Ocular involvement in STEC-associated hemolytic uremic syndrome.

BACKGROUND: Hemolytic uremic syndrome (HUS) is a systemic thrombotic microangiopathy characterized by hemolytic anemia, thrombocytopenia, and variable kidney involvement. Extrarenal thrombotic microangiopathy occurs in central nervous system (CNS), colon, and other organ systems, but ocular involvement is rarely recognized. This study aimed to analyze frequency and severity of ocular involvement in STEC-HUS, and the relationship between ocular involvement and disease severity, with emphasis on CNS, kidney, and colonic disease. METHODS: Prospective, longitudinal, observational study. INCLUSION CRITERIA: STEC-HUS patients September 2014-January 2019. Funduscopic examination (FE) was performed within 48 h of admission. We evaluated severity of CNS disease, kidney involvement, and presence of hemorrhagic colitis (HC). RESULTS: Ninety-nine patients were included (female 52), mean age 39.4 months (DE: 29.8; range 9-132). Thirteen patients (13.1%) had abnormal FE, 10 showing variable degrees of hemorrhagic exudates and 2 with typical Purtscher-like retinopathy. Other findings included tortuous vascularity, cotton wool spots, and transient retinal edema. CNS involvement was present in 16/99 patients, severe in 12 (75%). Abnormal FE occurred in 5/12 (31%) patients with severe CNS involvement vs. 8/87 (9.2%) with mild, moderate, or no CNS disease (p = 0.0191). Abnormal FE was present in 2/33 (6%) patients without dialysis vs. 11/66 (16.6%) requiring dialysis (p = 0.20). Finally, there were FE abnormalities in 6/20 patients with HC vs. 7/79 without HC (p = 0.012). CONCLUSIONS: FE abnormalities were present in 13% of HUS patients. Abnormal FE significantly associated with more severe disease, including severe CNS involvement and HC. We suggest FE should be performed in severe HUS, especially in cases with severe CNS disease. A higher resolution version of the Graphical abstract is available as Supplementary information.

Hypoalbuminemia: a risk factor in patients with STEC-associated hemolytic uremic syndrome.

BACKGROUND: We aimed to determine the prevalence of hypoalbuminemia in STEC-HUS patients with hemorrhagic colitis (HC) and whether serum albumin level (SAL), leukocyte count, hematocrit and serum sodium level (SSL) are prognostic markers of HC, central nervous system disease (CNSd) and/or dialysis requirement and evaluate if hypoalbuminemia is associated with fecal protein losses. METHODS: We prospectively evaluated STEC-HUS patients treated at our institution from 9/2011 to 2/2019, analyzing the presence of HC, CNSd and dialysis requirement and SAL, SSL, leukocytes, hematocrit and α1-antitrypsin clearance. RESULTS: We evaluated 98 patients, with mean age of 33.3 months. SAL ≤ 29.5 g/l, > 24,600 leukocytes/mm3 and hematocrit > 30% behave as independent prognostic markers for HC. SAL ≤ 28 g/l, > 25,200 leukocytes/mm3 and hematocrit > 30% behave as prognostic markers for CNSd. SAL ≤ 31.6 g/l, > 13,800 leukocytes/mm3, hematocrit > 18.9% and hyponatremia (≤ 132 mEq/l) behave as prognostic markers for dialysis requirement. However, in multivariate logistic regression models, only hypoalbuminemia behaved as a risk factor for HC, CNSd and dialysis. α1-antitrypsin clearance was performed in 69 patients and was high in 9/69 (13%), only 4 with HC. No significant association was observed between α1-antitrypsin clearance and albuminemia (χ2 = 0.1076, p = 0.7429) as well as α1-antitrypsin clearance and HC (χ2 = 1.7892, p = 0.1810). CONCLUSIONS: Almost all patients with HC had hypoalbuminemia, which behaves as a risk factor for HC, CNSd and dialysis requirement. No significant association was observed between elevated α1-antitrypsin clearance and hypoalbuminemia nor between elevated α1-antitrypsin clearance and HC. These findings could be related to the small number of evaluated patients.

Hyponatremia: a new predictor of mortality in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome.

OBJECTIVES: (1) Evaluate mortality rate in patients with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, (2) determine the leading causes of death, and (3) identify predictors of mortality at hospital admission. METHODS: We conducted a multicentric, observational, retrospective, cross-sectional study. It included patients under 18 years old with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome hospitalized between January 2005 and June 2016. Clinical and laboratory data were obtained from the Argentine National Epidemiological Surveillance System of Hemolytic Uremic Syndrome. Clinical and laboratory variables were compared between deceased and non-deceased patients. Univariate and multivariate analyses were performed. ROC curves and area under the curve were obtained. RESULTS: Seventeen (3.65%) out of the 466 patients died, being central nervous system involvement the main cause of death. Predictors of death were central nervous system involvement, the number of days since the beginning of diarrhea to hospitalization, hyponatremia, high hemoglobin, high leukocyte counts, and low bicarbonate concentration on admission. In the multivariate analysis, central nervous system involvement, sodium concentration, and hemoglobin were independent predictors. The best cut off for sodium was ≤ 128 meq/l and for hemoglobin ≥ 10.8 g/dl. CONCLUSIONS: Mortality was low in children with Shiga toxin-producing Escherichia coli hemolytic uremic syndrome, being central nervous system involvement the main cause of death. The best mortality predictors found were central nervous system involvement, hemoglobin, and sodium concentration. Hyponatremia may be a new Shiga toxin-producing Escherichia coli hemolytic uremic syndrome mortality predictor.

Fusión de labios menores vulvares: Experiencia en un hospital pediátrico / Labial adhesions: Experience in a children's hospital

La fusión de labios menores vulvares (FL) se define como la desaparición parcial o total de la hendidura vulvar por adherencia de los labios menores en la línea media. Se presenta, frecuentemente, entre los 3 meses y los 6 años de edad. Entre el 1 enero de 2002 y el 31 de diciembre de 2015, se analizaron 425 niñas con diagnóstico de FL atendidas en la Unidad de Ginecología Infantojuvenil del Hospital de Niños de La Plata, Argentina. La edad promedio correspondió a 2,7 años (desvío estándar: 2,6 años). La FL que comprometió más del 75% de la longitud fue la forma más frecuente de presentación (p < 0,0000001). El 84,2% de las pacientes fueron asintomáticas; 4% registraron síntomas urinarios. El 68,4% de las niñas con antecedente de infección urinaria presentó FL con compromiso >75%. Se resolvieron con tratamiento tópico con estrógenos 90,6% y presentaron efectos adversos 2,1%.

Labial adhesions are defined as the complete or partial fusion of the pudendal cleft due to the agglutination of the labia minora in the midline. They most commonly occur between 3 months and 6 years of life. Between January 1st, 2002 and December 31st, 2015, 425 girls diagnosed with labial adhesions and seen at the Unit of Pediatric and Adolescent Gynecology of Hospital de Niños de La Plata, Argentina, were analyzed. Their average age was 2.7 years (standard deviation: 2.6 years). The most common presentation of labial adhesions was that involving more than 75% of the total length of the labia (p < 0.0000001). A total of 84.2% of patients showed no symptoms and 4% had urinary symptoms. Also, 68.4% of the girls who had a history of urinary tract infection had labial adhesions with a length of involvement of > 75%. Finally, 90.6% of cases resolved with topical estrogens; and 2.1% had adverse events.

Labial adhesions: Experience in a children's hospital. / Fusión de labios menores vulvares. Experiencia en un hospital pediátrico.

Labial adhesions are defined as the complete or partial fusion of the pudendal cleft due to the agglutination of the labia minora in the midline. They most commonly occur between 3 months and 6 years of life. Between January 1st, 2002 and December 31st, 2015, 425 girls diagnosed with labial adhesions and seen at the Unit of Pediatric and Adolescent Gynecology of Hospital de Niños de La Plata, Argentina, were analyzed. Their average age was 2.7 years (standard deviation: 2.6 years). The most common presentation of labial adhesions was that involving more than 75% of the total length of the labia (p < 0.0000001). A total of 84.2% of patients showed no symptoms and 4% had urinary symptoms. Also, 68.4% of the girls who had a history of urinary tract infection had labial adhesions with a length of involvement of > 75%. Finally, 90.6% of cases resolved with topical estrogens; and 2.1% had adverse events.

La fusión de labios menores vulvares (FL) se define como la desaparición parcial o total de la hendidura vulvar por adherencia de los labios menores en la línea media. Se presenta, frecuentemente, entre los 3 meses y los 6 años de edad. Entre el 1 enero de 2002 y el 31 de diciembre de 2015, se analizaron 425 niñas con diagnóstico de FL atendidas en la Unidad de Ginecología Infantojuvenil del Hospital de Niños de La Plata, Argentina. La edad promedio correspondió a 2,7 años (desvío estándar: 2,6 años). La FL que comprometió más del 75% de la longitud fue la forma más frecuente de presentación (p < 0,0000001). El 84,2% de las pacientes fueron asintomáticas; 4% registraron síntomas urinarios. El 68,4% de las niñas con antecedente de infección urinaria presentó FL con compromiso >75%. Se resolvieron con tratamiento tópico con estrógenos 90,6% y presentaron efectos adversos 2,1%.

Prevalencia de vulvovaginits y su relación con hallazgos físicos en niñas evaluadas por sospecha de abuso sexual infantil / Prevalence of vulvovaginitis and relation to physical findings in girls assessed for suspected child sexual abuse

Introducción. La presencia de infecciones de transmisión sexual (ITS) en pacientes con sospecha de abuso sexual es poco frecuente en pediatría. Objetivos. Determinar la prevalencia de hallazgos anogenitales y su relación con la presencia de ITS en niñas referidas por sospecha de abuso sexual infantil. Material y métodos. Estudio retrospectivo realizado entre el 1 de enero de 2003 y el 31 de diciembre de 2013. Se analizaron los hallazgos físicos y la detección de ITS en niñas con sospecha de abuso sexual infantil. Resultados. Se incluyeron 1034 pacientes. La mediana de edad fue 7,9 años. Los hallazgos anogenitales correspondieron a clase I (normal):38,4%; clase II (inespecífico):38,1%; clase III (específico):19,9%; y clase IV (certeza):3,6%. Se registraron ITS en 42 pacientes (4,1%). Se relacionaron las ITS con las clases de hallazgos físicos: 10 (clase II: 9; clase III: 1) Neisseria gonorrhoeae, 17 (clase I: 2; clase II: 8; clase III: 7) Chlamydia trachomatis, 15 (clase I: 2; clase II: 10; clase III: 3) Trichomonas vaginalis. Se hallaron diferencias estadísticamente significativas para Trichomonas vaginalis (p= 0,01) y Neisseria gonorrhoeae (p < 0,0001), y predominaron signos clínicos inespecíficos. Chlamydia trachomatis (p= 0,03) presentó similares registros en hallazgos inespecíficos como específicos. Conclusiones. En la mayoría de los casos de niñas con sospecha de abuso sexual infantil, los hallazgos anogenitales son normales o inespecíficos. La prevalencia de ITS en estas niñas es baja. Trichomonas vaginalis y Neisseria gonorrhoeae se relacionaron con hallazgos inespecíficos, y Chlamydia trachomatis, tanto con hallazgos específicos como inespecíficos.

Introduction. The presence of sexually transmitted infections (STIs) in patients with suspected sexual abuse is uncommon in the field of pediatrics. Objectives. To establish the prevalence of anogenital findings and their relation to the presence of STIs in girls referred for suspected child sexual abuse. Material and Methods. Retrospective study conducted between January 1st, 2003 and December 31st, 2013. Physical findings and detection of STIs in girls with suspected child sexual abuse were analyzed. Results. One thousand thirty-four patients were included. Their median age was 7.9 years old. Anogenital findings were classified as class I (normal):38.4%, class II (nonspecific):38.1%, class III (specific):19.9% and class IV (definitive):3.6%. STIs were observed in 42 patients (4.1%). A relation was established between STIs and the classification of physical findings: 10 (class II: 9; class III: 1) Neisseria gonorrhoeae, 17 (class I: 2; class II: 8; class III: 7) Chlamydia trachomatis, 15 (class I: 2; class II: 10; class III: 3) Trichomonas vaginalis. Statistically significant differences for Trichomonas vaginalis (p= 0.01) and Neisseria gonorrhoeae (p < 0.0001) were observed, with predominance of nonspecific clinical signs. Both nonspecific and specific findings were similarly observed for Chlamydia trachomatis (p= 0.03). Conclusions. Most cases of girls with suspected child sexual abuse had normal or nonspecific anogenital findings. The prevalence of STIs in these girls is low. Trichomonas vaginalis and Neisseria gonorrhoeae were related to nonspecific findings, while both nonspecific and specific findings were observed for Chlamydia trachomatis.

Prevalencia de vulvovaginits y su relación con hallazgos físicos en niñas evaluadas por sospecha de abuso sexual infantil / Prevalence of vulvovaginitis and relation to physical findings in girls assessed for suspected child sexual abuse

Introducción. La presencia de infecciones de transmisión sexual (ITS) en pacientes con sospecha de abuso sexual es poco frecuente en pediatría. Objetivos. Determinar la prevalencia de hallazgos anogenitales y su relación con la presencia de ITS en niñas referidas por sospecha de abuso sexual infantil. Material y métodos. Estudio retrospectivo realizado entre el 1 de enero de 2003 y el 31 de diciembre de 2013. Se analizaron los hallazgos físicos y la detección de ITS en niñas con sospecha de abuso sexual infantil. Resultados. Se incluyeron 1034 pacientes. La mediana de edad fue 7,9 años. Los hallazgos anogenitales correspondieron a clase I (normal):38,4%; clase II (inespecífico):38,1%; clase III (específico):19,9%; y clase IV (certeza):3,6%. Se registraron ITS en 42 pacientes (4,1%). Se relacionaron las ITS con las clases de hallazgos físicos: 10 (clase II: 9; clase III: 1) Neisseria gonorrhoeae, 17 (clase I: 2; clase II: 8; clase III: 7) Chlamydia trachomatis, 15 (clase I: 2; clase II: 10; clase III: 3) Trichomonas vaginalis. Se hallaron diferencias estadísticamente significativas para Trichomonas vaginalis (p= 0,01) y Neisseria gonorrhoeae (p < 0,0001), y predominaron signos clínicos inespecíficos. Chlamydia trachomatis (p= 0,03) presentó similares registros en hallazgos inespecíficos como específicos. Conclusiones. En la mayoría de los casos de niñas con sospecha de abuso sexual infantil, los hallazgos anogenitales son normales o inespecíficos. La prevalencia de ITS en estas niñas es baja. Trichomonas vaginalis y Neisseria gonorrhoeae se relacionaron con hallazgos inespecíficos, y Chlamydia trachomatis, tanto con hallazgos específicos como inespecíficos.(AU)

Introduction. The presence of sexually transmitted infections (STIs) in patients with suspected sexual abuse is uncommon in the field of pediatrics. Objectives. To establish the prevalence of anogenital findings and their relation to the presence of STIs in girls referred for suspected child sexual abuse. Material and Methods. Retrospective study conducted between January 1st, 2003 and December 31st, 2013. Physical findings and detection of STIs in girls with suspected child sexual abuse were analyzed. Results. One thousand thirty-four patients were included. Their median age was 7.9 years old. Anogenital findings were classified as class I (normal):38.4%, class II (nonspecific):38.1%, class III (specific):19.9% and class IV (definitive):3.6%. STIs were observed in 42 patients (4.1%). A relation was established between STIs and the classification of physical findings: 10 (class II: 9; class III: 1) Neisseria gonorrhoeae, 17 (class I: 2; class II: 8; class III: 7) Chlamydia trachomatis, 15 (class I: 2; class II: 10; class III: 3) Trichomonas vaginalis. Statistically significant differences for Trichomonas vaginalis (p= 0.01) and Neisseria gonorrhoeae (p < 0.0001) were observed, with predominance of nonspecific clinical signs. Both nonspecific and specific findings were similarly observed for Chlamydia trachomatis (p= 0.03). Conclusions. Most cases of girls with suspected child sexual abuse had normal or nonspecific anogenital findings. The prevalence of STIs in these girls is low. Trichomonas vaginalis and Neisseria gonorrhoeae were related to nonspecific findings, while both nonspecific and specific findings were observed for Chlamydia trachomatis.(AU)

Prevalence of vulvovaginitis and relation to physical findings in girls assessed for suspected child sexual abuse.

INTRODUCTION: The presence of sexually transmitted infections (STIs) in patients with suspected sexual abuse is uncommon in the field of pediatrics. OBJECTIVES: To establish the prevalence of anogenital findings and their relation to the presence of STIs in girls referred for suspected child sexual abuse. MATERIAL AND METHODS: Retrospective study conducted between January 1st, 2003 and December 31st, 2013. Physical findings and detection of STIs in girls with suspected child sexual abuse were analyzed. RESULTS: One thousand thirty-four patients were included. Their median age was 7.9 years old. Anogenital findings were classified as class I (normal):38.4%, class II (nonspecific):38.1%, class III (specific):19.9% and class IV (definitive):3.6%. STIs were observed in 42 patients (4.1%). A relation was established between STIs and the classification of physical findings: 10 (class II: 9; class III: 1) Neisseria gonorrhoeae, 17 (class I: 2; class II: 8; class III: 7) Chlamydia trachomatis, 15 (class I: 2; class II: 10; class III: 3) Trichomonas vaginalis. Statistically significant differences for Trichomonas vaginalis (p= 0.01) and Neisseria gonorrhoeae (p < 0.0001) were observed, with predominance of nonspecific clinical signs. Both nonspecific and specific findings were similarly observed for Chlamydia trachomatis (p= 0.03). CONCLUSIONS: Most cases of girls with suspected child sexual abuse had normal or nonspecific anogenital findings. The prevalence of STIs in these girls is low. Trichomonas vaginalis and Neisseria gonorrhoeae were related to nonspecific findings, while both nonspecific and specific findings were observed for Chlamydia trachomatis.

Relationship between red blood cell transfusion requirements and severity of renal disease during the acute stage of hemolytic uremic syndrome.

BACKGROUND: We performed a retrospective evaluation of patients with diarrhea-associated hemolytic uremic syndrome (D + HUS) with the aims of: (1) determining the rate of red blood cell (RBC) transfusions; (2) establishing the relationship between need for RBC transfusion and severity of renal involvement; (3) determining whether precise measurements of lactic dehydrogenase (LDH) levels can predict the rate of hemolysis and severity of renal disease. METHODS: A total of 288 patients with D + HUS were retrospectively divided into three groups based on dialysis treatment: group 1, no dialysis treatment (144 patients); group 2, dialysis for 1-10 days (67 patients); group 3, dialysis for ≥11 days (77 patients). RESULTS: Of the patients in groups 1, 2 and 3, 73.6, 86.5 and 83.1%, respectively, required at least one RBC transfusion. The number of RBC transfusions in groups 1, 2 and 3 was 163, 107 and 162, respectively. Comparison of the groups revealed that the number of RBC transfusions was significantly higher in patients in groups 2 and 3 than in those in group 1 (p = 0.0001). Most RBC transfusions (94.2%) occurred during the first 2 weeks of the disease. The median peak LDH level was 2091 U/l in 32 patients with no RBC transfusion (group A), 3900 U/l in 73 patients with one transfusion (group B) and 6378 U/l in 62 patients with two or more transfusions (group C). Patients who received two or more RBC transfusions had a significantly higher median peak LDH level than those who did not receive RBC transfusions or received only one transfusion. This difference was also observed between patients who received only one RBC transfusion and those who did not receive any transfusions (p < 0.00001). Comparison of LDH levels on admission and peak LDH levels among patients in groups A, B and C revealed that 28/32 patients in group A, 56/73 patients in group B and 33/62 patients in group C had a stable LDH level, suggesting that patients with a stable LDH level require fewer RBC transfusions (p ≤ 0.006). Finally, we evaluated the possibility of an association between peak LDH levels and the degree of renal disease. The median peak LDH level in patients of group 1, 2 and 3 was 3538 (range 756-9373), 5165 (451-9205) and 7510 (1,145-16,340) U/l, respectively. Patients with >10 days of dialysis (group 3) had the highest LDH levels, followed by patients with 1-10 days of dialysis (group 2) and then by patients with no dialysis requirements (group 1) (p < 0.00001). CONCLUSIONS: The rate of RBC transfusion was higher in patients with the most severe renal injury, and most were performed during the first 2 weeks of the disease. Patients with stable LDH levels seemed to require fewer RBC transfusions. Median peak LDH levels were significantly higher in the group of patients with the most severe renal disease.

Vulvovaginitis in a pediatric population: relationship among etiologic agents, age and Tanner staging of breast development.

INTRODUCTION: Vulvovaginitis accounts for 25% of all pediatric gynecology consultations. OBJECTIVE: To assess the etiology of vulvovaginitis based on age and Tanner staging of breast development. MATERIAL AND METHODS: Descriptive, cross-sectional study conducted between January 1st and December 31st, 2011. Patients with vulvovaginitis were assessed based on two outcome measures: age group (GI: 0 to 8.9 years old, GII: 9 to 15.9 years old, and GIII: 16 to 18 years old), and the Tanner staging of breast development (I, II-III, IV-V). Results. Two hundred and twenty-nine patients were included, 78 girls in the GI group, 134 in the GII group, and 17 in the GIII group; 81 girls were classified as TI, 36 as TII-III, and 112 as TIV-V based on Tanner staging. Shigella and Oxyuris were the most commonly found etiologic agents in younger girls. Candida albicans, other Candida species, Gardnerella and Ureaplasma urealyticum were the germs most commonly observed in older patients. Oxyuris was predominant in prepubertal girls, while Candida albicans, in postpubertal girls. CONCLUSIONS: Hormonal influence was more relevant than the patient's age in terms of vulvovaginitis etiology.

Vulvovaginitis en una población pediátrica: relación entre el agente etiológico, la edad y el estadio de Tanner mamario / Vulvovaginitis in a pediatric population: relationship among etiologic agents, age and Tanner staging of breast development

Introducción. La vulvovaginitis representa el 25% de las consultas en ginecología pediátrica. Objetivo. Evaluar las etiologías de las vulvovaginitis en función de la edad y el estadio de Tanner mamario. Material y métodos. Estudio descriptivo y transversal realizado entre el 1 de enero y el 31 de diciembre de 2011. Se analizaron pacientes con vulvovaginitis en función de dos variables: la edad (GI: 0 a 8,9 años; GII: 9 a 15,9 años y GIII: 16 a 18 años) y el estadio de Tanner mamario (I; II-III; IV-V). Resultados. Se incluyeron 229 pacientes; 78 niñas en GI, 134 en GII y 17 en GIII; en relación con el estadio de Tanner mamario, se agruparon 81 niñas en TI, 36 en TII-III y 112 TIV-V. Shigella y Oxiurus se presentaron con mayor frecuencia a temprana edad. Candida albicans, otras especies de Candida, Gardnerella y Ureaplasma urealyticum se observaron en niñas mayores. Oxiurus predominó en la etapa prepuberal y Candida albicans, en la pospuberal. Conclusiones. En relación con la etiología de las vulvovaginitis, la influencia hormonal es más relevante que la edad cronológica de la paciente.

Introduction. Vulvovaginitis accounts for 25% of all pediatric gynecology consultations. Objective. To assess the etiology of vulvovaginitis based on age and Tanner staging of breast development. Material and Methods. Descriptive, cross-sectional study conducted between January 1st and December 31st, 2011. Patients with vulvovaginitis were assessed based on two outcome measures: age group (GI: 0 to 8.9 years old, GII: 9 to 15.9 years old, and GIII: 16 to 18 years old), and the Tanner staging of breast development (I, II-III, IV-V). Results. Two hundred and twenty-nine patients were included, 78 girls in the GI group, 134 in the GII group, and 17 in the GIII group; 81 girls were classified as TI, 36 as TII-III, and 112 as TIV-V based on Tanner staging. Shigella and Oxyuris were the most commonly found etiologic agents in younger girls. Candida albicans, other Candida species, Gardnerella and Ureaplasma urealyticum were the germs most commonly observed in older patients. Oxyuris was predominant in prepubertal girls, while Candida albicans, in postpubertal girls. Conclusions. Hormonal influence was more relevant than the patient's age in terms of vulvovaginitis etiology.

Vulvovaginitis in a pediatric population: relationship among etiologic agents, age and Tanner staging of breast development. / Vulvovaginitis in a pediatric population: relationship among etiologic agents, age and Tanner staging of breast development.

INTRODUCTION: Vulvovaginitis accounts for 25

of all pediatric gynecology consultations. OBJECTIVE: To assess the etiology of vulvovaginitis based on age and Tanner staging of breast development. MATERIAL AND METHODS: Descriptive, cross-sectional study conducted between January 1st and December 31st, 2011. Patients with vulvovaginitis were assessed based on two outcome measures: age group (GI: 0 to 8.9 years old, GII: 9 to 15.9 years old, and GIII: 16 to 18 years old), and the Tanner staging of breast development (I, II-III, IV-V). Results. Two hundred and twenty-nine patients were included, 78 girls in the GI group, 134 in the GII group, and 17 in the GIII group; 81 girls were classified as TI, 36 as TII-III, and 112 as TIV-V based on Tanner staging. Shigella and Oxyuris were the most commonly found etiologic agents in younger girls. Candida albicans, other Candida species, Gardnerella and Ureaplasma urealyticum were the germs most commonly observed in older patients. Oxyuris was predominant in prepubertal girls, while Candida albicans, in postpubertal girls. CONCLUSIONS: Hormonal influence was more relevant than the patients age in terms of vulvovaginitis etiology.

Estudo comparativo da mobilidade orientada pelo desempenho em idosos com e sem doença de Alzheimer / Comparative study of the performed-oriented mobility in elderly with and without Alzheimer?s disease

As alterações do envelhecimento, como declínio do equilíbrio e mobilidade funcional, são agravadas pela doença de Alzheimer (DA) que provavelmente desempenha um papel importante em muitas quedas em idosos. O risco de quedas pode ser previsto por características identificáveis durante a avaliação. O objetivo foi comparar a mobilidade orientada pelo desempenho em idosos com doença de Alzheimer (DA) e sem a doença. A presente pesquisa se caracteriza como um estudo causal-comparativo. Foram avaliados 20 sujeitos divididos em dois grupos, 10 no grupo DA e 10 no grupo-controle. Para avaliar a mobilidade funcional foi utilizado o teste ?Timed Up & Go? (TUG) e POMA-BRASIL. No escore total do teste POMA o grupo DA teve média 36,2 (±11,07) e o grupo-controle teve média 54,3 (±2,37). No TUG o grupo DA obteve média de 50,3s em comparação com 11,73s do grupo-controle. Foram encontradas diferenças estatisticamente significativas (P<0,01) entre os valores dos grupos, em que o grupo DA apresentou diminuição do equilíbrio, marcha e mobilidade funcional em relação ao grupo-controle, sugerindo um maior risco de quedas em idosos com doença de Alzheimer (DA).

Effect of temperature, photoperiod, flooding, and drying on the hatching pattern of the eggs of Strelkovimermis spiculatus (Nematoda: Mermithidae).

We assessed the number of Strelkovimermis spiculatus preparasites obtained from a known initial number of nematode eggs and the effect of abiotic conditions (temperature, photoperiod, flooding-drying) on the number of emerged preparasites. Two egg groups were maintained: one continuously flooded, another with flooding-drying cycles (every 15, 30, 60 days). Each egg group was studied at 25°C and 14:10 (L:D) and 16°C and 12:12 (L:D). The flooded eggs contained a higher overall percentage of S. spiculatus preparasites compared to the wet-dry-cycle eggs. The conditions of continuous flooding at 16°C and 12:12 (L:D) produced the maximum percent of emerged J2s (30±15%). Preparasites were recorded by 7 (25°C) and 14 (16°C) days, suggesting this period as the minimum time for embryonic development. The preparasite-emergence time observed from the same flooded-egg batch (98 and 112 days at 25°C and 16°C, respectively) suggested a nonsynchronous hatching, possibly through nonuniform egg embryonation. The time of exposure to drought in the assays did not significantly affect the total average percentage of J2s obtained at 25°C and 14:10 (L:D), whereas at 16°C the number of emerged J2s diminished with a prolongation of the drying period. The oviposition period was also recorded only at 16°C and 12:12 (L:D): S. spiculatus eggs were detected at 12.6 days after postparasite emergence, and oviposition was complete at 51days under those conditions. We propose a flooding schedule to optimize the mass-rearing of S. spiculatus.