ABSTRACT
Introdução: A procura pela estética do sorriso é crescente na Odontologia, pois, muitas vezes um sorriso alinhado e periodonto saudável não são o bastante. A cerâmica odontológica apresenta-se como uma ótima possibilidade restauradora, visto o avanço das técnicas de adesão entre o substrato dentário e as cerâmicas, torna-se mais previsível o resultado com este tipo de reabilitação. Objetivo: O presente artigo tem como objetivo descrever um caso clínico com envolvimento de diversos níveis de desgaste dentário para reabilitação estética com cerâmica de dissilicato de lítio. Relato de caso: Paciente 36 anos, gênero feminino, apresentava insatisfação com seu sorriso devido a forma e a alteração de cor dos seus dentes superiores anteriores e pré-molares. O plano de tratamento consistiu em realizar a troca da coroa metalocerâmica por coroa total cerâmica da unidade 14, coroa total cerâmica nas unidades 11, 21 e 22, facetas cerâmicas nas unidades 15, 13, 12, 23, 24 e 25, osteotomia e gengivoplastia das regiões de 2º prémolar superior esquerdo ao 2º pré-molar superior direito, clareamento dental caseiro da arcada inferior e placa oclusal superior de proteção. O material de escolha para a resolução do caso clínico foi a cerâmica vítrea reforçada à base de dissilicato de lítio, pois, possui um índice de refração de luz semelhante à estrutura dentária, sem interferência significativa da translucidez, além de ser passível de cimentação adesiva por se tratar de uma cerâmica ácido sensível e o tamanho do cristal e a sua disposição favorecem o aumento das propriedades mecânicas da restauração. Conclusão: O plano de tratamento realizado permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção da jovialidade e da harmonia no sorriso(AU)
Introduction:The demand for smile aesthetics is growing in Dentistry, because, often a smile aligned and healthy periodontium are not enough. Dental ceramics, presented as an excellent restorative possibility, since the advancement of adhesion techniques between the dental substrate and the ceramics, becomes more predictable the result with this type of rehabilitation. Objective: This article aims to describe a clinical case involving several levels of dental wear for aesthetic rehabilitation with ceramics. Case Report: A 36-year-old female patient presented dissatisfaction with her smile due to the shape and color alteration of her anterior and premolar upper teeth. The treatment plan consisted of exchanging the metal-ceramic crown for the total ceramic crown of unit 14, total ceramic crown in units 11, 21 and 22, ceramic veneers in units 15, 13, 12, 23, 24 and 25, osteotomy and gingivoplasty of the regions from 2nd left upper premolar to 2nd right upper premolar, home tooth whitening of the lower arch and upper occlusal plate of protection. The material of choice for the resolution of the clinical case was the glass ceramic reinforced on the basis of lithium disilicate because it has a refractive index of light similar to the dental structure, without significant interference of translucency, besides being liable to adhesive cementation because it is a sensitive acid ceramic and the size of the crystal and its disposition favor the increase of the mechanical properties of the restoration. Conclusion: The treatment plan performed allowed the restoration of function and aesthetics, with reproduction of the characteristics of natural teeth and promotion of joviality and harmony in the smile(AU)
Subject(s)
Humans , Female , Adult , Ceramics , Crowns , Dental Veneers , Esthetics, Dental , Lithium , Osteotomy , Tooth Bleaching , Periodontium , Occlusal Splints , Tooth Wear , GingivoplastyABSTRACT
Introdução: As cerâmicas odontológicas são amplamente utilizadas na Odontologia, desfrutando de grande popularidade devido a sua capacidade de mimetizar as características ópticas do esmalte e da dentina. O constante desenvolvimento de pesquisas tem desencadeado o lançamento de novos sistemas cerâmicos com propriedades aprimoradas e melhores resultados clínicos em longo prazo. Objetivo: O relato de caso aqui apresentado descreve uma reabilitação da zona estética do sorriso com laminados cerâmicos por meio de uma abordagem minimamente invasiva. Relato de caso: Paciente do gênero feminino, compareceu à clínica odontológica relatando insatisfação com a aparência do seu sorriso. Durante avaliação foram observadas, na região anterossuperior, restaurações extensas em resina composta deficientes nos incisivos, com proporção, volume, forma e texturização insatisfatórias, que em conjunto comprometia a zona estética do sorriso. Diante disso, após fotografias extra e intraorais, o tratamento proposto foi a reabilitação com laminados cerâmicos nas unidades 1.2 ao 2.2. Assim, foi realizado o enceramento e o mock-up, os quais serviram de orientação para os preparos dentários, a seguir, foram moldados e as restaurações confeccionadas no sistema IPS e.max. Após prova de cor e adaptação, os preparos e a superfície interna dos laminados cerâmicos foram tratados e cimentados com cimento resino fotopolimerizável. Conclusão: Instituindo uma abordagem conservadora, o plano de tratamento realizado através da reabilitação com laminados cerâmicos nas unidades dentárias anterossuperiores, permitiu o restabelecimento da função e estética, com reprodução das características dos dentes naturais e promoção do equilíbrio, da jovialidade e da harmonia no sorriso(AU)
Introduction: Dental ceramics are widely used in dentistry, enjoying great popularity due to the ability to mimic both enamel and dentin optical characteristics. The constant research development has triggered the launch of new ceramic systems with improved properties and better long-term clinical results. Objective: The case report presented here describes the zone rehabilitation of the aesthetic smile with ceramic laminates through a minimally invasive approach. Case report: Female patient, attended the dental clinic reporting dissatisfaction with the appearance of her smile. During the evaluation, extensive restorations in composite resin were observed in the incisors in the anterosuperior region, with unsatisfactory proportion, amount, shape and texturing, which together compromised the aesthetic zone of the smile. Faced with this, after extra and intraoral photographs, the proposed treatment was the restoration with the ceramic laminates in units 1.2 to 2.2. Thus, waxing and mock-up were performed, which served as guidance for the dental preparations, then they were molded and restorations fabricated in the IPS e.max system. After shade and adaptation proof, the preparations and the inner ceramic laminates surface were treated and cemented with light-cured resin cement. Conclusion: Adopting a conservative approach, the treatment plan carried out through restoration with ceramic laminates on the upper anterior teeth allowed the recovering function and aesthetics, reproducing characteristics of natural teeth and promoting balance, joviality and harmony in the smile(AU)
Subject(s)
Humans , Female , Ceramics , Dental Veneers , Esthetics, Dental , Smiling , Composite Resins , IncisorABSTRACT
Atualmente é constante a demanda por sorrisos harmoniosos nos procedimentos clínicos odontológicos, resultando em estímulos no desenvolvimento de técnicas minimamente invasivas, sistemas adesivos e materiais que sejam capazes de reproduzir as características naturais dos elementos dentários. Para as reabilitações estéticas, em especial nas unidades anteriores, os laminados cerâmicos apresentam destaque, em virtude das suas características físicas e ópticas. Como procedimento alternativo, as facetas pré-fabricadas em resina composta foram reintroduzidas na Odontologia Restauradora, exibindo versatilidade, facilidade e relação custo/benefício satisfatórias. Objetivo: Relatar um caso, demostrando uma das opções viáveis para solucionar problemas estéticos, como diastemas e desproporções dentárias. Relato de caso: A paciente procurou atendimento odontológico especializado relatando insatisfação com o sorriso. Durante avaliação, foram observados desarmonia nas proporções dentárias, diastemas múltiplos, restaurações deficientes em resina composta e fraturas nas bordas incisais. Diante disso, após o registro fotográfico, foi realizado a seleção do formato e cor das facetas pré-fabricadas, assim como, do agente de cimentação. A seguir, foi feito o isolamento relativo, remoção das restaurações deficientes e os ajustes das facetas ao dente. Para preparação da peça, foi realizado a limpeza e aplicação do adesivo; nos preparos dentários, após asperização da superfície, houve o condicionamento e aplicação do adesivo, a seguir procedeu-se a etapa de cimentação e, acabamento e polimento. Conclusão: O tratamento realizado conseguiu suprir as necessidades estéticas do sorriso da paciente, mostrando que as facetas préfabricadas em resina composta apresentam estética satisfatória, facilidade de instalação, baixo custo em relação as peças em cerâmica e conservação da estrutura dentária(AU)
Introduction: In present days, there is a constant demand for harmonious smiles in the dental clinical procedure, resulting in encouragement on development in minimally invasive techniques, adhesives systems and materials that can be capable to reproduce natural dental elements. For aesthetic rehabilitation in special in the anterior units, the ceramic laminates are highlighted due to their optical and physical features. As an alternative procedure, prefabricated composite resigns have been reintroduced into restorative dentistry, showing satisfactory versatility, ease and cost-effectiveness. Objective: Report a case, showing one of the viable options to solve aesthetical problems as diastemas and dental disproportions. Case Report: The patient sought specialized dental care reporting dissatisfaction with the smile. During evaluation, disharmony in tooth proportions, multiple diastemas, composite deficient resigns restorations and incisal edges fractures were observed. Therefore, after the photographic register, the shape and colour of the prefabricated facets, as well as cementing agent were selected. Hereinafter, relative isolation, removal of the deficient restorations and adjustments of tooth's veneers were then performed. For the piece preparation, cleaning and adhesive application were performed; on dental preparations, after the surface roughening, the adhesive was etched and applied followed by finishing and polishing cementation. Conclusion: The treatment was able to supply the aesthetical needs of the patient's smile, showing that prefabricated composite resigns veneers present satisfactory aesthetics, ease installation, low cost compared to ceramic pieces and conservation of the dental structure(AU)
Subject(s)
Female , Adult , Composite Resins , Dental Veneers , Diastema , Smiling , Esthetics, DentalABSTRACT
Introdução: a resina composta é um dos materiais restauradores mais pesquisados na Odontologia, visando melhorias nas suas propriedades e aperfeiçoamento da técnica. Este trabalho tem o objetivo de avaliar a rugosidade superficial de duas resinas compostas, micro-híbrida e nanoparticulada, após a polimerização adicional com micro-ondas. Materiais e métodos: para cada resina composta, foram confeccionados 24 corpos de prova, medindo 0,8 cm de diâmetro interno por 0,2 cm de espessura, dos quais, 12 receberam polimerização adicional com micro-ondas e 12, apenas a polimerização com luz azul visível. Foram estabelecidos quatro grupos: G1 - resina micro-híbrida submetida à polimerização convencional; G2 - resina nanoparticulada submetida à polimerização convencional; G3 - resina micro-híbrida exposta à polimerização adicional em forno de micro-ondas caseiro; e G4 - nanoparticulada exposta à polimerização adicional em forno de micro-ondas caseiro. Os corpos de prova foram lixados em politriz, com o intuito de uniformizar as superfícies, seguindo com leitura no rugosímetro digital Mitutoyo SJ 301. O teste não paramétrico Exato de Mann-Whitney (significância de 5%) foi realizado utilizando a média aritmética (Ra, µm). Conclusão: não houve significância estatística entre os tipos de polimerização e nem entre as diferentes resinas compostas estudadas.(AU)
Introduction: composite resin is one of the most researched restorative materials in dentistry, aiming to improve its properties and improve the technique. This work aims to evaluate the superficial rugosity of two composite resins, microhybrid and nanoparticulate, after additional polymerization with microwaves. Materials and methods: for each composite resin, 24 specimens were made, measuring 0.8cm internal diameter by 0.2cm thick, of which 12 received additional microwave polymerization and 12 visible-blue-light polymerization only. Four groups were established: G1 - microhybrid resin subjected to conventional polymerization; G2 - nanoparticulate resin subjected to conventional polymerization; G3 - microhybrid resin exposed to additional polymerization in a home microwave oven; and G4 - nanoparticulate exposed to additional polymerization in a home microwave oven. The specimens were sanded in a polishing machine in order to standardize the surfaces, followed by reading on the Mitutoyo SJ 301 digital roughness meter. The Mann-Whitney Exact nonparametric test (5% significance) was performed using the arithmetic mean (Ra, µm). Conclusion: there was no statistical significance between the polymerization types and neither among the different composite resins studied.(AU)
Subject(s)
Composite Resins/chemistry , Curing Lights, Dental , Polymerization , Microwaves , Surface Properties , Materials Testing , Statistics, Nonparametric , Nanoparticles/chemistryABSTRACT
Abstract Introduction There is no consensus about the immediate and latte follow-up effects of maxillary protraction in cleft lip and palate patients. Objective To evaluate the stability of Class III early treatment in cleft lip and palate patients through maxillary expansion and protraction. Material and method The sample consists in three lateral cephalometric radiographs of 28 patients (mean pre-treatment age of 6.7±1.8 years) who presented cleft lip and palate and were treated with maxillary expansion and Petit facial mask. The angular (SNA, SNB, ANB, SN.GoGn, FMA, Z Angle) and linear (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) cephalometric measures were evaluated through the Dolphin® software, in three moments: T0 (initial), T1 (after treatment), and T2 (follow-up). Data were submitted to the analysis of variance (ANOVA) and Tukey-Kramer test. The correlation between cephalometric measures and patient's age was determined by Pearson's chi-squared test. Result The SNA, ANB, and AO-BO measures increased considerably (p<0.05), and they did not present any differences compared to the initial ones after the follow-up time. The overjet measure increased (p<0.05) after treatment and, even with its decrease at the follow-up time, it was still higher than at the beginning (p<0.05). The Z angle showed improvement with treatment and remained stable at the follow-up time. Conclusion After treatment (maxillary expansion associated with protraction), there was a skeletal pattern improvement. During the follow-up period, those alterations decreased to a measure close to the beginning. There was an improvement in the dental pattern and facial profile that continued in the follow-up period.
Resumo Introdução Não há consenso sobre os efeitos imediatos e tardios da protração maxilar em pacientes com fissura lábio palatal. Objetivo avaliar a estabilidade do tratamento precoce da Classe III em pacientes com fissura labiopalatina por meio da expansão e protração maxilar. Material e método A amostra consistiu de 28 pacientes com fissura lábio palatal com (média de idade pré tratamento de 6.7±1.8) com fissura lábio palatal transforame unilateral, tratados com disjuntor maxilar e com máscara facial de Petit. Por meio de análise em telerradiografias laterais as grandezas angulares (SNA, SNB, ANB, SN.GoGn, FMA, Ângulo Z) e lineares (overjet, Co-A, Co-Gn, Nperp-A, Nperp-Pg, AO-BO) foram avaliadas, com o software Dolphin®, nos tempos: inicial (T0), após o tratamento (T1) e acompanhamento de 2 a 6 anos (T2). Os dados foram submetidos à ANOVA e teste Tukey-Kramer. A correlação entre as grandezas cefalométricas e a idade do paciente foi determinada pelo teste de Pearson. Todas as análises foram realizadas com nível de significância de 5%. Resultado SNA, ANB e AO-BO aumentaram significativamente (p<0,05) e após o período de acompanhamento voltaram a ser semelhantes às iniciais (p>0,05). O overjet aumentou significativamente após o tratamento e mesmo tendo diminuído com o tempo, ainda se apresentava maior quando comparado ao momento inicial (p<0,05). O ângulo Z apresentou melhora com o tratamento e se manteve estável no período de acompanhamento (p<0,05). Conclusão após o tratamento (disjunção associada à protração maxilar) houve melhora do padrão esquelético. No período de acompanhamento, verificou-se que essas melhoras voltaram a medidas próximas das iniciais. Houve melhora no padrão dentário e no perfil facial que se manteve no período de controle.
Subject(s)
Humans , Male , Female , Child , Palatal Expansion Technique , Continuity of Patient Care , Malocclusion, Angle Class III , Cleft Palate , Orthognathic Surgical ProceduresABSTRACT
ABSTRACT Background: Test-seeking is associated with HIV in Brazilian blood donors. This study sought to investigate the frequency with which three different donor groups: deferred donors, accepted donors who tested HIV positive [HIV (+)], and accepted donors who tested infectious disease markers negative [IDM (−)], came to the blood bank at the suggestion of a health care professional. Study design and methods: Donors deferred for reporting high-risk behaviors and participants in an HIV risk factor case-control study completed a confidential audio computer-assisted self-interview (ACASI) that included two questions related to health care professionals and test-seeking. Results: Of 4013 enrolled deferred donors, 468 (11.8%) reported a health care professional suggested donation as a way to be tested for infection. Of 341 HIV (+) and 791 IDM (−) participants, 43 (12.6%) and 11 (1.4%), respectively, reported a health care professional suggested donation as a way to be tested for infection. Physicians were the most frequently reported source of referral: [(61.5% of deferred, 69.1% of HIV (+), and 9.1% of IDM (−) donors)]. Conclusion: HIV (+) donors and deferred donors were 10 times more likely to report test-seeking behavior by suggestion of health care professional than IDM (−) donors. If true, efforts should be made to educate health care professionals and blood donors on how to safeguard the blood supply, emphasizing that HIV testing should be done at volunteer testing centers rather than at the blood centers.
Subject(s)
Blood Donors , Health PersonnelABSTRACT
Resumen La alimentación de los niños durante el horario escolar es fundamental, por lo que a fin de adecuar la oferta alimentaria, es indispensable conocer cuáles son las preferencias alimentarias del alumnado. Así, el propósito de este estudio fue identificar los motivos de las preferencias y el consumo de alimentos durante el recreo escolar. Participaron 38 niños de 9-10 años de edad (55% niñas y 45% niños), alumnos de una escuela primaria pública de tiempo completo. Este estudio etnográfico comprendió el registro de alimentos consumidos y preferidos habitualmente, así como las narrativas de los niños, a través de observación dirigida, entrevistas no estructuradas y elaboración de dibujos. Se encontró que las preferencias alimentarias de los niños están estrechamente vinculadas al contexto familiar y los sentimientos ligados a éste. No obstante, en dichas preferencias influyen también la educación alimentaria recibida (escolar y extra-escolar), así como la disponibilidad-restricción de alimentos dentro de la escuela. En conclusión, aunque las y los niños podían no consumir en el recreo escolar su alimento favorito, adaptaban sus preferencias en función de los alimentos disponibles en la escuela, de modo que la selección variaba en función de la percepción y ponderación de las propiedades organolépticas del alimento (e.g., sabor, consistencia, temperatura).
Abstract Feeding children during school hours is essential, so to adapt the food supply, it is necessary to know what students' food preferences are. Thus, the purpose of this study was to identify the reasons for preferences and food consumption during school breaks. Thirty-eight children with an age range of 9 to 10 years (55% girls and 45% boys), from a full-time public primary school participated. This ethnographic study comprised the recording of commonly consumed and preferred foods, as well as children's narratives, through directed observation, unstructured interviews and drawings. It was found that children's food preferences are closely linked to the family context and the feelings linked to them. However, these preferences also influence the food education received (school and extra-school), as well as the availability-restriction of food within the school. In conclusion, although children could not consume their favorite food at school, they adapted their preferences according to the foods available at school, so the selection varied based on the perception and weighting of the organoleptic properties of the food (e.g., taste, consistency, temperature).
ABSTRACT
OBJECTIVES: We evaluated the validity and reliability of ultrasonography measurement of rectus femoris cross-sectional area compared to computed tomography in patients in pre-dialysis chronic kidney disease and analyzed the association between these measurements and the diagnosis of sarcopenia. METHODS: One hundred patients with nondialysis chronic kidney disease were evaluated. Sarcopenia was defined using the criteria of the Foundation for the National Institutes of Health Sarcopenia Project (FNIH). The rectus femoris cross-sectional area was evaluated using ultrasonography and computed tomography. RESULTS: The prevalence of sarcopenia was 29% according to the FNIH criteria. The difference in mean rectus femoris cross-sectional area by ultrasonography and computed tomography was 3.97 mm, with a strong correlation between the two methods (p<0.001). Bland-Altman plot analysis showed good agreement between computed tomography and ultrasonography. Rectus femoris cross-sectional area was significantly correlated with muscle strength (r=0.300, p=0.002), lean body mass in the upper limbs (r=0.286, p=0.004), and lean body mass in the lower limbs (r=0.271, p=0.006). The prevalence of sarcopenia was 12% (n=12) based on the definition of low muscle mass according to ultrasonography of the rectus femoris cross-sectional area. CONCLUSION: Ultrasonography was demonstrated to be a valid and reliable method for evaluating the rectus femoris cross-sectional area in patients in pre-dialysis chronic kidney disease.
Subject(s)
Humans , Male , Female , Aged , Quadriceps Muscle/diagnostic imaging , Renal Insufficiency, Chronic/complications , Sarcopenia/diagnostic imaging , Tomography, X-Ray Computed , Cross-Sectional Studies , Reproducibility of Results , Ultrasonography , Sarcopenia/complicationsABSTRACT
Abstract Introduction: A combination of antihistamines and oral corticosteroids is often used to treat acute symptoms of allergic rhinitis. Objective: To evaluate safety and efficacy of desloratadine plus prednisolone in the treatment of acute symptoms of children (2-12 years) with allergic rhinitis, and to compare it to dexchlorpheniramine plus betamethasone. Methods: Children with moderate/severe persistent allergic rhinitis and symptomatic (nasal symptoms score [0-12] ≥ 6) were allocated in a double-blind, randomized fashion to receive dexchlorpheniramine plus betamethasone (n = 105; three daily doses) or desloratadine plus prednisolone (n = 105; single dose followed by two of placebo) for 7 days. At the beginning and end of the evaluation, the following were obtained: nasal symptoms score, extra nasal symptoms score, peak nasal inspiratory flow, blood biochemistry, and electrocardiogram. Ninety-six children of the dexchlorpheniramine plus betamethasone group and 98 of the desloratadine plus prednisolone group completed the protocol. Results: The two groups were similar regarding initial and final nasal symptoms scores, extra nasal symptoms scores and peak nasal inspiratory flow. A drop of 76.4% and 79.1% for nasal symptoms score, 86.0% and 79.2% for extra nasal symptoms score, as well as an increase of 25.2% and 24.3% for peak nasal inspiratory flow occurred for those treated with desloratadine plus prednisolone and dexchlorpheniramine plus betamethasone, respectively. There were no significant changes in blood chemistry. Sinus tachycardia was the most frequent electrocardiogram change, but with no clinical significance. Drowsiness was reported significantly more often among those of dexchlorpheniramine plus betamethasone group (17.14% × 8.57%, respectively). Conclusion: The desloratadine plus prednisolone combination was able to effectively control acute symptoms of rhinitis in children, improving symptoms and nasal function. Compared to the dexchlorpheniramine plus betamethasone combination, it showed similar clinical action, but with a lower incidence of adverse events and higher dosing convenience.
Resumo Introdução: A associação entre anti-histamínicos e corticosteroides orais é frequentemente empregada no tratamento de sintomas agudos de rinite alérgica. Objetivo: Avaliar a segurança e eficácia da associação desloratadina + prednisolona no tratamento de sintomas agudos de crianças (2-12 anos) com rinite alérgica e compará-las com as da associação dexclorfeniramina + betametasona. Método: Crianças com rinite alérgica persistente moderada/grave e sintomáticas (escore de sintomas nasais [0-12] ≥ 6) foram alocadas de modo duplo-cego e randômico para receber dexclorfeniramina + betametasona (n = 105; três doses diárias) ou desloratadina + prednisolona (n = 105; dose única seguida por duas de placebo) por 7 dias. No início e no fim da avaliação foram obtidos: escore de sintomas nasais, escore de sintomas extranasais, pico de fluxo inspiratório nasal, bioquímica sanguínea e eletrocardiograma. Do total, 96 crianças do grupo dexclorfeniramina + betametasona e 98 do grupo desloratadina + prednisolona concluíram o protocolo. Resultados: Os dois grupos foram iguais com relação ao escore de sintomas nasais, escore de sintomas nasais extranasais e pico de fluxo inspiratório nasal iniciais e finais. Observou-se queda de 76,4% e 79,1% nos escores para escore de sintomas nasais, de 86,0% e 79,2% para escore de sintomas extranasais, assim como incremento de 25,2% e de 24,3% para o pico de fluxo inspiratório nasal para os grupos desloratadina + prednisolona e dexclorfeniramina + betametasona, respectivamente. Não houve alterações significativas da bioquímica sanguínea. Taquicardia sinusal foi a alteração do eletrocardiograma mais encontrada, mas sem significância clínica. Sonolência foi significantemente mais referida entre os tratados com dexclorfeniramina + betametasona do que entre os desloratadina + prednisolona (8,57% × 17,14%, respectivamente). Conclusão: A associação desloratadina + prednisolona foi capaz de controlar efetivamente os sintomas agudos de rinite em crianças, melhorou sintomas e a função nasal. Na comparação com a associação dexclorfeniramina + betametasona, demonstrou ação clínica semelhante, mas com menor incidência de eventos adversos e maior comodidade posológica.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Prednisolone/administration & dosage , Loratadine/analogs & derivatives , Rhinitis, Allergic/drug therapy , Glucocorticoids/administration & dosage , Time Factors , Severity of Illness Index , Betamethasone/administration & dosage , Betamethasone/adverse effects , Prednisolone/adverse effects , Peak Expiratory Flow Rate , Double-Blind Method , Reproducibility of Results , Treatment Outcome , Loratadine/administration & dosage , Loratadine/adverse effects , Statistics, Nonparametric , Histamine H1 Antagonists, Non-Sedating/administration & dosage , Histamine H1 Antagonists, Non-Sedating/adverse effects , Drug Combinations , Glucocorticoids/adverse effectsABSTRACT
Reportamos el caso de un paciente masculino, 80 años, con historia de dispepsia y sin antecedente familiar de neoplasias. En la endoscopia digestiva alta, en tercio distal, se observó una lesión deprimida plana con aspecto de carcinoma precoz IIC que fue diagnosticada por biopsia como carcinoma escamoso in situ e infiltrante, no queratinizante moderadamente diferenciado grado II. Fue sometido a disección endoscópica submucosa, sin complicaciones. La histopatología concluyo: carcinoma de células escamosas, predominantemente in situ de esófago distal, midiendo 0,6 cm, con foco de 0,1 cm de infiltración en la lámina propia; ausencia de invasión neoplásica angiolinfática o perineural con márgenes de resección quirúrgica libre de neoplasia. Estadio pT1a. Tres meses después, en la endoscopia de control con toma de biopsias de la zona, no hubo evidencia de carcinoma. Presentamos el caso debido a que sigue siendo todo un reto establecer el diagnóstico de cáncer de esófago en etapa temprana, sobre todo en pacientes poco sintomáticos, resaltando la importancia de la cromoendoscopia y de una buena exploración endoscópica para llegar al diagnóstico. La disección endoscopia submucosa podría considerarse como un tratamiento alternativo seguro y eficaz a la cirugía radical.
We report the case of a male patient, 80 years old, with a history of dyspepsia and no family history of neoplasias. In the upper digestive endoscopy in the distal esophagus, a flat depressed lesion with the appearance of early carcinoma, type IIC of Paris classification, was diagnosed by biopsy as a squamous carcinoma in situ, infiltrating, moderately differentiated non-keratinizing grade II carcinoma. He underwent submucosal endoscopic dissection without complications. Histopathology concluded: carcinoma of squamous cells, predominantly in situ of distal esophagus, measuring 0.6 cm, with focus of 0.1 cm of infiltration in the own lamina; absence of angiolymphatic or perineural invasion. The histopathology specimen had margins of surgical resection free of neoplasia. Stage pT1a. Three months later, in the endoscopy control with biopsy of the area, there was no evidence of carcinoma. We present the case because it is still a challenge to establish the diagnosis of esophageal cancer at an early stage, especially in patients without symptoms, highlighting the importance of chromoendoscopy and a good endoscopic examination to reach the diagnosis. Submucosal endoscopy dissection could be considered as a safe and effective alternative treatment to radical surgery.
Subject(s)
Aged, 80 and over , Humans , Male , Esophageal Neoplasms/surgery , Carcinoma in Situ/surgery , Carcinoma, Squamous Cell/surgery , Early Detection of Cancer , Remission Induction , Esophageal Neoplasms/diagnosis , Carcinoma in Situ/diagnosis , Carcinoma, Squamous Cell/diagnosis , Cell Differentiation , Esophagoscopy , Dissection/methodsABSTRACT
Resumen La tuberculosis (TBC) extra-pulmonar alcanza al 26,2% de los casos totales de TBC en Chile. El cultivo es el método estándar de oro, pero es lento. La técnica Xpert® MTB/RIF permite detectar Mycobacterium tuberculosis complex (MTBc) por RPC en tiempo real en menos de 3 h, sin embargo, ha sido validada sólo para muestras respiratorias. El objetivo de este estudio fue determinar la utilidad de la prueba Xpert® MTB/RIF en la detección de MTBc en muestras extra-pulmonares en comparación con un estándar de oro combinado consistente en un cultivo de micobacterias positivo (medio sólido y líquido) y/o un método molecular validado positivo (q-RPC, Cobas® TaqMan-MTB). Se analizaron 50 muestras extra-pulmonares, de las cuales 25 fueron definidas positivas y 25 negativas para MTBc en base a estándar de oro combinado. Las 25 muestras definidas positivas tuvieron un resultado positivo por Xpert® MTB/RIF; de las 25 muestras definidas negativas, 24 tuvieron un resultado negativo y una de ellas un resultado positivo. Se obtuvo una concordancia global entre Xpert® MTB/RIF y el estándar de oro combinado de 98%. La prueba Xpert® MTB/RIF fue capaz de detectar 12 casos de TBC extra-pulmonar con baciloscopia negativa y 3 casos con cultivo negativo. El método Xpert® MTB/RIF ha demostrado tener una sensibilidad similar al q-RPC para detectar MTBc en muestras extra-pulmonares y permite reducir sustancialmente el tiempo de diagnóstico.
Extra-pulmonary tuberculosis (TB) represents the 26.2% of total TB cases in Chile. Culture is the gold standard method, but the process is extremely slow. Xpert®MTB/RIF technique detects Mycobacterium tuberculosis complex (MTBc) through real time PCR in less than 3 h. However, it has been validated only for respiratory specimens. We aimed to determine the performance of Xpert®MTB/RIF test in detecting MTBc in extra-respiratory specimens compared with a combined gold standard consisting in a positive (liquid and solid) mycobacterial culture and/or a positive validated molecular method (q-RPC, Cobas®TaqMan®-MTB). Fifty extra-respiratory specimens were analyzed, from which 25 were positive and 25 negative for MTBc based on the combined gold standard. The 25 positive specimens had a positive result by Xpert®MTB/RIF; from the 25 negative specimens, 24 had a negative result and one had a positive result. We obtained an overall concordance of 98% between Xpert®MTB/RIF and the combined gold standard. Xpert®MTB/RIF test was able to detect 12 smear-negative specimens and 3 culture-negative specimens, all of them corresponding to extra-pulmonary TB cases. Xpert®MTB/RIF showed similar sensitivity to q-RPC in detecting MTBc in extra-respiratory specimens. This procedure allowed a substantial reduction in the time of diagnosis.
Subject(s)
Humans , Tuberculosis/diagnosis , Bacteriological Techniques/methods , Mycobacterium tuberculosis/isolation & purification , Reproducibility of Results , Sensitivity and Specificity , Real-Time Polymerase Chain Reaction , Mycobacterium tuberculosis/geneticsABSTRACT
Introducción: la obesidad es actualmente un problema de salud pública mundial, se ha convertido en un factor determinante en la aparición de numerosas enfermedades, incrementando con ello los índices de morbimortalidad de la población adulta. Sin embargo, existen numerosos estudios que señalan que se inicia en edades tempranas. La juventud es una etapa decisiva para promover la salud y generar estilos de vida. Es por ello necesario identificar a los jóvenes con este problema, con el fin de iniciar medidas correctivas que eviten el desarrollo de complicaciones. Objetivo: determinar la prevalencia de sobrepeso y obesidad en estudiantes de la Facultad de Medicina de la Universidad Nacional de Itapúa. Metodología: diseño observacional, descriptivo, prospectivo realizado en estudiantes de la Facultad de Medicina del período 2011 al 2013. Resultados: de 165 alumnos estudiados, 61,8% presenta normopeso y 38,2% sobrepeso u obesidad. Dentro de antecedentes familiares, la hipertensión arterial y la obesidad están presentes en el 58,7% y 47,6%, respectivamente. La característica clínica resaltante del examen cardiovascular fue el hallazgo una presión arterial > 130/85 en el 22,2% de los estudiantes. Conclusión: la prevalencia de sobrepeso y obesidad fue 38,2%.
Introduction: obesity is currently a public health problem worldwide. It has become a determining factor in the appearance of numerous diseases, increasing the morbi-mortality rates of the adult population. However, there are many studies that indicate that it starts in early ages. Youth is a critical stage to promote health and generate life styles. Because of this, it is necessary to identify the young people with this problem in order to initiate the corrective measures that could avoid the development of complications. Objective: to determine the prevalence of overweight and obesity in students of the Faculty of Medicine of the National University of Itapúa. Material and methods: prospective, descriptive and observational design carried out in students of the Faculty of Medicine from 2011 to 2013. Results: out of 165 students, 61.8% had normal weight and 38.2% overweight or obesity. Concerning family history, blood hypertension and obesity were present in the 58.7% and 47.6% respectively. The remarkable clinical feature of the cardiovascular exam was the finding of a blood pressure of > 130/85 in 22.2% of the students. Conclusions: the prevalence of overweight and obesity was 38.2%.
ABSTRACT
Background: Genotyping of Mycobacterium tuberculosis complex (cMtb) allows us to know geographically predominant lineages. Some lineages spread more rapidly and are associated with multidrug resistance, particularly Beijing, which has been reported in Latin America (Peru). There is little information about this topic in Chile and there are no reports of the presence of the Beijing genotype. Aim: To determine the most prevalent lineages in the Metropolitan Region of Chile with emphasis on the search for Beijing in two health centers. Methods: Two complementary molecular methods were used: spoligotyping, based on the variations of the direct repeat regions in the genome of cMtb and MIRU-VNTR, based in the variable number of tandem repeats of mycobacterial interspersed repetitive units, and subsequent analysis in international databases. A designed lineage was assigned to 37 of the 43 strains studied (86%); 6 isolates could not be assigned to any genotype. LAM and T genotype were the most frequent (39.5 and 32.5%, respectively) followed by Haarlem (7.0%), Beijing (4.7%) and X (2.3%). Conclusion: We describe for the first time the presence of the Beijing genotype in Chile. cMtb molecular surveillance should be implemented in our country in order to know the dynamics of its transmission.
Introducción: La genotipificación del complejo Mycobacterium tuberculosis (cMtbc) permite conocer los genotipos geográficamente predominantes. Algunos genotipos se diseminan con mayor rapidez y se asocian a multi-resistencia, tal como Beijing, reportado en América Latina en Perú. Existe poca información al respecto en Chile, sin reportes de la presencia de Beijing. Objetivo: Conocer los genotipos prevalentes en dos centros de salud de la Región Metropolitana de Chile con énfasis en la búsqueda de Beijing. Métodos: Se utilizaron dos métodos moleculares complementarios basados en la variación de las regiones de repeticiones directa en el genoma de M. tuberculosis (espoligotipificación) y número variable de repeticiones en tandem de las unidades repetitivas de interespaciadores micobacterianos (MIRU-VNTRs) y posterior análisis en bases de datos internacionales. Resultados: Se asignó un genotipo conocido a 37 de las 43 cepas estudiadas (86%), mientras que en 14% no se asignó alguno. Los genotipos LAM y T fueron los más frecuentes (39,5 y 32,5%, respectivamente), seguidos por Haarlem (7,0%), Beijing (4,7%) y X (2,3%). Conclusión: Se describe por primera vez en Chile la presencia del genotipo Beijing en cepas de cMtb. Es necesario realizar una vigilancia epidemiológica molecular en el cMtb para conocer la dinámica de la transmisión en nuestro país.
Subject(s)
Humans , Bacterial Typing Techniques/methods , Mycobacterium tuberculosis/genetics , Tuberculosis/microbiology , Chile , Genotype , Molecular Typing , Mycobacterium tuberculosis/isolation & purification , Species Specificity , Tuberculosis/epidemiology , Tuberculosis/transmission , Urban PopulationABSTRACT
The incidence of whooping cough in Chile ranges from 4.1 and 7.5 per hundred thousand inhabitants. B. pertussis detection is performed by Real Time PCR (Q-PCR) directed to the insertion sequence IS481. However, this sequence is also found in the genome of B. bronchiseptica and B. holmesii. The latter is also a respiratory pathogen whose clinical features are similar to B. pertussis. However, it is important to differentiate between these species because in immunosuppressed patients B. holmesii is more likely to cause bacteremia and is less susceptible to erythromycin. The goal of this work is to measure prospectively and retrospectively the presence of B. holmesii in samples reported positive for B. pertussis in the period 2010-2011. During this period, 1994 nasopharyngeal specimens entered the laboratory for Bordetella sp. PCR, of which 224 were positive. The analysis by Q-PCR directed to the recA gene of B. holmesii of all 224 positive samples determined a prevalence of B. holmesii of 0.6% (12/1994). Because of its more aggressive behavior in immunosupressed patients and its different resistance pattern, routine screening of B. pertussis and B. holmesii is currently performed for all samples in which Bordetella sp PCR is initially detected.
La incidencia de coqueluche en Chile varía entre 4,1 y 7,5 por 100.000 habitantes. La detección de Bordetella pertussis se realiza por RPC-tiempo real (Q-RPC) dirigida a la secuencia de inserción IS481. Sin embargo, esta secuencia se encuentra también en el genoma de B. bronchiseptica y B. holmesii. Este último es también un patógeno respiratorio que produce un cuadro similar a B. pertussis. Sin embargo, es importante diferenciar entre estas especies porque en pacientes inmunosuprimidos B. holmesii tiene mayor tendencia a causar bacteriemia y además es menos susceptible a eritromicina. El objetivo de este trabajo es determinar, prospectiva y retrospectivamente, la presencia de B. holmesii en muestras informadas positivas para B. pertussis en el período 2010-2011. Durante ese período ingresaron al laboratorio 1. 994 muestras de hisopado nasofaríngeo para RPC de Bordetella sp., de las cuales 224 fueron positivas. El análisis por Q-RPC dirigido al gen recA de B. holmesii de las 224 muestras positivas determinó una prevalencia de B. holmesii de 0,6% (12/1994). Debido al comportamiento más agresivo en inmunosuprimidos y al patrón de resistencia de B. holmesi, se decide incorporar la detección de rutina de B. pertussis y B. holmesii en todas las muestras en que se detecta inicialmente la presencia de Bordetella sp.
Subject(s)
Adolescent , Adult , Child , Child, Preschool , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Young Adult , Bordetella/genetics , DNA, Bacterial/analysis , Whooping Cough/epidemiology , Whooping Cough/microbiology , Bordetella pertussis/genetics , Chile/epidemiology , Disease Outbreaks , Epidemiologic Methods , Extinction, Biological , Real-Time Polymerase Chain Reaction , Seasons , Sequence Analysis, DNAABSTRACT
Relatamos um caso de histiocitose cefálica benigna em uma criança do sexo masculino, de um ano e três meses de idade que desenvolveu múltiplas pápulas na região malar bilateralmente, sem outros comemorativos associados. A histopatologia caracterizou-se pelo padrão derme papilar, com imuno-histoquímica negativa para S100 e CD1a, e positiva para CD68, ficando assim estabelecido o diagnóstico desta histiocitose não- Langerhans, baseado nos aspectos clínicos, histopatológicos e imuno-histoquímicos característicos.
The present paper reports a case of benign cephalic histiocytosis in a 15-month baby boy, who developed multiple papules bilaterally in the malar region with no other associated manifestations. Histopathology revealed a papillary dermal pattern, while immunohistochemistry was negative for S100 and CD1a and positive for CD68. Therefore, diagnosis was established as non-Langerhans cell histiocytosis, based on the clinical, histopathological and immunohistochemical features present.
Subject(s)
Humans , Infant , Male , Antigens, CD/immunology , Antigens, Differentiation, Myelomonocytic/immunology , Histiocytosis, Non-Langerhans-Cell/pathology , Diagnosis, Differential , Histiocytosis, Non-Langerhans-Cell/immunology , ImmunohistochemistryABSTRACT
A síndrome de Sweet é enfermidade cutânea rara e de etiologia pouco esclarecida. Cerca de 20 por cento dos casos são associados a neoplasias hematológicas, sendo raros os casos relacionados à doença de Hodgkin. Relata-se caso de paciente masculino de 57 anos que desenvolveu a síndrome concomitantemente à neoplasia. As doenças foram controladas com o tratamento específico.
Sweet's syndrome is a rare cutaneous disease of unknown etiology. About 20 percent of the cases are associated with hematological neoplasms, and cases related with Hodgkin's disease are rare. We present the case of a 57-year old male patient who developed the syndrome concomitantly with the neoplasm. The diseases were controlled with specific treatment.
Subject(s)
Humans , Male , Middle Aged , Hodgkin Disease/complications , Sweet Syndrome/etiology , Hodgkin Disease/pathology , Neoplasm Staging , Sweet Syndrome/pathologyABSTRACT
Na Odontologia atual, a realização de restaurações em resina compsota para dentes posteriores vem sendo amplamente utilizada, devido ao aperfeiçoamento de suas propriedades físico-mecânicas e a apelo estético imposto pela sociedade moderna. No entanto, as resinas compostas convencionais à base de metacrilatos apresentam um porblema intrínseco: a contração de polimerização. Essa contração, em torno de 3 por cento, caracteriza-se pela alteração volumétrica proporcionada pela formação das cadeias poliméricas. Esse problema impulsionou pesquisadores e fabricantes na busca de resinas com novas formulações que pudessem reduzir essa contração. O presente artigo tem como objetivo apresentar um caso clínico com a resina composta Fitek P 90 (3MESPE) cuja matriz resinosa é a base de silorano.
Currently in dentistry, resin composite restorations for posterior teeth has been widely used because of the improvement of their physical-mechanical properties and aesthetic appeal imposed by modern society. However, the conventional resins composite based on methacrylates have an intrinsic problem: the polymerization shrinkage. This contraction of around 3%, is characterized by the volumetric change afforded by the formation of polymer chains. This problem spurred researchers and manufacturers in search of new formulations of resins, which could reduce this contraction. This article aims to present a case report with resin composite Filtek P 90 (3M ESPE), whose resin matrix is based on silorane.
Subject(s)
Humans , Female , Adult , Composite Resins , Dental Restoration, Permanent , Dentistry, Operative , Esthetics, Dental , MethacrylatesABSTRACT
OBJETIVO: Descrever as percepções de mulheres com Síndrome Pré-Menstrual a respeito do comportamento de seus parceiros diante delas. MÉTODOS: Pesquisa de abordagem qualitativa com desenvolvimento das cinco etapas do método de análise da narrativa para conhecer as representações a respeito dessa experiência. RESULTADOS: As experiências das 20 mulheres entrevistadas estão representadas nas categorias: Dificuldades para identificar a síndrome e adotar práticas de cuidado; Falta de conhecimento e sensibilidade dos homens e suas consequências sobre a relação entre o casal. CONCLUSÃO: Orientações sistematizadas sobre a Síndrome Pré-Menstrual devem ser fornecidas a todas as pessoas, em momento anterior à menarca, para evitar o surgimento de problemas decorrentes do desconhecimento da síndrome e suas consequências nas esferas pessoal, familiar e social das mulheres.
OBJECTIVE: To describe the perceptions of women with premenstrual syndrome regarding the behavior of their spouses in face of this event. METHODS: It is a qualitative research, with the method of the five stages of narrative analysis to know the representations of the women that experience the conjugal behavior. RESULTS: The experiences of 20 women interviewed are represented in the following categories: Difficulties in identifying the syndrome and in adopting care practices, lack of knowledge and sensitivity of men and, its impact on the couple relationship. CONCLUSION: It is necessary to provide systematized guidance on Premenstrual Syndrome to all people, before menarche, to avoid problems arising from the ignorance of the syndrome and its consequences in the women's person, family and social areas.
OBJETIVO: Describir las percepciones de las mujeres con Síndrome Premenstrual a respecto del comportamiento de sus compañeros delante de ellas. MÉTODOS: Investigación de abordaje cualitativo con desarrollo de las cinco etapas, del método análisis de narrativa, para conocer las representaciones a respecto de esa experiencia. RESULTADOS: Las experiencias de las 20 mujeres entrevistadas están representadas en las categorías: Dificultades para identificar el síndrome y adoptar prácticas de cuidado; falta de conocimiento y de sensibilidad de los hombres y, sus consecuencias sobre la relación de la pareja. CONCLUSIÓN: Es necesario ofrecer orientaciones sistematizadas sobre el Síndrome Premenstrual a todas las personas, en un momento anterior a la menarca, para evitar el surgimiento de problemas provenientes del desconocimiento del síndrome y de sus consecuencias en las esferas personal, familiar y social de las mujeres.
ABSTRACT
A calcinose idiopática é uma doença rara, caracterizada pelo depósito de sais de cálcio na derme. Possui diversas apresentações clínicas. Em pacientes com Síndrome de Down, ocorre uma rara associação com lesões de calcinose diopática semelhantes a milium.
Idiopathic calcinosis is a rare disease characterized by abnormal deposit of calcium salts on the dermis. It has several clinical presentations. In patients suffering from Down Syndrome, there is a rare association with idiopathic calcinosis lesions similar to milium.
Subject(s)
Child, Preschool , Female , Humans , Calcinosis/pathology , Skin Diseases/pathologyABSTRACT
Situações clínicas onde há a combinação de lesões cervicais, cariosas ou não, com recessão gengival, muitas vezes geram a necessidade de um planejamento restaurador-periodontal integrado. O tratamento para estas condições passa pelo uso de técnicas de enxerto de tecido conjuntivo associado ao aplainamento das lesões dentárias, restauração direta com ionômero de vidro ou resina composta, ou ainda, apenas com enxerto. A combinação imediata de restaurações e enxerto pode otimizar os resultados do tratamento, principalmente em casos com amplas recessões, sensibilidade ou risco estético. Este trabalho tem o intuito de mostrar, através de elementos da literatura e relato de um caso clínico, uma abordagem combinada de procedimento restaurador e periodontal no tratamento de recessões gengivais associadas a lesões cervicais