Introduction. Severity and outcome assessments are crucial in trauma. Our aim was to describe the role of a group of cytokines (TNFα, IL-6, IL-10, and HMGB-1) and ICAM-1 as severity and outcome assessment tools and their kinetics in the first 72 h after severe trauma. Materials and Methods. Authors designed a prospective cohort study of severe polytrauma patients (ISS > 15) in a level 1 Trauma Centre. Cytokines and ICAM-1 levels and Th1/Th2 ratios were assessed at admission, 24, 48, and 72 h. SIRS, SIRS with hypoperfusion, and shock were identified. Outcomes considered were ICU admission, ARDS, MODS, and death. Results. Ninety-nine patients were enrolled (median ISS: 29 and age 31). There was an early release of pro- and anti-inflammatory mediators with higher values at admission (except for ICAM-1). On admission, IL-6 was associated with ISS, IL-10 with SIRS with hypoperfusion, and HMGB-1 with shock. Several cytokines were associated with outcomes, especially IL-6 and IL-10 at 72 h with MODS and death. Low TNFα/IL-10 and IL-6/IL-10 ratios at 24 and 72 h were associated with MODS and death. Conclusions. Pro- and anti-inflammatory responses occur simultaneously and earlier after injury. Cytokines may be useful for outcome assessment, especially IL-6 and IL-10. Low Th1/Th2 ratio at 24 to 72 h is associated with MODS and death.

Knee joint lesions can be solitary or occur concomitantly with other lower limb abnormalities. Ring-shaped lateral meniscus (RSM) and hypoplasic anterior cruciate ligament (ACL) are two rare malformations. The therapeutic management of such abnormalities is not consensual, and highly depends on clinical symptomatology. We report a case of a 25-year-old girl with progressive knee pain whose MRI demonstrated a continuous segment of lateral meniscus situated along the medial aspect of the lateral compartment, continuous with the otherwise normal-appearing lateral meniscus, compatible with an RSM. This anatomic variant can be mistaken by a displaced meniscal fragment, like a bucket-handle tear, a central tear of a discoid meniscus, or incomplete discoid meniscus, as previously reported. Her MRI examination also showed a thinned ACL with anomalous lateral course. This abnormality may be mistaken for an ACL rupture and/or a meniscofemoral ligament with agenesis of ACL. Multiple images in different planes as well as following the course of meniscal and ligaments are critical clues to avoid misdiagnosis. As a result, the diagnosis of an RSM along with hypoplasic ACL with abnormal attachment was assumed based on MRI and confirmed during arthroscopy. The patient was treated conservatively with clinical outcome improvement.

We found that a large number of factors are implicated in CK and Mb variations. Rhabdomyolysis is a very frequent complication, but increase in CK marker alone does not seem to be correlated with the incidence of ARF. Therefore, Mb level should be considered in this group of patients.

AimThe objective of this study was to investigate whether dental hypersensitivity and dental fear were linked to the presence and severity of MIH. Methods For this cross-sectional study, 1830 students between the ages of 6 and 12 years were recruited from four randomly selected schools. The Children's Fear Survey Schedule-Dental Subscale questionnaire was used to assess dental anxiety and fear. The children's self-reported dental hypersensitivity resulting from MIH was evaluated using the Wong-Baker Facial Scale and the Visual Analog Scale (VAS). Results MIH was correlated with tooth hypersensitivity, particularly in severe cases. Dental fear was present in 17.4% of the children with MIH, but it was not associated with dental hypersensitivity, gender, or age. Conclusion No association was found between dental fear and dental hypersensitivity in children with MIH.

Objectives: To evaluate the outcome of patients with cervical carcinoma submitted to percutaneous nephrostomy due to malignant ureteral obstruction. Material and Methods: Retrospective cohort study with data obtained from medical records of patients diagnosed with cervical carcinoma with renal dysfunction (AKIN = stage 2) undergoing PCN for malignant obstructive uropathy between January 2019 and December 2020 at a tertiary hospital in Recife, Brazil. Results: We evaluated 31 patients submitted to percutaneous nephrostomy. Median age was 50 years, and the majority of women were non-white with an elementary education. Twenty-one patients required hemodialysis before the procedure, and 61.9% of them recovered renal function after nephrostomy. Bleeding and nephrostomy tube displacement were the leading causes of complications in the first 30 days (69%). Median overall survival after the procedure was 8.7 months. Survival was significantly worse in patients with anemia, ECOG performance status = 2 (p=0.04), pre-nephrostomy dialysis (p=0.01), and not recovery of renal function after PCN. Conclusions: Performing urinary diversion through percutaneous nephrostomy seems to offer greater benefits in patients with better functionality. Given the morbidity and complications inherent to percutaneous nephrostomy, the profile of patients who benefit most from the procedure remains unclear. Referrals for the procedure must be individualized and consider the patient's desire, treatment perspectives, and functionality.