Fetal Megacystis in the first trimester: Comparing management and outcomes between longitudinal bladder length groups.

Fetal megacystis is a sonographic sign, defined in first trimester as a longitudinal bladder length (LBD)>7 mm. Different causes may be associated with megacystis and outcomes vary with many factors. There are no international guidelines on how to manage megacystis cases, and invasive testing is controversial when no other abnormalities are found. The main objective of this study is to compare etiologies, management and outcomes of fetuses with first trimester megacystis, specifically between groups of LBD≤15 mm and >15 mm. This is a retrospective cohort study of megacystis cases managed in a Prenatal Diagnosis Center, between January 2009 and September 2020. Descriptive and bivariate analysis were performed. We studied 43 fetuses: 67.4% with LBD≤15 mm and 32.6% with LBD>15 mm. We found an association between LBD and isolated Low Urinary Tract Obstruction (LUTO) (3.4% vs 64.3%; p<0.001) and with isolated megacystis (44.8% vs 0.0%; p = 0.001). No differences were seen regarding the presence of aneuploidies (31.0% vs 14.3%; p = 0.213). Invasive testing was performed in 93.0% of cases. Overall, we report 41.9% of live births, 39.5% of pregnancy termination and 18.6% of intrauterine fetal demise. We found a higher rate of live births in fetuses with LBD≤15 mm (55.2% vs 14.3%; p = 0.011). For a mean follow-up time of 20.6 months, we report one neonatal death and one case of renal insufficiency. In conclusion, isolated LUTO is more frequent if LBD>15 mm whereas isolated megacystis is more frequently found if LBD≤15 mm. If LBD≤15 mm, live birth rates and long-term outcomes seem to be enhanced.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil.

BACKGROUND: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. METHODS: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. RESULTS: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. CONCLUSIONS: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Spontaneous Rupture of a Choledochal Cyst.

Teaching point: Spontaneous perforation with biliary peritonitis is a rare complication of bile duct cysts which should be considered in a patient presenting with acute abdomen, ascites, and dilated biliary tree on imaging.

Laboratory-based study of drug resistance and genotypic profile of multidrug-resistant tuberculosis isolates in Salvador, Bahia, Brazil

Abstract Background: Surveillance of multidrug resistant/extensively drug-resistant tuberculosis (MDR/XDR-TB) is essential to guide disease dissemination control measures. Brazil contributes to a significant fraction of tuberculosis (TB) cases worldwide, but only few reports addressed MDR/XDR-TB in the country. Methods: This cross-sectional, laboratory-based study describes the phenotypic resistance profiles of isolates obtained between January 2008 and December 2011 in Bahia, Brazil, and sociodemographic, epidemiological, and clinical characteristics (obtained from mandatory national registries) of the corresponding 204 MDR/XDR-TB patients. We analyzed the mycobacterial spoligotyping and variable number of tandem repeats of mycobacterial interspersed repetitive units in 12-loci profiles obtained from Salvador. Results: MDR/XDR-TB patients were predominantly male, had a median age of 43 years, belonged to black ethnicity, and failed treatment before MDR-TB diagnosis. Nearly one-third of the isolates had phenotypic resistance (evaluated by mycobacteria growth indicator tube assay) to second-line anti-TB drugs (64/204, 31%), of which 22% cases (14/64) were diagnosed as XDR-TB. Death was a frequent outcome among these individuals and was associated with resistance to second-line anti-TB drugs. Most isolates successfully genotyped belonged to the Latin-American Mediterranean (LAM) Family, with an unprecedented high proportion of LAM10-Cameroon subfamily bacilli. More than half of these isolates were assigned to a unique cluster by the genotyping methods performed. Large clusters of identical genotypes were also observed among LAM SIT42 and SIT376 strains. Conclusions: We highlight the need for strengthening local and national efforts to perform early detection of TB drug resistance and to prevent treatment discontinuation to limit the emergence of drug-resistant strains.

Therapeutic effects of andiroba (Carapa guianensis Aubl) oil, compared to low power laser, on oral mucositis in children underwent chemotherapy: A clinical study.

ETHNO-PHARMACOLOGICAL RELEVANCE: The Carapa guianensis Aubl, popularly known as andiroba, is a large tree of the Meliaceae family, commonly found in the Amazon region. The oil extracted from its seeds is recognized in traditional medicine and has high anti-inflammatory and analgesic potential, which are the basic prerequisites for a therapeutic agent that can be used in the treatment of oral mucositis (OM). Moreover, the aforementioned oil has antimicrobial, antiallergic, and parasiticidal actions and is effective in the management of cutaneous and muscular dysfunctions. AIM OF THE STUDY: To evaluate the therapeutic effects of andiroba gel (Carapa guianensis Aubl) on the symptomatology and evolution of OM in children with leukemia who underwent chemotherapy and to compare it to the effects of low power laser. MATERIALS AND METHODS: This randomized, double-blind clinical trial involved 60 patients of both genders with leukemia, with age ranging from six to twelve years. The patients were divided into two study groups: the andiroba group (n = 30) and the laser group (n = 30). The level of pain experienced by the patients was assessed using the Wong-Baker visual analog scale and the degree of severity of OM was assessed using a table, recommended by the World Health Organization, that depicts the degrees of severity of OM. The data obtained were analyzed using the Mann-Whitney test, with statistical significance indicated by a P value less than or equal to 0.05. RESULTS: A statistically significant reduction in the degree of OM was observed on the fourth, fifth, and sixth days and in the pain scores on the second, third, and fourth days in the andiroba group after the manifestation of OM, compared to the laser group. CONCLUSIONS: The use of andiroba oil effectively reduced the severity of OM and relieved pain, which resulted in a decrease in the severity of signs and symptoms in the patients in the andiroba group, compared to the laser group.

Constipação intestinal em idosos e sua associação com fatores físicos, nutricionais e cognitivos / Intestinal constipation in the elderly and its association with physical, nutritional and cognitive factors

O envelhecimento humano é uma realidade cada vez mais presente na sociedade pós-moderna. Nesse processo o trato gastrointestinal sofre alterações contínuas e gradativas. O objetivo deste estudo foi de estimar a prevalência de constipação intestinal nos idosos de um município do noroeste do Paraná e identificar os fatores associados. Trata-se de um estudo descritivo transversal com 377 idosos, residentes em um município do noroeste do Paraná. Para coleta dos dados foram utilizados os Critérios de Roma III, o Mini Exame do Estado Mental, o Mini Avaliação Nutricional, o Questionário Internacional de Atividade Física e a Escala de depressão Geriátrica. Notou-se que 23,34% dos idosos apresentavam constipação intestinal e o sexo feminino, o uso de fármacos, a saúde autorreferida ruim, o mau desempenho cognitivo e o sedentarismo se associam significativamente. Conclui-se que a prevalência de constipação intestinal nos idosos é elevada.(AU)

Human aging is an increasingly present reality in postmodern society. With the aging process the gastrointestinal tract undergoes changes. The objective of this study was to estimate the prevalence of intestinal constipation in the elderly of a municipality in the northwest of Paraná and to identify the associated factors. It is a cross-sectional descriptive study with 377 elderly people, living in a municipality in the northwest of Paraná. For data collection, the Criteria of Rome III, Mini Exam of the Mental State, Mini Nutritional Assessment, International Questionnaire of Physical Activity and the Geriatric Depression Scale were used. It was observed that 23.34% of the elderly had intestinal constipation and the elderly female sex, the use of drugs, poor self-reported health, poor cognitive performance and sedentary lifestyle were significantly associated. It is concluded that the prevalence of intestinal constipation in the elderly is high.(AU)

Pelvic tuberculosis: a forgotten diagnosis - case report.

We present a case of a 14-year-old girl, Bacillus Calmette-Guérin (BCG) vaccinated, who presented with vague symptoms of abdominal pain, weight loss, and fatigue. Imaging studies revealed a pelvic mass, later found to be pelvic tuberculosis, a rare diagnosis to consider at this age. The diagnostic approach was difficult, since all investigations pointed strongly to a malignancy, from clinical, imaging (ultrasound and magnetic resonance), laboratory (elevated CA-125), and even macroscopic findings at laparotomy. Histopathology was the first hint (noncaseous granulomata), but the ultimate documentation of Mycobacterium tuberculosis relied on a persistent clinical suspicion, despite contradicting results. Surgical approach could have been mutilating, with irreversible consequences, considering it was a girl with a long reproductive life ahead. Tuberculosis is still a great masquerade, especially the extrapulmonary forms, and although infrequently seen at this age, it should thus be considered in the differential diagnosis of complex pelvic masses in order to avoid surgical iatrogeny/morbidity.

Trametes villosa Lignin Peroxidase (TvLiP): Genetic and Molecular Characterization.

White-rot basidiomycetes are the organisms that decompose lignin most efficiently, and Trametes villosa is a promising species for ligninolytic enzyme production. There are several publications on T. villosa applications for lignin degradation regarding the expression and secretion of laccase and manganese peroxidase (MnP) but no reports on the identification and characterization of lignin peroxidase (LiP), a relevant enzyme for the efficient breakdown of lignin. The object of this study was to identify and partially characterize, for the first time, gDNA, mRNA, and the corresponding lignin peroxidase (TvLiP) protein from T. villosa strain CCMB561 from the Brazilian semiarid region. The presence of ligninolytic enzymes produced by this strain grown in inducer media was qualitatively and quantitatively analyzed by spectrophotometry, qPCR, and dye fading using Remazol Brilliant Blue R. The spectrophotometric analysis showed that LiP activity was higher than that of MnP. The greatest LiP expression as measured by qPCR occurred on the 7th day, and the ABSA medium (agar, sugarcane bagasse, and ammonium sulfate) was the best that favored LiP expression. The amplification of the TvLiP gene median region covering approximately 50% of the T. versicolor LPGIV gene (87% identity); the presence of Trp199, Leu115, Asp193, Trp199, and Ala203 in the translated amplicon of the T. villosa mRNA; and the close phylogenetic relationship between TvLiP and T. versicolor LiP all indicate that the target enzyme is a lignin peroxidase. Therefore, T. villosa CCMB561 has great potential for use as a LiP, MnP, and Lac producer for industrial applications.

Frequency of acute myeloid leukemia in children attended in Belém, Pará from August 2005 to May 2009 / Frequência de leucemia mieloide aguda em crianças atendidas em Belém, Pará, no período de agosto de 2005 a maio de 2009

Introduction: Acute myeloid leukemia (AML) has variable incidence in different regions of Brazil. Objective: To determine the frequency of AML subtypes in children aged 0-17 years attended at Belém, Pará, from August 2005 to May 2009. Patients and methods: A retrospective study was performed with 278 patients diagnosed with acute or chronic leukemia based on clinical and morphological criteria (French-American-British [FAB]/World Health Organization classification [WHO]) and immunophenotyping profile by flow cytometry, to determine the frequency of the subtypes in AML. Results: We found 70 (25.18%) cases of AML, 37 of these (52.9%) were children aged 0-17 years (median age of 7 years and 8 months). There was no statistical difference in relation to gender. We observed a higher frequency of AML subtype M2 (18/37 - 48.6%) and M0/M1 (10/37 - 27%), especially in the first decade of life (16/28 [57.1%] AML M2 and 9/28 [32.1%] AML M0/M1). Conclusion: In the pediatric population, the types of AML M2, M0/M1 and M3 were respectively the most frequent. .

Introdução: A leucemia mieloide aguda (LMA) tem incidência variável nas diferentes regiões do Brasil. Objetivos: Determinar a frequência dos subtipos de LMA em crianças entre 0-17 anos, atendidas em Belém, Pará, no período de agosto de 2005 a maio de 2009. Casuística e métodos: Estudo retrospectivo com 278 pacientes com diagnóstico de leucemias agudas ou crônicas com base nos critérios clínicos, morfológicos (classificação franco-americana-britânica [FAB]/Organização Mundial da Saúde [OMS]) e de perfil imunofenotípico por citometria de fluxo para determinação da frequência de subtipos de LMA. Resultados: Foram encontrados 70 (25,18%) casos de LMA; destes, 37 (52,9%) eram crianças entre 0-17 anos (idade mediana de 7 anos e 8 meses). Não houve diferença estatística em relação ao gênero. Observou-se maior frequência de LMA dos subtipos M2 (18/37 - 48,6%) e M0/M1 (10/37 - 27%), principalmente na primeira década de vida (16/28 [57,1%] LMA M2 e 9/28 [32,1%] LMA M0/M1). Conclusão: Na população pediátrica, os tipos de LMA M2, M0/M1 e M3 foram, respectivamente, as mais frequentes. .

Improving the Manchester Triage System for pediatric emergency care: an international multicenter study.

OBJECTIVES: This multicenter study examines the performance of the Manchester Triage System (MTS) after changing discriminators, and with the addition use of abnormal vital sign in patients presenting to pediatric emergency departments (EDs). DESIGN: International multicenter study. SETTINGS: EDs of two hospitals in The Netherlands (2006-2009), one in Portugal (November-December 2010), and one in UK (June-November 2010). PATIENTS: Children (<16 years) triaged with the MTS who presented at the ED. METHODS: Changes to discriminators (MTS 1) and the value of including abnormal vital signs (MTS 2) were studied to test if this would decrease the number of incorrect assignment. Admission to hospital using the new MTS was compared with those in the original MTS. Likelihood ratios, diagnostic odds ratios (DORs), and c-statistics were calculated as measures for performance and compared with the original MTS. To calculate likelihood ratios and DORs, the MTS had to be dichotomized in low urgent and high urgent. RESULTS: 60,375 patients were included, of whom 13% were admitted. When MTS 1 was used, admission to hospital increased from 25% to 29% for MTS 'very urgent' patients and remained similar in lower MTS urgency levels. The diagnostic odds ratio improved from 4.8 (95%CI 4.5-5.1) to 6.2 (95%CI 5.9-6.6) and the c-statistic remained 0.74. MTS 2 did not improve the performance of the MTS. CONCLUSIONS: MTS 1 performed slightly better than the original MTS. The use of vital signs (MTS 2) did not improve the MTS performance.

MR imaging of the pediatric liver.

Applications of MR imaging of the pediatric abdomen are expanding rapidly. New techniques of MR imaging, such as MRA or MRCP, are becoming commonplace. MR imaging is particularly helpful in the diagnosis and characterization of liver and biliary tree disease in children. Consistent and reproducible quality imaging is achieved with faster imaging sequences tailored to reduce motion artifacts. The lack of radiation, the ability to directly acquire multiple imaging planes, and the superior contrast resolution, particularly with the administration of gadolinium, have contributed to the acceptance of MR imaging as an invaluable tool in the pediatric age group.