Dental consensus on HSCT - Part II: dental Care during HSCT

ABSTRACT During the state of immune vulnerability in hematopoietic stem cell transplantation (HSCT), the patient has an increased risk of developing a vast number of complications, including severe problems in the oral cavity. These situations require professional oral care to act in the diagnosis and treatment of these conditions, as well as to develop prevention protocols to minimize patient's complications. Oral mucositis, opportunistic infections, bleeding, specific microbiota, taste, and salivary alterations are complications that can occur during HSCT and interfere with various aspects, such as pain control, oral intake, nutrition, bacteremia and sepsis, days of hospitalization and morbidity. Several guidelines have been published to address the role of professional oral care during the HSCT, we describe a consensus regarding these recommendations.

Perfil de parámetros hematológicos en el HIV pediátrico y los cambios asociados al tratamiento antirretroviral / Hematological parameters profile in pediatric HIV and changes associated with antiretroviral treatment / Perfil de parâmetros hematológicos no HIV pediátrico e as alterações associadas ao tratamento anti-retroviral

Resumen Las alteraciones hematológicas son comunes durante la infección por el virus de la inmunodeficiencia humana (HIV). El objetivo de este trabajo fue describir los perfiles hematológicos e inmunológicos de niños infectados, antes y después de 36 meses de implementado el tratamiento antirretroviral (TARV). Se revisaron historias clínicas de niños expuestos, atendidos en este hospital en el período 2008-2018, con edades entre 6 meses y 14 años. Fueron empleados un contador hematológico (ADVIA 2120), un citómetro de flujo (FACScalibur BD) y una PCR en tiempo real Nuclisens EasyQ (bioMérieux). En 486 historias clínicas se encontraron 58 pacientes sin TARV, 30 por diagnóstico reciente y 28 por adherencia incorrecta o abandono de tratamiento. En ambos grupos se observó disminución porcentual de hemoglobina (Hb) (53% y 43%), volumen corpuscular medio (VCM) (43% y 7%) y LTCD4+ (37% y 57%), respectivamente, sin alteraciones significativas en otros parámetros hematológicos. Veintidós niños con correcta adherencia al TARV incrementaron significativamente los niveles de LTCD4+ (t0:18,8±9%, t1:32,7±6%), Hb (t0:10,9±1,6 g/dL, t1:12,6±1,1g/dL) y VCM (t0:78,7±4,5 fL, t1:101,9±5,6 fL), con disminución simultánea de la carga viral (CV) (t0:4,4±0,75 log t1:<1,70 log) después del seguimiento. La disminución de Hb observada aproximadamente en el 50% de los pacientes sin TARV estaría asociada a la acción viral y al tiempo de evolución de la infección. El incremento en los niveles, asociados a macrocitosis, se relacionaría con el aumento de LTCD4+ y disminución de la CV.

Abstract Hematologic abnormalities are common during human immunodeficiency virus (HIV) infection. Our aim was to describe hematological and immunological profiles present in antiretroviral treatment (ART)-naïve infected children and the changes observed after 36 months of ART initiation. Medical records of exposed children attended at this hospital in the 2008-2018 period were reviewed. Children between 6 months and 14 years were included. An automated blood analyser ADVIA 2120, a FACScalibur BD flow cytometer, and a Nuclisens EasyQ bioMérieux real-time PCR were used to determine different parameters. In 486 medical records evaluated, 58 patients ART-naïve were found, 30 due to recent diagnosis and 28 for incorrect adherence or abandoned treatment. In both groups, a percentage decrease in hemoglobin (Hb) (53% and 43%), mean corpuscular volume (MCV) (43% and 7%) and LTCD4+ (37% and 57%) levels respectively, was observed, without significant alterations in other hematological parameters. Twenty-two children with ART correct adherence increased significantly CD4+T cells (t0:18.8±9%, t1:32.7±6%), Hb (t0:10.9±1.6 g/dL, t1:12.6±1.1 g/dL) and MCV (t0:78.7±4.5 fL, t1:101.9±5.6 fL) levels, with simultaneous decrease of viral load (VL), (t0:4.4±0.75 log, t1:<1.70 log), after 36 months of follow-up. The reduction in Hb levels observed in 50% approximately of patients without ART would be associated with viral action and time of evolution of the infection. The increase in Hb levels and an associated macrocytosis would be related to the CD4+ T cells increase and VL decrease.

Resumo Alterações hematológicas são comuns durante a infecção pelo vírus da imunodeficiência humana (HIV). Nosso objetivo foi descrever os perfis hematológicos e imunológicos em crianças infectadas, antes e após 36 meses de implementar o tratamento antirretroviral (TARV). Foram revisados os prontuários das crianças expostas atendidas neste hospital no período 2008-2018, com idade entre 6 meses e 14 anos. Um contador hematológico (ADVIA 2120), um citômetro de fluxo (FACScalibur BD) e um PCR em tempo real Nuclisens EasyQ (bioMérieux), foram usados. Em 486 prontuários foram encontrados 58 pacientes livres de TARV, 30 por diagnóstico recente e 28 por adesão incorreta ou abandono do tratamento. Em ambos os grupos, observou-se diminuição percentual de hemoglobina (Hb) (53% e 43%), volume corpuscular médio (VCM) (43% e 7%) e LTCD4+ (37% e 57%), respectivamente, sem alterações significativas nos demais parâmetros hematológicos. Vinte e duas crianças com adesão correta ao TARV aumentaram significativamente os níveis de LTCD4+ (t0:18,8±9%, t1:32,7±6%), Hb (t0:10,9±1,6 g/dL, t1:12,6±1,1 g/dL) e VCM (t0:78,7±4,5 fL, t1:101,9±5,6 fL), com diminuição simultânea da carga viral (CV) (t0:4,4±0,75 log, t1:<1,70 log), depois do seguimento. A diminuição dos níveis de Hb observada em aproximadamente 50% dos pacientes sem TARV estaria associada à ação viral e ao tempo de evolução da infecção. O aumento nos níveis, associados a macrocitose, estaria relacionado com o aumento de LTCD4+ e diminuição da CV.

Frequency and type of alterations during medical interpretation by trained healthcare interpreters / 国際保健医療

Objective  This study aimed to identify the types, frequency, and clinical significance of altered interpreta-tion in clinical settings.Methods  Routine outpatient encounters involving Portuguese-speaking Brazilian patients, Japanese doctors, and hospital-provided interpreters were digitally recorded and transcribed. Segments of consecutively interpreted utterances were coded as “altered,” in which the interpreter changed the meaning of the source utterance, or “unaltered (accurate),” and the types and frequency of occurrence were analyzed. Altered interpretations were categorized as clinically negative or positive and classified into four categories: omission, addition, substitution, or voluntary intervention. Incidents resulting from alterations were investigated. Reliability was assessed by examining the correlation between random independently coded samples.Results  In total, 111 encounters were analyzed. The mean segments per encounter was 67.9 (range 14-186), and the mean frequency (standard deviation) of altered interpretations per 100 segments was 46.7 (14.3) for accurate interpretations; 46.1 (17.9) for negative or not significant alterations, including 27.2 (10.3) for omissions, 6.0 (5.0) for additions, 10.4 (6.9) for substitutions, and 2.5 (2.7) for voluntary interventions; 0.0 (0.2) for alterations potentially leading to an incident; and 26.2 (11.9) for positive alterations, including 1.8 (2.6) for positive omissions, 7.7 (4.7) for positive additions, 7.8 (6.3) for positive substitutions, and 8.8 (5.2) for positive voluntary interventions. The frequency of negative alterations was weakly negatively correlated with number of segments per minute (r＝−0.339). Conclusion  Trained healthcare interpreters with fewer clinically significant altered interpretations were effective. Professional medical providers should recognize the importance of positive alterations by healthcare interpreters and collaborate with them to provide safe medical care for foreign patients. To facilitate the provision of appropriate medical care to a growing foreign population with diverse cultural and linguistic needs, undergraduate medical education should teach aspiring medical professionals how to collaborate with healthcare interpreters and foreign patients.

Improving the prognosis of pancreatic cancer: insights from epidemiology, genomic alterations, and therapeutic challenges / 医学前沿

Pancreatic cancer, notorious for its late diagnosis and aggressive progression, poses a substantial challenge owing to scarce treatment alternatives. This review endeavors to furnish a holistic insight into pancreatic cancer, encompassing its epidemiology, genomic characterization, risk factors, diagnosis, therapeutic strategies, and treatment resistance mechanisms. We delve into identifying risk factors, including genetic predisposition and environmental exposures, and explore recent research advancements in precursor lesions and molecular subtypes of pancreatic cancer. Additionally, we highlight the development and application of multi-omics approaches in pancreatic cancer research and discuss the latest combinations of pancreatic cancer biomarkers and their efficacy. We also dissect the primary mechanisms underlying treatment resistance in this malignancy, illustrating the latest therapeutic options and advancements in the field. Conclusively, we accentuate the urgent demand for more extensive research to enhance the prognosis for pancreatic cancer patients.

Relationship between pain, functional limitations, dependence, depression and osteoarthritis in older adults / Relação da dor, limitação funcional, dependência e depressão com a osteoartrite em idosos

Abstract Introduction Knee osteoarthritis (KOA) is a prevalent pathology in older adults, with physical, social and psychological impacts that reduce their quality of life. Objective Analyze the correlation between KOA in older individuals and biopsychosocial aspects such as pain, functional limitation, dependence, anxiety and depression. Methods A systematic review of English and Portuguese articles published on the Cochrane Library, PUBMED/MEDLINE, SciELO and Web of Science databases between 2016 and 2021, selected according to inclusion and exclusion criteria. Results After cross-checking specific to each database, studies were selected by reading the title (2,304), abstract (136) and full article (72), with 30 ultimately included based on the eligibility criteria. Conclusion Knee osteoarthritis has a significant negative impact on patients' lives and is correlated with pain, functional limitation, dependence, anxiety and depression, compromising interpersonal relationships, physical and mental status and causing disability due to chronic pain, making osteoarthritis (OA) a public health issue with a high financial, physical and emotional cost for patients.

Resumo Introdução A osteoartrite de joelho é uma patologia prevalente em idosos, impactando suas vidas em um contexto físico, social e psicológico, o que ocasiona redução na qualidade de vida desses indivíduos. Objetivo Analisar a correlação entre a osteoartrite de joelho em idosos e aspectos biopsicossociais como dor, limitação funcional, dependência, ansiedade e depressão. Métodos Revisão sistemática de artigos publicados nas bases de dados Cochrane Library, PUBMED/MEDLINE, SciELO e Web of Science, entre 2016 e 2021, em português e inglês. Após isso, realizou-se a seleção dos artigos de acordo com os critérios de inclusão e exclusão. Resultados Após cruzamentos específicos em cada base, selecionaram-se os artigos por meio da leitura do título (2.304), do resumo (136) e do artigo na íntegra (72). Assim, 30 artigos foram selecionados de acordo com os critérios de elegibilidade. Conclusão Confirmou-se que a osteoartrite de joelho impacta negativamente a vida dos pacientes e está correlacionada com dor, limitação funcional, dependência, ansiedade e depressão, prejudicando as relações interpessoais, afetando condições físicas e mentais e gerando incapacidade devido à dor crônica, tornando a osteoartrite uma questão de saúde pública de alto custo financeiro, físico e emocional aos pacientes.

Multiparametric flow cytometry directing the evaluation of CRLF2 rearrangements and JAK2 status in pediatric B cell precursor acute lymphoblastic leukemia

Asbtract Introduction This study aimed to determine whether cytokine receptor-like factor 2 (CRLF2) antigen expression evaluated using multiparametric flow cytometry (MFC) could predict the genotype of CRLF2 and Janus kinase 2 (JAK2) status for application in the diagnosis of pediatric B-cell precursor acute lymphoblastic leukemia (BCP-ALL). Methods A total of 321 BCP-ALL bone marrow samples were collected, 291 at diagnosis and 13 at first relapse, while 17 samples were excluded due to low cellular viability. The CRLF2 antigen expression was evaluated using flow cytometry (percentage of positivity and median fluorescence intensity [MFI]). The CRLF2 transcript levels were assessed via quantitative reverse transcription polymerase chain reaction using SYBR Green. The CRLF2 rearrangements (CRLF2-r) were identified using the CRLF2 break-apart probe via fluorescence in situ hybridization. Sanger sequencing was performed to identify the JAK2 exon 16 mutations. Results We observed that 60 of the 291 cases (20.6%) presented CRLF2 antigen positivity, whereas the CRLF2 transcript overexpression was found in 19 of 113 cases (16.8%). The JAK2 mutation was found in four out of 116 cases (3.4%), all of which had CRLF2 ≥10% of positive cells and intermediate or high MFI (p < 0.0001). In addition, in the 13 cases with the CRLF2-r, a positive correlation was found with the CRLF2 antigen intermediate (61.5%) MFI (p= 0.017). Finally, the CRLF2-positive antigen was identified in the BCP-ALL subclones. Conclusion The identification of the CRLF2 antigen using the MFC, based on the percentage of positivity and MFI values, is a useful tool for predicting JAK2 mutations and CRLF2-r.

Vestibular assessment in children aged zero to twelve years: an integrative review

Abstract Objective: To describe the main vestibular assessment tests performed in children aged zero to twelve years and the main causes of referral for vestibular assessment. Methods: The review was guided by the following question: What are themain vestibular assessment tests performed in children aged zero to twelve years and the main causes of referral for vestibular assessment? The PVO strategy was used, being defined as: Population (P) - newborns and children; study Variable (V) - causes of referral for vestibular assessment; study Outcome (O): the main vestibular assessment tests and the main findings. This study was carried out using the main available databases in the months of July, August and September 2021, with no restrictions regarding language and publication date, namely: PubMed, Web of Science, Scientific Electronic Library Online (SciELO), Latin-American and Caribbean Literature in Health Sciences (LILACS), ScienceDirect, Cochrane Library and Embase. The descriptors were obtained from the MeSH database: newborn, infant, child, children, vestibular screening, vestibular infant screening, vestibular newborn screening, test, vestibular function, vestibular function test. Results: A total of 7,078 studies were identified. After reading the titles and abstracts, 107 of them were selected, with 101 remaining after the exclusion of duplicates. After the full-text reading, 31 articles were included. It was observed that the most frequently used tests were: rotational tests, caloric stimulation and cervical vestibular evoked myogenic potential and the main causes of referral for vestibular evaluation were hearing loss and vestibular screening. Conclusion: The main tests for vestibular screening and/or assessment of children aged zero to twelve years are the rotary chair testing, caloric stimulation and cervical-vestibular evoked myogenic potential. Consequently, performing these procedures is extremely important, since the presence of vestibular dysfunction is quite common in the studied population.

Changes in somatosensory perception induced by trigeminal injury after Maxillofacial Surgical Procedures / Cambios en la percepción somatosensorial inducidos por lesiones trigeminales causadas por procedimientos quirúrgicos maxilofaciales

Abstract Evidence has been reported that shows that somatosensory perception can be altered by a trigeminal injury resulting from maxillofacial surgical procedures. However, the surgical procedures that most frequently cause trigeminal lesions and the risk factors are unknown. In the same way, there is little information on what has been determined in preclinical models of trigeminal injury. This article integrates relevant information on trigeminal injury from both clinical findings and primary basic science studies. This review shows that the age and complexity of surgical procedures are essential to induce orofacial sensory alterations.

Resumen Se han reportado evidencias que demuestran que la percepción somatosensorial puede ser alterada por la lesión trigeminal producto de procedimientos quirúrgicos maxilofaciales. Sin embargo, se desconoce cuáles son los procedimientos quirúrgicos que más frecuentemente producen lesiones trigeminales, y los factores de riesgo. De la misma forma hay poca información sobre lo que se ha determinado en modelos preclínicos de lesión trigeminal. El objetivo de este artículo es integrar información relevante sobre la lesión trigeminal desde los hallazgos clínicos como los principales estudios de ciencia básica. Esta revisión demuestra que la edad y el tipo de procedimiento son fundamentales para inducir alteraciones sensoriales orofaciales, así como los procesos neurobiológicos que subyacen a estos padecimientos.

Técnicas de citogenética para el estudio de las leucemias / Cytogenetic techniques for the study of leukemias

Introducción: La leucemia se define como un proceso clonal de células hematopoyéticas, que se origina cuando las células sanguíneas que se producen en la médula ósea, cambian y se multiplican sin control. Esta se caracteriza por su heterogeneidad genética y se explica a través de mecanismos causados por alteraciones cromosómicas utilizados en la práctica clínica diaria como biomarcadores útiles para el diagnóstico, el pronóstico o la predicción de respuesta al tratamiento. Objetivo: Describir las técnicas de citogenética convencional y molecular para el diagnóstico y seguimiento de las leucemias. Métodos: Se realizó una revisión de la literatura en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google Académico, de artículos publicados en los últimos cinco años. Se hizo un análisis y resumen de la bibliografía revisada. Análisis y síntesis de la información: En el transcurso de los años la citogenética ha proporcionado información crucial para el diagnóstico y el pronóstico de las neoplasias hematológicas. Tanto las técnicas de citogenética convencional y molecular, como la hibridación in situ fluorescente, la hibridación in situ fluorescente multicolor, el cariotipo espectral, la hibridación genómica comparada y los microarreglos, participan en el reconocimiento de alteraciones cromosómicas y de genes, así como de interacciones involucradas en el proceso de oncogénesis. Conclusiones: Las técnicas de citogenética contribuyen al diagnóstico, a la estratificación pronóstica y a la aplicación del tratamiento según el tipo o subtipo de leucemia(AU)

Introduction: Leukemia is defined as a clonal process of hematopoietic cells, which occurs when blood cells that are produced in the bone marrow change and multiply uncontrollably. This is characterized by its genetic heterogeneity and is explained through mechanisms caused by chromosomal alterations that are used in daily clinical practice as useful biomarkers for diagnosis, prognosis or prediction of response to treatment. Objective: To describe the conventional and molecular cytogenetic techniques used for the diagnosis and monitoring of leukemias. Methods: A review of the literature in English and in Spanish was carried out, in the PubMed website and using the search engine Google, for articles published in the last five years. We performed analysis and summary of the reviewed bibliography. Analysis and synthesis of information: Cytogenetics over the years has provided crucial information for the diagnosis and prognosis of hematologic malignancies. Both conventional and molecular cytogenetic techniques such as fluorescent in situ hybridization, multicolor fluorescent in situ hybridization, spectral karyotype, comparative genomic hybridization and microarrays, participate in the recognition of chromosomal and gene alterations, as well as interactions involved in the oncogenesis process. Conclusions: These cytogenetic techniques contribute to the diagnosis, prognostic stratification and application of treatment according to the type or subtype of leukemia(AU)

Association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone / Relação entre a influência da gravidade da apneia obstrutiva do sono e alterações craniofaciais e do posicionamento do osso hioide

Abstract Introduction The association between the intensity of obstructive sleep apnea and skeletal alterations in the face and hyoid bone is still scarcely addressed in the literature. Objective To evaluate whether the intensity of obstructive sleep apnea is associated with craniofacial alterations and the position of the hyoid bone in children with mixed dentition. Methods 76 children aged 7 to 10 years old were examined by otorhinolaryngological evaluation, polysomnography, and orthodontic assessment, including cephalometry. The participants were divided in 3 groups: primary snoring, mild obstructive sleep apnea and moderate to severe obstructive sleep apnea. Cephalometric measures of the face and hyoid bone were assessed. These measures were compared among the different groups by unpaired Student's t test. Moreover, these measures were correlated with the patient's obstructive apnea and hypopnea index variable using Pearson's correlation test. Results Of the 76 children, 14 belonged to group 1, with primary snoring; 46 to group 2, with mild obstructive sleep apnea; and 16 to group 3, with moderate-severe obstructive sleep apnea. There was no difference between the groups regarding the craniofacial variables. Children with obstructive sleep apnea showed a longer distance from the hyoid bone to the mandibular plane when compared to the primary snoring group (p < 0.05). Between the two obstructive sleep apnea subgroups, patients with moderate or severe disease showed significantly shorter horizontal distance between the hyoid bone and the posterior pharyngeal wall (p < 0.05), when compared to the groups with mild obstructive sleep apnea. We also observed a significant positive correlation between obstructive apnea and hypopnea index and the distance from the hyoid to the mandibular plane (p < 0.05) as well as a significant negative association between obstructive apnea and hypopnea index and the horizontal distance from the hyoid to the posterior pharyngeal wall (p < 0.01). Conclusion We did not observe any association between obstructive sleep apnea and linear lateral alterations of the face. In contrast, there is a direct association between obstructive sleep apnea severity and the inferior and posterior position of the hyoid bone in children aged 7 to 10 years old.

Resumo Introdução A relação entre a intensidade da apneia obstrutiva do sono e alterações esqueléticas da face e do hioide em crianças é pouco explorada na literatura. Objetivo Avaliar se a intensidade da apneia obstrutiva do sono correlaciona-se às alterações craniofaciais e ao posicionamento do osso hioide em crianças em fase de dentição mista. Método Foram submetidas 76 crianças entre 7 e 10 anos à avaliação otorrinolaringológica, polissonografia e avaliação ortodôntica, inclusive cefalometria. Os participantes foram divididos em 3 grupos: grupo 1 com ronco primário, grupo 2 com apneia obstrutiva do sono leve e grupo 3 com apneia obstrutiva do sono moderada/grave. Foram analisadas medidas cefalométricas da face e do osso hioide. Essas medidas foram comparadas entre si dentro dos diferentes grupos por teste t de Student não pareado. Além disso, essas medidas foram correlacionadas com a variável índice de apneias obstrutivas e hipopneias do paciente através do teste de correlação de Pearson. Resultados Das 76 crianças, 14 constituíram o grupo 1, ronco primário; 46 o grupo 2, apneia obstrutiva do sono leve; e 16 o grupo 3, apneia obstrutiva do sono moderada/grave. Não se observou diferença significante entre os grupos para as variáveis craniofaciais. Observou-se maior distância do osso hioide ao plano mandibular nos dois grupos com apneia obstrutiva do sono quando comparado ao ronco primário (p < 0,05). Entre os dois subgrupos da apneia obstrutiva do sono, os pacientes com doença moderada ou grave apresentaram distância horizontal entre o hioide e a parede posterior da faringe significantemente menor (p < 0,05), quando comparados aos grupos com apneia obstrutiva do sono leve. Observamos ainda correlação significantemente positiva entre índice de apneias obstrutivas e hipopneias e a distância do hioide ao plano mandibular (p < 0,05) e significantemente negativa entre índice de apneias obstrutivas e hipopneias e distância horizontal do hioide com a parede posterior da faringe (p < 0,01). Conclusão Não observamos relação da apneia obstrutiva do sono com alterações lineares laterais da face. Em contraste, existe relação direta entre a gravidade da apneia obstrutiva do sono e a posição inferior e posterior do osso hioide em crianças entre 7 e 10 anos.

Versatility of berberine as an effective immunomodulator and chemo sensitizer against p53 mutant cell

Cancer is the leading cause of death among individuals due to its poor prognosis. Various therapeutics treatments are available in form radiation therapy, chemotherapy, or immunotherapy but major point of concern is the treatment of cancer resistant cell lines. Homozygous loss of the p53 gene is virtually present in every type of cancer. Mutation in DNA binding domain of p53 leads to formation of mutant forms having altered amino acid sequence which lacks DNA binding activity. Berberine is chemo-sensitizing isoquinoline quaternary alkaloid molecule obtained from Berberis vulgaris. Berberine has the capability to suppress the growth of broad range of tumors. It exhibits pharmacological, biochemical and anticancer properties which can potentiate the activities of the existing therapeutics available in a way that it can re-sensitize the cancer resistant clones. Berberine has an immanent potential to bind with DNA and can communicate with several cellular targets, further it also shows hormetic effect which refers to biphasic dose response curve in order to determine dose dependent stimulatory and inhibitory effect. Mode of action involved is yet not well understood but mechanistic pathway involved are autophagy, up-regulation of tumor-suppressor gene (p53) and epigenetic alterations in the viral DNA. In this review, versatility of berberine can be utilized ideally or in combination with chemotherapeutics drugs to potentiate chemo sensitization of the resistant cancer cell line. Further, cancer cell specific receptor targeting can also be employed in combination with berberine for therapeutic treatment of metastasizing cancer cells.

Consecuencias de la hipertensión arterial en las funciones cognitivas / Consequences of Arterial Hypertension over Cognitive Functions

Introducción: La hipertensión arterial, por su influencia y afectación multisistémica, surge como un factor de riesgo potencial para el deterioro progresivo de las funciones cognitivas. Objetivo: Identificar las principales alteraciones cognitivas asociadas a la hipertensión arterial, específicamente en la atención y la memoria. Métodos: Se realizó revisión bibliográfica retrospectiva de 34 estudios, teniendo en cuenta los criterios de inclusión. Se estableció una ventana temporal en el período 2002 al 2019, incluyendo las bases de datos Pubmed, Scopus, Medline y SciELO. Los textos completos se sometieron a una lectura crítica y análisis documental mediante una matriz de rastreo. Conclusiones: Una de las consecuencias más importantes de esta enfermedad es la afectación en las funciones cognitivas particularmente la atención y la memoria, con una incidencia en el deterioro cognitivo leve, profundo y medio. Sin embargo, su impacto en la cognición es un área que recientemente ha despertado el interés en la neuropsicología y la neurociencia cognitiva. La hipertensión arterial está considerada como una de las enfermedades cardiovasculares que está vinculada con la demencia, proporciona en un 50 por ciento el desarrollo de dicha enfermedad(AU)

Introduction: Arterial hypertension, due to its influence and multisystemic involvement, emerges as a potential risk factor for the progressive deterioration of cognitive functions. Objective: To identify the main cognitive alterations associated with arterial hypertension, specifically in attention and memory. Methods: A retrospective literature review of 34 studies was carried out, taking into account inclusion criteria. A time window was established from 2002 to 2019, including the PUBMED, SCOPUS, MEDLINE and SCIELO databases. The full texts were subjected to critical reading and documental analysis using a tracking matrix. Conclusions: One of the most important consequences of this disease is the negative impact on cognitive functions, particularly attention and memory, with an incidence in mild, profound and medium cognitive impairment. However, its impact on cognition is an area that has recently aroused interest in neuropsychology and cognitive neuroscience. Arterial hypertension is considered one of the cardiovascular diseases linked to dementia, since it causes the development of this disease in 50 percent of cases(AU)

Alterações hepáticas em transplantados renais do maior centro de transplante do Brasil / Hepatic alterations in kidney transplant recipients from the largest kidney transplant center in brazil

ABSTRACT Background Kidney transplant is the treatment of choice for patients with end-stage renal disease and is associated with lower mortality when compared to dialysis methods. Brazil is the country with the second largest number of kidney transplants in the world and among these patients it has been observed that liver abnormalities are common. The frequency of liver abnormalities ranges from 20-50% post-transplantation, and have an important impact on the survival and quality of life of these patients. There are scarce data about the frequency, causes and characteristics of these alterations. Objective To determine the prevalence of the different causes of hepatic abnormalities in kidney transplant recipients, to associate the characteristics of these abnormalities with demographic, epidemiological and clinical variables, to compare the characteristics of hepatic alterations between different etiologies, and to evaluate possible changes in diagnosis over two different periods of time. Methods Descriptive, cross-sectional observational, epidemiological study was conducted at the outpatient "Hepato-Rim"clinic of Hospital São Paulo (EPM/UNIFESP), a center providing specialized care for patients with hepatic abnormalities and underlying kidney diseases. Results Five-hundred eighty-one transplant patients were evaluated. The most prevalent etiologies of liver abnormalities were hepatitis C and B, iron overload, nonalcoholic fatty liver disease (NAFLD), and drug-induced liver injury (DILI). The most common cause — hepatitis C — was analyzed in greater detail. Compared to the other causes, this infection was more frequent in older patients, female patients, and patients with a longer time since transplantation and hemodialysis. Analysis of the two periods showed that patients of period 1 (P1 — 1993 to 2005) were older and were more frequently referred because of positive serology; referral due to aminotransferases abnormalities predominated during period 2 (P2 — 2006 to 2018). The predominant diagnoses were hepatitis C and B during P1 and NAFLD and DILI during P2. Conclusion Assessment of the main hepatic alterations in kidney transplant recipients is important because it permits better management of these patients in terms of diagnostic investigation and treatment and contributes to the prevention of complications in this special population.

RESUMO Contexto O transplante renal é o tratamento de escolha para pacientes com doença renal terminal e está associado a menor mortalidade quando comparado aos métodos dialíticos. O Brasil é o país com o segundo maior número de transplantes renais do mundo e, entre esses pacientes, observa-se que as alterações hepáticas são comuns. A frequência das alterações hepáticas varia de 20 a 50% pós-transplante e tem importante impacto na sobrevida e qualidade de vida desses pacientes. Existem poucos dados sobre a frequência, causas e características dessas alterações. Objetivo Determinar a prevalência das diferentes causas de anormalidades hepáticas em receptores de transplante renal, associar as características dessas anormalidades a variáveis demográficas, epidemiológicas e clínicas, comparar as características das alterações hepáticas entre diferentes etiologias e avaliar possíveis alterações no diagnóstico em dois períodos diferentes de tempo. Métodos Estudo epidemiológico descritivo, transversal, observacional, realizado no ambulatório "Hepato-Rim" do Hospital São Paulo (EPM/UNIFESP), centro de atendimento especializado a pacientes com anormalidades hepáticas e doenças renais de base. Resultados Quinhentos e oitenta e um pacientes transplantados foram avaliados. As etiologias mais prevalentes de anormalidades hepáticas foram hepatite C e B, sobrecarga de ferro, doença hepática gordurosa não alcoólica e lesão hepática induzida por drogas. A causa mais comum — hepatite C — foi analisada em maiores detalhes. Em comparação com as outras causas, essa infecção foi a mais frequente em pacientes mais velhos, pacientes do sexo feminino e pacientes com mais tempo de transplante e hemodiálise. A análise dos dois períodos mostrou que os pacientes do período 1 (P1 — 1993 a 2005) eram mais velhos e encaminhados com maior frequência devido à sorologia positiva; encaminhamento devido a anormalidades de aminotransferases predominou durante o período 2 (P2 — 2006 a 2018). Os diagnósticos predominantes foram hepatite C e B durante P1 e doença hepática gordurosa não alcoólica e lesão hepática induzida por drogas durante P2. Conclusão A avaliação das principais alterações hepáticas em receptores de transplante renal é importante, pois permite melhor manejo desses pacientes na investigação diagnóstica e no tratamento e contribui para a prevenção de complicações nesta população especial.

Evaluation of aversive behavior in Rattus norvegicus experimentally infected by two distinct strains of Toxoplasma gondii (ME49 and VEG): study of epigenetic markers

ABSTRACT Background: Behavioral changes in Rattus norvegicus infected with two strains of Toxoplasma gondii (ME49 and VEG) were investigated. Methods: Rats were evaluated for motor activity and aversion or attraction to cat urine 60 days after infection. After euthanasia, arginine-vasopressin gene methylation in the central nervous system was evaluated. Results: A significant difference was observed in the methylation of the arginine-vasopressin promoter gene between rats infected with the ME49 and VEG strains. Conclusions: Although differences were not observed in many parameters, significant differences were observed in the methylation of the arginine-vasopressin promoter gene in rats infected with the two studied strains.

Asymptomatic HIV-Infected Patients Present Blood Parameters Changed, According to Use of Therapy and the CD4+ T Cells Count

Abstract In HIV-patients, the imbalance in immunological, hematological and biochemical factors can contribute to the progression to AIDS and non-AIDS comorbidities, even during combined antiretroviral therapy (cART). In this cross-sectional study, we aimed to analyze some of these parameters in 138 different asymptomatic HIV-infected patients, doing multiple comparisons between the groups, which are dichotomized in the presence / absence of cART and type of immune response (immunological responders [iR,>500cells/mL] or non-responders [iNR,<500cells/ mL]). Were analyzed cytokines and other routine laboratory parameters. Our results showed high creatine phosphokinase and low IL-10 levels in cART-patients. They also presented metabolic alterations, including elevations in total cholesterol and triglycerides, particularly in those iNR. In ART-iR an increased alanine aminotransferase was observed. Those NAÏVE-iNR presented high LDL-cholesterol, C-reactive protein and lactate dehydrogenase values. The long-term non-progressors (LTNP) showed the best laboratory results. In conclusion, many blood parameters were changed in HIV-patients, especially in those under cART. To identify LTNP individuals could be important to discussions their early therapeutic onset.

Síndrome de Gardner: informe de un caso y revisión de la literatura / Gardner syndrome: case report and literature review

El síndrome de Gardner es una enfermedad genética de herencia autosómica dominante, presenta múltiples manifestaciones craneofaciales caracterizadas por hipercrecimientos óseos conocidos como osteomas, riesgo de desarrollo de pólipos gastrointestinales con alto potencial de malignidad y de tumores o quistes en piel, así como alteraciones dentales, entre las que destacan la presencia de dientes supernumerarios, retenciones dentarias, permanencia de dientes deciduos y odontomas, estas últimas de gran importancia para el odontólogo. Se trata de una enfermedad que afecta a mujeres y hombres de forma indistinta, no obstante, su prevalencia es mayor en el sexo femenino. El objetivo del presente artículo es explicar las manifestaciones clínicas y radiográficas dentales y craneofaciales del síndrome de Gardner mediante la presentación de un caso clínico y revisión de la literatura (AU)

Gardner syndrome is a genetic disease of autosomal dominant inheritance, it presents multiple craniofacial manifestations characterized by bone overgrowths known as osteomas, risk of development of gastrointestinal polyps with high potencial of malignancy, and skin tumors or cysts, as well as dental alterations, among the characteristics of the presence of supernumerary teeth, dental retention, permanence of deciduous teeth and odontomas, the latter of great importance for the dentist. It is a disease that affects women and men indistinctly, however, its prevalence is higher in the female sex. The aim of this article is to explain the dental and craniofacial clinical and radiographic manifestations of Gardner syndrome by presenting a clinical case and a review of the literature (AU)

Aggregation of hepatic melanomacrophage centers in S. herzbergii (Pisces, Ariidae) as indicators of environmental change and well-being / [Agregação de centros de melanomacrófagos hepáticos em S. herzbergii (Pisces, Ariidae) como indicadores de mudança ambiental e de bem-estar]

The melanomacrophage centers (MMCs) in the liver of fish are indicators of environmental conditions, as they are involved in xenobiotic biotransformation. The objective of this study was to evaluate the number of MMC in the liver of juveniles and adults of Sciades herzbergii from areas with different levels of contamination. The fish were caught at three points (reference - A1, potentially impacted - A2 and contaminated - A3), in São José bay (Maranhão, Brazil), in four samples. The livers were subjected to the standard histological procedure and 5µm sections were stained with hematoxylin-eosin. In livers of A2 adult individuals (260.50±161.50 MMCs / mm²) they presented a greater number of MMCs when compared to A3 adults (60.00 ± 30.10 MMCs / mm²). Juveniles showed considerable values in A1 (100.00 ± 0.00 MMCs/mm²) and A2 (95.33 ± 33.00 MMCs / mm²) compared to juveniles in A3 (49.00±0.00 MMCs/mm²). These high values are unexpected for young people. The average number of MMC correlated with the rainy season in the region. The use of hepatic MMCs as a biomarker of exposure to pollutants, in particular substances from fisheries systems, such as ammonia and nitrite, proved to be adequate to differentiate areas with different levels of impacts.(AU)

Os centros melanomacrófagos (MMCs) no fígado de peixes são indicadores das condições ambientais, pois estão envolvidos na biotransformação xenobiótica. O objetivo deste estudo foi avaliar o número de MMC no fígado de juvenis e adultos de Sciades herzbergii de áreas com diferentes níveis de contaminação. Os peixes foram capturados em três pontos (referência - A1; potencialmente impactado - A2; e contaminado - A3), na baía de São José (Maranhão, Brasil), em quatro amostras. Os fígados foram submetidos ao procedimento histológico padrão e cortes de 5µm foram corados com hematoxilina-eosina. Em fígados de indivíduos adultos A2 (260,50±161,50 MMCs/mm²), eles apresentaram maior número de MMCs quando comparados aos adultos A3 (60,00±30,10 MMCs/mm²). Os juvenis apresentaram valores elevados em A1 (100,00 ± 0,00 MMCs/mm²) e A2 (95,33±33,00 MMCs/mm²) quando comparados aos juvenis em A3 (49,00±0,00 MMCs/mm²). Esses altos valores são inesperados para os jovens. O número médio de MMC correlacionou-se com a época chuvosa na região. A utilização de MMCs hepáticos como biomarcador de exposição a poluentes, em particular substâncias provenientes de sistemas pesqueiros, como amônia e nitrito, mostrou-se adequada para diferenciar áreas com diferentes níveis de impactos.(AU)

Hernia diafragmática: Un desafío diagnóstico / Diaphragmatic Hernia: A Diagnostic Challenge

Introducción: La hernia diafragmática traumática es una complicación grave del traumatismo abdominal o torácico. Se considera una entidad poco frecuente. El diagnóstico es difícil y, a menudo, puede pasar inadvertido. Objetivo: El propósito de este caso clínico es demostrar la necesidad de sospechar la presencia de hernia diafragmática en los pacientes con trauma toracoabdomial. Presentación del Caso: Paciente de 75 años que sufre accidente de tránsito, con evaluación inicial sin alteraciones clínico-radiológicas, que posteriormente presentan evolución desfavorable con hallazgo radiográfico de una hernia diafragmática traumática. Conclusiones: La hernia diafragmática cuando se presenta constituye un verdadero reto para el diagnóstico por parte del personal médico; pues esta requiere de un alto índice de sospecha y el uso adecuado de las imágenes diagnósticas. Se considera una entidad importante para la evaluación del paciente traumatizado(AU)

Introduction: Traumatic diaphragmatic hernia is a serious complication of abdominal or thoracic trauma. It is considered a rare pathology. The diagnosis is difficult and can often go unnoticed. Objective: The purpose of this clinical case is to demonstrate the need to suspect the presence of diaphragmatic hernia in patients with thoracoabdomial trauma. Case Presentation: Seventy-five-year-old patient who suffers a traffic accident. At initial evaluation no clinical-radiological alterations were observed, but later the patient presented an unfavorable evolution with radiographic finding of a traumatic diaphragmatic hernia. Conclusions: Diaphragmatic hernia, when present, is a real challenge for the diagnosis by the medical staff since it requires a high index of suspicion and an adequate use of diagnostic images. It is considered an important entity in the evaluation of the trauma patient(AU)

Leucemia linfoide crónica: aspectos citogenéticos y moleculares / Chronic Lymphoid Leukemia: cytogenetic and molecular aspects

Introducción: La leucemia linfoide crónica es un trastorno linfoproliferativo caracterizado por la acumulación de linfocitos pequeños de aspecto maduro en sangre periférica, médula ósea y tejidos linfoides con un período de vida prolongado. Presenta una gran variabilidad clínica y genética. Objetivo: Describir los aspectos citogenéticos y moleculares de la leucemia linfoide crónica. Métodos: Se realizó revisión de la literatura en inglés y español, a través del sitio web PubMed y el motor de búsqueda Google académico, de artículos publicados en los últimos 5 años. Se hizo un análisis y resumen de la bibliografía revisada. Desarrollo: En la leucemia linfoide crónica están presentes alteraciones citogenéticas frecuentes como la deleción de los cromosomas 13q, 11q y 17p, así como la trisomía 12, que unido al conocimiento del estado mutacional del gen de la región variable de la cadena pesada de la inmunoglobulina, y otras mutaciones somáticas en diferentes genes, así como a variables clínicas y de laboratorio permiten la estratificación pronóstica de los pacientes. Conclusiones: El diagnóstico a través de los estudios citogenéticos convencionales estimulados con mitógenos, la hibridación in situ por fluorescencia y la secuenciación génica permite una mayor comprensión de la biología de la enfermedad, así como tomar decisiones terapéuticas más personalizadas(AU)

Introduction: Chronic B lymphoid leukemia is a lymphoproliferative disorder characterized by the accumulation of small, mature-looking lymphocytes in peripheral blood, bone marrow and lymphoid tissues with a long life span. It has great clinical and genetic variability. Objective: To describe the cytogenetic and molecular aspects of the disease. Methods: A review of the literature in English and in Spanish was carried out, in the PubMed website and using the search engine of Google Scholar, for articles published in the last five years. We performed analysis and summary of the reviewed bibliography. Development: In chronic lymphoid leukemia, frequent cytogenetic alterations are present such as deletion of chromosomes 13q, 11q and 17p, as well as trisomy 12, which together with the knowledge of the mutational status of the gene for the variable region of the immunoglobulin heavy chain and other somatic mutations in different genes, as well as clinical and laboratory variables allows prognostic stratification of patients. Conclusions: Diagnosis through conventional mitogen-stimulated cytogenetic studies, fluorescence in situ hybridization and gene sequencing allow a better understanding of the biology of the disease, as well as making more personalized therapeutic decisions(AU)

Auditive and Vestibular Changes Related to the Use of Hydroxychlorochine and Chlorochine: An Integrative Review

Abstract Introduction The use of hydroxychloroquine and chloroquine is formally indicated in cases of chronic autoimmune diseases. However, the use of these medications has already been associated with possible transitory or definitive alterations in hearing function and/or vestibular function in humans, when administrated in the short and long terms. Objective To describe, through a literature analysis, the functional vestibular and/or hearing alterations, caused by the use of hydroxychloroquine and chloroquine in youths and adults. Data Synthesis In total, 2,481 studies were identified in the initial search: out of these 32 were selected for a full-text reading, and 9 were selected after the exclusion of those which did not meet the eligibility criteria. Of these, four articles pointed to the presence of vestibular and auditory-associated alterations, three indicated only auditory pathologies, and two, vestibular disorders. Regarding the auditory alterations, tinnitus was the most frequent symptom, and bilateral sensorineural hearing loss was described in most studies, varying in degree from mild to severe. As for the vestibular alterations, vertigo was the most reported symptom. Conclusion Knowledge of the auditory and vestibular effects after the use of these substances can help in the decision regarding the best treatment, enabling the consideration of other available therapies for patients at risk of suffering those alterations, reducing the risk of auditory and vestibular disorders.