Complex Craniosynostosis in Pitt-Hopkins Syndrome: Case Report in Twins.

INTRODUCTION: Pitt-Hopkins syndrome (PTHS) is a rare genetic syndrome associated with neurodevelopmental disorders and craniofacial dysmorphisms caused by variations in the TCF4 transition factor. The aim of this article was to report the case of two twin infants diagnosed with PTHS, confirmed by the identification of a heterozygous pathogenic variant in the TCF4 gene through DNA extracted from a buccal swab. CASE PRESENTATION: Both infants presented with craniofacial asymmetry with a metopic crest and cranial deformity. During the diagnostic investigation, computed tomography with three-dimensional reconstruction of the skull showed premature fusion of the left coronal and metopic sutures in both twins. They underwent craniofacial reconstruction at the 9th month of age using a combination of techniques. The postoperative outcomes were satisfactory in both cases. CONCLUSION: To the best of our knowledge, this is the first case report to describe the occurrence of complex craniosynostosis (CCS) in children with PTHS. Further studies are needed to determine whether the co-occurrence of PTHS and CCS described here indicates an association or is explained by chance.

Purification, Characterization, and Assessment of Antimicrobial Activity and Toxicity of Portulaca elatior Leaf Lectin (PeLL).

Lectins are carbohydrate-binding proteins with several bioactivities, including antimicrobial properties. Portulaca elatior is a species found at Brazilian Caatinga and data on the biochemical composition of this plant are scarce. The present work describes the purification of P. elatior leaf lectin (PeLL) as well as the assessment of its antimicrobial activity and toxicity. PeLL, isolated by chromatography on a chitin column, had native liquid charge and subunit composition evaluated by electrophoresis. Hemagglutinating activity (HA) of PeLL was determined in the presence of carbohydrates or divalent cations, as well as after heating and incubation at different pH values. Changes in the lectin conformation were monitored by evaluating intrinsic tryptophan fluorescence and using the extrinsic probe bis-ANS. Antimicrobial activity was evaluated against Pectobacterium strains and Candida species. The minimal inhibitory (MIC), bactericidal (MBC), and fungicidal (MFC) concentrations were determined. Finally, PeLL was evaluated for in vitro hemolytic activity in human erythrocytes and in vivo acute toxicity in mice (5 and 10 mg/kg b.w. per os). PeLL (pI 5.4; 20 kDa) had its HA was inhibited by mannose, galactose, Ca2+, Mg2+, and Mn2+. PeLL HA was resistant to heating at 100 °C, although conformational changes were detected. PeLL was more active in the acidic pH range, in which no conformational changes were observed. The lectin presented MIC and MBC of 0.185 and 0.74 µg/mL for all Pectobacterium strains, respectively; MIC of 1.48 µg/mL for C. albicans, C. tropicalis, and C. krusei; MIC and MFC of 0.74 and 2.96 µg/mL for C. parapsilosis. No hemolytic activity or signs of acute toxicity were observed in the mice. In conclusion, a new, low-toxic, and thermostable lectin was isolated from P. elatior leaves, being the first plant compound to show antibacterial activity against Pectobacterium.

Avaliação imunológica dos camundongos geneticamente selecionados para diferente capacidade de produção de anticorpo

INTRODUCTION: The potentiality of the inflammatory response or the specific immune response of the individual are complex characteristics that vary continuously and have a normal distribution in a heterogeneous population, since they are under polygenic control. Aiming at the study of the genetic regulation of specific immunity, our laboratory developed strains of heterogeneous mice genetically selected for high – HIII and low – LIII ability to produce antibodies to certain antigens through the process of genetic selection bidirectional. For some genetic and immunological studies, isogenic mice must be used. Therefore, we produced isogenic trunks of these parental lines in the vivarium of the Immunogenetics laboratory of the Butantan Institute, which after the selection process were subjected to inbreeding. OBJECTIVE: Evaluate the ability to produce antibodies as well as cells – B and T lymphocytes (CD4 and CD8) after stimulating the immune system with diphtheria anatoxin, comparing isogenic trunks with parental lineages. METHODOLOGY: Isogenic mice from Stem A (High) and Stem E (Low) and heterogeneous (HIII and LIII) were immunized with diphtheria anatoxin. The primary and secondary humoral immune response was evaluated in serum by quantifying the production of anti-diphtheria IgG antibodies using the ELISA technique. For the characterization of the T and B lymphocyte cell response profile, the spleen and lymph nodes were collected and the cells were identified by surface markers (CD4, CD8, B220) and evaluated by flow cytometry. RESULTS: The results show significant increases in the concentration of antibodies produced by the groups when comparing normal serum with primary and secondary responses. The production of antibodies in the secondary response was higher in animals from the HIII and Stem A strains compared to the other groups. In the cellular response, a significant increase in T lymphocytes (CD4+and CD8+) and B lymphocytes was seen in the lymph node in the experimental HIII group compared to the other groups, however in the spleen a significantly increased T cell response was detected in the immunized animals in the LIII group. Regarding the isogenic trunks, the animals from Stem A showed an increase in CD4+ T lymphocytes when compared to the experimental Stem E in splenic cells. CONCLUSIONS: Animals selected for high antibody production capacity showed greater responses both in IgG secretion in the secondary response and in the higher frequency of T and B cells in the lymph nodes. It is important to in-depth study of the modulation mechanism of the immune response in these strains to understand the multi-specific genetic effects against certain antigens.

INTRODUÇÃO: A potencialidade da resposta inflamatória ou da resposta imune específica do indivíduo são características complexas que variam de forma contínua e têm uma distribuição normal numa população heterogênea, pois estão sob controle poligênico. Visando o estudo da regulação genética da imunidade específica nosso laboratório desenvolveu linhagens de camundongos heterogênicos geneticamente selecionadas para alta (“High” - HIII) e baixa (“Low” - LIII) capacidade de produção de anticorpos a certos antígenos através do processo de seleção genética bidirecional. Para alguns estudos genéticos e imunológicos devem ser utilizados camundongos isogênicos, assim, produzimos no Biotério do laboratório de Imunogenética do Instituto Butantan troncos isogênicos destas linhagens parentais, que após o processo seletivo foram submetidas a cruzamentos consanguíneos. OBJETIVO: Avaliar a capacidade de produção de anticorpos assim como as células – linfócitos B e T (CD4+ e CD8+) após o estímulo do sistema imune com anatoxina diftérica comparando os troncos isogênicos com as linhagens parentais. METODOLOGIA: Camundongos isogênicos (High – Tronco A e Low – Tronco E) e heterogênicos (HIII e LIII) foram imunizados com anatoxina diftérica. A resposta imune humoral primária e secundária foram avaliadas no soro pela quantificação da produção de anticorpos IgG antidiftéricos através da técnica de ELISA. Para a caracterização do perfil de resposta celular de linfócitos T e B, foram coletados o baço e linfonodos e as células foram identificadas por marcadores de superfície (CD4, CD8, B220) e avaliadas por citometria de fluxo. RESULTADOS: Os resultados mostram aumentos significativos na concentração de anticorpos produzidos pelos grupos quando comparadas o soro normal com as respostas primária e secundária. A produção de anticorpos na resposta secundária foi maior nos animais das linhagens HIII e Tronco A em relação aos outros grupos. Na resposta celular foi visualizado no linfonodo um aumento significante de linfócitos T (CD4+e CD8+) e linfócitos B no grupo HIII experimental em relação aos outros grupos, entretanto no baço a resposta significativamente aumentada das células T foi detectada nos animais imunizados do grupo LIII. Em relação aos troncos isogênicos, os animais do Tronco A apresentaram um aumento de linfócitos T CD4+ quando comparados ao Tronco E experimental nas células esplênicas. CONCLUSÕES: Os animais selecionados para alta capacidade de produção de anticorpos apresentaram respostas maiores tanto na secreção de IgG na resposta secundária como na maior frequência de células T e B nos linfonodos. Sendo importante o estudo aprofundado do mecanismo de modulação da resposta imune nessas linhagens para entendimento de efeitos genéticos multiespecíficos frente a determinados antígenos.

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort

Abstract Background Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. Methods A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. Results From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. Conclusion Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

Assessment of main complications of regional anesthesia recorded in an acute pain unit in a tertiary care university hospital: a retrospective cohort.

BACKGROUND: Regional anesthesia has been increasingly used. Despite its low number of complications, they are associated with relevant morbidity. This study aims to evaluate the incidence of complications after neuraxial block and peripheral nerve block. METHODS: A retrospective cohort study was conducted, and data related to patients submitted to neuraxial block and peripheral nerve block at a tertiary university hospital from January 1, 2011 to December 31, 2017 were analyzed. RESULTS: From 10,838 patients referred to Acute Pain Unit, 1093(10.1%) had side effects or complications: 1039 (11.4%) submitted to neuraxial block and 54 (5.2%) to peripheral nerve block. The most common side effects after neuraxial block were sensory (48.5%) or motor deficits (11.8%), nausea or vomiting (17.5%) and pruritus (8.0%); The most common complications: 3 (0.03%) subcutaneous cell tissue hematoma, 3 (0.03%) epidural abscesses and 1 (0.01%) arachnoiditis. 204 of these patients presented sensory or motor deficits at hospital discharge and needed follow-up. Permanent peripheral nerve injury after neuraxial block had an incidence of 7.7:10,000 (0.08%). The most common side effects after peripheral nerve block were sensory deficits (52%) and 21 patients maintained follow-up due to symptoms persistence after hospital discharge. CONCLUSION: Although we found similar incidences of side effects or even lower than those described, major complications after neuraxial block had a higher incidence, particularly epidural abscesses. Despite this, other serious complications, such as spinal hematoma and permanent peripheral nerve injury, are still rare.

Development of the prickly pear cactus Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro in response to the replacement of potassium nitrate for a commercial kno 3 fertilizer / Desenvolvimento da palma Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro em resposta à substituição de nitrato de potássio (P.A.) por fertilizante comercial KNO 3

ABSTRACT: In micropropagation, potassium nitrate (KNO3), an ACS reagent grade chemical, used in the preparation of growing mediums is expensive and its procurement depends on bureaucratic procedures, as it is controlled by the Brazilian Army. This research to assessed the effect of replacing the ACS KNO3 for a commercially available fertilizer (KNO3- based) on the micropropagation of the prickly pear cactus (Opuntia stricta (Haw.) Haw. cv. Elephant Ear. Treatments used six different fertilizer concentrations (0, 0.5, 1, 1.5, 2 and 2.5 g L-1) and a control consisting of 1.9 g L-1 KNO3, as shown in the MS salts. The survival, size and number of sprouts and the value of fresh biomass were evaluated. After seedling acclimation, we assessed the survival, number of sprouts, length, and number of roots, racket formation, average fresh biomass mass, macronutrient absorption and morphological changes of the seedlings. Explants inoculated with fertilizers at concentrations of 0.0; 2.0 and 2.5 g L-¹ did not grow. The response of explants at concentrations of 0.5 and 1.5 g L-1 of the fertilizer were the same as those developed in a KNO3 medium, and at a concentration of 1.0 g L-1, in all variables, the means were higher than those of the control medium. Therefore, it showed the feasibility of using fertilizers in the in vitro cultivation of the prickly pear cactus, which may remove bureaucratic barriers and reduce product costs by 99.12%.

RESUMO: Na micropropagação, o nitrato de potássio (KNO3), reagente puro para análise (P.A.), utilizado no preparo dos meios de cultura, possui custo elevado e a sua aquisição depende de trâmites burocráticos, por se tratar de substância controlada pelo Exército Brasileiro. O objetivo deste trabalho foi avaliar o efeito da substituição do KNO3 P.A. por fertilizante comercial (com fonte de KNO3), encontrado livremente no comércio, na micropropagação de palma (Opuntia stricta (Haw.) Haw. cv Orelha de Elefante. Os tratamentos foram de seis concentrações do fertilizante (0; 0,5; 1; 1,5; 2 e 2,5 g L-1) e um controle constituído de 1,9 g L-1 de reagente KNO3, conforme mostrado nos sais MS. Avaliou-se a sobrevivência, tamanho e número de brotações do explante, e o valor da biomassa fresca. Após a aclimatização das mudas avaliou-se a sobrevivência, número de brotações, comprimento da parte aérea, número de raízes, formação da raquete, massa média da biomassa fresca, absorção de macronutrientes e alterações morfológicas das mudas. Os explantes inoculados em meio com fertilizantes nas concentrações de 0,0; 2,0 e 2,5 g L-¹ não se desenvolveram. A resposta dos explantes nas concentrações de 0,5 e 1,5 g L-1 do fertilizante foram iguais aos desenvolvidos em meio contendo KNO3, e na concentração de 1,0 g L-1, em todas as variáveis, as médias foram superiores em relação as do controle. Dessa forma, constatou-se a viabilidade do uso do fertilizante no cultivo in vitro da palma, o que propiciou a eliminação dos entraves burocráticos e redução no custo de 99,12% na compra do produto.

Percepção e práticas de pais/responsáveis sobre questões atuais da odontopediatria: um estudo piloto / Perceptions and practices of parents and guardians on current issues of pediatric dentistry: a pilot study

Objetivo: Investigar as percepções e atitudes de pais/responsáveis sobre cuidados relacionados à saúde bucal das crianças por meio de um estudo descritivo. Métodos: Foi aplicado um questionário semiestruturado aos pais/responsáveis de crianças atendidas nas clinicas de Odontopediatria da Pontifícia Universidade Católica de Minas Gerais (PUC-MG) em 78 pais/responsáveis. O questionário apresentava questões sociodemográficas, assim como questões específicas relacionadas aos cuidados e atitudes para a saúde bucal de seus filhos/crianças. Análise descritiva e exploratória, por meio de médias, frequências e porcentagens foram realizadas e ilustradas por meio de figuras. Resultados: Embora a maioria dos entrevistados tenha alegado já terem recebido informações a respeito dos cuidados bucais infantis, pais/responsáveis consideraram o momento propício para a primeira visita ao dentista somente após o 1º ano de vida, período inadequado para o aleitamento materno, além da utilização inadequada de chupeta e mamadeira por longos períodos e do período para a inserção do hábito da escovação. Além disso, temáticas relacionadas à erosão dentária, teste da linguinha e a importância do íon fluoreto para a saúde bucal foram os assuntos classificados com mais dúvidas. Conclusão: Em geral, as atitudes dos pais e responsáveis não se mostraram adequadas, apesar de possuírem informações prévias no que tange a saúde bucal das crianças. Com isso, verifica-se a necessidade de enfatizar mais a fundo questões referentes a esta temática e diferentes meios para a difusão deste tipo de informação.

Aim: To investigate the perceptions and attitudes of parents/guardians about oral health care for children through a descriptive/cross-sectional study. Methods: A semi-structured questionnaire was applied to 78 parents/guardians of children seen at the Pediatric Dentistry Clinics of the Pontific Catholic University of Minas Gerais (PUC-MG). The questionnaire presented sociodemographic questions, as well as specific questions related to the care and attitudes towards the oral health of their children. Exploratory and descriptive analyses by means of means, frequencies,and percentages were performed and illustrated in figures. Results: Although most of the interviewees claimed to have already received information regarding children's oral care, they considered the proper time for the first visit to the dentist only after the 1st year of life, an inadequate period for breastfeeding, as well as the inappropriate use of pacifiers and bottles for long periods and an improper period for the insertion of the habit of tooth brushing. Furthermore, issues related to dental erosion, the tongue test, and the importance of fluoride ions for oral health were the subjects classified with the most doubts. Conclusion: In general, the attitudes of parents and guardians proved to be inappropriate, although they have previous information regarding the oral health of children. Thus, there is a need to offer a more in-depth emphasis on issues related to this theme and different means through which to disseminate this type of information.

Development of the prickly pear cactus Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro in response to the replacement of potassium nitrate for a commercial kno 3 fertilizer / Desenvolvimento da palma Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro em resposta à substituição de nitrato de potássio (P.A.) por fertilizante comercial KNO 3

In micropropagation, potassium nitrate (KNO3), an ACS reagent grade chemical, used in the preparation of growing mediums is expensive and its procurement depends on bureaucratic procedures, as it is controlled by the Brazilian Army. This research to assessed the effect of replacing the ACS KNO3 for a commercially available fertilizer (KNO3- based) on the micropropagation of the prickly pear cactus (Opuntia stricta (Haw.) Haw. cv. Elephant Ear. Treatments used six different fertilizer concentrations (0, 0.5, 1, 1.5, 2 and 2.5 g L-¹) and a control consisting of 1.9 g L-¹ KNO3, as shown in the MS salts. The survival, size and number of sprouts and the value of fresh biomass were evaluated. After seedling acclimation, we assessed the survival, number of sprouts, length, and number of roots, racket formation, average fresh biomass mass, macronutrient absorption and morphological changes of the seedlings. Explants inoculated with fertilizers at concentrations of 0.0; 2.0 and 2.5 g L-¹ did not grow. The response of explants at concentrations of 0.5 and 1.5 g L-¹ of the fertilizer were the same as those developed in a KNO3 medium, and at a concentration of 1.0 g L-¹, in all variables, the means were higher than those of the control medium. Therefore, it showed the feasibility of using fertilizers in the in vitro cultivation of the prickly pear cactus, which may remove bureaucratic barriers and reduce product costs by 99.12%.

Na micropropagação, o nitrato de potássio (KNO3), reagente puro para análise (P.A.), utilizado no preparo dos meios de cultura, possui custo elevado e a sua aquisição depende de trâmites burocráticos, por se tratar de substância controlada pelo Exército Brasileiro. O objetivo deste trabalho foi avaliar o efeito da substituição do KNO3 P.A. por fertilizante comercial (com fonte de KNO3), encontrado livremente no comércio, na micropropagação de palma (Opuntia stricta (Haw.) Haw. cv Orelha de Elefante. Os tratamentos foram de seis concentrações do fertilizante (0; 0,5; 1; 1,5; 2 e 2,5 g L-¹) e um controle constituído de 1,9 g L-¹ de reagente KNO3, conforme mostrado nos sais MS. Avaliou-se a sobrevivência, tamanho e número de brotações do explante, e o valor da biomassa fresca. Após a aclimatização das mudas avaliou-se a sobrevivência, número de brotações, comprimento da parte aérea, número de raízes, formação da raquete, massa média da biomassa fresca, absorção de macronutrientes e alterações morfológicas das mudas. Os explantes inoculados em meio com fertilizantes nas concentrações de 0,0; 2,0 e 2,5 g L-¹ não se desenvolveram. A resposta dos explantes nas concentrações de 0,5 e 1,5 g L-¹ do fertilizante foram iguais aos desenvolvidos em meio contendo KNO3, e na concentração de 1,0 g L-¹, em todas as variáveis, as médias foram superiores em relação as do controle. Dessa forma, constatou-se a viabilidade do uso do fertilizante no cultivo in vitro da palma, o que propiciou a eliminação dos entraves burocráticos e redução no custo de 99,12% na compra do produto.

Development of the prickly pear cactus Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro in response to the replacement of potassium nitrate for a commercial kno 3 fertilizer / Desenvolvimento da palma Opuntia stricta (Haw.) Haw. (Cactaceae) in vitro em resposta à substituição de nitrato de potássio (P.A.) por fertilizante comercial KNO 3

In micropropagation, potassium nitrate (KNO3), an ACS reagent grade chemical, used in the preparation of growing mediums is expensive and its procurement depends on bureaucratic procedures, as it is controlled by the Brazilian Army. This research to assessed the effect of replacing the ACS KNO3 for a commercially available fertilizer (KNO3- based) on the micropropagation of the prickly pear cactus (Opuntia stricta (Haw.) Haw. cv. Elephant Ear. Treatments used six different fertilizer concentrations (0, 0.5, 1, 1.5, 2 and 2.5 g L-¹) and a control consisting of 1.9 g L-¹ KNO3, as shown in the MS salts. The survival, size and number of sprouts and the value of fresh biomass were evaluated. After seedling acclimation, we assessed the survival, number of sprouts, length, and number of roots, racket formation, average fresh biomass mass, macronutrient absorption and morphological changes of the seedlings. Explants inoculated with fertilizers at concentrations of 0.0; 2.0 and 2.5 g L-¹ did not grow. The response of explants at concentrations of 0.5 and 1.5 g L-¹ of the fertilizer were the same as those developed in a KNO3 medium, and at a concentration of 1.0 g L-¹, in all variables, the means were higher than those of the control medium. Therefore, it showed the feasibility of using fertilizers in the in vitro cultivation of the prickly pear cactus, which may remove bureaucratic barriers and reduce product costs by 99.12%.(AU)

Na micropropagação, o nitrato de potássio (KNO3), reagente puro para análise (P.A.), utilizado no preparo dos meios de cultura, possui custo elevado e a sua aquisição depende de trâmites burocráticos, por se tratar de substância controlada pelo Exército Brasileiro. O objetivo deste trabalho foi avaliar o efeito da substituição do KNO3 P.A. por fertilizante comercial (com fonte de KNO3), encontrado livremente no comércio, na micropropagação de palma (Opuntia stricta (Haw.) Haw. cv Orelha de Elefante. Os tratamentos foram de seis concentrações do fertilizante (0; 0,5; 1; 1,5; 2 e 2,5 g L-¹) e um controle constituído de 1,9 g L-¹ de reagente KNO3, conforme mostrado nos sais MS. Avaliou-se a sobrevivência, tamanho e número de brotações do explante, e o valor da biomassa fresca. Após a aclimatização das mudas avaliou-se a sobrevivência, número de brotações, comprimento da parte aérea, número de raízes, formação da raquete, massa média da biomassa fresca, absorção de macronutrientes e alterações morfológicas das mudas. Os explantes inoculados em meio com fertilizantes nas concentrações de 0,0; 2,0 e 2,5 g L-¹ não se desenvolveram. A resposta dos explantes nas concentrações de 0,5 e 1,5 g L-¹ do fertilizante foram iguais aos desenvolvidos em meio contendo KNO3, e na concentração de 1,0 g L-¹, em todas as variáveis, as médias foram superiores em relação as do controle. Dessa forma, constatou-se a viabilidade do uso do fertilizante no cultivo in vitro da palma, o que propiciou a eliminação dos entraves burocráticos e redução no custo de 99,12% na compra do produto.(AU)

Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine.

OBJECTIVE: To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia. METHODS: Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control. RESULTS: We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial. DISCUSSION: Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters. CONCLUSION: Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.

OBJETIVO: Rever a evidência sobre a necessidade de suplementação universal de ferro na gravidez para prevenção de anemia materna. MéTODOS: Pesquisa bibliográfica de ensaios clínicos aleatorizados e controlados, metanálises, revisões sistemáticas e normas de orientação clínica, publicados entre agosto de 2009 e agosto de 2019, utilizando os termos MeSH: iron, terapêuticas use; pregnancy; anemia, preventivos and control. RESULTADOS: Incluímos seis normas de orientação clínica, três metanálises e um ensaio clínico randomizado e controlado. DISCUSSãO: A maioria dos artigos aponta para a melhoria dos parâmetros hematológicos e redução do risco de anemia materna por meio da suplementação com ferro. Todavia, eles não correlacionam a melhoria destes parâmetros em grávidas sem anemia prévia com a eventual melhoria de parâmetros clínicos. CONCLUSõES: A suplementação universal com ferro na gravidez é controversa, pelo que atribuímos uma força de recomendação SORT C.

Oral Iron Supplementation in Pregnancy: Current Recommendations and Evidence-Based Medicine Suplementação oral de ferro na gravidez: recomendações atuais e medicina baseada na evidência

Abstract Objective To review the evidence about universal iron supplementation in pregnancy to prevent maternal anemia. Methods Bibliographic research of randomized and controlled clinical trials, meta-analyses, systematic reviews, and clinical guidelines, published between August 2009 and August 2019, using the MeSH terms: iron; therapeutic use; pregnancy; anemia, prevention and control. Results We included six clinical guidelines, three meta-analyses and one randomized controlled clinical trial. Discussion Most articles point to the improvement of hematological parameters and reduction of maternal anemia risk, with supplementary iron. However, they do not correlate this improvement in pregnant women without previous anemia with the eventual improvement of clinical parameters. Conclusion Universal iron supplementation in pregnancy is controversial, so we attribute a SORT C recommendation strength.

Resumo Objetivo Rever a evidência sobre a necessidade de suplementação universal de ferro na gravidez para prevenção de anemia materna. Métodos Pesquisa bibliográfica de ensaios clínicos aleatorizados e controlados, metanálises, revisões sistemáticas e normas de orientação clínica, publicados entre agosto de 2009 e agosto de 2019, utilizando os termos MeSH: iron, terapêuticas use; pregnancy; anemia, preventivos and control. Resultados Incluímos seis normas de orientação clínica, três metanálises e um ensaio clínico randomizado e controlado. Discussão A maioria dos artigos aponta para a melhoria dos parâmetros hematológicos e redução do risco de anemia materna por meio da suplementação com ferro. Conclusões A suplementação universal com ferro na gravidez é controversa, pelo que atribuímos uma força de recomendação SORT C.

Body Weight and Muscle Thickness Changes after Hemodialysis: A Pilot Study with Bayesian Approach.

Maintaining adequate body water balance is one aim of hemodialysis that is obtained by changing the blood volume. However, it is known that volume withdrawal is followed by water redistribution between extra- and intra-cellular spaces. In this context, the skeletal muscle tissue represents almost 50% of the total body mass, and like other soft tissues, consists of about 70%-80% water. Body weight is the main parameter used to monitor the body water change after a hemodialysis session, but it does not allow inferring about the water redistribution between extra and intracellular spaces. Thus, the present study aimed to assess the immediate impact of hemodialysis on body weight and the thickness of the rectus femoris muscle. Fifteen male patients with end-stage renal disease took part in the study. Muscle thickness, measured with ultrasound imaging, and body weight and were measured before (Pre) and after (Post) (within 5 to 10 minutes after) an hemodialysis session. Paired t-test was used to compare Pre and Post measures, and Bayesian analysis was applied to check the probability to replicate the same results (ie, the magnitude of the evidence). Our results indicated that body weight, but not rectus femoris muscle thickness, is significantly reduced immediately after hemodialysis. The rectus femoris muscle thickness seems not to be a reliable parameter to infer water redistribution after hemodialysis session.

Prophylactic Dendritic Cell Vaccination in Experimental Breast Cancer Controls Immunity and Hepatic Metastases.

BACKGROUND/AIM: Liver metastases are among the principal mortality causes in cancer patients. Dendritic cell immunotherapies have shown promising results in some tumors by mediating immunological mechanisms that could be involved in liver metastases during primary tumor growth. The present study aimed to evaluate the impact of prophylactic dendritic cell vaccination on the liver of mice with 4T1 mouse breast carcinoma. MATERIALS AND METHODS: Adult female Balb/c mice were submitted or not to vaccination with dendritic cells before the induction of 4T1 tumor lineage. Liver tissues from mice were analyzed by flow cytometry (markers CD3, CD4, CD8, CD25, IL-10, IL-12, IL-17, TNF-α, IFN-γ, T-bet, GATA3, RORγt, and FoxP3) and hematoxylin-eosin. The dendritic cell vaccine was differentiated and matured ex vivo from the bone marrow. RESULTS: Prophylactic vaccination reduced areas of liver metastases (p=0.0049), induced an increase in the percentage of total T and cytotoxic T lymphocytes (p<0.0001), as well as FoxP3+ (p<0.0001). It also increased the levels of cytokines IL-10 and IL-17 in helper T lymphocytes (p<0.0001). CONCLUSION: The prophylactic dendritic cell vaccine changed the cell phenotype in the immune response of liver, and it was able to reduce metastases. Cytotoxic T cells and regulatory T lymphocytes were more present, likewise, the production of IL-10 and IL-7 simultaneously, demonstrating that the vaccine can induce a state of control of pro-inflammatory responses, which can provide a less favorable environment for metastatic tumor growth.

Efficacy of essential oils in the management of soft rot caused by Pectobacterium aroidearum in lettuce

Lettuce is susceptible to several diseases, especially soft rot caused by bacteria of the genus Pectobacterium. Due to the adaptability of this pathogen and the lack of disease control registered for the crop, the objective of this work was to evaluate the effects of essential oils in the management of soft rot caused by P. aroidearum in lettuce. The study was developed at the Universidade do Estado da Bahia, Juazeiro, BA, Brazil, and the essential oils (EOs) of orange, bergamot, lemongrass, palmarosa, citronella, cloves, tea tree, rosemary, sage, and ginger were used in concentrations of 0.25; 0.5; 0.75 and 1.0% to assess the in vitro growth inhibition of the bacterium. Subsequently, the curative effects of the disease were evaluated by applying the EOs that obtained the best results in vitro in lettuce plants of the susceptible variety "Mônica". The treatments were applied, via spraying, 12 hours after inoculation using the bite method with bacterial suspension. The best in vivo treatment was selected to assess its preventive and curative activity, as well as to find the ideal concentration for reducing epidemiological variables and chromatographic characterization. The EOs of palmarosa, sage, citronella, lemongrass, and cloves (0.25%), and that of sage (0.75%), inhibited bacterial growth in vitro. The EO of salvia showed the best results in vivo, inhibiting the growth of the disease in concentrations of 0.50 and 0.75%, so it was selected for the preventive and curative control tests alone. The preventive treatment was not efficient for the management of soft rot in lettuce, however, from the regression analysis, a concentration of 0.64% of the salvia EO was found as a potential for curative control of this bacteriosis, as it reduces the incidence and severity of the disease. Linalyl acetate and linalool were found in higher concentrations in the chromatographic analysis. These components, probably, conferred the bactericidal capacity of the EO of sage, being potential for the use in the control of P. aroidearum in lettuce.

Clinical skills assessment and feedback in pediatric residency / Avaliação de habilidades clínicas e feedback na residência médica em Pediatria

Abstract: Introduction: A medical residency is the specialization par excellence in medical training and the program is responsible for ensuring that the recently graduated doctor reaches the established level of competence. A well-prepared assessment system with feedback is an effective tool to enhance the performance of future specialists and guarantee their qualification. Objective: To analyze the assessment system for pediatric residents at a university hospital, aiming to promote teaching training in assessment methods. Methodology: educational action research (research-teaching), conducted with teachers and preceptors in the pediatric residency of a university hospital. The stages consisted of: a) the application of a questionnaire on participant profile and assessment methods used to evaluate the medical residents; b) intervention (workshop) on the assessment of clinical skills and feedback; c) immediate assessment after the workshop, by applying another questionnaire based on level 1 of the Kirkpatrick model. Simple statistical analysis was used for the objective data and the content analysis, according to recommendations by Malheiros (2011) and Bardin (2013), for the qualitative part. Result: Ten (48%) of the 21 participants declared not being formally trained in assessment and that they applied the more traditional methods learned from personal experience. Regarding the assessment methods, 81% (17/21) of the participants used more than one, aiming to obtain a more encompassing and reliable assessment. However, none of the teachers/preceptors used a systematized assessment of the clinical skills or provided feedback to the medical residents. After the workshop, with a focus on assessing performance in a simulated 'Objective Structured Clinical Examination' (OSCE) environment, all the participants were favorable to apply the OSCE in their teaching-learning practice with residents and undergraduate students, reaching Kirkpatrick level 3. Conclusion: The action research helped identify limitations in the assessment and feedback system of the pediatric resident physician. The methodology used revealed an aggregating effect and contributed to the development of the collaborative and integrative sense in the group. However, it was not enough to positively interfere with the pediatric medical residency assessment in the short term.

Resumo: Introdução: A residência médica é a especialização por excelência na formação do médico, e cabe ao programa assegurar que o residente egresso atinja o nível almejado de competência. Um sistema avaliativo bem elaborado e com feedback é ferramenta efetiva para aprimorar o desempenho do futuro especialista e garantir a qualificação dele. Objetivo: Este estudo teve como objetivo analisar o sistema de avaliação do médico residente em pediatria de um hospital universitário, com o intuito de promover a formação docente em métodos avaliativos. Método: Trata-se de uma pesquisa-ação educacional (pesquisa-ensino) realizada com docentes e preceptores da residência médica em pediatria de um hospital universitário. As etapas consistiram em: 1. aplicação de questionário sobre o perfil dos participantes e os métodos avaliativos utilizados com os residentes; 2. intervenção com a realização de um workshop sobre avaliação de habilidades clínicas e feedback; 3. avaliação imediata, após o workshop, com aplicação de outro questionário, elaborado com base no nível 1 do método Kirkpatrick. Utilizaram-se a análise estatística simples, para os dados objetivos, e a análise de conteúdo, segundo recomendações de Malheiros e Bardin, para a parte qualitativa. Resultado: Dos 21 participantes, dez (48%) informaram que não tinham capacitação formal em avaliação e que utilizavam métodos avaliativos mais tradicionais. Quanto aos métodos, 81% (17/21) dos participantes informaram que utilizavam mais de um, com finalidade somativa, para obter uma avaliação mais abrangente e fidedigna. No entanto, nenhum utilizava uma avaliação sistematizada de habilidades clínicas com fornecimento de feedback. Após o workshop com enfoque em avaliação de desempenho em ambiente simulado, em que se adotou o Objective Structured Clinical Examination (OSCE), os participantes utilizaram, com os internos, o método avaliativo do aprendizado na sua prática cotidiana, e, dessa forma, o treinamento atingiu o nível 3 de Kirkpatrick. Conclusão: A pesquisa-ação propiciou identificar limitações no sistema de avaliação e feedback do médico residente em pediatria. A metodologia utilizada revelou um efeito agregador e contribuiu para desenvolver o sentido colaborativo e integrativo no grupo. No entanto, não foi suficiente para interferir positivamente, em curto prazo, na avaliação da residência médica em pediatria.

Essential oils in the management of soft rot of kale in the brazilian semiarid region / Óleos essenciais no manejo da podridão mole em couve no semiárido brasileiro

The aim of this study was to analyze the effect of essential oils on the control of soft rot of kale. Clove essential oil at 0.25%, lemongrass and palmarosa essential oils at 0.5%, melaleuca and orange essential oils at 0.75%, bergamot, rosemary, sage and ginger essential oils at 1% were evaluated for the in vitro inhibition of Pectobacterium carotovorum subsp. brasiliensis (Pcb) and control of soft rot of kale, sprayed 72 hours before or seven hours after inoculation. Clove, citronella, bergamot, rosemary, palmarosa, sage, melaleuca, and lemongrass oils completely inhibited the growth of Pcb. Lemongrass oil (0.5%) caused 0% of disease incidence (INC), providing 100% of disease control in both periods of inoculation. Clove oil (0.25%) showed a lower INC (25%) when applied after inoculation, providing a control percentage of 71.42%. The lemongrass and clove essential oils were analyzed by GC/FID (Gas Chromatography ­ Flame Ionization Detector) and by GC/MS (Gas Chromatography /Mass Spectrometer). The major components were eugenol (91,9%) for clove oil and citral, isometric mixture of neral (34,1%) and geranial (42,9%) for lemongrass oil. The Minimum inhibitory concentration (MIC) of lemongrass, clove oils and their major components (citral and eugenol, respectively) was determined by using a broth macrodilution technique, as well as they were evaluated at different concentrations on the control of soft rot of kale, sprayed according descriptions above. The MIC was 0.03125% for citral, and 0.0625 and 0.125% for lemongrass and clove oils, respectively. Eugenol didn't show MIC. Lemongrass oil at 0.125% (post-inoculation) and citral at 0.125% (pre and post-inoculation) provided the highest percentages of disease control (33.33, 50, and 100%, respectively). Clove oil at 0.125% (post-inoculation) showed better effectiveness than eugenol (0.25%), providing a percentage of disease control of 16.67%. Lemongrass and clove essential oils were the most effective in control of soft rot of kale, suggesting that these oils have a potential to be used as antibacterial agents.

O objetivo do estudo foi avaliar o efeito de óleos essenciais no controle da podridão mole em couve. Os óleos essenciais de cravo a 0,25%, capim-limão e palmarosa a 0,5%, citronela, melaleuca e laranja a 0,75%, bergamota, alecrim, sálvia e gengibre a 1% foram avaliados na inibição in vitro de Pectobacterium carotovorum subsp. brasiliensis (Pcb) e controle da podridão mole em couve, pulverizados 72 horas antes ou sete horas após a inoculação. Os óleos essenciais de cravo, citronela, bergamota, alecrim, palmarosa, sálvia, melaleuca e capim-limão inibiram completamente o crescimento de Pcb. O óleo de capimlimão (0,5%) promoveu 0% de incidência (INC) da doença (percentual de controle de 100%), em ambos os períodos de inoculação. O óleo de cravo (0,25%) proporcionou menor INC (25%) quando aplicado após inoculação (percentual de controle de 71,42%). Os óleos essenciais de capim-limão e cravo foram analisados por GC/FID (cromatografia gasosa/detector por ionização de chama) e por GC/MS (cromatografia gasosa/ espectometria de massas). Os componentes majoritários foram eugenol (91,9%) no óleo de cravo e citral (neral34,1% e geranial- 42,9%) no óleo de capim-limão. A concentração inibitória mínima (CIM) dos óleos essenciais de capim-limão e cravo e de seus componentes majoritários (citral e eugenol, respectivamente) foi determinada por meio da técnica de macrodiluição em caldo, bem como foram avaliados, em diferentes concentrações, no controle da podridão mole em couve, pulverizados conforme descrito acima. A concentração inibitória mínima (CIM) foi de 0,03125% para o citral, e de 0,0625 e 0,125% para os óleos de capim-limão e cravo, respectivamente. O eugenol não apresentou CIM. O óleo de capim-limão a 0,125% (pós-inoculação) e o citral (0,125%), em ambos os períodos de inoculação, proporcionaram os maiores percentuais de controle (33,33; 50 e 100%, respectivamente). O óleo de cravo a 0,125% (pós-inoculação) mostrou maior eficiência que o eugenol (0,25%), promovendo um percentual de controle de 16,67%. Os óleos essenciais de capim-limão e cravo destacaram-se na eficiência de controle da podridão mole em couve, sugerindo que esses óleos têm potencial para serem utilizados como agentes antibacterianos.

Quedas em idosos: aspectos perceptuais sobre o risco de quedas e medo de cair / Falls in elderly: perceptual aspects of fall risk and fear of falling / Caídas en ancianos: aspectos perceptuales de riesgo de caídas y temor de caídas

O envelhecimento é um processo natural e progressivo marcado por alterações musculoesqueléticas, cognitivas e perceptuais que podem levar o idoso a apresentar episódios de quedas. Este estudo teve como objetivo analisar a relação entre o número de quedas, a percepção do risco de quedas, e o medo de cair em idosos, de ambos os sexos, com idade igual ou superior a 60 anos. O estudo possui delineamento transversal e foi composto por 106 idosos (69,64 ± 8,94 anos). A percepção de quedas foi avaliada por meio do Falls Risk Awareness Questionnaire (FRAQ), e o medo de cair pela Falls Efficacy Scale - International (FES-I). Pôde-se concluir que, quanto menor for o número de medicamentos consumidos, o número de quedas e o medo de cair, maior será a percepção do risco de quedas do idoso. Além disso, também foi possível observar que, quanto maior for o consumo de medicamentos, maior será o medo de cair do idoso.

Aging is a natural and progressive process marked by musculoskeletal, cognitive and perceptual changes that can lead the elderly to present episodes of falls. This study aimed to analyze the relationship between the number of falls, the perception of the risk of falls and the fear of falling in the elderly, of both sexes, aged 60 years or over. The study has a cross-sectional design and was composed of 106 elderly people (69.64 ± 8.94 years). The perception of falls was assessed using the Falls Risk Awareness Questionnaire (FRAQ) and the fear of falling using the Falls Efficacy Scale - International (FES-I). It can be concluded that the smaller the number of drugs consumed, the number of falls and the fear of falling, the greater the perception of the risk of falls for the elderly. In addition, it was also possible to observe that the greater the consumption of medications, the greater the fear of falling for the elderly.

El envejecimiento es un proceso natural y progresivo marcado por cambios musculoesqueléticos, cognitivos y perceptivos que pueden llevar a los ancianos a presentar episodios de caídas. Este estudio tuvo como objetivo analizar la relación entre el número de caídas, la percepción del riesgo de caídas y el miedo a las caídas en los ancianos, de ambos sexos, de 60 años o más. El estudio tiene un diseño transversal y estuvo compuesto por 106 personas de edad avanzada (69,64 ± 8,94 años). La percepción de caídas se evaluó mediante el Cuestionario de conciencia de riesgo de caídas (FRAQ) y el miedo a caerse utilizando la Escala de eficacia de caídas - Internacional (FES-I). Se puede concluir que cuanto menor sea la cantidad de medicamentos consumidos, la cantidad de caídas y el miedo a las caídas, mayor será la percepción del riesgo de caídas para los ancianos. Además, también fue posible observar que cuanto mayor es el consumo de medicamentos, mayor es el miedo a enamorarse de los ancianos.

Tetanic Facilitation of Neuromuscular Transmission by Adenosine A2A and Muscarinic M1 Receptors is Dependent on the Uptake of Choline via High-Affinity Transporters.

BACKGROUND/AIMS: In this study, we evaluated the functional impact of facilitatory presynaptic adenosine A2A and muscarinic M1 receptors in the recovery of neuromuscular tetanic depression caused by the blockage of high-affinity choline transporter (HChT) by hemicholinium-3 (HC-3), a condition that mimics a myasthenia-like condition. METHODS: Rat diaphragm preparations were indirectly stimulated via the phrenic nerve trunk with 50-Hz frequency trains, each consisting of 500-750 supramaximal intensity pulses. The tension at the beginning (A) and at the end (B) of the tetanus was recorded and the ratio (R) B/A calculated. RESULTS: Activation of A2A and M1 receptors with CGS21680 (CGS; 2 nmol/L) and McN-A-343c (McN; 3 µmol/L) increased R values. Similar facilitatory effects were obtained with forskolin (FSK; 3 µmol/L) and phorbol 12-myristate 13-acetate (PMA; 10 µmol/L), which activate adenylate cyclase and protein kinase C respectively. HC-3 (4 µmol/L) decreased transmitter exocytosis measured by real-time videomicroscopy with the FM4-64 fluorescent dye and prevented the facilitation of neuromuscular transmission caused by CGS, McN, and FSK, with a minor effect on PMA. The acetylcholinesterase inhibitor, neostigmine (NEO; 0.5 µmol/L), also decreased transmitter exocytosis. The paradoxical neuromuscular tetanic fade caused by NEO (0.5 µmol/L) was also prevented by HC-3 (4 µmol/L) and might result from the rundown of the positive feedback mechanism operated by neuronal nicotinic receptors (blocked by hexamethonium, 120 µmol/L). CONCLUSION: Data suggest that the recovery of tetanic neuromuscular facilitation by adenosine A2A and M1 receptors is highly dependent on HChT activity and may be weakened in myasthenic patients when HChT is inoperative.

Lipossarcoma de laringe: relato de caso / Laryngeal liposarcoma: a case report

O lipossarcoma de laringe é uma neoplasia extremamente rara, acomete principalmente o sexo masculino, principalmente na quinta década de vida. Existindo apenas cerca de 40 casos descritos na literatura, desses nenhum em língua portuguesa. O presente caso relata o diagnóstico em um paciente do sexo masculino, 57 anos, ex-tabagista, apresentando alteração de voz e obstrução de via área. Foi optado por ressecção cirúrgica completa com achados sugestivos de lipossarcoma bem diferenciado. Foi optado por manter seguimento, não tendo sido indicado quimioterapia e radioterapia adjuvantes.(AU)

Laryngeal liposarcoma is an extremely rare neoplasm that affects especially men in the fifth decade of life. There are only about 40 cases described in the literature, none of them in the Portuguese language. We report the case of a 57-year-old, former smoker man presenting with voice disorders and airway obstruction. We opted for complete surgical resection with findings suggestive of well-differentiated liposarcoma. We chose to keep following the patient, and no adjuvant chemotherapy and radiotherapy were indicated. (AU)