[Rhinopoiesis after traumatic total amputation in childhood in an 11-year-old child]. / Rhinopoïese après amputation traumatique totale dans l'enfance chez un enfant de 11 ans.

Fortunately, traumatic total amputations of the nose are rare, especially in children. Their reconstructions generally require several operative steps, most often associating cartilaginous grafts (rib and/or concha), a free radial antebrachial flap for mucosal reconstruction and a frontal flap for the skin covering. These are therefore long and complex procedures requiring a trained surgical team and maximum patient adherence to their treatment plan. The clinical case described is that of an 11-year-old child presenting a sub-total amputation of the nose and having undergone reconstruction with skin expansion of the frontal flap due to a horizontal frontal scar of unknown origin and a particularly low hair implantation.

Impact of markers of endothelial injury and hypercoagulability on systemic lupus erythematosus.

We have explored the relationship between possible hemostatic changes and clinical manifestation of the systemic lupus erythematosus (SLE) as a function of greater or lesser disease activity according to Systemic Lupus Erythematosus Disease Activity Index-2000 (SLEDAI-2K) criteria. Endothelial injury and hypercoagulability were investigated in patients with SLE by measuring thrombomodulin (TM), D-dimer (DDi) and thrombin generation (TG) potential. A total of 90 participants were distributed into three groups: 1) women with SLE presenting with low disease activity (laSLE) (SLEDAI-2K ≤ 4), 2) women with SLE presenting with moderate to high disease activity (mhaSLE) (SLEDAI-2K > 4), and 3) a control group comprising healthy women. Levels of TM and DDi were higher both in the laSLE and mhaSLE groups compared to controls and in mhaSLE compared to the laSLE group. With respect to TG assay, lagtime and endogen thrombin potential, low concentrations of tissue factor provided the best results for discrimination among groups. Analysis of these data allow us to conclude that TM, DDi and TG are potentially useful markers for discriminating patients with very active from those with lower active disease. Higher SLE activity may cause endothelial injury, resulting in higher TG and consequently a hypercoagulability state underlying the picture of thrombosis common in this inflammatory disease.

Pincer nail in a lupus patient.

Pincer nail is a transverse overcurvature of the nail plate that may appear in association with a variable number of diseases. We present a case report of a 28-year-old woman with pincer nail deformity associated with systemic lupus erythematosus. A renal biopsy confirmed class V lupus nephritis and treatment had included systemic steroids and cyclophosphamide. After 6 months there was a marked improvement of nail deformities.

Rating of perceived exertion as a tool for prescribing and self regulating interval training: a pilot study.

The aim of the present study was to analyse the usefulness of the 6-20 rating of perceived exertion (RPE) scale for prescribing and self-regulating high-intensity interval training (HIT) in young individuals. Eight healthy young subjects (age = 27.5±6.7 years) performed maximal graded exercise testing to determine their maximal and reserve heart rate (HR). Subjects then performed two HIT sessions (20 min on a treadmill) prescribed and regulated by their HR (HR: 1 min at 50% alternated with 1 min at 85% of reserve HR) or RPE (RPE: 1 minute at the 9-11 level [very light-fairly light] alternated with 1 minute at the 15-17 level [hard-very hard]) in random order. HR response and walking/running speed during the 20 min of exercise were compared between sessions. No significant difference between sessions was observed in HR during low- (HR: 135±15 bpm; RPE: 138±20 bpm) and high-intensity intervals (HR: 168±15 bpm; RPE: 170±18 bpm). Walking/running speed during low- (HR: 5.7±1.2 km · h(-1); RPE: 5.7±1.3 km · h(-1)) and high-intensity intervals (HR: 7.8±1.9 km · h(-1); RPE: 8.2±1.7 km · h(-1)) was also not different between sessions. No significant differences were observed in HR response and walking/running speed between HIT sessions prescribed and regulated by HR or RPE. This finding suggests that the 6-20 RPE scale may be a useful tool for prescribing and self-regulating HIT in young subjects.

Validation of the SenseWear armband in circuit resistance training with different loads.

The use of the SenseWear™ armband (SWA), an objective monitor of physical activity, is a relatively new device used by researchers to measure energy expenditure. These monitors are practical, relatively inexpensive and easy-to-use. The aim of the present study was to assess the validity of SWAs for the measurement of energy expenditure (EE) in circuit resistance training (CRT) at three different intensities in moderately active, healthy subjects. The study subjects (17 females, 12 males) undertook CRT at 30, 50 and 70% of the 15 repetition maximum for each exercise component wearing an SWA as well as an Oxycon Mobile (OM) portable metabolic system (a gold standard method for measuring EE). The EE rose as exercise intensity increased, but was underestimated by the SWAs. For women, Bland-Altman plots showed a bias of 1.13 ± 1.48 METs and 32.1 ± 34.0 kcal in favour of the OM system, while for men values of 2.33 ± 1.82 METs and 75.8 ± 50.8 kcal were recorded.

Helicobacter pylori is not associated with anaemia in Latin America: results from Argentina, Brazil, Bolivia, Cuba, Mexico and Venezuela.

OBJECTIVE: To investigate the association between Helicobacter pylori infection and anaemia. DESIGN: Six cross-sectional studies. H. pylori infection was assessed by the [13C]urea breath test using MS or IR analysis. Hb was measured for all countries. Ferritin and transferrin receptors were measured for Argentina, Bolivia, Mexico, and Venezuela. SETTING: Health services in Argentina, Brazil and Mexico or public schools in Bolivia, Cuba and Venezuela. SUBJECTS: In Argentina, 307 children aged 4-17 years referred to a gastroenterology unit; in Bolivia, 424 randomly selected schoolchildren aged 5-8 years; in Brazil, 1007 adults (157 men, 850 women) aged 18-45 years attending thirty-one primary health-care units; in Cuba, 996 randomly selected schoolchildren aged 6-14 years; in Mexico, seventy-one pregnant women in their first trimester attending public health clinics; in Venezuela, 418 children aged 4-13 years attending public schools. RESULTS: The lowest prevalence of H. pylori found was among children in Argentina (25.1%) and the highest in Bolivia (74.0%). In Bolivia, Cuba and Venezuela children showed similar prevalence of H. pylori infection as in Brazilian and Mexican adults (range 47.5% to 81.8%). Overall anaemia prevalence was 11.3% in Argentina, 15.4% in Bolivia, 20.6% in Brazil, 10.5% in Cuba and 8.9% in Venezuela. Adjusted analyses allowing for confounding variables showed no association between H. pylori colonization and anaemia in any study. Hb, ferritin and transferrin receptor levels were also not associated with H. pylori infection in any country. CONCLUSIONS: The present study showed no evidence to support the hypothesis that H. pylori contributes to anaemia in children, adolescents, adults or pregnant women in six Latin American countries.

Diagnostic criteria in Pai syndrome: results of a case series and a literature review.

Pai syndrome was originally described as the association of a midline cleft lip, midline facial polyps, and lipoma of the central nervous system. However, only a few patients present with the full triad, and most exhibit a wide spectrum of phenotypic variability. The aim of this study was to phenotypically delineate Pai syndrome and to propose new criteria to facilitate a clinical diagnosis in the future. The study cohort consisted of seven case patients and an additional 60 cases diagnosed with Pai syndrome identified in a literature review. Only 23 of 67 patients presented the full triad as historically described by Pai et al. (1987). A congenital facial midline skin mass was always encountered, particularly affecting the nasal structures (60/67). A midline facial cleft was reported in 45 of 67 patients and a pericallosal lipoma in 42 of 67 patients. The proposed definition of Pai syndrome is the association of (1) a congenital nasal and/or mediofrontal skin mass and/or a mid-anterior alveolar process polyp as a mandatory criterion, and at least one of the following criteria: (2) midline cleft lip and/or midline alveolar cleft, and/or (3) a pericallosal lipoma or interhemispheric lipoma in the case of corpus callosum dysgenesis.

Brain ameloblastoma: metastasis or local extension case report and physipathological reflexion.

BACKGROUND: Ameloblastoma is a rare benign odontogenic tumor with a metastasis rate estimated at 2% of cases, mainly involving the lung (80%) and lymph nodes (20%). METHODS: We hereby present the case of a 26 year old patient with a history of locally recurrent mandibular ameloblastoma who developed a temporal intracranial ameloblastoma tumor requiring a collaborative neurosurgical and maxillo-facial radical surgical approach. CONCLUSION: Although ameloblastomas are histologically benign, the temporal topography questions the dissemination pathophysiology of the tumor (metastasis or local extension through temporal muscle fibers), mainly relevant in cases of multiple recurrences.

Speech evaluation after intravelar veloplasty. How to use Borel-Maisonny classification in the international literature?

OBJECTIVE: Comparing functional outcomes after velar repair appeared to be difficult because of the absence of international standardized scale. Moreover most of the studies evaluating speech after cleft surgery present multiple biases. The aim of our study was to assess speech outcomes in a homogeneous group of patients, and to define an equivalence table between different speech scales. MATERIALS AND METHODS: Patients with isolated cleft lip and palate (CLP), operated in our unit by the same senior surgeon were included. All patient were operated according to the same protocol (cheilo-rhinoplasty and intravelar veloplasty at 6 months, followed by a direct closure of the hard palate at 15 months). Speech evaluation was performed after 3 year-old and before the alveolar cleft repair. Borel-Maisonny scale and nasometry were used for speech evaluation. RESULTS: Twenty-four patients were included: 17 unilateral CLP and 7 bilateral CLP. According to the Borel-Maisonny classifications, 82.5% were ranged phonation 1, 1-2 or 2b. Nasometry were normal in almost 60% of cases. CONCLUSIONS: This study showed the efficiency of our protocol, and intravelar veloplasty. Moreover we proposed an equivalence table for speech evaluation scale.

Milk thickeners do not influence anthropometric indices in childhood.

BACKGROUND: Pediatric obesity is an important risk factor for chronic diseases in adulthood. Some infant feeding practices may contribute to childhood obesity. OBJECTIVE: To investigate whether the introduction of milk thickeners to bottle-fed infants between 3 and 6 months of age was associated with higher anthropometric measurements and indices at 1 and 4 years of age. METHODS: A population-based birth cohort study was conducted in 1993 in the urban area of Pelotas, Brazil. Information was obtained at birth, at 1, 3, 6, and 12 months, and at 4 years. Data were analyzed from the 596 children for whom information was available from all follow-up visits. The exposure of interest was the use of milk thickener (flour added to cow's milk) between the third and sixth months of life. The outcomes investigated were weight and length/height and the anthropometric indices weight-for-age, length/height-for-age, and weight-for-length/height z-scores at 1 and 4 years. RESULTS: The prevalence of use of milk thickener at any time between the third and sixth months was 44.6%. In the adjusted analysis, children who received milk thickener were, on average, 160 g heavier and 0.5 cm longer at I year than those who did not receive it. Weight-for-age and length-for-age z-scores were positively associated with use of milk thickener. No association was observed between this feeding practice and weight-for-length z-score. In the adjusted analysis, no effect of use of milk thickener on any of the anthropometric outcomes studied was observed at 4 years. CONCLUSIONS: No association was found between the use of milk thickeners and weight-for-length/height z-scores in the first and fourth years of life. Future studies in other contexts would be helpful to further test this hypothesis.

Prevalence of Helicobacter pylori infection and associated factors among adults in Southern Brazil: a population-based cross-sectional study.

BACKGROUND: Helicobacter pylori (Hp) infection is associated with several upper gastrointestinal disorders. Local data on the epidemiology of the infection are scarce in Brazil. The purpose of this study is to measure the prevalence rate and to explore the associated factors among the adult population living in Pelotas, a southern Brazilian city. METHODS: This was a population-based cross-sectional study. Through a multi-stage sampling method all individuals 20 years and over living at the selected households at the urban area of the city were interviewed regarding past and current socio-economic indicators; demographic characteristics; nutritional and behavioural habits; and history of upper gastrointestinal symptoms.Hp infection was ascertained through the 13C-UBT. Due to the high prevalence, data were analysed through robust Poisson regression. All analyses took into account the family clustering of the data. RESULTS: Among 563 eligible individuals, 363 agreed to perform the 13C-UBT (refusal rate of 35.5%). Refusals were associated with female sex, consumption of mate drinking, and presence of upper gastrointestinal symptoms. The prevalence rate of H. pylori infection was 63.4% (95%CI 59.3%-69.3%). In crude analyses, prevalence was associated with increasing age, non-white skin colour, lower current family income, lower education level, higher size of the family, low socio-economic conditions in childhood, higher number of siblings and attendance to day-care centres in childhood, and presence of dyspeptic symptoms. In adjusted analysis the level of education of the father was inversely associated with the infection, whereas number of siblings and attendance to day-care centre in childhood were directly associated with it. Non-white skin colour remained significantly associated with increased prevalence even after allowing for past and current socio-economic characteristics, age and sex. Compared to non-symptomatic individuals, those reporting dyspeptic symptoms presented a higher prevalence of the infection even after allowing for current and past socio-economic conditions, ethnicity, age, and sex. CONCLUSION: Hp infection is as common among adults in southern Brazil as it is in other developing countries. Socio-economic conditions in childhood besides ethnicity and presence of dyspeptic symptoms were the factors significantly associated with the infection.

Evaluation of the impact of a nutritional program for undernourished children in Brazil.

To assess the effectiveness on child growth and body composition of a supplementary feeding program (Milk Supplement Program), a prospective, controlled study was conducted in Northeast Brazil. When entering the Program, children from 10 municipalities with the highest coverage rates in the Program (intervention group) were compared to non-beneficiary children from 10 municipalities with the lowest coverage rates (control group). A total of 219 children aged 6-18 months were enrolled. At entry, both groups were comparable in terms of age, sex, and nutritional status. There were frequent gaps in delivery of the supplement, no extra milk was provided to siblings less than 5 years of age, intra-household redistribution of milk was high, and maternal compliance with recommendations was low. Adjusted analyses by multilevel modelling showed average changes in weight, length, weight-age and length-age Z-scores, and % body water (deuterium method), at 6 months, of 1.53 kg, 6.34 cm, 0.33, 0.05, and 1.11% respectively among supplemented children as compared to 1.54 kg, 6.5 cm, 0.26, 0.07, and 4.10% among controls, with no statistically significant difference between groups. Thus, the Program failed to compensate for nutritional deficiencies in undernourished children in Northeast Brazil.

[Blood glucose control in diabetes patients seen in primary health care centers]. / Controle glicêmico em pacientes diabéticos atendidos em centros de atenção primária à saúde.

OBJECTIVE: To identify factors associated to poor glycemic control among diabetic patients seen at primary health care centers. METHODS: A cross-sectional study was carried out in a sample of 372 diabetic patients attending 32 primary health care centers in southern Brazil. Data on three hierarchical levels of health unit infrastructure, medical care and patient characteristics were collected. RESULTS: The frequency of poor glycemic control was 50.5%. Multivariate analysis (multilevel method) showed that patients with body mass indexes below 27 kg/m2, patients on oral hypoglycemic agents or insulin, and patients diagnosed as diabetic over five years prior to the interview were more likely to present poor glycemic control when compared to their counterparts. CONCLUSIONS: Given the hierarchical data structuring, all associations found suggest that factors associated to hyperglycemia are related to patient-level characteristics.

[Feasability study of screening for malignant lesions in the oral cavity targeting tobacco users]. / Faisabilité d'une stratégie de dépistage des lésions malignes de la cavité buccale chez les fumeurs.

INTRODUCTION: Oral cavity cancer is frequent. Prognosis of this cancer is closely linked to the development. Although the oral cavity is a potentially accessible site for examination, up to 50% of oral cancers are not detected until the disease is well advanced. PATIENTS AND METHOD: In a region where incidence rate is particularly high, local teams involved in screening, in epidemiological survey, in diagnosis and treatment of oral cancer performed a pilot feasibility study to improve strategy of early detection of oral cancer and premalignant lesion. Tobacco venders were solicited to distribute a flyer, which invite smokers to a free examination by general practitioner. General practitioners were invited to examine smokers, and to fill a predeterminate systematic oral cavity examination record during 3 months. They were asked to refer to a specialist if there was a potentially malignant disorder. RESULTS: The involvement of tobacco venders was rated as 67.3%. Ninety-three patients were included in 3 months. General practitioners referred 27% of the examinated patients. Among them, only 63.6% really saw a specialist, and a premalignant lesion was confirmed in 15.3%; further exams were carried out in 28.6%; a benign lesion was diagnosed in 57.1%. DISCUSSION/CONCLUSION: Original incentives for oral cavity screening were performed, based on multidisciplinary network. Nevertheless, it remains hardship to reach the targeted population and to maintain the patients in health system.

Anatomical study of the course of the inferior alveolar nerve in craniofacial microsomia using three-dimensional computed tomography: correlation with the Pruzansky classification.

Dysmorphogenesis of the mandible complicates assessment of the course of the inferior alveolar nerve in patients with craniofacial microsomia. Our aim in the present study was to correlate the anatomical description of the course with the Pruzansky classification (which indicates the severity of hemifacial microsomia), in the mandibles of 22 affected patients using 3-dimensional computed tomography (CT). We measured the distance between fixed landmarks on the normal and the microsomic sides. The normal sides served as controls. In the group of five patients with type I disease, we found no significant differences between the unaffected and the microsomic side. In the nine patients with Pruzansky type II disease morphological views of the course showed a between-side difference in the length of the bony canal and the height of the mandibular ramus. In the five patients with Pruzansky type III disease, there was no bony canal. Three-dimensional CT analysis may be of value in plotting the course of the inferior alveolar nerve and assisting the surgeon in mandibular osteotomy or distraction osteogenesis.

Frequency and socio-psychological impact of taunting in school-age patients with cleft lip-palate surgical repair.

OBJECTIVES: Cleft lip-palate (CLP) is a "social" pathology because of its impact on the child's facial appearance and speech. School is the first place where children are confronted to others and when they start socializing. Taunting and bullying are common and their psychological impact remains hard to assess. The aim of this study was to evaluate the importance of taunting in school and its impact in CLP patients who had surgical repair. METHODS: We conducted a multicenter prospective study where we consecutively included patients ≥ 12 years who had CLP repair. During a multidisciplinary consultation they were asked to complete a questionnaire (3 parts: surgical outcomes, taunting and its impact, socio-economic status) previously approved by our psychologists. RESULTS: 55 patients were included (37 B, 18 G) (mean age 15.5 years): 11 CL, 13 CP and 31 CLP. 69% of patients reported having suffered from taunting and peer victimization in school. In 84% of the cases, taunting was linked to the CLP defect itself. The teasing started in primary school to reach a peak of aggressiveness in middle school. 42% of patients reported that bullying occurred at least once a day (16/38). Regarding the psychological impact of taunting, 50% of patients reported sadness, 31% depression and 26.3% were marked for life. At one time or another 29% of patients did not want to attend school because of the teasing. The grade retention rate amounted to 37.7% (20/53), and 2 patients were in special education classes. As a matter of fact, 50% of these children repeated their 1st or 2nd year of primary school. Furthermore, 47% of patients wanted to change something to their face, but 63% of them never spoke to their surgeon about additional surgeries even though they were teased in school. CONCLUSIONS: Taunting is common in children with CLP. This study highlights the high frequency and impact of taunting on the daily lives and self-perception of patients with CLP or CLP repair. It is important for healthcare professionals to be aware of this issue in the context of a multidisciplinary approach.

Effect of an acute beta-adrenergic blockade on the blood glucose response during lactate minimum test.

The aim of this study was to determine the relationship between blood lactate and glucose during an incremental test after exercise induced lactic acidosis, under normal and acute beta-adrenergic blockade. Eight fit males (cyclists or triathletes) performed a protocol to determine the intensity corresponding to the individual equilibrium point between lactate entry and removal from the blood (incremental test after exercise induced lactic acidosis), determined from the blood lactate (Lacmin) and glucose (Glucmin) response. This protocol was performed twice in a double-blind randomized order by ingesting either propranolol (80 mg) or a placebo (dextrose), 120 min prior to the test. The blood lactate and glucose concentration obtained 7 minutes after anaerobic exercise (Wingate test) was significantly lower (p < 0.01) with the acute beta-adrenergic blockade (9.1 +/- 1.5 mM; 3.9 +/- 0.1 mM), respectively than in the placebo condition (12.4 +/- 1.8 mM; 5.0 +/- 0.1 mM). There was no difference (p > 0.05) between the exercise intensity determined by Lacmin (212.1 +/- 17.4 W) and Glucmin (218.2 +/- 22.1 W) during exercise performed without acute beta-adrenergic blockade. The exercise intensity at Lacmin was lowered (p < 0.05) from 212.1 +/- 17.4 to 181.0 +/- 15.6 W and heart rate at Lacmin was reduced (p < 0 .01) from 161.2 +/- 8.4 to 129.3 +/- 6.2 beats min(-1) as a result of the blockade. It was not possible to determine the exercise intensity corresponding to Glucmin with beta-adrenergic blockade, since the blood glucose concentration presented a continuous decrease during the incremental test. We concluded that the similar pattern response of blood lactate and glucose during an incremental test after exercise induced lactic acidosis, is not present during beta-adrenergic blockade suggesting that, at least in part, this behavior depends upon adrenergic stimulation.

The effects of wet suits on physiological and biomechanical indices during swimming.

The objectives of this study were to verify the effects of wet suits (WS) on the performance during 1500m swimming (V1500), on the velocity corresponding to the anaerobic threshold (VAT) and on the drag force (AD) as well as its coefficient (Cx). 19 swimmers randomly completed the following protocols on different days (with and without WS): 1) maximal performance of 1500m swimming; 2) VAT in field test, with fixed concentration of blood lactate (4 mM) and 3) determination of hydrodynamic indices (AD and Cx). The results demonstrated significant differences (p < 0.05) in the VAT (1.27 +/- 0.09; 1.21 +/- 0.06 m.s-1), and in the V1500 (1.21 +/- 0.08; 1.17 +/- 0.08 m.s-1), with and without WS, respectively. However the AD, and its Cx did not present significant differences (p>0.05) for the respective maximal speeds of swimming. In summary, we can conclude that WS allows swimmers to reach greater speeds in both, long- and short-course swims. This improvement can be related to the decrease of the AD, since with higher speeds (with WS) the subjects presented the same resistance, as they did when compared to speeds without a WS. Moreover, these data suggest that the methodology used in this study to determine the Cx is unable to detect the improvement caused by WS.

[Avoidable infant deaths in the 1993 and 2004 Pelotas birth cohorts, Rio Grande do Sul State, Brazil.] / Óbitos infantis evitáveis nas coortes de nascimentos de Pelotas, Rio Grandedo Sul, Brasil, de 1993 e 2004.

Infant mortality classified as avoidable (through immunization, adequate prenatal, childbirth, and neonatal care, adequate diagnostic and therapeutic measures, and adequate health promotion associated with appropriate health care) was compared in the 1993 and 2004 Pelotas Birth Cohorts, Rio Grande do Sul State, Brazil. Deaths were monitored by visits to hospitals, notary public offices, cemeteries, and the Regional Health Division and by a search in the Mortality Information System database. There were 5,249 live births and 111 infant deaths in the 1993 cohort and 4,231 live births and 82 infant deaths in 2004. The avoidable infant mortality rate was 15.2:1,000 live births in 1993 and 15.4 in 2004. Avoidable neonatal and post-neonatal mortality rates were 11.2 and 4.0, respectively, in 1993, and 10.9 and 4.5 in 2004. Preterm births were the main variable associated with avoidable mortality in both cohorts. Strategies to prevent preterm birth may help reduce infant mortality in this context.

[A rare early-onset dystonia (DYT16) in a Portuguese girl]. / Distonia temprana poco frecuente (DYT16) en una niña portuguesa.

TITLE: Distonia temprana poco frecuente (DYT16) en una niña portuguesa.