Faculdade de Ciências Médicas da Santa Casa de São Paulo

Purpose To understand undergraduate training in bilingual speech and language therapy in Brazil and discuss its application to deaf individuals. Methods An exploratory, cross-sectional study with descriptive and interpretative analysis conducted between August 2022 and February 2023 in partnership with the Sociedade Brasileira de Fonoaudiologia. Data were collected through an electronic form sent to the 115 active speech and language programs in Brazil. Results Twenty-three programs participated, mainly from the Southeast Region and mostly public institutions. All programs offer courses on Brazilian Sign Language, mostly in-person, taught by hearing professors, ranging from 60 to 90 hours. Qualitative analysis revealed heterogeneous practices and perspectives on how curricula address deaf individuals’ needs, often lacking a clear stance on understanding deafness and deaf people regarding cultural and linguistic diversity. Other practices are divided into oral/auditory approaches to auditory rehabilitation and the use of technological resources and bilingual approaches that, besides Brazilian Sign Language, emphasize language development stages (oral, written, and signed). Conclusion Brazilian Sign Language content is present in curricula as required by law. However, there is still a tendency to overlook the needs of signing deaf individuals, favor oral/auditory practices, and limit bilingual speech and language therapy training to Brazilian Sign Language knowledge and non-mandatory projects and activities.

Purpose To understand undergraduate training in bilingual speech and language therapy in Brazil and discuss its application to deaf individuals. Methods An exploratory, cross-sectional study with descriptive and interpretative analysis conducted between August 2022 and February 2023 in partnership with the Sociedade Brasileira de Fonoaudiologia. Data were collected through an electronic form sent to the 115 active speech and language programs in Brazil. Results Twenty-three programs participated, mainly from the Southeast Region and mostly public institutions. All programs offer courses on Brazilian Sign Language, mostly in-person, taught by hearing professors, ranging from 60 to 90 hours. Qualitative analysis revealed heterogeneous practices and perspectives on how curricula address deaf individuals’ needs, often lacking a clear stance on understanding deafness and deaf people regarding cultural and linguistic diversity. Other practices are divided into oral/auditory approaches to auditory rehabilitation and the use of technological resources and bilingual approaches that, besides Brazilian Sign Language, emphasize language development stages (oral, written, and signed). Conclusion Brazilian Sign Language content is present in curricula as required by law. However, there is still a tendency to overlook the needs of signing deaf individuals, favor oral/auditory practices, and limit bilingual speech and language therapy training to Brazilian Sign Language knowledge and non-mandatory projects and activities.

Resumo Objetivo Avaliar a eficácia e a segurança da tenotomia percutânea do tendão do músculo iliopsoas guiada por ultrassonografia (USG) em cadáveres. Métodos Realizamos um estudo anatômico e descritivo da técnica de tenotomia percutânea do tendão do músculo iliopsoas guiada por USG para repassar nossa experiência ao realizá-la e a reprodutibilidade na prática clínica. Resultados Das 20 tenotomias, 17 foram totais, realizadas no nível da borda superior do acetábulo, e 3 foram parciais. Durante um dos procedimentos, houve uma lesão parcial do nervo femoral. Foram realizadas as medições da distância entre o local onde a lâmina foi introduzida e o nervo femoral, uma estrutura nobre que estaria em maior risco durante o procedimento, e a distância média foi de 8,4 mm. Conclusão Os procedimentos de liberação do tendão do iliopsoas guiados por USG podem ser executados em um modelo cadavérico, pois obtém-se de forma consistente a liberação total do tendão, exceto em casos de obesidade, com mínimas repercussões em estruturas adjacentes; os procedimentos demandam aproximadamente 4 minutos para serem concluídos.

Aortic arch aneurysms are often asymptomatic, being diagnosed incidentally in tests such as computed tomography, magnetic resonance imaging, or echocardiogram. Conventional treatment involves thoracotomy surgery, although treatment can also be performed using endovascular techniques. This article presents a case report of a complex aneurysm of the aortic arch with involvement of the left subclavian artery. Treatment was initiated with debranching of the supra-aortic trunks by carotid-carotid and carotid-subclavian bypasses, followed by ligation of the common carotid and left subclavian arteries. A second procedure was then needed to construct a surgical vascular conduit using a Dacron graft to obtain access to the aortic arch for the stent graft delivery device, due to the narrow caliber of the external femoral and iliac arteries. This report illustrates a satisfactory outcome in a case of aortic arch aneurysm with complex anatomy.

Leptospirose é uma zoonose que pode evoluir para formas graves, como a Síndrome de Weil, com icterícia e insuficiência hepática. Este relato descreve o caso de uma paciente de 13 anos com quadro inicial de epigastralgia, mialgia, febre e icterícia, evoluindo para hepatite fulminante. A sorologia confirmou leptospirose com IgM positivo, e a paciente foi submetida a transplante hepático emergencial devido à insuficiência hepática grave, com complicações como ascite, coagulopatia e necessidade de diálise. O explante hepático revelou necrose submaciça e fibrose avançada. A boa evolução pós-operatória reforça a necessidade de reconhecimento rápido da doença e intervenção multidisciplinar em casos críticos. Este relato adiciona uma contribuição significativa à literatura limitada sobre transplantes hepáticos associados à leptospirose

Leptospirosis is a zoonosis that can progress to severe forms, such as Weil’s syndrome, characterized by jaundice and liver failure. This report describes the case of a 13-year-old female patient who initially presented with epigastric pain, myalgia, fever, and jaundice, later progressing to fulminant hepatitis. Serology confirmed leptospirosis with positive IgM, and the patient underwent an emergency liver transplant due to severe hepatic failure, with complications including ascites, coagulopathy, and the need for dialysis. The liver explant revealed submassive necrosis and advanced fibrosis. The favorable postoperative outcome highlights the importance of early disease recognition and a multidisciplinary approach in critical cases. This report significantly contributes to the limited literature on liver transplantation associated with leptospirosis.

Introduction Despite the high lifetime prevalence and elevated disability rates, treatments for obsessive‐compulsive disorder (OCD) have limited efficacy. Considering the abnormal connectivity in the cortical‐striatal‐thalamic‐cortical loop circuits in OCD, several randomized controlled trials (RCTs) have addressed the efficacy of different non‐invasive brain stimulation (NIBS) modalities for the management of OCD. However, these RCTs yielded inconclusive results. Methods This network meta‐analysis (NMA) included RCTs of NIBS interventions, such as transcranial direct current stimulation (tDCS) and various repetitive transcranial magnetic stimulation (rTMS), in OCD patients. The primary outcomes were changes in the overall severity of OCD and acceptability (i.e., dropout rates). Results This NMA of 34 eligible RCTs (1089 participants) and 24 different NIBS interventions revealed that three NIBS interventions significantly improved overall OCD severity compared with sham controls, which were high‐frequency rTMS over the dorsolateral prefrontal cortex (DLPFC) [mean difference (MD) = −10.81, 95% confidence intervals (95% CIs) = −20.80 to −0.82], high‐frequency deep TMS over the dorsal medial prefrontal cortex/anterior cingulate cortex (dmPFC/ACC) (MD = −9.74, 95% CIs = −16.42 to −3.06), and low‐frequency rTMS over the right DLPFC (MD = −4.70, 95% CIs = −8.84 to −0.57). Conclusions This study highlighted that excitatory stimulation over the dmPFC / ACC and bilateral DLPFC , or inhibitory stimulation over the right DLPFC , was associated with significant improvements in overall OCD severity. Further large‐scale RCTs with longer follow‐up periods are needed to investigate the true impact of NIBS ‐based intervention to manage OCD . Trial Registration: PROSPERO: CRD42023394953

Purpose This study aimed to evaluate the epidemiological profile trends and economic impact of sickle cell disease (SCD) in Brazil from 2008 to 2022, focusing on incidence, mortality, and healthcare costs. Methods A cross-sectional analysis was conducted using data from the Fundação Oswaldo Cruz’s platform, Plataforma de Ciência de Dados Aplicada à Saúde, encompassing hospitalizations related to SCD from January 2008 to December 2022. The International Classification of Diseases codes for SCD were used to retrieve data on incidence, mortality, procedures performed, and healthcare costs. Results The study included 151,535 hospitalizations for SCD, with 69.92% associated with SCD crises and 22.48% without crises. The mean annual hospitalizations were higher for crises (6,883.06) compared to those without crises (2,221.12). Mortality rates were significantly higher for patients hospitalized with crises compared to those without crises (p < 0.001). The economic impact of SCD was substantial, with annual costs exceeding 413 million USD. Conclusion This study revealed a significant burden of SCD in Brazil, characterized by high hospitalization rates, particularly among younger patients, and elevated mortality rates associated with crises. Prospective studies and public health interventions are warranted to address SCD and mitigate its impact on public health.

Objective: To report on the experience of implementing low-power laser therapy in Primary Health Care (PHC) in the municipality of Santos. Method: Descriptive study with a time frame from 2017 to 2024. The participants were nurses (specialists and general practitioners) and managers. The analysis was based on the theoretical framework of clinical management. Results: The implementation of laser therapy began with one nurse in a small hospital. The success of the process was driven by the nurse’s political articulation, dialog with different levels of care and managers, and the acquisition of laser equipment. A total of 115 nurses were qualified to perform the technique in all SUS units in the municipality, with an emphasis on PHC. Final considerations: The experience demonstrates the potential of local initiatives to transform clinical management in the SUS. Collaboration between managers, health professionals, and the community is crucial for a more efficient, accessible, and humane health system. DESCRIPTORS Laser Therapy; Primary Health Care; Nursing Care; Organization and Administration

Objective: To report on the experience of implementing low-power laser therapy in Primary Health Care (PHC) in the municipality of Santos. Method: Descriptive study with a time frame from 2017 to 2024. The participants were nurses (specialists and general practitioners) and managers. The analysis was based on the theoretical framework of clinical management. Results: The implementation of laser therapy began with one nurse in a small hospital. The success of the process was driven by the nurse’s political articulation, dialog with different levels of care and managers, and the acquisition of laser equipment. A total of 115 nurses were qualified to perform the technique in all SUS units in the municipality, with an emphasis on PHC. Final considerations: The experience demonstrates the potential of local initiatives to transform clinical management in the SUS. Collaboration between managers, health professionals, and the community is crucial for a more efficient, accessible, and humane health system. DESCRIPTORS Laser Therapy; Primary Health Care; Nursing Care; Organization and Administration

Objective: To report on the experience of implementing low-power laser therapy in Primary Health Care (PHC) in the municipality of Santos. Method: Descriptive study with a time frame from 2017 to 2024. The participants were nurses (specialists and general practitioners) and managers. The analysis was based on the theoretical framework of clinical management. Results: The implementation of laser therapy began with one nurse in a small hospital. The success of the process was driven by the nurse’s political articulation, dialog with different levels of care and managers, and the acquisition of laser equipment. A total of 115 nurses were qualified to perform the technique in all SUS units in the municipality, with an emphasis on PHC. Final considerations: The experience demonstrates the potential of local initiatives to transform clinical management in the SUS. Collaboration between managers, health professionals, and the community is crucial for a more efficient, accessible, and humane health system. DESCRIPTORS Laser Therapy; Primary Health Care; Nursing Care; Organization and Administration

BACKGROUND Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary. AIM To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB. METHODS A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data. RESULTS 1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma. CONCLUSION Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.

BACKGROUND Cerebellar liponeurocytoma is a rare, low-grade neoplasm (WHO grade 2) characterized by neuronal or neurocytic differentiation and variable glial differentiation with lipoma-like alterations. First described in 1978 and recognized in the WHO classification in 2000, it presents significant challenges in radiological and pathological differentiation. This differentiation is crucial to avoid unnecessary or deleterious treatments. OBSERVATIONS The patient presented with symptoms including headache, dizziness, hiccups, nausea, vomiting, tinnitus, and left-sided ataxia. Imaging revealed a heterogeneous lesion in the left cerebellopontine angle. Resection was performed via a left suboccipital retrosigmoid approach, resulting in significant improvement in axial and appendicular ataxia, although left-sided anacusis persisted. Histopathological analysis confirmed cerebellar liponeurocytoma showing hypercellularity, with neurocytic cells containing lipid accumulations. Immunohistochemical analysis revealed diffuse expression of synaptophysin and focal expression of glial fibrillary acidic protein, with a Ki-67 proliferation index of 7%. LESSONS Cerebellar liponeurocytoma is a rare tumor requiring accurate histopathological differentiation to determine the appropriate treatment. Resection remains the mainstay of treatment, with postoperative radiotherapy potentially reducing recurrence. Multidisciplinary follow-up is crucial for managing residual symptoms and monitoring for recurrence. This case aligns with existing literature and underscores the importance of comprehensive diagnostic and therapeutic approaches to improve patient outcomes. https://thejns.org/doi/10.3171/CASE24521

Aim Describe the role of dedicated ultrasound in evaluating breast implants compared to breast magnetic resonance. Materials and Methods A prospective observational study was conducted in a single center to evaluate breast implant complications in patients referred to breast magnetic resonance (MRI) scan. All patients who had breast implants submitted to MRI scan were invited to a complementary dedicated ultrasound (US) evaluation of the breast implants. The implant changes were classified following a dedicated protocol. The classifiers used to evaluate the implant include evaluation of implant surface (shell), implant internal content homogeneity, fibrous capsule, intracapsular space, pericapsular space, and axillary extension. Results Preliminary results included evaluating 29 consecutive patients who underwent MRI. Twenty-nine patients with 49 implants were included in the study. The US showed a superior ability to assess the internal contents of the implants, the implant surface, and the intracapsular contents. There were no significant statistical differences in evaluating macro changes such as implant location, intracapsular collection, and radio-frequency identification (RFID) presence. MRI was superior to the US in classifying the fibrous capsule type. Conclusion US of silicone implants can be used as an alternative to MRI to evaluate implant complications.

We conducted a detailed experimental investigation of the Ag(977) vicinal surface, a high Miller index surface derived from the (111) surface. The sample surface was prepared using standard methodology and its quality was examined by XPS, LEED, and STM. I(V)-LEED analysis was used to determine the surface structure focusing the intricate relaxation dynamics expected for this surface. Our LEED analysis revealed an inward relaxation for the step chain (SC) atoms, whereas the corner atoms (CC) relaxed outwards. To gain more information on the obtained relaxations, we also performed density functional theory (DFT) calculations for the constructed structural model. Through charge distribution analysis, we found out that the step atoms interact weakly with their adjacent counterparts, resulting in terrace atoms presenting electronic environment similar to those found on flat surfaces. Furthermore, we conducted ARPES measurements to map the electronic structure of the surface. The DFT calculations and ARPES results have shown that the electronic bands observed arise from the hybridization between bulk and surface electronic states.

Background Health inequality in Latin America is particularly severe for individuals living with HIV (PLHIV) and key populations, such as men who have sex with men, transgender women, people who use drugs, and sex workers. Despite regional programs aimed at reducing health inequalities, such as the Sustainable Development Goals and the Sustainable Health Agenda for the Americas 2018–2030, the COVID-19 health crisis has exposed significant shortcomings in national healthcare systems for PLHIV and key populations. The multi-country, community-based research program, EPIC, was developed by Coalition PLUS within an network of community-based organizations engaged in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on 1) key populations (KP) and/or PLHIV or hepatitis C; 2) community health workers (CHWs) and peer educators; and 3) key innovations and adaptations in HIV/HCV services. The objective of this article is to highlight main issues faced in the region during the COVID-19 health crisis in order to inform national and international policies. Methods A general protocol and study materials were developed and included built-in flexibility to allow participating organizations to adapt the study to local needs in terms of target populations and specific areas of interest. Data were collected through surveys and/or interviews. In total 118 studies were conducted across 31 countries: 66 quantitative (n = 12,060 among KP or PLHIV or people living with HCV and n = 811 among CHWs) and 52 qualitative (n = 766 among KP or PLHIV or people living with HCV and n = 136 among CHWs). Discussion Findings in Latin America highlight the difficulties faced by PLHIV and KP in accessing health services, as well as issues of discrimination, violence, and mental health challenges, all of which have been exacerbated by the health crisis. Additionally, the study highlights strategies implemented by community CHWs and peer educators to mitigate the negative impact of the crisis. Moreover, EPIC demonstrates the ability of community agents to generate scientific evidence that raises public awareness of the situation faced by the most vulnerable populations. Conclusion National and international policies must recognize and support the unique capacity of CHWs and peer educators to adapt health interventions to the specific needs of communities. Policymakers are also urged to involve the community in the development of public policies aimed at reducing inequalities and improving the living conditions of vulnerable populations.