Oral fluconazole at a dosage of 6.5-8 mg/kg/d for 28 days should not be considered an effective treatment for CL caused by L. braziliensisClinical Trials Registration. NCT01953744.

Mayaro virus (MAYV) is an emergent arbovirus first described in forest regions of the American continent, with recent and increasing notification of urban area circulation. Similar to Chikungunya (CHIKV) and other arthritogenic Alphavirus, MAYV-induced disease shows a high prevalence of persistent arthralgia, and myalgia. Despite this, knowledge regarding pathogenesis and characteristics of host immune response of MAYV infections are still limited. Here, using different ages of wild-type (WT), adult Type I Interferon receptor deficient (IFNAR–/–), and adult recombination activation gene-1 deficient (RAG–/–) mice, we have investigated the dependence of age, innate and adaptive immunity for the control of MAYV replication, tissue damage, and inflammation in mice. We have found that MAYV induces clinical signal and replicates in young WT mice, which gain the ability to restrict MAYV replication with aging. In addition, we observed that mice age and type I interferon response are related to restriction of MAYV infection and muscular inflammation in mice. Moreover, MAYV continues to replicate persistently in RAG–/– mice, being detected at blood and tissues 40 days post infection, indicating that adaptive immunity is essential to MAYV clearance. Despite chronic replication, infected adult RAG–/– mice did not develop an apparent signal of muscle damage in early and late infection. On the other hand, MAYV infection in young WT and adult IFNAR-/- mice triggers an increase in the expression of pro-inflammatory mediators, such as TNF, IL-6, KC, IL-1β, MCP-1, and RANTES, in muscle tissue, and decreases TGF-β expression, that were not significantly modulated in adult WT and RAG–/– mice. Taken together, our data demonstrated that age, innate and adaptive immunity are important to restrict MAYV replication and that adaptive immunity is also involved in MAYV-induced tissue damage. These results contribute to the comprehension of MAYV pathogenesis, and describe translational mice models for further studies of MAYV infection, vaccine tests, and therapeutic strategies against this virus.

-Objective: To identify clinical and immunological markers associated with HTLV-I associated m y e l o p a t h y / t ropical spastic paraparesis (HAM/TSP). Method: 237 HTLV-I infected individuals were clinically assessed. They were classified according to the Expanded Disability Status Scale (EDSS) and Osame's Motor Disability Score (OMDS). Cytokine levels were determined in HTLV-I seropositive individuals. R e s u l t s : 37 patients had HAM/TSP. There was a correlation between the degrees of disability assessed by both scales. T h e re was also a correlation between the duration of HAM/TSP and the severity of disability assessed by either EDSS or OMDS. Higher levels of IFN-γ w e re detected in unstimulated peripheral blood mononuclear cells (PBMC) from HAM/TSP patients as compared with HTLV-I carriers. Conclusion: This study shows the validity of the neurological scales to classify the degree of neurological disability in HTLV-I carriers and suggests a pro g ressive behavior of HAM/TSP. This study also shows that IFN-γ in PBMC supernatants are markers of HAM/TSP. KEY WORDS: human T-lymphotropic virus 1, nervous system diseases, cytokines, neurological disability. PA L AV R A S -C H AVE: v í rus 1 linfotrópico T humano, doenças do sistema nervoso, citocinas, incapacidade neurológica. Associação de citocinas, incapacidade neurológica e duração da doença em pacientes com mielopatia associada ao HTLV-I/paraparesia espástica tropical (MAH/PET) RESUMO -O b j e t i v o: Identificar marc a d o res clínicos e imunológicos associados com a mielopatia associada ao HTLV-I / p a r a p a resia espástica tropical (MAH/PET

Objective To characterize the profile and pattern of alcohol consumption in adolescents, admitted with acute alcoholic intoxication (AAI) at a pediatric emergency department of North Portugal. Methods Retrospective descriptive study of adolescents aged between 10 and 17 years, admitted with AAI between 2012 and 2016. The following variables were evaluated: age, gender, drinking context, quantity and type of alcohol, Glasgow Coma Scale (GCS), previous episodes, associated injuries, transport to the emergency department, other drug consumption, blood alcohol level (BAL), blood glucose level, treatment and orientation. The χ2/Fisher's exact test and t-Student test were performed (p < 0.05). Results A total of 180 adolescents with AAI presented. The majority of adolescents were older than 15 years old (71%) and 3% were younger than 14 years old. The mean age was 15.9 years [standard deviation (SD) 1.1 years] and 65% were males. The most common type of alcohol consumed was distilled drinks (60%). Recurrent alcohol use was identified in 7% and binge drinking was reported in 37% of patients. The mean BAL was 1.58 g/L (SD 0.6 g/L) and there were other drug consumptions (mainly cannabinoids) observed in 11% of patients. After emergency department discharge, 17% were followed at hospital consultation. There was no significant difference between boys and girls or between BAL and injuries or other drugs consumption. Conclusion This study confirms a high rate of alcohol use among adolescents, in particular "heavy episodic drinking", revealing an easy access to alcohol at this age. The integration of alcohol use prevention programs in community and education systems should be encouraged and implemented in every adolescent consultation.

-Context -Taste food recognition has an important role in the nutritional conditions and also allows protection of the organism integrity against foods potentially dangerous. Objective -To investigate the presence of the selective taste regions on the tongue and also the palate participation in the oral taste definition. Methods -A standard tongue divided in six regions was exposed with the four basic tastes (sweet, salted, sour and bitter), 10 times each. Thirteen volunteers were studied from both side and 34 only from one side, performing 240 tests with opened mouth and 240 with closing mouth, just after tongue sapid stimulation. A second group, with 12 volunteers, had its taste recognition studied, with and without palate isolation, using silicone prosthesis (n = 120).Results -From results, chi-square (3×2) and (2×2), nonparametric independency test with P = 0.05 were obtained. ConclusionsAnterior, medium and posterior regions of the tongue, at both sides, had the same taste discriminative capacity. Nevertheless, closed mouth increased immediate and late recognition capacity by palate participation. It was possible to admit that palate participation increase the sapid perception in the mouth, by recruitment of the palate taste receptors and also by fluid compression and its scattering over tongue surface.

-Background -Usually the suitable consistence identified and indicated as safe by videofluoroscopic method has been empirically obtained by association of barium sulfate solution with meals. However, it has been evidenced to be very difficult to reproduce this consistence in nutritional rehabilitation therapy from subjective information. Aim -To build two reproductive similar crescent viscosities series of solutions, with and without barium sulfate, to be used, the first, as radiological contrasted mean and the second, as base to reproduce the defined safer consistence, in the oral diet rehabilitation of dysphagic patients. Methods -Two viscosity solutions series were obtained from starch and distilled water with and without 100% barium sulfate solution. The viscosity levels were defined step by step with digital viscosimeter (Brookfield, model LVTD-II) and with infrared thermometer Icel TD -960. The fluids viscosity was register in centipoises, with their inferior and superior values followed by complimentary information about spindle kind, rotation speed and temperature. Results -The two series of solutions, with and without barium sulfate, could be defined as aqueous (>1-143,5 cP), fine liquid (428 -551 cP), thick liquid (4.284 -7.346,5 cP)), pasty (7.346,4 -13.035 cP), pasty thick (19.260 -34.320 cP) and creamy (163.500 -255.300 cP). Conclusion -The study could offer reproductive formulas, with and without contrast mean, to be follow for obtaining the desirable viscosity to be used, each of them, in radiological evaluation and in nutritional diet minimizing the gaps fails between evaluation and therapy.

Thyroid Biopsy: Value of the Association of Two Techniques. Thyroid nodules have a high incidence in the population. This study aims to observe the value of the association between the aspiration and nonaspiration biopsy and to compare the obtained cytology by these two techniques. Sixty-one patients with thyroid nodules were selected and underwent ultrasound-guided thyroid biopsies by both techniques. Quality of the obtained material was analyzed by two independent pathologists, according to five criteria. There was no difference between the techniques regarding the sum of the points of the criteria when they were analyzed together or separately (p>0.05). The kappa index between the techniques was very small (k=0.13). There was no significant difference between techniques when they were compared to the sum of the criteria according to the pathologists (p>0.05). The non-aspiration technique was superior to the aspiration one in the hyperechogenic nodules (p<0.05). The techniques provided similar quality material and the association of both techniques reduced the number of false diagnoses.

The results demonstrate that increased lipolysis of caffeine + US is due to an increase in basal and beta-adrenoceptor response by caffeine, and caffeine's effect is local, avoiding unwanted effects.