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AIM: Gestational diabetes (GD) is a global health concern with significant implications for maternal and neonatal outcomes. This study investigates the association between early GD (eGD) diagnosis (<24 weeks), pharmacotherapy requirements and adverse neonatal outcomes. MATERIALS AND METHODS: A cohort of 369 pregnant women underwent a 75-g oral glucose tolerance test. Maternal variables, pharmacotherapy prescriptions and neonatal outcomes were analysed employing t-tests, χ2 tests, and logistic regression. A p < .05 was considered significant. RESULTS: Early GD increased the odds of neonatal hypoglycaemia [odds ratio (OR): 18.57, p = .013] and respiratory distress syndrome (OR: 4.75, p = .034). Nutritional therapy prescription by an accredited nutritionist was the most common treatment in women diagnosed after 24 weeks, but those with eGD required more frequently specialized nutritional consulting + metformin to achieve glycaemic control (p = .027). eGD was associated with a higher requirement of nutritional therapy prescription + metformin (OR: 2.26, 95% confidence interval: 1.25-4.09, p = .007) and with maternal hyperglycaemia during the post-partum period at 2 h of the oral glucose tolerance test (OR: 1.03, 95% confidence interval: 1.02-1.13, p = .024). CONCLUSION: Timely diagnosis and personalized treatment of GD are desirable because an earlier presentation is related to a higher risk of adverse neonatal and maternal outcomes.
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Diabetes Gestacional , Diagnóstico Precoce , Teste de Tolerância a Glucose , Hipoglicemiantes , Metformina , Humanos , Feminino , Gravidez , Diabetes Gestacional/tratamento farmacológico , Diabetes Gestacional/diagnóstico , Diabetes Gestacional/sangue , Recém-Nascido , Adulto , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Hipoglicemia/induzido quimicamente , Hipoglicemia/prevenção & controle , Hipoglicemia/epidemiologia , Resultado da Gravidez/epidemiologia , Estudos de Coortes , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Síndrome do Desconforto Respiratório do Recém-Nascido/epidemiologia , Glicemia/metabolismo , Glicemia/análiseRESUMO
OBJECTIVE: To provide information on the secular trend in age at menarche (AgM) in Argentinean girls in relation to excess weight (EW) and body adiposity. METHODS: Two cohorts (C) (C1, 2005-2007 and C2, 2015-2019) of children aged 8-14 years from La Plata district were studied using identical methodological criteria. Each participating child was asked about menarche (M) status: M presence (MP) or absence (MA). The AgM was estimated using the status quo method and logistic regression analysis. Body weight, height, and tricipital and subscapular skinfolds were collected to estimate EW (overweight + obesity) according to WHO criteria, and body adiposity (sum of skinfolds, SSK = [tricipital + subscapular]). The prevalence of EW by C was estimated and compared using the Chi-square test. The MP probability in relation to age, C, and EW was analyzed by applying logistic regression. Parents completed a questionnaire to assess family socioeconomic conditions. Data were compared using the Chi-square test. RESULTS: Differences in MP prevalence between C were significant (C1: 21.1% vs. C2: 28.7%). Median AgM was 12.81 years in C1 and 12.22 in C2. The prevalence of EW was higher in C2 (35.3%) than in C1 (24.6%). The probability of MP was higher in C2 than in C1 and children with EW. Both BMI and SSK showed inter-cohort increases. Socioeconomic conditions were substantially deteriorated between C. CONCLUSION: In an obesogenic context marked by the significant increase in body adiposity and EW, M prevalence exhibited a positive secular trend and AgM reduced by nearly seven months between the cohorts studied.
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Menarca , Humanos , Argentina/epidemiologia , Criança , Adolescente , Feminino , Fatores Etários , Sobrepeso/epidemiologia , Puberdade , Adiposidade , Estudos de Coortes , PrevalênciaRESUMO
Sella turcica development involves molecular factors and genes responsible for ossification. It is possible that single nucleotide polymorphisms (SNPs) in key genes are involved in morphological variation of sella turcica. Genes belonging to the WNT signaling pathway are involved in the ossification process and are candidates of sella turcica morphology. This study aimed to evaluate if SNPs in WNT6 (rs6754599) and WNT10A (rs10177996 and rs3806557) genes are associated with the calcification and patterns of the sella turcica. Nonsyndromic individuals were included in the research. Cephalometric radiographs were examined and the sella calcification was evaluated and classified according to the calcification of the interclinoid ligament (no calcification, partial calcification, and incomplete calcification) and sella turcica pattern (normal sella turcica, bridge type A-ribbon-like fusion, bridge type B-extension of the clinoid processes, incomplete bridge, hypertrophic posterior clinoid process, hypotrophic posterior clinoid process, irregularity in the posterior part, pyramidal shape of the dorsum, double contour of the floor, oblique anterior wall, and oblique contour of the floor). DNA samples were used to evaluate SNPs in the WNT genes (rs6754599, rs10177996, and rs3806557) using real-time PCR. Chi-square test or Fisher's exact test were used to compare the allele and genotype distributions according to sella turcica phenotypes. The alpha was set as 5% for all comparisons. A total of 169 individuals were included, 133 (78.7%) present sella turcica partially or completely calcified. Sella turcica anomalies were found in 131 individuals (77.5%). Sella turcica bridge type A (27.8%), posterior hypertrophic clinoid process (17.1%), and sella turcica bridge type B (11.2%) were the most prevalent morphological patterns observed. Individuals carrying the TT genotype in rs10177996 (TT vs. CT + CC) had higher chance to present a partially calcified sella turcica (p = 0.047; Odds ratio = 2.27, Confidence Interval 95% 1.01-5.13). In conclusion, the SNP in WNT10A is associated with the calcification phenotype of the sella turcica, the pleiotropic effect of this gene should be taken into consideration in future studies.
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Polimorfismo de Nucleotídeo Único , Sela Túrcica , Sela Túrcica/anormalidades , Via de Sinalização Wnt/genética , Radiografia , Calcificação Fisiológica , CefalometriaRESUMO
INTRODUCTION: The frame index (FI), based on measurements of elbow breadth and height, is the body frame size parameter most frequently used in child and adolescent populations to assess skeletal robustness. In 2018, the first FI reference percentiles were elaborated with data of boys and girls aged 0-18 years from different European populations. In Argentina, the FI reference values were published in 2022. OBJECTIVE: The present study aims to compare the Argentine (AR) and European (EU) FI reference percentiles to evaluate possible variation in bone robustness between populations. METHODS: The values of the 3rd, 50th and 97th percentiles of the AR and EU FI references for boys and girls aged 4-14 years were compared using the Wilcoxon test (p < .05). Percentage differences between means (PDM) were calculated to analyze the magnitude of the differences between both references. The R 3.2.0 program was used to plot the percentile curves. RESULTS: The FI reference values were lower in AR than in EU in both the 3rd and the 50th percentiles, regardless of sex and age. Conversely, the AR reference values of the 97th percentile were higher than the EU values at most ages. CONCLUSIONS: The comparison of the AR and EU FI references showed similar age and sex growth patterns. However, differences in percentile values between populations were observed, highlighting the importance of having local references for the evaluation of skeletal robustness.
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Estatura , Masculino , Criança , Feminino , Adolescente , Humanos , Valores de Referência , Argentina , Índice de Massa CorporalRESUMO
The genus Fusarium can be utilized to produce a great variety of secondary metabolites under specific culture conditions, including pigments of increasing biotechnological interest, such as bikaverin. Such pigments are important due to the biological properties they possess, including antitumor and antibiotic activities, among others. In Fusarium fujikuroi, bik1-bik6 have been identified as the genes that are responsible for the synthesis of bikaverin. Therefore, in this study, we screened for the presence of bik genes and examined changes in mRNA levels of the bik genes under the influence of NH4NO3 (0.024, 0.048, 0.50, 1.0, and 4.60 g L-1) and NH4Cl (0.50 and 1.0 g L-1) as nitrogen sources for the phytopathogen Fusarium oxysporum f. sp. lycopersici. Our results indicated the presence of at least six bik (bik1-bik6) genes and showed increased mRNA levels for bik4, bik5, and bik6 in conditions where NH4NO3 was used at pH 3.0. The characteristic coloration of bikaverin was obtained in 10 out of 16 culture conditions, except when the fungus was grown with higher concentrations of NH4NO3 (1.0 and 4.60 g L-1). The pigment was chloroform-extracted from the culture conditions of NH4NO3 (0.024, 0.048, and 0.50 g L-1) and NH4Cl (0.50 and 1.0 g L-1) with 3 and 9 days of incubation. Analysis via visible spectroscopy and matrix-assisted laser desorption ionization-time of flight mass spectrometry were used for the identification of bikaverin.
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Fusarium , Xantonas , Fusarium/genética , NitrogênioRESUMO
OBJECTIVES: The aim of this study was investigate the cranium dimensions of adult female rats, who suffered estrogen deficiency during the prepubertal stage, to assess the impact of estrogen deficiency on craniofacial morphology. MATERIAL AND METHODS: Twenty-two female Wistar rats were divided into ovariectomy (OVX) (n = 11) and sham-operated control (n = 11) groups. Bilateral ovariectomy were performed in both groups at 21 days old (prepubertal stage), and rats were euthanized at an age of 63 days (post-pubertal stage). Micro-CT scans were performed with rat skulls, and the cranium morphometric landmark measurements were taken in the dorsal, lateral, and ventral view positions. Differences in measurements between the OVX and sham control groups were assessed using t test with an established alpha error of 5%. RESULTS: The measures of the rats' skull showed that the inter-zygomatic arch width and anterior cranial base length were significantly larger in OVX group (p = 0.020 and p = 0.050, respectively), whereas the length of parietal bone was significantly higher in the sham group (p = 0.026). For the remaining measurements no significant differences between groups were detected (p > 0.05). CONCLUSION: This study provides evidence that ovariectomized rats had alterations in cranial bone dimensions, demonstrating that estrogens during puberty are important for skull morphology. CLINICAL RELEVANCE: To understand the role of estrogen on the postnatal cranium development will impact the clinical diagnose and therapy during childhood and adolescence.
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Estrogênios , Crânio , Animais , Densidade Óssea , Criança , Feminino , Humanos , Ovariectomia , Ratos , Ratos Wistar , Crânio/diagnóstico por imagem , Microtomografia por Raio-XRESUMO
Macrophages have been considered an elusive yet emerging therapeutic target in tumor development since they are an important component in tumor microenvironment. The purpose of the present study was to evaluate the effect of C. sinensis on macrophage function (a component of tumor microenvironment which can alter the virulence of cancer) in high-fat diet fed rats. IMR-32 human neuroblastoma cell cytotoxicity was also investigated. The following parameters were observed to evaluate macrophage function: superoxide anion, hydrogen peroxide, nitric oxide, lysosomal volume and phagocytic capacity. High fat diet (HFD) plus C. sinensis supplementation promoted a decreased superoxide anion and hydrogen peroxide levels as well as lysosomal volume and phagocytic capacity. Nitric oxide was increased in the same group. In summary, C. sinensis offered an important anti-tumoral perspective from the standpoint of the tumor microenvironment and in vitro IMR-32 cytotoxicity.
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Antineoplásicos/farmacologia , Cordyceps , Dieta Hiperlipídica , Hiperlipidemias/fisiopatologia , Macrófagos Peritoneais/efeitos dos fármacos , Fagocitose/efeitos dos fármacos , Animais , Antineoplásicos/isolamento & purificação , Linhagem Celular Tumoral , Sobrevivência Celular/efeitos dos fármacos , Cordyceps/química , Humanos , Peróxido de Hidrogênio/metabolismo , Hiperlipidemias/etiologia , Ativação de Macrófagos/efeitos dos fármacos , Macrófagos Peritoneais/fisiologia , Masculino , Neuroblastoma/metabolismo , Neuroblastoma/patologia , Óxido Nítrico/metabolismo , Ratos Wistar , Superóxidos/metabolismo , Microambiente Tumoral/efeitos dos fármacosRESUMO
The association between the myrmecophyte Triplaris and ants of the genus Pseudomyrmex is an often-reported example of mutualism in the Neotropics. The ants colonize the hollow stems of their hosts, and in exchange, the plants benefit from a reduced degree of herbivory. The previous studies have shown that workers can discriminate their host from other plants, including a closely related species. Little is known about how queens locate their host during the colonization process, but it has been suggested that host recognition is mediated by volatiles. Since queens of Pseudomyrmex mordax colonize their hosts during the seedling stage, we hypothesized that queens would discriminate leaves of seedlings from adult plants. To evaluate our hypothesis, we used a two-sided olfactometer, to test the preference of queens towards different leaf and plant ages of Triplaris americana. Virgin queens of Pseudomyrmex mordax preferred seedlings over adult plants, as well as plant leaves over empty controls, showing no discrimination for leaf age. Our results suggest that the volatiles virgin queens recognize are either produced or are more abundant at the early growing stage of the host when colonization is crucial for the host's survival.
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BACKGROUND: Preload dynamic tests, pulse pressure variation (PPV) and stroke volume variation (SVV) have emerged as powerful tools to predict response to fluid administration. The influence of factors other than preload in dynamic preload test is currently poorly understood in pediatrics. The aim of our study was to assess the effect of tidal volume (VT) on PPV and SVV in the context of normal and reduced lung compliance in a piglet model. MATERIAL AND METHOD: Twenty large-white piglets (5.2±0.4kg) were anesthetized, paralyzed and monitored with pulse contour analysis. PPV and SVV were recorded during mechanical ventilation with a VT of 6 and 12mL/kg (low and high VT, respectively), both before and after tracheal instillation of polysorbate 20. RESULTS: Before acute lung injury (ALI) induction, modifications of VT did not significantly change PPV and SVV readings. After ALI, PPV and SVV were significantly greater during ventilation with a high VT compared to a low VT (PPV increased from 8.9±1.2 to 12.4±1.1%, and SVV from 8.5±1.0 to 12.7±1.2%, both P<0.01). CONCLUSIONS: This study found that a high VT and reduced lung compliance due to ALI increase preload dynamic tests, with a greater influence of the latter. In subjects with ALI, lung compliance should be considered when interpreting the preload dynamic tests.
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Lesão Pulmonar Aguda/fisiopatologia , Hidratação/métodos , Complacência Pulmonar/fisiologia , Volume de Ventilação Pulmonar/fisiologia , Animais , Pressão Sanguínea/fisiologia , Modelos Animais de Doenças , Respiração Artificial/métodos , Volume Sistólico/fisiologia , SuínosRESUMO
INTRODUCTION: The aim of this study was to compare the osseointegration and the survival of dental implants (DIs) immediately placed in postextraction sites, in mandibles of minipigs that underwent radiotherapy (RT). MATERIALS AND METHODS: Twelve Brazilian minipigs were divided into the following groups: A, control; B, implants placement 15 days before RT; C, implants placement 3 months after RT. Implant loss rate (ILR), fibrointegration rate (FIR), bone-implant contact (BIC), and bone density inside the threads (BDIT) were determined in each group 90 days after implantation. RESULTS: ILR was higher in group C (68.7%) than in groups B (28.1%) and A (21.9%), (P = 0.001). FIR was more frequent in group C (30%) than in groups B (21.7%) and A (4%), although not statistically significant. The averages of BIC and BDIT were, respectively, 33.1 and 41.5 in group C; 18.5 and 26.6 in group B; and 11.5 and 16.3 in group A (P = 0.003 for both variables). CONCLUSIONS: RT showed a negative effect in periimplant bone regeneration. The implants placement before RT showed better results compared with the implants performed after RT, suggesting that DIs in head and neck cancer patients must be placed before RT or simultaneously during ablative tumor surgery.
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Implantes Dentários , Osseointegração , Radioterapia , Extração Dentária , Animais , Masculino , Mandíbula , Suínos , Porco MiniaturaRESUMO
The aim of the present study was to advance knowledge of the secular changes in the prevalence of excess weight (overweight and obesity) and body composition of children living in different localities of La Plata district (Buenos Aires province, Argentina) over the last two decades. For this purpose, anthropometric data and information on the socioeconomic and environmental context of residence of schoolchildren aged 4.0-12.9 years collected during 2005-2009 (Cohort 1, n = 1 233) and 2016-2019 (Cohort 2, n = 1 499) were analysed and compared. From a secular perspective, the current analysis showed that the socioeconomic and environmental conditions of families living in La Plata district have deteriorated in recent decades. In this context, child excess weight increased by 13% and body composition was altered, mainly as a result of an increase in fat mass, without observing changes in the muscle component.
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BACKGROUND: The sphenoid bone is an irregular, unpaired, symmetrical bone located in the middle of the anterior skull and is involved in craniofacial growth and development. Since the morphology of Sella turcica (ST) is associated with different craniofacial patterns, this study aimed to investigate if there is a correlation between ST morphology on the one hand and sagittal craniofacial patterns on the other hand. METHODS: This study was conducted with a convenience sample that included Brazilian individuals undergoing orthodontic treatment. Lateral cephalograms were used to evaluate the calcification pattern and morphology of ST, as well as skeletal class by analyzing the ANB angle. Pearson's chi-square test with Bonferroni post-hoc test was performed to evaluate the association between ST calcification pattern and morphology, and anteroposterior skeletal malocclusion. The established significance level was 0.05. RESULTS: The study collective was comprised of 305 orthodontic patients (178 (58.4 %) female, 127 (41.6 %) male), who had a mean age of 23.2 (±10.6) years. 131 participants (42.9 %) presented skeletal class I, 142 (46.6%) skeletal Class II, and 32 (10.5%) had a skeletal class III. The degree of prognathism of the mandible showed a homogenous distribution within the study collective (91 (29.9 %) orthognathic, 100 (32.9 %) retrognathic, 113 (37.2 %) prognathic mandible). Concerning the maxilla, 92 (30.2%) individuals presented an orthognathic upper jaw, whereas 60 (19.7%) showed maxillary retrognathism and 153 (50.2%) maxillary prognathism. Compared to patients with skeletal class I, skeletal class III individuals presented significantly more hypertrophic posterior clinoid process (p<0.007) and pyramidal shape of the dorsum of the ST (p<0.038). CONCLUSIONS: Our results suggest that the hypertrophic posterior clinoid process and pyramidal shape of the ST dorsum are more prevalent in individuals with skeletal class III malocclusion.
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Cefalometria , Má Oclusão , Sela Túrcica , Humanos , Feminino , Masculino , Sela Túrcica/patologia , Sela Túrcica/diagnóstico por imagem , Estudos Transversais , Má Oclusão/patologia , Adolescente , Adulto Jovem , Adulto , Brasil/epidemiologia , Calcinose/patologia , Calcificação FisiológicaRESUMO
Endometriosis is a chronic proinflammatory pathology characterized by the growth of tissue similar to the endometrium outside the uterus, affecting approximately 5 to 15% of women worldwide. Suffering from endometriosis entails a complex pathophysiological process, significantly impacting the quality of life and reproductive function of affected women; therefore, it must be addressed in a personalized and comprehensive manner, as its management requires a multidisciplinary approach. This article aims to conduct a comprehensive literature review of endometriosis, not only as a pathophysiological condition but also as a significant factor impacting the social, nutritional, and mental well-being of those who experience it. Emphasis is placed on the importance of understanding and assessing the impact of the pathology to provide a better and more comprehensive approach, integrating various alternatives and strategic treatments for the factors involved in its development. The aim is to provide a complete overview of endometriosis, from its pathophysiology to its impact on the quality of life of patients, as well as a review of current treatment options, both pharmacological and alternative, in order to broaden the perspective on the pathology to improve the care of patients with this disease.
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INTRODUCTION: Bacterial contamination from viscerotomy is a barrier to natural orifice translumenal endoscopic surgery (NOTES). The aim of this survival study is to evaluate pure (totally) transvaginal NOTES bacterial contamination compared with laparoscopy in pigs. METHODS: Twelve adult female pigs underwent peritoneoscopy with liver and peritoneal biopsies, using either laparoscopy (Glap, six animals) or pure transvaginal (GNOTES) access, and were maintained alive for 7 days. In all animals, blood cultures were taken at baseline, and after 24 h and 7 days postoperatively. Swab cultures from vagina (GNOTES) and skin (Glap) were obtained pre- and post-antisepsis. Peritoneal fluid culture was obtained at necropsy. For statistical analysis, Glap and GNOTES were compared for presence of positive bacterial cultures (qualitative bacterial analysis) using Fisher's test, with level of significance set at p < 0.05. RESULTS: All animals had good postoperative outcome. One animal had transient perioperative bleeding from a transvaginal access. Two animals in Glap and one in GNOTES had positive blood cultures after the procedure. All animals from GNOTES and Glap presented with mixed flora pre-antisepsis. After antisepsis, one animal (GNOTES) presented with a positive vaginal swab culture (a single bacterial strain was identified). There was no positive skin swab culture in Glap. There were no signs of intra-abdominal infection at necropsy. In two animals, one from Glap and another from GNOTES, intra-abdominal culture was positive for Corynebacterium spp. and Escherichia coli, respectively. There was no correlation between the bacterial flora found at the access site and in the peritoneal cultures. CONCLUSIONS: Pure transvaginal peritoneoscopy with liver and peritoneal biopsy in swine is feasible and associated with bacterial contamination comparable to laparoscopy. Peritoneal bacterial contamination was clinically insignificant after 1 week postoperatively. Preoperative antisepsis provided significant reduction of bacterial load prior to transvaginal and laparoscopic procedures.
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Bactérias/isolamento & purificação , Laparoscopia , Cirurgia Endoscópica por Orifício Natural , Pele/microbiologia , Vagina/microbiologia , Animais , Biópsia , Feminino , Fígado/patologia , Cirurgia Endoscópica por Orifício Natural/métodos , Peritônio/patologia , SuínosRESUMO
BACKGROUND: The effects of mild hypothermia (HT) on acute lung injury (ALI) are unknown in species with metabolic rate similar to that of humans, receiving protective mechanical ventilation (MV). We hypothesized that mild hypothermia would attenuate pulmonary and systemic inflammatory responses in piglets with ALI managed with a protective MV. METHODS: Acute lung injury (ALI) was induced with surfactant deactivation in 38 piglets. The animals were then ventilated with low tidal volume, moderate positive end-expiratory pressure (PEEP), and permissive hypercapnia throughout the experiment. Subjects were randomized to HT (33.5°C) or normothermia (37°C) groups over 4 h. Plasma and tissue cytokines, tissue apoptosis, lung mechanics, pulmonary vascular permeability, hemodynamic, and coagulation were evaluated. RESULTS: Lung interleukin-10 concentrations were higher in subjects that underwent HT after ALI induction than in those that maintained normothermia. No difference was found in other systemic and tissue cytokines. HT did not induce lung or kidney tissue apoptosis or influence lung mechanics or markers of pulmonary vascular permeability. Heart rate, cardiac output, oxygen uptake, and delivery were significantly lower in subjects that underwent HT, but no difference in arterial lactate, central venous oxygen saturation, and coagulation test was observed. CONCLUSIONS: Mild hypothermia induced a local anti-inflammatory response in the lungs, without affecting lung function or coagulation, in this piglet model of ALI. The HT group had lower cardiac output without signs of global dysoxia, suggesting an adaptation to the decrease in oxygen uptake and delivery. Studies are needed to determine the therapeutic role of HT in ALI.
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Lesão Pulmonar Aguda/prevenção & controle , Hipotermia Induzida/métodos , Inflamação/prevenção & controle , Pneumonia Associada à Ventilação Mecânica/prevenção & controle , Respiração Artificial/efeitos adversos , Anestesia , Animais , Apoptose/fisiologia , Biomarcadores/sangue , Coagulação Sanguínea/fisiologia , Permeabilidade Capilar/fisiologia , Caspase 3/sangue , Citocinas/sangue , Hemodinâmica/fisiologia , Pulmão/patologia , Respiração com Pressão Positiva , Troca Gasosa Pulmonar , Testes de Função Respiratória , Mecânica Respiratória/fisiologia , SuínosRESUMO
INTRODUCTION: Background: mid-upper arm circumference (MUAC), subcutaneous fat and muscle measurements are an alternative method to diagnose overweight and evaluate growth as well as protein and energy reserves. Aim: to compare MUAC, arm muscle area (AMA) and arm fat area (AFA) measurements of Argentinean boys and girls (Sa) with reference curves for US boys and girls (R). Subjects and methods: data from 22,736 school-children aged 4-14 years from six Argentinean provinces were collected. MUAC and triceps skinfold thickness were measured and the derived AMA and AFA measures were calculated. Analyses were performed with GAMLSS using the R software. Differences in mean values of Sa and R were compared in percentiles 3, 50 and 97. Results: mean values of MUAC and AMA in boys and girls were higher in R than in Sa at all ages; conversely, AFA values were lower. Conclusions: our results confirm differences in upper arm anthropometry of Argentinean school-children with respect to the US reference. The higher adipose tissue and lower skeletal muscle mass observed in Argentinean children could be partly associated with the different ethnic origin of both populations. However, differences should be interpreted in the context of an obesogenic environment, which has favored a calorie-protein imbalance.
INTRODUCCIÓN: Antecedentes: la medición de la circunferencia del brazo (MUAC), así como la estimación de la grasa subcutánea y muscular constituyen un método alternativo para diagnosticar el sobrepeso y evaluar el crecimiento y las reservas proteicas y energéticas. Objetivo: comparar las mediciones de MUAC, área muscular (AMA) y área grasa (AFA) del brazo de niños y niñas argentinos (Sa) con curvas de referencia para niños y niñas de Estados Unidos (R). Sujetos y métodos: se recopilaron datos de 22,736 escolares de 4 a 14 años de edad de seis provincias argentinas. Se obtuvieron medidas de MUAC y pliegue subcutáneo tricipital y se calcularon AMA y AFA. Los análisis se realizaron con GAMLSS utilizando el software R. Las diferencias en los valores medios de Sa y R se compararon para los percentiles 3, 50 y 97. Resultados: a todas las edades los valores medios de MUAC y AMA en niños y niñas fueron más altos en R que en Sa; por el contrario, los valores de AFA fueron más bajos. Conclusiones: nuestros resultados confirman la existencia de diferencias en la antropometría mesobraquial de los niños argentinos con respecto a los de la referencia. La mayor cantidad de tejido adiposo y menor de tejido muscular observada en los niños argentinos de ambos sexos puede ser parcialmente asociada con el diferente origen étnico de ambas poblaciones. Sin embargo, las diferencias podrían interpretarse en el contexto de un ambiente obesogénico, el cual habría favorecido el desbalance proteico-calórico.
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Adiposidade , Braço/anatomia & histologia , Músculo Esquelético/anatomia & histologia , Adolescente , Antropometria , Argentina , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Obesidade/diagnóstico , Sobrepeso/diagnóstico , Caracteres Sexuais , Dobras Cutâneas , Fatores Socioeconômicos , Estados UnidosRESUMO
BACKGROUND AND OBJECTIVES: Microspheres can be used as a controlled delivery system to prolong the duration of action of local anesthetics. The objective of this study was the preparation, characterization and analysis of the in vitro release of 50% enantiomeric excess bupivacaine (S75-R25)-loaded microspheres. METHODS: Microspheres were prepared using the copolymer of polylactide-co-glycolic acid by the spray-dryed method. RESULTS: Characterization of microspheres regarding their size and content were similar to the theoretical values. The in vitro release demonstrated a biphasic pattern. CONCLUSIONS: Manufacturing of 50% enantiomeric excess bupivacaine-loaded microspheres by the spray-dryed method with results similar to bupivacaine-loaded microspheres can be done.
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Anestésicos Locais , Bupivacaína , Microesferas , Anestésicos Locais/administração & dosagem , Bupivacaína/administração & dosagem , Tecnologia FarmacêuticaRESUMO
Resumen ANTECEDENTES: La ruptura uterina es la separación de las tres capas del útero que se asocia con una cicatriz. La mayoría de los casos se relacionan con intento de trabajo de parto, después de una cesárea. La ruptura es una complicación grave, que pone en riesgo a la madre y al feto. De forma excepcional puede haber ruptura uterina sin síntomas, y el hallazgo se advierte durante la cesárea de repetición. CASO CLÍNICO: Paciente de 27 años, programada para cesárea de repetición por disfunción de una prótesis valvular. A la apertura de la cavidad abdominal no se encontró hemoperitoneo y se visualizó un defecto transverso en el segmento uterino inferior de las tres capas uterinas, con saco amniótico íntegro, coincidente con ruptura uterina. Se obtuvo un recién nacido sano, de 2610 g y Apgar de 9-9. La herida uterina se suturó en dos planos y se practicó la oclusión tubaria bilateral. La evolución durante el puerperio fue satisfactoria. CONCLUSIONES: La ruptura uterina puede pasar inadvertida por algún descuido en la historia clínica y ausculatación, de ahí la necesidad de ser más minuciosos para poder indicar el tratamiento adecuado.
Abstract BACKGROUND: Uterine rupture is a separation of the three layers of the uterus and is associated with a uterine scar. Most cases are related to an attempted labor after a cesarean section. Uterine rupture is a serious complication that puts both mother and fetus at risk. Exceptionally uterine rupture can occur without symptoms, being a finding during a repeat cesarean section. CLINICAL CASE: A 27-year-old patient scheduled for repeat cesarean section due to dysfunction of a prosthetic valve. Upon opening the abdominal cavity, no hemoperitoneum was found and a transverse defect was visualized in the lower uterine segment of the three uterine layers, with an intact amniotic sac, coinciding with uterine rupture. A healthy newborn was obtained, weighing 2610 g and Apgar 9-9. The uterine wound was sutured in two planes and bilateral tubal occlusion was performed. The evolution during the puerperium was satisfactory. CONCLUSIONS: Uterine rupture may go unnoticed due to an oversight in the clinical history and auscultation, hence the need to be more thorough in order to indicate appropriate treatment.
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Resumen INTRODUCCIÓN: La epidermólisis bulosa engloba a un grupo de enfermedades caracterizadas por una fragilidad extrema de la piel y membranas mucosas, consecuencia de la formación de ampollas posterior a un traumatismo mínimo. Hay tres tipos principales de epidermólisis. Se comunica el caso para hacer notar las implicaciones del cuidado al momento del nacimiento, y las consideraciones anestésicas. CASO CLÍNICO: Paciente de 25 años en su segundo embarazo con epidermólisis bulosa distrófica recesiva. El nacimiento fue electivo mediante cesárea, con anestesia regional. CONCLUSIONES: Debe tenerse especial cuidado durante las intervenciones terapéuticas a fin de evitar la formación de bulas o exacerbar las existentes. Las fuerzas de fricción son más dañinas que las de compresión. La planeación multidisciplinaria es necesaria para un desenlace sin complicaciones.
Abstract BACKGROUND: Epidermolysis bullosa encompasses a group of diseases characterized by extreme fragility of the skin and mucous membranes, resulting in the formation of blisters after minimal trauma; There are three main types of epidermolysis. The case is presented to highlight the implications of care both at the time of birth, as well as anesthetic considerations. CLINICAL CASE: A 25-year-old patient in her second pregnancy with recessive dystrophic epidermolysis bullosa. The birth was elective by caesarean section under regional anesthesia. CONCLUSIONS: Special care must be taken during therapeutic interventions to avoid the formation of bullae or exacerbate those already present. Friction forces are more damaging than compression forces. Multidisciplinary planning is necessary for a smooth outcome.
RESUMO
Resumen ANTECEDENTES: El síndrome de Klippel Trenaunay es una enfermedad congénita rara, caracterizada por malformaciones capilares y venosas, sobrecrecimiento de miembros y en algunos casos malformaciones linfáticas. Quienes lo padecen tienen un riesgo incrementado de hemorragia y tromboembolismo. CASOS CLÍNICOS: Tres pacientes primigestas con diagnóstico de síndrome de Klippel Trenaunay con complicaciones del embarazo que finalizaron mediante cesárea con el nacimiento de sus hijos sanos, de término, en todos los casos. CONCLUSIONES: Las embarazadas y con síndrome de Klippel-Trenaunay tienen un riesgo significativo de que sus síntomas se agraven, de tener hemorragia durante el nacimiento y de eventos tromboembólicos, incluso después del nacimiento. La atención individualizada y multidisciplinaria ayudará a mitigar las complicaciones asociadas y a conseguir desenlaces óptimos.
Abstract BACKGROUND: Klippel Trenaunay syndrome is a rare congenital disease characterized by capillary and venous malformations, limb overgrowth and in some cases lymphatic malformations. Sufferers have an increased risk of hemorrhage and thromboembolism. CLINICAL CASES: Three primigravid patients diagnosed with Klippel Trenaunay syndrome with pregnancy complications that were terminated by cesarean section with the birth of their healthy, full-term children in all cases. CONCLUSIONS: Women with Klippel-Trenaunay syndrome and pregnancy are at significant risk for aggravation of their symptoms, hemorrhage during birth, and thromboembolic events, even after birth. Individualized, multidisciplinary care will help mitigate associated complications and achieve optimal outcomes.