ABSTRACT Introduction: Acute graft-versus-host disease (GVHD) is one of the major causes of morbidity and mortality in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) and has become the subject of several studies to understand and treat it. Objective: This study does a descriptive analysis of the apoptotic index (AI) evaluation and intestinal permeability (IP) alterations in association with the clinical, endoscopic and histopathological data on patients undergoing AHSCT, with emphasis on acute intestinal graft-versus-host disease (GVHD) diagnosis. Methods: Thirty-one patients were divided into two groups—one of patients with a clinical GVHD diagnosis and one of those without GVHD diagnosis. Results: Thirteen deaths (41.9%) occurred during the study period, thereby reaffirming the severity of the alterations found in the patients. Fifteen patients subjected to 21 esophagogastroduodenoscopy procedures prior to D + 90 post-transplant had visible endoscopic alterations and 19 biopsies revealed histological alterations to the stomach and duodenum. Higher apoptotic indices, not reaching statistical significance, were observed in patients who died of graft versus host disease (GVHD), in the more acute forms of GVHD and where clinical GVHD was present. The intestinal permeability evaluation was performed on nine patients able to undergo it in the three proposed study periods, which showed alterations, some of which were pronounced even during pre-transplant and, therefore, the pre-conditioning phase. Conclusion: Clinical judgment remains a fundamental tool in the diagnosis of GVHD. This study points to the known limitations of traditional diagnostic aids (endoscopy and histology) and points to new methods not usually employed in clinical practice.

Resumo Objetivo: investigar o perfil sociodemográfico e de morbidade de pacientes com demência avançada e dados sociodemográficos de seus respectivos cuidadores primários. Método: foram obtidos dados de 67 idosos recrutados para um estudo observacional, prospectivo, não randomizado e não cego de pacientes em fase avançada de demência, por meio de entrevistas realizadas com os cuidadores primários. Para as análises estatísticas, foi utilizado o Statistical Package for the Social Sciences (SPSSr) para Windowsr, na versão 19.0. Resultados: a maioria dos pacientes com demência avançada é do sexo feminino, viúva, não institucionalizada e de baixa renda. Destacam-se as elevadas taxas de acidente vascular encefálico, sarcopenia e úlceras por pressão. A maioria dos cuidadores são do sexo feminino, casados, filhos do paciente e desempregados. Somente um terço dos pacientes apresenta cuidador contratado. Conclusão: os pacientes com demência avançada apresentam elevado grau de morbidades, baixa renda e são dependentes de cuidados de familiares, geralmente filhas desempregadas.

Summary Introduction: To investigate the sociodemographic and morbidity profile of advanced dementia patients and sociodemographic data of their primary caregivers. Method: Data was obtained from 67 elderly recruited for an observational prospective study, through interviews performed with primary caregivers. For statistical analysis, the Statistical Package for the Social Sciences (SPSS(r)) for Windowsr, version 19.0. was employed. Results: Advanced dementia patients were mostly women, widows, and non-institutionalized, with low-income. An elevated rate of stroke, sarcopenia, and pressure ulcers in this population is noted. Caregivers were mostly women, married, children of the studied patients, and unemployed. Only one third of caregivers were hired for the task. Conclusion: Patients with advanced dementia present a high morbidity profile, low income, and depend on the care given by family members, mostly unemployed daughters.

Objective:The objective of this study was to evaluate the intestinal barrier function in leukemia patients before the start of the chemotherapy with an intestinal permeability test using lactulose and mannitol as markers.Methods:The study enrolled 20 patients diagnosed with leukemia (acute and chronic). Ten healthy volunteers were also submitted to the test as a control group.Results:The median lactulose/mannitol ratio was 0.019 for the Leukemia Patient Group, whereas in healthy controls the median was 0.009 (p-value = 0.244). The median lactulose/mannitol ratio in acute leukemia patients was 0.034 giving a p-value of 0.069 when compared to healthy controls. This same comparison was made between acute myeloid leukemia patients and healthy controls with a p-value of 0.149. There was no significant difference in the intestinal permeability between acute and chronic leukemia patients (p-value = 0.098).Conclusion:The intestinal barrier function measured using the intestinal permeability test was similar in leukemic patients overall and healthy controls, but a tendency toward a different pattern was found in the intestinal barrier function of acute leukemia patients.

Objective To investigate superior mesenteric artery flow measurement by Doppler ultrasonography as a means of characterizing inflammatory activity in Crohn's disease. Materials and Methods Forty patients were examined and divided into two groups – disease activity and remission – according to their Crohn's disease activity index score. Mean superior mesenteric artery flow volume was calculated for each group and correlated with Crohn's disease activity index score. Results The mean superior mesenteric artery flow volume was significantly greater in the patients with active disease (626 ml/min ± 236 × 376 ml/min ± 190; p = 0.001). As a cut off corresponding to 500 ml/min was utilized, the superior mesenteric artery flow volume demonstrated sensitivity of 83% and specificity of 82% for the diagnosis of Crohn's disease activity. Conclusion The present results suggest that patients with active Crohn's disease have increased superior mesenteric artery flow volume as compared with patients in remission. Superior mesenteric artery flow measurement had a good performance in the assessment of disease activity in this study sample.

OBJETIVO: Avaliar a sobrevida e complicações de pacientes idosos com doenças neurológicas em uso de nutrição enteral (NE). MÉTODOS: Avaliaram-se pacientes acima de 60 anos acompanhados pelo serviço de atenção domiciliar de um plano de saúde de Belo Horizonte, MG, Brasil. A avaliação ocorreu no domicílio após a alta hospitalar com NE, após três e seis meses e ao término do estudo. Foram realizadas avaliação nutricional, coleta de dados em prontuários e entrevistas com familiares ou cuidadores. RESULTADOS: Foram avaliados 79 pacientes, idade 82,9 ± 10,4 anos, 49,4% com demência e 50,6% com outros diagnósticos neurológicos, 100% com elevado grau de dependência avaliada pelo índice de Katz. A maioria dos pacientes (91,2%) apresentou complicações (pneumonia, perda da sonda, diarreia, constipação, vômito, extravasamento periostomia, obstrução da sonda, refluxo e miíase). Pneumonia foi a mais frequente, ocorrendo em 55,9%. A mortalidade foi de 15,2% aos três meses, 22,8% aos 6 meses e 43% ao término do estudo. A mediana de sobrevida após iniciada a NE foi de 364 dias. Não se observaram diferenças entre mortalidade e diagnóstico neurológico, vias de acesso de NE e complicações. A sobrevida foi menor em pacientes com estado nutricional inadequado e albumina < 3,5 mg/dL. CONCLUSÃO: A população acompanhada apresentou elevada taxa de complicações e óbito ao término do estudo. Os diagnósticos de demência, vias de acesso de NE e complicações não influenciaram a sobrevida. Entretanto, estado nutricional inadequado, de acordo com a avaliação clínica, e albumina inferior a 3,5 mg/dL influenciaram significativamente a sobrevida.

OBJECTIVE: To evaluate the occurrence of complications, as well as the survival rates, in elderly people having neurological diseases and undergoing enteral nutrition therapy (ENT). METHODS: Patients aged over 60 years, assisted by a home medical service from a healthcare plan in the city of Belo Horizonte, MG, Brazil, were thoroughly evaluated. The mentioned evaluation occurred at their homes after hospital discharge with enteral nutrition (EN) after a three-month period, a six-month period, and at the end of the study. A nutritional assessment was performed along with data collection performed on the patients' electronic medical records, and interviews performed with patients' family members and caregivers. RESULTS: Seventy-nine patients aged 82.9 ± 10.4 years old were evaluated; of these, 49.4% presented dementia, and 50.6% presented other neurological diagnoses. 100% of patients presented a high dependence level, assessed by the Katz index. The majority of patients (91.2%) presented some complications such as: pneumonia, catheter loss, diarrhea, constipation, vomiting, fluid leakage, periostotomy, tube obstruction, reflux, and myiasis. Pneumonia was the most frequent complication, occurring in 55.9% of cases. The mortality rates were 15.2% at a three-month period, 22.8% at a six-month period, and 43% at the end of study. The median survival after starting EN was 364 days. Differences among the mortality rate and neurological diagnosis, EN routes of access, and complications were not observed. The survival rate was lower in patients having inadequate nutritional status and albumin levels < 3.5 mg/dL. Conclusion: The population followed presented a high rate of complications and death at the end of the study. Diagnosis of dementia, EN routes of access, as well as complications, did not influence the survival rates. However, inadequate nutritional status according to the clinical assessment and albumin levels lower than 3.5 mg/dL significantly influenced the survival rates.

Este trabalho foi realizado com os objetivos de avaliar a influência de diferentes doses de nitrogênio (N) e de potássio (K), fornecidos via solução nutritiva, na intensidade da mancha de Phoma e determinar a quantidade de matéria seca e a concentração de macro e micronutrientes em folhas e ramos de mudas do cafeeiro. Os tratamentos consistiram em 5 doses de K (4, 5, 6, 7 e 8 mmol/L) combinadas com 5 doses de N (3, 7, 11, 15 e 19 mmol/L) em esquema fatorial, constituindo 25 tratamentos, com 3 repetições. Esse experimento foi repetido três vezes a 20ºC. Com o aumento das doses de N, houve aumento linear em 34,8%, para AACPI (Área abaixo da curva de progresso da incidência) e 34,3%, para AACPS (Área abaixo da curva de progresso da severidade). Aumentando as doses de K, verificou-se redução de forma quadrática, tanto para AACPI quanto para AACPS até a dose de 7 mmol/L, a partir da qual ocorreu aumento da doença. A matéria seca das mudas de café aumentou linearmente com o aumento das doses de N. Com o aumento das doses de N, observou-se aumento de N na parte aérea. As doses de potássio influenciaram significativamente os teores de N, K, Ca, S e B nas folhas e ramos. Assim, a nutrição balanceada, além de minimizar alterações nutricionais, pode ser manipulada para reduzir o número de pulverizações com fungicidas neste patossistema.

This work was carried out to evaluate different dosages of N and K amended through roots via nutrient solution on the intensity of Phoma spot in coffee seedlings, and to determine the dry matter and the concentration of macro and micronutrients in the aerial part of coffee seedlings inoculated with Phoma tarda. Treatments encompassed 5 dosages of K (4, 5, 6, 7 and 8 mmol/L) combined to 5 dosages of N (3, 7, 11, 15 and 19 mmol/L), in 25 treatments and three replicates. This assay was repeated three times at 20ºC. By increasing the amended N, there was a linear increase of 34.8% for AUIPC (Area under incidence progress curve) and 34.3% for AUSPC (Area under severity progress curve). By increasing the K, there was a square-shaped reduction for both AUIPC and AUSPC. The dry matter of coffee seedlings increased linearly with the increase in the amended N. By increasing the amended N, a corresponding increase in shoot N content was observed. Dosages of potassium significantly influenced the N, K, Ca, S and B contents in the shoot of coffee seedlings. Thus, balanced fertilization, besides minimizing nutritional problems, can be manipulated to reduce the number of fungicide applications in this pathosystem.

OBJETIVO: o presente trabalho avaliou a condição periodontal de pacientes com idades entre 10 e 18 anos. METODOLOGIA: todos os pacientes eram portadores das seguintes más oclusões: sobressaliência maior que 6mm, sobremordida maior que 6mm, sobressaliência e sobremordida associadas maiores que 6mm ou mordida cruzada posterior unilateral ou bilateral. Os parâmetros clínicos periodontais (índice de placa, sangramento gengival, mucosa ceratinizada inserida, recessão periodontal, profundidade de sondagem e perda de inserção) foram mensurados em dentes-índices (16, 11, 26, 36, 42 e 46). Os resultados foram analisados pelo teste estatístico de Kruskall Wallis (p<0,05). RESULTADOS: observou-se que a condição periodontal dos dentes índices, nos quatro grupos de más oclusões avaliadas, apresentou-se nos limites de normalidade. Entretanto, observou-se uma maior tendência ao acúmulo de placa nos pacientes portadores de sobressaliência e sobremordida associadas, bem como nos portadores de mordida cruzada posterior que, também, apresentaram aumento na profundidade de sondagem, no entanto, sem significância estatística. CONCLUSÃO: a gravidade da má oclusão não esteve relacionada de maneira significante à presença de doença periodontal.

AIM: to evaluate the periodontal status of 41 patients with ages between 10 and 18 years. METHODS: all the patients presented one of the following severe malocclusion: overjet greater than 6mm, overbite greater than 6mm, posterior unilateral or bilateral cross-bite or overjet and overbite greater than 6mm. The periodontal indexes of plaque and bleeding and the parameters of probing depth, amount of keratinized mucosa, periodontal recession and attachment level were measured in index teeth (16, 26, 36, 46, 11 and 42). The data collected was evaluated by the Kruskall Wallis statistical test (p< 0.05). RESULTS: periodontal of the teeth in the four groups of malocclusion was within the normal limits. However, the group with posterior cross-bite as well as the group with severe overjet and overbite associated, demonstrated tendency to have a greater plaque index when compared to normal parameters. The group, with posterior cross-bite malocclusion, also showed a tendency to have deeper probing depth, but without statistic significance. CONCLUSIONS: the severity of malocclusion was not significantly related with the presence of periodontal disease.

JUSTIFICATIVA E OBJETIVOS: Tradicionalmente os anestesiologistas desenvolveram as técnicas de anestesia regional que hoje dominam. Para participarem do tratamento dos pacientes com dores crônicas, necessitam transferir os conhecimentos adquiridos, além das indicações cirúrgicas, indicando-os no momento correto, tornando-os úteis e eficazes, num atendimento que deve ser multidisciplinar. O objetivo deste trabalho é mostrar aos anestesiologistas que os bloqueios anestésicos, no tratamento da dor crônica de origem cancerosa, para serem úteis e eficazes, devem ser indicados no momento correto inserindo-os como parte de um tratamento sistêmico, do qual deve-se participar ativamente. CONTEÚDO: O uso correto do protocolo da Organização Mundial da Saúde proporciona diretriz para o controle da dor na maioria dos pacientes com moléstia cancerosa avançada. A eficácia desta abordagem é demonstrada nos seus três primeiros passos, com pequeno número de complicações. Contudo, há pacientes que experimentam efeitos colaterais indesejáveis aos medicamentos opióides sistêmicos e a presença de metástases ósseas e as neuropatias podem determinar efeitos deletéricos nesses pacientes. Técnicas invasivas são raramente indicadas, mas podem resultar em analgesia no tratamento das dores resistentes aos opióides quando usados adequadamente. CONCLUSÕES: Bloqueios com agentes neurolíticos que exigiam alto grau de perícia dos anestesiologistas são as últimas opções de tratamento quando as drogas sistêmicas não mantêm o efeito desejado ou produzem efeitos colaterais de difícil tratamento. Bloqueios anestésicos e injeção de drogas opióides por via subaracnóidea, têm lugar de destaque no tratamento da dor de origem cancerosa e devem ser considerados em situações específicas como parte de um tratamento multidisciplinar.

BACKGROUND AND OBJECTIVES: Anesthesiologists have traditionally developed and mastered regional anesthetic techniques over the years. To help treating chronic pain, they need to transfer acquired know-how in addition to surgical indications, recommending procedures at the right time in a multidisciplinary approach. This research aimed at showing anesthesiologists that for anesthetic blocks to be useful and effective in treating chronic cancer pain, they have to be indicated in a timely manner, as part of a systemic approach where they need to play an active role. CONTENTS: WHO guidelines provide adequate pain control to most patients with advanced cancer disease. Its first three steps confirm the efficacy of this approach, with a low incidence of complications. There are however patients who experience undesirable side effects of systemic opioids, and the presence of bone metastases and neuropathies may determine noxious effects on those patients. Invasive techniques are seldom indicated, but they may provide analgesia in the treatment of opioid-resistant pain when adequately indicated. CONCLUSIONS: Neurolytic agent blocks, which require anesthesiologist skills, are the last treatment options when systemic drugs are unable to maintain desired effects or produce untreatable side effects. Anesthetic blocks and spinal opioids play an important role in the treatment of cancer pain and should be considered in specific situations as part of a multidisciplinary approach.

JUSTIFICATIVA Y OBJETIVOS: Tradicionalmente los anestesiologistas desarrollaron las técnicas regionales de anestesia que hoy dominan. Para participar del tratamiento de los pacientes con dolores crónicos, necesitan transferir los conocimientos adquiridos, además de las indicaciones quirúrgicas, indicándolos en el momento correcto, haciéndolos útiles y eficaces, a un atendimiento que debe ser multidisciplinar. El objetivo de este trabajo es mostrar a los anestesiologistas que los bloqueos anestésicos, en el tratamiento del dolor crónico de origen cancerosa, para que sean útiles y eficaces, deben ser indicados en el momento correcto, introduciéndolos como parte de un tratamiento sistémico, del cual se debe participar activamente. CONTENIDO: El uso correcto del protocolo de la Organización Mundial de la Salud proporciona orientación para el control del dolor en la mayoría de los pacientes con molestia cancerosa avanzada. La eficacia de este abordaje es demostrada en sus tres primeros pasos, con pequeño número de complicaciones. Con todo eso, hay pacientes que experimentan efectos colaterales indeseables a los medicamentos opioides sistémicos y a la presencia de metástases óseas y las neuropatias pueden determinar efectos deletéricos en esos pacientes. Técnicas invasivas son raramente indicadas, más pueden resultar en analgesia en el tratamiento de los dolores resistentes a los opioides, cuando usados adecuadamente. CONCLUSIONES: Bloqueos con agentes neurolíticos que exigían alto grado de pericia de los anestesiologistas son las últimas opciones de tratamiento cuando las drogas sistémicas no mantienen el efecto deseado o producen efectos colaterales de difícil tratamiento. Bloqueos anestésicos e inyección de drogas opioides por vía subaracnóidea tienen lugar de destaque en el tratamiento del dolor de origen canceroso y deben ser considerados en situaciones específicas como parte de un tratamiento multidisciplinar.