Intravitreal use of bone marrow mononuclear fraction containing CD34+ stem cells in patients with atrophic age-related macular degeneration

Carina Costa Cotrim, Luiza Toscano, André Messias, Rodrigo Jorge, Rubens Camargo Siqueira Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil Purpose: To evaluate the therapeutic potential and safety of intravitreal injections of bone marrow mononuclear fraction (BMMF) containing CD34+ cells in patients with atrophic age-related macular degeneration (AMD).Methods: Ten patients with atrophic AMD and best-corrected visual acuity (BCVA) in the worse-seeing eye of ≤20/100 were enrolled in this study. The bone marrow from all patients was ­aspirated and processed for mononuclear cell separation. A 0.1 mL suspension of BMMF CD34+ cells was injected into the vitreous cavity of the worse-seeing eye. Patients were evaluated at Baseline and 1,3,6,9 and 12 months after injection. Ophthalmic evaluation included BCVA measurement, microperimetry, infrared imaging, fundus autofluorescence and SD-optical coherence tomography at all study visits. Fluorescein angiography was performed at Baseline and at 6 and 12 months after intravitreal therapy.Results: All patients completed the 6-month follow-up, and six completed the 12-month follow-up. Prior to the injection, mean BCVA was 1.18 logMAR (20/320-1), ranging from 20/125 to 20/640-2, and improved significantly at every follow-up visit, including the 12-month one, when BCVA was 1.0 logMAR (20/200) (P<0.05). Mean sensitivity threshold also improved significantly at 6, 9 and 12 months after treatment (P<0.05). Considering the area of atrophy identified by fundus autofluorescence, significant mean BCVA and mean sensitivity threshold improvement were observed in patients with the smallest areas of atrophy. Fluorescein angiography did not identify choroidal new vessels or tumor growth.Conclusion: The use of intravitreal BMMF injections in patients with AMD is safe and is associated with significant improvement in BCVA and macular sensitivity threshold. Patients with small areas of atrophy have a better response. The paracrine effect of CD34+ cells may explain the functional improvement observed; however, larger series of patients are necessary to confirm these preliminary findings. Keywords: AMD, stem cells, hematopoietic cells&nbsp

Non-medical anabolic-androgenic steroid consumption and hepatitis B and C virus infection in regular strength training practitioners

The aim of this study is to analyse the use of non-medical anabolic-androgenic steroids (AAS) among Brazilian regular strength training practitioners and evaluate the prevalence of hepatitis B (HBV) and hepatitis C virus (HCV) infection among currently AAS injectors. The survey was addressed to 893 adult healthy males and regular strength-training practitioners from Northeast region of Brazil. Self-reported AAS users were additionally subjected to a physical exam, interview and blood sample collection, to analyse the presence of HBV and HCV. The results showed that punctual prevalence of AAS user was estimated in 16.5% (95% confidence interval [95% CI]: 14.1 to 19.1). The doses of testosterone and/or its derivatives injected in the last cycle ranged from 200 to 7,200 mg, and AAS vials were purchased predominantly from the black-market. The prevalence of HBV was 0.7% (95% CI: 0.5 to 3.3) and HCV was 0.7% (95% CI: 0.5 to 3.3) without co-infection. Hepatitis infection was associated to elementary educational level (2/29; p<0.05) and steroid vials sharing (2/14; p<0.01). In this sense, AAS use are relevant problem among this population and AAS injectors should be informed and not be neglected in efforts to prevent steroid abuse and harm-reduction strategies to reduce blood-borne virus prevalence among drug injectors.62215981605Fundacao de Amparo a Pesquisa do Estado da Bahia (FAPESB) [PPSUS0006/2007]IC grants from FAPESBFundacao de Amparo a Pesquisa do Estado da Bahia (FAPESB) [PPSUS0006/2007

Qualidade das informações sobre aleitamento materno e alimentação complementar em sites brasileiros de profissionais de saúde disponíveis na internet The quality of information on maternal breast feeding and complementary feeding on Brazilian internet sites available for health professionals

OBJETIVOS: analisar as informações de sites da internet sobre o aleitamento materno e alimentação complementar de acordo com a adequação às recomendações do Ministério da Saúde do Brasil. MÉTODOS: realizado estudo transversal, com amostra de 103 sites de profissionais de saúde. Analisaram-se informações sobre aleitamento materno (AM) e alimentação complementar (AC). As informações foram quantificadas e analisadas qualitativamente. RESULTADOS: as recomendações relativas ao AM foram: exclusivo até 6º mês (64,1%); sem água e chá (31,1%); duração de dois anos ou mais (36,9%); e não utilizar mamadeira e chupeta (33%). Para a AC foi utilizada a terminologia desmame (30,1%), recomendada a introdução alimentar no 6º mês (47,9%), introdução da primeira papa com fruta (11,6%) ou suco (9,7%); e a oferta de sopa (14,6%) como refeição. Na análise qualitativa, entre as informações incorretas, constavam recomendações de consumo de carne no 12º mês, horários regulares para refeições, introdução de alimentos no 7º mês e consumo de leite de vaca no 6º mês. CONCLUSÕES: a maior parte das informações sobre aleitamento materno está de acordo com o preconizado pelo Ministério da Saúde, mas são insuficientes para estimular a prática do aleitamento materno. Já as informações sobre alimentação complementar na sua maioria divergem do recomendado.<br>OBJECTIVES: to analyze the information available on internet sites regarding maternal breast feeding and complementary feeding according to the recommendations of the Brazilian Ministry of Health. METHODS: a cross-sectional study was carried out using a sample of 103 sites for professional healthcare workers. Information was analyzed on maternal breast feeding (MB) and complementary feeding (CF). The information was quantified and analyzed qualitatively. RESULTS: the recommendations for MB were: that it should be exclusive up to the 6th month of life (64.1%); that no water or tea should be added (31.1%); that it should last for two years or more (36.9%); and that bottles and/or pacifiers should not be used (33%). For CF, the term weaning was used (30.1%), it was recommended that solid feeding begin in the 6th month of life (47.9%), involving fruit pulp (11.6%) or juice (9.7%); and soup (14.6%). According to the qualitative analysis, incorrect information included recommending the consumption of meat in the 12th month of life, regular meals, the introduction of solid food in the 7th month and the consumption of cow's milk in the 6th month. CONCLUSIONS: most of the information on breast feeding accords with the advice of the Brazilian Ministry of Health, but is not sufficient to encourage breast feeding. The information on complementary feeding mostly diverges from the official recommendations