Positive changes in breastfeeding and complementary feeding indicators in Brazil are associated with favorable nurturing care environments.

OBJECTIVES: To analyze trends in breastfeeding and complementary feeding indicators for infants and young children receiving primary health care (PHC) services in Brazil, considering the contextual aspects of local nurturing care (NC) environments. STUDY DESIGN: Ecological time-series study. METHODS: Ten feeding indicators were extracted from 1,055,907 food intake records of children aged <2 years reported by PHC facilities from 2015 to 2019. Local NC environments were assessed with the Brazilian Early Childhood Friendly Municipal Index, calculating overall and stratified scores for the NC domains of adequate nutrition, good health, opportunities for early learning, and security and safety. Prais-Winsten regression was used to calculate annual percent changes (APC) by sex and the contrast in APC between the lower and upper quintiles of NC scores. Positive or negative APC with P-values <0.05 represented increasing or decreasing trends. RESULTS: No significant trends of exclusive and continued breastfeeding, food introduction, or minimum dietary diversity were observed, with 2019 prevalences of 54.5%, 45.2%, 92.5%, and 78.2%, respectively. Increasing trends were observed for mixed milk feeding (2019: 19.2%; APC, +2.42%) and minimum meal frequency (2019: 61.1%; APC, +2.56%), while decreasing trends were observed for sweet beverage consumption (2019: 31.9%; APC, -5.92%) and unhealthy foods (2019: 16.1%; APC, -4.69%). Indicator improvements were significantly stronger in environments more favorable for NC. CONCLUSIONS: Although the indicators did not meet global targets for infant feeding practices, the results suggest that the local NC environment encompasses facilitators that may be strategic in the design of early childhood programs and policies to improve nutrition.

Linfoma primario del sistema nervioso central: el aporte de las técnicas convencionales de diagnóstico por imágenes / Primary CNS lymphoma: The contribution of conventional diagnostic imaging techniques

El linfoma primario del sistema nervioso central (LPSNC) tiene una presentación predecible en las imágenes convencionales, tanto en pacientes inmunocompetentes como inmunodeprimidos. Analizamos las características imagenológicas que nos permiten reconocer ambos casos y realizamos una revisión de las formas clínicas más relevantes del LPSNC, así como su aspecto en las imágenes obtenidas con técnicas convencionales del Diagnóstico por Imágenes, basándonos en un análisis retrospectivo de nuestros archivos institucionales y la literatura actual. La revisión abarca todas las presentaciones relevantes de esta enfermedad poco frecuente para permitir un diagnóstico temprano, crucial para el adecuado tratamiento.

Primary central nervous system lymphoma (PCNSL) has a predictable imaging appearance on conventional imaging in immunocompetent and immunocompromised patients. The imaging features that enable both types of patients are discussed. The extensive imaging review presented here of the most relevant PCNSL clinical presentations and their imaging appearances using conventional imaging techniques is based on a retrospective analysis of our institutional files and on the current literature. The review covers all of the relevant appearances of this uncommon disease to enable early diagnosis, which is crucial for proper patient management.

Clinicians' prescribing practices for bariatric surgery patients: is there an issue?

WHAT IS KNOWN AND OBJECTIVES: Patients undergoing Roux-en-Y gastric bariatric (RYGB) surgery present a reduced absorption site, and special attention should therefore be taken when prescribing oral-dosage forms. This study was carried out to investigate the extent to which non-bariatric clinicians are aware of this issue when prescribing medicines for this population, and what type of information is available to aid them in their decision-making. METHODS: Two questionnaires were created, one for non-bariatric clinicians and another for their patients who had undergone RYGB surgery, to gather information about the prescription practices for this population. Additionally, a literature search of pharmacokinetic studies on bariatric patients and recommended prescription practices was carried out. RESULTS AND DISCUSSION: Of the 62 non-bariatric clinicians surveyed, 50% believed RYGB surgery interferes with drug absorption; however, 68% still prescribed tablets as the first choice form of dosage. Young clinicians (35%) were less likely to believe that RYGB surgery could affect drug absorption than experienced clinicians (43%). The main reasons for changing dosage forms were patient complaints about efficacy or difficulty in swallowing tablets. Of the 73 patients, 43 were taking drugs in tablet form after the surgery, 24 of whom had health issues unrelated to the surgery. None of the journals read by the clinicians contained pharmacokinetics (PK) studies involving bariatric surgery patients or presented recommendations for the prescription of oral-dosage forms for this population. The literature search revealed a total of 22 drugs that had undergone PK studies in RYGB patients. Fifteen of them were reported to have decreased effects, 12 of which were administered as tablets. WHAT IS NEW AND CONCLUSION: There is still a relative lack of clinical evidence to guide clinicians when prescribing medicines for bariatric patients. It is therefore recommended that pharmacists should have greater participation in the prescription process to advise non-bariatric clinicians and educate RYGB surgery patients to help avoid therapeutic failure.

Meconium aspiration syndrome - the experience of a tertiary center.

BACKGROUND: Approximately 5 % of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). AIM: The aims of this study were to analyse demographic data, morbidity and mortality associated with MAS and to identify possible risk factors. METHODS: Retrospective chart review of newborns with MAS delivered at a tertiary centre from January 1st, 1997 to December 31st, 2008. RESULTS: MAS was responsible for 1.4 % of all Neonatal Intensive Care Unit (NICU) admissions, with a trend towards a decreasing incidence during the study duration, especially in the cases of thin meconium. Seventy two newborns were analysed during the study period: 55.6 % (n = 40) were of the female gender, 62.5 % were delivered by caesarean section, 93 % had > 36 weeks of gestational age and 91.2 % had a birth weight over 2500g. Sixty-nine percent had an Apgar score < 7 at 1 minute and 23.6 % an Apgar score < 7 at 5 minutes; foetal bradicardia was present in 26.4 % of the newborns and tachycardia in 1.4 %. The presence of meconium was associated with severe asphyxia and carried a bad prognosis with an increased risk of developing hypoxia (58.3 %), need of mechanical ventilatory support (43.1 %), respiratory and/or metabolic acidosis (30.6 %), pulmonary hypertension (11.1 %) and hypoxic ischemic encephalopathy (29.2 %). The mortality rate was 2.8 %. Thick meconium was associated with higher morbidity and mortality rates. CONCLUSION: The number of admissions for MAS has been decreasing mostly because of a lower admission rate due to thin meconium; the number of cases with thick meconium has remained constant throughout the years. An Apgar score < 7 at 1 minute and signs of foetal distress during labour were associated with MAS. The MAS related morbidity remains significant.

Isolation, primary culture and morphological characterization of oenocytes from Aedes aegypti pupae.

Oenocytes are ectodermic cells that participate in a number of critical physiological roles such as detoxification and lipid storage and metabolism in insects. In light of the lack of information on oenocytes from Aedes aegypti and the potential role of these cells in the biology of this major yellow fever and dengue vector, we developed a protocol to purify and maintain Ae. aegypti pupa oenocytes in primary culture. Ae. aegypti oenocytes were cultured as clustered and as isolated ovoid cells with a smooth surface. Our results demonstrate that these cells remain viable in cell culture for at least two months. We also investigated their morphology in vivo and in vitro using light, confocal, scanning and transmission electron microscopes. This work is the first successful attempt in isolating and maintaining Ae. aegypti oenocytes in culture, and a significant step towards understanding the role of this cell type in this important disease vector. The purification and the development of primary cultures of insect oenocytes will allow future studies of their metabolism in producing and secreting compounds.

A case review of the MRI features in alternating Tolosa-Hunt syndrome.

Tolosa-Hunt syndrome (THS) consists of a painful ophthalmoplegia with typical features in magnetic resonance imaging (MRI). The recurring nature of this affliction has been known since its first description. However, compromise of the contralateral cavernous sinus, known as alternating THS, is very rare and has never been examined using MRI. We report clinical data, laboratory data and imaging features of a patient with alternating THS. According to our literature review, this is the first MRI study of THS.

New findings in partial trisomy 16q: clinical report.

UNLABELLED: Partial trisomy 16q is a rare disorder associated with significant dysmorphism, psychomotor retardation and limited postnatal survival. A female infant with a partial trisomy 16q from a de novo translocation 11;16 is described. Clinical findings were consistent with previous reports, with the exceptions of megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia. CONCLUSION: Based on this clinical report, megalocornea, partial callosal agenesis and mild bilateral occipital lobe hypoplasia should perhaps be included in the list of anomalies associated with partial trisomy 16q.