Teste de provocação oral com alimentos: o panorama brasileiro / Oral food challenge: a Brazilian panorama

Introdução: O teste de provocação oral (TPO) com alimentos é o padrão ouro para avaliação diagnóstica e de aquisição de tolerância em pacientes com alergia alimentar (AA). Exige, no entanto, equipe especializada e local apropriado para execução, uma vez que reações alérgicas, incluindo anafilaxia, podem acontecer. Foi recém-incorporado como procedimento reconhecido pelo Sistema Único de Saúde e pela Agência Nacional de Saúde, mas apenas no contexto da alergia ao leite de vaca para pacientes com até 24 meses de vida. Pouco se sabe sobre sua disponibilidade/execução no território brasileiro. Objetivos: Explorar o perfil de realização de TPO com alimentos em âmbito nacional, bem como as limitações para a sua não realização. Métodos: Inquérito virtual foi disponibilizado por e-mail aos 2.500 sócios cadastrados na Associação Brasileira de Alergia e Imunologia questionando sobre a prática de TPO, formação do profissional, limitações para sua não realização e possíveis soluções para sua execução. Resultados: Foram obtidas 290 respostas (11,6% dos associados), sendo a maioria deles proveniente da Região Sudeste (56,1%). Realizam TPO 54,5% (158/290) dos associados, 62% destes mais de 5 TPOs/mês, principalmente para leite e ovo. A execução de TPO na atualidade, majoritariamente na rede privada, esteve associada à prática do procedimento durante a especialização. Falta de recurso e ambiente apropriados são as maiores limitações para a não realização do TPO. Conclusões: Apesar do viés de seleção inerente à metodologia empregada do estudo, este inquérito pioneiro em território nacional tem importância por esclarecer e discutir a realização do TPO no âmbito do Brasil. Certamente este procedimento ainda é insuficientemente realizado no Brasil.

Background: Oral food challenge (OFC), the gold standard for diagnosing food allergy and determining tolerance levels, requires specialized staff and appropriate conditions since anaphylaxis may occur. In 2022, OFC was officially recognized in Brazilian public and private health systems, although only for milk allergy in children up to 24 months of age. Little is known about OFC practices in Brazil. Objectives: To explore OFC practices, barriers, and solutions among Brazilian allergists and immunologists. Methods: A survey was e-mailed to 2500 associates of the Brazilian Association of Allergy and Immunology regarding OFC practices, training experiences, barriers to this procedure, and workable solutions. Results: A total of 290 associates responded (11.6%), more than a half of whom (56.15) practiced in the southeast region: 158 (54.5%) reported performing OFC, of whom 62% performed > 5 procedures each month, mostly for cow milk and hen egg. OFCs were mostly performed in private practice and were associated with specialized training. Lack of an appropriate setting was seen as the main barrier to performing the procedure. Conclusions: Although this study's methodology involves intrinsic biases, this is the first exploration of OFC practice in Brazil. OFCs are still underperformed nationwide.

An American and Brazilian perspective on abstracts presented in coloproctology conferences converted into published manuscripts

Introduction: The presentation of abstracts in a congress is an important step for the dissemination of scientific information. The American Congress of Coloproctology is promoted by the American Society of Colon & Rectal Surgeons (ASCRS), and it is the largest in number of participants within the specialty, followed by the Brazilian Congress of Coloproctology. The present study aims to evaluate variables related to the quality of the scientific production of the abstracts presented in these two events and their conversion rate to published manuscripts. Materials and Methods: The present bibliometric study assesses secondary data from the review of abstracts presented in these 2 important conferences in 2016, followed by a research of the publications from these congress presentations. Results: The total number of abstracts evaluated was 854. The rate of articles containing statistical analyses was of 73.7% in the American congress, and of 34.1% in the Brazilian congress. Multicentric studies were more prevalent in the American congress (23.1%). Regarding study design, the most common were case reports in the Brazilian (44.8%) congress and retrospective studies in the American congress (67.7%). As for the works presented, the rate of conversion into full manuscripts in the American congress was of 24.2% compared with 10.6% in the Brazilian congress. Most papers from the American congress (93.7%) have citations compared with 68.6% of the other event evaluated. Conclusion: The scientific performance demonstrated by the conversion rate of abstracts into publications is below ideal, mainly in relation to the Brazilian meeting; yet, there were significant differences between the two events in terms of the profile of the presentations and several variables analyzed. (AU)

El final del Hospital Rawson y la diáspora finochiettista. A 45 años de estos hechos / The end of the Rawson Hospital and the finochiettista diaspora. 45 years after these events

La Asociación Médica Argentina (AMA) reconoce el valor de la Escuela Quirúrgica de los hermanos Finochietto y por tal motivo efectúa un homenaje anual desde el año 2002. En este artículo se hace una breve reseña histórica del Hospital Rawson, donde se inició y desarrolló dicha escuela. Se resaltan dos hechos: por un lado, el término "diáspora finochiettista", porque la dispersión de los cirujanos fue obligada y tuvieron que abandonar su lugar de procedencia original, el Hospital Rawson y, por el otro, que dicho nosocomio nació y murió como consecuencia de movimientos políticos cívico-militares. (AU)

The Argentine Medical Association (AMA) recognizes the value of the Surgical School of the Finochietto brothers, and for this reason has paid an annual tribute since 2002. Tthis article provides a brief historical review of the Rawson Hospital, where the school was initiated and developed. Two facts are highlighted: on the one hand, the term "Finochiettista diaspora" because the dispersal of the surgeons was forced and they had to leave their original place of origin, the Rawson Hospital; and on the other hand, the fact that this hospital was born and died as a consequence of civil-military political movements. (AU)

Asociación Argentina de Anatomía: sus Inicios / Argentine Association of Anatomy: its Beginnings

Realizamos una reseña de los primeros años de la Asociación Argentina de Anatomía, que se creó en el año 2000 y que actualmente continúa vigente. Se describen sus orígenes, objetivos, primeros presidentes y congresos, así como publicaciones, además de sus relaciones inter-societarias, entre ellas se destaca la Sociedad Chilena de Anatomía.

SUMMARY: We make a review of the first years of the Argentine Association of Anatomy, which was created in the year 2000 and which is currently still in force. Its origins, objectives, first presidents and congresses are described, as well as publications, in addition to its inter-societal relations, among them the Chilean Society of Anatomy stands out.

Recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil

Objective: To present the updated recommendations of the Brazilian College of Radiology and Imaging Diagnosis, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Methods: Between January 2012 and July 2022, searches for scientific evidence published in MEDLINE, Embase, Cochrane Library, EBSCO, CINAHL and LILACS were carried out. The recommendations were based on this evidence, with the consensus of a committee of experts from the three institutions. Recommendations: The annual mammography screening is recommended for normal-risk patients aged between 40 and 74 years. For women aged more than 75 years, it is reserved for those whose life expectancy is longer than seven years. Women whose risk is higher than normal, such as those with dense breasts, personal history of atypical lobular hyperplasia, classic in situ lobular carcinoma, atypical ductal hyperplasia, women undergoing breast cancer treatment or thoracic irradiation before the age of 30, or those with genetic mutation or strong family history, benefit from complementary screening, being considered in an individual manner. Tomosynthesis is an evolution of mammography and should be considered in screening whenever accessible and available

Participación de la mujer a nivel societario e institucional en la Asociación Argentina de Ortopedia y Traumatología / Participation of women at the societal and institutional level in the Argentine Association of Orthopedics and Traumatology

Objetivo: Analizar la representación de la mujer a nivel societario dentro de la Asociación Argentina de Ortopedia y Traumatología (AAOT). Materiales y Métodos: Se realizó un estudio observacional y descriptivo analizando datos obtenidos del período entre el 1 de enero de 2015 y el 31 de diciembre de 2019. Se evaluó la proporción de mujeres que son miembros de la AAOT y su participación a nivel institucional, jerárquico y académico. Resultados: La mujer representa el 10,6% de todos los miembros de la AAOT. Doce mujeres participan activamente en los diferentes Comités de la Asociación, lo que representa un 16% del total de los integrantes. Durante el período de estudio, el 2,8% de los cargos de la Comisión Directiva fueron ocupados por mujeres. Una mujer fue Presidenta en la historia de la AAOT. En 2019, el 6,9% de los docentes que dictaron el Curso Oficial Nacional Bianual de Certificación de Ortopedia y Traumatología fueron mujeres. Conclusión: La mujer representa el 10,6% de los miembros de la AAOT. Conocer su situación dentro de la AAOT permite sentar las bases para implementar medidas orientadas a mejorar la equidad en la Ortopedia y Traumatología. Nivel de Evidencia: IV

Objective: To analyze the representation of women at the societal level within the Argentine Association of Ortopedics and Traumatology (AAOT). Materials and Methods: An observational and descriptive study was conducted analyzing data obtained from the period between January 1, 2015 and December 31, 2019. The proportion of women members of the AAOT, as well as their participation at the institutional, hierarchical, and academic levels, was assessed. Results: Women represent 10.6% of all AAOT members. Twelve women actively participate in the different Committees of the Association, which represents 16% of the total number of members. During the study period, 2.8% of the positions on the Board of Directors were held by women. In the history of the AAOT, only one woman has served as President. In 2019, women made up 6.9% of teachers who taught the Biannual Official National Orthopedics and Traumatology Certification Course. Conclusion: Women represent 10.6% of AAOT members. Knowing their situation within the AAOT allows laying the foundations to implement measures aimed at improving equity in Orthopedics and Traumatology. Level of Evidence: IV

Dermatite atópica grave: guia prático de tratamento da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Severe atopic dermatitis: a practical treatment guide from the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

A dermatite atópica (DA) é uma doença cutânea inflamatória, crônica, comum, complexa e de etiologia multifatorial, que se manifesta clinicamente com prurido muitas vezes incapacitante, lesões recorrentes do tipo eczema, xerose e que pode evoluir para liquenificação. Embora o conhecimento sobre a sua fisiopatologia venham crescendo nos últimos anos, ainda as formas graves são frequentes e representam um desafio para o clínico. Para o presente guia realizou-se revisão não sistemática da literatura relacionada à DA grave refratária aos tratamentos habituais com o objetivo de elaborar um documento prático e que auxilie na compreensão dos mecanismos envolvidos na DA, assim como dos possíveis fatores de risco associados à sua apresentação. A integridade da barreira cutânea é um dos pontos fundamentais para a manutenção da homeostase da pele. Além dos cuidados gerais: evitação dos agentes desencadeantes e/ou irritantes, o uso de hidratantes, suporte emocional, entre outros, o uso de agentes anti-inflamatórios/imunossupressores de uso tópico e/ou sistêmico também foi revisado. A aquisição de novos agentes, os imunobiológicos e as pequenas moléculas, melhorou a terapêutica para os pacientes com formas graves de DA, sobretudo as refratárias aos tratamentos convencionais.

Atopic dermatitis is a chronic, common, and complex inflammatory skin disease with a multifactorial etiology. It manifests clinically with often disabling pruritus, recurrent eczema-like lesions, and xerosis, and can progress to lichenification. Although understanding of the disease's pathophysiology has been growing in recent years, severe forms are still frequent and represent a challenge for clinicians. A non-systematic review of the literature on severe atopic dermatitis refractory to conventional treatment was conducted to develop the present guide, whose purpose is to help clarify the mechanisms involved in the disease and possible risk factors. The integrity of the skin barrier is fundamental for maintaining skin homeostasis. In addition to general care, patients should avoid triggering and/or irritating agents and moisturizers and seek emotional support, etc.; the use of topical and/or systemic anti-inflammatory/immunosuppressive agents was also reviewed. New agents, immunobiologicals, and small molecules have led to a broader range of therapies for patients with severe forms of the disease, especially cases refractory to conventional treatment.

Assistência a pacientes com doenças imunoalérgicas no Sistema Único de Saúde brasileiro ­ Carta de São Paulo / Treating patients with allergic diseases in the Brazilian Unified Health System ­ Letter from São Paulo

O Sistema Único de Saúde (SUS) abrange todos os níveis de atenção à saúde e garante acesso integral, universal e gratuito para toda a população brasileira. As transições demográfica e epidemiológica observadas nas últimas décadas trouxeram um cenário de maior prevalência das doenças imunoalérgicas. Nesse contexto, a implementação de políticas de saúde voltadas à assistência à saúde dessa população tornou-se um desafio. Com o objetivo de discutir a atenção à saúde dos pacientes com doenças alérgicas e imunológicas no Brasil, a Associação Brasileira de Alergia e Imunologia (ASBAI) realizou em 26 de agosto de 2022, na cidade de São Paulo, o Fórum sobre a Assistência a Pacientes com Doenças Imunoalérgicas no SUS. O evento foi estruturado no formato de painéis e contou com a participação de membros da ASBAI e representantes da gestão pública federal, do Ministério Público, de sociedade de pacientes e profissionais de saúde de diversos serviços com experiência em programas e projetos bem sucedidos na assistência a pacientes com doenças imunoalérgicas. Após a discussão, concluiu-se que ainda existem muitas necessidades não atendidas em relação à atenção à saúde da população com doenças alérgicas e imunológicas no Brasil. A ASBAI tem trabalhado no sentido de contribuir para organizar, implantar e manter a assistência a estes pacientes no âmbito do SUS.

The Brazilian Unified Health System covers all levels of health care and guarantees full, universal and free access for the entire population. The demographic and epidemiological transitions observed in recent decades have led to a higher prevalence of allergic diseases. In this context, implementing health policies to benefit these patients has become a challenge. To discuss health care for patients with allergic and immunological diseases in Brazil, the Brazilian Association of Allergy and Immunology (ASBAI) held a forum in São Paulo on August 26, 2022 called "Treating Patients with Allergic Diseases in the Unified Health System". The event's panels included members of ASBAI, representatives of the federal government, the attorney general's office, patients, and health professionals from various services with experience in successful programs for patients with allergic diseases. It was concluded that there are still many unmet health care needs for Brazilians with allergic and immunological diseases. ASBAI is contributing to the organization, implementation, and maintenance of care for these patients within the scope of the Unified Health System.