2016 update of the Portuguese recommendations for the use of biological therapies in children and adolescents with Juvenile Idiopathic Arthritis.

OBJECTIVE: To provide evidence-based guidance for the rational and safe prescription of biological therapies in children and adolescents with juvenile idiopathic arthritis (JIAs) considering the latest available evidence and the new licensed biologics. METHODS: Rheumatologists and Pediatricians with expertise in Pediatric Rheumatology updated the recommendations endorsed by the Portuguese Society of Rheumatology and the Portuguese Society of Pediatrics based on published evidence and expert opinion. The level of agreement with final propositions was voted using an online survey. RESULTS: In total, 20 recommendations to guide the use of biological therapy in children and adolescents with JIAs are issued, comprising 4 general principles and 16 specific recommendations. A consensus was achieved regarding the eligibility and response criteria, maintenance of biological therapy, and procedures in case of non-response, for each JIA category. Specific recommendations concerning safety procedures were also updated. CONCLUSIONS: These recommendations take into account the specificities of each JIA category and are intended to continuously improve the management of JIA patients.

Patogenesia do óleo essencial e homeopatias de Eucalyptus citriodora em plantas de feijão (Phaseolus vulgaris) / Pathogenesis of essential oil and homeopathies of Eucalyptus citriodora in bean plants (Phaseolus vulgaris)

A homeopatia baseia-se no princípio da cura pelos semelhantes, e na experimentação no indivíduo sadio, doses mínimas e medicamento único. O uso de tratamentos a base de soluções dinamizadas aplicadas em vegetais aumentou nas ultimas décadas, sendo assim necessária a experimentação patogenésica para aplicação de todos os princípios homeopáticos e consolidação da Matéria Vegetal Homeopática. O ensaio patogenésico com plantas de feijão tratadas diariamente via pulverização e irrigação utilizando óleo essencial de Eucalyptus citriodora em diluições (0,5 e 1%) e dinamizados (12 e 30CH) revelaram sintomas externos semelhantes aos provocados por Pseudocercospora griseola, agente causal da mancha angular em feijoeiro. O estudo patogenésico com E. citriodora levanta a possibilidade deste ser utilizado no controle da mancha angular de acordo com o princípio homeopático da cura pela similitude.

Homeopathy is based on the principle of cure by similarity and on the prescription of minimal doses and single medicine to healthy individuals. In plants, performing treatments on the basis of drug dynamisation has increased in the recent decades. In these treatments, it is necessary to conduct a pathogenetic experimentation in order to apply homeopathic principles and to consolidate homeopathic plant material. Through a pathogenetic test with bean plants treated daily by pulverization and irrigation, using diluted and dynamized essential oil of Eucalyptus citriodora - (dilutions: 0.5 and 1%) (oil dynamisation: 12 and 30CH) -, there appeared external symptoms similar to those symptoms caused by Pseudocercospora griseola, i.e., the causal agent of angular leaf spot of bean. The pathogenetics study with E. citriodora raises the possibility of its application to control angular leaf spot in bean plants in accordance with the homeopathic principle of cure by similarity.

Complex inguinal hernia repairs.

INTRODUCTION: Complex inguinal hernia treatment is a challenge for general surgeons. The gold standard for the repair of inguinal hernias is the Lichtenstein repair (anterior approach). However, when multiple recurrent hernias or giant hernias are present, it is necessary to choose different approaches because the incidence of poor results increases. There are many preperitoneal approaches described in the literature. For example: (a) open procedure-Nyhus and Stoppa (b) laparoscopic technique-transabdominal pre-peritoneal (TAPP) and totally extraperitoneal (TEP). In this study, we show how we repair complicated cases using open access in huge unilateral or bilateral, recurrent, or multiple recurrent inguinal hernias. METHODS: The present study includes the period from November 1993 through December 2007. One hundred and eighty-eight patients, divided into 121 with unilateral hernias and 67 with bilateral hernias, totaling 255 inguinal hernia repairs, were treated by the Nyhus or Stoppa preperitoneal approach, depending on whether they were unilateral or bilateral. We used progressive preoperative pneumoperitoneum for oversize inguinal hernias in all patients. RESULTS: Orchiectomy was necessary on only two occasions. Despite the repair complexity involved, we had only two known recurrences. The mortality was zero and the morbidity was acceptable. CONCLUSIONS: We conclude that an accurate open preperitoneal approach using mesh prosthesis for complex inguinal hernias is safe, with very low recurrent rates and low morbidity. Progressive preoperative pneumoperitoneum for giant hernias was shown to be an important factor in accomplishing good intraoperative and immediate postoperative results.

Uso de anastomose mecanica com grampeador EEA nas varizes sangrantes do esofago. / The use of mechanical anastomosis with EEA stapler in esophageal bleeding varices

O uso da anastomose mecanica com grampeador EEA nas varizes sangrantes do esofago associada a esplenectomia, desvascularizacao esofagogastrica, vagotomia troncular e piloroplastia e apresentado como mais uma alternativa para os pacientes com hipertensao portal sangrado macicamente. O metodo foi usado em 6 pacientes com 2 obitos no pos-operatorio, nao havendo em nenhum dos casos ressangramento

Hipoglicemia induzida pelo alcool. / Alcohol induced hypoglycaemia

Os autores determinaram as glicemias de 25 individuos admitidos em servicos de emergencia em consequencia de ingestao alcoolica aguda, tendo observado a presenca de hipoglicemia estava relacionada com baixa ingestao de carboidratos ou jejum prolongado em 9 pacientes (69,2%) e provavelmente representando uma forma reativa em 4 pacientes (30,8%), os quais estavam sob dieta normal. Concluiram que a hipoglicemia induzida pelo alcool deve ser responsabilizada por grande parte das alteracoes psiquicas e neurologicas comumente atribuidas exclusivamente aos efeitos do alcool dai recomendando a determinacao de rotina da glicemia em todos os individuos com quadro de etilismo agudo