Defining remission in childhood-onset lupus: PReS-endorsed consensus definitions by an international task force.

OBJECTIVE: To derive childhood-onset SLE (cSLE) specific remission definitions for future treat-to-target (T2T) trials, observational studies, and clinical practice. METHODS: The cSLE International T2T Task Force conducted Delphi surveys exploring paediatric perspectives on adult-onset SLE remission targets. A modified nominal group technique was used to discuss, refine, and agree on the cSLE remission target criteria. RESULTS: The Task Force proposed two definitions of remission: 'cSLE clinical remission on steroids (cCR)' and 'cSLE clinical remission off steroids (cCR-0)'. The common criteria are: (1) Clinical-SLEDAI-2 K = 0; (2) PGA score < 0.5 (0-3 scale); (4) stable antimalarials, immunosuppressive, and biologic therapy (changes due to side-effects, adherence, weight, or when building up to target dose allowed). Criterion (3) in cCR is the prednisolone dose ≤0.1 mg/kg/day (maximum 5 mg/day), whereas in cCR-0 it is zero. CONCLUSIONS: cSLE definitions of remission have been proposed, maintaining sufficient alignment with the adult-SLE definition to facilitate life-course research.

Radiofrequency therapy as an effective treatment for granulomatous cheilitis: A CARE case report.

INTRODUCTION: Granulomatous cheilitis is a rare disorder characterized by recurrent, idiopathic, and painless lip swelling. The diagnosis is proven by histopathological examination. The unknown aetiology and poorly understood underlying mechanism contribute to the difficulty in establishing an effective treatment. This case study proposes the effectiveness of radiofrequency therapy in the management of refractory granulomatous cheilitis. CASE SUMMARY: A 68-year-old patient presented with hypertrophy and swelling of the lower lip, and a biopsy revealed actinic cheilitis. The patient underwent lip shaving and an advancement mucosal flap, and definitive histologic examination confirmed the diagnosis of granulomatous cheilitis. No other signs of orofacial granulomatosis were observed, and the complementary aetiological study was negative for systemic disease. The lip swelling reappeared and persisted, which interfered with the quality of life. Hence, radiofrequency therapy was performed in the submucosal and subdermal layers of the lip, resulting in significant aesthetic and functional improvement and no further relapses after five years. DISCUSSION: The management of granulomatous cheilitis is challenging. The current mainstay treatment is corticotherapy or reduction cheiloplasty in severe cases. Radiofrequency has potential as a treatment option in debilitating macrocheilia, presenting worthy long-lasting functional and aesthetical results, with minimal morbidity.

Anatomical and histochemical characterization of stem and leaves of Bauhinia pulchella Benth. (Fabaceae).

Bauhinia pulchella Benth. (Fabaceae), is native to Brazil and popularly known as pata-de-bode. In folk medicine, it is used to treat diabetes. Pharmacological studies have demonstrated different properties, such as cytotoxic and antioxidant, and different chemical constituents, such as essential oil, triterpenoids, steroids, among others. In order to highlight the morphological differences of the species B. pulchella from the others of the genus, and its pharmacological potential, the present study aimed to carry out the anatomical and histochemical characterization of the stem and leaves of B. pulchella. Usual methods in plant anatomy were used in the preparation of semi-permanent slides containing cross sections of the stem, petiole and leaf blade and paradermal sections of the leaf blade for analysis in light microscopy and polarized light. Histochemical tests were also performed to localize the metabolites in the stem and leaf blade. The stem of B. pulchella has a cylindrical outline, the bark is composed of 7-8 layers of cells and discontinuously distributed sclerenchyma; petiole presents flat convex contour, prominences in the adaxial region, concentric amphicrivral vascular bundle, surrounding a small concentric anfivasal intramedullary bundle, adaxially two accessory bundles and tector trichomes; leaf blade with anisocytic and tetracytic stomata on the adaxial surface and anisocytic, tetracytic and anomocytic on the abaxial surface; and midrib with plain-convex outline, 1-2 layers of collenchyma and covering trichomes. Characteristics that differ from other species of the genus Bauhinia. Alkaloids, phenolic compounds, lipophilic compounds, lignin, triterpenes, steroids and tannins were observed in the species. The results are fundamental for the pharmacobotanical standardization of the studied species.

Microbiological evaluation of homemade mayonnaise and self-serve acai sold in Araguaína, Tocantins.

Foodborne diseases are common illnesses caused by the consumption of food contaminated with microorganisms, such as viruses, fungi, bacteria, and protozoa. Every year, 600 million people become ill and 420,000 people die as a result of consuming contaminated food. Therefore, food safety is an important issue. In this study, samples of homemade spiced mayonnaise and self-serve acai sold in the city of Araguaína, Tocantins, Brazil were analyzed for microbiological contaminants. Acai was collected from 10 stores, one sample from each store, and tested for mold, yeast, and coliforms, as well as coliform identification and total and thermotolerant coliform counts. Mayonnaise was collected from 20 snack bars, one sample from each. These samples were inoculated on MacConkey and Salmonella Shigella agar plates, and the plates were analyzed for growth. Salmonella spp. were detected in some Mayonnaise samples, and coliforms were detected in all acai samples; 60% of samples had thermotolerant coliforms, and only 40% were within the limits established by ANVISA. The collected samples of mayonnaise and acai were contaminated with molds and yeasts above the established limit of 103 CFU/g. Thus, the analyzed mayonnaise and acai samples were contaminated and unfit for consumption, demonstrating the importance of hygienic-sanitary measures in food handling.

PReS-endorsed international childhood lupus T2T task force definition of childhood lupus low disease activity state (cLLDAS).

OBJECTIVE: To achieve a consensus-based definition of Low Disease Activity (LDA) for use in cSLE trials. METHODS: The International cSLE T2T Task Force, comprising of paediatric rheumatologists/nephrologists, and adult rheumatologists undertook a series of Delphi surveys/consensus meetings to discuss, refine, and vote upon cSLE LDA criteria. RESULTS: The Task Force agreed that LDA should be based upon the adult-SLE Lupus Low Disease Activity State definition (LLDAS), with modifications to make it applicable to cSLE (cLLDAS). They agreed upon five cLLDAS criteria: (1) SLE Disease Activity Index (SLEDAI)-2 K ≤4, with no activity in major organ systems; (2) no new features of lupus disease activity compared with the last assessment; (3) Physician Global Assessment score of ≤1 (0-3 scale); (4) prednisolone dose of ≤0.15 mg/kg/day, 7.5 mg/day/maximum; while on (5) stable antimalarials, immunosuppressives, and biologics. CONCLUSIONS: A cSLE-appropriate definition of cLLDAS has been generated, maintaining alignment with the adult-SLE definition to promote life-course research.

Effect of Salivary Flow on Bleached Enamel Roughness and Mineral Content: an In Situ and In Vitro Study.

This study aimed to evaluate the effect of human saliva in vitro and salivary flow in situ on the roughness and mineral content of bleached enamel. Dental specimens were divided into five groups (n=15): not bleached (NB); bleached (35% hydrogen peroxide) and exposed to distilled water (DW); human saliva in vitro (IV); normal salivary flow in situ (NSF); and low salivary flow (LSF) in situ. Enamel roughness (Ra, Rz) and calcium/phosphorus contents were evaluated with laser profilometry and energy-dispersive spectroscopy, respectively, at baseline (T1), after bleaching (T2), and after seven days (T3). Salivary pH and buffer capacity were evaluated with colorimetric strips and salivary calcium and phosphorus with absorbance spectrophotometry. Data were analyzed with non-parametric tests and linear regression (α=0.05). After contact with saliva, Ra and Rz of LSF=DW>IV=NSF=NB was found. For DW and LSF, the roughness of T1

Vulnerabilidade de placa coronariana com teste funcional normal contraindica exercício físico de alta intensidade? / Coronary plaque vulnerability with normal functional test contraindicate high-intensity physical exercise?

Doença arterial coronariana (DAC) é a principal causa de morte súbita em atletas com mais de 35 anos. Sedentarismo é um fator de risco para DAC porém há evidências de que atividade física vigorosa aumente o risco de eventos cardiovasculares de forma paradoxal. Segundo diretrizes, pacientes nos quais DAC é detectada em exames de screening devem ser restringidos de esportes de alta intensidade quando houver alteração em testes funcionais ou quando houver evidência de progressão de doença em avaliação seriada. No entanto, será que lesões coronarianas com teste funcional negativo porém com características de vulnerabilidade contraindicam atividade física intensa em esportistas?. Trazemos o caso de J.B., 59 anos feminina, hipertensa, dislipidêmica, história familiar de DAC precoce. Esportista, pratica corrida quatro vezes por semana, musculação três vezes por semana e ciclismo duas vezes por semana, em alta intensidade. Em avaliação pré-participação para maratona em serviço externo foi submetida a angiotomografia de coronárias evidenciando escore de cálcio 1772 (p99) com placas calcificadas e redução luminal importante em terço proximal de descendente anterior (DA) e diagonal (DG), e redução luminal discreta de artéria circunflexa (CX), e oclusão total em terço proximal de artéria coronária direita (CD). Ao cateterismo, confirmadas as lesões de 40% em terço médio CD, 70% em terço proximal de DA, 80% diagonal e 40% CX. Em nosso serviço foi submetida a cintilografia de perfusão miocárdica SPECT 99m-Tc precedida de teste de esforço. Não houve sinais de isquemia à imagem e o teste de esforço teve comportamento normal de PA, FC, ausência de arritmia ou de alteração de segmento ST ou sintomas, e desempenho de 12,9 METS, VO2 de 45. O caso foi discutido com conjunto com o setor de tomografia, coronariopatias, hemodinâmica e cardiologia do esporte, sendo contraindicada exercício físico de alta intensidade devido ao achado de vulnerabilidade de placas à angiotomografia e cateterismo, evidência ainda pouco debatida na literatura mundial.

Monitoring and Treatment of Juvenile Idiopathic Arthritis-associated Uveitis: Brazilian Evidence-based Practice Guidelines.

PURPOSE: To present a national guideline for ophthalmologic care and surveillance of juvenile idiopathic arthritis-associated uveitis (JIA-uveitis). METHODS: Review article based on medical literature and the experience of an Expert Committee composed of members of the Brazilian Society of Pediatric Ophthalmology/Brazilian Council of Ophthalmology and the Brazilian Society of Pediatrics/Brazilian Society of Rheumatology. Studies with a high level of evidence were selected by searching the PubMed/Medline database. The final document was approved by the experts. RESULTS: The main recommendations are that children/adolescents with JIA should undergo screening according to their risk factors. Ophthalmological checkups should also consider ocular inflammation and therapy. Topical glucocorticoids should be the first line of therapy, with systemic glucocorticoids acting as bridge treatments in severe uveitis. Methotrexate should be the first-line systemic therapy and anti-tumor necrosis factor (anti-TNF alpha) the second for uncontrolled uveitis. CONCLUSIONS: This evidence-based guideline for JIA-uveitis will be useful for both ophthalmology and rheumatology practice.

Executive function as measured by the Behavior Rating Inventory of Executive Function-2: children and adolescents with Williams syndrome.

BACKGROUND: Difficulties with executive functions (EF) are very common among individuals with Williams syndrome (WS). To characterise the pattern of relative strengths and weaknesses in EF for children and adolescents with WS, we considered the performance of a large sample on the parent version of the Behavior Rating Inventory of Executive Function-2 (BRIEF-2). Associations between distinct components of EF and adaptive behaviour, behaviour problems and intellectual ability were investigated. The concurrent effects of components of behaviour regulation and emotion regulation on attention problems and anxiety problems also were evaluated. METHODS: Participants were 308 6-17-year-olds with genetically confirmed classic WS deletions. Parent report of EF was measured by the BRIEF-2 questionnaire. Most participants (223/308) completed the Differential Ability Scales-II as a measure of intellectual ability. The parents of these individuals also completed the Child Behavior Checklist and the interview form of the Scales of Independent Behavior-Revised. RESULTS: As a group, the participants evidenced considerable parent-reported EF difficulty. A profile of relative strength and weakness was found at the index level, with performance on both the Behavior Regulation Index and the Emotion Regulation Index significantly better than performance on the Cognitive Regulation Index. Within each index, a statistically significant pattern of relative strength and weakness also was identified. Difficulties with behaviour regulation and emotion regulation were related to both behaviour problems and adaptive behaviour limitations. Higher inflexibility and more difficulty with self-monitoring were associated with lower overall intellectual ability. Difficulty with inhibition was uniquely associated with attention problems, and inflexibility was uniquely associated with anxiety problems. CONCLUSIONS: Executive function difficulties are highly prevalent among children and adolescents with WS and are associated with adaptive behaviour limitations, both internalising and externalising behaviour problems and more limited intellectual ability. These results highlight the importance of designing and delivering research-based interventions to improve the EF of children and adolescents with WS.

Apolipoprotein E polymorphism influences orthotopic liver transplantation outcomes in patients with hepatitis C virus-induced liver cirrhosis.

BACKGROUND: Hepatitis C virus (HCV) infection is responsible for a chronic liver inflammation, which may cause end-stage liver disease and hepatocellular carcinoma. Apolipoprotein E (protein: ApoE, gene: APOE), a key player in cholesterol metabolism, is mainly synthesized in the liver and APOE polymorphisms may influence HCV-induced liver damage. AIM: To determine whether APOE alleles affect outcomes in HCV-infected patients with liver cirrhosis following orthotopic liver transplantation (OLT). METHODS: This was a cohort study in which 179 patients, both genders and aged 34-70 years, were included before or after (up to 10 years follow-up) OLT. Liver injury severity was assessed using different criteria, including METAVIR and models for end-stage liver disease. APOE polymorphisms were analyzed by quantitative real-time polymerase chain reaction. RESULTS: The APOE3 allele was the most common (67.3%). In inflammation severity of biopsies from 89 OLT explants and 2 patients in pre-transplant, the degree of severe inflammation (A3F4, 0.0%) was significantly less frequent than in patients with minimal and moderate degree of inflammation (≤ A2F4, 16.2%) P = 0.048, in patients carrying the APOE4 allele when compared to non-APOE4. In addition, a significant difference was also found (≤ A2F4, 64.4% vs A3F4, 0.0%; P = 0.043) and (A1F4, 57.4% vs A3F4, 0.0%; P = 0.024) in APOE4 patients when compared to APOE3 carriers. The fibrosis degree of the liver graft in 8 of 91 patients and the lack of the E4 allele was associated with more moderate fibrosis (F2) (P = 0.006). CONCLUSION: Our results suggest that the E4 allele protects against progression of liver fibrosis and degree of inflammation in HCV-infected patients.

Clinical characteristics and risk factors for mortality in obstetric patients with severe COVID-19 in Brazil: a surveillance database analysis.

OBJECTIVE: To describe clinical characteristics of pregnant and postpartum women with severe COVID-19 in Brazil and to examine risk factors for mortality. DESIGN: Cross-sectional study based on secondary surveillance database analysis. SETTING: Nationwide Brazil. POPULATION OR SAMPLE: 978 Brazilian pregnant and postpartum women notified as COVID-19 Acute Respiratory Distress Syndrome (ARDS) cases with complete outcome (death or cure) up to 18 June 2020. METHODS: Data was abstracted from the Brazilian ARDS Surveillance System (ARDS-SS) database. All eligible cases were included. Data on demographics, clinical characteristics, intensive care resources use and outcomes were collected. Risk factors for mortality were examined by multivariate logistic regression. MAIN OUTCOME MEASURES: Case fatality rate. RESULTS: We identified 124 maternal deaths, corresponding to a case fatality rate among COVID-19 ARDS cases in the obstetric population of 12.7%. At least one comorbidity was present in 48.4% of fatal cases compared with 24.9% in survival cases. Among women who died, 58.9% were admitted to ICU, 53.2% had invasive ventilation and 29.0% had no respiratory support. The multivariate logistic regression showed that the main risk factors for maternal death by COVID-19 were being postpartum at onset of ARDS, obesity, diabetes and cardiovascular disease, whereas white ethnicity had a protective effect. CONCLUSIONS: Negative outcomes of COVID-19 in this population are affected by clinical characteristics but social determinants of health also seem to play a role. It is urgent to reinforce containment measures targeting the obstetric population and ensure high quality care throughout pregnancy and the postpartum period. TWEETABLE ABSTRACT: A total of 124 COVID-19 maternal deaths were identified in Brazil. Symptoms onset at postpartum and comorbidities are risk factors.

Study protocol to investigate biomolecular muscle profile as predictors of long-term urinary incontinence in women with gestational diabetes mellitus.

BACKGROUND: Pelvic floor muscles (PFM) and rectus abdominis muscles (RAM) of pregnant diabetic rats exhibit atrophy, co-localization of fast and slow fibers and an increased collagen type I/III ratio. However, the role of similar PFM or RAM hyperglycemic-related myopathy in women with gestational diabetes mellitus (GDM) remains poorly investigated. This study aims to assess the frequency of pelvic floor muscle disorders and pregnancy-specific urinary incontinence (PS-UI) 12 months after the Cesarean (C) section in women with GDM. Specifically, differences in PFM/RAM hyperglycemic myopathy will be evaluated. METHODS: The Diamater is an ongoing cohort study of four groups of 59 pregnant women each from the Perinatal Diabetes Research Centre (PDRC), Botucatu Medical School (FMB)-UNESP (São Paulo State University), Brazil. Diagnosis of GDM and PS-UI will be made at 24-26 weeks, with a follow-up at 34-38 weeks of gestation. Inclusion in the study will occur at the time of C-section, and patients will be followed at 24-48 h, 6 weeks and 6 and 12 months postpartum. Study groups will be classified as (1) GDM plus PS-UI; (2) GDM without PS-UI; (3) Non-GDM plus PS-UI; and (4) Non-GDM without PS-UI. We will analyze relationships between GDM, PS-UI and hyperglycemic myopathy at 12 months after C-section. The mediator variables to be evaluated include digital palpation, vaginal squeeze pressure, 3D pelvic floor ultrasound, and 3D RAM ultrasound. RAM samples obtained during C-section will be analyzed for ex-vivo contractility, morphological, molecular and OMICS profiles to further characterize the hyperglycemic myopathy. Additional variables to be evaluated include maternal age, socioeconomic status, educational level, ethnicity, body mass index, weight gain during pregnancy, quality of glycemic control and insulin therapy. DISCUSSION: To our knowledge, this will be the first study to provide data on the prevalence of PS-UI and RAM and PFM physical and biomolecular muscle profiles after C-section in mothers with GDM. The longitudinal design allows for the assessment of cause-effect relationships between GDM, PS-UI, and PFMs and RAMs myopathy. The findings may reveal previously undetermined consequences of GDM.

Blood pressure control in a registry of clinical practice, PINNACLEBRAZIL REGISTRY

INTRODUCTION: The prevalence of hypertension is estimated to be nearly 50% among Brazilian adults. Achieving an adequate control of this CVD risk factor is challenging but truly relevant on a public health perspective, as this is the top ranking cause of all deaths globally. PURPOSE: We aimed to describe crude and simple metrics of blood pressure management (including its control), as based on current guidelinederived recommendations, after one year of the clinical practice registry METHODS: Patients with documented Hypertension were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. The main goal of the PINNACLE program is to improve the quality of care in "real world" clinical practice. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated RESULTS: Currently, PINNACLEBrazil has enrolled 7598 patients, with 87% of diagnosed hypertension. Percentage of patients with a diagnosis of hypertension who had a blood pressure measurement <140/90 mmHg was 47.9%(baseline) and 57.3% (followup). Percentage of patients who had a blood pressure < 140/90 mm Hg, or who had a blood pressure >= 140/90 mm Hg and were prescribed >= 2 antihypertensive medications were 67.1% on baseline and 71.2% after 1 year. CONCLUSION: The preliminary data of PINNACLE Registry in Brazil shows that a significant proportion of hypertensive patients (nearly half) have not presented with adequate control of blood pressure levels and, moreover, a large proportion have not been treated with recommended combination of 02 or more antihypertensive medications to reach targeted BP levels the quality of care was improving after 01 year of registry. (AU)

Evolution of the use of antioxidants in anti-ageing cosmetics.

OBJECTIVE: Skin health and beauty are a cornerstone of general well-being in humans. Anti-ageing cosmetics are used to provide a healthy and youthful appearance. Among the different cosmetic actives, antioxidants are incorporated in anti-ageing products due to their beneficial effects in preventing and minimizing the signs of skin ageing. This work aims to understand how anti-ageing formulations changed in the past 7 years regarding pure antioxidants composition. METHODS: Data were collected from anti-ageing formulations commercialized in main stores and pharmacies in the Portuguese market. The study started on 2011 and was updated with products launched or whose composition has been renewed on 2013, 2015 or 2018. RESULTS: Ascorbic acid and tocopherol and their derivatives were consistently the most used antioxidants in anti-ageing formulations; followed by niacinamide and retinyl palmitate. Seven ascorbic acid derivatives are currently used in anti-ageing formulations while only three tocopherol derivatives were identified in this study. Several combinations of antioxidants were routinely found, mainly tocopherol (or tocopherol derivatives) with other antioxidants and tocopherol with tocopherol derivatives. We have not identified emerging antioxidants with great impact in anti-ageing formulations even though niacinamide and retinyl palmitate exhibited over 10% more usage in 2018. CONCLUSION: This insight is relevant to the cosmetic industry providing a better understanding of the scientific-based formulation of modern cosmetics and supports the need for innovative antioxidants in anti-ageing cosmetics.

OBJECTIF: La santé de la peau et la beauté constituent la base du bien-être général chez l'homme. Les cosmétiques anti-âge sont utilisés pour donner une apparence saine et jeune. Parmi les différents principes actifs des cosmétiques, des antioxydants sont incorporées dans les produits anti-âge en raison de leur effet bénéfique sur la prévention et la réduction des signes de vieillissement de la peau. Ce travail vise à comprendre comment les formulations anti-âge ont évolué au cours des 7 dernières années au niveau des antioxydants purs composition. MÉTHODES: Les données ont été recueillies sur des formulations anti-âge commercialisées dans les principaux magasins et pharmacies du marché portugais. Cette étude a commencé en 2011 et a été mise à jour avec des produits mis sur le marché ou dont la composition a été renouvelée en 2013, 2015 ou 2018. RÉSULTATS: L'acide ascorbique et tocophérol et leurs dérivés sont systématiquement les antioxydants les plus utilisés dans les formulations anti-âge; ils sont suivis de la niacinamide et du palmitate de rétinol. Sept dérivés d'acide ascorbique sont actuellement utilisés pour lutter contre le vieillissement, tandis que seulement trois dérivés de tocophérol ont été identifiés dans cette étude. Plusieurs combinaisons d'antioxydants ont été systématiquement observées, principalement le tocophérol ou les dérivés de tocophérol avec d'autres antioxydants, et le tocophérol avec des dérivés de tocophérol. Nous n'avons pas identifié de nouveaux antioxydants présentant un impact majeur dans les formulations anti-âge, même si la niacinamide et le palmitate de rétinol ont vu leur utilisation augmenter de 10% en 2018. CONCLUSION: Cette perspective est pertinente pour le secteur des cosmétiques. Elle permet de mieux comprendre la formulation scientifique des cosmétiques modernes et confirme le besoin d'innover au niveau des antioxydants utilisés dans les produits anti-âge. Les cosmétiques anti-âge sont utilisés pour donner une apparence saine et jeune. Parmi les différents actifs cosmétiques, les antioxydants sont incorporés dans les produits anti-âge en raison de leurs effets bénéfiques dans la prévention et la réduction des signes du vieillissement cutané. Ce travail vise à comprendre comment les formulations anti - vieillissement ont changé au cours des 7 dernières années en ce qui concerne la composition en antioxydants purs.

Linear and volumetric gain after vertical bone augmentation in the posterior mandible using an autologous cortical tenting method.

This study was performed to evaluate the linear and volumetric effects of a technique for reconstruction of the posterior atrophic mandible, including the final bone gain of the graft, by three-dimensional assessment. Thirteen individuals were recruited into the study and submitted to a total of 15 mandibular autogenous bone block surgeries. Cone beam computed tomography images were obtained at three different times. Bone graft length and thickness, and the volume, height, and width of the graft were measured. Data were compared statistically among the time points using the Friedman test, and cluster analysis was performed to identify the association between the study variables and the resorption rate (α = 0.05). Linear analysis of the width and height of the recipient area at the different time points revealed a statistically significant difference. The final average increase in height was 1.6 mm; all subjects showed an average volume gain of 3.412mm3, and 77% of the subjects showed an average graft resorption of 0.688mm3 construction of three-dimensional vertical defects of the posterior mandible resulted in good healing with minimal complications and minimal bone graft resorption, favouring vertical bone gain.

Distinguishing melanocytic nevi from melanomas using static and dynamic infrared thermal imaging.

BACKGROUND: The incidence rates of melanoma have risen to worrying levels over the last decade. Delayed diagnosis, due to faults on the detection stage, indicates the necessity of new aiding diagnosis techniques. Since metabolic activity is highly connected to neoplasia formation, a detection technique that focuses its results on vascular responses, as Infrared thermal (IRT), seems to be a viable option. MATERIALS AND METHODS: Static and dynamic (cooling) thermal images of melanoma and melanocytic nevi lesions were collected and analysed to retrieve thermal parameters characteristic of this skin lesion types. The steady-state and dynamic variables were tested separately with different machine learning classifiers to verify whether the distinction of melanoma and nevi lesions was achievable. RESULTS: The differentiation of both types of skin tumours was doable, achieving an accuracy of 84.2% and a sensitivity of 91.3% with the implementation of a learner based on support vector machines and an input vector composed by static variables. CONCLUSION: The use of IRT for skin tumour classification is achievable, but some improvement is needed to raise the metrics of sensitivity and specificity. For future work, it is recommended the study of dynamic parameters for the classification of other types of skin neoplasia.

Characteristics of 1555 childhood-onset lupus in three groups based on distinct time intervals to disease diagnosis: a Brazilian multicenter study.

Objective The objective of this study was to compare demographic data, clinical/laboratorial features and disease activity at diagnosis in three different groups with distinct time intervals between onset of signs/symptoms and disease diagnosis. Methods A multicenter study was performed in 1555 childhood-onset systemic lupus erythematosus (American College of Rheumatology criteria) patients from 27 pediatric rheumatology services. Patients were divided into three childhood-onset systemic lupus erythematosus groups: A: short time interval to diagnosis (<1 month); B: intermediate time interval (≥1 and <3 months); and C: long time interval (≥3 months). An investigator meeting was held to define the protocol. Demographic data, SLICC classification criteria and SLEDAI-2 K were evaluated. Results The number of patients in each group was: A = 60 (4%); B = 522 (33.5%); and C = 973 (62.5%). The median age at diagnosis (11.1 (4.2-17) vs. 12 (1.9-17.7) vs. 12.5 (3-18) years, P = 0.025) was significantly lower in group A compared with groups B and C. The median number of diagnostic criteria according to SLICC (7 (4-12) vs. 6 (4-13) vs. 6 (4-12), P < 0.0001) and SLEDAI-2 K (18 (6-57) vs. 16 (2-63) vs. 13 (1-49), P < 0.0001) were significantly higher in group A than the other two groups. The frequency of oral ulcers in the palate (25% vs. 15% vs. 11%, P = 0.003), pleuritis (25% vs. 24% vs. 14%, P < 0.0001), nephritis (52% vs. 47% vs. 40%, P = 0.009), neuropsychiatric manifestations (22% vs. 13% vs. 10%, P = 0.008), thrombocytopenia (32% vs. 18% vs. 19%, P = 0.037), leucopenia/lymphopenia (65% vs. 46% vs. 40%, P < 0.0001) and anti-dsDNA antibodies (79% vs. 66% vs. 61%, P = 0.01) were significantly higher in group A compared with the other groups. In contrast, group C had a less severe disease characterized by higher frequencies of synovitis (61% vs. 66% vs. 71%, P = 0.032) and lower frequencies of serositis (37% vs. 33% vs. 25%, P = 0.002), proteinuria >500 mg/day (48% vs. 45% vs. 36%, P = 0.002) and low complement levels (81% vs. 81% vs. 71%, P < 0.0001) compared with groups A or B. Conclusions Our large Brazilian multicenter study demonstrated that for most childhood-onset systemic lupus erythematosus patients, diagnosis is delayed probably due to mild disease onset. Conversely, the minority has a very short time interval to diagnosis and a presentation with a more severe and active multisystemic condition.

Recent use of medical infrared thermography in skin neoplasms.

BACKGROUND: Infrared thermal imaging captures the infrared radiation emitted by the skin surface. The thermograms contain valuable information, since the temperature distribution can be used to characterize physiological anomalies. Thus, the use of infrared thermal imaging (IRT) has been studied as a possible medical tool to aid in the diagnosis of skin oncological lesions. The aim of this review is to assess the current state of the applications of IRT in skin neoplasm identification and characterization. METHODS: A literature survey was conducted using the reference bibliographic databases: Scopus, PubMed and ISI Web of Science. Keywords (thermography, infrared imaging, thermal imaging and skin cancer) were combined and its presence was verified at the title and abstract of the article or as a main topic. Only articles published after 2013 were considered during this search. RESULTS: In total, 55 articles were encountered, resulting in 14 publications for revision after applying the exclusion criteria. It was denoted that IRT have been used to characterize and distinguish between malignant and benign neoplasms and different skin cancer types. IRT has also been successfully applied in the treatment evaluation of these types of lesions. CONCLUSION: Trends and future challenges have been established to improve the application of IRT in this field, disclosing that dynamic thermography is a promising tool for early identification of oncological skin conditions.

Mini Fiberglass Post for Ankylosed Tooth Reconstruction: A Clinical Technique.

It was possible to restore the shape and function of a severely ankylosed tooth by fabricating a ceramic crown for placement on a resin reconstruction supported by mini fiberglass posts. By increasing the retention of the morphological reconstruction for the future support of indirect restorations, cementable intradentinal fiberglass posts enhance the longevity of these restorations. Ultimately, all proposals that seek to improve the long-term prognosis of restorations on ankylosed teeth, especially severely impacted ones, are of extreme clinical relevance.

Detection of the antiviral activity of epicatechin isolated from Salacia crassifolia (Celastraceae) against Mayaro virus based on protein C homology modelling and virtual screening.

Mayaro fever, caused by Mayaro virus (MAYV) is a sub-lethal disease with symptoms that are easily confused with those of dengue fever, except for polyarthralgia, which may culminate in physical incapacitation. Recently, outbreaks of MAYV have been documented in metropolitan areas, and to date, there is no therapy or vaccine available. Moreover, there is no information regarding the three-dimensional structure of the viral proteins of MAYV, which is important in the search for antivirals. In this work, we constructed a three-dimensional model of protein C of MAYV by homology modelling, and this was employed in a manner similar to that of receptors in virtual screening studies to evaluate 590 molecules as prospective antiviral agents. In vitro bioassays were utilized to confirm the potential antiviral activity of the flavonoid epicatechin isolated from Salacia crassifolia (Celastraceae). The virtual screening showed that six flavonoids were promising ligands for protein C. The bioassays showed potent antiviral action of epicatechin, which protected the cells from almost all of the effects of viral infection. An effective concentration (EC50) of 0.247 µmol/mL was observed with a selectivity index (SI) of 7. The cytotoxicity assay showed that epicatechin has low toxicity, with a 50% cytotoxic concentration (CC50) greater than 1.723 µmol/mL. Epicatechin was found to be twice as potent as the reference antiviral ribavirin. Furthermore, a replication kinetics assay showed a strong inhibitory effect of epicatechin on MAYV growth, with a reduction of at least four logs in virus production. Our results indicate that epicatechin is a promising candidate for further testing as an antiviral agent against Mayaro virus and other alphaviruses.