Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva / Clinical manifestations after suppression of sedoanalgesia in adult patients in intensive care

Introducción: en la unidad de cuidados intensivos (UCI), las personas asistidas con patologías relevantes se encuentran bajo sedación, una vez que estas se encuentran bajo los principios de supresión de la sedación, es importante identificar cuáles son las manifestaciones que presentan, propias de las sedaciones. Objetivo: describir las manifestaciones clínicas del síndrome de supresión de la sedoanalgesia presentes en pacientes asistidos en un Hospital Público de la Ciudad de Corrientes de enero a diciembre del 2022. Metodología: estudio cuantitativo, descriptivo, transversal y observacional. La muestra incluyó pacientes adultos de UCI. El cálculo del tamaño muestral se realizó a través del método probabilístico aleatorio simple resultando de éste una muestra de 100 historias clínicas. Para la recolección de datos se utilizó la observación y como instrumento un formulario semiestructurado, de carácter anónimo. Cada formulario contenía datos específicos donde se categorizan las variables en estudio como ser edad, sexo, comorbilidades, tiempo de sedoanalgesia, tipo de sedación, sedoanalgesia utilizada, agitación, confusión, alucinación, diaforesis, taquicardia. Resultados: en cuanto a la edad se obtuvo un promedio de 49 años, el sexo predominante fue el masculino con 52%, en cuanto a las comorbilidades más frecuentes, el 20% presentó Insuficiencia Respiratoria Aguda y el 16% Insuficiencia renal. El motivo de ingreso a UCI en mayor medida con el 33% fue por dificultad respiratoria y Post Quirúrgicos complicados 32%. Los fármacos de mayor elección fueron midazolam 94%, seguido del fentanilo 80%. En cuanto al tiempo de sedación de los pacientes, se encontró una media de 1265 horas. Las manifestaciones clínicas que se observaron en la muestra en mayor medida corresponden a taquicardia 70%, agitación 52%, un 37% confusión e hipertensión y un 24% alucinación. Conclusión: las manifestaciones que se presentaron con mayor frecuencia fueron taquicardia, agitación, confusión, hipertensión y con menor frecuencia alucinación[AU]

Introduction: in the intensive care unit (ICU), people treated with relevant pathologies are under sedation. Once they are under the principles of sedation suppression, it is important to identify the manifestations they present, typical of sedations. Objective: To describe the clinical manifestations of sedation suppression syndrome present in patients treated at a Public Hospital in the City of Corrientes from January to December 2022. Methodology: quantitative, descriptive, cross-sectional and observational study. The sample included adult ICU patients. The calculation of the sample size was carried out through the simple random probabilistic method, resulting in a sample of 100 medical records. Manifestaciones clínicas post supresión de sedoanalgesia en pacientes adultos de una terapia intensiva. Observation was used to collect data and a semi-structured, anonymous form was used as an instrument. Each form contained specific data where the variables under study were categorized, such as age, sex, comorbidities, sedation time, type of sedation, sedation used, agitation, confusion, hallucination, diaphoresis, tachycardia. Results: regarding age, an average of 49 years was obtained, the predominant sex was male with 52%, regarding the most frequent comorbidities, 20% presented Acute Respiratory Failure and 16% Renal failure. The reason for admission to the ICU to a greater extent with 33% was due to respiratory difficulty and complicated Post-Surgeries 32%. The drugs of greatest choice were midazolam 94%, followed by fentanyl 80%. Regarding the sedation time of the patients, an average of 1265 hours was found. The clinical manifestations that were observed in the sample to a greater extent correspond to tachycardia 70%, agitation 52%, confusion and hypertension 37% and hallucination 24%. Conclusion: the manifestations that occurred most frequently were tachycardia, agitation, confusion, hypertension and, less frequently, hallucination[AU]

Introdução: na unidade de terapia intensiva (UTI), as pessoas tratadas com patologias relevantes estão sob sedação. Uma vez sob os princípios da supressão da sedação, é importante identificar as manifestações que apresentam, típicas das sedações. Objetivo: Descrever as manifestações clínicas da síndrome de supressão da sedação presentes em pacientes atendidos em um Hospital Público da Cidade de Corrientes no período de janeiro a dezembro de 2022. Metodologia: estudo quantitativo, descritivo, transversal e observacional. A amostra incluiu pacientes adultos internados em UTI. O cálculo do tamanho amostral foi realizado pelo método probabilístico aleatório simples, resultando em uma amostra de 100 prontuários. A observação foi utilizada para a coleta de dados e um formulário semiestruturado e anônimo foi utilizado como instrumento. Cada formulário continha dados específicos onde foram categorizadas as variáveis em estudo, como idade, sexo, comorbidades, tempo de sedação, tipo de sedação, sedação utilizada, agitação, confusão, alucinação, sudorese, taquicardia. Resultados: em relação à idade obteve-se uma média de 49 anos, o sexo predominante foi o masculino com 52%, quanto às comorbidades mais frequentes, 20% apresentavam Insuficiência Respiratória Aguda e 16% Insuficiência Renal. O motivo de internação na UTI em maior proporção com 33% foi por dificuldade respiratória e pós-cirúrgicos complicados 32%. Os medicamentos de maior escolha foram midazolam 94%, seguido de fentanil 80%. Quanto ao tempo de sedação dos pacientes, foi encontrada uma média de 1265 horas. As manifestações clínicas mais observadas na amostra correspondem a taquicardia 70%, agitação 52%, confusão e hipertensão 37% e alucinação 24%. Conclusão: as manifestações que ocorreram com maior frequência foram taquicardia, agitação, confusão, hipertensão e, menos frequentemente, alucinação[AU]

Epidemiología y clínica de los pacientes con lepra en un centro de referencia de Paraguay / Epidemiology and clinical features of patients with leprosy in a reference center in Paraguay

RESUMEN Introducción: lepra (enfermedad de Hansen) es una patología infecciosa desatendida que afecta piel y nervios periféricos, desencadenando neuropatías y complicaciones como deformidades y discapacidades. Objetivos: determinar características epidemiológicas y clínicas de pacientes con lepra en el Centro de Especialidades Dermatológicas del Ministerio de Salud Pública y Bienestar Social de Paraguay, de enero 2021 a diciembre 2022. Metodología: estudio descriptivo, observacional, retrospectivo, de corte transversal. La gestión y análisis de datos se realizó en planilla electrónica (Excel del programa Microsoft Office 365 versión 2405), luego se realizó estadística descriptiva. Resultados: se diagnosticaron 123 casos de lepra, 45 (36,58 %) eran mujeres y 78 (63,42 %) varones; las edades estaban entre 17 y 86 años, el rango más afectado fue de 41 a 50 años. Eran lepra multibacilar 112 casos (91,06%). El signo más frecuente fue la placa infiltrada, presentada en 88 casos (71,54%). 58 pacientes (47,15%) presentaron reacciones lepromatosas, siendo, 31 casos de tipo 1 (53,45 %). 34 casos (27,64%) presentaron discapacidad grado 1 y 10 casos (8,13%) discapacidad grado 2. Conclusión: el perfil del paciente con lepra fue del sexo masculino entre 41 a 50 años, siendo la mayoría casos multibacilares. Es fundamentales el diagnóstico precoz y el tratamiento adecuado para reducir la carga de la enfermedad y las discapacidades.

ABSTRACT Introduction: Leprosy (Hansen's disease) is a neglected infectious disease that affects skin and peripheral nerves, triggering neuropathies and complications such as deformities and disabilities. Objective: determine epidemiological and clinical characteristics of patients with Leprosy in the Dermatological Specialties Center of the Ministry of Public Health and Social Welfare of Paraguay, from January 2021 to December 2022. Methodology: descriptive, observational, retrospective, cross-sectional study. Data management and analysis was carried out in an electronic spreadsheet (Excel from Microsoft Office 365 version 2405), then descriptive statistics were performed. Results: 123 cases of leprosy were diagnosed, 45 (36.58 %) were women and 78 (63.42 %) were men; the ages were between 17 and 86 years, the most affected range was 41 to 50 years. 112 cases (91.06 %) were multibacillary leprosy. The most frequent sign was infiltrated plaque, present in 88 cases (71.54 %). 58 patients (47.15 %) presented lepromatous reactions, 31 cases of type 1 (53.45 %). 34 cases (27.64 %) presented grade 1 disability and 10 cases (8.13 %) grade 2 disability. Conclusion: The profile of the patient with leprosy was male between 41 and 50 years, the majority being multibacillary cases. Early diagnosis and adequate treatment are essential to reduce the burden of the disease and disabilities.

Transient synovitis of hip joint following COVID-19 infection in a child with Hodgkins lymphoma

Transient synovitis is a common cause of hip pain in children. COVID-19 pandemic affected pediatric cancer patients more often that general pediatric population. COVID-19 has been associated with various musculoskeletal symptoms including synovitis. Radiological assessment of these symptoms can contribute significantly in management of such patients. We report a case of transient synovitis of hip joint following COVID-19 infection in a 10-year-old boy with Hodgkins抯 lymphoma. He presented with fever and myalgia, found to be positive for COVID-19, managed conservatively. Two weeks later presented with right hip pain and limping. He was found to have restricted joint mobility and hip tenderness. Magnetic resonance imaging (MRI) pelvis was done which showed minimal right hip effusion and synovial thickening and enhancement. He was managed conservatively and recovered completely.

Percepção de cirurgiões-dentistas acerca de manifestações orais de doenças imunomediadas e autoimunes / Perception of dentists about oral manifestations of immune-mediated and autoimmune diseases / Percepción de los odontólogos sobre las manifestaciones bucales de las enfermedades inmunomediadas y autoinmunes

Objetivo: Avaliar o nível de conhecimento dos Cirurgiões-Dentistas sobre as manifestações orais de doenças autoimunes. Metodologia: Trata-se de um estudo analítico, observacional e transversal do tipo inquérito. O universo foi composto por Cirurgiões-Dentistas devidamente cadastrados nos Conselhos Regionais de Odontologia (CRO) do Brasil, atuantes tanto em instituições ou consultórios privados quanto em instituições públicas. A amostra foi constituída por conveniência e a participação dos Cirurgiões-Dentistas foi realizada através de formulários digitais que foram enviados aos e-mails e redes sociais dos profissionais. Ao todo 111 Cirurgiões-Dentistas participaram da pesquisa. Resultados: Do total de indivíduos que constituíram a amostra, 45,9% foi do gênero feminino e 54,1% do gênero masculino, com idades entre 22-46 anos, média de 29,57 ± 6,10. Quando avaliada a média percentual de acertos dos participantes da pesquisa, a amostra de Cirurgiões-Dentistas demonstrou um moderado conhecimento acerca das manifestações orais de doenças imunologicamente media[1]das e autoimunes (M=63,6%; DM= 23,4; DP= 29,1). Conclusão: Os Cirurgiões-Dentistas ainda demonstram uma carência considerável de conhecimento acerca de doenças imunomediadas e autoimunes, dificultando a realização de diagnósticos precoces e tratamentos adequados. A maioria dos Cirurgiões-Dentistas demonstra desconhecer completamente qual terapêutica deve ser adotada corretamente para cada caso... (AU)

Objective: To assess the level of knowledge of dentists about the oral manifestations of autoimmune diseases. Methodology: This is an analytical, observational and cross-sectional study of the survey type. The universe was composed of Dental Surgeons duly registered in the Regional Councils of Dentistry (CRO) in Brazil, working both in institutions or private offices and in public institutions. The sample was constituted for convenience and the participation of the Dental Surgeons was carried out through digital forms that were sent to the professionals' e-mails and social networks. A total of 111 Dental Surgeons participated in the survey. Results: Of the total number of individuals who constituted the sample, 45.9% were female and 54.1% were male, aged between 22-46 years, mean of 29.57 ± 6.10. When the average percentage of correct answers of the research participants was evaluated, the sample of Dental Surgeons demon[1]strated a moderate knowledge about the oral manifestations of immunologically mediated and autoimmune diseases (M=63.6%; DM= 23.4; SD= 29, 1). Conclusion: Dental surgeons still demonstrate a considerable lack of knowledge about immune-mediated and autoimmune diseases, making it difficult to carry out early diagnoses and adequate treatments. Most dentists are completely unaware of which therapy should be correctly adopted for each case... (AU)

Objetivo: Evaluar el nivel de conocimiento de los odontólogos sobre las manifestaciones bucales de las enfermedades autoinmunes. Metodología: Se trata de un estudio analítico, observacional y transversal del tipo encuesta. El universo estuvo compuesto por Cirujanos Dentistas debidamente registrados en los Consejos Regionales de Odontología (CRO) de Brasil, actuando tanto en instituciones o consultorios privados como en instituciones públicas. La muestra se constituyó por conveniencia y la participación de los Cirujanos Dentistas se realizó a través de formularios digitales que fueron enviados a los correos electrónicos y redes sociales de los profesionales. Un total de 111 Cirujanos Dentales participaron en la encuesta. Resultados: Del total de individuos que constituyeron la muestra, el 45,9% eran del sexo femenino y el 54,1% del sexo masculino, con edades entre 22-46 años, media de 29,57 ± 6,10. Cuando se evaluó el porcentaje promedio de respuestas correctas de los participantes de la investigación, la muestra de Cirujanos Dentistas demostró un conocimiento moderado sobre las manifestaciones orales de las enfermedades inmunológicas y autoinmunes (M=63,6%; DM= 23,4; DE= 29,1). Conclusión: Los cirujanos dentistas aún demuestran un desconocimiento considerable sobre las enfermedades inmunomediadas y autoinmunes, lo que dificulta la realización de diagnósticos tempranos y tratamientos adecuados. La mayoría de los odontólogos desconocen por completo qué terapia se debe adoptar correctamente para cada caso... (AU)

A puzzle unravelled: pancytopenia and hepatosplenomegaly in juvenile autoimmune hypothyroidism

Autoimmune thyroiditis is a common cause of hypothyroidism in adolescent females. While normocytic normochromic anemia is a recognized association with hypothyroidism, pancytopenia is seldom reported. This case report discusses a young adolescent girl with autoimmune hypothyroidism presenting with severe pancytopenia and hepatosplenomegaly. After extensive evaluation, hypoproliferative marrow with extramedullary hematopoiesis secondary to uncontrolled hypothyroidism was considered to be the most likely cause. Swift recovery following appropriate levothyroxine replacement further supports this hypothesis. Thus, hypothyroidism can be a potential cause of pancytopenia with hepatosplenomegaly. Early recognition and appropriate management can lead to prompt resolution and prevent unnecessary invasive procedures.

Cutaneous findings in neonates and their socio-demographic profile: a prospective observational study

Background: A wide range of disorders can manifest as skin lesions due to the great difficulty the skin encounters while transitioning from an aqueous to a dry environment in a neonate. Among the skin conditions commonly seen in neonates are temporary benign lesions, atopic dermatitis (and associated disorders), bullous dermatoses. Aim was to study the various patterns of skin lesions in neonates and to estimate the prevalence of physiological and pathological skin lesions.Methods: This prospective observational study was conducted in the department of pediatrics at Acharya Shri Chander College of Medical Sciences and Hospital (ASCOMS) a tertiary care hospital in Jammu. A total of 300 neonates (day 1 to day 28 of life) and having any skin lesions or manifestations born at the hospital or visiting out patient抯 department were included in the study. The data collected was compiled on excel sheet and was analyzed statistically by using statistical package for the social sciences (SPSS) software version 21.0.Results: It was found that the most of the skin manifestations were observed in neonates born to multiparous mothers at term gestation and having average weight. The male to female ratio was 1.3:1. The frequency of the cutaneous manifestations were seen more in neonates born via the caesarean section.Conclusions: It is concluded that the most common skin lesion was erythema toxicum followed by icterus neonatorum.

Pemphigus vulgaris versus Mucous Membrane Pemphigoid: Case Series

Pemphigus vulgaris (PV) and mucous membrane pemphigoid (MMP) are bullous autoimmune diseases that reach the oral mucosa and have common clinical features. The objective of the study was to present and compare the clinical manifestations of PV and MMP and the results of applied treatments. A case series of a stomatology service from 1985 to 2018. Data collection included epidemiological data, comorbidities, medications in use, duration of symptoms before the first visit, previous treatment, symptomatology, clinical description of lesions, presumptive diagnosis, histopathological description, extraoral manifestations, final diagnosis, treatment and follow-up. The medical records of 25 patients were analysed, 19 of whom were diagnosed with MMP and 6 with PV. The female gender was prevalent in MMP (84 %) and the male gender in PV (67 %). More than 60 % of patients complained of pain at their first visit. Patients with MMP took on average 6 months to seek professional help and patients with PV, about 2 months. Desquamative gingivitis was the most common lesion (63 %) in MMP and non-gingival ulcers (67 %) in PV. Minimal therapy was effective in all cases of MMP, and in PV one individual required minimal adjuvant therapy due to worsening of the case. Patients with PV have more intense signs and oral symptoms and may need more intensive treatment than patients with MMP. The use of topical and/or systemic corticosteroids was sufficient for most cases in both diseases.

Pénfigo vulgar (PV) y Penfigoide de la Membrana Mucosa (PMM) son enfermadades autoinmunes ampollosas que llegan a la mucosa oral y tienen características clínicas comunes. El objetivo de este estudio fue presentar y comparar las manifestaciones clínicas de PV y PMM y los resultados de los tratamientos aplicados. En el análisis se incluyó una serie de casos de un servicio de estomatología de 1985 a 2018. La recolección de información incluyó datos epidemiológicos, comorbilidades, medicamentos en uso, duración de los síntomas antes de la primera visita, tratamientos previos, sintomatología, descripción clínica de las lesiones, diagnóstico presuntivo, descripción histopatológica, manifestaciones extraorales, diagnóstico final, tratamiento y seguimiento. Se analizaron las historias clínicas de 25 pacientes, 19 de los cuales fueron diagnosticados de PMM y 6 de PV. El sexo feminino fue prevalente en PMM (84 %) y el sexo masculino en PV (67 %). Más del 60 % de los pacientes se quejaron de dolor durante la primera consulta. Los pacientes con PMM tardaron en promedio 6 meses en buscar ayuda profesional y los pacientes con PV, alrededor de 2 meses. La gingivitis descamativa fue la lesion más común (63 %) en PMM y las úlceras non gengivales (67 %) en PV. La terapia mínima fue efectiva en todos los casos de PMM, y en PV un individuo requirió terapia adyuvante mínima debido al empeoramiento del caso. Los pacientes con PV tienen signos y síntomas orales más intensos y pueden necesitar un tratamiento más intensivo que los pacientes con PMM. El uso de corticosteroides tópicos y/o sistémicos fue suficiente para la mayoría de los casos en ambas enfermedades.

Manifestaciones extraarticulares en pacientes con artritis reumatoide

Introducción : La artritis reumatoide (AR) es una enfermedad inflamatoria crónica, autoinmune, caracterizada por poliartritis crónica, aditiva, simétrica, que puede cursar con manifestaciones extraarticulares (MExA) asociadas a una mayor morbimortalidad. Objetivo: de describir las MExA más frecuentes en AR. Métodos: se realizó un estudio descriptivo, transversal y retrospectivo de revisión de historias clínicas de pacientes diagnosticados con AR, durante el periodo diciembre 2011-enero 2022. Resultados: Participaron 150 pacientes con AR, con una edad promedio de 53,7±12,5 años, el sexo predominante fue el femenino con 84,6%, el tiempo de evolución de la AR fue de 7,2±8,9 años; en cuanto a las características serológicas, 91,1% tenía Factor reumatoideo positivo y 76,9% tenía anticuerpos contra péptidos cíclicos citrulinados positivo. Tanto al ingreso, como en la última consulta los pacientes presentaron alguna manifestación extraarticular (MExA), 61,3% y 70%, respectivamente, siendo las más frecuentes la anemia de los trastornos crónicos (al ingreso 44,6% y en última consulta 50,6%), seguida de nódulos reumatoideos (al ingreso con 8% y en la última consulta 9,3%). Conclusiones: Las MExA se presentaron en 70% de los pacientes, siendo las más frecuentes la anemia y los nódulos reumatoideos. Estos datos muestras los cambios que han tenido la frecuencia de estas MExA en esta enfermedad a través del tiempo.

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory, autoimmune disease, characterized by chronic, additive, symmetrical polyarthritis, which can present with extra-articular manifestations (ExAM), associated with greater morbidity and mortality. Objective: to describe the most frequent ExAM in RA. Methods: a descriptive, cross-sectional and retrospective study was carried out to review the medical records of patients diagnosed with RA, during the period December 2011-January 2022. Results: 150 patients with RA participated, with an average age of 53.7±12.5 years, the predominant sex was female with 84.6%, the evolution time of RA was 7.2±8.9. years; Regarding serological characteristics, 91.1% had positive Rheumatoid Factor and 76.9% had positive antibodies against cyclic citrullinated peptides. Both upon admission and at the last consultation, patients presented some extra-articular manifestation (ExAM), 61.3% and 70%, respectively, with the most frequent being chronic anemia (at admission 44.6% and at last consultation 50.6%), followed by rheumatoid nodules (at admission with 8% and at the last consultation 9.3%). Conclusions: ExAM occurred in 70% of patients, the most frequent being anemia and rheumatoid nodules. These data show the changes in the frequency of ExAM in the disease over time.

Lupus de inicio tardío en un grupo de pacientes paraguayos

Introducción: Los pacientes con lupus eritematoso sistémico (LES) diagnosticados después de los 50 años presentan una enfermedad menos severa y un curso clínico más leve. El objetivo de este estudio es describir las características clínicas y de laboratorios del LES en pacientes de edad avanzada. Material y Método: Estudio observacional, descriptivo, de corte trasverso, retrospectivo, de pacientes con el diagnóstico de LES, de inicio posterior a los 50 años de edad, que consultaron en el Hospital Nacional, en el periodo comprendido entre diciembre de 2016 y mayo de 2024. Resultados: Se estudiaron 30 pacientes entre 51 y 87 años (edad media: 62,5 años ± 8,5), 16 mujeres (53,3%) y 14 varones 14 (46,6 %). El tiempo de enfermedad previo al diagnóstico fue de 59,4 ± 8.3 (50-80) días. La duración de la enfermedad fue en promedio 5 años ± 5,1 (1-26). Las principales manifestaciones clínicas fueron las artralgias 26 (86,6%), artritis 22 (72,3%), pérdida de peso 10 (33,3%) y fiebre prolongada (30%). Presentaron comorbilidades 19 pacientes (63,3 %), siendo la hipertensión arterial la principal. El anti-DNA fue positivo en 12 pacientes (42,8%), el anti-Ro en 5/25 pacientes (20%), el anti-Sm en 2/26 (7,9%). La eritrosedimentación en la primera hora fue ≥ 20 mm en 17/23 (73,9%). El 100% recibió tratamiento con hidroxicloroquina, mientras que recibieron corticoides 26 (86.6%) pacientes, micofenolato mofetil 7 (24,4%), ciclofosfamida 4 (13,3%). La mortalidad fue del 6,6 %. Conclusión: Los principales hallazgos fueron artralgias y artritis, siendo menos frecuentes los casos graves. La mayoría presentó comorbilidades, siendo la hipertensión arterial la más frecuente. La mortalidad fue del 6,6% de causa cardiovascular.

Introduction: Patients with systemic lupus erythematosus (SLE) diagnosed after the age of 50 have a less severe disease and a milder clinical course. The objective of this study is to describe the clinical and laboratory characteristics of SLE in elderly patients. Material and Method: Observational, descriptive, cross-sectional, retrospective study of patients with the diagnosis of SLE, with onset after 50 years of age, evaluated at the National Hospital, in the period between December 2016 and May of 2024. Results: 30 patients between 51 and 87 years old (mean age: 62.5 years ± 8.5) were studied, 16 women (53.3%) and 14 men (46.6%). The time to diagnosis was 59.4 ± 8.3 (50-80) days. The duration of the disease was on average 5 years ± 5.1 (1-26). The main clinical manifestations were arthralgia in 26 (86.6%), arthritis in 22 (72.3%), weight loss in 10 (33.3%) and prolonged fever (30%). Nineteen patients (63.3%) had comorbidities, the main one being high blood pressure. Anti-dsDNA was positive in 12 patients (42.8%), anti-Ro in 5/25 patients (20%), anti-Sm in 2/26 (7.9%). The erythrocyte sedimentation rate was ≥ 20 mm in 17/23 (73.9%). All patients were treatment with hydroxychloroquine, 26 (86.6%) patients received corticosteroids, 7 (24.4%) mycophenolate mofetil, 4 (13.3%) cyclophosphamide. Mortality was 6.6%. Conclusion: The main findings were arthralgia and arthritis, with severe cases being less frequent. The majority presented comorbidities, with high blood pressure being the most common. Mortality was 6.6% due to cardiovascular causes.

Myositis as a de-novo extraintestinal manifestation of ulcerative colitis in a pediatric patient developing post-colectomy: a case report

This report presents the case of a 13-year-old female with a history of ulcerative colitis who underwent ileostomy closure after total colectomy. Postoperatively, she developed right leg paresis and extensive swelling of the lower extremities. Imaging investigations revealed myositis with avascular necrosis in the distal femoral condyles. These findings were consistent with myositis as an extraintestinal complication of ulcerative colitis.

Modalidades de radioterapia empregadas para o câncer de cabeça e pescoço / Radiotherapy modalities used for head and neck cancer

O câncer de cabeça e pescoço (CCP) refere-se ao grupo de tumores que atingem a laringe, cavidade nasal, nasofaringe, orofaringe, cavidade oral e glândulas salivares. A radioterapia no paciente com CCP representa uma terapia para manutenção do órgão, através da destruição das células neoplásicas malignas. O objetivo do presente estudo foi identificar estratégias radioterápicas aplicadas ao paciente com CCP e seus respectivos efeitos colaterais em cavidade oral, além de investigar as principais modalidades utilizadas nos sistemas de saúde do Brasil. Tratou-se de uma revisão narrativa da literatura com busca ativa das bases eletrônicas PUBMED, LILACS e SCIELO. Após todas as etapas de refinamento, um total de 58 artigos foram incluídos na presente revisão. A radioterapia possui papel de destaque no tratamento do CCP. No entanto, por não ser um método terapêutico com alta especificidade, resulta em efeitos adversos ao tratamento como mucosite oral, trismo e disfunção salivar, que findam por reduzir a qualidade de vida do paciente. Dentre as principais técnicas radioterapêuticas utilizadas no Brasil, a IMRT e VMAT caracterizam-se como as formas mais avançadas da terapia em 3D, proporcionando doses equivalentes para cada área da lesão tumoral, poupando áreas teciduais circunvizinhas que não necessitam de irradiação. Além da toxicidade reduzida, uma maior sobrevida pode ser observada em pacientes tratados com essas técnicas. Um dos maiores desafios atuais na radioterapia contra o CCP é a proteção de tecidos saudáveis. Nesse sentido, a IMRT e VMAT apresentam superioridade em relação às demais técnicas.

Head and neck cancer (CCP) refers to the group of tumors that affect the larynx, nasal cavity, nasopharynx, oropharynx, oral cavity and salivary glands. Radiotherapy in patients with CCP represents a therapy for organ maintenance, through the destruction of malignant neoplastic cells. The aim of this study was to identify radiotherapy strategies applied to patients with CCP and their respective side effects in the oral cavity, and to investigate the main modalities used in health systems in Brazil. It was a narrative review of the literature with active search of electronic databases PUBMED, LILACS and SCIELO. After all stages of refinement, a total of 58 articles were included in this review. Radiotherapy has a prominent role in the treatment of CCP. However, because it is not a therapeutic method with high specificity, it results in adverse effects to treatment such as oral mucositis, trismus and salivary dysfunction, which end up reducing the quality of life of the patient. Among the main radiotherapeutic techniques used in Brazil, IMRT and VMAT are characterized as the most advanced forms of 3D therapy, providing equivalent doses for each area of the tumor sparing surrounding tissue areas that do not require irradiation. In addition to reduced toxicity, greater survival can be observed in patients treated with these techniques. One of the biggest current challenges in radiation therapy against CCP is the protection of healthy tissues. In this sense, the IMRT and VMAT present superiority in relation to the other techniques.

Avaliação laboratorial do sangue e da saliva de pacientes com doença renal crônica e manifestações orais: uma revisão sistemática / Laboratory evaluation of blood and saliva of patients with chronic kidney disease and oral manifestations: a systematic review

A cavidade oral é afetada pelo caráter multissistêmico das consequências da Doença Renal Crônica (DRC) e estima-se que cerca de 90% destes pacientes têm sintomas orais. Alterações laboratoriais sanguíneas e salivares são frequentemente observadas e por isso, investigações sobre correlações clínico-laboratoriais são fundamentais para o manejo e tratamento dos pacientes. Neste estudo foi realizada uma revisão sistemática para identificar e avaliar as principais alterações laboratoriais no sangue e na saliva de pacientes portadores de DRC que apresentam manifestações orais. A busca bibliográfica incluiu artigos das bases de dados eletrônicas PubMed, Scopus, Biblioteca Virtual em Saúde, Web of Science, Embase e literatura cinzenta, incluindo estudos caso-controle, transversais e de coorte. A análise do risco de viés seguiu a abordagem QUADAS-2. PROSPERO CRD42022250533 é o registro dessa revisão. As principais alterações laboratoriais encontradas foram o aumento das concentrações sanguíneas e salivares de ureia, creatinina, fosfato e diminuição das concentrações de cálcio e da taxa de fluxo salivar. As concentrações dessas substâncias no sangue e na saliva e a TGF estavam diretamente correlacionadas. Foi observada existência da correlação entre o aparecimento das manifestações orais e as alterações laboratoriais, principalmente xerostomia, disgeusia e hálito urêmico. Em conclusão, a literatura tem revelado que as principais alterações laboratoriais encontradas são aquelas descritas comumente na rotina laboratorial, que as concentrações dessas substâncias no sangue e na saliva estão diretamente correlacionadas com a TFG, e existe correlação entre o aparecimento das manifestações orais e as alterações laboratoriais. Grandes oportunidades estão abertas para a investigação sobre de novos marcadores.

The oral cavity is affected by the multisystemic nature of the consequences of Chronic Kidney Disease (CKD) and it is estimated that around 90% of these patients present oral symptoms. Blood and salivary laboratory changes are frequently observed and, therefore, investigations of clinical-laboratory correlations are essential for the management and treatment of these patients. This study was carried out as a systematic review to identify and evaluate the main laboratory changes in the blood and saliva of patients with CKD who present oral manifestations. The bibliographic search included articles from the electronic databases PubMed, Scopus, Virtual Health Library, Web of Science, Embase and gray literature, including case-control, cross-sectional and cohort studies. The risk of bias analysis advanced the QUADAS-2 approach. PROSPERO CRD42022250533 is the record of this review. The main laboratory changes found were an increase in blood and salivary concentrations of urea, creatinine, phosphate and a decrease in calcium concentrations and salivary flow. The concentrations of substances in blood and saliva and TGF were directly correlated. The existence of the manifestation was observed between the appearance of oral manifestations and laboratory changes, mainly xerostomia, dysgeusia and uremic breath. In conclusion, the literature revealed that the main laboratory changes found are those commonly described in laboratory routine, that the concentrations of these problems in blood and saliva are directly correlated with GFR, and there is a manifestation between the appearance of oral manifestations and laboratory changes. . Great opportunities are open for the investigation of new markers.

Alterações sistêmicas e bucais em pacientes usuários de cocaína: uma revisão integrativa da literatura / Cambios sistémicos y orales em pacientes consumidores de cocaína: una revisión bibliográfica integradora / Systemic and oral changes in cocaína-using patients: an integrative literature review

Introdução: A utilização de cocaína é bastante associada ao surgimento de algumas manifestações sistêmicas e também de algumas alterações orais. Objetivo: Identificaras alterações sistêmicas e bucais mais comuns a pacientes usuários de cocaína. Metodologia: Trata-se de uma revisão sistemática da literatura, considerando artigos com texto completo, com restrição de idioma em Português ou Inglês e que tenham sido publicados entre os anos de 2017 a 2022. Usou-se as bases de dados LiLaCS, MedLine e BBO, por via portal Biblioteca Virtual de Saúde, e SciELO. Os artigos excluídosf oram aqueles que não apresentaram relação explícita do uso de cocaína com alguma manifestação sistêmica e/ou bucal. Resultados: Após o processo de triagem,10 artigos foram salvos para serem analisados e 111 foram descartados por não atenderem aos critérios de inclusão. Dos 10 artigosselecionados,40% deles (n=4) trouxeram informações identificando possíveis riscos de desenvolvimento de doenças cardiovasculares sofridas pelos usuários de cocaína, 10%(n=1) identificou problemas cognitivos associados ao uso da cocaína,30% dos artigos (n=3) mostrou as alterações bucais associadas à utilização abusiva de cocaína. Conclusões: Houve a predominância de algumas manifestações sistêmicas e bucais nos indivíduos usuários de cocaína, como doenças cardiovasculares, xerostomia, perfurações no palato, etc. A partir disso, há algumas alterações sistêmicas e bucais provocadas por esse uso. Mediante o risco considerável, faz-se necessário que o Cirurgião-Dentista se atualize sobre essas alterações em pacientes usuários de cocaína visando promover um trabalho transdisciplinare multiprofissional para atender adequadamente às suas necessidades (AU).

Introduction: The use of cocaine is closely associated with the appearance of some systemic manifestations and also some oral alterations.Objective: To identify the most common systemic and oral alterations in cocaine-using patients.Methodology:This is a systematic review of the literature, considering full-text articles, with a language restriction of "Portuguese" or "English" and published between 2017 and 2022. We used the LiLaCS, MedLine and BBO databases, via the Virtual Health Library (VHL) portal, and SciELO.The articles excluded were those that did not explicitly relate cocaine use to some systemic and/or oral manifestation.Results: After the screening process, 10 articles were saved for analysis and 111 were discarded because they did not meet the inclusion criteria. Of the 10 articles selected, 40% (n=4) provided information identifying possible risks of developing cardiovascular diseases suffered by cocaine users, 10% (n=1)identified cognitive problems associated with cocaine use, 30% of the articles (n=3) showed oral alterations associated with cocaine abuse.Conclusions: There has been a predominance of some systemic and oral manifestations in cocaine users, such as cardiovascular diseases, xerostomia, perforations in the palate, etc. Based on this, there are some systemic and oral alterations caused by this use. Given the considerable risk, it is necessary for dentists to be up-to-date on these alterations in cocaine-using patients in order to promote transdisciplinary and multi-professional work to adequately meet their needs (AU).

Introducción: El consumo de cocaína está estrechamente asociado a la aparición de algunas manifestaciones sistémicas y también de algunas alteraciones orales. Objetivo:Identificar las alteraciones sistémicas y bucales más frecuentes en los consumidores de cocaína. Metodología: Se trata de una revisión sistemática de la literatura, considerando artículos a texto completo, con restricción de idioma en "portugués" o "inglés" y publicados entre 2017 y 2022. Se utilizaron las bases de datos LiLaCS, MedLine y BBO, a través del portal Biblioteca Virtual en Salud (BVS) y SciELO. Los artículos excluidos fueron aquellos que no mostraban una relación explícita entre el consumo de cocaína y alguna manifestación sistémica y/o oral. Resultados: Tras el proceso de cribado, se guardaron10 artículos para el análisis y se descartaron 111 por no cumplir los criterios de inclusión. De los 10 artículos seleccionados, el 40% (n=4) proporcionaba información que identificaba posibles riesgos de desarrollar enfermedades cardiovasculares sufridaspor consumidores de cocaína, el 10% (n=1) identificaba problemas cognitivos asociados al consumo de cocaína, el 30% de los artículos (n=3) mostraban alteraciones orales asociadas al abuso de cocaína.Conclusiones:Ha habido un predominio de algunas manifestaciones sistémicas y orales en los consumidores de cocaína, como enfermedades cardiovasculares, xerostomía, perforaciones en el paladar, etc. De acuerdo con esto, existen algunas alteraciones sistémicas y orales causadas por este uso. Dado el considerable riesgo, es necesario que los odontólogos estén al día sobre estas alteraciones en los pacientes consumidores de cocaína, con el fin de promover el trabajo transdisciplinar y multiprofesional para atender adecuadamente sus necesidades (AU).

O uso de drogas e seus efeitos na cavidade oral

Objetivos: Descrever as principais manifestações bucais associadas ao uso das drogas lícitas e ilícitas mais utilizadas atualmente, bem como os cuidados que devem ser tomados durante o atendimento odontológico desses pacientes. Revisão de literatura: Na revisão foi abordada a classificação das substâncias químicas, as principais manifestações orais e os cuidados que o cirurgião-dentista deve ter durante o atendimento odontológico. As substâncias descritas foram álcool, tabaco, benzodiazepínicos, maconha, anfetaminas e cocaína/crack. As complicações de saúde bucal associadas ao abuso de drogas podem resultar da exposição direta dos tecidos orais às drogas durante o fumo ou ingestão, da interação biológica das drogas com a fisiologia normal da cavidade oral e dos efeitos das drogas na função cerebral que resultam em um espectro de comportamentos de dependência, como comportamento de risco, falta de higiene e descuido. Considerações finais: O consumo de substâncias psicoativas, seja a curto ou longo prazo, pode desencadear consequências, tanto na saúde geral como na saúde bucal do usuário. Sob essa perspectiva, o cirurgião-dentista deve estar ciente das manifestações orais e sistêmicas causadas pelas substâncias psicoativas e estar capacitado para diagnosticar, tratar ou também encaminhar o usuário, se necessário, visando um cuidado integral e multiprofissional.

Objective: to describe the main oral manifestations associated with the use of the most commonly used licit and illicit drugs today, as well as the care that should be taken during the dental care of these patients. Literature review: The review covered the classification of chemical substances, the main oral manifestations and the care that dentist should take during dental care. The substances described were alcohol, tobacco, benzodiazepines, marijuana, amphetamines and cocaine/crack. Oral health complications associated with drug abuse can result from direct exposure of oral tissues to drugs during smoking or ingestion, from the biological interaction of drugs with the normal physiology of the oral cavity, and from the effects of drugs on brain function that result in a spectrum of addictive behaviors, such as risk behavior, poor hygiene and carelessness. Final considerations: The consumption of psychoactive substances, whether in the short or long term, can have consequences for both the general health and the oral health of the user. From this perspective, the dentist must be aware of the oral and systemic manifestations caused by psychoactive substances and be able to diagnose, treat or also refer the user, if necessary, aiming for comprehensive, multi-professional care.

Prevalência de anomalias dentárias e outros achados orais em radiografias panorâmicas de brasileiros com fissura labiopalatal: um estudo retrospectivo / Prevalence of dental anomalies and other oral findings on panoramic radiographs of Brazilian with cleft lip and palate: a retrospective study

Objetivo: avaliar a prevalência de anomalias dentárias (AD) e outros achados orais em radiografias panorâmicas de pacientes com fissuras labiopalatais (FLP) nascidos no Nordeste brasileiro. Métodos: a amostra foi composta por 69 pacientes com fissuras labiopalatais unilateral (FLPu) (n = 51) e bilateral (FLPb) (n = 18), não sindrômicos, de ambos os sexos, idade de 6 a 17 anos, nascidos no Nordeste brasileiro. Foram analisados prontuários e radiografias panorâmicas de pacientes atendidos de janeiro/2020 a julho/2022. Os dados categóricos foram expressos em forma de frequência absoluta e percentual e comparados por teste exato de Fisher ou qui-quadrado de Pearson (SPSS, p < 0,05). Resultados: entre os achados orais, destacaram-se as anomalias de número e as ausências dentárias por trauma, cárie ou doença periodontal. As AD foram identificadas em 34 pacientes (49,3%). As anomalias de número apresentaram maior prevalência, com diferença estatística significativa para pacientes FLPb do sexo masculino (p = 0,047). A agenesia foi a AD mais frequente (n = 24; 34,8%). As ausências dentárias por trauma, cárie ou doença periodontal foram observadas em 44 pacientes (n = 63,8%), com uma diferença estatística significativa entre os grupos FLPu e FLPb (p = 0,018). Conclusões: as AD e as ausências dentárias por trauma, cárie ou doença periodontal apresentaram uma alta prevalência entre pacientes brasileiros com FLP e devem ser consideradas durante o planejamento ortodôntico-cirúrgico desses indivíduos.

Aim: this study aimed to assess the prevalence of dental anomalies (DA) and other oral findings in panoramic radiographs of patients with cleft lip and palate (CLP) born in the Northeast region of Brazil. Methods: the sample consisted of 69 patients with unilateral cleft lip and palate (UCLP) (n = 51) and bilateral cleft lip and palate (BCLP) (n = 18), non-syndromic, of both genders, aged 6 to 17 years, born in the Brazilian Northeast. Patient records and panoramic radiographs from those treated between January 2020 and July 2022 were analyzed. Categorical data were expressed as absolute frequency and percentage and compared using Fisher's exact test or Pearson's chi-square test (SPSS, p < 0.05). Results: among oral findings, anomalies in number and tooth absences due to trauma, caries, or periodontal disease stood out. DAs were identified in 34 patients (49.3%). Anomalies in number showed higher prevalence, with a statistically significant difference for male BCLP patients (p = 0.047). Agenesis was the most frequent DA (n = 24; 34.8%). Tooth absences due to trauma, caries, or periodontal disease were observed in 44 patients (63.8%), with a statistically significant difference between the UCLP and BCLP groups (p = 0.018). Conclusions: DAs and tooth absences due to trauma, caries, or periodontal disease showed a high prevalence among Brazilian patients with CLP and should be considered during the orthodontic-surgical planning for these individuals.

An overview of attention-deficit hyperactivity disorder in the pediatrics

Attention-deficit hyperactivity disorder (ADHD), which is a disorder affecting children worldwide, has lasting effects on their behavior and cognitive functions. This review will explore the complexities of ADHD in children, including its classification, manifestations and management strategies. We will discuss the subtypes of ADHD and how they present challenges in various aspects of a child's life. From difficulties with attention to hyperactivity and impulsivity these subtypes have profiles that impact academic performance, social interactions and emotional regulation. The symptoms of ADHD intertwine inattentiveness, hyperactivity, impulsivity, emotional instability and academic struggles in patients. These symptoms significantly affect a child's functioning across areas such as schoolwork, social life and emotions. To effectively manage ADHD in children requires an approach that combines medication options with interventions, educational support systems tailored to individual needs and parental support programs that emphasize collaboration between healthcare professionals and families. This comprehensive approach seeks to address the requirements of children dealing with ADHD. Its goal is not to reduce symptoms but to improve their long-term outcomes and overall quality of life. By explaining the nature of ADHD in children, this analysis aims to provide an understanding of the disorder. It highlights the significance of customized interventions, early detection, and continuous support in order to enhance the well-being and developmental path of affected children.

Vital signs role and significance in detecting early cardiac events

Cardiovascular diseases continue to be a contributor to mortality highlighting the significance of intervention. Nurses are often the first healthcare professionals to assess patients and their ability to identify symptoms and deviations in signs is essential for early detection of cardiac distress. Many individuals encounter symptoms such as discomfort in the chest, trouble with breathing, irregularities, heartbeat and increased fatigue. These symptoms can be signs of events. Nurses’ attentiveness in monitoring these symptoms and vital signs enables response and lifesaving interventions. Furthermore, advancements in healthcare technology like automated monitoring systems and telehealth platforms enhance nurse’s ability to detect events by allowing real time data collection and remote monitoring. This review explores the role that nurses play in detecting events early on with a specific focus, on monitoring vital signs like blood pressure and heart rate. The comprehensive management of events encompasses accurate diagnosis, evidence-based treatment, patient education and modification of risk factors. The expertise and constant vigilance of nurses significantly contribute to improving care and enhancing patient outcomes. As healthcare technology continues to advance nurses role in detecting events becomes even more crucial solidifying their indispensable position, in promoting heart health.

Definition, epidemiology and characterization of sepsis

Sepsis is a condition that occurs when the body's response to infection becomes unbalanced and potentially life-threatening. In this study, there is a focus on understanding and addressing sepsis. This detailed review explores how sepsis is defined in its prevalence in populations and how it is present clinically. The development of sepsis involves a series of events triggered by infections resulting in inflammation and dysfunction in organs. The symptoms of sepsis can range from signs like fever and changes in state to more severe complications such as septic shock. Early recognition of these symptoms using criteria like Systemic inflammatory response syndrome (SIRS) is crucial for intervention, which can greatly impact patient outcomes. Various diagnostic markers, imaging techniques and a deeper understanding of the pathophysiology behind sepsis have contributed to identification and targeted treatment approaches. Managing sepsis involves a combination of therapy, support for blood circulation, respiratory interventions and careful use of agents that modulate the system. It's important to emphasize the efforts among healthcare professionals from disciplines when it comes to managing sepsis effectively. Providing follow up care is essential for survivors as they may experience long term consequences such as sepsis syndrome. Due to its impact on health ongoing research is necessary to explore therapeutic options and refine existing strategies for managing sepsis effectively. The field continues to evolve with advancements, in precision medicine host directed therapies and interdisciplinary collaboration playing roles. This review seeks to grasp the concept of sepsis, providing insights into its various aspects, including the difficulties, in diagnosis and the ever-evolving treatment strategies.

La piel como reflejo de trastornos hepáticos subyacentes / The skin as a reflection of underlying liver disorders

La piel es el órgano más grande y visible del cuerpo humano; en ella se pueden reflejar diversos hallazgos de enfermedades sistémicas, incluidas las hepatopatías crónicas y agudas, las cuales se asocian a múltiples lesiones dermatológicas como principal manifestación extrahepática. Las manifestaciones cutáneas son comunes pero inespecíficas y pueden encontrarse en diferentes enfermedades; por lo tanto, la piel funciona como una ventana a nuestra salud general, de ahí que el examen clínico de la piel, las uñas y el cabello pueda permitir el reconocimiento adecuado, el diagnóstico y tratamiento temprano de las enfermedades hepáticas y la mejoría de la calidad y esperanza de vida de los pacientes afectados.

La piel es el órgano más grande y visible del cuerpo humano; en ella se pueden reflejar diversos hallazgos de enfermedades sistémicas, incluidas las hepatopatías crónicas y agudas, las cuales se asocian a múltiples lesiones dermatológicas como principal manifestación extrahepática. Las manifestaciones cutáneas son comunes pero inespecíficas y pueden encontrarse en diferentes enfermedades; por lo tanto, la piel funciona como una ventana a nuestra salud general, de ahí que el examen clínico de la piel, las uñas y el cabello pueda permitir el reconocimiento adecuado, el diagnóstico y tratamiento temprano de las enfermedades hepáticas y la mejoría de la calidad y esperanza de vida de los pacientes afectados.

Manifestaciones cutáneas comunes de las principales enfermedades hepáticas / Common cutaneous manifestations of major liver diseases

Las enfermedades hepáticas presentan múltiples manifestaciones sistémicas, entre las cuales se destacan los hallazgos en piel, siendo los más comunes el prurito y la ictericia; así mismo, se pueden encontrar angiomas en araña, eritema palmar, xantomas, vasculitis y cambios en anexos. Este artículo tiene como objetivo describir los principales signos y síntomas cutáneos en las enfermedades hepáticas para brindar herramientas semiológicas al clínico en su práctica diaria

Liver disease present multiple systemic manifestations, among which skin findings stand out, being the most common pruritus and jaundice. Other findings can also be manifested like spider angiomas, palmar erythema, xanthomas, vasculitis and changes in skin appendages. The objective of this article is to describe the main skin signs and symptoms of liver diseases to provide semiological tools to the physician in his daily practice.