Lipodystrophy related to HIV-The Brazilian Public Health approach.

BACKGROUND: Lipodystrophy associated with the human immunodeficiency virus (HIV) is an unpleasant disorder found in 6%-80% of patients infected with HIV. Brazil has a universal public health system, an effective program for patients diagnosed with HIV, providing lipodystrophy treatment since 2004. The objective of this article is to describe the Brazilian approach to this complication. METHOD: A search in the Brazilian Health Care Legislation and the Brazilian Health System database was conducted to identify all the inclusion criteria and surgical treatment offered to HIV patients with lipodystrophy, identify all the facilities that offer this, and describe their geographic distribution. In addition, the number of procedures performed was obtained. RESULTS: The inclusion criteria were the following:1 diagnosis of HIV/AIDS and lipodystrophy due to the use of antiretroviral drugs for at least 12 months;2 no response or the impossibility of changing ART;3 clinical stability for six months without clinical manifestations suggestive of immunodeficiency in the last 6 months;4 laboratory results showing CD4 cell count >250 cells/mm3 and viral load <10,000 copies/ml in the last 6 months; and5 stable clinical and laboratory parameters. A total of 4,760 procedures were performed, with the most common procedure being facial filler with polymethylmethacrylate. Eleven hospitals were registered to offer this treatment. CONCLUSION: The Brazilian Health Care System approach to lipodystrophy has an organized plan with universal and integral coverage. All the procedures offered were safe and well-tolerated, according to the literature. However, regional distribution is the main issue and needs to be improved.

Facial Fractures Related to Soccer.

ABSTRACT: Soccer is one of the most popular sports in the world. Despite the concept that soccer is not a violent game, it can lead to several injuries in amateur and professional settings, including facial fractures. Previous studies of facial fractures in soccer were all retrospective and, to date, no prospective studies are available in the literature.The authors performed a comprehensive literature search using the terms "soccer" AND "facial fracture" OR "craniofacial fracture" and "football" AND "facial fracture" OR "craniofacial fracture" and retrieved 693 articles. After applying inclusion and exclusion criteria, 11 articles were included in the present study.A total of 647 patients had suffered facial trauma, with a male-to-female ratio of 63.7:1. The patients' mean age was 27.3 years.The articles reported 670 fractures as follows: 219 (32.7%) in the zygoma, 197 (29.4%) in the nasal bone, 153 (23.6%) in the mandibula, 54 (8.0%) in the orbital wall, 12 (1.8%) in the frontal sinus, 10 (1.5%) in the alveolar bone, 3 (0.4%) in the maxilla, 3 (0.4%) in a Le Fort pattern, and 1 (0.1%) in a naso-orbito-ethmoid (NOE) pattern.Sports are a frequent cause of maxillofacial trauma and are responsible for 9.2% to 33.2% of such injuries. Soccer is a contact sport more associated with lower-limb injuries, but with a significant rate of facial fractures. As soccer is a popular sport played without facial protection and involving high-intensity movements and contact, the prevention of facial fractures related to this sport is crucial to improve the players' safety.