Abstract Background: Malignant spinal cord compression (MSCC) is a rare but serious complication of pediatric malignancies that can result in permanent neurologic deficits. The prognosis depends on neurological symptoms at diagnosis. Case report: A nine-year-old girl was evaluated for worsening pain in the left anterior iliac spine with one month of evolution. Over the next two days, she showed progressive gait instability and low back pain. During hospitalization, she developed decreased strength and sensitivity in the lower limbs, hyperreflexia with clonus, Babinski sign, and inability to walk. Magnetic resonance imaging showed a compressive intracanalicular lesion at D8-12, later identified as Ewing sarcoma. The patient was treated and had no sequelae. Conclusion: Clinicians should be aware that MSCC may have an atypical presentation, such as pain in an unusual location, and early recognition is essential to improve prognosis.

Resumo Introdução: A compressão medular maligna (CMM) é uma complicação rara e grave de tumores em idade pediátrica, podendo conduzir a défices neurológicos permanentes. O prognóstico está relacionado com os sintomas neurológicos ao diagnóstico. Caso clínico: Uma criança do sexo feminino de nove anos de idade foi observada por agravamento de dor na crista ilíaca anterior esquerda com um mês de evolução. Nos dois dias seguintes, desenvolveu instabilidade progressiva da marcha e dor lombar. Durante o internamento, desenvolveu diminuição da força e sensibilidade nos membros inferiores, hiperreflexia com clónus, sinal de Babinsky positivo e incapacidade para a marcha. A ressonância magnética nuclear demonstrou uma lesão intracanalicular compressiva em D8-12, posteriormente identificada com sarcoma de Ewing. A criança recebeu tratamento, sem sequelas subsequentes. Conclusão: É importante considerar que a CMM pode ter uma apresentação atípica, como dor num local atípico, e o reconhecimento precoce é essencial para melhorar o prognóstico.

BACKGROUND Anopheles darlingi is the most efficient vector of malaria parasites in the Neotropics. Nevertheless, the specificities of its larval habitats are still poorly known. OBJECTIVES Characterize permanent larval habitats, and population dynamics of An. darlingi and other potential vectors in relation to climate, physicochemical variables, insect fauna and malaria cases. METHODS A 14-month longitudinal study was conducted in Porto Velho, Rondônia, western Brazilian Amazon. Monthly, 21 permanent water bodies were sampled. Immature anophelines and associated fauna were collected, physicochemical characteristics, and climate variables were recorded and analyzed. FINDINGS Five types of habitats were identified: lagoon, stream, stream combined with lagoon, stream combined with dam, and fishpond. A total of 60,927 anophelines were collected. The most abundant species in all habitats were Anopheles braziliensis and An. darlingi. The highest density was found in the lagoon, while streams had the highest species richness. Abundance was higher during the transition period wet-dry season. There was a lag of respectively four and five months between the peak of rainfall and the Madeira River level and the highest abundance of An. darlingi larvae, which were positively correlated with habitats partially shaded, pH close to neutrality, increase dissolved oxygen and sulphates. MAIN CONCLUSIONS The present study provides data on key factors defining permanent larval habitats for the surveillance of An. darlingi and other potential vectors as well as a log-linear Negative Binomial model based on immature mosquito abundance and climate variables to predict the increase in the number of malaria cases. Neotropics Nevertheless known An cases 14month month 14 Velho Rondônia Amazon Monthly 2 sampled collected characteristics analyzed identified lagoon dam fishpond 60927 60 927 60,92 richness wetdry wet dry season larvae shaded neutrality sulphates loglinear log linear 1 6092 6 92 60,9 609 9 60,

Resumo A neurofibromatose tipo 1 (NF1) é uma das doenças genéticas mais comuns, com uma incidência reportada de 1:3000. A condição é multissistémica e os critérios diagnósticos foram recentemente revistos como uma recomendação de consenso internacional. As características clínicas da doença evoluem lenta e progressivamente e frequentemente podem estar ausentes na primeira infância. Embora descritos há várias décadas nestas crianças, condições endócrinas e distúrbios do crescimento não estão incluídos nos critérios diagnósticos da doença. No entanto, são relativamente frequentes e podem ser a forma de apresentação de glioma da via ótica. Devido ao amplo espetro de implicações na saúde da NF1, o seguimento destas crianças é muitas vezes feito em contexto de consulta de Pediatria. O objetivo deste artigo é rever os distúrbios endócrinos mais frequentes em doentes com NF1, o que vigiar e quando referenciar os doentes à consulta de Endocrinologia pediátrica.

Abstract Neurofibromatosis type 1 (NF1) is one of the most common genetic disorders, with a reported incidence of 1:3000. The condition is multisystemic, and diagnostic criteria have been recently revised as an international consensus recommendation. The clinical features evolve slowly and progressively and may often be absent in early childhood. Disorders of growth and endocrine conditions, although described for several decades in these children, are not included in the diagnostic criteria. However, they are relatively frequent and may be the presenting feature of optic pathway glioma. Due to its wide spectrum of health implications, children with NF1 are often followed at Pediatric consultation. The aim of this article is to review the most frequent endocrine disorders in NF1 patients, what to look for, and when to refer patients to pediatric Endocrinology consultation.

ABSTRACT. The objective of this study was to evaluate the effect of replacement of corn with pre-dried cassava root silage (CRS) on intake, ingestive behavior, production and composition of goat milk. Five lactating Saanen goats were used, with 42.5 ± 4.2 kg body weight and production of 2 kg milk day-1, distributed in a 5 x 5 Latin square with five treatments: 0, 28.6, 58.0, 81.6 and 100% replacement of corn with CRS in the diet dry matter. Goats were monitored for five periods of 15 days each. The intake of dry matter, crude protein and neutral detergent fiber decreased linearly (p <0.05) with the replacement of corn with CRS. Feeding (348.5 ± 62.1 min.) and rumination (468.8 ± 83.8 min.) times were not influenced (p >0.05) by the replacement of corn with CRS, but the ingestion and rumination efficiencies had a linear increase (p > 0.05). Milk production (2.17 ± 0.45 kg day-1), fat (3.49 ± 0.42%), protein (3.11 ± 0.13%) and lactose (4.47 ± 0,11%) of goat milk were not influenced (p >0.05) by the replacement of corn with CRS. Therefore, it is recommended the total replacement of corn with pre-dried cassava root silage in the diet for dairy goats with an average production of 2 kg day-1.

Resumo Introdução O aborto é uma questão relevante para a saúde pública, por sua significância entre as causas de morbidade e mortalidade materna. Objetivo Descrever o perfil sociodemográfico e reprodutivo, bem como a assistência prestada e os custos da internação de mulheres em abortamento nos hospitais vinculados à rede SUS de Fortaleza, Ceará. Métodos Trata-se de estudo transversal, descritivo, por meio de entrevista, prontuários e relatórios da Autorização das Internações Hospitalares. Resultados Entre as 119 mulheres entrevistadas, 65% tinham menos de 30 anos, 78,2% eram não brancas e 54% possuíam baixa renda; a prevalência de mulheres que buscaram mais de um hospital para atendimento foi de 47% e 72,3% buscaram o serviço de saúde em até cinco dias; concentração de 98,3% do procedimento cirúrgico curetagem para finalização do aborto. Conclusão Percebeu-se a existência de pontos frágeis na atenção ao abortamento e a necessidade de discutir a temática aborto nas políticas públicas de saúde.

Abstract Background Abortion is a relevant issue for public health, due to is significance among the causes of maternal and mortality. Objective to describe the sociodemographic and reproductive profile, as well as the assistance provided and the costs of the hospitalization of women in abortion in the hospitals linked in the SUS network in Fortaleza, Ceará. Methods this is a cross-sectional, descriptive study by means of interviews, medical records and reports of the Authorization of Hospitalizations. Results among the 119 women interviewed, 65% were under 30 years of age, 78.2% were non-white and 54% had low income; the prevalence of women who sought more than one hospital for care was 47% and 72.3% of them sought health care within five days; concentration of 98.3% were submitted to a surgical procedure curettage for abortion termination. Conclusion it was noticed the existence of fragile points in the attention to abortion and the need to discuss abortion thematic in public health policies.

Distribution, abundance, feeding behaviour, host preference, parity status and human-biting and infection rates are among the medical entomological parameters evaluated when determining the vector capacity of mosquito species. To evaluate these parameters, mosquitoes must be collected using an appropriate method. Malaria is primarily transmitted by anthropophilic and synanthropic anophelines. Thus, collection methods must result in the identification of the anthropophilic species and efficiently evaluate the parameters involved in malaria transmission dynamics. Consequently, human landing catches would be the most appropriate method if not for their inherent risk. The choice of alternative anopheline collection methods, such as traps, must consider their effectiveness in reproducing the efficiency of human attraction. Collection methods lure mosquitoes by using a mixture of olfactory, visual and thermal cues. Here, we reviewed, classified and compared the efficiency of anopheline collection methods, with an emphasis on Neotropical anthropophilic species, especially Anopheles darlingi, in distinct malaria epidemiological conditions in Brazil.

The haematological changes and release of soluble mediators, particularly C-reactive protein (CRP) and nitric oxide (NO), during uncomplicated malaria have not been well studied, especially in Brazilian areas in which the disease is endemic. Therefore, the present study examined these factors in acute (day 0) and convalescent phase (day 15) patients infected with Plasmodium falciparum and Plasmodium vivax malaria in the Brazilian Amazon. Haematologic parameters were measured using automated cell counting, CRP levels were measured with ELISA and NO plasma levels were measured by the Griess reaction. Our data indicate that individuals with uncomplicated P. vivax and P. falciparum infection presented similar inflammatory profiles with respect to white blood cells, with high band cell production and a considerable degree of thrombocytopaenia during the acute phase of infection. Higher CRP levels were detected in acute P. vivax infection than in acute P. falciparum infection, while higher NO was detected in patients with acute and convalescent P. falciparum infections. Although changes in these mediators cannot predict malaria infection, the haematological aspects associated with malaria infection, especially the roles of platelets and band cells, need to be investigated further.

Introdução: A Síndroma Cornelia de Lange (SCdL) é uma síndroma polimalformativa rara, caracterizada por aparência facial peculiar, atraso de crescimento e do desenvolvimento psicomotor, alterações comportamentais e malformações major associadas (cardíacas, gastrointestinais e musculoesqueléticas). Caso clínico: Os autores descrevem o caso duma lactente de seis meses, sexo feminino, com SCdL grave e disgenesia cerebral congénita em que a pesquisa de mutações no gene NIPBL foi negativa. Actualmente, aos três anos e meio, esta criança mantém seguimento por uma equipa multidisciplinar, com uma evolução clínica positiva, particularmente nas áreas motoras (postura e manipulação). Discussão: O diagnóstico da SCdL é sobretudo clínico. A confirmação molecular pode ser útil em casos duvidosos, mas as mutações no gene NIPBL estão presentes em apenas 50% dos casos, pelo que perante um diagnóstico clínico seguro a ausência de mutações neste gene não exclui o diagnóstico. O diagnóstico precoce desta doença é útil para a programação de cuidados antecipatórios em relação às complicações mais frequentes e para aconselhamento genético aos pais.

Background: Cornelia de Lange Syndrome (CdLS) is a rare multiple malformation syndrome, characterized by specific facial features, small stature, developmental delay and major malformations (cardiac, gastrointestinal and musculoskeletal systems). Case Report: The authors describe a clinical case of a six-month-old female toddler, with severe CdLS and congenital cerebral dysgenesis, in whom no NIPBL mutation was found. Nowadays, at the age of three and half years, this patient maintains a multidisciplinary approach and has a favourable evolution of her motor status (posture and manipulation). Discussion: The diagnosis of CdLS is based in mostly on clinical grounds. Molecular confirmation can be helpful in atypical cases, but since mutations in the NIPBL gene are found in only around 50% of patients, failure to identify mutations does not exclude the diagnosis. An early diagnosis is important to program anticipatory surveillance for the most frequent complications of this condition and to provide adequate genetic counseling.

OBJETIVOS: Identificar e comparar as principais causas de morbi-mortalidade, entre homens e mulheres com 60 anos ou mais, residentes no município de Florianópolis -Santa Catarina, ano de 2007. MÉTODOS: Estudo descritivo por meio de dados secundários disponíveis no Sistema de Informações de Mortalidade (SIM/SUS), do Sistema de Internações Hospitalares (SIH/SUS) e para os dados demográficos segundo o IBGE. RESULTADOS: Identificou-se a doença isquêmica do coração, seguida da cerebrovascular e do câncer de pulmão, com os maiores coeficientes de mortalidade nos idosos. Ao comparar as principais causas de mortalidade e sexo, os homens apresentaram maior risco para câncer de pulmão, septicemia e cirrose e doença crônica do fígado (razão igual a 2,9; 2,4; 2,4, respectivamente). Entre as causas mais prevalentes de morbidade, destacam-se as doenças circulatórias, neoplasias e doenças respiratórias. Ao comparar as causas de morbidade ao sexo, as doenças circulatórias, seguidas das neoplasias e doenças geniturinárias, destacaram-se pela maior razão nas mulheres (razão igual a 0,93; 0,90; 0,89, respectivamente) embora com pequena diferença. CONCLUSÃO: A doença isquêmica do coração, doença cerebrovascular e câncer de pulmão foram as principais causas de óbito entre os idosos, mas comparadas ao sexo, observou-se que câncer de pulmão, septicemia e cirrose e doença crônica do fígado apresentaram-se como as principais responsáveis pela sobremortalidade masculina. As doenças circulatórias, seguidas das neoplasias e doenças respiratórias, destacaram-se pela maior causa de morbidade nos idosos, com predomínio nas mulheres, exceto as respiratórias, dando lugar às doenças geniturinárias.

OBJECTIVE: To identify and compare the main causes of morbi-mortality, between men and women aged 60 years or more, residents in the city of Florianópolis, Santa Catarina State, 2007. METHODS: It is a descriptive study, using secondary data from the Mortality Information System (SIM/SUS), Hospital Internment System (SIH/SUS) and demographic data according to IBGE. RESULTS: We identified ischemic heart diseases, followed by cerebrovascular and lung cancer as the highest coefficients of mortality among the elderly. Comparing the main causes of mortality and sex, men presented greater risks of lung cancer, septicemia and cirrhosis and chronic liver disease (ratios of 2,9; 2,4; 2,4, respectively). Among the most prevalent morbidity causes there are the circulatory diseases, cancer and respiratory diseases. Comparing the morbidity causes with sex, the circulatory diseases, followed by cancer and urinary disases presented the highest ratios among women (ratios of 0,93; 0,90; 0,89, respectively) although with little difference. CONCLUSIONS: Ischemic heart diseases, cerebrovascular diseases and lung cancer were the main death causes among the elderly, but when compared to sex, it was observed that lung cancer, septicemia and cirrhosis and chronic liver disease were responsible for most male deaths. The circulatory diseases, followed by cancer and respiratory diseases were the most common causes of morbidity in the elderly, mainly among women, except for respiratory diseases, replaced by urinary diseases.

Anopheles darlingi Root é o principal vetor de malária na Amazônia brasileira. Os objetivos deste trabalho foram avaliar a periodicidade de captura, a preferência por peri ou extradomicílio e a taxa de paridade de A. darlingi em quatro localidades em Porto Velho, RO, utilizando a atração humana. Todos os anofelinos capturados foram identificados e A. darlingi foi dissecada para caracterização da paridade. Do total de 985 anofelinos coletados, 972 eram A. darlingi. O número de fêmeas foi significativamente maior no extradomicílio em duas das localidades estudadas (São João e Candeias do Jamari) (P < 0,05). A taxa de paridade foi de 96% e não foi observado horário preferencial para captura de fêmeas de A. darlingi nas localidades estudadas.

Anopheles darlingi Root is the principal malaria vector in Amazonia region. The objectives of this work were to study the periodicity of Anopheles darlingi Root, the host preference for peri or extra-domestic environments and the parous rate in four field sites in Porto Velho (RO) by human-landing. All of the Anopheles specimens collected were identified, but only A. darlingi was dissected for the parous study. The results showed that human-landing colleted a total of 985 anophelines, with A. darlingi (972) being the most abundant species. Female mosquitoes were more abundant at extra-domestic environments in two of the locations studied (São João e Candeias do Jamari) (P < 0.05). The parous rate was 96% and no periodicity was observed for captures of females of A. darlingi in the field sites.

The increasing problems with multidrug resistance in relation to Corynebacterium, including C. diphtheriae, are examples of challenges confronting many countries. For this reason, Brazilian C. diphtheriae strains were evaluated by the E-Test for their susceptibility to nine antibacterial drugs used in therapy. Resistance (MIC < 0.002; 0.38 µg/ml) to penicillin G was found in 14.8% of the strains tested. Although erythromycin (MIC90 0.75 µg/ml) and azithromycin (MIC90 0.064 µg/ml) were active against C. diphtheriae in this study, 4.2% of the strains showed decreased susceptibility (MIC 1.0 µg/ml) to erythromycin. Multiple resistance profiles were determined by the disk diffusion method using 31 antibiotics. Most C. diphtheriae strains (95.74%) showed resistance to mupirocin, aztreonam, ceftazidime, and/or oxacillin, ampicillin, penicillin, tetracycline, clindamycin, lincomycin, and erythromycin. This study presents the antimicrobial susceptibility profiles of Brazilian C. diphtheriae isolates. The data are of value to practitioners, and suggest that some concern exists regarding the use of penicillin.

Stigmaphyllom paralias is a herb belonging to the family Malpighiaceae that occurs in sand soil of brazilian " restinga". This is the first report regarding phytochemical study with this species. The hexane extract of the aerial parts of plant afforded the triterpenes friedelin, lupenone, 3-oxo-alpha-amirin and 3-oxo-beta-amirin, the mixture of alpha-amirinyl palmitate and stearate, lupeol and 3,4-seco-friedelan-3-oic acid. The AcOEt extract yielded the flavonoid luteolin-7-rutinoside. All compounds were characterized by analysis of spectrometric data and the fatty acids esterified with alpha-amirine were identified by GC/MS of methyl derivatives of transesterified products . This is the first natural occurence of 3,4-seco-friedelan-3-oic acid and the 13C NMR spectral data were inequivocally assigned by two-dimensional techniques. This work also permitted to correct the 13C NMR resonances attributed to methyl groups C-26 and C-27 of fridelin.

Em 1992, foi realizado um ensaio de campo com mosquiteiros impregnados com deltametrina, em uma área endêmica de malária no Município de Costa Marques, Rondônia. No período de baixa transmissão, os mosquiteiros impregnados (MI) diminuíram a densidade vetorial no intradomicílio, de modo semelhante, porém, aos mosquiteiros não impregnados (NI) na maioria das avaliações-controle. Por outro lado, na época de alta transmissão, os MI provocaram diminuição significante da média horária de anofelinos capturados, ao passo que, nas casas com NI, verificou-se aumento do número de mosquitos capturados. No peridomicílio, em geral, não houve diferença do número de anofelinos capturados entre MI e NI. No grupo MI, a espécie mais capturada foi o An. darlingi (63,2%), mais freqüente no peridomicílio, seguida pelo An. deaneorum (35,3%), mais freqüente no intradomicílio. Os MI diminuíram a densidade vetorial no intradomicílio pelo efeito excito-repelente, sem diminuí-la, contudo, no peridomicílio.

In 1992 a survey on the use of deltamethrin-impregnated mosquito nets was conducted in the municipality of Costa Marques, Rondonia. In the intradomicile, impregnated nets decreased the vector density at rates similar to those for non-impregnated nets during low-transmission periods; during high anopheline density periods, they led to a significant reduction in vector density, while in the non-impregnated net group there was an increase in the number of anophelines captured. There was no change in vector density in the peridomicile. In the impregnated net group, the most frequently captured species was Anopheles darlingi (63.2%), found mostly in the peridomicile, while Anopheles deaneorum (35.3%) was most frequent indoors. The impregnated mosquito nets' excitatory-repellent effect decreased the intradomiciliary vector density but did not alter density in the peridomicile.

Em 1992, foi realizado um ensaio de campo com mosquiteiros impregnados com deltametrina, em uma área endêmica de malária no Município de Costa Marques, Rondônia. No período de baixa transmissão, os mosquiteiros impregnados (MI) diminuíram a densidade vetorial no intradomicílio, de modo semelhante, porém, aos mosquiteiros não impregnados (NI) na maioria das avaliações-controle. Por outro lado, na época de alta transmissão, os MI provocaram diminuição significante da média horária de anofelinos capturados, ao passo que, nas casas com NI, verificou-se aumento do número de mosquitos capturados. No peridomicílio, em geral, não houve diferença do número de anofelinos capturados entre MI e NI. No grupo MI, a espécie mais capturada foi o An. darlingi (63,2%), mais freqüente no peridomicílio, seguida pelo An. deaneorum (35,3%), mais freqüente no intradomicílio. Os MI diminuíram a densidade vetorial no intradomicílio pelo efeito excito-repelente, sem diminuí-la, contudo, no peridomicílio.

In 1992 a survey on the use of deltamethrin-impregnated mosquito nets was conducted in the municipality of Costa Marques, Rondonia. In the intradomicile, impregnated nets decreased the vector density at rates similar to those for non-impregnated nets during low-transmission periods; during high anopheline density periods, they led to a significant reduction in vector density, while in the non-impregnated net group there was an increase in the number of anophelines captured. There was no change in vector density in the peridomicile. In the impregnated net group, the most frequently captured species was Anopheles darlingi (63.2%), found mostly in the peridomicile, while Anopheles deaneorum (35.3%) was most frequent indoors. The impregnated mosquito nets' excitatory-repellent effect decreased the intradomiciliary vector density but did not alter density in the peridomicile.

Em 1992 foi feita uma investigação sobre o efeito protetor do uso de mosquiteiros impregnados com deltametrina, em uma população do município de Costa Marques, Rondônia, sujeita à transmissão malárica. Os mosquiteiros impregnados se comportaram de modo semelhante aos não impregnados, sem modificar os índices de infecção na época de baixa transmissão. A análise multivariada, por idade e títulos de anticorpos, mostrou uma proteção significante para o grupo com mosquiteiros impregnados contra o risco de infecção, apenas na estação de alta transmissão, quando os mosquiteiros foram usados mais regularmente. Não houve diferença no efeito de ambos os tipos de mosquiteiros na prevenção de elevadas parasitemias. Ao fim do estudo, ocorreu diminuição da prevalência de esplenomegalia em ambos os grupos, porém houve uma aparente recuperação da taxa normal de hematócrito em menores de 15 anos de idade em uso de mosquiteiros impregnados.

In 1992 an investigation regarding the value of insecticide impregnated mosquito nets was conducted in the municipality of Costa Marques, Rondonia. Impregnated mosquito nets gave similar protection to those not impregnated, without modifying the incidence of infection during the season of low transmission. The multivariate analysis for age and antibody titre showed a significant protection of impregnated nets against the risk of infection only in the season of high transmission, when bed nets were used more correctly. There was no difference in the effect of both kinds of bed nets in the prevention of high parasitaemia. At the end of the study, there was a reduction of the prevalence of splenomegaly in both groups but hematocrit values rose to normal in the below 15 year olds using impregnated nets.