Treatment outcomes of retinoblastoma patients at a Tertiary Government Hospital in the Philippines

Objective@#This study determined the treatment outcomes of patients with retinoblastoma seen at a Philippine tertiary government hospital from January 2000 to January 2020.@*Method@#This is a cohort study. Medical records of patients with histopathologic-proven retinoblastoma were reviewed and pertinent information on clinical profile and presentation, treatment and outcomes were recorded.@*Results@#This study included 118 patients (146 eyes) with mean age at symptom onset of 7.4 + 6.6 months and mean age at consult of 11.5 + 13.7 months. There were 69 (47%) eyes with International Classification of Retinoblastoma (ICRB) stage E. The most common primary treatment was enucleation (n=137, 94%). The most common high-risk histopathologic feature was involvement of the optic nerve at the cut-end section (n=27, 34%). Only 14 patients (11%) completed treatment with median follow-up of 30.5 months (range 4- 122). @*Conclusion@#The rate of overall survival of patients with retinoblastoma is low in this study, similar to other developing countries. This can be due to higher proportion of patients with advanced stage at presentation and lower percentage of treatment completion. Early diagnosis and treatment may lead to better survival rate, visual outcome and quality of life. Due to limited data on follow-up, globe preservation could not be determined.

TOXICITY OF AFLATOXIN B1 TOWARDS THE INDUCING ALTERATIONS IN THE LIVER FUNCTIONS

Since 2003, the world's developing countries are home to more than 5 billion people thought to be at danger of prolonged consumption of contaminated foods that are aflatoxic according to a number of study efforts conducted in South Africa, Egypt, and other countries in west and east Africa. Additionally, the presence occurrence of aflatoxins and their byproducts in animal tissues used to make food (such as beef and sheep meat) may contaminate human diets. As a result of their increasing prevalence, aflatoxins have recently been identified as a significant public health concern. Aflatoxins are dangerous second-generation byproducts of Aspergillus species. Due to their chemical makeup, the majority of aflatoxins are highly liposoluble substances that can be absorption from the exposed site, such as the gastro-intestinal and respiratory tracts, into the bloodstream, where they can then spread throughout the body and reach various organs, including the liver and kidneys. The primary goals of the study were to monitor and screen for levels of aflatoxin B1 in the Karbala Province using a case-control study. The connection between Aflatoxin B1 concentrations and the common biochemical indicators of liver function as well investigated. How alter liver function by Aflatoxin B1. The study also emphasised the necessity to determine the pathophysiology of AFB1's involvement in the rising number of patients with liver dysfunction. AFB1 levels were quantitated using utilising thin layer chromatography, together with High Pressure liquid chromatography being employed for the quantitative identification (HPLC). In the province of Karbala, an analysis of case-control studies was done to look at the Aflatoxin B1 affects (AFB1) exposure on kidney disease patients. AFB1 levels were quantitated using utilising thin layer chromatography with high-performance liquid chromatography to provide quality results. The evaluations of the samples that tested positive for AFB1 as well as the lipid profile and indicators of liver function tests. The findings indicated that the population under investigation had afflatoxins exposure. AFB1 was found in 100% of individuals with unknown kidney disease (KD) and in 24%, 20%, and 100% of patients with known CKD, respectively. AFB1 concentrations in serum samples ranged from 0.68 to 8.33 ng/mL for patients with questionable KD, 1.21 to For patients, 5.60 ng/mL with known KD, likewise, healthy controls ranged from 0.11 to 1.30 ng/mL. The presence of AFB1 was positively and strongly linked with liver enzymes, specifically ALT and ALP. AFB1 levels among serum samples from KD sufferers and wholesome controls showed a prolonged contact with the poison, suggesting an unknown cause. The evaluation of the biochemical marker of liver functioning supported the effect of AFB1 exposure. This work may help build effective nationwide programmes for tracking AFs exposure. The study also emphasised the necessity to determine the pathophysiology of AFB1's involvement in the rising number of patients with liver dysfunction. Future research is urged to concentrate on more comprehensive topics that cover the entire nation (Iraq)

PLACENTAL ALKALINE PHOSPHATASE AS A THRESHOLD CONCEPT FOR EARLY DETECTION OF PRIMARY LUNG CANCER

The biochemical existing tool of diagnostic methods to lung cancer cases need to be improved. In order to validate an early screening of primary tumor patients, a developed a simple procedure or technique was demanded. The aims of this study were to provide an overview of alkaline Placental Alkaline Phosphatase activity in lung cancer. Using heating inactivation method regarding the measurement of Placental Alkaline Phosphatase activity as an early diagnosis marker in lung cancer cases. Total alkaline phosphatase and Placental alkaline phosphatase activity were measured in patients of Lung cancer patients who were classified according to the site of tumor by histological picture. ALP isoenzymes were identified by heat inactivation, and compared with the most frequently applied method (ELISA). Monitoring of the Total ALP and Placental ALP activity in the studied groups using two different methods were shown a highly performance of heating method by an experimental assessment to confirm the accuracy and validity of the proposed method. The distribution of serum placental ALP isoenzyme activity in patients and control groups which was measured by two different methods were found to be (20.2-43.1) IU/L respectively (measured by heating method) and (394.3- 454.5) pg/mL measured by ELISA method) respectively. Placental ALP isoenzyme showed a high significant activity in lung cancer patients than healthy control with p value less than (0.05). That application of the heat inactivation method yields similar indication to the ones obtained by the highly and specific enzyme-linked immunosorbent assay. The results of detection Placental alkaline phosphatase in serum were in excellent agreement and could have a potentially extensive application for Placental alkaline phosphatase quantification.

THE ATP-BINDING CASSETTE TRANSPORTER A1 GENE POLYMORPHISMS AND TYPE 2 DIABETES MELLITUS.

Insulin resistance (IR), secretion of insulin, and abnormalities of lipid metabolism are all markers of type 2 diabetes (T2DM), which is a progressive and complex metabolic disorder. Major risk factors for the development of T2DM were identified as genetic, environmental, and lifestyle factors. Several studies found that many genes contribute to T2DM susceptibility after glucose tolerance. Adenosine Binding Cassette Transporter Proteins 1 is a member of the ABC gene superfamily that is involved in cholesterol transport and HDL cholesterol (HDL-C) biosynthesis. Abnormal cholesterol metabolism, particularly high-density lipoprotein, has been related to genetic variations in the ABCA1 gene (HDL-C). Previous research suggested that ABCA1 gene polymorphisms may a hereditary risk factor for type 2 diabetes, along with lower HDL levels in various populations.

MINI REVIEW: ASSOCIATION BETWEEN SERUM CORTISOL LEVELS AND COVID-19 DISEASE

Serum cortisol concentration indicates the severity of the underlying condition. More severe disease results in increased cortisol concentrations in the blood, increasing the probability of a catastrophic outcome. A high level of serum cortisol is found in patients with community-acquired pneumonia, and these patients are more likely to develop major complications and death. Corticosteroids are endogenous hormones that are produced by the hypothalamus pituitary adrenal pathway, which is involved for stress response. Considering, known risk factors of endocrine disturbance, there has been minimal discussion on measuring the serum cortisol concentration in COVID-19 patients. SARS-CoV-2 mediated pathogenetic pathways, may also affect endogenous steroid synthesis, particularly cortisol. For the purpose of improving survival rate in severe COVID-19 individuals, we discuss briefly about the current and new findings in the support of measuring the serum cortisol levels in severe COVID-19 individuals and facilitate better treatment management in this article.

COVID-19 AND MUCORMYCOSIS: A SHORT REPORT FROM INDIA

Many complications and symptoms were documented on COVID-19 patients in the second-phase of the COVID-19 outbreak in India. Patients with COVID-19 are already of increased risk of pulmonary embolism (PE), acute cardiac injury (ACI), arrhythmias, and a variety of additional consequences such as altered mental status and proptosis. Mucormycosis, a fungal infection produced by a type of moulds known as mucormycetes, was discovered in a COVID-19 patient. It is a very rare and serious fungal infection (Black Fungus). Mucormycosis, one of the most rapidly spreading infections in COVID-19 patients, has been recorded in 11,717 cases in India. Molds dwell in the environment and primarily affect people who have a weak immune system. Inhaling pathogenic organisms from the air usually causes it to harm the sinuses and lungs. COVID-19 individuals have immunosuppressive with significant drop in CD4+T and CD8+T cells, in addition to alveoli damage and severe pulmonary inflammation. As a result, severely ill-patients, particularly those sent in the intensive-care-unit (ICU) and requiring mechanical ventilation, or those with extended hospital stays 40 to 50 days were more susceptible to mucormycosis. Further, it is crucial to find out that COVID-19 patients especially the ones who are severely ill resulting in weaker immune system can further develop a fungal infection during the middle and or latter stages of COVID-19.

EARLY STEAM INHALATION THE FIRST CRUCIAL STEP IN COMBATING EVIL – THE COVID-19

Hot water is good for throat, but the coronavirus 2019 (COVID-19) hidden behind sinuses about 3-4 days. There was no way through which the warm water would reach behind sinuses. The virus that is hiding behind the sinuses enters the lungs within 4 to 5 days and causes respiratory problems. Inhaling vapor reaches the back of the sinuses. Steam inhalation thins mucus and clears nasal passages and reduces inflammation of the upper respiratory tract or inhibits viral replication due to the heat of the steam. The virus is paralyzed at 50 ° C. The virus becomes so weak at 60 C that it can be resisted by the human immune 0 system. The virus is completely dead at 70 °C. COVID-19 can be killed by breathing vapours through the nose and mouth, according to doctors. Symptoms of mild to moderate infection (COVID-19) usually disappear through vapor inhalation. If everyone started a week-long streaming campaign, the pandemic would end soon. The deadly COVID- 19 is likely to be eliminated if everyone inhales steam during the week. There are no negative consequences to this exercise, and it is inexpensive. This review article describes the benefits of inhalation of steam and its use as an adjunct treatment during the COVID-19 pandemic

SEROTONIN ROLE IN FIBROMYALGIA

Fibromyalgia (FM) is a musculo-skeletal disorder and tiredness which results in diffuse myalgia, localized pain, weakness, lower pain thresholds and non-restorative sleep. Multiple sources of evidence supporting the view of decreased flux via the serotonin pathway in FM patients. Supplementation with serotonin substrates, through L- tryptophan or 5-Hydroxytryptophan (5-HTP) significantly improves depression symptoms, anxiety, fatigue and poor sleep in FM patients. Advances in fibromyalgia recognition have helped to increase the therapy choices for FM patients. New medications, nutritional supplements, and nutritional / pharmacological improvement of deep-stage sleep are all being studied by researchers that emphasizes awareness, exercise, and serotonin substrate / receptor regulation.

Prevalence of rhinitis among 6 and 7-year old students in Fortaleza / Prevalência de rinite em escolares de 6 e 7 anos de Fortaleza

Objective: to evaluate the prevalence of rhinitis symptoms among 6 and 7-year old schoolchildren in Fortaleza, Brazil. Methods: a cross-sectional study using the rhinitis module of the ISAAC (International Study of Asthma and Allergies in Childhood) questionnaire. The sample included 2,020 students from public and private schools, in 2010. Results: the prevalence of cumulative rhinitis, active rhinitis, allergic rhinoconjunctivitis and physician-diagnosed rhinitis was 49.9%, 42%, 15.4% and 28.1%, respectively, being significantly more prevalent among private school students (OR = 0.55, 95CI: 0.46 - 0.66, p < 0.001; OR = 0.50, 95CI: 0.41 - 0.60, p < 0.001; OR = 0.67, 95CI: 0.52 - 0.85, p < 0.001; OR = 0.15, 95CI: 0.12 - 0.19, p < 0.001, respectively), without differences between genders. Interference with daily activities was reported by 25.3%, while 5.7% reported to be moderately or severely affected, without a difference between genders. Conclusion: the prevalence of rhinitis symptoms and associated morbidity among 6-7-year old schoolchildren in Fortaleza was above the Brazilian average, with predominance among private school students, without difference between genders. It was observed that rhinitis was underdiagnosed in this population. .

Objetivo: avaliar a prevalência de sintomas de rinite em crianças de 6 e 7 anos de idade, em Fortaleza. Métodos: foi aplicado o questionário ISAAC (International Study of Asthma and Allergies in Childhood), módulo rinite, em estudo de desenho transversal de base populacional, com amostragem probabilística de 2.020 escolares de escolas públicas e privadas, em 2010. Resultados: a prevalência de rinite cumulativa, rinite ativa, rinoconjuntivite alérgica e rinite diagnosticada foi, respectivamente, 49,9, 42, 15,4 e 28,1%, com predomínio de forma significativa entre as crianças das escolas particulares (RC = 0,55, IC95%: 0,46 a 0,66, p < 0,001; RC = 0,50, IC95%: 0,41 a 0,60, p < 0,001; RC = 0,67, IC95%: 0,52 a 0,85, p < 0,001; RC = 0,15, IC95%: 0,12 a 0,19, p < 0,001, respectivamente), e sem diferença entre os gêneros. Interferência dos sintomas com as atividades diárias foi relatada por 25,3% dos pesquisados, e 5,7% relataram ser moderada ou intensamente afetados, sem diferença entre os gêneros. Conclusão: a prevalência de sintomas de rinite e da morbidade associada, entre crianças de 6 e 7 anos de idade, em Fortaleza, mostrou-se acima da média nacional, com predomínio no grupo das escolas privadas, e sem diferença entre os gêneros. Observou-se também que rinite é subdiagnosticada entre as crianças de 6 e 7 anos de idade, em Fortaleza. .

Effects of rotating night shift and exposure of light at night on circadian pattern of salivary cortisol and urinary melatonin levels.

Objectives: The objective of the present study was to investigate the effects of rotating night shift and light exposure at night on circadian pattern of salivary cortisol and urinary melatonin levels. Methods: 62 healthy nursing professionals of both genders performing day and night shifts (continuous 9 days night shift with alternate day shifts) were recruited. Each month scheduled to continuous 9 days night shift (12 hours in regular 9 nights, from 20:00 to 08:00); after 9 days night shift they perform remaining duties in day shift and 4 days off. Saliva and Urine samples were collected at around 8 hours interval while they were performing night duties and repeated when they were assigned day duties. Saliva and Urine samples were analyzed by the ELISA method. Results: Significant difference was found in night cortisol among night (4.34 ± 3.37) vs day shift (2.70 ± 2.32), (p<0.001). Alteration in morning cortisol was also found between night (3.73 ± 2.47) vs day shift (5.00 ± 2.73). Night melatonin level was decreased as compared to morning melatonin. Significant deference were observed when compared night melatonin between night (16.71 ± 11.98) vs day shift (22.71 ± 13.25) (p<0.001), morning melatonin between night (20.07 ± 14.13) vs day shifts (28.26 ± 14.14) (p<0.001). The circadian pattern of cortisol and melatonin was altered by rotating night shift particularly at night and in the morning time. Conclusion: The present study concluded that the desynchronization was appeared during night shift and entrainment of circadian rhythm in the day shift.

Prevalência de asma em escolares de 6 e 7 anos de idade na cidade de Fortaleza, Brasil / Prevalence of asthma among 6-7 year-old schoolchildren in the city of Fortaleza, Brazil

Objetivo: Avaliar a prevalência de asma e de sintomas relacionados em escolares de 6 e 7 anos de Fortaleza, Brasil. Métodos: Neste estudo transversal, o questionário do International Study of Asthma and Allergies in Childhood (ISAAC) foi aplicado a 2.020 crianças de escolas públicas e privadas, em 2010. Resultados: A prevalência de “sibilos cumulativos” (sibilos na vida) foi 52,6% e a de “sibilos nos últimos 12 meses” (asma ativa), 28,3%, enquanto a taxa de “asma diagnosticada” foi 12,4%. Para os sintomas associados à gravidade da asma, como “sibilos com limite da fala”, “quatro ou mais crises de sibilos no último ano” e “sono interrompido por sibilos uma ou mais noites por semana”, as prevalências foram, respectivamente, 4,1, 3,9 e 6,7%. A taxa de “sibilos pós-exercícios” foi 7,2%, e a de “tosse seca noturna” foi de 39,7%. Houve predomínio no gênero masculino, com significância estatística, de “sibilos cumulativos” (p < 0,001) e asma ativa (p = 0,04).“Sibilos com limite da fala”, “sono interrompido por sibilos uma ou mais noites por semana” e “sibilos pós-exercícios” predominaram no grupo das escolas públicas, comparado ao das escolas privadas (p = 0,002; p = 0,002; e p = 0,003, respectivamente). Conclusões: A prevalência de asma e de sintomas relacionados em escolares de 6 e 7 anos morando em Fortaleza mostrou-se elevada e acima da média nacional, com predomínio dos sintomas no gênero masculino e entre o grupo das escolas públicas, onde a asma também foi mais grave. Observou-se, ainda, que a asma é subdiagnosticada entre as crianças de 6 e 7 anos de Fortaleza.

Objective: To assess the prevalence of asthma and related symptoms among 6-7-year old schoolchildren in the city of Fortaleza, north eastern Brazil. Methods: In this cross-sectional study, the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was applied to 2,020 schoolchildren attending public and private schools in 2010. Results: A prevalence of 52.6% was found for “wheeze ever” (lifetime wheeze), 28.3% for “wheeze within the last 12 months” (active asthma), and 12.4% for “asthma ever” (physician-diagnosed asthma). Symptoms associated with asthma severity, such as “speech-limiting wheeze,” “four or more wheezing attacksin the last 12 months,” and “sleep disturbed due to wheezing one or more nights a week,” showed prevalence rates of 4.1, 3.9, and 6.7%, respectively. The rate of “wheeze after exercise” was 7.2%, and that of “night cough,” 39.7%. “Wheezing ever” (p < 0.001) and active asthma (p = 0.04) were significantly more prevalent among males. Public school students showed higher prevalence rates of “speech-limiting wheeze,” “sleep disturbed due to wheezing one or more nights a week,” and “wheeze after exercise” (p = 0.002, p = 0.002, and p = 0.003, respectively) than children attending private schools. Conclusions: The prevalence of asthma and asthma-related symptoms among 6-7-year old schoolchildren was high – above the national average – in the city of Fortaleza, north eastern Brazil, especially in male students and in those attending public schools; asthma severity was also higher in these groups. We also observed that asthma is underdiagnosed in children aged 6-7 years in Fortaleza.

Doença de Dowling-Degos: apresentação clínica e histopatológica clássica / Dowling-Degos disease: classic clinical and histopathological presentation

A doença de Dowling-Degos é uma genodermatose rara que consiste numa desordem pigmentar reticulada. Caracteriza-se pela presença de máculas hiperpigmentadas nas regiões flexurais com distribuição em rede; lesões tipo comedão no dorso e na região cervical; e cicatrizes cribriformes na face, particularmente periorais. Apresentamos um caso de um paciente de 51 anos, masculino, com lesões tipo macrocomedões, cicatrizes cribriformes, cistos e máculas hipercrômicas no dorso, tórax anterior, axilas, pescoço, região genital e face. Relatava ter dois filhos, três irmãos e o pai com quadro semelhante. As biópsias de pele foram características da doença de Dowling-Degos, mostrando dilatação folicular, epiderme digitiforme, com áreas de aspecto de "chifre de veado" e focos de hiperpigmentação da camada basal.

Dowling-Degos disease (DDD) is a rare genetic disease of the skin (reticulate pigmented anomaly), clinically characterized by flexural brown pigmented reticulate macules, comedo-like papules on the back, neck and pitted perioral or facial scars. We present the case of a 51 year-old man with macrocomedo-like lesions, pitted scars, cysts, hyperpigmented macules in his back, chest, axillae, neck, groin and face. The patient reported having two children, three brothers and a father with a similar condition. The histopathology of the skin biopsies was very characteristic of Dowling-Degos disease, showing dilated follicular, fingerlike projections called rete ridges (dermal pegs), with thinning of the suprapapillary plates, resulting in an "antler-like" pattern and increased pigmentation of the basal layer.

Tinea granulomatosa de Majocchi / Majocchi's granuloma

Relata-se o caso de um homem de 45 anos com dermatofitose superficial de longa data, tratado, inadvertidamente, com corticoide e antibiótico, com progressão subsequente para a forma profunda, conhecida como granuloma de Majocchi. O tratamento com terbinafina VO foi curativo.

We report the case of a man of 45 with superficial dermatophytosis longtime inadvertently treated with antibiotics and corticosteroids with subsequent progression to the deep form, known as granuloma Majocchi. Treatment with orally terbinafine was successful.

Laparotomia / Laparotomy

Celiotomia, que significa precisamente incisão da parede abdominal em qualquer região, é considerado sinônimo de laparotomia, cuja acepção exata é "secção do flanco". A abertura da cavidade abdominal para fins diagnósticos e terapêuticos remonta a antiguidade, mas tornou-se rotineira a partir dos meados do século XX com o advento da anestesia geral, utilizando drogas curarizantes e entubação orotraqueal. Serão discutidos a classificação das laparotomias quanto a finalidade, direção, a complexidade e a relação com estruturas da parede abdominal.

Celiotomy, which precisely means incision of any region of the abdominal wall, is considered a synonym of laparotomy, whose exact definition is 'section of the flank'. Opening of the abdominal cavity for diagnostic and therapeutic purposes dates back to ancient times, but it became a routine procedure in the midtwentieth century with the advent of general anesthesia, by means of curaric agents and orotracheal intubation. We will discuss the classification of laparotomies according to their purposes, direction, complexity, and relation with abdominal wall structures.

Instrumental cirúrgico / Surgical instrumentation

Para a execução de cada uma das etapas do procedimento cirúrgico utilizam-se instrumentos distintos e são necessários ordem e método para permitir ao cirurgião executar o procedimento com precisão e rapidez. Para isso, o instrumental cirúrgico deve ser listado e preparado com antecedência, de acordo com o tipo de cirurgia a ser realizada e preferência do cirurgião.

Distinct instruments are employed during the accomplishment of each of the stages of a surgical procedure. For the surgeon to perform the procedure accurately and efficiently, order and method are mandatory. To this end, surgical instruments should be listed and prepared well in advance, according to the surgery type and the surgeon's preferences.

Evolution of critically ill patients with gastroschisis from three tertiary centers

OBJECTIVES AND INTRODUCTION: Gastroschisis is a congenital abdominal wall defect with increasing occurrence worldwide over the past 20-30 years. Our aim was to analyze the morbidity of newborns after gastroschisis closure, with emphasis on metabolic and hydroelectrolyte disturbances in patients at three tertiary university centers. METHODS: From January 2003 to June 2009, the following patient data were collected retrospectively: (A) Background maternal and neonatal data: maternal age, prenatal diagnosis, type of delivery, Apgar scores, birth weight, gestational age and sex; (B) Surgical modalities: primary or staged closure; and (C) Hospital course: levels of serum sodium and levels of serum albumin in the two first postoperative days, number of ventilation days, other postoperative variables and survival. Statistical analyses were used to examine the associations between some variables. RESULTS: 163 newborns were included in the study. Primary closure of the abdominal defect was performed in 111 cases (68.1 percent). The mean serum sodium level was 127.4¡6.7 mEq/L, and the mean serum albumin level was 2.35¡0.5 g/dL. Among the correlations between variables, it was verified that hyponatremia and hypoalbuminemia correlated with the number of days on the ventilator but not with the number of days on total parenteral nutrition (TPN); mortality rate correlated with infection. The final survival rate was 85.9 percent. CONCLUSION: In newborns with gastroschisis, more aggressive attention to hyponatremia and hypoalbuminemia would improve the outcome.

Pseudoxantoma elástico perfurante periumbilical e periareolar / Periumbilical and periareolar perforating pseudoxanthoma elasticum

O pseudoxantoma elástico perfurante periumbilical (PEPP), ou elastose cálcica perfurante, é distúrbio raro e sua patogênese está associada a alteração da fibra elástica, tendo o trauma provável participação. Apresenta-se caso de paciente de 70 anos com quadro de máculas enegrecidas e pápulas encimadas por crostas na região periareolar e periumbilical há mais de dez anos. O exame histopatológico revelou fibras elásticas alteradas, repletas de cálcio, e formação de pertuito na derme com fibras elásticas degradadas no seu interior. O caso descrito corresponde ao PEPP, que nesta paciente também acomete área periareolar bilateralmente.

The periumbilical perforating pseudoxanthoma elasticum or perforating calcific elastosis is a rare disorder and its pathogenesis is associated with the alteration of elastic fibers, which may probably result from trauma. We present the case of a 70-year-old woman with long-time blackish maculas and keratotic surface papules on the periareolar and periumbilical regions. The histopathological examination revealed altered elastic fibers, replete with calcium and formation of a path in the dermis with elastic fibers degraded in their interior, confirming the clinical diagnosis.

Estudo piloto no tratamento intensivo da celulite / Pilot study of the intensive treatment of cellulitis

Introdução: a celulite afeta em torno de 90% das mulheres, contudo não há uma forma eficaz de tratamento estabelecida. Objetivo: o objetivo do presente estudo é relatar uma nova forma de tratamento intensivo da celulite e nova hipótese da fisiopatologia desta doença. Método: foi avaliado o tratamento intensivo em quatro mulheres com celulite do grau IV, cujas idades foram de 22, 32, 25 e 26 anos. Os critérios de inclusão foram celulite do grau IV, estar dentro do peso corporal e sem edema. Os critérios de exclusão foram obesidade, história de edema e de qualquer doença clínica evidente. O tratamento foi drenagem linfática técnica Godoy & Godoy adaptada para celulite, drenagem linfática com RAGodoy® e mecanismos de contenção de baixa elástica durante quatro horas diárias por dez dias em duas semanas. A avaliação foi por fotografia e perimetria antes e após dez dias de tratamento. Resultados: todas as mulheres tiveram redução de medidas que variou entre 8 e 10 cm nas maiores variações, alterações fotográficas e clínicas. Conclusão: conclui-se que a forma intensiva preconizada permite a redução da celulite em curto período de tempo.

Caso para diagnóstico / Case for diagnosis

A calcinose idiopática é uma doença rara, caracterizada pelo depósito de sais de cálcio na derme. Possui diversas apresentações clínicas. Em pacientes com Síndrome de Down, ocorre uma rara associação com lesões de calcinose diopática semelhantes a milium.

Idiopathic calcinosis is a rare disease characterized by abnormal deposit of calcium salts on the dermis. It has several clinical presentations. In patients suffering from Down Syndrome, there is a rare association with idiopathic calcinosis lesions similar to milium.

O aleitamento materno nos programas brasileiros de pós-graduação em Pediatria: perfil das dissertações e teses elaboradas de 1971 a 2006 / Breastfeeding in Brazilian Pediatrics postgraduate programs: a profile of academic papers made from 1971 to 2006

OBJETIVO:Traçar o perfil da produção sobre o tema "aleitamento materno" na pós-graduação stricto sensu em Pediatria no Brasil. MÉTODOS: Análise descritiva das dissertações e teses produzidas no período de 1971 a 2006 pelos programas reconhecidos pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. RESULTADOS:Os 12 programas produziram 1.494 obras, das quais 68 (4,55 por cento) utilizaram o aleitamento materno como objeto de construção, sendo 50 em nível de mestrado e 18 de doutorado. A região Sudeste detém o maior número de Programas. Houve predominância dos estudos quantitativos. A Faculdade de Medicina de Ribeirão Preto, a Universidade de São Paulo e a Universidade Federal de São Paulo foram as que mais se dedicaram ao estudo do tema. Dois programas não apresentaram estudos sobre aleitamento materno. Os programas se diferenciaram quanto à especificidade dos estudos, geralmente quantificando e descrevendo o tema sob a ótica social e biológica, mas não foram explorados aspectos culturais que envolvem a prática do aleitamento materno. CONCLUSÕES:O número de obras produzidas não corresponde à importância da temática para a saúde da criança. A produção em aleitamento materno está concentrada no Sudeste, região que detém o maior número de Programas. Houve predominância dos estudos quantitativos, o que revela uma preocupação com a dimensão biológica da amamentação.

OBJECTIVE: To analyze the profile of knowledge production on breastfeeding in Brazilian pediatrics strict sensu post-graduation programs. METHODS:A descriptive analysis was carried out regarding academic studies produced between 1971 and 2006 at all programs recognized by the Coordination for Improvement of Professionals with University Level (Capes, Brasília, Brazil). RESULTS: The 12 programs produced 1.494 thesis, 68 of which (4,55 percent) had breastfeeding as the main object: 50 master and 18 PhD theses. The Southeast region had the largest number of programs. In terms of methodology, there was a predominance of quantitative studies. The Medical Schools of São Paulo Univer sity in Ribeirão Preto and in São Paulo together with the Federal University of São Paulo were the ones that were more dedicated to studying this issue. Two programs did not present studies on breastfeeding at all. The programs were very different regarding the specificity of their studies, generally quantifying and describing the subject under a social or a biological view, without investigating cultural aspects related to breastfeeding practice. CONCLUSIONS: The number of academic studies produced does not match the importance of the theme for children's health. The academic production on breastfeeding is concentrated in the Southeast, the region with the largest number of programs. In terms of methodology, there was a predominance of quantitative studies, which shows a concern for the biological dimension of breastfeeding.