Abstract Although widely used in medicine, separation technology, and other fields, the effects of cyclodextrins on the activities of phosphoryl transfer enzymes have not been previously evaluated. In vivo studies evaluated the function of cyclodextrins as active compounds. Despite the use of cyclodextrins as active compounds, the effects of cyclodextrins on hepatic and renal tissues remain to be fully elucidated. The primary objective of this study was to evaluate the effects of β- cyclodextrins, methyl-β-cyclodextrin (M-β- cyclodextrins), and (2-hydroxypropyl)-β-cyclodextrin (HP-β-cyclodextrins) on enzyme activities regulating the maintenance of energy homeostasis in the kidney and liver tissues in relation to toxicity. Serum levels of liver and kidney markers were measured, and oxidative stress parameters were assessed. After 60-day treatments, we observed that the administration of β-cyclodextrins and M-β-cyclodextrins inhibited the hepatic activity of pyruvate kinase, an irreversible enzyme within the glycolytic pathway. Additionally, administration of HP-β-cyclodextrins inhibited creatine kinase activity and increased the total sulfhydryl content in kidneys. Here, we demonstrated for the first time that β-cyclodextrins, M-β-cyclodextrins, and HP-β-cyclodextrins cause bioenergetic dysfunction in renal and hepatic tissues. These findings suggest that understanding the balance between cyclodextrins’ efficacy and adverse effects is essential for better accepting their use in medicine.

RESUMO: O Brasil é um dos países com maior avifauna do mundo. O confinamento de aves associado ao contato próximo a outros animais e seres humanos favorece a disseminação de agentes etiológicos causadores de doenças respiratórias. Dentre eles, os micoplasmas podem causar doença assintomática ou aparente que se manifesta em aves por espirros, estertores, conjuntivite, corrimentos oculares e nasais. São diversos os micoplasmas descritos causadores de doença em aves, com destaque para Mycoplasma gallisepticum (MG) e Mycoplasma synoviae (MS). O diagnóstico de Mycoplasma spp. pode ser feito pela observação clínica e análises laboratoriais. O diagnóstico molecular pela Reação em Cadeia da Polimerase (PCR) ganhou impulso por sua rapidez, sensibilidade e baixo custo em relação às técnicas de isolamento do agente que levam até 21 dias para conclusão do gênero Mycoplasma. Objetivou-se verificar a ocorrência da infecção por Mycoplasma spp. em aves no Zoológico do Rio de Janeiro (Rio Zoo), por isolamento e PCR. Do plantel de 635 aves do Rio Zoo, foram estudadas 81 para detecção de Mycoplasma spp., quando contidas para exames rotineiros de avaliação da condição de saúde. Essas aves eram pertencentes às ordens Psittaciformes (45), Accipitriformes (18), Galliformes (7), Piciformes (5), Strigiformes (4), Falconiformes (1) e Cariamiformes (1), todas já identificadas por microchip ou por anilha. Não houve isolamento de micoplasmas em nenhuma das amostras testadas, enquanto na PCR, 62,96% (51/81) foram positivas, sendo 1,96% (1/51) identificadas como MG e 19,61% (10/51) como MS, representando 1,23% (1/81) e 12,34% (10/81) da população total estudada. A PCR demonstrou ser uma técnica mais efetiva que o isolamento na detecção de Mycoplasma spp. em aves. Foi possível detectar micoplasmas nas aves do Riozoo sem sinal clínico respiratório, tendo MS maior prevalência do que MG. As positividades para Mycoplasma spp., MG e MS foram diferentes entre as ordens de aves estudadas, sendo a maior ocorrência nas aves de rapina, seguida dos Galliformes e dos Piciformes. A presença de MG e MS nas aves do Rio de Janeiro Zoo confirma a circulação destes agentes e a necessidade de mais estudos sobre a disseminação de micoplasmas em zoológicos para análise epidemiológica dessas bactérias nesse local.

ABSTRACT: Brazil is one of the countries with the most abundant avifauna in the world. The confinement of birds associated with close contact with other animals and humans favor the spread of agents of respiratory diseases. Among them, mycoplasmas can cause asymptomatic or apparent disease that manifests in birds by coughing, sneezing, rales, conjunctivitis, ocular and nasal discharge. Several described mycoplasmas cause disease in birds, especially Mycoplasma gallisepticum(MG) andMycoplasma synoviae(MS). The diagnosis ofMycoplasmaspp. can be done by clinical observation and laboratory analysis. Molecular diagnosis by PCR was boosted by its speed, sensitivity, and low cost of agent isolation techniques that take up to 21 days to complete. This study aimed to verify the occurrence ofMycoplasmaspp. in birds of the Rio de Janeiro Zoo (Rio Zoo), by isolation and PCR. Of the total 635 birds from the Rio Zoo, 81 were studied for detection ofMycoplasmaspp., when taken for routine health assessment exams. These birds belonged to the following orders: Psittaciformes (45), Accipitriformes (18), Galliformes (7), Piciformes (5), Strigiformes (4), Falconiformes (1) and Cariamiformes (1), all individuals already identified by microchip or leg-ring. There was no isolation of mycoplasmas in any of the samples tested, whereas, in the PCR, 62.96% (51/81) were positive, with 1.96% (1/51) identified as MG and 19.61% (10/51) as MS, representing 1.23% (1/81) and 12.34% (10/81) of the total population studied. PCR was shown to be a more effective technique than isolation in the detection ofMycoplasmaspp. in birds. It was possible to detect mycoplasmas in birds from Riozoo with no clinical respiratory signs, with higher MS prevalence than MG. The positivities forMycoplasmaspp., MS, and MG were different among the orders studied, being the highest occurrence in birds of prey, followed by Galliformes and Piciformes. The presence of MG and MS in birds of Rio de Janeiro Zoo confirms the circulation of these agents and the need for further studies on the dissemination of mycoplasmas in zoos for the epidemiological analysis of these bacteria in these places.

RESUMO: Com o avanço da distribuição do javali no ambiente rural, seus impactos não se restringem somente a sanidade suidea, embora as exigências quanto ao monitoramento e controle da espécie sejam exigências previstas pela OIE, para o reconhecimento do status de zona livre de peste suína clássica. A construção de modelos ecológicos de favorabilidade ou adequabilidade para a ocorrência de espécies-praga são ferramentas necessárias para as tomadas de decisão sobre áreas prioritárias de manejo visando gestão de risco. Este trabalho objetiva mapear o nível de adequabilidade para a ocorrência de javalis no sul do Estado de Mato Grosso do Sul, bem como levantar as principais variáveis de risco para o contato com o javali asselvajado e avaliar as medidas de biosseguridade adotadas por granjas comerciais integradas no sul do Estado do Mato Grosso do Sul. Para avaliar o potencial de risco exercido pelos javalis para a suinocultura comercial e de subsistência nesta região foi construído um modelo de adequabilidade ambiental para essa espécie na região produtora de suínos. Esse modelo considerou diferentes estratos ambientais, sendo que para a seleção das camadas consideram-se características fisiológicas e comportamentais da espécie. Em paralelo, entrevistas foram realizadas em uma amostragem de granjas comerciais de integração da região para levantamento da percepção quanto a presença da espécie invasora e as medidas de biossegurança adotadas. Os resultados desse trabalho indicam que o risco de contato entre javalis de vida livre e os animais criados em sistemas de produção fechados pode ser alto na área de estudo e somente estabelecimento de medidas de biosseguridade apropriadas, que considerem as características e hábitos do javali poderá impedir a intrusão dessa espécie e o contato com os suínos domésticos. O modelo construído pode ser considerado de elevada confiabilidade e recomenda-se a sua aplicação para as outras áreas do estado, sendo uma ferramenta útil para o setor produtivo, os órgãos ambientais e os tomadores de decisão.

ABSTRACT: With the advancement of wild boar distribution in the rural environment, its impacts are not limited to health in the pig sector, but the requirements for monitoring and control of the species are requirements laid down by the OIE for the recognition of classical swine fever free zone status. The construction of ecological models of favorability or suitability for the occurrence of pest species are necessary tools for the decision making on priority areas of management aiming at risk management. This work aims to map the level of suitability for the occurrence of wild boar in the southern state of Mato Grosso do Sul, as well as to identify the main risk variables for contact with the wild boar and evaluate the biosecurity measures adopted by commercial farms integrated in the south of the State of Mato Grosso do Sul. To evaluate the risk potential of wild boar for commercial and subsistence swine farming in southern Mato Grosso do Sul, a model of environmental suitability was constructed for this species in the swine producing region. This model considered different environmental strata, being the selection of the layers considered the physiological and behavioral characteristics of the species. In parallel, interviews were carried out in a sample of commercial farms integrating the region to survey the perception of the presence of the invasive species and the biosafety measures adopted. The results of this work indicate that the risk of contact among wild boars and animals reared in closed production systems may be high in the study area and only establishment of appropriate biosecurity measures that consider the characteristics and habits of the boar may prevent the intrusion of this species and contact with domestic swine. The built model can be considered of high reliability and it is recommended to apply it to other areas of the state, being a useful tool for the productive sector, environmental agencies and decision makers.

Abstract Tetranychus urticae Koch (Acari: Tetranychidae) is the main pest in rose (Rosa sp.) (Rosales: Rosaceae) by reducing the amount of chlorophyll in plants and at high densities they are overexploited and even killed. One of the most used biological controllers for this pest for its high efficiency is the mite Phytoseiulus persimilis Athias-Henriot (Acari: Phytoseiidae). Our hypothesis was: P. persimilis reduces the populations of T. urticae and therefore chlorophyll is not affected. The objectives were: 1) to determine the susceptibility or resistance of rose varieties to the attack of T. urticae, 2) determine the relationship between the condition of the plant and the population density of T. urticae, 3) know the predation effect of P. persimilis in the control of T. urticae and its efficiency; and 4) determine in which variety of rose P. persimilis performs best. We established the experiment in two parts; the first was one-way and the second consisted of repeated measurements to analyze the effects of T. urticae and the release of P. persimilis through the chlorophyll content variables in SPAD cm-2 units, percentage of damage per cm2 and the number of mites per cm2 in rose varieties. We did three repetitions for each stratum (upper, middle and lower) by variety of rosebush per week, for which we analyzed 72 samples per variety. The varieties of rose evaluated were Virginia and Ojo de Toro. At random we released 100 T. urticae and 12 P. persimilis mites per plant. The data analysis was one-way ANOVA and repeated means, simple linear, multiple and non-linear regressions to determine the dependence between the variables. Prior to the release of P. persimilis there were significant differences between the varieties with respect to the abundance of T. urticae per cm2, but not in the chlorophyll content and percentage of damage. After the release of P. persimilis, the abundance of T. urticae was different in the strata of both varieties. The Ojo de Toro variety had the lowest chlorophyll content. There was no difference in the percentage of damage and the abundance of P. persimilis between both varieties. Phytoseiulus persimilis was more efficient in the Ojo de Toro variety than in the Virginia variety. It also reduced the damage by T. urticae but did not prevent the reduction of chlorophyll content by the phytophagous.

Resumen Tetranychus urticae Koch (Acari: Tetranychidae) es la plaga principal en rosal (Rosa sp.) (Rosales: Rosaceae), al reducir la cantidad de clorofila de la planta y en grandes densidades la sobreexplotan e incluso las matan. Uno de los controladores biológicos más utilizados para esta plaga por su alta eficacia es el ácaro Phytoseiulus persimilis Athias-Henriot (Acari: Phytoseiidae). La hipótesis fue: P. persimilis reduce las poblaciones de T. urticae y por ende la clorofila no es afectada. Los objetivos fueron: 1) determinar la susceptibilidad o resistencia de variedades de rosal al ataque de T. urticae, 2) determinar la relación entre la condición de la planta y la densidad poblacional de T. urticae, 3) conocer el efecto de depredación de P. persimilis en el control de T. urticae y la eficiencia, y 4) determinar en cual variedad de rosal, P. persimilis se desempeña mejor. El experimento se estableció en dos partes, la primera fue de una vía y la segunda de medidas repetidas, para analizar los efectos de T. urticae y la liberación P. persimilis mediante las variables contenido de clorofila en unidades SPAD cm-2, porcentaje de daño por cm2 y el número de ácaros por cm2 en variedades de rosal. Las repeticiones fueron tres por cada estrato (superior, medio e inferior) por variedad de rosal por semana, por lo cual se analizaron 72 muestras por variedad. Las variedades de rosal evaluadas fueron Virginia y Ojo de Toro. Al azar se liberaron 100 T. urticae y 12 ácaros P. persimilis por planta. El análisis de datos fue ANDEVA de una vía y de medias repetidas, regresiones simples lineales, múltiples y no lineales para determinar la dependencia entre las variables. Previo a la liberación de P. persimilis hubo diferencias significativas entre las variedades con respecto a la abundancia de T. urticae por cm2, pero no, en el contenido de clorofila y porcentaje de daño. Después de la liberación de P. persimilis, la abundancia de T. urticae fue diferente en los estratos de ambas variedades. La variedad Ojo de Toro presentó el menor contenido de clorofila. No hubo diferencia en el porcentaje de daño y la abundancia de P. persimilis entre ambas variedades. Phytoseiulus persimilis fue más eficiente en la variedad Ojo de Toro que en la variedad Virginia. Además redujo el daño por T. urticae pero no evitó la reducción del contenido de clorofila por el fitófago.

Abstract Objective: To evaluate autoimmune hepatitis (AIH) in a multicenter cohort of childhood-onset systemic lupus erythematosus (cSLE) patients. Methods: This retrospective multicenter study included 847 patients with cSLE, performed in 10 Pediatric Rheumatology services of São Paulo state, Brazil. AIH was defined according to the International Autoimmune Hepatitis Group criteria (IAHGC). The statistical analysis was performed using the Bonferroni's correction (p < 0.0033). Results: AIH in cSLE patients confirmed by biopsy was observed in 7/847 (0.8%) and all were diagnosed during adolescence. The majority occurred before or at cSLE diagnosis [5/7 (71%)]. Antinuclear antibodies were a universal finding, 43% had concomitantly anti-smooth muscle antibodies and all were seronegative for anti-liver kidney microsomal antibodies. All patients with follow-up ≥18 months (4/7) had complete response to therapy according to IAHGC. None had severe hepatic manifestations such as hepatic failure, portal hypertension and cirrhosis at presentation or follow-up. Further comparison of 7 cSLE patients with AIH and 28 without this complication with same disease duration [0 (0–8.5) vs. 0.12 (0–8.5) years, p = 0.06] revealed that the frequency of hepatomegaly was significantly higher in cSLE patients in the former group (71% vs. 11%, p = 0.003) with a similar median SLEDAI-2 K score [6 (0–26) vs. 7 (0–41), p = 0.755]. No differences were evidenced regarding constitutional involvement, splenomegaly, serositis, musculoskeletal, neuropsychiatric and renal involvements, and treatments in cSLE patients with and without AIH (p > 0.0033). Conclusions: Overlap of AIH and cSLE was rarely observed in this large multicenter study and hepatomegaly was the distinctive clinical feature of these patients. AIH occurred during adolescence, mainly at the first years of lupus and it was associated with mild liver manifestations.

RESUMO Objetivo: Descrever as características clínicas e angiográficas da arterite de Takayasu em crianças e adolescentes brasileiros. Métodos: Foi feita coleta retrospectiva de dados de 71 crianças e adolescentes acompanhados em 10 centros brasileiros de referência em reumatologia pediátrica. A avaliação foi feita em três tempos: início dos sintomas até o diagnóstico, do 6º ao 12º mês de diagnóstico e última consulta. Resultados: Dos 71 pacientes selecionados, 51 (71,8%) eram meninas. As médias de idade de início dos sintomas e de tempo até diagnóstico foram 9,2 anos (± 4,2) e 1,2 anos (± 1,4), respectivamente. No fim do estudo, 20 pacientes estavam em atividade de doença, 39 em remissão e cinco haviam evoluído a óbito. Os sintomas mais frequentes nas avaliação inicial, segunda avaliação e avaliação final foram, respectivamente, os constitucionais, os musculoesqueléticos e os neurológicos. A redução de pulsos periféricos foi o sinal cardiovascular mais frequente e a elevação da velocidade de hemossedimentação foi o achado laboratorial mais frequente nos três períodos de avaliação. O teste tuberculínico foi reagente em 41%. A estenose foi a lesão angiográfica mais encontrada, a artéria abdominal foi o segmento mais afetado e tipo angiográfico IV o mais frequente. A maioria (90%) fez terapia com glicocorticoides, 85,9% necessitaram de outro imunossupressor e 29,6% foram submetidos à angioplastia. Conclusão: Este é o maior estudo de arterite de Takayasu juvenil e nós observar elevado número de pacientes com idade inferior a 10 anos e a predominância de sintomas constitucionais no início da doença.

ABSTRACT Objective: To describe the clinical and angiographic characteristics of Takayasu's arteritis in Brazilian children and adolescents. Methods: A retrospective data collection was performed in 71 children and adolescents followed in 10 Brazilian reference centers in Pediatric Rheumatology. The evaluation was carried out in three different time points: from onset of symptoms to diagnosis, from the 6 th to 12th month of diagnosis, and in the last visit. Results: Of 71 selected patients, 51 (71.8%) were girls. The mean age of onset of symptoms and of time to diagnosis was 9.2 (± 4.2) years and 1.2 (± 1.4) years, respectively. At the end of the study, 20 patients were in a state of disease activity, 39 in remission and 5 had evolved to death. The most common symptoms in baseline assessment, second evaluation, and final evaluation were, respectively: constitutional, musculoskeletal, and neurological symptoms. A decrease in peripheral pulses was the most frequent cardiovascular signal, and an increase in erythrocyte sedimentation rate was the most frequent laboratory finding in all three evaluation periods. The tuberculin test was positive in 41% of those tested. Stenosis was the most frequent angiographic lesion, abdominal artery was the most affected segment, and angiographic type IV the most frequent. Most (90%) participants were treated with glucocorticoids, 85.9% required another immunosuppressive drug, and 29.6% underwent angioplasty. Conclusion: This is the largest study on juvenile-onset Takayasu arteritis, and a high number of patients under the age of 10 years, with predominance of constitutional symptoms early in the disease, was observed.

Bauhinia forficata is native to South America and used with relative success in the folk medicine in Brazil. The diversity, antibacterial activity, and extracellular hydrolytic enzymes of endophytic fungi associated with this plant were studied. Plant samples, which included leaves, sepals, stems, and seeds, were used. Ninety-five endophytic fungal were isolated (18 from leaves, 22 from sepals, 46 from stems, and nine from seeds), comprising 28 species. The most frequently isolated species were Acremonium curvulum (9.5%), Aspergillus ochraceus (7.37%), Gibberella fujikuroi (10.53%), Myrothecium verrucaria (10.53%) and Trichoderma piluliferum(7.37%). Diversity and species richness were higher in stem tissues, and Sorensen’s index of similarity between the tissues was low. Eleven fungi showed antibacterial activity. Aspergillus ochraceus, Gibberella baccata, Penicillium commune, and P. glabrum were those with the greatest antibacterial activity against Staphylococcus aureus and/or Streptococcus pyogenes. Thirteen species showed proteolytic activity, particularly Phoma putaminum. Fourteen species were cellulase positive, particularly the Penicillium species and Myrmecridium schulzeri. All isolates tested were xylanase positive and 10 showed lipolytic activity, especially Penicillium glabrum. It is clear that the endophytic fungi from B. forficata have potential for the production of bioactive compounds and may be a source of new therapeutic agents for the effective treatment of diseases in humans, other animals, and plants. To our knowledge, this is the first study of endophytic fungi from different tissues of B. forficata and their biotechnological potential.

A castanha-do-brasil, também conhecida como castanha-do-pará, é muito utilizada na alimentação humana e na indústria cosmética. As sementes são ricas em lipídeos e proteínas, apresentando ainda uma quantidade considerável de Selênio. Poucas pesquisas vêm sendo realizadas na pós-colheita do produto, sendo as propriedades físicas importantes para o desenvolvimento de equipamentos relacionados à aeração, secagem, armazenamento e transporte de produtos. Assim, neste trabalho, teve-se por objetivos: determinar as propriedades físicas da castanha-do-brasil com e sem tegumento. O tamanho para as amêndoas com tegumento, foi de 39,35 mm no eixo X, 24,19 mm no eixo Y e 17,88 mm no eixo Z; já para a amêndoa sem tegumento os valores foram de 31,05 mm em X, 14,38 mm em Y e 15,91 em Z. A esfericidade foi de 66,40% e 51,59%, para as amêndoas com e sem tegumento, respectivamente. 63,00% e 47,72% foram os valores de esfericidade encontrados para as amêndoas com e sem tegumento, respectivamente. A massa de 1.000 amêndoas foi de 6,13 kg para a amêndoa com tegumento e de 3,18 kg para amêndoas sem tegumento. Valores de massa específica de 0,947 g.cm-3 e de 1,003 g.cm-3 para as amêndoas com e sem tegumento, associados a uma porosidade de 46,88% e 37,60%, produziram uma massa específica aparente de 0,504 g.cm-3 e de 0,626 g.cm-3. Finalmente, o ângulo de repouso para as amêndoas com tegumento foi de 36,37°.

The Brazil-nut, also known as Para-nut, is widely used as food and in cosmetic industries. The seeds are rich in lipids and protein, and also present a considerable amount of selenium. Limited research has been conducted on postharvest of the Brazil nut, being an important information to design equipment related to aeration, drying, storage and transportation steps. Thus, the objective of this study was to determine the physical properties of the Brazil-nut with and without tegument. The dimensions found for the almonds with tegument were 39.35 mm in the X axis, 24.19 mm in the Y axis, and 17.88 mm in the Z axis. However for the almond without tegument the values were 31.05 mm in X, 14.38 in Y and 15.91 mm in Z axis. The sphericity was 66.40% and 51.59% for the kernels with and without seed tegument respectively. The kernels with and without tegument presented sphericity of 63.00% and 47.72% respectively. The mass of 1000 almonds was 6.13 kg for almond with teguments and 3.18 kg for almonds without teguments. Specific mass of 0.947 g.cm-3 and 1.003 g.cm-3 for the kernels with and without tegument, coupled with a porosity of 46.88% and 37.60% and, resulting on a bulk density of 0.504 g.cm-3 and 0.626 g.cm-3 for almonds with and without teguments respectively. Finally, the angle of repose for the kernels with teguments was 36.37°.

INTRODUÇÃO: A reumatologia pediátrica (RP) é uma especialidade emergente, com número restrito de especialistas, e ainda não conta com uma casuística brasileira sobre o perfil dos pacientes atendidos e as informações sobre a formação de profissionais capacitados. OBJETIVO: Estudar o perfil dos especialistas e dos serviços em RP e as características dos pacientes com doenças reumáticas nessa faixa etária a fim de estimar a situação atual no estado de São Paulo (ESP). PACIENTES E MÉTODOS: No ano de 2010 o departamento científico de RP da Sociedade de Pediatria de São Paulo encaminhou um questionário respondido por 24/31 especialistas com título de especialização em RP que atuam no ESP e por 8/12 instituições com atendimento nesta especialidade. RESULTADOS: A maioria (91%) dos profissionais exerce suas atividades em instituições públicas. Clínicas privadas (28,6%) e instituições (37,5%) relataram não ter acesso ao exame de capilaroscopia e 50% das clínicas privadas não tem acesso à acupuntura. A média de tempo de prática profissional na especialidade foi de 9,4 anos, sendo 67% deles pós-graduados. Sete (87,5%) instituições públicas atuam na área de ensino, formando novos reumatologistas pediátricos. Cinco (62,5%) delas têm pós-graduação. Dois terços dos especialistas utilizam imunossupressores e agentes biológicos de uso restrito pela Secretaria da Saúde. A doença mais atendida foi artrite idiopática juvenil (29,1%-34,5%), seguida de lúpus eritematoso sistêmico juvenil (LESJ) (11,6%-12,3%) e febre reumática (9,1%-15,9%). Vasculites (púrpura de Henoch Schönlein, Wegener, Takayasu) e síndromes autoinflamatórias foram mais incidentes nas instituições públicas (P = 0,03; P = 0,04; P = 0,002 e P < 0,0001, respectivamente). O LESJ foi a doença com maior mortalidade (68% dos óbitos), principalmente por infecção. CONCLUSÃO: A RP no ESP conta com um número expressivo de especialistas pós-graduados, que atuam especialmente em instituições de ensino, com infraestrutura adequada ao atendimento de pacientes de alta complexidade.

INTRODUCTION: Paediatric rheumatology (PR) is an emerging specialty, practised by a limited number of specialists. Currently, there is neither a record of the profile of rheumatology patients being treated in Brazil nor data on the training of qualified rheumatology professionals in the country. OBJECTIVE: To investigate the profile of PR specialists and services, as well as the characteristics of paediatric patients with rheumatic diseases, for estimating the current state of rheumatology in the state of São Paulo. PATIENTS AND METHODS: In 2010, the scientific department of PR of the Paediatric Society of São Paulo administered a questionnaire that was answered by 24/31 accredited specialists in PR practising in state of São Paulo and by 8/21 institutions that provide PR care. RESULTS: Most (91%) of the surveyed professionals practise in public institutions. Private clinics (28.6%) and public institutions (37.5%) reported not having access to nailfold capillaroscopy, and 50% of the private clinics reported not having access to acupuncture. The average duration of professional practise in PR was 9.4 years, and 67% of the physicians had attended postgraduate programmes. Seven (87.5%) public institutions perform teaching activities, in which new paediatric rheumatologists are trained, and five (62.5%) offer postgraduate programmes. Two-thirds of the surveyed specialists use immunosuppressants and biological agents classified as "restricted use" by the Health Secretariat. The disease most frequently reported was juvenile idiopathic arthritis (29.1-34.5%), followed by juvenile systemic lupus erythematosus (JSLE) (11.6-12.3%) and rheumatic fever (9.1-15.9%). The incidence of vasculitis (including Henoch-Schönlein purpura, Wegener's granulomatosis, and Takayasu's arteritis) and autoinflammatory syndromes was higher in public institutions compared to other institutions (P = 0.03, P = 0.04, P = 0.002, and P < 0.0001, respectively). Patients with JSLE had the highest mortality rate (68% of deaths), mainly due to infection. CONCLUSION: The field of PR in the state of São Paulo has a significant number of specialists with postgraduate degrees who mostly practise at teaching institutions with infrastructures appropriate for the care of high-complexity patients.

As alterações ambientais, naturais ou resultantes de ações antrópicas e seu impacto sobre as doenças infecciosas têm sido avaliados em diversos estudos. Com o objetivo de analisar possíveis correlações entre o ambiente antrópico, flebotomíneos (Diptera: Psychodidae) e leishmanioses no Rio Grande do Norte, Nordeste do Brasil, foram associadas informações relativas à distribuição de espécies vetoras em áreas de leishmaniose visceral e tegumentar ao registro de casos notificados pelos órgãos de saúde pública. A análise aponta para a existência de associações entre as espécies vetoras e distribuição da doença com características demográficas, fisionômicas, crescimento desordenado da área metropolitana, condições de vida e degradação ambiental do Litoral Oriental, principal área de notificação de casos de leishmaniose visceral.

Natural environmental changes or those resulting from anthropic factors and their impact on infectious diseases have been evaluated in several studies. The objective of this work was to analyze the correlation between the anthropic environment, phlebotomine and leishmaniases in Rio Grande do Norte State, in Northeast Brazil. Information relative to the distribution of vector species in visceral and tegumentary leishmaniasis areas was associated to the record of cases notified by Public Health organs. The analysis suggests associations between the vector species and distribution of the disease with demographic and physionomic characteristics, disorderly growth in the metropolitan area, living conditions and environmental degradation of the Eastern Littoral, the principal area of notified visceral leishmaniasis cases.

OBJECTIVE: To report short and midtem follow-up results of balloon aortic valvuloplasty to treat congenital aortic stenosis. METHODS: Seventy-five patients (median age: 8 years) underwent the procedure through the retrograde femoral or carotid route. RESULTS: The procedure was completed in 74 patients (98.6%). The peak-to-peak systolic gradient dropped from 79.6±27.7 to 22.3±17.8 mmHg (P<0.001), the left ventricular systolic pressure dropped from 164±39.1 to 110±24.8 mmHg (P<0.001), and the left ventricular end diastolic pressure dropped from 13.3±5.5 to 8.5±8.3 mmHg (P< 0.01). Four patients (5.3%) died due to the procedure. Aortic regurgitation (AoR) appeared or worsened in 27/71 (38%) patients, and no immediate surgical intervention was required. A mean follow-up of 50±38 months was obtained in 37 patients. Restenosis and significant AoR were observed in 16.6% of the patients. The estimates for being restenosis-free and for having significant AoR in 90 months were 60% and 50%, respectively. CONCLUSION: Aortic valvuloplasty was considered the initial palliative method of choice in managing congenital aortic stenosis, with satisfactory short- and midterm results.