Body composition in Spinocerebellar ataxia type 3 and 10 patients: Comparative study with control group.

Background: Spinocerebellar ataxias (SCAs) are a group of neurodegenerative genetic diseases characterized by movement disorders that can affect nutritional status and body composition. This study sought to assess body composition in SCA3 and SCA10 patients. Methods: Anthropometric assessments and bioelectric impedance analysis were performed in 46 SCA3 and SCA10 patients and 76 controls of both genders. Results: Of the patients, 69.6% had SCA3 and 58.7% were women. SCA3 patients had significantly lower percentages of body fat (%BF) than controls (15.0 ± 6.1 vs. 20.6 ± 7.1; p=0.014) and (22.4 ± 6.9 vs. 30.1 ± 6.0; p<0.001), respectively. Among the women, there was a statistically significant difference in %BF between SCA3 and SCA10 patients (22.4 ± 6.9 vs. 32.4 ± 4.9; p<0.001). Male and female SCA3 patients had significantly lower fat-free mass (FFM) than controls [50.6 kg (46.9-54.7) vs. 58.6 kg (52.6-63.9); p=0.001] and [38.2 kg (35.1-42.6) vs. 42.8 kg (39.7-46.1); p=0.004], respectively. Male SCA10 patients also had lower FFM than controls [51.2 kg (47.1-55.4) vs. (52.6-63.9); p=0.008]. Female SCA10 patients had significantly higher FFM than controls and SCA3 patients [45.0 kg (43.3-45.6) vs. 42.8 kg (39.7-46.1); p=0.004] and [45.0 kg (43.3-45.6) vs. 38.2 kg (35.1-42.6); p=0.004], respectively. There was moderate correlation (-0.42) between disease duration and muscle mass (MM), and weak (-0.38) between SARA (Scale for the Assessment and Rating of Ataxia) and MM in SCA3. In SCA10, there was no significant correlation between these variables. Conclusion: Female SCA3 patients had more body composition changes than female SCA10 patients, mainly in relation to FFM. SCA3 and SCA10 patients need nutritional follow-up to minimize body compartment changes.

Cumulative Radiation Exposures from CT Screening and Surveillance Strategies for von Hippel-Lindau-associated Solid Pancreatic Tumors.

Purpose To assess the potential ionizing radiation exposure from CT scans for both screening and surveillance of patients with von Hippel-Lindau (VHL) syndrome. Materials and Methods For this retrospective study, abdomen-pelvic (AP) and chest-abdomen-pelvic (CAP) CT scans were performed with either a three-phase (n = 1242) or a dual-energy virtual noncontrast protocol (VNC; n = 149) in 747 patients with VHL syndrome in the National Institutes of Health Clinical Center between 2009 and 2015 (mean age, 47.6 years ± 14.6 [standard deviation]; age range, 12-83 years; 320 women [42.8%]). CT scanning parameters for patients with pancreatic neuroendocrine tumors (PNETs; 124 patients and 381 scans) were compared between a tumor diameter-based surveillance protocol and a VHL genotype and tumor diameter-based algorithm (a tailored algorithm) developed by three VHL clinicians. Organ and lifetime radiation doses were estimated by two radiologists and five radiation scientists. Cumulative radiation doses were compared between the PNET surveillance algorithms by analyses of variance, and a two-tailed P value less than .05 indicated statistical significance. Results Median cumulative colon doses for annual CAP and AP CT scans from age 15 to 40 years ranged from 0.34 Gy (5th-95th percentiles, 0.18-0.75; dual-energy VNC CT) to 0.89 Gy (5th-95th percentiles, 0.42-1.0; three-phase CT). For the current PNET surveillance protocol, the cumulative effective radiation dose from age 40 to 65 years was 682 mSv (tumors < 1.2 cm) and 2125 mSv (tumors > 3 cm). The tailored algorithm could halve these doses for patients with initial tumor diameter less than 1.2 cm (P < .001). Conclusion CT screening of patients with von Hippel-Lindau syndrome can lead to substantial radiation exposures, even with dual-energy virtual noncontrast CT. A genome and tumor diameter-based algorithm for pancreatic neuroendocrine tumor surveillance may potentially reduce lifetime radiation exposure. © RSNA, 2018 Online supplemental material is available for this article.

Estimation of skeletal muscle mass in patients with spinocerebellar ataxia type 3 and 10.

BACKGROUND: Neurodegenerative diseases may progress to a level in which patients present spontaneous weight loss, resulting in increased falls and functional disabilities when the disease is associated with muscle mass depletion. OBJECTIVE: Evaluate the muscle compartment in patients presenting spinocerebellar ataxia (SCA) type 3 and 10. METHODS: Forty-six patients presenting SCA type 3 and 10 were assessed and 76 volunteers were selected to the control group. In order to evaluate the muscle compartment, muscle mass anthropometric measurements were assessed and total skeletal muscle mass calculated through a predictive equation. RESULTS: Women with SCA3 presented greater weight loss and muscle mass reduction compared to those with SCA10 and the control group. Among the predictive measurements, calf muscle circumference showed a more significant correlation with total skeletal muscle mass (p = 0.718). CONCLUSION: Patients presenting both types of ataxia did not show severe depletion in their nutritional status; however, those with SCA3 displayed greater weight loss and muscle mass reduction compared to the SCA10 group.

Adequate dietary intake and nutritional status in patients with nephrolithiasis: new targets and objectives.

OBJECTIVES: Modifiable risk factors for kidney stones, such as diet and nutritional status, are targets in the treatment and prevention of nephrolithiasis. The aim of the present study was to assess the nutritional state and energy and nutrient adequacy of patients with nephrolithiasis via anthropometric evaluation, dietary inquiry, and urine biochemistry. DESIGN: The present observational cross-sectional study. SETTING: An outpatient, nephrolithiasis clinic of a tertiary care, university hospital. SUBJECTS: A total of 31 patients with nephrolithiasis and 25 controls were assessed. INTERVENTIONS: All patients were subjected to nutritional evaluation, including dietary inquiry and chemical tests of blood and 24-hour urine samples. MAIN OUTCOME MEASURE: Nutritional state and nutrient ingestion adequacy. RESULTS: The group of patients with nephrolithiasis exhibited high body mass index, abdominal circumference, and body fat percentage values. The protein, sodium, calcium, potassium, and oxalate intakes differed significantly from the recommended values in both the nephrolithiasis and control groups. The nephrolithiasis and control groups differed only in terms of oxalate intake (159 ± 119.27 vs. 112 ± 47.9, respectively, P = .042). Regarding urine biochemistry, 30% of the patients with nephrolithiasis exhibited hypercalciuria, versus 12% of the control group. CONCLUSIONS: The prevalence of individuals with overweight/obesity was high in both the nephrolithiasis and control groups. This finding indicates that in addition to orientation regarding nonlithogenic dietary habits, continuous education by a multidisciplinary staff must also address the prevention and treatment of obesity.

A Global Overview on Electronic Apex Locator Use From 1968 to 2023: A Bibliometric Analysis.

INTRODUCTION: This bibliometric review analyzed the research trends and main characteristics of articles related to Electronic Apex Locators (EALs). METHODS: The search was conducted in November 2023 on the Web of Science Core Collection. Narrative and systematic reviews, observational and intervention studies, laboratory, and clinical studies were included. Two researchers selected the articles and extracted the number of citations, year of publication, journal, study design, theme, country, continent, institutions, author, and keywords. Collaborative networks were generated using the VOSviewer software. The relationship between data were determined by Spearman's correlation. RESULTS: The search resulted in 374 articles, of which 294 were included. Most cited article had 175 citations. The most prevalent journal was the Journal of Endodontics (n = 84). The predominant study design was the laboratory-based (n = 223). The predominant theme was the EALs accuracy (n = 175). Piasecki L was the author with the highest number of articles (n = 11). Only 8.16% of the studies were conducted in deciduous teeth. The country with the most studies was Brazil (n = 46). Asia (n = 107) was the continent with the highest number of publications. There was a weak positive correlation between the number of citations and impact factor (rho = .294), and a strong negative correlation between citations and year of publication (rho = -.710). CONCLUSIONS: The majority of articles were laboratory-based studies conducted on permanent teeth, focusing on the accuracy of EALs. Future studies should prioritize research on deciduous teeth, systematic reviews, and, notably, clinical trials.

Predictive equations for muscle mass in patients with spinocerebellar ataxia.

INTRODUCTION: Objective: to compare anthropometric equations with one that uses BIA to predict muscle mass in patients with SCA. Methods: 76 patients with ages from 22 to 72 years had their muscle mass estimated by the equation that employs BIA and by five anthropometric equations. The results were analyzed using Pearson's and intraclass correlation coefficient, the paired t test and the Bland-Altman plot. Results: the mean weight and height ± SD were 64.2 ± 14 kg and 1.61 m ± 8 cm, respectively. The equation proposed by Lee et al. (2000), which uses body weight and height measurements, produced the best results in predicting muscle mass, since a significant bias value was not detected, and both a stronger linear correlation (r = 0.94) and higher intraclass correlation (ICC = 0.93). Conclusion: this anthropometric equation can be used to reliably estimate and monitor decreases in muscle mass in people with SCA.

INTRODUCCIÓN: Introducción: las ataxias espinocerebelosas (AEC) forman parte de un grupo de enfermedades que afectan al equilibrio y la marcha y al trofismo muscular. La utilización de la impedancia bioeléctrica (BIA) es cada vez más común en la evaluación de la composición corporal. Sin embargo, esta tecnología no siempre está disponible en los servicios de salud y su uso en un elevado número de personas presenta ciertas limitaciones. Objetivo: comparar diferentes ecuaciones antropométricas con una ecuación que utiliza valores de BIA en la predicción de la masa muscular en un grupo de pacientes con AEC. Métodos: se estimaron las cantidades de masa muscular de 76 pacientes portadores de la enfermedad con edades comprendidas entre los 22 y los 72 años con base en la ecuación que utiliza la BIA y otras cinco ecuaciones antropométricas. Para el análisis de los resultados se emplearon los coeficientes de correlación de Pearson, de correlación intraclase, el test de t pareado y el análisis de Bland-Altman. Resultados: la media de peso y altura ± desvío patrón fueron 64,2 ± 14 kg y 1,61 ± 8 m, respectivamente. La ecuación propuesta por Lee y cols. que utiliza parámetros de peso y estatura presentó mejor desempeño en la predicción de masa muscular pues no presentó sesgo significativo, mayor correlación lineal (r = 0,94) y mayor correlación intraclase (ICC = 0,93) en relación a las demás ecuaciones. Conclusiones: esa ecuación antropométrica se puede utilizar para estimar la masa muscular de los portadores de AEC.

Salivary immunoglobulin levels in juvenile autoimmune hepatitis.

AIMS: The aim of the present study was to investigate the presence of immunoglobulins (Ig) in whole saliva from patients affected by autoimmune hepatitis (AIH). DESIGN: Twelve individuals with AIH and 12 healthy individuals without (CON) autoimmune hepatitis, aged 8-18 years, participated in this study. Non-stimulated whole saliva was collected and centrifuged. Supernatants were separated and lyophilized. Salivary pH was measured and immunoglobulins were analyzed through ELISA technique. RESULTS: Salivary pH (CON, 7.17 ±â€¯0.45; AIH, 6.92 ±â€¯0.43) did not differ between groups (p = 0.183). Measurable levels of IgG, IgA, IgM and IgE were detected on all patients. IgG levels were higher in AIH individuals (CON, 1.058 ±â€¯0.386; AIH, 1.635 ±â€¯0.373; p = 0.001), whereas IgA (CON, 0.915 ±â€¯0.187; AIH, 0.995 ±â€¯0.235; p = 0.362), IgM (CON, 0.683 ±â€¯0.147, AIH, 0.646 ±â€¯0.161; p = 0.561) and IgE levels (CON, 1.241 ±â€¯0.378; AIH, 1.312 ±â€¯0.412; p = 0.664) did not present differences between groups. CONCLUSIONS: The results of the present study suggest differences in salivary IgG levels between individuals with and without AIH. Thus, saliva has the potential of becoming an important diagnostic tool for the assessment of AIH.

[Functional, microbiological and morphological intestinal findings among human immunodeficiency virus infected children]. / Aspectos funcionais, microbiológicos e morfológicos intestinais em crianças infectadas pelo vírus da imunodeficiência humana.

BACKGROUND: [corrected] Gastrointestinal tract disorders are frequent among human immunodeficiency virus infected children, with important repercussions on nutrition and survival. Most studies related to this subject were restricted to adults, being less investigated the problem in the children. AIMS: To study intestinal digestion, absorption, microbiological and morphological findings among human immunodeficiency virus infected children. MATERIAL AND METHODS: Eleven human immunodeficiency virus infected children under 13 years old, belonging to clinical categories A, B or C, separated in two groups: five patients with current or recent episode of diarrhea and six patients without diarrhea in the last 30 days preceding entering in study. Investigation proposed: microbiological and morphological analysis of small intestine and rectum biopsy; stool exams for bacterium, parasite, rotavirus, Mycobacterium species and Cryptosporidium; D-xylose test RESULTS: All tested subjects (9/11) had low D-xylose absorption (8,4 _ 24,4 mg d/L). Small intestinal mucosa histology findings were nonspecific, represented, in majority, of grade I/II enteropathy (6/10). Increased cellular infiltration of the chorion was observed in all specimens. Rectum histology alterations were also nonspecific, with chorion increased cellular infiltration. Mycobacterim avium intracellulare and Cryptosporidium were the solely microorganisms founded, both in stool CONCLUSIONS: Our study demonstrated high prevalence (100%) of intestinal malabsorption among human immunodeficiency virus infected children, despite the occurrence or not of diarrhea. It was not possible to establish relationships between the presence of microorganisms, intestinal malabsorption, intestinal morphologic findings and the occurrence or not of diarrhea. There was no correlation between D-xylose and intensity of villous atrophy.

Strengths of primary healthcare regarding care provided for chronic kidney disease.

OBJECTIVE: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. METHOD: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. RESULTS: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). CONCLUSION: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. OBJECTIVE: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. METHOD: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. RESULTS: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. CONCLUSION: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way. OBJETIVO: avaliar estrutura, processo e resultado do "Programa de Atenção a Doentes Renais Crônicos" em um município brasileiro. MÉTODO: estudo epidemiológico, transversal, realizado em 14 unidades de atenção primária e um centro de atenção secundária, no período de 2010-2013. Utilizou-se o referencial metodológico de Donabedian. Para avaliação de estrutura e processo, foram entrevistados 14 médicos, 13 supervisores e 11 agentes comunitários de saúde da atenção primária. Para avaliação de resultado, foram utilizados 1.534 prontuários de saúde na atenção primária e 282 na atenção secundária. RESULTADOS: na maioria das unidades faltam consultórios para atendimento médico e de enfermagem, as equipes estavam incompletas e a maioria dos profissionais não participou de capacitação para atenção à doença renal crônica. Médicos das unidades primárias, classificadas como capacitadas, encaminharam usuários à atenção secundária em estágios mais precoces da doença renal crônica (estágio 3B) quando comparados aos médicos das unidades não capacitadas (58% vs 36%) (p=0,049). As unidades de atenção primária, classificadas como capacitadas, apresentaram melhores taxas de estabilização da filtração glomerular (51%) quando comparadas às unidades parcialmente capacitadas (36%) e não capacitadas (44%) (p=0,046). CONCLUSÃO: usuários atendidos nas unidades de atenção primária com pontuação mais elevada em critérios de estrutura e processo apresentaram melhores resultados clínicos. OBJETIVO: evaluar la estructura, el proceso y los resultados del "Programa de Atención a Enfermos Renales Crónicos" en un municipio brasileño. MÉTODO: estudio epidemiológico, transversal, realizado en 14 unidades de atención primaria y en un centro de atención secundario, en el período de 2010 a 2013. Se utilizó el referencial metodológico de Donabedian. Para evaluación de estructura y proceso; fueron entrevistados 14 médicos, 13 supervisores y 11 agentes comunitarios de salud de la atención primaria. Para evaluación del resultado, fueron utilizadas 1.534 fichas médicas en la atención primaria y 282 en la atención secundaria. RESULTADOS: en la mayoría de las unidades faltaban consultorios para la atención médica y de enfermería, los equipos estaban incompletos y la mayoría de los profesionales no participó de capacitaciones sobre la atención a la enfermedad renal crónica. Los médicos de las unidades primarias, clasificados como capacitados, encaminaron usuarios para la atención secundaria en etapas más precoces de la enfermedad renal crónica (etapa 3B) cuando comparados a los médicos de las unidades no capacitadas (58% vs 36%) (p=0,049). Las unidades de atención primaria, clasificadas como capacitadas, presentaron mejores tasas de estabilización de la filtración glomerular (51%) cuando comparadas a las unidades parcialmente capacitadas (36%) y no capacitadas (44%) (p=0,046). CONCLUSIÓN: los usuarios atendidos en las unidades de atención primaria, con puntuación más elevada en criterios de estructura y proceso, presentaron mejores resultados clínicos.

Protein intake, nitrogen balance and nutritional status in patients with Parkinson's disease; time for a change?

OBJECTIVE: To evaluate protein intake, nitrogen balance and nutritional status of clinically stable patients with Parkinson's disease (PD). METHODS: A cross-sectional study of PD patients Hoehn-Yahr scale stage 1-3 and subjects with no neurologic disease (controls) matched for age and gender. All participants underwent a diet history interview, anthropometric measurements, bioelectrical impedance and food record over three non-consecutive days, including a weekend. A 24-hour urine collection and fasting venous blood sampling were collected from the participants for evaluation of creatinine clearance, creatinine height index and the nitrogen balance. RESULTS: The mean age of PD patients was 58.9 ± 12.8 year compared to 54.7 ± 12.6 year of the controls, P = 0.34. One third of PD group had symptoms of dysphagia and ingested less water and fibers when compared to controls. Calf circumference was small in PD group (35.5 ± 2.8 vs. 38.4 ± 3.5 cm, P = 0.012). Intake of nitrogen was significantly lower and nitrogen balance was negative in PD patients (-1.8 ± 3.9 vs. 1.1 ± 4.2 controls, P = 0.06). The antioxidants folate and vitamin E were consumed in small amounts in both groups, although significantly less in PD patients (P = 0.04 and 0.03, respectively). DISCUSSION: Daily intakes of protein of approximately 1.1 g/kg by clinically stable PD patients may not be enough to ensure a neutral calorie-nitrogen balance and muscle tissue conservation. Larger studies are necessary to provide a more comprehensive picture of PD patients' metabolic status.

Objetivo: evaluar ingestión proteica, balance nitrogenado y estado nutricional de pacientes con enfermedad de Parkinson (EP) clínicamente estables. Métodos: estudio transversal de pacientes con EP en los niveles 1-3 según la escala de Hoehn-Yahr e individuos sin enfermedad neurológica (controles), pareados por edad y género. Todos los participantes fueron sometidos a una entrevista de la historia nutricional, antropometría, impedancia eléctrica y registro alimentario de 3 días consecutivos, incluyendo un fin de semana. Fueron colectados sangre venosa en ayuno y orina de 24 horas para evaluación de la depuración de la creatinina, índice creatinina-altura y balance nitrogenado. Resultados: el promedio de edad en pacientes con EP fue 58,9 ± 12,8 años en comparación con 54,7 ± 12,6 años de los controles, p = 0,345. Un tercio del grupo EP tuvo síntomas de disfagia, con menor ingestión de agua y fibras, comparados a los controles. La circunferencia de la pantorrilla fue menor en grupo EP (35,5 ± 2,8 vs. 38,4 ± 3,5 cm, p = 0,012). La ingestión de nitrógeno fue significativamente menor y el balance de nitrógeno fue negativo en grupo EP (-1,8 ± 3,9 vs. 1,1 ± 4,2 controles, p = 0,064). Los antioxidantes folato y vitamina E fueron consumidos en pequeñas cantidades en ambos grupos, aunque significativamente menor en los pacientes con EP (p = 0,042 y 0,031, respectivamente). Discusión: la ingestión proteica diaria de aproximadamente 1,1 g/kg en pacientes clínicamente estables con EP puede no ser suficiente para garantizar un balance neutro de calorías-nitrógeno, así como para mantener la masa muscular. Serán necesarios mayores estudios que produzcan una imagen más completa del estado metabólico de los pacientes con Parkinson.

A longterm prospective real-life experience with leflunomide in juvenile idiopathic arthritis.

OBJECTIVE: To describe a clinical practice with leflunomide (LEF) in juvenile idiopathic arthritis (JIA). METHODS: Patients with JIA seen between May 2008 and May 2012 and considered nonresponsive to methotrexate (MTX) were given LEF and prospectively followed. Primary outcome was a 28-joint Disease Activity Score (DAS28) of low disease activity (< 3.2) in less than 6 months. Childhood Health Assessment Questionnaire (CHAQ) scores and safety data were recorded. RESULTS: Forty-three patients (33 female) were included with 25 (58.1%) polyarticular, 10 oligoarticular (7 extended; 3 persistent), 6 systemic, and 2 enthesitis-related. Ten (23.2%) were rheumatoid factor-positive and 7 (16.3%) had antinuclear antibodies. Prior drugs other than MTX: 11 (25.5%) chloroquine diphosphate + MTX and 2 (4.6%) sulfasalazine + MTX; mean prednisone dose was 6.4 ± 9.3 mg. The MTX dose prior to LEF was 14.5 ± 4.5 mg/m(2)/week. LEF dose and duration of therapy were 16.6 ± 5.2 mg/d and 3.6 ± 2.2 years, respectively. Nineteen patients (44.2%) interrupted LEF: 1 entered remission, 11 were nonresponsive, and 7 were intolerant (16.2%). Baseline DAS28 (5.57 ± 0.7) dropped to 3.7 ± 1.2 at final analysis (p < 0.001) and 16 patients (37.2%) had a low DAS28 [< 3.2; 12 (27.9%) while taking LEF + MTX and 4 (9.3%) while taking monotherapy]. At last followup, the number of patients with DAS28 > 5.1 dropped from 34 (79%) to 9 (20.9%) and CHAQ scores from 0.86 ± 0.7 to 0.44 ± 0.5 (p < 0.001). CONCLUSION: LEF isolated or combined with MTX is effective and safe to treat JIA in patients refractory to MTX.

Evaluation of the ultrastructure of the small intestine of hiv infected children by transmission and scanning electronic microscopy.

OBJECTIVES: To describe HIV children's small intestinal ultrastructural findings. METHODS: Descriptive, observational study of small intestine biopsies performed between August 1994 and May 1995 at São Paulo, SP, Brazil. This material pertained to 11 HIV infected children and was stored in a laboratory in paraffin blocks. Scanning and transmission electronic microscopy were used to view those intestine samples and ultrastructural findings were described by analyzing digitalized photos of this material. Ethical Committee approval was obtained. RESULTS: In most samples scanning microscopy showed various degrees of shortening and decreasing number of microvilli and also completes effacements in some areas. Derangement of the enterocytes was seen frequently and sometimes cells well defined borders limits seemed to be loosened. In some areas a mucous-fibrin like membrane with variable thickness and extension appeared to partially or totally coat the epithelial surface. Fat drops were present in the intestinal lumen in various samples and a bacterium morphologically resembling bacilli was seen in two occasions. Scanning microscopy confirmed transmission microscopy microvilli findings and also showed little "tufts" of those structures. In addition, it showed an increased number of vacuoles and multivesicular bodies inside various enterocytes, an increased presence of intraepithelial lymphocytes, mitochondrial vacuolization and basement membrane enlargement in the majority of samples analyzed. However, some samples exhibited normal aspect. CONCLUSIONS: Our study showed the common occurrence of various important intestinal ultrastructural alterations with variable degrees among HIV infected children, some of them in our knowledge not described before.

Improvement of intestinal permeability with alanyl-glutamine in HIV patients: a randomized, double blinded, placebo-controlled clinical trial.

CONTEXT: Glutamine is the main source of energy of the enterocyte and diarrhea and weight loss are frequent in HIV infected patients. OBJECTIVE: To determine the effect of alanyl-glutamine supplementation on intestinal permeability and absorption in these patients. METHODS: Randomized double-blinded, placebo-controlled study using isonitrogenous doses of alanyl-glutamine (24 g/day) and placebo (glycine, 25 g/day) during 10 days. Before and after this nutritional supplementation lactulose and mannitol urinary excretion were determined by high performance liquid chromatography. RESULTS: Forty six patients with HIV/AIDS, 36 of whom were male, with 37.28 ± 3 (mean ± standard error) years were enrolled. Twenty two and 24 subjects were treated with alanyl-glutamine and with glycine respectively. In nine patients among all in the study protocol that reported diarrhea in the 14 days preceding the beginning of the study, mannitol urinary excretion was significantly lower than patients who did not report this symptom [median (range): 10.51 (3.01-19.75) vs. 15.37 (3.93-46.73); P = 0.0281] and lactulose/mannitol ratio was significantly higher [median (range): 0.04 (0.00-2.89) vs. 0.02 (0.00-0.19); P = 0.0317]. There was also a significant increase in mannitol urinary excretion in the group treated with alanyl-glutamine [median (range): 14.38 (8.25-23.98) before vs 21.24 (6.27-32.99) after treatment; n = 14, P = 0.0382]. CONCLUSION: Our results suggest that the integrity and intestinal absorption are more intensely affected in patients with HIV/AIDS who recently have had diarrhea. Additionally, nutritional supplementation with alanyl-glutamine was associated with an improvement in intestinal absorption.

Influence of microgap location and configuration on radiographic bone loss in nonsubmerged implants: an experimental study in dogs.

PURPOSE: The implant-abutment connection (microgap) influences the peri-implant bone morphology. However, it is unclear if different microgap configurations additionally modify bone reactions. This preliminary study aimed to radiographically monitor peri-implant bone levels in two different microgap configurations during 3 months of nonsubmerged healing. MATERIALS AND METHODS: Six dogs received two implants with internal Morse taper connection (INT group) on one side of the mandible and two implants with external-hex connection (EXT group) on the other side. One implant on each side was positioned at bone level (equicrestal); the second implant was inserted 1.5 mm below the bone crest (subcrestal). Healing abutments were attached directly after implant insertion, and the implants were maintained for 3 months without prosthetic loading. At implant placement and 1, 2, and 3 months, standardized radiographs were taken to monitor peri-implant bone levels. RESULTS: All implants osseointegrated. A total bone loss of 0.48 ± 0.66 mm was measured in the equicrestal INT group, 0.69 ± 0.43 mm in the equicrestal EXT group, 0.79 ± 0.93 mm in the subcrestal INT group, and 1.56 ± 0.53 mm in the subcrestal EXT group (P > .05, paired t tests). Within the four groups, bone loss over time became significantly greater in the EXT groups than in the INT groups. The greatest bone loss was noted in the subcrestal EXT group. CONCLUSION: Within the limits of this animal study, it seems that even without prosthetic loading, different microgap configurations exhibit different patterns of bone loss during nonsubmerged healing. Subcrestal positioning of an external butt joint microgap may lead to faster radiographic bone loss.

Strengths of primary healthcare regarding care provided for chronic kidney disease / Potencialidades da atenção primária à saúde no cuidado à doença renal crônica / Potencialidades de la atención primaria a la salud en el cuidado de enfermedad renal crónica

ABSTRACT Objective: to assess the structure and results obtained by the "Chronic Renal Patients Care Program" in a Brazilian city. Method: epidemiological, cross-sectional study conducted in 14 PHC units and a secondary center from 2010 to 2013. The Donabedian Model was the methodological framework used. A total of 14 physicians, 13 supervisors, and 11 community health agents from primary healthcare were interviewed for the assessment of structure and process and 1,534 medical files from primary healthcare and 282 from secondary care were consulted to assess outcomes. Results: most units lacked sufficient offices for physicians and nurses to provide consultations, had incomplete staffing, and most professionals had not received proper qualification to provide care for chronic renal disease. Physicians from PHC units classified as capable more frequently referred patients to the secondary care service in the early stages of chronic renal disease (stage 3B) when compared to physicians of units considered not capable (58% vs. 36%) (p=0.049). Capable PHC units also more frequently presented stabilized glomerular filtration rates (51%) when compared to partially capable units (36%) and not capable units (44%) (p=0.046). Conclusion: patients cared for by primary healthcare units that scored higher in structure and process criteria presented better clinical outcomes. Objective: to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables. Method: this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies. Results: the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined. Conclusion: despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

resumo Objetivo: avaliar estrutura, processo e resultado do "Programa de Atenção a Doentes Renais Crônicos" em um município brasileiro. Método: estudo epidemiológico, transversal, realizado em 14 unidades de atenção primária e um centro de atenção secundária, no período de 2010-2013. Utilizou-se o referencial metodológico de Donabedian. Para avaliação de estrutura e processo, foram entrevistados 14 médicos, 13 supervisores e 11 agentes comunitários de saúde da atenção primária. Para avaliação de resultado, foram utilizados 1.534 prontuários de saúde na atenção primária e 282 na atenção secundária. Resultados: na maioria das unidades faltam consultórios para atendimento médico e de enfermagem, as equipes estavam incompletas e a maioria dos profissionais não participou de capacitação para atenção à doença renal crônica. Médicos das unidades primárias, classificadas como capacitadas, encaminharam usuários à atenção secundária em estágios mais precoces da doença renal crônica (estágio 3B) quando comparados aos médicos das unidades não capacitadas (58% vs 36%) (p=0,049). As unidades de atenção primária, classificadas como capacitadas, apresentaram melhores taxas de estabilização da filtração glomerular (51%) quando comparadas às unidades parcialmente capacitadas (36%) e não capacitadas (44%) (p=0,046). Conclusão: usuários atendidos nas unidades de atenção primária com pontuação mais elevada em critérios de estrutura e processo apresentaram melhores resultados clínicos.

RESUMEN Objetivo: evaluar la estructura, el proceso y los resultados del "Programa de Atención a Enfermos Renales Crónicos" en un municipio brasileño. Método: estudio epidemiológico, transversal, realizado en 14 unidades de atención primaria y en un centro de atención secundario, en el período de 2010 a 2013. Se utilizó el referencial metodológico de Donabedian. Para evaluación de estructura y proceso; fueron entrevistados 14 médicos, 13 supervisores y 11 agentes comunitarios de salud de la atención primaria. Para evaluación del resultado, fueron utilizadas 1.534 fichas médicas en la atención primaria y 282 en la atención secundaria. Resultados: en la mayoría de las unidades faltaban consultorios para la atención médica y de enfermería, los equipos estaban incompletos y la mayoría de los profesionales no participó de capacitaciones sobre la atención a la enfermedad renal crónica. Los médicos de las unidades primarias, clasificados como capacitados, encaminaron usuarios para la atención secundaria en etapas más precoces de la enfermedad renal crónica (etapa 3B) cuando comparados a los médicos de las unidades no capacitadas (58% vs 36%) (p=0,049). Las unidades de atención primaria, clasificadas como capacitadas, presentaron mejores tasas de estabilización de la filtración glomerular (51%) cuando comparadas a las unidades parcialmente capacitadas (36%) y no capacitadas (44%) (p=0,046). Conclusión: los usuarios atendidos en las unidades de atención primaria, con puntuación más elevada en criterios de estructura y proceso, presentaron mejores resultados clínicos.

Refractory congenital chylous ascites.

Refractory congenital chylous ascites (CCA) is an uncommon clinical condition. Few cases have been described and no gold standard treatment has been defined so far. This report describes a case of refractory CCA in a newborn child which was treated by surgery. Preoperative lower-limb lymphoscintigraphy associated with intraoperative patent blue testing and fibrin glue application were useful in order to provide a successful outcome.

[Yellow nail syndrome: case report]. / Síndrome da unha amarela: relato de caso.

The yellow nail syndrome is a rare disease, in which there is a triad of lymphedema, pleural effusion and slow-growing dystrophic yellow nails. Many associations have already been described; among them, chronic respiratory tract diseases, autoimmune disorders, malignancies and immunodeficiency conditions. Only one third of cases in the literature show all findings. The case reported next is an example of the classical triad.

Evaluation of tee ultrastructure of the small itestine of hiv infected childreen by transmission and scanning electronic microscopy

Objectives To describe HIV children's small intestinal ultrastructural findings. Methods Descriptive, observational study of small intestine biopsies performed between August 1994 and May 1995 at São Paulo, SP, Brazil. This material pertained to 11 HIV infected children and was stored in a laboratory in paraffin blocks. Scanning and transmission electronic microscopy were used to view those intestine samples and ultrastructural findings were described by analyzing digitalized photos of this material. Ethical Committee approval was obtained. Results In most samples scanning microscopy showed various degrees of shortening and decreasing number of microvilli and also completes effacements in some areas. Derangement of the enterocytes was seen frequently and sometimes cells well defined borders limits seemed to be loosened. In some areas a mucous-fibrin like membrane with variable thickness and extension appeared to partially or totally coat the epithelial surface. Fat drops were present in the intestinal lumen in various samples and a bacterium morphologically resembling bacilli was seen in two occasions. Scanning microscopy confirmed transmission microscopy microvilli findings and also showed little “tufts” of those structures. In addition, it showed an increased number of vacuoles and multivesicular bodies inside various enterocytes, an increased presence of intraepithelial lymphocytes, mitochondrial vacuolization and basement membrane enlargement in the majority of samples analyzed. However, some samples exhibited normal aspect. Conclusions Our study showed the common occurrence of various important intestinal ultrastructural alterations with variable degrees among HIV infected children, some of them in our knowledge not described before. .

Objetivos Descrever achados ultra-estruturais do intestino delgado de crianças infectadas pelo HIV. Métodos Estudo descritivo, observacional de biopsias do intestino delgado, realizada entre agosto de 1994 e maio de 1995 em São Paulo - Brasil. Este material pertencia a 11 crianças infectadas pelo HIV e foi armazenado em um laboratório em blocos de parafina. As amostras de intestino delgado foram analisadas por microscopia eletrônica de transmissão e de varredura e achados os achados ultra-estruturais foram descritos por meio da análise de fotos digitalizadas desse material. Foi obtida aprovação pelo Comitê de Ética. Resultados Na maioria das amostras a microscopia de varredura mostrou vários graus de encurtamento e diminuição do número das microvilosidades e até o completo apagamento dessas estruturas em algumas áreas. O desarranjo dos enterócitos foi visto com freqüência e, por vezes, os limites celulares estavam imprecisos. Em algumas áreas uma membrana fibrino-mucosa com espessura e extensão variáveis aparentava revestir parcial ou totalmente a superfície epitelial. Gotas de gordura no lúmen intestinal estavam presentes em várias amostras e bactérias morfologicamente semelhantes a bacilos foram observadas em duas amostras. A microscopia eletrônica de varredura confirmou as observações constatadas nas microvilosidades através da microscopia de transmissão e também mostrou pequenos “tufos” dessas estruturas. Além disso, mostrou aumento do número de vacúolos e de formações multivesiculares dentro de vários enterócitos, aumento da presença de linfócitos intraepiteliais, vacuolização mitocondrial e alargamento da membrana basal na maioria das amostras analisadas. ...

IMPROVEMENT OF INTESTINAL PERMEABILITY WITH ALANYL-GLUTAMINE IN HIV PATIENTS: a randomized, double blinded, placebo-controlled clinical trial

Context Glutamine is the main source of energy of the enterocyte and diarrhea and weight loss are frequent in HIV infected patients. Objective To determine the effect of alanyl-glutamine supplementation on intestinal permeability and absorption in these patients. Methods Randomized double-blinded, placebo-controlled study using isonitrogenous doses of alanyl-glutamine (24 g/day) and placebo (glycine, 25 g/day) during 10 days. Before and after this nutritional supplementation lactulose and mannitol urinary excretion were determined by high performance liquid chromatography. Results Forty six patients with HIV/AIDS, 36 of whom were male, with 37.28 ± 3 (mean ± standard error) years were enrolled. Twenty two and 24 subjects were treated with alanyl-glutamine and with glycine respectively. In nine patients among all in the study protocol that reported diarrhea in the 14 days preceding the beginning of the study, mannitol urinary excretion was significantly lower than patients who did not report this symptom [median (range): 10.51 (3.01–19.75) vs. 15.37 (3.93–46.73); P = 0.0281] and lactulose/mannitol ratio was significantly higher [median (range): 0.04 (0.00–2.89) vs. 0.02 (0.00–0.19); P = 0.0317]. There was also a significant increase in mannitol urinary excretion in the group treated with alanyl-glutamine [median (range): 14.38 (8.25–23.98) before vs 21.24 (6.27–32.99) after treatment; n = 14, P = 0.0382]. Conclusion Our results suggest that the integrity and intestinal absorption are more intensely affected in patients with HIV/AIDS who recently have had diarrhea. Additionally, nutritional supplementation with alanyl-glutamine was associated with an improvement in intestinal absorption. .

Contexto A glutamina é a principal fonte de energia do enterócito e diarreia e perda de peso são frequentes em pacientes infectados pelo HIV. Objetivo Determinar o efeito da alanil-glutamina sobre a permeabilidade e a absorção intestinais nesses pacientes. Métodos Estudo duplo-cego, randomizado, controlado por placebo, utilizando doses isonitrogênicas de alanil-glutamina (24 g/dia) e de placebo (glicina, 25 g/dia) durante 10 dias. Antes e depois dessa suplementação nutricional a excreção urinária de lactulose e manitol foi determinada por cromatografia líquida de alta performance. Resultados Quarenta e seis pacientes com HIV/AIDS, sendo 36 do sexo masculino, com 37,28 ± 3 anos (média ± erro padrão) foram incluídos. Vinte e dois e 24 indivíduos foram tratados com alanil-glutamina e com glicina, respectivamente. Nos nove pacientes que relataram ter apresentado diarreia nos 14 dias anteriores ao início do estudo, a excreção urinária de manitol foi significativamente menor do que nos pacientes que não referiram essa queixa [mediana (intervalo): 10,51 (3,01-19,75) vs 15,37 (3,93-46,73), P = 0,0281] e a razão lactulose/manitol foi significativamente mais elevada [mediana (intervalo): 0,04 (0,00-2,89) vs 0,02 (0,00-0,19), P = 0,0317]. Constatou-se também aumento significativo na excreção urinária de manitol no grupo tratado com alanil-glutamina [mediana (intervalo): 14,38 (8,25-23,98), antes vs 21,24 (6,27-32,99) após o tratamento, n = 14, P = 0,0382]. Conclusão Os resultados do presente estudo sugerem que a integridade e a absorção intestinais são mais intensamente afetadas em pacientes com HIV/AIDS que tiveram diarreia recentemente. Adicionalmente, a suplementação ...

Avaliação não invasiva de gordura abdominal total comparada à determinação tomográfica em pacientes hipertensos / A non-invasive estimative of the total abdominal fat compared to tomographic determination in hypertensive patients

A obesidade é uma doença crônica, cuja prevalência vem sobrepujando a desnutrição e as doenças infecciosas tanto em países desenvolvidos quanto nos em desenvolvimento, segundo a Organização Mundial da Saúde (OMS)1.Gordura abdominal total (GAT) representa um fator de risco cardiovascular. O estudo teve o objetivo de estabelecer uma associação de métodos não invasivos capazes de estimar a GAT. Foi avaliada a composição corporal de adultos (29-61 anos) obesos hipertensos (20M, 20F).A análise corporal foi realizada por meio de antropometria, bioimpedância elétrica (BIA) e tomografia computadorizada(TC). ..

Total abdominal fat (TAF) is a cardiovascular risk factor. The objective of this study was to establish an association of non-invasive methods able to estimate the total body fat. Body composition was assessed in obese hypertensive (20M, 20F) adults (29-61 years). Body analysis included anthropometry, bioelectrical impedance (BIA) and computed tomography (CT)...