An introduction to male breast cancer for urologists: epidemiology, diagnosis, principles of treatment, and special situations

ABSTRACT Breast cancer (BC) is mainly considered a disease in women, but male BC (MaBC) accounts for approximately 1.0% of BC diagnoses and 0.5% of malignant neoplasms in the western population. The stigmatization of MaBC, the fact that men are less likely to undergo regular health screenings, and the limited knowledge of health professionals about MaBC contribute to men being diagnosed at more advanced stages. The aim of this article is to increase the visibility of MaBC among urologists, who have more contact with male patients. This review highlights key points about the disease, the risk factors associated with MaBC, and the options for treatment. Obesity and increased population longevity are among the important risk factors for MaBC, but published studies have identified family history as extremely relevant in these patients and associated with a high penetrance at any age. There is currently no screening for MaBC in the general population, but the possibility of screening in men at high risk for developing BC can be considered. The treatment of MaBC is multidisciplinary, and, because of its rarity, there are no robust clinical studies evaluating the role of systemic therapies in the management of both localized and metastatic disease. Therefore, in current clinical practice, treatment strategies for men with breast cancer are extrapolated from information arising from studies in female patients.

Uso do desenho-estória para apreensão de entendimentos e sentimentos de crianças institucionalizadas sobre agressão física / Uso de historietas para comprender las percepciones y los sentimientos de los menores hospitalizados por maltrato físico / Using comic strips to understand perceptions and feelings of children hospitalized due to child physical abuse

Introdução: A punição corporal de crianças é uma prática recorrente que prejudica o seu desenvolvimento físico e emocional. Objetivo: apreender entendimentos e sentimentos de um grupo de crianças sobre a agressão física praticada por pais ou responsáveis. Materiais e Métodos: estudo descritivo, de abordagem qualitativa e uso do desenho-estória para responder ao estímulo indutor: o que vem à sua cabeça quando você ouve falar: "bater em criança"? Resultados: emergiram sentimentos de amor e ódio, culpa, tristeza, ressentimentos, desejo de vingança, vergonha e o entendimento de agressão física como uma atitude negativa e prejudicial. Conclusão: as crianças demonstraram ansiedade, timidez, agressividade, introspecção e tendência ao isolamento social. Para elas, as punições físicas constituíram episódios negativos que poderiam levá-las à morte, sugerindo que fossem substituídas por diálogo ou castigo.

Introduction: Child physical abuse is a recurrent practice that harms the physical and emotional development of children. Objective: To understand the perceptions and feelings of a group of children who have been physically abused by their parents or caretakers. Materials and Methods: A descriptive qualitative study was conducted using comic strips to respond to the inductive stimulus of what comes to mind when children are mistreated. Results: Feelings of love and hate, guilt, sadness, resentment, desire for vengeance and shame were experienced, as well as the perception of physical abuse as a harmful attitude. Conclusions: Children exhibited anxiety, shyness, aggressiveness, introspection and a tendency to social isolation since child physical abuse represents a tragic episode that would ultimately lead them to death, which is why it is suggested to use dialogue or other methods of punishment instead of physical abuse.

Introducción: El maltrato físico infantil es una práctica recurrente que perjudica el desarrollo físico y emocional de los menores. Objetivo: Entender las percepciones y los sentimientos de un grupo de menores que han sido maltratados físicamente por sus padres o cuidadores. Materiales y métodos: Estudio descriptivo de tipo cualitativo que mediante historietas busca responder al estímulo inductivo de qué se le viene a la mente al escuchar que están maltratando a un niño. Resultados: Se produjeron sentimientos de amor y odio, culpa, tristeza, resentimientos, deseo de venganza y vergüenza, además de percibir el maltrato físico como una actitud negativa y dañina. Conclusiones: Los niños manifestaron ansiedad, timidez, agresividad, introspección y tendencia al aislamiento social, puesto que el maltrato físico se constituye un episodio negativo que los podría llevar a la muerte, por lo que se sugiere que este fuese sustituido por el diálogo u otros castigos.

Repercussões da COVID-19 no cotidiano da mulher: reflexões sob o olhar sociológico de Michel Maffesoli / Repercussions of covid-19 in women's daily life: reflections under michel maffesoli's sociological view

Objetivo: Refletir sobre as repercussões da pandemia do novo coronavírus na vida cotidiana da mulher. Método: Estudo teórico-reflexivo embasado em discussões vigentes sobre a pandemia em interface entre sustentabilidade e equidade de gênero, com análise fundamentada em noções e pressupostos da Sociologia Compreensiva e do Quotidiano por Michel Maffesoli. Resultados: Foram previstas repercussões econômicas, emocionais, na segurança e autonomia da mulher. Nas econômicas prevê-se crescimento do desemprego. As emocionais supõe-se que a mulher chegará à exaustão e atingirá seu limiar de tolerância expresso em incertezas, medo, angústia, raiva, preocupação, impotência e frustrações, atingindo com maior intensidade, as profissionais de enfermagem. As repercussões na segurança e autonomia se darão pela maior exposição à violência doméstica e ausência feminina nos processos decisórios sobre a doença. Conclusão: a trágica crise representa empecilho para a conquista da autonomia feminina e aponta para drásticas modificações na vida da mulher, cuja sobrevivência exigirá adaptações a uma nova rotina e incluirá mudanças de hábitos, esforço pessoal e solidariedade de amigos e instituições. Este material reúne informações relevantes que contribuem para a sensibilização e esclarecimento da sociedade sobre o quadro que se configura, compreendendo que modificações somente ocorrerão quando as atuais assimetrias entre homens e mulheres forem superadas. (AU)

Objective: to reflect about repercussions of the pandemic caused by the new coronavirus in the daily life of women. Method: theoretical-reflective study based on current discussions on the pandemic at the interface between sustainability and gender equity, with analysis based on notions and assumptions of Comprehensive Sociology and Daily Life by Michel Maffesoli. Results: economic, emotional, security and women's autonomy repercussions were predicted. About economics is expected to increase unemployment. The emotional ones assume that the woman will reach exhaustion and reach her tolerance threshold expressed in uncertainties, fear, anguish, anger, concern, impotence, and frustrations, reaching nursing professionals with greater intensity. The repercussions on security and autonomy will occur due to the greater exposure to domestic violence and the absence of women in decision-making processes about the disease. Conclusion: the tragic crisis represents an obstacle to the achievement of female autonomy and points to drastic changes in the life of women, whose survival will require adaptations to a new routine and will include changes in habits, personal effort and solidarity from friends and institutions. This material gathers relevant information that contributes to the awareness and clarification of society about the situation that is taking shape, understanding that changes will only occur when the current asymmetries between men and women are overcom. (AU)

Objetivo: reflexionar sobre las repercusiones de la pandemia causada por el nuevo coronavirus en la vida cotidiana de las mujeres. Método: estudio teórico-reflexivo basado en debates actuales sobre la pandemia en la interfaz entre sostenibilidad y equidad de género, con análisis basado en nociones y suposiciones de Sociología integral y vida cotidiana por Michel Maffesoli. Resultados: se predijeron repercusiones económicas, emocionales y de seguridad y autonomía de la mujer. En la economía, se espera que el desempleo crezca. En los aspetos emocionales suponen que la mujer alcanzará el agotamiento y alcanzará su limite de tolerancia expresado en incertidumbres, miedo, angustia, ira, preocupación, impotencia y frustraciones, llegando a profesionales de enfermería con mayor intensidad. Las repercusiones em la seguridad y la autonomía se producirán debido a la mayor exposición a la violencia doméstica y la ausencia de mujeres en los procesos de toma de decisiones sobre la enfermedad. Conclusión: la trágica crisis representa un obstáculo para el logro de la autonomía femenina y apunta a cambios drásticos en la vida de las mujeres, cuya supervivencia requerirá adaptaciones a una nueva rutina e incluirá cambios en los hábitos, el esfuerzo personal y la solidaridad de amigos e instituciones. Este material reúne información relevante que contribuye a la conciencia y la clarificación de la sociedad sobre la situación que está tomando forma, entendiendo que los cambios solo ocurrirán cuando se superen las asimetrías actuales entre hombr. (AU)

Performance comparison in the Wingate test between standing and seated positions in competitive cyclists

Abstract Aims: The current study aimed to compare the anaerobic power output through the Wingate test in different positions, i.e., standing and seated, and identify the relationship between power-output and body mass. Methods: Eleven male competitive cyclists (age: 30.3 ± 4.7 years; body mass: 73.7 ± 7.7 kg; body fat: 11.3 ± 4.2%) were submitted to two sessions of the Wingate test (WT) in different positions, on different days. Results: The peak power (W), average power (W), relative peak power (W·kg-1), relative average power (W·kg-1), average cadence (rpm), and average velocity (km·h-1) presented significant differences in the standing position compared with the seated position (p < 0.05), 1155 ± 130 vs. 1082 ± 182 (W), 875 ± 96 vs. 818 ± 116 (W), 15.9 ± 1 vs. 15.0 ± 2 (W kg-1), 12.1 ± 1 vs. 11.3 ± 1 (W kg-1), 117.5 ± 7 vs. 109.8 ± 10 (rpm), 37.0 ± 2 vs. 34.6 ± 3 (km·h-1), respectively. However, when controlled the body mass, the differences in variables power output ceased to exist (p > 0.05). The fatigue and peak heart rate (bpm) indices did not present significant differences between the tests (p > 0.05). Conclusions: Sprint performance was improved when the WT was performed in a standing position in competitive cyclists. The study also reports the important relationship between body mass and anaerobic production capacity in the WT, emphasizing that it is desirable an increase in lean body mass and a reduction in fat mass, similar in competitions. We suggest that, for anaerobic assessment in cyclists, the standing position should be used during the WT, to determine the maximum power-output capacity.

Comparação da qualidade de vida entre atletas e paratletas brasileiros de alto rendimento / Comparison of the quality of life among high performance Brazilian athletes and parathletes

O objetivo do estudo foi comparar as características antropométricas e produção de potência aeróbia (pico de velocidade no teste de Carminatti [PVT-CAR]) entre diferentes categorias e níveis maturacionais em atletas de futebol. Cinquenta e três atletas do sexo masculino participaram do estudo divididos entre as categorias sub-11 (n=17), sub-13 (n=16), sub-15 (n=11) e sub-17 (n=9), e realizaram duas visitas: a primeira consistiu em avaliações antropométricas com massa corporal, estatura e dobras cutâneas, e questionário do estado pubertário; e a segunda visita foi avaliada a produção de potência aeróbia realizada com um teste progressivo com 5 séries de corrida vai-e-vem de 12 segundos, com 6 segundos de repouso, até a exaustão voluntária. A distância inicial do teste foi de 15 metros, com aumentos de progressivos de 1 metro a cada série, a maior velocidade atingida no teste (km.h-1 ) foi determinada como máxima produção de potência aeróbia (PVT-CAR). Os resultados demonstraram que as variáveis idade, estatura, massa corporal e PVT-CAR se diferenciam entre as categorias, e estágios maturacionais (púberes e pós-púberes, comparado com pré-púberes) (p<0,05), quanto a gordura corporal, não houve diferença entre as categorias e estágios maturacionais, assim como FCMÁXT-CAR (p>0,05). Em conclusão, a idade cronológica e os estágios maturacionais exercem importante função em relação as variáveis antropométricas e potência aeróbia. Por fim, o PVT-CAR se apresenta como uma ferramenta útil para classificação de um grupo, visto que atletas maturados suportam maiores cargas de treino....(AU)

The aim study was compare anthropometric characteristics and power aerobic production (peak velocity in Carminatt's Test [PVT-CAR]) between differences categories and levels maturational in soccer athletes. Fifty-three male athletes divided between categories under-11 (n=17), under-13 (n=16),under-15 (n=11) and under-17 (n=9) and performed two visits; the first consisted in evaluation anthropometrics with body mass, height and skinfolds, and pubertal status questionnaire; the second visit was evaluated the aerobic power production realized as the progressive test with 5 series running shuttlerun in 12 seconds, with 6 second rest, until the voluntary exhaustion. The distance initial the test was of 15 meters, with progressives increases in 1 meters every series, the highest velocity reached in the test (km.h1) was determined as maximum yield of aerobic power (PVT-CAR). The results demostred that variables age,stature, body mass and PVT-CAR differentiate between categories, and maturational stages (pre-pubertal and pubertal, compared with post-pubertal) (P<0.05), how much the body fat, there was no differences between categories and levels maturational, as HRMÁX-TCAR (P>0.05). In conclusion, the chronological age and maturational stages exert important function on anthropometric variables and aerobic power. Finally,the PVT-CAR presents itself as an useful tool for classifying a group, since mature athletes support higher training loads...(AU)

Comparação das características antropométricas e da potência aeróbia de atletas de futebol em diferentes categorias e estágios maturacionais / Comparation of anthropometric characteristics and aerobic power of soccer athletes in different categories and maturational stages

O objetivo do estudo foi comparar as características antropométricas e produção de potência aeróbia (pico de velocidade no teste de Carminatti [PVT-CAR]) entre diferentes categorias e níveis maturacionais em atletas de futebol. Cinquenta e três atletas do sexo masculino participaram do estudo divididos entre as categorias sub-11 (n=17), sub-13 (n=16), sub-15 (n=11) e sub-17 (n=9), e realizaram duas visitas: a primeira consistiu em avaliações antropométricas com massa corporal, estatura e dobras cutâneas, e questionário do estado pubertário; e a segunda visita foi avaliada a produção de potência aeróbia realizada com um teste progressivo com 5 séries de corrida vai-e-vem de 12 segundos, com 6 segundos de repouso, até a exaustão voluntária. A distância inicial do teste foi de 15 metros, com aumentos de progressivos de 1 metro a cada série, a maior velocidade atingida no teste (km.h-1 ) foi determinada como máxima produção de potência aeróbia (PVT-CAR). Os resultados demonstraram que as variáveis idade, estatura, massa corporal e PVT-CAR se diferenciam entre as categorias, e estágios maturacionais (púberes e pós-púberes, comparado com pré-púberes) (p<0,05), quanto a gordura corporal, não houve diferença entre as categorias e estágios maturacionais, assim como FCMÁXT-CAR (p>0,05). Em conclusão, a idade cronológica e os estágios maturacionais exercem importante função em relação as variáveis antropométricas e potência aeróbia. Por fim, o PVT-CAR se apresenta como uma ferramenta útil para classificação de um grupo, visto que atletas maturados suportam maiores cargas de treino....(AU)

The aim study was compare anthropometric characteristics and power aerobic production (peak velocity in Carminatt's Test [PVT-CAR]) between differences categories and levels maturational in soccer athletes. Fifty-three male athletes divided between categories under-11 (n=17), under-13 (n=16), under-15 (n=11) and under-17 (n=9) and performed two visits; the first consisted in evaluation anthropometrics with body mass, height and skinfolds, and pubertal status questionnaire; the second visit was evaluated the aerobic power production realized as the progressive test with 5 series running shuttlerun in 12 seconds, with 6 second rest, until the voluntary exhaustion. The distance initial the test was of 15 meters, with progressives increases in 1 meters every series, the highest velocity reached in the test (km.h1) was determined as maximum yield of aerobic power (PVT-CAR). The results demostred that variables age, stature, body mass and PVT-CAR differentiate between categories, and maturational stages (pre-pubertal and pubertal, compared with post-pubertal) (P<0.05), how much the body fat, there was no differences between categories and levels maturational, as HRMÁX-TCAR (P>0.05). In conclusion, the chronological age and maturational stages exert important function on anthropometric variables and aerobic power. Finally, the PVT-CAR presents itself as an useful tool for classifying a group, since mature athletes support higher training loads....(AU)

Fatal necrotizing Candida esophagitis in a patient with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis

Esophageal infection by Candida spp. is a common opportunistic entity in immunocompromised hosts; however, systemic fungal dissemination due to perforation or transmural necrosis, also known as necrotizing Candida esophagitis (NCE), is rare. We report the case of a 61-year-old male patient with diagnosed ankylosing spondylitis, severe arteriosclerosis, and vasculitis under immunosuppressive therapy who presented NCE with fungal and bacterial septicemia diagnosed at autopsy. Necrotizing esophagitis is a rare manifestation of Candida infection, which may be a final complication in severely ill patients. Unfortunately, it may be underdiagnosed, and we call attention to this devastating complication in patients with leukocytoclastic cutaneous vasculitis and ankylosing spondylitis.

Comparison of maturation and physical performance in basketball athletes of different playing positions / Comparação da maturação e desempenho físico em atletas de basquetebol de diferentes posições de jogo

Abstract The aim of this study was to compare the characteristics of somatic maturation, anthropometric and physical performance (vertical jump and aerobic power) in young basketball players of different playing positions (under 13 years) and analyze these relationships using Peak Height Velocity (PHV) as a measure of somatic maturation. For this, 26 male athletes were evaluated. Anthropometric variables were: body mass, standing and sitting height, and length of lower limbs. Maturation was determined by age at PHV. Physical performance was determined by lower limb power (counter movement jump - CMJ) and aerobic power (Intermittent Recovery Test) tests. MANOVA reported significant differences (p<0.05) among playing positions regarding variables Maturity Offset, estimated PHV age, standing height, sitting height, estimated leg length, body mass and Yo-Yo IR1. In addition, it was identified that point guards reached estimated PHV at later age than their peers who act as small forwards and centers. Regarding CMJ, no significant differences were identified among playing positions, but in relation to aerobic power, point guards and small forwards presented higher performance. These findings confirm that maturation has great effect on growth and physical performance measures and the estimated PHV age is an applicable tool in young athletes, mainly aiding professionals in structuring the teaching-learning- training process in this age group.

Resumo O objetivo do presente estudo foi comparar as características de maturação somática, antropométricas e desempenho físico entre as posições de jogo em jogadores de Basquetebol sub-13 e analisar estas relações utilizando o Pico de Velocidade de Crescimento (PVC) como uma medida da maturação somática. Para tanto, 26 atletas do sexo masculino foram avaliados. As variáveis antropométricas foram: massa corporal, estatura em pé e sentado e comprimento de membros inferiores. A maturação foi determinada pela idade do PVC. O desempenho físico foi através dos testes de potência de membros inferiores (salto com contra movimento - CMJ) e potência aeróbia (Yo-Yo IR1). A MANOVA reportou diferenças significativas (p<0,05) entre as posições em quadra nas variáveis Maturity Offset, idade do PVC estimado, estatura, altura sentado, comprimento de pernas estimado (CPE), massa corporal e Yo-Yo IR1. Além disso, foi identificado que os armadores alcançaram o PVC estimado, em uma idade mais tarde que seus companheiros que atuam como alas e pivôs. Em relação ao CMJ não foram identificadas diferenças significativas entre as posições, já em relação a potência aeróbia, os armadores e alas apresentaram desempenho significativo superior quando comparados aos pivôs. Estes achados confirmam que a maturação tem um grande efeito nas medidas de crescimento e desempenho físico e a determinação da idade estimada do PVC apresenta-se como uma ferramenta aplicável em jovens atletas, principalmente no auxílio de profissionais na estruturação do processo de ensino-aprendizagem-treinamento nesta faixa etária.

Traumatic injury to the internal carotid artery by the hyoid bone: a rare cause of ischemic stroke

Central nervous system (CNS) ischemic events, besides being a common and devastating disease, are accompanied by severe disability and other morbidities. The cause of such events is not always that simple to diagnose, and among the young, a broad spectrum of possibilities should be considered. We present the case of a young man who presented two episodes of CNS ischemia with a 1 year gap between them, which occurred in the same situation while he was walking and carrying a heavy backpack. The second event first presented as a transient ischemic attack followed by a stroke the day after. The diagnostic work-up showed an indentation of the greater cornu of the hyoid bone over the internal carotid artery, which injured the media and intimal layers. At the arterial injury site, a micro thrombus was found, which explained the source of the embolic event to the CNS. The patient was operated on, and the procedure included the resection of the posterior horn of the hyoid bone, the resection of the injured segment of the internal carotid artery followed by carotid­carotid bypass with the great saphenous vein. The postoperative period and the recovery were uneventful as was the 5-month follow-up. We call attention to this unusual cause of stroke and present other cases reported in the literature.

Relative age effect, skeletal maturation and aerobic running performance in youth soccer players

To investigate the presence of a relative age effect (RAE) and the influence of birth quarters (BQ), semesters (S) as well as skeletal maturation on anthropometric characteristics and aerobic peak speed (PST-CAR) in youth male soccer players. Methods: One hundred players were recruited to participate in this study. Players were allocated into 4 BQ's and 2 S. Skeletal maturity status was assessed using the Fels method. Assessments for players included determination of body size and composition and PST-CAR. Results: Overall, more players were born in BQ1 (38 %) and S1 (75%). The likelihood of players born in BQ1 and BQ2 being selected was 3.61 to 4.96 times higher than players in BQ3 and BQ4. Players in BQ4 maturing earlier were biologically older than their peers in BQ1. The players in BQ3 and S2 displayed higher PST-CAR compared with players in BQ2 and S1, respectively. However, players of contrasting skeletal maturity status did not differ in aerobic performance. Conclusion: Our findings indicate that coaches and talent scouts are systematically retaining average and early maturing players born in S1 and excluding late maturing players born in BQ4. However, aerobic performance appeared to be dependent on the relative age, but independent of skeletal maturation during puberty.(AU)

Bone marrow necrosis and fat embolism syndrome: a dreadful complication of hemoglobin sickle cell disease

Sickle cell disease encompasses a wide range of genotypic presentation with particular clinical features. The entity affects millions of people, particularly those whose ancestors came from sub-Saharan Africa and other countries in the Western Hemisphere, Saudi Arabia, and India. Currently, the high frequency of S and C genes reflects natural selection through the protection of heterozygotes against severe malaria, the high frequency of consanguineous marriages, improvement of some public health policies and the nutritional standards in the poorer countries where newborns are now living long enough to present for diagnosis and management. Although there is a high burden of the disease, in many countries, the new-born sickle cell screening test is being performed and is rendering an early diagnosis; however, it is still difficult for sickle cell patients to find proper treatment and adequate follow-up. Moreover, in many countries, patients are neither aware of their diagnosis nor the care they should receive to prevent complications; also, they do not receive adequate genetic counseling. Hemoglobin SC (HbSC) disease is the most frequent double sickle cell heterozygosis found in Brazil. The clinical course tends to be more benign with fewer hospitalizations compared with double homozygotic SS patients. However, HbSC patients may present severe complications with a fatal outcome. We report the case of a 36-year-old man who presented to the emergency care facility with symptoms consistent with the diagnosis of sickling crisis. The outcome was unfavorable and death occurred just hours after admission. The autopsy revealed a generalized vaso-occlusive crisis by sickled red cells, bone marrow necrosis, and fat embolism syndrome.

Sarcoma de Kaposi em Paciente Jovem Imunocompetente: uma Quinta Variante Epidemiológica? ­ Relato de Caso / Kaposi's Sarcoma in Young Immunocompetent Patient: a Fifth Epidemiological Variant? ­ Case Report / Sarcoma de Kaposi em Paciente Joven Inmunocompetente: ¿una Quinta Variante Epidemiológica? ­ Informe de Caso

Introdução: O sarcoma de Kaposi apresenta, classicamente, quatro tipos de variantes: clássico, endêmico, associado à imunossupressão (ou iatrogênico) e epidêmico (ou relacionado à Aids). Todos esses subtipos estão relacionados ao herpes-vírus humano 8. Uma quinta variante clínico-epidemiológica vem sendo proposta na literatura, que inclui uma apresentação visceral da doença no grupo de homens que fazem sexo com homens sem fatores de imunossupressão identificados. Relato de caso: Descreve-se o caso de um paciente masculino de 24 anos de idade, de orientação homossexual, sem fatores de imunossupressão, com apresentação linfonodal de sarcoma de Kaposi, e sem outros fatores que o incluam dentro das classificações da doença atualmente conhecidas. O paciente recebeu tratamento quimioterápico com paclitaxel, atingindo resposta completa e mantida até o momento, 42 meses após o término do tratamento. Conclusão: Esse caso reforça que a patogênese do sarcoma de Kaposi ainda é pouco clara, e que provavelmente múltiplos fatores, tanto do vírus como do hospedeiro, interajam entre si para desencadear a carcinogênese. É possível que o hábito sexual não encerre relação com essa patogênese, comportando-se apenas como fator confundidor. O paciente apresentou toxicidade mínima durante o tratamento com paclitaxel e atingiu resposta completa e mantida.

Introduction: Kaposi sarcoma classically presents four types of variants: classic, endemic, immunosuppression-associated (or iatrogenic) and epidemic (or AIDS-associated). All subtypes are invariably linked to human herpesvirus-8. A fifth clinical-epidemiological variant has been proposed in the literature, which includes a visceral presentation of the disease in the group of men who have sex with men without detected immunosuppressive factors. Case Report: We report the case of a 24-year-old male patient with a homosexual orientation without immunosuppressive factors, diagnosed with KS, with lymph node involvement, and without other disease characteristics that could include him within the currently known four types of Kaposi sarcoma classification. The patient received chemotherapy with paclitaxel, evolving with complete and sustained reponse until now, 42 months after the ending of treatment. Conclusion: This case reinforces that the pathogenesis of KS is still unclear, and that probably multiple factors, both virus and host, interact with each other to trigger carcinogenesis. It is possible that the sexual habit does not influence this pathogenesis, behaving only as a confounding factor. The patient had minimal toxicity during treatment with paclitaxel and achieved a complete and sustained response.

Introducción: El sarcoma de Kaposi presenta, clásicamente, cuatro tipos de variantes: clásico, endémico, asociado a inmunosupresión (o iatrogénico) y epidémico (o relacionado a SIDA). Todos estos subtipos están relacionados con el virus del herpes humano tipo 8 (HHV-8). Una quinta variante clínica-epidemiológica está en estudio, incluye una presentación visceral de la enfermedad en un grupo de hombres que tienen sexo con hombres sin factores de inmunosupresión de causa detectada. Informe de Caso: Se desarrolló un estudio sobre un paciente masculino de 24 años de edad, de orientación homosexual, sin factores de inmunosupresión, presentando diagnóstico de sarcoma de Kaposi con característica linfonodal de la enfermedad, y sin otros factores que incluyan dentro de las clasificaciones de sarcoma de Kaposi actualmente conocidas. El paciente recibió tratamiento quimioterápico con paclitaxel, alcanzando respuesta completa y sostenida hasta el momento, 42 meses después del término del tratamiento. Conclusión: Este caso refuerza que la patogénesis del sarcoma de Kaposi es poco clara, y que probablemente múltiples factores, tanto del virus y del hospedador, interactúan entre sí para desencadenar La carcinogénesis. Es posible que el hábito sexual no encierre relación con esa patogénesis, comportándose apenas como factor confundidor. El paciente presentó toxicidad mínima durante el tratamiento y alcanzó una respuesta completa y sostenida hasta el momento, pudiendo, el paclitaxel, ser considerado una opción sólida para el tratamiento del sarcoma de Kaposi en ese grupo de pacientes con esa variante de presentación.

Cambios en la presentación clínica de la influenza A H1N1pdm09 después de la pandemia / Changes in the clinical presentation of Influenza A H1N1pdm09 after the pandemic

Background: After the 2009 influenza pandemic the H1N1pdm09 strain circulate seasonally. In 2015, Puerto Montt Hospital in Chile faced a simultaneous outbreak of both seasonal H3N2 and H1N1pdm09 influenza A (IA). Aim: To evaluate the clinical differences between the two viral strains and recent changes in the behavior of H1N1pdm09 IA. Material and Methods: We set up a retrospective study including every adult hospitalized in Puerto Montt Hospital in 2015 due to IA, confirmed by reverse transcription polymerase chain reaction. We compared epidemiological data, clinical presentation, complications, and the outcome of patients with H1N1pdm09 versus those with seasonal influenza. In parallel, we compared 62 cases of thatH1N1 IA from 2015 with 100 cases who were hospitalized and analyzed in 2009. Results: Between July and October 2015, 119 adults with confirmed IA were hospitalized. From 2009 to 2015, the mean age of patients with IAH1N1pdm09 increased from 40.4 ± 17 to 58.8 ± 16 years (p < 0.01). Pneumonia as the cause of hospitalization decreased from 75 to 58% of patients, (p = 0.04). Likewise, the presence of comorbidities increased from 53 to 74%, (p < 0.01). Compared with seasonal H3N2, patients with IAH1N1pdm09 IA were more likely to require intensive care (p < 0.01) and mechanical ventilation (p < 0.01) and developed septic shock (p = 0.03). Their mortality was non-significantly higher (13 and 5% respectively). Conclusions: The clinical presentation of H1N1pdm09 IA has varied over time and now affects an older population, with a greater number of comorbidities. It also appears to be adopting the clinical behavior of a classic seasonal influenza virus.

Severe pulmonary hypertension due to combined pulmonary fibrosis and emphysema: another cause of death among smokers

In 2005, the combined pulmonary fibrosis and emphysema (CPFE) was first defined as a distinct entity, which comprised centrilobular or paraseptal emphysema in the upper pulmonary lobes, and fibrosis in the lower lobes accompanied by reduced diffused capacity of the lungs for carbon monoxide (DLCO). Recently, the fibrosis associated with the connective tissue disease was also included in the diagnosis of CPFE, although the exposure to tobacco, coal, welding, agrochemical compounds, and tire manufacturing are the most frequent causative agents. This entity characteristically presents reduced DLCO with preserved lung volumes and severe pulmonary hypertension, which is not observed in emphysema and fibrosis alone. We present the case of a 63-year-old woman with a history of heavy tobacco smoking abuse, who developed progressive dyspnea, severe pulmonary hypertension, and cor pulmonale over a 2-year period. She attended the emergency facility several times complaining of worsening dyspnea that was treated as decompensate chronic obstructive pulmonary disease (COPD). The imaging examination showed paraseptal emphysema in the upper pulmonary lobes and fibrosis in the middle and lower lobes. The echo Doppler cardiogram revealed the dilation of the right cardiac chambers and pulmonary hypertension, which was confirmed by pulmonary trunk artery pressure measurement by catheterization. During this period, she was progressively restricted to the minimal activities of daily life and dependent on caregivers. She was brought to the hospital neurologically obtunded, presenting anasarca, and respiratory failure, which led her to death. The autopsy showed signs of pulmonary hypertension and findings of fibrosis and emphysema in the histological examination of the lungs. The authors highlight the importance of the recognition of this entity in case of COPD associated with severe pulmonary hypertension of unknown cause.

Infobuttons en una historia clínica electrónica orientada a problemas / Infobuttons in a problem-oriented electronic health record / Infobuttons em um registro médico eletrônico orientado para o problema

Introdução, Na prática médica apresentam-se dúvidas e necessidade de informação, os Infobuttons são ferramentas que nos permitem resolver estas necessidades. Propõe-se descrever o desenvolvimento de Infobuttons na lista de problemas de um registro médico eletrônico. Materiais e Métodos, apresentam-se os componentes principais de infobuttons, completamente desenvolvidos in-House, definidos pelas especificações HL7-Infobutton Standard para especificar as pesquisas, automatiza-las e recuperar a informação contextual do paciente. Resultados, foi adicionado ícones Infobuttons no extremo direito dos términos para recuperar informação contextual e ser enviada solicitando resposta a UpToDate através dos dados Standard para serem recebidas como página web. Discussão-Conclusão, já foi descrita a importância de antecipar estas necessidades para resolvê-las, arquitetura foi desenvolvida em escala para um modelo integrado que pode incluir outros recursos. Outras organizações de saúde poderiam beneficiar-se baseando-se na aplicação de estratégias semelhantes.

Introducción, en la práctica médica se presentan dudas y necesidades de información, los Infobuttonsson herramientas que permiten resolver estas necesidades. Se propone describir el desarrollo e implementación de Infobuttons en la lista de problemas de la Historia Clínica Electrónica. Materiales y Métodos, se presentan los componentes principales de Infobuttons, completamente desarrollado in-House, definidos por las especificaciones HL7-Infobutton Standard para especificar las búsquedas, automatizarlas y recuperar la información contextual del paciente.Resultados, se agregaron íconos Infobuttons al extremo derecho de los términos para recuperar información contextualy ser enviada solicitando respuesta a UpToDate® a través de los datos estándar para ser recibidas como página web. Discusión-Conclusión, ya se describió la importancia de anticipar esas necesidades para resolverlas, la arquitectura se desarrolló pensando en escalar a un modelo integrado en el que se pueda incluir otros recursos. Otras organizaciones de salud podrían beneficiarse basándose en la aplicación de estrategias similares.

Introduction, in medical practice questions and information needs are presented, the Infobuttons are tools toanticipate these needs. It is proposed to describe the development and implementation of Infobuttons on the problems listin Electronic Health Record. Materials and Methods, the main components of Infobuttons are presented, fully developedin-house, defined by the HL7-infobutton Standard specifications in order to specify searches, automate it and retrievepatient´s contextual information. Results, were added Infobuttons icons on the right end of the each term to retrieve contextual information and be sent requesting a response to UpToDate® through standard data to be received as a webpage. Discussion-Conclusion, the importance to anticipate those needs and solve it, was described; the architecture was developed thinking to climb to an integrated model that can include other resources. Other health organizations could benefit based on the application of similar strategies.

Persistência dos sintomas de dengue em uma população de Uberaba, Minas Gerais, Brasil / Persistence of dengue symptoms in patients in Uberaba, Minas Gerais State, Brazil

O quadro clínico clássico de dengue caracteriza-se por duração máxima de 14 dias, embora freqüentemente pacientes refiram prolongamento dos sintomas. Este estudo avaliou a ocorrência de sinais e sintomas persistentes (> 14 dias) e seu impacto no cotidiano do indivíduo doente. Foram entrevistados 118 pacientes, cujos principais sintomas ao diagnóstico foram mialgia (98,3 por cento), febre (97,5 por cento) e fraqueza (95,8 por cento). A presença de pelo menos um sintoma persistente foi referida por 77 (65,2 por cento) entrevistados, sendo que 10 (8,5 por cento) relataram sua permanência de maneira intensa e por 30 dias ou mais. Os sintomas persistentes mais mencionados foram fraqueza (58 casos), hiporexia (49) e sonolência (40), ocorrendo mais no gênero feminino, com odds ratio: 5,4 (IC95 por cento: 2,3-12,3). Houve associação significativa entre a persistência dos sintomas e o relato de gastos adicionais (p = 0,02), e com o retorno às atividades habituais (p < 0,001). Assim, foi verificado que o dengue apresentou impacto na vida dos indivíduos, mesmo depois de 14 dias, sendo tal fato associado à presença de sintomas persistentes da doença.

The clinical picture of dengue is characterized by a maximum duration of 14 days despite frequent complaints of longer symptoms. This study evaluated the occurrence of persistent symptoms (> 14 days) and its impact on daily life. A hundred eighteen patients were interviewed, and the main symptoms at diagnosis were mialgia (98.3 percent), fever (97.5 percent) and weakness (95.8 percent). The presence of at least a persistent symptom was related by 77 (65.2 percent) individuals of wich 10 (8.5 percent) described it as intense and lasting for 30 days or more. The most persistent symptoms mentioned were weakness (58 cases), hiporexia (49) and sleepiness (40), occurring mostly in women, with odds ratio: 5.4 (IC95 percent: 2.3-12.3). A significant association between the persistence of the symptoms and the history of extra expenses (p = 0,02) was found, as well as a delay to return to normal activities (p < 0.001). Thus, it was verified that dengue presented a relevant impact on every day life, even after 14 days, a fact wich was associated with the presence of persistent symptoms of the illness.