Consensus on the diagnosis and treatment of cow's milk protein allergy of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition.

Cow's milk protein allergy (CMPA) is the most frequent cause of food allergy in the first months of life. Despite the fact that there are different guidelines and recommendations on the management of children with CMPA, there continues to be great variability in diagnostic and therapeutic criteria in Latin America. The Food Allergy Working Group of the Latin American Society for Pediatric Gastroenterology, Hepatology and Nutrition summoned a group of Latin American experts to reach a consensus and formulate a document to unify diagnostic and therapeutic criteria for CMPA. Three teams were formed, each with a coordinator, and the members of each team developed a series of statements for their corresponding module: a) clinical manifestations and diagnosis; b) diagnostic tools, and c) treatment. A search of the medical literature was carried out to support the information presented in each module and 28 statements were then selected. The statements were discussed, after which they were evaluated by all the experts, utilizing the Delphi method. Their opinions on statement agreement or disagreement were anonymously issued. The final statements selected were those with above 75% agreement and their corresponding recommendations were formulated, resulting in the document presented herein.

Actividad antioxidante del jugo de Passiflora edulis Sims (Gulupa) durante la poscosecha / Antioxidant activity of Passiflora edulis Sims (purple passion fruit) juice in the postharvest period

Introducción: las especies reactivas de oxígeno (ERO), afectan al organismo humano con patologías como las enfermedades cardiovasculares y las crónicas no transmisibles. La incidencia de éstas es menor si en la dieta diaria se incluye un alto consumo de frutos y hortalizas; por esta razón, es importante conocer sus propiedades fitoquímicas. Objetivo: determinar la capacidad antioxidante del jugo de gulupa (Passiflora edulis Sims) en poscosecha. Métodos: se cosecharon frutos en madurez fisiológica y se mantuvieron al ambiente (20 ºC y 70 % de HR) por 21 días, tiempo en el que se midió la actividad antioxidante con los métodos radical catiónico ABTS•+ y el poder antioxidante de reducción del Fe+3 (FRAP), el contenido de ácido ascórbico por HPLC y los carotenoides por espectrofotometría ultravioleta-visible (UV-Vis). Resultados: se apreció una tendencia ascendente en la actividad antioxidante a través del tiempo en poscosecha, con énfasis en el día 14, lo que conduce a manifestar que es la época recomendable para el consumo. El ácido ascórbico (vitamina C), se expresó de manera inestable, pero el aumento hacia el final del almacenamiento fue evidente, mientras que los carotenoides presentaron un incremento constante. Conclusiones: la actividad antioxidante del jugo de gulupa, puede estar dada por los contenidos de ácido ascórbico y carotenoides. Es importante la definición del tiempo de consumo después de la cosecha del fruto, para aprovechar al máximo su valor como alimento nutracéutico. Estos aspectos son útiles para fortalecer la posición de la gulupa en el mercado de exportación.

Introduction: reactive oxygen species (ROS) affect the human body with pathologies such as cardiovascular and chronic non-communicable diseases. The incidence of these diseases is lower when the daily diet includes a high intake of fruits and vegetables. This is the reason why it is important to be acquainted with their phytochemical properties. Objective: determine the antioxidant capacity of the juice of purple passion fruit (Passiflora edulis Sims) in the postharvest period. Methods: physiologically mature fruits were harvested and kept in the open (20 °C and 70 % RH) for 21 days. During that period, antioxidant activity was measured with ABTS•+ radical cation assay and Fe+3 ferric reducing ability of plasma (FRAP), whereas ascorbic acid content was determined by HPLC and carotenoids by ultraviolet-visible (UV-Vis) spectrophotometry. Results: antioxidant activity showed an upward trend during the postharvest period, reaching its peak on day 14. It is therefore advisable to consume the fruit around that day. Ascorbic acid (vitamin C) was expressed in an unstable manner, but increase was evident by the end of the storage period. Carotenoid content showed a steady increase. Conclusions: antioxidant activity of purple passion fruit juice may be due to the contents of ascorbic acid and carotenoids. It is important to define the most suitable time for consumption during the postharvest period, to obtain the maximum nutraceutical benefit. These notions are useful to strengthen the position of purple passion fruit in the export market.

Increasing barrier method use among oral contraceptive users at risk of STDs. What approach is best?

OBJECTIVES: We evaluated whether offering a choice of barrier methods can increase overall barrier method use without decreasing condom use in women using oral contraceptives (OCs) for contraception. STUDY DESIGN: We randomized 167 OC users at risk for sexually transmitted diseases (STDs) into two groups, one receiving male latex condoms only (Condom group), the other receiving both male latex condoms and nonoxynol-9 film (Choice group). All participants received similar hierarchical STD protection counseling. We assessed method use with daily diaries. RESULTS: The Choice group protected a significantly higher percentage of their coital acts with a barrier method (month 1 to 2: 29% vs. 22%; month 3 to 4: 33% vs. 21%; and month 5 to 6: 35% vs. 19%; adjusted P = 0.012). Condom use in the Choice group was higher as well (adjusted P = 0.036). When we used a transitional multilogistic regression approach to account for differential loss to follow-up in the two groups, results were similar. CONCLUSIONS: Offering a choice of barrier methods increased overall barrier method use without decreasing condom use.

PIP: When used correctly and consistently, male latex condom use is the most effective way to prevent sexually transmitted diseases (STDs) among sexually active individuals. Findings are reported from a study conducted to determine whether offering a choice of barrier contraceptive methods can increase overall barrier method use without decreasing condom use in women using oral contraceptives (OCs) for contraception. 167 OC users at risk for sexually transmitted diseases (STDs) were randomized into 2 groups, one receiving only male latex condoms and the other receiving both male latex condoms and nonoxynol-9 film. Participants were at least 18 years old and attended a publicly-funded family planning clinic in Texas. They all received similar hierarchical STD protection counseling and method use was assessed on a daily basis through diaries. The group provided both condoms and the film protected a significantly higher proportion of their coital acts with a barrier method. Condom use in the choice group was also higher. Therefore offering a choice of barrier methods increased overall barrier method use without decreasing condom use.

Identifying condom users at risk for breakage and slippage: findings from three international sites.

OBJECTIVES: This study examined whether past condom failure (breakage, slippage, or both) can predict future failure and evaluated other predictors of condom failure. METHODS: At each of 3 international sites, approximately 130 male condom users were enrolled and given 5 condoms to use for vaginal intercourse over a 3-week period. RESULTS: Men at increased risk (history of 1 or more condoms that broke or slipped off) reported approximately twice as many condom failures as those not in this group. Condom failure increased with the number of adverse condom use behaviors reported per participant. Opening condom packages with sharp objects and unrolling condoms before donning were associated with breakage. Unrolling condoms before donning and lengthy or intense intercourse were associated with slippage. Of background characteristics evaluated, having less education was associated with condom failure. CONCLUSIONS: These data suggest that a history of condom failure predicts future failure, a finding that may be useful for targeted intervention. Moreover, these data provide further evidence that certain behaviors and lower educational attainment are associated with condom failure.

Floruro de sodio al 5 por ciento por iontoforesis para el tratamiento de la hipersensibilidad dentinal / 5 sodium fluoride iontophoresis in the treatment of dentinal hipersensitivity

El propósito de esta investigación fue el de disminuir al máximo y por un período de tiempo prolongado la hipersensibilidad dentinaria. Se utilizó floruro de sodio en solución al 5 por ciento y corriente eléctrica de 27 voltios y 0.7 miliamperios durante 3 minutos. Los resultados mostraron una eficacia del 83.19 por ciento al primer mes, 76.32 por ciento al tercer mes y 68.96 por ciento al sexto mes...

The impact of lubricants on latex condoms during vaginal intercourse.

The objective was to evaluate the impact of additional lubricant on condom breakage and slippage. Two hundred and sixty-eight couples used 6 new and 6 aged condoms during vaginal intercourse and were instructed to use 2 of each type with either water-based lubricant, oil-based lubricant or no additional lubricant. The use of either oil-based or water-based lubricant increased slippage rates of new and aged condoms, although only one pairwise comparison (oil-based lubricant vs. no additional lubricant) was statistically significant (8.5% vs. 3.8%, P = 0.004). The use of oil-based lubricant increased breakage, although not statistically significantly, in both new and aged condoms. Water-based lubricant did not impact the breakage rate of the new condoms and decreased the breakage rate of the aged condoms (no additional lubricant 4.5% vs. water-based lubricant 2.1%, P = 0.029). From a functional perspective, this study suggests that condom users should be told not to use oil-based lubricants. The negative impact of water-based lubricant on slippage may be outweighted by the protective influence on breakage, especially for aged condoms. Over three-quarters of the couples (76%) had at least some incorrect knowledge, according to current condom instructions, of the type of lubricant that should be used with condoms.

Can condom users likely to experience condom failure be identified?

A study based on a convenience sample of 177 couples who each used 11 condoms found that 103 condoms (5.3%) broke before or during intercourse and 67 condoms (3.5%) slipped off during sex. Couples who had not used a condom in the past year were almost twice as likely to experience condom failure as were couples who had used at least one during that period (p < .001). Of the couples who had used a condom in the previous year, the failure rate among those who reported at least one condom break during that period was more than twice the failure rate among those who reported no breaks (p < .001). Among couples who had used condoms in the past year without breaking any, those who did not live with their partner and those who had a high school education or less were at increased risk of condom failure (adjusted odds ratios of 3.2 and 2.7, respectively).

PIP: Condoms, when in good physical condition and used properly, protect against the transmission of HIV and other sexually transmitted diseases. When condoms break or slip off during intercourse or withdrawal, however, their effectiveness is seriously compromised. Studies have found breakage rates in the range of 1-12%. This paper explores possible explanations for this wide range of breakage rates seen in the literature and tries to provide a basis for identifying condom users who are at increased risk of breaking condoms. The analysis is conducted upon a subset of data from a study conducted by Family Health International to assess the value of laboratory tests in predicting condom breakage. 177 couples of median age 30 years and with a median education of 15 years each used 11 condoms, for a total of 1947 condoms. 84% of the sample were Caucasian and 84% were either married or living together. 103 (5.3%) condoms broke before or during intercourse and 67 (3.5%) slipped off during intercourse. The study found a small group of users responsible for a disproportionate number of condom failures. Specifically, couples with no condom experience in the previous year, couples who had experienced condom breakage over that period, couples who were not living together, and couples in which the male partner had a high school education or less experienced comparatively higher rates of condom failure. Qualitative data suggest that incorrect methods of putting on condoms, use of oil-based lubricants, reuse of condoms, and duration and intensity of coitus may explain why higher rates of condom failure are found among couples in less stable relationships and couples who are less educated.

Comparison of condom breakage during human use with performance in laboratory testing.

This paper combines results from a study of the determinants of condom quality and use conducted by The Population Council in two countries in the Caribbean with results from a condom breakage study conducted by Family Health International (FHI) in the United States. The studies, conducted two years apart, compared the breakage rates of condoms from the same lot during human use to their performance in laboratory test results. Breakage rates of 12.9% for Barbados, 10.1% for St. Lucia and 6.7% for the United States compared to passing ASTM laboratory tests suggest that existing laboratory tests as used with the current pass/fail standards are either not sufficiently sensitive or not well-defined to reliably predict condom performance during human use. The study also suggests that user behaviors and practices may be a factor in condom breakage. If the condom is to be an effective method against unplanned pregnancy and STD/HIV infection, and if consumer confidence is to be retained, condom breakage during sexual intercourse must be reduced.

PIP: Family Health International (FHI) in North Carolina sampled and tested 52mm contour condoms with a reservoir tip and silicone lubrication in November 1988 and March 1990. Condoms from this same lot were used in 2 human use studies conducted in 2 Caribbean countries and in the US. The Population Council conducted 1 human use study in Barbados and St. Lucia among 50 heterosexual male condom users from each country. FHI conducted the other study in the Research Triangle area of North Carolina among 50 heterosexual male condoms users. Condom breakage rates of the human studies were high (12.9% in Barbados, 10.1% for St. Lucia, and 6.7% for North Carolina) in comparison with other studies (1-7%). Breakage did not occur due to poor storage conditions or oil based lubricant use. The researchers thought that it occurred due to men misusing the condoms or other user behaviors and practices. This belief was supported by the differences in breakage between the Caribbean men and the US men. More men experienced multiple condom breakages than those who experienced only 1 breakage. Condoms used in the study were from the same lot which passed elongation and tensile strength standards of the American Society for Testing and Materials (ASTM) in both 1988 and 1990, but failed the International Organization of Standardization (ISO) airburst tests in 1988 and just barely passed in 1990. Apparently the standards are not sensitive enough to predict increases in condom breakage. These findings suggest that the ISO standard for airburst testing is a more accurate predictor of condom quality than the ASTM standards for tensile strength and elongation. Further the breakage rates are too high given the AIDS epidemic. Moreover high breakage reduces customer confidence. In conclusion, researchers need to conduct studies on sexual behavior and practices to determine their effect on condom breakage rates.