Resumo Objetivo: Determinar a frequência em que a PET/CT com FDG-18F muda a classificação de probabilidade de malignidade do nódulo pulmonar solitário. Materiais e Métodos: Foi realizada análise retrospectiva de todas as PET/CTs com FDG-18F realizadas entre maio/2016 e maio/2017 num serviço de medicina nuclear, cuja indicação era a avaliação de nódulo pulmonar solitário. Foram analisados os prontuários e os exames de PET/CT para coleta das informações necessárias para o cálculo da probabilidade pré-teste de malignidade pelo modelo de Swensen e pelo modelo de Herder. Probabilidade menor que 5% foi considerada como baixa, maior que 65% foi definida como alta, e os casos restantes, como intermediária. Os casos classificados como intermediários pelo modelo de Swensen foram reclassificados de acordo com o modelo de Herder. Resultados: Trinta e três pacientes foram incluídos neste estudo, 17 (51,5%) deles eram do gênero masculino, e a média de idade foi 68,63 anos (± 12,20 anos). Em relação à classificação da probabilidade de malignidade pelo modelo de Swensen, 23 (69,7%) apresentaram probabilidade intermediária de malignidade. Destes, o modelo de Herder classificou 6 casos (26,1%) como probabilidade baixa e 8 casos (34,8%) como probabilidade alta de malignidade. Conclusão: A PET/CT com FDG-18F foi capaz de modificar a classificação probabilística do nódulo pulmonar solitário em mais da metade dos casos.

Abstract Objective: To determine the frequency with which 18F-FDG-PET/CT findings change the probability of malignancy classification of solitary pulmonary nodules. Materials and Methods: This was a retrospective analysis of all 18F-FDG-PET/CT examinations performed for the investigation of a solitary pulmonary nodule between May 2016 and May 2017. We reviewed medical records and PET/CT images to collect the data necessary to calculate the pre-test probability of malignancy using the Swensen model and the Herder model. The probability of malignancy was classified as low if < 5%, intermediate if 5-65%, and high if > 65%. Cases classified as intermediate in the Swensen model were reclassified by the Herder model. Results: We reviewed the records for 33 patients, of whom 17 (51.5%) were male. The mean age was 68.63 ± 12.20 years. According to the Swensen model, the probability of malignancy was intermediate in 23 cases (69.7%). Among those, the application of the Herder model resulted in the probability of malignancy being reclassified as low in 6 (26.1%) and as high in 8 (34.8%). Conclusion: 18F-FDG-PET/CT was able to modify the probability of malignancy classification of a solitary pulmonary nodule in more than 50% of the cases evaluated.

Abstract We aimed to verify the changes in the microbial community during bioremediation of gasoline-contaminated soil. Microbial inoculants were produced from successive additions of gasoline to municipal solid waste compost (MSWC) previously fertilized with nitrogen-phosphorous. To obtain Inoculant A, fertilized MSWC was amended with gasoline every 3 days during 18 days. Inoculant B received the same application, but at every 6 days. Inoculant C included MSWC fertilized with N–P, but no gasoline. The inoculants were applied to gasoline-contaminated soil at 10, 30, or 50 g/kg. Mineralization of gasoline hydrocarbons in soil was evaluated by respirometric analysis. The viability of the inoculants was evaluated after 103 days of storage under refrigeration or room temperature. The relative proportions of microbial groups in the inoculants and soil were evaluated by FAME. The dose of 50 g/kg of inoculants A and B led to the largest CO2 emission from soil. CO2 emissions in treatments with inoculant C were inversely proportional to the dose of inoculant. Heterotrophic bacterial counts were greater in soil treated with inoculants A and B. The application of inoculants decreased the proportion of actinobacteria and increased of Gram-negative bacteria. Decline in the density of heterotrophic bacteria in inoculants occurred after storage. This reduction was bigger in inoculants stored at room temperature. The application of stored inoculants in gasoline-contaminated soil resulted in a CO2 emission twice bigger than that observed in uninoculated soil. We concluded that MSWC is an effective material for the production of microbial inoculants for the bioremediation of gasoline-contaminated soil.

Este artigo tem como objetivo descrever e refletir, sistematicamente, sobre a experiência de implantação de processos de monitoramento do Programa Ação Saúde (PAS) como uma experiência de tradução, contextualizada na interface entre a atenção básica do Sistema Único de Saúde (SUS) e comunidades com características urbano-rurais. O PAS constituiu-se como uma proposta pedagógica baseada em competências e utilizou a metodologia da problematização. Os processos do PAS são tomados sob a ótica das operações de tradução, tais como: problematização, mobilização, enredamento e alinhamento. O monitoramento desses processos coloca em destaque os dilemas da mensuração, acompanhamento e reflexão compartilhada de seus efeitos tangíveis e intangíveis. A implementação do sistema de monitoramento intermediada por uma instituição pública acadêmica buscou contribuir para modelos de parcerias público-privadas em políticas de desenvolvimento social. Dentre as conexões promissoras estabelecidas no PAS, foi enfatizada a identificação da agenda pública no setor saúde como rota a ser fortalecida e potencializada, bem como ações de advocacy em torno da escolha de temáticas e prioridades locais. Concluiu-se que a configuração da rede de promoção de saúde foi influenciada por contextos geopolíticos diferenciados dos municípios, em especial para a sustentabilidade e implementação dos projetos locais e o estímulo a uma cultura local em Monitoramento e Avaliação - M&A.

This article aims to systematically describe and reflect on the experience of implementing monitoring processes of the Programa Ação Saúde (PAS), or Health Action Programme, as an experience of translation, contextualized in the interface between primary care from the Sistema Único de Saúde (SUS), or Unified Health System, and communities with urban-rural characteristics. The PAS has established itself as a pedagogic proposition based on skills and has used the methodology of problematization. The processes of the PAS are taken under the perspective of translation operations, such as: problematization, mobilization, networking and alignment. The monitoring of those processes highlights the dilemmas of measurement, monitoring and shared reflection of their tangible and intangible effects. The implementation of the monitoring system, mediated by a public academic institution sought to contribute to models of public-private partnerships in social development policies. Among the promising connections established in the PAS, the identification of the public agenda in the health sector has been emphasized as a route to be strengthened and improved, as well as advocacy actions around the choice of local themes and priorities. It was concluded that the configuration of the health promotion network was influenced by different geopolitical contexts of the municipalities, especially for the sustainability and implementation of local projects and the incentive to a local culture in Monitoring and Evaluation - M&E.

OBJETIVO: Avaliar se mulheres climatéricas submetidas a transplante de fígado tiveram maior prevalência de massa óssea diminuída do que aquelas sem antecedente de doença hepática. MÉTODOS: Estudo de corte transversal, com 48 mulheres em acompanhamento ambulatorial em um hospital universitário na região Sudeste do Brasil, no período de 04 de fevereiro de 2009 a 05 de janeiro de 2011. Foram incluídas 24 mulheres submetidas a transplante hepático há pelo menos um ano, com idades igual ou superior a 35 anos, e 24 sem antecedente de doença hepática, com idade (± três anos) e padrão menstrual semelhante ao das transplantadas. As mulheres foram submetidas a exames laboratoriais (hormônio folículo estimulante e estradiol) e densitometria óssea de coluna lombar e fêmur, com equipamento Hologic, Discovery WI. A análise estatística foi realizada por meio do teste exato de Fisher, por Odds Ratio (OR) simples e pela regressão logística múltipla. RESULTADOS: A média etária das mulheres incluídas no estudo foi de 52,8 (±10,7) anos, sendo que 27,1% estavam na pré-menopausa e 72,9%, na peri/pós-menopausa. Aproximadamente 14,6% dessas mulheres apresentaram osteoporose e 35,4%, baixa massa óssea. Os seguintes itens foram associados com massa óssea diminuída: estar na pós-menopausa (OR=71,4; IC95% 3,8 - 1.339,7; p<0,0001), idade atual maior que 49 anos (OR=11,4; IC95% 2,9 - 44,0; p=0,0002) e nível de estradiol sérico menor que 44,5 pg/mL (OR=18,3; IC95% 3,4 - 97,0; p<0,0001). Ter antecedente de transplante hepático não se associou massa óssea diminuída (OR=1,4; IC95% 0,4 - 4,3; p=0,5). CONCLUSÃO: O transplante hepático não se associou massa óssea diminuída nesse grupo de mulheres climatéricas.

PURPOSE: To evaluate whether climacteric women undergoing liver transplantation had higher prevalence of decreased bone mass than those without any liver disease. METHODS: A cross-sectional study with 48 women receiving follow-up care at a university hospital in Southeastern Brazil, from February 4th 2009 to January 5th 2011, was conducted. Of these women, 24 were 35 years or older and had undergone liver transplantation at least one year before study entry. The remaining 24 women had no liver disease and their ages and menstrual patterns were similar to those of transplanted patients. Laboratorial tests (follicle-stimulating hormone and estradiol) and bone density measurements of the lumbar spine and femur (equipment Hologic, Discovery WI) were performed. Statistical analysis was carried out by Fisher's exact test, simple Odds Ratio (OR), and multiple logistic regression. RESULTS: Mean age of the women included in the study was 52.8 (±10.7) years-old, 27.1% were premenopausal and 72.9% were peri/postmenopausal. Approximately 14.6% of these women exhibited osteoporosis and 35.4% had low bone mass. The following items were associated with decreased bone mass: being postmenopausal (OR=71.4; 95%CI 3.8 - 1,339.7; p<0.0001), current age over 49 years-old (OR=11.4; 95%CI 2.9 - 44.0; p=0.0002), and serum estradiol levels lower than 44.5 pg/mL (OR=18.3; 95%CI 3.4 - 97.0; p<0.0001). Having a history of liver transplantation was not associated with decreased bone mass (OR=1.4; 95%CI 0.4 - 4.3; p=0.56). CONCLUSION: Liver transplantation was not associated with decreased bone mass in this group of climacteric women.

Objetivo. Analizar las medidas de prevención de la transmisión vertical del VIH empleadas por las madres de niños VIH positivos que fueron acompañadas por el Servicio de Atención Especializado (SAE) del municipio de Pelotas, Rio Grande do Sul (Brasil). Metodología. Investigación cualitativa con abordaje descriptivo y exploratorio. Los datos fueron recolectados mediante de entrevistas semi-estructuradas a cinco madres de niños VIH positivos; el análisis de la información se hizo por categorización temática. Resultados. El principal factor que obstaculiza la realización de medidas de prevención de la transmisión vertical del VIH fue la omisión del personal de salud de solicitar la prueba del VIH. La mayoría de las encuestadas mostró conocimiento sobre la enfermedad y de las medidas de prevención de la misma. Conclusión. Existe la necesidad de capacitar a los profesionales de la salud en la difusión de medidas preventivas con el fin de mejorar la atención prenatal.

Objective. To analyze HIV vertical transmission preventive measurements used by mothers of HIV positive children who were supported by the Specialized Attention Service (EAS) of the municipality of Pelotas, Rio Grande do sul (Brazil). Methodology. Qualitative research with descriptive and exploratory approach. Data were collected through semi structured interviews applied to five mothers of HIV positive children. The analysis of the information was made through thematic categorization. Results. It was observed that the main factor that hampers HIV vertical transmission preventive measurements was the healthcare staff omission to order the HIV test. Most of the surveyed mothers showed knowledge about the disease and its preventive measurements. Conclusion. There is a need to train health care professionals in the diffusion of preventive measurements to improve prenatal attention.

Objetivo. Analisar as medidas de prevenção da transmissão vertical do HIV empregadas pelas mães de meninos HIV positivos que foram acompanhadas pelo Serviço de Atendimento Especializado (SAE) do município de Pelotas, Rio Grande do Sul (Brasil). Metodologia. Investigação qualitativa com abordagem descritiva e exploratório. Os dados foram coletados através de entrevistas semi-estruturadas a cinco mães de meninos HIV positivo; a análise da informação se fez por categorização temática. Resultados. Observou-se que o principal fator que põe obstáculos a realização de medidas de prevenção da transmissão vertical do HIV foi a omissão do pessoal de saúde de solicitar a prova do HIV. A maioria das interrogadas mostrou conhecimento sobre a doença e das medidas pára de prevenção da mesma. Conclusão. Existe a necessidade de capacitar aos profissionais da saúde na difusão de medidas preventivas com o fim de melhorar o atendimento pré-natal.

BACKGROUND: Secondary myeloid neoplasms comprise a group of secondary diseases following exposure to myelotoxic agents or due to congenital diseases. The improvement of anticancer agents and immunosuppressive drugs seem to be associated with an increased incidence of secondary myeloid neoplasms. Karyotyping of bone marrow is essential for diagnosis and prognosis. Previous use of alkylating agents and radiation are associated with clonal abnormalities such as recurrent unbalanced -5/5q-, -7/7q- and complex karyotypes, whereas topoisomerase-II inhibitors lead to changes such as the balanced 11q23 rearrangement, t(8;21), t(15;17) and inv(16). OBJECTIVE: To study the clinical and cytogenetic data of patients with secondary myeloid neoplasms who took antineoplastic and/or immunosuppressive drugs or progressed from aplastic anemia. METHODS: The clinical and cytogenetic characteristics of 42 patients diagnosed with secondary myeloid neoplasms in one institution were retrospectively evaluated. Of these, 25, 11 and 6 patients had had oncological diseases, aplastic anemia and other diseases, respectively. Conventional cytogenetic and FISH analyses were performed for monosomy 7. RESULTS: The cytogenetic study was conclusive in 32 cases with 84.4% of clonal abnormalities. Monosomy 7 and complex karyotypes were present in 44.4% and 37%, respectively. A high prevalence of unbalanced abnormalities (96.3%) was observed. Monosomy 7 was more prevalent in patients with myelodysplastic syndromes/myeloid neoplasms after aplastic anemia (66.6%). The median survival after diagnosis of myeloid neoplasms was only 5.7 months. Normal cytogenetics was associated to better survival (p-value = 0.03). There was a slightly worse trend of survival for patients with complex karyotypes (p-value = 0.057). Abnormal karyotype was an independent risk factor for poor survival (p-value = 0.012). CONCLUSION: This study enhances the importance of cytogenetic analysis of patients at the time of diagnosis of secondary myeloid neoplasms.

Geneticamente, a leucemia promielocítica aguda (LPA) caracteriza-se por alterações cromossômicas estruturais recorrentes, na grande maioria das vezes translocações, envolvendo sempre o lócus gênico para o receptor alfa do ácido retinoico (RARα) localizado no braço longo do cromossomo 17 (17q21), levando à formação de genes quiméricos e oncoproteínas de fusão. Em aproximadamente 98% dos casos, o gene RARα se encontra fusionado com o gene PML resultante da translocação cromossômica recíproca t(15;17)(q22;q21) e, em cerca de 2% dos casos, o gene RARα pode estar fusionado com outros genes que não o PML, levando à formação de proteínas de fusão conhecidas genericamente como X-RARα. A leucemia promielocítica aguda é um exemplo de malignidade hematológica onde se tem a combinação de alterações genéticas e epigenéticas (acetilação, desacetilação e metilação) no processo de leucemogênese, alterações cromossômicas estruturais influenciando no equilíbrio dinâmico da cromatina na região promotora de alguns genes. A utilização de técnicas moleculares que auxiliam no diagnóstico genético mais preciso e o desenvolvimento de uma terapia alvo molecular permitiram alcançar alta taxa de cura desta doença.

Acute promyelocytic leukemia (APL) is characterized by structural chromosomal abnormalities involving the RARα (retinoic acid receptor a) gene located on the long arm of chromosome 17 (17q21) that lead to the formation of chimeric genes and fusion oncoproteins. In about 98% of cases, the RARα gene is fused to the PML gene, the result of a reciprocal chromosomal translocation t(15;17)(q22;q21) and in the other 2% of cases the RARα gene may be fused to other genes, leading to the formation of fusion proteins known generically as X-RARα. Acute promyelocytic leukemia is an example of a hematologic malignancy where there is a combination of genetic and epigenetic (acetylation, deacetylation and methylation) changes in the leukemogenesis process, chromosome structural changes that affect the dynamic equilibrium of chromatin in the promoter region of some genes. The use of molecular techniques that improve genetic diagnosis and the development of targeted molecular therapy have provided a high cure rate of this disorder.