Clinical profile and treatment outcomes of Boerhaave's syndrome: A 13-year experience from an upper gastrointestinal surgical unit.

Objectives: IBoerhaave's syndrome (BS) is a rare, but potentially fatal condition, characterized by barogenic esophageal rupture and carries a high mortality. We aimed to study our institutional experience of managing patients with BS. Material and Methods: A retrospective review of patients with BS presenting to a tertiary care centre from 2005 to 2018 was carried out in this study. Clinical presentation, diagnostic evaluations, treatments received, and treatment outcomes were studied. Perforations were classified as early (<24 hours) and delayed (>24 hours), based on the time elapsed. Surgical complications were graded using Clavien-Dindo grade. The Pittsburgh perforation severity score was correlated with short-term treatment outcomes. Results: Of the 12 patients [male, 75%; mean (range) age, 53 (28-80) years] included, 10 patients had a delayed (>24 hours) presentation. Chest pain was the dominant symptom (58.3%); six patients presented either in shock (n= 1) or with organ failure (n= 3) or both (n= 2). All the perforations were sited in the lower thoracic esophagus, of which three were contained and nine were uncontained. The seal of the perforation was achieved by surgical repair in four patients (primary repair, 2; repair over a T-tube, 2) and endoscopic techniques in four patients (clipping, 1; stenting, 3). Sepsis drainage [surgical, 7 (open-5, minimally-invasive-2); non-surgical, 5] and feeding jejunostomy were performed in all patients. Five (41.7%) patients received a re-intervention. Median (range) hospital stay was 25.5 (12-101) days, 30-day operative morbidity was 50%, and there was one in-hospital death. The Pittsburgh perforation severity score was as follows: 2-5 in two patients and >5 in 10 patients; there were more delayed presentations, increased surgical interventions, post-procedure morbidity, and in-hospital mortality in the latter group, but the differences were statistically not significant. In 11 patients followed-up [median (range):1507 (17-5929) days], there was no disease recurrence, symptomatic reflux or dysphagia. Conclusion: Favourable treatment outcomes, including reduced mortality and organ preservation can be achieved for Boerhaave's perforations, through a multimodality approach. Minimally invasive, endoluminal or open surgical techniques may be safely utilized in its management. The Pittsburgh severity score can be a useful clinical tool that can be used to select the initial intervention and to predict treatment outcomes.

Toxicological Profile and Anti-Inflammatory Effect of Mucoadhesive Gel from Residues of Agave sisalana and Punica granatum.

Inflammation is a natural protective reaction of the body against endogenous and exogenous damage, such as tissue injuries, trauma, and infections. Thus, when the response is adequate, inflammation becomes a defense mechanism to repair damaged tissue, whereas when the response is inadequate and persistent, the increase in inflammatory cells, cytosines, and chymosins impair tissue regeneration and promote a response harmful to the organism. One example is chronic tissue inflammation, in which a simple lesion can progress to ulcers and even necrosis. In this situation, the anti-inflammatory medications available in therapy are not always effective. For this reason, the search for new treatments, developed from medicinal plants, has increased. In this direction, the plants Agave sisalana (sisal) and Punica granatum (pomegranate) are rich in saponins, which are secondary metabolites known for their therapeutic properties, including anti-inflammatory effects. Although Brazil is the world's leading sisal producer, approximately 95% of the leaves are discarded after fiber extraction. Similarly, pomegranate peel waste is abundant in Brazil. To address the need for safe and effective anti-inflammatory treatments, this study aimed to create a topical mucoadhesive gel containing a combination of sisal (RS) and pomegranate residue (PR) extracts. In vitro experiments examined isolated and combined extracts, as well as the resulting formulation, focusing on (1) a phytochemical analysis (total saponin content); (2) cytotoxicity (MTT assay); and (3) a pharmacological assessment of anti-inflammatory activity (phagocytosis, macrophage spreading, and membrane stability). The results revealed saponin concentrations in grams per 100 g of dry extract as follows: SR-29.91 ± 0.33, PR-15.83 ± 0.93, association (A)-22.99 ± 0.01, base gel (G1)-0.00 ± 0.00, and association gel (G2)-0.52 ± 0.05. In MTT tests for isolated extracts, cytotoxicity values (µg/mL) were 3757.00 for SR and 2064.91 for PR. Conversely, A and G2 exhibited no cytotoxicity, with increased cell viability over time. All three anti-inflammatory tests confirmed the presence of this activity in SR, PR, and A. Notably, G2 demonstrated an anti-inflammatory effect comparable to dexamethasone. In conclusion, the gel containing SR and PR (i.e., A) holds promise as a novel herbal anti-inflammatory treatment. Its development could yield economic, social, and environmental benefits by utilizing discarded materials in Brazil.

Emprego de dupla abordagem em fratura complexa de face: relato de caso / Use of dual approach in complex fracture of the face: case report / Uso de abordaje dual en fractura compleja de cara: reporte de caso

Objetivo: Relatar o tratamento de fratura de osso frontal e OPN. Relato de caso: Paciente G.S.M, 25 anos, foi encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial (CTBMF) do Hospital Geral Clériston Andrade (HGCA). Em análise facial, notaram-se lesões em tecidos moles, hiposfagma em ambos os globos oculares, equimose periorbital bilateral e edema da região hemifacial esquerda, além de crepitação em região de OPN. Após a solicitação de Tomografia Computadorizada (TC) de face observou-se fratura complexa em região de terço superior esquerdo e região de glabela, acometendo osso frontal e margem supra orbital esquerda, além de fratura de OPN sem deslocamento considerável. Foi realizada uma abordagem cruenta por meio de um acesso coronal, e por meio deste foi realizada a redução e fixação dos arcos com placas e parafusos de titânio do sistema 2.0. Para o tratamento da fratura de OPN optou-se por uma abordagem incruenta devido ao mínimo deslocamento. Conclusão: O tratamento cruento com redução aberta e fixação interna rígida, mostrou-se uma abordagem eficaz para o alinhamento das fraturas do osso frontal, da mesma forma, a abordagem incruenta da fratura de OPN, embora conservadora, também apresentou bons resultados, demonstrando o sucesso da técnica empregada nesse caso... (AU)

Objective: To report the treatment of frontal bone fracture and OPN. Case report: Patient G.S.M, 25 years old, was referred to the Oral and Maxillofacial Surgery and Traumatology Service (CTBMF) of Hospital Geral Clériston Andrade (HGCA). In facial analysis, soft tissue lesions, hyposphagma in both eyeballs, bilateral periorbital ecchymosis and edema of the left hemifacial region were noted, in addition to crackling in the OPN region. After requesting a Computed Tomography (CT) scan of the face, a complex fracture was observed in the upper left third and glabella region, affecting the frontal bone and left supraorbital margin, in 5addition to an OPN fracture without considerable displacement. An open approach was performed through a coronal access, and through this the arches were reduced and fixed with titanium plates and screws of the 2.0 system. For the treatment of the OPN fracture, a closed approach was chosen due to the minimal displacement. Conclusion: Open reduction treatment with open reduction and rigid internal fixation proved to be an effective approach for the alignment of frontal bone fractures. success of the technique employed in this case... (AU)

Objetivo: Reportar el tratamiento de la fractura de hueso frontal y OPN. Caso clínico: Paciente G.S.M, de 25 años de edad, remitido al Servicio de Cirugía y Traumatología Oral y Maxilofacial (CTBMF) del Hospital Geral Clériston Andrade (HGCA). En el análisis facial se observaron lesiones de partes blandas, hiposfagma en ambos globos oculares, equimosis periorbitaria bilateral y edema de región hemifacial izquierda, además de crepitantes en región OPN. Tras solicitar una tomografía computarizada (TC) de rostro, se objetivó una fractura compleja en tercio superior izquierdo y región de glabela, afectando hueso frontal y margen supraorbitario izquierdo, además de una fractura OPN sin desplazamiento importante. Se realizó un abordaje abierto a través de un acceso coronal, mediante el cual se redujeron las arcadas y se fijaron con placas de titanio y tornillos del sistema 2.0. Para el tratamiento de la fractura OPN se optó por un abordaje cerrado debido al mínimo desplazamiento. Conclusión: El tratamiento de reducción abierta con reducción abierta y fijación interna rígida demostró ser un abordaje eficaz para la alineación de las fracturas del hueso frontal, éxito de la técnica empleada en este caso... (AU)

Photodynamic Therapy in the Treatment of Herpes Simplex Type 1 Virus Infection / Terapia Fotodinâmica no Tratamento de Infecção pelo Vírus Herpes Simples Tipo 1

Herpes simplex virus type 1 (HSV-1) is primarily responsible for the development of painful mucocutaneous viral lesions in the head and neck region. Antimicrobial photodynamic therapy (aPDT) consists of the use of a photosensitizing chemical substance, which interacts with an appropriate light source under the presence of oxygen, with consequent destruction or microorganisms' inactivation . The aim of this study was to conduct a literature review on the use of aPDT in the treatment of HSV-1, as well as to identify and characterize the main photosensitizing agents used in this technique. This was a narrative literature review, based on the research of scientific articles carried out in the PubMed database, from February to June 2021, using the crossing of the descriptors Decs/Mesh "photodynamic therapy" and "viral infection"; "photodynamic therapy" and "herpes virus". According to the established criteria, a total of 27 articles published in the last 20 years were included. The results demonstrate that despite the scarcity of studies involving aPDT in herpetic lesions, a single application of this therapy and with different protocols improved the clinical appearance and associated symptoms. Thus, antiviral PDT has been shown to be effective in in vitro and in vivo studies, regardless of the dye used. However, more controlled clinical trials need to be carried out in order to establish the real effectiveness of this therapeutic resource in viral infections. (AU)

O vírus herpes simples tipo 1 (HSV-1) é o principal responsável pelo desenvolvimento de lesões virais dolorosas mucocutâneas em região de cabeça e pescoço. A terapia fotodinâmica antimicrobiana (aPDT), por sua vez, consiste no uso de uma substância química fotossensibilizadora, que interage com uma fonte de luz apropriada sob a presença de oxigênio, com consequente destruição ou inativação de microrganismos. O objetivo do presente trabalho foi realizar uma revisão de literatura sobre o uso da aPDT no tratamento de HSV-1, bem como identificar e caracterizar os principais agentes fotossensibilizadores utilizados nessa técnica. Tratou-se de revisão narrativa de literatura, com base na pesquisa de artigos científicos realizada na base de dados PubMed, de fevereiro a junho de 2021, utilizando o cruzamento dos descritores Decs/Mesh "photodinamic therapy" and "viral infection"; "photodynamic therapy" and "herpes virus". De acordo com os critérios estabelecidos, um total de 27 artigos publicados nos últimos 20 anos foram incluídos. Os resultados demonstram que apesar da escassez de estudos que envolvam a aPDT em lesões herpéticas, uma única aplicação desta terapia e com diferentes protocolos promoveu melhora do aspecto clínico e dos sintomas associados. Desta maneira, a PDT antiviral demonstrou ser efetiva em estudos in vitro e in vivo, independente do corante adotado. Entretanto, mais ensaios clínicos controlados precisam ser realizados com o objetivo de se estabelecer a real eficácia deste recurso terapêutico em infecções virais. (AU)

Oral Manifestations Associated with COVID-19: a Critical Review / Manifestações Orais Associadas ao COVID-19: uma Revisão Crítica

Abstract With a high global impact, the main target of recent health-related studies focuses on the current pandemic caused by COVID-19, a zoonotic infection mediated by the SARS-CoV-2 virus, which shows high transmission and mortality capacity. This paper aims to analyze, by means of a careful literature review , the current evidence on the manifestations of COVD-19 in the oral cavity, seeking to understand whether these are primarily from the virus, or secondary factors. This is a narrative literature review based on the research of articles carried out on the platforms: Pubmed, Google scholar, Scielo and Lilacs, in the period from June-August 2020, using the crossing of Decs / Mesh descriptors with the use of the Boolean operator AND. Only articles from 2020 were selected, in English or Portuguese and, after the search was refined, a total of 24 articles were selected. Among the manifestations expressed in the oral cavity, taste changes are present in most cases. In addition, vesiculobullous and ulcerative oral lesions have been observed in some case reports, however, due to the scarcity of information coupled with the recent emergence of this infection, further studies should be carried out in an attempt to prove or discard the association of COVID-19 with these oral manifestations. (AU)

Resumo Com alto impacto global, o principal alvo de estudos recentes na área de saúde concentra-se na atual pandemia causada pelo COVID-19, uma infecção zoonótica mediada pelo vírus SARS-CoV-2, que apresenta alta taxa de transmissão e mortalidade. O presente trabalho objetiva analisar, por meio de uma revisão criteriosa da literatura, as evidências atuais sobre as manifestações da COVD-19 na cavidade oral, buscando entender se estas são principalmente de origem viral ou de fatores secundários. Trata-se de uma revisão narrativa da literatura a partir da pesquisa de artigos realizada nas plataformas: Pubmed, Google scholar, Scielo e Lilacs, no período de junho a agosto de 2020, utilizando o cruzamento dos descritores Decs / Mesh com os uso do operador booleano AND. Foram selecionados apenas artigos do ano de 2020, em inglês ou português e, após o refinamento da busca, foram selecionados 24 artigos. Dentre as manifestações expressas na cavidade oral, as alterações do paladar estão presentes na maioria dos casos. Além disso, lesões orais vesiculobolhosas e ulcerativas têm sido observadas em alguns relatos de casos, porém, devido à escassez de informações aliada ao recente surgimento dessa infecção, novos estudos devem ser realizados na tentativa de comprovar ou descartar a associação do COVID-19 com essas manifestações orais. (AU)

Acute Oral Manifestations in Patients Submitted to Radiotherapy in the Head and Neck Region: Literature Narrative Review / Manifestações Orais Agudas em Pacientes Submetidos à Radioterapia em Região de Cabeça e Pescoço: Revisão Narrativa da Literatura

The use of ionizing radiation, affects not only malignant cells but also healthy tissues, and promotes several side acute or late effects in the oral cavity. Among the acute effects, oral mucositis, xerostomia, hyposalivation, dysgeusia and dysphagia present a prominent role. The present study aims to conduct a narrative literature review on radiotherapy in the head and neck region as a therapeutic modality for cancer in this region and the main acute oral manifestations and their respective treatments. This was an exploratory literature rev iew, through the database of Scielo, Pubmed, Medline and institutional websites using the crossing of the descriptors in English and Portuguese "head and neck neoplasms", "radiotherapy", "xerostomia", "dysgeusia" and "dysphagia". According to the established criteria, a total of 46 articles and 2 institutional websites were selected from the databases, and one book was added for presenting relevance on this theme. The results demonstrate that oral mucositis is the most prevalent acute effect and has a direct impact on patient's quality of life, but there is no gold standard treatment. Dysphagia, xerostomia, hyposalivation and dysgeusia are common manifestations in irradiated patients, and present several therapeutic modalities. Given the importance of side effects of radiotherapy in head and neck region, further studies are nee ded to widely disseminate acute oral manifestations in irradiated patients. (AU)

A utilização de radiação ionizante, no câncer de cabeça e pescoço, afeta não somente células malignas, mas também tecidos sadios, o que promove diversos efeitos colaterais em cavidade oral, classificados em agudos ou tardios. Dentre os efeitos agudos, a muc osite oral, xerostomia, hipossalivação, disgeusia e disfagia apresentam papel de destaque. O presente trabalho visou realizar uma revisão narrativa de literatura sobre a radioterapia em região de cabeça e pescoço como modalidade terapêutica para o câncer nesta região e as principais manifestações orais agudas decorrentes da radiação ionizante e seus respectivos tratamentos. Tratou-se de revisão de literatura do tipo exploratória, através das bases de dados da Scielo, Pubmed, Medline e sites institucionais utilizando o cruzamento dos descritores em inglês e português "neoplasias de cabeça e pescoço", "radioterapia", "mucosite oral", "xerostomia", "disgeusia" e "disfagia". De acordo com os critérios estabelecidos, um total de 46 artigos e 2 sites institucionais foram selecionados nas bases de dados, e 1 livro foi acrescentado por apresentar relevância sobre a temática em questão. Os resultados demonstram que a mucosite oral é o efeito agudo mais pre valente e apesar de ter impacto direto na qualidade de vida, não há tratamento considerado padrão ouro para esta condição. A disfag ia, xerostomia, hipossalivação e disgeusia são manifestações comuns em pacientes irradiados, e apresentam diversas modalidades terapêuticas que podem ser empregadas. Dada à importância dos efeitos colaterais da radioterapia de cabeça e pescoço, torna-se necessária a realização de mais estudos afim de divulgar amplamente as manifestações orais agudas em pacientes irradiados. (AU)

Conhecimento e aceitação das práticas integrativas e complementares por estudantes de medicina / Knowledge and acceptance of integrative and complementary practices by medical students

Objetivo: investigar o interesse, o conhecimento e o uso das Práticas Integrativas e Complementares (PIC) pelos estudantes de Medicina. Métodos: Aplicação de questionários estruturados com os estudantes de Medicina de uma instituição pública federal do 1º ao 8º períodos, no primeiro semestre de 2015. Os dados foram analisados no programa estatístico R versão 3.2.2. Resultados: O percentual de alunos que indicaria as PIC a seus pacientes é 82,5%. As variáveis associadas a indicar o uso das PIC foram: raça/cor não branca, ser aluno dos períodos iniciais, achar importante ter as PIC na grade curricular, ter cursado alguma disciplina ou atividade sobre as PIC, informar que usaria as PIC como pacientes e ter usado alguma PIC nos últimos 12 meses. Conclusões: O contato do aluno com as PIC, por meio de disciplinas e atividades, é fundamental para que os futuros médicos sejam capazes de indicar essas modalidades terapêuticas aos seus pacientes, ampliando as ferramentas terapêuticas disponíveis. Logo, torna-se necessária a inclusão, no currículo ativo, das PIC, a fim de ampliar a formação do aluno como médico generalista.

Objective: to investigate the interest, knowledge and use of Integrative and Complementary Practices (ICP) by medical students. Method: Application of structured questionnaires with medical students of a federal public institution from 1st to the 8th TERMS in the first semester of 2015. The data were analyzed in the statistical program R version 3.2.2. Results: The percentage of students that would indicate ICP to their patients is 82.5%. The variables associated with indicating the use of ICPs were: non-white race/color, being a student from the initial TERMS, finding it important to have ICP in the curriculum, having studied some discipline or activity on the ICPs, informing that they would use the ICPs as patients and have used any ICP in the last 12 months. Conclusions: The student's contact with ICP through disciplines and activities is fundamental for future physicians to be able to indicate these therapeutic modalities to their patients, broadening the available therapeutic tools. Therefore, it is necessary to include the ICP in the active curriculum in order to broaden the student's training as a general practitioner.