SUMMARY OBJECTIVE: The aim of this study was to analyze the occurrence and risk factors associated with infections during pregnancy in patients with systemic lupus erythematosus. METHODS: This is a retrospective cohort study using the data of pregnant women who were followed up between 2011 and 2018 at a university hospital. RESULTS: The data of 221 pregnant women with systemic lupus erythematosus were analyzed. The incidence of infections was 22.6% (50/221), with the urinary tract being the most frequent site of infection (32/221, 14.5%) followed by the respiratory tract (15/221, 6.8%). The bivariate analysis showed that active disease, hematological systemic lupus erythematosus, reduced complement, and use of prednisone ≥5 and ≥10 mg increased the chance of infection during early pregnancy (p=0.05, p=0.04, p=0.003, p=0.008, and p=0.02, respectively), while disease activity and anti-DNA positivity increased it at the end of pregnancy (p=0.03 and p=0.04, respectively). Prednisone at a dose ≥5 mg increased the chance of infection in the beginning (p=0.01) and at the end of pregnancy (p=0.008). Multivariate analysis showed that increasing the dose of prednisone from 5 to 10 mg tripled the chance of developing infections in pregnant women with lupus (p=0.02). CONCLUSION: The study showed an increased chance of infections in pregnant women with systemic lupus erythematosus and it was associated with the use of prednisone.

ABSTRACT Background: Non-metastatic castration resistant prostate cancer (M0 CRPC) has seen important developments in drugs and diagnostic tools in the last two years. New hormonal agents have demonstrated improvement in metastasis free survival in M0 CRPC patients and have been approved by regulatory agencies in Brazil. Additionally, newer and more sensitive imaging tools are able to detect metastasis earlier than before, which will impact the percentage of patients staged as M0 CRPC. Based on the available international guidelines, a group of Brazilian urology and medical oncology experts developed and completed a survey on the diagnosis and treatment of M0 CRPC in Brazil. These results are reviewed and summarized and associated recommendations are provided. Objective: To present survey results on management of M0 CRPC in Brazil. Design, setting, and participants: A panel of six Brazilian prostate cancer experts determined 64 questions concerning the main areas of interest: 1) staging tools, 2) treatments, 3) side effects of systemic treatment/s, and 4) osteoclast-targeted therapy. A larger panel of 28 Brazilian prostate cancer experts answered these questions in order to create country-specific recommendations discussed in this manuscript. Outcome measurements and statistical analysis: The panel voted publicly but anonymously on the predefined questions. These answers are the panelists' opinions, not a literature review or meta-analysis. Therapies not yet approved in Brazil were excluded from answer options. Each question had five to seven relevant answers including two non-answers. Results were tabulated in real time. Conclusions: The results and recommendations presented can be used by Brazilian physicians to support the management of M0 CRPC patients. Individual clinical decision making should be supported by available data, however, for Brazil, guidelines for diagnosis and management of M0 CRPC patients have not been developed. This document will serve as a point of reference when confronting this disease stage.

Um dos maiores problemas dos pacientes pós-cirurgia bariátrica é o excedente de pele nas regiões glútea e lombar. Somado a isso, há escassez de tecido para preencher a região glútea, que pode ser corrigida por vários métodos, entre eles a lipoenxertia ou, ainda, o implante de prótese isoladamente, nos casos em que não haja ptose. Se o contrário ocorre, essas opções tornam-se muito limitadas e pouco expressivas. O lifting glúteo com emprego de retalho fasciocutâneo em cambalhota permite resolver tanto a flacidez como o excesso de pele com ptose. Este trabalho tem por objetivo demonstrar a facilidade de confecção e a versatilidade de utilização do retalho glúteo em cambalhota para correção de flacidez das regiões glútea e lombar. Uma paciente foi submetida ao procedimento cirúrgico de lifting glúteo associado ao emprego de retalho fasciocutâneo desepidermizado em cambalhota, para correção de falta de preenchimento local. Melhora acentuada das regiões glútea e lombar foi obtida após a retirada do excesso de tecido superior, confecção de um retalho fasciocutâneo de pedículo inferior e tração da pele. Além disso, a rotação do retalho e sua fixação ao músculo glúteo melhoraram acentuadamente o contorno posterior da paciente, com pós-operatório bastante cômodo. Com morbidade mínima, foi retirado o excesso cutâneo e, concomitantemente, aumentada a região glútea com retalho autólogo, que é desprezado durante a execução de muitas técnicas, melhorando o contorno da paciente e deixando uma cicatriz discreta, que poderá ser ocultada pelas roupas íntimas.

A major problem for patients after bariatric surgery is the excess skin in the gluteal and lumbar regions. In addition, there is a lack of available tissue to fill the gluteal region, which can be overcome by various methods, including fat grafting or even prosthesis implantation alone, in cases where no ptosis is noted. However, if this is not the case, the options become very limited and those available are not very effective. The use of a buttock lift with a fasciocutaneous flap solves the problems of sagging and excess skin with ptosis. In the present article, we aimed to demonstrate the ease of preparation and the versatility of use of the gluteal flap to correct sagging of the lumbar and gluteal regions. One patient underwent a buttock lift using a de-epidermized fasciocutaneous flap to overcome the lack of local filling. Marked improvement of the gluteal and lumbar regions was noted after removal of the excess tissue, construction of an inferior fasciocutaneous flap, and use of skin traction. In addition, rotation of the flap and its attachment to the gluteal muscle markedly improved the patient's posterior contour and postoperative comfort. With minimal morbidity, excess skin was removed and the gluteal region was concomitantly increased using an autologous flap that is neglected in many techniques; this resulted in an improved contour and a discreet scar that could be hidden by the patient's underwear.