Abstract Introduction: Arterial lactate, mixed venous O2 saturation, venous minus arterial CO2 partial pressure (Pv-aCO2) and the ratio between this gradient and the arterial minus venous oxygen content (Pv-aCO2/Ca-vO2) were proposed as markers of tissue hypoperfusion and oxygenation. The main goals were to characterize the determinants of Pv-aCO2 and Pv-aCO2/Ca-vO2, and the interchangeability of the variables calculated from mixed and central venous samples. Methods: 35 cardiac surgery patients were included. Variables were measured or calculated: after anesthesia induction (T1), end of surgery (T2), and at 6–8 hours intervals after ICU admission (T3 and T4). Results: Macrohemodynamics was characterized by increased cardiac index and low systemic vascular resistances after surgery (p < 0.05). Hemoglobin, arterial-pH, lactate, and systemic O2 metabolism showed significant changes during the study (p < 0.05). Pv-aCO2 remained high and without changes, Pv-aCO2/Ca-vO2 was also high and decreased at T4 (p < 0.05). A significant correlation was observed globally and at each time interval, between Pv-aCO2 or Pv-aCO2/Ca-vO2 with factors that may affect the CO2 hemoglobin dissociation. A multilevel linear regression model with Pv-aCO2 and Pv-aCO2/Ca-vO2 as outcome variables showed a significant association for Pv-aCO2 with SvO2, and BE (p < 0.05), while Pv-aCO2/Ca-vO2 was significantly associated with Hb, SvO2, and BE (p < 0.05) but not with cardiac output. Measurements and calculations from mixed and central venous blood were not interchangeable. Conclusions: Pv-aCO2 and Pv-aCO2/Ca-vO2 could be influenced by different factors that affect the CO2 dissociation curve, these variables should be considered with caution in cardiac surgery patients. Finally, central venous and mixed values were not interchangeable.

Abstract: Introduction: Anaphylaxis is an emergency condition. According to the latest international guide lines, early recognition and treatment with intramuscular epinephrine are associated with increased survival. Objective: To determine the level of knowledge of pediatricians in a tertiary Pediatric Hos pital about the diagnostic criteria and treatment of anaphylaxis. Material and Method: A cross-sec tional descriptive study was conducted, designing, applying, and validating an anonymous survey to physicians with complete residency in pediatrics who are on call at a third level hospital. The statisti cal analysis was made using the SPSS v.21 software, presenting measures of central tendency (median, range, and frequency table) and Chi-square test for comparison. A value of p < 0.05 was considered significant. Results: 71 physicians completed the survey with a median of three years after the end of residency.35% of them identified all clinical criteria, 99% (70) indicated epinephrine, 73% chose the intramuscular route, and 55% indicated the correct dose. Only 48% of responders chose the dose and administration route correctly. In general, 21% recognized anaphylaxis and used epinephrine correctly. Physicians with less than five years of experience performed better in the intramuscular administration of epinephrine (83% vs 52% p = 0.005) and in the detection of gastrointestinal symp toms (60% vs 35% p = 0.043). Conclusions: There are difficulties in the identification and proper management of anaphylaxis by pediatricians of a tertiary Pediatric Hospital in a theoretical clinical setting. Although most of pediatricians chose epinephrine as a first-line drug, half of them did not indicate it correctly, and only one-third recognized anaphylaxis in all scenarios.

Resumen: Introducción: La anafilaxia es una emergencia. De acuerdo con las últimas recomendaciones internacionales el reconocimiento de los criterios clínicos y el tratamiento temprano con adrenalina intramuscular se asocian a mayor sobrevida. Objetivo: Determinar el conocimiento de los médicos pediatras de un Hospital Pediátrico de tercer nivel sobre los criterios diagnósticos y el tratamiento de la anafilaxia. Material y Método: Estudio descriptivo transversal que considera diseño, aplicación y validación de una encuesta anónima a médicos con residencia completa en pediatría que realizan guardias en un hospital de tercer nivel. Los ítems de la Encuesta comprendieron tres dimensiones, experiencia del operador (2 ítems), manejo farmacológico (3 ítems) e identificación del cuadro (4 ítems). El análisis estadístico utilizó el programa SPSS v.21, presentando medidas de tendencia cen tral (mediana, rango y tabla de frecuencias) y para su comparación prueba de Chi cuadrado. Se con sideró significativo un valor de p < 0,05. Resultados: Se encuestaron 71 médicos con una mediana de 3 años transcurridos desde el fin de la residencia. 35% identificó todos los criterios clínicos; 99% (70) indicó adrenalina, 73% por vía intramuscular y 55% a dosis correcta (solo el 48% contestó la dosis y vía correctamente). En forma global la adecuación para identificación más manejo correcto fue del 21%. Los médicos con menos de 5 años de experiencia tuvieron mejor desempeño en la administración de adrenalina intramuscular (83% vs 52% p = 0,005) y en la detección de síntomas gastrointestinales (60%vs35% p = 0,043). Conclusiones: Existen dificultades para la identificación y el manejo apropiado de la anafilaxia por pediatras de un Hospital de tercer nivel en un escenario teórico. Aunque la mayoría eligió la adrenalina como droga de primera línea, la mitad no la indicó de forma correcta y solo un tercio reconoció el cuadro en todos sus escenarios.

ABSTRACTAvian metapneumovirus (aMPV) is a negative-sense single-stranded RNA enveloped virus of the Metapneumovirus genus belonging to theParamyxoviridae family. This virus may cause significant economic losses to the poultry industry, despite vaccination, which is the main tool for controlling and preventing aMPV. The aim of this study was to evaluate the antiviral activity of extracts of four different native plants of the Brazilian Cerrado against aMPV. The antiviral activity against aMPV was determined by titration. This technique measures the ability of plant extract dilutions (25 to 2.5 µg mL-1) to inhibit the cytopathic effect (CPE) of the virus, expressed as inhibition percentage (IP). The maximum nontoxic concentration (MNTC) of the extracts used in antiviral assay was 25 µg mL-1for Aspidosperma tomentosumand Gaylussacia brasiliensis, and 2.5 µg mL-1for Arrabidaea chicaand Virola sebifera. Twelve different extracts derived from four plant species collected from the Brazilian Cerrado were screened for antiviral activity against aMPV. G. brasiliensis, A. chica,and V. sebifera extracts presented inhibition rates of 99% in the early viral replication stages, suggesting that these extracts act during the adsorption phase. On the other hand, A. tomentosum inhibited 99% virus replication after the virus entered the cell. The biomonitored fractioning of extracts active against aMPV may be a tool to identify the active compounds of plant extracts and to determine their precise mode of action.

A cultura do melão se caracteriza como importante atividade na agricultura familiar; ressalta-se que a produção orgânica de frutas e hortaliças tem apresentado, no Brasil e no mundo, grande crescimento em área. Este trabalho teve, como objetivo, estudar a qualidade pós-colheita de melão cultivado em sistema orgânico. Os tratamentos orgânicos foram constituídos por adubação de base com vermicomposto bovino (dose recomendada, ½ da dose e dobro da dose) mais utilização de biofertilizante na forma pulverizada ou pulverizada e regada, além de um tratamento adicional com adubação química. A qualidade pós-colheita foi avaliada através de atributos físico-químicos e fitoquímicos. O manejo orgânico com a metade da dose de húmus recomendada mais o biofertilizante pulverizado e o manejo de adubação química produziram frutos com maiores teores de açúcares, carotenoides totais, ácido ascórbico e ácido fólico obtendo-se frutos mais equilibrados e de melhor qualidade fitoquímica. A capacidade antioxidante foi definida, sobretudo pela presença dos compostos fenólicos influenciados pelo tipo e pela dose das adubações, com superioridade nos tratamentos orgânicos com o dobro da dose de húmus.

Melon farming is characterized as an important family agriculture activity and the organic production of fruits and vegetables has shown a large growth in terms of areas in Brazil and around the world. This work aimed to study the postharvest quality of melon cultivated in an organic system. The organic treatments constituted of base fertilizer with cattle manure vermicompost (recommended dose, ½ dose and double dose) plus the use of biofertilizer (sprayed or sprayed + irrigated), and an additional treatment with chemical fertilization. The postharvest quality was evaluated through physico-chemical and phytochemical attributes. The organic management with half the recommended dose of vermicompost plus the sprayed biofertilizer and the chemical fertilization management produced fruits with higher levels of sugar, total carotenoids, ascorbic acid and folates, obtaining more balanced fruits, with a better phytochemical quality. The antioxidant capacity was defined mainly by the presence of the phenolic compounds, which were influenced by the type and the dose of the evaluated fertilizers, with superiority in the organic treatments with double the dose of cattle manure vermicompost.

Rhino-orbital-cerebral mucormycosis is a potentially fatal mycotic infection in immunosuppressed patients. The main risk factors for acquiring this infection are poorly controlled diabetes mellitus, iron overload, potent immunosuppression and chronic steroid use. In this review, we present the case of a kidney transplant patient who, after treatment of an acute rejection episode with high doses of steroids and potent immunosuppression with tacrolimus and mycophenolate, presented with rapidly progressing rhino-orbital-cerebral mucormycosis that required aggressive surgical treatment, immunosuppression discontinuation and potent antifungal treatment.

La mucormicosis rino-órbito-cerebral es una infección micótica potencialmente mortal en los pacientes inmunosuprimidos. Los principales factores de riesgo para adquirirla son la diabetes mellitus mal controlada, la sobrecarga de hierro, la inmunosupresión potente y el uso crónico de esteroides. En esta revisión presentamos el caso de un paciente trasplantado de riñón que, luego del tratamiento de un rechazo agudo con dosis altas de esteroides e inmunosupresión potente con tacrolimus más micofenolato, presentó mucormicosis rino-órbito-cerebral de rápida progresión con necesidad de tratamiento quirúrgico agresivo, suspensión de la inmunosupresión y tratamiento antifúngico potente.

CONTEXTUALIZAÇÃO: Existem evidências de ativação autossustentada em certos músculos pós-estimulação elétrica. OBJETIVOS: Mostrar que, em alguns sujeitos, o músculo do pé (Flexor Digitorum Brevis - FDB) também pode apresentar aumento de atividade autossustentada na posição ortostática pós-trem de estímulo no nervo tibial. MÉTODOS: Sujeitos foram solicitados a permanecer na posição ortostática e sinais eletromiográficos foram coletados dos músculos FDB, sóleus e tibial anterior do membro inferior direito. Após a aquisição dos sinais eletromiográficos base (sem estimulação - BGA), um trem de estímulos de 50 Hz foi aplicado no nervo tibial (fossa poplítea). Foram analisados os valores RMS dos dados BGA e dos sinais coletados pós-estímulo. RESULTADOS: Ao fim do estímulo, houve um aumento de 13,8% da atividade muscular do FDB em comparação com BGA. O mesmo fenômeno não aconteceu com o músculo sóleus, que apresentou uma diminuição de 9,2% da sua atividade pós-estímulo. Uma das hipóteses para a geração pós-estímulo da contração sustentada do FDB seria a da geração de corrente de entrada persistente (PIC) nos motoneurônios espinais do FDB. A diminuição da atividade do sóleus, pós-estímulo, pode ter ocorrido pela ação inibitória dos interneurônios causada pelos PICs gerados pelo trem de estímulo. CONCLUSÕES: Essas alterações das atividades sustentadas dos músculos posturais, pós-estímulo, encontradas em alguns sujeitos e em diferentes intensidades, podem fazer parte de um conjunto de possíveis respostas que contribuem para o controle postural.

BACKGROUND: Evidence of self-sustained muscle activation following a brief electrical stimulation has been reported in the literature for certain muscles. OBJECTIVES: This report shows that the foot muscle (Flexor Digitorum Brevis - FDB) shows a self-sustained increase in muscle activity during upright stance in some subjects following a train of stimuli to the tibial nerve. METHODS: Healthy subjects were requested to stand upright and surface EMG electrodes were placed on the FDB, Soleus and Tibialis Anterior muscles. After background muscle activity (BGA) acquisition, a 50 Hz train of stimuli was applied to the tibial nerve at the popliteal fossa. The root mean square values (RMS) of the BGA and the post-stimulus muscle activation were computed. RESULTS: There was a 13.8% average increase in the FDB muscle EMG amplitude with respect to BGA after the stimulation was turned off. The corresponding post-stimulus Soleus EMG activity decreased by an average of 9.2%. We hypothesize that the sustained contraction observed in the FDB following stimulus may be evidence of persistent inward currents (PIC) generated in FDB spinal motoneurons. The post-stimulus decrease in soleus activity may have occurred due to the action of inhibitory interneurons caused by the PICs, which were triggered by the stimulus train. CONCLUSIONS: These sustained post-stimulation changes in postural muscle activity, found in different levels in different subjects, may be part of a set of possible responses that contribute to overall postural control.

EL USO DE LA TERAPIA CON ANTICOAGULANTES ORALES es cada vez más frecuente. Hay evidencia creciente de la mejoría de resultados cuando la anticoagulación es manejada por servicios o clínicas de anticoagulación. Este manejo sistemático se traduce en optimización del rango terapéutico y disminución de hemorragias, de trombosis y del uso de recursos médicos. El Hospital San Vicente de Paúl (HUSVP) cuenta con una clínica de anticoagulación desde hace más o menos veinte años pero se desconoce su rendimiento. Nuestro objetivo es describir las características demográficas, las indicaciones y el comportamiento de la terapia antitrombótica de los pacientes inscritos y activos en la clínica de anticoagulación del HUSVP hasta diciembre de 2002. Se estudiaron 139 pacientes, 57,6% mujeres y 42,2% hombres; el promedio de edad fue de 64 años; el régimen de cobertura en salud fue: vinculado en el 55,4%, subsidiado en el 26,6% y contributivo en el 18%. Las Indicaciones de anticoagulación más comunes fueron: fibrilación auricular (40%), enfermedad cerebro vascular (26%) y estados de hipercoagulabilidad (20%). Los pacientes inscritos en la clínica de anticoagulación tuvieron un tiempo en el rango terapéutico de 41% con un promedio de controles al año de 4,5 veces. Las complicaciones se presentaron en 16% de los pacientes. Nuestro estudio caracterizó la clínica de anticoagulación del HUSVP en sus variables demográficas, indicaciones de pertenencia y enfermedades concomitantes asociadas y evaluó parámetros objetivos para compararla con otras clínicas en el mundo.

THE USE OF ORAL ANTICOAGULATION therapy is more common every day. There is increasing evidence of better outcome in patients when anticoagulation is handled by anticoagulation clinics or services. This systemic managing has proved in that therapeutical range results in clinical improvement and decrease of hemorrhage, thrombosis and the use of medical resources. Even more, there are less hospitalizations and visits to the Emergency Department. The San Vicente of Paúl Hospital (HUSVP for it’s initials in Spanish) has an anticoagulation clinic functioning for over twenty years, but until now, there has been no work concerning it’s results and benefits. Our task is to describe the demographic characteristics, indications and behavior of the antithrombotic therapy of those patients adscript and active in the clinic of the mentioned Hospital until December 2002. 139 patients were found, 57.6% were women and 42.2% men; the average age was 64 years; and the health system coverage was entail in 55.4% of the patients, subsided in 26.6% and contributive 18%. The most common anticoagulation indications were atrial fibrillation (40%), stroke (26%) y hypercoagulability states (20%). The registered patients had a therapeutical range time of 41% with an annual control average of 4.5 times. Complications were present in 16% of the patients. This study was able to characterize the HUSVP anticoagulation clinic in its demographic variables, relevancy indications and co-morbid associated diseases. As well, some standardized parameters were evaluated in order to be compared with other clinics in the world.

Foi realizado o estudo do tegumento do corpo de Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasito de Mugil liza (tainha) do Canal de Marapendi, Rio de Janeiro, Brasil, pela microscopia eletrônica de transmissão. O tegumento é formado por uma camada externa sincicial, uma camada muscular e uma camada interna contendo células tegumentares. O sincício consiste em matriz com três tipos de corpos de inclusão e mitocôndrias. A musculatura é formada por diversas camadas de fibras musculares longitudinais e circulares. As células tegumentares apresentam núcleo bem desenvolvido, citoplasma preenchido por ribossomas, retículo endoplasmático rugoso e mitocôndrias, organelas características das células tegumentares.

The ultrastructure of the body tegument of Metamicrocotyla macracantha (Alexander, 1954) Koratha, 1955, parasite of Mugil liza from Brazil, was studied by transmission electron microscopy. The body tegument is composed of an external syncytial layer, musculature, and an inner layer containing tegumental cells. The syncytium consists of a matrix containing three types of body inclusions and mitochondria. The musculature is constituted of several layers of longitudinal and circular muscle fibers. The tegumental cells present a well-developed nucleus, cytoplasm filled with ribosomes, rough endoplasmatic reticulum and mitochondria, and characteristic organelles of tegumental cells.

Rhipidocotyle pentagonum (Ozaki, 1924) é referida pela primeira vez na América do Sul parasitando Auxis thazard e em um novo hospedeiro: Katsuwonus pelamis. Tergestia laticollis (Rudolphi, 1819) é referida pela primeira vez na América do Sul e em Thunnus albacares, que representa um novo hospedeiro para essa espécie. Copiatestes filiferus (Leuckart, in Sars, 1885) é assinalada pela primeira vez no Brasil em um novo hospedeiro: Thunnus albacares. Tetrochetus coryphaenae (Yamaguti, 1934) é assinalada pela primeira vez no Brasil parasitando Thunnus albacares.

Rhipidocotyle pentagonum (Ozaki, 1924) is reported for the first time in South America parasitizing Auxis thazard and in a new host Katsuwonus pelamis. Tergestia laticollis (Rudolphi, 1819) is reported for the first time in South America and in Thunnus albacares, representing a new host record. Copiatestes filiferus (Leuckart, in Sars, 1885) is recorded for the first time in Brazil and in Thunnus albacares, another new host record. Tetrochetus coryphaenae (Yamaguti, 1934) is presented for the first time in Brazil parasitizing Thunnus albacares.

Crassicutis cichlasomae Manter, 1936 é redescrito pela primeira vez na América do Sul e em um novo hospedeiro: Geophagus brasiliensis (Cichlidae). Iheringtrema iheringi Travassos, 1948 é redescrita pela primeira vez desde sua descrição original, de Pseudopimelodus zungaro (Pimelodidae); novos hospedeiros são referidos para Genarchella genarchella Travassos et al., 1928, e para Parspina argentinensis (Szidat, 1954). Outras espécies estudadas são: Microrchis oligovitellum Lunaschi, 1987, Neocladocystis intestinalis (Vaz, 1932), Pseudosellacotyla lutzi (Freitas, 1941), Thometrema overstreeti (Brooks et al., 1979) e Zonocotyle bicaecata Travassos, 1948. Serão apresentadas figuras originais e medidas.

Crassicutis cichlasomae Manter, 1936 is redescribed for the first time in South America and from a new host: Geophagus brasiliensis (Cichlidae). Iheringtrema iheringi Travassos, 1948 is redescribed for the first time since its original description from Pseudopimelodus zungaro (Pimelodidae); and new host records are referred to Genarchella genarchella Travassos et al., 1928, and to Parspina argentinensis (Szidat, 1954). Other reported species are: Microrchis oligovitellum Lunaschi, 1987, Neocladocystis intestinalis (Vaz, 1932), Pseudosellacotyla lutzi (Freitas, 1941), Thometrema overstreeti (Brooks et al., 1979) and Zonocotyle bicaecata Travassos, 1948. Original figures and measurements are presented.

A new nematode genus and species. Neoparaseuratum travassosi n. g., n. sp., is described from the intestine of the freshwater thorny catfish, Pterodoras granulosus (Valenciennes), from the Paraná River, Brazil. This seuratoid nematode species represents a new genus of the family Quimperiidae, being characterized mainly by the presence of numerous narrow longitudinal bands of inflated cuticle extending along the cephalic region of the body, small deirids, postoesophageal position of the excretory pore, relatively short (0.159-0.303 mm), equal spicules and a gubernaculum, the absence of caudal alae and preanal sucker in the male, and by some other features.

No presente trabalho são apresentados sete trematódeos, quatro nematóides e um acantocéfalo parasitas de diferentes espécies de peixes do rio Mogi-Guassu. Creptotrema lynchi, tramatódeo descrito originalmente de anfíblio (Bufo marinus) na Colômbia, é referido pela primeira vez em peixes e no Brasil. Bellumcorpus major é assinalado em um novo hospedeiro e são apresentados novos dados morfológicos referentes ao tegumento. O gênero Zonocotyloides Padilha, 1978 é considerado sinônimo de Zonocotyle Travassos, 1948 e é proposta uma nova combinação para a espécieZonocotyloides haroltravassosi Padilha, 1978. Os nematóides Cucullanus pinnai e Procamallanus (Spirocamallanus) inopinatus e o trematódeo Pararhipidocotyle jeffersoni são assinalados em novos hospedeiros. O acantocéfalo Neoechinorhynchus curemai é redescrito de nova localidade. São também registrados nematóides Travnema travnema (referido em nova localidade) e Rondonia rondoni; e os trematódeos Cladocystis intestinalis, Pseudosellacotyla lutzi (em nova localidade), Teratotrema sp. e Zonocotyle bicaecata.

Twelve species of parasitic helminths, seven trematodes, four nematodes and one acanthocephalan are reported from various hosts. Creptotrema lynchi, a parasite from Bufo marinus in Colombia, is described for the first time in fish and from Brazil, parasitizing two different species. A list of the host species, measurements and figures of most parasites are included with particular reference to the tegument of Bellumcorpus major recovered from a new host. The genus Zonocotyloides Padilha, 1978 is considered a synonym of Zonocotyle and the new combination: Zonocotyle haroltravassosi is proposed to the species Zonocotyloides haroltravassosi Padilha, 1978. The nematodes Cucullanus pinnai and Procamallanus (Spirocamallanus) inopinatus and the trematode Pararhipidocotyle jeffersoni are reported in new hosts. The description of the acanthocephalan Neoechinorhynchus curemais (new locality record) is supplemented. Other parasites recovered include the nematodes Travnema travnema (new locality record), Rondonia rondoni and the digenetic trematodes Cladocystis intestinalis, Pseudosellacotyla lutzi (new locality record), Teratotrema sp. and Zonocotyle bicaecata.

De setembro, 1980 a agosto, 1981 foram examinados 40 exemplares de Haemulon sciurus, provenientes da Praia da Ribeira, Ilha do Governador, Estado do Rio de Janeiro. Neste trabalho são apresentados os resultados parciais, correspondentes aos trematodeos, grupo que apresentou maior ocorrência de parasitismo. As especies estudadas foram: Diplomonorchis leiostomi Hopkins, 1941 (primeira ocorrencia no Brasil e em novo hospedeiro); Lasiotocus beauforti (Hopkins, 1941) Thomas, 1959 (em novo hospedeiro); Genolopa ampullacea Linton, 1910; Parahemiurus merus (Linton, 1910) Yamaguti, 1938 (em um novo hospedeiro); Aponurus pyriformis (Linton, 1910) Overstreet, 1973 e Diplangus paxillus Linton, 1910. São apresentadas figuras, medidas e comentários.

From September, 1980 to August, 1981 forty specimens of Haemulon sciurus from "Praia da Ribeira, Ilha do Governador", Rio de Janeiro State, were examined for parasites. In this paper, parcial results concerning only the collected trematodes are reported: Diplomonorchis leiostomi Hopkins, 1941 (first record in Brazil and in a new host); Lasiotocus beauforti (Hopkins, 1941) Thomas, 1959 (new host record); Genolopa ampullacea Linton, 1910; Parahemiurus merus (Linton, 1910) Yamaguti, 1938 (new host record): Aponurus pyriformis (Linton, 1910) Overstreet, 1973 and Diplangus paxillus Linton, 1910. Figures, measurements and comments of each species are given.