Incidence of Muscular Strength, Anthropometry, and Asymmetry in the General Index of Autonomy in Older Chilean Women

SUMMARY: Frailty affects the functional autonomy (FA) of older adults and could manifest itself in muscle imbalances in the limbs, resulting in a disparity in size and strength between them. In Chile, information on the relationship between muscle strength (MS) levels and FA asymmetries in older women is limited. This study related the levels of MS, anthropometric parameters, and asymmetries of the lower and upper limbs, with the FA of a group of older Chilean women. The study included 39 women who participated, and their FA was evaluated using the GDLAM index (IG). Based on the score obtained in the IG, they were classified by percentiles as Group 1 with favorable FA (P ≤ 50) and Group 2 with low FA (P > 50). Anthropometric parameters were BMI, fat percentage, bone mass, circumferences (arm, thigh, calf), diameters (humerus, femur) and upper/lower limb strength was evaluated to determine asymmetries. The differences between the covariates of both groups were evaluated using the student's t test and the Mann-Whitney test for independent samples. G1 presented less asymmetry (p > 0.05) in the lower limbs and greater calf circumference than G2 (p < 0.05). G1 presented greater bilateral strength (dominant and non-dominant limb) compared to G2 (p < 0.05). The covariates of age, anthropometry, MS, and lower/upper limb asymmetries influence FA in older women.

La fragilidad afecta la autonomía funcional (AF) de las personas mayores y podría manifestarse en desequilibrios musculares en los miembros, dando lugar a una disparidad de tamaño y fuerza entre ellos. En Chile, la información que relaciona los niveles de fuerza muscular (FM) y las asimetrías con la AF en mujeres mayores es limitada. Este estudio relacionó los niveles de FM, parámetros antropométricos y asimetrías de los miembros inferiores y superiores, con la AF de un grupo de mujeres mayores chilenas. Participaron 39 mujeres, cuya AF se evaluó mediante el índice GDLAM (IG). En función de la puntuación obtenida en el IG, se clasificaron por percentiles en Grupo 1 con AF favorable (P ≤ 50) y Grupo 2 con AF baja (P > 50). Los parámetros antropométricos fueron IMC, porcentaje de grasa, masa ósea, circunferencias (brazo, muslo, pantorrilla), diámetros (húmero, fémur) y se evaluó la fuerza de los miembros superiores/ inferiores para determinar asimetrías. Las diferencias entre las covariables de ambos grupos se evaluaron mediante la prueba t de student y la prueba de Mann-Whitney para muestras independientes. G1 presentó menor asimetría (p > 0,05) en los miembros inferiores y mayor perímetro de pantorrilla que G2 (p < 0,05). G1 presentó mayor fuerza bilateral (miembro dominante y no dominante) en comparación con G2 (p < 0,05). Las covariables de antropometría, FM y asimetrías de extremidades inferiores/superiores influyen en la AF en mujeres mayores.

Acupuncture for generalized anxiety disorder: a study protocol for a randomized controlled trial

During the COVID-19 outbreak, there was a sharp increase in generalized anxiety disorder (GAD). Acupuncture therapy has the advantages of accurate clinical efficacy, safety and reliability, few adverse reactions, and no dependence, and is gradually becoming one of the emerging therapies for treating GAD. We present a study protocol for a randomized clinical trial with the aim of exploring the mechanism of brain plasticity in patients with GAD and evaluate the effectiveness and reliability of acupuncture treatment. Transcranial magnetic stimulation (TMS) will be used to assess cortical excitability in GAD patients and healthy people. Sixty-six GAD patients meeting the inclusion criteria will be randomly divided into two groups: TA group, (treatment with acupuncture and basic western medicine treatment) and SA group (sham acupuncture and basic western medicine treatment). Twenty healthy people will be recruited as the control group (HC). The parameters that will be evaluated are amplitude of motor evoked potentials (MEPs), cortical resting period (CSP), resting motor threshold (RMT), and Hamilton Anxiety Scale (HAMA) score. Secondary results will include blood analysis of γ-aminobutyric acid (GABA), glutamate (Glu), glutamine (Gln), serotonin (5-HT), and brain-derived nerve growth factor (BDNF). Outcomes will be assessed at baseline and after the intervention (week 8). This study protocol is the first clinical trial designed to detect differences in cerebral cortical excitability between healthy subjects and patients with GAD, and the comparison of clinical efficacy and reliability before and after acupuncture intervention is also one of the main contents of the protocol. We hope to find a suitable non-pharmacological alternative treatment for patients with GAD.

Cases Analysis and Countermeasures Discussion on Ethical Review of Clinical Trial Protocol Violation / 中国医学伦理学

To ensure the rights and safety of the subjects and improve the quality of clinical trials, the author analyzed and discussed the deviation type and typical cases from 184 cases of protocol violation reviewed by the ethics committee in 56 clinical trials in a tertiary hospital in 2020. Among the 184 cases of violating the protocol, there were 29 major protocol violation cases and its proportion is 16%; 99 cases (54%) violated the GCP principle; 56 cases of other violations of the protocol that require to be reported, accounting for 30%. Through the case analysis of the researcher gave the wrong doses to subjects without following the protocol and drug administration did not conform to the rules, analyzed and discussed from the five perspectives of the research protocol design, the researcher, the clinical trial institution, the sponsor and the ethics committee, and put forward solutions and suggestions, so as to provide reference to improve the compliance of clinical trial protocol, reduce the risk of subjects and protect their rights and safety and ensure the successful progress of clinical trials.

Consensus of the Brazilian association of hematology, hemotherapy and cellular therapy on patient blood management: Management of critical bleeding

Abstract The management of major bleeding is a critical aspect of modern healthcare and it is imperative to emphasize the importance of applying Patient Blood Management (PBM) principles. Although transfusion support remains a vital component of bleeding control, treating severe bleeding goes beyond simply replacing lost blood. A more comprehensive, multidisciplinary approach is essential to optimize patient outcomes and minimize the risks associated with excessive transfusions.

Evaluación de validez convergente y discriminante de un protocolo de cribado online para detección de deterioro cognitivo leve en personas mayores en Chile

Introducción: La detección temprana del deterioro cognitivo en personas mayores permite disminuir la incertidumbre y mejorar las tareas de intervención. El objetivo de esta investigación fue determinar las características psicométricas de un protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores. Método: el método usado fue de tipo mixta con preguntas de tipo cuantitativas y cualitativas. La muestra fue de 75 personas mayores del gran Concepción, región del Bio-Bio. El protocolo estaba compuesto por: Cuestionario sociodemográfico, Test del Reloj Versión Cacho, Moca, Escala Depresión Yesavage y Test Acentuación de Palabras. El procedimiento consistió en la aplicación del protocolo a través de un Tablet o Laptop, videollamadas. Resultados: Se encontró que el protocolo presenta validez discriminante y convergente. Conclusiones: se concluye que el protocolo de cribado online para detectar tempranamente deterioro leve en personas mayores es válido y fiable. Se discute el uso y la aplicación de un protocolo cribado usando la Teleneuropsicología (TeleNP), en personas mayores

ABTRACT Introduction: Early detection of cognitive impairment in the elderly allows us to reduce uncertainty and improve intervention tasks. The objective of this research was to determine the psychometric characteristics of an online screening protocol for early detection of mild impairment in the elderly. Method: the method used was of a mixed type with quantitative and qualitative questions. The sample consisted of 75 older people from the greater Concepción, Bio-Bio region. The protocol consisted of: Sociodemographic Questionnaire, Cacho Version Clock Test, Mocha, Yesavage Depression Scale and Word Stress Test. The procedure consisted of the application of the protocol through a Tablet or Laptop, video calls. Results: It was found that the protocol presents discriminant and convergent validity. Conclusions: it is concluded that the online screening protocol for early detection of mild deterioration in the elderly is valid and reliable. The use and application of a screening protocol using Teleneuropsychology (TeleNP) in older people is discussed.

Protocolo para el tratamiento de la recesión gingival con membrana de fibrina rica en plaquetas

Introducción: Es necesario la aplicación de protocolos de actuación como herramientas que permiten homogeneizar los procedimientos plásticos periodontales regenerativos y establecer las pautas de actuación del Periodontólogo para el abordaje de las recesiones gingivales con esta modalidad terapéutica de avanzada. Objetivo: Diseñar un protocolo para el tratamiento de la recesión gingival mediante la utilización de la membrana de fibrina rica en plaquetas, asociada al colgajo de avance coronal. Métodos: Se realizó una investigación con enfoque cualitativo en la Facultad de Estomatología de Villa Clara, de julio de 2020 a diciembre de 2021. Para el diseño del protocolo se empleó una fase de preparación y una de elaboración; dentro de esta última se estructuraron tres momentos: revisión sistemática de la literatura, aplicación de técnicas grupales (grupo focal y nominal) y conclusión del documento. Se realizó una valoración por criterios de especialistas externos antes de concluir la estructura definitiva del protocolo. Resultados: Se consultaron cinco guías para la confección de protocolos, cinco protocolos de atención médica y enfermería y 10 estomatológicos. La estructura del documento quedó conformada por: portada, introducción, objetivos, profesionales a quienes va dirigido, población diana, proceso de elaboración, procedimiento, algoritmo, fecha de implementación y revisión, proceso de implantación, indicadores de evaluación, glosario y referencias bibliográficas. Conclusiones: Se diseñó un protocolo de actuación que establece las pautas para la realización del proceder terapéutico regenerativo, desde la selección de los pacientes hasta la evolución de la terapéutica. El documento se valoró por especialistas externos como positivo.

Introduction: It is necessary to apply action protocols as tools to homogenize regenerative periodontal plastic procedures and to establish the guidelines for the periodontist to approach gingival recession with this advanced therapeutic modality. Objective: To design a protocol for the treatment of gingival recession using platelet-rich fibrin membrane associated with coronal advancement flap. Methods: A research with a qualitative approach was carried out in the School of Stomatology of Villa Clara, from July 2020 to December 2021. For the design of the protocol, a preparation phase and an elaboration phase were used; within the latter, three moments were structured: systematic review of the literature, application of group techniques (focal and nominal group) and conclusion of the document. An evaluation by external specialists was carried out before finalizing the definitive structure of the protocol. Results: Five guides for the preparation of protocols, five medical and nursing care protocols and 10 stomatological protocols were consulted. The structure of the document consisted of: cover page, introduction, objectives, target professionals, target population, elaboration process, procedure, algorithm, implementation and revision date, implementation process, evaluation indicators, glossary and bibliographic references. Conclusions: An action protocol was designed that establishes the guidelines for carrying out the regenerative therapeutic procedure, from the selection of patients to the evolution of the therapy. The document was positively evaluated by external specialists.

Multidisciplinary treatment program for improvement in pain and disability associated with nonspecific chronic low back pain / Programa de tratamento multidisciplinar para melhora da dor e incapacidade associada a dor crônica lombar inespecífica

ABSTRACT BACKGROUND AND OBJECTIVES: Lumbar disorders, which contribute to significant workplace absenteeism and chronic disability, are associated with a considerable financial and social burden. Although a conservative approach provides satisfactory pain relief, biomechanical improvement and is associated with a low risk of adverse effects, there is lack of consensus in the literature regarding the best therapeutic strategy in such cases. METHODS: This retrospective longitudinal study used secondary data from the institutional medical records of patients who completed a multidisciplinary program for the treatment of low back pain between 2019 and 2021. Data regarding pain levels and motor skills were obtained from patients who completed the care program at a private hospital in Bento Gonçalves, RS. The following step-wise treatment algorithm was used: evaluation by a specialist physician for the etiological diagnosis of pain, pharmacological management and dry needling, followed by standard rehabilitation intervention performed by the physiotherapy team and exercises by the physical education team. The visual analogue scale (VAS) was used to measure pain at the start and at the completion of the intervention, and the Oswestry Disability Index (ODI) was used to measure motor skills at the start and at 6 and 12 months following the multiprofessional intervention for rehabilitation. RESULTS: A reduction in pain and motor disability in patients who completed all stages of the treatment program was observed. Pain by the VAS presented the following scores: baseline 7 [5-8] and after treatment 2 [0-4]; and the scores of the ODI were: at baseline 0.34 [0.26 - 0.40], at 6 months 0.16 [0.08 - 0.26] and after treatment 0.12 [0.04 - 0.21]. CONCLUSION: The treatment program reduced the pain and disability associated with low back pain and can serve as the basis for further studies carried out to confirm the effectiveness of this intervention.

RESUMO JUSTIFICATIVA E OBJETIVOS: As doenças lombares, que contribuem para um absenteísmo significativo no local de trabalho e para a incapacidade crônica, estão associadas a um encargo financeiro e social considerável. Embora a abordagem conservadora proporcione alívio satisfatório da dor, melhore a biomecânica e esteja associada a baixo risco de efeitos adversos, não há consenso na literatura sobre a melhor estratégia terapêutica nesses casos. MÉTODOS: Neste estudo longitudinal retrospectivo, foram utilizados dados secundários dos prontuários médicos institucionais de pacientes que completaram um programa multidisciplinar para tratamento de dor lombar entre 2019 e 2021. Dados sobre níveis de dor e habilidades motoras foram obtidos de pacientes que completaram o programa assistencial de um hospital privado de Bento Gonçalves, RS. Foi utilizado o seguinte tratamento passo a passo: avaliação por médico especialista para diagnóstico etiológico da dor, manejo farmacológico e agulhamento a seco, seguido de intervenção de reabilitação padrão realizada pela equipe de fisioterapia e exercícios pela equipe de educação física. A escala analógica visual (EAV) foi utilizada para medir a dor no início e após a conclusão da intervenção, e o Índice de Incapacidade de Oswestry (ODI) foi usado para medir as habilidades motoras no início e aos 6 e 12 meses após a intervenção multiprofissional para reabilitação. RESULTADOS: Observou-se redução na dor e na incapacidade motora em pacientes que completaram todas as etapas do programa de tratamento. A intensidade da dor medida pela EAV apresentou as seguintes pontuações: basal 7 [5-8] e após tratamento 2 [0-4]; enquanto o ODI apresentou as pontuações: basal 0,34 [0,26 - 0,40], até 6 meses 0,16 [0,08 - 0,26] e após o tratamento 0,12 [0,04 - 0,21]. CONCLUSÃO: O programa de tratamento reduziu a dor e a incapacidade associadas à dor lombar e pode servir de base para novos estudos realizados para confirmar a eficácia desta intervenção.

Protocolo de avaliação para apraxia de fala adquirida / Assessment protocol for acquired apraxia of speech

RESUMO Objetivo Elaborar um protocolo de avaliação do planejamento motor da fala com estímulos fonologicamente balanceados para o português brasileiro e que contemple todas as variáveis necessárias para este diagnóstico. Método Foram realizadas três etapas: Na primeira, construíram-se listas de palavras cujo critério principal foram os padrões silábicos e acentuais. Do levantamento realizado na Etapa 1, procedeu-se à seleção dos vocábulos que compuseram a primeira versão do protocolo na Etapa 2, reunidas em duas tarefas: de repetição e de Leitura em Voz Alta (LVA). Em seguida, investigou-se a ocorrência das palavras usando a base de dados do Corpus Brasileiro (PUC-SP) - Linguateca. Na etapa 3 realizou-se a análise estatística para verificar se as listas de repetição e de LVA estavam equilibradas quanto à ocorrência das palavras. Assim, as listas foram distribuídas em quartis e foram analisadas de forma descritiva e bivariada. O nível de significância utilizado foi de 5%. Resultados Após a realização de todas as etapas, foi possível obter as palavras que compuseram as listas das tarefas de repetição e de LVA. Finalmente, foram então acrescidas ao protocolo as demais tarefas consideradas essenciais para a avaliação da apraxia como as taxas diadococinéticas e a prancha para a emissão oral espontânea. Conclusão O protocolo desenvolvido contém as tarefas consideradas padrão para a avaliação da apraxia de fala pela literatura internacional, o que torna esse instrumento importante para o diagnóstico desse distúrbio em falantes do português brasileiro.

ABSTRACT Purpose To develop an assessment protocol for speech motor planning with phonologically balanced stimuli for Brazilian Portuguese, including all necessary variables for this diagnosis. Methods Three stages were carried out: In the first, word lists were built with the main criterion being syllabic and accentual patterns. From the survey conducted in Stage 1, the words that composed the first version of the protocol lists in Stage 2 were selected, and grouped into two fundamental tasks for diagnosing acquired apraxia of speech (AOS): repetition and Reading Aloud (RA). In Stage 3, the occurrence of words was investigated using the Brazilian Corpus (PUC-SP) - Linguateca database, and a statistical analysis was performed to verify if the repetition and RA lists were balanced in terms of the occurrences. Thus, the lists were distributed in quartiles and submitted to both descriptive and bivariate analyses. A significance level of 5% (p<0.05) was adopted. Results After completion of all stages, the words that composed the lists of the repetition and RA tasks were obtained. Finally, other tasks considered essential for the assessment of AOS, such as diadochokinetic rates and the board for spontaneous oral emission, were then added to the protocol. Conclusion The developed protocol contains the tasks considered standard for the assessment of AOS according to the international literature, which makes this instrument important for diagnosing this disorder in speakers of Brazilian Portuguese.

Outcomes of topography-guided PRK/CXL in keratoconus using the NIDEK CXIII system棓Bharat Protocol� (Pilot study)

Purpose: Outcome of topography?guided excimer laser ablation in conjunction with accelerated, high?fluence cross?linking in corneal ecstatic disease using the NIDEK CXIII equipped with CATz algorithm from the FinalFit software棓Bharat Protocol.� Methods: Retrospective case record review of 30 eyes of 17 patients of stage 1?3 keratoconus who underwent the procedure was performed. Data collected were for visual acuity, distortion?induced eye pain, and keratometry. Pachymetry, lower order and higher order aberrations, spherical aberrations, and topographic cylinder were documented from by Scheimpflug imaging (Pentacam 70700: Oculus, Wetzlar, Germany). Results: At a minimum follow?up of 6 months (range 6.2� months), there was significant improvement in UCVA (P < 0.00001), BCVA (P = 0.0061), decrease in Kmax (P = 0.0349), Ksteep (P < 0.0411), Kflat (P = 0.0099), and pachymetry (P = 0.0001). Significant improvement was also seen in distortion?induced eye pain (27/30 to 2/30; P < 0.00001). A more than two?line improvement in UCVA and BCVA was seen in 23/30 and 17/30 cases, respectively. Ectasia was stabilized in all cases at the last follow?up, and no complications were seen. Conclusions: The 揃harat� Protocol to arrest keratectasia progression and improve corneal regularity is a safe and efficacious alternative as a keratoconus management option. This is the first such study on Nidek Platform for the same.

Impact of Telemedicine use on clinical care indicators of pediatric intensive care units: protocol for a cluster randomized clinical trial / Impacto do uso da Telemedicina nos indicadores clínicos assistenciais de unidades de terapia intensiva pediátricas: protocolo para um ensaio clínico randomizado em cluster

ABSTRACT The objective of this study is to present the protocol of a cluster randomized clinical trial to be conducted through the TeleICU project - Qualification of Intensive Care by Telemedicine. The study will consist of a cluster randomized clinical trial, open label, in pediatric intensive care units, with an allocation ratio of 1:1, to compare the intervention group (support of Telemedicine for patients admitted to the pediatric intensive care unit) with a control group (pediatric intensive care unit usual care). The study proposed to select 16 pediatric intensive care units, including 100 participants per site, with a total of 1,600 participants. The intervention group will receive telerounds from Monday to Friday and will have specialists and continuing education activities available. The primary outcome measure will be the length of stay in the pediatric intensive care unit, defined as the difference between the date of discharge of the participant and the date of admission to the intensive care unit. The secondary outcomes will be mortality rate, invasive mechanical ventilation-free days, days using antibiotics, days using vasoactive drugs and days using sedoanalgesia. This study will be conducted in accordance with Resolution 466/12 of the National Health Council, with approval by the Research Ethics Committee of the institutions involved. The present study has the potential to reproduce studies on Telemedicine in intensive care and may make important contributions to care in intensive care units in Brazil and other settings. If Telemedicine shows positive clinical care results compared to conventional treatment, more pediatric patients may benefit. ClinicalTrials.gov registry: NCT05260710

RESUMO O objetivo deste estudo será apresentar o protocolo de um ensaio clínico randomizado em cluster a ser realizado por meio do projeto TeleUTI - Qualificação da Assistência em Terapia Intensiva por Telemedicina. O estudo consistirá em um ensaio clínico randomizado por cluster, open label, em unidades de terapia intensiva pediátricas, com proporção de alocação de 1:1, com o intuito de comparar o grupo de intervenção (apoio da telemedicina para os pacientes internados na unidade de terapia intensiva pediátrica) com um grupo controle (cuidados habituais da unidade de terapia intensiva pediátrica). O estudo se propõe a selecionar 16 unidades de terapia intensiva pediátricas, incluindo 100 participantes por local, com o total de 1.600 participantes. O grupo intervenção receberá telerounds de segunda-feira a sexta-feira e terá à disposição especialistas e atividades de educação continuada. O desfecho primário a ser avaliado será o tempo de permanência nas unidades de terapia intensiva pediátricas, definido pela diferença entre a data de alta do participante com a data de admissão na unidade de terapia intensiva. Os desfechos secundários serão: taxa de mortalidade; dias livres de ventilação mecânica, dias de uso de antibióticos, dias de uso de drogas vasoativas e dias de uso de sedoanalgesia. Este estudo será conduzido em conformidade com a resolução 466/12 do Conselho Nacional de Saúde, com aprovação pelo Comitê de Ética em Pesquisa das instituições hospitalares envolvidas. O trabalho tem o potencial de reproduzir estudos sobre Telemedicina em cuidados intensivos, podendo trazer contribuições importantes ao atendimento em unidades de terapia intensiva no Brasil e em outras realidades. Se a Telemedicina mostrar resultados clínicos assistenciais positivos em relação ao tratamento convencional, mais pacientes pediátricos poderão ser beneficiados. Registro ClinicalTrials.gov: NCT05260710

Predictors of Mortality and Functional recovery after severe traumatic brain injury: protocol for a prospective cohort study

Introduction: traumatic brain injury is a global public health problem due to its severity and high rates of morbimortality worldwide. Identifying predictors associated with increased mortality and unfavorable functional outcomes after the traumatic brain injury event is crucial for minimizing morbidity and mortality rates. Therefore, this study aims to establish a protocol to investigate the predictors of mortality and functional recovery after severe traumatic brain injury in Brazil.Methods: The study will include all patients admitted for severe traumatic brain injury (Glasgow Coma Scale ≤ 8) at the State Hospital of Urgency and Emergency, which is the referral trauma hospital of Espirito Santo. The outcomes of interest are hospital mortality and functional recovery 24 months after hospital discharge. Subjects will be followed up at seventy-two hours, three months, six months, twelve months, and twenty-four months after the trauma. Morbidity will be determined by assessing: 1) the level of motor and cognitive disability, 2) functional impairment and quality of life, and 3) aspects of rehabilitation treatment. Additionally, the traumatic brain injury load, estimated by the years of life lost, will be calculated. Discussion: the results of this study will help identify variables that can predict morbidity and mortality, as well as diagnostic and therapeutic targets for patients with severe traumatic brain injury. Furthermore, the findings will have practical implications for: 1) the development of public policies, 2) investments in hospital infrastructure 3) understanding the socioeconomic impact of functional loss in the individuals.Study registration: the study received approval from the Ethics Committee of the Federal University of Espirito Santo under protocol number 4.222.002 on August 18, 2020.

Introdução: traumatismo cranioencefálico é um problema global de saúde pública devido à sua gravidade e altas taxas de morbimortalidade em todo o mundo. Identificar preditores associados ao aumento da mortalidade e desfechos funcionais desfavoráveis após o evento do traumatismo craniencefálico é primordial para minimizar as taxas de morbidade e mortalidade. Portanto, este estudo tem como objetivo estabelecer um protocolo para investigar os preditores de mortalidade e recuperação funcional após traumatismo cranioencefálico grave no Brasil. Métodos: este estudo tem como objetivo investigar os preditores de mortalidade e recuperação funcional em pacientes com traumatismo cranioencefálico, além de fornecer uma visão geral do traumatismo cranioencefálico no estado do Espírito Santo. O estudo abrangerá todos os pacientes internados por traumatismo cranioencefálico grave (Escala de Coma de Glasgow ≤ 8) no Hospital Estadual de Urgência e Emergência, o hospital de referência para traumas no Espírito Santo. Os desfechos de interesse incluem mortalidade hospitalar e recuperação funcional após 24 meses da alta hospitalar. Os participantes serão acompanhados em setenta e duas horas, três meses, seis meses, doze meses e vinte e quatro meses após o trauma. A morbidade será determinada pela avaliação de: 1) nível de incapacidade motora e cognitiva, 2) comprometimento funcional e qualidade de vida, e 3) aspectos do tratamento e reabilitação. Além disso, a carga de traumatismo cranioencefálico, estimada em anos de vida perdidos, será calculada. Discussão: os resultados deste estudo ajudarão a identificar variáveis que podem predizer a morbidade e a mortalidade após traumatismo cranioencefálico grave. Além disso, as descobertas terão implicações práticas para: 1) o desenvolvimento de políticas públicas, 2) investimentos em infraestrutura hospitalar e 3) compreensão do impacto socioeconômico da perda funcional nesses indivíduos. Registro do estudo: o estudo recebeu aprovação do Comitê de Ética da Universidade Federal do Espírito Santo sob o número de protocolo 4.222.002 em 18 de agosto de 2020

Photobiomodulation efficacy of major salivary glands in children with caries activity: study protocol for randomized, double-blind, placebo-controlled, parallel-group clinical trial / Efeito da fotobiomodulação das principais glândulas salivares em crianças com actividade de cárie: ensaio clínico aleatório duplo-cego

Background: Dental caries is one of the most prevalent diseases among children worldwide. Saliva plays a significant role in the demineralization/remineralization of the dental surface. Several salivary characteristics, such as flow rate, pH, and buffering capacity, provide relevant information regarding the development of carious lesions. Photobiomodulation has shown promising results in improving salivary flow rate and buffer capacity in the adult population. Purpose: of this trial was to evaluate the efficacy of photobiomodulation of the major salivary glands on salivary parameters in children with caries. Methods: This protocol details a randomized, double-blind, parallel-group, controlled trial that evaluated salivary parameters through photobiomodulation in children. Fifty 6- to 12-year-old participants will be randomly divided into two groups:1) photobiomodulation experimental group (G1) (n=25) and 2) photobiomodulation placebo group (G2) (n=25). Infrared light will be applied at 16 intra-and extraoral points and placebo, respectively. Unstimulated salivary samples will be collected before and immediately after application once a week for three consecutive weeks. Salivary samples will be analyzed for their flow rate, pH, and buffering capacity. The primary outcomes are the differences in salivary flow rates between G1 and G2. The secondary outcomes are differences in salivary pH and buffering capacity between G1 and G2. Discussion: The results of this clinical trial will offer evidence for the efficacy of photobiomodulation in salivary parameters and to support decision-making regarding non-invasive treatments to control dental caries.

Contexto: A cárie dentária é uma das doenças mais prevalentes entre as crianças em todo o mundo. A saliva desempenha um papel significativo na desmineralização/remineralização da superfície dentária. Várias características salivares, como a taxa de fluxo, o pH e a capacidade de tamponamento, fornecem informações relevantes sobre o desenvolvimento de lesões de cárie. A fotobiomodulação demonstrou resultados promissores na melhoria da taxa de fluxo salivar e da capacidade de tamponamento na população adulta. Objetivo: deste estudo foi avaliar a eficácia da fotobiomodulação das glândulas salivares principais sobre os parâmetros salivares em crianças com cárie. Métodos: Este protocolo detalha um estudo randomizado, duplo-cego, de grupos paralelos e controlado que avaliou parâmetros salivares por meio da fotobiomodulação em crianças. Cinquenta participantes de 6 a 12 anos de idade serão divididos aleatoriamente em dois grupos: 1) grupo experimental de fotobiomodulação (G1) (n=25) e 2) grupo placebo de fotobiomodulação (G2) (n=25). A luz infravermelha será aplicada em 16 pontos intra e extraorais e o placebo, respectivamente. Amostras salivares não estimuladas serão coletadas antes e imediatamente após a aplicação, uma vez por semana, durante três semanas consecutivas. As amostras salivares serão analisadas quanto à sua taxa de fluxo, pH e capacidade de tamponamento. Os resultados primários são as diferenças nas taxas de fluxo salivar entre G1 e G2. Os resultados secundários são as diferenças no pH salivar e na capacidade de tamponamento entre G1 e G2. Discussão: Os resultados desse ensaio clínico oferecerão evidências da eficácia da fotobiomodulação nos parâmetros salivares e apoiarão a tomada de decisões em relação a tratamentos não invasivos para o controle da cárie dentária.

Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Management of Diabetic Macular Edema Through Ayurveda: A Single Case Study

Diabetic macular edema is one of the leading causes of visual acuity loss in people with diabetes. It produces blurry vision, particularly in the centre of the vision field, floaters and black spots in front of the eyes etc. The treatment recommended by modern science is laser photocoagulation and anti-VEGF injection, which is pricey and does not ensure visual reversal in the patient. In Ayurveda text, diabetic retinopathy and diabetic macular edema are not directly described but etiopathogenesis of eye diseases and Prameha gives an idea of possible correlation between these two diseases. So, DME resembles Timira (Pramehajanya). In Ayurveda, Timira has been explained in detail by our Acharyas. Clinical manifestations of Timira are Vihwal Drishti (blurred vision), Makshika Mashaka Kesha Jaala Pashyati (floaters), Tamasa Darshanam (Scotoma- black spots in front of eyes) and Nasa Akshi Yuktani Vipritani Vikshate (Metamorphopsia or distorted vision) which has similarity with features of DME. Material & Methods: In the present study, a female patient aged 51 years, visited the Shalakya Tantra OPD of National Institute of Ayurveda, Jaipur, with complaining of Blurriness of vision since 6 months and uncontrolled blood sugar level. Result: Blood sugar level was controlled and saw reduction in subjective and objective parameters. Discussion: Following an Ayurvedic drugs and routine will assist to slow the advancement of the condition, prevent further diabetes complications, and improve quality of life.

Research on Logic Design of Proton Treatment Control System / 中国医疗器械杂志

The proton treatment control system is the supporting software of the proton therapy device, which specifically coordinates and controls the status and work of each subsystem. In this study, the software architecture and hardware implementation of the proton treatment control system was developed and built a foundation for the overall debugging. Using C# programming language and WPF programming techniques, TCP network communication protocol specified by the proton treatment technical document and MVVM pattern in Windows system, the logic design and implementation of each level were studied. Meanwhile, the communication interface between the subsystems under TCP communication protocol was agreed. The logic design and research of the setup field and treatment field were carried out. And the User Interface was designed and developed using the above technology. The program realizes the communication and interaction between the proton treatment control system and each subsystem, so as to control and monitor the whole treatment process. The proton treatment control system provides a software basis for the remote overall debugging and on-line monitor and control of proton treatment device.

Effectiveness of Self-directed Virtual Learning on Retention of Cardiopulmonary Resuscitation Knowledge and Skills among Hospital Nurses in North-western Nigeria: Protocol Paper

@#Introduction: The instructor-led CPR training method has been used for over 4 decades. However, nurses’ knowledge and skills are still low. Instructor-led CPR training is an extremely capital-intensive programme that requires more time, workforce, and space, thus serving as an impediment to effective learning among the prospective nurses’ trainees. Self-directed training method is suggested to improve the knowledge and skills of CPR among healthcare practitioners due to the low cost and flexibility. This study aims to evaluate the effectiveness of self-directed method in improving nurses’ knowledge and skill retention from baseline to post-test, one, three-, and six months. Method: A two-arm double-blinded randomised controlled trial will be conducted in two referral hospitals. The control group training consists of a one-day session taught by AHA-certified instructors, whereas the intervention group training entails participants learning on computers in a simulation lab for seven days. A generalised estimated equation model will be used for statistical analysis. Discussion: Through the self-directed training method, participants will have significantly better knowledge and skills of CPR compared to the conversational training method across the time points. Self-directed training method is a simple, cost-effective and flexible method, which can facilitate the training of more nurses in the acquisition and retention of knowledge and skills, especially for those who prefer to learn at their own pace. Trial Registration: Registration Code: UDUTH/NHREC/30/012/2019 and NHREC/28/01/2020/AKTH/EC/2934

Validação de um protocolo de teleconsulta pré-operatória de enfermagem em hernioplastia e colecistectomia / Validation of a preoperative nursing teleconsultation protocol for hernioplasty and cholecystectomy

Objetivo: Validar um protocolo de teleconsulta pré-operatória de enfermagem em hernioplastia e colecistectomia. Método: Estudo metodológico realizado em um hospital filantrópico localizado em Rio Branco, Acre. Participaram dez enfermeiros especialistas em assistência perioperatória. A validação ocorreu no período de agosto a outubro de 2021. O protocolo do estudo foi fundamentado na revisão de escopo do Instituto Joanna Briggs (JBI) e nos diagnósticos e nas intervenções de enfermagem de ansiedade e o risco de recuperação cirúrgica retardada. Os dados foram analisados pelo índice de validade de conteúdo, adotando o valor maior ou igual a 0,8 na análise global. Resultados: Os enfermeiros validaram o conteúdo proposto, atestando sua abrangência, clareza e relevância em todos os itens, com altos índices de validade de conteúdo globais maiores que 0,95. Conclusão: O protocolo construído foi validado por especialistas, sendo evidenciadas sua abrangência, clareza e relevância de sua tecnologia didática instrucional para aplicabilidade clínica no período pré-operatório

Objective: To validate a preoperative nursing teleconsultation protocol for hernioplasty and cholecystectomy. Method: This is a methodological study carried out at a philanthropic hospital located in the city of Rio Branco, state of Acre, Brazil. Ten nurses specialized in perioperative care participated in the study. The validation took place from August to October 2021. The study protocol was based on the scoping review by the Joanna Briggs Institute ( JBI) and on nursing diagnoses and interventions for anxiety and the risk of delayed surgical recovery. Data were analyzed using the content validity index, adopting a value greater than or equal to 0.8 in the overall analysis. Results: The nurses validated the proposed content, attesting to its comprehensive-ness, clarity, and relevance in all items, with high overall content validity indices greater than 0.95. Conclusions: The developed protocol was validated by experts, showing the comprehensiveness, clarity, and relevance of its instructional didactic technology for clinical applicability in the preoperative period

Osteonecrosis of the jaws in patients under osteoporosis treatment: a nine-year experience report

ABSTRACT Objective: This study aimed to report the experience of medication-related osteonecrosis of the jaws (MRONJ) in osteoporotic patients for nine years, and their associated initiating factors. Materials and methods: The numbers of invasive oral procedures (IOP) (tooth extraction, dental implant placement, and periodontal procedures) and removable prostheses performed from January 2012 to January 2021 were obtained from the digital records of a large public dental center. There were an estimated 6,742 procedures performed in patients under osteoporosis treatment. Results: Two cases (0.03%) of MRONJ were registered in nine years amongst patients with osteoporosis who had dental treatment at the center. From the 1,568 tooth extractions, one patient (0.06%) developed MRONJ. There was also one case from the 2,139 removable prostheses delivered (0.05%). Conclusions: The prevalence of MRONJ associated with osteoporosis treatment was very low. The protocols adopted seem to be adequate for the prevention of this complication. The findings of this study reinforce the rare frequency of MRONJ associated with dental procedures in patients submitted to the pharmacological management of osteoporosis. An integral analysis of systemic risk factors and oral preventive strategies may be considered regularly in the dental treatment of these patients.

Class III treatment with mini-implants anchorage in young adult patients: short and long-term results

ABSTRACT Introduction: Class III malocclusion should be intercepted and treated at early age, to prevent the necessity of future complex and expensive procedures. The orthopedic facemask therapy has the goal to achieve skeletal changes, minimizing side effects on dentition. The use of skeletal anchorage, combined with Alternate Rapid Maxillary Expansion and Constriction (Alt-RAMEC) protocol, may be effective in treating a greater number of growing Class III patients. Objective: To summarize the existing evidence-based literature on Class III malocclusion treatment in young adult patients, and to illustrate its application and effectiveness, by presenting an emblematic case report. Conclusion: The resolution of the present case, its long-term follow up, along with the studies conducted on a larger sample, demonstrate the effectiveness of the strategic combination of orthopedic and orthodontic treatments by using an hybrid rapid palatal expander and Alt-RAMEC protocol for treating Class III malocclusions in adult patients.

RESUMO Introdução: A má oclusão de Classe III deve ser interceptada e tratada em idade precoce, a fim de evitar uma futura necessidade de procedimentos complexos e invasivos. O tratamento com máscara facial ortopédica tem o objetivo de obter alterações esqueléticas, minimizando os efeitos colaterais na dentição. O uso de ancoragem óssea em mini-implantes, associada ao protocolo Alt-RAMEC (Alternate Rapid Maxillary Expansion and Constriction) pode ser eficaz no tratamento de um grande número de pacientes Classe III em crescimento. Objetivo: Realizar uma síntese da literatura baseada em evidência sobre o tratamento da má oclusão de Classe III em pacientes adultos jovens, e ilustrar sua aplicação e eficácia por meio do relato de um caso emblemático. Conclusão: A resolução e o acompanhamento em longo prazo do caso apresentado, juntamente com estudos conduzidos em uma amostra maior, demonstram a eficácia da combinação estratégica dos tratamentos ortopédico e ortodôntico usando um expansor palatal híbrido e o protocolo Alt-RAMEC para corrigir a má oclusão de Classe III em pacientes adultos.

Effect of radiotherapy on the differentiation and osteogenic activity of mesenchymal stem cells on dental implants / Efeito da radioterapia na diferenciação e atividade osteogênica de células-tronco mesenquimais em implantes dentários

Objective: to evaluate the differentiation and gene expression of transcripts related to osteogenesis in a primary culture of Mesenchymal Stem Cells (MSCs) derived from rat femurs submitted to radiotherapy and the installation of pure titanium implants. Material and Methods: fifty-four rats received titanium implants in both femurs and were divided into three groups: Control: implant surgery (C); Implant + immediate irradiation (IrI), and Implant + late irradiation (IrL). Euthanasia occurred 3, 14, and 49 days after surgery. The bone marrow MSCs from the femurs were isolated and cultivated. The cell viability, total protein content, alkaline phosphatase (ALP) activity, and the formation of mineralization nodules and cellular genotoxicity were analyzed. The gene expression of Alkaline Phosphatase (phoA), Collagen 1 (COL1), Runt-related transcription factor 2 (RUNX2), Osterix (OSX), Osteopontin (OPN), Integrin ß1(ITGB1), Bone Sialoprotein (BSP), Osteonectin (SPARC), Osteocalcin (Bglap), Transforming Growth Factor ß-type (TGF-ß), Granulocyte Macrophage Colony Stimulating Factor (GM-CSF), Interleukin-6 (IL-6), Apolipoprotein E (APOE) and Prostaglandin E2 synthase (PGE2) were evaluated by qRT- PCR. Results: ionizing radiation suppresses the gene expression of essential transcripts for bone regeneration, as well as cellular viability, as observed in the IrI and IrL groups. Conclusion: although this can lead to the loss of osseointegration and failure of the implant, the MSCs showed more activity at 49 days than at 3 and 14 days. (AU)

Objetivo: avaliar a diferenciação e expressão gênica de transcritos relacionados à osteogênese em cultura primária de MSCs derivadas de fêmures de ratos submetidos à radioterapia e instalação de implantes de titânio puro. Material e Métodos: cinquenta e quatro ratos receberam implantes de titânio em ambos os fêmures e foram divididos em três grupos: Controle: cirurgia de implante (C); Implante + irradiação imediata (IrI) e Implante + irradiação tardia (IrL). A eutanásia ocorreu 3, 14 e 49 dias após a cirurgia. As MSCs de medula óssea dos fêmures foram isoladas e cultivadas. Foram analisadas a viabilidade celular, teor de proteína total, atividade da fosfatase alcalina (ALP), formação de nódulos de mineralização e genotoxicidade celular. A expressão gênica de Fosfatase Alcalina (phoA), Colágeno 1 (COL1), fator de transcrição relacionado a Runt 2 (RUNX2), Osterix (OSX), Osteopontina (OPN), Integrina ß1 (ITGB1), Sialoproteína Óssea (BSP), Osteonectina (SPARC), Osteocalcina (Bglap), Fator de Crescimento Transformador tipo ß (TGF-ß), Fator Estimulante de Colônia de Granulócitos-Macrófagos (GM-CSF), Interleucina-6 (IL-6), Apolipoproteína E (APOE) e Prostaglandina E2 sintase (PGE2) foram avaliados por qRT-PCR. Resultados: a radiação ionizante suprime a expressão gênica de transcritos essenciais para a regeneração óssea, bem como a viabilidade celular, como observado nos grupos IrI e IrL. Conclusão:embora isso possa levar à perda da osseointegração e falha do implante, as MSCs apresentaram maior atividade aos 49 dias do que aos 3 e 14 dias (AU)