Food Insecurity and Nutritional Inadequacy in Children and Adolescents of Basic Education Schools of Cantagalo District in São Tomé and Príncipe, Central Africa.

Food insecurity (FI) is a critical socioeconomic and public health problem globally, particularly affecting children's nutritional status and development. This cross-sectional study aimed to assess the prevalence of nutritional inadequacy among children and adolescents in the Cantagalo district of São Tomé and Príncipe (STP), in Central Africa. It also assessed their households' FI situation and examined sociodemographic, anthropometric, and nutritional characteristics associated with severe FI. Data included 546 children/adolescents (51.8% males, aged 9-15 years) from the eight public basic education schools. A structured questionnaire provided sociodemographic data, while anthropometric measurements assessed nutritional status. Dietary intake data were gathered using a single 24 h dietary recall, and the adjusted prevalences of nutritional inadequacy were obtained using version 2.0 of the PC-Software for Intake Distribution Estimation (PC-SIDE®). The Household Food Insecurity Access Scale was used to assess FI, and households were classified as severely or non-severely food insecure. Multivariable binary logistic regression models adjusted for potential confounders identified factors related to FI. Children's/adolescents' thinness was exhibited in 34.1% of participants, and over 95% had inadequate intake of essential micronutrients, including iron. Notably, 73.7% were severely food insecure. A higher severity of FI was positively associated with a lower intake of iron and certain household head characteristics, such as being female or older, and negatively associated with having a home garden.

Efficacy and safety of guttiferone E in melanoma-bearing mice.

Melanoma, an aggressive and potentially fatal skin cancer, is constrained by immunosuppression, resistance, and high toxicity in its treatment. Consequently, there is an urgent need for innovative antineoplastic agents. Therefore, this study investigated the antimelanoma potential of guttiferone E (GE). In an allogeneic murine B16 melanoma model, GE was administered subcutaneously and intraperitoneally. Antitumor evaluation included tumor volume/weight measurements and histopathological and immunohistochemical analysis. Furthermore, the toxicity of the treatments was evaluated through body/organ weights, biochemical parameters, and genotoxicity. Subcutaneous administration of 20 mg/kg of GE resulted in a significant reduction in both tumor volume and weight, effectively suppressing melanoma cell proliferation as evidenced by a decrease in mitotic figures. The tumor growth inhibition rate was equivalent to 54%. This treatment upregulated cleaved caspase-3, indicating apoptosis induction. On the other hand, intraperitoneal administration of GE showed no antimelanoma effect. Remarkably, GE treatments exhibited no toxicity, evidenced by non-significant differences in body weight gain, as well as organ weight, biochemical parameters of nephrotoxicity and hepatotoxicity, and genotoxic damage. This study revealed, for the first time, the efficacy of subcutaneous administration of GE in reducing melanoma, in the absence of toxicity. Furthermore, it was observed that the apoptotic signaling pathway is involved in the antimelanoma property of GE. These findings offer valuable insights for further exploring GE's therapeutic applications in melanoma treatment.

Comparison between whole-body magnetic resonance imaging and whole-body metaiodobenzylguanidine scintigraphy in the evaluation of primary tumor and metastases in neuroblastoma.

BACKGROUND: Whole-body metaiodobenzylguanidine (131 I-MIBG) scintigraphy is the gold standard method to detect neuroblastoma; however, it depends on radioactive material and is expensive. In contrast, whole-body magnetic resonance imaging (WB-MRI) is affordable in developing countries and has been shown to be effective in the evaluation of solid tumors. This study aimed to compare the sensitivity and specificity of WB-MRI with MIBG in the detection of primary tumors and neuroblastoma metastases. PROCEDURE: This retrospective study enrolled patients with neuroblastoma between 2013 and 2020. All patients underwent WB-MRI and MIBG at intervals of up to 15 days. The results were marked in a table that discriminated anatomical regions for each patient. Two experts evaluated, independently and in anonymity, the WB-MRI images, and two others evaluated MIBG. The results were compared in terms of sensitivity and specificity, for each patient, considering MIBG as the gold standard. This study was approved by the UNIFESP Ethics Committee. RESULTS: Thirty patients with neuroblastoma were enrolled in this study. The age ranged from 1 to 15 years, with a mean of 5.7 years. The interval between exams (WB-MRI and MIBG) ranged from 1 to 13 days, with an average of 6.67 days. Compared to MIBG, WB-MRI presented a sensitivity and specificity greater than or equal to 90% for the detection of primary neuroblastoma in bones and lymph nodes. When we consider the patient without individualizing the anatomical regions, WB-MRI presented sensitivity of 90% and specificity of 73.33%. CONCLUSION: In conclusion, WB-MRI is a sensitive and specific method to detect neuroblastoma in bone and lymph nodes and highly sensible to primary tumor diagnosis, suggesting that this test is a viable alternative in places where MIBG is difficult to access. Studies with a larger number of cases are necessary for definitive conclusions.

Pharmacotherapeutic follow-up of a patient with multimorbities: experience report / Acompanhamento farmacoterapêutico em paciente com multimorbidades: um relato de experiência / Seguimiento farmacoterapéutico en pacientes con multimorbilidad: informe de una experiencia

Chronic non-communicable diseases are growing global health problems. The objective of this study was to promote pharmaceutical care for a patient with multimorbidities in order to improve its quality of life. A pharmacotherapeutic follow-up was performed using the SOAP method, registered in the form of clinical evolution, along with laboratory tests, anthropometric measurements and application of validated instruments to assess pharmacological adherence, mental health and quality of life. The report deals with a female patient, 55 years old, obese and dyslipidemic, sedentary, hypertensive, diabetic and on the control phase of breast cancer. Self-medication with antibiotics and a proton pump inhibitor was identified. Despite the good pharmacological adherence, the patient had decompensated diabetes, accompanied by dyslipidemia without treatment and interruption of supplements. After pharmacological and non- pharmacological interventions, the patient showed a significant improvement in the reduction of anthropometric measurements and in biochemical parameters. At the end of the follow-up, pharmaceutical care proved to be fundamental in identifying the patient's health problems, contributing to obtain a more rational pharmacotherapy.

As doenças crônicas não transmissíveis são problemas de saúde globais crescentes. O objetivo deste estudo foi promover a assistência farmacêutica a um paciente com multimorbidades, a fim de melhorar sua qualidade de vida. Foi realizado acompanhamento farmacoterapêutico pelo método SOAP e aplicação de instrumentos validados para avaliar adesão farmacológica, saúde mental e qualidade de vida. O relato trata de uma paciente do sexo feminino, 55 anos, obesa e dislipidêmica, sedentária, hipertensa, diabética e em fase de controle do câncer de mama. Foi identificada automedicação com antibióticos e inibidor de bomba de prótons. Apesar da boa adesão farmacológica, a paciente apresentava diabetes descompensado, acompanhada de dislipidemia sem tratamento e interrupção das suplementações. Após intervenções farmacológicas e não farmacológicas, a paciente apresentou melhora significativa na redução das medidas antropométricas e nos parâmetros bioquímicos. Ao final do acompanhamento, a assistência farmacêutica mostrou-se fundamental na identificação dos problemas de saúde do paciente.

Las enfermedades crónicas no transmisibles constituyen un creciente problema de salud mundial. El objetivo de este estudio fue promover la asistencia farmacéutica a un paciente con multimorbilidades para mejorar su calidad de vida. Se realizó seguimiento farmacoterapéutico por el método SOAP y aplicación de instrumentos validados para evaluar adherencia farmacológica, salud mental y calidad de vida. O relato trata de uma paciente do sexo feminino, 55 anos, obesa e dislipidêmica, sedentária, hipertensa, diabética e em fase de controle do câncer de mama. Se identificó automedicación con antibióticos e inhibidor de la bomba de protones. A pesar del buen cumplimiento farmacológico, la paciente presentó diabetes descompensada, acompañada de dislipidemia no tratada e interrupción de la suplementación. Tras intervenciones farmacológicas y no farmacológicas, la paciente mostró una mejoría significativa en la reducción de las medidas antropométricas y los parámetros bioquímicos. Al final del seguimiento, la asistencia farmacéutica demostró ser fundamental en la identificación de los problemas de salud del paciente.

Reconstructive surgery and adjuvant radiotherapy for the multimodal approach in oral cancer: a single cancer centre experience.

Introduction and importance: Ablative surgery for oral cancer, irrespective of the histological subtype, causes large tissue defects, functional and aesthetic damage. Microsurgical free flaps have been widely used in reconstruction after resection, with satisfactory success rates in conjunction with adjuvant radiotherapy (RT). This study aims to describe our clinical institutional experience based on the multimodal treatment performed in four cases diagnosed with oral squamous cell carcinoma with the use of different microvascular free flaps and RT. Case series presentation: Four patients underwent reconstructive microsurgery after surgical resection of oral cancer, using three types of free flap: radial forearm fasciocutaneous, osteomyocutaneous fibular, and anterolateral thigh musculocutaneous flaps; RT was performed in Case 2 and Case 3. In the period of 3 years after microsurgical reconstruction and RT, flaps remain clinically stable without failure signs in full patients submitted to multimodal treatment. Clinical discussion: After resection of oral carcinomas, extensive tissue defects can be successfully treated with reconstructive microsurgery using different types of microvascular free flaps. RT for locoregional control is a feasible option and did not seem to interfere with the survival of flaps. Conclusion: An enhance long-term follow-up to assess overall and disease-free survival rates and quality of life must be carried out; however, cohort studies would be necessary for better understanding of the role of each treatment in the multimodal scheme.

Radiation-induced Sarcoma in the Head and Neck: Clinical, Imaging, Histopathological, and Therapeutic Characterization.

Radiation-induced head and neck sarcoma (RIHNS) is a rare and serious long-term complication of radiotherapy (RT), with poor prognosis and high morbidity and mortality. Diagnosis is based on immunohistochemistry and molecular biomarker analysis, and therapy is usually surgical. Other adjuvant therapies might be considered. This case report aimed to describe the clinical, imaging, histopathological, and therapeutic characteristics of a rare case of RIHNS in the mandible after 21 years of RT. A 68-year-old male patient underwent a partial left parotidectomy in 1995, was diagnosed with pleomorphic adenoma, and after recurrence of the lesion in 2000, underwent an ipsilateral total parotidectomy with adjuvant RT. In May 2021, he complained of an ulcerated nodular lesion on the tongue that extended toward the lower gingiva, associated with oral bleeding and difficulties with swallowing. After biopsy in the gingival margin and histopathological analysis, the diagnosis of high-grade spindle-cell sarcoma was established. Complete surgical resection with microsurgical reconstruction using a fibular osteomusculocutaneous free flap was performed. RIHNS could appear after a period of almost 20 years after RT. Surgical resection with reconstructive surgery was a reliable and feasible therapeutic option that showed favorable clinical results after an appropriate follow-up.

Is there an association between prostate-specific antigen and androgen levels in 46, XX patients with congenital adrenal hyperplasia?

INTRODUCTION: Congenital adrenal hyperplasia (CAH), a genetic disease characterized by defective cortisol synthesis and excessive levels of sex hormones, can cause precocious puberty in both sexes in untreated individuals and virilization in female patients with a 46, XX karyotype. The female paraurethral (Skene's) gland has been reported as prostate analogous. Growth of prostate tissue is associated with androgen production; therefore, prostate-specific antigen (PSA) levels may represent a marker of virilization in 46, XX patients with CAH. OBJECTIVES: To describe PSA levels in 46, XX patients and evaluate whether higher PSA levels are associated with androgenization and the severity of the disease. STUDY DESIGN: Sixty-six patients with CAH and a 46, XX karyotype were included, irrespective of age. Serum PSA, testosterone, 17-hydroxyprogesterone (17-OHP) and androstenedione levels were measured. Patients' age, age at diagnosis, forms of the disease, Prader classification, bone age assessment, sex of rearing, surgery, and the presence of clinical complications were obtained from their medical records. RESULTS: The mean age of patients was 11.45 ± 10.74 years. Forty-three patients (65%) were diagnosed neonatally at a median of 0.08 years (mean 1.47 ± 2.34 years), with registers of 17-OHP measurements (Guthrie test) being available in 51%. Testosterone, 17-OHP and androstenedione were significantly high. PSA was detectable in 25% of cases (levels >0.01 ng/ml), with a mean of 0.03 ± 0.09 ng/ml, and only in patients over five years of age. A correlation was found between PSA and age (p < 0.001), age at diagnosis (p = 0.002), testosterone (p = 0.001) and androstenedione (p = 0.023). There was no correlation between PSA and the forms of CAH or Prader classification. A sub-analysis of the patients over five years of age in whom PSA was detectable also showed that there was a correlation between PSA (p < 0.05) and age at analysis, age at diagnosis, testosterone and androstenedione levels. DISCUSSION: Limitations of this study include the small sample size due to the rareness of the disease, its retrospective nature, the absence of a control group, the fact that the sample was selected at two referral centers, which could have resulted in a selection bias, and the use of different reference values in the different laboratories conducting the PSA tests. CONCLUSIONS: PSA is detectable in 25% of 46, XX patients with CAH, only after five years of age. PSA level increases significantly with age, age at diagnosis, and testosterone and androstenedione levels, confirming a correlation between PSA levels and elevated androgen levels.

Adjuvant radiotherapy in the treatment of dedifferentiated liposarcoma of the spermatic cord: a rare entity.

Dedifferentiated liposarcoma (DDL) of the spermatic cord is a very rare entity in which management is remarkably controversial due to scarce literature. Although the actual standard of care is surgery via radical inguinal orchiectomy, adjuvant therapies like radiotherapy have demonstrated improved local control, particularly in cases with higher risk for local recurrence and worse prognosis. The role of adjuvant chemotherapy remains questionable in this subset of patients. On literature review, the most important prognostic factors for survival outcomes were surgical margin status, histological grade and the presence of metastases prior to the initial surgery. In this report, we discuss the case of a 59-year-old man with DDL of the spermatic cord that was treated with surgery followed by adjuvant radiotherapy. We also provide a comprehensive literature review about the management of this entity.

Resenha da obra Entre devaneios e ilusões: educação especial e memórias inclusivas / Book review "Entre devaneios e ilusões: educação especial e memórias inclusivas" / Reseña de libro "Entre devaneios e ilusões: educação especial e memórias inclusivas"

Resenhou-se o livro "Entre devaneios e ilusões: educação especial e memórias inclusivas", resultado do Pós-doutoramento de Carlos Fernando França Mosquera. É um ensaio subdividido em dois capítulos. No primeiro, destacou-se a tentativa de reescrever a história da educação especial. No segundo, apresentou-se um ensaio sobre uma pedagogia acerca da relação do objeto de conhecimento (os conteúdos e currículo do Judô), com os aprendizes (pessoas com deficiência visual (DV)), além de relatar a experiência profissional e acadêmica do Projeto Judô, realizado em instituição para pessoas com DV. Foram analisados: 1) Estilo e correção de linguagem; 2) Qualidade das fontes utilizadas; 3) Coerência interna e com a metodologia anunciada; 4) Aprofundamento e atualização da discussão com a literatura; e 5) Contribuições e inovações. A inovação pedagógica é inegável na compreensão filosófica do "vazio" que norteia e motiva a pessoa com deficiência visual e a todos que estão envolvidos no processo inclusivo.

The book "Entre devaneios e ilusões: educação especial e memórias inclusivas", is the result of Carlos Fernando França Mosquera's Post-doctorate. It is an essay divided into two chapters. In the first, the history of special education was highlighted. In the second, an essay on a pedagogyabout the relationship between the object of knowledge (the contents and curriculum of Judo), with apprentices (people with visual impairments), in addition to reporting the professional and academic experience of the Judo Project carried out in institutions for visually impaired people. Were analyzed: 1) Style and language correction; 2) Quality of the sources used; 3) Internal coherence with the announced methodology; 4) Deepening and updating the discussion with the literature; and 5) Contributions and innovations. Pedagogical innovation is undeniable in the philosophical understanding of the "void" that guides and motivates the visually impaired person and everyone involved in the inclusive process.

El libro "Entre devaneios e ilusões: educação especial e memórias inclusivas", resultado del postdoctorado de Carlos Fernando França Mosquera. Es un ensayo de dos capítulos. En el primero, se destaca la historia de la educación especial. En el segundo, el diálogo de una pedagogía sobre la relación del objeto de conocimiento (los contenidos y el currículum del judo), con aprendices (personas con discapacidad visual), también informa la experiencia profesional y académica del Proyecto Judo llevado a cabo en instituciones para personas con discapacidad visual. Se analizaron: 1) Corrección de estilo y lenguaje; 2) Calidad de las fuentes utilizadas; 3) Coherencia interna y con la metodología anunciada; 4) Profundizar y actualizar la discusión con la literatura; y 5) Contribuciones e innovaciones. La innovación pedagógica es innegable en la comprensión filosófica del "vacío" que guía y motiva a la persona con discapacidad visual y a todos los involucrados en el proceso inclusivo.

Faces da desigualdade no Brasil: um olhar sobre os que ficam para trás / Faces of inequality in Brazil: a look at those left behind

RESUMO Este artigo analisou avanços na redução das desigualdades no Brasil durante o período de 2003 a 2015, para além da perspectiva de renda. Os dados refletem que, embora transformações relevantes tenham ocorrido, mesmo assim, o Brasil persiste como um dos países mais desiguais do mundo. Entretanto, ao colocar uma lupa nos dados de acesso a bens e serviços dos 5% e dos 20% mais pobres disponibilizados pela Pesquisa Nacional por Amostra de Domicílios (PNAD), os achados se contrapõem ao lugar comum de que só se promoveu acesso à renda e ao consumo dos mais pobres no período estudado, inexistindo alterações significativas no quadro de acesso a direitos básicos, políticas públicas de educação, saúde e de infraestrutura.

ABSTRACT This article analyzed advances in the reduction of inequalities in Brazil during the period from 2003 to 2015, in addition to the income perspective. The data reflect that, although relevant transformations have occurred, nevertheless, Brazil persists as one of the most unequal countries in the world. However, by placing a magnifying glass on the data about access to goods and services of the poorest 5% and 20% made available by the National Household Sample Survey (PNAD), the findings contradict the commonplace that only access to income and the consumption of the poorest was promoted in the period studied, without significant changes in the framework of access to basic rights, public policies of education, health, and infrastructure.

Risk indicators for Peri-implantitis. A cross-sectional study with 916 implants.

OBJECTIVES: The aim of this study was to identify systemic and local risk indicators associated with peri-implantitis. MATERIAL AND METHODS: One hundred eighty-three patients treated with 916 osseointegrated titanium implants, in function for at least 1 year, were included in the present study. The implants were installed at the Foundation for Scientific and Technological Development of Dentistry (FUNDECTO) - University of Sao Paulo (USP) - from 1998 to 2012. Factors related to patient's systemic conditions (heart disorders, hypertension, smoking habits, alcoholism, liver disorders, hepatitis, gastrointestinal disease, diabetes mellitus I and II, hyperthyroidism or hypothyroidism, radiation therapy, chemotherapy, menopause, osteoporosis, active periodontal disease, history of periodontal disease and bruxism), implant's characteristics (location, diameter, length, connection, shape, and antagonist), and clinical parameters (wear facets, periodontal status on the adjacent tooth, plaque accumulation on the adjacent tooth, modified plaque index, sulcus bleeding index, probing depth, bleeding on probing, width of keratinized tissue and marginal recession). RESULTS: An increased risk of 2.2 times for history of periodontal disease (PD), 3.6 times for cemented restorations compared to screw-retained prostheses, 2.4 times when wear facets were displayed on the prosthetic crown and 16.1 times for total rehabilitations when compared to single rehabilitations were found. Logistic regression analysis did not show any association between the implant's characteristics and peri-implantitis. CONCLUSIONS: A history of periodontal disease, cemented prostheses, presences of wear facets on the prosthetic crown and full mouth rehabilitations were identified as risk indicators for peri-implantitis. Implants' characteristics were not related to the presence of peri-implantitis.

Prevalência e perfil de sensibilidade de bactérias isoladas da urina de gestantes atendidas no serviço de obstetrícia de um hospital terciário / Prevalence and susceptibility profile of bacteria isolated from urine of pregnant women seen at the department of obstetrics of a tertiary hospital

OBJETIVOS: Avaliar a prevalência e o perfil de sensibilidade aos antimicrobianos de bactérias isoladas de uroculturas de gestantes atendidas no ambulatório do Serviço de Obstetrícia do Hospital Universitário de Santa Maria, Brasil. MÉTODOS: Foi realizado um estudo retrospectivo dos laudos emitidos pelo Laboratório de Análises Clínicas do Hospital Universitário de Santa Maria. Foram incluídas no estudo todas as uroculturas positivas de gestantes atendidas no ambulatório do Serviço de Obstetrícia deste hospital, no período de janeiro a dezembro de 2014. Os testes de identificação dos micro-organismos isolados e os perfis de sensibilidade frente aos antimicrobianos foram efetuados por meio de um sistema automatizado. RESULTADOS: No período do estudo foram identificadas neste laboratório 423 uroculturas positivas provenientes de gestantes. A bactéria Gram negativa Escherichia coli foi a mais prevalente (46,50% das culturas positivas). A segunda bactéria mais frequente foi a Gram positiva Staphylococcus saprophyticus (6,2%). O fungo Candida spp. foi isolado de 94 (21,8%) amostras de urina. Nitrofurantoína e amoxicilina/ácido clavulânico foram os antimicrobianos com menor taxa de resistência por parte de E. coli (91,33% e 90,77% de sensibilidade, respectivamente). Já frente às bactérias Gram positivas prevalentes, ampicilina foi a que mostrou maior sensibilidade. CONCLUSÕES: O perfil de suscetibilidade apresentado neste estudo indica que a escolha para o tratamento da ITU na gestação pode recair em nitrofurantoína e/ou amoxicilina/ácido clavulânico para as bactérias Gram negativas. Tendo em vista a prevalência encontrada, esses antimicrobianos podem ser iniciados empiricamente antes do resultado da urocultura, nos casos de ITU sintomática. Este estudo ratifica, entretanto, a importância da realização da urocultura entre os exames pré-natais e sua repetição no terceiro trimestre da gravidez, tendo em vista a variedade de micro-organismos identificados e os diferentes perfis de sensibilidade aos antimicrobianos testados.

AIMS: To evaluate the prevalence of bacteria in urine cultures of pregnant women seen at the outpatient clinic of the Department of Obstetrics at the University Hospital of Santa Maria, Brazil, and to determine the antibiotic sensitivity profile of these bacteria. METHODS: The reports issued by the Laboratory of Clinical Analysis of the University Hospital of Santa Maria were retrospectively analyzed. All positive urine cultures of pregnant women seen at the Department of Obstetrics from January to December 2014 were included in the study. The tests for the identification of bacterial isolates and their sensitivity profiles were assessed by an automated system. RESULTS: A total of 423 positive urine cultures were detected in the pregnant women. Gram-negative Escherichia coli was the most prevalent microorganism (46.50%). Gram-positive Staphylococcus saprophyticus was the second most prevalent bacterium (6.2%). Candida spp. was isolated from 94 (21.8%) urine samples. Nitrofurantoin and amoxicillin/clavulanic acid showed the lowest antimicrobial resistance against E. coli (91.33% and 90.77%, respectively). Ampicillin had the highest sensitivity among prevalent Gram-positive bacteria. CONCLUSIONS: The sensitivity profile found in this study allows us to suggest nitrofurantoin and/or amoxicillin/clavulanic acid for the treatment of urinary tract infection caused by Gram-negative bacteria during pregnancy. Given the prevalence rates detected in this study, these antimicrobials can be initiated empirically before the urine culture results are known, in the cases of symptomatic urinary tract infection. This study underscores the importance of urine culture in the prenatal period and in the third trimester because of the different microorganisms identified and the different sensitivity to the antimicrobials tested.

A família no cuidado ao idoso após o acidente por quedas / La familia en el cuidado a personas mayores tras accidente por caídas / The family in the care process of an elderly after a fall accident

It aims at knowing elderly family care after fall accidents. Method: qualitative approach and ecologic insertion method, based on Ecologic Theory of Systems. Results: it has been identified that the family plays an important role in the recovery of impaired elderly, once it offers affective support, necessary for the development of this group. The vicissitudes suffered by the elderly - in this case fall accidents - bring the families together, promoting a restructuration of family bounds and of the activities developed by each member of this core. Conclusion: getting to know family care devoted to elderly after fall accidents elucidates tools helping health professionals to orientate their attention beyond these individuals, trying to understand family functioning as an essential component for service planning towards therapeutic success...

Conhecer o cuidado familiar dedicado ao idoso após o acidente por quedas. Método: abordagem qualitativa e o método utilizado foi inserção ecológica, fundamentada na Teoria dos Sistemas Ecológicos. Resultados: identificou-se que a família executa um importante papel para recuperação do idoso fragilizado, sendo que ela oferece suporte afetivo necessário para o desenvolvimento desse grupo. As intercorrências que acometem os idosos - nesse caso o acidente por quedas - fazem com que as famílias se aproximem, promovendo, assim, uma reestruturação do vínculo familiar e das atividades desenvolvidas por cada membro constituinte desse núcleo. Conclusão: conclui-se que conhecer o cuidado familiar dedicado ao idoso após acidente por queda instrumentaliza e auxilia os profissionais de saúde a direcionarem seu olhar para além dos indivíduos, buscando compreender a funcionalidade familiar como um componente essencial do planejamento assistencial para o alcance do sucesso terapêutico...

Conocer el cuidado familiar dedicado al mayor tras el accidente por caídas. Método: enfoque cualitativo y el método de la inserción ecológica fundamentada en la teoría de los sistemas ecológicos. Resultados: se identificó que la familia ejecuta un importante rol para la recuperación del mayor debilitado, por lo que ofrece soporte afectivo necesario para el desarrollo de ese grupo. Las complicaciones que acometen al mayor, enese caso, el accidente por caídas, hacen con que las familias se aproximen, promoviendo una reestructuración del vínculo familiar. Conclusión: se concluye que conocer el cuidado familiar dedicado al mayor, tras accidente por caída instrumentaliza y auxilia a los profesionales de la salud a direccionar su mirada más allá de los individuos, en la búsqueda por entender la funcionalidad familiar como componente esencial del planeamiento asistencial para el alcance del suceso terapéutico...

Twenty Years of Experience in Pediatric Living Donor Liver Transplantation: Focus on Hepatic Artery Reconstruction, Complications, and Outcomes.

BACKGROUND: Hepatic artery thrombosis (HAT) increases morbidity and mortality after liver transplantation (LT). The identification of risk factors for HAT may aid transplant teams in the development of strategies aimed at reducing HAT. This article describes the risk factors for HAT and outcomes after LT. METHODS: This report describes a retrospective study (1995 to 2015) of primary pediatric living donor LT (LDLT). Pretransplant and technical variables were included in the study. Binary logistic regression was used for data analysis. RESULTS: This study included 656 primary LDLT. The median age, body weight, and pediatric end-stage liver disease score at the time of transplant were 13 months, 8.4 kg and 15, respectively. Twenty-one (3.2%) patients developed HAT. Intraoperative HAT (odds ratio, 62.63; 95% confidence interval, 12.64-310.19; P < 0.001) and the use of liver grafts with a graft-to-recipient weight ratio less than 1.1% (odds ratio, 24.46; 95% confidence interval, 4.55-131.56; P < 0.001) retained statistical significance in the multivariate model. Patient and graft survivals were significantly worse in cases with HAT. The overtime trend analysis revealed a decrease in the incidence of HAT (P = 0.008) and an increase in the use of 2-arterial anastomosis (P < 0.001). CONCLUSIONS: A graft-to-recipient weight ratio of 1.1% or less and intraoperative HAT were independently associated with HAT. Trend analysis further revealed a significant reduction in the incidence of HAT over time, as well as the increased use of 2 hepatic arteries for anastomosis during graft implantation. The double artery anastomosis may represent an extra protection to pediatric recipients undergoing LDLT.

As características protéticas das reabilitações implantossuportadas podem influenciar no sangramento a sondagem? Um estudo retrospectivo em 916 implantes / Does the prosthesis type over implant-supported rehabilitations can infl uence on bleeding on probing? A retrospective study with 916 dental implants

Objetivos: avaliar se a união entre implantes e/ou a presença de gengiva artifi cial infl uencia no sangramento a sondagem dos tecidos peri-implantares. Material e métodos: foram incluídos pacientes tratados com implantes de titânio (Implacil De Bortoli, São Paulo, Brasil), instalados no período de 1998 a 2012, na Universidade de São Paulo (USP). Os implantes foram examinados para avaliação do sangramento a sondagem, sendo divididos de acordo com o tipo de prótese: unitárias (n=167), parciais (n=522) e totais (n=227); e de acordo com a ausência (n=674) ou presença (n=242) de gengiva artifi cial. O teste estatístico com equação de estimativa generalizada foi usado para testar possíveis associações. Resultados: foram examinados 183 pacientes reabilitados com 916 implantes em função, pelo menos por um ano. Ao menos um ponto de sangramento a sondagem foi detectado em 85 (50,9%), 304 (58,2%) e 129 (56,8%) implantes das próteses unitárias, parciais e totais, respectivamente. Em relação à gengiva artificial, 378 (56,1%) dos implantes sem e 140 (57,9%) dos implantes com esta característica apresentaram sangramento a sondagem. Não foram verificadas diferenças significativas entre os grupos. Conclusão: a união dos implantes ou a presença de gengiva artificial não foram associadas com os resultados de sangramento a sondagem nos implantes em função.

Objective: to evaluate whether the prosthesis type (single, partial, complete) and/or the presence of artifi cial gingiva can influence on bleeding on probing of peri-implant tissues. Material and methods: patients treated with titanium dental implants (Implacil De Bortoli, São Paulo, Brazil) between 1998 to 2012 at the University of Sao Paulo (USP) were included in this study. The implants were divided according the following prosthodontic types: single (n=167), partial (n=522), and complete (n=277), and also regarding the presence (n=674) or absence (n=242) or artificial gingiva. The generalized estimating equation test was used to verify possible associations. Results: 183 patients and 916 implants at least 1 year in function were screened. At least one bleeding point was detected in 85 (50.9%), 304 (58.2%), and 129 (56.8%) implants for single, partial, and complete prostheses, respectively. 378 (56.1%) and 140 (57.9%) implant from groups without and with artificial gingiva presented bleeding on probing. No significant differences were identified among groups. Conclusion: the prosthesis design and/or artifi cial gingiva were not associated to bleeding on probing for dental implants in function.

Staphylococcal scalded skin syndrome in a premature newborn caused by methicillin-resistant Staphylococcus aureus: case report / Síndrome da pele escaldada estafilocócica em um recém-nascido prematuro causada por Staphylococcus aureus meticilina-resistente: relato de caso

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria.

CONTEXTO: A síndrome da pele escaldada estafilocócica é uma doença esfoliativa de pele. São raros os relatos desta síndrome causada por Staphylococcus aureusresistente à meticilina em neonatos, mas, quando presentes, exigem diagnóstico e tratamento rápidos para diminuir a morbidade e mortalidade. RELATO DE CASO: Uma menina recém-nascida prematura, pesando 1.520 g ao nascimento, com idade gestacional de 29 semanas e 4 dias, desenvolveu síndrome da pele escaldada estafilocócica no quinto dia de vida. As culturas de sangue coletadas no primeiro e quarto dias foram negativas, mas houve desenvolvimento de Pseudomonas aeruginosa e Enterococcus sp. (vancomicina sensível) na hemocultura realizada no dia do óbito (sétimo dia) e Pseudomonas aeruginosa e Serratia marcescens foram identificadas nas culturas de secreção da nasofaringe, nádega e da secreção abdominal. Na cultura do coto umbilical (sétimo dia), além desses dois bacilos Gram-negativos, foi isolado o Staphylococcus aureus resistente à meticilina. O diagnóstico da síndrome da pele escaldada estafilocócica foi baseado em critério clínico.

Prevalence of methicillin-resistant Staphylococcus aureus in a University Hospital in the South of Brazil

Methicillin-resistant Staphylococcus aureus (MRSA) stand out as one of the main agents causing nosocomial and community infections. This retrospective study aimed to analyze the MRSA predominance in a university hospital in the south of Brazil and it was carried out for five years (from 2007 to 2011). 616 MRSA (33,3% of the total) were isolated and an important reduction in the MRSA predominance was observed along the study. Although it was registered a reduction in the MRSA predominance, male adult patients (41-70 years old), who were in the Medical Clinic and Adult ICU, had the highest infection rates and concerning MRSA isolates rates, these were higher in blood and tracheal aspirates. In conclusion, studies of this type are becoming relevant to recognize pathogens like MRSA and to determine its predominance.

Staphylococcus aureus resistentes à meticilina (MRSA) destacam-se mundialmente como um dos mais frequentes patógenos nosocomiais e comunitários. Este estudo retrospectivo teve por objetivo analisar a prevalência de MRSA em um hospital universitário no sul do Brasil. Durante cinco anos (2007 a 2011), 616 MRSA (33,3% do total de S. aureus) foram isolados, sendo que sua frequência de isolamento apresentou considerável redução no decorrer do estudo. Nossos resultados demonstraram que as maiores taxas de isolamento dos MRSA ocorreram em amostras de sangue e secreção traqueal. As infecções prevaleceram em pacientes adultos (41 a 70 anos), do sexo masculino, internados na Clínica Médica e UTI adulto. Estudos como este se tornam importantes para o reconhecimento de patógenos resistentes, como o MRSA, e para a determinação da sua prevalência.

Avaliação das taxas de sucesso e sobrevivência de 497 implantes há cinco anos ou mais em função – estudo retrospectivo com 139 pacientes / Success and survival rates of 497 implants with at least 5 years of function – a retrospective study with 139 patients

Objetivo: avaliar as taxas de sucesso e sobrevivência de implantes há cinco anos ou mais em função. Material e métodos: pacientes tratados com implantes de titânio (Implacil De Bortoli, São Paulo, Brasil) na Fundecto (USP), no período de 1998 a 2008 foram incluídos neste estudo. Os implantes foram classificados individualmente, de acordo com um rigoroso critério de sucesso. Também foram levados em consideração o formato e o tipo de plataforma dos implantes. Resultados: a taxa de sobrevivência dos implantes tipo hexágono externo (n=357) e interno (n=140) foi de 99,4% e 99,3%, respectivamente. Já com relação aos implantes cônicos (n=88) e cilíndricos (n=409), a taxa de sobrevivência foi de 100% e 99,3%, respectivamente. A taxa de sucesso para implantes tipo hexágono externo e interno foi de 90,8% e 93,6%, respectivamente. Implantes cônicos obtiveram 90,9%, enquanto que implantes cilíndricos apresentaram 91,7% de taxa de sucesso. Conclusão: de acordo com o presente estudo, a taxa geral de sobrevivência dos implantes foi de 99,4%, enquanto a taxa de sucesso foi de 91,5%.

Objective: to assess success and survival rates from implants in function for five or more years. Material and methods: patients treated with osseointegrated implants (Implacil De Bortoli, Sao Paulo, Brazil) at Fundecto (USP), from 1998 to 2008, were included in this study. Implants were individually classified using strict success criteria. For further analysis, data were obtained regarding implant’s platform and implant’s macro design. Results: survival rates for external (n=357) and internal hexagon implants (n=140) were 99,4% and 99,3%, respectively. Regarding tapered (n=88) and cylindrical implants (n=409), survival rates were 100% and 99,3%, respectively. Success rates for external and internal hexagon implants were 90,8% and 93,6%. Tapered implants had 90,9% and cylindrical implants presented 91,7% of success rates. Conclusion: according to this retrospective study, the overall survival rate was 99,4% and the overall success rate was 91,5%.

Extensão da reabilitação protética implantossuportada e a relação com o índice de placa modificado / The relationship between the extent of implant-supported posthetic rehabilitation with the modified plaque index

Objetivo: avaliar retrospectivamente a relação da extensão da reabilitação protética com o índice de placa modificado. Material e métodos: pacientes tratados com implantes (Implacil De Bortoli, São Paulo, Brasil) na Fundecto (USP), no período de 1998 a 2012, foram incluídos neste estudo. Três grupos foram formados, de acordo com a extensão da reabilitação protética (unitária, parcial ou total). O parâmetro clínico índice de placa modificado foi utilizado para comparação entre os grupos. Para análise estatística, a equação de estimativa generalizada (GEE) foi utilizada. Resultados: foram examinados 183 pacientes, reabilitados com 916 implantes em função por pelo menos um ano. A taxa de sobrevivência dos implantes foi de 98,28%. Observou-se que havia placa bacteriana abundante (escore 3) ao redor de 30% (n=68) dos componentes protéticos de implantes pilares de reabilitações totais fixas sobre implantes. Já para os grupos de reabilitações parciais e unitárias, os valores foram de 3,6% (n=19) e 0,6% (n=1), respectivamente. Conclusão: componentes protéticos de implantes pilares de próteses totais fixas implantossuportadas apresentaram maior acúmulo de placa bacteriana abundante em sua superfície.

Objective: to retrospectively evaluate the relationship between the extent of prosthetic rehabilitation with modified plaque index. Material and methods: patients treated with osseointegrated implants (Implacil De Bortoli, Sao Paulo, Brazil) at Fundecto (USP) from 1998 to 2012 were included in this study. Three groups were formed according to the extent of prosthetic rehabilitation (single, partial or total). The modified plaque index was used for comparison among groups. Generalized estimating (GEE) equation was used for statistical evaluation. Results: 183 patients with 916 implants with at least 1 year in function were examined. The implant survival rate was 98.28%. Abundant soft matter (score 3) around 30% (n=68) of the prosthetic abutments from implants supporting total rehabilitations was seen. For the groups that comprised partial and single rehabilitations, the values were 3.6% (n=19) and 0.6% (n=1), respectively. Conclusion: prosthetic abutments from implants supporting total rehabilitations presented the greatest values for abundant bacterial plaque accumulation.