Pushing Backwards: Evaluating Effectiveness of Conservative Treatment of Intestinal Intussusception.

OBJECTIVE: Intestinal intussusception (II) is a common cause for acute abdomen in children, occurring in 0.33 to 0.71 per 1000 children per year. Early diagnosis and treatment are fundamental for prevention of irreversible intestinal damage. The first line of treatment is conservative, with saline reduction enema or air reduction enema. Our goal is to evaluate results with conservative treatment of II in children. METHODS: A retrospective single-center review of all patients with diagnosis of II from January 2014 to December 2019 was performed. Demographics, clinical data, treatment option, and results were assessed. RESULTS: Thirty-eight cases were identified. The mean age was 26 months, and 68% were males. Most presented with abdominal pain (95%) and vomiting (66%), after an average of 30 hours. Rectal bleeding was present in 32% of patients. Abdominal ultrasound was performed in all patients for diagnosis. Conservative treatment was first option in 95% of patients, with a global effectiveness of 83% after 1 attempt. Saline reduction enema was more effective than air reduction enema (88% vs 70%), and patients with successful reduction were younger (24 vs 33 months), but neither reached statistical significance. Two patients had a subsequent II episode within 1 week after hospital discharge. Neither age, sex, symptoms and respective duration, rotavirus inoculation, intussuscepted bowel length, nor technique used was predictive of treatment failure or II relapse. CONCLUSIONS: Conservative treatment in II is a safe and effective option, preventing invasive surgical procedures. Effectiveness of such treatments may be as high as 88% after 1 attempt, with rapid diet reintroduction. Same-day discharge after oral feeding toleration is safe.

Dietary glycemic load and its association with glucose metabolism and lipid profile in young adults.

BACKGROUND AND AIM: To evaluate the association of Glycemic Load (GL) with glucose metabolism and blood lipids among young adults. METHODS AND RESULTS: This study included 1538 participants (51% females), evaluated at 21 years of age as part of the EPITeen cohort. The GL of each individual was obtained from the assessment of their dietary intake by using a 86-item semi-quantitative food frequency questionnaire. The evaluation included anthropometric measurements and a fasting blood sample was used to measure glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). Insulin resistance was calculated based on the homeostasis model method (HOMA-IR). The association between the GL and the biochemical parameters was evaluated by linear regression models using ß and 95% confidence intervals (95% CI), stratified by sex and adjusted for body mass index (BMI), energy and fiber intake, and self-perceived social class. No association was found between GL and the glucose metabolism parameters after adjustment. Regarding blood lipids, a positive association was found with LDL-C (ß = 1.507, 95% CI 0.454; 2.561 for females; ß = 0.216, 95% CI -0.587; 1.020 for males) and a negative association with HDL-C (ß = -0.647, 95% CI -1.112; -0.181 for females; ß = -0.131, 95% CI -0.422; 0.160 for males). CONCLUSIONS: Our results suggest that, in healthy young subjects, a high GL diet may have a negative impact on lipid profile.

Soil degradation and Cu, Cr, Ni, Pb and Zn contamination in dumpsites of humid and semiarid tropical regions in northeastern Brazil.

We investigated soil characteristics and heavy metal content changes in 12 inactive dumpsites in humid and semiarid tropical climates in Northeast Brazil. The metals Cu, Cr, Ni, Pb and Zn in soil samples were determined by atomic absorption spectrophotometry. Other parameters measured include pH, electric conductivity, soil texture, soil organic carbon, total porosity and available P. The soil contents of sand, clay, soil organic carbon, available P and heavy metals, and soil bulk density, total porosity and pH were efficient indicators of soil degradation. We found no influence of current use, soil class or climate on the soil response. The mean concentrations of heavy metals in the dumpsite soils followed the order Zn (49.96 mg kg-1) > Cu (38.48 mg kg-1) > Pb (24.64 mg kg-1) > Cr (21.94 mg kg-1) > Ni (7.77 mg kg-1). They were 6- to 36-fold higher than the background values for the region and were above the Brazilian guideline values for metals. The four dumpsite soils that showed simultaneous contamination with two or more heavy metals were located in the semiarid region. This challenges the assumption that soil impacts in the semiarid region are minimal due to lower leaching and high evaporation. Soil changes increase with time under activity, size and decommission time of the dumpsite. These data are important for local authorities to establish more effective targeting policies for closure of dumps and control of the spread of contaminants in areas impacted by the disposal of municipal waste.

Temporal record and spatial distribution of fire foci in State of Minas Gerais, Brazil.

The objectives of this study are: (i) to evaluate the space-temporal variability of fire foci by environmental satellites, CHIRPS and remote sensing products based on applied statistics, and (ii) to identify the relational pattern between the distribution of fire foci and the environmental, meteorological, and socioeconomic variables in the mesoregions of Minas Gerais (MG) - Brazil. This study used a time series of fire foci from 1998 to 2015 via BDQueimadas. The temporal record of fire foci was evaluated by Mann-Kendall (MK), Pettitt (P), Shapiro-Wilk (SW), and Bartlett (B) tests. The spatial distribution by burned area (MCD64A1-MODIS) and the Kernel density - (radius 20 km) were estimated. The environmental variables analyzed were: rainfall (mm) and maximum temperature (°C), besides proxies to vegetation canopy: NDVI, SAVI, and EVI. PCA was applied to explain the interaction between fire foci and demographic, environmental, and geographical variables for MG. The MK test indicated a significant increasing trend in fire foci in MG. The SW and B tests were significant for non-normality and homogeneity of data. The P test pointed to abrupt changes in the 2001 and 2002 cycles (El Niño and La Niña moderated), which contributes to the annual increase and in winter and spring, which is identified by the Kernel density maps. Burned areas highlighted the northern and northwestern regions of MG, Triângulo Mineiro, Jequitinhonha, and South/Southwest MG, in the 3rd quarter (increased 17%) and the 4th quarter (increased 88%). The PCA resulted in three PCs that explained 71.49% of the total variation. The SAVI was the variable that stood out, with 11.12% of the total variation, followed by Belo Horizonte, the most representative in MG. We emphasize that the applied conceptual theoretical model defined here can act in the environmental management of fire risk. However, public policies should follow the technical-scientific guidelines in the mitigation of the resulting socioeconomic - environmental damages.

Total, added and free sugar intakes, dietary sources and determinants of consumption in Portugal: the National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016).

OBJECTIVE: To assess total sugar (TS), added sugar (AS) and free sugar (FS) intakes, dietary sources, adherence to recommendations and determinants of consumption, in a Portuguese national sample. DESIGN: Cross-sectional study. Dietary assessment was obtained by two food diaries in children aged <10 years and two non-consecutive 24 h recalls for other age groups. TS, AS and FS intakes were estimated by using SPADE software. TS content in food was estimated at the ingredient level. AS content in food was assessed through a systematic methodology and FS was based on the WHO definition. SETTING: National Food, Nutrition and Physical Activity Survey (IAN-AF 2015-2016), Portugal. PARTICIPANTS: Representative sample from the Portuguese population, aged from 3 months to 84 years (n 5811). RESULTS: Mean daily intake and contribution to total energy intake (E%) were 84·3 g/d (18·5 E%) for TS, 32·1 g/d (6·8 E%) for AS and 35·3 g/d (7·5 E%) for FS. Of the population, 76 % adhered to the FS recommendation (FS < 10 E%). The lowest adherence was in children (51·6 %) and adolescents (51·3 %). The main dietary source of TS was fruit across all ages, except in adolescents which was soft drinks. In children, the main dietary sources of FS were yoghurts and sweets, soft drinks in adolescents and table sugar in adults/elderly. FS intake was lower in children with more educated parents and in adults who practised physical activity regularly, and higher among smokers. CONCLUSIONS: Interventions ought to be planned towards decreasing intakes of added and free sugars considering population-specific characteristics.

Going beyond classic echo in aortic stenosis: left atrial mechanics, a new marker of severity.

BACKGROUND: There is limited information regarding left atrial (LA) mechanics in aortic valve stenosis (AS). We assessed LA mechanics in AS through speckle-tracking echocardiography (STE) according to severity and prognosis. METHODS: We included 102 patients diagnosed with severe AS (sAS) and 80 patients with moderate AS (mAS), all with preserved ejection fraction and no coronary artery disease. LA mechanics and left ventricular global longitudinal strain (LV-GLS) were assessed by STE. The cohort was followed-up for a median of 30 (IQR 12.6-50) months, and outcomes were determined (combined outcome of HF, death, and aortic valve replacement). RESULTS: In our sample set, values of LV-GLS (- 18.5% vs - 17.1, p = 0.025), E/e' ratio (15.8 vs 18.4, p = 0.03), and global LA mechanics (LA ɛsys, 23% vs 13.8%, p < 0.001) were worse for sAS compared to those for mAS. However, LA ɛsys (AUC 0.85, 95% CI 0.78-0.90, p < 0.001), ɛe (AUC 0.83, 95% CI 0.75-0.88, p < 0.001), and ɛa (AUC 0.80, 95% CI 0.70-0.84, p < 0.001) were the best discriminators of sAS, with sensitivities higher than 85%. LA ɛsys showed a stronger correlation with both aortic valve area (r2 = 0.6, p < 0.001) and mean LV/aortic gradient (r2 = 0.55, p < 0.001) than LV-GLS (r2 = 0.3 and r2 = 0.25, p = 0.01). Either LV-GLS or LA ɛsys, but not the E/e' ratio, TAPSE, or RV/RA gradient, were a significant predictors of the combined outcome. CONCLUSIONS: LA global strain was the best discriminator of severity, surpassing E/e' ratio and LV-GLS, and a significant predictor of prognosis in AS.

Prevalence and risk analysis for depression after open-heart valve replacement surgery.

BACKGROUND AND PURPOSE: Cardiac surgery may account for long term complications as depression. Geriatric Depression Scale (GDS) is a reliable 30-item questionnaire for assessing depressive symptoms in several populations. The aim of the present study was to determine the prevalence and predictors of depression after open-heart valve replacement surgery in a portuguese population. METHODS: Prospective observational study enrolling 52 patients (55.8% men, mean age 67.7 ± 11.3 years) with no history of depression, submitted to elective open-heart valve replacement surgery. Patients completed the GDS questionnaire at 6-month follow-up. Cardiovascular risk factors, medical history, left ventricular function, prescription table, analytical and surgical variables and length of hospital stay were collected to verify its influence on postoperative depression. RESULTS: Twenty-seven patients (41.4% men, mean age 69.3 ± 10.3 years) had scores consistent with symptoms of depression (GDS score >10), representing 51.9% of the sample. Twenty-one (77.8%) were mildly depressed, 6 (22.2%) were severely depressed and only 4 (19.0%) and 3 (50.0%) were on antidepressants, respectively. Postoperative complications (29.6 vs 8.0%, p=0.045), lower postoperative hemoglobin concentration (8.9 ± 0.8 vs 9.8 ± 1.5 g/dL p=0.015) and longer time of hospitalization (12.2 ± 7.7 vs 8.2 ± 3.4 days, p=0.020) were found to be significant predictors for postoperative depression. No other statistically significant differences were found. CONCLUSION: Depression after open-heart valve replacement surgery is frequent but appears to be generally overlooked. Strategies for systematic screening and early guidance should be implemented to ensure better health and quality-of-life of patients undergoing major cardiac surgery.

Evaluation of SARS-CoV-2 interferon gamma release assay in BNT162b2 vaccinated healthcare workers.

To predict protective immunity to SARS-CoV-2, cellular immunity seems to be more sensitive than humoral immunity. Through an Interferon-Gamma (IFN-γ) Release Assay (IGRA), we show that, despite a marked decrease in total antibodies, 94.3% of 123 healthcare workers have a positive cellular response 6 months after inoculation with the 2nd dose of BNT162b2 vaccine. Despite the qualitative relationship found, we did not observe a quantitative correlation between IFN-γ and IgG levels against SARS-CoV-2. Using stimulated whole blood from a subset of participants, we confirmed the specific T-cell response to SARS-CoV-2 by dosing elevated levels of the IL-6, IL-10 and TNF-α. Through a 20-month follow-up, we found that none of the infected participants had severe COVID-19 and that the first positive cases were only 12 months after the 2nd dose inoculation. Future studies are needed to understand if IGRA-SARS-CoV-2 can be a powerful diagnostic tool to predict future COVID-19 severe disease, guiding vaccination policies.

Bone Mineral Density is Related to CD4+ T Cell Counts and Muscle Mass is Associated with B Cells in Common Variable Immunodeficiency Patients.

BACKGROUND: Common variable immunodeficiency (CVID) is a primary immunodeficiency characterized by chronic/recurrent respiratory infections, bronchiectasis, autoimmunity, inflammatory, gastrointestinal diseases and malignancies associated with a chronic inflammatory state and increased risk of osteoporosis and muscle loss. AIM: The aim of this study was to evaluate bone mineral density (BMD), body composition and their relationship with lymphocyte subpopulations in CVID patients. METHODS: Dual-energy X-ray absorptiometry was performed to assess BMD, lean mass, and fat mass in CVID patients. Peripheral blood CD4+, CD8+, and CD19+ cells were measured using flow cytometry. RESULTS: Thirty-three patients (37.3 ± 10.8 years old) were examined. Although only 11.8% of the individuals were malnourished (BMI <18.5 kg/m2), 27.7% of them had low skeletal muscle mass index (SMI), and 57.6% of them had low BMD. Patients with osteopenia/osteoporosis presented lower weight (p = 0.007), lean mass (p = 0.011), appendicular lean mass (p = 0.011), SMI (p = 0.017), and CD4+ count (p = 0.030). Regression models showed a positive association between CD4+ count and bone/muscle parameters, whereas CD19+ B cell count was only associated with muscle variables. Analysis of ROC curves indicated a cutoff value of CD4+ count (657 cells/mm3; AUC: 0.71, 95% CI 0.52-0.90) which was related to low BMD. Weight (p = 0.004), lean mass (p = 0.027), appendicular lean mass (p = 0.022), SMI (p = 0.029), total bone mineral content (p = 0.005), lumbar (p = 0.005), femoral neck (p = 0.035), and total hip BMD (p<0.001) were found to be lower in patients with CD4+ count below the cutoff. CONCLUSION: CVID patients presented with low BMD, which was associated with CD4+ count. Moreover, low muscle parameters were correlated with B cell count.

Immunogenicity of COVID-19 adsorbed inactivated vaccine (CoronaVac) and additional doses of mRNA BNT162b2 vaccine in immunocompromised adults compared with immunocompetent persons.

Inactivated COVID-19 vaccines data in immunocompromised individuals are scarce. This trial assessed the immunogenicity of two CoronaVac doses and additional BNT162b2 mRNA vaccine doses in immunocompromised (IC) and immunocompetent (H) individuals. Adults with solid organ transplant (SOT), hematopoietic stem cell transplant, cancer, inborn immunity errors or rheumatic diseases were included in the IC group. Immunocompetent adults were used as control group for comparison. Participants received two CoronaVac doses within a 28-day interval. IC received two additional BNT162b2 doses and H received a third BNT162b2 dose (booster). Blood samples were collected at baseline, 28 days after each dose, pre-booster and at the trial end. We used three serological tests to detect antibodies to SARS-CoV-2 nucleocapsid (N), trimeric spike (S), and receptor binding domain (RBD). Outcomes included seroconversion rates (SCR), geometric mean titers (GMT) and GMT ratio (GMTR). A total of 241 IC and 100 H adults participated in the study. After two CoronaVac doses, IC had lower SCR than H: anti-N, 33.3% vs 79%; anti-S, 33.8% vs 86%, and anti-RBD, 48.5% vs 85%, respectively. IC also showed lower GMT than H: anti-N, 2.3 vs 15.1; anti-S, 58.8 vs 213.2 BAU/mL; and anti-RBD, 22.4 vs 168.0 U/mL, respectively. After the 3rd and 4th BNT162b2 doses, IC had significant anti-S and anti-RBD seroconversion, but still lower than H after the 3rd dose. After boosting, GMT increased in IC, but remained lower than in the H group. CoronaVac two-dose schedule immunogenicity was lower in IC than in H. BNT162b2 heterologous booster enhanced immune response in both groups.

Efficacy of oral 20-hydroxyecdysone (BIO101), a MAS receptor activator, in adults with severe COVID-19 (COVA): a randomized, placebo-controlled, phase 2/3 trial.

Background: SARS-CoV-2 binding to ACE2 is potentially associated with severe pneumonia due to COVID-19. The aim of the study was to test whether Mas-receptor activation by 20-hydroxyecdysone (BIO101) could restore the Renin-Angiotensin System equilibrium and limit the frequency of respiratory failure and mortality in adults hospitalized with severe COVID-19. Methods: Double-blind, randomized, placebo-controlled phase 2/3 trial. Randomization: 1:1 oral BIO101 (350 mg BID) or placebo, up to 28 days or until an endpoint was reached. Primary endpoint: mortality or respiratory failure requiring high-flow oxygen, mechanical ventilation, or extra-corporeal membrane oxygenation. Key secondary endpoint: hospital discharge following recovery (ClinicalTrials.gov Number, NCT04472728). Findings: Due to low recruitment the planned sample size of 310 was not reached and 238 patients were randomized between August 26, 2020 and March 8, 2022. In the modified ITT population (233 patients; 126 BIO101 and 107 placebo), respiratory failure or early death by day 28 was 11.4% lower in the BIO101 (13.5%) than in the placebo (24.3%) group, (p = 0.0426). At day 28, proportions of patients discharged following recovery were 80.1%, and 70.9% in the BIO101 and placebo group respectively, (adjusted difference 11.0%, 95% CI [-0.4%, 22.4%], p = 0.0586). Hazard Ratio for time to death over 90 days: 0.554 (95% CI [0.285, 1.077]), a 44.6% mortality reduction in the BIO101 group (not statistically significant). Treatment emergent adverse events of respiratory failure were more frequent in the placebo group. Interpretation: BIO101 significantly reduced the risk of death or respiratory failure supporting its use in adults hospitalized with severe respiratory symptoms due to COVID-19. Funding: Biophytis.

Primary immunodeficiency diseases in different age groups: a report on 1,008 cases from a single Brazilian reference center.

Primary immunodeficiencies (PIDs) represent a large group of diseases that affect all age groups. Although PIDs have been recognized as rare diseases, there is epidemiological evidence suggesting that their real prevalence has been underestimated. We performed an evaluation of a series of 1,008 infants, children, adolescents and adults with well-defined PIDs from a single Brazilian center, regarding age at diagnosis, gender and PID category according to the International Union of Immunological Societies classification. Antibody deficiencies were the most common category in the whole series (61 %) for all age groups, with the exception of <2-year-old patients (only 15 %). In the >30-year-old group, antibody deficiencies comprised 84 % of the diagnoses, mostly consisting of common variable immunodeficiency, IgA deficiency and IgM deficiency. Combined immunodeficiencies represented the most frequent category in <2-years-old patients. Most congenital defects of phagocytes were identified in patients <5 -years of age, as were the diseases of immune dysregulation, with the exception of APECED. DiGeorge syndrome and ataxia-telangiectasia were the most frequent entities in the category of well-defined syndromes, which were mostly identified in patients <10-years of age. Males represented three-quarters and two-thirds of <2 -years-old and 2-5-years -old patients, respectively, whereas females predominated among the >30-year-old patients. Our data indicated that some PIDs were only detected at early ages, likely because affected patients do not survive long. In addition, our data pointed out that different strategies should be used to search for PIDs in infants and young children as compared to older patients.

Sociodemographic determinants of prevalence and incidence of Helicobacter pylori infection in Portuguese adults.

BACKGROUND: Understanding the determinants of Helicobacter pylori infection in adults is essential to predict the burden of H. pylori-related diseases. We aimed to estimate the prevalence and incidence of H. pylori infection and to identify its major sociodemographic correlates in an urban population from the North of Portugal. MATERIAL AND METHODS: A representative sample of noninstitutionalized adult inhabitants of Porto (n = 2067) was evaluated by ELISA (IgG) and a subsample (n = 412) was tested by Western Blot to assess infection with CagA-positive strains. Modified Poisson and Poisson regression models were used to estimate crude and sex-, age-, and education-adjusted prevalence ratios (PR) and incidence rate ratios (RR), respectively. RESULTS: The prevalence of H. pylori infection was 84.2% [95% confidence interval (95%CI): 82.4-86.1]. It increased across age-groups in the more educated subjects, (18-30 years: 72.6%; ≥71 years: 88.1%; p for trend <0.001) and decreased with education in the younger (≤4 schooling years: 100.0%; ≥10 schooling years: 72.6%; p for trend <0.001). Living in a more deprived neighborhood was associated with a higher prevalence of infection, only in the younger (PR = 1.20, 95%CI: 1.03-1.38) and more educated participants (PR = 1.15, 95%CI: 1.03-1.29). Among the infected, the proportion with CagA-positive strains was 61.7% (95%CI: 56.6-66.9). The incidence rate was 3.6/100 person-years (median follow-up: 3 years; 95%CI: 2.1-6.2), lower among the more educated (≥10 vs ≤9: RR = 0.25, 95%CI: 0.06-0.96). The seroreversion rate was 1.0/100 person-years (95%CI: 0.6-1.7). CONCLUSIONS: The prevalence of infection among adults is still very high in Portugal, suggesting that stomach cancer rates will remain high over the next few decades.

Vaccination in children with immune-mediated disorders.

OBJECTIVE: To present an updated review of recommendations for the vaccination of children with immune-mediated diseases, with an emphasis on rheumatic and inflammatory diseases. SOURCE OF DATA: Studies published in the PubMed and Scielo databases between 2002 and 2022, Guidelines of Brazilian Scientific Societies, Manuals and Technical Notes of the Ministry of Health of Brazil, on current immunization schedules for special populations. DATA SYNTHESIS: Immunosuppressive drugs and biological agents reduce the immunogenicity of vaccines and favor susceptibility to infections. The safety and efficacy of immunogens are important points for vaccination in children with immune-mediated diseases. The safety threshold of a vaccine applied to immunocompromised individuals can be reduced when compared to healthy individuals. Very often, the recommendations for the immunization of children with immune-mediated diseases follow the recommendations for immunocompromised patients. Vaccination against COVID-19, on the other hand, should ideally occur when the disease is stabilized and in the absence of a low degree of immunosuppression. The patients should be informed about the possibility that the immunization may fail during treatment with immunosuppressants. Specific vaccination schedules should be considered to ensure better protection. CONCLUSIONS: Recent studies have allowed updating the recommendations on the safety and immunogenicity of vaccination in children with immune-mediated diseases, especially for live attenuated vaccines. There is a scarcity of data on the safety and efficacy of COVID-19 vaccines in patients, particularly pediatric patients, with rheumatic diseases. The completion of ongoing studies is expected to help guide recommendations on COVID-19 vaccines in this group of patients.

Macronutrient intake during infancy and neurodevelopment in preschool children from the EDEN mother-child cohort.

BACKGROUND: Although the deleterious effect of micronutrient deficiency at sensitive periods on neurodevelopment is well established, the potential influence of macronutrient intake on early life neurodevelopment of healthy term infants has been seldomly studied. We aimed to explore whether macronutrient intake at 12 months was related to neurodevelopmental scores in preschool children. METHODS: Analyses were based on data from the EDEN mother-child cohort. Macronutrient intake was assessed by 3-day food records at 12 months of age. Neurodevelopment was assessed at 3 years using the French version of the Ages and Stages Questionnaire (ASQ) (n = 914), and at 5-6 years, using the French version of the Wechsler Preschool and Primary Scale of Intelligence-Third Edition (n = 785). An association between macronutrient intake and neurodevelopmental scores were analysed by multivariable linear regression for 3-year Full Score ASQ or 5-6-year intelligence quotient scores and multivariable logistic regression for 3-year ASQ subdomains. RESULTS: Macronutrient intake in infancy was not associated with neurodevelopmental scores in preschool children. No association was found between PUFA intake and overall neurodevelopmental scores, after accounting for multiple testing. CONCLUSION: In the present study, macronutrient intake at one year did not appear to influence the child's cognitive ability at 3 and 5-6 years. Further studies are needed to clarify the relationship between early fatty acid intake and neurodevelopment.

Quality of life after otoplasty for prominent ears in children.

AIM: Prominent ears are a common congenital malformation and are associated with low self-esteem, social isolation and diminished school performance. Our goal was to evaluate the influence of otoplasty on children's quality of life (QoL). MATERIAL AND METHODS: Patients submitted to otoplasty from 2016 to 2018 were summoned for a reevaluation. Seventy patients and respective caregivers agreed to participate. Surgical, demographic and clinical data were reviewed from electronic registries. TWO SETS OF INQUIRIES WERE PERFORMED: Pediatric Quality of Life Inventory 4.0 (for parent and child) and an adaptation of the Glasgow Children Benefit Inventory (GCBI-b). Fifteen patients were excluded for incomplete inquiries. RESULTS: Fifty-five patients were included, 70.9% were males. Median age at surgery was 7.7 ±â€¯3.3 years. Aesthetic dissatisfaction was the main previous negative experience. Median self-report quality of life was 85.6% and parent-report was 86.9%. Median GCBI-b was +20.5, indicating an improvement in patients' QoL. Bullying and high parental expectations for life change post-surgery were predictive of higher GCBI-b scores (p < 0.05). Ninety-six percent of parents would recommend surgery to other children. CONCLUSIONS: Otoplasty is a valid treatment option for prominent ears in children,improving not only aesthetics but also health-related QoL.

Association of dietary macronutrient intake with adiposity during childhood according to sex: Findings from the generation XXI birth cohort.

BACKGROUND/OBJECTIVES: Few studies have assessed the independent and longitudinal effects of each macronutrient intake on adiposity throughout childhood. We aimed to prospectively assess the independent associations between each macronutrient intake at 4, 7, and 10 years (protein, carbohydrates, fat, and fibre) and each measure of adiposity from 7 to 10 years of age by sex. METHODS: Data from the population-based birth cohort Generation XXI was used (n = 3999). At 4, 7, and 10 years old, dietary, anthropometric and sociodemographic data were collected. The dietary intake of the children was evaluated by a validated food frequency questionnaire. Age- and sex-specific body mass index z-scores (zBMI), percentage of body fat (%FM) from bio-impedance, and waist-to-hip ratio (Whr) were used as measures of adiposity. Path analysis tested the independent associations between each macronutrient intake (protein, carbohydrates, fat, and fibre) and each measure of adiposity from 7 to 10 years of age. RESULTS: In fully adjusted models, an increase in energy from fibre intake at the age of 7 was associated with lower zBMI at the same age (ß = -0.073; 95%CI [-0.127,-0.019]) and at 10 years (ß = -0.083; 95%CI [-0.137,-0.029]). Similar results were found for %FM and Whr, and in each sex separately. At the age of 10, an increase in energy from fibre intake was associated with lower %FM and Whr, while an increase in energy from protein was associated with an increase in Whr (ß = 0.061; 95%CI [0.014, 0.107]). CONCLUSIONS: Our study supports the protective effect of fibre intake on adiposity development during childhood in both sexes.

PLEURAL METASTASIS OF A PEDIATRIC OSTEOSARCOMA.

INTRODUCTION: Osteosarcoma is the most common primary bone tumor in children and young adults. Although osteosarcoma is a tumor with a great metastatic potential, mainly to the lung; pleural metastasis in patients with osteosarcoma are rarely reported. We present a case of 16 years-old male with a pleural metastasis of a tibial osteosarcoma diagnosed 4years earlier. He was submitted to a left thoracotomy and intra-operatively a pleural mass and a left upper lobe lesion was identified. Video-assisted resection of the extra-pulmonary mass and a wedge resection of the left upper lobe lesion was performed. The surgery was uneventful. The patient is clinically well, asymptomatic, maintains active surveillance.