Effects of dapagliflozin on blood pressure variability in patients with prediabetes and prehypertension without pharmacological treatment: a randomized trial.

AIM: The aim of the study was to evaluate the effect of dapagliflozin on blood pressure variability (BPV) in patients with prediabetes and prehypertension without pharmacological treatment. METHODS: A double-blind, randomized, placebo-controlled clinical study was performed in 30 patients (30-60 years) diagnosed with prediabetes and prehypertension. Study subjects were divided into two groups: a 10-mg dose of dapagliflozin was administered daily before breakfast for 12 weeks in 15 patients or placebo in the remaining 15 patients. At the beginning and end of the study, clinical and metabolic evaluations were performed, and the 24-h BPV was calculated. RESULTS: Dapagliflozin significantly decreased body weight (P = 0.010), BMI (P = 0.011), fasting plasma glucose (P = 0.002), glycated hemoglobin A1c (P = 0.004), office systolic blood pressure (SBP) (P = 0.001), office diastolic blood pressure (DBP) (P = 0.011), 24-h SBP (121 ± 8 vs. 117 ± 11 mmHg, P = 0.046), nighttime SBP (114 ± 11 vs. 108 ± 10 mmHg, P = 0.017), nocturnal mean arterial pressure (P = 0.043), and nocturnal hypertensive load (P = 0.015); and it significantly increased the percentage of the dipper circadian BP pattern (16.7 vs. 30.8%, P = 0.047). After the administration of dapagliflozin, some of the patients did not meet the diagnostic criteria for prediabetes (26.9%) or prehypertension (26.9%). CONCLUSIONS: The administration of 10 mg dapagliflozin once daily for 90 days in patients with prediabetes and prehypertension decreased BPV by reducing 24-h and nighttime SBP, and increasing the dipper circadian BP pattern.

Ketogenic Diet Provided During Three Months Increases KCC2 Expression but Not NKCC1 in the Rat Dentate Gyrus.

Ketogenic diet, a high fat and low carbohydrate diet, has been used as a non-pharmacological treatment in refractory epilepsy since 1920. In recent years, it has demonstrated to be effective in the treatment of numerous neurological and non-neurological diseases. Some neurological and neuropsychiatric disorders are known to be caused by gamma-aminobutyric acid (GABA)-mediated neurotransmission dysfunction. The strength and polarity of GABA-mediated neurotransmission are determined by the intracellular chloride concentration, which in turn is regulated by cation-chloride cotransporters NKCC1 and KCC2. Currently, it is unknown if the effect of ketogenic diet is due to the modulation of these cotransporters. Thus, we analyzed the effect of a ketogenic diet on the cation-chloride cotransporters expression in the dentate gyrus. We estimated the total number of NKCC1 immunoreactive (NKCC1-IR) neuronal and glial cells by stereology and determined KCC2 labeling intensity by densitometry in the molecular and granule layers as well as in the hilus of dentate gyrus of rats fed with normal or ketogenic diet for 3 months. The results indicated that ketogenic diet provided during 3 months increased KCC2 expression, but not NKCC1 in the dentate gyrus of the rat. The significant increase of KCC2 expression could explain, at least in part, the beneficial effect of ketogenic diet in the diseases where the GABAergic system is altered by increasing its inhibitory efficiency.

Tratamento da Classe III esquelética associada à mordida aberta ­ relato de caso / Treatment of skeletal Class III associated with open bite ­ case report

A Classe III esquelética, apesar de baixa prevalência na população, representa um grande desafio ao ortodontista em virtude da imprevisibilidade do padrão de crescimento da mandíbula que é determinado geneticamente. Pode ser causada por uma retrusão maxilar, protrusão mandibular ou uma combinação de ambas. Sua associação à mordida aberta esquelética constitui um desafio adicional. Entre os tratamentos preconizados para a Classe III, encontram-se a protração maxilar, a camuflagem ortodôntica e a correção orto-cirúrgica. Este trabalho objetiva apresentar um caso clínico de um paciente do sexo masculino em fase de crescimento. Foi diagnosticada Classe III esquelética por retrognatismo maxilar, hipoplasia da região zigomática, perfil facial convexo e leve padrão dolicofacial; incisivos superiores vestibularizados e incisivos inferiores levemente retruídos, mordida aberta anterior e posterior associada à postura alterada da língua. A terapia escolhida foi a disjunção com aparelho Hyrax e tração reversa da maxila com máscara de Petit, seguida de Ortodontia fixa com exodontia dos primeiros pré-molares para correção da mordida aberta; também foi utilizado arco lingual com esporões para correção da postura da língua. A oclusão normal foi obtida de acordo com os princípios funcionais e estéticos, com correção da Classe III e da mordida aberta. Houve melhora no relacionamento entre a maxila e a mandíbula sem alterações significativas no padrão vertical. A limitação facial foi plenamente aceita pelo paciente que havia recusado a opção pelo tratamento cirúrgico.(AU)

Skeletal Class III malocclusion, despite low prevalence in the population, represents a great challenge to the orthodontist due to the unpredictability of the jaw growth pattern, which is genetically determined. It can be caused by a maxillary retrusion, mandibular protrusion or a combination of both. Its association with skeletal open bite consists in an additional challenge. Among the treatment options recommended for Class III, there are maxillary protraction, orthodontic camouflage, and orthodontic-surgical correction. This article aims to present a case report of a male patient, in growth phase. It was diagnosed skeletal Class III due to maxillary retrognathism, zygomatic hypoplasia, convex facial profile, mild dolichofacial pattern; proclined upper incisors and slightly retruded lower incisors, anterior and posterior open bite associated with altered tongue posture. The therapy chosen was the disjunction with Hyrax appliance and reverse traction of the maxilla with Petit facemask, followed by fixed orthodontics with first premolars extraction for correction of open bite; and lingual arch with spurs was also used for tongue posture correction. Normal occlusion was obtained according to functional and aesthetic principles, with Class III and open bite correction. There was improvement in the relationship between the maxilla and the mandible without significant changes in the vertical pattern. The facial limitation was fully accepted by the patient who had refused the option for surgical treatment.(AU)

Tratamento compensatório da Classe III em adulto com expansão cirúrgica da maxila e uso de máscara facial / Compensatory Class iii treatment in adult with surgical maxillary expansion and facial mask use

A má oclusão de Classe III, apesar de ser menos prevalente na população mundial, gera preocupação clínica devido ao seu difícil tratamento e grande comprometimento estético. Em adultos, devido à impossibilidade de abordagem ortopédica, o tratamento pode seguir dois caminhos: ortodôntico, com compensação dentoalveolar ou orto-cirúrgico, com preparo para cirurgia ortognática. Para pacientes adultos diagnosticados com má oclusão esquelética de Classe III, mas que relutam em se submeter ao procedimento cirúrgico, a camuflagem ortodôntica consiste em uma opção viável de tratamento. O objetivo deste trabalho foi relatar a compensação de uma má oclusão de Classe III em um paciente adulto, com utilização de mecânica corretiva fixa, realização de Expansão Rápida da Maxila Assistida Cirurgicamente (ERMAC) e utilização de máscara facial de Petit. Os resultados obtidos neste caso demonstraram que a abordagem terapêutica proporcionou melhora oclusal, funcional e estética para o paciente. (AU)

Class III malocclusion, although less prevalent in the world population, generates clinical concern, due to difficulty to treat it and great aesthetic impairment. In adults, due to the impossibility of orthopedic approach, treatment can follow two paths: orthodontic, with dentoalveolar compensation or orthosurgical, with preparation for orthognathic surgery. For adult patients diagnosed with malocclusion Class III, but who are reluctant to go through surgery, orthodontic camouflage consists of a viable treatment option. The purpose of this article was to report the compensation of a Class III malocclusion in an adult patient, with fixed corrective mechanics, rapid maxillary expansion surgically assisted (SARME) and use of Petit facial mask. The results obtained in this case showed that the therapeutic approach provided occlusal, functional and aesthetic improvement for the patient. (AU)

Schwannoma gigante del ángulo pontocerebeloso / Giant Schwannoma of the cerebellopontine angle

Los Schwannomas del acústico son tumores benignos de crecimiento lento de la división superior del nervio vestibular, con una incidencia de 1,9 por cada 100.000 habitantes. En la actualidad, la tecnología de la neuroimagen en conjunto con la exploración audiológica clínica e instrumentada permiten el diagnóstico en estadios tempranos e incluso como hallazgo clínico, por tal motivo solo el 6 % a nivel mundial se cataloga como tumor grande al momento del diagnóstico. Se presenta el caso de una mujer de 16 años con cefalea, mareo, vómito, hipoacusia, parálisis facial y diadococinesia, por lo que se realizaron estudios de neuroimagen en los que se evidenció masa ocupativa a nivel ángulo pontocerebeloso; por las dimensiones se cataloga según la clasificación de Koss como estadio IV. Se confirmó diagnóstico mediante estudio histopatológico.

Acoustic schwannomas are benign tumors of slow growth in the top division of the vestibular nerve, with an incidence of 1.9 per 100,000 inhabitants. Currently, imaging technology together with the clinical examination audiological and implemented allow diagnosis at an early stage and even as a clinical finding, on that ground only 6 % worldwide are categorized as large tumor at diagnosis. For a woman of 16 with headache, dizziness , vomiting , hearing loss, facial paralysis and diadochokinesia occurs, so neuroimaging studies in which a space- occupying mass level cerebellopontine angle were made evident ; by the dimensions it is classified as classified as stage IV Koss . Diagnosis was confirmed by histopathology.

Tratamiento endovascular e indicadores predictivos de complicaciones y mortalidad en la hemorragia subaracnoidea espontanea de origen aneurismática / Endovascular treatment and predictive indicators of complications and mortality in spontaneous subarachnoid haemorrhage of aneurysmal origin

Introducción: La causa más frecuente de hemorragia subaracnoidea espontánea es la ruptura aneurismática (75-80 %), con una elevada tasa de mortalidad 40-50 %. Objetivo: Determinar los principales indicadores predictivos de complicación y mortalidad en hemorragia subaracnoidea espontánea de origen aneurismático, en pacientes que recibieron tratamiento endovascular. Pacientes y métodos: Estudio prospectivo ­ retrospectivo, analítico, observacional de los pacientes con hemorragia subaracnoidea de origen aneurismático que recibieron tratamiento endovascular. Los datos obtenidos al ingreso hospitalario incluyeron edad, género, procedencia, escala de Glasgow, escala de Hunt y Hess, clasificación tomográfica de Fisher, complicaciones médicas, características del aneurisma, momento del tratamiento endovascular. Los datos obtenidos al ingreso hospitalario incluyeron edad, género, procedencia, escala de Glasgow, escala de Hunt y Hess, clasificación tomográfica de Fisher, complicaciones médicas, características del aneurisma, momento del tratamiento endovascular. Resultados: Se evaluaron 16 pacientes, 6 hombres (37,5 %) y 10 mujeres (62,5%), con promedio de edad >61 años en 8 pacientes (50 %). Fallecieron 4 (25%) y sobrevivieron 12 (75 %). En la escala Fisher se obtuvo una mortalidad del 42,85 % en grado III correlacionándose con la escala de Hunt y Hess y escala de la federación mundial de neurocirugía grado V ­ IV, respectivamente, con una tasa de mortalidad del 100 %. La complicación más frecuente que se encontró es el vasoespasmo más isquemia, con un total de 43,75 % y una mortalidad de 28,57 %. Conclusión: Los factores que influyeron en el pronóstico de los pacientes con hemorragia subaracnoidea fueron la edad y género. Se observó una relación directa en cuanto a las escalas de valoración clínicas e imagenologías con la mortalidad, a decir a mayor gradación a la escala mayor mortalidad.

Introduction: The most common cause of spontaneous subarachnoid hemorrhage is aneurysmal rupture (75-80%), with a high mortality rate of 40-50%. Objective: To determine the main predictive indicators of complication and mortality in spontaneous subarachnoid hemorrhage of aneurysmal origin, in patients who received endovascular treatment. Patients and Methods: Prospective, retrospective, analytical, observational study of patients with subarachnoid hemorrhage of aneurysmal origin who received endovascular treatment.The data obtained at hospital admission included age, gender, origin, Glasgow scale, Hunt and Hess scale, Fisher's tomographic classification, medical complications, aneurysm characteristics, time of endovascular treatment. Results: Sixteen (37.5%) men and 10 (62.5%) women were evaluated, with mean age> 61 years in 8 patients (50%). They died 4 (25%) and survived 12 (75%). On the Fisher scale, a mortality rate of 42.85% in grade III was obtained,correlating with the Hunt and Hess scale and scale of the world federation of neurosurgery grade V - IV, respectively, with a mortality rate of 100%. The most frequent complication found was vasospasm plus ischemia with a total of 43.75% and a mortality of 28.57%. Conclusion: The factors that influenced the prognosis of patients with subarachnoid hemorrhage were age, gender. We observed a direct relation as to clinical scales and clinical imaging with mortality, to say at greater gradation to scale higher mortality.

Development of electroactive nanofibers based on thermoplastic polyurethane and poly(o-ethoxyaniline) for biological applications.

Electroactive nanofibers based on thermoplastic polyurethane (TPU) and poly(alkoxy anilines) produced by electrospinning has been explored for biomaterials applications. The thermoplastic polyurethane is a biocompatible polymer with good mechanical properties. The production of TPU nanofibers requires the application of high voltage during electrospinning in order to prepare uniform mats due to its weak ability to elongate during the process. To overcome this limitation, a conductive polymer can be incorporated to the process, allowing generates mats without defects. In this study, poly(o-ethoxyaniline) POEA doped with dodecylbenzene sulfonic acid (DBSA) was blended with thermoplastic polyurethane (TPU) by solution method. Films were produced by casting and nanofibers were prepared by electrospinning. The effect of the POEA on morphology, distribution of diameter and cell viability of the nanofibers was evaluated. The results demonstrated that the incorporation of POEA in TPU provided to the mats a suitable morphology for cellular growth. © 2016 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 105A: 601-607, 2017.

Percepção estética e funcional de pacientes submetidos à cirurgia ortognática / Functional and aesthetic perception of patients that undergone orthognathic surgery

As deformidades dentofaciais promovem implicações funcionais e estéticas variáveis em função da percepção dos pacientes. De modo semelhante, o tratamento orto-cirúrgico promove mudanças na condição do complexo maxilomandibular e facial, com melhorias naqueles aspectos. Assim, o objetivo deste estudo foi compreender a percepção estética e funcional relacionadas aos pacientes submetidos à cirurgia ortognática por motivos ortodônticos não relacionados ao trauma, analisando as implicações psicossociais atreladas à sua condição clínica pregressa e atual. Adotou-se um delineamento metodológico em que vinte pacientes que já se submeteram à cirurgia ortognática foram questionados quanto à dificuldade em desempenhar oito atividades diárias, em ambos os momentos pré e pós-cirúrgico. Utilizou-se o índice IODD (Impacto Oral no Desempenho Diário) como instrumento de pesquisa. A análise dos resultados revelou que, na fase pré-cirúrgica, 85% dos participantes referiram impacto em alguma atividade diária, sendo que as dificuldades mais relatadas nas atividades funcionais foram justificadas por dor, desconforto ou limitação na função. Já na fase pós-cirúrgica, 55% dos indivíduos relataram algum impacto nas atividades diárias, o que denota uma percepção positiva quanto à satisfação dos resultados da cirurgia. No geral, os dados foram conclusivos ao mostrar a influência da condição bucal na qualidade de vida dos participantes com aspectos que transcendem o plano funcional e envolvem a dimensão psicossocial. A cirurgia ortognática, por sua vez, permitiu uma melhoria funcional e estética com repercussão nas relações pessoais e sociais (AU)

Dentofacial deformities promote functional and aesthetic implications that vary according to patients' perception. Similarly, the orthosurgical treatment causes changes in the maxillomandibular and facial complex condition, with improvements in those aspects. Thus, the aim of this study was to understand the functional and aesthetic perceptions related to patients who had undergone orthognathic surgery for orthodontic reasons not related to trauma, analyzing psychosocial implications linked to their past and present condition. It was adopted a methodological design in which twenty patients who had undergone orthognathic surgery were asked about the difficulty of performing eight daily activities, pre and post-surgery. The OIDP (Oral Impact on Daily Performance) index was used as a research tool. The results analysis showed that during the presurgical phase 85% of participants reported some impact on daily activity, the most reported difficulties in functional activities were justified by pain, discomfort or limitation in function. In the post-surgical phase, 55% individuals reported having some impact on daily activities, which indicates a positive perception about surgery results satisfaction. Overall, data were conclusive showing the influence of oral conditions in the par-ticipant's life quality with aspects that transcend the functional level and involve the psychosocial dimension. Orthognathic surgery, in turn, allowed a functional and aesthetic improvement having effects on the personal and social relationships. (AU)

Abordagem ortodôntica em pacientes portadores de fissuras labiopalatinas – relato de caso / Orthodontic approach in patients with cleft lip and palate – case report

Objetivo: Este artigo tem como objetivo fazer uma revisão de literatura sobre as fissuras labiopalatinas, bem como apresentar um caso clínico de paciente fissurado tratado ortodonticamente. Materiais e Métodos: A paciente relatada apresentava Fissura Pré-Forame Incisivo Bilateral Completa, já com o lábio fissurado reparado por queiloplastia pelo cirurgião-plástico. Inicialmente, foi feita interceptação com a mecânica 2 x 2 para correção dos dentes anteriores vestibularizados e girovertidos, seguida de enxertia óssea alveolar secundária realizada com o cirurgião bucomaxilofacial e tendo a finalização do tratamento com Ortodontia Corretiva Fixa e reanatomizações dentárias com especialista em Dentística. Conclusão: Pôde-se concluir que os ortodontistas devem estar preparados para atender tais pacientes e para implementar o melhor tratamento para cada caso, sendo imprescindível uma equipe interdisciplinar atuante.(AU)

Objective: This article aims to make a literature review on cleft lip and palate, as well as to present a clinical case of a patient with a cleft lip treated ortodontically. Materials and Methods: The patient presented had complete bilateral incisive pre-foramen cleft with cleft lip already repaired through cheoloplasty performed by a plastic surgeon. The first interception was made with 2 x 2 mechanics for correction of proclined and rotated anterior teeth, followed by secondary alveolar bone grafting performed by a maxillofacial surgeon and the conclusion of the treatment was made with fixed orthodontic appliance and dental reshaping with a cosmetic dentistry specialist. Conclusion: It could be concluded that orthodontists should be prepared to attend such patients and implement the best treatment for each case, being essential an active interdisciplinary team.

Tratamento ortodôntico compensatório da má oclusão de Classe III esquelética / Compensatory orthodontic treatment of skeletal Class III malocclusion

Este trabalho visa apresentar alguns conceitos e formas de diagnóstico da má oclusão de Classe III esquelética moderada e discutir as diversas formas de tratamento desta displasia, ressaltando como a compensação pode trazer benefícios dentoesqueléticos além da melhora do perfil tegumentar. As vantagens e desvantagens deste protocolo de tratamento serão discutidas. Um paciente leucoderma adulto procurou tratamento ortodôntico na ABO-SE, queixando-se que os dentes inferiores estavam para frente. Cefalometricamente, ele apresentava perfil ósseo côncavo, padrão dolicofacial, retrusão maxilar e mandíbula levemente retruída. Dentariamente, incisivos superiores vestibularizados e incisivos inferiores verticalizados. Como resultados, houve uma melhora da relação maxilomandibular além da obtenção da harmonia e equilíbrio do perfil facial. Dependendo da severidade da má oclusão de Classe III, a camuflagem quando bem indicada em indivíduos com crescimento exaurido, apresenta excelentes resultados e vantagens na relação custo-benefício para o paciente.

The present work aims to present some concepts and ways to diagnose and treat a mild skeletal Class III malocclusion, as well as discuss different treatments to correct this dysplasia. It will be emphasized that compensation can bring dentoskeletal benefits as well as facial profile improvements. Advantages and disadvantages of this protocol will be approached. A caucasian adult male patient searched orthodontic treatment at ABO-SE, complaining about anterior positioning of inferior dental arch. According to cephalometric evaluation he presented an unaesthetic concave profile, vertical pattern, maxillary retrusion, and slightly retruded mandible. Regarding dental aspects the patient presented, proclined upper incisors and vertical lower incisors. A better maxilomandibular relation and normalized facial profile were achieved providing a balanced facial profile. Depending on the severity of Class III malocclusion the camouflage when properly indicated, provide excellent results and lower costs for the patients.

Renal cortical scan as the first investigation in identifying children at risk for vesicoureteral reflux and renal defects: A 10-year retrospective review of DMSA and VCUG imaging in patients with first febrile urinary tract infection

The objective of the study is to determine the accuracy of renal cortical scan in detection of vesicoureteral reflux (VUR) in children five years old and below diagnosed with urinary tract infection and to determine if Renal cortical scan can predict the prevalence of VUR in children and screening those who will need voiding cystourethrography (VCUG).METHODS: The medical records of 302 patients who presented with a first febrile urinary tract infection and underwent VCUG and renal cortical scan during a 10-year period starting from 2000 to 2010 were reviewed retrospectively. Patients with systemic diseases other than acute pyelonephritis/VUR and those with other concomitant anatomic or neurological abnormalities were dropped from the study. Included participants were then grouped according to age range; 1 day to 1 month, 1 to 12 months, 13 to 24 months, and 2 to 5 years.RESULTS: The study consisted of 302 patients and 604 renal units. Males were 45.3% and females were 54.6% of the population. Computed odds ratio and relative risk associated with positive VUR and renal cortical scan using dimercaptosuccinic acid (DMSA) was at 4.15 [Cl 2.93-5.908] and 2.398 [Cl 1.924-2.989] respectively. This suggests that patients with positive Renal cortical scans are 4.15 times more likely to have VUR, or conversely, the risk of developing VUR with a positive renal cortical scan is approximately 2.398 times than if DMSA results were negative. Renal cortical scan has been found to be 96.6% sensitive in detecting VUR among patients with the condition and is 89.82% specific in detecting the absence of VUR among normal individuals [PPV 55.8% and NPV 76.7%].CONCLUSION: Renal cortical scan could be used a first line imaging investigation tool for determining high grade VUR. VCUG may not be necessary in all young children with first febrile UTI when the renal cortical scan is negative. VCUG could be warranted only foe those children with positive results on renal cortical scan.

Estabilidade da compensação ortodôntica da mordida aberta anterior em paciente adulto / Stability of anterior open bite orthodontic compensation in adult patient

As mordidas abertas anteriores consistem em uma dasmás-oclusões mais difíceis de serem tratadas, devido aos seusmúltiplos fatores etiológicos, podendo ser divididas em dentárias,dentoesqueléticas e esqueléticas, a depender da sua severidade. Afalta de estabilidade consiste na causa mais conhecida de recidiva,podendo prolongar a fase de contenção indefinidamente na fase adulta.Portanto, o propósito deste trabalho foi apresentar um caso clínico demordida aberta anterior dentoesquelética, tratado ortodonticamentesem extrações. O paciente adulto apresentava relação molar e caninosem Classe I, mordida aberta anterior esquelética, biprotrusão e severaperda óssea alveolar anterior associada à doença periodontal, apresentandohistória de leucopenia, dificultando o tratamento extracionista.Cefalometricamente, os incisivos superiores e inferiores apresentavamvestibularização excessiva e o prognóstico era desfavorável em virtudedo padrão vertical e perfil convexo. O tratamento foi realizado comelásticos intermaxilares verticais durante dez meses, tendo o pacientemostrado excelente cooperação, e o tempo total de tratamento foide 36 meses. As contenções foram empregadas por 24 meses pós-tratamento.Adotaram-se sessões fonoaudiológicas para normalizaçãodas posturas lingual e labial por 12 meses antes e após o fim do tratamento.Observou-se boa oclusão, estética e função, com selamentolabial passivo acompanhado de harmonia facial ao final do tratamento,sendo o paciente ainda monitorado anualmente por cinco anos póstratamentopara avaliação da estabilidade do tratamento. Verificou-seque este protocolo pode ser empregado sem intervenção cirúrgica pormeio da compensação dentária da mordida aberta anterior, mantendo-sea relação molar e de caninos em Classe I.

The anterior open bite consists on one of the most difticultmalocclusion to treat because of its multiple etiologic factors. Can bedivided on dental, dentoskeletal and skeletal depending on its severity.The lack of stability of the extruded anterior teeth can be de majorcause of relapse, which may extend the retention period indefinitelyin adufthood. Therefore, the purpose of this paper is to present andentoskeletal anterior open bite case treated orthodontically withoutextractions. The adult patient had a molar and cuspid Class I, skeletalanterior open bite, biprotrusion and severe anterior alveolar bone lossassociated with periodontal disease, leukopenia's history, makingextraction treatment difficult. Cephalometrically, the upper and lowerincisors had excessive forward tipping and poor prognosis due to thevertical pattem and convex profile. The treatment was performed withvertical intermaxillary elastics for ten months. The patient showedexcel/ent cooperation and total treatment time was 36 months. Theretainers were employed for 24 months after treatment. Speechtherapy sessions were conducted for lingual and labial normafizationposture for 12 months before and after treatment. There was goodocclusion, esthetic and function, with passive fip seal accompaniedby facial harmony at the end of treatment, the patient is still beingmonitored every year to evaluate longterm treatment's stability tiveyears retention. In conclusion, this protocol could be employed withoutsurgical intervention by dental compensation of anterior open bite,maintaining cuspid and molar in Class I.

Hipersensibilidade ao níquel em ortodontia: relato de caso clínico / Nickel hypersensitivity in orthodontics: case report

A prática ortodôntica utiliza fios e acessórios de composições clínicas diferentes. O níquel consiste em um íon metálico bastante empregado na produção destes materiais, sendo um potente sensibilizador biológico. Desta forma, este estudo objetivou ilustrar o tema sobre hipersensibilidade ao níquel com um relato de caso clínico durante a terapia ortodôntica fixa em um paciente do gênero masculino, de nove anos e quatro meses de idade. Utilizou-se como meio de diagnóstico o teste de contato, patch test, através de fita adesiva contendo sulfato de níquel, sulfato de cromo e cloreto de cobalto, a qual foi aplicada na parte superior das costas do paciente. Concluiu-se que houve hipersensibilidade ao níquel no caso clínico apresentado com aparelho ortodôntico fixo por meio da leitura positiva ao patch test, evidenciada pela presença de eritema, pápulas e vesículas no local examinado.

The orthodontic practice utilizes wires and accessories of different clinical compositions. Nickel is a metal often used in the production of these materials, since it is a powerful biological sensitizer. For this reason, this study aimed to display the matter by reporting a clinical case about nickel hypersensitivity during fixed orthodontic therapy in a male patient who was nine years and four months old. A patch test was used for diagnosis, which consisted on na adhesive tape with nickel sulfate, chromium sulfate and cobalt chloride that was placed on the superior part of patient’s back. It was concluded that there was nickel hypersensitivity due to orthodontic appliances in the presented clinical case since there was a positive reading to the patch test, evidenced by the presence of erythema, papules and vesicles in the examined area.

Cost-effectiveness of extracorporeal shock wave lithotripsy vs percutaneous nephrolithotomy in the management of lower pole nephrolithiasis: A study in local figures

OBJECTIVE: We determined the efficacy of extracorporeal shock wave lithotripsy (ESWL) monotherapy and compared its cost-effectiveness with percutaneous nephrolithotomy (PCNL) for the management of lower pole renal calculi with a size of 1.0cm to 2.0cm in widest dimension. MATERIALS AND METHODS: Using the cost estimate data available locally from patient billing charges and average professional fee, efficacy and complication rates data from the literature, the cost-effectiveness for the percutaneous nephrolithotomy and shock wave lithotripsy as primary therapy for lower pole stones were evaluated. We developed a decision analysis model in which a patient in whom primary therapy (either ESWL or PCNL failed was rendered stone-free with secondary ESWL using a trial version add-in software for Microsoft Excel from www.TreePlan.com with some modifications. RESULTS: The average cost over all outcomes from the decision to perform ESWL in patients with lower pole stones 1.0 to 2.0 cm is Php 53,801.07 and Php 127,019.27 for PCNL. For PCNL to be as cost effective, cost incurred should be lowered to Php 47,746.38 CONCLUSIONS: Extracoporeal shock wave lithotripsy, despite its considerable low efficacy as compared to PCNL as a primary treatment for lower pole stones 1.0 to 2.0 cm, is still more cost-effective.

Pulmonary calcification detected by bone scintigraphy in a pediatric case of acute lymphoblastic leukemia

This is a case report of a pediatric patient with acute lymphoblastic leukemia and presenting with a rare finding of bilateral pulmonary calcification. The patient's pulmonary calcification was detected as an incidental finding during a routine bone scan performed to evaluate the patient's bone pains. Bone scintigraphy is one of the most sensitive and efficient modalities for detecting extra-osseous calcification.

Diagnóstico ortodôntico pela análise facial / Facial analysis in orthodontic diagnosis

A necessidade de estabelecer metas de normalidade descritas como objetivos ortodônticos criou um paradoxo entre as expectativas dos ortodontistas e de seus pacientes. Na tentativa de revogar esta controvérsia, a Ortodontia como ciência vem evoluindo no que diz respeito ao seu diagnóstico e planejamento. A percepção da beleza é subjetiva e de influência cultural, por isso a análise facial torna-se primordial para o sucesso do tratamento ortodôntico. As informações obtidas por meio dessa análise orientam os procedimentos que devem ser realizados para que a beleza seja valorizada e preservada, por isso os efeitos causados na face devem ser criticamente analisados. Diante disso, este trabalho realizou uma revisão da literatura sobre a análise facial e sua influência no tratamento ortodôntico. De acordo com os artigos revisados, concluiu-se que os dados cefalométricos devem ser interpretados e associados ao padrão facial do paciente; os exames tridimensionais auxiliam no diagnóstico ortodôntico; a análise facial é indispensável para que se obtenha sucesso no tratamento ortodôntico; cada paciente deve ser tratado de acordo com sua individualidade que reside na etnia, gênero e idade em que se encontra.

The need to establish normal objectives described as orthodontic goals created a paradox between the expectations of orthodontists and their patients. In an attempt to repeal this paradox, the science of Orthodontics has evolved with regard to diagnosis and planning. The perception of beauty is subjective and cultural influenced, so the facial analysis is a paramount to orthodontic treatment success. Information obtained through this analysis guide the procedures to be performed to value and preserve beauty so that the effects on the face should be critically analyzed. This article is a literature review on facial analysis and its influence on orthodontic treatment. According to articles reviewed, it was concluded that cefalometric data should be interpreted in association with patient facial pattern; the three dimensional examination is helpful in diagnosing orthodontics, facial analysis is essential to gain a successful orthodontic treatment; each patient must be treated according to their individuality which lies in ethnicity, gender and age in which it is.

Tracionamento de canino superior impactado: uma abordagem conservadora / Superior cuspid impacted traction: a conservative approach

O reposicionamento de dentes impactados pode envolver uma combinação de procedimentos cirúrgicos, endodônticos, periodontais, protéticos e ortodônticos. O tracionamento dentário pode ser realizado por meio da movimentação ortodôntica axial do dente comprometido, sendo um tratamento auxiliar, objetivando controlar o problema e restaurar a função. Envolve, portanto, objetivos ortodônticos limitados, utilizando-se aparelhos que atuam no arco dentário em um curto período de tempo, respeitando os espaços biológicos. Desta forma, será apresentado um caso clínico de um jovem com retenção prolongada do canino superior decíduo esquerdo e sucessor permanente com boa condição de tracionamento pós-exposição cirúrgica confirmada pelos exames solicitados na documentação ortodôntica. O paciente apresentava uma má-oclusão de Classe I de Angle bilateral, linha média superior desviada para esquerda e bom posicionamento dentário dos incisivos superiores e inferiores. Utilizou-se braquetes pré-ajustados StraightWire, prescrição MBT, para alinhamento e nivelamento dentário dos arcos até alcançar o fio retangular de aço inoxidável de estabilização para iniciar o tracionamento da unidade retida. Ao final do tratamento, observou-se ótima relação oclusal, com estética e função satisfatórias, além de intercuspidação dentária harmoniosa. As contenções foram instaladas para se alcançar um equilíbrio biofisiológico e estabilidade no pós-tratamento. O prognóstico favorável repercutiu no sucesso do resultado oclusal constatado no estabelecimento do sorriso harmonioso e obtenção dos movimentos bordejantes bilaterais. O presente estudo proporcionou ao leitor subsídios para um adequado diagnóstico e descreveu aspectos referentes ao processo de erupção do canino, importância estética e funcional, incidência, frequência, etiologia, prognóstico e diversas formas de tratamento de caninos superiores retidos.

Repositioning of impacted teeth may involve a combination of surgical, endodontic, periodontal, prosthetic and orthodontic procedures. Dental traction may be executed by axial orthodontic tooth movement, as an aid treatment, aiming to control the problem and reestablish function. Therefore, this involves limited orthodontic objectives utilizing appliances that act in dental arch for a short period of time, regarding biological spaces. This way, a clinical case study will present a young adult with retention of upper left deciduous canine and its permanent successor tooth with good conditions for traction after surgical exposition confirmed by requested exams in orthodontic documentation. The patient presented a bilateral Angle’s Class I malocclusion, deviation of superior midline to the left, and good dental positioning of lower and upper incisors. Pre-adjusted Straight Wire brackets were used, with MBT prescription, for tooth alignment and leveling in arches until they reached stainless steel rectangular wires for stabilization to begin the traction of the retained dental unit. By the end of treatment, an excellent occlusal relationship was observed with satisfactory esthetic and function besides harmonious dental intercuspidation. Orthodontic contentions were installed to reach a biophysiological balance and stability in post-treatment. A favorable prognostic reflected the success of occlusal result verified on patient’s harmonious smile and acquisition of bilateral border movements. The present study provides the reader aids for an adequate diagnosis and describes aspects referring to canine eruption process, importance of esthetics and function, incidence, frequency, etiology, prognostic and many ways of treating retained upper canines.