Resumen Introducción: Las osteotomías supramaleolares son una opción de tratamiento para la artrosis asimétrica de tobillo. El objetivo de este artículo es describir los resultados clínicos, radiográficos y subjetivos obtenidos en pacientes con artrosis de tobillo que fueron sometidos a una osteotomía supramaleolar. Materiales y Métodos: Estudio observacional descriptivo retrospectivo de pacientes sometidos a una osteotomía supramaleolar por artrosis de tobillo entre enero de 2010 y julio de 2017. Se analizaron las historias clínicas para recabar datos clínicos y radiográficos preoperatorios y posoperatorios. Resultados: Se incluyó a 13 pacientes que se habían sometido a una osteotomía supramaleolar de tobillo: 8 con una desalineación del tobillo y retropié en valgo (61,5%) y 5 (38,5%) en varo. El puntaje medio posoperatorio de la escala analógica visual de los pacientes con deformidad en varo disminuyó de 9 ± 0,45 a 3 ± 1 (p <0,05) y de una media de 7,88 ± 0,35 a 2,15 ± 1,64 (p <0,05) en aquellos con deformidad en valgo. El puntaje medio de la escala de la AOFAS se modificó de 32,8 ± 16,2 antes de la cirugía a 82,1 ± 13,6 en el posoperatorio, en el grupo con deformidad en varo (p <0,05) y de 31 ± 17,3 a 93,1 ± 6,20, respectivamente, en aquellos con deformidad en valgo (p <0,05). Se constató la consolidación radiográfica en 12 pacientes (92,3%), en un tiempo promedio de 10.4 semanas. Conclusión: La osteotomía supramaleolar como tratamiento de la artrosis asimétrica de tobillo es una técnica predecible, con muy buenos resultados clínicos y radiográficos a corto y mediano plazo.

Abstract Introduction: Supramalleolar osteotomies are a treatment option for asymmetric ankle osteoarthritis. Our work aims to describe the clinical, radiographic, and subjective outcomes obtained in patients with ankle osteoarthritis who underwent a supramalleolar osteotomy (SMOT). Materials and Methods: Retrospective, observational, and descriptive study on patients who underwent SMOT for ankle osteoarthritis between January 2010 and July 2017. The patients’ clinical records were analyzed. Results: We included 13 patients who underwent SMOT, 8 patients with valgus (61.5%) and 5 (38.5%) with varus rearfoot and ankle misalignment. The mean varus VAS score decreased from 9 ± 0.45 to 3 ± 1 postoperatively (p <0.05) and, in valgus deformities, from a mean 7.88 ± 0.35 to 2.15 ±1.64 postoperatively (p <0.05). The mean AOFAS score changed from 32.8 ± 16.2 to 82.1 ± 13.6 postoperatively in the varus deformity group (p <0.05) and from 31 ± 17.3 preoperatively to 93.1 ± 6.20 postoperatively in the valgus deformity group (p <0.05). Twelve patients (92.3%) achieved radiographic union in an average time of 10.4 weeks. Conclusion: Supramalleolar osteotomy as a treatment for asymmetric ankle osteoarthritis is a predictable technique with very good clinical and radiological outcomes in the short and medium term.

Abstract Brachycephalic breeds of dogs, most of which show signs of the brachycephalic syndrome may have greater parasympathetic stimulation than other breeds, leading to higher values of heart rate variability and vagal tone index. The aim of this study was to establish a computerized electrocardiographic study and an assessment of the vagus sympathetic balance through heart rate variability and vagal tone index of five brachycephalic breeds compared to mesocephalic dogs. Sixty dogs were used, divided into groups made up of Boxers, English Bulldogs, French Bulldogs, Pugs, Shih-Tzu and no defined breed mesocephalic dogs. Statistical analysis was carried out using the Shapiro-Wilk test, Kruskal-Wallis and Dunn’s test or ANOVA and Bonferroni (p<0.05). In the evaluation of vagal sympathetic balance among all the dogs, there was a negative correlation between heart rate and HRV 10RR (r = - 0.7678; p < 0.0001), HRV 20RR (r = - 0.8548, p < 0.0001) and VVTI (r = - 0.2770; p = 0.0321). It can therefore be concluded that the dog’s breed and morphology did not alter its electrocardiographic parameters or heart rate variability. The vagal tone index, which in other studies differed in brachycephalic dogs, showed no difference when compared separately in brachycephalic breeds. used Boxers Bulldogs Pugs ShihTzu Shih Tzu ShapiroWilk Shapiro Wilk KruskalWallis Kruskal Wallis Dunns Dunn s p<0.05. p005 p<0.05 . 0 05 (p<0.05) RR r 0.7678 07678 7678 0.0001, 00001 0.0001 , 0001 08548 8548 0.8548 0.2770 02770 2770 0.0321. 00321 0.0321 0321 0.0321) dog p00 p<0.0 (p<0.05 0.767 0767 767 0000 0.000 000 0854 854 0.854 0.277 0277 277 0032 0.032 032 p0 p<0. (p<0.0 0.76 076 76 0.00 00 085 85 0.85 0.27 027 27 003 0.03 03 p<0 (p<0. 0.7 07 7 0.0 08 8 0.8 0.2 02 2 p< (p<0 0. (p< (p

Resumen Introducción: El objetivo principal fue evaluar la relación entre la formación de calcificaciones heterotópicas y los parámetros de alineación de la prótesis. Materiales y Métodos: La población estaba formada por 31 pacientes. Se evaluaron variables radiográficas de alineación, como ángulos alfa y beta, centro de rotación astragalino y el porcentaje de cobertura posterior de la tibia en el posoperatorio inmediato y a los 2 años. Las variables de evaluación clínica fueron: la escala analógica visual y la escala de la AOFAS, y el cuestionario SF-36 para evaluar la calidad de vida al final del seguimiento. Resultados: La etiología más frecuente de la artrosis fue la postraumática (67,7%). En el posoperatorio inmediato, el ángulo alfa promedio fue de 88,7° (rango 82-92,6; DE ± 2,61); el ángulo beta, de 84,46° (rango 78,62-91,40; DE ± 3,59). La alineación del componente tibial en el plano frontal fue neutra en 25 pacientes (80,6%), en valgo en 6 (19,4%) y en varo (0%). A los 2 años de seguimiento, el 96% tenía calcificaciones heterotópicas. Mejoraron los puntajes en la escala de la AOFAS (preoperatorio/posoperatorio: 31,90/80,94) y en la escala analógica visual (preoperatorio/posoperatorio: 8,7/1,97) (p <0,05). Conclusiones: No se halló una relación entre calcificaciones heterotópicas y peores resultados funcionales ni de dolor, excepto en los parámetros de calidad de vida (SF-36), como el rol físico, la limitación emocional y la percepción de la salud general, que empeoraron a medida que aumentó el grado de calcificaciones alrededor de la prótesis.

Abstract Introduction: The main objective of this work is to evaluate the relationship between the formation of heterotopic calcifications and the alignment parameters of the prosthesis. Materials and Methods: The population under study comprised 31 patients. The radiographic alignment variables evaluated were alpha and beta angles, the talar center of rotation, and the percentage of posterior coverage of the tibia in the immediate postoperative period and after 2 years. The clinical evaluation variables were: VAS, AOFAS, and the SF-36 questionnaire to evaluate quality of life at the end of follow-up. Results: The most frequent etiology of osteoarthritis was post-traumatic (67.7%). In the immediate postoperative period, the mean alpha angle was 88.7° (range 82-92.6°; SD± 2.61); the mean beta angle was 84.46° (range 78°, 62-91.40°; SD ±3.59). The alignment of the tibial component in the anteroposterior plane was neutral in 25 patients (80.6%), valgus in 6 (19.4%), and varus in none. At 2 years of follow-up, 96% presented heterotopic calcifications. An improvement was verified both in the AOFAS (pre/post 31.90/80.94) and in the VAS scales (pre/post: 8.7/1.97) (p<0.05). Conclusions: No relationship was found between heterotopic calcification and worse functional outcomes or pain, except for quality-of-life parameters (SF-36) such as physical condition, emotional limitation, and general health perception, which worsened as the degree of calcifications around the prosthesis increased.

Resumen Objetivo: Evaluar los resultados radiográficos y funcionales al año de la cirugía, en una serie consecutiva de pacientes con diagnóstico de pie plano valgo estadio IIB, sometidos a una osteotomía de Evans sin injerto óseo. Materiales y Métodos: Se evaluó, en forma retrospectiva, a dos grupos de pacientes: grupo 1 (placa con espaciador, n = 12) y grupo 2 (celdas de PEEK, n = 14). La edad promedio era de 47 años (DE 18) en el grupo 1 y de 54 años (DE 12) en el grupo 2. Resultados: Se evaluó a 26 pacientes (28 pies operados); 20 (77%) eran mujeres. Las mediciones radiográficas: ángulo de inclinación del calcáneo, ángulo astrágalo-calcáneo (perfil), ángulo astrágalo-calcáneo (frente), cobertura astragalonavicular, altura de la columna medial, longitud de la columna externa, arrojaron diferencias estadísticamente significativas entre las determinaciones preoperatorias y al año de la cirugía. El puntaje promedio de la escala de la AOFAS al año fue de 96 (DE 4,70) en el grupo 1 y de 95 (DE 4,98) en el grupo 2. El puntaje en la escala analógica visual para dolor fue de 1,2 (DE 0,42) en el grupo 1 y 1,16 (DE 0,46) en el grupo 2. Conclusiones: De acuerdo con los resultados obtenidos, concluimos en que la osteotomía de Evans sin el uso de injerto óseo logra preservar las correcciones obtenidas en el mediano plazo utilizando placas con espaciador o celdas de PEEK.

Abstract Objective: To evaluate the radiological and functional outcomes one year after surgery in a consecutive series of patients diagnosed with stage IIB adult-acquired flatfoot deformity who underwent Evans osteotomy without the use of bone graft. Materials and Methods: Two groups of patients were retrospectively evaluated: group 1 (spacer plate, n=12) and group 2 (PEEK cage, n=14). The mean age was 47 years (SD 18) in group 1 and 54 years (SD 12) in group 2. Results: 26 patients (28 feet) were evaluated; 14 (84%) of the patients were women. Radiographic measurements—calcaneal pitch angle, (lateral) talocalcaneal angle, (AP) talocal-caneal angle, talonavicular coverage angle, medial column height, lateral column length—yielded statistically significant differences between preoperative measurements and those taken one year after surgery. The mean score on the AOFAS scale one year after surgery was 96 (SD 4.70) in group 1 and 95 (SD 4.98) in group 2. Regarding the visual analog scale, it was 1.2 (SD 0.42) in group 1 and 1.16 (SD 0.46) in group 2. Conclusions: According to the results obtained, we conclude that Evans osteotomy without the use of bone graft manages to preserve the corrections obtained in the medium term, using either spacer plates or PEEK cages.

RESUMO Yersinia enterocolitica é uma bactéria com potencial zoonótico, e não há informações desse agente como causa de abortamento em equinos. O objetivo deste relato é descrever um caso de sepse por Y. enterocolitica em um feto equino abortado aos sete meses. O feto foi submetido à necropsia, e amostras de todos os órgãos foram processadas para histopatologia. Para microbiologia, foram coletadas amostras de fígado, pulmão, placenta e conteúdo estomacal. Macroscopicamente, observou-se fígado aumentado com coloração amarelada heterogênea; coração com áreas pálidas no miocárdio; pulmões não colabados, pesados e brilhantes; e cordão umbilical espessado e recoberto por fibrina e pus. Na análise histopatológica, havia miocardite necrossupurativa multifocal moderada e trombose, broncopneumonia supurativa difusa moderada, hepatite fibrinonecrótica multifocal discreta e onfalite necrossupurativa difusa moderada com miríades bacterianas intralesionais e trombose. Observou-se também placentite, nefrite, miosite, cistite e dermatite supurativa multifocal discreta, além de rarefação linfoide difusa discreta. A avaliação microbiológica identificou Y. enterocolitica no fígado, no pulmão e no líquido estomacal. Este é o primeiro relato de sepse por Y. enterocolitica causando abortamento na espécie equina. Essa bactéria tem importância zoonótica, portanto deve ser investigada em casos de abortamento nessa espécie, servindo como diagnóstico diferencial em tal distúrbio reprodutivo.

ABSTRACT Yersinia enterocolitica is a bacterium with zoonotic potential and there are no previous records of this bacteria being isolated from aborted foals. This report aims to describe a case of sepsis due to Y. enterocolitica in a seven month old aborted equine. The fequinoetus was submitted to necropsy and samples of all the organs were collected for the histological exam. Samples of liver, lung, placenta, and stomach contents were collected for bacterial culture. Macroscopically, the liver was enlarged with yellowish heterogeneous color, heart with pale myocardial areas; lungs not collapsed, heavy and shiny, thickened umbilical cord covered with fibrin and pus. Histopathologically, there was moderate multifocal necrosuppurative myocarditis and thrombosis, moderate diffuse suppurative bronchopneumonia, mild multifocal fibrinonecrotic hepatitis, and moderate diffuse necrosuppurative omphalitis with intralesional bacterial myriads and thrombosis. Mild multifocal suppurative placentitis, nephritis, myositis, cystitis, and dermatitis were also observed, in addition to mild diffuse lymphoid rarefaction. The microbiological evaluation identified Y. enterocolitica in the liver, lung, and stomach fluid. This is the first report of sepsis due to Y. enterocolitica causing an abortion in a horse. This bacterium has zoonotic importance; therefore, it should be investigated in abortion in this species, serving as a differential diagnosis in reproductive disorders.

Resumo Objetivo: Comparar as formas de avaliar as habilidades aritméticas em crianças brasileiras com TDAH, combinando três testes neuropsicológicos validados, e verificar se são sensíveis ao tratamento com metilfenidato. Métodos: Quarenta e duas crianças (9‒12 anos) participaram deste estudo: 20 eram crianças com TDAH (DSM-IV) e 22 eram controles pareados por idade. Usamos um critério de classificação para cada teste separadamente e outro para a combinação entre eles, visando detectar a presença de dificuldades aritméticas em dois momentos: início (tempo 1) e quando as crianças com TDAH estavam tomando 0,3‒0,5 mg/kg de metilfenidato (tempo 2). O estudo também avaliou o desempenho dessas crianças em operações de subtração, combinando partes desses testes. Resultados: Separadamente, os testes foram sensíveis apenas às diferenças entre os grupos sem medicação. Entretanto, ao combinar os três testes neuropsicológicos, foi possível observar uma diferença e detectar uma redução das dificuldades aritméticas associadas ao tratamento com metilfenidato. Os mesmos efeitos foram encontrados em exercícios de subtração que exigem o procedimento de empréstimo. Conclusões: O estudo foi capaz de detectar dificuldades aritméticas em crianças brasileiras com TDAH e os efeitos do metilfenidato. Dada essa melhora na sensibilidade, combinar testes poderia ser uma alternativa promissora ao trabalhar com amostras limitadas.

Abstract Objective: To compare the ways of evaluating arithmetic skills in Brazilian children with ADHD by combining three validated neuropsychological tests and determining whether they are sensitive to the methylphenidate treatment. Methods: Forty-two children (9‒12 years old) participated in the present study: 20 were children with ADHD (DSM-IV) and 22 were age-matched controls. A classification criterion was used for each test separately and one, for their combination to detect the presence of arithmetic difficulties at two time points: baseline (time 1); and when children with ADHD were taking 0.3‒0.5 mg/kg of methylphenidate (time 2). The study also assessed children’s subtraction performance, combining parts of these tests. Results: Separately, the tests were only sensitive to differences between groups without medication. However, by combining the three neuropsychological tests, we observed a difference and detected a reduction in arithmetic difficulties associated with the methylphenidate treatment. The same effects were found in subtraction exercises, which require a borrowing procedure. Conclusions: The present study detected arithmetic difficulties in Brazilian children with ADHD and the effects of methylphenidate. Given this improvement in sensitivity, combining tests could be a promising alternative when working with limited samples.

Several studies have focused on the heart rate variability (HRV) of murine species, while studies discussing HRV in murine neonates and infants remain scarce, since recording hemodynamic signals through invasive methods in small animals has been found to be quite challenging. Thus, this study aimed at describing and validating a novel method to assess HRV in newborn rats. An electrocardiogram (ECG) system was used to determine RR intervals in awake newborns and evaluate HRV in normotensive (Wistar) and hypertensive (SHR) neonate rats. After birth, ECG was recorded in the awake newborns, and they were allowed to rest on a heated surface, restricted only by the weight of the adhesive ECG electrodes. The electrodes were cut and adapted to provide more comfort to the animal, and gently placed on the newborn's skin. RR intervals were recorded over a 30-min period using an ECG system together with LabChart software (4 KHz). Three sequences of 5 min each from the ECG recording period were analyzed in time and frequency domains, using CardioSeries software. ECG data resulted in a clearly interpretable signal that was used to generate an RR interval sequence through time for the analysis of HRV. SHR neonates presented increased cardiac sympathovagal balance compared to Wistar neonates (low frequency/high frequency: 3.85±0.71 vs 0.90±0.09). In conclusion, the ECG setup here described may be used to record RR intervals to assess HRV in neonate rats, thus detecting early impairment of HRV in hypertensive newborns.

Questions regarding the transmissibility of the novel coronavirus disease (COVID-19) remain unanswered. It is known that the transmission of the severe acute respiratory syndrome coronavirus (SARS-CoV) occurs predominantly through droplets and contact. However, aerosols can be generated in some situations, such as orotracheal intubation, ventilation, and the use of electric or ultrasonic scalpels, and can therefore potentially contaminate the care team if adequate protection is not used. It is therefore necessary to assess issues of transmissibility of COVID-19 during surgery in infected patients. This review gathers the recent research pertaining to this topic. A search of the literature was performed using the PubMed and UpToDate databases with the search terms “surgery” and “covid-2019,” in addition to other MeSH variants of these terms. We do not have consistent evidence on the exposure of healthcare professionals assisting patients with COVID-19 undergoing laparoscopy or the impact of such exposure. In view of the evidence obtained and drawing parallels with other infectious and contagious diseases, medical personnel must wear complete protective attire for proper protection against the generated aerosol. Further studies are required to assess the impact of such surgeries on healthcare professionals conducing or assisting with these procedures.

A combined phytochemical, crystallographic and biological study of Worsleya procera roots was performed. Fifteen alkaloids were identified by gas chromatography mass spectrometry (GC-MS) and seven of them were isolated. The structures of the alkaloids were elucidated by spectroscopic methods, and a detailed crystallographic study of tazettine was carried out. The isolated alkaloids and the obtained extracts were tested in vitro against Plasmodium falciparum (3D7 and K1 strains) and human hepatocarcinoma cells (HepG2) to assess their antiplasmodial and cytotoxic effects, respectively. One of the isolated alkaloid derivatives, lycorine, exhibited antiplasmodial activity against both sensitive (3D7) and resistant (K1) parasite strains in the low micromolar range (half-maximal sample inhibitory concentration (IC50) values of 2.5 and 3.1 µM, respectively) and displayed a low cytotoxicity profile, with a selectivity index greater than 100. Our findings indicate that lycorine is a hit for antimalarial drug discovery.

Objetivo: Investigar a imagem corporal em diferentes períodos da adolescência.Métodos: Estudo transversal com estudantes de dez a 19 anos de escolas da rede pública de municípios de pequeno porte do interior da Zona da Mata Mineira. Aplicaram-se o Body Shape Questionnaire (BSQ), a Escala de Evaluación de Insatisfación Corporal para Adolescentes e a Escala de Silhueta para Adolescentes (ESA). Classificou-se o período da adolescência por meio da idade. A massa corporal e a estatura foram mensuradas para o cálculo do índice de massa corpórea e do estado nutricional. Os resultados foram avaliados por regressão logística.Resultados: Participaram 531 adolescentes (318 meninas). A média de idade foi de 15,6±2,2 anos e 84,6% eram eutróficos. A prevalência de insatisfação corporal variou de 28,9% (BSQ) a 78,9% (ESA). Indivíduos com excesso de peso apresentaram maior chance de insatisfação (BSQ: OR 3,66, p<0,001; ESA: OR 4,108, p<0,001). O mesmo ocorreu para meninas e indivíduos no período inicial da adolescência (p<0,05).Conclusões: A prevalência de insatisfação com a imagem corporal foi baixa entre os adolescentes das cidades pequenas de Minas Gerais, porém a maioria desejava uma silhueta diferente da atual. Os resultados mostraram maior insatisfação entre os participantes no período inicial da adolescência, assim como nos do sexo feminino e naqueles com excesso de peso.

Objective: To analyze body image in different periods of adolescence.Methods: This cross-sectional study enrolled students aged ten to 19 years old of public schools in small districts of Minas Gerais, Southeast Brazil. The Body Shape Questionnaire (BSQ), the Body Dissatisfaction Assessment Scale for Teenagers and the Silhouette Scale for Teenagers (SST) were used. Adolescence phases were classified according to the subjects' ages. Weight and height were measured in order to calculate the body mass index and the nutritional status. Results were analyzed by logistic regression.Results: The study emolled 531 teenagers (318 females). The average age was 15.6±2.2 years and 84.6% were eutrophic. The prevalence of body dissatisfaction varied from 28.9% (BSQ) to 78.9% (SST). Overweight adolescents presented greater dissatisfaction (BSQ: OR 3.66, p<0.001; SST: OR 4.108, p<0.001). Dissatisfaction also occurred for females and those at the early adolescence (p<0.05).Conclusions:A low prevalence of dissatisfaction with the body image was observed among adolescents in small towns of Minas Gerais; however, most of them wished a different silhouette than the current one. The results showed that younger adolescents had higher dissatisfaction than their peers, as well as female and overweighed adolescents.

Objetivo: Investigar la imagen corporal en distintos periodos de la adolescencia.Métodos: Estudio transversal con estudiantes de diez a 19 años de escuelas de la red pública de municipios de pequeño porte del interior de la Zona de Bosque de Minas Gerais (Brasil). Se aplicaron el Body Shape Questionnaire(BSQ), la Escala de Evaluación de Insatisfacción Corporal para Adolescentesy la Escala de Silueta para Adolescentes (ESA). Se clasificó el periodo de la adolescencia por la edad. La masa corporal y la estatura fueron medidas para el cálculo del índice de masa corporal y del estado nutricional. Se realizaron análisis descriptivo, inferencias y regresión.Resultados: Participaron 531 adolescentes (318 muchachas). El promedio de edad fue de 15,6±2,2 años y 84,6% eran eutróficos. La prevalencia de insatisfacción corporal varió del 28,9% (BSQ) al 78,9% (ESA). Individuos con exceso de peso presentaron mayor posibilidad de insatisfacción (BSQ: OR 3,66, p<0,001; ESA: OR 4,108, p<0,001). Lo mismo pasó con muchachas e individuos en el periodo inicial de la adolescencia (p<0,05).Conclusiones: La prevalencia de insatisfacción con la imagen corporal fue baja entre los adolescentes de las ciudades pequeñas de Minas Gerais, pero la mayoría deseaba una silueta distinta de la actual. Los resultados mostraron mayor insatisfacción entre los participantes en el periodo inicial de la adolescencia, así como en los del sexo femenino y en aquellos con exceso de peso.

Ethyl acetate extracts of cultures grown in liquid Czapek and on solid rice media of the fungal endophyte Fusarium oxysporum SS46 isolated from the medicinal plant Smallanthus sonchifolius (Poepp.) H. Rob., Asteraceae, exhibited considerable cytotoxic activity when tested in vitro against human cancer cells. Chromatographic separation yielded anhydrofusarubin (1) and beauvericin (2) that were identified based on their ¹H and 13C NMR data. Compounds 1 and 2 showed the strongest cytotoxic activity against different cancer cell lines. Compound 2 also showed promising activity against Leishmania braziliensis. Hexanic extract of F. oxysporum SS50 grown on solid rice media also afforded a mixture of compounds that displayed cytotoxic activity against different cancer cell lines. Chemical analysis of the mixture of compounds, investigated by gas chromatography-mass spectrometry (GC-MS), showed that there was a predominance of methyl esters of fatty acids and alkanes.

OBJECTIVE: This study aims to evaluate the production of interferon-gamma and interleukin-10 by stimulated peripheral blood mononuclear cells isolated from patients with supraglottic laryngeal cancer before and after surgical treatment. METHODS: Fourteen patients with advanced supraglottic laryngeal cancer were studied. Cultures of peripheral blood mononuclear cells isolated during the preoperative and late postoperative periods were stimulated with concanavalin A and Bacille Calmette-Guerin, and the supernatant concentrations of interferon-gamma and interleukin-10 were measured. RESULTS: For non-stimulated cultures, the interferon-gamma levels produced by the preoperative period and the late postoperative period cultures were lower than the levels produced by the control group cultures. The interferon-gamma levels after stimulation with concanavalin A were higher in the late postoperative period cultures than in the preoperative evaluation cultures. Stimulation with Bacille Calmette-Guerin led to the production of similar levels of interferon-gamma and interleukin-10 by all cultures; thus, stimulation increased the levels of interferon-gamma produced by both the preoperative and postoperative cultures relative to the levels produced by the corresponding unstimulated cultures. CONCLUSION: Patients with advanced supraglottic laryngeal cancer exhibit an in vitro deficiency in interferongamma secretion by mononuclear cells. Stimulated cells seem to recover this function during the postoperative period.

JUSTIFICATIVA E OBJETIVOS: Diferentes estímulos são necessários para avaliar a integridade das fibras aferentes e compreender melhor os mecanismos envolvidos nas diferentes condições dolorosas que podem afetar a região orofacial. O principal objetivo deste estudo foi realizar uma revisão da literatura, proporcionando diretrizes para a prática clínica. CONTEÚDO: Foram realizadas buscas na literatura de 1990 a 2011, na base de dados PubMed utilizando-se termos MeSH. A estimulação mecânica pôde ser realizada mediante o uso de monofilamentos de Von-Frey, para testar as fibras A-beta e A-delta. O teste de picada é uma maneira simples de se avaliar as fibras A-delta e C. O limiar de dor à pressão (LDP) testa as fibras A-delta e C. Dentre as modalidades de ensaios térmicos, pode-se utilizar cubos de gelo ou um spray aerosol congelante para medir a nível de sensibilização central envolvido. Os estímulos elétricos, aplicados pelo aparelho Neurometer/Neurotron®, avaliam os três tipos principais de fibras (A-delta, A-beta e C), hiperestesia e hipoestesia. Além disso, as fibras do tipo C também podem ser avaliadas por estímulos químicos com capsaicina e/ou mentol. CONCLUSÃO: Os testes quantitativos sensoriais consistem em uma forma confiável para avaliação da função sensorial das fibras nervosas. O déficit sensorial pode ser quantificado e os dados utilizados como auxílio diagnóstico ou para comparações de eficácia entre diferentes modalidades de tratamento.

BACKGROUND AND OBJECTIVES: Different stimulations are needed to evaluate the integrity of afferent fibers and to better understand the mechanisms involved in different pain conditions which may affect the orofacial region. This study aimed primarily at reviewing the literature to provide guidelines to the clinical practice. CONTENTS: PubMed database was searched from 1990 to 2011 using MeSH terms. Mechanical stimulation could be done with Von-Frey monofilaments to test A-beta and A-delta fibers. Pinprick test is a simple way to evaluate A-delta and C fibers. Pressure pain threshold (PPT) tests A-delta and C fibers. Among thermal test modalities one may use ice cubes or a freezing spray to measure the level of central sensitization involved. Electric stimulations applied by the Neurometer/Neurotron® device evaluated three major fibers (A-delta, A-beta and C), hyperesthesia and hypoesthesia. In addition, C fibers can also be evaluated by chemical stimulations with capsain and/or menthol. CONCLUSION: Quantitative sensory tests are a reliable way to evaluate nervous fibers sensory function. Sensory deficit may be quantified and data may be used as diagnostic aid or to compare the effectiveness of different treatment modalities.

São relatados três novos casos humanos de rickettsiose no Uruguai. Os três casos clínicos apresentam manifestações clínicas semelhantes às descritas em casos de infecção por Rickettsia parkeri previamente relatados nos Estados Unidos, tais como: febre moderada (< 40 ºC), mal-estar, cefaléia, exantema, escara de inoculação no sítio de fixação do carrapato, linfadenopatia regional e ausência de letalidade. Testes sorológicos de absorção de anticorpos com antígenos de R. parkeri e Rickettsia rickettsii, associados à reação de imunofluorescência indireta, sugerem que os pacientes de dois casos foram infectados por R. parkeri. Evidências clínicas e epidemiológicas, associadas com nossas análises sorológicas, sugerem que R. parkeri é o agente etiológico de casos humanos de febre maculosa no Uruguai, uma doença que tem sido reconhecida naquele país como rickettsiose cutâneo-ganglionar.

We report three new rickettsiosis human cases in Uruguay. The three clinical cases presented clinical manifestations similar to previous reported cases of Rickettsia parkeri in the United States; that is mild fever (< 40 ºC), malaise, headache, rash, inoculation eschar at the tick bite site, regional lymphadenopathy, and no lethality. Serological antibody-absorption tests with purified antigens of R. parkeri and Rickettsia rickettsii, associated with immunofluorescence assay indicated that the patients in two cases were infected by R. parkeri. Epidemiological and clinical evidences, coupled with our serological analysis, suggest that R. parkeri is the etiological agent of human cases of spotted fever in Uruguay, a disease that has been recognized in that country as cutaneous-ganglionar rickettsiosis.