Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations.

OBJECTIVES: To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. METHODS: Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. RESULTS: Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n = 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. CONCLUSIONS: In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Outcomes and factors associated with tolerance in infants with non-IgE-mediated cow's milk allergy with gastrointestinal manifestations

Abstract Objectives To evaluate outcomes of oral food challenge (OFC) test to assess tolerance in infants with non-IgE-mediated cow's milk allergy (CMA) with gastrointestinal manifestations and explore clinical data predictive of these outcomes. Methods Single-center retrospective study including infants (age < 12 months) who were referred for CMA between 2000 and 2018 and underwent OFC on follow-up. A univariate logistic regression test was performed to evaluate variables associated with the outcomes of the follow-up OFC test. Results Eighty-two patients were included, 50% were male. Eighteen patients had a positive OFC test (22%). Most patients had presented with hematochezia (77%). The median age of symptom onset was 30 days. Two-thirds of the patients were on appropriate infant formula (extensively hydrolyzed or amino acid-based formula), exclusively or in association with breastfeeding. The median time on an elimination diet before the OFC test was 8 months (Q1 6 - Q3 11 months). All cases with positive follow-up OFC tests (n= 18) had been exposed to cow's milk-based formula before the first clinical manifestation of CMA. Five out of eight cases with Food Protein-Induced Enterocolitis Syndrome (FPIES) had positive OFC tests. Exposure to cow's milk-based formula before diagnosis, a history of other food allergies, hematochezia and diarrhea were predictors of a positive OFC test. Conclusions In infants with non-IgE-mediated CMPA with gastrointestinal manifestations, the use of cow's milk-based formula, a history of other food allergies, and hematochezia and diarrhea upon initial presentation were associated factors for the later achievement of tolerance.

Ursolic acid-rich extract presents trypanocidal action in vitro but worsens mice under experimental acute Chagas disease.

Chagas disease is a neglected tropical disease with only two drugs available for treatment and the plant Cecropia pachystachya has several compounds with antimicrobial and anti-inflammatory activities. This study aimed to evaluate a supercritical extract from C. pachystachya leaves in vitro and in vivo against Trypanosoma cruzi. A supercritical CO2 extraction was used to obtain the extract (CPE). Cytotoxicity and immunostimulation ability were evaluated in macrophages, and the in vitro trypanocidal activity was evaluated against epimastigotes and trypomastigotes forms. In vivo tests were done by infecting BALB/c mice with blood trypomastigotes forms and treating animals orally with CPE for 10 days. The parasitemia, survival rate, weight, cytokines and nitric oxide dosage were evaluated. CPE demonstrated an effect on the epi and trypomastigotes forms of the parasite (IC50 17.90 ± 1.2 µg/mL; LC50 26.73 ± 1.2 µg/mL) and no changes in macrophages viability, resulting in a selectivity index similar to the reference drug. CPE-treated animals had a worsening compared to non-treated, demonstrated by higher parasitemia and lower survival rate. This result was attributed to the anti-inflammatory effect of CPE, demonstrated by the higher IL-10 and IL-4 values observed in the treated mice compared to the control ones. CPE demonstrated a trypanocidal effect in vitro and a worsening in the in vivo infection due to its anti-inflammatory activity.

The influence of final endodontic irrigation techniques and irrigants on the push-out resistance of glass fiber posts.

This study evaluated the influence of different combinations of 3 final endodontic irrigation techniques (positive-pressure irrigation [PPI], passive ultrasonic irrigation [PUI], and continuous ultrasonic irrigation [CUI]) and 2 irrigants (5.25% sodium hypochlorite [NaOCl] and 2% chlorhexidine [CHX]) on the push-out resistance of glass fiber posts. Ninety bovine roots were prepared and divided into 6 groups (n = 15): PPIN, PPI with 5.25% NaOCl; PUIN, PUI with 5.25% NaOCl; CUIN, CUI with 5.25% NaOCl; PPIC, PPI with 2% CHX; PUIC, PUI with 2% CHX; and CUIC, CUI with 2% CHX. In the PPI groups, a 30-gauge needle was used to deliver the irrigating solution. In the PUI groups, a 30-gauge needle was used to deliver the irrigating solution, which was activated for 10 seconds by means of a stainless steel file mounted on an ultrasonic unit. In the CUI groups, delivery and continuous agitation of the irrigating solution for 10 seconds were performed using a stainless steel file mounted on the ultrasonic unit. After canal preparation was completed, glass fiber posts were cemented with a dual-cure resin cement. The roots were sectioned into 1-mm-thick slices (coronal, middle, and apical thirds). After 7 days' storage in distilled water, the slices were submitted to a push-out test. The mean bond strength values were compared using 2-way analysis of variance and Tukey post hoc test (P < 0.05). The mean (SD) overall bond strength values of the specimens were as follows: PPIN, 4.46 (1.43) MPa; PUIN, 6.13 (2.35) MPa; CUIN, 7.41 (1.83) MPa; PPIC, 3.59 (1.70) MPa; PUIC, 5.49 (1.41) MPa; and CUIC, 6.0 (1.63) MPa. Irrespective of the irrigating solution, continuous ultrasonic irrigation achieved significantly greater push-out bond strengths for glass fiber posts, mainly at the apical third of the root specimens (P < 0.05).

Ochratoxin a levels in fermented specialty coffees from Caparaó, Brazil: Is it a cause of concern for coffee drinkers?

Although postharvest coffee fruit fermentation can improve coffee flavour and quality, the mycotoxin ochratoxin A (OTA) can also be a result of microbiological activity, albeit in the later drying step of coffee processing. To evaluate the possible occurrence of OTA contamination in postharvest fruit fermentation, fourteen coffees that entailed two different postharvest fruit fermentation times were evaluated. These coffees originated in the surroundings of the village of Pedra Menina in the qualified Denomination of Origin and coffee producer region of Caparaó on the border between Minas Gerais and Espírito Santo states in Brazil. All coffees were classified according to the Specialty Coffee Association (SCA) protocol and 12 achieved specialty level. OTA was determined in all 14 coffees using immunoaffinity for sample clean-up and high-performance liquid chromatography with fluorescence detection for quantification. One sample presented an OTA concentration of 0.75 µg kg-1 and two samples showed OTA concentrations of 0.87 µg kg-1. The other samples had concentrations of OTA below the limit of quantification obtained in this work (0.64 µg kg-1). Thus, all samples showed OTA concentrations far below the most stringent maximum residue limit (MRL) of 5 µg kg-1 established for roasted coffees by European legislation. These low levels were similar to most of the previous results for Brazilian coffees listed and tabled in this work. This comparison showed that OTA contamination due to this kind of postharvest process - fruit fermentation - should not be a concern for producers and consumers of these fermented coffees.

Increased Prevalence of Left Lobe Atrophy in Long-standing Extrahepatic Portal Vein Obstruction.

OBJECTIVES: The aim of this study was to describe long-term changes in standard blood tests and ultrasound (US) findings in pediatric patients with Extrahepatic Portal Vein Obstruction (EHPVO) who have not undergone Meso-Rex Bypass (MRB) surgery. METHODS: US, laboratory, and endoscopic data of 77 patients were analyzed and compared at 2 different points in time: at initial workup and at most recent follow-up. Differences were assessed using McNemar and Wilcoxon tests, while correlations were evaluated using generalized estimating equations. RESULTS: Upper gastrointestinal bleeding was the most frequent initial manifestation of EHPVO, in 45.4% of subjects. The mean age at diagnosis was 4.3 years. Seventy-four percentage had a previous history of umbilical catheterization and/or neonatal sepsis. Over time, there was a significant increase in the prevalence of leukopenia, thrombocytopenia, and, interestingly, of left lobe atrophy (LLA), even though the number of esophageal varices and the need for endoscopic interventions reduced. A significant correlation was found between history of umbilical catheterization and LLA, splenomegaly and LLA, and gallbladder wall thickening and LLA. Overall, the number of patients with cholelithiasis at initial workup was low (and therefore, not analyzed with inferential statistics); however, we observed a relative increase over time. CONCLUSIONS: In this cohort of patients with EHPVO followed over more than 8 years without treatment with MRB, we report the novel finding of a significant increase in the prevalence of LLA over time. LLA correlated with past medical history of umbilical catheterization, and findings of splenomegaly and gallbladder wall thickening. We propose that that LLA should be further explored as a marker of portal hypertension, particularly in the context of a history of umbilical catheterization.

Cotidiano de pessoas adultas com deficiência motora numa Unidade de Saúde da Família / Daily life of elderly people with motor deficiency in a Family Health Unit / Cotidiano de personas adultas con deficiência motora en una Unidad de Salud de la Familia

Objetivo: o presente estudo objetivou compreender o cotidiano de pessoas com deficiência motora de uma Unidade de Saúde numa cidade do interior da Bahia. Método: trata-se de um estudo qualitativo com abordagem fenomenológico, de caráter descritivo, exploratório. Participaram desse estudo 29 pessoas com deficiência motora. A coleta de dados foi realizada através de entrevista semiestruturada, após autorização do Comitê de ética parecer nº 633.531/2014. Os dados empíricos foram submetidos a análise de conteúdo. Resultados: emergiram as seguintes categorias: o sofrimento no processo do viver com deficiência motora; a aceitação do viver com deficiência e o preconceito no conviver com as diferenças no processo relacional. Conclusões: esse estudo revelou que o cotidiano da pessoa diante de suas relações sociais é fundamental para a reconstrução do significado do viver com a deficiência motora.

Objective: This study aimed to understand the daily routine of people with motor deficiency in a Health Unit in a city in the interior of Bahia. Method: This is a descriptive, exploratory study with a qualitative approach. 29 people with motor deficiencyparticipated in this study. The data collection was done through a semistructured interview, after being authorized by the Ethics Committee by resolution No. 633.531 / 2014. The empirical data were subjected to content analysis. Results: The following categories emerged: Suffering in the process of living with motordeficiency; the acceptance of living with deficiency and prejudice when living with differences in the relational process. Conclusions: This study revealed that the daily life of the person in front of their social relations is fundamental for the reconstruction of the meaning of living with motor deficiency.

Objetivo: El presente estudio buscó comprender el cotidiano de personas con deficiência motora de una Unidad de Salud en una ciudad del interior de Bahía. Método: Se trata de un estudio descriptivo, exploratorio con un abordaje cualitativo. Participaron en este estudio 29 personas con deficiência motora. La colecta de datos fue realizada a través de una entrevista semiestructurada, después de ser autorizada por el Comité de Ética mediante el parecer nº633.531/2014. Los datos empíricos fueron sometidos a análisis de contenido. Resultados: Surgieron las siguientes categorías: El sufrimiento en el proceso de vivir con deficiência motora; la aceptación de vivir con deficiência y el prejuicio al convivir con las diferencias en el proceso relacional. Conclusiones: Este estudio reveló que el cotidiano de la persona frente a sus relaciones sociales es fundamental para la reconstrucción del significado de vivir con deficiência motora.

Oral health status of pregnant and puerperal women in the municipality of Feira de Santana, at three different times between 2005 and 2015. / Condição bucal de gestantes e puérperas no município de Feira de Santana, em três diferentes períodos entre os anos de 2005 e 2015.

OBJECTIVE: to evaluate the oral health condition of pregnant/postpartum women attending public services in the city of Feira de Santana, BA, Brazil, at three different times between 2005 and 2015. METHODS: this is a study socioeconomic and demographic characteristics, health condition and health care, lifestyle and oral health status of 1,245 participants obtained from a database of three previous investigations: I Intervention Study (2005-2007); II Case-Control Study (2010-2011); III Case-Control Study (2012-2015). RESULTS: comparing the three periods, the frequency of gingivitis (24.41% versus 8.90% versus 5.77%; p<0.01) and periodontitis (44.64% vs 9.16% vs 11.55%; p<0.01) was found to decrease; the worst dental conditions regarding the number of teeth present, healthy and extracted and the DMFT index were found in period III compared to period II. CONCLUSION: an improvement was seen in the participants' periodontal condition over time, which coincides with the implementation of policies pertaining to women's health, oral health and income redistribution in this city.

Condição bucal de gestantes e puérperas no município de Feira de Santana, em três diferentes períodos entre os anos de 2005 e 2015 / Condición bucal de gestantes y puérperas en el municipio de Feira de Santana, en tres diferentes momentos entre los años 2005 y 2015 / Oral health status of pregnant and puerperal women in the municipality of Feira de Santana, at three different times between 2005 and 2015

Objetivo: avaliar a condição bucal de gestantes e puérperas, usuárias de serviços públicos de saúde de Feira de Santana, BA, Brasil, em três momentos distintos do período 2005-2015. Métodos: estudo sobre características socioeconômico-demográficas, condição e cuidado com a saúde, estilo de vida e condição bucal de 1.245 participantes, obtidas de banco de dados de três investigações - I Estudo de intervenção (2005-2007), II Estudo caso-controle (2010-2011), III Estudo caso-controle (2012-2015). Resultados: comparando-se os três períodos, as frequências de gengivite (24,41% versus 8,90% versus 5,77%; p<0,01) e periodontite (44,64% vs 9,16% vs 11,55%; p<0,01) diminuíram; relativamente à condição dentária, as piores situações no número de dentes presentes, hígidos, extraídos e índice CPO-D observaram-se no período III, comparativamente ao período II. Conclusão: a condição periodontal melhorou nos anos estudados, coincidentemente com o processo de implantação de políticas de assistência pré-natal, saúde da mulher e saúde bucal, e de redistribuição de renda no município.

Objetivo: evaluar la condición bucal de gestantes y puérperas, usuarias de servicios públicos de salud de la ciudad de Feira de Santana/BA, en tres momentos distintos comprendidos entre 2005 y 2015. Metodos: se trata de un estudio con información sobre características socioeconómicas-demográficas, de condición y cuidado com la salud, de estilo de vida y de condición bucal de 1245 participantes obtenidas en un banco de datos de tres investigaciones previas: I (2005-2007), II (2010-2011), III (2012-2015). Resultados: tanto la frecuencia de gingivitis (24,41% versus 8,90% versus 5,77%; p<0,01) y periodontitis (44,64% vs 9,16% vs 11,55%; p<0,01) disminuyó; em relación a la condición dental, las peores situaciones en cuanto al número de dientes presentes, hígidos, extraídos y el índice CPO-D se observaron en el período III, en comparación con las del período II. Conclusión: se há mejorado la condición periodontal a lo largo de los años, período que coincide com el proceso de implantación de políticas de salud de la mujer, salud bucal, así como redistribución de ingresos en el municipio.

Objective: to evaluate the oral health condition of pregnant/postpartum women attending public services in the city of Feira de Santana, BA, Brazil, at three different times between 2005 and 2015. Methods: this is a study socioeconomic and demographic characteristics, health condition and health care, lifestyle and oral health status of 1,245 participants obtained from a database of three previous investigations: I Intervention Study (2005-2007); II Case-Control Study (2010-2011); III Case-Control Study (2012-2015). Results: comparing the three periods, the frequency of gingivitis (24.41% versus 8.90% versus 5.77%; p<0.01) and periodontitis (44.64% vs 9.16% vs 11.55%; p<0.01) was found to decrease; the worst dental conditions regarding the number of teeth present, healthy and extracted and the DMFT index were found in period III compared to period II. Conclusion: an improvement was seen in the participants' periodontal condition over time, which coincides with the implementation of policies pertaining to women's health, oral health and income redistribution in this city.

Laryngeal paracoccidioidomycosis presenting as solitary true vocal fold disease.

Paracoccidioidomycosis (PCM) is a systemic granulomatous disease caused by Paracoccidioides brasiliensis or P. lutzii. It is a neglected tropical infectious disease that poses a major public health burden in endemic areas of Latin America. Mucosae of the upper digestive and respiratory tracts are commonly involved and many patients have disease at multiple mucosal sites, with or without lung involvement. Mucosal PCM presenting as solitary true vocal fold disease is relatively rare. We present the case of a 67-year-old Brazilian forest guard who presented with a 6-month history of hoarseness and globus pharyngeus due to a solitary left true vocal fold infiltration and vegetation diagnosed as PCM. Silent pulmonary disease was also present. A laryngoscopy video is offered as supplemental material to this report. He completely remitted after surgical removal and amphotericin B deoxycholate treatment.

Tratamento endovascular do aneurisma aortoilíaco: relato do primeiro caso utilizando endoprótese brasileira com ramo ilíaco / Endovascular treatment of aortoiliac aneurysm: first report of a case using a Brazilian device with an iliac branch

Resumo O aneurisma aortoilíaco tem representado desafio terapêutico principalmente em relação ao tratamento endovascular, visto que a embolização das artérias ilíacas internas pode levar a graves complicações. Inúmeras técnicas cirúrgicas convencionais e endovasculares têm sido descritas para a preservação de ao menos um ramo ilíaco interno. Dentre as opções de tratamento totalmente endovascular, podemos citar as endopróteses ramificadas e a técnica de próteses paralelas. Os autores relatam o primeiro caso de tratamento endovascular com preservação de ramo ilíaco interno utilizando endoprótese nacional ramificada.

Abstract Aortoiliac aneurysms are particularly challenging to treat using a totally endovascular approach, because embolization of the internal iliac arteries can cause major complications. Several conventional and endovascular surgical techniques have been described that offer preservation of at least one internal iliac branch and options for completely endovascular treatment include branched stentgrafts and the parallel grafts technique. Here, the authors report the first case of endovascular treatment with preservation of an internal iliac branch using a Brazilian iliac branch device.

Percepções de mulheres portadoras do papilomavírus humano acerca da infecção: estudo exploratório / Feelings of women with human papilloma virus regarding their infection: an exploratory study / Percepciones de mujeres portadoras del virus papiloma humano a cerca de la infección: estudio exploratorio

OBJETIVO: Conhecer a percepção de mulheres infectadas pelo papilomavírus humano (HPV), acerca desta infecção sexualmente transmissível. MÉTODO: Estudo exploratório com abordagem qualitativa, realizado com 14 mulheres, usuárias de um serviço de atenção especializada em Juazeiro do Norte-Ceará-Brasil, entre março a junho de 2012, utilizando a técnica do Discurso do Sujeito Coletivo. RESULTADOS: Constatou-se percepções equivocadas a respeito do HPV, desconhecimento da não eliminação do vírus mediante a terapêutica instituída, sentimentos relatados com características negativas frente ao diagnóstico e atitudes de autoproteção e proteção aos filhos. CONCLUSÃO: As percepções encontradas tendem a prejudicar o empoderamento das mulheres para lidarem com maior segurança nesta situação. Lacunas também são apontadas na educação em saúde. Deve-se continuar a discussão sobre a temática, com informações dirigidas ao viver com o HPV através de uma abordagem singular, respeitando a individualidade de cada mulher, tornando a assistência mais humanizada e eficaz.

AIM: to understand the feelings of women infected with the human papilloma virus (HPV) regarding this sexually transmitted disease. METHOD: this is an exploratory study, with a qualitative approach, performed with 14 women who are users of a specialized care service in the municipality of Juazeiro do Norte, in the Brazilian state of Ceará, in the Northeast of Brazil, between March and June 2012, using the Collective Subject Discourse technique. RESULTS: it was observed that there were some misconceptions regarding HPV, unfamiliarity with the fact the therapies used do not eliminate the virus, feelings linked to negative characteristics of the diagnosis, and self-protecting and children-protecting attitudes. CONCLUSION: the perceptions described tend to harm the empowerment process of these women to deal with the illness with more confidence. Gaps were found in health education. The discussion about the topic must continue, with directed information regarding living with HPV in a singular approach, respecting the individuality of each woman, providing more humane and effective care.

OBJETIVO: Conocer la percepción de mujeres infectadas por el virus papiloma humano (HPV), acerca de esta infección sexualmente trasmisible. MÉTODO: Estudio exploratorio con enfoque cualitativo, realizado con 14 mujeres, usuarias de un servicio de atención especializada en Juazeiro del Norte-Ceará-Brasil, entre marzo a junio de 2012, utilizando la técnica del Discurso del Sujeto Colectivo. RESULTADOS: se encontraron percepciones equivocadas con respecto al HPV, desconocimiento de la no eliminación del virus mediante la el enfoque terapéutico, sentimientos relatados con características negativas frente al diagnóstico y actitudes de autoprotección y protección a los hijos. CONCLUSIÓN: Las percepciones encontradas tienden a perjudicar el empoderamiento de las mujeres para lidiar con mayor seguridad en esta situación. Lagunas también son mostradas en la educación en salud. Se debe continuar la discusión sobre la temática, con informaciones dirigidas al vivir con el HPV a través de un enfoque singular, respetando la individualidad de cada mujer, tornando la asistencia más humanizada y eficaz.

Tecnologias na promoção da saúde de idosos com doenças crônicas na atenção primária à saúde / Tecnologías de promoción de la salud en ancianos con enfermedades crónicas en la atención primaria de salud / Health promotion technologies in elderly people with chronic diseases in primary health care

Objetivo: conhecer as tecnologias empregadas pelos enfermeiros na promoção da saúde de idosos com doenças crônicas na Atenção Primária à Saúde. Método: pesquisa exploratória, com abordagem qualitativa e de caráter descritivo, realizada em uma cidade da região do Cariri, sul do Ceará, Brasil. Foram incluídos os enfermeiros da atenção primária que empregavam tecnologias para idosos com doença crônica. Utilizou-se entrevista semiestruturada para coleta de dados nos meses de julho e agosto de 2014, com análise de conteúdo temático. Resultados: emergiram duas categorias: Tecnologias empregadas na promoção da saúde de idosos com doenças crônicas e Estratégias para emprego de tecnologias no grupo de idosos na Atenção Primária à Saúde. Destacaram-se as tecnologias leves (acolhimento humanizado e vínculo) e duras (glicosímetro, tensiômetro e outras), que foram escolhidas pelos profissionais para as atividades de promoção da saúde. Conclusão: não existe clareza no conceito de tecnologias de saúde, especialmente no emprego das tecnologias leve-duras.

Aim: to know the technology adopted by nurses in health promotion for elderly people with chronic diseases in Primary Health Care. Method: this is an exploratory research, with qualitative and descriptive approach, held at Cariri, south of Ceará, Brazil. Nurses who adopt technologies for the older adults with chronic were included. Semi-structured interview was used for data collection during July and August 2014, using thematic content analysis. Results: from the analysis, two categories emerged: Technologies used in health promotion of elderly people with chronic diseases and Strategies for the use of technologies in the elderly group in Primary Health Care. Light technologies stood out (humanized host and bond) and hard (glucose meter, tensiometer among others). They were chosen for health promotion activities by professionals. Conclusion: there is no clarity on the concept of health technologies, especially in the use of soft-hard technologies.

Objetivo: conocer la tecnología empleada por las enfermeras en la promoción de la salud para ancianos con enfermedades crónicas en la Atención Primaria de Salud. Método: investigación exploratoria, cualitativa y descriptiva, realizada en Cariri, ciudad del sur de Ceará, Brasil. Se incluyó enfermeras de atención primaria que emplean tecnologías para ancianos con enfermedades crónicas. Fue utilizada para la recolección de datos una entrevista semi-estructurada realizada entre julio y agosto 2014. Resultados: a partir del análisis de las categorías surgieron: tecnologías empleadas en la salud para ancianos con enfermedades crónicas y estrategias para el empleo de tecnologías para ancianos en la Atención Primaria de Salud. Se destacaron las tecnologías leves (anfitrión humanizado y bonos) y severas (medidor de glucosa, tensiómetro y otros) que fueron elegidas para actividades de promoción de la salud por los profesionales. Conclusión: no hay claridad sobre el concepto de tecnologías de la salud, especialmente en el uso de blandas-duras.

Emergency embolization after resection of a laryngeal Schwannoma / Embolizacao de urgencia apos resseccao de schwanoma de laringe

Schwannoma is a rare cause of benign tumors of the larynx. The first-choice treatment is surgical resection. The objective of this paper is to report on a rare case of a young female patient who suffered severe intraoperative hemorrhaging during surgical resection of a laryngeal Schwannoma and needed emergency embolization.

O schwanoma representa etiologia rara de tumor benigno de laringe, tendo como principal tratamento a ressecção cirúrgica. O objetivo deste trabalho é relatar um caso raro de paciente jovem submetido à ressecção cirúrgica de schwanoma laríngeo, evoluindo, no transperatório, para complicação hemorrágica grave e necessitando de embolização de urgência.

Implante profilático e temporário de filtro de veia cava inferior no trauma / Prophylactic and temporary inferior vena cava filter implant in trauma

O tromboembolismo pulmonar (TEP) é importante causa de óbito no trauma e esse, na maioria das vezes, contraindica a principal farmacoterapia na prevenção e no tratamento do TEP: a anticoagulação. Relatamos um caso de paciente politraumatizado, com risco elevado de embolia pulmonar, submetido ao implante preventivo e temporário de filtro de veia cava inferior (FVC).

Pulmonary embolism (PE) is a major cause of death in trauma and that, on most cases, the main contraindication for pharmacotherapy in the prevention and treatment of PE: the anticoagulation. We report a case of multiple trauma patient at high risk of pulmonary embolism, preventive and implant subjected to temporary inferior vena cava filter (VCF).

Can renal nutrition education improve adherence to a low-protein diet in patients with stages 3 to 5 chronic kidney disease?

OBJECTIVE: Low adherence is frequently observed in patients with chronic kidney disease (CKD) who are following a low-protein diet. We have evaluated whether a specific nutrition education program motivates patients with CKD who do not yet receive dialysis to reduce their protein intake and whether such a program improves adherence to a low-protein diet over and above standard dietary counseling. DESIGN AND METHODS: This was a randomized controlled clinical trial conducted at the CKD outpatient clinic at Pedro Ernesto University Hospital, Rio de Janeiro, Brazil. SUBJECTS: This study included adult patients with an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m(2) who were receiving conservative treatment. Participants had received their first referrals to a renal dietitian. INTERVENTION: Patients were randomized to a normal counseling group (individualized dietary program: 0.6 to 0.75 g protein/kg/day or 0.6 to 0.8 g/kg/day for patients with diabetes and 25 to 35 kcal/kg/day with sodium restriction) or an intense counseling group (same dietary program plus nutrition education materials). The nutrition education material included 4 different actions to improve patient knowledge and understanding of the low-protein and low-sodium diet. Both groups were followed by means of individual monthly visits to the outpatient clinic for 4 months. MAIN OUTCOME MEASURE: We looked for a change in protein intake from baseline values as well as the adherence rate, assessed as a 20% decrease of the initial protein intake (by 24-hour food recall). RESULTS: Eighty-nine patients completed the study (normal counseling n = 46; intense counseling n = 43). The number of patients who adhered to a low-protein diet was high but did not differ between groups (in the last visit 69% vs. 48%; P = .48; intense vs. normal counseling, respectively). The reduction in protein intake from baseline values was greater for the intense counseling group compared with the normal counseling group (at the last visit, -20.7 g/day [-30.9%] vs. -10.5 g/day [-15.1%], intense vs. normal counseling, respectively; P = .04). CONCLUSION: An intense nutrition education program contributed to reducing protein intake in patients with stage 3 to 5 CKD over and above our standard dietary counseling. Nutritional education programs are effective in increasing patient adherence to protein intake recommendations.

Tratamento endovascular da disfunção erétil por fístula arterioesponjosa traumática: relato de caso / Endovascular treatment of erectile dysfunction by arteriospongiosum traumatic fistula: case report

A disfunção erétil (DE) representa um distúrbio comum de caráter multifatorial. Os autores relatam um caso de paciente vítima de trauma perineal evoluindo com DE por fístula da artéria bulbar para o corpo esponjoso peniano, promovendo um shunt arteriovenoso culminando com déficit de ereção, congestão peniana e dor. O mesmo foi submetido ao tratamento endovascular por embolização com sucesso e encontra-se no sexto mês de acompanhamento ambulatorial, com retorno às suas atividades sexuais e sem queixas de rigidez peniana e dor.

The erectile dysfunction (ED) is a common multifactorial disorder . The authors report a case of perineal trauma patients with evolving secondary bulbar penile artery fistula to the spongy body, promoting an arteriovenous shunt culminating with a deficit of erection, congestion and penile pain. The same was treated by endovascular embolization with success and is in 6¢ªmonths of follow up with return to sexual activity and no complaints of penile rigidity and pain.

Tratamento endovascular da oclusão de ramo ilíaco de endoprótese bifurcada de aorta abdominal: trombectomia rotativa e aspirativa seguida de angioplastia com stent primário / Endovascular treatment of iliac limb occlusion of a bifurcated abdominal aortic stent graft: rotational and aspiration thrombectomy followed by primary angioplasty and stenting

A oclusão de ramo ilíaco de endoprótese bifurcada de aorta surge como complicação decorrente da correção endovascular do aneurisma de aorta abdominal e várias abordagens terapêuticas têm sido empregadas para o tratamento dessa complicação em casos de isquemia de membro inferior. Apresentamos dois casos de tratamento totalmente percutâneo da oclusão de ramo ilíaco de endoprótese de aorta abdominal com dispositivo de trombectomia rotativa e aspirativa seguida de angioplastia com stent primário, sem complicações operatórias.

Iliac limb occlusion of bifurcated aortic stent graft appears as complication of endovascular repair of abdominal aortic aneurysm and several therapeutic approaches have been used to treat this problem in cases of lower limb ischemia. In two cases a totally endovascular approach was used to treat the limb occlusion by means of rotational and aspiration thrombectomy, followed by stenting. In both cases there were no postoperative complications.