Abstract Vulvar leiomyosarcoma is a malignant tumor with a very rare presentation; there are about 50 cases published in the literature. Its prognosis is poor due to its local recurrence and hematogenous dissemination, with mainly lung and liver involvement. We present the case of a 30-year-old patient with a rapidly growing palpable tumor on the right labia majora, which, due to its size and vascular component, was embolized by interventional radiology before surgical removal, with good clinical evolution.

Resumen El leiomiosarcoma vulvar es un tumor maligno de presentación muy rara, existen publicados cerca 50 casos en la literatura. Su pronóstico es malo, por su recidiva local y diseminación por vía hematógena con principal afección pulmonar y hepática. Se presenta el caso de una paciente de 30 años con tumoración palpable de rápido crecimiento en labio mayor derecho, el cual debido a su tamaño y componente vascular fue embolizado por radiología intervencionista previo a extirpación quirúrgica, con buena evolución clínica.

Abstract Renal involvement is one of the most severe morbidities of Fabry disease (FD), a multisystemic lysosomal storage disease with an X-linked inheritance pattern. It results from pathogenic variants in the GLA gene (Xq22.2), which encodes the production of alpha-galactosidase A (α-Gal), responsible for glycosphingolipid metabolism. Insufficient activity of this lysosomal enzyme generates deposits of unprocessed intermediate substrates, especially globotriaosylceramide (Gb3) and derivatives, triggering cellular injury and subsequently, multiple organ dysfunction, including chronic nephropathy. Kidney injury in FD is classically attributed to Gb3 deposits in renal cells, with podocytes being the main target of the pathological process, in which structural and functional alterations are established early and severely. This configures a typical hereditary metabolic podocytopathy, whose clinical manifestations are proteinuria and progressive renal failure. Although late clinical outcomes and morphological changes are well established in this nephropathy, the molecular mechanisms that trigger and accelerate podocyte injury have not yet been fully elucidated. Podocytes are highly specialized and differentiated cells that cover the outer surface of glomerular capillaries, playing a crucial role in preserving the structure and function of the glomerular filtration barrier. They are frequent targets of injury in many nephropathies. Furthermore, dysfunction and depletion of glomerular podocytes are essential events implicated in the pathogenesis of chronic kidney disease progression. We will review the biology of podocytes and their crucial role in regulating the glomerular filtration barrier, analyzing the main pathogenic pathways involved in podocyte injury, especially related to FD nephropathy. FD, , (FD) Xlinked X linked pattern Xq22.2, Xq222 Xq Xq22.2 Xq22 2 (Xq22.2) alphagalactosidase alpha galactosidase αGal, αGal α Gal (α-Gal) metabolism substrates Gb (Gb3 derivatives subsequently nephropathy process severely podocytopathy failure elucidated capillaries barrier nephropathies Furthermore progression (FD Xq22. Xq2 (Xq22.2 (α-Gal (Gb (Xq22. (Xq22 (Xq2 (Xq

Resumo O acometimento renal é uma das mais severas morbidades da doença de Fabry (DF), enfermidade multissistêmica de depósito lisossômico com padrão de herança ligada ao cromossomo X, decorrente de variantes patogênicas do gene GLA (Xq22.2), que codifica a produção de alfa-galactosidase A (α-Gal), responsável pelo metabolismo de glicoesfingolipídeos. A atividade insuficiente dessa enzima lisossômica gera depósitos de substratos intermediários não processados, especialmente do globotriaosilceramida (Gb3) e derivados, desencadeando injúria celular e, posteriormente, disfunção de múltiplos órgãos, incluindo a nefropatia crônica. A lesão renal na DF é classicamente atribuída aos depósitos de Gb3 nas células renais, sendo os podócitos o alvo principal do processo patológico, nos quais as alterações estruturais e funcionais são instaladas de forma precoce e severa, configurando uma podocitopatia metabólica hereditária típica, cujas manifestações clínicas são proteinúria e falência renal progressiva. Embora os desfechos clínicos tardios e as alterações morfológicas estejam bem estabelecidos nessa nefropatia, os mecanismos moleculares que deflagram e aceleram a injúria podocitária ainda não estão completamente elucidados. Podócitos são células altamente especializadas e diferenciadas que revestem a superfície externa dos capilares glomerulares, desempenhando papel essencial na preservação da estrutura e função da barreira de filtração glomerular, sendo alvos frequentes de injúria em muitas nefropatias. A disfunção e depleção dos podócitos glomerulares são, além disso, eventos cruciais implicados na patogênese da progressão da doença renal crônica. Revisaremos a biologia dos podócitos e seu papel na regulação da barreira de filtração glomerular, analisando as principais vias patogênicas envolvidas na lesão podocitária, especialmente relacionadas à nefropatia da DF. DF, , (DF) X Xq22.2, Xq222 Xq Xq22.2 Xq22 2 (Xq22.2) alfagalactosidase alfa galactosidase αGal, αGal α Gal (α-Gal) glicoesfingolipídeos processados Gb (Gb3 derivados posteriormente órgãos crônica renais patológico severa típica progressiva elucidados glomerular nefropatias disso (DF Xq22. Xq2 (Xq22.2 (α-Gal (Gb (Xq22. (Xq22 (Xq2 (Xq

Resumo As arboviroses são endêmicas em vários países e representam um preocupante problema de saúde pública. A mais importante delas é a dengue, que teve um aumento progressivo do número de casos, atingindo a marca dos milhões de casos anuais no Brasil desde a última década. Outras arboviroses de importância para a saúde pública incluem a chikungunya e a Zika, ambas causas de epidemias recentes, e a Febre Amarela, que também tem causado surtos epidêmicos em nosso país. Assim como a maioria das doenças infecciosas, as arboviroses têm o potencial de acometer os rins, por meio de diversos mecanismos que levam à injúria renal, incluindo ação direta dos vírus, inflamação sistêmica, fenômenos hemorrágicos e outras complicações, além da toxicidade de drogas utilizadas no tratamento. Neste artigo de revisão, serão abordados os aspectos epidemiológicos das principais arboviroses no Brasil e em outros países onde estas doenças são endêmicas, os aspectos clínicos e as principais alterações laboratoriais encontradas, incluindo as alterações na função renal. Como as arboviroses se comportam nos pacientes transplantados renais também será descrito. Serão também descritos os mecanismos fisiopatológicos da injúria renal associada às arboviroses e, por fim, o tratamento recomendado para cada doença e as recomendações para o suporte renal neste contexto. dengue década Zika recentes Amarela país infecciosas rins vírus sistêmica complicações revisão encontradas descrito fim contexto

Abstract Arboviruses are endemic in several countries and represent a worrying public health problem. The most important of these diseases is dengue fever, whose numbers continue to rise and have reached millions of annual cases in Brazil since the last decade. Other arboviruses of public health concern are chikungunya and Zika, both of which have caused recent epidemics, and yellow fever, which has also caused epidemic outbreaks in our country. Like most infectious diseases, arboviruses have the potential to affect the kidneys through several mechanisms. These include the direct action of the viruses, systemic inflammation, hemorrhagic phenomena and other complications, in addition to the toxicity of the drugs used in treatment. In this review article, the epidemiological aspects of the main arboviruses in Brazil and other countries where these diseases are endemic, clinical aspects and the main laboratory changes found, including changes in renal function, are addressed. It also describes how arboviruses behave in kidney transplant patients. The pathophysiological mechanisms of kidney injury associated with arboviruses are described and finally the recommended treatment for each disease and recommendations for kidney support in this context are given. problem fever decade Zika epidemics country viruses inflammation complications article found function addressed patients given

Resumo Introdução: Nonagenários constituem um percentual de pacientes internados em ascensão, sendo a injúria renal aguda (IRA) frequente nesses pacientes. Sendo assim, é importante analisar as características clínicas dessa população e seu impacto na mortalidade. Métodos: Estudo retrospectivo de pacientes nonagenários com IRA entre 2013 e 2022 em um hospital terciário. Apenas o último internamento foi considerado e pacientes com dados incompletos foram excluídos. Uma análise por regressão logística foi realizada para definir fatores de risco para mortalidade. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 150 pacientes com mediana de idade 93,0 anos (91,2–95,0) e sexo masculino em 42,7%. Sepse foi a causa mais comum de IRA (53,3%), seguida de desidratação/hipovolemia (17,7%) e insuficiência cardíaca (17,7%). Admissão na UTI ocorreu em 39,3% dos pacientes, ventilação mecânica em 14,7%, uso de vasopressores em 22,7% e realização de terapia renal substitutiva (TRS) em 6,7%. Óbito ocorreu em 56,7% dos pacientes. Desidratação/hipovolemia como etiologia da IRA foi associado a menor risco de mortalidade (OR 0,18; IC 95% 0,04–0,77, p = 0,020). Estágio KDIGO 3 (OR 3,15; IC 95% 1,17–8,47, p = 0,023), admissão na UTI (OR 12,27; IC 95% 3,03–49,74, p < 0,001) e oligúria (OR 5,77; IC 95% 1,98–16,85, p = 0,001) foram associados à mortalidade. Conclusão: Nonagenários com IRA apresentaram alta mortalidade e IRA KDIGO 3, oligúria e admissão na UTI foram associadas ao óbito. Introdução ascensão (IRA assim Métodos 201 202 terciário excluídos 005 0 05 0,0 significativo Resultados 15 930 93 93, 91,2–95,0 912950 91 2 95 (91,2–95,0 427 42 7 42,7% 53,3%, 533 53,3% , 53 (53,3%) desidrataçãohipovolemia desidratação hipovolemia 17,7% 177 17 (17,7% 17,7%. . 393 39 39,3 147 14 14,7% 227 22 22,7 TRS (TRS 67 6 6,7% 567 56 56,7 Desidrataçãohipovolemia Desidratação OR 0,18 018 18 004077 04 77 0,04–0,77 0,020. 0020 0,020 020 0,020) 3,15 315 117847 1 8 47 1,17–8,47 0,023, 0023 0,023 023 0,023) 12,27 1227 12 27 3034974 03 49 74 3,03–49,74 0,001 0001 001 5,77 577 5 1981685 98 16 85 1,98–16,85 Conclusão óbito 20 00 0, 9 91,2–95, 91295 (91,2–95, 4 42,7 53,3 (53,3% 17,7 (17,7 39, 14,7 22, 6,7 56, 0,1 01 00407 0,04–0,7 002 0,02 02 3,1 31 11784 1,17–8,4 12,2 122 303497 3,03–49,7 0,00 000 5,7 57 198168 1,98–16,8 91,2–95 9129 (91,2–95 42, 53, (53,3 17, (17, 14, 6, 0040 0,04–0, 1178 1,17–8, 12, 30349 3,03–49, 5, 19816 1,98–16, 91,2–9 912 (91,2–9 (53, (17 004 0,04–0 117 1,17–8 3034 3,03–49 1981 1,98–16 91,2– (91,2– (53 (1 0,04– 11 1,17– 303 3,03–4 198 1,98–1 91,2 (91,2 (5 ( 0,04 1,17 30 3,03– 19 1,98– 91, (91, 1,1 3,03 1,98 (91 1, 3,0 1,9 (9

Abstract Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. Results: A total of 150 patients were included, with a median age of 93.0 years (91.2–95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04–0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17–8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03–49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98–16.85, p = 0.001) were associated with mortality. Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death. Introduction inpatients (AKI population Thus Methods 201 2022 excluded pvalue value 005 0 05 0.0 significant Results 15 included 930 93 93. 91.2–95.0, 912950 91.2–95.0 , 91 2 95 (91.2–95.0) 427 42 7 42.7 sample 53.3%, 533 53.3% 53 (53.3%) dehydrationhypovolemia dehydration hypovolemia 17.7%, 177 17.7% 17 (17.7%) 17.7%. . 393 39 39.3 147 14 14.7% 227 22 22.7 RRT (RRT 67 6 6.7% 567 56 56.7 Dehydrationhypovolemia Dehydration OR 0.18 018 18 004077 04 77 0.04–0.77 0.020. 0020 0.020 020 0.020) 3.15 315 117847 1 8 47 1.17–8.47 0.023, 0023 0.023 023 0.023) 12.27 1227 12 27 3034974 03 49 74 3.03–49.74 0.001, 0001 0.001 001 5.77 577 5 1981685 98 16 85 1.98–16.85 Conclusion rate death 20 202 00 0. 9 91295 91.2–95. (91.2–95.0 4 42. 53.3 (53.3% 17.7 (17.7% 39. 14.7 22. 6.7 56. 0.1 01 00407 0.04–0.7 002 0.02 02 3.1 31 11784 1.17–8.4 12.2 122 303497 3.03–49.7 000 0.00 5.7 57 198168 1.98–16.8 9129 91.2–95 (91.2–95. 53. (53.3 17. (17.7 14. 6. 0040 0.04–0. 3. 1178 1.17–8. 12. 30349 3.03–49. 5. 19816 1.98–16. 912 91.2–9 (91.2–95 (53. (17. 004 0.04–0 117 1.17–8 3034 3.03–49 1981 1.98–16 91.2– (91.2–9 (53 (17 0.04– 11 1.17– 303 3.03–4 198 1.98–1 91.2 (91.2– (5 (1 0.04 1.17 30 3.03– 19 1.98– 91. (91.2 ( 1.1 3.03 1.98 (91. 1. 3.0 1.9 (91 (9

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. Introdução (IRA mundo apresentação etiologia terciário Métodos 2 1 36 Pediátrica 201 2021 KDIGO. . (KDIGO) proteinúria, (proteinúria meses. meses meses) Resultados 4 130 13 0 13, 3,5–15,5 35155 5 15 (3,5–15,5 n 24 52,2% 522 52 28,3% 283 28 (28,3% anúricos p 0,001. 0001 0,001 001 0,001) 10 21,7% 217 21 7 substitutiva 60 26 sequela 38,5% 385 38 P25–75 P2575 P P25 (P25–75 proteínacreatinina proteína creatinina 030 30 0,3 0,27–0,44 027044 27 44 (0,27–0,44 mg/mg, mgmg mg/mg , mg mg/mg) (TFG 11 27,5% 275 62–83 6283 62 83 (62–83 mLmin173 mLmin mL min 73 mL/min/1,7 m2. m2 m m2) Conclusões substancial prazo 20 202 (KDIGO 3,5–15, 3515 (3,5–15, 52,2 28,3 (28,3 000 0,00 00 21,7 38,5 P25–7 P257 P2 (P25–7 03 0, 0,27–0,4 02704 (0,27–0,4 27,5 62–8 628 8 (62–8 mLmin17 mL/min/1, 3,5–15 351 (3,5–15 52, 28, (28, 0,0 21, 38, P25– (P25– 0,27–0, 0270 (0,27–0, 27, 62– (62– mLmin1 mL/min/1 3,5–1 35 (3,5–1 (28 (P25 0,27–0 027 (0,27–0 (62 mL/min/ 3,5– (3,5– (2 (P2 0,27– 02 (0,27– (6 mL/min 3,5 (3,5 ( (P 0,27 (0,27 3, (3, 0,2 (0,2 (3 (0, (0

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. Introduction (AKI worldwide noncritically non settings presentation etiology evolution center Methods singlecenter single 2 1 36 201 2021 (KDIGO criteria proteinuria, (proteinuria hypertension followup follow up assessments. assessments . assessments) Results Fortysix Forty six 130 13 0 13. 3.5–15.5 35155 5 15 (3.5–15.5 included n 24 52.2% 522 52 28.3% 283 28 (28.3% anuric p 0.001. 0001 0.001 001 0.001) 10 21.7% 217 21 7 therapy 60 26 38.5% 385 38 P25–75 P2575 P P25 (P25–75 proteintocreatinine protein creatinine 030 30 0.3 0.27–0.44 027044 27 44 (0.27–0.44 mg/mg, mgmg mg/mg , mg mg/mg) (GFR 11 27.5% 275 62–83 6283 62 83 (62–83 mLmin173 mLmin mL min 73 mL/min/1.7 m2. m2 m m2) Conclusions morbidity longterm long term prognosis 20 202 3.5–15. 3515 (3.5–15. 52.2 28.3 (28.3 000 0.00 00 21.7 38.5 P25–7 P257 P2 (P25–7 03 0. 0.27–0.4 02704 4 (0.27–0.4 27.5 62–8 628 8 (62–8 mLmin17 mL/min/1. 3.5–15 351 (3.5–15 52. 28. (28. 0.0 21. 38. P25– (P25– 0.27–0. 0270 (0.27–0. 27. 62– (62– mLmin1 mL/min/1 3.5–1 35 (3.5–1 (28 (P25 0.27–0 027 (0.27–0 (62 mL/min/ 3.5– (3.5– (2 (P2 0.27– 02 (0.27– (6 mL/min 3.5 (3.5 ( (P 0.27 (0.27 3. (3. 0.2 (0.2 (3 (0. (0

RESUMO Introdução: A biópsia renal (BR) percutânea é fundamental para diagnóstico e manejo de diversas patologias renais. Dados nacionais sobre BR nativa em pacientes pediátricos são escassos. Nosso objetivo foi revisar características demográficas, clínicas e padrões histopatológicos em crianças submetidas a BR percutânea nativa ao longo de 24 anos. Métodos: Estudo observacional retrospectivo de pacientes submetidos a BR percutâneas nativas em unidade de nefrologia pediátrica entre 1998 e 2021, comparando três períodos: período 1 (1998–2005), período 2 (2006–2013), período 3 (2014–2021). Resultados: Constatamos que foram realizadas 228 BR, 78 (34,2%) no período 1, 91 (39,9%) no período 2, 59 (25,9%) no período 3. A idade mediana na BR foi 11 (7–14) anos. As principais indicações para BR foram síndrome nefrótica (SN) (42,9%), hematúria e/ou proteinúria não nefrótica (35,5%), lesão renal aguda (13,2%). Glomerulopatias primárias foram mais frequentes (67,1%), principalmente doença de lesão mínima (DLM) (25,4%), nefropatia por IgA (12,7%), glomerulonefrite mesangioproliferativa (GN) (8,8%). Das glomerulopatias secundárias, nefrite lúpica (NL) foi a mais prevalente (11,8%). No grupo 1, hematúria e/ou a proteinúria não nefrótica foram os principais motivos para BR, ao contrário da SN nos grupos 2 e 3 (p < 0,01). A NL apresentou tendência crescente (período 1–3: 2,6%–5,3%) e a glomeruloesclerose segmentar focal (GESF) apresentou leve tendência decrescente (período 1–3: 3,1%–1,8%), sem significância estatística. Conclusões: A principal indicação para BR foi SN, que aumentou ao longo do tempo, justificando o achado de DLM como principal diagnóstico histológico. A NL apresentou aumento na incidência ao longo do tempo, enquanto os casos de GESF não aumentaram. Introdução (BR renais escassos demográficas anos Métodos 199 2021 períodos 1998–2005, 19982005 1998–2005 , 2005 (1998–2005) 2006–2013, 20062013 2006–2013 2006 2013 (2006–2013) 2014–2021. 20142021 2014–2021 . 2014 (2014–2021) Resultados 22 7 34,2% 342 34 (34,2% 9 39,9% 399 39 (39,9% 5 25,9% 259 25 (25,9% 7–14 714 14 (7–14 (SN 42,9%, 429 42,9% 42 (42,9%) eou ou 35,5%, 355 35,5% 35 (35,5%) 13,2%. 132 13,2% 13 (13,2%) 67,1%, 671 67,1% 67 (67,1%) (DLM 25,4%, 254 25,4% 4 (25,4%) 12,7%, 127 12,7% 12 (12,7%) GN (GN 8,8%. 88 8,8% 8 (8,8%) secundárias (NL 11,8%. 118 11,8% (11,8%) p 0,01. 001 0,01 0 01 0,01) 1–3 2,6%–5,3% 2653 6 (GESF 3,1%–1,8%, 3118 3,1%–1,8% 3,1%–1,8%) estatística Conclusões tempo histológico aumentaram 19 202 1998200 1998–200 200 (1998–2005 2006201 2006–201 201 (2006–2013 2014202 2014–202 (2014–2021 34,2 (34,2 39,9 (39,9 25,9 (25,9 7–1 71 (7–1 42,9 (42,9% 35,5 (35,5% 13,2 (13,2% 67,1 (67,1% 25,4 (25,4% 12,7 (12,7% 8,8 (8,8% 11,8 (11,8% 00 0,0 1– 2,6%–5,3 265 311 3,1%–1,8 20 199820 1998–20 (1998–200 200620 2006–20 (2006–201 201420 2014–20 (2014–202 34, (34, 39, (39, 25, (25, 7– (7– 42, (42,9 35, (35,5 13, (13,2 67, (67,1 (25,4 12, (12,7 8, (8,8 11, (11,8 0, 2,6%–5, 26 31 3,1%–1, 19982 1998–2 (1998–20 20062 2006–2 (2006–20 20142 2014–2 (2014–20 (34 (39 (25 (7 (42, (35, (13, (67, (12, (8, (11, 2,6%–5 3,1%–1 1998– (1998–2 2006– (2006–2 2014– (2014–2 (3 (2 ( (42 (35 (13 (67 (12 (8 (11 2,6%– 3,1%– (1998– (2006– (2014– (4 (1 (6 2,6% 3,1% (1998 (2006 (2014 2,6 3,1 (199 (200 (201 3, (19 (20

Introduction: Percutaneous kidney biopsy (KB) is crucial to the diagnosis and management of several renal pathologies. National data on native KB in pediatric patients are scarce. We aimed to review the demographic and clinical characteristics and histopathological patterns in children who underwent native percutaneous KB over 24 years. Methods: Retrospective observational study of patients undergoing native percutaneous KB in a pediatric nephrology unit between 1998 and 2021, comparing 3 periods: period 1 (1998–2005), period 2 (2006–2013), and period 3 (2014–2021). Results: We found that 228 KB were performed, 78 (34.2%) in period 1, 91 (39.9%) in period 2, and 59 (25.9%) in period 3. The median age at KB was 11 (7–14) years. The main indications for KB were nephrotic syndrome (NS) (42.9%), hematuria and/or non-nephrotic proteinuria (35.5%), and acute kidney injury (13.2%). Primary glomerulopathies were more frequent (67.1%), particularly minimal change disease (MCD) (25.4%), IgA nephropathy (12.7%), and mesangioproliferative glomerulonephritis (GN) (8.8%). Of the secondary glomerulopathies, lupus nephritis (LN) was the most prevalent (11.8%). In group 1, hematuria and/or non-nephrotic proteinuria were the main reasons for KB, as opposed to NS in groups 2 and 3 (p < 0.01). LN showed an increasing trend (period 1–3: 2.6%–5.3%) and focal segmental glomerular sclerosis (FSGS) showed a slight decreasing trend (period 1–3: 3.1%–1.8%), without statistical significance. Conclusions: The main indication for KB was NS, which increased over time, justifying the finding of MCD as main histological diagnosis. LN showed an increase in incidence over time, while FSGS cases did not increase. Introduction (KB pathologies scarce years Methods 199 2021 periods 1998–2005, 19982005 1998–2005 , 2005 (1998–2005) 2006–2013, 20062013 2006–2013 2006 2013 (2006–2013) 2014–2021. 20142021 2014–2021 . 2014 (2014–2021) Results 22 performed 7 34.2% 342 34 (34.2% 9 39.9% 399 39 (39.9% 5 25.9% 259 25 (25.9% 7–14 714 14 (7–14 (NS 42.9%, 429 42.9% 42 (42.9%) andor or nonnephrotic non 35.5%, 355 35.5% 35 (35.5%) 13.2%. 132 13.2% 13 (13.2%) 67.1%, 671 67.1% 67 (67.1%) (MCD 25.4%, 254 25.4% 4 (25.4%) 12.7%, 127 12.7% 12 (12.7%) GN (GN 8.8%. 88 8.8% 8 (8.8%) (LN 11.8%. 118 11.8% (11.8%) p 0.01. 001 0.01 0 01 0.01) 1–3 2.6%–5.3% 2653 6 (FSGS 3.1%–1.8%, 3118 3.1%–1.8% 3.1%–1.8%) significance Conclusions time 19 202 1998200 1998–200 200 (1998–2005 2006201 2006–201 201 (2006–2013 2014202 2014–202 (2014–2021 34.2 (34.2 39.9 (39.9 25.9 (25.9 7–1 71 (7–1 42.9 (42.9% 35.5 (35.5% 13.2 (13.2% 67.1 (67.1% 25.4 (25.4% 12.7 (12.7% 8.8 (8.8% 11.8 (11.8% 00 0.0 1– 2.6%–5.3 265 311 3.1%–1.8 20 199820 1998–20 (1998–200 200620 2006–20 (2006–201 201420 2014–20 (2014–202 34. (34. 39. (39. 25. (25. 7– (7– 42. (42.9 35. (35.5 13. (13.2 67. (67.1 (25.4 12. (12.7 8. (8.8 11. (11.8 0. 2.6%–5. 26 31 3.1%–1. 19982 1998–2 (1998–20 20062 2006–2 (2006–20 20142 2014–2 (2014–20 (34 (39 (25 (7 (42. (35. (13. (67. (12. (8. (11. 2.6%–5 3.1%–1 1998– (1998–2 2006– (2006–2 2014– (2014–2 (3 (2 ( (42 (35 (13 (67 (12 (8 (11 2.6%– 3.1%– (1998– (2006– (2014– (4 (1 (6 2.6% 3.1% (1998 (2006 (2014 2.6 3.1 (199 (200 (201 2. (19 (20

Abstract Introduction Facial trauma can cause damage to the facial nerve, which can have negative effects on function, aesthetics, and quality of life if left untreated. Objective To evaluate the effectiveness of peripheral facial nerve direct end-to-end anastomosis and/or nerve grafting surgery for patients with facial nerve injury after facial trauma. Methods Fifty-nine patients with peripheral facial nerve paralysis after facial injuries underwent facial nerve rehabilitation surgery from November 2017 to December 2021 at Ho Chi Minh City National Hospital of Odontology. Results All 59 cases of facial trauma with damage to the peripheral facial nerve underwent facial nerve reconstruction surgery within 8 weeks of the injury. Of these cases, 25/59 (42.3%) had end-to-end anastomosis, 22/59 (37.3%) had nerve grafting, and 12/59 (20.4%) had a combination of nerve grafting and end-to-end anastomosis. After surgery, the rates of moderate and good recovery were 78.4% and 11.8%, respectively. All facial paralysis measurements showed statistically significant improvement after surgery, including the Facial Nerve Grading Scale 2.0 (FNGS 2.0) score, the Facial Clinimetric Evaluation (FaCE) scale, and electroneurography. The rate of synkinesis after surgery was 34%. Patient follow-up postoperatively ranged from 6 to > 36 months; 51 out of 59 patients (86.4%) were followed-up for at least 12 months or longer. Conclusion Nerve rehabilitation surgery including direct end-to-end anastomosis and nerve grafting is effective in cases of peripheral facial nerve injury following facial trauma. The surgery helps restore nerve conduction and improve facial paralysis. function aesthetics untreated endtoend end andor Fiftynine Fifty nine 201 202 Odontology 5 2559 25 25/5 42.3% 423 42 3 (42.3% 2259 22 22/5 37.3% 373 37 (37.3% 1259 12/5 20.4% 204 20 4 (20.4% 784 78 78.4 118 11 11.8% respectively 2 0 2. FNGS score FaCE (FaCE scale electroneurography 34 34% followup follow up 86.4% 864 86 (86.4% followedup followed 1 longer 255 25/ 42.3 (42.3 225 22/ 37.3 (37.3 125 12/ 20.4 (20.4 7 78. 11.8 86.4 (86.4 42. (42. 37. (37. 20. (20. 11. 86. (86. (42 (37 (20 (86 (4 (3 (2 (8 (

Abstract Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome. otolaryngologists blindly 10 42 4 2 4. 307 3 07 3.0 years steps trainee 0 points locations 24%, 24 24% , (24%) 12%, 12 12% (12%) 4%, 4% (4%) 2%. 2% . (2%) 46 23% 23 11% 11 ridge 10% orifice 2%) 29 13 mucosa 6 6% muscles 19 9 9% 1 1% outcome 30 3. (24% (12% (4% (2% (24 (12 (4 (2 (1 (

RESUMO Introdução: O padel é um esporte crescente e popular em todo o mundo. No entanto, o aumento da prática desse esporte levou a um aumento das lesões relacionadas. Objetivo: determinar quais são as regiões e os tecidos corporais mais lesionados, bem como as principais lesões relacionadas à prática do padel; assim como os fatores de risco e as medidas para sua prevenção. Materiais e métodos: foi realizada uma pesquisa na literatura para abordar diferentes aspectos relacionados ao paddle, os fatores de risco para lesões também foram investigados e as estratégias de prevenção existentes foram analisadas. Resultados: os resultados indicam que o peso da raquete é um fator determinante no aparecimento de lesões, e recomenda-se que ele não ultrapasse 350 gramas. Além disso, foram identificadas diferenças nas lesões entre homens e mulheres, sendo que as mulheres são mais propensas a lesões ligamentares e os homens a lesões tendinosas ou musculares. Também são observadas diferenças nas lesões de acordo com o nível de jogo e a experiência dos jogadores. Em termos de prevenção de lesões, são recomendados exercícios de fortalecimento, estabilidade e propriocepção, além de trabalhar a técnica e usar equipamentos adequados. Conclusões: é importante implementar estratégias preventivas baseadas em evidências para reduzir o risco de lesões e promover a saúde dos jogadores de padel.

ABSTRACT Introduction: padel is a growing and popular sport worldwide. However, the increase in the practice of this sport has led to an increase in related injuries. Objective: to determine which are the most injured body regions and tissues, as well as the main injuries related to the practice of padel; the risk factors and measures for their prevention. Materials and methods: a bibliographic search was carried out to address different aspects related to padel, the risk factors for injuries were also investigated and the existing prevention strategies were analyzed. Results: the results indicate that the weight of the paddle is a determining factor in the appearance of injuries, and it is recommended that it should not exceed 350 grams. In addition, differences in injuries between men and women have been identified, with women being more prone to ligament injuries and men to tendon or muscle injuries. Differences in injuries are also observed according to the level of play and experience of the players. Regarding injury prevention, it is recommended to perform strengthening, stability and proprioception exercises, as well as to work on technique and use appropriate equipment. Conclusions: it is important to implement evidence-based preventive strategies to reduce the risk of injuries and promote health in padel players.

RESUMEN Introducción: el pádel es un deporte en crecimiento y popularidad a nivel mundial. Sin embargo, el aumento en la práctica de este deporte ha llevado a un incremento en las lesiones relacionadas. Objetivo: determinar cuáles son las regiones corporales y tejidos más lesionados, así como las lesiones principales relacionadas con la práctica del pádel; así como los factores de riesgo y las medidas para su prevención. Materiales y métodos: se ha realizado una búsqueda bibliográfica para abordar diferentes aspectos relacionados con el pádel, también se han investigado los factores de riesgo de lesiones y se han analizado las estrategias de prevención existentes. Resultados: los resultados indican que el peso de la pala es un factor determinante en la aparición de lesiones, siendo recomendable que no supere los 350 gramos. Además, se han identificado diferencias en las lesiones entre hombres y mujeres, con las mujeres siendo más propensas a lesiones ligamentosas y los hombres a lesiones tendinosas o musculares. También se observan diferencias en las lesiones según el nivel de juego y la experiencia de los jugadores. En cuanto a la prevención de lesiones, se recomienda realizar ejercicios de fortalecimiento, estabilidad y propiocepción, así como trabajar la técnica y utilizar equipamiento adecuado. Conclusiones: es importante implementar estrategias preventivas basadas en la evidencia para reducir el riesgo de lesiones y promover la salud en los jugadores de pádel.

ABSTRACT Purpose To assess the incidence of the most common intra- and early postoperative complications following RIRS in a large series of patients with kidney stones. Methods We conducted a retrospective analysis of patients with kidney stones who underwent RIRS across 21 centers from January 2018 to August 2021, as part of the Global Multicenter Flexible Ureteroscopy Outcome (FLEXOR) Registry. Results Among 6669 patients undergoing RIRS, 4.5% experienced intraoperative pelvicalyceal system bleeding without necessitating blood transfusion. Only 0.1% of patients, required a blood transfusion. The second most frequent intraoperative complication was ureteric injury due to the ureteral access sheath requiring stenting (1.8% of patients). Postoperatively, the most prevalent early complications were fever/infections requiring antibiotics (6.3%), blood transfusions (5.5%), and sepsis necessitating intensive care unit admission (1.3%). In cases of ureteric injury, a notably higher percentage of patients exhibited multiple stones and stone(s) in the lower pole, and these cases were correlated with prolonged lasing and overall surgical time. Hematuria requiring a blood transfusion was associated with an increased prevalence of larger median maximum stone diameters, particularly among patients with stones exceeding 20 mm. Furthermore, these cases exhibited a significant prolongation in surgical time. Sepsis necessitating admission to the intensive care unit was more prevalent among the elderly, concomitant with a significantly larger median maximum stone diameter. Conclusions Our analysis showed that RIRS has a good safety profile but bleeding requiring transfusions, ureteric injury, fever, and sepsis are still the most common complications despite advancements in technology. intra 2 201 2021 FLEXOR (FLEXOR Registry 666 45 4 5 4.5 01 0 1 0.1 1.8% 18 8 (1.8 patients. . patients) Postoperatively feverinfections fever infections 6.3%, 63 6.3% , 6 3 (6.3%) 5.5%, 55 5.5% (5.5%) 1.3%. 13 1.3% (1.3%) s stone(s pole time diameters mm Furthermore elderly diameter technology 202 66 4. 0. 1.8 (1. 6.3 (6.3% 5.5 (5.5% 1.3 (1.3% 1. (1 6. (6.3 5. (5.5 (1.3 ( (6. (5. (6 (5

RESUMEN Introducción: las enfermedades del pie relacionadas a la diabetes mellitus representan una de las causas de mayor morbilidad e incapacidad en las personas con diabetes mellitus tipo 2, siendo la causa más frecuente de ingreso hospitalario en dicho grupo. Objetivo: describir las características clínicas de los pacientes con enfermedad del pie relacionadas a la diabetes mellitus del Hospital Nacional 2022-2023. Metodología: se seleccionaron 113 pacientes portadores de diabetes mellitus tipo 2 con pie diabético mayores de 18 años. Se evaluaron las variables demográficas, medidas antropométricas, características de la enfermedad, comorbilidades y características clínicas del pie. Resultados: de los 113 estudiados 42 pacientes (37 %) correspondieron al sexo femenino y 71 (63 %) al sexo masculino, promedio de edad fue de 65 años DE 12,191. 75 pacientes (66 %) presentaron pie diabético, con lesión Wagner grado 4. El 81 % (92) tenía hipertensión arterial, sedentarismo 65 % (84), en menor frecuencia pacientes con sobrepeso 38 % (43), obesidad 25 % (38), tabaquismo 23 % (26) y dislipidemia 18 % (20). Conclusión: las características clínicas de los pacientes con diabetes tipo 2 con lesión en el pie coinciden con otros trabajos obtenidos a nivel mundial. Es muy importante prestar atención a este grupo de riesgo, mediante medidas preventivas y realizar el tratamiento precoz para disminuir las complicaciones.

ABSTRACT Introduction: foot diseases related to diabetes mellitus represent one of the causes of greatest morbidity and disability in people with type 2 diabetes mellitus, being the most frequent cause of hospital admission in said group. Objective: to describe the clinical characteristics of patients with foot disease related to diabetes mellitus at Hospital Nacional 2022-2023. Methodology: 113 patients with type 2 diabetes mellitus with diabetic foot over 18 years of age were selected. Demographic variables, anthropometric measurements, disease characteristics, comorbidities, and clinical characteristics of the foot were evaluated. Results: of the 113 studied, 42 patients (37 %) were female and 71 (63 %) were male, average age was 65 years SD 12,191. 75 patients (66 %) presented diabetic foot, with Wagner grade 4 lesion. 81 % (92) had high blood pressure, sedentary lifestyle 65 % (84), less frequently overweight patients 38 % (43), obesity 25% (38) ), smoking 23 % (26) and dyslipidemia 18 % (20). Conclusion: the clinical characteristics of patients with type 2 diabetes with foot injury coincide with other works obtained worldwide. It is very important to pay attention to this risk group, through preventive measures and carry out early treatment to reduce complications.

RESUMEN La subluxación atlantoaxial es la lesión más frecuente en la columna cervical causada por la artritis reumatoidea. Se manifiesta por rigidez de nuca, dolor cervical y déficit neurológico. El diagnóstico se realiza con tomografía computarizada e imágenes de resonancia magnética. El intervalo atlanto dental anterior mayor a 5mm indica inestabilidad atlantoaxial, el intervalo atlanto dental posterior menor a 14mm advierte riesgo neurológico. Las indicaciones más frecuentes de cirugía son: dolor cervical severo, inestabilidad y síntomas de mielopatía. Cuando existe compresión medular es necesaria la descompresión cervical alta sea por vía posterior o por vía anterior (odontoidectomía endonasal versus transoral). La línea rinopalatina nos indicará la factibilidad de una odontoidectomía endonasal endoscópica (OEE). El objetivo de la presentación del presente caso es compartir nuestra experiencia con la primera odontoidectomía endonasal endoscópica realizada en nuestro país y fomentar la utilización de la técnica. La cirugía fue realizada en un paciente con cuadriparesia espástica por subluxación atlantoaxial por artritis reumatoidea y que presentó excelente evolución pos operatoria, con recuperación casi completa. La OEE es una técnica operatoria mínimamente invasiva, ideal para pacientes con múltiples comorbilidades y que ofrece de buenos a excelentes resultados.

ABSTRACT Atlantoaxial subluxation is the most common injury to the cervical spine caused by rheumatoid arthritis. It is manifested by neck stiffness, neck pain and neurological deficit. Diagnosis is made with computed tomography and magnetic resonance imaging. The anterior dental atlanto interval greater than 5mm indicates atlantoaxial instability, the posterior dental atlanto interval less than 14mm warns of neurological risk. The most frequent indications for surgery are: severe neck pain, instability and symptoms of myelopathy. When there is spinal cord compression, upper cervical decompression is necessary, either via a posterior or anterior approach (endonasal versus transoral odontoidectomy). The rhinopalatine line will indicate the feasibility of an endoscopic endonasal odontoidectomy (EEO). The objective of the presentation of this case is to share our experience with the first endoscopic endonasal odontoidectomy performed in our country and to promote the use of the technique. The surgery was performed on a patient with spastic quadriparesis due to atlantoaxial subluxation due to rheumatoid arthritis and who presented excellent postoperative evolution, with almost complete recovery. EEO is a minimally invasive surgical technique, ideal for patients with multiple comorbidities and offering good to excellent results.

BACKGROUND: Maintaining or promoting employment in the presence of disability or reducing the impact of disability on employability should be the adopted focus to decrease the negative impact that disability has on the economy and just as important on the livelihood and well-being of exposed insured individuals. Group risk disability insurance protects an employee's income when illness or injury result in work disability. To achieve this, factors that promote the success of rehabilitation and support for return-to-work of employees following illness and injury need to be understood from an insurance perspective. OBJECTIVES: To explore principles of disability claims management during the rehabilitation and work reintegration stage using a multi-stakeholder approach for the purpose of successful return to work. METHODS: An exploratory qualitative design was used to collect data via semi-structured interviews with 26 purposively selected participants. Interviews were audio-recorded, data were transcribed and analysed thematically. Qualitative research was used to understand the necessary role players in the work reintegration process, factors that hinder and promote work reintegration and best practice principles for Disability Claims Management (DCM). RESULTS: Three themes emerged from the study; (i) role players and their functions with collaboration is integral to disability claims management, (ii) various factors promote and restrict return-to-work planning, and (iii) best practice principles in the DCM pathway that promote return-to-work. These principles include behavioural economics as the central principle, with resource identification and competency, governance, role engagement and education and awareness as supporting principles. CONCLUSION: Collaborative and integrated approaches by role players within a workers' family unit, health system, employer structure and insurance compensation are required for positive return-to-work outcomes. The various role players are responsible for creating policies, structures, intervention strategies, and environments that foster return-to-work. IMPLICATIONS FOR PRACTICE • An integrated approach is required for optimal RTW outcomes as employers' policies restrict work integration. • A collaborative approach by all role players involved in DCM, focusing on positive RTW outcomes is required in the RTW process • Occupational therapists can influence employer incapacity and disability policies in order to keep people employed and productive in the presence of medical conditions with the application of reasonable accommodations where necessary. • Occupational therapists are suitably positioned to outline workplace environment and other supports required to guide and support employees through rehabilitation and RTW and in ensuring that employees who can remain at work while on a partial or fully insured benefit, can engage optimally in aspects of work function.

BACKGROUND. Pathology of the hand causes functional impairment, with downstream effects for patient occupation, and consequently presents a socioeconomic burden. Investigation of the epidemiology of hand pathology in KwaZulu-Natal (KZN) can help reduce the burden of disease. Identifying where the greatest need is can direct patient awareness initiatives, medical training and appropriate allocation of resources. OBJECTIVES. To establish the prevalence of hand pathology at regional hospitals that offer orthopaedic services in KZN, to describe the patients most commonly affected by these pathologies and to identify the most common pathologies. METHODS. A cross-sectional investigation of hospital records and charts of patients presenting for orthopaedic care across all 10 regional hospitals in KZN that offer orthopaedic services was undertaken for 1 week's duration (June 2022). Patients were categorised into hand pathology (HP) and general orthopaedic pathology (OP) groups, which were each subdivided into trauma and non-trauma subgroups. Demographic details were collected for all patients. For HP patients, additional detail was collected regarding diagnosis, mechanism, admission and management. The prevalence of HP was calculated as a factor of all orthopaedic presentations. RESULTS. During the investigation, 2 335 patients presented to orthopaedic services. HP represented 21% of these cases. The majority (17%, 406/2 335) were related to trauma and represented 23% of all the traumatic orthopaedic presentations. Distal radius (DR) fractures were the most common hand injury (46%, 188/406) and a large proportion of trauma to the bony elements of the hand were open injuries (23%, 93/406). The remainder of HP cases comprised the non-traumatic group (4%, 91/2 335) and were predominantly infections (68%, 62/91), and many patients with non-traumatic hand pathology required surgery (60%, 55/91) and admission (56%, 52/91). CONCLUSION. HP represents approximately one-fifth of all orthopaedic presentations to regional health facilities in KZN offering orthopaedic care, and close to a quarter of orthopaedic trauma occurs in the hand. Based on these findings, targeted efforts to improve community awareness of precautions against trauma to the hand, osteopaenia and hand hygiene are suggested as preventive measures. Medical training should emphasise the appropriate management of DR fractures and hand infections, and resources should be differentially allocated to the management of these debilitating HPs to decrease the burden of disease.