Anatomical study of length and branching pattern of main trunk of the left coronary artery.

The left coronary artery is responsible for the irrigation of important heart structures. The objective of this study was to analyze the morphological characteristics of the main trunk of left coronary artery in the Brazilian population and its clinical implications. The study was carried out by using 63 adult human hearts of the human anatomy laboratory of the Federal university of Ceará, Brazil. The hearts were dissected for exposure and analysis of the left coronary artery and its branches. The data collected were statistically analyzed. The main trunk arose from the left aortic sinus under the left atrial auricle in all the 63 hearts. The mean length of the main trunk was 8.53±4.03mm. According to the criteria for the classification of the main trunk length, about 78% were medium-sized. The majority of the hearts (52.38%) showed trifurcation of the main trunk. Anova test followed by the Tukey's post hoc test showed that the main trunk length of hearts with trifurcation was significantly longer when compared with hearts with bifurcation (9.77±4.31mm vs. 6.44±3.01mm; P=0.0029). Similar findings were observed in the main trunk length of the hearts with tetrafurcation in comparison with hearts with bifurcation (10.78±1.4mm vs. 6.44±3.01mm; P=0.0387). This study showed that there is a correlation between the branching pattern and the length of the main trunk. Additionally, we showed that the most common branching pattern of the main trunk is the trifurcation, differing from other Brazilian studies and providing additional information to professionals of cardiology, cardiovascular surgery, and radiology.

Parents' acceptance of minimal intervention procedures for dental caries management in children: a scoping review.

PURPOSE: In recent years, minimal intervention procedures (MIPs) for treating dental caries in children have stood out as an innovative method. Nevertheless, the treatment decision should be based on scientific evidence, professional expertise, and parents' preference/acceptance. Evaluating the acceptance of MIPs by parents is an essential factor, but little information is available on what guides this preference. METHODS: This scoping review aims to synthesize the evidence on parents'/caregivers' acceptance of MIP for managing cavitated caries lesions in children. A search was performed in the PubMed, Cochrane Library, Lilacs and Google Scholar databases with no restriction on date or language. RESULTS: A total of 19 articles were selected (6 clinical trials, 1 longitudinal and 12 cross-sectional studies). The application of silver diamino fluoride (SDF) was the most commonly evaluated procedure (n = 17), followed by the atraumatic restorative technique (ART) and the Hall Technique (HT). The acceptance of MIPs ranged from 1.4% to 100%, and the application of SDF was better accepted in posterior teeth and in uncooperative children. ART had better aesthetic acceptance than HT. CONCLUSION: Application of SDF, Hall Technique and ART was well accepted by parents/caregivers. However, a gap remains in the literature regarding the acceptance of other procedures. Therefore, further studies in this area will contribute toward a better understanding of the opinion of parents/caregivers, and thus improve caries lesion management in children.

[The low quality of home-made oral rehydration solution in Salvador, Bahia (Brazil)]. / A baixa qualidade do soro caseiro em Salvador, Brasil.

In 1988 a nation-wide campaign aiming to inform the Brazilian population about preparation and use of simple sugar/salt oral rehydration solution (ORS) was carried out. The campaign was massively shown by the media. This preliminary study assessed the quality of ORS prepared by 23 mothers of in-patient children from a pediatric hospital in Salvador, State of Bahia. Fourteen (60.9%) among the 23 mothers prepared solutions containing Na concentrations ranging from 30 to 80 mmol/L which is recommended by the World Health Organization. Eleven (47.8%) solutions contained glucose within the recommended range of 30 to 112 mmoI/L Only 6 (26%) out of the 23 mothers prepared ORS with simultaneously adequate Na and glucose concentrations. However, just 3 (13%) out of these 6 ORS also presented balanced electrolyte concentrations. Potential iatrogenicity due to high concentrations of Na and glucose was found in 30.4% and 43.5% of the solutions, respectively. These data raise serious concerns about the quality of home-made sugar/salt ORS, and therefore about its use as a safe agent in a campaign of diarrhoeal diseases control.

[Epidemiology and risk factors of eating disorder in adolescence: a review]. / La epidemiología y los factores de riesgo de los trastornos alimentarios en la adolescencia: una revisión.

INTRODUCTION: Currently, there is a higher occurrence of biopsychosocial diseases, especially eating disorders, involving different body systems and aspects related to the individual and their social relations. OBJECTIVE: Addressing current and relevant issues about the prevalence, incidence and risk factors for anorexia and bulimia nervosa in adolescence. METHODS: Search the databases: MEDLINE, SciELO and LILACS for studies published on the epidemiology and risk factors for eating disorders in adolescence. RESULTS: The highest incidence of anorexia and bulimia nervosa among girls in the middle and final phase of adolescence. Factors that increase the risk for the onset of eating disorders in adolescents are: genetics, body changes during puberty, the vulnerability of adolescents to the ideals of thinness, social pressures to be thin, body image dissatisfaction, restrictive diet, depression and low self-esteem. However, it is suggested that in different cultures, eating disorders may come from a number of conditions unrelated to compensatory behaviors or weight, but the shape of the body. CONCLUSIONS: Several factors determine the occurrence of anorexia and bulimia nervosa in adolescence, however, there is no consensus how these factors interact in this complex process, which indicates the need for further investigations.

La epidemiología y los factores de riesgo de los trastornos alimentarios en la adolescencia; una revisión / Epidemiology and risk factors of eating disorder in adolescence; a review

Introducción: En la actualidad, existe la mayor ocurrencia de enfermedades de origen biopsicosocial, en especial los trastornos alimentarios, que involucran diferentes sistemas del cuerpo y los aspectos inherentes a la persona y sus relaciones sociales. Objetivo: Abordar temas actuales y relevantes acerca de la prevalencia, la incidencia y los factores de riesgo de anorexia y bulimia nerviosa en la adolescencia. Métodos: Búsqueda en las bases de datos MEDLINE, SciELO y LILACS de estudios publicados sobre la epidemiología y los factores de riesgo de trastornos alimentarios en la adolescencia. Resultados: La mayor incidencia de la anorexia y bulimia nerviosa se presenta entre las niñas en la fase media y final de la adolescencia. Entre los factores que aumentan el riesgo para la aparición de los trastornos alimentarios en la adolescencia se encuentran: la genética, los cambios corporales en la pubertad, la vulnerabilidad de los adolescentes a los ideales de delgadez, la presión social por ser delgada, la insatisfacción con la imagen corporal, la dieta restrictiva, la depresión y la baja autoestima. Sin embargo, se sugiere que en las diferentes culturas los trastornos del comportamiento alimentario pueden venir de una serie de condiciones no relacionadas con las conductas compensatorias o con el peso, pero con la forma del cuerpo o parte de lo mismo. Conclusiones: Varios factores determinan la aparición de la anorexia y la bulimia en la adolescencia, sin embargo, no hay consenso en cómo interactúan estos factores en este complejo proceso, lo que indica la necesidad de más investigaciones (AU)

Introduction: Currently, there is a higher occurrence of biopsychosocial diseases, especially eating disorders, involving different body systems and aspects related to the individual and their social relations. Objective: Addressing current and relevant issues about the prevalence, incidence and risk factors for anorexia and bulimia nervosa in adolescence. Methods: Search the databases: MEDLINE, SciELO and LILACS for studies published on the epidemiology and risk factors for eating disorders in adolescence. Results: The highest incidence of anorexia and bulimia nervosa among girls in the middle and final phase of adolescence. Factors that increase the risk for the onset of eating disorders in adolescents are: genetics, body changes during puberty, the vulnerability of adolescents to the ideals of thinness, social pressures to be thin, body image dissatisfaction, restrictive diet, depression and low self-esteem. However, it is suggested that in different cultures, eating disorders may come from a number of conditions unrelated to compensatory behaviors or weight, but the shape of the body. Conclusions: Several factors determine the occurrence of anorexia and bulimia nervosa in adolescence, however, there is no consensus how these factors interact in this complex process, which indicates the need for further investigations (AU)

Alanine-based oral rehydration therapy for infants with acute diarrhea.

Twenty male infants less than 1 year of age with acute diarrhea and dehydration were randomly assigned to a study group and studied in blind fashion in a metabolic unit to assess the efficacy of the addition of 30 mmol/L alanine to the standard World Health Organization (WHO) oral rehydration solution (ORS). Patients were exclusively rehydrated with one of two types of ORS during the first 24 hours of treatment. On the second day, oral feedings were started with a lactose-free formula, and ORS was given to replace stool losses. Body weight, ORS, food intake, vomitus, stool, and urine output were recorded at 6-hour intervals. Blood was drawn at the time of admission, after rehydration, and at 24 and 48 hours of hospitalization to monitor blood gases and electrolytes. Rehydration was satisfactory in both groups of patients. ORS that contained alanine did not reduce the purging rates of the infants compared with those who received standard ORS. Clinically no adverse effect of the alanine-based ORS was observed during hospitalization. None of the patients had significant hypernatremia or hyponatremia, and serum amino acid levels were not altered. These data show that the addition of 30 mmol/L alanine to the standard WHO-ORS produces no further improvement in the outcome of the infants with acute diarrhea compared with those fed the standard WHO-ORS.

Correct case management of childhood diarrhea: a survey of nine state capitals in northeast Brazil.

The National Program for Maternal and Child Health (COSMI) of the Ministry of Health (MOH) of Brazil conducted a survey in nine state capitals from 29 March to 30 April 1993 to assess how well health facilities were managing diarrhea cases in patients under 5 years of age. One of seven PAHO/WHO health facility surveys performed in Latin America and the Caribbean in 1992-1993, the Brazilian survey took place in the Northeast Region where most diarrheal morbidity and mortality occur. Like the other six surveys, it used a new PAHO/WHO methodology designed to collect data on certain principal indicators through observation, interviews, and review of clinical records. Overall, 475 cases of patients with diarrhea were observed in 192 facilities, and 463 health workers and 474 caretakers were interviewed. The results indicated that few diarrhea patients received care that strictly followed the PAHO/WHO/Ministry of Health treatment guidelines. In terms of these guidelines, the correct procedure was used to assess the patient's hydration status only 8% of the time, and only 1% of the health workers provided correct advice to the caretaker on prevention and home care aspects of diarrheal diseases. The procedure used to rehydrate patients with oral rehydration salts (ORS) was correct in only 6% of the cases. Of those patients with bloody stools, 24% were treated appropriately with antibiotics. Besides collecting information on correct case management, the survey provided a basis for developing two-year operational plans of action in each of the nine participating states to strengthen efforts directed at controlling and preventing diarrheal diseases, including cholera.

Treatment of acute diarrhea with oral rehydration solutions containing glutamine.

OBJECTIVE: In a randomized, double-blind, controlled clinical trial we compared the efficacy of adding 90 mmol/L L-glutamine to the standard World Health Organization oral rehydration salts (WHO-ORS). SUBJECTS: One hundred twenty male infants, > 1 month and < 1 year of age, with acute non-cholera diarrhea and dehydration were randomly assigned to one of the two treatment groups. METHODS: Patients were kept in a metabolic unit where body weight, ORS, water and food intake, as well as stool, urine and vomitus output were recorded at 6-hour intervals. Laboratory evaluation, including blood gases and electrolytes, were monitored during hospitalization. RESULTS: Diarrheal stool output, duration of diarrhea and volume of ORS required to achieve and maintain hydration was not significantly different between the treatment groups. CONCLUSION: This study demonstrated that a glutamine-based ORS did not provide any additional therapeutic advantage over the standard WHO-ORS during treatment of dehydration in infants with acute non-cholera diarrhea.