Errata – Consenso da Associação Brasileira de Nutrologia Sobre Recomendações do Uso de Probióticos

Correction to: Brazilian Association of Nutrology Consensus Recommendations for the Use of ProbioticsInternational Journal of Nutrology 2019; 12(02): 051-051DOI: 10.1055/s-0039-3402021   Rio de Janeiro, 13 de Abril de2020 Caros leitores, No artigo Consenso da Associação Brasileira de Nutrologia Sobre Recomendações do Uso de Probióticos (Int J Nutrol 2019;12(2):50. DOI: https://doi.org/10.1055/s-0039-3402021.), publicado online e impresso na International Journal of Nutrology em Dezembro de 2019: Onde se lê: No tratamento dietético, os prebióticos da dieta, especialmente as bifidobactérias, visam modificar a composição do ecossistema intestinal por meio de mudanças nutricionais. Leia-se: No tratamento dietético, os prebióticos da dieta, ou seja, substâncias fermentáveis, não digeríveis, que promovem o desenvolvimento seletivo e ativam o metabolismo de bactérias benéficas no trato intestinal, especialmente as bifidobactérias, visam modificar a composição do ecossistema intestinal por meio de mudanças nutricionais.4, 1

Brazilian Association of Nutrology Consensus Recommendations for the Use of Probiotics

ERRATA/CORRECTED BY: https://doi.org/10.1055/s-0040-1710399 Conceptually, dysbiosis can be defined as any undesirable change in the composition of the intestinal microbiota resulting in imbalance between beneficial and pathogenic bacteria. It may be associated with various diseases affecting the gut, as well as multifactorial causes such as poor lifestyle, imbalanced diet and stress. The treatment of dysbiosis comprises two lines. The first one is dietary, through the ingestion of foods that benefit the constitution of the gut microbiota. The other one is through drugs. Dietary prebiotics, especially bifidobacteria, aim to modify the composition of the intestinal ecosystem through nutritional changes. In addition, diet therapy for the prevention and treatment of dysbiosis requires dietary reeducation, avoiding excess carbohydrate intake. To ensure a continuous effect, probiotic intake, when indicated, should be daily. There are reports in the literature of favorable changes in the gut microbiota with doses of 100 g of food product with 108 to 109 colony forming units (CFU) of probiotic microorganisms (107 to 106 CFU/g product) if administered for 15 days. Bacteria belonging to genera Lactobacillus and Bifidobacterium are most often employed as probiotic food supplements because they are isolated from all portions of the healthy human gastrointestinal tract. Products containing probiotics, whether drugs or dietary supplements, must be registered and approved by Brazilian Health Regulatory Agency (Anvisa) and meet specific and stringent rules to prove safety and efficacy

Posicionamento atual sobre vitamina D na prática clínica: Posicionamento da Associação Brasileira de Nutrologia (Abran)

Objective: To establish a position statement to standardize the recommendations of the Brazilian Association of Nutrology related to vitamin D deficiency management in the clinical practice with an emphasis on the diagnosis, treatment and prevention. Methods: We present an update on the diagnosis, prevention and treatment of vitamin D deficiency, based on the most recent scientific evidence, including an extensive data review of PubMed, Lilacs and SciELO. Results: Based on the recent information obtained in contrast to previous published Brazilian and American guidelines, the authors drafted the agreement, which was approved by the scientific board of the Brazilian Association of Nutrology. Conclusion: After a critical analysis of the most recent data, a scientific update regarding vitamin D management was presented resulting in the present institutional guide from the Brazilian Association of Nutrology about the prevention, diagnosis and treatment of this condition in Brazil

Natural latex (Hevea brasiliensis) mold for neovaginoplasty

OBJETIVO: avaliar a utilização do molde de látex natural (Hevea brasiliensis) como modificação à neovaginoplastia de McIndoe e Bannister em pacientes portadoras da síndrome de Mayer-Rokitansky-Küster-Hauser (MRKH). MÉTODOS: análise retrospectiva de nove pacientes com o diagnóstico de síndrome de MRKH, submetidas à neovaginoplastia pela técnica de McIndoe e Bannister com molde de látex natural. Foram avaliadas epitelização, amplitude e profundidade das neovaginas, ocorrência de coitos bem como satisfação e complicações cirúrgicas. RESULTADOS: após cinco semanas do procedimento, oito pacientes apresentavam neovaginas epitelizadas, com profundidade de 7 a 12 cm. Houve um caso de estenose neovaginal completa em decorrência do uso incorreto do molde pela paciente no pós-operatório. Após seguimento mínimo de um ano, todas as pacientes mantinham neovaginas com profundidade de 4 a 8 cm e capacidade para o coito, com 66,7% de satisfação. Uma paciente apresentou fístula retovaginal precoce e episódios tardios de fistulização uretrovaginal. Duas pacientes apresentaram estenose distal das neovaginas a longo prazo. Uma delas e a paciente com fístulas foram submetidas a novo procedimento. CONCLUSÕES: o uso do molde de látex natural como modificação à técnica clássica de neovaginoplastia permitiu a criação de neovaginas morfológica e funcionalmente similares ao órgão normal em pacientes com estenose vaginal.PURPOSE: to evaluate the use of natural latex mold (Hevea brasiliensis) as a modification of McIndoe and Bannister neovaginoplasty in patients presenting Mayer-Rokitansky-Küster-Hauser (MKRH) syndrome. METHODS: we retrospectively included nine patients presenting MKRH syndrome, who had been submitted to McIndoe and Bannister neovaginoplasty modified by the use of natural latex mold. Neovaginal epithelization and depth, coitus occurrence and satisfaction, and surgical complications were evaluated. RESULTS: five weeks after the procedure, eight patients presented an epithelized 7 to 12 cm deep neovagina. There was one case of complete neovaginal stenosis, because of incorrect use of the mold. After at least one year, the others maintained 4 to 8 cm deep neovaginas and capacity for intercourse, with 66.7% satisfaction. One woman presented precocious rectovaginal fistula and late episodes of uretrovaginal fistulae. Two patients presented distal neovaginal stenosis in long-term follow-up. One of these and the patient with fistulae were submitted to a new procedure. CONCLUSIONS: the use of natural latex mold as a modification of classic neovaginoplasty technique allows the creation of neovaginas morphologically and functionally similar to the normal vagina in patients with vaginal agenesis

A reconfiguração da indústria de entretenimento eletrônico

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Distorção da autopercepção de imagem corporal em adolescentes

Introduction: During adolescence, a period of acceleration of growth and body changes, there may be contending behaviors that make the individual vulnerable to concerns about his or her body and appearance. Objective: To verify the presence of body image self-perception distortion in adolescents of the city of Ribeirão Preto, SP. Methods: The present work is a cross-sectional, observational and analytical study. A total of 343 adolescents aged between 12 and 19 years old and belonging to the Professional Information Program (PIP, in the Portuguese acronym) of the University of Ribeirão Preto, state of São Paulo, Brazil, were evaluated. The adolescents responded how they considered themselves in relation to their body weight. Anthropometric measurements of the participants (weight, height, and body mass index [BMI]) were performed. The presence of body image distortion was assessed through the discrepancy between the BMI diagnosed by the professional and the BMI perceived by the adolescent. Results: There was a prevalence of 41.7% of adolescents with body image distortion, either due to overestimation or underestimation of the body size. Female adolescents had greater distortions in the perception of self-image. The overestimation of body image was higher in eutrophic adolescents, while the underestimation was greater in obese and overweight adolescents. Conclusion: The results indicate the need to implement public policies and projects within the school context for the prevention of body image and eating disorders, including in eutrophic adolescents

Efeito protetor e curativo do epoxiconazole mais piraclostrobina no controle da ferrugem asiática da soja

Objetivando avaliar o efeito do fungicida sistêmico epoxiconazole + piraclostrobina no controle da ferrugem da soja (Phakopsora pachyrhizi) foram conduzidos dois experimentos em casa de vegetação adotando o delineamentointeiramente casualizado com sete tratamentos e três repetições. Os tratamentos realizados foram : T1- 30” depois inoculação ; T2- 4 dias depois da inoculação (DDI); T3- 8 DDI; T4- 12 DDI; T5- 16 DDI; T6- 20 DDI; T7- 24 DDI no experimento 1, e T1-30” antes da inoculação (DAI); T2- 4 dias antes da inoculação (DAI); T3- 8 DAI; T4- 12 DAI; T5-16 DAI; T6- 20 DAI; T7- 24 DAI no experimento 2.). A AACPF nos tratamentos 1, 2, 3, 4, 5, 6 e 7 foi de 73,8; 86,8;92,9; 105,1; 154,1; 165,6 e 220,3, respectivamente, e a severidade final (Ymáx) foi de 2,92; 3,49; 3,93; 4,20; 6,79; 8,20 e 10,40 % , respectivamente, no experimento 1; no experimento 2 a AACPF de 17,51; 20,05; 31,49; 33,24; 55,21; 86,63 e 98,01, respectivamente e o Ymáx foi de 0,99; 1,07; 1,89; 2,05; 3,00; 6,00 e 7,11% respectivamente. Em ambos os experimentos, o epoxiconazole + piraclostrobina foi mais eficiente quando aplicado em um período mais próximo dainoculação

Multiple gliomas: four different presentations

Multiple gliomas are uncommon and may be classified according to: a) the time of presentation in early (at diagnosis) or late (during treatment); b) the characteristics of computed tomography or magnetic resonance imaging (CT/MRI) in multifocal (with evidence of spread) and multicentric (without evidence of spread). From 212 patients with histopathologic diagnosis of glioma evaluated from March/90 to September/99, 15 (7%) had multiple lesions. We describe 4 patients: early multicentric, late multicentric, early multifocal and late multifocal, with emphasis on characteristics of CT/MRI and possible differential diagnosis. The differential diagnosis of multiple lesions in the central nervous system includes mainly infectious/inflammatory diseases and metastasis, however multiple gliomas should always be considered, even in patients with known systemic cancer, as described by others. Considering that CT/MRI features are not definite, the diagnosis should always be confirmed by histopathologic examination.Os gliomas múltiplos são relativamente raros e podem ser classificados didaticamente de acordo com: a) a época da apresentação, em precoces (quando presentes desde o diagnóstico inicial) ou tardios (quando presentes durante a evolução); e b) as características dos exames de imagem, em multifocais (quando há evidência de contiguidade das lesões) ou multicêntricos (quando não é possível identificar contiguidade das lesões). Entre os 212 pacientes com diagnóstico anatomopatológico de glioma, acompanhados prospectivamente no setor de neuro-oncologia de março/90 a setembro/99, 15 (7%) apresentaram lesões múltiplas. Descrevemos 4 casos característicos de cada uma das possíveis apresentações: multicêntrico precoce, multicêntrico tardio, multifocal precoce e multifocal tardio, com ênfase nas características de imagem e possíveis diagnósticos diferenciais. O diagnóstico diferencial das lesões múltiplas no sistema nervoso central inclui doenças inflamatórias e infecciosas, além de metástases. A possibilidade de tratar-se de tumores de origem glial, entretanto, deve ser sempre lembrada, mesmo naqueles pacientes com diagnóstico de neoplasia sistêmica conhecida, conforme já descrito na literatura. O diagnóstico histológico se impõe, uma vez que as características de imagem não permitem diagnóstico de certeza.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Umbilical endometriosis without previous pelvic surgery

OBJETIVO: apresentar série de casos de endometriose na cicatriz umbilical, em pacientes no menacme, sem cirurgias pélvicas prévias. MÉTODOS: foram incluídas no estudo quatro pacientes com idade entre 33 e 43 anos, com queixa de sangramento umbilical associado ou não a dor pélvica, com evolução de dois meses a quatro anos. A ultra-sonografia da parede abdominal foi utilizada para o diagnóstico, procedendo-se à exérese cirúrgica das lesões sugestivas de endometriose umbilical e confirmação anatomopatológica. RESULTADOS: as avaliações ultra-sonográficas das quatro pacientes evidenciaram imagens umbilicais hipoecogênicas compatíveis com a hipótese diagnóstica de endometriose e, assim, todas elas foram encaminhadas para exérese cirúrgica da lesão. A dosagem do marcador sérico CA-125 foi realizada em três das quatro pacientes, com níveis dentro da normalidade, variando de 6,8 a 10,1 U/mL. A concomitância de endometriose pélvica apenas foi confirmada em uma paciente. Durante o seguimento de um ano, as pacientes não apresentaram recidiva dos sintomas nem das lesões. CONCLUSÕES: a endometriose umbilical é uma entidade nosológica rara, mas que deve ser sempre lembrada quando da presença de nodulações ou sangramento umbilicais, ainda que não exista relato de cirurgia pélvica prévia com manipulação endometrial. Seu tratamento cirúrgico é, em geral, suficiente para a remissão total da lesão e dos sintomas.PURPOSE: to present a series of cases of umbilical endometriosis in patients in reproductive age, with no previous pelvic surgery. METHODS: four patients aged between 33 and 43 years were included in the study. They all presented umbilical bleeding associated or not with pelvic pain, and medical history varied from two months to four years. Abdominal wall ultrasound was performed for diagnosis support before surgical excision of the umbilical lesions, and histological examination was also performed. RESULTS: the ultrasonographic evaluation of the four patients showed hypoechogenic umbilical lesion suggestive of endometriosis. All patients were submitted to surgical excision and histological examination of the lesions. CA-125 serum levels were measured in three of the patients, but they were within normal ranges (from 6.8 to 10.1 U/mL). In addition to umbilical surgery, laparoscopy was performed in all patients, but only one presented concomitant pelvic endometriosis. In a one-year follow-up, patients maintained asymptomatic and there was no recurrence of the lesions. CONCLUSIONS: umbilical endometriosis is a rare entity, but it may be remembered as a possibility in cases of umbilical nodulations or bleeding, even if there is no previous history of pelvic surgery with endometrial manipulation. Its treatment is always surgical and, in general, it is enough to promote complete elimination of the lesion and of the symptoms

In-hospital and late outcomes of patients undergoing percutaneous mitral valvuloplasty in a center with intermediate volume of structural procedures

ABSTRACTBackgroundPercutaneous mitral valvuloplasty is the treatment of choice for rheumatic mitral stenosis with favorable anatomy, for its ability to prevent complications inherent to a surgical procedure, while maintaining effectiveness. It is necessary to promote comparisons between the results obtained by the procedure performed at referral centers with high patient inflow and at institutions with lower volume and fewer patients, which represents the main objective of this study.MethodsThirty-one consecutive patients undergoing percutaneous mitral valvuloplasty were analyzed from September 2006 to January 2015. Immediate procedural success and late event-free survival rates were evaluated, defined as cardiovascular death or need for a new mitral valve intervention.ResultsThe mean age was 40.9 ± 14.2 years, with a predominance of females (96.8%). The mean Wilkins and Block score was 8.1 ± 1.2. All procedures were performed using the Inoue technique, with an immediate success rate of 90.3%. At mean follow-up of 6.8 ± 2.5 years, seven events (22.6%) were observed: two cardiovascular deaths, four surgeries for mitral valve replacement, and one mitral commissurotomy.ConclusionsIn a hospital with intermediate procedure volume, the results of percutaneous mitral valvuloplasty in the treatment of rheumatic mitral stenosis with favorable anatomy were comparable to those achieved by high-volume centers