Pseudotumor of the Maxillary Sinus in a Child with Von Willebrand Disease.

Introduction: Mandibular pseudotumors, also known as blood cysts, are rare complications which occur more frequently in patients with an associated bleeding disorder such as hemophilia. Case Report: We present a case of a 2-year and 6-month-old patient with a hemophilic pseudotumor associated with Von Willebrand's disease, who consulted the emergency room due to spontaneous increase in volume of the left maxillary region, with no previous relevant medical history. Conclusions: Different imaging studies were carried out to characterize the lesion, providing the necessary information for the correct approach. Due to the low prevalence of this complication, we believe it is of vital importance to understand the adequate management in this patient population.

Prevalence of Juvenile Osteochondral Conditions in Yearling Thoroughbred Racehorses in Southern Brazil.

This study aimed to investigate the prevalence of juvenile osteochondral conditions (JOCCs) in yearling Thoroughbred (TB) racehorses in Southern Brazil, as well as to examine the same animals studied as weanlings by Bastos et al. (2017) and compare the radiographic findings for the two ages. Radiographs of 76 male and female TB yearlings from Paraná State, Southern Brazil, were investigated. The proximal interphalangeal, metacarpophalangeal/metatarsophalangeal (MC/MT), tarsal, and femorotibial (FT) joints were evaluated using 24 radiographic projections. The evaluation consisted of a severity index (rated as 0, 1, 2, 4, or 8), the sum of which resulted in an osteoarticular status (OAS) of good, intermediate, or poor for each animal. Radiographs of 92% of the investigated animals presented at least one finding consistent with JOCCs. The most affected region was the tarsal joint (72.9%), followed by the FT (50%), MT (25%), and MC (23%) joints. Thirty-three (43.4%) horses presented a decline in their OAS, whereas nine (11.8%) presented an improvement from the weanling to yearling age. The radiographic findings suggest that JOCCs are frequent in TB yearlings, but the meaning and relevance of these radiographic findings require further study.

Pressuring of Acupoints as a Complement to the Diagnosis of Stifle Diseases in Horses.

Diseases of the stifle joint remain a challenge for veterinarians. The objective of this study was to achieve a valuable acupuncture suggestive diagnosis to be considered for stifle joint diseases in horses. Thirty-nine nonlame horses involved in different activities were assessed. Acupuncture was independently performed by two evaluators. Reactions of the animal when pressurizing the point suggestive of stifle disease (PSSD), Bladder-20 and/or Bladder-21, were considered as the inclusion criteria for inclusion in the stifle group (SG, n = 31), and the animals with no reactions were assigned to the control group (n = 8). Radiographic and ultrasonographic examinations were performed and evaluated by two independent professionals blinded to the group allocation. Thermographic examination of the PSSD and stifles was also performed, after acclimatization. The ultrasound scores and radiographic findings were higher in the SG than in the control group. Thermography evidenced increased temperature in the PSSD and stifles in the SG. The minimum acupuncture diagnostic criteria for stifle joint disease had a sensitivity of 87.5% and a specificity of 57.0%, and the addition of the acupoints Gallbladder-dorsal tuber coxae, Gallbladder-27, and Spleen-13 to the minimum diagnostic criteria improved sensitivity and specificity. In conclusion, assessing the reaction at the demonstrated acupoints can facilitate a diagnosis of a potential stifle lesion.

Recurrent superficial venous thrombophlebitis because of mutations in the protein C and fibrinogen genes in a young Argentinian female.

: Hypodysfibrinogenemia and protein C deficiency are coagulopathies and in this report, we describe a young patient with both defects confirmed by molecular genetic tests. The patient was a 24-year-old woman referred for recurrent thrombophlebitis and finally deep venous thrombosis. Routine coagulation studies revealed mild decrease of protein C (0.49 IU, reference values 0.7-1.40 IU) and hypodysfibrinogenemia (0.88 g/l and 1.83 g/l for activity and antigen, respectively, reference values 2.0-4.0 g/l). Direct sequencing analyses were performed on FGA, FGB, and FGG genes to confirm hypodysfibrinogenemia and on the protein C gene to confirm protein C deficiency. As a result, the patient was shown to be heterozygous p.Ala82Gly in the FGG gene (Fibrinogen Dunedin) and for compound heterozygous missense mutation in protein C gene. To our knowledge, this is the first report on a case of combined dysfibrinogenemia and protein C deficiency confirmed by molecular genetic tests.

Digital health for the End TB Strategy: developing priority products and making them work.

In 2014, the World Health Organization (WHO) developed the End TB Strategy in response to a World Health Assembly Resolution requesting Member States to end the worldwide epidemic of tuberculosis (TB) by 2035. For the strategy's objectives to be realised, the next 20 years will need novel solutions to address the challenges posed by TB to health professionals, and to affected people and communities. Information and communication technology presents opportunities for innovative approaches to support TB efforts in patient care, surveillance, programme management and electronic learning. The effective application of digital health products at a large scale and their continued development need the engagement of TB patients and their caregivers, innovators, funders, policy-makers, advocacy groups, and affected communities.In April 2015, WHO established its Global Task Force on Digital Health for TB to advocate and support the development of digital health innovations in global efforts to improve TB care and prevention. We outline the group's approach to stewarding this process in alignment with the three pillars of the End TB Strategy. The supplementary material of this article includes target product profiles, as developed by early 2016, defining nine priority digital health concepts and products that are strategically positioned to enhance TB action at the country level.

Vitamina K epóxido reductada (VKORC1): polimorfismos y sensibilidad a los dicumarínicos / Vitamin K epoxide reductase (VKORC1): polimorphisms and sensitivity to coumarin

Introducción: Los antagonistas de la vitamina K, tienen como blanco el complejo vitamina K epóxido reductasa. Hay polimorfismos (SNPs) en el gen de la subunidad 1 (VKORC1), como 1173 C>T (rs9934438) (intrón 1) y -1639 G>A (rs9923231) (región 3'UTR), asociados con diferente sensibilidad a los dicumarínicos. Objetivo: confirmar la relación entre estos SNPs y la dosis media requerida para una correcta anticoagulación. Material y Método: Estudiamos 102 pacientes (15-87 años) bajo tratamiento anticoagulante oral crónico, principalmente acenocumarol. La genotipificación fue realizada usando RFLPs (amplificación del ADN por PCR, seguida por digestión con Msp I para -1639 G>A y Sty I para 1173 C>T); analizándose luego la dosis media en los portadores de los diferentes SNPs. La frecuencia alélica obtenida para 1173 C>T fue similar a la calculada para -1639 G>A, observándose que 1179 C>T y -1639 G>A se hallan en desequilibrio de unión. La dosis media fue más alta en los pacientes portadores hemocigotos del alelo 1173 CC o -1639 GG que en los no portadores. La dosis media fue menor en individuos mayores de 70 años, independientemente de su genotipo. Reultados: Estos confirman la relación entre los SNPs analizados y la dosis de dicumarínicos.

Vitamin K epoxide reductase complex is the target of Vitamin K antagonists. Polymorphism (SNPs) in the gene of subunit 1 (VKORC1), 1173 C>T (rs9934438) (intrón 1) y -1639 G>A (rs9923231) (3'UTR), are associated with different sensitivity to oral anticoagulants. Objectives: our aim was to comfirm the relationship between these SNPs and the mean dose required for anticoagulation. Material and methods: One hundred and two patients (15-87 years) on chronic oral anticoagulant therapy, mainly acenocoumarol, were tested. Genotyping was performed using RFLPs (DNA's PCR amplification, followed by digestion with Msp I to Sty I to 1173 C>T). The mean dose of anticoagulantin carriers of different SNPs was calculated. A similar allelic frequency was obtained for 1173 C>T and -1639 G>A with linkage desequilibrium between them. The mean dose was higher in patients homozygous for 1173 CC or -1639 GG alleles than in non carriers. In those individuals over the age of 70, regardless of genotype, a lower mean dose was observed. Results: The results confirm the relationship between SNPs and oral anticoagulants.

Vitamina K epóxido reductada (VKORC1): polimorfismos y sensibilidad a los dicumarínicos / Vitamin K epoxide reductase (VKORC1): polimorphisms and sensitivity to coumarin

Introducción: Los antagonistas de la vitamina K, tienen como blanco el complejo vitamina K epóxido reductasa. Hay polimorfismos (SNPs) en el gen de la subunidad 1 (VKORC1), como 1173 C>T (rs9934438) (intrón 1) y -1639 G>A (rs9923231) (región 3UTR), asociados con diferente sensibilidad a los dicumarínicos. Objetivo: confirmar la relación entre estos SNPs y la dosis media requerida para una correcta anticoagulación. Material y Método: Estudiamos 102 pacientes (15-87 años) bajo tratamiento anticoagulante oral crónico, principalmente acenocumarol. La genotipificación fue realizada usando RFLPs (amplificación del ADN por PCR, seguida por digestión con Msp I para -1639 G>A y Sty I para 1173 C>T); analizándose luego la dosis media en los portadores de los diferentes SNPs. La frecuencia alélica obtenida para 1173 C>T fue similar a la calculada para -1639 G>A, observándose que 1179 C>T y -1639 G>A se hallan en desequilibrio de unión. La dosis media fue más alta en los pacientes portadores hemocigotos del alelo 1173 CC o -1639 GG que en los no portadores. La dosis media fue menor en individuos mayores de 70 años, independientemente de su genotipo. Reultados: Estos confirman la relación entre los SNPs analizados y la dosis de dicumarínicos. (AU)

Vitamin K epoxide reductase complex is the target of Vitamin K antagonists. Polymorphism (SNPs) in the gene of subunit 1 (VKORC1), 1173 C>T (rs9934438) (intrón 1) y -1639 G>A (rs9923231) (3UTR), are associated with different sensitivity to oral anticoagulants. Objectives: our aim was to comfirm the relationship between these SNPs and the mean dose required for anticoagulation. Material and methods: One hundred and two patients (15-87 years) on chronic oral anticoagulant therapy, mainly acenocoumarol, were tested. Genotyping was performed using RFLPs (DNAs PCR amplification, followed by digestion with Msp I to Sty I to 1173 C>T). The mean dose of anticoagulantin carriers of different SNPs was calculated. A similar allelic frequency was obtained for 1173 C>T and -1639 G>A with linkage desequilibrium between them. The mean dose was higher in patients homozygous for 1173 CC or -1639 GG alleles than in non carriers. In those individuals over the age of 70, regardless of genotype, a lower mean dose was observed. Results: The results confirm the relationship between SNPs and oral anticoagulants. (AU)

Conflitos de poder entre profissionais da saúde / Power conflicts among health professionals

Foi objetivo desse estudo realizar uma análise teórica sobre os conflitos de poder nas relações humanas, nas organizaçõese, particularmente, suas implicações nas relações entre profissionais de saúde, estimulando a revisão de atitudes duranteo exercício da profissão, visando à satisfação do paciente com o profissional e melhor qualidade da interaçãoprofissional/paciente. Enfatizou-se modelos de relacionamento profissional/paciente e a tendência de humanização doserviço prestado em unidades de saúde. Percebeu-se que o conflito é um fato em qualquer relação interpessoal e, no localde trabalho, é um fenômeno natural e esperado que, quando administrado construtivamente, pode fortalecer as relaçõesinterpessoais. O ambiente de trabalho sem a criatividade e o progresso decorrentes dos conflitos é entediante e poucocriativo. Logo, sugere-se que medidas sejam tomadas e a confrontação positiva, seja administrada.

A importância da terapia familiar como ferramenta auxiliar no processo sucessório de empresas familiares / Importance of the familiar therapy as tool auxiliary in the successory process of familiar companies

Neste estudo de revisão de literatura foi apresentada a importância da terapia familiar como ferramenta auxiliar no processosucessório de empresas familiares, visando a redução dos conflitos interpessoais entre os membros da família e agregados,condição mister para a paz do clã e a perenidade da empresa mantenedora da família. Foi realizado um levantamento doacervo referente ao tema estudado e para tanto foram consultados livros, artigos científicos, anais de congressos e revistasespecializadas que tratam do assunto. A análise apresentada tem como fonte de dados um total de 24 estudos. A escolhapautou-se na priorização dos textos que forneciam elementos satisfatórios para a compreensão da temática abordada. Porfim, ficou evidente a contribuição da terapia de família no sentido de unir esforços na redução dos conflitos de poderinerentes ao processo de sucessão das empresas familiares.

Conflitos de poder na relação entre profissionais de saúde sob a óptica do paciente / Conflicts of power in the relationship among professionals of health under the optical of the patient

Estudo exploratório e descritivo, de abordagem qualitativa, com o objetivo de investigar os conflitosde poder na relação de profissionais de saúde sob a óptica do paciente em um Hospital Escola PúblicoFederal de Recife. Para a coleta de informações foi utilizado um roteiro de entrevista semiestruturadocom os pacientes e profissionais de saúde, no período Junho e Julho de 2006, apósaprovação do projeto de pesquisa pelo Comitê de Ética em Pesquisa da Universidade Federal dePernambuco e com autorização através do termo de consentimento livre e esclarecido dosparticipantes. A amostra foi de dez profissionais de saúde do ambulatório e da enfermaria de clínicamédica; 15 pacientes que estavam sendo assistidos no ambulatório e dez pacientes das enfermarias.As entrevistas foram codificadas, transcritas e definidas as seguintes categorias: 1) Conflitos frente àsrelações pessoais e grupais, no ambiente físico no trabalho dos profissionais de saúde; 2) Conflitosabordados e processados na equipe de profissionais de saúde; 3) Conseqüências dos conflitos geradosna relação profissionais de saúde vs profissionais de saúde na qualidade da assistência ao paciente e,4) Conseqüências dos conflitos de poder na relação profissionais de saúde vs paciente. A análise decada categoria foi com base na fundamentação teórica associadas aos fatos e relatos dosentrevistados, considerando similitudes e diferenças entre as informações, relacionando-as aosconflitos de poder na relação entre profissionais de saúde sob a óptica do paciente.

Vigilância de doenças e agravos não-transmissíveis na América Latina: o estado da arte / Surveillance of Diseases and Non-Transmissible Diseases in Latin America - the State of the Art

Este artigo faz uma revisão da vigilância de doenças e agravos não-transmissíveis na base de dados Lilacs. Retornaram 2.121 artigos com o descritor "vigilância em saúde pública", dos quais 100 artigos focalizavam doenças ou agravos não-transmissíveis. Entre as estratégias para vigilância de doenças e agravos não-transmissíveis sobressaíram os registros de base populacional e a integração de bases de dados secundários. Conclui-se que, embora a necessidade de ampliação do conceito de vigilância seja uma discussão antiga na Saúde Coletiva, pouco se tem avançado no sentido de uma vigilância das doenças e agravos não-transmissíveis.