Probiotic Supplementation in Chronic Kidney Disease: A Double-blind, Randomized, Placebo-controlled Trial.

OBJECTIVE: The objective of the study was to evaluate the effects of probiotic supplementation on the gut microbiota profile and inflammatory markers in chronic kidney disease patients undergoing maintenance hemodialysis (HD). DESIGN AND METHODS: This was a randomized, double-blind, placebo-controlled study. Forty-six HD patients were assigned to receive 1 of 2 treatments: probiotic (n = 23; Streptococcus thermophilus, Lactobacillus acidophilus e Bifidobacterialongum, 90 billion colony-forming units per day) or placebo (n = 23) daily for 3 months. Blood and feces were collected at baseline and after intervention. The inflammatory markers (C-reactive protein and interleukin-6) were analyzed by immunoenzymatic assay (enzyme-linked immunosorbent assay). Uremic toxins plasma levels (indoxyl sulfate, p-cresyl sulfate, and indole-3-acetic acid) were obtained by Reversed-Phase High-Performance Liquid Chromatography. Routine laboratory parameters were measured by standard techniques. Fecal pH was measured by the colorimetric method, and the gut microbiota profile was assessed by Denaturing Gradient Gel Electrophoresis analysis. RESULTS: Sixteen patients remained in the probiotic group (11 men, 53.6 ± 11.0 year old, 25.3 ± 4.6 kg/m2) and 17 in the placebo group (10 men, 50.3 ± 8.5 year old, 25.2 ± 5.7 kg/m2). After probiotic supplementation there was a significant increase in serum urea (from 149.6 ± 34.2 mg/dL to 172.6 ± 45.0 mg/dL, P = .02), potassium (from 4.4 ± 0.4 mmol/L to 4.8 ± 0.4 mmol/L, P = .02), and indoxyl sulfate (from 31.2 ± 15.9 to 36.5 ± 15.0 mg/dL, P = .02). The fecal pH was reduced from 7.2 ± 0.8 to 6.5 ± 0.5 (P = .01). These parameters did not change significantly in placebo group. Changes in the percentage delta (Δ) between groups were exhibited with no statistical differences observed. The inflammatory markers and gut profile were not altered by supplementation. CONCLUSIONS: Aprobiotic supplementation failed to reduce uremic toxins and inflammatory markers. Therefore, probiotic therapy should be chosen with caution in HD patients. Further studies addressing probiotic therapy in chronic kidney disease patients are needed.

Is there interaction between gut microbial profile and cardiovascular risk in chronic kidney disease patients?

AIM: To evaluate the gut microbial profile in chronic kidney disease (CKD) patients and evaluate the possible relationship with inflammation and cardiovascular risk. PATIENTS & METHODS: Markers inflammation plasma and bacterial community profile (denaturing gradient gel electrophoresis) were analyzed. RESULTS: The average number of bands was not different in healthy individuals and CKD patients. The number of bands was negatively associated with plasma levels of VCAM-1 in patients. Flavobacteriaceae bacterium and Listeria monocytogenes were found in patients and Lachnospiraceae bacterium and Butyrivibrio crossotus in healthy individuals. CONCLUSION: Although CKD patients did not present altered gut microbial profile, the sequencing of bands suggested a different microbiota between groups. The result suggests a possible relationship between gut microbiota and cardiovascular risk in CKD patients.

Herpesvirus in the oral cavity of children with leukaemia and its impact on the oral bacterial community profile.

AIMS: This cross-sectional study investigated the association between eight herpesviruses and the bacterial community profiles from the oral cavity of children with and without leukaemia. METHODS: Sixty participants (aged 3-13), divided into the leukaemia group (LG) and healthy group (HG), were evaluated. Collection of medical data, intraoral examination and collection of clinical specimens were carried out. Single PCR and nested-PCR techniques were used to identify the viral types; denaturing gradient gel electrophoresis (DGGE) and real-time PCR techniques were used to evaluate the profile and abundance of bacterial communities. RESULTS: All the children with leukaemia were positive for at least one type of herpesvirus, compared with healthy participants (33.3%; p<0.000). Human cytomegalovirus (HCMV; 46.7%), human herpesvirus-7 (HHV-7; 20%) and HHV-8 (77.3%) were in higher prevalence in the LG (p ≤ 0.01). Children with leukaemia had positive associations with the presence of HCMV, HHV-7 and HHV-8 in the oral cavity when under chemotherapy (p<0.05). There was a qualitative (means of DGGE bands) and quantitative (means of 16S rRNA gene abundance) difference in relation to the bacterial community between the two groups (p<0.05). CONCLUSIONS: Based on the results, the prevalence of herpesviruses and the qualitative bacterial profiles was higher in children with leukaemia and HCMV, HHV-7 and HHV-8 were related to the use of chemotherapy. Moreover, HHV-6 was correlated with an increased bacterial community profile in patients with leukaemia (p<0.05). More attention should be paid to the oral health of these individuals, mainly those under chemotherapy, in order to prevent infections by opportunistic pathogens.

Molecular microbiological evaluation of passive ultrasonic activation as a supplementary disinfecting step: a clinical study.

INTRODUCTION: This in vivo study used molecular microbiology methods to evaluate the effects of passive ultrasonic irrigation (PUI) as a supplementary disinfecting step after root canal preparation. METHODS: Samples were taken from 10 necrotic root canals of teeth with apical periodontitis before (S1) and after rotary nickel-titanium instrumentation using 2.5% NaOCl as the irrigant (S2) and then after PUI for NaOCl activation (S3). The parameters examined included the incidence of positive broad-range polymerase chain reaction (PCR) results for bacterial presence, the impact on bacterial diversity evaluated by PCR-denaturing gradient gel electrophoresis (DGGE), the quantitative bacterial reduction determined by real-time PCR, and the identification of persistent species by clone library analysis. RESULTS: All S1 samples were positive for bacteria in all tests. Treatment procedures were significantly effective in reducing the incidence of positive results for bacteria, the number of bacterial cells (infectious bioburden), and the bacterial diversity (number of species and abundance). However, the supplementary PUI approach did not succeed in significantly enhancing disinfection beyond that achieved by chemomechanical preparation. Several bacterial species/phylotypes were identified in post-treatment samples that were positive for bacteria. CONCLUSIONS: Findings from this clinical study including a small sample size suggest that PUI can be ineffective in significantly improving disinfection of the main root canal after chemomechanical procedures.

Mielopatia sinalizando o diagnóstico tardio da infecçãopor HtlV: um relato de caso / Myelopathy signaling the late diagnosis of HIV infection: a case report

A infecção pelo vírus T-linfotrópico humano (HTLV) caracteriza-se como uma doença sexualmente transmissível (DST), que pode também ser adquirida pelas vias parenteral e vertical. Subdivide-se em dois tipos: o HTLV-I, relacionado com doenças como mielopatia associada a HTLV/paraparesia espástica tropical (HAM/TSP) e a leucemia/linfoma de células T do adulto (ATL). Já o HTLV-II ainda não foi correlacionado cientificamente com nenhuma patologia na atualidade. Seu diagnóstico é realizado pela triagem sorológica para a detecção de anticorpo anti-HTLV-I/II, sendo o exame confirmatório o western blot. Neste contexto, o objetivo do presente estudo foi descrever um relato de caso em que a mielopatia foi a manifestação clínica sinalizadora da infecção pelo HTLV, em consequência do diagnóstico tardio da infecção por este patógeno, na qual a paciente apresentou os sintomas, progrediu lentamente e recebeu o diagnóstico apenas no último estágio da patologia (HAM/TSP), quando se tornou cadeirante. Embora a paciente realize na atualidade a terapêutica proposta e o acompanhamento ambulatorial segundo o protocolo estabelecido para o manejo desta infecção viral, membros de sua família também foram avaliados e diagnosticados e apenas um se apresentou positivo para a infecção. Este estudo visa demonstrar a importância do rastreio laboratorial para a infecção pelo HTLV, na mesma dimensão do diagnóstico da sífilis e do HIV, de modo que o mesmo não ocorra de forma tardia, quando associado a suas manifestações clínicas nos pacientes ou a infecções oportunistas relacionadas.

The human T-lymphotropic virus (HTLV) is characterized as a sexually transmitted disease (STD), it can also be transmitted by parenteral and vertical routes. It is subdivided into two types: the HTLV-I related diseases such as myelopathy/tropical spastic paraparesis (HAM/TSP) and adult T-cell leukemia/lymphoma (ATL). HTLV-II has not been scientifically correlated with pathology yet. This diagnosis is made by serological screening for detection of HTLV antibody, and the western blot confirmatory test. In this context, the objective of this study was to describe a case in which myelopathy was signaling to the clinical manifestation of HTLV, as a result of delayed diagnosis of infection by this pathogen in which the patient had symptoms progressed slowly and received diagnosis only in the last stage of pathology (HAM/TSP), becoming a wheelchair user. Although nowadays the patient performs the therapeutic proposed and outpatient treatment according to the established protocol for the management of this viral infection, members of her family were also diagnosed and only one had a positive diagnosis of infection. This study aims to demonstrate the importance of laboratory screening for HTLV infection, in the same dimension of the diagnosis of syphilis and HIV, so that it does not occur so late, when it is associated to clinical manifestations in patients or related opportunistic infections

Supplementing the antimicrobial effects of chemomechanical debridement with either passive ultrasonic irrigation or a final rinse with chlorhexidine: a clinical study.

INTRODUCTION: The ability of 2 different approaches to supplement the antimicrobial effects of chemomechanical debridement in infected root canals was compared in vivo. METHODS: Samples from necrotic root canals of teeth with apical periodontitis were taken at the baseline (S1), after preparation with rotary nickel-titanium BioRaCe instruments and 2.5% NaOCl irrigation (S2), and then after either passive ultrasonic irrigation (PUI) for activation of NaOCl (n = 13) or a final rinse with 2% chlorhexidine (CHX) (n = 14) (S3). The incidence of positive culture for bacteria and fungi as well as positive broad-range polymerase chain reaction (PCR) results for bacteria, fungi, and archaea was determined. RESULTS: All S1 samples were positive for bacteria in all methods. Fungi were not detected, and archaea occurred in only one S1 sample. Treatment procedures were significantly effective in reducing the incidence of positive culture and PCR results. Although both supplementary approaches reduced the incidence of positive bacteriologic results when compared with postinstrumentation samples, reduction was not statistically significant (P > .05). There was no significant difference for intergroup comparisons either (P > .05). CONCLUSIONS: Although supplementary disinfection with either PUI or a final rinse with CHX can reduce the number of cases with positive culture and PCR results for bacteria, many cases still remain with detectable bacteria in the main root canal. Research on alternative or supplementary antimicrobial methods or substances should be encouraged.

Reação de Jarisch-Herxheimer em gestante com sífilis: relato de caso / Jarisch-Herxheimer reaction in pregnant woman with syphilis: case report

Introdução: a sífilis é uma doença relatada desde o século XV e que ainda hoje representa um sério desafio para a Saúde Pública. Mais de 12 milhões de novos casos são registrados por ano, especialmente nos países em desenvolvimento. Com a comercialização da penicilina, à qual o Treponema pallidum é suscetível, acreditou-se na possibilidade de sua erradicação, o que não se concretizou. Em certas doenças infecciosas a primeira dose de um tratamento antimicrobiano eficaz pode desencadear uma resposta inflamatória no hospedeiro. Neste trabalho apresenta-se o caso de uma gestante, de classe socioeconômica baixa, nulípara, com feto morto com 24 semanas por sífilis congênita, que ao receber o tratamento para sífilis recente apresentou Reação de Jarisch-Herxheimer, ocorrida na maternidade do Hospital da Mulher Heloneida Stuart, em São João do Meriti, Rio de Janeiro.

Introduction: syphilis is a disease which has been reported since the fifteenth century and still represents a reasonable challenge to public health care sistem. More than 12 million new cases are reported every year, especially in developing countries. With the commerce of penicillin, to which Treponema pallidum is susceptible, the possibility of eradication had been considered true, which however, did not happen. In certain infectious diseases, the first dose of an effective antimicrobial treatment can initiate an inflammatory response in the host. This work presents the case of a pregnant woman, low socioeconomic status, nulllipara, with a dead fetus with 24 weeks, upon receiving therapy for early syphilis, triggered Jarisch-Herxheimer reaction, which occurred at the Hospital for Women Heloneida Stuart, in São João de Meriti, Rio de Janeiro.

Herpesvirus carriage in saliva and posttreatment apical periodontitis: searching for association.

OBJECTIVE: Herpesvirus infection can cause immunosuppression and then act as a modifier of apical periodontitis, influencing the disease severity and response to treatment. The purpose of this study was to investigate if herpesvirus infection, as inferred by salivary carriage, may influence the endodontic treatment outcome. STUDY DESIGN: The study population included 72 patients who had root canals treated more than 1 year previously because of necrotic pulps and apical periodontitis. At the follow-up examination, 27 of these patients presented with posttreatment apical periodontitis (failure) and 45 individuals exhibited healed/healing periradicular tissues (success). Saliva was collected from these individuals, DNA was extracted, subjected to multiple displacement amplification, and screened by polymerase chain reaction (PCR) assays for the presence of 6 herpesviruses: herpes simplex virus types 1 and 2 (HSV-1/2), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), and human herpesvirus-8 (HHV-8). RESULTS: Except for HSV-1/2, all other herpesviruses were detected in saliva from both healed/healing and diseased groups. HHV-8 was the most frequent herpesvirus found in saliva (84% in success, 89% in failure), followed by HCMV (22% in success, 30% in failure), EBV (16% in success, 18.5% in failure) and HHV-6 (7% in success, 15% in failure). No significant association of herpesvirus carriage in saliva with poor treatment outcome was discernible in the population studied (P > .05). CONCLUSIONS: Data from the present study suggest that herpesvirus infection may not influence the outcome of endodontic treatment. Further longitudinal studies are warranted to confirm these findings.

Viral-bacterial associations in acute apical abscesses.

OBJECTIVE: Viral-bacterial and bacterial synergism have been suggested to contribute to the pathogenesis of several human diseases. This study sought to investigate the possible associations between 9 candidate endodontic bacterial pathogens and 9 human viruses in samples from acute apical abscesses. STUDY DESIGN: DNA extracts from purulent exudate aspirates of 33 cases of acute apical abscess were surveyed for the presence of 9 selected bacterial species using a 16S ribosomal RNA gene-based nested polymerase chain reaction (PCR) approach. Single or nested PCR assays were used for detection of the human papillomavirus (HPV) and herpesviruses types 1 to 8. RESULTS: Two-thirds of the abscess samples were positive for at least one of the target viruses. Specifically, the most frequently detected viruses were HHV-8 (54.5%); HPV (9%); and varicella zoster virus (VZV), Epstein-Barr virus (EBV), and HHV-6 (6%). Bacterial DNA was present in all cases and the most prevalent bacterial species were Treponema denticola (70%), Tannerella forsythia (67%), Porphyromonas endodontalis (67%), Dialister invisus (61%), and Dialister pneumosintes (57.5%). HHV-8 was positively associated with 7 of the target bacterial species and HPV with 4, but all these associations were weak. Several bacterial pairs showed a moderate positive association. Viral coinfection was found in 6 abscess cases, but no significant viral association could be determined. CONCLUSIONS: Findings demonstrated that bacterial and viral DNA occurred concomitantly in two-thirds of the samples from endodontic abscesses. Although this may suggest a role for viruses in the etiology of apical abscesses, the possibility also exists that the presence of viruses in abscess samples is merely a consequence of the bacterially induced disease process. Further studies are necessary to clarify the role of these viral-bacterial interactions, if any, in the pathogenesis of acute apical abscesses.

Atenção precoce e educação em saúde na atividade laboral: uma abordagem da infecção pelo HIV/Aids na odontologia do trabalho / Early attention and health education in work activity: an approach to HIV/Aids Iinfection in dental work

Introdução: a equipe de saúde ocupacional possui a responsabilidade de exercer o cuidado e a atenção integral de indivíduos infectados pelo HIV, noque diz respeito à saúde bucal, que perpassa desde a assistência até a realização de campanhas informativas e preventivas nas empresas em que prestam serviço. Objetivo: descrever os aspectos preventivos e educativos relacionados à infecção pelo HIV/aids por meio de uma visão da atuação prática da Odontologia do Trabalho através de uma revisão da literatura. Métodos: foi realizado um levantamento bibliográfico que utilizou periódicos científicos,livros técnicos, notas técnicas, publicações de organismos nacionais e internacionais (Medline, SciELO e Lilacs no período de 1988 até 2010). Resultados:as atribuições do cirurgião-dentista na odontologia do trabalho perpassam desde a observação e o controle de infecções da cavidade oral, bem como depossíveis manifestações orais provenientes da infecção pelo HIV, além do trabalho de promoção da saúde bucal, até a realização de campanhas informativase preventivas nas empresas em que prestam serviços. Conclusão: a busca pela atualização dos conhecimentos técnico-científicos é prevista por norma regulamentadora e dará ao profissional a segurança necessária para não agir de forma preconceituosa e discriminatória, capacitando-o para a realização deum trabalho educativo junto aos demais componentes do seu ambiente laboral e social, incluindo indivíduos infectados pelo HIV.

Introduction: the occupational health team has the responsibility of taking comprehensive care of individuals infected by HIV in relation to oral health care since that comprehends the informative campaigns and preventive actions in companies that provide service. Objective: to describe the preventive and educational aspects related to HIV/aids through an over view of the performance practice of dentistry labour through the literature review. Methods:we conducted a literature review that used scientific journals, technical books, technical notes, publications, national and international (Medline, SciELO and Lilacs in the period between 1988 to 2010). Results: the tasks of the dentist in dental work permeate the observation and control of infections of theoral cavity, as well as oral manifestations of HIV infection, in addition to efforts to promote oral health, the informative and preventive campaigns in the companies they serve. Conclusion: the search for the updating of technical and scientific knowledge is provided by regulation and professional will secureenough acting not to prejudicial and discriminatory way, enabling him to carry out educational work with the other components of their work environmentand social, including individuals infected by HIV.

Identification of herpesviruses types 1 to 8 and human papillomavirus in acute apical abscesses.

INTRODUCTION: It has been suggested that viruses, especially herpesviruses, can play a role in the pathogenesis of marginal and apical periodontitis. This study aimed to detect herpesviruses types 1 to 8, namely herpes simplex virus (HSV-1/2), varicella zoster virus (VZV), Epstein-Barr virus (EBV), human cytomegalovirus (HCMV), human herpesvirus-6 (HHV-6), human herpesvirus-7 (HHV-7), and human herpesvirus-8 (HHV-8) as well as human papillomavirus (HPV) in acute apical abscesses. METHODS: Twenty-four samples were taken by aspiration of the purulent exudate from acute apical abscesses. DNA extracted from clinical samples served as a template in single or nested polymerase chain reaction (PCR) assays for the detection of the target viruses. RESULTS: Control PCR reactions with ß-globin gene primers revealed that all samples but one had detectable human DNA. Of the 23 abscess samples positive for the ß-globin gene, 14 (61%) were positive for at least one of the target human viruses. Thirteen (56.5%) cases had herpesvirus: HHV-8 occurred in 11 (48%), VZV and HHV-6B in two (9%), and HHV-7 and HSV-1/2 in one (4%). EBV and HCMV were not present in any of the examined samples. HPV was detected in three (13%) abscess samples. Viral coinfection was found in five cases, with one case harboring three of the targeted viruses. CONCLUSION: A large number of abscess samples were positive for at least one target virus. Unexpectedly, HHV-8 was for the first time detected and in a high prevalence. Papillomavirus and other herpesviruses were also found for the first time in endodontic abscesses. Although these findings suggest an association, the specific role of viruses in the pathogenesis of acute apical abscesses awaits further clarification.

Perfil sexual e frequência de infecções genitais em adolescentes atendidos em uma clínica universitária / Sexual profile and frequency of genital infections in teenagers treated in the university clinic

Introdução: atualmente os adolescentes se encontram em situação de vulnerabilidade para infecções genitais, devido às altas taxas de atividade sexual com diferentes parceiros e falhas no uso do preservativo. Objetivo: descrever o perfi l sexual e a frequência das infecções genitais diagnosticadas em adolescentes atendidos no Setor de DST da Universidade Federal Fluminense (UFF) nos anos de 2005 e 2006. Métodos: foi realizado um estudo seccional, descritivo,observacional e quantitativo através da análise dos prontuários de adolescentes entre 12 e 19 anos de idade atendidos no Setor de DST/UFF no período de janeiro de 2005 a dezembro de 2006. Os dados foram tratados através de análise descritiva por meio de porcentagem. Resultados: a parcela de adolescentes que frequentou o serviço foi igual para ambos os sexos, porém a maioria acima dos 16 anos de idade, com parceiro(a) sexual fixo(a) exclusivo(a) em 57,2% dos casos no ano de 2005 e 57,63% para o ano de 2006, onde a maioria não utilizava preservativo e não apresentava história de prévia de DST em ambos os anos do estudo. Destes, 46,9% (2005) e 38,98% (2006) possuíam o ensino fundamental incompleto, e 50,3% (2005) e 55,93% (2006) eram estudantes. A iniciação sexual ocorreu em torno dos 13 anos de idade e o diagnóstico mais comum foi de infecção pelo vírus do papiloma humano (HPV) com a frequência de 46,8% em 2005 e 54,84% em 2006. Conclusão: os adolescentes constituem um grupo vulnerável em relação à sexualidade, assim, porvezes, não percebem o risco em adquirir infecções genitais, tais como as DST, portanto, não se protegem por meio do uso do preservativo. Esses resultados demonstraram elevada frequência de DST, principalmente no que diz respeito à infecção pelo HPV, indicando a necessidade de medidas de prevenção, programas de educativos que busquem a redução deste risco, além de um atendimento especializado realizado por profissionais habilitados a fi m de realizarum correto diagnóstico e, consequentemente, um tratamento das infecções genitais no acompanhamento do grupo em questão.

Introduction: now adays, young people are in vulnerable situation for genital infections, due to high rates of sexual activity with different partners andfailures in the use of condoms. Objectives: describe the sexual profile and frequency of genital infections diagnosed in adolescents seen in a DST Clinicof Federal Fluminense University (UFF) in the years 2005 and 2006. Methods: a cross-sectional study was conducted, descriptive, observational and quantitative through records analysis of adolescents between 12 and 19 years of age attended in DST/UFF Sector from January to December of the years 2005 and 2006. The data was processed through descriptive analysis by percentage. Results: the share of teenagers who attended the service was equalfor both sexes, but the majority over 16 years of age, with fi xed sexual partner only in 57.2% of cases in 2005 and 57.63% for the year 2006, in which the majority did not use condoms and had no history of the DST in both years of study. Of these 46.9% (2005) and 38.98% (2006) had incomplete primary school and 50.3% (2005) and 55.93% (2006) were students. The sexual initiation occurred around 13 years of age and genital infection by the human papilloma virus (HPV) was described as the most frequent in this group. Conclusion: teenagers are a vulnerable group in relation to sexuality, thus, theyare not aware of the risks of acquiring genital infections such as STDs, therefore they do not protect themselves through preservatives. These results showhighly frequent STD's, mostly the ones related to HPV, indicating the need for prevention measures, educational programs that aim at the reduction of thisrisk along with a specialized care by qualifi ed professionals in order to make a correct diagnosis and, as a result, a treatment for the genital infections inthe following up of the group.

Penile myiasis as a differential diagnosis for genital ulcer: a case report.

The genital localized myiasis is a rare zooparasitic dermatosis. This case reported to a penile myiasis by Dermatobia hominis larvae in a 62 year-old man, who is a retired military official from São Gonçalo city, Rio de Janeiro state, Brazil. This patient was guided to the sexually transmitted diseases (STD) clinic from Universidade Federal Fluminense (UFF) by professionals from a urology outpatient clinic of a public hospital from Rio de Janeiro state. The exam showed a 2 cm diameter nodular lesion with a hyperemic area in the glands penis that had arisen 20 days before the exam. It evolved in a favorable way after larvae removal, through previous local anesthesia and slight pressure in lesion's base with the extraction of the larvae. Penile myiasis is not a very frequent situation, although it must be considered as an option in differential diagnosis of genital infectious diseases, even among people of low economical level, as in the case presented.

Penile myiasis as a differential diagnosis for genital ulcer: a case report

The genital localized myiasis is a rare zooparasitic dermatosis. This case reported to a penile myiasis by Dermatobia hominis larvae in a 62 year-old man, who is a retired military official from São Gonçalo city, Rio de Janeiro state, Brazil. This patient was guided to the sexually transmitted diseases (STD) clinic from Universidade Federal Fluminense (UFF) by professionals from a urology outpatient clinic of a public hospital from Rio de Janeiro state. The exam showed a 2 cm diameter nodular lesion with a hyperemic area in the glands penis that had arisen 20 days before the exam. It evolved in a favorable way after larvae removal, through previous local anesthesia and slight pressure in lesion's base with the extraction of the larvae. Penile myiasis is not a very frequent situation, although it must be considered as an option in differential diagnosis of genital infectious diseases, even among people of low economical level, as in the case presented.

Condiloma acuminado extragenital associado ao intertrigo: relato de caso / Acuminata condyloma extragenital associated to intertrigo: case report

Introdução: papilomavírus humano (HPV) é um vírus de DNA que pode infectar a pele e mucosas, com mais de 100 tipos diferentes descritos, sendo 45 deles considerados sexualmente transmissíveis. Objetivo: relatar o caso de condiloma acuminado extragenital, facilitado pela presença de intertrigo. Métodos: relato de caso de paciente com condiloma acuminado em região hipogástrica. Resultados: mulher atendida no ambulatório de DST/AIDS do setor de Ginecologia da Santa Casa de Misericórdia de Vitória, em 2007, com 46 anos de idade, apresentando lesão condilomatosa extensa associada à intertrigo em região hipogástrica, acima da cicatriz de Pfannestiel e pequenas lesões vulvares compatíveis, clinicamente, com condilomas. Feita a opção pela exérese cirúrgica em lesão de abdome, a qual evidenciou condiloma acuminado e cauterização química de lesões vulvares. Solicitados exames para doenças sexualmente transmissíveis, que foram normais, incluindo citologia oncótica, colposcopia e teste rápido para gonococo e clamídia. Conclusão: a umidade e o calor locais, provocados pelo abdome em avental, com concomitância de área de intertrigo, poderiam justifi car a presença de condiloma acuminado nesta região.

Introduction: the human papillomavirus (HPV) is a DNA virus that can infect skin and mucosa, already described in more than 100 different types,being 45 of those considered to be sexually transmitted. Objective: report the extra-genital case of condyloma acuminata, facilitated by the presenceof intertrigo. Method: report of a case of female patient presenting extensive condylomatous lesions associated to intertrigo in hypogastric region. Results: a 46-year-old female patient assisted in the DST/AIDS Clinic of the Gynecology Sector at Santa Casa de Misericórdia from Vitória in 2007, presenting extensive condylomatous lesions associated to intertrigo in hypogastric region above the Pfannestiel scar and small compatible vulvar verrucosa lesions suggestive of condyloma. Surgical excision was made in the abdomen lesion which evidenced condyloma acuminatum and chemical cauterization of vulvar warts. Tests for sexually transmitted diseases were requested, all of them were normal, including oncotic cytology, colposcopy and fast test for gonococcus and chlamydia. Conclusion: local humidity and heat provoked by abdomen in apron with concurrence of area of intertrigo could justify the presence of condyloma acuminatum in this region.

Infecção pelo HIV e a atividade laboral do portador: uma relação ética e legal na visão da odontologia do trabalho / HIV infection and working patient activity: a ethical and legal relation in the vision of the work dentistry

Introdução: o controle da infecção pelo vírus da imunodeficiência humana (HIV) na vida do trabalhador infectado é de responsabilidade da equipe de saúde ocupacional, na qual o dentista do trabalho está inserido. Objetivo: realizar uma revisão bibliográfica a fim de trazer ao conhecimento dos cirurgiões-dentistas, principalmente os profissionais que exercem sua função monitorando a saúde do trabalhador, os aspectos éticos e legais relacionados com os indivíduos infectados pelo HIV. Métodos: para isto foi realizado um levantamento bibliográfico que utilizou periódicos científicos, livros técnicos, notas técnicas, publicações de organismos nacionais e internacionais (Medline e Lilacs dos últimos 10 anos). Resultados: as atribuições do dentista do trabalho perpassam desde a observação e o controle das manifestações orais provenientes da aids, a promoção da saúde bucal, até a realização de campanhas informativas e preventivas nas empresas em que prestam serviço. Conclusão: a busca pela atualização dos conhecimentos técnico-científicos é prevista por norma regulamentadora e dará ao profissional a segurança necessária para não agir de forma preconceituosa e discriminátoria, capacitando-o para a realização de um trabalho educativo junto aos demais componentes do seu ambiente laboral e social.

Correlação clínico-terapêutica e aspectos moleculares da infecção pelo HIV em pacientes pediátricos: em busca de melhor qualidade de vida / Physician-therapeutical correlation and molecular aspects of the infection for the HIV in pediatric patients: in search of the better quality of life

Introdução: o controle da infecção pelo HIV em pacientes pediátricos tem alcançado um amplo espectro que vai desde a abordagem da família naadesão ao tratamento anti-retroviral até a análise dos aspectos moleculares da infecção neste grupo, a fim de que ocorra a promoção de uma melhor qualidade de vida e uma maior sobrevida destes. Objetivo: descrever os aspectos clínico-terapêuticos de pacientes pediátricos infectados pelo HIV e descrever sua correlação com os aspectos moleculares da infecção, nutricionais e psicológicos. De modo a enfatizar a importância de se avaliar estas crianças sobre a ótica da qualidade de vida. Métodos: foi realizado um levantamento bibliográfico que teve como base publicações de organismos nacionais e internacionais (Medline e Lilacs), periódicos científicos e livros técnicos. Resultados: as particularidades no curso da infecção pelo HIV em pacientes pediátricos vão desde as manifestações clínicas que os diferem dos adultos, a necesaidsde do apoio familiar na adesão ao tratamento proposto pelo médico até a superação de possíveis efeitos adversos da terapia anti-retroviral, como a intolerância e a toxicidade. Por outro lado diantedo quadro patológico impõem-se desafios, como amparar estas crianças que podem desenvolver desordens psicológicas, conceder uma dieta que contribua em uma melhor ação no tratamento, assim como a necesaidsde de se estudar as possíveis mutações que implicam em resistência viral a fim de que ocorra o desenvolvimento de novas drogas. Conclusão: o curso clínico-terapêutico deve ser a base no conhecimento dos diversos aspectos da infecção pelo HIV em pacientes pediátricos concedendo ao profissional de saúde o apoio fundamental na escolha dos meios de fornecer uma melhor qualidade de vida a estes pacientes e uma maior tranqüilidade durante o acompanhamento clínico a seus responsáveis.

Introduction: the control of the HIV infection in pediatrics patients has reached a larger specter that goes since the boarding of the family in theadhesion to the anti-retroviral treatment until the analysis of the molecular aspects of the infection in this group topromove better quality of life and agreater follow-up. Objective: report the clinical-therapeutical aspects of pediatrics patients infecty by the HIV and describe its psychological correlation with the molecular aspects of the infection, nutricionais. In order to emphasize the importance of evaluating these children on the optics of the quality of life. Methods: it was carried through a bibliographical survey that had as base publications of national and international organisms (- Medline and Lilacs), periodic scientific and books technician. Results: the particularitities in the course of the infection for the HIV in pediatrics patients go since the clinical manifestations that differ them from the adults, the necessity of the familiar support in the adhesion to the treatment considered for the doctor until the overcoming of possible adverse effect of the anti-retroviral therapy as the intolerance and the toxicological effects. On the other hand ahead of the pathological picture one imposes challenges as to support these children who can develop psychological clutters, to grant a diet that contribute in one better action in the treatment, as well as the necessity of if studying the possible mutations that imply in viral resistance so that the development of new drugs occurs. Conclusion: the clinical-therapeutical course must be the base in the knowledge of the diverse aspects of the infection for the HIV in pediatrics patients granting to the health professional the basic support in the choice of the ways to supply to one better quality of life to these patients and a bigger tranquillity during the clinical accompaniment its responsible ones.

Estudo da prevalência de sífilis congênita em um Hospital da rede SUS de Niterói-RJ / Prevalency study of congenital syphilis in one Hospital of SUS Group in Niterói City-RJ

Identifica e descreve a prevalência de sífilis congênita notificados no Hospital Estadual Azevedo Lima. O número de casos de sífilis congênita durante os anos do estudo manteve-se alto e constante. As taxas de prevalência e incidência foram superiores às preconizadas pela OMS

Importância e possibilidades do aleitamento natural e transmissão de doenças infecciosas para o nascituro / The importance and choices in breast-feeding and the transmition of infeccious diseases to the bay

O aleitamento natural na literatura mundial continua sendo cada vez mais encorajado, devido a seus inúmeros benefícios à mãe e ao nascituro, desde a contribuição no seu processo de desenvolvimento, bem como o satisfazer no âmbito nutricional.Porém, o leite materno pode ser veículo de agentes infecciosos,cabendo desta forma ao profissional de saúde orientar a nutriz,demonstrando todos os riscos a que ambos estarão expostos de forma que ocorra a melhor opção na escolha da alimentação e condução deste recém-nato