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Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.

Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.

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Este estudo teve como objetivo avaliar o dimorfismo sexual em uma coleção de mandíbulas portuguesas através de uma metodologia métrica digital, utilizando análise estatística descritiva, inferencial e multivariada para identificar quais parâmetros são mais dimórficos e quais são os melhores preditores de sexo. Trinta e três mandíbulas (14 mulheres e 19 homens) e pertences pessoais foram fotograficamente registrados com código e sexo. Os dados foram coletados por tomografia e as medidas foram feitas pelo software Simplant Pro. Foram registrados a largura máxima e mínima do ramo mandibular, altura condilar, altura do processo coronoide, altura da sínfise mandibular, ângulo mandibular, distâncias bimentual, biantegonial, bigonial e bicondilar e comprimento máximo mandibular. A análise estatística foi realizada utilizando IBM® SPSS. Os resultados mostraram diferenças estatisticamente significativas para os seguintes parâmetros: altura do processo coronoide, altura do côndilo, comprimento máximo da mandíbula e largura mínima do ramo mandibular. Na análise estatística multivariada foi possível identificar a altura do processo coronoide como melhor preditor de sexo com precisão em 72,2% dos casos. Isto permite uma diferenciação mais fácil entre mandíbulas femininas e masculinas com uma precisão de 64,3% e 78,9%, respectivamente. Foi possível concluir que a altura do processo coronoide é o parâmetro mais dimórfico e o melhor preditor de sexo na amostra.

This study aimed to assess sex dimorphism in a collection of Portuguese mandibles through a digital metric methodology by using descriptive, inferential, and multivariate statistical analysis to identify which parameters are the most dimorphic and which are the best sex predictors. Thirty-three mandibles (14 females and 19 males) and personal belongings were photographically registered with code and sex. Data was collected using tomography, and measurements were made using the Simplant Pro software. The maximum and minimum width of the mandibular ramus, condylar height, coronoid process height, mandibular symphysis height, mandibular angle, bi-mental, bi-antegonial, bi-gonial and bi-condylar distances, and maximal mandibular length were registered. Statistical analysis was performed using IBM® SPSS. The results showed statistically significant differences for the following parameters: coronoid process height, condyle height, the maximum length of the mandible, and the minimum width of the mandibular ramus. In the multivariate statistical analysis, it was possible to identify the coronoid process height as the best sex predictor accurately in 72.2% of cases. This allows for easier differentiation between female and male mandibles with an accuracy of 64.3% and 78.9%, respectively. It was possible to conclude that the coronoid process height is the most dimorphic parameter and the best sex predictor in the sample.

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Cemento-ossifying fibroma (COF) is a slow-growing, well-defined unilocular benign mesenchymal odontogenic tumor, that can have sclerotic edges and mixed areas. This case report details a conservative surgical treatment approach for COF that preserved both the cortical basal bone and the tooth segment. A thirty-three-year-old female presented with an asymptomatic extensive lesion in the anterior mandible, manifesting mild facial asymmetry, with one year of evolution. Imaging revealed a mixed dense lesion with sclerotic edges, with extension to the periapex of the teeth 33-44, expanding and thinning the cortical bone. Histopathology confirmed COF, showing fibrous stroma with spherical cementoid calcifications, overlayed with intact bone tissue. Conservative surgery was performed combining enucleation and curettage, with peripheral ostectomy, maintaining the cortical basal bone from the mandibulae, and tooth by apicoectomies. Three- and ten-months postoperative imaging displayed peripheral bone neoformation at the site, indicating effectiveness in the short-term follow-up, with no evidence of residual disease or recurrence. (AU)

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Introduction: The elimination of viral hepatitis is one of the goals of the 2030 agenda, particularly because it poses significant public health challenges. Objective: To analyze the temporal trend, spatial distribution, and factors associated with the detection and mortality of viral hepatitis B and C in Brazil from 2010 to 2019. Methods: Ecological study on Brazilian regions and Federative Units. Annual detection and mortality coefficients were calculated. Trend analysis was performed using polynomial regression models. Thematic maps were constructed to illustrate spatial distribution. The Spearman correlation coefficient was employed to assess the association with seven socioeconomic indicators. Results: Brazil exhibited a decreasing trend in hepatitis detection and mortality. The South and North regions had the highest rates of hepatitis B, with a decreasing and stable trend, respectively. The South and Southeast regions had the highest rates of hepatitis C, both showing a decreasing trend. Hepatitis B detection was more prevalent in Acre and Rondônia, while hepatitis C detection was higher in Rio Grande do Sul and Acre. There was an increase in the detection of infections and a decline in mortality from hepatitis C in Pará and Acre. Hepatitis detection was inversely related to the illiteracy rate and related to the human development index, life expectancy, and per capita income. Conclusion: Regional and state disparities in the behavior of viral hepatitis B and C in Brazil were evident, with areas (states) of higher development indexes exhibiting higher detection rates of the infections.

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Introducción. Los tumores de cuerpo carotídeo son infrecuentes. Además de tener una clínica inespecífica, en muchos casos son asintomáticos lo cual produce retraso en el diagnóstico. Métodos. Se realizó una revisión narrativa posterior a la búsqueda de literatura internacional por medio de la base de datos PubMed. Resultados. Dado que la realización de biopsia esta contraindicada, los estudios de imagen tienen una gran importancia para el diagnóstico. Dentro de las opciones de tratamiento se cuentan la cirugía, la radioterapia y la quimioterapia. La primera opción es la más recomendada debido a su potencial curativo, pero también es la que conlleva más riesgo de morbimortalidad. Aún hay controversia sobre el uso de embolización prequirúrgica. La radioterapia es una buena opción, con mínimo riesgo en pacientes que no sean candidatos o que rechacen la cirugía. Conclusiones. Los tumores de cuerpo carotídeo son neoplasias poco comunes, con una fisiopatología aún inconclusa, a pesar de las múltiples hipótesis en la literatura. Desafortunadamente, no se cuenta con un número suficiente de ensayos clínicos que permitan emitir recomendaciones de calidad.

Introduction. Carotid body tumors are rare. In addition to having non-specific symptoms, in many cases they are asymptomatic, which makes a diagnostic delay. Methods. A narrative review was carried out after searching international literature using the PubMed database. Results. Since performing a biopsy is contraindicated, imaging studies are of great importance for diagnosis. Treatment options include surgery, radiotherapy and chemotherapy. The first option is the most recommended due to its curative potential, but it is also the one that carries the highest risk of morbidity and mortality. There is still controversy regarding the use of presurgical embolization. Radiotherapy is a good option, with minimal risk in patients who are not candidates or who reject surgery. Conclusions. Carotid body tumors are rare neoplasms with a pathophysiology that is still inconclusive, despite the multiple hypotheses in the literature. Unfortunately, there is not a sufficient number of clinical trials to make quality recommendations.

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ABSTRACT Mantle cell lymphoma of the ocular and periorbital regions is extremely rare but should be considered in the differential diagnosis of lesions affecting the periorbital tissues. In this study, we present a rare case of mantle cell lymphoma of the lacrimal sac in a 65-year-old male presenting with a mass in the lacrimal sac region and epiphora. After clinical examinations and imaging studies, the mucocele was misdiagnosed. Considering the unexpected findings during external dacryocystorhinostomy, a frozen biopsy was performed, which confirmed the diagnosis of lymphoma.

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ABSTRACT A patient presented with corneoscleral thinning five months after the treatment of suspected ocular squamous surface neoplasia with mitomycin-C and interferon. For tectonic and aesthetic purposes, we decided to perform lamellar corneoscleral transplantation. The approach used established new tectonic support and corneal homeostasis. This technique might be an option in similar cases.

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ABSTRACT Purpose: To describe the epidemiological and clinical profile of hospitalized patients with retinoblastoma in Brazil. Methods: Using data from the Hospital Cancer Registry of the Instituto Nacional de Câncer, patients with the morphological codes of retinoblastoma who were diagnosed between 2000 to 2018, aged 0-19 years, and followed up in registered hospitals (analytical cases) were selected. The relative and absolute frequencies of demographic, clinical, diagnostic, therapeutic, and outcome variables were described. Hospital performance indicators were calculated and compared between hospitals qualified and not qualified to treat pediatric oncology cases and between hospitals with different case volumes (<20, 20-75, >75 cases). Results: Of the 2,269 identified analytical cases from 86 institutions, 48% were from the Southeast, 54% were male, and 66% were aged <4 years. The proportion of missing data (NA) was too high for several variables. Approximately 84% of the patients were from the public health system, 40% had a positive family history, and 88% had unilateral involvement. The first treatment included surgery in 58.3% of the patients (NA=2), Approximately 36.6% of these patients achieved complete remission, 10.8% achieved partial remission, and 12.7% died (NA=59%). Hospital performance indicators were within the target in >90% of the patients. The median time between the first appointment and diagnosis (6 days, interquartile range [IQR] 1-14) was significantly lower and the median time to death was longer (343 days, IQR, 212-539) in high-volume hospitals (>75 cases) than in medium- and low-volume hospitals. Conclusions: Despite the high proportion of missing data, we found that the delay in diagnosis is due to prehospital factors. Additionally, there is a need for educational programs for healthcare professionals and families that emphasize early identification and referral to specialized centers. Future studies should focus on the impact of Hospital Cancer Registry data completeness on outcomes, causes of delay in diagnosis, regional inequalities, and barriers to accessing specialized services.

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Introduction Central nervous system (CNS) tumors are the most common solid tumors in childhood, comprising 20% of all neoplasms in that age. Besides, they constitute the biggest cause of morbidity and mortality among childhood tumors, and about two thirds of the surviving patients have sequelae. The build-up of sequelae due to neoplastic growth is directly related with the time until diagnosis. Therefore, late diagnosis has a negative influence on the prognosis. Objective To analyze the journey of the pediatric patients with CNS tumors and their families to the reference center. Materials and Methods The present is a retrospective, prospective cohort study based on chart analyses and questionnaire application. Results The mean age of the patients was 8.39 years, most were male (58%), white (56%), and originated from the Southeast of Brazil (56%). A total of 83% of the patients were accompanied by their mothers, and the family income obtained was below 3 minimum wages (20%). The average time until perception of the first signs or symptoms was 48 days, the mean time from symptom perception until the first medical appointment was 30 days, and the mean time between the first medical appointment and referral to Hospital de Amor Infantojuvenil de Barretos was 315 days. The most frequently present signs and symptoms were neurological manifestations (72%), such as headaches (14.8%) and projectile vomiting (6.5%). There was an association between the medical service (public or private service) where the first medical appointment took place and the first medical specialty consulted, although it did not relate to a shorter time until diagnosis. Conclusion The difficulties in the journey of CNS tumor pediatric patients occurred mainly due to health system flaws and medical professionals' hardships. Thus, it is essential to reinforce the importance of continued medical education and to encourage new studies that may reveal precisely where these system flaws are taking place.

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ABSTRACT Optic neuritis is an important cause of unilateral and acute visual loss in young adults, but other differential diagnoses should be considered, especially when the disease has an atypical presentation. This report presents the case of a young woman with reduced visual acuity in her right eye, associated with optic disc edema and a relative afferent pupillary defect, that was initially misdiagnosed as optic neuritis and subsequently found to have paracentral acute middle maculopathy, possibly secondary to subtle impending central retinal vein occlusion. This case emphasizes the need to remember that retinal vascular diseases can occasionally mimic optic neuritis. Detailed anamnesis and ophthalmic examination can avoid unnecessary interventions.

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ABSTRACT Langerhans cell histiocytosis comprises a heterogeneous range of clinical manifestations secondary to clonal proliferation of histiocytes, characterized by the accumulation of these cells in various organs and tissues. The ophthalmological component commonly involved is the orbit. Herein, we report a rare case of Langerhans cell histiocytosis with eyelid involvement, which resulted in severe ocular surface complications, which subsequently significantly impacted the patient's quality of life. This case report highlights the fact that despite being rare, Langerhans cell histiocytosis should be included in the differential diagnosis of eyelid lesions. Furthermore, a multidisciplinary approach with a systemic overview is crucial for managing the ocular complications.

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ABSTRACT Purpose: Although Brazil has a high prevalence of retinoblastoma, there is a lack of epidemiological data on the disease. Thus, in this study, we aimed to evaluate the epidemiological profile of patients diagnosed with retinoblastoma in the ophthalmology department of a pediatric tertiary referral hospital in Ceara, Brazil. Methods: A descriptive and cross-sectional study was conducted by retrospectively analyzing the clinical and socioeconomic data from the medical records of pediatric patients followed-up at the hospital between 2007 and 2021. Retinoblastoma was diagnosed on the basis of a fundoscopic or histopathologic examination. Results: The data of 105 patients were included in the study, and the mean patient age at the time of diagnosis was 1.7 years. Most of the patients were women (50.5%) and hailed from rural areas (57.4%), which was associated with a higher tumor stage. Of the 150 patients, 57.1% initially presented with leukocoria. Ocular hyperemia was associated with more advanced stages of retinoblastoma (p=0.004). Bilateral involvement was observed in 25.7% of the patients and at a significantly younger age (p=0.009). The presence of retinal detachment, vascularized lesions, and vitreous seeds significantly increased the likelihood of requiring enucleation. Discussion: This study presents an epidemiological description of retinoblastoma in Brazil, which highlights the significance of early detection. Delayed diagnosis is associated with a poorer visual prognosis and higher mortality rate, particularly in patients with unilateral disease. Risk factors for a more severe disease were retinal detachment, vascularized lesions, and vitreous seeds. The correlation between histopathological features and clinical outcomes was limited. Conclusion: Further studies are required to assess the influence of ocular hyperemia, fundoscopic assessment, and histopathologic findings on the prognosis of retinoblastoma. Moreover, it is critical to devise interventions to reduce the time-to-diagnosis in rural areas.

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El quiste de la bifurcación mandibular bucal es un quiste odontogénico inflamatorio generalmente ubicado hacia bucal de primeros o segundos molares mandibulares permanentes y se presenta a temprana edad. El presente estudio reporta el caso de un paciente pediátrico varón quien presentó un quiste de bifurcación mandibular bucal (QBMB) asociado con un primer molar mandibular erupcionado. Se revisan y describen los principales hallazgos de esta entidad. El examen clínico intraoral reveló un leve borramiento del fondo de surco vestibular a nivel del primer molar mandibular izquierdo. La tomografía computarizada cone beam mostró una imagen hipodensa de límites definidos, que condiciona el desplazamiento dentario hacia lingual del primer molar mandibular izquierdo y la erosión de la tabla ósea vestibular (corte axial). La lesión se extirpó quirúrgicamente mediante enucleación, curetaje e injerto óseo. Se confirmó el diagnóstico de QBMB mediante estudio histopatológico.

A mandibular buccal bifurcation cyst is an inflammatory odontogenic cyst that usually occurs on the buccal aspect of the permanent mandibular first or second molar and it occurs at an early age. The aim of present study is to report a case of mandibular buccal bifurcation cyst (MBBC) detected in a male pediatric patient. The main findings of this entity are reviewed and described. Clinically, slight effacement of vestibular sulcus base at the level of the first mandibular molar on the left side. A cone beam computed tomography was performed and revealed a hypodense image with defined limits, which conditions the displacement of the first mandibular molar on the left side toward the lingual cortex and the erosion of the buccal cortical bone (axial section). The lesion was surgically removed through enucleation, curettage, and bone grafting. The diagnosis of MBBC was confirmed by histological analysis.

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Introducción: El ser humano que enferma, a veces necesita ser hospitalizado para establecer su homeostasis. Este proceso lo vuelve vulnerable, ya que asume el "estatus de paciente", que afecta también aspectos psico-afectivos y puede hacerlo sentir como un objeto debido al trato de los profesionales de salud que, en ocasiones, es poco empático. Esto produce emociones negativas que generan afecciones para la salud y prolongan la recuperación, lo que a su vez eleva el costo asociado a días de hospitalización. Objetivo: Identificar factores de riesgos que vulneren la dignidad humana de pacientes hospitalizados. Metodología: Estudio descriptivo, cuantitativo. Se identifican factores de riesgo percibidos por pacientes a través del Cuestionario de Percepción de Dignidad de Paciente Hospitalizado (CuPDPH) y del diagnóstico enfermero "Riesgo de compromiso de la dignidad humana 00174" de la NANDA-I. Resultados: De la muestra de 60 pacientes (16 hombres y 44 mujeres), el ítem con mayor puntuación fue "me han llamado por mi nombre" (M = 4.73; DE = 0.84) y el menor, "en ocasiones me he sentido como un objeto" (M = 1.75; DE = 1.29). Asimismo, el factor de riesgo "comprensión inadecuada de la información de salud" fue el más presente (65 %) y "valores incongruentes con las normas culturales" el menos presente (1.7 %). Conclusión: Los factores de riesgo más percibidos por los pacientes en la unidad de salud fueron relacionados con su intimidad, integridad, comprensión de información y privacidad, por lo que es importante estudiar esta variable e intervenirla

Introdução: O ser humano que adoece, por vezes, necessita ser hospitalizado para restabelecer sua homeostase. Esse processo o torna vulnerável, pois ele assume o "estado de paciente", o que também afeta os aspectos psicoafetivos e pode fazer com que se sinta como um objeto devido ao tratamento por parte dos profissionais de saúde, que, em algumas ocasiões, é pouco empático. Isso gera emoções negativas, que afetam a saúde e prolongam a recuperação, o que, por sua vez, eleva o custo associado aos dias de hospitalização. Objetivo: Identificar fatores de risco que vulneram a dignidade humana de pacientes hospitalizados. Metodologia: Estudo descritivo, quantitativo. Foram identificados fatores de risco percebidos pelos pacientes por meio do Questionário de Percepção de Dignidade do Paciente Hospitalizado (CuPDPH) e do diagnóstico de enfermagem "Risco de comprometimento da dignidade humana 00174" da NANDA-I. Resultados: Da amostra de 60 pacientes (16 homens e 44 mulheres), o item com maior pontuação foi "me chamaram pelo meu nome" (M = 4,73; DP = 0,84) e o menor foi "às vezes me senti como um objeto" (M = 1,75; DP = 1,29). Além disso, o fator de risco "compreensão inadequada das informações de saúde" foi o mais presente (65 %) e "valores incongruentes com as normas culturais" o menos presente (1,7 %). Conclusão: Os fatores de risco mais percebidos pelos pacientes na unidade de saúde estavam relacionados à sua intimidade, integridade, compreensão das informações e privacidade, sendo, portanto, importante estudar essa variável e intervir

Introduction: The human being who gets sick, sometimes needs to be hospitalized to establish his homeostasis. This process makes him/her vulnerable, as he/she assumes the "patient status", which also affects psycho-affective aspects and can make him/her feel like an object due to the treatment of health professionals, which is sometimes not very empathetic. This produces negative emotions that generate health conditions and prolong recovery, which in turn increases the cost associated with days of hospitalization. Objective: To identify risk factors that violate the human dignity of hospitalized patients. Methodology: Descriptive, quantitative study. Risk factors perceived by patients were identified through the Hospitalized Patient Dignity Perception Questionnaire and the NANDA-I nursing diagnosis "Risk of compromise of human dignity 00174". Results: Of the sample of 60 patients (16 men and 44 women), the item with the highest score was "I have been called by name" (M = 4.73; SD = 0.84) and the lowest, "I have sometimes felt like an object" (M = 1.75; SD = 1.29). Likewise, the risk factor "inadequate understanding of health information" was the most present (65 %) and "values incongruent with cultural norms" the least present (1.7 %). Conclusion: The risk factors most perceived by patients in the health unit were related to their intimacy, integrity, understanding of information and privacy, so it is important to study this variable and intervene in it.

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Abstract Objective Evaluate the level of information of pediatricians about the diagnosis and management of cryptorchidism. Method A cross-sectional observational study was conducted using a form via the "Google Forms" platform. The study population included pediatricians and pediatric residents associated with the Brazilian Society of Pediatrics. Seven hundred twenty-eight responses were recorded and analyzed using IBM SPSS v21. Results 728 valid responses were obtained. Of these answers, only 20.5 % answered that the physical examination was sufficient for the diagnosis, and 79.4 % responded that they requested ultrasound as the best test to aid in diagnosing cryptorchidism. When questioned about the ideal age for referring a patient with cryptorchidism, the survey recorded 56.3 % of the responses defending the correct age as six months old, 30.2 % shortly after birth, and 13.2 % at two years old. Other topics were addressed in the form, such as the frequency of evaluation of testicular position and investigation for DDS, among others. Still, the answers to these questions were compatible with current manuals and guidelines on cryptorchidism. Conclusion It is evident that the understanding of the professionals consulted about the diagnosis and management of cryptorchidism needs to be updated with the current practices adopted and that pediatricians, in general, must maintain periodic programs on this subject. Therefore, this topic should be part of a continuing education program with pediatric surgery.

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La encefalopatía hepática consiste en la disfunción o deterioro cerebral, consecuente a afecciones como insuficiencia hepática e hipertensión portal, en el ámbito médico es catalogada como una grave complicación clínica asociada al daño hepático severo. Se llevó a cabo un estudio cualitativo de revisión sistemática aplicando la declaración PRISMA 2020, en donde se utilizó los documentos disponibles en las diferentes bases de datos y con la aplicación de los operadores booleanos para su búsqueda. De los documentos seleccionados se pudieron obtener 840 referencias de información en una primera búsqueda en las bases de datos y 8 registros de datos. Finalmente, para la investigación se consiguió un total de 16 fuentes bibliográficas. La encefalopatía hepática se compone de un síndrome neuro-psiquiátrico que incluye deterioro psicomotor y/o sensitivo, desorientación, incoordinación, alteración de la memoria, confusión, somnolencia, estupor y coma, existen diversas herramientas para el diagnóstico desde el primer nivel de atención, una de las principales es la anamnesis y la exploración física del paciente donde se espera encontrar hallazgos cognitivos y neuromusculares relacionados a la enfermedad hepática grave, entre los estudios complementarios se emplea principalmente exámenes de laboratorio, Criterios de West Haven, prueba psicométrica, prueba neurofisiológica y estudios de neuroimagen como resonancia magnética.

Hepatic encephalopathy consists of brain dysfunction or deterioration, consequent to conditions such as hepatic insufficiency and portal hypertension, and in the medical field it is cataloged as a serious clinical complication associated with severe liver damage. A qualitative study of systematic review was carried out applying the PRISMA 2020 statement, using the documents available in the different databases and Boolean operators for the search. From the selected documents it was possible to obtain 840 references of information in a first search in the databases and 8 data records. Finally, a total of 16 bibliographic sources were obtained for the research. Hepatic encephalopathy is composed of a neuropsychiatric syndrome that includes psychomotor and/or sensory impairment, disorientation, incoordination, memory alteration, confusion, somnolence, stupor and coma, there are several tools for diagnosis from the first level of care, One of the main ones is the anamnesis and physical examination of the patient where it is expected to find cognitive and neuromuscular findings related to severe liver disease, among the complementary studies are mainly used laboratory tests, West Haven Criteria, psychometric test, neurophysiological test and neuroimaging studies such as magnetic resonance imaging.

A encefalopatia hepática consiste na disfunção ou deterioração cerebral, consequente a condições como a insuficiência hepática e a hipertensão portal, e é classificada no domínio médico como uma complicação clínica grave associada a lesões hepáticas graves. Foi efectuado um estudo de revisão sistemática qualitativa aplicando a declaração PRISMA 2020, utilizando os documentos disponíveis nas diferentes bases de dados e operadores booleanos para a pesquisa. A partir dos documentos selecionados, foi possível obter 840 referências de informação numa primeira pesquisa nas bases de dados e 8 registros de dados. Por fim, obteve-se um total de 16 fontes bibliográficas para a investigação. A encefalopatia hepática é uma síndrome neuropsiquiátrica que inclui comprometimento psicomotor e/ou sensorial, desorientação, incoordenação, comprometimento da memória, confusão, sonolência, estupor e coma, e existem várias ferramentas para o diagnóstico no primeiro nível de cuidados, Um dos principais instrumentos é a anamnese e o exame físico do doente, onde se esperam encontrar achados cognitivos e neuromusculares relacionados com a doença hepática grave. Os estudos complementares incluem testes laboratoriais, os critérios de West Haven, testes psicométricos, testes neurofisiológicos e estudos de neuroimagem, como a ressonância magnética.

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Objetivo: Presentar un caso clínico de linfoma no Hodgkin (subtipo difuso de células B grandes) asentado en paladar duro y describir sus particularidades clínicas, imagenológicas e histopatológicas. Teniendo presente la baja ocurrencia del linfoma difuso de células B grandes primario en la cavidad bucal, es oportuno enfatizar la importancia del reconocimiento de esta entidad. Asimismo, es de considerar la dificultad que conlleva su diagnóstico debido a su manifestación clínica inespecífica por lo que, frecuentemente, se confunde con otras entidades patológicas como procesos inflamatorios odontogénicos. Caso clínico: Un paciente de 82 años acude a la consulta estomatológica privada derivado por su odontóloga. El paciente refería una lesión indolora en el paladar de dos meses de evolución. El examen estomatológico confirmó la presencia de un tumor ulcerado. El diagnóstico de la entidad fue confirmado por medio de biopsia con estudio anatomopatológico junto a técnicas de inmunomarcación.(AU)

Aim: To present a clinical case of a non-Hodgkin lymphoma (diffuse large B subtype) located in the hard palate and describe its clinical, imaging and histopathological features. Considering the rare occurrence of primary diffuse large B cell lymphoma in the oral cavity, it is appropriate to emphasize the importance of identifying this entity. In addition, it is significant to note the difficulty that making a diagnosis entails, due to its non-specific clinical manifestation, which is why it is frequently confused with other pathological entities such as odontogenic inflammatory processes. Case report: An 82-year-old male patient was referred to the private dentistry office referred by his dentist. The patient reported a painless lesion on the palate of two months. The stomatological examination confirmed the presence of an ulcerated tumor. The diagnosis of the entity was confirmed by biopsy with anatomopathological study together with immunostaining techniques.(AU)

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Se presenta caso de preescolar femenina de 3 años, quien presenta un surco perineal o perineal grovee, malformación ano rectal (MAR) baja, caracterizada por un surco perineal que comunica la horquilla vulvar con la región anal. Es necesario conocer dicha MAR ya que puede llevar a confundirse con una agresión sexual, con todas las consecuencias que ello implica, además, de evaluaciones y planteamientos no indicados.

We present the case of a 3-year-old female preschooler with a perineal groove or perineal grovee, a low anorectal malformation (ARM), characterized by a perineal groove that communicates the vulvar fork with the anal region. It is necessary to know this MAR because it can be confused with sexual aggression, with all the consequences that this implies, as well as inappropriate evaluations and approaches.

ABSTRACT

Introdução: O diagnóstico de TEA é um assunto contemporâneo, todavia, as pesquisas estão direcionadas para diagnóstico precoce e pouco se discute sobre os relatos de diagnóstico tardios. Além disso, incluir a variável sexo feminino nesta discussão amplia a complexidade da temática. Objetivos: Detalhar o processo diagnóstico tardio de TEA em mulheres, considerando se o sexo teve impacto nesse processo e quais foram as mudanças na vida após receberem o diagnóstico. Método: Trata-se de uma pesquisa de cunho qualitativa e descritiva. Participaram desta pesquisa 3 mulheres que foram selecionadas a partir de páginas das redes sociais que continham relatos pessoais com a temática de seus processos de diagnóstico de TEA. As entrevistas foram realizadas via Plataforma Google Meet e presencial. Resultados: As mulheres entrevistadas tinham idade entre 20 e 33 anos. Todas relataram que o diagnóstico foi corroborado por um médico e testes neuropsicológicos. Além disso, mencionaram a variável sexo como um fator correlacionado aos seus diagnósticos tardios. A análise e interpretação dos dados foi realizada a partir de uma posição linguística-discursiva. A discussão abordou o peso do discurso médico e os efeitos nas relações e posições subjetivas e linguística-discursivas nas mulheres entrevistadas a partir de autores filiados a Clínica de Linguagem e a Psicanálise. Considerações finais: Esta pesquisa amplia as possibilidades de discussão pouco investigadas na literatura sobre o diagnóstico tardio em mulheres. Essa temática é constantemente explorada em mídias sociais e ainda merece devido refinamento teórico a partir de pesquisas que considerem a linguagem e a constituição subjetiva. (AU)

Introduction: The diagnosis of ASD is a contemporary issue; however, research is focused on early diagnosis and little is discussed about reports of late diagnosis. Furthermore, including the female variable in this discussion increases the complexity of the topic. Objectives: Detail the late diagnosis process of autism spectrum disorder (ASD) in women, considering whether sex had an impact on this process and what were the changes in life after receiving the diagnosis. Method: This is a qualitative and descriptive research. Three women participated in this research who were selected from social media pages that contained personal reports on the theme of their ASD diagnosis processes. The interviews were carried out via the Google Meet Platform and in person. Results: The women interviewed were between 20 and 33 years old. All reported that the diagnosis was corroborated by a doctor and neuropsychological tests. Furthermore, they mentioned the gender variable as a factor correlated with their late diagnoses. Data analysis and interpretation was carried out from a linguistic-discursive position. The discussion addressed the weight of medical discourse and the effects on subjective and linguistic-discursive relationships and positions in the women interviewed from authors affiliated with the Language Clinic and Psychoanalysis. Final considerations: This research expands the possibilities for discussion that are little investigated in the literature on late diagnosis in women. This theme is constantly explored on social media and still deserves theoretical refinement based on research that considers language and subjective constitution. (AU)

Introducción: El diagnóstico de TEA es un tema contemporáneo, sin embargo, las investigaciones se centran en el diagnóstico temprano y poco se discute sobre los informes de diagnóstico tardío. Además, incluir la variable femenina en esta discusión aumenta la complejidad del tema. Objetivos: Detallar el proceso de diagnóstico tardío del Trastorno del Espectro Autista (TEA) en mujeres, considerando si el sexo tuvo impacto en este proceso y cuáles fueron los cambios en la vida después de recibir el diagnóstico. Método: Se trata de una investigación cualitativa y descriptiva. En esta investigación participaron tres mujeres que fueron seleccionadas de páginas de redes sociales que contenían relatos personales sobre la temática de sus procesos de diagnóstico de TEA. Las entrevistas se realizaron a través de la plataforma Google Meet y de forma presencial. Resultados: Las mujeres entrevistadas tenían entre 20 y 33 años. Todos informaron que el diagnóstico fue corroborado por un médico y pruebas neuropsicológicas. Además, mencionaron la variable género como un factor correlacionado con sus diagnósticos tardíos. El análisis e interpretación de los datos se realizó desde una posición lingüístico-discursiva. La discusión abordó el peso del discurso médico y los efectos sobre las relaciones y posiciones subjetivas y lingüístico-discursivas en las mujeres entrevistadas de autores afiliados a la Clínica del Lenguaje y Psicoanálisis. Consideraciones finales: Esta investigación amplía las posibilidades de discusión poco investigadas en la literatura sobre diagnóstico tardío en mujeres. Este tema se explora constantemente en las redes sociales y aún merece un refinamiento teórico basado en investigaciones que consideren el lenguaje y la constitución subjetiva. (AU)

ABSTRACT

La sepsis neonatal temprana es un desafío de salud pública en Ecuador, con altas tasas de morbilidad-mortalidad. El diagnóstico precoz es crucial, pero los métodos actuales tienen limita-ciones. El índice neutrófilo linfocito se presenta como un biomarcador prometedor para detec-ción y manejo de la sepsis neonatal temprana. Este estudio busca establecer su punto de corte y evaluar su eficacia en el Hospital de Especialidades Carlos Andrade Marín. MATERIALES Y MÉTODOS: Se realizó un estudio retrospectivo y descriptivo en este hospital, recopilando datos clínicos neonatales de enero de 2017 a diciembre de 2021. Se incluyeron expedientes de pacientes con sospecha de sepsis neonatal temprana nacidos desde la semana 26, excluyendo historias clínicas incompletas o con sepsis tardía. Se analizaron variables como edad, sexo y biomarcadores, utilizando el software SPSS versión 27. El estudio fue aprobado por el Comité de Ética de Investigación en Seres Humanos del Hospital de Especialidades Carlos Andrade Marín. RESULTADOS: Se analizaron 102 expedientes de recién nacidos con sepsis neonatal en 5 años. La mayoría eran neonatos muy prematuros y nacidos por cesárea. Con punto de cor-te de 0.86 para el índice neutrófilo linfocito, con una sensibilidad del 98.1% y especificidad del 85.4%. DISCUSIÓN: No se encontró una relación significativa entre el sexo y la sepsis. Aunque el índice neutrófilo linfocito mostró alta sensibilidad y especificidad, su baja área bajo la curva indica que no es un marcador fiable para diagnosticar de sepsis neonatal. CONCLUSIÓN: Se requieren estudios adicionales con muestras más grandes y otros marcadores biológicos para mejorar la capacidad diagnóstica de la sepsis neonatal.

Early neonatal sepsis is a public health challenge in Ecuador, with high morbidity and mortality rates. Early diagnosis is crucial, but current methods have limitations. The neutrophil-lympho-cyte ratio, emerges as a promising biomarker for the detection and management of early neo-natal sepsis. This study aims to establish its cutoff point and evaluate its efficacy at the Carlos Andrade Marín Specialty Hospital. MATERIALS AND METHODS: A retrospective and descrip-tive study was conducted at this hospital, collecting neonatal clinical data from January 2017 to December 2021. Records of patients with suspected early neonatal sepsis born from week 26 were included, excluding incomplete medical records or those with late-onset sepsis. Variables such as age, sex, and biomarkers were analyzed using SPSS version 27 software. The study was approved by the hospital's ethics committee. RESULTS: A total of 102 medical records of newborns with neonatal sepsis over 5 years were analyzed. Most were very premature and born by cesarean section. A cutoff point of 0.86 for the neutrophil-lymphocyte ratio was determined, with a sensitivity of 98.1% and a specificity of 85.4%. DISCUSSION: No significant relationship was found between sex and sepsis. Although the neutrophil-lymphocyte ratio showed high sen-sitivity and specificity, its low area under the curve indicates that it is not a reliable marker for diagnosing neonatal sepsis. CONCLUSION: Additional studies with larger samples and other biological markers are needed to improve the diagnostic capacity for neonatal sepsis.