Effectiveness of non-operative approaches in active enamel carious lesions: a retrospective longitudinal study

Abstract The aim of the study was to investigate the effectiveness of non-invasive and micro-invasive treatments in active enamel carious lesions in high-caries-risk children. Clinical records of children treated in a dental school setting were retrospectively screened for active enamel carious lesions treated non-invasively (topical fluoride applications, oral hygiene instruction, or dietary guidance) or micro-invasively (sealant). The control of active carious lesions was set as the main outcome established by the combination of inactivation and non-progression of the lesions based on Nyvad and ICDAS criteria, respectively. Individual and clinical factors associated with the outcome were analyzed by Poisson regression. The sample consisted of 105 high-caries-risk children with a mean age of 8.3 (± 2.4) years. From a total of 365 active enamel carious lesions, most lesions (84.1%) were active non-cavitated carious lesions (ICDAS scores 1 and 2) and only 15.9% presented localized enamel breakdown (ICDAS score 3). Of these, 72.6% were inactivated and 92.1% did not progress (mean time of 6.5 ± 4.1 months). The prevalence of controlled carious lesions was higher among children older than 6 years (PR:1.43; 95%CI:1.00-2.03; p = 0.04) and in those with better biofilm control (PR:0.99; 95%CI: 0.98-0.99; p = 0.03). Non-operative approaches are effective for controlling active enamel carious lesions. The majority of active enamel carious lesions became inactive and did not progress after treatment. Caries control was associated with older children and better biofilm control.

A 12-month Follow-Up Study of Pulp Oxygen Saturation in Deciduous Molars After Selective and Nonselective Carious-Tissue Removal: A Randomized Pilot Trial

ABSTRACT Objective: To compare the pulp vitality of deciduous molars before and after selective caries removal (SCR) or nonselective caries removal to hard dentin (NSCR) over one year, using oxygen saturation percentage (%SaO2). Material and Methods: Deciduous molars with deep occlusal/proximal-occlusal caries lesions were randomized to SCR (n=22) or NSCR groups (n=22). After the caries removal, the teeth were protected with calcium hydroxide cement and restored with composite resin (Filtek Z250). The pulp condition diagnosis was evaluated at baseline, immediately after caries removal, and follow-up (7 days, 1-, 6- and 12-months) by %SaO2. Pulp exposure and pulp necrosis were primary outcomes, and %SaO2 was secondary. Results: Intraoperative pulp exposure occurred in four teeth of the NSCR group (18.2%) and one tooth of the SCR group (4.5%) (p>0.05). Two cases of pulp necrosis occurred in the NSCR group (10%). No difference in %SaO2 pulp was observed in the inter-and intragroup comparison over time (p>0.05). Conclusion: Advantageously, the %SaO2 minimizes preoperatory pulp vitality diagnosis subjectivity before SCR/ NSCR treatments. Furthermore, the pilot study results suggest the pulp response of deciduous molars, when evaluated by clinical, radiographic, and pulp %SaO2 seems not to differ between teeth treated with SCR or NSCR.

Epidemiological indicators of Chagas disease in the metropolitan region of Salvador, Bahia, Brazil

ABSTRACT Background: Chagas disease (CD) is caused by Trypanosoma cruzi and transmitted by triatomines. Historical information from the 20th century demonstrates T. cruzi records in the metropolitan region of Salvador (MRS), the third largest urban agglomeration in the Brazilian Northeast and the eighth largest in Brazil, an area with intense migratory activity from CD-endemic regions. Therefore, this study aimed to evaluate CD indicators (prevalence and mortality) in the MRS. Methods: A mixed ecological and descriptive study was conducted using secondary data. We analyzed data from 2008 to 2015: deaths due to CD, self-reported cases of CD, and blood donors that were non-negative for T. cruzi infection. Results: São Francisco do Conde was one of the municipalities with the highest mortality rates due to CD. The seroprevalence rates varied by year and municipality; those with the highest values were 2008: Vera Cruz, 2009: Mata de São João, 2010: Dias D'Ávila, 2011 and 2015: São Francisco do Conde, 2012: São Sebastião do Passé, and 2013 and 2014: Pojuca. Spatial correlations between the municipalities were not detected. Conclusions: We conclude that CD is present in the MRS. The indicators analyzed in the MRS are below-state-level data. Given the importance of indicator analysis for the surveillance and control of CD at the state and national levels, it is important to strengthen the surveillance program at the municipal level, including the regions classified as low risk for T. cruzi vector transmission.

Performance of resin composite restorations placed in high caries risk children: a clinical retrospective study

Background: Resin composite has been usually used for restoring primary teeth. Nevertheless, there is a lack of supporting clinical data regarding the survival of resin composite restorations and risk factors that may dictate the service time of the treatment in children. Aim: To evaluate the survival and factors associated with composite resin restoration failure in high caries risk children treated under risk-factor management clinical protocol for dental caries prior to restorative therapy. Design: A total of 230 restorations in primary teeth from records of 48 patients were included in the study. Restoration longevity, up to 3-year follow-up, was assessed using the Kaplan-Meier survival test. Multivariate Cox regression analysis with shared frailty was used to evaluate the factors associated with failures (p<0.05). Results: Mean survival time was 2.7 -year (95 %CI: 0.75-0.87). Restoration survival reached 82.5 % up to 3-year evaluation, with an overall annual failure rate of 6.2 %. The unadjusted model showed restorations performed in children with dmf-t greater than 10 had more restoration failure risk (HR 5.59, 95 % CI 1.03-30.34; p=0.04) However, this association lost significance in the adjusted analysis (p=0.08). Conclusions: Composite resin restorations in primary teeth presented satisfactory survival after 3-year follow-up

Antecedentes: El composite de resina se ha utilizado habitualmente para restaurar dientes primarios. Sin embargo, se carece de datos clínicos de apoyo sobre la supervivencia de las restauraciones de resina compuesta y los factores de riesgo que pueden dictar el tiempo de servicio del tratamiento en los niños. Objetivo: Evaluar la supervivencia y los factores asociados al fracaso de las restauraciones de resina compuesta en niños con alto riesgo de caries tratados con un protocolo clínico de gestión de factores de riesgo de caries dental antes del tratamiento restaurador. Diseño: Se incluyeron en el estudio un total de 230 restauraciones en dientes primarios de registros de 48 pacientes. La longevidad de las restauraciones, hasta los 3 años de seguimiento, se evaluó mediante la prueba de supervivencia de Kaplan-Meier. Se utilizó un análisis multivariante de regresión de Cox con fragilidad compartida para evaluar los factores asociados a los fracasos (p<0,05). Resultados: El tiempo medio de supervivencia fue de 2,7 -años (IC95%: 0,75-0,87). La supervivencia de la restauración alcanzó el 82,5 % hasta la evaluación a los 3 años, con una tasa global anual de fracasos del 6,2 %. El modelo no ajustado mostró que las restauraciones realizadas en niños con dmf-t superior a 10 tenían más riesgo de fracaso de la restauración (HR 5,59; IC 95 %: 1,03-30,34; p=0,04). Sin embargo, esta asociación perdió significación en el análisis ajustado (p=0,08). Conclusiones: Las restauraciones de resina compuesta en dientes primarios presentaron una supervivencia satisfactoria tras un seguimiento de 3 años.

Neuraxial block anesthetic technique in a patient with SCN8A encephalopathy: case report

Abstract Mutations in SCN8A gene lead to changes in sodium channels in the brain, which are correlated with severe epileptic syndrome. Due to the rarity, there are few studies that support anesthesia in that population. The present study aims to report alternatives to inhalation anesthesia at epileptic encephalopathy. Case report: Male, 4 years old, with SCN8A encephalopathy with surgical indication of orchidopexy. Neuroaxis block was performed and dexmedetomidine was used as a pre-anesthetic and sedation. The anestheticsurgical act was uneventful. Conclusion: The association of neuraxial block and dexmedetomidine proved to be a viable alternative for surgery in patients with SCN8A encephalopathy.

Is there a better interceptive treatment for unerupted palatally displaced canines? A network meta-analysis

Abstract This systematic review aimed to investigate if there is a better interceptive treatment for palatally displaced canines (PDC) in the mixed dentition stage. The PubMed/MEDLINE, CENTRAL, Scopus, and EMBASE databases were searched for randomized clinical trials related to the research topic. The gray literature and reference lists were also assessed. Network meta-analysis was conducted to analyze the effects of different approaches on PDC eruption. The surface under the cumulative ranking area was calculated to rank the treatments. The certainty of the evidence was evaluated using the GRADE approach. Of the 892 eligible studies, 18 were selected for full-text analysis and 9 for meta-analysis, involving 506 participants and 730 PDC, to compare 9 approaches. The proportion of erupted PDC was significantly higher for all interceptive treatments compared with control (no intervention). Furthermore, the proportion of erupted PDC was higher in patients subjected to rapid maxillary expansion (RME) than those who underwent double extraction of primary canine and primary molar (relative risk (RR) = 2.68 ICr95%: 1.12-9.35). A higher proportion of erupted PDC was found for RME (RR = 3.07 ICr95%: 1.31-10.67), RME plus use of transpalatal arch (TA) plus extraction of primary canine(s) (EC) (RR = 1.43 ICr95%: 1.09-1.95), EC plus use of cervical pull headgear (RR = 1.38 ICr95%: 1.11-1.79), and EC plus use of TA (RR = 1.36 ICr95%: 1.00-1.9) than for EC. RME was most likely to be considered as the best interceptive treatment. Overall, the certainty of the evidence was considered low due to imprecision and indirectness. In conclusion, no intervention in the mixed dentition stage is the worst choice for PDC.

Aspectos anatômicos e funcionais da língua após frenectomia em gemelares: relato de casos clínicos / Anatomic and functional aspects of the tongue after frenectomy in twin: clinical cases report

Objetivo: Relatar dois casos clínicos de alteração de frênulo lingual em gemelares, com 10 anos de idade, ambas do sexo feminino, avaliadas nos aspectos anatômicos e funcionais da língua antes e 15 dias após a frenectomia. Relato de casos: Inicialmente, o odontopediatra realizou a anamnese com a mãe. Em seguida, as participantes foram submetidas à avaliação clínica odontológica e, posteriormente, foi realizada a avaliação fonoaudiológica do frênulo lingual. A avaliação fonoaudiológica foi realizada por meio do Protocolo de Avaliação do Frênulo da Língua, que foi aplicado antes e 15 dias após a frenectomia. As duas participantes apresentaram melhor desempenho em provas anatômicas após o procedimento cirúrgico. Entretanto, algumas alterações, principalmente ao elevar a língua, continuaram sendo observadas em uma das pacientes 15 dias após a frenectomia. Ademais, as duas participantes passaram a executar a maioria dos movimentos de língua com maior precisão. No que se refere à fala, somente a participante que apresentava um maior número de alterações fonéticas anteriores, permaneceu com algumas alterações na fala decorridos 15 dias da cirurgia. Discussão: Algumas dificuldades envolvendo mobilidade da língua e alterações na fala podem persistir após a realização da cirurgia, indicando a necessidade de intervenção fonoaudiológica específica. Conclusão: Ambos os casos apresentaram melhora no desempenho tanto nas provas anatômicas quanto funcionais após a frenectomia.

Aim: to report two clinical cases of alteration of the lingual frenulum in twins, aged 10 years, both female, evaluated in the anatomical and functional aspects of the tongue before and 15 days after the frenectomy. Case reports: Initially, the paediatric dentistry performed the anamnesis with the mother. Then, the participants were submitted to a dental clinical evaluation and, sub-sequently, the speech language pathologist evaluation of the lingual frenulum was performed. The speech language pathologist assessment was performed using the Tongue Frenulum Evaluation Protocol, which was applied before and 15 days after the frenectomy. Both participants performed better in anatomical tests after the surgical procedure. However, some changes, especially when elevating the tongue, continued to be observed in one of the patients 15 days after the frenectomy. In addition, the two participants started to perform most of the tongue movements with greater precision. About speech, only the participant who had a greater number of previous phonetic changes, remained with some speech disorders after 15 days of surgery. Discussion: Some di-fficulties involving mobility of the tongue and changes in speech may persist after surgery, indicating the need for specific speech therapy intervention. Conclusion:Both cases showed improvement in performance both in anatomical and functional tests after frenectomy

Reduction in erosive tooth wear using stannous fluoride-containing dentifrices: a meta-analysis

Abstract Dentifrices containing different active agents may be helpful to allow rehardening and to increase the resistance of the eroded surface to further acids or mechanical impacts. This study aimed to compare the effects of conventional (sodium fluoride [NaF]) and stannous fluoride (SnF2)-containing dentifrices on reducing erosive tooth wear (ETW). The PubMed/MEDLINE, Scopus, LILACS, BBO, EMBASE, TRIP electronic databases, and grey literature were searched until January 2021 to retrieve relevant in vitro and in situ studies related to research question. There were no restrictions on publication year or language. Two authors independently selected the studies, extracted the data, and assessed the risk of bias. ETW data were pooled to calculate and compare both dentifrices (overall analysis) and in vitro and in situ studies separately (subgroup analysis). Statistical analyses were performed using RevMan5.3 with a random effects model. Of 820 potentially eligible studies, 101 were selected for full-text analysis, and 8 were included in the systematic review and meta-analysis. There was a significant difference between SnF2-containing dentifrices and NaF dentifrices only for in vitro studies (p=0.04), showing a higher effect of the SnF2-containing dentifrices against the erosion/abrasion (effect size: -6.80 95%CI: -13.42; -0.19). Most in vitro and in situ studies had high and low risk of bias, respectively. In vitro literature suggests that the ETW reduction is greater when using SnF2-containing dentifrices instead NaF-containing dentifrices. However, the evidence level is insufficient for definitive conclusions. Clinical trials are necessary for a better understanding of the effect of these compounds on ETW.

Uses and limits of the clinical laboratory in the COVID-19 pandemic: a didactic review

SUMMARY The world is currently experiencing an unprecedented pandemic of a new disease, the coronavirus disease (COVID-19), which has unusual clinical and immunological presentations. This is especially true regarding the choice and interpretation of laboratory test results. In this review, we have provided didactic information for physicians on the current concepts and practical guidance regarding COVID-19.

The Role of Mother's Knowledge, Attitudes, Practices in Dental Caries on Vulnerably Preschool Children

Abstract Objective: To analyze the association between Early Childhood Caries (ECC) and mother´s knowledge, attitudes, and practices (KAP). Material and Methods: This cross-sectional study included a random sample of 163 preschool children aged 3-4 old in southern Brazil. The severity of dental caries and ECC was assessed by ICDAS criteria, while mothers completed the semi-structured questionnaire (KAP-ECC). Maternal behavior characteristics and answered questions about socioeconomic and demographic variables. Logistic regression was performed to evaluate the association of exploratory variables with ECC. For this approach, we calculated the odds ratio (OR) and 95% confidence intervals (95% IC). Results: Dental examinations revealed that 91.4% of children presented ECC (ICDAS = 3, 4, 5 or 6). Among those children, 31.9% presented cavities (ICDAS ≥ 3). Family income was significantly associated with the presence of ECC (OR 2.17; 95% CI: 1.41-3.36). Regarding KAP-ECC, mothers have knowledge related to ECC etiology, reported dental hygiene attitudes and practices that can prevent ECC but reported less healthy attitudes and practices regarding child's diet, specifically with respect to bottle and breastfeeding habits (OR 0.52; 95% CI: 0.33-0.81). Conclusion: ECC was more frequent in children from low-income families and whose mothers reported the belief that milk with chocolate does not contribute to caries and that disagreed that it is normal that a 2-year-old baby wakes up during the night to suckle. That is, good knowledge toward health habits may impact on lower occurrence of ECC; however, this condition also depends on the socioeconomic level.

Evaluation of PSA requests in men under 40 years of age / Avaliação das solicitações de PSA em homens com menos de 40 anos de idade

ABSTRACT Objectives: To evaluate the frequency of PSA requests in men under age 40 years; and to observe the possible influence of medical specialty of the requesting physician. Material and method: This is an observational, cross-sectional study using the database of a national clinical laboratory on PSA requests from October 1, 1997 until December 31, 2016. Descriptive statistics were used. The work was approved by the Ethics Committee of our institution. Results: 2,514,375 PSA requests were evaluated, 158,399 (6.3%) in men younger than 40 years old. These percentages did not vary significantly when observed over time (1998-2016). The prevalence of requests for patients under 40 years of age, was 18.2% among general practitioners; 16.5% among cardiologists, 8.4% among geriatricians and 6.8% among urologists. Conclusion: There is a very high frequency of PSA requests in men with low probability of benefiting from the test. It is necessary to invest in the dissemination of best practices related to prostate cancer screening, especially among clinicians and cardiologists.

RESUMEN Objetivos: Evaluar la cantidad de solicitudes del antígeno prostático específico (PSA) para hombres menores de 40 años, así como observar la posible influencia de la especialidad del médico solicitante. Material y método: Estudio observacional, de corte transversal, que utilizó la base de datos de un gran laboratorio clínico brasileño con las solicitudes de PSA desde el 1 de octubre de 1997 hasta el 31 de Diciembre de 2016. Se analizaron los datos mediante estadística descriptiva. El estudio fue aprobado por el comité ético de nuestra institución. Resultados: Se evaluaron 2.514.375 solicitudes de PSA, 158.399 (6.3%) en hombres menores de 40 años. Los porcentajes no variaron significantemente con el tiempo (1998-2016). La prevalência de solicitudes para pacientes menores de 40 años, fue de 18,2% entre los clínicos, 16,5% entre cardiólogos, 8,4% geriatras y 6,8% entre los urólogos. Conclusión: Hay una cantidad muy grande de solicitudes de PSA en hombres con baja probabilidad de sacar provecho de la realización del test. Es necesario invertir en la divulgación de mejores prácticas de tamizaje del cáncer de próstata, especialmente entre los clínicos y cardiólogos.

RESUMO Objetivos: Avaliar a frequência das solicitações de antígeno prostático específico (PSA) para homens com menos de 40 anos, bem como observar a possível influência da especialidade do médico solicitante. Material e método: Estudo observacional, de corte transversal, que utilizou o banco de dados de um laboratório clínico brasileiro de grande porte com as solicitações de PSA no período de 1º de outubro de 1997 a 31 de dezembro de 2016. Os dados foram analisados por estatística descritiva. O trabalho foi aprovado pelo Comitê de Ética de nossa instituição. Resultados: Foram avaliadas 2.514.375 solicitações de PSA, 158.399 (6,3%) em homens com menos de 40 anos. Esses percentuais não variaram significativamente quando observados no tempo (1998-2016). Entre as solicitações com identificação da especialidade do médico para pacientes com menos de 40 anos de idade, 18,2% foram de clínicos, 16,5% de cardiologistas, 8,4% de geriatras e 6,8% de urologistas. Conclusão: Há uma frequência muito elevada de solicitações de PSA em homens com baixa probabilidade de se beneficiarem com a realização do exame. Faz-se necessário investimento na divulgação das melhores práticas em relação ao rastreamento do câncer de próstata, especialmente entre os clínicos e cardiologistas.

Impact of Early Childhood Caries and Maternal Behaviors on Oral Health-Related Quality of Life of Children

Abstract Objective: To evaluate the impact of early childhood caries, maternal behaviors and associated factors on the oral health-related quality of life (OHRQoL) of preschool children. Material and Methods: This cross-sectional study was conducted with 163 preschool children aged 3-4 old from Porto Alegre, Southern Brazil. Mothers completed the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) and answered questions about sociodemographic and maternal behaviors characteristics. The severity of dental caries was assessed by ICDAS criteria for evaluated early childhood caries (ECC). A Poisson regression model was used to investigate the association of ECC and associated factors on OHRQoL. Results: A total of 91.4% of preschooler children was ECC (ICDAS ≥ 1). Mean ECOHIS function domain and parental anxiety domain scores were significantly higher in children with dental caries (p<0.05). The adjusted Poisson regression model showed that household income, maternal education, mother's job status and breastfeeding time was significantly associated with ECOHIS scores. Regarding oral conditions, child caries experience was associated with worsening child and family quality of life (RR 2.21; 95% IC: 1.43-3.41). Conclusion: Our findings suggest that ECC, socioeconomic and maternal behaviors characteristics influence children's OHRQoL.

Delayed trigeminocardiac reflex after maxillofacial surgery: case report / Reflexo trigêmino-cardíaco tardio após cirurgia buco-maxilo-facial: relato de caso

Abstract Background: Trigeminocardiac reflex is a physiological phenomenon that may occur in head and neck surgery, and is usually benign. However, it may present with exaggerated responses with severe morbidity. Case report: Male patient, 26 years old, candidate for surgical treatment of zygomatic-orbital complex fracture. The surgery with bilateral nasal packing placed at the end of the procedure was uneventful. After being admitted to the post-anesthesia care unity, the patient complained of shortness of breath and nausea. Pulse oximetry fell below 90% in ambient air, and 100% O2 was then offered through a Hudson mask. He showed no improvement in oximetry and presented with worsening dyspnea, diffuse wheezing, reduced heart rate, and blood pressure. Atropine was given, which raised the heart rate, but without resolution of hypotension and bronchospasm. Our suspicion was of a trigeminal-cardiac reflex, and then the removal of the nasal packing was done with complete remission of the signs and symptoms. Discussion: Florian Kratschmer (1870) was the first to describe the influences of nasal mucosal reflexes on respiration and circulation, which became known as Kratschmer's reflex. It is a reflex arc whose afferent originates in the nerve endings of the trigeminal nerve. The clinical presentation of trigeminocardiac reflex is the occurrence of sudden bradycardia, hypotension, apnea, and gastric hypermotility. Conclusion: Trigeminocardiac reflex may be a protective neurogenic, oxygen-conserving response with low morbidity, however, exacerbated in certain situations. The interaction between surgeon and anesthesiologist, together with a careful monitoring of blood pressure and heart rate are fundamental for diagnosis and treatment.

Resumo Justificativa: O reflexo trigêmino-cardíaco é um fenômeno fisiológico passível de ocorrer em cirurgias da cabeça e pescoço, e normalmente é benigno. Contudo, pode apresentar respostas exageradas, com grave morbidade. Relato de caso: Paciente masculino, 26 anos, candidato a tratamento cirúrgico de fratura do complexo zigomático-orbitário. Ato cirúrgico sem intercorrências com tamponamento nasal bilateral ao final. Após admitido na sala de recuperação pós-anestésica, queixou-se de "falta de ar" e náusea. A oximetria de pulso caiu abaixo 90% em ar ambiente e foi ofertado então O2 a 100% sob máscara de Hudson. Não houve melhora da oximetria e apresentou piora da dispneia, com sibilos difusos, redução da frequência cardíaca e da pressão arterial. Administrada atropina, que elevou a frequência cardíaca, mas sem resolução da hipotensão arterial e broncoespasmo. Aventamos a hipótese de reflexo trigêmino-cardíaco e então foi feita a remoção do tamponamento nasal com remissão completa dos sinais e sintomas. Discussão: Florian Kratschmer (1870) foi o primeiro a descrever as influências de reflexos da mucosa nasal na respiração e na circulação, o que ficou conhecido como reflexo de Kratschmer. Trata-se de um arco reflexo cuja aferência é originária nas terminações nervosas do nervo trigêmeo. A apresentação clínica do reflexo trigêmino-cardíaco é a ocorrência de súbita bradicardia, hipotensão, apneia e hipermotilidade gástrica. Conclusão: O reflexo trigêmino-cardíaco pode ser uma resposta neurogênica protetora, oxigênio-conservadora, de baixa morbidade, contudo exacerbada em determinadas situações. A interação entre cirurgião e anestesiologista, aliada à monitoração criteriosa da pressão arterial e do ritmo cardíaco, é fundamental para o diagnóstico e o tratamento.

A continuous fall of PSA use for prostate cancer screening among Brazilian doctors since 2001. Good or bad notice?

ABSTRACT Purpose: To evaluate the trend of use of Prostate Specific Antigen (PSA) for screening of prostate cancer (PC) among Brazilian doctors, from the beginning of its regular availability in clinical laboratories. Material and Methods: A serial cross-sectional study was performed using data obtained from a large database between 1997 and 2016. The general PSA screening trend during this period, adjusted for the total number of exams performed in men, was analyzed. Time-series analysis was performed through observation of the general regression curve using the generalized least squares method, and the impact of the recommendations was assessed with autoregressive integrated moving average (ARIMA) models. Results: During the period studied 2,521,383 PSA determinations were done. The age of the participants ranged from 21 to 111 years, with an average of 56.7 ± 22.7 years. The relative number of PSA tests/100.000 exams in males showed a constant reduction since 2001, and this trend was more evident in the group aged 55-69 years. Although statistically significant, the impact of reduced PSA screening after the 2012 USPSTF publication was clinically irrelevant. Conclusions: Our results indicated a continuous reduction in the use of PSA screening over time, regardless of the publication of recommendations or clinical guidelines. The fact that this trend was more pronounced among those with a greater benefit potential (55-69 years), relative to groups with a greater damage potential due to overdiagnosis and overtreatment (aged >74 years and <40 years), is a matter of concern. Follow-up studies of these trends are advisable.

A supervisão na clínica-escola como báscula para a psicanálise na universidade / The supervision on clinical training school as a counterweight for psychoanalysis in the university / La supervisión en la clínica-escuela como báscula para el psicoanálisis en la universidad

O artigo parte da elaboração sobre a experiência de trabalho como supervisor em uma Clínica-Escola de Psicologia. Indaga-se sobre as formas através das quais a supervisão pode emergir como espaço privilegiado de transmissão da psicanálise. Procede-se a uma revisão bibliográfica sobre a supervisão na história da psicanálise e no contexto das Clínicas-escola em seu tensionamento com a universidade. A partir de vinhetas clínicas de supervisão, delineamos uma reflexão por duas vias: a respeito da formação dos praticantes e da sua função de suporte na condução dos tratamentos. Finalmente, argumenta-se que a supervisão pode emergir, a partir do discurso do analista, como báscula e que este pode encontrar ali terreno fértil para exercer sua função de operar giros nos discursos, os quais coexistem na Universidade. Conclui-se que a supervisão pode gerar efeitos de transmissão que presentifiquem a ética da psicanálise em extensão, ou seja, presente no mundo para além dos consultórios

The article emerges from the elaboration of an experience of some years working with supervision in a clinical training school. We investigate the ways in which supervision can emerge as a privileged space for psychoanalytical transmission. Thus, a bibliographic review is carried out looking forward to highlight the supervision's role in the history of psychoanalysis and in the context of the clinical training schools, questioning the relationship psychoanalysis-university. Starting from supervision's clinical vignettes, we delineate a reflection in two ways: concerning the training of practitioners and its function as support role in treatments' conduct. Finally, it is argued that supervision might emerge from the analyst's discourse as a counterweight in which he may find fertile ground for the exercise of his function of operating turns in discourses, which coexist, including in the University. It is concluded that the supervision can produce effects of transmission that presents the ethics of psychoanalysis in extension, that is, present in the world beyond the offices

El artículo parte de la elaboración sobre la experiencia de trabajo como supervisor en una Clínica-Escuela de Psicología. Se indaga sobre las formas a través de las cuales la supervisión puede emerger como espacio privilegiado de transmisión del psicoanálisis. Se procede a una revisión bibliográfica sobre la supervisión en la historia del psicoanálisis, y en el contexto de las Clínicas-escuela en su tensión con la universidad. A partir de viñetas clínicas de supervisión, delineamos una reflexión por dos vías: acerca de la formación de los practicantes y su función de soporte en la conducción de los tratamientos. Finalmente, se argumenta que la supervisión puede emerger, a partir del discurso del analista, como báscula y que éste puede encontrar allí terreno fértil para ejercer su función de operar giros en los discursos, los cuales coexisten en la Universidad. Se concluye que la supervisión puede generar efectos de transmisión que presentifiquen la ética del psicoanálisis en extensión, o sea, presente en el mundo más allá de los consultorios

Negative pressure pulmonary edema: report of case series and review of the literature / Edema pulmonar por pressão negativa: relato de casos e revisão da literatura

Abstract Background and objectives: Negative pressure pulmonary edema occurs by increased intrathoracic negative pressure following inspiration against obstructed upper airway. The pressure generated is transmitted to the pulmonary capillaries and exceeds the pressure of hydrostatic equilibrium, causing fluid extravasation into the pulmonary parenchyma and alveoli. In anesthesiology, common situations such as laryngospasm and upper airway obstruction can trigger this complication, which presents considerable morbidity and requires immediate diagnosis and propaedeutics. Upper airway patency, noninvasive ventilation with positive pressure, supplemental oxygen and, if necessary, reintubation with mechanical ventilation are the basis of therapy. Case report: Case 1: Male, 52 years old, undergoing appendectomy under general anesthesia with orotracheal intubation, non-depolarizing neuromuscular blocker, reversed with anticholinesterase, presented with laryngospasm after extubation, followed by pulmonary edema. Case 2: Female, 23 years old, undergoing breast reduction under general anesthesia with oro-tracheal intubation, non-depolarizing neuromuscular blocker, reversed with anticholinesterase,presented with inspiration against closed glottis after extubation, was treated with non-invasiveventilation with positive pressure; after 1 hour, she had pulmonary edema. Case 3: Male, 44 yearsold, undergoing ureterolithotripsy under general anesthesia, without neuromuscular blocker,presented with laryngospasm after laryngeal mask removal evolving with pulmonary edema. Case 4: Male, 7 years old, undergoing crude fracture reduction under general anesthesia withorotracheal intubation, non-depolarizing neuromuscular blocker, presented with laryngospasmreversed with non-invasive ventilation with positive pressure after extubation, followed bypulmonary edema. Conclusions: The anesthesiologists should prevent the patient from perform a forced inspirationagainst closed glottis, in addition to being able to recognize and treat cases of negative pressurepulmonary edema.

Resumo Justificativa e objetivos: O edema pulmonar por pressão negativa ocorre por aumento da pressão negativa intratorácica após inspiração contra via aérea superior obstruída. A pressão gerada é transmitida aos capilares pulmonares e supera a pressão de equilíbrio hidrostático, o que causa extravasamento de líquido para o parênquima pulmonar e alvéolos. Em anestesiologia, situações comuns como laringoespasmo e obstrução de via aérea superior podem desencadear essa complicação, que apresenta considerável morbidade e exige diagnóstico e propedêutica imediatos. A desobstrução das vias aéreas superiores, ventilação não invasiva com pressão positiva, oxigênio suplementar e, se necessário reintubação com ventilação mecânica são a base da terapia. Relato de caso: Caso 1: Masculino, 52 anos, submetido a apendicectomia sob anestesia geral com intubação orotraqueal, uso de bloqueador neuromuscular adespolarizante, revertido com anticolinesterásico; apresentou laringoespasmo após extubação, seguido de edema pulmonar. Caso 2: Feminino, 23 anos, submetida a mamoplastia redutora sob anestesia geral com intubação orotraqueal, bloqueador neuromuscular adespolarizante revertido com anticolinesterásico, apresentou inspiração contra glote fechada após extubação, tratada com ventilação não invasiva com pressão positiva; após uma hora apresentou edema pulmonar. Caso 3: Masculino, 44 anos, submetido a ureterolitotripsia sob anestesia geral, sem bloqueador neuromuscular, apresentou laringoespasmo após retirada de máscara laríngea e evoluiu com edema pulmonar. Caso 4: Masculino, sete anos, submetido a redução cruenta de fratura sob anestesia geral com intubação orotraqueal, uso de bloqueador neuromuscular adespolarizante; apresentou laringo-espasmo revertido com ventilação não invasiva com pressão positiva após extubação, seguidode edema pulmonar. Conclusões: O anestesiologista deve evitar que o paciente faça inspiração forçada contra glotefechada, além de ser capaz de reconhecer e tratar os casos de edema pulmonar por pressãonegativa.

Spine metastasis of intracranial hemangiopericytoma: case report of two treatments / Metástase na coluna de hemangiopericitoma intracraniano: relato de 2 tratamentos

ABSTRACT Objective: To report the use of two techniques (radiosurgery and en bloc vertebrectomy) on the same patient for the treatment of two metastases in different sites of the spine arising from intracranial hemangiopericytoma. Intracranial hemangiopericytomas are rare, comprising approximately 2.4% of meningeal tumors and <1% of all tumors of the central nervous system. Metastases to the spine are even rarer: The largest case series reported in the literature has 5 and 7 cases. Methods: A 37-year-old man diagnosed with intracranial hemangiopericytoma was referred for a metastatic lesion in T12 and underwent en bloc resection using the Tomita technique. Results: The disease evolved with a metastasis to T2 treated by radiosurgery with 1600 cGy. The patient died 1,706 days after the en bloc resection of T12 and 1324 days after the radiosurgery of T2, and no recurrence occurred in these locations due to progression of the systemic diseases (liver and central nervous system). Conclusion: This is the first case reported in the literature in which two different techniques were used to treat metastatic lesions in the spine from an intracranial hemangiopericytoma and is unique for its use of two treatments in the same patient. Level of evidence: V, case report

RESUMO Objetivo: Reportar o uso de duas técnicas (radiocirurgia e vertebrectomia em bloco) no mesmo paciente, para o tratamento de metástases de um hemangiopericitoma intracraniano em dois locais da coluna. Hemangiopericitomas intracranianos são raros, consistindo em cerca de 2,4% dos tumores da meninge e menos de 1% de todos os tumores do sistema nervoso central, e metástases para a coluna são ainda mais raras: as maiores séries de casos publicada tinham 5 e 7 casos. Métodos: Um homem de 37 anos com diagnóstico de hemangiopericitoma intracraniano foi encaminhado para resecção em bloco de lesão metastática em T12 com a técnica de Tomita. Resultados: A doença evoluiu com metástase em T2, tratada com radiocirurgia (dose de 1600 cGy). O paciente morreu 1.706 dias após a resecção em bloco de T12 e 1.324 dias após a radiocirurgia de T2, livre de recorrência nessas localizações, devido a progressão sistêmica da doença (para fígado e sistema nervoso central). Conclusão: Este é o primeiro caso na literatura no qual duas técnicas diferentes foram usadas pra tratar lesões metastáticas da coluna de hemangiopericitoma intracraniano, único pelo uso de duas técnicas de tratamento no mesmo paciente. Nível de evidência V, relato de caso.

Rotation assessment in adolescent idiopathic scoliosis with rod derotation / Avaliação da rotação na escoliose idiopática do adolescente com derrotação da haste

ABSTRACT Objective: Adolescent idiopathic scoliosis (AIS) is characterized by rotational and lateral deformity of the spine. The measurement of vertebral rotation is important for prognosis and treatment. Our objective was to evaluate whether the Nash-Moe method can be used to measure axial deformity correction with surgical treatment using the rod derotation maneuver at both the apex and extremities of the deformity in patients with AIS. Methods: Rotation was assessed using the Nash and Moe criteria, on preoperative and postoperative radiographs. We also evaluated the severity on the coronal plane using the Cobb method, ratio of correction achieved, screw density, and number of vertebrae involved in the instrumentation. Results: The Cobb method correction average was 54.8%. When we disregarded vertebrae that presented preoperative Nash-Moe grade 0, the average measurable correction was 54.5% in the first non-instrumented vertebra above, 69.2% in the first instrumented vertebra, 32.2% in the apical vertebra, 36.8% in the last instrumented vertebra, and 30% in the first non-instrumented vertebra below. In our study, 32.14% of the patients presented a measurable correction in the apical vertebra. Conclusion: On the axial plane, correction can be satisfactorily evaluated using the Nash-Moe method. Level of Evidence VI. Case Series.

RESUMO Objetivo: A escoliose idiopática do adolescente é caracterizada por deformidade rotacional e lateral da coluna vertebral. A medição da rotação vertebral é importante para o prognóstico e tratamento. Nosso objetivo foi avaliar se o método de Nash-Moe pode ser usado para medir a correção da deformidade axial com o tratamento cirúrgico usando a manobra de derotação em ambos os ápices e extremidades da deformidade em pacientes com EIA. Métodos: A rotação foi avaliada usando os critérios de Nash e Moe em radiografias pré e pós-operatórias. Também avaliamos a severidade no plano coronal pelo método de Cobb, a razão de correção alcançada, a densidade do parafuso e o número de vértebras envolvidas na instrumentação. Resultados: A correção do método de Cobb foi de 54,8%. Quando desconsideramos vértebras que apresentavam grau 0 no pré-operatório de Nash-Moe, encontramos, em média, 54,5% de correção mensurável na primeira vértebra não instrumentada acima, 69,2% na primeira vértebra instrumentada, 32,2% na vértebra apical, 36,8% na última vértebra instrumentada e 30% na primeira vértebra não instrumentada abaixo. Em nosso estudo, ٣٢,١٤٪ dos pacientes apresentaram uma correção mensurável na vértebra apical. Conclusão: No plano axial, a correção pode ser avaliada satisfatoriamente pelo método de Nash-Moe. Nível de Evidência VI. Série de casos.