Abstract Background Systemic sclerosis (SSc) is a rare chronic autoimmune disease with heterogeneous manifestations. In the last decade, several clinical trials have been conducted to evaluate new treatment options for SSc. The purpose of this work is to update the recommendations of the Brazilian Society of Rheumatology in light of the new evidence available for the pharmacological management of SSc. Methods A systematic review including randomized clinical trials (RCTs) for predefined questions that were elaborated according to the Patient/Population, Intervention, Comparison, and Outcomes (PICO) strategy was conducted. The rating of the available evidence was performed according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. To become a recommendation, at least 75% agreement of the voting panel was needed. Results Six recommendations were elaborated regarding the pharmacological treatment of Raynaud’s phenomenon, the treatment (healing) and prevention of digital ulcers, skin involvement, interstitial lung disease (ILD) and gastrointestinal involvement in SSc patients based on results available from RCTs. New drugs, such as rituximab, were included as therapeutic options for skin involvement, and rituximab, tocilizumab and nintedanib were included as therapeutic options for ILD. Recommendations for the pharmacological treatment of scleroderma renal crisis and musculoskeletal involvement were elaborated based on the expert opinion of the voting panel, as no placebo-controlled RCTs were found. Conclusion These guidelines updated and incorporated new treatment options for the management of SSc based on evidence from the literature and expert opinion regarding SSc, providing support for decision-making in clinical practice. (SSc manifestations decade (RCTs PatientPopulation Patient Population Patient/Population Intervention Comparison PICO (PICO Assessment GRADE (GRADE methodology recommendation 75 needed Raynauds Raynaud s phenomenon healing (healing ulcers ILD (ILD drugs rituximab placebocontrolled placebo controlled found decisionmaking decision making practice 7

Abstract Background Parkinson's disease (PD) causes a series of movement disorders, many of them starting in the early stage. Objective To analyze the pulmonary function of mild-stage subjects with PD and to investigate the effects of levodopa on it. Methods We included 21 patients with idiopathic PD and 20 healthy control subjects. The participants were submitted to spirometry and impulse oscillometry assessments. The PD patients were evaluated during the “off” and “on” phases of their anti-PD medication, which was was converted to levodopa in an equivalent daily dose. A statistical analysis was performed with cross-sectional (PD patients “off” medication versus controls) and paired (PD patients “off” medication versus PD patients “on” medication) tests. The effect of levodopa was calculated with partial Eta-squared (η2ρ). Significance was set at 5%. Results The PD patients presented normal values in the impulse oscillometry. Regarding spirometry, the results indicated an incipient obstructive ventilatory disorder in the PD group – confirmed by patients' flow-volume curves. The PD patients received a daily dose of 354.7 ± 148.2 mg of levodopa. The paired analyses showed a small effect of anti-PD medication on pulmonary parameters (η2ρ = 0.197 for spirometry and η2ρ = 0.043 for impulse oscillometry). Conclusion Patients with PD in the mild stage of the disease present pulmonary compliance and resistance compatible with normal parameters. The differences regarding the spirometric results indicate an incipient obstructive ventilatory disorder in patients with PD. Levodopa had small effect on pulmonary function in the mild stage of the disease. Parkinsons Parkinson s disorders mildstage it 2 assessments off “off “on antiPD anti crosssectional cross sectional controls tests Etasquared Eta squared η2ρ. ηρ . η ρ (η2ρ) 5 5% flowvolume flow volume curves 3547 354 7 354. 1482 148 148. 0197 0 197 0.19 0043 043 0.04 oscillometry) 35 14 019 19 0.1 004 04 0.0 3 1 01 0. 00

Resumo Antecedentes A doença de Parkinson (DP) causa uma série de distúrbios do movimento, muitos deles se desenvolvendo na fase inicial. Objetivo Analisar função pulmonar de pessoas com DP em estágio leve e investigar o efeito da levodopa nesse processo. Métodos Vinte e um participantes com DP idiopática e vinte controles saudáveis foram incluídos na pesquisa. Todos os sujeitos foram submetidos a avaliações de espirometria e oscilometria de impulso. Participantes com DP foram avaliados nas fases ‘on’ e 'off' de medicação anti-parkinsoniana. A medicação dos pacientes foi convertida em dose diária de levodopa. A análise estatística foi realizada com testes transversais (Parkinson na fase ‘off’ da medicação vs controles) e pareados (Parkinson nas fases ‘off’ vs ‘on’ da medicação). O efeito da levodopa foi calculado pelo eta ao quadrado parcial (η2ρ). Significância foi estipulada em 5%. Resultados Pacientes com DP apresentaram valores normais na oscilometria de impulso. Na espirometria, os resultados indicaram uma desordem ventilatória obstrutiva incipiente no grupo DP – confirmada pelas curvas fluxo-volume dos pacientes. Pacientes com DP receberam uma dose diária de 354,7 ± 148,2 miligramas de levodopa. Análises pareadas mostraram baixo impacto da medicação anti-parkinsoniana nos parâmetros pulmonares (η2ρ = 0,197 na espirometria e η2ρ = 0,043 na oscilometria de impulso). Conclusão Pacientes com DP na fase leve apresentam complacência e resistência pulmonares compatíveis com parâmetros normais. Diferenças espirométricas indicam distúrbio ventilatório obstrutivo incipiente em pacientes com DP. A administração de levodopa apresentou baixo efeito na função pulmonar na fase leve da doença. (DP movimento inicial processo pesquisa impulso ‘on on off 'off antiparkinsoniana. antiparkinsoniana anti parkinsoniana. parkinsoniana ‘off medicação. . medicação) η2ρ. ηρ η ρ (η2ρ) 5 5% fluxovolume fluxo volume 3547 354 7 354, 1482 148 2 148, 0197 0 197 0,19 0043 043 0,04 impulso) 35 14 019 19 0,1 004 04 0,0 3 1 01 0, 00

Resumo A toxoplasmose, causada pelo protozoário Toxoplasma gondii, é uma zoonose e uma das doenças parasitárias transmitidas por alimentos mais importantes em todo o mundo. A prevalência em humanos é altamente variável, sendo influenciada por hábitos culturais, condições socioeconômicas e ambientais. O objetivo deste estudo foi estimar a prevalência de infecção por T. gondii em humanos, no arquipélago de Fernando de Noronha, Pernambuco, Brasil, e identificar os fatores de risco associados a essa infecção nesse contexto insular. A soroprevalência de anticorpos IgG anti-T. gondii nos ilhéus foi de 50,4% (172/341, 95% CI: 45,2%–55,7%). Os fatores associados à infecção encontrados foram o consumo de água do poço ou de água da chuva (Odds ratio [OR]: 2,43, p=0,020) e consumo de carne de caça (OR: 1,80, p=0,026). Este é o primeiro estudo a fornecer informações epidemiológicas da infecção por T. gondii entre os moradores da Ilha de Fernando de Noronha, revelando uma considerável soroprevalência de anticorpos nessa população. Este estudo fornece informações para subsidiar a adoção de medidas de prevenção e controle em ambientes insulares.

Abstract Toxoplasmosis, caused by the protozoan Toxoplasma gondii, is zoonotic disease and is one of the most important foodborne parasitic diseases globally. The prevalence in humans is highly variable, being influenced by cultural habits, socioeconomic, and environmental conditions. The objective of this study was to estimate the prevalence of T. gondii infection in humans on the archipelago of Fernando de Noronha, Pernambuco State, Brazil, and to identify the risk factors associated with this infection. The seroprevalence of immunoglobulin G anti-T. gondii antibodies was 50.4% (172/341, 95% CI: 45.2%–55.7%). Factors associated with the infection were consumption of well water or rainwater (odds ratio [OR]: 2.43, p=0.020) and consumption of game meat (OR: 1.80, p=0.026). This is the first study to provide epidemiological information of T. gondii infection among the residents of the Island of Fernando de Noronha, revealing a considerable antibody seroprevalence in this population. This study provides information for the adoption of prevention and control measures in island environments.

ABSTRACT Purpose To analyze and compare the reactions at the interface between the composite, composed of fragmented heterologous mineralized bone matrix (MOMHF) and polymethylmethacrylate (PMMA), and the rabbit’s tibias, through macroscopic evaluation and scanning electron microscopy (SEM) in different periods. Methods In this study, 12 New Zealand adult rabbits were used (E1: n = 3, E2: n = 3, E3: n = 3 and E4: n = 3). They had the right tibial defects filled with composite and were evaluated immediately after surgery and at 30, 60, 90, and 120 days. Results The composites were incorporated and integrated into the recipient beds in 100% of the cases, defined by the MOMHF osseointegration and the PMMA fibrointegration, with no sign of infection, migration, or rejection. Conclusions The behavior of the composites in the recipient beds demonstrates that these biomaterials have the potential to be used in bone defect repairs, offering, thus, better quality of life to the orthopedic patient.

RESUMO Objetivo Correlacionar o desempenho de usuários de implante coclear unilateral em testes de reconhecimento de fala, no silêncio e no ruído, com as respostas ao questionário de autoavaliação Hearing Implant Sound Quality Index (HISQUI19) e correlacionar o desempenho em testes de reconhecimento de fala com o tempo de uso do dispositivo e a orelha implantada. Métodos Participaram 27 usuários de implante coclear unilateral com deficiência auditiva pós-lingual, que faziam uso do dispositivo há, pelo menos, um ano e apresentavam limiar tonal em campo livre menor que 40 dBA. Todos os participantes foram submetidos à audiometria tonal em campo livre, responderam ao questionário HISQUI19 e realizaram testes de reconhecimento de fala no silêncio e no ruído. Resultados As respostas ao questionário foram comparadas com os testes de reconhecimento de fala no silêncio e no ruído e não houve diferença estatisticamente significativa. Na comparação em relação ao tempo de uso do implante coclear, só houve diferença estatisticamente significativa para o teste de reconhecimento de fala no silêncio. Não houve correlação significativa entre o reconhecimento de fala e a orelha implantada. Conclusão independentemente do tempo de uso do dispositivo e/ou do desempenho nos testes de reconhecimento de fala, muitos participantes classificaram a qualidade sonora do implante coclear como moderada. A aplicação de testes que possibilitem mensurar a satisfação e o benefício dos usuários deve fazer parte da rotina clínica dos centros de implante.

ABSTRACT Purpose To correlate the performance of unilateral cochlear implant users in speech recognition tests, in quiet and noise, with the answers to the Hearing Implant Sound Quality Index (HISQUI19) self-assessment questionnaire; also, to correlate the performance in speech recognition tests with the time of CI use and the implanted ear. Methods A total of 27 unilateral CI users with postlingual hearing loss, who had been using the device for at least one year and had free-field pure-tone threshold lower than 40 dBA, participated in the study. All the participants were submitted to free-field pure-tone audiometry, answered the HISQUI19 questionnaire, and took speech recognition tests in quiet and noise. Results The answers to the questionnaire were compared with the speech recognition tests in quiet and noise; there was no statistically significant difference. When comparing with the time of CI use, there was a statistically significant difference only for the speech recognition test in quiet. There was no significant correlation between speech recognition and the implanted ear. Conclusion Regardless of the time of CI use and/or performance in the speech recognition tests, many participants classified the sound quality of their cochlear implant as moderate. Administering tests to measure the users’ level of satisfaction and benefit should integrate the clinical routine in implantation centers.

RESUMO A cinética, o equilíbrio e os parâmetros termodinâmicos de adsorção foram investigados para a adsorção do corante azul de metileno (AM) por meio dos biossorventes Pinus elliottii (pinus) e Drepanostachyum falcatum (bambu). A cinética de adsorção foi descrita mais precisamente pelo modelo de pseudossegunda ordem, os dados de equilíbrio monocomponente foram mais bem representados pela isoterma de Langmuir, para as três temperaturas estudadas (15, 25 e 35°C), e os parâmetros termodinâmicos demonstraram que o processo de adsorção é exotérmico, de natureza química e não espontâneo. A máxima capacidade adsortiva do pinus foi de 47 mg L-1 e a do bambu, de 38 mg L-1 para os ensaios de adsorção realizados com AM (100 mg L-1 a 35°C). Por fim, os biossorventes foram considerados promissores para a remoção do adsorvato AM em matriz aquosa sob valor de pH próximo à neutralidade (6,5).

ABSTRACT Kinetics, equilibrium and thermodynamic adsorption parameters were investigated for the adsorption of the methylene blue dye (MB) by means of the biosorbents Pinus elliottii (pinus) and Drepanostachyum falcatum (bamboo). The adsorption kinetics were described more precisely by the pseudo-second order model; the monocomponent equilibrium’s data were better represented by the Langmuir isotherm for the three temperatures studied (15, 25 and 35°C) and the thermodynamic parameters showed the adsorption process is exothermic, of a chemical nature and not spontaneous. The maximum adsorptive capacity of pinus was 47 mg L-1 and 38 mg L-1 bamboo for adsorption tests performed with MB (100 mg L-1 at 35°C). Finally, the biosorbents were considered promising for the adsorbate MB removal in aqueous matrix under pH value close to neutrality (6.5).

Abstract: Pentavalent antimonials are the first-line drug treatment for American tegumentary leishmaniasis. We report on a patient with chronic renal failure on hemodialysis who presented with cutaneous lesions of leishmaniasis for four months. The patient was treated with intravenous meglumine under strict nephrological surveillance, but cardiotoxicity, acute pancreatitis, pancytopenia, and cardiogenic shock developed rapidly. Deficient renal clearance of meglumine antimoniate can result in severe toxicity, as observed in this case. These side effects are related to cumulative plasma levels of the drug. Therefore, second-line drugs like amphotericin B are a better choice for patients on dialysis.

Abstract Nailfold capillaroscopy (NFC) is a reproducible, simple, low-cost, and safe imaging technique used for morphological analysis of nail bed capillaries. It is considered to be extremely useful for the investigation of Raynaud's phenomenon and for the early diagnosis of systemic sclerosis (SSc). The capillaroscopic pattern typically associated with SSc, scleroderma (“SD”) pattern, is characterized by dilated capillaries, microhemorrhages, avascular areas and/or capillary loss, and distortion of the capillary architecture. The aim of these recommendations is to provide orientation regarding the relevance of NFC, and to establish a consensus on the indications, nomenclature, the interpretation of NFC findings and the technical equipments that should be used. These recommendations were formulated based on a systematic literature review of studies included in the database MEDLINE (PubMed) without any time restriction.

Abstract Purpose: To evaluate abdominal ventral wound healing by using a specific biomaterial, a handmade polyamide surgical mesh. Methods: A surgical incisional defect was made in ten rabbits to simulate a hernia in the ventral abdominal musculature. A polyamide surgical mesh was used in hernioplasty. They were monitored for surgical wound healing, and macroscopically and histologically evaluated at the end of the experiment. The polyamide surgical mesh did not cause foreign body reaction, pain, edema, or infection in the surgical site. The manure production was not affected by intestinal tissue adherences to the mesh, consistent with the ultrasonography result where adherences were not observed and organized scarring tissue formed in the incisional defect. The polyamide mesh was fixed over the abdominal wall, and its external and internal sides were surrounded by a vascularized connective tissue. Results: None of the experimental animals developed adherences from internal organs to the polyamide mesh, except two rabbits where the omentum formed adherence to the internal scarring tissue without present herniation or compromise of the rabbit’s health. Conclusion: Polyamide surgical mesh for hernioplasty presents, in rabbits, excellent biocompatibility, with minimal body adverse reactions and low cost.

Abstract Objective: Single dose of systemic antibiotics and short-term use of mouthwashes reduce bacteremia. However, the effects of a single dose of preprocedural rinse are still controversial. This study evaluated, in periodontally diseased patients, the effects of a pre-procedural mouth rinse on induced bacteremia. Material and Methods: Systemically healthy individuals with gingivitis (n=27) or periodontitis (n = 27) were randomly allocated through a sealed envelope system to: 0.12% chlorhexidine pre-procedural rinse (13 gingivitis and 13 periodontitis patients) or no rinse before dental scaling (14 gingivitis and 15 periodontitis patients). Periodontal probing depth, clinical attachment level, plaque, and gingival indices were measured and subgingival samples were collected. Blood samples were collected before dental scaling, 2 and 6 minutes after scaling. Total bacterial load and levels of P. gingivalis were determined in oral and blood samples by real-time polymerase chain reaction, while aerobic and anaerobic counts were determined by culture in blood samples. The primary outcome was the antimicrobial effect of the pre-procedural rinse. Data was compared by Mann-Whitney and Signal tests (p<0.05). Results: In all sampling times, polymerase chain reaction revealed higher blood bacterial levels than culture (p<0.0001), while gingivitis patients presented lower bacterial levels in blood than periodontitis patients (p<0.0001). Individuals who experienced bacteremia showed worse mean clinical attachment level (3.4 mm vs. 1.1 mm) and more subgingival bacteria (p<0.005). The pre-procedural rinse did not reduce induced bacteremia. Conclusions: Bacteremia was influenced by periodontal parameters. In periodontally diseased patients, pre-procedural rinsing showed a discrete effect on bacteremia control.

RESUMO: A doença da dilatação proventricular (PDD) e uma importante e fatal doença de psitacídeos de cativeiro, que afeta uma grande variedade de espécies e não tem um tratamento efetivo até o momento. Este relato descreve PDD em três araras canindé (Ara ararauna) no sul do Brasil. Todas as três araras eram provenientes do mesmo criatório e apresentaram sinais clínicos semelhantes incluindo anorexia, apatia, emaciação e prostração. Na necropsia, uma das araras apresentou proventrículo dilatado. No exame histopatológico, infiltrados linfoplasmacitários foram observados em gânglios e nervos do esôfago, inglúvio, proventrículo, moela, coração, glândulas adrenais e rins de todos os casos. Adicionalmente, meningoencefalomielite foi observada em duas araras e miocardite em uma. A imuno-histoquímica identificou antígenos de PaBV no encéfalo, coração, proventrículo e moela de todos os casos.

ABSTRACT: Proventricular dilatation disease (PDD) is a lethal and important disease of captive psittacine birds, and affects a wide range of species, including endangered ones, and lacks an effective treatment. This report describes PDD in three blue-and-gold macaws (Ara ararauna) in southern Brazil. All three macaws originated from the same aviary and presented similar clinical signs including anorexia, apathy, emaciation and prostration. At necropsy, one of the macaws presented an enlarged proventriculus. Histologically, lymphoplasmacytic infiltrates was observed in the ganglia and nerves of the esophagus, crop, proventriculus, ventriculus, heart, adrenal glands, and adrenal medulla of all three cases. Two macaws had meningoencephalomyelitis and one had myocarditis. Immunohistochemistry identified PaBV antigen in the brain, proventricular, ventricular ganglia, and epicardial ganglia, and cardiomyocytes of all three macaws.

RESUMO: Toxoplasma gondii e Neospora caninum são reconhecidos como protozoário causadores de aborto em ovinos e caprinos. Desta forma, objetivou-se descrever a transmissão transplacentária desses agentes em pequenos ruminantes na região Nordeste do Brasil. Foram examinados seis fetos caprinos e onze fetos ovinos, totalizando 78 amostras de diferentes tecidos (cérebro, fígado, pulmão, rim e coração) provenientes de propriedades rurais com histórico de aborto. As amostras foram analisadas por Reação em Cadeia da Polimerase (PCR), Histopatologia (HP) e Imunohistoquímica (IHQ), com a finalidade de associar o abortamento a T. gondii e/ou N. caninum. Nenhuma amostra foi positiva na PCR e IHQ para T. gondii. Algumas amostras de cérebro, fígado, pulmão, rim e coração de fetos de caprinos e ovinos foram positivas na PCR para N. caninum. Na histopatologia foi observado leve infiltrado mononuclear no fígado e necrose com calcificação no SNC de um caprino, associada à imunomarcação positiva para N. caninum na IHQ e PCR positiva. Os resultados confirmam a transmissão vertical de N. caninum em caprinos naturalmente infectados na região nordeste do Brasil.

ABSTRACT: Toxoplasma gondii and Neospora caninum are causative agents of abortion in sheep and goats. Thus, the present study aimed to describe the transplacental transmission of these protozoans in small ruminants of northeastern Brazil. Seventeen fetuses (6 goats and 11 sheep) from farms with history of abortion were necropsied and samples were collected from different tissues (brain, liver, lung, kidney and heart). The samples were analyzed by PCR, histopathology (HP) and immunohistochemistry (IHC) to evaluate whether T. gondii and/or N. caninum infection were the cause of abortion. None of the samples was positive for T. gondii according to PCR and IHC results. Some brain, liver, lung, kidney and heart samples of goat fetuses were positive for N. caninum by PCR. In the histopathology, mild mononuclear infiltration and necrosis with calcification were observed in the liver and brain of one goat fetus, respectively, that also was positive for N. caninum by PCR and IHC. The results confirmed vertical transmission of N. caninum in naturally infected goats of northeastern, Brazil.

Abstract INTRODUCTION: The objective was to identify comorbidities related to HIV-positive patients in Blumenau, State of Santa Catarina. METHODS: A retrospective, descriptive observational design study which analyzed data from 424 patients assisted by the sexually transmitted disease/acquired immunodeficiency syndrome (STD/AIDS) Specialized Care Service (SCS). RESULTS: Of 424 medical records analyzed, 388 patients presented CD4+/CD8+ ratios lower than 1. The most prevalent comorbidities were smoking, depression, alcoholism, and herpes zoster infection, in males and females. CONCLUSIONS: The most relevant comorbidity in both genders was herpes zoster, an important marker of immunity in patients. The lowest mean was observed among patients with neurotoxoplasmosis.

Mulher, 33 anos, apresenta quadro de alopecia progressiva do couro cabeludo há 3 anos. Tratamento com hidroxicloroquina há 12 meses, sem apresentar melhora. Ao exame físico exibe múltiplas áreas de alopecia cicatricial no couro cabeludo, além de hipotricose axilar e pubiana. A dermatoscopia evidencia hipercetose folicular e acentuação dos óstios foliculares. O exame anatomopatológico revela diminuição do número de folículos pilosos, infiltrado perifolicular e fibrose. A síndrome de Graham-Little Piccardi Lassueur é uma dermatose rara, caracterizada pela tríade de alopecia cicatricial multifocal do couro cabeludo, ceratose folicular disseminada e hipotricose das regiões axilares e pubianas. A terapêutica desta dermatose é um desafio, muitas medicações relatadas tem resultados controversos. Relatamos o caso desta síndrome rara que apresentou melhora com corticoterapia.

A 33-year-old woman presented with a 3-year history of progressive alopecia of the scalp. Past treatment with hydroxicloroquine did not show improvement. Physical examination revealed multiple areas of alopecia with atrophic aspect of the scalp, and axillary and pubic hypotrichosis. Dermoscopy showed hyperkeratosis and accentuation of follicular ostia. Anatomopathological examination revealed decrease in the number of hair follicles, upper perifollicular infiltrate and areas with fibrosis. The Piccardi-Lassueur-Graham-Little syndrome is a rare disorder, characterized by the triad of multifocal scarring alopecia of the scalp, keratotic follicular eruption and hypotrichosis of axillary and pubic regions. Management is a challenge and many medications tried have controversial results. We report a case of this rare syndrome which improved with corticoids.