Peritoneal Cryptococcosis in a Dog

Background: Cryptococcosis is an opportunistic, systemic mycotic disease caused by a yeast of Cryptococcus neoformans. These pathogens cause serious public health problems, as they can be transmitted to humans, domestic and wild animals. In cats and dogs, the main site of infection is the upper lower respiratory tract, however, the infection can extend and affect other sites in the organism, however, the peritoneal manifestation of the disease is rare. Thus, the present work aims to report a case of cryptococcosis in a canine, mixed breed, female, adult, from the Metropolitan Region of Belém.Case: A mixed breed dog, female, adult was admitted in a veterinary hospital at Belém, presenting abdominal discomfort and, after the clinical examination, emergency exploratory laparotomy was indicated, and it were observed disseminated lesions in the abdominal cavity, with multiple nodules attached to the peritoneum and intestinal serosa and bladder, uterus, among other organs. Fragments from the surgical biopsy were fixed, and processed routinely according to the techniques for histological tissue processing. Histological examination revealed a predominance of granulomatous lesions in peritoneum and mesentery organs. It was observed a discrete inflammatory reaction of macrophages, epithelioid cells and giant cells, many in phagocytosis of spherical or ovoid organisms, with a thick capsule and a clear perinuclear halo. In the PAS staining, the Cryptococcus conidia presented eosinophilic characteristics and some of them had the capsule well demarcated, which was shown to be radiated. Also it was possible to see the budding yeast and in the Grocott stain, the Cryptococcus stained in black.Discussion: Cryptococcosis with peritoneal involvement in animals is rarely reported in the literature. Cryptococcus is an agent that presents tropism by the central nervous system and nasal cavity, however atypical presentations have been reported, especially at the level of the abdominal cavity (intestines and mesentery). It is believed that the gastrointestinal tract is the gateway for ascending contamination, or that the contamination can occur by fungal ingestion. The lesions presented a multiple distribution, with isolated and coalescent nodules adhered to the peritoneum and adjacent structures. The literature reports two cases of dogs with intra-abdominal cryptococcosis, in which, macroscopically, granulomatous formations were observed in the jejunum, with lymph nodes and mesentery. Microscopically, a discrete inflammatory infiltrate of macrophages and lymphocytes were observed. Some areas with granulomatous reaction, lymphocytes, epithelioid macrophages and giant cells and, in other areas, yeasts in the cytoplasm were observed. The yeasts were spherical or ovoid, surrounded by a thick capsule of polysaccharide. The periodic acid Schiff (PAS) and silver impregnation (Grocott) staining were used to highlight structures of the Cryptococcus wall which were presented by a strong stained polysaccharide capsule. It must be emphasized the zoonotic potential of cryptococcosis, a disease that can affect both animals and humans. Cryptococcosis in humans normally occurs when the fungus accesses the airways through inhalation and ranges from asymptomatic pulmonary colonization to compromised meninges, causing the human patient's life-threatening condition. In the present report, the diagnosis of cryptococcosis was established through histopathological and histochemical examination of the fungal structure, which were determinant in the etiological diagnosis of cryptococcosis

Effect of Transcranial Direct-Current Stimulation Combined with Treadmill Training on Balance and Functional Performance in Children with Cerebral Palsy: A Double-Blind Randomized Controlled Trial

Background: Cerebral palsy refers to permanent, mutable motor development disorders stemming from a primary brain lesion, causing secondary musculoskeletal problems and limitations in activities of daily living. The aim of the present study was to determine the effects of gait training combined with transcranial direct-current stimulation over the primary motor cortex on balance and functional performance in children with cerebral palsy. Methods: A double-blind randomized controlled study was carried out with 24 children aged five to 12 years with cerebral palsy randomly allocated to two intervention groups (blocks of six and stratified based on GMFCS level (levels I-II or level III).The experimental group (12 children) was submitted to treadmill training and anodal stimulation of the primary motor cortex. The control group (12 children) was submitted to treadmill training and placebo transcranial direct-current stimulation. Training was performed in five weekly sessions for 2 weeks. Evaluations consisted of stabilometric analysis as well as the administration of the Pediatric Balance Scale and Pediatric Evaluation of Disability Inventory one week before the intervention, one week after the completion of the intervention and one month after the completion of the intervention. All patients and two examiners were blinded to the allocation of the children to the different groups. Results: The experimental group exhibited better results in comparison to the control group with regard to anteroposterior sway (eyes open and closed; p<0.05), mediolateral sway (eyes closed; p<0.05) and the Pediatric Balance Scale both one week and one month after the completion of the protocol. Conclusion: Gait training on a treadmill combined with anodal stimulation of the primary motor cortex led to improvements in static balance and functional performance in children with cerebral palsy. Trial Registration Ensaiosclinicos.gov.br/RBR-9B5DH

Twin pregnancy of hydatidiform mole and viable fetus: a late diagnosis - case report / Gestação gemelar de mola hidatiforme e feto viável: um diagnóstico tardio - relato de caso

Twin pregnancy with hydatidiform mole and viable fetus is a rare event, evolving, in most cases, to abortion or medical interruption due the associated risks. Prenatal diagnosis allows individualized, rigorous and specialized monitoring, favoring the early identification of complications. We report, based on information obtained through medical record review, interviews with patient and professionals involved and literature review, a case of twin pregnancy with hydatidiform mole and healthy newborn diagnosed at delivery. Although the uncomplicated outcome that was presented suggests the possibility of expectant conduct, it is important to recognize the rarity of the case and the associated risks, both during pregnancy, after uterine emptying and in future pregnancies, and a follow-up after molar pregnancy is essential, which is interrupted approximately half of the patients. Adherence to follow-up is favored by the correct guidance to pregnant women, and prenatal diagnosis is fundamental for ensuring better doctor-patient dialogue. Therefore, it is important to highlight that, in order to properly manage hydatidiform mole pregnancies, due attention should be paid to the early diagnosis

Conhecimento produzido sobre os resultados da “Nursing Outcomes Classification – NOC”: revisão integrativa

Objetivo: Identificar o conhecimento produzido sobre os Resultados de Enfermagem da Nursing Outcomes Classification (NOC).Método: Trata-se de uma revisão integrativa da literatura realizada nas bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), US National Library of Medicine (PUBMED), Cumulative Index to Nursing & Allied Health Literature (CINAHL) e Scopus Info Site (SCOPUS), durante os meses de agosto e setembro de 2014.Resultados: Compuseram esta revisão, 21 artigos que abordaram diferentes enfoques: tradução e adaptação cultural de Resultados de Enfermagem e seus indicadores (4,77%); aplicabilidade dos mesmos na prática clínica (33,33%); e, validação de seus elementos (63,90%). Após a análise dos artigos, verificou-se que o conhecimento produzido abordou os aspectos da tradução e adaptação cultural dos Resultados, a avaliação de sua aplicabilidade e a validação de seus itens.Conclusão: Por apresentar desenvolvimento contínuo, sugere-se a realização de revisões periódicas que identifiquem o conhecimento, uso e efeito da NOC.Palavras-chave: Enfermagem. Classificação. Avaliação de resultados (Cuidados de saúde)

Knowledge Produced From The Outcomes Of The Nursing Outcomes Classification - Noc": Integrative Review."

To identify the knowledge produced from the outcomes of the Nursing Outcomes Classification (NOC). A literature review using the integrative databases: Latin American and Caribbean Health Sciences (LILACS), US National Library of Medicine (PubMed), Cumulative Index to Nursing & Allied Health Literature (CINAHL) and Scopus Info Site (SCOPUS), during the months of August and September 2014. The review consisted of 21 articles that addressed different issues: Translation and Cultural adaptation (4.77%); Applicability in clinical practice (33.33%); and, Validation (63.90%). Analysis of these articles showed that the knowledge produced from the Nursing Outcomes Classification includes translation and cultural adaptation, evaluation of applicability and validation of its items. Considering the continuous evolution of this classification, periodic reviews should be carried out to identify the knowledge, use and effects of the NOC.36104-11

Effect of Reciprocating and Rotary Systems on Postoperative Pain: A Systematic Review and Meta-Analysis

Introduction: Our study aimed to compare the incidence and intensity of postoperative pain after endodontic instrumentation with reciprocating and rotary systems. Methods and Materials: An electronic literature search was performed with MEDLINE via PubMed, Scopus, and Web of Science databases from January 2008 to June 2020. Two high-impact endodontic journals were also hand searched. The selection criteria were: Population; patients requiring endodontic treatment, Intervention and Comparison; endodontic instrumentation with reciprocating versus rotary systems, and Outcome; postoperative pain. We extrapolated all included research data and reported them as dichotomized ordinal variables to evaluate the incidence of pain and continuous variables to assess pain intensity. Standardized mean difference (SMD) was calculated with Inverse Variance method for pain intensity; the incidence of postoperative pain was calculated using relative risk (RR) with the Mantel-Haenszel method. Random-effects model and 95% confidence interval (CI) were used for all meta-analyses. The I2 statistic was used to evaluate the statistical heterogeneity among studies (P&lt;0.05). Results: Twenty-one articles were selected and 17 of them were included in the meta-analysis for the evaluation of postoperative pain in the first 24h. The meta-analysis was performed in two steps: a) all studies were included; b) subsequently studies with preoperative pain were excluded. A significant difference was observed in the intensity of postoperative pain; with rotary system having more favorable in both steps [a) SMD: 0.27; 95% CI: 0.13 to 0.41; P=0.0002; b) SMD: 0.37; 95% CI: 0.15 to 0.58; P=0.0010]. There was no significant difference in the incidence of pain, and the incidence of mild, moderate and severe pain . Conclusion: The meta-analysis results revealed that rotary system were the instrument of choice as they had lower intensity of postoperative pain. Further controlled studies are advocated to provide clarification for intensity/incidence of postoperative pain in endodontic treatment with mechanized instruments

Endodontic Treatment of Complex Dens Invaginatus Teeth with Long Term Follow-Up Periods

Dens invaginatus is characterized by invagination of enamel and dentin in the dental papilla prior to tissue calcification. This malformation commonly occurs in the maxillary lateral incisors. The present study reports two complex endodontic treatments in Oehlers’ type II and III dens invaginatus, with periapical lesion and presence of bone resorption. In the reported cases, conventional endodontic therapy was successful and sufficient enough to eliminate the infectious process, allowing periapical bone neoformation and absence of symptomatology. Dens invaginatus is a relatively easy-to-diagnose dental malformation. However, it is necessary to know its radiographic aspects. The treatment results demonstrated that, although the cases of dens invaginatus of high complexity are challenging, an accurate diagnosis accompanied with proper endodontic treatment can avoid unnecessary surgical intervention and allow great chances of favorable prognosis in long term.Keywords: Anomalies; Classification; Dens Invaginatus; Root Canal Therap

Obstetric violence in the perception of puerperal women in a public maternity hospital in northern Brazil - Violência obstétrica na percepção de puérperas em uma maternidade pública do norte do Brasil

Objective: to verify the occurrence of obstetric violence in a public maternity hospital in a northern Brazilian capital, from the point of view of puerperal women. Method: descriptive-exploratory and quantitative study, carried out with 123 postpartum women hospitalized in rooming-in. Data were collected in June and July 2020, using a structured questionnaire, analyzed in the Statistical Package for the Social Sciences®, version 21. Results: most were unaware (59%) but had experienced obstetric violence (74.8%). The prevalent practices were pilgrimage (34.1%), prevented from having a companion (22.8%), baby removed from the field of vision (20.3%), prohibition of food intake (18.7%), vaginal touches repetitive (17.9%), Kristeller maneuver (14.6%) and lithotomy (12.2%), occurring in the pre-delivery, delivery and postpartum sector (83.1%) and the medical category (92 .8%) involved. Conclusion: there was a high occurrence, inferring changes in professional conduct and restructuring of guidelines for comprehensive care for women in the pregnancy-puerperal period.Objetivo: verificar la ocurrencia de violencia obstétrica en una maternidad pública de una capital del norte de Brasil, desde el punto de vista de las puérperas. Método: estudio descriptivo-exploratorio y cuantitativo, realizado con 123 puérperas hospitalizadas en alojamiento conjunto. Los datos fueron recolectados en junio y julio de 2020, utilizando un cuestionario estructurado, analizado en el Statistical Package for the Social Sciences®, versión 21. Resultados: la mayoría desconocía (59%) pero había sufrido violencia obstétrica (74,8%). Las prácticas predominantes fueron la peregrinación (34,1 %), la prohibición de tener acompañante (22,8 %), la retirada del bebé del campo de visión (20,3 %), la prohibición de ingesta de alimentos (18,7 %), los toques vaginales repetitivos (17,9 %), Kristeller maniobra (14,6%) y litotomía (12,2%), ocurriendo en el sector de preparto, parto y puerperio (83,1%) y la categoría médica (92,8%) involucrada. Conclusión: hubo alta ocurrencia, infiriendo cambios en la conducta profesional y reestructuración de las directrices para la atención integral a la mujer en el período embarazo-puerperio.Objetivo: verificar a ocorrência de violência obstétrica em uma maternidade pública de uma capital norte-brasileira, na percepção de puérperas. Método: estudo descritivo-exploratório e quantitativo, realizado com 123 puérperas internadas em alojamento conjunto. Os dados foram coletados em junho e julho de 2020, por meio de um questionário estruturado, analisados no Statistical Package for the Social Sciences®, versão 21. Resultados: a maioria desconhecia (59,3%) mas vivenciou (74,8%) a violência obstétrica. As práticas prevalentes foram peregrinação (34,1%), não ter acompanhante (22,8%), bebê retirado do campo de visão (20,3%), proibição de ingestão de alimentos (18,7%), toques vaginais repetitivos (17,9%), manobra de Kristeller (14,6%) e litotomia (12,2%), ocorridos no setor pré-parto, parto e pós parto (83,1%) e a categoria médica (92,8%) envolvida. Conclusão: houve alta ocorrência, inferindo mudanças na conduta profissional e reformulação de políticas para um cuidado integral à mulher no período gravídico-puerperal.

Effect of transcranial direct current stimulation combined with gait and mobility training on functionality in children with cerebral palsy: study protocol for a double-blind randomized controlled clinical trial

Background: The project proposes three innovative intervention techniques (treadmill training, mobility training with virtual reality and transcranial direct current stimulation that can be safely administered to children with cerebral palsy. The combination of transcranial stimulation and physical therapy resources will provide the training of a specific task with multiple rhythmic repetitions of the phases of the gait cycle, providing rich sensory stimuli with a modified excitability threshold of the primary motor cortex to enhance local synaptic efficacy and potentiate motor learning. Methods/design A prospective, double-blind, randomized, controlled, analytical, clinical trial will be carried out.Eligible participants will be children with cerebral palsy classified on levels I, II and III of the Gross Motor Function Classification System between four and ten years of age. The participants will be randomly allocated to four groups: 1) gait training on a treadmill with placebo transcranial stimulation; 2) gait training on a treadmill with active transcranial stimulation; 3) mobility training with virtual reality and placebo transcranial stimulation; 4) mobility training with virtual reality and active transcranial stimulation. Transcranial direct current stimulation will be applied with the anodal electrode positioned in the region of the dominant hemisphere over C3, corresponding to the primary motor cortex, and the cathode positioned in the supraorbital region contralateral to the anode. A 1 mA current will be applied for 20 minutes. Treadmill training and mobility training with virtual reality will be performed in 30-minute sessions five times a week for two weeks (total of 10 sessions). Evaluations will be performed on four occasions: one week prior to the intervention; one week following the intervention; one month after the end of the intervention;and 3 months after the end of the intervention. The evaluations will involve three-dimensional gait analysis, analysis of cortex excitability (motor threshold and motor evoked potential), Six-Minute Walk Test, Timed Up-and-Go Test, Pediatric Evaluation Disability Inventory, Gross Motor Function Measure, Berg Balance Scale, stabilometry, maximum respiratory pressure and an effort test. Discussion This paper offers a detailed description of a prospective, double-blind, randomized, controlled, analytical, clinical trial aimed at demonstrating the effect combining transcranial stimulation with treadmill and mobility training on functionality and primary cortex excitability in children with Cerebral Palsy classified on Gross Motor Function Classification System levels I, II and III. The results will be published and will contribute to evidence regarding the use of treadmill training on this population. Trial registration ReBEC RBR-9B5DH

Risk Factors for the Incidence of Dental Caries in Low, Very Low, and Extremely Low Birth Weight Children: A Cohort Study

Objective:&nbsp;To assess the incidence of caries in a two-year period among low birth weight (LBW), very low birth weight (VLBW), and extremely low birth weight (ELBW) children considering socioeconomic indicators, dietary factors and oral hygiene.&nbsp;Material and Methods:&nbsp;A convenience sample was formed of 42 low birth weight children aged two to five years at baseline. Two examiners diagnosed caries using the World Health Organization criteria. Birth weight, socioeconomic indicators and diet were collected from medical records and questionnaires. Binomial models were used to estimate unadjusted and adjusted rate ratios (RR) and respective 95% confidence intervals for the factors evaluated.&nbsp;Results:&nbsp;Thirty-six children were re-examined after two years. The incidence of dental caries was 36.7%. The dmft index was 0.44 (±1.25) at baseline and increased to 1.36 (±3.85) at follow-up. VLBW children (1,000 to 1,500 g) (RR=0.23; 95%CI: 0.08-0.72) and LBW children (1,500 to 2,500 g) (RR=0.06; 0.01-0.55) had fewer carious lesions compared to ELBW children (&lt;1,000 g). Carious lesions were more frequent among children with a lower income (RR=6.05; 1.05-34.84) and less frequent among those who did not consume sweetened juice, tea or yogurt (RR: 0.21; 0.07-0.62).&nbsp;Conclusion: An inverse dose-response relation was found between birth weight and the incidence of caries. A lower income and the consumption of sweetened beverages were risk factors for the development of caries