Successful treatment of lipoid pneumonia associated with bowel obstruction by Ascaris lumbricoides.

Partial bowel obstruction is a serious complication of ascariasis infestation generally treated with mineral oil. This prospective study aimed to evaluate the efficacy of multiple bronchoalveolar lavages (BAL) as a therapeutic strategy for reducing lung inflammation of lipoid pneumonia associated with ascariasis. The study included five children (mean age 25 months) with partial small-bowel obstruction by Ascaris lumbricoides, who underwent diagnostic bronchoalveolar lavage for assessment of refractory pneumonia. Routine biochemical, microbiological and cytological analysis were carried out in the BAL. Protein, lactate dehydrogenase and tumor necrosis factor-alpha (TNF-α) cytokine levels were determined in the serum before and after treatment. At admission, children consistently had respiratory symptoms, altered hematological function, increased immunoglobulin E serum level and peripheral blood eosinophilia. Chest tomography showed consolidation with air bronchogram (4/4), ground-glass infiltration (3/4) and decreased attenuation in the consolidation areas (2/4). Presence of marked pleocytosis with Sudan positive foamy alveolar macrophages, high protein and lactate dehydrogenase levels in the BAL indicated presence of mixed alveolitis. One child with extensive consolidation and air bronchogram in both lungs died before treatment. Multiple bronchoalveolar lavages efficiently removed alveolar oil deposits, restored BAL cellularity, improved clinical symptoms, radiological parameters and further reduced inflammatory reaction evidenced by marked decrease of the inflammatory cytokine, TNF-α. This study presents a therapeutic strategy for management of lung complications caused by mineral oil administration to treat intestinal bowel obstruction associated with ascariasis.

Pediatric tuberculosis in the metropolitan area of Rio de Janeiro.

AIM: To evaluate the clinical characteristics, diagnostic approach, and treatment outcomes of tuberculosis (TB) in children living in a high-burden metropolitan area. METHODS: This was a retrospective study, based on a medical chart review, involving children under 15 years old treated for TB between 2007 and 2016, in four primary health units (PHU) and three reference centers (RC) in five cities of Rio de Janeiro metropolitan area. Factors associated with TB treatment setting, microbiological diagnosis, and treatment outcomes were evaluated. RESULTS: A total of 544 children were enrolled; 71% were treated in PHU, 36% were under 5 years old, and 72% had pulmonary TB (PTB). The HIV prevalence was 10% (31/322). Fifty-three percent had at least one microbiological test for TB, 68% of them (196/287) had TB confirmed. Among 222 children with previous TB contact, information on LTBI was available for 78 (35%), and only 17% (13/78) were treated. Extrapulmonary TB (56% vs 32%), microbiologically confirmed TB (77% vs 60%), and HIV positivity (18.5% vs 4.0%) were significantly more frequent in RC. Treatment in RC (odds ratio (OR) 3.08, 95% confidence interval (CI) 1.74-5.44) and PTB (OR 2.47, 95% CI 1.34-4.56) were independently associated with a microbiological diagnosis of TB. The treatment success rate was 85%. In the logistic regression analysis, HIV-infected children had a 2.5-fold higher risk of an unfavorable outcome (OR 2.53, 95% CI 1.0-6.38; p = 0.05). CONCLUSIONS: Opportunities for TB prevention and early TB treatment are missed due to suboptimal close contact screening. Microbiological diagnosis of TB and drug susceptibility testing in children should be made available through more sensitive and accessible tests.

Serological biomarkers for monitoring response to treatment of pulmonary and extrapulmonary tuberculosis in children and adolescents.

Key measures to halt the spread of tuberculosis (TB) include early diagnosis, effective treatment, and monitoring disease management. We sought to evaluate the use of serum immunoglobulin levels against antigens present in cell envelope of Mycobacterium tuberculosis to monitor TB treatment response in children and adolescents with pulmonary (PTB) or extrapulmonary TB (EPTB). Blood samples were collected prior to and one, two, and six months following treatment initiation. Serum immunoglobulin levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein were measured by ELISA. Serum from 53 TB patients and 12 healthy participants were analyzed. After six months of successful treatment, there was a significant decrease (p < 0.0001) in IgM levels against cardiolipin, sulfatide, mycolic acid and Mce1A protein and IgG levels against Mce1A protein when compared to baseline immunoglobulin levels. There was no significant variation in antibody levels during follow-up between participants with PTB and EPTB, confirmed and unconfirmed TB diagnosis, and HIV infection status. Antibody levels in control participants without TB did not decrease during follow-up. These results suggest that immunoglobulin responses to mycobacterial cell wall products may be a useful tool to monitor treatment response in children and adolescents with PTB or EPTB.

Metodologia Lean Healthcare e a Odontologia: Uma Revisão Da Literatura / Lean Healthcare Method and Dentistry: a Literature Review

O objetivo do presente estudo foi realizar uma revisão de literatura sobre a metodologia lean, avaliando sua aplicabilidade na odontologia. A pesquisa delineada é de natureza bibliográfica, descritiva e retrospectiva. Assim, foram selecionados artigos científicos que abordavam conceitos sobre metodologia lean e odontologia. As buscas foram realizadas nos bancos de dados virtuais: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SciELO) e Public MEDLINE (PubMed). Foram incluídos sobretudo artigos dos últimos 35 anos (1987-2022) e que apresentaram pelo menos o resumo, em inglês ou português, com os seguintes termos: "metodologia lean"; "gestão em saúde e odontologia". A saúde mundial sofreu uma explosão no conhecimento, na inovação e na capacidade de gerenciar as condições anteriormente fatais. Contudo, ainda está longe do padrão esperado de qualidade, resultados, custo e equidade. O lean thinking, ou pensamento enxuto, tem sido implementado em clínicas, consultórios e hospitais com o objetivo de conseguir melhorias nos processos de serviços odontológicos e de saúde bucal, resultando em melhorias significativas nos processos, qualidade do atendimento e redução de custos para as organizações. A metodologia lean pode ser aplicada na odontologia visto que pode atuar na redução de desperdícios, eliminação de redundâncias de atividades e aumento da segurança da assistência.

This study aimed to carry out a literature review on the lean method, assessing its applicability in dentistry. The research has a bibliographic, descriptive, and retrospective scope. Thus, we selected scientific articles that addressed concepts on the lean method and dentistry. We researched the following databases: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Biblioteca Regional de Medicina (BIREME), Scientific Electronic Library Online (SciELO), and Public MEDLINE (PubMed). We included, essentially, articles from the last 35 years (1987-2022) with abstracts (in English or Portuguese) that presented the following terms: "Lean Methodology" and "Health Management and Dentistry." Worldwide healthcare has experienced an explosion in knowledge, innovation, and the ability to manage formerly fatal conditions. However, it is still far from the expected standard of quality, results, cost, and equity. Lean Methodology has been implemented in clinics, offices, and hospitals to attain improvements in dental and oral health service processes, resulting in significant advances in these, as well as in the quality of care and cost reduction for organizations. The Lean Method can be applied in dentistry since it can act in reducing waste, eliminating redundancies in activities, and increasing the safety of care.

Draft Genome Sequence of a Community-Associated Methicillin-Resistant Panton-Valentine Leukocidin-Positive Staphylococcus aureus Sequence Type 30 Isolate from a Pediatric Patient with a Lung Infection in Brazil.

The sequence of methicillin-resistant Staphylococcus aureus strain B6 (sequence type 30 [ST30], spa type t433, staphylococcal chromosomal cassette mec element [SCCmec] type IVc, Panton-Valentine leukocidin [PVL] positive), isolated from a pediatric patient with a lung infection in Niterói, Rio de Janeiro, Brazil, is described here. The draft genome sequence includes a 2.8-Mb chromosome, accompanied by a 20-kb plasmid containing blaZ and two small cryptic plasmids.