Comparison of Clinical and Pathological Staging in Patients with Head and Neck Cancer After Neck Dissection

Abstract Introduction Clinical and pathological staging plays an important role on the prognosis of head and neck cancer (HNC) patients. Objective The present study aims to compare clinical and pathological T, N and overall staging in patients with HNC, to identify factors associated with these discrepancies, and to analyze and compare survival or disease-free survival in staging disagreements. Methods Retrospective cohort including every patient submitted to neck dissection from January 2010 to December 2020 in the department of Otorhinolaryngology of a tertiary hospital center. Results A total of 79 patients were analyzed; their mean age was 58.52 ± 13.15 years old and 88.9% were male. Assessing overall staging, discrepancies were noted in 53% (36.4% upstaging and 16.6% downstaging) and were significantly associated with clinical overall staging (p = 0.006). Regarding T staging, differences were noted in 45.5% (30.3% upstaging and 15.2% downstaging) and were significantly associated with imaging modality (p = 0.016), clinical T staging (p = 0.049), and histology (p = 0.017). Discrepancies in N staging were noted in 38% (25.3% upstaging and 12.7% downstaging) and were significantly associated with age (p = 0.013), clinical N staging (p < 0.001), and presence of extranodal invasion (p < 0.001). Both in Overall, T, and N staging, the aforementioned disagreements were not associated with either higher mortality or higher disease relapse. Conclusion Overall, T, and N staging disagree in an important number of cases, and the overall stage can disagree in up to 53% of the cases. These disagreements do not seem to influence overall and disease-free survival.

Tendência temporal de mortalidade por câncer de cabeça e pescoço no Brasil entre os anos de 2000 e 2020 / Temporal trend of mortality from head and neck cancer in Brazil between 2000 and 2020 / Tendencia temporal en la mortalidad de la cabeza y el cáncer de cuello en Brasil entre 2000 y 2020

Analisar a tendência temporal de mortalidade por câncer de cabeça e pescoço no Brasil e em suas regiões geográficas entre os anos de 2000 a 2020. Métodos: Foram analisados os números de óbitos por neoplasias malignas de cabeça e pescoço (CID-10: C00-C14; C30-C32) disponibilizados no portal oficial do Ministério da Saúde do Brasil para o período, bem como os dados sobre população residente. O padrão temporal e geográfico foi analisado através da taxa de mortalidade padronizada por idade (TMPI) e avaliado em modelo de regressão por pontos de inflexão. Resultados: No Brasil, a TMPI permaneceu estável independente do sexo (AAPC: -0,3; IC95: -1,0-0,3) no período avaliado. O estudo das regiões brasileiras evidenciou crescimento médio da TMPI independente do sexo nas regiões Nordeste (AAPC: 2,8; IC95: 2,1-3,5) e Norte (AAPC: 1,3; IC95: 0,8-1,9), em oposição ao decréscimo anual médio no Sul (AAPC: -1,4; IC95: -2,7--0,3) e no Sudeste (AAPC: -1,5; IC95: -1,9--1,1). No Centro-Oeste, a TMPI também apresentou decréscimo anual médio no grupo feminino (AAPC: -1,8; IC95: -2,8--0,8), embora tenha permanecido estável no grupo masculino e independente do sexo. Considerações finais: A compreensão desses dados pode auxiliar o estudo e implementação de estratégias de enfrentamento para esse grupo de doenças de acordo com as necessidades específicas de cada grupo e região.

To analyze the temporal trend of mortality from head and neck cancer in Brazil and its geographical regions between the years 2000 to 2020. Methods: We analyzed the number of deaths due to malignant neoplasms of the head and neck (ICD- 10: C00-C14; C30-C32) available on the official portal of the Brazilian Ministry of Health for the period, as well as the data on resident population. The temporal and geographical pattern was analyzed using the standardized mortality rate by age (TMPI) and evaluated in an inflection point regression model. Results: In Brazil, TMPI remained stable independent of gender (AAPC: -0.3; IC95: -1.0-0.3) in the evaluated period. The study of the Brazilian regions showed average growth of the TMPI independent of sex in the Northeast (AAPC: 2.8; 95 CI: 2.1-3.5) and North (AAPC: 1.3; 95 CI: 0.8-1.9) regions, as opposed to the average annual decrease in the South (AAPC: -1.4; 95 CI: -2.7-0.3) and in the Southeast (AAPC: -1.5; 95 CI: -1.9-1.1). In the Midwest, the TMPI also showed an average annual decrease in the female group (AAPC: -1.8; IC95: -2.8­0.8), although it remained stable in the male group and independent of the sex. Final Considerations: Understanding this data can assist in the study and implementation of coping strategies for this group of diseases according to the specific needs of each group and region.

Análisis de la tendencia temporal de la mortalidad por cáncer de cabeza y cuello en Brasil y sus regiones geográficas entre los años 2000 y 2020. Métodos: Se analizó el número de muertes por neoplasias malignas de cabeza y cuello (CID-10: C00- C14; C30-C32), que se publicó en el portal oficial del Ministerio de Salud del Brasil para el período, así como en los datos sobre la población residente. El patrón temporal y geográfico se analizó a través de la tasa de mortalidad estandarizada por edad (TMPI) y se evaluó como modelo de regresión por puntos de inflexión. Resultados: En el Brasil, la TMPI se mantuvo estable, independiente del género (AAPC: -0,3; IC95: -1,0-0,3) en el período evaluado. El estudio de las regiones brasileñas mostró un crecimiento medio de la TMPI independiente de género en el noreste (APC: 2,8; IC95: 2,1-3,5) y en el norte (AAPC: 1,3; IC95: 0,8-1,9), frente a la disminución media anual en el sur (AAPC: -1,4; CI95: -2,7­0,3) y en el sudeste (AAPC: -1,5; IC95: -1,9-1,1). En el Medio Oeste, el IPM también mostró una disminución promedio anual en el grupo femenino (AAPC: -1,8; IC95: -2,8-0,8), aunque se mantuvo estable en el grupo independiente masculino y de género. Consideraciones finales: la comprensión de estos datos puede ayudar a estudiar y aplicar estrategias para tratar este grupo de enfermedades de acuerdo con las necesidades específicas de cada grupo y región.

Accuracy of elastography in the assessment of reduction in liver steatosis and fibrosis in the early postoperative period after bariatric surgery / Acuidade da elastografia na avaliação da redução da esteatose e fibrose hepáticas no pós-operatório precoce pós cirurgia bariátrica

ABSTRACT BACKGROUND: Nonalcoholic hepatic steatosis is found in most obese patients and has a strong association with metabolic syndrome. The Roux-en-Y gastric bypass and the sleeve gastrectomy are the two techniques of bariatric surgery. Patients who underwent bariatric surgery have regression of nonalcoholic steatohepatitis due to a reduction in body mass index and changes in incretin hormones. AIMS: This study aimed to analyze the acuity of elastography in the regression of hepatic steatosis and fibrosis in obese patients undergoing Roux-en-Y gastric bypass and sleeve gastrectomy 2 months after surgery. METHODS: Patients in the preoperative period of bariatric surgery underwent an anthropometric evaluation and hepatic elastography to quantify fibrosis and hepatic steatosis. Two months after surgery, the same evaluation was performed again. RESULTS: All 17 patients who met the inclusion criteria participated in the study. Out of this, nine underwent sleeve gastrectomy, and eight underwent Roux-en-Y gastric bypass. The Roux-en-Y gastric bypass group had lower fibrosis levels postoperatively compared to preoperatively (p=0.029, p<0.05). As for steatosis, patients who underwent Roux-en-Y gastric bypass had lower postoperative values (p=0.01, p<0.05). There was also a reduction in fibrosis postoperatively in the sleeve gastrectomy group compared to preoperatively (p=0.037, p<0.05). CONCLUSIONS: Elastography accurately demonstrated decreased hepatic steatosis and fibrosis in the early postoperative period of bariatric surgery. Moreover, Roux-en-Y gastric bypass and sleeve gastrectomy are suitable surgical methods to improve hepatic steatosis and fibrosis within 2 months postoperatively.

RESUMO RACIONAL: A esteatose hepática não alcoólica é encontrada na maioria dos pacientes com obesidade e tem forte associação com a síndrome metabólica. O bypass gástrico em Y de Roux e a gastrectomia vertical são as duas técnicas de cirurgia bariátrica. Pacientes que são submetidos a cirurgia bariátrica tem regressão da esteatose hepática não alcoólica devido a redução do índice de massa corpórea e mudanças dos hormônios incretínicos. OBJETIVOS: analisar a acuidade da elastografia na regressão da esteatose e fibrose hepáticas em pacientes obesos submetidos a bypass gástrico em Y de Roux e gastrectomia vertical dois meses após a cirurgia. MÉTODOS: Pacientes em pré-operatório de cirurgia bariátrica foram submetidos a avaliação antropométrica e elastografia hepática para quantificação de fibrose e esteatose hepática. Dois meses após a cirurgia, a mesma avaliação foi realizada novamente. RESULTADOS: Dezessete pacientes preencheram todos os critérios de inclusão no estudo. Nove foram submetidos a gastrectomia vertical e 8 a bypass gástrico em Y de Roux. O grupo bypass gástrico em Y de Roux apresentou níveis de fibrose mais baixos no pós-operatório em comparação com o pré-operatório, (p=0,029, p<0,05). Quanto à esteatose, os pacientes que realizaram bypass gástrico em Y de Roux apresentaram valores menores no pós-operatório (p=0,01, p<0,05). No grupo gastrectomia vertical, também houve redução da fibrose no pós-operatório em relação ao pré-operatório (p=0,037, p<0,05). CONCLUSÕES: A elastografia mostrou acuidade para demonstrar diminuição da esteatose e fibrose hepáticas, no pós-operatório precoce de cirurgia bariátrica. Além disso, bypass gástrico em Y de Roux e gastrectomia vertical são métodos cirúrgicos adequados para melhorar a esteatose e fibrose hepática em um período de 2 meses de pós-operatório.

Liaisons dangereuses: cross-border gene flow and dispersal of insecticide resistance-associated genes in the mosquito Aedes aegypti from Brazil and French Guiana

BACKGROUND In recent years, South America has suffered the burden of continuous high impact outbreaks of dengue, chikungunya and Zika. Aedes aegypti is the main mosquito vector of these arboviruses and its control is the only solution to reduce transmission. OBJECTIVES In order to improve vector control it is essential to study mosquito population genetics in order to better estimate the population structures and the geneflow among them. METHODS We have analysed microsatellites and knockdown resistance (kdr) mutations from a trans-border region in Amazonia between the state of Amapá (Brazil) and French Guiana (overseas territory of France), to provide further knowledge on these issues. These two countries have followed distinct vector control policies since last century. For population genetic analyses we evaluated variability in 13 well-established microsatellites loci in Ae. aegypti from French Guiana (Saint Georges and Cayenne) and Brazil (Oiapoque and Macapá). The occurrence and frequency of kdr mutations in these same populations were accessed by TaqMan genotype assays for the sites 1016 (Val/Ile) and 1534 (Phe/Cys). FINDINGS We have detected high levels of gene flow between the closest cross-border samples of Saint-Georges and Oiapoque. These results suggest one common origin of re-colonisation for the populations of French Guiana and Oiapoque in Brazil, and a different source for Macapá, more similar to the other northern Brazilian populations. Genotyping of the kdr mutations revealed distinct patterns for Cayenne and Macapá associated with their different insecticide use history, and an admixture zone between these two patterns in Saint Georges and Oiapoque, in accordance with population genetic results. MAIN CONCLUSIONS The present study highlights the need for regional-local vector surveillance and transnational collaboration between neighboring countries to assess the impact of implemented vector control strategies, promote timely actions and develop preparedness plans.

Solitary pancreatic renal cell carcinoma metastasis

Pancreatic metastases are rare; they account for only 2% of all pancreatic malignancies and usually occur when associated with a disseminated metastatic disease. Solitary pancreatic metastases are even less frequent, and there are few reports regarding surgical resection. We report the case of a 77-year-old female patient diagnosed with a single cephalo-pancreatic metastasis of renal cell carcinoma, 16 years after a total nephrectomy. The patient underwent successful pancreaticoduodenectomy, and the diagnosis was confirmed. A subsequent positron emission tomography (PET) scan showed disease relapse, and tyrosine kinase inhibitor treatment with sunitinib was initiated. After 1 year and 4 months, the PET-computed tomography scan showed a complete radiologic response.

Hemoptysis and endometriosis: An unusual association - case report and review of the literature / Hemoptise e endometriose: uma associação não usual - relato de caso e revisão da literatura

Abstract Thoracic endometriosis syndrome is a rare condition that includes four entities: catamenial pneumothorax, catamenial hemothorax, catamenial hemoptysis and lung nodules. We describe the case of a 23-year-old woman with complaints of hemoptysis during menstrual period in the two years prior to the appointment. Initially, a treatment for tuberculosis was established with no success. Further investigation showed a 4 mmnodule in the right lung, and the transvaginal ultrasonography indicated the presence of deep endometriosis. Considering the occurrence of symptoms only during menses, an empirical therapy was instituted with remission of the complaints.

Resumo A síndrome da endometriose torácica é uma condição rara que inclui quatro entidades: pneumotórax catamenial, hemotórax catamenial, hemoptise catamenial e nódulos pulmonares. Descrevemos o caso de umamulher de 23 anos de idade comqueixas de hemoptise durante o período menstrual por 2 anos. Inicialmente, um tratamento para a tuberculose foi estabelecido sem sucesso. Uma investigação adicional mostrou um nódulo de 4 mm no pulmão direito, e a ultrassonografia transvaginal indicou a presença de endometriose profunda. Considerando a ocorrência de sintomas somente durante a menstruação, uma terapia empírica foi instituída com remissão das queixas.

Actinomycosis, a lurking threat: a report of 11 cases and literature review

Abstract Actinomycosis remains characteristically uncommon, but is still an important cause of morbidity. Its clinical presentation is usually indolent and chronic as slow growing masses that can evolve into fistulae, and for that reason are frequently underdiagnosed. Actinomyces spp is often disregarded clinically and is classified as a colonizing microorganism. In this review of literature, we concomitantly present 11 cases of actinomycosis with different localizations, diagnosed at a tertiary hospital between 2009 and 2016. We outline the findings of at least one factor of immunosuppression in > 90% of the reported cases.

Avaliação de fatores de risco e prevalência da hipertensão arterial sistêmica entre os acadêmicos do primeiro e oitavo períodos da Faculdade de Medicina de Barbacena / Risk factor assessment and prevalence of hypertension among academics of the first and eighth periods of the Medical School of Barbacena

Objetivo: Determinar a prevalência e os fatores de risco para hipertensão arterial em acadêmicos do primeiro e oitavo períodos da Faculdade de Medicina de Barbacena. Metodologia: Foram utilizados questionários e aferição de pressão arterial para obtenção dos resultados. Valores maiores ou iguais a 140 mmHg para a pressão sistólica e/ou 90 mmHg para a pressão diastólica em pelo menos duas aferições realizadas em momentos diferentes foram considerados como risco do desenvolvimento da HA. Nos questionários foram obtidas informações sociodemográficas e acerca dos fatores de risco para a doença estudada. Resultados: A amostra foi constituída de 110 estudantes, dos quais 80 aceitaram participar da pesquisa. As variáveis relacionadas com o risco do desenvolvimento da HA foram: ICQ (índice cintura quadril), PAD (pressão arterial diastólica), tabagismo e etilismo. Conclusão: A prevalência de HA e de seus fatores de risco entre os acadêmicos de Medicina foi baixa, entretanto, observou-se que os que cursavam o oitavo período tiveram maior prevalência de fatores de risco, como tabagismo e etilismo.

Objective: The aim of this study was to evaluate the prevalence of High blood pressure (HBP) and the hypertension risk factors in medical students of the first and eighth semester of Barbacena`s Medical School. Methodology: The blood pressure was measured twice in different times and values over or equal to 140 mm Hg for systolic pressure and / or 90 mmHg to diastolic blood pressure were considered as risk for the development of HBP. Besides, questionnaires for sociodemographic and risk factors were applied. Results: The sample consisted of 110 students, but only 80 agreed to participate. The variables that were directly related to the risk of developing HBP were: waist hip ratio (WHR), diastolic blood pressure (DBP), smoking and alcohol consumption. Conclusion: The present study showed low prevalence of high blood pressure and its risk factors among medical students. However, the risk factors for HBP such as alcoholic and smoke were more prevalent among medical students of the eighth semester.

Impact of Cleft Lip and Palate on Oral Health-Related Quality of Life (OHRQOL) in Brazilian Patients

Objective: To evaluate self-esteem, satisfaction with facial aesthetics and the impact of oral health on the quality of life of patients with cleft lip and palate aged from 12 years treated at the Hospital for Rehabilitation of Craniofacial Anomalies (HRAC), Brazil. Material and Methods: A cross-sectional study was conducted with patients (n=94) with cleft lip and palate, aged 12 years and older, treated at the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo, Brazil. The instruments used in this study were: Rosenberg's Self-Esteem Scale, the Oral Health Impact Profile-14 (OHIP), and a visual analogue scale of self-perceived facial aesthetics were applied, and socioeconomic and contextual data were collected from all patients. The statistical analysis included Poisson regression with robust variance (RR ­ rate ratio) and it was performed to evaluate the association between predictors and the outcome oral health related-quality of life. Results: Worse OHRQoL was reported by female patients (RR 1.21; 95%CI: 1.09-1.35) and older individuals (RR 1.25; 95%CI:1.13- 1.39). Conclusion: The presence of cleft lip and palate has a negative impact on OHRQoL. Females and older individuals reported worse qualify of life.

Interrelationship between implant and orthognathic surgery for the rehabilitation of edentulous cleft palate patients: a case report

A 43-year-old woman with a unilateral cleft lip and palate, presenting a totally edentulous maxilla and mandible with marked maxillomandibular discrepancy, attended the Prosthodontics section of the Hospital for Rehabilitation of Craniofacial Anomalies, University of São Paulo for treatment. She could not close her mouth and was dissatisfied with her complete dentures. Treatment planning comprised placement of six implants in the maxilla, four in the mandible followed by prostheses installation and orthognathic surgery. The mandibular full arch prosthesis guided the occlusion for orthognathic positioning of the maxilla. The maxillary complete prosthesis was designed to assist the orthognathic surgery with a provisional prosthesis (no metal framework), allowing reverse treatment planning. Maxillary and mandibular realignment was performed. Three months later, a relapse in the position of the maxilla was observed, which was offset with a new maxillary prosthesis. This isa complex interdisciplinary treatment and two-year follow-up is presented and discussed. It should be considered that this type of treatment could also be applied in non-cleft patients.

Angiofibroma celular paratesticular: relato de caso / Paratesticular cellular angiofibroma: a case report

OBJETIVO: relatar um caso de angiofibroma celular paratesticular de paciente submetido à terapêutica cirúrgicaeletiva. Método: relato de caso ocorrido em um hospital público no ano de 2012. Relato de caso: paciente de 71anos com queixa de massa testicular com aumento de volume há 5 anos associado a disúria e noctúria (3x/noite).Considerações finais: paciente com angiofibroma celular paratesticular submetido a tratamento cirúrgico eletivocom exérese de tumor.

OBJECTIVE: report a case of paratesticular cellular angiofibroma of patient undergoing elective surgical therapy.Method: case report occurred in a public hospital in the year 2012. Case Report: man, 71 years old, complainingof testicular mass with increased volume for 5 years associated with dysuria and nocturia (3x/night). Conclusion:patient with paratesticular cellular angiofibroma undergoing elective surgery with excision of tumor.

Tumor estromal gastrointestinal de intestino delgado: relato de caso / Gastrointestinal stromal tumor of small bowel: a case report

Objetivo: relatar um caso de tumor estromal gastrointestinal (GIST) de intestino delgado em um paciente residente no município de Mocajuba-PA, ano de 2012. Método: as informações foram obtidas através de revisão do prontuário, en-trevista com o paciente, registro fotográfico dos métodos diagnósticos e procedimentos cirúrgicos, aos quais o paciente foi submetido e revisão da literatura. Considerações Finais: o caso relatado contraposto com a literatura acerca da doença em questão, mostra a escassez de sintomas de um paciente com GIST e a necessidade de tratamento precoce.

Objective: report a case of gastrointestinal stromal tumor of small bowel of a lender in the city of Mocajuba-PA in2012. Methodology: the necessary data was obtained by medical chart review, interview with the patient, photographicregister of the image diagnose exams and surgical procedures that were performed and literature review. Final con-siderations: this case opposed to the literature on the disease in question shows a lack of symptoms of a patient withGIST and the need for early treatment.

Suprapubic laparoscopic cholecystectomy: technique and preliminary results / Colecistectomia laparoscopica suprapubica: tecnica e resultados preliminares

Background : The minimally invasive abdominal surgery has evolved to reduce portals, culminating with a single incision and natural orifice operation. However, these methods are still expensive, difficult to implement and with questionable aesthetic results. Aim : To present the standardization and preliminary results of a technique for performing laparoscopic suprapubic access by the principle which was called the Supra Pubic Endoscopic Surgery for cholecystectomy. Method : The average body mass index of patients, the mean operative time, clinical data of the postoperative complications and quality of life were prospectively studied. The operation incisions consisted of: A) umbilical for instrumental dissection and clipping; B) in the right groin for handling and gallbladder gripping; C) suprapubic for the camera. With the patient in reverse Trendelenburg and left lateral decubitus, the operation flew by the camera trocar in C, proceeding with dissection and isolation of the biliary pedicle, identification of cystic duct and artery, with usual instrumentation. Transcystic intraoperative cholangiography was performed in all cases in which there were indications. The procedure was completed with clipping and sectioning of the cystic duct and artery, retrograde resection of the gallbladder and extracting it by the umbilical trocar incision under direct vision. Results : Thirty patients undergone this surgical procedure between March and June 2012 and were evaluated. The mean age was 40.7 years and the indications were typical biliary colic in 18 cases (60 %), cholecystitis in five cases (16.6 %), biliary pancreatitis in one case (3.3%); polyp in three cases (10%) and obstructive jaundice at three cases (10%). The average body mass index was 27.8 (23.1-35.1) and surgical time ranged between 24 and 70 minutes. Conclusion : The technique proved to be feasible and safe , with no significant complications, and satisfactory cosmetic results. .

Racional: A cirurgia minimamente invasiva abdominal tem evoluído para redução dos portais, culminando com a por incisão única e a operação por orifícios naturais. Porém, estes métodos ainda são dispendiosos, de difícil execução e com resultados estéticos questionáveis. Objetivo : Apresentar a padronização e os resultados preliminares de uma técnica para realização de colecistectomia por acesso suprapúbico pelo princípio que foi chamado de Supra-Pubic Endoscopic Surgery para colecistectomia . Método: Foram pesquisados prospectivamente o índice de massa corporal médio dos pacientes, a média do tempo operatório e os dados clínicos do pós-operatório com vistas às complicações e qualidade de vida. A operação consistiu de incisão: A) umbilical para o instrumental de dissecção e clipagem; B) na região inguinal direita para manipulação e preensão da vesícula biliar; C) suprapúbica para a câmera. Com o paciente em proclive e decúbito lateral esquerdo, a operação transcorria com a câmera no trocarte C. Procedia-se a dissecção e isolamento do pedículo biliar, identificação de ducto e artéria císticas, utilizando instrumental habitual. Colangiografia transoperatória transcística era realizada em todos os casos em que havia indicação. O procedimento era concluído com a clipagem e secção do ducto e artéria cística, ressecção retrógrada da vesícula biliar e extração dela pelo trocarte na incisão umbilical, sob visão direta. Resultados : Foram avaliados 30 pacientes submetidos a esta modalidade cirúrgica entre março e junho de 2012. A média de idade foi de 40,7 anos ...

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) - Part 5: Institutional outcomes assessment and the role of the Laboratory of Physiology

The Laboratory of Physiology provides support for the diagnosis of functional disorders associated with cleft lip and palate and also conducts studies to assess, objectively, the institutional outcomes, as recommended by the World Health Organization. The Laboratory is conceptually divided into three units, namely the Unit for Upper Airway Studies, Unit for Stomatognathic System Studies and the Unit for Sleep Studies, which aims at analyzing the impact of different surgical and dental procedures on the upper airways, stomatognathic system and the quality of sleep of individuals with cleft lip and palate. This paper describes the main goals of the Laboratory in the assessment of procedures which constitute the basis of the rehabilitation of cleft lip and palate, i.e., Plastic Surgery, Orthodontics and Maxillofacial Surgery and Speech Pathology.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies/USP (HRAC/USP) Part 4: Oral Rehabilitation

Treatment of patients with cleft lip and palate is completed with fixed prostheses, removable, total, implants and aims to restore aesthetics, phonetics and function and should be guided by the basic principles of oral rehabilitation, such as physiology, stability, aesthetics, hygiene and the expectations of the patient. In order to obtain longevity of a prosthetic rehabilitation, the periodontal and dental tissue as well as the biomechanics of the prosthesis are to be respected. The purpose of this article is to describe the types of prosthetics treatment, which are performed at HRAC/USP for the rehabilitation of cleft area in adult patients.

Aedes aegypti on Madeira Island (Portugal): genetic variation of a recently introduced dengue vector

The increasing population of Aedes aegypti mosquitoes on Madeira Island (Portugal) resulted in the first autochthonous dengue outbreak, which occurred in October 2012. Our study establishes the first genetic evaluation based on the mitochondrial DNA (mtDNA) genes [cytochrome oxidase subunit I (COI) and NADH dehydrogenase subunit 4 (ND4)] and knockdown resistance ( kdr ) mutations exploring the colonisation history and the genetic diversity of this insular vector population. We included mosquito populations from Brazil and Venezuela in the analysis as putative geographic sources. The Ae. aegypti population from Madeira showed extremely low mtDNA genetic variability, with a single haplotype for COI and ND4. We also detected the presence of two important kdr mutations and the quasi-fixation of one of these mutations (F1534C). These results are consistent with a unique recent founder event that occurred on the island of Ae. aegypti mosquitoes that carry kdr mutations associated with insecticide resistance. Finally, we also report the presence of the F1534C kdr mutation in the Brazil and Venezuela populations. To our knowledge, this is the first time this mutation has been found in South American Ae. aegypti mosquitoes. Given the present risk of Ae. aegypti re-invading continental Europe from Madeira and the recent dengue outbreaks on the island, this information is important to plan surveillance and control measures.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - part 3: Oral and Maxillofacial Surgery

This paper presents the treatment protocol of maxillofacial surgery in the rehabilitation process of cleft lip and palate patients adopted at HRAC-USP. Maxillofacial surgeons are responsible for the accomplishment of two main procedures, alveolar bone graft surgery and orthognathic surgery. The primary objective of alveolar bone graft is to provide bone tissue for the cleft site and then allow orthodontic movements for the establishment of an an adequate occlusion. When performed before the eruption of the maxillary permanent canine, it presents high rates of success. Orthognathic surgery aims at correcting maxillomandibular discrepancies, especially anteroposterior maxillary deficiencies, commonly observed in cleft lip and palate patients, for the achievement of a functional occlusion combined with a balanced face.

Dor nas unidades de internação de um hospital universitário / Pain management at inpatient wards of a university hospital / Dolor en las unidades de ingreso de un hospital universitario

JUSTIFICATIVA E OBJETIVOS: Estudo exploratório-descritivo, transversal, com objetivo de determinar a prevalência, caracterização, localização, mensuração e discussão de medidas farmacológicas analgésicas em dor aguda em cinco unidades de internação de um hospital universitário. MÉTODO: Participaram 856 sujeitos, dos quais 272 com dor no momento. As informações relacionadas à dor foram obtidas através de entrevista estruturada junto ao leito. Usou-se a escala numérica de dor e diagrama corporal. RESULTADOS: A analgesia foi verificada no prontuário. A prevalência geral de dor foi de 31,8%, sendo intensa em 44,2% e a média de 6,6 na escala numérica de dor. O motivo principal foi traumatismo, o local mais frequente, o abdômen. O analgésico mais usado foi a dipirona em 76,1%, com/sem associação. Opioide forte foi prescrito em 4,4%. Para 27,5% não houve melhoria. CONCLUSÃO: Conclui-se que a dor é de alta prevalência, pouco avaliada, subtratada, com uso incorreto de analgésicos.

BACKGROUND AND OBJECTIVES: This is an exploratory, descriptive and transversal study aiming to determine the prevalence, characterization, location, and measurement and discuss pharmacological analgesic measures for acute pain management in five inpatient wards of a university hospital. METHOD: We enrolled 856 subjects in the study, of whom 272 were in pain at the time. Information related to pain was obtained using a bedside structured interview. Numeric pain scale and body diagram were used. RESULTS: Analgesia was assessed through medical records. The overall prevalence of pain was 31.8%, with severe pain in 44.2% and mean of 6.6 on numeric pain scale. The main reason was trauma and the most common site the abdomen. The most widely used analgesic was dipyrone (76.1%) with/without combination. Strong opioid was prescribed to 4.4%. For 27.5% there was no improvement. CONCLUSION: We conclude that pain is highly prevalent, poorly evaluated, undertreated, with inappropriate use of analgesics.

JUSTIFICATIVA Y OBJETIVOS: Estudio exploratorio, descriptivo y transversal, con el objetivo de determinar la prevalencia, la caracterización, la ubicación, la mensuración y la discusión de las medidas farmacológicas analgésicas en dolor agudo, en cinco unidades de ingreso de un hospital universitario. MÉTODO: Participaron 856 sujetos, de los cuales 272 tenían dolor en ese momento. Las informaciones relacionadas con el dolor se obtuvieron por medio de una entrevista estructurada con el paciente y junto a la cama de hospital. Se usó la escala numérica de dolor y el diagrama corporal. RESULTADOS: La analgesia fue verificada en la historia clínica del paciente. La prevalencia general de dolor fue de un 31,8% siendo intensa en un 44,2% y con un promedio de 6,6 en la escala numérica de dolor. El motivo principal fue el traumatismo y la región más frecuente fue el abdomen. El analgésico más usado fue la dipirona en un 76,1%, con/sin asociación. Se prescribió opioide fuerte en un 4,4%. Para el 27,5% no se registró mejoría. CONCLUSIONES: Llegamos a la conclusión de que el dolor es de alta prevalencia, poco evaluado, mal tratado, y con el uso incorrecto de analgésicos.

Rehabilitative treatment of cleft lip and palate: experience of the Hospital for Rehabilitation of Craniofacial Anomalies - USP (HRAC-USP) - Part 2: Pediatric Dentistry and Orthodontics

The aim of this article is to present the pediatric dentistry and orthodontic treatment protocol of rehabilitation of cleft lip and palate patients performed at the Hospital for Rehabilitation of Craniofacial Anomalies - University of São Paulo (HRAC-USP). Pediatric dentistry provides oral health information and should be able to follow the child with cleft lip and palate since the first months of life until establishment of the mixed dentition, craniofacial growth and dentition development. Orthodontic intervention starts in the mixed dentition, at 8-9 years of age, for preparing the maxillary arch for secondary bone graft procedure (SBGP). At this stage, rapid maxillary expansion is performed and a fixed palatal retainer is delivered before SBGP. When the permanent dentition is completed, comprehensive orthodontic treatment is initiated aiming tooth alignment and space closure. Maxillary permanent canines are commonly moved mesially in order to substitute absent maxillary lateral incisors. Patients with complete cleft lip and palate and poor midface growth will require orthognatic surgery for reaching adequate anteroposterior interarch relationship and good facial esthetics.