A ETIOLOGIA DA APENDICITE AGUDA. SERÁ A ALERGIA O ELO PERDIDO? UMA REVISÃO NARRATIVA

Acute appendicitis is the most common abdominal surgical emergency. Since the work of Fitz in the XIX century it has been assumed that luminal obstruction is the main pathological event. However, this theory has been recently challenged by some new insights that suggest that an allergic reaction can be one of the possible causes or co-factors. The current knowledge on the aetiology of acute appendicitis was reviewed in this article, with a special emphasis on allergic features.A apendicite aguda é a mais comum urgência cirúrgica abdominal. Desde o trabalho paradigmático de Fitz, no final do século XX, assumiu-se que a obstrução do lúmen apendicular é o principal evento patológico. Esta teoria foi questionada recentemente, pois alguns estudos sugerem que a alergia pode ser uma causa ou co-factor na etiologia da apendicite aguda. Os autores procedem a revisão da etiologia da apendicite aguda, com particular enfase na reação alérgica.   &nbsp

Placental transfer of Haemophilus influenzae type b antibodies in malnourished pregnant women

This study evaluated the vaccination response to Haemophilus influenzae type b (Hib) in malnourished pregnant women (MN), cord blood (CB) and in infants at two and six months of age for comparison with a control group (C). Twenty-eight malnourished pregnant women and 29 pregnant controls were immunized with conjugated Act-HIB® in the third trimester of pregnancy. Blood samples were collected from all before the immunization, during labor (post immunization), and from CB. All infants were immunized with Hib vaccine according to normal vaccine schedule and sera were collected at two and six months of age. Antibody levels to polyribosylribitol phosphate (PRP) were similar for both groups. Preimmunization: MN 1.94 µg/mL, C 1.68 µg/mL; post-vaccination: MN 18.53 µg/mL and C 17.55 µg/mL; in CB from MN 14.46 µg/mL and from C 17.04 µg/mL. Infants from MN and C mothers presented respectively at two months: 5.18 µg/mL and 8.60 µg/mL and at six months: MN 3.42 µg/mL and C 2.18 µg/mL. Antibody levels were similar in both groups studied (p = 0.485), however the vertical transmission rate was 14% lower in the MN pregnant group. Levels of antibodies > 0.15 µg/mL were found in all newborns from the MN pregnant group. Pregnant MN presented an immunological response to Hib vaccine similar to group C, however, vertical transmission rate of antibodies to PRP in the MN pregnant group was 14% lower than that in C, suggesting a less efficient passage of antibodies within this group.University State of Pará Department of Integrated HealthFederal University of São Paulo Medical School of São Paulo Department of PediatricsUNIFESP, Medical School of São Paulo Department of PediatricsSciEL

Técnicas ecocardiográficas para la evaluación de la presión de la arteria pulmonar

This paper aims to perform an analysis of the indirect methods of pulmonary artery pressure assessment based on the scientific literature. Through bibliographic survey, scientific articles were selected according to their relevance to the theme.The assessment of pulmonary artery pressure allows to infer whether the individual has pulmonary arterial hypertension (PAH), which is associated with a poor prognosis in dogs diagnosed with mitral valve degeneration. The standard examination is pulmonary artery catheterization, but this method has not been used in routine veterinary medicine because the clinical status of the animal usually does not allow sedation and it is a costly procedure. The diagnosis of PAH in small animals through Doppler echocardiography can be obtained by evaluating the regurgitation of the tricuspid or pulmonary valve, subjective characteristics and measurement of the acceleration time (AT) and the acceleration time-to-ejection time ratio of pulmonary artery (AT:ET), pulmonary artery-to-pulmonary vein ratio, distensibility of the right pulmonary artery (RAPD), and assessment of right ventricular function, especially TEI index and strain. The aim of this review was to demonstrate the main echocardiographic techniques to estimate PAH, with the intention of contributing to the cardiologist in the diagnosis of PAH. All techniques have positive and negative factors however, it is important to emphasize that there is no ideal technique, and the most assertive way to arrive at the diagnosis is to associate the different techniques.Este artículo tiene como objetivo realizar un análisis de los métodos indirectos de evaluación de la presión de la arteria pulmonar con base en la literatura científica. A través de la encuesta bibliográfica, los artículos científicos se seleccionaron de acuerdo con su relevancia para el tema. La evaluación de la presión de la arteria pulmonar permite inferir si el individuo tiene hipertensión arterial pulmonar (HAP), que se asocia con un mal pronóstico en perros diagnosticados con degeneración de la válvula mitral. El examen estándar es el cateterismo de la arteria pulmonar, pero este método no se ha utilizado rutinariamente en medicina veterinaria porque el estado clínico del animal generalmente no permite la sedación y es un procedimiento costoso. El diagnóstico de HAP en animales pequeños a través de la ecocardiografía Doppler puede obtenerse evaluando la regurgitación de la válvula tricúspide o pulmonar, las características subjetivas y la medición del tiempo de aceleración (AT) y la relación tiempo de aceleración / tiempo de expulsión de la arteria pulmonar (TA:TE), relación arteria pulmonar-vena pulmonar, distensibilidad de la arteria pulmonar derecha (RAPD) y evaluación de la función ventricular derecha, especialmente el índice TEI y strain. El objetivo de esta revisión fue demostrar las principales técnicas ecocardiográficas para estimar la HAP, con la intención de ayudar al cardiólogo en el diagnóstico de la HAP. Todas las técnicas tienen factores positivos y negativos, sin embargo es importante enfatizar que no existe una técnica ideal, y la forma más asertiva de llegar al diagnóstico es asociar las diferentes técnicas.O presente trabalho tem como objetivo realizar uma análise dos métodos indiretos da avaliação da pressão da artéria pulmonar com base na literatura científica. Por meio de levantamento bibliográfico, artigos científicos foram selecionados conforme a sua relevância para o tema. A avaliação da pressão da artéria pulmonar permite inferir se o paciente apresenta hipertensão arterial pulmonar (HAP), a qual está associada a um prognóstico ruim em cães.  O exame padrão é a cateterização da artéria pulmonar, porém este método não tem sido utilizado na rotina da medicina veterinária porque o quadro clínico do animal comumente não permite a sedação e por se tratar de um procedimento oneroso. O diagnóstico da HAP em pequenos animais por meio da ecodopplercardiografia pode ser obtido com a avaliação da regurgitação da valva tricúspide ou pulmonar, características subjetivas e mensuração do tempo de aceleração (TA) e relação entre o tempo de aceleração e o tempo de ejeção do fluxo pulmonar (TA:TE), relação entre a artéria pulmonar e a veia pulmonar, distensibilidade da artéria pulmonar direita (RPAD), e ainda por avaliação da função do ventrículo direito, principalmente o índice de TEI e o strain. O objetivo desta revisão foi demonstrar as principais técnicas ecocardiográficas para estimar HAP, com o intuito de contribuir com o cardiologista no diagnóstico da HAP. Todas as técnicas apresentam fatores positivos e negativos, porém é importante ressaltar que não existe uma técnica ideal, e a forma mais assertiva de se chegar ao diagnóstico é associando as diversas técnicas

We stick together!: COVID-19 and psychological adjustment in youth residential care

The COVID-19 pandemic had a great impact also on residential care institutions. These contexts were forced to introduce many adaptations to their regular functioning in order to serve children and families throughout such unpredictable times. According to the literature adolescents in residential care have an increased risk of developing psychological, behavioral and social problems compared with general population rearing with their biological families. Our purpose was to examine the effects of cohesion on adolescents’ psychological adjustment over the COVID pandemic. We tested whether adolescents` perception of cohesion in residential care mitigates the emergency of adolescents` psychological adjustment during the current pandemic situation on previous association. Participants were 243 adolescents 12 to 18 aged, living in 21 different residential care institutions. The results suggested a moderating role of cohesion on the stability of adolescents’ emotional distress across time. Lower levels of cohesion were related with higher emotional distress stability across time. On the contrary, as cohesion increased, the association between adolescents’ emotional distress at T0 and T1 decreased. Results are discussed considering the impact of the COVID-19 pandemic on the psychological adjustment of adolescents living in residential care.Communication presented at XVI European Scientific Association on Residential & Family Care for Children and Adolescents Conference (EUSARF). This work was funded by Portuguese National funds FCT - Fundação para a Ciência e a Tecnologia, I.P (PTDC/PSI-ESP/28653/2017)

Initial discovery of microplastic pollution in Mnemiopsis leidyi (Ctenophora: Lobata)

The production of plastics has exponentially increased over time such that the observation of microplastics in the oceans has become a major concern given how frequently these particles and marine biota may interact. Microplastics can be ingested by diverse species, including invertebrates, which can lead to physical damage due to their small size and potentially chemical damage related to the ingestion of monomers, polymeric additives, or adsorbed chemicals. This study reports on the first evidence of microplastics in Mnemiopsis leidyi. Microplastics were described by type, quantified, and had their chemical composition identified. In total, 328 samples of microplastic (MP) candidates were observed: blue fibers were the most abundant, followed by black, red, and green fibers as well as blue fragments. Three types of microplastics were chemically identified as polyurethane, unplasticized polyvinylchloride, and polyethylene polylauryllactam. Overall, this study demonstrated that Mnemiopsis leidyi have the capacity to incorporate microplastics. Although more studies are needed, Mnemiopsis leidyi is relatively abundant on the Atlantic coast and should be recommended for use as a bioindicator for microplastics.Campus Lima Nort

Abordagens e Teorias de Aprendizagem Propostos pelos Projetos dos Cursos de Pedagogia a Distância para o Desenvolvimento de Tecnologias Educacionais

O presente trabalho traz os resultados de uma pesquisa que procurou identificar de quais abordagens e teorias de aprendizagem provêm os princípios didático-pedagógicos que os Projetos Pedagógicos de Curso (PPCs) dos cursos de Pedagogia a distância oferecidos por universidades federais da Região Nordeste propõem para o planejamento e desenvolvimento de suas tecnologias educacionais (ambientes, materiais e atividades). Após a revisão de literatura sobre abordagens e teorias de aprendizagem, seguida das análises documental e de conteúdo dos PPCs, identificamos que preponderam princípios escolanovistas, construtivistas e socioconstrutivistas. Contudo: a) a forma de operacionalização de tais princípios no planejamento e desenvolvimento dos ambientes, materiais e atividades é pouco objetiva; e b) os processos de avaliação da aprendizagem (e instrumentos utilizados) não são descritos ou o são de forma imprecisa. Tais achados sugerem que os PPCs, documentação balizadora dos cursos, não são utilizados como referência para o planejamento e o desenvolvimento das tecnologias educacionais empregadas nos cursos investigados. Palavras-chave: Educação a distância, Pedagogia, Teorias de aprendizagem, Tecnologias educacionais, Projeto pedagógico de curso. Approaches and Theories of Learning Proposed by the Projects of Pedagogy Distance Education Course for the Development of Educational TechnologiesAbstractThis paper presents the results of a study that aimed to identify from which learning approaches and theories come the didactic and pedagogical principles that the Courses Pedagogical Project o (PPCs) of Pedagogy distance courses offered by federal universities in the Northeast region propose to design and develop their educational technologies (environments, materials and activities). After a literature review of approaches and learning theories, followed by the documentary and content analysis of PPCs, we identified that the prevail principles come from New School, Constructivist and Socioconstrutivism. However: a) the documents are not objectives on how to operationalize these principles in designing and developing environments, materials and activities, and; b) the learning evaluation processes (and instruments) are not described or are inaccurate. These findings suggest that the PPCs, the basic documentation of the courses, are not used as references for designing and developing the educational technologies used in the investigated courses.Keywords: Distance education, Pedagogy, Learning theories, Educational technologies, Course projects

Metabolic and hematologic changes occurring after rapid intravenous infusion of gammaglobulin in patients with antibody deficiency syndromes

OBJECTIVE: We wished to investigate whether increased IgG infusion rates are associated with metabolic and hematologic changes in pediatric patients with antibody deficiency syndromes.METHODS: We studied 7 patients (2-16 years old) with primary antibody deficiencies who had been on regular IgG replacement treatment, 350-600 mg/kg/dose every 3 weeks with a 3% IVIG preparation, for periods ranging from 6 months to 4 years. Initially, the IgG concentration of IVIG preparations was increased to 6, 9 and 12% in consecutive infusions at a constant IgG infusion rate of 4 mg/kg/min. Subsequently, the infusion rates were increased to 8, 12, and 16 mg/kg/min using the IVIG 12% preparation.RESULTS: Clinically, all patients tolerated increases in IVIG concentrations while the infusion rate was 4 mg/kg/min. However, 3 patients presented side effects when the infusion rate was increased to 8 and 16 mg/kg/min.CONCLUSION: We conclude that metabolic and hematologic sides effects occur with rapid infusion of IVIG even in patients who tolerate the increased infusion rate clinically. The advantages of using high infusion rates have to be re-evaluated.OBJETIVO: Nós pretendemos investigar se o aumento de velocidade de infusão de gamaglobulina intravenosa (IVIG), está associada com alterações metabólicas e hematológicas em pacientes com deficiência de anticorpo. CASUÍSTICA E MÉTODO: Nós estudamos sete pacientes (2-16 anos) com deficiência primária de anticorpo que já estavam em tratamento com reposição regular de IgG, na dose de 350-600 mg/kg a cada três semanas em preparados a 3%, por períodos de seis meses a quatro anos. Inicialmente a concentração dos preparados de IVIG foi aumentando para 6, 9 e 12% em infusões consecutivas numa velocidade constante 4 mg/kg/min. Subseqüentemente, na segunda fase do estudo, mantivemos a concentração a 12% e a velocidade de infusão foi aumentando para 8, 12, e 16 mg/kg/min. RESULTADOS: Clinicamente, todos os pacientes toleraram o aumento da concentração de IVIG na velocidade constante de 4 mg/kg/min. Entretanto, 3 pacientes apresentaram efeitos colaterais quando a velocidade de infusão aumentou para 8 e 16 mg/kg/min. CONCLUSÃO: Nós concluímos que alterações metabólicas e hematológicas podem ocorrer quando se administra preparados de IVIG em altas concentração e velocidade mesmo que os pacientes tolerem bem clinicamente. As vantagens de utilizar velocidades elevadas na infusão de IVIG devem ser reavaliadas.Universidade Federal de São Paulo (UNIFESP)Escola Paulista de MedicinaInstituto de Ciências Biomédicas IIILouisiana State University Medical CenterUNIFESP, EPMSciEL

Osteitis in a female infant after vaccination with BCG Moreau in the neonatal period

Secretaria de Estado da Saúde do Estado de São Paulo Instituto Clemente FerreiraHospital Israelita Albert EinsteinUniversidade Federal de São Paulo (UNIFESP) Departamento de PediatriaUNIFESP, Depto. de PediatriaSciEL

The importance of sex education in schools

Em Portugal existe legislação referente à educação sexual em meio escolar desde 1984. A mais recente é de agosto de 2009. Este estudo pretende perceber se esta lei está a ser cumprida num Agrupamento de Escolas do norte do país e quais as principais dúvidas, relacionadas com a sexualidade, que os adolescentes apresentam. Para isso foi aplicado um questionário a 274 alunos (46.4% de rapazes e 53.6% de raparigas), entre os 10 e os 20 anos de idade (média = 13.7%). O estudo permitiu concluir que a maioria (75.4%) concorda com aulas de educação sexual nas escolas, no entanto, do total da amostra, 59.0% nunca tiveram aulas de educação sexual. Também se percebeu que grande parte não fala nunca destes assuntos com os pais (34.1%). As dúvidas relacionadas com a temática são variadas (desde as mudanças na adolescência, às doenças sexualmente transmissíveis ou aos métodos contracetivos, passando pela relação que estes jovens estabelecem com os pais e amigos), pelo que se torna necessária e urgente a aplicação da atual legislação sobre a educação sexual nas escolas do nosso país.In Portugal there is legislation regarding sex education in schools since 1984. The latest is from August 2009. This study aims to understand whether this law is being accomplished in a Group of Schools from the north of the country and what are the main questions that adolescents have as far as sexuality is concerned. For this purpose a questionnaire was given to 274 students (46.4% were boys and 53.6% were girls) between the ages of 10 and 20 (average = 13.7%). The study concluded that the majority (75.4%) agrees with sex education in schools, however, from the total sample 59.0% have never had sex education classes. It was also noticed that most never speak about these matters with their parents (34.1%). Doubts related to the topic are varied; it is therefore necessary and urgent the implementation of current legislation on sex education in the schools of our country