The impact of the SARS-CoV-2 pandemic on tuberculosis notifications and deaths in the state of São Paulo, Brazil: a cross-sectional study.

Background: The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 2020-2021. Methods: This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (2020-2021) compared to the pre-pandemic period (2019). Findings: Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, respectively, with declines 2-3 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%-12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation: The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. Funding: FAPESP, CNPq and CAPES, Brazil.

Análise comparativa do comportamento verbal nos três níveis de suporte do autismo / Comparative analysis of verbal behavior in the three levels of autism support / Análisis comparativo de la conducta verbal en los tres niveles de apoyo al autismo

OBJETIVO: O presente trabalho teve por objetivo avaliar e comparar a habilidade do comportamento verbal em crianças com distintos níveis de suporte do TEA. MÉTODO: Foram avaliadas onze crianças diagnosticadas com autismo e com faixa etária entre 2 e 7 anos e que apresentassem diversidade entre si quanto ao nível de suporte TEA. Para a averiguação do repertório de comunicação, eles foram avaliados a partir de um instrumento elaborado por uma equipe de profissionais especializados, investigando o comportamento não verbal, ecoico, mando, tato e intraverbal em três tentativas. RESULTADOS: Apesar do número reduzido de participantes, os resultados indicaram que pacientes no nível 3 de suporte apresentam maior comprometimento na comunicação comparado aos demais. O estudo destacou a importância do rastreio de habilidades comportamentais para um planejamento com maior eficácia para a intervenção e concomitantemente evolução clínica, respeitando assim as particularidades e singularidades de cada pessoa no espectro. CONCLUSÃO: Concluiu-se assim, a importância da análise de comportamentos e a investigação detalhada para cada paciente, a fim de que as intervenções sejam focadas em suas reais necessidades.

OBJECTIVE: The present work aimed to evaluate and compare the verbal behavior ability in children with different levels of ASD support. METHOD: Eleven children diagnosed with autism and aged between 2 and 7 years old and who presented diversity among themselves in terms of the level of ASD support were evaluated. To investigate their communication repertoire, they were evaluated using an instrument developed by a team of specialized professionals, investigating non-verbal, echoic, command, tact and intraverbal behavior in three attempts. RESULTS: Despite the small number of participants, the results indicated that patients at level 3 of support have greater impairment in communication compared to the others. The study highlighted the importance of screening behavioral skills for more effective planning for intervention and concomitant clinical evolution, thus respecting the particularities and singularities of each person on the spectrum. CONCLUSION: This concludes the importance of behavioral analysis and detailed investigation for each patient, so that interventions are focused on their real needs.

OBJETIVO: El presente trabajo tuvo como objetivo evaluar y comparar la capacidad de conducta verbal en niños con diferentes niveles de apoyo al TEA. MÉTODO: Se evaluaron once niños diagnosticados con autismo, con edades entre 2 y 7 años y que presentaban diversidad entre sí en cuanto al nivel de apoyo al TEA. Para investigar su repertorio comunicativo, fueron evaluados mediante un instrumento desarrollado por un equipo de profesionales especializados, investigando el comportamiento no verbal, ecoico, de mando, tacto e intraverbal en tres intentos. RESULTADOS: A pesar del pequeño número de participantes, los resultados indicaron que los pacientes en el nivel 3 de apoyo tienen un mayor deterioro en la comunicación en comparación con los demás. El estudio destacó la importancia del cribado de habilidades conductuales para una planificación más eficaz de la intervención y la evolución clínica concomitante, respetando así las particularidades y singularidades de cada persona del espectro. CONCLUSIÓN: Se concluye la importancia del análisis conductual y la investigación detallada de cada paciente, para que las intervenciones estén enfocadas a sus necesidades reales.

The impact of the SARS-CoV-2 pandemic on tuberculosis notifications and deaths in the state of São Paulo, Brazil: a cross-sectional study

Background The state of São Paulo reports the highest number of tuberculosis cases in Brazil. We aimed to analyze the SARS-CoV-2 pandemic's impact on tuberculosis notifications and identify factors associated with reduced notifications and tuberculosis deaths in 2020­2021. Methods This retrospective cross-sectional study analyzed data from 126,649 patients with tuberculosis notified in São Paulo from 2016 to 2021. Interrupted time series analysis assessed the pandemic's impact on notifications. Descriptive statistics and logistic regressions identified factors associated with decreased tuberculosis notifications and deaths during the pandemic (2020­2021) compared to the pre-pandemic period (2019). Findings Tuberculosis notifications decreased by 10% and 8% in 2020 and 2021, espectively, with declines 2­3 times higher among individuals with no education or deprived of liberty. Contrastingly, tuberculosis notifications increased 68% among corrections workers in 2021. Diagnostics and contact tracing were compromised. Individuals with HIV, drug addiction, or deprived of liberty had lower odds of notification during the pandemic. Black and Pardo individuals or those with diabetes, treatment interruption history, or treatment changes post-adverse events had higher odds of notification. However, adverse events and tuberculosis-diabetes cases have been increasing since 2016. During the pandemic, tuberculosis-related deaths rose 5.0%­12.7%. Risk factors for mortality remained similar to 2019, with Pardo ethnicity, drug addiction and re-treatment post-adverse events emerging as risk factors in 2020/2021. Interpretation The pandemic affected tuberculosis notifications and deaths differently among populations, exacerbating inequalities. Treatment interruption, loss of follow-up, and challenges in accessing healthcare led to increased mortality. (AU)

The Effectiveness of the Association of Chlorhexidine with Mechanical Treatment of Peri-Implant Mucositis.

(1) Background: The aim of the study was to evaluate the benefit of combining chlorhexidine with the mechanical treatment of peri-implant mucositis. (2) Methods: Articles from 2016 to 2021 included in the PubMed and Scopus databases were analyzed, following the PICOS criteria and the randomized controlled study model that used chlorhexidine in various forms in the treatment of peri-mucositis. According to the established criteria, a limited number of studies were selected. These studies had as their criteria of evaluation for the effectiveness of chlorhexidine, plaque indices, bleeding indices and depth probing indices. Chlorhexidine has been used after mechanical debridement as a solution, with different concentrations of 0.06%/0.12%/0.2% alone or in a concentration of 0.03%, in combination with 0.05% cetylpyridinium chloride, as well as in the form of a gel with a concentration of 0.2%. (3) Results: The results were assessed to a placebo or other substances, and showed a significant reduction in the indices with a follow-up period ranging from 3 months to 1 year. (4) Conclusions: The association of chlorhexidine with the mechanical treatment of peri-implant mucositis has a role in reducing inflammation, although a complete remission was not obtained in all cases, and the results were not statistically significantly different from the use of other antiseptics.

Clinical Aspects and Therapeutic Management of an Aggressive Manifestation of Stage III Grade C Periodontitis in a Female Teenager.

The main objective of this study was to evaluate the improvement of periodontal health in patients with periodontitis treated with non-surgical periodontal therapy and subgingival-administrated local and systemic antimicrobial agents. A female teenager with periodontitis-associated health issues and a history of dental trauma was selected for this study. Clinical indices were obtained, and radiographic examination was performed at the beginning of the study. The patient was treated with periodontal therapy and administration of antibiotics. After this therapy, visits were scheduled at regular intervals to observe the clinical changes. Non-surgical periodontal therapy and administration of local and systemic antibiotics resulted in a reduction in the patient pocket depth probing, plaque index, and bleeding on probing. Gingival and periodontal health improved in terms of gingival overgrowth, plaque, tartar index, and tooth mobility. Suppuration was eliminated, and no gingival inflammation signs were observed.

Role of histopathology in the management of the gingival enlargement in a patient on antihypertensive therapy based on calcium channel blockers: a case report.

Periodontal pathology is often represented by increases in gingival volume, with pronounced inflammatory phenomena. These manifestations require a more accurate diagnosis and knowledge of the etiopathogenic factors involved. The periodontal treatment applied must be related with the etiopathogenic circumstances. Periodontal disease sometimes has a complex appearance, with intertwined local and systemic favorable factors that make it difficult to include it in a certain taxonomic form. Also, in general, the adult patients have associated chronic diseases that involve the administration of several drugs, which induce on long-term both therapeutic and side effects. Furthermore, diseases in the oral cavity may occur frequently, which require complex and associated dental and periodontal treatment, also occlusal rebalancing, which is a real interdisciplinary challenge. In this case report, periodontal status is determined by a combination of local and systemic favorable factors. However, the histopathological analysis of the gingival samples revealed inflammation without characteristic fibrous hyperplasia changes of the Amlodipine calcium channel blocker (CCB) administration, the antihypertensive medication of the patient. Thus, Amlodipine does not have a hyperplasic effect on gingival mucosa in all cases. Therefore, even if they are more expensive, investigations must be complex, if necessary, in establishing the involvement of the side effect of the systemic medication in periodontal pathological changes. CCB systemic medication is essential, even vital, for maintain the arterial pressure at normal values, should not be altered without the real indication and to the recommendation from a specialist doctor, and the periodontal treatment must be focused to eliminate the local factors.

A new oncoplastic technique with immediate nipple reconstruction for central breast tumors using Würinger's septum-based flap.

INTRODUCTION: Centrally located breast tumors represent a challenge for both oncological and reconstructive surgeons, mainly due to the necessity of nipple-areola complex (NAC) removal. We describe an original oncoplastic solution utilizing a displacement flap technique with immediate nipple reconstruction. METHODS: Since 2008, we developed an oncoplastic technique using a septum-based island flap for the reconstruction of central breast defects, including the NAC. This technique is based on the Würinger's septum which is centered around the intercostal perforators. A retrospective study was performed collecting data on patient characteristics, oncological features, and outcomes. Patient satisfaction was reported using a Likert scale. RESULTS: Reconstruction was successfully realized in 15 patients (14 immediate and one delayed post-lumpectomy correction). In immediate surgery, the excision margins were all free of tumor. Minor complications occurred in three patients; one small area of skin necrosis was managed by secondary intention, and two cases of partial nipple necrosis were treated by debridement under local anesthesia. Contralateral symmetrization surgery was performed on nine patients. Patient satisfaction scored high. CONCLUSION: In comparison with the previous oncoplastic techniques used for reconstructing central defects, the septum-based island flap has increased flexibility, provides better projection, and can be combined with immediate NAC reconstruction.

Saúde ocupacional dos trabalhadores no contexto das organizações: estresse percebido e estresse avaliado / Occupational health of workers in the context of organizations: perceived stress and assessed stress / Salud ocupacional de los trabajadores en el contexto de las organizaciones: estrés percibido y estrés evaluado

INTRODUÇÃO: Dentre as formas de acometimento do estresse encontra-se o estresse ocupacional, vinculado especificamente ao trabalho. Sabe-se que determinadas amostras da população estão mais propensas a apresentarem este adoecimento, seja pela alta carga de trabalho ou pela pressão psicológica existente na empresa. Além de apresentarem adoecimento no trabalho, há relatos de casos de intenção de desistência da carreira e brigas no âmbito ocupacional em decorrência da alta pressão por resultados e pouca valorização do trabalho realizado. OBJETIVO: Com base em tais dados, o presente trabalho teve por objetivo investigar o acometimento de estresse e a saúde ocupacional dos trabalhadores em contextos organizacionais distintos, avaliando o estresse percebido pelos eles e o estresse avaliado por meio de um instrumento que mensurasse esses níveis. MATERIAIS E MÉTODOS: Além de pesquisa bibliográfica, o estudo contou com aplicação de dois instrumentos de coleta de dados, Inventário de Sintomas de Stress para Adultos Lipp (ISSL) e uma ficha de questões, os quais foram respondidos por 38 indivíduos, efetivados em diferentes empresas. RESULTADOS E DISCUSSÃO: Os resultados foram tabulados e devidamente analisados pela metodologia proposta, demonstrando que na percepção própria dos entrevistados a variação acerca do estresse foi grande, porém após a aplicação do ISSL, obteve-se como resultados que mais de 50% da amostra total se encontravam com estresse e na fase de Resistência, evidenciando dessa forma, a necessidade de maior suporte aos funcionários de empresas. Assim, o presente trabalho pode contribuir para a ampliação da discussão prática desse tema, além de proporcionar maior conhecimento sobre a relevância da temática, apontando que o estresse está mais presente nos trabalhadores do que se supõe. CONSIDERAÇÕES FINAIS: Maiores estudos na área, especificando as empresas e estratégias utilizadas ou não são fundamentais para promover maior qualidade de vida e saúde aos trabalhadores.

INTRODUCTION: Among the forms of stress involvement is occupational stress, specifically linked to work. It is known that certain samples of the population are more likely to have this illness, either because of the high workload or the psychological pressure involved in the company. In addition to presenting illness at work, there are reports of cases of intention to give up their careers and fights in the occupational sphere due to the high pressure for results and little appreciation of the work performed. OBJECTIVE: Based on such data, the present study aimed to investigate the involvement of stress and the workers' occupational health in different organizational contexts, evaluating the stress perceived by them and the stress evaluated through an instrument that measures the same. MATERIALS AND METHODS: In addition to bibliographic research, the study included the application of two data collection instruments, the Inventory of Stress Symptoms for Lipp Adults (ISSL) and a question sheet, which were answered by 38 individuals, carried out in different companies. RESULTS AND DISCUSSION: The results were tabulated and duly analyzed by the proposed methodology, demonstrating that, in the interviewees' own perception, the variation regarding stress was large, but after the application of ISSL, it was obtained as results that more than 50% of the total sample were under stress and in the Resistance phase, thus evidencing the need for greater support for company employees. Thus, the present work can contribute to the expansion of the practical discussion of this theme, in addition to providing greater knowledge about the relevance of the theme, pointing out that stress is more present in workers than is supposed. FINAL CONSIDERATIONS: Further studies in the area, specifying the companies and strategies used or not are fundamental to promote a better quality of life and health for workers.

INTRODUCCIÓN: Entre las formas de afectación del estrés se encuentra el estrés laboral, específicamente vinculado al trabajo. Se sabe que ciertas muestras de la población son más propensas a padecer esta enfermedad, ya sea por la alta carga de trabajo o por la presión psicológica que implica la empresa. Además de presentar enfermedad en el trabajo, existen relatos de casos de intención de abandono de la carrera y luchas en el ámbito ocupacional debido a la alta presión por resultados y poca valoración del trabajo realizado. OBJETIVO: Con base en tales datos, el presente estudio tuvo como objetivo investigar la participación del estrés y la salud ocupacional de los trabajadores en diferentes contextos organizacionales, evaluando el estrés percibido por ellos y el estrés evaluado a través de un instrumento que mide el mismo. MATERIALES Y MÉTODOS: Además de una búsqueda bibliográfica, el estudio incluyó la aplicación de dos instrumentos de recolección de datos, el Inventario de Síntomas de Estrés de Lipp para Adultos (ISSL), y una hoja de preguntas, que fueron respondidas por 38 personas, realizadas en diferentes empresas. RESULTADOS Y DISCUSIÓN: Los resultados fueron tabulados y debidamente analizados por la metodología propuesta, demostrándose que, en la percepción de los propios entrevistados, la variación respecto al estrés era grande, pero luego de la aplicación del ISSL se obtuvo como resultados que más del 50% de la muestra total se encontraba bajo estrés y en fase de Resistencia, evidenciando así la necesidad de un mayor apoyo a los trabajadores de la empresa. Así, el presente trabajo puede contribuir para la ampliación de la discusión práctica de este tema, además de proporcionar mayor conocimiento sobre la relevancia del tema, apuntando que el estrés está más presente en los trabajadores de lo que se supone. CONSIDERACIONES FINALES: Mayores estudios en el área, especificando las empresas y las estrategias utilizadas o no, son fundamentales para promover una mejor calidad de vida y salud de los trabajadores.

The influence of social isolation on the incidence of positivity in COVID-19 tests in a metropolitan region of São Paulo, Brazil / A influência do isolamento social na incidência de positividade nos testes de COVID-19 em região metropolitana de São Paulo, Brasil

INTRODUCTION: With the arrival of the SARS-CoV-2 (Coronavirus 2 of severe acute respiratory syndrome) pandemic in Brazil, especially in the city of São Paulo, there was a need to apply social isolation policies associated with testing, covering all municipalities. The Clinical Analysis Laboratory of Centro Universitário FMABC was one of the first laboratories to receive certification and qualification to perform RT-PCR (reverse transcriptase reaction followed by polymerase chain reaction) tests in the metropolitan region of São Paulo OBJECTIVE: Aim to analyze the influence of adopting social isolation on the incidence of positivity in COVID-19 tests in the metropolitan region of São Paulo, Brazil METHODS: a descriptive study carried out from March to May 2020, epidemiological data were collected from each unit served and organized by the data controllership team of the Clinical Analysis Laboratory of FMABC. Epidemiological, demographic, and laboratory data were extracted from the Matrix® outpatient data management system. Clinically suspected cases and confirmed by laboratory tests (RT-PCR and serological tests) were entered. The tests were divided into serological tests using the RT-PCR molecular test, on samples of nasopharyngeal mucosal scrapings collected with sterile Swab RESULTS: It were evaluated PCR test and antibody presence (IgA, IgM and IgG) in blood samples of 16.297 patients. 22.718 tests were performed for the diagnosis of COVID-19, both RT-PCR (10.410 tests) and serological tests to detect anti-SARS-CoV-2 antibodies, IgA, IgM and IgG, a total of 16.297 patients were assessed, 63% women and 37% men. It was observed that the social isolation policies adopted during this period contained the massive expansion of contamination, at least while the social isolation rates were above 55% CONCLUSION: The data of this study demonstrated the effectiveness of social isolation in containing the positive contamination of SARS-CoV-2 in the metropolitan region of São Paulo, at least for the first three months

INTRODUÇÃO: com a chegada da pandemia de SARS-CoV-2 (Coronavirus 2 da síndrome respiratória aguda grave) ao Brasil, especialmente na cidade de São Paulo, houve a necessidade de aplicar medidas de distanciamento social associado a testagem, que abrangesse todos os municípios. A região metropolitana de São Paulo compreende 39 municípios e possui uma rede de laboratórios habilitados a realizar a testagem para a detecção do coronavírus, tanto testes sorológicos quanto moleculares. O Laboratório de Análises Clínicas do Centro Universitário ABC/FMABC foi um dos primeiros laboratórios a receber a certificação e habilitação para realizar os testes RT-PCR (reação da transcriptase reversa seguida pela reação em cadeia da polimerase) na região metropolitana de São Paulo OBJETIVO: analisar a influência da adoção do isolamento social na incidência de positividade nos testes de COVID-19 em região metropolitana de São Paulo, Brasil MÉTODO: estudo descritivo realizado no período de março a maio de 2020, os dados epidemiológicos foram coletados de cada unidade atendida e organizada pela equipe de controladoria de dados do Laboratório de Análises Clínicas da FMABC. Os dados epidemiológicos, demográficos e laboratoriais foram extraídos do sistema Matrix® de gerenciamento de dados ambulatoriais. Foram inseridos os casos clinicamente suspeitos e confirmados por testes de laboratório (RT-PCR e testes sorológicos). Os testes foram divididos em testes sorológicos no teste molecular RT-PCR, em amostras de raspado de mucosa nasofaríngea coletada com Swab estéril RESULTADOS: foram avaliados o teste de RT-PCR e a presença de anticorpos (IgA, IgM e IgG) em amostras de sangue de 16.297 pacientes. Foram realizados 22.718 testes para o diagnóstico de COVID-19, tanto RT-PCR (10.410 testes), quanto testes sorológicos para detecção de anticorpos anti-SARS-CoV-2, IgA, IgM e IgG, um total de 16.297 pacientes foram avaliados, 63% mulheres e 37% homens. Observou-se que as políticas de isolamento social adotadas nesse período continham a expansão massiva da contaminação, pelo menos enquanto as taxas de isolamento social eram superiores a 55% CONCLUSÃO: nossos dados demonstraram a efetividade do isolamento social na retenção da positividade da contaminação do SARS-CoV-2 nas cidades contempladas pelo serviço de testagem do Centro Universitário Saúde ABC, pelo menos nos três primeiros meses

Sickle cell anemia with perforated duodenal ulcer as a complication: when to suspect this rare entity?

Perforated duodenal peptic ulcers are often not considered when making a differential diagnosis of abdominal pain, especially in the context of sickle cell disease, and cases have not been frequently described in the literature. This study reports the case of a 14 year-old girl with sickle cell anemia complicated with duodenal ulcer perforation, focusing mainly on the imaging aspects. Abdominal CT should be considered as a method for this diagnosis and it requires the knowledge of this entity and its characteristic imaging findings.

The Success of Topical Treatment of Onychomycosis Seems to Be Influenced by Fungal Features.

AIM: To evaluate the topical treatment of onychomycosis using a 10% hydroalcoholic propolis extract (PE) in two aleatorily chosen patients and analyze possible risk factors from hosts including some particularities of the isolated fungi that may justify the outcomes achieved. MATERIALS AND METHODS: A topical treatment, with PE, was started in two cases of toe onychomycosis due to T. rubrum. The in vitro PE antifungal activity against these isolates was confirmed. Moreover, the ability of the fungi to infect the human nail was evaluated also in an ex vivo study, analyzed by histopathology. RESULTS: Within four months, both patients showed evident improvement, but with different outcomes. The possible host-related risk factors justifying the poorer outcome in patient 1 include a longer duration time of onychomycosis (50 years). Some particularities in the T. rubrum strain isolated from this patient in relation to that found in patient 2 were observed: (1) the hypha morphology suggesting a major adaptation of the fungus to the host; (2) a 16 times greater propolis concentration was required in vitro; and (3) a faster ability to start a growth using the nail as the only nutritional source. Additionally, this isolate was more efficient in producing a biofilm on the nail surface. CONCLUSIONS: A partial clinical and complete mycological cure for the two patients was achieved after four months of PE daily use. Despite a complete recovery, a different outcome was observed between both cases. A more persistent onychomycosis, added to greater fungal potential to produce biofilm on the nail, seems to influence greatly the success of a topical treatment with PE.

Thickening of aerial roots of Pandanus Parkinson (Pandanaceae) species / Espessamento das raízes aéreas de espécies de Pandanus Parkinson (Pandanaceae)

Monocotyledon roots and stems are organs that usually do not show secondary growth or thickness. However, it can occur and for the roots, the literature does not provide much information. Species of the genus Pandanus are easily found in urban areas and are characterized by the presence of thickened aerial roots, originating from the stem. To verify how thickening occurs, roots of P. utilis Bory, P. baptisti Hort., P. amaryllifolius Roxb e P. veitchii Hort samples of the roots were collected in urban areas, fixed and processed according to the usual technique for analysis under a light microscope. For all species, thickening occurs in the acropetal direction, through the formation and expansion of spaces of intercellular spaces in the cortex and in the vascular cylinder, meristematic activity of the proendodermis, division and increase in volume of the parenchymatic cells of the cortex and the vascular cylinder and meristematic activity of the pericycle.

Raízes e caules de monocotiledôneas são órgãos que, usualmente, não apresentam crescimento secundário ou em espessura. Porém, pode ocorrer e, para as raízes, a literatura não fornece muitas informações. Espécies do gênero Pandanus são facilmente encontradas em áreas urbanas e se caracterizam pela presença de raízes aéreas espessadas, oriundas do caule. Para verificar como ocorre o espessamento, raízes de P. utilis Bory, P. baptisti Hort., P. amaryllifolius Roxb e P. veitchii Hort, foram coletadas amostras das raízes em áreas urbanas, fixadas e processadas conforme técnica usual para análise ao microscópio de luz. Para todas as espécies o espessamento ocorre no sentido acrópeto, por meio da formação e expansão de espaços de espaços intercelulares no córtex e no cilindro vascular, atividade meristemática da proendoderme, divisão e aumento de volume das células parenquimáticas do córtex e do cilindro vascular e atividade meristemática do periciclo.

6 Years of Breast Reconstruction in One Center - An Objective Analysis.

Background: Breast cancer represents the most common type of neoplasm in women around the world. Breast reconstruction following mastectomy has become a demanding procedure in the treatment of patients suffering from breast cancer. Their major role is to improve the quality of life of women, leading to better aesthetic outcomes. Based on each type of reconstruction, the complications following surgery and the duration of hospital stay, the financial implications slightly vary. Methods: Our study included 168 female patients who underwent immediate or delayed breast reconstruction after mastectomy. We assessed the clinical management of each of these cases and we evaluated the average final cost of the treatment after the reconstruction, focusing on the reconstructive method used, the complications that occurred and the number of days of hospitalization. Results: The total cost of care in breast reconstruction surgery depends on the type of reconstructive procedure used, which consequently affects the duration of hospitalization of the patients. The expenses also depend on the materials that are used: the type of implant/expander or the use of ADM. Costs were higher in patients who underwent breast reconstruction using a latissimus dorsi flap associated with an implant, in comparison to reconstruction using a free flap. Conclusions: Breast reconstruction represents a crucial process in the management of women who underwent mastectomies following cancer and presumes variable financial resources, depending on the chosen reconstructive method.

Does nebivolol have renoprotective action in patients with chronic kidney disease conditions? An integrative review.

Systemic arterial hypertension (SAH) is a chronic disease of multifactorial origin and one of the main risk factors for major adverse cardiovascular events (MACE), which are the leading causes of morbidity and mortality worldwide. The pharmacological treatment of SAH involves five main classes of drugs, and Nebivolol (NEB) is one of those drugs, belonging to the class of third generation ß1-adrenoceptors selective blockers. NEB is composed of a racemic mixture of two enantiomers: d-nebivolol, which exerts antagonist effects on ß1-adrenoceptors, and l-nebivolol, a vascular ß3 receptor agonist. There are several studies that report different actions of NEB, not only for the treatment of SAH, but also as an antioxidant agent or even as a protector of renal damage. The aim of this systematic review was to investigate the available evidence regarding the effects of NEB on kidney diseases, evaluating its possible renoprotective action.

The efficiency of using enamel matrix derivative in therapeutic approach of periodontal furcation defects of maxillary and mandibular molars.

Periodontal disease is an inflammatory condition which affects the covering and support structures of the teeth and, if left untreated, leads to tooth loss. Resorption of the alveolar bone from bi- and trifurcation regions of a multirooted tooth due to the progression of a periodontal disease bears involvement furcation. The degree of furcation involvement is clinically assessed by changes in the vertical and horizontal plane at the root separation area. In the approach of the furcation treatment, the morphological and functional particularities of pluriradicular teeth must be considered and the current techniques look for solutions for the regeneration of the destroyed periodontal tissues. Enamel matrix derivative (EMD) has the role of stimulating healing processes through effects on various growth factors, cement formation, angiogenesis and are used single or in combination with bone graft substitute (BGS) or guided tissue regeneration (GTR) in the complex treatment of periodontal disease. The present study follows PubMed publications on the efficiency of EMD in the treatment of pluriradicular tooth furcations. The findings are that there are not many studies in the usage of EMD associated with the treatment of furcations, but it is an important choice in the complex treatment of destructive periodontal disease, and further studies are needed to be done in periodontal regeneration.

Vaginal Reconstruction in Patients with Mayer-Rokitansky-Küster-Hauser Syndrome-One Centre Experience.

Background and Objectives: The Mayer-Rokitansky-Küster-Hauser syndrome is a congenital condition in which patients are born with vaginal and uterus agenesis, affecting the ability to have a normal sexual life and to bear children. Vaginal reconstruction is a challenging procedure for plastic surgeons. The aim of this study is to report our experience in the management of twelve patients with congenital absence of the vagina due to the MRKH syndrome. Materials and Methods: We performed a retrospective study on 12 patients admitted to the Plastic Surgery Department of the Clinical Emergency Hospital "Prof. Dr. Agrippa Ionescu", Bucharest, Romania, for vaginal reconstruction within a period of eleven years (January 2009-December 2019). All patients were diagnosed by the gynaecologists with vaginal agenesis, as part of the Mayer-Rokitansky-Küster-Hauser syndrome. The Abbe'-McIndoe technique with an autologous skin graft was performed in all cases. Results: The average age of our patients was 20.16 (16-28) years. All patients were 46 XX. The average surgical timing was 3.05 h (range 2.85-4h). Postoperative rectovaginal fistula was encountered in 1 patient. Postoperative average vaginal length was 10.4 cm (range 9.8-12.1 cm). Regular sexual life was achieved in 10 patients. Conclusion: Nowadays, there is no established standard method of vaginal reconstruction. In Romania, the McIndoe technique is the most applied. Unfortunately, even if the MRKH syndrome is not uncommon, less and less surgeons are willing to perform the procedure to create a neovagina.

Microbiological and virulence aspects of Rhodotorula mucilaginosa.

We aimed to characterize microbiologically clinical isolates of R. mucilaginosa isolated from colonization of a patient with chronic renal disease (CKD), as well as to evaluate their phylogeny, antifungal susceptibility, virulence, and pathogenicity in order to infer the potential to become a possible infective agent. For this study, two isolates of R. mucilaginosa from oral colonization of a CKD patient were isolated, identified and characterized by classical (genotypic and phenotypic) methods. Susceptibility to conventional antifungals was evaluated, followed by biofilm production, measured by different techniques (total biomass, metabolic activity, colony forming units and extracellular matrix quantification). Finally, the pathogenicity of yeast was evaluated by infection of Tenebrio molitor larvae. All isolates were resistant to azole and sensitive to polyenes and they were able to adhere and form biofilm on the abiotic surface of polystyrene. In general, similar profiles among isolates were observed over the observed periods (2, 24, 48 and 72 hours). Regarding extracellular matrix components of biofilms at different maturation ages, R. mucilaginosa was able to produce eDNA, eRNA, proteins, and polysaccharides that varied according to time and the strain. The death curve in vivo model showed a large reduction in the survival percentage of the larvae was observed in the first 24 hours, with only 40 % survival at the end of the evaluation. We infer that colonization of chronic renal patients by R. mucilaginosa offers a high risk of serious infection. And also emphasize that the correct identification of yeast is the main means for an efficient treatment.

Thermographic camera in traumatology, diabetic foot and reconstructive procedures.

Traumatic lacerations, burns and ulcerations are a common cause of admission in the plastic surgery wards. Clinical evaluation alone sometimes provides insufficient or even inaccurate information. Thermographic camera is a new tool that could provide additional information regarding skin vascularization, presence of inflammation or involvement of deep tissue. A prospective study was realized for assessing pre and postoperative status of patients with lacerations, trauma, burn and diabetic foot. Preoperative evaluation helped in assessing bone involvement, inflammation and infection in order to decide the necessity of surgery. Postoperative evaluation was useful in preventing and lowering the rate of complications. Thermographic camera could be a new helpful and non-invasive tool especially in emergency hospitals in order to assess rapidly and objectively wound status and to start if necessary, a surgical treatment.

Investigação das alterações emocionais e comportamentais de universitários iniciantes em Medicina e Enfermagem / Investigation of emotional and behavioral changes in undergraduate medical and nursing students

A saúde mental pode ser definida como estado de bem-estar geral, no qual o indivíduo consegue realizar suas habilidades, enfrentar o estresse diário, ser produtivo e contribuir socialmente, o rompimento desses fatores pode ocasionar no adoecimento psicológico e psiquiátrico. Nesse sentido, ressaltam-se as variáveis ambientais e comportamentais responsáveis pela saúde dos acadêmicos da área da saúde. O presente trabalho teve como objetivo investigar a saúde mental de universitários iniciantes dos cursos de medicina e enfermagem de uma universidade particular, a partir de aspectos emocionais e comportamentais. Aplicou-se um questionário, elaborado pelas autoras, em 136 estudantes do primeiro ano, sendo 89 de medicina e 47 de enfermagem. A partir dos resultados, foi possível identificar a predominância do sexo feminino na amostra e entre a faixa etária de 17 a 22 anos, também se verificou que 28 estudantes do total receberam algum diagnóstico psicológico ou psiquiátrico ao longo do primeiro ano. Com relação ao estresse percebido, os estudantes apresentaram índices considerados como estresse médio em tal percepção, o que do ponto de vista da saúde é preocupante, visto que os mesmos tem uma trajetória academia extensa até a conclusão do curso, podendo aumentar tais níveis. Mediante o exposto, concluiu-se que o adoecimento entre universitários é uma realidade atual e traz consigo consequências que podem ser estendidas, para tal, é notória a importância de maiores pesquisas em tal temática, bem como de ações por parte das instituições de ensino, visando suporte, em especial do ponto de vista psicológico a fim de promover um ambiente reforçador para o estudo e preparação para o mercado de trabalho.

Mental health can be defined as a state of general well-being, in which the individual is able to perform his / her abilities, face daily stress, be productive and contribute socially, the disruption of these factors can cause psychological and psychiatric illness. In this sense, the environmental and behavioral variables responsible for the health of health students are highlighted. The present study aimed to investigate the mental health of university students beginning medical and nursing courses at a private university, based on emotional and behavioral aspects. A questionnaire, prepared by the authors, was applied to 136 first-year students, 89 of whom were medical and 47 who were nursing. From the results, it was possible to identify the predominance of females in the sample and among the age group of 17 to 22 years, it was also found that 28 students of the total received some psychological or psychiatric diagnosis during the first year. Regarding the perceived stress, the students presented indices considered as average stress in such perception, which from the health point of view is worrying, since they have an extensive academic trajectory until the conclusion of the course, which may increase such levels. Based on the above, it was concluded that illness among university students is a current reality and brings with it consequences that can be extended. For this, it is clear the importance of further research on this topic, as well as actions by educational institutions, seeking support, especially from a psychological point of view in order to promote a reinforcing environment for the study and preparation for the job market.

HDL-C and non-HDL-C levels are associated with anthropometric and biochemical parameters.

BACKGROUND: Dyslipidemias are associated with atherosclerosis and cardiovascular diseases. Recently, non-high-density lipoprotein cholesterol (non-HDL-c) has emerged as a new target for assessment and prediction of risk of cardiovascular disease (CVD) and is closely associated with atheroma plaque progression. OBJECTIVES: To evaluate associations between HDL-c and non-HDL-c levels and anthropometric and biochemical parameters and with the Castelli risk indexes I and II. METHODS: 300 randomly selected people were subdivided into two groups: patients with normal values for non-HDL-c and patients with altered values for non-HDL-c. These parameters were analyzed for associations with glycemia, total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL-c), Castelli Index I (CI-I), Castelli Index II (CI-II), waist circumference (WC), body mass index (BMI) and presence of metabolic syndrome (MS). RESULTS: Glycemia, TC, TG, LDL-c, CI-I, CI-II, WC and BMI were all significantly different between subjects with normal and altered values of HDL-c and non-HDL-c. TC and WC both exhibited significantly higher values among patients with abnormal non-HDL-c when compared to patients with abnormal HDL-c. A significant difference was observed in occurrence of MS among patients with altered values of HDL-c and non-HDL-c. CONCLUSIONS: Our results show that both HDL-c and non-HDL-c are associated with insulin resistance, dyslipidemia, atherogenic indices, and obesity. There is therefore a need for randomized clinical intervention trials examining the potential role of non-HDL-c as a possible primary therapeutic target.

CONTEXTO: A dislipidemia está associada à aterosclerose e às doenças cardiovasculares. Recentemente, a lipoproteína de não alta-densidade de colesterol (não HDL-c) emergiu como um novo alvo para avaliação da predição de risco de doença cardiovascular, intimamente associada à progressão da placa de ateroma. OBJETIVOS: Avaliar as associações de níveis de HDL-c e não HDL-c com parâmetros antropométricos e bioquímicos, bem como com índices de Castelli I e II (CI-I e CI-II). MÉTODOS: Trezentas pessoas selecionadas aleatoriamente foram divididas em dois grupos: pacientes com valores normais de não HDL-c e pacientes com valores alterados de não HDL-c. Esses parâmetros foram associados a glicemia, colesterol total (CT), triglicerídeos (TG), lipoproteína de baixa densidade (LDL-c), CI-I, CI-II, circunferência de cintura (CC), índice de massa corporal (IMC) e presença de síndrome metabólica (SM). RESULTADOS: Glicemia, CT, TG, LDL-c, CI-I, CI-II, CC e IMC exibiram valores significativamente maiores para o não HDL-c quando comparado ao HDL-c. Uma diferença significativa na ocorrência de SM foi encontrada em pacientes com valores alterados de HDL-c e não HDL-c. CONCLUSÕES: Nossos resultados mostram que tanto o HDL-c quanto o não HDL-c estão associados a resistência à insulina, dislipidemia, índices de aterogênese e obesidade. Assim, há uma necessidade de futuros ensaios randomizados de intervenção clínica examinando o papel potencial do não HDL-c como possível alvo terapêutico primário.