Minipuberty in Male Full-term Neonates Appropriate and Small for Gestational Age and in Preterm Babies: Data from a Single Centre

Objective: The postnatal activation of the hypothalamic-pituitary-gonadal (HPG) axis is usually known as “minipuberty”. There are still open questions about its biological function and significance depending on sex, gestational age (GA) and birth weight (BW) with few available longitudinal data. Methods: A single-centre, longitudinal study to quantify urinary follicle stimulating hormone (uFSH), luteinizing hormone (uLH) and testosterone (uTs) in male neonates. Neonates were enrolled and stratified into three subgroups: full-term boys appropriate for GA (FT AGA); FT boys with BW ≤3rd centile [FT small for gestational age (SGA)]; and preterm (PT) boys ≤33 weeks of GA. Urinary hormones were correlated to simultaneous auxological parameters, linear growth and external genitalia at scheduled time-points. Results: Forty-six boys were recruited, with subgroup sizes FT AGA n=23, FT SGA n=11 and PT n=12. PT boys display a pulsatile pattern of urinary gonadotropins (uGns) with higher levels of uLH and a gradual increase of uTs. Testicular descent started from 29-32 weeks with the peak of uTs. During the first 12-months post-term age (PTA), FT AGA boys displayed a better linear growth (p<0.05). PT showed higher uGns levels until 3-months PTA. PT babies had higher uLH levels than FT AGA, with a peak at 7 and 30 days, during the first 90 days of life (p<0.001) and higher uTs levels. Correlation analysis between penile growth of all neonates and uTs was significant (p=0.04) but not within subgroups. Conclusion: This study investigated postnatal HPG axis activation in term and PT infants. Minipuberty may involve an early window of opportunity to evaluate the functionality of the HPG axis. Further studies with a long-term follow-up are needed with a special focus on possible consequences of GA and BW

Análise de atos normativos por meio do comportamento de busca de usuários: O caso da Agência Nacional de Energia Elétrica – Aneel

Objective. It presents research on the analysis of normative acts issued by the Agência Nacional de Energia Elétrica – Aneel from the point of view of user information. The overall objective of the research is to compare the search strategy that Aneel servers use at the time of search normative acts through the agency's search engine with search behavior in the literature in order to elicit convergences and demonstrate inconsistencies in the normative act content representation.Method. The survey was to benchmark the work done within the Agency's Documentation Centre with treatment and representation of normative acts and their recovery by the agency's servers and sought inputs in literature on documentary analysis, legal information, Information Retrieval Systems and user search behavior information. Presents as a general method of research the study of descriptive case and used as data collection technique observation and verbal protocol thinking aloud.Results. The results showed the user's difficulty in recovering the normative acts and the constant comparison between the search system used in Aneel, Sophia, with the Google search engine, which influences users' search behavior to make their search in the library catalog.Objetivo. Presenta la investigación sobre el análisis de las normas legales generadas por la Agência Nacional de Energia Elétrica – Aneel bajo el punto de vista del usuario de la información. El objetivo general de la investigación fue comparar la estrategia de investigación que los servidores de la Aneel utilizan, en el momento de la búsqueda de las normas legales por medio del sistema de búsqueda de la agencia, con los comportamientos de búsqueda presentados en la literatura, a fin de obtener convergencias y demostrar inconsistencias en la representación del contenido de la norma legal.Método. La investigación tuvo como punto de referencia el trabajo realizado dentro del Centro de Documentación de Aneel con el tratamiento y representación de las normas legales y su recuperación por los servidores de la agencia, y buscar los elementos en la literatura sobre el análisis documental, la información jurídica, los sistemas de recuperación de información y el  comportamiento de búsqueda del usuario de información. Presenta como método general de investigación el estudio de caso descriptivo y utiliza como técnica de recolección de datos la observación y el protocolo verbal pensar alto.Resultados. Los resultados demostraron la dificultad del usuario en recuperar las normas legales y la constante comparación entre el sistema de búsqueda utilizado en la Aneel, con el buscador Google, que influencia el comportamiento de búsqueda de los usuarios al realizar sus búsquedas en el catálogo de la biblioteca.Objetivo. Apresenta pesquisa sobre a análise dos atos normativos emanados pela Agência Nacional de Energia Elétrica – Aneel sob o ponto de vista do usuário da informação. O objetivo geral da pesquisa foi comparar a estratégia de pesquisa que os servidores da Aneel utilizam no momento da busca de atos normativos por meio do sistema de busca da agência com os comportamentos de busca apresentados na literatura, a fim de elicitar convergências e demonstrar inconsistências na representação de conteúdo do ato normativo.Método. A pesquisa teve como ponto de referência o trabalho realizado dentro do Centro de Documentação da Agência com o tratamento e representação de atos normativos e sua recuperação pelos servidores da agência e buscou insumos na literatura sobre análise documentária, informação jurídica, Sistemas de Recuperação de Informação e comportamento de busca do usuário de informação. Apresenta como método geral de pesquisa o Estudo de Caso descritivo e utilizou como como técnica de coleta de dados a observação e o protocolo verbal pensar alto.Resultados. Os resultados demonstraram a dificuldade do usuário em recuperar os atos normativos e a constante comparação entre o sistema de busca utilizado na Aneel, com o buscador Google, que influencia o comportamento de busca dos usuários ao realizar as suas buscas no catálogo da biblioteca

Finding a way: long-term care homes to support dementia

An ageing demographic has increased the number of people with dementia. Although dementia is commonly associated with memory loss, other early symptoms include difficulty with wayfinding. Dementia alters visuo-spatial perception and the processes used to interpret the physical environment. The role of the design of the physical environment for people with dementia has gained increased recognition. Despite this, design for dementia is often overlooked, focusing on issues relating to physical impairment. This paper presents the results of a PhD study and aims to examine the role of the design of the physical environment in supporting wayfinding for people with dementia living in long-term care settings in Northern Ireland. Mixed methods combined the observation of wayfinding walks and conversational style interviews to elicit perspectives and experiences of residents with dementia. The findings aim to promote well-being for those with dementia living in long-term care settings

Clinical presentation of celiac disease and diagnosis accuracy in a single-center european pediatric cohort over 10 years

(1) Background: Changes in the clinical presentation of celiac disease (CD) in children have been reported. The guidelines of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) allow esophagogastroduodenoscopy (EGD) with biopsies to be avoided under specific circumstances. We aimed to assess the clinical picture of pediatric CD patients at diagnosis and to validate ESPGHAN non-biopsy criteria. (2) Methods: Patients with suspected CD or undergoing screening from 2004 to 2014 at the University Hospital in Modena, Italy were enrolled. The accuracy of ESPGHAN non-biopsy criteria and modified versions were assessed. (3) Results: In total, 410 patients were enrolled, of whom 403 were considered for analysis. Of the patients considered, 45 were asymptomatic and diagnosed with CD (11.2%) while 358 patients (88.2%) were symptomatic, of whom 295 were diagnosed with CD. Among symptomatic CD patients, 57 (19.3%) had gastrointestinal symptoms, 98 (33%) had atypical symptoms and 140 (47.4%) had both. No difference was found for the presence of gastrointestinal symptoms at different ages. The non-biopsy ESPGHAN criteria yielded an accuracy of 59.4% with a positive predictive value (PPV) of 100%; 173 out of 308 EGD (56.2%) could have been avoided. The modified 7× and 5× upper limit of normal cut-offs for IgA anti tissue-transglutaminase reached 60.7% and 64.3% of EGD avoided, respectively. (4) Conclusions: Over 10 years, late age at diagnosis and increased rates of atypical CD presentation were found. ESPGHAN non-biopsy criteria are accurate for CD diagnosis and allow half of unneeded EGD to be avoided. Modified versions allowed sparing a greater number of EGD

Late-Onset Sepsis Mortality among Preterm Infants: Beyond Time to First Antibiotics

Objective: To investigate the impact of timing, in vitro activity and appropriateness of empirical antimicrobials on the outcome of late-onset sepsis among preterm very low birth weight infants that are at high risk of developing meningitis. Study design: This retrospective study included 83 LOS episodes in 73 very low birth weight infants born at ≤32 weeks’ gestation with positive blood and/or cerebrospinal fluid culture or polymerase chain reaction at >72 h of age. To define the appropriateness of empirical antimicrobials we considered both their in vitro activity and their ideal delivery through the blood-brain barrier when meningitis was confirmed or not ruled out through a lumbar puncture. The primary outcome was sepsis-related mortality. The secondary outcome was the development of brain lesions. Timing, in vitro activity and appropriateness of empirical antimicrobials, were compared between fatal and non-fatal episodes. Uni- and multi-variable analyses were carried out for the primary outcome. Results: Time to antibiotics and in vitro activity of empirical antimicrobials were similar between fatal and non-fatal cases. By contrast, empirical antimicrobials were appropriate in a lower proportion of fatal episodes of late-onset sepsis (4/17, 24%) compared to non-fatal episodes (39/66, 59%). After adjusting for Gram-negative vs. Gram-positive pathogen and for other supportive measures (time to volume administration), inappropriate empirical antimicrobials remained associated with mortality (aOR, 10.3; 95% CI, 1.4–76.8, p = 0.023), while timing to first antibiotics was not (aOR 0.9; 95% CI, 0.7–1.2, p = 0.408; AUC = 0.88). The association between appropriate antimicrobials and brain sequelae was also significant (p = 0.024). Conclusions: The risk of sepsis-related mortality and brain sequelae in preterm very low birth weight infants is significantly associated with the appropriateness (rather than the timing and the in vitro activity) of empirical antimicrobials. Until meningitis is ruled out through lumbar puncture, septic very low birth weight infants at high risk of mortality should receive empiric antimicrobials with high delivery through the blood-brain barrier

Association Of Anticardiolipin Antibody And C677t In Methylenetetrahydrofolate Reductase Mutation In Women With Recurrent Spontaneous Abortions: A New Path To Thrombophilia?

Recurrent spontaneous abortion (RSA) has been associated with venous thrombosis in the mother. Acquired and inherited thrombophilia factors are possible causes. To evaluate the association between thrombogenic factors and recurrent spontaneous abortion. Case-control study. Centro de Atenção Integral à Saúde da Mulher, Universidade Estadual de Campinas. 40 ml of blood was collected from 88 women attending an RSA clinic and 88 fertile women attending a family planning clinic, to evaluate the presence of acquired and inherited thrombophilia factors. Anticardiolipin antibodies (ACA), lupus anticoagulant and deficiencies of proteins C and S and antithrombin III were evaluated by enzyme-linked immunosorbent assay (ELISA), dilute Russell Viper Venom time (dRVVT), coagulometric and chromogenic methods. DNA was amplified by the polymerase chain reaction (PCR) to study factor V Leiden and G20210A mutations in the prothrombin gene and C677T mutation in the methylenetetrahydrofolate reductase (MTHFR) gene. Data were analyzed using odds ratios and a regression model for age adjustment. Fishers exact test was used to evaluate statistical relationships between associated factors and RSA. ACA was detected in 11 women with RSA and one fertile woman. Heterozygous C677T was detected in 59 women with RSA and 35 fertile women. Concomitant presence of ACA and C677T was found in eight women with RSA and no fertile women (p < 0.01). The meaning of the association between C677T mutation in the MTHFR gene and ACA is still not clear. It is possible that an inherited factor that alone would not strongly predispose a woman to thrombosis could, when associated with an acquired factor, start the process and increase the likelihood of thrombosis expression. ACA and C677T in the MTHFR gene are statistically associated with RSA. The association of these two conditions is a new finding in thrombogenic factors and RSA.12315-2

Alterações comportamentais de bezerras criadas em bezerreiros tropicais com cobertura alternativa

O trabalho avaliou o comportamento de bezerras leiteiras, criadas em bezerreiros de modelo tropical, contendo diferentes geossintéticos como material de cobertura. Foram avaliadas 20 fêmeas Girolando, Jersey e Holandesa com peso inicial médio de 40,6 Kg durante a fase de aleitamento. O delineamento experimental foi de blocos casualizados completos, em arranjo fatorial 4 x 3 com 5 repetições. Os materiais de cobertura foram: malha de polietileno, geocomposto drenante, geotêxtil não-tecido e geotêxtil tecido foram o primeiro fator e os períodos do dia (08 às 11, 11:15 às 14 e 14:15 às 18 horas) foram o segundo fator. Foram avaliadas as variáveis ambientais e calculados os índices de conforto térmico: índice de temperatura do globo negro e umidade e índice de temperatura equivalente. As médias do índice de temperatura do globo negro e índice de temperatura equivalente foram 79 e 26, respectivamente. O comportamento andando diferiu entre tratamentos (P<0,05), sendo mais frequente no tratamento geotêxtil tecido. A frequência comportamental mais observada ao longo do dia foi deitada à sombra (53%) deixando evidente a importância da disponibilização de sombreamento artificial para essa fase de vida. Os materiais de cobertura geossintéticos Geodrenante e Geotêxtil não-tecido, comparados à malha de polietileno, foram os mais apropriados para a utilização como sombreamento em regiões de clima tropical para bezerras em fase de aleitamento. Palavras-chave: bovinos; estresse térmico; etograma; sombreamento; geotêxtil

Calcified Abdominal Pregnancy With Eighteen Years Of Evolution: Case Report.

CONTEXT: The lithopedion (calcified abdominal pregnancy) is a rare phenomenon and there are less than 300 cases reported in the medical literature. CASE REPORT: In this case, a 40 year-old patient had had her only pregnancy 18 years earlier, without medical assistance since then. She came to our hospital with pain and tumoral mass of approximately 20 centimeters in diameter. Complementary examinations (abdominal X-ray, ultrasonography and computerized tomography) demonstrated an extra-uterine abdominal 31-week pregnancy with calcification areas. Exploratory laparotomy was performed, with extirpation of a well-conserved fetus with partially calcified ovular membranes.118619219