Helminth infections, atopy, asthma and allergic diseases: protocol for a systematic review of observational studies worldwide.

INTRODUCTION: Childhood infections, particularly those caused by helminths are considered to be important environmental exposures influencing the development of allergic diseases. However, epidemiological studies focusing on the relationship between helminth infections and risk of allergic diseases, performed worldwide, show inconsistent findings. Previous systematic reviews of observational studies published 10 or more years ago showed conflicting findings for effects of helminths on allergic diseases. Over the past 10 years there has been growing literature addressing this research area and these need to be considered in order to appreciate the most contemporary evidence. The objective of the current systematic review will be to provide an up-to-date synthesis of findings of observational studies investigating the influence of helminth infections on atopy, and allergic diseases. METHODS AND ANALYSIS: This systematic review protocol was registered at PROSPERO. We will search Cochrane Library, MEDLINE, EMBASE, CINAHL, AMED, ISI Web of Science, WHO Global Health Library, Scielo, IndMed, PakMediNet, KoreaMed, Ichushi for published studies from 1970 to January 2020. Bibliographies of all eligible studies will be reviewed to identify additional studies. Unpublished and ongoing research will also be searched in key databases. There will be no language or geographical restrictions regarding publications. Critical Appraisal Skills Programme quality assessment tool will be used to appraise methodological quality of included studies. A descriptive summary with data tables will be constructed, and if adequate, meta-analysis using random-effects will be performed. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist will be followed for reporting of the systematic review. ETHICS AND DISSEMINATION: Since this systematic review will be only based on published and retrievable literature, no ethics approval will be sought. The multidisciplinary team performing this systematic review will participate in relevant dissemination activities. Findings will be presented at scientific meetings and publish the systematic review in international, peer-reviewed, open-access journals. PROSPERO REGISTRATION NUMBER: CRD42020167249

Hematoma Subdural em Pediatria Diagnosticar e Tratar Precocemente

Introdução: O hematoma subdural agudo não traumático é uma entidade rara em Pediatria. A presença de sintomas neurológicos de instalação aguda associada a anti coagulação obriga à exclusão desta entidade. Caso clínico: Apresentamos o caso de uma criança, do sexo masculino, de sete anos de idade, com prótese mitral mecânica, medicada com varfarina, que recorreu ao serviço de urgência por cefaleias intensas e progressivas, associadas a alteração no estado de consciência e convulsões. A nível laboratorial o INR (International Normalized Ratio) era de 4,2. Foi admitida na Unidade de Cuidados Intensivos Pediátricos (UCIP) em coma com anisocoria. Iniciou ventilação mecânica, medidas anti-edema cerebral e antiepilépticos. O exame de imagem mostrou hematoma subdural agudo à esquerda, com desvio da linha média. Foi submetida a craniotomia descompressiva, 56 horas após o início da sintomatologia, com recuperação clínica e actualmente sem sequelas. Conclusão: Este caso clínico ilustra a importância da suspeição clínica de hematoma subdural em doentes anti coagulados, bem como a necessidade de optimização das condições cirúrgicas e da utilização das técnicas não invasivas na monitorização do nível de consciência

Primary pulmonary melanoma: the unexpected tumour

A 62-year-old woman was referred to our pulmonology team with exertional dyspnoea and chest tightness of 2 months duration. Her medical history included cervical cancer and thyroid nodules. Imaging studies showed collapse of left upper lobe. Fiberoptic bronchoscopy unveiled an endoluminal lesion and bronchial biopsy displayed features of melanoma. She denied a history of melanoma or excision of lesions of skin, mucous membranes or the eye. A thorough evaluation including combined positron emission tomography with CT scan excluded other possible sites of primary melanoma, but there was a metastasis in a thoracic vertebra. Palliative radiotherapy of the spine was performed. Chemotherapy initiation with dacarbazine was postponed by the appearance of a malignant pleural effusion, confirmed by pleural fluid cytology. After four cycles chemotherapy was discontinued due to disease progression. The patient is still alive with a follow-up of 12 months, currently on best supportive care

Olfactory sensitivity to changes in environmental Ca2 in the freshwater teleost Carassius auratus: an olfactory role for the Ca2+ -sensing receptor?

Olfactory sensitivity to changes in environmental Ca2+ has been demonstrated in two teleost species; a salmonid (Oncorhynchus nerka) and a marine/estuarine perciform (Sparus aurata). To assess whether this phenomenon is restricted to species that normally experience large fluctuations in external ion concentrations (e.g. moving from sea water to fresh water) or is present in a much wider range of species, we investigated olfactory Ca2+ sensitivity in the goldfish (Carassius auratus), which is a stenohaline, non-migratory freshwater cyprinid. Extracellular recording from the olfactory bulb in vivo by electroencephalogram (EEG) demonstrated that the olfactory system is acutely sensitive to changes in external Ca2+ within the range that this species is likely to encounter in the wild (0.05–3 mmol l–1). The olfactory system responded to increases in external calcium with increasing bulbar activity in a manner that fitted a conventional Hill plot with an apparent EC50 of 0.9±0.3 mmol l–1 (close to both ambient and plasma free [Ca2+]) and an apparent Hill coefficient of 1.1±0.3 (means ± S.E.M., N=6). Thresholds of detection were below 50 mmol l–1. Some olfactory sensitivity to changes in external [Na+] was also recorded, but with a much higher threshold of detection (3.7 mmol l–1). The olfactory system of goldfish was much less sensitive to changes in [Mg2+] and [K+]. Preliminary data suggest that Ca2+ and Mg2+ are detected by the same mechanism, although with a much higher affinity for Ca2+. Olfactory sensitivity to Na+ may warn freshwater fish that they are reaching the limit of their osmotic tolerance when in an estuarine environment. Olfaction of serine, a potent odorant in fish, was not dependent on the presence of external Ca2+ or Na+. Finally, the teleost Ca2+-sensing receptor (Ca-SR) was shown to be highly expressed in a subpopulation of olfactory receptor neurones by both immunocytochemistry and in situ hybridisation. The olfactory sensitivity to Ca2+ (and Mg2+) is therefore likely to be mediated by the Ca-SR. We suggest that olfactory Ca2+ sensitivity is a widespread phenomenon in teleosts and may have an input into the physiological mechanisms regulating internal calcium homeostasis

Biologia floral e morfologia polínica de Q. amara L. (Simaroubaceae).

O estudo descritivo do pólen e da biologia floral de Quassia amara L. (Simaroubaceae) foi desenvolvido em área de terra firme no Campo Experimental da Embrapa Amazônia Oriental, em Belém-Pará, durante o período de julho de 1997 a setembro 1998. Esta espécie desempenha importante papel econômico devido ao aproveitamento de seus princípios ativos, que atuam no combate a diversas moléstias e também como inseticida natural. Apresenta-se como planta arbustiva, que a pleno sol floresce durante todo o ano. As flores são bissexuadas, reunidas em inflorescências paniculadas eretas. A antese ocorre por volta das 22 horas e a senescência manifesta-se com 3-4 dias após a antese. As anteras são amarelas, deiscência rimosa, com exposição do pólen entre 11 e 12:30 horas, estando dispostas centralmente circundando o gineceu. O estigma é filiforme e apresenta maior receptividade no ápice. O pólen, juntamente com o néctar é o recurso ofertado pela flor; e apresenta maior viabilidade após a abertura das anteras. Foram registradas visitas esporádicas do beija-flor. Trigona fulviventris é a espécie de abelha que visita as flores de Q. amara à procura de néctar. É considerada pilhadora e apresenta um comportamento destrutivo na flor. Os grãos de pólen são médios, 3(-4)-colporados, superfície punctada no apocolpo e microrreticulada no mesocolpo. A biologia floral demonstrou que esta espécie apresenta um conjunto de características florais que a torna atraente à polinização ornitófila. Contudo, o fato do polinizador realizar visitas rápidas e esporádicas, não impediu a frutificação no experimento de Q. amara

Lúpus Erythematosus

O Lúpus Eritematoso Sistémico (LES) é uma doença multissistémica, auto-imune, caracterizada por inflamação vascular e do tecido conjuntivo, com anticorpos antinucleares. As manifestações clínicas são variáveis, com uma história natural progressiva e imprevisível. Apresentamos o caso de uma adolescente, com antecedentes de artrite dos joelhos, febre e astenia de etiologia não esclarecida, com um ano de evolução. Internada na Unidade de Cuidados Intensivos Pediátricos por pneumonia bilateral a Streptococcus pneumoniae complicada com derrame pleural, anasarca e hematúria macroscópica. Iniciou antibioticoterapia, com evolução favorável, após o que se verifica agravamento clínico, com reaparecimento do derrame pleural, lesões vesiculares disseminadas sugestivas de etiologia herpética, hipertensão arterial sintomática e convulsão tónico-clónica generalizada. Da investigação, destaca-se estudo imunológico compatível com LES em actividade, poliserosite, proteinúria nefrótica, nefrite lúpica classe IV e anemia grave

Anatomia endobrônquica: estudo prospectivo das variações anatómicas da árvore traqueobrônquica

ResumoO conhecimento detalhado do normal padrão de ramificações da árvore traqueobrônquica é um requisito essencial para qualquer pneumologista. Os sistemas de classificação funcional que guiam a prática clínica corrente têm um carácter eminentemente estático e raramente contemplam referências aos desvios possíveis dentro do espectro normal.Por forma a caracterizar as variações anatómicas da árvore traqueobrônquica, os autores desenvolveram um estudo prospectivo que decorreu entre Fevereiro e Julho de 2009, onde se incluíram todos os doentes referenciados para realização de broncofibroscopias diagnósticas e/ou terapêuticas.Um total de 181 indivíduos foram incluídos no estudo tendo-se observado variantes anatómicas em 79 (43% do total). Globalmente observamos 20 diferentes variantes anatómicas. Estas variantes foram mais frequentemente observadas no lobo superior direito (16,6%). O lobo médio e a língula não foram sede de variantes anatómicas. A variante mais frequentemente observada foi o padrão bifurcado do lobo superior direito (13,8%).O presente estudo revelou uma elevada frequência de formas alternativas ao clássico padrão de ramificação traqueobrônquica. O conhecimento da tipologia, morfologia e frequência de expressão dessas variantes revela-se de extrema importância para o broncologista no estabelecimento das fronteiras da anatomia normal e na planificação de técnicas endoscópicas ou de procedimentos cirúrgicos.AbstractA comprehensive knowledge of the normal pattern of endobronchial branching is essential to any pulmonologist. The classification systems available are predominantly static descriptions and only seldom do they refer to possible variations within the normal spectrum.To evaluate all possible anatomical variants of the tracheobronchial tree we conducted a prospective study in our endoscopy unit between February, 1st and July, 10th (2009).A total of 181 individuals were included in the study. Anatomical variants were found to be present in 79 individuals (43% of total). Overall we found 20 different anatomical variants. Variations were more frequently found within the right upper lobe (16.6% of individuals). Middle lobe and lingula presented no variations. The variant most frequently found was the presence of a bifurcate pattern of the right upper bronchus (13.8%).The present study revealed a relatively high frequency of anatomical alternatives to the normal endobronchial branching pattern. Recognition of these variants and the frequency of their expression are fundamental for the bronchologist in establishing the limits of normal anatomy and preparing endobronchial techniques or surgical procedures

Factors associated with poor asthma symptom control in adult Angolan regularly seen at an outpatient respiratory clinic

Background: Asthma is one of the most common chronic respiratory diseases and one of the most frequent causes of hospital care. Objectives: To describe the clinical characteristics of asthma and factors associated with its control. Methods: A cross-sectional study was conducted at the Military Hospital in Luanda, from April 2018 to March 2019. Data collection was performed using questionnaires on asthma symptoms and treatment, socio-demographic and environmental questions, and a Global Initiative for Asthma (GINA) questionnaire to assess the level of asthma control. Ordinal logistic regression analyses were performed. We estimated odds ratios, for higher categories of asthma control. P<0.05 was considered significant. Results: The sample consisted of 305 asthmatics ≥18-years-old, 56% women, with a mean age of 41.3 years. About 28% of patients had controlled asthma, 36% partially controlled and 35% uncontrolled. Poor asthma control was associated with frequent use of short-acting beta-2 agonists [OR 5.70 (95%CI 2.37;13.7)], oral corticosteroids [OR 3.68 (95%CI 2.24;6.04)], and incorrect inhaler technique [OR 4.08 (95%CI 1.25;13.3)]. Conclusions: A significant number of adults living in Luanda have uncontrolled asthma due to the under-use of inhaled corticosteroid therapy. It is necessary to develop strategic management and prevention plans to improve Angolan asthmatics' medical care.info:eu-repo/semantics/publishedVersio

Evaluation of antimicrobial resistance of different phylogroups of Escherichia coli isolates from feces of breeding and laying hens

Animal and food sources are seen as a potential transmission pathway of multi-drug resistance (MDR) micro-organisms to humans. Escherichia. coli is frequently used as an indicator of fecal contamination in the food industry and known as a reservoir of antimicrobial resistance genes (ARGs). Microbial contamination as a major outcome for the poultry and egg industry and is a serious public health problem. In the present study we performed the quantification of β-glucoronidase positive E. coli in 60 fecal samples of breeding and laying hens collected in Portugal in 2019. Phylogenetic and pathotypic characterization, antimicrobial susceptibility, and detection of resistant extended-spectrum β-lactamase (ESBL) genes were assessed. The phylogenetic and pathogenic characterization and detection of ESBL genes were assessed by real-time PCR and antimicrobial susceptibility was evaluated using the disk diffusion method. Overall, E. coli quantification was 6.03 log CFU/g in breeding hens and 6.02 log CFU/g in laying hens. The most frequent phylogroups were B1. None of the isolates was classified as diarrheagenic E. coli (DEC). In total, 57% of the isolates showed MDR and 3.8% were positive for ESBL. Our study highlights that consumers may be exposed to MDR E. coli, presenting a major hazard to food safety and a risk to public health.This research received no external funding.info:eu-repo/semantics/publishedVersio