Cutaneous mastocytosis: Two pediatric cases treated with topical pimecrolimus.

Cutaneous mastocytosis is characterized by increased numbers of skin mast cells that release mediators causing pruritus, urticaria, and flushing. Most pediatric mastocytosis patients exhibit the pattern of urticaria pigmentosa, which typically appears during the first two years of life and resolves spontaneously in late adolescence. However, while the disease is active, patients are frequently symptomatic and uncomfortable, which justifies symptomatic treatment. We report 2 patients, a 14-month-old girl and a 26-month-old boy, with localized cutaneous erythematous lesions with a positive Darier sign. In each, a punch biopsy confirmed the diagnosis of mastocytosis. Treatment was instituted with pimecrolimus cream twice a day and oral antihistamine. An almost complete response was achieved after 4 months of therapy in both patients, with no clinical evidence of recurrence after 4 years and 2 years of follow-up, respectively. In children, the treatment of mastocytosis is directed primarily to avoiding potential mast cell degranulating agents and alleviating symptoms. Topical calcineurin inhibitors act by inhibiting T-cell activation and cytokine release; they may suppress mast cell- mediated reactions by reducing their degranulation. These two cases suggest that in localized cutaneous mastocytosis they are a safe and efficacious alternative to topical steroid therapy

Impacto de uma experiência de quase-morte e conversão religiosa sobre a saúde mental de um criminoso: relato de caso e revisão da literatura

OBJECTIVE: Near-death experiences have been defined as profound psychological events that may occur to a person while close to death or in a situation of extreme physical or emotional distress. These experiences seem to have an important effect on the patients’ mental health and may occur in several situations despite their cultural and religious beliefs. CASE DESCRIPTION: The present case report describes the positive impact of a near-death experience (Greyson scale > 7) followed by religious conversion on the mental health of a former prisoner. COMMENTS: Investigation of the role of near-death experiences by the scientific community could shed light on the coping mechanisms and moral/ethical transformations that take place in these individuals.OBJETIVO: As experiências de quase-morte são definidas como eventos psicológicos profundos, que podem ocorrer quando uma pessoa está em morte iminente ou em situação de intensa crise física ou emocional. Essas experiências parecem ter efeito importante sobre a saúde mental desses pacientes e ocorrem em diversas situações, a despeito de culturas e crenças religiosas. RELATO DE CASO: O presente relato de caso descreve a influência positiva de uma experiência de quase-morte (escala de Greyson > 7) seguida de conversão religiosa sobre a saúde mental de um ex-detento. COMENTÁRIO: A investigação do papel de experiências de quase-morte em âmbito científico poderia ajudar a elucidar os mecanismos de coping e transformações éticas e morais que ocorrem nesses indivíduos.Universidade Federal de São Paulo (UNIFESP) Hospital São PauloAssociação Médico-Espírita de São PauloClínica OtossonoFaculdade de Ciências Médicas Santa Casa de São PauloInstituto de Psiquiatria Hospital das Clínicas da Faculdade de Medicina da Universidade de São PauloInstituto de Psiquiatria HCFMUSP Conselho Penitenciário do Estado de São PauloUniversidade Federal de Juiz de ForaHospital João EvangelistaUNIFESP, Hospital São PauloSciEL

A decade of microchip electrophoresis for clinical diagnostics – a review of 2008-2017

A core element in clinical diagnostics is the data interpretation obtained through the analysis of patient samples. To obtain relevant and reliable information, a methodological approach of sample preparation, separation, and detection is required. Traditionally, these steps are performed independently and stepwise. Microchip capillary electrophoresis (MCE) can provide rapid and high-resolution separation with the capability to integrate a streamlined and complete diagnostic workflow suitable for the point-of-care setting. Whilst standard clinical diagnostics methods normally require hours to days to retrieve specific patient data, MCE can reduce the time to minutes, hastening the delivery of treatment options for the patients. This review covers the advances in MCE for disease detection from 2008 to 2017. Miniaturised diagnostic approaches that required an electrophoretic separation step prior to the detection of the biological samples are reviewed. In the two main sections, the discussion is focused on the technical set-up used to suit MCE for disease detection and on the strategies that have been applied to study various diseases. Throughout these discussions MCE is compared to other techniques to create context of the potential and challenges of MCE. A comprehensive table categorised based on the studied disease using MCE is provided. We also comment on future challenges that remain to be addressed

Um exercício de avaliação da qualidade da pesquisa agropecuária na EMBRAPA.

Medir qualidade da pesquisa é um empreendimento polêmico e difícil, que raramente tem sido enfrentado. O trabalho propõe um método globalizante para medir a qualidade da pesquisa e o aplica às unidades da Empresa Brasileira de Pesquisa Agropecuária (EMBRAPA). Baseia-se teoricamente na concepção de status social aplicando-a às unidades da organização. Um painel de 44 juízes, formados por especialistas,.foi usado corno a fonte de julgamentos, dos quais foram gerados os (ndices de Qualidade, de Concordância e de Visibilidade. A medida de qualidade foi validada, apresentando o coeficiente de fidedignidade de r .= 0,890 através do processo teste-reteste com apenas seis juízes, após u'm intervalo médio de aplicação de seis meses. Foram estudadas a validade lógica e do construto, chegando,,"e à conclusão de que o Indice de Qualidade discrimina de modo consistente, previsível e coerente os objetos submetidos à mensuração. Com a finalidade de estudar as discrepâncias entre os julgamentos, o painel de juízes foi submetido a análise no que se refere a quatro características: localização do juíz na estrutura organizacional, nível educacional, experiência internacional e conhecimento do sistema. A educação revelou-se corno o maior correlato com as diferenças de julgamento. Conclui-se que os fndices de Quali·dade. Concordância· e Visibilidade podem servir corno instrumento para a análise e melhoria das organizações de pesquisa agropecuária e para aperfeiçoamento das técnicas de mensuração

Respiratory muscles's thermographic analysis in asthmatic youth with and without bronchospasm induced by eucapnic voluntary hyperpnea

Objective To compare the thermographic pattern of regions of interest (ROI) of respiratory muscles in young asthmatics with and without bronchospasm induced by eucapnic voluntary hyperpnea (EVH). Materials and Methods Cross-sectional study carried out with 55 young (55% male and 45% females) aged 12.5 ± 3.3 years, divided in nine nonasthmatics, 22 asthmatics without exercise-induced bronchospasm compatible response (EIB-cr) and 24 asthmatics with EIB-cr. The diagnosis of EIB was given to subjects with a fall in forced expiratory volume in the first second (FEV1) ≥ 10% compared to baseline. Thermographic recordings of respiratory muscles were delimited in ROI of the sternocleidomastoid (SCM), pectoral, and rectus abdominis intention area. Thermal captures and FEV1 were taken before and 5, 10, 15 and 30 min after EVH. Results Twenty-four (52.1%) of asthmatics had EIB-cr. There was a decrease in temperature at 10 min after EVH test in the SCM, pectoral and rectus abdominis ROIs in all groups (both with p < 0.05). There was a decrease in temperature (% basal) in asthmatic with EIB-cr compared to nonasthmatics in the rectus abdominis area (p < 0.05). Conclusion There was a decrease in temperature in the ROIs of different muscle groups, especially in asthmatics. The greater drop in FEV1 observed in individuals with EIB-cr was initially associated with a decrease in skin temperature, with a difference between the nonasthmatics in the abdominal muscle area. It is likely that this decrease in temperature occurred due to a temporary displacement of blood flow to the most used muscle groups, with a decrease in the region of the skin evaluated in the thermography

Análise da produção de embriões na fertilização in vitro e transferência de embriões para doadoras Nelore.

Ajustou-se uma função de densidade probabilidade para o número de embriões viáveis produzidos após fertilização in vitro em doadoras da raça Nelore, a partir de dados fornecidos pela Associação Brasileira de Criadores de Zebu (ABCZ), referente à análise de 20.619 doadoras, 71.602 aspirações e um total de 509.643 embriões. Modelou-se a densidade probabilidade do número de embriões viáveis mediante a função exponencial, executando-se a determinação dos parâmetros por meio da máxima verossimilhança, em um método de gradiente não linear. O nível de precisão obtido foi de RMSE = 0,040 e R2 = 0,98, para a representação da probabilidade do número de embriões viáveis produzidos por doadoras Nelore na técnica de fertilização in vitro(FIV). Para comparar os modelos (curvas de probabilidade de transferência de embriões ajustada por Beltrame, em 2006, e de FIV, neste trabalho), aplicou-se a técnica de comparação de curvas com o teste F (Silva e Azevedo, 2002). Não foram encontradas diferenças entre as curvas do número de embriões viáveis obtidos após coleta e produzidos após aspiração de doadoras na raça Nelore. Ainda, sugere-se a existência de um fator único limitante que afete biologicamente a produção de embriões nas técnicas de transferência de embriões e fertilização in vitro

Impact of remnant vital tissue after locoregional treatment and liver transplant in hepatocellular cancer patients. A multicentre cohort study

The role of pathological findings after locoregional treatments as predictors of hepatocellular cancer recurrence after liver transplantation has been poorly addressed. The aim of the study was to identify the role of remnant vital tissue (RVT) of the target lesion in predicting hepatocellular cancer recurrence. Two hundred and seventy-six patients firstly undergoing locoregional treatment and then transplanted between January 2010 and December 2015 in four European Transplant Centres (i.e. Rome Tor Vergata, Birmingham, Brussels and Ancona) were enrolled in the study to investigate the role of pathological response at upfront locoregional treatment. At multivariable Cox regression analysis, RVT ≥2 cm was a strong independent risk factor for post-LT recurrence (HR = 5.6; P < 0.0001). Five-year disease-free survival rates were 60.8%, 80.9% and 95.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. When only Milan Criteria-IN patients were analysed, similar results were reported, with 5-year disease-free survival rates of 58.1%, 79.0% and 94.0% in patients presenting a RVT ≥2 cm vs. 0.1-1.9 vs. no RVT, respectively. RVT is an important determinant of tumour recurrence after liver transplantation performed for hepatocellular cancer. Its discriminative power looks to be evident also in a Milan-IN setting, suggesting to more liberally use locoregional treatments also in these patients