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Resenha do catálogo O Arquivo Vivo de Sérvulo Esmeraldo Sobre a exposição homônima realizada no IAC entre maio e dezembro de 2014. Tendo como curador Ricardo Resende, a mostra apresentou obras do acervo de Sérvulo Esmeraldo, enfatizando sua produção em Paris entre as décadas de 1950 e 1970, exibindo obras guardadas por cerca de 40 anos no ateliê de Júlio Le Parc, em Paris. O catálogo, com texto de apresentação de Raquel Arnaud, comenta a importância e a diferença entre a produção artística de Esmeraldo e as práticas mercantilistas contemporâneas. O projeto gráfico do catálogo indica o processo criativo do artista através de documentação fotográfica detalhada.

In clinical practice, not all patients seem to benefit from treatment with calcium hydroxyapatite, often due to the improper indication of this procedure for patients who may require an associated surgical approach. In this context, our objective was to describe a practical method for evaluating and selecting the ideal patient for a non-surgical approach to abdominal skin laxity, along with presenting clinical cases treated with the combined use of calcium hydroxylapatite (CaHA) and microneedling with radiofrequency.

Introduction: Benzathine benzylpenicillin G is a drug present in the list of essential medicines of the World Health Organization and largely used in Brazil, where this antibiotic is used for treating pneumonias, pharyngitis, syphilis, and other infections caused by Gram-positive bacteria, being one of the most prescribed antibiotics of the public healthcare system. Objective: The objective of this study was to evaluate the relative bioavailability of two formulations of benzathine benzylpenicillin (Benzetacil®) 1,200,000 IU, both manufactured by Eurofarma Laboratórios S/A, by comparison of plasma levels of both drugs administered intramuscularly, evaluating the pharmacokinetic parameters: Cmax and AUC0-t, being t=672 h. Methods: A randomized, parallel, open-label study with one treatment and one period in 168 healthy male volunteers. Subjects received the test or reference formulations by intramuscular injection. A total of 20 blood samples were collected after administration for plasmatic quantification of the drug by LC-MS/MS along 672 h. Results: Both formulations were considered well tolerated, and no serious adverse event was reported during the trial. Cmax and AUC0-t were compared: the rate between test and reference formulations for Cmax was 97.75% with confidence interval (CI) (86.34–110.67%) and power 90.55%. The rate between test and reference formulations for AUC0-t was 91.15% CI (85.29–97.42%) and power of 99.99%. The rate between test and reference formulations for AUC0-inf was 87.98% with CI (81.29–95.23%) and power of 99.85%. Conclusion: Reference and test formulations were shown to be statistically bioequivalents according to their rate and extension of absorption, based on ANVISA criteria.

Background/Objectives: The pediatric definition of severe obesity (OB) depends on the body mass index (BMI) references. We evaluated different BMI-derived metrics of the World Health Organization (WHO) system to define which cut-off is associated with the highest cardiometabolic risk (CMR); Methods: In this multicentric study, data were retrieved for 3727 youths (1937 boys; 2225 children, 1502 adolescents). OB was defined as BMI > 97th percentile (BMI97th), severe OB was defined as BMI > 99th percentile (BMI99th), BMI ≥ 120% of the 97th percentile (120% BMI97th), or BMI Z-score > 3 (WHO tables), or BMI ≥ the International Obesity Task Force (IOTF) value crossing a BMI of 35 kg/m2 at the age of 18 (IOTF35). The continuous CMR Z-score (sum of residual standardized for age and sex of waist-to-height ratio, systolic and diastolic blood pressure, triglycerides, and HDL-cholesterol x −1) and the cluster of at least two CMR factors (hypertension, high triglycerides, low HDL-cholesterol, and high waist-to-height ratio) were calculated. Results: Continuous CMR Z-score was significantly higher both in children or adolescents with severe OB defined by 120% BMI97th compared to BMI99th (p < 0.0001), while it was lower only in adolescents with severe OB defined by 120% BMI97th compared to BMI Z-score >3 (p < 0.0001). Compared to 120% BMI97th, BMI Z-score > 3 and IOTF35 had higher specificity, but lower sensitivity in identifying children and adolescents with clustered CMR factors. Conclusions: The definition of severe OB based on 120% BMI97th is superior to BMI99th but it is inferior to BMI Z score > 3 as far as the association between severe OB and CMR factors is concerned. Pediatricians should take into consideration the implication of the use of different BMI metrics in those countries that recommend the WHO system. WHO BMI Z-score > 3 and IOTF35 can be used interchangeably to predict cardiometabolic risk.

Background: Pediatric obesity treatment is based on high-intensity lifestyle counseling. However, high dropout rates and low effectiveness have been reported, even in specialized centers. Mobile health technologies have been used to overcome these limits with contrasting results. This study aims at evaluating the effectiveness of a six-month intervention with a mobile app for the treatment of pediatric obesity at 6 and 12 months of follow-up. Methods: Seventy-five patients were randomly assigned to standard care or standard care plus mobile app (2:1) using an online randomizer system. The mobile app delivered high-intensity lifestyle counseling for diet and physical activity. Results: At six months of follow-up, the M-App group showed significantly lower dropout rates compared to standard care (p = 0.01). The risk of dropout was significantly higher in controls compared to the intervention group (OR 3.86, 95% C.I. 1.39–10.42, p = 0.01). After one year, we observed lower albeit non-statistically significant dropout rates in the M-App compared to the standard care group (p = 0.24). No differences were observed in z-score BMI and percentage of BMI reduction between the two groups. Conclusions: Our findings suggest that the mobile app might help in the clinical management of children and adolescents with obesity in terms of dropout reduction.

Matheus dos Santos Teodoro,1 David Di Sessa,2 João Henrique da Fonseca Armada Barros,1 Rossana Cantanhede Farias de Vasconcelos,3 Hélio Amante Miot4 1Instituto Corpo e Pele, Belo Horizonte, MG, Brazil; 2Clinica David Di Sessa, São Paulo, SP, Brazil; 3Clinica Nomina, São Paulo, SP, Brazil; 4Departamento de Dermatologia da FMB-Unesp, Botucatu, SP, BrazilCorrespondence: Hélio Amante Miot, Departamento de Dermatologia da FMB-Unesp Rua Magnólia, 400, Jd. Bom Pastor, Botucatu, SP, 18.607-670, Brazil, Tel +55 14 38134727, Email heliomiot@gmail.comBackground: The demand for body procedures is increasing, and buttocks beautification is one of the most sought-after procedures in dermatological and plastic surgery clinics. Several aspects affect the beauty of this area, including sagging, cellulite, contour irregularity, and volume reduction. This makes treatment of the area more challenging. Calcium hydroxylapatite (CaHA), which may be injected into the buttocks, stimulates local neocollagenesis, provides volume replacement, increases the strength and elasticity of the dermis, and thickens the underlying superficial fascia. However, no protocol for buttocks beautification tailors the dilution and deep application of CaHA filler simultaneously according to clinical assessments and personal priorities regarding contour, sagging, and cellulite.Purpose: To report the results of a minimally invasive protocol using different dilutions of CaHA (Buttocks Beautification 3D) in the buttocks with application in different planes. The treatment was performed according to a previous individualized evaluation to improve the area aesthetically.Patients and methods: Six women and one man were submitted to the protocol. An assessment was performed to determine the shape, sagging, cellulite (in women), and patients’ preferences for buttocks beautification. The dilution, volume, depth, and injection technique for CaHA were based on these assessments. The results of the treatment were then assessed using standardized photographs and patient satisfaction.Results: We reported favorable results in six women and one man with different grades of sagging, female cellulite, and shapes of the gluteal region who were treated with CaHA injections according to a tailored protocol. All participants reported high satisfaction with the procedure.Conclusion: Highly satisfactory results were achieved in seven adult patients who were assessed and treated for the buttocks with CaHA using an individualized protocol. Prospective studies should be performed to corroborate our findings and optimize the use of Buttocks Beautification 3D as a reliable modality of treatment for this body area.Keywords: Rejuvenation, biostimulatory treatment, neocollagenesis, calcium hydroxylapatite

Abstract This Position Statement updates the different components of the therapy of obesity (lifestyle intervention, drugs, and surgery) in children and adolescents, previously reported in the consensus position statement on pediatric obesity of the Italian Society of Pediatric Endocrinology and Diabetology and the Italian Society of Pediatrics. Lifestyle intervention is the first step of treatment. In children older than 12 years, pharmacotherapy is the second step, and bariatric surgery is the third one, in selected cases. Novelties are available in the field of the medical treatment of obesity. In particular, new drugs demonstrated their efficacy and safety and have been approved in adolescents. Moreover, several randomized control trials with other drugs are in process and it is likely that some of them will become available in the future. The increase of the portfolio of treatment options for obesity in children and adolescents is promising for a more effective treatment of this disorder.

Acute kidney injury (AKI) presents significant challenges in pediatric care, often remaining underrecognized. This paper provides an overview of pediatric AKI, highlighting its epidemiology, pathophysiology, diagnosis, predisposing conditions, and treatment. AKI in children stems from diverse causes, including renal tubular damage, vasoconstriction, and inflammation. Diagnosis relies on traditional markers such as serum creatinine and urine output, alongside emerging biomarkers such as Cystatin C, NGAL, KIM-1, IL-18, TIMP-2 and IGFBP7, urinary calprotectin, URBP4, L-FABP, and clusterin. Various pediatric conditions predispose to AKI, including type 1 diabetes, pneumonia, bronchiolitis, appendicitis, gastroenteritis, COVID-19, multisystem inflammatory syndrome, sickle cell disease, and malignancies. Treatment entails supportive care with fluid management and, in severe cases, renal replacement therapy. Timely recognition and management are essential to mitigating adverse outcomes. Enhanced awareness and integration of novel biomarkers could improve pediatric AKI care, warranting further research for better diagnosis and management.

Ana Lucia Gonzaga da Cunha,1 Rossana Vasconcelos,2 David Di Sessa,3 Gabriel Sampaio,4 Pitila Ramalhoto,5 Bruno F Zampieri,6 Bárbara S Deus,7 Suyan Vasconcelos,8 Talitha Bellote,9 Juiano Carvalho,10 Giseli Petrone,5 Vinicius Figueredo,11 Gustavo Limongi Moreira3 1Clínica Skinline, Santo André, SP, Brazil; 2Nomina Clinica Médica De Cirurgia Plástica, Dermatologia e Oncologia, São Paulo, SP, Brazil; 3DSL Clínica Médica, São Paulo, SP, Brazil; 4Host Clínica, São Paulo, SP, Brazil; 5Private Clinic, Rio de Janeiro, RJ, Brazil; 6Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil; 7Clinica Avatié, São Paulo, SP, Brazil; 8Clinica Splendore, Aracaju, SE, Brazil; 9Instituto La Beautè, Curitiba, PR, Brazil; 10Private Clinic, São Paulo, SP, Brazil; 11Host Clinica, São Paulo, SP, BrazilCorrespondence: Gustavo Limongi Moreira, DSL Clínica Médica, Rua Pamplona 145 / 1717, Jardim Paulista, Sao Paulo, SP, 01405-900, Brazil, Email drgustavolimongi@gmail.comBackground: There is substantial interpersonal variation in the patterns of muscular contraction that substantiates the use of personalized points of application and dosages in clinical practice to achieve optimal results. Nevertheless, there has been no real-life therapeutic series with botulinum toxin for aesthetic treatment of the face in which the subjects were systematically followed to assess its long-term benefit.Purpose: To assess the performance and length of the treatment of glabellar and forehead lines with IncobotulinumtoxinA in a real-life setting.Patients and Methods: We enrolled 20 adults with indications for the treatment of upper facial dynamic lines (glabella and forehead) with botulinum toxin. The protocols of injection points were personalized by the injectors. The participants were photographed under maximum facial contraction before the application (D0) and after 15, 90, 120, and 180 days. The photos were randomly assessed by two blinded experienced raters to consensually grade the dynamic lines according to the Merz Aesthetics Scales (MAS). Efficacy was defined as the reduction in the MAS score.Results: At D15, 18 (90%; 95% CI: 80%– 100%) participants reached the zero score, or a 2-point reduction on the MAS score from the forehead and 16 (80%; 95% CI: 65– 90%) reached that reduction for the glabella. These values from D90 were 14 (70%; 95% CI: 55– 85%) for both sites. At D120, these values were 11 (55%; 95% CI: 35– 75%) and 8 (40%; 95% CI: 25– 55%) for the forehead and glabella. At D180, 10 (50%; 95% CI: 30– 70%) participants presented a MAS score for forehead or glabella dynamic lines lower than the score assessed at D0.Conclusion: As much as 70% of the patients sustained a reduction of scores after 120 days of the treatment for dynamic glabellar and forehead lines. Half of the patients evidenced prolonged benefit at 180 days.Keywords: incobotulinumtoxinA, botulinum toxin, injection technique, ONE21, dynamic wrinkles, upper face, Xeomin

Introduction: Magnetic resonance imaging (MRI) T2* technique is used to assess iron overload in the heart, liver and pancreas of thalassaemic patients. Optimal iron chelation and expected tissue iron response rates remain under investigation. The objective of this study was to analyse serum ferritin and the iron concentration in the heart, liver and pancreas measured by MRI T2*/R2* during regular chelation therapy in a real-world cohort of patients with thalassemia. Methods: We evaluated thalassaemic patients ≥ 7 years old undergoing chelation/transfusion therapy by MRI and assessed serum ferritin at baseline and follow-up from 2004-2011. Results: We evaluated 136 patients, 92% major thalassaemic, with a median age of 18 years, and median baseline ferritin 2.033ng/ml (range: 59–14,123). Iron overload distribution was: liver (99%), pancreas (74%) and heart (36%). After a median of 1.2 years of follow-up, the iron overload in the myocardium reduced from 2,63 Fe mg/g to 2,05 (p 0.003). The optimal R2* pancreas cut-off was 148 Hertz, achieving 78% sensitivity and 73% specificity. However, when combining the R2* pancreas cut off ≤ 50 Hertz and a ferritin ≤ 1222 ng/ml, we could reach a negative predictive value (NPV) of 98% for cardiac siderosis. Only 28% were undergoing combined chelation at baseline assessment, which increased up to 50% on follow up evaluation. Conclusions: Chelation therapy significantly reduced cardiac siderosis in thalassaemic patients. In patients with moderate/severe liver iron concentration undergoing chelation therapy, ferritin levels and myocardium iron improved earlier than the liver siderosis.

Aim: To assess the prevalence and determinants of failure to thrive (FTT) among patients with vesico‐ureteral reflux (VUR) and evaluating the effects of supplementation on growth in patients with urinary solute losses. Methods: We retrospectively enrolled 1277 patients with VUR (mean age at diagnosis = 6.5 months). Patients with FTT were screened for renal tubular function impairment (TFI). If fractional excretion of sodium (FENa) >2% or blood bicarbonate <20 mmol/L, supplementation was provided. Results: Among 1277 patients, 56 (4.4%) had FTT. Of these, 42 (75%) presented extrarenal causes of FTT, 3 (5.4%) had chronic kidney disease (CKD), 9 (16.1%) had TFI, and 2 (3.5%) had CKD and TFI. FTT occurred in 8/208 patients (3.8%) with and in 48/1069 patients (4.5%) without (p = 0.68) recurrent urinary tract infections (UTIs). At multiple logistic regression, birthweight <10th percentile, preterm birth, TFI, identified or suspected syndromes and other diseases were predictors of FTT. Eleven (19.6%) patients with FTT had TFI; five with increased FENa and/or acidosis received supplementation and showed catch‐up growth. The remaining six patients exhibited spontaneous catch‐up growth. Conclusion: FTT was found in <5% of children with VUR. It was not determined by recurrent UTIs and was mainly associated with extrarenal causes. Supplementation with sodium and bicarbonates could be useful in selected cases. [ABSTRACT FROM AUTHOR]

The role of obesity as a risk factor for chronic kidney disease (CKD) in adulthood has been well established. Over the last years, kidney damage (KD) has emerged as a significant consequence of obesity since childhood. Indeed, a complex interplay of metabolic factors, including insulin resistance (IR), hypertension, oxidative stress, adipose tissue dysfunction, and systemic inflammation, might affect renal hemodynamics, contributing to CKD development over time in at-risk young patients. As the prevalence of pediatric obesity continues to rise globally, understanding the implications for kidney health in terms of early intervention is of paramount importance. Careful monitoring of kidney function within a multidisciplinary approach in children with obesity is crucial for detecting early KD, allowing for timely lifestyle modifications and treatment. In this framework, continued research is essential to further elucidate mechanisms linking obesity and KD and to explore not only effective preventive strategies but also the long-term impact of obesity on kidney health in children with obesity. Given the intimate link of KD with the metabolic milieu in children with obesity, we aimed to provide a comprehensive and insightful overview on KD and its implications in pediatric obesity by reviewing the most recent literature in the field. [ABSTRACT FROM AUTHOR]

We tested whether oxidized linoleic acid metabolites (OXLAM) are associated with pediatric metabolic syndrome (MetS) and a proatherogenic lipoprotein profile in 122 obese adolescents. Furthermore, we examined whether genetic and metagenomic factors can modulate plasma OXLAM concentrations by genotyping the fatty acid desaturase 1/2 (FADS) gene and by characterizing the gut microbiota. Subjects with MetS (n = 50) showed higher concentrations of 9- and 13-oxo-octadecadienoic acid (9- and 13-oxo-ODE) than subjects without MetS (n = 72). Both metabolites were associated with an adverse lipoprotein profile that was characterized by elevated very small-dense low-density lipoprotein (p

BackgroundThyroid hormones (TH) play multiple effects on glucose metabolism. Some recent studies carried out in adult patients suggested an association between altered sensitivity to TH and type 2 diabetes, obesity, and metabolic syndrome. No studies are currently available on the presence of altered sensitivity to the action of TH in youths with prediabetes.ObjectiveTo evaluate the relationship between sensitivity to TH and impaired glucose tolerance (IGT), impaired fasting glucose (IFG), or glycosylated hemoglobin (HbA1c) ≥ 5.7% in youths with overweight/obesity (OW/OB).Materials and methodsThis cross-sectional study included 805 Caucasian youths with OW or OB (aged 6-18 years) recruited at seven Italian centers for the care of OW/OB. Individuals with TH out of the normal range of TH in each center were excluded. The fT3/fT4 ratio was evaluated to assess peripheral sensitivity, while TSH index (TSHI), Thyrotroph T4 Resistance Index (TT4RI), Thyroid Feedback Quantile-based Index (TFQI) and Parametric TFQI were calculated to assess central sensitivity.ResultsYouths with IGT (n =72) showed higher levels of TSH (3.08 ± 0.98 vs 2.68 ± 0.98 mIU/L, P =0.001), TSHI (3.06 ± 0.51 vs 2.85 ± 0.53, P =0.001), TT4RI (46.00 ± 17.87 vs 38.65 ± 16.27, P

Foreign body aspiration is common in the pediatric age group, especially in males. Despite the high frequency of this potentially life-threatening event, it is not always easy to recognize it given the high variability of the clinical presentation and the potential of “pauci-symptomatic” inhalation. Moreover, a variable latency of the onset of symptoms since the moment of aspiration may be possible determining difficulties in the identification of the inhalation on an anamnestic basis. We describe the case of a 19-month-old boy who accessed the emergency room initially for a head trauma. The clinical evaluation, however, revealed an unexplained serious respiratory distress needing tracheal intubation. After our evaluation, we hypothesized that the severe respiratory distress determined an altered state of consciousness with following head trauma. The radiological findings raised the suspicion of foreign body aspiration for the presence of an atelectasis of the entire left lung. The computed tomography showed an abrupt interruption of the main bronchus at 12 mm from the hull. The following bronchoscopy identified an almond of 2 cm. We will review the literature to underline the diagnostic issues behind foreign body aspiration in children by highlighting the diagnostic clues that are helpful for emergency clinicians in the management of this condition.