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Aim. To highlight the relevance of gastrointestinal manifestations of cytomegalovirus infection (CMVI), to highlight the main risk factors for the development of this pathology, current trends in diagnosis and treatment. Key points. CMVI is one of the most common opportunistic diseases, characterized by a variety of manifestations from asymptomatic to severe generalized forms affecting internal organs and body systems. The prevalence of CMVI worldwide ranges from 20 to 95%. Particular attention is paid to timely diagnosis, treatment and prevention of CMVI. The “gold standard” in the diagnosis of digestive diseases associated with CMVI is immunohistochemical examination and detection of cytomegalovirus (CMV) DNA in tissues using the polymerase chain reaction (PCR). Of undoubted interest in the diagnosis of CMV is the detection of CMV DNA in stool using digital PCR. Compared to quantitative PCR, digital PCR has higher accuracy and sensitivity. As first-line therapy, the drugs of choice are ganciclovir and valganciclovir. Maribavir has been successfully used to treat patients with CMV infection refractory to one or more previous therapies. One of the promising directions in the treatment of cytomegalovirus colitis in patients with ulcerative colitis is fecal microbiota transplantation. Conclusion. Timely identification of risk factors for the development of CMV infection, the introduction of innovative methods and approaches in diagnosis, and the use of effective methods for treating diseases of the digestive system associated with CMV infection can improve the prognosis of the underlying disease and reduce the risk of developing urgent conditions in gastroenterology.

Copyright of Forensische Psychiatrie, Psychologie, Kriminologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: This study aimed to explore the spectrum of causes and clinical aspects of headaches in primary healthcare clinics. Methods: A cross-sectional study was conducted in the outpatient clinics of two general hospitals. The convenience sampling technique was used to conduct the study from March 2022 to December 2023. Consultants at the outpatient clinics in the two hospitals examined all subjects. Results: Out of a total of 2,501 outpatient visits, 308 (12.3%) had headaches. Headache was common among those aged 20 years or over (65%). Almost half of the headache cases (46%) were due to disorders in the cranium, face, or neck. Headaches attributed to disorder of homeostasis (12%), and headache due to infection (10%), were second in frequency. Tension-type headache (TTH) accounted for 8.1%, while migraine headache was found in 5% of the cases. Pain in the head was the most common presenting symptom (58%), followed by fever, sore throat, and cough. Headache was similar in males and females. A large proportion of patients with headaches (44%) needed investigations to conclude the diagnosis. The majority of patients with fever were prescribed antimicrobial treatment, acetaminophen, or non-steroidal anti-inflammatory drugs. Only 6.6% needed admission to the hospital for further care or referral to a higher level (1.3%). Counseling about the disease was almost neglected (0.3%). Conclusion: Headache was a common presenting symptom among outpatient visits. TTH and migraine were the most common causes of headache. Primary healthcare physicians should pay more effort to educate the people about prevention and control of headaches. [ABSTRACT FROM AUTHOR]

ABSTRACT: Bovine enzootic hematuria (BEH) is a clinical form of poisoning in cattle caused by the consumption of Pteridium spp. (bracken fern), which has no treatment. However, selenium (Se) and vitamin E supplementation are feasible. The aim of this study was to evaluate the effects of supplementation with increasing doses of selenium associated with vitamin E in cattle with BEH, compare the levels of Se in whole blood and blood serum, and evaluate the activity of glutathione peroxidase, total antioxidants, and the relative activity of the enzyme monoamine oxidase (MAO). Four groups of cattle with BEH were supplemented parenterally for 13 weeks with increasing doses of Se: Control group, Treatment group 1 (0.05mg/kg), Treatment group 2 (0.1mg/kg), and Treatment group 3 (0.2mg/kg). All groups received 500mg of vitamin E in combination with the Se supplementation. The measured variables included weight, hematuria intensity, hematocrit, total plasma protein, plasma fibrinogen, blood glutathione peroxidase activity, and total antioxidant levels. The blood concentrations of Se and relative MAO activity were evaluated every two weeks. Kruskal-Wallis and Friedman tests (P0.05) between the treatments, but there was a significant difference over time (P0.05). For glutathione peroxidase, there was no significant difference (P>0.05) among the treatments, but there was a significant difference (P0.05). Selenium levels were higher in Treatment group 1, reaching the highest concentration (235.3µg/L) in the blood serum at eight weeks. Therefore, supplementation with Se at a dose of 0.05mg/kg associated with vitamin E improved the clinical condition of hematuria but did not interfere with glutathione peroxidase activity or with levels of total antioxidants. MAO activity was reduced by vitamin E supplementation. These results indicate that the serum is the best site for measuring Se levels.

Aim of the study The objective of this study is represented by the identification of the clinical aspects of the oral mucosa in patients with bruxism occurring during sleep. Material and methods. The study group was represented by a number of 70 patients, women and men. The oral examinations were performed on a number of 51 patients who self-reported bruxism during sleep at the Oral Rehabilitation Clinic of the Faculty of Dentistry, “Ovidius” University in Constanța between January 2018 and January 2019. The collected data have were analyzed using the MICROSOFT-EXCEL program. Results. A number of 127 modifications in the oral mucosa were analyzed. The most frequent modifications were in the following regions: jugal mucosa (24%), inferior buccal alveolar mucosa (17%), superior buccal alveolar mucosa (10%), the dorsal surface of the tongue (10%). The presence of linea alba was observed in 51% of patients. The presence of geographic tongue (11.8%) and the presence of dental impressions (10.7%) was also observed. Conclusions. Oral mucosal modifications in patients with self-reported sleep bruxism are frequently found at the level of the jugal mucosa, inferior alveolar vestibular mucosa, superior alveolar vestibular mucosa and the dorsal surface of the tongue. Some of these modifications are manifestations in the context of bruxism, others have not been associated with bruxism until now.

Introduction: Vitiligo is a chronic skin condition caused by progressive cutaneous hypomelanosis. Aim: The aim of the study was to determine its epidemiology and clinical aspects. As considerable progress has been made in understanding of the pathogenesis of vitiligo and its classification as an autoimmune disease, the paper pays particular attention to coexisting autoimmune or atopic diseases. Material and methods: The study included 55 patients attending the Diagnostic and Treatment Center of Skin Diseases in Lodz. Data were collected during outpatient dermatological consultation. Results: The most common type of vitiligo was nonsegmental (85.5%) followed by segmental (12.7%) and unclassified (2.1%). The first skin lesions were mostly located on the hands (45.5%) and face (38.2%). Older patients with higher body mass index tended to demonstrate a higher body surface area. Of the patients, 63.6% demonstrated an autoimmune or atopic comorbidity, the most common of which were type 1 diabetes mellitus (18.2%), psoriasis (16.4%) or Hashimoto's thyroiditis (14.5%). Location on the face was associated with a significantly greater incidence of autoimmune or atopic co-morbidities. Conclusions: A facial location may serve as a predictive factor for other autoimmune or atopic diseases in vitiligo patients. Determining clinical factors in vitiligo patients which could be associated with a higher risk of autoimmune comorbidities may allow for their early diagnosis and suitable treatment. [ABSTRACT FROM AUTHOR]

Most human cystic echinococcosis (CE) cases worldwide are attributed to Echinococcus granulosus sensu stricto (s.s), followed by the G6 and G7 genotypes. While E. granulosus s.s. has a cosmopolitan distribution, the G6 genotype is restricted to areas where camels and goats are present. Goats are the primary livestock in the Neuquén province in Argentina where the G6 genotype has been reported to be responsible for a significant percentage of CE human cysts genotyped. In the present study, we genotyped 124 Echinococcus cysts infecting 90 CE-confirmed patients. Echinococcus granulosus s.s. was identified in 51 patients (56.7%) with 81 cysts and the G6 genotype in 39 patients (43.3%) harbouring 43 cysts. Most CE cases ≤18 years were male suggesting pastoral work could be a risk factor for the infection. Echinococcus granulosus s.s. was significantly found more frequently in the liver (32/51 patients) and the G6 genotype in the lungs and extrahepatic localizations (27/39). The patients infected with E. granulosus s.s., presented up to 6 cysts while patients infected with G6 presented a maximum of 2. The diameter of lung cysts attributed to E. granulosus s.s. was significantly larger compared to lung cysts from G6. Following the WHO ultrasound classification of liver cysts, we observed inactive cysts in 55.6% of G6 cysts and only 15.3% of E. granulosus s.s cysts. In conclusion, we provide evidence of differences in clinical aspects of CE caused by E. granulosus s.s. and the G6 genotype of E. granulosus s.l. complex infecting humans.

This article, published in the Romanian Journal of Oral Rehabilitation, examines the oral mucosa in patients with sleep-occurring bruxism. The study involved 70 patients, with oral examinations conducted on 51 patients who reported bruxism during sleep. The findings revealed that the most common changes in the oral mucosa were observed in the jugal mucosa, inferior buccal alveolar mucosa, superior buccal alveolar mucosa, and the dorsal surface of the tongue. Some of these changes are associated with bruxism, while others have not been previously linked to the condition. Further research is necessary to fully understand all oral mucosal modifications in the context of bruxism. The article also mentions other studies on different oral conditions, such as mucocoele of the lower lip and geographic tongue. [Extracted from the article]

Nasopalatine duct cyst (NPCD) is a pathology of the oral cavity, non-odontogenic and of low incidence. routine. Radiographically, a circumscribed radiolucent lesion located between the roots of the upper central incisors is observed, forming a classic image of the heart. Enucleation and curettage is the most appropriate treatment with low recurrence rates. The L-PRF membrane consists of a fibrin rich in platelets and leukocytes, and it is an autologous material obtained with a concentration of leukocytes and platelets from the controlled centrifugation of blood plasma. The objective of this article is to carry out a literature review, addressing evidence regarding the treatment of CDNP associated with L-PRF. A bibliographic survey was carried out in the "PubMED/Medline", "SCIELO" and "Google Academic" databases, including articles in full format that evaluated the clinical repercussions of CDNP, resulting in a total of 30 articles after the inclusion and exclusion criteria. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) is classified into five stages with kidney failure being the most severe stage (stage G5). CKD conveys a high risk for coronary artery disease, heart failure, arrhythmias, and sudden cardiac death. Cardiovascular complications are the most common causes of death in patients with kidney failure (stage G5) who are maintained on regular dialysis treatment. Because of the high death rate attributable to cardiovascular (CV) disease, most patients with progressive CKD die before reaching kidney failure. Classical risk factors implicated in CV disease are involved in the early stages of CKD. In intermediate and late stages, non-traditional risk factors, including iso-osmotic and non-osmotic sodium retention, volume expansion, anaemia, inflammation, malnutrition, sympathetic overactivity, mineral bone disorders, accumulation of a class of endogenous compounds called 'uremic toxins', and a variety of hormonal disorders are the main factors that accelerate the progression of CV disease in these patients. Arterial disease in CKD patients is characterized by an almost unique propensity to calcification and vascular stiffness. Left ventricular hypertrophy, a major risk factor for heart failure, occurs early in CKD and reaches a prevalence of 70–80% in patients with kidney failure. Recent clinical trials have shown the potential benefits of hypoxia-inducible factor prolyl hydroxylase inhibitors, especially as an oral agent in CKD patients. Likewise, the value of proactively administered intravenous iron for safely treating anaemia in dialysis patients has been shown. Sodium/glucose cotransporter-2 inhibitors are now fully emerged as a class of drugs that substantially reduces the risk for CV complications in patients who are already being treated with adequate doses of inhibitors of the renin-angiotensin system. Concerted efforts are being made by major scientific societies to advance basic and clinical research on CV disease in patients with CKD, a research area that remains insufficiently explored. [ABSTRACT FROM AUTHOR]

Abstract Background For interpretation of pulmonary function tests (PFTs), reference values based on sex, age, height and ethnicity are needed. In Norway, the European Coal and Steel Community (ECSC) reference values remain widely used, in spite of recommendations to implement the more recent Global Lung Function Initiative (GLI) reference values. Objective To assess the effects of changing from ECSC to GLI reference values for spirometry, DLCO and static lung volumes, using a clinical cohort of adults with a broad range in age and lung function. Methods PFTs from 577 adults (18–85 years, 45% females) included in recent clinical studies were used to compare ECSC and GLI reference values for FVC, FEV1, DLCO, TLC and RV. Percent predicted and lower limit of normal (LLN) were calculated. Bland-Altman plots were used to assess agreement between GLI and ECSC % predicted values. Results In both sexes, GLI % predicted values were lower for FVC and FEV1, and higher for DLCO and RV, compared to ECSC. The disagreement was most pronounced in females, with mean (SD) difference 15 (5) percent points (pp) for DLCO and 17 (9) pp for RV (p

Most human cystic echinococcosis (CE) cases worldwide are attributed to Echinococcus granulosus sensu stricto (s.s), followed by the G6 and G7 genotypes. While E. granulosus s.s. has a cosmopolitan distribution, the G6 genotype is restricted to areas where camels and goats are present. Goats are the primary livestock in the Neuquén province in Argentina where the G6 genotype has been reported to be responsible for a significant percentage of CE human cysts genotyped. In the present study, we genotyped 124 Echinococcus cysts infecting 90 CE-confirmed patients. Echinococcus granulosus s.s. was identified in 51 patients (56.7%) with 81 cysts and the G6 genotype in 39 patients (43.3%) harbouring 43 cysts. Most CE cases ≤18 years were male suggesting pastoral work could be a risk factor for the infection. Echinococcus granulosus s.s. was significantly found more frequently in the liver (32/51 patients) and the G6 genotype in the lungs and extrahepatic localizations (27/39). The patients infected with E. granulosus s.s., presented up to 6 cysts while patients infected with G6 presented a maximum of 2. The diameter of lung cysts attributed to E. granulosus s.s. was significantly larger compared to lung cysts from G6. Following the WHO ultrasound classification of liver cysts, we observed inactive cysts in 55.6% of G6 cysts and only 15.3% of E. granulosus s.s cysts. In conclusion, we provide evidence of differences in clinical aspects of CE caused by E. granulosus s.s. and the G6 genotype of E. granulosus s. l. complex infecting humans. [ABSTRACT FROM AUTHOR]

ABSTRACT: Canine atopic dermatitis (cAD) is a worldwide allergic skin disease. The affected dog population can show different clinical patterns according to geographic region, and a lack of studies in Brazil is observed. Therefore, the aim of the present study was to assess the clinical and epidemiological data of cAD in dogs treated in a private clinical practice in Fortaleza, a city located in the Northeast Region of Brazil. cAD was diagnosed in 35% of dogs, being Shih-tzu and Poodle the most affected breeds. Paws and ears were frequently injured sites. Almost 50% of atopic dogs were diagnosed with superficial pyoderma and 36% with cutaneous malasseziosis. Atopic dogs with outdoor habits were less likely to develop cutaneous malassezial infection, and with routine ear, cleaning habits were less likely to develop bacterial otitis externa. In conclusion, canine atopic dermatitis is a prevalent disease in private clinical practice in Fortaleza, and lifestyle habits can be considered a risk factor for cutaneous malasseziosis infection and bacterial otitis externa in atopic dogs.

Background: For interpretation of pulmonary function tests (PFTs), reference values based on sex, age, height and ethnicity are needed. In Norway, the European Coal and Steel Community (ECSC) reference values remain widely used, in spite of recommendations to implement the more recent Global Lung Function Initiative (GLI) reference values. Objective: To assess the effects of changing from ECSC to GLI reference values for spirometry, DLCO and static lung volumes, using a clinical cohort of adults with a broad range in age and lung function. Methods: PFTs from 577 adults (18–85 years, 45% females) included in recent clinical studies were used to compare ECSC and GLI reference values for FVC, FEV1, DLCO, TLC and RV. Percent predicted and lower limit of normal (LLN) were calculated. Bland-Altman plots were used to assess agreement between GLI and ECSC % predicted values. Results: In both sexes, GLI % predicted values were lower for FVC and FEV1, and higher for DLCO and RV, compared to ECSC. The disagreement was most pronounced in females, with mean (SD) difference 15 (5) percent points (pp) for DLCO and 17 (9) pp for RV (p < 0.001). With GLI, DLCO was below LLN in 23% of the females, with ECSC in 49% of the females. Conclusions: The observed differences between GLI and ECSC reference values are likely to entail significant consequences with respect to criteria for diagnostics and treatment, health care benefits and inclusion in clinical trials. To ensure equity of care, the same reference values should be consistently implemented across centers nationwide. [ABSTRACT FROM AUTHOR]

Introduction: Parietal hernias were the first pathology after appendicitis at the Chad-China Friendship Hospital. Objective: The aim of this study was to specify the epidemiological, clinical, diagnostic and therapeutic aspects of parietal hernias. Patients and method: This was a retrospective descriptive cross-sectional and analytical study of adult patients operated for parietal hernias between June 2015 and July 2020. Results: Of the 386 cases, there were 281 men (72.8%) and 105 women (27.2%). The sex ratio was 2.68. The mean age of the patients was 43.14 years with extremes of 20 and 79 years. In 7.5% of the cases, it was the strangulated hernias received in emergency (n=29). Inguinal hernia (n=268) was the most frequent variety with 69.4% of cases, followed bylinea alba hernia (78=20.2%) and umbilical hernia (40=10.4%). The main surgical technique used was the Bassini technique. Postoperative complications were 2 cases of hemorrhage (0.5%), 4 cases of hematoma (1%), 7 cases of urinary retention (1.8%) and 10 cases of parietal suppuration (2.6%). Conclusion: Parietal hernias are dominated by inguinal hernias. Raphy was the only technique performed. Early consultations could prevent complications. [ABSTRACT FROM AUTHOR]

Approximately 3500 children with sickle cell disease (SCD) are born in Brazil each year, but the burden of SCD morbidity is not fully characterised. A large, multi-centre cohort was established to characterise clinical outcomes in the Brazilian SCD population and create the infrastructure to perform genotype-phenotype association studies. Eligible patients were randomly selected from participating sites and recruited at routine visits. A biorepository of blood samples was created and comprehensive demographic and clinical outcome data were entered in a centralized electronic database. Peripheral blood genome-wide single nucleotide polymorphism (SNP) genotyping was performed using a customized Transfusion Medicine (TM) Array. A total of 2795 participants at six Brazilian sites were enrolled between 2013 and 2015. The cohort included slight predominance of children

Non-carious dental lesions, such as abrasion, erosion and abfraction, are frequently found in the cervical area of the teeth. The etiologic factors are multiple and frequently the mechanisms which lead to their appearance and progression are complex, therefore an accurate diagnosis is mandatory and often a multidisciplinary collaboration is needed. This implies a thorough anamnesis and detailed clinical examination which includes periodontal examination and occlusion analysis. A proper and complete diagnosis of cervical noncarious lesions is absolutely essential for a correct therapeutic approach, which is conditioned by the identification and removal of etiologic factors, followed by restorative treatment. [ABSTRACT FROM AUTHOR]

In epilepsy, there may be impairment of psychosocial aspects, including restrictions for the license to drive vehicles., Objective: To evaluate the license to drive a vehicle in patients with epilepsy according to Brazilian legislation and to relate it to demographic and clinical variables., Methodology: The license-to-drive vehicle rate was related to the demographic and clinical data of 305 patients with epilepsy., Results: The mean age was 49.2 years, with 176 females, the mean education was six years, and structural epilepsy occurred in 203 patients. The license to drive vehicles occurred in 35 (11.5 %) patients. In the multiple logistic regression analysis, with stepwise variable selection criteria, it was observed that the variables that together best predict the possession of a driving license are education (p-value = 0.012; OR = 1.15 (1.03, 1.29)), sex (p-value = 0.001; OR = 4.05 (1.80, 9.68)), marital status (p-value = 0.022; OR = 2.67 (1.18, 6.41)), neurological examination (p-value = 0.029; OR = 3.62 (1.25, 13.22)) and number of antiseizure medication (ASM) in use (p-value = 0.019; OR = 3.04 (1.26, 8.28)). The license did not comply with Brazilian legislation in 21 (60 %) patients. In nine patients, the practice violated the law due to the type of vehicle, and in 12 patients, due to the maintenance of seizures in the last year. Patients with non-legal aspects of the license were older, had less education, were male, and had a spouse., Conclusion: In patients with epilepsy, the rate of license to drive vehicles was low, and it was associated with higher schooling, males, having a spouse, having no alterations in the neurological examination, and the use of a single ASM. The non-compliance with current legislation was high, suggesting a lack of information or denial of the disease., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Ectodermal dysplasia is a complex group of genetic disorders identified through the abnormal development of ectodermal structures. It is a genetic disorder that affects the development or functions of tissues such as the teeth, hair, nails, and sweat glands. Methods: This review aimed to introduce the outcomes and increase awareness of ectodermal dysplasia reviewing by the literature. Results: The characteristic features of this disease, including hypodontia, hypohidrosis, and hypotrichosis, have been discussed. Conclusions: Ectodermal dysplasia is a heterogeneous group of hereditary disorders with similar clinical findings. It leads to the development of tissue malformations and affects the quality of life of the patient. This review demonstrates that dentists can provide viable and safe alternative conventional treatment modalities for oral rehabilitation in patients with ectodermal dysplasia.

Giant cell arteritis (GCA) is a chronic vasculitic disorder predominantly affecting medium to large sized arteries, prevalent in the 50 plus age group. This case illustrates an atypical presentation of this disease in the form of bilateral sensorineural hearing loss (SNHL). Apart from the presence of constitutional and vertiginous symptoms, there were essentially no classical features of GCA. Differentials were broad including infection, malignancy and medication toxicity as well as brain, eye and ear syndromes such as Cogan's syndrome, all of which were eventually excluded. Her diagnosis was ultimately confirmed on positron emission tomography, which highlights the diagnostic importance of this modality. She was managed with corticosteroids then tocilizumab and is making a gradual recovery. Literature review demonstrates that SNHL is more prevalent than previously suggested in GCA, although this does not have widespread recognition. Mechanisms of SNHL in GCA include vascular occlusion, immunological mechanisms including cross reactivity with viral antigens and direct viral infection. SNHL does appear to improve with corticosteroids. This case emphasizes the importance of considering GCA as an important differential in SNHL. [ABSTRACT FROM AUTHOR]

Background: Discordance between patient global assessment (PGA) and physician global assessment (PhGA) of rheumatoid arthritis (RA) disease activity is mainly determined by pain and functional disabilities. This study aimed to investigate the shift in PGA‐PhGA discordance and the variables associated with future positive discordance (PGA > PhGA) based on the NinJa database in Japan. Methods: We examined 7557 adults with RA registered in both NinJa 2014 and 2018, with a discordance cutoff of 3 on a 10‐cm scale. The affected joint distribution was investigated using the joint indices x, y, and z, which were calculated as indices for the upper joint, lower joint, and large joint involvement, respectively. The variables in NinJa 2014 that were associated with positive discordance in NinJa 2018 were examined using binary stepwise logistic regression analysis. Results: Due to the small number of patients with RA categorized as having negative discordance (PGA < PhGA), we focused on patients with RA categorized as having either concordance or positive discordance. Logistic regression analysis revealed that positive discordance in NinJa 2018 was associated with age, pain, modified Health Assessment Questionnaire (mHAQ) score, corticosteroid use, and existent positive discordance and was inversely associated with C‐reactive protein (CRP) and x at baseline (NinJa 2014). The same findings were observed when patients with RA were divided based on the discordance status at baseline. Persistence (positive discordance to positive discordance) was associated with pain and mHAQ scores but inversely associated with CRP. Conclusions: Positive discordance may persist. Circumventing this requires adequate management of pain and functional impairment. [ABSTRACT FROM AUTHOR]

The objective: to study the main clinical aspects of infertility in women with various variants of thyroid pathology. Materials and methods. A clinical screening examination of 496 women with infertility (main group), of which 238 were diagnosed the various thyroid pathologies, and 80 women with thyroid pathology without reproductive function disorders (control group) was carried out. Results. Primary infertility was diagnosed in 49.4 % of examined women, and secondary infertility – in 50.6 % of patients. Female infertility was diagnosed in 327 (65.9 %) patients, male infertility in 126 (25.4 %) women; infertility of unknown genesis was established during the examination of 43 married couples (8.7 %). In the structure of the causes of female infertility, the tubal-peritoneal factor prevailed (37 %), the frequency of external genital endometriosis was 36.4 %, the endocrine factor – 23.2 %, and the uterine factor – 3.4 %. A combination of infertility factors was determined in 23.8 % of women. The results of studying the reproductive history showed that 251 patients with secondary infertility have a history of 279 pregnancies. The positive obstetrical outcomes such as term uncomplicated childbirth was established only in 48 (19.1 %) patients; the first term birth occurred in 28 (11.1 %) women, the second birth – in 16 (6.4 %) patients. Pregnancy ended with premature birth in 27 (10.7 %) women, induced abortions – in 41 (16.3 %), spontaneous abortions – in 58 (23.1 %), 41of them (16.3 %) had one spontaneous abortion; missed abortion – in 57 (22.7 %) patients, ectopic pregnancy – in 19.1 %. A comparative evaluation of thyroid screening results in infertile and fertile women demonstrated that the prevalence of thyroid pathology in infertile patients was 3.8 times higher compared to fertile women (48 % and 12.5 %, respectively). In the structure of the thyroid gland pathology in both groups the presence of antibodies to thyroperoxidase combined with echo signs of autoimmune thyroiditis prevailed, which is 2.8 times more often diagnosed in the group of infertile women compared to fertile women (24 % and 8.7 %, respectively). Conclusions. The prevalence of thyroid pathology in patients with infertility is 3.8 times higher compared to fertile women. In women with secondary infertility pregnancy loss in the I trimester of gestation is dominated in the structure of reproductive outcomes. [ABSTRACT FROM AUTHOR]

Objective: To test whether a schizophrenia polygenic risk score (PRS) based on the subset of polymorphisms that affect brain expression of genes with altered expression by antipsychotics (exprAP PRS) is associated with psychiatric readmission of patients with schizophrenia. Methods: The study involved 427 patients with schizophrenia. Genes with altered expression by antipsychotics were extracted from the Comparative Toxigenomics Database. ExprAP PRS was estimated using the clumping and thresholding (p < 0.05) method. Two additional PRS were tested based on subsets of exprAP polymorphisms whose schizophrenia risk allele has the same (unrestored PRS) or opposite (restored PRS) direction of effect on gene expression than antipsychotics. A general SCZ PRS was tested for comparison. Logistic and ordinal regression were used to test for association of each PRS with ever readmission and admission history, an outcome based on length and number of admissions, respectively. Webgestalt was used for Gene Ontology enrichment analysis. Results: ExprAP PRS was associated with ever readmission (OR = 1.48, 95%CI:1.10–1.97) and admission history (OR = 1.30, 95%CI 1.07–1.57). SCZ PRS (OR = 1.22, 95%CI: 1.01–1.48) and unrestored PRS (OR = 1.26, 95%CI 1.04–1.53) were only associated with admission history. Genes at exprAP PRS were enriched in regulation of cytokine production. Conclusion: Our findings suggest that PRS based on genes with altered expression by antipsychotics may be better predictors of readmission than SCZ PRS, warranting further investigation in larger cohorts of patients. The action of antipsychotics may be related to brain gene expression, mainly in genes involved in immunity. [ABSTRACT FROM AUTHOR]

Feline sporotrichosis is enzootic in different regions of Brazil, especially in Rio de Janeiro. This study compared the genotype profiles of Sporothrix sp. isolated from cats in Rio de Janeiro between 1998 and 2018 and evaluated their association with clinical and epidemiological characteristics. One hundred nineteen Sporothrix sp. isolates from a cohort of cats with sporotrichosis seen at INI/Fiocruz were included. Clinical and epidemiological data were obtained from the medical records of the animals. T3B PCR fingerprinting was used for molecular identification of the Sporothrix species. All isolates were characterized as Sporothrix brasiliensis, with the observation of low intraspecific variation in 31 isolates (31.3%). The interval between lesion onset and first medical visit at INI/Fiocruz, as well as treatment duration until clinical cure, was longer in cats from the first decade of the epizootic. In addition, the frequency of the variables "good general status" and "presence of lymphadenomegaly" was higher among cats whose strains did not exhibit intraspecific variation. So far, S. brasiliensis has been the only species identified in feline cases of sporotrichosis since the beginning of the epizootic in Rio de Janeiro at INI/Fiocruz. [ABSTRACT FROM AUTHOR]

Myocardial injury in patients with SARS-CoV-2 infection may be attributed to the presence of the virus at the cellular level, however, it may also be secondary to other diseases, playing an essential role in the evolution of the disease. We evaluated 16 patients who died because of SARS-CoV-2 infection and analyzed the group from both clinical and pathological points of view. All autopsies were conducted in the Sibiu County morgue, taking into consideration all the national protocols for COVID-19 patients. Of the 16 autopsies we performed, two were complete, including an extensive examination of the cranial cavity. In our study, the cardiac injury was primarily cumulative. Chronic cardiac injuries included fatty infiltration of the myocardium in five cases, fibrosis in 11 cases, and coronary atherosclerosis in two cases. Among the cases with evidence of acute cardiovascular injuries, inflammatory lymphocytic infiltrate was observed in nine cases, subepicardial or visceral pericardial neutrophil-rich vascular congestion in five cases, and venous thrombosis in three cases. Acute ischemia or myocytic distress was identified by vacuolar degeneration in four cases; areas of undulated and/or fragmented myocardial fibers, with eosinophilia and nuclear pyknosis with or without enucleation of the myocytes in nine cases; and in one case, we observed a large area of myocardial necrosis. Immunohistochemical criteria confirmed the presence of the SARS-CoV-2 antigen at the level of the myocardium in only two cases. Comorbidities existing prior to SARS-CoV-2 infection associated with systemic and local inflammatory, thrombotic, hypoxic, or immunological phenomena influence the development of cardiac lesions, leading to death. [ABSTRACT FROM AUTHOR]

Summary: Waldenström's macroglobulinaemia (WM) is a B‐cell neoplasm resulting from bone marrow lymphoplasmacytic infiltration and monoclonal IgM secretion. Some patients present concomitant inflammatory syndrome attributed to the disease activity; we named this syndrome inflammatory WM (IWM). We retrospectively analysed all WM patients seen in a single tertiary referral centre from January 2007 to May 2021, and after excluding aetiologies for the inflammatory syndrome using a pertinent blood workup, including C‐reactive protein (CRP), and imaging, we identified 67 (28%) IWM, 166 (68%) non‐IWM, and nine (4%) WM with inflammatory syndrome of unknown origin. At treatment initiation, IWM patients had more severe anaemia (median Hb 90 vs 99 g/l; p < 0.01), higher platelet count (median 245 vs 196 × 109/l; p < 0.01) and comparable serum IgM level (median 24.9 vs 23.0 g/l; p = 0.28). A positive correlation was found between inflammatory and haematological responses (minimal response or better) (odds ratio 32.08; 95% confidence interval 8.80–98.03; p < 0.001). Overall survivals (OS) were similar (median OS: 17 vs 20 years; p = 0.11) but time to next treatment (TNT) was significantly shorter for IWM (TNT1: 1.6 vs 4.8 years, p < 0.0001). IWM mostly shared the same presentation and outcome as WM without inflammatory syndrome. [ABSTRACT FROM AUTHOR]

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Over the years, the attention towards the role of phytochemicals in dietary natural products in reducing the risk of developing cancer is rising. Cancer is the second primary cause of mortality worldwide. The current therapeutic options for cancer treatment are surgical excision, immunotherapy, chemotherapy, and radiotherapy. Unfortunately, in case of metastases or chemoresistance, the treatment options become very limited. Despite the advances in medical and pharmaceutical sciences, the impact of available treatments on survival is not satisfactory. Recently, natural products are a great deal of interest as potential anti-cancer agents. Among them, phenolic compounds have gained a great deal of interest, thanks to their anti-cancer activity. The present review focuses on the suppression of cancer by targeting BRCA gene expression using dietary polyphenols, as well as the clinical aspects of polyphenolic agents in cancer therapy. They regulate specific key processes involved in cancer progression and modulate the expression of oncogenic proteins, like p27, p21, and p53, which may lead to apoptosis, cell cycle arrest, inhibition of cell proliferation, and, consequently, cancer suppression. Thus, one of the mechanisms underlying the anti-cancer activity of phenolics involves the regulation of tumor suppressor genes. Among them, the BRCA genes, with the two forms (BRCA-1 and BRCA-2), play a pivotal role in cancer protection and prevention. BRCA germline mutations are associated with an increased risk of developing several types of cancers, including ovarian, breast, and prostate cancers. BRCA genes also play a key role in the sensitivity and response of cancer cells to specific pharmacological treatments. As the importance of BRCA-1 and BRCA-2 in reducing cancer invasiveness, repairing DNA damages, oncosoppression, and cell cycle checkpoint, their regulation by natural molecules has been examined. [ABSTRACT FROM AUTHOR]

Summary: Lymphoplasmacytic lymphoma (LPL) not fulfilling the WHO diagnostic criteria (2017) for Waldenstrom's macroglobulinemia (WM) (named non‐WM LPL) is a rare disease and only a few systematic studies have been published. Here, we present a population‐based study of non‐WM LPL focusing on diagnostic difficulties, patient characteristics, and outcome. From 1511 patients included in the Swedish Lymphoma Registry 1 Jan 2000 – 31 Dec 2014 with a diagnosis of WM/LPL, we could confirm the diagnosis of non‐WM LP in only 33 patients. The median age at diagnosis was 69 years. A paraprotein was found in most (IgG in 54%, IgA in 15%) and 12% of the cases were non‐secretory. Compared with the WM patients, the non‐WM LPL patients were younger, had more adverse prognostic factors such as elevated LDH, anaemia, and lymphocytosis at diagnosis. In addition, the non‐WM LPL patients more often were symptomatic and received treatment at diagnosis. The overall survival (OS) did not significantly differ between the non‐WM LPL and WM groups (P = 0.247), with a median survival time of 71 and 96 months, respectively. To conclude, we found differences in clinical features between WM and non‐WM LPL, but no difference in survival. [ABSTRACT FROM AUTHOR]

Trypanosomosis in sheep is a hemoparasitic disease of worldwide interest due to its effects on the health of animals and the economic impact on producers, is caused by the protozoan Trypanosoma sp. In the present study, the occurrence of Trypanosoma sp. in sheep from the urban-rural area of the canton Salitre was determined, through an applied study with a qualitative descriptive prospective crosssectional approach, carried out between October 1, 2019, and February 19, 2020. Blood samples were extracted from the jugular vein and analyzed by the blood smear method using the Giemsa and Diff-Quick staining techniques. Previously, in a first study realized between 2018 and 2019, 2 cases (2%) of Trypanosoma sp., 1 case of Babesia sp. (1%), and 4 cases of Anaplasma marginale (4%) were identified, but without the presence of symptoms of the disease. However, in this new research study, of 170 animals sampled from 5 herds and aged between 3 and 8 years, 34 (20%) were positive for Trypanosoma sp., 6 for Babesia sp. (3.52%) and 6 for A. marginale (3.52%) with coinfection between them. In this research, deteriorated clinical aspects and low hematological values were also determined in positive animals; besides of the total of positive cases, 25 presented symptoms of hemoparasitic disease, 3 sheep had abortions and 8 died. The results of this study showed that Trypanosoma sp. could already become an endemic parasitosis in sheep in the country, representing a serious problem of animal health. [ABSTRACT FROM AUTHOR]

Introduction: Dento-maxillary anomalies with distocclusion is not a singular diagnostic entity, but a result of a numerous possible associations of skeletal, dento-alveolar elements, which give a great diversity of clinical forms. Aim and objectives: The goal of this statistical study was to evaluated the frequency of distalized occlusion in the adult patients and to analyze the clinical features (dental and facial) caused by this malocclusion. Material and method: The evaluation was performed on a group of 62 adult subjects (15 male and 47 female), from urban environment, aged between 20-50 years, with distalized occlusion, who did not benefited from previous prosthetic and orthodontic treatments. Results and discussions: Especially among women there is a higher incidence of class II malocclusion (possible due to the higher number of them that require the alignment of the anterior teeth) and it’s a large number of combinations regarding the clinical aspects caused by this dento-maxillary anomaly. Conclusions: The clinical aspects of distoclussion (dental, skeletal and facial characteristics) are influenced by sagittal discrepancy between lower and upper jaws, associated or not with dental arch transverse problems and asymmetry of the jaws.

ABSTRACT: This study aimed to characterize the prevalence and clinical, macroscopic and histopathological aspects of dogs affected by testicular tumors based on biopsy specimens from the Laboratório de Patologia Veterinária of the Universidade Federal de Santa Maria (LPV-UFSM) over 19 years. Parameters regarding the age, size, and breed of the affected dogs were also established. Of all dogs with some type of neoplasm submitted to histopathological analysis at the LPV over these 19 years (n=1,900), 213 (11.2%) had at least one testicular neoplasm. The tissues of 190 dogs (with 220 neoplasms) were available for histological reassessment. The dogs in this study had different types of testicular tumors with relatively similar frequencies. In descending order, the most frequent testicular neoplasms were seminomas (88/220), Leydig (interstitial) cell tumor (LCT; 64/220), Sertoli cell tumor (SCT; 61/220), and mixed germ cell-sex cord stromal tumor (MGSCT) (07/220). Among the dogs of defined breed (119 cases), large breeds had the largest number of cases (50/119), followed by small (47/119) and medium-sized (22/119) breeds. The ages of dogs affected by testicular tumors ranged from 10 months to 18 years. Increased testicular volume was the most common clinical manifestation. Eleven dogs presented information about clinical signs suggestive of hyperestrogenism syndrome (feminization). In seminomas, the diffuse pattern predominated over the intratubular pattern. Two sites (luminal and basal compartments) suggestive of the onset of neoplastic transformations in germ cells were observed in intratubular seminomas. They corroborate the hypothesis that canine seminomas possibly have pathogenesis similar to that observed in human spermatocytic seminomas. The SCTs and LCTs presented high cell morphology variation. SCTs had neoplastic cells organized in five different histological arrangements. As for LCT, solid-diffuse and cystic-vascular histological patterns were the most commonly observed. Through this study, it was possible to establish some of the leading clinical, macroscopic, and histopathological aspects of testicular neoplasms diagnosed over 19 years in the area covered by the LPV-UFSM.

Juvenile nasopharyngeal angiofibroma (JNA) is a rare benign tumor described by slow progression, vigorous growth, high vascularization, and increased recurrence rate. The aim of this article is to describe a case of JNA from our tertiary hospital and discuss the diagnosis and management in our current practice. A 16-year-old male patient presented with bleeding from the left nasal cavity. On examination, there was a non-pulsatile ovoid like mass occluding the entire left nasal cavity which was able to probe medially, superiorly, and laterally except inferiorly and on probing and it resulted in minimal bleed. Cold spatula test revealed decreased fogging on the left side. Contrast-enhanced computed tomography scan of the paranasal sinuses and nose showed the presence of a large ill-defined heterogeneously enhancing soft-tissue density mass lesion with its epicenter in posterior part of the left nasal cavity and left pterygopalatine fossa and was extending into the left orbit and left cavernous sinus. Complete embolization of the left nasopharyngeal vascular mass was done preoperatively. Two days post-embolization, surgical excision of JNA under general anesthesia was done. The approach was done through sublabial incision. This classic case of JNA was operated endoscopically because of its benefits over the conventional methods. [ABSTRACT FROM AUTHOR]

Background: Ectodermal dysplasia is a complex group of genetic disorders identified through the abnormal development of ectodermal structures. It is a genetic disorder that affects the development or functions of tissues such as the teeth, hair, nails, and sweat glands. Methods: This review aimed to introduce the outcomes and increase awareness of ectodermal dysplasia reviewing by the literature. Results: The characteristic features of this disease, including hypodontia, hypohidrosis, and hypotrichosis, have been discussed. Conclusions: Ectodermal dysplasia is a heterogeneous group of hereditary disorders with similar clinical findings. It leads to the development of tissue malformations and affects the quality of life of the patient. This review demonstrates that dentists can provide viable and safe alternative conventional treatment modalities for oral rehabilitation in patients with ectodermal dysplasia. [ABSTRACT FROM AUTHOR]

ABSTRACT: Equine leukoencephalomalacia (LEM) is a disease caused by the ingestion of food, especially corn, contaminated by fumonisin, a Fusarium verticillioides (synonymous with F. moniliforme) metabolite. The clinical signs of brain injuries have an acute onset and rapid evolution. This study aimed to describe the clinical findings in 11 animals diagnosed with LEM, including cerebrospinal fluid (CSF) analysis. Of these animals, 91% (10/11) were horses, and only 9% (1/11) were asinine. The clinical localization of the lesions was 64% (7/10) cerebral, manifested mainly by altered mental state and behavioral disturbance, and 36% (4/11) were brainstem lesions, manifested by incoordination, head tilt, nystagmus, facial hypoalgesia, difficulty in apprehension, chewing, and swallowing food. Postmortem findings revealed that 82% (9/11) of the lesions were in the cerebrum and 18% (2/11) in the brainstem. CSF findings, such as xanthochromia (43%, 3/7), hyperproteinorrachia (50%, 3/6), and pleocytosis (43%, 3/7) were observed. The affected animals showed neurological signs that were compatible with cerebral and/or brainstem injuries. The CSF from animals with LEM may present with xanthochromia, hyperproteinorrachia, and pleocytosis, reinforcing the fact that this disease should be included in the differential diagnosis of encephalomyelopathies.

Viral infections are posing a great threat to humanity for the last few years. Among these, Chikungunya which is a mosquito-borne viral infection has produced enormous epidemics around the world after been rebounded. Although this infection shows a low mortality rate, patients suffer from fever, arthralgia, and maculopapular rashes, which reduce the quality of life for several weeks to years. The currently available treatments only provide symptomatic relief based on analgesics, antipyretics, and anti-inflammatory drugs which are nonspecific without satisfactory results. Medicinal plants are a widely accepted source of new molecules for the treatment of infectious diseases including viral infections. The scientific reports, primarily focusing on the anti-chikungunya activity of plant extracts, natural origin pure compounds, and their synthetic analog published from 2011 to 2021, were selected from PubMed, Google Scholar, and Scopus by using related keywords like anti-chikungunya plants, natural antivirals for Chikungunya. The present review decodes scientific reports on medicinal plants against chikungunya virus (CHIKV) infection and demystifies the potential phytoconstituents which reveals that the screening of flavonoids containing plants and phytochemicals showing efficacy against other arbovirus infections, may prove as a potential lead for drug development against CHIKV. The present article also outlines pathogenesis, clinical aspects, molecular virology, and diagnostic approaches of CHIKV infection. [ABSTRACT FROM AUTHOR]

Despite plenty of effective antidepressant (AD) treatments, the outcome of major depressive disorder (MDD) is often unsatisfactory, probably due to improvable exploitation of available therapies. This European, cross-sectional, naturalistic multicenter study investigated the frequency of additional psychotherapy in terms of a manual-driven psychotherapy (MDP) in 1410 adult in- and outpatients with MDD, who were primarily treated with AD psychopharmacotherapy. Socio-demographic and clinical patterns were compared between patients receiving both treatments and those lacking concomitant MDP. In a total of 1279 MDD patients (90.7%) with known status of additional MDP, those undergoing a psychopharmacotherapy-MDP combination (31.2%) were younger, higher educated, more often employed and less severely ill with lower odds for suicidality as compared to patients receiving exclusively psychopharmacotherapy (68.8%). They experienced an earlier mean age of MDD onset, melancholic features, comorbid asthma and migraine and received lower daily doses of their first-line ADs. While agomelatine was more often established in these patients, MDD patients without MDP received selective serotonin reuptake inhibitors more frequently. These two patient groups did not differ in terms of response, non-response and treatment resistant depression (TRD). Accordingly, the employment of additional MDP could not be related to better treatment outcomes in MDD. The fact that MDP was applied in a minority of patients with rather beneficial socio-demographic and clinical characteristics might reflect inferior accessibility of these psychotherapeutic techniques for socially and economically disadvantaged populations. [ABSTRACT FROM AUTHOR]

Diverticula of the colon are very common and usually asymptomatic but 20% of people with diverticulosis develop symptoms and sometimes also complications, such as diverticulitis with abscesses or perforation and bleeding. In the long-term stenoses or a conglomerate can occur. The treatment depends on the type of diverticular disease, on the knowledge of risk indicators and imaging with sonography or computed tomography (CT). The uncomplicated diverticular disease is treated on an outpatient and conservative basis, while complicated diverticular disease is treated on an inpatient basis and often surgically. [ABSTRACT FROM AUTHOR]

Heartworm disease (HWD) is a clinically important parasitic disease of the cardiovascular system in dogs, and is caused by Dirofilaria immitis (D. immitis), which resides in pulmonary arteries. Infected domestic and wild canids as hosts, and mosquitoes as intermediate hosts, are the main reservoirs of D. immitis. Because D. immitis does not reach complete development in humans, HWD is considered to be a disease with zoonotic potential. In addition to its veterinary relevance and zoonotic potential, the disease is distributed worldwide, and thus, a multidisciplinary approach is necessary to control this disease on the global level. The life cycle of D. immitis explains the pathogenesis and clinical signs of HWD in dogs, and determines its diagnosis, therapy and prophylactic measures. In this review, the most important aspects of HWD in canine patients are emphasized: establishment of correct diagnosis of the disease, proper diagnostic procedures for monitoring the clinical condition of an infected dog, different therapeutic protocols and how efficient they are and finally, recommendations for adequate prophylactic measures. Dogs with and without clinical signs of HWD should be tested for both microfilariae and adults of D. immitis at appropriate times. If positive for heartworm, the pathological changes in relevant organs, mainly lungs and heart, should be assessed in the dog. Their extent and severity determine therapeutic protocol. For dogs cured from HWD and non-infected ones, adequate preventive measures should be applied.

The frequency of impactation of the maxillary permanent incisors is low in dental practice, the orthodontist having the duty to determine the cause and establish and apply an orthodontic treatment as early as possible. The diagnosis of certainty of impactation of the permanent maxillary incisors is established when there is a delay in their eruption for about one year after the exfoliation of milky teeth. The interceptive and curative orthodontic treatment is important for facial aesthetics, for harmonious facial and skeletal development, for correcting possible malfunctions (phoniatric, masticatory, deglutition).

Sabrina Sampaio Bandeira,1,2 Carla Avelar Pires,2,3 Juarez Antonio Simões Quaresma2,3 1Sanitary Dermatology Referral Unit “Dr. Marcello Cândia”, Secretary of State for Public Health, Marituba, PA, Brazil; 2Tropical Medicine Center, Federal University of Para, Belem, PA, Brazil; 3Center of Health and Biological Sciences, State University of Para, Belem, PA, BrazilCorrespondence: Juarez Antonio Simões QuaresmaTropical Medicine Center, Federal University of Para, Av. Generalissimo Deodoro 92, Umarizal, Belem, PA 66055-240, BrazilEmail juarez@ufpa.brBackground and objective: In highly endemic areas, severe multibacillary forms of leprosy and reactional episodes are not rare in children. The objective of the present study was to describe the clinical and epidemiological aspects of leprosy reactions in children from the Brazilian Amazon.Methods: This was a prospective cohort study of 34 leprosy patients aged under 15 years diagnosed at a health referral unit in northern Brazil between April 2014 and June 2015. Follow-up medical consultations were performed during multidrug therapy (MDT) and one year after the end of treatment. Participants underwent a simple neurologic examination and answered a structured questionnaire.Results: Of the 34 recruited patients, 18 (52.9%) had leprosy reactions and/or neuritis. Among these, 10 (55.6%) had reactions at diagnosis, 13 (72.2%) had reactions after MDT, and 14 (77.8%) had two or more reactional episodes. Type I reactions occurred in 14 (77.8%) cases. Complications, such as disabilities, necrotizing erythema nodosum, or Cushing’s syndrome, occurred in six (33.3%) patients. The following variables showed significant associations (p ≤ 0.05) with leprosy reactions: age 8–14 years, number of doctors seen (≥3), multibacillary classification, number of skin lesions (≥10), or borderline and lepromatous clinical forms. The high frequency of type I reactions resulted in prolonged corticosteroid therapy, which may cause deficient bone maturation in childhood.Conclusion: Older age in children, consulting many physicians for diagnosis, severe clinical forms, and numerous skin lesions were positively associated with reaction development. Reactions after MDT highlight the need for continuity in healthcare of children with leprosy.Keywords: Mycobacterium leprae, leprosy, children, clinical aspects, Brazil, Amazon

Abstract Background During recent years, Quality of Life (QoL) is a significant assessment factor in clinical trials and epidemiological researches due to the advent of Antiretroviral Therapy (ART), Human Immunodeficiency Virus (HIV) has become a manageable,chronic disease. With regards, more attention must be paid to the QoL of infected patients. Limited evidence exists on the impact of ART on QoL among HIV infected patients. Due to lacking of a systematic approach to summarizing the available evidence on the clinical determinants of People Who Live with HIV/AIDS (PWLHs’) QoL, this study aimed to analyze the impact of clinical determinants (ART experience, CD4 count

Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are acute and potentially fatal inflammatory vesiculobullous reactions that affect the skin and mucous membranes, and which are most often triggered by particular medications and infections. In Brazil, the drugs most frequently associated with TEN and SJS include cold medicine such as dipyrone and NSAIDs, followed by carbamazepine, phenobarbital, penicillin, and allopurinol. Genetic variations have been found to increase the risk of SJS/TEN in response to triggering factors such as medications. The most closely associated genes found in Brazilian cold-medicine-related SJS/TEN patients with severe ocular complications are HLA-A*66:01 in those of mixed African and European ancestry and HLA-B*44:03 and HLA-C*12:03 in those of solely European ancestry. Our classification system for grading ocular surface complication severity in SJS/TEN patients revealed the most severe complications to be limbal stem cell deficiency and dry eye. Changes to the conjunctival flora have also been observed in SJS/TEN patients. Our group identified bacterial colonization in 95% of the eyes (55.5% of which were gram-positive cocci, 25.5% of which were gram-negative bacilli, and 19% of which were gram-positive bacilli). Several new treatment options in the acute and chronic ocular management of the SJS/TEN patients have been described. This article highlights some Brazilian institutions' contributions to ocular surface care in both the acute phase (including the use of amniotic membrane transplantation) and the chronic phase (such as eyelid margin and fornix reconstruction, minor salivary gland transplantation, amniotic membrane and limbal transplantation, scleral contact lenses, anti-angiogenic eyedrops for corneal neovascularization, ex-vivo cultivated limbal epithelium transplantation, conjunctival-limbal autografting, oral mucosa transplantation, and keratoprosthesis).