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Objectives To assess people's level of recognition of rheumatic disease symptoms and their awareness that the rheumatologist is the main effector when it comes to these disorders. Materials and methods Survey performed in 8 towns in the Buenos Aires Province. Every town had at least one rheumatologist. Three clinical cases were presented: (1) inflammatory low back pain, (2) systemic disease, and (3) chronic polyarthritis. The population was asked whether (a) a physician should be immediately consulted, or (b) they could wait. They were asked whether they would advocate any initial treatment. They were also asked which physician should be consulted. Results Out of 150 surveys, 68% were female, the average age was 51.7 years old. Most people asserted that treatment with anti-inflammatory drugs should come first: 83% in inflammatory low back pain, 70% in systemic disease, and 70% in chronic polyarthritis (p = 0.02). The number of men that suggested waiting was higher (47% vs. 28% of women; p = 0.04). A rheumatologist was recommended by 51% for chronic polyarthritis, 15% for systemic disease, and 8% for inflammatory low back pain (p Conclusions Chronic polyarthritis was the disease people identified best as within the rheumatologist's field of expertise. Men tended to delay consultation more than women. Consultation is less likely when the level of education is lower.

Tuberous sclerosis complex (TSC) and autosomal dominant polycystic kidney disease (ADPKD) are conditions related to renal failure that can rarely occur in association as a contiguous gene syndrome. Angiomyolipomas (AMLs) are renal tumors strongly related to TSC that may rupture and cause life-threatening bleedings. We present a patient with TSC, ADPKD, and renal AMLs with persistent hematuria requiring blood transfusion. The persistent hematuria was successfully treated through endovascular embolization, a minimally invasive nephron sparing technique. Keywords: Tuberous Sclerosis; Polycystic [...]

Trauma has emerged as the leading cause of death during pregnancy. Penetrating abdominal trauma in pregnancy requires a rigorous clinical evaluation to establish a complete assessment of obstetric and non-obstetric lesions. In the case of major trauma, treatment is essentially carried out in a trauma centre with a multidisciplinary team to improve maternal and fetal prognosis. This is a case of a 20-year-old primigravid woman, 33 weeks and 4 days age of gestation, who was admitted for impaled foreign body. She was brought to the emergency department for a penetrating wound of the chest and abdomen after being accidentally impaled by a metre-long, inch-thick steel rod. Emergency laparotomy, caesarean section and thoracotomy were performed. The aim of this report is to discuss the assessment, management and role of the multidisciplinary team in the management of a pregnant trauma patient.

Objectives To evaluate the serrated lesion detection rate in colonoscopy at a specialized clinic and its role as quality criteria for endoscopic examination. Methods This is an observational cross-sectional study with all patients that underwent colonoscopy between October 2018 and May 2019, performed by an experimented physician. A questionnaire was answered before the examination by the patient, and another questionnaire after the colonoscopy was answered by the medical team. All polyps identified were removed and sent to the same pathologist for analysis. Results A total of 1,000 colonoscopies were evaluated. The average age of the patients was 58.9 years old, and most of them were female (60.6%). In 62.5% of the procedures, polyps were removed, obtaining a total of 1,730 polyps, of which 529 were serrated lesions, being 272 sessile serrated lesions (SSL). This data resulted in a serrated lesion detection rate (SDR) of 29.2%, and of 14% when considering only the SSL detection rate (SSLDR). The right colon had higher rates, with 22.3% SDR and 15.3% SSLDR. Screening colonoscopies also presented a higher serrated detection rate, of 20%, followed by diagnostics and follow-up exams. Smoking was the only risk factor associated with higher serrated detection rate. Conclusions The serrated lesion detection rate is higher than the ones already previously suggested and the have the higher rates were stablished in the right colon and on screening exams.

SARS-CoV-2 infection (COVID-19) has become a pandemic with a high case fatality rate that mainly affects adults. Most severely ill adult patients develop a coagulopathy that was not described until recently, and which is currently considered a main cause of death. Everything indicates that a similar phenomenon also occurs in children with COVID-19. Anticoagulant treatment has become one of the therapeutic foundations for this infection; however, its implementation in children can be difficult since, until recently, it was not considered in the pediatric population. Evidence regarding the use of anticoagulants in COVID-19 is rapidly generated, changes constantly, it is often difficult to interpret, and can be contradictory. After an extensive review of the published literature, a proposal was generated that offers suggestions for anticoagulant treatment, considering available resources in Mexico.La infección por SARS-CoV-2 (COVID-19) se ha constituido en una pandemia con alto índice de letalidad que afecta principalmente a los adultos. La mayor parte de los pacientes adultos graves desarrolla una coagulopatía que no estaba descrita, la cual actualmente se considera la principal causa de muerte. Todo indica que un fenómeno parecido ocurre también en el niño con COVID-19. El tratamiento anticoagulante se ha convertido en uno de los fundamentos terapéuticos de esta infección; sin embargo, su establecimiento en el niño puede ser difícil ya que, hasta hace poco, no estaba considerado en la población pediátrica. La evidencia respecto al uso de anticoagulantes en COVID-19 se genera con rapidez, cambia constantemente, con frecuencia es difícil de interpretar y puede ser contradictoria. Después de una extensa revisión de la literatura publicada, se generó una propuesta que ofrece sugerencias para el tratamiento anticoagulante en la que se consideran los recursos disponibles en México.

Background: Non-contrast chest CTs (NCCT) are performed routinely for coronary artery calcium (CAC) scoring and lung cancer screening. However, a large amount of noncoronary and nonpulmonary data from these scans remain unassessed. We aimed to validate a deep learning model to automatically segment and measure left atrial (LA) volumes from routine NCCT and evaluate prediction for cardiovascular outcomes. Methods: We retrospectively evaluated 273 patients (median age 69 years, 55.5% male) who underwent a routine non-ECG gated NCCT for lung cancer screening. LA volumes were quantified by three expert cardiothoracic radiologists and a prototype AI algorithm. LA volumes were then indexed to the body surface area (BSA). Expert and AI LA volume index (LAVi) were compared and used to predict cardiovascular outcomes within five years. Logistic regression with appropriate univariate statistics were used for modelling outcomes. Findings: There was excellent correlation between AI and expert results with an LAV intraclass correlation of 0.950 (0.936-0.960). Bland-Altman plot demonstrated the AI underestimated LAVi by a mean 5.86 mL/m 2 . AI-LAVi was associated with new-onset atrial fibrillation (AUC 0.86; OR 1.12, 95% CI 1.08-1.18, p

The Helping to End Addiction Long-termSM Initiative (NIH HEAL InitiativeSM) is an aggressive trans-NIH effort to speed solutions to stem the national opioid public health crisis, including through improved pain management. Toward this end, the NIH HEAL Initiative launched a common data element (CDE) program to ensure that NIH-funded clinical pain research studies would collect data in a standardized way. NIH HEAL Initiative staff launched a process to determine which pain-related core domains should be assessed by every clinical pain study and what questionnaires are required to ensure that the data is collected uniformly. The process involved multiple literature reviews, and consultation with experts inside and outside of NIH and the investigators conducting studies funded by the initiative. Ultimately, nine core pain domains, and questionnaires to measure them, were chosen for studies examining acute pain and chronic pain in adults and pediatric populations. These were augmented with dozens of study-specific supplemental questionnaires to enable uniform data-collection methods of outcomes outside of the core domains. The selection of core domains will ensure that valuable clinical pain data generated by the initiative is standardized, useable for secondary data analysis, and useful for guiding future research, clinical practice decisions, and policymaking. Perspective: The NIH HEAL Initiative launched a common data element program to ensure that NIH-funded clinical pain research studies would collect data in a standardized way. Nine core pain domains and questionnaires to measure them were chosen for studies examining acute pain and chronic pain in adults and pediatric populations.

Worldwide, knee osteoarthritis (KOA) accounts for 2.2% of total years lived with disability. There is a low correlation between joint tissue damage and pain intensity. Periarticular structures may be involved and cannot be identified in X-rays. To describe the main ultrasonography (USG) changes in symptomatic patients with primary KOA; to correlate the number of USG findings with KOA severity assessed by Kellgren and Lawrence (K&L) radiological scores, with pain intensity measured by a visual analogue scale (VAS) and with functioning scores assessed with the Timed up and go test (TUG) and Western Ontario and McMaster Universities (WOMAC) questionnaire. 100 patients with primary symptomatic KOA were assessed with X-ray and USG. Quantitative and qualitative analyses were evaluated in a systematic manner. The most frequent findings were joint effusion, pes anserinus bursitis, quadriceps tendon enthesopathy, popliteal cyst, iliotibial band tendinitis and patellar tendinitis. Pearson’s correlation analysis demonstrated a significant moderate positive association between VAS scores and the number of USG findings (r = 0.36; p

OBJECTIVE To develop a machine learning algorithm that identifies detrusor overactivity (DO) in Urodynamic Studies (UDS) in the spina bifida population. UDS plays a key role in assessment of neurogenic bladder in patients with spina bifida. Due to significant variability in individual interpretations of UDS data, there is a need to standardize UDS interpretation. MATERIALS AND METHODS Patients who underwent UDS at a single pediatric urology clinic between May 2012 and September 2020 were included. UDS files were analyzed in both time and frequency domains, varying inclusion of vesical, abdominal, and detrusor pressure channels. A machine learning pipeline was constructed using data windowing, dimensionality reduction, and support vector machines. Models were designed to detect clinician identified detrusor overactivity. RESULTS Data were extracted from 805 UDS testing files from 546 unique patients. The generated models achieved good performance metrics in detecting DO agreement with the clinician, in both time- and frequency-based approaches. Incorporation of multiple channels and data windowing improved performance. The time-based model with all 3 channels had the highest area under the curve (AUC) (91.9 ± 1.3%; sensitivity: 84.2 ± 3.8%; specificity: 86.4 ± 1.3%). The 3-channel frequency-based model had the highest specificity (AUC: 90.5 ± 1.9%; sensitivity: 68.3 ± 5.3%; specificity: 92.9 ± 1.1%). CONCLUSION We developed a promising proof-of-concept machine learning pipeline that identifies DO in UDS. Machine-learning-based predictive modeling algorithms may be employed to standardize UDS interpretation and could potentially augment shared decision-making and improve patient care.

Made available in DSpace on 2022-04-29T08:38:39Z (GMT). No. of bitstreams: 0 Previous issue date: 2022-01-01 Introduction: To investigate the influence of a training of mobility, gait speed and postural balance of pelvic floor muscles (PFM). Methods: A single-arm clinical trial study was approved and registered at the Brazilian Clinical Trials Registry (RBR-4rxhd4). Eighteen women over the age of 60 with pelvic floor dysfunction complaints were subjected to 10 sessions of functional electrical stimulation and digital palpation of PFM. Mobility and gait speed were evaluated by the Timed up and Go and the 10-m walk tests respectively. Standing balance was evaluated using a force plate. Results: No significant differences were found in mobility, gait speed, and standing balance. PFM contraction worsened mobility, gait speed, and standing balance performance. Conclusions: The training protocol enhanced PFM strength and endurance, but the improved ability to recruit PFM did not positively affect balance, mobility, and gait speed. Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP) Human Development and Technologies Program Institute of Biosciences São Paulo State University (UNESP) Department of Tocogynecology Botucatu Medical School (FMB) São Paulo State University (UNESP) Department of Physiotherapy and Occupational Therapy Faculty of Philosophy and Sciences São Paulo State University (UNESP)

Background The high-risk human papillomavirus (HPV) infection represents one of the main etiologic pathways of penile carcinogenesis in approximately 30–50 % of cases. Several techniques for the detection of HPV are currently available including Polymerase chain reaction-based techniques, DNA and RNA in situ hybridization (ISH), p16 immunohistochemistry (IHC). The multiplex HPV RNA ISH/p16 IHC is a novel technique for the simultaneous detection of HPV E6/E7 transcripts and p16INK4a overexpression on the same slide in a single assay. The main aim of this study was to evaluate the discrepancy of p16 IHC expression relatively to HPV RNA ISH in penile cancer tissue. Methods We collected a series of 60 PCs. HPV has been analysed through the RNA ISH, p16 IHC and the multiplex HPV RNA ISH/p16 IHC. Results The multiplex HPV RNA ISH /p16 IHC results in the series were in complete agreement with the previous results obtained through the classic p16 IHC and HPV RNA scope carried out on two different slides. The multiplex HPV RNA ISH /p16 IHC showed that HPV positivity in our series is more frequently in usual squamous cell carcinoma than in special histotypes (19 out of 60 − 15 %- versus 6 out of 60 − 10 %-), in high-grade than in moderate/low grade carcinomas (6 out of 60 − 10 %- versus 4 out of 60 − 6.7 %-). In addition, our data revealed that in 5 out of 20 cases with p16 high intensity expression is not associated with HPV RNA ISH positivity. Conclusions Our findings emphasize that the use of p16 as a surrogate of HPV positivity was unsuccessful in approximatively 8 % of cases analysed in our series. Indeed, p16 IHC showed a sensitivity of 100 % and a specificity of 71 %, with a positive predictive value (PPV) of 54 % and a negative predictive value of 100 %; when considering high intensity, p16 IHC showed a sensitivity of 100 %, a specificity of 89 %, with a PPV of 75 % and NPV of 100 %. Since HPV positivity could represent a relevant prognostic and predictive value, the correct characterization offered by this approach appears to be of paramount importance.

Made available in DSpace on 2022-04-29T08:35:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Extrusion of sodium hypochlorite (NaOCl) is a very rare accident with the most common complications including pain, swelling, and hematoma. It can occur even if procedural guidelines, predisposing conditions, and risk factors are taken into consideration. A 59-year-old female patient was admitted to the endodontics department to treat a left maxillary first premolar (World Dental Federation tooth 24). The medical history included osteoporosis and systemic medication with alendronate. Initially, the diagnosis was “symptomatic irreversible pulpitis” with “normal apical tissues.” During instrumentation of the buccal canal, accidental extrusion of 2.5% NaOCl occurred into the periapical tissues, resulting from misinterpretation of the working length, and caused severe pain and bleeding. The canal was immediately flushed using copious irrigation with saline solution. An analgesic and corticosteroid were prescribed. At 3 and 7 days, ecchymosis and slight hematoma were observed extraorally in the area of the affected tooth and an intraoral ulceration at the apex of the affected tooth. At 15 days, minimal signs of ecchymosis were observed, and the treatment was resumed. At 30 days after the accident, there was complete remission of the sequelae. The clinical, radiographic, and tomographic assessment after 1 month, 1 year, and 8 years showed favorable case evolution. During the 8-year follow-up, the patient maintained the systemic use of alendronate. It can be concluded that NaOCl extrusion is an accident that causes patients and clinicians to experience an unpleasant consequence. The radiographic working length should always be determined carefully. A successful outcome can be achieved in patients who take alendronate. Department of Restorative Dentistry Araraquara School of Dentistry São Paulo State University Department of Endodontics Cayetano Heredia Peruvian University Department of Restorative Dentistry Araraquara School of Dentistry São Paulo State University

Aims Multisystemic inflammatory syndrome in children (MIS‐C) is a condition noted in some children asymptomatic but positive to Sars‐cov‐2 antibody and it presents clinical and laboratory changes similar to Kawasaki disease (KD). Oral changes have also been observed. This systematic review evaluated oral manifestations detected in children with MIS‐C and KD associated to COVID‐19. Methods and Results This work was registered at PROSPERO (#CRD42020225909), following PRISMA guidelines. A comprehensive research was conducted in MEDLINE, Web of Science, EMBASE, LILACS, Scopus, and Grey Literature through August 2021, based on original research evaluating children diagnosed with MIS‐C or KD related to COVID‐19. Two authors independently screened all retrieved references. Twenty five selected studies evaluated 624 children, mean age 8.78 years. The assessment of the risk of bias (ROB) showed that most of them presented low ROB. Oral manifestations were erythematous mucous membrane, oral ulcers lesions, dry, swollen and cracked lips, and strawberry tongue. Conclusion MIS‐C and KD share the same oral manifestations and their identification may lead to an early diagnosis.

A síndrome braquicefálica é um conjunto de alterações anatômicas e fisiológicas, que dificultam a passagem de ar nas vias aéreas. Essa síndrome combina a estenose de narinas e alongamento do palato mole como alterações primárias, que levam a alterações secundárias. Em função desses fatores, o animal faz maior esforço respiratório, apresentando sinais clínicos como ronco durante o sono e acordado, intolerância ao exercício físico, disfagia, espirro reverso e cianose. O relato objetiva apresentar as técnicas cirúrgicas estafilectomia e rinoplastia utilizadas para correção da angústia respiratória em canino da raça Bulldog Francês.

Cervical glioblastoma multiforme (GBM) is rare, and its early diagnosis and management is crucial to patient survival. In the young population, it’s even more difficult to diagnose. The main challenges in GBM therapy are associated with the location of the disease and its complex and heterogeneous biology. Here, we present a case of a 35-year-old female patient admitted due to complain of pain in her right lower limb. She reported the evolution of the condition for dysesthesia in upper limbs and lower limbs 4 weeks ago. MRI showed an intramedullary lesion extending from C2 to C5. The patient was managed surgically. The purpose of this report is to document this rare condition, especially in the young age group, and reveal the current knowledge regarding intramedullary GBM.

Dentre as dificuldades encontradas para a inclusão de crianças com Transtorno do Espectro Autista (TEA) nas escolas está a falta de conhecimentos técnicos e instrumentos específicos que ofereçam suporte à prática dos profissionais da educação e às escolas. Considerando essa necessidade, foi aplicado um programa de capacitação, com base no referencial teórico da Análise do Comportamento, para 18 professores do Ensino Fundamental de uma escola de cidade do interior do Estado de São Paulo, com o objetivo de capacitá-los a aprenderem estratégias para promover a participação de alunos com TEA em atividades de grupo utilizando jogos cooperativos. Foram ministradas cinco aulas com enfoque prático, abordando os temas: jogos cooperativos, prompt e reforço. A avaliação do curso foi feita de três modos: aplicação de Pré-Teste, Pós Teste e Follow-up. Para avaliar a aprendizagem dos professores participantes, foi solicitada aos professores uma atividade de simulação de situações e intervenções vivenciadas junto a alunos com TEA, a partir dos conteúdos aprendidos, e a aplicação da Escala de Avaliação do Ensino em Língua Oral em Contexto Escolar (EVALOE) para avaliar a atuação dos ministrantes. Os resultados indicaram que os participantes apresentaram mais acertos no pós-teste do que no pré-teste, a avaliação deles sobre o curso foi positiva e a atuação dos ministrantes satisfatória. Ressalta-se a importância de elaborar capacitações para os docentes e a necessidade de fornecer a eles mais materiais de apoio e atividades de autoaprendizagem.

Transplant-associated thrombotic microangiopathies (TA-TMAs) are inflammatory and thrombotic disorders of the microvasculature characterized by hemolytic anemia, thrombocytopenia, and organ dysfunc...

Scientists are working to identify prevention/treatment methods and clinical outcomes of coronavirus disease 2019 (COVID-19). Nutritional status and diet have a major impact on the COVID-19 disease process, mainly because of the bidirectional interaction between gut microbiota and lung, that is, the gut–lung axis. Individuals with inadequate nutritional status have a pre-existing imbalance in the gut microbiota and immunity as seen in obesity, diabetes, hypertension and other chronic diseases. Communication between the gut microbiota and lungs or other organs and systems may trigger worse clinical outcomes in viral respiratory infections. Thus, this review addresses new insights into the use of probiotics and prebiotics as a preventive nutritional strategy in managing respiratory infections such as COVID-19 and highlighting their anti-inflammatory effects against the main signs and symptoms associated with COVID-19. Literature search was performed through PubMed, Cochrane Library, Scopus and Web of Science databases; relevant clinical articles were included. Significant randomised clinical trials suggest that specific probiotics and/or prebiotics reduce diarrhoea, abdominal pain, vomiting, headache, cough, sore throat, fever, and viral infection complications such as acute respiratory distress syndrome. These beneficial effects are linked with modulation of the microbiota, products of microbial metabolism with antiviral activity, and immune-regulatory properties of specific probiotics and prebiotics through Treg cell production and function. There is a need to conduct clinical and pre-clinical trials to assess the combined effect of consuming these components and undergoing current therapies for COVID-19.

Reporting a case of simultaneous bilateral oral ranula treated by marsupialization and to present a literature review on the profile of affected patients and also to correlate the treatment. Woman presenting a simultaneous bilateral oral ranula with no apparent etiology. Marsupialization was performed on both sides with the preservation of sublingual glands. No recurrence has been noted for 2 years of following. The literature review was conducted in August 2021 using PubMed, Web of Science, Embase, Scopus, LILACS and OpenGrey databases. Included articles were reviewed for mean age at presentation, gender, average size, treatment and recurrence. Literature review revealed 6 previous reported cases of bilateral oral ranula occurring simultaneously. Only 6 cases of bilateral oral ranula occurring simultaneously have been described in the literature. In general, the treatment is the excision of the lesion and also of the associated gland, as it has a lower recurrence rate. However, in the present case, we proposed marsupialization as a less invasive conduction of bilateral oral ranula occurring simultaneously, and the remission of the lesion occurred after this treatment with preservation of the gland.

Although serum ferritin (SF) has been shown in several studies to be a potential cancer biomarker, the results are inconsistent. Herein, a systematic review was performed to investigate the clinical SF levels in different types of tumors in order to verify the role of SF levels as a biomarker for cancer diagnosis. The search was performed using the PubMed/Medline, Cochrane Library, and Scopus databases. Observational studies comparing SF levels between healthy adults and patients with cancer were included. The meta-analysis was carried out according to the inverse variance and random effects model. The standardized mean differences (SMDs) were assessed at 95% confidence intervals (CIs). We found that SF was higher in patients with cancer (SMD 3.07; CI 1.96,4.17), especially for head and neck cancer (SMD 3.88; CI 0.42,7.34), lung cancer (SMD 1.72; CI 0.67,2.78), pancreatic cancer (SMD 6.79; CI 5.66,7.91), and renal cell carcinoma (SMD 1.77; CI 0.48,3.05). Moreover, in the advanced stages (Stages III and IV), ferritin levels were higher than in healthy adults (SMD 4.89; CI 2.72,7.06, and SMD 8.40; CI 6.99,9.82, respectively). SF acts as a biomarker for pancreatic cancer, renal cell carcinoma, lung cancer, and head and neck cancer and is a sensitive biomarker for the detection of advanced stages of tumors.

Made available in DSpace on 2022-04-29T08:33:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-10-30 Acute kidney injury pathogenesis in envenoming by snakes is multifactorial and involves immunologic reactions, hemodynamic disturbances, and direct nephrotoxicity. Sildenafil (SFC), a phosphodiesterase 5 inhibitor, has been reported to protect against pathological kidney changes. Objective: This study aimed to investigate the protective effect of sildenafil against Bothrops alternatus snake venom (BaV)-induced nephrotoxicity. Methods: Kidneys from Wistar rats (n = 6, weighing 260–300 g) were isolated and divided into four groups: (1) perfused with a modified Krebs-Henseleit solution (MKHS) containing 6 g% of bovine serum albumin; (2) administered 3 μg/mL SFC; (3) perfused with 3 μg/mL BaV; and (4) administered SFC + BaV, both at 3 μg/mL. Subsequently, the perfusion pressure (PP), renal vascular resistance (RVR), urinary flow (UF), glomerular filtration rate (GFR), and percentage of electrolyte tubular sodium and chloride transport (%TNa+, %TCl−, respectively) were evaluated. The cyclic guanosine monophosphate (cGMP) levels were analyzed in the perfusate, and the kidneys were removed to perform oxidative stress and histopathological analyses. Results: All renal parameters evaluated were reduced with BaV. In the SFC + BaV group, SFC restored PP to normal values and promoted a significant increase in %TNa+ and %TCl−. cGMP levels were increased in the SFC + BaV group. The oxidative stress biomarkers, malondialdehyde (MDA) and glutathione (GSH), were reduced by BaV. In the SFC + BaV group, a decrease in MDA without an increase in GSH was observed. These findings were confirmed by histological analysis, which showed improvement mainly in tubulis. Conclusion: Our data suggest the involvement of phosphodiesterase-5 and cGMP in BaV-induced nephrotoxicity since its effects were attenuated by the administration of SFC. Department of Physiology and Pharmacology School of Medicine Federal University of Ceara, Coronel Nunes de Melo St., 1127 Drug Research and Development Center (NPDM) Federal University of Ceara, Coronel Nunes de Melo St., 1000 Department of Dental Clinic School of Pharmacy Dentistry and Nursing Federal University of Ceara, Monsenhor Furtado St. Center for the Study of Venoms and Venomous Animals Fazenda Experimental Lageado São Paulo State University, José Barbosa de Barros St. 1780 Center for the Study of Venoms and Venomous Animals Fazenda Experimental Lageado São Paulo State University, José Barbosa de Barros St. 1780

Background: Cancer is a complex, multifactorial disease, and a major public health problem, as it is a leading cause of morbidity and mortality worldwide. Although treatments have significantly improved, still more effective drugs are searched. One source for these drugs is natural products (NPs). One NP that has shown anticancer activity is Limonene. However, the mechanisms of limonene's antiproliferative, anticancer and antineoplastic activity are not fully understood. Objective: The objective of this study is, therefore, to undertake a systematic review and meta-analysis of the literature on this subject. Methods: A comprehensive literature search was performed using the Scopus, MEDLINE-PubMed, Web of Science, and Science Direct databases using the keywords: “limonene”, “cancer”, “neoplasm”, and “tumor”. The inclusion criteria were: in vivo and in vitro studies on the use of limonene in cancer published in English, Portuguese and Spanish until December 2019. Review articles, meta-analyses, abstracts, conference papers, editorials/ letters and case reports were excluded. Results: The search identified 3568 articles, of which, 126 were selected for full reading, with 11 papers meeting the review criteria. Six more papers were added from the references of the initial 11 texts, giving a total of 17 papers. There was a high level of agreement in inclusion/exclusion (Kappa index > 80%). The risk of bias in the texts was shown to be high. Conclusion: The meta-analysis suggests that limonene acts mainly on tumor regression induced apoptosis and is a promising natural product for use in the treatment of several types of cancer.

A disfunção precoce de enxerto hepático consiste em uma síndrome multifatorial caracterizada por alterações clínicas e laboratoriais associadas à alta morbidade nos primeiros dias pós-transplante. Relacionada à lesão de isquemia e reperfusão do fígado, pode levar em sua forma mais grave a alterações sistêmicas abruptas. Apesar de ser um quadro grave, as alterações podem ser transitórias, possibilitando recuperação do enxerto hepático. Sua ocorrência em população pediátrica é rara. A N-acetilcisteína, comumente utilizada no tratamento de hepatotoxicidade secundária à overdose por paracetamol, tem surgido como alternativa eficaz na melhora clínica de pacientes transplantados com má função de enxerto. Relatamos um caso de paciente do sexo masculino, dois anos, submetido a transplante de fígado por atresia de vias biliares, sem intercorrências intraoperatórias. Evoluiu com quadro de disfunção precoce grave de enxerto no segundo dia pós-operat óio, sem boa resposta às medidas de suporte, cogitando-se indicação de retransplante. Foi iniciada administração de n-acetilcisteína, dosagem de 100mg três vezes ao dia, progredindo com melhora clínica significativa, sobretudo da função hepática. O acompanhamento de dados clínicos e laboratoriais de pacientes no período pós-transplante é fundamental, tendo em vista riscos e graves repercussões da disfunção precoce do enxerto hepático. A N-acetilcisteína é uma droga que tem sido relatada atuando no aumento da oferta de oxigênio tecidual e na remodelação dos hepatócitos, a partir da recuperação dos níveis de glutationa. Os efeitos em pacientes com disfunções hepáticas pós -transplante têm sido promissores nos poucos relatos científicos de seu uso, como o caso em questão.

The incidence of human papillomavirus (HPV)-associated cancers, especially those from the head and neck region, has increased. The relatively early age of presentation of HPV-positive head and neck cancer (HNC) indicates that viral infection might be acquired early in life. Persistent HPV infection has been recognized as the main risk factor for cancer development, but most studies have focused on evaluating HPV persistence in the genital region. Thus, in this work, we aimed to evaluate the prevalence of HPV in oral cavity and oropharynx in a young population, as well as the possible persistence of the infection after 12 months. Our results indicate that almost half (46.8%) of the analyzed population harbors an HPV infection either in the oral cavity or in the oropharynx. Furthermore, after 1 year of initial identification, half of them eliminated the infection, and only one person (5.26%) exhibited persistence. Interestingly, 50% of the individuals who successfully eliminated the infection acquired a new viral type, indicating that even when the primary infection is effectively eliminated by the immune system, there is a dynamic circulation of HR-HPV types that produce reinfection. This dynamic HPV infection among young individuals could influence the future establishment of cancer in some proportion of the cases. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s42770-021-00602-3.

Large populations across sub-Saharan Africa remain at risk of devastating acute bacterial meningitis epidemics and endemic disease. Meningitis surveillance is a cornerstone of disease control, essential for describing temporal changes in disease epidemiology, the rapid detection of outbreaks, guiding vaccine introduction and monitoring vaccine impact. However, meningitis surveillance in most African countries is weak, undermined by parallel surveillance systems with little to no synergy and limited laboratory capacity. African countries need to implement comprehensive meningitis surveillance systems to adapt to the rapidly changing disease trends and vaccine landscapes. The World Health Organization and partners have developed a new investment case to restructure vaccine-preventable disease surveillance. With this new structure, countries will establish comprehensive and sustainable meningitis surveillance systems integrated with greater harmonization between population-based and sentinel surveillance systems. There will also be stronger linkage with existing surveillance systems for vaccine-preventable diseases, such as polio, measles, yellow fever, and rotavirus, as well as with other epidemic-prone diseases to leverage their infrastructure, transport systems, equipment, human resources and funding. The implementation of these concepts is currently being piloted in a few countries in sub-Saharan Africa with support from the World Health Organization and other partners. African countries need to take urgent action to improve synergies and coordination between different surveillance systems to set joint priorities that will inform action to control devastating acute bacterial meningitis effectively.

Background As part of the global Invasive Bacterial Vaccine-Preventable Diseases Surveillance Network, 12 African countries referred cerebrospinal fluid (CSF) samples to South Africa’s regional reference laboratory. We evaluated the utility of real-time polymerase chain reaction (PCR) in detecting and serotyping/grouping Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae (HNS). Methods From 2008 to 2017, CSF samples collected from children Results The overall HNS PCR positivity rate for all countries was 10% (1195 of 11 626 samples). In samples with both PCR and culture results, HNS PCR positivity was 11% (744 of 6747 samples), and HNS culture positivity was 3% (207 of 6747). Molecular serotype/serogroup was assigned in 75% of PCR-positive specimens (762 of 1016). Compared with PCR-negative CSF samples, PCR-positive samples were more often turbid (adjusted odds ratio, 6.80; 95% confidence interval, 5.67–8.17) and xanthochromic (1.72; 1.29–2.28), had elevated white blood cell counts (6.13; 4.71–7.99) and high protein concentrations (5.80; 4.34–7.75), and were more often HNS culture positive (32.70; 23.18–46.12). Conclusion PCR increased detection of vaccine-preventable bacterial meningitis in countries where confirmation of suspected meningitis cases is impeded by limited culture capacity.

Objectives Trigeminal neuralgia (TN) is a neuropathic pain, usually unilateral, affecting one or more trigeminal nerve innervation territories. The current study aimed to evaluate the effectiveness of acupuncture in TN pain control. Methods An integrative review was developed on Medline (Pubmed), LILACS (BVS) and Cochrane Library databases. Keywords “trigeminal neuralgia” AND “acupuncture” were combined in different ways to ensure a wide search of primary studies. Article reference lists were also screened. Inclusion criteria comprised clinical studies developed in humans, without date publication limit, published in languages English, Portuguese and Spanish, performing any type of acupuncture therapy for TN pain control. Results Among the six studies selected, most were randomized controlled clinical trials, developed in China. Only one study performed a retrospective cross-sectional. To assess pain, most used the VAS scale. There were very similar methods concerning points selection and treatment protocols. All studies found a significant decrease in pain frequency or intensity, disregarding the type of acupuncture applied. Conclusion Acupuncture therapy seems to decrease frequency and intensity of TN pain episodes, alone or in combination with gold standard medications. However, there is a need for standardizing methodological issues and prospective evaluations.

Background The emergence of highly active novel agents has led some to question the role of autologous haematopoietic stem-cell transplantation (HSCT) and subsequent consolidation therapy in newly diagnosed multiple myeloma. We therefore compared autologous HSCT with bortezomib-melphalan-prednisone (VMP) as intensification therapy, and bortezomib-lenalidomide-dexamethasone (VRD) consolidation therapy with no consolidation.Methods In this randomised, open-label, phase 3 study we recruited previously untreated patients with multiple myeloma at 172 academic and community practice centres of the European Myeloma Network. Eligible patients were aged 18-65 years, had symptomatic multiple myeloma stage 1-3 according to the International Staging System (I S S), measurable disease (serum M protein >10 g/L or urine M protein >200 mg in 24 h or abnormal free light chain [FLC] ratio with involved FLC >100 mg/L, or proven plasmacytoma by biopsy), and WHO performance status grade 0-2 (grade 3 was allowed if secondary to myeloma). Patients were first randomly assigned (1:1) to receive either four 42-day cycles of bortezomib (1.3 mg/m 2 administered intravenously or subcutaneously on days 1, 4, 8, 11, 22, 25, 29, and 32) combined with melphalan (9 mg/m(2) administered orally on days 1-4) and prednisone (60 mg/m(2) administered orally on days 1-4) or autologous HSCT after high-dose melphalan (200 mg/m(2)), stratified by site and ISS disease stage. In centres with a double HS CT policy, the first randomisation (1:1:1) was to VMP or single or double HSCT. Afterwards, a second randomisation assigned patients to receive two 28-day cycles of consolidation therapy with bortezomib (1.3 mg/m(2)either intravenously or subcutaneously on days 1, 4, 8, and 11), lenalidomide (25 mg orally on days 1-21), and dexamethasone (20 mg orally on days 1, 2, 4, 5, 8, 9, 11, and 12) or no consolidation; both groups received lenalidomide maintenance therapy (10 mg orally on days 1-21 of a 28-day cycle). The primary outcomes were progression-free survival from the first and second randomisations, analysed in the intention-to-treat population, which included all patients who underwent each randomisation. All patients who received at least one dose of study drugs were included in the safety analyses. This study is registered with the EU Clinical Trials Register (EudraCT 2009-017903-28) and ClinicalTrials.gov (NCT01208766), and has completed recruitment.Findings Between Feb 25, 2011, and April 3, 2014, 1503 patients were enrolled. 1197 patients were eligible for the first randomisation, of whom 702 were assigned to autologous HSCT and 495 to VMP; 877 patients who were eligible for the first randomisation underwent the second randomisation to VRD consolidation (n=449) or no consolidation (n=428). The data cutoff date for the current analysis was Nov 26, 2018. At a median follow-up of 60.3 months (IQR 52. 2-67. 6), median progression-free survival was significantly improved with autologous HSCT compared with VMP (56.7 months [95% CI 49.3-64.5] vs 41.9 months [37.5-46.9]; hazard ratio [HR] 0.73, 0.62-0.85; p=0.0001). For the second randomisation, the number of events of progression or death at data cutoff was lower than that preplanned for the final analysis; therefore, the results from the second protocol-specified interim analysis, when 66% of events were reached, are reported (data cutoff Jan 18, 2018). At a median follow-up of 42.1 months (IQR 32.3-49.2), consolidation therapy with VRD significantly improved median progression-free survival compared with no consolidation (58.9 months [54.0-not estimable] vs 45.5 months [39.5-58.4]; HR 0.77, 0.63-0.95; p=0.014). The most common grade >= 3 adverse events in the autologous HSCT group compared to the VMP group included neutropenia (513 [79%] of 652 patients vs 137 [29%] of 472 patients), thrombocytopenia (541 [83%] vs 74 [16%]), gastrointestinal disorders (80 [12%] vs 25 [5%]), and infections (192 [30%] vs 18 [4%]). 239 (34%) of 702 patients in the autologous HSCT group and 135 (27%) of 495 in the VMP group had at least one serious adverse event. Infection was the most common serious adverse event in each of the treatment groups (206 [56%] of 368 and 70 [37%] of 189). 38 (12%) of 311 deaths from first randomisation were likely to be treatment related: 26 (68%) in the autologous HSCT group and 12 (32%) in the VMP group, most frequently due to infections (eight [21%]), cardiac events (six [16%]), and second primary malignancies (20 [53%]).Interpretation This study supports the use of autologous HSCT as intensification therapy and the use of consolidation therapy in patients with newly diagnosed multiple myeloma, even in the era of novel agents. The role of high-dose chemotherapy needs to be reassessed in future studies, in particular in patients with undetectable minimal residual disease after four-drug induction regimens including a monoclonal antiboby combined with an immunomodulatory agent and a proteasome inhibitor plus dexamethasone. Copyright (C) 2020 Elsevier Ltd. All rights reserved.

Aim and objective To appraise the validity of measuring macular ganglion cell layer (mGCL) thickness as an indicator of early glaucoma, as compared to measurement of peripapillary retinal nerve fiber layer (pRNFL) thickness. Materials and methods This was a single-center, single-observer, cross-sectional, retrospective study. Records included Filipino adult patients seen from January 2017 onward. Patients underwent testing of both automated visual field (VF) testing with either Humphrey Visual Field Analyzer (24-2 SITA program) or Octopus 311 (G1 program), and standard Spectral-Domain Optical Coherence Tomography (Cirrus HD-OCT 5000). Modified Hodapp-Anderson-Parrish criteria were used to classify subjects as either healthy, suspect, or early glaucomatous eyes. Thickness changes were directly observed through optical coherence tomography. Area under receiver operating curve (AUC) analysis was used to determine ability of mGCL and pRNFL to discriminate between healthy and early glaucomatous states. Results A total of 96 eyes were included. Progressive thinning for all parameters was noted for both pRNFL and mGCL from healthy to suspect to early glaucomatous eyes. The highest AUC of 0.744 was seen in average pRNFL of healthy vs early glaucomatous eyes. However, AUC values for both pRNFL and mGCL were all above 0.500. Conclusion Measurements of mGCL thickness in Filipino patients exhibit comparable performance to pRNFL measurements in detecting early anatomic glaucomatous change. It is a tool that can be utilized for early glaucoma detection in addition to current standard diagnostic tests. Clinical significance This study, the first to be performed on Filipino patients, validates using mGCL thickness as a good parameter in discriminating between normal and early glaucoma patients for this particular population and Ethnic group. How to cite this article Aquino LG, Aquino NM. Evaluation of Macular Ganglion Cell Layer Thickness vs Peripapillary Retinal Nerve Fiber Layer Thickness for Glaucoma Detection Using Spectral-domain Optical Coherence Tomography in a Tertiary Philippine Hospital. J Curr Glaucoma Pract 2020;14(2):50-56.

Background Elevated epidermal interleukin (IL)-36 expression distinguishes psoriasis from eczematous dermatitis, but other psoriasiform dermatitides (PDs) have not been thoroughly investigated for IL-36 expression. In this study, we assess the IL-36 staining pattern (IL36-SP) in psoriasis variants and other PDs including lichen simplex chronicus (LSC), prurigo nodularis (PN), lichen planus (LP), tinea, pityriasis rubra pilaris (PRP), mycosis fungoides (MF), pemphigus foliaceus (PF), acute generalized exanthematous pustulosis (AGEP), impetigo (IMP), and syphilis (SY). Methods IL-36 immunostaining was performed on 307 cases of psoriasis and various PDs. IL36-SP in the upper epidermis was graded on a scale of 0-4. Results High IL36-SP occurred in all variants of psoriasis, as well as in AGEP, PRP, PN, tinea, IMP, and LP (P > 0.05). SY, PF, LSC, and MF showed a lower IL36-SP (P ≤ 0.05) compared with psoriasis. Conclusion All variants of psoriasis exhibit high IL36-SP. IL-36 staining can assist in differentiating MF, PF, SY, and LSC from psoriasis, particularly MF and LSC, which have consistent low IL-36 expression. AGEP, PRP, tinea, IMP, PN, and LP exhibit high IL-36 expression similar to psoriasis, indicating Th17 activation in these diseases.

Objective: To investigate the effectiveness of Maitland’s joint mobilization and therapeutic exercises on the functionality of the hands in patients with systemic sclerosis. Design: Randomized controlled trial. Setting: Tertiary university hospital. Subjects: Twenty-four patients diagnosed with systemic sclerosis according to ACR/EULAR 2013 criteria; age ⩾18 years and Cochin Hand Functional Scale (COCHIN) score ⩾10. They were randomized to physical therapy group ( n = 12) or control group ( n = 12). Interventions: The physical therapy group received joint mobilization and undertook therapeutic exercises, twice a week, for 12 weeks, and received a booklet with information about the disease. The control group only received the booklet about the disease. Main measures: The primary outcome measure was functionality of the hands (COCHIN). The secondary outcomes measures were disability (SHAQ), pain (visual analogic scale), range of motion (HAMIS and Delta finger-to-palm), grip strength (JAMAR dynamometer), and quality of life (SF12). Results: Twenty-two patients were female, with a mean age of 47.4 ± 11.1 years and 18 had limited cutaneous form. The physical therapy group showed a decrease of 11.33 points in the COCHIN in comparison with the control group ( P = 0.09). There was a significant increase in range of motion by HAMIS (3.00 ± 1.48 vs 5.42 ± 2.64, P = 0.008), reduction in pain VAS (3.42 ± 2.78 vs 7.75 ± 2.53, P < 0.001), and increase in the physical component of SF12 (38.51 ± 9.60 vs 32.65 ± 9.10, P = 0.038). Conclusion: Maitland’s joint mobilization and therapeutic exercises improved the functionality of the hands, reduced pain in the hands and wrists, increased range of motion, and improved quality of life in patients with systemic sclerosis.

Background: People with HIV (PWH) on antiretroviral therapy (ART) still experience an increased risk of morbidity and mortality, presumably driven by chronic inflammation, yet predictors of discrete or combinatorial outcomes remain unclear. Galectin-9 (Gal-9), a driver of both inflammatory and immunosuppressive responses, has been associated with HIV disease progression and multimorbidity. Objective: To determine whether plasma Gal-9 levels are associated with the occurrence of specific non-AIDS events (NAEs) in PWH initiating ART. Design: We performed a nested case–control study of PWH enrolled from 2001 to 2009 and evaluated pre-ART (66 cases, 97 controls), a year post-ART (112 cases, 211 controls), and immediately preceding an event (89 cases, 162 controls). Events included myocardial infarction/stroke, malignancy, serious bacterial infection, or death. Methods: Plasma Gal-9 levels were assessed by ELISA. Conditional logistic regression assessed associations with NAEs and Spearman's correlations compared Gal-9 with other previously assessed biomarkers. Results: NAEs occurred at a median of 2.8 years (1.7–4.6) after ART initiation. Higher Gal-9 levels were associated with increased risk of NAEs at year 1 and preevent [odds ratio (OR) per 1 interquartile range = 1.4–1.6; all P

PRECIS In primary open-angle glaucoma (POAG), micropulse trans-scleral cyclophototherapy (MPTCP) is effective in lowering intraocular pressure (IOP), but its effects are not permanent. Hence, it can serve as a temporizing measure before definitive glaucoma surgery. PURPOSE There is limited data on MPTCP in POAG. This is the first study that looks at MPTCP treatment specifically in POAG patients. PATIENTS AND METHODS This is an interventional, single-institution exploratory case series with 55 eyes of 48 patients with POAG. Data was collected from clinical records, including patient demographics, clinical information, number of glaucoma medications, MPTCP laser settings, complications, and clinical outcomes. RESULTS Patients had a mean age of 67.3±14.1 years with a preponderance of males. IOP was 24.8±1.0 mm Hg before MPTCP and decreased to 19.7±1.1, 21.9±1.1, and 21.8±1.1 mm Hg at postoperative month 3, 6, and 12 respectively. IOP remained below pretreatment levels throughout the postoperative period (P

A exposição excessiva à radiação solar é um dos principais contribuintes para o desenvolvimento do câncer de pele e fotoenvelhecimento. A fotoproteção oral tem sido utilizada como uma nova estratégia para o cuidado da pele, mesmo não sendo utilizada no lugar dos filtros solares tópicos ela pode agir de forma complementar a estes. Os antioxidantes orais parecem ser bons candidatos para reduzir os danos mediados pela radiação ultravioleta e prevenir as consequências para a saúde em razão da exposição excessiva. O objetivo deste estudo é revisar sistematicamente a utilização de antioxidantes orais na fotoproteção, identificando quais os principais antioxidantes orais existentes com evidências científicas comprovadas, evidenciando o mecanismo de ação de cada um deles, bem como demonstrar os possíveis efeitos no fotoenvelhecimento e câncer de pele. Para isso foi realizada uma pesquisa nas bases de dados: Science Direct, Pubmed, Scielo e Lilacs. Os critérios utilizados para a seleção dos artigos foram: artigos científicos relacionados com a temática em estudo, artigos disponíveis integralmente na internet, estudos pré-clínico in vitro e em animais (in vivo) e estudos clínicos em humanos. Um total de 16 artigos abordaram acerca de substâncias que possuem potenciais antioxidantes e que são candidatas a fornecer os efeitos fotoprotetores contra radiação UV. No entanto, não foi verificada nenhuma substância com evidência científica comprovada, quanto ao mecanismo de ação, foram encontradas poucas evidências e essas ainda são preliminares. E os efeitos antienvelhecimento e anticarcinogênico, nenhuma substância evidenciou a capacidade de atenuar estes danos.

Multiple myeloma (MM) patients are at higher risk for severe COVID-19. Their mRNA vaccination response against SARS-CoV-2 is unknown. Thus, we analyzed responses to mRNA vaccination against COVID-19 among these patients. Using an ELISA-based assay that detects IgG antibodies to SARS-CoV-2 spike protein, we determined serum antibody levels prior to immunization and 12–21 and 14–21 days following the first and second vaccinations, respectively, with mRNA-1273 (Moderna) or BNT162b2 (Pfizer/BioNTech) among 103 MM patients (96 and 7 with active and smoldering disease, respectively). We stratified patients into clinically relevant responders (>250 IU/mL), partial responders (50–250 IU/mL, which was above pre-COVID-19 background), and nonresponders ( second line of treatment, and among those not in complete remission. Patients who received mRNA-1273 vaccine had higher anti-spike antibody levels than those who were vaccinated with BNT162b2. Thus, most MM patients have impaired responses to mRNA vaccination against COVID-19, and specific clinical and myeloma-related characteristics predict vaccine responsiveness.

Introduction: Malocclusion is a pathology which has caused by multifactorial factores, being related to a lot of factors, as breastfeeding and deleterious oral habits. Objectives: The objective of this work was to verify the prevalence and association between time and type of breastfeeding with the installation of deleterious oral habits and consequential malocclusions. Materials and Methods: This is a transversal-type, observational, descriptive study, which evaluated 297 children, aged from three to five years, enrolled in municipal kindergartens. The first phase was carried out with a form directed to parents and guardians and collected information on the lactation period, presence of deleterious oral habits (DOH) and socioeconomic data. The second step consisted of the clinical occlusal examination of children whose parents or guardian had signed the Informed Consent Form and that were within the inclusion criteria of the survey. The data analysis was conducted at a level of significance of 5% through the tests χ2 and odds ratio, the OddsRatio were determined by formula OR = ad/bc, both processed in the software SPSS version 14.0. Results: Deleterious oral habits had a prevalence of 96.6% in the sample, the average time of exclusive breastfeeding was 4.57 months. The habit of highest incidence was the bottle suction, present in 69% of children, but the pacifier was the main responsible for developing malocclusions. Conclusion: The obtained data allow concluding that the breastfeeding time influenced directly the presence of deleterious oral habits and malocclusions in the primary dentition, and that digital sucking habits, pacifier sucking and baby’s bottle are associated with malocclusions in the studied population. Key words: Breastfeeding, Children, Habits, Malocclusion, Oral Health.

Introdução: As pneumoconioses correspondem a um grupo de doenças causadas pela inalação e acúmulo de poeira nos pulmões relacionado ao ambiente de trabalho. No âmbito mundial, o número de casos desta patologia aumentou em 66,0% de 1990 a 2017. Objetivo: Descrever dados epidemiológicos notificados e relacionados ao acometimento dos trabalhadores por pneumoconioses, no período de 2017 a 2019, no estado de São Paulo. Métodos: Trata-se de um estudo descritivo que aborda informações sociodemográficas e profissionais dos casos de pneumoconioses notificados no estado entre 2017 a 2019. Os dados foram coletados no Sistema de Informação de Agravos de Notificação. Resultados: Houve 721 notificações de pneumoconiose, com uma média de 240 casos/ano. A doença foi mais frequente em homens de 50 a 64 anos. Quanto à situação no mercado de trabalho, 73,6% dos casos ocorreram em trabalhadores registrados. A ocupação mais frequente foi servente de obras; já o ramo de atividade econômica foi o de fabricação de artefatos de concreto, cimento, fibrocimento, gesso e estuque. Entre os agentes causadores, o asbesto predominou (77,3%), seguido da sílica e da poeira mista. A maioria dos tratamentos ocorreu em regime ambulatorial, mas foram os hospitais e Centros de Referência em Saúde do Trabalhador os maiores notificadores. Considerando os Grupos de Vigilância Epidemiológica de São Paulo, observou-se o predomínio de Santo André, região com 480 notificações no período estudado. Conclusão: São necessários esforços na conscientização da importância da notificação para a construção e implantação de linha de cuidado que contemple as peculiaridades desta grave doença ocupacional.

Avaliar o reflexo da alimentação vegetariana no estado nutricional de crianças de uma escola privada que adota tal alimentação na merenda; verificar a opinião dos pais e das crianças sobre o cardápio da instituição. Obteve-se o estado nutricional através do Índice de Massa Corpórea e a opinião dos pais sobre a merenda através de questionário. O valor nutricional do cardápio foi obtido através do software DIET PRO 5®. Obteve-se a opinião dos estudantes sobre a merenda através de escala hedônica. Observou-se inadequação em todos os macro e micronutrientes, em ao menos um dia da semana. As refeições eram bem aceitas pelas crianças, das quais 75% apresentaram eutrofia. 87% das famílias achavam a merenda vegetariana uma boa ideia; 3% tinham a opinião contrária e 10% eram indiferentes. Apesar da boa aceitação da merenda vegetariana e predominância da eutrofia, o acompanhamento profissional é importante, evitando possíveis deficiências nutricionais.

Objectives: the aim of this study is to evaluate the impact of co-detection of Flu A and RSV using rapid immunochromatographic tests at the point of care, in pediatric patients under 2 years of age in a general hospital. Methods: a retrospective cohort study was conducted to analyze clinical outcomes in hospitalized infants with viral respiratory disease with positive results of rapid immunochromatographic test for RSV and/or Flu-A, from 2013 to 2018. A logistic regression model was adjusted to analyze predictors of orotracheal intubation during hospitalization. Results: we analyzed 220 cases: RSV (192), Flu-A (9), co-detection (19). Lethality rate was 1.8% (2 cases), and 88% (194) were under 1 year of age. Mean time of hospitalizations was higher in patients with co-detection. Variables significantly associated with orotracheal intubation were: younger age in months, comorbidities, RSV and Flu-A co-detection, and bacterial pneumonia during hospitalization. Conclusions: RSV and Flu-Aco-detection was associated with the least favorable clinical prognoses in this study. Rapid test diagnosis may provide important information at the point of care, because molecular panels are not widely accessible in general hospitals. Rapid diagnosis allows timely evaluation and treatment. Resumo Objetivos: avaliar o impacto da codetecção de Influenza A (FluA) e Vírus Sincicial Respiratório (VSR) por meio de testes imunocromatográficos rápidos em tempo real, em pacientes menores de 2 anos em hospital público e universitário. Métodos: estudo de coorte retrospectivo foi conduzido para analisar os desfechos clínicos de crianças hospitalizadas com doença respiratória viral com resultados positivos do teste rápido imunocromatográfico para VSR e/ou FluA, de 2013 a 2018. Um modelo de regressão logística foi ajustado para analisar preditores de intubação orotraqueal durante a internação. Resultados: foram analisados 220 casos: RSV (192), FluA (9) eco-detecção (19). A letalidade foi de 1,8% (2 casos) e 88% (194) casos em menores de 1 ano. O tempo médio de internação foi maior nos pacientes com codetecção. As variáveis significativamente associadas à intubação orotraqueal foram: menor idade em meses, comorbidades, codetecção de VSR e Flu-A e pneumonia bacteriana durante a internação. Conclusões: codetecção VSR e FluA foi associada a prognósticos clínicos desfavoráveis. O teste rápido fornece informações importantes a beira-leito, pois os painéis moleculares não são amplamente acessíveis em hospitais públicos. O diagnóstico rápido permite a avaliação e tratamento oportunos.

Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant's anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion. Maternal antibody-mediated fetal red blood cell destruction secondary to non-D Rh system antibodies is a significant cause of hemolytic disease of the fetus and newborn. Here, we report a rare case of severe perinatal hemolytic disease associated with maternal antibody to the e antigen. In addition to severe anemia, the infant developed hyperbilirubinemia. Resolution of the infant’s anemia and hyperbilirubinemia occurred after treatment with phototherapy, intravenous immunoglobulin, and transfusion.

Background: Bortezomib-based induction followed by high-dose melphalan (200 mg/m2) and autologous stem-cell transplantation (MEL200-ASCT) and maintenance treatment with lenalidomide alone is the current standard of care for young and fit patients with newly diagnosed multiple myeloma. We aimed to evaluate the efficacy and safety of different carfilzomib-based induction and consolidation approaches with or without transplantation and of maintenance treatment with carfilzomib plus lenalidomide versus lenalidomide alone in newly diagnosed multiple myeloma. Methods: UNITO-MM-01/FORTE was a randomised, open-label, phase 2 trial done in 42 Italian academic and community practice centres. We enrolled transplant-eligible patients with newly diagnosed multiple myeloma aged 65 years or younger with a Karnofsky Performance Status of 60% or higher. Patients were stratified according to International Staging System stage (I vs II/III) and age (

Oral diseases such as periodontitis can have a more negative influence on the quality of life of obese than in normal-weight patients. The objective of the present study was to assess the impact of one-stage full-mouth disinfection (OSFMD) therapy on the oral health-related quality of life (OHRQL) of obese and non-obese individuals with periodontitis. Fifty-five obese and thirty-nine non-obese patients were evaluated. The questionnaires oral impacts on daily performance (OIDP) and oral health and quality of life (OHQoL) were given to all patients at baseline and 6 months after periodontal treatment by the OSFMD protocol. For statistical analysis, Chi-square, the two-factor repeated-measures ANOVA, and correlation tests were used. At baseline, mean global OHQoL and OIDP scores were similar for both groups (p > 0.05). At 6 months, OSFMD resulted in OHQoL and OIDP global scores improvements in both groups (p

Left ventricular noncompaction (LVNC) is a congenital pathology that directly affects the lining walls of myocardial tissue, causing trabeculations with blood filling in the inner wall of the heart, concomitantly with the development of a mesocardial thinning. Although LVNC was described for the first time as long ago as 1984, our understanding of the disease with regard to its genetic pattern, diagnosis, clinical presentation and treatment is still scanty. LVNC can present as an isolated condition or associated with congenital heart disease, genetic syndromes or neuromuscular disease. This suggests that LVNC is not a distinct form of cardiomyopathy, but rather a morphological expression of different diseases. Recognition of the disease is of fundamental importance because its clinical manifestations are variable, ranging from the absence of any symptom to congestive heart failure, lethal arrhythmias and thromboembolic events. The study of this disease has emphasized its genetic aspects, as it may be of sporadic origin or hereditary, in which case it most commonly has an autosomal dominant inheritance or one linked to the X chromosome. Echocardiography is the gold standard for diagnosis, and magnetic resonance imaging may refine the identification of the disease, especially in those patients with non-conclusive echocardiography. This article sets out to review the main characteristics of LVNC and present updates, especially in the genetic pattern, diagnosis and treatment of the disease.

Francianne Silva Rocha,1,* Jersey Heitor da Silva Maués,2,3,* Cynthia Mara Brito Lins Pereira,4 Caroline Aquino Moreira-Nunes,5 Rommel Mário Rodriguez Burbano2,3 1Mastology Department, Ophir Loyola Hospital, Belém, PA, Brazil; 2Laboratory of Molecular Biology, Ophir Loyola Hospital, Belém, PA, Brazil; 3Laboratory of Human Cytogenetics, Institute of Biological Sciences, Federal University of Pará, Belém, PA, Brazil; 4Oncology Research Center, Hospital Universitário João De Barros Barreto, Belém, PA, Brazil; 5Laboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Fortaleza, CE, Brazil*These authors contributed equally to this workCorrespondence: Caroline Aquino Moreira-NunesLaboratory of Pharmacogenetics, Drug Research and Development Center (NPDM), Federal University of Ceará, Coronel Nunes De Melo St, n 1000, Rodolfo Teófilo, CEP: 60416-000, Fortaleza, CE, BrazilTel +55 85333668033Email carolfam@gmail.comIntroduction: Breast cancer (BC) is the second most frequent cancer worldwide. It is known that a subset of BC has amplification, and overexpression of the epidermal growth factor receptor (EGFR) and high expression of the insulin-like growth factor receptor-1 (IGF-1R) are correlated with a favorable prognosis. This study aimed to evaluate the prognostic and predictive values of the EGFR and IGF-1R in tumor samples from patients with BC and their correlation with socio-epidemiological features.Patients and Methods: We analyzed socio-epidemiological, clinical–pathological data and tumor tissues from 124 patients with BC undergoing treatment, to assess levels of EGFR and IGF-1R mRNA and protein. The predictive performance included the calculation of area-under-the-curve (AUC) to discriminate groups of patients with high and low mRNA expression associated with survival analysis within each molecular group of BC.Results: We found a significant expression increase (p < 0.001) in EGFR associated with body mass index, angiolymphatic invasion, compromised lymph nodes and follow-up in 58.1% of the triple-negative and HER overexpression tumors. The increase in IGF-IR was significant (p < 0.001) in 41.9% of luminal tumors A and B. ROC analysis showed that EGFR had a higher predictive performance (AUC = 0.891) than IGF-1R (AUC = 0.60). The Kaplan–Meier analysis indicated that only the high expression of EGFR was associated with a decreased probability of survival for patients, what did not happen with IGF-1R.Conclusion: Our results suggest that EGFR and IGF-1R expression patterns associated with the clinical characteristics of patients and biological profile influenced the evolution of BC.Keywords: breast cancer, hormonal receptors, EGFR, IGF-IR, predictive performance

Jaccoud's Arthropathy is a rare manifestation that occurs in several diseases, mainly in rheumatological diseases, with emphasis on systemic lupus erythematosus. Despite being initially described in association with rheumatic fever, this condition is characterized by deformities reducible to passive movement in the feet and hands, causing mainly fingers in the swan neck and ulnar deviation. This arthropathy involves the synovial and the periarticular region: it compromises nearby tendons, in addition to being chronic and non-erosive. Thus, Jaccoud's arthropathy may have a manifestation similar to several rheumatic comorbidities. Its identification and recognition of a reducible and non-erosive character help the clinical suspicion for diagnostic clarification. Although the initial reports of comorbidity date back a century, its treatment is based on controlling the underlying disease, in addition to preventing the loss of mobility and function of the affected joints. Surgical treatment, although described, still does not offer a good prognosis for patients.

Background Uric acid has been related to a tendency to precipitate to form crystals, presenting asymptomatically, until the formation of arthritis, tophi or renal lithiasis. Previously, the presence of asymptomatic hyperuricaemia has been associated with the presence of cardiovascular disease. Objectives To determine the association of complex coronary artery disease in patients with asymptomatic hyperuricaemia. Material and methods An observational retrospective, transversal, unicentric study was conducted in a tertiary hospital in Mexico, in the period from June 2017 to March 2019. All patients admitted for coronary angiography were included; patients with gout, use of diuretics and chronic kidney disease were excluded. Results During the study period, a total of 300 patients were collected, of which 40% presented hyperuricaemia. The patients with hyperuricaemia were older (59 vs. 63, P = .002). The group of patients with asymptomatic hyperuricaemia had a higher proportion of complex coronary lesions (64 vs. 35%, P ≤ .0001) as well as a higher SYNTAX I score (27 vs. 17, P ≤ .001). There was a higher probability of presenting complex coronary lesions in this group of patients (OR 3.4, P ≤ .0001). In addition, in the group division of uric acid levels, it was related to the presence of complex coronary lesions (Q1 = .5, P = .06), (Q2 = 2, P = .01) and (Q3 = 3, P ≤ .0001). Conclusion Asymptomatic hyperuricaemia has a higher prevalence and association of presenting complex coronary lesions.

espanolAntecedentes El acido urico se ha relacionado con la tendencia de precipitarse para formar cristales, que se presenta desde manera asintomatica hasta con artritis, tofos o litiasis renal. Con anterioridad, se ha asociado la hiperuricemia asintomatica a la presencia de enfermedad cardiovascular. Objetivos Determinar la asociacion de enfermedad arterial coronaria compleja en pacientes con hiperuricemia asintomatica. Material y metodos Se realizo estudio observacional, transversal, retrospectivo, unicentrico. En un hospital de tercer nivel de Mexico, en el periodo comprendido de junio del 2017 a marzo del 2019. Se incluyo a todos los pacientes que ingresaron para realizar angiografia coronaria; se excluyo a los pacientes con gota, uso de diureticos y enfermedad renal cronica. Resultados Durante el periodo del estudio se selecciono a un total de 300 pacientes, de los cuales 40% presentaron hiperuricemia. Los pacientes con hiperuricemia eran de mayor edad (59 vs. 63; p = 0,002). El grupo de pacientes con hiperuricemia asintomatica tuvo mayor proporcion de lesiones coronarias complejas (64 vs. 35%; p ≤ 0,0001), asi como tambien mayor puntuacion del SYNTAX I score (27 vs. 17; p ≤ 0,001). Hubo mayor probabilidad de presentar lesiones coronarias complejas en este grupo de pacientes (OR 3,4; p ≤ 0,0001). Ademas, en la division por grupos de nivel de acido urico, se relacionaba con la presencia de lesiones coronarias complejas (Q1 = 0,5; p = 0,06); (Q2 = 2; p = 0,01) y (Q3 = 3; p ≤ 0,0001). Conclusion Los pacientes con hiperuricemia asintomatica tienen mayor riesgo de presentar lesiones coronarias complejas. EnglishBackground Uric acid has been related to a tendency to precipitate to form crystals, presenting asymptomatically, until the formation of arthritis, tophi or renal lithiasis. Previously, the presence of asymptomatic hyperuricaemia has been associated with the presence of cardiovascular disease. Objectives To determine the association of complex coronary artery disease in patients with asymptomatic hyperuricaemia. Material and methods An observational retrospective, transversal, unicentric study was conducted in a tertiary hospital in Mexico, in the period from June 2017 to March 2019. All patients admitted for coronary angiography were included; patients with gout, use of diuretics and chronic kidney disease were excluded. Results During the study period, a total of 300 patients were collected, of which 40% presented hyperuricaemia. The patients with hyperuricaemia were older (59 vs. 63, P = .002). The group of patients with asymptomatic hyperuricaemia had a higher proportion of complex coronary lesions (64 vs. 35%, P ≤ .0001) as well as a higher SYNTAX I score (27 vs. 17, P ≤ .001). There was a higher probability of presenting complex coronary lesions in this group of patients (OR 3.4, P ≤ .0001). In addition, in the group division of uric acid levels, it was related to the presence of complex coronary lesions (Q1 = .5, P = .06), (Q2 = 2, P = .01) and (Q3 = 3, P ≤ .0001). Conclusion Asymptomatic hyperuricaemia has a higher prevalence and association of presenting complex coronary lesions.