to be influenced, regardless of whether it is or not, must be considered. The advent of Evidence-based Medicine and Administered Health poses tensions between the population focus of medicine and the duties that doctors have to individual patients. As in other countries, national scientific societies must prompt the study, knowledge, and diffusion of those factors that may contribute to bias in medical judgment, as well as institute local ethical codes to guide professionals.

La literatura médica está prestando creciente atención al conflicto de intereses, de modo principal aunque no exclusivo, desde la perspectiva de las relaciones entre los médicos y la industria farmacéutica. Cuando hay intereses en competencia muchas veces la posibilidad de la distorsión del juicio médico no es visible a primera vista. Deben considerarse el posible sesgo inconsciente y no intencionado de autoservicio, como los efectos de que el juicio profesional parezca influenciado, independiente de si lo está o no. El advenimiento de la Medicina basada en la Evidencia y de la Salud Administrada plantea tensiones entre el enfoque poblacional de la medicina y las obligaciones de los médicos hacia sus pacientes individuales. Al igual que en otros países, es necesario que las sociedades científicas nacionales impulsen el estudio, conocimiento y difusión de aquellos factores que pueden contribuir a sesgar el juicio médico, como asimismo instituir pautas éticas locales que guíen a los profesionales.