Recomendação de Curvas de Crescimento para Crianças Nascidas Pré-Termo

Em 2013, a Secção de Neonatologia da Sociedade Portuguesa de Pediatria, face à existência de várias curvas de avaliação de crescimento para crianças nascidas pré-termo e à falta de homogeneidade de critérios na sua escolha, nomeou um grupo de peritos que procedeu à revisão crítica das curvas disponíveis e recomenda as que considera mais adequadas para utilização na prática clínica em fases específicas da vida: ao nascimento (Fenton 2013), durante o internamento na unidade de Neonatologia (Fenton 2013 e Ehrenkranz 1999) e a longo prazo (OMS 2006). As decisões foram tomadas com base na classificação sistemática do nível de evidência e do grau de recomendação. A presente recomendação: é válida enquanto não forem publicados os resultados do estudo do consórcio multicêntrico INTERGROWTH-21st, recentemente incumbido da construção de valores de referência, mais próximos do padrão, de crianças nascidas pré-termo; tem o propósito de auxiliar os clínicos na decisão clínica, mas não ser o único instrumento de avaliação do crescimento das crianças nascidas pré-termo; pode não proporcionar elementos suficientes para orientação do crescimento de todas estas crianças

Presence of Gardnerella vaginalis in healthy portuguese women: a pilot study

Bacterial vaginosis (BV) has an important position worldwide, as the leading vaginal disorder in women, and affects 30-50% of African women and 10-20% of White women of reproductive age. This condition although not mortal causes great discomfort and may lead to other complications such as pre-term labour or increase susceptibility for HIV infection. During BV occur a decrease of Lactobacillus spp. present in the vaginal epithelium and an increase in the number of anaerobic microorganisms like Gardnerella vaginalis, Pretovella spp., Mobilincus spp.; Mycoplasma hominis and Atopobium vaginae. Gardnerella vaginalis is also responsible for the formation of a biofilm in the vaginal epithelium in sick women’s. However, the direct correlation between the pathology and the causing agent (or agents) has not been clearly established. Currently there is only one article in PubMed (Guerreiro et. al, 1998) referring to the prevalence of bacterial vaginosis in Portugal and we aim to extend the research in this field specifically to the portuguese population. As part of this effort one of our aims it to characterise the bacterial population of portuguese women both healthy and diagnosed with BV. As such we collected swab samples of vaginal fluids from protuguese women with the help of health professionals and using self collection. The swabs were collected and treated within 24 hours at the University of Minho for the characterization of the bacterial population present, by using conventional microbiological growth techniques, PNA-FISH microscopy and 16S PCR. It was found that about 20% of the samples tested possessed G. vaginalis and all possessed Lactobacillus spp. using all 3 identification techniques described. This result is consistent with previous reports of G. vaginalis prevalence althought slightly lower, and shows that traditional microbiological techniques, microscopy and molecular methods were consistent in terms of results

Body image dissatisfaction during adolescence and its relation to sexual maturation

Sérios problemas comportamentais envolvendo hábitos alimentares, com repercussão na percepção da imagem corporal, tornam-se cada vez mais comuns. O presente estudo objetivou avaliar a percepção da insatisfação da imagem corporal de um grupo de adolescentes. Pesquisou-se jovens de uma Instituição de Rede Particular de Ensino Fundamental, de 10 a 14 anos, de ambos os sexos. Para análise de dados utilizou-se como critério a idade, transformada em fase de maturação sexual. Para avaliar a percepção da imagem corporal aplicou-se escala de satisfação adaptada, composta por 15 áreas corporais. Registrou-se para meninos, maior insatisfação para peso corporal, cintura e estômago e meninas para peso corporal, tórax/seio e estômago. Na associação entre insatisfação corporal e maturação corporal, as áreas significantes foram, para os meninos, ombro/costas e para as meninas, rosto, cabelo, quadril, estômago, cintura, tórax/seio, tônus muscular, altura e aspectos gerais. Conclui-se que meninas pós-púberes mostraram-se mais suscetíveis à manifestação da insatisfação corporal quando comparadas aos seus pares.Severe behavioral problems related to feeding habits, with repercussion on body presentation, perception and image, and related to feeding practices have, nowadays, its prevalence increased. The present study aimed to verify adolescents' perception regarding body image dissatisfaction. We analyzed students of a private school, aged 10 to 14, of both sexes. The boys and girls were divided for the analysis based on their age, transformed into sexual maturation phase. To assess body image perception, an adapted body satisfaction scale was applied, composed of 15 body areas. Boys showed more dissatisfaction with weight, waist and stomach. Girls with weight, chest/breast and stomach. The association between sexual maturation and body satisfaction was significant, among the boys, for the shoulder/back area, while among girls, the significant areas were: face, hair, hip, stomach, waist, chest/breast, muscle strength, height and general aspects. We concluded that post-pubescent girls proved to be more susceptible to the manifestation of body dissatisfaction when compared with their peers

Comparison between classical and molecular (FISH and PCR) methods for Lactobacillus spp. detection in clinical samples

Lactobacillus species constitute the main beneficial bacteria in our body by inhibiting the growth from pathogenic microorganisms. Fluorescence In Situ Hybridization (FISH) is an ideal method for cultivation-independent detection of microorganisms in microbial communities or clinical samples. Therefore, the current aims of this research are to identify and discriminate Lactobacillus spp. contained in clinical samples by the use of PNA-FISH methodology. In spite this method is proved to be useful to visualize target cells in natural habitats, it wasn't possible to find a Lactobacillus spp. 16S conservative region that allowed an unique and efficient identification in clinical samples. To overcome this problem, we used morphological visualization to differentiate Lactobacillus genus from another relative genera of the same Lactobacillaceae order. In addition, we also needed to overcome some methodological limitations, such as minimizing probe penetration problems and increasing hybridization efficiencies. As a result, we investigated the effect of different pre-treatment procedures of the exopolymer cell walls prior to the hybridization step, such as, several types of fixation compounds (paraformaldehyde and ethanol percentages), buffer steps and enzymatic (lysozyme and protease) pre-treatment. Furthermore, we modified PNA FISH protocol in several steps, for instance, hybridization and washing steps. In resume, the use of PNA probe specific for Lactobacillus spp. in situ hybridization by fluorescence microscopy could be perfectly used to study the complex and spatial organization of vaginal microbial samples. To conclude, we validate Lactobacillus spp. PNA probe by FISH to quantify and characterize in mixed microbiologic populations present in clinical samples

Chronic interstitial pneumonitis

A patologia pulmonar intersticial compreende um grupo de doenças crónicas caracterizadas por alterações das paredes alveolares e perda das unidades funcionais alveolocapilares. São doenças raras nas crianças, na sua maioria de causa desconhecida e revestindo-se habitualmente de uma elevada morbimortalidade, dada a pouca eficácia da terapêutica actualmente disponível. Os autores descrevem o caso clínico de uma criança de 3 anos, previamente saudável, que no contexto de uma infecção respiratória desenvolve um quadro de sibilância e insuficiência respiratória grave, na investigação do qual é diagnosticada uma pneumonite intersticial crónica. Foram tentadas diversas terapêuticas (corticoterapia sistémica, hidroxicloroquina, N-acetilcisteína) sem melhoria evidente.Interstitial lung disease includes a group of chronic diseases characterized by alterations in alveolar walls and loss of functional alveolar-capillary units. These are rare diseases in children, mostly with an unknown cause and associated with a high morbidity and mortality due to insufficient therapeutic effectiveness. The authors report a case of a previously healthy 3 years old child who presented with wheezing and severe respiratory insufficiency following a respiratory infection. The investigation performed led to the diagnosis of chronic interstitial pneumonitis. Several treatments have been tried (corticosteroids,hydroxychloroquine, N-acetylcysteine) without any obvious improvement

Fluorescence in situ hybridization method using peptide nucleic acid probes for rapid detection of Lactobacillus and Gardnerella spp

Background: Bacterial vaginosis (BV) is a common vaginal infection occurring in women of reproductive age. It is widely accepted that the microbial switch from normal microflora to BV is characterized by a decrease in vaginal colonization by Lactobacillus species together with an increase of Gardnerella vaginalis and other anaerobes. Our goal was to develop and optimize a novel Peptide Nucleic Acid (PNA) Fluorescence in situ Hybridization assay (PNA FISH) for the detection of Lactobacillus spp. and G. vaginalis in mixed samples. Results: Therefore, we evaluated and validated two specific PNA probes by using 36 representative Lactobacillus strains, 22 representative G. vaginalis strains and 27 other taxonomically related or pathogenic bacterial strains commonly found in vaginal samples. The probes were also tested at different concentrations of G. vaginalis and Lactobacillus species in vitro, in the presence of a HeLa cell line. Specificity and sensitivity of the PNA probes were found to be 98.0% (95% confidence interval (CI), from 87.8 to 99.9%) and 100% (95% CI, from 88.0 to 100.0%), for Lactobacillus spp.; and 100% (95% CI, from 92.8 to 100%) and 100% (95% CI, from 81.5 to 100.0%) for G. vaginalis. Moreover, the probes were evaluated in mixed samples mimicking women with BV or normal vaginal microflora, demonstrating efficiency and applicability of our PNA FISH. Conclusions: This quick method accurately detects Lactobacillus spp. and G. vaginalis species in mixed samples, thus enabling efficient evaluation of the two bacterial groups, most frequently encountered in the vagina.This work was supported by European Union funds (FEDER/COMPETE) and by national funds (FCT) under the project with reference FCOMP-01-0124-FEDER-008991 (PTDC/BIA-MIC/098228/2008). AM acknowledges the FCT individual fellowship - SFRH/BD/62375/2009)

Cognitive Dysfunction Is Sustained after Rescue Therapy in Experimental Cerebral Malaria, and Is Reduced by Additive Antioxidant Therapy

Neurological impairments are frequently detected in children surviving cerebral malaria (CM), the most severe neurological complication of infection with Plasmodium falciparum. The pathophysiology and therapy of long lasting cognitive deficits in malaria patients after treatment of the parasitic disease is a critical area of investigation. In the present study we used several models of experimental malaria with differential features to investigate persistent cognitive damage after rescue treatment. Infection of C57BL/6 and Swiss (SW) mice with Plasmodium berghei ANKA (PbA) or a lethal strain of Plasmodium yoelii XL (PyXL), respectively, resulted in documented CM and sustained persistent cognitive damage detected by a battery of behavioral tests after cure of the acute parasitic disease with chloroquine therapy. Strikingly, cognitive impairment was still present 30 days after the initial infection. In contrast, BALB/c mice infected with PbA, C57BL6 infected with Plasmodium chabaudi chabaudi and SW infected with non lethal Plasmodium yoelii NXL (PyNXL) did not develop signs of CM, were cured of the acute parasitic infection by chloroquine, and showed no persistent cognitive impairment. Reactive oxygen species have been reported to mediate neurological injury in CM. Increased production of malondialdehyde (MDA) and conjugated dienes was detected in the brains of PbA-infected C57BL/6 mice with CM, indicating high oxidative stress. Treatment of PbA-infected C57BL/6 mice with additive antioxidants together with chloroquine at the first signs of CM prevented the development of persistent cognitive damage. These studies provide new insights into the natural history of cognitive dysfunction after rescue therapy for CM that may have clinical relevance, and may also be relevant to cerebral sequelae of sepsis and other disorders

Nod2 Suppresses Borrelia burgdorferi Mediated Murine Lyme Arthritis and Carditis through the Induction of Tolerance

The internalization of Borrelia burgdorferi, the causative agent of Lyme disease, by phagocytes is essential for an effective activation of the immune response to this pathogen. The intracellular, cytosolic receptor Nod2 has been shown to play varying roles in either enhancing or attenuating inflammation in response to different infectious agents. We examined the role of Nod2 in responses to B. burgdorferi. In vitro stimulation of Nod2 deficient bone marrow derived macrophages (BMDM) resulted in decreased induction of multiple cytokines, interferons and interferon regulated genes compared with wild-type cells. However, B. burgdorferi infection of Nod2 deficient mice resulted in increased rather than decreased arthritis and carditis compared to control mice. We explored multiple potential mechanisms for the paradoxical response in in vivo versus in vitro systems and found that prolonged stimulation with a Nod2 ligand, muramyl dipeptide (MDP), resulted in tolerance to stimulation by B. burgdorferi. This tolerance was lost with stimulation of Nod2 deficient cells that cannot respond to MDP. Cytokine patterns in the tolerance model closely paralleled cytokine profiles in infected Nod2 deficient mice. We propose a model where Nod2 has an enhancing role in activating inflammation in early infection, but moderates inflammation after prolonged exposure to the organism through induction of tolerance