What is the evidence for the effect of physical exercise on bone health in menopausal women? An umbrella systematic review.

This study aimed to analyze the effects of physical exercise (PE) on bone health in menopausal women through an umbrella review and to assess the quality of systematic reviews (SRs) and meta-analyses (MAs) included. The review was registered in PROSPERO (CRD42020208130) and the Rayyan application was used. The methodological quality of the included studies was evaluated by A MeaSurement Tool to Assess Systematic Reviews (AMSTAR), and Grading of Recommendations Assessment, Development and Evaluation (GRADE) was applied to assess the level of evidence of the results. The results showed that low-intensity jumping exercises with longer sessions proved to be efficient in the hip segment. Swimming requires further investigation, as it showed high heterogeneity. Aerobic and resistance exercises showed inconsistent results, requiring further studies with these modalities of PE. Concurrent training showed improvements in the lumbar spine, femoral neck, Ward's triangle and trochanter. Finally, combined resistance exercises are effective in preserving bone mineral density (BMD) of the femoral neck and lumbar spine in postmenopausal women. In conclusion, jumping exercises were efficient in the hip, while aerobic and resistance exercises are still inconsistent. Concurrent training showed improvements in BMD of the lumbar spine, femoral neck, Ward's triangle and trochanter. Finally, combined resistance protocols are effective in preserving BMD of the femoral neck and lumbar spine in postmenopausal women.

CT and MR imaging of orbital inflammation.

PURPOSE: Orbital inflammation can be idiopathic or in the context of a specific disease and it can involve different anatomical orbital structures. On imaging, inflammatory disease is frequently mistaken for infection and malignant tumors, and its underlying cause is often not determined. Through this article we aim to improve orbital inflammation diagnosis and underlying inflammatory diseases recognition. METHODS: The imaging protocols and characteristics of orbital inflammation were reviewed. RESULTS: A decision tree for the evaluation of these patients is provided. First, a combination of clinical and radiological clues is used to recognize inflammation, in particular to differentiate it both from orbital infection and tumor. Subsequently, different radiological patterns are recognized, often allowing the differentiation of the several orbital inflammatory diseases. CONCLUSION: The use of adequate imaging protocols and subsequent evaluation allow the recognition of an orbital lesion as inflammatory and the diagnosis of the underlying inflammatory disease. All in all, a proper treatment can be established, and at times, a biopsy can be avoided.

Dental implants in patients with osteoporosis: a systematic review with meta-analysis.

There is currently no consensus regarding the survival rate of osseointegrated implants in patients with osteoporosis. A systematic review with meta-analysis was performed to evaluate the survival rate of implants in such patients. The PubMed/MEDLINE, Web of Science, Cochrane Library, and SciELO databases were used to identify articles published up to September 2016. The systematic review was performed in accordance with PRISMA/PICO requirements and the risk of bias was assessed (Australian National Health and Medical Research Council scale). The relative risk (RR) of implant failure and mean marginal bone loss were analyzed within a 95% confidence interval (CI). Fifteen studies involving 8859 patients and 29,798 implants were included. The main outcome of the meta-analysis indicated that there was no difference in implant survival rate between patients with and without osteoporosis, either at the implant level (RR 1.39, 95% CI 0.93-2.08; P=0.11) or at the patient level (RR 0.98, 95% CI 0.50-1.89; P=0.94). However, the meta-analysis for the secondary outcome revealed a significant difference in marginal bone loss around implants between patients with and without osteoporosis (0.18mm, 95% CI 0.05-0.30, P=0.005). Data heterogeneity was low. An increase in peri-implant bone loss was observed in the osteoporosis group. Randomized and controlled clinical studies should be conducted to analyze possible biases.

Evaluation of light-touch sensation in the buccal mucosa of leprosy patients.

OBJECTIVE: The aim of this study is to evaluate the light-touch sensation of the oral mucosa in leprosy patients. MATERIALS AND METHODS: A cross-sectional study included 228 adults, 133 being leprosy patients and 95 normal controls. To assess light-touch sensation, the five-filament standard Semmes-Weinstein kit in eight regions of the oral mucosa was used. Chi-square test was used to verify the differences in responses between the studied groups. RESULTS: Normal sensation was predominant in both groups, and diminished sensation was found also in the nonleprosy group. Normal controls showed diminished light-touch sensation in at least one point, which may be attributed to the definition of sensation normality. The chi-square test revealed no significant difference between the two groups (p = 0.43171). Severe diminished sensation was detected only in the leprosy group. CONCLUSION: It is concluded that altered light-touch sensation in the oral cavity may not be a common feature in leprosy. CLINICAL RELEVANCE: Decreased or lost sensation in skin lesions is a paramount in leprosy diagnosis; however, clinicians must be aware that this seems not to be true in the oral mucosa in leprosy cases for diagnosis purpose.

Evaluation of light-touch sensation in the buccal mucosa of leprosy patients

OBJECTIVE: The aim of this study is to evaluate the light-touch sensation of the oral mucosa in leprosy patients. MATERIALS AND METHODS: A cross-sectional study included 228 adults, 133 being leprosy patients and 95 normal controls. To assess light-touch sensation, the five-filament standard Semmes-Weinstein kit in eight regions of the oral mucosa was used. Chi-square test was used to verify the differences in responses between the studied groups. RESULTS: Normal sensation was predominant in both groups, and diminished sensation was found also in the nonleprosy group. Normal controls showed diminished light-touch sensation in at least one point, which may be attributed to the definition of sensation normality. The chi-square test revealed no significant difference between the two groups (p = 0.43171). Severe diminished sensation was detected only in the leprosy group. CONCLUSION: It is concluded that altered light-touch sensation in the oral cavity may not be a common feature in leprosy.CLINICAL RELEVANCE: Decreased or lost sensation in skin lesions is a paramount in leprosy diagnosis; however, clinicians must be aware that this seems not to be true in the oral mucosa in leprosy cases for diagnosis purpose.

Evaluation of the presence of major anionic surfactants in marine sediments.

The contamination of aquatic environments has become the focus of increasing regulation and public concern due to their potential and unknown negative effects on the ecosystems. The present work develops a monitoring and statistical study, based on the analysis of variance test (ANOVA) and the multivariable analysis, both for insoluble soap and LAS in order to compare the behavior of different anionic surfactants in this environmental compartment. First, a novel and successfully validated methodology to analyze insoluble soap in these samples is developed. The matrix effect and the comparison of different extraction techniques were also performed. The optimized analytical methodologies were applied to 48 representative samples collected from the Almeria Coast (Spain) and then a statistical analysis to correlate anionic surfactant concentration and several variables associated with marine sediment samples was also developed. The results obtained showed relevant conclusions related to the environmental behavior of anionic surfactants in marine sediments.

Spontaneous isolated non-haemorrhagic thrombosis in a child with development venous anomaly: case report and review of the literature.

INTRODUCTION: The natural history of developmental venous anomalies (DVAs) is said to be relatively benign. CASE REPORT: We herein report the clinical case of a 9-year-old female child with sudden right hemiparesis. An ischaemic infarct secondary to an isolated spontaneous thrombosis of a DVA was diagnosed by brain magnetic resonance imaging, further confirmed by digital subtraction angiography. CONCLUSION: Considering the therapeutic options, early diagnosis is mandatory.

MR imaging features of brain stem hypoplasia in familial horizontal gaze palsy and scoliosis.

We report the case of a child with horizontal gaze palsy, pendular nystagmus, and discrete thoracolumbar scoliosis. MR imaging of the brain depicted pons hypoplasia with an absence of the facial colliculi, hypoplasia, butterfly configuration of the medulla, and the presence of a deep midline pontine cleft (split pons sign). These MR imaging findings suggest familial horizontal gaze palsy with progressive kyphoscoliosis, a rare congenital disorder. To the best of our knowledge, MR imaging findings of only 4 similar cases, with or without progressive idiopathic scoliosis, have been reported. We discuss the pathogenesis substratum of this entity. Early recognition of this rare entity is important if supportive therapeutic measures in progressive scoliosis are to be applied.

Differential diagnosis of mesiotemporal lesions: case report of neurosyphilis.

We report a clinical and imaging case of suspected herpes simplex encephalitis subsequently diagnosed as neurosyphilis based on positive antibodies in the CSF. MRI of the brain showed cortical and subcortical lesions in the mesial temporal region, septal area, insula and cingulated gyrus of the right cerebral hemisphere. Neurosyphilis should be included in the differential diagnosis of mesial temporal region lesions on MRI.

Profile of thyroid hormones in breast cancer patients.

Estrogen involvement in breast cancer has been established; however, the association between breast cancer and thyroid diseases is controversial. Estrogen-like effects of thyroid hormone on breast cancer cell growth in culture have been reported. The objective of the present study was to determine the profile of thyroid hormones in breast cancer patients. Serum aliquots from 26 patients with breast cancer ranging in age from 30 to 85 years and age-matched normal controls (N = 22) were analyzed for free triiodothyronine (T3F), free thyroxine (T4F), thyroid-stimulating hormone (TSH), antiperoxidase antibody (TPO), and estradiol (E2). Estrogen receptor ss (ERss) was determined in tumor tissues by immunohistochemistry. Thyroid disease incidence was higher in patients than in controls (58 vs 18%, P < 0.05). Subclinical hyperthyroidism was the most frequent disorder in patients (31%); hypothyroidism (8%) and positive anti-TPO antibodies (19%) were also found. Subclinical hypothyroidism was the only dysfunction (18%) found in controls. Hyperthyroidism was associated with postmenopausal patients, as shown by significantly higher mean T3 and T4 values and lower TSH levels in this group of breast cancer patients than in controls. The majority of positive ERss tumors were clustered in the postmenopausal patients and all cases presenting subclinical hyperthyroidism in this subgroup concomitantly exhibited Erss-positive tumors. Subclinical hyperthyroidism was present in only one of 6 premenopausal patients. We show here that postmenopausal breast cancer patients have a significantly increased thyroid hormone/E2 ratio (P < 0.05), suggesting a possible tumor growth-promoting effect caused by this misbalance.

Profile of thyroid hormones in breast cancer patients

Estrogen involvement in breast cancer has been established; however, the association between breast cancer and thyroid diseases is controversial. Estrogen-like effects of thyroid hormone on breast cancer cell growth in culture have been reported. The objective of the present study was to determine the profile of thyroid hormones in breast cancer patients. Serum aliquots from 26 patients with breast cancer ranging in age from 30 to 85 years and age-matched normal controls (N = 22) were analyzed for free triiodothyronine (T3F), free thyroxine (T4F), thyroid-stimulating hormone (TSH), antiperoxidase antibody (TPO), and estradiol (E2). Estrogen receptor ß (ERß) was determined in tumor tissues by immunohistochemistry. Thyroid disease incidence was higher in patients than in controls (58 vs 18 percent, P < 0.05). Subclinical hyperthyroidism was the most frequent disorder in patients (31 percent); hypothyroidism (8 percent) and positive anti-TPO antibodies (19 percent) were also found. Subclinical hypothyroidism was the only dysfunction (18 percent) found in controls. Hyperthyroidism was associated with postmenopausal patients, as shown by significantly higher mean T3 and T4 values and lower TSH levels in this group of breast cancer patients than in controls. The majority of positive ERß tumors were clustered in the postmenopausal patients and all cases presenting subclinical hyperthyroidism in this subgroup concomitantly exhibited Erß-positive tumors. Subclinical hyperthyroidism was present in only one of 6 premenopausal patients. We show here that postmenopausal breast cancer patients have a significantly increased thyroid hormone/E2 ratio (P < 0.05), suggesting a possible tumor growth-promoting effect caused by this misbalance.

Intracranial angiolipoma as cause of subarachnoid haemorrhage. Case report and review of the literature.

A 33-year-old female with a longstanding history of seizures was admitted to our hospital with subarachnoid haemorrhage (SAH). Computed tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA) depicted a vascular fat-containing lesion overlying a right frontal cortical polymicrogyria. The diagnosis of angiolipoma was established. Conservatory management was undertaken with full recovery. She has been followed for 5 years since, with neither re-bleeding nor morphologic change of the lesion. This is a rare intracranial lesion, with only 11 intracranial angiolipomas published in the literature, and is the first case reported which is associated with SAH caused by this lesion.

[Corpus callosum agenesis]. / Agenesia del cuerpo calloso.

BACKGROUND: Corpus callosum agenesis (CCA) is an uncommon entity, which can be diagnosed in utero. Uncertain prognosis makes prenatal counseling difficult. AIM. We have tried to establish a positive correlation between clinical history and imaging findings in patients with CCA. PATIENTS AND METHODS: We retrospectively reviewed clinical data and imaging findings of patients with callosal agenesis diagnosed at our institution between December 1995 and September 2002. RESULTS: Eight patients with CCA were found, five males and three females. Mean age at last clinical follow up was six years and six months, ranging from three months to 20 years. All diagnoses except for one were post natal. All patients underwent, at least, one magnetic resonance (MR) of the brain. Abnormal pregnancy was reported in three patients. Family history was unremarkable in all patients. Three patients were diagnosed with isolated CCA. One of these patients was asymptomatic at three months. Another had a slight language delay at seventeen months. The other patient had a mild developmental delay at five years. All other five patients had non isolated CCA and all were symptomatic, with variable clinical pictures: psicomotor developmental delay (4), epilepsy (4), hemiparesis (1), ocular apraxia (1), macrocephaly (2). CONCLUSION: Non isolated CCA is likely to have a worse prognosis. This may be of significant value in prenatal counseling.

Agenesia del cuerpo calloso / Corpus callosum agenesis

Introducción. La agenesia del cuerpo calloso (ACC) es una enfermedad rara, susceptible de diagnosticarse en el útero, de pronóstico variable,lo que dificulta el consejo prenatal. Objetivos. El objetivo del estudio es evaluar la relación eventual entre los datos clínicos y los descubrimientos imaginológicos en pacientes con ACC. Pacientes y métodos. Se realizó el estudio retrospectivo de las historias clínicas de los pacientes con ACC diagnosticados en el Hospital Garcia de Orta entre diciembre de 1995 y septiembre del 2002. Resultados. Se encontraron ocho pacientes con ACC, cinco de sexo masculino y tres de femenino. La edad media en el momento de realizarse la última observación clínica fue de 6 años y 6 meses, y varió entre los 3 meses y los 20 años. El diagnóstico fue posnatal en siete pacientes y prenatal en un paciente; este diagnóstico incluyó, en todos los casos, un estudio por resonancia magnética (RM). Los antecedentes gestacionales se consideraron relevantes en tres de los casos. Los antecedentes familiares se consideraron irrelevantes en todos los pacientes. La ACC se consideró aislada en tres pacientes. Uno de ellos era asintomático a los 3 meses, otro presentaba un leve retraso en el lenguaje a los 17 meses y el otro, un leve retraso en el desarrollo psicomotor (ADPM) a los 5 años. En los otros cinco pacientes, la ACC se consideró no aislada. Estos pacientes eran todos sintomáticos y presentaban cuadros clínicos variados: ADPM (4), epilepsia (4), hemiparesia (1), apraxiaocular (1), macrocefalia (2). Conclusiones. Los pacientes con ACC no aislada parecen tener un pronóstico clínico peor, lo cual puede ser relevante a la hora de dar un consejo prenatal (AU)

Background. Corpus callosum agenesis (CCA) is an uncommon entity, which can be diagnosed in utero. Uncertain prognosis makes prenatal counseling difficult. Aim. We have tried to establish a positive correlation between clinical history and imaging findings in patients with CCA. Patients and methods. We retrospectively reviewed clinical data and imaging findings of patients with callosal agenesis diagnosed at our institution between December 1995 and September 2002. Results. Eight patients with CCA were found, five males and three females. Mean age at last clinical follow-up was six years and six months, ranging from three months to 20 years. All diagnoses except for one were post-natal. All patients underwent, at least, one magnetic resonance (MR) of the brain. Abnormal pregnancy was reported in three patients. Family history was unremarkable in all patients. Three patients were diagnosed with isolated CCA. One of these patients was asymptomatic at three months. Another had a slight language delay at seventeen months. The other patient had a mild developmental delay at five years. All other five patients had non-isolated CCA and all were symptomatic, with variable clinical pictures: psicomotor developmental delay (4), epilepsy (4), hemiparesis (1), ocular apraxia (1), macrocephaly (2). Conclusion. Non-isolated CCA is likely to have a worse prognosis. This may be of significant value in prenatal counseling (AU)

Neuroradiological practices in Europe: Working ESNR Committee on Neuroradiological Practices in Neuroradiology. European Society of Neuroradiology.

In order to achieve an overview of neuroradiology in Europe a questionnaire was sent to all ESNR National Delegates. The answers received were submitted to a data-based analysis, leading to the conclusion that neuroradiology is an expanding discipline among neurological sciences.

Evaluation of the respiratory function in myasthenia gravis. An important tool for clinical feature and diagnosis of the disease.

Myasthenic gravis may affect both inspiratory and expiratory muscles. Respiratory involvement occurred in almost all patients with myasthenia gravis in all clinical forms of the disease: 332 lung function tests done in 324 myasthenic patients without respiratory symptoms (age 34.6 +/- 18.3 years) were examined. Lung volumes analysis showed that all the patients of both sexes with generalized or ocular myasthenia gravis showed "myasthenic pattern". Male patients with "ocular" form only presented the "myasthenic pattern" with lung impairment and had, from the lung function point of view, a more benign behaviour. Female patients with the "ocular" form exhibited a behaviour of respiratory variables similar to that of the generalized form. It was not observed modification of the variables that suggested obstruction of the higher airways. The "myasthenic pattern" was rarely observed in other neuromuscular diseases, except in patients with laryngeal stenosis.

Heart and unilateral lung transplantation for cardiomyopathy with high pulmonary vascular resistance.

Heart and left lung (en bloc) transplantation was used as an approach to end-stage cardiomyopathy with very high pulmonary vascular resistance. This surgical method was applied to a 13-year-old girl who did very well initially, but died 5 months later of severe pulmonary and cardiac rejection. The pulmonary perfusion scintigraphy showed equalization of the blood flow in both lungs after 42 days, and complete reversal of the pulmonary vascular changes in the opposite lung was observed at autopsy.

Relative sizes of cortical visual areas in marmosets: functional and phylogenetic implications.

Visual areas V1, V2 and MT (V5) were identified through myeloarchitectonic criteria and their sizes estimated in a flattened map of caudal cerebral cortex in the marmoset Callithrix penicillata. The ratio MT/V1 in this species is similar to values reported for other species of primates, but the ratio V2/V1 in Callithrix penicillata is smaller than that in macaques and larger than that in Aotus. The possible implications of these results are discussed.

Balanço de energia durante a hospitalizaçäo de lactentes desnutridos com diarréia / Energy balance in the malnourished infants with diarrhea during the hospitalization

Lactentes desnutridos com diarréia apresentam balanço energético negativo nos primeiros dias de internaçäo. A estimativa da energia ingerida, da energia fecal e do gasto energético de repouso tornam-se extremamente úteis no planejamento do fornecimento calórico diário para essas crianças. Estudaram-se 13 lactentes(10 do sexo masculino) com idades inferiores a 12 meses, desnutridos com diarréia, em 3 ocasiöes durante a internaçäo: no período inicial (PI), na recuperaçäo (PR) e no período de alta (PA). As ingestöes e perdas, diárias de energia foram calculadas a partir dos conteúdos energéticos de leite, urina e fezes que foram determinadas por bomba calorimétrica. O gasto energético de repouso (GER) foi medido por calorimetria indireta. No PI a ingestäo diária correspondeu à metade do PA (59,7 ñ 12,2 vs. 132,9 ñ 27,9 Kcal/Kg, -p (menor que) 0,05). O GER aumentou no PR significativamente (71,1 ñ 11.4 vs. 58,3 ñ 10,9 Kcal/kg, p (menor que) 0.05). Os balanços médicos de energia foram significativamente diferentes nos 3 períodos: PI= -21 ñ 20; pr= 29 ñ 22; PA 29ñ 22; PA= 52 ñ 21 Kcal/Kg/dia, p (menor que) 0,01. Em conclusäo pode-se afirmar que o balanço negativo de energia no PI foi consequente a menor ingestäo e a maior perda fecal (proporcionalmente ao ingerido) de energia. Os balanços efetuados durante a recuperaçäo hospitalar desses pacientes foram úteis como fonte de informaçöes para um adequado tratamento nutricional

Gasto energetico evolutivo durante a recuperacao nutricional de lactentes desnutridos graves com infeccoes associadas / Evolutional energetics expenditures during the nutrition rehabilitation of severe undernourished infants with associated infections

Determinaram-se o gasto de energia em repouso (GER) e o quociente respiratorio (QR) de 8 lactentes desnutridos e infectados, apos a admissao hospitalar (Adm) e durante a recuperacao (Rec), que durou em media 37 dias. As idades variam de 3 a 12 meses e apresentavam um deficit medio de peso para a idade superior a 35%. Utilizou-se a tecnica de calorimetria indireta, empregando-se um calorimetro de circuito fechado. As determinacoes de VO2 e VCO2 foram efetuadas por cromatografia gasosa. A atividade fisica foi avaliada pelo score de Scopes e Ahmed. Os dados pareados mostraram que o GER, calculado pelo peso real foi semelhante entre a Adm = 70,4+/-17,4kcal/kg/dia e Rec = 79,4+/-14,7 kcal/kg/dia. Quando o GER foi calculado pelo peso/altura houve diferenca significativa entre Adm = 44,5+/-7,3 kcal/kg/dia e Rec = 55,3+/-9,5 (p<0,05).O aumento da atividade fisica na Adm como na Rec proporcionou aumento semelhante (20%) e significativo (p<0,05) do GE (tanto por peso real como por peso/altura). O QR sa Adm=0,76+/-0,09 foi significativamente menor do que na Rec = 0,83+/-0,16 p<0,05).Os AA especulam que a admissao, o GER diminuido (calculado pelo peso/altura) traduz a menor massa celular ativa dos lactentes desnutridos infectados. Conclui-se que o QR e um bom parametro para avaliar a normalizacao da atividade metabolica desses desnutridos em recuperacao nutricional .