Efectos de una intervención de enfermería en el control del dolor posoperatorio del paciente adulto / Effects of a Nursing Intervention on Postoperative Pain Control in the Adult Patient

ntroducción: El control apropiado del dolor es un desafío crucial y necesario de abordar en el campo quirúrgico, al producir un gran impacto en la recuperación del paciente. Objetivo: Evaluar el efecto de una intervención de enfermería aplicada en el periodo perioperatorio para el control del dolor del paciente adulto en el posoperatorio inmediato. Métodos: Estudio cuantitativo, cuasi experimental, con grupo experimental y control de adultos intervenidos en el quirófano de una institución de salud en Bucaramanga - Colombia en el primer semestre de 2017, con un universo de 3240 pacientes y muestra calculada de 120. La intervención constó de tres fases, enmarcada en la teoría de síntomas desagradables. Para evaluar el dolor se utilizó la Escala Visual Análoga. Se realizó análisis descriptivo, bivariado y múltiple, se calcularon Betas con modelos de regresión lineal con los puntajes de la escala de dolor a los 10-20 y 30 minutos, 1- 1,5 y 2 horas. Resultados: Los grupos presentaron características similares, en el grupo experimental disminuyeron los puntajes en la escala de dolor a los 10 minutos en -0,98 (IC 95 por ciento: -2,0; 0,02), a la hora de -0,77(IC 95 por ciento: -1,60; 0,05), a las 1,5 horas de -0,71(IC 95 por ciento: -1,13; -0,12) y las 2 horas de -0,60(IC 95 por ciento: -1,09; -0,10). Conclusiones: La intervención de enfermería en perioperatorio, más allá de la administración de analgésicos, es fundamental para modificar las respuestas, como lo refiere la teoría de Swanson, se mejora o controlan los síntomas desagradables y sus efectos negativos, en este caso el dolor posoperatorio(AU)

Introduction: Appropriate pain control is a crucial and necessary challenge to address in the surgical field, since it would produce a great impact patient recovery. Objective: To assess the effect of a nursing intervention applied during the perioperative period for pain control in the adult patient in the immediate postoperative period. Methods: Quantitative and quasiexperimental study carried out with two groups, an experimental and a control group, of adults operated on in the surgical room of a health institution in Bucaramanga, Colombia, in the first semester of 2017. The universe consisted of 3240 patients, while the calculated sample was 120. The intervention consisted in three phases, framed within the theory of unpleasant symptoms. The visual analog scale was used to assess pain. Descriptive, bivariate and multiple analyses were performed. Betas were calculated with linear regression models and using the scores of the pain scale at ten to twenty and thirty minutes; as well as at one to one and half hours, and two hours. Results: The groups presented similar characteristics: in the experimental group, the scores of the pain scale decreased at ten minutes by 0.98 (95 percent CI: -2.0; 0.02); at one hour, by 0.77 (95 percent CI: -1.60; 0.05; at one and a half hours, by 0.71 (95 percent CI: -1.13; -0.12); and at two hours, by 0.60 (95 percent CI: -1.09; -0.10). Conclusions: The nursing intervention in the perioperative period, beyond the administration of analgesics, is fundamental to modify responses, as referred by Swanson's theory, unpleasant symptoms and their negative effects are improved or controlled; in this case, postoperative pain(AU)

Psychosocial concerns predict longitudinal trajectories of distress in newly diagnosed cancer patients

INTRODUCTION@#Unmet psychosocial concerns are associated with emotional distress among cancer patients. This longitudinal study aimed to identify specific psychosocial concern profiles and trajectories of emotional distress, and examine their association among newly diagnosed adult cancer patients across the first year of diagnosis.@*METHODS@#Adult patients aged 21-64 years were screened to determine their eligibility for this study. Psychosocial concerns and psychological distress were measured using the Problem List and the Distress Thermometer, respectively (n = 221). Latent transition mixture analysis was used to determine specific psychosocial concern profiles and trajectories of emotional distress, and examine associations with adjustments made for demographic and medical variables.@*RESULTS@#Two classes of psychosocial concerns were identified: low (81%) and high (19%) concerns. Two trajectories of distress were identified: low stable (69%) and high stable (31%) trajectories. Patients in the high concerns class were significantly more likely to demonstrate the high stable trajectory of distress.@*CONCLUSION@#Our findings highlight the importance of concurrent assessment of multiple psychosocial concerns and screening of emotional distress throughout a cancer patient's treatment journey. Such assessments can effectively guide interventions to address individual concerns and alleviate emotional distress among newly diagnosed cancer patients.

Smile Arc Esthetics in Middle-Aged Man from the Layperson's Perspective Via Eye-Tracking

Abstract Objective: To evaluate the perceptions of smile esthetics associated with variations in the vertical plane of the maxillary incisors in the smile arc using eye-tracking software. Material and Methods: An image of a 59-year-old Caucasian male model was adapted and edited to make three changes in the vertical plane, simulating a convex, straight, and reverse smile arc. Four areas of interest were inserted at the right and left eyes, nose, and mouth. Forty laypeople raters between 18 and 45 years of age participated of the study. Eye-tribe hardware and Ogama software were used to perform eye-tracking. Attractiveness and age-perception questions were also incorporated into the study. ANOVA test and Pearson's correlation coefficient, at p < 0.05. Results: The most observed AOI in images with convex, straight, and reverse smiles, as assessed using heatmaps and point maps, was the mouth, followed by the right eye. A significant difference for the eye (p=0.02) was found when comparing convex and reverse smiles, whereas a significant difference for the mouth was observed between the straight and reverse smiles (p=0.03). Conclusion: Convex and straight smile arcs were associated with equal levels of attractiveness; the reverse smile was less attractive. No significant difference was noticed regarding age perception and the smile arcs. However, the reverse smile recorded a more complete fixation time.

A double-blinded randomized clinical trial of pain perception during orthodontic treatment / Ensaio clínico randomizado duplo cego de percepção da dor durante tratamento ortodôntico

Introduction: Orthodontic movement can cause painful symptoms, especially in the early stages of treatment. Objective: This study aimed to compare the performance of chewing gum and ibuprofen in pain control during the initial period of orthodontic treatment. Material and method: A randomized blind clinical trial, with an allocation ratio of 1:1, was developed with patients aged ≥18 years old. The sample size was established considering a significance level of 5% and test power of 80%, resulting in a minimum of 30 volunteers per group (n=90). Participants were paired regarding sex, age, the severity of malocclusion, defined by the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN), and crowding, determined by Little's irregularity index. The sample was randomly allocated to three groups: Group I (control) placebo; Group II chewing gum; and Group III Ibuprofen. Pain perception was evaluated by the Visual Analog Scale (VAS) in the first 24, 36, and 48 hours after activation of the orthodontic appliance. The data were analyzed by generalized linear models for repeated measures in time. Result: No statistically significant difference (p>0.05) was observed among the groups for the methods of pain therapy evaluated in 24, 36, and 48 hours post-activation. Conclusion: There was no difference among the method used for pain control during the orthodontic treatment.

Introdução: A movimentação ortodôntica pode causar sintomatologia dolorosa, principalmente nas fases iniciais do tratamento. Objetivo: Este estudo teve como objetivo comparar o desempenho da goma de mascar e do ibuprofeno no controle da dor durante o período inicial do tratamento ortodôntico. Material e método: Foi desenvolvido um ensaio clínico randomizado cego, com razão de alocação de 1:1, com pacientes com idade ≥ 18 anos. O tamanho da amostra foi estabelecido considerando um nível de significância de 5% e poder do teste de 80%, resultando em um mínimo de 30 voluntários por grupo (n=90). Os participantes foram pareados quanto ao sexo, idade, gravidade da má oclusão, definida pelo Componente de Saúde Bucal (DHC) do Índice de Necessidade de Tratamento Ortodôntico (IOTN), e apinhamento, determinado pelo índice de irregularidade de Little. A amostra foi distribuída aleatoriamente em três grupos: Grupo I (controle) placebo; Goma de mascar Grupo II; e Grupo III Ibuprofeno. A percepção da dor foi avaliada pela Escala Visual Analógica (EVA) nas primeiras 24, 36 e 48 horas após a ativação do aparelho ortodôntico. Os dados foram analisados por modelos lineares generalizados para medidas repetidas no tempo. Resultado Não foi observada diferença estatisticamente significativa (p>0.05) entre os grupos para os métodos de terapia da dor avaliados em 24, 36 e 48 horas pós-ativação. Conclusão: Não houve diferença entre o método utilizado para controle da dor durante o tratamento ortodôntico.

Evaluación de la efectividad y satisfacción de las pacientes tras miomectomía histeroscópica en consulta / Evaluation of effectiveness and patient satisfaction of hysteroscopic myomectomy in office

OBJETIVO: Analizar la efectividad de las miomectomías histeroscópicas en consulta realizadas con minirresector y conocer si hay factores relacionados con el grado de satisfacción de las pacientes. MÉTODO: Estudio observacional, transversal y prospectivo, de mujeres sometidas a miomectomía histeroscópica en consulta durante el año 2018. Las pacientes recibieron medicación para la preparación cervical, analgesia oral y anestesia paracervical. La miomectomía se realizó con un minirresector de 5.8 mm. Se registraron el tiempo y el dolor en una escala visual analógica (EVA) durante la entrada y la resección, así como la satisfacción de las pacientes a los 3 meses con el cuestionario validado CSQ-8. RESULTADOS: El estudio incluyó 59 pacientes. El tiempo medio de entrada fue menor de 1 minuto (47,93 segundos) y el de resección fue de 13,51 minutos. El dolor referido por las pacientes en la EVA durante la entrada y la resección puntuó en torno a 3 y 4, respectivamente. Se consiguió un 74.6% de resecciones completas de los miomas y la puntuación media de satisfacción de las pacientes fue de 27.17. La resección completa del mioma se asoció con una mayor satisfacción total de las pacientes. CONCLUSIONES: La miomectomía histeroscópica en consulta llevada a cabo con un minirresector de 5.8 mm con analgesia paracervical obtiene buenos resultados clínicos, con buena satisfacción de las pacientes. Esta última se relaciona con una resección completa del mioma, sin que influyan el tiempo necesario para su exéresis ni el dolor.

OBJECTIVE: To analyze the effectiveness of hysteroscopic myomectomy in office performed with mini-resectoscope, and to know if there is any variable related with patient satisfaction. METHOD: Observational and prospective transversal study, which included all women who underwent a hysteroscopic myomectomy in office in 2018. Patients received drugs for cervical preparation and pain management, as well as paracervical block. We used the 5.8 mm mini-resectoscope. We kept record of time and AVS pain during entrance and resection, as well as patient satisfaction 3 months after the procedure using the CSQ-8. RESULTS: The study included 59 patients. Mean entrance time was less than 1 minute (47.93 seconds), while mean resection time was 13.51 minutes. AVS pain during entrance and resection was around 3 and 4, respectively. We achieved 74.6% rate of complete resection. Mean patient satisfaction rate was 27.17 points. We found that a complete myoma resection is related to higher patient satisfaction. CONCLUSIONS: Hysteroscopic myomectomy in office performed with the 5.8 mm mini-resectoscope, using cervical block, achieves good clinical results and a good patient satisfaction. Patient satisfaction is associated with a complete resection of the myoma, without any influence of pain experienced or time required.

Estimulação elétrica nervosa transcutânea interativa e convencional em mulheres com dismenorreia primária / Interactive and conventional transcutaneous electrical nerve stimulation in women with primary dysmenorrhoea

A dismenorreia primária é uma dor na região inferior do abdômen, antes ou durante a menstruação e independente de patologias pélvicas. Tratamentos fisioterapêuticos são alternativas para a melhora dos sintomas, dentre esses recursos, a estimulação elétrica nervosa transcutânea (TENS). O objetivo deste estudo foi comparar o efeito terapêutico e analgésico da TENS interativa e convencional na dor secundária à dismenorreia primária. A aplicação da TENS, em ambos os grupos, foi realizada no primeiro dia do período menstrual por 35 minutos. Na TENS interativa todas as voluntárias optaram pelos seguintes parâmetros: frequência de 250 Hz, duração de pulso de 25 µs e intensidade conforme nível sensorial, sendo essa ou a duração do pulso reajustado, a cada 5 minutos, conforme houvesse necessidade. Na TENS convencional foi utilizado os seguintes parâmetros: frequência de 100 Hz, duração de pulso de 50 µs e com a intensidade conforme grupo anterior. A análise estatística foi realizada por meio do software GraphPadPrism®, versão 5.0, sendo empregado o teste t de Student e com nível de significância de p < 0,05. Obteve-se como resultado uma redução da dor entre as participantes de ambos os grupos logo após o tratamento. Porém não houve diferença na analgesia promovida pelos dois métodos de tratamento. (AU)

Primary dysmenorrhea (PD) is a lower region of the abdomen pain, before or during menstruation and independent of pathologies. Physical therapy treatments are alternatives to improve symptoms, among these resources, transcutaneous electrical nerve stimulation (TENS). The aim of this study was to compare the therapeutic and analytical effect of interactive and conventional TENS in high school in PD. The application of TENS, in both groups, was performed on the first day of the menstrual period for 35 minutes. In the interactive TENS all the volunteers chose the following parameters: frequency of 250 Hz, pulse duration of 25 µs and intensity according to sensory level, whether this or the duration of the readjustment of the pulse, every 5 minutes, according to the need for use. In conventional TENS, the following parameters were used: frequency of 100 Hz, pulse duration of 50 µs and intensity according to the previous group. A statistical analysis was performed using the GraphPadPrism® software, version 5.0, being employed Student's test with a significance level of p < 0.05. The result is a reduction in pain among participants in both groups right after treatment. However, there was no difference in the analgesia promoted by the two treatment methods. (AU)

Evaluación de la obstrucción nasal por métodos subjetivos y pico flujo inspiratorio nasal en niños y adolescentes con rinitis crónica / Assessment of nasal obstruction by subjective methods and peak nasal inspiratory flow in children and adolescents with chronic rhinitis

Introducción. La obstrucción nasal (ON) es el síntoma más molesto de la rinitis crónica (RC). Los estudios que correlacionaron métodos subjetivos y objetivos de ON realizados en niños y adultos produjeron resultados contradictorios. Objetivos. Analizar la correlación entre escalas subjetivas de ON con determinaciones de pico flujo inspiratorio nasal (PFIN) y comparar la valoración subjetiva de la ON y el PFIN en niños según su edad. Población y métodos. Participaron pacientes con RC. Se estimó la correlación entre la evaluación subjetiva de la ON mediante una escala visual análoga (ON-EVA, por su sigla en inglés) y la Escala de evaluación de los síntomas de obstrucción nasal (NOSE, por su sigla en inglés) y medición del flujo aéreo nasal pre- y posvasoconstrictor, mediante PFIN. Se analizaron las diferencias entre los grupos de 8 a 11 años y los de 12 a 15 años para la valoración subjetiva de la ON y PFIN. Resultados. Se incluyeron 79 pacientes entre 8 y 15 años. No se comprobó correlación entre ON-EVA y PFIN antes y después del vasoconstrictor (r = -0,19; p = 0,11 y r = -0,18; p = 0,15 respectivamente) ni entre NOSE y PFIN basal (r = -0,23; p = 0,07). Hubo diferencias en el PFIN entre niños de 8-11 años y 12 a 15 años (p = <0,0001), pero no se demostraron diferencias en la percepción subjetiva por ON-EVA (p = 0,7591). Conclusión. No se demostró correlación entre puntajes subjetivos de ON y PFIN en niños y adolescentes con RC. Los niños mayores perciben menos la ON que los de menor edad. Las escalas subjetivas de ON no reemplazan su medición con PFIN en pacientes con rinitis.

Introduction. Nasal obstruction (NO) is the most irritating symptom of chronic rhinitis (CR). The results of studies that correlated subjective and objective methods of NO in children and adults were contradictory. Objectives. To analyze the correlation between subjective NO scales and peak nasal inspiratory flow (PNIF) measurements and compare the subjective NO assessment and PNIF in children by age. Population and methods. Participants were patients with CR. The correlation between the subjective NO assessment using a visual analog scale (NO-VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) and nasal airflow measurement pre- and post-vasoconstrictor administration using the PNIF was estimated. The differences in the subjective NO assessment and PNIF between children aged 8-11 years and 12-15 years were analyzed. Results. A total of 79 patients aged 8-15 years were included. No correlation was established between the NO-VAS and the PNIF before and after vasoconstrictor administration (r = -0.19; p = 0.11 and r = -0.18; p = 0.15 respectively) or between the NOSE and the baseline PNIF (r = -0.23; p = 0.07). Differences were observed in the PNIF between children aged 8-11 years and 12-15 years (p = < 0.0001), but there were no differences in the subjective perception assessed with the NO-VAS (p = 0.7591). Conclusion. No correlation was demonstrated between the subjective NO score and the PNIF in children and adolescents with CR. Older children have a lower perception of NO than younger ones. Subjective NO scales cannot replace the PNIF measurement in patients with rhinitis

Sintomatología depresiva y dolor de espalda crónico en pacientes que inician rehabilitación en Lima, Perú / Depressive symptoms and chronic back pain in patients who start rehabilitation in Lima, Perú

Introducción: La unión entre sintomatología depresiva y el dolor está evidenciada, por eso deben tratarse en conjunto. Objetivo: Determinar la relación entre la sintomatología depresiva y el dolor de espalda crónico en pacientes que inician rehabilitación. Material y métodos: Estudio observacional, prospectivo y transversal. Participaron 118 pacientes con dolor de espalda crónico que iniciaron rehabilitación. El dolor se midió con la Escala Visual Analógica y la sintomatología depresiva con el Inventario de Depresión de Beck II. Resultados: Pacientes presentaron como promedio de dolor 6,69 ± 1,98; nivel de intensidad moderado 52,5 por ciento y localización lumbar 55,1 por ciento; el mayor tiempo de duración en el rango de 1 a 3 años 54,2 por ciento. La sintomatología depresiva tuvo puntaje promedio 19,13±10,62; se analizaron en dos grupos: sintomatología de nivel mínimo (0-13 puntos) y de riesgo (14-63 puntos), conformado por los niveles leve, moderado y severo con 66,9 por ciento. La relación entre la sintomatología depresiva y el dolor de espalda crónico fue significativa, a mayor nivel de dolor mayor presencia de sintomatología, en el nivel severo de dolor la sintomatología leve/moderado/severo fue de 80,9 por ciento (p = 0,03); para el sexo femenino 73,3 por ciento (p = 0,02); en estado civil el grupo separado/viudo 93,8 por ciento (p = 0,04) y sin instrucción 100 por ciento (p = 0,03). Conclusiones: La sintomatología depresiva está relacionada al dolor de espalda crónico, a mayor nivel de dolor mayor presencia de sintomatología depresiva. También está asociada al sexo femenino, a personas separadas o viudas y sin instrucción(AU)

Introduction: The association between depressive symptoms and pain is evidenced, so they must be treated together. Objective: To determine the relationship between depressive symptoms and chronic back pain in patients who start rehabilitation. Material and methods: An observational, prospective and cross-sectional study was conducted in 118 patients with chronic back pain who started rehabilitation. The pain was measured using the Visual Analog Scale and depressive symptoms were measured with the Beck Depression Inventory-II. Results: The patients presented an average pain of 6,69 ± 1,98, with moderate levels of intensity (52,5 percent) and lumbar location (55,1 percent); the longest time duration ranged from 1 to 3 years (54,2 percent). Depressive symptoms had an average score of 19,13 ± 10,62; they were analyzed in two groups: minimum level of symptoms (0-13 points) and risk (14-63 points) including mild, moderate and severe levels (66,9 percent). The relationship between depressive symptoms and chronic back pain was significant; that is, the higher the level of pain, the greater the presence of symptoms. In the case of severe level of pain, the mild/moderate/severe symptoms were 80,9 percent (p = 0,03); 73,3 percent for females (p = 0,02); concerning marital status, 93,8 percent were separated/widowed (p = 0,04) and 100 percent had no levels of education (p = 0,03). Conclusions: Depressive symptoms are related to chronic back pain; the higher the level of pain, the greater the presence of depressive symptoms. It is also associated with the female sex, separated or widowed persons and persons without any education(AU)

Aplicação do refinamento das regras de ligação da CIF à Escala Visual Analógica e aos questionários Roland Morris e SF-36 / Application of the refinements of ICF linking rules to the Visual Analogue Scale, Roland Morris questionnaire and SF-36

Resumo A Escala Visual Analógica (EVA), o Questionário de Incapacidade de Roland Morris (RMDQ) e Questionário de Qualidade de Vida SF-36, amplamente utilizados, tiveram seu conteúdo conectado à CIF por regras propostas em 2002 e 2005. Em 2016 foram refinadas e ainda não foram aplicadas. Aplicar as regras de conexão de conteúdo refinadas para os instrumentos EVA, RMDQ e SF-36. Dois profissionais de saúde identificaram os conceitos significativos e vincularam às categorias mais específicas da CIF, um terceiro arbitrou divergências. O grau de concordância foi dado pelo coeficiente kappa. Houve alto grau de concordância (Kappa=0,93 p<0,001). O conceito principal da EVA foi conectado à categoria b280, os 24 conceitos principais do RMDQ, à categoria b28013 e os 27 adicionais a outras categorias. O SF-36 teve 36 conceitos principais e 30 adicionais identificados, do total, 17 não foram definíveis pela CIF. Dos conceitos conectados dos 3 instrumentos 39 referem-se à Funções do Corpo, 57 à Atividades e Participação e 4 à Fatores Ambientais. O refinamento das regras propiciou mais clareza no processo de identificar, relacionar o conteúdo dos instrumentos à CIF e expor os resultado e aumentou o número de conceitos identificados e categorias contempladas pelos instrumentos.

Abstract The Visual Analogue Scale (VAS), Roland Morris Disability Questionnaire (RMDQ), Short Form Health Survey (SF-36) are broadly used and had their content linked to ICF by the linking rules of 2002 and 2005. In 2016 were refined and were not applied yet. To apply the refinements of ICF linking rules to VAS, RMDQ, and SF-36. Two health professionals identified the meaningful concepts and linked to the most precise ICF categories and a third triggered in divergences. The degree of agreement was calculated by kappa statistic. There was almost perfect agreement (Kappa=0.93 p<0,001). The main concept of VAS was linked to ICF category b280, the 24 main concepts of RMDQ linked to b28013, and 27 additional linked to other categories. The SF-36 had 36 main concepts and 30 additional concepts identified which 27 were definable by the ICF and 17 do not. From the total of ICF linked concepts, 39 refer to Body Functions, 57 to Activities and Participation and 4 to Environmental Factors. The refinements of linking rules propitiated more clarity in the process to identify, to link instruments content with ICF and to expose the results. Thus, increased the number of identified and linked concepts as well as the categories in the instruments.

What is the effect of vigorous exercise on the brain?

Abstract Aims: This study aimed to verify whether vigorous exercise is capable of generating mental fatigue. Methods: To do so, 16 young adult male (29.4 ± 5.2 years old) cyclists (5.4 ± 4.6 years of training) underwent three visits: 1) control session (rest); 2) session with cognitive demand (20 minutes of AX-CPT); 3) session with vigorous exercise (10km time trial). Mental fatigue was assessed using the visual analog scale of fatigue in the pre-and post-session moments. A two-way ANOVA of repeated measures followed by the Bonferroni posthoc was used to verify the effect of the condition (control, cognitive demand, and exercise) and time (pre and post) interaction. The paired "t" test was used to compare the delta of mental fatigue (post - pre) of the sessions. The partial eta squared was used to determine the effect size of the variance. The significance adopted was p < 0.05. Results: A condition x time interaction was observed (F (2.30) = 5.349, p = 0.010, partial η2 = 0.263). When comparing the deltas, a mean difference was found between the control and vigorous exercise (p = 0.033) conditions and cognitive demand and vigorous exercise (p = 0.017) conditions. Control and cognitive demand sessions showed no difference (p = 0.801). Conclusion: The findings suggest that intense physical exercise seems to cause mental fatigue after practice.

An eye-tracking and visual analogue scale attractiveness evaluation of black space between the maxillary central incisors

ABSTRACT Objective: To study the influence of black space between the maxillary central incisors on the aesthetic visual perception of the face, via eye-tracking and visual analogue scale (VAS). Methods: Black space between the central incisors was created, for both sexes, as follows: control, 1-mm black space, 2-mm black space and 3-mm black space. Ninety raters participated in this study, divided into three groups: 30 laypeople, 30 nonorthodontists, and 30 orthodontists. After the visual calibration of each observer, eight photographs were presented in the Ogama® software concomitant with the use of the hardware The Eye Tribe®. Ogama generated information depending on the eye-tracking of each rater, regarding the time until the first fixation, time of fixation, heatmap, scanpath, and total time of fixation, to evaluate the areas deemed to be of interest according to the raters. Later on, the VAS was used, where each rater evaluated the images in an album on a scale of zero to 10 points. Results: The eyes and mouth were the areas more often noticed by the raters according to the heatmaps, while no significant difference was observed in time until the first fixation between the three groups of raters (p> 0.05). However, regarding the time of fixation on the mouth, a significant difference was observed (p< 0.05) when comparing the three groups. Conclusion: Black space has a negative effect on the aesthetic perception of the face. The amount of attention on the mouth is correspondent to the size of the black space.

RESUMO Objetivo: Avaliar a percepção visual e estética do espaço negro entre os incisivos centrais superiores, via rastreamento do olhar e escala visual analógica (EVA). Métodos: Manipulou-se o espaço negro entre os incisivos centrais superiores, para ambos os sexos, da seguinte forma: imagem controle, espaço negro de 1 mm, espaço negro de 2 mm e espaço negro de 3 mm. Participaram desse estudo noventa avaliadores, divididos em três grupos: 30 leigos, 30 cirurgiões-dentistas e 30 ortodontistas. Após a calibração visual de cada observador, foram projetadas oito fotografias no software OGAMA® em conjunto com o hardware The Eye Tribe®. O OGAMA gerou informações do rastreamento do olhar de cada avaliador com relação ao tempo até a primeira fixação, mapa de calor, trajetória do olhar e tempo total de fixação para avaliar as áreas consideradas de interesse, de acordo com os avaliadores. Posteriormente, utilizou-se a EVA para avaliar as imagens a partir de um álbum, em uma escala de 0 a 10 pontos. Resultados: Os olhos e a boca foram as áreas com maior fixação pelos avaliadores, de acordo com os mapas de calor. Os resultados estatísticos não apresentaram diferença estatisticamente significativa entre os três grupos de avaliadores (p> 0,05), quanto ao tempo até a primeira fixação. Porém, em relação ao tempo de fixação na boca, observou-se diferença estatisticamente significativa (p< 0,05) na comparação dos três grupos. Conclusão: O espaço negro apresentou um efeito negativo na percepção estética da face. O aumento de fixação na boca correspondeu ao aumento do tamanho do espaço negro.

Ferric Sulfate Versus Calcium-Enriched Mixture Cement in Pulpotomy of Primary Molars: A Randomized Clinical Trial

ABSTRACT Objective: To evaluate the postoperative pain and clinical and radiographic success of pulpotomized primary molars using two materials, Ferric Sulfate (FS) and Calcium-Enriched Mixture (CEM) cement, over a period of 3 and 6 months. Material and Methods: This randomized clinical trial was conducted on a total of 38 teeth selected from 19 patients aged 3-9 years. FS 15.5% and CEM cement were used as pulpotomy agents. Permanent restorations were Stainless Steel Crowns (SSCs) in both groups. Patients were recalled for follow-up at 3 and 6 months intervals for clinical and radiographic assessment. Postoperative pain was recorded by using Visual Analogue Scale up to ten days following the treatment. The data were statistically analyzed using chi-square test and repeated measures ANOVA. Results: At 6 months, a 100% clinical success rate was observed in the FS and CEM cement groups. The radiographic success rate in the FS group was 94.7%, whereas 100% in the CEM cement group at 6 months. No statistically significant difference was found between the two groups (p>0.05). There was no significant difference in postoperative pain between the teeth that received either FS or CEM cement as pulpotomy agents following the procedure (p>0.05). Conclusion: There were favorable outcomes of FS and CEM cement in pulpotomy of primary molar teeth.

Difference in Orthodontic Patients' Perceptions of Essix and Hawley Retainers

Abstract Objective: To determine differences in how orthodontic patients perceive the aesthetics relating to the use of Essix and Hawley retainers. Material and Methods: Photographs of a female patient using an Essix retainer and a Hawley retainer, respectively, were assessed by 70 orthodontic patients aged between 21 and 55 years. All participants were provided with the same images of the two retainer types being worn and were asked to grade the aesthetics of each retainer using a visual analog scale. The significance of differences in orthodontic patient perceptions of aesthetics in the use of Essix and Hawley Retainers in the young adult and adult age groups were tested using the Mann-Whitney test with assumed significance p<0.01. Results: There were differences in participants' perceptions between the two retainers that were statistically significant, with responses varying between young adults aged 21 to 35 years and adults aged 36 to 55 years. According to the VAS, the two retainers' average scores in the total population are 82 for Essix Retainer and 60 for Hawley Retainer in both groups. Conclusion: The Essix retainer as a retention appliance is considered more aesthetically pleasing than the Hawley retainer among both young and middle-aged adults.

Efficacy of Oil Pulling in the Management of Oral Submucous Fibrosis: A Preliminary Study

ABSTRACT Objective: To evaluate the effectiveness of oil pulling in the management of oral submucous fibrosis (OSMF). Material and Methods: A total of 62 patients clinically and histopathologically diagnosed as OSMF were incorporated in the present study. The subjects are randomly divided equally into two groups, Group A (oil pulling group) and Group B (placebo group). Subjects in Group A were asked to perform OP with sesame oil on an empty stomach in the morning for 3 months and Group B was given placebo capsules for 3 months. Assessment of various clinical parameters was done regularly, and data were analyzed using the Chi-square test. Results: Eighty-two percent had a habit of betel nut chewing, while 18% of the patients had tobacco chewing habits, which were among the main causative factors for OSMF. Clinical improvements in mouth opening, tongue protrusion, difficulty in speech and deglutition, and burning sensation were significant in the Group A. None of the patients reported any discomfort or side effects. The symptoms were not severe in nature and resolved in few days without stopping the therapy. Conclusion: Oil pulling can bring about significant clinical improvements in the symptoms like a mouth opening and tongue protrusion.

Revisión sistemática de la literatura sobre la evaluación del proceso de la masticación / Systematic Review Of The Literature On The Evaluation Of The Chewing Process

El objetivo del presente estudio fue presentar una revisión sistemática de la literatura relacionada con los estudios que aborden los métodos de evaluación de la masticación y sus características principales. Como estrategia de investigación se realizó en las bases de datos PubMed, Web Of Science, Medline, SciELO y Lilacs desde 2006 al 2020. Como criterios de selección se escogieron todos los estudios disponibles, sin restricción de idioma; de los últimos 14 años; cuyos participantes no presentaron alteraciones neurológicas ni psiquiátricas. Fueron analizados a partir de su relación con el objeto del presente estudio. Las palabras clave utilizadas en la búsqueda de los artículos fueron identificados en los Descriptores en Ciencias de la Salud (DEDS) siendo las siguientes: "Evaluation", "Mastication", "Masticatory Muscles", "Masseter Muscle" y "Temporal Muscle". Utilizando también OR y AND como operadores lógicos. Se encontró 1311 estudios en las bases de datos investigadas, después de la revisión fueron eliminados 1278 y elegidos 33 artículos; y considerándose sólo 21 artículos según criterios de selección y objetivo. Todos los artículos revisados obtuvieron un alto grado de evidencia (nivel I) luego de realizar una evaluación crítica de la evidencia científica, determinando que todos los artículos evaluados fueron catalogados como estudios clínicos aleatorizados y con diseños experimentales. Siendo excluidos los estudios longitudinales, con individuos con patologías. Se concluye que el método que se utiliza mayormente es la evaluación clínica fonoaudiológica, mediante observación y palpación de musculatura orofacial, seguido de electromiografía de superficie, electrognatografía y la escala analógica visual para la saciedad. Las características observadas fueron, número de ciclos de masticación, velocidad de la masticación, porcentaje de actividad muscular eléctrica, fuerza muscular, tipo de masticación según el lado de preferencia de masticación, eficiencia masticatoria y tipología facial.

The objective of the present study was to present a systematic review of the literature related to studies that address chewing evaluation methods and their main characteristics. As a research strategy, it was carried out in the PubMed, Web Of Science, Medline, SciELO and Lilacs databases from 2006 to 2020. All available studies were chosen as selection criteria, without language restriction; of the last 14 years; whose participants did not present neurological or psychiatric alterations. They were analyzed based on their relationship with the object of the present study. The keywords used in the search for the articles were identified in the Health Sciences Descriptors (DEDS) being the following: "Evaluation", "Mastication", "Masticatory Muscles", "Masseter Muscle" and "Temporal Muscle". Also using OR and AND as logical operators. 1311 studies were found in the investigated databases, after the review 1278 were eliminated and 33 articles were chosen; and considering only 21 articles according to selection and objective criteria. All the articles reviewed obtained a high degree of evidence (level I) after making a critical evaluation of the scientific evidence, determining that all the articles evaluated were classified as randomized clinical studies with experimental designs. Longitudinal studies with individuals with pathologies being excluded. It is concluded that the method most used is the speech therapy clinical evaluation, by observation and palpation of the orofacial muscles, followed by surface electromyography, electrognatography and the visual analog scale for satiety. The observed characteristics were, number of chewing cycles, chewing speed, percentage of electrical muscle activity, muscle strength, chewing type according to chewing preference side, chewing efficiency and facial typology.

Odontogenic Maxillofacial Infections in a High-level Hospital: Orofacial Pain and Related Conditions

ABSTRACT Objective: Odontogenic infection is a common condition in America; the aim of this research was to determine the profile of odontogenic maxillofacial infections and to identify the link between these and the pain felt by patients admitted to the emergency dental service of the Hernân Henriquez Aravena Hospital in Temuco, Chile. Methods: A cross-sectional, double-blind study analysed 49 individuals admitted for emergency dental care. Included were admissions associated with odontogenic infection identified by clinical examination, establishing a relation to pain through a survey. The diagnosis was made clinically using the fascial spaces involved in the infection, presence of self-medication prior to admission, need for surgical treatment and the patient 's systemic conditions. The data were analysed using descriptive statistics, Chi-squared, ANOVA, considering a value of p < 0.05 as significant. Results: The average pain level measured by visual analogue scale (VAS) in emergency admission was 8.1. There was no association between the diagnosis (pulp infection, periodontal infection or pericoronitis) and the VAS (p = 0.078), but there was association between age and the diagnosis (p = 0.022), and the VAS was associated with pain compared to other types of pathologies or traumas (p = 0.011). Conclusion: Odontogenic infection is frequent and linked to age and high-pain values. New public policies should be adopted based on these results. New studies are needed to assess new variables associated with these pathologies.

Efficacy of Higher Gauged Needles or Topical Pre-Cooling for Pain Reduction during Local Anesthesia Injection: A Split-Mouth Randomized Trial

ABSTRACT Objective: To evaluate the efficacy of pre-cooling and the use of higher gauged needles in reducing pain during local anesthetic infiltration. Material and Methods: We conducted a split-mouth randomized controlled trial among 70 patients who require bilateral maxillary local anesthetic (LA) injections for dental treatment. After applying the topical anesthetic, each participant received four local anesthetic injections, two on buccal and two palatal sides. At each visit, the participants received one buccal and one palatal infiltration based on the randomization. On the buccal aspect, participants received LA with a 26G needle injection on one side (control) and a 31G needle (test) on the contralateral side. On the Palatal aspect, participants either received LA with a 31G needle on one side (control). In contrast, the opposite side was preceded by topical ice application (iced cotton swab) before LA with a 31G needle (test). Both the visits were spaced with a gap of 7-10 days based on the participants' feasibility. Participants were asked to rate the pain on a visual analog scale independently for buccal and palatal LA injections. Results: On the Buccal aspect, the mean pain scores were 2.74 ± 1.26 and 2.11 ± 1.26 for control and test groups, respectively (p=0.002). On the Palatal aspect, the mean pain scores were 4.14 ± 1.49 and 4.3 ± 1.80 for control and test groups, respectively (p=0.295). Conclusion: Significant lower pain scores were reported with higher gauge needles (31G) when compared to traditional (26G) needles on the buccal aspect. No significant difference was seen with pre-cooling the injection site on the palatal aspect when used with higher gauged needles (31G).

Evaluation of Masticatory Performance and Patient Satisfaction Before and After Posterior Implant Restoration

ABSTRACT Objective: To evaluate the improvement in masticatory performances two weeks after posterior implant restoration. Material and Methods: Nine patients with missing first and second molars were included in the study. Masticatory performances were evaluated using subjective and objective methods utilizing color-changeable chewing gum and the visual analog scale (VAS) assessment. The subjects were asked to chew the color-changeable chewing gums before and two weeks after the posterior implant restoration. Their expectations regarding aesthetics and function were verified on the VAS before implant placement. Additionally, the VAS was used for the posttreatment completion rating two weeks after the implant restoration. Results: Significant differences in masticatory performance were noted at baseline (before implant posterior restoration) and two weeks after implant restoration (p<0.05). The posttreatment aesthetic and functional expectations ratings significantly exceeded the expectations (p<0.05). Conclusion: Masticatory performances were improved two weeks after implant restoration. In addition, the significant posttreatment ratings of the patients exceeded their initial expectations. In particular, patients with poor masticatory functions demonstrated significant improvements and satisfaction following implant restoration compared to those with good mastication. These findings indicate that a posterior implant restoration can increase the masticatory performance.

Effects of nasal aspiration by the Proetz® method in pediatric patients with sinusitis

SUMMARY OBJECTIVE: To characterize the effects of nasal aspiration with Proetz® in peak nasal inspiratory flow (PNIF) in pediatric sinusitis (PS) patients with nasal obstruction. METHODS: This is a non-randomized descriptive-analytical clinical trial with a quantitative approach. The sample comprised 30 children. Initially, the PNIF was measured and the Visual Analogical Scale (VAS) was used for nasal obstruction, followed by the nasal aspiration procedure. The SNOT-22 questionnaire was applied to the legal guardian of each child, and one week later, it was reapplied for the sake of follow-up. RESULTS: 16 (53.3%) patients were females and 14 (46.7%) were males, with an average age of 6.4±1.8 years (between 4 and 10 years of age). Analyses of the VAS for obstruction before the intervention revealed that 10 of the participants (33.3%) presented moderate levels, and 20 of them (66.7%) severe levels. However, after the Proetz® method was applied, all the samples (n=30) had mild levels. The PNIF significantly increased after the technique was used, with an improvement of 23.4% in mean values. There was no significant correlation between the VAS and the PNIF. CONCLUSION: Nasal aspiration with the Proetz® method significantly improved the clinical condition of sinusitis patients with nasal obstruction according to the visual analogical scale, the PNIF, and the SNOT-22 questionnaire. No correlation between the VAS and the PNIF could be found. The study confirms the importance of non-pharmacological interventions in the treatment of sinusitis in children, thus resulting in an improvement in their quality of life.

RESUMO OBJETIVO: Caracterizar os efeitos da aspiração nasal com Proetz® no pico do fluxo inspiratório nasal (Pnif) em pacientes com sinusite pediátrica (SP) com obstrução nasal. MÉTODOS: Trata-se de um ensaio clínico analítico descritivo, não randomizado, com abordagem quantitativa. A amostra foi composta por 30 crianças. Inicialmente, o Pnif foi medido e a escala visual analógica (EVA) foi utilizada para obstrução nasal, seguida do procedimento de aspiração nasal. O questionário Snot-22 foi aplicado ao responsável legal de cada criança e, uma semana depois, foi reaplicado para fins de acompanhamento. RESULTADOS: Dezesseis (53,3%) pacientes eram do sexo feminino e 14 (46,7%) do sexo masculino, com idade média de 6,4±1,8 anos (entre 4 e 10 anos). A análise da EVA para obstrução antes da intervenção revelou que dez dos participantes (33,3%) apresentaram níveis moderados e 20 deles (66,7%), níveis graves. No entanto, após a aplicação do método Proetz®, todas as amostras (n=30) apresentaram níveis leves. O Pnif aumentou significativamente após a utilização da técnica, com uma melhoria de 23,4% nos valores médios. Não houve correlação significativa entre EVA e Pnif. CONCLUSÃO: A aspiração nasal com o método Proetz® melhorou significativamente o quadro clínico de pacientes com sinusite com obstrução nasal, de acordo com a escala visual analógica, o Pnif e o questionário Snot-22. Não foi encontrada correlação entre EVA e Pnif. O estudo confirma a importância de intervenções não farmacológicas no tratamento da sinusite em crianças, resultando em melhoria na sua qualidade de vida.