ABSTRACT Objective The establishment of reference values for a subset of leukocytes is common in clinical practice, and ethnic variations are strongly associated with disease development. In Brazil, indigenous people are vulnerable to infections, and few studies have described the health and disease conditions of this population. This study aimed to provide reference values for immunological cell subsets in indigenous Brazilians living in the state of Mato Grosso do Sul. Methods Flow cytometry and 4-color combinations of monoclonal antibodies were used to characterize cells. A total of 115 healthy adults, mostly females (72%), were included in the study. The results are presented as mean and median (2.5%-97.5% percentiles) for T and B lymphocytes, CD4+ T cells, CD8+ T cells, Natural Killer cells, monocytes, and dendritic cells, providing an average immunological profile for the population in question. Results The relative medians of CD3+, CD4+, and CD8+ T cells were significantly higher in women than in men in a healthy indigenous population. Conclusion To our knowledge, cell reference data from indigenous Brazilians are unknown in the literature. The immune cell results presented in this pioneering study will contribute to the clinical and laboratory evaluation of the Brazilian indigenous population, especially given the important differences when compared with other Brazilian ethnic groups. practice development Brazil infections Sul 4color color 4 11 adults 72%, 72 72% , (72%) 2.5%97.5% 25975 2.5% 97.5% 2 5 97 (2.5%-97.5 percentiles lymphocytes CD4 CD CD8 monocytes question CD3 CD3+ knowledge literature groups 1 7 (72% 2.5%97.5 2597 25 2.5 975 97.5 9 (2.5%-97. (72 2.5%97. 259 2. 97. (2.5%-97 (7 2.5%97 (2.5%-9 ( 2.5%9 (2.5%- (2.5% (2.5 (2. (2

RESUMO Objetivo: Estimar a reprodutibilidade intra e interobservadores da avaliação da obliquidade pélvica (OP) nos pacientes com deformidades neuromusculares pelo método que usa as cristas ilíacas e pelo método que usa o platô superior de S1e avaliar se há relação entre os métodos. Métodos: Trinta radiografias panorâmicas digitalizadas de pacientes com paralisia cerebral e mielomeningocele acompanhados em ambulatório foram avaliadas por quatro examinadores, sendo dois cirurgiões de coluna experientes e doisfellows. Foram excluídas duas radiografias que impossibilitavam a análise. Todos os exames foram obtidos conforme protocolo de acompanhamento periódico, na posição sentada, em filme digitalizado e distância foco-filme de 110 cm. Resultados: Observou-se alta concordância intra e interobservadores tanto do método que usa as cristas ilíacas quanto do método que avalia o platô de S1. No entanto, não foi observada relação significativa entre os dois métodos. Conclusões: Os métodos avaliados apresentam boa reprodutibilidade e concordância entre os observadores. Verificou-se que, por conta da relação linear existente, é possível estimar o valor do método das cristas ilíacas conhecendo o valor obtido pelo método do platô de S1 multiplicado por 0,76. Não houve concordância entre o método de avaliação da OP pelas cristas ilíacas em comparação com o método de avaliação pelo platô de S1. Nível de evidência IV; Estudo transversal retrospectivo.

ABSTRACT Objective: To evaluate the intra- and inter-observer reproducibility of the evaluation of the pelvic obliquity (PO) in patients with neuro-muscular deformities via the method that uses the iliac crests and the method that uses the upper endplate of S1 and to determine whe ther there is a relationship between the methods. Methods: The digitized panoramic radiographies of thirty patients with cerebral paralysis or myelomeningocelein outpatient monitoring were evaluated by four examiners: two experienced spinal surgeons and two fellows. Two radiographs were excluded because analysis was impossible. All exams were obtained in accordance with the periodic monitoring protocol in the sitting position, using digitized film and a film-focus distance of 110 cm Results: High intra- and inter-observer agreement was observed both for method that uses the iliac crests and the method that evaluates the S1 endplate. However, no significant relationship between the two methods was observed. Conclusions: The methods evaluated had good reproducibility and agreement among the observers. It was confirmed that, on account of the existent linear relation, it is possible to estimate the value of the iliac crest method knowing the value obtained by the S1 plateau multiplied by 0.76. There was no agreement between the iliac crest and S1 plateau PO evaluation methods. Level of evidence IV; Retrospective cross-sectional study.

RESUMEN Objetivo: Estimar la reproducibilidad intra e interobservador de la evaluación de la oblicuidad pélvica (OP) en pacientes con deformidades neuromusculares por el método que utiliza las crestas ilíacas y por el método que utiliza la meseta superior de S1 y evaluar si existe una relación entre los métodos. Métodos: Treinta radiografías panorámicas digitales de pacientes con parálisis cerebral y mielomeningocele acompañadosen clínica ambulatoria fueron evaluados por cuatro examinadores, dos cirujanosde columna de vasta experiencia y dos fellows. Se excluyeron dos radiografías porque imposibilitaban el análisis. Todos los exámenes se obtuvieron según el protocolo de acompañamiento periódico, en posición sentada, sobre película digitalizada y distancia foco-película de 110 cm. Resultados: Se observó una alta concordancia intra e interobservador tanto en el método que utiliza las crestas ilíacas como en el que evalúa la meseta de S1. Sin embargo no se observó ninguna relación significativa entre los dos métodos. Conclusiones: Los métodos evaluados presentaron buena reproducibilidad y concordancia entre los observadores. Se observó que, debido a la relación lineal existente, es posible estimar el valor del método de las crestas ilíacas conociendo el valor obtenido por el método demeseta de S1 multiplicado por 0,76. No hubo concordancia entre el método de evaluación de la OP por las crestas ilíacas en comparación conel método de evaluación por meseta de S1. Nivel de evidencia IV; Estudio transversal retrospectivo.

Abstract Background: The increasingly frequent use of dermoscopy makes us think about the possibility of transfer of microorganisms, through the dermatoscope, between doctor and patients. Objectives: To identify the most frequent gram-positive cocci in dermatoscopes and smartphone adapters, as well as the resistance profile, and to evaluate the factors associated with a higher risk of bacterial contamination of the dermatoscopes. Methods: A cross-sectional study was carried out with 118 dermatologists from Porto Alegre/Brazil between September 2017 and July 2018. Gram-positive cocci were identified by MALDI-TOF MS and habits of use of the dermatoscope were evaluated through an anonymous questionnaire. Results: Of the dermatoscopes analysed, 46.6% had growth of gram-positive cocci on the lens and 37.3% on the on/off button. The microorganisms most frequently found were S. epidermidis, S. hominis and S. warneri. Attending a hospital, using the dermatoscope at the hospital, with inpatients and in the intensive care unit were significantly associated with colonisation by gram-positive cocci. The highest resistance rates were observed for penicillin, erythromycin and sulfamethoxazole-trimethoprim. Study limitations: The non-search of gram-negative bacilli, fungi and viruses. Moreover, the small number of adapters did not make it possible to better define if the frequency differences were statistically significant. Conclusion: Coagulase-negative staphylococci were frequently identified. S. aureus was detected only on the lens.

ABSTRACT Background: To analyze the effectiveness and the safety of Sofosbuvir-based regimens to treat patients with chronic hepatitis C virus (HCV) infection and chronic kidney disease (CKD). Methods: A retrospective, observational study in patients with chronic HCV infection and CKD treated with Sofosbuvir-based regimens was performed. Liver fibrosis, comorbidities, HCV genotype and sustained virological resposnse (SVR) at 12th week post-treatment were evaluated. Kidney function was accessed by serum creatinine and glomerular filtration rate (GFR). The assumed level of significance was 5 %. Results: Thirty-five patients were treated. The mean age was 52.1 ± 10.9 years, 19 (54.3 %) were women, 32 (91.4 %) were already kidney transplanted and 3 (8.6 %) were on hemodialysis. The SVR by intention to treat was 88.6 %. The mean GFR was 65.8 ± 28.6 and 63.7 ± 28.3 ml/min pre- and post-treatment respectively (p > 0.05). Treatment was interrupted in 1 (2.85 %) patient due to anemia and in 2 (5.7 %) due to loss of kidney function. Conclusion: Sofosbuvir-based regimens are effective to treat HCV in patients with CKD. In patients with mild CKD this type of therapy seems to be safe.

O objetivo do presente estudo foi comparar a influência do Teste de Sentar e Alcançar (TSA) modificado com e sem aquecimento sobre o score final obtido por diferentes faixas etárias de homens e mulheres fisicamente ativos. A amostra foi composta por 412 sujeitos, sendo 321 do gênero feminino (45 ± 14,09 anos; 66 ± 12,23Kg; 1,55 ± 0,05m) e 91 do gênero masculino (42 ± 15,75 anos; 74,6 ± 12,41Kg; 1,65 ± 0,07m). Todos os indivíduos realizaram o TSA modificado e convencional, com e sem aquecimento. O TSA modificado apresentou resultados significativos quando comparado à forma convencional, em ambos os gêneros avaliados (p = 0,0001). Em relação à condição para realizar o teste (com e sem aquecimento), o protocolo com aquecimento foi superior ao protocolo sem aquecimento, em ambos os gêneros, para o TSA modificado e convencional (p = 0,0001). Como conclusão, para avaliar a flexibilidade de membros inferiores, seria interessante utilizar um TSA adaptado, a fim de minimizar uma possível influência no score obtido no final do teste.

The aim of this study was to compare the influence of the modified Sit-and-Reach test (MSR) with or without warm-up on the final score obtained by groups of men and women of different ages, physically actives. The sample consisted of 412 subjects, 321 females (45 ± 14.09 years, 66 ± 12.23 kg, 1.55 ± 0.05 m) and 91 males (42 ± 15.75 years; 74, 6 ± 12.41 kg, 1.65 ± 0.07 m). All subjects underwent the MSR and the conventional Sit-and-Reach test (CSR), with or without warm up. The MSR showed significant results when compared to the CSR protocol, in both genders (p = 0.0001). Regarding the condition for testing (with or without warm up), the protocol with warm up showed better results than the protocol without warm up, for both genders, for the MSR and CSR (p = 0.0001). In conclusion, to evaluate the lower body flexibility, it would be interesting to use a MSR to minimize a possible influence in the score obtained at the test.

OBJETIVO: Identificar o papel do broncodilatador no tempo de apneia voluntária máxima em pacientes com distúrbios ventilatórios obstrutivos (DVOs). MÉTODOS: Estudo caso-controle incluindo pacientes com DVOs e grupo controle. Foram realizadas espirometrias antes e após o uso de broncodilatador, assim como testes de apneia respiratória, utilizando-se um microprocessador eletrônico e um pneumotacógrafo como transdutor de fluxo. As curvas de fluxo respiratório foram exibidas em tempo real em um computador portátil, e os tempos de apneia voluntária inspiratória e expiratória máximos (TAVIM e TAVEM, respectivamente) foram determinados a partir do sinal adquirido. RESULTADOS: Um total de 35 pacientes com DVOs e 16 controles foram incluídos no estudo. O TAVIM sem o uso de broncodilatador foi significativamente menor no grupo DVO que no grupo controle (22,27 ± 11,81 s vs. 31,45 ± 15,73; p = 0,025), mas essa diferença não foi significativa após o uso de broncodilatador (24,94 ± 12,89 s vs. 31,67 ± 17,53 s). Os valores de TAVEM foram significativamente menores no grupo DVO que no grupo controle antes (16,88 ± 6,58 s vs. 22,09 ± 7,95 s; p = 0,017) e após o uso de broncodilatador (21,22 ± 9,37 s vs. 28,53 ± 12,46 s; p = 0,024). CONCLUSÕES: Estes resultados fornecem uma evidência adicional da utilidade clínica do teste de apneia na avaliação da função pulmonar e do papel do broncodilatador nesse teste.

OBJECTIVE: To identify the role of bronchodilators in the maximal breath-hold time in patients with obstructive lung disease (OLD). METHODS: We conducted a case-control study including patients with OLD and a control group. Spirometric tests were performed prior to and after the use of a bronchodilator, as were breath-hold tests, using an electronic microprocessor and a pneumotachograph as a flow transducer. Respiratory flow curves were displayed in real time on a portable computer. The maximal breath-hold times at end-inspiratory volume and at end-expiratory volume (BHTmaxV EI and BHTmaxV EE, respectively) were determined from the acquired signal. RESULTS: A total of 35 patients with OLD and 16 controls were included. Prior to the use of a bronchodilator, the BHTmaxV EI was significantly lower in the OLD group than in the control group (22.27 ± 11.81 s vs. 31.45 ± 15.73 s; p = 0.025), although there was no significant difference between the two groups in terms of the post-bronchodilator values (24.94 ± 12.89 s vs. 31.67 ± 17.53 s). In contrast, BHTmaxV EE values were significantly lower in the OLD group than in the control group, in the pre- and post-bronchodilator tests (16.88 ± 6.58 s vs. 22.09 ± 7.95 s; p = 0.017; and 21.22 ± 9.37 s vs. 28.53 ± 12.46 s; p = 0.024, respectively). CONCLUSIONS: Our results provide additional evidence of the clinical usefulness of the breath-hold test in the assessment of pulmonary function and add to the existing knowledge regarding the role of the bronchodilator in this test.

Cefepime, uma cefalosporina de quarta geração, com amplo espectro de ação, é um antibiótico largamente utilizado no tratamento de infecções graves em ambientes hospitalares. O registro de segurança deste fármaco é considerado favorável. Vários casos de encefalopatia grave, associada ao uso de cefepime, reversível, foram descritos recentemente. No presente artigo, descrevemos sete casos de encefalopatia induzida por cefepime, com achados eletroencefalográficos (EEG) característicos, que apresentaram reversão do quadro com a suspensão da droga. As relações do padrão EEG encontrado nestes pacientes com estado epiléptico não-convulsivo são consideradas, bem como a possibilidade de enquadrar os pacientes estudados na entidade "encefalopatia epileptiforme".

Cefepime, a fourth-generation cephalosporin, with large antibacterial spectrum, is a commonly used antibiotic for the treatment of serious hospitalar infections. Its security report is considered favourable. Recently, many cases of a severe and reversible cefepime-induced encephalopathy were described. In this paper, we report seven patients with reversible cefepime-induced encephalopathy, with a peculiar EEG pattern, characterized by semiperiodic diffuse triphasic waves. We discuss the EEG abnormalities found and their association with nonconvulsive status epilepticus.