RESUMO Antecedentes: Insônia é um distúrbio do sono caracterizado por dificuldade de iniciar e manter o sono, afetando diferentes faixas etárias. Atualmente, a melatonina é utilizada no tratamento de insônia em crianças, adultos e idosos. Objetivo: Avaliar a eficácia da melatonina nos distúrbios do sono, posologia e potenciais efeitos adversos, bem como a regulamentação vigente no Brasil. Métodos: Trata-se de uma revisão integrativa, os artigos foram identificados nas bases de dados Cochrane Library, Medline (Pubmed) e Science Direct, totalizando 25 artigos, e foram selecionados três materiais disponíveis no site da Sociedade Brasileira de Endocrinologia e Metabologia e Agência Nacional de Vigilância Sanitária, publicados entre 2015 e 2020. Resultados: Verificou-se na maioria dos artigos selecionados que a melatonina reduz a latência do sono. Quanto as dosagens de melatonina identificou-se variação em cada faixa etária, para crianças de 0,5 a 3mg; adolescentes de 3 a 5mg; adultos de 1 a 5mg e idosos 1 mg a 6 mg demostraram serem eficazes. Em doses habituais os efeitos colaterais são leves. No Brasil, não foi identificado medicamento registrado e regulamentação vigente sobre o uso e comercialização de melatonina. Conclusão: A utilização da melatonina é uma alternativa que pode ser utilizada em distúrbios do sono. De acordo com as evidências encontradas, não demonstrou toxicidade ou efeitos colaterais severos, nem dependência mesmo em doses elevadas, sendo, portanto, segura para tratamento de pacientes desde crianças a idosos que sofrem de distúrbios do sono.

ABSTRACT Background: Insomnia is a sleep disorder characterized by difficulty of falling asleep or maintaining sleep, which affects different age groups. Currently, melatonin is used as a therapeutic treatment in cases of insomnia in children, adults, and elderly people. Objective: To evaluate the effectiveness of melatonin in sleep disorders, its dosage, potential adverse effects, as well as labeling laws and regulations in Brazil. Methods: This integrative review was carried out using the Cochrane Library, Medline (Pubmed), and Science Direct databases. Twenty-five articles and three documents available on the Brazilian Society of Endocrinology and Metabology (SBEM) and National Health Surveillance Agency (ANVISA) websites published between 2015 and 2020 were selected to be evaluated in full. Results: It was found that in most of the selected articles the use of melatonin reduces sleep latency. The effective melatonin doses varied according to each age group, from 0.5 to 3 mg in children, 3 to 5 mg in adolescents, 1 to 5 mg in adults, and 1 to 6 mg in elderly people. Side effects are mild when taking usual doses. In Brazil, no registered drug and current regulation on the use and marketing of melatonin has been identified. Conclusion: The use of melatonin is an alternative therapy that can be used for sleeping disorders. According to the evidences found, it did not demonstrate toxicity or severe side effects, nor dependence even when administered at high doses, suggesting that it is a safe medication to treat patients of different ages suffering from sleeping disorders.

Abstract The promotion of oral health in the early years of life is important to promote well-being and prevent early childhood cavities. The aim of this work was to determine the level of knowledge, beliefs, and perceptions of a group of Mexican university students in the area of health on early childhood cavities. A questionnaire was applied to students (N = 515) of the tenth semester of the degrees of Nursing, Medicine, and Dentistry based on the "Health professional’s guide to pediatric oral health management, "Guide for oral health risk assessment training" and "Dental Beliefs Scale N". The x2 test was used to analyze the association of variables among students. Of the total respondents, 80.7% scored regular knowledge, 13.3% good, and 6% poor. Association was observed in the belief of knowing how to treat problems of tooth decay (x2 = 0.003, p < 0.05), how to perform oral hygiene on children (x2 = 0.025, p < 0.05) and in perception between the information and bachelor’s degree (x2 = 0.012, p < 0.05). Educational programs in the area of health must find ways to introduce topics on best practices in child oral health, particularly those related to dental cavities and early childhood cavities.

Resumen La promoción de la salud bucal en los primeros años de vida es importante para conservar el bienestar integral y prevenir la caries temprana de la infancia. El objetivo del trabajo fue determinar el nivel de conocimientos, creencias y percepción de un grupo de estudiantes universitarios mexicanos del área de la salud sobre caries temprana de la infancia. Se aplicó un cuestionario a alumnos (N = 515) del décimo semestre de las licenciaturas de Enfermería, Medicina y Odontología con base en el Health profesional´s guide to pediatric oral health management, Guide for oral health risk assessment training y Dental Beliefs Scale N. Se utilizó la prueba x2 para analizar la asociación de las variables entre los estudiantes. Del total de encuestados, el 80.7% obtuvo un conocimiento regular, 13.3% bueno y 6% deficiente. Se observó asociación en la creencia de saber atender los problemas de caries (x2 = 0.003, p < 0.05), de cómo realizar la higiene bucal infantil (x2 = 0.025, p < 0.05) y en la percepción entre la información y la licenciatura (x2 = 0.012, p < 0.05). Los programas educativos del área de la salud deben encontrar maneras de introducir tópicos sobre mejores prácticas en salud oral infantil, particularmente los relacionados con caries dental y caries temprana en la infancia.

Abstract: Langerhans cell histiocytosis is rare and more frequent in children. The skin is affected in 50% of the cases and is the only site in 10%. Its course varies from self-limited and localized forms to severe multisystemic forms. Congenital cases are usually exclusively cutaneous and self-limited, with spontaneous remission in months. This study presents a rare congenital case, initially restricted to the skin, with subsequent dissemination and fatal outcome. A male newborn presented congenital disseminated erythematous scaly lesions. The biopsy was conclusive for Langerhans cell histiocytosis. The patient evolved into the multisystemic form in weeks, when chemotherapy was started, according to the LCH-2009 protocol; however, the patient was refractory to treatment and died.

Com o objetivo de melhor caracterizar incidência, epidemiologia, síndromes específicas, tratamento e prognóstico associado com infecções fúngicas sistêmicas em pacientes neutropênicos foi feito um estudo prospectivo de 8 anos. Durante este período foram diagnosticadas 30 infecções fúngicas em 30 pacientes neutropênicos febris (10%). Houve 15 casos de candidíase, 5 aspergiloses pulmonares, 3 sinusites por Aspergillus fumigatus, 5 infecções por Fusarium sp., uma infecção por Trichosporon sp., e uma infecção por Rhodotorula rubra. As hemoculturas foram positivas em 18 casos (60%). Os fatores de risco para infecção fúngica em análise multivariada foram: presença de cateter venoso central (p<0,001), duração maior de neutropenia <100/mm³ (p<0,001), uso de corticosteróides (p<0,001), bacteremia por germes gram-positivos (p=0,002) e idade menor (p=0.03). Em análise multivariada apenas recuperação da neutropenia (p<0,001) esteve associada com bom prognóstico, enquanto que o diagnóstico de infecção por Fusarium sp. (p=0,006) se correlacionou com um mau prognóstico. A taxa de óbito foi de 43%. Não houve diferença estatisticamente significante nas taxas de óbito em pacientes que receberam (52%) ou não (50%) terapia anti-fúngica. A identificação de grupos de risco, síndromes específicas e fatores prognósticos pode contribuir para a redução na elevada letalidade das infecções fúngicas em pacientes neutropênicos.

In this paper we report a eight-year prospective study designed to further characterize incidence, epidemiology, specific syndromes, treatment and prognosis associated with fungal infections in neutropenic patients. During the study period 30 fungal infections were diagnosed in 30 patients among 313 episodes of fever and neutropenia (10%). There were 15 cases of candidiasis, 5 pulmonary aspergillosis, 3 sinusitis by Aspergillus fumigatus, 5 infections by Fusarium sp., one infection by Trichosporon sp., and one infection due to Rhodotorula rubra. Blood cultures were positive in 18 cases (60%). The predisposing factors for fungal infection in multivariate analysis were the presence of central venous catheter (p<0.001), longer duration of profound (<100/mm³) neutropenia (p<0.001), the use of corticosteroids (p<0.001), gram-positive bacteremia (p=0.002) and younger age (p=0.03). In multivariate analysis only recovery of the neutropenia (p<0.001) was associated with good prognosis whereas the diagnosis of infection by Fusarium sp. (p=0.006) was strongly associated with a poor outcome. The death rate was 43%. There was no statistically significant difference in the death rate between patients who did receive (52%) or did not receive (50%) antifungal treatment. Identifying patients at risk, specific syndromes and prognostic factors may help to reduce the high mortality associated with disseminated fungal infections in neutropenic patients.