Eosinophilic esophagitis: Updated consensus recommendations for children and adults.

Eosinophilic esophagitis (EoE) is a clinicopathologic condition of increasing recognition and prevalence. In 2007, a consensus recommendation provided clinical and histopathologic guidance for the diagnosis and treatment of EoE; however, only a minority of physicians use the 2007 guidelines, which require fulfillment of both histologic and clinical features. Since 2007, the number of EoE publications has doubled, providing new disease insight. Accordingly, a panel of 33 physicians with expertise in pediatric and adult allergy/immunology, gastroenterology, and pathology conducted a systematic review of the EoE literature (since September 2006) using electronic databases. Based on the literature review and expertise of the panel, information and recommendations were provided in each of the following areas of EoE: diagnostics, genetics, allergy testing, therapeutics, and disease complications. Because accumulating animal and human data have provided evidence that EoE appears to be an antigen-driven immunologic process that involves multiple pathogenic pathways, a new conceptual definition is proposed highlighting that EoE represents a chronic, immune/antigen-mediated disease characterized clinically by symptoms related to esophageal dysfunction and histologically by eosinophil-predominant inflammation. The diagnostic guidelines continue to define EoE as an isolated chronic disorder of the esophagus diagnosed by the need of both clinical and pathologic features. Patients commonly have high rates of concurrent allergic diatheses, especially food sensitization, compared with the general population. Proved therapeutic options include chronic dietary elimination, topical corticosteroids, and esophageal dilation. Important additions since 2007 include genetic underpinnings that implicate EoE susceptibility caused by polymorphisms in the thymic stromal lymphopoietin protein gene and the description of a new potential disease phenotype, proton pump inhibitor-responsive esophageal eosinophila. Further advances and controversies regarding diagnostic methods, surrogate disease markers, allergy testing, and treatment approaches are discussed.

Helicobacter pylori in dyspeptic children and adults: endoscopic, bacteriologic and histologic correlations

Using different bacteriological (urease test, Gram staining and culture) and histological (Steiner staining and modified Giemsa staining) techniques, we searched for the presence of Helicobacter pylori in the gastric antrum of 200 dyspeptic Brazilian patients (106 females and 94 males aged 19 days to 81 years). The presence of bacteria was then correlated with the endoscopic and histological findings. H. pylori was present in 59.5 of the population studied. In Brazil, colonization occurs early, involving 37 of the dyspeptic population by 20 years of age. The presence of H. pylori in the gastric antrum was strongly associated with duodenal ulcer (P < 0.001) and a normal endoscopic examination did not exclude the possibility of colonization of the gastric antrum by H. pylori. The most sensitive test was the preformed urease test (89). We conclude that more than one diagnostic method should preferably be used for the detection of H. pylori and that the presence of H. pylori is closely correlated with active chronic gastritis (P < 0.001).

Health education, public information, and communication in schistosomiasis control in Brazil: a brief retrospective and perspectives

In recent years, the strategy for the control of schistosomiasis has placed increased emphasis on the role of health education, public information, and communication. This should, not only bring about specific changes in behavior aiming at disease prevention, but also stimulate participation of the community in health programs. Beyond this, it is desirable that both community members and researchers should seek better life conditions through a transformative social action. The present paper addresses these concerns; first, by critically reviewing some health education programs that were developed in Brazil, and, secondly, by analyzing and suggesting ways to improve this area.

Education for science and science for education: more than a play upon words

In the celebration of the Oswaldo Cruz Institute centenary, we wanted to stress our concern with the relationship between two of its missions: research and education. What are the educational bases required for science and technology activities on health sciences for the future years? How can scientists collaborate to promote the popularization of academic knowledge and to improve a basic education for citizenship in an ethic and humanistic view? In this article we pointed out to need of commitment, even in the biomedical post-graduation level, of a more integrated philosophy that would be centered on health education, assuming health as a dynamic biological and social equilibrium and emphasizing the need of scientific popularization of science in a cooperative construction way, instead of direct transfer of knowledge, preserving also macro views of health problems in the development of very specific studies. The contemporary explosion of knowledge, particularly biological knowledge, imposes a need of continuous education to face the growing illiteracy. In order to face this challenge, we think that the Oswaldo Cruz Institute honors his dialectic profile of tradition and transformation, always creating new perspectives to disseminate scientific culture in innovated forms.

TT virus infection in children and adults who visited a general hospital in the south of Brazil for routine procedure

TT virus (TTV) is a newly described nonenveloped human virus, with a circular, negative-stranded DNA genome, that was first identified in the blood of a patient with posttransfusion hepatitis of unknown etiology. PCR primers and conditions used for TTV DNA amplification may greatly influence the level of TTV detection in serum. Three PCR assays, with different regions of the genome as targets, were used to test TTV DNA in 130 sera from children and adults visiting a hospital in the south of Brazil, most of them for routine procedure. Forty-four percent of adult sera and 73% of sera from children aged 0-10 years were TTV positive with at least one PCR assay. However, the three assays were able to detect only 33%, 35%, and 70% of the total positive samples. Our results showed a high prevalence of TTV infection in the south of Brazil, particularly among young children, and confirmed the necessity of performing several PCR assays to assess the true TTV prevalence in a determined population.

Identification of entomopathogenic Bacillus isolated from Simulium (Diptera, Simuliidae) larvae and adults

Entomopathogenic bacteria isolated from Simulium larvae and adults from breeding sites in the states of São Paulo and Rio de Janeiro, Brazil, were identified as 18 strains of Bacillus thuringiensis and one of B. sphaericus. Most of these strains were serotyped according to their flagellar antigens. However, nine of the B. thuringiensis samples, could not be serotyped and were designated as "autoagglutinating"; they were also shown to be toxic in preliminary tests against Aedes aegypti larvae. Additionally, B. sphaericus was also shown to be toxic towards Culex quinquefasciatus larvae.

Supporting A Better Transition From Second Level To Higher Education: Key directions and Next Steps

Supporting A Better Transition From Second Level To Higher Education. Provided by the Department of Education and Skills, Ireland.

Assistances ventriculaires gauches dans le choc cardiogène et l'insuffisance cardiaque terminate [Left ventricular assist devices in cardiogenic shock and chronic refractory heart failure].

Decompensated heart failure, either acute (cardiogenic shock) or chronic (terminal heart failure) may become refractory to conventional therapy, then requiring mechanical assistance of the failing heart to improve hemodynamics. In the acute setting, aortic balloon counterpulsation is used as first line therapy. In case of failure, other techniques include the extracorporal membrane oxygenator or a percutaneous left ventricular assist device, such as the TandemHeart or the Impella. In chronic heart failure, long-term left ventricular assist devices can be surgically implanted. The continuous flow devices give here the best results. The aim of the present review article is to present with some details the various methods of mechanical left ventricle assistance to which the intensivist may be confronted in his daily practice.

Different profiles of immune reconstitution in children and adults with HIV-infection after highly active antiretroviral therapy.

BACKGROUND Recent advances in characterizing the immune recovery of HIV-1-infected people have highlighted the importance of the thymus for peripheral T-cell diversity and function. The aim of this study was to investigate differences in immune reconstitution profiles after highly active antiretroviral therapy (HAART) between HIV-children and adults. METHODS HIV patients were grouped according to their previous clinical and immunological status: 9 HIV-Reconstituting-adults (HIV-Rec-adults) and 10 HIV-Reconstituting-children (HIV-Rec-children) on HAART with viral load (VL) and CD4+ >or=500 cells/microL at least during 6 months before the study and CD4+ adults and 20 healthy-children (control subjects) were used to calculate Z-score values to unify value scales between children and adults to make them comparable. RESULTS HIV-Rec-children had higher T-cell receptor excision circles (TREC) and lower interleukin (IL)-7 levels than HIV-Rec-adults (p < 0.05). When we analyzed Z-score values, HIV-Rec-children had higher TREC Z-score levels (p = 0.03) than HIV-Rec-adults but similar IL-7 Z-score levels. Regarding T-cell subsets, HIV-Rec-children had higher naïve CD4+ (CD4+CD45RA hi+CD27+), naïve CD8+ (CD8+CD45RA hi+CD27+), and memory CD8+ (CD8+CD45RO+) cells/microl than HIV-Rec-adults, but similar memory CD4+ (CD4+CD45RO+) counts. HIV-Rec-children had lower naïve CD8+ Z-score values than HIV-Rec-adults (p = 0.05). CONCLUSION Our data suggest that HIV-Rec-children had better thymic function than HIV-Rec-adults and this fact affects the peripheral T-cell subsets. Thus, T-cell recovery after HAART in HIV-Rec-adults could be the consequence of antigen-independent peripheral T-cell expansion while in HIV-Rec-children thymic output could play a predominant role in immune reconstitution.

Serving Iowa Youth and Families with a Youth Development Approach : JJDP Act Formula Grant Application and Three-Year Comprehensive Plan

This report is Iowa’s Three-Year Plan, which serves as the application for federal Juvenile Justice and Delinquency Prevention Act formula grant funding (JJDP Act). The Division of Criminal and Juvenile Justice Planning (CJJP) wrote Iowa’s Three-Year Plan. CJJP is the state agency responsible for administering the JJDP Act in Iowa. Federal officials refer to state administering agencies as the state planning agency (SPA). The Plan was developed and approved by Iowa’s Juvenile Justice Advisory Council. That Council assists with administration of the JJDP Act, and also provides guidance and direction to the SPA, the Governor and the legislature regarding juvenile justice issues in Iowa. Federal officials refer to such state level groups as state advisory groups (SAG’s). The acronyms SPA and SAG are used through this report.

Reproducibility of acute mountain sickness in children and adults : a prospective study

Objectif: Alors qu'un antécédent d' AMS est couramment utilisé pour fournir des conseils et recommander une prophylaxie médicamenteuse pour les expositions ultérieures à la haute altitude, la reproductibilité intra-individuelle de l'AMS au cours d'expositions répétées n'a jamais été examinée dans une étude prospective contrôlée. Méthodes : Chez 27 enfants et 29 adultes non acclimatés, nous avons évalué la présence et la sévérité de l' AMS durant les 48 premières heures après une montée rapide à 3450m, et ceci en deux occasions distantes de 9 à 12 mois. Résultats: 18 adultes (62 %) et 6 enfants (22 %) ont souffert d'AMS durant la première exposition et 14 adultes (48 %) et 4 enfants (15 %) durant la seconde (P=O.Ol, adultes versus enfants). Mais surtout, la reproductibilité intra-individuelle de l'AMS était très différente (P < 0.001) entre les deux groupes; en effet, aucun des 6 enfants ayant souffert d'AMS au cours de la première exposition n'en n'a souffert au cours de la seconde mais 4 enfants sans AMS lors de la première exposition ont été touchés lors de la seconde exposition. Contrairement à cela, 14 des 18 adultes qui ont souffert de 1' AMS lors de la première exposition ont également présenté ce problème au cours de la seconde et aucun nouveau cas ne s'est développé dans ceux qui n'avaient pas souffert de cette affection lors de la première occasion. ConClusion : Si chez 1' adulte, un antécédent d' AMS a une bonne valeur prédictive d'un nouvel épisode durant les expositions futures dans des conditions similaires, il n'en est pas de même chez l'enfant chez lequel il n'a pas de valeur prédictive. Un antécédent d'AMS ne devrait donc pas inciter les praticiens à déconseiller la réexposition ou à prescrire une prophylaxie médicamenteuse chez l'enfant.

Argumentation and education. Theoretical foundations and practices

During the last decade, argumentation has attracted growing attention as a means to elicit processes (linguistic, logical, dialogical, psychological, etc.) that can sustain or provoke reasoning and learning. Constituting an important dimension of daily life and of professional activities, argumentation plays a special role in democracies and is at the heart of philosophical reasoning and scientific inquiry. Argumentation, as such, requires specific intellectual and social skills. Hence, argumentation will have an increasing importance in education, both because it is a critical competence that has to be learned, and because argumentation can be used to foster learning in philosophy, history, sciences and in many other domains. Argumentation and Education answers these and other questions by providing both theoretical backgrounds, in psychology, education and theory of argumentation, and concrete examples of experiments and results in school contexts in a range of domains. It reports on existing innovative practices in education settings at various levels.

Asessing public policies. The case of education in Europe and the interaction between personal and institutional factors

The paper deals with the comparative study of European citizens' satisfaction with the state of education in their respective countries. Individual and contextual effects are tested applying multilevel analysis. The results show that educational public policies (level of decentralization, degree of comprehensiveness and public spending) as well as the students' social environment (socioeconomic and cultural status) have a sound impact on the opinions about the state of education.