RESUMO
Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.
Assuntos
Humanos , Feminino , Idoso , Actinomicose/diagnóstico , Abdome/anormalidades , Lipossarcoma/diagnóstico , Diagnóstico DiferencialRESUMO
Actinomycosis is an uncommon, endogenous, and chronic infection with varied and nonspecific clinical features such as abdominal, pelvic or cervical masses, ulcerative lesions, abscesses, draining fistula, fibrosis, and constitutional symptoms. The disease ensues when the bacteria disrupt the mucosal barrier, invade, and spread throughout interfascial planes. Currently, the diagnosis of actinomycosis is challenging because of its very low frequency and depending on the clinical presentation it may masquerade malignancies. Therapy consists initially in intravenous penicillin, followed by an oral regimen that may be extended until a year of treatment. A timely diagnosis is crucial to avoid extensive therapeutic attempt as surgery. However, a biopsy or drainage of abscesses and fistula's tract may be required not only as a diagnostic procedure as part of the therapy. We report the case of a 72-year-old woman with an abdominal mass initially misdiagnosed as a liposarcoma. A second biopsy of a skin lesion of the abdominal wall made the diagnosis of actinomycosis, avoiding a major surgical procedure. The patient was treated with a long-term course of antibiotics with favorable outcome. Liposarcoma was ruled out after the patient's full recovery with antibiotics and the misdiagnosis was credit to the overconfidence on the immunohistochemical positivity to MDM2.
RESUMO
Objetivo: Analisar os atendimentos no acolhimento com classificação de risco em uma maternidade pública terciária de Fortaleza, Ceará. Metodologia: Estudo descritivo, retrospectivo, com abordagem quantitativa, que utilizou técnica de análise documental, com amostra de 365 instrumentos para classificação de risco, realizados no setor de emergência de uma maternidade pública terciária, no período de janeiro a junho de 2016. Resultados: A maioria (57,5%) das mulheres foi classificada como pouco urgente para o atendimento, sendo classificadas com a cor verde. As principais queixas nos atendimentos foram: dor (34,5%), sangramento vaginal (17,5%) e perda de líquido (14%). Conclusão: A clientela que busca atendimento precisa ser mais bem orientada sobre os sinais e sintomas do trabalho de parto, durante as consultas de pré-natal na atenção básica.
Objective: To analyze the host with risk classification in a tertiary public maternity hospital in Fortaleza, Ceará. Methodology: A descriptive, retrospective study with a quantitative approach using a documental analysis technique, with a sample of 365 instruments for risk classification, performed in the emergency sector of a tertiary public maternity hospital, from January to June, 2016. Results: The majority (57.5%) of the women were classified as not very urgent for care being classified as green. The main complaints were pain (34.5%), vaginal bleeding (17.5%) and fluid loss (14%). Conclusion: Clients seeking care need to be better informed about the signs and symptoms of labor during prenatal consultations in basic care.
Objetivo: Analizar la acogida con clasificación de riesgo en una maternidad pública terciaria de Fortaleza, Ceará. Metodología: Estudio descriptivo, retrospectivo, con abordaje cuantitativo, que utilizó técnica de análisis documental, con muestra de 365 instrumentos para clasificación de riesgo, realizados en el sector de emergencia de una maternidad pública terciaria, en el período de enero a junio de 2016. Resultados: La mayoría (57,5%) de las mujeres fue clasificada como poco urgente para la atención siendo clasificadas con el color verde. Las principales quejas en las atenciones fueron: dolor (34,5%), sangrado vaginal (17,5%) y pérdida de líquido (14%). Conclusión: La clientela que busca atención necesita ser mejor orientada sobre los signos y síntomas del trabajo de parto, durante las consultas de prenatal en la atención básica.
Assuntos
Masculino , Feminino , Humanos , Acolhimento , Emergências , Enfermagem Obstétrica , Grupos de Risco , HospitalizaçãoRESUMO
Resumo A qualidade de vida familiar (QdVF) em famílias de pessoas com deficiência intelectual (DI) tem interessado investigadores, sugerindo potencialidades em termos de avaliação e intervenção. O presente artigo realizou uma revisão sistemática dos estudos empíricos que analisam a QdVF em famílias de pessoas com DI. Efetuou-se uma pesquisa bibliográfica num portal de bases de dados e recorreu-se a critérios de inclusão previamente definidos. Do total de 32 estudos selecionados, 15 recorreram ao instrumento FQOLS-2006, focando-se na análise das dimensões e domínios da mesma; 11 ao Beach Center FQOL Survey, relacionando o constructo com diversas variáveis; e seis a outras formas de avaliação, essencialmente qualitativas. Assim, a QdVF mostra-se pertinente para compreender e intervir com famílias de pessoas com DI.
Abstract Family quality of life (FQoL) for families with members who have an intellectual disability (ID) has recently captured the interest of researchers and demonstrated potential for evaluation and intervention. This paper intends to revise systematically empirical studies that analyze FQoL in families with members having ID. A bibliographic search was carried out in a database and previously defined inclusion criteria were used. From a total of 32 studies, 15 used the FQOLS-2006 that focused on the analysis of their dimensions and domains, 11 the Beach Center FQOL Survey that related the construct to other individual and family variables and six other methods to evaluate FQoL. Thus, FQoL is relevant to understand and intervene with families of persons with ID.
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Recent studies have shown Hg methylation in mangrove sediments, however, little is known about the different microorganism consortia involved. We investigated the participation of prokaryotes in general, iron-reducing bacteria-IRB, sulfate-reducing bacteria-SRB, methanogens and fungi in Hg methylation and sulfate reduction rates (SRR) in mangrove sediments using iron amendments for IRB and specific inhibitors for the other microorganisms. Sediment samples were collected from two mangrove zones, tidal flat and mangrove forest (named root sediments). Samples were incubated with 203Hg or 35SO42- and Me203Hg/35Sulfur were measured by liquid scintillation. Methylmercury (MeHg) formation was significantly reduced when SRB (87.7%), prokaryotes (76%) and methanogens (36.5%) were inhibited in root sediments, but only SRB (51.6%) and prokaryotes (57.3%) in tidal flat. However, in the tidal flat, inhibition of methanogens doubled Hg methylation (104.5%). All inhibitors (except fungicide) significantly reduced SRR in both zones. In iron amended tidal flat samples, Hg methylation increased 56.5% at 100 µg g-1 and decreased at 500 and 1000 µg g-1 (57.8 and 82%). In the roots region, however, MeHg formation gradually decreased in response to Fe amendments from 100 µg g-1 (37.7%) to 1000 µg g-1 (93%). SRR decreased in all iron amendments. This first simultaneous evaluation of Hg methylation and sulfate-reduction and of the effect of iron and inhibitors on both processes suggest that SRB are important Hg methylators in mangrove sediments. However, it also suggests that SRB activity could not explain all MeHg formation. This implies the direct or indirect participation of other microorganisms such as IRB and methanogens and a complex relationship among these groups.
Assuntos
Sedimentos Geológicos , Mercúrio/análise , Compostos de Metilmercúrio/análise , Consórcios Microbianos , Poluentes do Solo/análise , Áreas Alagadas , Brasil , Sedimentos Geológicos/química , Sedimentos Geológicos/microbiologia , Ferro/química , Mercúrio/química , Metilação , Compostos de Metilmercúrio/química , Oxirredução , Poluentes do Solo/química , Sulfatos/química , Bactérias Redutoras de Enxofre/crescimento & desenvolvimentoRESUMO
Mercury (Hg) and methylmercury (MeHg) are highly toxic and poorly studied in mangroves. Burrowing Uca crabs change sediment topography and biogeochemistry and thus may affect Hg distribution and MeHg formation. We studied added (203)Hg distribution, Me(203)Hg formation and sulfate reduction rates (SRR) in sediment aquariums containing Uca leptodactyla; and analyzed profiles of Me(203)Hg formation and SRR in sediment cores from two mangroves with distinct environmental impacts. MeHg formation and SRR were higher in the top (≤6cm) sediment and there was no significant difference in Hg methylation in more or less impacted mangroves. In aquariums, crab bioturbation favored Hg retention in the sediment. In the treatment without crabs, Hg volatilization and water Hg concentrations were higher. Hg methylation was higher in bioturbated aquariums but SRR were similar in both treatments. These findings suggest that bioturbating activity favors Hg retention in sediment but also promotes MeHg formation near the surface.
Assuntos
Braquiúros , Sedimentos Geológicos , Mercúrio , Poluentes Químicos da Água , Animais , Brasil , Metilação , Compostos de Metilmercúrio , SulfatosRESUMO
The presence and formation of methylmercury (MMHg), a highly toxic form of Hg, in mangrove ecosystems is poorly studied. Therefore the aim of this study was to evaluate mercury methylation potentials in sediment, litter and root samples (Avicennia shaueriana and Spartina alterniflora) from different regions of a mangrove ecosystem, as well as the influence of salinity on methylation. Sediment was sampled under different depths and in mangrove regions with different plant covers and salinities. All samples were incubated with (203)Hg and MM(203)Hg was extracted and measured by liquid scintillation. MMHg was formed in all samples and sites tested including plant roots and litter. Higher Hg methylation was found in the superficial fraction of sediments (0.47-7.82%). Infralittoral sandy sediment had low MMHg formation (0.44-1.61%). Sediment under Rhizophora mangle had lower MMHg formation (0.018-2.23%) than under A. shaueriana (0.2-4.63%) and Laguncularia racemosa (0.08-7.82). MMHg formation in sediment tended to increase with salinity but the differences were not significant. Therefore, MMHg formation occurs in different sites of mangrove ecosystems and may be an important threat that requires further study.
Assuntos
Avicennia/química , Ecossistema , Sedimentos Geológicos/química , Compostos de Metilmercúrio/análise , Poaceae/química , Avicennia/crescimento & desenvolvimento , Brasil , Mercúrio/análise , Metilação , Folhas de Planta/química , Raízes de Plantas/química , Raízes de Plantas/crescimento & desenvolvimento , Poaceae/crescimento & desenvolvimento , Rizosfera , SalinidadeRESUMO
BACKGROUND: To evaluate the effect of magnesium (Mg) replacement on insulin resistance and cardiovascular risk factors in women with metabolic syndrome (MS) without diabetes. METHODS: This 12-week clinical randomized double-blind study compared the effects of 400 mg/day of Mg with those of a placebo (n = 72) on fasting glucose, insulin, HOMA-IR, lipid profile and CRP. Mg was measured in serum (SMg) and in mononuclear cells (MMg). RESULTS: Hypomagnesemia (SMg < 1.7 mg/dL) was seen in 23.2% of patients and intracellular depletion in 36.1% of patients. The MMg means were lower in patients with obesity (0.94 ± 0.54 µg/mg vs. 1.19 ± 0.6 µg/mg, P = 0.04), and insulin resistance (0.84 ± 0.33 µg/mg vs. 1.14 ± 0.69 µg/mg, P < 0.05). Mg replacement did not alter SMg (1.82 ± 0.14 mg/dL vs. 1.81 ± 0.16 mg/dL, P = 0.877) and tended to increment MMg (0.90 ± 0.40 µg/mg vs. 1.21 ± 0.73 µg/mg, P = 0.089). HOMA-IR did not alter in interventions nor in placebo group (3.2 ± 2.0 to 2.8 ± 1.9, P = 0.368; 3.6 ± 1.9 to 3.2 ± 1.8, respectively), neither did other metabolic parameters. CONCLUSION: Serum and intracellular Mg depletion is common in patients with MS; however, Mg replacement in recommended dosage did not increase significantly Mg levels, neither reduced insulin resistance or metabolic control.
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Mercury is a toxic pollutant and spreads to several compartments in the environment. Previous in-vitro studies showed that roots of aquatic macrophytes are sites of methylmercury formation, performed mainly by sulfate-reducing bacteria (SRB). The objective of this study was to observe MMHg formation and distribution among filtered water (0.2µm), suspended and settled particles and macrophyte roots during seventeen days, in (203)Hg- spiked mesocosms with and without live Eichhornia crassipes whole plants and a SRB inhibitor. Root samples were also incubated in-vitro for comparison of MM(203)Hg formation under in-vitro and in-vivo conditions. To evaluate the effect of SRB inhibition by sodium molybdate on total heterotrophic activity, the latter was measured by (3)H-leucine uptake. Inhibition of Hg methylation by sodium molybdate decreased with time in mesocosms. MMHg averaged 10, 12.4 and 0.23 percent of total (203)Hg present in filtered water, suspended particles and roots respectively. In vitro MMHg formation in roots averaged 5.54 percent of total added (203)Hg, with a clearer SRB inhibition effect than in mesocosms. Though significant, MMHg formation in roots from in-vivo mesocosms was one order of magnitude lower than previously found in in-vitro incubations of roots alone.
Assuntos
Eichhornia/metabolismo , Mercúrio/metabolismo , Bactérias/metabolismo , Eichhornia/química , Eichhornia/efeitos dos fármacos , Inibidores Enzimáticos/farmacologia , Mercúrio/análise , Metilação/efeitos dos fármacos , Compostos de Metilmercúrio/farmacologia , Molibdênio/farmacologia , Raízes de Plantas/química , Raízes de Plantas/efeitos dos fármacos , Raízes de Plantas/metabolismoRESUMO
Macrophyte-associated periphyton is known as a site of Hg accumulation and methylation in tropical environments. Sulfate-reducing bacteria (SRB) is found in periphyton and its role in Hg methylation is acknowledged. However, the contribution of other microorganisms to this process is largely unknown. We tested the effect of inhibitors for different microorganisms on methylmercury (MMHg) formation on distinct macrophyte species from lakes of the Bolivian Amazon basin and in Brazil. We also tested the effect of inhibitors on bacterial secondary activity at two lakes in Brazil. Samples were incubated on-site with (203)Hg and Me(203)Hg was extracted and measured by liquid scintillation. MMHg formation on macrophytes varied among species ranging from 0.2% to 36%. Treatments with specific inhibitors resulted in reduction of MMHg production on most sites and inhibitors. The most successful treatment was the co-inhibition of SRB and methanogens. The inhibitions of algae and fungi activity showed fewer effects on methylation rates at all sites analyzed. Bacterial secondary activity was slightly affected by algae and fungi inhibition, and largely influenced by prokaryotic, SRB and methanogens inhibition. The data suggest that MMHg formation may not be directly performed by all microorganisms in periphyton but depends on complex interactions among them.
Assuntos
Eichhornia/microbiologia , Mercúrio/análise , Compostos de Metilmercúrio/análise , Onagraceae/microbiologia , Polygonum/microbiologia , Poluentes Químicos da Água/análise , Biotransformação , Bolívia , Eichhornia/efeitos dos fármacos , Eichhornia/metabolismo , Sedimentos Geológicos/química , Sedimentos Geológicos/microbiologia , Herbicidas/farmacologia , Lagos/química , Mercúrio/metabolismo , Metilação , Compostos de Metilmercúrio/metabolismo , Onagraceae/efeitos dos fármacos , Onagraceae/metabolismo , Raízes de Plantas/efeitos dos fármacos , Raízes de Plantas/metabolismo , Raízes de Plantas/microbiologia , Polygonum/efeitos dos fármacos , Polygonum/metabolismo , Rios/química , Poluentes Químicos da Água/metabolismoRESUMO
This cross sectional study evaluated serum (SMg) and intramononuclear (MMg) magnesium in patients with metabolic syndrome without diabetes and correlated them with cardiovascular risk factors. 72 patients and 57 controls (blood donors) were studied. Hypomagnesemia (SMg<1.7 mg/dL) was seen in 23.2% and intracellular depletion in 36.1% of the patients. SMg and MMg means were significantly lower in patients than in controls: 1.80+/-0.18 mg/dL vs. 2.43+/-0.43 mg/dL and 0.98+/-0.55 microg/mg vs. 1.67+/-0.64 microg/mg of protein (P<0.001). Inverse correlation was observed between, SMg and MMg with BMI; SMg with systolic blood pressure and waist circumference in women. Patients with acanthosis nigricans had lower SMg (1.75+/-0.18 mg/dL vs. 1.85+/- 0.18 mg/dL, P<0.05). Non-white people had lower SMg (1.78+/-0.16 mg/dL vs. 1.92+/-0.24 mg/dL, P=0.007) and MMg (0.95+/-0.59 microg/mg vs. 1.13+/-0.42 microg/mg, P=0.03). Patients with IR showed lower MgM means (0.84+/-0.33 microg/mg vs. 1.14+/-0.69 microg/mg, P<0.05). The same occurred in patients with low HDL-c levels (0.92+/-0.46 microg/mg vs. 1.20+/-0.70 microg/mg, P=0.03), and those with moderate and severe hepatic steatosis (0.77+/-0.29 microg/mg vs. 1.21+/-0.80 microg/mg, P<0.05). In conclusion, magnesium depletion in serum and mononuclear cells is common in obese people with metabolic syndrome, and it is more evident in non-white people with insulin resistance. This depletion may contribute to a post-receptor insulin resistance.