Oral Lesions of Immune-Mediated and Autoimmune Diseases: A 12-year Experience at a Single Brazilian Referral Center.

BACKGROUND: Oral lesions of immune-mediated and autoimmune diseases have been well-documented, but studies from Brazil are limited. The varied spectrum of oral lesions within this demographic group poses challenges to clinicians, particularly when they occur in isolation. This study aimed to evaluate the occurrence, clinical characteristics, and management of patients with oral lesions of immune-mediated and autoimmune diseases at a single center in Brazil. METHODS: A retrospective cross-sectional study was conducted from 2010 to 2022. Clinicodemographic data, histopathological features, and treatment modalities were analyzed descriptively and analytically. RESULTS: Of the 3,790 oral and maxillofacial lesions diagnosed, 160 (4.2%) were confirmed as immune-mediated or autoimmune diseases. The population surveyed predominantly consisted of women (73.7%), with a mean age of 60.2 years. Oral lichen planus (51.3%), mucous membrane pemphigoid (MMP) (23.7%), and pemphigus vulgaris (PV) (19.4%) were the most prevalent lesions. The buccal mucosa (59.4%) was predominantly affected, with pain reported in 46.2% of cases, notably in individuals with PV and MMP. The average time to disease stabilization post-local and/or systemic corticosteroid therapy was 15.8 months for systemic lupus erythematosus, 8.7 months for MMP, and 6.5 months for PV. CONCLUSION: Although oral lesions related to immune-mediated and autoimmune diseases are uncommon, their diverse clinicopathological aspects require multidisciplinary management.

Prevalence of human herpesvirus in plasma and saliva of cirrhotic patients: A pilot study.

AIMS: The objective of this study was to identify the presence of human herpesvirus (HHV) in the plasma and saliva of hepatic-cirrhosis patients and correlate it with clinical data and laboratory tests. This is a pilot, observational, and cross-sectional study. METHODS AND RESULTS: Specimens of plasma and saliva from 72 cirrhotic individuals were analyzed by means of polymerase chain reaction. The patient population had a mean age of 54.84 years old (SD ± 10) and was 70% males (51/72). Approximately 47% (n = 34) of the patients had leukopenia and HHV was not identified in the plasma specimens. The main species of HHV identified in the saliva were HHV-7 (n = 42, 62%) and Epstein-Barr virus (EBV) (n = 30, 41%). Moreover, there was a significant decrease in the total number of leukocytes and lymphocytes in saliva containing EBV (P = .038 and P = .047, respectively). CONCLUSION: The results show that the presence of EBV in the saliva of cirrhotic patients was correlated with their circulating immune status. It may be possible that the immune dysfunction displayed by the cirrhotic patients plays a role in the shedding of EBV into saliva.

Aportes del Hospital de Día para la atención de niños/as y adolescentes con patologías mentales graves, en la formación de residentes de Psiquiatría Pediátrica / Contributions from the Day Hospital for the care of children and adolescents with serious mental pathologies, in the training of Pediatric Psychiatry residents

Cerca del 20 % de niños en todo el mundo experimentan trastornos mentales, independientemente de su procedencia o cultura. La manifestación de un trastorno mental durante la infancia puede ocasionar alteraciones en el desarrollo, impactando negativamente en la calidad de vida, la dinámica familiar, y en el progreso académico y social. En nuestro país los problemas de salud mental en la infancia y adolescencia están entre los principales problemas de salud en este grupo de edades, y las consultas y hospitalizaciones de niños, niñas y adolescentes se encuentran con una oferta de servicios limitada. En 2017, se aprueba la Ley de Salud Mental, que promueve la atención de los problemas en el ámbito comunitario, y la implementación de distintos dispositivos de atención alternativos a la hospitalización a tiempo completo. Uno de los dispositivos intermedios es el hospital de día, para la atención de trastornos mentales en forma ambulatoria diurna, como alternativa a la hospitalización. En el 2021 se abre el primer Hospital de Día para niños, niñas y adolescentes con trastornos psiquiátricos severos en el Centro Hospitalario Pereira Rossell. Con un equipo interdisciplinario con recursos de la Administración de los Servicios de Salud del Estado y la Facultad de Medicina, brinda la oportunidad de pasantías para estudiantes de distintas disciplinas. El Hospital de Día enriquece la formación de residentes de Psiquiatría Pediátrica para enfrentar desafíos clínicos y desarrollar estrategias de tratamiento interdisciplinarias, complementarias al abordaje tradicional, una atención de mayor calidad y una oportunidad de aprendizaje en trabajo en equipo.

About 20% children experience mental disorders worldwide, regardless of background or culture. Mental disorders appearing during childhood can cause developmental changes, with negative impact on quality of life, family dynamics, as well as on academic and social progress. In our country, Mental Health problems in childhood and adolescence are among the main health problems in this age group, increasing consultations and hospitalizations of children and adolescents, stressing a limited supply of services. In 2017, the Mental Health Law was passed, which promotes mental health care at the community level, and the implementation of different care strategies as alternatives to fulltime hospitalization. One of the intermediate strategies is the day hospital, for the care of mental disorders on a daytime outpatient basis, as an alternative to conventional hospitalization. In 2021, the first day hospital for children and adolescents with severe psychiatric disorders was opened in Uruguay at the Pereira Rossell Hospital Center. With an interdisciplinary team with resources from ASSE and the Faculty of Medicine, it provides opportunity for internships for students from different disciplines. The Day Hospital enriches the training of Pediatric Psychiatry residents. They learn how to cope with clinical challenges, have a teamwork learning opportunity, and develop interdisciplinary treatment strategies, complementary to the traditional approach, providing higher quality care in the management of serious childhood mental disorders.

Desarrollo infantil y sus principales desafíos en los primeros años de vida: lugar e importancia de los centros de educación y protección del Instituto del Niño y Adolescente del Uruguay / Child development and its main challenges in the first years of life: place and importance of the education and protection centers of the Children and Adolescents Institute of Uruguay

Existe un aumento progresivo de los problemas del neuropsicodesarrollo. Las intervenciones psicoeducativas y sociales oportunas con soporte en evidencias mejoran la evolución a lo largo de la vida de los niños. Los Centros Educativos en Primera Infancia tienen el potencial de identificar precozmente a niños con riesgos de alteraciones en el neuropsicodesarrollo. El Centro de Formación y Estudios del Instituto del Niño y Adolescente del Uruguay convoca a la Unidad Académica de Psiquiatría Pediátrica para la formación y actualización en esta problemática. El objetivo del trabajo es implementar un Programa de Capacitación en desarrollo normal, sus variaciones y desafíos; oportunidades de estimulación, identificación precoz de alteraciones e intervenciones en Centros Educativos en Primera Infancia; simultáneamente capacitar en habilidades de comunicación y trabajo interdisciplinario a posgrados de psiquiatría pediátrica y otras disciplinas de salud mental. Está dirigido a trabajadores del Instituto del Niño y Adolescente del Uruguay que trabajan con niños de 0 a 3 años. La implementación se realiza a través de tres modalidades articuladas, escalando progresivamente en contenidos: 1) Conferencias abiertas. 2) Curso introductorio a través de talleres virtuales sincrónicos. 3) Instancias docentes de profundización con equipos de Centros Educativos en Primera Infancia. Resultados: 2800 inscriptos. Se realizaron dos conferencias (4500 participantes en total), ocho cursos introductorios y se está implementando la modalidad 3 para el año 2024. Las encuestas de satisfacción han sido entre muy buenas-excelente. Se concluye que la implementación de este Programa de Capacitación permite la difusión de conocimientos y el intercambio interdisciplinario, por lo que es necesario continuar la cooperación entre Unidades Académicas, explorar otras modalidades pedagógicas y estudiar el impacto de la capacitación.

A progressive increase in neuro-psycho- developmental problems has taken place; timely evidence-based psycho-educational and social interventions improve children's lifelong development. Early Childhood Educational Centers have the potential for early identification of children at risk for neurodevelopmental disorders. The Training and Studies Center of the Institute of Childhood and Adolescence of Uruguay convenes the Academic Unit of Pediatric Psychiatry for training and updating on this issue. The objective is to implement a Training Program on normal development, its variations and challenges; stimulation opportunities, early identification of changes and interventions in Early Childhood Educational Centers, while training pediatric psychiatry postgraduates and other mental health disciplines in communication skills and interdisciplinary work. Methodology: Aimed at workers of the Institute of Childhood and Adolescence of Uruguay, working with children from 0 to 3 years old. Three articulated modalities, progressively increasing in content: 1) Open lectures. 2) Introductory course: synchronous virtual workshops. 3) Teaching instances with teams from Early Childhood Educational Centers. Results: 2800 participants. Two conferences (4500 participants) and eight introductory courses were held. Modality 3 is being organized for 2024. Satisfaction surveys show very good to excellent results. It is concluded that the implementation of this training Program makes knowledge dissemination and interdisciplinary exchange possible, so it is necessary to continue cooperation between academic units, explore other pedagogical modalities and study training impact.

Bleeding during tooth extraction in patients with chronic kidney disease: A cross-sectional pilot study.

OBJECTIVE: This work measures the intra-operative bleeding in end-stage renal disease patients and assesses whether laboratory coagulation tests and nitrogenous compounds are related to a higher bleeding risk. METHODS: Laboratory tests were performed on the day of surgery and some patients with thrombocytopenia and values above the normal levels of international normalised ratio (INR), thrombin time (TT) and activated partial thromboplastin time (aPTT) were identified. RESULTS: Haemostatic time ranged from 2 to 35 min (mean of 8.51 min) after suture. Bleeding volume ranged from 0.02 to 67.06 mL (mean of 4.38 mL) and the bleeding volume per minute ranged from 0.05 to 2.10 mL/min (median of 0.6 mL/min). Only seven patients (16.27%) had abnormal bleeding (more than 0.6 mL/min). Spearman's coefficient showed weak correlations between bleeding volume (mL/min) and serum urea (r = 0.226), TT (r = 0.227), plasma urea (r = 0.148) and creatinine (r = 146), as well as very weak correlations with all other variables (r < 0.140) such as age, haemodialysis time, glycaemia, glycated haemoglobin, platelets, INR, aPTT and fibrinogen. CONCLUSION: It was not possible to associate any laboratory test or nitrogenous compounds present in the blood and saliva with an increased bleeding.

Quantification of Torque Teno Virus (TTV) in plasma and saliva of individuals with liver cirrhosis: a cross sectional study.

Introduction: Torque teno virus (TTV) has been pointed as an endogenous marker of immune function, the objective of this study was to investigate the TTV viral load in plasma and saliva of cirrhotic individuals and correlate it with clinical characteristics. Methods: Blood, saliva, clinical data from records and laboratory tests were collected from 72 cirrhotic patients. Plasma and saliva were submitted to real-time polymerase chain reaction for quantification of TTV viral load. Results: The majority of the patients presented decompensated cirrhosis (59.7%) and 47.2% had alterations in the white blood series. TTV was identified in 28 specimens of plasma (38.8%) and in 67 specimens of saliva (93.0%), with median values of TTV copies/mL of 90.6 in plasma and 245.14 in saliva. All the patients who were positive for TTV in plasma were also positive in saliva, with both fluids having a moderately positive correlation for the presence of TTV. There was no correlation between TTV viral load, either in plasma or in saliva, and any of the variables studied. Conclusion: TTV is more frequently found and in greater amount in the saliva than in the plasma of cirrhotic patients. There was no correlation between TTV viral load and clinical parameters.

Orofacial manifestations in Brazilian people living with HIV/AIDS under long-term antiretroviral therapy: a cross-sectional study.

OBJECTIVE: The aim of this study was to assess the prevalence of orofacial manifestations in a Brazilian cohort of people living with HIV/AIDS (PLWHIV) using long-term combined antiretroviral therapy (cART) and to correlate the presence of these manifestations with clinical and laboratory characteristics. STUDY DESIGN: A cross-sectional observational study evaluated 101 Brazilian PLWHIV. Demographic characteristics, medical history, and laboratory data were collected. Physical examination and measurement of stimulated salivary flow were performed. RESULTS: The study included 101 participants who were mainly male (61%) and White (73%), with an average age of 48 years, using long-term cART. The most common oral manifestations were facial lipoatrophy (33%), xerostomia (30%), and salivary gland enlargement (12%). Facial lipoatrophy was linked to a longer duration of cART use (P = .002), whereas hairy leukoplakia was linked to a detectable viral load (P = .031). The salivary flow of <0.7 mL/min was associated with an HIV infection time >20 years (P = .023). CONCLUSIONS: People living with HIV/AIDS who use cART often experience facial lipoatrophy, xerostomia, and bilateral enlargement of the parotid glands. Although opportunistic infections and malignant neoplasms are not frequent occurrences, they can still arise.

ABO Blood Type and Metabolic Markers in COVID-19 Susceptibility and Severity: A Cross-Sectional Study.

Background and Aims: To evaluate the effect of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus on the function and metabolic changes, as well as the relationship of the virus with blood groups. Methods and Results: This cross-sectional study included a matched sample of adult individuals with coronavirus disease 2019 (COVID-19) (n = 114) or without (controls; n = 236). Blood samples were collected and processed for triglycerides (TGs), total cholesterol, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, and blood typing analysis. The results showed that subjects with COVID-19 had higher TG and lower HDL-C levels compared with the control group. As for blood typing, the risk of COVID-19 was higher in subjects with blood group A than in those with blood group B and in those with other blood groups. In addition, an association of COVID-19 with blood type and Rh A- was observed. When related to the severity of COVID-19 symptoms, blood type A was more protective against moderate/severe symptoms compared with blood type O. In addition, individuals with blood type O were 2.90 times more likely to have symptoms moderate/severe symptoms of COVID-19 than those with other blood groups and individuals with type A blood were less likely to have severe/moderate symptoms of COVID-19 compared with individuals without type A blood. Conclusion: The results suggest that blood type may play a role in susceptibility to SARS-CoV-2 infection and add evidence that infection with the novel coronavirus may be associated with changes in lipid metabolism.

Contaminação pelo SARS-COV-2 entre profissionais de saúde do Oeste Baiano

Este estudo tem como objetivo descrever a ocorrência e caracterizar o perfil da contaminação pelo SARS-CoV-2 em profissionais de saúde na macrorregião Oeste da Bahia. Trata-se de um estudo transversal com abordagem quantitativa e descritiva, realizado através da estratégia Web Survey, no período de fevereiro a maio de 2021, com profissionais de saúde atuantes na região. Participaram do estudo 186 profissionais, de 22 categorias profissionais distintas e provenientes de 23 municípios da região. Do total de entrevistados, 63 participantes (33,9%) testaram positivo para o SARS-CoV-2, com predominância do sexo feminino (70,0%), idade média de 36 anos (DP ± 8,7), de enfermeiros contaminados (25,4%) e da forma leve da doença (76,2%), entretanto, 15,9% (n=10) desenvolveram sequelas e 11,1% (n=07) necessitaram de readaptações das atividades de trabalho. 40,9% dos entrevistados (n=76) relataram que após o início da pandemia desenvolveram algum problema de ordem mental ou tiveram piora de condição já existente e 58,1% (n=108) informaram indisponibilidade de cuidado em saúde mental no local de trabalho. Pelo exposto, torna-se cada vez mais importante a adoção/atualização de estratégias de proteção, promoção e recuperação da saúde direcionadas para estes profissionais, considerando as suas diferentes realidades e necessidades.

Pesquisar em enfermagem no contexto de luta pela valorização profissional e vivência da crise sanitária da covid-19 / Research in nursing in the context of the struggle for professional appreciation and the experience of the covid-19 health crisis / Investigación en enfermería en el contexto de lucha por la valorización profesional y dela vivencia de la crisis sanitaria de la covid-19

Descrever a experiência do desenvolvimento da pesquisa "Práticas de enfermagem no contexto da Atenção Primária à Saúde (APS): estudo nacional de métodos mistos", com recorte regional para o Centro-Oeste e o Distrito Federal. Relato de experiência do estudo de métodos mistos, com ênfase na realização da pesquisa no Centro-Oeste e no Distrito Federal. Os(As) enfermeiros(as) pesquisados(as) atuavam na APS há no mínimo três anos e desenvolviam práticas assistenciais ou de gestão. A pesquisa foi realizada no período de novembro de 2019 a agosto de 2021. Os dados foram coletados por meio de instrumento eletrônico e roteiro de entrevista. Cumpriram-se os preceitos éticos dispostos na Resolução CONEP 466/2012 e no Ofício Circular 2/2021. No processamento dos dados utilizaram-se os softwares SPSS e NVivo. As entrevistas foram analisadas por meio da técnica de análise de conteúdo de Bardin. São apresentadas as estratégias de divulgação da pesquisa evidenciando-se as parcerias institucionais, o uso de mídias e redes sociais e outras iniciativas de alcance dos(as) profissionais nos municípios. Contextualiza-se a pesquisa em enfermagem no âmbito de lutas da categoria e enfrentamento à pandemia de covid-19. Ressaltam-se as importantes contribuições do estudo. A realização da pesquisa caracterizou-se por um momento singular, refletido nas lutas pela valorização profissional e na vivência dos(as) enfermeiros(as) na crise sanitária da pandemia de covid-19. As evidências encontradas contribuem para o ensino e a pesquisa, para o trabalho dos gestores do SUS e dos tomadores de decisões em saúde e para as corporações de enfermagem. O estudo multimétodos proporcionou uma resposta ampliada ao problema investigado, mostrando assim a realidade das práticas, das condições de trabalho e do escopo de atividades dos(as) enfermeiros(as) na APS. (AU)

To describe the experience in developing the research "Nursing practices in the context of Primary Health Care (PHC): national study of mixed methods", with a regional focus for the Midwest and the Federal District. Experience report on the study of mixed methods, with emphasis on conducting the research in the Midwest and in the Federal District. The nurses surveyed worked in PHC for at least three years and conducted practices of care or management. The survey was conducted from November 2019 to August 2021. Data was collected through an electronic instrument and an interview script. The ethical precepts set forth in CONEP Resolution 466/2012 and Circular Letter 2/2021 were complied with. SPSS and NVivo software were used for data processing. The interviews were analyzed using Bardin's content analysis technique. Research dissemination strategies are presented, highlighting institutional partnerships, the use of media and social networks and other initiatives to reach professionals in the municipalities. Nursing research is contextualized amidst the struggles of the category and of fighting the Covid-19 pandemic. The important contributions of the study are highlighted. The research was characterized by a unique moment, reflected in the struggles for professional appreciation and in the experience of nurses in the health crisis of the Covid-19 pandemic. The evidence found contributes to teaching and research, to the work of SUS managers and decision makers in health and to nursing associations. The multimethod study provided an expanded response to the investigated problem, thus showing the reality of practices, working conditions and the scope of activities of nurses in PHC. (AU)

Describir la experiencia de desarrollo de la investigación "Prácticas de enfermería en el contexto de la Atención Primaria de Salud (APS): estudio nacional de métodos mixtos", con enfoque regional para el Centro Oeste y Distrito Federal. Informe de experiencia del estudio de métodos mixtos, con énfasis en la realización de la investigación en el Centro Oeste y en el Distrito Federal. Los enfermeros encuestados tenían al menos tres años de actuación en la APS y desarrollaban prácticas de cuidado o gestión. La encuesta se realizó de noviembre de 2019 a agosto de 2021. Los datos se recolectaron a través de instrumento electrónico y guión de entrevista. Se cumplieron los preceptos éticos establecidos en la Resolución CONEP 466/2012 y la Circular 2/2021. Para el procesamiento de datos se utilizaron los softwares SPSS y NVivo. Las entrevistas fueron analizadas mediante la técnica de análisis de contenido de Bardin. Se presentan estrategias de difusión de la investigación, destacándose alianzas institucionales, el uso de medios y redes sociales y otras iniciativas para llegar a los(as) profesionales de los municipios. La investigación en enfermería se contextualiza en la situación de luchas de la corporación de la categoría y el enfrentamiento de la pandemia de Covid-19. Se destacan las importantes contribuciones del estudio. La investigación se caracterizó por un momento único, reflejado en las luchas por la valorización profesional y en las vivencias de los(as) enfermeros(as) en la crisis sanitaria de la pandemia de Covid-19. Las evidencias encontradas contribuyen para la enseñanza y la investigación, para el trabajo de los gestores y decisores del SUS y para las corporaciones de enfermería. El estudio multimétodo proporcionó una respuesta ampliada al problema investigado, mostrando así la realidad de las prácticas, de las condiciones de trabajo y del ámbito de actuación de los(as) enfermeros(as) en la APS. (AU)

Gestão da informação e tradução do conhecimento no trabalho de enfermeiros(as) da atenção primária à saúde no estado da Paraíba - Nordeste do Brasil / Information management and knowledge translation in the work of primary health care nurses in the state of Paraíba - Northeast Brazil / Gestión de la información y traducción del conocimiento en el trabajo de enfermeras de atención primaria de salud en el estado de Paraíba - Nordeste de Brasil

Objetivo: Analisar a gestão da informação e tradução do conhecimento, considerando diferentes variáveis do acesso à informação, no processo de trabalho, dos(as) Enfermeiros(as) da Atenção Primária à Saúde (APS) em atuação no estado da Paraíba, Nordeste do Brasil. Material e Métodos: Estudo de métodos mistos; integração de dados quantitativos e dados qualitativo. Utilizou-se a estratégia "Transformativa Concomitante", em que os dados quantitativos e qualitativos, foram coletados concomitantemente. Pesquisa realizada no estado da Paraíba entre novembro de 2019 a agosto de 2021, nos serviços da Atenção Primária à Saúde do modelo tradicional de Unidades Básicas de Saúde e os do modelo da Estratégia Saúde da Família. Dos(as) 1.635 enfermeiras(as) em atuação nesses modelos de atenção na Paraíba, 462 participaram do estudo quantitativo. Na pesquisa qualitativa 45 profissionais foram selecionados: 09 no município intermediário adjacente; 21 nos municípios rurais adjacentes e 15 no município urbano, selecionado nesta tipologia, o município de João Pessoa. Foram incluídos enfermeiros(as) que desenvolviam práticas de assistência ou gestão na APS e na ESF. Excluídos, enfermeiros(as) na APS há menos de três anos; que não exercessem preceptoria nos serviços, consultoria; e sem vínculo formal de trabalho e aqueles ausentes do trabalho por férias ou licença de qualquer natureza. Os dados quantitativos foram processados através do software SPSS®, versão 21. No processamento dos qualitativos, utilizou-se o software NVivo®; e adotou-se a técnica de análise de conteúdo temática. Para os estudos de métodos mistos, fez-se a integração dos resultados quantitativos e qualitativos, favorecendo as análises das evidências da pesquisa. O projeto de pesquisa teve aprovação do Comitê de Ética em Pesquisa da Faculdade de Ciências da Saúde da Universidade de Brasília, sob Parecer nº 3.619.308 e do Certificado de Apresentação de Apreciação Ética - CAAE nº 20814619.2.0000.0030. Resultados: A maioria, dos(as) profissionais pesquisados(as), acessa informações relativas à Atenção Primária à Saúde/Estratégia Saúde da Família. O principal meio de acesso é digital. Os lugares de acesso, prevaleceram a casa e o trabalho. As fontes governamentais, são acessadas por 330 profissionais, seguidas das mídias sociais. As revistas científicas, foram referidas por 187 (40,5%) participantes da pesquisa. Os livros especializados são acessadas por menos da metade dos(as) pesquisados(as): apenas 155 (33,5%). Mais da metade dos(as) pesquisados(as), 235 (50,9%), registraram não terem participado de seminários e/ou encontros científicos de sua área de atuação, nos últimos dois anos. Apenas 28 profissionais, 6,1%; dos enfermeiros(as) estão associados(as) à Associação Brasileira de Enfermagem; e apenas 1 (0,2%) afirmou estar associado(a) à Associação Brasileira de Enfermagem de Família e Comunidade. Mais de 90% (418 profissionais) revelaram a necessidade de aprimorar seus conhecimentos em Atenção Primária à Saúde/Estratégia Saúde da Família. Conclusão: O estudo evidenciou que os profissionais em atuação na Atenção Primária à Saúde na Paraíba, avançam no que concerne à gestão da informação e tradução do conhecimento, uma vez que a maioria dos pesquisado(as) relataram acessar as informações. Embora predomine o acesso às fontes governamentais, as publicações cientificas e livros especializados, ainda são referenciais adotas pelos profissionais. Quase a totalidade dos pesquisados(as), demonstraram necessidade de aprimorar seus conhecimentos no que tange à sua área atuação ­ a Atenção Primária à Saúde/Estratégia Saúde da Família. Criticamente, há de se ressaltar, a baixa participação dos profissionais quando se busca investigar a sua associação a entidades representativas da Enfermagem. (AU)

Objective: To analyze information management and knowledge translation, considering different variables of access to information, in the work process, of Primary Health Care (PHC) Nurses working in the state of Paraíba, Northeast of Brazil. Brazil. Material and Methods: Mixed methods study; integration of quantitative data and qualitative data. The "Transformative Concomitant" strategy was used, in which quantitative and qualitative data were collected concomitantly. Research carried out in the state of Paraíba between November 2019 and August 2021, in the Primary Health Care services of the traditional model of Basic Health Units and those of the Family Health Strategy model. Of the 1,635 nurses working in these care models in Paraíba, 462 participated in the quantitative study. In the qualitative research, 45 professionals were selected: 09 in the adjacent intermediate municipality; 21 in the adjacent rural municipalities and 15 in the urban municipality, selected in this typology, the municipality of João Pessoa. Nurses who developed care or management practices in PHC and ESF were included. Excluded, nurses in PHC for less than three years; who did not exercise preceptorship in services, consultancy; and without formal employment relationship and those absent from work on vacation or leave of any kind. Quantitative data were processed using SPSS® software, version 21. In the processing of qualitative data, NVivo® software was used; and the thematic content analysis technique was adopted. For mixed methods studies, quantitative and qualitative results were integrated, favoring the analysis of research evidence. The research project was approved by the Research Ethics Committee of the Faculty of Health Sciences, University of Brasília, under Opinion nº 3.619.308 and the Certificate of Presentation of Ethical Appreciation - CAAE nº 20814619.2.0000.0030. Results: Most of the professionals surveyed access information related to Primary Health Care/Family Health Strategy. The main means of access is digital. The places of access, home and work prevailed. Government sources are accessed by 330 professionals, followed by social media. Scientific journals were mentioned by 187 (40.5%) research participants. Specialized books are accessed by less than half of those surveyed: only 155 (33.5%). More than half of those surveyed, 235 (50.9%), reported not having participated in seminars and/or scientific meetings in their area of expertise in the last two years. Only 28 professionals, 6.1%; of nurses are associated with the Brazilian Nursing Association; and only 1 (0.2%) claimed to be associated with the Brazilian Association of Family and Community Nursing. More than 90% (418 professionals) revealed the need to improve their knowledge in Primary Health Care/Family Health Strategy. Conclusion: The study showed that professionals working in Primary Health Care in Paraíba, advance in terms of information management and knowledge translation, since most respondents reported accessing information. Although access to government sources predominates, scientific publications and specialized books are still references adopted by professionals. Almost all of those surveyed demonstrated the need to improve their knowledge regarding their area of activity ­ Primary Health Care/Family Health Strategy. Critically, it should be noted the low participation of professionals when seeking to investigate their association with representative entities of Nursing. (AU)

Objetivo: Analizar la gestión de la información y la traducción del conocimiento, considerando diferentes variables de acceso a la información en el proceso de trabajo de Enfermeras de Atención Primaria a la Salud (APS) que actúan en la provincia de Paraíba, región Nordeste de Brasil. Material y métodos: Estudio de métodos mixtos; integración de datos cuantitativos y datos cualitativos. Se utilizó la Estrategia Transformativa Concomitante, en la que se recolectaron datos cuantitativos y cualitativos de manera concomitante. Investigación realizada en Paraíba, entre noviembre de 2019 y agosto de 2021, en los servicios de APS del modelo tradicional de Unidades Básicas de Salud (UBS) y de Estrategia de Salud de la Familia (ESF). De los 1.635 enfermeros que actúan en esos modelos de atención en Paraíba, 462 participaron del estudio cuantitativo. En la investigación cualitativa fueron seleccionados 45 profesionales: nueve en el municipio intermedio colindante; 21 en municipios rurales adyacentes; y 15 en el municipio urbano seleccionado en esta tipología, João Pessoa. Se incluyeron enfermeros que desarrollaron prácticas de cuidado o gestión en la APS y en la ESF. Excluidos: enfermeros en APS por menos de tres años; que no ejercieron preceptoría en servicios/consultoría; que no tenían relación laboral formal; y que estaban ausentes del trabajo por vacaciones o licencias de cualquier tipo. Los datos cuantitativos se procesaron a través del software SPSS®, versión 21. En el procesamiento cualitativo se utilizó el software NVivo® y se adoptó la técnica de análisis de contenido temático. Para los estudios de métodos mixtos, se realizó la integración de los resultados cuantitativos y cualitativos, favoreciendo el análisis de las evidencias de la investigación. El proyecto fue aprobado por el Comité de Ética en Investigación de la Facultad de Ciencias de la Salud de la Universidad de Brasilia, bajo el Dictamen nº 3.619.308 y el Certificado de Presentación de Apreciación Ética - CAAE nº 20814619.2.0000.0030. Resultados: la mayoría de los profesionales encuestados accede a información relacionada con la APS/ESF. El principal medio de acceso es digital. Los lugares de acceso que prevalecieron son el hogar y el trabajo. Las fuentes gubernamentales son consultadas por 330 profesionales, seguidas de las redes sociales. Las revistas científicas fueron mencionadas por 187 (40,5%) participantes de la investigación. A los libros especializados acceden menos de la mitad de los encuestados: sólo 155 (33,5%). Más de la mitad de los encuestados, 235 (50,9%), informaron no haber participado en seminarios y/o reuniones científicas en su área de especialización en los últimos dos años. Sólo 28 profesionales (el 6,1%) de los enfermeros están asociados a la Asociación Brasileña de Enfermería; y sólo 1 (0,2%) está asociado a la Asociación Brasileña de Enfermería Familiar y Comunitaria. Más del 90% (418 profesionales) revelaron la necesidad de mejorar sus conocimientos en Atención Primaria de Salud/Estrategia de Salud de la Familia. Conclusión: el estudio mostró que los profesionales que actúan en la Atención Primaria de Salud de Paraíba avanzan en términos de gestión de la información y traducción del conocimiento, una vez que la mayoría de los encuestados informaron tener acceso a la información. Si bien predomina el acceso a fuentes gubernamentales, las publicaciones científicas y los libros especializados siguen siendo referencias adoptadas por los profesionales. Casi todos los encuestados demostraron la necesidad de mejorar su conocimiento sobre su área de actuación ­ Atención Primaria de Salud/Estrategia de Salud de la Familia. Críticamente, se destaca la baja participación de los profesionales cuando se busca investigar su vinculación con entidades representativas de la Enfermería. (AU)

Consultation-Liaison Case Conference: Psychiatric Care of Patients Who Undergo Bariatric Surgery.

We present the case of a 42-year-old female with major depressive disorder who received a Roux-en-Y gastric bypass and subsequently decompensated in her depression symptoms and began newly engaging in problematic alcohol use. Top experts in the consultation-liaison field, specifically bariatric surgery psychiatry, provide guidance for this commonly encountered clinical case based on their experience and a review of the available literature. Key teaching points include the presurgical psychosocial assessment, pertinent perioperative psychopharmacology, and problematic alcohol use after bariatric surgery.

Epstein-Barr virus oral shedding and viremia and their association with oral hairy leukoplakia in HIV+ individuals.

OBJECTIVE: To assess the oral shedding and viremia of Epstein-Barr virus (EBV) in HIV-positive patients and their relationship with oral hairy leukoplakia (OHL). METHODOLOGY: A total of 94 HIV-positive patients were included in the study, in which blood and saliva samples were collected for EBV quantification. Data on gender, age, time of HIV seropositivity, combined antiretroviral therapy (cART), CD4+ T-cell counts, and HIV viral load were collected. OHL diagnosis was based on histopathological examination and EBV in situ hybridization. RESULTS: The EBV load in the 94 HIV-positive patients was higher in saliva than in blood (2.4 and 1.6, respectively), and there was a positive correlation between EBV oral shedding and viremia (p = 0.001). Twenty (21.27%) patients had OHL and also a higher EBV load in saliva (mean log10  = 3.11) compared to those who had no OHL (p = 0.045). Presence of OHL was only associated with age (p = 0.030). CONCLUSION: In HIV-positive patients, the presence of OHL was associated with EBV oral shedding but not with viremia, regardless of the amount of circulating CD4+ T cells.

Focal melanocytic lesions of the oral mucosa: An epidemiological and morphological study.

OBJECTIVE: This study aimed to analyse the clinical and histopathological characteristics of focal oral melanocytic lesions in a Brazilian reference service in Oral and Maxillofacial Pathology. MATERIALS AND METHODS: A cross-sectional study was conducted over an 18-year period. Demographic data and clinical features were collected from the archives, and all biopsy specimens diagnosed as oral melanocytic lesions were retrieved and reviewed. RESULTS: We identified 339 melanocytic lesions. Of these, 191 were melanotic macules, 112 melanocytic nevi, 14 mucosal lentigo simplex, 12 melanomas, 9 solar lentigos, and 1 melanoacanthoma. Lesions occurred mostly in white-skinned (74.2%) women (65.2%). The main reported clinical aspect was the macule (67.4%), and the most affected site was the lip vermilion (25.4%), followed by the palate (22.9%). Melanomas were larger in size and were observed in older patients with an overall shorter time of onset. The most frequent subtypes of melanocytic nevi were intramucosal (44.6%), compound (24.1%), and blue nevus (20.5%). They showed a heterogeneous architectural pattern with the presence of the three cell types. CONCLUSION: The most frequent lesions are melanotic macule and nevus, especially the intramucosal subtype. Patients are usually white-skinned women presenting a small, long-lasting, macular lesion on the lip vermilion or palate.

Análise situacional de uma clínica-escola de Fonoaudiologia de uma universidade federal da Bahia: um enfoque sobre os problemas / Situational analysis of a Speech, Hearing and Language clinical school at a federal university in Bahia: a focus on problems

Resumo Trata-se de uma análise situacional de uma clínica-escola de Fonoaudiologia de uma universidade federal da Bahia no que tange ao seu funcionamento e à articulação com a rede municipal de saúde de Salvador-BA. Estudo de caso descritivo, cuja estratégia metodológica foi baseada no Enfoque por Problemas na perspectiva do Planejamento Estratégico Situacional (PES), de Carlos Matus. A investigação empregou como estratégia metodológica a análise documental, a observação participante, entrevistas semiestruturadas e grupo focal com os atores institucionais. Os resultados apontaram fragilidades em quatro das cinco categorias de análise, quais sejam: infraestrutura, financiamento, organização e gestão, o que remete a fragilidades no processo de formação dos discentes e na integração da Instituição com a rede municipal de saúde. Dos vinte problemas identificados, dez encontram-se dentro da capacidade de governo e dentro da governabilidade dos atores institucionais, ou seja, são passíveis de intervenção pelos atores institucionais. Conclui-se que a clínica-escola deve institucionalizar a prática do planejamento estratégico situacional para combater a improvisação de ações e conseguir cumprir com efetividade suas duas importantes funções: ensino e atenção à saúde.

Abstract This work describes a situational analysis of a Speech, Hearing and Language clinical school at a federal university in Bahia, examining how it functions and coordinates with the municipal health system in Salvador, Bahia. It is a descriptive case study, whose methodological strategy is based on Carlos Matus' Situational Strategic Planning (Planejamento Estratégico Situacional: PES) with a Focus on Problems. Our methodological strategy employed document analysis, participant observation, semi-structured interviews and a focus group with institutional actors. The results indicate weaknesses in four of the five categories of analysis, which were: infrastructure, funding, organization, and management. These have led to failings in student training and in the institution's integration with the municipal health system. Of the twenty identified problems, ten related to the institutional actors' capacity for both governance and governability, in other words, problems that are amenable to intervention. We conclude that the clinical school must institutionalize the practice of situational strategic planning to combat improvisational practices and enable it to effectively fulfil its two important functions: teaching and healthcare.

História do Centro Docente Assistencial de Fonoaudiologia da Universidade Federal da Bahia / History of the Speech-Language Pathology Teaching Assistance Center at the Federal University of Bahia / Historia del Centro de Asistencia Docente de Logopedia de la Universidad Federal de Bahía

Introdução: As clínicas-escolas de fonoaudiologia exercem papel fundamental na formação dos futuros profissionais. O Centro Docente Assistencial de Fonoaudiologia (CEDAF) foi criado com o intuito de ser uma clínica-escola do Curso de Graduação em Fonoaudiologia da Universidade Federal da Bahia. Objetivo: Descrever a história do CEDAF, a fim de contextualizar as mudanças pelas quais passou, destacando os principais acontecimentos a partir do olhar de atores que fazem parte desse percurso. Método: Trata-se de um estudo qualitativo, caracterizado como exploratório e descritivo, realizado na clínica CEDAF. Foram utilizadas fontes de dados orais, coletadas por meio de entrevistas e grupo focal, gravadas em áudio, transcritas e analisadas conforme categoria temática, buscando identificar os núcleos de sentido. Resultados: Foi possível perceber a intensa transformação pela qual o CEDAF passou ao longo dos seus vinte anos de história. Entre as mudanças mais significativas estão a ampliação do espaço físico, aumento do número de alunos do curso e a contratação de novos docentes, a admissão de fonoaudiólogas na clínica e o convênio firmado com a rede municipal de saúde. Conclusão: Deixar registrada uma primeira versão da história do CEDAF pode contribuir para fazer deste local um campo de pesquisa em contínuo aperfeiçoamento na formação dos futuros profissionais de fonoaudiologia e na prestação de serviço.

Introduction: Speech therapy clinic-schools play a fundamental role in the training of future professionals. The Speech-Language Pathology Teaching Assistance Center (CEDAF) was created with the intention of being a clinic-school of the Graduation Course in Speech Therapy at the Federal University of Bahia. Purpose: Describe the history of CEDAF, to contextualize the changes it has gone through, highlighting the main events from the perspective of actors who are part of this path. Method: This is a qualitative study, characterized as exploratory and descriptive, carried out at the CEDAF clinic. Oral data sources were used, collected through interviews and focus groups, recorded in audio, transcribed, and analyzed according to thematic category, seeking to identify the core meanings. Results: It was possible to perceive the intense transformation that CEDAF has undergone throughout its twenty years of history. Among the most significant changes are the expansion of the physical space, the increase in the number of students in the course and the hiring of new professors, the admission of speech therapists in the clinic and the agreement signed with the municipal health network. Conclusion: Registering a first version of the history of CEDAF can contribute to making this place a field of research in continuous improvement in the training of future professionals in speech therapy and service provision.

Introducción: Las clínicas-escuelas de logopedia juegan un papel fundamental en la formación de los futuros profesionales. El Centro de Asistencia Docente de Logopedia (CEDAF) se creó con la intención de ser clínica-escuela del Curso de Graduación en Logopedia de la Universidad Federal de Bahía.Objetivo: Describir la historia del CEDAF, con el fin de contextualizar los cambios que ha atravesado, destacando los principales hechos desde la perspectiva de los actores que forman parte de este camino. Método: Se trata de un estudio cualitativo, caracterizado como exploratorio y descriptivo, realizado en la clínica CEDAF. Se utilizaron fuentes de datos orales, recolectadas a través de entrevistas y grupos focales, grabadas en audio, transcritas y analizadas según categoría temática, buscando identificar los significados centrales. Resultados: Se pudo percibir la intensa transformación que ha experimentado CEDAF a lo largo de sus veinte años de historia. Entre los cambios más significativos se encuentran la ampliación del espacio físico, el aumento del número de alumnos en el curso y la contratación de nuevos profesores, la admisión de logopedas en la clínica y el convenio suscrito con la red municipal de salud. Conclusión: Registrar una primera versión de la historia del CEDAF puede contribuir a hacer de este lugar un campo de investigación en mejora continua en la formación de los futuros profesionales en logopedia y prestación de servicios.

Sex differences on the response to antidepressants and psychobiotics following early life stress in rats.

Major depressive disorder (MDD) is the most prevalent mood disorder globally. Most antidepressants available for the treatment of MDD increase the concentration of monoamines in the synaptic cleft. However, such drugs have a high latency time to obtain benefits. Thus, new antidepressants with fast action and robust efficacy are very important. This study evaluated the effects of escitalopram, ketamine, and probiotic Bifidobacterium infantis in rats submitted to the maternal deprivation (MD). MD rats received saline, escitalopram, ketamine, or probiotic for 10, 30, or 50 days, depending on the postnatal day (PND):21, 41, and 61. Following behavior, this study examined the integrity of the blood-brain barrier (BBB) and oxidative stress markers. MD induced depressive-like behavior in females with PND21 and males with PND61. All treatments reversed depressive-like behavior in females and escitalopram and ketamine in males. MD induced an increase in the permeability of the BBB, an imbalance between oxidative stress and antioxidant defenses. Treatments regulated the oxidative damage and the integrity of the BBB induced by MD. The treatment with escitalopram, ketamine, or probiotics may prevent behavioral and neurochemical changes associated with MDD, depending on the developmental period and gender.

Oral findings in kidney transplant children and adolescents.

BACKGROUND: Children and adolescents undergoing kidney transplantation may present oral conditions after the procedure, but a few studies have recently described them. AIM: To describe the oral conditions of post-renal transplant children and adolescents. DESIGN: Two calibrated dentists examined all the participants by assessing caries experience, enamel defects, periodontal condition and soft tissue lesions. RESULTS: A total of 120 participants were included in the study, in which 63 (52.5%) were male and 57 (47.5%) were female, with a mean age of 12.78 ± 3.9 years. Among the participants, 104 (86.7%) showed at least one oral change directly related to kidney disease. The most frequent oral findings were enamel defect (49/120; 40.8%) and drug-induced gingival overgrowth (DIGO) (20/120; 16.7%). Gingival bleeding was observed on probing in 115 (95.8%) participants, whereas 69 (57.5%) presented dental calculus and 51 (42.5%) had caries experience. CONCLUSION: Gingival bleeding, enamel defects and DIGO were the most frequent oral findings in kidney transplant children and adolescents. The use of amlodipine and anticonvulsants was associated with DIGO, and there was a positive correlation between oral ulcers and use of everolimus.

Oral manifestations of autoimmune polyglandular syndrome type 1.

AIMS: Autoimmune polyglandular syndrome type I (APS-I) is a rare condition of autosomal recessive and monogenic inheritance, which is characterized clinically by at least two signs of the classic triad: mucocutaneous candidosis, hypoparathyroidism, and Addison's disease. This study aims to report the oral manifestations of APS-I in a 42-year-old woman, who attended the Special Care Dentistry Center. METHODS AND RESULTS: The patient presented with hypoparathyroidism, diabetes mellitus, and autoimmune hepatitis. Chronic hyperplastic candidosis (CHC) was the main oral manifestation and it was diagnosed based on clinical and cytologic characteristics. Microstomia, angular cheilitis, xerostomia, enamel hypoplasia, and microdontia were also present. CONCLUSIONS: CHC was treated with topical nystatin and oral fluconazole, resulting in a significant improvement of the lesions.

Nitrogenous compounds in the saliva and blood of cirrhotic patients: a cross-sectional study.

OBJECTIVES: Serum increase of nitrogenous compounds (NC) in cirrhotic patients has been associated with the development of hepatic encephalopathy (HE). However, the relation between NC in saliva and HE is unclear. The objective of this study is to measure the levels of nitric oxide and urea in the blood and saliva in 38 cirrhotic patients and correlate them with clinical characteristics and presence and grades of HE. MATERIAL AND METHODS: Automated enzymatic colourimetric assays were performed to determine the levels of NC. Diagnosis and severity of HE were determined based on the West Haven criteria and by using the inhibitory control test. RESULTS: HE was diagnosed in 89.47% of the patients, with the majority (60.50%) presenting covert HE. With regard to the measurement of NC, although nitric oxide is moderately correlated with its amount in blood and saliva (r = 0.630; P < 0.001), only salivary levels were associated with the presence of ascites and ecchymosis (P = 0.013 and P = 0.030, respectively). In patients with HE, the serum levels of urea were higher (P = 0.013) than those in patients without HE or minimal HE. CONCLUSIONS: Nitrogenous compounds in the saliva were correlated with neither the presence nor grades of HE, whereas in the blood, only urea was positively correlated with the severity and presence of HE. CLINICAL RELEVANCE: Saliva is an excellent fluid for diagnosing several diseases, but it does not seem to be able to collaborate with the identification of HE.