Universidade Nilton Lins

Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm caused by the t(9;22)(q34;q11.2) translocation, known as the Philadelphia chromosome (Ph+), which generates the BCR::ABL1 fusion oncogene central to CML pathogenesis. The disease accounts for approximately 15% of adult leukemias, predominantly affects males, and has a median age at diagnosis of around 57 years. CML typically presents in the chronic phase and may progress to advanced disease phases, with prognostic risk stratification guiding treatment decisions. Tyrosine kinase inhibitors (TKIs) are the cornerstone of therapy, aiming to achieve durable molecular disease control and, in selected patients, sustained deep molecular response and treatment-free remission. This study evaluated the demographic, clinical, and molecular response profiles of patients with Ph + CML treated with first- and second-line TKIs at the Fundação Hospitalar de Hematologia e Hemoterapia do Amazonas (HEMOAM). This retrospective, longitudinal study analyzed medical records of 176 patients diagnosed with Ph + CML between 2011 and 2020. Demographic characteristics, clinical data, and laboratory findings were extracted from medical records. Longitudinal molecular response was assessed in patients with available BCR::ABL1 monitoring. Among the 176 patients identified, 122 were included in the analysis of treatment outcomes. The mean age at diagnosis was 49.6 years, with a slight male predominance. Most patients were diagnosed in the chronic phase, and high-risk Sokal score was the most frequent prognostic category among evaluable cases. The e14a2 (b3a2) transcript was the most prevalent molecular subtype. Clinically meaningful molecular responses were observed in both first- and second-line treatment settings, although response assessment was influenced by real-world constraints, including incomplete molecular monitoring and heterogeneous follow-up. These findings provide real-world insights into the epidemiological, clinical, and molecular response characteristics of Ph + CML patients treated in the Amazon region. The study highlights the challenges of implementing guideline-based molecular monitoring in geographically constrained settings and supports the need for adapted strategies to optimize long-term CML management in routine clinical practice.

A Síndrome de Guillain-Barré (SGB) é uma polineuropatia aguda caracterizada por fraqueza progressiva, simétrica e ascendente, acompanhada de arreflexia ou hiporreflexia, frequentemente precedida por infecções. Por seu caráter potencialmente fatal, o reconhecimento precoce e intervenção imediata são fundamentais para evitar desfechos desastrosos. Este caso retrata uma paciente de 57 anos admitida com história de diarreia aquosa há 10 dias, já em melhora, que evoluiu com parestesia de membros superiores, seguida de plegia e, posteriormente, tetraplegia e arreflexia global. A paciente manteve o nível de consciência preservado e a força da musculatura ocular. Ressonância de neuroeixo não evidenciou alterações. Com escore de Erasmus (EGRIS) de 6 pontos, a paciente foi encaminhada à UTI. A análise do líquor não revelou dissociação proteica-citológica. Nesse contexto, foram consideradas duas hipóteses diagnósticas: Botulismo e Síndrome de Guillain Barré, variante atípica. A rápida progressão do déficit neurológico, caracterizado por plegia de membros superiores evoluindo para tetraplegia, associada a disfonia, disartria, disfagia, sialorreia e insuficiência respiratória aguda, em menos de 48 horas da admissão, levou à coleta de amostras para identificação de Clostridium botulinum e à instituição empírica de tratamento com soro antibotulínico AB e imunoglobulina. Posteriormente, o painel para gastroenterite (24 patógenos) identificou Escherichia coli enteropatogênica (EPEC) e a eletroneuromiografia evidenciou polirradiculoneuropatia desmielinizante e axonal aguda grave, confirmando o diagnóstico de Síndrome de Guillain-Barré atípica, com início nos membros superiores. Até o momento, há apenas dois relatos de caso de gastroenterocolite por EPEC associada à SGB; este constitui o terceiro, com início atípico.

Flavobacterium spp. are the etiological agents of columnaris disease. Although there is evidence that columnaris poses a significant threat to the farming of tambaqui (Colossoma macropomum), there remains a large gap in understanding the genetic and phenotypic diversities of columnaris-causing bacteria (CCB). This study was designed to identify diversity traits of CCB from tambaqui reared in Brazil. From 26 CCB outbreaks previously identified as F. columnare with MALDI-TOF were prospected. A multiplex PCR was conducted to confirm the bacterial species, while REP-PCR was used to determine the differences in genetic patterns (GP), and putative virulence genes were accessed using PCR (norB, trx and gtf). All isolates were identified as F. oreochromis by multiplex PCR. REP-PCR identified 4 genetic variants (GP1, GP2, GP3 and GP4), with GP3 being the most frequent. All the putative virulence genes were detected in all analysed strains. One strain representing each GP was subjected to the description of phenotypic traits (growth patterns, morphology and pathogenicity). The pathogenicity and patterns of virulence were assessed and achieved for all GP, and AMFO14 (GP3) displayed the highest frequency. Based on recent taxonomic advances on Flavobacterium spp. from freshwater fish worldwide, this study provides unprecedented insights regarding CCB retrieved from tambaqui.

O conceito histórico de Carbono Social foi desenvolvido ao longo de anos pelo Instituto Ecológica, a partir da amostragem de projetos que visam promover a melhoria da qualidade de vida em comunidades locais, operando créditos de carbono no Tocantins. Na COP 30, em novembro de 2025, apresentou-se um projeto, ainda em fase de elaboração, intitulado: Entre o mercado e a moralidade: mecanismos de créditos de carbono em comunidades tradicionais e ribeirinhas no Amazonas através de ferramentas da Indústria 5.0. A iniciativa fundamenta-se no Carbono Socioambiental 5.0, atrelado às tecnologias da Indústria 5.0. Essa abordagem surge como uma evolução tecnológica no mercado de carbono, substituindo trabalhos mecânicos por tecnologia moderna adaptada ao padrão amazônida uma proposta inovadora que opera nos mecanismos de crédito de carbono do estado. O projeto contempla, ainda, a repavimentação da BR-319, com soluções voltadas à mitigação de impactos ambientais, e a abertura da BR-230, estabelecendo dois eixos centrais para a economia regional. Nesse contexto, o Crédito de Carbono Socioambiental 5.0 (CCS) amplia o conceito tradicional ao incorporar dimensões ambientais, sociais, culturais e comunitárias. O objetivo é assegurar que comunidades tradicionais e ribeirinhas, protagonistas da preservação, recebam benefícios diretos e transparentes. Tal projeto, amplamente discutido pela pesquisadora Lima (UEA) na COP 30, representa uma oportunidade estratégica para a valorização da floresta em pé. Conclui-se, portanto, que a implantação do CCS 5.0 é fundamental para garantir renda, protagonismo comunitário e adaptação tecnológica, consolidando um modelo de desenvolvimento que alia justiça climática, bioeconomia e dignidade humana.

BackgroundEvidence on the accuracy and safety of the ESAT-6/CFP-10–based Diaskintest® in BCG-vaccinated populations outside Eastern Europe remains limited. In Brazil, recurrent shortages of purified protein derivative (PPD) have challenged the implementation of tuberculin skin testing, underscoring the need to evaluate alternative tools for tuberculosis infection (TBI) screening. This trial compared the diagnostic performance and safety of Diaskintest® with the tuberculin skin test (TST) using PPD Rt-23 in Brazilian adults, a predominantly BCG-vaccinated population.MethodA double-blind randomized clinical trial was conducted at eight centers in Brazil between July 2023 and September 2024. Participants were allocated to the TB group (microbiologically confirmed pulmonary TB), in whom sensitivity was estimated, and the control group (healthy, unexposed adults), in whom specificity was estimated using the QuantiFERON-TB Plus® (QFT-Plus) as the reference standard. All participants first underwent QFT-Plus testing, followed by intradermal application of Diaskintest® and TST in opposite arms, with randomized right–left allocation. Induration was measured at 48–96 h using a prespecified 5 mm cutoff. Secondary outcomes included safety, assessed through active monitoring of adverse events (AEs), included injection site reactions.ResultsA total of 337 controls and 136 TB participants were enrolled. TST showed higher sensitivity than both Diaskintest and QFT-plus (0.84 [95% CI 0.76–0.90] vs. 0.68 [95% CI 0.59–0.76], and 0.63 [95% CI 0.54–0.72], respectively). Diaskintest® demonstrated higher specificity than TST (0.93 [95% CI 0.90–0.96] vs. 0.75 [95% CI 0.70–0.80]). Injection-site reactions occurred less frequently with Diaskintest® than with TST (1.7% vs. 4.9%. RR = 0.35 [0.15–0.79]). The most common reactions were phlyctenular reactions and itching. No serious AEs were observed.ConclusionTST had greater sensitivity than Diaskintest®, whereas Diaskintest® demonstrated higher specificity and fewer local adverse reactions. In this study, specificity was estimated using QFT-Plus as a surrogate reference standard, acknowledging the absence of a true gold standard for tuberculosis infection. These complementary performance profiles highlight a trade-off between false-positive reduction and case detection, suggesting that the choice of test should consider programmatic priorities and local epidemiological context.Clinical trial registrationhttps://ensaiosclinicos.gov.br/, identifier RBR-7tn2ysw.

ABSTRACT The Amazon bioeconomy produces byproducts that have potential as ingredients in aquaculture feed. This study aims to evaluate nutritional composition, digestibility, and attractiveness of six regional byproducts - Artisanal Fish Waste Meal (FM), Defatted Brazil Nut Meal (BN), Cassava Leaf Meal (CL), Decaffeinated Guarana Bagasse (GB), Defatted Murumuru Meal (MU), and Defatted Ucuuba Meal (UC) - for use as tambaqui (Colossoma macropomum) feed. The byproducts had diverse nutrient profiles, with FM providing significantly more digestible protein and energy, followed by BN and CL. Attractiveness tests indicate that CL and BN are approached more rapidly and consumed more readily. BN and CL have potential as plant-based alternatives, due to their digestibility and attractiveness to the fish. In contrast, GB and UC were limited in both digestibility and feeding stimulation. We suggest that the byproducts FM, BN, and CL can easily be integrated into tambaqui diets, supporting sustainable aquaculture practices in the Amazon. Additional research can determine how to optimize processing and inclusion to fully exploit the functional properties of these ingredients while ensuring cost-effective and environmentally friendly fish farming.

Children who are contacts of individuals with active pulmonary tuberculosis (PTB) are at risk of acquiring Mycobacterium tuberculosis infection (TBI). We evaluated the determinants of TBI in child and adolescent contacts. Pediatric (≤ 18 years old) close contacts of PTB patients enrolled in a multi-center Brazilian observational cohort were followed up to 6 months. Clinical evaluation, radiographic examination, and interferon gamma release assay (IGRA) were performed. Positive IGRA result at baseline or month 6 (IGRA-conversion) was considered an indicator of TBI. Multivariable mixed-effects logistic regressions were performed to identify factors associated with TBI. Among 562 close contacts enrolled, 171 (30.4%) had a positive IGRA at baseline, and 37 (9.5%) converted at month 6. Positive AFB, persistent cough and cavity on chest X-ray of TB index were independently associated with a positive IGRA result at baseline. IGRA-conversion was independently associated with older age among contacts and chest X-ray cavitations in the index cases. Contacts ≥ 15.9 years old had 3.4 (95%CI: 1.49–7.78, p = 0.004) adjusted odds ratio of IGRA-conversion than those < 15.9 years old. Among pediatric close TB contacts, the prevalence of IGRA positivity increased with age. Older children have substantially higher susceptibility to TBI upon exposure.

Este Trabalho de Conclusão de Curso investiga o papel do fisioterapeuta na prevenção de complicações em pacientes internados com fração de ejeção reduzida (FER). A fração de ejeção, um indicador crucial da função sistólica do ventrículo esquerdo, é considerada baixa quando fica abaixo de 40%. Isso eleva o risco de problemas como insuficiência cardíaca descompensada, trombose venosa profunda e pneumonia. A fisioterapia é essencial na reabilitação cardiorrespiratória, na mobilização precoce e na utilização de técnicas específicas para aprimorar a função pulmonar e a capacidade funcional dos pacientes. A revisão bibliográfica integrativa conduzida evidencia a eficácia das intervenções fisioterapêuticas na diminuição da morbidade e na melhoria da qualidade de vida desses pacientes. A implementação de protocolos fisioterapêuticos específicos é fundamental para melhorar a recuperação funcional e minimizar complicações.

Wheat ( Triticum aestivum ) is a product widely used in fish feed and can have a high market value, and cheaper ingredients, such as fruit residues, have been researched as alternatives. This study aimed to investigate how whole guava ( Psidium guajava ) meal (WGM) as a substitute for wheat bran (WB) could affect juvenile Nile tilapia ( Oreochromis niloticus ) digestibility, intestinal histology, and growth, hematology, and biochemical (plasma and liver) parameters. The first experiment evaluated the apparent digestibility coefficients (ADC) (crude protein, crude energy, and dry matter) of the test diet (70 % reference diet plus 30 % WGM). Fish (n = 60) were allocated to these two treatments (in triplicate). In the second experiment, fish (n = 300) were distributed in five treatments (in quadruplicate) and were fed for 45 days with graded levels of WGM replacing WB in diets: 0 (control), 50, 100, 150, and 200 g kg −1 . The ADC of WGM was 60 %. As the level of WB replacement by WGM increased, the fish reduced the weight gain, intestinal villus height, hemoglobin, and hepatic aspartate aminotransferase (AST) activity and increased the feed conversion ratio and plasma AST activity. With 200 g kg −1 of substitution of WB by WGM, simple columnar epithelium showed an intense reaction on the cell surface. In conclusion, replacing 50 g kg −1 of WB with WGM is suggested for manufacturing practical diets for Nile tilapia. • Whole guava meal (WGM) replacing wheat bran (WB) reduced nutrient digestibility in Nile tilapia. • WGM inclusion above 50 g kg −1 impaired growth performance and intestinal villus height. • Hematological and metabolic disruptions were observed with the increase of WGM inclusion. • Replacing 50 g kg −1 of wheat bran with WGM maintained growth and health.

A Doença de Parkinson (DP) é uma patologia neurodegenerativa progressiva caracterizada por sintomas motores e não motores, que comprometem significativamente a qualidade de vida dos pacientes. Entre os sintomas motores, a alteração da marcha e a instabilidade postural se destacam como fatores determinantes de incapacidade funcional. Nesse contexto, o treino de dupla tarefa tem se mostrado uma estratégia promissora na fisioterapia, visando a melhoria da coordenação motora e da independência funcional. O presente estudo teve como objetivo analisar, por meio de uma revisão integrativa, o impacto do Treino de Dupla Tarefa (TDT) na marcha de indivíduos com Doença de Parkinson. Foram selecionados artigos publicados entre 2015 e 2025, nas bases PubMed, Scielo, LILACS e repositórios acadêmicos, utilizando descritores em saúde (DeCS/MeSH). Os resultados apontaram que o treino de dupla tarefa contribui para a melhora do padrão de marcha, aumento da velocidade, redução de episódios de freezing e maior segurança na deambulação. Conclui-se que essa abordagem fisioterapêutica representa um recurso eficaz, mas ainda necessita de protocolos padronizados para sua implementação clínica.