Effect of Plate Configuration in the Primary Stability of Osteotomies and Biological Reconstructions of Femoral Defects: Finite-Element Study.

BACKGROUND/OBJECTIVE: Osteosynthesis is an alternative treatment for stabilizing femur-bone traumas. The initial stability of the fixation systems is one of the biomechanical parameters affecting implant failure and bone union, especially in surgeries of intercalary reconstructions after the removal of bone tumors. This study aimed to investigate the initial biomechanical effect of using one or two osteosynthesis plate configurations for femoral fixation and the effect of fastening the allograft to the osteosynthesis plate in the case of femoral allograft reconstructions. METHODS: Three finite-element models of a femur with three different fixation conditions for a transverse osteotomy in the middle of the diaphysis, i.e., using one and two osteosynthesis plates and an intercalary allograft, were constructed. An eight-hole compression plate and a six-hole second plate were used to simulate osteosynthesis plates. The plate screws were tightened previously to the loading, and the tightening sequences simulate the bolt-tightening procedure in a surgical environment. The models were imported into the ADINA System for nonlinear analysis, using compression loads applied over the femur head. RESULTS: Models with the dual fixation systems had the most outstanding compression stiffness. The femur head movement in the dual plate system was 24.8% smaller than in the single plate system. A statistical analysis of a region of interest (VOI) placed in the femur diaphysis showed that the biomechanical effect of using the dual plate system is smaller in the osteotomy region than at the femur head, e.g., a displacement average decrease of only 5% between the two systems, while the maximum value decreases by 26.8%. The allograft fixation to the second osteosynthesis plate leads to an improvement in the system stability. CONCLUSIONS: The results presented in this work show that including the bolt analysis in the femoral diaphysis osteotomy fixation will allow for capturing the nonlinear behavior of the osteotomy region more realistically. The stability of the intercalary reconstruction of the femoral diaphysis was higher when the allograft was fastened to the second osteosynthesis plate.

The physiological quality of Vigna unguiculata L. seeds shows tolerance to salinity.

Salinity reduces feijão-caupi production, and the search for tolerant varieties becomes important within the agricultural context, as, in addition to being used in the field, they can be used in genetic improvement. The objective was to for a identify variety that is tolerant to salinity considering the physiological quality of seeds and seedling growth. A 2 × 4 factorial scheme was used, referring to the varieties Pingo-de-ouro and Coruja, and four electrical conductivities of water (0; 3.3; 6.6 and 9.9 dS m-1). The physiological quality of seeds and the growth of seedlings were analyzed, in addition to the cumulative germination. The Pingo-de-ouro variety showed no germination, length of the shoot and root, dry mass of the shoot and root compromised up to electrical conductivity of 6 dS m-1 in relation to 0.0 dS m-1. On the other hand, the Coruja variety showed reduced germination, increased shoot and root length. The creole variety Pingo-de-ouro proved to be tolerant to salinity.

Extract of Cimicifuga racemosa (L.) Nutt protects ovarian follicle reserve of mice against in vitro deleterious effects of dexamethasone.

The present study aims to investigate if Cimicifuga racemosa (L.) Nutt extract (CIMI) reduces deleterious effects of dexamethasone (DEXA) in ovaries cultured in vitro. Mouse ovaries were collected and cultured in DMEM+ only or supplemented with 5 ng/mL of CIMI, or 4 ng/mL DEXA, or both CIMI and DEXA. The ovaries were cultured at 37.5°C in 5% CO2 for 6 days. Ovarian morphology, follicular ultrastructure, and the levels of mRNA for Bax, Bcl-2, and Caspase-3 were evaluated. The results showed that DEXA reduced the percentage of morphologically normal follicles, while CIMI prevented the deleterious effects caused by DEXA. In addition, DEXA negatively affected the stromal cellular density, while CIMI prevented these adverse effects. Ovaries cultured with DEXA and CIMI showed similar levels of mRNA for Bax, Bcl-2, and Caspase-3 compared to those cultured in control medium, while ovaries cultured with DEXA had increased expression of the above genes. Additionally, the ultrastructure of the ovaries cultured with CIMI was well preserved. Thus, the extract of CIMI was able to prevent the deleterious effects caused by DEXA on cultured mouse ovaries.

Clinical experience of a specialized urticaria outpatient clinic from a Portuguese UCARE.

Summary: Background. Chronic urticaria (CU) is a frequent disease, with a prevalence of at least 1%. It is characterized by pruritic wheals, angioedema or both for a period longer than 6 weeks. Objective. Identify the demographic, clinical, laboratory and therapeutic profile of patients treated in a Portuguese Urticaria Center of Reference and Excellence (UCARE) and compare it with international series. Methods. Retrospective analysis of database of patients observed in a specialized urticaria outpatient clinic, from January 2017 through September 2019, of a UCARE center in Portugal. Demographic and clinical features, laboratory findings and pharmacological treatment were obtained from the records. Descriptive analyses were performed for all variables. Chi square and fisher's exact tests were applied to analyze the independence of variables and the fit of distribution. P less than 0.05 was considered significant. Results. During this period, 477 patients were observed, of whom 429 (90%) were diagnosed with chronic urticaria. Mean age (years) at the onset of symptoms was 43.7 (standard deviation (SD) 17.6, range 6-88) and at diagnosis 46.7 (SD 17.8, range 6-88) resulting in an average diagnostic delay of 3 years (range 0-25). Median follow-up period since first attendance in the specialized outpatient clinic was 1.7 years (interquartile range (IQR) 0.79, range 0.1-2.75) . Concerning the whole group of CU patients, 347 (81%) had chronic spontaneous urticaria (CSU) - 79% female, 39 (9%) had isolated chronic inducible urticaria (CIndU) and 43 (10%) had CSU with CIndU. Autologous serum skin test (ASST) was done in 76 patients (positive in 24 (32%)) and basophil activation test (BAT) was done in 38 (positive in 13 (34%)). At the moment of study, 204 (48%) of CU patients were medicated with a second-generation H1-antihistamine (sgAH) daily (first-line therapy), 99 (23%) with sgAH up to four times the standard dose (second-line therapy) and 126 (29%) with omalizumab (third-line therapy). Additionally, 7 (2%) patients were completing a short course of systemic corticosteroids for management of disease exacerbation. Disease control was achieved in 316 of CSU patients (81%). Conclusions. Referral to a specialized urticaria outpatient clinic is important for a proper assessment of the disease and adequately symptom control.

Extract of Cimicifuga racemosa (L.) Nutt protects ovarian follicle reserve of mice against in vitro deleterious effects of dexamethasone

The present study aims to investigate if Cimicifuga racemosa (L.) Nutt extract (CIMI) reduces deleterious effects of dexamethasone (DEXA) in ovaries cultured in vitro. Mouse ovaries were collected and cultured in DMEM+ only or supplemented with 5 ng/mL of CIMI, or 4 ng/mL DEXA, or both CIMI and DEXA. The ovaries were cultured at 37.5°C in 5% CO2 for 6 days. Ovarian morphology, follicular ultrastructure, and the levels of mRNA for Bax, Bcl-2, and Caspase-3 were evaluated. The results showed that DEXA reduced the percentage of morphologically normal follicles, while CIMI prevented the deleterious effects caused by DEXA. In addition, DEXA negatively affected the stromal cellular density, while CIMI prevented these adverse effects. Ovaries cultured with DEXA and CIMI showed similar levels of mRNA for Bax, Bcl-2, and Caspase-3 compared to those cultured in control medium, while ovaries cultured with DEXA had increased expression of the above genes. Additionally, the ultrastructure of the ovaries cultured with CIMI was well preserved. Thus, the extract of CIMI was able to prevent the deleterious effects caused by DEXA on cultured mouse ovaries.

Hereditary angioedema: 24 years of experience in a Portuguese Reference Center.

Summary: Hereditary angioedema (HAE) poses a high burden of disease, being its epidemiological and clinical data heterogeneous among countries, with no recent published studies concerning Portuguese patients. Therefore, we aimed to raise awareness of HAE and to contribute to clinical knowledge. An observational, descriptive, retrospective, and cross-sectional study was performed, that included a cohort of 126 patients followed in a single Portuguese Center. We observed a high prevalence of HAE-C1-INH type II (45.2% of patients). Most HAE patients (67.4%) presented the initial manifestations of the disease before adulthood, at a mean age of 12.6 ± 8.4 years. However, we found a long delay in HAE diagnosis, especially in those without family history (mean 20.7 ± 17.3 years). Stress was the most common trigger, followed by trauma and infection. Symptoms involving different systems were increasingly reported with increased disease duration. Cutaneous symptoms (95.0%) were more frequent, followed by gastrointestinal (80.7%), and respiratory symptoms (50.4%). HAE symptoms led to abdominal surgery in 22 (17.5%) patients and induced laryngeal edema requiring intubation/tracheostomy in 8 (6.3%) patients. Most patients were under long-term prophylaxis, mainly with attenuated androgens (62.7% of patients).The correct distinction between HAE and other common causes of angioedema is critical, allowing reduction of diagnostic delay, improvement of adequate management, and ultimately improving outcomes and quality of life of HAE patients.

Body dysmorphic disorder and personality in breast augmentation: The big-five personality traits and BDD symptoms.

BACKGROUND: Breast augmentation is one of the most performed cosmetic surgeries in the world. Personality traits predict the presence of psychological and social factors that may affect the patient satisfaction with a cosmetic surgical procedure and may be risk factors for body dysmorphic disorder. The aim of this study was to assess symptoms of body dysmorphic disorder in patients undergoing breast augmentation and identify their personality traits. METHODS: Thirty-six women with hypoplasia of the breast (Sacchini index < 9 cm), a mean age of 28.1 years (SD = 6.2), body mass index ≤ 25 kg/m2, and no history of breast surgery or breast-associated conditions were included in this prospective study.The Brazilian versions of the Structured Clinical Interview (SCID-I), Big Five Inventory (IGFP-5), and Body Dysmorphic Symptoms Scale (BDSS) were applied preoperatively and at 2 and 4 months after breast augmentation. RESULTS: Personality traits were associated with symptoms of body dysmorphic disorder. A significant decrease (p< 0.001) in IGFP-5 scores on the Conscientiousness dimension, symptoms of body dysmorphic disorder (BDSS scores), and the number of patients with body dysmorphic disorder (SCID-I) were observed among different time points. In the study population, breast augmentation decreased the symptoms of body dysmorphic disorder, psychosocial impairment, and mean scores on Conscientiousness. CONCLUSION: Personality traits varied in intensity and overlapped over time, and were associated with core symptoms of body dysmorphic disorder and the onset of body dissatisfaction.

Alloplastic temporomandibular joint replacement: present status and future perspectives of the elements of embodiment.

Medical device embodiment involves the following elements: materials, design, and manufacturing. Failure of any one of these elements can result in failure of the device, despite the others being satisfactory. The abundance of clinical and basic science literature published since 1986, demonstrates the safety and efficacy of alloplastic temporomandibular joint replacement (TMJR). Currently, there are 19 countries producing 41 TMJR devices. More than 75% are custom designed, and 27% are additively manufactured. In light of the increasing number of TMJR devices being designed and manufactured around the world, this paper will discuss TMJR embodiment so that clinicians understand their present status as well as the prospects for the future of new and/or improved TMJR devices, to ensure that these devices continue to be safe and effective long-term surgical options for the management of end-stage TMJ pathologies.

Disección didáctica de fibra blanca en cerebelo humano en tres pasos: entrenamiento microneuroanatómico / 3-Step didactic white matter dissection of human cerebellum: Micro-neuroanatomical training

Objetivos: Un buen conocimiento anatómico del cerebelo es fundamental para llevar a cabo abordajes al IV ventrículo (frecuentes en la neurocirugía pediátrica) de forma segura, evitando secuelas como el mutismo cerebeloso. El propósito del presente trabajo es realizar una disección didáctica del cerebelo humano centrándonos especialmente en los pedúnculos cerebelosos y en los núcleos dentados (DN); estructuras en riesgo durante estos procedimientos. Material y métodos :Se disecó el órgano, siguiendo el método de Klingler para fibras blancas, usando material de microcirugía estándar y específico, bajo un microscopio D. F. Vasconcellos M900 con aumento x6-x40. Se utilizó una cámara Canon EOS T7 con un objetivo de 18-55 mm y se editaron las imágenes con Adobe Lightroom Classic CC y Keynote. Se emplearon métodos especiales como la iluminación endoscópica con luz LED para la obtención de algunas fotografías. Resultados: Se logró disecar con éxito los DN del cerebelo y describir su relación con los pedúnculos cerebelosos, vermis inferior y velos medulares. Mediante esta guía de tres pasos (1. cara tentorial; 2. cara suboccipital; 3. estructuras del IV ventrículo) se consiguió mostrar los elementos más importantes para el estudio del órgano y caracterizar sus implicaciones en los distintos abordajes al IV ventrículo. Conclusiones: La mejor forma de completar el estudio de neuroanatomía es la disección de especímenes, ya que aporta una visión 3 D. La transiluminación con luz LED se reveló como una herramienta útil para el registro fotográfico de estructuras del IV ventrículo, lo que mejora la visión espacial. Su principal aplicación la encontramos en los velos medulares y forámenes de la fosa romboide, ya que son permeables a la luz. La guía de disección en tres fases propuesta en este trabajo puede ayudar a los neurocirujanos, en cualquier etapa de su formación, a comprender mejor el cerebelo (AU)

Objectives: A thorough understanding of cerebellum anatomy is essential in 4th ventricle approaches (more frequent in pediatric neurosurgery), avoiding relevant complications such as cerebellar mutism. The aim of the present work is to show the feasibility of a didactic dissection of human cerebellum focusing on cerebellar peduncles and dentate nucleus (DN), which are structures at high risk during these surgical procedures. Material and methods: The cerebellum was dissected according to the Klingler method for white matter, using standard and specific microsurgery tools. Surgical microscope magnification (x6-x40) provided by a D.F. Vasconcellos M900 was required. A Canon EOS T7 18-55 mm digital camera was used and Adobe Lightroom Classic CC and Keynote were selected as photo enhancing software. Special methods such as LED light endoscopic transillumination were used for photographical reasons. Results: DN dissection was successfully achieved and the relations between these nucleus and the cerebellar peduncles, inferior vermis and medullary velums were described. Through this three steps dissection guide (1. tentorial surface; 2. suboccipital surface; 3. 4th ventricle structures), the most relevant anatomical structures were shown and its implications in different 4th ventricle approaches were characterised. Conclusion: 3 D perspective provided by real specimen anatomical dissection is critical for learning neuroanatomy. ED transillumination was shown as a useful technique for the 4th ventricle structures photographic documentation which improves spatial recognition. This benefit can be applied for the study of the relations between the medullary velums and the rhomboid fossa foramina, which are permeable to light. The proposed three-steps dissection guide helps to a better understanding of human cerebellum and to gain self-confidence, allowing safer practice for neurosurgeons in all stages of their career (AU)

Subcutaneous immunotherapy with aeroallergens: safety profile assessment.

SUMMARY: Introduction. Severe systemic reactions (SR) to allergen subcutaneous immunotherapy (SCIT) are rare but local reactions (LR) are common. We aimed to characterize the type of reactions and safety profile. Methods. Retrospective analysis of medical record from patients under SCIT between 2013-2016. Results. Total of 7372 SCIT injections in 323 patients: 52% female; mean age 30 years (SD 13); mean treatment time 19 months (SD 13). There were 57 patients (17.6% of population, 70% female) with at least one adverse reaction, for 93 reactions described (1.3% injections). There were 79 LR (1.1% injections) in 46(14.2%) patients: 36 in build-up, 43 in maintenance. There were 14 SR (0.19% injections) in 12(3.7%) patients: 12 in build-up, 2 in maintenance. All SR were grade 1. The majority of reactions were caused by mite SCIT (69.9%). Conclusions. SCIT is safe and well tolerated, with no report of SR grade > 1.

Ionic homeostasis, biochemical components and yield of Italian zucchini under nitrogen forms and salt stress / Homeostase iônica, componentes bioquímicos e produção da abobrinha italiana sob formas de nitrogênio e estresse salino

This research was carried out aiming at evaluating the effects of nitrate and ammonium ions on nutrient accumulation, biochemical components and yield of Italian zucchini (cv. Caserta) grown in a hydroponic system under salt stress conditions. The experiment was carried out in a greenhouse utilizing an experimental design in randomized blocks, arranged in a 2 x 5 factorial scheme, with 4 replications. The treatments consisted of two forms of nitrogen (nitrate - NO3- and ammonium - NH4+) and 5 electrical conductivity levels of irrigation water (ECw) (0.5, 2.0, 3.5, 5.0 and 6.5 dS m-1). The analysis of the results indicated that supply of N exclusively in NH4+ form promotes greater damage to the leaf membrane and reduction in accumulation of macronutrients and higher Na+/K+, Na+/Ca++ and Na+/Mg++ ratios in the shoots of zucchini plants. Electrical conductivity of irrigation water above 2.0 dS m-¹ reduces the accumulation of nutrients in shoot and yield of Italian zucchini plant. The toxicity of NH4+ under Italian zucchini plants overlap the toxicity of the salinity, since its fertilization exclusively with this form of nitrogen inhibits its production, being the NO3- form the most suitable for the cultivation of the species.

Este trabalho foi desenvolvido com o objetivo de avaliar os efeitos dos íons nitrato e amônio sobre o acúmulo de nutrientes e produção da abobrinha italiana (cv. Caserta) cultivada em sistema hidropônico sob estrese salino. O experimento foi conduzido em casa de vegetação utilizando o delineamento experimental em blocos casualizados, arranjados em esquema fatorial 2 x 5, com 4 repetições. Os tratamentos foram constituídos de duas formas de nitrogênio (nitrato - NO3- e amônio - NH4+) e cinco níveis de condutividade elétrica da água de irrigação (CEa) (0,5; 2,0; 3,5; 5,0 e 6,5 dS m-¹). As análises dos resultados indicaram que suprimento de N exclusivamente em forma de NH4+ promove maiores danos na membrana foliar e redução no acúmulo de macronutrientes e maiores relações Na+/K+, Na+/Ca++ e Na+/Mg++ na parte aérea das plantas de abobrinha. A irrigação com água a cima de 2,0 dS m-¹ reduz o acúmulo de nutrientes na parte aérea das plantas e a produção de abobrinha. A toxicidade do NH4+ sob abobrinha italiana sobrepõe-se à toxicidade da salinidade, pois a fertilização exclusiva com esta forma de nitrogênio inibe sua produção, sendo a forma NO3- a mais adequada para o cultivo da espécie.

Ionic homeostasis, biochemical components and yield of Italian zucchini under nitrogen forms and salt stress

Abstract This research was carried out aiming at evaluating the effects of nitrate and ammonium ions on nutrient accumulation, biochemical components and yield of Italian zucchini (cv. Caserta) grown in a hydroponic system under salt stress conditions. The experiment was carried out in a greenhouse utilizing an experimental design in randomized blocks, arranged in a 2 x 5 factorial scheme, with 4 replications. The treatments consisted of two forms of nitrogen (nitrate - NO3- and ammonium - NH4+) and 5 electrical conductivity levels of irrigation water (ECw) (0.5, 2.0, 3.5, 5.0 and 6.5 dS m-1). The analysis of the results indicated that supply of N exclusively in NH4+ form promotes greater damage to the leaf membrane and reduction in accumulation of macronutrients and higher Na+/K+, Na+/Ca++ and Na+/Mg++ ratios in the shoots of zucchini plants. Electrical conductivity of irrigation water above 2.0 dS m-1 reduces the accumulation of nutrients in shoot and yield of Italian zucchini plant. The toxicity of NH4+ under Italian zucchini plants overlap the toxicity of the salinity, since its fertilization exclusively with this form of nitrogen inhibits its production, being the NO3- form the most suitable for the cultivation of the species.

Resumo Este trabalho foi desenvolvido com o objetivo de avaliar os efeitos dos íons nitrato e amônio sobre o acúmulo de nutrientes e produção da abobrinha italiana (cv. Caserta) cultivada em sistema hidropônico sob estrese salino. O experimento foi conduzido em casa de vegetação utilizando o delineamento experimental em blocos casualizados, arranjados em esquema fatorial 2 x 5, com 4 repetições. Os tratamentos foram constituídos de duas formas de nitrogênio (nitrato - NO3- e amônio - NH4+) e cinco níveis de condutividade elétrica da água de irrigação (CEa) (0,5; 2,0; 3,5; 5,0 e 6,5 dS m-1). As análises dos resultados indicaram que suprimento de N exclusivamente em forma de NH4+ promove maiores danos na membrana foliar e redução no acúmulo de macronutrientes e maiores relações Na+/K+, Na+/Ca++ e Na+/Mg++ na parte aérea das plantas de abobrinha. A irrigação com água a cima de 2,0 dS m-1 reduz o acúmulo de nutrientes na parte aérea das plantas e a produção de abobrinha. A toxicidade do NH4+ sob abobrinha italiana sobrepõe-se à toxicidade da salinidade, pois a fertilização exclusiva com esta forma de nitrogênio inibe sua produção, sendo a forma NO3- a mais adequada para o cultivo da espécie.

Ionic homeostasis, biochemical components and yield of Italian zucchini under nitrogen forms and salt stress / Homeostase iônica, componentes bioquímicos e produção da abobrinha italiana sob formas de nitrogênio e estresse salino

This research was carried out aiming at evaluating the effects of nitrate and ammonium ions on nutrient accumulation, biochemical components and yield of Italian zucchini (cv. Caserta) grown in a hydroponic system under salt stress conditions. The experiment was carried out in a greenhouse utilizing an experimental design in randomized blocks, arranged in a 2 x 5 factorial scheme, with 4 replications. The treatments consisted of two forms of nitrogen (nitrate - NO3 - and ammonium - NH4 + ) and 5 electrical conductivity levels of irrigation water (ECw) (0.5, 2.0, 3.5, 5.0 and 6.5 dS m-1). The analysis of the results indicated that supply of N exclusively in NH4 + form promotes greater damage to the leaf membrane and reduction in accumulation of macronutrients and higher Na+ /K+ , Na+ /Ca++ and Na+ /Mg++ ratios in the shoots of zucchini plants. Electrical conductivity of irrigation water above 2.0 dS m-1 reduces the accumulation of nutrients in shoot and yield of Italian zucchini plant. The toxicity of NH4 + under Italian zucchini plants overlap the toxicity of the salinity, since its fertilization exclusively with this form of nitrogen inhibits its production, being the NO3 - form the most suitable for the cultivation of the species.

Este trabalho foi desenvolvido com o objetivo de avaliar os efeitos dos íons nitrato e amônio sobre o acúmulo de nutrientes e produção da abobrinha italiana (cv. Caserta) cultivada em sistema hidropônico sob estrese salino. O experimento foi conduzido em casa de vegetação utilizando o delineamento experimental em blocos casualizados, arranjados em esquema fatorial 2 x 5, com 4 repetições. Os tratamentos foram constituídos de duas formas de nitrogênio (nitrato - NO3 - e amônio - NH4 + ) e cinco níveis de condutividade elétrica da água de irrigação (CEa ) (0,5; 2,0; 3,5; 5,0 e 6,5 dS m-1). As análises dos resultados indicaram que suprimento de N exclusivamente em forma de NH4 + promove maiores danos na membrana foliar e redução no acúmulo de macronutrientes e maiores relações Na+ /K+ , Na+ /Ca++ e Na+ /Mg++ na parte aérea das plantas de abobrinha. A irrigação com água a cima de 2,0 dS m-1 reduz o acúmulo de nutrientes na parte aérea das plantas e a produção de abobrinha. A toxicidade do NH4 + sob abobrinha italiana sobrepõe-se à toxicidade da salinidade, pois a fertilização exclusiva com esta forma de nitrogênio inibe sua produção, sendo a forma NO3 - a mais adequada para o cultivo da espécie.

Spontaneous emission in inertial and dissipative nematic liquid crystals: the role of critical phenomena.

We develop a rigorous, field-theoretical approach to the study of spontaneous emission in inertial and dissipative nematic liquid crystals (LCs), disclosing an alternative application of the massive Stückelberg gauge theory to describe critical phenomena in these systems. This approach allows one not only to unveil the role of phase transitions in the spontaneous emission in LCs but also to make quantitative predictions for quantum emission in realistic nematics of current scientific and technological interest in the field of metamaterials. Specifically, we predict that one can switch on and off quantum emission in LCs by varying the temperature in the vicinities of the crystalline-to-nematic phase transition, for both the inertial and dissipative cases. We also predict from first principles the value of the critical exponent that characterizes such a transition, which we show not only to be independent of the inertial or dissipative dynamics, but also to be in good agreement with experiments. We determine the orientation of the dipole moment of the emitter relative to the nematic director that inhibits spontaneous emission, paving the way to achieve directionality of the emitted radiation, a result that could be applied in tuneable photonic devices such as metasurfaces and tuneable light sources.

Evaluation of amoxicillin, metronidazole and gentamicin dosage regimens for use in antibiotic prophylaxis in colorectal surgery.

OBJECTIVES: To evaluate amoxicillin, metronidazole and gentamicin dosage regimens for antibiotic prophylaxis in colorectal surgery. METHODS: The study was conducted in 20 patients undergoing colorectal surgery. Patients received one or two doses of amoxicillin 1000 mg, metronidazole 500 mg and gentamicin 3 mg/kg ideal body weight, banded by height. Antibiotic concentrations were measured up to 7 h post dose. Population pharmacokinetic (PopPK) analysis with NONMEM followed by Monte Carlo simulation of different dosage regimens was used to estimate the PTA for potential organisms associated with surgical site infections (SSIs). RESULTS: A median of 5 (range 3-6) concentrations were available per patient. CL and V of all antibiotics were related to weight; gentamicin CL was also related to CLCR. The administered doses maintained the desired PTA up to 8 h for the Streptococcus anginosus group but not for enterococci, Bacteroides fragilis group, MSSA, and Escherichia coli. An additional 500 mg amoxicillin every 4 h was sufficient to achieve the PTA for most relevant organisms but 2 hourly dosing was required for patients at risk of infective endocarditis. A metronidazole dose of 1000 mg was required for patients >85 kg. In patients with CLCR >50 mL/min, 5 mg/kg gentamicin (with an additional 2.5 mg/kg in prolonged surgery at 6 h) maintained PTA targets for >10 h. CONCLUSIONS: PopPK analysis with Monte Carlo simulation identified prophylactic antibiotic regimens that would maintain the PTA for organisms associated with SSIs during short- and long-duration colorectal surgery.

Urticaria por frío. Caracterización de la población de una clínica ambulatoria especializada en urticaria / Cold Urticaria. Characterizing the Population From an Urticaria Outpatient Clinic

Introducción La urticaria por frío (UF) es un tipo de urticaria crónica inducible (CIndU) donde aparecen ronchas pruriginosas recurrentes y/o angioedema tras la exposición a estímulos fríos. Aunque normalmente solo afecta a áreas expuestas, pueden producirse reacciones sistémicas. Nuestro objetivo es caracterizar los casos de UF de nuestro hospital. Material y métodos Estudio retrospectivo de casos de UF seguidos en nuestra consulta de urticaria en Portugal hasta octubre de 2020. Resultados Se incluyeron 52 pacientes, de ellos 40 mujeres. La edad media fue de 35años. En 19 pacientes, los síntomas comenzaron antes de los 18años de edad. La UF se clasificó como adquirida en todos los pacientes. Las pruebas de provocación por frío fueron negativas en 9 pacientes, clasificados como UF atípica. No se encontraron diferencias con respecto al inicio en edad pediátrica o adulta. Más de la mitad de los pacientes (52%) tenían una UF localizada. A pesar de no ser estadísticamente significativa, la temperatura umbral evaluada con TempTest® 4.0 fue más alta y el tiempo de estimulación más corto en los pacientes con síntomas más graves. Todos los pacientes fueron tratados con antihistamínicos y uno con omalizumab. Los pacientes controlados con dosis estándar de antihistamínicos tenían temperatura umbral más baja que los que necesitaban dosis más altas (p<0,01). Conclusión La UF es una enfermedad heterogénea que, en algunos casos, puede poner en peligro la vida del paciente. Las pruebas de provocación con frío pueden ser útiles en el manejo e identificación de grupos de gravedad (AU)

Introduction Cold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients. Material and methods Retrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020. Results We included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p<0.01). One patient was under treatment with omalizumab. Conclusion ColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups (AU)

Psychic suffering and depression in black children and adolescents: systematic review and meta-analysis.

Depression is a common disorder in the population, but some people are more vulnerable to this condition. Groups at higher risk of developing psychic suffering include black children and adolescents living in vulnerable socioeconomic conditions. This study aimed to analyze race and life conditions as determinants of depression in children and adolescents. This was a systematic review with meta-analysis. The study sources were MEDLINE Ovid, Web of Science, Latin American and Caribbean Health Science Information database, Science Citation Index-Expanded, PubMed, EMBASE, and Scopus. The following keywords were used: Child, Adolescent, Stress, Psychological, Depression, and African Continental Ancestry Group, using the logical operators AND and OR. The general criteria were observational studies published in the last 20 years. Language was not restricted to avoid possible bias in the selection of articles. Studies with a high risk of bias were excluded. General analysis was conducted with RStudio 3.0 software using odds ratio analysis with a 95% confidence interval and 0.05 significance level. We firstly found 654 studies, of which 18 met the criteria and were included in this review. Race and life conditions were determinants of depression in children and adolescents, with a negative impact for the black population.

Ionic homeostasis, biochemical components and yield of Italian zucchini under nitrogen forms and salt stress.

This research was carried out aiming at evaluating the effects of nitrate and ammonium ions on nutrient accumulation, biochemical components and yield of Italian zucchini (cv. Caserta) grown in a hydroponic system under salt stress conditions. The experiment was carried out in a greenhouse utilizing an experimental design in randomized blocks, arranged in a 2 x 5 factorial scheme, with 4 replications. The treatments consisted of two forms of nitrogen (nitrate - NO3- and ammonium - NH4+) and 5 electrical conductivity levels of irrigation water (ECw) (0.5, 2.0, 3.5, 5.0 and 6.5 dS m-1). The analysis of the results indicated that supply of N exclusively in NH4+ form promotes greater damage to the leaf membrane and reduction in accumulation of macronutrients and higher Na+/K+, Na+/Ca++ and Na+/Mg++ ratios in the shoots of zucchini plants. Electrical conductivity of irrigation water above 2.0 dS m-1 reduces the accumulation of nutrients in shoot and yield of Italian zucchini plant. The toxicity of NH4+ under Italian zucchini plants overlap the toxicity of the salinity, since its fertilization exclusively with this form of nitrogen inhibits its production, being the NO3- form the most suitable for the cultivation of the species.

Cold Urticaria. Characterizing the population from an urticaria outpatient clinic.

INTRODUCTION: Cold Urticaria (ColdU) is a type of chronic inducible urticaria (CIndU) where recurrent pruritic wheals and/or angioedema occur after exposure to cold stimulus. Although it usually only affects exposed areas, systemic reactions can occur in severe cases. In this study, we seek to characterize the ColdU cases within our Centre's population of patients. MATERIAL AND METHODS: Retrospective study based on clinical files of patients diagnosed with ColdU followed in an urticaria outpatient clinic in Portugal prior to October 2020. RESULTS: We included 52 patients total (40 women) with median age of 35 years, 19 patients with symptom onset before 18 years-old. ColdU was classified as acquired in all patients. Cold provocation tests were negative in 9 patients and these were classified as atypical ColdU. No significant differences were found between those with pediatric or adult onset of disease. Most of the patients had a localized form of the disease (52%). Despite not being statistically significant, it was found that patient's temperature threshold, assessed with TempTest® 4.0, was higher and stimulation time was shorter in more severe groups. All patients were treated with non-sedating antihistamines (daily or on-demand), finding that those controlled with standard dosages had lower temperature thresholds than those needing higher dosages (p < 0.01). One patient was under treatment with omalizumab. CONCLUSION: ColdU is an heterogenous disease that can have life-threatening event consequences. Cold provocation tests and threshold assessment can be an important tool in the management treatment and in identifying severity groups.