Abstract Several topics related to the oral cavity are briefly addressed in this article, from anatomical variations that, when recognized, avoid unnecessary investigations, to diseases that affect exclusively the mouth, mucocutaneous diseases, as well as oral manifestations of systemic diseases. A complete clinical examination comprises the examination of the mouth, and this approach facilitates clinical practice, shortening the path to diagnosis in the outpatient clinic as well as with in-hospital patients. The objective of this article is to encourage the examination of the oral cavity as a useful tool in medical practice, helping to recognize diseases in this location.

Abstract Background: Only a fraction of patients with cutaneous lupus erythematosus (CLE) will eventually progress toward systemic disease (SLE). Objective: To find inflammatory biomarkers which could predict the progression of cutaneous lupus erythematosus (CLE) into systemic lupus erythematosus (SLE) using immunohistochemical (IHC) assays. Methods: Immunohistochemical markers for cytotoxic, inflammatory, and anti-inflammatory responses and morphometric methods were applied to routine paraffin sections of skin biopsies, taken from lesions of 59 patients with discoid lupus, subacute lupus, and lupus tumidus. For the diagnosis of SLE, patients were classified by both the American College of Rheumatology (ACR-82) and the Systemic Lupus International Collaborating Clinics (SLICC-12) systems. Results: Skin samples from CLE/SLE +patients presented higher expression of IL-1β (ARC-82: p = 0.024; SLICC-12: p = 0.0143) and a significantly higher number of cells marked with granzyme B and perforin (ARC: p = 0.0097; SLICC-12: p = 0.0148). Biopsies from CLE/SLE- individuals had higher expression of IL-17 (ARC-82: p = 0.0003; SLICC-12: p = 0.0351) and presented a positive correlation between the density of granzyme A+and FoxP3+ cells (ARC-82: p = 0.0257; SLICC-12: p = 0.0285) and CD8+ cells (ARC-82: p = 0.0075; SLICC-12: p = 0.0102), as well as between granulysin-positive and CD8+ cells (ARC-82: p = 0.0024; SLICC-12: p = 0.0116). Study limitations: Patients were evaluated at a specific point in their evolution and according to the presence or not of systemic disease. The authors cannot predict how many more, from each group, would have evolved towards SLE in the following years. Conclusions: In this cohort, immunohistochemical findings suggested that patients with a tendency to systemic disease will show strong reactivity for IL-1β, while those with purely cutaneous involvement will tend to express IL-17 more intensely.

Abstract Objectives: to identify the scientific evidence on excessively resistant and multidrug resistant tuberculosis in pediatric patients. Methods: this is a scope review of the literature, with a guiding question: “What is the scientific evidence on multidrug-resistant tuberculosis (MDR-TB) and extensively drug-resistant tuberculosis in pediatric patients?”. The research used the descriptors: “extensively drug-resistant tuberculosis” OR “multidrug-resistant tuberculosis” AND “pediatrics”. The research was carried out in a double-blind manner in the following databases of the Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific’s Institutional Repository for Information Sharing, Embase/Elsevier and International Clinical Trials Registry Platform, with a temporal cut-off from 2011 to 2021, sending a final synthesized sample of 18 articles, which evaluated the methodological content through the level of evidence. Results: the results show the lack of research with a high level of evidence related to MDR-TB in children, the lack of adequate dosage of second-line drugs for the pediatric population and the importance of drug sensitivity testing for the cases of treatment Conclusions: it was identified that the obstacles to MDR-TB treatment were concentrated in the lack of detailed protocols, safe drug dosages with a low side effect, and mainly in the social health determinants and disease process involving MDR-TB.

Resumo Objetivos: identificar as evidências científicas sobre tuberculose excessivamente resistente e multidroga resistente em pacientes pediátricos. Métodos: trata-se de uma revisão de escopo da literatura, tendo como questão norteadora: “Quais as evidências científicas sobre tuberculose multidroga-resistente (TB-MDR) e tuberculose extensivamente resistente em pacientes pediátricos?” A pesquisa usou os descritores: “tuberculose extensivamente resistente a medicamentos” OR “tuberculose resistente a múltiplos medicamentos” AND “pediatria”. A pesquisa foi realizada de modo duplo-cego nas bases de dados Medical Literature Analysis and Retrieval System Online, Regional Office for the Western Pacific’s Institutional Repository for Information Sharing, Embase/Elsevier e International Clinical Trials Registry Platform, com um corte temporal de 2011 a 2021, sendo a amostra final sintetizada de 18 artigos, nos quais avaliou-se o conteúdo metodológico por meio do nível de evidência. Resultados: os resultados mostraram a escassez de pesquisas de alto nível de evidência relacionadas à TB-MDR em crianças, ausência de posologia adequada das drogas de segunda linha para o público pediátrico e a importância do teste de sensibilidade a drogas para o tratamento dos casos. Conclusões: identificou-se que os obstáculos do tratamento TB-MDR se concentraram na ausência de protocolos detalhados, de dosagens medicamentosas seguras e com menor efeito colateral, e, principalmente, nos determinantes sociais do processo saúde e doença que envolvem a TB-MDR.

Abstract Anthropogenic interventions have had a compromising effect on environmental health, intensifying the degradation of ecosystems, and the quantity of chemical pollutants released into nature. Therefore, research areas within the scope of environmental assessments and monitoring such as ecotoxicology have contributed to the determination of the toxic potential of contaminants. A small cyprinid known as the zebrafish (Danio rerio), the use of which has exponentially grown, is an alternative vertebrate model for scientific research, mainly in the assessment of environmental risks. The species exhibits several advantages for breeding in a laboratory, in addition to presenting multi-biomarkers of environmental toxicity. Thus, this review aims to present the main characteristics and advantages of working with this species, as well as show studies related to ecotoxicology involving biomarkers of toxicity in zebrafish. The results show a progressive trend towards employing the species in environmental risk analyses, it is an increasingly recommended species in the assessment of the toxicity level of a range of chemical pollutants. The development of future technologies must contribute to scientific advancement, rendering the potential application of this model organism an even more widespread one, which will certainly help in bridging knowledge gaps in various areas of study.

Abstract Introduction: Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria. Objective: To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population. Method: Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed. Results: A total of 1138 subjects were interviewed, with a median age of 36 years old (27–52); 55.1% were female. Regarding the “creatinine” biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were “I don’t know” (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into “knows” and “does not know” the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16–8.43, p < 0.001). Conclusion: There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.

Resumo Introdução: A doença renal crônica costuma ser assintomática e seu diagnóstico depende da realização de exames laboratoriais, com destaque para a creatinina sérica e pesquisa de proteinúria. Objetivo: Avaliar em uma amostra da população brasileira o conhecimento sobre o papel da creatinina sérica como marcador de função renal. Método: Estudo observacional transversal realizado na cidade de São Paulo (SP, Brasil), em que foi entrevistada uma população adulta aleatória. Resultados: Foram entrevistados 1138 indivíduos, com idade mediana de 36 anos (27–52); 55,1% do sexo feminino. Com relação ao marcador “creatinina”, 40,6% afirmaram que nunca realizaram tal dosagem. Quando questionados quanto ao conhecimento sobre a utilidade desse exame, somente 19,6% sabiam a sua função. As outras respostas foram “não sei” (71,6%), avaliar o funcionamento do coração (0,9%) e fígado (7,8%). Dos que afirmaram já terem realizado o exame de creatinina, somente 29,4% acertaram a função da creatinina. Ao dividir os grupos em “sabe” e “não sabe” a função da creatinina, percebeu-se diferença estatisticamente significante (p < 0,05) em relação ao grau de escolaridade, sexo feminino, ser aluno/trabalhador da saúde, ter dosado creatinina alguma vez, conhecer alguém com doença renal e maior idade. Na análise multivariada, a principal variável relacionada com conhecer a função da creatinina foi ter realizado o exame anteriormente (OR 5,16; IC 95% 3,16–8,43, p < 0,001). Conclusão: Há grande desconhecimento sobre a creatinina e seu uso em check-ups. Os resultados indicam que é necessário maior esforço por parte dos profissionais de saúde para divulgar o papel da creatinina sérica.

RESUMO Objetivo: Descrever o desenvolvimento, a implementação e o uso de painéis para a análise epidemiológica de dados abertos durante a pandemia de COVID-19. Métodos: Os painéis foram criados para analisar dados públicos relacionados á COVID-19 de várias fontes, incluindo dados oficiais dos governos e de redes sociais, a nível global. Técnicas de processamento e limpeza foram utilizadas para aglutinar os bancos de dados. Calculamos o coeficiente de correlação de Spearman entre as curvas de sintomas gripais da pesquisa da Universidade de Maryland em conjunto com o Facebook, chamada COVID Trends and Impacts Survey (CTIS), e a curva de casos notificados pelo Ministério da Saúde no Brasil. Resultados: Os painéis obtiveram sucesso em antecipar a chegada de novas ondas de COVID-19 no Brasil. A análise do dado revelou a correlação entre a pesquisa CTIS e o número oficial de casos no país. O artigo destaca o potencial de painéis interativos como uma ferramenta de tomada de decisão no contexto de emergências de saúde pública, como, por exemplo, no uso destes para a comunicação oficial do governo do Rio Grande do Sul. Conclusão: O uso de painéis para prever o avanço da COVID-19 no Brasil foi uma ferramenta útil para a tomada de decisão. A antecipação de ondas da doença possibilita tempo oportuno para que essas decisões sejam potencialmente mais assertivas. Isso esboça a necessidade de mais ações interdisciplinares dessa natureza, com ferramentas de visualização nas pesquisas epidemiológicas.

ABSTRACT Objective: Describe the development, implementation, and utilization of dashboards for epidemiological analysis through open data research during the COVID-19 pandemic. Methods: The dashboards were designed to analyze COVID-19 related public data from various sources, including official government data and social media, at world level. Data processing and cleaning techniques were used to join datasets. We calculated Spearman correlation coefficient between the COVID-like symptoms data of the University of Maryland and Facebook Health research, called COVID Trends and Impacts Survey (CTIS) and the official data of notified COVID-19 cases by the Brazilian Health Ministry. Results: The dashboards were successful in predicting the onset of new waves of COVID-19 in Brazil. The data analysis revealed a correlation between the CTIS and the official number of cases the country. This article shows the potential of interactive dashboards as a decision-making tool in the context of public health emergencies, as it was used by the official communication of the Rio Grande do Sul state government. Conclusion: The use of dashboards for predicting the spread of COVID-19 in Brazil was a useful tool for decision-making. To anticipate waves of the disease gives time so that these decisions can be potentially more assertive. This drafts the need of more interdisciplinary actions of this nature, with visualization tools on epidemiologic research.

Abstract This study scrutinizes structural racism’s influence on the training and work of Black professionals in primary health care (PHC) in Rio de Janeiro, particularly focusing on the experiences of Black female physicians. Employing a qualitative approach via a Focus Group, conducted in November 2022, we adopted symbolic interactionism to interpret racism-related experiences. Our findings encompass two primary dimensions: the manifestation of structural and institutional racism within the Unified Health System (SUS), and how racism permeates health work processes and consequences. Results highlight enduring impacts, spanning education to PHC roles, hindering healthcare process recalibration. Participants identify institutional and structural racism, from managerial neglect to territorial violence and physician scarcity, constraining comprehensive care. It is crucial to unveil and grasp racism’s structural essence within healthcare, aligned with the vision of health as a fundamental right.

Resumo Trata-se de estudo sobre o racismo estrutural na formação e na ocupação de trabalhadoras e trabalhadores negros atuando na atenção primária à saúde (APS) no município do Rio de Janeiro, a partir da experiência de médicas negras. Realizou-se um estudo qualitativo, utilizando grupo focal, conduzido em novembro de 2022. Utilizou-se o interacionismo simbólico como referência para a interpretação relacionada às situações que compõem as experiências/vivências a partir do racismo. Os achados foram reunidos em dois eixos: manifestação do racismo estrutural e institucional no âmbito do SUS; e como o racismo atravessa os processos de trabalho em saúde e suas repercussões. Os resultados revelam uma continuidade das implicações do racismo desde a formação de médicas negras até o trabalho na APS, tornando-se um obstáculo na reorganização do processo de trabalho na perspectiva territorial de atenção à saúde. As participantes identificam o racismo institucional e estrutural na negligência da gestão, na violência do território e na vacância de médicos nas equipes desses territórios, limitando a oferta de um cuidado adequado. É necessário desvelar e aprofundar a compreensão do caráter estrutural do racismo da organização do trabalho em saúde, tendo como imagem-objetivo a saúde como direito.

Resumen: Este estudio tuvo como objetivo investigar la práctica de actividad física en cuatro dominios (ocio, desplazamiento, actividad doméstica y trabajo) y la prevalencia de síntomas depresivos en adultos brasileños, en general y estratificada por sexo, escolaridad y diagnóstico de depresión autoinformado. Se trata de un estudio transversal con datos de 88.531 individuos de 18 años o más, que respondieron la Encuesta Nacional de Salud en el 2019. Los síntomas depresivos se evaluaron mediante el Cuestionario sobre la Salud del Paciente-9 (PHQ-9). Aquellos que realizan actividad física al menos una vez por semana en un dominio determinado se consideraron físicamente activos. Además, se calculó el tiempo de actividad física y luego se dividió en cuartiles para cada dominio. Para los análisis de asociación, se calcularon el odds ratio crudo (ORcrudo) y el odds ratio ajustado (ORajustado) para los análisis total y estratificado. Los individuos que son físicamente activos en durante el ocio presentaron menos probabilidades de tener síntomas depresivos, en el total (ORajustado = 0,74; IC95%: 0,64-0,86) y en todas las estratificaciones, excepto los individuos con depresión autoinformada. Las asociaciones de actividad física en el tiempo libre fueron más frecuentes en quienes practicaban de 121 a 360 minutos/semana. Los individuos que eran activos en los dominios desplazamiento, actividad doméstica y trabajo tuvieron más probabilidades de presentar síntomas depresivos en algunos grupos, con resultados más consistentes para las actividades domésticas. Los resultados mostraron que la relación entre actividad física y depresión entre los brasileños varía según el dominio y la duración, y el concepto de que “cada movimiento cuenta” parece ser correcto solo para el dominio del ocio.

Abstract: This study aimed to investigate the practice of physical activities in the four domains (leisure time, transportation, household, and work) and the prevalence of depressive symptoms in Brazilian adults, in general and stratified by sex, schooling level, and having or not a self-reported diagnosis of depression. This is a cross-sectional study with data from 88,531 individuals aged 18 years or older, who responded to the Brazilian National Health Survey in 2019. The depressive symptoms were evaluated by the Patient Health Questionnaire-9 (PHQ-9). Those who practice physical activities at least once a week in a given domain were considered physically active. Additionally, the calculation of physical activities duration was conducted and later divided into quartiles for each domain. For the association analyses, the crude odds ratio (crudeOR) and adjusted odds ratio (adjustedOR) were calculated for the total and stratified analyses. Individuals who are physically active during leisure time showed a lower chance of presenting depressive symptoms, in total (adjustedOR = 0.74; 95%CI: 0.64-0.86) and in all stratifications, except for individuals with self-reported depression. The associations of leisure-time physical activity were most frequent in those who practice from 121 to 360 minutes/week. The individuals who were active in the transportation, household, and work domains had a higher chance of presenting depressive symptoms in some groups, with more consistent results for household physical activities. The results showed that the relationship between physical activities and depression among Brazilians varies according to domain and duration, and that the concept that “every move counts” seemed to be correct only for the leisure-time domain.

Resumo: O objetivo desta pesquisa foi investigar a relação da prática de atividade física nos quatro domínios (tempo livre, deslocamento, doméstico e trabalho) e a prevalência de sintomas depressivos em adultos brasileiros, de maneira geral e estratificando-se por sexo, escolaridade e ter ou não diagnóstico referido de depressão. Estudo transversal, com dados de 88.531 indivíduos de 18 anos ou mais, respondentes da Pesquisa Nacional de Saúde de 2019. Os sintomas depressivos foram avaliados pelo Patient Health Questionnaire-9 (Questionário de Saúde do Paciente-9, PHQ-9). Foram considerados fisicamente ativos aqueles que referiram realizar atividade física pelo menos uma vez por semana no respectivo domínio. Adicionalmente, foi realizado o cálculo de tempo de prática semanal, sendo posteriormente divididos em quartis em cada domínio. Para as análises de associação, foram calculados o odds ratio bruto (ORbruto) e ajustado (ORajustado), no total e nas análises estratificadas. Os fisicamente ativos no tempo livre tiveram menor chance de apresentar sintomas depressivos, no total (ORajustado = 0,74; IC95%: 0,64-0,86) e em todas as estratificações, menos naqueles com depressão autorreferida. As associações na atividade física no tempo livre foram mais frequentes naqueles que praticavam entre 121 e 360 minutos semanais. Os indivíduos ativos nos domínios de deslocamento, doméstico e trabalho tiveram maior chance de apresentar sintomas depressivos em alguns grupos, com resultados mais consistentes para a atividade física doméstica. Os resultados evidenciaram que a relação da atividade física com a depressão em brasileiros varia conforme o domínio e a duração da atividade física, e que a ideia de que “todo movimento conta” parece adequada apenas para o domínio de tempo livre.

ABSTRACT BACKGROUND: Abnormal uterine bleeding (AUB) is a common condition, and the Menstrual Bleeding Questionnaire (MBQ) is used for its assessment. OBJECTIVES: To translate, assess the cut-off point for diagnosis, and explore psychometric properties of the MBQ for use in Brazilian Portuguese. DESIGN AND SETTING: Prospective cohort study including 200 women (100 with and 100 without AUB) at a tertiary referral center. METHODS: MBQ translation involved a pilot-testing phase, instrument adjustment, data collection, and back-translation. Cut-off point was obtained using receiver operating curve analysis. Menstrual patterns, impact on quality of life due to AUB, internal consistency, test-retest, responsiveness, and discriminant validity were assessed. For construct validity, the Pictorial Blood Assessment Chart (PBAC) and World Health Organization Quality of Life – abbreviated version (WHOQOL-BREF) were applied. RESULTS: Women with AUB were older, had higher body mass indices, and had a worse quality of life during menstruation. Regarding the MBQ's psychometric variables, Cronbach's alpha coefficient was > 0.70 in all analyses, high intraclass correlation coefficient was found in both groups; no ceiling and floor effects were observed, and construct validity was demonstrated (correlation between MBQ score, PBAC score, and clinical menstrual cycle data). No difference between MBQ and PBAC scores were perceived after the test-retest. Significant differences were found between MBQ and PBAC scores before and after treatment. An MBQ score ≥ 24 was associated with a high probability of AUB; accuracy of 98%. CONCLUSION: The MBQ is a reliable questionnaire for Brazilian women. The cut-off ≥ 24 shows high accuracy to discriminate AUB.

Abstract Aim: Polymorphisms in the COMT gene can alter enzymatic functions, raising levels of endogenous catecholamines, which stimulates beta-adrenergic receptors related to pain. This study aimed to evaluate whether a polymorphism in the COMT gene (rs4818) is associated with dental pain in children. Methodology: A cross-sectional study was conducted with a representative sample of 731 pairs of children and parents randomly selected from a population-based sample of eight-year-old children. Reports of dental pain was evaluated using a question directed at the parents and self-reported pain using the Faces Pain Scale – Revised. Dental caries experience was determined using the Decayed, Missing, and Filled Teeth (DMFT) index. For genetic analysis, DNA was obtained from oral mucosa epithelial cells of 352 children randomly selected from the initial sample. Results: Children with the CC genotype had higher odds of reporting moderate to intense pain than those with the GG genotype (OR=3.60; 95% CI=0.80–16.20; p=0.03). These same children had greater odds of parental reports of pain (OR=1.93; 95% CI=0.91-4.08; p=0.02). Moreover, lower schooling of parents/guardians and caries experience in the primary dentition were significantly associated with greater odds of a parental report of dental pain (OR=2.06; 95% CI=1.47–2.91; p<0.001; OR=6.26; 95% CI=4.46–8.78; p<0.001). Conclusions: The rs4818 polymorphism of the COMT gene is associated with dental pain. Children with the C allele are more likely to report higher levels of pain. Clinical Relevance: Even though the experience of pain is subjective and multifactorial, this study raises the hypothesis that there is a genetic predisposition to dental pain that should be considered in clinical practice.

Abstract Objective To analyze the role of formal and informal social support in the practice of physical activity during workers’ leisure time. Methods A cross-sectional study carried out with 395 technical administrative workers at a public university. Data were collected using sociodemographic questionnaire, Baecke Habitual Physical Activity Questionnaire and Physical Activity and Social Support Scale. Data were analyzed using descriptive statistics, Student’s t test, Cohen’s d test and Analysis of Variance. Results Participants who reported some type of support for physical activity in their leisure time (92.2%) had higher means in the physical activity score. Institutional support (58.0%) had a prominent role as a potential influencer compared to support from immediate superiors (14.2%), although they had a certain differential among maintenance workers. Conclusion Social support plays an important role in promoting physical activity in workers’ leisure time. Institutional initiatives to encourage active behavior in the work environment need to be aligned with encouragement by immediate superiors so that they are more effective.

Resumen Objetivo Analizar la función del apoyo social formal e informal en la práctica de actividad física durante el tiempo libre de trabajadores. Métodos Estudio transversal realizado con 395 trabajadores técnicos administrativos de una universidad pública. Los datos se recopilaron utilizando un cuestionario sociodemográfico, el Cuestionario de Actividad Física Habitual de Baecke y la Escala de Apoyo Social para la Práctica de Actividad Física. Los datos se analizaron mediante estadística descriptiva, test-T de Student, prueba d de Cohen y análisis de varianza. Resultados Los participantes que relataron algún tipo de apoyo para actividad física en el tiempo libre (92,2 %) presentaron mayores promedios en el puntaje de actividad física. El apoyo institucional (58,0 %) tuvo una función destacada como posible influenciador en comparación con el apoyo de jefes directos (14,2 %), aunque estos últimos hayan ejercido cierto diferencial entre los trabajadores de mantenimiento. Conclusión El apoyo social tiene una función importante en la promoción de la actividad física en el tiempo libre de trabajadores. Las iniciativas institucionales de estímulo a un comportamiento activo en el ambiente de trabajo necesitan estar alineadas con el incentivo por parte de los superiores inmediatos para que sean más efectivas.

Resumo Objetivo Analisar a função dos apoios sociais formal e informal na prática de atividade física durante o tempo livre de trabalhadores. Métodos Estudo transversal realizado com 395 trabalhadores técnicos administrativos em uma universidade pública. Os dados foram coletados utilizando: questionário sociodemográfico, Questionário de Atividade Física Habitual de Baecke e Escala de Apoio Social para a prática de Atividade Física. Os dados foram analisados por meio de estatística descritiva, teste t de Student, teste d de Cohen e Análise de Variância. Resultados Os participantes que referiram algum tipo de apoio para atividade física no tempo livre (92,2%) apresentaram maiores médias no escore de atividade física. O apoio institucional (58,0%) teve função de destaque como potencial influenciador em comparação ao apoio de chefias imediatas (14,2%), embora elas tenham exercido um certo diferencial entre os trabalhadores da manutenção. Conclusão O apoio social tem função importante na promoção da atividade física no tempo livre de trabalhadores. As iniciativas institucionais de estímulo ao comportamento ativo no ambiente de trabalho carecem de alinhamento com o incentivo por parte dos superiores imediatos, para que sejam mais efetivas.

Abstract Over the last three decades, stroke care has undergone significant transformations mainly driven by the introduction of reperfusion therapy and the organization of systems of care. Patients receiving treatment through a well-structured stroke service have a much higher chance of favorable outcomes, thereby decreasing both disability and mortality. In this article, we reviewed the scientific evidence for stroke reperfusion therapy, including thrombolysis and thrombectomy, and its implementation in the public health system in Brazil.

Resumo Nas últimas três décadas, o tratamento do AVC sofreu transformações significativas, impulsionadas principalmente pela introdução das terapias de reperfusão e pela organização dos serviços de AVC. Os pacientes que recebem tratamento em um serviço de AVC bem estruturado têm uma probabilidade muito maior de resultados favoráveis, diminuindo assim a incapacidade funcional e a mortalidade. Neste artigo, revisamos as evidências científicas para as terapias de reperfusão do AVC, incluindo trombólise e trombectomia e sua implementação no sistema público de saúde no Brasil.

Abstract Background Infantile epileptic spasms syndrome (IESS) is a rare but severe condition affecting children early and is usually secondary to an identifiable brain disorder. It is related to psychomotor deterioration in childhood and epilepsy in adult life. Treatment is challenging as infantile spasms may not respond to most antiseizure medication, and relapse is frequent. Objective To evaluate the literature regarding treatment of IESS and provide a practical guidance to a healthcare system with limited resources. Methods An expert committee from the Brazilian Society of Child Neurology reviewed and discussed relevant scientific evidence in the treatment of IESS regarding the drugs available in Brazil. Results Oral prednisolone and vigabatrin are the most common drugs used as first-line therapy; they are efficient and affordable therapy as both are available in the Brazilian unified health system (SUS, in the Portuguese acronym). Intramuscular adrenocorticotropic hormone (ACTH) presents similar efficacy as oral prednisolone but has a higher cost and is not available in Brazil. Other antiseizure medications such as topiramate, levetiracetam, or benzodiazepines have limited response and are prescribed as adjuvant therapy. If the health service has nutritionists, a ketogenic diet should be implemented for those not responding to hormonal and vigabatrin treatment. Epilepsy surgery is mainly indicated for patients with focal lesions that do not respond to pharmacological therapy. Conclusion Early treatment of IESS with efficient drugs is feasible in our country. Using standard protocols increases the odds of achieving complete cessation in a shorter time and decreases relapse.

Resumo Antecedentes A síndrome do espasmo epiléptico infantil (IESS) é uma condição rara, mas grave, que afeta crianças precocemente e geralmente é secundária a um distúrbio cerebral identificável, estando relacionada a deterioração psicomotora na infância e a epilepsia na vida adulta. O tratamento é desafiador, pois os espasmos infantis podem não responder à maioria dos medicamentos anticrises e as recidivas são frequentes. Objetivo Avaliar a literatura sobre o tratamento de IESS e fornecer uma orientação prática para um sistema de saúde com recursos limitados. Métodos Um comitê de especialistas da Sociedade Brasileira de Neurologia Infantil revisou e discutiu evidências científicas relevantes no tratamento da IESS em relação aos medicamentos disponíveis no Brasil. Resultados Prednisolona oral e vigabatrina são os fármacos mais comumente usados como terapia de primeira linha; são eficientes e acessíveis, já que ambos estão disponíveis no sistema único de saúde brasileiro (SUS). O ACTH intramuscular apresenta eficácia semelhante à prednisolona oral, mas tem custo mais elevado e não está disponível no Brasil. Outros medicamentos anticonvulsivos, como topiramato, levetiracetam ou benzodiazepínicos, têm resposta limitada e são prescritos como terapia adjuvante. Se o serviço de saúde tiver nutricionista, deve-se implementar dieta cetogênica para aqueles que não respondem ao tratamento hormonal e vigabatrina. A cirurgia de epilepsia é indicada principalmente para pacientes com lesões focais que não respondem à terapia farmacológica. Conclusão O tratamento precoce da IESS com fármacos eficazes é factível em nosso meio. O uso de protocolos padronizados aumenta as chances de alcançar a cessação completa em um tempo menor e diminui a recaída.

Abstract Background: Livedoid vasculopathy (LV) manifests as ulcers and atrophic white scars on the lower extremities. The main known etiopathogenesis is hypercoagulability with thrombus formation, followed by inflammation. Thrombophilia, collagen and myeloproliferative diseases may induce LV, but the idiopathic (primary) form predominates. Bartonella spp. may cause intra-endothelial infection and skin manifestations caused by these bacteria may be diverse, including leukocytoclastic vasculitis and ulcers. Objective: The aim of this study was to investigate the presence of bacteremia by Bartonella spp. in patients with difficult-to-control chronic ulcers diagnosed as primary LV. Methods: Questionnaires and molecular tests (conventional PCR, nested PCR and real-time PCR) were applied and liquid and solid cultures were performed in the blood samples and blood clot of 16 LV patients and 32 healthy volunteers. Results: Bartonella henselae DNA was detected in 25% of LV patients and in 12.5% of control subjects but failed to reach statistically significant differences (p = 0.413). Study limitations: Due to the rarity of primary LV, the number of patients studied was small and there was greater exposure of the control group to risk factors for Bartonella spp. infection. Conclusion: Although there was no statistically significant difference between the groups, the DNA of B. henselae was detected in one of every four patients, which reinforces the need to investigate Bartonella spp. in patients with primary LV.

Abstract Background Frontotemporal dementia (FTD) is a frequent cause of young-onset dementia and represents a major challenge for the diagnosis and clinical management. It is essential to evaluate the difficulties faced by physicians on the diagnostic workup and on patient care. Objective The aim of this study was to investigate the current practices and the local limits on the diagnosis and management of FTD in Brazil. Methods We elaborated an online survey, composed of 29 questions and divided in four parts, comprising questions about existing health facilities, clinical practices related to FTD, and suggestions to increment the national research on FTD. The invitation to participate was sent by email to all neurologists affiliated to the Brazilian Academy of Neurology (n = 3658), and to all physicians who attended the XII Meeting of Researchers on Alzheimer's disease, in 2019 (n = 187). The invitation was also diffused through social media. Results 256 Brazilian physicians answered the questionnaire. The three most relevant disorders for the differential diagnosis of FTD were Alzheimer's disease (AD) (n = 211), bipolar disorder (n = 117) and dementia with Lewy bodies (n = 92). Most respondents (125/256) reported the difficulty in performing genetic testing as the main limit in the diagnostic of FTD. 93% and 63% of participants considered that the assessment of social cognition and AD CSF biomarkers are useful for the diagnosis of FTD, respectively. Conclusions The present study may provide valuable insights for the medical education and clinical training of physicians, and to foster future research on FTD in Brazil.

Resumo Antecedentes A demência frontotemporal (DFT) é causa frequente de demência pré-senil e representa um desafio em termos de diagnóstico e de manejo clínico. É essencial avaliar as dificuldades existentes na propedêutica e nos cuidados médicos. Objetivo Investigar as práticas médicas e as dificuldades para diagnóstico e manejo da DFT no Brasil. Métodos Elaborou-se um questionário online, composto de 29 questões, divididas em quatro partes, com perguntas sobre infraestrutura existente, práticas clínicas relacionadas à DFT e sugestões para desenvolver a pesquisa nacional na área. O convite para participação foi enviado por e-mail a todos neurologistas afiliados à Academia Brasileira de Neurologia (n = 3658), e aos médicos que participaram da XII Reunião de Pesquisadores de Doença de Alzheimer, em 2019 (n = 187). O convite também foi divulgado através de mídias sociais. Resultados 256 médicos brasileiros responderam o questionário. Os três principais diagnósticos diferenciais de DFT foram doença de Alzheimer (n = 211), transtorno bipolar (n = 117) e demência com corpos de Lewy (n = 92). A maior parte dos respondedores (125/256) apontou a dificuldade em realizar testagem genética como o maior limite no diagnóstico de DFT. 93% e 63% dos respondedores indicaram que a avaliação de cognição social e o uso de biomarcadores liquóricos de doença de Alzheimer são úteis no diagnóstico de DFT, respectivamente. Conclusões Estes resultados devem ser considerados na educação e treinamento médicos, e no desenvolvimento da pesquisa brasileira em DFT.