Covid-19 and its Correlation with Thromboembolic and Cardiovascular Events: a Systematic Review / Covid-19 e sua Correlação com Eventos Tromboembólicos e Cardiovasculares: uma Revisão Sistemática

Abstract Identified in China in December 2019 as a new class of viral pneumonia of unknown origin, the new Coronavirus has already passed the milestone of 100 million people infected worldwide. The clinical course of this infection is characterized by fever, cough, upper airway congestion and complications related to Acute Respiratory Distress Syndrome. In addition, the virus can have repercussions that go beyond the impairment of the respiratory system, affecting other systems. Therefore, the aim of this study is to describe the correlation between Covid-19 and thromboembolic and cardiovascular events. It is a Systematic Review that was submitted to searches in the PubMed, SciELO, Lilacs and Bireme databases. Six observational studies comprising 1539 patients were included in this review. The quality of the articles was evaluated according to the New Castle-Ottawa scale. After extracting data from the studies, it was observed that hospitalized patients diagnosed with Covid-19 infection are more likely to develop Venous Thromboembolism (VTE) and Pulmonary Embolism (PE), as well as cardiovascular events, although the latter are less frequent. These patients also have alterations in the pulmonary parenchyma, being proportional to the severity of the case, as well as the prevalence of d-dimer, the rate of thrombosis in the pulmonary artery, the need for intensive care and the mortality rate. Thus, the severe form of infection by Covid-19 manifests consequences that do not only involve the respiratory system, compromising the blood clotting of affected patients, leading to a higher incidence of thromboembolic and cardiovascular events. (AU)

Resumo Identificado na China em dezembro de 2019 como uma nova classe de pneumonia viral, de origem desconhecida, o novo Coronavírus já ultrapassou o marco de 100 milhões de pessoas infectadas em todo o mundo. A evolução clínica desta infecção é caracterizada por febre, tosse, congestão das vias aéreas superiores e complicações relacionadas a um quadro de Síndrome do Desconforto Respiratório Agudo. Além disso, o vírus pode apresentar repercussões que vão além do comprometimento do sistema respiratório, afetando outros sistemas. Portanto, o objetivo deste estudo é descrever a correlação entre a Covid-19 e os eventos tromboembólicos e cardiovasculares. Trata-se de uma Revisão Sistemática que foi submetida a pesquisas nos bancos de dados PubMed, SciELO, Lilacs e Bireme. Foram incluídos 6 estudos observacionais envolvendo 1539 pacientes nesta revisão. A qualidade dos artigos foi avaliada de acordo com a escala New Castle-Ottawa. Após a extração de dados dos estudos, observou-se que pacientes hospitalizados e diagnosticados com infecção por Covid-19 apresentam maior predisposição a desenvolver Tromboembolismo Venoso (TEV) e Embolia Pulmonar (EP), bem como eventos cardiovasculares, apesar destes últimos serem menos frequentes. Estes pacientes também cursam com alterações do parênquima pulmonar sendo proporcionais a gravidade do caso, assim como a prevalência de d-dímero, a taxa de trombose na artéria pulmonar, a necessidade de cuidados intensivos e a taxa de mortalidade. Assim, a forma grave da infecção por Covid-19 manifesta consequências que não envolvem apenas o sistema respiratório, comprometendo a coagulação sanguínea dos pacientes acometidos levando a maior incidência de eventos tromboembólicos e cardiovasculares. (AU)

Oral Juvenile Xanthogranuloma: A Clinicopathological, Immunohistochemical and BRAF V600E Study of Five New Cases, with Literature Review.

Juvenile xanthogranuloma (JXG) is the most common form of non-Langerhans cell histiocytosis and oral mucosal involvement is exceedingly rare. Histiocytic disorders harbor activating mutations in MAPK pathway, including the report of BRAF V600E in JXG of extracutaneous site. However, no information is available for oral JXG. Herein, the clinicopathological and immunohistochemical features of five new oral JXG were evaluated in conjunction with literature review. Also, we assessed the BRAF V600E in oral samples. Five oral JXG were retrieved from pathology archives. Morphological and immunohistochemical analyses were performed. The BRAF V600E status was determined with TaqMan allele-specific qPCR. The series comprised of three female and two male patients, most of them adults, with a median age of 39 years (range 13-68 years). Clinically, the lesions appeared as asymptomatic solitary nodules, measuring until 2.5 cm, with more incident to the buccal mucosa. Morphologically, most of the cases presented classical histological features of JXG, with histiocytic cells consistent with the non-Langerhans cell immunophenotype. BRAF V600E was not detected in the cases tested. This is the first and largest published series of oral JXG affecting adults and a Brazilian population. The molecular pathogenesis of oral JXG remains unknown. Clinicians and pathologists must recognize JXG to avoid misdiagnoses with oral benign or malignant lesions.

Incidence, characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department.

BACKGROUND: Diabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design. OBJECTIVE: To describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years. DESIGN AND SETTING: Prospective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil. METHODS: All patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate. RESULTS: The incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission. CONCLUSIONS: Diabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.

Fat-free pleomorphic lipoma of the buccal mucosa: An immunohistochemical study and literature review.

Pleomorphic lipomas are extremely rare in the oral cavity. Due to the significant overlap of morphological findings with several benign and malignant soft tissue tumors, especially in the absence of adipocytes, the diagnosis is challenging. We reported the clinicopathological and immunohistochemical features of an uncommon case of a fat-free variant of pleomorphic lipoma in a 48-year-old female presenting clinically as a painless nodule on the buccal mucosa. Microscopically, the lesion showed atypical spindle cells, numerous floret-like giant multinucleated cells, and abundant ropey collagen fibers bundles. Immunohistochemistry showed strong positivity for vimentin and CD34. Mast cell tryptase highlighted numerous mast cells distributed throughout all tumor stroma. S-100 protein, pan-cytokeratin, desmin, α-SMA, EMA, CD68, STAT6, Bcl-2, MDM2, and CDK4 were negative. Conservative surgical excision was carried out, and no recurrence was observed after 13 months of follow-up. Careful histopathological and immunohistochemistry analysis of these lesions is recommended to ensure the correct diagnosis and provide adequate management through a conservative surgical approach. To the best of our knowledge, this is the second case of fat-free pleomorphic lipoma in the oral cavity.

Intervenção fisioterapêutica em uma criança com coronavírus em um hospital de referência: relato de caso / Physiotherapeutic intervention in a child with coronavirus in a reference hospital: case report

INTRODUÇÃO: Apesar de apresentar-se em menor frequência, os casos graves do COVID-19 podem também afetar a população pediátrica. Considerando este fato, constata-se a eficácia da fisioterapia, que consiste numa especialidade terapêutica que exerce papel fundamental na prevenção e tratamento de complicações pulmonares. OBJETIVO: Descrever o quadro clínico de uma criança portadora de Cardiopatia Congênita com Coronavírus positivo e abordar a atuação fisioterapêutica pediátrica. MATERIAIS E MÉTODOS: Trata-se de um relato de caso de uma paciente de 5 anos e 11 meses de idade, com diagnóstico antecedente de Cardiopatia Congênita dos tipos: Persistência do Canal Arterial e Comunicação Interventricular. A paciente foi admitida na Unidade de Terapia Intensiva Pediátrica do Instituto Couto Maia apresentando-se taquicárdica, taquipneica, com saturação periférica de oxigênio (SpO2) de 85% em uso de máscara não reinalante, com aumento do trabalho ventilatório e tosse produtiva ao comando verbal. Ao realizar RT-PCR obteve resultado positivo para o Coronavírus. RESULTADOS: Os dados coletados por meio de análise de prontuário e observação clínica da paciente demonstraram que a intervenção fisioterapêutica, quando contou com técnicas de higiene brônquica, manobras reexpansivas e condutas motoras ativas, contribuiu com a evolução clínica da paciente evidenciando melhora na SpO2 e no desconforto ventilatório. CONCLUSÃO: As intervenções fisioterapêuticas aplicadas a este perfil de paciente, demonstraram resultados positivos no que diz respeito a melhora das trocas gasosas e desconforto respiratório, bem como parece influenciar a redução do risco de declínio funcional.

INTRODUCTION: Despite presenting less frequently, severe cases of COVID-19 can also affect the pediatric population. Considering this fact, the effectiveness of physiotherapy is evidenced, which consists of a therapeutic specialty that plays a fundamental role in the prevention and treatment of pulmonary complications. OBJECTIVE: To describe the clinical picture of a child with Congenital Heart Disease with positive Coronavirus and to address pediatric physiotherapeutic activities. MATERIALS AND METHODS: This is a case report of a 5-year 11-month-old patient with a previous diagnosis of Congenital Heart Disease of the following types: Artery Channel Persistence and Interventricular Communication. The patient was admitted to the Pediatric Intensive Care Unit of the Couto Maia Institute, presenting tachycardia, tachypnea, with peripheral oxygen saturation (SpO2) of 85% using a non-reinalin mask, with increased ventilatory work and productive cough at the verbal command. When performing RT-PCR, he obtained a positive result for the Coronavirus. RESULTS: The data collected through the analysis of medical records and clinical observation of the patient demonstrated that the physical therapy intervention, when using bronchial hygiene techniques, reexpansive maneuvers and active motor conducts, contributed to the clinical evolution of the patient, showing improvement in SpO2 and ventilatory discomfort. CONCLUSION: Physiotherapeutic interventions applied to this patient profile have shown positive results with regard to the improvement of gas exchange and respiratory discomfort, as well as appearing to influence the reduction in the risk of functional decline.

Incidence, characteristics and long-term outcomes of patients with diabetic ketoacidosis: a prospective prognosis cohort study in an emergency department

ABSTRACT BACKGROUND: Diabetic ketoacidosis is the most frequent hyperglycemic complication in the evolution of diabetes mellitus. Common precipitating factors include newly diagnosed diabetes mellitus, noncompliance with therapy and infections. However, few studies have been conducted in Brazil and none were prospective in design. OBJECTIVE: To describe the incidence, clinical and laboratory characteristics and precipitating factors of diabetic ketoacidosis among emergency department patients in a tertiary-level teaching hospital in Brazil. We also aimed to identify immediate and long-term mortality within two years. DESIGN AND SETTING: Prospective prognosis cohort study conduct at a tertiary-level teaching hospital in São Paulo, Brazil. METHODS: All patients > 12 years old presenting diabetic ketoacidosis who were admitted to the emergency department from June 2015 to May 2016 were invited to participate. RESULTS: The incidence of diabetic ketoacidosis per 1,000 admissions was 8.7. Treatment noncompliance and infection were the most common causes of diabetic ketoacidosis. The immediate mortality rate was 5.8%, while the six-month, one-year and two-year mortality rates were 9.6%, 13.5% and 19.2%, respectively. Death occurring within two years was associated with age, type 2 diabetes, hypoalbuminemia, infection at presentation and higher sequential organ failure assessment (SOFA) score at admission. CONCLUSIONS: Diabetic ketoacidosis among patients presenting to the emergency department was relatively frequent in our hospital. Treatment noncompliance and infection were major precipitating factors and presence of diabetic ketoacidosis was associated with immediate and long-term risk of death.

Sialolipomas of minor salivary glands: A multi-institutional study and literature review.

BACKGROUND: Sialolipoma is a rare histological variant of lipoma commonly misdiagnosed and composed of a proliferation of mature adipocytes with secondary entrapment of normal salivary gland tissue. The purpose of the present study is to report the clinicopathologic and immunohistochemical features of 10 new cases of sialolipomas in conjunction with a review of the literature. METHODS: A retrospective descriptive cross-sectional study was performed. A total of 54,190 biopsy records of oral and maxillofacial lesions from four oral and maxillofacial pathology services in Brazil were analysed. All cases of lipomas were reviewed, and clinical, demographic and histopathological data were collected of all cases compatible with sialolipomas. In addition, immunohistochemistry stains (AE1/AE3, CK7, 34ßE12, S-100, HHF35, α-SMA and Ki-67) and a literature review based on a search of three electronic databases (PubMed, Web of Science and Scopus) were performed. RESULTS: Among all lipomas reviewed, there were 10 cases of sialolipomas. The series comprised of 7 females (70.0%) and 3 males (30.0%), with a mean age of 46.1 ± 21.5 years (range: 11-71 years) and a 2.3:1 female-to-male ratio. The lower lip (n = 3, 30.0%) and tongue (n = 2, 20.0%) were the most common locations, presenting clinically as a nodule of slow growth and normal colour. Conservative surgical excision was the treatment in all cases. No recurrence was observed. CONCLUSION: Sialolipomas are a rare histological variant of lipoma, affecting the salivary glands, mainly in the parotid gland and palate of female adults. Pathologists must recognise sialolipomas to avoid misdiagnoses with other lipomatous tumours that can affect salivary glands.

Antinociceptive Effect of the Essential Oil of Schinus terebinthifolius (female) Leaves on Adult Zebrafish (Danio rerio).

Schinus terebinthifolius Raddi (Anacardiaceae) is popularly known in Brazil as aroeira-da-praia and has pharmacological use as an astringent, antidiarrheal, anti-inflammatory, depurative, diuretic, and antifebrile agent. Although the neuropathic antinociceptive potential of S. terebinthifolius fruits has already been investigated, this study is the first one to analyze the acute antinociceptive effect of the essential oil of S. terebinthifolius (female) leaves (EOFSt) on adult zebrafish. EOFSt was submitted to antioxidant activity evaluation by two methods (ferrous ion-chelating capacity [FIC] and ß-carotene). The animals (n = 6/group) were treated orally (20 µL) with EOFSt (0.1, 0.5, or 1.0 mg/mL) or vehicle (0.9% sodium chloride [NaCl]; 20 µL), and submitted to nociception (formalin, cinnamaldehyde, capsaicin, glutamate, acidic saline, and hypertonic saline). Possible neuromodulation mechanisms, as well motor alterations and toxicity were also evaluated. In the FIC assay, EOFSt showed ferrous ion-chelating capacity in ∼40% to 90%. Regarding the ß-carotene bleaching assay, EOFSt showed inhibition in a 58% to 80% range. Oral administration of EOFSt showed no acute toxicity and did not alter the locomotor system of aZF, and reduced the nociceptive behavior in all tested models. These effects of EOFSt were significantly similar to those of morphine, used as a positive control. The antinociceptive effect of EOFSt was inhibited by naloxone, L-NAME, ketamine, camphor, ruthenium red, and amiloride. The antinociceptive effect of the EOFSt cornea was inhibited by capsazepine. EOFSt has the pharmacological potential for acute pain treatment and this effect is modulated by the opioid system, NMDA receptors, and transient receptor potential ankyrin 1 (TRPA1), transient receptor potential vanilloid 1 (TRPV1), and acid-sensing ion channels. The EOFSt also has the pharmacological potential for corneal pain treatment and this effect is modulated by the TRPV1 channel.

Need for dental treatment in patients on the waiting list for liver and simultaneous pancreas-kidney transplant at a single center. / Necessidade de tratamento odontológico em pacientes candidatos a transplante simultâneo de pâncreas-rim e fígado num centro único.

OBJECTIVE: to evaluate the oral conditions and the main predisposing factors for dental treatment of patients on the waiting list for liver and simultaneous pancreas-kidney transplantation, in a single center. METHODS: we evaluated 100 patients in the waiting list, 50 candidates for liver transplantation and 50 for simultaneous kidney-pancreas transplantation, from August 2015 to February 2018. We correlated extra and intraoral examinations with pre-transplant demographic variables. RESULTS: the main oral alteration in the pancreas-kidney and liver transplant candidates were decayed, lost and filled teeth, present in 83% and 100% of the candidates, respectively (p=0.03). The need for dental treatment was equal in both groups: 71% and 70%. In liver transplant candidates, the predisposing factors for dental treatment were age, color and etiological diagnosis of liver cirrhosis. We did not identify predisposing factors for dental treatment in candidates for simultaneous pancreas-kidney transplant. CONCLUSION: candidates for liver and for simultaneous pancreas-kidney transplantation had poor oral hygiene, with cavities, residual roots, gingivitis and periodontitis, revealing that dental evaluation should be part of the transplantation waiting list.

OBJETIVO: avaliar as condições bucais e os principais fatores predisponentes para tratamento odontológico de pacientes em lista de espera para transplante simultâneo de pâncreas-rim e para transplante hepático, em um centro único. MÉTODOS: foram avaliados 100 pacientes na fila de espera, 50 candidatos a transplante hepático e 50 a transplante simultâneo de pâncreas-rim, no período de agosto de 2015 a fevereiro de 2018. Exames extra e intrabucais foram correlacionados com variáveis demográficas pré-transplante. RESULTADOS: a principal alteração bucal nos candidatos a transplante de pâncreas-rim e de transplante hepático foram dentes cariados, perdidos e obturados, presentes em 83% e 100% dos candidatos, respectivamente (P=0,03). A necessidade de tratamento odontológico foi igual nos dois grupos: 71% e 70%. Nos candidatos a transplante hepático, os fatores predisponentes para tratamento odontológico foram idade, cor e diagnóstico etiológico da cirrose hepática. Não identificamos fatores predisponentes para tratamento odontológico nos candidatos a transplante simultâneo pâncreas-rim. CONCLUSÃO: pacientes candidatos a transplante simultâneo de pâncreas-rim e transplante hepático apresentaram higiene bucal precária com presença de cárie, raízes residuais, gengivite e periodontite, revelando que a avaliação odontológica deve fazer parte do protocolo de atendimento dos pacientes em fila de espera para transplantes.

What do Cochrane systematic reviews say about the management of irritable bowel syndrome?

BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.

What do Cochrane systematic reviews say about the management of irritable bowel syndrome?

ABSTRACT BACKGROUND: Irritable bowel syndrome (IBS) is a clinical disorder associated with high socioeconomic burden. Despite its importance, management of IBS remains difficult and several interventions have been hypothesized as beneficial for this condition. This study identified and summarized all Cochrane systematic reviews (SRs) about the effects of interventions for managing IBS patients. DESIGN AND SETTING: Review of systematic reviews, carried out in the Discipline of Evidence-Based Medicine, Escola Paulista de Medicina (EPM), Universidade Federal de São Paulo (UNIFESP). METHODS: Review of Cochrane SRs addressing interventions for IBS. RESULTS: We included six SRs assessing acupuncture, bulking agents, antispasmodics, antidepressants, herbal medicines, homeopathy, hypnotherapy and psychological therapy for IBS. The certainty of evidence ranged from unknown to moderate, mainly due to imprecision in the estimates and high risk of bias from the primary studies included. There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life, compared with sham acupuncture. There was also very low certainty of evidence that homeopathic asafoetida, used alone or in association with nux, was better than placebo regarding self-reported overall improvement. CONCLUSION: There was moderate certainty of evidence that acupuncture had no important benefit regarding improvement of symptoms and quality of life. Further well-designed and well-conducted randomized clinical trials are needed in order to reduce the uncertainties regarding the most commonly used interventions for patients with IBS.

Mutational mechanism for DAB1 (ATTTC)n insertion in SCA37: ATTTT repeat lengthening and nucleotide substitution.

Dynamic mutations by microsatellite instability are the molecular basis of a growing number of neuromuscular and neurodegenerative diseases. Repetitive stretches in the human genome may drive pathogenicity, either by expansion above a given threshold, or by insertion of abnormal tracts in nonpathogenic polymorphic repetitive regions, as is the case in spinocerebellar ataxia type 37 (SCA37). We have recently established that this neurodegenerative disease is caused by an (ATTTC)n insertion within an (ATTTT)n in a noncoding region of DAB1. We now investigated the mutational mechanism that originated the (ATTTC)n insertion within an ancestral (ATTTT)n . Approximately 3% of nonpathogenic (ATTTT)n alleles are interspersed by AT-rich motifs, contrarily to mutant alleles that are composed of pure (ATTTT)n and (ATTTC)n stretches. Haplotype studies in unaffected chromosomes suggested that the primary mutational mechanism, leading to the (ATTTC)n insertion, was likely one or more T>C substitutions in an (ATTTT)n pure allele of approximately 200 repeats. Then, the (ATTTC)n expanded in size, originating a deleterious allele in DAB1 that leads to SCA37. This is likely the mutational mechanism in three similar (TTTCA)n insertions responsible for familial myoclonic epilepsy. Because (ATTTT)n tracts are frequent in the human genome, many loci could be at risk for this mutational process.

Necessidade de tratamento odontológico em pacientes candidatos a transplante simultâneo de pâncreas-rim e fígado num centro único / Need for dental treatment in patients on the waiting list for liver and simultaneous pancreas-kidney transplant at a single center

RESUMO Objetivo: avaliar as condições bucais e os principais fatores predisponentes para tratamento odontológico de pacientes em lista de espera para transplante simultâneo de pâncreas-rim e para transplante hepático, em um centro único. Métodos: foram avaliados 100 pacientes na fila de espera, 50 candidatos a transplante hepático e 50 a transplante simultâneo de pâncreas-rim, no período de agosto de 2015 a fevereiro de 2018. Exames extra e intrabucais foram correlacionados com variáveis demográficas pré-transplante. Resultados: a principal alteração bucal nos candidatos a transplante de pâncreas-rim e de transplante hepático foram dentes cariados, perdidos e obturados, presentes em 83% e 100% dos candidatos, respectivamente (P=0,03). A necessidade de tratamento odontológico foi igual nos dois grupos: 71% e 70%. Nos candidatos a transplante hepático, os fatores predisponentes para tratamento odontológico foram idade, cor e diagnóstico etiológico da cirrose hepática. Não identificamos fatores predisponentes para tratamento odontológico nos candidatos a transplante simultâneo pâncreas-rim. Conclusão: pacientes candidatos a transplante simultâneo de pâncreas-rim e transplante hepático apresentaram higiene bucal precária com presença de cárie, raízes residuais, gengivite e periodontite, revelando que a avaliação odontológica deve fazer parte do protocolo de atendimento dos pacientes em fila de espera para transplantes.

ABSTRACT Objective: to evaluate the oral conditions and the main predisposing factors for dental treatment of patients on the waiting list for liver and simultaneous pancreas-kidney transplantation, in a single center. Methods: we evaluated 100 patients in the waiting list, 50 candidates for liver transplantation and 50 for simultaneous kidney-pancreas transplantation, from August 2015 to February 2018. We correlated extra and intraoral examinations with pre-transplant demographic variables. Results: the main oral alteration in the pancreas-kidney and liver transplant candidates were decayed, lost and filled teeth, present in 83% and 100% of the candidates, respectively (p=0.03). The need for dental treatment was equal in both groups: 71% and 70%. In liver transplant candidates, the predisposing factors for dental treatment were age, color and etiological diagnosis of liver cirrhosis. We did not identify predisposing factors for dental treatment in candidates for simultaneous pancreas-kidney transplant. Conclusion: candidates for liver and for simultaneous pancreas-kidney transplantation had poor oral hygiene, with cavities, residual roots, gingivitis and periodontitis, revealing that dental evaluation should be part of the transplantation waiting list.

Influência da família e sucesso na carreira das executivas brasileiras / Family influence and Brazilian female executives' career success / Influencia de la familia y éxito profesional de las ejecutivas brasileñas

O objetivo deste artigo é identificar a influência dos pais na carreira das mulheres brasileiras que fizeram sucesso como executivas. Trata-se de pesquisa qualitativa descritiva com 47 executivas que conseguiram chegar aos três níveis mais altos de 27 grandes organizações. Para o tratamento dos dados foi utilizada a técnica de análise de conteúdo. Os resultados da pesquisa indicaram que, embora tenham crescido em famílias que valorizavam os estudos, foram as mães que mais influenciaram na escolha das filhas para entrar no mercado de trabalho. Mães que queriam ter vivenciado a experiência de ter um trabalho e não tiveram também projetaram esse desejo para a vida de suas filhas. Características pessoais das mães (fortes, corajosas) também influenciaram as filhas a buscarem realização profissional. Já em relação ao pai, os resultados demonstraram que o grande incentivo não foi em relação a ter uma carreira, mas sim em dar enfoque aos estudos

This article aims to identify the influence of parents in the career of Brazilian women who succeeded in the executive world. This is a descriptive and qualitative research. We interviewed 47 top executives who have managed to reach the three highest organizational levels in 27 corporations. Data treatment used the content analysis technique. Results show that, although they grew up in families that valued studying, the mothers were those who influenced more the daughters' choice to go for the labor market. Mothers who wanted to have had the experience of having a job and had not fulfilled it also transmitted that desire to their daughters. The mothers' personal characteristics (being "strong" and "brave") also influenced daughters to seek professional fulfillment. Regarding the father, the results showed that the great incentive was not to have a career, but to focus on the studies

Este artículo pretende identificar la influencia de los padres en la carrera de las mujeres brasileñas que tuvieran éxito como ejecutivas. Se trata de una investigación cualitativa descriptiva con 47 ejecutivas que llegaron a los tres niveles superiores de 27 grandes organizaciones. Los datos fueran tratados con la técnica de análisis de contenido. Los resultados indicaron que, si bien han crecido en familias que valoran los estudios, fueron las madres que más influyeron en la elección de las hijas para entrar al mercado de trabajo. Las madres que querían haber vivido la experiencia laboral y no lo habían logrado transmitieron este deseo a sus hijas. Las características personales de las madres ("ser fuerte", "valiente") también influyeron en las hijas para buscar su realización profesional. Ya con relación al padre, los resultados demostraron que el gran incentivo no fue influir para que sus hijas tuvieran una carrera, sino centrarse en los estudios

Acute pancreatitis associated with boceprevir: a case report

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.

Acute pancreatitis associated with boceprevir: a case report.

Approximately 170 million people are infected with hepatitis C, and the sustained virological response rate to treatment with pegylated interferon and ribavirin is 30-50%. In an attempt to improve the chances of cure, boceprevir is being added to therapy, but it is associated with an increased incidence of adverse events. We herein report a case of acute pancreatitis developed during treatment with pegylated interferon, ribavirin and boceprevir. Boceprevir was the most likely cause of drug-associated pancreatitis after the most common causes were ruled out, since this adverse event had not occurred when the patient had previously been exposed to pegylated interferon and ribavirin and there was no recurrence of the episode of pancreatitis when these two drugs were reintroduced. Acute pancreatitis is a rare adverse event associated with boceprevir therapy, but a potentially fatal event. Sequential determination of pancreatic enzymes should be considered during hepatitis C treatment with boceprevir.

[Clinical guideline for detection and diagnosis of hypertensive pregnancy disease]. / Guía de práctica clínica. Enfermedades hipertensivas del embarazo.

Hypertensive disorders in pregnancy (HDP) are the main complication and cause of maternal and perinatal death. Pre-eclampsia represents a 34%, according to the Secretaría de Salud de México. To offer the family physicians tools for the opportune detection and diagnosis of HDP a clinical guideline was developmented. Clinical questions were formulated and structured. A standardized sequence to search for Practice Guidelines, based on the key words: hypertensive disorders in pregnancy, pre-eclampsia. Tripdatabase, MDConsult, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, National Institute for Health and Clinical Excellence were used. In addition, Cochrane Library Plus, Science Direct and OVID were used. Most of the recommendations were taken from guidelines selected and supplemented with the remaining material. The information is expressed in levels of evidence and grade of recommendation according to the characteristics of the study design and type of publications. To reduce morbidity and mortality from HDP health professionals should identify risk factors; conduct a close monitoring and early diagnosis. It is essential to provide information to the pregnant patient on alarm data and behavior to follow. This clinical practice guide offers current evidence for screening and diagnosis of HDP in primary care.

Análise comportamental de problemas de interação social de indivíduos com psoríase / Behavioral analysis of social interaction problemas of individuals with psoriasis

Psoríase é uma doença crônica que acomete a pele de indivíduos de ambos os sexos a partir da segunda década de vida. Além do desconforto físico decorrente de sintomas como descamação e prurido, queixas referentes a dificuldades interpessoais são relatadas com frequência por pacientes que buscam atendimento médico. O indivíduo com psoríase pode apresentar dificuldades de interação social em diversos contextos pela reação negativa dos outros à aparência inestética das lesões. Por esta razão, este indivíduo tenta fugir ou esquivar-se de situações em que exista a possibilidade de exposição física, com o intuito de escapar aos olhares constantes e comentários das outras pessoas em relação à sua aparência. Quando isso não é possível, procura ocultar as lesões por meio de cosméticos (camuflagem) ou de roupas mais fechadas, mesmo em dias de clima quente. Neste artigo, os autores avaliam esse enfoque psicológico, como possíveis variáveis ambientais podem controlá-lo, alterando a probabilidade de sua ocorrência em diferentes contextos sociais.

Estresse e sofrimento no trabalho dos executivos / Estrés y sufrimiento en el trabajo de los ejecutivos / Top managers' stress and suffering at work

O objetivo deste artigo é identificar as possíveis correlações entre o padrão de comportamento e o nível de estresse percebido pelos executivos das grandes empresas no Brasil. O referencial teórico aborda os conceitos sobre o estresse baseando-se em autores que são referência na temática, como Selye (1959), Albrecht (1990), Cooper (1988) e Moraes et al. (2001). Em seguida, apresentamos o conceito do Tipo Comportamental, de Friedman e Rosenman (1976), e de autores que tratam o sofrimento no trabalho e a sua relação com o estresse, como Dejours (1992; 1994; 1996) e Codo et al. (1993). Os resultados indicaram que há predominância do padrão de comportamento Tipo A entre os executivos, que se disseram mais insatisfeitos e infelizes do que os do Tipo B em relação a aspectos profissionais e pessoais. Foram os que se percebem mais estressados, quadro manifesto no nervosismo, em ímpetos de raiva, irritabilidade fácil e ansiedade.

This article aims to identify possible relations between behavior pattern and stress level among Brazilian corporations top managers. The theoretical framework encompasses the literature on stress (Selye, 1959; Albrecht, 1990; Cooper, 1988; Moraes et al., 2001) and on types-A/B behavior patterns (Friedman e Rosenman, 1976), as well as the literature on labor-related pathologies (Dejours, 1992, 1994, 1996; Codo et al., 1993). Results show a predominance of type-A behavior. Type-A managers are more unsatisfied and unhappier concerning professional and private matters than type- B managers. Type-A managers feel more anxious, stressed, nervous and easily enraged and irritated than type-B managers.

El objetivo de este artículo es identificar las posibles correlaciones entre el patrón de comportamiento y el nivel de estrés que notan los ejecutivos de las grandes empresas en Brasil. El referencial teórico aborda los conceptos sobre el estrés basándose en autores que son referencia en esta temática, como Selye (1959), Albrecht (1990), Cooper (1988) y Moraes et al. (2001). Seguidamente presentamos el concepto del Tipo Comportamental, de Friedman y Rosenman (1976), y de autores que tratan el sufrimiento en el trabajo y su relación con el estrés, como Dejours (1992; 1994; 1996) y Codo et al. (1993). Los resultados indicaron que hay una predominancia del patrón de comportamiento Tipo A entre los ejecutivos, que se declararon más insatisfechos e infelices que los del Tipo B con relación a los aspectos profesionales y personales. Fueron los que se perciben más estresados, cuadro manifestado en el nerviosismo, en ímpetus de rabia, irritabilidad fácil y ansiedad.