Oil-soluble vitamins: illegal use for lip augmentation.

Fillers for lip augmentation have become more and more popular in recent years and seem to be indispensable in the cosmetic market nowadays. A series of six young females is presented who developed massive swellings and pain after vitamins A and/or E lip augmentation. The vitamins were extracted from gelatinous capsules (Gericaps [Adipharm EAD, Sofia, Bulgaria], Geritamins [Actavis EAD, Balkanpharma-Dubnitsa AD, Bulgaria], or vitamin E yellow gel capsules) and injected by unprofessional physicians and beauticians in different cosmetic centers. Physical examination revealed firm indurations of the lips and perioral skin, tenderness, erythema, and hard dermal nodules. Histological analysis revealed numerous round-to-ovoid cavities of varying sizes, resulting in a Swiss cheese-like appearance, consistent with lipogranulomas. The patients were treated with systemic and intralesional triamcinolone injections and broad-spectrum antibiotics with good clinical response. In conclusion, these cases demonstrate the danger of the use of unregistered products as fillers injected by unprofessional physicians and beauticians.

Thrombophlebitis of the temporal vein as an extracranial complication of acute bacterial rhinosinusitis

A 39-year-old white man presented with a swollen left upper eyelid secondary to progressive acute bacterial rhinosinusitis (ABRS). Physical examination found a 40% reduction in vision in the left eye and right-sided erythematous temporal swelling with tenderness to palpation. Computed tomography revealed the presence of an inflammatory lesion in the left orbit. Duplex ultrasonography demonstrated a thrombotic occlusion in the right superficial temporal vein (STV). For treatment of the complicated ARBS, the patient received intravenous antibiotics and underwent surgery. The STV thrombophlebitis was treated with low-molecular-weight heparin. Postoperatively, the patient recovered completely and his vision normalized; 10 days later, duplex ultrasonography showed a patent STV. The development of contralateral STV thrombophlebitis is conceivably facilitated by venous anastomoses of the scalp in the front of the head. As a result, embolic spread would be a possible complication of infectious ABRS foci communicating with intraorbital and pericranial veins. To the best of our knowledge, this is the first reported case of such a complication of ARBS in the literature.

Interventions for hirsutism (excluding laser and photoepilation therapy alone)

BACKGROUND Hirsutism occurs in 5% to 10% of women of reproductive age when there is excessive terminal hair growth in androgen-sensitive areas (male pattern). It is a distressing disorder with a major impact on quality of life. The most common cause is polycystic ovary syndrome. There are many treatment options, but it is not clear which are most effective. OBJECTIVES To assess the effects of interventions (except laser and light-based therapies alone) for hirsutism. SEARCH METHODS We searched the Cochrane Skin Group Specialised Register, CENTRAL (2014, Issue 6), MEDLINE (from 1946), EMBASE (from 1974), and five trials registers, and checked reference lists of included studies for additional trials. The last search was in June 2014. SELECTION CRITERIA Randomised controlled trials (RCTs) in hirsute women with polycystic ovary syndrome, idiopathic hirsutism, or idiopathic hyperandrogenism. DATA COLLECTION AND ANALYSIS Two independent authors carried out study selection, data extraction, 'Risk of bias' assessment, and analyses. MAIN RESULTS We included 157 studies (sample size 30 to 80) comprising 10,550 women (mean age 25 years). The majority of studies (123/157) were 'high', 30 'unclear', and four 'low' risk of bias. Lack of blinding was the most frequent source of bias. Treatment duration was six to 12 months. Forty-eight studies provided no usable or retrievable data, i.e. lack of separate data for hirsute women, conference proceedings, and losses to follow-up above 40%.Primary outcomes, 'participant-reported improvement of hirsutism' and 'change in health-related quality of life', were addressed in few studies, and adverse events in only half. In most comparisons there was insufficient evidence to determine if the number of reported adverse events differed. These included known adverse events: gastrointestinal discomfort, breast tenderness, reduced libido, dry skin (flutamide and finasteride); irregular bleeding (spironolactone); nausea, diarrhoea, bloating (metformin); hot flushes, decreased libido, vaginal dryness, headaches (gonadotropin-releasing hormone (GnRH) analogues)).Clinician's evaluation of hirsutism and change in androgen levels were addressed in most comparisons, change in body mass index (BMI) and improvement of other clinical signs of hyperandrogenism in one-third of studies.The quality of evidence was moderate to very low for most outcomes.There was low quality evidence for the effect of two oral contraceptive pills (OCPs) (ethinyl estradiol + cyproterone acetate versus ethinyl estradiol + desogestrel) on change from baseline of Ferriman-Gallwey scores. The mean difference (MD) was -1.84 (95% confidence interval (CI) -3.86 to 0.18).There was very low quality evidence that flutamide 250 mg, twice daily, reduced Ferriman-Gallwey scores more effectively than placebo (MD -7.60, 95% CI -10.53 to -4.67 and MD -7.20, 95% CI -10.15 to -4.25). Participants' evaluations in one study with 20 participants confirmed these results (risk ratio (RR) 17.00, 95% CI 1.11 to 259.87).Spironolactone 100 mg daily was more effective than placebo in reducing Ferriman-Gallwey scores (MD -7.69, 95% CI -10.12 to -5.26) (low quality evidence). It showed similar effectiveness to flutamide in two studies (MD -1.90, 95% CI -5.01 to 1.21 and MD 0.49, 95% CI -1.99 to 2.97) (very low quality evidence), as well as to finasteride in two studies (MD 1.49, 95% CI -0.58 to 3.56 and MD 0.40, 95% CI -1.18 to 1.98) (low quality evidence).Although there was very low quality evidence of a difference in reduction of Ferriman-Gallwey scores for finasteride 5 mg to 7.5 mg daily versus placebo (MD -5.73, 95% CI -6.87 to -4.58), it was unlikely it was clinically meaningful. These results were reinforced by participants' assessments (RR 2.06, 95% CI 0.99 to 4.29 and RR 11.00, 95% CI 0.69 to 175.86). However, finasteride showed inconsistent results in comparisons with other treatments, and no firm conclusions could be reached.Metformin demonstrated no benefit over placebo in reduction of Ferriman-Gallwey scores (MD 0.05, 95% CI -1.02 to 1.12), but the quality of evidence was low. Results regarding the effectiveness of GnRH analogues were inconsistent, varying from minimal to important improvements.We were unable to pool data for OCPs with cyproterone acetate 20 mg to 100 mg due to clinical and methodological heterogeneity between studies. However, addition of cyproterone acetate to OCPs provided greater reductions in Ferriman-Gallwey scores.Two studies, comparing finasteride 5 mg and spironolactone 100 mg, did not show differences in participant assessments and reduction of Ferriman-Gallwey scores (low quality evidence). Ferriman-Gallwey scores from three studies comparing flutamide versus metformin could not be pooled (I² = 62%). One study comparing flutamide 250 mg twice daily with metformin 850 mg twice daily for 12 months, which reached a higher cumulative dosage than two other studies evaluating this comparison, showed flutamide to be more effective (MD -6.30, 95% CI -9.83 to -2.77) (very low quality evidence). Data showing reductions in Ferriman-Gallwey scores could not be pooled for four studies comparing finasteride with flutamide as the results were inconsistent (I² = 67%).Studies examining effects of hypocaloric diets reported reductions in BMI, but which did not result in reductions in Ferriman-Gallwey scores. Although certain cosmetic measures are commonly used, we did not identify any relevant RCTs. AUTHORS' CONCLUSIONS Treatments may need to incorporate pharmacological therapies, cosmetic procedures, and psychological support. For mild hirsutism there is evidence of limited quality that OCPs are effective. Flutamide 250 mg twice daily and spironolactone 100 mg daily appeared to be effective and safe, albeit the evidence was low to very low quality. Finasteride 5 mg daily showed inconsistent results in different comparisons, therefore no firm conclusions can be made. As the side effects of antiandrogens and finasteride are well known, these should be accounted for in any clinical decision-making. There was low quality evidence that metformin was ineffective for hirsutism and although GnRH analogues showed inconsistent results in reducing hirsutism they do have significant side effects.Further research should consist of well-designed, rigorously reported, head-to-head trials examining OCPs combined with antiandrogens or 5α-reductase inhibitor against OCP monotherapy, as well as the different antiandrogens and 5α-reductase inhibitors against each other. Outcomes should be based on standardised scales of participants' assessment of treatment efficacy, with a greater emphasis on change in quality of life as a result of treatment.

La jerarquía de vínculos socioafectivos en Ilíada XXIII.1-256

El artículo analiza las relaciones entre Aquiles y sus camaradas en la primera parte del canto XXIII (vv. 1-256), sobre la base de una mirada lingüístico-poética y un enfoque ético-pedagógico. Aquiles tiene dos comportamientos diferentes: como amigo y como caudillo. A Patroclo le dedica sus mejores manifestaciones de ternura y afecto. Como jefe, se dirige primero a sus camaradas más próximos, los mirmidones, y luego, según avanza el canto, a Agamenón, los nobles, las tropas, la comitiva más circunscripta de deudos y, finalmente, a los panaqueos en tanto cuerpo militar completo. Para una mayor comprensión de estas vinculaciones, se examina la autoridad y sus grados, a partir del grupo sémico correspondiente

La jerarquía de vínculos socioafectivos en Ilíada XXIII.1-256

El artículo analiza las relaciones entre Aquiles y sus camaradas en la primera parte del canto XXIII (vv. 1-256), sobre la base de una mirada lingüístico-poética y un enfoque ético-pedagógico. Aquiles tiene dos comportamientos diferentes: como amigo y como caudillo. A Patroclo le dedica sus mejores manifestaciones de ternura y afecto. Como jefe, se dirige primero a sus camaradas más próximos, los mirmidones, y luego, según avanza el canto, a Agamenón, los nobles, las tropas, la comitiva más circunscripta de deudos y, finalmente, a los panaqueos en tanto cuerpo militar completo. Para una mayor comprensión de estas vinculaciones, se examina la autoridad y sus grados, a partir del grupo sémico correspondiente

La jerarquía de vínculos socioafectivos en Ilíada XXIII.1-256

El artículo analiza las relaciones entre Aquiles y sus camaradas en la primera parte del canto XXIII (vv. 1-256), sobre la base de una mirada lingüístico-poética y un enfoque ético-pedagógico. Aquiles tiene dos comportamientos diferentes: como amigo y como caudillo. A Patroclo le dedica sus mejores manifestaciones de ternura y afecto. Como jefe, se dirige primero a sus camaradas más próximos, los mirmidones, y luego, según avanza el canto, a Agamenón, los nobles, las tropas, la comitiva más circunscripta de deudos y, finalmente, a los panaqueos en tanto cuerpo militar completo. Para una mayor comprensión de estas vinculaciones, se examina la autoridad y sus grados, a partir del grupo sémico correspondiente

Hyperalgesic agents increase a tetrodotoxin-resistant Na+ current in nociceptors.

Sensitization of primary afferent neurons underlies much of the pain and tenderness associated with tissue injury and inflammation. The increase in excitability is caused by chemical agents released at the site of injury. Because recent studies suggest that an increase in voltage-gated Na+ currents may underlie increases in neuronal excitability associated with injury, we have tested the hypothesis that a tetrodotoxin-resistant voltage-gated Na+ current (TTX-R INa), selectively expressed in a subpopulation of sensory neurons with properties of nociceptors, is a target for hyperalgesic agents. Our results indicate that three agents that produce tenderness or hyperalgesia in vivo, prostaglandin E2, adenosine, and serotonin, modulate TTX-R INa. These agents increase the magnitude of the current, shift its conductance-voltage relationship in a hyperpolarized direction, and increase its rate of activation and inactivation. In contrast, thromboxane B2, a cyclooxygenase product that does not produce hyperalgesia, did not affect TTX-R INa. These results suggest that modulation of TTX-R INa is a mechanism for sensitization of mammalian nociceptors.

Efeitos da Imunocastração e de agonistas beta-adrenérgicos sobre a qualidade da carne de bovinos

Os agonistas beta-adrenérgicos (βAA) são conhecidos por aumentar a hipertrofia muscular e lipólise, neste caso uma maneira de se reduzir o efeito da lipólise seria a imunocastração. Dessa forma, o objetivo deste projeto foi avaliar o efeito dos βAA e da imunocastração sobre a qualidade da carne de bovinos Nelore. Foram utilizados noventa e seis bovinos Nelore, sendo que metade dos animais (n=48) receberam uma dose da vacina de imunocastração, e após 30 dias receberam a segunda dose. A outra metade dos animais (n=48) não recebeu nenhuma dose da vacina. Durante 70 dias os animais foram alimentados com uma dieta padrão composta de 24% volumoso e 76% de concentrado. Após 70 dias de confinamento os animais foram divididos em três grupos, dentro de bloco (peso inicial) e condição sexual e foram alimentados por 30 dias, com umas das seguintes dietas: CON - dieta padrão utilizada na fase anterior, sem a adição de βAA; ZIL - dieta padrão acrescida de 80 mg/dia Cloridrato de Zilpaterol; RAC - dieta padrão acrescida de 300 mg/dia Cloridrato de Ractopamina. Ao final desse período os animais foram abatidos e colhidas amostras do músculo Longissimus dorsi para as avaliações de qualidade de carne, lipídeos totais, perfil de ácidos graxos, análise sensorial do consumidor, perfil morfométrico muscular, expressão dos genes calpaína e calpastatina, comprimento de sarcômero. Para a maioria das características avaliadas não foram observadas interações entre os tratamentos. Ao avaliar o efeito da condição sexual, os animais imunocastrados apresentaram maiores intensidades de cor L, a e b, lipídios totais, ácidos oleico, palmítico e total de monoinsaturados e maior frequência para as fibras oxidativas (FO) e glicolíticas (FG) em relação aos não-castrados. Contudo, os animais não-castrados tiveram uma tendência a apresentarem uma carne mais macia na análise sensorial e obtiveram maior frequência das fibras oxidativasglicolíticas (FOG) em relação aos imunocastrados. Quanto ao efeito dos βAA, o grupo ZIL apresentaram uma carne menos macia na força de cisalhamento, maiores concentrações de ácidos heptadecanoico, linoleico, araquidonico ácido C20:3 N6C8C11C14, ômega 6, maior frequência para as FO e menor para FG em comparação ao grupo RAC e CON. No entanto, os animais do grupo CON e ZIL apresentaram maior área para as FO em comparação ao grupo RAC, enquanto que para as FOG, os animais do grupo CON tiveram maior área do que os animais do grupo RAC e ZIL. Na análise sensorial, os grupos RAC e ZIL receberam menores notas para os atributos textura e qualidade global em relação ao CON. Não foi observado efeito da condição sexual e dos βAA sobre a expressão dos genes e comprimento de sarcômero. Conclui-se que a condição sexual e a suplementação com os βAA podem alterar a qualidade da carne, perfil de ácidos graxos e morfométrico muscular, sem, contudo, alterar a expressão dos genes e do comprimento de sarcômero.

Impacto do pH final na maciez do músculo Longissimus lumborum de animais zebuínos: mudanças estruturais de proteínas da carne crua e cozida durante a maturação

O objetivo do presente trabalho foi determinar a força de cisalhamento Warner-Bratzler do músculo Longissimus lumborum de animais zebuínos machos inteiros (Bos indicus) durante o período de maturação, nas faixas de pH final (pHf 48 horas post mortem) normal (pH entre 5,5 e 5,8) e anormal (pH entre 5,81 e 6,19) e temperaturas internas de cozimento. Concomitante com a avaliação de força de cisalhamento, foram avaliadas também a degradação da desmina e troponina T, o comprimento do sarcômero, o teor de colágeno total e solúvel, as temperaturas máximas de desnaturação das proteínas e a morfologia geral de agregação das fibras do músculo no cozimento. A degradação da desmina e troponina T foi maior no pHf normal, aparecendo produtos de degradação a partir do dia 7 nessa faixa de pHf. Não houve diferenças nos valores de comprimento do sarcômero, descartando-se assim, a contribuição desse parâmetro sobre a temperatura máxima de desnaturação (Tmáx) das proteínas, determinada utilizando calorímetro exploratório diferencial (DSC). Similarmente, não foram encontradas diferenças para os teores de colágeno total e solúvel, e os valores de colágeno total foram baixos, sugerindo que sua contribuição na segunda transição térmica e nos valores de força de cisalhamento foi mínima. As Tmáx1 e Tmáx2, correspondentes à desnaturação da meromiosina leve e pesada, respectivamente, foram menores no pHf normal, mas o efeito foi maior para a Tmáx2. A Tmáx3 da actina e titina aumentou até 14 dias post mortem na faixa de pHf normal, e posteriormente diminuiu significativamente após 21 dias, sugerindo possível degradação dessas proteínas nesse período de dias. Não foram encontradas diferenças nos valores de Tmáx no pHf anormal, em todos os dias post mortem, o que sugere a contribuição de um possível mecanismo de proteção que estabiliza as miofibrilas no aquecimento. Houve maior agregação das fibras do músculo no pHf normal nas temperaturas internas de cozimento de 65 e 80°C, provavelmente devido à maior desnaturação térmica das miofibrilas. Os valores de força de cisalhamento foram maiores com o aumento da temperatura interna de cozimento, devido ao aumento da desnaturação térmica das miofibrilas do músculo. Independente da temperatura interna de cozimento, os valores de força de cisalhamento foram altos em quase todos os dias post mortem para ambas as faixas de pHf, o que sugere a necessidade de utilizar métodos físicos ou químicos para aumentar a maciez do músculo Longissimus lumborum de animais zebuínos.

Temperamento divergente em bovinos está associado à alteração no amaciamento de carne e atividade inibitória de calpastatina

Embora muitos avanços tenham ocorrido no entendimento dos fatores que afetam a maciez, a incidência de carne dura ainda é significativa. Animais mais reativos apresentam carnes mais duras, porém o mecanismo que determina este efeito ainda não foi estabelecido. Presume-se que o maior estresse nos animais reativos aumente a atividade de calpastatina afetando o amaciamento post mortem. Com objetivo de testar esta hipótese, foram avaliadas correlações da força de cisalhamento (FC), temperamento e temperatura corporal obtida de noventa e seis novilhos Nelore castrados, com cerca de 20 meses de idade. O temperamento foi baseado nas variáveis velocidade de fuga (VF) e escore de tronco (ET) avaliadas 3 - 4 semanas antes do abate (Manejo 1) e 2 dias pré-abate (Manejo 2). A análise de componentes principais com as variáveis de temperamento obtidas em ambos os manejos resultou em dois índices: índice de temperamento (IT) e índice de habituação (IH). Estes índices apresentaram maior correlação com a FC do que a VF. O IH apresentou correlação negativa e positiva com FC e pH (P < 0,05), respectivamente. A temperatura retal foi positivamente correlacionada com IT e negativamente com FC. A termografia infravermelho de várias regiões corporais apresentou correlações baixas com IT ou FC. Dois grupos divergentes quanto à FC (extremos da população para FC), cada qual com 6 novilhos, foram comparados para variáveis de temperamento, expressão dos genes CAPN1, CAST, CAST1 e CAST2, e características de carne. O grupo de alta FC (AFC) apresentou maior (P< 0,05) VF, ET, IT e índice de temperamento com base na média da VF e ET (ITM). Os grupos de AFC e baixa FC (BFC) não diferiram (P > 0,05) para comprimento de sarcômero e pH final, mas tiveram diferenças no amaciamento post mortem, com diferenças em maciez que persistiram em todos os tempos de maturação (2, 16 e 30 dias post mortem; P < 0,05). O grupo AFC apresentou maior atividade inibitória de calpastatina total 48 h post mortem medida no M. triceps brachii (P < 0,05), embora diferenças não tenham sido observadas no M. longissimus lumborum (P > 0,05). No entanto, o grupo AFC teve no M. longissimus maior expressão de CAST do que o grupo de BFC (P < 0,05). Em conclusão, temperamentos divergentes têm impacto na atividade de calpastatina que influência o amaciamento post mortem.

Groove pancreatitis a propósito de um caso clínico

Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2014

The Little red lark : song for mezzo-soprano, or baritone /

First line of text: Oh swan of slenderness, dove of tenderness, jewel of joys, arise.

Reliability of the Knee Examination in Osteoarthritis: Effect of Standardization

Objective. To assess the reliability of physical examination of the osteoarthritic (OA) knee by rheumatologists, and to evaluate the benefits of standardization. Methods. Forty-two physical signs and techniques were evaluated using a 6 X 6 Latin square design. Patients with mild to severe knee OA, based on physical and radiographic signs, were examined in random order prior to and following standardization of techniques. For those signs with dichotomous scales, agreement among the rheumatologists was calculated as the prevalence-adjusted bias-adjusted kappa (PABAK), while for the signs with continuous and ordinal scales, a reliability coefficient (R-c) was calculated using analysis of variance. A PABAK of >0.60 and an Re of >0.80 were considered to indicate adequate reliability. Results. Adequate poststandardization reliability was achieved for 30 of 42 physical signs/techniques (71%). The most highly reliable signs identified by physical examination of the OA knee included alignment by goniometer (R-c = 0.99), bony swelling (R-c = 0.97), general passive crepitus (R-c = 0.96), gait by inspection (PABAK = 0.78), effusion bulge sign (R-c = 0.97), quadriceps atrophy (R. = 0.97), medial tibiofemoral tenderness (R-c = 0.94), lateral tibiofemoral tenderness (R-c = 0.85), patellofemoral tenderness by grind test (R-c = 0.94), and flexion contracture (R-c = 0.95). The standardization process resulted in substantial improvements in reliability for evaluation of a number of physical signs, although for some signs, minimal or no effect of standardization was noted. After standardization, warmth (PABAK = 0.14), medial instability at 30degrees flexion (PABAK = 0.02), and lateral instability at 30degrees flexion (PABAK = 0.34) were the only 3 signs that were highly unreliable. Conclusion. With the exception of physical examinations for instability, a comprehensive knee examination can be performed with adequate reliability. Standardization further improves the reliability for some physical signs and techniques. The application of these findings to future OA studies will contribute to improved outcome assessments in OA.

Trinity, polyphony and pastoral relationships

The author explores the Christian doctrine of the Trinity to shed light on the nature of the pastoral ministry. Using the trinitarian term, "polyphony" (David Cunningham) for this purpose, he explicates unity and difference as key polyphonic categories in the doctrine of the Trinity. The author suggests that the polyphonic notes sounded by pastoral caregivers are toughness and tenderness, woundedness and health, wisdom and folly, and communion, nearness and distance.

Effect of high power ultrasound waves on properties of meat: A review

The effect of high power ultrasound waves on physical, biochemical, and microbial properties of meat have been the subject of a great deal of interest in recent years. The present review details the basic principles underlying the effects of ultrasound on the properties of food systems, followed by discussion of specific effects of high power ultrasound on meat products, including muscle, cellular, and subcellular components. In addition, the specific effects of high power ultrasound on the following parameters are discussed: enzyme activities and efficiencies, muscle proteolysis, quality criteria such as tenderness; extraction of protein, gelation, and restructuring of meat products and germicidal properties against meat micro-organisms.