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Botulinum toxin has been used to treat persistent erythema and flushing in rosacea for several years. Here, we describe two women and one man, each with rosacea with flushing and permanent erythema refractory to conventional treatment, who achieved satisfactory and lasting results following intradermal application of botulinum toxin. Two different botulinum toxin types were used. Toxin concentrations of 3.75U per 0.1 mL (abobotulinum) and 1.25U per 0.1 mL (incobotulinum) were used for each patient were used for each patient. The outcomes were measured using polarized photography to evaluate the decrease in vascular involvement. In the three cases presented here, botulinum toxin was effective for controlling erythema and flushing associated with rosacea; we also observed a prolonged duration of these improvements without the rebound effect of topical therapies.

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The present study aimed to investigate the ability of a microbial consortium to produce biosurfactant in the presence of two carbon sources and also to evaluate the efficiency of the cell-free supernatant cultures to mobilize As from naturally contaminated soil. Pseudomonas and Stenotrophomonas were the main microorganisms in the microbial consortium. The pH, the incubation time, the temperature, and the glucose and glycerol ratios in the culture medium are the main factors influencing biosurfactant production. The lowest surface tension, 30 mN.m-1, and the higher emulsification index, 58%, were achieved at the optimum production conditions (OPC), i.e., pH 9.5, a 2.5 glucose/glycerol ratio, after three days of incubation at 25 °C. The cell-free extracts containing biosurfactants were more efficient in mobilizing As than distilled water, CaCl2 0.1 mol.L-1; saponin, 0.1%; or sodium dodecyl sulfate, 1% during a sequential soil-flushing procedure. The As mobilization using the supernatants containing biosurfactant was sensitive to pH. The use of OPC cell-free supernatant under alkaline conditions leads to the best-obtained results: 24.6% of As removal (678 mg.kg-1) during sequential extractions. The toxicity reduction of the column eluted solution from the first to the seventh cycle evaluated by the germination index (GI) and morphological structures of Allium cepa in the ecotoxicological assessment confirmed the efficiency of the proposed treatment. Allium cepa seeds and seedlings were sensitive in detecting As in soil and eluted solutions with short time responses to the contaminant. Seeds development increased gradually with arsenic removal. The germination index rose from 0 to 55% after soil decontamination through the proposed soil-flushing procedure.

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Introdução: rosácea é uma doença inflamatória crônica da pele, e a aplicação intradérmica de toxina botulínica (TB) tem sido estudada como uma opção terapêutica aos pacientes de difícil manejo do flushing e/ou eritema facial persistente. Ainda não há protocolo-padrão para aplicação da TB na rosácea. Objetivo: avaliar o efeito da aplicação de toxina botulínica na rosácea eritêmato-telangiectásica. Métodos: estudo-piloto com série de casos. Foi realizada a aplicação intradérmica da TB em 10 pacientes com diagnóstico de rosácea e sintomas de eritema persistente e/ou flushing facial. Os pacientes foram submetidos a 10 a 15 injeções por hemiface (1 unidade de TB onabotulínica por injeção) e 0 a 5 injeções na região nasal, totalizando 25 a 35 unidades por paciente. Resultados: apresentaram redução na intensidade do flush e do eritema 75% dos pacientes. O tempo de acompanhamento foi de três meses e nenhum evento adverso grave foi observado. Conclusões: a aplicação intradérmica de TB tipo A deve ser considerada no arsenal terapêutico para controle do eritema e flushing facial da rosácea, especialmente em casos refratários ao tratamento habitual

Introduction: Rosacea is a chronic inflammatory skin disease. The intradermal application of botulinum toxin (BT) has been studied as a therapeutic option for patients who struggle to manage flushing and/or persistent facial erythema. There is no standard protocol for TB application in rosacea. Objective: To evaluate the effectiveness of botulinum toxin application on erythematotelangiectatic rosacea. Methods: Pilot study with case series. We applied intradermal TB in 10 patients with a diagnosis of rosacea and symptoms of persistent erythema and/or facial flushing. Patients received 10 to 15 injections per hemiface (1 unit of onabotulinum TB per injection) and 0 to 5 injections in the nasal region, totaling 25 to 35 units per patient. Results: Seventy-five percent of the patients presented a reduction in flush and erythema intensity. The follow-up time was three months, and no serious adverse events were observed. Conclusions: The therapeutic arsenal to control erythema and facial flushing of rosacea, especially refractory to the usual treatment, should consider the intradermal application of TB type A.

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Resumen La eritromelalgia es una enfermedad rara, crónica, poco conocida, de difícil diagnóstico y tratamiento. Caracterizada por enrojecimiento, calor, dolor intenso y ardor en la parte distal de las extremidades. Afecta fundamentalmente manos, pies, nariz y orejas. El rubor, el dolor y el calor de las extremidades aumentan al exponerse a altas temperaturas, así como después de realizar ejercicio. Los síntomas suelen aliviarse mediante la inmersión de la extremidad afectada en agua fría. Se presenta un caso de una mujer de 33 años de edad, blanca, con afectación predominantemente en las manos. A través del interrogatorio minucioso y la realización de los exámenes complementarios realizados se concluyó que la variante etiológica que presentó la paciente era una eritromelalgia primaria o idiopática. Se impuso tratamiento con aspirina y nifedipino. La evolución clínica de la paciente fue favorable (AU).

ASBTRACT Erythromelalgia is a rare, chronic, little known disease, of difficult diagnosis and treatment. It is characterized by redness, heat, and intense pain and burning in the distal part of the extremities. It mainly affects hands, feet, nose and ears. The flushing, pain and warmth of the extremities increase when exposed to high temperatures as well as after exercise. The symptoms are usually relieved by immersing the affected limb in cold water. The authors present the case of a white, 33-years-old woman, with predominantly involved hand. Through a detailed interview and complementary tests they concluded that the etiological variant presented by the patient was a primary or idiopathic erythromelalgia. Treatment with aspirin and nifedipine was prescribed; the clinical progress of the patient was successful (AU).

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This study was conducted to assess effects of different doses of pFSH on follicular recruitment, superovulatory response, ova/embryo recovery, and embryo yield in lactating ewes. Ewes (n = 24) had a superovulation treatment regimen imposed. All ewes were implanted with a progesterone intravaginal device for 9 d, and administered either 100 (G-100) or 200 (G-200) mg pFSH, proportioned into six doses administered at 12-h intervals, starting 60 h before device removal. At 7 days subsequent to progesterone device removal, there were non-surgical embryo recoveries (NSER) from ewes having three or more corpora lutea. At the time of the first pFSH injection, number of antral follicles were similar (P < 0.05) between ewes in the G-100 and G-200 group, however, there were more 3.1-4.0 mm follicles in ewes of the G-200 than G-100 group at the time of the second pFSH administration. Estrous response and CL number were less (P < 0.05) in ewes of the G-100 (66.7 % and 2.6 ±â€¯0.7) than G-200 (91.7 % and 11.6 ±â€¯1.2) group. There were embryo collections from 100 % and 90.9 % of ewes in the G-100 and G-200 groups, respectively (P > 0.05). Viable embryo numbers and ova/embryo recovery rate were greater (P < 0.05) in ewes of the G-200 (6.9 ±â€¯1.1 and 67.8 %) than G-100 (1.0 ±â€¯0.5 and 27.6 %) group. A dose of 200 mg pFSH was more effective in inducing a superovulatory response and embryo yield after NSER in ewes, however, the 100 mg dose was insufficient for these purposes.

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BACKGROUND: In patients with peripheral intravenous catheters (PIVCs), performing flushing is an essential procedure to maintain catheter patency and prevent complications. These PIVC related complications can lead to premature removal and therapeutics interruption, which implies the need of a new catheterization thus increasing patient discomfort and pain. AIMS: To identify nursing practices related to the flushing procedure, namely: moment(s) of the flushing; the syringe size used; the flush solution, volume and technique; the knowledge and accomplishment of the recommended standards on flushing by nurses. METHODS: A cross-sectional study was conducted between July and December 2017, with Brazilian and Portuguese nurses. An online questionnaire was developed based on the international recommendations on flushing procedure. Descriptive analysis was performed. RESULTS: A total of 76 nurses answered the questionnaire. The majority of nurses (84.2%) performed flushing: the most common technique used was continuous syringe pressure (31.2%), with the push-pause technique being performed by 23.4% of the nurses. Despite the majority performs flushing at four distinct moments (after the PIVC insertion, before, between and after drug delivery), there are inconsistencies in flush solution, volume, and syringe size. The most used volume to perform flushing was 5 mL, filled using normal saline. Despite this, they also recognized the omission of this procedure due to time constrains, no familiarity with the procedure and unavailable material. CONCLUSIONS: This study identified that flushing procedure isn't always performed by nurses in their clinical practice. Also, several inconsistencies were observed between nurses that performed flushing, reflecting the lack of empirical evidence in this area of research.

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This study assessed the effect of progestogen treatment length on ovarian parameters and embryo yield in superovulated Lacaune ewes collected by nonsurgical embryo recovery. Twenty-three lactating ewes were superovulated 30 d apart using a cross-over design. All ewes received 60 mg of MAP intravaginal sponges for 6 (G-6 group) or 9 (G-9 group) d. A total dose of 133 mg pFSH was given in six decreasing doses (twice a day) starting at 60 h before device removal. Ultrasound examination of the ovaries was performed at the first pFSH injection and one day before embryo recovery, which was performed 6-7 d after the onset of estrus. Embryo recovery was conducted only in ewes that expressed estrus and were mated. There was no difference (P > 0.05) in the total number of follicles between G-6 (15.7 ± 1.0) and G-9 (15.6 ± 0.8) at the time of the first pFSH treatment. The percentage of responding donors with ≥3 corpora lutea (CL; 78.2% [18/23] vs 69.5% [16/23]), mean (±SEM) CL number (7.0 ± 1.2 vs 8.1 ± 1.6), transcervical passage rate (94.4% [17/18] vs 83.3% [15/18], and ova/embryo recovery rate (54.5% [60/110] vs 68.0% [83/122]) were not different (P > 0.05) between the G-6 and G-9 groups. However, the mean number of viable embryos was lower (P < 0.05) in the G-6 group (1.8 ± 0.7) than in the G-9 group. (3.5 ± 1.1). In conclusion, treatment with an intravaginal MAP sponge for 9 d during a superovulation protocol is beneficial for viable embryo yield in Lacaune ewes out of the breeding season.

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AbstractThe effects of two feed levels offered during two estrous cycles before insemination were evaluated on the reproductive performance of gilts. A total of 93 gilts (PIC Hendersonville, TN) were individually housed and manually fed twice a day with 2.1 or 3.6 kg/d of a corn and soybean meal-based diet (3.15 Mcal ME/kg and 0.64% standardized ileal digestible lysine), during two estrous cycles before breeding (cycle 1, between first and second estrus; cycle 2, between second and third estrus). Gilts were weighed at the beginning of the experiment, at second and third estrus, and at slaughter (30.2 ± 1.2 d of gestation). Follicles were counted at second estrus, and the embryo-placental units and the corpora lutea were individually counted, measured, and weighed at slaughter. Gilts fed 3.6 kg/d had greater BW gain during cycle 1 and cycle 2 (P < 0.001; + 9.8 kg and + 10.0 kg, respectively) becoming heavier at second and third estrus (P < 0.001). At second estrus, gilts fed 3.6 kg/d had 1.6 more medium-large follicles (P = 0.074) but no difference in follicle size (P = 0.530) was observed. Gilts fed 3.6 kg/d in cycle 1 or cycle 2 had a greater ovulation rate at third estrus (P < 0.016) than those receiving 2.1 kg/d. Also, 3.6 kg/d in cycle 2 increased early embryo mortality (P = 0.006; 2.3 vs. 1.1 dead embryos) and consequently reduced total embryo survival (P = 0.002; 84.6 vs. 90.1%). Gilts fed 3.6 kg/d during cycle 1 had two more total embryos (P < 0.001; 17.2 vs. 15.1) and two more vital embryos on day 30 (P < 0.001; 16.7 vs. 14.5) in comparison with gilts fed 2.1 kg/d. The coefficient of variation for placental length was greater for gilts fed 3.6 kg/d during cycle 1 (P = 0.003). No further significant effects of feeding levels were observed on embryo and placental traits (P ≥ 0.063). These results suggest that the feeding level during the first cycle after pubertal estrus is crucial to set ovulation rate and potential litter size for breeding at next estrus. However, flush feeding gilts before insemination can negatively impact litter size by reducing embryo survival when breeding at third estrus.

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The objective of this study was to assess the effect of the duration of progesterone-based estrus induction protocols on preovulatory follicular dynamics, ovulatory response, and embryo yield after non-surgical embryo recovery (NSER) in Lacaune ewes. Females received acetate medroxyprogesterone intravaginal sponges for six (G-6; n = 14) or nine (G-9; n = 14) days plus d-cloprostenol and eCG 24 h before sponge removal (Day 0). Preovulatory follicular dynamics and the luteal characteristics are evaluated by B-mode and Color-Doppler ultrasonography. NSER was performed five to six days after ovulation. The estrous behavior rate was 85.7% for both groups, and the percentage of ewes that ovulated was 92.9% in G-6 and 100% in G-9. The day of wave emergence (relative to Day 0) did not differ (P > 0.05) between G-6 (-3.0 ±â€¯0.5) and G-9 (-4.2 ±â€¯0.5). The number of follicles of size 4.1-5.0 mm was higher (P < 0.05) in G-9 (1.4 ±â€¯0.2) compared to G-6 (0.8 ±â€¯0.2) during the Days -4 to 0. At NSER, the transcervical penetration rate was 95.2% (20/21) and its duration time was lower (P < 0.05) in G-9 (3.4 ±â€¯0.6 min) than in G-6 (7.2 ±â€¯1.3 min). The number of ovulations and viable embryos was higher (P < 0.05) in G-9 (2.9 ±â€¯0.3 and 1.3 ±â€¯0.4, respectively) than in G-6 (1.9 ±â€¯0.3 and 0.4 ±â€¯0.2, respectively). In conclusion, the 9-day protocol promoted higher ovulation rate and embryo yield; moreover, the cervical dilation treatment allowed NSER in a high percentage of Lacaune ewes.

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Abstract We report field infestation under natural conditions by the cacao plum moth, Michaelophorus nubilus (Felder & Rogenhofer) on leaves of cacao (Theobroma cacao L.; Malvaceae) for the first time in Southern Chiapas, Mexico. The larvae of M. nubilus damages new "flushing" or light green leaves from buds, from either the main or lateral branches of cacao plants.

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In this study, we aimed to evaluate the effect of concentrate supplementation containing crude glycerin (CG) before and during the breeding season on the physiological and blood biochemical variables as well as on the reproductive performance of Santa Inês ewes. A total of 24 ewes (12 pluriparous and 12 nulliparous ewes, 4 and 1.5 years old, weighing an average of 40 ± 5 and 27 ± 3 kg, respectively) were randomly assigned to three treatments consisting of different dietary concentrations of CG (0%, 5%, and 10 % of the total dry matter). The experiment lasted 63 days and was divided into three 21-day phases. In the first and second phases, the animals were subjected to flushing. In the second and third phases, we evaluated the animals' reproductive performance. Weather, physiological, and blood biochemical variables were also studied. The results indicated that the inclusion of CG did not influence significantly (P > 0.05) either the ewes' body weight or their body condition score. All ewes exhibited estrus during the breeding season. Their respiratory rate was significantly influenced by the time of day (P < 0.0001). A 10% CG supplementation did not drastically change the hematological and biochemical variables, which were within the reference ranges. However, the week of supplementation influenced sérum metabolites (P < 0.05). Thus, these results indicate that CG could be used in up to 10% in replacement of ground corn without significantly affecting the physiological, hematological, and biochemical parameters of the ewes or their reproductive performance before and during the breeding season.(AU)

Neste estudo, objetivamos avaliar o efeito da suplementação concentrada contendo glicerina bruta (GB) antes e durante a estação de monta sobre as variáveis bioquímicas e fisiológicas, bem como sobre o desempenho reprodutivo das ovelhas Santa Inês. Um total de 24 ovelhas (12 pluríparas e 12 nulíparas, de 4 e 1,5 anos de idade, pesando em média 40 ± 5 e 27 ± 3 kg, respectivamente) foram distribuídas aleatoriamente em três tratamentos constituídos por diferentes concentrações dietéticas de GB (0, 5 e 10% da matéria seca total). O experimento durou 63 dias e foi dividido em três fases de 21 dias. Na primeira e segunda fase, os animais foram submetidos ao flushing alimentar. Na segunda e terceira fase, avaliamos o desempenho reprodutivo dos animais. Variáveis climáticas, fisiológicas e bioquímicas sanguíneas também foram estudadas. Os resultados indicaram que a inclusão de GB não influenciou significativamente (P > 0,05) no peso corporal das ovelhas nem em seu escore de condição corporal. Todas as ovelhas exibiram estro durante a estação reprodutiva. A frequência respiratória foi significativamente influenciada pela hora do dia (P < 0,0001). Uma suplementação com 10% de GB não alterou drasticamente as variáveis hematológicas e bioquímicas, que estavam dentro do intervalo de referência. No entanto, a semana de suplementação influenciou os metabólitos séricos (P < 0,05). Sendo assim, esses resultados indicam que a GB pode ser utilizada em até 10% na substituição do milho moído, sem afetar significativamente os parâmetros fisiológicos, hematológicos e bioquímicos das ovelhas assim como o desempenho reprodutivo antes e durante a estação de monta.(AU)

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The impact of microplastics on wildlife is a recent problem for which methods to evaluate exposure still need development. Being able to identify and quantify microplastics (particles < 5 mm) in the gastric contents of live crocodiles allows us to evaluate exposure, at both individual and population level, and also its contribution as transporter of other contaminants. The method was validated to determine and quantify microplastics in crocodile stomach contents recovered during an experiment where a known amount of this contaminant was given to crocodiles via oral administration. Through stomach flushing we were able to recover more than 80 % of the total volume of microplastic administrated to each crocodile. In summary, the method used during the experiment consists of 1) immobilization of the crocodile; 2) extraction of microplastics from stomach contents obtained through stomach flushing; 3) separation, identification and quantification of recovered microplastic fragments using microscopy and FTIR. •Low cost method that uses a small number of materials, does not take long to produce results and can easily be performed in the field or the laboratory.•Effective in extracting stomach contents (95 %).•High (>80 %) and good (>60 %) recovery efficiencies within two and four days after ingestion of microplastics by crocodiles.

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This study compared the effects of intravaginal and intravenous routes of oxytocin (OT) administration in 46 oestrous-induced Santa Inês ewes (6-day treatment with progestin-releasing intravaginal sponges and a single injection of 200 IU of eCG at the time of sponge removal) that underwent transcervical embryo recovery 6-7 days after oestrous onset and mating. All ewes received 37.5 µg of d-cloprostenol via latero-vulvar route, and 1 mg of oestradiol benzoate i.m. 16 hr before and 50 IU of OT 20 min before non-surgical embryo recovery (NSER), with OT being administered intravenously (n = 21) or intravaginally (n = 21). An overall oestrous response was 95.6% (44/46), and adequate cervical retraction could be accomplished in 78.6% (33/42) of ewes. The percentage of successful NSER procedures was 57% (24/42) or 72.7% (24/33) of animals with sufficient cervical retraction. The duration of NSER procedure averaged 28 min (range: 17-40 min) and ~96% of flushing fluid could be recovered (range: 85%-100%). Out of 18 ewes that could not undergo NSER, 12 (66.6%) presented various anatomical barriers, whilst the other 33.4% did not present these barriers and still could not be traversed. Excluding the ewes with those anatomical features, the overall success rate of NSER was 80% (24/30). The route of OT administration had no effect on NSER efficiency or the ease with which transcervical embryo flushing was performed. Both routes of OT administration can be used for cervical dilation protocol. Discarding ewes with anatomical features precluding cervical penetration is highly recommended to increase the efficacy of NSER in sheep.

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Diaphorina citri Kuwayama (Hemiptera: Liviidae), named as Asian citrus psyllid (ACP), is the vector of the bacterium associated with huanglongbing (HLB), the most destructive citrus disease. The use of citrus flushing and ACP monitoring tools is essential for the knowledge of the occurrence pattern of cycles of both and for the improvement of the ACP management. During 3 years, 20 branches from 20 trees were evaluated for vegetative flushing, ACP abundance, and occupation in tree and branches in a Brazilian citrus area free for HLB. The obtained data was investigated through spectral and co-spectral analyses. Four to 12 flush shoot cycles occurred per year, which were similar to abundance and occupation cycles of ACP, with an apparent synchronization between these variables. In general, there was a difference from 14 to 19 days between flushing and ACP peaks, with an occurrence of the flushing peaks before the ACP peaks. Results will provide useful information to citrus growers and agricultural defense agencies to apply a suitable and targeted ACP management, which will avoid or delay the disease entrance into still free HLB areas. In addition, the modeling of occupation and abundance cycles of vectors as applied in this study may be useful for other pathosystems which insect vectors are associated or even in the intrusion monitoring programs.

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El rubor facial transitorio se define como una sensación de calor, acompañada de enrojecimiento de la piel, causada por una respuesta vasomotora con el resultante incremento en el flujo sanguíneo regional, debido a la acción directa de diferentes mediadores liberados por los nervios. Los cuadros pueden ser episódicos o constantes y se relacionan con respuestas fisiológicas y con patologías de origen benigno y maligno. El objetivo de la revisión es realizar un abordaje racional de esta condición en el escenario de atención primaria, con el fin de llegar a un diagnóstico precoz y completo, abordando los principales diagnósticos diferenciales asociados con esta condición.

The definición of flushing involves a sensation of heat along with redness of the skin, caused by vasomotor influx resulting in an increased of the regional vascular blood flow due to the direct action of different mediators through the vasomotor nerves. These symptoms can be episodio or repetitive and they' can be related to benign or malignant conditions. The objective of this review is to develope a racional approach of the condition at primary care, with the purpose of an early and complete diagnosis, covering the main differential diagnosis related to this condition.

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BACKGROUND: Frey's syndrome is a group of symptoms that include unilateral sweating with malar region and external ear reddening after eating or drinking some food. It is a lesion of the auriculotemporal nerve that is secondary to surgery, parotid gland infection or facial trauma. CLINICAL CASES: Three children between 4 and two and a half years of age: two girls and one boy. They had self-limiting unilateral erythematous facial macules that reached the external ear, without rash, itching, angioedema and gastrointestinal or respiratory symptoms; its onset was associated with the consumption of acid and some sweet foods. Symptom reproduction of was observed in the path of the auriculotemporal nerve. Their histories included cesarean section delivery owing to cephalopelvic disproportion (case 1), birth by operative vaginal delivery with forceps (case 2) and cesarean delivery owing to preeclampsia (case 3). CONCLUSIONS: Frey's syndrome is often mistaken with food allergy, leading to unnecessary dietary restrictions. Sweating is often absent in children owing to possible eccrine glands immaturity.

Antecedentes: El síndrome Frey es un conjunto de síntomas que incluyen la sudoración unilateral con enrojecimiento de la región malar y pabellón auricular después de comer o beber algún alimento. Se trata de una lesión del nervio auriculotemporal secundaria a cirugía o infección de las glándulas parotídeas o traumatismo facial. Casos clínicos: Tres niños entre cuatro y dos y medio años de edad: dos niñas y un niño. Presentaban máculas eritematosas unilaterales en la cara que llegaban el pabellón auricular de resolución espontánea, sin erupciones, prurito, angioedema, síntomas gastrointestinales ni respiratorios; su aparición estaba asociada con el consumo de alimentos ácidos y algunos dulces. Se observó la reproducción de los síntomas en el recorrido del nervio aurículo-temporal. Entre sus antecedentes se encontraban nacimiento por cesárea debido a desproporción cefalopélvica (caso 1), nacimiento por parto instrumentado con fórceps (caso 2) y nacimiento por cesárea debido a preeclampsia (caso 3). Conclusiones: A menudo el síndrome de Frey suele ser confundido con alergia alimentaria, ocasionando restricciones innecesarias de la dieta. En los niños suele estar ausente la sudoración debido a la posible inmadurez de las glándulas ecrinas.

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Abstract: Harlequin syndrome is a rare condition in which one half of the face fails to flush and sweat due to damage of the sympathetic fibers on the ipsilateral side. The majority of cases are idiopathic, but may be iatrogenic or caused by space-occupying lesions or brainstem infarction. We report a case of idiopathic harlequin syndrome in a 34-year-old man with a 5-month history of unilateral facial flushing and sweating after exercise. Despite the rarity of this syndrome, dermatologists should be aware of this condition in order to diagnose properly and provide multidisciplinary assistance.

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BACKGROUND: Neuroendocrine tumors (NETs) are heterogeneous neoplasms that originate from cells with a secretory function. Small bowel NETs (SB-NETs) are related to serotonin hypersecretion which causes: flushing, diarrhea, abdominal pain, bronchoconstriction and heart involvement, also known as carcinoid syndrome (CS). CS can be confused with an allergic reaction and thus should be considered as a differential diagnosis in the allergy consult. We present the case of a pediatric patient initially referred under the suspicion of food allergies. CASE PRESENTATION: We present the case of a 17-year-old male with evanescent non-pruriginous erythematous lesions- flushing that appeared with food consumption, associated with conjunctival injection, warmth and diaphoresis after the lesions disappeared. He denied abdominal pain, diarrhea, cough or wheezing. The 24-h urinary 5-hydroxyindoleacetic acid (5-HIAA) excretion was elevated. The CT scan showed thickening of the distal ileum and multiple lesions on both hepatic lobules and the colonoscopy revealed a tumor in the ileocecal valve. Hepatic and intestinal biopsies reported a well-differentiated NET of the ileocecal valve with hepatic metastasis. He was started on octreotide and underwent a wide hepatectomy and right hemicolectomy with improvement of symptoms. CONCLUSIONS: NETs can present as carcinoid syndrome (flushing, diarrhea, abdominal pain, wheezing), which constitutes vague symptomatology and represents a challenging diagnosis for physicians. They can be confused with an allergic reaction and the allergist should consider it as a differential diagnosis. Accurate diagnostic tests will help to diagnose NETs earlier and potentially prevent carcinoid heart disease, bowel obstruction, and improve quality of life and mortality in these patients.

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Todos os Santos Bay (BTS) is the 2nd largest bay in Brazil and an important resource for the people of the State of Bahia. We made measurements of radon and radium in selected areas of the bay to evaluate if these tracers could provide estimates of submarine groundwater discharge (SGD) and flushing times of the Paraguaçu Estuary and BTS. We found that there were a few areas along the eastern and northeastern shorelines that displayed relatively high radon and low salinities, indicating possible sites of enhanced SGD. A time-series mooring over a tidal cycle at Marina do Bonfim showed a systematic enrichment of the short-lived radium isotopes 223Ra and 224Ra during the falling tide. Assuming that the elevated radium isotopes were related to SGD and using measured radium activities from a shallow well at the site, we estimated groundwater seepage at about 70 m3/day per unit width of shoreline. Extrapolating to an estimated total shoreline length provided a first approximation of total (fresh + saline) SGD into BTS of 300 m3/s, about 3 times the average river discharge into the bay. Just applying the shoreline lengths from areas identified with high radon and reduced salinity results in a lower SGD estimate of 20 m3/s. Flushing times of the Paraguaçu Estuary were estimated at about 3-4 days based on changing radium isotope ratios from low to high salinities. The flushing time for the entire BTS was also attempted using the same approach and resulted in a surprisingly low value of only 6-8 days. Although physical oceanographic models have proposed flushing times on the order of months, a simple tidal prism calculation provided results in the range of 4-7 days, consistent with the radium approach. Based on these initial results, we recommend a strategy for refining both SGD and flushing time estimates.

Assuntos

RESUMO

PURPOSE: The purpose of this study is to investigate the impact of follicular flushing on the number of oocytes retrieved, oocyte maturity, fertilization rate, embryo development, and pregnancy rate of poor ovarian responders (POR). METHODS: Retrospective study of 524 cycles of 384 patients with POR submitted to assisted reproductive technology (ART) and who had follicular flushing during oocyte retrieval was used in the study. We included patients with <5 oocytes at oocyte retrieval (POR group) and matching the Bologna criteria. RESULTS: POR patients had a mean age of 38.2 ± 4.2 years. A total of 1355 follicles (mean = 3.5 ± 1.6) were aspirated and 1040 oocytes recovered, with 709 (68.2%) obtained by direct aspiration and 331 (31.8%) by follicular flushing. We found a difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 22%. Association was observed between pregnancy rate and the number of oocytes retrieved, the number of MII oocytes, and the number of embryos transferred. The patients matching the Bologna criteria had a mean age of 38.9 ± 3.9 years. A total of 309 follicles were aspirated (mean = 3.1 ± 1.5) and 242 oocytes recovered, with 156 (64.5%) obtained by direct aspiration and 86 (35.5%) by follicular flushing. There was a significant difference between the total number of oocytes and the number of aspirated oocytes. Overall pregnancy rate was 12.1%. There was no association between the pregnancy rate and the number of oocytes retrieved, the number of MII, and the number of embryos. CONCLUSIONS: Follicular flushing might be a suitable alternative to increase the number of oocytes and pregnancy rates in patients with POR.

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