Enteral Nutrition in Preterm Infants: Update of the National Consensus Document

Na presente actualização da recomendação sobre nutrição entérica no recém-nascido pré-termo, da Secção de Neonatologia da Sociedade Portuguesa de Pediatria, é dada especial relevância às necessidades nutricionais do recém-nascido pré-termo, aspetos particulares da nutrição entérica durante o internamento na unidade neonatal, nomeadamente em relação ao momento de iniciar a nutrição entérica, como progredir, modo de administração, especificidades do leite humano pré-termo, sua fortificação, nutrição em situações particulares e nutrição após alta hospitalar. É incluída informação sobre a composição das fórmulas especiais, fortificante e suplemento proteico do leite humano comercializados em Portugal

Recomendação de Curvas de Crescimento para Crianças Nascidas Pré-Termo

Em 2013, a Secção de Neonatologia da Sociedade Portuguesa de Pediatria, face à existência de várias curvas de avaliação de crescimento para crianças nascidas pré-termo e à falta de homogeneidade de critérios na sua escolha, nomeou um grupo de peritos que procedeu à revisão crítica das curvas disponíveis e recomenda as que considera mais adequadas para utilização na prática clínica em fases específicas da vida: ao nascimento (Fenton 2013), durante o internamento na unidade de Neonatologia (Fenton 2013 e Ehrenkranz 1999) e a longo prazo (OMS 2006). As decisões foram tomadas com base na classificação sistemática do nível de evidência e do grau de recomendação. A presente recomendação: é válida enquanto não forem publicados os resultados do estudo do consórcio multicêntrico INTERGROWTH-21st, recentemente incumbido da construção de valores de referência, mais próximos do padrão, de crianças nascidas pré-termo; tem o propósito de auxiliar os clínicos na decisão clínica, mas não ser o único instrumento de avaliação do crescimento das crianças nascidas pré-termo; pode não proporcionar elementos suficientes para orientação do crescimento de todas estas crianças

Diagnóstico diferencial de ascite em doente AgHBs positivo: caso clínico

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High levels of T lymphocyte activation in Leishmania-HIV-1 co-infected individuals despite low HIV viral load

<p>Abstract</p> <p>Background</p> <p>Concomitant infections may influence HIV progression by causing chronic activation leading to decline in T-cell function. In the Americas, visceral (AVL) and tegumentary leishmaniasis (ATL) have emerged as important opportunistic infections in HIV-AIDS patients and both of those diseases have been implicated as potentially important co-factors in disease progression. We investigated whether leishmaniasis increases lymphocyte activation in HIV-1 co-infected patients. This might contribute to impaired cellular immune function.</p> <p>Methods</p> <p>To address this issue we analyzed CD4⁺T absolute counts and the proportion of CD8⁺T cells expressing CD38 in <it>Leishmania</it>/HIV co-infected patients that recovered after anti-leishmanial therapy.</p> <p>Results</p> <p>We found that, despite clinical remission of leishmaniasis, AVL co-infected patients presented a more severe immunossupression as suggested by CD4⁺T cell counts under 200 cells/mm³, differing from ATL/HIV-AIDS cases that tends to show higher lymphocytes levels (over 350 cells/mm³). Furthermore, five out of nine, AVL/HIV-AIDS presented low CD4⁺T cell counts in spite of low or undetectable viral load. Expression of CD38 on CD8⁺T lymphocytes was significantly higher in AVL or ATL/HIV-AIDS cases compared to HIV/AIDS patients without leishmaniasis or healthy subjects.</p> <p>Conclusions</p> <p><it>Leishmania </it>infection can increase the degree of immune system activation in individuals concomitantly infected with HIV. In addition, AVL/HIV-AIDS patients can present low CD4⁺T cell counts and higher proportion of activated T lymphocytes even when HIV viral load is suppressed under HAART. This fact can cause a misinterpretation of these laboratorial markers in co-infected patients.</p

Comparative ecology of the European eel, Anguilla anguilla (L.1758), in a large Iberian river

A total of 1,816 eels were sampled in 1988, from seven sampling areas. Four areas were located in brackish water and the remaining three were located in freshwater reaches of the Tagus river basin. Eels were more abundant in the middle estuary and decreased both in the upstream and in the downstream directions, with a predominance of males in higher density areas. Smaller individuals preferred more peripheral areas, such as margins and upper reaches in the brackish water zone, and the tributaries of the freshwater habitats. It was assumed that this distribution pattern resulted from three main factors: (i) the dominance of larger specimens; (ii) the need to avoid predators and; (iii) the search for better trophic conditions. The condition of the individuals generally decreased toward the upper reaches, apparently due to a corresponding decrease in feeding intensity. The presence of the Belver dam in the main river, 158 km upstream from the sea, seemed to impose major alterations to the described patterns. The concentration of specimens below this impassable obstacle yielded a reduction in the proportion of females and a decrease in the condition and survival of the eels, contributing to a reduction in the spawning success of this population. Suggestions to diminish the effects of the dam, and to preserve the fishery are also presente

Treatment of American tegumentary leishmaniasis in special populations : a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making