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The association of Comamonas kerstersii with peritonitis resulting from the presence of perforated appendix has previously been described by our research team. In the present study, we describe the isolation of this microorganism from two forms of unusual presentations of C. kerstersii infection not previously described in the literature: localized intra-abdominal infection (psoas abscess) and pelvic peritonitis.

Copaiba oil is used as a popular medicine in the Amazonian forest region, especially due to its anti-inflammatory properties. In this paper, we describe the formulation of hydrogel containing copaiba oil nanoemulsions (with positive and negative charges), its skin permeation, and its anti-inflammatory activity in two in vivo models: mouse ear edema and rat paw edema. Three hydrogels were tested (Carbopol®, hydroxyethylcellulose and chitosan), but only Carbopol® and hydroxyethylcellulose hydrogels presented good stability and did not interfere with the nanoemulsions droplet size and polydispersity index. In skin permeation assay, both formulations, positively charged nanoemulsion (PCN) and negatively charged nanoemulsion (NCN), presented a high retention in epidermis (9.76 ± 2.65 μg/g and 7.91 ± 2.46 μg/cm2, respectively) followed by a smaller retention in the dermis (2.43 ± 0.91 and 1.95 ± 0.56 μg/cm2, respectively). They also presented permeation to the receptor fluid (0.67 ± 0.22 and 1.80 ± 0.85 μg/cm2, respectively). In addition, anti-inflammatory effect was observed to NCN and PCN with edema inhibitions of 69 and 67% in mouse ear edema and 32 and 72% in rat paw edema, respectively. Histological cuts showed the decrease of inflammatory factors, such as dermis and epidermis hyperplasia and inflammatory cells infiltration, confirming the anti-inflammatory effect from both copaiba oil nanoemulsions incorporated in hydrogel.

Background: Streptococcus agalactiae (group B Streptococcus - GBS) remains a leading cause of neonatal infections and an important cause of invasive infections in adults with underlying conditions. Methods: This study evaluated for the first time the effect of an oleoresin collected from Copaifera multijuga Hayne (copaiba oil) alone or in combination with silver nanoparticles produced by green synthesis using Fusarium oxysporum (AgNPbio) against planktonic and sessile cells of GBS isolated from colonized women. Results: Copaiba oil showed a dose-dependent bactericidal activity against planktonic GBS strains, including those resistant to erythromycin and/or clindamycin. Scanning and transmission electron microscopy of GBS treated with copaiba oil revealed morphological and ultrastructural alterations, displaying disruption of the cell wall and decreased electron density due to leakage of cytoplasmic content. Copaiba oil also exhibited antibacterial activity against biofilms of GBS strains, inhibiting their formation as well as the viability of mature biofilms. In addition, the combination of copaiba oil with AgNPbio resulted in a synergistic effect against planktonic cells and biofilm formation, reducing the minimal inhibitory concentration values of both compounds. No hemolytic activity was detected for both compounds. Conclusion: These results indicate the potential of copaiba oil, alone or in combination with AgNPbio, for the development of new alternative strategies for controlling GBS infections.

Small cell bladder cancer (SCBC) is found in 0.5–1.2% of all bladder tumors. Ureteroceles are dilatation of the distal portion of an ectopic ureter, which association with tumors are rare. This article reports the first case described of an SCBC developed into a ureterocele, beyond a literature review. Keywords: Ureterocele, Double ureter, Small-cell, Bladder cancer

IntroductionMental ill health is common among doctors. Fast, efficient diagnosis and treatment are needed as mentally ill doctors pose a safety risk to themselves and to patients, yet they are often reluctant to seek help. Focusing on psychiatry, it is known that psychiatrists as a professional group are prone to stress burnout and suicide. Thus, it seems relevant and current to address on the burnout in this professional group.Objectives/aimTo analyze the burnout levels and the existence of psychopathology in a Portugal psychiatry department.MethodsAnonymous self-completion questionnaire, prepared by the Suicide Prevention Consultation (also using MBI-Maslach Burnout Inventory and QIS-Suicide Ideation Questionnaire) and distributed by e-mail and online submitted for all psychiatrists in the department.ResultsForty-two percent of psychiatrists responded, mostly women. Although the percentages of responses related to fatigue/amount of work are significant, there were not high levels of emotional exhaustion and depersonalisation, but before satisfactory levels of personal fulfilment.ConclusionsHigh levels of “burnout” are associated with high scores of emotional exhaustion and depersonalisation, but also with low scores of personal fulfilment. Despite the preliminary results of this study, it is important to remember important prevention strategies. Further studies directed to psychiatry trainees seem important, as this represents an important risk group, where an early intervention can make a difference.Disclosure of interestThe authors have not supplied their declaration of competing interest.

OBJETIVO: comparar dois grupos de meninas em idade escolar, de diferentes extratos sociais, quanto à percepção e conhecimento sobre aleitamento materno. MÉTODOS: aplicou-se um questionário estruturado a todas as 346 meninas da 4ª à 8ª séries de duas escolas, uma particular, com alunos de alto poder aquisitivo (Escola A), e outra pública, com alunos de nível econômico-social baixo (Escola B). RESULTADOS: cerca de 90% das meninas relataram ter sido amamentadas, e mais de 98% já viram alguma mãe amamentando. Somente 14% das da Escola A e 26% da Escola B (p=0,01) ofereciam exclusivamente o seio ou o seio e mamadeira em suas brincadeiras com bonecas. Mais de 80% das meninas gostariam que seu parto fosse normal e de amamentar seu filho por mais de 6 meses, mas 46% das da Escola A e 32% da B teriam vergonha de amamentar em público. Cerca de 90% das meninas consideram o leite humano o melhor alimento para o bebê, porém apenas pequena parcela delas reconhece outras vantagens mais específicas. Menos de 1/3 delas optaria pelo aleitamento exclusivo e perto de 60% delas ofereceria chupeta para o nenê. CONCLUSÕES: as meninas de ambos extratos sociais sabem que o aleitamento materno é a melhor dieta de um recém-nascido, porém desconhecem vantagens específicas. O aleitamento materno exclusivo não está incorporado no conhecimento da maioria dessas meninas, já que foram consideradas como práticas adequadas o oferecimento de água, chá, sucos e chupeta. O ensino do aleitamento nas escolas deve enfatizar esses conceitos. OBJECTIVE: to compare two groups of school age girls from different social strata were compared in terms of their perception and knowledge about breastfeeding. METHODS: a structured questionnaire was applied to all 346 4th to 8th grade girls attending two schools, a private one, whose students belonged to the upper class (School A), and a public one, whose students belonged to the lower class (School B). RESULTS: about 90% of the girls reported having been breastfed and more than 98% had seen a mother breastfeeding. Only 14% of girls from School A and 26% from School B (p = 0.01) exclusively offered their breast or their breast and a bottle when playing with dolls. More than 80% of the girls stated that they would like to have a normal delivery and to breast-feed their child for more than 6 months, but 46% of the girls from School A and 32% from School B stated that they would be ashamed to breastfeed in public. About 90% of the girls considered human milk to be the best food for the baby, but only a small portion of them recognized other more specific advantages. Less than 1/3 would choose exclusive breastfeeding and about 60% would offer a pacifier to the baby. CONCLUSIONS: girls from both social strata are aware of the fact that breastfeeding is the best diet for a newborn baby, but are not aware of its specific advantages. Exclusive breastfeeding is not incorporated into the knowledge of most of these girls, since most of them consider offering water, tea, juices and a pacifier to be adequate practices. Teaching about breastfeeding at school should emphasize these concepts.

Objetivo Evaluar la eficacia y seguridad del tratamiento de la tromboembolia pulmonar submasiva (TEP) con enoxaparina en comparacion con heparina no fraccionada Pacientes Y Metodos Se incluyo en el estudio, de forma prospectiva, a 56 pacientes con TEP que no precisaron tratamiento fibrinolitico. Se asignaron de forma aleatoria a dos grupos de tratamiento: el grupo A, que recibio enoxaprina (1 mg/kg cada 12 h) y el grupo B, al que se le administraron dosis ajustadas de heparina no fraccionada. La anticoagulacion oral se inicio una vez que el diagnostico se comprobo y se mantuvo durante 6 meses. Se evaluo la incidencia de recurrencia tromboembolica y de hemorragia mayor al cabo de ese tiempo Resultados Seis pacientes fueron excluidos del estudio. De los 50 finalmente incluidos, 29 fueron asignados al grupo A (enoxaparina) y 21 al grupo B (heparina no fraccionada). Tres pacientes del grupo A (10,7%) fueron diagnosticados de recurrencia tromboembolica, mientras que dicha complicacion se constato en dos pacientes del grupo B (9,5%). No se encontraron diferencias significativas. Dos pacientes fallecieron, siendo una de las muertes achacada a hemorragia secundaria a la anticoagulacion oral (grupo A) y la otra a un proceso independiente a la enfermedad tromboembolica Conclusiones El empleo de enoxaparina en el tratamiento inicial del TEP parece ser tan efectivo y seguro como el uso de heparina no fraccionada

To discover new possible therapies for Chagas' disease, we evaluated against all Trypanosoma cruzi life stages the in vitro trypanocidal and synergistic activity of terpenes isolated from Copaifera oleoresins collected in the Amazon and investigated their possible mechanism of action. Seven acid diterpenes and one sesquiterpene were tested. Terpenes promoted changes in oxidative metabolism followed by autophagic processes in the parasite cell leading to selective death. Furthermore, they were more effective against replicative forms, in particular amastigotes. A synergistic effect occurred. Cytotoxicity to erythrocytes and nucleated cells was moderate. This is the first study showing synergic activity between two terpenes against T. cruzi. Combinations of natural compounds can show high activity and may lead to new alternative treatments in the future.

The present study was performed in vivo in rabbits to evaluate the functional and morphologic effects of verapamil in a model of ischemic acute renal failure (ARF). Particularly impressive was the ultrastructural integrity of renal tubules in the animals exposed to both ischemia and verapamil. Three groups were studied: Group A: no ischemia; Group B: renal ischemia alone; and Group C: renal ischemia with verapamil. Creatinine clearance was higher in Group C (0.77 mL/min/kg) compared to Group B (0.13 mL/min/kg) at 24 h of reperfusion (p.005) as well as at 48 and 72 h (0.73 mL/min/kg) vs. 0.35 mL/min/kg; p.05 and 0.90 mL/min/kg vs. 0.46 mL/min/kg; p0.05, respectively). Light microscopic evaluation of Group C rabbits revealed significantly better preservation of proximal tubule (PT) brush border (p.0005) and less desquamation of PT (p.05) compared to Group B. Ultrastructural examination of in vivo perfused kidneys also demonstrated decreased loss of microvilli of PT (p.0005) as well as less cellular edema (p.005), fewer cells with apical PT membrane rupture (p.01), better preservation of mitochondria (p.005), less flattening of the PT basolateral labyrinth (p.05), and fewer hypertrophic actin bands at the basal surface of PT epithelial cells (p.05). These results suggest that verapamil markedly attenuates PT morphologic injury in a rabbit model of reversible ischemic ARF. The functional protection observed in these studies may be related, in part, to the improved structural integrity of the renal tubules. Renal transplantation and anticipated renal ischemia (i.e., surgical interventions) are two important situations where treatment with verapamil or other calcium channel blockers may prove to be clinically beneficial.

rosuvastatin on coronary atheroma in stable coronary artery disease: multicenter coronary atherosclerosis study measuring effects of rosuvastatin using intravascular ultrasound in Japanese subjects (COSMOS). Circ J 2009;73:2110–7. [5] Smith Jr SC, Allen J, Blair SN, Bonow RO, Brass LM, Fonarow GC, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update: endorsed by the National Heart, Lung, and Blood Institute. Circulation 2006;113:2363–72. [6] Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report. Circulation 2002;106:3143–421. [7] Grundy SM, Cleeman JI, Merz CN, Brewer Jr HB, Clark LT, Hunninghake DB, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227–39. [8] Deedwania P, Singh V, Davidson MH. Low high-density lipoprotein cholesterol and increased cardiovascular disease risk: an analysis of statin clinical trials. Am J Cardiol 2009;104:3E–9E. [9] Barter P, Gotto AM, LaRosa JC, Maroni J, Szarek M, Grundy SM, et al. HDL cholesterol, very low levels of LDL cholesterol, and cardiovascular events. N Engl J Med 2007;357:1301–10. [10] Gordon DJ, Probstfield JL, Garrison RJ, Neaton JD, Castelli WP, Knoke JD, et al. Highdensity lipoprotein cholesterol and cardiovascular disease: Four prospectiveAmerican studies. Circulation 1989;79:8–15. [11] Shewan LG, Coats AJ. Ethics authorship publishing scientific articles Int J Cardiol 2010;144:1–2.

Although the teleworking literature continues to raise concerns regarding the adverse consequences of professional isolation, researchers have not examined its impact on work outcomes. Consequently, the authors first examine professional isolation's direct impact on job performance and turnover intentions among teleworkers and then investigate the contingent role of 3 salient work-mode-related factors. Survey data from a matched sample of 261 professional-level teleworkers and their managers revealed that professional isolation negatively impacts job performance and, contrary to expectations, reduces turnover intentions. Moreover, professional isolation's impact on these work outcomes is increased by the amount of time spent teleworking, whereas more face-to-face interactions and access to communication-enhancing technology tend to decrease its impact. On the basis of these findings, an agenda for future research on professional isolation is offered that takes into account telework's growing popularity as a work modality.

We report results regarding the use of 1H-NMR spectroscopy in the study of the conformational behaviour and optical activity of omeprazole. Changes in the chemical shifts of chosen atoms reveal that the conformational behaviour of omeprazole is temperature and pH sensitive. Separation and identification of omeprazole enantiomers in the presence of natural and derivative cyclodextrins, such as β-cyclodextrin (βCD) and methyl-β-cyclodextrin (MβCD) are achieved using 1H-NMR spectroscopy, with information from molecular dynamics simulation. This work shows that βCD includes preferentially R-(–)-omeprazole, acting as a chiral selector. This discrimination of omeprazole enantiomers by cyclodextrins allows development of pharmaceutical formulations with a better bioavailability profile.

This present phytomedicinal study aims at both identifying the variety of the Croton cajucara lead molecule trans-dehydrocrotonin (DCTN), in all parts of 1 1 2 to 6 year old plants, and perform a general evaluation of its biological efficacy. In addition, the biochemical evaluation of trans-crotonin (CTN), trans-cajucarin B (t-CJC-B), cis-cajucarin B (c-CJC-B), acetyl aleuritolic acid (AAA), cajucarinolide (CJCR) and isocajucarinolide (ICJCR) were performed. The pharmacological action of bioactive extracts and semi-purified fractions of this Croton are discussed herein. The phytochemical investigation proved that only the stem bark of the mature plants (MP) is a rich source of DCTN (1.4% of dry bark), while 3-year-old plants contained only 0.26%. In young plants (YP) the triterpene AAA was the major component and in these the diterpene DCTN was not present. Phytochemical investigation of the C. cajucara stem bark yields AAA, CTN, DCTN, t-CJC-B, c-CJC-B, CJCR, ICJCR, trans-cajucarin A (t-CJC-A) and isosacacarin. In addition, the common metabolites 4-hydroxy-3-methoxy-benzoic acid (vanilic acid), 4-hydroxy-benzoic acid and 2-methylamino-3-(4-hydroxyphenyl)propanoic acid (N-methyltyrosine) were isolated. The structure elucidation of DCTN and CTN was revised using 600 MHz NMR (nuclear magnetic resonance) spectrum, confirming their original structure. Synthetic transformation of DCTN afforded great amount of semi-synthetic CTN, CJCR and ICJCR derivatives, which were submitted to pharmacological experiments. Among the pharmacological experiments, DCTN and CTN were studied for their in vivo antitumor activities on Ehrlich carcinoma and Sarcoma 180 (S-180), and in vivo release was evaluated. The in vitro antiproliferative effects of DCTN and CTN were determined on the cultured Ehrlich carcinoma cells. The cytotoxic effects of CJCR, ICJCR, t-CJC-B, c-CJC-B, a tea preparation, and a MeOH extract were evaluated for human K562 leukemia and Ehrlich carcinoma cells. The tea preparation was also studied for its hepatotoxic effects on the weight variations and glutamic pyruvic transaminase (GPT) dosage in mice, in which GPT value variations revealed a dosage–response relation. The genotoxic action of DCTN was examined in Swiss mouse bone marrow cells in vivo, submitted to acute intraperitoneal treatment, by micronucleus (MN) and chromosomal aberration (CA) tests. Statistical analysis indicated that DCTN doses (50% and 75% of the LD50 via intraperitoneal or gavage treatments) were antimutagenic with regard to cyclophosphamide. The oral administration of DCTN and AAA (100 mg/kg) reduced gastrointestinal transit of mice and index of gastric mucosa damage (GMD) induced by cold stress. After pylorus ligature in rats, similar dose of DCTN decreased acid secretion and volume. These compounds (1 μM) also reduced the 14C-AP uptake induced by histamine (10−5 M); however, uniquely DCTN decreased the uptake induced by bethanechol.

Objective.– To determine the value of procalcitonin (PCT) as a prognostic biomarker in elderly patients with respiratory infection comparing it with Curb-65 and acute phase reactants: C-reactive protein (CRP), erythrocyte sedimentation rate (ESR)and leukocytes. Methods.– Prospective observational study in elderly patients admitted to an Acute Geriatric Unit with the diagnosis of upper respiratory infection or pneumonia. We collected sociodemographic variables, clinical and geriatric assessment. Samples were taken to determine PCT, CRP and ESR at admission and 72hours after. Results.– We included 50 patients, 30 with pneumonia and 20 with respiratory infection, with an average age of 86 years, significant comorbidity (Charlson Index≥3 in more than 50%), cognitive impairment (70%) and poor functional status (Katz≥D 56%). Mortality during admission was high (37% in pneumonia and 25% in upper respiratory infection). At admission 60% of patients have elevated PCT (≥0.25ng/mL), 100% PCR, 84% ESR and 36% leukocytes. In all patients the PCT difference between admission and 72hours was marginal (P=0.059); in patients with respiratory infection decreased significantly at 72hours (P=0.046),while there wasnovariation inpatientswithpneumonia. Theother acutephase reactants, except leukocytes (P≤0.05) showedno significant differences during the first 72hours. Conclusions.– In elderly patients with suspected upper respiratory infection, decreased procalcitonin levels at 72hours indicates a good prognosis. In those with pneumonia study these evolutionary parameters at 72hours show no change, so control should be delayed.

A new technique of choledochoenterostomy was devised to solve some of the problems of enterobiliary anastomosis with a normal calibre. The distal extremity of the common bile duct is completely surrounded by the bowel mucosa to a length of 3 cm after seromyectomy of a bowel wall rectangle of 4 × 1 cm. Experimental studies in rats and dogs demonstrated that this procedure prevents the risks of anastomotic disruption and functions like a mechanical unidirectional valve, which has great efficacy in stopping enterobiliary reflux. Studies in ten patients with obstructive jaundice with an extrahepatic biliary dilation less than 1.2 cm diameter submitted to this procedure confirmed the experimental results. All patients were asymptomatic, without jaundice and with normalization of the liver enzymes after 2 months. The permeability of the valvular anastomosis studied by cholangiography, the HIDA 99mTc test and manometry was quite similar to other classical biliary-enteric anastomosis. In contrast, anti-reflux efficacy was only demonstrated in patients with a valvular anastomosis.

Chromatographic fractions of the medicinal plant Crotoncajucara Benth. were studied in human promyelocytic leukemiaHL-60 cells for antiproliferative and cell differentiation–induc-ing properties. The chromatographic fractions F26–30, F39-42 ,F50–51, and F60–66, but not 19-nor-clerodane diterpene trans-dehydrocrotonin (t-DCTN) alone, inhibited cell proliferationbased on IC 50 values (the concentration that inhibits the 50% ofcell proliferation) obtained using the 3-(4,5-dimethylthiazol-2-yl) diphenyltetrazolium bromide (MTT) assay. These fractionsalso inhibited 5-bromodeoxyuridine incorporation, indicatingthat the growth-inhibitory effect involved the inhibition ofdeoxyribonucleic acid synthesis. The same fractions inducedmorphologic changes and caused significant nitroblue tetrazoli-um reduction in HL-60 cells as well. In summary, the results ofthis study demonstrate that the chromatographic fractions ofCroton cajucara contain substances differing from t-DCTN thatinhibit cell proliferation and also induce cell differentiation inHL-60 cells.Further studies are warranted to define the contribution ofeach component to these pharmacologic activities of the frac-tions.Key words: cell differentiation, cell proliferation, Crotoncajucara, HL-60, leukemia

The aim of this study was to develop a new computerized gammagraphic method to evaluate gastrooesophageal (GER), bileo-oesophageal (BER) and bileogastric reflux (BGR) simultaneously with gastric and gallbladder emptying: a long duration (60 min) and a dual energy detection (113Inm-sulphur colloid and 99Tcm-HIDA) test of the different refluxes during slow gastric emptying of an enteric feeding liquid meal. Forty patients with oesophagitis and 18 normal volunteers were evaluated. Good reproducibility of all the quantified parameters was found with r Spearman between 0.75 (P < 0.05) and 1.0 (P < 0.001). Patients with oesophagitis have a tendency for slower gastric emptying patterns (gastric emptying T1/2, GT1/2 P < 0.05). The calculated specificity for gallbladder emptying parameters was 77.8% for the gallbladder T1/2 BT1/2) and 94.4% for gallbladder residue at 60 min (BR60). The calculated accuracy for the GER index was 90%. The predictability for positive values was 95%, owing to a 90% sensitivity and 89% specificity. The predictability for negative values was 80%. The mean GER index in oesophagitis was greater than in controls (P < 0.001). The calculated specificity for BGR was 94.4% and reflux was detected in 12 out of 40 patients. The calculated specificity for BER was 83.3% for a '+' index and 94.4% for a '++' BER index. In 14 patients a positive BER index has been determined ('+' in three and '++' in 11 cases).(ABSTRACT TRUNCATED AT 250 WORDS)

The purpose of this report was to evaluate the efficacy of cardiomyotomy combined with fundoplication in the treatment of achalasia. Results obtained in 15 patients are compared with those collected in 19 asymptomatic patients treated by the classical Heller operation (12 patients), or by cardiomyotomy combined with suture of phrenoesophageal ligament to the underside of the diaphragm (7 patients). The preventive action of fundoplication on reflux esophagitis and especially the effect of surgery on esophageal emptying are particularly examined, using two rigorous isotopic tests. It is demonstrated that even asymptomatic patients have, after cardiomyotomy without antireflux maneuvers, a very high risk of esophagitis. The statistical comparison using the gastroesophageal reflux index between patients treated by Heller cardiomyotomy and normals wasp 0.1), and maintained the improvement of the esophageal emptying.

SummaryThis study aims to establish the relative effectiveness and safety of low molecular weight heparin in elderly patients with venous thrombosis in order to find an alternative to oral anticoagulant therapy with less bleeding complications in the long-term treatment of deep venous thrombosis (DVT).One hundred consecutive elderly patients (>75 years old) with venographically demonstrated proximal DVT were included in a randomized trial. All patients were treated for ten days with adjusted doses of intravenous heparin. Informed consent was obtained and on the eight day, patients were randomly allocated to receive acenocoumarol (INR 2.0-3.0) or subcutaneous enoxaparin (4000 anti-Xa units once a day) for three months. All patients were followed-up clinically and venographically for a one year period. The results were analyzed with Fisher’s exact test or chi-square test as appropriate.During the treatment and surveillance period, 6 of the 50 patients (12%) who received acenocoumarol and 8 of the 50 patients (16%) who received enoxaparin had new episodes of venous thromboembolism confirmed by objective testing (p = 0.6; 95% CI for the difference: −19.5 to 11.5). Hemorrhagic complications occurred in six of the 50 patients (12%) who received acenocoumarol and in one (2%) of those on enoxaparin (p = 0.1; 95% CI for the difference: -1.8 to 21.8). Vertebral fractures developed in 2 patients (4%) in the enoxaparin group (p = 0.5; 95% CI for the diference: −11.4 to 3.4).These results show that fixed dose enoxaparin seems to be effective and safe in the long-term treatment of proximal DVT in the elderly. In comparison with oral anticoagulants, the findings are inconclusive due to the wide confidence intervals for differences between outcomes, however they suggest that the former may have less bleeding complications with similar efficacy.