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PURPOSE: The prevalence of ocular allergy varies according to the population and location of the study. Severe forms of ocular allergy are associated with compromised quality of life. In this study, we aimed to evaluate the application of the Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire to children and adolescents with different subtypes of allergic conjunctivitis. METHOD: A total of 48 patients (aged 5-12 years) with allergic conjunctivitis were included in this study. They were enrolled and monitored at a specialized center. After the clinical appointment, the children responded to the questionnaire on two occasions at an interval of 30 days. Individual scores (ranging from 0 to 3) of the 16 items were added. RESULTS: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire demonstrated good translation, adaptation, and intellectual properties, with substantial internal consistency (Cronbach's α coefficient = 0.702). There was no significant difference between the responses of the two interviews, revealing good reproducibility. The moderate/severe forms of allergic conjunctivitis had significantly higher quality of life scores (indicating a poorer quality of life) than the mild forms. CONCLUSIONS: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis proved to be quick, reliable, and reproducible for assessing the quality of life in children with allergic conjunctivitis. However, its ability to detect changes resulting from symptom aggravation or treatment needs to be further evaluated.

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ABSTRACT Purpose: The prevalence of ocular allergy varies according to the population and location of the study. Severe forms of ocular allergy are associated with compromised quality of life. In this study, we aimed to evaluate the application of the Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire to children and adolescents with different subtypes of allergic conjunctivitis. Method: A total of 48 patients (aged 5-12 years) with allergic conjunctivitis were included in this study. They were enrolled and monitored at a specialized center. After the clinical appointment, the children responded to the questionnaire on two occasions at an interval of 30 days. Individual scores (ranging from 0 to 3) of the 16 items were added. Results: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis questionnaire demonstrated good translation, adaptation, and intellectual properties, with substantial internal consistency (Cronbach's α coefficient = 0.702). There was no significant difference between the responses of the two interviews, revealing good reproducibility. The moderate/severe forms of allergic conjunctivitis had significantly higher quality of life scores (indicating a poorer quality of life) than the mild forms. Conclusions: The Brazilian-Portuguese version of the Quality of Life in Children with Keratoconjunctivitis proved to be quick, reliable, and reproducible for assessing the quality of life in children with allergic conjunctivitis. However, its ability to detect changes resulting from symptom aggravation or treatment needs to be further evaluated.

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Objective: Assess the incidence of anaphylaxis in the emergency room (ER) of a private pediatric hospital in the city of São Paulo, Brazil, and describe associated factors. Method: This was a cross-sectional, retrospective, and observational study based on the medical records of patients from 0 to 18 years old seen at the emergency unit during the years of 2016-2019, who had a diagnosis potentially related to anaphylaxis according to ICD-10. All medical records were individually reviewed for the presence of compatible signs and symptoms that identified "possible" cases of anaphylaxis. Cases were considered probable anaphylaxis when medical history was compatible and indicative of anaphylaxis in the opinion of at least 2 allergists. Results: The incidence of anaphylaxis was 0.013%. Among the 56 patients identified (mean age 4.2 years), food was the most predominant suspected factor (53%), followed by unknown factors (32%), and drugs (12.5%). All patients presented with cutaneous symptoms, 74% with respiratory, and 53% with gastrointestinal. Allergic disease as a comorbidity was found in 39% of the children and 11% had a history of previous anaphylaxis. There were neither cases of syncope or shock, nor deaths. Intramuscular (IM) adrenaline was prescribed in 37.5% of cases. Conclusions: The incidence of anaphylaxis was low when compared to the worldwide incidence. The severity of most cases was mild, cutaneous symptoms were predominant, and food was the suspected trigger most frequently associated with reactions.

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As fistulas liquóricas rinogênicas são definidas como comunicações entre as fossas nasais e o espaço subaracnóideo. A origem dessas falhas pode ser de origem traumática ou não traumática, e o quadro clínico cursa com rinorréia ou otorréia citrina, geralmente unilateral. As fístulas não traumáticas espontâneas são menos comuns de ocorrer do que as traumáticas. O paciente relatado apresentava um quadro de rinoliquorreia através de fossa nasal direita, com aumento de fluxo ao se inclinar para frente e/ou realizar flexão anterior do pescoço. Realizando investigação diagnóstica por imagem a tomografia computadorizada de seios da face evidenciou a fístula localizada em recesso lateral de seio esfenoidal direito. Nesse caso o paciente foi submetido a correção cirúrgica, sendo escolhida uma abordagem endoscópica endonasal transpitrigoide para acessar a região do defeito. Realizado o fechamento da fístula o paciente evoluiu sem sinais de recidiva e sem outras sintomatologias.

Rhinogenic cerebrospinal fluid (CSF) leaks are communications between the nasal cavities and the subarachnoid space. The etiology of these leaks could be traumatic or non-traumatic, citrus rhinorrhea or otorrhea are the most common symptoms. The spontaneous non-traumatic leaks are less common to occur than the traumatic ones. The reported patient had CSF rhinorrhea through the right nostril, with an increased flow when leaning forward and/or perform anterior neck flexion. Imaging diagnostic by computed tomography cisternography showed the leak located in the lateral recess of the right sphenoid sinus. In this case the patient underwent a surgical procedure, the choice was an endoscopic endonasal traspterygoid approach to access the defect. A robust reconstruction of the defect was performed and the patient evolved without signs of recurrence or any other symptoms.

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Venezuelan Equine Encephalitis Virus (VEEV) is a major biothreat agent that naturally causes outbreaks in humans and horses particularly in tropical areas of the western hemisphere, for which no antiviral therapy is currently available. The host response to VEEV and the cellular factors this alphavirus hijacks to support its effective replication or evade cellular immune responses are largely uncharacterized. We have previously demonstrated tremendous cell-to-cell heterogeneity in viral RNA (vRNA) and cellular transcript levels during flaviviral infection using a novel virus-inclusive single-cell RNA-Seq approach. Here, we used this unbiased, genome-wide approach to simultaneously profile the host transcriptome and vRNA in thousands of single cells during infection of human astrocytes with the live-attenuated vaccine strain of VEEV (TC-83). Host transcription was profoundly suppressed, yet "superproducer cells" with extremely high vRNA abundance emerged during the first viral life cycle and demonstrated an altered transcriptome relative to both uninfected cells and cells with high vRNA abundance harvested at later time points. Additionally, cells with increased structural-to-nonstructural transcript ratio exhibited upregulation of intracellular membrane trafficking genes at later time points. Loss- and gain-of-function experiments confirmed pro- and antiviral activities in both vaccine and virulent VEEV infections among the products of transcripts that positively or negatively correlated with vRNA abundance, respectively. Lastly, comparison with single cell transcriptomic data from other viruses highlighted common and unique pathways perturbed by infection across evolutionary scales. This study provides a high-resolution characterization of the VEEV (TC-83)-host interplay, identifies candidate targets for antivirals, and establishes a comparative single-cell approach to study the evolution of virus-host interactions.

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Introdução: A conjuntivite alérgica (CA) é uma doença inflamatória da conjuntiva ocular causada principalmente por mecanismo IgE-mediado. É o tipo mais comum de alergia ocular. O presente estudo teve por objetivo identificar fatores associados à CA de diferentes intensidades em pacientes acompanhados em ambulatório pediátrico especializado em doenças alérgicas, visando, assim, facilitar o diagnóstico, a terapêutica e a profilaxia dessa morbidade. Métodos: Este estudo retrospectivo analisou prontuários de pacientes (n = 120) com diagnóstico clínico de CA acompanhados em ambulatório especializado por pelo menos um ano. O diagnóstico de CA foi realizado por oftalmologista, e, segundo os medicamentos utilizados, os pacientes foram classificados em CA grave (corticosteroide oral, imunossupressor tópico ou sistêmico e/ou com lesão corneana) ou não grave. Todos foram submetidos a testes cutâneos de leitura imediata com bateria padronizada de aeroalérgenos. Quinze pacientes foram escolhidos aleatoriamente e submetidos à pesquisa de IgE sérica específica (ImmunoCap-ISAC; Thermo Scientific). Resultados: Formas graves de CA ocorreram em 36/120 pacientes, com predomínio de sexo masculino (86,1%), presença de história familiar de CA e uso de lubrificantes e de imunossupressores tópicos. Não houve diferenças quanto à sensibilização a aeroalérgenos, mas entre as formas graves predominou a polissensibilização. Houve predomínio de sensibilização aos ácaros da poeira domiciliar. Conclusão: Nosso estudo-piloto mostrou que formas graves de CA foram associadas ao sexo masculino, ter história familiar de conjuntivite alérgica, e ser sensibilizado a ácaros da poeira domiciliar. Estudos adicionais são necessários para melhor caracterizar os possíveis fatores de risco associados à maior gravidade da CA.

Introduction: Allergic conjunctivitis (AC) is an inflammatory disease of the ocular conjunctiva mainly caused by IgE-mediated mechanism. It is the most common type of ocular allergy. The present study aimed to identify factors associated with AC of different degrees of severity in patients followed in a pediatric outpatient clinic specializing in allergic diseases, in order to facilitate the diagnosis, therapy and prophylaxis of this morbidity. Methods: This retrospective study assessed medical records of patients (n = 120) with clinical diagnosis of AC followed at a specialized outpatient clinic for at least one year. The diagnosis of AC was performed by an ophthalmologist and, according to the medications used, the patients were classified as having severe AC (oral corticosteroid, topical or systemic immunosuppressive drug and/or corneal injury) or non-severe AC. All patients underwent skin prick tests with a standardized battery of aeroallergens. Fifteen patients were randomly selected to undergo serum specific IgE screening (ImmunoCap-ISAC; Thermo Scientific). Results: Severe forms of AC occurred in 36/120 patients with predominance of male sex (86.1%), presence of family history of AC, and use of lubricants and topical immunosuppressive drugs. There were no differences in sensitization to aeroallergens, but polysensitization prevailed among the severe forms. There was a predominance of sensitization to house dust mites. Conclusion: Our pilot study showed that severe forms of AC were associated with being male, having a family history of allergic conjunctivitis and being sensitized to house dust mites. Additional studies are needed to better characterize possible risk factors associated with increased AC severity.

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Introdução: O presente trabalho consiste de uma revisão da bibliografia a respeito de artigos relacionados às diferentes manifestações e formas da perfuração nasal septal, com ênfase principal na descrição de suas técnicas de correções cirúrgicas. Quanto à etiologia, essa é fundamentalmente iatrogênica, por consequência de trauma cirúrgico. Outras causas incluem exposição a reagentes químicos industriais, uso de cocaína, terapêutica esteroídica intranasal, neoplasias e condições infecciosas. Há poucos dados com relação à prevalência de perfuração do septo na população em geral. As tomadas de decisão sobre correção cirúrgica ou tratamento médico dependem das características anatômicas e da patogênese da perfuração septal.

Introduction: The present study consists in a bibliographical' review concerning the articles related to the different manifestations and forms of the septum nasal perforation, with a main emphasis in the description of its techniques of surgical correction. As the etiology, that is fundamentally iatrogenic, accordingly surgical trauma. Other causes include exhibition to chemical industrial reagents, cocaine use, intranasal steroidal therapeutic, neoplasia and, infectious conditions. There is a few data concerning the prevalence of septum perforation in the general population. The decision making about surgical correction or medical treatment depend on the anatomic characteristics and of the pathogenesis of the septal perforation.

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Os autores apresentam um caso de colesteatoma de conduto auditivo externo (CCAE) com extensa invasão da mastóide, mas estando preservadas a membrana timpânica e a cadeia ossicular. Como único sintoma apresentava otorréia crônica. O diagnóstico da lesão foi clínico, sendo o seu estadiamento e planejamento cirúrgico realizados através da tomografia computadorizada. Como tratamento procedeu-se a mastoidectomia radical modificada associada à meatoplastia. O CCAE, por seu caráter insidioso e correlacão topográfica com estruturas nobres, deve ser sempre lembrado no diagnóstico diferencial das lesões do conduto auditivo externo. O relato deste caso tem o objetivo de revisar alguns aspectos clínicos e cirúrgicos no tratamento do CCAE e expor nossa conduta em um caso bastante evoluído da doenca.

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The authors present a case of cholesteatoma of external auditory canal (CEAC) with extensive invasion of mastoid; ossicle chain and tympanic membrane remained intact. The only symptom was chronic otorrhea. Diagnosis was based on clinical elements and CT scan was used to measure pathology and program surgery. Treatment was modified radical mastoidectomy associated with meatoplasty. Due to the insidious character of CEAC and the proximity with important structures of the external auditory canal, it must be always considered in differential diagnosis for lesions of external auditory canal. This case report intended to review clinical and surgical aspects of treatment of CEAC and present our approach in a case with severe lesions.

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A Angina de Ludwig, uma celulite freqüentemente originada de infecção dentária, emborain comum, é ainda uma ameaça pelo seu risco iminente de obstrução de vias aéreas. O sucesso do tratamento é baseado no seu reconhecimento precoce, uso de antibióticos adequados, manutenção da via aérea e a drenagem da infecção; Relato do caso - paciente de 16 anos, gestante, com quadro de angina de Ludwig. Foi iniciada antibioticoterapia com clindamicina e ceftriaxone drenagem cirúrgica. Tendo evoluído bem, foi dada alta hospitalar. Discussão -a manutenção das vias aéreas é a principal preocupação, com a traqueostomia favorecida. Os autores apresentam um caso de angina de Ludwig com uma breve revisão da literatura...

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