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Highlights • Dieulafoy lesion of the gallbladder is a very rare cause of hemobilia. • Hemobilia should be considered as a cause of acute pancreatitis. • Intraoperative cholangiogram is effective in flushing small biliary clots., Introduction Dieulafoy lesion of the gallbladder is very rare. It can cause hemobilia and, consequently, acute pancreatitis. After extensive research, the authors found six reported cases of this entity, none of them presenting as acute pancreatitis. Case presentation A 78-year-old woman presented to the emergency department a right upper-quadrant pain and nausea. Abdominal ultrasound showed a gallbladder full of a heterogenic content with no signs of lithiasis or acute cholecystitis. Blood lipase was significantly elevated. She was admitted for acute pancreatitis. During hospitalization she developed jaundice and hematemesis requiring blood transfusion. The upper gastrointestinal (GI) endoscopy with side-view duodenoscopy showed blood through the papilla of Vater. Computed tomography and magnetic resonance imaging confirmed the content of the gallbladder with no changes in the biliary tree. A laparoscopic cholecystectomy with intraoperative cholangiogram was performed. Histology revealed a Dieulafoy lesion. The patient was discharged three days after surgery and had no subsequent episodes. Conclusion Hemobilia should be considered as a cause of upper GI bleeding and acute pancreatitis, especially if both are concurrent. Treatment is directed to the cause, with bleeding control and restoration of bile flow, which can be accomplished by a single minimally invasive surgery.

A 77-year-old-man who was a retired primary school teacher with probable Alzheimer dementia diagnosed after 2 years of progres sive short-term memory loss and predominant hippocampal atro phy onmagnetic resonance scan of the brain was brought to the out patient neurology clinic by his wife because of persistent ab normal behavior. The caretaker reported that he was frequently puzzled and astonished by his own mirror image. His medical his tory was remarkable for controlled hypertension and type 2 diabe tes. He did not have any personal or family history of psychiatric dis ease. There were no recent changes with the patient’s regular medications (rivastigmine, 9.5 mg daily transdermally; enalapril; and metformin). His wife described him as being a very quiet and relaxed person until the start of restrictions imposed by the COVID-19 pandemic, when he started with complaints of seeing a strangeman whenever he saw his face reflection in the mirror. info:eu-repo/semantics/publishedVersion

Objectives: to analyze the obstetric and sociodemographic profile on perinatal deaths in Teresina the capital of Piauí, from data obtained from the Sistema de Informação de Mortalidade e Sistema de Informação de Nascidos Vivos (Brazilian Mortality Information System and Livebirth Information System). Methods: this is a retrospective cohort on perinatal deaths of mothers whose babies were born and resided in Teresina between 2010 and 2014. The analyzed variables were age and the mother´s schooling, gestational age, type of pregnancy (singleton or multiple), route of delivery (vaginal or cesarean), place of death (in and out hospital), time of death in relation to the delivery (prior, during or after), and birth weight. Results: the perinatal mortality coefficient (PMC) varied from 17.5 to 19.3 per 1,000 births. We found similarities in the sociodemographic profile and in the obstetric fetal and non-fetal deaths, both with a great incidence on 20 to 27 years-old mothers, vaginal delivery and singleton pregnancy. Low birth weight was positively related to early neonatal deaths. Conclusions: perinatal mortality presented a statistical correlation in gestational age, birth weight, and type of delivery. The PMC in our study was higher than other Brazilian capitals. Resumo Objetivos: analisar o perfil obstétrico e sociodemográfico dos óbitos perinatais ocorridos em Teresina, capital do Piauí, a partir de dados provenientes dos Sistema de Informação de Mortalidade e Sistema de Informação de Nascidos Vivos. Métodos: coorte retrospectiva de óbitos perinatais nascidos de mães residentes em Teresina, entre 2010 e 2014. As variáveis analisadas foram faixa etária e escolaridade da mãe, idade gestacional, tipo de gravidez (única ou múltipla), via de parto (vaginal ou cesáreo), local do óbito (intra ou extra-hospitalar), momento do óbito em relação ao parto (antes, durante ou após), e peso do concepto. Resultados: o coeficiente de mortalidade perinatal (CMP) variou entre 17,5 e 19,3 por mil nascidos. Verificaram-se semelhanças quanto ao perfil sociodemográfico e obstétrico dos óbitos fetais e não fetais, ambos com maior incidência em mães com faixa etária entre 20 e 27 anos, em parto vaginal e no tipo de gravidez única. Baixo peso ao nascer se relacionou positivamente com os óbitos neonatais precoces. Conclusões: a mortalidade perinatal apresentou correlação estatística com a idade gestacional, o peso ao nascer, e o tipo de parto. O CMP no nosso estudo foi mais elevado do que o de outras capitais brasileiras.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:56:05Z No. of bitstreams: 1 S0102-09352008000200031.pdf: 199936 bytes, checksum: 9dcfd9480c09ffecebb4f743fef16ea4 (MD5) Made available in DSpace on 2013-08-22T18:56:05Z (GMT). No. of bitstreams: 1 S0102-09352008000200031.pdf: 199936 bytes, checksum: 9dcfd9480c09ffecebb4f743fef16ea4 (MD5) Previous issue date: 2008-04-01 Made available in DSpace on 2013-09-30T19:49:36Z (GMT). No. of bitstreams: 2 S0102-09352008000200031.pdf: 199936 bytes, checksum: 9dcfd9480c09ffecebb4f743fef16ea4 (MD5) S0102-09352008000200031.pdf.txt: 12684 bytes, checksum: bb933daa6147470698b4d06f3f14ef5f (MD5) Previous issue date: 2008-04-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:39:49Z No. of bitstreams: 2 S0102-09352008000200031.pdf: 199936 bytes, checksum: 9dcfd9480c09ffecebb4f743fef16ea4 (MD5) S0102-09352008000200031.pdf.txt: 12684 bytes, checksum: bb933daa6147470698b4d06f3f14ef5f (MD5) Made available in DSpace on 2014-05-20T13:39:49Z (GMT). No. of bitstreams: 2 S0102-09352008000200031.pdf: 199936 bytes, checksum: 9dcfd9480c09ffecebb4f743fef16ea4 (MD5) S0102-09352008000200031.pdf.txt: 12684 bytes, checksum: bb933daa6147470698b4d06f3f14ef5f (MD5) Previous issue date: 2008-04-01 Relata-se a ocorrência de graves sintomas de mastite hiperaguda em vaca, causada por Klebsiella pneumoniae, na terceira semana de lactação. Descrevem-se aspectos epidemiológicos, sintomas clínicos, procedimentos de diagnóstico microbiológico, conduta terapêutica e medidas de controle. UNESP Faculdade de Medicina Veterinária e Zootecnia UNESP Faculdade de Medicina Veterinária e Zootecnia

Objectives: This study evaluated the development of the therapeutic alliance and the emergence of alliance ruptures, in a sample of patients with different diagnosis and different therapeutic outcome. Design: We examined the longitudinal data of 38 therapeutic dyads receiving cognitive-behavioural therapy, including dropouts as well as successful and unsuccessful cases. The sample included cases with Axis I and Axis II disorders. Method: At the end of each session, patients evaluated the alliance using the Working Alliance Inventory (WAI). Six judges trained in the observation of alliance rupture markers with an observational system of ruptures, rated 201 videotaped sessions. Longitudinal statistical models were applied to the data. Results: We found that the pattern of alliance development of successful cases was different from the unsuccessful and dropouts cases. In addition on average, patients with personality disorders began therapy with a lower WAI score that decreased over time, whereas patients with Axis-I disorders began therapy with a higher WAI score that increased over time

Individuals with Williams syndrome (WS) present a set of cognitive, affective and motor symptoms that resemble those of patients with lesions to the cerebellum. Although there is some evidence for overall structural alterations in this brain region in WS, explorations on cerebellar white matter and cerebellar cortex volumes remain rather neglected. We aimed to compare absolute and relative cerebellar volumes, as well as patterns of white matter to cortex volumes in this brain region, between a group of individuals with WS and a group of healthy controls. T1 -weighted magnetic resonance images were acquired in 17 individuals with WS and in 15 typically developing individuals. Our results showed that even though individuals from the clinical group had significantly smaller cerebrums (and cerebellums), cerebellar volumes relative to intracranial volumes were significantly enlarged. In addition, while gray matter was relatively spared and white matter disproportionately reduced in the cerebrum in WS, relative cerebellar cortex and white matter volumes were preserved. These findings support the hypothesis that volume alterations in the cerebellum are associated with the cognitive, affective and motor profiles in WS. (c) 2014 Elsevier Ltd. All rights reserved.

This is a case report of enteric protothecosis caused by Prototheca zopfii in an eight-year-old male mixed breed dog with a history of chronic bloody diarrhea, loss of appetite and weight loss. Algae were isolated from rectal scrapings in defibrinated sheep blood agar and dextrose Sabouraud agar. Cytological evaluation showed the presence of globular and cylindrical organisms with a defined capsule and variable number of endospores, characteristic of the genus Prototheca, in the rectum of the animal. Scanning electron microscopy of P. zopfii strains at different development stages confirmed the diagnosis of algal infection. Molecular identification using a conserved 18S rDNA gene sequence determined that the strain belonged to genotype 2. This report describes success on treatment of canine protothecosis, diagnosed based on clinical, cytological, microbiological, scanning electron microscopy and genotypical findings.

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T18:56:26Z No. of bitstreams: 1 S0102-09352010000400031.pdf: 252818 bytes, checksum: daee539bd43ee8db33bcb2591225a571 (MD5) Made available in DSpace on 2013-08-22T18:56:26Z (GMT). No. of bitstreams: 1 S0102-09352010000400031.pdf: 252818 bytes, checksum: daee539bd43ee8db33bcb2591225a571 (MD5) Previous issue date: 2010-08-01 Made available in DSpace on 2013-09-30T19:50:20Z (GMT). No. of bitstreams: 2 S0102-09352010000400031.pdf: 252818 bytes, checksum: daee539bd43ee8db33bcb2591225a571 (MD5) S0102-09352010000400031.pdf.txt: 14299 bytes, checksum: 015a9b51f94d99ffb0a6cbf825a0fde3 (MD5) Previous issue date: 2010-08-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T15:13:09Z No. of bitstreams: 2 S0102-09352010000400031.pdf: 252818 bytes, checksum: daee539bd43ee8db33bcb2591225a571 (MD5) S0102-09352010000400031.pdf.txt: 14299 bytes, checksum: 015a9b51f94d99ffb0a6cbf825a0fde3 (MD5) Made available in DSpace on 2014-05-20T15:13:09Z (GMT). No. of bitstreams: 2 S0102-09352010000400031.pdf: 252818 bytes, checksum: daee539bd43ee8db33bcb2591225a571 (MD5) S0102-09352010000400031.pdf.txt: 14299 bytes, checksum: 015a9b51f94d99ffb0a6cbf825a0fde3 (MD5) Previous issue date: 2010-08-01 UNESP Faculdade de Medicina Veterinária e Zootecnia UNESP Faculdade de Medicina Veterinária e Zootecnia

Submitted by Guilherme Lemeszenski (guilherme@nead.unesp.br) on 2013-08-22T19:05:23Z No. of bitstreams: 1 S0036-46652008000300009.pdf: 2173007 bytes, checksum: 18bec24e8efa83481c4063277e743716 (MD5) Made available in DSpace on 2013-08-22T19:05:23Z (GMT). No. of bitstreams: 1 S0036-46652008000300009.pdf: 2173007 bytes, checksum: 18bec24e8efa83481c4063277e743716 (MD5) Previous issue date: 2008-06-01 Made available in DSpace on 2013-09-30T18:24:36Z (GMT). No. of bitstreams: 2 S0036-46652008000300009.pdf: 2173007 bytes, checksum: 18bec24e8efa83481c4063277e743716 (MD5) S0036-46652008000300009.pdf.txt: 50950 bytes, checksum: 248cda6ae2b97d98f6938881a6f9498a (MD5) Previous issue date: 2008-06-01 Submitted by Vitor Silverio Rodrigues (vitorsrodrigues@reitoria.unesp.br) on 2014-05-20T13:38:42Z No. of bitstreams: 2 S0036-46652008000300009.pdf: 2173007 bytes, checksum: 18bec24e8efa83481c4063277e743716 (MD5) S0036-46652008000300009.pdf.txt: 50950 bytes, checksum: 248cda6ae2b97d98f6938881a6f9498a (MD5) Made available in DSpace on 2014-05-20T13:38:42Z (GMT). No. of bitstreams: 2 S0036-46652008000300009.pdf: 2173007 bytes, checksum: 18bec24e8efa83481c4063277e743716 (MD5) S0036-46652008000300009.pdf.txt: 50950 bytes, checksum: 248cda6ae2b97d98f6938881a6f9498a (MD5) Previous issue date: 2008-06-01 A caracterização fenotípica, perfil de sensibilidade aos antimicrobianos e aspectos clínico-epidemiológicos foram avaliados em 28 linhagens de Nocardia isoladas de 19 casos de mastite, oito lesões tegumentares e um caso de pneumonia em cão. Foram utilizados no diagnóstico métodos microbiológicos, bioquímicos, citológicos e microscopia eletrônica de varredura. Nocardia asteroides tipo IV, N. otitidiscaviarum,N. nova (tipo III) e N. farcinica (tipo V) foram isoladas do leite de vacas com mastite, de material de lavado transtraqueal e de lesões cutâneas de cães. Nocardiose mamária bovina foi diagnosticada predominantemente sob a forma clínica, em propriedades com precárias condições de higiene na pré e pós-ordenha, e inadequado procedimento de terapia intramamária. Nocardiose canina foi diagnosticada comumente em animais co-infectados com o vírus da cinomose. Sulfametoxazole/trimetoprim (92,8%), amicacina (92,8%) e ceftiofur (92,8%) foram os antimicrobianos mais efetivos frente às linhagens de Nocardia. Resistência múltipla a três ou mais e cinco ou mais antimicrobianos foram observadas, respectivamente, em dez (35,7%) e três (10,7%) linhagens, notadamente frente à cloxacilina, cefoperazona e ampicilina. A caracterização de espécies (tipo), aspectos clínico-epidemiológicos, diagnóstico, resistência múltipla aos antimicrobianos e reflexos em saúde pública de linhagens de Nocardia isoladas de bovinos e cães no Brasil foram discutidos. Foi destacada a similaridade entre as espécies de Nocardia isoladas de animais e do homem, e a primeira descrição no Brasil de N. otitidiscaviarum na etiologia da mastite bovina. Phenotypic characteristics, antimicrobial susceptibility profile, and clinical-epidemiological features of 28 Nocardia strains isolated from 19 cases of bovine mastitis, eight cutaneous-subcutaneous lesions and one case of pneumonia in dogs were evaluated. Microbiological, biochemical, cytological and scanning electron microscopy methods were used in diagnosis. Nocardia asteroides type IV, Nocardia otitidiscaviarum,Nocardia nova (type III) and Nocardia farcinica (type V) were isolated from bovine milk, bronchial lavage and/or cutaneous-subcutaneous abscesses in dogs. Nocardial bovine mastitis was diagnosed predominantly in clinical cases, in dairy herds with poor environmental hygienic conditions between milking and inappropriate intramammary therapy. Canine nocardiosis was observed commonly in animals co-infected with distemper virus. Sulphamethoxazole-trimethoprim (92.8%), amikacin (92.8%) and ceftiofur (92.8%) were the most effective drugs in 28 isolates. Multiple drug resistance to three or more and five or more antimicrobials was observed in ten (35.7%) and three (10.7%) strains, respectively, predominantly with use of cloxaxillin, cefoperazone and ampicillin. The species (type) classification, clinical-epidemiological characteristics, diagnosis, multiple-drug resistance and public health considerations in Nocardia strains isolated from cattle and dogs in Brazil are discussed, with special reference to report of bovine mastitis by N. otitidiscaviarum by first time in Brazil and the similarity between Nocardia species isolated from human and animal origin. UNESP Faculdade de Medicina Veterinária e Zootecnia Departamento de Higiene Veterinária e Saúde Pública UNESP FMVZ Universidade do Estado do Rio de Janeiro Faculdade de Ciências Médicas UNESP FMVZ Departamento de Higiene Veterinária e Saúde Pública UNESP Faculdade de Medicina Veterinária e Zootecnia Departamento de Higiene Veterinária e Saúde Pública UNESP FMVZ UNESP FMVZ Departamento de Higiene Veterinária e Saúde Pública