PurposeSkin aging is a progressive and degenerative process caused by a decrease in the physiological functions of the skin tissue. In addition, environmental factors as well as concomitant diseases and lifestyle (nutrition, sedentary lifestyle, smoking, etc) negatively impact the aging process. An association between oral administration of collagen peptides combined with vitamin C and extracts of Hibiscus sabdariffa and Aristotelia chilensis (Delphynol®) (Eximia Firmalize Age complex®) on dermal thickness was studied and the improvement in aging signs was evaluated.Patients and methodsFemale adult patients received an oral nutritional supplement containing collagen peptides, vitamin C, H. sabdariffa, and A. chilensis (Delphynol) in a sachet and were instructed to consume 1 sachet diluted in 200 mL of water once daily for 12 weeks. They were evaluated clinically, by high frequency ultrasound and cutometry.ResultsThere was a significant improvement of firmness and elasticity and an increase in dermal thickness by ultrasound after 3 months of use.ConclusionThe association of collagen peptides, vitamin C, H. sabdariffa and A. chilensis (Delphynol) could improve the signs of dermal skin aging.

PurposeTelogen effluvium (TE) is defined as a diffuse hair loss characterized by shortening of the anagen phase and precipitation of the telogen phase, with a consequent reduction of total hair volume. Nutritional supplementation is indicated under conditions in which TE is related to dietary disorders. The aim of this clinical study was to compare the efficacy of two different supplements in monotherapy for TE.Patients and methodsFemale adult patients were randomized to receive two oral nutritional supplements (group 1: a supplement composed of zinc, biotin, iron, vitamins A, C, E, and B complex, folic acid, magnesium, and amino acids of keratin and collagen and group 2: calcium pantothenate cystine, thiamine nitrate, medicinal yeast, keratin, and aminobenzoic acid) to treat hair loss for 180 days. They were evaluated clinically and by digital trichoscopy.ResultsClinical evaluation showed significant clinical improvement (P<0.05) for the evaluated parameters: hair loss, hair volume, density of hair (scalp cover), hair shine, hair strength, in 180 days. At 90 days evaluation, group 1 showed significant improvement for all parameters, while group 2 did not show any significant improvement for hair shine and hair strength. In the digital trichoscopy, there was a significant improvement only in group 1 (11.09%×7.76%) after 180 days.ConclusionIn idiopathic TE, the nutritional component should be suspected; the supplementation of an association of nutrients in recommended daily intake can lead to significant improvement of the condition from the first trimester of use. The use of an association with proven efficacy and a safety profile and posologic convenience facilitate its indication and patient adherence.

Marshall-Smith Syndrome (OMIM 602535) was described initially by Marshall in two infants with a syndrome characterized by accelerated skeletal maturation, failure to thrive, and dysmorphic facial features. We report a new patient with clinical features of Marshall-Smith syndrome with additional findings such as hyperpigmented lines on trunk and the four extremities. © 2011 Wiley-Liss, Inc.

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In the quest to improve the quality of health services and ensure more excellent patient safety, healthcare institutions look for alternatives that could help them achieve this goal. The Lean methodology has been a solution found by these organizations. This study has explored through Lean healthcare literature i) main barriers and facilitators to implementing the Lean approach into healthcare service organizations, and ii) practices and tools of Lean used to improve them continuously. One hundred two documents retrieved from Scopus and Web of Science databases were analyzed to reach the search goals. Through content analysis, the main barriers to Lean program implementation within healthcare institutions are related to resistance to change, low level of staff involvement, firm commitment to a cultural change, departments working in a silo approach, and misunderstanding of Lean concepts and its benefits. On the other hand, the main facilitators are support and engagement by leadership, training, and development of workers, and crossfunctional collaboration. This study also contributes to labeling the most frequent Lean practices and tools -value stream mapping, fishbone diagram, and SIPOC. The findings of this research provide practical implications since the barriers and facilitators raised from the literature will support healthcare professionals in their Lean healthcare journey in their organizations and consequently improve their competitiveness through a high level of efficiency, quality of care, and practitioner satisfaction.