Isospora bertoi n. sp. of the saffron finch, Sicalis flaveola (Aves: Passeriformes) from Brazil1.

A new species of coccidia (Protozoa: Apicomplexa: Eimeriidae) is described from the saffron finch, Sicalis flaveola, is reported from Brazil. Sporulated oocysts of Isospora bertoi n. sp. are spherical to subspherical; 23.6 (21.1-26.5) x 22.0 (19.4-24.6) µm; shape Index (L/W ratio) 1.1 (1.0-1.2) µm; with bilayer smooth walls, ~1.1 µm. Micropyle and oocyst residuum are absent, but polar granules are present. Sporocysts are elongated ellipsoidal, 16.2 (13.6-17.9) x 10.1 (8.9-12.4) µm. Stieda body is button-shaped and Sub-Stieda and Para-Stieda body are absent. Sporocyst residuum is compact and composed of hundreds of granules scattered among the sporozoites. The sporozoite is claviform with an elongated posterior refractile body and nucleus.

Bone density in youth with prediabetes: results from the National Health and Nutrition Examination Survey, 2005-2006.

Youth with type 2 diabetes might have suboptimal peak bone mass, but it is unknown whether similar effects are evident in youth with prediabetes. Results from this study suggest that diabetes-related effects on peak bone mass likely occur before disease onset, and involve the muscle-bone unit. INTRODUCTION: Type 2 diabetes might adversely influence bone health around the age of peak bone mass, but it is unknown whether diabetes-related effects on areal bone mineral density (aBMD) are evident in youth with prediabetes. We compared age-related trends in aBMD and associations between lean body mass (LBM) and aBMD between children and adolescents with prediabetes vs. normal glucose regulation. METHODS: Cross-sectional analysis of data from the National Health and Nutrition Examination Survey (2005-2006) in youth ages 12-20 years (49% female, 34% black) with prediabetes (n = 267) and normal glucose regulation (n = 1664). Whole body aBMD and LBM were assessed via DXA. LBM index (LBMI) and Z-scores for aBMD and LBMI were computed. RESULTS: Unadjusted between-group comparisons revealed greater mean weight and LBMI Z-scores in youth with prediabetes vs. normal glucose regulation, but similar bone Z-scores between the two groups. While accounting for differences in BMI Z-score, there was a significant interaction between prediabetes status and age with respect to whole body aBMD Z-score (P < 0.05), such that children with prediabetes tended to have increased aBMD but adolescents and young adults with prediabetes tended have lower aBMD. Furthermore, the positive association between LBMI and whole body aBMD was moderated in youth with prediabetes (P < 0.001), who had slightly lower whole body aBMD for a given LBMI (P = 0.068). Lumbar spine bone measures did not differ between the two groups. CONCLUSIONS: Type 2 diabetes-related threats to peak bone mass might occur prior to disease onset, therefore potentially impacting a considerable proportion of US youth.

High BRAF variant allele frequencies are associated with distinct pathological features and responsiveness to target therapy in melanoma patients.

BACKGROUND: BRAF mutant melanoma patients are commonly treated with anti-BRAF therapeutic strategies. However, many factors, including the percentage of BRAF-mutated cells, may contribute to the great variability in patient outcomes. PATIENTS AND METHODS: The BRAF variant allele frequency (VAF; defined as the percentage of mutated alleles) of primary and secondary melanoma lesions, obtained from 327 patients with different disease stages, was assessed by pyrosequencing. The BRAF mutation rate and VAF were then correlated with melanoma pathological features and patients' clinical characteristics. Kaplan-Meier curves were used to study the correlations between BRAF VAF, overall survival (OS), and progression-free survival (PFS) in a subset of 62 patients treated by anti-BRAF/anti-MEK therapy after metastatic progression. RESULTS: A highly heterogeneous BRAF VAF was identified (3%-90%). Besides being correlated with age, a higher BRAF VAF level was related to moderate lymphocytic infiltration (P = 0.017), to melanoma thickness according to Clark levels, (level V versus III, P = 0.004; level V versus IV, P = 0.04), to lymph node metastases rather than cutaneous (P = 0.04) or visceral (P = 0.03) secondary lesions. In particular, a BRAF VAF >25% was significantly associated with a favorable outcome in patients treated with the combination of anti-BRAF/anti-MEK drug (OS P = 0.04; PFS P = 0.019), retaining a significant value as an independent factor for the OS and the PFS in the multivariate analysis (P = 0.014 and P = 0.003, respectively). CONCLUSION: These results definitively support the role of the BRAF VAF as a potential prognostic and predictive biomarker in melanoma patients in the context of BRAF inhibition.

Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model.

OBJECTIVE: The extent of surgery, the type of device used and head position may influence nasal irrigation. The aim of this study was to determine the effectiveness of topical irrigant delivery to the paranasal sinuses according to these factors. METHOD: Four cadaveric heads underwent four stepwise endoscopic dissections. Irrigations were evaluated after every stage using different delivery devices (squeeze-bottle, gravity-dependent device and syringe) in two head positions (nose-to-sink and vertex down). Irrigant penetration into each sinus was estimated using a four-point scale. RESULTS: A significant positive effect of surgery was demonstrated for each sinus as well as for the delivery device. High-volume irrigant devices are more effective, and the head position plays a significant role in irrigant distribution to the frontal sinus. CONCLUSION: This study further confirms the efficacy of high-volume irrigant devices. A vertex down position during the irrigation could improve delivery to the frontal sinus, and the widening of the ostia increases irrigant access to the sinuses.

Gastrointestinal parasites of a population of emus (Dromaius novaehollandiae) in Brazil / Parasitas gastrointestinais de emus Dromaius novaehollandiae de cativeiro no Brasil

Abstract Emus are large flightless birds in the ratite group and are native to Australia. Since the mid-1980s, there has been increased interest in the captive breeding of emus for the production of leather, meat and oil. The aim of this study was to identify gastrointestinal parasites in the feces of emus Dromaius novaehollandiae from a South American scientific breeding. Fecal samples collected from 13 birds were examined by direct smears, both with and without centrifugation, as well as by the fecal flotation technique using Sheather's sugar solution. Trophozoites, cysts and oocysts of protozoa and nematode eggs were morphologically and morphometrically evaluated. Molecular analysis using PCR assays with specific primers for the genera Entamoeba, Giardia and Cryptosporidium were performed. Trophozoites and cysts of Entamoeba spp. and Giardia spp., oocysts of Eimeria spp. and Isospora dromaii, as well as eggs belonging to the Ascaridida order were found in the feces. Three animals were diagnosed with Giardia spp., and three were positive for Entamoeba spp. based on PCR techniques. After analyzing the data, we concluded that emus were infected enzootically by nematode and protozoan species.

Resumo Emus são aves grandes que não voam pertencentes ao grupo das ratitas e são originários da Austrália. Desde meados da década de 1980, aumentou o interesse pela criação de emus em cativeiro para a produção de couro, carne e óleo. O objetivo deste estudo foi identificar parasitas gastrointestinais nas fezes de emus Dromaius novaehollandiae de um criatório científico da América do Sul. Amostras de fezes coletadas de 13 aves foram examinadas por esfregaços diretos, tanto com e sem centrifugação, quanto com a técnica de flutuação fecal utilizando solução de açúcar de Sheather. Trofozoítos, cistos e oocistos de protozoários e ovos de nematóides foram avaliados morfologicamente e morfometricamente. Foram realizadas análises moleculares utilizando ensaios de PCR com primers específicos para os gêneros Entamoeba, Giardia e Cryptosporidium. Trofozoítos e cistos de Entamoeba spp. e Giardia spp., oocistos de Eimeria spp. e Isospora dromaii, bem como ovos pertencentes à ordem Ascaridida foram encontrados nas fezes. Três animais foram diagnosticados com Giardia spp., e três foram positivos para Entamoeba spp. com base em técnicas de PCR. Depois de analisar os dados, concluímos que os emus estavam infectados enzooticamente por espécies de nematóides e protozoários.

Gastrointestinal parasites of a population of emus (Dromaius novaehollandiae) in Brazil.

Emus are large flightless birds in the ratite group and are native to Australia. Since the mid-1980s, there has been increased interest in the captive breeding of emus for the production of leather, meat and oil. The aim of this study was to identify gastrointestinal parasites in the feces of emus Dromaius novaehollandiae from a South American scientific breeding. Fecal samples collected from 13 birds were examined by direct smears, both with and without centrifugation, as well as by the fecal flotation technique using Sheather's sugar solution. Trophozoites, cysts and oocysts of protozoa and nematode eggs were morphologically and morphometrically evaluated. Molecular analysis using PCR assays with specific primers for the genera Entamoeba, Giardia and Cryptosporidium were performed. Trophozoites and cysts of Entamoeba spp. and Giardia spp., oocysts of Eimeria spp. and Isospora dromaii, as well as eggs belonging to the Ascaridida order were found in the feces. Three animals were diagnosed with Giardia spp., and three were positive for Entamoeba spp. based on PCR techniques. After analyzing the data, we concluded that emus were infected enzootically by nematode and protozoan species.

Frontal sinus ablation (Riedel-Mosher’s procedure): indications and role in the endonasal endoscopic era.

BACKGROUND: The aim of this article is to describe the Riedel-Mosher’s surgical technique and identify its current role in the endoscopic endonasal era based on the experience of a tertiary care medical centre. It also provides a brief excursus on materials available for frontal reconstruction. METHODS: A retrospective review of patients submitted to Riedel-Mosher’s procedure from 2005 to 2018 at a single tertiary care centre was carried out. Details of the surgical technique along with data on frontal reconstruction timing and materials used were collected. RESULTS: A total of 21 patients (16 males and 5 females) underwent the Riedel-Mosher’s procedure. The age of the patients ranged from 15 to 84 years. The underlying pathology was represented mainly by chronic osteitis of the frontal bone (17 cases), followed by benign tumours (3 cases) and malignancy (1 case). Perioperative complications occurred in 3 patients. Cranioplasty was carried out only on 16 cases and delayed by an average time of 10 months. Materials for reconstruction included titanium, ceramic, plastic and free flap . CONCLUSIONS: Nowadays, Riedel-Mosher’s procedure is still indicated in selected cases of benign and malignant pathologies of the frontal sinus and/or frontal bone. Surgical expertise is key to approach the frontal sinus safely. Its reconstruction requires proper planning and a wide variety of materials to perform it is now available.

Multi-option therapy vs observation for small acoustic neuroma: hearing-focused management.

The current treatment options for acoustic neuromas (AN) - observation, microsurgery and radiotherapy - should assure no additional morbidity on cranial nerves VII and VIII. Outcomes in terms of disease control and facial function are similar, while the main difference lies in hearing. From 2012 to 2016, 91 of 169 patients (54%) met inclusion criteria for the present study, being diagnosed with unilateral, sporadic, intrameatal or extrameatal AN up to 1 cm in the cerebello-pontine angle; the remaining 78 patients (46%) had larger AN and were all addressed to surgery. The treatment protocol for small AN included observation, translabyrinthine surgery, hearing preservation surgery (HPS) and radiotherapy. Hearing function was assessed according to the Tokyo classification and the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) classification. Sixty-one patients (71%) underwent observation, 19 (22%) HPS and 6 (7%) translabyrinthine surgery; 5 patients were lost to follow-up. Median follow-up was 25 months. In the observation group, 24.6% of patients abandoned the wait-and-see policy for an active treatment; the risk of switching from observation to active treatment was significant for tumour growth (p = 0.0035) at multivariate analysis. Hearing deteriorated in 28% of cases without correlation with tumour growth; the rate of hearing preservation for classes C-D was higher than for classes A-B (p = 0.032). Patients submitted to HPS maintained an overall preoperative hearing class of Tokyo and AAO-HNS in 63% and 68% of cases, respectively. Hearing preservation rate was significantly higher for patients presenting with preoperative favourable conditions (in-protocol) (p = 0.046). A multi-option management for small AN appeared to be an effective strategy in terms of hearing outcomes.

Implementing strategies for data collection in chronic rhinosinusitis.

SUMMARY: Chronic rhinosinusitis (CRS) is a debated topic in the international rhinologic literature because of its high prevalence, heterogeneity of clinical manifestations and unpredictability of disease course. Recently, the focus in CRS research has moved to identify biological subtypes that might explain its aetiology and clinical variability. However, these analyses are still expensive and limited to scientific purposes, so that they cannot be used on a large scale in daily practice. For this reason, we wondered if it was possible to define a risk stratification for CRS patients based only on first level investigations. The heterogeneity of the disease has given us a large amount of data compelling to find an additional storage system. Herein, we present the results of our work, the RhinoBank, as we believe that it is an easy-to-use tool for those professionals dealing with CRS and an effective system to exploit in clinical research.

Horizontal lateral lamella as a risk factor for iatrogenic cerebrospinal fluid leak. Clinical retrospective evaluation of 24 cases.

BACKGROUND: Several authors highlighted the limitations of the Keros classification system in predicting intracranial entry risk. Recently, our group proposed a new classification system based on the angle formed between the lateral lamella of the cribriform plate (LLCP) and the continuation of an horizontal plane passing through the cribriform plate (Gera classification). The aim of this study was to analyze whether the risk of iatrogenic cerebrospinal fluid leak (CSF-L) was better predicted by Keros or Gera classification. METHODOLOGY: The pre-operative CT scans of 24 patients (CSF-L group) who suffered from iatrogenic CSF-L during endoscopic sinus surgery (ESS) were compared to those obtained from a group of 100 patients who underwent uneventful ESS (control group). The skull base measurements as well as the distribution of Keros and Gera classes in the 2 groups were analyzed. RESULTS: No difference in the distribution of Keros classes or in the depth of the cribriform plate between CSF-L and control group were demonstrated. On the contrary, significant differences in the distribution of Gera classes and in the degree of the angle formed by the LLCP and the continuation of the horizontal plane passing through the cribriform plate were found. In particular, according to Gera classification system, 19 out of 24 patients in the CSF-L group were considered at risk for iatrogenic CSF-L. CONCLUSIONS: Gera classification system might be more sensitive to anatomical variations associated with CSF-L than the Keros one, further suggesting the application of the former during the preoperative CT scan evaluation.

Speech perception in noise by young sequential bilingual children.

The objective of this study was to ascertain the effects of competitive noise on second language perception skills of sequentially bilingual children and to compare the results with those relating to matched monolingual peers. Fifteen bilingual immigrant children (aged 6-10 years) (BL) learning through their second language (L2), which was Italian, were matched with 15 peers who only spoke Italian (IO). All immigrant children had arrived in Italy and were exposed to L2 after their 4th year of life. The speech-to-noise ratio (SNR) needed to obtain 50% intelligibility - the speech reception threshold (SRT) - for Italian words was measured against the Italian version of ICRA noise, using an adaptive method. Moreover, presentation of phrases against a contralateral continuous discourse (informational masking) was carried out to exclude possible biases due to differences in memory, attention, or other central auditory processing disorders between groups. The SNR was -2.7 dB (SD 1.7; range: -5.5 to + 0.9) for the BL group and -5.3 dB (SD 2.3; range: -8.8 to -0.9) for the IO group (p < 0.01). With contralateral continuous discourse presentation the SNR were -32.8 dB (SD 2.4; range: -36.1 to -28.2) for the BL group and -27.8 dB (SD 2.1; range: -31.7 to -24.1) for the OI group (p < 0.01). Even sequential bilingual individuals exposed to L2 at 4 years old had worse speech perception in noise than their matched IO peers. On the other hand, the BL group demonstrated superior divided attention skills in tests with competitive contralateral discourse (p < 0.01).

Endoparasites and ectoparasites of rheas (Rhea americana) from South America.

The aim of the present study was to identify the endoparasites and ectoparasites found in Rhea americana in captivity in Brazil. Faecal samples of seven adult rheas were collected and evaluated using the Sheather technique and samples positive for oocysts were submitted to sporulation. Molecular analysis was also performed for diagnosis of the genera Cryptosporidium, Giardia and Entamoeba. Feathers and skin of rheas were analysed for ectoparasites. Eggs of Capillaria sp., Procyrnea sp. and Procyrnea sp.-type and other nematode eggs of the Strongylida order as well as cysts of Entamoeba sp. and oocysts of Isospora rheae and Eimeria sp. were found in the faeces. Six faecal samples (85.7%) were diagnosed as positive for Entamoeba by PCR, and no positive samples for Cryptosporidium or Giardia were detected. Specific malophagous lice classified as Struthiolipeurus nandu were found distributed throughout the animals' bodies. It was concluded that rheas of the present study were infected enzootically by nematode and protozoan species in addition to being infested with lice.

First Report of Athesmia Foxi Goldberger and Crane, 1911 (Digenea, Dicrocoeliidae) from Chrysocyon Brachyurus (Illiger, 1815) (Carnivora, Canidae) and Pathological Findings.

Chrysocyon brachyurus, the largest South American canid, is a native species of the Brazilian cerrado. The present study is aimed to report the occurrence of the trematode, Athesmia foxi, in the liver of a new host, C. brachyurus, and to describe its morphology and pathology. One C. brachyurus individual was necropsied and examined for the presence of parasites. Worms were collected from the bile ducts and based on morphological and morphometrical characteristics, such as a relatively large, slender, aspinose, elongated shape with vitellarium present on the upper left side of the body were identified as A. foxi. On the host, hepatic lesions limited to the bile ducts and periportal regions, were characterized as chronic-active cholangitis, biliary hyperplasia, and fibrosis . This is the first report of A. foxi parasitizing C. brachyurus, demonstrating that this parasite has no host specificity and can be widely distributed. A. foxi lesions noted in C. brachyurus are similar to those noted in various other mammalian hosts.

Lateral lamella of the cribriform plate, a keystone landmark: proposal for a novel classification system.

BACKGROUND: The aim of this study is to propose a classification of the angle formed by the lateral lamella of the cribriform plate (LLCP) and the horizontal plane passing through the cribriform plate. In particular, the angle was classified into class I (over 80 degrees), class II (45 to 80 degrees, and class III (under 45 degrees) METHODOLOGY: A total of 190 computed tomography scans were retrospectively reviewed in order to obtain four sets of measurements. 1) depth of the cribriform, 2) angle, 3) length of the LLCP, 4) width of the fovea ethmoidalis. The relationship among these measurements were analyzed. RESULTS: The angle was significantly correlated with the depth of the cribriform and the length of the fovea, while it was negatively correlated with the length of the LLCP. Significant negative correlation was also found between the length of the LLCP and the width of the fovea. CONCLUSIONS: This angle classification is based on the theoretical risk of iatrogenic injuries, but it could be helpful also in clinical practice by providing indirect information on the thickness of the anterior skull base. As the angle decreases, in fact, the portion of the anterior skull base composed by the LLCP, increases.

Hematological and morphometric differences of blood cells from rheas, Rhea americana (Struthioniformes: Rheidae) on two conservation farms / Diferenças hematológicas e morfométricas de células sanguineas de emas, Rhea americana (Struthioniformes: Rheidae) em dois criatórios conservacionistas

Abstract Today, blood tests are an indispensable tool in avian medicine. This study aimed to describe and compare hematological and morphometric data of erythrocytes, leukocytes and thrombocytes of rhea, Rhea americana. To do so, 58 rheas of both sexes on two farms, one in Cachoeiro do Itapemirim, Espírito Santo (ES), and the other in São Carlos, São Paulo (SP), were selected. Blood samples were taken and their RBC counts, PCV and Hb levels were determined and used in hematimetric index calculations. The total and differentiated leukocyte counts and the TPP and fibrinogen serum levels were also obtained. The results from the two farms analyzed were compared by means of the t test. There were differences in the parameters of the erythrocyte series between the two flocks because of a process of hypochromic macrocytic anemia observed among the rheas in ES. The values for the erythrocyte series and indexes were: RBC, 2.81 ± 0.15 x106/μl; PCV, 44.20 ± 2.86%; Hb, 12.12 ± 0.74 g/dL; MCV, 15.75 ± 0.89 fL; MCH, 43.18 ± 1.82 pg; and MCHC, 27.44 ± 0.80 g/dL. The values for the leukocyte series were: WBC, 12,072 ± 4116 /μL; heterophils, 64.10 ± 9.90%; eosinophils, 2.05 ± 2.06%; monocytes, 6.40 ± 2.99%; lymphocytes, 26.93 ± 9.62%; and basophils, 0.52 ± 1.27%. These can all be suggested as references for rheas reared in Brazil. Statistical differences were observed in erythrocyte length measurements, which were higher in the rheas in SP than in those in ES. Regarding width, the heterophils, lymphocytes and monocytes of the birds in ES were statistically greater than those of the birds in SP. It was concluded that rheas may exhibit morphometric alterations to blood cells and differences in blood elements according to the type of management to which they are subjected.

Resumo Atualmente exames de sangue são ferramentas indispensáveis na medicina aviária. Este estudo teve como objetivo descrever e comparar valores hematológicos e morfométricos de eritrócitos, leucócitos e trombócitos de emas, Rhea americana. Para isso, foram selecionadas 58 emas de ambos os sexos de dois criatórios, um em Cachoeiro do Itapemirim, Espírito Santo (ES) e o outro em São Carlos, São Paulo (SP). Amostras de sangue foram coletadas e realizadas a hematimetria, Hto e dosagem de Hb que foram utilizados nos cálculos dos índices hematimétricos. Também foram efetuadas as contagens total e diferencial de leucócitos, além da dosagem de proteínas total e do fibrinogênio séricos. Os resultados referentes às duas propriedades analisadas foram comparados pelo Teste t. Ocorreram diferenças nos parâmetros da série vermelha entre as aves dos dois criatórios devido a um processo de anemia macrocítica hipocrômica observado nas emas do ES. Os valores para a série vermelha e índices hematimétricos como: hematimetria, 2,81±0,15 x106/μl; Hto, 44,20±2,86%; Hb, 12,12±0,74 g/dL; VCM, 15,75±0,89 fL; HCM, 43,18±1,82 pg; CHCM, 27,44±0,80, além dos valores da série branca como: leucometria total, 12.072±4.116/μL, heterofilo, 64,10±9,90%, eosinófilo, 2,05±2,06%, monócito, 6,40±2,99%, linfócito, 26,93±9,62%, basófilo, 0,52±1,27% foram sugeridos como os de referência para as emas criadas no Brasil. Diferenças estatísticas foram observadas no comprimento de eritrócitos, o qual estava maior nas emas de SP do que aquelas do ES. Em relação à largura, os heterófilos, linfócitos e monócitos das aves do ES foram estatisticamente maior do que aquelas das aves de SP. Concluiu-se que emas podem apresentar alterações morfométricas de células sanguíneas e diferenças nos elementos do sangue de acordo com o tipo de manejo a que são submetidos.

Subclinical endometritis in beef cattle in early and late postpartum: Cytology, bacteriology, haptoglobin and test strip efficiency to evaluate the evolution of the disease.

In cows, detrimental effects on fertility are mainly caused by clinical and subclinical endometritis (SEM). As demonstrated in previous work, Piedmontese cattle are affected by a higher rate of infertility and presence of SEM. The objective of this study is to assess the pattern of SEM at 30 and 60 days postpartum by evaluating the correlation between uterine cytology and microbiology, analyzing SEM consequences on reproductive career and verifying the reliability of rising inflammatory proteins - haptoglobin and the test strip test. Seventy healthy cows were enrolled and sampled at 30 and 60 days postpartum; cytology and bacteriology as well as haptoglobin and test strip were evaluated. The ROC curve for cytology set the optimal cut-off at 6.5% at 30 days and 2.5% at 60 days for a Partum-to-Conception (PC) interval of 120 days. The cytological positivity was negatively correlated with fertility, at 30 days, but not at 60 days. A positive bacteriological test was not correlated with an increase in the PC at either 30 or 60 days postpartum. The presence of a calving parlor affect the fertility (P < 0.05) but not the presence of parity or suckling calf and parity. The ROC curve for strip test protein at 30 days postpartum set a cut-off of 2% for PC. No difference in serum haptoglobin was observed between negative or positive cytology/bacteriology in postpartum cattle. The test strip results for proteins have demonstrated a utility at 30 days postpartum for screening the cows that are at risk of developing an increased PC > 120 days.

[Hand fine motor skills and use of both hand and arm in subjects after a stroke: a systematic review]. / Herramientas de evaluacion del uso fino de la mano y uso de la mano y el brazo en sujetos con secuela de ictus: revision sistematica.

INTRODUCTION: In clinical practice it is important to be able to assess the function of the upper limb of the patient who has suffered a stroke. There is currently no systemic review that could identify assessment tools for the 'fine use of the hand' and 'use of both hand and arm'. AIMS: Primary, to identify observational tools which can assess the fine use of the hand and the use of both hand and arm in patients with stroke sequels. Secondary, to analyze the bias risk in the included articles, describing and categorizing the clinical utility, validity and reliability. PATIENTS AND METHODS: A search was carried in Medline, LILACS, SciELO and Open Grey, which included articles published until October 2015. Studies that validate assessing tools of the upper limb in subjects with a stroke sequel which evaluate the fine use of the hand and the use of both hand and arm were included. RESULTS: Eleven tools in evaluate observational haven been selected, which assess the fine use of the hand and the use of hand and arm. CONCLUSIONS: In every case both validity and reliability have been reported, but clinical utility has been less considered for assessment. The studies that researched these tools showed a high risk of bias in their development. ARAT-19 showed a lower bias risk, but when it has to do with applicability and the reference trial is taken into account, the level of concern is high.

TITLE: Herramientas de evaluacion del uso fino de la mano y uso de la mano y el brazo en sujetos con secuela de ictus: revision sistematica.Introduccion. En la practica clinica resulta importante poder evaluar la funcion de la extremidad superior paretica del paciente que ha sufrido un ictus. No hay una revision sistematica que identifique herramientas de evaluacion del 'uso fino de la mano' o el 'uso de la mano y el brazo'. Objetivos. Como objetivo primario, identificar las herramientas observacionales que evaluan el uso fino de la mano o el uso de la mano y el brazo en pacientes con secuela de ictus. Secundariamente, analizar el riesgo de sesgo de los articulos incluidos, describir y categorizar la validez, fiabilidad y utilidad clinica. Pacientes y metodos. Se realizo una busqueda en Medline, LILACS, SciELO y Open Grey hasta octubre de 2015. Se incluyeron estudios de validacion de herramientas de evaluacion del miembro superior en sujetos con secuela de ictus, que evaluen el uso fino de la mano o el uso de la mano y el brazo. Resultados. Se han seleccionado 11 herramientas que evaluan el uso fino de la mano y el uso de la mano y el brazo. Conclusiones. Si bien se comunicaron la fiabilidad, la validez y la utilidad clinica, esta ultima fue menos evaluada. Los estudios que investigaron estas herramientas presentaron alto riesgo de sesgo, en particular en la eleccion de la prueba de referencia. La herramienta ARAT-19 fue la que presento un menor riesgo de sesgo, pero cuando se evaluo la aplicabilidad, esta presento una preocupacion alta para la prueba de referencia.

Diet diversity, growth and adiposity in healthy breastfed infants fed homemade complementary foods.

BACKGROUND/OBJECTIVES: Infant complementary feeding is important for establishing food preferences. Few studies exist on the effects of infant complementary feeding choices (food preparation methods) on dietary intake, growth or adiposity. We examined whether provision of homemade complementary food is associated with the development of dietary diversity, nutrient intakes and quality of infant growth. SUBJECTS/METHODS: Secondary analysis of feeding practices from a randomized trial of vitamin D supplementation in 132 healthy breastfed 1-month-old infants from Montréal, Canada. This longitudinal study used diet records, anthropometric and body composition data (dual-energy X-ray absorptiometry) from assessments that occurred when infants were 6, 9, 12 and 36 months of age. Infants were grouped into three categories of food preparation method on the basis of whether or not they had consumed homemade or commercial meat or fruit and vegetable by 9 months (homemade, commercial and both). Multivariable regression controlled for family income, maternal education and infant sex. RESULTS: Dietary data were available for 65 infants. By 9 months, 22% of infants had exclusively received homemade (n=14), 14 infants had exclusively received commercial and 37 infants had received both. The development of dietary diversity (number of World Health Organization-recommended food groups) was higher (0.76 (95% confidence interval (CI): 0.14, 1.38); P<0.05) in the homemade group versus commercial. Energy and nutrient intakes did not differ by group over time. The homemade group had 773 g (-1364, -182; P<0.01) lower whole-body fat mass and 7.1% (-12.6, -1.6; P<0.05) lower % body fat at 12 months compared with the reference group (both homemade and commercial). Reduced whole-body fat mass in the homemade group persisted at 36 months (-696 g (95% CI: -1341, -52); P<0.05). There were no differences between groups for changes in growth Z-scores (length-for-age, weight-for-age and body mass index-for-age). CONCLUSIONS: Provision of homemade complementary food is associated with increased dietary diversity during the first year of life and reduced adiposity.