Ambulation for latency during expectant management of preterm prelabor rupture of membranes: a randomized controlled trial (AMBLE).

BACKGROUND: Individuals hospitalized with preterm prelabor rupture of membranes are often advised to limit their activity or adhere to bed rest. Some evidence suggests that greater activity is associated with longer latency and improved outcomes, but no high-quality evidence from a randomized controlled trial exists. OBJECTIVE: This study aimed to evaluate whether encouragement to ambulate at least 2000 steps daily affects latency among individuals with preterm prelabor rupture of membranes compared with usual care. STUDY DESIGN: This was a multisite unblinded, 2-arm randomized trial of individuals at 23 0/7 to 35 0/7 weeks of gestation undergoing inpatient expectant management of preterm prelabor rupture of membranes with planned delivery at least 7 days away. Each participant wore a Fitbit Inspire that tracked steps. The intervention arm was encouraged (verbal and Fitbit-based reminders) to reach a goal of 2000 steps per day. The usual-care arm was allowed ad libitum activity with no step goal or reminders. The primary outcome was latency (days) from randomization to delivery. Secondary analyses included composite neonatal and maternal clinical outcomes and maternal mental health survey results. Statistical analyses were conducted with an intent-to-treat approach under a Bayesian framework using neutral priors (a priori assumed 50:50 likelihood of longer latency in either arm). A total of 100 participants were required to have 80% power to demonstrate a 4-day difference in latency with 75% certainty (Bayesian probability). RESULTS: Among 163 eligible individuals, 100 (61%) were randomized, and after loss to follow-up, 95 were analyzed. Gestational age at randomization was 29 3/7 weeks (interquartile range, 26 2/7 to 31 5/7) in the intervention arm and 27 4/7 weeks (interquartile range, 25 4/7 to 29 6/7) in the usual-care arm. Median step counts were 1690 per day in the intervention arm (interquartile range, 1031-2641) and 1338 per day in the usual-care arm (interquartile range, 784-1913). Median days of latency were 9 days in the intervention arm (interquartile range, 4-17) and 6 days in the usual-care arm (interquartile range, 2-14). The primary analysis indicated a 65% posterior probability that the intervention increased latency relative to usual care (posterior relative risk, 1.09; 95% credible interval, 0.70-1.71). The relative risk was 0.55 (95% credible interval, 0.32-0.82) for the composite neonatal adverse outcome, with 99% posterior probability of intervention benefit, and was 0.94 (95% credible interval, 0.72-1.20) for the composite maternal adverse outcome, with 70% posterior probability of intervention benefit. There was a 94% posterior probability of the intervention arm having a greater decrease in maternal stress score from baseline to before delivery compared with the usual-care arm (mean arm difference, 3.24 points [95% credible interval, -7.23 to 0.79]). Adjustment for gestational age at randomization had minimal impact on secondary outcome results. CONCLUSION: Individuals with preterm prelabor rupture of membranes randomized to encouragement to ambulate had a longer latency to delivery and improved neonatal and mental health outcomes, with similar maternal clinical outcomes compared with usual care.

Prevalencia de obstrucción intestinal en pacientes con cáncer de colon: Un estudio transversal de centro único / Prevalence of intestinal obstruction in patients with colon cancer: A cross-sectional single-center study

Introducción: Los pacientes con cáncer de colon tienen un riesgo de obstrucción intestinal maligna (OIM). El objetivo del estudio fue determinar la prevalencia de la OIM en un grupo de pacientes con cáncer de colon en un centro de referencia regional público. Metodología: El presente estudio transversal se realizó en el Hospital General IESS Ceibos de Guayaquil -Ecuador de marzo 2017 a junio del 2020. Se incluyeron pacientes con cáncer de colon incidentes en el período de estudio. Las variables fueron edad, sexo, presencia de OIM. Se utiliza estadística descriptiva en frecuencias y porcentajes. Resultados: Se analizan 90 pacientes, 55 hombres (61.11%). La edad más prevalente fue el grupo de 61 a 70 años 27 casos (30%).La comorbilidad más prevalente fue la hipertensión arterial en el 36%. El tipo histológico predominante fue el adenocarcinoma de colon en el 94.44%. 61.11% tuvieron un tumor en el recto y 15.56% en la unión rectosigmoidea. La prevalencia de OIM fue de 55 casos 61.11% (IC95% 60.77-61.45%). En 15 casos (16.67%) fue obstrucción completa y 36 casos (40%) fue obstrucción parcial. La mortalidad fue de 52 casos (57.78%). La presencia del tumor en la unión rectosigmoidea OR=6.188 (IC95% 1.282-29.86) P=0.0232. Conclusión: La prevalencia de OIM es alta más del 61%. La presencia del tumor en la unión recto-sigmoidea fue un factor de riesgo para el desarrollo de OIM.

Introduction: Patients with colon cancer are at risk of malignant intestinal obstruction (MIO). The study aimed to determine the prevalence of MIO in a group of patients with colon cancer in a public regional reference center. Methodology: This cross-sectional study was carried out at the IESS Ceibos General Hospital in Guayaquil, Ecuador, from March 2017 to June 2020. Patients with incident colon cancer were included in the study period. The variables were age, sex, and the presence of MIO. Descriptive statistics are presented as frequencies and percentages. Results: Ninety patients were analyzed, 55 men (61.11%). The most prevalent age group was 61 to 70, with 27 cases (30%). The most prevalent comorbidity was arterial hypertension (36%). The predominant histological type was colon adenocarcinoma (94.44%). A total of 61.11% had a tumor in the rectum, and 15.56% had a tumor in the rectosigmoid junction. The prevalence of MIO was 55 cases, 61.11% (95% CI 60.77-61.45%). In 15 cases (16.67%), there was complete obstruction; in 36 cases (40%), there was partial obstruction. Mortality was 52 cases (57.78%). The presence of the tumor in the rectosigmoid junction OR=6.188 (95% CI 1.282-29.86) P=0.0232. Conclusion: The prevalence of MIO is high, at more than 61%. The presence of a tumor in the rec-tosigmoid junction was a risk factor for the development of MIO.

Soil contamination by zoonotic parasites in leisure areas: an integrative review / Contaminação do solo por parasitas zoonóticos em áreas de lazer: uma revisão integrativa / Contaminación del suelo por parásitos zoonóticos en áreas de ocio: una revisión integradora

Enteropasites are a risk to both human and animal health, and soil is an important route for their propagation and perpetuation, due to the easy animal access to leisure environments. Furthermore, the contamination of these areas is a public health problem, due to the high number of people who visit these places and can acquire these parasitoses. The purpose of this study was to research information described in the scientific literature on the prevalence of parasites with zoonotic potential in leisure areas, their distribution and associated factors. This is an integrative review of the literature in which scientific studies on parasites of zoonotic potential in leisure areas were selected from the Virtual Health Library, with MEDLINE and LILACS as its database, in addition to PUBMED, SCIELO and "Periódicos Capes" published between 2010 and 2020 in Portuguese, English and Spanish. Eleven articles were selected from the 494 found after applying criteria for inclusion, exclusion and content evaluation. Ancylostoma spp. and Toxocara spp. proved to be widely distributed, and soil contamination by parasites is directly linked to the presence of animals in these environments, due to their feces and favorable environmental conditions.

Os enteropasitas são um risco para a saúde humana e animal, sendo o solo uma importante via para sua propagação e perpetuação, devido ao fácil acesso dos animais aos ambientes de lazer. Além disso, a contaminação dessas áreas é um problema de saúde pública, devido ao grande número de pessoas que visitam esses locais e podem adquirir essas parasitoses. O objetivo deste estudo foi pesquisar informações descritas na literatura científica sobre a prevalência. de parasitas com potencial zoonótico em áreas de lazer, sua distribuição e fatores associados. Trata-se de uma revisão integrativa da literatura em que foram selecionados estudos científicos sobre parasitos de potencial zoonótico em áreas de lazer, da Biblioteca Virtual em Saúde, tendo como base de dados MEDLINE e LILACS, além de PUBMED, SCIELO e "Periódicos Capes" publicados entre 2010 e 2020 em português, inglês e espanhol. Onze artigos foram selecionados dos 494 encontrados após aplicação dos critérios de inclusão, exclusão e avaliação de conteúdo. Ancylostoma spp. e Toxocara spp. provou ser amplamente distribuída, e a contaminação do solo por parasitas está diretamente ligada à presença de animais nesses ambientes, devido às suas fezes e às condições ambientais favoráveis.

Las enteropasitas son un riesgo para la salud tanto humana como animal, y el suelo es una vía importante para su propagación y perpetuación, debido al fácil acceso de los animales a los entornos de ocio. Además, la contaminación de estas áreas es un problema de salud pública, debido a la gran cantidad de personas que visitan estos lugares y pueden adquirir estas parasitosis. El propósito de este estudio fue investigar información descrita en la literatura científica sobre la prevalencia de parásitos con potencial zoonótico en áreas de ocio, su distribución y factores asociados. Se trata de una revisión integradora de la literatura en la que se seleccionaron estudios científicos sobre parásitos de potencial zoonótico en áreas de ocio de la Biblioteca Virtual en Salud, con MEDLINE y LILACS como base de datos, además de PUBMED, SCIELO y "Capas Periódicos" publicados entre 2010. y 2020 en portugués, inglés y español. Se seleccionaron once artículos de las 494 encontradas tras aplicar criterios de inclusión, exclusión y evaluación de contenido. Ancylostoma spp. y Toxocara spp. demostró estar ampliamente distribuida, y la contaminación del suelo por parásitos está directamente relacionada con la presencia de animales en estos ambientes, debido a sus heces y condiciones ambientales favorables.

Impacto del tiempo entre la extracción y el análisis de la gasometría arterial en la práctica clínica / The Effect Of Time Between Sample Extraction And Arterial Blood Gas Analysis In Clinical Practice

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Fragilidad del X y otras entidades asociadas al gen FMR1: estudio de 28 familias afectadas / Fragile X syndrome and other entities associated with the FMR1 gene: Study of 28 affected families

El síndrome de fragilidad del cromosoma X es la causa de discapacidad intelectual heredable más frecuente. Asociado a trastornos del espectro autista en un tercio de los pacientes, afecta, con mayor prevalencia, a los varones. Se debe a una expansión de trinucleótidos CGG (citosina, guanina, guanina), llamada mutación completa en el locus Xq27.3 del gen FMR1, que conduce a la hipermetilación en el promotor del gen y reduce los niveles de expresión de FMRP, una proteína implicada en la maduración y plasticidad sináptica. Una expansión menor de CGG es la causa de insuficiencia ovárica primaria y del síndrome de temblor/ataxia asociado a X frágil, caracterizado por ataxia cerebelosa progresiva, de inicio tardío, y temblor de intención. En el presente estudio de serie de casos, se analiza la segregación de mutaciones del gen FMR1 en diferentes familias y la variabilidad de expresión clínica que llevó a la consulta genética.

The fragile X syndrome occurs due to an expansion of CGG trinucleotides, called full mutation, which is found at the Xq27.3 locus of the FMR1 gene. It is the most common cause of inherited intellectual disability. Associated with autistic spectrum disorders in one third of the patients, it affects males with higher prevalence. It also leads to hypermethylation of the gene promoter, silencing it and reducing the expression levels of FMRP, a protein involved in synaptic maturation and plasticity. A lower expansion causes primary ovarian failure syndrome as well as tremor and ataxia syndrome characterized by progressive cerebellar ataxia of late onset and intention tremor. In the present case-control study we analyze the segregation of mutations of the FMR1 gene in different families and the variability of expression that led to the genetic consultation.

[Fragile X syndrome and other entities associated with the FMR1 gene: Study of 28 affected families]. / Fragilidad del X y otras entidades asociadas al gen FMR1: estudio de 28 familias afectadas.

The fragile X syndrome occurs due to an expansion of CGG trinucleotides, called full mutation, which is found at the Xq27.3 locus of the FMR1 gene. It is the most common cause of inherited intellectual disability. Associated with autistic spectrum disorders in one third of the patients, it affects males with higher prevalence. It also leads to hypermethylation of the gene promoter, silencing it and reducing the expression levels of FMRP, a protein involved in synaptic maturation and plasticity. A lower expansion causes primary ovarian failure syndrome as well as tremor and ataxia syndrome characterized by progressive cerebellar ataxia of late onset and intention tremor. In the present case-control study we analyze the segregation of mutations of the FMR1 gene in different families and the variability of expression that led to the genetic consultation.

El síndrome de fragilidad del cromosoma X es la causa de discapacidad intelectual heredable más frecuente. Asociado a trastornos del espectro autista en un tercio de los pacientes, afecta, con mayor prevalencia, a los varones. Se debe a una expansión de trinucleótidos CGG (citosina, guanina, guanina), llamada mutación completa en el locus Xq27.3 del gen FMR1, que conduce a la hipermetilación en el promotor del gen y reduce los niveles de expresión de FMRP, una proteína implicada en la maduración y plasticidad sináptica. Una expansión menor de CGG es la causa de insuficiencia ovárica primaria y del síndrome de temblor/ataxia asociado a X frágil, caracterizado por ataxia cerebelosa progresiva, de inicio tardío, y temblor de intención. En el presente estudio de serie de casos, se analiza la segregación de mutaciones del gen FMR1 en diferentes familias y la variabilidad de expresión clínica que llevó a la consulta genética.

Lingual frenotomy in a newborn, from diagnosis to surgery: a case report / Frenotomia lingual em recém-nascido, do diagnóstico à cirurgia: relato de caso

ABSTRACT This report describes the diagnostic approach and frenotomy in a newborn with breastfeeding difficulty, and the observation and analysis during the following 6 months. The patient was delivered normally and without complications, but showed breastfeeding difficulty during her first 5 days of life. The protocol proposed by Martinelli in 2013 was used to evaluate the lingual frenulum. After applying the protocol, the newborn was determined to require a frenotomy and the urgery was performed. The patient was reassessed using the protocol immediately after surgery and again 24 hours latter. There were improvements in the protocol scores at both reassessments. The newborn was observed and analyzed during the next six months by collecting monthly data from the vaccination card and by asking the mother for information. She was given no food supplements, pacifiers, nor sucked the thumbs, and was fed only breast milk and presented an age-appropriate weight gain. We conclude that the diagnosis using the Martinelli protocol is of fundamental importance to recognizing the need for early intervention and that the frenotomy helped improve the patient's breastfeeding and swallowing capacity.

RESUMO O objetivo foi descrever um relato de caso clínico, de diagnóstico e frenotomia em um recém-nascido com dificuldade de aleitamento e acompanhado por 6 meses. Recém-nascido, parto normal, 5 dias de vida sem alterações de saúde, apresentando dificuldade em aleitamento no seio materno. Para avaliação do frênulo lingual, utilizou-se o protocolo proposto por Martinelli, 2013. Após aplicar o protocolo, notou-se que o recém-nascido apresentou necessidade de frenotomia. Foi realizada a cirurgia, em seguida, reaplicado o protocolo imediatamente e após 24 horas. Observou-se melhora nos escores do protocolo nas aplicações imediatas e após 24 horas. O recém-nascido foi acompanhado por seis meses mensalmente, por meio de coleta de dados na carteirinha de vacinação e perguntas dirigidas mãe. Constatou- se que o recém-nascido, após a cirurgia, não fez uso de complemento alimentar, uso de chupeta e/ou dedo,sendo alimentado somente no seio materno, apresentando ganho de peso satisfatório para a idade. Concluimos que o diagnóstico por meio do protocolo é de fundamental importância, indicando a necessidade de intervenção precoce, e que a frenotomia contribuiu com a melhora no aleitamento do recém-nascido.

Diffuse alveolar hemorrhage in childhood-onset systemic lupus erythematosus: a severe disease flare with serious outcome.

OBJECTIVE: To evaluate prevalence, clinical manifestations, laboratory abnormalities and treatment in a multicenter cohort study including 847 childhood-onset systemic lupus erythematosus (cSLE) patients with and without diffuse alveolar hemorrhage (DAH), as well as concomitant parameters of severity. METHODS: DAH was defined as the presence of at least three respiratory symptoms/signs associated with diffuse interstitial/alveolar infiltrates on chest x-ray or high-resolution computer tomography and sudden drop in hemoglobin levels. Statistical analysis was performed using Bonferroni correction (p < 0.0022). RESULTS: DAH was observed in 19/847 (2.2%) cSLE patients. Cough/dyspnea/tachycardia/hypoxemia occurred in all cSLE patients with DAH. Concomitant parameters of severity observed were: mechanical ventilation in 14/19 (74%), hemoptysis 12/19 (63%), macrophage activation syndrome 2/19 (10%) and death 9/19 (47%). Further analysis of cSLE patients at DAH diagnosis compared to 76 cSLE control patients without DAH with same disease duration [3 (1-151) vs. 4 (1-151) months, p = 0.335], showed higher frequencies of constitutional involvement (74% vs. 10%, p < 0.0001), serositis (63% vs. 6%, p < 0.0001) and sepsis (53% vs. 9%, p < 0.0001) in the DAH group. The median of disease activity score(SLEDAI-2 K) was significantly higher in cSLE patients with DAH [18 (5-40) vs. 6 (0-44), p < 0.0001]. The frequencies of thrombocytopenia (53% vs. 12%, p < 0.0001), intravenous methylprednisolone (95% vs. 16%, p < 0.0001) and intravenous cyclophosphamide (47% vs. 8%, p < 0.0001) were also significantly higher in DAH patients. CONCLUSIONS: This was the first study to demonstrate that DAH, although not a disease activity score descriptor, occurred in the context of significant moderate/severe cSLE flare. Importantly, we identified that this condition was associated with serious disease flare complicated by sepsis with high mortality rate.

Vulnerabilidades de pescadores de comunidades ribeirinhas às Infecções Sexualmente Transmissíveis / Vulnerabilidad de los pescadores de las comunidades costeras a las infecciones de transmisión sexual / Vulnerability of fishermen from coastal communities to sexually transmitted infections

RESUMO Introdução: as Infecções Sexualmente Transmissíveis, especificamente a Síndrome da Imunodeficiência Adquirida são patologias que representam grandes desafios para a saúde no contexto mundial, merecendo destaque devido ao seu alto potencial de disseminação. No universo masculino, verifica-se que vem se intensificando o aumento da incidência dessas patologias, sobretudo nos grupos representados pelos adolescentes e jovens. Objetivo: analisar as vulnerabilidades de pescadores de comunidades ribeirinhas às infecções sexualmente transmissíveis. Métodos: trata-se de uma pesquisa exploratória e descritiva de abordagem qualitativa, realizada nas comunidades ribeirinhas do interior piauiense, Brasil. A amostra foi composta por 18 homens que vivem nessas comunidades. Resultados: os resultados foram divididos em duas categorias, a saber: Vulnerabilidades de pescadores relacionadas as infecções sexualmente transmissíveis e práticas preventivas; Políticas públicas de saúde voltadas para a saúde sexual dos homens. Percebeu-se que há uma grande deficiência de conhecimento dos pescadores sobre essas infecções, devido ao baixo grau de escolaridade e a ausência de ações educativas em saúde por parte da Estratégia de Saúde da Família, o que os torna muito vulneráveis às Infecções Sexualmente Transmissíveis. Conclusão: há uma necessidade de realizar ações educativas em saúde para os pescadores, por parte da Estratégia Saúde da Família, visto que as políticas de saúde para os homens contemplam ações para as populações mais vulneráveis(AU)

RESUMEN Introducción: las infecciones de transmisión sexual son enfermedades que constituyen importantes desafíos para la salud en el contexto global, y el síndrome de inmunodeficiencia adquirida merece una mención especial debido a su alto potencial de propagación. En el universo masculino, parece que se está intensificando la creciente incidencia de estas enfermedades, especialmente en los grupos representados por adolescentes y jóvenes. Objetivo: analizar las vulnerabilidades de pescadores de comunidades ribereñas con las infecciones de transmisión sexual. Métodos: estudio con enfoque cualitativo, exploratorio y descriptivo, llevado a cabo en las comunidades ribereñas de Piauí interior. La muestra consistió en 18 hombres que viven en estas comunidades. Resultados: se dividieron en dos categorías, a saber: los pescadores de vulnerabilidad relacionados con las prácticas de prevención de infecciones y las políticas públicas de salud centrados en la salud sexual de los hombres de transmisión sexual. Se observó que existe deficiencia de los conocimientos de los pescadores sobre estas infecciones, debido al bajo nivel de educación y la falta de las acciones en salud en la Estrategia Salud de la Familia, que los hace muy vulnerables a las infecciones de transmisión sexual. Conclusión: se necesitan actividades de educación en la salud de los pescadores, mediante la estrategia de salud de la familia, como las políticas de salud para los hombres que incluyen acciones para las poblaciones más vulnerables(AU)

ABSTRACT Introduction: Sexually transmitted infections, specifically the acquired immunodeficiency syndrome are diseases that pose major challenges for health in the global context deserves special mention because of its high potential for spread. In the male universe, it appears that is intensifying the increasing incidence of these diseases, especially in the groups represented by adolescents and youth. Objective: Analyze the fishing vulnerabilities related to sexuality and sexually transmitted infections prevention practices. Methods: This is an exploratory and descriptive qualitative approach, carried out in the riverine communities of Piaui interior. The sample consisted of 18 men who live in these communities. Results: The results were divided into two categories, namely: Vulnerability fishermen related and prevention practices Sexually Transmitted Infections; health public policies focused on the sexual health of men. It was noticed that there is a big fishermen's knowledge deficiency on these infections, due to the low level of education and lack of educative health actions by the Family Health Strategy, which makes them very vulnerable to sexually transmitted infections. Conclusion: There is a need for educational activities in health for fishermen, by the Family Health Strategy, as health policies for men include actions for the most vulnerable populations(AU)

Anti-RO/SSA and anti-La/SSB antibodies: Association with mild lupus manifestations in 645 childhood-onset systemic lupus erythematosus.

BACKGROUND: To our knowledge there are no studies assessing anti-Ro/SSA and anti-La/SSB autoantibodies in a large population of childhood-systemic lupus erythematosus (cSLE) patients. METHODS: This was a retrospective multicenter cohort study performed in 10 Pediatric Rheumatology services, São Paulo state, Brazil. Anti-Ro/SSA and anti-La/SSB antibodies were measured by enzyme linked immunosorbent assay (ELISA) in 645 cSLE patients. RESULTS: Anti-Ro/SSA and anti-La/SSB antibodies were evidenced in 209/645 (32%) and 102/645 (16%) of cSLE patients, respectively. Analysis of cSLE patients with and without anti-Ro/SSA antibodies revealed higher frequencies of malar rash (79% vs. 71%, p=0.032), photosensitivity (73% vs. 65%, p=0.035), cutaneous vasculitis (43% vs. 35%, p=0.046) and musculoskeletal involvement (82% vs. 75%, p=0.046) in spite of long and comparable disease duration in both groups (4.25 vs. 4.58years, p=0.973). Secondary Sjögren syndrome was observed in only five patients with this antibody (2.5% vs. 0%, p=0.0035), two of them with concomitant anti-La/SSB. The presence of associated autoantibodies: anti-Sm (50% vs. 30%, p<0.0001), anti-RNP (39% vs. 21%, p<0.0001) and anti-ribossomal P protein (46% vs. 21%, p=0.002) was also significantly higher in patients with anti-Ro/SAA antibodies. Further evaluation of cSLE patients with the presence of anti-La/SSB antibodies compared to those without these autoantibodies showed that the frequency of alopecia (70% vs. 51%, p=0.0005), anti-Sm (59% vs. 31%, p<0.0001) and anti-RNP (42% vs. 23%, p<0.0001) were significantly higher in the former group. CONCLUSIONS: Our large multicenter cohort study provided novel evidence in cSLE that anti-Ro/SSA and/or anti-La/SSB antibodies were associated with mild manifestations, particularly cutaneous and musculoskeletal. Secondary Sjögren syndrome was rarely observed in these patients, in spite of comparable frequencies of anti-Ro/SSA and/or anti-La/SSB reported for adult SLE.

Parâmetros de qualidade de polpas de frutas congeladas / Parameters of quality of frozen fruit

Neste trabalho foram avaliadas as qualidades microbiológica, física e química de polpas de frutas congeladas de diferentes sabores e marcas, comercializadas no município de Cuiabá – MT. O experimento foi conduzido em DIC, disposto em um arranjo fatorial 3 x 2, em amostras de três marcas (X, Y e Z) de dois períodos de coletas (junho/2014 e outubro/2014), e em triplicata. Foram realizadas análises de: coliformes a 35 oC e a 45 oC, Salmonella spp., fungos filamentosos e leveduras, cor (L*a*b*), pH, acidez titulável, sólidos solúveis, ratio e vitamina C. Todas as amostras de polpas de frutas congeladas analisadas, independentemente do sabor, da marca e do período de coleta, não apresentaram contagens de coliformes a 35 oC e a 45 oC, tampouco houve isolamento de Salmonella spp.; e baixas contagens de fungos filamentosos e leveduras foram detectadas. Houve variações dos valores de cor (L*a*b*), pH, acidez titulável, sólidos solúveis, ratio e vitamina C entre as marcas e os períodos de coletas em todas as amostras de polpas de frutas analisadas. Algumas amostras de polpas demonstraram valores fora dos limites preconizados pela IN nº 1 de 7 de janeiro de 2000 do MAPA, que indicaram padrões de identidade e de qualidade deficientes...

Safety and efficacy of wavefront-guided myopic laser in situ keratomileusis using a new wavefront sensor technology: first 100 cases.

PURPOSE: To evaluate the safety and efficacy of wavefront-guided laser in situ keratomileusis (LASIK) for the correction of low to high myopia and myopic astigmatism using data derived from a new-generation Hartmann-Shack aberrometer. SETTING: Refractive Surgery Unit, Bordeaux Hospital University, France. DESIGN: Retrospective case series. METHODS: This retrospective study analyzed the initial group of eyes treated with wavefront-guided LASIK for myopia and myopic astigmatism using the Visx S4IR excimer laser and wavefront data derived from a new Hartmann-Shack aberrometer (iDesign Advanced Wavescan aberrometer). Refractive (refraction and refractive accuracy) and visual outcomes (uncorrected [UDVA] and corrected [CDVA] distance visual acuities) were recorded 3 months postoperatively. RESULTS: The study included 100 eyes of 50 consecutively treated patients. The mean decimal UDVA improved from 0.1 ± 0.1 (SD) preoperatively to 1.1 ± 0.15 postoperatively (P < .01). A monocular UDVA of 20/16, 20/20, and 20/25 were achieved in 76.6%, 94.4%, and 96.6% of eyes, respectively. The postoperative manifest spherical equivalent was within ±0.5 diopter in all eyes. No eye lost 2 or more lines of CDVA, and 29.2% of the eyes gained 1 or more lines of CDVA. CONCLUSION: Wavefront-guided LASIK performed using data derived from the new Hartmann-Shack aberrometer was safe, effective, and predictable for treating myopia and myopic astigmatism. FINANCIAL DISCLOSURE: No author has a financial or proprietary interest in any material or method mentioned.

Chronic Spontaneous Urticaria: A Survey of 852 Cases of Childhood-Onset Systemic Lupus Erythematosus.

BACKGROUND: Data regarding the prevalence of chronic spontaneous urticaria (CSU) in childhood-onset systemic lupus erythematosus (cSLE) patients and possible associated factors are limited to a few case reports. The objectives of this study were to assess CSU in a large cSLE population, in order to evaluate the demographic data, clinical manifestations, disease activity/damage, laboratory abnormalities and treatment. METHODS: A retrospective multicenter cohort study (Brazilian cSLE group) was performed in 10 Pediatric Rheumatology services and included 852 cSLE patients. CSU was diagnosed according to the guidelines of the European Academy of Allergy and Clinical Immunology, the Global Allergy and Asthma European Network, the European Dermatology Forum and the World Allergy Organization. Patients with CSU (evaluated at urticaria diagnosis) and patients without CSU (evaluated at the last visit) were assessed for lupus clinical/laboratory features and treatment. RESULTS: CSU was observed in 10/852 cSLE patients (1.17%). The median of cSLE duration at urticaria diagnosis was 0 (-3 to 5) years. Comparison of cSLE patients with and without CSU revealed a greater frequency of constitutional symptoms (40 vs. 8%, p = 0.006), reticuloendothelial system involvement (30 vs. 3%, p = 0.003), mucocutaneous (90 vs. 28%, p < 0.0001) and musculoskeletal manifestations (50 vs. 6%, p < 0.0001) and methylprednisolone pulse therapy use (60 vs. 9%, p < 0.0001) in the former group. The frequency of immunosuppressive treatment was lower in patients with CSU (p = 0.018). The median SLE Disease Activity Index 2000 (12 vs. 2, p < 0.0001) and erythrocyte sedimentation rate (40 vs. 19 mm/1st hour, p = 0.024), was higher in patients with CSU. CONCLUSIONS: To our knowledge, this is the first study with evidence that CSU may be linked to cSLE. We also demonstrated that this particular skin manifestation occurs predominantly at disease onset and is associated with lupus moderate/high disease activity without major organ involvement.

Wavefront analysis after wavefront-guided myopic LASIK using a new generation aberrometer.

PURPOSE: To evaluate the short-term aberrometric outcomes of wavefront-guided LASIK for the correction of low to moderate myopia and myopic astigmatism using a new generation aberrometer (iDesign System; Abbott Medical Optics, Inc., Santa Ana, CA). METHODS: Charts of 92 eyes of 46 patients successively treated by wavefront-guided LASIK for myopia and/or myopic astigmatism were retrospectively reviewed at 3 months postoperatively. Aberrometric analysis of the wavefront errors was performed for a 6-mm pupil diameter to investigate the surgical induction of the total higher-order aberrations (HOAs), spherical aberrations Z41, and coma-like aberrations Z3 . Additionally, correlations between the magnitude of aberrations induced with the level of achieved correction and the preoperative amount of aberrations were tested. RESULTS: A minimal but statistically significant induction in all of the aberrations tested was observed at 3 months postoperatively (P < .01), with an increase (calculated for a 6-mm pupil) of +0.12 + 0.2, +0.06 + 0.1, and 0.05 + 0.1 pm in the root mean square (RMS) total HOA, RMS spherical aberration Z41, and RMS coma Z31, respectively. The postoperative change in aberrations was poorly correlated with both the level of achieved myopic correction for all of the aberrations tested (r < 0.3; P < .001) and the preoperative level of spherical aberrations (r = 0.3; P < .05) and coma (r = 0.46; P < .05). CONCLUSIONS: Wavefront-guided LASIK using the new generation Hartmann-Shack aberrometer allows a minimal induction of HOAs regardless of the level of myopic correction achieved or the preoperative magnitude of aberrations.

"Milk of calcium": a rare presentation of calcinosis.

Rheumatic diseases such as juvenile dermatomyositis (JDM), juvenile sistemic lupus erythematosus (JSLE) and sistemic sclerosis may have calcium deposits in the subcutaneous and muscle tissues known as calcinosis. Extensive calcium-laden fluid collections referred as "milk of calcium" are rare forms of calcinosis in JDM. We describe a 15-year old patient with overlap syndrome (sclerodermatomyositis and JSLE), whose magnetic resonance imaging (MRI) showed perimusculares fluid collections in the lower limbs. During surgery, we observed the presence of whitish fluid collection suggestive of "milk of calcium".

"Milk of calcium": uma apresentação rara de calcinose / "Milk of calcium": a rare presentation of calcinosis

Algumas doenças reumáticas, como dermatomiosite juvenil (DMJ), lúpus eritematoso sistêmico juvenil (LESJ) e esclerose sistêmica (ES), podem apresentar depósitos de cálcio nos tecidos subcutâneo e muscular, lesões conhecidas como calcinoses. Extensas coleções líquidas de cálcio referidas como milk of calcium são formas raras de calcinoses presentes na DMJ. Descrevemos um paciente de 15 anos de idade, com diagnóstico de síndrome de sobreposição ou overlap (esclerodermatomiosite e LESJ), cuja ressonância magnética (RM) evidenciou coleções líquidas perimusculares em membros inferiores e que, durante procedimento cirúrgico, foi observada a presença de coleção líquida esbranquiçada sugestiva de milk of calcium.

Rheumatic diseases such as juvenile dermatomyositis (JDM), juvenile sistemic lupus erythematosus (JSLE) and sistemic sclerosis may have calcium deposits in the subcutaneous and muscle tissues known as calcinosis. Extensive calcium-laden fluid collections referred as "milk of calcium" are rare forms of calcinosis in JDM. We describe a 15-year old patient with overlap syndrome (sclerodermatomyositis and JSLE), whose magnetic resonance imaging (MRI) showed perimusculares fluid collections in the lower limbs. During surgery, we observed the presence of whitish fluid collection suggestive of "milk of calcium".