Clinical, laboratory and tomographic characteristics associated with obesity and BMI at hospital admission in adult patients with COVID-19: a cross-sectional study / Características clínicas, laboratoriais e tomográficas associadas à obesidade e IMC na admissão hospitalar em pacientes adultos com COVID-19: um estudo transversal

INTRODUCTION: The pathological status of obesity can influence COVID-19 from its initial clinical presentation, therefore, the identification of clinical and laboratory parameters most affected in the presence of obesity can contribute to improving the treatment of the disease. OBJECTIVE: To identify the clinical, laboratory, and tomographic characteristics associated with obesity and BMI at t hospital admission in adult patients with COVID-19. METHODS: This is a cross-sectional observational study with a total of 315 participants with COVID-19 confirmed by rt-PCR. The participants were divided into non-Obese (n=203) and Obese (n=112). Physical examinations, laboratory tests, and computed tomography of the chest were performed during the first 2 days of hospitalization. RESULTS: Patients with obesity were younger, and they had higher systolic and diastolic blood pressure, higher frequency of alcoholism, fever, cough, and headache, higher ALT, LDH, and red blood cell count (RBC), hemoglobin, hematocrit, and percentage of lymphocytes. Also, they presented a lower value of leukocyte count and Neutrophil/Lymphocyte Ratio (RNL). The parameters positively correlated with BMI were alcoholism, systolic and diastolic blood pressure, fever, cough, sore throat, number of symptoms, ALT in men, LDH, magnesium, RBC, hemoglobin, hematocrit, and percentage of lymphocytes. The parameters negatively correlated with the BMI were: age and RNL. CONCLUSION: Several parameters were associated with obesity at hospital admission, revealing better than expected results. However, these results should be interpreted with great caution, as there may be some influence of a phenomenon called the Obesity Paradox that can distort the severity and prognosis of the patient.

Clinical Aspects Of Hypertensive Patients With COVID-19 Hospitalized In A Campaign Hospital In Northeast Brazil

Abstract Background In view of the absence of effective therapy for COVID-19, many studies have been conducted seeking to identify determining factors for the development of severe forms, aiming to direct efforts to avoid the worst outcomes in patients susceptible to severe conditions. One of the main comorbidities associated with complicated forms of the disease is systemic arterial hypertension (SAH). Objective To assess aspects of the clinical, demographic, laboratory, and radiological characteristics of hypertensive patients with COVID-19 to contribute to the knowledge of the relationship between the presence of this comorbidity and the severity of the disease. Methods A total of 380 patients with a diagnosis of acute SARS-CoV-2 infection hospitalized between June and August 2020 were included. Patients were divided into two groups according to the presence or absence of a previous diagnosis of hypertension. For comparison between groups, a significant difference was established if p < 0.05. Results Of the total of 380 patients, 202 (53.16%) had a clinical diagnosis of SAH. Hypertensive patients were significantly older (p < 0.01) and had more comorbidities (p < 0.01) than the non-hypertensive group. In laboratory tests, hypertensive patients had higher levels of blood glucose (p = 0.014), creatinine (p = 0.002), and urea (p = 0.003), while values for alanine aminotransferase (ALT) (p < 0.01), aspartate aminotransferase (AST) (p = 0.006), and sodium (p = 0.024) were lower. There was no difference between groups in radiographic parameters. Conclusions This study showed that, although the hypertensive group had some laboratory alterations that elicited severe disease, these patients did not have worse outcomes.

Differences in hormonal levels between heterozygous CYP21A2 pathogenic variant carriers, non-carriers, and females with non-classic congenital hyperplasia

ABSTRACT Objective: CYP21A2 mutation heterozygote carriers seem to have an increased risk of hyperandrogenism. However, the clinical relevance of the heterozygote carrier status and the reliability of hormonal testing in discriminating a carrier from a non-carrier are puzzling questions. We aimed to characterize a population of Portuguese females suspected of having non-classic congenital adrenal hyperplasia (NC-CAH) due to clinical and biochemical criteria and who have undergone CYP21A2 molecular analysis. Subjects and methods: Retrospectively, we have analyzed the clinical records of 131 females (32 girls aged 3-9 and 99 adolescents and premenopausal women aged 13-49) who underwent complete CYP21A2 molecular analysis due to suspicion of NC-CAH. We divided included participants into three groups according to the CYP21A2 molecular analysis: NC-CAH females (46), heterozygous carriers (49), and wild type (36). We then compared clinical signs and symptoms as well as biochemical and molecular data between carriers and NC-CAH individuals and between carriers and wild type females. We measured 17OHP by electrochemiluminescence immunoassay. Results: Clinical features were similar between groups. Heterozygous carriers presented higher basal and post-cosyntropin 17-hydroxyprogesterone (17OHP) than wild type individuals (p < 0.05) and lower basal and stimulated 17OHP levels than NC-CAH patients (p < 0.05). We discovered a considerable overlap between 17OHP levels among groups. The most common pathogenic variant we identified was p.Val282Leu. Conclusion: In this population of hyperandrogenic women and children, heterozygous carriers showed higher basal and stimulated 17OHP than non-carriers although normal basal and stimulated 17OHP responses do not exclude heterozygosity for CYP21A2 pathogenic variants. In this study, only the molecular analysis presented good sensitivity in identifying heterozygotes.

Correlación entre el umbral de ciclo de la RPC en tiempo real y la clasificación clínica de la COVID-19 / Correlation between real-time PCR cycle threshold and clinical classification of COVID-19

INTRODUCCIÓN: El umbral de ciclo (en inglés cycle threshold-Ct) de la reacción de polimerasa en cadena en tiempo real con transcripción reversa (RT-qPCR) indica la concentración relativa de una secuencia de ARN; este valor se ha relacionado con la expresión de cuadros clínicos en infecciones virales. OBJETIVO: Determinar la correlación entre el valor Ct y la clasificación clínica de la COVID-19. MÉTODO: Se realizó un estudio transeccional correlacional; los valores Ct se obtuvieron mediante RT-qPCR dirigida al gen N del SARS-CoV-2 agrupándolos mediante un estimador robusto central y relacionándose con la clasificación clínica de la COVID-19. RESULTADOS: De los 718 casos incluidos en el estudio; 77,7% (558) fueron leves; 21,3% (153) moderados y 1% (7) graves. El valor Ct se agrupó en niveles: Ct bajo 18,83 - 30,10 y Ct alto > 30,10. Existió correlación significativa inversa débil (p = 0,002; rho de Spearman = -0,117) entre el valor Ct y la clasificación clínica. Las características: sexo, edad menor a 65 años, fiebre, escalofrío, diarrea, anosmia y sobrepeso-obesidad estuvieron asociadas al valor de Ct. CONCLUSIÓN: A menor valor Ct se espera una clasificación de mayor gravedad de la COVID-19; no obstante, debido a que la correlación es débil, su utilidad como predictor de gravedad es limitada.

BACKGROUND: The cycle threshold (Ct) of real-time reverse transcription PCR (RT-qPCR) indicates the relative concentration of an RNA sequence, this value has been related to clinical profile in viral infections. AIM: To determine the correlation between the Ct value and the clinical classification of COVID-19. METHOD: A correlational cross-sectional study was carried out, the Ct values were obtained by RT-qPCR directed to the N gene of SARS-CoV-2, grouping them by means of a central robust estimator and related to the clinical classification of COVID-19. RESULTS: Of the 718 cases included in the study; 77.7% (558) were mild; 21.3% (153) moderate and 1% (7) severe. The Ct value was grouped into levels: low Ct 18.83-30.10 and high Ct> 30.10. There was a weak inverse significant correlation (p = 0.002; Spearman's rho = -0.117) between the Ct value and the clinical classification. The characteristics: sex, age under 65 years, fever, chills, diarrhea, anosmia, and overweightobesity were associated with the Ct value. CONCLUSION: The lower the Ct value, a classification of greater severity of COVID-19 is expected, however, because the correlation is weak, its usefulness as a severity predictor is limited.

Tumor tritón maligno en región mandibular y cervical / Malignant triton tumor in the mandibular and cervical region

Introducción: El tumor tritón maligno es una neoplasia rara en la que se encuentran células rabdomioblásticas en un tumor maligno de la vaina de nervios periféricos, que se caracteriza por su agresividad y mal pronóstico. La localización en la cabeza y el cuello es poco frecuente. La inmunohistoquímica juega un papel importante en el diagnóstico. Objetivo: Describir un tumor tritón maligno de tamaño inusual. Presentación del caso: Paciente femenino, de 16 años, es referida al servicio de cirugía maxilofacial del Instituto Nacional de Pediatría, Ciudad de México, con un diagnóstico de tumor neuroectodérmico en región facial y cervical de un año de evolución. Clínicamente el tumor era exofítico, multilobulado, con zonas extensas de necrosis, superficie de varias tonalidades y un tamaño aproximado de 18 x 10 x 12 cm. Se realizó una biopsia e inmunohistoquímica que confirmó el diagnóstico de tumor tritón maligno. La paciente fue intervenida quirúrgicamente, procedimiento con el cual se eliminó totalmente la lesión, con márgenes de seguridad. La paciente presentó una evolución tórpida, con desenlace fatal al cabo de seis meses del tratamiento. Conclusiones: El tumor tritón es una neoplasia agresiva y su detección oportuna orienta al cirujano a ofrecer al paciente un tratamiento adecuado(AU)

Introduction: Malignant triton tumor is a rare neoplasm in which rhabdomyoblasts are present in a malignant tumor of the peripheral nerve sheath. This condition is characterized by its aggressiveness and bad prognosis. Location in the head and neck is infrequent. Immunohistochemical testing plays an important role in its diagnosis. Objective: Describe an unusually large malignant triton tumor. Case presentation: A case is presented of a female 16-year-old patient referred to the maxillofacial surgery service of the National Institute of Pediatrics in Mexico City with a diagnosis of neuroectodermal tumor of one year's evolution in the facial and cervical region. In clinical terms, the tumor was exophytic, multilobed, with extensive areas of necrosis, a surface in several shades of color and an approximate size of 18 x 10 x 12 cm. Biopsy and immunohistochemical testing confirmed the diagnosis of malignant triton tumor. The patient underwent surgery in which the lesion was totally excised with a safety margin. Evolution was clumsy, with a fatal outcome at six months of treatment. Conclusions: Triton tumor is an aggressive neoplasm whose early detection makes it possible for surgeons to provide an appropriate treatment(AU)

A dança na prática pedagógica dos docentes de educação física da rede municipal de ensino de Joinville / Dance in the pedagogical practice of physical education teachers in the municipal network of Joinville teaching / La danza en la práctica pedagógica de profesores de educación física de la red municipal de enseñanza de Joinville

O objetivo geral deste artigo é analisar a oferta do conteúdo de Dança na prática pedagógica dos professores de Educação Física da rede municipal de ensino de Joinville. A pesquisa é descritiva e explicativa, utilizando o processo misto (quanti-qualitativo). Para tanto, foi aplicado um questionário para 73 professores. Os resultados indicaram que o conteúdo da Dança faz parte do planejamento de alguns deles. Porém, isso ocorre de forma parcial e não convergente em relação ao que propõe a Matriz Curricular. Esse documento orienta que o conteúdo da Dança seja ministrado como cultura corporal do movimento e deve contribuir para o desenvolvimento integral dos alunos (AU).

The general objective of this article is to analyze the offer of Dance content in the pedagogical practice of Physical Education teachers of Joinville municipal teaching network. The research is descriptive and explanatory, using the mixed process (quanti-qualitative). A questionnaire was applied to 73 teachers. The results indicated that the content of Dance is part of some teachers planning. However, this occurs partially and not convergent in relation to what the Curricular Matrix proposes. This document guides that the content of Dance is taught as the body culture of the movement and should contribute to the students' integral development.

El objetivo general de este artículo es analizar la oferta del contenido de Danza en la práctica pedagógica de los profesores de Educación Física de la red municipal de enseñanza de Joinville. La búsqueda es descriptiva y explicativa, utilizando el proceso mixto (cuanti-cualitativo). Se aplicó una encuesta para 73 profesores. Los resultados indicaron que el contenido de la Danza es parte de la planificación de algunos profesores. Sin embargo, esto ocurre de manera parcial y no convergente en relación a lo que propone la Matriz Curricular. Este documento orienta que el contenido de la Danza se impartido como cultura corporal del movimiento y debe contribuir al desarrollo integral de los alumnos (AU).

Perfil e trajetória dos egressos de programas de residência das áreas básicas: um corte transversal / Profile and professional career of graduates from a residency program of the basic medical areas: a cross section study

Resumo: Introdução: A residência médica é reconhecida como o "padrão ouro" para a formação de especialistas. O estudo do perfil dos egressos da residência médica é importante para identificar potencialidades e fragilidades da especialização. Objetivo: Este estudo teve como objetivo conhecer o perfil e a satisfação profissional dos egressos dos programas de residência das áreas básicas de um hospital-escola do Nordeste. Método: Trata-se de estudo de corte transversal que utilizou a plataforma eletrônica Survey. Incluíram-se residentes das áreas básicas que concluíram o programa no período de 2013 a 2017. O Termo de Consentimento Livre e Esclarecido foi enviado com o formulário. Realizaram-se análises descritivas das variáveis, e os dados foram apresentados em frequências absoluta e relativa. O trabalho foi aprovado pelo Comitê de Ética do IMIP. Resultados: Dentre os 194 egressos, tivemos a adesão de 79 (40,72%). Com relação aos participantes do estudo: 73,4% eram do gênero feminino e 60,8% já estavam casados. Destacamos que 55,7% informaram que tinham uma renda mensal de dez a 20 salários mínimos. Dos egressos, 54 (68,4%) tinham cursado graduação em instituição de ensino superior privada. Sobre a pós-graduação stricto sensu, 19 egressos (21,7%) tinham mestrado. Sobre a atuação profissional, 93,7% exercem a especialidade e 54 (68,4%) trabalham no estado onde cursaram o programa. Em relação ao serviço público, 64,6% são vinculados ao Sistema Único de Saúde do estado de Pernambuco. Sobre a quantidade de horas de trabalho semanais, 43% trabalham entre 40 e 60 horas. Cerca de 75% dos egressos afirmaram que cursariam o programa novamente na instituição e declararam que a realização da residência facilitou a vida profissional deles. Conclusão: A monitoração periódica de egressos de programa de residência é um instrumento útil para avaliação do programa e permite monitoramento das intervenções implementadas, viabilizando inclusive a obtenção de informações que ajudem no planejamento de novos programas.

Abstract: Introduction: medical residency is known as the "gold standard" for the qualification of specialists. Research into the profile of medical residency program graduates is important to identify potentialities and fragilities of the specialization. Objective: The objective of this study was to understand the profile and professional satisfaction of the graduates from the residency programs of basic medical areas of a teaching hospital in the northeast of Brazil. Methods: a cross-sectional study was conducted through an online questionnaire that was sent to the participants via electronic mail. The study population consisted of residency program graduates of the basic medical areas who graduated between 2013 and 2017. The Informed Consent Form was sent together with the form. Descriptive analyses were performed and data were presented as relative and absolute frequencies. The study was approved by the Research Ethics Committee of the IMIP. Results: of the 194 graduates, 79 (40.72%) answered the questionnaire. 73.4% were female and 60.8% were married. Approximately 55.7% of the graduates earned salaries corresponding to 11 and 22 minimum monthly wages. 54 graduates (68.4%) had attended a private medical school. Regarding stricto sensu postgraduate studies, 19 (21.7%) had a master´s degree. 93.7% are practicing their medical specialization and 54 (68.4%) still live in Pernambuco. Regarding public service, 64.6% are linked to the Unified Health System of Pernambuco state. 43% of the graduates worked between 40 and 60 h per week. About 75% of the graduates stated that they would attend the program again at the hospital and declared that completing the residency at the institution facilitated their professional life. Conclusion: the periodic monitoring of graduates from a residency program is a useful tool for evaluating the program and allows for surveillance of implemented interventions

Subjetividade e espaço: um olhar pela teoria ator-rede / Subjectivity and space: an actor network-theory perspective / Subjetividad y espacio: una visión por la teoría del actor-red

O presente trabalho é uma reflexão teórica sobre uma maneira não moderna de conceituar a subjetividade. Por esse viés, os humanos não são os únicos responsáveis pela construção de sua subjetividade, mas também os ambientes e os elementos não humanos. Para isso, são utilizados como referenciais teóricos Bruno Latour, David Lapoujade, Gabriel Tarde e John Law. Desenvolvemos, ainda, a noção de uma ciência barroca, que lida com certas questões epistemológicas de maneira diferente do que uma ciência tradicional, além de se exigir outra postura ético-política dos pesquisadores. A noção de subjetividade, a partir desse percurso epistemológico-metodológico, deve ser apreendida como linhas ou campos de interesse e afetação interagindo num lugar e momento que não se reduzem a sujeitos individuais egocêntricos.

This study is a critical thinking about a non modern way to conceptualize subjectivity. In this perspective humans are not the only responsibles for the construction of their own subjectivity but also the environment and non human elements. For that, we use theorical references such as Bruno Latour, David Lapoujade, Gabriel Tarde and John Law. We develop the notion of a baroque science, that deals with certains epistemological questions different from the traditional way of science. In addition we support a new politic and ethic posture for the researchers. The notion of subjectivity, from this epistemological and methodological perspective is understood as fields and lines of interest e affections that interact in a determined time and place that are not reduced to individual egocentric subjects.

El presente trabajo es una reflexión teórica sobre una manera no moderna de conceptualizar la subjetividad. Por ese enfoque, los humanos no son los únicos responsables de la construcción de su subjetividad, sino también los ambientes y los elementos no humanos. Para ello, se utilizan como referenciales teóricos Bruno Latour, David Lapoujade, Gabriel Tarde y John Law. Desarrollamos aún, la noción de una ciencia barroca, que se ocupa de ciertas cuestiones epistemológicas de manera diferente que una ciencia tradicional, la postura ético-política de los investigadores. La noción de subjetividad, a partir de ese recorrido epistemológico-metodológico, debe ser aprehendida como líneas o campos de interés y afectación interactuando en un lugar y momento que no se reducen a sujetos individuales egocéntricos.

Cerebral amyloid angiopathy: a cross-sectional study in a single center in Northeastern Brazil / Angiopatia amiloide cerebral: um estudo transversal em um único centro no Nordeste brasileiro

ABSTRACT Background: Cerebral amyloid angiopathy (CAA) is a cerebrovascular disorder caused by progressive deposition of β-amyloid peptides in the walls of small and medium-sized cortical and leptomeningeal vessels. Until today, the prevalence of CAA is unknown in our region. Objective: This study aims to analyze the prevalence of this entity in a specific elderly population in a tertiary hospital in Northeastern Brazil. Methods: A cross-sectional, retrospective study with the enrollment of patients aged 65 or older followed in the neurological outpatient service of the Universidade Federal do Piauí, Brazil, who underwent brain magnetic resonance imaging (MRI) from July 2016 to June 2018. Results: One hundred and seventy-four patients were enrolled, of whom 100 were women (57.4%) and 74, men (42.6%), aged from 65 to 91 years old (median age 73.27). Nine patients were excluded from the study due to unavailability of MRI sequences needed for an appropriate analysis. Out of the 165 remaining patients, 12 (7.2%) had established the diagnosis of CAA, according to the modified Boston criteria. Conclusion: The prevalence of CAA in our study was like those of medical literature, with a progressive age-related increase.

RESUMO Introdução: A angiopatia amiloide cerebral (AAC) é uma desordem vascular causada pela deposição progressiva de peptídeos β-amiloides nas paredes de pequenos e médios vasos corticais e leptomeníngeos. Até a presente data, a epidemiologia da AAC é desconhecida em nossa região. Objetivos: Avaliar a prevalência da AAC em uma população específica de pacientes idosos de um hospital terciário no nordeste brasileiro. Métodos: Estudo transversal, retrospectivo, com seleção de pacientes com idade igual ou superior a 65 anos, acompanhados no serviço de Neurologia do Hospital Universitário da Universidade Federal do Piauí, Brasil, e que foram submetidos a exame de ressonância nuclear magnética entre julho de 2016 e junho de 2018. Resultados: Foram recrutados 174 pacientes, dos quais 100 eram mulheres (57,4%) e 74 homens (42,6%), com idades entre 65 e 91 anos (média de 73,27). Nove pacientes foram excluídos devido à indisponibilidade de sequências de ressonância magnética necessárias para uma análise apropriada. Dos 165 pacientes restantes, 12 (7,2%) foram diagnosticados com AAC de acordo com os critérios de Boston modificados. Conclusão: A prevalência da AAC em nosso estudo foi semelhante ao resultado encontrado na literatura médica, com um aumento progressivo relacionado à idade.

Chegadas e partidas: o estádio como elemento memorial para os torcedores do San Lorenzo E West Ham / Arrivals and departures: the stadium as a memorial element for the fansof San Lorenzo and West Ham

Este trabalho tem por objetivo analisar, comparativamente, relações de territorialidade construídas em torno dos estádios San Lorenzo (Buenos Aires) e West Ham (Londres), consideradas sob perspectiva histórica. Embora tenham se constituído como equipamentos materiais e simbólicos, nos quais gerações vivenciaram experiências e estabeleceram redes de sociabilidade, recentemente passaram por mudanças significativas: o projeto de retorno do San Lorenzo ao Viejo Gasómetro, ativando a memória da ditadura argentina e a partida do West Ham para o Estádio Olímpico, após mais de 100 anos no Upton Park. Neste sentido, pretende-se, através de análise das narrativas memoriais produzidas na mídia escrita, analisar a maneira pela qual os agentes acionam o elemento memorial para referir-se aos estádios como monumentos afetivos e marcas territoriais.

This work has for objective to analyze comparatively territoriality relationships built around the stadiums of San Lorenzo (Buenos Aires) and West Ham (London) considered under historical perspective. Although they have been constituted as material and symbolic equipment, where generations have gone through experiences and established social networks, they recently went through significant changes: the project of return of the San Lorenzo to the Viejo Gasómetro, activating the memory of the Argentine dictatorship and the departure of the West Ham to the Olympic Stadium after more than 100 years at Upton Park. In this sense, it is intended, through analysis of the narratives memorials produced in written media, analyze the way in which the agents trigger the memorial element to refer to the stadiums as affective monuments and territorial markings.

Development of odontoma in the permanent dentition after intrusion of primary incisors: case report

Introduction: Dental trauma in childhood is a serious and high incidence complication, mostly due to the discovery phase. This is when the first steps begin, without adequate motor coordination, making children more prone to falls. Trauma to a deciduous tooth can leave sequelae owing to the anatomical proximity to the permanent successor tooth germ. Objective: This study aimed to report a case of severe intrusion in a 10-month-old baby with the emergence of odontoma after dental trauma. Case Report: A 9-year-old patient, accompanied by the guardian, sought attendance for delayed primary teeth exfoliation. During anamnesis, the trauma to the deciduous dentition was found in a 10-month old child, followed by clinical and radiographic examination, showing the presence of odontoma in teeth 11 and 21. The multidisciplinary treatment plan included surgery to remove the odontoma, with subsequent rehabilitation. Conclusion: Trauma to primary dentition can have several consequences for permanent dentition. Thus, dental care is required soon after the incident, besides careful follow-up to evaluate possible sequelae.

Introdução: O traumatismo dentário na infância é uma intercorrência grave, de incidência alta devido principalmente a fase de descobertas, com o início dos primeiros passos, sem ter coordenação motora adequada, tornando as crianças mais propensas a quedas. Um trauma em um dente decíduo pode deixar sequelas em razão da proximidade anatômica ao germe do dente sucessor permanente. Objetivo: O objetivo deste trabalho foi relatar um caso de intrusão grave em bebê de 10 meses, com surgimento de Odontoma após trauma dentário. Relatode Caso: Paciente de 9 anos de idade, acompanhada pela responsável, procurou atendimento pelo atraso na esfoliação dos dentes decíduos. Durante a anamneses foi constatado traumatismo na dentição decídua aos 10 meses de idade, e em seguida realizado o exame clínico e radiográfico, demostrando a presença de odontoma nos dentes 11 e 21. O plano de tratamento multidisciplinar compreedeu a cirurgia para remoção do odontoma, com posterior tratamento ortodôntico reabilitador. Conclusão: O trauma na dentição decídua pode gerar diversas consequências para a dentição permanente. Desse modo é necessário um atendimento odontológico logo após o incidente e um proservação do caso, para avaliar possíveis sequelas.

Treatment of Blowout fracture with video-assisted surgery / Tratamento de fratura Blowout com auxílio de vídeo-cirurgia

ABSTRACT Posterior fractures of the orbital floor are challenging, since an incomplete visualization of the defect through conventional surgical accesses may compromise the surgical outcome. The use of the endoscope as an auxiliary method during orbital reconstructions may be considered as a tool of considerable importance, mainly due to the visualization of the whole extension of fracture and adaptation of meshes or bone grafts. This study aims to report a clinical case of a patient diagnosed with extensive blowout fracture showing diplopy, enophthalmos, and ophthalmoplegia in supraversion, who underwent a subciliary approach combined with transantral video assisted surgery. There were no intercurrences on the procedure. Currently, patient has 1 year of follow up, with reestablished orbital function and architecture.

RESUMO As fraturas posteriores do assoalho orbital são desafiadoras, visto que a incompleta visualização do defeito por meio dos acessos cirúrgicos convencionais poderá comprometer o resultado cirúrgico. O uso do endoscópio como método auxiliar durante as reconstruções orbitais pode ser considerado uma ferramenta de grande importância principalmente para visualização de toda a extensão da fratura e adaptação das malhas ou enxertos ósseos. Este trabalho tem como objetivo relatar um caso clínico de um paciente diagnosticado com uma extensa fratura blowout apresentando clinicamente diplopia, enoftalmo e oftalmoplegia em supraversão, o qual foi submetido a tratamento através da abordagem subciliar combinada com a cirurgia vídeo-assistida transantral. O procedimento foi realizado sem intercorrências, estando o paciente com 1 ano de acompanhamento, com função e arquitetura orbital restabelecidos.

Transplante Dental Autógeno / Autogenous Dental Transplantation

O transplante dental autógeno pode ser considerado uma opção viável para substituição de dentes perdidos, sendo assim necessário um dente doador em boas condições para sua realização. A principal vantagem dessa técnica é que pode ser realizada em pacientes em fase de crescimento, devolvendo a estética e a função mastigatória para esses pacientes. Este trabalho tem como objetivo relatar um caso clínico de transplante dental autógeno de uma paciente jovem, a qual foi submetida ao transplante do elemento dental 28 para o alvéolo do dente 26, o qual teve indicação de exodontia devido a extensa lesão coronária causada por cárie. O transplante dental autógeno mostrou-se eficaz para o referido caso, visto que proporcionou ao paciente uma reabilitação funcional e estética satisfatória, sendo um tratamento rápido, seguro e economicamente viável.

The autogenous dental transplantation can be considered a viable option to replacement of lost teeth. For this it´s necessary a healthy donor tooth to perform. The main advantage of this technique is can be used in growing patients, reestablishing aesthetics and masticatory function for them. This paper aims report a clinical case of autogenous dental transplantation of a young patient, who was submitted to transplantation from the upper left third molar to the alveolus of upper left first molar, which had indication of exodontia due extensive lesion caused by caries. Autogenous dental transplantation showed to be effective for this case, because the patient had a satisfactory functional and aesthetic rehabilitation, being a fast, safe and economically viable.

Avaliação do efeito de cepas probióticas em biofilme de S. aureus sobre discos de titânio com superfície tratada / Assessment of probiotic bacterial strains effect on S. aureus biofilm on titanium discs with treated surfaces

Resumo Introdução As doenças peri-implantares apresentam como um dos principais fatores etiológicos o biofilme bacteriano, geralmente formado por uma microbiota semelhante à das doenças periodontais. Seu tratamento está centrado na descontaminação da superfície do implante e na remoção mecânica do biofilme, podendo ainda estar associado à administração de agentes antimicrobianos. Nesse sentido, tem sido cogitada a utilização de probióticos, que são microrganismos benéficos à saúde e que podem ter grande importância na cavidade oral, como coadjuvante no tratamento das peri-implantites. Objetivo Avaliar o efeito das cepas probióticas de Lactobacillus brevis e Bifidobacterium bifidum no crescimento do biofilme monoespécie de Staphylococcus aureus. Material e método Discos de titânio padronizados e com superfície tratada foram submersos em meio contendo caldo BHI e Staphylococcus aureus durante sete dias. Após esse período, o caldo foi retirado, os discos foram lavados e, então, introduzidos em um novo caldo BHI contendo as suspensões probióticas, sendo assim comparados a um grupo controle, sem probióticos. As amostras foram incubadas por 24h e então foram realizadas as diluições e a contagem das UFC (unidades formadoras de colônia) para Staphylococcus aureus. Resultado Após análise estatística dos dados, observou-se que a adição de ambos os probióticos resultaram em redução significativa (p<0,05) de UFC, quando comparados ao controle. Conclusão Conclui-se que os probióticos analisados (Lactobacillus brevis e Bifidobacterium bifidum) reduziram consideravelmente o crescimento do patógeno Staphylococcus aureus. Além disso, a cepa de Lactobacillus brevis apresentou efeito inibidor superior ao da cepa Bifidobacterium bifidum para ser utilizada como controle do biofilme bacteriano de Staphylococcus aureus.

Abstract Introduction One of the main etiological factors for peri-implant diseases is the bacterial biofilm, which usually features a similar microbiota to periodontal diseases. Its treatment focus on the decontamination of the implant surface and on the mechanical removal of biofilm, and it may also be associated to the administration of antimicrobial agents. Thus, the use of probiotics has been considered, since they feature beneficial microorganisms to health and may be of great importance for the oral cavity as an adjunct for the treatment of peri-implant diseases. Objective The aim of this in vitro study was to assess the effect of probiotic strains of Lactobacillus brevis and Bifidobacterium bifidum on the growth of single-species biofilm of Staphylococcus aureus. Material and method Standardized surface-treated titanium discs were submerged in a medium containing BHI broth and Staphylococcus aureus, for 7 days. After this period, the broth was removed, the discs were washed and, then, submerged in a new BHI broth containing probiotic suspensions and compared to a control group (with no probiotics). Samples were incubated for 24 hours and then the dilutions and CFU (colony-forming units) counting for Staphylococcus aureus were performed. Result Statistical analysis revealed that the addition of both probiotics resulted in a significant reduction (p<0,05) of CFU, when compared to the control group. Conclusion The assessed probiotics (Lactobacillus brevis and Bifidobacterium bifidum) considerably reduced Staphylococcus aureus growth. In addition, Lactobacillus brevis strain presented a superior inhibition effect than Bifidobacterium bifidum strain for Staphylococcus aureus bacterial biofilm control.

Vertical bone augmentation of posterior mandibular region: a description of two surgical techniques / Aumento ósseo em altura da região mandibular posterior: descrição de duas técnicas cirúrgicas

ABSTRACT Correction of severe vertical bone deficiency in the posterior region of mandibular alveolar ridge requires surgical management if implants are scheduled and cannot have primary stability. The aim of the present study is to report two cases; one treated with alveolar osteogenesis distraction and the other with segmental osteotomy with autologous graft interposition, by describing the surgical steps as well as show the results and experiences acquired with these techniques. We opted for these methods to reconstruct the posterior mandibular region after remarkable vertical bone loss based mainly by the height and thickness of the remaining bone. Alveolar osteogenic distraction is highly advisable when vertical deficiency is severe, and if these cases are treated with the segmental osteotomy and autologous graft interposition, complications as graft failure, necrosis and resorption are more prone to occur due to insufficient vascularization. After bone maturation and bone neoformation secondary to alveolar osteogenic osteogenic distraction and segmental osteotomy with autologous graft interposition, respectively, the two presented case reports were able to securely receive dental implants. In cases of vertical bone loss of the posterior mandibular region, both surgeries currently represent the best choice for bone gain prior dental implants placement for oral rehabilitation, without technical challenges, although biological evidence to assure the superiority of one technique over the other must be further investigated.

RESUMO A correção de deficiência óssea severa em altura na região posterior do rebordo alveolar da mandíbula requer tratamento cirúrgico caso a inserção de implantes dentários seja necessária e não se pode ter uma estabilidade primária. O objetivo do presente estudo é relatar dois casos; um tratado com distração osteogênica alveolar e o outro com osteotomia segmentar associada à interposição de um enxerto autógeno, descrevendo a sequência cirúrgica, bem como mostrar os resultados e as experiências adquiridas com essas técnicas. Optamos por esses métodos para reconstruir a região mandibular posterior baseados principalmente na altura e espessura óssea remanescentes. A distração osteogênica alveolar é altamente recomendável quando essa deficiência é avançada e, se esses casos são tratados com a osteotomia segmentar e interposição de enxerto autógeno, complicações como falha do enxerto, necrose e reabsorção são mais prováveis de ocorrer devido à vascularização sua insuficiente. Após os períodos de reparação e neoformação óssea secundária à distração osteogênica alveolar e à osteotomia segmentar com interposição de enxerto autógeno, respectivamente, os dois casos relatados estavam aptos a receberem seguramente os implantes dentários. Nos casos de perda óssea em altura na região mandibular posterior, ambas as cirurgias representam, atualmente, a melhor escolha para o ganho de estrutura óssea antes da colocação dos implantes dentários e reabilitação oral, sem muita complexidade quanto à técnica cirúrgica, embora ainda sejam necessário estudos posteriores para assegurar a superioridade de uma técnica em relação a outra.

Intubação submentoniana nas fraturas complexas do terço médio facial û relato de caso / Submental intubation in complex fractures of midface û case report

A intubação submentoniana é uma técnica segura, eficaz e que apresenta sucesso comprovado no manejo das vias aéreas de pacientes com traumatismo facial. Está indicada em casos de fratura de terço médio de face, em que há necessidade de realização do bloqueio maxilomandibular com manipulação da oclusão dental e da pirâmide nasal transoperatória. A técnica consiste na realização de uma incisão de 2 centímetros de extensão, na região submentoniana, paralela à borda inferior da mandíbula, seguida de divulsão romba dos tecidos e a passagem do tubo através do acesso. É uma técnica que apresenta excelentes resultados, menor morbidade quando comparada à traqueostomia e as complicações são raras. O presente trabalho apresenta um caso clínico-cirúrgico de um paciente com fratura complexa do terço médio facial, que foi submetido ao tratamento cirúrgico aberto e a intubação submentoniana foi utilizada com sucesso para a manutenção das vias aéreas.

The submental intubation is a safe technique, effective and has proven success in handling the airways of patients with facial trauma. It is indicated in cases of midfacial fractures that require maxillo-mandibular block with manipulation of dental occlusion and nasal bone transoperative. The technique consists of making an incision of 2 cm, in the submental region, parallel to the lower border of the mandible, followed by blunt dissection of the tissue and passing the tube through the access. It is a technique that shows excellent results with rare complications, and has lower morbidity when compared to tracheostomy. This paper presents a clinical-surgical case of a patient with complex midface fracture who underwent open surgical treatment and the submental intubation was successfully used for maintenance of the airways.

Vasoconstrictor effect of Africanized honeybee (Apis mellifera L. ) venom on rat aorta

Background : Apis mellifera stings are a problem for public health worldwide, particularly in Latin America due to the aggressiveness of its Africanized honeybees. Massive poisoning by A. mellifera venom (AmV) affects mainly the cardiovascular system, and several works have described its actions on heart muscle. Nevertheless, no work on the pharmacological action mechanisms of the AmV in isolated aorta has been reported. Thus, the present work aimed to investigate the actions of AmV and its main fractions, phospholipase A2 (PLA2) and melittin, on isolated aorta rings and a probable action mechanism. Results : AmV and the complex PLA2 + melittin (0.1-50 μg/mL) caused contraction in endothelium-containing aorta rings, but neither isolated PLA2 nor melittin were able to reproduce the effect. Endothelium removal did not change the maximum vasoconstrictor effect elicited by AmV. Ca2+-free medium, as well as treatment with phentolamine (5 μM), verapamil (10 μM), losartan (100 μM), and U-73122 (10 μM, a phospholipase C inhibitor), eliminated the AmV-induced contractile effects. Conclusions : In conclusion, AmV caused contractile effect in aorta rings probably through the involvement of voltage-operated calcium channels, AT1 and α-adrenergic receptors via the downstream activation of phospholipase C. The protein complex, PLA2 + melittin, was also able to induce vasoconstriction, whereas the isolated proteins were not.(AU)

Vasoconstrictor effect of Africanized honeybee (Apis mellifera L.) venom on rat aorta

Background : Apis mellifera stings are a problem for public health worldwide, particularly in Latin America due to the aggressiveness of its Africanized honeybees. Massive poisoning by A. mellifera venom (AmV) affects mainly the cardiovascular system, and several works have described its actions on heart muscle. Nevertheless, no work on the pharmacological action mechanisms of the AmV in isolated aorta has been reported. Thus, the present work aimed to investigate the actions of AmV and its main fractions, phospholipase A2 (PLA2) and melittin, on isolated aorta rings and a probable action mechanism. Results : AmV and the complex PLA2 + melittin (0.1-50 g/mL) caused contraction in endothelium-containing aorta rings, but neither isolated PLA2 nor melittin were able to reproduce the effect. Endothelium removal did not change the maximum vasoconstrictor effect elicited by AmV. Ca2+-free medium, as well as treatment with phentolamine (5 M), verapamil (10 M), losartan (100 M), and U-73122 (10 M, a phospholipase C inhibitor), eliminated the AmV-induced contractile effects. Conclusions : In conclusion, AmV caused contractile effect in aorta rings probably through the involvement of voltage-operated calcium channels, AT1 and -adrenergic receptors via the downstream activation of phospholipase C. The protein complex, PLA2 + melittin, was also able to induce vasoconstriction, whereas the isolated proteins were not.