Sarcoidosis and Polymethyl Methacrylate (PMMA) Granulomas following COVID-19 Vaccination (ChAdOx1): Successful Treatment with Tofacitinib.

Sarcoidosis and complications related to fillers have been reported following the COVID-19 vaccination. Additionally, cutaneous sarcoidosis has been observed around polymethyl methacrylate (PMMA) injection sites. Foreign-body reactions to PMMA can occur simultaneously with systemic sarcoidosis, suggesting a shared pathogenic mechanism between both conditions. To report a case of sarcoidosis and PMMA granulomas following COVID-19 vaccination (ChAdOx11), successfully treated with tofacitinib. We present a 59-year-old woman who developed systemic sarcoidosis and a granulomatous reaction to PMMA filler following the COVID-19 vaccination (ChAdOx11). Notably, both PMMA and the vaccine were potential triggers for sarcoidosis. Treatment with tofacitinib produced marked improvement in both the cutaneous and pulmonary involvement of sarcoidosis and the granulomatous reaction to PMMA. This successful outcome suggests tofacitinib, a pan-JAK inhibitor, an alternative treatment for cutaneous and systemic sarcoidosis, as well as a potential therapy for granulomatous complications of dermal fillers, such as PMMA.

Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know.

In dermatologists' clinical practice, the use of systemic glucocorticoids is recurrent for the management of different comorbidities that require chronic immunosuppression. The prescription of this medication requires caution and basic clinical knowledge due to the several adverse effects inherent to the treatment. However, different doubts may arise or inappropriate conduct may be adopted due to the lack of objective and specific guidelines for the screening, prophylaxis and management of complications from chronic corticosteroid therapy. Considering this problem, the authors carried out a narrative review of the literature to gather up-to-date data on adverse effects secondary to the chronic use of systemic glucocorticoids. The broad approach to this topic made it possible to review the pathophysiology and risk factors for these complications, as well as to develop updated orientation that can be used as a learning tool and quick reference for dermatologists during their clinical practice with glucocorticoids.

Side effects of chronic systemic glucocorticoid therapy: what dermatologists should know

Abstract In dermatologists' clinical practice, the use of systemic glucocorticoids is recurrent for the management of different comorbidities that require chronic immunosuppression. The prescription of this medication requires caution and basic clinical knowledge due to the several adverse effects inherent to the treatment. However, different doubts may arise or inappropriate conduct may be adopted due to the lack of objective and specific guidelines for the screening, prophylaxis and management of complications from chronic corticosteroid therapy. Considering this problem, the authors carried out a narrative review of the literature to gather up-to-date data on adverse effects secondary to the chronic use of systemic glucocorticoids. The broad approach to this topic made it possible to review the pathophysiology and risk factors for these complications, as well as to develop updated orientation that can be used as a learning tool and quick reference for dermatologists during their clinical practice with glucocorticoids.

Home-based self-management for sedentary individuals with mild walking disability after stroke: protocol for a randomised pilot study.

BACKGROUND: A Phase I study showed that it is feasible to implement a home-based self-management program aimed at increasing physical activity in individuals after stroke with mild walking disability in Brazil. The next step is to test this program against a control group in order to provide a power analysis for a fully-powered Phase III clinical trial. METHODS: A Phase II pilot randomised clinical trial with concealed allocation, blinded measurement, and intention-to-treat analyses will be carried out. The inclusion criteria will be individuals diagnosed with stroke, in the acute or subacute phase, with mild walking disability, sedentary, and no significant language impairment. The participants will be randomly allocated to the experimental or control group. The experimental group will receive six sessions of a home-based self-management program based on behaviour change techniques through the Social-Cognitive Theory and Control Theory over 11 weeks. The control group will receive one session of education about stroke (regarding the importance of practising physical activity after a stroke) and usual care. A total of 24 participants will be recruited. The primary outcome will be physical activity, measured through steps taken per day by an activity monitor (Actigraph wGT3X-BT, Pensacola, FL, USA). The mean of daily steps will be analysed to compare groups after intervention. Secondary outcomes will be cardiovascular risk (body mass index, waist circumference, and blood pressure), depressive symptoms (Geriatric Depression Scale), walking ability (6-Minute Walk Test and 10-Meter Walk Test), exercise self-efficacy (Self-Efficacy for Exercise scale), social participation (Stroke Impact Scale) and quality of life (EuroQual-5D). Two-way analyses of variance will be implemented for all parametric outcomes, and the Kruskal-Wallis test for non-parametric outcomes will be used to determine the statistical significance of the between-group differences and reported as mean differences between groups (95% CI). All analyses will be conducted intention-to-treat. All outcomes will be measured at baseline (Week 0), post-intervention (Week 12), and follow-up (Week 24). This pilot clinical trial was registered online at Clinical Trials under number NCT05461976 on 4th April 2022. DISCUSSION: If beneficial, this Phase II pilot randomised trial will provide data to plan a fully powered future Phase III clinical trial aimed at verifying the efficacy of this program to promote physical activity after stroke. TRIAL REGISTRATION: Clinical Trials NCT05461976 on 4th April 2022.

Self-management to promote physical activity after discharge from in-patient stroke rehabilitation: a feasibility study.

OBJECTIVES: To investigate the feasibility of a self-management program aimed at increasing physical activity in community-dwelling ambulators after stroke in a middle-income country with high income inequality. METHODS: A Phase 1, pre-post intervention study was conducted with 20 sub-acute stroke participants. The self-management program was delivered in six home-based sessions over 3 months. Feasibility of recruitment, intervention, and measurement was determined. Physical activity, cardiovascular risk, depression, walking speed, self-efficacy for exercise, participation, and quality of life were measured at baseline, 3, and 6 months. RESULTS: 16% of eligible participants were recruited. 90% completed the program and were measured at 3 months, and 65% at 6 months. The most common reasons for withdrawal were return to work, lack of interest/motivation and surgery. 92% of the sessions were delivered for 59 (SD 23) minutes per session. Participants did not increase physical activity at 3 months (MD 364 steps/day, 95% CI -282 to 1010) or 6 months (MD 312 steps/day, 95% CI -881 to 1504). Post-hoc analysis showed that sedentary participants increased their step count at 3 months by 1,300 (95% CI 152 to 2447) and at 6 months by 1,701 (95% CI -556 to 3959) more steps than non-sedentary participants. CONCLUSIONS: A Phase 2 study of the self-management program appears to be feasible in a middle-income country with high income inequality and has the potential to increase physical activity levels in sedentary individuals with mild disability after stroke. TRIAL REGISTRATION: RBR-6bdmsk.

Impact on Fertility Rate and Embryo-Larval Development Due to the Association Acidification, Ocean Warming and Lead Contamination of a Sea Urchin Echinometra lucunter (Echinodermata: Echinoidea).

Ocean warming and acidification can cause deleterious effects on marine biota, which may be potentialized when associated with metal pollution. Thus, the aim of this work was to evaluate the effects of pH decrease, temperature increase and lead contamination on fertility rate and embryo-larval development of Echinometra lucunter. Gametes and embryos were exposed at pH 8.2 (control) and 7.5; at 26°C (control) and 28°C; and at lead concentrations of 0 (control), 125, 250 and 500 µg/L. These conditions were tested individually and in combination. The fertilization rate of E. lucunter was only significantly reduced in the treatments where temperature was increased and in the treatment where pH decreased. However, the development rate of the pluteus larvae was significantly affected in the majority of treatments: metal contamination in the higher concentration; decreased pH in all metal concentrations; increased temperature in the highest metal concentration; decreased pH and increased temperature and all variables combined, which is decreased pH, increased temperature and metal contamination in relation to the control group (C). The development test was shown to be more sensitive than the fertilization test in all the studied scenarios. In general, the present study suggests that pH decrease, temperature increase and metal pollution may have a significant impact on E. lucunter reproductive cycle.

Depressive symptoms and functional status are associated with sleep quality after stroke.

Objective: To investigate the sleep state and determine whether variables, such as age, functional status, walking capacity, fatigue, depressive symptoms, and quality of life were associated with sleep quality of individuals with chronic stroke.Methods: For this exploratory study, the dependent variable was sleep quality, which was measured by the Pittsburgh Sleep Quality Index (PSQI). Step-wise multiple linear regression analysis was employed to identify which of the independent variables, that is, age, functional status (Modified Rankin Scale-mRS), walking capacity (6-minute Walk Test), fatigue (Fatigue Severity Scale), depressive symptoms (Geriatric Depression Scale-GDS), and quality of life (EuroQol) were associated with sleep quality.Results: Ninety participants, 55 (61%) men, who had a mean age of 61 (SD 12) years and a mean time since the onset of the stroke of 58.2 (SD 58.7) months, were included. Sleep quality was significantly associated with depressive symptoms and functional status. Together, they explained 30% of the variance in the PSQI scores (p < .0001). The GDS scores alone explained 22% (F = 25.76; p < .0001) of the variance in sleep quality (PSQI). When mRS scores were included in the model, the explained variance increased to 30% (F = 20,38; p < .0001).Conclusion: Depressive symptoms and functional status, which are both potentially modifiable factors, were associated with the sleep quality of individuals with chronic stroke. It is important to consider the assessment of sleep quality in the context of stroke rehabilitation.

Perceived barriers to exercise reported by individuals with stroke, who are able to walk in the community.

PURPOSE: To identify the perceived barriers to exercise, which could be modified, as well as the associated factors in people at the sub-acute post-stroke stages, who were able to walk in the community. METHODS: For this exploratory study, barriers to exercise were identified by the Exercise Barrier sub-scale of the Exercise Benefits/Barriers Scale. Step-wise multiple linear regression analysis was employed to identify which of the clinical and sociodemographic variables, that is, age, walking speed, levels of physical activity, socioeconomic status, and depressive symptoms, could significantly predict the Exercise Barrier sub-scale scores. RESULTS: Ninety-five individuals, who had a mean age of 63 (13) years and a mean time since the onset of the stroke of 4 (1) months participated. The main reported barriers to exercise were related to fatigue, as well as availability and distance from the exercise places. Additional reported barriers were "lack of a person to help" and "knowledge on how to practice exercise." Perceived barriers were associated with depressive symptoms and socioeconomic status. Together, they explained 9% of the variance in the Exercise Barrier sub-scale scores (p < 0.01). CONCLUSIONS: Fatigue, reduced number of places, and long distances to exercise places were the main reported barriers to exercise. Depressive symptoms and socioeconomic status were the only variables that explained the variance in the Exercise Barrier sub-scale scores. Rehabilitation interventions should include strategies to reduce fatigue during and after exercise, provide guidance regarding both structured and unstructured exercise venues, in addition to screening and managing depressive symptoms. Implications for Rehabilitation Stroke survivors, who are able to walk in the community, should be referred and instructed on how to reduce fatigue through the practice of exercise. Health professionals should guide stroke survivors about the existing places for practice of exercise and how to exercise without structured environments. It is necessary to create or reformulate environments for exercise and provide orientation to practice through qualified professionals. Health professionals should also be able to assess the presence of depressive symptoms and address proper referral and management of the potential barriers to exercise.

Self-Efficacy to Engage in Physical Exercise and Walking Ability Best Predicted Exercise Adherence after Stroke.

AIM: To describe exercise preferences and to investigate the contribution of exercise preferences, walking ability, and current levels of physical activity in predicting exercise adherence in individuals with chronic stroke. METHODS: For this exploratory study, exercise adherence was measured using the first question of the first section of the Exercise Preference Questionnaire (stroke)-Brazil (EPQ (stroke)-Brazil). Nine independent variables were included as potential predictors of exercise adherence: the seven factors of the EPQ (stroke)-Brazil, walking speed, and level of physical activity. RESULTS: Participated 93 individuals with stroke, who had a mean age of 62 (SD 12) years and a mean time since the onset of the stroke of 58 (SD 67) months. The most preferable exercise was walking. Logistic regression analysis revealed that self-efficacy to engage in physical exercise and walking ability predicted and explained 80% of the variance in exercise adherence. CONCLUSION: The findings showed that feeling able to perform physical exercise and having higher walking ability predicted higher exercise adherences in individuals with chronic stroke. The knowledge of potential contributors to exercise adherence may help in designing exercise programs for individuals with stroke.

Genotoxic, biochemical and bioconcentration effects of manganese on Oreochromis niloticus (Cichlidae).

Manganese and iron were found at high concentrations (3.61 mg/L and 19.8 mg/L, respectively) in the water of the Rio Doce after the dams of Fundão and Santarém broke in Mariana/MG (Brazil). These same metals were found in fish and crustacean muscle (15 mg/kg and 8 mg/kg wet weight, respectively) in the specimens collected near the Rio Doce's outfall. Due to the variation in Mn concentration found in the lower Rio Doce, this study aimed to determine the effects of Mn in Oreochromis niloticus, at the concentrations allowed by CONAMA, and in concentrations found in the Rio Doce after the dams broke. The animals were exposed to the following dissolved concentrations: control group (0.0 mg/L), 0.2; 1.5 and 2.9 mg/L manganese for 96 h. In addition, a positive control was conducted, injecting intraperitoneally with cyclophosphamide (at 25 mg/kg). These exposures caused significant erythrocyte micronucleus formation in the organisms exposed to the highest concentration, as well a significant increase in the DNA damage index of erythrocytes from organisms exposed to 1.5 mg/L and 2.9 mg/L treatments. The glutathione S-transferase enzyme activity also showed a significant increase in the liver of the organisms exposed to 2.9 mg/L. However, catalase activity increased significantly in the gills of the animals exposed to all concentrations of manganese that were tested. Manganese bioconcentrated in greater quantities in the liver than the gills. Thus, manganese causes significant damage to genetic material, generates nuclear abnormalities, activates the body's detoxification system and can accumulate in animal tissue.

In vivo confocal Raman spectroscopy for intrinsic aging and photoaging assessment.

BACKGROUND: In vivo confocal Raman spectroscopy is a non-invasive method to assess either the epidermis or the dermis composition. Few studies have focused on dermis collagen alterations through intrinsic aging and photoaging. OBJECTIVE: This study evaluated the in vivo Raman spectra from the dermis of a photoexposed site versus a non-photoexposed region in different age groups, and evaluated the correlation between peak intensities and age, photoaging score and the amount of collagen assessed with histology and high frequency ultrasound (HFUS). METHODS: Fifteen volunteers aged 28-82 years were divided into three groups according to forearm photoaging degree. In vivo Raman spectra from the dermis were collected on the dorsal forearm (chronically photoexposed skin) and on the proximal medial arm (non-photoexposed skin). Cross-sectional images of the skin were obtained using a 20MHz ultrasound unit exactly on the same sites, which were further submitted to punch biopsies for histologic study (collagen I immunohistochemistry, picrosirius red staining and Verhoeff). Principal Component Analysis (PCA) and Orthogonal Partial Least Squares Discriminant Analysis (OPLS-DA) were taken in the spectral region of 796cm-1-996cm-1 to determine its potential to discriminate between different groups. The Spearman rank correlation coefficient of individual peak intensities and ratios with age, clinical score and the amount of collagen assessed by ultrasound and histology were calculated. RESULTS: PCA of pairs of groups and OPLS-DA could discriminate the intrinsically from the photoaged skin and the young group from the elderly one, with important contribution of the 938cm-1 and 855cm-1 peaks intensities. The intensity of the peaks in 855cm-1 and/or 938cm-1 presented moderate correlation with age (rho=0.579, p=0.049) and moderate to high inverse correlation with HFUS echogenicity (rho=-0.710, p=0.010) and collagen I immunohistochemistry (rho=-0.833, p=0.005) in the non-photoexposed region. The I1275/I1450 intensities ratio presented moderate to high correlation coefficients with age (rho=-0.730, p=0.007), photoaging score (rho=-0.594, p=0.042), HFUS echogenicity (rho=0.760, p<0.001) and histology (collagen I immunohistochemistry (rho=0.643, p=0.024), picrosirius (rho=0.773, p=0.005) and Verhoeff (rho=-0.727, p=0.011)) in the photoexposed site. CONCLUSION: The wavenumber region between 798 and 994cm-1 is useful for the analysis of dermal collagen alterations through the intrinsic aging process, while photoaging is better assessed by the I1275/I1450 intensities ratio. This is the first skin aging study to show a correlation between Raman peaks and the amount of collagen assessed by HFUS and histology.

Cross-cultural adaptation and measurement properties of the Brazilian version of the Exercise Preference Questionnaire(stroke).

BACKGROUND: The Exercise Preference Questionnaire (EPQ(stroke)) captures exercise preferences and measures personal factors, that influence motivation and adherence to exercise in stroke subjects. OBJECTIVES: To perform the cross-cultural adaptation of the EPQ(stroke) into the Brazilian-Portuguese language and to evaluate its measurement properties. METHODS: The EPQ(stroke) was cross-culturally adapted and primarily tested in 30 chronic stroke subjects. After the final version of the EPQ(stroke)-Brazil was created, its test-retest reliability was verified, using Kappa indices and intra-class correlation coefficients (ICCs) (n=50), and internal consistency was verified using Cronbach's alpha coefficients (n=101). Construct validity was assessed using exploratory factor analysis (n=101), content validity using the content validity index (CVI) (n=8), and face validity using the rate of agreement regarding the clarity, wording, ability to answer the questions, and lay-out and style of the questionnaire with two groups, including individuals with stroke (n=81) and multidisciplinary health professionals (n=32). RESULTS: The pre-final version required revisions (items 9, 29, and 30) and, after another pre-test, it was shown to be appropriate. The Kappa indices ranged from 0.58 to 0.95; the ICCs from 0.35 to 0.93, and the Cronbach's alpha coefficient was 0.82 (0.768-0.869 CI), showing adequate internal consistency. The exploratory factor analysis and CVI confirmed the validity of the EPQ(stroke)-Brazil. The rate of agreement was greater than 80% for both groups. CONCLUSION: The EPQ(stroke)-Brazil was found to be a valid and reliable measure for verifying exercise preferences of Brazilian individuals with stroke.

Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus.

The pemphigus group comprises the autoimmune intraepidermal blistering diseases classically divided into two major types: pemphigus vulgaris and pemphigus foliaceous. Pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus are rarer forms that present some clinical, histological and immunopathological characteristics that are different from the classical types. These are reviewed in this article. Future research may help definitively to locate the position of these forms in the pemphigus group, especially with regard to pemphigus herpetiformis and the IgG/ IgA pemphigus.

Non-classical forms of pemphigus: pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus

The pemphigus group comprises the autoimmune intraepidermal blistering diseases classically divided into two major types: pemphigus vulgaris and pemphigus foliaceous. Pemphigus herpetiformis, IgA pemphigus, paraneoplastic pemphigus and IgG/IgA pemphigus are rarer forms that present some clinical, histological and immunopathological characteristics that are different from the classical types. These are reviewed in this article. Future research may help definitively to locate the position of these forms in the pemphigus group, especially with regard to pemphigus herpetiformis and the IgG/ IgA pemphigus.

Different instructions during the ten-meter walking test determined significant increases in maximum gait speed in individuals with chronic hemiparesis / Diferentes instruções durante teste de velocidade de marcha determinam aumento significativo na velocidade máxima de indivíduos com hemiparesia crônica

OBJECTIVE: To evaluate the effects of different instructions for the assessment of maximum walking speed during the ten-meter walking test with chronic stroke subjects. METHODS: Participants were instructed to walk under four experimental conditions: (1) comfortable speed, (2) maximum speed (simple verbal command), (3) maximum speed (modified verbal command-"catch a bus") and (4) maximum speed (verbal command + demonstration). Participants walked three times in each condition and the mean time to cover the intermediate 10 meters of a 14-meter corridor was registered to calculate the gait speed (m/s). Repeated-measures ANOVAs, followed by planned contrasts, were employed to investigate differences between the conditions (α=5%). Means, standard deviations and 95% confidence intervals (CI) were calculated. RESULTS: The mean values for the four conditions were: (1) 0.74m/s; (2) 0.85 m/s; (3) 0.93 m/s; (4) 0.92 m/s, respectively, with significant differences between the conditions (F=40.9; p<0.001). Comfortable speed was significantly slower than the maximum speed, indicating that the participants were able to increase speeds when required. Significant differences were observed between the second condition with the third (p=0.002; 95%CI=-0.13 to -0.03) and the fourth conditions (p=0.004; 95%CI=-0.12 to -0.02) with no differences between the third and fourth conditions (p=1.00; 95%CI=-0.04 to 0.05). CONCLUSIONS: The results indicated that simple verbal commands were not sufficient to capture maximum gait speed with chronic stroke subjects. Thus, for clinical assessments and research purposes, where measurements of the maximum gait speed are necessary, modified verbal commands or demonstration strategies could be employed by physical therapists to ensure acurate information.

OBJETIVO: Avaliar os efeitos de diferentes instruções para avaliação da velocidade de marcha máxima de indivíduos hemiparéticos durante o teste de caminhada de 10 metros. MÉTODOS: Os indivíduos deambularam em quatro condições experimentais: (1) velocidade habitual, (2) velocidade máxima (comando verbal simples), (3) velocidade máxima (comando verbal modificado: pegar ônibus), (4) velocidade máxima (comando verbal + demonstração). Solicitou-se a cada participante que deambulasse três vezes em cada condição, e a média do tempo necessário para percorrer os 10 metros intermediários de um corredor de 14 metros foi utilizada para cálculo da velocidade (m/s). A ANOVA de medidas repetidas, com contrastes pré-planejados, foi utilizada para comparação dos dados (α=5%), sendo apresentados valores de média, desvio-padrão e intervalos de confiança (IC) de 95%. RESULTADOS: As médias de velocidade para as quatro condições foram: (1) 0,74m/s; (2) 0,85m/s; (3) 0,93m/s; (4) 0,92m/s, respectivamente, apresentando diferenças significativas entre as condições (F=40,9; p<0,001). A velocidade de marcha habitual diferiu das demais condições, indicando que os indivíduos foram capazes de aumentar a velocidade quando solicitados. Foram observadas diferenças significativas entre a segunda condição, a terceira (p=0,002; IC95%=-0,13 a -0,03) e a quarta (p=0,004; IC95%=-0,12 a -0,02), sendo que as duas últimas condições não diferiram entre si (p=1,00; IC95%=-0,04 a 0,05). CONCLUSÕES: Os resultados indicaram que comandos verbais simples não foram suficientes para captar velocidade de marcha máxima em indivíduos com hemiparesia crônica. Assim, em situações em que seja necessária a avaliação de velocidade máxima, deve-se utilizar estratégia de comando verbal modificada ou associada à demonstração para garantir acurácia da informação.

Different instructions during the ten-meter walking test determined significant increases in maximum gait speed in individuals with chronic hemiparesis.

OBJECTIVE: To evaluate the effects of different instructions for the assessment of maximum walking speed during the ten-meter walking test with chronic stroke subjects. METHODS: Participants were instructed to walk under four experimental conditions: (1) comfortable speed, (2) maximum speed (simple verbal command), (3) maximum speed (modified verbal command--"catch a bus") and (4) maximum speed (verbal command + demonstration). Participants walked three times in each condition and the mean time to cover the intermediate 10 meters of a 14-meter corridor was registered to calculate the gait speed (m/s). Repeated-measures ANOVAs, followed by planned contrasts, were employed to investigate differences between the conditions (α=5%). Means, standard deviations and 95% confidence intervals (CI) were calculated. RESULTS: The mean values for the four conditions were: (1) 0.74m/s; (2) 0.85 m/s; (3) 0.93 m/s; (4) 0.92 m/s, respectively, with significant differences between the conditions (F=40.9; p<0.001). Comfortable speed was significantly slower than the maximum speed, indicating that the participants were able to increase speeds when required. Significant differences were observed between the second condition with the third (p=0.002; 95%CI=-0.13 to -0.03) and the fourth conditions (p=0.004; 95%CI=-0.12 to -0.02) with no differences between the third and fourth conditions (p=1.00; 95%CI=-0.04 to 0.05). CONCLUSIONS: The results indicated that simple verbal commands were not sufficient to capture maximum gait speed with chronic stroke subjects. Thus, for clinical assessments and research purposes, where measurements of the maximum gait speed are necessary, modified verbal commands or demonstration strategies could be employed by physical therapists to ensure accurate information.

A avaliação do desenvolvimento infantil: um desafio interdisciplinar / Evaluation of childhood development: an interdisciplinary challenge

OBJETIVO: Avaliar o desenvolvimento de crianças de 2 meses a 2 anos de idade por meio da Atenção Integrada às Doenças Prevalentes na Infância (AIDPI), no contexto do Programa de Educação pelo Trabalho em Saúde (PET-Saúde). MÉTODO: Estudo transversal realizado com 122 crianças, com idades entre 2 meses e 2 anos, da área de abrangência do Centro de Saúde São Bernardo (CSSB) - Belo Horizonte (MG), em 2009. Os dados relativos ao desenvolvimento foram obtidos através da aplicação de dois questionários: AIDPI e Caderneta de Saúde da Criança (CSC). Foram comparadas as classificações do desenvolvimento pela AIDPI e pela CSC, a associação entre atraso do desenvolvimento e as variáveis estudadas. RESULTADOS: As características com maior frequência na população estudada foram a baixa escolaridade das mães (62,1%), seguida de parentes com deficiência mental (71,3%) e problemas na gestação (71,3%). A AIDPI evidenciou que 61,5% da população estudada encontra-se normal com fator de risco, 16,4% normal sem fator de risco, 11,5% com possível atraso e 10,7% com provável atraso do desenvolvimento infantil. A concordância observada entre a classificação da AIDPI e da CSC foi de 0,34, coeficiente Kappa igual a - 0,12 (p = 0,98). Não houve associação estatisticamente significativa entre as variáveis analisadas (frequenta creches; convívio com problemas emocionais; escolaridade da mãe; idade gestacional; e peso ao nascer) e atraso possível/provável do desenvolvimento identificado pela AIDPI. CONCLUSÃO: O PET-Saúde, como proposta de integração da educação pelo trabalho, permitiu uma oportunidade de convivência e troca de experiências entre alunos e profissionais de diferentes áreas de atuação, trabalhando em um projeto comum.

OBJECTIVE: The aim of this study was to evaluate early childhood development, from two months to two years of age, based on Integrated Management of Childhood Illness, IMCI (or AIDPI in Portuguese) in the context of the Educational Program for Health Work (PET-Saúde). METHODS: A cross-sectional study was conducted with 122 children two months to two years of age from the coverage area of the São Bernardo Health Center in Belo Horizonte, Minas Gerais State, in 2009. Data on the children´s development were obtained using two questionnaires: IMCI and the Children's Health Booklet (CSC in Portuguese). Early childhood development according to the IMCI classification was compared to the results with CSC. The authors also investigated potential associations between independent variables and developmental delay. RESULTS: The most frequent characteristics in the study population were low maternal schooling (62.1%), followed by relatives with mental disability (71.3%), and problems during the pregnancy (71.3%). Based on the IMCI classification, 61.5% of the study population was normal with some risk factor, 16.4% normal without any risk factor, 11.5% with possible delay, and 10.7% with probable childhood developmental delay. Agreement between the IMCI and CSC classifications was 0.34, kappa index - 0.12 (p = 0.98). There was no statistically significant association between the variables (daycare attendance; contact with emotional problems; maternal schooling; gestational age; and birth weight) and possible or probable early childhood developmental delay according to the IMCI classification. CONCLUSION: PET-Saúde, as a proposal for integration between education and work, provided an opportunity for contact and exchange of experiences between students and health professionals from various fields, working in a common project.

Hidrosadenite da vulva: caso exuberante com resolução cirúrgica / Hidradenitis suppurativa of the vulva: case lush with surgical resolution

Contexto: A hidrosadenite é uma doença cutânea crônica e recorrente, com prevalência estimada de 1% e mais comum no sexo feminino. Apesar de se tratar de entidade há muito tempo conhecida, a dificuldade terapêutica ainda é uma realidade. Relato de caso: Apresenta-se um caso de hidrosadenite em paciente de 49 anos envolvendo os grandes lábios bilateralmente, a qual foi submetida à exérese ampla com fechamento por primeira intenção, obtendo-se excelente resultado terapêutico e estético. Discussão: A hidrosadenite é causa de grande transtorno psicológico e social, com prejuízo na qualidade de vida. As possibilidades terapêuticas variam desde antibióticos tópicos e sistêmicos, medicamentos com ação antiandrogênica, retinoides sistêmicos, imunossupressores e, mais recentemente, os antagonistas do fator de necrose tumoral, o uso de tecnologias como o laser e a terapia fotodinâmica até drenagens intermitentes, exéreses parciais e cirurgia radical. A abordagem cirúrgica ampla com margens, associada à cicatrização por segunda intenção, é a preferida de vários autores, porém, o fechamento primário pode estar indicado em casos selecionados.Conclusões: Apesar dos diversos estudos, ainda não existem tratamentos padronizados e com resposta clínica previsível. Cabe ao médico conseguir individualizar cada paciente na busca do melhor tratamento, baseando-se nas evidências existentes até hoje na literatura.