RESUMO: Mycobacterium bovis é o agente etiológico da tuberculose animal (aTB), uma doença zoonótica negligenciada. A tuberculose animal pode afetar muitas espécies, incluindo suínos. Os granulomas compatíveis com a aTB nesses animais levam ao descarte de carcaças, gerando perdas econômicas e trazendo riscos à saúde humana. No presente estudo, um surto de aTB foi identificado em um sistema de criação intensiva de suínos na região Sul do Brasil. A inspeção durante um abate de suínos revelou lesões suspeitas de tuberculose, as quais foram coletadas para diagnóstico por histologia, PCR e isolamento bacteriano. Os animais não apresentavam sinais clínicos de tuberculose. Lesões granulomatosas foram identificadas em 0,73% (59/8.071) dos suínos abatidos, e foram confirmadas pela histologia. Nove amostras foram posteriormente examinadas por PCR e isolamento bacteriano, com 44,4% e 55,5% de resultados positivos, respectivamente. Dados de frigoríficos submetidos à vigilância federal demostram prevalência da aTB de < 0,001% no Brasil. Os dados presentes indicam, portanto, um surto de aTB em suínos de criação intensiva. A infecção em suínos pode estar relacionada à exposição a animais infectados, alimentos ou ambientes contaminados. Medidas de biossegurança devem ser tomadas para evitar a transmissão da aTB. Embora as granjas suinícolas certificadas adotem tais medidas, este relato indica que o monitoramento constante é crucial, e maior controle nas unidades de criação e terminação de suínos é necessário para prevenir surtos e disseminação da tuberculose.

ABSTRACT: Mycobacterium tuberculosis var. bovis is the etiologic agent of animal tuberculosis (aTB), a neglected zoonotic disease. Animal tuberculosis can affect many species, including swine. aTB-consistent granulomas in these animals lead to carcass disposal, generating economic losses and posing risks to human health. In the present study, an aTB outbreak was identified at an intensive swine farming operation in Southern Brazil. Inspection during swine slaughter revealed aTB-suspected lesions, which were collected for diagnosis by histology, PCR, and bacterial isolation. The animals had no clinical signs of tuberculosis. Granulomatous lesions were identified in 0.73% (59/8,071) of the slaughtered swine, and were confirmed by histology. Nine samples were further examined by PCR and bacterial isolation, with 44.4% and 55.5% positive results, respectively. Data from abattoirs subjected to federal surveillance show an aTB prevalence in Brazil of <0.001%. The present data thus indicate a swine aTB outbreak in intensive breeding. Swine infection can be related to exposure to infected animals or to contaminated food or environment. Biosecurity measures must be taken to avoid aTB transmission. Although certified swine breeding farms adopt such measures, this report indicates that constant monitoring is crucial, and greater control in swine breeding and finishing units is required to prevent outbreaks and spread of tuberculosis.

OBJETIVO: A presença de lesão com apresentação atípica, história clínica indefinida, que não melhora com tratamentos clássicos, deve colocar a equipe médica em alerta. Nesses casos, a hipótese de lesão factícia tem de ser levada em conta. Muitas vezes o diagnóstico correto na avaliação inicial pode evitar a realização de testes diagnósticos de alto custo, tratamentos desnecessários e desgaste da equipe médica. Por meio da apresentação de dois casos clássicos de lesão factícia na mão mostramos que, assim como descrito na literatura, tal patologia é de difícil diagnóstico e tratamento.

OBJECTIVE: The presence of a lesion with atypical presentation, obscure clinical history, which does not improve with classic treatments, shall raise the red flag of the medical team. In such cases, the hypothesis of a factitious lesion shall be considered. Many times the correct diagnosis on the initial assessment may avoid high-cost diagnostic tests, unnecessary treatments, and time consumption of the medical team. We present here two classic cases of factitious lesions that, similar to those described in the literature, is difficult to diagnose and difficult to treat.

The objective of this study was to assess the sward canopy structure of Brachiaria brizantha cv. Marandu pastures maintained in three grazing intensities under continuous stocking system during the rainy season, along with the behavior and performance of grazing beef heifers supplemented with mineral salt or an energy/protein supplement. Three levels of forage allowance were assessed: 2.0, 2.5 and 3.0 kg of forage/kg of live weight, combined with two supplements (ad libitum mineral salt, and an energy/protein supplement at 0.3% of live weight/day, supplied daily). The experiment was designed as a randomized block study with two replications. The supplements did not influence the variables related to the canopy structure. Canopy height was greater at higher forage allowances during the late summer and early fall. Similarly, the stem mass was greater in pastures with higher forage allowances. Animals fed protein supplement spent less time grazing than animals supplemented with mineral salt. Stocking rate was higher in pastures with lower forage allowance levels, which increased the live weight gain per grazing area. Daily weight gain did not vary according to the forage allowance levels. The use of an energy/protein supplement did not affect the stocking rate; however, it increased individual live weight gain and live weight gain per grazing area compared with mineral salt supplementation. The use of energy/protein supplements is an efficient alternative to enhance animal performance and production under grazing systems during the rainy season

Inadequate nutrition and acute lower respiratory infection (ALRI) are overlapping and interrelated health problems affecting children in developing countries. Based on a critical review of randomized trials of the effect of nutritional interventions on ALRI morbidity and mortality, we concluded that: (1) zinc supplementation in zinc-deficient populations prevents about one-quarter of episodes of ALRI, which may translate into a modest reduction in ALRI mortality; (2) breastfeeding promotion reduces ALRI morbidity; (3) iron supplementation alone does not reduce ALRI incidence; and (4) vitamin A supplementation beyond the neonatal period does not reduce ALRI incidence or mortality. There was insufficient evidence regarding other potentially beneficial nutritional interventions. For strategies with a strong theoretical rationale and probable operational feasibility, rigorous trials with active clinical case-finding and adequate sample sizes should be undertaken. At present, a reduction in the burden of ALRI can be expected from the continued promotion of breastfeeding and scale-up of zinc supplementation or fortification strategies in target populations.

Problemas interrelacionados que se solapan, la mala nutrición y las infecciones agudas de las vías respiratorias inferiores (IAVRI) afectan a los niños de los países en desarrollo. A partir de una reseña crítica de los ensayos aleatorizados sobre el efecto de las intervenciones nutricionales en la morbilidad y mortalidad por IAVRI, llegamos a la conclusión de que: (1) la administración de suplementos de zinc en las poblaciones con déficit de ese elemento previene aproximadamente una cuarta parte de los episodios de IAVRI, lo que puede traducirse en una reducción moderada de la mortalidad por IAVRI; (2) el fomento de la lactancia materna reduce la morbilidad por IAVRI; (3) la administración de suplementos de hierro por sí sola no reduce la incidencia de IAVRI; y (4) los suplementos de vitamina A superado el periodo neonatal no reducen la incidencia de IAVRI ni la mortalidad por esa causa. La evidencia respecto a otras intervenciones nutricionales potencialmente beneficiosas era insuficiente. Cuando las estrategias tengan una justificación teórica sólida y probabilidades de ser operacionalmente viables, deberían emprenderse ensayos rigurosos con procedimientos de búsqueda activa de casos clínicos y tamaños de muestra adecuados. Por el momento, cabe prever una reducción de la carga de IAVRI como consecuencia del fomento continuo de la lactancia materna y de la extensión masiva de las estrategias de uso de zinc como suplemento o como enriquecimiento de los alimentos en las poblaciones objetivo.

La malnutrition et les infections aiguës des voies respiratoires inférieures (ALRI) sont des problèmes sanitaires interdépendants et imbriqués, qui affectent les enfants des pays en développement. Sur la base d'une analyse critique d'essais randomisés étudiant les effets d'interventions nutritionnelles sur la morbidité et la mortalité par ALRI, nous avons conclu que (1) la supplémentation en zinc des populations déficitaires en ce métal prévient environ un quart des épisodes d'ALRI, d'où éventuellement une diminution modeste de la mortalité associée ; (2) la promotion de l'allaitement fait baisser la morbidité due aux ALRI ; (3) la supplémentation en fer ne suffit pas seule à réduire l'incidence des ALRI ; et (4) la supplémentation en vitamine A au-delà de la période néonatale ne diminue ni l'incidence des ALRI, ni la mortalité qui leur est imputable. Les éléments disponibles à propos des autres interventions nutritionnelles potentiellement bénéfiques étaient insuffisants. Concernant les stratégies bénéficiant d'une justification théorique solide et probablement réalisables sur le plan opérationnel, il conviendrait d'entreprendre des essais rigoureux, avec une recherche des cas active et des échantillons de taille appropriée. On pourrait à présent s'attendre à une baisse de la charge d'ALRI comme conséquence de la promotion permanente de l'allaitement et du passage à l'échelle supérieure des stratégies de supplémentation ou d'enrichissement en zinc, menées parmi les populations cibles.