ABSTRACT The diagnosis of antibody-mediated rejection has become more common and represents a major cause of kidney graft loss. The ideal treatment remains unknown, with little evidence supporting the use of a specific therapy. The definition of antibody-mediated rejection is based on serologic (presence and/or development of donor-specific antibodies) and histologic (evidence of acute tissue injury with C4d deposition or other signs of antibody interaction with the vascular endothelium) criteria. Antibody-mediated rejection without donor‐specific antibodies is a subcategory with a defying diagnosis. This particularly entity is increasingly being reported as an important cause of allograft dysfunction in kidney transplantation. We describe the case of a kidney transplant recipient with a low immunological risk and delayed graft function due to an antibody-mediated rejection with negative donor-specific antibodies.

Abstract Every activity that involves exploitation of natural resources, such as fishing, needs to be organized and conducted based on information from monitoring programs to allow continuous evaluation. With the increasing fishing pressure in Brazil, the understanding of the importance of fisheries monitoring programs and how they can inform and assist in conservation decision-making remains limited. Based on the literature on fisheries and participatory conservation, we call attention to the need to generate information on the national fisheries sector in order to improve fisheries in the country. Given the context of the need to generate information on fishing stocks under exploitation, as well as to identify potential alternative fisheries and carry out various sectoral analyses in compliance with the 2030 Agenda for Sustainable Development, we present and discuss in the present paper the lack of a system of continuous fishing monitoring in Brazil and its effects on the fisheries sustainability in the country.

Resumo Toda atividade que atua envolvendo a exploração de recursos naturais, como a pesca, precisa ser organizada e conduzida com base nas informações dos programas de monitoramento para permitir uma avaliação contínua. Com o aumento da pressão pesqueira no Brasil, o entendimento da importância dos programas de monitoramento da pesca e como eles podem informar e auxiliar na tomada de decisões de conservação permanece limitado. Com base na literatura sobre pesca e conservação participativa, chamamos a atenção para a necessidade de gerar informações sobre o setor pesqueiro nacional para melhorar a pesca no país. Dado o contexto da necessidade de gerar informações sobre os estoques pesqueiros em exploração, bem como identificar potenciais alternativas de pesca e realizar diversas análises setoriais em conformidade com a Agenda 2030 para o Desenvolvimento Sustentável, é apresentada e discutida no presente trabalho a falta de um sistema de monitoramento contínuo da pesca no Brasil e seus efeitos na sustentabilidade da pesca no país.

Resumo Introdução: A colestase intra-hepática falciforme (CIHF) é uma das manifestações hepáticas agudas mais raras e graves da doença de células falciformes (DCF), que pode progredir rapidamente para falência hepática aguda. Associa-se a uma elevada taxa de mortalidade, que exige identificação e intervenção imediatas. Caso clínico: Descreve-se o caso de um rapaz de 7 anos com DCF, homozigótico para a HbS, que recorreu ao serviço de urgência por febre, dor abdominal de agravamento progressivo e icterícia. Verificou-se evolução para lesão hepática aguda (AST 9,472 UI/L, ALT 2,683 UI/L, bilirrubina total 15.4 mg/dL; bilirrubina conjugada 8.69 mg/dL, hipoalbuminemia 2.6 g/dL, hipoglicemia persistente), com falência hepática aguda (coagulopatia não corrigida por administração de vitamina K com INR 3.26, diminuição dos fatores V 10% e VII 28%, assim como encefalopatia grau I (critérios de West Haven) e hiperamoniemia ligeira 71 µmol/L). Após exclusão de outras etiologias de falência hepática aguda, o doente foi diagnosticado com CIHF e realiza-da exsanguineo-transfusão manual, com sucesso. Discussão/Conclusão: Este caso reforça que a exsanguineo-transfusão é uma terapêutica eficaz na CIHF, que deve ser instituída precocemente para prevenir falência hepática fulminante e potencialmente fatal.

Abstract Introduction: Sickle cell intrahepatic cholestasis (SCIC) is one of the rarest and the most severe acute hepatic manifestations of sickle cell disease (SCD) and it can rapidly progress to acute liver failure. It is associated with a high mortality rate, demanding prompt recognition and management. Case Presentation: We report a case of a 7-year-old boy with a history of homozygous HbS SCD who presented to the emergency department with fever, increasing abdominal pain, and jaundice. His course was complicated by acute liver injury (AST 9,472 IU/L, ALT 2,683 IU/L, total bilirubin 15.4 mg/dL; conjugated bilirubin 8.69 mg/dL, hypoalbuminemia 2.6 g/dL, and persistent hypoglycemia), with acute liver failure (coagulopathy not corrected by vitamin K administration with INR 3.26, decreased factors V 10% and VII 28%, and West Haven grade I hepatic encephalopathy associated with mild hyperammonemia of 71 µmol/L). After excluding other causes of acute liver failure, the patient was diagnosed as having SCIC and was successfully treated with manual exchange transfusion. Conclusion: This case reinforces that exchange transfusion is an effective treatment for SCIC and that it should be introduced promptly to prevent fulminant and potentially fatal liver failure.

ABSTRACT Introduction: Diabetes is the leading cause of chronic kidney disease and end-stage kidney disease worldwide. A kidney biopsy in a diabetic patient must be considered when non-diabetic renal disease is suspected, such as in the presence of a rapid decline in renal function or severe unexplained proteinuria. However, the timing and criteria of a biopsy remain controversial in these patients. We aimed to identify clinical and histological markers that could help differentiate diabetic and non-diabetic renal disease and decide if this invasive approach is needed or not. Subjects and Methods: We reviewed 30 years of biopsies from diabetic patients performed at a tertiary hospital. We collected patient demographic data, biopsy indications, histological findings, and clinical and analytical data both at the moment of the biopsy and extensive followup. Based on kidney biopsy findings, patients were categorized as isolated diabetic nephropathy, non-diabetic kidney disease, or non-diabetic kidney disease superimposed on diabetic nephropathy (diabetic kidney disease). Results and Discussion: We enrolled 92 patients, mostly with type 2 diabetes, with a mean age of 62.9 ± 13.2 years. Nearly half of them had isolated diabetic nephropathy (53.3%), and 15.2% had diabetic nephropathy superimposed on non-diabetic kidney disease, comprising a total of 63 patients (68.5%) with diabetic kidney disease. Twenty-nine patients (31.5%) were considered to have non-diabetic kidney disease. These last patients were significantly less likely to need insulin therapy (p=0.002), had more frequently an acute deterioration of renal function (p=0.01), lower albumin levels (p=0.03), and a higher prevalence of microhematuria (p=0.001). We found the latter to be an independent predictor of non-diabetic kidney disease. Further, patients with the primary diagnosis of diabetic nephropathy had higher survival than those who had nondiabetic kidney disease, contradicting published data. Conclusions: The criteria for performing a biopsy in diabetic patients still lack consensus, although the priority to identify non-diabetic kidney disease prevails. We believe the non-diabetic kidney disease predictors we describe may prove helpful for determining the need for a histological assessment in diabetic patients.

Abstract INTRODUCTION Mayaro virus (MAYV) was found in Pará state, Brazil, in 1955. Since then, sporadic outbreaks have occurred in different regions of the country. METHODS: Serum sample were collected from 49 individuals in 2016 and were initially tested for dengue virus (DENV) by real-time (RT) polymerase chain reaction (PCR). DENV-negative samples were tested for MAYV and Oropouche virus (OROV) by multiplexed RT quantitative PCR. RESULTS: All samples were negative for DENV and OROV, but MAYV was detected in four samples. CONCLUSIONS: Differential diagnoses of acute febrile syndrome are required, especially in regions where several arboviruses with similar clinical manifestations are endemic.

RESUMO Uma nova espécie de Hyphessobrycon pertencente ao grupo Hyphessobrycon heterorhabdus é descrita da região do baixo rio Tapajós, estado do Pará, Brasil. A nova espécie é incluída no grupo Hyphessobrycon heterorhabdus devido ao seu padrão de coloração, composto por uma mancha umeral alongada, anteriormente bem definida, que se torna difusa e borrada posteriormente, onde se sobrepõe a uma conspícua faixa escura médio-lateral que se torna borrada próxima ao pedúnculo caudal, e pela presença, em exemplares vivos, de um padrão longitudinal tricolor, composto por uma faixa longitudinal vermelha ou avermelhada dorsal, uma faixa média iridescente dourada ou prateada e, mais ventralmente, o padrão longitudinal escuro composto pela faixa escura médio-lateral e mancha umeral. A espécie pode ser distinguida das outras espécies pertencentes ao grupo por possuir uma mancha umeral com região ventral retilínea ou levemente arredondada, sem uma expansão ventral presente nas demais espécies do grupo. A espécie também se diferencia de Hyphessobrycon heterorhabdus por uma distância genética de 9,6% no gene citocromo c oxidase I. A sutil diferença morfológica da nova espécie quando comparada ao seu congênere mais similar, H. heterorhabdus, indica que a nova espécie é uma das primeiras espécies de peixes verdadeiramente crípticas descritas da Bacia Amazônica.

ABSTRACT A new species of Hyphessobrycon belonging to the Hyphessobrycon heterorhabdus species-group from the lower rio Tapajós, state of Pará, Brazil, is described. The new species is allocated into the Hyphessobrycon heterorhabdus species-group due to its color pattern, composed by an anteriorly well-defined, horizontally elongated humeral blotch that becomes diffuse and blurred posteriorly, where it overlaps with a conspicuous midlateral dark stripe that becomes blurred towards the caudal peduncle and the presence, in living specimens, of a tricolored longitudinal pattern composed by a dorsal red or reddish longitudinal stripe, a middle iridescent, golden or silvery longitudinal stripe, and a more ventrally-lying longitudinal dark pattern composed by the humeral blotch and dark midlateral stripe. It can be distinguished from all other species of the group by possessing humeral blotch with a straight or slightly rounded ventral profile, lacking a ventral expansion present in all other species of the group. The new species is also distinguished from Hyphessobrycon heterorhabdus by a 9.6% genetic distance in the cytochrome c oxidase I gene. The little morphological distinction of the new species when compared with its most similar congener, H. heterorhabdus, indicates that the new species is one of the first truly cryptic fish species described from the Amazon basin.

Resumo Estudos recentes nas drenagens costeiras da Amazônia oriental e seus arredores revelaram novas espécies de peixes que às vezes exibem pouca diferenciação morfológica (espécies crípticas). Assim, usamos uma abordagem de delimitação de espécies baseada em DNA para testar se as populações que apresentam o morfotipo e os estados de caráter típicos do holótipo Aphyocharax avary correspondem a A. avary ou A. brevicaudatus, duas espécies conhecidas da região, ou se formam linhagens independentes, indicando especiação críptica. As análises de WP e GMYC recuperaram cinco linhagens (espécies) no grupo interno, enquanto uma análise de bPTP delimitou três linhagens. As análises ABGD produziram dois resultados possíveis: um corroborando os métodos WP e GMYC e outro corroborando o método bPTP. Todos os métodos indicam espécies crípticas não descritas na região e apresentam variação de pelo menos uma a quatro espécies no grupo interno, dependendo da abordagem, corroborando estudos anteriores, e revelando esta região como um possível “hotspot” para descoberta de espécies de peixes não descritas.

Abstract Recent studies in eastern Amazon coastal drainages and their surroundings have revealed new fish species that sometimes exhibit little morphological differentiation (cryptic species). Thus, we used a DNA-based species delimitation approach to test if populations showing the morphotype and typical character states of the Aphyocharax avary holotype correspond either to A. avary or A. brevicaudatus, two known species from the region, or if they form independent lineages, indicating cryptic speciation. WP and GMYC analyses recovered five lineages (species) in the ingroup, while a bPTP analysis delimited three lineages. ABGD analyses produced two possible results: one corroborating the WP and GMYC methods and another corroborating the bPTP method. All methods indicate undescribed cryptic species in the region and show variation from at least 1 to 4 species in the ingroup, depending on the approach, corroborating previous studies, and revealing this region as a possible hotspot for discovering undescribed fish species.

Resumo O grupo Hoplias malabaricus compreende seis espécies válidas e ainda acredita-se que abriga diversidade críptica. Neste trabalho, uma abordagem integrativa incluindo considerações morfológicas, de DNA barcoding e de citogenética foi conduzida para caracterizar uma população de H. malabaricus da bacia amazônica que foi recentemente alocada na mesma linhagem mitocondrial de H. misionera, uma espécie originalmente descrita para a bacia La Plata. A análise molecular por DNA barcoding revelou que essa população amazônica forma um clado monofilético com espécimes de H. misionera provenientes da bacia La Plata (BIN AAB1732). A distância genética intragrupo (0,5%) é 12 vezes menor do que para o vizinho mais próximo (6%). A comparação morfométrica demonstrou pequena variação entre as populações amazônica e La Plata, sendo os primeiros ligeiramente maiores. Entretanto, os dados morfológicos corroboram com evidência molecular e confirmam a ocorrência de H. misionera na bacia amazônica. A caracterização cariotípica de H. misionera na população amazônica apresentou 2n=40 e fórmula cariotípica 20m+20sm, que aliada aos resultados de banda C, Ag-NOR e 18S sugerem que seja similar ao cariomorfo C de H. malabaricus. Esse trabalho revela o primeiro registro de H. misionera fora da bacia La Plata e estende a distribuição da espécie por mais de 2500 km ao Norte, até a Ilha do Marajó, estuário do rio Amazonas.

Abstract The Hoplias malabaricus group encompasses six valid species and still is believed to harbors cryptic diversity. In this work, an integrative approach including morphological, DNA barcoding, and cytogenetic considerations was conducted to characterize a population of H. malabaricus from the Amazon basin that was recently allocated in the same mitochondrial lineage with H. misionera, a species originally described from La Plata basin. The DNA barcoding analysis revealed that the Amazon population nested together with H. misionera specimens from the La Plata basin (BIN AAB1732) in the same cluster. The intragroup distance (0.5%) was 12 times lower than the nearest neighbor (6%) distance. The morphometric analysis demonstrated slightly variation between Amazon and La Plata populations, being the former composed by larger specimens. Further morphological data supported the molecular evidence of H. misionera inhabiting Amazon basin. The karyotype characterization of H. misionera in the Amazon population showed 2n=40 and karyotypic formulae 20m+20sm, that added to C-banding, Ag-NOR and 18S results are suggestive of the similarity to karyomorph C of H. malabaricus. This work reveals the first record of H. misionera outside of La Plata basin and expands the species distribution for 2500 km northward until the Marajó Island, estuary of Amazonas River.

RESUMEN Las especies de anfibios de la familia Centrolenidae están adaptadas a vivir en regiones de elevada altitud, por lo que no sorprende que su mayor diversidad ocurra en la Cordillera de los Andes. Aquí expandimos el ámbito de distribución de Vitreorana ritae por más de 550 km al sur del río Amazonas. La identificación de la especie se realizó con base en la comparación de las características morfológicas, acústicas y moleculares (marcador mitocondrial 16S rRNA). Nuestro registro es el primero de este género para el Estado de Mato Grosso, Brasil, así como para la zona de transición entre los biomas Amazonía y Cerrado. Este registro es concordante con la hipótesis de que el bajo número de especies registradas en la planicie amazónica puede ser el resultado de un menor esfuerzo de muestreo. Observamos que, a pesar de la amplia distribución de la especie en la Amazonía, la mayoría de las características morfológicas diagnósticas de V. ritae se conservan. Sugerimos que los grandes ríos de la cuenca amazónica parecen no actuar como barrera geográfica para esta especie. Sin embargo, y como resultado de nuestro pequeño tamaño de muestra, se requerirán estudios acústicos y moleculares adicionales para confirmar esta hipótesis.

ABSTRACT Frogs of the family Centrolenidae are adapted to live at high altitudes, and so it is not surprising that their greatest diversity is in the Andes mountain range. Here we extend the known geographic distribution of Vitreorana ritae by more than 550 km towards southern Amazonia. The species was identified by morphological, acoustic and molecular characteristics (mitochondrial marker 16S rRNA). The records reported here are the first for the genus Vitreorana in the state of Mato Grosso, Brazil, as well as for the transition zone between the Amazonia and Cerrado biomes. These records are consistent with the hypothesis that the low number of species of centrolenids reported in the lowlands of the Amazon region may be the result of limited sampling. Even though V. ritae is distributed throughout the Amazon, most of its diagnostic morphological characteristics are conserved. Thus, the great rivers of the Amazon Basin do not seem to act as geographical barriers for this species; however, due to the limited sample size, further acoustic and molecular studies are needed to confirm this hypothesis.

Introduction: Central venous stenosis can be the main obstacle to the creation of a vascular access. The Surfacer® device was developed to solve the problem of complete occlusions of the right internal jugular vein, right brachiocephalic vein and superior vena cava, allowing for the placement of a vascular access in this venous axis. Case Report: We present the case of a 77-year-old patient on long-term hemodialysis with a long history of failed vascular accesses and of central vein stenosis, chronically dialyzed using a tunneled catheter placed through the left femoral vein. With use of the Surfacer® device it was possible to recreate, with an inside-out technique, a tract through the fibrous tissue of the completely occluded right brachiocephalic and right internal jugular veins, subsequently placing a tunneled catheter into the right atrium through this later vein. Conclusion: We report the first successful use in Portugal of a new vascular access device that allows us to rescue a previous unusable right central venous axis for the placement of a central venous catheter, thus avoiding the use of less advantageous options such as the femoral veins and preserving venous vascular capital.

RESUMO Objetivo: Analisar a prevalência do conhecimento e experimentação do cigarro eletrônico (CE) entre universitários, bem como as características associadas ao conhecimento desse tipo de dispositivo. Métodos: Estudo transversal, utilizando-se questionário específico, onde foram entrevistados 489 estudantes da Universidade Federal de Mato Grosso (Campus Cuiabá) no ano de 2015. Estimou-se a prevalência e foram analisadas as principais características relacionadas ao conhecimento e uso do CE. Resultados: A prevalência de conhecimento do CE foi de 37%, e a taxa de experimentação foi de 2,7%. Verificou-se associação entre o conhecimento do CE com o estado civil, estado laboral do estudante, nível de escolaridade dos pais e presença de fumantes na família. Conclusões: Foi alta a proporção de universitários que conhecem o CE. Apesar de ser pequena a prevalência dos que o experimentaram, torna-se preocupante um possível aumento do consumo desse tipo de dispositivo. Medidas devem ser direcionadas aos jovens dentro das instituições universitárias a fim de promover a conscientização e prevenção do uso do CE.

ABSTRACT Objective: To analyze the prevalence of electronic cigarette (e-cigarette) awareness and experimentation among university students, as well as the characteristics associated with that awareness. Methods: This was a cross-sectional study, conducted in 2015, in which 489 university students at the Federal University of Mato Grosso (Cuiabá campus), Brazil, were interviewed with the use of a specific questionnaire. We estimated the prevalence of e-cigarette awareness and use, as well as analyzing the major characteristics associated with that awareness and use. Results: The prevalence of e-cigarette awareness was 37%, and the rate of e-cigarette experimentation was 2.7%. Awareness of e-cigarettes was found to be associated with marital status, work status, the level of parental education, and the presence or absence of smokers in the family. Conclusions: A high proportion of university students were aware of e-cigarettes. Although the prevalence of those who had experimented with e-cigarettes was low, there is concern that there could be an increase in the use of these types of device. There is a need for measures targeting university students, in order to build awareness of and prevent e-cigarette use.

C3 Glomerulopathy is a rare disease caused by abnormal control of the alternative complement pathway, resulting in a predominant glomerular C3 deposition. Its association with multiple myeloma has been reported in recent literature. We present a case of a 66-year-old women, referred for a nephrology consultation with a stage 4 chronic kidney disease, microhematuria, leukocyturia, sub-nephrotic range proteinuria (1.3 g/24hours), albumin 3.7 g/dl and dyslipidemia. She had been previously studied in a Hematology consultation for a normocytic anemia and an IgG Kappa monoclonal gammopathy, with 16% of plasma cells in bone marrow aspiration, but no hypercalcemia or lytic bone lesions. Autoimmune tests (ANCA, ANA, Anti-dsDNA antibody), C3 and C4 were negative. Eight months later, the patient complained of hypertension and edema, and presented a mild decrease in serum C3 (0.86 g/L [0.90-1.80]) and progressive nephrotic proteinuria (from 4.5 to 6.1 g/24h), with hypoalbuminemia. A kidney biopsy was performed, and we found mild chronic non-specific glomerular and tubule-interstitial findings, on light microscopy, and mesangial C3 deposits (+++), without immunoglobulin deposits, on immunofluorescence. Immunofluorescence with protease-digested paraffin sections was also negative. Genetic study found no complement gene mutation. She was treated with prednisone 1mg/Kg/day, with a favorable clinical and laboratorial response, but whether this treatment is enough it is still being pondered between nephrologists and hematologists

É reconhecido que a prática regular de atividade física, sobretudo na adolescência, uma fase marcada por um importante processo de transição biopsicossocial, constitui uma mais-valia pelos benefícios a nível fisiológico e funcional, afetivo, social e moral. A prática de modalidades náuticas, atividades desportivas da natureza, têm vindo assumir um importante papel no processo educativo global, com potenciais ganhos ao nível da auto-estima, autoconfiança e autoconhecimento. Assim, pretende-se caracterizar o autoconceito e a auto-estima de adolescentes praticantes de modalidades naúticas (remo, vela, canoagem e surf). Para tal, foi aplicado um questionário sociodemográfico e a Escala de Autoconceito e Auto-Estima a 103 jovens dos 11 aos 17 anos (59 rapazes e 44 raparigas). Os principais resultados indicam algumas diferenças estatisticamente significativas, em diferentes dimensões do autoconceito e na auto-estima relativamente a diferenças entre rapazes e raparigas e entre grupos etários. Os resultados globais observados confirmam que os jovens do presente estudo se destacam na dimensão Competência em Matemática e no fator Autoconceito Académico, tendo sido apurados resultados discretos relativamente às restantes dimensões e fatores do autoconceito e auto-estima.

It is recognized that regular physical activity, especially in adolescence, a phase marked by an important process of biopsychosocial transition , is an asset for the benefits the physiological and functional level, emotional, social and moral. The practice of nautical sports have come to play an important role in the overall educational process, with potential gains to self-esteem, self-confidence and self-knowledge. We intend to characterize the self-concept and self-esteem of adolescents practicing nautical sports (rowing, sailing, canoeing and surfing). A sociodemographic questionnaire and the Self-Concept and Self-Esteem Scale were applied to 103 young people from 11 to 17 years (59 boys and 44 girls) . The main results indicate statistically significant differences in different dimensions of self-concept and self-esteem in relation to differences between boys and girls, and between age groups. The observed overall results confirm that the participants of this study show better results on the Competence in mathematics and Self-Academic fator dimensions. In relation to other dimensions and factors of self-concept and self-esteem regular outcomes were found.