Temporal validation of the MMCD score to predict kidney replacement therapy and in-hospital mortality in COVID-19 patients.

BACKGROUND: Acute kidney injury has been described as a common complication in patients hospitalized with COVID-19, which may lead to the need for kidney replacement therapy (KRT) in its most severe forms. Our group developed and validated the MMCD score in Brazilian COVID-19 patients to predict KRT, which showed excellent performance using data from 2020. This study aimed to validate the MMCD score in a large cohort of patients hospitalized with COVID-19 in a different pandemic phase and assess its performance to predict in-hospital mortality. METHODS: This study is part of the "Brazilian COVID-19 Registry", a retrospective observational cohort of consecutive patients hospitalized for laboratory-confirmed COVID-19 in 25 Brazilian hospitals between March 2021 and August 2022. The primary outcome was KRT during hospitalization and the secondary was in-hospital mortality. We also searched literature for other prediction models for KRT, to assess the results in our database. Performance was assessed using area under the receiving operator characteristic curve (AUROC) and the Brier score. RESULTS: A total of 9422 patients were included, 53.8% were men, with a median age of 59 (IQR 48-70) years old. The incidence of KRT was 8.8% and in-hospital mortality was 18.1%. The MMCD score had excellent discrimination and overall performance to predict KRT (AUROC: 0.916 [95% CI 0.909-0.924]; Brier score = 0.057). Despite the excellent discrimination and overall performance (AUROC: 0.922 [95% CI 0.914-0.929]; Brier score = 0.100), the calibration was not satisfactory concerning in-hospital mortality. A random forest model was applied in the database, with inferior performance to predict KRT requirement (AUROC: 0.71 [95% CI 0.69-0.73]). CONCLUSION: The MMCD score is not appropriate for in-hospital mortality but demonstrates an excellent predictive ability to predict KRT in COVID-19 patients. The instrument is low cost, objective, fast and accurate, and can contribute to supporting clinical decisions in the efficient allocation of assistance resources in patients with COVID-19.

Potential and limitations of machine meta-learning (ensemble) methods for predicting COVID-19 mortality in a large inhospital Brazilian dataset.

The majority of early prediction scores and methods to predict COVID-19 mortality are bound by methodological flaws and technological limitations (e.g., the use of a single prediction model). Our aim is to provide a thorough comparative study that tackles those methodological issues, considering multiple techniques to build mortality prediction models, including modern machine learning (neural) algorithms and traditional statistical techniques, as well as meta-learning (ensemble) approaches. This study used a dataset from a multicenter cohort of 10,897 adult Brazilian COVID-19 patients, admitted from March/2020 to November/2021, including patients [median age 60 (interquartile range 48-71), 46% women]. We also proposed new original population-based meta-features that have not been devised in the literature. Stacking has shown to achieve the best results reported in the literature for the death prediction task, improving over previous state-of-the-art by more than 46% in Recall for predicting death, with AUROC 0.826 and MacroF1 of 65.4%. The newly proposed meta-features were highly discriminative of death, but fell short in producing large improvements in final prediction performance, demonstrating that we are possibly on the limits of the prediction capabilities that can be achieved with the current set of ML techniques and (meta-)features. Finally, we investigated how the trained models perform on different hospitals, showing that there are indeed large differences in classifier performance between different hospitals, further making the case that errors are produced by factors that cannot be modeled with the current predictors.

Stroke Outcome Measurements From Electronic Medical Records: Cross-sectional Study on the Effectiveness of Neural and Nonneural Classifiers.

BACKGROUND: With the rapid adoption of electronic medical records (EMRs), there is an ever-increasing opportunity to collect data and extract knowledge from EMRs to support patient-centered stroke management. OBJECTIVE: This study aims to compare the effectiveness of state-of-the-art automatic text classification methods in classifying data to support the prediction of clinical patient outcomes and the extraction of patient characteristics from EMRs. METHODS: Our study addressed the computational problems of information extraction and automatic text classification. We identified essential tasks to be considered in an ischemic stroke value-based program. The 30 selected tasks were classified (manually labeled by specialists) according to the following value agenda: tier 1 (achieved health care status), tier 2 (recovery process), care related (clinical management and risk scores), and baseline characteristics. The analyzed data set was retrospectively extracted from the EMRs of patients with stroke from a private Brazilian hospital between 2018 and 2019. A total of 44,206 sentences from free-text medical records in Portuguese were used to train and develop 10 supervised computational machine learning methods, including state-of-the-art neural and nonneural methods, along with ontological rules. As an experimental protocol, we used a 5-fold cross-validation procedure repeated 6 times, along with subject-wise sampling. A heatmap was used to display comparative result analyses according to the best algorithmic effectiveness (F1 score), supported by statistical significance tests. A feature importance analysis was conducted to provide insights into the results. RESULTS: The top-performing models were support vector machines trained with lexical and semantic textual features, showing the importance of dealing with noise in EMR textual representations. The support vector machine models produced statistically superior results in 71% (17/24) of tasks, with an F1 score >80% regarding care-related tasks (patient treatment location, fall risk, thrombolytic therapy, and pressure ulcer risk), the process of recovery (ability to feed orally or ambulate and communicate), health care status achieved (mortality), and baseline characteristics (diabetes, obesity, dyslipidemia, and smoking status). Neural methods were largely outperformed by more traditional nonneural methods, given the characteristics of the data set. Ontological rules were also effective in tasks such as baseline characteristics (alcoholism, atrial fibrillation, and coronary artery disease) and the Rankin scale. The complementarity in effectiveness among models suggests that a combination of models could enhance the results and cover more tasks in the future. CONCLUSIONS: Advances in information technology capacity are essential for scalability and agility in measuring health status outcomes. This study allowed us to measure effectiveness and identify opportunities for automating the classification of outcomes of specific tasks related to clinical conditions of stroke victims, and thus ultimately assess the possibility of proactively using these machine learning techniques in real-world situations.

Practical considerations in the use of a porcine model (Sus scrofa domesticus) to assess prevention of postoperative peritubal adhesions.

Infertility has been a common postoperative problem caused by peritoneal adhesions. Since several prophylactic agents have recently shown promising preliminary results, more complete studies comparing their real efficacy and safety are needed urgently. The aim of this study was to investigate and describe practical considerations of a porcine model that can be used to assess such prophylactic agents. First, 10 healthy 5½ months old female pigs (24.3-31.3 Kg) underwent a standardized laparoscopy to provoke peritubal adhesion formation without prophylactic agents. After 30 days, a second-look laparoscopy was performed to evaluate adhesions and perform adnexectomy for histopathological evaluation. Adhesions at different sites were classified by grade, for which the scores range from 0 (no adhesion) to 3 (very strong vascularized adhesions), and also by area, with scores ranging from 0 (no adhesion) to 4 (>75% of the injured area). The histopathological evaluation of the distal uterine horns, oviducts and ovaries were compared withthose from a control group of six healthy pigs with no previous surgery. Biological samples were collected to assess vitality, inflammation and renal, hepatic and hematopoietic systems. There were small (but significant) changes in serum albumin (P = 0.07), globulin (P = 0.07), C-reactive protein (P = 0.011), fibrinogen (P = 0.023) and bilirubin (P<0.01) after 30 days, but all values were within the normal range. No inflammation or abscess formation was observed, but different degrees of adhesion were identified. The estimated occurrence of adhesion (scores >0) and of strong / very strong adhesion (scores >1) was 75% (95% CI: 55-94.9) and 65% (95% CI: 45-85), respectively. The porcine model represents a useful animal platform that can be used to test the efficacy and safety of candidate prophylactic agents intended to prevent postoperative peritubal adhesions formation. We present several practical considerations and measures that can help to minimize animal suffering and avoid problems during such experiments.

Safe neoadjuvant trastuzumab-based treatment in HER2 + inflammatory early breast cancer in a glucose 6-phosphate dehydrogenase-deficient postmenopausal woman: A case report and review of the literature.

INTRODUCTION: Glucose 6-phosphate dehydrogenase (G6PD) is a basic antioxidant pathway for erythrocytes, being its deficiency the most common gene mutation worldwide. As breast cancer is one of the most frequent tumors, many of these patients may present with G6PD deficiency prior treatment without notice. CASE REPORT: We present the case of a woman deficient for G6PD with the diagnosis of Stage IIIB (cT4d cN1 cM0) HER2-enriched early breast cancer. MANAGEMENT AND OUTCOME: The patient underwent neoadjuvance with trastuzumab and anthracycline-free chemotherapy, based on docetaxel (75 mg/m2, 120 mg) and carboplatin (AUC 5, 560 mg). She did not present hemolytic crisis and no blood transfusions were needed. She achieved a good pathologic response and completed one-year adjuvant trastuzumab without incidences. DISCUSSION: Although the role of HER2 and trastuzumab in oxidative stress is not yet completely understood, we suggest that trastuzumab may be a suitable agent for treatment in patients with HER2-enriched breast cancer in a non-oxidative chemotherapy scheme, with acceptable responses and no triggering hemolytic crisis.

MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese.

BACKGROUND: Childhood obesity is associated with increased risk of atherosclerosis and cardiovascular disease in adulthood. Increased intima-media thickness (IMT) of the carotid artery is linked to the initiation and progression of the chronic inflammatory processes implicated in cardiovascular disease. Matrix metalloproteinase-9 (MMP-9) plays an important role in the degradation of the extracellular matrix and, consequently, in the development, morphogenesis, repair and remodeling of connective tissues. OBJECTIVES: (i) to determine and compare the concentrations of MMP-9, tissue inhibitor of metalloproteinase -1 (TIMP-1), and MMP-9/TIMP-1 ratio in obese and non-obese children and adolescents; (ii) to investigate the association of these markers with common and internal IMT of carotid arteries. METHODS: Cross-sectional study involving 32 obese and 32 non-obese (control) individuals between 8 - 18 years of age. RESULTS: Significantly (p < 0.05) higher values of MMP-9 concentration, as well as a higher MMP-9/TIMP-1 ratio were detected in the obese group compared to control counterparts. Common and internal carotid IMT values were significantly higher (p < 0.001) in the obese group compared to the control group. Positive correlations were observed between the common carotid IMT values and MMP-9 concentrations as well as MMP-9/TIMP-1 ratio. CONCLUSIONS: Our data demonstrate that obese children and adolescents present higher mean IMT values, plasma MMP-9 and MMP-9/TIMP-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.

MMP-9 Levels and IMT of Carotid Arteries are Elevated in Obese Children and Adolescents Compared to Non-Obese / Níveis de MMP-9 e EIMC mostram-se Elevados em Crianças e Adolescentes Obesos em Comparação a Não Obesos

Abstract Background: Childhood obesity is associated with increased risk of atherosclerosis and cardiovascular disease in adulthood. Increased intima-media thickness (IMT) of the carotid artery is linked to the initiation and progression of the chronic inflammatory processes implicated in cardiovascular disease. Matrix metalloproteinase-9 (MMP-9) plays an important role in the degradation of the extracellular matrix and, consequently, in the development, morphogenesis, repair and remodeling of connective tissues. Objectives: (i) to determine and compare the concentrations of MMP-9, tissue inhibitor of metalloproteinase -1 (TIMP-1), and MMP-9/TIMP-1 ratio in obese and non-obese children and adolescents; (ii) to investigate the association of these markers with common and internal IMT of carotid arteries. Methods: Cross-sectional study involving 32 obese and 32 non-obese (control) individuals between 8 - 18 years of age. Results: Significantly (p < 0.05) higher values of MMP-9 concentration, as well as a higher MMP-9/TIMP-1 ratio were detected in the obese group compared to control counterparts. Common and internal carotid IMT values were significantly higher (p < 0.001) in the obese group compared to the control group. Positive correlations were observed between the common carotid IMT values and MMP-9 concentrations as well as MMP-9/TIMP-1 ratio. Conclusions: Our data demonstrate that obese children and adolescents present higher mean IMT values, plasma MMP-9 and MMP-9/TIMP-1 ratio compared to the non-obese. Thus, these findings indicate that this group presents a risk profile for early atherosclerosis.

Resumo Fundamento: A obesidade infantil está associada a um aumento do risco de aterosclerose e doenças cardiovasculares na fase adulta. O aumento da espessura da íntima-média carotídea (EIMC) está associado ao início e progresso do processo inflamatório crônico envolvido em doenças cardiovasculares. A metaloproteinase-9 da matriz (MMP-9) tem um papel importante na degradação da matriz extracelular e, consequentemente, no desenvolvimento, morfogênese, reparação e remodelação de tecidos conjuntivos. Objetivos: (i) determinar e comparar as concentrações de MMP-9, inibidor de tecido de metaloproteinase-1 (TIMP-1) e a razão MMP-9/TIMP-1 em crianças e adolescente obesos e não obesos; (ii) investigar a associação desses marcadores com a EIM das carótidas interna e comum. Métodos: Estudo transversal com 32 indivíduos obesos e 32 não obesos (controle) entre 8 e 18 anos de idade. Resultados: Foram detectados valores significativamente mais altos (p < 0,05) de concentrações de MMP-9 e da razão MMP-9/TIMP-1 no grupo de obesos em comparação ao grupo de não obesos. Valores de EIM das carótidas comum e interna mostraram-se significativamente mais altos (p < 0,001) no grupo de obesos em comparação ao grupo controle. Correlações positivas foram observadas entre os valores de EIM da carótida comum e concentrações de MMP-9 e razão MMP-9/TIMP-1. Conclusões: Nossos dados demonstram que crianças e adolescente obesos apresentam valores médios mais altos de EIMC, MMP-9 plasmática e da razão MMP-9/TIMP-1 em comparação aos não obesos. Portanto, esses achados indicam que esse grupo apresenta maior risco de aterosclerose precoce.

Kissing molars extraction: Case series and review of the literature.

UNLABELLED: Kissing molars are a very rare form of inclusion defined as molars included in the same quadrant, with occlusal surfaces contacting each other within a single dental follicle. We present four cases of this pathology: a 35 year-old male, referred to the Oral and Maxillofacial Surgery Department of the Hospital Virgen del Rocio in Seville, and three females of 24, 26, and 31 years, all of which had kissing molars that were treated by tooth extraction. We have found only 10 cases published in the medical literature in which this type of inclusion is briefly described, none of which elaborate on the surgical technique employed. In these cases, the indication for surgery is established when there is a history of recurring infections or cystic lesions associated with dental inclusions. The extraction of kissing molars requires an exhaustive comprehension of the anatomy of the region involved, sufficiently developed surgical abilities, and an extensive planning process. KEY WORDS: Impacted molar, kissing molar, surgical extraction.

Metástase extensa para o seio maxilar como primeira manifestação de carcinoma tireoidiano / Extensive metastasis to the maxillary sinus as the first manifestation of thyroid carcinoma

Introdução: A incidência do câncer de tireoide vem crescendo de maneira considerável, sendo o sexo feminino mais acometido. O carcinoma da tireoide pode ser classificado em bem diferenciado, pouco diferenciado, medular e anaplásico. Metástases em seio maxilar raramente são encontradas, com um número reduzido de casos na literatura. Relato do caso: Paciente do sexo feminino, 78 anos, sem queixas iniciais, trazida ao ambulatório de Cirurgia de Cabeça e Pescoço do Hospital Estadual Mario Covas por familiares, que notaram, há dois meses, protrusão de olho esquerdo associada à diminuição da acuidade visual do mesmo. Ao exame físico se notou uma tireoide cinco vezes aumentada, endurecida, heterogênea e aparentemente multinodular; assimetria de hemiface esquerda com parestesia; e proptose de órbita esquerda. O tratamento da paciente consistiu em tireoidectomia total e radioterapia adjuvante. Paciente foi a óbito no 29º pós-operatório por pneumonia nosocomial e edema agudo de pulmão. Conclusões: Paciente possuía carcinoma pouco diferenciado de tireoide, uma variante incomum de câncer tireoidiano, com metástase rara para seio maxilar. Trata-se de uma manifestação agressiva do carcinoma tireoidiano, resultando em prognóstico ruim e taxa de mortalidade alta.

Identifying predictors of unacceptable pain at office hysteroscopy.

STUDY OBJECTIVE: To identify predictors of unacceptable pain during office hysteroscopy without anesthesia. DESIGN: Prospective observational study (Canadian Task Force classification II-2). SETTING: Teaching hospital. PATIENTS: Five hundred fifty-eight women aged 17 to 73 years. INTERVENTION: Elective office hysteroscopy without anesthesia. MEASUREMENTS AND MAIN RESULTS: Pain intensity was assessed via a verbal rating scale (VRS, 0-10). Pain was considered unacceptable when severe during the procedure (VRS ≥7) or moderate to severe at discharge (VRS ≥4). After preliminary statistical analysis, factors including diabetes, age ≤50 years, previous curettage, dyspareunia, severe dysmenorrhea, and hysteroscopist experience were selected to compose 2 binary multivariate models to predict unacceptable pain. As expected, hysteroscopist experience was protective against unacceptable pain during office hysteroscopy (p = .03; adjusted odds ratio [OR], 0.63; 95% confidence interval [CI], 41-96) and also at discharge (p = .002; adjusted OR, 0.48; 95% CI, 30-77). Severe dysmenorrhea was a significant risk factor for pain (cramps) at discharge (p < .001; adjusted OR, 3.07; 95% CI, 1.97-4.78). CONCLUSION: Women with severe dysmenorrhea will benefit from preemptive analgesia regardless of hysteroscopist level of experience because this condition significantly increased the occurrence of unacceptable cramps at discharge.

Acesso transoral-cervical para tratamento cirúrgico de tumores localmente avançados da orofaringe (?operação tipo pull-through?): técnica cirúrgica e experiência inicial com quatro casos / The transoral-transcervical approach for surgical treatment of selected locally advanced oropharyngeal tumors (the pull-through oropharyngectomy): surgical technique and initial experience with four cases

Introdução: Sem o acesso à tecnologia robótica (TORS), a qualainda não está disponível de maneira disseminada, é difícil realizara ressecção oncologicamente segura de lesões avançadas daorofaringe com a manutenção da integridade do arco mandibular.Assim, os acessos transmandibulares, com mandibulotomia emandibulectomia, permanecem como opções válidas para ressecçãodesses tumores. Em duas publicações recentes, foi retomado o usode um acesso combinado transoral-transcervical descrito em 1998,que possibilita a manutenção da integridade mandibular durante asressecções da orofaringe. A descrição deste acesso, assim como aapresentação de nossa experiência inicial com a técnica, motivou arealização do presente estudo. Delineamento: Estudo prospectivo.Método: Foram incluídos inicialmente quatro pacientes portadoresde carcinoma epidermoide da orofaringe localmente avançados(T3 e T4a), sendo três da loja tonsilar e um da base da língua,passíveis de serem operados conforme a técnica a seguir descrita.Técnica cirúrgica: após realização de esvaziamento cervical, otumor é incialmente acessado por via transoral, sendo realizadaa ressecção de suas porções superior, medial e lateral. Estecorresponde ao tempo oral da ressecção que pode ser realizada ounão com o auxílio de cheek flap inferior. No tempo cervical, realizaseo acesso aos espaços parafaríngeo e mastigatório após secçãodo ventre posterior do músculo digástrico e músculo estilohióideo.O músculo pterigóideo medial é desinserido do ângulo interno damandíbula. A artéria carótida interna e o nervo hipoglosso sãodissecados, a fim de permitir sua visualização durante a ressecçãodo tumor. Após estas manobras, é possível o deslocamento doproduto da ressecção transoral para o pescoço, realizando, comsegurança o término da ressecção através de um pull-throughlateral. O fechamento dá-se por sutura primária ou, rotação deretalhos locais ou regionais conforme o defeito. Resultados:Todas as lesões foram ressecadas com margens cirúrgicassatisfatórias comprovadas por anatomopatológico. Nenhumpaciente apresentou complicações maiores. Todos os pacientesforam decanulados precocemente e foram capazes de se alimentarexclusivamente por via oral em menos de 2 meses após a cirurgia.Conclusão: O acesso ?tipo pull-though? é uma alternativa válida para ressecção de tumores avançados selecionados da orofaringe,particularmente os localizados na loja tonsilar e base de língua.Em virtude das dificuldades de acesso à tecnologia robótica emnosso meio, esta técnica mostra-se promissora para o tratamentocirúrgico destas lesões, sem as complicações associadas aosacessos transmandibulares.

Detection of paramyxoviruses in Magellanic penguins (Spheniscus magellanicus) on the Brazilian tropical coast.

Aquatic migratory birds are a major vectors by which influenza viruses and paramyxoviruses are spread in nature. Magellanic penguins (Spheniscus magellanicus) are usually present on the southern shores of South America and can swim as far as the southern coast of Brazil in winter. In 2008, however, several Magellanic penguins were observed on the northeastern coast of Brazil. Paramyxoviruses were isolated from Magellanic penguins on the Espírito Santo state coast, approximately 4000 km from their breeding colonies, although influenza viruses were not detected. Among the paramyxoviruses, five Avulavirus isolates belonging to serotype APMV-2 and the serotype APMV-10, which was proposed by Miller et al. (2010), were identified. These results highlight the risks associated with the spread of paramyxoviruses between natural to non-natural habitats by birds exhibiting unusual migration patterns, and they document for the first time the presence of the APMV-2 and APMV-10 serotypes on penguins in Brazil. The local avifauna may become infected with these viruses through close contact between migratory and resident birds. Continued surveillance of virus incidence in these migratory populations of penguins is necessary to detect and prevent the potential risks associated with these unusual migration patterns.

Avaliação do efeito do óleo-resina de copaíba (Copaifera s) na proliferação celular in vitro / Effect of copaiba oleoresin (Copaifera sp) on the in vitro cellular proliferation

O óleo de copaíba é uma resina extraída pela perfuração do tronco de árvores do gênero Copaifera sp., usado como cicatrizante em várias regiões do Brasil. São comprovados seus efeitos antimicrobianos e antiinflamatórios, sem relatos de atividade sobre a proliferação celular. No presente trabalho foi observada a dinâmica da proliferação de células MDBK (Madin Darby Bovine Kidney) mantidas em meio de cultivo adicionado de diferentes concentrações do óleo de copaíba, utilizando-se como controle células mantidas em meio sem adição do oleoresina (grupo M) e células no meio com aplicação do solvente tween 80, na diluição 10-3 (grupo MT). Diluições decimais de 10-1 até 10-3 mostraram-se tóxicas e, portanto, os estudos de proliferação partiram da diluição 10-4 até 10-7. Observou-se que houve crescimento mais acelerado em todos os grupos adicionados do óleo-resina nas primeiras 24 horas, com destaque para a diluição 10-5, que teve sua taxa de proliferação 5,47 vezes maior que a do grupo M. Concluiu-se que o óleo-resina de copaíba se mostrou estimulante da multiplicação celular, o que pode ser um dos mecanismos de seu efeito positivo sobre a cicatrização, somado àqueles previamente comprovados na literatura.

Copaiba oleoresin is extracted from the trunk of Copaifera sp genus trees and used for treating wounds in several regions of Brazil. Its antimicrobial and anti-inflammatory effects have been proved, however there are no reports of activity on cell growth. Proliferation of MDBK (Madin Darby Bovine Kidney) cells was evaluated under the influence of different concentrations of Copaiba oleoresin. Control groups consisted of cells in medium without addition of oleoresin (M group) and cells in the medium with application of the solvent Tween 80 at dilution 10-3 (TM group). Decimal dilutions of 10-1 to 10-3 were shown to be toxic and, therefore, the proliferation studies were conducted from dilution 10-4 to 10-7. Cell growth was faster in all groups that received the Copaiba oleoresin dilutions in the first 24 hours, specially the 10-5 dilution group, which proliferation rate was 5,47 higher than that of M group. It was concluded that Copaiba oleoresin stimulates cell multiplication, which may be one mechanism of its positive effect on wound healing, in association with those previously known.

Intermediários mais usados em prótese parcial fixa implantossuportada no Centro-Oeste do Brasil / Frequency of transmucosal abutments used for implant-supported, fixed partial dentures in the west center of Brazil

Esse trabalho teve o propósito de avaliar quais intermediários estão sendo mais utilizados para a confecção de prótese parcial fixa implantossuportada no Centro-Oeste do Brasil, verificar se a seleção do intermediário era, na realidade, feita pelo cirurgião-dentista ou pelo técnico em prótese dentária e saber se houve mistura de intermediários na mesma prótese. Foram enviados questionários para 15 laboratórios de prótese dentária, mas somente sete se mostraram receptivos em aplicar os formulários e colaborar com esta pesquisa, perfazendo uma taxa de resposta de 46%. Com amostra de 81 casos estudados e 206 intermediários, foi verificado que os intermediários mais utilizados foram: microscone em 54% dos casos, estheticone em 27% dos casos, Ucla calcinável em 10% dos casos e o Ucla com ouro em 9% dos casos. Das 81 respostas recebidas sobre a escolha do intermediário, as respectivas porcentagens foram: em 56% dos casos foram os cirurgiões-dentistas que fizeram a escolha e 44% das escolhas restantes foram realizadas pelos técnicos em prótese dentária e houve mistura de intermediários em 7% dos casos.

A survey was made with dental laboratories in the west center region of Brazil using self-applied questionnaires, with the purpose to evaluate the use of transmucosal abutments for implant-supported fixed partial dentures. The data obtained in 260 clinical cases showed that the microscone-type was more prevalent (54% of cases, followed by the estheticone-type (27% of cases), Ucla-burnout type (10% of cases), and Ucla gold abutment (9% of cases). From the 81 responses, it was also verified that choices by the TPD and dental surgeons accounted for 44% and 56% of cases, respectively. Also, mixed results were found in 77% of situations.

Estudo comparativo de três métodos de diagnóstico para detecção de anticorpos anti-Theileria equi em eqüinos de áreas endêmicas do estado do Rio de Janeiro / Comparative studies of three methods for detection Theileria equi antibody in endemic areas horses from Rio de Janeiro state

Este trabalho teve o objetivo de avaliar a reação de imunofluorescência indireta (RIFI), ensaio imunoenzimático (ELISA) e a reação de fixação do complemento (RFC) no diagnóstico de Theileria equi em amostras de soro de 79 equinos na Universidade Federal Rural do Rio de Janeiro(UFRRJ), Seropédica, RJ, Brasil. Houve reação positiva para Theileria equi em 74,7, 75,9 e 60,8% das amostras testadas pela RIFI, ELISA eRFC, respectivamente. Observou-se discrepância em 16,45% (n=13) das amostras de soro testadas pelo ELISA indireto e RIFI. Quando comparado a RIFI e a RFC, a discrepância observada entre os soros testados foi de 36,70% (n=29). O teste ELISA indireto e a RFC apresentaram discordância em 37,97% (n=30) das amostras de soros. Os resultados do presente estudo sugerem que a melhor alternativa para o diagnóstico sorológico de T. equi em eqüinos portadores é aassociação dos testes de RIFI e ELISA indireto, especialmente para a realização de estudos soroepidemiológicos

This study was carried out to evaluate indirect fluorescent antibody test (IFAT), enzyme-linked immunosorbent assay (ELISA) and complement fixation test (CFT) of Theileria equi diagnosis in sera samples of 79 horses at Universidade Federal Rural do Rio de Janeiro(UFRRJ), Seropédica, RJ, Brazil were tested. Positive reaction was obtained in 74.7, 75.9 and 60.8% of samples tested by IFAT, indirect ELISA and CFT, respectively. Discrepancy was observed in 16.45%(n=13) of serum samples tested by ELISA and IFAT. While IFAT and CFT were compared, the discrepancy observed among the samples tested were 36.71% (n=29). Indirect ELISA and CFT test presented disagreement in 37.97% (n=30) of serum samples tested. Results of present study suggests that the best alternative for serological diagnosis T. equi in carriers horses is the combined use of IFAT and indirect ELISA test, especially for accomplishment of seroepidemiological studies.

O retalho músculo-cutâneo peitoral maior na reconstrução do câncer de cabeça e pescoço / The pectoralis major musculocutaneous flap in head and neck cancer reconstruction

Introdução: Descrito inicialmente por Ariyan na década de 1970, o retalho de peitoral maior tem grande aceitação nas reconstruções por câncer em cabeça e pescoço pela sua versatilidade. Ele é irrigado pela artéria toracoacromial com uma circulação adicional proveniente da artéria torácica lateral. Método e casuística: O retalho foi utilizado para a reconstrução de 104 pacientes com câncer de cabeça e pescoço, sendo: reconstrução de boca/língua (57); reconstrução do trânsito faringo-esofágico (12); reparo de perda de pele cervical (15); reconstrução de faringe (10); reparo de perda de pele de face (7); e reparo de fístula faringo-cutânea (3). Resultados: Necrose total do retalho foi observada em quatro pacientes, necrose parcial e deiscência em 22 pacientes e epidermólise em 31. Conclusão: O retalho foi funcionalmente adequado para a reconstrução de grandes defeitos cirúrgicos.

Introduction: The pectoralis major flap was initially described by Ariyan in the 1970s. It has high acceptance due to its versatility for head and neck cancer reconstruction. It is supplied by the thoracoacromial artery with additional circulation provided by the lateral thoracic artery. Methods and subjects: We performed that flap for the reconstruction of 104 patients with head and neck cancer, as following: mouth/tongue reconstruction (57); pharyngoesophageal transit reconstruction (12); repair of cervical skin loss (15); pharynx reconstruction (10); repair of facial skin loss (7); and repair of pharyngocutaneous fistula (3). Results: Total necrosis of the flap was observed in four patients, partial necrosis with dehiscence in 22 and epidermolysis in 31. Conclusions: The flap was functionally adequate for the repair of large surgical defects.

Reconstrução de resgate com retalhos pediculados pós falha reconstrutiva em câncer de cabeça e pescoço / Salvage reconstruction with pedicled flaps following the failure of flaps for head and neck cancer

Introdução: existem poucos estudos sobre falha do tratamento reconstrutivo em cirurgia de câncer em cabeça e pescoço. Métodos: foi conduzido um estudo retrospectivo de 205 pacientes que foram submetidos à reconstrução com retalho após cirurgia oncológica de cabeça e pescoço entre 1996 e 2006, dentre os quais 28 pacientes (13,6 %) tinham indicação de reconstrução de resgate por deiscência (18 pacientes) ou necrose total/parcial (10 pacientes), sendo 23 homens e cinco mulheres. Resultados: dois pacientes foram a óbito antes de qualquer tratamento reconstrutivo de resgate. Os 26 restantes foram submetidos à cirurgia de resgate com reconstrução a partir de retalho muscular deltopeitoral e peitoral maior músculo-cutâneo com taxa de sucesso de 80,7%. Conclusão: a reconstrução de resgate apresenta uma taxa de sucesso de 61,5%, enquanto a reconstrução imediatamente após ressecção oncológica obteve sucesso em 86,4%.

Introduction: there is a lack of reports about the subsequent treatment for patients in whom the reconstructive approach for head and cancer had failed. Methods: a retrospective chart review of 205 patients who had undergone flap transfer after the resection of head and neck cancer between 1990 and 2006, from whom 28 patients (13.6%) had indication of salvage reconstruction due to dehiscence (18 patients) or total/partial necrosis (10 patients), being 23 men and 5 women. Results: two patients died before any salvage reconstructive approach, and the remaining 26 patients underwent salvage reconstruction through deltopectoral flap and pectoral major musculocutaneous flap salvage reconstruction with success rate of 80.7%. Conclusion: the success rate of the salvage reconstruction was 61.5%, whereas the immediate reconstruction after the oncological resection success rate was 86.4%.

Tireoidectomia vídeo assistida: experiência de 120 casos / Video-assisted thyroidectomy: experience in 120 cases

OBJETIVO: O objetivo desse trabalho é avaliar o resultado da experiência de 120 casos operados pela mesma equipe, fazendo uso da técnica vídeo-assistida. MÉTODO: Entre setembro de 2004 e fevereiro de 2006 foram realizadas 120 tireoidectomias video-assistidas, sendo 119 em pacientes do sexo feminino e um em paciente do sexo masculino. A idade variou de 19 a 58 anos, com média de 34. O procedimento foi indicado para pacientes com suspeita de malignidade, na ausência de tireoidite, cirurgia anterior sobre a glândula tireóide ou radioterapia prévia, em glândulas com tamanho ultrassonográfico inferior a 20cc e nódulos com até 3cm de diâmetro. RESULTADOS: O tempo de operação variou entre 25 e 180 minutos, com tempo médio de 85 minutos para tireoidectomia total e 59 para parcial. O tamanho da cicatriz variou de 1,6 a 3,5cm, com média de 2,5cm. São relatadas quatro conversões. O índice de disfonia relatado foi de 5,8 por cento. Não houve nenhum caso de hipoparatireoidismo ou hematoma. Todos os pacientes receberam alta no 1° dia de pós-operatório. CONCLUSÃO: A tireoidectomia video-assistida é uma nova forma de cirurgia sobre a tireóide, com índice de complicações comparável à técnica convencional, parecendo haver vantagem no que diz respeito ao tamanho da cicatriz cirúrgica e evolução pós-operatória. Outros fatores como tempo de operação, custo e exeqüibilidade em nosso meio necessitam de maior número de casos para uma avaliação mais criteriosa.

BACKGROUND: The objective of this paper is to describe a 120 cases experience in the video-assisted technique, performed by the same surgical team. METHODS: Between september 2004 and february 2006, 120 video-assisted thyroidectomies has been performed - 119 females and 1 male. Age: 19 - 58, median 34 years. Indications: suspicion of malignancy, without any cervical surgery, radiotherapy, thyroid volume under 20 cc and nodules under 3 cm. RESULTS: Surgery time: 25 - 180, median time 85 minutes for total and 59 minutes for parcial thyroidectomy. The incision: 1,6 - 3,5cm, median 2,5cm. Four conversions to conventional technique are related. Nerve palsy was observed in 5,8 percent. There was no hypoparathyroidism or hematoma in this series. All patients were released in the first postoperative day. CONCLUSION: The video assisted approach is a safe procedure, and its complication index is similar to the conventional technique, with advantages in incision size and postoperative evolution. However, more studies are needed to confirm these findings.