Factors associated to mortality in children with critical COVID-19 and multisystem inflammatory syndrome in a resource-poor setting.

SARS-CoV-2 infection in children is usually asymptomatic/mild. However, some patients may develop critical forms. We aimed to describe characteristics and evaluate the factors associated to in-hospital mortality of patients with critical COVID-19/MIS-C in the Amazonian region. This multicenter prospective cohort included critically ill children (1 mo-18 years old), with confirmed COVID-19/MIS-C admitted to 3 tertiary Pediatric Intensive Care Units (PICU) in the Brazilian Amazon, between April/2020 and May/2023. The main outcome was in-hospital mortality and were evaluated using a multivariable Cox proportional regression. We adjusted the model for pediatric risk of mortality score version IV (PRISMIV) score and age/comorbidity. 266 patients were assessed with 187 in the severe COVID-19 group, 79 included in the MIS-C group. In the severe COVID-19 group 108 (57.8%) were male, median age was 23 months, 95 (50.8%) were up to 2 years of age. Forty-two (22.5%) patients in this group died during follow-up in a median time of 11 days (IQR, 2-28). In the MIS-C group, 56 (70.9%) were male, median age was 23 months and median follow-up was 162 days (range, 3-202). Death occurred in 17 (21.5%) patients with a median death time of 7 (IQR, 4-13) days. The mortality was associated with higher levels of Vasoactive Inotropic-Score (VIS), presence of acute respiratory distress syndrome (ARDS), higher levels of Erythrocyte Sedimentation Rate, (ESR) and thrombocytopenia. Critically ill patients with severe COVID-19 and MIS-C from the Brazilian Amazon showed a high mortality rate, within 12 days of hospitalization.

Searching for Metabolic Markers of Stroke in Human Plasma via NMR Analysis.

More than 12 million people around the world suffer a stroke every year, one every 3 s. Stroke has a variety of causes and is often the result of a complex interaction of risk factors related to age, genetics, gender, lifestyle, and some cardiovascular and metabolic diseases. Despite this evidence, it is not possible to prevent the onset of stroke. The use of innovative methods for metabolite analysis has been explored in the last years to detect new stroke biomarkers. We use NMR spectroscopy to identify small molecule variations between different stages of stroke risk. The Framingham Stroke Risk Score was used in people over 63 years of age living in long-term care facilities (LTCF) to calculate the probability of suffering a stroke. Using this parameter, three study groups were formed: low stroke risk (LSR, control), moderate stroke risk (MSR) and high stroke risk (HSR). Univariate statistical analysis showed seven metabolites with increasing plasma levels across different stroke risk groups, from LSR to HSR: isoleucine, asparagine, formate, creatinine, dimethylsulfone and two unidentified molecules, which we termed "unknown-1" and "unknown-3". These metabolic markers can be used for early detection and to detect increasing stages of stroke risk more efficiently.

Doença de chagas aguda: Um relato de experiência no município de crateús / Acute chagas disease: An experience report in the municipality of crateús

Objective: To report the experience of analyzing the epidemiological profile of patients with Acute Chagas disease in the municipality of Crateús-Ceará. Method: This is an experience report. The technical visit to the health department was in September 2022. The compulsory notification form of the patient diagnosed with Acute Chagas Disease was analyzed. Results: The epidemiological profile of the patient diagnosed with Acute Chagas Disease was identified, being: male, 42 years old, born in the rural area of Crateús - Ceará, unknown race, agricultural worker, arrived at the health unit with suspicions of acute symptoms of Chagas disease according to the notification form of injuries, made on August 02, 2022. Conclusion: Acute Chagas disease is considered a neglected disease, since it demonstrates human poverty, presenting a high morbidity and mortality rate in the endemic region.(AU)

Objetivo: Relatar a experiência de análise do perfil epidemiológico dos pacientes com doença de Chagas Aguda no município de Crateús-Ceará. Método: Trata-se de um relato de experiência. A visita técnica à secretaria de saúde ocorreu em setembro de 2022. Foi analisada a ficha de notificação compulsória do paciente diagnosticado com Doença de Chagas Aguda. Resultados: Identificou-se o perfil epidemiológico do paciente diagnosticado com Doença de Chagas Aguda, sendo: sexo masculino, 42 anos, natural da zona rural de Crateús - Ceará, raça desconhecida, trabalhador rural, chegou à unidade de saúde com suspeita de sintomas agudos da doença de Chagas conforme ficha de notificação de agravos, realizada em 02 de agosto de 2022. Conclusão: A doença de Chagas aguda é considerada uma doença negligenciada, pois demonstra pobreza humana, apresentando alto índice de morbimortalidade na região endêmica.(AU)

Diagnosis and treatment of systemic mastocytosis in Brazil: Recommendations of a multidisciplinary expert panel

ABSTRACT Introduction: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. Objective: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. Method and results: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. Conclusion: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.

Diagnosis and treatment of systemic mastocytosis in Brazil: Recommendations of a multidisciplinary expert panel.

INTRODUCTION: Systemic Mastocytosis comprises a group of neoplastic diseases characterized by clonal expansion and infiltration of mast cells into several organs. The diagnosis and treatment of this disease may be challenging for non-specialists. OBJECTIVE: Make suggestions or recommendations in Systemic Mastocytosis based in a panel of Brazilian specialists. METHOD AND RESULTS: An online expert panel with 18 multidisciplinary specialists was convened to propose recommendations on the diagnosis and treatment of Systemic Mastocytosis in Brazil. Recommendations were based on discussions of topics and multiple-choice questions and were graded using the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence Chart. CONCLUSION: Twenty-two recommendations or suggestions were proposed based on a literature review and graded according to the findings.

Nationwide questionnaire data of 229 Williams-Beuren syndrome patients using WhatsApp tool.

BACKGROUND: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. OBJECTIVE: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. METHODS: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. RESULTS: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. CONCLUSIONS: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

Nationwide questionnaire data of 229 Williams-Beuren syndrome patients using WhatsApp tool / Resultados de um questionário nacional de 229 pacientes com síndrome de Williams-Beuren obtidos por WhatsApp

ABSTRACT Background: Williams-Beuren syndrome is a multisystemic disorder caused by a microdeletion of the 7q11.23 region. Although familial cases with autosomal dominant inheritance have been reported, the vast majority are sporadic. Objective: To investigate the main complaints and clinical findings of patients with Williams-Beuren syndrome. Methods: A total of 757 parents of patients registered in the Brazilian Association of Williams-Beuren Syndrome (ABSW) received a questionnaire via WhatsApp from March to July 2017. Results: In total, 229 parents answered the survey. Age of diagnosis ranged from 2 days to 34 years (median: 3 years). The main clinical findings reported by the parents were abdominal colic (83.3%), failure to thrive (71.5%), feeding difficulty in the first year (68.9%), otitis (56.6%), urinary tract infections (31.9%), precocious puberty (27.1%) and scoliosis (15.9%). Cardiac defects were present in 66% of patients, and the most frequent defect was supravalvular aortic stenosis (36%). Arterial hypertension was reported in 23%. Hypercalcemia was reported in 10.5% of patients, mainly during the first year of life. Hyperacusis and hypersociability were common complaints (both present in 89%). Other behavioral and neuropsychiatric symptoms reported by the parents included attention deficit (89%), anger crises (83%), excessive fear (66%), depression (64%), anxiety (67%) and hypersexuality (33%). The most common complaints were hypersensitivity to sounds, talkative personality, emotional dependence and learning difficulties. In 98.3%, the parents denied family history. Conclusions: Williams-Beuren syndrome requires close follow-up with different medical specialties due to their variable clinical comorbidities, including language and school learning difficulties, behavioral and psychiatric problems.

RESUMO Antecedentes: A síndrome de Williams-Beauren é doença de acometimento multisistêmico causado pela microdeleção da região 7q11.23. Apesar de haver casos familiares com herança autossômica dominante, a grande maioria dos casos é esporádica. Objetivo: Investigar as principais queixas e achados clínicos da síndrome. Métodos: 757 pais de pacientes inscritos na Associação Brasileira de Síndrome de Williams-Beuren (ABSW) receberam um questionário pelo WhatsApp, entre março e julho de 2017. Resultados: 229 pais de pacientes responderam à pesquisa. A idade de diagnóstico variou de 2 dias até 34 anos (mediana: 3 anos). Os principais achados reportados pelos pais: cólicas abdominais (83,3%), deficiência ponderoestatural (71,5%), dificuldade de alimentação no primeiro ano (68,9%), otite (56,6%), infecções do trato urinário (31,9%), puberdade precoce (27,1%) e escoliose (15,9%). Cardiopatias estavam presentes em 66%, sendo que a mais frequente era a estenose pulmonar supravalvar (36%). Hipertensão arterial foi reportada em 23%. Hipercalcemia foi reportada em 10,5%, principalmente no primeiro ano de vida. Hiperacusia e hiperssociabilidade foram achados comuns (89%). Os principais achados comportamentais e psiquiátricos reportados pelos pais foram: déficit de atenção (89%), crises de raiva (83%), medo excessivo (66%), depressão (64%), ansiedade (67%) e hiperssexualidade (33%). As queixas principais referidas foram hipersensibilidade a sons, personalidade excessivamente amigável, dependência emocional e dificuldades escolares. Em 98,3% dos casos os pais negaram história familial. Conclusões: A síndrome de Williams-Beuren é requer um seguimento e manejo estritos, com diferentes especialidades médicas devido às comorbidades clínicas variadas, que incluem dificuldades de linguagem e aprendizagem escolar, além de dificuldades comportamentais e psiquiátricas.

Mini Hyrax vs Hyrax expanders in the rapid palatal expansion in adolescents with posterior crossbite: a randomized controlled clinical trial.

PURPOSE: The aim of this study was to compare the dental effects, impact on quality of life, and pain perception of adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion. METHODS: Thirty-four adolescents aged 11 to 16 years, with maxillary transverse deficiency (unilateral or bilateral posterior crossbite), were randomly allocated into two groups, Mini Hyrax group and Hyrax group (1:1 ratio). Dental effects were evaluated by digitally superimposed pretreatment and postretention three-dimensional intraoral scans on the palatal rugaes using the software 3DSlicer. Impact on quality of life was assessed with the OHIP-14 questionnaire applied in the pretreatment, posttreatment and postretention. Visual analog scale was applied 24, 48, and 72 h and 7 days after the first activation of the expander. RESULTS: Thirty of the 34 adolescents recruited completed the study. There were no statistically significant differences in dentoalveolar effects between groups. OHIP-14 scores across time among Mini Hyrax wearers were similar to those of the Hyrax wearers. The inter-group comparisons showed no difference between groups with respect to the OHIP-14 scores in posttreatment and postretention (p > 0.05). There were no differences in pain perception between groups. Considering intra-group comparison, the reduction in pain perception among adolescents in the Mini Hyrax group was gradual. Among adolescents in the Hyrax group, a statistically significant reduction between 48 and 72 h was observed. CONCLUSION: There were no significant differences in dental effects, impact on quality of life and pain perception between adolescents wearing Mini Hyrax and Hyrax expanders in rapid palatal expansion.

Current Evidence Regarding Low-carb Diets for The Metabolic Control of Type-2 Diabetes.

The management of diabetes requires a medical nutrition therapy as an essential part of this treatment. There should be no "one-size-fits-all" eating pattern for different patient´s profiles with diabetes. It is clinically complex to suggest an ideal percentage of calories from carbohydrates, protein and lipids recommended for all patients with diabetes. Among the eating patterns that have shown beneficial effects on metabolic control of patients with type 2 diabetes is the lowcarb diet, since the carbohydrate ingestion is viewed as the most important determinant of postprandial glucose and insulin response. In this context, theoretically, it could make sense to reduce the daily amount of carbohydrates ingested, to achieve lower levels of HbA1c. There could be risks associated to this approach. The adherence to a low-carb diet is here also discussed. This narrative review shows on the current evidence for answering these questions regarding low-carb diet as a possible alternative eating pattern for type 2 diabetes.

Three-dimensional nasal septum and maxillary changes following rapid maxillary expansion in patients with cleft lip and palate.

OBJECTIVES: To determine the three-dimensional changes of the nasal septum (NS), alveolar width, alveolar cleft volume, and maxillary basal bone following rapid maxillary expansion (RME) in consecutive patients with unilateral cleft lip and palate (UCLP). MATERIALS AND METHODS: A retrospective investigation was conducted based on the analysis of cone-beam computed tomography (CBCT) data of 40 consecutive patients with UCLP (mean age 11.1 ± 2.2 years). Scans were acquired prior to RME (T0) and after removal of the expander (T1) before graft surgery. A three-dimensional analysis of the effects of RME on the nasal septum, alveolar width, alveolar cleft volume, and maxillary basal bone was performed. RESULTS: No changes in the NS deviation were observed following RME (P > .05). Significant increases of the alveolar transverse dimension were found in the anterior (14.2%; P < .001) and posterior (7.7%; P < .001) regions as well as in the volume of the alveolar cleft (19.6%; P < .001). No changes in the basal bone dimensions and morphology were observed (P > .05). CONCLUSIONS: Following RME, no changes were observed in the NS and maxillary basal bones of patients with UCLP despite the significant gain in the anterior and posterior alveolar width and the increase of the alveolar cleft defect. Clinicians should be aware that maxillary changes following RME in patients with UCLP are restricted to the dentoalveolar region.

CD45RA, CD8ß, and IFNγ Are Potential Immune Biomarkers of Human Cognitive Function.

There is increasing evidence that in humans the adaptive immunological system can influence cognitive functions of the brain. We have undertaken a comprehensive immunological analysis of lymphocyte and monocyte populations as well as of HLA molecules expression in a cohort of elderly volunteers (age range, 64-101) differing in their cognitive status. Hereby, we report on the identification of a novel signature in cognitively impaired elderly characterized by: (1) elevated percentages of CD8+ T effector-memory cells expressing high levels of the CD45RA phosphate receptor (Temra hi); (2) high percentages of CD8+ T cells expressing high levels of the CD8ß chain (CD8ßhi); (3) augmented production of IFNγ by in vitro activated CD4+ T cells. Noteworthy, CD3+CD8+ Temra hi and CD3+CD8ßhi cells were associated with impaired cognition. Cytomegalovirus seroprevalence showed that all volunteers studied but one were CMV positive. Finally, we show that some of these phenotypic and functional features are associated with an increased frequency of the HLA-B8 serotype, which belongs to the ancestral haplotype HLA-A1, Cw7, B8, DR3, DQ2, among cognitively impaired volunteers. To our knowledge, this is the first proof in humans linking the amount of cell surface CD45RA and CD8ß chain expressed by CD8+ Temra cells, and the amount of IFNγ produced by in vitro activated CD4+ T cells, with impaired cognitive function in the elderly.

Takayasu arteritis: showed by a hypertensive crisis

Takayasu Arteritis (TA) is a primary granulomatous large vessel vasculitis, affecting predominantly young women1. It mainly affects the aorta and its major branches. TA and the required immunosuppressive therapy cause considerable morbidity and mortality2. Early in the disease course, symptoms can be non-specific, leading to a difficult diagnosis3. Consequences of vascular stenosis, occlusions, and, less commonly, vascular dilation, account for the typical clinical presentation; the latter can sometimes lead to aneurysmal rupture or dissection. Though the importance of a comprehensive history and a thorough physical examination cannot be over-emphasized, clinical assessment is frequently inaccurate when evaluating disease activity, which may sometimes progress silently. Also the diagnostic modalities currently used are unsatisfactory. X-Ray angiography, the "gold standard" for TA diagnosis, can image luminal defects but does not detect changes of the vessel wall4. The diagnosis of TA can be confirmed with histopathological examination; however, tissue from blood vessels is obtained only in the minority of patients requiring a surgical intervention. There are currently no specific biomarkers for diagnosing TA. Identifying disease activity in TA is challenging3.Glucocorticosteroids are anchor drugs for this disease, like other vasculitis. Most cases in Japan respond with 0.3-0.5 mg/kg/day prednisolone, but we frequently found that some patients revealed flare-ups during tapering of glucocorticosteroids. Since TAK mainly affects young women, side-effects of glucocorticosteroids, especially moon face, severely damage their quality of life. Immunosuppressive agents, including methotrexate, cyclosporine, cy-clophosphamide, mycophenolate mofetil and TACROLIMUS have been used for patients with TAK. Biological agents targeting tumor necrosis factor (TNF) have also been used for patients with TAK. Since IL-6 is highly expressed within inflamed arteries and serum levels correlate with disease activity, block-ing IL-6 showed effectiveness in TA. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor, and the first report of successful use of tocilizumab in a patient with refractory TA was published in 2008. Later, nine additional cases of TA treated with tocilizumab 8 mg/kg every 4 weeks were reported. In the majority of the cases, disease activity improved and CS doses were discontinued or tapered. Abatacept is another promising biologic agent inhibiting the co-stimulation of T cells, and is currently being investigated in the first randomized, placebo-controlled trial of LVV patients including TA7.This article aims the description of a clinical case of a serious appearance form of an uncommon disease, Takayasu's arteritis

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Débito cardíaco disminuido: mapeo cruzado de las intervenciones de enfermería y su contribución en la práctica clínica / Heart debit decreased: cross-mapping of nursing interventions and their contribution in clinical practice / Débito cardíaco diminuído: mapeamento cruzado das intervenções de enfermagem e sua contribuição na prática clínica

Objetivo: Analizar el uso de las intervenciones propuestas por la Clasificación de las Intervenciones de Enfermería indicadas para el Diagnóstico de Enfermería débito cardíaco disminuido en Unidad de Cuidados Intensivos Pediátrica. Métodos: Estudio descriptivo y exploratorio realizado con 11 enfermeros de la Unidad de Cuidados Intensivos Pediátrica de un hospital en São Luís - Maranhão, de septiembre de 2016 a octubre de 2017. El levantamiento y el análisis de los datos se realizaron en tres momentos: levantamiento de las actividades de enfermería junto a los enfermeros de la Unidad de Cuidados Intensivos Pediátrica; mapeo cruzado y análisis y refinamiento de los datos por enfermeros expertos. Resultados: Se identificaron 113 actividades descritas por los enfermeros, asignadas para 38 actividades de la NIC, contenida sen 11 intervenciones. Cuidados del corazón; Cuidados cardíacos: fase aguda, y Regulación hemodinâmica fueron las intervenciones que presentaron mayor número de actividades relatadas. Conclusiones: El análisis de los datos permitió verificar que para todas las actividades relatadas por las enfermeras, se encontraron actividades equivalentes em la NIC para el diagnóstico trabajado

Objective: Analyze the use of the interventions proposed by the Classification of Nursing Interventions indicated for the Diagnosis of Nursing cardiac output decreased in Pediatric Intensive Care Unit. Methods: A descriptive and exploratory study was carried out with 11 nurses from the Pediatric Intensive Care Unit of a hospital in São Luís - Maranhão, from September 2016 to October 2017. Data collection and analysis were performed in three moments: survey of nursing activities with nurses from the Pediatric Intensive Care Unit; cross-mapping and data analysis and refinement by expert nurses. Results: Were identified 113 activities described by nurses, mapped to 38 Classification of Nursing Interventions activities, contained in 11 interventions. Cardiac care; Cardiac care: acute phase, and Hemodynamic regulation were the interventions that presented the highest number of reported activities. Conclusions: The analysis of the data allowed to verify that for all the activities reported by the nurses, equivalent activities were found in the Classification of Nursing Interventions for the diagnosis worked

Objetivo: Analisar o uso das intervenções propostas pela Classificação das Intervenções de Enfermagem indicadas para o Diagnóstico de Enfermagem débito cardíaco diminuído em Unidade de Terapia Intensiva Pediátrica. Métodos: Estudo descritivo e exploratório realizado com 11 enfermeiros da Unidade de Terapia Intensiva Pediátrica de um hospital em São Luís - Maranhão, de setembro de 2016 a outubro de 2017. O levantamento e a análise dos dados foram realizados em três momentos: levantamento das atividades de enfermagem junto aos enfermeiros da Unidade de Terapia Intensiva Pediátrica; mapeamento cruzado e análise e refinamento dos dados por enfermeiros experts. Resultados: Identificou-se 113 atividades descritas pelos enfermeiros, mapeadas para 38 atividades da Classificação das Intervenções de Enfermagem, contidas em 11 intervenções. Cuidados cardíacos; Cuidados cardíacos: fase aguda e Regulação hemodinâmica foram as intervenções que apresentaram maior número de atividades relatadas. Conclusões: A análise dos dados permitiu verificar que para todas as atividades relatadas pelas enfermeiras, foram encontradas atividades equivalentes na Classificação das Intervenções de Enfermagem para o diagnóstico trabalhado

Can a physical activity similar to activities of daily living cause dynamic hyperinflation and change the thoracoabdominal configuration in patients with chronic obstructive pulmonary disease?

Introduction: COPD is characterized by the ventilatory limitation, with reduction of the inspiratory reserve volume and dynamic hyperinflation (DH), which changes the configuration of the thoracic compartment, resulting in a disadvantage in respiratory muscle kinetics, and reduced functional capacity. The optoelectronic plethysmography (OEP) has been used to monitor changes in thoracoabdominal mobility. The Glittre-ADL test is a short battery of functional tests that simulate activities of daily living. In mild and moderate COPD, the effect of Glittre-ADL on thoracoabdominal kinetics and DH is understudied. Objective: The aim of our study was to evaluate the acute effects of the Glittre-ADL test on lung function and thoracoabdominal mobility using OEP in patients with mild and moderate COPD. Materials and methods: Twenty-five male and female patients between 45 and 80 years of age with COPD were submitted to the exercises that simulated Glittre-ADL test. Spirometry and OEP were performed before and after the test. Results: After the Glittre test, increases were found in EV (p=0.005), percentage of contribution of the abdominal compartment (p=0.054) and expiratory reserve volume (ERV) (p=0.006) and reductions were found in the contribution of the upper thoracic compartment (p=0.008) and inspiratory capacity (IC) (p=0.040). Conclusion: The acute effect of ADL was a change in thoracoabdominal kinetics, especially the percentage of contribution of the abdominal compartment, as demonstrated by OEP. These findings, together with the reduction in IC and increase in ERV, after the Glittre-ADL test suggest the occurrence of DH, even in patients with mild to moderate COPD according to the GOLD classification.

Characterization of Portuguese honey from Castelo Branco region according to their pollen spectrum, physicochemical characteristics and mineral contents.

The aim of this work was to evaluate the quality of 16 honey samples from Castelo Branco region (Portugal). Twelve are monofloral from Calluna vulgaris, Erica, Lavandula, Echium and Campanula. The mean values obtained for physicochemical parameters were: 3.82 pH; 16.80% moisture; 81.6°Brix; 0.21% ash; 357.6 µS cm-1 electrical conductivity; 33.7 meq/kg free acidity; 5.7 meq/kg lactonic acidity; 39.3 meq/kg total acidity; 9.11 mg/kg HMF; 21.3 IN invertase and 9.0° Gothe for diastase activities. The results indicate a good quality, adequate processing, good maturity and freshness of honey. Additionally, the determination of mineral contents revealed that the K was the major element. Mean values obtained were (mg/kg): Ca, 28.36; K, 701.87; Mg, 74.00; Na, 31.04; Fe, 097; Cu, 0.65; Zn, 1.23; Mn, 2.78 and P, 48.80. Among the overall determined parameters, CB2 stands out by its high values in minerals, pH, moisture, ash, electrical conductivity and enzyme activity.

Estratégias educativas para pessoas com estomia intestinal: revisão integrativa / Educational strategies for people with ostomy bowel: integrative review

Objetiva-se analisar o conhecimento científico sobre as estratégias educativas empregadas pela enfermagem para o ensino-apredizagem das pessoas com estomia intestinal. Trata-se de uma revisão integrativa realizada nas bases de dados PubMed, LILACS e CINAHL, entre 1996 a 2014. Obteve-se amostra de 11 estudos. O Brasil liderou o numero de publicações e dos artigos incluídos na revisão e todos foram publicados em periódicos de enfermagem. Estes dados revelam o envolvimento dos enfermeiros com a temática em questão. O uso de tecnologias educativas foi identificado em sete estudos que desenvolveram atividades de cunho individual e/ou em grupo por meio de uma abordagem interativa. Foi realizada em consultas ambulatoriais ou apenas pela distribuição de materiais educativos, como: cartilhas, materiais educativos impressos, cursos on-line e programas multimídias, intensificando os cuidados com pele periestoma e/ou reforçando os cuidados gerais. Para que o processo de ensino aprendizagem seja efetivo no campo da saúde, os recursos didáticos empregados devem capacitar e motivar os pacientes com vistas a conseguirem incorporar novos significados, propiciando mais autonomia. Esta revisão permitiu identificar que estratégias de educação com o uso de tecnologias educativas são mais consistentes nas mensagens transmitidas ocasionando rápida mudança de comportamento

The study aimed to analyze the scientific knowledge of the educational strategies used by nurses for teachinglearning programs for ostomy people. This is an integrative review carried out in the databases: PubMed, LILACS, SciELO and CINAHL from 1996 to 2014, was obtained sample of 11 studies. Brazil led the the number of publications and articles included in the review (11-100%) were published in magazines in general nursing journals. These data reveal the nurses' involvement with the questioned theme. It was carried out in outpatient clinics or only through the distribution of educational materials, such as: booklets, printed educational materials, online courses and multimedia programs, intensifying peristaltic skin care and / or reinforcing general care. In order for the teaching-learning process to be effective in the health field, the didactic resources employed must enable and motivate patients in order to incorporate new meanings, providing more autonomy. This review identified that education strategies with the use of educational technologies are more consistent in the messages transmitted causing rapid change of behavior

Behavior of temporal parameters of the ground reactive forces for the walking of postmenopausal women.

The study aimed to examine the influence of body composition and menopause characteristics on certain temporal parameters of the behavior of vertical and anteroposterior components of ground reactive forces, as well as the vertical and anteroposterior rates on the walking of postmenopausal women. The sample consisted of 67 postmenopausal women, average age 59 years. Body composition was assessed by octapolar bioimpedance and ground reactive force by the Kistler force platform. Vertical loading rate correlated positively with age (r = 0.02) and negatively with weight (r = -0.33). The relationship between the rates of vertical loading and unloading associated positively with menopause time (r = 0.27) but negatively with weight (r = -0.27). Vertical unloading rate showed a negative association with abdominal visceral adiposity (r = -0.27). The relationship between the times of the intermediate and final phases of the support correlated significantly with abdominal visceral adiposity (r = 0.25) and fat mass (r = 0.24). The study suggests that fat mass and abdominal visceral adiposity affect the support time, and increased abdominal visceral adiposity implies a slower pre-suspension phase during the walking of postmenopausal women. Hormone replacement therapy was shown to be an enhancer of steeper vertical loading and anteroposterior unloading and longer time in the double support phase, indicating a greater stability of postmenopausal women when walking.

Análise das características e dos preceitos normativos da Política Nacional de Atenção Integral às Pessoas com Doenças Raras / Analysis of characteristics and normative precepts of the National Comprehensive Care Policy for People with Rare Diseases

Este artigo aborda a Política Nacional de Atenção Integral às Pessoas com Doenças Raras. Objetivou-se analisar as características e preceitos normativos da referida Política a partir dos elementos percebidos como essenciais na construção e dinâmica de gestão de uma política de saúde. Para subsidiar as análises, foram recrutados ainda a Portaria nº 981, textos normativos de Políticas Concorrentes e arcabouços teóricos pertinentes às Doenças Raras, Políticas Públicas e Advocacia em Saúde, sendo estes três eixos o Marco Conceitual deste estudo. Utilizou-se como metodologia a análise documental e o levantamento da literatura pertinente aos eixos elencados. Conclui-se que embora a Política Nacional de Atenção Integral às Pessoas com Doenças Raras contemple em suas diretrizes ações com vias a corrigir as lacunas dos serviços de saúde especializados por meio de incentivos e adequações profissionais, tanto o diagnóstico como a terapêutica requerem a efetivação das diretrizes que já orientam o Sistema Único de Saúde ­ SUS: universalidade, integralidade, equidade e descentralização. Destaca-se ainda que embora tenham sido observados os elementos objetivos e subjetivos essenciais na construção de uma política de saúde, é de fundamental importância que haja o espírito colaborativo de outras instâncias da gestão pública, assim como dos profissionais de saúde.

This article discusses the National Policy on Comprehensive Care for People with Rare Diseases. This study aimed to analyze the characteristics and normative precepts of that policy from the elements perceived as essential in building and dynamic management of a health policy. To support the analyzes were also recruited to Ordinance No. 981, normative texts of Competitors Policies and theoretical frameworks relevant to Rare Diseases, Public Policy and Health Advocacy, being these three axes the Conceptual Framework of the study. It was used as a document analysis methodology and the survey of the literature to listed axes. It is concluded that although the National Comprehensive Care Policy for People with Rare Diseases contemplates in its guidelines actions to correct the shortcomings of specialized health services through professional incentives and adjustments, both diagnosis and therapy require the execution of guidelines that have guided the Unified Health System - SUS: universality, comprehensiveness, equity and decentralization. It is noteworthy that even though they have been subject to the objective and subjective elements essential in building a health policy, it is of fundamental importance that there is the collaborative spirit of other bodies of public administration, as well as health professionals

Este artículo aborda la Política Nacional de Atención Integral a Personas con Enfermedades Raras. Este estudio tuvo como objetivo analizar las características y los preceptos normativos de que la política de los elementos percibidos como esenciales en la construcción y gestión dinámica de una política de salud. Para apoyar los análisis también fueron reclutados a la Ordenanza Nº 981, los textos normativos de Competidores Políticas y marcos teóricos pertinentes a las Enfermedades Raras, Políticas Públicas y Salud Abogacía, y estos tres ejes del marco conceptual del estudio. Se utilizó como metodología para documentar el análisis y estudiar la literatura a los ejes mencionados. Llegamos a la conclusión de que a pesar de la Política Nacional de Atención Integral a Personas con Enfermedades Raras contempla en sus directrices comparte maneras de corregir las deficiencias de los servicios especializados de salud a través de incentivos y ajustes profesionales, tanto en el diagnóstico y la terapia requieren la ejecución de directrices que han guiado el Sistema Único de Salud - SUS: universalidad, integralidad, equidad y descentralización. Es de destacar que a pesar de que han sido objeto de los elementos objetivos y subjetivos esenciales en la construcción de una política de salud es de importancia fundamental que es el espíritu de colaboración de otros órganos de la administración pública, así como profesionales de la salud

Mammary hamartoma in a male / Hamartoma mamario en el varón

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Th1 and Th2-like protein balance in human inflammatory radicular cysts and periapical granulomas.

INTRODUCTION: Chronic dental periapical lesions result from chronic inflammation of periapical tissues caused by continuous antigenic stimulation from infected root canals. Recent findings have suggested that T helper (Th) 1 and Th2-like cytokines are important in the pathogenesis of chronic periapical inflammatory diseases. However, the mechanisms regulating these immunoinflammatory pathways have not been fully elucidated. Thus, the aim of this study was to evaluate interleukin (IL)-4, IL-12, and interferon γ (IFN-γ) protein levels in human radicular cysts and periapical granulomas. METHODS: Archived samples of cysts (n = 52) and granulomas (n = 27) were sectioned and submitted to immunohistochemistry to evaluate the tissue expression of IL-4, IL-12, and IFN-γ. The data were analyzed using the Mann-Whitney U test (P < .05). RESULTS: An increased expression of IFN-γ was observed in radicular cysts. IL-4 expression was stronger in periapical granulomas than in radicular cysts. IL-12 was not detected in any of the samples. CONCLUSIONS: Our study showed that IFN-γ protein levels are increased in radicular cysts, whereas IL-4 expression is stronger in samples of periapical granulomas. Further studies are necessary to elucidate the signaling pathways mediated by these cytokines and to facilitate the development of more effective periapical disease management strategies.