Platelet-rich plasma: applications in dermatology.

In recent years, the use of platelet-rich plasma has increased notably in a range of diseases and settings. Uses of these products now go beyond skin rejuvenation therapy in patients with facial ageing. Good outcomes for other dermatological indications such as skin ulcers and, more recently, alopecia have been reported in case series and controlled studies. However, these indications are not currently included in the labeling given that stronger scientific evidence is required to support their real benefits. With the increased use of these products, dermatologists need to become familiar with the underlying biological principles and able to critically assess the quality and outcomes of the studies of these products in different skin diseases.

Spontaneous subarachnoid haemorrhage from rupture of an anterior communicating artery aneurysm in a patient with pituitary macroadenoma.

The presence of a cerebral aneurysm in patients with pituitary adenoma is a rare event. Diagnostic suspicion may stem from magnetic resonance imaging, which should lead to complementary investigation. As for treatment, even in conditions in which there has been no previous bleeding, the simultaneous approach should be considered, prioritising the aneurysm most of the time. The present report describes the case of a patient with a history of pituitary macroadenoma, who had undergone a partial transsphenoidal resection ten years earlier. Admission to our service occurred after a sudden headache followed by mental confusion. A cranial computed tomography showed subarachnoid haemorrhage and expansive suprasellar lesion. Cerebral angiography showed a saccular aneurysm of the anterior communicating complex. The patient underwent a surgical procedure for microsurgical clipping of the aneurysm and partial resection of the pituitary tumour. We have also included a brief review of the literature on this subject.

Effect of Calcium Hydroxide and Antioxidant Agents Filling the Pulp Chamber after Internal Bleaching.

To evaluate the effect of calcium hydroxide (CH), sodium ascorbate (SA) and sodium thiosulfate (ST) filling the pulp chamber on color stability and longevity of teeth after internal bleaching. Crowns of bovine incisors were submitted to internal bleaching and divided into groups according the material used in the pulp chamber: Control, CH, SA, ST. Each group was divided into two subgroups according to the time to perform restorative procedures (7 or 15 days). Color measurement was performed with a spectrophotometer at nine periods. The darkening (ΔE) values were calculated. The Mann-Whitney test was used to statistically analyze the data (p ⟨ 0.05). After bleaching, ΔE values were higher than 3.5, showing that the procedure was effective. After 24 hours, no difference was observed between groups. After 7 days, SA showed higher ΔE than the control group (p ⟨ 0.05). CH and TS did not differ from the control group. In restorations performed after 7/15 days, SA group showed higher values of darkening after 1 and 4 months than the control group (p ⟨ 0.05). SA induced perceptible darkening after bleaching and should not be used to fill the pulp chamber. ST and CH show color stability and longevity after 12 months.

Influence of the river flow pulse on the maturity, resilience, and sustainability of tropical coastal ecosystems.

Coastal marine ecosystems have structural and functional features usually connected by the seasonal transfer of nutrients and organisms. These environments can utilize inter-ecosystem subsidies to increase resilience and maturity and support human activities like fishing. However, the importance of the connection and the role of the seasonal pulse of energy flows to enhance maturity are still poorly understood and reported. Our objective in this paper is to assess the effect of seasonal hydrological pulses on two tropical coastal interconnected ecosystems. Thus, we made four Ecopath models for estuarine and neritic environments considering the dry and rainy seasons, with a similar sampling design that allowed them to be compared. Our results provide evidence for the occurrence of the pulsed ecosystems since both environments seem driven by the river flow. Estuary presents more and more substantial differences (measured by ecosystem attributes) in both seasons because it is directly affected by river floods than the neritic environment. The neritic is affected indirectly by the movement of species from the estuary and by a weaker river flow. In the dry season, the differences between ecosystems are lower because the dry season trend to homogenize cycling, maturity, homeostasis, and resilience. We found that the seasonal river flow (pulse) forces the variability of biomass, flows, and ecosystem features, and this variance creates the required stability for both ecosystems. Still, these environments benefit through the exchange of components that relieve the pressures of predation on specific groups and maintain the energy flow necessary for the functioning of their trophic webs. The pulse by the rainfall favors connectivity and equalizes the two systems, increasing the connectivity between them and the exchange of subsidies that strengthens the trophic structures, contributing to the increase in maturity. In these ecosystems, seasonal changes become a key factor for exchanging flows that will promote sustainability, the accumulation of more biomass (growth), and the optimization of reserve energy (development) in both systems. This efficient joint strategy of perpetuation is what promotes resistance and resilience to these ecosystems, which together can reach different states of equilibrium, translated into maturity to withstand new environmental changes.

Patient needs four years after first psychiatric hospitalization in a Brazilian cohort.

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.

Vocal universals and geographic variations in the acoustic repertoire of the common bottlenose dolphin.

Acoustical geographic variation is common in widely distributed species and it is already described for several taxa, at various scales. In cetaceans, intraspecific variation in acoustic repertoires has been linked to ecological factors, geographical barriers, and social processes. For the common bottlenose dolphin (Tursiops truncatus), studies on acoustic variability are scarce, focus on a single signal type-whistles and on the influence of environmental variables. Here, we analyze the acoustic emissions of nine bottlenose dolphin populations across the Atlantic Ocean and the Mediterranean Sea, and identify common signal types and acoustic variants to assess repertoires' (dis)similarity. Overall, these dolphins present a rich acoustic repertoire, with 24 distinct signal sub-types including: whistles, burst-pulsed sounds, brays and bangs. Acoustic divergence was observed only in social signals, suggesting the relevance of cultural transmission in geographic variation. The repertoire dissimilarity values were remarkably low (from 0.08 to 0.4) and do not reflect the geographic distances among populations. Our findings suggest that acoustic ecology may play an important role in the occurrence of intraspecific variability, as proposed by the 'environmental adaptation hypothesis'. Further work may clarify the boundaries between neighboring populations, and shed light into vocal learning and cultural transmission in bottlenose dolphin societies.

In vitro chondral culture under compression and shear stimuli. From mesenchymal stem cells to hyaline cartilage. / Cultivo condral in vitro bajo estímulos de compresión y cizallamiento. De las células troncales mesenquimales al cartílago hialino.

INTRODUCTION: The in vitro creation of hyaline joint cartilage is a challenge since, to date, the ex vivo synthesis of a structured tissue with the same biomechanical and histological properties of the joint cartilage has not been achieved. To simulate the physiological conditions we have designed an in vitro culture system that reproduces joint movement. MATERIAL AND METHOD: We have developed a cell culture bioreactor that prints a mechanical stimulus on an elastin matrix, in which mesenchymal stem cells (MSC) are embedded. The first phase of study corresponds to the development of a bioreactor for hyaline cartilage culture and the verification of cell viability in the elastin matrix in the absence of stimulus. The second phase of the study includes the MSC culture under mechanical stimulus and the analysis of the resulting tissue. RESULTS: After culture under mechanical stimulation we did not obtain hyaline tissue due to lack of cellularity and matrix destructuring. CONCLUSION: The stimulus pattern used has not been effective in generating hyaline cartilage, so other combinations should be explored in future research.

Raillietiella mottae (Pentastomida: Raillietiellidae) infecting Ameiva ameiva (Squamata: Teiidae) in Araripe Plateau, Northeast Brazil.

We investigated the infection by pulmonary parasites in the lizard Ameiva ameiva (Teiidae) inhabiting the Environmental Protection Area of Araripe (APA-Araripe). A total of 45 specimens were collected in three areas between the cities of Várzea Alegre and Barbalha. A Pentastomid species (Raillietiella mottae) was parasitizing (nine specimens) a male of A. ameiva with a prevalence of 2.22% considering all lizards collected in the region and prevalence of 50% considering only rainforest environment. The Pentastomids infection rates shown in this study are similar to data found for infections of other insectivorous lizards. Raillietiella mottae is considered a generalist parasite, which uses insects as intermediate hosts. The results of this study represent the first record of a Pentastomid infecting this species of lizard in South America.

Neotropical Species of Metaphycus (Hymenoptera, Encyrtidae) Parasitoids of Ceroplastes (Hemiptera, Coccidae): New Species, Interaction Records, and a Checklist.

Parasitoids of Ceroplastes Gray were surveyed in the State of São Paulo, Brazil. Among the parasitoids reared, seven species of Metaphycus Mercet (Hymenoptera, Encyrtidae) were obtained. Metaphycusanaluciaesp. nov., M. floridensissp. nov., and M. grandissp. nov., are described as new species, and M. ceros Noyes, M. comes Noyes, M. dardanus Noyes, M. opis Noyes are recorded for the first time from Brazil. Ten new host-parasitoid associations are reported: M. analuciaesp. nov. parasitizing C. formicarius Hempel, C. glomeratus Peronti and C. iheringi Cockerel; M. ceros parasitizing C. cirripediformis Comstock; M. comes parasitizing C. formicarius; M. dardanus parasitizing C. glomeratus; M. floridensissp. nov. parasitizing C. floridensis; M. grandissp. nov. parasitizing C. grandis Hempel; and M. opis parasitizing C. glomeratus and C. janeirensis (Gray). A checklist of Metaphycus species associated with Ceroplastes, their distribution and host ranges are summarized and discussed.

[Cervical hematoma after discectomy for spondylosis. An indication of urgent tracheotomy]. / Hematoma cervical tras disquectomía por espondilosis. Indicación de Traqueotomía Urgente.

We report the clinical case of a hematoma after surgery of cervical spondylosis which required an urgent tracheotomy due to failure in the orotracheal intubation. This illness in advanced degree, so called cervical spondylotic myelopathy, is the most serious consequence of cervical intervertebral disc degeneration.

[Morphology of the parathyroid glands. A study of 146 samples and review of the literature]. / Morfología de las glándulas paratiroides. Estudio de 146 muestras y revisión de la literatura.

Parathyroid hyperfunction condition has a very diverse and unspecific symptoms and signs. We have performed an anatomopathologic study of 146 parathyroid gland from patients diagnosed from hyperparathyroidism. About a 72.6% of the patients presented a parathyroid adenoma while in the rest 27.4% it was observed principal cells hyperplasia. Up to now we have not registered any cases of parathyroid carcinoma after anatomopathological exam of the removed gland. The mayority of the adenomas (85%) were found on the lower parathyroids and its size varied between 6 mm and 5 cm. In one case an double adenoma was diagnosed and in another two cases the adenoma was located in the superior mediastine.

[Diffuse large B-cells lymphoma of the parotid gland (MALT). Report of a case and review of the literature]. / Linfoma difuso de células b grandes parotídeo (MALT). A propósito de 1 caso y revisión de la literatura.

Althouh lymphomas are an illness that characteristically affects the lymph nodes they can present in other locations (extranodes). The lymphoid tissue of the salivary glands can be considered part of the called mucosa-associated lymphoid tissue (MALT). We report the case of a diffuse large B-cells parotid lymphoma. The location on the parotid gland, within its rareness, is the most common for salivary gland lymphomas whose diagnosis is always histological by examination of the removed piece since the biopsy can be nonsufficient and take to a wrong diagnosis besides the greater risk of injury on the facial nerve.

[Sudden cardiorespiratory arrest in adults with acute epiglottitis. Report of 2 cases]. / Parada cardiorrespiratoria súbita en adultos con epiglotitis aguda presentación de dos casos.

We report two adult cases of sudden cardiorespiratory arrest because an acute epiglottitis that ocurred in our hospital. Although it is an uncommon pathology nowdays with good prognosis generally, we try to call the attention about this complication which can happen of unforseeable way even in previous absence of respiratory obstruction. One of the patients required coniotomy in ICU due to impossibility of orotracheal intubation (OI) and the other died in spite of an urgent performance.

[Spontaneous cervical and pharyngolaryngeal hematoma after coughing attacks]. / Hematoma faringolaríngeo y cervical espontáneo tras crisis tusígena.

We report the case of a 86 years old male who, in the course of a coughing attack, refers spontaneous cervical and pharyngeal pain in addition to hoarness, dysphagia and some dyspnea. His exploration revealed a small right neck hematoma but with infiltration of the orohypopharynx and right hemilarynx for spreading later to posterior pharyngeal wall and left aryepiglottic fold. The patient was sent to ICU although he did not required a control of airway by intubation or tracheotomy finally.

[Pseudomonas and acute external otitis. Results of a microbiological study in patients without previous antibiotic treatment]. / Pseudomonas y otitis externa aguda. Resultados de un estudio microbiológico en pacentes sin tratamiento antibiótico previo.

We report the results of a microbiological clinic study that was performed by our ENT Department between years 2000 and 2001 whose main objective was to determine, in Badajoz Area of Health, which bacteria were involved in the acute diffuse external otitis of patients without previous antibiotic treatment (two weeks before obtaining the samples). Of 79 isolated microorganisms in 62 patients that fulfilled the requirements established Pseudomonas, mainly P. Aeruginosa, represented a 46.83% altogether followed by Staphylococcus (18.98%). In almost one fourth part of the cases strains of associated fungi were identified.

[Treatment of the benign paroxysmal positional vertigo (BPPV) by Epley maneuver]. / Tratamiento del vértigo posicional paroxístico benigno (VPPB) mediante la maniobra de epley.

Benign paroxysmal positional vertigo (BPPV) is the most common of the peripheral vertigo. We report the case of a 45 years old female with that pathology suspected by the symptoms which the patient related to head changes of positions and movements. Her diagnosis was confirmed by the maneuver of Dix-Hallpike, that was positive, and the treatment consisted in a maneuver of canalicular reposition according to Epley's technique. Such maneuver was successful and actually the patient is without symptoms after more than 2 years since the first episode. Finally we have performed a bibliographic review to verify the effectiveness of that treatment.

[Recurrent intrathyroid abscess in children. Clinical case and review of the literature]. / Absceso recurrente intratiroideo en niños. Caso clinico y revisión de la literatura.

Recurrent thyroid abscesses in children are an uncommon clinical disorder that use to be due to 3rd or 4th branchial anomalies and pyriform sinus fistula. We are reporting the clinical case ofa 6 year-girl who was diagnosed as left thyroid lobe and istmic abscess of 3 cm, drained by general anesthesia with positive culture for St. Viridans. Four months later she was re-admitted by the same cause and we performed a new drainage, by punction, and endovenous antimicrobial therapy for aerobic and anaerobic pathogens with good evolution. The imaging tests showed no anatomical alterations.

Hormone replacement therapy and venous disease.

Hormone replacement therapy was first proposed as a magic solution to all the health problems of middle aged women, however, recently a great number of side effects were proven, including an increased incidence of thromboembolic events. In the last decades, a great number of women around the world were in use of HRT, believing that they would have fewer heart attacks and hip fractures. Nevertheless, large clinical trials failed to show the benefits attributed to the use of estrogen and progestin. They proved that not only HRT exposed its users to a higher risk of thromboembolic events, breast cancer and gall bladder disease, but also did not protect the women against heart attacks as it was first thought, although fewer hip fractures occurred. The truth is that we do not know the precise mechanisms by which hormones act, as we do not know all the aspects concerning coagulation and fibrinolysis. We already know that the vessel wall, as well as other target organs, have a large number of estrogen and progestagen receptors which distribution is variable from person to person, rendering a reasonably number of persons more sensitive to the hormone effects. There are still questions about the risks and benefits of the hormone replacement therapy, including its action on the chronic venous disease. Despite the impact of the recent clinical trials, many women still remained on HRT and a great number are under treatment with tamoxifene and raloxifene, for breast cancer and osteoporosis prevention.