O que o reumatologista deve saber sobre as manifestações orofaciais das doenças reumáticas autoimunes

Manifestações orofaciais ocorrem com frequência nas doenças reumáticas e, comumente, representam sinais iniciais ou de atividade da doença que ainda são negligenciados na prática clínica. Entre as doenças reumáticas autoimunes com possíveis manifestações orais, incluem-se a artrite reumatoide (AR), miopatias inflamatórias (MI), esclerose sistêmica (ES), lúpus eritematoso sistêmico (LES), policondrite recidivante (PR) e síndrome de Sjögren (SS). Sinais e sintomas orofaciais como hipossalivação, xerostomia, disfunções temporomandibulares, lesões na mucosa bucal, doença periodontal, disfagia e disfonia podem ser a primeira expressão dessas doenças reumáticas. Esse artigo revisa as principais manifestações orofaciais das doenças reumáticas que podem ser de interesse do reumatologista, para diagnóstico e acompanhamento das doenças reumáticas autoimunes.Orofacial manifestations occur frequently in rheumatic diseases and usually represent early signs of disease or of its activity that are still neglected in clinical practice. Among the autoimmune rheumatic diseases with potential for oral manifestations, rheumatoid arthritis (RA), inflammatory myopathies (IM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), relapsing polychondritis (RP) and Sjögren's syndrome (SS) can be cited. Signs and symptoms such as oral hyposalivation, xerostomia, temporomandibular joint disorders, lesions of the oral mucosa, periodontal disease, dysphagia, and dysphonia may be the first expression of these rheumatic diseases. This article reviews the main orofacial manifestations of rheumatic diseases that may be of interest to the rheumatologist for diagnosis and monitoring of autoimmune rheumatic diseases

Atividade antimicrobiana de compostos isolados e derivados semissintéticos de Miconia ferruginata

This study evaluated the antimicrobial activity of isolated compounds and semisynthetic derivatives from Miconia ferruginata (Melastomataceae) against five microorganisms: Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Bacillus subtilis (ATCC 6623), Pseudomonas aeruginosa (ATCC 15442), and Candida albicans (ATCC 10231). The isomeric mixture of ursolic and oleanolic acids was active against S. aureus (MIC = 250 μg mL-1) and against E. coli, B. subtilis, and P. aeruginosa (MIC = 500 μg mL-1). The flavone 5,6,7-trihydroxy-4’-methoxyflavone and the methyl esters, semisynthetic derivatives of a mixture of ursolic and oleanolic acids, showed no activity against the tested microorganisms. These results suggest that the carboxyl group present in the triterpenes may contribute to antimicrobial activity.Este estudo descreve a avaliação da atividade antimicrobiana de compostos isolados e derivados semissintéticos de Miconia ferruginata (Melastomataceae) contra cinco microorganismos: Staphylococcus aureus (ATCC 25923), Escherichia coli (ATCC 25922), Bacillus subtilis (ATCC 6623), Pseudomonas aeruginosa (ATCC 15442) and Candida albicans (ATCC 10231). A mistura isomérica dos ácidos ursólico e oleanólico foi ativa contra S. aureus (CIM = 250 μg mL-1) e contra E. coli, B. subtilis e P. aeruginosa (CIM = 500 μg mL-1). A flavona 5,6,7-trihidroxi-4’-metóxiflavona e os ésteres metílicos, derivados semissintéticos da mistura dos ácidos ursólico e oleanólico, não apresentaram atividade contra os microrganismos testados. Estes resultados sugerem que o grupo carboxila presente nos triterpenos podem contribuir para a atividade antimicrobiana

Objective Structured Clinical Examination’s adaptation for final evaluation of the curricular component “Semiological Bases”

BACKGROUND: The combination of both physiological knowledge of a variety of sistems and the clinical findings it is of extreme relevance to the medical student learning process. The proposal of a simulated enviroment, with clinical data collection and regular physical examination, is crucial to this process. The Semiological bases of Escola Bahiana de Medicina e Saúde Pública module, used by the OSCE’s 4th semester medical students, capacitate them for such means. SUMMARY OF WORK: The evaluation logistic was divided into two segments: the first one was made through a theorical exam with close questioning, exhibiting images and videos, but also containing an open-ended question requesting a construction of a fictional clinical case; in the second one it was applied a practical exam segmented by different fields of medical knowledge (neurological, cardiovascular and respiratory/abdomen), with the evaluation of 120 students and followed by the teacher’s feedbacks at the conclusion of each field exam. SUMMARY OF RESULTS: The experience was important, however, it is notable the need for a complex management and understanding of the evaluational process. Discussion between students and teachers happened in behalf of the development of such proposal. CONCLUSIONS: The application of theorical exams throughout the semester combined with a practical exam (the OSCE) at the conclusion of the curricular component Bases Semiológicas had significant weight to the whole process

Identifying adolescents at risk for depression: a prediction score performance in cohorts based in three different continents:A Prediction Score Performance in Cohorts Based in 3 Different Continents

OBJECTIVE: Prediction models have become frequent in the medical literature, but most published studies are conducted in a single setting. Heterogeneity between development and validation samples has been posited as a major obstacle for the generalization of models. We aimed to develop a multivariable prognostic model using sociodemographic variables easily obtainable from adolescents at age 15 to predict a depressive disorder diagnosis at age 18 and to evaluate its generalizability in 2 samples from diverse socioeconomic and cultural settings. METHOD: Data from the 1993 Pelotas Birth Cohort were used to develop the prediction model, and its generalizability was evaluated in 2 representative cohort studies: the Environmental Risk (E-Risk) Longitudinal Twin Study and the Dunedin Multidisciplinary Health and Development Study. RESULTS: At age 15, 2,192 adolescents with no evidence of current or previous depression were included (44.6% male). The apparent C-statistic of the models derived in Pelotas ranged from 0.76 to 0.79, and the model obtained from a penalized logistic regression was selected for subsequent external evaluation. Major discrepancies between the samples were identified, impacting the external prognostic performance of the model (Dunedin and E-Risk C-statistics of 0.63 and 0.59, respectively). The implementation of recommended strategies to account for this heterogeneity among samples improved the model’s calibration in both samples. CONCLUSION: An adolescent depression risk score comprising easily obtainable predictors was developed with good prognostic performance in a Brazilian sample. Heterogeneity among settings was not trivial, but strategies to deal with sample diversity were identified as pivotal for providing better risk stratification across samples. Future efforts should focus on developing better methodological approaches for incorporating heterogeneity in prognostic research

Changes in infant and neonatal mortality and associated factors in eight cohorts from three Brazilian cities

Stillbirth (SBR), perinatal (PMR), neonatal (NMR) and infant mortality rates (IMR) are declining in Brazil and the factors associated with these falls are still being investigated. The objective of the present study was to assess changes in SBR, PMR, NMR and IMR over time and to determine the factors associated with changes in NMR and IMR in eight Brazilian cohorts. All cohorts are population-based (Ribeirão Preto in 1978/79, 1994 and 2010; Pelotas in 1982, 1993 and 2004; and São Luís in 1997/98 and 2010). Were included data on 41440 children. All indicators were decreased, except in the city of Pelotas, from 1993 to 2004, and except SBR in São Luís. Sociodemographic variables seem to be able to explain reductions of NMR and IMR in Ribeirão Preto, from 1978/79 to 1994, and in São Luís. In Ribeirão Preto, from 1994 to 2010 declines in NMR and IMR seem to be explained by reductions in intrauterine growth restriction (IUGR). Newborn’s gestational age had diminished in all cohorts, preventing even greater reductions of NMR and IMR. Improved sociodemographic variables and reduction of IUGR, seem to be able to explain part of the decrease observed. NMR and IMR could have been reduced even more, were it not for the worsening in gestational age distribution

Análise epidemiológica do perfil clínico de pacientes com Hérnia Encarcerada no Hospital Regional da Ceilândia no Distrito Federal

FUNDO: O paciente com o quadro de hérnia inguinal encarcerada está em um estágio de urgência, necessitando de um procedimento cirúrgico de emergência. Buscando avaliar esse quadro, para entender o perfil clínico, para fomentar uma análise clínico-epidemiológica, analisando as variáveis importantes nesse tipo de paciente, definir os fatores de risco e quadros mais comumente encontrados. Se faz necessário também abordar os achados intraoperatórios, complicações e tempo pós-operatório. Assim, poderiam ser tomadas mudanças em relação às condições encontradas, que podem mudar o desfecho clínico de muitos pacientes. MÉTODOS: Um estudo observacional qualitativa descritiva, com 40 pacientes com o quadro clínico de hérnia encarcerada, todos os pacientes foram submetidos a hernioplastia. Seguindo a mesma técnica cirúrgica. O desfecho primário foi que apenas os  pacientes com comorbidades/fatores de risco apresentaram complicações e o segundo desfecho foi que os pacientes submetidos ao procedimento cirúrgico não chegaram a óbito. RESULTADOS: Após o acompanhamento de quadros semelhantes por 12 meses. O primeiro desfecho, foi possível observar que os pacientes com comorbidades/fatores de risco anteriores, 35 (87,5%) dos 40 selecionados, possuíam os quadros de:  14 (35%) pacientes com quadro de obesidade, os 7 (17,5%) eram tabagistas crônicos  e 14 (35%) dos pacientes possuíam quadro de tenesmo prévio e 5 pacientes não possuíam fatores de risco. Dentro das comorbidades, 1 paciente possuía síndrome de Down, 3 paciente apresentava cirrose hepática, 8 com hipertensão arterial sistêmica, sendo que 5 eram definidos como de difícil controle, 4 com diabetes mellitus, 6 pacientes com diverticulose anterior e 6 com constipação crônica. O desfecho secundário aconteceu com 40 pacientes, já que todos do grupo foram operados em caráter de urgência, ademais os pacientes que não são submetidos ao procedimento cirúrgico vão a óbito. CONCLUSÕES: Conclui-se que os 5 pacientes que não apresentavam comorbidades/fatores de risco, chegaram ao hospital em um quadro mais leve em comparação aos outros (35) pacientes, tendo eles uma recuperação melhor e menos dias de internação. Podendo ser implementadas medidas preventivas para os pacientes que possuem hérnia, recomenda-se o acompanhamento dos fatores de risco, visando evitar quadros graves e internações longas

COVID-Inconfidentes - SARS-CoV-2 seroprevalence in two Brazilian urban areas during the pandemic first wave: study protocol and initial results

Background: A population study is an important tool that can be used to understand the actual epidemiological scenario of the Covid-19 in different territories, identify its magnitude, understand its transmission dynamics, and its demographic, geographical, and social distribution. Objective: The aim of this study was to determine the prevalence and dynamics of SARS-CoV-2 infection in the population of two Brazilian cities during the pandemic first wave and subsequent socioeconomic and health effects. Materials & methods: This paper described the methodological procedures adopted and the prevalence of the SARS-CoV-2 infection in the population. A household survey was conducted between October and December 2020, in two historic cities of Brazil's mining region. Anti-SARS-CoV-2 antibody was detected using the Wondfo® rapid test. The face-to-face interview consisted of administration of a questionnaire containing registration data, sociodemographic and economic variables, living habits, general health condition, mental health, sleep habits, and eating and nutrition. Results: We evaluated 1,762 residents, of which 764 (43.4%) were in Mariana and 998 (56.6%) in Ouro Preto. For both cities, 51.9% of the interviewees were female, with a predominance of the age range 35 to 59 years old (47.2%). The prevalence of the SARS-CoV-2 infection was 5.5% in all cities, 6.2% in Ouro Preto, and 4.7% in Mariana. The prevalence was similar between cities (P>0.05). Conclusion: The study was effective in verifying the seroprevalence of infection by the virus and its findings will enable further analyses of the health conditions of the population related to social isolation and the risk of infection with SARS-CoV-2