Abstract Objectives: To evaluate the inconsistency between clinical diagnosis of death and autopsy findings in adolescents with chronic diseases. Methods: A cross-sectional study including a sample of adolescents’ autopsies who died in a pediatric and adolescent tertiary hospital over 18 consecutive years. During this period, there were n = 2912 deaths, and n = 581/2912(20%) occurred in adolescents. Of these, n = 85/581(15%) underwent autopsies and were analyzed. Further results were divided into two groups: Goldman classes I or II (high disagreement between main clinical diagnosis of death and anatomopathological findings, n = 26) and Goldman classes III, IV or V (low or no disagreement between these two parameters, n = 59). Results: Median age at death (13.5 [10‒19] vs. 13 [10‒19] years, p = 0.495) and disease duration (22 [0‒164] vs. 20 [0‒200] months, p = 0.931), and frequencies for males (58% vs. 44%, p = 0.247) were similar between class I/II vs. class III/IV/V. The frequency of pneumonia (73% vs. 48%, p = 0.029), pulmonary abscess (12% vs. 0%, p = 0.026), as well as isolation of yeast (27% vs. 5%, p = 0.008), and virus (15% vs. 2%, p = 0.029) identified in the autopsy, were significantly higher in adolescents with Goldman class I/II compared to those with Goldman class III/IV/V. In contrast, cerebral edema was significantly lower in adolescents of the first group (4% vs. 25%, p = 0.018). Conclusion: This study showed that 30% of the adolescents with chronic diseases had major discrepancies between clinical diagnosis of death and autopsy findings. Pneumonia, pulmonary abscess, as well as isolation of yeast and virus were more frequently identified at autopsy findings in the groups with major discrepancies.

Resumen Objetivo: El objetivo de este estudio fue aislar levaduras pertenecientes al complejo de especies Cryptococcus neoformans de los excrementos de paloma de Castilla (Columba livia) recolectados de plazas y parques públicos de El Salvador. Métodos: Las muestras se sembraron en medios de cultivos convencionales y a las colonias confirmadas se les efectuó una tipificación mediante la técnica de restricción enzimática del gen URA5. Resultados: De un total de 66 muestras analizadas, tres estaban positivas por levaduras pertenecientes al complejo de especies Cryptococcus neoformans. El estudio molecular agrupó los aislamientos en los tipos moleculares VNI y VNII; ambos corresponden a la especie Cryptococcus neoformans sensu stricto. Conclusión: En los sitios estudiados, la presencia de esta levadura es muy reducida, probablemente debido a factores ambientales. Se presenta el primer reporte de Cryptococcus neoformans sensu stricto, genotipos VNI y VNII en El Salvador, esta especie es de relevancia en salud pública por el ser el responsable de más del 90% de los casos de criptococosis a nivel mundial.

Abstract Aim: The objective of this study was to isolate yeast that belonged to the Cryptococcus neoformans species complex from the feces of the Feral Pigeon (Columba livia), from public places in El Salvador. Methods: Samples were seeded in conventional culture media and confirmed colonies were typed using the enzyme restriction technique of the URA5 gene. Results: Of a total of 66 samples analyzed, three were positive for yeasts that belonged to the Cryptococcus neoformans species complex. The molecular study grouped the isolates in the molecular types VNI and VNII; both belonging to the species Cryptococcus neoformans sensu stricto. Conclusions: In the studied sites the presence of this yeast is very low, probably due to environmental factors. We present the first report of Cryptococcus neoformans sensu stricto genotypes VNI and VNII in El Salvador. This specie is relevant in public health for being responsible for more than 90% of cases of cryptococcosis worldwide.

RESUMEN El objetivo del estudio fue determinar el perfil hematológico de la paloma (Columba livia) criada en la costa norte del Perú. Se utilizaron 96 muestras de sangre de palomas juveniles y adultas (51 hembras y 45 machos). Las muestras fueron colectadas en tubos con anticoagulante entre abril y diciembre de 2019. Se utilizaron las técnicas hematológicas de Natt y Herrick (recuento de glóbulos rojos y blancos), método de microhematocrito (hematocrito), método de cianometahemoglobina (hemoglobina) y frotis de sangre teñidos con coloración Wright (recuento diferencial de leucocitos y contaje de plaquetas). Los valores para hembras juveniles y adultas y machos juveniles y adultos fueron de 262.4±48.5, 308.8±38.0, 258.2±56.1 y 303.8±42.9 g, hematocrito de 40.8±4.9, 45.8±3.9, 40.9±3.4 y 43.6±5.2%, hemoglobina de 14.1±1.9, 15.4±1.8, 13.9±1.9 y 14.8±2.6 g/dl, recuento de glóbulos rojos de 3.09±1.0, 3.1±0.6, 3.0±0.8 y 3.3±0.7 x106/µl, plaquetas de 32.4±12.9, 35.9±8.8, 33.6±12.5 y 34.0±10.7 x103/µl, glóbulos blancos de 19.8±1.4, 17.6±0.9, 18.2±1.0 y 17.0±1.0 x103/µl, y ratio heterófilos/linfocitos de 1.8, 1.5, 1.7 y 1.4, respectivamente. Los valores promedio encontrados estaban dentro de lo reportado para el orden Columbiforme.

ABSTRACT The aim if this study was to determine the haematological profile of the pigeon (Columba livia) raised on the north coast of Peru. In total, 96 blood samples from juvenile and adult pigeons (51 females and 45 males) were used. Samples were collected in tubes with anticoagulant between April and December 2019. Natt and Herrick haematological techniques (red and white blood cell count), microhematocrit method (hematocrit), cyanmethemoglobin method (haemoglobin) and stained blood smears with Wright staining (differential leukocyte count and platelet count) were used. The values for juvenile and adult females and juvenile and adult males were 262.4±48.5, 308.8±38.0, 258.2±56.1 and 303.8±42.9 g, haematocrit of 40.8±4.9, 45.8±3.9, 40.9±3.4 and 43.6±5.2% , haemoglobin of 14.1±1.9, 15.4±1.8, 13.9±1.9 and 14.8±2.6 g/dl, red blood cell count of 3.09±1.0, 3.1±0.6, 3.0±0.8 and 3.3±0.7x106/µl, platelets of 32.4±12.9, 35.9±8.8, 33.6±12.5 and 34.0±10.7x103/µl, white blood cells of 19.8±1.4, 17.6±0.9, 18.2±1.0 and 17.0±1.0x103/µl, and heterophile/ lymphocyte ratio of 1.8, 1.5, 1.7 and 1.4, respectively. The average values found were within those reported for the Columbiform order.

RESUMO Introdução: A clientela crítica encontra-se exposta à riscos. Assim, compreender as relações entre os elementos que envolvem a segurança e proteção torna-se fundamental. Objetivo: verificar a associação entre os diagnósticos de enfermagem do domínio segurança e proteção da NANDA Internacional com seus componentes em pacientes críticos internados em unidade de terapia intensiva. Métodos: estudo transversal, realizado com 86 pacientes críticos de um hospital no Nordeste do Brasil, por meio do formulário. Na análise estatística, foram aplicados os testes de Qui-quadrado e exato de Fisher. Resultados: O diagnóstico Risco de resposta adversa ao meio de contraste com iodo apresentou associação estatística com os componentes: Propriedades físicas e químicas dos meios de contraste, Ansiedade, Uso concomitante de medicamentos, Veias fragilizadas, Doença subjacente e Extremos de idade. O diagnóstico Risco de desequilíbrio na temperatura corporal associou-se à taxa metabólica alterada, extremos de idade e sedação. Conclusão: Esses achados proporcionam avanço científico para a enfermagem ao fornecerem auxílio na inferência diagnóstica, na previsão dos cuidados e na tomada de decisão do enfermeiro.

ABSTRACT Introduction: Critically-ill patients, admitted to an intensive care unit, are exposed to risks. Therefore, understanding the relationships between the elements involving their safety and protection becomes fundamental. Objective: To verify the association between the nursing diagnoses within the domain safety and protection of NANDA (North American Nursing Diagnosis Association) International with its components in critically-ill patients hospitalized in an intensive care unit. Methods: Cross-sectional study carried out through a form conducted on 86 critically-ill patients of a hospital in the northeast of Brazil. The chi-square and Fisher's exact tests were applied in the statistical analysis. Results: The diagnosis of the risk of adverse response to the contrast medium with iodine presented statistical association with the components: physical and chemical properties of the contrast media, anxiety, concomitant use of medications, fragile veins, underlying disease, and age extremes. The diagnosis of the risk of imbalance in body temperature was associated with the altered metabolic rate, age extremes, and sedation. Conclusion: These findings provide scientific advances for nursing by providing help in diagnostic inference, in the anticipation of care, and in the decision-making by the nursing staff.

RESUMEN Introducción: Los pacientes en estado crítico, internados en una unidad de terapia intensiva, se encuentran expuestos a riesgos. Así, comprender las relaciones entre los elementos que involucran su seguridad y su protección se vuelve fundamental. Objetivo: Verificar la asociación entre los diagnósticos de enfermería del dominio seguridad y protección de la NANDA Internacional con sus componentes en pacientes críticos internados en unidad de terapia intensiva. Métodos: Estudio transversal, realizado con 86 pacientes críticos de un hospital en el Nordeste de Brasil, a través del formulario. En el análisis estadístico, se aplicaron las pruebas de Qui-cuadrado y exacto de Fisher. Resultados: El diagnóstico Riesgo de respuesta adversa al medio de contraste con yodo presentó asociación estadística con los componentes: Propiedades físicas y químicas de los medios de contraste, Ansiedad, Uso concomitante de medicamentos, Venas fragilizadas, Enfermedad subyacente y Extremos de edad. El diagnóstico Riesgo de desequilibrio en la temperatura corporal se asoció a la tasa metabólica alterada, extremos de edad y sedación. Conclusión: Estos hallazgos proporcionan avances científicos para la enfermería al proporcionar ayuda en la inferencia diagnóstica, en la previsión de los cuidados y en la toma de decisión del personal de enfermería.

O Consenso em síndrome das pernas inquietas contou com a participação de neurologistas de vários estados brasileiros, os quais incansavelmente revisaram a literatura dos últimos anos em busca de evidências, tanto no que se refere ao diagnóstico como ao tratamento, de acordo com a Classificação do Centro de Oxford para Medicina Baseada em Evidências.

The Consensus on restless legs syndrome is an effort of neurologists from several Brazilian states, which tirelessly reviewed the literature of recent years in search of evidence, both in regard to diagnosis and treatment, according to the Oxford Centre for Evidence-based Medicine.

BACKGROUND: Immunofluorescence testing is an important tool for diagnosing blistering diseases. OBJECTIVE: To characterize the immunofluorescence findings in patients diagnosed with autoimmune blistering skin diseases. METHODS: We retrospectively analyzed immunofluorescence results encompassing a 10-year period. RESULTS: 421 patients were included and divided into 2 groups: group 1- intraepidermal blistering diseases (n=277) and 2- subepidermal blistering diseases (n=144). For group 1, positive DIF findings demonstrated: predominance of IgG intercellular staining (ICS) and C3 for pemphigus foliaceus-PF (94% and 73% respectively), pemphigus vulgaris-PV (91.5%-79.5%) and paraneoplastic pemphigus-PNP (66%-33%); ICS IgA in 100% of IgA pemphigus cases, and IgG deposits in the basement membrane zone (BMZ) along with ICS in one Hailey-Hailey patient. The IIF findings revealed mean titers of 1:2.560 for PV and 1:1.280 for PF. For paraneoplastic pemphigus, IIF was positive in 2 out of 3 cases with rat bladder substrate. In group 2, positive DIF findings included multiple deposits at basement membrane zone for epidermolysis bullosa acquisita-EBA (C3-89%,IgG-79%,IgA-47%,IgM-21%) mucous membrane pemphigoid-MMP (C3,IgG,IgA,IgM-80%) and bullous pemphigoid-BP (C3-91%,IgG-39%,IgA-11%,IgM-6%), and IgA at basement membrane zone for IgA linear disease (99%) and dermatitis herpetiformis-DH (dermal papillae in 84.6%). For lichen planus pemphigoides, there was C3 (100%) and IgG (50%) deposition at basement membrane zone. indirect immunofluorescence positive findings revealed basement membrane zone IgG deposits in 46% of BP patients, 50% for EBA, 15% for IgA linear dermatosis and 50% for LPP. Indirect immunofluorescence positive results were higher for BP and EBA with Salt-Split skin substrate. CONCLUSION: Our results confirmed the importance of immunofluorescence assays in diagnosing autoimmune blistering diseases, and higher sensitivity for indirect immunofluorescence when Salt-split skin technique is performed.

OBJETIVO: Investigar os fatores associados à lesão renal aguda e o prognóstico em pacientes com doença pulmonar. MÉTODOS: Foi realizado estudo prospectivo com cem pacientes consecutivos admitidos em uma unidade de terapia intensiva respiratória em Fortaleza (CE). Foram investigados fatores de risco para lesão renal aguda e mortalidade em um grupo de pacientes com doenças pulmonares. RESULTADOS: A média de idade foi de 57 anos, sendo 50% do gênero masculino. A incidência de lesão renal aguda foi maior nos pacientes com PaO2/FiO2<200 mmHg (54% versus 23,7%; p=0,02). O óbito ocorreu em 40 casos. A mortalidade no grupo com lesão renal aguda foi maior (62,8% versus 27,6%; p=0,01). A relação PaO2/FiO2<200 mmHg foi fator independente associado à lesão renal aguda (p=0,01); PEEP na admissão (OR: 3,6; IC95%: 1,3-9,6; p=0,009) e necessidade de hemodiálise (OR: 7,9; IC95%: 2,2-28,3; p=0,001) foram fatores de risco independentes para óbito. CONCLUSÃO: Houve maior mortalidade no grupo com lesão renal aguda. Mortalidade aumentada foi associada com ventilação mecânica, PEEP alta, ureia e necessidade de diálise. Estudos futuros devem ser realizados para melhor estabelecer as inter-relações entre lesão renal e pulmonar e seu impacto no prognóstico.

OBJECTIVE: To examine the factors associated with acute kidney injury and outcome in patients with lung disease. METHODS: A prospective study was conducted with 100 consecutive patients admitted to a respiratory intensive care unit in Fortaleza (CE), Brazil. The risk factors for acute kidney injury and mortality were investigated in a group of patients with lung diseases. RESULTS: The mean age of the study population was 57 years, and 50% were male. The incidence of acute kidney injury was higher in patients with PaO2/FiO2<200 mmHg (54% versus 23.7%; p=0.02). Death was observed in 40 cases and the rate of mortality of the acute kidney injury group was higher (62.8% versus 27.6%; p=0.01). The independent factor that was found to be associated with acute kidney injury was PaO2/FiO2<200 mmHg (p=0.01), and the independent risk factors for death were PEEP at admission (OR: 3.6; 95%CI: 1.3-9.6; p=0.009) and need for hemodialysis (OR: 7.9; 95%CI: 2.2-28.3; p=0.001). CONCLUSION: There was a higher mortality rate in the acute kidney injury group. Increased mortality was associated with mechanical ventilation, high PEEP, urea and need for dialysis. Further studies must be performed to better establish the relationship between kidney and lung injury and its impact on patient outcome.

Nos últimos anos, a dermatoscopia tem sido utilizada como importante ferramenta auxiliar no diagnóstico de inúmeras dermatoses, incluindo infecções e infestações (Entodermatoscopia). A Tinea nigra é uma feoifomicose rara, que afeta principalmente a pele glabra das palmas e plantas. Descrevemos o caso de doente de 14 anos, com mácula pigmentada de crescimento progressivo na mão esquerda, diagnosticada como Tinea nigra após o exame clínico e dermatoscópico. Estas imagens enfatizam a importância da dermatoscopia na prática dermatológica diária.

Dermoscopy has being used over the past twenty years as a noninvasive aid in the diagnosis of innumerable skin conditions, including infectious diseases and infestations (Entodermoscopy).Tinea nigra is a superficial phaeohyfomycosis that affects mainly the glabrous skin of palms and soles. We describe a 14 year-old girl with a three-month history of an enlarging brown patch of her hand diagnosed as Tinea Nigra following clinical and dermoscopy examination.These images emphasize the importance of dermoscopy as a diagnostic tool in the daily routine of dermatologists.

Inicialmente, denominada "Balanoposthite chronique circonscrite benigne a plasmocytes", a balanite plasmocitária de Zoon é uma dermatose inflamatória crônica da glande e prepúcio afetando homens não circuncisados. As diferentes opções de tratamento para esta afecção apresentam frequentemente resultados parciais. Relatos têm demonstrado sucesso terapêutico, com o uso de tacrolimo tópico. Relatamos o uso de pimecrolimus, um homólogo de tacrolimo, com boa resposta. Dois doentes do sexo masculino, com diagnóstico de Balanite de Zoon confirmado através de biópsia, foram submetidos a um tratamento diário com pimecrolimus tópico a 1%, com importante melhora da doença após 6 semanas para o paciente, 1 e 8 semanas para o 2. Conclusão: O pimecrolimus em creme pode ser uma opção para o tratamento da doença

Initially called (in French) "Balanoposthite chronique circonscrite benigne a plasmocytes", Zoon's plasma cell balanitis is a chronic inflammatory dermatosis affecting the glans and foreskin of uncircumcised men. The different treatment options for this condition often present partial results. Reports have shown therapeutic success using topical tacrolimus. We report the use of pimecrolimus, a homologue of tacrolimus, with good response. Two male patients diagnosed with Zoon's plasma cell balanitis, confirmed by biopsy, were subjected to daily treatment with topical pimecrolimus1%. Significant improvement was noted in patient 1 after 6 weeks and after 8 weeks in patient 2. Conclusion: Pimecrolimus cream may be an option for the treatment of this disease

OBJETIVO: Descrever um caso de encefalopatia de Wernicke associada à doença de Crohn na infância. DESCRIÇÃO DO CASO: Menino de cinco anos, com diagnóstico de doença de Crohn por colonoscopia com biópsia há um ano; desde então, fez uso de diversos medicamentos sem resultados terapêuticos. Evoluiu com pancreatite há três meses, quando foi iniciada nutrição parenteral. Apresentou subitamente sonolência, episódios de frases desconexas e alteração da movimentação ocular. O exame neurológico evidenciou nistagmo vertical para cima em todas as posições e nistagmo horizontal no desvio conjugado do olhar. A ressonância magnética do encéfalo mostrou alterações compatíveis com a encefalopatia de Wernicke, sendo instituído o tratamento com tiamina parenteral imediatamente, com reversão completa dos sintomas por volta do 30º dia de tratamento. COMENTÁRIOS: Embora seja uma entidade rara, deve-se suspeitar de encefalopatia de Wernicke frente à presença de fatores de risco, uma vez que o tratamento imediato evita as sequelas neurológicas.

OBJECTIVE: To report a case of Wernicke encephalopathy associated with Crohn disease in childhood. CASE DESCRIPTION: A five year-old boy with Crohn disease, diagnosed by colonoscopy and biopsy one year ago; he has been treated with many different medications without results. During the past year, the patient was diagnosed with pancreatites and has received parenteral nutrition since then. After three months, the child suddenly presented drowsiness, meaningless speech and ocular movement disturbance. Neurologic examination disclosed upbeat nystagmus in all positions and horizontal nystagmus during conjugate deviation of the eyes. Magnetic resonance showed abnormalities consistent with Wernicke encephalopathy. Parenteral thiamine has been administered soon after diagnosis and by the 30th day of treatment, recovery of symptoms was complete. COMMENTS: Despite being a rare entity, neurological symptoms associated to the presence of risk factors such as prolonged parenteral nutrition should suggest Wernicke encephalopathy. Immediate treatment is important to avoid neurological disabilities.