Infantile melanoma: early diagnosis by total body mapping in dysplastic nevus syndrome

Melanoma is a rare neoplasm in the pediatric population, and it is even rarer in children under 10 years of age. Total body mapping constitutes a low-cost and non-invasive method that increases diagnostic accuracy in evaluating pigmented lesions, especially in high-risk patients. We reported the case of a 9-year boy with dysplastic nevus syndrome, in which one lesion presented a subtle change (asymmetry of structures) within a 6-months follow-up. Its excision resulted in melanoma with a Breslow thickness of 1 mm and a negative sentinel lymph node. Total body mapping reduces the number of unnecessary excisions. It allows diagnosis of melanomas in early and potentially curable stages, especially in children and patients with risk factors such as dysplastic nevus syndrome. We report this case due to the rarity of the neoplasia in this age group and also to demonstrate the importance of sequential digital dermoscopy in early diagnosis of melanoma in this population

InfoDengue – Ferramenta Colaborativa de Combate e Prevenção à Dengue

Dengue fever is an infectious disease caused by a mosquito and itoccurs mostly in tropical areas. The best method to avoid dengue is identifyingpropitious proliferation areas. The Internet and mobile apps have beenchanging social living, mainly by sharing information. This paper presents acollaborative system prototype composed by a Web portal and a mobile app.They allow citizens to create and view annotations about proliferation areas ofdengue. The prototype seems to be useful for citizens and for government

Fixed-Dose Artesunate-Amodiaquine Combination vs Chloroquine for Treatment of Uncomplicated Blood Stage P. vivax Infection in the Brazilian Amazon: An Open-Label Randomized, Controlled Trial

BACKGROUND: Despite increasing evidence of the development of Plasmodium vivax chloroquine (CQ) resistance, there have been no trials comparing its efficacy with that of artemisinin-based combination therapies (ACTs) in Latin America. METHODS: This randomized controlled trial compared the antischizontocidal efficacy and safety of a 3-day supervised treatment of the fixed-dose combination artesunate-amodiaquine Winthrop(R) (ASAQ) versus CQ for treatment of uncomplicated P. vivax infection in Manaus, Brazil. Patients were followed for 42 days. Primary endpoints were adequate clinical and parasitological responses (ACPR) rates at day 28. Genotype-adjustment was performed. RESULTS: From 2012 to 2013, 380 patients were enrolled. In the per-protocol (PP) analysis, adjusted-ACPR was achieved in 100% (165/165) and 93.6% (161/172) of patients in the ASAQ and CQ arm (difference 6.4%, 95% CI 2.7%; 10.1%) at day 28 and in 97.4% (151/155) and 77.7% (129/166), respectively (difference 19.7%, 95% CI 12.9%; 26.5%), at day 42. Apart from ITT D28 assessment, superiority of ASAQ on ACPR was demonstrated. ASAQ presented faster clearance of parasitaemia and fever. Based on CQ blood level measurements, CQ resistance prevalence was estimated at 11.5% (95% CI: 7.5-17.3) up to day 42. At least one emergent adverse event (AE) was recorded for 79/190 (41x6%) in the ASAQ group and for 85/190 (44x7%) in the CQ group. Both treatments had similar safety profiles. CONCLUSIONS: ASAQ exhibited high efficacy against CQ resistant P. vivax and is an adequate alternative in the study area. Studies with an efficacious comparator, longer follow-up and genotype-adjustment can improve CQR characterization

Does acute alcohol intoxication interfere with colonic anastomosis wound healing? : a rat model of nondestructive colon trauma

PURPOSE: To evaluate the effects of acute alcohol intoxication on healing of colonic anastomosis. METHODS: Thirty-six rats were allocated into two groups. Animals in the alcohol (A) were given 2 mL of ethanol diluted in 0.9% saline solution to a concentration of 40% by gavage immediately before anesthesia, whereas control (C) animals received 2 mL of 0.9% saline solution via the same route. A colonic anastomosis was then performed in all animals. On postoperative days 1, 3, and 7, anastomotic breaking strength was assessed and histopathological examination was performed. Change in body weight and mortality were also evaluated. RESULTS: The median of anastomotic tensile strength on the postoperative day 1 was 0.09 Newtons for group A and 0.13 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 3 was 0.13 Newtons for group A and 0.17 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 7 was 0.30 Newtons for group A and 0.35 for group C. (p>0.05). There was no significant difference between the groups A and C, in the first, third or seventh POD (p>0.05), in any of the analyzed parameters. There were no statistical differences between groups in the weight. Three animals died, all from the group A. CONCLUSION: Acute alcohol intoxication did not interfere with wound healing of colonic anastomoses, although it caused early postoperative mortality

Identificação de manifestações patológicas em pontes de concreto armado e metálicas: Identification of pathological manifestations in reinforced and metallic bridges

O presente artigo trata-se de uma revisão de literatura que expõe sobre o conhecimento de patologias em pontes, fortalecendo, assim, o acervo literário existente. A ausência de manutenção é uma das condições que mais ocasionam o surgimento de manifestações patológicas, tais como: fissuras e trincas, flambagem, corrosão, desagregação, eflorescência e manchas. Dentro desse contexto, analisou-se diversos artigos e produções científicas que apresentavam no seu escopo patologias em pontes. Então, através de estudos de casos, as manifestações patológicas encontradas foram esclarecidas e aprofundadas, de modo a encontrar os motivos a que levaram a essas patologias. Por fim, chegou-se a conclusão de que as pontes de concreto armado apresentam como principais patologias as fissuras, já as pontes metálicas apresentam a corrosão, química ou eletroquímica, como principal patologia, além da fadiga e a deformação

ABORDAGEM MULTIDISCIPLINAR NO TRATAMENTO DE DEFORMIDADES FACIAIS: REVISÃO DE LITERATURA

The face is the region of expression of the soul, where all feelings are represented. It plays an important role in establishing social relationships, as well as communication and quality of life. This functional, aesthetic and social relevance of the face makes facial deformities the cause of anguish and isolation for individuals. Facial deformities can be congenital or acquired through trauma or mutilation, and the severity of the injury is very particular, which makes the use of metrics difficult. The objective of this literature review is to demonstrate the multidisciplinary approach in the treatment of facial deformities. Among the main facial deformities of congenital origin, cleft lip and palate are the most frequent and can develop various changes that compromise everything from the position of the teeth, such as speech, eating, breathing and aesthetics. Treatment for facial injuries must involve a multidisciplinary team, including a plastic and maxillofacial surgeon, otorhinolaryngologist, orthodontist, prosthetist, speech therapist, geneticist, psychologist and nutritionist. Therefore, facial deformities have a strong influence on the aesthetics, quality of life and social integration of individuals affected by these injuries. It is also important to highlight the need to have a multidisciplinary team in the care of patients with facial deformities, considering that these changes can compromise the individual's various physical and psychological functions. It is extremely important to monitor different professionals in a multidisciplinary approach in the treatment of facial deformities from the beginning of the diagnosis and throughout the patient's life, always seeking the well-being and quality of life for those with these injuries.A face é a região de expressão da alma, onde todos os sentimentos são representados. Desempenha um importante papel no estabelecimento das relações sociais, bem como na comunicação e na qualidade de vida. Essa relevância funcional, estética e social da face torna as deformidades faciais a causa de angústia e isolamento dos indivíduos. As deformidades faciais podem ser do tipo congênitas ou adquiridas por traumas ou mutilações, e a gravidade da lesão é muito particular, o que torna difícil a utilização de métricas. O  objetivo  desta  revisão de literatura  é  demonstrar a abordagem multidisciplinar no tratamento das deformidades faciais. Dentre  as  principais  deformidade faciais de origem congênita, as fissuras lábio palatinas são as mais frequentes e podem desenvolver diversas alterações que comprometem desde a posição dos dentes, como a fala, a alimentação, a respiração e a estética. O tratamento para lesões na face deve envolver uma equipe multidisciplinar, incluindo cirurgião plástico e bucomaxilofacial, otorrinolaringologista,   ortodontista, protesista, fonoaudiólogo, geneticista, psicólogo e nutricionista. Portanto, as deformidade faciais exercem forte influência na estética, na qualidade de vida e na integração social de indivíduos acometidos por essas lesões. Também é importante ressaltar a necessidade de conter uma equipe multidisciplinar no atendimento de pacientes com deformidades faciais, tendo em vista que essas alterações podem comprometer diversas funções físicas e psicológicas do indivíduo. É de suma importância o acompanhamento de diversos profissionais em uma abordagem multidisciplinar no tratamento de deformidade faciais desde o início do diagnóstico e durante toda a vida do paciente buscando sempre o bem-estar e qualidade de vida para portadores dessas lesões

ANÁLISE COMPARATIVA DO USO DA ESTATINA E DO ÁCIDO NICOTÍNICO NO TRATAMENTO DA SÍNDROME METABÓLICA

Considering metabolic syndrome (MS) as a pathophysiological condition characterized by arterial hypertension, central obesity, insulin resistance, dyslipidemia, and hyperglycemia, this study aims to compare the use of statins and nicotinic acid in the treatment of MS. To this end, a comparative analysis based on relevant clinical and epidemiological studies was conducted. Thus, it is observed that statins significantly reduce LDL cholesterol by about 50% and decrease the risk of cardiovascular events by 25% to 35%, with an odds ratio (OR) of improvement between 0.70 and 0.80. Statins are widely available and accessible, especially in generic versions, and have a relatively manageable adverse effect profile. In contrast, nicotinic acid reduces LDL cholesterol by 15% to 25%, increases HDL cholesterol, and reduces triglycerides, but with less consistent efficacy in preventing cardiovascular events (OR ranging from 0.90 to 1.10) and significant side effects, such as skin flushing and hepatotoxicity. The cost and availability of nicotinic acid are more limited compared to statins. It is concluded that statins are the preferred choice for the treatment of MS due to their robust efficacy and accessibility, while nicotinic acid may be considered in specific cases, with caution due to its adverse effects.Considerando a síndrome metabólica (SM) como uma condição fisiopatológica caracterizada por hipertensão arterial, obesidade central, resistência à insulina, dislipidemia e hiperglicemia, este estudo objetiva comparar o uso de estatinas e ácido nicotínico no tratamento da SM. Para tanto, procede-se a uma análise comparativa baseada em estudos clínicos e epidemiológicos relevantes. Desse modo, observa-se que as estatinas reduzem significativamente o LDL-colesterol em cerca de 50% e diminuem o risco de eventos cardiovasculares em 25% a 35%, com odds ratio (OR) de melhora entre 0,70 e 0,80. As estatinas são amplamente disponíveis e acessíveis, especialmente nas versões genéricas, e apresentam um perfil de efeitos adversos relativamente manejável. Em contraste, o ácido nicotínico reduz o LDL-colesterol em 15% a 25%, aumenta o HDL-colesterol e reduz os triglicerídeos, mas com uma eficácia menos consistente na prevenção de eventos cardiovasculares (OR variando de 0,90 a 1,10) e efeitos colaterais significativos, como rubor cutâneo e hepatotoxicidade. O custo e a disponibilidade do ácido nicotínico são mais limitados em comparação às estatinas. Conclui-se que as estatinas são a escolha preferida para o tratamento da SM devido à sua eficácia robusta e acessibilidade, enquanto o ácido nicotínico pode ser considerado em casos específicos, com precaução devido aos seus efeitos adversos