Abstract Objective: To evaluate in vitro erosive effect of analgesics on primary tooth enamel. Material and Methods: The pH and the titratable acidity measurements of the medicines were performed in triplicate using a digital pH meter. Enamel slabs of primary teeth flat and polished were selected by initial surface microhardness analysis. Medications were selected and specimens were assigned into five groups (n=12): Dalsy; Magnopyrol; Paracetamol; Tylenol; and distilled water (negative control). Specimens were immersed in 5 ml of each group solution for 30 min, 4x/day for three days and stored in artificial saliva at 37 °C between immersions and at night. Final microhardness was determined. The data were submitted to Oneway ANOVA and Tukey's test. Scanning electron microscopy (SEM) analysis was performed in three specimens of each group. Results: Medicines showed acidic pH and mean values of titratable acidity ranged from 1.46 to 11.66 ml of 0.1N NaOH. The mineral loss of Magnopyrol was statistically significant in relation to the control group (p<0.01). Magnopyrol showed higher values when compared to Tylenol (p<0.05). SEM images displayed microstructure alterations in the Paracetamol group. Conclusion: Despite the low pH values, only Magnopyrol showed greater enamel softening. Paracetamol demonstrated morphological changes in primary tooth enamel.

ABSTRACT Objective: To evaluate the emotional and social experiences of parents or caregivers of children with cleft lip and/or palate (CL/P) in a city in the Northeastern of Brazil. Material and Methods: A quantitative and cross-sectional study was conducted among parents or caregivers of children with CL/P by interviews based on a questionnaire. Interviews were conducted during the First Smile Project in Sobral, Ceará, Brazil. All participants (n=41) agreed to participate in the interview and signed an informed consent. The data was analyzed in SPSS software version 22.0. Results: The majority of participants were female (87.2%), with a mean age of 37 years, with a low level of education and low family income. The great majority (90.2%) of the parents were not prenatally diagnosed to have CL/P babies. Of those interviewed, 56.1% mentioned that the first diagnosis of cleft lip and palate was not presented by the professionals in a clarifying way to the family. Fear (36.6%) and sadness (19.5%) were the main feelings experienced when the child was diagnosed with fissure. Feeding (48.8%) was pointed out as the main concern in caring for a child with CL/P. Conclusion: The parents and caregivers interviewed faced important emotional and social problems that must be addressed by the professional team that assists the child with CL/P.

ABSTRACT Malignant tumors of the penis are rare, most of them being squamous cell carcinomas (SCCs). We report the case of a 75-year-old man with a large penile mass submitted to partial penectomy. The specimen showed an exophytic mass involving the glans, coronal sulcus, and prepuce. Microscopic examination showed a carcinoma with two distinct areas: a mixed SCC and a sarcomatoid carcinoma. The SCC component had areas of verrucous carcinoma and areas of classical invasive SCC. The tumor cells expressed p63 with the absence of p16 expression. Vimentin and p53 were positive in the sarcomatous component. The morphology and immunohistochemistry were compatible with mixed SCC (verrucous hybrid-sarcomatoid carcinoma). Additionally, the tumor cells also expressed 3 different clones of PDL1 (22C3, SP263, and SP142). Two months later, the patient presented local recurrence with multiple lymph nodes and lung metastases, dying 7 weeks later. Mixed tumors represent diagnostic challenges. The correct identification of adverse prognostic factors can be the first step to implement the treatment with a higher probability of success.

OBJECTIVES: The COVID-19 pandemic brought abrupt changes when quarantine measures were implemented. Most medical students had distance learning as their main content delivery mode, but in clerkship (fifth and sixth years), in-person activities were maintained under new protocols. These different modes may have affected student mental health. This study examines mental burden and empathy in medical students during the beginning of the COVID-19 pandemic according to the year of attendance. METHODS: All students attending first to the sixth year in the same medical school were invited to participate. The Hospital Anxiety and Depression Scale (HADS), the Self-Reporting Questionnaire (SRQ-20), the Interpersonal Reactivity Index (IRI), and the Mindful Attention Awareness Scale (MAAS) were provided. RESULTS: HADS scores for Anxiety and Depression (n=347) were 9.8±4.3 and 7.1±3.6, respectively; the SRQ-20 (n=373) score was 8.1±4.5; all scores were negatively correlated with the year of attendance. IRI (n=373) scores were: 2.6±0.5 (Empathic Concern), 2.7±0.7 (Perspective Taking), 2.5±0.9 (Fantasy), and 1.7±0.7 (Personal Distress). Fantasy was negatively correlated with the year of attendance. MAAS scores were positively correlated with the year of attendance. Worse mental health scores were found for first-year students across all scales. CONCLUSIONS: We found high levels of mental burden in medical students in the early period of the COVID-19 pandemic, especially in first-year students, who may have fewer resources to deal with stress. Moreover, as they entered college a short time before the pandemic, they were unable to experience academic life fully or create important new social support networks to deal with adversities.

Abstract The objective of this study was to evaluate the fertility of buffalo semen for in vitro embryo production (IVEP) by comparing the effectiveness of refrigerated versus frozen semen. Three OPU sessions were held at 30-day intervals. For oocyte fertilization three buffalo bulls were used, one per session. At each OPU-IVEP session, one ejaculate was collected and divided into two equal aliquots. Each aliquot was either refrigerated at 5ºC/24 hours or frozen. A TRIS extender containing 10% low density lipoproteins, 0.5% lecithin and 10 mM acetylcysteine was used adding 7% glycerol for freezing. Sperm motility/kinetic was evaluated by CASA and sperm membrane integrity by the hypoosmotic swelling test. The evaluations were performed at 0 h (post final dilution at 37ºC), at 4 and 24 hs post-incubation at 5ºC and post-thaw. At 24 hs incubation and immediately post thaw sperm cells were used for in vitro fertilization of buffalo oocytes equally distributed between both groups. Cleavage rates and embryo development were followed. The embryo/matured and embryo/cultured rates were 25.4 x 14.0% and 29.4 x 18.5% (P<0.05), for chilled and frozen semen, respectively. It is concluded that cooled semen can be used for in vitro embryo production in buffalo and that a better efficiency may be expected for cooled compared to frozen semen.

Resumo O termo prevenção em saúde vem sendo utilizado desde a mudança no paradigma médico com certa frequência dentro e fora do campo da medicina. Entretanto, ao se debater esse conceito fora desse campo, torna-se necessário trazer algumas particularidades em questões atravessadas pelo tempo e espaço em que se dão. Este artigo problematiza a ideia de prevenção no pensamento de Freud. Assim, investigam-se, a partir de uma revisão dos seus escritos, os diversos empregos e concepções que ele faz dos termos prevenção e profilaxia. Com origem nos textos de 1896, passando por outros textos em 1910, 1913, 1926, 1934 até os artigos mais tardios de 1937, destacam-se suas principais elaborações sobre a temática, marcadas por uma flutuação de posicionamentos referentes às possibilidades e limites de uma prática psicanalítica de caráter preventivo. Para auxiliar na articulação utilizamos também escritos de outros psicanalistas sobre o tema, com o objetivo de reatualizar o debate da noção de prevenção em psicanálise.

Abstract The term health prevention has been used since the medical paradigm shift quite often within and outside the field of medicine. However, when discussing this concept outside of the field, it is necessary to bring some particularities in question with regards to the time and space in which they occur. The present paper discusses the idea of prevention in Freud’s thinking. Thus, from a review of his writings, the various uses and conceptions he makes of the terms prevention and prophylaxis are investigated. Originating in the 1896 texts and going through others in 1910, 1913, 1926, 1934 until the later articles of 1937, his main elaborations on the subject are highlighted, marked by a fluctuation of positions regarding the possibilities and limits of a preventive psychoanalytic practice. To assist in the articulation we will also use writings of other psychoanalysts on the subject, with the aim of updating the debate on the notion of prevention in psychoanalys.

Resumo O Parque Nacional da Serra dos Órgãos (PARNASO) constitui um dos maiores remanescentes de Mata Atlântica no estado do Rio de Janeiro. Bromeliaceae possui neste bioma um dos seus principais centros de diversidade, com 31 gêneros e 803 espécies, sendo mais de 500 pertencentes à subfamília Bromelioideae. Como parte do projeto Bromeliaceae organensis desenvolvido no Departamento de Botânica do Museu Nacional- UFRJ, o presente trabalho buscou inventariar as espécies de Aechmea, Billbergia, Hohenbergia e Quesnelia no PARNASO, fornecendo a descrição morfológica das espécies e uma chave para identificação, além de dados sobre sua distribuição, geral e dentro do parque. O estudo taxonômico foi realizado através da análise de material herborizado, coletas e observações de campo. Foram encontradas no parque: seis espécies de Aechmea, cinco de Billbergia, uma de Hohenbergia e quatro de Quesnelia. Apesar de bem representado em número de espécies na unidade de conservação, Billbergia conta com poucos registros nos herbários, sendo quatro de suas espécies referenciadas por um ou poucos indivíduos nas coleções. A localidade guarda ainda populações de espécies endêmicas do estado do Rio de Janeiro, como A. wellbachii, A. fasciata, Q. lateralis e Q. edmundoi var. edmundoi.

Abstract The Serra dos Órgãos National Park (PARNASO) constitutes one of the largest remnants of the Brazilian rainforest in Rio de Janeiro state. In this biome, Bromeliaceae has one of its main centers of diversity, with 31 genera and 803 species, being more than 500 belonging to the subfamily Bromelioideae. As a part of the project Bromeliaceae organensis in development in the Departament of Botany of the Museu Nacional- UFRJ, the present work aims to inventory the species of Aechmea, Billbergia, Hohenbergia and Quesnelia on PARNASO, providing the morphological description of the species and an identification key, in addition to data about its distribution, general and inside the park. The taxonomic study was carried on through the analysis of the dried specimens, collections and field observations. Six species of Aechmea, five of Billbergia, one of Hohenbergia and four of Quesnelia, were revealed. Although well represented in number of species, Billbergia counts with a poor number of herbarium records, with four of them referenced by one or little more individuals in the collections. The locality also houses populations of endemic species of Rio de Janeiro state, like A. wellbachii, A. fasciata, Q. lateralis and Q. edmundoi var. edmundoi.

A pseudopolipose gigante do cólon é uma complicação rara, habitualmente associada a doença inflamatória intestinal. Corresponde a uma exuberante coleção de pseudopólipos que podem confundir-se com neoplasia. Descreve-se o caso de um doente de 23 anos com colite ulcerosa que iniciou um quadro de suboclusão intestinal. Realizou colonoscopia que demonstrou no cólon transverso uma massa polipóide que ocupava a quase totalidade do lúmen intestinal. Foi submetido a hemicolectomia direita alargada e a peça cirúrgica em seção demonstrava a presença de múltiplos pseudopólipos de grandes dimensões que microscopicamente correspondiam a exuberante hiperplasia glandular, com denso infiltrado inflamatório transmural, sem evidência de displasia ou neoplasia, permitindo assim o diagnóstico de pseudopolipose gigante do cólon associada a doença inflamatória intestinal.

Localized giant pseudopolyposis is an extremely rare feature of pseudopolyposis complicating inflammatory bowel disease. It represents a localized exuberant collection of pseudopolyps, which may simulate neoplasms such as polypoid cancer. We report a case of a 23-year-old man with the diagnosis of ulcerative colitis, who presented with symptoms of subacute large bowel obstruction. At colonoscopy a large polypoid lesion was found in the transverse colon, causing almost complete luminal obstruction. The patient underwent an extended right hemicolectomy and the surgical specimen examination showed multiple pseudopolyps corresponding to exuberant glandular hyperplasia with mucosal dense mixed cell transmural infiltrate with no dysplasia or malignancy. The diagnosis of giant inflammatory polyposis associated with inflammatory bowel disease was therefore made.

Os autores reportam o caso de um doente de 25 anos de idade, com um quadro clínico compatível com pneumonia que condicionou o primeiro episódio de descompensação de doença hepática crónica, sem diagnóstico prévio. Os exames complementares de diagnóstico revelaram a presença de Doença de Wilson. A Doença de Wilson é uma entidade rara, autossómica recessiva, em que ocorre uma diminuição da excreção biliar de cobre, resultando na sua acumulação no fígado, cérebro, rim e córnea. A apresentação clínica desta entidade inclui um espectro alargado de manifestações, entre as quais se inclui a doença hepática crónica descompensada, como ocorreu no caso clínico descrito.

The authors present the case of 25-year-old male with pneumonia, that caused the first decompensation of chronic liver disease, without previous diagnosis. Diagnostic workup revealed the presence of Wilson disease. Wilson disease is a rare, autosomal recessive disorder in which inadequate hepatic copper excretion leads to its accumulation in the liver, brain, kidney and cornea. The clinical presentation include a broad spectrum of symptoms, like decompensated chronic liver disease, as in our case.

A esofagite eosinofílica constitui uma condição inflamatória em que ocorre exuberante infiltração do epitélio esofágico por eosinófilos. No adulto, apenas recentemente foi reconhecida como uma entidade distinta. Devido à semelhança clínica, é muitas vezes confundida e tratada como a doença do refluxo gastroesofágico severa antes do estabelecimento do diagnóstico correto. Apresenta-se o caso de uma doente jovem com asma em quem a esofagite eosinofílica foi suspeitada perante sintomas de refluxo gastroesofágico refratários à terapêutica médica standard. A obtenção de biopsias da mucosa esofágica com aspeto endoscopicamente normal foi essencial para o estabelecimento do diagnóstico. A doente foi tratada com sucesso com fluticasona deglutida. Como as características clínicas e anatomo-patológicas da doença do refluxo gastroesofágico e da esofagite eosinofílica poderão sobrepor-se, o diagnóstico requer um elevado grau de suspeita. Torna-se assim necessária a crescente sensibilização para esta entidade, já que a corticoterapia tópica poderá ser mais eficaz do que a supressão ácida.

Eosinophilic esophagitis is an inflammatory condition in which there is dense eosinophilic infiltration of the esophageal lining epithelium. The adult form has only recently gained recognition as a distinct entity. Because of the reflux-type symptomatology, it is commonly misdiagnosed and treated as severe gastroesophageal reflux disease before an appropriate diagnosis is made. We herein present a case of an asthmatic young woman in whom eosinophilic esophagitis was suspected based on symptoms of gastroesophageal reflux disease refractory to standard medical therapy. Biopsies taken from esophageal normal appearing mucosa were essential to establish the diagnosis. She was successfully treated with swallowed fluticasone. As clinical and pathologic features of gastroesophageal reflux disease and eosinophilic esophagitis may overlap, proper diagnosis requires a keen index of suspicion. Increased awareness of eosinophilic esophagitis is necessary, since treatment with topical steroids may be more effective than acid suppression.

Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients' lives and related factors affecting stent patency, clinical success and complications. Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients' lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, long-term clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality.

Os autores reportam o caso de uma doente de 38 anos de idade com um quadro clínico de odinofagia, dor retroesternal e emagrecimento. Os exames complementares de diagnóstico revelaram a presença de uma lesão ulcerada no esófago, como forma de manifestação de tuberculose primária do esófago. A Tuberculose esofágica é uma doença pouco frequente, sendo responsável por 0,15% da mortalidade por tuberculose. A Tuberculose primária do esófago, sem envolvimento de outros órgãos, como o nosso caso clínico, é ainda mais raro. A maioria dos casos é tratada de forma eficaz com tuberculostáticos, sendo que o atraso no diagnóstico e início da terapêutica dita um mau prognóstico.

The authors present a case of 38 year old woman with symptoms of odynophagia, retrosternal pain and weight loss. Diagnostic workup revealed the presence of an esophageal ulcer as the first manifestation of primary esophageal tuberculosis. Esophageal tuberculosis is a rare disease, estimated to account for 0,15% of deaths from tuberculosis. Moreover, primary esophageal tuberculosis without active extraesophageal tuberculosis, just like our case, is even more uncommon. Most cases of primary tuberculosis of the esophagus can be treated successfully with antituberculous chemotherapy and delay in diagnosis and in the start of treatment may cause a poor prognosis.