Electrical burn-induced vocal cord injury: insights from a case report and literature review.

We report a rare case of vocal cord injury from an electrical burn, managed successfully with conservative, non-invasive treatment. This unique case illustrates potential complications of electrical trauma and underscores the need for vigilance and consideration of conservative management approaches.

Thinking Outside the Box: The Interventional Surgeon.

Advances in treatment of structural heart disease have been disruptive to cardiovascular surgery, and there have been discussions about how to incorporate these technologies into the surgeons' therapeutic arsenal. Transcatheter procedures, complex redo interventions, and endovascular aortic approaches are already practiced by cardiovascular surgeons in Brazil. The expansion of these techniques, coupled with recent changes in the country's medical residency program in cardiovascular surgery, has led to an urgent need to acquire catheter-based skills. In this article, we discuss these aspects in the light of the reality of cardiovascular surgery training in Brazil.

Giant Tophaceous Gout: The Importance of Therapeutic Compliance.

Gout is a metabolic disease resulting from the deposition of monosodium urate crystals in joints, tissues, and organs. Nowadays, the treatment of hyperuricemia is easily accessible and widespread and mainly consists of xanthine oxidase inhibitors and uricosurics. In refractory and advanced cases of gout, amputation surgery may be required. The authors present the case of an 85-year-old man who is non-compliant with hypouricemic medication, has exuberant gout, and has refused amputation surgery several times. The patient went to the emergency department with a triad of acute kidney injuries, acute gout, and poorly controlled pain. Cases of tophaceus gout such as the one presented are very rare nowadays.

Myocardial Injury After Transcatheter Mitral Valve Replacement Versus Surgical Reoperation.

This study aimed to evaluate the incidence and clinical implications of myocardial injury, as determined by cardiac biomarker increase, in patients who underwent mitral bioprosthesis dysfunction treatment with transcatheter mitral valve replacement (TMVR) versus surgical mitral valve replacement reoperation (SMVR-REDO). Between 2014 and 2023, 310 patients with mitral bioprosthesis failure were included (90 and 220 patients for TMVR and SMVR-REDO, respectively). Multivariable analysis and propensity score matching were performed to adjust for the intergroup differences in baseline characteristics. Creatinine kinase-MB (CK-MB) and cardiac troponin I (cTn) were collected at baseline and 6 to 12, 24, 48, and 72 hours after intervention. The cardiac biomarkers values were evaluated in relation to their reference values. The outcomes were determined according to the Mitral Valve Academic Research Consortium criteria. CK-MB and cTn increased above the reference level in almost all patients after SMVR-REDO and TMVR (100% vs 94%, respectively), with the peak occurring within 6 to 12 hours. SMVR-REDO was associated with a two- to threefold higher increase in cardiac biomarkers. After 30 days, the mortality rates were 13.3% in the TMVR and 16.8% in the SMVR-REDO groups. At a median follow-up of 19 months, the mortality rates were 21.1% in the TMVR and 17.7% in the SMVR-REDO groups. Left ventricular ejection fraction, estimated glomerular filtration rate, CK-MB, and cTn were predictors of mortality. In conclusion, some degree of myocardial injury occurred systematically after the treatment of mitral bioprosthetic degeneration, especially after SMVR, and higher CK-MB and cTn levels were associated with increased cumulative late mortality, regardless of the approach.

Presentation and outcomes of chronic kidney disease patients with COVID-19 / Apresentação e desfechos de pacientes com doença renal crônica com COVID-19

Abstract Introduction: COVID-19 is currently a global health issue and an important cause of mortality. Chronic kidney disease (CKD) is one of the risk factors for infection, morbidity and mortality by SARS-CoV-2. In our study, we aimed to evaluate the clinical presentation and outcomes of CKD patients with COVID-19, as well as identify predictors of mortality. Methods: This was a retrospective study of CKD patients admitted in a tertiary-care Portuguese hospital between March and August of 2020. Variables were submitted to univariate and multivariate analysis to determine factors predictive of in-hospital mortality. Results: 130 CKD patients were analyzed (median age 73.9 years, male 60.0%). Hypertension (81.5%), cardiovascular disease (36.2%), and diabetes (54.6%) were frequent conditions. Cough, dyspnea, fever and respiratory failure were also common. Almost 60% had anemia, 50% hypoalbuminemia, 13.8% hyperlactacidemia and 17% acidemia. Mean serum ferritin was 1531 µg/L, mean CRP 8.3 mg/dL and mean LDH 336.9 U/L. Most patients were treated with lopinavir/ritonavir, hydroxychloroquine or corticosteroids and only 2 with remdesivir. Eighty percent had acute kidney injury and 16.2% required intensive care unit admission. The 34 patients who died were older and more likely to have heart failure. They had higher neutrophils/lymphocytes ratio, ferritin, lactate, and LDH levels. Multivariate analysis identified an association between older age [OR 1.1 (CI 1.01-1.24), p=0.027], higher ferritin [OR 1.0 (CI 1.00-1.00), p=0.009] and higher LDH levels [OR 1.0 (CI 1.00-1.01), p=0.014] and mortality. Conclusion: In our cohort of CKD patients with COVID-19, older age, higher ferritin, and higher LDH levels were independent risk factors for mortality.

Resumo Introdução: COVID-19 é atualmente um problema de saúde global e uma causa importante de mortalidade. Doença renal crônica (DRC) é um dos fatores de risco para infecção, morbilidade e mortalidade por SARS-CoV-2. Neste estudo, objetivamos avaliar a apresentação clínica e os outcomes de doentes com DRC com COVID-19, bem como identificar preditores de mortalidade. Métodos: Estudo retrospetivo de doentes com DRC internados num hospital terciário português entre Março-Agosto/2020. As variáveis foram submetidas a análise univariada e multivariada para determinar fatores preditivos de mortalidade hospitalar. Resultados: analisámos 130 pacientes com DRC (média de idades 73,9 anos; 60,0% homens). Hipertensão (81,5%), doença cardiovascular (36,2%) e diabetes (54,6%) foram comorbilidades frequentes. Tosse, dispneia, febre e insuficiência respiratória também foram comuns. Quase 60% apresentavam anemia, 50% hipoalbuminemia e 13,8% hiperlactacidemia, 17% acidemia. A ferritina sérica média foi 1531 µg/L, PCR média 8,3 mg/dL, LDH médio 336,9 U/L. A maioria foi tratada com lopinavir/ritonavir, hidroxicloroquina ou corticosteroides e apenas 2 com remdesivir. Oitenta por cento tiveram lesão renal aguda; 16,2% necessitaram de internamento na unidade de cuidados intensivos. Os 34 pacientes que faleceram eram mais velhos e mais propensos a ter insuficiência cardíaca. Estes apresentaram razão neutrófilos/linfócitos e níveis de ferritina, lactato e LDH mais elevados. A análise multivariada identificou uma associação entre idade avançada [OR 1,1 (IC 1,01-1,24), p=0,027], níveis de ferritina [OR 1,0 (IC 1,00-1,00), p=0,009] e LDH mais elevados [OR 1,0 (IC 1,00-1,01), p=0,014] e mortalidade. Conclusão: Na nossa coorte de doentes com DRC com COVID-19, a idade avançada e níveis mais elevados de ferritina e LDH foram fatores de risco independentes para mortalidade.

The impact of transient and persistent acute kidney injury in hospital mortality in COVID-19 patients / O impacto da lesão renal aguda transitória e persistente na mortalidade hospitalar em pacientes com COVID-19

Abstract Introduction: Acute kidney injury (AKI) has been described in Coronavirus Disease 2019 (COVID-19) patients and is considered a marker of disease severity and a negative prognostic factor for survival. In this study, the authors aimed to study the impact of transient and persistent acute kidney injury (pAKI) on in-hospital mortality in COVID-19 patients. Methods: This was a retrospective observational study of patients hospitalized with COVID-19 in the Department of Medicine of the Centro Hospitalar Universitario Lisboa Norte, Lisbon, Portugal, between March 2020 and August 2020. A multivariate analysis was performed to predict AKI development and in-hospital mortality. Results: Of 544 patients with COVID-19, 330 developed AKI: 166 persistent AKI (pAKI), 164 with transient AKI. AKI patients were older, had more previous comorbidities, had higher need to be medicated with RAAS inhibitors, had higher baseline serum creatine (SCr) (1.60 mg/dL vs 0.87 mg/dL), higher NL ratio, and more severe acidemia on hospital admission, and more frequently required admission in intensive care unit, mechanical ventilation, and vasopressor use. Patients with persistent AKI had higher SCr level (1.71 mg/dL vs 1.25 mg/dL) on hospital admission. In-hospital mortality was 14.0% and it was higher in AKI patients (18.5% vs 7.0%). CKD and serum ferritin were independent predictors of AKI. AKI did not predict mortality, but pAKI was an independent predictor of mortality, as was age and lactate level. Conclusion: pAKI was independently associated with in-hospital mortality in COVID-19 patients but its impact on long-term follow-up remains to be determined.

Resumo Introdução: A lesão renal aguda (LRA) foi descrita em pacientes com doença do Coronavírus 2019 (COVID-19) e é considerada um marcador de gravidade da doença e fator prognóstico negativo para sobrevivência. Neste estudo, os autores visaram estudar o impacto da lesão renal aguda transitória e persistente (LRAp) na mortalidade hospitalar em pacientes com COVID-19. Métodos: Estudo observacional retrospectivo de pacientes internados com COVID-19 no Departamento de Medicina do Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal, entre Março-Agosto de 2020. Realizou-se análise multivariada para prever desenvolvimento de LRA e mortalidade hospitalar. Resultados: De 544 pacientes com COVID-19, 330 desenvolveram LRA: 166 LRA persistente (LRAp), 164, LRA transitória. Pacientes com LRA eram mais velhos, apresentaram mais comorbidades prévias, maior necessidade de serem medicados com inibidores do SRAA, apresentaram creatina sérica basal mais elevada (CrS) (1,60 mg/dL vs 0,87 mg/dL), maior razão NL, e acidemia mais grave na admissão hospitalar, e necessitaram mais frequentemente de internação na UTI, ventilação mecânica, e uso de vasopressores. Pacientes com LRA persistente apresentaram maior nível de CrS (1,71 mg/dL vs 1,25 mg/dL) na admissão hospitalar. A mortalidade hospitalar foi de 14,0% e foi maior em pacientes com LRA (18,5% vs 7,0%). A DRC e ferritina sérica foram preditores independentes de LRA. A LRA não previu mortalidade, mas a LRAp foi um preditor independente de mortalidade, assim como idade e nível de lactato. Conclusão: A LRAp foi associada independentemente à mortalidade hospitalar em pacientes com COVID-19, mas seu impacto no acompanhamento de longo prazo ainda precisa ser determinado.

Ring Fracture of Brazilian Aortic Valve Bioprostheses Using Non-Compliant High-Pressure Transcatheter Balloon, an Ex Vivo Test

ABSTRACT Introduction: Aortic valve bioprostheses ring fracture in valve-in-valve procedures has shown low complication rates and presents as an option in the treatment of patients at high risk for conventional surgery, avoiding high transvalvular gradients, which are associated with increased mortality. Some prostheses available in the market cannot be fractured. In an ex vivo test, the possibility of ring fracture of aortic valve bioprostheses produced in Brazil when submitted to radial force application using a high-pressure non-compliant balloon was evaluated. Methods: One unit of each aortic valve bioprosthesis model, sizes 19 and 21 mm, produced by Brazilian companies (Braile Biomédica, Cardioprótese, and Labcor), was used. In the experiment, a non-compliant high-pressure balloon (Atlas®-Gold), 1 mm larger than the external diameter of the prosthesis, was positioned inside the valve annulus and inflated gradually aiming to fracture the prosthesis. Fracture pressures and photographic and radiological images of the prostheses before and after test were recorded. Results: All prostheses were fractured. In the models with metal ring, the fracture pressures were between 23 and 25 atm. In the other prostheses, the rupture occurred between 10 and 13 atm. No deformations in the structure were observed, which could potentially damage the aortic root. Conclusion: All the Brazilian prostheses evaluated were fractured, although the presence of a metal ring in the prosthesis framework increases the pressure required for fracture. The information obtained helps in the planning of valve-in-valve procedures in patients with aortic valve bioprostheses.

Ring Fracture of Brazilian Aortic Valve Bioprostheses Using Non-Compliant High-Pressure Transcatheter Balloon, an Ex Vivo Test.

INTRODUCTION: Aortic valve bioprostheses ring fracture in valve-in-valve procedures has shown low complication rates and presents as an option in the treatment of patients at high risk for conventional surgery, avoiding high transvalvular gradients, which are associated with increased mortality. Some prostheses available in the market cannot be fractured. In an ex vivo test, the possibility of ring fracture of aortic valve bioprostheses produced in Brazil when submitted to radial force application using a high-pressure non-compliant balloon was evaluated. METHODS: One unit of each aortic valve bioprosthesis model, sizes 19 and 21 mm, produced by Brazilian companies (Braile Biomédica, Cardioprótese, and Labcor), was used. In the experiment, a non-compliant high-pressure balloon (Atlas®-Gold), 1 mm larger than the external diameter of the prosthesis, was positioned inside the valve annulus and inflated gradually aiming to fracture the prosthesis. Fracture pressures and photographic and radiological images of the prostheses before and after test were recorded. RESULTS: All prostheses were fractured. In the models with metal ring, the fracture pressures were between 23 and 25 atm. In the other prostheses, the rupture occurred between 10 and 13 atm. No deformations in the structure were observed, which could potentially damage the aortic root. CONCLUSION: All the Brazilian prostheses evaluated were fractured, although the presence of a metal ring in the prosthesis framework increases the pressure required for fracture. The information obtained helps in the planning of valve-in-valve procedures in patients with aortic valve bioprostheses.

Vampyrum spectrum (Phyllostomidae) movement and prey revealed by radio-telemetry and DNA metabarcoding.

The spectral bat (Vampyrum spectrum), the largest bat species in the Americas, is considered Near Threatened by the International Union for Conservation of Nature and is listed as a species of special concern or endangered in several countries throughout its range. Although the species is known as carnivorous, data on basic ecology, including habitat selection and primary diet items, are limited owing to its relative rarity and difficulty in capturing the species. Leveraging advances in DNA metabarcoding and using radio-telemetry, we present novel information on the diet and movement of V. spectrum based on locations of a radio-collared individual and fecal samples collected from its communal roost (three individuals) in the Lowland Dry Forest of southern Nicaragua. Using a non-invasive approach, we explored the diet of the species with genetic markers designed to capture a range of arthropods and vertebrate targets from fecal samples. We identified 27 species of vertebrate prey which included birds, rodents, and other bat species. Our evidence suggested that V. spectrum can forage on a variety of species, from those associated with mature forests to forest edge-dwellers. Characteristics of the roost and our telemetry data underscore the importance of large trees for roosting in mature forest patches for the species. These data can inform conservation efforts for preserving both the habitat and the prey items in remnants of mature forest required by Vampyrum spectrum to survive in landscape mosaics.

O lugar do desejo na matriz de identidade / The place of desire in the matrix of identity / El lugar del deseo en la matriz de identidad

RESUMO O texto considera as raízes etimológicas da palavra "desejo". Discute abordagens filosóficas do conceito e expõe contribuições psicanalíticas. Destaca o lugar do desejo dentro da concepção relacional de Moreno, dando ênfase à matriz de identidade. Leva em conta o desejo e suas circunstâncias: o desejo e a memória, o desejo e a linguagem, o desejo e a demanda, o desejo e a falta, o desejo e a dependência. Discutem-se as implicações, do ponto de vista terapêutico, de trazer à consciência os elementos inconscientes do desejo. Isso facilitaria ao sujeito desatar os seus nós e redirecionar suas demandas.

ABSTRACT The text considers the etymological roots of the word "desire". It discusses philosophical approaches to the concept and presents psychoanalytic contributions. It highlights the place of desire within Moreno's relational conception, emphasizing the matrix of identity. It takes into account desire and its circumstances: desire and memory, desire and language, desire and demand, desire and lack, desire and dependence. The implications, from a therapeutic point of view, of bringing to consciousness the unconscious elements of desire are discussed. This would make it easier for the subject to untie his knots and redirect his demands.

RESUMEN El texto considera las raíces etimológicas de la palabra "deseo". Discute enfoques filosóficos del concepto y presenta contribuciones psicoanalíticas. Destaca el lugar del deseo dentro de la concepción relacional de Moreno, enfatizando la matriz de identidad. Tiene en cuenta el deseo y sus circunstancias: deseo y memoria, deseo y lenguaje, deseo y demanda, deseo y carencia, deseo y dependencia. Se discuten las implicaciones, desde un punto de vista terapéutico, de traer a la conciencia los elementos inconscientes del deseo. Esto facilitaría que el sujeto desatara sus nudos y redirigiera sus demandas.

Aphasia assessment: impact of material on naming performance / Avaliação da afasia: impacto do material no desempenho da nomeação

ABSTRACT Background: Naming and lexical retrieval difficulties are common symptoms of aphasia. Naming abilities are usually evaluated by means of real objects or pictures or line drawings that are printed. Objective: The aim of this study was to investigate whether the ability to name objects among individuals with aphasia is influenced by the dimensions of the visual stimuli and to understand whether the order of presentation of the stimuli, number of years of education and length of time post-onset are involved in the success of naming. Methods: The naming abilities of healthy controls and patients with acute or chronic aphasia due to stroke were assessed through presentation of two sets of 24 stimuli consisting of real objects and color photographs of the same objects presented on a screen. The results obtained under these two conditions were compared by means of within-subject paired ANOVA, controlling for presentation order. Results: 40 patients (62.4 ± 17.3 years old; 70% females; mean education level of 8.5 ± 5.3 years; and 60% evaluated within the first eight days after stroke) and 50 controls that were age, gender and education-matched were included. Object naming was significantly better than naming color photographs among the patients (p = 0.001), but no differences were observed among the controls. Age, education, length of time post-onset and presentation sequence did not have any impact on naming performance. Conclusion: These results suggest that use of digital color photographs for naming objects in assessment of aphasia may be associated with lower naming performance, compared with use of real objects. This needs to be taken into account when different forms of stimuli are presented in sequential aphasia evaluations.

RESUMO Antecedentes: As dificuldades de nomeação e de evocação lexical são sintomas comuns de afasia. A nomeação é geralmente avaliada por objetos reais, imagens ou desenhos de contorno, impressos. Objetivo: Este estudo visa investigar se a capacidade de nomear objetos em pessoas com afasia é influenciada pelas dimensões dos estímulos visuais e compreender se a ordem de apresentação dos estímulos, os anos de escolaridade e o tempo de evolução estão envolvidos no sucesso da nomeação. Métodos: A nomeação de pessoas saudáveis e pessoas com afasia, em fase aguda ou crónica, por AVC foi avaliada com dois conjuntos de 24 estímulos, objetos reais e fotografias a cores, dos mesmos objetos, apresentadas num ecrã. Os resultados obtidos nas duas condições foram comparados por uma ANOVA para amostras emparelhadas, controlando para a ordem de apresentação. Resultados: Foram incluídos 40 sujeitos com afasia (62,4±17,3 anos de idade, 70% mulheres, com uma escolaridade média de 8,5±5,3 anos, 60% avaliados nos primeiros 8 dias após o acidente vascular cerebral) e um grupo de controlo de 50 pessoas saudáveis, emparelhadas para a idade, sexo e escolaridade. A nomeação de objetos foi significativamente melhor do que a nomeação de fotografias a cores (p=.001), mas isso não se verificou nos controles. A idade, a escolaridade, o tempo de evolução e a sequência de apresentação não tiveram impacto na nomeação dos dois tipos de estímulos. Conclusão: Estes resultados sugerem que a utilização de fotografias digitais a cores para avaliar a nomeação de objetos na afasia pode ser associada a um pior desempenho quando comparada com objetos reais. Isto deve ser tido em conta quando são apresentadas diferentes formas de estímulos nas reavaliações.

Hallux varo. Caso clínico / Halluxvarus. Clinical case / Halluxvarus. Caso clínico

RESUMEN Introducción: hallux varo congénito es una deformidad rara, que puede estar asociada a otras deformidades. Caso clínico: paciente masculino, de 18 años de edad. Acude a consulta por presentar deformidad del pie e imposibilidad para caminar y usar calzado. Al examen físico se observa angulación medial del primer dedo del pie a nivel de la articulación metatarsofalángica y deformidad en varo de 90 grados. Se indicó rayos X del pie derecho anteposterior. Discusión: la radiografía mostró angulación en varo de la articulación metatarsofalángica derecha. El tratamiento de la deformidad es por corrección quirúrgica, y varias técnicas han sido descritas. Conclusión: se plantea Halluxvarus congénito primario del pie derecho como diagnóstico. El tratamiento de la deformidad fue quirurgico con técnina de Framer, la cual resultó ser efectiva.

ABSTRACT Introduction: congenital Hallux varus is a rare deformity that may be associated with other deformities. Clinical case: male patient, 18 years old. He goes to the consultation for presenting a foot deformity and inability to walk and wear shoes. Physical examination revealed medial angulation of the first toe at the level of the metatarsophalangeal joint and a 90-degree varus deformity. An X-ray of the anteposterior right foot was indicated. Discussion: X-ray showed varus angulation of the right metatarsophalangeal joint. Treatment of the deformity is by surgical correction, and several techniques have been described. Conclusion: primary congenital Hallux varus of the right foot is considered as a diagnosis. The deformity treatment was surgical with Framer's technique, which turned out to be effective.

RESUMO Introdução: hálux varo congênito é uma deformidade rara que pode estar associada a outras deformidades. Caso clínico: paciente masculino, 18 anos. Ele vai à consulta por apresentar deformidade no pé e incapacidade de andar e usar sapatos. O exame físico revelou angulação medial do primeiro dedo do pé ao nível da articulação metatarsofalangiana e uma deformidade em varo de 90 graus. Foi indicada radiografia do pé direito anterior. Discussão: a radiografia mostrou angulação em varo da articulação metatarsofalangiana direita. O tratamento da deformidade é por correção cirúrgica, e várias técnicas foram descritas. Conclusão: o Hálux varo congênito primário do pé direito é considerado diagnóstico. O tratamento da deformidade foi cirúrgico com a técnica de Framer, que se mostrou eficaz.

The Arabidopsis Iron-Sulfur (Fe-S) Cluster Gene MFDX1 Plays a Role in Host and Nonhost Disease Resistance by Accumulation of Defense-Related Metabolites.

Until recently, genes from the iron-sulfur (Fe-S) cluster pathway were not known to have a role in plant disease resistance. The Nitrogen Fixation S (NIFS)-like 1 (NFS1) and Mitochondrial Ferredoxin-1 (MFDX1) genes are part of a set of 27 Fe-S cluster genes induced after infection with host and nonhost pathogens in Arabidopsis. A role for AtNFS1 in plant immunity was recently demonstrated. In this work, we showed that MFDX1 is also involved in plant defense. More specifically, Arabidopsis mfdx1 mutants were compromised for nonhost resistance against Pseudomonas syringae pv. tabaci, and showed increased susceptibility to the host pathogen P. syringae pv. tomato DC3000. Arabidopsis AtMFDX1 overexpression lines were less susceptible to P. syringae pv. tomato DC3000. Metabolic profiling revealed a reduction of several defense-related primary and secondary metabolites, such as asparagine and glucosinolates in the Arabidopsis mfdx1-1 mutant when compared to Col-0. A reduction of 5-oxoproline and ornithine metabolites that are involved in proline synthesis in mitochondria and affect abiotic stresses was also observed in the mfdx1-1 mutant. In contrast, an accumulation of defense-related metabolites such as glucosinolates was observed in the Arabidopsis NFS1 overexpressor when compared to wild-type Col-0. Additionally, mfdx1-1 plants displayed shorter primary root length and reduced number of lateral roots compared to the Col-0. Taken together, these results provide additional evidence for a new role of Fe-S cluster pathway in plant defense responses.

Repeated Positive Cervical HPV Testing and Absent or Minor Cytology Abnormality at Pap Smear. What is the Next Step?

BACKGROUND: Human papillomavirus (HPV) screening has significantly reduced cervical cancer (CC) mortality. Women who consecutively test positive for high-risk HPV without and minor changes on reflex cytology (atypical squamous cells of undetermined significance [ASC-US] or low-grade squamous intraepithelial lesion [LSIL]) or dysplasia on cervical colposcopy-oriented biopsy are always referred to colposcopy. The aim of the present study was to assess whether this guidance is appropriate for COBAS HPV testing with reflex cytology. METHODS: A cross-sectional, retrospective study was carried out in 5,227 women who underwent routine CC screening over a period of five years (2012-2017). All HPV tests were performed using Cobas®4800 HPV. The study included women attending gynecology appointments whose first HPV test was positive and who had any type of follow-up. Patients' HPV test results as well as cytology and biopsy findings obtained during the abovementioned period were analyzed. A descriptive and comparative statistical study was conducted using this data. RESULTS: A total of 765 out of 6003 HPV tests performed in 5,227 women were positive, and 141 women who had a positive HPV test (with negative for intraepithelial lesion or malignancy [NILM] or inflammation, or ASC-US and LSIL cytology, but no lesions on colposcopy, or absence of dysplasia on histology) repeated the HPV test at least once. Of these 141 women, 6 were diagnosed with high-grade squamous intraepithelial lesion (HSIL) during the follow-up period. All cases of HSIL were diagnosed after the second HPV test. CONCLUSION: This study shows that, at cervical cancer screening, all women testing positive for HPV regardless of Pap smear result should be referred to colposcopy.

Análise da incidência de dengue em pacientes notificados em Montes Claros entre 2017 e 2019 / Analysis of the incidence of dengue in patients reported in Montes Claros between 2017 and 2019 / Análisis de la incidencia de dengue en pacientes notificados en Montes Claros entre 2017 y 2019

Objetivo: analisar a incidência de casos notificados de dengue em Montes Claros. Método: estudo descritivo, exploratório, documental, retrospectivo, transversal, quantitativo, realizado no SINAN online da Secretaria Municipal de Saúde. A amostra foi constituída por 10.879 pacientes notificados entre 2017 e 2019. O tratamento dos dados se deu por epidemiologia descritiva simples. Resultados: a incidência de casos em 2017 foi baixa, quando comparada aos anos subseqüentes. Em 2018, o aumento percentual em relação a 2017 foi de 362,3%. Em 2019, houve um aumento exponencial na incidência, de modo a atingir 912,8% em relação a 2018 e 4.592,3% em relação a 2017. Ainda, houve aumento dos casos confirmados laboratorialmente como positivos em 2019 (3,8%). Conclusão: a incidência de casos notificados para a doença da dengue mostrou-se alta em 2019 e progressivo com o tempo. O aumento sintomático dos casos mostrou-se bem altos, devendo-se intensificar o acompanhamento desses pacientes.(AU)

Objective: to analyze the incidence of reported cases of dengue in Montes Claros. Method: descriptive, exploratory, documentary, retrospective, transversal study, quantitative, carried out at SINAN online of the Municipal Health Secretariat. The sample consisted of 10,879 patients notified between 2017 and 2019. The data treatment was done by simple descriptive epidemiology. Results: the incidence of cases in 2017 was low when compared to subsequent years. In 2018, the percentage increase compared to 2017 was 362.3%. In 2019, there was an exponential increase in the incidence, to reach 912.8% in relation to 2018 and 4,592.3% in relation to 2017. In addition, there was an increase in laboratory confirmed cases as positive in 2019 (3.8%). Conclusion: the incidence of reported cases of dengue disease was high in 2019 and progressive over time. The symptomatic increase of cases was very high, and the follow-up of these patients should be intensified. (AU)

Objetivo: analizar la incidencia de los casos reportados de dengue en Montes Claros. Método: estudio descriptivo, exploratorio, documental, retrospectivo, transversal, cuantitativo, realizado en el SINAN en línea de la Secretaría Municipal de Salud. La muestra estaba formada por 10.879 pacientes notificados entre 2017 y 2019. El tratamiento de los datos fue mediante epidemiología descriptiva simple. Resultados: la incidencia de casos en 2017 fue baja en comparación con los años siguientes. En 2018, el incremento porcentual respecto a 2017 fue del 362,3%. En 2019 se ha producido un aumento exponencial de la incidencia, de forma que se ha alcanzado el 912,8% respecto a 2018 y el 4.592,3% respecto a 2017. Además, hubo un aumento en el número de casos confirmados en los laboratorios como positivos en 2019 (3,8%). Conclusión: la incidencia de los casos reportados de la enfermedad del dengue fue alta en 2019 y progresiva en el tiempo. El aumento sintomático de los casos fue muy elevado, por lo que se debe intensificar el seguimiento de estos pacientes.(AU)

La suplementación con ácido ascórbico atenúa el trastorno metabólico inducido por un derivado de juglona / Ascorbic supplementation attenuates juglone induced metabolic derangement

Los derivados de juglona, como 2-(4-hidroxifenil) amino-1,4-naftoquinona (Q7), son conocidos agentes antitumorales. Ellos generan especies reactivas de oxígeno (ROS), que podrían producir un desbalance de ROS y un metabolismo anormal de lípidos. El objetivo del estudio fue evaluar el efecto del ascorbato sobre el metabolismo de lípidos y carbohidratos en condición de estrés oxidativo inducido por Q7. A ratas Wistar macho, se les administró oralmente Q7 (10 mg/Kg) y/o ascorbato (500 mg/Kg) durante 20 días. Las ratas tratadas con Q7 mostraron un aumento de los triglicéridos en suero, del colesterol VLDL y de los niveles de peróxidación lipídica. Cuando el tratamiento con Q7 fue seguido de la administración de ascorbato (500 mg/Kg), observamos una disminución de los triglicéridos en suero, del colesterol VLDL y de la peroxidación lipídica. La administración oral de ascorbato redujo el aumento de lípidos inducido por Q7 y la glicemia postprandial. Esto podría estar asociado con la actividad redox del ascorbato, que reduce el estrés oxidativo inducido por Q7. Concluimos que el ascorbato modula el aumento del metabolismo de lípidos y carbohidratos inducido por Q7.

Juglone derivatives like 2-(4-hydroxyphenyl) amino-1,4-naphthoquinone (Q7) are used as antitumor agents, and act through reactive oxygen species (ROS) generation. Such may lead to abnormal lipid metabolism and ROS dysregulation. The objective of this study was to evaluate the effect of ascorbate on the metabolism of lipids and carbohydrates following Q7-induced oxidative stress. Male Wistar rats were administered Q7 (10 mg/Kg) and/or ascorbate (500 mg/Kg) orally for 20 days. Rats treated with Q7 showed an increase in serum triglycerides, VLDL cholesterol and lipid peroxidation levels. When Q7 treatment was followed up by ascorbate (500 mg/Kg) administration, we observed a reduction in serum triglycerides, VLDL cholesterol and lipid peroxidation. The oral administration of ascorbate reduced the Q7-induced increases in lipids, and postprandial glycemia. This could be associated with the redox activity of ascorbate that reduced the oxidative stress induced by Q7. We thus conclude that ascorbate modulates the Q7-induced increase of lipid and carbohydrate metabolism.

Trajetórias educacionais como evidência da qualidade da educação básica brasileira / Educational trajectories as evidence of the quality of Brazilian basic education / Trayectorias educativas como evidencia de la calidad de la educación básica brasileña

Segundo a Constituição Federal brasileira, o direito à educação significa a garantia do acesso à escola, onde a população deve permanecer durante o tempo legalmente determinado, a fim de adquirir os conhecimentos e habilidades necessários para a vida adulta plena. Este artigo tem como foco a análise da permanência dos estudantes na escola, condição essencial para a aprendizagem e representada por suas trajetórias educacionais. Dados longitudinais do Censo Escolar, de 2007 a 2015, foram utilizados para analisar as trajetórias educacionais classificadas em três tipos: regular; com poucas irregularidades; e com muitas irregularidades. Os resultados mostram que alguns grupos sociais são muito mais propensos a ter uma trajetória regular e outros a ter repetência ou a ficar fora da escola em alguns anos. Uma proporção alta de meninos de cor/raça preta tem trajetórias com muitas irregularidades. O artigo mostra que o Índice de Desenvolvimento da Educação Básica (Ideb) - o indicador oficial para medir a qualidade da educação nos municípios - pode atingir um valor alto, mesmo que muitos estudantes tenham trajetórias irregulares. Isso evidenciou o efeito da seletividade embutido nesse indicador. Em conclusão, este trabalho sugere a incorporação das trajetórias educacionais no monitoramento da qualidade da educação nos municípios.

According to the Federal Brazilian Constitution, the right to education means that all children had access to a school, and remained there for the legally determined time and, acquired the knowledge and skills necessary for full adult life. This paper focuses on the analysis of students' permanence in school, an essential condition for learning represented here by their educational trajectories. The School Census longitudinal data, from 2007 to 2015 were used to analyze the student's educational trajectories classified into three types: regular; with few irregularities; and with many irregularities. The results show that some social groups are much more prone to having a regular trajectory, and others to having grade repetition or being out of school after few years. A large proportion of black boys have trajectories with many irregularities. In addition, this paper shows that the Basic Education Development Index (IDEB, acronym in Portuguese) - the official index for measuring the quality of education in the municipalities - can reach a high value even if many students have irregular trajectories. This evidenced the selectivity effect embedded in this indicator. This paper suggests the incorporation of educational trajectories into the indicator to monitor the quality of education in Brazilian municipalities.

De acuerdo con la Constitución Federal brasileña, el derecho a la educación significa la garantía de acceso a la escuela, donde los estudiantes deben permanecer por el tiempo legalmente determinado para adquirir los conocimientos y habilidades necesarios para la vida adulta plena. Este artículo se centra en el análisis de la permanencia de los estudiantes en la escuela, condición esencial para el aprendizaje, y representada por sus trayectorias educativas. Datos longitudinales de los censos escolares desde 2007 hasta 2015 se utilizaron para estudiar las trayectorias educativas del alumno, que se clasificaron en tres tipos: regular, con pocas irregularidades, con muchas irregularidades. Los resultados muestran que algunos grupos sociales son mucho más propensos a tener una trayectoria regular y otros a repetir el grado o quedar fuera de la escuela por algunos años. Una gran proporción de estudiantes negros tiene trayectorias con muchas irregularidades. Además, este trabajo muestra que el Índice de Desarrollo de la Educación Básica (IDEB) —índice oficial para medir la calidad de la educación en los municipios— puede alcanzar un valor alto a pesar de que muchos estudiantes tienen trayectorias irregulares. Esto evidenció el efecto de selectividad incorporado en este indicador. Este trabajo sugiere la incorporación de las trayectorias educativas en el indicador de seguimiento de la calidad de la educación en los municipios brasileños.

Quiste óseo solitario. Presentación de un caso / Solitary bone cyst. Presentation of a case / Cisto ósseo solitário. Apresentação de um caso

RESUMEN Introducción: el quiste óseo solitario (QOS) ha sido reconocido durante muchos años como una lesión benigna; es una cavidad llena de líquido claro. Caso clínico: paciente masculino de 12 años de edad, refiere que hace 2 años sufrió una caída de sus pies provocándole un trauma leve a nivel del humero derecho, fue atendido de urgencia en cuerpo de guardia diagnosticándole una fractura patológica de humero derecho por un quiste óseo solitario. El mismo fue tratado conservadoramente con férula de yeso en U y posterior de humero y Velpeaux de yeso durante 2 meses. Al cabo de 1 año el paciente viene porque presenta ligero dolor y aumento de volumen en la región antero-externa de humero derecho sin cambio de coloración. Examen Físico: Ligero dolor a la palpación, aumento de volumen y limitación a los movimientos de la abducción y flexo extensión del brazo derecho. Discusión: se indicó radiografía que mostro: Lesión metafisaria bien delimitada, radio lúcida, con la cortical adelgazada, atravesado por tabiques. Conclusiones: se diagnosticó un quiste óseo solitario. El tratamiento quirúrgico realizado fue raspado y relleno con Hidroxiapatita.

ABSTRACT Introduction: the Solitary Bone Cyst (QOS) has been recognized for many years as a benign injury; it's a cavity full of clear liquid. Clinical case: 12-year-old male patient, who says that two years ago he suffered a fall from his feet causing him a mild trauma at the level of the right humerus, was seen urgently in the guard corps diagnosing a pathological fracture of right humerus by a solitary bone cyst. It was treated conservatively with U-gypsum splint and later humerus and plaster Velpeaux for 2 months. After 1 year the patient comes because he has slight pain and increased volume in the antero-external region of right humerus without color change. Physical Examination: Slight pain to palpation, increased volume and limitation to the movements of abduction and flexo extension of the right arm. Discussion: x-ray was indicated to show: Well-delimited metaphysarian lesion, lucid radius, with the cortical thinned, crossed by septums. Conclusions: a solitary bone cyst was diagnosed. The surgical treatment performed was scraping and filling with Hydroxyapatite.

RESUMO Introdução: o cisto ósseo solitário (CEC) é reconhecido há muitos anos como uma lesão benigna; é uma cavidade cheia de um líquido claro. Caso clínico: paciente do sexo masculino, 12 anos, relata que há dois anos sofreu uma queda de pé causando leve trauma no úmero direito, foi atendido com urgência na guarita com diagnóstico de fratura patológica do úmero direito devido a um cisto osso solitário. Foi tratado conservadoramente com tala de gesso em forma de U e úmero posterior com gesso Velpeaux por 2 meses. Após 1 ano o paciente chega porque apresenta dor discreta e aumento de volume na região ântero-externa do úmero direito sem descoloração. Exame Físico: Dor leve à palpação, aumento de volume e limitação dos movimentos de abdução e flexoextensão do braço direito. Discussão: foi indicada radiografia que evidenciou: Lesão metafisária bem definida, rádio lúcido, com córtex adelgaçado, cruzado por septos. Conclusões: foi diagnosticado um cisto ósseo solitário. O tratamento cirúrgico realizado foi raspagem e obturação com Hidroxiapatita.