Aplicações dos óleos essenciais na odontologia: uma revisão de literatura / Applications of essential oils in dentistry: a literature review

Objetivo: Analisar as evidências disponíveis na literatura sobre o uso tópico de óleos essenciais como potencial agentes para a atividade de clínica odontológica. Métodos: Foram utilizadas as bases de dados BVS e PubMed. Selecionando artigos-chave que abordavam a aplicação de óleos essenciais em odontologia, utilizando como palavras-chave o nome científico e popular associado a "dentistry", nos idiomas português e inglês, publicados no período de 2018 a 2022. Resultados: Obteve-se uma tabela contendo os principais óleos essenciais de utilização comum ­ 54 óleos ­, sendo 34 excluídos por não possuírem ligação com a odontologia, e 20 óleos fazendo referência a utilização na prática clínica, dessa maneira analisados as suas principais propriedades, notou-se eficácia em diversas áreas como em: periodontia; endodontia; odontopediatria; cicatrização de lesões na cavidade oral; analgésicos, anti-inflamatórios e anestésicos. Conclusão: Dessa forma, pode-se observar que há aplicação de óleos essenciais na odontologia, e que possui diversos benefícios quando utilizada de maneira correta e adequada, manifestando efeitos que abordam o paciente em sua universalidade. Nesse sentido, é necessário maiores estudos nessa área, pois apresentou um número considerável de resultados positivos na utilização de óleos essenciais na atividade odontológica para poder tirar proveito dos benefícios oferecidos através dos óleos.

Objective: To analyze the available evidence in the literature regarding the topical use of essential oils as potential agents for dental clinic activities. Methods: BVS and PubMed databases were utilized. Key articles addressing the application of essential oils in dentistry were selected, using scientific and common names associated with "dentistry" as keywords in Portuguese and English, published between 2018 and 2022. Results: A table was compiled containing the main essential oils commonly used­54 oils in total. Thirty-four oils were excluded as they had no connection to dentistry, leaving 20 oils associated with clinical practice. The analysis of these oils revealed their primary properties, showing efficacy in various areas such as periodontics, endodontics, pediatric dentistry, healing of oral cavity lesions, analgesic, anti-inflammatory, and anesthetic effects. Conclusion: Thus, it can be observed that there is an application of essential oils in dentistry, and they offer various benefits when used correctly and appropriately, manifesting effects that address the patient universally. In this regard, further studies in this area are necessary as it presented a considerable number of positive results in the use of essential oils in dental practice to fully take advantage of the benefits offered by these oils.

Early visual intervention, visual function analysis, and grating visual acuity outcomes in children with congenital Zika syndrome

ABSTRACT Purpose: This study aimed to assess grating visual acuity and functional vision in children with congenital Zika syndrome. Methods: Initial and final grating visual acuity was measured using Teller acuity cards. Cerebral vision impairment standardized tests were used to assess functional vision. Patients were referred to the early visual intervention program for visually disabled children. Neuroimaging was performed. Results: In this study, 10 children were included with an age range of 1-37 months. Eight patients presented with macular atrophic scars. Neuroimaging revealed microcephaly and cerebral abnormalities in all patients. Low vision and cerebral vision impairment characteristics were observed in all children. The final grating visual acuity in this group varied from 3.00 to 0.81 logMAR. Conclusions: The grating visual acuity test revealed low vision in all children with congenital Zika syndrome. Functional vision evaluation revealed cerebral vision impairment characteristics in all patients, who were referred to the early visual intervention program. Visual acuity improved in six children.

Lacrimal gland enlargement in inactive thyroid eye disease: a case series and literature review

ABSTRACT Purpose: This study aimed to evaluate the morphometric and volumetric dimensions of the lacrimal gland in patients with inactive thyroid eye disease and compare them with the values reported in the literature. Methods: This case series evaluated consecutive patients with inactive thyroid eye disease treated at a tertiary eye hospital from 2015 to 2020. The patients' baseline demographics and clinical characteristics were obtained. The axial and coronal length, width, and volume of the lacrimal gland were measured on computed tomography scan images, and the results were statistically analyzed. Results: A total of 21 patients (42 orbits) with inactive thyroid eye disease were evaluated. Their mean age was 49.0 ± 14.6 years, and 12 (57.1%) of them were men. The main complaint was dryness, and the majority of the patients had good vision and mild proptosis. The mean axial length and width of the lacrimal gland were 19.3 ± 3.9 mm and 7.5 ± 2.1 mm, respectively; coronal length and width, 20.4 ± 4.5 mm and 7.5 ± 2.1 mm, respectively; and lacrimal gland volume, 0.825 ± 0.326 mm3. Age, sex, or laterality were not found to be determinants of lacrimal gland enlargement. Conclusion: Patients with thyroid eye disease have enlarged lacrimal gland even in the nonactive phase of the disease multifactorial aspects influence the lacrimal gland in thyroid eye disease, making it difficult to establish a clear correlation with predisposing factors. Further studies are warranted to better understand the association between thyroid eye disease and the lacrimal gland.

Optic disc edema and visual loss from paracentral acute middle maculopathy mimicking optic neuritis

ABSTRACT Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.

Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Yoga como terapia complementaria para el Adulto Mayor / Yoga as a complementary therapy for older adult

Introducción: El yoga es una actividad que trata de un ejercicio el cual contiene una intensidad baja a moderada, la cual no se centra exclusivamente en el entrenamiento físico, sino que también en el desarrollo de la mente y el espíritu de uno mismo. El yoga puede obtener un mayor impacto en el equilibrio y en la ganancia de fuerza de la parte superior del cuerpo, además, demuestra mejora en la aptitud cardiorrespiratoria y flexibilidad. Metodología: El enfoque de desarrollo fue de tipo cuantitativo en donde se realizó una revisión sistemática como metodología de búsqueda de información, relacionada al yoga como una terapia complementaria y los beneficios que éste aportaba al bienestar de las personas mayores. Resultados: En cada uno de los ensayos controlados aleatorizados que fueron recabados para fines de esta revisión sistemática. Se destaca la importancia y los beneficios del yoga en la movilidad, fuerza, flexibilidad y espiritualidad de los usuarios que practican esta terapia. Discusión: Los artículos analizados pertenecen a ensayos clínicos o estudios aleatorizados, los cuales permitieron responder de manera efectiva a nuestra pregunta de investigación, la cual consiste en reconocer si el yoga es efectivo para disminuir el riesgo de dependencia funcional y eliminar hábitos que no son saludables para las personas mayores, además de mejorar la calidad de vida actual. Gracias a ello se pudo evidenciar que esta terapia en adultos mayores genera cambios positivos respecto a estado y condición física, la ejecución de esta práctica mejora la calidad de vida en un 80% Conclusión: La yoga como terapia complementaria si entrega beneficios en la calidad de vida de la población adulta mayor, dado que, que hubo una mejora tanto en la movilidad, calidad de vida y autovalencia de los adultos mayores[AU]

Introduction: Yoga is an activity that deals with a low to moderate intensity exercise, which is not exclusively focused on physical training, but also on the development of the mind and spirit itself. Yoga may have a greater impact on balance and upper body strength gains, and have shown improvements in cardiorespiratory fitness and flexibility. Methodology:the development approach was of a quantitative type where a systematic review was carried out as a methodology for searching for information related to yoga as a complementary therapy and the benefits that it brought to the well-being of the elderly. Results:The importance and benefits of yoga on the mobility, strength, flexibility and spirituality of users who practice this therapy are highlighted in each of the randomized controlled trials that were collected for the purposes of this systematic review. Discussion: The articles analyzed belong to clinical trials or randomized studies, which allowed us to effectively answer our research question. The activity of yoga in older adults generates positive changes regarding state and physical condition, the execution of this practice improves the quality of life by 80% Conclusion: Yoga as a complementary therapy delivers benefits in the quality of life of the adult population elderly, it can be said that there was an improvement in mobility, quality of life and self-valence of the elderly[AU]

Introdução: O Yoga é uma atividade que trata de um exercício de intensidade baixa a moderada, que não se foca exclusivamente no treino físico, mas também no desenvolvimento da mente e do espí-rito. A ioga pode ter um impacto maior no equilíbrio e nos ganhos de força da parte superior do corpo e mostrou melhorias na apti-dão cardiorrespiratória e flexibilidade. Metodologia: a abordagem de desenvolvimento foi do tipo quantitativo onde foi realizada uma revisão sistemática como metodologia de busca de informações re-lacionadas ao yoga como terapia complementar e os benefícios que trouxe para o bem-estar dos idosos. Resultados: A importância e os benefícios do yoga na mobilidade, força, flexibilidade e espiri-tualidade dos usuários que praticam esta terapia são destacados em cada um dos ensaios clínicos randomizados que foram coletados para fins desta revisão sistemática. Discussão: Os artigos analisa-dos pertencem a ensaios clínicos ou estudos randomizados, o que nos permitiu responder de forma eficaz à nossa questão de inves-tigação. A atividade de yoga em idosos gera mudanças positivas quanto ao estado e condição física, a execução desta prática mel-hora a qualidade de vida em 80% Conclusão: o yoga como terapia complementar traz benefícios na qualidade de vida da população adulta idosa, pode-se dizer que houve melhora na mobilidade, qualidade de vida e autovalência dos idosos[AU]

Endoscopic Combined Intrarenal Surgery: best practices and future perspectives

ABSTRACT Introduction: Endoscopic Combined Intrarenal Surgery (ECIRS) has emerged as a promising technique for the management of large and complex kidney stones, potentially offering advantages over traditional Percutaneous Nephrolithotomy (PCNL). This study aims to evaluate best practices, outcomes, and future perspectives associated with ECIRS. Materials and Methods: A comprehensive PubMed search was conducted from 2008 to 2024, using MESH terms and the following key words: "ECIRS" and "Endoscopic Combined Intrarenal Surgery" The search yielded 157 articles, including retrospective cohort studies, two randomized controlled trials (RCTs), and four meta-analyses comparing ECIRS with PCNL. Most important findings were summarized regarding indications, patient positioning, kidney access, tract size, surgical outcomes, and complications. Results: ECIRS demonstrated higher stone-free rate, lower complication rate, and a reduced need for multiple procedures compared to traditional PCNL. Additionally, ECIRS has the potential to integrate new technologies to further enhance outcomes. Conclusion: ECIRS demonstrates significant advantages in the management of large kidney stones. Future research should focus on well-designed RCTs to provide robust evidence of its efficacy, safety, and cost-effectiveness, potentially establishing ECIRS as the first option treatment for complex kidney stones.

Development of nerves and vessels in the penis during the human fetal period

ABSTRACT Introduction: Although nerves and vessels of the penis play important role in erection, there are few studies on their development in human fetus. Therefore, the objective of the present study is to analyze, quantitatively, in the corpora cavernosa and corpus spongiosum, the development of the nerves and vessels in the fetal penis at different gestational ages. Material and Methods: Fifty-six fresh, macroscopically normal human fetuses aged from 13 to 36 weeks post-conception (WPC) were used. Gestational age was determined by the foot length criterion. Penises were immediately fixed in 10% formalin, and routinely processed for paraffin embedding, after which tissue sections from the mid-shaft were obtained. We used immunohistochemical staining to analyze the nerves and vessels in the corpus cavernous and in the corpus spongiosum. These elements were identified and quantified as percentage by using the Image-J software. Results: The quantitative analysis showed that the percentage of nerves varied from 3.03% to 20.35% in the corpora cavernosa and from 1.89% to 23.88% in the corpus spongiosum. The linear regression analysis indicated that nerves growth (incidence) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.9421, p<0.0001) and (r2=0.9312, p<0.0001), respectively, during the whole fetal period studied. Also, the quantitative analysis showed that the percentage of vessels varies from 2.96% to 12.86% in the corpora cavernosa and from 3.62% to 14.85% in the corpus spongiosum. The linear regression analysis indicated that vessels growth (appearance) in the corpora cavernosa and corpus spongiosum correlated significantly and positively with fetal age (r2=0.8722, p<0.0001) and (r2=0.8218, p<0.0001), respectively, during the whole fetal period studied. In addition, the linear regression analysis demonstrated a more intense growth rate of nerves in the corpus spongiosum during the 2nd trimester of gestation, when compared with nerves in the corpora cavernosa. In addition, the linear regression analysis demonstrated a more intense growth rate of vessels in the corpus spongiosum when compared with the corpora cavernosa, during the whole fetal period studied. Conclusions: In the fetal period, the human penis undergoes major developmental changes, notably in the content and distribution of nerves and vessels. We found strong correlation between nerves and vessels growth (amount) with fetal age, both in the corpora cavernosa and corpus spongiosum. There is significant greater proportional number of nerves than vessels during the whole fetal period studied. Also, nerves and vessels grow in a more intense rate than that of the corpora cavernosa and corpus spongiosum areas.

Renal medulla in hypertension

Abstract: Studies have found that blood flow to the renal medulla is an important determinant of pressure-natriuresis and the long-term regulation of arterial pressure. First, a brief review of methods developed enabling the study of the medullary circulation is presented. Second, studies performed in rats are presented showing medullary blood flow plays a vital role in the pressure-natriuresis relationship and thereby in hypertension. Third, it is shown that chronic reduction of medullary blood flow results in hypertension and that enhancement of medullary blood flow reduces hypertension hereditary models of both salt-sensitive rats and salt-resistant forms of hypertension. The key role that medullary nitric oxide production plays in protecting this region from ischemic injury associated with circulating vasoconstrictor agents and reactive oxygen species is presented. The studies cited are largely the work of my students, research fellows, and colleagues with whom I have performed these studies dating from the late 1980s to more recent years.

Diversidad de ninfas de Leptohyphidae (Ephemeroptera) en el río Quenane-Quenanito, piedemonte llanero colombiano / Diversity of Leptohyphidae (Ephemeroptera) nymphs in the Quenane-Quenanito river, Colombian plain foothills

Resumen Introducción: Varias presiones antrópicas sufren los ecosistemas acuáticos del piedemonte llanero en Colombia. La respuesta a estresores ambientales aún se desconoce en organismos bioindicadores como Leptohyphidae. Objetivo: Determinar la diversidad de ninfas de Leptohyphidae del río Quenane-Quenanito, en dos periodos hidrológicos contrastantes y su relación con algunas variables fisicoquímicas. Métodos: En diciembre (2014) y febrero (2015) se recolectaron organismos con red Surber en seis estaciones a lo largo del río. Se analizó la diversidad alfa y beta y se aplicó análisis de redundancia y modelos lineales generalizados con el fin de establecer la relación entre los taxones y las variables ambientales. Resultados: Se identificaron 369 organismos pertenecientes a cuatro géneros (Amanahyphes, Traverhyphes, Tricorythopsis y Tricorythodes), dos especies y ocho morfoespecies. Se reporta por primera vez para el departamento del Meta Amanahyphes saguassu. Se registró la mayor diversidad de ninfas en la transición a la sequía y la mayor abundancia en sequía. La diversidad beta señaló que la configuración del ensamblaje cambia a nivel espacial y temporal. Conclusiones: Los organismos de Leptohyphidae prefieren hábitats de corrientes, particularmente en el periodo de sequía, donde hallan alimento (hojarasca, detritos) y refugio para establecerse exitosamente; actividades antrópicas como la urbanización afectan notablemente la diversidad. La alta diversidad registrada en este pequeño río de piedemonte llanero refleja la necesidad de incrementar este tipo de trabajos y esfuerzos de recolección de material de estudio en la región.

Abstract Introduction: Various anthropic pressures affect the aquatic ecosystems of the foothills of Colombia. The response to environmental stressors is still unknown in bioindicator organisms such as Leptohyphidae. Objective: To determine the diversity of Leptohyphidae nymphs of the Quenane-Quenanito river, in two contrasting hydrological periods and its relationship with some physicochemical variables. Methods: In December (2014) and February (2015), organisms were collected with a Surber net at six stations along the current. Alpha and beta diversity was analyzed and redundancy analysis and generalized linear model were applied to establish the relationship between taxa and environmental variables. Results: Were identified 369 organisms belonging to four genera (Amanahyphes, Traverhyphes, Tricorythopsis, and Tricorythodes), two species, and eight morphospecies. Amanahyphes saguassu is reported for the first time for the Meta department. High diversity of Leptohyphidae nymphs was recorded in the transition to drought season and greater abundance in drought. Beta diversity indicated that the configuration of the assemblage changes spatially and temporally. Conclusions: Leptohyphidae organisms prefer fast habitats, particularly in the dry period where they find food (leaf litter, detritus) and shelter to establish themselves successfully; anthropic activities such as urbanization notably affect diversity. The high diversity recorded in this small river in the foothills of the plains reflects the need to increase this type of works and collection efforts of study material in the region.

Insulin reference intervals in Brazilian adolescents by direct and indirect approaches: validation of a data mining method from laboratory data

Abstract Objective To determine reference intervals (RI) for fasting blood insulin (FBI) in Brazilian adolescents, 12 to 17 years old, by direct and indirect approaches, and to validate indirectly determined RI. Methods Two databases were used for RI determination. Database 1 (DB1), used to obtain RI through a posteriori direct method, consisted of prospectively selected healthy individuals. Database 2 (DB2) was retrospectively mined from an outpatient laboratory information system (LIS) used for the indirect method (Bhattacharya method). Results From DB1, 29345 individuals were enrolled (57.65 % female) and seven age ranges and sex partitions were statistically determined according to mean FBI values: females: 12 and 13 years-old, 14 years-old, 15 years-old, 16 and 17 years-old; and males: 12, 13 and 14 years-old, 15 years-old, 16 and 17 years-old. From DB2, 5465 adolescents (67.5 % female) were selected and grouped according to DB1 partitions. The mean FBI level was significantly higher in DB2, on all groups. The RI upper limit (URL) determined by Bhattacharya method was slightly lower than the 90 % CI URL directly obtained on DB1, except for group female 12 and 13 years old. High agreement rates for diagnosing elevated FBI in all groups on DB1 validated indirect RI presented. Conclusion The present study demonstrates that Bhattacharya indirect method to determine FBI RI in adolescents can overcome some of the difficulties and challenges of the direct approach.

Bioelectrical impedance phase angle and nutritional status in children with intestinal failure on prolonged parenteral nutrition

Abstract Objective To compare the phase angle (PhA) through bioelectrical impedance (BIA) of children with intestinal failure (IF) using prolonged parenteral nutrition (PN) followed by an Intestinal Rehabilitation Program, with a control group. Methods Children under 10 years of age with IF using prolonged PN for >60 days (study group) were included. The control group consisted of healthy children without chronic pathologies, matched by sex and age. Anthropometric parameters evaluated were: weight, height, weight/age z-score (W/A), height/age z-score (H/A), BMI, BMI/A z-score, arm circumference, triceps skinfold, subscapular skinfold, mid-arm muscle circumference. BIA parameters were resistance (R), reactance (Xc), and phase angle (PhA). Results Twenty-eight children were included in the study group, median (IQR) age was 11 (8-27) months, 53.6 % were male. In the control group, 28 children were included, median (IQR) age was 12.5 (8-24.7) months, 50 % were male. Children from the study group had W/A z-scores and H/A z-scores significantly lower than controls. There was no significant difference between PhA in the study group and controls, [median (IQR) 4.3° (3.8;4.6) vs 4.0° (3.8;5.4) respectively, p = 0.980]. Prematurity was significantly higher in the study group than in the controls, but there was no significant correlation between gestational age at birth and PhA of the children from the study group. Conclusion Children with IF using prolonged PN showed lower W/A and H/A compared to the control group, but without significant difference between the PhA of children with IF compared to controls.

Inflammatory markers in prepubertal children and their associations with abdominal fat

Abstract Objective To evaluate the association between inflammatory markers and abdominal fat assessed by ultrasound in prepubertal children with and without excess weight. Methods A cross-sectional study involving 241 prepubertal children, 156 with obesity, 37 with overweight, and 48 with normal weight, aged five to ten years, who were followed at a research unit on Childhood Obesity from a teaching hospital belonging to a public health system. The concentration of interleukin-6, tumor necrosis factor-α and C-reactive protein were assessed and regression analyses, considering outcome variables such as abdominal wall and intra-abdominal fat thickness measured by ultrasound, were performed. Results The findings highlighted an association between abdominal fat and inflammatory markers, even in children at this young age group. Subcutaneous fat showed a stronger association with inflammatory biomarkers compared to intra-abdominal fat when performing logistic regression, with a positive association between tumor necrosis factor-α and abdominal wall thickness equal to or greater than the 75th percentile in adjusted logistic regression (OR: 18.12; CI 95 %: 1.57: 209.55). Conclusions Abdominal wall fat, in contrast to what is often observed in adults, appears to have a greater impact on chronic inflammation related to excessive weight in very young children.

Abdominal complications of ascariasis in childhood

Abstract Objective Complications of ascariasis are a significant cause of abdominal pain in pediatric emergencies, especially where it is endemic. A literature review was conducted with the aim of improving diagnostic and therapeutic approaches for these patients. Data sources A PubMed search was conducted using the key terms "ascariasis complications" and "hepatobiliary ascariasis". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, case reports, and reviews published up to December 2023. Summary of findings Obstruction of the small bowel is the most common complication. Others that are, rarer and more difficult to properly identify and treat, such as biliary, hepatic, and pancreatic complications, acute appendicitis, Meckel's diverticulitis, or peritoneal granulomas. Hepatic and pancreatic complications are rarer and more serious in children than in adults. While plain radiography is usually the only option in cases of intestinal obstruction, ultrasonography is the examination of choice in cases of hepatobiliary, pancreatic, and appendicular ascariasis complications in childhood. The treatment is clinical and conservative in most patients. Surgical treatment is indicated if conservative therapy fails, or if there are signs of complications. Laparoscopy has been used as an excellent technical alternative in adults with hepatobiliary complications of ascariasis, but further studies on its use in children are still needed. Conclusion The creation of protocols and greater debate on this subject should be encouraged for a better understanding of the disease and to establish an early diagnosis and adequate treatment for children with complications resulting from massive infestation by Ascaris lumbricoides.

Occupational risks associated with chronic kidney disease of non-traditional origin (CKDnt) in Brazil: it is time to dig deeper into a neglected problem / Riscos ocupacionais associados à doença renal crônica de origem não tradicional (DRCnt) no Brasil: é hora de nos aprofundarmos em um problema negligenciado

Abstract In the past decades, an epidemic of chronic kidney disease (CKD) has been associated with environmental and occupational factors (heat stress from high workloads in hot temperatures and exposure to chemicals, such as pesticides and metals), which has been termed CKD of non-traditional origin (CKDnt). This descriptive review aims to present recent evidence about heat stress, pesticides, and metals as possible causes of CKDnt and provide an overview of the related Brazilian regulation, enforcement, and health surveillance strategies. Brazilian workers are commonly exposed to extreme heat conditions and other CKDnt risk factors, including increasing exposure to pesticides and metals. Furthermore, there is a lack of adequate regulation (and enforcement), public policies, and strategies to protect the kidney health of workers, considering the main risk factors. CKDnt is likely to be a significant cause of CKD in Brazil, since CKD's etiology is unknown in many patients and several conditions for its development are present in the country. Further epidemiological studies may be conducted to explore causal associations and estimate the impact of heat, pesticides, and metals on CKDnt in Brazil. Moreover, public policies should prioritize reducing workers´ exposure and promoting their health and safety.

Resumo Nas últimas décadas, uma epidemia de doença renal crônica (DRC) tem sido associada a fatores ambientais e ocupacionais (estresse térmico decorrente de cargas de trabalho elevadas em altas temperaturas e exposição a produtos químicos, como agrotóxicos e metais), denominada DRC de origem não tradicional (DRCnt). Esta revisão descritiva tem como objetivo apresentar evidências recentes sobre estresse térmico, agrotóxicos e metais como possíveis causas de DRCnt e fornecer uma visão geral das estratégias brasileiras de regulamentação, fiscalização e vigilância sanitária relacionadas. Os trabalhadores brasileiros são comumente expostos a condições extremas de calor e outros fatores de risco de DRCnt, incluindo o aumento da exposição a agrotóxicos e metais. Além disso, há uma falta de regulamentação e fiscalização, políticas públicas e estratégias adequadas para proteger a saúde renal dos trabalhadores em relação aos principais fatores de risco. É provável que a DRCnt seja uma causa significativa de DRC no Brasil, uma vez que a etiologia da doença é desconhecida em muitos pacientes e diversas condições para seu desenvolvimento estão presentes no país. Estudos epidemiológicos devem ser realizados para explorar associações causais e estimar o impacto do calor, dos agrotóxicos e dos metais na DRCnt no Brasil. Além disso, as políticas públicas devem priorizar a redução da exposição dos trabalhadores e a promoção de sua saúde e segurança.

Analysis of neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios as inflammatory biomarkers in chronic kidney disease: impact of parathyroidectomy / Análise das relações neutrófilo/linfócito e plaqueta/linfócito como marcadores inflamatórios na doença renal crônica: impacto da paratireoidectomia

Abstract Introduction: Secondary hyperparathyroidism (SHPT) is one of the causes for inflammation in CKD. We assessed the impact of parathyroidectomy (PTX) on neutrophil-to-lymphocyte (N/L) and platelet-to-lymphocyte (P/L) ratios in SHPT patients. Methods: A total of 118 patients [hemodialysis (HD, n = 81), and transplant recipients (TX, n = 37)] undergoing PTX between 2015 and 2021 were analyzed. Results: There was a significant reduction in calcium and PTH levels in both groups, in addition to an increase in vitamin D. In the HD group, PTX did not alter N/L and P/L ratios. In the TX group, there was a reduction in N/L and P/L ratios followed by a significant increase in total lymphocyte count. Conclusion: N/L and P/L ratios are not reliable biomarkers of inflammation in SHPT patients undergoing PTX. Uremia, which induces a state of chronic inflammation in dialysis patients, and the use of immunosuppression in kidney transplant recipients are some of the confounding factors that prevent the use of this tool in clinical practice.

Resumo Introdução: O hiperparatireoidismo secundário (HPTS) é uma das causas de inflamação na DRC. Avaliamos o impacto da paratireoidectomia (PTX) nas relações neutrófilo/linfócito (N/L) e plaqueta/linfócito (P/L) em pacientes com HPTS. Métodos: Foram analisados 118 pacientes [hemodiálise (HD, n = 81) e transplantados (TX, n = 37)] submetidos à PTX entre 2015 e 2021. Resultados: Houve redução significativa de cálcio e PTH nos dois grupos, além de elevação de vitamina D. No grupo HD, a PTX não mudou as relações N/L e P/L. Já no grupo TX, houve redução nas relações N/L e P/L acompanhadas de elevação significativa do número de linfócitos totais. Conclusão: As relações N/L e P/L não são marcadores fidedignos de inflamação em pacientes com HPTS submetidos à PTX. A uremia, que induz um estado de inflamação crônica em pacientes dialíticos, e o uso de imunossupressão em pacientes transplantados renais são alguns dos fatores de confusão que impedem o uso dessa ferramenta na prática clínica.

Padrão de realce tardio não descrito na cardiomiopatia hipertrófica: subendocárdico circunferencial / Delayed enhancement pattern not described in hypertrophic cardiomyopathy: circumferential subendocardial

INTRODUÇÃO: Na cardiomiopatia hipertrófica (CMH) o achado mais típico na ressonância magnética é o realce tardio do mesocárdico, localizado principalmente na parede inferosseptal. Este realce não está presente em todos os casos e ocorre preferencialmente em paredes onde há maior hipertrofia. Apresentamos dois casos com fenótipo típico de CMH e padrão atípico de realce tardio. RELATO DE CASO: CASO 1-Assintomático, confirmou o diagnóstico de CMH durante a investigação de quadro recorrente de acidente vascular encefálico isquêmico. CASO 2- Histórico familiar de morte súbita, assintomático, feito diagnóstico de CMH por cascata familiar. Demais detalhes das características e achados podem ser avaliados na tabela 1. Na ressonância cardíaca: 1: hipertrofia ventricular esquerda com predomínio septal, com espessura máxima de 20 mm em septo ínfero-medial associado a presença de realce tardio miocárdico com predomínio subendocárdico difuso nos segmentos apicais. (Figura A/B). 2- aumento significativo da espessura do ápice do ventrículo direito causando redução da sua cavidade efetiva e dilatação do átrio direito. Função sistólica do ventrículo direito preservadas com presença de realce tardio subendocárdico no ápice. Espessura normal das paredes do ventrículo esquerdo com a presença de áreas de realce tardio subendocárdico circunferencial envolvendo as porções basal, médio e apical com pontos de infiltração gordurosa esparsos predominantemente na porção apical e média (Figura C/D). DISCUSSÃO E CONCLUSÃO: Na CMH, o padrão de realce tardio mais prevalente é o mesocárdico, geralmente nas paredes ventriculares onde há maior hipertrofia, e é puntiforme. Na presença de aneurisma apical na CMH, tem sido descrito o padrão transmural de realce. O realce subendocárdico circunferencial evidenciado no presente estudo, representa um achado radiológico atípico e infrequente da CMH. Suscitando amplo debate quanto a sua fisiopatologia. Após discussão, sua ocorrência foi atribuída a um possível infarto tipo 2, relacionado à isquemia na CMH por desproporção entre oferta e demanda. Assim sendo, propomos a consideração do realce tardio subendocárdico circunferencial como uma potencial apresentação da CMH e concluímos ser de suma importância clínica o reconhecimento dos diversos padrões de realce tardio, ainda que atípicos, para uma abordagem propedêutica mais precisa e eficaz.