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INTRODUCTION AND AIMS: Pancreatic steatosis is an incidental radiologic finding in asymptomatic patients, and its clinical importance is unclear. PRIMARY AIM: to study the prevalence of pancreatic steatosis (PS) in consecutive patients registered at our hospital, that underwent computed axial tomography (CAT) scanning of the abdomen and pelvis, excluding known pancreatic diseases. Secondary aim: to review the association of PS with the demographic and clinical data of the patients, as well as with hepatic steatosis (HS). MATERIALS AND METHODS: An observational study was conducted on adult patients that had CAT scans of the abdomen and pelvis. DEFINITIONS: a) tissue density was measured in Hounsfield units (HU) in five 1 cm2 areas of the pancreas, three areas of the spleen, and in segments VI and VII of the liver; b) fatty pancreas: a difference < -10 HU between the mean pancreas and mean spleen densities; and c) fatty liver: density < 40 HU. We registered the epidemiologic and laboratory data of the patients. The association of those factors with the presence of PS was analyzed using SPSS version 24.0 software, and statistical significance was set at a p < 0.05. RESULTS: Of the 203 patients, PS was found in 61 (30%). The patients with PS were significantly older and had a higher body mass index. We found no significant association with the rest of the parameters studied, nor with HS (55 patients). None of the patients had symptoms attributable to a disease of the exocrine pancreas. CONCLUSIONS: Fatty infiltration of the pancreas is a frequent finding in CAT scans, and its clinical importance is unclear. Aging of the population and the increase in obesity underline the need for future studies on PS.

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The crystal growth kinetics and interfacial properties of titanium (Ti) are studied using molecular dynamics computer simulation. The interactions between the Ti atoms are modeled via an embedded atom method potential. First, the free solidification method (FSM) is used to determine the melting temperature Tm at zero pressure where the transition from liquid to body-centered cubic crystal occurs. From the simulations with the FSM, the kinetic growth coefficients are also determined for different orientations of the crystal, analyzing how the coupling to the thermostat affects the estimates of the growth coefficients. At Tm, anisotropic interfacial stiffnesses and free energies as well as kinetic growth coefficients are determined from capillary wave fluctuations. The so-obtained growth coefficients from equilibrium fluctuations and without the coupling of the system to a thermostat agree well with those extracted from the FSM calculations.

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PURPOSE: Multidisciplinary tumour boards (MDTs) are conducted worldwide for the management of patients with cancer, and they deliver a higher standard of care by simultaneously involving different specialists in diagnosis and treatment planning. However, information of paediatric MDTs functioning is scarce. A pilot study was conducted in Spain in the frame of the European Expert Paediatric Oncology Reference Network for Diagnostics and Treatment (ExPO-r-Net). METHODS: A specific questionnaire was designed regarding various features of MDT practice. Data collected included information on the centres and the team, infrastructure for meetings, MDT organization/logistics and clinical decision-making. The survey was distributed to all Paediatric Oncology Units that register patients in the Spanish Registry of Childhood Tumours (RETI-SEHOP). RESULTS: 32 out of 43 contacted centres responded the questionnaire (74 % response rate; 88 % response rate for centres with >25 new patients/year). All units with >25 new patients/year have a dedicated Paediatric MDT compared to 76 % of units with ≤25 new patients/year. MDTs should be improved at institutional level by clear protected time in service planning for all specialists involved, incentives for attendance and attendance registration. Clinical decision-making process and follow-up of recommendation adherence should be assessed and potential legal responsibilities for physicians participating in Tumour Board defined. Network collaboration through virtual MDTs, using available videoconferencing tools, is an opportunity to share expertise among centres.

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Multidrug-resistant bacteria (MDRB) have emerged as a public health problem and the World Health Organization recommends actions to control MDRB in healthcare-associated infections (HCAIs). This study describes a surveillance programme for MDRB in HCAIs at Curitiba, Brazil. MDRB in pneumonia, bloodstream, urinary tract and surgical site infections has been surveyed since January 2010. Carbapenem-resistant Acinetobacter baumannii and third generation resistant Klebsiella pneumoniae were the most frequent MDRB in HCAIs. Infection control strategies enrolling hospitals and public health have been developed. The data presented describe MDRB prevalence and the feasibility of this municipal MDRB surveillance programme in Brazil.

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Introduction: Finding out the effect of interventions on patient's Health Related Quality of Life (HRQL), and it's comparison to the healthy population, is needed in the field of Rehabilitation. Objective: Our goal was to determine how the HRQL of patient, who receive treatment at Santiago's Teletón Institute, differed from the HRQL reported for the equivalent healthy population. Method: This study compared the results for 32 patients, between 10 and 14 years of age, carrying physical disability (secondary to cerebral palsy, myelomeningocele, and Duchenne muscular dystrophy), and 32 subjects from a control group, equivalent in age and gender. Both groups were evaluated using the Kidscreen-52. Results: A comparison between both groups showed a significant difference only for the scores in the physical well-being dimension. Throughout the rest of the dimensions, scores behaved similarly for both groups. The friends and social support dimension obtained the highest median (near 60 points) and the social acceptance dimension obtained the lowest scores (37 points), for both groups. Conclusion: The HRQL for both groups differ only in the scores obtained in the well-being dimension. This finding coincides with the presence of neuromuscular-skeletal pathology in the studied group, and could indicate that the rest of the dimensions are affected by elements other than the presence of illness. Further studies, with greater number of subject and ideally with specific measurement scales, are required to determine the variables that have a bearing on the HRQL for certain illnesses.

Introducción: En rehabilitación resulta necesario conocer el impacto de las intervenciones en la Calidad de Vida Relativa a la Salud (CVRS) de los pacientes y comparar con población de niños sanos. Objetivo: Determinar si la CVRS de los pacientes atendidos en el Instituto Teletón Santiago, difiere de la reportada por niños sanos de edades y géneros similares. Método: El estudio compara resultados de 32 pacientes de 10 a 14 años, portadores de discapacidad física (secundaria parálisis cerebral, mielomeningocele y distrofia muscular Duchenne) y 32 niños sanos emparejados por género y edad. A ambos grupos se les aplicó el instrumento genérico de medición de CVRS, Kidscreen-52. Resultados: Al comparar ambos grupos, se obtuvo una diferencia significativa en sus puntajes sólo en la dimensión de bienestar físico. En el resto de las dimensiones, los puntajes se comportaron en forma similar. Para ambos grupos, la dimensión amigos y apoyo social obtuvo la mayor mediana (alrededor de 60 puntos) y la de menor puntaje, la dimensión de aceptación social (37 puntos). Conclusión: La CVRS de ambos grupos difiere sólo en el aspecto bienestar físico, lo que concuerda con la presencia de patologías de origen neuromúsculo-esquelético en el grupo de casos, e indicaría que el resto de las dimensiones de la CVRS se ven influidas por elementos distintos a la presencia de la enfermedad. Se requiere más estudios, con mayor número de pacientes e idealmente con instrumentos específicos, para determinar las variables que inciden en la CVRS de enfermedades determinadas.

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This is a review of the main factors currently perceived as threats to the biodiversity of Amazonia. Deforestation and the expansion of the agricultural frontier go hand in hand within the context of occupation and land use in the region, followed by a hasty process of industrialization since the 1950s and, more recently, by a nation-wide attempt to adapt Brazil to economic globalization. Intensive agriculture and cattle-raising, lack of territorial planning, the monoculture of certain crops often promoted by official agencies, and the introduction of exotic species by cultivation are some of the factors affecting Amazonian biodiversity. There are still large gaps in knowledge that need to be dealt with for a better understanding of the local ecosystems so as to allow their preservation, but such investigation is subjected to manifold hindrances by misinformation, disinformation and sheer ignorance from the legal authorities and influential media. Data available for select groups of organisms indicate that the magnitude of the loss and waste of natural resources associated with deforestation is staggering, with estimated numbers of lost birds and primates being over ten times that of such animals illegally commercialized around the world in one year. The challenges to be met for an eventual reversal of this situation demand more systematic and concerted studies, the consolidation of new and existing research groups, and a call for a halt to activities depleting the Amazonian rainforest.

Este trabalho mostra um panorama dos principais fatores hoje percebidos como ameaças à biodiversidade na Amazônia. O desmatamento e a expansão da fronteira agrícola caminham lado a lado dentro do contexto da ocupação e do uso da terra na região, seguidos de um processo acelerado de industrialização desde a década de 1950 e, mas recentemente, de tentativas em escala nacional para adaptar o Brasil à globalização econômica. Agricultura e pecuária intensiva, a falta de ordenamento territorial, a monocultura de certas espécies e a introdução de espécies exóticas para cultivo são alguns dos fatores que afetam a biodiversidade da Amazônia. Ainda há grandes lacunas de conhecimento que precisam ser resolvidas para o melhor conhecimento dos ecossistemas locais de modo a possibilitar sua preservação, mas essa investigação anda sujeita a inúmeros empecilhos devido à desinformação, contra-informação e pura ignorância das autoridades legais e da mídia influente. Dados disponíveis para alguns grupos de organismos indicam que a magnitude da perda e desperdício de recursos naturais devida ao desmatamento é imensa, com estimativas de números de aves e primatas perdidos da ordem de mais de dez vezes maior que as desses animais comercializados ilegalmente em um ano em todo o mundo. Os desafios necessários a uma eventual reversão desse quadro exigem estudos mais sistemáticos e coordenados, a consolidação de grupos de pesquisa novos e já existentes, e um apelo para a cessação das atividades que exaurem a Floresta Amazônica.

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This is a review of the main factors currently perceived as threats to the biodiversity of Amazonia. Deforestation and the expansion of the agricultural frontier go hand in hand within the context of occupation and land use in the region, followed by a hasty process of industrialization since the 1950s and, more recently, by a nation-wide attempt to adapt Brazil to economic globalization. Intensive agriculture and cattle-raising, lack of territorial planning, the monoculture of certain crops often promoted by official agencies, and the introduction of exotic species by cultivation are some of the factors affecting Amazonian biodiversity. There are still large gaps in knowledge that need to be dealt with for a better understanding of the local ecosystems so as to allow their preservation, but such investigation is subjected to manifold hindrances by misinformation, disinformation and sheer ignorance from the legal authorities and influential media. Data available for select groups of organisms indicate that the magnitude of the loss and waste of natural resources associated with deforestation is staggering, with estimated numbers of lost birds and primates being over ten times that of such animals illegally commercialized around the world in one year. The challenges to be met for an eventual reversal of this situation demand more systematic and concerted studies, the consolidation of new and existing research groups, and a call for a halt to activities depleting the Amazonian rainforest.

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A 37-year-old man with a three-year history of Acquired Immunodeficiency Syndrome was admitted with impaired consciousness, seizures and fever. He was on highly active antiretroviral therapy and on neurotoxoplasmosis secondary prophylaxis. Laboratory exams from two months before showed a CD4 cell count of 37/microL and a viral load of 230,000 copies/mL. Three months before admission he developed herpetic skin rash in the right trunk and acyclovir was added to his treatment regimen. On physical exam he was drowsy and had motor and sensory aphasia. The patient had elevated protein levels and normal pressure in the cerebrospinal fluid (CSF). Contrast enhanced computed tomography scan of the brain showed a hypodense lesion in the left parietal lobe, with poorly defined margins and no contrast enhancement. The magnetic resonance scan (MRI) showed multiple hyperintensities in T2-weighted image in white and grey matters and hypointense products of hemorrhage in both hemispheres and in the cerebellum. He was empirically treated with intravenous acyclovir and prednisone. Viral DNA of Varicella-zoster virus (VZV) was detected in the CSF by means of polymerase chain reaction (PCR) analysis. Acyclovir was continued for 10 days and the patient became well, with improvement of aphasia. We present a case of VZV encephalitis, confirmed by nested PCR, in a patient with suggestive MRI findings, who succeeded with treatment. VZV encephalitis is a rare opportunistic infection, occurring in 0.1 to 4% of AIDS patients with neurological disease; it is related to severe immunodeficiency and has a high mortality.

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A 37-year-old man with a three-year history of Acquired Immunodeficiency Syndrome was admitted with impaired consciousness, seizures and fever. He was on highly active antiretroviral therapy and on neurotoxoplasmosis secondary prophylaxis. Laboratory exams from two months before showed a CD4 cell count of 37/µL and a viral load of 230,000 copies/mL. Three months before admission he developed herpetic skin rash in the right trunk and acyclovir was added to his treatment regimen. On physical exam he was drowsy and had motor and sensory aphasia. The patient had elevated protein levels and normal pressure in the cerebrospinal fluid (CSF). Contrast enhanced computed tomography scan of the brain showed a hypodense lesion in the left parietal lobe, with poorly defined margins and no contrast enhancement. The magnetic resonance scan (MRI) showed multiple hyperintensities in T2-weighted image in white and grey matters and hypointense products of hemorrhage in both hemispheres and in the cerebellum. He was empirically treated with intravenous acyclovir and prednisone. Viral DNA of Varicella-zoster virus (VZV) was detected in the CSF by means of polymerase chain reaction (PCR) analysis. Acyclovir was continued for 10 days and the patient became well, with improvement of aphasia.We present a case of VZV encephalitis, confirmed by nested PCR, in a patient with suggestive MRI findings, who succeeded with treatment. VZV encephalitis is a rare opportunistic infection, occurring in 0.1 to 4 percent of AIDS patients with neurological disease; it is related to severe immunodeficiency and has a high mortality.

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