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O artigo é uma revisão sobre os aspectos relacionados ao envelhecimento masculino e necessidades de tratamentos, com ênfase no hipogonadismo tardio, baixa produção de testosterona e possível desenvolvimento do Distúrbio Androgênico do Envelhecimento Masculino (DAEM). O objetivo foi apresentar o DAEM e suas implicações sobre a qualidade de vida do paciente para promover e validar o tratamento, quando realmente for apropriado, para esse quadro clínico. Utilizou-se como a fonte de pesquisa Google Acadêmico, banco de dados Biblioteca Virtual em Saúde e do PubMed foram obtidos artigos com as aplicações dos seguintes filtros: 2010-2023 e descritores em saúde (andropausa, reposição hormonal, testosterona, DAEM, hipogonadismo e síndromes metabólicas). Os critérios de inclusão utilizados foram a disponibilidade integral dos artigos, ter os idiomas inglês e português, e abordar o tema da Doença Androgênica do Envelhecimento, todas as suas repercussões sobre a qualidade de vida do homem e, sobretudo, o seu tratamento. Para excluir artigos encontrados na busca, foram observadas obras que apenas tangenciam o tema e tinham enfoque em outros aspectos, como: estética e esporte. Após a aplicação do método, 14 trabalhos foram selecionados por estabelecerem grande relação com o tema. Esse distúrbio acarreta para o indivíduo um conjunto de sinais e sintomas capazes de comprometer sua qualidade de vida: disfunção erétil, baixa libido, obesidade, redução de massa magra ou sarcopenia, osteoporose e distúrbios do humor. O diagnóstico é feito clinicamente e através de exames laboratoriais de dosagem sérica de testosterona. Perante a confirmação diagnóstica e sem patologizar processos fisiológicos do envelhecimento, o tratamento indicado é a reposição de testosterona que tende a normalizar o quadro do idoso por amenizar ou finalizar os sinais e sintomas desse paciente, proporcionando-o uma terceira idade com qualidade de vida. Vale destacar que as disposições de formulações de testosterona são inúmeras: orais, transdérmicas, intramusculares ou injetáveis. A via de administração depende da situação individual de cada paciente e cada tipo de medicamento tem seus benefícios se comparado aos outros, seja por comparação entre efeitos colaterais, estabilidade de níveis séricos hormonais, custo e acesso. O DAEM precisa ser identificado e diagnosticado naqueles pacientes que necessitam de um tratamento por apresentar sinais e sintomas prejudiciais ao bem-estar. Para isso, a indústria farmacêutica disponibiliza uma gama de formas de administração de testosterona. Entretanto, é preciso ter clareza sobre a real necessidade de medicar um paciente.

The article is a review of aspects related to male aging and treatment needs, with an emphasis on late-onset hypogonadism, low testosterone production and the possible development of Androgenic Male Aging Disorder (AMAD). The aim was to present the AMAD and its implications for the patient's quality of life in order to promote and validate treatment, where appropriate, for this clinical condition. The search source used was Google Scholar, the Virtual Health Library database and PubMed, where articles were obtained using the following filters: 2010-2023 and health descriptors (andropause, hormone replacement, testosterone, AMAD, hypogonadism and metabolic syndromes). The inclusion criteria used were that the articles were available in full, that they were in English and Portuguese, and that they dealt with the subject of Androgenic Ageing Disorder, all its repercussions on men's quality of life and, above all, its treatment. To exclude articles found in the search, we looked at works that only touched on the subject and focused on other aspects, such as aesthetics and sport. After applying the method, 14 articles were selected because they were closely related to the topic. This disorder leads to a set of signs and symptoms that can compromise the individual's quality of life: erectile dysfunction, low libido, obesity, reduced lean mass or sarcopenia, osteoporosis and mood disorders. The diagnosis is made clinically and through laboratory tests of serum testosterone levels. Once the diagnosis has been confirmed and without pathologizing the physiological processes of ageing, the treatment indicated is testosterone replacement, which tends to normalize the condition of the elderly by easing or ending the signs and symptoms of the patient, providing them with a quality old age. It's worth noting that there are many different formulations of testosterone: oral, transdermal, intramuscular or injectable. The route of administration depends on the individual situation of each patient and each type of medication has its benefits compared to the others, whether it's a comparison of side effects, stability of serum hormone levels, cost and accessibility. AMAD needs to be identified and diagnosed in those patients who need treatment because they have signs and symptoms that are detrimental to their well-being. To this end, the pharmaceutical industry offers a range of forms of testosterone administration. However, it is necessary to be clear about the real need to medicate a patient.

El artículo es una revisión de los aspectos relacionados con el envejecimiento masculino y las necesidades de tratamiento, con énfasis en el hipogonadismo de inicio tardío, la baja producción de testosterona y el posible desarrollo del Trastorno Androgénico del Envejecimiento Masculino (TAME). El objetivo fue presentar el TAME y sus implicaciones en la calidad de vida del paciente, con el fin de promover y validar el tratamiento de esta condición clínica, cuando sea apropiado. La fuente de búsqueda utilizada fue Google Scholar, la base de datos de la Biblioteca Virtual de Salud y PubMed, donde se obtuvieron artículos utilizando los siguientes filtros: 2010-2023 y descriptores de salud (andropausia, reemplazo hormonal, testosterona, TAME, hipogonadismo y síndromes metabólicos). Los criterios de inclusión utilizados fueron que los artículos estuvieran disponibles en su totalidad, en inglés y portugués, y que abordaran el tema del Trastorno Androgénico del Envejecimiento, todas sus repercusiones en la calidad de vida de los hombres y, sobre todo, su tratamiento. Para excluir los artículos encontrados en la búsqueda, se consideraron los trabajos que sólo tocaban el tema y se centraban en otros aspectos, como la estética y el deporte. Tras aplicar el método, se seleccionaron 14 artículos por estar estrechamente relacionados con el tema. Este trastorno conlleva un conjunto de signos y síntomas que pueden comprometer la calidad de vida del individuo: disfunción eréctil, libido baja, obesidad, reducción de la masa magra o sarcopenia, osteoporosis y trastornos del estado de ánimo. El diagnóstico se realiza clínicamente y mediante pruebas de laboratorio de los niveles séricos de testosterona. Una vez confirmado el diagnóstico y sin patologizar los procesos fisiológicos del envejecimiento, el tratamiento indicado es el reemplazo de testosterona, que tiende a normalizar la condición del anciano, aliviando o terminando con sus signos y síntomas, proporcionándole una vejez con calidad de vida. Cabe destacar que existen diversas formulaciones de testosterona: oral, transdérmica, intramuscular o inyectable. La vía de administración depende de la situación individual de cada paciente y cada tipo de medicación tiene sus ventajas frente a las demás, ya sea en comparación con los efectos secundarios, la estabilidad de los niveles séricos de la hormona, el coste y la accesibilidad. Es necesario identificar y diagnosticar el TAME en aquellos pacientes que necesitan tratamiento porque presentan signos y síntomas perjudiciales para su bienestar. Para ello, la industria farmacéutica ofrece diversas formas de administración de testosterona. Sin embargo, es necesario tener clara la necesidad real de medicar a un paciente.

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Cardiovascular diseases stand as the leading cause of mortality among adults globally. For decades, comprehensive evidence has underscored the correlation between infections, particularly those involving the respiratory system, and an elevated risk of cardiovascular and cerebrovascular events, as well as all-cause mortality. The mechanisms through which infections heighten cardiovascular events are intricate, encompassing immune system activation, systemic inflammation, hypercoagulable states, sympathetic system activation, and increased myocardial oxygen demand. Respiratory infections further contribute hypoxemia to this complex interplay. These mechanisms intertwine, giving rise to endothelial dysfunction, plaque ruptures, myocardial depression, and heart failure. They can either instigate de novo cardiovascular events or exacerbate pre-existing conditions. Compelling evidence supports the safety of influenza, pneumococcal, herpes zoster, COVID-19 and respiratory syncytial virus vaccines in individuals with cardiovascular risk factors or established cardiovascular disease. Notably, the influenza vaccine has demonstrated safety even when administered during the acute phase of a myocardial infarction in individuals undergoing angioplasty. Beyond safety, these vaccinations significantly reduce the incidence of cardiovascular events in individuals with an augmented cardiovascular risk. Nevertheless, vaccination rates remain markedly suboptimal. This manuscript delves into the intricate relationship between infections and cardiovascular events. Additionally, we highlight the role of vaccinations as a tool to mitigate these occurrences and reduce residual cardiovascular risk. Finally, we emphasize the imperative need to optimize vaccination rates among individuals with heart diseases.

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OBJECTIVE: To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. METHODS: Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. RESULTS: The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. CONCLUSIONS: Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

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RESUMEN Los adultos fumadores, con comorbilidades, y los ancianos tienen mayor riesgo de contraer infecciones pulmonares y de tener peor evolución. La neumonía adquirida en la comunidad debida a virus, neumococo, además de otras bacterias y microorga nismos "atípicos" afecta tanto a adultos sanos como enfermos. La vacuna antigripal se diseña el verano anterior orientada a las cepas esperadas para la temporada siguiente. Su eficacia depende fundamentalmente de la variante viral que finalmente sea la responsable del brote. La vacuna anti-neumocócica polisacárida existe desde 1983 y será inexorablemente reemplazada por vacunas conjugadas de mayor eficacia, que previenen la infección por los serotipos presentes en la vacuna. La inmunización contra SARS-CoV-2 aceleró la reducción del contagio y la gravedad de COVID-19 notablemente. La vacuna acelular para Bordetella pertussis no está en el calendario de adultos, aun cuando vacunarlos fortalece el control del contagio infantil. La vacunas doble bacteriana (difteria y tétanos), y triple (doble + pertusis), y contra sarampión, varicela, rubeola, HPV, Haemophylus influenzae, meningococo, herpes zóster, fiebre hemorrágica argentina y fiebre amarilla están disponibles, pero son de uso limitado. Nuevas vacunas, como la recientemente aprobada por los CDC contra el virus sincicial respiratorio, pronto estarán disponibles.

ABSTRACT Adult smokers, subjects with comorbidities, and the elderly are at higher risk of pulmo nary infections and worse outcomes. Community-acquired pneumonia due to viruses, pneumococcus, other bacteria, and "atypical" microorganisms affects healthy and sick adults. The flu vaccine is designed the previous summer for the strains expected for the following season. Its effectiveness depends fundamentally on the viral variant ultimately responsible for the outbreak. The anti-pneumococcal polysaccharide vaccine has been available since 1983 and it is expected to be replaced by conjugate vaccines which are more effective in preventing infection due to serotypes present in the vaccine. Immuniza tion against SARS-CoV-2 diminished contagion and severity of COVID-19 remarkably. The acellular vaccine for Bordetella pertussis is not on the schedule for all adults, even when vaccinating them strengthens the control of contagion in children. Double bacterial (diphtheria and tetanus), triple (double + pertussis), measles, varicella, rubella, HPV, Haemophilus influenzae, meningococcal, herpes zoster, Argentine hemorrhagic fever, and yellow fever vaccines are available, but their use is limited. New vaccines such as the one recently approved by the CDC against respiratory syncytial virus will soon be available.

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Abstract Objective To review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. Methods Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. Results The topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. Conclusions Peripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

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Herpesvirus reactivates from a latent infection in older adults and critically ill and immunocompromised individuals. Herpes zoster ophthalmicus (HZO) is a latent infection that affects the fifth cranial nerve. It is an infrequent cause of increased intraocular pressure. We present the case of a 50-year-old man with a reactivation of latent varicella-zoster virus infection involving the ophthalmic branch of the fifth cranial nerve. The patient was initially managed as an outpatient with an antiviral, but his clinical evolution worsened and required urgent surgical decompression. Lateral canthotomy was performed with cantholysis of the inferior crus of the lateral canthal tendon. Only partial decompression was achieved, so cantholysis of the upper crus was performed with significant tissue tension release. The patient evolved well and was discharged after 6 days without symptoms for outpatient management.

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El herpes zóster es el cuadro clínico constituido por las manifestaciones dermatológicas (erupción vesiculosa) y neurológica (dolor). Es la expresión de la recurrencia del virus varicela-zóster latente en los ganglios sensitivos, su aparición se favorece por el envejecimiento y la inmunosupresión con una prevalencia que se estima en un 20 %. Se describe los pasos clínicos para la confección de una prótesis ocular en el mejoramiento estético a un paciente con defecto ocular en ojo izquierdo provocado por herpes zoster. Se trata de un paciente masculino de piel blanca de 50 años de edad, que acudió a la consulta de prótesis del Policlínico Universitario Julio Antonio Mella de la provincia Camagüey remitido del Servicio de Oculoplastia del Hospital Universitario Manuel Ascunce Domenech con diagnóstico de defecto ocular izquierdo por evisceración como consecuencias de infección por herpes zoster y antecedente de inmunodepresión. El paciente expuso que la pérdida ocular fue por las complicaciones que se fueron sucediendo en la medida que se agravó su cuadro clínico. Además, refirió que presentaba dolor en la zona y que le irradiaba a la cabeza y que le preocupaba su estética. Se determinó la elaboración de una prótesis ocular acrílica para mejorar el aspecto estético, lo cual permitió que el paciente mejorara su autoestima y calidad de vida(AU)

Herpes zoster is the clinical picture constituted by dermatological (vesicular rash) and neurological (pain) manifestations. It is the expression of the recurrence of the latent varicella-zoster virus in the sensitive ganglia, its appearance is favored by aging and immunosuppression with a prevalence estimated at 20%. We describe the clinical steps for the fabrication of an ocular prosthesis for the aesthetic improvement of a patient with ocular defect in the left eye caused by herpes zoster. This is a 50-year-old male patient with white skin, who came to the prosthesis consultation of the Julio Antonio Mella University Polyclinic in Camagüey province, referred from the Oculoplasty Service of the Manuel Ascunce Domenech University Hospital with a diagnosis of left ocular defect due to evisceration as a consequence of herpes zoster infection and a history of immunosuppression. The patient explained that the ocular loss was due to the complications that occurred as his clinical condition worsened. In addition, he reported that he had pain in the area that radiated to the head and that he was concerned about his esthetics. It was decided to make an acrylic ocular prosthesis to improve the esthetic aspect, which allowed the patient to improve his self-esteem and quality of life(AU)

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The burden of herpes zoster disease is significant worldwide, with millions affected and an increasing incidence. Increased age and immunosuppression due to disease or drugs have been related to its recurrence. The aim of this work was to determine the pharmacological management of herpes zoster and identify factors associated with recurrence, representing a longitudinal retrospective study identifying the pharmacological management of patients with herpes zoster and the factors related to the first recurrence using a population database. Follow-up was carried out for up to 2 years, and descriptive analysis and Cox proportional hazards regression were performed. A total of 2978 patients with herpes zoster were identified, with a median age of 58.9 years and 65.2% being women. The treatment mainly involved acyclovir (98.3%), acetaminophen (36.0%), and non-steroidal anti-inflammatory drugs (33.9%). A total of 2.3% of patients had a first recurrence. Corticosteroids were used in a greater proportion for recurrence than for the initial herpes episode (18.8% vs. 9.8%, respectively). Being female (HR:2.68;95%CI:1.39-5.17), age ≥60 years (HR:1.74;95%CI:1.02-2.96), having liver cirrhosis (HR:7.10;95%CI:1.69-29.80), and having hypothyroidism (HR:1.99;95%CI:1.16-3.40) were associated with greater probability of a first recurrence. The vast majority of patients were managed with acyclovir, and the use of acetaminophen or non-steroidal anti-inflammatory drugs for pain management was frequent. Several conditions were found that increased the probability of presenting a first recurrence of herpes zoster, such as age over 60 years, being a woman, suffering from hypothyroidism, and liver cirrhosis.

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Abstract Background: Studies have shown that the overall incidence rate of herpeszoster (HZ) in China is 6.64 cases per 1000 people, despite such harms brought by postherpetic neuralgia (PHN), the mechanism of the disease remains unclear in China. Currently, effective biomarkers to predict PHN remain unavailable, which makes it difficult to prevent and successfully treat PHN. Objectives: The aim of the study was to determine the serum interleukin-6 level in PHN. Methods: The serum levels of interleukin 6 (IL-6) were measured by multi-antibody sandwich ELISA. The likert scale was used to represent the degree of neuralgia in the patients. Patients with PHN were divided into a mild PHN group and a severe PHN group according to the Likert scale. ROC curve was performed for evaluating the diagnostic efficiency of IL6 for PHN. The correlation between the IL6 level and the Likert scale before and after treatment with gabapentin and mecobalamin was analyzed. Results: IL6 levels in PHN patients resulted higher compared to volunteers. Patients in the severe PHN group had a higher serum IL6 level than in the mild PHN group. The Likert scale score was related to the serum IL6 levels and the frequency of IL6 levels above the cutoff value (4.95pg/mL) in PNH groups before and after treatment (p<0.05). Study limitations: Pain is subjective. Some mental states, such as anxiety and depression, greatly influence an individual's perception of pain, and pain tolerance can vary between people. Therefore, pain scores can be affected by different individual factors. Conclusions: The serum IL6 levels may be used as a biochemical indicator of the severity of PNH.

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El SARS-CoV-2 es un virus de afectación sistémica que impacta con gran intensidad en el sistema inmunológico; esto permite que virus de naturaleza latente, como el virus de Varicela Zoster (VVZ), tengan oportunidad de reactivarse y agravar el cuadro respiratorio con afectaciones cutáneas, mucosas y neurológicas. Se presenta un caso de Zoster sine herpete, durante la convalecencia del SARS-CoV-2, en un paciente masculino de 43 años, que acudió a consulta por dolor precordial de gran intensidad, sensación de escozor en tórax posterior y dificultad respiratoria; 10 días después de prueba de hisopado nasofaríngeo positiva para antígeno de SARS-CoV-2. Es importante no olvidar la probabilidad de presentaciones atípicas de virus latentes con el fin de realizar un diagnóstico y tratamiento oportuno a los pacientes.

SARS-CoV-2 is a systemic virus that has a strong impact on the immune system; this allows latent viruses, such as varicella-zoster virus (VZV), to reactivate and aggravate the respiratory symptoms with cutaneous, mucosal and neurological involvement. We present a case of Zoster sine herpete, during convalescence from SARS-CoV-2, in a 43-year-old male patient who presented with severe precordial pain, stinging sensation in the posterior thorax and respiratory distress; 10 days after a positive nasopharyngeal swab test for SARS-CoV-2 antigen. It is important not to forget the probability of atypical presentations of latent viruses to make a timely diagnosis and treatment of patients.

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Post-herpetic neuralgia (PHN) is an entity derived from peripheral nerve damage that occurs during the reactivation of the Varicella Zoster Virus (VZV), which manifests itself through pain with neuropathic characteristics. This can prove to be very difficult to manage in the chronic stages of disease reappearance. There currently exists a multitude of treatment alternatives for PHN, however, prevention through the early initiation of antiviral regimens is vital. There are various pharmacological options available, but it is important to individualize each patient to maximize efficacy and minimize adverse effects. Interventional procedures have become a cornerstone in difficult-to-manage cases, and have shown promising outcomes when used in a multimodal approach by experienced specialists. It is necessary to make an objective diagnosis of PHN and start early treatment. Additionally there is current evidence that vouches for interventional therapies as well as individualization, with a clear establishment of therapeutic objectives according to the needs of each patient.

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BACKGROUND: Studies have shown that the overall incidence rate of herpeszoster (HZ) in China is 6.64 cases per 1000 people, despite such harms brought by postherpetic neuralgia (PHN), the mechanism of the disease remains unclear in China. Currently, effective biomarkers to predict PHN remain unavailable, which makes it difficult to prevent and successfully treat PHN. OBJECTIVE: The aim of the study was to determine the serum interleukin-6 level in PHN. METHODS: The serum levels of interleukin 6 (IL-6) were measured by multi-antibody sandwich ELISA. The likert scale was used to represent the degree of neuralgia in the patients. Patients with PHN were divided into a mild PHN group and a severe PHN group according to the Likert scale. ROC curve was performed for evaluating the diagnostic efficiency of IL6 for PHN. The correlation between the IL6 level and the Likert scale before and after treatment with gabapentin and mecobalamin was analyzed. RESULTS: IL6 levels in PHN patients resulted higher compared to volunteers. Patients in the severe PHN group had a higher serum IL6 level than in the mild PHN group. The Likert scale score was related to the serum IL6 levels and the frequency of IL6 levels above the cutoff value (4.95 pg/mL) in PNH groups before and after treatment (p < 0.05). STUDY LIMITATIONS: Pain is subjective. Some mental states, such as anxiety and depression, greatly influence an individual's perception of pain, and pain tolerance can vary between people. Therefore, pain scores can be affected by different individual factors. CONCLUSIONS: The serum IL6 levels may be used as a biochemical indicator of the severity of PNH.

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INTRODUCTION: The risk of herpes zoster (HZ) increases with age. In countries with an ageing population such as Mexico, a rise in the risk of HZ and complications is expected. The goal of this study was to provide an updated estimate of the potential burden of HZ and associated complications in Mexico. METHODS: A retrospective database study was performed using data from the national surveillance database of the Ministry of Health (Secretaría de Salubridad y Asistencia/Dirección General de Información en Salud). HZ cases and associated complications were identified via the International Classification of Diseases 10th Revision codes. Emergency room (ER) visits, hospitalizations, and deaths were extracted and analyzed by age group and year. The observation period was between 2011 and 2020 for ER visits and hospitalizations and between 2011 and 2019 for deaths. Cumulative incidence per 1000 people and case fatality rate were estimated. RESULTS: During the observation period, 53,030 ER visits, 4172 hospitalizations, and 263 deaths due to HZ were reported nationwide. The cumulative incidence of HZ based on ER visits was 1.04 per 1000 people aged ≥ 50 years but increased in older age groups (1.47 per 1000 people aged ≥ 65 years). The most common complications were neuralgia (10.9%), ocular disease (7.0%), meningoencephalitis (2.9%), and disseminated disease (3.1%). Patients ≥ 65 years accounted for 37% of hospitalizations and 81% of deaths. CONCLUSION: In Mexico, HZ and its complications impose a considerable burden on the population and the healthcare system. Prospective surveillance studies are required to obtain an accurate picture of the current epidemiology of HZ in Mexico and to estimate the benefits of future vaccination strategies against HZ.

Herpes zoster (HZ), also called shingles, is a disease typically characterized by a painful skin rash. It affects mostly older adults and immunocompromised populations. Approximately 30% of patients have complications such as prolonged, severe pain; eye disease; or disease affecting parts of the body other than the skin. In this study, we analyzed national passive surveillance data for HZ disease and related complications in Mexico. Over the last 10 years (2011­2020), more than 50,000 cases and 4000 hospitalizations have been observed. In those, 263 people died, and most of the deaths (81%) occurred in people aged 65 years or older. Since the proportion of older people in the Mexican population will increase over the next decades, herpes zoster will probably become more frequent and complicated. Vaccination against HZ could help protect the older population against this serious disease.

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O herpes-zóster é uma infecção viral causada pela reativação do vírus da varicela-zóster (VZV) sendo os ramos do nervo trigêmeo afetados em até 20% dos casos. Apresenta-se comumente com dor em queimação e caracteristicamente, o zoster se manifesta como uma erupção vesicular unilateral que aparece na face, cabeça, tronco e até mesmo nas extremidades, variando de lesão leve e de rápida cicatrização à lesões graves e extensas com duração de semanas. Embora se reconheça que o zoster pode ocorrer sem exantema, classicamente apresenta-se como dermátomo unilateral, doloroso e/ou pruriginoso. A terapia fotodinâmica antimicrobiana (aPDT) tem sido indicada como uma modalidade promissora no tratamento de potenciais lesões infecciosas. Neste trabalho será relatado o caso clínico de um paciente diagnosticado com herpes zóster com manifestação atípica e que recebeu tratamento medicamentoso convencional associado à aPDT.

Herpes zoster is a viral infection caused by the reactivation of the varicella zoster virus (VZV), with the branches of the trigeminal nerve affected in up to 20% of cases. It commonly presents with burning pain and characteristically, zoster manifests as a unilateral vesicular eruption appearing on the face, head, trunk, and even the extremities, ranging from a mild, rapidly healing lesion to severe, extensive lesions lasting up to weeks. Although it is recognized that zoster can occur without rash, it classically presents as a unilateral, painful and/or pruritic dermatome. Antimicrobial photodynamic therapy (aPDT) has been indicated as a promising modality in the treatment of potential infectious lesions. In this work, the clinical case of a patient diagnosed with herpes zoster with atypical manifestation and who received conventional drug treatment associated with aPDT will be reported.

El herpes zóster es una infección vírica provocada por la reactivación del virus de la varicela zóster (VZV), con afectación de las ramas del nervio trigémino hasta en un 20% de los casos. Comúnmente se presenta con dolor ardiente y característicamente, el zoster se manifiesta como una erupción vesicular unilateral que aparece en la cara, la cabeza, el tronco e incluso las extremidades, que van desde una lesión leve que cura rápidamente hasta lesiones graves y extensas que duran semanas. Aunque se reconoce que el herpes zoster puede ocurrir sin exantema, clásicamente se presenta como un dermatoma unilateral, doloroso y/o pruriginoso. La terapia fotodinámica antimicrobiana (aPDT) se ha indicado como una modalidad prometedora en el tratamiento de posibles lesiones infecciosas. En este trabajo se reportará el caso clínico de un paciente diagnosticado de herpes zoster con manifestación atípica y que recibió tratamiento farmacológico convencional asociado a TFPa.

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Durante los últimos meses, quienes trabajamos en Argentina en el ámbito de la atención primaria como médicos de cabecera hemos recibido muchas consultas de pacientes solicitando nuestra opinión sobre una vacuna que no está actualmente incluida en el Calendario Nacional de Vacunación y que además estaba fuera de nuestra agenda: la vacuna contra el herpes zóster. Este artículo editorial pretende ayudar a los equipos de salud a realizar con sus pacientes un proceso de toma de decisiones compartidas en las consultas acerca de esta nueva vacuna. (AU)

During the last few months, those of us who work in Argentina in the field of primary care as general practitioners have received many inquiries from patients requesting our opinion about a vaccine that is not currently included in the National Vaccination Schedule and that, in addition, was off our scope: the herpes zoster vaccine. This editorial article aims to help our health teams carry out a shared decision-making process with their patients regarding this new vaccine. (AU)

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Introduction:Ramsay-Hunt syndrome, also called otic zoster, is a rare complication of herpes zoster. The syndrome is characterized by peripheral facial nerve palsy and an erythematous vesicular eruption in the ear or mouth. Preceding the appearance of the vesicles, unilateral otalgia or neck pain may occur more commonly. However, persistent hemicrania is infrequent in the preeruptive phase. Objective:To present an atypical case of Ramsay Hunt syndrome with continuous unilateral headache preceding the onset of other symptoms and signs of the syndrome. Case report:Report of a 69-year-old woman who presented subacute onset of moderate to severe left hemicrania with no autonomic signs. Eight days after the start and continuous headache maintenance, she presented with peripheral facial paralysis. After four days, she noticed the presence of vesicles in the left ear and odynophagia. She developed nausea with several episodes of vomiting and severe imbalance that made it impossible for her to walk unassisted. On physical examination, she presented vesicles in the left ear and oropharynx, left peripheral facial palsy (House Brackmann grade IV), left hypoacusis, nystagmus, and vestibular gait. Diagnostic tests for screening several metabolic diseases and diagnosis of infection (including HIV) were unremarkable. Brain computed tomography and cerebrospinal fluid analysis showed no abnormalities. Conclusion:Ramsay-Hunt syndrome mainly involves the facial and vestibulocochlear nerves, causing peripheral facial palsy, otalgia, hypoacusis, and, less frequently, imbalance. Although pain is a frequent manifestation of the preeruptive phase of RHS, unilateral headache is not common in this scenario. On the other hand, it is a prevalent complaint in the emergency department and has several different etiologies. Hence, diagnosing RHS when patients present exclusively unilateral headaches is challenging for clinicians. Physicians must consider RHS a vital differential diagnosis of sided-locked headaches, avoiding diagnostic errors and treatment delays.

Introdução: A síndrome de Ramsay-Hunt, também chamada de ótico-zóster, é uma complicação rara do herpes-zóster. A síndrome é caracterizada por paralisia do nervo facial periférico e erupção vesicular eritematosa no ouvido ou na boca. Precedendo o aparecimento das vesículas, pode ocorrer mais comumente otalgia unilateral ou dor cervical. No entanto, a hemicrania persistente é pouco frequente na fase pré-eruptiva. Objetivo: Apresentar um caso atípico de síndrome de Ramsay Hunt com cefaleia unilateral contínua precedendo o aparecimento de outros sintomas e sinais da síndrome. Relato de caso: Relato de uma mulher de 69 anos que apresentou hemicrania esquerda de início subagudo, moderada a grave, sem sinais autonômicos. Oito dias após o início e manutenção contínua da cefaleia, apresentou paralisia facial periférica. Após quatro dias, notou presença de vesículas em orelha esquerda e odinofagia. Ela desenvolveu náuseas com vários episódios de vômitos e desequilíbrio grave que a impossibilitou de andar sem ajuda. Ao exame físico apresentava vesículas em orelha esquerda e orofaringe, paralisia facial periférica esquerda (grau IV de House Brackmann), hipoacusia esquerda, nistagmo e marcha vestibular. Os testes de diagnóstico para rastreio de diversas doenças metabólicas e diagnóstico de infeções (incluindo VIH) não apresentaram resultados dignos de nota. A tomografia computadorizada de cérebro e a análise do líquido cefalorraquidiano não mostraram alterações. Conclusão: A síndrome de Ramsay-Hunt envolve principalmente os nervos facial e vestibulococlear, causando paralisia facial periférica, otalgia, hipoacusia e, menos frequentemente, desequilíbrio. Embora a dor seja uma manifestação frequente da fase pré-eruptiva da SHI, a cefaleia unilateral não é comum neste cenário. Por outro lado, é uma queixa prevalente no serviço de urgência e tem diversas etiologias. Portanto, diagnosticar SHI quando os pacientes apresentam dores de cabeça exclusivamente unilaterais é um desafio para os médicos. Os médicos devem considerar a SHI um diagnóstico diferencial vital de cefaleias laterais, evitando erros de diagnóstico e atrasos no tratamento.

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This systematic review describes herpes zoster (HZ) economic burden in terms of healthcare resource use and cost outcomes in the Latin America and Caribbean (LAC) region. We searched online databases from 1 January 2000 to 20 February 2020 to identify eligible publications. We identified 23 publications that reported direct costs, indirect costs, and resources associated with HZ and its complications. The primary direct medical resources reported in the different studies were visits to doctors, transportation, days in the hospital, nursing, medication schedules, and physical therapy. Direct total costs per patient ranged from $99.99 to $4177.91. The highest cost was found in Brazil. Direct costs are, in average, 81.39% higher than indirect costs. The cost per patient that includes postherpetic neuralgia treatment is 115% higher on average for the directs and 73% for the indirect costs. Brazil reported a higher total cost per patient than Argentina and Mexico, while for indirect costs per patient, Brazil and Argentina had higher costs than Mexico, respectively. A meta-analysis on the number of days due to HZ hospitalization, performed on non-immunosuppressed patients over 65 years of age from three studies, resulted in a cumulative measure of 4.5 days of hospitalization. In the LAC region, the economic burden of HZ and associated complications is high, particularly among high-risk populations and older age groups. Preventative strategies such as vaccination could help avoid or reduce the HZ-associated disease economic burden in the LAC region.

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As individuals age, they become increasingly prone to infectious diseases, many of which are vaccine-preventable diseases (VPDs). Adult immunization has become a public health priority in the modern era, yet VPDs vaccination rates for adults are low worldwide. In Central America and Caribbean, national recommendations and vaccination practices in adults differ across countries, and adult vaccination coverage data are limited. An advisory board comprised infectious disease experts, pulmonologists, geriatricians, occupational health, and public health professionals for Central America and Dominican Republic was convened to: a) describe adult immunization practices in these countries; b) discuss challenges and barriers to adult vaccination; and c) find strategies to increase awareness about VPDs. The advisory board discussions reflect that national immunization guidelines typically do not include routine vaccine recommendations for all adults, but rather focus on those with risk factors. This is the case for influenza, pneumococcal, and hepatitis B immunizations. Overall, knowledge lacks about the VPD burden among health-care professionals and the general public. Even more, there is insufficient information on vaccinology for students in medical schools. Actions from the responsible authorities - medical schools and scientific societies which can advocate for vaccination and a better knowledge in vaccinology - can help address these issues. A preventive medicine culture in the workplace may contribute to the advancement of public opinion on vaccination. Promoting vaccine education and research could be facilitated via working groups formed by disease experts, public and private sectors, and supranational authorities, in an ethical and transparent manner.

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Objective: the aim of this study was to relate sociodemographic, epidemiological and clinical conditions to the occurrence of severe cases of HZ in reference hospital of Fortaleza. Methods: this is a cross-sectional analytical study, based on medical records of patients admitted from 2009 to 2018. Pearson's x2 test or Fisher's exact test were used when appropriate. Results: we analyzed 196 medical records. The presence of complications occurred in 69.9%, the most affected region was the cranial (68.9%), and 1.5% died. The presence of vesicles (PR=1.37; 95%CI: 1.03-1.82; p=0.01) and the choice of antibiotic associated antiviral therapy (PR=0.58; 95%CI: 0.46-0.73; p=0.00) were significantly associated with the severity. Conclusions: the disease may be more severe at ages over 50. The presence of lesions in vesicles was associated with a higher prevalence of complications and the use of antibiotics and antivirals as a protective factor.

Objetivo: relacionar condições sociodemográficas, epidemiológicas e clínicas à ocorrência de casos graves de HZ em hospital de referência de Fortaleza. Métodos: trata-se de um estudo analítico transversal, baseado em prontuários de pacientes internados de 2009 a 2018. Foram utilizados o teste x2 de Pearson ou o teste exato de Fisher, quando apropriado. Resultados: foram analisados 196 prontuários. A presença de complicações ocorreu em 69,9%, a região mais acometida foi a craniana (68,9%), e 1,5% foi a óbito. A presença de vesículas (RP=1,37; IC95%: 1,03-1,82; p=0,01) e a escolha da terapia antiviral associada a antibióticos (RP=0,58; IC95%: 0,46-0,73; p=0,00) foram significativamente associadas com a gravidade. Conclusões: a doença pode ser mais grave a partir dos 50 anos. A presença de lesões em vesículas foi associada à maior prevalência de complicações e o uso de antibióticos e antivirais como fator de proteção.

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El Síndrome de Ramsay-Hunt (SRH), es la segunda causa de parálisis facial periférica (PFP). Causado por el virus Varicella zoster (VVZ), ipsilateral a la PFP,presenta unaerupción herpetiforme y cefalea en distribución del nervio facial. Presentamos el caso de una mujer, 54 años, con SRH y cefalea persistente cuyo líquido cerebroespinal (LCE) fue compatible con meningitis. Se indicó aciclovir endovenoso (EV). La literatura no recomienda estudio de LCE en PFP; y en SRH se sugiere en inmunosuprimidos y complicaciones del SRH como queratopatía, accidentes-cerebrovasculares, y meningitis. Un LCE alterado en SRH, indica modificar la conducta terapéutica.

Ramsay-Hunt Syndrome (RHS) is the second leading cause of peripheral facial palsy (PFP). Caused by the Varicella zoster virus (VZV), ipsilateral to the PFP, it presents a herpetiform rash and headache in the facial nerve distribution. We present the case of a 54-year-old woman with RHS and persistent headache whose cerebrospinal fluid (CSF) was compatible with meningitis. Intravenous acyclovir was indicated. The literature does not recommend an CSF study in PFP; in RHS it is suggested in immunosuppressed patients and complications of RHS such as keratopathy, cerebrovascular accidents, and meningitis. An altered CSF in RHS indicates modifying the therapeutic conduct.