Lipschütz Ulcer and Epstein-Barr Virus Infection

Aims: Lipschütz ulcer (LU), also known as acute vulvar ulcer, is a rare cause of vulvar ulcerations of nonvenereal origin. Our aim is to alert about this manifestation of the disease and to prevent unnecessary treatment.Case description: we present a 15 years old female, without relevant family and past history, admitted in the emergency room with a painful vulvar ulcer, preceded by five days of fever and sore throat. On physical examination, she had enlarged, and erythematous tonsils and bilateral anterior cervical lymphadenopathy and the genital examination revealed vulvar oedema and a deep ulcer with necrotic plaques in labium minus. The exclusion of transmitted sexual disease led to a diagnosis of Lipschütz ulcer. She started symptomatic treatment, oral antibiotic and corticoid therapy. She was discharged from the hospital after 6 days of admission and returned to a consult one month later when it was observed an almost complete resolution of the lesions. No recurrences occurred until 3 months.Conclusion: LU is a misdiagnosed pathology, probably because doctors, in general, are not familiarized with that, and since the diagnosis is made by exclusion. Infectious, such as Epstein-Barr Virus infections, are proposed etiologies.

Indicações de cesárea nas gestantes classificadas como Robson 1

Objetivos: os objetivos foram identificar as indicações mais prevalentes de cesárea em parturientes Robson 1, comparando variáveis maternas, antecedentes obstétricos e resultados perinatais.Métodos: estudo analítico observacional transversal, onde avaliou-se o Livro de Partos e prontuários eletrônicos das gestantes em trabalho de parto, classificadas como Robson 1. As variáveis quantitativas foram comparadas utilizando-se Teste T de Student ou Mann Whitney, às qualitativas foi empregado teste Qui-quadrado ou Exato de Fisher.Resultados: elegíveis 2267 gestantes, sendo 570 (25,1%) cesáreas. As indicações mais prevalentes de cesariana foram: sofrimento fetal, em 213 (37,4%) dos casos, e desproporção cefalopélvica, em 212 (37,2%). As variáveis relevantes para o desfecho do parto foram: idade materna (razão de chance 1,0), idade gestacional (1,4), índice de massa corpórea pré-gestacional (1,6 em sobrepeso e 1,8 em obesidade) e presença de síndrome hipertensiva (aumentou 3,6).Conclusão: conclui-se que algumas características maternas e obstétricas afetam diretamente a indicação de cesariana.

Anti-Staphylococcus aureus Methicillin-Resistant (MRSA) Activity of a Novel 3-Chalcogenyl Indole

Objective: the development of new drugs against Methicillin-resistant Staphylococcus aureus is a priority to the World Health Organization. So, the objective of this study was to evaluate the antibacterial activity and toxicity of 5-bromo-3-((4-methoxyphenyl) sulfenyl)-1H-indole (3b) against MRSA.Methods: minimum inhibitory concentration (MIC) of 3b was determined against S. aureus ATCC 29213 and 43 clinical isolates. The time-kill assay was performed for 9 isolates. Analysis of variance followed by the post hoc Bonferroni test was used for the statistical tests.Results and conclusions: the MIC50 and MIC90 of 3b were 4 μg.mL-1 and 16 μg.mL-1 respectively. In time-kill assay, the 3b showed bactericidal activity to all evaluated isolates at concentrations of 1xMIC and 2xMIC and the re-growth effect was not observed. About the toxicity tests, 3b has not presented cytotoxicity, mutagenicity, or allergenicity. 3b had particularly good activity against MRSA demonstrating high potential for the development of new antimicrobials products.

Assessment of individual competence

Aims: the assessment of individual competence in medical education is about finding a balance between having sufficient resources to make valid and reliable decisions and not using more resources than necessary. Sequential assessment, in which more resources are used for borderline performing candidates than for poorly or clearly satisfactorily performing candidates, can be used to achieve that balance. Although sequential assessment is commonly associated with larger groups of candidates to be assessed, in many practical settings numbers of candidates may be small.Objective: this article presents a single case design with a statistical model for the assessment of individual competence that can be used regardless of the number of candidates.Method: a worked example of a solution that can be used for an individual candidate, using simulated data in the zero-cost Open Source statistical program R version 4.0.5., is provided.Results: the aforementioned solution provides statistics that can be used to make pass/fail decisions at the level of the individual candidate as well as to make decisions regarding the length and timing of an exam (or parts thereof) for the individual candidate.Conclusion: the solution provided can help to reduce resources needed for assessment to a considerable extent while maximizing resources for borderline candidates. This facilitates both decision making and cost reduction in assessment.

The 12 women who won the Nobel Prize in Medicine or Physiology

Introduction: the Nobel Prize is one of the highest academic honors in the world. Since its first edition, in 1901, until 2021, there have been hundreds of winners. In the Medicine or Physiology category, chosen by the Karolinska Institute in Stockholm, Sweden, 112 awards have been given to 224 laureates, among them, only 12 (5.4%) women.Aims and source of data: with the aim of reviewing the biographies, characteristics, and peculiarities of each woman awarded the Nobel Prize for Medicine or Physiology. Data were analyzed from the following sources: the Award page, websites of the institutions to which some of them have been or are affiliated, books with biographies of Nobel laureates in Medicine or Physiology, and articles in the PubMed database.Summary of findings: the average age when receiving the award was 63.4 years. The most recurrent country of origin was the United States of America, also responsible for the largest number of institutions to which the laureates were affiliated at the time of the award. The academic training of the laureates was quite diverse, ranging among medicine, chemistry, physics, biology, pharmacy, psychology and natural sciences. Five of the 12 laureates did not have children.Comments: the origins and trajectories, although plural, have points in common, such as a fascination with science since childhood and the need to overcome additional barriers throughout their education, because of their sex.Conclusion: investments on a global scale are necessary to increase equity between sexes.

Frequência de alterações espirométricas, aprisionamento aéreo e hiperinsuflação pulmonar em crianças e adolescentes com asma grave resistente à terapia

Objetivos: avaliar a frequência de alterações espirométricas e pletismográficas em crianças e adolescentes com asma grave resistente à terapia (AGRT). Além disso, testaram-se possíveis associações entre esses desfechos.Métodos: trata-se de um estudo retrospectivo, no qual foram incluídas crianças e adolescentes (6-18 anos), com diagnóstico de AGRT, e que se encontravam em acompanhamento ambulatorial regular. Todos deveriam possuir informações antropométricas (peso, altura, índice de massa corporal), demográficas (idade, etnia e sexo), clínicas (teste cutâneo, teste de controle da asma, tabagismo familiar e medicações em uso) e de função pulmonar (espirometria e pletismografia corporal) registradas no banco de dados do serviço. Os testes de função pulmonar seguiram as recomendações das diretrizes nacionais e internacionais. Para fins estatísticos, utilizou-se análise descritiva e o teste de qui-quadrado de Pearson.Resultados: de um total de 15 pacientes com AGRT, 12 deles foram incluídos na amostra. A média de idade foi de 12,2 anos, com predomínio do sexo feminino (66,7%). Destes, 50,0% apresentaram a doença controlada, 83,3% foram considerados atópicos e 50,0% tinham histórico de tabagismo familiar. Em relação aos testes de função pulmonar (% do previsto), as médias dos parâmetros espirométricos e de plestismografia corporal encontraram-se dentro dos limites inferiores da normalidade. Apenas 16,7% da amostra apresentou espirometria alterada (<percentil 5), 25,0% aprisionamento aéreo (volume residual>130,0%) e 16,7% hiperinsuflação pulmonar (capacidade pulmonar total>120,0%). Houve frequência estatisticamente maior (p=0,045) de aprisionamento aéreo nos participantes com espirometria alterada, em comparação à espirometria normal. Contudo, não se observou diferença (p=0,341) em relação à hiperinsuflação pulmonar.Conclusões: os achados demonstraram pouco comprometimento espirométrico e dos volumes e das capacidades pulmonares em crianças e adolescentes com AGRT. Além disso, aqueles participantes com espirometria alterada obtiveram frequência maior de aprisionamento aéreo no exame de pletismografia corporal.

Article numbers as a leading indicator of publication time

Aims: in health professions education (HPE), the use of statistics is commonly associated with somewhat larger samples, whereas smaller samples or single subjects (i.e., N = 1) are usually labelled as needing some kind of ‘qualitative’ approach. However, statistical methods can be very useful in small samples and for individual subjects as well, especially where we have time series of repeated measurements of the same outcome variable(s) of interest. The aim of this article is twofold: to demonstrate an example of a cross-correlation function for single subjects in a HPE context and to suggest a few settings in HPE where this cross-correlation function can be of use.Method: the example uses data from a recent Open Access publication on among others article numbers and publication time in a number of major HPE journals to examine the relation between the number of articles published and median publication time over time in the zero-cost Open-Source statistical program R version 4.0.5.Results: as to be expected, the number of articles published appears somewhat of a leading indicator of publication time: both number of articles in year ‘y’ and number of articles in year ‘y minus 1’ correlate > 0.6 with median publication time in year ‘y’, while correlations of other time differences (e.g., number of articles in year ‘y minus 2’ and median publication time in year ‘y’, or median publication time in year ‘y’ and number of articles in year ‘y plus 1’) are substantially smaller.Conclusion: in line with recent literature, this article demonstrates that the cross-correlation function can be used in the context of small samples and single subjects. While the example focusses on article numbers and publication times, it can equally be applied in for example studying relations between knowledge, skills and attitude in individuals, or relations between behaviors of individuals working in pairs or small groups.

Panorama da obesidade em crianças brasileiras cadastradas no SISVAN

Objetivo: verificar a evolução da obesidade em crianças de zero a dez anos cadastradas no Sistema de Vigilância Alimentar e Nutricional no período de 2008 a 2018 em diferentes regiões do Brasil e em sua totalidade.Métodos: estudo de abordagem quantitativa do tipo ecológico, desenvolvido com dados secundários de domínio público e de livre acesso no meio eletrônico. Foram coletados percentuais e calculada média e intervalo de confiança do indicador Índice de Massa Corporal/idade em crianças de zero a dez anos, de ambos os sexos no período de 2008 a 2018 para os estratos regionais (regiões Centro-Oeste, Nordeste, Norte, Sudeste e Sul) e nacional (Brasil).Resultados: a obesidade apresentou valores maiores nas regiões Nordeste e Sul para a faixa etária de zero a cinco anos incompletos e de cinco a dez anos incompletos, respectivamente. Na sua totalidade, a Região Nordeste volta a ser destaque com maiores percentuais de obesidade e diferindo-se estatisticamente (p>0,0001) da Região Norte com valores menores.Conclusão: a análise do panorama apontou para o aumento da obesidade nas diferentes regiões do Brasil em crianças, fato que deve ser considerado importante na esfera pública para a formulação de políticas eficientes para essa população.

Prognostic factors and long-term survival in oral squamous cell carcinoma

Objective: this study aimed to evaluate long-term survival and prognostic factors in patients with oral squamous cell carcinoma (OSCC) in an economically poor region of Brazil.Methods: the data were obtained from analysis of medical and mortality records of 210 patients with OSCC treated at an oncology hospital providing services to the Brazilian Unified National Health System in a State of northeastern Brazil between January 2006 and December 2008. Sociodemographic and clinical information, treatment performed, recurrence and evolution were collected. Survival curves were estimated by the Kaplan-Meier method and the log rank and Cox regression tests were used to compare the curves.Results: the median survival in the study period was 47.4 months (95% CI = 38.2 - 56.7). The overall survival rates at 5 and 10 years were 29% and 19.8%, respectivelly. Individuals over 60 years of age (HR = 1.70; 95% CI = 1.06 - 2.73), presence of regional metastasis (HR = 2.51; 95% CI = 1.55 - 4.08), presence of recurrence (HR = 3.18; 95% CI = 1.88 - 5.39) and no surgical treatment (HR = 2.10; 95% CI = 1.31 - 3.35) had a worse prognosis.Conclusions: advanced age, presence of regional metastasis, tumor recurrence and non-surgical treatment predict poorer survival in patients diagnosed with OSCC.

Aplicação da nota de transferência e do Paediatric Early Warning Score no serviço de emergência pediátrica do Hospital de Clínicas de Porto Alegre

Objetivo: avaliar a adesão dos enfermeiros ao preenchimento da Nota de Transferência com emissão do Paediatric Early Warning Score (PEWS) em pacientes pediátricos do Serviço de Emergência.Método: estudo quantitativo, transversal e retrospectivo. O estudo foi realizado a partir da análise de 1.219 prontuários de pacientes de uma unidade de emergência pediátrica, no ano de 2018.Resultados: na avaliação da nota de transferência e PEWS, houve adesão de, respectivamente, 86,8% e 75,2% ao longo do ano. Os motivos de hospitalização variam conforme época do ano. Os pacientes atendidos no Serviço de Emergência foram, majoritariamente, estabilizados no serviço e, somente os pacientes com PEWS alterado, foram encaminhados à unidade de terapia intensiva pediátrica.Conclusões: são necessárias ações de educação com os profissionais, com a finalidade de melhoria dos indicadores relacionados à aplicação do PEWS e da nota de transferência para a garantia de uma assistência segura no que tange à continuidade do cuidado.