Guillain-Barre syndrome related to COVID-19: muscle and nerve biopsy findings

Background: The involvement of the peripheral nervous system (PNS) in COVID-19 is rare and, to date, morphological aspects from muscle and nerve biopsies have not been reported. Here, we describe a case of Guillain-Barré Syndrome (GBS) related to COVID-19 and demonstrate findings from peripheral nerve and skeletal muscle biopsies. A 79-year-old man presented with progressive weakness in both legs over one-week, evolving to both arms and urinary retention within 6 days. Four days earlier, he had a cough, febrile sensation and mild respiratory discomfort. On admission, his was afebrile, and without respiratory distress. A neurological examination disclosed asymmetric proximal weakness, diminished reflexes and no sensitive abnormalities. Three days later, the patient presented with bilateral facial weakness and proximal muscle strength worsened. Deep tendon reflexes and plantar responses were absent. Both superficial and profound sensitivity were decreased. From this point, oxygen saturation worsened, and the patient was placed on mechanical ventilation. CSF testing revealed one cell and protein 185 mg/dl. A chest CT showed the presence of ground-glass opacities and RT-PCR for SARS-CoV-2 was positive. The muscle biopsy revealed moderate neuromyopathic findings with positive expression for MHC-class I, C5b9, CD8 and CD68. The nerve biopsy showed inflammatory infiltrates predominantly with endoneurial compound formed by CD45 and CD68. The patient was treated with Oseltamivir for 9 days followed by IVIG for 5 days and died three days later of septic shock. Discussion: This is the first documented case of GBS associated with COVID-19 with a muscle and nerve anatomopathological study. A systematic review about neurological complications caused by COVID-19 described 11 patients with GBS. The morphological features reported in our patient showed signs of involvement of the immune system, suggesting that direct viral invasion could have played a role in the pathogenesis of peripheral nerve injury. Hereafter, further research will be necessary to understand the triggers for these cells migrating into the peripheral nerve

A atuação da advocacia pública na solução consensual dos conflitos envolvendo a administração pública no Brasil

O acentuado grau de litigiosidade na sociedade brasileira tem produzido elevadas taxas de congestionamento no Judiciário. A Fazenda Pública constitui uma das maiores litigantes do país. As demandas envolvendo a administração pública não devem ser necessariamente equacionadas pelo Estado-Juiz. Esse trabalho busca discutir os impactos das mudanças ocorridas no ordenamento jurídico brasileiro a partir de 2015 no tocante a utilização dos métodos consensuais de solução de conflitos pela Advocacia Pública. Por meio da pesquisa bibliográfica foi utilizado o método hipotético-dedutivo para aferir a compatibilidade dos mecanismos não adversariais no âmbito da Administração Pública frente à indisponibilidade do interesse público

Multiple brown tumours of tertiary hyperparathyroidism in a renal transplant recipient: : a case report

Tertiary Hyperparathyroidism (HPT) is an uncommon condition that affects patients with secondary HPT after a successful kidney transplant. Bone alterations are the main consequences of this endocrine condition, including the development of an osteolytic lesion called brown tumour. This paper reports an unusual case of multiple brown tumours located in the maxilla and mandible in a 58-year-old renal transplant recipient, with tertiary HPT. Incisional biopsies were performed and, in both samples, the histopathological diagnoses were giant cell lesions. Due to these diagnoses, the medical history of chronic renal failure, and high levels of serum calcium and PTH, lesions were diagnosed as multiple brown tumours of tertiary HPT. The lesions showed regression within the two months following a total parathyroidectomy. Minimal local interventions were established to make an early diagnosis and to treat these lesions. The diagnosis of primary oral lesions was very important in order to demonstrate the relevance of interdisciplinary activity and the inclusion of dentists as part of organ transplant units

TERRITÓRIO E FOME, CONCEITOS E REFLEXÃO

O território é algo de intensa necessidade de pesquisa, devido a sua complexidade. Atos, cultura, sociedade, relações de poder, enfim, uma série de questões que nos remete ao pensamento de como tudo isso está impregnado no local onde se desenvolveu, se torna fascinante pensar nos amores, no passado glorioso, no desenvolvimento social que um território pode apresentar. O presente artigo, inicialmente, discute os conceitos de território, desterritorialização e fome. A criação de territórios é entendida como territorialização, e sua destruição se entende por desterritorialização, seja ela em qualquer escala temporal, por menor que ela seja, e sua recriação se explica pelos processos de reterritorialização. O fenômeno da fome ocorre dentro de um território, e discuti-la não é uma tarefa fácil, já que a fome pode ser distinguida em diferentes formas segundo Josué de Castro: a endêmica ou epidêmica nas massas humanas, podendo não ser a fome de forma total, e sim a fome crônica, denominada também como fome oculta. Nesta, há falta de elementos nutritivos na alimentação cotidiana, um fenômeno que corrói silenciosamente inúmeras populações do mundo

MONITORAMENTO LIMNOLÓGICO DO RIO SÃO FRANCISCO – RJ COMO FERRAMENTA DE GESTÃO AMBIENTAL PARA AS EMPRESAS QUE O UTILIZAM COMO FONTE DE RECURSOS HÍDRICOS

The limnological monitoring is an important environmental management tool because it represents the quality of water that will be used throughout the manufacturing process, including the disposal of effluent. This paper aims to present the limnological monitoring as key instrument in making decisions of corporate environmental issues. The interfaces of the limnological monitoring and the positive impacts were discussed, both for business and for society, generated by the process of implementing an environmental monitoring program. The object of this study was the San Francisco River in the Rio de Janeiro state, as well as all industrial hub that use the river as a source of water resources. The reality is local, however the environmental theme of the discussion can be widely applied to all freshwater ecosystems where there are companies using limnologic environments as a source of water resources. Special attention was given to environmental education, a key to the implementation of any contemporary environmental activity. Social, economic, environmental, legal and cultural aspects make up the set of interfaces which the limnological assessment relates.O monitoramento limnológico do corpo hídrico é uma importante ferramenta de gestão ambiental, pois retrata a qualidade da água que será utilizada em todo o processo industrial, inclusive no descarte do efluente. O presente trabalho tem o objetivo de apresentar o monitoramento limnológico como instrumento determinante na tomada de decisões das questões ambientais empresariais. Foram discutidos as interfaces do monitoramento limnológico e os impactos positivos, tanto para as empresas quanto para a sociedade, gerados pelo processo de implantação de um programa de monitoramento ambiental. O objeto de estudo deste trabalho foi o rio São Francisco, no estado do Rio de Janeiro, assim como todo o pólo industrial que utilizam as águas do rio como fonte de recursos hídricos. A realidade é local, todavia a discussão da temática ambiental pode ser amplamente aplicada a todos os ambientes aquáticos continentais em que haja empresas utilizando ambientes líminicos como fonte de recursos hídricos. Atenção especial fora dada a educação ambiental, peça fundamental para a execução de qualquer atividade ambiental contemporânea. Aspectos sociais, econômicos, ambientais, legais e culturais compõem o conjunto das interfaces as quais o monitoramento limnológico se relaciona

Força, qualidade muscular e marcadores de risco cardiometabólico em mulheres idosas

O processo de envelhecimento está associado a um declínio nas funções fisiológicas, refletindo em reduções na qualidade muscular, bem como em alterações de marcadores de risco cardiometabólico. Nesse sentido, o objetivo do estudo foi verificar a associação entre qualidade muscular e marcadores de risco cardiometabólico em mulheres idosas. Trinta mulheres idosas (66,13±5,26 anos, 67,33±12,45 kg, 1,54±0,07 m, 28,20±4,72 IMC) foram submetidas à avaliação da espessura e força musculares do quadríceps, e à análise sanguínea de marcadores de risco cardiometabólico (glicemia, insulina basal, proteína C-reativa, colesterol total, HDL-colesterol, LDL-colesterol, VLDL-colesterol, triglicerídeos, e índice HOMA-IR). Não foram encontradas correlações significativas entre os fenótipos musculares e os marcadores de risco cardiometabólico estudados, mesmo com controle para fatores de confusão. A presente pesquisa indica não haver correlação entre força e qualidade muscular com os marcadores de risco cardiometabólico estudados.The aging process is associated with a decline in physiological functions, including a reduction in muscle quality, as well as changes in cardiometabolic risk factors. Thus, the aim of this study was to verify if a correlation exists between muscle strength and quality and cardiometabolic risk markers in older women. Thirty older women (66.13±5.26 years, 67.33±12.45 kg, 1.54±0.07 m, body mass index: 28.20±4.72) were submitted to the evaluation of muscle thickness and strength and blood analysis of cardiometabolic risk markers (glucose, basal insulin, C-reactive protein, total cholesterol, HDL-cholesterol, LDL-cholesterol, VLDL-cholesterol, triglycerides, and HOMA-IR). No significant correlations were found between muscle phenotypes and markers of cardiometabolic risk, even after adjustment for confounding factors. The present study indicates that muscle strength or quality is not correlated with markers of cardiometabolic risk

Oral lipomas in a Brazilian population : a 10-year study and analysis of 450 cases reported in the literature

Objectives: Lipomas are common benign mesenchymal neoplasms that rarely occur in the oral cavity and correspond to less than 4.4% of all benign oral soft tissue tumors. This study describes the clinical, radiological and histological features of cases of oral lipomas seen over a period of 10 years and compared the findings with those reported in the literature. Study Design: All cases of oral lipomas seen between 1999 and 2009 were retrieved from the archives of the Stomatology Division of the Federal University of Ceará, Brazil. Age, gender, tumor location, clinical findings, duration, histological subtypes, and treatment outcome were recorded. In addition, the English-language literature was searched for studies published between 1966 and 2009. Results: Ten patients (6 women and 4 men) were enrolled in this study. The mean age was 53.4 years (range: 21-73 years). The specific sites involved were the oral mucosa (n=5), vestibule (n=3), gingiva (n=1), and retromolar region (n=1). The mean size of the tumors was 1.94 cm (range 1.0 to 3.0 cm). Radiographically, only one case appeared as a radiolucent area on occlusal film. Microscopically, 4 cases were classified as simple lipoma, 4 as fibrolipoma, 1 as myxoid lipoma, and 1 as angiolipoma. The duration of the tumors ranged from 2 to 84 months, with a mean duration of 30.4 months. All cases were treated by simple surgical excision and there was no recurrence after a mean post-treatment period of 34.5 months. The findings were compared with 450 cases of oral lipomas reported in the literature. Conclusions: Lipomas continue to be an uncommon neoplasm of the oral cavity. Radiography is a valuable tool due to the possible occurrence of bone involvement. Surgical excision is the treatment of choice and recurrence is not expected

Early selection efficiency for recommendation of Eucalyptus sp.

This paper aims to estimate genetic and phenotypical parameters to assess the viability of early selection in progeny tests of Eucalyptus sp. We analyzed data from experiments conducted in the state of Minas Gerais, Brazil. The evaluated traits were diameter at breast height and plant height in 482 progenies of full sibs under randomized block design, into nine experiments: four of which were assessed at progenies mean level, and five assessed at individuals mean level. It were evaluated the predicted gains with combined selection index under 5, 10 and 20% of selection; the coincidence among selected families in juvenile and adult ages, and the efficiency of early selection. Results indicated that the procedures were efficient in most of the scenarios, and the gains comparable to the direct selection on tree harvest age