Acinic cell carcinoma of the oral and maxillofacial region: an international multicenter study

Abstract The aim of this study was to describe the prevalence, clinicopathological, and prognostic features of acinic cell carcinoma (AciCC) of the oral and maxillofacial region. AciCC cases were retrospectively retrieved from 11 pathology centers of three different countries. Medical records were examined to extract demographic, clinical, pathologic, and follow-up information. A total of 75 cases were included. Females (65.33%) with a mean age of 45.51 years were mostly affected. The lesions usually presented as an asymptomatic (64.28%) nodule (95.66%) in the parotid gland (70.68%). The association of two histopathological patterns was the most common finding (48.93%) and the tumors presented mainly conventional histopathological grades (86.11%). Surgical treatment was performed in the majority of the cases (59.19%). Local recurrence was observed in 20% of the informed cases, regional metastasis in 30.43%, and distant metastasis in 12.50%. The statistical analysis showed that the cases with a solid histopathological pattern (p=0.01), high-grade transformation (p=0.008), recurrence (p=0.007), and regional metastasis (p=0.03) were associated with poor survival. In conclusion, high histopathological transformation, presence of nodal metastasis, and recurrence were prognostic factors for AciCC of the oral and maxillofacial region.

Does smoking habit affect dendritic cell expression in oral squamous cell carcinoma?

Abstract: The aim of this study was to determine the presence of immature CD1a+ and mature CD83+ dendritic cells in oral squamous cell carcinoma, to compare immunoreactivity between smokers and nonsmokers, and to correlate the results with histopathological grading. In this observational study, twenty-eight paraffin-embedded biopsies of oral squamous cell carcinoma were retrospectively retrieved and submitted to immunohistochemistry for immature CD1a+ and mature CD83+. Descriptive and statistical analyses were performed. The sample consisted of 18 man (64.3%) and 10 women (35.7%), with a mean age of 64.6 years in the nonsmoker group and 53.2 years in the smoker group. The tongue (11 cases, 39.2%) was the most commonly affected anatomical site, followed by gingiva (6 cases, 21.4%). Histopathological grading revealed 7 low-grade and 7 high-grade malignancy cases in each group, and no correlation with the number of positive DCs. The number of immature CD1a+ was not significantly different between smoker and nonsmoker groups, while a lower number of mature CD83+ was detected in the smoker group (p = 0.001). Smoking changes the oral immune system and decreases the ability to activate and mature dendritic cells, which may influence the development and progression of oral squamous cell carcinoma.

Contribuições da psicanálise à atuação na clínica cardiológica / Contributions of psychoanalysis to performance at the cardiology clinic

O presente ensaio tem como objetivo refletir sobre as contribuições psicanalíticas à atuação do psicólogo/psicanalista na clínica cardiológica a partir de uma breve articulação e discussão teóricas. Lançou-se mão de compreensões tais quais a inserção do analista no hospital, o corpo adoecido para a psicanálise e os principais aspectos subjetivos presentes na clínica cardiológica. Concluiu-se que o cerne das contribuições psicanalíticas à problemática é o oferecimento de possibilidade de acesso ao simbólico, diante de conteúdos difíceis de ser elaborados, que emergem a partir do processo de adoecimento.

This essay aims to reflect on the psychoanalytic contributions to the role of the psychologist/psychoanalyst in the cardiology clinic from a brief articulation and theoretical discussion. Understandings such as the insertion of the analyst in the hospital, the sick body for psychoanalysis and the main subjective aspects present in the cardiology clinic were used. It was concluded that the core of psychoanalytic contributions to the problem is the possibility of providing access to the symbolic, in view of content that is difficult to elaborate, which emerge from the illness process.

Production components of crambe in paraiba semi-arid region with nitrogen fertilization and different spacings / Componentes de produção de crambe no semiárido paraibano com adubação nitrogenada e diferentes espaçamentos

Crambe (Crambe abyssinica H.), a promising species in the production of biodiesel, has low planting cost, high oil content and easy extraction, besides being an alternative for the crop rotation system. The objective of this study was to evaluate the effects of nitrogen fertilization and line spacing on the production components and yield of the crambe crop under semi-arid conditions. The study was conducted under field conditions in the experimental area of the National Semi-Arid Institute-INSA, located in the city of Campina Grande-PB. The experimental design was a randomized complete block design in 4 x 2 factorial scheme, consisting of four nitrogen doses (30, 60, 90, 120 kg ha-1) with two spacings between planting lines (0.20 and 0.40 meters) with three replications, totaling 24 experimental plots. The evaluated parameters were: number of siliques per plant, dry weight of shoots, number of branches (primary and secondary), primary stem length, number of siliques per stem, mass of 1000 grains and productivity. The data were submitted to analysis of variance, in which the nitrogen doses (quantitative factor) were compared by regression analysis. The different spacings were compared by means of a t-test at the 0.05 probability level by using statistical software SISVAR version 5.2. Nitrogen fertilization at 0.40 m spacing between the planting lines led to the best results for the production components, and the highest productivity was obtained at 0.20 m spacing of with nitrogen fertilization of 120 kg ha-1.

O crambe (Crambeabyssinica H.), espécie promissora na produção de biodiesel, apresenta baixo custo de plantio, elevado teor de óleo e de fácil extração, além de ser alternativa para o sistema de rotação de culturas. Mediante a necessidade de conhecimento para ampliação do cultivo dessa espécie, este estudo teve como objetivo avaliar os efeitos da adubação nitrogenada e espaçamento entre linhas no cultivo nos componentes de produção e na produtividade da cultura do crambe em condições semiáridas. O estudo foi conduzido em condições de campo na área experimental pertencente ao Instituto Nacional do Semiárido-INSA, situado no município de Campina Grande-PB. O delineamento experimental utilizado foi em blocos casualizados, no esquema fatorial 4 x 2, sendo constituído de quatro doses de nitrogênio (30; 60; 90; 120 kg ha-1) com dois espaçamentos entre linhas de plantio (0,20 e 0,40 metros) e com três repetições, totalizando 24 parcelas experimentais. Os parâmetros avaliados foram: número de síliquas por planta, massa seca da parte aérea, número de ramificações (primárias e secundárias), comprimento de haste primária, número de silíquas por haste, massa de 1000 grãos e produtividade. Os dados obtidos foram submetidos à análise de variância, em que as doses de nitrogênio (fator quantitativo) foram comparadas por análise de regressão. Os diferentes espaçamentos foram comparados por meio de comparação de médias, pelo teste t, ao nível de 0,05 de probabilidade utilizando-se software estatístico SISVAR versão 5.2. A adubação nitrogenada sob espaçamento de 0,40 m, entre as linhas de plantio, proporcionou os melhores resultados quanto aos componentes de produção, e a maior produtividade foi obtida no espaçamento referente a 0,20 m com a adubação nitrogenada de 120 kg ha-1.

A multicenter study of biopsied oral and maxillofacial lesions in a Brazilian pediatric population

Abstract The aim of this study was to investigate the prevalence of oral and maxillofacial lesions among children from representative regions of Brazil. A retrospective descriptive study was conducted. Biopsy records comprising the period from 2000 to 2015 were obtained from the archives of three Brazilian oral pathology referral centers. A total of 32,506 biopsy specimens were analyzed, and specimens from 1,706 children aged 0-12 years were selected. Gender, age, anatomical location and histopathological diagnosis were evaluated. Descriptive statistics was carried out. Likelihood ratio tests were used to evaluate the association between the categorical variables. The level of significance was set at 0.05. The post-hoc test was used to identify the subgroups that significantly differed from one another, and the Bonferroni correction was applied. A total of 1,706 oral and maxillofacial lesions were diagnosed in pediatric patients, including 51.9% girls. Oral mucocele was the most prevalent reactive/inflammatory lesion (64%). The most commonly affected sites were the lips (34.5%) and mandible (19.9%). A significant association was observed between age and the group of lesions of the oral cavity (p < 0.001), and between age and anatomical location (p < 0.001). Pediatric oral and maxillofacial lesions were frequent and showed wide diversity, with the prevalence of mucocele. Knowledge of oral lesions is important for pediatric dentists worldwide, since it provides accurate data for the diagnosis and oral health of children.

Demographic and Clinical Profile of Oral Squamous Cell Carcinoma from a Service-Based Population

Abstract The aim of this study was to evaluate the demographic and clinical profile of the oral squamous cells carcinoma (OSCC) cases registered in a center of oral diagnosis in southern Brazil. Eight hundred and six individuals with OSCC from 1959 to 2012 were included in this study. The variables recorded were: sex, age, occupation according to workplace, alcohol and tobacco consumption, skin color, tumor location, histological type, clinical appearance, size, evolution time, presence of pain and lymph node metastasis. Descriptive analysis was performed and the associations between variables were assessed using the chi-square and Fisher's exact test, with a confidence level of 5%. OSSC was more common in males (76.6%) aged between 51 to 70 years (53.9%). The most frequent sites were lower lip vermilion (23.3%), tongue (20.2%) and gingiva/alveolar ridge (18.1%). There was a strong association between outdoor occupation and white skin color with lip squamous cell carcinoma (LSCC). OSCC intraoral lesions were commonly more painful, larger than 2 cm and presented lymphatic metastasis. In conclusion, most of the results confirm the data from literature about sex, age, tumor location and occupation. Moreover, the positive correlations between LSCC and occupation, between LSCC and white skin color, and between bigger lesions and presence of pain/cervical metastasis also corroborate the literature data.

Resumo O objetivo desse estudo foi avaliar o perfil clínico-demográfico dos casos de carcinoma de células escamosas oral (CCEO) oral registrados em um centro de diagnóstico bucal no Sul do Brasil. Oitocentos e seis indivíduos com CCEO de 1959 a 2012 foram incluídos no estudo. As variáveis coletadas foram: sexo, idade, ocupação de acordo com o ambiente de trabalho, consumo de álcool e tabaco, cor de pele, localização do tumor, tipo histológico, aparência clínica, tamanho, tempo de evolução, presença de dor e metástase linfonodal. Foi realizada análise descritiva e as associações entre as variáveis foram avaliadas usando qui-quadrado e teste exato de Fisher, com nível de confiança de 5%. CCE oral foi mais comum em homens (76,6%), entre 51 e 70 anos de idade (53,9%). Os sítios mais frequentes foram vermelhão de lábio inferior (23,3%), língua (20,2%) e gengiva/rebordo alveolar (18,1%). Houve uma forte associação entre ocupação em ambiente externo e cor de pele branca com CCEO em lábio. Lesões intraorais de CCEO foram comumente mais dolorosas, maiores que 2 cm e apresentaram metástase linfática. Em conclusão, a maioria dos resultados confirma os dados da literatura em relação a sexo, idade, localização do tumor e ocupação. Além disso, as correlações positivas entre CCE em lábio e ocupação, entre CCEO em lábio e cor de pele branca, e entre lesões maiores e presença de dor/metástase cervical também corroboram os dados da literatura.

Evaluation of chemical attributes of soil under different management systems of sugarcane in an area of expansion / Avaliação de atributos químicos do solo submetido a diferentes manejos em área de expansão de cana-de-açúcar

In the area of expansion, where if you have restriction on fertility, soil preparation has contributed considerably to the improvement of the physical, chemical and water conditions of soils and, consequently, to the proper development of culture of sugarcane. The aim of this study was to evaluate the effect of different management techniques on the availability of nutrients in soil in an area of expansion of sugarcane, formerly with Brachiaria decumbens, in the Cerrado region. The experiment was conducted using the CTC 2 variety at Jalles Machado mill in Goianésia, GO. The experiment was established in a randomized block design, with six treatments and four replications. Chemical attributes of soil were evaluated at depths of 0-20, 20-40 and 40-60 cm. Significant differences were found among depths for all analyzed attributes. Adopted management systems influenced chemical attributes and the availability of nutrients for plants. Invertion of soil through plowing and harrowing is extremely beneficial to carry out soil amendment in the first year of cultivation, improving the incorporation and effectiveness of the corrective. The adoption of no-tillage system did not prove to be the best option for the first year of sugarcane cultivation, hindering the incorporation of the corrective.

Em área de expansão, onde se têm restrições quanto à fertilidade, o preparo do solo contribui consideravelmente para a melhoria das condições físicas, químicas e hídricas dos solos e, consequentemente, para o desenvolvimento adequado da cultura da cana-de-açúcar. O objetivo deste trabalho foi avaliar o efeito de diferentes técnicas de manejo, sobre a disponibilidade de nutrientes no solo, em área de expansão de cana-de-açúcar, anteriormente com a presença de Brachiaria decumbens, na região do cerrado. O experimento foi conduzido na usina Jalles Machado, em Goianésia, GO, sendo utilizada a variedade CTC 2. O experimento foi implantado em delineamento de blocos casualizados, com seis tratamentos e quatro repetições. Foram avaliados os atributos químicos do solo, nas profundidades de 0-20, 20-40 e 40-60 cm. Foram observadas diferenças significativas entre as profundidades para todos os atributos analisados. Os diferentes manejos adotados interferiram nos atributos químicos e na disponibilidade de nutrientes para as plantas. O revolvimento do solo através de aração e gradagem é extremamente benéfico para a realização da correção do solo para o primeiro ano de cultivo, tornando melhores a incorporação e eficácia do corretivo. A adoção do sistema plantio direto não demonstrou ser a melhor opção para o primeiro ano de cultivo de cana-de-açúcar, dificultando a incorporação dos corretivos utilizados.

Pénfigo vulgar: revisión de 12 casos / Pemphigus vulgaris: a review of 12 cases

Introduction: pemphigus vulgaris is an autoimmune mucocutaneous disease, which presents at clinical examination as blisters, erosions and ulcerations of the skin and mucous membranes. Objective: the aim of this study was to review 12 cases of pemphigus vulgaris diagnosed at the Stomatology Department of São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul. Methods: the medical charts were analyzed considering patients age and sex; anatomic site and clinical aspect of the lesions; as well as symptoms, duration and clinical course of the disease. Results: the mean age of the patients was 46.7 years; most of cases occurred in females (75.0 percent); buccal mucosa was the site most frequently affected (83.3 percent), and 25 percent of cases showed extraoral manifestations. Erosion/ulceration was the most prevalent clinical appearance (83.3 percent), and pain occurred in 100 percent of cases. The mean time of development of the lesions reported by the time of the diagnosis was 12.3 months, and the mean time of follow-up was 2 years. All patients received systemic therapy with prednisone, meanwhile in 58.3 percent of cases it was associated with topic therapy and in 25 percent, with systemic immunosuppressive therapy. One case (8.3 percent) remained in remission regardless of the treatment withdrawal. Conclusion: Pemphigus vulgaris is a disease with important morbidity, which requires the attention of the dentist as a way to achieve early diagnosis(AU)

Introducción: el pénfigo vulgar es una enfermedad autoinmune mucocutánea, que presenta al examen clínico ampollas, erosiones y ulceraciones de la piel y de las membranas mucosas. Objetivo: presentar una revisión de 12 casos de pénfigo vulgar diagnosticados en el Departamento de Estomatología del Hospital São Lucas - Pontifical Catholic University of Rio Grande do Sul. Métodos: los registros médicos fueron evaluados por edad y sexo de los pacientes; el sitio anatómico y el aspecto clínico de las lesiones; así como los síntomas, duración y el curso clínico de la enfermedad. Resutados: la edad media fue 46,7 años y la mayoría de los casos fueron mujeres (75,0 por ciento). La mucosa bucal fue el sitio más frecuentemente afectado (83,3 por ciento) y el 25 por ciento de los pacientes presentaron manifestaciones extraorales de la enfermedad. La presentación clínica ulcerada fue la más frecuente (83,3 por ciento) y el dolor estaba presente en el 100 por ciento de los casos. La duración media de las lesiones en el diagnostico fue de 12,3 meses y el tiempo medio del seguimiento fue de 2 años. Todos los pacientes recibieron la terapia sistémica con prednisona. En el 58,3 por ciento de los casos hubo una asociación con terapia tópica y en el 25 por ciento con terapia inmunosupresora. Uno de los casos (8,3 por ciento) permaneció en remisión después de la interrupción de la terapia. Conclusión: el pénfigo vulgar es una enfermedad con una morbilidad importante, que requiere la atención del dentista como una manera de lograr el diagnóstico temprano(AU)

Post-kala-azar dermal Leishmaniasis in two different clinical contexts

In Brazil, visceral Leishmaniasis is caused by Leishmania chagasi. The development of cutaneous lesions in visceral leishmaniasis patients has been described in two different clinical contexts. Patients with compromised immunity can develop skin lesions as a direct consequence of a current visceral disease. Equally, patients with a history of kala-azar and progressive, immune improvement occasionally develop skin lesions as a consequence of immune reconstitution infl ammatory syndrome. These cases manifest in similar fashion to the classic form of post-kala-azar dermal Leishmaniasis. We describe different cases that exemplify these two clinical presentations.

Aplicação de diferentes fontes de ureia de liberação gradual na cultura do milho / Application of different sources of urea with gradual release in corn

Diversos trabalhos estão sendo desenvolvidos para avaliar o comportamento de diferentes tipos de revestimentos em fertilizantes, pois é necessário o entendimento de sua dinâmica de liberação no sistema solo-planta.O objetivo deste trabalho foi avaliar o comportamento do milho submetido à adubação com diferentes doses de uréia convencional e uréias encapsuladas. A área experimental foi implantada no distrito de Tapuirama localizado no município de Uberlândia-MG. Instalou-se o delineamento em blocos casualizados em esquema fatorial 5 x 3 com quatro repetições. A variedade de milho utilizado foi o Pionner 30F53H. Os tratamentos consistiam na aplicação do equivalente á 0, 100, 120, 150 e 180 kg ha-1 de uréia convencional sem tratamento com polímero, Uremax (uréia encapsulada com polímero) e Uremax Plus (uréia revestida com uma camada de polímero e outra de carbonato).A aplicação foi aos 25 dias após emergência e a primeira avaliação foi realizada aos 30 dias após aplicações das fontes.Ao final do ciclo foi quantificada a produtividade total por hectare. Não houve diferença significativa entre as fontes analisadas em todas as variáveis. Independente do revestimento o uso de uréia proporcionou incremento nas variáveis vegetativas e na produtividade.

Several studies are underway to test and evaluate the behavior of these different types of coatings understand its dynamics in soil-plant system. The objective of this study was to evaluate the behavior of corn subjected to fertilization with different doses of ureas and conventional encapsulated by measuring plant height at the end of the tassel, the total height of the plant until the end of last leaf, productivity and stem diameter corn at the time of insertion of the first sheet baixeiro. The experimental area was established in the district of Tapuirama located in Uberlândia-MG. Plants were randomized block design in 3 x 5 factorial scheme with four replications. . The maize variety used was Pioneer 30F53H. The treatments consisted of applying the equivalent of 0, 100, 120, 150 and 180 kg urea ha-1 without treatment with conventional polymer Uremax (Urea polymer-encapsulated) and Uremax Plus (Urea coated with a layer of polymer and other carbonate). The application was for 25 days after emergence and the first evaluation was performed 30 days after application of the sources. Total height was measured from the plant to the tip of the last leaf, plant height and tassel at the end of the stem diameter at the time of insertion of the first sheet baixeiro. At the end of the cycle was quantified total productivity per hectare. There was no significant difference between the sources for all variables analyzed. Regardless of the use of coated urea variables positively motivated and vegetative productivity.

Influencia da aplicação de diferentes fontes de map revestido com polimeros de liberação gradual na cultura do milho / Influence ofapplication of differentsources ofmapcoated withgradualreleasepolymersincornculture

Entre os fatores que podem contribuir para a melhoria da produtividade da cultura do milho está o melhor aproveitamento das fontes de fertilizantes. Atecnologia de revestimento de fontes solúveis com polímeros de liberação gradualé uma das alternativas mais promissoras, sendo fundamental avaliar o seucomportamento no sistema solo-planta.O objetivo foi avaliar duas fontes de MAP revestidos com polímeros de liberação gradual e MAP convencional.Instalou-se em casa de vegetação, um ensaio em delineamento em blocos casualizados com 3 fontes e 5 doses de fósforo.Os tratamentos consistiram na aplicação do equivalente a 0, 40, 60, 80 e 120 kg ha-1 de P2O5 de MAP sem tratamento com polímero, Phosmax e Phosmax Plus (MAP revestidos).As doses foram aplicadas em vasos de 3 kg de solo em cobertura sem incorporação e subseqüente semeadura do milho. O experimento foi conduzido por 30 diasquando foram realizadas as mensurações vegetativas de diâmetro de colmo e produção de matéria seca. O uso de MAP revestido com polímeros e MAP convencional influenciaram todos os dados vegetativos e químicos avaliados.O uso de revestimento com polímero de liberação gradual permite uma disponibilização gradual do P para o solo sem reduzir a eficiência na absorção pela planta de milho.Independente da fonte aplicada o solo apresenta teor de P remanescente equivalente.

T Among the factors than can contribute to improving the productivity of maize is the best use of fertilizer sources. Is available coating technology with soluble polymers gradual release and it is essential to evaluate the behavior in soil-plant system. He settled in a greenhouse at the Federal University of Uberlândia-UFU, an essay in randomized block design with three sources and five doses of phosphorus. The treatments consisted of applying the equivalent of 0, 40, 60, 80 and 120 kg ha-1 P2O5 MAP without treatment with conventional polymer, and PhosmaxPhosmax Plus (MAP coated). The doses were applied to pots of 3 kg of soil cover without incorporation and subsequent seeding of corn. The experiment was conducted for 30 days and made measurements of vegetative, dry matter (DM). The use of polymers coated with MAP and MAP conventional influenced all vegetative and chemical data measured. The use of polymer coating allows a gradual release of the gradual release to soil P without reducing the efficiency of uptake by the corn plant. Regardless of the source has applied to the soil P content remaining equal

Patient care and administrative activities of nurses in clinical/surgical units / Atividades assistenciais e administrativas do enfermeiro na clínica médico-cirúrgica

Objectives: To identify the administrative and nursing care activities most performed by nurses in clinical/surgical units and to determine which are most and least pleasant to them. Methods: A descriptive-exploratory study, with a quantitative approach and with a sample made up of 40 nurses working in clinical/surgical units who answered a three-part questionnaire composed of identification data and characterization of the professional; a list of nursing and administrative activities for the nurse to grade according to the numbers: "0 = I do not perform it", "1 = I perform it occasionally", "2 = I perform it often", "3 = I perform it daily"; two open-ended questions, in which the nurse listed the activities he/she enjoyed the most and the least. Results: The administrative activities most performed by the nurses were: changing work shifts, preparing employee daily task charts and managing tests; the most performed nursing care activities were related to the stages of the Nursing Care Systematization and the interaction with the multi-professional team; the most enjoyable activities were direct patient care, patient evaluation and implementation of the systematization; the least enjoyable activities were administrative and bureaucratic routines, justification of complaints/problem-solving and preparation of employee task charts. Conclusion: Compared to administrative activities, nursing activities were performed most during the daily routine of the nurse, and the most enjoyable activities were those related to patient care, according to the opinions of the professionals.

Objetivo: Identificar as atividades administrativas e assistenciais mais realizadas pelos enfermeiros nas clínicas médico-cirúrgicas e conhecer as mais e menos prazerosas para esses profissionais. Métodos: Pesquisa de campo descritivo-exploratória, com abordagem quantitativa, cuja amostra constituiu-se de 40 enfermeiros que trabalham em clínicas médico-cirúrgicas, os quais responderam a um questionário composto de três partes: dados de identificação e caracterização do profissional; relação de atividades assistenciais e administrativas para o enfermeiro, que deveria enumerar: "0 = não realizo", "1 = realizo eventualmente", "2 = realizo moderadamente", "3 = realizo diariamente"; duas questões semiabertas, nas quais o enfermeiro listou as atividades que lhe eram mais e menos prazerosas. Resultados: As atividades administrativas mais realizadas pelos enfermeiros foram: passagem de plantão, escala diária e de tarefas de funcionários e gerenciamento de exames; as atividades assistenciais mais realizadas relacionavam-se às etapas da Sistematização da Assistência de Enfermagem e ao relacionamento com a equipe multiprofissional; as atividades mais prazerosas foram assistência direta ao paciente, avaliação do paciente e implementação da sistematização; as atividades menos prazerosas foram as rotinas administrativas e burocráticas, justificativa de queixas/resolução de problemas e realização de escalas de funcionários. Conclusão: As atividades assistenciais foram as mais realizadas, comparadas às atividades administrativas na rotina diária do enfermeiro, sendo também as mais prazerosas, segundo a opinião dos próprios profissionais.

Síndrome de Melkersson-Rosental: relato de caso / Melkersson-Rosental syndrome: a case report

A Síndrome de Melkersson-Rosenthal é uma desordem rara caracterizada por edema orofacial recorrente, paralisia facial e língua fissurada. A patogênese dessa condição é incerta, fazendo com que seja limitado o sucesso do tratamento. O objetivo deste trabalho é o de relatar um caso da referida síndrome bem como discutir o uso do corticóide intralesional como modalidade terapêutica

Assistência ambulatorial a pacientes com tuberculose multirresistente - A experiência de construção de uma unidade de referência no Instituto Estadual de Doenças do Tórax Ary Parreiras, Niterói - RJ / Out patient care of multidrug resistant tuberculosis patients in a referenc e unit - Experience of building up of the reference unit in the Instituto Estadual de Doenças do Tórax Ary Parreiras, Niterói - RJ

A tuberculose é uma das principais enfermidades infecciosas no mundo. Nos últimos anos, entre os fatores que contribuíram para o agravamento da situação está o crescimento dos casos de tuberculose multirresistente (TBMR), tornando necessária a criação de novosespaços para o adequado acompanhamento dos enfermos. Descrever a construção de um ambulatório de referência para a atenção de pacientes com TBMR é o objetivo deste artigo