Combined Use of Fatty Acid Profiles and Elemental Fingerprints to Trace the Geographic Origin of Live Baits for Sports Fishing: The Solitary Tube Worm (Diopatra neapolitana, Annelida, Onuphidae) as a Case Study.

Diopatra neapolitana Delle Chiaje, 1841 (Annelida, Onuphidae) is one of the most exploited polychaete species in European waters, particularly in Ria de Aveiro, a coastal lagoon in mainland Portugal, where the overexploitation of this resource has led to a generalized decline of local populations. In an attempt to reduce the impact of harvesting, several management actions were implemented, but illegal poaching still fuels a parallel economy that threatens the sustainable use of this marine resource. The present study evaluated the combination of fatty acid profiles and elemental fingerprints of the whole body and jaws, respectively, of D. neapolitana collected from four harvesting locations within Ria de Aveiro in order to determine if their geographic origin could be correctly assigned post-harvesting. Results showed that both fatty acid profiles and elemental fingerprints differ significantly among locations, discriminating the geographic origin with higher accuracy when combining these two natural barcodes than when employing each individually. The present work can, therefore, contribute to the implementation of an effective management plan for the sustainable use of this marine resource, making it possible to detect if D. neapolitana was sourced from no-take zones and if it was collected from the place of origin claimed by live bait traders.

Effects of H2O2 pretreatment on the elemental fingerprints of bivalve shells and their implications for the traceability of geographic origin.

The fraudulent mislabelling of seafood geographic origin has been growing due to complex supply chains and growing consumer demand. To address this issue, seafood traceability tools, such as those based on elemental fingerprints (EF) of bivalve shells, have been successfully used to confirm their harvesting location. However, despite the usefulness of these methodologies, there is still room for optimization. Therefore, this study evaluated the effects of a routine procedure during bivalve shells preparation for ICP-MS analysis - their pretreatment with H2O2 to remove organic components. More specifically, the present study evaluated the effects of H2O2 on i) the elemental fingerprints of shells of two bivalve species (Ruditapes philippinarum and Cerastoderma edule) from four different locations over the north-western and the western Iberian coast, and ii) their influence on the accuracy of models (based on the EF of shells) used to confirm the geographic origin of these species. Significant differences were observed between untreated and pretreated shells of R. philippinarum (p within location ranging from 0.0001 to 0.0011) and C. edule (p ranging from 0.0001 to 0.0007 for C. edule) for both their elemental fingerprints as a whole and several individual elements. The accuracy of the models employed to determine the origin of the two bivalve species, using i) untreated shells, ii) pretreated shells, and iii) both pretreated and untreated shells grouped per location, was high, with the models accurately predicting the geographic origin of 100, 90 and 95% of R. philippinarum and 95, 100 and 95% of C. edule, respectively. These results show that the shifts in the EF of bivalve shells promoted by treating them with H2O2 prior to ICP-MS analysis did not affect the accuracy of the models used to confirm the geographic origin of both bivalve species. Therefore, the need to pre-treat bivalve shells with H2O2 can be dismissed in future studies addressing the traceability of bivalves when using ICP-MS, thus contributing to reducing environmental impacts and economic costs associated with this procedure, as well as the time required to obtain results.

Fatty Acid Profiling as a Tool for Fostering the Traceability of the Halophyte Plant Salicornia ramosissima and Contributing to Its Nutritional Valorization.

Salicornia ramosissima, commonly known as glasswort or sea asparagus, is a halophyte plant cultivated for human consumption that is often referred to as a sea vegetable rich in health-promoting n-3 fatty acids (FAs). Yet, the effect of abiotic conditions, such as salinity and temperature, on the FA profile of S. ramosissima remains largely unknown. These factors can potentially shape its nutritional composition and yield unique fatty acid signatures that can reveal its geographical origin. In this context, samples of S. ramosissima were collected from four different locations along the coastline of mainland Portugal and their FAs were profiled through gas chromatography-mass spectrometry. The lipid extracts displayed a high content of essential FAs, such as 18:2n-6 and 18:3n-3. In addition to an epoxide fatty acid exclusively identified in samples from the Mondego estuary, the relative abundance of FAs varied between origin sites, revealing that FA profiles can be used as site-specific lipid fingerprints. This study highlights the role of abiotic conditions on the nutritional profile of S. ramosissima and establishes FA profiling as a potential avenue to trace the geographic origin of this halophyte plant. Overall, the present approach can make origin certification possible, safeguard quality, and enhance consumers' trust in novel foods.

The role of neck ultrasound in the follow-up of low- and intermediate- risk papillary thyroid cancer

ABSTRACT Objective: The optimal time for a neck ultrasound (US) in the follow-up of papillary thyroid cancer (PTC) after the first year is undetermined. We aimed to verify the utility of routine neck US in the surveillance of patients diagnosed with low- and intermediate-risk PTC with no evidence of disease at the one-year assessment. Materials and methods: We conducted a retrospective longitudinal study of patients with low- and intermediate-risk PTC with normal neck US, unstimulated serum thyroglobulin (Tg) < 1 ng/mL and negative anti-Tg antibodies at the one-year follow-up. Patients were divided into group 1 [undetectable Tg (<0.20 ng/mL)] and group 2 [detectable Tg but < 1 ng/mL]. The negative predictive value (NPV) of the one-year unstimulated Tg at the five-year and last follow-up visits was calculated. Results: We included n = 88 patients in group 1 and n = 8 patients in group 2. No patient from group 1 presented suspicious US findings at the five-year evaluation [NPV: 100.0% (95% confidence interval (CI): 95.5%-100.0%)], and at the last visit, only one patient had developed a lymph node classified as suspicious [NPV: 98.8% (95% CI: 93.2%-100.0%); mean follow-up: 6.7 years]. In group 2, two patients' USs presented suspicious findings at the five-year evaluation [NPV: 75.0% (95% CI: 34.9%-96.8%)]. At the last visit, only one patient persisted with suspicious findings in the US [NPV: 87.5% (95% CI: 47.4%-99.7%); mean follow-up: 6.5 years]. Conclusion: Low- and intermediate-risk PTC with an excellent response to treatment at the one-year assessment can be safely monitored with regular unstimulated Tg assessments. Conclusions should not be drawn for Tg levels between 0.20-0.99 ng/mL.

Dolor plantar calcáneo. Experiencias y opciones de tratamiento / Calcaneal plantar pain. Experiences and treatment options

La talalgia se define como la percepción de dolor localizado en el talón que anatómicamente corresponde al hueso calcáneo y a las partes blandas colaterales, constituye la causa más frecuente de consulta a los especialistas en pie y tobillo, identificando dos zonas de aparición del dolor, el dolor plantar y el dolor posterior, los que están directamente relacionados con la inervación de esa zona del pie, realizamos un análisis general para evaluar las opciones iniciales de tratamiento y las indicaciones fisioterapéuticas exponiendo nuestra opinión y experiencias(AU)

Talalgia is defined as the perception of localized pain in the heel that anatomically corresponds to the calcaneus bone and collateral soft tissue, is the most frequent cause of consultation with foot and ankle specialists, identifying two areas of pain appearance, pain plantar and subsequent pain, which are directly related to the innervation of that area of the foot, we perform a general analysis to evaluate the initial treatment options and physiotherapeutic indications exposing our opinion and experiences(AU)

PlayStation PortableTM como tratamiento de la ambliopía en los niños / PlayStation PortableTM as treatment for children with amblyopia

Objetivo: Determinar la efectividad de la terapia visual con el uso del PlayStation PortableTM en la ambliopía. Método: Se incluyeron 40 pacientes de 5-10 años de edad con ambliopía estrábica, anisometrópica o ambas, aleatorizados en 4 grupos según el tipo de terapia a utilizar (10 pacientes por grupo): grupo 1, PlayStation PortableTM y lentes rojo-verde; grupo 2, PlayStation PortableTM y lentes con vidrio esmerilado en el ojo fijador (no ambliope); grupo 3, PlayStation PortableTM y parche oclusivo en el ojo fijador; grupo 4, parche oclusivo en el ojo fijador sin el PlayStation PortableTM. Todos los pacientes utilizaron su refracción. Las actividades de los grupos 1 al 3 incluyeron jugar videojuegos y ver películas 1-2 horas al día; el grupo 4 podía realizar cualquier actividad. Se valoró la agudeza visual mejor corregida semanalmente, hasta completar 3 meses de tratamiento. En el postratamiento se valoró la agudeza visual mejor corregida mensualmente durante 3 meses. Resultados: En total se estudiaron 40 pacientes, de los cuales el 60 por ciento fueron del sexo femenino, con un promedio de edad de 8,2 años, rango de 5-10 años. El tipo más frecuente de ambliopía fue la estrábica (55 por ciento), seguido de la anisometrópica (37,5 por ciento) y ambas (7,5 por ciento). En cuanto al ojo afectado, en el 62,5 por ciento fue el ojo izquierdo y en el 37,5 por ciento el ojo derecho. Conclusiones: En este estudio el grupo con mejores resultados fue el de filtro rojo-verde. Al suspender la terapia se observó un deterioro visual en los cuatro grupos, sin regresar a la basal. Se demuestra que el PlayStation PortableTM funciona como terapia en la ambliopía con una mejoría en la agudeza visual mejor corregida(AU)

Objective: Determine the effectiveness of visual therapy with PlayStation PortableTM for amblyopia. Methods: The study sample was composed of 40 patients aged 5-10 years with strabismic amblyopia, anisometropic amblyopia or both, randomized to 4 groups according to the therapy to be used (10 patients per group): Group 1: PlayStation PortableTM and red-green lenses; Group 2: PlayStation PortableTM and frosted glass lenses on the fixating (non-amblyopic) eye; Group 3: PlayStation PortableTM and occlusive patch on the fixating eye; Group 4: occlusive patch on the fixating eye without PlayStation PortableTM. All the patients used their refraction. The activities performed by Groups 1-3 included playing video games and watching movies 1-2 hours per day; Group 4 could perform any activity. Best corrected visual acuity was measured weekly until completing 3 months of treatment. In the post-treatment period best corrected visual acuity was measured monthly for 3 months. Results: A total 40 patients were studied, of whom 60 percent were female, with a mean age of 8.2 years, range of 5-10 years. Strabismic amblyopia was the most common type (55 percent), followed by anisometropic amblyopia (37,5 percent) and both (7.5 percent). The affected eye was the left eye in 62.5 percent and the right eye in 37.5 percent. Conclusions: It was found that PlayStation PortableTM is effective as therapy for amblyopia, improving best corrected visual acuity. The group with the best results was the red-green filter group. Upon suspension of the therapy, visual deterioration was observed in the 4 groups, without returning to baseline values(AU)

The low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism: candidate for susceptibility to type 1 diabetes mellitus

ABSTRACT Objective: The present study has investigated the association between low-density lipoprotein receptor-related protein 5 (LRP5) 4037C>T polymorphism and type 1 diabetes mellitus (T1DM) susceptibility in a Brazilian population. Subjects and methods: A total number of 134 T1DM patients and 180 normoglycemic individuals (NG) aged 6-20 years were studied. Glycated hemoglobin and glucose levels were determined. Genotyping of LRP5 4037C>T (rs3736228) was performed. Results: T1DM patients showed poor glycemic control. Genotypes in the codominant (CT: OR = 2.99 [CI 95%: 1.71-5.24], p < 0.001; TT: OR = 5.34 [CI 95%: 1.05-2702], p < 0.001), dominant (CT + TT: OR = 3.16 [CI 95%: 1.84-5.43], p < 0.001) and log-additive (OR = 2.78 [CI 95%: 1.70-4.52], p < 0.001) models, and LRP5 4037T allele (OR = 2.88, [CI 95%: 1.78-4.77], p < 0.001) were associated with an increased risk of developing T1DM. LRP5 4037CT and CT+TT carriers in T1DM group showed higher concentrations of serum glucose and glycated hemoglobin when compared with CC carriers. Conclusion: The LRP5 4037C>T may represent a candidate for T1DM susceptibility, as well as poor glycemic control.

Relationship between glycemic control and OPG gene polymorphisms with lower bone mineral density in patients with type 1 Diabetes mellitus

ABSTRACT The aim of the present study was to investigate the bone mineral density (BMD) of patients with type 1 Diabetes mellitus (T1DM). We also assessed the association between osteoprotegerin (OPG) genetic polymorphisms and BMD. Genotyping was performed for 1181G>C and 163A>G OPG polymorphisms by allelic discrimination in 119 patients with T1DM and 161 normoglycemic (NG) individuals, aged 6 to 20 years old. Glycemic control, serum parameters of bone metabolism and BMD were evaluated. T1DM patients showed low BMD, poor glycemic control and decreased total calcium values when compared to controls (p < 0.05). For all the polymorphisms studied, the genotype and allele frequencies in patients with T1DM were not significantly different from the controls. In patients with T1DM, carriers of OPG 1181CC showed higher concentrations of ionized calcium compared to patients with GG+GC genotypes. These results suggest that low BMD is associated with poor glycemic control in T1DM. Despite the lack of a detected association between OPG polymorphisms and BMD in these patients, the increased ionized calcium in those carrying OPG 1181CC suggests a possible increase in osteoclastogenesis, a conclusion that may be supported by the lower BMD observed in these subjects.

Revisão: aplicativos para dispositivos móveis (?Apps?) na automonitorização em pacientes diabéticos / Review: mobile applications (“Apps”) on self-monitoring in diabetic patients / Revisión: aplicaciones móviles (“Apps”) en la auto-monitorización en pacientes diabéticos

A crescente incidência do diabetes mellitus (DM) na população mundial demanda recursos e atenção ao diagnóstico e seguimento adequados, que reduzam a morbimortalidade. A monitorização glicêmica é uma das chaves para o bom controle, e com a universalização das tecnologias de informação e comunicação (TICs), principalmente através de celulares com acesso à internet e capacidade para processamento de dados (smartphones), e dispositivos portáteis (tablets), vem proporcionando ferramentas para o gerenciamento ambulatorial da doença. Buscando levantar em bases de dados o perfil dos aplicativos (apps) destinados a estes aparelhos, o objetivo principal foi descrever as características básicas destes aplicativos e visualizar a tendência de incorporação de recursos esperada para um futuro próximo. A análise do material obtido, provavelmente devida à atualização dinâmica da área, não permitiu quantificar precisamente os benefícios da mHealth (?saúde móvel?) em diabetes, mas há consenso que as perspectivas são bastante animadoras.

The worldwide increasing incidence of diabetes mellitus (DM) demand resources and attention to proper diagnosis and follow-up, to reduce morbidity and mortality. The glucose monitoring is one of the keys to good control, and the widespread of information and communication technologies (ICT), especially through mobile phones with internet access and capacity for data processing (smartphones), and portable devices (tablets), has been providing tools for the outpatient management of the disease. Seeking to raise the profile databases of applications (apps) for these devices, the main objective was to describe the basic characteristics of these applications and analyze the trend of incorporating features expected for the near future. The analysis of the material obtained, probably due to the dynamic update of the area did not allow precisely quantify the benefits of mHealth (?mobile health?) in diabetes , but there is consensus that the prospects are very encouraging.

El aumento de la incidencia de la diabetes mellitus (DM) los recursos de la demanda en todo el mundo y la atención al correcto diagnóstico y seguimiento, para reducir la morbilidad y la mortalidad. El monitoreo de la glucosa es una de las claves para un buen control, y la universalización de la información y la comunicación (TIC), especialmente a través de los teléfonos móviles con acceso a Internet y capacidad de procesamiento de datos (teléfonos inteligentes) las tecnologías y dispositivos portátiles (tabletas), ha estado proporcionando herramientas para el manejo ambulatorio de la enfermedad. Buscando elevar las bases de datos de perfiles de aplicaciones (apps) para estos dispositivos, el principal objetivo fue describir las características básicas de estas aplicaciones y ver la tendencia de incorporar características que se esperan para el futuro cercano. El análisis del material obtenido, probablemente debido a la actualización dinámica de la zona no permitió cuantificar con precisión los beneficios de mHealth ( ?salud móvil? ) en la diabetes, pero hay consenso en que las perspectivas son muy alentadoras.

Contribuição das características antropométricas na predição dos estádios de maturação puberal de jovens do sexo masculino / Contribution of anthropometric characteristics to pubertal stage prediction in young male individuals

Objetivo: Identificar a contribuição de variáveis antropométricas para a predição do estádio maturacional em jovens do sexo masculino. Métodos: Estudo transversal, sendo investigados 190 sujeitos do sexo masculino, com idades entre 8 e 18 anos, selecionados aleatoriamente em escolas públicas e privadas de Natal. Foram selecionadas 32 variáveis antropométricas, todas avaliadas de acordo com as recomendações da International Society for the Advancement of Kineanthropometry (ISAK). A avaliação da maturação sexual se baseou na observação de dois especialistas experientes, que identificaram o desenvolvimento da genitália, segundo as recomendações propostas por Tanner (1962). Resultados: As variáveis antropométricas apresentaram um aumento significativo no decorrer do avanço do desenvolvimento puberal (p<0,05). As variáveis de altura troncocefálica, diâmetro biepicôndilo femural, perímetro de antebraço, dobra cutânea de tríceps, alturas ósseas tibial e acrômio-radial apresentaram a melhor relação para predição dos grupos maturacionais, sendo responsáveis por estimar os estádios puberais com índice de 76,3% de chance de acerto. Conclusão: As características antropométricas apresentaram diferenças significativas entre os momentos dos estádios maturacionais, sendo encontradas, de forma representativa, sete variáveis que melhor predizem os estádios de maturação sexual...

Objective: To identify the contribution of anthropometric variables to predict the maturational stage in young males. Methods: Cross-sectional study that enrolled 190 male subjects aged between eight and 18 years, randomly selected from public and private schools in Natal, Northeast Brazil. Thirtytwo anthropometric variables were measured following the recommendations of the International Society for the Advancement of Kineanthropometry (ISAK). The assessment of sexual maturation was based on the observation of two experienced experts, who identified the pubertal development according to Tanner guidelines (1962). Results: The anthropometric variables showed a significant increase of their values during the advancement of pubertal development (p<0.05). The following variables showed the best value for prediction of maturational groups: sitting height, femoral biepicondylar diameter, forearm girth, triceps skinfold, tibiale laterale and acromiale-radiale bonelenghts. These variables were able to estimate the pubertal stages in 76.3% of the sujects. Conclusion: The anthropometric characteristics showed significant differences between the moments of maturational stages, being found, representatively, seven variables that best predict the stages of sexual maturation...

Discriminant analysis of pubertal maturation in young males based on anthropometric characteristics / Analise discriminante da maturacao puberal de jovens do sexo masculino, a partir das caracteristicas antropometricas

The relationship between anthropometric variables and maturation stages is important for a more detailed monitoring of pubertal development and may provide a suitable tool for clinical diagnosis. The aim of this study was to analyze the predictive contribution of anthropometric variables to pubertal maturation using multivariate discriminant analysis. A total of 190 boys aged 8 to 18 years, from public and private schools in Natal, Brazil, participated in the study. Thirty-two anthropometric variables were measured and pubertal maturation was evaluated objectively by observing pubic hair development. Measures of central tendency and dispersion, inferential analysis of variance, and multivariate discriminant analysis were used for statistical analysis. Pubertal advancement was accompanied by significant changes in anthropometric variables (p<0.05). Discriminant analysis identified eight variables with a high predictive capacity of pubertal maturation: age, sitting height, biacromial breadth, acromiale-radiale, trochanterion-tibiale laterale and tibiale laterale bone lengths, and abdominal and forearm girths. The anthropometric variables showed a high correlation with the classification of pubertal maturation, demonstrating a high predictive level among them. These findings indicate the possibility of developing a predictive equation for pubertal stages.

A relação entre a antropometria e os momentos maturacionais é de grande importância para o acompanhamento mais detalhado do desenvolvimento puberal, pois pode ser considerado como um meio externo adequado para o diagnóstico clínico. O objetivo do presente estudo foi analisar a contribuição preditiva das variáveis antropométricas sobre a maturação puberal, a partir do método multivariado de análise discriminante. Foram avaliados 190 sujeitos do sexo masculino, entre oito e 18 anos, alunos de escolas públicas e privadas de Natal, Brasil. Trinta e duas variáveis antropométricas foram mensuradas e a avaliação da maturação puberal foi realizada a partir do método objetivo da pilosidade púbica. A estatística foi representada pelos valores de tendência central e seus derivados, e de forma inferencial, pela Análise de Variância e análise discriminante multivariada. O avanço dos estágios puberais foi acompanhado de modificações significativas das variáveis antropométricas (p< 0,05). A análise discriminante identificou oito variáveis com alta capacidade preditiva da maturação puberal, sendo elas a idade, ATC, diâmetro bi-acromial, comprimentos ósseos acrômio-radial, trocânter-tibial e tibial, e perimetrias de abdômen e antebraço. Estas variáveis foram responsáveis por estimar os estágios puberais com índice preditivo de 77,4% de chance de acerto, confirmando a alta relação entre estes parâmetros. As variáveis antropométricas apresentaram uma alta relação com a classificação da maturação puberal, demonstrando um alto nível preditivo entre elas, e confirmando a viabilidade da criação de uma equação preditiva dos estágios puberais.

Risco coronariano em adolescentes estimado pelo índice de conicidade / Coronary risk in adolescents as estimated by the conicity index

The objective of this study was to estimate the prevalence of coronary risk using the conicity index and to compare this index with other indicators of body adiposity in adolescents. This was a cross-sectional study with 185 adolescent students from public schools in Natal, Brazil, selected by random samplingin two stages, considering the two health districts of the city. The corporal adiposity was assessed using conicity index, abdominal circumferences,waist-height ratio and body mass index. Sexual maturity was clinically assessed according to Tanner. Measures of central tendency and dispersion (mean, median and standard deviation) and percentiles distribution of the corporal adiposity are compared according to sex. The correlation between conicity index and other variables of the corporal adiposity was performed using Pearson's partial correlation, considering age, sex and sexual maturation. These findings verified that 27.6% of adolescents have high coronary risk, regardless of sex (p=0,764). The low/medium and high categories of coronary risks were respectively 1.16 and 1.20, for the median values of conicity index concerning both sexes. Strong correlations were found between conicity index and the waist-height ratio (0.732), followed by moderate correlations with abdominal circumferences and the bodymass index. All correlations were significant (p < 0.0001). Therefore, the prevalence of high coronary risk rates was considerable. The conicity indexis strongly correlated with the waist-height ratio. This index can be used inadolescent coronary disease screening.

El objetivo de este estudio fue estimar la prevalencia de riesgo coronario en adolescentes mediante el índice de conicidad y evaluar su relación con otros indicadores antropométricos de grasa corporal. Es un estudio transversal con 185 adolescentes de escuelas pública sen dos distritos de salud de la ciudad de Natal, RN, Brasil, seleccionados mediante muestre o estratificado en dos etapas. La adiposidad corporal fue evaluada por el índice de conicidad, las circunferencias dela cintura, relación cintura / talla e índice de masa corporal. La madurez sexual fue clínicamente evaluada de acuerdo a Tanner. Todas las variables relacionadas con la adiposidad se analizaron mediante medidas de tendencia central y de dispersión, según el sexo. El coeficiente de correlación parcial de Pearson fue utilizado para verificar la relación entre el índice de conicidad y otras variables antropométricas, ajustado por edad, sexo y madurez sexual. Los resultados mostraron que 27,6% de los adolescentes presentan alto riesgo coronario, independientemente del sexo (p = 0,764). Los valores promedio de este índice, por categoría de riesgo: bajo/medio y alto fueron1,16 y 1,20, respectivamente para ambos sexos. Se observó una elevada correlación entre el índice de conicidad y el de cintura-altura(0, 732) y correlaciones moderadas con la circunferencia de la cintura y el IMC, todas estadísticamente significativas (p <0,0001). Porlo tanto, el alto riesgo coronario estimado por el índice de conicidad mostró elevada correlación, positiva y significativa, con el de cintura-altura. Este índice puede ser utilizado en adolescentes para detección de enfermedades coronarias.

Objetivou-se estimar a prevalência de risco coronariano em adolescentes, utilizando o índice de conicidade e avaliar sua relação com outros indicadores antropométricos de excesso de a diposidade corporal. Trata-se de um estudo transversal, realizado com 185 adolescentesde escolas públicas municipais de dois distritos sanitários de Natal, selecionados por amostra estratificada, em dois estágios. A adiposidade corporal foi avaliada pelo índice de conicidade, circunferências abdominais, razão cintura altura e índice de massa corporal. A maturação sexual foi avaliada conforme classificação de Tanner. Todas as variáveis relacionadas à adiposidade corporal foram analisadas por medidas de tendência central e de dispersão, segundo o sexo. A correlação parcial de Pearson foi utilizada para verificar a relação entre o índice de conicidade e as demais variáveis antropométricas, ajustadas por idade, sexo e maturação sexual. Os resultados indicaram que 27,6% dos adolescentes apresentaram risco coronariano elevado, sem associação com o sexo (p = 0,764). Os valores médios deste índice, segundo as categorias de risco baixo/médio e elevado foram 1,16 e 1,20, respectivamente para ambos os sexos. Constatou-se uma forte correlação entre o índice de conicidade e a razão cintura-altura (0,732) e correlações moderadas com as circunferências abdominais e o índice de massa corporal, todas significantes estatisticamente (p<0,0001). Dessa forma, o risco coronariano avaliado pelo índice de conicidade apresentou alta magnitude e mostrou correlação positiva e significante com a razão cintura-altura. Destaca-se, portanto, que este índice pode ser utilizado na triagem para a detecção precoce de eventos cardiovasculares em adolescentes.

Trastorno depresivo mayor en México: la relación entre la intensidad de la depresión, los síntomas físicos dolorosos y la calidad de vida

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SUMMARY Background: Major Depressive Disorder (MDD) is a disease associated to emotional, vegetative and physical symptoms, including for the latter those pain-related symptoms. MDD has a high prevalence rate with a substantial burden of illness, and it expected that by 2020 it will become the second cause of world disability. The diagnosis of MDD is difficult due to the high prevalence of painful physical symptoms, and also due to the fact these symptoms are more evident that the embedded emotional ones. Over 76% of patients with MDD, report painful physical symptoms observed, like headache, abdominal pain, back pain and unspecific-located pain; observing these symptoms can even predict depression severity. In addition, the likelihood of psychiatric disease increases, importantly, with the number of physical symptoms observed; moreover, the remission of physical symptoms predicts the complete remission in MDD. We present an observational, prospective study to examine the clinical profile of Mexican outpatients suffering MDD and determine the relationship between depression severity, painful physical symptoms in quality of life and depression. Methods: Adult patients with current episodes of MDD, treated with antidepressants were included. MDD was defined according to the criteria of the Statistical Manual of Mental Disorders - 4th Edition (DSM-IV) or in the International Classification of Diseases and Related Health Problems, 10th Revision (ICD-10). Patients should have been free of depression symptoms prior to the current episode for at least 2 months. Duration of current episode should not exceed two years. Treatment-resistant patients and those with other psychiatric diagnosis were excluded. Treatment-resistance was defined as: a) a failure to respond to treatment when two different antidepressants were employed at therapeutic doses for at least four weeks each, b) when the subject was previously treated with IMAO inhibitors, c) when electro-convulsive therapy (ECT) was previously employed. Other exclusion criteria comprise previous or current diagnosis of schizophrenia, schizophreniform or schizoaffective disorder, bipolar disorder, dementia or mental impairment. Patients were selected in 34 centers in Mexico. Patients were classified according to the presence (SFD+) or absence (SFD-) of painful physical symptoms using the Somatic Symptom Inventory (SSI); SFD+ was defined as scores ≥ 2 for the pain-related items in the SSI (items 2, 3, 9, 14, 19, 27 and 28). Visual Analogue Scale (VAS) quantified pain severity (cervical pain, headache, back pain, shoulder pain, interference of pain in daily activities and vigil-time with pain). HAMD17 and CGI-S determined depression severity, while the Quality of Life in Depression Scale (QLDS) quantified subjective well-being. Linear regression models were employed to compare groups for VAS, HAMD17, CGI-S, and QLDS, to fit the confusions or clinical predictors when needed. Proportions between groups were established with Fisher exact test or logistic regression. Significance levels were established at 0.005 due to the observational nature of the study. In the result tables, standard deviation (SD) is reported as a variation around the mean value as Mean ± SD, and 95% confidence intervals are denoted 95% IC. Results: A total of 313 patients were enrolled in the study. All of the enrolled patients were Mexican, almost them were women and had at least a previous MDD episode. Painful physical symptoms were reported by 73.7% of patients, these patients were classified into the SFD+ group. Neither statistical nor clinical significant differences between the SFD+ and SFD- groups were found when analyzing socio-demographic variables (age, gender, ethnical origin) and disease history variables (number of previous episodes of MDD, in the last 24 months, duration of current episode). At baseline, patients had a CGI-S mean score of 4.6 and HAMD17 of 26.3. HAMD17 mean score (27.1) in SFD+ patients was significantly higher (p<0.0001) than the SFD- patients (23.8), but nonsignificant differences between groups were found for the subscales central, Maier & retard. CGI-S scores were similar between SFD+ and SFD-; 4.6 and 4.5 respectively (p>0.05). Prevalent painful physical symptoms were also the most painful, when a five-point scale was employed to measure severity, and comprised muscular pain (84.9%), cervical pain (84.2%) and headache (83.5%). SFD+ patients had higher pain severity in all VAS scales (p<0.0001), with perceived severity scores twice as large when compared to SFDgroup. In particular, the global pain VAS reported average values of 49.0 and 19.7 for the SFD+ and SFD- groups respectively. Patients came to the first psychiatric consultation treated with psychotherapy (27.9%), antidepressants (37.3%), anxiolytics (28.6%) and analgesics (9.7%); more than 50% of all patients were not taking any drugs or receiving psychotherapy for treatment of MDD at baseline. Analgesics were used only by 9.7% of patients for the treatment of painful physical symptoms in their current MDD episode. No significant differences between groups were found when comparing the use of psychotherapy, antidepressants, anxiolytics, antipsychotics, mood stabilizers or analgesics. Quality of life was poor for all patients, but significantly worse in the SFD+ group than in the SFD- group (QLDS scores of 23.2 and 20.0 respectively, p<0.001). Discussion: The diagnosis and symptoms manifestation can be influenced by local socio-cultural factors, in particular cultural differences are associated with the prevalence of painful physical symptoms, but this finding is not consistent. The results of this study can be extrapolated to the MDD Mexican population, as selection criteria comprised only operative diagnosis criteria, and not enrollment into the study took place due to the presence of painful physical symptoms. Patients included into the study presented a moderate to severe disease as measured with the HAMD17 scores. The high prevalence of painful physical symptoms in patients with depression was confirmed in this study; it has been reported the patients report pain-related symptoms as the main (even the only) symptom when consulting general practitioners. Painful physical symptoms in MDD include headache, cervical pain, back pain or neck pain; the presence of painful physical symptoms in depression is associated to higher intakes medication, but in this study more than 50% of subjects were not receiving any treatment, including psychotherapy. The treatment of MDD is by no means optimal, as only 30%- 40% of these patients reach complete remission of symptoms with their first antidepressant. Psychological symptoms respond to antidepressant treatment, but in general, this is not the case for the physical symptoms. The lack of efficacy can be explained as a failure in the treatment of these painful physical symptoms. Resolving these symptoms is even a predictor for the complete remission of MDD; the evidence might suggest that treatment of emotional and physical manifestations of depression could improve successful-treatment rates. Conclusion: As found in other reports, a high prevalence of painful physical symptoms was found in MDD patients. Increase in pain severity is associated with higher HAMD17 scores but not CGI-S scores; this discrepancy in the final rates obtained with both scales suggests that both emotional and physical dimensions of MDD should be considered when the clinical assessment is performed. We concluded that clinical judgment of Mexican psychiatrists differs between their global impression and a semi-structured interview in the same patient and therefore is fundamental that the clinical evaluation consists of both emotional and physical manifestations as important components of MDD.

Intervenção coronariana percutânea em artéria coronariana única em paciente com angina instável de alto risco / Percutaneous coronary intervention in single coronary artery in a patient with hig-risk unstable angina

No presente caso, relatamos a realização de angioplastia coronariana com implante de stent na artéria coronariana direita de paciente com quadro de angina instável de alto risco, portadora de artéria coronariana única com origem no seio coronariano direito. As artérias descendente anterior e circunflexa originavam-se isoladamente no terço proximal da artéria coronariana direita. Trata-se de rara anomalia coronariana com poucos relatos de intervenção coronariana percutânea na literatura. Este caso ilustra a necessidade da avaliação anatômica pormenorizada do trajeto das artérias coronarianas, precedendo a realização da angioplastia transluminal percutânea, objetivando-se a prevenção de complicações.

In the present case, we report the performance of coronary angioplasty with stent implantation in the right coronary artery of a patient with high-risk unstable angina and single coronary artery originating from the right coronary sinus. The anterior descending and circumflex arteries originated separately from the proximal third of the right coronary artery. This is a rare coronary anomaly and few reports of percutaneous coronary intervention are found in the literature. This case illustrates the need for a detailed anatomical assessment of the course of the coronary arteries prior to the performance of a percutaneous transluminal angioplasty, with the purpose of preventing complications.

Estudo comparativo entre técnicas de superposições cefalométricas totais / Comparative study among total cephalometric superimposition techniques

OBJETIVOS: o presente trabalho propôs-se a verificar se existem diferenças entre os resultados propiciados por métodos de superposições totais. METODOLOGIA: utilizou-se uma amostra de 50 telerradiografias de pacientes entre as idades de 8,25 a 16,25 anos, avaliando-se as alterações provenientes do crescimento e desenvolvimento craniofacial e do tratamento ortodôntico, por meio de variáveis cefalométricas representativas da direção e da magnitude dos deslocamentos dos componentes faciais esqueléticos. RESULTADOS E CONCLUSÕES: constatou-se que as técnicas de superposições podem produzir informações significantemente diferentes.

Alternative methodology for flexural strength testing in natural teeth

Tem-se observado na área odontológica a utilização de dentes naturais para a realização de pesquisas diversas (in vivo, in situ e/ou in vitro ). O comportamento mecânico de dentes, sujeitos aos esforços mastigatórios, geralmente é utilizado como variável de resposta. Durante uma condição de maloclusão, a componente mais relevante para a integridade da estrutura dental é a não-axial (de flexão). Esta, quando atua em um dente em função na cavidade bucal, gera uma situação semelhante à de uma viga em equilíbrio suportando uma carga concentrada na extremidade livre. Com base nessa configuração, foi desenvolvida uma metodologia para o estudo do comportamento de dentes sujeitos a esforços dessa natureza. A metodologia leva em consideração aspectos particulares do dente analisado, tais como área de secção transversal, momento de inércia, etc. Na determinação da área da secção transversal, descreveu-se a utilização de um analisador de imagens. Para a determinação das demais variáveis, implementou-se um programa em linguagem de programação C++ utilizando o compilador Borland C++ Builder, versão 1.0, para ambiente Windows (Borland International, EUA). Os resultados mostraram que, com o emprego da metodologia desenvolvida, alcançam-se resultados mais precisos, sendo sua utilização adequada a pesquisas que utilizam o comportamento à flexão de dentes extraídos como variável de resposta.

Avaliação da dieta habitual de crianças e adolescentes com sobrepeso e obesidade / Evaluation of usual diet of obese and overweight children and adolescents

OBJETIVO: Investigar a dieta habitual de crianças e adolescentes com sobrepeso e obesidade, atendidas no Ambulatório de Endocrinologia Pediátrica da Universidade Federal do Rio Grande do Norte. MÉTODOS: Foram constituídos os grupos sobrepeso (n=15), obesidade (n=30) e controle (n=21) de ambos os sexos. A avaliação antropométrica foi realizada utilizando-se o índice de Massa Corporal e a dieta habitual por registro alimentar e analisada pelo Virtual Nutri 1.0. RESULTADOS: As calorias totais e fibra alimentar do grupo obesidade feminino foram inferiores e diferente significativamente do controle masculino. Observou-se elevada ingestão de proteínas nos grupos sobrepeso masculino e obesidade feminino. Uma correlação negativa foi verificada entre o índice de Massa Corporal e a fibra alimentar no grupo obesidade feminino. CONCLUSAO: As crianças e adolescentes com sobrepeso e obesidade da amostra estudada, possuem uma dieta habitual inadequada, com elevada ingestão de proteínas e lipídios e deficiente em fibras.

Wrist and palm indexes in carpal tunnel syndrome

According to median sensory latency > or = 3.7 ms (wrist-index finger [WIF], 14 cm), median/ulnar sensory latency difference to ring finger > or = 0.5 ms (14 cm) or median midpalm (8 cm) latency > or = 2.3 ms (all peak-measured), 141 Brazilian symptomatic patients (238 hands) have CTS confirmation. Wrist ratio (depth divided by width, WR) and a new wrist/palm ratio (wrist depth divided by the distance between distal wrist crease to the third digit metacarpophalangeal crease, WPR) were measured in all cases. Previous surgery/peripheral neuropathy were excluded; mean age 50.3 years; 90.8 percent female. Control subjects (486 hands) have mean age 43.0 years; 96.7 percent female. The mean WR in controls was 0.694 against 0.699, 0.703, 0.707 and 0.721 in CTS groups of progressive WIF severity. The mean WPR in controls was 0.374 against 0.376, 0.382, 0.387 and 0.403 in CTS groups of WIF progressive severity. Both were statistically significant for the last two groups (WIF > 4.4 ms, moderate, and, WIF unrecordable, severe). BMI increases togetherwith CTS severity and WR. It was concluded that both WR/WPR have a progressive correlation with the severity of CTS but with statistically significance only in groups moderate and severe. In these groups both WR and BMI have progressive increase and we believe that the latter could be a risk factor as important as important WR/WPR

Body mass index and carpal tunnel syndrome

Carpal tunnel syndrome (CTS) has been correlated to body mass index (BMI) increase. The present study was done in a Brazilian population to compare BMI values in the following groups: first, CTS vs. controls subjects, and, second CTS groups of increasing median sensory latency (MSL). According to MSL33.7 ms (wrist-index finger, 14 cm), median/ulnar sensory latency difference30.5 ms (ring finger, 14 cm) or median palm-to-wrist (8 cm) latency32.3 ms (all peak-measured), 141 cases (238 hands) had CTS confirmation. All were symptomatic; previous surgery and polyneuropathy were excluded; mean age 50.3; 90.8 prcent female. Controls subjects (n=243; mean age 43.0; 96.7 percent female) and CTS cases had BMI calculated (kg/m2). Controls subjects had a mean BMI of 25.43 +/- 4.80 versus 28.38 +/- 4.69 of all CTS cases, a statistically significant difference (p<0.001). The CTS groups of increasing MSL severity do not show additional increase in BMI (28.44 for incipient, 28.27 for mild, 28.75 for moderate and 29.0 for severe). We conclude that CTS cases have a significant correlation with higher BMI when compared to controls subjects; however, higher BMI do not represent a statistically significant increasing risk for more severe MSL.