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Background: Caregiver health literacy (HL) in patients' transition from hospital to home care is an important factor for good results., Methods: This cross-sectional study included 89 patient-informal caregiver dyads in Brazil. Data were collected using a sociodemographic questionnaire and the European Health Literacy Survey Questionnaire short-short form. Data were analyzed using descriptive statistics, univariate analyses, and a binary logistic regression model., Results: The caregivers' average age was 48 ± 13.48 years, and 73.0% of them were female. It was found that 6.7% of the caregivers had inadequate HL, 61.8% had problematic HL, and 31.4% had sufficient HL. Being a healthcare professional was significantly associated with sufficient HL (P = 0.016). Furthermore, healthcare workers had more years of schooling than other caregivers (15.3 ± 4.6 vs. 11.2 ± 4.6; P = 0.013). For every 1-year increase in caregiver age, there was a decrease of 0.041 points on the European Health Literacy Survey Questionnaire short-short form. Being a healthcare professional, increased HL scores by 11.4%., Conclusions: Key findings showed that caregivers with higher HL were typically younger, male, better educated, and more likely to be healthcare professionals. These caregivers managed patients with lower dependence on daily activities, while those with lower HL, mainly females, cared for patients with higher dependence. The study highlights the need for targeted interventions and public policies to enhance HL among caregivers, particularly to improve outcomes for patients with complex needs., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Soil mineralogy and texture are directly related to soil carbon due to the physical properties of the clay surface. Traditional techniques for quantifying carbon in soil are time-consuming and expensive, making large-scale quantification for mapping unfeasible. The alternative is the use of soil sensors, such as diffuse reflectance spectroscopy (DRS), an economical, fast, and accurate technique for predicting carbon stocks. In this sense, this study aimed to (a) investigate the relationship of C with different soil mineralogical, chemical, and physical attributes for different geological and geomorphological compartments; (b) understand which spectral bands are most important for estimating C content; (c) estimate C content from diffuse reflectance spectroscopy using different mathematical techniques and indicate which one is the best for tropical soil conditions; and (d) map C contents in detail. The study area was the Western Plateau of São Paulo (WPSP), which covers approximately 13 million hectares (~ 48% of the State of São Paulo, Brazil). A total of 265 samples were collected in this area. The attributes clay, silt, sand, crystalline and non-crystalline iron, base saturation, soil density, total pore volume, total C, C stock, kaolinite/(kaolinite + gibbsite) and hematite/(hematite + goethite), hematite and goethite contents, and spectral curves were evaluated. The spectra were recorded at 0.5-nm intervals, with an integration time of 2.43 nm s -1 over the 350 to 2500-nm range (350-800 nm-visible-VIS and 801-2500 nm-near-infrared-NIR). The data were subjected to descriptive statistics, Spearman correlation, stepwise analysis, and cluster grouping for characterization purposes; partial least squares regression (PLSR) and random forest (RF) for estimation purposes; and geostatistics analysis for creation of spatial maps. Our results indicate that the highest C contents are associated with more clayey soils, oxidic mineralogy, higher total pore volume, and lower soil density in highly dissected basalt compartments. The random forest algorithm associated with the Vis-NIR spectral range is more efficient for estimating and mapping C contents. This suggests that integrating diffuse reflectance spectroscopy with machine learning techniques holds promise for shaping public policies related to land use, mitigating CO 2 emissions, and facilitating the implementation of carbon credit policies in a rapid and economically efficient manner., (© 2024. The Author(s).)

Holding and restraining children during non-urgent clinical procedures continues to be surrounded by uncertainty and mired in controversy. This review aimed to locate, appraise and map the evidence related to health professionals reported and observed practice of holding and restraining children, from birth to 16 years, for clinical procedures. This scoping review, conducted in April 2022, was based on the Joanna Briggs Institute protocol. Screening and full text review resulted in the inclusion of 30 papers. In total, 14 different terms were used to refer to the act of holding or restraining a child for a procedure, in many papers the action of holding was not defined. Professionals report the main factors influencing their decisions to use restraint and/or holding were the age of a child, with younger children being restrained or held most frequently; a child's behaviour; and concerns around a child's safety. Professionals also report that they can perceive pressure from parent/carers to hold or restrain their child and describe how holding practices can be influenced by service and organisational pressures. Health professionals, mainly nurses, continue to report ethical and moral tensions linked to their involvement in the restraint or holding of a child against their will for a clinical procedure. Evidence indicates a need to move practice forward as the issues identified in paediatric practice are long-standing and historical., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The aim of this study is to evaluate the effect of different thermal pretreatments of the inoculum on the diversity of the microbial community producing hydrogen from sugarcane vinasse. High-throughput sequencing of the 16S and 18S rRNA genes was performed. The reactor samples were also selected for the isolation of strict anaerobes. Decreased microbial diversity was observed with increasing pretreatment temperatures, with Firmicutes predominating: 90% to 97%. The highest abundance of Staphylococcus (7.9%) was found in pretreatment at 120 °C / 20 min at pH 6. The fungal analysis revealed a high prevalence of Candida (47%), Agaricomycetes, Pezizomycotina and Aspergillus in assays with higher H 2 production (90° C / 10 min at pH 6). Three species of Clostridium were isolated: C. bifermentans, C. saccharoperbutylacetonicum and C. saccharobutylicum. The isolates were tested separately and in co-cultures for the production of hydrogen. Hydrogen-producing capacity by co-culture of Clostridium species was increased by 18%. Knowing microorganisms and understanding the interaction between eukaryotes and prokaryotes is essential to obtain strategies for biotransformation of vinasse for the production of bioenergy.

Background: Because MS-related fatigue could be associated with enhanced proinflammatory cytokine production, drugs with immunomodulatories properties, such as salbutamol, may represent an alternative treatment. We aimed to evaluate the effect of salbutamol on MS-related fatigue., Methods: Thirty patients with relapsing-remitting MS who were between 18 and 69 years old, and suffering from fatigue, were evaluated with the Fatigue Severity Scale (FSS) and the Brazilian version of the neurological fatigue index for multiple sclerosis (NFI/MS-BR). They received salbutamol 2 mg twice a day or a placebo in a pilot randomized, double-masked placebo-controlled trial. The primary outcome was the change in the FSS score at the end of 90 days. The secondary outcome was the efficacy, represented by changes in their scores on the NFI/MS-BR subdomains (in the same period) and the Expanded Disability Status Scale (EDSS) at the end of 90 days., Results: Thirty subjects were allocated to receive either salbutamol (14) or a placebo (16). There was no superiority of salbutamol over the placebo in the FSS outcome at 30 (p ==0.498), 60 (p = 0.854) and 90 (p = 0.240) days. There was no a significant decrease in the proportion of patients with severe or moderate fatigue in the salbutamol group at the end of the follow-up. The scores on the NFI/MS-BR and its subscales did not improve significantly with treatment. No significant difference was observed in the EDSS outcome (p = 0.313). No serious adverse events were found. An increase in heart rate was evident in the salbutamol group only in the first 30 days, but without statistical significance in relation to placebo (p = 0.077)., Conclusion: Treatment with salbutamol does not improve fatigue in patients with relapsing-remitting MS., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Membrane bioreactor (MBR) has been widely employed for industrial effluent treatment, as its higher efficiency in removing pollutants makes effluent reuse more feasible. However, membrane fouling remains as a limiting factor for its greater diffusion. This work performed a sensitivity analysis study to investigate the effects of analytical and operating variables on membrane permeability. The case study is a MBR treating oil refinery effluents. After the identification and validation of a predictive neural model for permeability, sensitivity analysis methods based on both connection weights and variable disturbances were used to quantify and rank the variables influence. A comprehensive analysis showed that Suspended solids and Days between cleanings exerted greater effects on permeability, whereas sludge filterability and sludge temperature were less significant. In sequence, a specific analysis revealed distinct dynamics in MBR operation given different solids concentrations. For instance, from higher solids concentrations, among all the evaluated parameters, only COD presented low significance to the permeability. This evidence suggests that permeability is more susceptible to variations when operating with higher concentrations of Suspended solids. The global result of this study contributes to more efficient MBR operations since distinct relations with permeability imply different effects on membrane fouling.

Household food insecurity (HFI) is a powerful stressor negatively associated with early childhood development (ECD). However, no comprehensive review has examined the association of HFI and ECD. Therefore, this systematic review and meta-analysis investigated the association between HFI and ECD domains and subdomains in children under 5 years old. Peer-reviewed and grey literature were systematically searched in electronic databases with no year or language restrictions. Studies were eligible if they assessed the association between HFI and one or more ECD domains. Data were extracted using a standard predefined protocol. Meta-analysis was performed, and the heterogeneity across studies was explored. Nineteen studies were included in the systematic review and 14 in the meta-analysis. Of the studies, 15 were from high income countries (HICs) and four from low-middle income countries (LMICs). For developmental risk and the cognitive/math and cognitive/school readiness and reading subdomains, the only studies available were conducted in HICs. The meta-analysis showed that HFI was associated with developmental risk (OR 1.28; 95% CI [1.14, 1.45]), cognitive/vocabulary (OR 0.94; 95% CI [0.90, 0.98]), and cognitive/math (OR 0.84; 95% CI [0.73, 0.96]). HFI was marginally associated with cognitive/school readiness and reading (OR 0.91; 95% CI [0.82, 1.00]) and motor development (OR; 0.91, 95% CI [0.80, 1.04]). HFI was associated with poor ECD in children under 5 years old. Specifically, HFI was associated with developmental risk and poor math skills in studies conducted in HICs and with poor vocabulary skills in studies conducted in both HICs and LMICs. Prospective studies examining HFI and ECD are needed in LMICs., (© 2020 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Objective: To identify the objectives and competencies sought by the discipline of food and nutrition education (FNE) in the training of nutritionists., Design: A qualitative study, based on the Theory of Social Representations., Setting: A total of 381 Brazilian public and private higher education institutions with undergraduate courses in nutrition were invited to complete an online questionnaire., Participants: A total of 104 professors of FNE participated in the study., Analysis: Qualitative analysis using the Discourse of the Collective Subject method and the Central Core Theory., Results: The FNE discipline aims to bring awareness to the importance of the promotion of health and food and nutrition security, to break with the biological and normative vision of food, to problematize the factors related to food, and to seek strategies of promoting healthy eating habits. In addition to preparing students for their role as educators, from planning to the evaluation of FNE actions, the intended competencies range from the development of criticality in educational practices to the application of appropriate pedagogical approaches., Conclusion: The objectives of FNE and the desired competencies are articulated and involve, among others, preparing nutritionists for their role of educators., (Copyright © 2019 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.)

Approximately 90% of pre-clinically validated drugs fail in clinical trials owing to unanticipated clinical outcomes, costing over several hundred million US dollars per drug. Despite such critical importance, translating pre-clinical data to clinical outcomes remain a major challenge. Herein, we designed a modality-independent and unbiased approach to predict clinical outcomes of drugs. The approach exploits their multi-organ transcriptome patterns induced in mice and a unique mouse-transcriptome database "humanized" by machine learning algorithms and human clinical outcome datasets. The cross-validation with small-molecule, antibody, and peptide drugs shows effective and efficient identification of the previously known outcomes of 5,519 adverse events and 11,312 therapeutic indications. In addition, the approach is adaptable to deducing potential molecular mechanisms underlying these outcomes. Furthermore, the approach identifies previously unsuspected repositioning targets. These results, together with the fact that it requires no prior structural or mechanistic information of drugs, illustrate its versatile applications to drug development process., Competing Interests: Declaration of Interests T.N.S. is the inventor of the patents filed on hMDB-i and is the scientific founder of and holds shares of Karydo TherapeutiX, Inc., which owns the right to this patent. S.K., S.F., S.E., G.M.D.A., and Y.M. are employees of Karydo TherapeutiX, Inc. Correspondence and requests for materials should be addressed to T.N.S (island1005@gmail.com)., (Copyright © 2019 The Author(s). Published by Elsevier Inc. All rights reserved.)

From the perception of human populations, we can assess the changes occurring in certain landscapes and the factors that cause those changes. Such studies have proven helpful in increasing the knowledge of the history of a landscape, recognizing past formations and projecting its future. Our research objective was to determine how a landscape dominated by the palm tree Attalea speciosa, a species of ecological, economic, and cultural importance, has been changing over time by synthesizing and comparing historical documents and local perceptions. This study was conducted in Araripe Environmental Protection Area, Northeast Region, Brazil. To understand local landscape change, we interviewed active harvesters in four communities in which A. speciosa use has been documented. Historical documents were evaluated as a complement to the interview data. According to local informants, areas previously used for cultivation and animal husbandry that were abandoned or decimated by droughts in the region may have fostered the expansion of a monodominant A. speciosa forest. Furthermore, other forms of landscape management resulting from human population growth may also have affected the current and past distribution of this forest.

Extracellular matrix (ECM) is known to play several important roles in vascular development, although the molecular mechanisms behind these remain largely unknown. RECK, a tumor suppressor downregulated in a wide variety of cancers, encodes a membrane-anchored matrix-metalloproteinase-regulator. Mice lacking functional Reck die in utero, demonstrating its importance for mammalian embryogenesis; however, the underlying causes of mid-gestation lethality remain unclear. Using Reck conditional knockout mice, we have now demonstrated that the lack of Reck in vascular mural cells is largely responsible for mid-gestation lethality. Experiments using cultured aortic explants further revealed that Reck is essential for at least two events in sprouting angiogenesis; (1) correct association of mural and endothelial tip cells to the microvessels and (2) maintenance of fibronectin matrix surrounding the vessels. These findings demonstrate the importance of appropriate cell-cell interactions and ECM maintenance for angiogenesis and the involvement of Reck as a critical regulator of these events.

Vaccinia virus (VACV), the etiological agent of bovine vaccinia (BV), is widespread in Brazil and present in most of the milk-producing regions. We conducted a horizontal study of BV in Bahia, a state of Brazil in which the production of milk is increasing. During 2011, human and bovine clinical samples were collected during outbreaks for BV diagnosis, virus isolation and molecular analysis. We collected data for epidemiological inferences. Vaccinia virus was detected in 87.7% of the analyzed outbreaks, highlighting the effective circulation of VACV in Bahia. The molecular data showed the spreading of group 1 Brazilian VACV to Bahia. We observed a seasonal profile of BV, with its peak in the drier and cooler season. Manual milking was observed in 96 % of the visited properties, showing its importance to viral spread in herds. Under-notification of BV, ineffective animal trade surveillance, and bad milking practices have contributed to the spread of VACV in Brazil.

Objective: to analyze the implementation of a trauma registry in a university teaching hospital delivering care under the unified health system (SUS), and its ability to identify points for improvement in the quality of care provided., Methods: the data collection group comprised students from medicine and nursing courses who were holders of FAPESP scholarships (technical training 1) or otherwise, overseen by the coordinators of the project. The itreg (ECO Sistemas-RJ/SBAIT) software was used as the database tool. Several quality "filters" were proposed to select those cases for review in the quality control process., Results: data for 1344 trauma patients were input to the itreg database between March and November 2014. Around 87.0% of cases were blunt trauma patients, 59.6% had RTS>7.0 and 67% ISS<9. Full records were available for 292 cases, which were selected for review in the quality program. The auditing filters most frequently registered were laparotomy four hours after admission and drainage of acute subdural hematomas four hours after admission. Several points for improvement were flagged, such as control of overtriage of patients, the need to reduce the number of negative imaging exams, the development of protocols for achieving central venous access, and management of major TBI., Conclusion: the trauma registry provides a clear picture of the points to be improved in trauma patient care, however, there are specific peculiarities for implementing this tool in the Brazilian milieu.

Amoebas of the genus Acanthamoeba are protists that are associated with human disease and represent a public health concern. They can harbor pathogenic microorganisms, acting as a platform for pathogen replication. Acanthamoeba polyphaga mimivirus (APMV), the type species of the genus Mimivirus, family Mimiviridae, represents the largest group of amoeba-associated viruses that has been described to date. Recent studies have demonstrated that APMV and other giant viruses may cause pneumonia. Amoebas can survive in most environments and tolerate various adverse conditions, including UV light irradiation, high concentrations of disinfectants, and a broad range of temperatures. However, it is unknown how the amoebal intracellular environment influences APMV stability and resistance to adverse conditions. Therefore, in this work, we evaluated the stability of APMV, either purified or carried by the amoeba host, under extreme conditions, including UV irradiation, heat and exposure to six different chemical biocides. After each treatment, the virus was titrated in amoebas using the TCID50 method. APMV was more stable in all resistance tests performed when located inside its host. Our results demonstrate that Acanthamoeba acts as a natural bunker for APMV, increasing viral resistance to extreme physical and chemical conditions. The data raise new questions regarding the survival of APMV in nature and in hospital environments.

Viruses are extremely diverse and abundant and are present in countless environments. Giant viruses of the Megavirales order have emerged as a fascinating research topic for virologists around the world. As evidence of their ubiquity and ecological impact, mimiviruses have been found in multiple environmental samples. However, isolation of these viruses from environmental samples is inefficient, mainly due to methodological limitations and lack of information regarding the interactions between viruses and substrates. In this work, we demonstrate the long-lasting stability of mimivirus in environmental (freshwater and saline water) and hospital (ventilator plastic device tube) substrates, showing the detection of infectious particles after more than 9 months. In addition, an enrichment protocol was implemented that remarkably increased mimivirus detection from all tested substrates, including field tests. Moreover, biological, morphological and genetic tests revealed that the enrichment protocol maintained mimivirus particle integrity. In conclusion, our work demonstrated the stability of APMV in samples of environmental and health interest and proposed a reliable and easy protocol to improve giant virus isolation. The data presented here can guide future giant virus detection and isolation studies.

Marshall's syndrome is a form of acquired cutis laxa without systemic involvement, which is preceded by an inflammatory dermatitis with a neutrophilic component. We report a case of a 6-year-old boy with clinical and histopathological features of this syndrome. The etiology remains unknown and there is no definitive treatment.

Dyspnea, hunger for air, and urge to flee are the cardinal symptoms of panic attacks. Patients also show baseline respiratory abnormalities and a higher rate of comorbid and antecedent respiratory diseases. Panic attacks are also precipitated by infusion of sodium lactate and inhalation of 5% CO₂ in predisposed patients but not in healthy volunteers or patients without panic disorder. Accordingly, Klein [Klein (1993) Arch Gen Psychiatry 50:306-317] suggested that clinical panic is the misfiring of an as-yet-unidentified suffocation alarm system. In rats, selective anoxia of chemoreceptor cells by potassium cyanide (KCN) and electrical and chemical stimulations of periaqueductal gray matter (PAG) produce defensive behaviors, which resemble panic attacks. Thus, here we examined the effects of single or combined administrations of CO₂ (8% and 13%) and KCN (10-80 μg, i.v.) on spontaneous and PAG-evoked behaviors of rats either intact or bearing electrolytic lesions of PAG. Exposure to CO₂ alone reduced grooming while increased exophthalmus, suggesting an arousal response to non-visual cues of environment. Unexpectedly, however, CO₂ attenuated PAG-evoked immobility, trotting, and galloping while facilitated defecation and micturition. Conversely, KCN produced all defensive behaviors of the rat and facilitated PAG-evoked trotting, galloping, and defecation. There were also facilitatory trends in PAG-evoked exophthalmus, immobility, and jumping. Moreover, whereas the KCN-evoked defensive behaviors were attenuated or even suppressed by discrete lesions of PAG, they were markedly facilitated by CO₂. Authors suggest that the PAG harbors an anoxia-sensitive suffocation alarm system which activation precipitates panic attacks and potentiates the subject responses to hypercapnia., (Copyright © 2011 IBRO. Published by Elsevier Ltd. All rights reserved.)

Background and Objectives: The brachial plexus represents an important network of nerves, commonly approached in nerve blocks prior to surgical procedures. Therefore, the knowledge of its anatomy is indispensable so those procedures can be carried out accordingly. The objective of the present study was to analyze the morphology of brachial plexus cords with special emphasis to its topographic relationships., Methods: This study was undertaken by dissecting the cervical, axillary, and brachial regions of a human cadaver fixed in 10% phormol, from the Human Anatomy Laboratory of the Morphology Department of Universidade Federal de Santa Maria. Access to the cords was obtained by pushing back the pectoralis minor and pectoralis major muscles, clavicular section, and extraction of part of the subclavius muscle., Results: Cords originated from the anterior and posterior divisions of the trunks (upper, middle, and lower) of the brachial plexus. The lateral fascicle originated from the anterior divisions of the upper and middle trunks; the posterior, from the posterior divisions of the trunks; and the middle fascicle consisted from the continuation of the anterior division of the lower trunk. The cords showed relationships with the axillary artery, and they were located posteriorly to the pectoralis minor muscle, close to its insertion on the coracoid process., Conclusions: The results were in concordance with the anatomical descriptions of classical authors. This study allowed the analysis of the morphology of the brachial plexus cords, demonstrating its main topographic relationships., (© 2010 Elsevier Editora Ltda. All rights reserved.)

The emergence of less common fungal pathogens has been increasingly reported in the last decade. We describe 25 cases of Rhodotorula spp. isolated from blood cultures at a large Brazilian tertiary teaching hospital from 1996-2004. We also investigated the in vitro activity of four antifungal drugs, using a standardized method. The median age of patients was 43 years. The majority of patients (88%) had a central venous catheter (CVC) and 10 (40%) were recipients of a bone marrow transplant. The episode was classified as a bloodstream infection (BSI) in 80% of the patients. Amphotericin B deoxycholate was the most common antifungal used and CVC was removed in 89.5% of the patients. Death occurred in four patients (17.4%), all classified as BSI. All strains were identified as R. mucilaginosa by conventional methods. Misidentification of the species was observed in 20% and 5% of the strains with the Vitek Yeast Biochemical Card and API 20C AUX systems, respectively. Amphotericin B demonstrated good in vitro activity (MIC50/90, 0.5 microg/ml) and the MICs for fluconazole were high for all strains (MIC50/90, >64 microg/ml).

Rhodotorula spp. are emergent opportunistic pathogens, particularly in immunocompromised individuals. They have been associated with endocarditis, peritonitis, meningitis endophthalmitis and catheter-associated fungemia. The aim of this study was to review all cases of central venous catheter-related fungemia due to Rhodotorula spp. reported in the literature in order to determine the best management of this uncommon infection. All patients but one in the 88 cases examined had some form of underlying disease including sixty-nine (78.4%) who had cancer. Rhodotorula mucilaginosa was the species most frequently recovered (75%), followed by Rhodotorula glutinis (6%). Amphotericin B deoxycholate was the most common antifungal agent used as treatment and the overall mortality was 9.1% in this review. This fungemia is a rare disease which can be found in immunocompromised and in the intensive care patients. The use of specific antifungal therapy may be associated with an increase in the survival. It should be noted that Rhodotorula spp. is resistant to fluconazole.

In vitro susceptibility of 58 isolates of Pichia anomala to five antifungal drugs using two broth microdilution methods (CLSI and EUCAST) was analyzed. Low susceptibility to itraconazole was observed. Fluconazole, voriconazole, amphotericin B, and caspofungin showed good antifungal activity, although relatively high drug concentrations were necessary to inhibit the isolates.

Two cases of spontaneous bacterial peritonitis (SBP) caused by Listeria monocytogenes in cirrhotic patients are reported. In one of the cases, the microorganism was isolated from pleural effusion and ascites. SBP is a serious and common complication of patients with ascites caused by hepatic cirrhosis and the culture of the ascitic fluid is an important tool for the diagnosis and for the more appropriate treatment. Although a third generation cephalosporin has usually been employed for empiric treatment of SBP, it does not provide adequate coverage against Listeria spp. In such cases the use of ampicillin (with or without sulbactam) or sulfamethoxazole-trimethoprim is recommended. The last one is used for secondary prophylaxis, instead of norfloxacin. To summarize, Listeria monocytogenes infection is a rare cause of SBP, whose treatment should be specific for the bacteria.

The pathophysiology of oropharyngeal candidiasis in patients infected with human immunodeficiency virus (HIV) type 1 is poorly understood. Association between oropharyngeal yeast carriage and various clinical factors in HIV-1-infected patients was studied in 83 patients with no clinical evidence of thrush and no recent antifungal use. Of the clinical factors measured, the only correlate of yeast colonization was with plasma HIV-1 RNA levels (P=.001), whereas the correlation with CD4 cell count was poor (P=.36). By multivariable regression modeling, plasma HIV-1 RNA was the only parameter that correlated with the extent of colonization with Candida infection (P=.003). These data indicate that the presence and amount of asymptomatic oropharyngeal yeast carriage in persons with HIV-1 infection is more significantly correlated with plasma HIV-1 RNA levels than with CD4 cell count. Further studies on the effect of HIV-1 on oropharyngeal yeast colonization, infection, and local immunity are warranted.

Multiple isolates of Cryptococcus neoformans, including those with fluconazole resistance, were tested to assess the in vitro activity of the new triazole TAK-187. MICs of TAK-187 were at least eightfold lower than those of fluconazole, and fungicidal concentrations for most isolates were 4 microg/ml or less. TAK-187 also was evaluated as intermittent therapy using two dosages in a rabbit model of experimental cryptococcal meningitis. Compared to daily treatment with fluconazole, as little as two doses of TAK-187 given 7 days apart were found to be effective. Plasma and cerebrospinal fluid TAK-187 concentrations were many times higher than MICs and fungicidal concentrations. Based upon its therapeutic efficacy and long half-life in the rabbit model, TAK-187 should be investigated for intermittent dosing in treatment or suppression of cryptococcal infections in humans.

A 55-year-old woman with chronic spinal subdural hematoma, diagnosed by magnetic resonance (MR) is presented. There was no coagulation defect, anticoagulant therapy, or trauma.

The authors describe two patients with the association of polyposis-coli and central nervous system tumor (Turcot's syndrome). Clinical, genetic and therapeutic aspects are discussed.

A case of a acoustic neuroma with a two-stage removal due to severe bleeding is presented. The patient remained drowsy after the second operation and by the 8th day deteriorated quickly with progressive right hemiplegia and aphasia. The cerebrospinal fluid was bloody, vasospasm was shown in the angiograms, and an ischemic area was disclosed in the computed tomography scan. The outcome and the neuroradiologic examinations suggested that blood in the basal cisterns caused the vasospasm and the brain ischemia. A review of the literature disclosed only one similar case.

A case of calcified choroid plexus papilloma in a 7 years old child is reported. The radiologic findings are discussed.

In the vast majority of techniques used to treat carotid-cavernous fistulas the carotid artery has been occluded. Occlusion of the fistula with preservation of carotid blood flow is achieved by new techniques as those proposed by Parkinson, Serbinenko and Mullan. However the sophisticated equipments and surgical acts which are needed for these methods has not allowed its general use. The use of Fogarty type balloon catheters has had a place in the treatment of carotido-cavernous fistulas. The carotid artery has to be occluded too, but the procedure is much safer and easier. Our results in a series of 6 cases are reported. Considerations about indications and the technical aspects are made. The results were good and the procedure may be used with conventional equipment.

The case of 15 years old boy with an enterogenous cyst causing compression of the spinal cord at T-2 is reported. The diagnosis was made by thoracic laminectomy and confirmed by histological examination. The motor disorders improved progressively after surgery.

The radiological findings of syringomyelography are described in a five years old patient who underwent a percutaneous injection of opaque contrast medium (Lipiodol) into the intraspinal syringomyelic cavity. The clinical picture, the usual diagnostic methods and the place of syringomyelography for the diagnosis of syringomielia are discussed.

Techniques of microsurgical revascularization are reviewed. A series of 5 cases, submitted to 6 anastomosis of the superficial temporal artery is presented.

An 88-year-old man was found at laminectomy to have an encapsulated spinal epidural hematoma. The surgical result was gratifying and reinforced a recent statement that spinal surgical procedures in the very elderly should not be withheld on the basis of age alone. Moreover, the rarity of this pathology in this age group and the clear identification of the lesion on the computed tomography scan of this case are to be noted.

Solitary granulomatous lesions due to cysticercosis in the brain were found by computed tomography in six patients. The CT images were in all cases very similar to those from brain neoplasms. The cerebrospinal fluid complement fixation test for cysticercosis was negative in all of the cases. The definite etiological diagnosis could only be made by craniotomy in this series.

The differential diagnosis between brain atrophy versus subdural effusion in children has shown some difficulties in a few cases, mainly when the frontal subarachnoid space is very large on computed tomography. We think that a simple procedure, that is, CT scans in the lateral and prone position following the standard examination, may be worth to clarify those cases of doubtful diagnosis.

Computed Tomography (CT) has been very useful in the follow-up of patients with brain tumors. Soon after the craniotomy, CT would show any residual tumor if an incomplete excision was done. CT has been essential when one needs to evaluate any deterioration in the patient's neurological status post operatively. In such instances, CT may detect brain edema, hematoma, hydrocephalus and the presence of air. CT findings are more accurate than those obtained from conventional neuroradiology or from intracranial pressure monitoring, being also more innocuous than those methods. Later in the post operative follow-up, CT allows, besides precocious diagnosis of tumor recurrences, a good evaluation of the results obtained by chemiotherapy or radiotherapy. When hydrocephalus is accompanying the primary pathology, ventricular size can be rapidly evaluated by CT. Difficulties may arise when one wishes to differentiate CT images of radionecrosis from tumor recurrences at least in the initial stages.