Versatility of the medial corticoperiosteal flap: from recalcitrant non-unions up to large bony defects.

BACKGROUND: Reconstructive microsurgery techniques using vascularized bone grafts have revolutionized the treatment of complex cases associated with recalcitrant non-unions or osteomyelitis. The medial femoral corticoperiosteal flap (MFCP flap) has emerged as a valuable option in bone reconstruction. Its clinical applications have been extended over the years considering this flap from non-unions with minimal bone lost, up to large intercalary defects of the upper and lower extremities. This article aims to present the clinical applications and outcomes of the MFCP flap in various reconstructive scenarios. METHODS: Seventy-nine patients with persistent non-union and bone defects of the upper and lower limb were evaluated from June 2008 to October 2020. All of them were reconstructed with a corticoperiosteal flap from the medial femoral condyle in our hospital. Previous procedures, bone gap and type of flap used were recorded. Postoperative functional status was assessed with time of bone healing, complications and clinical final outcome. RESULTS: Radiological evidence of bone union was observed at 4.09 months (range 2-9). Healing rate was 97% with periosteal corticocancellous flaps (PCC flaps) and 93% with corticoperiosteal flaps (CP flaps). Average follow-up was 14.5 months (range 5-28). There were no significant donor site complications. CONCLUSIONS: The MFCP flap offers a versatile and reliable option for bone reconstruction. Its ability to provide vascularized bone tissue with low morbidity enhances the healing process and improves outcomes. The MFCP flap has been increasing its applications and it serves as a valuable option in the treatment of recalcitrant non-unions or bony defects irrespective of site and size up to 5 cm in the upper and lower extremities.

Dual-Language Use and Cognitive Function Among Mexican Americans Aged 65 and Older.

Background: Better English proficiency and higher frequency of using English among non-native speakers are associated with lower dementia risk. Objective: We investigated if Mexican American older adults who use English and Spanish to a more similar degree demonstrate better cognitive function than those who use one language more than the other. Methods: We used data from waves one (1992/93) to eight (2012/13) of the Hispanic Established Population for the Epidemiological Study of the Elderly. At baseline, participants were asked what language they usually use across communicative contexts. We based dual language on participants' use of Spanish and English within and across contexts. We categorized participants as low (n = 1,145), medium (n = 717), and high (n = 702) dual-language users. Linear mixed models were used to estimate the association between dual-language use, baseline Mini-Mental State Examination (MMSE) scores, and change in MMSE. Results: Participants in the medium and high dual-language use categories scored 1.91 points and 3.03 points higher at wave one compared to the low dual-language use category. Adjusting for education reduced the association between dual-language use and baseline MMSE (medium B = 0.99 SE = 0.19 p < 0.01; high B = 1.41 SE = 0.21 p < 0.01). The association between dual-language use and decline in the MMSE was not statistically significant. Conclusions: Greater dual-language use was associated with higher MMSE scores but not change in MMSE scores among Mexican Americans aged 65 and older. Future work should characterize bilingualism with greater nuance and use more rigorous cognitive measures to identify the components of the bilingual experience that may benefit the cognitive functioning of older adult bilinguals.

Peripheral odontogenic fibroma in a child with Ellis-van Creveld syndrome: Case report.

INTRODUCTION: Ellis-van Creveld (EVC) syndrome is an autosomal recessive disorder predominantly characterized by a disproportionate dwarfism, ectodermal dysplasia, postaxial polydactyly, and congenital heart malformations and pulmonary hypoplasia. OBJECTIVE: In this article, we hereby present a case of a 6-year-old Brazilian boy with EVC syndrome who presented a rare oral lesion as well as a remarkable number of classical and uncommon oral and dental features. CASE REPORT: Clinical and radiographic examination revealed multiple enamel hypoplasia, teeth agenesis, conical teeth, lower canine rotation, bilateral posterior crossbite, taurodontism of deciduous and permanent molars and delayed tooth eruption, dental caries, and absent vestibular sulcus. Additionally, a whitish lobulated nodule located in the alveolar ridge in the anterior region of the mandible was noted. Anatomopathological examination was compatible with the diagnosis of peripheral odontogenic fibroma (POF). In a 10-month clinical follow-up, no signs of recurrence were observed. CONCLUSION: In view of the characteristic oral findings of EVC syndrome and the potential for recurrence of POF, the pediatric dentist plays an essential role in clinical follow-up, planning and preventive, and rehabilitative treatment.

Luxación intrusiva en dentición primaria: reporte de caso / Luxação intrusiva na dentição decídua: relato de caso clínico / Intrusive luxation in primary dentition: clinical report

La luxación intrusiva es el tipo más común de lesión traumática en la dentición primaria, caracterizada por el desplazamiento del diente hacia el interior del alvéolo. Requieren minucioso examen clínico, buena radiografía y seguimiento del caso, siendo el prognóstico desfavorable, principalmente por la probabilidad de daño al germen del diente permanente. Este trabajo tiene como objetivo reportar un caso clínico de luxación intrusiva en dentición primaria, desde el diagnóstico hasta el seguimiento. Se trata de un paciente masculino, de 3 años, que acudió a la Emergencia de la Clínica de Especialidades Infantiles ­ Universidad Estatal de Londrina (UEL) por traumatismo dentoalveolar en la región antero-superior ocurrido hace tres días. En el examen físico, se observó que el diente 61 presentaba intrusión de grado II con un tercio de la corona visible y el diente 62 intrusión de grado I, con más de un tercio de la corona visible. Radiográficamente se observa inclinación vestibular, sin fractura de la placa ósea, por lo que se optó por un tratamiento conservador, a la espera de la reerupción espontánea de los dientes afectados. Se informó a los padres sobre posibles consecuencias de este tipo de traumatismo y la necesidad de consultas de seguimiento clínico y radiológico. Después de ocho meses de seguimiento, los dientes erupcionaron satisfactoriamente. Es de suma importancia establecer un protocolo de observación y control del diente en el cual se ha identificado el trauma, observando signos y síntomas de los tejidos involucrados en el trauma para reducir secuelas en ambas denticiones

A luxação intrusiva é o tipo de lesão traumática mais frequente na dentição decídua, caracterizada pelo deslocamento do dente para o alvéolo. As intrusões requerem exame físico minucioso, radiografias de valor diagnóstico e acompanhamento do caso, pois o prognóstico é desfavorável, principalmente pela probabilidade de danos ao germe dentário permanente. Este trabalho tem como objetivo relatar um caso clínico de luxação intrusiva na dentição decídua, desde o diagnóstico até o acompanhamento. Trata-se de paciente do sexo masculino, 3 anos de idade, atendido no Pronto Socorro do Ambulatório de Especialidades Infantis da Universidade Estadual de Londrina (UEL) devido a trauma dento-alveolar em região ântero-superior ocorrido há três dias. Ao exame físico intraoral, observou-se que o dente 61 apresentava intrusão grau II (um terço da coroa visível) e o dente 62 apresentava intrusão grau I, com mais de um terço da coroa visível. Radiograficamente foi observada inclinação vestibular, sem fratura da tábua óssea. Assim, optou-se pelo tratamento conservador, aguardando a reerupção espontânea dos dentes envolvidos. Além disso, os pais foram informados sobre as possíveis consequências deste tipo de trauma e a necessidade de consultas de proservação clínica e radiográfica. Após oito meses de acompanhamento, os dentes erupcionaram satisfatoriamente. É de extrema importância estabelecer um protocolo de observação e controle do dente traumatizado, observando sinais e sintomas dos tecidos envolvidos no trauma para reduzir sequelas em ambas as dentições.

Intrusive dislocation is the most frequent type of traumatic injury in the primary dentition, characterized by displacement of the tooth into the alveolus. Intrusions require a thorough physical examination, radiographs of diagnostic value, and follow-up of the case, since the prognosis is unfavorable, mainly due to the probability of damage to the permanent tooth germ. This work aims to report a clinical case of intrusive dislocation in the primary dentition, from diagnosis to follow-up. This is a male patient, 3 years old, who attended in the Emergency of the Children's Specialty Clinic ­ State University of Londrina (UEL) due to dento-alveolar trauma in the antero-superior region that occurred three days ago. On clinical examination, tooth 61 had grade II intrusion (one-third of the crown visible), and tooth 62 with grade I intrusion, with more than one-third of the crown visible. Radiographically, a buccal inclination was observed, with no fracture of the bone plate. Thus, we opted for conservative treatment, waiting for the spontaneous re-eruption of the teeth involved. Furthermore, parents were informed about the possible consequences of this type of trauma and the need for clinical and radiographic follow-up consultations. After eight months of follow-up, the teeth erupted satisfactorily. It is extremely important to establish a protocol for observation and control of the traumatized tooth, observing signs and symptoms of the tissues involved in the trauma to reduce sequelae in both dentitions

Multidisciplinary management of a tooth with severe root dilaceration and enamel hypoplasia: a case report.

Dental trauma in primary teeth can cause irreversible changes in the development of permanent tooth germs, including enamel hypoplasia, crown dilaceration, and root dilaceration. This article discusses multidisciplinary treatment of enamel hypoplasia and root dilaceration in the maxillary left central incisor of an 11-year-old girl. A 10-year follow-up is reported to demonstrate the long-term clinical outcomes. At the initial presentation, the patient's mother reported that the child had an accident at the age of 2 years, resulting in intrusive luxation of the primary maxillary left central incisor. After the accident, the patient was monitored for eruption of the permanent successor tooth, and different approaches were proposed during each period of the patient's development on the basis of the clinical diagnosis of root dilaceration and enamel hypoplasia. The crown was restored with composite resin, and the root defect was restored with resin-modified glass ionomer cement. After 10 years, the clinical outcomes highlight that the multidisciplinary approach was successful in preserving the natural tooth with good periodontal health conditions.

The Tandem Control-IQ advanced hybrid system improves glycemic control in children under 18 years of age with type 1 diabetes and night rest in caregivers.

OBJECTIVE: To determine the impact of switching from the predictive low glucose suspend (PLGS) system to the advanced hybrid Tandem Control-IQ system on glucometrics and glycosylated haemoglobin (HbA1c) at one year. To assess the impact on the quality of life perceived by parents. METHOD: Prospective study in 71 patients aged 6-18 years with type 1 diabetes (DM1), in treatment with PLGS, who switched to an advanced hybrid system. Glucometric data were collected before the change, at 4 and 8 weeks, and at one year of use; HbA1c before the change and after one year. The Diabetes Impact and Devices Satisfaction (DIDS) questionnaire was used at weeks 4 and 8. RESULTS: An increase in time in range (TIR) was observed with a median of 76% (P<.001) at 4 weeks, which was maintained after one year (+8% in the total group). Overall, 73.24% of patients achieved a TIR above 70%. The subgroup with an initial TIR of less than 56% increased it by 14.4%. After one year there was a 0.3% reduction in HbA1c. Level 1 hypoglycaemia, level 1 and level 2 hyperglycaemia, mean glucose (GM) and coefficient of variation (CV) decreased. Auto mode stayed on 97% of the time and no dropouts occurred. Caregivers had a perception of better glycaemic control and less need to monitor blood glucose variations during the night. None of them would switch back to the previous system and they feel safe with the new system. CONCLUSIONS: The Tandem Control-IQ advanced hybrid system was shown to be effective one year after its implementation with improvement in all glucometric parameters and HbA1c, as well as night-time rest in caregivers.

Undergraduate nursing students' knowledge and experience in infusion therapy and peripheral vascular acces.

OBJECTIVES: to analyze the knowledge and experience of undergraduate nursing students regarding infusion therapy and peripheral vascular access. METHODS: descriptive, cross-sectional, analytical study with 123 undergraduate nursing students who answered a semi-structured instrument. RESULTS: the majority were women, with a median age of 51 years old; 87% considered the teaching received insufficient to perform in clinical practice. The mean overall knowledge score was 78.1 (SD± 8.97). The themes catheter flushing and lock (38.1%), catheter selection (34.2%), infusion equipment (30.9%) and insertion site (30.9%) presented a significant number of errors. CONCLUSIONS: practical classes and execution of procedures in health services were predictors for a better knowledge about infusion therapy and vascular access by undergraduate nursing students.

Analysis of the SHARPEN Score in the Prediction of In-Hospital Mortality of Patients With Infective Endocarditis Undergoing Cardiac Surgery

Abstract Background The SHARPEN score was developed to predict in-hospital mortality in patients hospitalized for infective endocarditis (IE), undergoing or not undergoing cardiac surgery. A comparison with other available scores has not yet been carried out. Objective To evaluate the performance of the SHARPEN score in predicting in-hospital mortality in patients hospitalized for IE undergoing cardiac surgery and compare it with that of both nonspecific and IE-specific surgical scores. Methods Retrospective cohort study including all admissions of patients ≥18 years who underwent cardiac surgery due to active IE (modified Duke criteria) at a tertiary care university hospital between 2007 and 2016. The SHARPEN score was compared to the EuroSCORE, EuroSCORE II, STS-IE, PALSUSE, AEPEI, EndoSCORE and RISK-E scores. Differences P<0.05 were considered statistically significant. Results A total of 105 hospitalizations of 101 patients (mean age 57.4±14.6 years; 75.2% male) were included. The median SHARPEN score was 11 (9-13) points. The observed in-hospital mortality was 29.5%. There was no statistically significant difference in observed vs. estimated mortality (P = 0.147), with an area under the ROC curve of 0.66 (P = 0.008). In comparison with the other scores, no difference was observed in discriminative ability. The statistics of the SHARPEN score at a cutoff >10 points — positive predictive value (PPV): 38.1%, 95%CI:30.4-46.6; negative predictive value (NPV): 80.0%, 95%CI:69.8-87.4; and accuracy: 58.1%, 95%CI:48.1-67.6 — showed overlapping 95%CIs, indicating no significant difference between scores. Conclusions The SHARPEN score did not present parameters with a significant difference in relation to the other scores analyzed; despite the easy obtainment of its few variables, it has limited applicability in clinical practice, like other existing scores.

Caracterización física y sensorial de 24 genotipos especiales de cacao Theobroma cacao

Colombia, se destaca como país productor de cacao fino y de aroma, por lo cual, resulta de gran importancia explorar las características físicas y sensoriales de la diversidad genética existente. Para el presente estudio, se seleccionaron 22 genotipos de colecciones de trabajo con atributos productivos sobresalientes y dos testigos comerciales, reconocidos por su productividad y calidad sensorial; las muestras evaluadas fueron tomadas, de acuerdo con un muestreo aleatorio simple y se realizó un proceso de poscosecha homogéneo, controlado e independiente por genotipo, para obtener muestras de cacao seco individuales. Se realizaron análisis físicos al grano de cada genotipo y se preparó licor de cacao con cada una de las muestras obtenidas. Posteriormente, se evaluó cada licor por medio del panel de evaluación sensorial entrenado, donde se identificó y cuantificó la intensidad de atributos básicos, atributos especiales y atributos adquiridos, característicos de cada muestra. La información fue analizada mediante estadística descriptiva y análisis de componentes principales, lo que permitió la identificación de tres genotipos sobresalientes por el índice de grano y el porcentaje de cascarilla. El análisis sensorial evidenció que, en diecisiete genotipos, predominaron los atributos especiales, como herbal, floral, frutal, frutos secos y dulce. Estos resultados son un aporte importante para la selección de nuevas variedades de alta productividad, con características sensoriales de interés para la comercialización, que pueden ser evaluadas en diferentes regiones, para aumentar la disponibilidad genética en futuros programas de renovación y siembra de cacao que está en expansión, en los distintos territorios del país.

Colombia stands out as a country that produces fine and aroma cocoa; therefore, it is of great importance to explore the physical and sensory characteristics of the existing genetic diversity. For the present study, 22 genotypes from working collections with outstanding productive attributes and two recognized commercial controls were selected and evaluated for its productivity and sensory quality; the evaluated samples were taken according to a simple random sampling and a homogeneous, controlled, and independent post-harvest process was carried out by genotype, to obtain individual dry cocoa samples. Physical analyzes were carried out on the grain of each genotype and cocoa liquor was prepared with each of the samples obtained. Subsequently, each liquor was evaluated by means of the trained sensory evaluation panel, where the intensity of basic attributes, special attributes and acquired attributes characteristic of each sample was identified and quantified. The information was analyzed through descriptive statistics and principal component analysis, which allowed the identification of three outstanding genotypes by the grain index, and the husk percentage. The sensory analysis showed that, in seventeen genotypes, special attributes predominated such as: herbal, floral, fruity, dried fruit and sweet. These results are an important contribution for the selection of new high productivity varieties with sensory characteristics of interest for commercialization, which can be evaluated in different regions, to increase genetic availability in future renewal and planting programs of cocoa that is expanding in the different territories of the country.

Early variation of inflammatory indexes refines prognostic prediction in patients with hepatocellular carcinoma under systemic treatment.

Prognostic markers in advanced hepatocellular carcinoma (HCC) are relevant for clinical decisions. Variations in inflammatory indexes, such as neutrophil-to-lymphocyte ratio (NLR) or platelet-to-lymphocyte ratio (PLR), may correlate with outcomes. In the present study, it was aimed to assess the prognostic role of inflammation indexes in patients with HCC and the evolutionary behavior of these variables within the first month of treatment in a cohort of patients treated with sorafenib from 2009-2021. Subgroups were divided based on the median of each variable ('low' or 'high)'. Survival was estimated using the Kaplan-Meier method. Hazard Ratio (HR) with 95% confidence interval (CI) were estimated using Cox regression models. A total of 373 patients were included, most Child-Pugh-A (83.1%) and BCLC-C (74%). Child-Pugh-A (P=0.011), performance status 0 (P<0.001), no ascites (P<0.001) and NLR<2.6 (P<0.001) were independently associated with improved survival. Baseline PLR was not correlated with survival (P=0.137). Patients who maintained low NLR at baseline and at 1 month (reference subgroup) had improved survival (18.6 months, 95% CI:15.4-22.0) compared with the subgroup that maintained high NLR at baseline and at 1 month (4.2 months, 95% CI:3.6-5.9), with HR: 3.80 (95% CI: 2.89-4.96). The subgroup with low NLR at baseline and high NLR at 1 month had a worse prognosis compared with the reference group (HR:1.4, 95% CI: 1.1-2.0), whereas the subgroup with high NLR at baseline and low at 1 month had similar outcome (HR:1.2, 95% CI: 0.8-1.6). It was concluded that evolutionary variation of NLR has a prognostic role in HCC patients under systemic therapy. This finding suggested that systemic inflammation and early modulation of the immune environment during treatment may correlate with outcomes.

Fragment reattachment or direct restoration? An in vitro study.

BACKGROUND/AIM: The fracture resistance of teeth subjected to fragment reattachment may improve when the technique is performed using intermediate materials. The aim of this study was to evaluate the influence of different bonding materials, including pre-heated composite resin, on the fracture resistance of teeth subjected to the reattachment technique compared with a direct composite resin restoration. MATERIALS AND METHODS: After simulating a tooth fracture, each specimen was reattached by using one of the following intermediate materials (n = 15): G0, negative control (sound teeth); G1, Z100; G2, pre-heated Z100; G3, Filtek Z350 XT; G4, pre-heated Filtek Z350 XT; G5, Filtek Z350 XT Flow; and G6, RelyX Veneer. In G7, direct class IV restorations were performed using Filtek Z350 XT composite resin. The fracture resistance was evaluated using a universal testing machine under a compressive load of 1 mm/min. One-way analysis of variance (ANOVA) and the post hoc Tukey test (5%) were conducted. RESULTS: G0 showed the highest fracture resistance, and this was statistically different from the other experimental groups (p < .05) except for G2 and G4, in which the fragments were bonded using pre-heated resins. A statistically significant difference was found between groups G1 and G6 (one-way ANOVA, p = .04). For G1 and G2, a significant difference was found between bonding with and without pre-heating (p < .05). This difference was not observed in G3 and G4 (p > .05). No statistically significant difference was found between the reattached and directly restored groups (t-test, p = .53). CONCLUSIONS: The tooth reattachment technique using pre-heated composite resin showed fracture resistance values similar to those of the sound tooth group. No difference was found between the fragment reattachment and direct composite resin techniques.

Cervical dorsal root ganglion stimulation for complex regional pain syndrome: Technical description and results of seven cases.

INTRODUCTION: Complex regional pain syndrome (CRPS) is characterized by nociplastic pain with alterations in sympathetic function. Neuromodulation could be a useful alternative therapy option. Dorsal root ganglion (DRG) stimulation has demonstrated better results than conventional spinal cord stimulation (SCS) for patients with CRPS in lower limbs. METHODS: We report a case series of seven patients treated with cervical DRG stimulation for CRPS of the hand that required neuromodulation for pain relief, after no response with other analgesic techniques (medication and interventional). We report retrospective data collection of seven consecutive patients with a 1-year follow-up. RESULTS: Seven patients were trialed, and six were implanted with a permanent pulse generator after achieving more than 50% pain relief during 2-7 days of trial phase. The average pain relief (rated on a standard 100 mm visual analog scale) after 1 year of treatment was 64.3% ± 16.6. No major complications were observed during a 1-year follow-up. DISCUSSION: The results for cervical DRG stimulation are similar to other DRG stimulation studies for the treatment of refractory CRPS at lower levels. The cervical DRG implant technique guided with C-arm fluoroscopy and under conscious sedation could be a safe and effective option for relieving pain of the upper limbs CRPS. Monitoring neural status is required for cervical DRG stimulation either with a responder awake patient or with intraoperative neural monitoring in non-responder patients.

Undergraduate nursing students' knowledge and experience in infusion therapy and peripheral vascular acces / Conocimiento y experiencia de estudiantes avanzados de enfermería en terapia infusional y accesos vasculares periféricos / Conhecimento e experiência de graduandos de enfermagem em terapia infusional e acessos vasculares periféricos

ABSTRACT Objectives: to analyze the knowledge and experience of undergraduate nursing students regarding infusion therapy and peripheral vascular access. Methods: descriptive, cross-sectional, analytical study with 123 undergraduate nursing students who answered a semi-structured instrument. Results: the majority were women, with a median age of 51 years old; 87% considered the teaching received insufficient to perform in clinical practice. The mean overall knowledge score was 78.1 (SD± 8.97). The themes catheter flushing and lock (38.1%), catheter selection (34.2%), infusion equipment (30.9%) and insertion site (30.9%) presented a significant number of errors. Conclusions: practical classes and execution of procedures in health services were predictors for a better knowledge about infusion therapy and vascular access by undergraduate nursing students.

RESUMEN Objetivos: analizar el conocimiento y experiencia de estudiantes avanzados de enfermería sobre terapia infusional y accesos vasculares periféricos. Métodos: investigación descriptiva, transversal, analítica; con 123 estudiantes del último curso de enfermería, que respondieron a un instrumento semiestructurado. Resultados: mayoría de mujeres, mediana de 51 años; el 87% considera insuficiente la enseñanza recibida para desempeñarse en la práctica clínica. El promedio general de puntos de conocimiento fue del 78% (DE± 8,97). Los temas flushing y lock del catéter (38,1%), selección del catéter (34,2%), equipos de infusión (30,9%) y punto de inserción (30,9) mostraron un número significativo de errores. Conclusiones: clases prácticas y realización de procedimientos en servicios de salud fueron el camino a un mayor conocimiento en terapia infusional y acceso vascular para los estudiantes del último curso de enfermería.

RESUMO Objetivos: analisar o conhecimento e a experiência de graduandos de enfermagem relacionados à terapia infusional e aos acessos vasculares periféricos. Métodos: pesquisa descritiva, transversal, analítica, com 123 estudantes do curso de graduação em enfermagem que responderam a um instrumento semiestruturado. Resultados: a maioria, mulheres, com mediana de 51 anos; 87% consideraram o ensino recebido insuficiente para atuar na prática clínica. A média de pontos geral de conhecimento foi de 78,1 (DP± 8,97). Os temas flushing e lock do cateter (38,1%), seleção do cateter (34,2%), equipamentos para infusão (30,9%) e sítio de inserção (30,9%) apresentaram número significativo de erros. Conclusões: aulas práticas e realização de procedimentos nos serviços de saúde foram preditores para um melhor conhecimento sobre terapia infusional e acesso vascular pelos estudantes do curso de graduação em enfermagem.

Manifestaciones orales en paciente infantil con síndrome de Ellis-van Creveld: informe de caso / Manifestações orais em paciente infantil com síndrome de Ellis-van Creveld: relato de caso / Oral manifestations in child patient with Ellis-van Creveld syndrome: case report

El síndrome de Ellis-van Creveld es un trastorno autosómico recesivo caracterizado por una tétrada de enanismo desproporcionado, displasia ectodérmica, polidactilia postaxial y malformaciones cardíacas congénitas. En este artículo, presentamos el caso de un niño brasileño de 6 años con síndrome de Ellis-van Creveld que presentó un número notable de características orales y dentales clásicas y hallazgos poco comunes como taurodontismo. El examen clínico reveló hipoplasia múltiple del esmalte, surco vestibular ausente, aserraduras alveolares en la región anterior del maxilar, dientes ausentes, dientes cónicos, canino inferior girado, mordida cruzada posterior bilateral, caries dental y un nódulo. Radiográficamente se observa agenesia dentaria, taurodontismo de molares primarios y permanentes y retraso en la erupción dentaria. Los hallazgos clínicos y radiográficos pueden estar presentes desde el nacimiento y el odontopediatra tiene un papel fundamental en el diagnóstico precoz del síndrome de Ellis-van Creveld, así como en la prevención de problemas orales, rehabilitación e intervenciones estéticas.

A síndrome de Ellis-van Creveld é uma doença autossômica recessiva caracterizada por uma tétrade de baixa estatura desproporcional, displasia ectodérmica, polidactilia pós-axial e malformações cardíacas congênitas. Neste artigo, será relatado um caso de um menino brasileiro de 6 anos de idade com síndrome de Ellis-van Creveld que apresenta um número notável de características orais e dentárias clássicas e achados incomuns como taurodontismo. Ao exame clínico foi revelado hipoplasia múltipla do esmalte, sulco vestibular ausente, serrilhas alveolares na maxila anterior, dentes ausentes, dentes cônicos, canino inferior rotacionado, mordida cruzada posterior bilateral, cárie dentária e um nódulo. Radiograficamente, foi observado agenesia dentária, taurodontismo de molares decíduos e permanentes e atraso na erupção dentária. Os achados clínicos e radiográficos podem estar presentes desde o nascimento e o odontopediatra tem papel fundamental no diagnóstico precoce da síndrome de Ellis-van Creveld, bem como na prevenção de problemas bucais, reabilitação e intervenções estéticas.

Ellis­van Creveld syndrome is an autosomal recessive disorder characterized by a tetrad of disproportionate dwarfism, ectodermal dysplasia, postaxial polydactyly, and congenital heart malformations. In this article, we hereby present a case of a 6-year-old Brazilian boy with Ellis­van Creveld syndrome who presented with a remarkable number of classical oral and dental features and uncommon findings such as taurodontism. Clinical examination revealed multiple enamel hypoplasia, absent vestibular sulcus, alveolar serrations in the maxilla anterior region, missing teeth, conical teeth, lower canine rotation, bilateral posterior crossbite, dental caries, and a nodule. Radiographically were observed teeth agenesis, taurodontism of deciduous and permanent molars, and delayed tooth eruption. Clinical and radiographic findings may be present from birth and the pediatric dentist has a fundamental role in the early diagnosis of Ellis­van Creveld syndrome, as well as oral problems prevention, rehabilitation, and aesthetic interventions.

Técnica de micromarsupialización en ránula oral: reporte de dos casos clínicos en paciente infantil / Técnica de micromarsupialização em rânula oral: relato de dois casos clínicos em paciente infantil / Micromarsupialization technique in oral ranula: report of two clinical cases in child patient

Introducción: Ránulas orales son pseudoquistes resultantes de la retención de mucus o extravasación de saliva que suelen afectar a los niños. Este artículo tiene como objetivo reportar dos casos clínicos de ránulas orales y discutir el tratamiento mediante la técnica de micromarsupialización. Reporte de caso 1: Niña de 6 años de edad, acudió al servicio de urgencia en odontopediatría de la Bebé Clínica de la Universidad Estatal de Londrina refiriendo "bolita debajo de la lengua" de aproximadamente 3 meses de evolución. Clínicamente se observó burbuja rojiza de aproximadamente 1,5 cm de diámetro ubicada en el lado derecho del suelo bucal en forma de cúpula, base sésil y fluctuante. Reporte de caso 2: Niña de 5 años, acudió al mismo servicio con queja de "burbuja en la lengua" de aproximadamente 2 meses de evolución. Clínicamente se observó burbuja de color rosado similar a la mucosa de aproximadamente 1 cm de diámetro ubicada en el lado izquierdo del suelo bucal con forma circunscrita, base sésil y fluctuante. Con base en los aspectos clínicos y la historia actual de las lesiones, el diagnóstico fue ránula oral y el tratamiento quirúrgico realizado fue micromarsupialización. En el seguimiento clínico de 8 y 6 meses, respectivamente, hubo regresión total de las lesiones sin signos clínicos de recurrencia. Conclusión: Con base en dos casos clínicos reportados, se puede concluir que el uso de la técnica de micromarsupialización representa procedimiento quirúrgico efectivo en niños por su rápida ejecución, abordaje conservador, sin el uso de anestesia local infiltrativa, bien tolerado y con buen pronóstico.

Introdução: Rânulas orais são pseudocistos resultantes da retenção de muco ou extravasamento de saliva que frequentemente acometem crianças. Este artigo objetiva relatar dois casos clínicos de rânulas orais e discutir o tratamento utilizando a técnica de micromarsupialização. Relato de caso 1: menina de 6 anos, compareceu ao Pronto-Socorro da Bebê Clínica da Universidade Estadual de Londrina queixando-se de "bola embaixo da língua" com duração aproximada de 3 meses. Ao exame intraoral, notou-se bolha avermelhada de aproximadamente 1,5 cm de diâmetro localizada no lado direito do assoalho bucal em forma de cúpula, base séssil e flutuante. Relato de caso 2: menina de 5 anos, compareceu ao mesmo serviço com queixa de "bolha na língua" com duração aproximada de 2 meses. Clinicamente, notou-se bolha de coloração rósea igual à mucosa de aproximadamente 1 cm de diâmetro localizada no lado esquerdo do assoalho bucal de formato circunscrito, base séssil e flutuante. Com base nos aspectos clínicos e na história atual das lesões, o diagnóstico foi de rânula oral e o tratamento cirúrgico realizado foi a micromarsupialização. Em acompanhamento clínico de 8 e 6 meses, respectivamente, foi observado regressão total das lesões sem sinais clínicos de recidiva. Conclusão: A partir dos casos clínicos relatados, pode-se concluir que a utilização da técnica de micromarsupialização representa um procedimento cirúrgico eficaz em crianças devido à rápida execução, abordagem conservadora, sem uso de anestesia local infiltrativa, bem tolerada e com bom prognóstico.

Introduction: Oral ranulas are pseudocysts resulting from the retention of mucus or extravasation of saliva that often affect children. This article aims to report two clinical cases of oral ranulas and discuss the treatment using the micromarsupialization technique. Case report 1: 6-year-old girl, attended the Emergency Room of the Baby Clinic of the State University of Londrina complaining of a "ball under the tongue" lasting approximately 3 months. Clinically, reddish bubble of approximately 1.5 cm in diameter was noted located on the right side of the dome-shaped mouth floor, sessile base and fluctuating. Case report 2: 5-year-old girl, attended the same service with a complaint of "bubble on the tongue" lasting approximately 2 months. Clinically, pink-colored bubble similar to the mucosa of approximately 1 cm in diameter was observed located on the left side of the floor of the mouth with a circumscribed shape, sessile base and fluctuating. Based on the clinical aspects and the current history of the lesions, the diagnosis was oral ranula and the surgical treatment performed was micromarsupialization. In a clinical follow-up of 8 and 6 months, respectively, total regression of the lesions was observed, with no clinical signs of recurrence. Conclusion: Based on the reported clinical cases, it can be concluded that the use of micromarsupialization technique represents an effective surgical procedure in children due to its quick execution, conservative approach, without the use of local infiltrative anesthesia, well tolerated and with good prognosis.

Direct Resin Composite Restoration in Anterior Tooth: 10 Years of Clinical Follow-Up

The emergence and development of resin-based materials, such as resin composites and adhesive systems, have shifted the restorative treatment of anterior teeth with caries lesions and/or fractures. Thus, based on the disadvantages of indirect restorations, direct esthetic restorations are restorative options even for anterior teeth with exten sive loss of hard tissues. This study aimed to describe and discuss the direct resin composite restoration performed to solve the esthetic and functional impairments of the upper anterior teeth with diastemas. The upper left central incisor received total crown preparation for indirect restoration. Clinical results after 10 years were recorded. Considering the clinical characteris tics of dental restorations, it is possible to conclude that direct resin composite restorations reestablished the esthetic and functional properties satisfactorily, even in a tooth with extensive coronal destruction. The success of the restorative treatm ent was dependent on factors related to the materials´ properties, oral habits of the patient, and mostly the clinical skills of th e dental clinician.

La aparición y el desarrollo de materiales con base de resina, como las resinas compuestas y los sistemas adhesivos, han cambiado el tratamiento restaurador de los dientes anteriores con lesiones de caries y/o fracturas. Por lo tanto, en base a las desventajas de las restauraciones indirectas, las restauraciones estéticas directas son opciones de restauración, incluso para los dientes anteriores con una gran pérdida de tejidos duros. Este estudio tuvo como objetivo describir y discutir la restauración directa con resina compuesta, realizada para solucionar las deficiencias estéticas y funcionales de los dientes anteriores superiores con diastemas. El incisivo central superior izquierdo recibió preparación de corona total para restauración indirecta. Se registraron los resultados clínicos después de 10 años. Considerando las características clínicas de las restauraciones dentales, es posible concluir que las restauraciones directas en resina compuesta restablecieron las propiedades estéticas y funcionales satisfactoriamente, incluso en un diente con destrucción coronal extensa. El éxito del tratamiento restaurador dependió de factores relacionados con las propiedades de los materiales, los hábitos bucales del paciente y, sobre todo, las habilidades clínicas del odontólogo.

Histological, Immunohistochemical and Antioxidant Analysis of Skin Wound Healing Influenced by the Topical Application of Brazilian Red Propolis.

Skin wound healing is a complex process that requires the mutual work of cellular and molecular agents to promote tissue restoration. In order to improve such a process, especially in cases of impaired healing (e.g., diabetic ulcer, chronic wounds), there is a search for substances with healing properties and low toxicity: two features that some natural products-such as the bee product named propolis-exhibit. Propolis is a resinous substance obtained from plant resins and exudates with antioxidant, anti-inflammatory, and antitumoral activities, among other biological ones. Based on the previously reported healing actions of different types of propolis, the Brazilian red propolis (BRP) was tested for this matter. A skin wound excision model in male Wistar rats was performed using two topical formulations with 1% red propolis as treatments: hydroalcoholic extract and Paste. Macroscopical, histological and immunohistochemical analysis were performed, revealing that red propolis enhanced wound contraction, epithelialization, reduced crust formation, and modulated the distribution of healing associated factors, mainly collagen I, collagen III, MMP-9, TGF-ß3 and VEGF. Biochemical analysis with the antioxidants SOD, MPO, GSH and GR showed that propolis acts similarly to the positive control, collagenase, increasing these molecules' activity. These results suggest that BRP promotes enhanced wound healing by modulating growth factors and antioxidant molecules related to cutaneous wound healing.

Abordagem multidisciplinar no tratamento de incisivo lateral com fratura oblíqua e lesão periapical: relato de caso clínico / Multidisciplinary approach in the treatment of lateral incisor with oblique fracture and periapical injury: clinical case report

Casos de fraturas dentárias oblíquas muitas vezes possuem um prognóstico desfavorável, geralmente com indicação da extração do elemento dental. O presente artigo visou relatar o tratamento do caso clínico de um paciente do sexo masculino, 12 anos, que compareceu à Unidade de Saúde Bucal do Hospital Universitário de Brasília com encaminhamento de extração do dente 12, apresentando fratura oblíqua que se estendia subgengivalmente na face vestibular. O trauma havia ocorrido há três anos e o paciente havia sido submetido a diversas intervenções endodônticas, apresentando no momento da consulta inicial por nossa equipe uma lesão periapical extensa. Após a realização da anamnese, exame clínico e radiográfico, foi adotada uma abordagem multidisciplinar conservadora com a manutenção do dente e a realização da enucleação da lesão periapical por meio de intervenção cirúrgica e posterior reabilitação. Em uma mesma sessão, foi realizada a obturação do conduto com cone de guta percha e cimento sealer 26 e a cirurgia parendodôntica juntamente com a apicoplastia. Uma semana após a intervenção cirúrgica foi realizada restauração classe IV com resina composta baseada no enceramento dos modelos de diagnóstico montados em articulador. Com base em uma avaliação criteriosa e multidisciplinar, foi possível adotar uma abordagem conservadora no caso em questão, com a manutenção e reabilitação de um dente permanente em um paciente jovem, evitando a indicação de exodontia(AU)

Cases of oblique dental fractures often have an unfavorable prognosis, usually with the indication of extraction of the dental element. The present article aimed to report the treatment of the clinical case of a 12-year-old male patient, who attended the Oral Health Unit of the Hospital Universitário de Brasília with a referral for extraction of tooth 7, presenting an oblique fracture that extended subgingivally on the labial surface. The trauma had occurred three years ago and the patient had undergone several endodontic interventions, presenting an extensive periapical lesion at the time of the initial consultation by our team. After anamnesis, clinical and radiographic examination, a conservative multidisciplinar approach was adopted with the maintenance of the tooth and the enucleation of the periapical lesion through surgical intervention and subsequente rehabilitation. In the same session, the conduit was filled with gutta-percha cone and sealer cement 26 and parendodontic surgery was performed together with apicoplasty. One week after the surgical intervention, class IV restoration was performed with composite resin based on the waxing of the diagnostic models mounted on an articulator. Based on a careful and multidisciplinary evaluation, it was possible to adopt a conservative approach in the case in question, with the maintenance and rehabilitation of a permanent tooth in a young patient, avoiding the indication of extraction(AU)

The assistance gaps in combating COVID-19 in Brazil: for whom, where and when vaccination occurs.

BACKGROUND: Following the emergence of the COVID-19 pandemic, the number of infected Brazilian people has increased dramatically since February 2020, with Brazil being amongst the countries with the highest number of cases and deaths. Brazilian vaccination began in January 2021, aimed at priority groups. This study analysed the spatial and temporal evolution of vaccination in Brazil between the 3rd and 21st epidemiological weeks (EW) of 2021. METHODS: Spatial and temporal analyses were performed comprising 19 EW. Cases were structured into priority groups-elderly population (EP); healthcare workers (HW); indigenous and quilombola populations (I/Q), dose, vaccine (CoronaVac or AstraZeneca), and place of vaccination. A sweep test was performed to identify vaccination rate clusters. Vaccination rates (VR) were calculated according to a spatial window for each Health Region, indicating clusters above/below expected VR. Based on the discrete Poisson probability model, spatial analysis was performed to detect high/low VR clusters, which were converted into Kernel maps. Points were generated from SaTScan analyses associated with Health Region centroids. Temporal analysis of VR was carried out to identify significant trends, and results were converted into temporal cluster graphs. P-value ≤ 0.05 was adopted. RESULTS: Southeast region concentrated most of the vaccines of EP and HW, followed by the Northeast. The latter region had the largest contingent of I/Q vaccinated. In all priority age groups and all regions, a higher percentage of complete CoronaVac vaccination schedules were observed compared with AstraZeneca. The temporal analysis identified high VR clusters of CoronaVac first and second dose in the early weeks, except for the EP; of AstraZeneca first dose, only for HW in the early weeks, and for EP and I/Q in the final weeks; of AstraZeneca second dose for all priority groups in the final weeks. I/Q populations had the lowest general VR. The spatial profile of VR indicated significant regional cluster differences between the priority groups. CONCLUSION: This study highlights the importance of establishing vaccination priority groups, considering the asymmetries that a pandemic can trigger, notably in vast geographic areas, to contemplate the main objective of vaccination: to prevent casualties.

Beta-caryophyllene as an antioxidant, anti-inflammatory and re-epithelialization activities in a rat skin wound excision model.

The skin is a critical organ for the maintenance of the integrity and protection of the organism. When a wound occurs, a sequence of healing mechanisms is triggered to reconstruct the wounded area. ß-caryophyllene is a sesquiterpene in Copaifera langsdorffii oleoresin with antioxidant and anti-inflammatory potential. On the basis of previous studies with C. langsdorffii, ß-caryophyllene was selected to evaluate its wound healing potential and pharmacological mechanisms. The excision wound model was used with male Wistar rats and macroscopic, histological, immunohistochemical and biochemical analyses were performed with skin samples, comparing the ß-caryophyllene-treated group with reference drugs. The results showed macroscopic retraction of the wounds treated with ß-caryophyllene. Biochemical assays revealed the antioxidant and anti-inflammatory mechanisms of the ß-caryophyllene-treated group with increasing levels of IL-10 and GPx and decreasing levels of pro-inflammatory molecules, including TNF-α, IFN-γ, IL-1ß and IL-6. After ß-caryophyllene treatment, immunohistochemical assays showed enhanced re-epithelialization, through the increase in laminin-γ2 and desmoglein-3 immunolabeling. ß-caryophyllene also act in the remodeling mechanism, increasing the collagen content in the Masson's trichrome staining. These findings indicated the wound-healing potential of ß-caryophyllene topical formulation in rat skin wounds, mediated by antioxidant, anti-inflammatory and re-epithelialization mechanisms.