Vaginal Microbiome Components as Correlates of Cervical Human Papillomavirus Infection.

BACKGROUND: Interplay between vaginal microbiome and human papillomavirus (HPV) remains unclear, partly due to heterogeneity of microbiota. METHODS: We used data from 546 women enrolled in a cross-sectional study in 5 Brazil. We genotyped vaginal samples for HPV and sequenced V3-V4 region of 16S rRNA gene for vaginal microbiome analysis. We used stepwise logistic regression to construct 2 linear scores to predict high-risk HPV (hrHPV) positivity: one based exclusively on presence of individual bacterial taxa (microbiome-based [MB] score) and the other exclusively on participants' sociodemographic, behavioral, and clinical (SBC) characteristics. MB score combined coefficients of 30 (of 116) species. SBC score retained 6 of 25 candidate variables. We constructed receiver operating characteristic curves for scores as hrHPV correlates and compared areas under the curve (AUC) and 95% confidence intervals (CI). RESULTS: Overall, prevalence of hrHPV was 15.8%, and 26.2% had a Lactobacillus-depleted microbiome. AUCs were 0.8022 (95% CI, .7517-.8527) for MB score and 0.7027 (95% CI, .6419-.7636) for SBC score (P = .0163). CONCLUSIONS: The proposed MB score is strongly correlated with hrHPV positivity-exceeding the predictive value of behavioral variables-suggesting its potential as an indicator of infection and possible value for clinical risk stratification.

Effectiveness of fluoride-containing toothpastes associated with different technologies to remineralize enamel after pH cycling: an in vitro study.

BACKGROUND: To evaluate the efficacy of fluoride-containing toothpastes with different technologies to remineralize artificial caries lesions in enamel. METHODS: Bovine enamel blocks were divided into three thirds: intact (untreated), demineralized (artificial caries lesion), and treated (caries lesion, pH cycling with dentifrices). Enamel blocks were randomly distributed into five groups (n = 12): Fluoride-free toothpaste, Colgate Oral Care (NC); Arginine-containing toothpaste, Colgate Total Daily Repair (PC); Silicate-based fluoride toothpaste: REFIX technology, regenerador + sensitive (RDC), NR-5 technology, Regenerate Enamel Science (RES), and NOVAMIN technology, Sensodyne Repair and Protect (SRP). The specimens were submitted to a pH cycling model for 6 days. The efficacy of the toothpastes was estimated by calculating the surface microhardness recovery (%SMHR) and the fluorescence recovery (ΔFRE) with quantitative light-induced fluorescence. The cross-sectional micromorphology of the enamel surface was also assessed using scanning electron microscopy. Elemental analyses (weight%) were determined with an energy-dispersive X-ray spectrometer (EDS). The results were compared to that of the control (NC). Data were statistically analyzed (5%). RESULTS: %SMHR could be ranked as follows: RDC = PC = RES = SRP > NC. Significantly higher %SMHR and ΔFRE means were observed after enamel treatment with RDC (22.7 and 46.9, respectively). PC (%SMHR = 18.8) was as efficacious as RDC to recover the surface microhardness with a significantly lower mean of ΔFRE (19.5). Only RDC was able to promote the formation of a mineralized layer on the surface of enamel enriched with silicon on the surface. CONCLUSIONS: The silicate-based fluoride toothpaste containing REFIX technology demonstrated greater efficacy in the remineralizing artificial caries than the other products.

Oxandrolone for treatment of lipodermatosclerosis: case report.

Lipodermatosclerosis is a panniculitis characterized by hardening and hyperpigmentation of the skin involving the calves with an "inverted champagne bottle" appearance. Many therapeutic approaches have been recommended, but the use of oxandrolone for this purpose has been studied very little to date. We report a case of acute lipodermatosclerosis in a 61-year-old woman with a previous history of surgical treatment for venous insufficiency of the lower limbs. The patient presented with edema and painful, erythematous lesions with diffuse infiltration, mainly affecting the posterior aspect of the left calf. She was initially treated with stanozolol and pentoxifylline, with good response. Due to unavailability of stanozolol, she was put on oxandrolone. This treatment was well tolerated, reduced the intensity of edema, erythema, and infiltration in the lower limbs, effectively leading to pain relief. Oxandrolone may be a useful and safe treatment for patients with acute lipodermatosclerosis.

Volumetric alterations in the basal ganglia in autism Spectrum disorder: A systematic review.

INTRODUCTION: Recent research indicates that some brain structures show alterations in conditions such as Autism Spectrum Disorder (ASD). Among them, are the basal ganglia that are involved in motor, cognitive and behavioral neural circuits. OBJECTIVE: Review the literature that describes possible volumetric alterations in the basal ganglia of individuals with ASD and the impacts that these changes have on the severity of the condition. METHODOLOGY: This systematic review was registered in the design and reported according to the PRISMA Items and registered in PROSPERO (CRD42023394787). The study analyzed data from published clinical, case-contemplate, and cohort trials. The following databases were consulted: PubMed, Embase, Scopus, and Cochrane Central Register of Controlled Trials, using the Medical Subject Titles (MeSH) "Autism Spectrum Disorder" and "Basal Ganglia". The last search was carried out on February 28, 2023. RESULTS: Thirty-five eligible articles were collected, analyzed, and grouped according to the levels of alterations. CONCLUSION: The present study showed important volumetric alterations in the basal ganglia in ASD. However, the examined studies have methodological weaknesses that do not allow generalization and correlation with ASD manifestations.

Bilateral Tessier no. 7 cleft with an accessory maxilla and osseous choristoma: a case report.

Tessier no. 7 clefts are characterized by macrostomia, facial muscular diastasis and maxillary and zygomatic bone abnormalities. It is caused by a lack of ectomesenchyme formation or penetration of the maxillary and mandibular processes during the fourth and fifth weeks of development. A case of bilateral transverse facial cleft with an accessory maxilla and an osseous choristoma is presented. The diagnosis of accessory maxilla was based on clinical findings due to the inaccessibility of orthopantomography and computed tomography scan. Orbicularis oris muscle reconstruction, cheiloplasty and excision of accessory maxilla were done. Histopathological examination of the bony lesion showed an osseous choristoma. There were no postoperative complications or local recurrence of the lesion excised. This case report demonstrates the importance of early diagnosis and intervention in maxillofacial congenital anomalies. Cheiloplasty restores function and gives the patient a natural appearance. The excision of accessory bone prevents further complications in the child's growth.

Case Report: Cutaneous Leishmaniasis in a Rheumatoid Arthritis Patient Receiving Methotrexate.

The immunosuppressive effect of methotrexate has rarely been associated with reactivation of cutaneous leishmaniasis. Here we present a case of a cutaneous leishmaniasis patient with atypical clinical symptoms without splenomegaly but with cutaneous manifestations after treatment of rheumatoid arthritis with methotrexate and blood recovery of the parasite. Next-generation sequencing was used to identify Leishmania infantum chagasi in the patient's blood sample.

PD-1/PD-L1 Inhibition Enhances Chemotherapy-Induced Neuropathic Pain by Suppressing Neuroimmune Antinociceptive Signaling.

Cytotoxic agents synergize with immune checkpoint inhibitors and improve outcomes for patients with several cancer types. Nonetheless, a parallel increase in the incidence of dose-limiting side effects, such as peripheral neuropathy, is often observed. Here, we investigated the role of the programmed cell death-1 (PD-1)/programmed death-ligand 1 (PD-L1) axis in the modulation of paclitaxel-induced neuropathic pain. We found that human and mouse neural tissues, including the dorsal root ganglion (DRG), expressed basal levels of PD-1 and PD-L1. During the development of paclitaxel-induced neuropathy, an increase in PD-L1 expression was observed in macrophages from the DRG. This effect depended on Toll-like receptor 4 activation by paclitaxel. Furthermore, PD-L1 inhibited pain behavior triggered by paclitaxel or formalin in mice, suggesting that PD-1/PD-L1 signaling attenuates peripheral neuropathy development. Consistent with this, we observed that the combined use of anti-PD-L1 plus paclitaxel increased mechanical allodynia and chronic neuropathy development induced by single agents. This effect was associated with higher expression of inflammatory markers (Tnf, Il6, and Cx3cr1) in peripheral nervous tissue. Together, these results suggest that PD-1/PD-L1 inhibitors enhance paclitaxel-induced neuropathic pain by suppressing PD-1/PD-L1 antinociceptive signaling.

Cervicofacial necrotizing fasciitis after topical application of herbal medicine.

Cervical necrotizing fasciitis represents an aggressive form of deep neck space infection with a high mortality rate. The origin is generally odontogenic, in most cases, resulting from a dental abscess. A series of three cases developed after local application of herbal medicine in patients with no co-morbidities and with a history of a toothache in the lower quadrants for >2 weeks is presented. All patients were managed with antibiotics, extraction of offending tooth and serial wound debridement. Two patients recovered with a resultant skin defect on the neck and one died due to multiple organ failure. This case series demonstrated that early diagnosis, prompt surgical intervention and appropriate medical treatment are very important to increase patient survival. Late report to hospital because of financial constraints and over-reliance on herbal preparation could lead to the development of serious complication in patients with dental infections and could even lead to death of the patient.

Influence of energy drinks on enamel erosion: In vitro study using different assessment techniques.

BACKGROUND: Dental erosion has become a relevant public health problem in recent years and is related to the increase in the consumption of acidic beverages. Objective: The aim of the present study was to evaluate the erosive potential of energy drinks on dental enamel using an in vitro erosion model. MATERIAL AND METHODS: Thirty-eight blocks of human enamel were divided into four groups: G1- TNT Energy Drink®(n=8), G2- Red Bull® (n=10), G3- Monster Energy® (n=10), and G4- Coca-Cola® (n=10) (positive control). For the chemical analysis, the pH values, titratable acidity, and buffering capacity of the beverages were measured in triplicate. For the erosive test, the specimens were immersed in the beverages (5ml/block) for 30 minutes at room temperature with gentle shaking. Initial and final surface microhardness values were measured and the percentage of the loss of surface microhardness was calculated. Profilometry (surface loss and lesion depth) and mineral loss analysis (quantitative light-induced fluorescence) were performed. The data were analysed statistically using ANOVA followed by the Bonferroni correction, Pearson's correlation test, and multiple linear regression (p<0.05). RESULTS: The energy drinks had pH values ranging from 2.36 to 3.41. The lowest titratable acidity value was recorded for Monster Energy® and the highest was recorded for TNT Energy Drink®. All energy drinks had buffering capacity values higher than Coca-Cola®. Analysing the eroded enamel surface, the specimens submitted to TNT Energy Drink® had the greatest percentage loss of surface microhardness, surface loss, depth, and mineral loss, followed by those submitted to Red Bull® and Monster Energy®. Surface loss was the only predictor of mineral loss (p<0.001). CONCLUSIONS: Based on the study model employed, all the energy drinks examined were erosive to tooth enamel and TNT Energy Drink® had the worst behaviour. Key words:Energy drinks, tooth erosion, tooth demineralisation, hardness tests, quantitative light-induced fluorescence.

Implantable Medical Devices and Tissue Engineering: An Overview of Manufacturing Processes and the Use of Polymeric Matrices for Manufacturing and Coating their Surfaces.

Medical devices are important diagnosis and therapy tools for several diseases which include a wide range of products. Technological advances in this area have been proposed to reduce adverse complication incidences. New technologies and manufacturing processes, as well as the development of new materials or medical devices with modified surface and the use of biodegradable polymeric devices such as a substrate for cell culture in the field of tissue engineering, have attracted considerable attention in recent years by the scientific community intended to produce medical devices with superior properties and morphology. This review article focused on implantable devices, addresses the major advances in the biomedical field related to the devices manufacture processes such as 3D printing and hot melting extrusion, and the use of polymer matrices composed of copolymers, blends, nanocomposites or grafted with antiproliferative drugs for manufacturing and/or coating the devices surface.

Perfil de Egresos de Psicología de una Universidad del Interior Cearense / Perfil de egressos de psicologia de uma universidade do interior cearense / Profile of psychology graduates from a university in the countryside of the state of ceará

RESUMO O objetivo deste estudo foi analisar o perfil dos egressos do curso de Psicologia da Universidade Federal do Ceará, campus Sobral. Realizou-se um levantamento por meio de questionário autoaplicável (n = 157). A maioria dos participantes era do gênero feminino e tinha entre 20 e 30 anos. Os dados foram analisados com o programa IBM SPSS (versão 22). Foram produzidas estatísticas descritivas. Dentre os achados, viu-se que a maioria dos egressos nascera e residia na macrorregião de Sobral/Ibiapaba. Grande parte dos egressos trabalhava como psicólogo e a clínica foi a área de atuação mais citada. A principal dificuldade para a inserção no mercado de trabalho foi a reduzida experiência profissional. Depreende-se que a interiorização das universidades está relacionada à inclusão social ao possibilitar o acesso à educação e a fixação de profissionais no interior dos estados.

RESUMEN El propósito de la presente investigación fue examinar el perfil de los egresados de la carrera de Psicología en la Universidad Federal de Ceará, ubicada en el campus de Sobral. Para ello, se efectuó una recolección de datos mediante un cuestionario autoadministrado, el cual fue completado por un total de 157 participantes. La mayoría de estos eran mujeres, con edades comprendidas entre los 20 y 30 años. El análisis de los datos recabados se llevó a cabo utilizando el software IBM SPSS, versión 22, generando estadísticas descriptivas. Entre los hallazgos, la mayoría de los egresados son originarios y residentes de la macrorregión de Sobral/Ibiapaba. Se observó que un número considerable de los graduados se desempeña profesionalmente como psicólogos, siendo la práctica clínica el ámbito más frecuentemente señalado de actuación. Uno de los principales obstáculos identificados para la inserción en el mercado laboral fue la limitada experiencia profesional de los egresados. A partir de estos resultados, se infiere que la descentralización de las universidades cumple un papel fundamental en la inclusión social, al facilitar el acceso a la educación superior y promover la retención de profesionales en las áreas más alejadas de los centros urbanos.

ABSTRACT The purpose of this study was to examine the demographic and professional characteristics of Psychology graduates from the Federal University of Ceará's Sobral campus. Conducted via a self-administered questionnaire with 157 respondents, the survey found that a predominant number of participants were female, aged 20 to 30 years. Data analysis was performed using IBM SPSS software (version 22), generating descriptive statistics. Results indicated that most graduates originated from and resided within the Sobral/Ibiapaba macro-region, with a significant number employed as psychologists, particularly in clinical practice. The primary barrier to job market entry identified was limited professional experience. This study suggests that the decentralization of higher education contributes to social inclusion, promoting both access to education and the retention of professionals in less urbanized areas.

Is Inspiratory Muscle Weakness a Determinant of Endurance Exercise Tolerance During NIV-Supported Exercise in Patients With COPD?

PURPOSE: Previous research has reported that inspiratory muscle weakness is critical to decreased exercise tolerance and exercise tolerance improves with 10 cmH2O pressure support ventilation in patients with chronic obstructive pulmonary disease (COPD). The purpose of this study was to evaluate the effects of proportional assist ventilation (PAV) and continuous positive airway pressure (CPAP) compared with sham on exercise tolerance in patients with and without inspiratory muscle weakness. METHODS: In a prospective design, 12 of 54 patients were eligible after clinical and comprehensive lung function evaluation, including maximum inspiratory pressure (MIP) measurement. Using baseline measures, participants were divided into 2 age-matched groups that differed in regard to MIP (Group 1, MIP <60 cmH2O, and Group 2, MIP ≥60 cmH2O). Each participant performed 3 constant work rate tests with noninvasive support (PAV, CPAP, sham) in random order on different days at 80% of maximal incremental power. RESULTS: During the endurance tests, heart rate, peripheral oxygen saturation (SpO2), dyspnea perception scale, and exercise tolerance were measured. There were no significant differences between groups for heart rate, SpO2, dyspnea perception, or exercise tolerance during PAV, CPAP, or sham-supported exercise (P > .05 for all). CONCLUSIONS: In this small representative group of patients with COPD, inspiratory muscle weakness was not a determining factor of performance during CPAP or PAV-supported aerobic exercise.

Xantelasma palpebral: tratamento cirúrgico como primeira escolha / Eyelid Xanthelasma: surgical treatment as the first choice

Introdução: O xantelasma palpebral é a forma mais comum de xantoma cutâneo, caracterizado por placas amareladas localizadas na pele das pálpebras. Apesar de ser uma condição benigna e não cursar com limitação funcional, é uma importante queixa estética que tem impacto na vida social e emocional do portador. Existem opções terapêuticas clínicas, mas a abordagem mais difundida é a cirúrgica com excisão das lesões, procedimento simples, com poucas complicações e menores taxas de recidivas locais. O objetivo deste estudo é descrever o tratamento cirúrgico do xantelasma palpebral, avaliar a satisfação dos pacientes no pós-operatório e as taxas de recidivas pós-cirúrgicas. Métodos: Trata-se de um estudo retrospectivo realizado com uma amostra de 25 pacientes submetidos a tratamento cirúrgico de xantelasmas palpebrais. O acompanhamento pós-operatório foi realizado em intervalos de 7 dias, 30 dias, 90 dias e 12 meses com entrevista, exame físico e aplicação de questionário que contemplaram identificação de recidivas locais, complicações pós-operatórias e satisfação com o resultado estético. Resultados: Quatro pacientes evoluíram com recidiva local e apenas dois pacientes manifestaram insatisfação com o resultado estético após o desfecho final. Em nenhum paciente submetido a ressecção cirúrgica das lesões associadas à autoenxertia foi observada recorrência ou insatisfação com o resultado estético. Conclusões: O tratamento cirúrgico como primeira opção na abordagem terapêutica dos xantelasmas palpebrais deve ser considerado, visto o impacto estético e psicológico de tal afecção. É uma técnica simples, de fácil aplicação e reprodutibilidade, eficaz, segura, com relevantes taxas de satisfação e baixa ocorrência de recidivas.

Introduction: Eyelid xanthelasma is the most common form of cutaneous xanthoma, characterized by yellowish patches on the eyelid's skin. Despite being a benign condition and not presenting with functional limitations, it is an important aesthetic complaint that impacts the patient's social and emotional life. There are clinical therapeutic options, but the most widespread approach is the surgical approach with excision of the lesions, a simple procedure with few complications and lower local recurrence rates. This study aims to describe the surgical treatment of palpebral xanthelasma, to assess postoperative patient satisfaction and post-surgical recurrence rates. Methods: This is a retrospective study with a sample of 25 patients undergoing surgical treatment of eyelid xanthelasmas. Postoperative follow-up was performed at intervals of 7 days, 30 days, 90 days and 12 months with an interview, physical examination and application of a questionnaire that included the identification of local recurrences, postoperative complications and satisfaction with the aesthetic result. Results: Four patients evolved with local recurrence, and only two expressed dissatisfaction with the aesthetic result after the outcome. No patient who underwent surgical resection of lesions associated with autograft recurrence or dissatisfaction with the aesthetic result was observed. Conclusions: Surgical treatment as the first option in the therapeutic approach of eyelid xanthelasmas should be considered, given the aesthetic and psychological impact of such a condition. It is a simple technique, easy to apply and reproducible, effective, and safe, with relevant satisfaction rates and low recurrences.

Lung function and left ventricular hypertrophy in morbidly obese candidates for bariatric surgery.

OBJECTIVE: To look for correlations between lung function and cardiac dimension variables in morbidly obese patients, in order to test the hypothesis that the relative size of the small airways is independently correlated with left ventricular hypertrophy. METHODS: This was a retrospective study involving 192 medical records containing a clinical protocol employed in candidates for bariatric surgery between January of 2006 and December of 2010. RESULTS: Of the 192 patients evaluated, 39 (10 males and 29 females) met the inclusion criteria. The mean BMI of the patients was 49.2 ± 7.6 kg/m2, and the mean age was 35.5 ± 7.7 years. The FEF25-75/FVC, % correlated significantly with left ventricular posterior wall thickness and relative left ventricular posterior wall thickness, those correlations remaining statistically significant (r = -0.355 and r = -0.349, respectively) after adjustment for weight, gender, and history of systemic arterial hypertension. Stepwise multivariate linear regression analysis showed that FVC and FEV1 were the major determinants of left ventricular mass (in grams or indexed to body surface area). CONCLUSIONS: A reduction in the relative size of the small airways appears to be independently correlated with obesity-related cardiac hypertrophy, regardless of factors affecting respiratory mechanics (BMI and weight), gender, or history of systemic arterial hypertension. However, FEV1 and FVC might be important predictors of left ventricular mass in morbidly obese individuals.

Pulmonary emphysema induced by methylphenidate: experimental study.

CONTEXT AND OBJECTIVE: Methylphenidate is the most widely used drug for treating attention deficit hyperactivity disorder. However, it has important side effects, such as abdominal pain, insomnia, anorexia and loss of appetite, and also some cases of early severe emphysema after drug abuse have been reported. Our aim was to investigate the development of pulmonary emphysema in rats that were subjected to different doses of methylphenidate. DESIGN AND SETTING: Experimental study carried out at the laboratory of a public university. METHODS: Eighteen male Wistar rats were divided into three groups: control (0.9% saline solution); MP 0.8 (methylphenidate, 0.8 mg/kg); MP 1.2 (methylphenidate, 1.2 mg/kg). After 90 days of daily gavage, the animals were sacrificed and lung tissue samples were prepared for analysis on the mean alveolar diameter (Lm). RESULTS: The Lm was greater in MP 0.8 (47.91 ± 3.13; P < 0.01) and MP 1.2 (46.36 ± 4.39; P < 0.05) than in the control group (40.00 ± 3.48). CONCLUSION: Methylphenidate caused an increase in the alveolar diameter of rats, which was compatible with human pulmonary emphysema.

Effects of a structured patient-centered discharge interview on patients' knowledge about their medications.

PURPOSE: Many recently hospitalized patients lack knowledge about important aspects of their medications. We evaluated whether a structured discharge interview could improve medication knowledge. METHODS: Patients discharged with at least one discharge medication were recruited from two general internal medicine services (one experimental and one control) of a teaching hospital. During a 3-month baseline period, usual care at discharge was provided in both services. During the ensuing 3-month period, observation was continued in the control service; residents in the experimental service implemented the intervention, which consisted of a structured patient-centered discharge interview during which a computer-generated individualized treatment card was discussed with and provided to patients. One week after discharge, patients' knowledge about their medications was assessed by telephone. RESULTS: We enrolled a total of 809 patients. After adjustment for patients' characteristics and for the effect of time, the intervention significantly increased the percentage of medications for which patients correctly knew the purposes (adjusted difference = 6%; 95% confidence interval [CI]: 3% to 8%; P <0.001), possible side effects (adjusted difference = 19%; 95% CI: 9% to 29%; P <0.001), and precautions to observe (adjusted difference = 9%; 95% CI: 2% to 19%; P <0.001). However, the number of medications that patients discontinued after discharge was not modified. Patients with a better knowledge of side effects of their active treatment were less likely to discontinue their medications, but there were no associations with other types of knowledge. CONCLUSION: A structured patient-centered discharge interview, performed by residents using a standardized treatment card, significantly increased patients' knowledge about their medications. Its effects on compliance require further study.

Oxandrolona no tratamento da lipodermatoesclerose: relato de caso / Oxandrolone for treatment of lipodermatosclerosis: case report

A lipodermatoesclerose é uma paniculite que se caracteriza por endurecimento e hiperpigmentação da pele envolvendo as panturrilhas, com a aparência de "garrafa de champanhe invertida". Muitas abordagens terapêuticas têm sido recomendadas, mas o uso de oxandrolona para essa finalidade foi pouco estudado até o momento. Relatamos um caso de lipodermatoesclerose aguda em uma mulher de 61 anos, com história prévia de tratamento cirúrgico para insuficiência venosa de membros inferiores. A paciente apresentava edema e lesões dolorosas e eritematosas com infiltração difusa, que acometiam principalmente a face posterior da panturrilha esquerda. Foi tratada inicialmente com estanozolol e pentoxifilina, com boa resposta. Devido à indisponibilidade do estanozolol, iniciou-se o uso de oxandrolona. Esse tratamento foi bem tolerado, resultando em redução significativa do edema, do eritema e da infiltração presentes nos membros inferiores, além de alívio da dor. A oxandrolona pode representar uma opção útil e segura no tratamento da lipodermatoesclerose aguda

Lipodermatosclerosis is a panniculitis characterized by hardening and hyperpigmentation of the skin involving the calves with an "inverted champagne bottle" appearance. Many therapeutic approaches have been recommended, but the use of oxandrolone for this purpose has been studied very little to date. We report a case of acute lipodermatosclerosis in a 61-year-old woman with a previous history of surgical treatment for venous insufficiency of the lower limbs. The patient presented with edema and painful, erythematous lesions with diffuse infiltration, mainly affecting the posterior aspect of the left calf. She was initially treated with stanozolol and pentoxifylline, with good response. Due to unavailability of stanozolol, she was put on oxandrolone. This treatment was well tolerated, reduced the intensity of edema, erythema, and infiltration in the lower limbs, effectively leading to pain relief. Oxandrolone may be a useful and safe treatment for patients with acute lipodermatosclerosis

Transtorno dismórfico corporal sob a perspectiva do cirurgião plástico / Body dysmorphic disorder from the perspective of the plastic surgeon

O transtorno dismórfico corporal é encontrado com uma certa frequência nos atendimentos relacionados à estética. Entretanto, permanece subdiagnosticado devido à dificuldade de diferenciar uma insatisfação pessoal natural com a imagem corporal de uma queixa patológica. Para os pacientes com TDC, o incômodo gerado pelo seu "defeito" costuma ser desproporcional ao que observamos no exame físico. Além disso, na tentativa de corrigir aquilo que não lhe agrada, ele se submete a diversos procedimentos cirúrgicos que, em grande parte das vezes, considerará insuficiente para a resolução do seu problema. Nesse sentido, buscamos, com este trabalho, ampliar as discussões já existentes na literatura especializada. Assim, assumindo a escassa bibliografia, tencionamos, além de construir discussões acerca dessa afecção, o que pode contribuir para a identificação dos traços desse transtorno, evitando, por conseguinte, a realização de procedimentos cirúrgicos desnecessários e nortear as ações do especialista no que diz respeito à possibilidade de uma disputa judicial.

Body dysmorphic disorder (BDD) is found with a certain frequency in aesthetic-related care. However, it is underdiagnosed due to the difficulty in differentiating a personal dissatisfaction with body image of a pathological complaint. For BDD patients, the discomfort generated by their "defect" is often disproportionate to that observed on physical examination. In addition, in an attempt to correct their "defect", the patients undergoes various surgical procedures, which are often considered insufficient by the patients to solve their problem. Hence, this study aimed to expand the already existing discussions in the specialized literature. Since there are only a few studies on the topic, we plan to discuss this condition so as to contribute towards identification of the characteristics of this disorder, thus, avoiding unnecessary surgical procedures and guiding the specialist's actions in case of a legal dispute.

Associação entre o estresse percebido dos pais e distúrbios do sono com o possível bruxismo do sono em crianças e adolescentes com transtorno do espectro autista: um estudo preliminar / Association between parents' perceived stress and sleep disturbances with possible sleep bruxism in children and adolescents with autism spectrum disorder: a preliminary study

O transtorno do espectro autista (TEA) é uma desordem do neurodesenvolvimento relacionado a problemas de interação social, dificuldades de comunicação, prática de comportamentos repetitivos e sensibilidade sensorial. Crianças e adolescentes com TEA podem apresentar maior ocorrência de problemas de saúde bucal, como o bruxismo do sono. Existem poucos estudos avaliando o bruxismo do sono nesses indivíduos, embora seja um problema significante nessa população. Assim, este estudo tem como objetivo investigar a associação do possível bruxismo do sono (PBS) em crianças/adolescentes com TEA com o estresse percebido dos pais/responsáveis e com distúrbios do sono da criança/adolescente. Foi realizado um estudo transversal com crianças/adolescentes com TEA, de 5 a 19 anos de idade, e seus pais/responsáveis na Fundação Centro Integrado de Apoio ao Portador de Deficiência (FUNAD) na Paraíba. Os pais/responsáveis responderam a um questionário sociodemográfico e de características da criança/adolescente, que coletou dados sobre escolaridade, grau de parentesco com a criança, renda familiar, número de filhos, idade e sexo da criança, nível funcional de autismo e uso de medicamento para o TEA. O PBS foi diagnosticado a partir do relato dos pais/responsáveis sobre a presença do comportamento de ranger/apertar os dentes nas crianças/adolescentes durante o sono. A Escala de Estresse Percebido (BPSS10) foi utilizada para avaliação do estresse dos pais/responsáveis. O seu escore total pode variar de 0 a 40 pontos, sendo que quanto maior o escore, maior o estresse percebido. Também foi empregado o Sleep Disturbance Scale for Children (SDSC), para investigar possíveis distúrbios do sono nas crianças/adolescentes, que possui 26 itens, com 5 opções de resposta, sendo que uma maior pontuação no questionário representa uma maior severidade clínica dos sintomas. O SDSC ainda classifica os distúrbios do sono em seis categorias: (1) distúrbios de iniciar e manter o sono; (2) distúrbios respiratórios do sono; (3) distúrbios do despertar; (4) distúrbios de transição sono-vigília; (5) distúrbios de sonolência excessiva e (6) hiperidrose do sono. Os dados obtidos foram analisados estatisticamente no programa Statistical Package for the Social Sciences (SPSS), versão 22.0. Foram realizadas análises descritiva, bivariada e Regressão de Poisson não ajustada e ajustada (RP, IC=95%; p<0,05). A amostra preliminar do presente estudo foi composta por 50 crianças/adolescentes com TEA, sendo 84% (n=42) do sexo masculino. O PBS em crianças e adolescentes com TEA foi relatado por 28% (n=14) dos pais/responsáveis. A média do escore total do estresse percebido dos pais/responsáveis foi de 20,38 (±8,535) e de 48,84 (±17,552) para distúrbios do sono da criança/adolescente. O modelo final ajustado da Regressão de Poisson revelou associação entre o PBS e os maiores escores na Escala de Estresse Percebido dos pais/responsáveis (RP: 1,05; IC95%: 1,01-1,09; p=0,013); e das categorias de distúrbios respiratórios do sono (RP: 1,14; IC95%: 1,05-1,24; p=0,002) e de hiperidrose do sono (RP: 1,15; IC95%: 1,01-1,31; p=0,039) do SDSC. A prevalência do PBS em crianças e adolescentes com TEA foi de 28% e apresentou associação com maiores níveis de estresse percebido dos pais/responsáveis, além das categorias de distúrbios respiratórios do sono e de hiperidrose do sono da criança/adolescente.

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder related to social interaction problems, communication difficulties, repetitive behavior and sensory sensitivity. Children and adolescents with ASD may have a higher occurrence of oral health problems, such as bruxism. There are few studies evaluating sleep bruxism in these individuals, although it is a significant problem in this population. Thus, this study aims to investigate the association between possible sleep bruxism (PSB) in children and adolescents with ASD with the parents/guardians' perceived stress and with children/adolescents' sleep disturbances. A cross-sectional study was carried out with children/adolescents with ASD, aged 5 to 19 years old, and their parents/guardians at Fundação Centro Integrado de Apoio ao Portador de Deficiência (FUNAD) in Paraíba. Parents/guardians answered a socio-demographic and child/adolescent's characteristics questionnaire, which collected data on schooling, degree of kinship with the child, family income, number of children, age and sex of the child, functional level of autism and use of medication for ASD. PSB was diagnosed based on parents/guardians' reports on the presence or absence of teeth grinding/clenching behavior in children/adolescents during sleep. The Perceived Stress Scale (BPSS-10) was used to assess the parents/guardians' stress. Its total score can vary from 0 to 40 points, and the higher the score, the greater the perceived stress. The Sleep Disturbance Scale for Children (SDSC) was used to investigate possible children/adolescents' sleep disturbances, which has 26 items, with 5 answer options, with a higher score on the questionnaire representing greater clinical severity of the symptoms. The SDSC further classifies sleep disturbances into six categories: (1) disorders of initiating and maintaining sleep; (2) sleep-disordered breathing; (3) disorders of arousal; (4) sleep-wake transition disorders; (5) disorders of excessive somnolence and (6) sleep hyperhidrosis. The data obtained were statistically analyzed using Statistical Package for the Social Sciences (SPSS), version 22.0. Descriptive, bivariate, and unadjusted and adjusted Poisson Regression analyzes were performed (PR, CI=95%; p<0.05). The preliminary sample of the present study was composed by 50 children/adolescents with ASD, 84% (n=42) male. PSB in children and adolescents with ASD was reported by 28% (n=14) of parents/guardians. The mean score of parents/guardians' perceived stress was 20.38 (±8.535) and 48.84 (±17.552) for children/adolescents' sleep disorders. The final adjusted Poisson Regression model revealed an association between PSB and higher scores on the Perceived Stress Scale by parents/guardians (PR: 1.05; 95%CI: 1.01-1.09; p=0.013); and the categories of sleep-disordered breathing (PR: 1.14; 95%CI: 1.05-1.24; p=0.002) and sleep hyperhydrosis (PR: 1.15; 95%CI: 1.01-1 .31; p=0.039) of the SDSC. The prevalence of PSB in children and adolescents with ASD was 28% and was associated with parents/guardians' higher levels of perceived stress, in addition to the categories of children/adolescents' sleep-disordered breathing and sleep hyperhydrosis.