SUMMARY This study aimed to evaluate the efficacy of the action of the Lactobacillus Plantarum probiotic as a immunomodulatory and hypolipidemic agent in dyslipidemic nephrotic children and adolescents. METHODS: This is a randomized, double-blind, placebo-controlled clinical trial in pediatric, compensated or partially compensated nephrotic syndrome and dyslipidemic subjects undergoing regular outpatient follow-up. Serum lipid and TNF-α (proinflammatory) and IL-10 (anti-inflammatory) cytokine variations were evaluated. Cytokines were analyzed by enzyme-linked immunosorbent assay (ELISA). RESULTS: In the probiotic group there was a tendency to reduce TNF-α levels and increase IL-10 levels when compared to controls. Regarding the lipid profile, there was a decrease in serum triglyceride (6.0 mg / dL) and total cholesterol (41.5 mg / dL) levels in the probiotic group when compared to baseline levels, while in the control group there was an increase in serum triglyceride (49.5 mg / dL) and total cholesterol (8.0 mg / dL) levels, respectively. CONCLUSION: Preliminary results suggest that L. Plantarum showed an immunomodulatory and hypolipidemic effect in nephrotic and dyslipidemic pediatric subjects.

Achalasia is a disorder of the lower esophagus in which its sphincter is unable to relax even during a peristaltic reflex. Its development is related to the loss of both Auerbach's (myenteric) and Meissner's (submucous) plexuses of the distal esophagus and lower sphincter, due to a neurodegenerative process that may be autoimmune or secondary to an infection. In Brazil, Chagas disease is one of this disorder's main etiologies, by promoting the destruction of the myenteric plexus due an inflammatory response to the Trypanosoma cruzi. The Chagas megaesophagus is one of its presentations, consisting of the addition of achalasia to ineffective peristalsis that results in esophageal dilatation (1). The world's incidence of achalasia is about 1/100,000 and, because of its chronicity, its prevalence is about 9 to 10/100,000. It is estimated that, currently, about 1 million chronic Chagas patients live in Brazil. Megaesophagus affects about 7% to 10% of these patients, manifesting during about 20 to 40 years old (1-3). The main symptom of this condition is the long-lasting dysphagia, that may be followed by regurgitation, retrosternal pain, heartburn and sialorrhea. When facing symptoms like dysphagia, it is necessary, at first, to exclude diagnostic hypothesis of gastroesophageal reflux disease, mechanical obstruction of esophagus, or malignancy, since those are more prevalent; then, it must be proceeded the investigation of esophageal motility disorders, such as achalasia (4). Because of this illness' importance in our setting, and because of the need of accessible radiologic methods that allow diagnosis, classification and follow-up of patients, the barium-based contrast radiography of the esophagus (esophagogram) is still highlighted in the spite of more modern

Introdução: O câncer de laringe é o 14º câncer mais comum no mundo. Sem considerar os tumores de pele não-melanoma, na Região Centro-Oeste, o câncer de laringe é o 8º câncer mais comum entre homens e o 16º entre mulheres. Aproximadamente 2/3 dos casos desse tipo de tumor surgem na prega vocal verdadeira, localizada na glote; o tipo histológico mais prevalente nesse caso, em mais de 90% dos pacientes, é o carcinoma de células escamosas. Objetivo: Dada a importância dessa neoplasia, o objetivo do nosso estudo é delinear seu perfil epidemiológico em nossa instituição, centro de referência de cânceres de cabeça e pescoço na região Centro Oeste, a fim de contribuir na determinação de fatores de risco e, assim, propor diagnósticos mais precoces. Métodos: Trata-se de estudo epidemiológico observacional, retrospectivo, descritivo e quantitativo, de todos os casos de pacientes com diagnóstico de câncer de laringe atendidos pelo SUS no Serviço de Cirurgia de Cabeça e Pescoço do Hospital do Câncer do Estado de Goiás, no período de 2014 a 2018. Os casos foram analisados segundo: idade, sexo, tabagismo, etilismo, atividade ocupacional, subsítio, estadiamento, tipo histológico, e tempo entre queixa principal e diagnóstico. Resultados: Foram analisados 426 pacientes submetidos à biópsia de laringe, sendo destas 155 biópsias glóticas, das quais 152 corresponderam a carcinoma glótico epidermóie. Nesse universo de 152 casos, a média de idade foi 63,21 anos; 89,9% eram do sexo masculino; 92,9% eram tabagistas; 80,8% eram etilistas; 41,4% eram lavradores; o tempo médio para evoluir com disfonia foi 7,69 meses; 67,7% tinham o tumor na prega vocal direita; 41,4% tinham estadiamento T1; e 59,6% eram CEC II. Conclusão: Nossa epidemiologia regional mostrou semelhança com as epidemiologias nacional e mundial, que tendem a mostrar que homens tabagistas são o grupo mais vulnerável a ter câncer de laringe, em especial pela atividade econômica desenvolvida no Brasil Central, os trabalhadores rurais se mostraram como ocupação mais prevalente. Por isso programas de prevenção devem englobar esse grupo como foco principal.

This study presents a rare case of abscess associated with vaginocutaneous fistula due to atypical mycobacterial infection after sling surgery, which was successfully treated. Abscesses and fistulas are rare postoperative complications in treatment of stress urinary incontinence by transobturatory sling surgery, due to its high rate of positive outcomes in the treatment of urinary incontinence in women. These complications are considered to be related to the composition of the mesh and bacterial infection. We report a case of a 50-year-old patient who developed, in the 7th postoperative year of perineoplasty with sling placement, pelvic abscess and cutaneous fistula in the left thigh. Microbiological examination of the lesion revealed infection by Mycobacterium avium. Antibiotic therapy plus abscess drainage surgery and surgical correction of the fistulous pathway were the treatment of choice. During the surgery, a vaginal opening of the cutaneous fistula was evidenced, originating from the sling mesh, which was removed and later proved to be colonized by M. avium. The patient became asymptomatic after 1 year of postoperative follow-up.

Rev Med (São Paulo). 2019 set.-out.;98(5):315-23. 315 Teles Filho RV, Abe GM, Azevêdo LHS, Melo NC, Rabahi MF, Daher MT. Perfil epidemiológico da tuberculose óssea no Brasil, 201-2017 / Epidemiological profile of bone tuberculosis in Brazil, 2001-2017. Rev Med (São Paulo). 2019 set.-out.;98(5):315-23.