ABSTRACT SARS-CoV-2 has a high risk of outbreak in long-term skilled nursing facilities (SNF). Coronavirus disease (COVID-19) has high mortality rates among the elderly with chronic health conditions. Following identification of COVID-19 index case in a SNF, serial point-prevalence was implemented with reverse transcription–polymerase chain reaction (RT-PCR) and immunochromatographic assays. Active surveillance and early isolation of infected patients were implemented. Out of 23 SNF residents and 26 healthcare workers (HCW), 18 (78%) and 12 (46%) tested positive for SARS-CoV-2, respectively. High proportion (38%) of positive patients were asymptomatic and RT-PCR was positive up to six days before symptoms. Five (21.74%) residents were hospitalized with COVID-19, and 2 (9%) died; only 1 (4%) HCW needed to be hospitalized and no staff members died. Active surveillance helped COVID-19 control and management in a SNF. Testing symptomatic individuals only may fail to identify and isolate all persons contributing to transmission. In high-risk elderly, only symptoms screening may not be enough for outbreak control.

RESUMO Objetivo: A asma e a obesidade são doenças prevalentes e inter-relacionadas. Na população pediátrica, o efeito da inflamação sistêmica associada à obesidade, levando à inflamação das vias aéreas, é controverso. Nosso objetivo foi comparar padrões inflamatórios, clínicos e espirométricos entre crianças obesas e aquelas com peso normal. Métodos: Setenta e nove meninos e meninas de 6‒10 anos de idade foram selecionados e divididos em quatro grupos: asmáticos obesos, asmáticos não obesos, não asmáticos obesos e não asmáticos não obesos. Além de dados clínicos e antropométricos, todas as crianças foram submetidas a espirometria e testes cutâneos para alérgenos inalantes. Também foram coletadas amostras de sangue para dosagem de citocinas e adipocinas. Resultados: Obesos asmáticos tiveram um controle significativamente pior da asma do que os não obesos (RP 4,9; IC95% 1,1‒22,1), independentemente do sexo, atividade física e atopia. Não foram observadas diferenças nos níveis de espirometria, citocinas Th1 e Th2 e adipocinas entre os quatro grupos. Os testes cutâneos foram positivos em 81,8 e 80% dos não obesos asmáticos e obesos asmáticos, respectivamente. Conclusões: O grau de controle da asma foi significativamente menor no grupo obeso, apesar de não ter havido diferenças nos achados espirométricos. Esse resultado sugere que fatores extrapulmonares podem ser responsáveis por esse perfil sintomático. A alta positividade do teste cutâneo nos dois grupos, considerado um bom marcador de atopia, demonstrou o componente atópico como preponderante na gênese da asma, tanto em crianças com obesidade quanto naquelas com peso normal.

ABSTRACT Objective: Asthma and obesity are prevalent and interrelated diseases. In the pediatric population, the effect of systemic inflammation associated to obesity, leading to inflammation of the airways, is currently controversial. Our aim was to compare inflammatory, clinical and spirometric patterns between children with asthma and obesity and those within the normal weight status range. Methods: A total of 79 boys and girls from 6 to 10 years old were selected and divided into four groups: obese asthmatics, non-obese asthmatics, obese non-asthmatics, and non-obese non-asthmatics. In addition to collecting clinical and anthropometric data, all children underwent spirometry and skin prick tests for inhalant allergens. Blood samples for measurement of cytokines and adipokines were also collected. Results: Obese asthmatics had significantly worse control of asthma than non-obese asthmatics (OR 4.9; 95%CI 1.1‒22.1), regardless of sex, physical activity and atopy. No differences in spirometry, Th1 and Th2 cytokines and adipokines levels were observed among the four groups. The prick tests were positive in 81.8 and 80% of non-obese asthmatics and obese asthmatics, respectively. Conclusions: The degree of control of asthma was significantly lower in the obese group, regardless of the findings of no differences in spirometry. Extra-pulmonary factors could be responsible for this symptomatic profile. High positivity of skin test in both groups, which is considered a good marker of atopy, shows a preponderant atopic component in the genesis of asthma, both in children with obesity and in those within the normal weight status.

Resumo A fístula aortoentérica é uma grave condição clínica, e seu manejo permanece sendo um grande desafio técnico aos cirurgiões. A abordagem por cirurgia convencional nesses casos está relacionada a altos índices de morbimortalidade. A cirurgia endovascular apresenta-se como uma ótima alternativa nesses casos; contudo, por não se tratar de aorta nativa, a anatomia pode não ser compatível com os dispositivos endovasculares comercialmente disponíveis, fazendo-se necessário, em casos de urgência, a utilização de dispositivos modificados pelo cirurgião. O caso relatado reporta uma fístula aortoentérica secundária, tratada em situação de urgência por técnica endovascular com dispositivo modificado.

Abstract Aortoenteric fistula is a severe clinical condition and its management remains a major technical challenge for surgeons. In these cases, the conventional surgical approach is associated with high rates of morbidity and mortality. Endovascular surgery is an excellent option in these cases, but considering that the aorta has been treated previously, anatomy may not be compatible with commercially available endovascular devices and so physician-modified endografts may be needed in urgent cases. The case reported involves a secondary aortoenteric fistula, treated on an emergency basis with endovascular techniques, using a physician-modified endograft.

Resumo A veia jugular interna direita é considerada a melhor via para um acesso vascular, devido a baixas taxas de complicação e ao fornecimento de fluxo satisfatório durante a hemodiálise dado seu trajeto mais retilíneo para o átrio direito. O presente estudo relata a identificação, prévia à punção, de uma variação anatômica da posição da veia jugular interna em relação à artéria carótida comum. Destaca-se o benefício dessa identificação prévia, enfatizando-se a importância de se realizar a ultrassonografia vascular com Doppler em detrimento de utilizar somente reparos anatômicos externos para a punção da veia jugular interna.

Abstract The right internal jugular vein is considered the best route for vascular access, because of low complication rates and satisfactory flow during hemodialysis, due to its straight route to the right atrium. This paper reports the identification, prior to puncture, of an anatomic variant position of the internal jugular vein in relation to the common carotid artery. The benefit of this prior identification is highlighted, emphasizing the importance of performing vascular Doppler ultrasound rather than using only external anatomical observation for puncture of the internal jugular vein.

RESUMO Objetivo: Pulmonary Embolism Severity Index (PESI) foi desenvolvido para a estratificação de risco após tromboembolia pulmonar (TEP) aguda. Nosso objetivo foi validá-lo para uso no Brasil. Métodos: Estudo retrospectivo unicêntrico incluindo pacientes com TEP admitidos numa unidade de emergência. O PESI (versão original e simplificada) foi calculado utilizando-se dados dos prontuários na admissão hospitalar. O desfecho analisado foi mortalidade geral em 30 dias (MG30). Resultados: Foram incluídos 123 pacientes, com média de idade de 57 ± 17 anos, predomínio do sexo feminino (60%) e MG30 de 28 óbitos (23%). Na análise agrupada, a MG30 (classes I-II vs. III-IV-V) foi de 2,40% vs. 20,00% (risco relativo [RR] = 5,9; IC95%: 1,88-18,51; p = 0,0002). A MG30 na versão simplificada (0 vs. ≥ 1 ponto) foi de 3,25% vs. 19,51% (RR = 2,38; IC95%: 0,89-6,38; p = 0,06). A análise da sobrevida mostrou que as curvas de Kaplan-Meier foram semelhantes nas classes I e II (p = 0,59) e entre as classes III, IV e V (p = 0,25). A curva da versão original agrupada mostrou que a MG30 foi significativamente maior no grupo III-IV-V que no grupo I-II (RR = 7,63; IC95%: 2,29-25,21; p = 0,0001). A análise agrupada da versão original mostrou área sob a curva ROC maior que a da versão simplificada (0,70; IC95%: 0,62-0,77 vs. 0,60; IC95%: 0,51-0,67; p = 0,05). Conclusões: O PESI mensurou adequadamente o prognóstico de MG30 após TEP aguda nesta amostra da população brasileira. A utilização da versão original agrupada foi a mais adequada nesse cenário.

ABSTRACT Objective: To validate the Pulmonary Embolism Severity Index (PESI), which was developed for risk stratification after acute pulmonary embolism (PE), for use in Brazil. Methods: This was a single-center retrospective study involving patients admitted to the emergency department with acute PE. The original and simplified versions of the PESI were calculated using hospital admission data from medical records. The outcome measure was the overall 30-day mortality rate. Results: We included 123 patients. The mean age was 57 ± 17 years, and there was a predominance of females, who accounted for 60% of the cohort. There were 28 deaths, translating to an overall 30-day mortality rate of 23%. In the cluster analysis by risk class, overall 30-day mortality was 2.40% for classes I-II, compared with 20.00% for classes III-IV-V (relative risk [RR] = 5.9; 95% CI: 1.88-18.51; p = 0.0002). When we calculated overall 30-day mortality using the simplified version (0 points vs. ≥ 1 point), we found it to be 3.25% for 0 points and 19.51% for ≥ 1 point (RR = 2.38; 95% CI: 0.89-6.38; p = 0.06). Using the original version, a survival analysis showed that risk classes I and II presented similar Kaplan-Meier curves (p = 0.59), as did risk classes III, IV, and V (p = 0.25). However, the curve of the clusters based on the original version, showed significantly higher mortality in the III-IV-V classes than in the I-II classes (RR = 7.63; 95% CI: 2.29-25.21; p = 0.0001). The cluster analysis based on the original version showed a greater area under the ROC curve than did the analysis based on the simplified version (0.70; 95% CI: 0.62-0.77 vs. 0.60; 95% CI: 0.51-0.67; p = 0.05). Conclusions: The PESI adequately predicted the prognosis after acute PE in this sample of the population of Brazil. The cluster analysis based on the original version is the most appropriate analysis in this setting.

RESUMO As questões objetivas ou testes de múltipla escolha com somente uma alternativa correta constituem um dos métodos mais utilizados em todo o mundo em exames destinados a avaliar habilidades cognitivas, especialmente nas avaliações somativas. Provas que contêm predominantemente questões objetivas de múltipla escolha são utilizadas sobretudo nos exames em que muita coisa está em jogo, como concursos vestibulares, provas finais de cursos de graduação e exames próprios dos concursos de ingresso à residência médica ou de obtenção de título de especialista. Esta ampla difusão justifica-se pelo fato de os exames compostos com este tipo de questão preencherem mais completamente os requisitos de validade e de fidedignidade, além de terem vantagens quanto à viabilidade ou factibilidade, particularmente em provas com grande número de candidatos. No entanto, os requisitos de validade e fidedignidade, em especial, somente são preenchidos adequadamente quando se seguem normas próprias das boas práticas de construção de exames e de elaboração dos testes propriamente ditos. Neste artigo se descrevem algumas das boas práticas na elaboração de testes de múltipla escolha, baseadas em fontes da literatura nacional e internacional, bem como na experiência dos autores. Apresenta-se e se discute um conjunto de regras práticas para construir questões de múltipla escolha de boa qualidade no que se refere à forma e ao conteúdo e se comenta como compor tabelas de especificação. Este tipo particular de matriz da avaliação permite verificar o alinhamento entre os temas abordados na prova e os objetivos curriculares ou o que se espera que os estudantes/candidatos dominem, o que configura um importante indicador de validade. Apresenta-se também uma experiência bem-sucedida de trabalho em grupo na organização de exames que utilizam este tipo de questão, como exemplo de desenvolvimento de processo organizado para obtenção de questões de melhor qualidade, que também contribuiu para o desenvolvimento docente no campo de avaliação da aprendizagem.

ABSTRACT Objective items or multiple choice questions with just one correct answer are among the most widely used methods for cognitive skills assessment, especially in exams designed for summative purposes. Assessments related to the cognitive domain using multiple choice questions are mostly used in high-stake exams, i.e. where the risks of failing are associated with serious consequences for the candidates. The widespread use of objective items for assessing learning in the cognitive domain may be explained by the fact that this exam modality fulfills both validity and reliability requirements, with the additional advantage that they are practical for use in exams with large numbers of candidates. Nevertheless, the validity and reliability requirements, in particular, will only be properly fulfilled when the process of writing multiple choice questions follows the rules of good practices for constructing exams and writing tests. This manuscript describes some of the rules for developing high quality multiple choice tests, based on both national and international published sources, as well as on the author’s experience. These rules relate to the content, language and presentation of the questions. This paper also addresses the importance of following appropriate rules for blueprinting construction, in order to show the alignment between assessment and curriculum and thereby contribute to meeting the validity requirements. It also briefly describes and discusses a successful experience of team work for constructing items and organizing exams. This experience exemplifies the combination of an organized process for constructing high quality questions for a well-balanced examination with an institutional strategy for faculty development in the field of learning assessment.

Abstract Purpose: To evaluate the vascular ventilatory response in different stages of lung development and to compare them to the neonates with congenital diaphragmatic hernia (CDH) in a rabbit model. Methods: New Zealand rabbits were divided into 8 groups (n=5): E25, E27, E30, and CDH. All groups were ventilated on a FlexiVent (Scireq, Montreal, QC, Canada), compounding the other 4 groups. The CDH surgery was performed at E25 and the harvest at E30. Dynamic compliance (CRS), dynamic elastance (ERS) and dynamic resistance (RRS) were measured every 4 min/24 min. Median wall thickness (MWT) and airspace were measured. ANOVA Bonferroni tests were used to perform statistical analysis. Significance was considered when p<0.05. Results: CRS was higher in E30 compared to all other groups (p<0.05). CRS and RRS of CDH and E27 were similar and were higher in E25 (p<0.05). MWT was decreased according to the gestational age, was increased in E27V and E30V (p<0.05) and decreased in CDHV (p<0.05), airspace was decreased in E25 and increased in all ventilated groups (p<0.05). Conclusions: The ventilation response of congenital diaphragmatic hernia is like the pseudoglandular stage of the lung development. These findings add information about the physiology of pulmonary ventilation in CDH.

Este artigo descreve a experiência do projeto Pró-Ensino na Saúde (Capes-Edital 024/2010) da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Entre 2011 e 2016 o projeto formou quatro mestres e cinco doutores, além de criar disciplinas abordando tópicos de ensino-aprendizagem na saúde. Nesse período, consolidou-se grupo de pesquisa em educação na saúde, que vem desenvolvendo projetos específicos e publicando artigos inéditos e revisões sobre temas relevantes à docência na saúde. Todos os objetivos do edital Capes foram alcançados, apesar das dificuldades enfrentadas, como a pouca flexibilidade da pós-graduação na universidade, o que restringiu a admissão de pós-graduandos e o credenciamento de novos orientadores. Mesmo após o término do projeto, manteve-se o grupo de ensino e pesquisa, que continua contribuindo para a valorização da formação docente na pós-graduação e da pesquisa na área de ensino na saúde.

This article describes the experience of the Capes Pro-Ensino na Saude project (Capes notice 024/2010) at the School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil. Between 2011 and 2016 the project provided the degrees of four masters and five doctors, in addition to creating subjects approaching topics on teaching-learning in health. In this period, there was the consolidation of the research group in health education, which has been developing specific projects and publishing original articles and reviews on subjects relevant to teaching in health. All objectives of the Capes notice were met, despite the difficulties faced such as little flexibility on the part of the graduate program in the university, which restricted the admission of graduate students and the accreditation of new advisors. The teaching and research group was kept even after the end of the project, and it still contributes to adding value to the teacher education in graduate studies and research in the health education area.

Este artículo describe la experiencia del proyecto Capes Pró-Ensino na Saúde (Capes-Pliego de Condiciones 024/2010) de la Facultad de Medicina de Ribeirão Preto, Universidad de São Paulo. Entre 2011 y 2016 se graduaron en el proyecto cuatro alumnos de maestría y dos de doctorado, además de crear asignaturas abordando tópicos de enseñanza-aprendizaje en salud. En ese período se consolidó el grupo de investigación en educación en salud que ha desarrollado proyectos específicos y publicado artículos inéditos y revisiones sobre temas relevantes a la docencia en salud. Todoslos objetivos del edicto Capes se alcanzaron, a pesar de las dificultades enfrentadas, tales como la poca flexibilidad del postgrado en la universidad, lo que restringió la admisión de alumnos de postgrado y la acreditación de nuevos orientadores. Aún después del final del proyecto, se mantuvo el grupo de enseñanza e investigación que continúa contribuyendo con la valorización de la formación docente en el postgrado y de la investigación en el área de enseñanza en salud.

Este artigo descreve a experiência do projeto Pró-Ensino na Saúde (Capes-Edital 024/2010) da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo. Entre 2011 e 2016 o projeto formou quatro mestres e cinco doutores, além de criar disciplinas abordando tópicos de ensino-aprendizagem na saúde. Nesse período, consolidou-se grupo de pesquisa em educação na saúde, que vem desenvolvendo projetos específicos e publicando artigos inéditos e revisões sobre temas relevantes à docência na saúde. Todos os objetivos do edital Capes foram alcançados, apesar das dificuldades enfrentadas, como a pouca flexibilidade da pós-graduação na universidade, o que restringiu a admissão de pós-graduandos e o credenciamento de novos orientadores. Mesmo após o término do projeto, manteve-se o grupo de ensino e pesquisa, que continua contribuindo para a valorização da formação docente na pós-graduação e da pesquisa na área de ensino na saúde.

This article describes the experience of the Capes Pro-Ensino na Saude project (Capes notice 024/2010) at the School of Medicine, University of Sao Paulo, Ribeirao Preto, Brazil. Between 2011 and 2016 the project provided the degrees of four masters and five doctors, in addition to creating subjects approaching topics on teaching-learning in health. In this period, there was the consolidation of the research group in health education, which has been developing specific projects and publishing original articles and reviews on subjects relevant to teaching in health. All objectives of the Capes notice were met, despite the difficulties faced such as little flexibility on the part of the graduate program in the university, which restricted the admission of graduate students and the accreditation of new advisors. The teaching and research group was kept even after the end of the project, and it still contributes to adding value to the teacher education in graduate studies and research in the health education area.

Este artículo describe la experiencia del proyecto Capes Pró-Ensino na Saúde (Capes-Pliego de Condiciones 024/2010) de la Facultad de Medicina de Ribeirão Preto, Universidad de São Paulo. Entre 2011 y 2016 se graduaron en el proyecto cuatro alumnos de maestría y dos de doctorado, además de crear asignaturas abordando tópicos de enseñanza-aprendizaje en salud. En ese período se consolidó el grupo de investigación en educación en salud que ha desarrollado proyectos específicos y publicado artículos inéditos y revisiones sobre temas relevantes a la docencia en salud. Todoslos objetivos del edicto Capes se alcanzaron, a pesar de las dificultades enfrentadas, tales como la poca flexibilidad del postgrado en la universidad, lo que restringió la admisión de alumnos de postgrado y la acreditación de nuevos orientadores. Aún después del final del proyecto, se mantuvo el grupo de enseñanza e investigación que continúa contribuyendo con la valorización de la formación docente en el postgrado y de la investigación en el área de enseñanza en salud.

Resumo O aneurisma arterial induzido por uso de muleta é um evento raro, e a associação com aneurismas venosos não está descrita na literatura. Relatamos o caso de uma paciente que, após o uso prolongado dessa órtese, apresentou quadro de isquemia aguda de membro superior secundária à trombose de um aneurisma da artéria braquial, associado ao achado incidental de aneurismas da veia braquial. Embora a principal causa de oclusão arterial aguda de membro superior seja a embolização de fonte cardíaca, deve-se considerar a possibilidade de embolização arterioarterial por aneurismas provocados pelo uso prolongado de muletas. Os aneurismas venosos também devem ser suspeitados, uma vez que podem ser sede de trombos e fonte de êmbolos pulmonares.

Abstract Crutch-induced arterial aneurysm is a rare event and there are no descriptions in the literature of cases with concomitant venous aneurysms. We report the case of a patient who, after prolonged crutch use, presented with acute ischemia of the upper limb secondary to brachial artery aneurysm thrombosis, associated with the incidental finding of brachial vein aneurysms. Although the main cause of acute upper limb occlusion is embolization of cardiac origin, consideration should be given to the possibility of arterio-arterial embolization due to an aneurysm induced by prolonged use of crutches. Venous aneurysms should also be suspected since they can be sites of thrombosis, and a source of pulmonary embolism.

ABSTRACT Objective Leptin has been suggested as a potential biomarker of cardiovascular risk. This paper aims to ascertain, based on a sample of prepubertal children, which serum leptin value best suited to identify metabolic syndrome (MS). Subjects and methods This observational, cross-sectional study recruited children from the outpatient pediatrics clinic, with the purpose of validating serum leptin level cutoffs to identify MS. All obese and overweight children who met eligibility criteria were included in the study, as was a sample of normal-weight children. The sample underwent clinical assessment and blood fasting glucose, lipid profile, insulin, and leptin were measured. Sensitivity and specificity were estimated for each leptin measurement, using MS as the outcome. These values were used to construct a receiver operating characteristic (ROC) curve. The association between MS and leptin was assessed using logistic models to predict MS. Results A total of 65 normal weight, 46 overweight, and 164 obese children were analyzed (160 boys, 115 girls; age: 93.7 ± 17.8 months). The most appropriate leptin cutoff was 13.4 ng/mL (sensitivity 67.6%; specificity 68.9%; accuracy 72.1%). The logistic model indicated that leptin levels above 13.4 ng/dL were significantly associated with MS and that, for every 1 ng/dL increase in leptin levels, the odds of MS increase by 3% (p = 0.002; OR 1.03; 95% CI 1.01-1.05). Conclusions Leptin may be a useful biomarker of cardiovascular risk in prepubertal children, with an optimal cutoff of 13.4 ng/mL. Identification of potential new risk markers for cardiovascular disease in children could contribute to the development of preventive strategies.

Dengue is the most important arboviral disease in the world. As chloroquine, an antimalarial agent, has shown some antiviral effects, this study evaluated its effect in patients with dengue. A randomised, double-blind study was performed by administering chloroquine or placebo for three days to 129 patients with dengue-related symptoms. Of these patients, 37 were confirmed as having dengue and completed the study; in total, 19 dengue patients received chloroquine and 18 received placebo. There was no significant difference in the duration of the disease or the degree and days of fever. However, 12 patients (63%) with confirmed dengue reported a substantial decrease in pain intensity and a great improvement in their ability to perform daily activities (p = 0.0004) while on the medication and the symptoms returned immediately after these patients stopped taking the medication. The same effect was not observed in patients with diseases other than dengue. Therefore, this study shows that patients with dengue treated with chloroquine had an improvement in their quality of life and were able to resume their daily activities. However, as chloroquine did not alter the duration of the disease or the intensity and days of fever, further studies are necessary to confirm the clinical effects and to assess the side effects of chloroquine in dengue patients.

OBJECTIVE: Subjects exposed to laboratory animals are at a heightened risk of developing respiratory and allergic diseases. These diseases can be prevented by simple measures such as the use of personal protective equipment. We report here the primary findings of the Laboratory Animals and Respiratory Allergies Study regarding the prevalence of allergic diseases among laboratory animal workers, the routine use of preventive measures in laboratories and animal facilities, and the need for prevention programs. METHODS: Animal handlers and non-animal handlers from 2 Brazilian universities (University of São Paulo and State University of Campinas) answered specific questionnaires to assess work conditions and symptoms. These subjects also underwent spirometry, a bronchial challenge test with mannitol, and skin prick tests for 11 common allergens and 5 occupational allergens (rat, mouse, guinea pig, hamster, and rabbit). RESULTS: Four hundred fifty-five animal handlers (32±10 years old [mean±SD], 209 men) and 387 non-animal handlers (33±11 years old, 121 men) were evaluated. Sensitization to occupational allergens was higher among animal handlers (16%) than non-animal handlers (3%, p<0.01). Accessibility to personal protective equipment was measured at 85% (median, considering 73 workplaces of the animal handler group). Nineteen percent of the animal handlers indicated that they wear a respirator at all times while handling animals or working in the animal room, and only 25% of the animal handlers had received an orientation about animal-induced allergies, asthma, or rhinitis. CONCLUSION: In conclusion, our data indicate that preventive programs are necessary. We suggest providing individual advice to workers associated with institutional programs to promote a safer work environment.

O herpes zoster pode resultar em neuralgia pós-herpética, que é definida como dor prolongada predominantemente mediada por hiperatividade do sistema nervoso central. Esse fenômeno pode ser revertido pelo uso da (S)-cetamina, mas seu uso pode resultar em efeitos adversos intoleráveis, enquanto seu uso tópico parece ser seguro. Este é um estudo "cross-over" com 12 pacientes distribuídos aleatoriamente em dois grupos. Observou-se efeito importante do tempo sobre a intensidade da dor, mas não houve diferenças estatísticas do uso da SKET, ou do placebo, no escore da dor, neste esquema de tratamento. Discretas reações cutâneas foram observadas com o uso de SKET tópico.

Herpes zoster infection may cause postherpetic neuralgia, which is defined by prolonged pain predominantly mediated by central nervous system hypersensitivity. This phenomenon may be reversed by (S)-ketamine (SKET), but its use results in intolerable side effects, while its topical administration seems to be safe. It is a cross-over design study with 12 patients randomly divided into two groups. There was a significant effect of time on pain intensity, but no statistical difference in pain scores for SKET or placebo use in this sample in this treatment regimen. Only few mild cutaneous reactions were observed with topical SKET use.