Clinical and histopathological features of congenital epulis in a newborn submitted to laser surgery.

Congenital epulis (CE) is a rare condition in newborns, whose histogenesis remains unclear. It mostly presents as a circumscribed mass in the maxilla alveolar ridge of female neonates and can interfere with their normal breathing and breastfeeding. This benign oral lesion usually appears as a pedunculated nodule covered with normal mucosa that extends from the anterior vestibular alveolar ridge up to the posterior region. There are some pathological conditions that show clinical and histopathological features similar to those of CE, such as granular cell tumor, gingival cyst of the newborn, vascular malformations and others. This case report aimed to describe the clinical and pathological features of a newborn patient with a clinical and histopathological diagnosis of CE on the right side of the maxillary alveolar ridge, treated with excision by laser surgery, with a follow-up of 5 months without any sign of recurrence.

Guidelines for the management of human brucellosis in the State of Paraná, Brazil.

Human brucellosis is a re-emerging disease with the potential for bioterrorism. The number of cases in Brazil has increased; however, the ideal management has not been established. These guidelines are intended for use by clinicians and other health-care workers providing medical care for patients with suspected brucellosis in the State of Paraná. We included a brief description of the epidemiology, clinical presentation, diagnosis, prevention of exposure, prevention of disease by chemoprophylaxis, treatment of disease, monitoring of adverse effects during treatment, management of treatment failure and relapse cases.

Rapid, actionable diagnosis of urban epidemic leptospirosis using a pathogenic Leptospira lipL32-based real-time PCR assay.

BACKGROUND: With a conservatively estimated 1 million cases of leptospirosis worldwide and a 5-10% fatality rate, the rapid diagnosis of leptospirosis leading to effective clinical and public health decision making is of high importance, and yet remains a challenge. METHODOLOGY: Based on parallel, population-based studies in two leptospirosis-endemic regions in Brazil, a real-time PCR assay which detects lipL32, a gene specifically present in pathogenic Leptospira, was assessed for the diagnostic effectiveness and accuracy. Patients identified by active hospital-based surveillance in Salvador and Curitiba during large urban leptospirosis epidemics were tested. Real-time PCR reactions were performed with DNA-extracted samples obtained from 127 confirmed and 23 unconfirmed cases suspected of leptospirosis, 122 patients with an acute febrile illness other than leptospirosis, and 60 healthy blood donors. PRINCIPAL FINDINGS: The PCR assay had a limit of detection of 280 Leptospira genomic equivalents/mL. Sensitivity for confirmed cases was 61% for whole blood and 29% for serum samples. Sensitivity was higher (86%) for samples collected within the first 6 days after onset of illness compared to those collected after 7 days (34%). The real-time PCR assay was able to detect leptospiral DNA in blood from 56% of serological non-confirmed cases. The overall specificity of the assay was 99%. CONCLUSIONS: These findings indicate that real-time PCR may be a reliable tool for early diagnosis of leptospirosis, which is decisive for clinical management of severe and life-threatening cases and for public health decision making.

Guidelines for the management of human brucellosis in the State of Paraná, Brazil

Abstract Human brucellosis is a re-emerging disease with the potential for bioterrorism. The number of cases in Brazil has increased; however, the ideal management has not been established. These guidelines are intended for use by clinicians and other health-care workers providing medical care for patients with suspected brucellosis in the State of Paraná. We included a brief description of the epidemiology, clinical presentation, diagnosis, prevention of exposure, prevention of disease by chemoprophylaxis, treatment of disease, monitoring of adverse effects during treatment, management of treatment failure and relapse cases.

Does virus-bacteria coinfection increase the clinical severity of acute respiratory infection?

This retrospective cohort study investigated the presence of bacteria in respiratory secretions of patients hospitalized with acute respiratory infections and analyzed the impact of viral and bacterial coinfection on severity and the mortality rate. A total of 169 patients with acute respiratory infections were included, viruses and bacteria in respiratory samples were detected using molecular methods. Among all samples, 73.3% and 59.7% were positive for viruses and bacteria, respectively; 45% contained both virus and bacteria. Bacterial coinfection was more frequent in patients infected by community respiratory viruses than influenza A H1N1pdm (83.3% vs. 40.6%). The most frequently bacteria detected were Streptococcus pneumoniae and Haemophilus influenzae. Both species were co-detected in 54 patients and identified alone in 22 and 21 patients, respectively. Overall, there were no significant differences in the period of hospitalization, severity, or mortality rate between patients infected with respiratory viruses alone and those coinfected by viruses and bacteria. The detection of mixed respiratory pathogens is frequent in hospitalized patients with acute respiratory infections, but its impact on the clinical outcome does not appear substantial. However, it should be noted that most of the patients received broad-spectrum antibiotic therapy, which may have contributed to this favorable outcome.

As notificações de acidentes de trabalho com material biológico em um hospital de ensino de Curitiba/PR / Reporting on work accidents with biological materials in a teaching hospital in the city of Curitiba, state of Paraná, Brazil

Estudo descritivo, de natureza qualitativa, com o objetivo de conhecer a realidade da notificação de acidentes de trabalho com material biológico no Serviço de Epidemiologia Hospitalar de Hospital de Ensino de Curitiba - PR. A coleta de dados foi realizada em bancos de dados do SINAN-Net e por meio de entrevistas semiestruturadas com dez informantes-chave. A análise dos dados, fundamentada no materialismo histórico e dialético, permitiu identificar processos relacionados às dimensões estrutural, particular e singular na notificação dos acidentes de trabalho.

This is a descriptive study based on qualitative methods aimed at outlining the connection between occurrence and lack of reporting of occupational accident with biological material reported in a teaching hospital at Curitiba, Parana State, Brazil. Data collection involved searching report made in 2010 by the Epidemiology unit and semi-structured interviews with key informants from a hospital. Data were examined according to historical and dialectical materialism that led to the identification of structural, specific and unique aspects of occupational accident reports.

Laboratory diagnosis, epidemiology, and clinical outcomes of pandemic influenza A and community respiratory viral infections in southern Brazil.

Community respiratory viruses (CRVs) are commonly associated with seasonal infections. They have been associated with higher morbidity and mortality among children, elderly individuals, and immunosuppressed patients. In April 2009, the circulation of a new influenza A virus (FLUA H1N1v) was responsible for the first influenza pandemic of this century. We report the clinical and epidemiological profiles of inpatients infected with CRVs or with FLUA H1N1v at a tertiary care hospital in southern Brazil. In addition, we used these profiles to evaluate survivor and nonsurvivor patients infected with FLUA H1N1v. Multiplex reverse transcription-PCR (RT-PCR) and real time RT-PCR were used to detect viruses in inpatients with respiratory infections. Record data from all patients were reviewed. A total of 171 patients were examined over a period of 16 weeks. Of these, 39% were positive for FLUA H1N1v, 36% were positive for CRVs, and 25% were negative. For the FLUA H1N1v- and CRV-infected patients, epidemiological data regarding median age (30 and 1.5 years), myalgia (44% and 13%), need for mechanical ventilation (44% and 9%), and mortality (35% and 9%) were statistically different. In a multivariate analysis comparing survivor and nonsurvivor patients infected with influenza A virus H1N1, median age and creatine phosphokinase levels were significantly associated with a severe outcome. Seasonal respiratory infections are a continuing concern. Our results highlight the importance of studies on the prevalence and severity of these infections and that investments in programs of clinical and laboratory monitoring are essential to detect the appearance of new infective agents.

Características sociodemográficas e mortalidade materna em um hospital de referência na cidade de Curitiba-Paraná / Socio-demographic characteristics and maternal mortality in a reference hospital in the city of Curitiba-Paraná

A mortalidade materna atrai inúmeras discussões e preocupações no Brasil visto que reflete a qualidade da assistência prestada nos serviços de saúde, bem como a operacionalização das políticas públicas voltadas à saúde da mulher. Esta pesquisa teve como objetivo identificar o perfil sociodemográfico e causal da mortalidade materna no período de 2004 a 2007, em um hospital de ensino da cidade de Curitiba, Estado do Paraná. Após análise das fichas hospitalares de investigação confidencial de óbitos e dos pareceres técnicos do Comitê Estadual de Prevenção de Mortalidade Materna encontrou-se um percentual de 80% de óbitos evitáveis, sendo que 45,16% destes ocorreram devido às causas diretas de óbito materno. Dentre essas causas, as que mais provocaram óbitos foram aquelas relacionadas a doenças do aparelho circulatório, embolias obstétricas e doenças renais. O estudo possibilitou concluir que há deficiência nos registros de informações nos prontuários quanto aos dados sociodemográficos, bem como a necessidade de discutir a melhoria de acesso aos serviços de saúde com vistas a reduzir as taxas de mortalidade materna.

[Study of 312 children with meningitis treated at a University Hospital in the South of Brazil]. / Estudio de 312 niños con meningitis atendidos en un Hospital Universitario en el Sur de Brasil.

The aim of this study is to evaluate the clinical and laboratorial aspects, as well as the etiological profile and the evolution characteristics, of the diverse types of severe meningitis treated at a Pediatric Clinic of a public university hospital. From a descriptive and retrospective study, 312 children at the Pediatric Clinic of the Hospital de Clínicas of the Federal University of Paraná were evaluated between January 2003 and January 2007. All of them had a probable diagnosis of meningitis based on clinical signs, and on the cytological and biochemical alterations in the cerebrospinal fluid routine examination. Viral meningitis (VM) was present in 140 children (45%), 58 had bacterial meningitis (BM - 19%) and etiology was undetermined in 114 (36%). In MB, Neisseria meningitidis was the most frequent etiological agent (25 cases). Predominant clinical symptoms were fever, sickness and headache. The cerebrospinal fluid test showed a high number of polymorphonuclear leukocytes, high protein and low glucose level in MB; mononuclear cells were predominant in VM. Neurological complications were more frequent in BM, and convulsion the most common symptom (6/58 patients). Death happened to one case in VM and 3 in BM. Our conclusions were that the classical triad (headache, vomiting and fever) was the most common clinical manifestation, the cytological and biochemical abnormalities were typical, helping in the differentiation of MB from VM, although a good number of cases ended up with no etiological definition and, finally, immediate neurological complications and death were rare.

Estudio de 312 niños con meningitis atendidos en un Hospital Universitario en el Sur de Brasil / Study of 312 children with meningitis treated at a University Hospital in the South of Brazil

El objetivo de este trabajo fue evaluar los aspectos clínicos, análisis de laboratorio, el perfil etiológico y las características evolutivas de los distintos tipos de meningitis aguda atendidos en un Servicio de Pediatría de un Hospital Público Universitario. Fueron evaluados a partir de un estudio descriptivo y retrospectivo de niños atendidos en el Servicio de Pediatría del Hospital de Clínicas de la Universidad Federal del Paraná, durante el periodo entre enero 2003 a enero 2007, con el diagnóstico probable de meningitis basado en manifestaciones clínicas y en alteraciones citológicas y bioquímicas del LCR. Se diagnosticó meningitis viral (MV) en 140 niños (45%), meningitis bacteriana (MB) en 58 (19%) y en 114 la etiología fue indeterminada (36%). Entre las MB el agente etiológico más frecuente fue Neisseria meningitidis (25 casos). Lo datos clínicos predominantes fueron fiebre, vómitos y cefalea. En el LCR de la MB hubo predominio de polimorfonucleares, proteína elevada y glucosa baja. En la MV predominaron los mononucleares. Las complicaciones neurológicas fueron más frecuentes en la MB, siendo la convulsión el hallazgo más común (6/58 pacientes). El óbito ocurrió en un caso en la MV y tres en la MB. Se llegó a la conclusión de que la clásica tríada fue la manifestación clínica más común, las anormalidades citológicas y bioquímicas fueron típicas auxiliando en la diferenciación entre las MB y MV, aunque un gran número de casos haya quedado sin definición etiológica; las complicaciones neurológicas inmediatas y los óbitos han sido pocos frecuentes en esta muestra.

The aim of this study is to evaluate the clinical and laboratorial aspects, as well as the etiological profile and the evolution characteristics, of the diverse types of severe meningitis treated at a Pediatric Clinic of a public university hospital. From a descriptive and retrospective study, 312 children at the Pediatric Clinic of the Hospital de Clínicas of the Federal University of Paraná were evaluated between January 2003 and January 2007. All of them had a probable diagnosis of meningitis based on clinical signs, and on the cytological and biochemical alterations in the cerebrospinal fluid routine examination. Viral meningitis (VM) was present in 140 children (45%), 58 had bacterial meningitis (BM - 19%) and etiology was undetermined in 114 (36%). In MB, Neisseria meningitidis was the most frequent etiological agent (25 cases). Predominant clinical symptoms were fever, sickness and headache. The cerebrospinal fluid test showed a high number of polymorphonuclear leukocytes, high protein and low glucose level in MB; mononuclear cells were predominant in VM. Neurological complications were more frequent in BM, and convulsion the most common symptom (6/58 patients). Death happened to one case in VM and 3 in BM. Our conclusions were that the classical triad (headache, vomiting and fever) was the most common clinical manifestation, the cytological and biochemical abnormalities were typical, helping in the differentiation of MB from VM, although a good number of cases ended up with no etiological definition and, finally, immediate neurological complications and death were rare.

Risco de cárie em bebês / Caries risk in baby

O presente trabalho retrata a análise de 192 prontuários do Projeto de Atendimento Odontológico para Bebês da cidade de Goiânia. Os principais pontos observados foram o risco de cárie na primeira e última consulta da criança foi determinado através de métodos anamnésicos. A análise constatou que, após a aplicaçäo de medidas educativas e preventivas houve uma reversäo significativa no risco de cárie das crianças

A importância dos hábitos de higiene bucal / The importance of buccal hygiene habits

As autoras, em trabalho de revisão bibliográfica apresentam dados epidemiológicos das doenças bucais mais prevalentes no Brasil, criticando o tipo de prática odontológica hegemônica vigente no país que não propicia a redução no grau de morbidade odontológica da população. Destacam a importância da limpeza dos dentes associada à fluorterapia em programas de saúde bucal, enfatizando a necessidade de motivação dos pacientes para incorporação de hábitos de higiene bucal, visando a obtenção de eficácia nos programas de Odontologia

Importância de hábitos de higiene bucal em programas que visam a promoção de saúde / Importance of oral hygiene habits in dental public health programs

As autoras, em trabalho de revisão bibliográfica apresentam dados epidemiológicos das doenças bucais mais prevalentes no Brasil, criticando o tipo de prática odontológica hegemônica vigente no país que não propicia a redução no grau de morbidade odontológica da população. Destacam a importância da limpeza dos dentes associada a fluorterapia em programas de saúde bucal, enfatizando a necessidade da motivação dos pacientes para incorporação de hábitos de higiene bucal, visando a obtenção de eficácia nos programas de odontologia

Consideraçöes sobre o trabalho educativo-preventivo a nível comunitário / Considerations about educational and preventive work at community level

As autoras tecem consideraçöes que subsidiam o desenvolvimento de açöes de promoçäo de saúde junto a crianças com idade pré-escolar e alunos da rede escolar de ensino público e de instituiçöes públicas ou filantrópicas. Colocam a importância do conhecimento prévio da realidade da vida das pessoas para dar início ao processo de planejamento do trabalho educativo-preventivo bem como a implementaçäo das açöes pertinentes

Trombocitose e doença de Crohn / Thrombocytosis and Crohn disease

A correlaçäo entre trombocitose e atividade da doença de Crohn (DC) tem sido constatada por alguns autores. Entretanto, esta observaçäo näo tem sido extensamente utilizada pela existência de comprovaçöes limitadas. Assim, os autores analisaram, retrospectivamente, os dados dos últimos 30 pacientes atendidos na Disciplina de Gastroenterologia do Departamento de Clínica Médica do Hospital das Clínicas da Faculdade de Medicina da Universidade de Säo Paulo, e na clínica privada de um dos autores (A.B.). Levou-se em consideraçäo a contagem de plaquetas (método de Brecher-Cronkite; valores normais 200.000 a 400.000 plaquetas/mm3) e o índice clínico de atividade da DC segundo os critérios de Harvey e Bradshaw. Onze pacientes (37%) apresentaram trombocitose (x=500.818 + ou - 56.845) e o valor médio do índice clínico de atividade desse grupo foi 8,6 (intervalo de confiança: 6-13). Dezenove pacientes (63%) näo apresentaram trombocitose (267.789 + ou - 62.124) e o seu valor médio de atividade foi 5,7 (intervalo de confiança: 2-11). Diferença estatisticamente significante foi verificada entre os valores médios dos índices clínicos de atividade dos dois grupos (z=2,84, para alfa < ou = 0,05), bem como entre as médias do número de plaquetas/mm3 (z = 4,5, para alfa < ou = 0,05). Näo houve relaçäo estatisticamente significante entre trombocitose e formas íleo-cólica, jejuno-ileal e cólica da DC. Entretanto, dos nove pacientes da casuística com forma ileal, oito (88%) näo apresentaram trombocitose e tiveram índices de atividade < ou = 6. Os possíveis mecanismos fisiopatológicos da trombocitose na DC säo comentados e revisados. A relaçäo entre trombocitose e a atividade da DC, observada na presente casuística, näo constitui, certamente, elemento diagnóstico para a afecçäo, mas associadamente ao quadro clínico, pode representar importante parâmentro para indicar a atividade da doença

Análise da clientela que consultou em 1973 na Faculdade de Odontologia da Universidade Federal do Rio Grande do Sul e que deixou de re-consultar em 1974 / Analysis of patients who came for visits at UFRGS Dental School in 1973 and did not return in 1974

Foram entrevistados trezentos e quinze pacientes que consultaram na Faculdade de Odontologia da UFRGS no ano base de 1973 e foram identificadas as principais causas do näo retorno em 1974. Analisaram-se fatores relevantes como: caracterizaçäo da clientela em dados pessoais e sócio-econômicos, fatores que influenciaram a utilizaçäo dos serviços ambulatoriais da Faculdade, opiniäo sobre o tratamento recebido e posicionamento quanto a futura reconsulta na Faculdade. Vários cruzamentos säo feitos para estudo de associaçäo entre os fatores. As principais razöes apresentadas para näo re-consultar foram: falta de tempo do paciente, ausência de necessidades de tratamento odontológico e procura de outro dentista

Estudo comparativo do nivel de aptidao de futuros oficiais antes e depois de uma manobra militar

A presente pesquisa pretendeu averiguar a influencia de uma manobra militar em diferentes aptidaoes. Para a realiacao da mesma, foi escolhida uma amostra de 46 individuos de uma populacao de 168 alunos do Curso de Formacao de Oficiais da Academia de Policia Militar do Rio Grande do Sul. Nestes, foi aplicada uma testagem antes e depois de uma manobra militar, levantnado-se os dados atraves de um tratamento estatistico que foi a prova de 'T' de Wilcoxon para amostras relacionadas. Tendo como referencia os resultados alcancados atraves deste levantamento, constatamos que a manobra influencia positivo e siginificativamente em divesas aptidoes dos alunos oficiais.