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ABSTRACT Introduction: Acute kidney injury (AKI) is an abrupt deterioration of kidney function. The incidence of pediatric AKI is increasing worldwide, both in critically and non-critically ill settings. We aimed to characterize the presentation, etiology, evolution, and outcome of AKI in pediatric patients admitted to a tertiary care center. Methods: We performed a retrospective observational single-center study of patients aged 29 days to 17 years and 365 days admitted to our Pediatric Nephrology Unit from January 2012 to December 2021, with the diagnosis of AKI. AKI severity was categorized according to Kidney Disease Improving Global Outcomes (KDIGO) criteria. The outcomes considered were death or sequelae (proteinuria, hypertension, or changes in renal function at 3 to 6 months follow-up assessments). Results: Forty-six patients with a median age of 13.0 (3.5-15.5) years were included. About half of the patients (n = 24, 52.2%) had an identifiable risk factor for the development of AKI. Thirteen patients (28.3%) were anuric, and all of those were categorized as AKI KDIGO stage 3 (p < 0.001). Almost one quarter (n = 10, 21.7%) of patients required renal replacement therapy. Approximately 60% of patients (n = 26) had at least one sequelae, with proteinuria being the most common (n = 15, 38.5%; median (P25-75) urinary protein-to-creatinine ratio 0.30 (0.27-0.44) mg/mg), followed by reduced glomerular filtration rate (GFR) (n = 11, 27.5%; median (P25-75) GFR 75 (62-83) mL/min/1.73 m2). Conclusions: Pediatric AKI is associated with substantial morbidity, with potential for proteinuria development and renal function impairment and a relevant impact on long-term prognosis.

RESUMO Introdução: Insuficiência renal aguda (IRA) é uma deterioração abrupta da função renal. A incidência de IRA pediátrica está aumentando em todo o mundo, em ambientes críticos e não críticos. Nosso objetivo foi caracterizar apresentação, etiologia, evolução e desfechos da IRA em pacientes pediátricos internados em um centro de atendimento terciário. Métodos: Realizamos estudo retrospectivo observacional de centro único de pacientes com idade entre 29 dias a 17 anos e 365 dias internados em nossa Unidade de Nefrologia Pediátrica, de janeiro de 2012 a dezembro de 2021, com diagnóstico de IRA. A gravidade da IRA foi categorizada de acordo com os critérios do Kidney Disease Improving Global Outcomes (KDIGO). Os desfechos considerados foram óbito ou sequelas (proteinúria, hipertensão ou alterações na função renal em avaliações de acompanhamento de 3 a 6 meses). Resultados: Incluímos 46 pacientes com idade mediana de 13,0 (3,5-15,5) anos. Cerca de metade (n = 24; 52,2%) apresentou um fator de risco identificável para o desenvolvimento de IRA. Treze pacientes (28,3%) eram anúricos; todos foram classificados como IRA KDIGO 3 (p < 0,001). Quase um quarto (n = 10; 21,7%) dos pacientes necessitaram de terapia renal substitutiva. Aproximadamente 60% (n = 26) apresentou pelo menos uma sequela, sendo proteinúria a mais comum (n = 15; 38,5%; mediana (P25-75) da relação proteína/creatinina urinária 0,30 (0,27-0,44) mg/mg), seguida de taxa de filtração glomerular (TFG) reduzida (n = 11; 27,5%; mediana (P25-75) da TFG 75 (62-83) mL/min/1,73 m2). Conclusões: A IRA pediátrica está associada à morbidade substancial, com potencial para desenvolvimento de proteinúria e comprometimento da função renal e impacto relevante no prognóstico de longo prazo.

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OBJECTIVES: to understand nursing students' perception regarding Escape Room use to develop leadership skills. METHODS: a qualitative exploratory-descriptive study, with 97 nursing students. Escape Room game sessions were held, totaling ten. Subsequently, a debriefing and analysis was carried out using the Discourse of the Collective Subject method, through the focus group technique. Ethical procedures were respected. RESULTS: students' perceptions about using this methodology to develop leadership skills were positive and significant. The effectiveness of the game in teaching and developing these skills in nursing practice stands out. FINAL CONSIDERATIONS: the game was an effective active methodology in approaching the proposed content, promoting satisfaction and easy assimilation.

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BACKGROUND: Real-time quantitative PCR (RT-qPCR) is one of the most widely used gene expression analyses for validating RNA-seq data. This technique requires reference genes that are stable and highly expressed, at least across the different biological conditions present in the transcriptome. Reference and variable candidate gene selection is often neglected, leading to misinterpretation of the results. RESULTS: We developed a software named "Gene Selector for Validation" (GSV), which identifies the best reference and variable candidate genes for validation within a quantitative transcriptome. This tool also filters the candidate genes concerning the RT-qPCR assay detection limit. GSV was compared with other software using synthetic datasets and performed better, removing stable low-expression genes from the reference candidate list and creating the variable-expression validation list. GSV software was used on a real case, an Aedes aegypti transcriptome. The top GSV reference candidate genes were selected for RT-qPCR analysis, confirming that eiF1A and eiF3j were the most stable genes tested. The tool also confirmed that traditional mosquito reference genes were less stable in the analyzed samples, highlighting the possibility of inappropriate choices. A meta-transcriptome dataset with more than ninety thousand genes was also processed successfully. CONCLUSION: The GSV tool is a time and cost-effective tool that can be used to select reference and validation candidate genes from the biological conditions present in transcriptomic data.

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PURPOSE OF REVIEW: Laser acupuncture (LA) demonstrates promising results in the treatment of musculoskeletal disorders. However, its effects on temporomandibular disorder (TMD) are not yet fully understood. Thus, the aim of this systematic review and network meta-analysis was to assess the effectiveness of LA on pain intensity and maximum mouth opening range (MMO) related to TMD. A search was carried out in 11 electronic databases and references of included studies to locate randomized clinical trials (RCTs) that evaluated LA as a primary treatment for TMD. The risk of bias was assessed using the RoB 2 tool. Network meta-analysis was conducted on the MetaInsight platform, considering the pain intensity and counseling (C) as the outcome of reference. The GRADE system was used to assess the certainty of the evidence. RECENT FINDINGS: Five studies evaluated pain intensity, four with a high risk of bias and one with a low risk. Two studies evaluated pain intensity on palpation (one with high and one with low risk of bias), and one study with high risk of bias evaluated MMO. Laser parameters were: 690-810 nm, 40-150 mW, and 7.5-112.5 J/cm2. Occlusal splint (OS) [- 2.47; CI 95% - 3.64, - 1.30] and Physiotherapy (PT) [-2.64; CI 95% - 3.94, - 1.34] reduced pain intensity compared to C. The ranking of treatments in order of effectiveness was PT > OS > LA > C > CR (craniopuncture). The certainty of the evidence was very low or low. The data do not support the indication of LA for the treatment of TMDs and new placebo-controlled RCTs must be conducted to demonstrate its effectiveness more precisely.

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Background. Gestational weight gain (GWG) constitutes an essential aspect of the gestational process. Due to factors such as pregestational body mass index (BMI), nutritional intake, level of physical activity, and psychological aspects, the recommended GWG may not be achieved, leading to adverse neonatal outcomes. Adolescents, due to their physiological and mental developmental stage, are at a higher risk of inappropriate GWG. Our aim is to highlight the importance of GWG in our population and to determine the correlation with perinatal outcomes. Methods. Pregnant adolescents who attended a tertiary care institution for prenatal care were included; maternal data such as preBMI and GWG were used to determine maternal and neonatal outcomes using the chi-square test and OR determination. Results. A total of 202 adolescent pregnant patients were included, comprising those with inadequate GWG (n = 70), adequate GWG (n = 85), and excessive GWG (n = 47). A statistically significant association was found between low BMI and inadequate GWG. Patients with inadequate GWG demonstrated a correlation with IUGR and low birth weight, while patients with excessive GWG gave birth to macrosomic neonates. Conclusion. We concluded that previous habits play a significant role in determining weight gain throughout pregnancy. GWG has a direct impact on neonatal growth and development.

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Vancomycin is the cornerstone in treating methicillin-resistant Staphylococcus aureus (MRSA) infections. However, therapeutic failures can occur when MRSA strains with decreased susceptibility to glycopeptides (DSG) are involved. The aim of this study was to detect and characterize DSG in MRSA recovered from children with invasive diseases at a reference pediatric hospital between 2009 and 2019. Fifty-two MRSA strains were screened using agar plates with vancomycin 3 and 4 mg/L (BHI-3 and BHI-4); the VITEK2 system; and standard and macro E-tests. Suspicious hVISA were studied by population analysis profiling-area under the curve (PAP-AUC), and wall thickness was analyzed by transmission electron microscopy. Neither VRSA nor VISA were detected in this set. As only three strains met the hVISA criteria, the PAP-AUC study included 12 additional MRSA strains that grew one colony on BHI-4 plates or showed minimum inhibitory concentrations of vancomycin and/or teicoplanin ≥ 1.5 mg/L. One strain was confirmed as hVISA by PAP-AUC. The wall thickness was greater than the vancomycin-susceptible control strain; it belonged to ST30 and carried SCCmec IV. As expected, a low frequency of hVISA was found (1.9%). The only hVISA confirmed by PAP-AUC was not detected by the screening methods, highlighting the challenge that its detection represents for microbiology laboratories.

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Herein, a detailed molecular phylogeny analysis was developed to determine the phylogenetic position of a new freshwater histozoic myxosporean cnidarian, Henneguya markiana sp. nov. from the world's largest tropical wetland area, Pantanal, Brazil. The new species is described using an integrative taxonomy approach including morphology, biological traits and molecular data. Phylogenetic analysis inferred by Maximum Likehood method showed the new Henneguya species in a well-supported clade of myxosporean gill parasites of South American characids fishes. In this same clade, the new Henneguya described appeared in a sub-clade clustering with H. lacustris and H. chydadea. Nevertheless, the sequences of the new species and H. lacustris and H. chydadea have a large genetic divergence of 10.4% (148 nucleotides-nt) and 10.5% (147 nt) respectively. To the best of our knowledge, this is the first report of a cnidarian myxosporean species parasitizing a fish from Stevardiinae from South America. In the light of the differences observed from the integrative taxonomy, we are confident that this isolate is a new species of Henneguya, increasing the knowledge of diversity of this enigmatic group of cnidarians.

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Background: Osteoradionecrosis (ORN) of the jaws is a late complication after radiotherapy to head and neck cancer. Objective: To describe a rare case of ORN of the torus mandibularis that was successfully managed exclusively with antimicrobial photodynamic therapy (aPDT). Case report: A 72-year-old man presented an exposed necrotic bone observed in the torus mandibularis, extending to the lingual alveolar ridge with no edema nor suppuration. The treatment provided a noninvasive treatment leading to spontaneous sequestrectomy of the torus in 2 weeks with complete mucosal repair in 5 weeks and absence of lesion signs and/or symptoms even after 6 months of follow-up. Conclusions: The aPDT indicated to be a satisfactory treatment for ORN affecting torus mandibularis, a region with surgical limitations, avoiding surgery.

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BACKGROUND: Angiosarcoma is an aggressive malignant neoplasm of vascular origin. Oral metastases of angiosarcoma are rare and have a non-specific clinical presentation, thus the diagnosis may be challenging. CASE REPORT: Herein we report a case of a 34-year-old female patient after treatment of a high-grade angiosarcoma of the breast, who presented an asymptomatic bleeding purplish nodule in the maxillary interdental papilla between the first and second premolar. A biopsy was performed, and the histological examination revealed infiltration by malignant neoplasm of epithelioid and fusocellular pattern. Immunohistochemical analysis demonstrated that neoplastic cells were positive for ERG and CD31, and negative for cytokeratins AE1/AE3, confirming the diagnosis of metastatic angiosarcoma. After investigation, multiple metastases were discovered. The patient is under management with chemotherapy and palliative radiotherapy for the bone lesions. CONCLUSION: Metastases should be considered in the differential diagnosis of oral lesions in patients with a previous history of cancer. Due to the morphology of angiosarcomas, the metastatic lesions may resemble benign vascular lesions, therefore, biopsy is mandatory to exclude malignancy.

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ABSTRACT Objectives: to understand nursing students' perception regarding Escape Room use to develop leadership skills. Methods: a qualitative exploratory-descriptive study, with 97 nursing students. Escape Room game sessions were held, totaling ten. Subsequently, a debriefing and analysis was carried out using the Discourse of the Collective Subject method, through the focus group technique. Ethical procedures were respected. Results: students' perceptions about using this methodology to develop leadership skills were positive and significant. The effectiveness of the game in teaching and developing these skills in nursing practice stands out. Final Considerations: the game was an effective active methodology in approaching the proposed content, promoting satisfaction and easy assimilation.

RESUMEN Objetivos: comprender la percepción de estudiantes de enfermería sobre el uso del Escape Room para desarrollar habilidades de liderazgo. Métodos: estudio cualitativo exploratorio-descriptivo, con 97 estudiantes de enfermería. Se realizaron sesiones de juegos de Escape Room, en total diez. Posteriormente, se realizó un debriefing y análisis mediante el método del Discurso del Sujeto Colectivo, mediante la técnica del grupo focal. Se respetaron los procedimientos éticos. Resultados: las percepciones de los estudiantes sobre el uso de esta metodología para desarrollar habilidades de liderazgo fueron positivas y significativas. Se destaca la efectividad del juego en la enseñanza y el desarrollo de estas habilidades en la práctica de enfermería. Consideraciones Finales: el juego resultó una metodología activa eficaz en el abordaje de los contenidos propuestos, promoviendo satisfacción y fácil asimilación.

RESUMO Objetivos: compreender a percepção do discente de enfermagem quanto ao uso do Escape Room para o desenvolvimento de habilidades de liderança. Métodos: estudo qualitativo exploratório-descritivo, com 97 graduandos de enfermagem. Foram aplicadas sessões de jogos de Escape Room, totalizando dez. Posteriormente, foi realizado um debriefing e análise feita pelo método do Discurso do Sujeito Coletivo, por meio da técnica do grupo focal. Os procedimentos éticos foram respeitados. Resultados: as percepções dos discentes sobre o uso dessa metodologia para desenvolver habilidades de liderança foram positivas e significativas. Destacam-se a eficácia do jogo no ensino e o desenvolvimento dessas habilidades na prática da enfermagem. Considerações Finais: o jogo foi uma metodologia ativa efetiva na abordagem do conteúdo proposto, promovendo satisfação e fácil assimilação.

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Resumen Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el trata miento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médi ca de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por can didemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas ge nerales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolu cionando favorablemente con mejoría clínica e image nológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfer medades complejas como la diabetes.

Abstract Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treat ment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and gen eral symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imag ing improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.

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INTRODUCTION: Radiotherapy remains one of the main treatments for head and neck cancer; however, it is accompanied by acute and chronic adverse effects. Use of three-dimensional (3D) oral stents to modulate radiation intensity to specific target areas have been developed to minimize these adverse effects. This study aimed to present a scoping review of studies published on 3D printing of oral stents and their clinical applicability. METHODS: MEDLINE/Pubmed, Scopus, Web of Science and CENTRAL Cochrane data bases were searched, studies selected, and data collected by three independent reviewers up to December 2022. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Extension for Scoping Reviews (PRISMA-ScR). RESULTS: The search resulted in 404 studies and 5 articles fulfilled the eligibility criteria and were considered for this review. Three-dimensional printed intraoral stents were produced for 56 patients with indication for radiotherapy. 3D-printed stents were well-tolerated by all tested patients and demonstrated great reproducibility of maxillomandibular relation, required less time for production and lower cost to manufacture. Two studies showed great protection of healthy tissues with 3D-printed stents during radiotherapy. CONCLUSIONS: Three-dimensional printing is promising for production of intraoral stents, however, more studies are needed to improve the technique and further investigate the safety and prevention of oral toxicities from radiotherapy.

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The gingival cyst of the adult (GCA) is a rare odontogenic cyst, consisting of 0.3% of all odontogenic cysts. This case report, based on CARE guidelines for case reports, aims to present a case of a 52-year-old female patient with a symptomatic translucent nodule in the upper left anterior gingiva, measuring approximately 6mm. Excisional biopsy was performed, and the histological examination revealed multiple cystic cavities lined by the squamous epithelium of varying thickness with focal areas of nodular thickenings. The presence of clusters of cells with clear cytoplasm within epithelial thickenings was observed. PAS staining was negative in clear cells. The diagnosis of the GCA was established. Despite its rarity, GCA should be considered in the differential diagnosis of gingival lesions. Conservative surgical treatment proved to be effective, with no signs of recurrence.

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Renal abscesses are a rare complication of urinary tract infections and may be associated with increased morbidity and mortality. Most cases occur in patients with predisposing factors such as immunosuppression. Diagnosis requires high clinical suspicion and its treatment consists in the use of parenteral antibiotics and antifungals associated or not with surgical interventions such as nephrostomy and nephrectomy. Few cases have been published in the medical literature of multifocal bilateral renal abscesses and even fewer due to Candida albicans. We present the case of a 20-year-old woman with type 1 diabetes mellitus, diagnosed at age 8, multiple hospitalizations for diabetic ketoacidosis, and recent hospitalization for candidemia (Candida albicans) treated with fluconazole for 23 days. Eighteen days after her discharge, she consulted for dull flank pain and general symptoms. Contrast enhanced abdominal tomography showed bilateral multifocal abscesses and Candida albicans was isolated in one of the samples obtained from lesions. She received fluconazole 400 mg, 6 weeks i.v. and 2 weeks via enteral route, evolving favorably with clinical and imaging improvement, continuing outpatient clinical monitoring. This report highlights the importance of diagnosis and treatment of this rare complication in complex diseases such as diabetes mellitus.

Los abscesos renales son una complicación poco frecuente de las infecciones del tracto urinario y suelen asociarse con un aumento de la morbi-mortalidad. La mayoría de los casos ocurre en pacientes con factores predisponentes como la inmunosupresión. El diagnóstico requiere de una elevada sospecha clínica y el tratamiento consiste en el uso de antibióticos y antifúngicos parenterales asociados o no a intervenciones quirúrgicas como nefrostomía y nefrectomía. Son pocos los casos publicados en la literatura médica de abscesos renales bilaterales multifocales y menos aún por Candida albicans. Se presenta el caso de una mujer de 20 años de edad con diabetes mellitus tipo 1 diagnosticada a los 8 años, múltiples internaciones por cetoacidosis diabética y reciente internación por candidemia (Candida albicans) completando tratamiento con fluconazol por 23 días. A los 18 días de su externación, consulta por dolor en flancos de tipo sordo y síntomas generales; se realizó tomografía de abdomen con contraste que mostró abscesos multifocales bilaterales. Aislándose Candida albicans en una de las muestras obtenidas de las lesiones; recibió tratamiento con fluconazol 400 mg por 6 semanas endovenoso y 2 semanas vía enteral, evolucionando favorablemente con mejoría clínica e imagenológica continuando seguimiento clínico ambulatorio. Este reporte resalta la importancia del diagnóstico y tratamiento de esta complicación infrecuente en enfermedades complejas como la diabetes.

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RESUMO A Política Nacional de Atenção Básica (PNAB), quando estabelecida em 2006, corroborou o direcionamento do modelo assistencial em conformidade com a universalização do sistema de saúde brasileiro. Contudo, alterações recentes na sua organização e financiamento demonstram inflexões. O objetivo do artigo foi analisar processos decisórios relacionados com a PNAB, em distintos espaços de deliberação do Sistema Único de Saúde (SUS), que incidiram em mudanças nessa política, no período de 2016 a 2020. Trata-se de um estudo de caso exploratório e retrospectivo, que adotou o process tracing. Foram analisadas as atas das reuniões do Conselho Nacional de Saúde (CNS) e da Comissão Intergestores Tripartite (CIT) de 2016 a 2020. As gravações de Reuniões Ordinárias da CIT, entre 2019 e 2020, também foram fontes de informações. Alterações na política deram-se sob a baixa interlocução e desaprovação da instância nacional de participação e controle social do SUS. O CNS atuou como um espaço de denúncia e resistência às mudanças, porém, com baixa capacidade de influenciar as decisões políticas. Por sua vez, o espaço intergovernamental do SUS revelou cooperação entre representantes de gestores subnacionais, com poucas tensões, no que diz respeito à agenda de mudança proposta pela União.

ABSTRACT The National Primary Care Policy (PNAB), when established in 2006, corroborated the direction of the care model in accordance with the universalization of the Brazilian health system. However, recent changes in its organization and funding demonstrate inflections. The aim of the study is to analyze decision-making processes related to the PNAB, in different deliberation spaces of the SUS, which influenced changes in such policy, in the period between 2016 and 2020. This is an exploratory and retrospective case study, which adopted process tracing. Meeting minutes of the National Health Council (CNS) and Tripartite Inter-managers Commission (CIT) from 2016 to 2020 were analyzed. Recordings of Ordinary CIT Meetings, between 2019 and 2020, were also sources of information. Changes in the policy took place under the low dialogue and disapproval of the national instance of participation and social control of the SUS. The CNS acted as a space for denunciation and resistance to changes, but with a low capacity to influence political decisions. In turn, the intergovernmental space of the SUS revealed cooperation between representatives of subnational managers, with few tensions, with regard to the change agenda proposed by the Union.

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AIMS: Evaluate the existing evidence of osteoradionecrosis (ORN) treatment in adults with head and neck cancer, the methodological quality and the evidence grade within systematic reviews (SRs). METHODS: An extensive systematic literature search of SRs that addressed ORN in head and neck cancer patients was conducted with screening of eligible studies, data extraction, methodological (AMSTAR 2) and evidence quality assessment (GRADE) of the SRs by independent and calibrated authors. RESULTS: A total of six SRs were enrolled. Based primarily on studies from the 1990s, there is critically low- or moderate-quality evidence that hyperbaric oxygen therapy (HBO) improves ORN healing. From 2005 onward, evidence has been discovered in relation to treatment with pentoxifylline and tocopherol (PENTO). The SRs indicate that the management of ORN with PENTO appears to be promising. The greatest rates of healing are seen in mild and moderate stages of ORN. However, the quality of evidence regarding PENTO, surgery and other treatments remains critically low. CONCLUSION: There is no standardized protocol to treat ORN. PENTO appears to be the most promising conservative treatment; however, the current level of evidence regarding PENTO is still critically low. More robust clinical studies are needed to establish the best treatment for ORN.

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ABSTRACT The gingival cyst of the adult (GCA) is a rare odontogenic cyst, consisting of 0.3% of all odontogenic cysts. This case report, based on CARE guidelines for case reports, aims to present a case of a 52-year-old female patient with a symptomatic translucent nodule in the upper left anterior gingiva, measuring approximately 6mm. Excisional biopsy was performed, and the histological examination revealed multiple cystic cavities lined by the squamous epithelium of varying thickness with focal areas of nodular thickenings. The presence of clusters of cells with clear cytoplasm within epithelial thickenings was observed. PAS staining was negative in clear cells. The diagnosis of the GCA was established. Despite its rarity, GCA should be considered in the differential diagnosis of gingival lesions. Conservative surgical treatment proved to be effective, with no signs of recurrence.

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Abstract Musculoskeletal symptoms (MS) can derive from injuries or dysfunctions that affect biological tissues such as muscles, bones, and nerves, among others. Military Firefighters (MF) exercise their activities exposed to varied and complex biological conditions, in which the physical demands are intense. Shift work is another remarkable characteristic of the career, which is associated with sleep disorders. Our objective was to estimate the association between the risk of chronification of MS and sleep quality in MF with MS. Our study is a Cross-Sectional Observational Study, whose sample was composed of 753 BM from the Federal District. The analysis was performed with a Sample Characterization Questionnaire, Örebro Musculoskeletal Symptoms Screening Questionnaire (OMPSQ) and the Pittsburgh Sleep Quality Index (PSQI), answered remotely. Statistical analysis used the Spearman Correlation test, p<0.05. The correlation between OMPSQ and PSQI was rated moderate, demonstrating that sleep quality has an influence on the chronification process. The average of the evaluation of Sleep Quality through the PSQI is 8.79, indicating that military personnel present a deficient quality of sleep. There was a correlation between the PSQI score and the OMPSQ of 0.542 (p<0.001), a moderate correlation between the variables. We conclude that MF show correlation between SM and sleep quality, indicating a moderate relationship between the variables, where sleep quality explains 25% of SM. We found that most MF were classified as Low Risk for chronification of SM.

Resumo Os sintomas musculoesqueléticos (SM) podem derivar de lesões ou disfunções que afetam tecidos biológicos como músculos, ossos, nervos, entre outros. Os Bombeiros Militares (BM) exercem suas atividades expostos a condições biológicas variadas e complexas, nas quais as demandas físicas são intensas. O trabalho em turno é outra característica marcante na carreira, o qual está associado a distúrbios do sono. Nosso objetivo foi estimar a associação entre o risco de cronificação de SM e a qualidade do sono em BM com SM. Nosso estudo é um Estudo Observacional Transversal, cuja amostra foi composta por 753 BM do Distrito Federal. A análise foi realizada com um Questionário de Caracterização Amostral, Questionário Örebro de Triagem de Sintomas Musculoesqueléticos (OMPSQ) e com o Índice de Qualidade do Sono de Pittsburgh (PSQI), respondidos remotamente. A análise estatística utilizou o teste de Correlação Spearman, p<0,05. A correlação entre OMPSQ e PSQI foi classificada em moderada, demonstrando que a qualidade do sono apresenta influência no processo de cronificação. A média da avaliação da Qualidade do Sono através do PSQI é de 8,79, indicando que militares apresentam uma qualidade do sono deficitária. Houve correlação entre a pontuação no PSQI e o OMPSQ de 0,542 (p<0.001), correlação moderada entre as variáveis. Concluímos que os BM apresentam correlação entre os SM e a qualidade do sono, indicando uma relação moderada entre as variáveis, onde a qualidade de sono explica 25% dos SM. Verificamos que a maioria dos BM foram classificados como Baixo Risco de cronificação de SM.

RESUMO

Listeriosis is an infectious disease caused by bacteria of the genus Listeria, the neurological form being more common in ruminants. There are many reports of listeriosis in small ruminants in the region that includes Brazil, Argentina and Uruguay. However, these diagnoses were mainly based on histological lesions in the central nervous system (CNS) without the isolation and characterization of the involved Listeria strains. The aim of this study was to report sheep and goats listeriosis cases from 2016 to 2021 in northwestern Uruguay. The diagnosis was made according to lesions observed at histopathology, plus Listeria isolation in CNS, identifying it at specie and serotype level. Nine animals (n=9) of three outbreaks and five sporadic cases of listeriosis were studied. Sheep was the species with more cases in relation to goats, and adults were the category most affected. Cases occurred in spring and less frequently in winter. All presented neurological clinical signs and the lesions in the CNS were consistent with suppurative meningoencephalitis and micro-abscesses in the brainstem. In eight of nine CNS samples, Listeria strains were isolated (seven L. monocytogenes and one L. innocua). All the L. monocytogenes isolates carried the inlA gene; serotyping showed that four strains belonged to serotype 1/2b, two isolates belonged to serotype 4b, and one to serotype 1/2a. Considering that listeriosis is a common disease in this region and the fact that isolates are scarcely recovered from small ruminants, it would be important to emphasize the need for Listeria isolation to better characterize the strains that affect animals. Not only to improve knowledge about the epidemiology of disease but also with the objective of developing serotype specific vaccines for animal use.

Listeriose uma doença bacteriana causada pelo gênero Listeria, a forma nervosa é a mais comum em ruminantes. No Brasil, Argentina e Uruguai há vários relatos de listeriose em pequenos ruminantes com diagnóstico baseado na histopatologia do sistema nervoso central (SNC), sem o isolamento e a caracterização do agente. O objetivo deste trabalho foi relatar uma série de casos diagnosticados em ovinos e caprinos no período 2016-2021 no noroeste do Uruguai. O diagnóstico foi feito basado nas lesões observadas na histopatologia, e caracterização das cepas de Listeria recuperadas do SNC quanto à espécie e sorotipo. Nove animais (n=9) do três surtos e cinco casos isolados de listeriose foram estudados. Os ovinos foram a espécie com o maior número de casos em relação aos caprinos, sendo os animais adultos a categoria mais afetada em ambas espécies. A doença ocorreu principalmente na primavera com alguns casos observados no inverno. Todos os casos apresentavam sinais clínicos nervosos e as lesões no SNC caracterizavam-se por meningoencefalite supurativa com presença de microabscessos no tronco encefálico. Em oito de nove amostras do SNC foram isoladas cepas de Listeria (sete L. monocytogenes e uma L. innocua). Todos os isolados de L. monocytogenes continham o gene inlA; a sorotipagem apresentou quatro cepas do serotipo 1/2b, duas cepas serotipo 4b e uma cepa 1/2a. Levando em consideração que nesta região a listeriose é uma doença frequente e que existem poucos isolados recuperados de casos clínicos em pequeño ruminantes, torna-se relevante o isolamento deste agente para caracterização das cepas que afetam os animais. Não só para melhorar o conhecimento sobre a epidemiologia da doença, mas também com o objetivo de desenvolver vacinas sorotipo-especificas para uso animal.

Assuntos