Estatus taxonómico de Talides basistrigata Eaton, 1932 (Lepidoptera, Hesperiidae) y su reincorporación basados en una evaluación integrativa

Talides basistrigata Eaton, 1932, originalmente descrita de Perú, posteriormente fue transferida por Evans (1955) al género Hylephila Billberg, 1820, y considerada como una subespecie de H. phyleus (Drury, 1773), argumentando que basistrigata ocurre en ambientes más secos que los que habita phyleus. Actualmente se mantiene el rango taxonómico propuesto por Evans. El objetivo del presente trabajo es restituir el estatus taxonómico de especie válida para basistrigata con base en un análisis integrativo considerando aspectos morfológicos, ecológicos y genéticos. Se examinó las estructuras genitálicas en ejemplares de basistrigata y phyleus, se obtuvo secuencias del gen mitocondrial COI para ambas especies y se recopiló datos en campo para conocer su comportamiento de oviposición en los alrededores de Arequipa, suroeste de Perú. Como resultado del examen morfológico se halló diferencias notorias entre las estructuras genitálicas de ambas especies, principalmente en los procesos caudales de las valvas, la disposición de las pectinas y la forma del uncus en los machos. Con relación al análisis genético, se halló una distancia genética mayor a 3% entre ambas especies, apoyando así el estatus taxonómico de especie para basistrigata. Adicionalmente, desde una perspectiva ecológica, se registró que ambas especies utilizan distintos mecanismos de oviposición y diferentes plantas hospederas, exhibiendo además simpatría espacial y sincronía temporal en la vertiente occidental de los Andes en Perú. Se redescribe el macho y hembra adultos de basistrigata y se designa su lectotipo.

Talides basistrigata Eaton, 1932, originally described from Peru, was subsequently transferred to the genus Hylephila Billberg, 1820 by Evans (1955) and considered a subspecies of H. phyleus (Drury, 1773), arguing that basistrigata inhabits drier environments than phyleus. Currently, the taxonomic status proposed by Evans is retained. The aim of this study is to reinstate the taxonomic status of valid species for basistrigata based on an integrative analysis considering morphological, ecological, and genetic aspects. Genitalic structures were examined in specimens of both basistrigata and phyleus, mitochondrial COI gene sequences were obtained for both species, and field data were collected to understand their oviposition behaviour in the vicinity of Arequipa city, southwestern Peru. As a result of the morphological examination, notable differences were found between the male genitalia structures of both species, primarily in the caudal processes of the valvae, the arrangement of the pectines, and the shape of the uncus. Regarding the genetic analysis, a genetic distance of greater than 3% was observed between the two species, thus supporting the taxonomic status of species for basistrigata. Additionally, from an ecological perspective, it was recorded that both species employ distinct oviposition mechanisms and different host plants, exhibiting spatial sympatry and temporal synchrony on the western slope of the Andes in Peru. Male and female adults of basistrigata are redescribed, and a lectotype is designated.

Associação entre a função sexual, imagem corporal e autoimagem genital de idosas fisicamente ativas / Association between sexual function body image and genital self-image of old physically active

A sexualidade é uma necessidade básica que permanece com o envelhecimento e está relacionada com a função sexual bem como com as percepções de imagem corporal e genital. Este estudo tem como objetivo verificar a associação entre função sexual e imagem corporal e autoimagem genital de idosas fisicamente ativas. Estudo de natureza quantitativa explicativa e retrospectiva com 132 idosas de um núcleo de atividade física. Utilizou-se uma ficha de avaliação adaptada, Índice de Função Sexual Feminina (FSFI), Body Appreciation Scale (BAS) e o Female Genital Self-Image Scale (FGSIS). A amostra apresentou indicativos de disfunção sexual (FSFI=18,8±12,7) bem como uma boa imagem corporal (BAS=4,8±0,4) e autoimagem genital (FGSIS=25,4±3). A função sexual esteve correlacionada com a autoimagem genital (r=0,231, p=0,008), e com a imagem corporal (r=0,978, p=0,000) e entre a autoimagem genital e a imagem corporal (r=0,389, p=0,000). Ao separar os domínios da função sexual, todos apresentaram correlação com a imagem corporal. Com a autoimagem genital, apenas a satisfação não apresentou correlação (r=0,131 e p=0,132). É relevante investigar os aspectos relacionados a sexualidade dos idosos pois podem interferir na qualidade de vida e bem-estar físico, psicológico e social.(AU)

Sexuality is a basic need that remains with aging and is related to sexual function as well as perceptions of the body and genital image. This study aims to verify the association between sexual function and body image and genital self-image of physically active elderly women. Quantitative, explanatory, and retrospective study with 132 elderly women from a physical activity center. An adapted evalua- tion form, Female Sexual Function Index (FSFI), Body Appreciation Scale (BAS), and the Female Genital Self-Image Scale (FGSIS) were used. The sample showed signs of sexual dysfunction (FSFI = 18.8 ± 12.7) as well as a good body image (BAS = 4.8 ± 0.4) and genital self-image (FGSIS = 25.4 ± 3). Sexual function was correlated with genital self-image (r = 0.231, p = 0.008), and with body image (r = 0.978, p = 0.000) and between genital self-image and body image (r = 0.389, p = 0.000). When separating the domains of sexual function, all showed a correlation with body image. With genital self- image, satisfaction was not correlated (r = 0.131 and p = 0.132). It is relevant to investigate aspects related to the sexuality of the elderly as they can interfere with the quality of life and physical, psychological, and social well-being.(AU)

Fios de PDO, hidroxiapatita de cálcio e ácido l-polilático para flacidez vulvar - indicações, técnica e resultados / PDO threads, calcium hydroxyapatite and l-polylactic acid for vulvar flaccidity - indications, technique and results

Os grandes lábios tornam-se flácidos com o envelhecimento. Apesar de o preenchimento com ácido hialurônico proporcionar um rejuvenescimento significativo, ele também pode levar à formação de verdadeiros testículos vulvares se mal indicado, principalmente em vulvas excessivamente flácidas, que não suportam qualquer volumização adicional. Nesses casos de flacidez excessiva, acreditamos que os bioestimuladores de colágeno seriam o melhor tratamento inicial, pois sua injeção levaria à reposição de colágeno dérmico, com melhora da frouxidão, sem acréscimo expressivo de volume. Temos utilizado a hidroxiapatita de cálcio, o ácido l-polilático e os fios não espiculados de PDO, desde 2019, com bons resultados.

The labia majora become saggy with aging. Although filling with hyaluronic acid provides significant rejuvenation, it can also lead to the formation of true vulvar testicles if poorly indicated, especially in excessively flaccid vulvas, which do not support any further volumization. In these cases of excessive flaccidity, we believe that collagen biostimulators would be the best initial treatment, as their injection would lead to the replacement of dermal collagen and improvement in laxity, without a significant increase in volume. We have been using calcium hydroxyapatite, l-polylactic acid, and PDO threads since 2019, with good results.

Factores de riesgo asociados a defectos congénitos de genitales externos y gónadas masculinas

Introducción: Los defectos congénitos del tracto urogenital se encuentran entre las anomalías más encontradas en el feto o neonato, lo que da una idea de su extraordinaria importancia clínica, unido a las escasas investigaciones en la provincia Camagüey, sobre factores de riesgo asociados a los defectos congénitos de genitales externos y gónadas masculinas. Objetivo: Determinar los factores de riesgo asociados a defectos congénitos de genitales externos y gónadas masculinas. Métodos: Se realizó un estudio correlacional del tipo retrospectivo en el Hospital Pediátrico Eduardo Agramonte Piña en el periodo de enero de 2013 a diciembre de 2020. El universo se conformó por los 96 pacientes que fueron intervenidos quirúrgicamente por presentar defectos congénitos de los genitales externos y gónadas masculinas. Para determinar la asociación de los factores de riesgo con la aparición de defectos congénitos se empleó la prueba de independencia, en caso de p<0,05 se consideró asociación significativa. Para medir la magnitud de la asociación estadística entre las variables se utilizó el coeficiente Phi, se consideró mientras más fuerte a uno fuera su valor, más correlacionadas se encontraron las variables estudiadas. Resultados: La criptorquidia fue la forma clínica con mayor número de pacientes, seguida de la hipospadias y la hidrocele. La asociación entre los padres trabajadores agrícolas y la hipospadias y la criptorquidia con padres trabajadores industriales, resultaron significativas. El hecho que la madre fuera fumadora pasiva, constituyó una variable con asociación significativa, tanto para la aparición de hipospadias como de criptorquidia. El ser fumadora pasiva fue el factor de riesgo que tuvo mayor correlación con la aparición de los defectos congénitos. Conclusiones: Existieron factores de riesgo con asociación significativa a la aparición de defectos congénitos de genitales externos y gónadas masculinas.

Introduction: Congenital defects of the urogenital tract are among the anomalies most found in the fetus or neonate, which gives an idea of ​​their extraordinary clinical importance, together with the few investigations in the Camagüey province, on risk factors associated with congenital defects of external genitalia and male gonads. Objective: To determine the risk factors associated with congenital defects of the external genitalia and male gonads. Methods: A retrospective correlational study was carried out at the Eduardo Agramonte Piña Pediatric Hospital from January 2013 to December 2020. The universe was made up of the 96 patients who underwent surgery for presenting congenital defects of the external genitalia and male gonads. To determine the association of the risk factors with the appearance of congenital defects, the independence test was used; in case of p<0.05, a significant association was considered. To measure the magnitude of the statistical association between the variables, the Phi coefficient was used, it was considered that the stronger its value was, the more correlated the studied variables were found. Results: Cryptorchidism was the clinical form with the highest number of patients, followed by hypospadias and hydrocele. The association between farm worker parents and hypospadias and cryptorchidism with industrial worker parents was significant. The fact that the mother was a passive smoker was a variable with a significant association, both for the appearance of hypospadias and cryptorchidism. Being a passive smoker was the risk factor that had the highest correlation with the appearance of birth defects. Conclusions: There were risk factors with a significant association with the appearance of congenital defects of the external genitalia and male gonads.

Hipospadias: del diagnóstico ecográfico prenatal al manejo posnatal / Hypospadias: from prenatal ultrasound diagnosis to postnatal management

El hipospadias es la localización anormal del meato urinario y es la malformación de genitales externos más frecuentemente diagnosticada. El diagnóstico prenatal es posible mediante ecografía sistemática desde la semana 20 de gestación, siendo más fácil su diagnóstico en el tercer trimestre. Las formas leves suelen ser aisladas, familiares o asociadas a disfunción placentaria o restricción de crecimiento intrauterino, mientras que las formas más graves presentan hasta un 30% de asociación a defectos fetales, anomalías cromosómicas/genéticas o anomalías del desarrollo sexual. La tríada para el diagnóstico ecográfico prenatal consiste en curvatura ventral del pene, anomalía del prepucio dorsal y punta del pene roma. La valoración de la uretra durante la micción y el aspecto del chorro miccional son de gran utilidad para clasificar el defecto. Cuando se diagnostica hipospadias peneano o escrotal es aconsejable realizar una amniocentesis para estudio genético fetal y valorar otros signos de adecuada virilización, como el descenso testicular a partir de la semana 27. El seguimiento tras el parto debe ser multidisciplinario, incluyendo urólogo y endocrinólogo infantil. En hipospadias leves el pronóstico es bueno con reparación quirúrgica en el primer año de vida, pero las formas graves pueden presentar un reto mayor para su corrección funcional y estética.

Hypospadias refers to the abnormal location of the meatus; it is the most common genital malformation detected in the fetus and newborn. Prenatal diagnosis is feasible from 20 weeks onwards with routine ultrasound; however, it is easier to diagnose during the third trimester of pregnancy. Mild defects are usually isolated, familiar o related to placental disfunction or intrauterine growth restriction, while the severe hypospadias are associated to other fetal defects, genetic or chromosomal abnormalities or disorders of sex development. In about 30% of cases. The triad of ultrasound findings prenatally is ventral curvature of the penis, redundant dorsal foreskin and blunt distal penis. The identification of the urethra during the micturition and the direction of the urinary stream help in the classification of the defect. When severe hypospadias is detected, the recommendation is to perform genetic amniocentesis and search for other ultrasound findings related to poor virilization in the fetus, as testicular descent after 27 weeks of gestation. Postnatal follow up should be multidisciplinary including infantile urologist and endocrinologist. The prognosis in distal hypospadias is usually good following surgical repair, however in severe cases surgical interventions may be more challenging in order to obtain satisfactory outcome in terms of function and esthetic.

Una asociación de riesgo: SARS-CoV-2 y sistema reproductivo / A risk association: SARS-CoV-2 and the reproductive system

RESUMEN Introducción: El SARS-CoV-2 puede afectar el sistema reproductivo de hombres y mujeres. Objetivo: Describir las probables afectaciones de la COVID-19 sobre el sistema reproductor. Métodos: Se realizó una revisión bibliográfica en Google Académico (https://scholar.google.com.cu), PubMed Central (https://www.ncbi.nlm.nih.gov/pmc), SciELO (https://scielo.org/es) e Infomed (http://www.bvscuba.sld.cu/clasificacion-de-revista/revistas-cubanas), con los descriptores COVID-19, SARS-CoV-2 y sistema reproductor sacados de DeCS - Descriptores en Ciencias de la Salud en https://decs.bvsalud.org/es. Se seleccionaron artículos disponibles a texto completo en español e inglés, de revistas revisadas por pares y páginas de organizaciones sanitarias reconocidas. Conclusiones: La presencia del receptor de la enzima convertidora de la angiotensina 2 (ACE2) y de proteasas celulares en el sistema reproductor provoca afectaciones por la COVID-19 de diverso grado, más marcados en los hombres. Parece poco probable que el virus se transmita por vía sexual. La afectación del sistema reproductor pudiera tener implicaciones clínicas importantes para la fertilidad, la descendencia y la transmisión del virus. Se requieren más investigaciones con muestras más representativas para evaluar la magnitud del daño y el impacto a largo plazo de la COVID-19 sobre el sistema reproductor humano.

ABSTRACT Introduction: SARS-CoV-2 can affect the reproductive system of men and women. Objective: to describe the probable effects of COVID-19 on the reproductive system. Methods: a literature review was carried out in Google Scholar (https://scholar.google.com.cu), PubMed Central (https://www.ncbi.nlm.nih.gov/pmc), SciELO (https://scielo.org/es) and Infomed (http://www.bvscuba.sld.cu/clasacion-de-revista/revistas-cubanas), with the descriptors COVID-19, SARS-CoV-2 and reproductive system taken from DeCS -Health Sciences Descriptors at https://decs.bvsalud.org/es. Articles from peer-reviewed journals and websites of recognized health organizations available in full text in Spanish and English languages were selected. Conclusions: the presence of the angiotensin-converting enzyme 2 receptor and cellular proteases in the reproductive system causes affectations of varying degrees, more marked in men. It seems unlikely that the virus is transmitted sexually. Reproductive system involvement could have important clinical implications for fertility, offspring, and virus transmission. Further research with more representative samples is required to assess the extent of damage and the long-term impact of COVID-19 on the human reproductive system.

Avaliação do interesse das mulheres assistidas pelo centro de atenção à mulher de Rio do Sul em cirurgias estéticas íntimas / Evaluation of the interest of women assisted by the Centro de Atenção à Mulher (CAM) of Rio do Sul in intimate aesthetic surgeries

Introdução: O termo cirurgia genital feminina engloba várias técnicas com o objetivo de melhorar a área vulvar feminina estética e funcionalmente. Sentimentos de sofrimento emocional são comuns nas mulheres que buscam tais cirurgias, impactando significativamente em sua autoestima, sexualidade, higiene e funcionalidade vulvar. O objetivo é avaliar Avaliar o interesse das mulheres assistidas em um Centro de Atenção à Mulher em cirurgias íntimas. Métodos: Estudo observacional transversal ocorrido no Centro de Atenção à Mulher (CAM) de Rio do Sul-SC. Para coleta dos dados, foi utilizado um questionário semiestruturado elaborado pelos autores. Os dados foram tratados e agrupados no programa Microsoft Excel e realizadas as análises descritivas dos dados utilizando o programa Statistical Package for the Social Sciences (SPSS). Resultados: Os achados indicaram que houve um grande interesse geral na realização de cirurgias de estética íntima. Das 100 mulheres entrevistadas, 32 apresentavam interesse em realizar algum tipo de cirurgia de estética íntima. Conclusão: Devido à importância dada à estética íntima na interferência física, psicossocial, sexual e cotidiana, com importante impacto na qualidade de vida dessas pessoas, é imperativo que recursos adequados sejam alocados para maior fornecimento de tais procedimentos no Sistema Único de Saúde para a população do Brasil.

Introduction: The term female genital surgery encompasses several techniques to improve the female vulvar area, both aesthetically and functionally. Feelings of emotional distress are common in women who seek such surgeries, significantly impacting their self-esteem, sexuality, hygiene and vulvar functionality. The objective is to To evaluate the interest of women assisted in a Women Care Center in intimate surgery. Methods: Observational study carried out at the Women Care Center (CAM) in Rio do Sul-SC. For data collection, a semi-structured questionnaire developed by the authors was used. Data were processed and grouped in Microsoft Excel, and descriptive data analysis was performed using the Statistical Package for Social Sciences (SPSS) program. Results: The findings indicated a great general interest in performing intimate aesthetic surgeries. Of the 100 women interviewed, 32 were interested in performing some intimate aesthetic surgery. Conclusion: Due to the importance given to intimate cosmetics in physical, psychosocial, sexual and everyday interference, with a major impact on the quality of life of these people, adequate resources must be allocated to a greater supply of such procedures in the Unified Health System for the population of Brazil.

Leydig and Sertoli cell function in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion: a case-control study

Abstract BACKGROUND: Because normal male sexual differentiation is more complex than normal female sexual differentiation, there are more cases of disorders of sex development (DSDs) with 46,XY karyotype that have unclear etiology. However, Leydig and Sertoli cell markers are rarely used in distinguishing such individuals. OBJECTIVES: To evaluate the function of Leydig and Sertoli cells in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion. STUDY DESIGN AND SETTING: Case-control study with 77 patients, including eight with partial androgen insensitivity syndrome, eight with 5α-reductase deficiency type 2 (5ARD2) and 19 with idiopathic 46,XY DSD, and 42 healthy controls, from the Interdisciplinary Study Group for Sex Determination and Differentiation (GIEDDS), at the State University of Campinas (UNICAMP), Campinas, Brazil. METHODS: Baseline levels of gonadotropins, anti-Müllerian hormone (AMH), inhibin B, insulin-like 3 (INSL3), testosterone and dihydrotestosterone in cases, and AMH, inhibin B, and INSL3 levels in controls, were assessed. RESULTS: There was no significant difference in age between cases and controls (P = 0.595). AMH and inhibin B levels were significantly lower in cases than in controls (P = 0.031 and P < 0.001, respectively). INSL3 levels were significantly higher in cases than in controls (P = 0.003). Inhibin B levels were lower in 5ARD2 patients (P = 0.045) and idiopathic patients (P = 0.001), in separate comparisons with the controls. CONCLUSION: According to our findings, we can speculate that inhibin B levels may be used to differentiate among DSD cases.

Fotobiomodulação associada a cosméticos: percepção de profissionais sobre melhora de flacidez e hiperpigmentação genital / Photobiomodulation associated with cosmetics: perception of professionals on the improvement of flaccidity and genital hyperpigmentation

INTRODUÇÃO: A fotobiomodulação associada a cosméticos despigmentantes e rejuvenescedores tem mostrado benefícios na melhora da flacidez e hiperpigmentação genital em mulheres. OBJETIVO: O objetivo do estudo foi descrever a percepção de profissionais acerca da melhora de flacidez e hiperpigmentação genital tratados por fotobiomodulação associada a cosméticos. MÉTODO: O estudo evidenciou percepção de melhora no aspecto geral, flacidez e pigmentação genital com uso da terapêutica proposta. RESULTADOS: Amostra composta por dez mulheres submetidas a quatro sessões de tratamento. A análise dos profissionais foi mediante a comparação dos registos fotográficos de antes e depois do tratamento da região genital. CONCLUSÃO: No entanto, é necessário que novos modelos de avaliação para evidenciar a efetividade terapêutica para tratamentos de flacidez e discromias na região genital sejam desenvolvidos ampliando assim os métodos de avaliação para além da percepção de melhora do aspecto geral.

INTRODUCTION: Photobiomodulation associated with depigmenting and rejuvenating cosmetics has shown benefits in improving sagging and genital hyperpigmentation in women. OBJECTIVE: The aim of the study was to describe the perception of professionals about the improvement of sagging and genital hyperpigmentation treated by photobiomodulation associated with cosmetics. METHOD: The study showed a perception of improvement in the general appearance, sagging and genital pigmentation with the use of the proposed therapy. RESULTS: Sample composed of ten women submitted to four treatment sessions. The analysis of the professionals was by comparing the photographic records of before and after the treatment of the genital region. CONCLUSION: However, it is necessary that new evaluation models to evidence the therapeutic effectiveness for treatments of flaccidity and dyschromias in the genital region are developed, thus expanding the evaluation methods beyond the perception of improvement in the general aspect.

Insights on the evolution of Ululodini (Insecta: Neuroptera: Myrmeleontidae: Ascalaphinae), focusing on the systematics of the genus Ascalorphne Banks, 1915

ABSTRACT The tribe Ululodini is one of the most remarkable taxa of Neotropical Neuroptera, mainly due to its great flight ability, eyes divided into two lobes, and production of abortive eggs that act as a chemical barrier against predators. Nonetheless, Ululodini remains little studied. One genus of this tribe, Ascalorphne Banks 1915, currently comprises four valid species: A. macrocerca (Burmeister, 1839), A. impavida (Walker, 1853), A. umbrina (Gerstaecker, 1884), and A. leisewitzi (Navás, 1911). This study reviews the taxonomy of Ascalorphne, redescribing the external morphology and, for the first time, the male and female genitalia. Furthermore, A. leisewitzi is proposed as a new synonym of A. umbrina, an identification key is presented, and the geographic distribution of the genus is updated based on collected specimens and data available in the citizen science project iNaturalist. Also, the body and genital morphology of Ululodini were comparatively studied and analyzed in a phylogenetic context with all other Ascalaphinae tribes that occur in the Neotropics, allowing a better understanding of the evolution and biology of these insects. As a result, new synapomorphies for Ululodini are presented, Albardia furcata Oswald, 1903 is recovered as the sister taxon to the rest of the tribe, Ameropterus Esben-Petersen, 1922 was recovered as paraphyletic, and Ascalorphne was recovered as monophyletic in all analyses.

Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso / Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a case

Nevo epidérmico verrucoso inflamatório linear e diagnóstico diferencial com a psoríase linear: a respeito de um caso RELATO DE CASOMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,O nevo epidérmico verrucoso inflamatório linear (NEVIL) é uma variedade clínica rara de nevo epidérmico verrucoso, que se manifesta no início da infância, como lesões inflamatórias de superfície ceratósica, que coalescem e se distribuem em faixa, acompanhando as linhas de Blaschko. Faz diagnóstico diferencial com a psoríase linear, sendo difícil a diferenciação, dado os aspectos clínicos e histopatológicos comuns aos dois, enfantizando-se a necessidade de conhecer as características específicas de cada um. O objetivo deste relato é demonstrar uma afecção relativamente rara, descrita em uma menina de 5 anos, evoluindo desde os primeiros dias de vida com placas papuloceratósicas dispostas linearmente, acompanhadas de sinais inflamatórios e áreas erosadas ocupando grandes lábios, períneo e face interna e superior da coxa esquerda. Também pápulas e placas ceratósicas na região cervical posterior e borda lateral externa da planta do pé esquerdo, ascendendo ao longo da região posterior deste membro. Os critérios clínicos e histopatológicos corroboram o diagnóstico de NEVIL na diferenciação com a psoríase linear, ressaltando a importância do estabelecimento de critérios/ ferramentas que auxiliem na diferenciação destas duas dermatoses visando agilizar o diagnóstico, otimizar o tratamento e minimizar o desconforto para esses pacientes. O acompanhamento a longo prazo dos portadores é sugerido pela possibilidade ainda que mínima de malignização do NEVIL. (AU)

Inflammatory linear verrucous epidermal nevus and differential diagnosis with linear psoriasis: about a caseCASE REPORTMaria Isabel Muniz Zemero1, Maria Amélia Lopes dos Santos1, Alena Margareth Darwich Mendes1, Carla Andrea Avelar Pires1,Inflammatory Linear Verrucous Epidermal Nevus (ILVEN) is a rare clinical variety of verrucous epidermal nevus that manifests in early childhood as inflammatory lesions of keratosis surface, which coalesce and spread in band, following Blaschko lines. It makes a differential diagnosis with Linear Psoriasis; it is difficult to differentiate them given the clinical and histopathological aspects common to both, emphasizing the need to know the specific characteristics of each. The purpose of this report is to demonstrate a relatively rare affection, expressed in a 5-year-old girl, evolving from the first days of life with papulokeratosic plaques arranged linearly, followed by inflammatory signs and eroded areas, placed linearly, overtaking labia majora, perineum, the inner and upper face of the left thigh. Also, the patient showed keratotic papules and plaques in the posterior cervical region and external lateral border of the left foot plant, ascending along the posterior region of this limb. The clinical and histopathological criteria corroborate the diagnosis of ILVEN in differentiation with linear psoriasis, emphasizing the importance of establishing criteria/instruments to assist in distinguishing these two dermatoses in order to expedite the diagnosis, to optimize the treatment and minimize patients' discomfort. Long-term follow-up of patients with this disease is suggested due to the possibility, albeit minimal, of ILVEN malignancy. (AU)

Human Papillomavirus infection in oral and anogenital sites: prevalence and rates of concordance / Infecção pelo Papilomavírus Humano em regiões orais e anogenitais: prevalência e taxa de concordância

Introduction: HPV infection causes cancer at several anatomical sites. However, the infection's natural history in non-cervical sites is understudied. Objective: To evaluate oral and anogenital HPV infections, correlating HPV prevalence rates and genotypes with site of infection and risk factors. Methods: In the present study, 351 samples from oral, genital, and anal sites of 117 patients were investigated by using PCR MY09/11 detection, followed by genotyping with RFLP. Results: HPV DNA prevalence was 89.7% (105/117) in genital lesions, 53.8% (63/117) in oral samples, and 58.9% (69/117) in anal samples. Regarding the risk factors associated with HPV in genital lesions, statistically significant rates for oral (p=0.039) and anal sex practices (p=0.0000012) were found. For oral samples, a relevant correlation concerning oral contraceptive use (p=0.039), tobacco smoking (p=0.036), and alcohol use (p=0.0075) were observed; whereas in anal samples, higher risk for HPV infection in patients who reported non-exclusive sexual partners (p=0.013) were found. The presence of viral DNA in all the three sites concurrently was observed in 36.8% of the cases (43/117). Among them, 18% (21/117) presented concordant HPV genotypes, diverging from the literature, and thus corroborating that there is still much to learn about HPV natural history, since different biological behaviors are expected within different populations. Differences in anatomy and physiology of the studied sites can determine different prevalence rates of infection by diverse genotypes. Conclusion: Due to the high prevalence of HPV DNA in extragenital sites, further studies are required to define aspects of HPV natural history among different human anatomical sites.

Introdução: As infecções causadas pelos papilomavírus humanos (HPV) são responsáveis pelo desenvolvimento de cânceres em diversos sítios anatômicos humanos. Entretanto, a história natural da infecção em sítios que não a cérvice uterina não é muito clara. Objetivo: Avaliar infecções orais, genitais e anais por HPV, correlacionando taxas de prevalência do vírus e seus genótipos aos sítios de infecção e a fatores de risco sócio-demográficos. Métodos: Em nosso estudo, investigamos 351 amostras coletadas dos sítios oral, genital e anal de 117 pacientes, por meio da técnica de PCR MY09/11, seguida de genotipagem por RFLP. Todos os pacientes apresentavam lesões genitais benignas. Resultados: A prevalência do HPV foi de 89,7% (105/117) nas lesões genitais, 53,8% (63/117) nas amostras orais e 58,9% (69/117) nas amostras anais. Em relação aos fatores de risco associados à infecção genital, encontramos diferenças estatísticas significativas para prática de sexo oral (p=0,039) e sexo anal (p=0,0000012). Já para as amostras orais, observamos importante correlação entre infecção e uso de contraceptivo oral (p=0,039), tabagismo (p=0,036) e uso de álcool (p=0,0075) enquanto nas amostras anais, alto risco de infecção pelo HPV foi associado a pacientes relatando parceiros sexuais não exclusivos (p=0,013). A presença do DNA viral simultaneamente nos três sítios estudados foi observada em 36,8% dos casos (43/117). Desses, 18% (21/117) apresentaram genótipos concordantes, diferindo da literatura, na qual há grande disparidade de descrições. Conclusão: Há a necessidade de novos estudos a fim de esclarecer a história natural do HPV em sítios extragenitais em diferentes populações, avaliando características anatômicas e fisiológicas com o intuito de esclarecer diferentes taxas de infecção por genótipos do HPV e diferentes processos de doença.

Reconstrucción estético - funcional de labios menores post amputación Iatrogénica amplia con colgajo de avance V - Y / Aesthetic-functional reconstruction of labia minora after extensive iatrogenic amputation with V-Y advancement flap

La hipertrofia de labios menores es la prolongación de estos más allá de los límites anatómicos de los labios mayores. La creencia de la simplicidad en la reducción de los labios menores y la falla en observar importantes aspectos de la técnica quirúrgica que llevan a la resección total del labio. En tales casos, la cirugía reconstructiva es la única forma posible de rectificar la situación. Presentamos el caso de una mujer de 36 años que acude por amputación de los labios menores secundario a cirugía de labioplastia por hipertrofia realizada por médico esteticista. Se realiza reconstrucción de labios menores en dos tiempos quirúrgicos. Los colgajos de avance en V-Y del capuchón del clítoris, con remanentes de tejido de la horquilla posterior, pueden lograr resultados satisfactorios y permitir la adaptación a la anatomía genital y los deseos estéticos únicos de cada mujer.

Labia minora hypertrophy is the prolongation of these beyond the anatomical limits of the labia majora. The belief in simplicity in the reduction of the labia minora and the failure to observe important aspects of the surgical technique that lead to total lip resection. In such cases, reconstructive surgery is the only possible way to rectify the situation. A 36-year-old woman with medical history of labia minora amputation secondary to labiaplasty surgery for hypertrophy of the labia minora performed by a beautician. The labia minora reconstruction is performed in two surgical stages. The V-Y advancement flaps of the clitoral hood with remnants of tissue from the posterior fork can be achieved with satisfactory results and allow adaptation to the genital anatomy and unique aesthetic wishes of each woman.

Why pediatricians need to know the disorders of sex development: experience of 709 cases in a specialized service / Por que os pediatras precisam conhecer os distúrbios da diferenciação do sexo: experiência de 709 casos de um serviço especializado

Abstract Objective: To evaluate, in a sample of patients with disorders of sex development (DSD), data related to the age at referral and their correlation with the initial complaints, gender at referral, defined gender after diagnosis and etiological diagnosis. Methods: Retrospective review of the age at the first consultation and the reason for it, initial social gender and gender after the diagnosis, karyotype and etiological diagnosis of all cases treated at a DSD outpatient clinic between 1989 and 2016. Cases that did not involve DSD and DSD diagnoses that do not usually involve ambiguous genitalia, thus not requiring specialized monitoring, were excluded. Results: Of the 1793 treated cases, 1139 were diagnosed with some type of DSD. This study excluded 430 cases (272 with Turner's syndrome, 66 with Klinefelter syndrome, and 92 with pure gonadal dysgenesis), thus a total 709 individuals were included. Of these, 82.9% were referred due to ambiguous genitalia; only one-quarter were still in the first month of life, and 6.6% were referred due to pubertal delay, with most of them aged 10 years or older. Of these patients, 68.6% had a diagnosis of XY DSD, 22.4% of XX DSD, and 9% of sex chromosome abnormalities. Conclusions: This study presents the largest series in the literature of patients with DSD treated in a single center. The time of referral of the majority of patients with ambiguous genitalia fell short of the ideal, and milder cases of ambiguous genitalia and many with pubertal manifestations were referred even later. The results reinforce the importance of continuing education for professionals who will have the first contact with these patients, mainly pediatricians and neonatologists.

Resumo Objetivo: Avaliar em uma amostra de pacientes com distúrbios da diferenciação do sexo (DDS), dados relacionados à idade, ao encaminhamento e sua correlação com as queixas iniciais, ao sexo ao encaminhamento e ao sexo final e diagnóstico etiológico. Métodos: Revisão retrospectiva da idade por ocasião da primeira consulta e motivo dela, sexo social inicial e após definição do diagnóstico, cariótipo e diagnóstico etiológico de todos os casos atendidos em um ambulatório especializado em DDS entre 1989 e 2016. Foram excluídos casos que não compreendiam DDS e diagnósticos de DDS que não cursam comumente com ambiguidade genital, não necessitam de acompanhamento especializado. Resultados: Dos 1.793 casos atendidos, 1.139 foram diagnosticados com algum DDS. Excluíram-se 430 (272 síndrome de Turner, 66 síndrome de Klinefelter e 92 disgenesia gonadal pura), totalizando 709. Desses, 82,9% foram encaminhados por ambiguidade genital, somente um quarto ainda no primeiro mês de vida e 6,6% por atraso puberal, a maioria com 10 anos ou mais; 68,6% tiveram diagnóstico de DDS XY; 22,4% DDS XX e 9% de anomalias dos cromossomos sexuais. Conclusões: Este estudo apresenta a maior casuística na literatura de pacientes com DDS atendidos em um único serviço. O momento de encaminhamento da maioria dos pacientes com ambiguidade genital foi aquém do ideal e casos mais leves de ambiguidade e muitos com manifestações puberais foram encaminhados ainda mais tardiamente. Os resultados reforçam a importância do ensino continuado a profissionais que terão o primeiro contato com esses pacientes, principalmente pediatras e neonatologistas.

Traumatismo de genitales externos masculinos por proyectil de arma de fuego. Reporte de casos / External male genital trauma caused by firearm projectile. Case report

RESUMEN Los traumatismos de genitales externos son lesiones producidos por agentes mecánicos externos y se observa en el 68,1% de todos los casos de traumas genitourinarios. Los traumas producidos por un mecanismo penetrante por proyectil de arma de fuego están incrementando en sucesos delictivos que ocurren en centros urbanos; estas lesiones comprometen el escroto en 78% y el pene en 28%. El manejo consiste en la exploración escrotal y del pene con reparación de la túnica albugínea, incluso orquiectomía si el testículo no es recuperable. La cirugía se realiza para evitar complicaciones como la disfunción sexual y miccional. Presentamos dos casos con el objetivo de dar a conocer el manejo actual de las lesiones genitales en nuestro centro, ante la ausencia de reportes o estudios previos en nuestro medio relacionados al traumatismo de genitales externos por proyectil de arma de fuego.

SUMMARY External genital trauma is caused by external mechanical agents and account for 68.1% of all genitourinary trauma. Firearm projectile trauma are increasing as a result of escalating delinquency in urban settings, these traumas involve the scrotum and penis in 78% and 28%, respectively. Management of these traumas require evaluation of the scrotum and penis; orchiectomy is needed if the testes are not recuperable. Surgical procedures are aimed at avoiding complications such as sexual and urinary dysfunction. We present two cases aimed at reporting the management of external genital trauma at our centre in absence of local reports of firearm projectile trauma.

Parasitic twin with major cardiac defect: a case report

Parasitic twins are an extremely rare form of asymmetrical conjoined monochorial monoamniotic twins where one of them has a mostly intact body that is able to survive and which is referred to as 'autosite', while the counterpart, referred to as 'parasite', is only rudimentarily developed being physically attached to and nourished by the other twin. Our case is a baby boy with Single Ventricle Heart defect with a thoraco-abdominal mass (epigastric heteropagus twin) attached to the anterior abdominal wall near the umbilicus with minimal visceral sharing. The twins had two external genitalia both in host and parasite micturating separately. After high risk surgery the parasite could be separated completely from the host and postoperative recovery was uneventful.

Association between atherogenic dyslipidemia and fourniers gangrene

SUMMARY OBJECTIVE We aimed to determine whether atherogenic dyslipidemia is associated with the disease and morbidity in our patients treated for Fournier's gangrene (FG). METHODS Sixty-two patients who were treated with the diagnosis of FG at our center between 2012 and 2017 were retrospectively screened. RESULTS The triglyceride values of the patients who required reconstructive surgery were statistically significantly higher than those of the patients for whom wound debridement and primary suturing was sufficient (p:0.001). A total of 65.7% of the patients had normal triglyceride values in the group in which wound debridement and primary suturing was sufficient, while this rate was 22.2% in the group of patients who needed reconstructive surgery; the difference was statistically significant (p: 0.002). The UFGSI score of those with triglyceride values higher than the normal range was statistically significantly higher (p:0.006). The cut-off point for the triglyceride value for which Fournier's gangrene was more morbid and the probability of reconstructive surgery need was significantly higher, i.e., >233mg. CONCLUSION Our study has demonstrated that atherogenic dyslipidemia, especially hypertriglyceridemia, is an important factor affecting morbidity and associated with high patient care costs after hospitalization and discharge in FG.

RESUMO OBJETIVO Nosso objetivo foi determinar se as dislipidemias aterogênicas estão associadas à doença e à morbidade em nossos pacientes tratados para a gangrena de Fournier (GF). MÉTODOS Sessenta e dois pacientes tratados com o diagnóstico de GF em nosso centro entre 2012 e 2017 foram selecionados retrospectivamente. RESULTADOS Os valores de triglicérides dos pacientes que necessitaram de cirurgia reconstrutiva foram estatisticamente significativamente maiores em comparação com aqueles dos pacientes nos quais o desbridamento da ferida e a sutura primária foram suficientes (p:0,001); 65,7% dos pacientes apresentaram valores normais de triglicérides no grupo em que desbridamento da ferida e sutura primária foram suficientes, enquanto que essa taxa foi de 22,2% no grupo de pacientes que necessitaram de cirurgia reconstrutiva, e a diferença foi estatisticamente significativa (p:0,002). O escore UFGSI daqueles com valores de triglicerídeos acima da faixa normal foi estatisticamente significativamente maior (p:0,006). O ponto de corte para o valor de triglicérides pelo qual a gangrena de Fournier era mais mórbida e a probabilidade de necessidade de cirurgia reconstrutiva era significativamente maior foi >233 mg. CONCLUSÃO Nosso estudo demonstrou que a dislipidemia aterogênica, especialmente a hipertrigliceridemia, é um fator importante que afeta a morbidade e os altos custos associados ao cuidado do paciente após hospitalização e alta na GF.

Vidas após a cirurgia de redesignação sexual: sentidos produzidos para gênero e transexualidade / Life after sexual reassignment surgery: significance for gender and transsexuality

Resumo O Processo Transexualizador é o principal serviço direcionado à saúde trans-específica no Brasil, o qual oferta aquisições como hormonioterapia e cirurgias de redesignação sexual à população trans. Neste artigo, analisaram-se os sentidos produzidos em torno do procedimento cirúrgico, da nova genitália, sobre gênero e transexualidade entre mulheres que realizaram cirurgia de redesignação sexual no Hospital Universitário Cassiano Antônio de Moraes (HUCAM), localizado em Vitória, Estado do Espírito Santo, Brasil. Foi realizada pesquisa qualitativa com entrevistas narrativas gravadas em áudio, e realizada análise de conteúdo. Foram selecionadas 09 participantes a partir da metodologia bola de neve. Conclui-se que as cirurgias estão relacionadas à busca pela humanização dos corpos. As compreensões sobre ser mulher não se limitaram a um estatuto biológico para os gêneros. A transexualidade foi apresentada como uma experiência de transição entre os gêneros. A cirurgia de redesignação sexual foi apontada como estratégia para a construção de um corpo em consonância com a experiência das participantes nas relações sociais de gênero, cujo sucesso é avaliado sob signos de beleza, prazer e passabilidade.

Abstract The Transsexualization Process is the main service directed to trans-specific health in Brazil, which provides services such as hormone therapy and sexual reassignment surgeries to the trans population. In this article, the significance surrounding the surgical procedure, the new genitalia, gender and transsexuality among women who underwent sexual reassignment surgery at the Cassiano Antônio de Moraes University Hospital (HUCAM), located in Vitória, Espírito Santo State, Brazil, was analyzed. Qualitative research was carried out, narrative interviews were recorded, and thematic content analysis was performed. The sample was composed of 9 participants selected by snowball sampling. The conclusion drawn is that the surgeries are related to the search for the humanization of bodies. The comprehension about being a woman was not limited to a biological status for gender. Transsexuality was presented as a transitional experience between genders. The sexual reassignment surgery was seen as a strategy of corporal correction in line with expectations about social relationships in gender by participants, the success of which is evaluated from the standpoint of beauty, pleasure and passability.

Autoimagem genital feminina no processo de envelhecimento: revisão integrativa de literatura / Female genital self-image in the aging process: integrative literature review / Autoimagen genital femenina en el proceso de envejecimiento: revisión bibliográfica integradora

O objetivo deste estudo foi verificar o perfil dos estudos que tratam sobre a autoimagem genital feminina no processo de envelhecimento e os fatores intervenientes nessa questão. Revisão bibliográfica integrativa nas bases de dados SciELO, LILACS, MEDLINE e PubMed. Encontraram-se 28 artigos, sendo a maioria com mulheres na perimenopausa, utilizando-se a escala Female Genital Self Image Scale e tendo, como fatores intervenientes, a função sexual, cirurgias genitais, status do relacionamento, idade, entre outros.

The aim of this study was to verify the profile of studies that deal with female genital self-image in the aging process and the intervening factors in it. Integrative bibliographic review in the SciELO, LILACS, MEDLINE and PubMed databases. 28 articles were found, most of them with women in perimenopause, using the Female Genital Self Image Scale and having as intervening factors sexual function, genital surgeries, relationship status, age, among others.

El objetivo de este estudio fue verificar el perfil de los estudios que abordan la autoimagen genital femenina en el proceso de envejecimiento y los factores que intervienen en él. Revisión bibliográfica integradora en las bases de datos SciELO, LILACS, MEDLINE y PubMed. Se encontraron 28 artículos, la mayoría de ellos con mujeres en perimenopausia, utilizando la Escala de autoimagen genital femenina y teniendo como factores intervinientes la función sexual, cirugías genitales, estado civil, edad, entre otros.

El autocuidado del sistema genitourinario en jóvenes estudiantes universitarios / Self-care of the genitourinary system in young university students

RESUMEN Fundamento: las infecciones del sistema genitourinario se han identificado entre las más frecuentes en las consultas de la atención primaria de salud; existe un porciento significativo de estudiantes universitarios que las padecen, lo cual repercute en su calidad de vida. Objetivo: elaborar un sistema de actividades para promover el autocuidado del sistema genitourinario en los estudiantes universitarios. Métodos: se realizó una investigación de desarrollo en 2015, en la Facultad de Tecnología de la Salud. Se utilizaron métodos teóricos: histórico-lógico, analítico-sintético e inductivo-deductivo; del nivel empírico: análisis de documentos, observación, cuestionarios y entrevistas a los jóvenes y profesores, y el criterio de especialistas para valorar la propuesta. Resultados: se constató poca percepción de riesgo de los factores que provocan afectaciones en el sistema genitourinario por los jóvenes estudiantes, no habían concientizado el valor del autocuidado para la preservación de su salud y no lo asumían como influyente en la calidad de vida; omitían la responsabilidad individual en la prevención y control de las causas que ejercen influencias negativas en su organismo, por lo que se elaboró un sistema de actividades que fue valorado por criterios de especialistas. Conclusiones: el sistema elaborado promueve el autocuidado del sistema genitourinario a través de la articulación de actividades curriculares y extracurriculares que fomentan actitudes positivas hacia el cuidado del cuerpo y el mejoramiento de la calidad de vida; fue valorado como pertinente y adecuado a los propósitos para los que fue creado.

ABSTRACT Background: the genitourinary system infections have been identified among the most frequent in primary health care consultations; there is a significant percentage of university students who suffer from them, which affect their quality of life. Objective: to develop a system of activities to promote self-care of the genitourinary system in university students. Methods: a development research was carried out in 2015, at the Faculty of Health Technology. Theoretical methods were used: historical-logical, analytic-synthetic and inductive-deductive; empirical ones: analysis of documents, observation, questionnaires and interviews with young people and teachers, and the criteria of specialists to assess the proposal. Results: there was little risk perception of the factors that cause affectations in the genitourinary system of young students, they had not been aware of the self-care value for the preservation of their health and they did not assume it as influencing in life quality; they omitted the individual responsibility in the prevention and control of the causes that exert negative influences in their organism, so a system of activities was elaborated that was valued by criteria of specialists. Conclusions: the elaborated system promotes the self-care of the genitourinary system through the articulation of curricular and extracurricular activities that promote positive attitudes towards the care of the body and the improvement of quality life; it was assessed as relevant and adequate to the purposes for which it was created.