CT scan in the evaluation of pediatric abdominal trauma.

OBJECTIVE: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. METHODS: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. RESULTS: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. CONCLUSION: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.

Parry Romberg disease with En Coup de Sabre Scleroderma: Effect of tocilizumab on periodontal bone inflammation.

Parry Romberg disease and En Coupe de Sabre Scleroderma are frequently associated disorders that affect the face and can cause severe aesthetic and functional impairment. Systemic immunosuppression is the gold standard of first-line treatment in the pediatric rheumatology standpoint although it is often delayed in the pediatric dermatology clinics and more often used in cases of refractory neurological impairment. We report on a case with dental root resorption and severe periodontal bone inflammation detected on magnetic resonance imaging, which was successfully treated with the anti-IL-6 agent tocilizumab.

Impact of antigenic and genetic drift on the serologic surveillance of H5N2 avian influenza viruses.

BACKGROUND: Serologic surveillance of Avian Influenza (AI) viruses is carried out by the hemagglutination inhibition (HI) test using reference reagents. This method is recommended by animal health organizations as a standard test to detect antigenic differences (subtypes) between circulating influenza virus, vaccine- and/or reference- strains. However, significant discrepancies between reference antisera and field isolates have been observed during serosurveillance of influenza A viruses in pig and poultry farms. The objective of this study was to examine the effects of influenza virus genetic and antigenic drift on serologic testing using standard HI assays and reference reagents. Low pathogenic AI H5N2 viruses isolated in Mexico between 1994 and 2008 were used for phylogenetic analysis of AI hemagglutinin genes and for serologic testing using antisera produced with year-specific AI virus isolates. RESULTS: Phylogenetic analysis revealed significant divergence between early LPAI H5N2 viruses (1994 - 1998) and more recent virus field isolates (2002 - 2008). Results of the HI test were markedly influenced by the selection of the AI H5N2 virus (year of isolation) used as reference antigen for the assay. These analyses indicate that LPAI H5N2 viruses in Mexico are constantly undergoing genetic drift and that serosurveillance of AI viruses is significantly influenced by the antigen or antisera used for the HI test. CONCLUSIONS: Reference viral antigens and/or antisera need to be replaced constantly during surveillance of AI viruses to keep pace with the AI antigenic drift. This strategy should improve the estimation of antigenic differences between circulating AI viruses and the selection of suitable vaccine strains.

Protection of White Leghorn chickens by recombinant fowlpox vector vaccine with an updated H5 insert against Mexican H5N2 avian influenza viruses.

Despite decades of vaccination, surveillance, and biosecurity measures, H5N2 low pathogenicity avian influenza (LPAI) virus infections continue in Mexico and neighboring countries. One explanation for tenacity of H5N2 LPAI in Mexico is the antigenic divergence of circulating field viruses compared to licensed vaccines due to antigenic drift. Our phylogenetic analysis indicates that the H5N2 LPAI viruses circulating in Mexico and neighboring countries since 1994 have undergone antigenic drift away from vaccine seed strains. Here we evaluated the efficacy of a new recombinant fowlpox virus vector containing an updated H5 insert (rFPV-H5/2016), more relevant to the current strains circulating in Mexico. We tested the vaccine efficacy against a closely related subcluster 4 Mexican H5N2 LPAI (2010 H5/LP) virus and the historic H5N2 HPAI (1995 H5/HP) virus in White Leghorn chickens. The rFPV-H5/2016 vaccine provided hemagglutinin inhibition (HI) titers pre-challenge against viral antigens from both challenge viruses in almost 100% of the immunized birds, with no differences in number of birds seroconverting or HI titers among all tested doses (1.5, 2.0, and 3.1 log10 mean tissue culture infectious doses/bird). The vaccine conferred 100% clinical protection and a significant decrease in oral and cloacal virus shedding from 1995 H5/HP virus challenged birds when compared to the sham controls at all tested doses. Virus shedding titers from vaccinated 2010 H5/LP virus challenged birds significantly decreased compared to sham birds especially at earlier time points. Our results confirm the efficacy of the new rFPV-H5/2016 against antigenic drift of LPAI virus in Mexico and suggest that this vaccine would be a good candidate, likely as a primer in a prime-boost vaccination program.

Avian influenza: genetic evolution under vaccination pressure.

Antigenic drift of avian influenza viruses (AIVs) has been observed in chickens after extended vaccination program, similar to those observed with human influenza viruses. To evaluate the evolutionary properties of endemic AIV under high vaccination pressure (around 2 billion doses used in the last 12 years), we performed a pilot phylogenic analysis of the hemagglutinin (HA) gene of AIVs isolated from 1994 to 2006. This study demonstrates that Mexican low pathogenicity (LP) H5N2-AIVs are constantly undergoing genetic drifts. Recent AIV isolates (2002-2006) show significant molecular drifts when compared with the H5N2 vaccine-strain or other field isolates (1994-2000). This study also demonstrates that molecular drifts in the HA gene lineages follow a yearly trend, suggesting gradually cumulative sequence mutations. These findings might explain the increasing incidence of LP H5N2 AIV isolated from commercial avian farms. These findings support recent concerns about the challenge of AIV antigenic drift and influenza epidemics.

CT scan in the evaluation of pediatric abdominal trauma / Tomografia computadorizada na avaliação do trauma abdominal pediátrico

ABSTRACT Objective: to assess the need of computed tomography (CT) for the definition of management in pediatric abdominal trauma. Methods: observational retrospective study with patients under 18 years old victims of blunt or penetrating abdominal trauma that underwent CT of the abdomen and pelvis at admission. We evaluated CT scan findings, indications and management. We calculated the sensitivity, specificity, positive predictive value and negative predictive value of clinical variables and energy of trauma for findings on CT. Results: among the 236 patients included in our study, 72% (n=170) did not present abnormal findings on CT. It was performed surgical treatment in 15% (n=10), conservative treatment in 54,5% (n=36) and 27% (n=18) did not receive treatment for abdominal injuries. In the assessment of CT indications, 28,8% (n=68) presented no justifications. In this group, 91% (n=62) did not show any abnormal findings. Among the six patients with positive findings, half were selected for conservative treatment, while the rest did not need any treatment for abdominal injuries. The presence of abdominal pain, hemodynamic alterations and high energy blunt trauma had low positive predictive values when isolated, whereas the negative predictive values were higher. Conclusion: although CT is necessary in some instances, there is a possible high number of exams that did not make any difference in the management of the pediatric population.

RESUMO Introdução: avaliar a necessidade da tomografia computadorizada (TC) para definição de condutas em trauma abdominal pediátrico. Métodos: estudo observacional retrospectivo com pacientes menores de 18 anos vítimas de trauma abdominal contuso ou penetrante e que realizaram TC de abdome e pelve na admissão. Avaliou-se achados das tomografias, condutas e justificativas para indicação da TC. Foram calculados sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de fatores clínicos e energia do trauma para alterações na TC. Resultados: dentre os 236 pacientes incluídos, 72% (n=170) não apresentaram alterações na TC. Foi realizado tratamento cirúrgico em 15% (n=10), tratamento conservador em 54,5% (n=36) e 27% (n=18) não receberam tratamento por lesões abdominais. Na avaliação das indicações de TC, 28,8% (n=68) não apresentavam nenhuma justificativa, sendo que nesse grupo 91% (n=62) resultaram em ausência de achados. Dentre os seis pacientes com achados positivos, metade recebeu tratamento conservador, enquanto o restante não necessitou de tratamento por lesões abdominais. A presença de dor abdominal, alteração hemodinâmica e trauma contuso de alta energia apresentaram baixos valores preditivos positivos de forma isolada, enquanto os valores preditivos negativos foram mais altos. Conclusão: apesar de a TC ser necessária e justificável em alguns casos, há um possível excesso de tomografias dispensáveis para definição de condutas em população pediátrica.

[Opportunistic infections in the acquired inmunodeficiency syndrome: the history in Mexico 20 years after the beginning of the epidemic]. / Infecciones oportunistas en el síndrome de inmunodeficiencia adquirida: la historia en México a 20 años del inicio de la epidemia.

Opportunistic infections (OI's) complicate the outcome of HIV-positive patients. There have been observed regional differences in the incidence and the prevalence of OI's in AIDS patients secondary to immunological deficiencies, environmental factors and socioeconomic and sanitary conditions. At the beginning of the epidemic, the global incidence of OI's in HIV-positive patients was between 60 and 100%. Later, the incidence of tuberculosis, intestinal pathogens, Pneumocystis jiroveci and Mycobacterium avium has decreased in the western hemisphere, because of the pharmacological prophylaxis, the improvement in the medical care and the introduction of the antiretroviral therapy. This phenomenon has been more evident in the United States, in Western Europe, and most Latin American countries. At the beginning of the HIV epidemic, the frequency of the different OI's in Mexico was similar among all the clinical reports; the majority of the cases showed mucocutaneous or esophagic candidiasis, followed by P. jiroveci pneumonia, and Cryptosporidium sp. enteritis. Recently, we have seen an increased in the number of episodes of CMV retinitis and M. avium disseminated infection as evidence of a prolonged survival of the HIV-positive patients. In conclusion, the morbidity and mortality rates in the HIV-positive patients have diminished as a result of the improvement of the medical care, the application of specific OI's prevention measures and more recently to the introduction of HAART.

Infecciones oportunistas en el síndrome de inmunodeficiencia adquirida: La historia en México a 20 años del inicio de la epidemia / Opportunistic infections in the acquired inmunodeficiency syndrome: the history in Mexico 20 years after the begining of the epidemic

Las infecciones oportunistas (IO's) complican la evolución de los pacientes VIH-positivos. Se han observado diferencias regionales en la incidencia y en la prevalencia de las IO's en los pacientes con SIDA en relación con deficiencias inmunológicas, factores ambientales y a las condiciones socioeconómicas y sanitarias en el entorno de estos pacientes. Al inicio de la epidemia, la incidencia global de IO's alcanzó entre 60 y 100% de los pacientes VIH-positivos. Posteriormente, la incidencia de tuberculosis, de enteropatógenos, de Pneumocystis jiroveci y de Mycobacterium avium ha disminuido en el hemisferio occidental debido a la profilaxis farmacológica, a la mejoría en la atención médica y a la introducción de la terapia antirretroviral. Este fenómeno ha sido más obvio en Estados Unidos, en Europa occidental y en la mayoría de los países de América Latina. Al inicio de la epidemia de VIH, la frecuencia de las diferentes IO's en México fue similar en todos los reportes clínicos, la mayoría de los casos mostraban candidiasis mucocutánea o esofágica seguida por neumonía por P. jiroveci y enteritis por Cryptosporidium sp. Recientemente, se ha observado un incremento en el número de episodios de retinitis por CMV y de infección diseminada por M. avium como consecuencia de la sobrevida más prolongada de los pacientes VIH-positivos. En conclusión, las tasas de morbilidad y de mortalidad en los pacientes VIH-positivos han disminuido como resultado de la mejoría de la atención en el cuidado de estos pacientes, la aplicación de medidas de prevención específicas para IO's y más recientemente por la introducción de terapia antirretroviral muy activa.

Opportunistic infections (OI's) complicate the outcome of HIV-positive patients. There have been observed regional differences in the incidence and the prevalence of OI's in AIDS patients secondary to immunological deficiencies, environmental factors and socioeconomic and sanitary conditions. At the beginning of the epidemic, the global incidence of OI's in HIV-positive patients was between 60 and 100%. Later, the incidence of tuberculosis, intestinal pathogens, Pneumocystis jiroveci and Mycobacterium avium has decreased in the western hemisphere, because of the pharmacological prophylaxis, the improvement in the medical care and the introduction of the antiretroviral therapy. This phenomenon has been more evident in the United States, in Western Europe, and most Latin American countries. At the beginning of the HIV epidemic, the frequency of the different OI's in Mexico was similar among all the clinical reports; the majority of the cases showed mucocutaneous or esofagic candidiasis, followed by P. jiroveci pneumonia, and Cryptosporidium sp. enteritis. Recently, we have seen an increased in the number of episodes of CMV retinitis and M. avium disseminated infection as evidence of a prolonged survival of the HIV-positive patients. In conclusion, the morbidity and mortality rates in the HIV-positive patients have diminished as a result of the improvement of the medical care, the application of specific IO's prevention measures and more recently to the introduction of HAART. KEY WORDS. AIDS. HAART. Pneumocystis jiroveci. Mycobacterium avium. Toxoplasma gondii. Opportunistic infections.

Análise radiográfica de obra de arte: aplicaçäo nos processos de restauraçäo, conservaçäo e autenticaçäo / Radiographic analysis in art's work: its utilization in the restoration, conservation and autentication

As técnicas radiológicas constituem um método importante na investigaçäo científica das obras de arte e objetos arqueológicos, sendo amplamente utilizadas em outros países. Por meio de análise radiográfica de seis pinturas atribuidas a Ataíde (Manuel da Costa Ataíde), pintor mineiro do século XVIII, responsável por obras de estilo barroco presentes nas igrejas mineiras, procurou-se documentar suas principais características (uso de pigmentos de chumbo, padräo de pinceladas, etc). Esses dados foram associados a informaçöes obtidas do estudo bioquímico dos seus elementos componentes e da análise com radiaçäo ultravioleta e infravermelha, constituindo um documento histórico do estilo próprio de Ataíde.