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The present study aims at investigating the possibility of assessing performance and depuration conditions of an activated sludge wastewater treatment plant through an exploration of the microfauna. The plant, receiving textile industrial (70%) and domestic (30%) sewage, consists of a two-step biological depurating plant, with activated sludge followed by a percolating system. A total of 35 samples were analyzed during five months, and 30 taxa of protozoa and small metazoa were found. Epistylis rotans, Vorticella microstoma, Aspidisca cicada and Arcella sp. were the most frequent protozoa identified. Several significant correlations between biological, physical–chemical and operational parameters were determined, but no significant correlations could be established between biological parameters and removal efficiencies. The Sludge Biotic Index (SBI) reflected the overall state of the community but only presented statistically significant correlations with the influent total suspended solids (TSS), total suspended solids in mixed-liquor (MLTSS) and dissolved oxygen (DO). The determination of key groups and taxa along with general community parameters showed to have potential value as indicators of the depuration conditions. Despite the impossibility of correlating biological parameters and the removal efficiencies, the present study attests the value of the microfauna to assess the operation of the activated sludge systems even in the case of non-conventional plants and/or plants receiving industrial sewage., The authors gratefully acknowledge Carla Sa Carneiro and Joana Silva from Ecobarcelos, A.C.E. The financial support from the Portuguese Foundation for Science and Technology (FCT) and European Community fund FEDER, trough Program COMPETE, in the ambit of the Project FCOMP-01-0124-FEDER-007025 (PTDC/AMB/68393/2006) is gratefully acknowledged. The authors also thank the FCT Strategic Project PEst-OE/EQB/LA0023/2013, the FCT Project RECI/BBB-EBI/0179/2012 (FCOMP-01-0124-FEDER-027462) and the Project "BioEnv - Biotechnology and Bioengineering for a sustainable world", REF. NORTE-07-0124-FEDER-000048, co-funded by the Programa Operacional Regional do Norte (ON.2 - O Novo Norte), QREN, FEDER.

The scope of this article is to analyze the characteristics of scientific literature on work and education in health in Brazil from 1990 to 2010. A synthetic study was conducted from abstracts published in Brazilian journal articles selected from the SCIELO and LILACS databases. Five hundred and thirty-two articles were selected, categorized according to their origin, year of publication, theme, and type of study. The publication of these scientific articles increased during the period analyzed, particularly from 2007 onwards. The main areas researched were education and training of health professionals, and the majority of works in these areas examine curriculum reform, methods of learning and teaching, and teaching in-service experiences. Besides these issues, others questions were addressed such as the labor market configuration and trends in health, and characteristics of the work process in several areas, like primary healthcare units. It was also observed that there are only a small number of studies related to policy, planning and management of work in public and private health institutions, as well as a scarcity of studies presenting reflections on theoretical and conceptual aspects of this theme.

Biodegradable polydioxanone stents were developed for the treatment of refractory benign esophageal strictures but have been suggested as a new therapeutic option for intestinal strictures. The primary advantage of biodegradable stents over self-expandable metallic stents is that removal is not required. There are, however, few data available on their use in the small or large bowel. We herein describe the case of a 33-year-old patient with long-standing Crohn's disease (CD) who developed a fibrotic stricture of the sigmoid too long to be amenable to balloon dilation. The use of a biodegradable polydioxanone stent was chosen to avoid surgery. Combined endoscopic and fluoroscopic placement of the stent was technically simple, safe and clinically successful, and no recurrence of obstructive symptoms occurred during a 16-mo follow-up. Further studies are needed to evaluate the long-term efficacy and safety of biodegradable stents in the treatment of intestinal strictures, particularly in the context of CD.

Background/Aims: To compare biomechanical properties of vaginal tissues between women with and without pelvic organ prolapse (POP) and investigate factors that may influence these properties. Methods: Forty patients submitted to POP surgery and 15 non-POP cadavers were evaluated. The tissue was excised from anterior and posterior middle third vagina. The biomechanical properties considered were stiffness (E) and maximum stress (Smax), and they were evaluated by means of uniaxial tension tests. Results: POP patients were associated with higher values of E (13.1 ± 0.8 vs. 9.5 ± 0.7 MPa; p < 0.001) and Smax (5.3 ± 0.5 vs. 3.2 ± 0.9 MPa; p < 0.001) in the anterior vaginal wall compared to the posterior wall. In contrast, non-POP women presented lower values of E (6.9 ± 1.1 vs. 10.5 ± 1.0 MPa; p = 0.01) and Smax (2.6 ± 0.4 vs. 3.5 ± 0.4 MPa; p = 0.043) in the anterior wall. The occurrence of POP was the only independent predictor of higher values of E and Smax in anterior vaginal samples (p = 0.003 and p = 0.008, respectively). Women with severe anterior vaginal prolapse presented higher levels of E and Smax in the anterior sample compared to those with lower POP stages (p = 0.001 and p = 0.01; respectively). Conclusion: Women with POP present significant changes of biomechanical properties in the vagina.

The aim of this study is to characterize and model the damage process in the anterior rectus abdominal aponeurosis (anterior rectus sheath) undergoing finite deformations. The resistance of the anterolateral abdominal aponeuroses is important when planning the surgical repair of incisional hernias, among other medical procedures. Previous experiments in prolapsed vaginal tissue revealed that a softening process occurs before tissue rupture. This nonlinear damage behaviour requires a continuum damage theory commonly used to describe the softening behaviour of soft tissues under large deformations. The structural model presented here was built within the framework of non-linear continuum mechanics. Tissue damage was simulated considering different damage behaviours for the matrix and the collagen fibres. The model parameters were fit to the experimental data obtained from anterior rectus sheath samples undergoing finite deformations in uniaxial tension tests. The tests were carried out with samples cut along the direction of the collagen fibres, and transversal to the fibres. Longitudinal and transverse mechanical properties of human anterior rectus sheath are significantly different. The damage model was able to predict the stress–strain behaviour and the damage process accurately. The error estimations pointed to an excellent agreement between experimental results and model fittings. For all the fitted data, the normalized RMS error e presented very low values and the coefficient of determination R 2 was close to 1. The present work constitutes the first attempt (as far as the authors know) to present a damage model for the human rectus sheath.

Mucolipidosis type II α/β is a severe, autosomal recessive lysosomal storage disorder, caused by a defect in the GNPTAB gene that codes for the α/β subunits of the GlcNAc-phosphotransferase. To date, over 100 different mutations have been identified in MLII α/β patients, but no large deletions have been reported. Here we present the first case of a large homozygous intragenic GNPTAB gene deletion (c.3435-386_3602 + 343del897) encompassing exon 19, identified in a ML II α/β patient. Long-range PCR and sequencing methodologies were used to refine the characterization of this rearrangement, leading to the identification of a 21 bp repetitive motif in introns 18 and 19. Further analysis revealed that both the 5' and 3' breakpoints were located within highly homologous Alu elements (Alu-Sz in intron 18 and Alu-Sq2, in intron 19), suggesting that this deletion has probably resulted from Alu-Alu unequal homologous recombination. RT-PCR methods were used to further evaluate the consequences of the alteration for the processing of the mutant pre mRNA GNPTAB, revealing the production of three abnormal transcripts: one without exon 19 (p.Lys1146_Trp1201del); another with an additional loss of exon 20 (p.Arg1145Serfs*2), and a third in which exon 19 was substituted by a pseudoexon inclusion consisting of a 62 bp fragment from intron 18 (p.Arg1145Serfs*16). Interestingly, this 62 bp fragment corresponds to the Alu-Sz element integrated in intron 18.This represents the first description of a large deletion identified in the GNPTAB gene and contributes to enrich the knowledge on the molecular mechanisms underlying causative mutations in ML II.

Family integrity is a normal challenge to the development of elderly people, influenced by family factors. This study aims at contributing to a better understanding of family integrity in later life. A semi-structured open interview (based on King & Wynne, 2004) was administered to 8 participants aged over 64 years old. Main results suggest that family integrity is influenced by: i) identity readjustment supported by a life philosophy; ii) existence of emotional proximity in family relationships; iii) acceptation of past or present conflicts; iv) satisfaction with the legacy transmission; v) continuity in family relationships; vi) life projects centred on the future. Family integrity does not exclude negative current or past events, but involves the acceptance of life as it is/was, integrating all life in a peaceful meaning. The intervention must help elderly people accepting the self and the other, so the path to family integrity is facilitated., L’intégrité familière constitue un défi normal dans le développement des personnes âgées, fortement influencé par des facteurs du système familier. Cette étude prétend approfondir la connaissance sur ce qui contribue au développement du sentiment d’intégrité familière chez les personnes âgées. La collecte de données s’est effectuée avec l’application d’une interview semi structurée (basée sur King & Wynne, 2004), dirigée à 8 personnes ayant plus de 64 ans (5 femmes et 3 hommes), ils vivent dans un contexte familier. Les principaux résultats suggèrent que le sens d’intégrité familière chez la personne âgée soit influencé par: i) la redéfinition de l’identité personnelle soutenue par une philosophie de vie; ii) l’existence de proximité affective dans les relations; iii) l’acceptation de conflits ; iv) la satisfaction avec la transmission de legs; v) la continuité des relations familières; vi) l’existence de projets de vie future. L’intégrité n’exclut pas de contrariétés et d’angoisse, mais elle les implique dans une signification de paix avec la vie. Dans l’intervention les personnes âgées doivent être soutenues dans le processus d’acceptation d’elle et de l’autre, donc celui-ci est un mécanisme de facilité de l’intégrité familière., A integridade familiar constitui um desafio normal no desenvolvimento das pessoas idosas, fortemente influenciado por factores do sistema familiar. Este estudo pretende aprofundar o conhecimento sobre o que contribui para o desenvolvimento do sentimento de integridade familiar em pessoas idosas. A recolha de dados efectuou-se com a aplicação de uma entrevista semi-estruturada (baseada em King & Wynne, 2004), administrada a 8 indivíduos com idade superior a 64 anos (5 mulheres e 3 homens), que vivem em contexto familiar. Os principais resultados sugerem que o sentido de integridade familiar na pessoa idosa é influenciado por: i) redefinição da identidade pessoal sustentada por uma filosofia de vida; ii) existência de proximidade afectiva nas relações; iii) aceitação de conflitos; iv) satisfação com a transmissão de legado; v) continuidade das relações familiares; vi) existência de projectos de vida futuros. A integridade não exclui contrariedades e amarguras, mas envolve-as num significado de paz com a vida. Na intervenção as pessoas idosas devem ser apoiadas no processo de aceitação de si e do outro, pois este é um mecanismo facilitador da integridade familiar.

The aim of this study was to determine the effect of a carotenoid mixture (Capsantal FS-30-NT), containing capsanthin and capsorubin, on growth and aflatoxins (AF) production of AF-producing Aspergillus flavus isolates. Each isolate, previously isolated from paprika and chilli, was inoculated on Czapek Yeast extract Agar (CYA) medium supplemented with different amounts of capsantal (0–1%) and incubated at 10, 15 and 25 °C during 21 days. Growth rates and lag phases were obtained, and AF production was determined at 7, 14 and 21 days. None of the isolates grew at 10 °C and one isolate (UdLTA 3.193) hardly grew at 15 °C. Capsantal addition had no effect over lag phases and growth rates at 15 °C. At 25 °C capsantal reduced growth rates and increased lag phases. However, the effect of capsantal on AF production was inconclusive, because it depended on temperature or time, and most of the times it was not significant. Low temperature has been a crucial factor in AF production, regardless of the capsantal concentration tested. Industrial storage temperature for paprika and chilli use to be approximately 10 °C, so if this temperature is maintained mould growth and AF production should be prevented.

Material inheritance constitutes a challenge for families in later life. Yet inheritance decisions, the underlying reasons and motivations and patterns of family interaction have barely been studied. Research suggests that motivations fluctuate on a continuum between unconditional donation (altruism, normative obligation) and conditional donation (strategic exchange, reciprocity). However, the literature emphasises the need for further research into the motivations that constitute this continuum and on the patterns of family interaction attached to them. This exploratory study therefore sets out to examine the motivations and patterns of family interaction in the process of transmitting material inheritances. Using the critical incidents technique (CIT) 55 usable incidents were collected from 43 participants (7 donors, 16 heirs and 20 professionals). Results of this study suggest four motivations: (i) altruism driven by family solidarity; (ii) equity centred on the equal division of possessions in order to maintain family unity; (iii) strategy focused on reciprocity (I give you if you give me); (iv) egoism based on self-interest. Findings contribute to a better knowledge of the factors that promote and prevent family problems over inheritance.

Polycyclic Aromatics (PCA) are aromatic hydrocarbons and related sulphur and nitrogen compounds, containing three or more fused aromatic rings, which are considered as toxic compounds. PCA control is a complex task because the Base Oil production involves different processes with many variables such as pressure, temperature, feedstock quality, catalyst, etc. This study focuses on controlling the hydrotreating temperature as main variable in the reduction of PCA in Naphthenic Bases. Two Naphthenic distillate fractions taken from an industrial plant were hydrotreated in pilot plant at different temperatures. The results show that PCA are reduced as hydrotreating temperature increases; however there is an optimum temperature above it, the thermodynamic equilibrium of aromatic hydrogenation reverses, increasing as a result, the PCA content. These results were implemented in the industrial Unit by installing a hydrogen quench between the two industrial reactors to guarantee that the profile of temperature, due to exothermic character of some reactions, be always in the optimun operating range. Los PCA están relacionados con el contenido de Policiclo Aromáticos de más de tres anillos y moléculas asociadas de nitrógeno y azufre, los cuales son considerados como compuestos tóxicos. Hacer control de PCA es tarea compleja, pues la producción de Bases involucra diferentes procesos industriales y muchas variables de control como presión, temperatura, calidad de carga, catalizador, etc. Este estudio se enfoca en el control de la temperatura de hidrotratamiento como variable principal en la reducción de PCA en las bases Nafténicas. Se tomaron dos fracciones de destilado Nafténico de la planta industrial y se hidrotrataron en planta piloto a diferentes temperaturas. Los resultados muestran que los PCA son reducidos a medida que se incrementa la temperatura de hidrotratamiento; sin embargo se encontró una temperatura óptima de máxima reducción por encima de la cual se invierte el equilibrio termodinámico de las reacciones de hidrogenación de aromáticos, lo cual incrementa por consiguiente el contenido de PCA. Basado en lo anterior se estableció un quench de hidrógeno entre los dos reactores industriales para garantizar que el perfil de temperatura, debido a la exotermicidad de las reacciones, se mantenga en el rango óptimo de operación.

Background/Aims: This study aims to evaluate the pelvic floor (PF) tension response during simulated increased intra-abdominal pressure (IAP) and the vaginal biomechanical properties. Methods: A 3-dimensional computational finite element model for PF was developed based on magnetic resonance imaging from a nulliparous healthy volunteer. The model was used to simulate an IAP of 90 cm H2O and to evaluate the PF stresses in the longitudinal and transversal axes. The vaginal samples were obtained from 15 non-prolapsed female cadavers. A uniaxial tensile test to obtain stiffness and maximum stress of vaginal tissue in the longitudinal and transversal axes was performed. Results: The simulated IAP was associated with a similar PF stress state in the longitudinal and transversal axes. The stiffness and maximum stress in vaginal tissues presented a great variability between subjects. There was no difference in the vaginal tissue elasticity (6.2 ± 1.5 vs. 5.4 ± 1.1 MPa; p = 0.592) and maximum stress (2.3 ± 0.5 vs. 2.6 ± 0.9 MPa; p = 0.692) regarding the measurements in the longitudinal and transversal axes. Conclusion: The isotropic biomechanical behavior of vagina is in agreement with the PF stress state response during increased IAP.

Tese de mestrado, Ecologia e Gestão Ambiental, 2009, Universidade de Lisboa, Faculdade de Ciências Nível de preservação: critical, Criado em: 2009-12-21 14:15:27, Criado por: creator:LSARAM, Alterado em: 2009-12-21 15:24:58, Modificado por: viewer:internal Made available in DSpace on 2010-07-27T08:58:09Z (GMT). No. of bitstreams: 2 20475_ulfc080625_tm.pdf: 853706 bytes, checksum: cd0eb9c675c97472db1397b6d6163f00 (MD5) 20475.xml: 8226 bytes, checksum: aa3a505155bd6014b4883d289aa45adc (MD5) Previous issue date: 2009 Portugal. Faculdade de Ciências da Universidade de Lisboa, Centro de Biologia Ambiental

Background: Fatalities resulting from paraquat (PQ) self-poisonings represent a major burden of this herbicide. Specific therapeutic approaches have been followed to interrupt its toxic pathway, namely decontamination measures to prevent PQ absorption and to increase its excretion from organism, as well as the administration of anti-inflammatory and immunosuppressive drugs. Until now, none of the postmortem studies resulting from human PQ poisonings have assessed the relationship of these therapeutic measures with PQ toxicokinetics and related histopathological lesions, these being the aims of the present study. Methodology/principal findings: For that purpose, during 2008, we collected human fluids and tissues from five forensic autopsies following fatal PQ poisonings. PQ levels were measured by gas chromatography-ion trap mass spectrometry. Structural inflammatory lesions were evaluated by histological and immunohistochemistry analysis. The samples of cardiac blood, urine, gastric and duodenal wall, liver, lung, kidney, heart and diaphragm, showed quantifiable levels of PQ even at 6 days post-intoxication. Structural analysis showed diffused necrotic areas, intense macrophage activation and leukocyte infiltration in all analyzed tissues. By immunohistochemistry it was possible to observe a strong nuclear factor kappa-B (NF-kappaB) activation and excessive collagen deposition. Conclusions/significance: Considering the observed PQ levels in all analyzed tissues and the expressive inflammatory reaction that ultimately leads to fibrosis, we conclude that the therapeutic protocol usually performed needs to be reviewed, in order to increase the efficacy of PQ elimination from the body as well as to diminish the inflammatory process. info:eu-repo/semantics/publishedVersion

European Biotechnology Congress 2015, Bucharest, Activated-sludge represents a component of the largest biotechnology in the world: wastewater treatment. Yet it differs substantially from the large-scale production of economically important metabolites or biomass: for decades, the aerating tanks of the wastewater treatment plants (WWTP) have remained black boxes, its complexity discouraging most microbiologists. Moreover, studies integrating both the prokaryotic and the eukaryotic populations in activated-sludge are, even presently, rare. Particularly, there is an assumed difficulty in establishing how the interactions between the bacterial and the protozoa populations can affect the performance of the activated sludge system. On the other hand, excessive growth of filamentous bacteria is considered the main concern of WWTP managers. It is said that every WWTP in the world went, go or will go through the well-known phenomena of filamentous bulking or foaming. It is also said that the basis for understanding and fighting these problems depends on the proper identification of the causing microorganisms: by acting upon the factor favoring the problematic species, one can expect to control its overgrowth. In the 80s and 90s of the last century, some surveys suddenly revealed the extent and severity of filamentous overgrowth. In Portugal, a detailed investigation has been carried out recently through the PROTOFILWW Project: protozoa, little metazoa and filamentous bacteria populations of 37 WWTP were extensively studied during two years. The prevalence and the correlations among the prokaryotic and eukaryotic components and between them and the operational and performance parameters will be presented.

A regionalização da saúde é objeto de políticas nacionais desde os primórdios do século XX. No Brasil, a descentralização do sistema de saúde foi um tema relevante desde o início da década de 1960, sendo destaque já na 3ª Conferência Nacional de Saúde, em 1963. A criação do Sistema Único de Saúde (SUS) aloca à problemática da descentralização e da regionalização novas texturas e um plano de complexidade que problematiza políticas, gestão e avaliação, colocando em destaque contextos locorregionais, capacidades institucionais e o cotidiano do sistema de saúde e a participação dos diferentes atores na sua configuração. Este artigo analisa a construção de uma iniciativa de regionalização desenvolvida no Estado da Bahia desde 2007, articulada à educação permanente em saúde. A iniciativa se materializou em um processo de planejamento e implementação de diversas modalidades de formaçãode quadros, como atividades de especialização, de aperfeiçoamento e de atualização no conjunto de nove macrorregiões de saúde. O plano de análise constituiu-se em duas etapas: a primeira descreve a construção epistemológica dessas iniciativas, com base em conceitos e teorias da Saúde Coletiva, da Educação e da Geografia contemporâneas; e a segunda descreve o escopo das iniciativas desenvolvidas.

Defects in apoptosis have been implicated in the resistance of cancer cells to a wide variety of anticancer drugs. XIAP, an inhibitor of both intrinsic and extrinsic apoptotic pathways by inhibiting caspases-3, -7 and -9, has been proposed as a good molecular target for enhancing the effects of cytotoxic drugs since: it is widely expressed in human cancer cell lines and human cancer tissues; downregulation of XIAP expression enhanced the effects of chemotherapeutic agents in various cancer cell line models; XIAP expression correlates with prognosis in some cancers, including in acute myeloid leukemia. Small molecules able to inhibit XIAP have been developed. Furthermore, antisense oligonucleotide inhibitors of XIAP (AEG35156) are already in clinical trials. However, the potential chemosensitization effect of XIAP has not been thoroughly explored, both concerning different tumor models and drugs. The purpose of the current study was to investigate if downregulation of XIAP enhances the effects of doxorubicin and of cytarabine, drugs used in the treatment of acute leukemias, in an in vitro model of blastic phase Chronic Myeloid Leukemia, the K562 cell line. The approach was to downregulate XIAP in K562 cells by using: transient transfection with siRNAs and stable transfection with shRNAs cloned into an appropriate vector. Two different siRNAs targeting XIAP were tested, using two different transfection conditions for siRNA delivery. Relatively modest downregulation of XIAP was observed by Western Blot, and the more potent siRNA sequence and transfection conditions were chosen for the chemosensitization studies. Our results show that downregulation of XIAP expression: reduced cellular viability but this effect was not significant; sensitized cells to doxorubicin (IC50 decreased from 78nM to 55nM) but not to cytarabine. To confirm these results, stable cell lines were established by transfection of shRNAs cloned into an appropriate vector. Modest downregulation of XIAP was achieved in the stable cell line when compared to the control shRNA cell line. In these cell lines the results confirmed that downregulation of XIAP sensitizes to doxorubicin (IC50 decreased from 68nM to 50nM) but not to cytarabine. Further analysis of the cells following treatment with the cytotoxic drugs allowed to confirm that both drugs induced programmed cell death by apoptosis (with cleavage of pro-caspase 3) and further reduction of XIAP protein levels, which is probably due to the apoptotic process itself. However, the shRNAs did not provide a better model for studying chemosensitization than the siRNAs. This fact, together with the modest levels of XIAP downregulation, probably reflects that the shRNA sequence corresponds to the siRNA sequence previously used. In conclusion, downregulation of XIAP sensitized K562 cells to doxorubicin but not to cytarabine. This may be partially due to the level of XIAP downregulation obtained but may also be due to the different mechanisms of action of these drugs, indicating that this should be taken into account when considering targeting XIAP for achieving sensitization to cytotoxic drugs.

Recently, it has been suggested an association between red cell distribution width (RDW) and Crohn's disease activity index (CDAI), but its use is not yet performed in daily clinical practice.To determine whether RDW can be used as a marker of Crohn's disease (CD) activity.This was a cross-sectional study including patients with CD, observed consecutively in an outpatient setting between January 1st and September 30th 2013. Blood cell indices, erythrocyte sedimentation rate (ESR), and C-reactive protein were measured. CD activity was determined by CDAI (active disease if CDAI ≥ 150). Associations were analyzed using logistic regression (SPSS version 20).119 patients (56% female) were included in the study with a mean age of 47 years (SD 15.2). Twenty patients (17%) had active disease. The median RDW was 14.0 (13-15). There was an association between RDW and disease activity (In this study, RDW proved to be an independent and relatively specific marker of CD activity. These results may contribute to the implementation of this simple parameter, in clinical practice, aiming to help therapeutic decisions.Recentemente, tem vindo a ser sugerida uma associação entre o valor de RDW e a atividade da doença de Crohn (DC), mas a sua utilização não está ainda implementada na prática clínica diária.Determinar se o RDW pode ser utilizado como marcador de atividade da DC.Estudo transversal, em doentes com DC, observados consecutivamente em consulta de Doença Inflamatória Intestinal, entre 1 de janeiro e 30 de setembro de 2013. Analisaram-se índices do hemograma, proteína C reativa e velocidade de sedimentação. A gravidade da doença foi avaliada peloIncluídos 119 doentes (56% do sexo feminino), com idade média de 47 anos (DP 15,2 anos). Vinte doentes (17%) tinham doença ativa. O valor do RDW mediano foi 14,0% (13-15). Verificou-se uma associação entre RDW e atividade da doença (Neste estudo, o valor do RDW demonstrou ser um marcador independente e relativamente específico da atividade da doença de Crohn. Estes resultados poderão contribuir para a aplicação deste parâmetro simples, na prática clinica diária, visando auxiliar decisões terapêuticas.

RESUMO Introdução: Para comparar a classificação de hipertensão arterial sistêmica (HAS) utilizado pelo programa de hipertensão arterial (HA) em centros de saúde com os achados de alterações retinianas encontradas compatíveis com doença hipertensiva, e para demonstrar a importância da utilização do exame oftalmoscópico como parâmetro para avaliação clínica e prognóstica da doença hipertensiva arterial, foram submetidos ao exame oftalmoscópico direto 119 pacientes inscritos no programa de HA do Centro de Saúde Avelino Vieira (CSA V), localizado na periferia de Curitiba. Resultados: A faixa etária vario u entre 2 8 e 90 anos (média = 60,1) sendo a maioria do sexo feminino (78,2%). A maior parte (62,2%) dos pacientes eram considerados pelo CSAV como portadores de HAS leve, porém quando submetidos à fundoscopia, notou-se achados vasculares retinianos compatíveis com HAS moderada (p < 0,001). Não houve relação entre idade, sexo, tem pode diagnóstico com achados oftalmológicos. Conclusões: A classificação utilizada pelo CS não foi compatível com a classificação de doença quando utilizou-se o exame oftalmoscópico. O exame oftalmológico foi de fundamental importância como coadjuvante na avaliação clínica e prognóstica da doença hipertensiva.

RESUMO O exame de acuidade visual é um teste importante na seleção dos candidatos à Carteira Nacional de Habilitação (CNH), uma vez que uma boa visão é essencial para a segurança no trânsito. Entretanto, muitos oftalmologistas recebem em seus consultórios pacientes reprovados neste teste sem alteração da acuidade visual (AV). Com o objetivo de verificar as causas de reprovação no teste da AV do Departamento de Trânsito (Detran), bem como sua sensibilidade, foram avaliados 120 candidatos à CNH, que reprovaram no exame da AV, onde verificou-se que 56 (46,7%) candidatos reprovados teriam condições de aprovação e poderiam obter qualquer tipo de CNH. O erro de refração foi encontrado em 95 (79,2%) pacientes reprovados no teste de AV do Detran. Os autores concluíram que o Detran, por ter um teste de AV muito sensível no que tange à reprovação, poderia ter fornecido a CNH para a maior parte dos candidatos sem que houvesse necessidade de encaminhamento ao oftalmologista.

A 74-year-old man attended our gastroenterology outpatient clinic with hipogastric aching pain for the past 5 years associated with recent worsening of chronic constipation. Physical examination as well as abdomino-pelvic ultrasound and colonoscopy was unremarkable. Anti-antispasmodics and dietary measures did not improve the clinical condition. For this reason, we performed an abdomino-pelvic computed tomography (CT) scan which showed thickening of the terminal ileum. The patient repeated colonoscopy with ileoscopy and regular hogback in the terminal ileum was observed that could not be overcome, lined by normal mucosa. It was biopsed, but histologic examination was normal. The entero-resonance was suggestive of nonspecific mesenteritis, but did not reveal changes in small bowel. Serologies to Crohn’s disease and celiac disease were negative. A video capsule enteroscopy was performed which revealed diffuse pattern of linfagiectasia and segmental pseudopolypoid whitish areas in jejunum and ileum (Fig. 1). Through push enteroscopy (Fig. 2) with a pediatric colonoscope, biopsies of proximal jejunum were taken. Microscopic examination demonstrated neoplastic proliferation of lymphoid tissue with follicular pattern (Fig. 3). The tumor cells were positive for CD20, CD10, BCL2, BCL6 and negative for CD3, CD5, CD23, and 5 blasts per high power field were observed. Based on these findings, a diagnosis of follicular lymphoma grade 1 was established.