Vulvar herpes zoster infection: a rare and challenging diagnosis.

A 26-year-old woman under immunosuppression with infliximab due to Crohn's disease was referred to the gynaecology emergency room with dispersed and coalescing vesicular lesions on the vulvar region extending to the right lower limb involving S2-S3 dermatome, associated with severe pain. Clinical history, physical examination and serological testing was consistent with herpes zoster infection. The patient was treated with valaciclovir for 14 days and cefradine for 7 days (due to the possibility of secondary bacterial infection). Significant symptomatic improvement was noted after 1 week. The 1-year follow-up was unremarkable. According to our knowledge and review of the literature, this is one of the few cases reported of vulvar herpes zoster, especially related to infliximab.

Hand-carried ultrasound performed at bedside in cardiology inpatient setting - a comparative study with comprehensive echocardiography.

BACKGROUND: Hand-carried ultrasound (HCU) devices have been demonstrated to improve the diagnosis of cardiac diseases over physical examination, and have the potential to broaden the versatility in ultrasound application. The role of these devices in the assessment of hospitalized patients is not completely established. In this study we sought to perform a direct comparison between bedside evaluation using HCU and comprehensive echocardiography (CE), in cardiology inpatient setting. METHODS: We studied 44 consecutive patients (mean age 54 +/- 18 years, 25 men) who underwent bedside echocardiography using HCU and CE. HCU was performed by a cardiologist with level-2 training in the performance and interpretation of echocardiography, using two-dimensional imaging, color Doppler, and simple calliper measurements. CE was performed by an experienced echocardiographer (level-3 training) and considered as the gold standard. RESULTS: There were no significant differences in cardiac chamber dimensions and left ventricular ejection fraction determined by the two techniques. The agreement between HCU and CE for the detection of segmental wall motion abnormalities was 83% (Kappa = 0.58). There was good agreement for detecting significant mitral valve regurgitation (Kappa = 0.85), aortic regurgitation (kappa = 0.89), and tricuspid regurgitation (Kappa = 0.74). A complete evaluation of patients with stenotic and prosthetic dysfunctional valves, as well as pulmonary hypertension, was not possible using HCU due to its technical limitations in determining hemodynamic parameters. CONCLUSION: Bedside evaluation using HCU is helpful for assessing cardiac chamber dimensions, left ventricular global and segmental function, and significant valvular regurgitation. However, it has limitations regarding hemodynamic assessment, an important issue in the cardiology inpatient setting.

Pregnancy after hydrosalpinx treatment with Essure.

We present a case of a 29-year-old woman, with a history of ectopic pregnancy, which required left salpingectomy, and with a tortuous and impermeable right fallopian tube, compatible with hydrosalpinx. As hydrosalpinx itself can compromise a future pregnancy, treatment with Essure was proposed before passing to medically assisted procreation techniques. Five months after placement of Essure in the right fallopian tube, an in vitro fertilisation cycle was successfully completed and the woman had a singleton pregnancy and vaginal delivery without intercurrences.

Borderline Ovarian Tumor during Pregnancy: A Case Report.

We report a case of a 33 year-old pregnant woman who was diagnosed at the time of the first trimester ultrasound with a multilocular solid arising form the right ovary. An abdominal MRI was performed afterwards and it revealed a pelvic mass, developing from the right ovary, with a liquid component but with a major solid area. CA 125 was within the normal range values. A laparotomy followed by right salpingo-oophorectomy was performed at 14 weeks of gestation and both the frozen section and the definitive histology revealed a borderline mucinous ovarian tumor. Ovarian tumors of low malignant potential comprise 10%-20% of all ovarian malignancies. They carry an excellent prognosis with 95%-99% long-term survival. Whereas in the past, radical surgery (hysterectomy and bilateral salpingo-oophorectomy with peritoneal staging) was standard regardless of the age of the patient, unilateral salpingo-oophorectomy with or without staging has become the recommended management for women who desire childbearing. In the absence of large prospective randomized trials it is difficult to know which are the best management practices and especially to determine the right moment during pregnancy to perform surgery in these patients.

O ensino dos fundamentos de enfermagem na Escola Anna Nery em meados do Século XX / La enseñanza de los fundamentos de enfermería en la Escuela Anna Nery en meados del Siglo XX / Mid-20th Century teaching of foundations at the Anna Nery School of Nursing

Estudo histórico-social sobre o ensino dos fundamentos de enfermagem na Escola de Enfermagem Anna Nery (EEAN), nos anos de 1950 a 1960. Os objetivos foram: descrever as características do ensino dos fundamentos de enfermagem ministrado às alunas do curso de enfermagem; analisar as percepções da professora, de enfermeiras-chefes e de ex-alunas sobre o assunto; discutir a importância das relações administrativo-pedagógicas entre a EEAN e o Hospital Escola São Francisco de Assis. As fontes foram buscadas no Centro de Documentação, no Banco de Textos do Núcleo de Pesquisa de História da Enfermagem Brasileira e na Biblioteca Setorial de Pós-Graduação da EEAN/Universidade Federal do Rio de Janeiro. Também foram construídas fontes orais. As características do ensino eram a hierarquia e a disciplina, o estudo pelo trabalho e o ensino pelo exemplo. Conclui-se que houve consenso entre as entrevistadas quanto à importância da articulação interinstitucional para o ensino e a assistência; o ensino dos fundamentos de enfermagem era decisivo para a formação de enfermeiras de alto padrão pela EEAN.

This historical-social study of the teaching of the Foundations of Nursing at the Anna Nery School of Nursing (EEAN) in the 1950s and 60s aimed to: characterize the teaching of foundations to student nurses; examine the related perceptions of the teacher, head nurses and former students involved; and discuss the importance of administrative-educational relations between the Anna Nery School and the St. Francis of Assis Teaching Hospital. Sources were sought at the Documentation Center, Brazilian Nursing History Research Unit Text Bank and Postgraduate Sector Library of the EEAN/Rio de Janeiro Federal University. Oral sources were also consulted. The teaching was characterized by hierarchy and discipline, by study by work and teaching by example; the interviewees agreed on the importance of inter-institutional relations for teaching and care; and the teaching of the Foundations of Nursing was decisive in EEAN’s educating nurses to high standards.

Estudio histórico y social sobre la enseñanza de los fundamentos de enfermería en la Escuela de Enfermería Anna Nery (EEAN), en los años 50/60. Los objetivos fueron: describir las características de la enseñanza de los fundamentos de enfermería a las estudiantes del curso de enfermería; analizar las percepciones de la maestra, de las enfermeras jefes y de ex alumnos sobre la temática; discutir la importância entre las relaciones de los órganos administrativos y de educación de la EEAN y del Hospital Escuela São Francisco de Assis. Se realizaron búsquedas en las fuentes del Centro de Documentación, del Banco de Textos del Núcleo de Investigación de Historia de la Enfermería Brasileña y de la Biblioteca del Sector de Posgrado de la EEAN/Universidade Federal del Rio de Janeiro. También se construyeron fuentes orales. Las características de la enseñanza fueron la jerarquía y la asignatura, el estudio por el trabajo y la enseñanza por el ejemplo. Se concluye que hubo consenso entre las entrevistadas cuanto a la importancia de la articulación interinstitucional para la enseñanza y la asistencia; la enseñanza de los fundamentos de enfermería era decisiva para la formación de enfermeras de alto estándar por la EEAN.

Lesões intraepiteliais de baixo grau e atipias de significado indeterminado em células escamosas: conduta em adolescentes / Low grade squamous intraepithelial lesion and atypical squamous cells of undetermined significance: management on adolescents

Este trabalho teve como objetivo identificar a melhor conduta para mulheres adolescentes com diagnóstico citopatológico de atipias de significado indeterminado em células escamosas (ASC-US) e de lesão intraepitelial de baixo grau (LSIL). Foi realizada pesquisa na literatura médica procurando se identificar, criticar e extrair informações de fontes nacionais e internacionais, incluindo as recomendações publicadas em diretrizes relacionadas ao tema. Essa revisão teve como bases de dados: MEDLINE (por meio do PubMed), LILACS, EBSCO e Google Acadêmico. As diretrizes e as recomendações foram identificadas e aquelas relacionadas ao tema foram avaliadas segundo sua validade, sendo, então, sumarizadas. As recomendações feitas por Moscicki, pelo American College of Obstetricians and Gynecologists e pelo consenso australiano indicam encaminhamento à colposcopia após alteração citopatológica em duas amostras com intervalo de 12 meses, enquanto a recomendação do Ministério da Saúde do Brasil é o encaminhamento à colposcopia após alteração citopatológica em duas amostras com intervalo de seis meses. Concluiu-se que adolescentes devem ter abordagem cautelosa pela alta possibilidade de regressão da lesão. Foi observado que a conduta mais adotada é a repetição de duas citologias com intervalo de 12 meses, antes do encaminhamento à colposcopia.

The objective of this paper was to identify the best procedure in cases of adolescents which have the diagnosis of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). A research in medical literature carried out in order to identify, criticize and get information from national and international sources, including the recommendations and guidelines on this subject. The databases used in this review were MEDLINE (by PubMed), LILACS, EBSCO and Google Scholar. The guidelines and recommendations were summarized according to their validity. The recommendations made by Moscicki, by the American College of Obstetricians and Gynecologists and the Australian consensus indicate colposcopy only after two abnormals cytopathological exams with interval of 12 months. The Brazilian Health Ministry recommends colposcopy after two abnormal cytopathological exams with interval of six months. It was concluded that the approach on the adolescent women should be cautious because of the high possibility of regression of the wound. It was observed that the best procedure is the repetition of 2 exams, in an interval of 12 months, before referring the patient to colposcopy.

Estudo comparativo entre Fibroscan, APRI e FIB4 em pacientes com hepatite C crônica / Comparative study between Fibroscan, APRI and FIB4 in patients with chronic hepatitis C

RESUMO Introdução: O tratamento da hepatite C necessita do estadiamento da fibrose hepática. A biópsia hepática ainda é considerada o padrão-ouro, porém é um método invasivo e de alto custo. Por isso, foram desenvolvidos métodos não invasivos como FibroScan, APRI e FIB4 na tentativa de substituir a biópsia em pacientes com hepatite C crônica. Objetivo: Avaliar a acurácia de métodos não invasivos em predizer fibrose significativa nos pacientes com hepatite C crônica. Métodos: Estudo observacional e prospectivo, com pacientes com hepatite C crônica que realizaram FibroScan com o objetivo de estadiar o grau de fibrose. A acurácia dos escores APRI e FIB4 foi determinada pela medida das áreas sob as curvas ROC. Resultados: Foram incluídos 44 pacientes, destes 29 com fibrose significativa ( F ≥ 2) e 50% com esteatose hepática. As AUROC foram: 0,862 para APRI em predizer fibrose significativa com p < 0,001 e 0,722 para FIB4 com p=0,017. Utilizando valor de corte 1,5 para APRI e 3,25 para FIB4, obtivemos VPP e VPN de 100% e 42%, 100% e 43%, respectivamente. Conclusão: Os marcadores séricos apresentaram boa acurácia em predizer fibrose significativa, sendo o escore APRI superior ao FIB4. Palavras-chave: FibroScan, APRI, FIB4

Sobrevidas: histórias além do câncer / Survival: stories beyond cancer

Aborda a luta contra o câncer através do relato de 4 pessoas que tiveram as suas vidas abaladas pela doença. Conta também com o relato de um médico oncologista condutor do diálogo científico, dr. Fábio Franke. O aspecto informativo a respeito da doença é fundamental no documentário. (Projeto de final de curso de alunos de Comunicação Social da Universidade de Inijuí, Rio Grande do Sul...