Conhecimentos e condutas dos cirurgiões-dentistas do estado do Rio Grande do Norte sobre denúncias e notificações de maus-tratos infantis / Knowledge and conduct of dentists of State of Rio Grande do Norte regarding complaints and notifications of child abuse

Os maus-tratos infantis são considerados um problema de saúde a nível mundial. Diante dessa realidade, destaca-se a relevante atuação dos profissionais de saúde na identificação, diagnóstico, notificação e, consequentemente, na redução no número de casos. O Cirurgião-Dentista apresenta-se em uma posição privilegiada no que diz respeito à identificação de casos de violência, visto que a maioria das lesões de ordem física a crianças e adolescentes se apresenta em região de cabeça e pescoço. Dessa forma, objetiva-se identificar as experiências e conduta dos cirurgiões-dentistas do Rio Grande do Norte sobre maus-tratos infantis. Foi realizado um estudo exploratório de caráter quantitativo mediante aplicação de um formulário eletrônico, com questões semiestruturadas, enviado aos dentistas com inscrições ativas no Conselho Regional de Odontologia do Rio Grande do Norte. Foi obtido um total de 100 questionários respondidos. Para análise dos dados, utilizou-se a estatística descritiva e testes de associação. Os resultados revelaram que 14% dos profissionais relataram ter visto caso suspeito de abuso físico, porém nenhum destes realizou notificação no último semestre. Apesar das médias das respostas terem sido superiores a 6 quanto à disposição para detecção, capacidade de diagnóstico e de identificação dos maus-tratos, esses resultados não corroboram com o número de profissionais que considera necessário maior qualificação em diagnóstico ou que desconhecem qualquer meio de notificação. A capacitação técnico-científica para a identificação e diagnóstico diferencial é importante e a responsabilidade pela notificação de casos suspeitos às autoridades é imprescindível para o exercício da profissão em consonância com os valores de cidadania e justiça

Child abuse is considered a global health problem. Given this reality, the relevant role of health professionals in identifying, diagnosing, reporting and, consequently, reducing the number of cases stands out. The dentist is in a privileged position with regard to identifying cases of violence, given that the majority of physical injuries to children and adolescents occur in the head and neck region. Thus, the objective is to identify the experiences and conduct of dentists in Rio Grande do Norte regarding child abuse. An exploratory quantitative study was carried out using an electronic form, with semi-structured questions, sent to dentists with active registrations at the Rio Grande do Norte Regional Dentistry Council. A total of 100 completed questionnaires were obtained. For data analysis, descriptive statistics and association tests were used. The results revealed that 14% of professionals reported having seen a suspected case of physical abuse, but none of them reported it in the last semester. Although the response averages were higher than 6 in terms of willingness to detect, diagnose and identify abuse, these results do not corroborate the number of professionals who consider it necessary to have greater qualifications in diagnosis or who are unaware of any means of reporting. Technical-scientific training for identification and differential diagnosis is important and the responsibility for reporting suspected cases to the authorities is essential for exercising the profession in line with the values of citizenship and justice

Synchronization of Leishmania amazonensis Cell Cycle Using Hydroxyurea.

Leishmania spp. comprises a group of protozoan parasites that affect millions of people around the world. Understanding the main cell cycle-dependent events could provide an important route for developing specific therapies since some factors involved in cell cycle control may have low similarity relative to their homologs in mammals. Furthermore, accurate cell cycle-dependent analyses often require many cells, which can be achieved through cell cycle synchronization. Here, we described a useful method to synchronize procyclic promastigote forms of Leishmania amazonensis using hydroxyurea (HU) and the analysis of its DNA content profile. This approach can be extended to other trypanosomatids, such as Trypanosoma cruzi or Trypanosoma brucei, and provides an effective method for arresting more than 80% of cells at the G1/S phase transition.

Cell Cycle, Telomeres, and Telomerase in Leishmania spp.: What Do We Know So Far?

Leishmaniases belong to the inglorious group of neglected tropical diseases, presenting different degrees of manifestations severity. It is caused by the transmission of more than 20 species of parasites of the Leishmania genus. Nevertheless, the disease remains on the priority list for developing new treatments, since it affects millions in a vast geographical area, especially low-income people. Molecular biology studies are pioneers in parasitic research with the aim of discovering potential targets for drug development. Among them are the telomeres, DNA-protein structures that play an important role in the long term in cell cycle/survival. Telomeres are the physical ends of eukaryotic chromosomes. Due to their multiple interactions with different proteins that confer a likewise complex dynamic, they have emerged as objects of interest in many medical studies, including studies on leishmaniases. This review aims to gather information and elucidate what we know about the phenomena behind Leishmania spp. telomere maintenance and how it impacts the parasite's cell cycle.

Bladder Urothelial Carcinoma in a Child: Case Report and Review of Literature.

Bladder urothelial carcinoma (UC) it is the fifth most prevalent carcinoma in humans, nevertheless in children and young adults it's very rare. It usually occurs in older adults. Literature on UC in pediatric population is limited and important information (risk factors, follow-up protocols, etc.) are poorly defined. We present an 11-year-old boy with a painful macroscopic hematuria. Ultrasound revealed a heterogeneous intravesical mass without extravesical extension, which was confirmed by computed tomography (CT) and magnetic resonance imaging (MRI). The first biopsy was compatible with urothelial papilloma. After 1 year, he returned with a bigger mass. Transurethral resection of the bladder (TURB) was performed and immunohistochemistry showed low-grade papillary UC with a high-grade component, with tumor free margin. Tumor had mutations in the BRAF and KRAS genes. Two and a half years after the resection the patient has no recurrence. Less than 1% of bladder UC occur in the first two decades of life. Gross hematuria is a common symptom. Ultrasound is generally the first diagnostic tool. MRI is also helpful, but cystoscopy allows definitive diagnosis. Transurethral resection of the bladder (TURB) is the standard treatment, with good results and low recurrence rate, and it was the treatment of choice for our patient, that remains free of disease. The BRAF and KRAS gene mutations were never described before in pediatric UC. There are only few cases in literature of pediatric UC that present a tumor genetic profile; therefore, our case report adds more information to this very rare disease in children.

Open Versus Laparoscopic Splenectomies in Children: A Comparative Study Performed at a Public Hospital in Brazil.

Introduction: In pediatric population, the two most common indications for splenectomy include traumatic rupture and hematological diseases such as hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and autoimmune hemolytic anemia. Traditionally, splenectomy has been an open procedure; however, since the first laparoscopic splenectomy was reported in 1991, the minimally invasive laparoscopic approach has become increasingly popular. In most public hospitals in Brazil, where vessel sealing devices are not available, most surgeons seem to prefer open splenectomy to guarantee intraoperative safety and improved outcomes. Objectives: To compare outcomes between open and laparoscopic splenectomy in children in a public hospital in Brazil. Materials and Methods: Retrospective study conducted between January 2010 and June 2018. Patients from 0 to 14 years old who underwent open or laparoscopic splenectomy at the University Hospital of Federal University of Paraná were included. Clinical, laboratory, imaging, and surgical data were collected. Results: For 8 years, 35 patients underwent splenectomy. Mean age was 4 years old and 54% were female. Of the 35 subjects, 69% had sickle cell anemia and 23% spherocytosis. The most common indication for surgery was a previous episode of splenic sequestration. The 13 laparoscopic surgeries were performed without harmonic scalpel or other vessel sealing devices. During the laparoscopic procedure, 2 patients experienced intraoperative complications: bleeding and prolonged surgical time due to technical problems with the equipment. Mean operative time was higher in laparoscopy group than in open group (186 minutes versus 66 minutes). Oral feeds began earlier on the laparoscopic group. Postoperatively, there were more complications on the open group, and no reoperations. There was only one fatality, likely secondary to fulminant sepsis, which occurred 34 days after the surgery in a patient who was undergoing prophylactic oral antibiotics therapy. Discussion: Performing laparoscopic splenectomy without harmonic scalpel or other vessel sealing devices is feasible, but it implicates in a significantly higher surgical time. Laparoscopic splenectomy had earlier oral feeds and fewer complications than open surgery.

Bronchogenic cyst in an unusual location / Cisto broncogênico de localização não habitual

ABSTRACT This article reports the case of a patient with lingual bronchogenic cyst and presents a brief review of discrepancies in the nomenclature of lingual cysts. A 2-year-old male patient was admitted to the pediatric surgery outpatient clinic of a university hospital due to the presence of a 2 cm mass on the dorsal surface of the tongue. The tumor was excised and the anatomopathological report revealed a foregut cyst, bronchogenic subtype. Lingual cysts are rare, especially when compatible with bronchogenic formations. Their pathogenic process is not clear; one of the possibilities is the separation of cells from the primitive gut, before the separation between the esophagus and the trachea. The treatment usually consists of surgical excision.

RESUMEN Este artículo relata el caso de un paciente con quiste broncogénico lingual y presenta una breve revisión de las discrepancias de nomenclatura para quistes linguales. Paciente de sexo masculino, de 2 años de edad, acudió a cirugía pediátrica de un hospital universitario con una masa de 2 cm en la cara dorsal de la lengua. El tumor fue extirpado y el informe anatomopatológico reveló quiste de duplicación, subtipo broncogénico. Quistes linguales no son frecuentes, sobre todo cuando concomitantes con formaciones broncogénicas. Su patogénesis es incierta: una de las posibilidades es la separación de células del intestino primitivo antes de la separación entre esófago y tráquea. El tratamiento, en general, consiste en escisión quirúrgica.

RESUMO Este artigo relata o caso de um paciente com cisto broncogênico lingual e apresenta uma breve revisão das discrepâncias de nomenclatura para cistos linguais. Paciente do sexo masculino, 2 anos de idade, foi admitido no ambulatório de cirurgia pediátrica de um hospital universitário devido à presença de uma massa de 2 cm na face dorsal da língua. O tumor foi excisionado; o laudo anatomopatológico revelou foregut cyst, subtipo broncogênico. Cistos linguais são raros, especialmente quando compatíveis com formações broncogênicas. Seu processo de patogênese é incerto, e uma das possibilidades é a separação de células do intestino primitivo antes da separação entre esôfago e traqueia. O tratamento, comumente, consiste em excisão cirúrgica.

Selection of Coffea canephora parents from the botanical varieties Conilon and Robusta for the production of intervarietal hybrids / Seleção de genitores de Coffea canephora das variedades botânicas Conilon e Robusta visando à produção de híbridos intervarietais

ABSTRACT: The objective of this research was to quantify the genetic divergence of potential Coffea canephora parents, with the goal of developing progenies that associate the best traits of the Conilon and Robusta botanical varieties for hybrid vigor expression. Thus, 10 morphological and productive characteristics of 130 clones of Conilon and Robusta botanical varieties and their intervarietal hybrids were evaluated over 2 years. The experiment was conducted in a randomized block design with four replicates of four plants per plot. For selection of parents, the main component analysis was used to associate values with reference points obtained from the average of each botanical variety. The first two principal components allowed for the separation of the botanical varieties representing the variability contained in the original data with 76% for the first year and 69% for the second year. Although, the genotype × years interaction had significant effects, there were minor differences in the grouping from one year to the next, which is associated with the higher repeatability estimates observed in this study. It was observed that crosses with the 16-1-81I, 9-1-82L, and 13-1-61I parents of the botanical variety Robusta and the 167I, 890E, and 130I parents of the Conilon botanical variety presented greater potential for obtaining selection gains.

RESUMO: O objetivo deste trabalho foi quantificar a divergência genética entre matrizes de C. canephora visando desenvolver progênies que associem características das variedades botânicas Conilon e Robusta à expressão do vigor do híbrido. Para isso, foram avaliadas dez características morfológicas e produtivas de 130 clones das variedades botânicas Conilon, Robusta e de híbridos intervarietais, ao longo de dois anos, em delineamento de blocos casualizados com quatro repetições de quatro plantas por parcela. Para seleção de genitores foi utilizada a técnica de componentes principais associada a pontos referenciais obtidos a partir da média de cada variedade botânica. Os dois primeiros componentes principais permitiram a separação das variedades botânicas e dos híbridos intervarietais com uma representação da variabilidade contida nos dados originais de 76% no primeiro ano e 69% no segundo ano. Apesar da significância da interação genótipos x anos, observou-se pouca diferença no agrupamento ao longo do tempo, o que está associado às maiores estimativas de repetibilidade observadas nesse estudo. Observou-se que as matrizes 16-1-81I, 9-1-82L e 13-1-61I da variedade botânica Robusta e as matrizes 167I, 890E e 130I da variedade botânica Conilon apresentaram maior potencial para a obtenção de ganhos com a seleção.

O papel dos métodos diagnósticos na estratificação de risco de morte súbita na doença de Chagas / The role of diagnostic methods in the stratification of risk of sudden death in Chagas disease

A doença de Chagas ainda é uma enfermidade bastante prevalente, principalmente em países subdesenvolvidos (inclusive o Brasil), e acarreta morbimortalidade importante e prejuízo sociais econômicas e para a saúde da população - dentre os quais se encontra a morte súbita. A morte súbita é responsável por cerca de 50% das mortes de causa cardíaca...

Análise do desempenho de autocuidado em crianças com Síndrome de Down / Self-care functional development analysis of children with Down Syndrome

A Síndrome de Down (SD), uma das mais frequentes anomalias dos cromossomos autossômicos e a mais antiga causa de retardo mental, é uma desordem genética diferenciada por apresentar uma série de características físicas e mentais específicas. Caracteriza-se por ser uma alteração na divisão cromossômica, resultando na triplicação do material genético referente ao cromossomo 21. O objetivo foi evidenciar o desempenho funcional na área de autocuidado de crianças com SD na faixa etária dos 3 aos 7 anos. Participaram da pesquisa 17 crianças com SD, assistidas na Associação de Pais e Amigos dos Excepcionais (APAE), utilizando-se o teste Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Após a aplicação do teste observou-se que o desempenho funcional de crianças com SD é inferior ao de crianças sem a síndrome e que fatores externos como a inserção das crianças no processo escolar e o grau de escolaridade das cuidadoras interferem no desenvolvimento delas. O PEDI mostrou ser um instrumento importante para profissionais de saúde, em especial os terapeutas ocupacionais, visto que identifica a área específica em que a criança está em desvantagem, permitindo vislumbrar a possibilidade de intervir de forma estratégica nas dificuldades específicas de cada uma.(AU)

Down syndrome (DS) differs from other genetic disorders by presenting a specific group of physical and mental characteristics, representing one of the most usual abnormalities of autosomal chromosomes and being the oldest known cause of mental retardation. It is characterized by a change in chromosome division resulting in the tripling of genetic material on chromosome 21. Objective: Highlight the functional performance in the area of self-care with DS in children from three to seven years old. Methodology: Seventeen children with DS participated in the research, attended at the Association of Parents and Friends of the Mentally Disabled (APAE), using the Pediatric Evaluation Disability Inventory (PEDI). Result: After test application, it was possible to observe that the functional performance of children with DS is lower than that of children with no syndrome, and that external factors such as the inclusion of children in the school process and the educational level of caretakers interfere in the development of children. Conclusion: PEDI has proved to be an important tool for health professionals, mainly for occupational therapists, since it identifies the specific areas that children are disadvantaged, allowing the possibility to intervene strategically in the specific difficulties of each child.(AU)

Análise do desempenho de autocuidado em crianças com Síndrome de Down / Self-care functional development analysis of children with Down Syndrome

A Síndrome de Down (SD), uma das mais frequentes anomalias dos cromossomos autossômicos e a mais antiga causa de retardo mental, é uma desordem genética diferenciada por apresentar uma série de características físicas e mentais específicas. Caracteriza-se por ser uma alteração na divisão cromossômica, resultando na triplicação do material genético referente ao cromossomo 21. O objetivo foi evidenciar o desempenho funcional na área de autocuidado de crianças com SD na faixa etária dos 3 aos 7 anos. Participaram da pesquisa 17 crianças com SD, assistidas na Associação de Pais e Amigos dos Excepcionais (APAE), utilizando-se o teste Inventário de Avaliação Pediátrica de Incapacidade (PEDI). Após a aplicação do teste observou-se que o desempenho funcional de crianças com SD é inferior ao de crianças sem a síndrome e que fatores externos como a inserção das crianças no processo escolar e o grau de escolaridade das cuidadoras interferem no desenvolvimento delas. O PEDI mostrou ser um instrumento importante para profissionais de saúde, em especial os terapeutas ocupacionais, visto que identifica a área específica em que a criança está em desvantagem, permitindo vislumbrar a possibilidade de intervir de forma estratégica nas dificuldades específicas de cada uma.

Down syndrome (DS) differs from other genetic disorders by presenting a specific group of physical and mental characteristics, representing one of the most usual abnormalities of autosomal chromosomes and being the oldest known cause of mental retardation. It is characterized by a change in chromosome division resulting in the tripling of genetic material on chromosome 21. Objective: Highlight the functional performance in the area of self-care with DS in children from three to seven years old. Methodology: Seventeen children with DS participated in the research, attended at the Association of Parents and Friends of the Mentally Disabled (APAE), using the Pediatric Evaluation Disability Inventory (PEDI). Result: After test application, it was possible to observe that the functional performance of children with DS is lower than that of children with no syndrome, and that external factors such as the inclusion of children in the school process and the educational level of caretakers interfere in the development of children. Conclusion: PEDI has proved to be an important tool for health professionals, mainly for occupational therapists, since it identifies the specific areas that children are disadvantaged, allowing the possibility to intervene strategically in the specific difficulties of each child.

Avaliação do desempenho motor em crianças com mucopolissacaridose II / Motor development evaluation in children with mucopolysacharidosis II

A mucopolissacaridose (MPS) é uma doença multissistêmica decorrente da incapacidade do organismo em realizar um processo metabólico específico da degradação lisossômica dos glicosaminoglicanos (GAGs). O acúmulo progressivo de GAG em vários órgãos e tecidos resulta em desordens funcional e estrutural no indivíduo acometido pelas MPS. A MPS do tipo II trata-se de uma doença metabólica hereditária, ligada ao cromossomo X, cujo principal comprometimento é o atraso no desenvolvimento neuropsicomotor. O objetivo do estudo foi avaliar o desenvolvimento motor de crianças com MPS II. Foi realizado um estudo de caso com duascrianças, atendidas na APAE de Maceió (AL). Para a coleta de dados utilizou-se a Escala de Desenvolvimento Motor, e a análise de dados foi realizada por meio da comparação entre a idade cronológica de cada criança. Os resultados apontaram que as crianças apresentam perfil motor classificado em ?Muito Inferior?, corroborando com os achados na literatura e destacando a necessidade de intervenção precoce através da redução de danos e manutenção das habilidades remanescentes. O presente estudo também observou a característica progressiva dessa doença genética ainda pouco estudada. Dessa forma, destaca-se a importância de estudos sobre o desempenho motor, visando conhecer ao desenvolvimento de crianças com MPS II em diferentes etapas evolutivas, para fundamentar a prática clínica auxiliando na redução dos déficits funcionais, contribuindo, consequentemente, no desenvolvimento cognitivo, afetivo e social.(AU)

Mucopolysaccharidosis (MPS) is a multisystem disease caused by the body?s inability to perform a metabolic process specific to lysosomal degradation of glycosaminoglycans (GAGs). The progressive accumulationof GAG in various organs and tissues results in functional and structural disorders in individuals affected by MPS. MPS type II is an inherited metabolic disease, linked to the X chromosome, whose main impairment isthe delay in neuropsychomotor development. The purpose of this study was to evaluate the motor development of children affected by MPS II. A case study was carried out with two children, attending the ?APAE Maceio? institution. The Scale of Motor Development was used for data collection and data analysis was performed by comparing the chronological age of each child. Results showed that the children present motor profile classified as ?Very Low?, confirming the findings in the literature, highlighting the need for early intervention through harmreduction and maintenance of the remaining skills. This study also observed that the progressive characteristic of this genetic disease is still poorly studied. Therefore, the importance of studies on motor performance should be highlighted in order to determine the development of children affected by MPS II at different evolutionary stages to support the clinical practice in helping to reduce functional deficits, thus contributing to the cognitive, affective and social developments.(AU)

Avaliação do desempenho motor em crianças com mucopolissacaridose II / Motor development evaluation in children with mucopolysacharidosis II

A mucopolissacaridose (MPS) é uma doença multissistêmica decorrente da incapacidade do organismo em realizar um processo metabólico específico da degradação lisossômica dos glicosaminoglicanos (GAGs). O acúmulo progressivo de GAG em vários órgãos e tecidos resulta em desordens funcional e estrutural no indivíduo acometido pelas MPS. A MPS do tipo II trata-se de uma doença metabólica hereditária, ligada ao cromossomo X, cujo principal comprometimento é o atraso no desenvolvimento neuropsicomotor. O objetivo do estudo foi avaliar o desenvolvimento motor de crianças com MPS II. Foi realizado um estudo de caso com duas crianças, atendidas na APAE de Maceió (AL). Para a coleta de dados utilizou-se a Escala de Desenvolvimento Motor, e a análise de dados foi realizada por meio da comparação entre a idade cronológica de cada criança. Os resultados apontaram que as crianças apresentam perfil motor classificado em ?Muito Inferior?, corroborando com os achados na literatura e destacando a necessidade de intervenção precoce através da redução de danos e manutenção das habilidades remanescentes. O presente estudo também observou a característica progressiva dessa doença genética ainda pouco estudada. Dessa forma, destaca-se a importância de estudos sobre o desempenho motor, visando conhecer ao desenvolvimento de crianças com MPS II em diferentes etapas evolutivas, para fundamentar a prática clínica auxiliando na redução dos déficits funcionais, contribuindo, consequentemente, no desenvolvimento cognitivo, afetivo e social.

Mucopolysaccharidosis (MPS) is a multisystem disease caused by the body?s inability to perform a metabolic process specific to lysosomal degradation of glycosaminoglycans (GAGs). The progressive accumulationof GAG in various organs and tissues results in functional and structural disorders in individuals affected by MPS. MPS type II is an inherited metabolic disease, linked to the X chromosome, whose main impairment isthe delay in neuropsychomotor development. The purpose of this study was to evaluate the motor development of children affected by MPS II. A case study was carried out with two children, attending the ?APAE Maceio? institution. The Scale of Motor Development was used for data collection and data analysis was performed by comparing the chronological age of each child. Results showed that the children present motor profile classified as ?Very Low?, confirming the findings in the literature, highlighting the need for early intervention through harmreduction and maintenance of the remaining skills. This study also observed that the progressive characteristic of this genetic disease is still poorly studied. Therefore, the importance of studies on motor performance should be highlighted in order to determine the development of children affected by MPS II at different evolutionary stages to support the clinical practice in helping to reduce functional deficits, thus contributing to the cognitive, affective and social developments.

Acute kidney injury risk in patients with ST-segment elevation myocardial infarction at presentation to the ED.

INTRODUCTION: Acute kidney injury (AKI) is common in acute myocardial infarction (AMI) patients and has serious prognostic implications. The early identification of patients at risk of developing AKI at the emergency department (ED) can reduce its incidence. METHODS: Patients with ST-segment elevation myocardial infarction (STEMI) at the ED were included. Associated factors playing a role at ED presentation and during hospitalization were collected, and independent risk factors of developing AKI were assessed. RESULTS: Mean age among patients (n = 406, 69.7% male) was 62.5 ± 12.5 years. At ED admission, the mean glomerular filtration rate (GFR) was 70.5 ± 28.1 mL/min per 1.73 m(2), and 140 (34.5%) patients had a GFR <60 mL/min per 1.73 m(2). Eighty-three patients (20.4%) developed AKI: 47 (11.6%) with stage 1, 26 (6.4%) with stage 2 and 10 (2.5%) with stage 3. Mortality was 11.8% and was higher in patients with AKI (34.9% vs 5.9%, P < .0001). Univariate analysis disclosed age, reduced GFR at presentation, severe Killip class, heart rate and longer door-to-needle time as risk factors to develop AKI. Moreover, these patients received less ß-blocker and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker in the ED. Multivariate analysis revealed that age, Killip class, heart rate, door-to-needle time, and ß-blocker non-use were independent factors associated with AKI. These factors provided the ED physician with good accuracy in identifying patients at high risk of developing AKI. CONCLUSION: Factors associated with AKI in STEMI patients allowed physicians to identify patients at high risk in the ED. Moreover, reduced door-to-needle time and ß-blocker use were associated with renal protection in AMI patients.