Abstract Objectives: To evaluate the effect of azithromycin (AZM) on biofilm formation and composition in multidrug resistant (MDR) Acinetobacter baumannii. Material and methods: Ninety-six A. baumannii isolates were studied. Antimicrobial susceptibility and sub-minimum inhibitory concentration (sub-MIC) were determined by the broth microdilution method. Carbapenemase genes were detected by polymerase chain reaction and clonal diversity by pulsed-field gel electrophoresis (PFGE). Biofilm formation without AZM and AZM sub-MIC were determined by crystal violet staining. AZM-free biofilm composition and AZM sub-MIC were determined by detachment assays. Results: The selected A. baumannii were MDR; 93.8 % were carbapenem-resistant and 24 were OXA-24-positive. PFGE showed predominance of clones A (53 %), B (34.7 %) and C (12.5 %). Biofilm production at AZM sub-MICs decreased in 53.1 %, increased in 34.7 % and showed no differences in 12.5 % of isolates, in comparison with biofilm production without AZM. Conclusion: AZM sub-MIC can reduce biofilm production in A. baumannii MDR isolates with decreased protein and DNA in the biofilm. Our results may be useful in synergy studies for new therapeutic alternatives.

Resumen Objetivos: Evaluar el efecto de la azitromicina (AZM) en la formación y composición de biopelículas en Acinetobacter baumannii resistente a múltiples fármacos (MDR). Material y métodos: Se estudiaron 96 aislamientos de A. baumannii. La susceptibilidad antimicrobiana y la concentración inhibitoria submínima (sub-MIC) se determinaron por el método de microdilución del caldo. Los genes carbapenemasa fueron detectados por reacción en cadena de la polimerasa y la diversidad clonal por electroforesis en gel de campos pulsados (PFGE). La formación de biopelículas sin AZM y la sub-MIC de AZM por tinción de cristal violeta. La composición de la biopelícula sin AZM y la sub-MIC de AZM se determinaron mediante ensayos de desprendimiento. Resultados: Los A. baumannii seleccionados fueron MDR; el 93.8% resistentes al carbapenem y 24 OXA-24 positivos. El PFGE demostró predominancia en los clones A (53%), B (34.7%) y C (12.5%). La producción de biopelículas en sub-MIC de AZM disminuyó en un 53.1%, aumentó en un 34.7% y no mostró diferencias en un 12.5% de los aislamientos, comparado con la producción de biopelículas sin AZM. Conclusión: La sub-MIC de AZM puede reducir la producción de biopelículas en aislamientos de A. baumannii MDR con disminución de proteínas y el ADN en la biopelícula. Nuestros resultados pueden ser útiles en estudios de sinergia para nuevas alternativas terapéuticas.

Abstract The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly pathogenic virus that causes severe pneumonia and acute respiratory distress syndrome. On March 11, 2020, this novel coronavirus was declared a pandemic by the World Health Organization. To date, millions of patients have been infected. Recent reports indicate that a substantial proportion of cases present with neurological symptoms. However, it remains to be elucidated whether these manifestations are secondary to direct nervous system invasion, indirect damage mediated by a systemic inflammatory response, or a combination of both. In this review, we explore the potential routes for central nervous system involvement, the possible pathogenic mechanisms in the nervous system and the conceivable neurological long-term sequela of infection by SARS-CoV-2 infection. Future efforts should concentrate on clarifying the pathophysiology of the neurological component of COVID-19.

Resumen El SARS-CoV-2 es un virus altamente patogénico que causa neumonía grave y síndrome de dificultad respiratoria aguda. El 11 de marzo de 2020, este nuevo coronavirus fue declarado como pandemia por la Organización Mundial de la Salud. Hasta la fecha, millones de pacientes se han infectado. Informes recientes indican que una proporción sustancial de casos presenta síntomas neurológicos. Sin embargo, aún no se ha dilucidado si estas manifestaciones son secundarias a una invasión directa del virus al sistema nervioso, efecto del daño indirecto mediado por una respuesta inflamatoria sistémica o el resultado de una combinación de ambas situaciones. En esta revisión se describen las posibles vías para la invasión del sistema nervioso central por SARS-CoV-2 y sus mecanismos patogénicos en el sistema nervioso y las secuelas neurológicas de infección a largo plazo. Se requieren investigaciones adicionales para precisar la fisiopatología del componente neurológico del COVID-19.

RESUMO O funcionamento da atenção é complexo, função primordial em diversos processos cognitivos e de grande interesse para a neuropsicologia. O Teste de Variáveis de Atenção (T.O.V.A) é um teste computadorizado de desempenho contínuo que avalia alguns componentes de atenção, como tempo de resposta a um estímulo e erros por desatenção e impulsividade. Objetivo: 1) Avaliar a aplicabilidade do T.O.V.A em adultos brasileiros; 2) Analisar as diferenças de desempenho entre os gêneros, faixas etárias e níveis de escolaridade; 3) Examinar a associação entre as variáveis T.O.V.A e outros testes de atenção e triagem cognitiva. Métodos: O TOVA foi aplicado a 63 adultos saudáveis (24 a 78 anos) submetidos ao Mini-Exame do Estado Mental (MEEM), Montreal Cognitive Assessment (MoCA), Digit Span e Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) e o Trail Making Test. Resultados: T.O.V.A teve pouca influência da idade e escolaridade, mas foi influenciado pelo gênero. As correlações entre algumas variáveis T.O.V.A e o símbolo Digit e o teste Trail Making foram fracas (valores de r entre 0,2 e 0,4), mas significativas (p <0,05). Não houve correlação com o teste Digit Span. Conclusão: T.O.V.A apresentou boa aplicabilidade e foi adequado para avaliar os processos de atenção em adultos.

ABSTRACT The functioning of attention is complex, a primordial function in several cognitive processes and of great interest to neuropsychology. The Test of Variables of Attention (T.O.V.A) is a continuous computerized performance test that evaluates some attention components such as response time to a stimulus and errors due to inattention and impulsivity. Objective: 1) To evaluate the applicability of T.O.V.A in Brazilian adults; 2) To analyze the differences in performance between genders, age ranges, and levels of education; 3) To examine the association between T.O.V.A variables and other attention and cognitive screening tests. Methods: The T.O.V.A was applied to 63 healthy adults (24 to 78 years of age) who also underwent the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Digit Span and Digit Symbol (Wechsler Intelligence Scale for Adults – WAIS-III) and the Trail Making Test. Results: the T.O.V.A was little influenced by age or education, but was influenced by gender. The correlations between some T.O.V.A variables and the Digit Symbol and Trail Making test were weak (r-values between 0.2 and 0.4), but significant (p<0.05). There was no correlation with the Digit Span test. Conclusion: The T.O.V.A showed good applicability and proved adequate for evaluating attentional processes in adults.

Background: In order to provide appropriate advice to the patient at the time of dispensing and over-the-counter (OTC) medication counseling, community pharmacists need access to current and reliable information about medicines. Brazilian pharmacists have assumed new functions such as prescribing medication, in a dependent model, based in protocols. Objective: To examine the practice of community pharmacists in a Brazilian State, focusing on OTC recommendation. Method: A cross-sectional survey of community pharmacists in a state of Brazil was conducted from October 2013 to January 2014, with data collection through a pre-piloted self-administered anonymous survey via Survey Monkey® platform. Following ethical approval, the online instrument was sent to 8,885 pharmacists registered in Parana State, Brazil, focusing on professionals working in community pharmacies. The questionnaire assessed the community pharmacy setting, the search for information, the knowledge of the evidence-based practice, the important factors to consider when recommending an OTC medicine, and the pharmacist prescribing. Responses were imported into SPSS® (version 22.0) for analysis. Nonparametric tests were used to assess the association between responses and demographic information with a significance level less than 5% (p<0.05). Results: Of the pharmacists, 97.4% dispensed medications and counseled patients for a median of six hours per day. Product's efficacy (97%) and adverse effects (62.3%) were the most important factors taken into account when counseling a nonprescription medicine. Few pharmacists knew the meaning of terms related to evidence-based health. Most respondents agreed that pharmacists have the necessary training to prescribe. Conclusion: Over-the-counter medication counseling is a daily practice among Brazilian pharmacists. Learning needs exist for community pharmacists in relation to evidence-based practice. Thus, sources of information with good evidence could be used daily by community pharmacists, especially as regards nonprescription medication counseling.

Antecedentes: Para proporcionar asesoramiento adecuado al paciente en la dispensación de medicamentos over-the-counter (OTC), los farmacéuticos comunitarios necesitan acceso a información actual y fiable sobre medicamentos. Los farmacéuticos brasileños han asumido nuevas funciones, tales como la prescripción de la medicación, en un modelo independiente basado en protocolos. Objetivo: Examinar la práctica de los farmacéuticos comunitarios en un estado de Brasil, centrándose en las recomendaciones de OTC. Métodos: Se realizó un estudio transversal de farmacéuticos comunitarios en un estado de Brasil entre octubre 2013 y enero 2014, con recogida de datos mediante un cuestionario auto-administrado, pre-pilotado y anónimo en una plataforma Survey Monkey®. Después de la aprobación ética, se envió el instrumento online a 8.885 farmacéuticos registrados en el estado de Paraná (Brasil), centrándose en los profesionales que trabajan en farmacia comunitaria. El cuestionario evaluaba el establecimiento de la farmacia comunitaria, la busca de información, el conocimiento de las prácticas basadas en la evidencia, los factores importantes a considerar cuando se recomienda un medicamento OTC, y la prescripción del farmacéutico. Las respuestas se importaron a SPSS® (versión 22.0) para su análisis. Se usaron pruebas no paramétricas para evaluar la asociación entre respuestas y la información demográfica con un nivel de significancia de menos del 5% (p<0,05). Resultados: El 97,4% de los farmacéuticos dispensaba medicamentos y aconsejaba a pacientes durante una mediana de seis horas por día. Los factores más importantes a tener en cuenta cuando se aconsejaba un medicamento sin receta eran la eficacia del producto (97%) y los efectos adversos (62,3%). Pocos farmacéuticos conocían el significado de los términos relacionados con la práctica basada en la evidencia. La mayoría de los respondentes estaban de acuerdo con que los farmacéuticos tienen la formación necesaria para prescribir medicamentos. Conclusión: El asesoramiento en medicamentos over-the-counter es una práctica diaria entre los farmacéuticos brasileños. Existen necesidades formativas de los farmacéuticos comunitarios en relación a la práctica basada en la evidencia. Así, los farmacéuticos comunitarios podrían usar a diario las fuentes de información con buena evidencia, especialmente relativas al asesoramiento de medicación sin receta.

The notalgia paresthetica is a chronic sensory neuropathy, characterized by intense pain and/or itching in the upper or middle back, typically below the left shoulder. Usually associated hyperpigmentation area in the affected area, or close to it. Although the aetiology has not been established with certainty, has been explained by two reasons: either by a central degenerative process, or by a process of peripheral nerve entrapment at that level. There is not standardized treatment available, but is usually treated as any other process with neuropathic pain or itching. We present six typical cases of notalgia paresthetica, together with a review of the literature, with special emphasis on the different theories that try to explain the pathophysiology of this entity.

La notalgia parestésica es una neuropatía sensitiva crónica caracterizada por cursar con intenso dolor y/o prurito en la zona superior o media de la espalda, típicamente debajo del hombro izquierdo. Suele asociar una zona de hiperpigmentación en el área afectada o cercana a ella. Aunque la etiología no se ha establecido con certeza, se ha intentado explicar por dos motivos, bien por un proceso degenerativo central, o bien por un cuadro de atrapamiento periférico de un nervio en ese ámbito. Aunque no se dispone de un tratamiento estandarizado, se suele tratar como cualquier otro tipo de proceso que curse con dolor o prurito neuropático. Se presenta una serie de seis casos de notalgia parestésica y se realiza una revisión de la literatura, haciendo especial hincapié en las diferentes teorías que intentan dilucidar la fisiopatología de esta entidad.

There has been a resurgence in the number of pertussis cases in Brazil and around the world. Here, the genome of a clinical Bordetella pertussis strain (Bz181) that was recently isolated in Brazil is reported. Analysis of the virulence-associated genes defining the pre- and post-vaccination lineages revealed the presence of the prn2-ptxS1A-fim3B-ptxP3 allelic profile in Bz181, which is characteristic of the current pandemic lineage. A putative metallo-β-lactamase gene presenting all of the conserved zinc-binding motifs that characterise the catalytic site was identified, in addition to a multidrug efflux pump of the RND family that could confer resistance to erythromycin, which is the antibiotic of choice for treating pertussis disease.

BACKGROUND: Primary healthcare is the foundation of a country's healthcare system. Without an efficient and cost-effective programme, the level of healthcare offered across all levels of health management is adversely affected. OBJECTIVE: To analyse the effectiveness of the management of hypertension and diabetes mellitus (DM) among two distinct patient populations, one with significant cardiovascular risk factors and the other without. METHOD: We performed a case control study of a high-risk group of patients presenting with chronic critical limb ischaemia (CLI) to the Divisions of Vascular Surgery at Charlotte Maxeke Johannesburg Academic Hospital and Chris Hani Baragwanath Academic Hospital, and a randomly selected group of 'healthy' community participants from Johannesburg's South Western Townships (Soweto). RESULTS: We assessed 217 patients with CLI and 1 030 participants from the community. We assessed the number of patients who were not achieving their therapeuatic targets, among those known to be hypertensive (CLI: 44.7%; community: 59.9%) and diabetic (CLI: 83.5%; community: 66%). Undiagnosed diabetes affected 10.8% of patients with CLI and 11% of the community sample. CONCLUSION: Traditional vascular risk factors are managed poorly at both primary healthcare and at tertiary care levels. There is a need to identify factors that will address this issue.

Monocirrhus polyacanthus (Polycentridae) é uma espécie de peixe cuja aparência e hábitos mimetizam uma folha morta à deriva, e que habita igarapés e margens de rios e lagos da bacia Amazônica. A despeito de seu reconhecido comportamento predatório e do fato de ser frequentemente explorada no comércio internacional de peixes ornamentais, pouco se conhece sobre sua dieta em condições naturais. Nós examinamos 35 exemplares de peixe-folha (28,5-82,0 mm CP), dos quais 19 continham presas no estômago. Trinta e três presas foram encontradas, das quais foi possível estabelecer o comprimento total de 19 delas (2,0-33,0 mm CT). Até cinco presas foram encontradas no estômago de um único exemplar. A dieta dos peixes-folha foi constituída por peixes (n = 12; 63,15% FO) e invertebrados (n = 4; 21,05% FO); peixes e invertebrados ocorreram juntos em três estômagos examinados (15,8% FO). Das 33 presas encontradas nos estômagos analisados, 21 foram peixes e 12 invertebrados. Dentre os peixes consumidos, Characiformes e Perciformes representaram 76,1% e 14,2%, respectivamente. Characidae foi a família de presas mais comum, seguida de Lebiasinidae. Invertebrados (presas) foram representados por camarões (Decapoda) e insetos (Coleoptera, Hymenoptera, Ephemeroptera e Odonata). Constatou-se uma relação positiva entre o tamanho do predador e da presa. A combinação da camuflagem corporal do peixe-folha, a baixa atividade dos caracídeos nos horários de crepúsculo e a eficiência do mecanismo de captura de presas por sucção, provavelmente possibilitam a captura de presas ágeis e de hábitos nectônicos. A posição encurvada dos peixes nos estômagos dos exemplares de M. polyacanthus possivelmente facilita a acomodação simultânea de mais de uma presa no estômago, o que deve ser especialmente importante para predadores que consomem presas grandes e apenas ocasionalmente.

Monocirrhus polyacanthus (Polycentridae) is a remarkable leaf-mimicking fish that inhabits streams, lake and river margins along the Amazon basin. Despite its obvious predatory habits and being frequently present in the international aquarium trade, little is known about its diet under natural conditions. We examined 35 specimens of leaf fish (28.5-82.0 mm SL), of which 19 had food the stomach. Thirty-three preys were found in the stomach contents, 19 of which were measured (2.0-33.0 mm total length). Up to five preys were found in the stomach contents of a single leaf fish specimen. The diet of the leaf fish was constituted by fish (63.15% FO, n = 12) and invertebrates (36.3% FO, n = 4); fish and invertebrate preys occurred together in three stomachs (15.8% FO). Of the 33 prey found in the stomachs, 21 were fish and 12 invertebrates. Among the consumed prey fishes, Characiformes and Perciformes represented 76.1% and 14.2% respectively. Characidae was the most commonly recorded prey family, followed by Lebiasinidae. Invertebrates were represented by shrimps (Decapoda) and insects (Coleoptera, Hymenoptera, Ephemeroptera and Odonata). There was a positive relation between the size of the leaf fish specimens and of its consumed preys. The combination of leaf fish's visually effective body camouflage and the reduced activity of the characids at crepuscular hours probably allow the capture of such fast moving preys. The coiled position of the fishes found in the stomach of M. polyacanthus possibly allowed the accommodation of more than one prey simultaneously, which seems to be important for predators that consume proportionally large preys that are captured only occasionally.

Três triterpenos pentacíclicos inéditos foram isolados da resina de Protium kleinii. Suas estruturas, 3-oxo-11beta,16beta-diidróxi-urs-12-eno (1), 3-oxo-11beta-hidróxi-urs-12-eno (2) e 3-oxo-11beta-hidróxi-olean-12-eno (3), foram elucidadas por espectroscopia de RMN. A administração sistêmica destes compostos (10-100 mg kg-1, i.p.) foi capaz de inibir tanto a primeira quanto a segunda fase da nocicepção induzida pela formalina em camundongos. Em adição, foram isolados os triterpenos conhecidos 3beta,16beta-dihidróxi-urs-12-eno (breina) (4) e uma mistura de alfa (5)- e beta-amirina (6).

Three novel pentacyclic triterpenes have been isolated from the resin of Protium kleinii and their structures elucidated by NMR spectroscopy as 3-oxo-11beta,16beta-dihydroxy-urs-12-ene (1), 3-oxo-11beta-hydroxy-urs-12-ene (2) and 3-oxo-11beta-hydroxy-olean-12-ene (3). The systemic administration of the above compounds (10-100 mg kg-1, i.p.) was able to inhibited both first and second phase of the formalin-induced nociception in mice. The known triterpenes 3beta,16beta-dihydroxy-olean-12-ene (brein) (4) and a mixture of alpha (5)- and beta-amyrin (6) were also found.

Malign mesothelioma is a pleural neoplasia related to the occupational exposure to asbestos, although other factors can be involved; its incidence is increasing in Western Europe. Pain in the thorax and dyspnoea are its most frequent clinical manifestations. An important role in the evaluation of the disease is played by imaging techniques, of which CAT is the most widely used, although MR and PET are suggested as techniques that can provide additional information in the diagnosis and prognosis of these patients. Survival is short and there is no consensus in the literature that would orientate treatment of these patients. This is due to a lack of data that would confirm an increase of survival with any therapeutic method, although recent efforts have led to the development of new treatments that could change the present pessimistic view of the disease held by doctors and patients.

El mesotelioma maligno es una neoplasia pleural relacionada con la exposición laboral a amianto, aunque otros factores pudieran estar implicados, con una incidencia en aumento en Europa Occidental. El dolor torácico y la disnea son sus manifestaciones clínicas más frecuentes. Las técnicas de imagen juegan un papel importante en la evaluación de la enfermedad, siendo la TAC las más ampliamente utilizada, si bien la RM y el PET se postulan como técnicas que pueden aportar información adicional en el diagnóstico y pronóstico de estos pacientes. La supervivencia es corta y no existe un consenso en la literatura que guíe el tratamiento de estos pacientes debido a la falta de datos que apoyen un aumento de supervivencia de ninguna modalidad terapéutica, si bien, recientemente los esfuerzos realizados han llevado al desarrollo de nuevos tratamientos que podrían cambiar la actual visión pesimista de la enfermedad por parte de médicos y pacientes.