Cláudia Maria Valete-Rosalino

American tegumentary leishmaniasis (ATL) and other infectious granulomatous diseases (IGDs) may present with oral/oropharyngeal mucosal lesions (OOPML). IGD-OOPML can result from fungal, parasitic, or bacterial infections, and squamous cell carcinoma (SCC) represents the main differential diagnosis. ATL, other IGD, and SCC share overlapping clinical and epidemiological features, making diagnostic suspicion challenging. This study compared sociodemographic and clinical characteristics among ATL, other IGD, and SCC. Descriptive, comparative, and multivariable logistic regression analyses were performed. Among 7551 patients, 213 met inclusion criteria (83-SCC and 130-IGD). Except for smoking, which differed only between ATL and SCC, most IGD parameters were similar. Male patients predominated in all groups. SCC patients were significantly older (p < 0.001) and had a shorter median disease duration (p = 0.007). The presence of pain increased the odds of SCC-OOPML by 3.96 times (95% CI 1.97–12.51). SCC patients were more likely to present lesions in a single subsite, either the oral cavity or oropharynx. Painful, ulcerated, or exophytic lesions favored SCC diagnosis, whereas infiltrative, granular, or mulberry-like lesions, involvement of multiple subsites, or associated nasal and laryngeal lesions suggested IGDs. Although clinical differentiation remains difficult, these findings may support early diagnostic suspicion, prompt treatment, and reduced sequelae.

Introduction: Restrictive measures during the COVID-19 pandemic directly impacted on the population's eating habits. Objective: To evaluate changes in eating habits, access to food and perceived stress during COVID-19 confinement, reported by patients returning to nutritional outpatient follow-up in a public reference unit in the treatment of infectious diseases in Rio de Janeiro. Methods: Cross-sectional study, with 75 patients over 18 years of age, from July to December 2020. We collected sociodemographic data, eating habits during confinement, and applied validated questionnaires to access healthy and unhealthy food intake markers (Sistema de Vigilância Alimentar e Nutricional form), food insecurity (short version of Brazilian Food Insecurity Scale), and Perceived Stress Scale. Statistical Package for Social Sciences (SPSS®) version 16.0 (IBM Corp, Armonk, NY) was used for data analysis. Variables were described as median and interquartile range (IQR), and absolute numbers and frequencies, and association between them was investigated by Pearson’s chi-square test. P values < 0.05 showed statistically significant tests. Institution's Ethics Committee approved the study and all participants signed an informed consent. Results: During confinement, most patients changed their eating habits (68%) and felt that they “used food to cope with stress and anxiety” (53.3%), despite this, healthy food had the highest frequency of consumption. Almost half of participants (46.7%) were in food insecurity situation. The majority (61.9%) were categorized as moderate stress. Food insecurity was more frequent among people with low household income (p=0.004), people living with HIV (p=0.024), people who changed food purchase routine (p=0.008), people with worsening eating habits (p=0.009), and people with moderate/high stress (p=0.004). Conclusions: COVID-19 confinement interfered negatively in patient’s eating habits and perceived stress. Although negative feelings were reported by most patients, and the majority presented moderate stress, healthy food intake markers had the highest frequency of consumption.

Objective: To describe the sociodemographic profile and prevalence of different phenotypes of patients with chronic rhinosinusitis (CRS) treated at a specialized outpatient clinic of a university hospital in Brazil. Methods: A cross-sectional retrospective study was conducted on patients treated at a clinic in Brazil. The following were evaluated: sex, age, age at symptom onset, primary CRS phenotype, etiology of secondary CRS, and severity of symptoms. Results: A total of 342 patients were included, of whom 45.61% were men and 8.24% had secondary CRS. The median age of all patients with CRS was 61 years. Nasal polyps were present in 86.22% of patients. The median age at symptom onset was 41 years. The prevalence of primary CRS phenotypes was chronic eosinophilic rhinosinusitis (eCRS) (75%), anti-inflammatory drug exacerbated respiratory disease, which was considered a subgroup of eCRS (19.40%), chronic non-eosinophilic rhinosinusitis (18.66%), central compartment atopic disease (4.1%), and allergic fungal rhinosinusitis (2.24%). The most prevalent diagnoses of secondary CRS were allergic bronchopulmonary aspergillosis (ABPA) (27.59%), immunodeficiencies (20.69%), and vasculitis (13.79%). Conclusions: Patients diagnosed with CRS are predominantly women over 60 years of age who began experiencing nasal symptoms in their fifth decade of life. Most patients have CRS with nasal polyps, primary CRS, and a predominant eCRS phenotype. Secondary CRS accounted for 8.4% of cases, and the most prevalent diagnoses of secondary CRS were Allergic Bronchopulmonary Aspergillosis, immunodeficiencies, and vasculitis.

Background: COVID-19 led to social isolation, potentially reducing physical activity (PA), increasing sedentary time, and lowering quality of life (QoL). This study investigated the association between these factors in patients with Chagas disease (ChD) during the pandemic. Methods: This cross-sectional study included 187 patients with ChD. PA and sedentary time were assessed by the IPAQ-short and QoL by the WHOQOL-Bref. The relationship between PA levels and sedentary time with QoL were assessed using unadjusted and adjusted generalized linear models. Results: The highest tertile of total PA was positively associated with the psychological (Exp β = 1.11; 95% CI: 1.02–1.22) and environmental (Exp β = 1.12; 95% CI: 1.01–1.23) QoL domains. The intermediate (Exp β = 1.12; 95% CI: 1.01–1.25) and highest (Exp β = 1.14; 95% CI: 1.02–1.27) tertiles of moderate-to-vigorous PA were positively associated with the physical domain. Similarly, both the intermediate (Exp β = 1.11; 95% CI: 1.01–1.22) and highest (Exp β = 1.12; 95% CI: 1.01–1.21) tertiles of moderate-to-vigorous PA were positively associated with the psychological domain. The highest tertile of sedentary time was associated with a decrease in the physical domain (Exp β = 0.88; 95% CI: 0.79–0.98). Conclusions: Higher levels of total and moderate-to-vigorous PA were associated with better QoL, while greater sedentary time was associated with poorer QoL.

Highlights ■ Most patients had an inadequate intake of selenium, calcium, magnesium, and fiber. ■ Patients with mucosal had lower body weight, arm muscle circumference, and serum albumin and zinc intake. ■ Mucosal is associated with insufficient zinc intake, low body weight, and the depletion of serum albumin and transferrin. ■ Oropharyngeal lesions are associated with calorie malnutrition and serum protein depletion. ABSTRACT Objective: Patients with American Tegumentary Leishmaniasis often experience malnutrition, weight loss, and dehydration; however, their eating profile

Objective: To compare the spatio-temporal distribution of cutaneous leishmaniasis (CL) cases with mucosal leishmaniasis (ML) cases in the state of Rio de Janeiro (RJ) between 2001 and 2011. Method: The incidence rates (IR) of CL and ML were calculated for the cases notified between 2001–2011 in the Information System of Notifiable Diseases for Rio de Janeiro (RJ, and for the municipalities of Rio de Janeiro and Angra dos Reis, with georeferencing and construction of thematic maps. A negative binomial regression model was used to assess the temporal dependency between CL and ML. Results: Higher IR of CL and ML were observed up to 2006. The cases of CL and ML increased annually concomitantly in the state of RJ and in Angra dos Reis, even when they were controlled by the CL rates of the previous year. The municipality of Rio de Janeiro presented smaller annual CL IR after the occurrence of high ML IR in the two previous years. Conclusion: The temporal association observed between CL and ML suggests that: either the mucosal lesions were already incipient from the beginning of CL manifestation, or the Leishmania species circulating in RJ is able to produce early mucosal lesions.

Introduction: American Tegumentary Leishmaniasis (ATL) treatment is based on pentavalent antimonials (Sb⁵⁺), but these drugs have been associated to several adverse effects. Hearing loss and tinnitus during treatment with meglumine antimoniate (MA) have already been reported. This study aimed to describe the usefulness of self-reporting of hearing loss and tinnitus in diagnosing MA-induced ototoxicity. Methods: A prospective longitudinal study was conducted with 102 patients with parasitological diagnosis of ATL, treated with different MA schemes. The presence of clinical auditory toxicity was defined as the emergence or worsening of self-reporting hearing loss and/or tinnitus during monitoring. Measures of sensitivity, specificity, and the positive and negative predictive value of the patient’s self-reporting of hearing loss and tinnitus in relation to the result of the audiometric test (considered the gold standard) were calculated. Results: The age of the evaluated patients ranged from 15 to 81 years, with a median of 41 years, and most were male (73.5%). Seventy-five patients (73.5%) had cutaneous leishmaniasis and 27 (26.5%) mucosal leishmaniasis. Eighty-six patients (84.3%) received intramuscular (IM) treatment and 16 (15.7%) were treated with intralesional MA. During treatment, 18 (17,6%) had tinnitus and 7 (6,9%) had complaint of hearing loss. 53 (52%) patients had cochlear toxicity confirmed by tone threshold audiometry and high frequency audiometry, from which 60% received a dose of 20 mg Sb⁵⁺/kg/day (p = 0.015) and 96.2% were treated with IM MA (p = 0.001). Tinnitus has greater specificity and positive predictive value than hearing loss, with a low number of false positives, but with a high false negative value. Conclusion: Although the large number of false negatives suggests that self-report of hearing loss or tinnitus cannot be considered a good screening test for referring the patient to an audiometry, the low number of false positives suggests the need to value the patient’s complaint for referral. Otherwise, this study reinforces the importance of audiological monitoring during treatment with MA, especially in those patients with self-reporting of hearing loss or tinnitus when treated with 20 mg Sb⁵⁺/kg/day via IM.