Is There an Over-Indication for Elective Tracheostomy in Patients With Oral Cavity Cancer?

OBJECTIVES: Temporary tracheostomies (TT) are often used in oral oncologic surgery to secure the postoperative airway. Our primary objective was to determine if there was an over-indication for elective tracheostomy in our population. If so, our secondary objective was to ascertain which patients could have possibly avoided TT. MATERIALS AND METHODS: We performed a retrospective study of patients with oral and oropharyngeal squamous cell carcinoma in which resection with curative intent and TT were performed. Variables collected included demographics, comorbidities, and complications. Additionally, we retrospectively applied the Cameron and TRACHY tracheostomy scoring systems to evaluate overall tracheostomy recommendations. RESULTS: A total of 116 elective tracheostomies were performed between January 2019 and December 2020. According to the Cameron and TRACHY scoring systems, recommendations for tracheostomy coincided in only 54.3% and 45.7%, respectively. Tumor anatomy and type of reconstruction were associated with less time until decannulation. Additionally, in patients without TT recommendation determined by both scores with tumor anatomy and location, as well as T and N stages were also associated with less time until decannulation. CONCLUSION: There appears to be an over-indication for elective tracheostomy in our patients with oral cavity and oropharyngeal cancer. The patients that could have potentially avoided elective TT were those with lateral anatomy, without flap or with fasciocutaneous flap, location in the mandibular alveolus or anterior tongue, as well as N0/N1 and T1/T2 patients.

Paraneoplastic Lambert-Eaton myasthenic syndrome: a diagnostic challenge.

Lambert-Eaton myasthenic syndrome (LEMS) is a rare neuromuscular junction disorder. Underlying small cell lung cancer is found in more than half of patients. Proximal muscle weakness, autonomic features and areflexia are typical manifestations. However, LEMS is often misdiagnosed. We report a rare case of paraneoplastic LEMS, identified amid admission due to a different diagnosis. Our patient was initially admitted due to aspiration pneumonia. Further investigation revealed clinical and electrophysiological manifestations of LEMS. High clinical suspicion and early diagnostic workup were paramount in the patient outcome. Nevertheless, paraneoplastic aetiology was difficult to confirm and revealed itself a difficult challenge. Clinical awareness is crucial to diagnose LEMS and urge cancer screening and early treatment.

FLUORO-CT GUIDED BIOPSY OF LUNG NODULES: A STEP BY STEP REVISION.

INTRODUCTION: Transthoracic biopsies under fluoro-computer tomography (CT) guidance play an important role on the diagnosis and management of lung nodules, permitting histological examination and differentiation between benign and malignant lesions(1). Furthermore, with recent advances in target therapy, it is increasingly necessary to obtain tumor tissue for the analysis of molecular fingerprints allowing personalized treatment(1). Although many studies report low complication rates for this procedure, they are not negligible, urging the need for a structured and reproducible guide to reduce technique-related complications(1,2).

Rheumatoid Nodule Simulating a Parotid Tumor.

Rheumatoid nodules are an extra-articular manifestation of rheumatoid arthritis that are rarely found in the maxillofacial region. A 59-year-old woman with rheumatoid arthritis treated with methotrexate, leflunomide, and tocilizumab, presented with an enlarging mass in the left parotid region. Magnetic resonance imaging (MRI) displayed a lesion compatible with a neoplasm. However, an incisional biopsy showed features consistent with a rheumatoid nodule. The patient was managed conservatively, including cessation of methotrexate and initiation of treatment with hydroxychloroquine. At 15-month follow-up, the lesion had a significant reduction in size. To our knowledge, this is the first case report of a rheumatoid nodule in the parotid region. Although it is a rare manifestation, clinicians should consider this a possible differential diagnosis of parotid masses in patients with a history of rheumatoid arthritis or connective tissue disease.

Terapia de reposição hormonal e câncer de mama: uma revisão de literatura acerca da influência do tratamento hormonal no desenvolvimento neoplásico / Hormone Therapy and Breast Cancer: a literature review about the influence of hormonal treatment on neoplastic development

A menopausa é decorrente da queda gradativa de secreção hormonal ovariana e, nesse período, muitas mulheres apresentam sintomas que comprometem a qualidade de vida. A terapia hormonal (TH) surgiu como importante ferramenta para amenizar a sintomatologia climatérica. No entanto, foram levantadas suspeitas sobre a correlação entre o tratamento e o aumento do risco do câncer de mama (CM). O presente trabalho objetiva avaliar a relação entre CM e TH, abrangendo as implicações da terapia nos sintomas da menopausa, na incidência da neoplasia e na mortalidade. Trata-se de uma revisão narrativa de literatura, em que foram buscados artigos publicados entre julho de 2010 e julho de 2020, nas bases de dados LILACS, MEDLINE e SciELO. Os principais tipos de TH são o estrogênio isolado e o combinado com progesterona. Nos estudos analisados, a terapia combinada foi relacionada à maior incidência de CM quando comparada ao regime estrogênico. De acordo com a literatura, modificações na densidade mamográfica, induzidas pela TH, podem elevar o risco para carcinoma mamário. Os artigos relataram que fatores além da terapia hormonal, como o estilo de vida, podem interferir na incidência de CM e devem ser analisados individualmente. A mortalidade por CM influenciada pela TH não demonstrou aumento significativo. No geral, a TH foi considerada o tratamento mais eficaz para aliviar sintomas climatéricos. Entretanto, estudos a longo prazo que analisem os riscos e a confiabilidade da terapia devem ser estimulados, a fim de indicar a terapêutica mais segura e evitar intervenções indevidas.

Menopause is due to the gradual drop in ovarian hormonal secretion, and, during this period, many women have symptoms that compromise quality of life. Hormone therapy (HT) has emerged as an important tool to alleviate climacteric symptoms. However, suspicions were raised about the correlation between treatment and the increased risk of breast cancer (BC). The present study aims to evaluate the relationship between BC and HT, covering the implications of therapy for menopausal symptoms, the incidence of neoplasia and mortality. This is a narrative review of the literature, in which articles published between July 2010 and July 2020 were searched for in the LILACS, MEDLINE and SciELO databases. The main types of HT are estrogen alone and combined formula with progesterone. In the studies analyzed, combined therapy was related to a higher incidence of BC when compared to the estrogenic regimen. According to the literature, changes in mammographic density, induced by HT, can increase the risk for breast carcinoma. The articles reported that factors other than hormone therapy, such as lifestyle, can interfere with the incidence of BC and should be analyzed individually. Mortality from BC influenced by HT did not show a significant increase. Overall, HT was considered to be the most effective treatment for relieving climacteric symptoms. Although, long-term studies that analyze the risks and reliability of therapy should be encouraged in order to indicate the safest therapeutics and to avoid unnecessary interventions.

Focal segmental glomerulosclerosis and mild intellectual disability in a patient with a novel de novo truncating TRIM8 mutation.

Mutations in the TRIM8 gene have been described in patients with severe developmental delay, intellectual disability and epilepsy. Only six patients have been described to date. All the previous mutations were truncating variants clustered in the C-terminus of the protein. A previous patient with TRIM8-related epileptic encephalopathy was reported to have nephrotic syndrome. Here we describe the clinical, radiological and histological features of an 8-year-old male patient with a TRIM8 mutation who, in contrast to previous patients, had only mild intellectual disability and well-controlled epilepsy. The patient was found to have proteinuria at 2 years of age. Renal biopsy findings were suggestive of focal segmental glomerulosclerosis. His kidney function declined and peritoneal dialysis was started at 5 years of age. He underwent renal transplant at 7 years of age. Trio-based whole genome sequencing identified a novel de novo heterozygous frameshift mutation in TRIM8 (NM_030912.2) c.1198_1220del, p.(Tyr400ArgfsTer2). This patient is further evidence that TRIM8 mutations cause a syndrome with both neurological and renal features. Our findings suggest the spectrum of TRIM8-related disease may be wider than previously thought with the possibility of milder neurodevelopmental problems and/or a more severe, progressive renal phenotype. We highlight the need for proteinuria screening in patients with TRIM8 mutations.

Deep neck space infection and Lemierre's syndrome caused by Streptococcus anginosus: A case report.

INTRODUCTION: Deep neck space infections most commonly arise from a septic focus of the mandibular teeth, tonsils, parotid gland, middle ear or sinuses, usually with a rapid onset and frequently with progression to life-threatening complications. Lemierre's syndrome is classically defined by an oropharyngeal infection with internal jugular vein thrombosis followed by metastatic infections in other organs. CASE PRESENTATION: A 32-year-old female patient, with no significant past medical history, was diagnosed with a dental abscess on her left inferior 3rd molar. Six days later, the condition complicated with severe upper respiratory distress, odynophagia and trismus, and extension of the inflammatory signs to the anterior cervical region, involving the upper airway. Computed tomography scan confirmed extension to submandibular, parapharyngeal and retrosternal spaces), which required nasotracheal intubation due to compromised airway. Urgent and subsequent surgical drainages were performed, alongside with concomitant antibiotic therapy. Additionally, left internal jugular vein thrombosis was described - with later extension to the brachiocephalic vein, without other complications, consistent with Lemierre's syndrome, although without full features. Streptococcus anginosus was identified in the drained pus specimens. The patient made a satisfactory clinical progress and was discharged after 25 days, still under therapeutic hypocoagulation. CONCLUSION: As deep neck space infections can be life-threatening, clinicians must be aware and not underestimate their potential severity. Lemierre's syndrome is a complication difficult to recognize, which requires additional awareness of the many possible presentations, for appropriate diagnostic studies and therapeutic plan.

Surveillance of Enteric Viruses and Thermotolerant Coliforms in Surface Water and Bivalves from a Mangrove Estuary in Southeastern Brazil.

This study was conducted to evaluate the microbiological quality of a mangrove estuary in the Vitória Bay region, Espírito Santo, Brazil. We analyzed the presence and concentration of enteric viruses and thermotolerant coliforms in water, mussels (Mytella charruana and Mytella guyanensis), and oysters (Crassostrea rhizophorae), collected over a 13-month period. Human adenovirus, rotavirus A (RVA), and norovirus genogroup II were analyzed by quantitative PCR. The highest viral load was found in RVA-positive samples with a concentration of 3.0 × 104 genome copies (GC) L-1 in water samples and 1.3 × 105 GC g-1 in bivalves. RVA was the most prevalent virus in all matrices. Thermotolerant coliforms were quantified as colony-forming units (CFU) by the membrane filtration method. The concentration of these bacteria in water was in accordance with the Brazilian standard for recreational waters (< 250 CFU 100 mL-1) during most of the monitoring period (12 out of 13 months). However, thermotolerant coliform concentrations of 3.0, 3.1, and 2.6 log CFU 100 g-1 were detected in M. charruana, M. guyanensis, and C. rhizophorae, respectively. The presence of human-specific viruses in water and bivalves reflects the strong anthropogenic impact on the mangrove and serves as an early warning of waterborne and foodborne disease outbreaks resulting from the consumption of shellfish and the practice of water recreational activities in the region.

Comparison of fish and oil supplements for a better understanding of the role of fat level and other food constituents in determining bioaccessibility.

In order to investigate the effects of fat level and protein and other components on lipid bioaccessibility, the bioaccessibility of total lipids and particular fatty acids (FAs) of fish samples with different fat levels (5.4% w/w, 10.2% w/w, and 16.6% w/w) and cod liver oil supplement in different quantities (82, 154, 313, 604, and 1,027 mg) was determined by an in vitro digestion model. Digestion of the fish and oil (up to 154 mg) samples as measured by TAG disappearance was complete. Lipolysis was impaired by high amounts of oil (313 mg and higher). Bioaccessible FA profiles had similarities with the initial (before digestion) FA profiles. However, total MUFA and oleic acid contents were higher in the bioaccessible fraction. The bioaccessibility of EPA and DHA was generally lower than that of oleic acid and total MUFA. Fat level did not affect FAs' bioaccessibility. On the other hand, protein and other components may have interfered in lipid bioaccessibility and it was found that the reduction of bioaccessibility was stronger when the ratio of the lipid fraction to the nonlipid fraction (mainly protein) was smaller.

High prevalence of enteric viruses associated with acute gastroenteritis in pediatric patients in a low-income area in Vitória, Southeastern Brazil.

Acute gastroenteritis (AGE) is a significant cause of child mortality worldwide. In Brazil, despite the reduction in infant mortality achieved in recent years, many children still die because of undiagnosed AGE. The prevalence, viral load, and circulating genotypes of rotavirus A (RVA), human adenovirus (HAdV), and norovirus GII (NoV GII) were investigated in children with AGE during 12 months in Vitoria, Espírito Santo, Southeastern Brazil. Enteric viruses were detected in stool samples, quantified by quantitative polymerase chain reaction, sequenced, and compared phylogenetically. The overall prevalence was 93.3% (125/134). Cases of single infection (41.8%) and mixed infection (51.5%) were observed; in 21.6% of cases, all the three viruses were detected. RVA had the highest number of copies in all infections. Phylogenetic analysis revealed predominantly the presence of RVA genotype G3, followed by G2 and G9. HAdV clustered within subgroup C, but some samples harbored subgroups A, D, or F. All sequenced NoV-positive samples clustered within the prevalent genotype GII.4. The high prevalence of RVA, HAdV, and NoV in diarrheal feces clarifies the etiology of AGE in this population, and the presence of RVA in vaccinated children reinforces the importance of monitoring programs to identify the causes of gastroenteritis and contribute to the reliability of diagnosis.

Perfil audiológico de idosos submetidos à reabilitação vestibular / Audiologic profile of older adults subjected to vestibular rehabilitation therapy

OBJETIVO: caracterizar o perfil auditivo de idosos com tontura submetidos à Reabilitação Vestibular e comparar os resultados obtidos nas avaliações auditivas de idosos sem tontura. MÉTODOS: estudo observacional analítico transversal com 87 idosos, sendo 35 no grupo com tontura e 52 no grupo sem tontura. Foram realizadas anamnese, audiometria tonal limiar e vocal. Para a análise estatística foi utilizado o programa estatístico Statistical Package for the Social Sciences versão 17.0, com nível de significância de 5% nas análises. RESULTADOS: a perda auditiva neurossensorial de grau leve e moderada esteve presente em 72,4% da amostra, com piora dos limiares de audibilidade por via aérea a partir de 4000Hz em ambos os grupos. O zumbido foi a queixa mais frequente observada na amostra. CONCLUSÃO: o perfil auditivo de idosos com tontura não se diferencia daquele encontrado em idosos sem tontura, sendo observada com maior frequência a perda auditiva neurossensorial leve bilateral de configuração descendente. .

PURPOSE: to characterize the auditory profile of older adults with dizziness undergoing vestibular rehabilitation therapy and to compare the results with the profile of older adults without dizziness. METHODS: a cross-sectional, observational, and analytical study conducted with 87 older adults, 35 in the group with dizziness and 52 in the group without dizziness. The participants were interviewed and subjected to pure-tone threshold audiometry and speech audiometry. Statistical analysis was performed using the software Statistical Package for the Social Sciences version 17.0, at 5% significance. RESULTS: approximately 72.4% of the sample exhibited mild sensorineural hearing loss, with the air conduction threshold of audibility beginning to be affected at 4,000 Hz in both groups. Tinnitus was the complaint most frequently reported by the participants. CONCLUSION: the auditory profile of older adults with dizziness did not differ from the profile exhibited by older adults without dizziness; bilateral mild sensorineural hearing loss with a downward sloping configuration was the most frequent finding. .

Metabolic syndrome and risk of cancer: which link?

Metabolic syndrome (MS) is characterized by a group of metabolic disturbances which lead to an enhanced risk of cardiovascular diseases and type 2 diabetes mellitus. MS constitutes a preoccupant issue with elevated prevalence in the western countries and is often related with cancer development. Elucidating the mechanisms linking these two pathologies is, therefore, essential to identify potential therapeutic molecular targets for cancer treatment in MS patients. The main goals of this review are, to identify the relation between MS and cancer development, handling specifically each one of the main players on this process: insulin and IGF system, estrogen, pro-inflammatory cytokines and others; and, given that colorectal cancer is one of the most prevalent types of cancer in MS patients, we intend to particularly highlight the mechanisms that promote colorectal cancer development in MS individuals. Finally, we will also focus on the clinical implications of the presented mechanisms on cancer therapy and care.

Low prevalence of pneumococcal carriage and high serotype and genotype diversity among adults over 60 years of age living in Portugal.

Pneumococcal disease is frequent at the extremes of age. While several studies have looked at colonization among young children, much less is known among the elderly. We aimed to evaluate pneumococcal carriage among elderly adults living in Portugal. Between April 2010 and December 2012, nasopharyngeal and oropharyngeal swabs of adults over 60 years of age, living in an urban area (n = 1,945) or in a rural area (n = 1,416), were obtained. Pneumococci were isolated by culture-based standard procedures, identified by optochin susceptibility, bile solubility and PCR screening for lytA and cpsA, and characterized by antibiotype, serotype, and MLST. Associations between pneumococcal carriage, socio-demographic and clinical characteristics were evaluated by univariate analysis and multiple logistic regression. The global prevalence of carriage was 2.3% (95% CI: 1.8-2.8). In the multiple logistic regression analysis, smoking, being at a retirement home, and living in a rural area increased the odds of being a pneumococcal carrier by 4.4-fold (95% CI: 1.9-9.2), 2.0-fold (95% CI: 1.1-3.6) and 2.0-fold (95% CI: 1.2-3.5), respectively. Among the 77 pneumococcal isolates, 26 serotypes and 40 STs were identified. The most prevalent serotypes were (in decreasing order) 19A, 6C, 22F, 23A, 35F, 11A, and 23B, which accounted, in total, for 60.0% of the isolates. Most isolates (93.5%) had STs previously described in the MLST database. Resistance to macrolides, non-susceptibility to penicillin and multidrug resistance were found in 19.5%, 11.7%, and 15.6% of the isolates, respectively. We conclude that the prevalence of pneumococcal carriage in the elderly, in Portugal, as determined by culture-based methods, is low. Serotype and genotype diversity is high. Living in a rural area, in a retirement home, and being a smoker increased the risk of pneumococcal carriage. This study contributes to the establishment of a baseline that may be used to monitor how novel pneumococcal vaccines impact on colonization among the elderly.

The metal transporter PgIREG1 from the hyperaccumulator Psychotria gabriellae is a candidate gene for nickel tolerance and accumulation.

Nickel is an economically important metal and phytotechnologies are being developed to limit the impact of nickel mining on the environment. More than 300 plant species are known to hyperaccumulate nickel. However, our knowledge of the mechanisms involved in nickel accumulation in plants is very limited because it has not yet been possible to study these hyperaccumulators at the genomic level. Here, we used next-generation sequencing technologies to sequence the transcriptome of the nickel hyperaccumulator Psychotria gabriellae of the Rubiaceae family, and used yeast and Arabidopsis as heterologous systems to study the activity of identified metal transporters. We characterized the activity of three metal transporters from the NRAMP and IREG/FPN families. In particular, we showed that PgIREG1 is able to confer nickel tolerance when expressed in yeast and in transgenic plants, where it localizes in the tonoplast. In addition, PgIREG1 shows higher expression in P. gabriellae than in the related non-accumulator species Psychotria semperflorens. Our results designate PgIREG1 as a candidate gene for nickel tolerance and hyperaccumulation in P. gabriellae. These results also show how next-generation sequencing technologies can be used to access the transcriptome of non-model nickel hyperaccumulators to identify the underlying molecular mechanisms.

Recuperando vidas: uma proposta de atendimento / Recuperación de vidas: una propuesta de atención / Recovering lives: a care proposal

O presente artigo busca problematizar a respeito da atuação do Serviço Social em um centro de tratamento público destinado a adolescentes usuários e usuários abusivos de drogas no Rio de Janeiro - Centro de Tratamento Recuperando Vidas - gerenciado pelo Departamento Geral de Ações Socioeducativas (DEGASE), responsável pela execução de medidas socioeducativas no referido estado. Traz, ainda, as análises relativas aos limites impostos pela execução dessa política no sistema socioeducativo que atua com adolescentes em conflito com a lei, como também destaca as possibilidades que tal campo fértil traz à profissão.

This paper seeks to ask questions about the actions of the social service at a public treatment center for drug using and drug abusing teenagers in Rio de Janeiro: the Recovering Lives Treatment Center, managed by the General Department for Socioeducational Actions (DEGASE), which is responsible for carrying out socioeducational measures in that Brazilian state. This paper also provides analyses relating to the limits imposed by implementing these policies within the socioeducational system that acts in relation to teenagers who are in conflict with the law, and also highlights the possibilities that this fertile field provides for our profession.

El presente artículo trata de problematizar con respecto a la actuación del Servicio Social en un centro de tratamiento público destinado a adolescentes usuarios y usuarios abusivos de drogas en Rio de Janeiro, Brasil - Centro de Tratamiento Recuperando Vidas - administrado por el Departamento General de Acciones Socio-educativas (DEGASE), responsable por la ejecución de medidas socio-educativas en el referido estado. Comprende también los análisis relativos a los límites impuestos por la ejecución de esta política en el sistema socio-educativo que actúa con adolescentes en conflicto con laley, destacando también las posibilidades que tan fértil campo proporciona a la profesión.

[Pregnancy and smoking: an opportunity to change behaviours]. / Gravidez e tabagismo: uma oportunidade para mudar comportamentos.

INTRODUCTION: Maternal smoking during pregnancy is related not only to perinatal adverse events but also to important postnatal problems. Smoking is very prevalent in women with several socio-demographic factors playing an important role. AIMS: To assess the frequency of smoking as well as mothers' change in behaviours during pregnancy. To identify socio-demographic factors associated to smoking and to assess women's knowledge and sources of information about adverse effects of smoking during pregnancy. METHODS: We started a cohort study between March and October 2003 at the Maternity, Hospital Santa Maria. After an informed consent the mothers in the post natal ward were asked to fill in a questionnaire. RESULTS: Four hundred and seventy five mothers responded to the questionnaire and among them 30% were smokers before pregnancy. Thirty five percent stopped smoking during pregnancy and those who continued significantly reduced the number of cigarettes per day. Smoking was less prevalent in married women, with higher educational level and with stable employment (statistically significant correlations). Forty five percent of the mothers were misinformed or had no information about the adverse effects of smoking during pregnancy. Their main source of information were the media. DISCUSSION: Smoking prevalence was high (30%) among the respondents but the pregnancy lowered the numbers of cigarettes per day. The percentage of misinformed mothers concerned about the adverse effects of smoking during pregnancy was high (45%), which also showed that doctors' role as a source of information was surpassed by the media. The study also brought to light the need for the health professionals to improve their competences in their role on prevention of smoking during pregnancy and the postnatal period.