Panniculitis in childhood and adolescence

Background: The purpose of the present paper was to describe the clinical manifestations and treatment of patients with panniculitis. Methods: From January 1983 to December 2002, 4294 patients were treated for pediatric rheumatological diseases at Pediatric Rheumatology Unit, University of São Paulo, Brazil. Of these, 35 children and adolescents (0.8%) presented with panniculitis: erythema nodosum (EN) or Weber–Christian disease (WCD). Clinical characteristics, laboratory exams, biopsy of the lesion, treatment and clinical course were studied. Results: Of the 35 patients, 29 presented with EN and six with WCD, one of these with cytophagic histiocytic panniculitis. Mean age at symptom onset was 85 months (6–204 months) and the mean duration of follow up was 55 months (1–144 months). All the patients presented with inflammatory subcutaneous nodules. The patients with WCD presented with systemic manifestations and cutaneous atrophy. The principal etiologies of EN were streptococcal infection (42%), undetermined (13.5%), pulmonary tuberculosis (10%), and acute rheumatic fever (10%). Biopsy of the nodules indicated septal panniculitis in 14 patients with EN and lobular panniculitis without vasculitis in the patients with WCD, one of which had cytophagic histiocytic panniculitis. There was recurrence in 11 patients (38%) with EN and in all those with WCD. Non‐steroidal anti‐inflammatory drugs were used in 15 patients with EN and corticosteroids and/or immunosuppressive drugs in the six patients with WCD. Three patients died. Conclusions: EN is the most frequent panniculitis, with a benign course and is mainly associated with infections. WCD is a severe disease, with systemic involvement, that proceeds with cutaneous atrophy and requires the use of corticosteroids and or immunosuppressive drugs.     

Family and home correlates of children's physical activity in a multi-ethnic population: the cross-sectional child heart and health study in england (CHASE)

Background  

The influence of the family and home environment on childhood physical activity (PA) and whether this differs between ethnic groups remains uncertain. This paper investigates associations between family and home factors and childhood PA in a multi-ethnic population and explores whether associations differ between ethnic groups.     

HIV prevalence among female sex workers,drug users and men who have sex with men in Brazil: A Systematic Review and Meta-analysis

Background  

The Brazilian response towards AIDS epidemic is well known, but the absence of a systematic review of vulnerable populations ─ men who have sex with men (MSM), female sex workers (FSW), and drug users (DU) remains a main gap in the available literature. Our goal was to conduct a systematic review and meta-analysis of studies assessing HIV prevalence among MSM, FSW and DU, calculating a combined pooled prevalence and summarizing factors associated the pooled prevalence for each group.     

IGOB131, a novel seed extract of the West African plant Irvingia gabonensis, significantly reduces body weight and improves metabolic parameters in overweight humans in a randomized double-blind placebo controlled investigation

Background  

A recent in vitro study indicates that IGOB131, a novel seed extract of the traditional West African food plant Irvingia gabonensis, favorably impacts adipogenesis through a variety of critical metabolic pathways including PPAR gamma, leptin, adiponectin, and glycerol-3 phosphate dehydrogenase. This study was therefore aimed at evaluating the effects of IGOB131, an extract of Irvingia gabonensis, on body weight and associated metabolic parameters in overweight human volunteers.     

The Accelerating Access Initiative: experience with a multinational workplace programme in Africa

Problem

A multinational company with operations in several African countries was committed to offer antiretroviral treatment to its employees and their dependants.

Approach

The Accelerating Access Initiative (AAI), an initiative of six pharmaceutical companies and five United Nations’ agencies, offered the possibility of obtaining brand antiretroviral drugs (ARVs) at 10% of the commercial price. PharmAccess, a foundation aimed at removing barriers to AIDS treatment in Africa, helped to establish an HIV policy and treatment guidelines, and a workplace programme was rolled out from September 2001.

Local setting

Private sector employers in Africa are keen to take more responsibility in HIV prevention and AIDS care. An important hurdle for African employers remains the price and availability of ARVs.

Relevant changes

The programme encountered various hurdles, among them the need for multiple contracts with multiple companies, complex importation procedures, taxes levied on ARVs, lack of support from pharmaceutical companies in importation and transportation, slow delivery of the drugs, lack of institutional memory in pharmaceutical companies and government policies excluding the company from access to ARVs under the AAI.

Lessons learned

The launch of the AAI enabled this multinational company to offer access to ARVs to its employees and dependants. The private sector should have access to these discounted drugs under the AAI. A network of local AAI offices should be created to assist in logistics of drugs ordering, purchase and clearance. No taxes should be levied on ARVs.     

The effect on minimum tumor dose of restricting target-dose inhomogeneity in optimized three-dimensional treatment of lung cancer

An examination was made of the effect upon the minimum tumor dose of a limit placed on the variation of dose across target. If the required level of target dose uniformity is slightly relaxed, a substantial improvement in the minimum tumor dose might appear. It was conjectured that this effect could be seen with treatments optimally planned and evaluated in three-dimensions. A model of advanced carcinoma of the lung treated with a computer controlled accelerator was used to test this hypothesis. A mathematical program for optimizing beam weights was used to determine the largest minimum tumor dose possible. In the six cases tested, a minimum tumor dose of greater than 80 Gy could be delivered if a 20% inhomogeneity limit was accepted. The minimum tumor dose fell to the range 44-64 Gy when the inhomogeneity limit was tightened to 13-17%. The results imply a need to examine the choice of a required level of dose uniformity from the range of values suggested in the 2-dimensional planning literature. If a strict bound-on-dose uniformity is preserved, mechanisms--such as formal optimization--which can reduce target dose inhomogeneity will be valuable.     

Monte Carlo calculations of scatter dose for small field sizes in a 60Co beam

Photon dose calculations are frequently based on the separation of primary and scatter dose components. For small field sizes it is difficult to make this separation from measured data. Such problems lend themselves to solution by calculational methods, which permit rigorous definition of primary and scatter dose. Using Monte Carlo methods, we verify an equation derived from O'Connor's scaling theorem relating scatter-primary ratios at small depths and field sizes to those at larger depths and fields. This equation may prove to be useful when separating primary and scatter dose components, and consequently in dose calculations involving irregular fields or inhomogeneities.     

低血糖指数膳食改善超重老年糖尿病患者氧化应激水平

目的:观察低血糖指数的膳食对2型糖尿病患者氧化应激状态的影响。方法:2004-10/11在上海市静安区二个社区卫生服务中心招募受试者,经医生明确诊断为2型糖尿病、病程超过6个月,体质量指数≥24kg/m2的老年糖尿病志愿者43名,受试者对试验知情同意。采用随机交叉试验随机分配至低血糖指数饮食组和高血糖指数饮食组,每种膳食分别连续使用4周,间隔洗脱期4周,比较试验前后患者超氧化物歧化酶、脂质过氧化产物丙二醛和谷胱甘肽过氧化物酶含量的变化。结果:受试者依从性好,除1人因试验期间发现肿瘤而退出试验,42名志愿者按设计要求完成试验。膳食干预后低血糖指数饮食组和高血糖指数饮食组的超氧化物歧化酶活力分别升高了15.68%和21.33%,丙二醛水平分别下降23.94%和21.55%,谷胱甘肽过氧化物酶活力分别升高了15.74%和17.09%;干预后低血糖指数饮食组丙二醛下降水平与高血糖指数饮食组比较差异有显著性意义(P<0.05),而超氧化物歧化酶和谷胱甘肽过氧化物酶活性两组间差异无显著性意义(P>0.05)。结论:在控制总能量的基础上给予平衡膳食能够改善其氧化应激水平,采用低血糖指数食物有助于氧化应激水平的改善。     

Perspective display of patient external and internal contours

The two-dimensional perspective display of three-dimensional patient contour data is useful in radiotherapy treatment planning as it provides a comprehensive view of the relative positions of patient internal (organ and target) and external contours. The advent of minicomputers and video display systems has made possible the integration of such display techniques into the treatment planning routine. This paper describes and gives an example of the methods we have found useful in producing perspective displays of patient contour data. Included is a solution to the problem of removing hidden line segments from the displayed image.