INTRODUÇÃOO herpes simples orofacial (HSO) -tanto em sua forma primá-ria quanto recorrente -é uma infecção de prevalência considerá-vel no mundo. Esta prevalência na população pediátrica, por sua vez, não é menos significativa. Etimologicamente, sabemos que o termo 'herpes' provém do grego antigo, que significa 'rastejar', 'arrastar-se' (1) .As lesões do herpes genital e oral são decorrentes de infecção pelo vírus herpes simples. O vírus herpes simples tipo 1 (HSV-1) ou herpesvírus humano 1 (HHV-1), é o agente etiológico principal das lesões vesiculares da região orofacial, enquanto o vírus herpes simples 2 (HSV-2), ou herpesvírus humano 2 (HHV-2) é a causa principal das lesões na região genital (2,3) . Entretanto, o HSV-1 pode levar a lesões na região genital e, embora mais raro, o HSV-2 pode ser manifestado na região orofacial (2,4) . As infecções pelos vírus herpes simples (HSV-1 e HSV-2) representam as doenças sexualmente transmissíveis mais comuns a nível global, alcançando uma soroprevalência de 80% em adultos, e apresentam um amplo espectro de acometimento clínico (4,5) .Esperamos, com esta revisão atualizada da literatura, abordando os aspectos clínicos da infecção por HSV-1, incluindo epidemiologia, etiologia, manifestações clínicas, métodos diagnósticos e tratamentos, bem como uma breve descrição da imunogenética da infecção pelo HSV-1, contribuir para o conhecimento sobre o HSO e seu manejo médico-clínico. ETIOLOGIA (1,6-8)Herpes é uma infecção causada por dois vírus da família Herpesviridae (herpes simples tipos 1 e 2), e pode afetar a região da boca, principalmente labial, órgãos genitais e áreas próximas. As formas de manifestação divergem de indivíduo para indivíduo.A família Herpesviridae abrange oito espécies passíveis de infectar seres humanos, que compartilham as seguintes características:• vírion apresentando um padrão arquitetural similar, composto de quatro partes: (a) núcleo eletrodenso, (b) capsídeo icosapentaédrico, (c) tegumento e (d) envelope; • são capazes de produzir várias espécies de enzimas, capazes de agir sobre o metabolismo dos ácidos nucleicos e proteínas da célula infectada (timidina quinase, DNA polimerase, helicase); • são capazes de assumir estado de latência infecciosa, e de se reativar periodicamente; • possuem genoma grande, com mais de 200 genes. RESUMOHerpes é uma infecção causada por dois vírus da família Herpesviridae (herpes simples tipos 1 e 2; HSV-1 e HSV-1), que apresenta curso clínico variável e para o qual atualmente não existe cura. As manifestações da infecção por HSV-1 incluem herpes simples orofacial primário e recorrente, enquanto as do HSV-2 em geral ocorrem na forma de herpes simples genital, embora casos de lesões genitais pelo HSV-1 e orais pelo HSV-2 possam ocorrer. As infecções pelo vírus herpes simples (HSV-1 e HSV-2) representam as doenças sexualmente transmissíveis mais comuns a nível global, alcançando uma soroprevalência de 80% em adultos. Nesta revisão da literatura, abordaremos os aspectos clínicos da infecção pelo HSV, incluindo a epidemiol...

Background. Phlebotonics have beneficial effects on some symptoms related to chronic venous disease (CVD) of the lower limbs. The most commonly used one is diosmin, available in a pure semisynthetic form or as a micronized purified flavonoid fraction. Patients and Methods. The primary objective of this single-blind, randomized, parallel-group, prospective study was to assess the clinical noninferiority of nonmicronized diosmin 600 mg once daily (D-group) compared to micronized diosmin 900 mg plus hesperidin 100 mg once daily (D/H-group) over a 6-month treatment period. Adult patients with a symptomatic CVD of the lower limbs (C0-C3 grade; 20-60 mm on a 100 mm visual analog scale (VAS)) were included. The primary endpoint was the change (from baseline to last postbaseline value) of the intensity of the lower-limb symptoms on VAS. Results. 114 patients (mean age, 44.4 years; women, 90.4%) were randomized in the per-protocol analysis (D-group, n=57; D/H-group, n=57). Symptoms significantly improved in both groups with adjusted mean VAS changes of -24.9 mm (p<0.0001) in the D-group and -22.8 mm (p<0.0001) in the D/H-group, corresponding to approximately 50% reduction in basal symptom intensity. The difference between groups was -2.1 mm with an upper limit of one-sided 90% confidence interval equal to 1.0 mm for a noninferiority margin set at 20 mm (noninferiority demonstrated). Intent-to-treat analysis confirmed per-protocol analysis. Difficulty in swallowing the tablets (VAS) was significantly lower in the D-group compared to the D/H-group (9.4 mm and 54.7 mm at 6 months, respectively; p<0.0001). The overall safety of both study drugs was good. Conclusion. Nonmicronized diosmin 600 mg was proven to have a noninferior efficacy compared to micronized diosmin 900 mg plus hesperidin 100 mg, associated with greater ease in swallowing the tablet.

Purpose Urinary antiseptics including methenamine and methylene blue are used in the symptomatic treatment of urinary tract infections (UTIs). Patients and Methods This was a prospective, double-blind, randomized, double-dummy safety and efficacy study of 2 urinary antiseptic combinations in the symptomatic treatment of recurrent cystitis: methenamine 120mg + methylene blue 20mg (Group A) versus acriflavine 15mg + methenamine 250mg + methylene blue 20mg + Atropa belladonna L. 15mg (Group B). All subjects underwent pretreatment urine culture and antibiotic sensitivity tests prior to 3-day oral treatment with study drug, followed by 3 days of antibiotic therapy (based on urine culture) + study drug treatment. Efficacy was evaluated using the Urinary Tract Infection Symptoms Assessment Questionnaire (UTISA). The primary endpoint was the percentage of patients presenting improvement in cystitis manifestations on the UTISA domain “Urination Regularity” at Visit 2. The primary safety variable was the incidence of treatment-related adverse events. Results A total of 144 subjects were randomized per group and 272 completed the study. Primary endpoint analysis demonstrates homogeneity between treatment groups, with 69.4% and 72.2% subjects, respectively, showing improvement in the score of the urinary regularity UTISA domain after 3 days of treatment ( p = 0.87). At Visit 2, incidence of treatment-related adverse events was higher in Group B (Group A: n= 11, Group B: n= 31, p = 0.0057). Conclusion Both treatments were effective in reducing UTI symptoms assessed by UTISA questionnaire after 3 days of treatment. The two regimens were comparable in incidence of adverse events, but the combination of methenamine + methylene blue resulted in fewer treatment-related adverse effects.

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Introduction: Neurofibromatosis type 1 (NF1) is one of the most common autosomal dominant genetic disorders. Some clinical manifestations are present at birth, while some develop during childhood, and others can occur at any age. Given the early age at which patients develop clinical features, diagnosis is often made during childhood. The most prevalent features of NF1 are café au lait spots, dermal and plexiform neurofibromas, and learning disability. A variety of skeletal problems may be seen in NF1, including scoliosis, short stature, and pseudoarthrosis. Reduced skeletal bone mass has been documented to be a common phenomenon in children and adults with NF1. Decreased serum 25-hydroxyvitamin D (vitamin D) levels have been noted in adults and children with NF1 and have been reported to be inversely correlated with the number of dermal neurofibromas in adults. However, the actual correlation of vitamin D level to bone density and dermal neurofibroma number in children with NF1 remains unclear. Objectives: The primary objective of this study was to evaluate vitamin D levels among children and adolescents with NF1. The secondary objective was to describe the levels of vitamin D among children and adolescents with NF1, to verify in which age group there is a higher frequency of vitamin D alterations, and to explore vitamin D level correlations between age, gender, sun exposure, number of neurofibromas, and number of plexiform neurofibromas. Methods: This was an observational, cross-sectional, hospital-based study. We obtained a convenience sample of individuals with confirmed diagnosis of NF1 from patients attending the Medical Genetics Service of the IPPMG-UFRJ and Santa Casa de Misericórdia of Rio de Janeiro over a 24-month period. We evaluated vitamin D levels in blood samples of patients with NF1 by a chemiluminescent immunoassay method, and we correlated the results with gender, age, number of neurofibromas, number of plexiform neurofibromas, and satisfactory sun exposure. Results: Of the 55 patients, 28 (50.9%) were female and 27 (49.1%) were male. Patient ages ranged from a minimum of 1.2 to a maximum of 19.6 years (mean age 10.95 years) and the median was 11.11 years. Median and mean body mass index (BMI; z score) were -0.09 (minimum value -1.63 and maximum of 4.62) and 0.16, respectively. The mean value of vitamin D was 30.82 ng/mL (±12.31) and the median was 29 ng/mL (minimum value of 10.40 ng/mL and maximum of 79.19 ng/mL). Conclusions: The levels of vitamin D did not differ according to gender, age group, or the presence or number of cutaneous neurofibromas. Among patients with adequate sun exposure, there was a higher incidence of sufficient serum vitamin D levels. Patients with cutaneous neurofibromas in the 0 to 11 age group had a greater tendency to vitamin D sufficiency in relation to patients aged 11 to 19 years.