Search

Drawing from Elizabeth Grosz’s notion of the body as a socio-cultural artefact and the exterior of the subject bodies as psychically constructed, and Rosi Braidotti’s concept of nomadic identities, in this article I introduce world-renowned Indian painter MF Husain’s verbal and visual autobiography Em. Ef. Husen kī kahānī apnī zubānī as a series of sketches of a performative self, surfing the world in space and time. Bodies and spaces are envisioned as “assemblages or collections of parts” in constant movement, crossing borders and creating relationships with other selves and other spaces. People and places become a catalyst for manifestations of the self in art – MF Husain being foremost a painter – and eventually also in literature. I look for strategies that MF Husain uses in order to construct or deconstruct the self through crossings and linkages. I try to investigate how the self is performed inside and outside private and public spaces, how the complex (sometimes even contradictory) relationship between self and community is portrayed, and how this autobiography does articulate notions of (imagined) community/ies, nationalism, transnational subjectivity, nostalgia.

Abstract Background Although a satisfactory disease control is nowadays achievable in most patients with JIA, a substantial proportion of them still do not respond adequately or reach long-term drug-free remission. According to current recommendations, treatment should be escalated in subsequent steps. A different approach is based on the assumption that the initial start of an aggressive therapy may take advantage of the “window of opportunity” and could alter the biology of the disease, leading to an improvement of long-term outcomes, including the prevention of cumulative joint damage. Objectives This randomised clinical trial aims to compare the effectiveness of a conventional therapeutic regimen, based on treatment escalation and driven by the treat-to-target approach, with that of an early aggressive intervention based on the initial start of a combination of conventional and biological DMARDs. Methods JIA patients with oligoarthritis or RF negative polyarthritis aged more than 2 years and with less than 4 months of disease course will be included in the study. Children will be randomised into two arms: patients in Step-up arm with less severe oligoarthritis will undergo an intra-articular corticosteroid injection (IACI) in all affected joints; patients with polyarthritis or severe oligoarthritis will receive IACI and methotrexate. Subsequent treatment will follow a standardised protocol based on the patients’ level of disease activity measured with the JADAS, according to a treat-to-target strategy. Patients in Step-down arm will receive a 6-month early combined treatment (methotrexate plus IACI for less severe oligoarthritis, methotrexate plus etanercept for severe oligoarthritis and polyarthritis). The primary endpoint is the frequency of achievement of the status of clinical remission (i.e. persistence of inactive disease for at least 6 months) at the 12-month visit. Safety events, physician-centred measures and parent/patient-reported outcomes will be collected through the Paediatric Rheumatology International Trials Organisation on line database. Expected results The STARS trial aims to provide important evidence supporting the first-line treatment choices in the care of children with oligoarticular and polyarticular JIA. If the superiority of an early aggressive therapy will be demonstrated, this will demand further studies on the biological definition of the window of opportunity for JIA. Trial registration The Trial is registered on the ClinicalTrials.gov registry (NCT03728478) on the 31st October 2018 and EU Clinical Trials Register on the 14th May 2018 (EudraCT Number: 2018–001931-27).

Abstract Immunity with SARS-CoV-2 infection during the acute phase is not sufficiently well understood to differentiate mild from severe cases and identify prognostic markers. We evaluated the immune response profile using a total of 71 biomarkers in sera from patients with SARS-CoV-2 infection, confirmed by RT-PCR and controls. We correlated biological marker levels with negative control (C) asymptomatic (A), nonhospitalized (mild cases-M), and hospitalized (severe cases-S) groups. Among angiogenesis markers, we identified biomarkers that were more frequently elevated in severe cases when compared to the other groups (C, A, and M). Among cardiovascular diseases, there were biomarkers with differences between the groups, with D-dimer, GDF-15, and sICAM-1 higher in the S group. The levels of the biomarkers Myoglobin and P-Selectin were lower among patients in group M compared to those in groups S and A. Important differences in cytokines and chemokines according to the clinical course were identified. Severe cases presented altered levels when compared to group C. This study helps to characterize biological markers related to angiogenesis, growth factors, heart disease, and cytokine/chemokine production in individuals infected with SARS-CoV-2, offering prognostic signatures and a basis for understanding the biological factors in disease severity.

ABSTRACT Introduction: The dental pulp is completely normal in teeth with periapical cemento-osseous dysplasia. However, orthodontic and endodontic treatments are contraindicated in cases with this injury. Objective: Present some biological, clinical and imaging reasons opposing these contraindications and questioning which are the real ones impediments and the reasons for the lack of research on the disease, analyzing cases submitted to orthopedic treatment under controlled and ethically approved conditions. Conclusion: The clinician can act safely based in available knowledge and aware of the possible consequences of orthodontic movement in teeth with periapical cemento-osseous dysplasia, as well as in the proper way of making a safe and definitive diagnosis.

ABSTRACT Justification: Canines represent corners in the dental arch, and are important features in facial esthetics, as they support the upper lip, wing of the nose, and influence the nasolabial fold and the appearance of facial aging. In the laterality movements, the canines guidance coordinate the opening and closing of the teeth, saving the TMJ from sudden movements. Discussion: As a result of the lack of eruption or the inadequate positioning of the maxillary canine, the loss of the laterality guide may occur, which will then occur in the maxillary lateral incisor, inducing lesions of “occlusal trauma”, such as inflammatory root resorption. Likewise, without well positioned canines, there may be premature aging and change in facial esthetics. Conclusion: In order to avoid problems with eruption and positioning of the maxillary canines, early diagnosis is made by analyzing their position and their relationship with the other teeth, and in the three-dimensional context of the maxilla, between 8-10 years of age. Preventive measures can create bone space and direction so that the maxillary canines can occupy their position in the dental arch.

ObjectiveCervical cancer is one of the deadliest cancers among women in Latin America and Caribbean (LAC), where most of the countries have not been successful in implementing population-level cytology-based screening programs. An increasing body of evidence supports the validity of self-sampling as an alternative to clinician collection for primary Human papillomavirus (HPV) screening. Therefore, this work aims to summarize recent HPV self-sampling approaches in LAC.MethodWe performed a systematic review to identify studies focused on “Self-sampling”, and “Human Papillomavirus DNA test” and “Latin America” in PubMed, Embase, Web of Science, Cochrane library and SCOPUS databases for publications dating between 01 January 2017 and 15 March 2022 based on the Preferred Reporting Items for systematic reviews and meta-analysis (PRISMA) statement. Additionally, the references of the articles were carefully reviewed.ResultsOf the 97 records selected, 20 studies including 163,787 participants, with sample sizes for individual studies ranging from 24 to 147,590 were included in this review. Studies were conducted in 10 LAC countries (18.5%), most with upper medium-income economies (70%). The range of age was 18 to ≥65 years. The vast majority of the studies (85%) addressed the HPV self-sampling strategy for primary cervical cancer screening with overall success for all women including under/never screened and those from special populations (rural, indigenous and gender minorities). Women generally found HPV self-sampling highly acceptable regardless of age, setting of collection, target population or country of residence.ConclusionsHPV self-sampling is a promising strategy to overcome the multiple barriers to cervical cancer screening in LAC settings and increasing attendance in underscreened women in countries/territories with well-established screening programs. Furthermore, this strategy is useful even in LAC countries/territories without organized cervical cancer screening and in special populations such as indigenous, rural and transgender women. Therefore, the information generated by the recent initiatives for HPV self-sampling approach in LAC can be beneficial for decision-making in both new and existing programs in the region.

ABSTRACT Endodontically treated teeth may be moved, as endodontic treatment is not a contraindication for orthodontic treatment. Apical periodontal repair begins when the periapical or pulp lesion has completely resolved. This may happen immediately after treatment if the filling material causes little or no irritation of periapical tissues, and particularly if the material is fully contained within the canal. When it leaks, a foreign body granuloma forms and persists for some months or indefinitely, depending on the composition of the filling material. Materials containing calcium hydroxide with no resin components undergo phagocytosis and disappear in some months, as macrophages gradually remove them. Materials containing resins, silicone, ionomers, zinc oxide-eugenol, bioceramics or gutta-percha remain in the site and induce the formation of foreign body granulomas. Although this does not preclude tooth movement, patients should be followed up every three months using periapical images to control the position of the material in relation to the tooth apex. “Pseudo” overfilling may be avoided if permanent filling is delayed until the time when orthodontic treatment is completed.

ABSTRACT The atrophy of the periodontal ligament places the tooth very close to the bone or another tooth, as occurs in unerupted teeth. The absent interdental bone and the lack of functional periodontal stimulus may lead to the fusion of the appositional layers of cement between the roots of the teeth. Concrescence almost always occurs in the region of the maxillary molars. Asymptomatic, it should always be remembered when the proper response to orthodontic movement is not obtained, and there is no apparent explanation. When surgically extracting a tooth and there is resistance, insisting will not be the best strategy. Moving the teeth with concrescence is not convenient, as it requires very intense forces. Once separated, these teeth can be considered normal for movement. It is possible to separate two teeth presenting concrescence, but it depends on the extension of the area, the surgical access and, especially, the clinical convenience. The tooth to be extracted will be repaired with new cement deposited in the sectioned area. The simple separation with the maintenance of the proximity and the lack of function of one of the teeth will cause a new concrescence. After a period of 1 to 3 months, the separated teeth are biologically prepared to be moved. The most important detail in this separation of teeth presenting concrescence is that the diagnosis should be made in advance, and not at the time of the intervention.

ABSTRACT Introduction: Assessment of two radiographic images reveals two distinct, extreme situations of physiological tooth resorption, characteristic of primary teeth with or without permanent successor, due to partial anodontia. Discussion: In all primary teeth, rhizolysis begins after the completion of formation, thanks to the apoptosis of their cells. When apoptosis induced by cementoblasts has denuded the root of these cells, the process of rhizolysis inevitably begins: This will be accelerated by mediators arising from the pericoronal follicle. When there is no permanent successor due to partial anodontia, rhizolysis occurs extremely slowly, and months later, without the epithelial rests of Malassez that were dead due to apoptosis, alveolodental ankylosis becomes established, and the tooth will gradually be replaced by bone, still within a physiological context. Conclusion: Rhizolysis and physiological tooth resorption may occur rapidly or slowly, early or late, and this depends on the presence of the permanent tooth, or its absence due to partial anodontia.

ABSTRACT Introduction: Induced tooth-bone movement occurs by a synchronicity of dental and bone phenomena, thanks to the osteocytic network, which is a three-dimensional network that controls the bone shape or design. Objective: To describe the tooth-bone movement induced by enhanced anchorage, divided into three distinct moments: zero, start and stop. Question: From this description, the main question arises: with the use of mini-implants/miniplates, what changes in the biology of induced tooth-bone movement? The answer is: nothing changes, either biologically or microscopically. Conclusion: This technique optimizes the treatment time, and the range of therapeutic possibilities is broadened, thanks to the synchronicity of phenomena - which remain the same, in all teeth and bones, yet in a synchronized manner. Bone anchorage represents synchronicity in induced tooth-bone movement.

Abstract Background There is mounting evidence on the existence of a Pediatric Inflammatory Multisystem Syndrome-temporally associated to SARS-CoV-2 infection (PIMS-TS), sharing similarities with Kawasaki Disease (KD). The main outcome of the study were to better characterize the clinical features and the treatment response of PIMS-TS and to explore its relationship with KD determining whether KD and PIMS are two distinct entities. Methods The Rheumatology Study Group of the Italian Pediatric Society launched a survey to enroll patients diagnosed with KD (Kawasaki Disease Group – KDG) or KD-like (Kawacovid Group - KCG) disease between February 1st 2020, and May 31st 2020. Demographic, clinical, laboratory data, treatment information, and patients’ outcome were collected in an online anonymized database (RedCAP®). Relationship between clinical presentation and SARS-CoV-2 infection was also taken into account. Moreover, clinical characteristics of KDG during SARS-CoV-2 epidemic (KDG-CoV2) were compared to Kawasaki Disease patients (KDG-Historical) seen in three different Italian tertiary pediatric hospitals (Institute for Maternal and Child Health, IRCCS “Burlo Garofolo”, Trieste; AOU Meyer, Florence; IRCCS Istituto Giannina Gaslini, Genoa) from January 1st 2000 to December 31st 2019. Chi square test or exact Fisher test and non-parametric Wilcoxon Mann-Whitney test were used to study differences between two groups. Results One-hundred-forty-nine cases were enrolled, (96 KDG and 53 KCG). KCG children were significantly older and presented more frequently from gastrointestinal and respiratory involvement. Cardiac involvement was more common in KCG, with 60,4% of patients with myocarditis. 37,8% of patients among KCG presented hypotension/non-cardiogenic shock. Coronary artery abnormalities (CAA) were more common in the KDG. The risk of ICU admission were higher in KCG. Lymphopenia, higher CRP levels, elevated ferritin and troponin-T characterized KCG. KDG received more frequently immunoglobulins (IVIG) and acetylsalicylic acid (ASA) (81,3% vs 66%; p = 0.04 and 71,9% vs 43,4%; p = 0.001 respectively) as KCG more often received glucocorticoids (56,6% vs 14,6%; p

ABSTRACT Introduction: Teeth frequently fail to erupt and situations arise that prevent the canines from reaching the occlusal plane. Objective: Discourse about the three situations in which the canine does not reach the occlusal plane, and remains unerupted; and at the same time, point how to make a safe diagnosis of alveolodental ankylosis - one of the three causes -, based on tomography. Conclusions: Ankylosis occurs in impacted teeth by atrophy of the periodontal ligament, including the epithelial rests of Malassez. The tomographic signs of alveolodental ankylosis in unerupted canines are the interruption of hypodense periodontal space, discontinuity of the lamina dura and its continuity with the root surface, which gradually loses its regular shape.

Background and AimWhile considerable success has been achieved in the management of patients hospitalized with severe coronavirus disease 2019 (COVID-19), far less progress has been made with early outpatient treatment. We assessed whether the implementation of a home treatment algorithm—designed based on a pathophysiologic and pharmacologic rationale—and including non-steroidal anti-inflammatory drugs, especially relatively selective cyclooxygenase-2 inhibitors and, when needed, corticosteroids, anticoagulants, oxygen therapy and antibiotics—at the very onset of mild COVID-19 symptoms could effectively reduce hospital admissions.MethodsThis fully academic, matched-cohort study evaluated outcomes in 108 consecutive consenting patients with mild COVID-19, managed at home by their family doctors between January 2021 and May 2021, according to the proposed treatment algorithm and in 108 age-, sex-, and comorbidities-matched patients on other therapeutic schedules (ClinicalTrials.gov: NCT04854824). The primary outcome was COVID-19-related hospitalization. Analyses were by intention-to-treat.ResultsOne (0.9%) patient in the “recommended” cohort and 12 (11.1%) in the “control” cohort were admitted to hospital (P = 0.0136). The proposed algorithm reduced the cumulative length of hospital stays by 85% (from 141 to 19 days) as well as related costs (from €60.316 to €9.058). Only 9.8 patients needed to be treated with the recommended algorithm to prevent one hospitalization event. The rate of resolution of major symptoms was numerically—but not significantly—higher in the “recommended” than in the “control” cohort (97.2 vs. 93.5%, respectively; P = 0.322). Other symptoms lingered in a smaller proportion of patients in the “recommended” than in the “control” cohort (20.4 vs. 63.9%, respectively; P < 0.001), and for a shorter period.ConclusionThe adoption of the proposed outpatient treatment algorithm during the early, mild phase of COVID-19 reduced the incidence of subsequent hospitalization and related costs.

ABSTRACT Introduction: When miniplates are used as anchoring for orthodontic mechanics for anterior open bite correction by retraction of anterior teeth and posterior teeth intrusion and retraction, orthodontically induced inflammatory external apical root resorption is clinically negligible. Methods: A homogeneous sample of 32 patients was used, and the roots of the teeth were compared on CT scans performed before and after orthodontic treatment. Results: The observed root resorption was minimal, and this can be explained by the uniform distribution of forces in several teeth, simultaneously, in the set of the dental arch and in the bone that supports the teeth. Conclusion: The most important thing to prevent root resorption in orthodontic practice, besides being concerned with the intensity of the applied forces, is to be careful with its distribution along the roots of each tooth, in the dental arch and in the bone that supports the teeth.

Abstract Background Despite the demonstrated role of human Papillomavirus (HPV) in the etiology of cervical cancer and the strong evidence suggesting the importance of HPV in the development of oropharyngeal cancer, several aspects of the interrelationship between HPV infection in both body sites remain unknown, specifically in female human immunodeficiency virus (HIV)-positive (HIV+) patients. We aimed to assess the prevalence, distribution, and concordance of cervical and oral HPV in HIV+ women and matched HIV-negative (HIV-) controls in Brazil. Material and methods Cervical and endocervical samples for cytological screening and HPV detection and oral samples were collected from 115 HIV+ women using highly active antiretroviral therapy (HAART) and 139 HIV-matched controls (HIV-) in Maringá City, Brazil. Risk factors were assessed using a standardized questionnaire, and the data regarding HIV infection were obtained from the patients’ medical records. HPV detection and typing were performed using the Kit Multiplex XGEN Multi HPV Chip HS12. Results HIV infection was well controlled in this cohort, but women who exhibited detectable HIV loads were significantly associated with HPV-positive status overall (P = 0.03) and in cervical mucosa (P = 0.01). HIV+ women had significantly more abnormal cytological findings (P = 0.04) than HIV- women. Of the 115 HIV+ women, 48.7% were positive for cervical and/or oral HPV DNA; of the 139 HIV- women, 41% were positive for cervical and/or oral HPV (P = 0.25). Both HIV+ and HIV- women had a statistically higher prevalence of cervical HPV infection than oral infection. The concurrent HPV infection in two anatomical sites was similar in HIV+ and HIV- women; however, HPV type concordance was not observed. HPV type distribution was different between the anatomical sites in both groups, and HIV+ women presented less common types, mainly in oral mucosa. Conclusion Our data support the importance of testing HPV infection in HIV+ women, even when the HIV infection is well controlled. Prospective studies are required to better understand the natural history of HPV infection in both anatomical sites, specifically in HIV+ women.

ABSTRACT The starting point for the treatment of unerupted teeth should consider the fact that, biologically, the pericoronal follicle maintains the ability to release EGF and other mediators responsible for eruption over time. The eruptive events may be guided and directed, so that teeth may occupy the space prepared to receive them in the dental arch, as showed in the case presented to evidence the following principle to be considered in these cases: “Regardless of the position of an unerupted tooth, it may be biologically directed to its place in the dental arch. The orthodontist should apply a mechanics to guide it and park it at its site.”

ABSTRACT The replacement of natural teeth that have extreme external apical root resorption, induced by orthodontic treatment, with osseointegrated implants is not justifiable biologically or clinically. These teeth should be preserved and keep their normal functions, as there is no greater mobility, pain or color change. They may undergo usual procedures, such as bleaching, restorations with veneers and other esthetic procedures that may be necessary along life. The pulp of these teeth is normal. If mobility of a tooth with extreme resorption is identified, the cause of mobility should be investigated, as it is not associated with resorption, not even at advanced stages. Tooth mobility may be associated with recent removal of orthodontic appliance, occlusal trauma, chronic inflammatory periodontal disease, or even severe cervical bone loss. In such cases, the cause of mobility should be eliminated and possible sequelae should be corrected, because these, and not root resorption, may actually require retention.

SARS-CoV-2 antibodies in saliva serve as first line of defense against the virus. They are present in the mucosa, more precisely in saliva, after a recovered infection and also following vaccination. We report here the antibody persistence in plasma and in saliva up to 15 months after mild COVID-19. The IgG antibody response was measured every two months in 72 participants using an established and validated in-house ELISA assay. In addition, the virus inhibitory activity of plasma antibodies was assessed in a surrogate virus neutralization test before and after vaccination. SARS-CoV-2-specific antibody concentrations remained stable in plasma and saliva and the response was strongly boosted after one dose COVID-19 vaccination.

In this observational study, we report the clinical, therapeutics and outcome features of 23 patients with multisystem inflammatory syndrome (MIS-C) who have been treated in Gaslini Children Hospital (Genoa, Italy) with a multistep antinflammatory treatment protocol, based on disease severity at admission. Patients were initially assigned to four severity classes on admission and treated accordingly. The therapeutic options ranged from IV immunoglobulin alone to a combination of IVIG plus pulses of methylprednisolone plus anakinra for patients with marked cardiac function impairment or signs of macrophage activation syndrome, with rapid treatment escalation in case of inadequate therapeutic response. With the application of this therapeutic strategy, no patient required admission to Intensive Care Unit (ICU) or invasive mechanical ventilation, and no inotropic drugs administration was required. Early aggressive treatment of MIS-C, with therapeutic interventions modulated based on the severity of clinical manifestations may help to prevent the progression of the inflammatory process and to avoid the need of admission to the ICU. A timely intervention with anti-IL-1 blockers can play a pivotal role in very severe patients that are at risk to have an incomplete response to immunoglobulins and steroids.

ABSTRACT Objective: Biologically explain some of the bone mechanisms involved in the intrusion, or intrusive effect, of teeth submitted to skeletal open bite correction using four miniplates. Methods: The results of dental intrusion were measured and compared in 3D reconstructions of cone beam computed tomography scans taken before and after treatment of 20 patients with skeletal open bite, aged between 18 and 59 years. Results: The results allow deducing that the compression and traction forces biologically promoted deformation or deflection of the osteocyte network that controls bone design, and these effects involved the external and internal surfaces of the bone, with the formation of new layers, including the cervical portion of the alveolar bone crest. This helps understanding how dental intrusion occurs in intrusive mechanics, whose forces are of inclination rather than intrusion. The root resorptions caused by the use of miniplates were insignificant, due to the more homogeneous distribution of forces in the several teeth simultaneously involved. Conclusion: Imaging studies in CT scans tend to capture in details the subperiosteal and endosteal phenomena of dental intrusion - before and after the application of intrusive mechanics -, in the form of a set of modifications called dental intrusion or intrusive effect .

This article deals with some issues regarding masculinity in contemporary India, focusing on popular culture, the clothing semiotics, and the media discourse on masculinity, referred to Prime Minister Narendra Modi, leader of the Hindu nationalist party Bharatiya Janata Party (BJP). Modi has manipulated many figures from the nationalist past in order to build an image of himself as “the real man,” reaffirming the mandate of masculinity in order to lead the nation into the new millennium.

ABSTRACT Introduction: Supernumerary teeth in cases of cleft lip and palate do not result from the division of normal germs before the formation of hard tissue. Deciduous and permanent teeth odontogenesis begins after the face has formed, either with or without the cleft. Discussion: The most acceptable hypothesis to enable understanding of the presence of supernumerary teeth on one or both sides of the cleft palate is hyperactivity of the dental lamina in its walls. This hyperactivity, with the formation of more tooth germs, must be attributed to mediators and genes related to tooth formation, under strong influence of local epigenetic factors, whose developmental environment was affected by the presence of the cleft. Conclusion: The current concepts of embryology no longer support the fusion of embryonic processes for the formation of the face, but rather the leveling of the grooves between them. All human teeth have a dual embryonic origin, as they are composed of ectoderm and mesenchyme/ectomesenchyme, but this does not make it easy for them to be duplicated to form supernumerary teeth.

Background: Effective home treatment algorithms implemented based on a pathophysiologic and pharmacologic rationale to accelerate recovery and prevent hospitalisation of patients with early coronavirus disease 2019 (COVID-19) would have major implications for patients and health system. Methods: This academic, matched-cohort study compared outcomes of 90 consecutive consenting patients with mild COVID-19 treated at home by their family physicians between October 2020 and January 2021 in Northern and Central Italy, according to the proposed recommendation algorithm, with outcomes for 90 age-, sex-, and comorbidities-matched patients who received other therapeutic regimens. Primary outcome was time to resolution of major symptoms. Secondary outcomes included prevention of hospitalisation. Analyses were by intention-to-treat. Findings: All patients achieved complete remission. The median [IQR] time to resolution of major symptoms was 18 [14–23] days in the ‘recommended schedule' cohort and 14 [7–30] days in the matched ‘control’ cohort (p = 0·033). Other symptoms persisted in a lower percentage of patients in the ‘recommended’ than in the ‘control’ cohort (23·3% versus 73·3%, respectively, p90%. Interpretation: Implementation of an early home treatment algorithm failed to accelerate recovery from major symptoms of COVID-19, but reduced the risk of hospitalisation and related treatment costs. Given the study design, additional research would be required to consolidate the proposed treatment recommendations. Funding: Fondazione Cav.Lav. Carlo Pesenti

Hijṛā communities from South Asia are often taken as an example of social acknowledgment of transgender in a ‘traditional’ context. Nevertheless, this exoticizing representation erases all distinctions among hijṛā, kinnar, koṭhī, third gender persons, transmen and transwomen, and other individuals whose gender identity does not conform to the man/woman binary. In this article, I will introduce the debate about identity construction of people that complicate the binary gender identity, within the framework of citizenship claims and homonationalism.

One of the most intriguing and mysterious phenomena observed during the COVID-19 pandemic has been represented by the occurrence of the multisystem inflammatory syndrome in children and adolescents (MIS-C). Patients with this condition have some overlapping signs and symptoms with those of Kawasaki disease (KD), but also display clinical features that are uncommon or less frequent in this illness, such as diarrhea, abdominal pain and myocardial involvement. The sickest patients may develop multiorgan failure and shock, usually due to myocarditis. Management is based on the administration of intravenous immunoglobulin, glucocorticoids and, in the most severe instances, anakinra. It is still debated whether MIS-C and KD represent different illnesses or are part of the same disease spectrum. The aim of the present review is to analyze critically the evidence in favor of the latter hypothesis and to provide the authors' personal interpretation of the relationship between the two conditions.

With this article we tried to focus our reading upon the poems that compose Chilean writer Tomás Harris’ La vida a veces toma la forma de los muros (a section included in his 1992 work Cipango). After considering the texts depending on their order of appearance, we intended to identify those changes experienced by the image of the wall and its relation with the lyrical subjects. Actually, the evident relevance of the wall affects not only the work themes, but also the verbal form itslef. This proceeding approached us to a variety of impressions that could promote an existential perspective of wide reach, in addition to agreeing with other critical contributions. Thanks to the support of the thinking of authors like Deleuze, Guattari, and Sartre, among others, we realised that, starting from the wall element, a series of manifestations happens by questioning the notion of human perception and consciousness.

Abstract Heterozygous mutations of the ACAN gene have been associated with a broad spectrum of non-lethal skeletal dysplasias, called Aggrecanopathies. We report a case of a child with severe inflammatory elbow involvement mimicking septic arthritis who carried the new ACAN missense variant c.6970 T > C, p.Trp2324Arg. The comprehensive clinical evaluation of the patient and his family, focused on the associated clinical features (facial dysmorphisms, short stature, brachydactily), led us to suspect a hereditary condition. Our findings suggest that Aggrecanopathies should be considered in children with familial short stature, poor growth spurt and joint involvement.

Abstract Background To investigate the frequency of achievement of inactive disease (ID) in children with juvenile idiopathic arthritis (JIA) treated with methotrexate (MTX) as the sole disease-modifyng antirheumatic (DMARD) therapy and to develop a prediction model for lack of attainment of ID. Methods The clinical charts of consecutive patients started with MTX as the sole DMARD between 2000 and 2013 were reviewed. Patient follow-up was censored at first episode of ID or, in case ID was not reached, at last follow-up visit or when a biologic DMARD was prescribed. The characteristic at MTX start of patients who achieved or did not achieve ID were compared with univariate and multivariable analyses. Regression coefficients (β) of variables that entered the best-fitting logistic regression model were converted and summed to obtain a “prediction score” for lack of achievement of ID. Results A total of 375 patients were included in the study. During MTX administration, 8.8% were given systemic corticosteroids and 44.1% intra-articular corticosteroids. After MTX start, 229 (61%) patients achieved ID after a median of 1.7 years, whereas 146 patients (39%) did not reach ID after a median of 1.2 years. On multivariable analysis, independent correlations with lack of achievement of ID were identified for the disease categories of systemic arthritis, enthesitis-related arthritis (ERA) and polyarthritis and C-reactive protein (CRP) > 1.4 mg/dl. The prediction score ranged from 0 to 3 and its cutoff that discriminated best between patients who achieved or did not achieve ID was > 0.5. The categories of systemic arthritis or ERA, both of which had a score greater than 0.5, were sufficient alone to predict a lower likelihood to reach ID. Polyarthritis and increased CRP, whose score was 0.5, assumed a predictive value only when present in association. Conclusion A conventional treatment regimen based on MTX as the sole DMARD led to achievement of ID in a sizeable proportion of children with JIA. Our findings help to outline the characteristics of patients who may deserve a synthetic DMARD other than MTX or the introduction of a biologic DMARD from disease outset.

Abstract Objective To compare the long-term disease state, in terms of activity and damage, of children with juvenile idiopathic arthritis (JIA) who had their disease onset in methotrexate (MTX) or biologic eras. Methods Patients were included in MTX or biologic era cohort depending on whether their disease presentation occurred before or after January 2000. All patients had disease duration ≥ 5 years and underwent a prospective cross-sectional assessment, which included measurement of disease activity and damage. Inactive disease (ID) and low disease activity (LDA) states were defined according to Wallace, JADAS10, and cJADAS10 criteria. Articular and extraarticular damage was assessed with the Juvenile Arthritis Damage Index (JADI). Results MTX and biologic era cohorts included 239 and 269 patients, respectively. Patients were divided in the “functional phenotypes” of oligoarthritis and polyarthritis. At cross-sectional visit, patients in the biologic era cohort with either oligoarthritis or polyarthritis had consistently higher frequencies of ID and LDA by all criteria. The measurement of disease damage at cross-sectional visit revealed that the frequency of impairment of > 1 JADI-Articular items was higher in MTX than in biologic era cohort (17.6% versus 11% in oligoarthritis and 52.6% versus 21.8% in polyarthritis). Likewise, frequency of involvement of > 1 JADI-Extraarticular items was higher in the MTX than in the biologic era cohort (26.5% versus 16.2% in oligoarthritis and 31.4% versus 13.5% in polyarthritis). Conclusion Our study provides evidence of the remarkable outcome improvement obtained with the recent therapeutic advance in JIA.

Abstract This study contributes to the understanding of the mechanisms associated with signs and symptoms of tooth eruption, by investigating the presence of mast cells in pericoronal tissues during the intraosseous (Group 1) and submucosal (Group 2) phases of eruption. We compared findings for these two groups with each other and with those for the oral mucosa (Group 3). In each group, 14 specimens were analyzed microscopically after hematoxylin and eosin staining and immunohistochemical analysis of c-Kit and tryptase expression. Results revealed that the number and density of mast cells is different in follicular tissues according to the eruption phase, which may mean that: 1) masticatory trauma of the oral mucosa and dental follicles in the submucosa may explain why reduced enamel epithelium exposes enamel to the cells of the connective tissue; 2) exposure of antigenic enamel proteins might correspond to the release of sequestered antigens, which may lead to the interaction of IgE and a greater number of mast cells in the region; and 3) the consequent degranulation and the local release of mediators, such as histamine, leukotrienes, prostaglandins, proteases, cytokines and growth factors, contribute to the understanding of signs and symptoms associated with tooth eruption.

Background and aims – Hummingbirds are dependent and specialized on nectar-feeding, and many plants depend upon them for pollination. However, the degree of plant-pollinator interdependence varies greatly among species; thus, information on plant mating systems and availability of resources may help to clarify the dependence of interacting organisms. The goals of this study were to (1) quantify the floral resource available during the flowering of Dicliptera squarrosa Nees for comparison with other co-flowering ornithophilous species, and to (2) determine the importance of floral visitors for the reproductive success of this plant.Methods – Data collection was performed in a forest fragment within the urban perimeter of Catalão, Goiás, from September 2012 to August 2013. We investigated the flowering phenology, floral biology, nectar characteristics, flower visitors and mating systems of D. squarrosa. Additionally, we evaluated the amount of floral resource offered (number of flowers and energy in joules) by co-flowering ornithophilous species within an area of 6000 m2 for comparison with D. squarrosa.Key results – Dicliptera squarrosa presents flowers adapted to pollination by hummingbirds, which act as the sole pollinator group for flowers of this species. Flowering occurs from June to September and is synchronous with five other co-flowering species. During the months between July and September, D. squarrosa is the main food source for hummingbirds in the area, offering more floral resources than all of the other five ornithophilous species together. Plants of this species are self-compatible, but they depend on hummingbirds to transfer pollen; levels of autonomous autogamy were low.Conclusions – We suggest that D. squarrosa is an important species for maintaining hummingbirds in the forest fragment due to its high production of nectar resources. In addition, data on floral biology, flower visitors, and mating systems showed the importance of hummingbirds for reproduction of D. squarrosa, suggesting a mutualistic interaction between plant and hummingbirds.

Abstract Background The availability of methotrexate and the introduction of multiple biological agents have revolutionized the treatment of juvenile idiopathic arthritis (JIA). Several international and national drug registries have been implemented to accurately monitor the long-term safety/efficacy of these agents. This report aims to present the combined data coming from Pharmachild/PRINTO registry and the national registries from Germany (BiKeR) and Sweden. Methods Descriptive statistics was used for demographic, clinical data, drug exposure, adverse events (AEs) and events of special interest (ESIs). For the Swedish register, AE data were not available. Results Data from a total of 15,284 patients were reported: 8274 (54%) from the Pharmachild registry and 3990 (26%) and 3020 (20%) from the German and the Swedish registries, respectively. Pharmachild children showed a younger age (median of 5.4 versus 7.6 years) at JIA onset and shorter disease duration at last available visit (5.3 versus 6.1–6.8) when compared with the other registries. The most frequent JIA category was the rheumatoid factor–negative polyarthritis (range of 24.6–29.9%). Methotrexate (61–84%) and etanercept (24%–61.8%) were the most frequently used synthetic and biologic disease-modifying anti-rheumatic drugs (DMARDs), respectively. There was a wide variability in glucocorticoid use (16.7–42.1%). Serious AEs were present in 572 (6.9%) patients in Pharmachild versus 297 (7.4%) in BiKeR. Infection and infestations were the most frequent AEs (29.4–30.1%) followed by gastrointestinal disorders (11.5–19.6%). The most frequent ESIs were infections (75.3–89%). Conclusions This article is the first attempt to present a very large sample of data on JIA patients from different national and international registries and represents the first proposal for data merging as the most powerful tool for future analysis of safety and effectiveness of immunosuppressive therapies in JIA. Registry registration The Pharmachild registry is registered at ClinicalTrials.gov (NCT01399281) and at the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance (ENCePP) (http://www.encepp.eu/encepp/viewResource.htm?id=19362). The BiKeR registry is registered at ENCePP (http://www.encepp.eu/encepp/viewResource.htm?id=20591).