Ânus anterior: está ou não associado com a constipação crônica na criança?

OBJECTIVE: To study the association between the anterior anus, measured through anal position index, and the presence of longstanding chronic constipation in children.MATERIALS AND METHODS: 195 pediatric patients of the outpatient unit at HCPA were analyzed (ages: from 10 days to 9 years and 10 months; sex: 94 girls and 101boys). Children were considered constipated when presenting a period of more than 3 days without bowel movements and large and hard, or pelletlike, stools. Anterior anus was identified by anal indexes lower than the average minus the standard deviation of the control group of children without constipation; that is < 0.40 for boys, and < 0.24 for girls.RESULTS: Chronic constipation was diagnosed in 58 of the 195 children (29.7%; 28.7% of boys, and 30.9% of girls). There was no significant difference in relation tosex, constipation, or regarding the presence of anterior anus. Fifty-eight children (39.4%) with constipation had anterior anus, whereas 60.6% of children without constipation had anterior anus. There was no significant correlation between anterior position of anus and chronic constipation.CONCLUSION: There was no correlation between chronic constipation and anterior anus among the analyzed children.OBJETIVO: Estudar a associação entre o deslocamento ventral do ânus, através da medida do índice ânus-genital, e a presença de constipação crônica em crianças.MATERIAL E MÉTODOS: Foram estudadas 195 crianças atendidas no ambulatório de gastroenterologia pediátrica do HCPA, com idades entre 10 dias e 9 anos e 10 meses, 94 meninas e 101 meninos. Foram consideradas constipadas as crianças que não evacuavam há mais de 3 dias e que apresentavam fezes disquézicas ou cibalosas. Ânus anteriorizado fois definido como IAG menor do que um desvio-padrãodaquele obtido da média das crianças controles não constipadas (IAG < 0,40 em meninos e < 0,24 em meninas).RESULTADOS: Foram identificadas 58/195 crianças (29,7%) com constipação crônica (28,7% em meninos e 30,9% em meninas). Não houve diferença estatisticamente significativa em relação ao sexo (30,9%) ou quanto à presença do ânus anterior. Entre as 58 crianças constipadas, 39,4% apresentavam ânus anteriorizado, enquanto que dentre as não constipadas 60,6% o apresentavam. Não houve correlação estatisticamente significativa entre a presença de ânus anteriorizado e constipação, ou entre constipação e as medidas do IAG.CONCLUSÃO: Não houve relação entre constipação e a posição anteriorizada do ânus nas crianças estudada

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

General aspects of muscle glucose uptake

Glucose uptake in peripheral tissues is dependent on the translocation of GLUT4 glucose transporters to the plasma membrane. Studies have shown the existence of two major signaling pathways that lead to the translocation of GLUT4. The first, and widely investigated, is the insulin activated signaling pathway through insulin receptor substrate-1 and phosphatidylinositol 3-kinase. The second is the insulin-independent signaling pathway, which is activated by contractions. Individuals with type 2 diabetes mellitus have reduced insulin-stimulated glucose uptake in skeletal muscle due to the phenomenon of insulin resistance. However, those individuals have normal glucose uptake during exercise. In this context, physical exercise is one of the most important interventions that stimulates glucose uptake by insulin-independent pathways, and the main molecules involved are adenosine monophosphate-activated protein kinase, nitric oxide, bradykinin, AKT, reactive oxygen species and calcium. In this review, our main aims were to highlight the different glucose uptake pathways and to report the effects of physical exercise, diet and drugs on their functioning. Lastly, with the better understanding of these pathways, it would be possible to assess, exactly and molecularly, the importance of physical exercise and diet on glucose homeostasis. Furthermore, it would be possible to assess the action of drugs that might optimize glucose uptake and consequently be an important step in controlling the blood glucose levels in diabetic patients, in addition to being important to clarify some pathways that justify the development of drugs capable of mimicking the contraction pathway

Ânus anterior: está ou não associado com a constipação crônica na criança?

OBJECTIVE: To study the association between the anterior anus, measured through anal position index, and the presence of longstanding chronic constipation in children.MATERIALS AND METHODS: 195 pediatric patients of the outpatient unit at HCPA were analyzed (ages: from 10 days to 9 years and 10 months; sex: 94 girls and 101boys). Children were considered constipated when presenting a period of more than 3 days without bowel movements and large and hard, or pelletlike, stools. Anterior anus was identified by anal indexes lower than the average minus the standard deviation of the control group of children without constipation; that is < 0.40 for boys, and < 0.24 for girls.RESULTS: Chronic constipation was diagnosed in 58 of the 195 children (29.7%; 28.7% of boys, and 30.9% of girls). There was no significant difference in relation tosex, constipation, or regarding the presence of anterior anus. Fifty-eight children (39.4%) with constipation had anterior anus, whereas 60.6% of children without constipation had anterior anus. There was no significant correlation between anterior position of anus and chronic constipation.CONCLUSION: There was no correlation between chronic constipation and anterior anus among the analyzed children.OBJETIVO: Estudar a associação entre o deslocamento ventral do ânus, através da medida do índice ânus-genital, e a presença de constipação crônica em crianças.MATERIAL E MÉTODOS: Foram estudadas 195 crianças atendidas no ambulatório de gastroenterologia pediátrica do HCPA, com idades entre 10 dias e 9 anos e 10 meses, 94 meninas e 101 meninos. Foram consideradas constipadas as crianças que não evacuavam há mais de 3 dias e que apresentavam fezes disquézicas ou cibalosas. Ânus anteriorizado fois definido como IAG menor do que um desvio-padrãodaquele obtido da média das crianças controles não constipadas (IAG < 0,40 em meninos e < 0,24 em meninas).RESULTADOS: Foram identificadas 58/195 crianças (29,7%) com constipação crônica (28,7% em meninos e 30,9% em meninas). Não houve diferença estatisticamente significativa em relação ao sexo (30,9%) ou quanto à presença do ânus anterior. Entre as 58 crianças constipadas, 39,4% apresentavam ânus anteriorizado, enquanto que dentre as não constipadas 60,6% o apresentavam. Não houve correlação estatisticamente significativa entre a presença de ânus anteriorizado e constipação, ou entre constipação e as medidas do IAG.CONCLUSÃO: Não houve relação entre constipação e a posição anteriorizada do ânus nas crianças estudada

Molecular detection of Cytauxzoon spp. in asymptomatic Brazilian wild captive felids

Cytauxzoon. spp. DNA was detected for the first time in blood samples from asymptomatic Brazilian wild captive felids. In 2606, 72 EDTA blood samples from seven wild felids species: Puma concolor (pinna), Leopardus pardalis (ocelot), Puma yagouaroundi (jaguarundi), Leopardus wiedii (margay), Leopardus tigrinus (little spotted cat), Oncifelis colocolo (pampas cat) and Panthera. onca. (jaguar) were analyzed using polymerase chain reaction to amplify the 18S rRNA gene segment in order to verify the presence of Cytauxzoon spp. DNA. Nine samples were positive: six ocelots, two pumas, and one jaguar. In Brazil, wild felids may be natural reservoirs for Cytauxzoon spp

Oocyte maturation in the sloth's giant tick Amblyomma varium (Acari: Ixodidae) in an ecological context

The sloth's giant tick Amblyomma varium Koch, which is a neotropical species that inhabits tropical rainforests, is the largest tick reported to date. The adult stage of this tick parasitizes mammals from the families Bradypodidae and Magalonychidae (Xenarthra) nearly exclusively. This study aimed to describe morphological and histological features of the reproductive system and the oocyte maturation process of this tick species. The ovary of A. varium is a long single tubular organ that is horseshoe-shaped, winding and arranged in the posterior part of the body. Two oviducts are connected to the ovary on each side; these thicken at certain region forming the uterus (common oviduct), followed by a muscular connecting tube, vagina and genital aperture. A large number of oocytes at different stages of development are attached to the ovary wall by the pedicel, as they reach maturity they are released into the ovary lumen and from there to the genital aperture. These oocytes develop simultaneously and asynchronically along the ovary. Amblyomma varium oocytes were classified into five development stages (i.e., I-V), and specific characteristics were observed; the processes of yolk and chorion deposition begin early in oocytes stage II, and oocytes V exhibit a very thick chorion and eggs of a large size. These characteristics are likely adaptations that enhance the survival and the reproductive success of this extremely host-specific tick, which is limited to a particular environment.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq