INTRODUÇÃO: As ressecções oncológicas da cavidade oral, orofaringe, hipofaringe e laringe, que têm como objetivo a extirpação completa do tumor com margens de segurança, podem determinar grandes defeitos anatômicos tridimensionais e que afetam funções nobres, entre elas a deglutição, a fala e a respiração. Entre as alternativas de reconstrução o retalho miocutâneo de platisma (RMP) pode ser empregado, dada sua versatilidade e facilidade de execução técnica, com a vantagem de ser menos espesso que os outros retalhos miocutâneos e adaptar-se melhor a uma série de condições clínicas. O objetivo deste trabalho foi estudar os resultados do RMP empregado nas reconstruções após ressecções oncológicas de tumores da cavidade oral, orofaringe, hipofaringe e laringe do ponto de vista funcional e complicações. CASUÍSTICA E MÉTODO: Estudo retrospectivo, aprovado pelo CEP-FMUSP.O banco de dados utilizado é constituído de pacientes matriculados no ambulatório do Hospital Santa Marcelina (Serviço de Cirurgia de Cabeça e Pescoço), com o diagnóstico de neoplasias malignas de boca, orofaringe, hipofaringe e laringe, sendo critério de inclusão todos aqueles que foram operados e reconstruídos com o RMP de pedículo superior e de exclusão aqueles submetidos a outro tipo de reconstrução ou tratamento oncológico, o diagnóstico foi sempre confirmado com biópsia prévia e o estadiamento clínico, TNM, Classificação de Tumores Malignos, seguiu a padronização da União Internacional Contra o Câncer. Foram operados 250 casos de tumores malignos de cabeça e pescoço no período de janeiro de 1990 a dezembro de 2015, todos reconstruídos com o RMP. Destes 184 casos eram elegíveis para o presente estudo. A técnica utilizada para a reconstrução foi o RMP com pedículo superior. A avaliação funcional da reconstrução pelo retalho foi realizada para a respiração, deglutição, aspiração e comunicação. RESULTADOS: Dos 184 casos, 90,2% eram do estádio III e IVA. A dieta ficou normal em 153 (83,1%) dos pacientes, 29(15,8%) ficaram com dieta pastosa e líquida e 2(1,1%) somente com dieta liquida, 146(79,3%) dos casos ficaram com voz laríngea e 38(20,7) com outro tipo de voz. A aspiração da dieta ocorreu em 60,5% dos pacientes e 39,5% não tiveram. Os tumores da base de língua tiveram aspiração em 40,4% dos casos, nos primeiros 7 a 15 dias comparado com outras regiões (p < 0,001). Os pacientes com tumores da hipofaringe tiveram aspiração moderada e os da cavidade oral tiveram a taxa mais baixa. Necroses parciais ocorreram em 10 (4,5%) e foram mais frequentes na cavidade oral 6(3,3%) dos casos. As fístulas ocorreram em 15(8,1%) dos pacientes, a mais alta incidência ocorreu na hipofaringe com 8(4,3%) dos casos. CONCLUSÕES: A reabilitação funcional quanto à deglutição, aspiração, respiração e comunicação foi efetiva, a maioria dos pacientes ficaram com dieta normal por via oral. O RMP mostrou-se um procedimento cirúrgico seguro com índices de complicações baixos, mesmo em pacientes de estádios oncológicos avançados / INTRODUCTION: Oncological resections of the oral cavity, oropharynx, hypopharynx and larynx, which aim at the complete removal of the tumor with safety margins, can determine large anatomical defects in three dimensions and affect noble functions, such as swallowing, speech and breathing. Among the alternatives of reconstruction, the platysma myocutaneous flap (PMF) have been employed given its versatility and ease of technical execution with the advantage of being less thick than the other myocutaneous flaps, making it better for adaptation in a series of clinical conditions. To study the results of PMF used in reconstructions after resections of tumors of oral cavity, oropharynx and hypopharynx from a functional point of view as well as its possible complications. PATIENTS AND METHOD: Retrospective study of patients enrolled in the outpatient clinic of Santa Marcelina Hospital (Department of Head and Neck Surgery), with the diagnosis of malignant neoplasms of the oral cavity, oropharynx, hypopharynx an larynx, being inclusion criteria all those that were operated and reconstructed with RMP. The diagnosis was always confirmed by previous biopsy and clinical staging TNM, followed the standardization of the UICC, There were 250 cases of malignant head and neck tumors from January 1990 to December 2015. Of these, 184 cases were eligible for the present study. The reconstructive technique used was PMF with superior pedicle and the functional evaluation was performed for breathing, swallowing, aspiration and communication Project approved by the Research Ethics Committee of the Faculty of Medicine of the University of São Paulo. RESULTS: From 184 cases operated, 90.2% of the cases were stage III and IVa. The diet was normal in 153 (83.1%) of the patients, 29 (15.8%) had a pasty and liquid diet and 2 (1.1%) had a liquid diet. As for the type of speech: 146 (79.3%), another type of speech 38 (20.7%) had laryngeal voice. The postoperative diet aspiration occurred in 60.5% and did not have aspiration 39.5 % of cases. Tumors of the tongue base when compared to other regions had aspiration in 40.3% in the first 7 to 15 days. Those of the hypopharynx had intermediate aspiration and those of the mouth had the lowest aspiration. Partial necrosis occurred in 10 (4.5%) and total 6 (3.3%) were more frequent in the oral cavity. We had a total of 15 (8.1%) fistulas, the highest incidence occurred in the hypopharynx in 8 (4.3%). CONCLUSIONS: Functional rehabilitation was effective regarding swallowing, breathing and communication, most of the patients were on a normal oral diet. PMF has shown to be a safe technique with low complications rates, even in patients with advanced oncologic stages

As doenças periodontais são infecções locais que apresentam morbidade e têm sido relacionadas com outras doenças ou complicações sistêmicas. Pacientes tabagistas apresentam taxas elevadas e maior predisposição às doenças periodontais severas e avançadas. A administração sistêmica de antibióticos, particularmente metronidazol (M) e amoxicilina (A), associados ao tratamento periodontal mecânico (raspagem e alisamento radiculares - RAR) tem sido amplamente estudada frente às doenças periodontais crônicas. Porém, pouco tem sido esclarecido referente aos efeitos desses tratamentos sobre Porphyromonas gingivalis e seus genótipos. Os objetivos deste trabalho foram: avaliar os efeitos clínicos (profundidade a sondagem - PS, nível de inserção clínica - NIC, índice de placa - IP, sangramento gengival - SG, sangramento à sondagem SS, e supuração - SUP) e microbiológicos (referente à presença de P. gingivalis e seus genótipos fimA II, fimA IV e ragB) após 180 dias do tratamento periodontal mecânico (RAR) associado à administração sistêmica de antibióticos (RAR+M+A), comparados ao tratamento periodontal mecânico (RAR), utilizando-se o PCR convencional (primers específicos para 16S rRNA); e relacionar a presença de P. gingivalis e seus genótipos fimA II, fimA IV e ragB com a profundidade de sondagem (PS) em pacientes fumantes com periodontite crônica. Foram avaliadas 167 amostras oriundas de sítios de 20 sujeitos tratados com RAR (n=11) e RAR + M + A (n=9), no exame inicial e 180 dias após a terapia. Parâmetros clínicos (PS, NIC, IP, SG, SS e SUP) e coletas microbiológicas foram mensuradas em ambos tempos. A detecção da freqüência de P. gingivalis foi realizada por PCR convencional, bem como para os genótipos fimA II, fimA IV e ragB. Não houve diferença estatisticamente significante entre o tratamento periodontal mecânico associado à administração sistêmica de antibióticos (RAR+M+A) e o tratamento periodontal mecânico (RAR), nos pacientes fumantes, em relação à detecção de P. gingivalis. O grupo RAR apresentou-se mais efetivo (estatisticamente significante) na redução de prevalência do genótipo ragB, em comparação ao grupo RAR+M+A, após 180 dias do tratamento. Não foi observada relação estatisticamente significante entre a prevalência de P. gingivalis e dos genótipos fimA II, fimA IV e ragB com a PS no exame inicial. / Periodontal diseases are local infections that present morbidity and have been relation with others systemic diseases or complications. Smoking patients present high levels and bigger predisposition to the severe and advanced periodontal diseases. The systemic administration of antibiotics, mainly metronidazole (M) and amoxicillin (A), associated to the mechanical periodontal treatment (scaling and root planing - SRP) has been largely researched referring to the chronic periodontal diseases. However, not much has been cleared up referring to the effects of those treatments about Porphyromonas gingivalis and its genotypes. The purpose of this research was to evaluate the clinical effects (depth probing - DP, clinical attachment level - CAL, plaque index - PI, gingival bleeding - GB, bleeding on probing - BOP, and supuration - SUP) and microbiological (referring to the presence of P. gingivalis and its genotypes fimA II, fimA IV and ragB) after 180 days of the mechanical periodontal treatment (SRP) associated to the systemic administration of antibiotic (SRP+M+A), compared to the mechanical periodontal treatment (SRP) in smoking patients with chronic periodontitis, by using the conventional PCR (specific primers to the 16S rRNA); to associate the P. gingivalis presence and its genotypes fimA II, fimA IV and ragB with depth probing (DP) of the researched population. 167 samples from the sites of 20 subjects treated with SRP (n=11) and SRP+M+A (n=9) have been evaluated, at the baseline and 180 days after the therapy. Clinical parameters (DP, CAL, PI, GB, BOP and SUP) and microbiological samples were evaluated in both moments. The detection of P. gingivalis frequence was made by using conventional PCR, and also to the genotypes fimA II, fimA IV and ragB. There was no statistically significative difference between the mechanical periodontal treatment associated to the systemic administration of antibiotics (SRP+M+A) and the mechanical periodontal treatment (SRP), in the smoking patients, related to the detection of the P. gingivalis. The SRP group showed more effective (statiscally significative) on the reduction of the genotype ragB prevalence, comparing to the SRP+M+A group, after 180 days of therapy. No statistically significative relation between the prevalence of P. gingivalis and its genotypes fimA II, fimA IV e ragB with DP at the baseline have been observed.

Abstract Pneumonia is a common diagnosis for intensive care unit (ICU) admission. In 2012, 51% of the ICU-treated infections in Finland were of pulmonary origin. The ICU-treated pneumonias can be classified according to acquisition of infection as community-acquired (CAP) or hospital-acquired (HAP). Ventilator-associated pneumonia (VAP) is a subtype of HAP. Patients with severe community-acquired pneumonia (SCAP) require ICU treatment due to need of mechanical ventilation or hemodynamic support. SCAP is associated with high morbidity and high ICU and hospital mortality. The aim of this observational study was to evaluate the clinical characteristics and outcome of SCAP, with special interest on imaging, viral etiology, combination antibiotic treatment and long-term outcome. The thesis comprises three retrospective studies with altogether 392 SCAP patients, median age 55 years, 55.9% of them male. The usefulness of early chest CT and β-lactam-respiratory quinolone (βQ) versus β-lactam-macrolide (βM) therapy for SCAP treatment was evaluated. The hospital and long-term outcomes of SCAP patients were compared with 66 HAP and 25 VAP cases. A prospective study included 49 mechanically ventilated SCAP patients. The frequency of viral etiology in SCAP was analyzed. In SCAP patients, the chest CT as compared to the chest radiograph yielded new imaging findings for 58.5% of the SCAP patients. This information led to procedures or treatment changes in 43% of the cases. The severity of oxygenation disorder correlated to the extent of lung involvement. In prospective SCAP series ICU- mortality was 6.1% and hospital mortality was 12.2%. Viral etiology was found to be common in SCAP and viruses were demonstrated in 49% of patients. The outcome was similar whether SCAP patients were treated with βQ or βM combination. The type of pneumonia did not have a significant association with hospital mortality in ICU-treated SCAP, HAP and VAP patients. Among the hospital survivors, the long-term mortality was substantial, SCAP patients representing the best 1-year outcome. In conclusion, early CT might be useful in SCAP diagnostics and treatment. Viral etiology is common in SCAP. Both β-lactam-respiratory quinolone and β-lactam macrolide combinations were equally good in SCAP treatment. Hospital mortality did not differ among ICU-treated pneumonia cases, but SCAP had the best long-term survival. / Tiivistelmä Keuhkokuume on yleinen tehohoitoon johtava tulehdussairaus. Suomessa vuonna 2012 teho-osastolla hoidetuista infektioista 51&#160;% oli keuhkoalkuisia. Keuhkokuume luokitellaan hankintapaikan mukaan kotisyntyiseksi (CAP) tai sairaalasyntyiseksi (HAP). Hengityslaitehoitoon liittyvä keuhkokuume (VAP) on sairaalasyntyisen keuhkokuumeen alatyyppi. Vakavalla kotisyntyisellä keuhkokuumeella (SCAP) tarkoitetaan vaikeaa keuhkoinfektiota, joka vaatii hengityslaitehoitoa tai verenkierron tukihoitoa teho-osastolla. SCAP:iin liittyy korkea sairastuvuus sekä tehohoito- ja sairaalakuolleisuus. Tässä havainnoivassa kliinisessä tutkimuksessa selvitettiin SCAP:n kliinistä kuvaa ja ennustetta. Erityishuomion kohteena oli varhaisvaiheessa suoritetun keuhkojen tietokonekerroskuvauksen (CT), keuhkokuumeen aiheuttajamikrobien ja antibimikrobihoidon vaikutus taudin hoitoon ja ennusteeseen sekä tehohoidettujen keuhkokuumepotilaiden pitkäaikaisennuste. Väitöskirja koostuu kolmesta retrospektiivisestä osatyöstä, joissa oli yhteensä 392 SCAP-potilasta. Potilaiden mediaani-ikä oli 55 vuotta ja heistä 55,9&#160;% oli miehiä. Varhaisvaiheen keuhkojen CT:n sekä beetalaktaami-kinoloni- ja beetalaktaami- makrolidi-yhdistelmähoidon vaikutusta keuhkokuumeen hoitoon arvioitiin retrospektiivisesti. SCAP-potilaiden sairaalakuolleisuutta ja pitkäaikaisennustetta verrattiin 25:n VAP- ja 66:n HAP-potilaan ennusteeseen. Prospektiivisessa tutkimuksessa oli 49 hengityskonehoidettua potilasta. Tutkimuksessa tarkasteltiin virusten osuutta ja merkitystä vaikeassa SCAP:ssa. Keuhkojen CT havaitsi 58,5&#160;%:lla SCAP-potilaista löydöksiä, joita ei todettu keuhkojen natiiviröntgentutkimuksessa. Löydökset johtivat toimenpiteisiin 43&#160;%:lla SCAP-potilaista. Happeutumishäiriön vaikeusasteen ja CT:llä todettujen keuhkojen tulehdusmuutosten laajuuden välillä havaittiin yhteys. Virusetiologia on SCAP:ssa yleinen. Viruksia havaittiin 49&#160;%:lla SCAP-potilaista. Beetalaktaami-kinoloni- ja beetalaktaami-makrolidi -yhdistelmähoidon välillä ei havaittu eroa SCAP-potilaiden ennusteessa. SCAP-, HAP- ja VAP-potilaiden ennustevertailussa keuhkokuumetyypin ei todettu vaikuttavan sairaalakuolleisuuteen. Paras yhden vuoden ennuste oli SCAP-potilailla. Yhteenvetona todettakoon, että varhaisvaiheen keuhkojen CT on hyödyllinen SCAP:n hoidossa. Virukset ovat yleisiä SCAP:n aiheuttajamikrobeja. Molemmat tutkitut antimikrobiyhdistelmät todettiin hyviksi SCAP:n hoidossa. Sairaalakuolleisuus ei eroa keuhkokuumealatyyppien välillä, mutta SCAP- potilailla on paras pitkäaikaisennuste.

Abstract Deep brain stimulation (DBS) of the subthalamic nucleus (STN) has been gaining importance in the treatment of advanced Parkinson's disease. This study was undertaken to evaluate the beneficial effects of bilateral STN stimulation on patient's clinical symptoms and quality of life related to the potential risks and side effects of the treatment. A consecutive series of 42 patients operated on for Parkinson's disease with STN DBS in Oulu University Hospital were included. A subgroup of these patients was evaluated using the Unified Parkinson's Disease Rating Scale (UPDRS), neuropsychological tests, and Health Related Quality of Life (HRQoL) instruments i.e. the Parkinson's Disease Questionnaire (PDQ-39) and the Finnish version of the Nottingham Health Profile (NHP). The costs of the treatment were calculated from the perspective of the health care provider. The possible effects of bilateral STN-operation on cardiovascular autonomic function were analyzed by measuring various time- and frequency domain indexes as well as non-linear indexes of heart rate variability (HRV) from 24-hour EKG recording before and 12 months after the operation. This study showed that STN DBS significantly improves the clinical symptoms and HRQoL of parkinsonian patients. The dyskinesia and clinical fluctuation scores were reduced very significantly in the UPDRS IV subscale. The clinical fluctuations were reduced by 53 %. After DBS best motor response (UPDRS III) scores also improved significantly. The HRQoL measured with both instruments improved significantly. Improvement was seen in the PDQ-39 summary index and the subscales of activities of daily living, emotional well-being, stigma and bodily discomfort. Only communication became worse during the follow-up. There was a statistically significant improvement in the score of the subscales of NHP measuring problems with energy, sleep, emotional reactions and social isolation. One patient died from pulmonary embolism and another contracted a late postoperative intracerebral hemorrhage leading to a permanent deterioration of her neurological condition to the bedridden stage. Other complications were much milder. Clinical improvement and improvement in HRQoL were positively correlated. STN DBS does not influence tonic autonomic cardiovascular regulation. The incremental costs of performing bilateral STN DBS in Finland compared to preoperative medical treatment amounted to an average of 25 591 EUR per patient during the first postoperative year. The majority of parkinsonian patients experienced significant and long lasting relief in their motor symptoms and an improvement in HRQoL following STN stimulation.

Estudo comparativo entre o tratamento farmacológico, o treinamento físico moderado e o treinamento postural passivo em pacientes portadores de síncope neurocardiogênica. A síncope neurocardiogênica é uma disfunção autonômica que leva a hipotensão e perda de consciência. Setenta pacientes foram randomizados em 4 grupos: controle, treinamento físico, treinamento postural e tratamento farmacológico. Avaliou-se recorrência clínica, índices de ansiedade e a sensibilidade barorreflexa para a freqüência cardíaca e atividade nervosa simpática muscular. Ocorreu diminuição da recorrência nos 4 grupos. Diminuição da ansiedade foi observada em 3 grupos, exceto no grupo controle. O treinamento físico melhorou a sensibilidade barorreflexa / Neurocardiogenic syncope is an autonomic disfunction that leads to hypotension and loss of conciousness. Seventy patients were randomized in 4 groups: control, physical training, tilt training and pharmacological treatment. Clinical outcome, anxiety levels and baroreflex sensitivity for heart rate and muscle sympathetic nervous activity were evaluated. Lower recurrence rates were obtained in all groups. Anxiety levels decrease was achieved in 3 groups, except controls. Physical training improved baroreflex sensitivity

Background: The treatment outcome of temporomandibular disorders (TMD) can be assessed with Symptom Severity Index (SSI). In addition to this self-report measure, Patients’ Global Impression of Change (PGIC) provides information about the overall impression of change. The use of SSI and PGIC when assessing treatment outcome in the field of TMD, and their correlation, has not previously been reviewed. Aim: The aims of this study were to investigate the correlation between the scales SSI and PGIC, to gain knowledge about which factors that contribute to the impression of change and to identify the diagnoses that have the most improvement. Methods: Data from 193 patients was analyzed. The percentage change in symptoms between baseline and follow up was compared to PGIC. The patients were divided into three groups based on main diagnoses, for further analysis. PGIC categories “much improved” and “very much improved” were set as successful treatment outcome. Different factors impact on PGIC were analyzed.  Results: Majority of the patients had a successful treatment outcome. A higher mean percentage change correlated with a better PGIC value. Patients with articular related diagnoses needed a greater reduction in SSI to rate the impression of change as improved. According to the regression analysis, diagnosis group, age, number of treatment visits and SSI-baseline were associated with treatment outcome. Conclusions: The present study supports the use of both SSI and PGIC for assessment of the treatment outcome when treating TMD. However, a possible discrepancy between the scales addresses the need for further examination and change of treatment approach.

Bakgrund: Graves sjukdom är den vanligaste formen av hypertyreos med en incidens på 20 fall per 100 000 individer och år. Graves sjukdom är ett autoimmunt tillstånd där autoantikroppar riktade mot tyreoideastimulerande hormonreceptorer (TSH-R) orsakar okontrollerad syntes och sekretion av tyreoideahormonerna trijodtyronin (T3) och tyroxin (T4). Hur tillståndet uppkommer är inte fullständigt förstått, riskfaktorer inkluderar dock rökning, kvinnligt kön och emotionell stress. Det finns i dagsläget tre etablerade behandlingsmetoder vid Graves sjukdom, dessa är tyreostatikabehandling, radiojodbehandling och tyreoidektomi. Behandling med tyreostatika pågår i regel i 12-18 månader, efter avslutad behandling är risken för recidiv mellan 50-60%. Både tyreoidektomi och radiojodbehandling är definitiva behandlingsmetoder som för majoriteten innebär övergång i hypotyreos med livslångt behov av levotyroxin-(LT4)behandling. Syfte: Syftet med examensarbetet var att undersöka långvarig effekt av radiojodbehandling vid Graves sjukdom och hur radiojodbehandling påverkar livskvalitet. Metod: Arbetet utfördes som en litteraturstudie, en sökning efter kliniska studier gjordes i PubMed med sökorden ”Graves disease” AND ”iodine radioisotopes”. Totalt åtta artiklar som i praktiken baserades på fem studier inkluderades i litteraturstudien. Resultat: Studie 1A, 1B och 1C var uppföljningsstudier av en tidigare utförd randomiserad klinisk studie. I studie 1A sågs det att samtliga individer som behandlats för Graves sjukdom hade sämre livskvalitet än den generella befolkningen 14-21 år efter behandling, ingen skillnad kunde ses beroende på behandlingsmetod. Studie 1B visade att skillnaderna i livskvalitet som funnits i studie 1A inte berodde på tyreoideahormonstatus. Resultaten i studie 1C visade att autoimmun aktivitet i form av tyreoideastimulerande hormonreceptorantikropp(TRAk)-nivåer var förhöjda bland individer som behandlats med radiojod i samtliga fem år som uppföljningen skedde, bland tyreostatika- och kirurgibehandlade individer var TRAk-nivåer normaliserade ett år efter behandling.  Studie 2 visade att tidig insättning av LT4 efter radiojodbehandling kunde förebygga försämring i livskvalitet de sex första månaderna efter radiojodbehandling. I studie 3 sågs det att större andel individer utvecklade oftalmopati efter radiojodbehandling jämfört med tyreostatika, vidare sågs sämre livskvalitet bland individer som utvecklat oftalmopati jämfört med individer utan oftalmopati. Studie 4 eftersökte optimumdosering av radiojod för att uppnå eutyreos bland individer med Graves sjukdom, det fanns att 1,85 MBq/g resulterade i eutyreos hos 72% 12 år efter behandling. I studie 5A sågs det att majoriteten av radiojodbehandlade individer övergick i hypotyreos samt att andelen som upplevde återställning 6-10 år efter diagnostisering var mindre bland de som efter behandling av Graves sjukdom var i behov av LT4-behandling. Studie 5B visade att radiojodbehandlade individer hade sämre livskvalitet jämfört med individer som behandlats med tyreostatika eller kirurgi 6-10 år efter behandling av Graves sjukdom. Vidare hade hela studiepopulationen, oavsett behandlingsmetod, sämre livskvalitet jämfört med den generella populationen. Slutsats: På grund av skillnader i upplägg och utfallsvariabler i de inkluderade studierna kan inga generella slutsatser dras utifrån samtliga studieresultat. Sammantaget sågs dock att individer som behandlats för Graves sjukdom har sämre livskvalitet jämfört med den generella befolkningen många år efter behandling. Det förefaller finnas ökad risk för sämre livskvalitet efter radiojodbehandling av Graves sjukdom jämfört med tyreostatika och tyreoidektomi, det krävs dock fler studier för att säkerställa dessa resultat samt undersöka hur och varför radiojodbehandling påverkar livskvalitet. / Graves´ disease is an autoimmune disease resulting in uncontrolled auto antibody-mediated secretion of the thyroid hormones triiodothyronine (T3) and thyroxine (T4). Graves´ disease is the most common cause of hyperthyroidism and has an annual incidence of 20 cases per 100 000 inhabitants. The pathogenesis of the disease is not yet fully understood, but risk factors include smoking, female gender and emotional stress. Since thyroid hormones act in almost every cell in the body, an imbalance in thyroid hormone levels can lead to severe consequences and affected quality of life. Symptoms of Graves´ disease include weight loss, tremor, tachycardia, heat intolerance, increased sweating, anxiety, fatigue and loss of libido.  There are three established treatment approaches for Graves´ disease including antithyroid drugs, radioiodine treatment and surgical thyroidectomy. The treatment goal for Graves´ disease is to stop the hyperthyroid state and reduce the risk of complications from the condition. Antithyroid drugs is the treatment modality most frequently used in newly diagnosed Graves´ disease and the duration of treatment is normally 12-18 months. The risk of recurrence after antithyroid drugs is 50-60%. Both radioiodine treatment and surgery are considered definitive treatments for Graves´ disease, the majority of treated individuals become hypothyroid with a life-long need for levothyroxine (LT4) treatment. The three available treatment options have both advantages and disadvantages that should be discussed with the patient in each individual case.  The aim of this study was to evaluate the long-term effects of radioiodine treatment for Graves´ disease and how radioiodine treatment affects the quality of life.  This is a literature study based on eight articles that, in practice, were based on five different clinical trials. The included studies were collected from the database PubMed. Since the included studies were different in both study design and outcome, no general conclusion can be drawn from all of the included studies. Two of the studies examined long-term effects on the quality of life of radioiodine treatment for Graves´ disease. Both studies found that persons diagnosed with Graves´ disease have a lower quality of life many years after treatment compared to the general population. The quality of life in individuals treated for Graves´ disease seems to be lower than the general population regardless of thyroid hormone state and mode of treatment. There seems to be an increased risk for lower quality of life among individuals treated with radioiodine compared to antithyroid drugs and surgery. Early administration of LT4 after radioiodine treatment could prevent worsening of quality of life according to the short form health survey (SF-36), whilst the long-term need for LT4 treatment after treatment of Graves´ disease is associated with a lower chance of feeling fully recovered 6-10 years after diagnosis.  There is a need for future studies to determine the effects of radioiodine treatment, especially regarding the long-term quality of life. There is also a need to determine the pathogenesis of Graves´ disease and to find new treatment options for the disease since the established treatment methods result in chronic illness or risk of recurrence.

Introduction: Coronavirus 2019 (SARS-CoV-2) infection in children occurred in Peru as of March 2020, leading to pediatric patients' hospitalization in areas adapted for this purpose at the Edgardo Rebagliati Martins National Hospital. In the beginning, the demand for hospitalization was low, but it increased gradually. Consistent with international reports, the majority of patients presented mild or moderate symptoms. Nonetheless, there were also severe cases, even fatal ones. Objectives: To describe the characteristics and clinical outcome of pediatric patients with COVID-19 hospitalized in a referral hospital in Lima, Peru, between March and August 2020. Methods: A descriptive and inferential cross-sectional study was carried out. The population includes all hospitalized patients in the Department of Pediatrics, with clinical and surgical diagnoses associated with COVID-19. Results: We included 100 patients, with an average age of 83.4 ± 54 months, with a predominance of male patients (55%). Hospitalized patients were grouped into five categories: respiratory failure (17%), multisystemic inflammatory syndrome (MIS-C) (31%), neurological presentation (19%), acute abdomen (20%), and patients with oncological problems (13%). Most of the patients (74%) had comorbidities. Regarding the presenting symptoms, intestinal pain predominated in the appendicitis group (90%, p < 0.001), fever was present in most patients with respiratory failure (64.7%); multisystemic inflammatory syndrome (90.3%), neurological manifestations (15.8%), acute abdomen (50%) and oncological conditions (61.5%) were also present in these patients. Kawasaki symptoms were found in 38.7% of the patients with multisystemic inflammatory syndrome. Mortality was 4%. Respiratory problems (29.4%) and multisystemic inflammatory syndrome (22.6%) required admission to intensive care, more frequently than the other presentations (p = 0.008). Conclusions: We conclude that the vulnerability in the pediatric population is the one that has preexisting conditions. We divided our patients according to presentation, diagnosis, and complications, which were predominantly respiratory. We also had oncological patients with COVID-19. / Introducción: La infección por coronavirus 2019 (SARS-CoV-2) en niños se presentó en Perú desde marzo del 2020. Desde entonces fue necesario internar pacientes pediátricos en el Hospital Nacional Edgardo Rebagliati Martins, en el área de hospitalización adaptada para dicho propósito. Al inicio, la demanda de hospitalización era baja y se fue incrementando progresivamente. Coincidiendo con los reportes internacionales, la mayoría presentó cuadros leves o moderados, pero también hubo casos graves e incluso mortales. Objetivos: Describir las características y el desenlace clínico de los pacientes pediátricos con COVID-19 hospitalizados en un hospital de referencia en Lima, Perú, entre marzo y agosto de 2020. Métodos: Se realizó un estudio transversal descriptivo e inferencial. La población incluyó a todos los pacientes que se hospitalizaron en el Departamento de Pediatría Clínica, con diagnósticos clínicos y quirúrgicos asociados a COVID-19. Resultados: Incluimos 100 pacientes, con edad promedio de 83,4 ± 54 meses, con predominio de varones (55%). Los pacientes hospitalizados fueron agrupados en cinco categorías: insuficiencia respiratoria (17%), síndrome inflamatorio multisistémico (31%), presentación neurológica (19%), abdomen agudo (20%) y pacientes con problemas oncológicos (13%). La mayoría de los pacientes (74%) tenían comorbilidades. Respecto a los síntomas de presentación, el dolor intestinal predominó en el grupo de apendicitis (90%, p < 0,001), la fiebre estuvo presente en la mayoría de los pacientes con falla respiratoria (64,7%), el síndrome inflamatorio multisistémico se registró en 90,3%, la sintomatología neurológica en 15,8%, el abdomen agudo 50% y oncológicos en 61,5% de los pacientes. Los síntomas de Kawasaki estuvieron presentes en 38,7% de los pacientes con síndrome inflamatorio multisistémico. La mortalidad fue de 4%. En 29,4% de problemas respiratorios y en 22,6% de síndrome inflamatorio multisistémico, se requirió de admisión en cuidados intensivos, lo que fue más frecuente que las otras presentaciones (p = 0,008). Conclusiones: Se concluye que la población pediátrica vulnerable es aquella con comorbilidades preexistentes. La división de pacientes en nuestro estudio fue definida por la presentación, diagnóstico y complicaciones predominantemente con problemas respiratorios, y en pacientes oncológicos con COVID-19. / Revisión por pares

Thesis (MPH.) -- University of Limpopo, 2022 / Background: Tuberculosis(TB) and Human Immunodeficiency virus(HIV) continues to be a public health concern globally. There is no data on TB outcomes on HIV programme outcome in Lebowakgomo hospital of Limpopo Province. The main objective of this study was to determine the TB treatment outcomes in TB/HIV co-infected people at Lebowakgomo hospital in Limpopo Province. Methodology: A quantitative retrospective design was used in the study in which a sample size of 180 patients’s files who are 18 years and above and TB/HIV co-infected were reviewed. A self-designed data collection tool was used to collect data. The tool covered variables such as age, gender, HIV status, CD4 cell count, type TB, duration on TB treatment and the outcome. Data was analysed using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The majority of records were age group 35-44 years at 32%. There was a statistical significance differences (p˂0.001) between males and females in relation to age groups. TB treatment success rate was 68.9% and mortality 16.9%. Females were more likely to complete TB treatment successfully than males. Overall age, gender, previous TB infections, TB type, duration on ART and CD4 Count were not significantly associated with treatment outcomes amongst TB/HIV co-infected people. Conclusion: This study has revealed that TB treatment success rate in HIV co-infected is lower (68.3%) than the WHO target of 85%.

Objective:The purpose of this study was to determine factors associated with rehabilitation outcomes following vestibular rehabilitation (VR). Methods:In this prospective cohort study, 116 patients who completed at least 2 supervised sessions participated. Patient characteristics and comorbidities were recorded. Initial and discharge measures included symptom intensity, balance confidence, quality of life, time symptoms interfere with life, perceived benefits of VR, gait speed, fall risk, visual acuity during head movement, and anxiety/depression. Intention-to-treat analyses were performed to determine outcomes at discharge. Bivariate correlations between independent (group characteristics and baseline measures) and dependent (discharge measures) variables were determined. Logistic regressions were performed to identify factors associated with whether a patient would have a normal score or meaningful change at discharge. Results:There was a large effect of VR with significant improvement for the group as a whole on each outcome measure. For each outcome measure most patients improved. Based on preliminary logistic regression, 2 patient characteristics were associated with outcome: number of therapy visits predicted meaningful improvement in gait speed and falls after the onset of the UVH predicted meaningful change in the percent of time symptoms interfered with life. Initial Activities-based Balance Confidence (ABC) scale and Dynamic Gait Index (DGI) scores predicted normal ABC scores at discharge, and initial ABC scores predicted recovery of DGI scores. Preliminary prediction models were generated for balance confidence, impact of dizziness on life, dynamic visual acuity, gait speed, and fall risk. Conclusions:Therapists may use these findings for patient education or the need for adjunct therapy such as counseling. Impact:Not all people with UVH improve following VR, but there is little research examining why. This study looked at multiple factors and identified number of visits and falls after onset of UVH as patient characteristics associated with outcomes following VR, which will help therapists create better predictive models.