A Gelatinous Pleural Effusion as a Diagnostic Clue.

Pleural effusion is a common presentation of several pathologies, and the determination of its cause is facilitated by macroscopic, biochemical, microbiological, and cellular analysis. A systematic approach to analyzing the fluid allows for a reduction in clinical diagnoses. Only a select number of diagnoses can be established definitively by thoracentesis, including effusions because of malignancy. We report the case of an 84-year-old male with a right large-volume pleural effusion with an initial diagnostic thoracocentesis demonstrating an exudate with a gelatinous appearance and exudate characteristics. The physical characteristics of the pleural effusion quickly raised the suspicion of mesothelioma, a rare tumor associated with a poor prognosis. In most diseases related to pleural effusion, fluid analysis yields important diagnostic information, and in certain cases, fluid analysis alone is enough for diagnosis. Malignant pleural mesothelioma may present as a viscous pleural effusion with gelatinous characteristics, which may immediately raise suspicion and contribute as a diagnostic clue in the initial study of a pleural effusion. This article was previously presented as a meeting abstract at the 28º Congresso Nacional de Medicina Interna in October 2022.

Prevalence of constipation on an internal medicine ward.

In hospitalized patients the prevalence of constipation is high, especially among elderly patients. Constipation impacts significantly the quality of life of patients and is associated with increased morbidity and length of hospital stay. This retrospective observational study intended to identify the prevalence of constipation in patients hospitalized in an internal medicine ward. In a sample of 80 patients, the median age was 79 years and 53% (n = 42) were women. We identified constipation in 68% (n = 56) of the patients during hospitalization. The medical team prescribed treatment only to 70% of those patients. Constipation was responsible for delirium in 11% of patients and 5% suffered urinary retention. This study shows constipation is prevalent among patients admitted in an internal medicine ward. Systematic assessment of this problem can improve the overall care of the patients, alleviate symptoms, and prevent complications.

Aortic Dissection With Cardiac Tamponade in Pregnancy: A Challenging Clinical Scenario.

Aortic dissection is the acute aortic syndrome with the highest mortality, and pregnancy and arterial hypertension are known risk factors. Its association with the perinatal period is a particularly unique and potentially devastating clinical catastrophe which is why the approach to a pregnant woman in cardiorespiratory arrest (CRA) should be multidisciplinary and early, with extraction of the fetus ideally within five minutes after the arrest. We present the case of a 39-year-old pregnant woman, who presented with a cardiorespiratory arrest in the context of an aortic dissection with cardiac tamponade and the need for an urgent perimortem cesarean section. Increasing knowledge and understanding among healthcare professionals has the potential to aid in the early detection and effective treatment of this challenging medical issue.

Spontaneous Pneumomediastinum: A Rare Cause of Chest Pain.

Spontaneous pneumomediastinum is a rare medical condition characterized by the presence of free air in the mediastinum, not preceded by trauma, surgery, or another medical procedure. It predominantly affects young adult males and usually has a benign course, and in most cases, it is not possible to identify the precipitating factor. There are some conditions that predispose to its occurrence, namely those that lead to an increase in intrapleural pressure, such as coughing, vomiting, or vigorous exercise. We report a case of a 21-year-old male who presented with acute-onset shortness of breath after an episode of coughing and was found to have mediastinal and subcutaneous emphysema. Clinical, laboratory, and radiological studies did not demonstrate any predisposing factor, and the case was classified as spontaneous pneumomediastinum.

Using the Expanded Andersen Model to Determine Factors Associated with Mexican Adolescents' Utilization of Dental Services.

Many factors contribute as facilitators of or barriers to adolescents' use of dental services. Guided by the expanded Andersen model for dental service utilization, the aim of this study was to identify factors associated with the use of dental services among adolescents ages 12-16 in south Mexico City (n = 247). Adolescents answered a questionnaire on predisposing factors (age and gender), enabling factors (socioeconomic status, oral health support, parental years of education, and previous dental treatments), and psychosocial and behavioral factors (attitudes towards oral health; knowledge of gingivitis; alcohol, drug, and tobacco use; and depressive symptoms), and they underwent a visual clinical exam to determine their need factors (caries and gingivitis). The adolescents reported whether or not they had attended a dental visit in the last year for any reason. Multiple logistic regression was used to evaluate these factors. Having oral health support increased the odds of a dental visit by 2.69 (95% CI = 1.24-5.84). Previous dental treatment increased the odds of a dental visit by 2.25 (95% CI = 1.12-4.52). The presence of depressive symptoms reduced the odds of a dental visit by 4% (OR = 0.96, 95% CI = 0.94-0.99). Enabling and psychosocial factors of oral health support and previous dental treatment were positively associated with the utilization of dental services, while depressive symptoms were negatively associated.

Diseño y validación de una escala de soporte social para adolescentes / Design and validation of a social support scale for adolescents

Introducción: el soporte social es de gran importancia en la adolescencia; aquellos adolescentes con mayor soporte tienen mejores estrategias de salud. Existen pocos instrumentos para evaluar el soporte social en todas sus dimensiones y las fuentes de éste, ninguno ha sido validado en español. El objetivo de este estudio es evaluar la validez y confiabilidad de un nuevo instrumento para identificar el soporte social y la fuente de este soporte en adolescentes. Material y métodos: la escala de soporte social para adolescentes (ESSA) consiste en un cuestionario de autoaplicación de 22 ítems, con cinco opciones de respuesta tipo Likert que van de nunca a siempre, con seis subescalas: familia, mejor amigo, compañeros de clase, profesores, otras relaciones, y salud general y oral. Los datos de la ESSA se recogieron de estudiantes de secundaria (N = 191; edad media 16.1 ± 1.2 años). Los análisis psicométricos incluyeron análisis factorial de ejes principales, consistencia interna (alfa de Cronbach) y correlaciones de la escala con la Escala Multidimensional de Apoyo Social Percibido (MSPSS) y la Escala de Depresión 20 del Centro de Estudios Epidemiológicos (CESD20) (correlaciones de Spearman, p). Resultados: el análisis factorial de ejes principales mostró que la escala explica el 72.23% de la variabilidad. La escala completa mostró una consistencia interna adecuada, con un alfa de Cronbach = 0.92 [0.90-0.93]. En cuanto a la validez discriminativa, la correlación con las puntuaciones de la escala CES-D20 fue ρ = -0.32, la escala mostró una fuerte correlación con las puntuaciones MSPSS (p = 0.81). Los resultados fueron estables en la repetibilidad (ICC = 0.93). Conclusiones: la ESSA es válida y confiable. Este instrumento podría ser adecuado para una amplia gama de aplicaciones de investigación entre la población adolescente (AU)

Introduction: social support is of great importance in adolescence; those who have more support have better health strategies. There are few instruments to evaluate social support in all its dimensions and the sources of this support, and none has been validated in Spanish. The aim of this study is to evaluate the validity and reliability of a new instrument to identify social support and the source of this support for adolescents. Material and methods: the adolescent social support scale (ADSSS) consists of a 22-item self-report questionnaire with 5 Likert-type responses ranging from never to always and six different subscales: family, best friend, classmates, teachers, other relationships, and general and oral health. ADSSS data were collected from high school students (N = 191; mean age 16.1 years [standard deviation = 1.2]). Psychometric analyses included main axis factor analysis, internal consistency (Cronbach's alpha), and scale correlations with the multidimensional scale of perceived social support (MSPSS) and the Center for Epidemiologic Studies Depression Scale-20 (CES-D20) (Spearman correlations, p). Results: main axis factor analysis showed that the scale explained 72.23% of the variability. The entire scale showed adequate internal consistency, with Cronbach's alpha = 0.92 [0.90-0.93]. For discriminative validity, the correlation with CES-D20 scores was p = -0.32, and the scale showed a strong correlation with MSPSS scores (p = 0.81). The results were stable across repeated measurements (ICC = 0.93). Conclusions: the ADSSS has good reliability and validity. This instrument could be suitable for a broad range of research applications among adolescents (AU)

Crisis renal esclerodérmica: una causa rara de hipertensión potencialmente mortal / Scleroderma renal crisis: a rare life-threatening cause of hypertension

Scleroderma renal crisis is a rare and severe complication of systemic sclerosis. There are many risk predictors for the development of this complication. Diagnostic criteria are non-consensual, including arterial hypertension and oliguric acute kidney injury (AKI). Angiotensin-converting enzyme inhibitors are an effective treatment, with huge impact in prognosis. We describe a case of a scleroderma renal crisis in a 78-years-old woman who was diagnosed with systemic sclerosis and treated with prednisone at high dosage, who presented with new onset congestive heart failure, arterial hypertension and oliguric AKI. The diagnosis of scleroderma renal crisis was performed, and angiotensin-converting enzyme inhibitor was initiated with blood pressure control and slightly improved renal function. The prognosis of scleroderma renal crisis remains poor with high 5-year mortality rate. Medical awareness on tensional values and well-known risk factors could have a huge impact in diagnosis and prognosis and even on prevention of this complication. (AU)

Problemas de saúde em população cadastrada na estratégia saúde da família: o agente comunitário de saúde como informante-chave / Health problems in a population registered at the family health strategy: the community health agent as the key informant

Objetivo: identificar os principais problemas de saúde nos territórios da Estratégia Saúde da Família na visão dos agentes comunitários de saúde de Montes Claros, Minas Gerais, Brasil. Métodos: o desenho do estudo é transversal, quantitativo e censitário. A coleta de dados deu-se por meio de questionário semiestruturado aplicado aos agentes comunitários de saúde (ACS) vinculados à Estratégia Saúde da Família. A pesquisa foiaprovada pelo Comitê de Ética em Pesquisa da Universidade Estadual de Montes Claros (Unimontes), sob o parecer número 1.966-10. Resultados: participaram do estudo 241 agentes comunitários de saúde. A maioria (97,5%) declarou conhecer a situação de saúde do território. Em relação aos problemas de saúde mais comuns na comunidade adscrita, os agentes destacaram, nas crianças, as doenças do sistema respiratório (82,40%); nos adolescentes, a dependência química (23,56%); e nos adultos e idosos, a hipertensão arterial foi a mais destacada, 77,25% e 79,16%, respectivamente. Conclusão: a maioria dos agentes comunitários de saúde conhece a situação de saúde dos territórios onde atua. A identificação dos principais problemas de saúde foi destacada conforme o ciclo de vida da população. O diagnóstico local a partir do ACS, como informante-chave, contribui para definir as prioridades e estabelecer objetivos e metas para o enfrentamento dos problemas nos territórios de Saúde da Família.

Objective: to identify the main health problems in the territories of the Family Health Strategy in the view of communitarian agents of health from Montes Claros, Minas Gerais, Brazil. Methods: this was a quantitative, transversal, and census based study. The data collection took place through a semi-structured questionnaire applied to community health agents (CHA) linked to the Family Health Strategy. The research was approved by the Research Ethics Committee from the Montes Claros State University(Unimontes) under the protocol number 1966-10. Results: 241 agents participated in the study. The majority (97.5%) declared knowing the health situation in the territory. Regarding the most common health problems in the community, agents pointed out diseases of the respiratory system (82.40%) in children, chemical dependency (23.56%) in adolescents; and hypertension in adults and elders, in 77.25% and 79.16%, respectively.Conclusion: most community health agents know the health situation of the territories in which they operate. The identification of the main health problems was highlighted according to the cycle of life of the population. The local diagnosis from the CHA, as key informants, contributes to set priorities and establish goals and objectives for tackling problems in the territories of Family Health.

Utilização do arco lingual como mantenedor de espaço / Utilization of lingual arch for space maintenance

O presente trabalho relata o caso clínico de um paciente com 10 anos de idade, atendido na Clínica de Odontopediatria da UFPB, que apresentou a necessidade de exodontia do primeiro e segundo molar decíduo inferior direito, estando indicada posterior manutenção de espaço. A manutenção de espaço deve ser realizada nos casos em que houver perda precoce de dentes decíduos e o sucessor permanente ainda não tenha atingido o est gio 6 ou 7 de Nolla. Quanto maior é o intervalo entre a perda precoce e a erupção do seu sucessor permanente, maior ser a probabilidade de má posição do permanente. Um dos aparelhos utilizados para este fim é o arco lingual, que foi o dispositivo empregado no caso clínico apresentado neste trabalho, uma vez que o paciente apresentava perda de mais de um elemento dentário no mesmo hemiarco e os incisivos inferiores permanentes já haviam erupcionados.

Cisto dentígero na infância: relato de caso e revisão de literatura / Dentigerous cyst in infants: literature review and case report

O cysto dentígero é uma lesão de importante significado clínico na odontopediatria, pois acomete um número considerável de pacientes jovens. Sua ocorrência na primeira década de vida não é tão elevada, mas vários casos têm sido relatados na literatura. Os autores descrevem um caso clínico de um cisto dentígero acometendo uma paciente infantil tratado conservadoramente, através de marsupialização.