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INTRODUCCIÓN: La bronquiolitis es una patología frecuente en la práctica clínica pediátrica. Constituye una de las principales entidades clínicas dentro de las infecciones respiratorias agudas bajas (IRAB). Se define como el primer episodio de sibilancias con manifestaciones clínicas de infección viral en un niño menor de dos años y afecta principalmente a lactantes menores de 6 meses. El tratamiento es fundamentalmente de soporte con oxigenoterapia e hidratación, quedando el resto de las terapéuticas bajo una profunda controversia acerca de su real efectividad. METODOLOGÍA: Desde la exposición de un escenario clínico se planteó una pregunta estructurada para luego realizar una búsqueda bibliográfica con el fin de dar respuesta a la pregunta sobre la efectividad en el tratamiento del bronquiolitis con broncodilatadores. Se realizó una búsqueda en PubMed utilizando los Mesh (Medical Subject Headings) "bronchodilators AND bronchiolitis", se aplicaron distintos filtros, tras lo cual se llegó al número final de 23 artículos. Tras una lectura de los títulos y resúmenes de los artículos, se escogió el artículo "Bronchodilators for bronchiolitis". ANÁLISIS DEL ARTÍCULO: Nos hemos centrado las siguientes variables con el fin de responder a la pregunta clínica: la mejoría en el score clínico, la reducción de la tasa de internación y la saturometría de oxígeno. Realizamos luego un análisis secundario de los datos de las distintas variables con el fin de definir los valores de riesgo relativo (RR), reducción de riesgo absoluto (RRA), reducción del riesgo relativo (RRR) y el número necesario a tratar (NNT) con sus respectivos intervalos de confianza del 95% (IC 95%). También se llevó a cabo un análisis estadístico para evaluar la variable de saturación de oxígeno. RECOMENDACIÓN FINAL: No está recomendado el uso de broncodilatadores en el manejo del bronquiolitis, ya que no mejoran ninguna de las variables analizadas. Los broncodilatadores no sólo no tienen eficacia, sino que suponen un gasto y presentan efectos adversos indeseables. (AU)

INTRODUCTION: Bronchiolitis is a frequent pathology in pediatric clinical practice. It constitutes one of the main clinical entities within acute lower respiratory infections. It is defined as the first episode of wheezing with clinical manifestations of viral infection in a child younger than two years and mainly affects infants under 6 months. The treatment is fundamentally support with oxygen therapy and hydration, leaving the rest of the therapeutic under a deep controversy about its real effectiveness. METHODOLOGY: From the exposition of a clinical scenario, a structured question was presented for a bibliographic search in order to answer the question about the effectiveness in the treatment of bronchiolitis with bronchodilators. A PubMed search was performed using the Mesh (Medical Subject Headings) "Bronchodilators AND Bronchiolitis", different filters were applied, and we reached the final number of 23 articles. After a reading of the titles and summaries of the articles, the article "Bronchodilators for Bronchiolitis" was chosen. ANALYSIS OF THE ARTICLE: We have focused the following variables in order to answer the clinical question: the improvement in the clinical score, the reduction of the hospitalization rate and oxygen saturation. Then, we performed a secondary analysis of the data of the different variables in order to define the values of relative risk, absolute risk reduction, relative risk reduction, and the number needed to treat, with their respective 95% Confidence Intervals. We also carried out the statistical analysis needed to evaluate the oxygen saturation. Recommendation: The use of bronchodilators in the management of bronchiolitis is not recommended because none of the analyzed variables improve. Bronchodilators not only do not have efficacy, but they suppose an expense and present undesirable adverse effects. (AU)

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Slow seed coat darkening is desirable in common bean cultivars and genetic parameters are important to define breeding strategies. The aims of this study were to estimate genetic parameters for plant architecture, grain yield, grain size, and seed-coat darkening in common bean; identify any genetic association among these traits; and select lines that associate desirable phenotypes for these traits. Three experiments were set up in the winter 2012 growing season, in Santo Antônio de Goiás and Brasília, Brazil, including 220 lines obtained from four segregating populations and five parents. A triple lattice 15 x 15 experimental design was used. The traits evaluated were plant architecture, grain yield, grain size, and seed-coat darkening. Analyses of variance were carried out and genetic parameters such as heritability, gain expected from selection, and correlations, were estimated. For selection of superior lines, a "weight-free and parameter-free" index was used. The estimates of genetic variance, heritability, and gain expected from selection were high, indicating good possibility for success in selection of the four traits. The genotype x environment interaction was proportionally more important for yield than for the other traits. There was no strong genetic correlation observed among the four traits, which indicates the possibility of selection of superior lines with many traits. Considering simultaneous selection, it was not possible to join high genetic gains for the four traits. Forty-four lines that combined high yield, more upright plant architecture, slow darkening grains, and commercial grade size were selected.

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The aim of the current study was to alert about dermatological alterations in the clinical evolution of lipo-lymphedema. The case of a 48-year-old patient is reported with clinical diagnosis of stage II lipo-lymphedema treated in the Angiology and Vascular Surgery Service of FAMERP. On physical examination the edema was hard, not reversible during rest, with nodules in the lower one-third of the limbs and a positive Stemmer's sign. The sizes of the nodules were different between legs. This report stresses the clinical findings and the differences in each disease. Additionally a review of publications is presented. The dermatological changes occurring in the evolution of lipedema may be associated with the evolution of lipo-lymphedema.

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We evaluated genetic variants of apolipoprotein E (APOE HhaI) and their association with serum lipids in colorectal cancer (CRC), together with eating habits and personal history. Eight-seven adults with CRC and 73 controls were studied. APOE*2 (rs7412) and APOE*4 (rs429358) were identified by polymerase chain reaction-restriction fragment length polymorphism. APOE gene polymorphisms were similar in both groups, but the å4/å4 genotype (6 percent) was present only in controls. The patients had reduced levels (mean ± SD) of total cholesterol and low-density lipoprotein cholesterol fraction (180.4 ± 49.5 and 116.1 ± 43.1 mg/dL, respectively) compared to controls (204.2 ± 55.6, P = 0.135 and 134.7 ± 50.8 mg/dL; P = 0.330, respectively) indicating that they were not statistically significant after the Bonferroni correction. The APOE*4 allele was associated with lower levels of total cholesterol, low- and high-density lipoprotein cholesterol fraction and increased levels of very low-density lipoprotein cholesterol fraction and triglycerides only among patients (P = 0.014). There was a positive correlation between the altered lipid profile and increased body mass indexes in both groups (P < 0.010). Moreover, a higher rate of hypertension and overweight was observed in controls (P < 0.002). In conclusion, the presence of the å4/å4 genotype only in controls may be due to a protective effect against CRC. Lower lipid profile values among patients, even those on lipid-rich diets associated with the APOE*4 allele, suggest alterations in the lipid synthesis and metabolism pathways in CRC.

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We evaluated genetic variants of apolipoprotein E (APOE HhaI) and their association with serum lipids in colorectal cancer (CRC), together with eating habits and personal history. Eight-seven adults with CRC and 73 controls were studied. APOE*2 (rs7412) and APOE*4 (rs429358) were identified by polymerase chain reaction-restriction fragment length polymorphism. APOE gene polymorphisms were similar in both groups, but the epsilon4/epsilon4 genotype (6%) was present only in controls. The patients had reduced levels (mean +/- SD) of total cholesterol and low-density lipoprotein cholesterol fraction (180.4 +/- 49.5 and 116.1 +/- 43.1 mg/dL, respectively) compared to controls (204.2 +/- 55.6, P = 0.135 and 134.7 +/- 50.8 mg/dL; P = 0.330, respectively) indicating that they were not statistically significant after the Bonferroni correction. The APOE*4 allele was associated with lower levels of total cholesterol, low- and high-density lipoprotein cholesterol fraction and increased levels of very low-density lipoprotein cholesterol fraction and triglycerides only among patients (P = 0.014). There was a positive correlation between the altered lipid profile and increased body mass indexes in both groups (P < 0.010). Moreover, a higher rate of hypertension and overweight was observed in controls (P < 0.002). In conclusion, the presence of the epsilon4/epsilon4 genotype only in controls may be due to a protective effect against CRC. Lower lipid profile values among patients, even those on lipid-rich diets associated with the APOE*4 allele, suggest alterations in the lipid synthesis and metabolism pathways in CRC.

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