The aim of this work is to report a case of orthognathic surgery and to discuss the contraindications for the surgery-first approach. A literature review on the topic was performed to highlight some key points. A 22-year-old female patient sought treatment. The patient was clear on orthognathic surgery indication due to aesthetic and functional reasons. The discussion was not related to orthognathic surgery itself, but if there was a clear indication for surgery-first approach. A literature review was conducted on contraindications for surgery-first approach. There are 3 main types of contraindications: related to the patient, to clinical conditions, and to occlusal or skeletal disorders. Each contraindication was discussed individually. Information on case reports and contraindications from the literature was compared. There are 2 clear contraindications for surgery-first approach: unreasonable patients expectations and surgery first protocol implies a change in the surgical plan. Further studies are needed to highlight or delist other contraindications when virtual planning is possible.
BACKGROUND Bacterial purulent pericarditis is rare and can be fatal if not treated appropriately. Streptococcus anginosus can cause invasive and cryptogenic infections, and purulent pericarditis is an uncommon presentation. Alcohol abuse can be a risk factor for abscesses caused by this agent. Cell-free DNA testing is a noninvasive method that has great potential in cases of serious infections in which pathogens are not easily identifiable by traditional microbiological techniques. CASE REPORT A 27-year-old man reported alcohol abuse and was hospitalized for acute pericarditis without signs of severity. He developed cardiac tamponade on the fifth day of hospitalization, requiring emergency pericardiocentesis. A significant persistent pericardial effusion was observed. Videopericardiectomy revealed a large amount of fibrin and purulent secretion in the pericardial sac. Additional tests and cultures did not identify systemic disease or an etiological agent. A cell-free DNA assay identified S. anginosus. He was discharged after 4 weeks of broad-spectrum antimicrobial therapy. There was no progression to constrictive pericarditis. CONCLUSIONS We present a case of purulent bacterial pericarditis with a cryptogenic focus in a young adult patient with a history of alcohol, marijuana, and e-cigarette abuse. He developed cardiac tamponade but received rapid and appropriate in-hospital therapeutic support, with clinical recovery within a few weeks. Alcohol and smoking may have facilitated bacterial translocation from the oropharynx to the bloodstream and then to the pericardium. S. anginosus was identified only by molecular research.
RESUMO A Linha de Cuidado em Nefrologia Pediátrica é essencial para o diagnóstico, acompanhamento e manejo de crianças com Doença Renal Crônica (DRC). A detecção precoce de alterações renais é fundamental, uma vez que muitas condições podem ser silenciosas, mas ter grande impacto no crescimento e desenvolvimento da criança. A estrutura da Linha de Cuidado inclui triagem neonatal, avaliação de condições predisponentes à doença renal, cálculo da estimativa da função renal e classificação do estágio da DRC, visando à programação de intervenções terapêuticas medicamentosas e não medicamentosas. Desafios como a escassez de especialistas, a necessidade de exames e o acesso desigual aos serviços reforçam a importância de políticas públicas robustas e programas de treinamento. Protocolos personalizados são recomendados para retardar a progressão para Terapia Renal Substitutiva (TRS). Em setembro de 2024, foi lançado o Protocolo Clínico e Diretrizes Terapêuticas (PCDT) para DRC em adultos. Neste artigo de opinião, um grupo de nefrologistas pediátricos comenta as perspectivas para a criação de um PCDT para crianças e adolescentes com DRC.
This study analyzed recent changes in the utilization of allogeneic hematopoietic cell transplantation (HCT) for treatment of acute myeloid leukemia (AML), myelodysplastic syndrome (MDS), and myeloproliferative diseases (MPDs) and the survival of HCT recipients >= 60 years of age in Brazil. This retrospective registry study included patients who received a first allogeneic HCT from any donor between 2012 and 2023. Of the 6657 patients, 444 (7%) were 60 years of age or older who received grafts from human leukocyte antigen (HLA)-matched related (42%) or unrelated (20%) donors or HLA-haploidentical donors (32%). The proportion of HCT recipients 60 years of age or older increased gradually from 3.2% in 2012 to 16% in 2023 mostly due to the increased use of HLA-haploidentical donors since 2018. Overall survival (OS) at day 100 was 77%, and estimated OS at 12 months was 53% (95% CI, 48%-58%). OS at 12 months was higher for transplants during 2015 to 2017 (58%) and 2018 to 2020 (68%) compared with 2012 to 2014 (45%), but it did not differ for those during 2021 to 2023 (49%). Mortality with HLA-haploidentical donors (HR, 2.35; 95% CI, 1.65-3.34 [P < .001]) and cord blood donors (HR, 4.68; 95%,CI, 1.29-16.9 [P = .01]) was higher than with HLA-matched related donors. Mortality was lower for patients with transplants during the 2015 to 2020 period (HR, 0.57; 95% CI, .34-.96 [.037]) than for those during 2012 to 2014.This study revealed a gradual increase in the use of allogeneic HCT in individuals aged 60 years and older in Brazil. While use of haploidentical donors has increased worldwide, its association with increased mortality in the elderly population warrants caution when considering this treatment
