Saúde bucal e condições sistêmicas em idosos da Baixada Fluminense: coorte retrospectivo / Oral health and systemic conditions in elderly people from Baixada Fluminense: retrospective cohort

O equilíbrio sistêmico e a saúde bucal são condições clínicas que estabelecem entre si uma relação multidimensional capaz de exercer grande impacto sobre o bem-estar cotidiano do indivíduo. As disfunções metabólicas associadas ao estado nutricional e a perda da capacidade muscular geram uma maior necessidade de cuidados em pessoas idosas. Sob o ponto de vista odontológico a presença de dentes naturais bem como o grau de doença periodontal, estão associados a competência mastigatória e, desta forma, são fatores determinantes na saúde da população acima dos 60 anos de idade. O presente estudo teve como objetivo avaliar, através da análise retrospectiva dos últimos 05 anos, a relação entre a saúde bucal e as condições sistêmicas de indivíduos acima de 60 anos residentes na Baixada Fluminense (Rio de Janeiro/Brasil) com evidente crescimento demográfico populacional. Para isso foram analisados 11.390 prontuários de pacientes usuários da Clínica Odontológica da Universidade Iguaçu/RJ sendo selecionados 1.125 que atendiam aos critérios de inclusão. Os resultados destacam a presença de doença periodontal em cerca de 56% dos indivíduos diabéticos, além de 43% com quadro hipertensivo no momento do atendimento apontando para uma importante relação entre a atenção com a saúde bucal da população assistida nessa região e suas condições sistêmicas.

Systemic balance and oral health are clinical conditions that establish a multidimensional relationship capable of having a great impact on the individual's daily well-being. Metabolic dysfunctions associated with nutritional status and loss of muscle capacity generate a greater need for care in the elderly. From the dental point of view, the presence of natural teeth, as well as the degree of periodontal disease, are associated with masticatory competence and, thus, are determining factors in the health of the population over 60 years of age. The present study aimed to describe descriptively, through the retrospective analysis of the last 05 years, the relationship between oral health and the systemic conditions of individuals over 60 years old living in the Baixada Fluminense (Rio de Janeiro / Brazil) with evident population demographic growth. For that purpose, 11,390 medical records of patients who were users of the Clínica Odontológica of Universidade Iguaçu / RJ were analyzed, 1,125 who met the inclusion criteria were selected. The results highlight the presence of periodontal disease in about 56% of diabetic individuals, in addition to 43% with the hypertensive condition at the time of care, pointing to an important relationship between the attention to the oral health of the assisted population in this region and their systemic conditions.

Síntesis de evidencia. Covid persistente / Evidence synthesis. persistent covid

El término Covid persistente fue utilizado por primera vez por la Dra. Elisa Perego, como un hashtag de Twitter en mayo de 2020. Describía su propia experiencia de una condición cíclica multifásica, que difería de la evolución clínica característica de Covid-19 tanto en sintomatología como en tiempo. El término Covid persistente o 'Long Covid' tiene varios nombres dependiendo de la literatura consultada: 'secuelas post-agudas de Covid-19', 'Covid¬-19 en curso', 'síndrome crónico de Covid', 'Covid de larga distancia' (Long haulers) y 'condición post-Covid-19', esta última es la utilizada por la Organización Mundial de la Salud (OMS) y todas son consideradas por los Centros para el Control y la Prevención de Enfermedades (CDC) como 'condiciones pos Covid. Aún no existe consenso en cuanto al reconocimiento de Covid persistente como entidad clínica, así como tampoco en cuanto a su nombre y criterios diagnósticos. Sin embargo, dada la alta prevalencia de la sintomatología a la que se le asocia, es imperativo que los servicios y las políticas de salud prioricen su atención. A la vez, es necesario efectuar estudios a futuro para identificar en detalle los diferentes subtipos de Covid persistente y, permitir así, su atención médica estratificada sin que los servicios de salud no se vean abrumados.

The term persistent Covid was used for the first time by Dr. Elisa Perego, as a Twitter hashtag in May 2020. It described her own experience of a multiphasic cyclical condition, which differed from the characteristic clinical evolution of Covid-19 both in symptomatology as in time The term persistent Covid or 'Long Covid' has several names depending on the literature consulted: 'post-acute sequelae of Covid-19', 'Covid¬-19 in progress', 'chronic Covid syndrome', 'Long-distance Covid ' (Long haulers) and 'post-Covid-19 condition', the latter is the one used by the World Health Organization (WHO) and all are considered by the Centers for Disease Control and Prevention (CDC) as ' post covid conditions. There is still no consensus regarding the recognition of persistent Covid as a clinical entity, nor regarding its name and diagnostic criteria. However, given the high prevalence of the symptoms to which it is associated, it is imperative that health services and policies prioritize care. At the same time, it is necessary to carry out future studies to identify in detail the different subtypes of persistent Covid and, thus, allow their stratified medical care without the health services being overwhelmed.

Reporte de dos casos de neuro-paracoccidiomicosis / Report of two cases of neuro-paracoccidiomycosis

La paracoccidiodomicosis es la micosis sistémica más frecuente en América Latina. La afectación del sistema nervioso central (SNC) está descrita en un 10-27%. El objetivo es presentar dos pacientes del sexo masculino con neuroparacoccidiodomicosis internados en el Departamento de Medicina Interna del Hospital Nacional, uno en el año 2017 y el otro en el 2021. Ambos pacientes presentaron síntomas neurológicos con mejoría de las lesiones con anfotericina B. Los granulomas cerebrales de PCM pueden tener comportamiento pseudotumoral. La regresión de las lesiones fue completa con anfotericina B y trimetoprin sulfametoxasol en el primer caso y anfotericina B e itraconazol en el segundo caso.

Paracoccidioidomycosis is the most common systemic mycosis in Latin America. Central nervous system (CNS) involvement is described in 10-27%. The objective is to present two male patients with neuroparacoccidioidomycosis admitted to the Department of Internal Medicine of the National Hospital, one in 2017 and the other in 2021. Both patients presented neurological symptoms with improvement of the lesions with amphotericin B. The granulomas brain cells of PCM may have pseudotumor behavior. Regression of the lesions was complete with amphotericin B and trimethoprim sulfamethoxazole in the first case and amphotericin B and itraconazole in the second case.

Fatores associados à visita à emergência ou hospitalização em cuidados paliativos oncológicos domiciliares: uma revisão integrativa / Factors associated with emergency room visit or hospitalization in care oncolagy home care: an integrative review / Factores asociados a la visita a urgencias o a la hospitalización en cuidado atención oncológica a domicilio: una revisión integradora

Objetivo: identificar os fatores associados à visita à emergência ou hospitalização dos pacientes oncológicos em cuidados paliativos domiciliares. Método: revisão integrativa nas bases PubMed, LILACS, Web of Science e Embase. Perguntou-se "quais os fatores associados à visita a serviços de emergência ou hospitalização de pacientes oncológicos em cuidados paliativos domiciliares?". Descritores foram neoplasias; cuidados paliativos; hospitalização; serviços médicos de emergência; serviços de assistência domiciliar. Critérios de elegibilidade foram texto na íntegra; entre 2012 e 2022; idioma inglês, português ou espanhol; idade adulta. Resultados:foram selecionados 16 artigos. As causas mais comuns de visita à emergência/hospitalização foram dor, falta de ar, infecção, sintomas digestivos, delirium e queda do estado geral/fadiga. Conclusão: este estudo identificou lacunas em que os cuidados paliativos domiciliares podem ser aprimorados.

Objective: to identify the factors associated with the emergency visit or hospitalization of cancer patients in palliative home care. Method: integrative review in PubMed, LILACS, Web of Science and Embase. The question was "what factors are associated with visiting emergency services or hospitalization of cancer patients in palliative home care?". Descriptors were neoplasms; palliative care; hospitalization; emergency medical services; home care services. Eligibility criteria were full text; between 2012 and 2022; English, Portuguese or Spanish language; adulthood. Results: 16 articles were selected. The most common causes of emergency room visits/hospitalization were pain, shortness of breath, infection, digestive symptoms, delirium, and poor general condition/fatigue. Conclusion: this study identified gaps in which palliative home care can be improved.

Objetivo: identificar los factores asociados a la visita a urgencias u hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios. Método: revisión integrativa en PubMed, LILACS, Web of Science y Embase. La pregunta fue "¿qué factores se asocian con la visita a los servicios de emergencia o la hospitalización de pacientes oncológicos en cuidados paliativos domiciliarios?". Descriptores fueron neoplasias; Cuidados paliativos; hospitalización; servicios médicos de emergencia; servicios de atención domiciliaria. Los criterios de elegibilidad fueron texto completo; entre 2012 y 2022; idioma inglés, portugués o español; edad adulta. Resultados:se seleccionaron 16 artículos. Las causas más comunes de visitas a la sala de emergencias/hospitalización fueron dolor, dificultad para respirar, infección, síntomas digestivos, delirio y mal estado general/fatiga. Conclusión: este estudio identificó brechas en las que se pueden mejorar los cuidados paliativos domiciliários.

Seroprevalence of SARS-CoV-2 immunoglobulin G antibody during COVID-19 pandemic in Fayoum District, Egypt: a community-based pilot survey

Introduction: controlling the worldwide pandemic, coronavirus disease (COVID-19), could be impossible due to the hesitancy about the available vaccines and the difficulty to implement strict restrictions. Little information is available about herd immunity in the highly vulnerable region of North East Africa, Egypt. Objectives: to assess the seroprevalence of SARS-CoV-2 during the pandemic in one of the highly vulnerable populations in Egypt, Fayoum district of Fayoum Governorate. Additionally, to assess the predictive value of symptoms and other associated risk factors towards a positive COVID-19 test. Methods: in this cross-sectional community-based pilot study, immunoglobulin G (IgG) antibodies that are specific for the SARS-CoV-2 spike (S1-RBD) protein were tested during the period from February 2021 to July 2021. Results: out of 155 participants, 60.6% were SARS-CoV-2 seropositive. Out of symptomatic and asymptomatic individuals, 76.5% and 56.2% were seropositive, respectively. Surprisingly, only one individual had received the COVID-19 vaccine. Previous history of COVID-19; such as symptoms and gender are statistically significant predictors of high seroconversion independent of age, comorbidities, and level of education. Conclusion: this study which disclosed unexpectedly high SARS-CoV-2 seroconversion among the Egyptians, might provide a clear insight into COVID-19 transmission patterns and state of immunity. Further study with a larger sample size on a large scale is required to represent the whole local population.

Sepsis et choc septique en réanimation à Brazzaville (Congo) / Sepsis and septic shock in polyvalent intensive care at Brazzaville (Congo)

Objectifs. Décrire les aspects cliniques, bactériologiques et évolutifs du sepsis et du choc septique dans le service de réanimation polyvalente du CHUB. Patients et méthodes. Il s'agit d'une étude transversale, monocentrique et descriptive, durant 12 mois, incluant les patients âgés d'au moins 18 ans admis en réanimation polyvalente pour un sepsis ou choc septique. Les variables épidémiologiques, cliniques, bactériologiques et évolutives ont été analysées avec Excel 2019. Résultats. 56 patients ont été retenus (20,7%). Leur âge moyen était de 43,1 ± 17,9 ans (extrêmes de 18 et 84 ans), avec 66,1% des hommes. Le foyer infectieux initial était péritonéal (64,3 %). À l'admission, le nombre médian de défaillances d'organes par patient était de trois (maximum 5). Les défaillances rénale (71,4%), hépatique (69,6%) et hémodynamique (62,5%) étaient les plus représentées. Le taux de réalisation du bilan bactériologique était de 35,7% : hémoculture (10,7%), uroculture (14,3%), porte d'entrée infectieuse (7,1%). La durée d'hospitalisation des patients sortis vivants était de 8,1 ± 6,3 jours (extrêmes de 2 et 31 jours). Le taux de mortalité était de 57,1%. Les décès survenaient au-delà de 24 h d'hospitalisation (75%), chez des patients avec comorbidités (65,6%), porte d'entrée péritonéale (59,4%), et défaillances hémodynamique (81,2%) et rénale (75%). Conclusion. Les prévalences du sepsis et du choc septique dans notre série sont superposables à celles de la littérature. Le taux de réalisation des bilans bactériologiques reste faible. La mortalité du sepsis demeure très élevée.

Introduction. No accurate data on sepsis and septic shock in intensive care unit (ICU) in the Republic of Congo are available. The aim of the study was to describe the course of patients with sepsis and/or septic shock in the polyvalent ICU of the University Teaching Hospital of Brazzaville. Patients and methods. This was a cross-sectional, monocentric and descriptive study, lasting 12 months, including patients aged at least 18 years admitted to ICU for sepsis or septic shock. The clinical presentation, the bacteriological findings and the outcome were analyzed with Excel 2019. Results. 56 patients were selected (20.7%). The average age was 43.1 ± 17.9 years (extremes 18 and 84 years), with 66.1% of men. The initial infection was peritoneal (64.3%). At admission, the median number of organ failures per patient was three (maximum 5). Renal (71.4%), hepatic (69.6%) and hemodynamic (62.5%) failures were the most common. Bacteriological assessment rate was 35.7%: blood culture (10.7%), urine culture (14.3%). The duration of hospitalization of alive patients was 8.1 ± 6.3 days (extremes 2 and 31 days). The mortality rate was 57.1%. Deaths occurred beyond 24 hours of hospitalization (75%), in patients with comorbidities (65.6%), peritonitis (59.4%), hemodynamic (81.2%) and renal (75%) failures. Conclusion. The prevalence of sepsis and septic shock in our study is comparable to other published series. The bacteriological assessments rate is still low. The mortality is very high.

Prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde, Cameroon

Background. The COVID-19 pandemic has added an additional burden in countries with already fragile health systems. Our objective was to determine the prevalence and seroprevalence of COVID-19 in suspected malaria during the second wave in Yaounde. Methods. A descriptive cross-sectional study was conducted at the Jordan Medical Services for 8 weeks from April 19 to June 13, 2021, i.e., during the second wave in Cameroon. For the 86 patients with suspected malaria, nasopharyngeal and blood samples were taken for SARS-CoV-2 antigen and anti-SARS-CoV-2 IgG and IgM using the STANDARD TM Q COVID-19 Ag kit from SD BIOSENSOR, Korea, 2020 and Standard TM Q COVID 19 Ac IgG/IgM kit from SD BIOSENSOR, Korea, 2020 respectively. Confirmation of malaria was done by microscopic examination of stained blood smears. Results. Malaria was confirmed in 20.9% (18) of cases. The prevalences of COVID-19 and COVID-19/malaria co-infection were 8.1% and 0.9% respectively. Of the 25.6% (54) of patients with anti-COVID-19 IgM, no positive microscopic cases were found. On the other hand, a little more than half of the patients had IgG antibodies against COVID-19 whether they had a positive thick drop or not (56.0% (42/75) and 52.2% (71/136) respectively). Conclusion. In case of suspicion of malaria in a malaria area, it seems important to consider COVID-19 as a differential diagnosis.

Introduction. La pandémie de la COVID-19 a ajouté un fardeau supplémentaire dans les pays aux systèmes de santé déjà fragiles. Objectif : déterminer la prévalence et la séroprévalence de la COVID-19 en cas de suspicion du paludisme au cours de la deuxième vagueà Yaoundé. Méthodologie. Une étude transversale descriptive a été menée au Centre Médical le Jourdain pendant 8 semaines du 19 Avril au 13 Juin 2021 soit durant la deuxième vague au Cameroun. Pour les 86 patients avec suspicion de paludisme, des prélèvements nasopharyngé et sanguins ont été réalisés pour la recherche d'antigène du SRAS- CoV 2 et des IgG et IgM anti-SARS-CoV-2 grâce aux kits STANDARDTM Q COVID-19 Ag de SD BIOSENSOR, Corée, 2020 et StandardTM Q COVID 19 Ac IgG/IgM de SD BIOSENSOR, Corée, 2020 respectivement. La confirmation du paludisme a été faite grâce à l'examen microscopique des étalements de sang colorés. Résultats. Le paludisme était confirmé dans 20,9% (18) des cas. Les prévalences de la COVID-19 et de la coïnfection COVID19/Paludisme étaient de 8,1% et de 0,9% respectivement. Sur les 25,6% (54) des patients avec des IgM anti-COVID-19, aucun cas de microscopie positive n'a été retrouvé. Par ailleurs un peu plus de la moitié des patients avaient des anticorps IgG anti-COVID-19 qu'ils aient une goutte épaisse positive ou pas soit 56,0% (42/75) et 52,2% (71/136) respectivement. Conclusion. En cas de suspicion du paludisme en zone impaludée, il parait non négligeable de considérer la COVID-19 comme un diagnostic différentiel.

Cone-beam computed tomography analysis of degenerative changes, condylar excursions and positioning and possible correlations with temporomandibular disorder signs and symptoms

Aim: To describe cone-beam computed tomography (CBCT) features in patients with temporomandibular disorders (TMDs), in terms of degenerative changes, condylar excursions and positioning as well as their possible correlations with signs and symptoms. Methods: Clinical records of patients diagnosed with TMD who were seen between January 2018 and December 2019 were retrospectively evaluated. These patients were divided into the following groups based on the Diagnostic Criteria for Temporomandibular Disorders (DC/TMD): arthralgia, myalgia, and arthralgia and myalgia groups. The CBCT examination findings of the patients were evaluated in relation to degenerative changes, estimates of condylar excursion, and condylar positioning. The likelihood ratio test was used to verify the possible differences among the three groups, whereas the chi-square test was used to verify the possible differences among the signs and symptoms for the tomographic findings (p ≤ 0.050). Results: In this study, 65 patients with TMD were included. These patients were predominantly female (84.6%) with a mean age of 40.6 years. Tomographic findings of flattening, hyperexcursion and posterior condylar positioning were frequent. A significant correlation was noted between osteophyte and lateral capsule pain (p = 0.027), erosion and posterior capsule pain (p = 0.026), and flattening, pseudocysts (p < 0.050) and condylar excursion (p < 0.001) with mouth opening. Conclusion: Few correlations were noted between degenerative changes and signs of joint pain as well as degenerative changes and condylar hypoexcursion with mouth opening. These correlations were likely associated with division by diagnosis, whereas condylar positioning did not correlate with signs and symptoms

49,XXXXY: investigação da idade no diagnóstico, apresentação clínica e tratamento: uma revisão narrativa da literatura / 49,XXXXY: age investigation in diagnosis, clinical and treatment: a narrative review review of the literature

O cariótipo 49,XXXXY, uma variante rara da Síndrome de Klinefelter, acomete 1:85.000­100.000 nascidos vivos do sexo masculino e surge a partir de uma dupla não disjunção durante as duas rodadas da meiose (I e II) materna. No entanto, as pesquisas envolvendo indivíduos com essa constituição cromossômica são limitadas. Deste modo, este estudo tem como objetivo geral caracterizar a idade no diagnóstico, a apresentação clínica e o tratamento de indivíduos 49,XXXXY. Foi realizada uma revisão da literatura na base de dados PubMed utilizando os descritores 49,XXXXY and diagnosis e 49,XXXXY. Os critérios de inclusão foram: artigos originais e relato de caso, idioma inglês, versão completa disponível online gratuitamente e que contenham as informações que respondam integralmente ao objetivo geral. Os resultados dos 20 estudos incluídos nessa revisão mostraram que a identificação de indivíduos com cariótipo 49,XXXXY ocorre geralmente após o nascimento, sendo que o diagnóstico no pré-natal é extremamente raro. A presença de diversas anomalias congênitas pode contribuir significativamente para o diagnóstico precoce, ao contrário de pacientes com cariótipo 47,XXY, que geralmente são assintomáticos até a puberdade. Nossos achados podem contribuir para despertar a atenção dos profissionais de saúde no reconhecimento desse distúrbio genético, visto que o diagnóstico precoce dessa síndrome permite o tratamento adequado mais rapidamente, a fim de se obter menor impacto no desenvolvimento global desse indivíduo, com consequente melhora na sua qualidade de vida.

Hemocromatosis: revisión de la literatura a propósito de un caso clínico / Hemochromatosis: case report and literature review

Hemochromatosis (HC) is a disorder that alters the body's ability to metabolize iron, increasing its absorption, causing iron overload, and consequently an accumulation of the mineral in multiple organs such as the liver, heart, and pancreas. The amount of total iron in the body is 2-4 g in healthy individuals and remains within these limits throughout life thanks to the control of intestinal absorption. In patients with CH, this amount is increased by at least 10 times, which translates into body deposits of 20-40 grams of iron on average. Factors that increase the risk of having HC: having two copies of the mutated HFE gene, family history, ethnicity or ancestry from Northern Europe (less common in blacks, Hispanics, and Asians), and male gender.

Symptomatic perception of patients affected by chronic chikungunya: a qualitative perspective / Percepção dos sintomas de pacientes acometidos por chikungunya crônica: um olhar qualitativo

Objective: To understand the demands caused by chikungunya in the chronic phase and their impacts on patients' mental health and quality of life. Materials and methods: This is a qualitative study, performed from November 2019 to January 2020. Focus groups and deep interviews were carried out. Then, the Discourse Analysis was performed. Results: Chronic pain was the main clinical manifestation reported by the participants, being responsible for affecting aspects related to quality of life and mental health. As for psycological view, this study showed that chronic pain was also reported as one of the main symptoms related to anxiety and depression among research subjects. Conclusion: this study demonstrated how the chronic illness caused by Chikungunya impacted the subjects' perception in the domains related to quality of life and mental health. Furthermore, we seek to focus on the management of disease in a holistic way, putting the patients' own awareness of the impacts of the disease on their lives in a relevant level of their treatment.

Objetivo: Compreender as demandas causadas pela chikungunya em sua fase crônica e seus impactos na saúde mental e na qualidade de vida dos pacientes. Métodos: Trata-se de um estudo com abordagem qualitativa, realizado entre novembro de 2019 a janeiro de 2020. Inicialmetne, foram realizados grupos focais e entrevistas em profundidade; seguidas da Análise do Discurso. Resultados: A dor crônica foi a principal manifestação clínica relatada pelos participantes, sendo responsável por afetar aspectos relacionados à qualidade de vida e saúde mental. Quanto ao aspecto psicológico, este estudo mostrou que a dor crônica também foi relatada como um dos principais sintomas relacionados à ansiedade e depressão entre os sujeitos da pesquisa. Conclusão: este estudo demonstrou como a doença crônica causada pela chikungunya impactou na percepção dos sujeitos em seus domínios relacionados à qualidade de vida e saúde mental. Além disso, procuramos centrar-nos na gestão da doença de forma holística, colocando a consciência dos próprios doentes sobre os impactos da doença nas suas vidas num nível relevante do seu tratamento.

COVID-19 associated rhinomaxillary mucormycosis: a case series and review of literature

During COVID-19 pandemic, fulminant deep fungal infection started emerging in India, known as Mucormycosis. This type of mucormycosis was termed as COVID-19 associated mucormycosis (CAM). These patients had previous history of COVID-19 infection. Such cases were mainly reported in immunocompromised patients such as patients with poorly controlled diabetes and chronic renal diseases etc. Rhinomaxillary mucormycosis is an aggressive, fulminant, fatal deep fungal infection of head and neck region. Early diagnosis and prompt treatment can reduce the mortality and morbidity associated with the disease; hence we present case series of rhinomaxillary mucormycosis to create awareness amongst dental surgeons

Leishmaniose visceral: aspectos epidemiológicos, espaciais e temporais no município de Sobral, nordeste do Brasil, 2007-2019 / Visceral leishmaniasis: epidemiological, spatial and temporality aspects in the municipality of Sobral, northeast Brazil, 2007-2019

Objetivos: descrever os aspectos epidemiológicos, espaciais e temporais da leishmaniose visceral humana, no município de Sobral, no período de 2007 a 2019. Métodos: foi realizado um estudo epidemiológico descritivo e ecológico de análise espacial e temporal, com uso dos programas Quantum-Gis e Joinpoint. Resultados: foram confirmados 316 casos novos, predominantemente, no sexo masculino, nas faixas etárias de 1 a 4 anos (26,3%) e de 20 a 39 anos (24,0%), na zona urbana. Febre (95,9%), fraqueza (85,1%), emagrecimento (80,1%), palidez (73,7%), esplenomegalia (75,6%) e hepatomegalia (69,3%) foram os sinais clínicos mais frequentes. A doença se concentrou em quatro bairros: Terrenos Novos, Centro, Expectativa e Sinhá Saboia, expressando áreas mais densas (quentes). A incidência e a letalidade foram crescentes no início do período e decrescentes no final, com uma inversão destes indicadores no ano de 2014. Conclusão: em Sobral, a leishmaniose visceral humana é um agravo considerado relevante para o serviço de vigilância em saúde com necessidade de intensificação das ações de controle entomológico, zoonótico e de manejo ambiental, principalmente nas áreas mais densas.

Objectives: the objective was to describe the epidemiological, spatial, and temporal aspects of human visceral leishmaniasis, in the municipality of Sobral, from 2007 to 2019. Methods: A descriptive, spatial and temporal ecological study was carried out using Quantum-Gis and Joinpoint programs. Results: 316 new cases were confirmed, predominantly in males, in the age groups of 1 to 4 years (26.3%) and 20 to 39 years (24.0%), mainly in the urban area. Fever (95.9%), weakness (85.1%), weight loss (80.1%), pallor (73.7%), splenomegaly (75.6%), and hepatomegaly (69.3%) were the most frequent clinical signs. The disease was concentrated in four neighborhoods (Terrenos Novos, Centro, Expectativa, and Sinhá Saboia), hot spots. The incidence and case-fatality increased at the beginning of the period but decreased at the end, with an inversion in these in the year 2014. Conclusion: In Sobral, human visceral leishmaniasis is a disease considered relevant to the health surveillance service, with the need to intensify entomological, zoonotic, and environmental management actions, especially in denser areas.

Rendimiento diagnóstico de la prueba rápida para la detección del antígeno NS1 y anticuerpos IgM e IgG contra el virus del dengue / Diagnostic performance of the rapid test for the detection of NS1 antigen and IgM and IgG anti-antibodies against dengue virus

Objetivos. Determinar el rendimiento diagnóstico de la prueba rápida SD dengue DUO (Inyecta) para la detección de NS1, IgM e IgG en comparación con la prueba de ELISA. Materiales y métodos. Es una evaluación de prueba diagnóstica que incluyó 286 muestras de suero de pacientes con sintomatología atribuible a dengue de zonas endémicas del Perú. Las muestras se analizaron por ELISA y la prueba rápida SD dengue DUO (Inyecta) para IgM, NS1 e IgG en el Instituto de Investigación Nutricional en Lima. Resultados. La sensibilidad de la prueba rápida fue de 68% para NS1 e IgM, y 86% para IgG, mejorando este parámetro a 75% y 81% para NS1 e IgM, respectivamente, en los tres primeros días. La especificidad para los tres analitos fue mayor a 87%. La concordancia de los resultados obtenidos medidos por el coeficiente Kappa para los tres analitos fue buena y no se encontró reacción cruzada con otros arbovirus. Conclusiones. La prueba rápida SD Dengue DUO permite detectar con una adecuada sensibilidad y especificidad NS1, IgM e IgG. La sensibilidad para IgM y NS1 aumenta cuando se detecta en los tres primeros días de síntomas, por lo que se recomienda su implementación en los centros de primer nivel de atención para un diagnóstico temprano y oportuno.

Objectives . To assess the diagnostic performance of the SD dengue DUO rapid test (Inyecta) for the detection of NS1, IgM and IgG in comparison to the ELISA test. Materials and methods . This is a diagnostic test evaluation that included 286 serum samples from patients with symptomatology attributable to dengue from endemic areas of Peru. The samples were analyzed by ELISA and the SD dengue DUO rapid test (Inyecta) for IgM, NS1 and IgG at the Instituto de Investigación Nutricional in Lima. Results . The sensitivity of the rapid test was 68.0% for NS1 and IgM, and 86.0% for IgG, improving to 75.0% and 81.0% for NS1 and IgM, respectively, during the first three days. The specificity for all three analytes was greater than 87.0%. The concordance of the results, measured by the Kappa coefficient for the three analytes, was good and no cross-reaction with other arboviruses was found. Conclusions . The SD dengue DUO rapid test allows detection of NS1, IgM and IgG with adequate sensitivity and specificity. Sensitivity for IgM and NS1 increases when detected during the first three days of symptoms. Therefore, we recommend its implementation in primary care centers for early and timely diagnosis.

Las fallas en las castraciones simbolígenas y los efectos observables en la clínica. Comentario del caso de un niño de cinco años / Echecs des castrations symboligenes eteffets observables dans la clinique. Commentaires sur le cas d'un garçon de cinq ans / Failures in symboligenous castrations and observable effects in the clinic. Comments about the case of a five-year-old boy / Falhas em castrações simbolígenas e efeitos observáveis na clínica. Comentários sobre o caso de um menino de cinco anos

Concepto novedoso e indispensable propuesto por Françoise Dolto, las castraciones simbolígenas, asociadas a la noción de imagen inconsciente del cuerpo y su destino, se convierten en el corazón de su teoría. El tratamiento psicoanalítico con niños consistiría en trabajar sobre las pulsiones no castradas, puntos en donde han quedado detenidas las modalidades de satisfacción y fijadas a un fantasma. El presente escrito recorre fragmentos de sesiones del caso de un niño de cinco años y el trabajo con sus padres, durante dos años de análisis. Tomando como eje rector las fallas en las castraciones simbolígenas y los efectos que se observaron en la clínica, se ilustran articulaciones teóricas que permiten comprender la importancia y riqueza del concepto AU

Concept inédit et indispensable proposé par Françoise Dolto, les castrations symboliques, associées à la notion d'image inconsciente du corps et de son destin, sont au cœur de sa théorie. Le traitement psychanalytique avec les enfants consisterait à travailler sur les pulsions désencastrées, points où les modalités de satisfaction ont été retenues et fixées à un phantasme.Le présent article passe en revue des fragments de sessions du cas d'un garçon de cinq ans et du travail avec ses parents, pendant deux ans d'analyse. En prenant comme axe directeur les échecs des castrations symboliques et les effets observés dans la clinique, on illustre des articulations théoriques qui nous permettent de comprendre l'importance et la richesse du concept AU

An original and indispensable concept proposed by Françoise Dolto, the symbolic castrations, associated with the notion of the unconscious image of the body and its destiny, become the heart of her theory. Psychoanalytic treatment with children would consist in working on the uncastrated drives, places where the modalities of satisfaction have been stopped and set to a phantasm. The present paper reviews sessions fragments of a five years old boy and the work with his parents, during two years of analysis. Taking as a guiding axis the failures in the symbolic castrations and the effects that were observed, theoretical articulations are developed in order to show and understand the importance and richness of the concept AU

Um conceito novo e indispensável proposto por Françoise Dolto, as castrações simbólicas, associadas à noção de imagem inconsciente do corpo e do seu destino, estão no cerne da sua teoria. O tratamento psicanalítico com crianças consistiria em trabalhar em unidades desencarceradas, pontos onde as modalidades de satisfação foram mantidas e fixadas a um fantasma. O presente artigo analisa fragmentos de sessões do caso de uma criança de cinco anos e o trabalho com os seus pais, ao longo de dois anos de análise. Tomando como orientação os fracassos das castrações simbólicas e os efeitos observados na clínica, são ilustradas articulações teóricas que nos permitem compreender a importância e a riqueza do conceito AU

Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS) questionnaire: translation, cultural adaptation and validation to Brazilian Portuguese

ABSTRACT Introduction: Constitutional symptoms and thrombohemorrhagic events are common in patients with myeloproliferative neoplasms (MPNs). Hence, the treatment's primary goal is to control symptoms and improve the quality of life (QoL). In order to assess response to therapy, symptom burden, and QoL among patients with MPN, the "Myeloproliferative Neoplasm Symptom Assessment Form - Total Symptom Score (MPN-SAF TSS)" questionnaire was developed in the USA in 2012. Herein, we translated and validated the MPN-SAF TSS questionnaire to Brazilian Portuguese. Methods: The ten-item questionnaire was translated from the English language and its psychometric properties (reliability, convergent and construct validities) were evaluated in 101 MPN patients. Results: There were 41 patients with essential thrombocythemia, 39 with myelofibrosis and 21 with polycythemia vera. The median age of all patients at diagnosis was 68 years and 59% were female. The Cronbach's alpha coefficient for the overall questionnaire was 0.78, ranging from 0.73 to 0.79, if each item was deleted. Validity analyses showed that the strongest item-item correlation were between early satiety and abdominal discomfort. Strong correlations were also found between physician and patient perceptions of itching (r = 0.81) and fatigue (r = 0.70). The Pearson coefficient correlation between the MPN-SAF TSS global score and the EORTC QLQ-C30 functional scales ranged from 0.51 to 0.64. The exploratory factor analysis showed that seven of the ten symptoms loaded into one single factor. Conclusion: The Brazilian Portuguese version of the MPN-SAF-TSS showed good psychometric properties and can be an available tool to assess symptom burden in this group of patients.

Conducta selectiva en trauma penetrante de cuello / Selective management in penetrating neck trauma

Objetivo: evaluar la incidencia de hallazgosquirúrgicos positivos en pacientes con diagnóstico de traumapenetrante de cuello de dos instituciones hospitalariascapitalinas, sometidos a exploración quirúrgica inmediatao conducta selectiva. Métodos: en un estudio descriptivo,cuantitativo y transversal, se evaluaron 22 heridos condiagnóstico de lesiones penetrantes de cuello entre años 2017y 2021. Se dividieron en dos grupos de acuerdo al tipo deconducta aplicada. Las distintas frecuencias fueron expresadas ennúmero y porcentaje. Resultados: Grupo A, ocho heridos (36,4%), siete ingresaron con signos duros sometidos a exploraciónquirúrgica inmediata, el 87,5 % presentó hallazgos positivos ala cervicotomía; dos fueron incluidos en un esquema de cirugíade control de daños. Grupo B, catorce lesionados con signosblandos admitidos para conducta selectiva mediante observaciónfrecuente y realización de diversos estudios paraclínicos (63,6%),tres requirieron intervención operatoria por la presencia deenfisema subcutáneo expansivo después de las primeras 48 horas;se identificó una lesión esofágica, que se reparó con cierreprimario y rotación de colgajo muscular. Conclusión: En elpresente estudio, la incorporación de la conducta selectiva enel manejo multidisciplinario del trauma penetrante de cuellopermitió incrementar el número de exploraciones positivas yreducir las negativas. Nuevas estrategias como la cirugía decontrol de daños y la zona cero han sido incluidas en algunasheridas vasculares o lesiones extensas(AU)

Objective: To evaluate the incidence of positiveexplorations in patients with penetrating neck trauma oftwo capitals hospitals underwent to immediate surgicalexploration or selective management. Method: Studydescriptive, quantitative and transversal of twenty-two patientswith penetrating neck trauma since years 2017 to 2021. Distribute in two groups in the basis of the management.Different frequency express in frequency and percentages.Results: Group A, eight injured, 36.4 %. Seven with hardsigns, underwent immediate surgical exploration of the neck.the 87.5 % had positive explorations. Two were included in ascheme of surgery damaged control. Evidenced injuries extentsand for high velocity projectile. Group B, fourteen wounded,63.6 %. three required surgical intervention for the presence ofpersistent emphysema. One occult esophagical injury, repairedwith suture and muscular rotation. Conclusion: In the present study the selective management of penetrating neck traumapermit increase the number of positive explorations and reducethe negatives. this alternative was viable and secures(AU)

La adenopatía como clave diagnóstica para la sífilis primaria. Informe de casos / Adenopathy as diagnostic key for primary syphilis. Case reports

Objetivo: Describir tres situaciones clínicas en las que se presentan distintas manifestaciones bucales para una misma entidad patológica. En los tres casos la sospe- cha diagnóstica de sífilis primaria se basó en la presencia de una adenopatía. Los estudios de laboratorio permitieron confirmar el diagnóstico de sífilis. Por su polimorfismo y variabilidad clínica en sus diferentes etapas evolutivas, la sífilis es descripta clásicamente como "la gran simuladora". Este artículo propone que la presencia de adenomegalias características puede ser una clave para orientar el diagnós- tico de la patología, lo cual no ha sido aún reportado en la literatura. Casos clínicos: Se presentan tres casos clínicos de pa- cientes que acudieron a una consulta estomatológica privada y al Servicio de Estomatología del Hospital Alemán de Bue- nos Aires. Los tres acuden con signos y síntomas diferentes, pero compartiendo la presencia de adenopatías múltiples, en las que se destaca un elemento ganglionar más voluminoso (AU)

Aim: To describe three clinical cases that present dif- ferent oral manifestations for the same pathological entity. In all three cases, the suspected diagnosis of primary syph- ilis was based on the presence of an adenopathy. Labora- tory studies confirmed the diagnosis of syphilis. Due to its polymorphism and clinical variability in the different evo- lutionary stages, syphilis is classically described as "the great simulator". This article proposes that the presence of characteristic adenomegalies can be a key to guide the di- agnosis, which has not yet been reported in the literature. Clinical reports: Three clinical cases of patients who attended a private stomatology consultation and the Stoma- tology Service of the Hospital Alemán de Buenos Aires are presented. The three patients showed different signs and symptoms but shared the presence of multiple adenopathies with a more voluminous ganglial element (AU)

Mucormicosis asociada a COVID-19: revisión de la literatura para odontólogos / COVID-19 associated mucormycosis: a literature review for dentists

La mucormicosis es una infección fúngica rara, con alta morbilidad y mortalidad. Se presenta principalmente en pa- cientes con diabetes mellitus no controlada, inmunocompro- metidos, con tratamiento crónicos con esteroides, entre otros. Actualmente, se cree que la pandemia de COVID-19 y los tratamientos con corticosteroides podrían estar implicados en el aumento de casos de esta micosis. Este hongo invade el sistema vascular, ocluyendo el flujo sanguíneo arterial y generando una rápida trombosis e isque- mia, lo que provoca la necrosis de los tejidos duros y blandos, con invasión rápida a los tejidos circundantes. Hay varias formas clínicas. En la cavidad bucal se presenta la variante rino-orbito-cerebral, que afecta el paladar en forma de lesión eritematosa o grisácea que puede progresar hacia la formación de una masa necrótica o ulceración con muy escaso sangrado de mucosa. Se manifiesta con síntomas típicos de una rinosinusitis con fiebre y dolor en las piezas dentarias superiores. El tratamiento consta de tres pilares fundamentales: el diagnóstico, un manejo adecuado de las comorbilidades y la combinación de las terapias antifúngica y quirúrgica. Desde el año 2020, la mucormicosis asociada a COVID-19 pasó a ser un evento de notificación obligatoria inmediata al Sistema Nacional de Vigilancia de la Salud (SNVS2.0) me- diante el Sistema Integrado de Información Sanitaria Argen- tina (SISA). Es importante destacar que se han reportado casos de mu- cormicosis luego de extracciones dentales; lo que impulsa a afianzar los conocimientos sobre esta enfermedad, extremar las medidas preventivas e incentivar el diagnóstico precoz en la atención odontológica, debido a la rapidez en la evolución de la patología (AU))

Mucormycosis is a rare fungal infection, with high mor- bidity and mortality. It occurs mainly in patients with uncon- trolled diabetes mellitus, immunocompromised, on chronic treatment with steroids, among others. Currently, it is believed that the COVID-19 pandemic and the corticosteroid treatments could be one of the causes of increased cases. This fungus invades the vascular system, occluding arteri- al blood flow and generating rapid thrombosis and ischemia, which causes necrosis of hard and soft tissues, with rapid in- vasion to the surrounding tissues. There are several clinical forms. In the oral cavity, the rhino-orbito-cerebral variant presents itself affecting the pal- ate in the form of an erythematous or grayish lesion that can progress towards the formation of a necrotic mass or ulcera- tion with very little mucosal bleeding. It manifests itself with typical symptoms of rhinosinusitis, with fever and pain in the upper teeth. The treatment consists of three fundamental pillars: diag- nosis, proper management of comorbidities and the combina- tion of antifungal and surgical therapies. Since 2020, COVID-19 associated mucormycosis became an event of mandatory immediate notification to the National Health Surveillance System (SNVS2.0,) through the Argentina Integrated Health Information System (SISA). It is important to emphasize that mucormycosis cases had been reported following tooth extractions, which drives to strengthen knowledge about this disease, extreme preventive measures and encourage early diagnosis in dental care, due to the speed of the evolution of the pathology (AU))

Apendicite aguda na infância: epidemiologia, quadro clínico e exames complementares / Acute appendixis in the infancy: epidemiology, clinical picture and complementary exams

Acute appendicitis is a common disease among children, with an incidence peak between 10-20 years of age and a higher prevalence in males. It often presents with periumbilical pain that migrates to the right iliac fossa, accompanied by symptoms. The diagnosis is clinical; however, some tests can be helpful, such as: blood count, PCR, partial urine, ultrasonography, X-ray, computed tomography and magnetic resonance imaging. The aim of this study was to verify the prevalence of appendicitis according to sex and age and the most prevalent clinical symptoms in the infancy. Retrospective study analyzing the medical records of patients who underwent appendectomy. Epidemiological characteristics, clinical aspects, physical examination and complementary exams of the patients were identified. In conclusion, acute appendicitis is suspected in a male, aged between 6-12 years, with abdominal pain, fever, nausea, vomiting, diarrhea, anorexia or positive Blumberg, aided by complementary tests, being ultrasonography and laboratory tests preferred

A apendicite aguda é doença comum entre as crianças, tendo pico de incidência entre os 10-20 anos e maior prevalência no sexo masculino. Frequentemente ela cursa com dor periumbilical que migra para a fossa ilíaca direita, acompanhada de sintomas. O diagnóstico é clínico; entretanto, alguns exames complementares podem ser de grande valia: hemograma, PCR, parcial de urina, ultrassonografia, raio-X simples, tomografia computadorizada e ressonância magnética. O objetivo desse estudo foi verificar a prevalência de apendicite de acordo com o sexo e idade e os sintomas clínicos mais prevalentes na infância. Estudo retrospectivo analisando prontuários de pacientes que realizaram apendicectomia. Foram identificadas as características epidemiológicas, quadro clínico, exame físico e exames complementares tes. Em conclusão, é suspeitada apendicite aguda em paciente masculino, entre 6-12 anos, com dor abdominal, febre, náuseas, vômitos, diarreia, anorexia ou Blumberg positivo, auxiliados por exames complementares, sendo a ultrassonografia e os exames laboratoriais os preferenciais.