Human diprosopus: Case report of a rare congenital abnormality.

Diprosopus is a congenital anomaly in which partial or complete duplication of craniofacial structures occurs. Because it is rare, the mortality rate is high, and information concerning this anomaly is scarce. This study describes a case of human diprosopus in a 9-year-old male individual, who has severe complications associated with the central nervous, cardiovascular, respiratory, and digestive systems. Since birth, he has been monitored in a specialized hospital environment, where he has undergone several surgeries and multidisciplinary treatments. Regarding the craniofacial aspects, he had agenesis of the corpus callosum, floor of the nasal cavity, and floor of the anterior cranial fossa, in addition to the presence of bone dysplasia, ocular hypertelorism and cleft palate with nasal and oral teratoma. Regarding dental characteristics, the patient has duplication of the maxilla, mandible, tongue, and some teeth. After complementary imaging exams, several supernumerary teeth were found, with some being impacted and in complex regions, with an indication for extraction due to the risks of impaction, irruptive deviation, root resorption, and associated cystic or tumoral lesions. Because of the numerous complications, knowledge, and preparation of the entire team is necessary for the correct management of the case.

The "Phase Down" of Dental Amalgam Restorations - What are the Criteria for Replacement and Indication?

ABSTRACT Objective: To guide professionals about the criteria for replacing amalgam restorations and inform them about the new guidelines regarding the use/indication of this (amalgam) material after the Minamata Convention - COP-4. Material and Methods: The articles were selected from the databases (PubMed, Scielo, Bireme), and relevant articles on the subject between the years 2003-2021 were selected. Recently, social media have been flooded with dental treatments that aim to perform restorations only with composite resins or other types of esthetic material and completely replace all dental amalgam restorations, irrespective of their time in place, size, and functionality. Results: Although improperly, it has been noted that this information reaches patients, and they are led to believe in the inaccurate data that is passed on, such as, for example, (that amalgam leads to) permanent contamination by mercury, causing systemic problems and the loss of the tooth. Conclusion: The "phase down" of amalgam in research and teaching has previously been observed in several countries worldwide; however, its use is still necessary given particular circumstances, which, theoretically, make it a material with exact indication.

Is the computed tomography exam important for planning mini-implant installation?

Background: Mini-implants are devices used to provide absolute and temporary anchorage for tooth movement. Objectives: The present study was carried out to compare the use of periapical radiographs and computed tomography (CT) for planning mini-implants performed by orthodontists. Material and Methods: Five radiographs and five CT scans of premolars and molars regions. These were analyzed by ten Orthodontists. Initially (T1), the evaluators indicated the preferred location for the insertion of a mini-implant, as well as the diameter and length of the device, using only a periapical radiograph. After 30 days (T2), the same evaluation was performed. Sixty days later (T3), the orthodontists reassessed the radiographs in association with the CT scans. Finally, after 90 days (T4), the evaluation was performed with the same exams. The comparison of the chosen diameter and length of the mini-implants was performed using the Student's t-test. The evaluation of the chosen insertion sites was analyzed by the Wilcoxon test. For both tests, the level of significance was 5%. The kappa concordance test was also performed for the intra- and inter-examiner evaluations. Results: The results of the study showed substantial or perfect intra-examiner and reasonable to perfect inter-examiner agreement. Considering the length and diameter of the mini-implants, no statistical difference was found between the groups. Regarding the insertion site, more than 20% of the treatment plans were changed when the CT scan was associated. Conclusions: The results showed that the association of a CT scan with radiography frequently leads the professional to change the insertion point for the installation of mini-implants. Key words:Orthodontic anchorage procedures. Mini Dental Implants. Bone Screws. Cone-beam computed tomography. Periapical radiography.

Patient with McCune albright syndrome: Case report and 10 Years of follow-up imaging examination.

The McCune Albright syndrome (MAS) is a rare, multi-system disease composed of the triad of polyostotic fibrous dysplasia of bone (PFDB), café-au-lait skin hyperpigmentation, and endocrine disorders. The diagnosis involves clinical, biochemical and imaging findings, with dentistry playing an important role in MAS, since many patients present DFPO in the craniofacial bones, including the maxilla and mandible, and in view of their dental needs, the correct management of these patients is not only an essential but important area to be investigated. This report presents a case of a patient with McCune Albright Syndrome, the behavior of the disease over a period of 10 years and how imaging exams such as scintigraphy and tomography were important for planning the dental treatment of this patient, since they are fundamental allies for identification and evaluation of the progression and/or stability of the disease. Key words:Craniofacial fibrous dysplasia, cone-beam computed tomography, scintigraphy, imaging diagnosis.

Impact of orthodontic correction of dental crowding with pre-molar extraction in the anterior mandible evaluated by cone-beam computed tomography.

INTRODUCTION: To evaluate, by cone-beam computed tomography (CBCT), the change in thickness and height of the alveolar bone and interdental septum in the anterior mandible after orthodontic treatment for dental crowding using tooth extraction. MATERIAL AND METHODS: The sample consisted of 48 mandibular incisors from adult patients who presented with Class I malocclusion and required orthodontic treatment with the extraction of mandibular premolars. CBCT images were taken before starting the treatment (T1) and three months after treatment (T2). The following measurements were evaluated: width and height of the alveolar bone and the interdental septum, the distance between the cementoenamel junction and the bone ridges (F-CEJ-MBC and L-CEJ-MBC), as well as the vertical positioning and inclination of the incisor, using the Lingual Plane as the reference point. The paired Student's t-test and Pearson correlation were used with a significance level of 5%. RESULTS: A significant increase was observed in the distance L-CEJ-MBC, which shows the appearance of bone dehiscence. The degree of dental crowding was not a risk factor for the development of dehiscence. The decrease in the incisor inclination and intrusion was related to the formation of dehiscence on the lingual surface. CONCLUSION: The variation in the incisor's inclination and intrusion during the treatment of dental crowding using tooth extraction are related to the formation of bone dehiscence on its lingual surface.

Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020.

OBJECTIVE: to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. METHODS: ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. RESULTS: 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. CONCLUSION: the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.

Tendência Temporal da Incidência das Hepatites Virais e AIDS Adquiridas por Contato Sexual no Estado de Santa Catarina / Temporal Trend of the Incidence of Viral Hepatitis and Aids Acquired by Sexual Contact in the State of Santa Catarina

Introdução: Este estudo tem o objetivo de estudar a tendência histórica e a distribuição das taxas de incidência das hepatites virais e Aids adquiridas por contato sexual no período de 2007-2017, no estado de Santa Catarina, com descrição do perfil sociodemográfico e epidemiológico dos indivíduos acometidos, análise da evolução temporal da ocorrência dessas infecções sexualmente transmissíveis e sua gravidade. Métodos: Pesquisa observacional do tipo ecológica, tendo como fonte de dados o Sistema de Agravos de Notificação ­ SINAN. Resultados: Evidenciou-se predomínio do sexo masculino, em torno de dois homens para cada mulher acometida por ambas as infecções no estado de Santa Catarina. A faixa etária predominante para a Aids foi a dos 35-49 anos, enquanto para as hepatites virais, a maior concentração foi entre os 25-39 anos. No entanto, a variação média anual assumiu novos perfis no período estudado: na Aids, os jovens de 15-19 anos apresentaram a maior taxa de crescimento anual (22,76%), enquanto nas hepatites virais, os idosos lideraram a tendência de crescimento, com aumento de 41,61% ao ano na faixa etária de 80 anos, e mais e de 14,53% entre os idosos de 65 a 79 anos. Em ambas as infecções, observou-se tendência de crescimento acelerado nas macrorregiões da Serra Catarinense e do Planalto Norte. Conclusão: Os resultados indicaram a relevância do tema abordado e a necessidade de medidas de prevenção, visto que as hepatites virais e a Aids estão modificando o estigma e o estereótipo restrito do passado e ampliando o risco da doença.

Introduction: This study aims to study the historical trend and the distribution of the incidence rates of viral hepatitis and AIDS acquired by sexual contact in the period 2007-2017, in the state of Santa Catarina, with a description of the socio-demographic and epidemiological profile of affected individuals, analysis of the temporal evolution of the occurrence of these sexually transmitted infections and their severity. Method: observational research of the ecological type having as a data source the Notifiable Diseases Information System [Sistema de Informação de Agravos de Notificação (SINAN)]. Results: The results showed a predominance of males, about two men for every woman affected by both infections in the state of Santa Catarina. The predominant age range for AIDS was 35-49 years, while for viral hepatitis, the highest concentration was between 25-39 years. However, the average annual variation assumed new profiles in the period studied: in AIDS, 15-19 year-olds showed the highest annual growth rate (22.76%), while in viral hepatitis, the elderly led the growth trend, with an increase of 41.61% per year in the age group 80 years and older and of 14.53% among the 65-79 year-olds. In both infections, the study showed an accelerated growth trend in the macro-regions of the Santa Catarina Mountain Range and the North Plateau. Conclusion: The results indicated the relevance of the theme addressed and the need for preventive measures since viral hepatitis and AIDS are changing the stigma, the restricted stereotype of the past and increasing the risk of the disease.

Telemedicine to Timor-Leste: implementing an international cardiac telehealth service during population dislocation, floods and COVID-19.

BACKGROUND: The East Timor Hearts Fund has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. AIM: To develop collaborative telehealth services between Australia and Timor-Leste in the context of international border closures due to the COVID-19 pandemic. METHODS: Scoping discussions identified major challenges (structural, patient related and medical system related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared with an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. RESULTS: Twenty-three patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared with an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients; 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23; 73.9%) and Dili based (18/23; 78.3%), with a mean age of 25.9 ± 7.2 years. The majority (12/23; 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-min walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. Eleven (47.8%) patients were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at the current inability to provide interventional services was highlighted. CONCLUSION: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.

An Imaging Perspective to Multiple Calcifying Hyperplastic Dental Follicles - A Report of Three Cases.

Rationale: Multiple Calcifying Hyperplastic Dental Follicle (MCHDF) is an extremely rare condition and is characterised by multiple impacted permanent teeth, with enlarged dental follicles, containing calcifications. Cone-beam computed tomography (CBCT) is the ideal exam for the identification of this condition. Patient Concerns: The present study seeks to compare the behaviour of MCHDF in imaging exams of three clinical cases with their MCHDF imaging diagnoses, in which a change about tooth eruption was observed. Diagnosis: CBCT proved to be an important diagnostic tool for MCHDF, as it is able to identify these small calcifications, as well as measure the size of the follicle.Treatment Outcomes and Take. Away Lessons: With a consistent imaging diagnosis, less invasive treatments become a viable option for this condition, since functional and aesthetic involvement is common in these patients, who often tend to be quite young.

Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020 / Tendência temporal da utilização da traqueostomia em pacientes hospitalizados pelo Sistema Único de Saúde no Brasil no período de 2011 a 2020

ABSTRACT Objective: to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. Methods: ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. Results: 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. Conclusion: the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.

RESUMO Objetivo: analisar a tendência temporal da utilização da traqueostomia em pacientes hospitalizados pelo Sistema Único de Saúde no Brasil no período de 2011 a 2020. Método: estudo observacional de tipo ecológico, com abordagem quantitativa, e incluiu a população brasileira com 20 anos ou mais que, internadas pelo Sistema Único de Saúde, tiveram registro de realização do procedimento de traqueostomia em qualquer momento da hospitalização. Resultados: das 113.569.570 hospitalizações estudadas, foram identificadas 172.456 traqueostomias realizadas no Brasil (0,15%). A taxa média de realização deste procedimento apresentou tendência de queda no período estudado. A maior taxa média de traqueostomia foi encontrada na Região Sul, e a faixa etária mais afetada foi a dos 80 anos ou mais. A taxa média de traqueostomia no sexo masculino foi de 1,8 vezes maior do que no sexo feminino. As principais causas associadas à realização de traqueostomia foram as patologias respiratórias, oncológicas e decorrentes de causas externas, sendo que as causas respiratórias contribuíram com 73% do total de procedimentos estudados. Conclusões: as taxas médias de mortalidade e letalidade das internações com traqueostomia no Brasil foram de 3,36 e 28,57%, mas apresentaram tendência de redução no período.

Domínios de competências essenciais nas práticas colaborativas em equipe interprofissional: revisão integrativa da literatura / Core competency domains in the collaborative practices of interprofessional health teams: an integrative literature review / Dominios de competencias esenciales en las prácticas colaborativas en equipo interprofesional: revisión integradora de la literatura

O objetivo desta pesquisa foi sintetizar evidências das práticas colaborativas interprofissionais segundo os domínios de competências essenciais do Canadian Interprofessional Health Collaborative (CIHC). Foi conduzida revisão integrativa da literatura, dos últimos dez anos, nas bases Pubmed, Web of Science e Biblioteca Virtual em Saúde e síntese das práticas segundo a estrutura proposta pela CIHC. Dos 364 artigos selecionados, 21 foram incluídos com amostras entre 12 e 972 participantes; 11 estudos utilizaram instrumentos para avaliação das práticas; 43% evidenciaram os seis domínios essenciais; e 38%, de três a quatro. A resolução de conflitos interprofissionais não foi abordada em 48% dos artigos. Foi observada a adesão aos domínios de competências essenciais, o que tende a qualificar o processo de trabalho. Entretanto, a lacuna observada na abordagem do enfrentamento dos conflitos interprofissionais representa um obstáculo para vencer a formação uniprofissional. (AU)

The aim of this study was to synthesize evidence of collaborative practices based on the core competency domains proposed by the Canadian Interprofessional Health Collaborative (CIHC). We conducted an integrative literature review of articles published over the last 10 years. Searches were performed of the PubMed, Web of Science and Virtual Health Library databases and a synthesis of the practices based on the framework proposed by the CIHC. The search yielded 364 articles, 21 of which were included in the sample. The included studies used samples of between 12 and 972 participants. Eleven of the studies used practice assessment instruments; 43% included all six core competency domains and 38% included three to four. Forty-eight per cent of the studies did not address interprofessional conflict resolution. The findings demonstrate that adherence to the core competency domains tends to improve the quality of work process. However, the gap represented by the failure to address interprofessional conflict resolution is an obstacle to overcoming uniprofessional training. (AU)

El objetivo de este estudio fue sintetizar evidencias de las prácticas colaborativas interprofesionales según los dominios de competencias esenciales del Canadian Interprofessional Health Collaborative (CIHC). Se realizó una revisión integradora de la literatura de los últimos diez años en las bases Pubmed, Web of Science y Biblioteca Virtual em Saúde y síntesis de las prácticas según la estructura propuesta por la CIHC. De los 364 artículos seleccionados se incluyeron 21, con muestras entre 12 y 972 participantes. Once estudios utilizaron instrumentos para evaluación de las prácticas, el 43% puso en evidencia los seis dominios esenciales, y el 38% de 3 a 4. La resolución de conflictos interprofesionales no se abordó en el 48% de los artículos. Se observó la adhesión a los dominios de competencias esenciales, lo que tiende a calificar el proceso de trabajo. Sin embargo, la brecha observada en el abordaje del enfrentamiento de los conflictos interprofesionales representa un obstáculo para vencer la formación uniprofesional. (AU)

Risk rates of workplace accidents in Brazil: effect of the Accidental Prevention Factor (APF)? / Taxas de risco de acidentes de trabalho no Brasil: efeito do Fator Acidentário de Prevenção (FAP)?

Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.

Taxas de risco de acidentes de trabalho no Brasil: efeito do Fator Acidentário de Prevenção (FAP)? / Risk rates of workplace accidents in Brazil: effect of the Accidental Prevention Factor (APF)?

Resumo A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.

Abstract Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

Automated Identification of Dental Implants Using Artificial Intelligence.

PURPOSE: To develop and evaluate the accuracy of a computer-assisted system based on artificial intelligence for detecting and identifying dental implant brands using digital periapical radiographs. MATERIALS AND METHODS: A total of 1,800 digital periapical radiographs of dental implants from three distinct manufacturers (f1 = 600, f2 = 600, and f3 = 600) were split into training dataset (n = 1,440 [80%]) and testing dataset (n = 360 [20%]) groups. The images were evaluated by software developed by means of convolutional neural networks (CNN), with the aim of identifying the manufacturer of the dental implants contained in them. Accuracy, sensitivity, specificity, positive and negative predictive values, and the receiver operating characteristic (ROC) curve were calculated for detection and diagnostic performance of the CNN algorithm. RESULTS: At the final epoch (25), system accuracy values of 99.78% were obtained for group training data, 99.36% for group testing data, and 85.29% for validation data. The latter value corresponded to the actual accuracy of carrying out the system learning process. CONCLUSION: This study demonstrated the effectiveness of CNN for identifying dental implant manufacturers, which was proven to be a precise method of great clinical significance.

Single-View Echocardiography by Nonexpert Practitioners to Detect Rheumatic Heart Disease: A Prospective Study of Diagnostic Accuracy.

BACKGROUND: Echocardiographic screening can detect asymptomatic cases of rheumatic heart disease (RHD), facilitating access to treatment. Barriers to implementation of echocardiographic screening include the requirement for expensive equipment and expert practitioners. We aimed to evaluate the diagnostic accuracy of an abbreviated echocardiographic screening protocol (single parasternal-long-axis view with a sweep of the heart) performed by briefly trained, nonexpert practitioners using handheld ultrasound devices. METHODS: Participants aged 5 to 20 years in Timor-Leste and the Northern Territory of Australia had 2 echocardiograms: one performed by an expert echocardiographer using a GE Vivid I or Vivid Q portable ultrasound device (reference test), and one performed by a nonexpert practitioner using a GE Vscan handheld ultrasound device (index test). The accuracy of the index test, compared with the reference test, for identifying cases with definite or borderline RHD was determined. RESULTS: There were 3111 enrolled participants; 2573 had both an index test and reference test. Median age was 12 years (interquartile range, 10-15); 58.2% were female. Proportion with definite or borderline RHD was 5.52% (95% CI, 4.70-6.47); proportion with definite RHD was 3.23% (95% CI, 2.61-3.98). Compared with the reference test, sensitivity of the index test for definite or borderline RHD was 70.4% (95% CI, 62.2-77.8), specificity was 78.1% (95% CI, 76.4-79.8). CONCLUSIONS: Nonexpert practitioners can be trained to perform single parasternal-long-axis view with a sweep of the heart echocardiography. However, the specificity and sensitivity are inadequate for echocardiographic screening. Improved training for nonexpert practitioners should be investigated.

Bone changes in the mandibular incisors after orthodontic correction of dental crowding without extraction: A cone-beam computed tomographic evaluation.

PURPOSE: This study aimed to evaluate changes of the alveolar bone and interdental bone septum of the mandibular incisors through cone-beam computed tomography (CBCT) after orthodontic treatment of mandibular dental crowding without dental extraction. MATERIALS AND METHODS: The sample consisted of 64 CBCT images (32 pre-treatment and 32 post-treatment) from 32 adult patients with class I malocclusion and an average age of 23.0±3.9 years. The width and height of the alveolar bone and interdental septum, the distance between the cementoenamel junction (CEJ) and the facial and lingual bone crests, and the inclination of the mandibular incisors were measured. RESULTS: The distance between the CEJ and the marginal bone crest on the facial side increased significantly (P<0.05). An increased distance between the CEJ and the bone crest on the facial and lingual sides showed a correlation with the irregularity index (P<0.05); however, no significant association was observed with increasing mandibular incisor inclination (P>0.05). The change in the distance between the CEJ and the marginal bone crest on the facial side was correlated significantly with bone septum height (P<0.05). CONCLUSION: Bone dehiscence developed during the treatment of crowding without extraction only on the incisors' facial side. Increasing proclination of the mandibular incisor was not correlated with bone dehiscence. The degree of dental crowding assessed through the irregularity index was associated with the risk of developing bone dehiscence. The interdental septum reflected facial marginal bone loss in the mandibular incisors.

New procedures for the confirmation of brain death in Brazil: results from the Central Estadual de Transplantes de Santa Catarina. / Novos procedimentos de confirmação da morte encefálica no Brasil: resultados da Central Estadual de Transplantes de Santa Catarina.

OBJECTIVE: To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina. METHODS: This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student's t-test, and qualitative variables were analyzed by Pearson's chi-squared test. RESULTS: The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods. CONCLUSION: In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.

OBJETIVO: Analisar o impacto da resolução 2.173/2017 do Conselho Federal de Medicina nos resultados da Central Estadual de Transplantes de Santa Catarina. MÉTODOS: Estudo observacional do tipo transversal, com dados de prontuário de todos os pacientes (1.605) com suspeita de morte encefálica notificados à Central Estadual de Transplantes de Santa Catarina e que iniciaram procedimentos para confirmação desse diagnóstico entre julho de 2016 e dezembro de 2017 e entre janeiro de 2018 e junho de 2019. A mediana do tempo de duração do protocolo em cada período foi considerada para a comparação entre os intervalos. Os dados coletados foram transformados em taxas (por milhão de população). As taxas médias dos períodos antes e depois da implantação do protocolo foram analisadas pelo teste t de Student, e as variáveis qualitativas foram analisadas pelo teste do qui-quadrado de Pearson. RESULTADOS: O tempo médio de duração dos procedimentos de confirmação de morte encefálica apresentou redução de mais de 1 hora no segundo período em relação ao primeiro, com significância estatística (p = 0,001). As taxas de fígados captados e de pâncreas transplantados, o número de notificações por porte hospitalar e a taxa de parada cardiorrespiratória na macrorregião do Vale do Itajaí também apresentaram diferenças com significância estatística na comparação entre os dois períodos. CONCLUSÃO: No período após a nova resolução sobre morte encefálica, houve redução do tempo de duração do diagnóstico. Contudo, outros indicadores não sofreram alteração significativa, evidenciando a natureza multidimensional do processo de transplante de órgãos em Santa Catarina e a necessidade de mais estudos para a melhor compreensão e otimização do processo.

Prevalence and characterization of maxillary sinus septa in a brazilian population.

BACKGROUND: The aim of this study was to assess the anatomic aspects of the maxillary sinus septa, by means of computed tomography images, in a Brazilian population. The results might be of clinical significance in sinus lift surgery planning. MATERIAL AND METHODS: In the study, 123 computed tomographs obtained from a private radiology clinic were used. They were analyzed by a single, trained and calibrated observer in order to evaluate the presence, quantity, localizations, dimensions, orientations and different characteristics in dentate, partially edentulous and completely edentulous individuals of the sinus septa. RESULTS: Of the individuals analyzed, 26% had a septum in the maxillary sinus, with 59.6% being classified as complete, 44.2% showed prevalence for the middle region of the maxillary sinus. There was no statistically significant difference between the right and left sides (p>0.05). CONCLUSIONS: The majority of patients in the sample analyzed presented to septa in the maxillary sinuses, and when septa were present, a higher number of occurrence was noted in the middle region of the maxillary sinus. (This region is normally the choice of sinus lift surgery). There was no predilection relative to age, sex and type of dentition. Key words:Multislice computed tomography, maxillary antrum, anatomic variation.

Análise da tendência histórica das relações da AIDS com a tuberculose em Santa Catarina entre 2001 e 2016 / Analysis of the historical trend of the relationships of AIDS with tuberculosis in Santa Catarina between 2001 and 2016

RESUMO Introdução: A prevalência da AIDS em Santa Catarina, além do seu impacto direto sobre a saúde, ampliou o risco para os infectados, pois tornou mais frequente a associação com outras infecções, caso das coinfecções AIDS-Tb (Tuberculose). Objetivo: Caracterizar a evolução temporal da Tuberculose, da AIDS e da coinfecção da Tuberculose com a AIDS, bem como analisar suas relações em Santa Catarina no período 2001-2016. Métodos: As informações obtidas foram baseadas nos registros do Sistema de Informação de Agravos de Notificação (SINAN) e em dados secundários sob guarda da Divisão de Vigilância Epidemiológica (DIVE). Resultados: A pesquisa estudou 44.410 casos notificados com os agravos de interesse, todos residentes no estado de Santa Catarina. As macrorregiões de maior ocorrência foram as da Foz do Rio Itajaí, Grande Florianópolis, Nordeste, Vale do Itajai. A distribuição da Tuberculose, do HIV e da Coinfecção TB-HIV em Santa Catarina no período estudado acometeu mais pacientes na faixa etária entre 30 e 39 anos, seguidos pela faixa etária dos 40 a 49 anos. Conclusão: Houve um aumento de incidência na faixa etária dos 50 a 59 anos, demonstrando uma possível tendência de envelhecimento do perfil etário da população infectada por estes agravos. O sexo masculino também demonstrou ter mais risco de agravos, mas mantendo o padrão da relação nacional de 2:1 quando comparado ao sexo feminino. PALAVRA-CHAVE: AIDS, Tuberculose, Coinfecção AIDS-Tuberculose, estudos ecológicos

ABSTRACT Introduction: The prevalence of AIDS in Santa Catarina, in addition to its direct impact on health, increased the risk for those infected, as it made the association with other infections more frequent, such as HIV-Tb (Tuberculosis) coinfections. Objective: To characterize the temporal evolution of Tuberculosis, AIDS and the HIV-Tb coinfection, as well as analyze their relationships in Santa Catarina in the period 2001-2016. Methods: The information obtained was based on the records of the Notifiable Diseases Information System (SINAN) and on secondary data under the custody of the Epidemiological Surveillance Division (DIVE). Results: The research studied 44,410 cases reported with the diseases of interest, all residing in the state of Santa Catarina. The most frequent macro-regions were Foz do Rio Itajaí, Grande Florianópolis, Northeast, and Vale do Itajai. As for the distribution of tuberculosis, HIV and Tb-HIV coinfection in Santa Catarina in the study period, more patients aged between 30 and 39 years were affected, followed by those between 40 and 49 years. Conclusion: There was an increase in the incidence in the 50-59 years age group, demonstrating a possible trend of aging in the age profile of the population infected by these diseases. Males were also shown to have a higher risk of disease, but maintaining the national ratio pattern of 2:1 as compared to females. KEYWORDS: HIV, tuberculosis, HIV-tuberculosis coinfection, ecological studies