Determinants of skeletal fragility in acromegaly: a systematic review and meta-analysis.

PURPOSE: Vertebral fractures (VFs) are a potential complication in acromegaly. However, the etiology of this skeletal fragility is unknown. This review aimed to evaluate the effect of acromegaly on VFs, bone turnover, areal bone mineral density (aBMD), and bone quality/microarchitecture. The effect of disease activity and gonadal status in these determinants of skeletal fragility was also evaluated. METHODS: Articles published in English until September 6, 2020 on PubMed and Embase that reported at least one determinant of skeletal fragility in acromegalic patients, were included. Odds ratio (OR) to evaluate the risk of VFs and the standardized mean difference (SMD) to evaluate bone turnover, aBMD and bone quality/microarchitecture were calculated. RESULTS: Fifty-eight studies met eligibility criteria, assembling a total of 2412 acromegalic patients. Of these, 49 studies were included in the meta-analysis. Acromegalic patients, when compared to non-acromegalic patients, had higher risk of VFs [OR 7.00; 95% confidence interval (CI) 2.80-17.52; p < 0.0001], higher bone formation (SMD 1.14; 95% CI 0.69-1.59; p < 0.00001), higher bone resorption (SMD 0.60; 95% CI 0.09-1.10; p = 0.02) and higher aBMD at the femoral neck (SMD 0.36; 95% CI 0.15-0.57; p = 0.0009). No significant differences were found regarding aBMD at lumbar spine. Considering the results of the different techniques evaluating bone quality/microarchitecture, the main reported alterations were a decrease in trabecular bone thickness and density, and an increase in trabecular separation. The presence of active disease and/or hypogonadism were associated with worst results. CONCLUSION: Patients with acromegaly are at increased risk of VFs, mainly because of deterioration in bone microarchitecture.

Prevalence of enteropathogens in normal feces from healthy children at an infant day care in Brazil.

INTRODUCTION: The diarrhea associated with gastroenteritis is a major cause of morbidity and mortality worldwide, affecting mainly infants. The characterization of both viral and bacterial agents associated with gastroenteritis can establish policies for surveillance, prevention and treatment of infections. Group A rotaviruses are the major infectious agent associated with dehydration in children, followed by pathotypes of Escherichia coli. There are three main types of clinical infections caused by E. coli strains that have acquired virulence genes: (i) enteric and diarrheal diseases, (ii) urinary tract infections, and (iii) sepsis and meningitis. METHODOLOGY: In this study, the objective was to identify the presence of rotavirus and diarrhogenic E. coli in the feces of children 4 to 14 months of age who displayed no gastroenteritis symptoms and stayed all day in a day-care center. We analyzed 188 samples using PAGE and PCR to identify rotaviruses and E. coli virulence genes, respectively. RESULTS: Thirty-six samples (19.1%) were positive for at least one pathotype of E. coli. Nineteen were identified to be of the EPEC group and fifteen of the EAEC group. Rotaviruses were not identified. CONCLUSIONS: As EPEC and EAEC are potential pathogens for children less than one year of age or immunocompromised individuals, our results show the importance of appropriate monitoring by public health agencies. In the situation that we have studied, children can be considered asymptomatic carriers of these pathogens and can transmit them to other susceptible children.

Color stability of a nanofill composite: effect of different immersion media.

OBJECTIVE: The aim of this in vitro study was to evaluate the color stability of a nanofill composite resin (Filtek Z350) in different immersion media. MATERIALS AND METHODS: Twelve resin-based composite specimens were prepared using a silicon cylindrical mold measuring congruent with 1mm of thickness and congruent with 10mm of diameter. Specimens were light-cured for 40 s from both sides using a LED Radii at 1400 mW/cm(2) and were randomized into 4 groups (n= 3) according to immersion media: coffee, yerba mate, grape juice or water (control solution). A digital spectrophotometer was used to evaluate the color changes at baseline and at 1-week after immersion in each solution. Specimens were stored in the different staining media for 4 h/day during 1 week. The color differences (DE) were analyzed by paired t-test and one-way ANOVA with complementary Tukey test (p<0.05). RESULTS: After 1-week of immersion, a perceptive color change for the group stored in the grape juice compared to baseline (p=0.008) was observed. Coffee and yerba mate did not show any color changes visible for the human eyes or significantly different from the control group (p>0.05) CONCLUSIONS: The findings of the present study suggest that the tested nanofill resin-based composite was susceptible to staining by substances present in the grape juice.