Postoperative Antibiotic Prophylaxis in Reduction Mammaplasty: A Randomized Controlled Trial.

BACKGROUND: Reduction mammaplasty is a well-established procedure. Studies have shown benefits of using antibiotics in this procedure. Nevertheless, there is no solid evidence to support postoperative antibiotic prophylaxis. The authors evaluated the influence of postoperative antibiotic delivery on infection rates after reduction mammaplasty. METHODS: The authors conducted a randomized trial of noninferiority, with two parallel groups, with triple blinding. The participants were 124 women with breast hypertrophy, with reduction mammaplasty already scheduled, selected consecutively. All patients underwent reduction mammaplasty, performed by the same surgical team, using the superomedial pedicle technique for ascending the nipple-areola complex. All patients received cephalothin (1 g) intravenously at the anesthetic induction and every 6 hours for 24 hours. At hospital discharge, they were assigned randomly to either the placebo (n = 62) or antibiotic group (n = 62) and were instructed to take identical capsules containing 500 mg of cephalexin or placebo, respectively, every 6 hours, for 7 days. Patients were assessed weekly, for 4 weeks, regarding the occurrence of surgical-site infection, by a surgeon who was unaware of the allocation. The criteria and definitions of the Centers for Disease Control and Prevention were adopted. RESULTS: There was no statistical difference between groups regarding age, body mass index, or resected breast tissue weight. The overall surgical-site infection rate was 0.81 percent. Only one patient, allocated to the antibiotic, presented infection, classified as superficial incisional (p = 1.00). In the placebo group, surgery time was higher (p = 0.003). CONCLUSION: The maintenance of antibiotics in the postoperative period of reduction mammaplasty did not influence the rates of surgical-site infection. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, I.

Tap water versus sterile saline solution in the colonisation of skin wounds.

Irrigating wounds with tap water does not increase colonisation, but controlled studies are required for further evidence. Microbial colonisation was assessed in skin wounds, before and after irrigation with tap water, and was compared with irrigation using 0·9% sodium chloride sterile solution. The study included 120 subjects with chronic, traumatic, vascular, pressure or neuropathic wounds. A total of 60 wounds were randomly assigned to be irrigated with tap water (tap water group) and another 60 to be irrigated with 0·9% sodium chloride sterile solution (saline group), at a pressure of 0·46-0·54 PSI. Samples were collected from the centre of each wound using Levine's technique, before and after irrigation, and cultivated in thioglycollate, hypertonic mannitol agar, eosin methylene blue (EMB) agar, blood agar and Sabouraud agar at 37°C for 72 hours. There was concordance (kappa test) and discordance (McNemar test) regarding the count of positive and/or negative samples before and after irrigation in each group. The proportion of reduction of positive samples was similar for both groups in all cultures. Colony-forming unit count before and after irrigation was similar in both groups and in all cultures, except for the culture in hypertonic mannitol agar from the tap water group, for which the count was lower after irrigation (Wilcoxon z = 2·05, P = 0·041). It is concluded that skin wound irrigation with tap water leads to further reduction of Gram-positive bacteria compared with 0·9% sodium chloride sterile solution, with no difference in colonisation of haemolytic bacteria, Gram-negative bacteria and fungi.

Sensitivity of the Nipple-Areola Complex and Sexual Function Following Reduction Mammaplasty.

BACKGROUND: The sensitivity of the nipple-areola complex (NAC) is very relevant to female sexuality. OBJECTIVE: To evaluate NAC sensitivity and sexual function after breast reduction, and to assess whether altered NAC sensitivity is related to sexual dysfunction. METHODS: The study included 80 patients, who were allocated to a control group with eutrophic breasts (CG, n = 20), a hypertrophy group without surgery (HG, n = 20), or a mammaplasty group (MG, n = 40). The MG was assessed preoperatively and 6 months postoperatively. The HG and CG were evaluated once. NAC sensitivity was assessed for touch, temperature, vibration, and pressure in four areola quadrants and the nipple. Sexual function was assessed with the Brazilian version of the Female Sexual Function Index, which has six domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) and a total score that indicates the presence or absence of sexual dysfunction. RESULTS: Compared to the CG, the MG had worse sensitivity to temperature and pressure in the nipple and areola medial quadrants postoperatively (P < 0.01). Compared to their preoperative assessment, the MG had reduced temperature and pressure sensitivity in the nipple and areola medial quadrants postoperatively (P < 0.05). Compared to the CG and HG, patients in the MG had higher postoperative scores of excitation (P = 0.0001), lubrication (P = 0.0004), orgasm (P < 0.0001), and satisfaction (P < 0.0001). There was an association between sexual dysfunction and low NAC sensitivity to temperature and vibration (P ≤ 0.041) in the MG's preoperative and postoperative scores, and to touch, temperature, and pressure across all three groups. CONCLUSIONS: Breast reduction with a superomedial pedicle reduced NAC sensitivity but did not interfere with sexual function.

A pilot study assessing the effect of prolonged administration of high daily doses of vitamin D on the clinical course of vitiligo and psoriasis.

Autoimmunity has been associated with vitamin D deficiency and resistance, with gene polymorphisms related to vitamin D metabolism frequently described in affected patients. High doses of vitamin D3 may conceivably compensate for inherited resistance to its biological effects. This study aimed to assess the efficacy and safety of prolonged high-dose vitamin D3 treatment of patients with psoriasis and vitiligo. Nine patients with psoriasis and 16 patients with vitiligo received vitamin D3 35,000 IU once daily for six months in association with a low-calcium diet (avoiding dairy products and calcium-enriched foods like oat, rice or soya "milk") and hydration (minimum 2.5 L daily). All psoriasis patients were scored according to "Psoriasis Area and Severity Index" (PASI) at baseline and after treatment. Evaluation of clinical response of vitiligo patients required a quartile grading scale. All patients presented low vitamin D status (serum 25(OH)D3 ≤ 30 ng/mL) at baseline. After treatment 25(OH)D3 levels significantly increased (from 14.9 ± 7.4 to 106.3 ± 31.9 ng/mL and from 18.4 ± 8.9 to 132.5 ± 37.0 ng/mL) and PTH levels significantly decreased (from 57.8 ± 16.7 to 28.9 ± 8.2 pg/mL and from 55.3 ± 25.0 to 25.4 ± 10.7 pg/mL) in patients with psoriasis and vitiligo respectively. PTH and 25(OH)D3 serum concentrations correlated inversely. The PASI score significantly improved in all nine patients with psoriasis. Fourteen of 16 patients with vitiligo had 25-75% repigmentation. Serum urea, creatinine and calcium (total and ionized) did not change and urinary calcium excretion increased within the normal range. High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.

A prospective study of nutrition education and oral nutritional supplementation in patients with Alzheimer's disease.

BACKGROUND: Weight loss in patients with Alzheimer's disease (AD) is a common clinical manifestation that may have clinical significance. OBJECTIVES: To evaluate if there is a difference between nutrition education and oral nutritional supplementation on nutritional status in patients with AD. METHODS: A randomized, prospective 6-month study which enrolled 90 subjects with probable AD aged 65 years or older divided into 3 groups: Control Group (CG) [n = 27], Education Group (EG) [n = 25], which participated in an education program and Supplementation Group (SG) [n = 26], which received two daily servings of oral nutritional supplementation. Subjects were assessed for anthropometric data (weight, height, BMI, TSF, AC and AMC), biochemical data (total protein, albumin, and total lymphocyte count), CDR (Clinical Dementia Rating), MMSE (Mini-mental state examination), as well as dependence during meals. RESULTS: The SG showed a significant improvement in the following anthropometric measurements: weight (H calc = 22.12, p =< 0.001), BMI (H calc = 22.12, p =< 0.001), AC (H calc = 12.99, p =< 0.002), and AMC (H calc = 8.67, p =< 0.013) compared to the CG and EG. BMI of the EG was significantly greater compared to the CG. There were significant changes in total protein (H calc = 6.17, p =< 0.046), and total lymphocyte count in the SG compared to the other groups (H cal = 7.94, p = 0.019). CONCLUSION: Oral nutritional supplementation is more effective compared to nutrition education in improving nutritional status.

Glycosaminoglycans of abdominal skin after massive weight loss in post-bariatric female patients.

BACKGROUND: The number of post-bariatric patients had a significant increase over the last years, and a better understanding of the consequences of massive weight loss on skin is imperative. Despite weight-loss-related changes in collagen and elastin have been reported, less is known about changes in another of the matrix components of the skin, the glycosaminoglycans. The objective of this study is to evaluate abdominal skin glycosaminoglycans concentrations and perlecan and collagen III expression in post-bariatric female patients. METHODS: Skin tissue samples from the abdomen of lean (n = 19) and post-bariatric (n = 24) female patients were compared. Sulfated glycosaminoglycans and hyaluronic acid were extracted, characterized and quantified. Perlecan and collagen III expression was assessed by immunofluorescence. RESULTS: The major glycosaminoglycans found were dermatan sultafe and hyaluronic acid; the others were found in smaller amounts. The skin of the post-bariatric patients had lower concentrations of heparan sulfate (p = 0.002) while hyaluronic acid, dermatan sulfate, and chondroitin sulfate concentrations were similar to the lean women's skin. Post-bariatric skin showed decreased expression of perlecan and increased expression of collagen III. No correlation was found among glycosaminoglycans concentrations and age, body mass index, frequency of pregnancies, or skin types, but it was observed in higher skin heparan sulfate concentrations in post-bariatric patients who had their weights stabilized for over than 24 months (p = 0.000). CONCLUSION: Abdominal skin of post-bariatric women presented decreased heparan sulfate concentrations and perlecan expression and increased expression of collagen III.

The role of antibiotics in reduction mammaplasty.

This prospective study was conducted to assess the influence of antibiotics use on surgical site infections (SSI) rates after reduction mammaplasty. Patients undergoing reduction mammaplasty were assigned to group 1 (n = 50), which received intravenous cephalotin pre- and postoperatively, besides oral cephalexin for 6 days after discharge, or to group 2 (n = 50), which received no antibiotics. Patients were followed up weekly for 30 days, regarding to SSI, by a blinded surgeon. The Centers for Disease Control and Prevention definitions and classification of SSI were adopted. There was no statistical difference between the groups in regard to age, body mass index, duration of operation, and total resection weight. SSI rates were 2% and 14% in groups 1 and 2, respectively (P = 0.03). In group 2, older patients and those with higher resection weight had significant higher SSI rates (P = 0.02 and P = 0.04, respectively). We observed that antibiotics use decreased SSI rates after reduction mammaplasty.

Quality-of-life and self-esteem outcomes after oncoplastic breast-conserving surgery.

BACKGROUND: This prospective trial was designed to assess the impact of oncoplastic surgery on quality of life and self-esteem of breast cancer patients undergoing breast-conserving treatment. METHODS: Forty-five patients with primary breast cancer to be treated with breast-conserving surgery and immediate partial breast reconstruction were assessed with regard to quality-of-life and self-esteem outcomes preoperatively and 6 and 12 months postoperatively. Another 42 breast cancer patients, treated by conservative surgery without breast reconstruction at least 1 year previously, were assessed for the control group. Validated questionnaires (Short Form-36, Brazilian version, and the Rosenberg-EPM Self-Esteem Scale) were used. Data were analyzed by using the Mann-Whitney and Friedman tests. RESULTS: Participation rates at the follow-up assessments were 95.5 percent at the 6-month follow-up and 88.9 percent at the 12-month follow-up. Control and reconstruction groups were matched for age, body mass index, and demographic and oncologic aspects. At postoperative month 12, the breast reconstruction group had significantly better health status than the control group with regard to physical functioning (p < 0.000), health perception (p < 0.002), vitality (p < 0.007), social functioning (p < 0.02), role emotional (p < 0.02), mental health (p < 0.000), and self-esteem (p < 0.02). Compared with preoperatively, breast reconstruction group scores were significantly higher at 12 months postoperatively for seven of the eight dimensions of the Short Form-36: physical functioning (p < 0.01), role physical (p < 0.02), health perception (p < 0.02), vitality (p < 0.01), social functioning (p < 0.02), role emotional (p < 0.05), and mental health (p < 0.02). Self-esteem was also significantly better at 12 months (p < 0.02). CONCLUSION: Oncoplastic surgery had a positive impact on quality of life and self-esteem of patients undergoing breast-conserving treatment.

Matricectomia da unha encravada do hálux: estudo imuno-histoquímico da matriz retirada / Matricectomy of the hallux's ingrowing nail: immunohistochemical study of the removed matrix

Introdução: A extensão lateral da matriz germinal da unha não é demonstrada na literatura. Objetivo: Identificar os limites laterais da matriz ungueal. Material e métodos: Avaliamos a área de proliferação da extensão lateral da matriz ungueal em amostras cirúrgicas resultantes da matricectomia para tratamento da unha encravada do hálux com o marcador immuno-histoquímico Ki-67. Obtivemos 21 amostras e observamos a epiderme, as regiões ventral e dorsal da matriz, bem como as matrizes ventral e dorsal do ângulo lateral/medial. Resultados: O teste de comparação múltipla demonstrou que o número de células na matriz ventral é maior que o número encontrado na pele, na matriz dorsal, no ângulo da matriz dorsal e no ângulo da matriz ventral. O número de células na pele e no ângulo da matriz ventral é maior que o número encontrado no ângulo da matriz dorsal. Conclusão: O limite lateral da matriz ungueal possui atividades proliferativas. A cirurgia realizada sem remoção completa da região proliferativa lateral/medial da matriz ungueal pode infl uenciar a taxa de recorrência de matricectomias. Palavras-chave: hálux, unha, imuno-histoquímica, procedimento cirúrgico ambulatorial.

Introduction: The lateral extent of the germinal matrix area of the nail is not demonstrated in the literature. Objective: To identify the lateral limits of the ungueal matrix. Methods: We evaluated the proliferation area of the lateral extent of the nail matrix on surgical samples resulting from the technique of canthotomy for the treatment of ingrowing toenail of the hallux with the Ki-67 immunohistochemical marker. We obtained 21 samples and observed the epidermis, ventral and dorsal region of the matrix, as well as ventral and dorsal matrix of the lateral/medial angle. Results: The test of multiple comparisons demonstrated that the number of cells in the ventral matrix is higher than the number found in the skin, in the dorsal matrix, in the angle of the dorsal matrix and in the angle of the ventral matrix. The number of cells in the skin and in the angle of the ventral matrix is higher than the number found in the angle of the dorsal matrix. Conclusion: The lateral limit of the ungueal matrix has proliferation activities. The surgery performed without the complete removal of the lateral/medial proliferation region of the nail matrix may infl uence the recurrence rate of matricectomies.

Comparative study of the changes in partial pressure of plasma carbon dioxide during carbon dioxide insufflation into the intraperitoneal and preperitoneal spaces.

BACKGROUND: We aimed to compare plasma concentrations of carbon dioxide (CO(2)) in dogs that underwent intra- and preperitoneal CO(2) insufflation. MATERIALS AND METHODS: Thirty dogs were studied. Ten formed a control group, 10 underwent intraperitoneal CO(2) insufflation, and 10 underwent preperitoneal CO(2) insufflation. General anesthesia with controlled ventilation was standardized for all dogs. After stabilizing the anesthesia, blood samples were collected at predetermined times and were sent for immediate gasometric analysis. Analysis of variance was used for comparing variables. RESULTS: The plasma CO(2) concentration in the intraperitoneal insufflation group increased significantly more than in the preperitoneal insufflation group and was significantly greater than in the control group (P < 0.05). The pH values in the intraperitoneal group were lower than in the preperitoneal group (P < 0.05). CONCLUSION: The data from this study suggest that a greater plasma concentration of CO(2) is achieved by insufflation at constant pressure into the intraperitoneal space than into the preperitoneal space.

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil / Atitudes alimentares e imagem corporal em meninas adolescentes de ascendência nipônica e caucasiana em São Paulo (SP)

OBJETIVO: Há muita controvérsia nos estudos que analisam a relação entre etnia e transtornos alimentares a despeito do rápido aumento desses distúrbios em diversos grupos étnicos. O objetivo do presente estudo foi verificar as atitudes alimentares em adolescentes de ascendência nipônica e caucasiana no Brasil. A influência do índice de massa corporal (IMC), da menarca e das relações socioafetivas no desenvolvimento dos transtornos alimentares também foi discutida. MÉTODOS: Questionários sobre atitudes alimentares e influências socioafetivas foram aplicados a 544 adolescentes de origem nipo-brasileira e caucasiana: adolescentes pré-menarca de 10 e 11 anos nipo-brasileiras (n = 122) e caucasianas (n = 176) e adolescentes pós-menarca de 16 e 17 anos nipo-brasileiras (n = 71) e caucasianas (n = 175). RESULTADOS: Adolescentes caucasianas apresentaram maiores escores no Teste de Atitudes Alimentares (EAT-26), mostraram maior insatisfação com suas imagens corporais, faziam mais dieta e tinham mais modelos de dietas representados pelas mães e pares do que as adolescentes nipo-brasileiras. CONCLUSÃO: As adolescentes caucasianas, de um modo geral, parecem sentir mais as pressões culturais e estéticas sobre a imagem corporal do que as nipônicas. A frequência alta de meninas caucasianas pré-menarca com escore acima de 20 no EAT-26 mostra que a preocupação com a imagem corporal vem ocorrendo cada vez mais cedo. A análise de regressão múltipla revelou muitas associações entre a interação das adolescentes com suas mães e o desenvolvimento de atitudes alimentares inadequadas.

OBJECTIVE: Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed. METHODS: Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents. RESULTS: Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION: The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Eating attitudes and body image in ethnic Japanese and Caucasian adolescent girls in the city of São Paulo, Brazil.

OBJECTIVE: Despite investigations into the rapid increase in eating disorders across diverse ethnic groups, conclusions concerning ethnicity and eating disorders are contradictory. The objective of the present study was to investigate eating attitudes in ethnic Japanese and Caucasian adolescents in Brazil. The influence of body mass index (BMI), menarche and social-affective relationships on the development of eating disorders was also assessed. METHODS: Questionnaires evaluating the incidence of eating disorders and the influence of social-affective relationships were applied to 544 Japanese-Brazilian and Caucasian adolescent girls: 10 to 11-year-old Japanese-Brazilian (n = 122) and Caucasian (n = 176) pre-menarcheal adolescents, and 16 to 17-year-old Japanese-Brazilian (n = 71) and Caucasian (n = 175) post-menarcheal adolescents. RESULTS: Caucasian girls obtained higher scores on the Eating Attitudes Test (EAT-26), showed greater body image dissatisfaction, dieted more often and had more diet models introduced by their mothers and peers than the Japanese-Brazilian girls. CONCLUSION The Caucasian adolescents overall appeared to be more sensitive to aesthetic and social pressures regarding body image than the Japanese adolescents. The high incidence of EAT-26 scores above 20 in the Caucasian pre-menarcheal group indicates that individual body image concerns are developing at an earlier age. Multiple logistic regression revealed several associations between mother-teen interactions and the development of abnormal eating attitudes.

Anthropometry and body composition in ethnic Japanese and Caucasian adolescent boys.

BACKGROUND: The effect of environmental conditions on development, including growth, maturation and the fulfillment of genetic potential, can be identified through the study of the variations found among different ethnic groups in the same population. The objectives of the present study were: (i) to compare the various anthropometric and body composition parameters based on ethnicity and maturation stage in 31 Japanese and 99 Caucasian prepubescent boys and 50 Japanese and 98 Caucasian post-pubescent boys; and (ii) to assess body mass index (BMI) and its relationship with other methods of body fat evaluation. METHODS: The percentage of body fat was measured using bioelectrical impedance, near-infrared interactance and Slaughter cutaneous skinfold equations. RESULTS: Weight and height were statistically lower for the Japanese than the Caucasian subjects. There were no differences in body fat between the ethnic groups, but the Japanese subjects had statistically lower levels of fat-free mass. The gain in fat-free mass and the loss in body fat when attaining maturation were greater in the Caucasian subjects. The agreement of BMI with other methods was good in all of the groups but lower for the Japanese than for the Caucasian subjects. CONCLUSION: Height and weight differences between the ethnic groups indicated distinct genetic potential ranges. The body fat mass did not differ between the ethnic groups, but the degree of changes when attaining maturation in the Caucasian subjects was greater. If this difference were to be maintained between the groups then years later there would be a greater accumulation of fat in the Japanese subjects.

Resistência à insulina com a suplementação de creatina em animais de experimentação / Resistencia a la insulina con la suplementación de creatina en animales de experimentación / Insulin resistance with creatine supplementation in laboratory animals

INTRODUÇÃO E OBJETIVO: A suplementação de creatina tem sido usada para melhorar o desempenho muscular. Esta afeta o metabolismo da glicose e estimula a secreção de insulina in vitro e in vivo. No entanto, a hipersecreção de insulina em longo prazo pode induzir também resistência à insulina. O presente trabalho analisou os efeitos da suplementação oral de creatina para avaliar a possibilidade da ocorrência de resistência à insulina in vivo. MÉTODOS: Quarenta e oito ratos Wistar (24 fêmeas/24 machos) foram divididos em dois grupos de 24 (controle e estudo) e subdivididos em seis grupos de oito. Por quatro semanas, foram alimentados com ração padrão, tendo livre acesso a água. Além disso, o grupo de estudo recebeu dieta suplementar de creatina (0,4g de creatina para 30mL de água por rato/dia). Nos 7°, 14°, 21° e 28° dias do experimento, 12 ratos foram anestesiados (tiopental sódico 0,15mL/100g), após jejum de seis horas, sendo submetidos ao teste intravenoso de tolerância à insulina (0,5mL de uma solução de 30 por cento de insulina humana regular e 70 por cento de salina). As amostras de sangue foram coletadas das veias dos rabos dos ratos, nos tempos basal, três, seis, nove, 12 e 15 minutos após a administração da insulina. A mensuração da glicose foi feita pelo método da glicose-oxidase. O trabalho foi previamente aprovado pelo Comitê de Ética em Pesquisa do CCMB- PUCSP. RESULTADOS: A média da constante de decaimento da glicose (K ITT) foi calculada pela fórmula 0,693/T1/2. O grupo de estudo, quando comparado com o grupo controle, apresentou resistência insulínica no 21° dia (p < 0,0004) e 28° dia (p < 0,0001). CONCLUSÃO: Este trabalho mostra que a suplementação prolongada de creatina pode levar à resistência à insulina e que deveria ser usada com cautela em indivíduos com distúrbios do metabolismo da glicose.

INTRODUCTION AND OBJECTIVE: Creatine supplementation has been used in order to improve muscular performance. This substance affects glucose metabolism and stimulates the in vitro as well as the in vivo insulin secretion. Nevertheless, long-term insulin hypersecretion may also induce insulin resistance. The present work analyzed the effects of creatine oral supplementation in order to evaluate the possibility of occurrence of resistance to in vivo insulin. METHODS: Forty-eight Wistar rats (24 female/24 male) were divided in two groups of 24 (control and study) and subdivided in six groups of eight. They were fed with standard food during four weeks, having water ad libitum. Moreover, the study group received dietetic supplement of creatine (0.4 g creatine for 30 ml of water per rat/day). In the 7th, 14th, 21st and 28th day of the experiment, 12 rats were anesthetized (sodium thiopental 0.15 mL/100 g) after six hour-fasting, being submitted to intravenous insulin tolerance test (0.5 mL of 30 percent regular human insulin and 70 percent saline solution). The blood samples were collected from the tail veins of the rats, in the basal, three, six, nine, 12 and 15 minutes after insulin administration times. The glucose measurement was performed through the glucose oxidase method. The study was previously approved by the Research Ethics Committee of CCMB- PUC-SP. RESULTS: The mean of the glucose decrease constant (K ITT) was calculated through the formula 0.693/T1/2. The study group, when compared with the control group, presented insulin resistance at day 21 (p < 0.0004) and day 28 (p < 0.0001). CONCLUSION: This study shows that extended creatine supplementation may lead to insulin resistance. Besides that, it should be carefully used in individuals with glucose metabolism disturbances.

INTRODUCCION Y OBJETIVO: La suplementación con creatina viene siendo usada para mejorar el desempeño muscular. Esta afecta el metabolismo de la glucose y estimula la secreción de insulina in vitro e in vivo. Entretanto, la hipersecreción de insulina a largo plazo puede inducir tambien resistencia a la insulina. El presente trabajo analizó los efectos de la suplementación oral de creatina para evaluar la posibilidad de la ocurrencia de resistencia a la insulina in vivo. MÉTODOS: Cuarenta y ocho ratones Wistar (24 hembras/24 machos) fueron divididos en dos grupos de 24 (control y estudio) y subdivididos en seis grupos de ocho. Por cuatro semanas, fueron alimentados con ración padrón, teniendo libre acceso al agua. Además de eso, el grupo estudio recibió dieta suplementaria de creatina (0,4 g de creatina para 30 mL de água por ratón/día). En los días 7, 14, 21 e 28 del experimento, 12 ratones fueron anestesiados (tiopental sódico 0,15 mL/100 g), despues de seis horas de ayuno, y sometidos a un test intravenoso de tolerancia a la insulina (0,5 ml de una solución de 30 por ciento de insulina humana regular y 70 por ciento de salina). Las muestras de sangre fueron colectadas de las venas de los rabos de los ratones, en los tiempos basal, tres, seis, nueve, 12 y 15 minutos trás la administración de insulina. La medida de la glucosa fué hecha por el método de la glucosa oxidasa. El trabajo fué previamente aprobado por lo Comité de Ética en Investigación del CCMB-PUCSP. RESULTADOS: La media constante de descenso de la glucosa (K ITT) fué calculada por la fórmula 0,693/T1/2. El grupo de estudio cuando fué comparado con el grupo control presentó resistencia insulínica en el día 21 (p < 0,0004) y en el dia 28 (p < 0,0001). CONCLUSION: Este trabajo muestra que la suplementación prolongada con creatina puede llevar a resistencia a la insulina y que debería ser usada con cautela en individuos con disturbios del metabolismo de la glucose.

Gravidez na adolescência: resultados obstétricos e neonatais / Adolescent pregnancy: obstetric and neonatal outcomes

OBJETIVO: Verificar se houve diferenças nos resultados obstétricos e neonatais de três grupos de gestantes adolescentes atendidas em Hospital Assistencial na Região Sul de São Paulo. MATERIAL E MÉTODOS: Foram estudados, retrospectivamente, os resultados obstétricos e neonatais de gestantes assim divididas: Grupo I: 10 gestantes de 13 a 15 anos incompletos; Grupo II: 80 gestantes de 15 a 17 anos incompletos; Grupo III: 256 gestantes de 17 a 20 anos incompletos. RESULTADOS: Não foram encontradas diferenças significantes nos resultados entre os grupos estudados. CONCLUSÕES: Nossos resultados sugerem que os malefícios advindos da gestação na adolescência parecem ser principalmente de ordem psíquica e social; do ponto de vista biológico, não parece haver diferenças significantes nos resultados obstétricos e neonatais

[Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease]. / Perfil lipídico e efeitos da orientação nutricional em adolescentes com história familiar de doença arterial coronariana prematura.

OBJECTIVE: To assess lipid profile and nutritional parameters from adolescents with family history of premature coronary artery disease (CAD) and assess the effects of nutritional counseling. METHODS: The study included 48 adolescents of both gender and with ages ranging from 10 and 19 years old (case group, n=18; control group, n=30). RESULTS: Offspring of young individuals with coronary artery disease showed higher values of total cholesterol (189 +/- 30 vs. 167 +/- 26 mg/dl, p < 0.01), LDL-C (144 +/- 20 vs. 100 +/- 27 mg/dl, p < 0.001) and apoB (80 +/- 15 vs. 61 +/- 18 mg/dl, p = 0.001) and lower values of HDL-C (45 +/- 9 vs. 51 +/- 13 mg/dl, p < 0.02) than control young individuals. Differences were not found for triglycerides and apoA-I. With a dietotherapeutic counseling, we obtained a reduction in alimentary consumption of saturated fatty acids (pre: 15.5 +/- 4.7% vs. post: 6.6 +/- 3.7%, p = 0.003) and an improvement in lipid profile: TC (-8%, p = 0.033), LDL-C (-18.2%, p = 0.001), TG (-53%, p = 0.002) rates in offspring of premature CAD patients who showed hyperlipidemia. CONCLUSION: The presence of dyslipidemia was more prevalent among offspring adolescents of premature CAD patients, but it was responsive to nutritional intervention.

Perfil lipídico e efeitos da orientação nutricional em adolescentes com história familiar de doença arterial coronariana prematura / Lipid profile and nutrition counseling effects in adolescents with family history of premature coronary artery disease

OBJETIVO: Examinar o perfil lipídico e parâmetros nutricionais de adolescentes com história familiar de doença arterial coronariana (DAC) prematura e avaliar os efeitos da orientação nutricional. MÉTODOS: O estudo incluiu 48 adolescentes de ambos os sexos e idades entre 10 e 19 anos (grupo caso, n=18; grupo controle, n=30). RESULTADOS: Os filhos de coronarianos jovens apresentaram valores mais elevados de colesterol total (189 ± 30 vs. 167 ± 26 mg/dl, p<0,01), LDL-C (144 ± 20 vs. 100 ± 27 mg/dl, p<0,001) e Apo B (80 ± 15 vs. 61 ± 18 mg/dl, p=0,001) e valores mais baixos de HDL-C (45 ± 9 vs. 51 ± 13 mg/dl, p<0,02) que os jovens controles. Não se observaram diferenças para os triglicérides e Apo A-I. Com a orientação dietoterápica obteve-se redução no consumo alimentar de ácidos graxos saturados (pré: 15,5 ± 4,7 por cento vs. pós: 6,6 ± 3,7 por cento, p=0,003) e melhora no perfil lipídico: CT (-8 por cento, p=0,033), LDL-C (-18,2 por cento, p=0,001), TG (-53 por cento, p=0,002) nos filhos de pacientes com DAC prematura que apresentavam hiperlipidemia. CONCLUSÃO: A presença de dislipidemia foi mais prevalente em adolescentes filhos de portadores de DAC prematura, mas foi responsiva à intervenção nutricional.

Relationship between the diameter of great saphenous vein and body mass index

OBJECTIVE: This study has been designed to correlate the diameter of the greater saphenous vein in different levels of the lower limbs with the body mass index of each individual to determine a possible relation between them. METHODS: Fifty-two lower limbs in 26 volunteers (six males and 20 females) without a chronic venous disease record, aged 21-68 were evaluated. Prior to color-flow duplex scanning the body mass index was defined. The deep and superficial venous systems and perforator veins were assessed as described in the literature. The diameter of the greater saphenous vein was measured with ultrasound longitudinal imaging in seven different levels. For the statistical analysis, Student t test for paired data and Spearman test were used. RESULTS: The difference observed in saphenous venous in the second and third levels when compared to the lower right and left limbs was not considered significant and a single group was formed to correlate with body mass index. The correlation was considered statistically irrelevant. CONCLUSION: By correlating the diameters of the greater saphenous vein with the body mass index of each individual it was noted that the relation between them is not significant, therefore it can be assumed that tall thin individuals can have greater saphenous vein with similar diameter as short fat individuals.

OBJETIVO: Este estudo teve o objetivo de comparar o diâmetro da veia safena magna em diferentes níveis dos membros inferiores e o índice de massa corporal dos sujeitos para determinar uma possível relação entre esses fatores. MÉTODOS: Cinqüenta e dois membros inferiores de 26 voluntários (seis homens e 20 mulheres) sem registro de doença venosa crônica, com idades entre 21 e 68 anos, foram avaliados. O índice de massa corporal foi definido antes do eco-Doppler colorido. Os sistemas venosos superficial e profundo e as veias perfurantes foram avaliados de acordo com a literatura. O diâmetro da veia safena magna foi medido através de imagem ultra-sonográfica longitudinal em sete níveis diferentes. Para a análise estatística, foram utilizados o teste t de Student para dados pareados e o teste de Spearman. RESULTADOS: A diferença observada na veia safena no segundo e terceiro níveis, quando comparada aos membros inferiores direito e esquerdo, não foi considerada significativa, e somente um grupo foi formado para a comparação com o índice de massa corporal. A correlação foi considerada estatisticamente irrelevante. CONCLUSÃO: Através da comparação dos diâmetros da veia safena magna com o índice de massa corporal dos sujeitos, percebeu-se que a relação entre esses dois fatores não é significativa e, portanto, pode-se concluir que indivíduos altos e magros podem ter veias safenas magnas com diâmetros similares aos de indivíduos baixos e gordos.

[Clinical-epidemiological study of toxocariasis in a pediatric population]. / Estudo clínico-epidemiológico da toxocaríase em população infantil.

OBJECTIVE: The variety of toxocariasis clinic manifestations and its relationship with asthma motivated this study. The aim was to study T.canis seropositivity at a public pediatric service and its association with laboratory, epidemiological and clinical factors. METHODS: This study was cross-sectional and controlled. Two hundred and eight children, from 1 to 14 years old and treated at the University of Santo Amaro Pediatric Department s Immunology and Pneumology clinic between January 2000 and January 2001, underwent serology testing. Antibodies were detected by ELISA testing for the larval excretory-secretory antigen of T. canis. We used the chi-square test for T.canis seropositivity (titers > or = 1:320) associations with: puppies at home, contact with soil, geophagia, onicophagia, mother's educational level, asthma, chronic cough, repetitive pneumonia, skin manifestations, rhinitis, hepatomegaly, splenomegaly, abdominal pain, anemia, eosinophilia, immunoglobulins, parasitosis and stunted growth. The Kruskal-Wallis variance analysis method was used for mean comparisons between seropositive and seronegative groups. Significance was set at p < or = 0.05. RESULTS: Seroprevalence was 54.8%, with a mean age of 6.5 years while for seronegative children the mean age was 5.8 years, showing no significant difference. There was also no difference between sexes. Seropositivity was significantly associated with puppies at home, contact with soil, hepatomegaly, asthma, eosinophilia, increased serum immunoglobulin (Ig) E levels and stunted growth. CONCLUSION: Seroprevalence was elevated in this study . T.canis infection must be considered in at-risk children, such as those with puppies at home, who have had contact with soil, who have hepatomegaly and/or asthma with eosinophilia and increased serum IgE.

Estudo clínico-epidemiológico da toxocaríase em população infantil / Clinical-epidemiological study of toxocariasis in a pediatric population

OBJETIVO: A diversidade de manifestações clínicas da toxocaríase e sua relação com asma motivaram este estudo, cujo objetivo foi estudar a soropositividade de T. canis nas crianças atendidas no serviço público de saúde e sua associação com variáveis clínicas, epidemiológicas e laboratoriais. MÉTODOS: Este estudo é de corte transversal e controlado. Foram realizadas sorologias em 208 crianças de 1 a 14 anos de idade, atendidas nos ambulatórios de Pediatria, Imunologia e Pneumologia Pediátrica da Universidade de Santo Amaro, no período de janeiro de 2000 a janeiro de 2001. Os anticorpos foram detectados por ELISA usando-se antígeno de excreção e secreção do T. canis.. Foi utilizado teste qui-quadrado para associações da soropositividade para T. canis (título > 1:320) com cães filhotes domiciliares, contato com terra, geofagia, onicofagia, escolaridade materna, asma, tosse crônica, pneumonias de repetição, manifestações cutâneas, rinite, hepatomegalia, esplenomegalia, dor abdominal, anemia, eosinofilia, imunoglobulinas, parasitoses e desnutrição, e método de análise de variância por postos de Kruskal-Wallis para comparação média dos soropositivos e soronegativos, sendo significante p < 0,05. RESULTADOS: A soroprevalência foi 54,8 por cento, com média etária de 6,5 anos; nos soronegativos, 5,8 anos (não significante), também não houve diferença quanto ao sexo. A soropositividade foi significante com: cães filhotes domiciliares, contato com terra, hepatomegalia, asma, eosinofilia, IgE aumentada e desnutrição pregressa. CONCLUSAO: A soroprevalência encontrada foi alta. A infecção pelo T. canis deve ser investigada em crianças com fatores de risco como presença de cães filhotes domiciliares e contato com terra, em portadores de hepatomegalia e/ou asma, com eosinofilia ou aumento de IgE.