Tratamento cirúrgico da otite média secretora na população infantil: uma revisão sistemática

Este artigo tem como objetivo realizar uma revisão sistemática da produção bibliográfica referente a eficácia do tratamento cirúrgico e suas indicações como terapêutica do quadro clínico de otite média com efusão na população pediátrica.  Após formular a frase de pesquisa, foram realizadas buscas na base de dados Medline, sendo utilizados os seguintes descritores: Otitis Media with Effusion, Middle Ear Effusion, Secretory Otitis Media e Serous Otitis Media. Foram incluídos ensaios clínicos e ensaios clínicos randomizados que apresentavam dados que versavam diretamente sobre as intervenções cirúrgicas da otite média com efusão e foram analisados os resultados obtidos nas avaliações. Os resultados indicaram que a inserção de tubos de ventilação combinada com a adenoidectomia resultou em menor recorrência do quadro em comparação com a inserção do tubo de ventilação de forma isolada. Além disso, observou-se que a inserção do tubo de ventilação em crianças com otite média com efusão persistente não apresentou efeito benéfico na qualidade de vida geral, mas evidências indicaram um desfecho positivo na saúde funcional relacionada à dificuldade auditiva nesta população. Por fim, observou-se que nas crianças com fissura palatina que passaram por reparo no palato mole e que permaneceram com o quadro de otite média com efusão, a inserção do tubo de ventilação deve ser considerada. A análise dos estudos destacou a complexidade das decisões clínicas em relação às intervenções cirúrgicas para o quadro descrito, considerando fatores como recorrência, qualidade de vida e características individuais dos pacientes

Common coding variant in SERPINA1 increases the risk for large artery stroke

Large artery atherosclerotic stroke (LAS) shows substantial heritability not explained by previous genome-wide association studies. Here, we explore the role of coding variation in LAS by analyzing variants on the HumanExome BeadChip in a total of 3,127 cases and 9,778 controls from Europe, Australia, and South Asia. We report on a nonsynonymous single-nucleotide variant in serpin family A member 1 (SERPINA1) encoding alpha-1 antitrypsin [AAT; p.V213A; P = 5.99E-9, odds ratio (OR) = 1.22] and confirm histone deacetylase 9 (HDAC9) as a major risk gene for LAS with an association in the 3?-UTR (rs2023938; P = 7.76E-7, OR = 1.28). Using quantitative microscale thermophoresis, we show that M1 (A213) exhibits an almost twofold lower dissociation constant with its primary target human neutrophil elastase (NE) in lipoprotein-containing plasma, but not in lipid-free plasma. Hydrogen/deuterium exchange combined with mass spectrometry further revealed a significant difference in the global flexibility of the two variants. The observed stronger interaction with lipoproteins in plasma and reduced global flexibility of the Val-213 variant most likely improve its local availability and reduce the extent of proteolytic inactivation by other proteases in atherosclerotic plaques. Our results indicate that the interplay between AAT, NE, and lipoprotein particles is modulated by the gate region around position 213 in AAT, far away from the unaltered reactive center loop (357-360). Collectively, our findings point to a functionally relevant balance between lipoproteins, proteases, and AAT in atherosclerosis

Intrahepatic Cholestasis of Pregnancy Leading to Severe Vitamin K Deficiency and Coagulopathy

Intrahepatic cholestasis of pregnancy is seldom associated with significant vitamin K deficiency. We report a case of a 16-year-old primigravid patient at 24 weeks and 3 days of gestation who presented with pruritus, hematuria, and preterm labor. Laboratory work-up showed severe coagulopathy with Prothrombin Time (PT) of 117.8 seconds, International Normalized Ratio (INR) of 10.34, and elevated transaminases suggestive of intrahepatic cholestasis of pregnancy. Her serum vitamin K level was undetectable (<0.1 nMol/L). Initial therapy consisted of intramuscular replacement of vitamin K and administration of fresh frozen plasma. Her hematuria and preterm labor resolved and she was discharged. She presented in active labor and delivered at 27 weeks and 1 day. Her bile acids (93 μ/L) and INR (2.32) had worsened. She delivered a male infant, 1150 grams with Apgar scores 7 and 9. The newborn received 0.5 mg of intramuscular vitamin K shortly after delivery but went on to develop bilateral grade III intraventricular hemorrhages by day 5. Intrahepatic cholestasis in pregnancy and nutrition issues were identified as the main risk factors for the severe coagulopathy of this patient. This case underlines the importance of evaluation of possible severe coagulopathy in patients with intrahepatic cholestasis of pregnancy in order to avoid serious maternal or fetal adverse outcomes

Incorporation of N and O into the shell of Silicon Nanoparticles offers tunable photoluminescence for imaging uses

Silicon nanoparticles (SiNPs) show tunable photoluminescence (PL), water-dispersibility, high photostability, and low cytotoxicity, thus constituting promising candidates for bioimaging applications. Because SiNP PL depends finely on particles' crystallinity and surface composition, specific tuning of PL properties has remained elusive. Herein, using steady and time-resolved PL studies, absorbance spectroscopy, and electrochemical techniques, we have deeply analyzed the origin of the PL of SiNPs obtained from a wet chemical synthesis procedure based on the oxidation of Zintl salts in dimethyl formamide (DMF). Obtained SiNPs, surface-functionalized with propylamine terminal groups, were amorphous and 2.8-3.7 nm in size. The photophysical evidence, together with XPS and FTIR spectroscopy, supported a core-shell structure of the nanoparticles consisting of a silicon core surrounded by a 0.7-1.25 nm-thick oxidized silicon shell containing low concentrations of trapped iminium siloxyl ions Cl-(CH3)2N+=CH-O-Si or related compounds. The introduction of N-functionalities in the nanoparticle shell was assigned to the reaction of Si-Cl and Si-H bonds formed during synthesis, with DMF. The use of increasing amounts of NH4Cl in the synthesis procedure led to more oxidized shell structures of SiNPs. It is suggested that the presence of an oxidized silicon shell containing trapped iminium siloxyl ions provided a high density of localized states capable of quenching the core-state emission and of being themselves populated by absorption of visible light. Moreover, it was experimentally confirmed that emission preferentially takes place from localized states introduced by O-functionalities with a high quantum efficiency (ηPL-trap≅ 1). As fluorophores, the obtained SiNPs display tunable PL emission and an important red-edge shift, allowing the selection of the PL by changing the excitation wavelength without modification of its chemical composition and size, thus meeting the needs of various types of biosensing methods.Fil: Romero, Juan José. YPF - Tecnología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Dell'arciprete, Maria Laura. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Rodriguez, Hernan Bernardo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Ciudad Universitaria. Instituto de Química, Física de los Materiales, Medioambiente y Energía. Universidad de Buenos Aires. Facultad de Ciencias Exactas y Naturales. Instituto de Química, Física de los Materiales, Medioambiente y Energía; ArgentinaFil: Gonik, Eduardo. Universidad Nacional de San Martin. Instituto Tecnologico de Chascomus. - Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - la Plata. Instituto Tecnologico de Chascomus.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Cacciari, Rodolfo Daniel. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; ArgentinaFil: Moore, Ana L. Arizona State University; Estados UnidosFil: Gonzalez, Monica Cristina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas. Universidad Nacional de La Plata. Facultad de Ciencias Exactas. Instituto de Investigaciones Fisicoquímicas Teóricas y Aplicadas; Argentin

Preterm birth:Case definition &amp; guidelines for data collection, analysis, and presentation of immunisation safety data

AbstractPreterm birth is commonly defined as any birth before 37 weeks completed weeks of gestation. An estimated 15 million infants are born preterm globally, disproportionately affecting low and middle income countries (LMIC). It contributes directly to estimated one million neonatal deaths annually and is a significant contributor to childhood morbidity. However, in many clinical settings, the information available to calculate completed weeks of gestation varies widely. Accurate dating of the last menstrual period (LMP), as well as access to clinical and ultrasonographic evaluation are important components of gestational age assessment antenatally. This case definition assign levels of confidence to categorisation of births as preterm, utilising assessment modalities which may be available across different settings. These are designed to enable systematic safety evaluation of vaccine clinical trials and post-implementation programmes of immunisations in pregnancy