Objective: To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts. Methods: PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples. Results: Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts. Conclusion: Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

RESUMO A esclerose múltipla é uma doença imunomediada do sistema nervoso central. Seu tratamento tem sido focado no controle da inflamação o mais cedo possível para evitar incapacidade. O transplante autólogo de células tronco hematopoiéticas (TACTH) vem sendo usado para tratar esclerose múltipla desde 1996, e recentes resultados foram decisivos a respeito do benefício na eficácia a longo prazo. Cinco pacientes seguidos num centro de esclerose múltipla de Belo Horizonte, Brasil, que apresentavam forma clínica remitente recorrente com alta atividade de doença foram submetidos a esse tratamento de 2009 a 2011. Após o transplante foram avaliados clinicamente e com ressonância magnética, e escala de EDSS, a cada seis meses até julho de 2018. Os pacientes eram quatro mulheres e um homem, com idade entre 25 e 50 anos e tempo de doença variando de 4 a 17 anos na época do procedimento. Quatro pacientes melhoraram após a primeira avaliação e um manteve-se estável. Todos os pacientes permaneceram sem evidência de doença clínica ou radiológica de 5 a 9 anos após. Com uma seleção cada vez mais criteriosa de pacientes o TACTH pode interromper a disseminação do epítopo e controlar a progressão da doença. Apesar de várias outras opções terapêuticas aprovadas para esclerose múltipla o TACTH continua a ser uma forma de tratamento a ser considerada em casos de doença muito agressiva.

ABSTRACT Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. Its treatment has focused on inflammation control as early as possible to avoid disability. Autologous hematopoietic stem cell transplantation (AHSCT) has been used for treating MS since 1996, with recent decisive results regarding benefits in long-term efficacy. Five patients followed up at an MS center in Belo Horizonte, Brazil, who had relapsing-remitting MS with high disease activity, underwent AHSCT between 2009 and 2011. They were evaluated clinically, with magnetic resonance imaging, and by the EDSS every six months after transplantation, up to July 2018. The patients were four women and one man, with ages ranging from 25-50 years, and time since disease onset ranging from 4-17 years at the time of the procedure. Four patients improved, one patient was stabilized, and all patients were free of disease activity after 5-9 years. Through improving patient selection and decreasing the time from disease onset, AHSCT could stop epitope spreading and disease progression. Despite multiple other therapeutic choices being approved for relapsing-remitting MS, AHSCT continues to be a treatment to consider for aggressive MS disease.

Resumo Neste estudo foi investigada a ocorrência, prevalência, abundância média e intensidade média de Monogenoidea parasitos de Piaractus mesopotamicus, cultivados em tanques-rede no reservatório da Usina Hidrelétrica de Itaipu, rio Paraná, Brasil. Foram investigados ainda o padrão de distribuição parasitária e a correlação entre a prevalência e abundância com o comprimento total dos hospedeiros. Quatro espécies de Monogenoidea foram coletadas: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni e M. viatorum. Todos os parasitos coletados em P. mesopotamicus apresentaram típico padrão de distribuição agregada e não foi observada correlação entre a abundância e a prevalência e o comprimento total dos hospedeiros.

Abstract This study investigated the occurrence, prevalence, mean abundance and mean intensity of monogenoidean parasites in Piaractus mesopotamicus farmed in cages in the reservoir of the Itaipu Hydroelectric Power Station, Paraná River, Brazil. The parasite distribution pattern and the correlation of prevalence and abundance with the total length of hosts were also investigated. Four monogenoidean species were collected: Anacanthorus penilabiatus, A. toledoensis, Mymarothecium ianwhitingtoni and M. viatorum. All the parasites collected in P. mesopotamicus showed the typical aggregated distribution pattern, and the abundance and the prevalence did not shown any correlation with the total length of hosts.

Objectives:To investigate whether the muscle strength decrease that follows anterior cruciate ligament (ACL) reconstruction would lead to different cardiorespiratory adjustments during dynamic exercise.Method:Eighteen active male subjects were submitted to isokinetic evaluation of knee flexor and extensor muscles four months after ACL surgery. Thigh circumference was also measured and an incremental unilateral cardiopulmonary exercise test was performed separately for both involved and uninvolved lower limbs in order to compare heart rate, oxygen consumption, minute ventilation, and ventilatory pattern (breath rate, tidal volume, inspiratory time, expiratory time, tidal volume/inspiratory time) at three different workloads (moderate, anaerobic threshold, and maximal).Results:There was a significant difference between isokinetic extensor peak torque measured in the involved (116.5±29.1 Nm) and uninvolved (220.8±40.4 Nm) limbs, p=0.000. Isokinetic flexor peak torque was also lower in the involved limb than in the uninvolved limb (107.8±15.4 and 132.5±26.3 Nm, p=0.004, respectively). Lower values were also found in involved thigh circumference as compared with uninvolved limb (46.9±4.3 and 48.5±3.9 cm, p=0.005, respectively). No differences were found between the lower limbs in any of the variables of the incremental cardiopulmonary tests at all exercise intensities.Conclusions:Our findings indicate that, four months after ACL surgery, there is a significant deficit in isokinetic strength in the involved limb, but these differences in muscle strength requirement do not produce differences in the cardiorespiratory adjustments to exercise. Based on the hypotheses from the literature which explain the differences in the physiological responses to exercise for different muscle masses, we can deduce that, after 4 months of a rehabilitation program after an ACL reconstruction, individuals probably do not present differences in muscle oxidative and peripheral perfusion capacities that could elicit higher levels of peripheral cardiorepiratory stimulus during exercise.

Background: The Vestibular Disorders Activities of Daily Living Scale (VADL) is considered an important subjective assessment to evaluate patients suffering from dizziness and imbalance. Although frequently used, its metric characteristics still require further investigation.Objective: This paper aims to analyze the psychometric properties of the Brazilian version of the VADL in an elderly population. Method: The sample comprises patients (≥65 years old) with chronic dizziness resulting from vestibular disorders. For discriminant analysis, patients were compared to healthy subjects. All subjects answered the VADL-Brazil by interview. To examine the VADL validity, patients filled out the Dizziness Handicap Inventory (DHI) and the ABC scale and were tested on the Dynamic Gait Index (DGI). To evaluate the VADL responsiveness, 20 patients were submitted to rehabilitation.Results: Patients (n=140) had a VADL total score of 4.1±1.6 points. Healthy subjects scored significantly less than patients in all the subscales and in the VADL total score. The VADL-Brazil was weakly correlated with the DHI and moderately to the ABC scale and the DGI. Instead of the original 3 subscales, factor analysis resulted in 6 factors. The VADL was capable of detecting changes after rehabilitation, which means that the instrument has responsiveness.Conclusions: This study provided more data about the psychometric properties and usefulness of the VADL-Brazil. The use of such a reliable and valid instrument increases the knowledge about disability in patients with vestibular disorders.

The prevalence and mechanisms of antibiotic resistance of Helicobacter pylori have not yet been investigated in Uruguay. The objective of this study was to assess the susceptibility of H. pylori to the most frequently used antibiotics and to determine the mechanism of resistance to clarithromycin. Seventy-nine isolates were obtained from gastric biopsies of 50 adult patients during two periods, 2001 and 2006. The former group enrolled the general population (GP), the latter group Afro-descendant (AD) subjects. The minimum inhibitory concentrations of clarithromycin, amoxicillin, tetracycline, metronidazole, and levofloxacin were determined using the E-test technique. Amplification was achieved through PCR and nucleic acid sequencing to detect mutations in the site of action of clarithromycin in the rRNA gene 23S. No amoxicillin or tetracycline-resistant strains were found. Clarithromycin resistance was found in 12% of the patients overall: 19.4% resistance in AD patients and no resistance in the GP group. This difference was statistically significant. The highest resistance was seen with metronidazole (36%), present in similar proportions in the two groups: 36.8% (GP) and 35.5% (AD). One GP patient and one AD patient had levofloxacin-resistant strains. Sequencing analysis of gene 23S rRNA showed that only mutation in position 2143 was presented in all clarithromycin-resistant strains.

The aim of this work was to evaluate the carotenoid content and genetic variability of banana accessions from the Musa germplasm collection held at Embrapa Cassava and Tropical Fruits, Brazil. Forty-two samples were analyzed, including 21 diploids, 19 triploids and two tetraploids. The carotenoid content was analyzed spectrophotometrically and genetic variability was estimated using 653 DArT markers. The average carotenoid content was 4.73 µg.g-1, and ranged from 1.06 µg.g-1 for the triploid Nanica (Cavendish group) to 19.24 µg.g-1 for the triploid Saney. The diploids Modok Gier and NBA-14 and the triploid Saney had a carotenoid content that was, respectively, 7-fold, 6-fold and 9-fold greater than that of cultivars from the Cavendish group (2.19 µg.g-1). The mean similarity among the 42 accessions was 0.63 (range: 0.24 to 1.00). DArT analysis revealed extensive genetic variability in accessions from the Embrapa Musa germplasm bank.

Work objective To determine the in-hospital mortality rate and the predictors of mortality of infective endocarditis (IE) in Argentina. Research Design and Methods Prospective, multicentric survey carried out in 82 hospitals all over the country (16 provinces). Patients were enrolled according to Duke criteria (definite or possible IE) during an 18-month period (June 2001-November 2002). Results Four hundred and seventy episodes in 452 patients were included (mean age 58.1±17.6 years, 69.7% male, 83% definite and 17% possible IE). Blood cultures were negative in 17.7%. The most frequent causative microorganisms were: Staphylococcus 38% (S. aureus 30%, S. coagulase-negative 8%), Streptococcus 39.4% (S. viridans 26.8%), Enterococcus 10,8%, S. coagulase-negative 8%, HACEK group 6,6% and S. bovis 5,5%. Underlying heart disease was present in 66.4% and prosthetic-valve IE was diagnosed in 19.2%. Surgical treatment was indicated in 33.3% and in-hospital mortality was 24.3%. In a logistic regression analysis the following variables were independent predictors of increased mortality: age > 65 years (OR 2.1; 95% CI 1.1-3.96; p = 0.024); heart failure (OR 5.9; 95% CI 3.1-10.9; p <0,001), septic shock (OR 25.1; 95% CI 9.9- 62.5; p <0.001), hepatic failure (OR 12.2, 95% CI 1.9-76.9; p = 0.008); persistent hyperthermia (OR 2.3, 95% CI 1.2-4; p= 0.014); altered states of consciousness and stroke showed strong predictive trends but no statistical significance. Conclusions In-hospital mortality due to IE in Argentina is high. Simple and readily available variables are strong predictors of inhospital mortality. Their use can help in identifying highrisk patients and could lead to decisions made in order to improve the outcomes of patients with IE.

Objetivo Determinar la mortalidad hospitalaria y los marcadores clínicos relacionados con la mortalidad de la endocarditis infecciosa (EI) en la República Argentina. Métodos Registro prospectivo, multicéntrico (82 centros de 16 provincias de la Argentina) de EI definidas o posibles según los criterios Duke, entre junio de 2001 y noviembre de 2002. Resultados Se evaluaron 470 episodios de EI en 452 pacientes (edad media: 58,1 ± 17,6 años; sexo masculino 69,7%; EI definida 83% y posible 17%). Bacteriología: Staphylococcus 38% (S. aureus 30%, Staphylococcus coagulasa negativo 8%), Streptococcus 39,4% (S. viridans 36,8%), Enterococcus 10,8%, HACEK 6,6%, hemocultivos negativos 17,7%. Existía cardiopatía subyacente en el 66,4% y EI de válvula protésica en el 19,2%. Se indicó tratamiento quirúrgico en el 33,3% de los pacientes. La mortalidad fue del 24,3%. En el análisis de regresión logística fueron predictores independientes de mortalidad: edad > 65 años (OR 2,1; IC 95%, 1,1- 3,96; p = 0,024); insuficiencia cardíaca en la evolución (OR 5,9; IC 95%, 3,1-10,9; p < 0,001), shock séptico (OR 25,1; IC 95%, 9,9-62,5; p < 0,001), insuficiencia hepática (OR 12,2, IC 95%, 1,9-76,9; p = 0,008); hipertermia persistente (OR 2,3, IC 95%, 1,2-4; p = 0,014); la alteración del estado de conciencia y el accidente cerebrovascular presentaron fuertes tendencias sin significación estadística. Conclusiones La mortalidad de la EI en la Argentina es alta. Variables de determinación sencilla constituyen marcadores asociados en forma independiente con mayor mortalidad, cuyo empleo para identificar pacientes de alto riesgo puede resultar de utilidad para guiar la toma de decisiones.

Foi realizado o estudo do tegumento do corpo de Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasito de Mugil liza (tainha) do Canal de Marapendi, Rio de Janeiro, Brasil, pela microscopia eletrônica de transmissão. O tegumento é formado por uma camada externa sincicial, uma camada muscular e uma camada interna contendo células tegumentares. O sincício consiste em matriz com três tipos de corpos de inclusão e mitocôndrias. A musculatura é formada por diversas camadas de fibras musculares longitudinais e circulares. As células tegumentares apresentam núcleo bem desenvolvido, citoplasma preenchido por ribossomas, retículo endoplasmático rugoso e mitocôndrias, organelas características das células tegumentares.

The ultrastructure of the body tegument of Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasite of Mugil liza from Brazil, was studied by transmission electron microscopy. The body tegument is composed of an external syncytial layer, musculature, and an inner layer containing tegumental cells. The syncytium consists of a matrix containing three types of body inclusions and mitochondria. The musculature is constituted of several layers of longitudinal and circular muscle fibers. The tegumental cells present a well-developed nucleus, cytoplasm filled with ribosomes, rough endoplasmatic reticulum and mitochondria, and characteristic organelles of tegumental cells.

Duas espécies de Digenea foram registradas pela primeira vez na América do Sul e em novos hospedeiros: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) foi coletado de Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) e Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae), de Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). Deste último hospedeiro, uma espécie de Nematoda Heliconema heliconema Travassos, 1919 (Physalopteridae) foi coletada, representando também um novo hospedeiro para este nematóide.

Two species of Digenea were recorded for the first time in South America and in new hosts: Acanthostomum spiniceps (Looss, 1896) (Cryptogonimidae) was reported from Astroscopus sexspinosus (Steindachner, 1877) (Uranoscopidae) and Diplomonorchis sphaerovarium Nahhas & Cable, 1964 (Monorchiidae) from Ophichthus gomesi (Castelnau, 1855) (Ophichthidae). From the latter, Heliconema heliconema Travassos, 1919 (Nematoda, Physalopteridae), was also recovered representing also a new host for this nematode species.

Os autores avaliaram três atletas do sexo masculino, submetidos a tratamento cirúrgico de hérnia discal lombar, com o objetivo de avaliar os resultados, após serem submetidos a um protocolo de reabilitação com base em hidroterapia. Este método permitiu a reabilitação precoce dos atletas, iniciando-se na primeira semana após a cirurgia. Os atletas foram avaliados em 5 ocasiões: pré-operatório e nos 4 meses seguintes. Houve melhora completa da dor em dois atletas. O terceiro caso apresentou no 4º mês 1,3% da intensidade máxima. As atividades de vida diária no período pré-operatório em média apresentaram-se com 21,6% da freqüência máxima, chegando a 99,3% no 4º mês. A freqüência de prática esportiva teve em média 10% da intensidade no pré-operatório, no 4º mês os atletas já praticavam a atividade esportiva com uma freqüência de 84,6% do normal. O nível de atividade esportiva foi relatado em média como 10% daquele estabelecido pelos atletas antes do início dos sintomas, atingindo 88,3% no 4º mês. Concluímos que os atletas apresentaram melhora evolutiva em todos os parâmetros analisados, especialmente em relação a dor. Portanto, a hidroterapia mostrou-se um método eficaz e bem tolerado na reabilitação precoce da cirurgia de hérnia discal em atletas.

Three male athletes submitted to surgical treatment of lumbar disc herniation were assessed aiming to evaluate the results of a rehabilitation protocol based on aquatic therapy. This method allowed early rehabilitation of the athletes, within a week after surgery. The athletes were evaluated in 5 occasions: pre-operatively and in the 4 following months. Complete improvement of pain was observed in two athletes. The third case had 1.3% of the maximum intensity in the 4th month. The daily life activities during the pre-operative period presented 21.6% of the maximum frequency on average, reaching 99.3% in the 4th month. The frequency of practicing sports was on average 10% the pre-operative intensity; in the 4th month the athletes already played sports with a frequency 84.6% of the normal. The level of sporting activities was reported as 10% on average of the one established by the athletes before the symptoms had started, reaching 88.3% in the 4th month. We conclude that the athletes had an evolutionary improvement in all the analyzed parameters, especially as regards pain. Thus, hydrotherapy was an effective and well tolerated method in the early rehabilitation of athletes after disc herniation surgery.

The syndromic treatment of gonococcal and chlamydial infections in women seeking primary care in clinics where resources are scarce, as recommended by WHO and implemented in many developing countries, necessitates a balance to be struck between overtreatment and undertreatment. The present paper identifies factors that are relevant to the selection of specific strategies for syndromic treatment in the above circumstances. Among them are the general aspects of decision-making and caveats concerning the rational decision-making approach. The positive and negative implications are outlined of providing or withholding treatment following a specific algorithm with a given accuracy to detect infection, i.e. sensitivity, specificity and predictive values. Other decision-making considerations that are identified are related to implementation and include the stability of risk factors with regard to time, space and the implementer, acceptability by stakeholders, and environmental constraints. There is a need to consider empirically developed treatment algorithms as a basis for policy discourse, to be evaluated together with the evidence, alternatives and arguments by the stakeholders.

El tratamiento sindrómico de las infecciones por gonococos y clamidias en las mujeres que recurren a los servicios de atención primaria en dispensarios con recursos escasos, según las recomendaciones de la OMS que aplican muchos países en desarrollo, obliga a llegar a un compromiso entre el riesgo de sobretratamiento y el de subtratamiento. En este artículo se identifican diversos factores de interés para seleccionar estrategias específicas de tratamiento sindrómico en las mencionadas circunstancias. Se incluyen entre ellos aspectos generales de la adopción de decisiones y salvedades concernientes al enfoque de la adopción de decisiones racionales. Se exponen sucintamente las ventajas y los inconvenientes que se derivan de proporcionar o no tratamiento según los resultados de un algoritmo específico que permite detectar la infección con una precisión determinada, esto es, con una sensibilidad, una especificidad y un valor predictivo determinados. Se hacen también diversas consideraciones sobre la aplicación de los algoritmos decisionales, en relación concretamente con la estabilidad de los factores de riesgo en función del tiempo, del espacio y de los encargados de aplicarlos, con su aceptabilidad por los interesados y con las limitaciones ambientales. Los algoritmos terapéuticos establecidos empíricamen deben constituir la base de las propuestas normativas en este campo, y han de ser evaluados contrastándolos con la evidencia y las alternativas disponibles y con los argumentos de las partes interesadas.

Le traitement syndromique des infections à gonocoques et à Chlamydia chez les femmes consultant un service de soins de santé primaires dans un contexte de ressources limitées, tel qu'il est recommandé par l'OMS et mis en œuvre dans de nombreux pays en développement, suppose que l'on trouve un juste milieu entre sous-traitement et surtraitement. Le présent article identifie les facteurs entrant en ligne de compte dans le choix de stratégies adaptées au traitement syndromique dans un tel contexte. En font partie les aspects généraux de la prise de décision et les inconvénients de l'approche rationnelle. L'article expose les aspects positifs et négatifs du traitement ou de l'abstention thérapeutique cidés selon un algorithme spécifique permettant de détecter une infection avec une certaine exactitude (sensibilité, spécificité et valeur prédictive). Les autres aspects décisionnels reconnus sont liés à la mise en œuvre de la décision - stabilité des facteurs de risque en fonction du temps, du lieu et du responsable de la mise en œuvre, acceptabilité par les parties intéressées et contraintes liées à l'environnement. Il est nécessaire d'examiner comme base de discussion les algorithmes de traitement établis selon des critères empiriques, et de les évaluer conjointement avec les faits, les options et les arguments présentés par les divers partenaires.