Tratamientos de ortodoncia con resoluciones no convencionales. Alternativa de tratamiento. Exodoncia de caninos superiores e inferiores: reporte de casos clínicos / Orthodontic treatments with unusual resolutions. Alternative treatment. Extraction of upper and lower canines: report of clinical cases

En algunas situaciones particulares, hay que tomar decisiones, independientemente de lo preestablecido en los cánones de la ortodoncia. Es sabida la importancia de la presencia de los caninos en la oclusión, no solamente por su relación con la función del sistema estomatognático, sino por la relevante importancia en la estética de la sonrisa. Sin embargo, la desición crítica de extraer un canino por erupción atípica o por retención ósea desfavorable, o con daño periodontal, puede ser justificada por un pronóstico desfavorable para reducir el tiempo de tratamiento. Esta decisión involucra un compromiso estético y funcional, ya que las características anatómicas del canino lo hacen el verdadero pilar de la oclusión, tanto en relación céntrica como en los movimientos laterales mandibulares. No obstante, se demuestra con los siguientes casos que, a pesar de las decisiones que se han tomado con respecto a la exodoncia, los pacientes han finalizado su tratamiento con una correcta estética y función; por lo tanto, esta alternativa de tratamiento debe ser considerada válida y aceptable...

Drug-induced sedation endoscopy in pediatric obstructive sleep apnea syndrome.

AIM: To describe the pattern of upper airway (UA) obstruction during drug-induced sedation endoscopy (DISE) and to evaluate the outcome of DISE-directed treatment. METHODS: Prospective study of DISE in surgically naive obstructive sleep apnea syndrome (OSAS) children without syndromic comorbidity or craniofacial abnormalities. Treatment was individually tailored according to UA findings during DISE and polysomnographic data. Reported values are median (lower-upper quartile). RESULTS: Thirty-seven children aged 4.1 years (2.1-6.0), with body mass index z-score 0.3 (-0.9 to 0.9), and obstructive apnea-hypopnea index (oAHI) 9.0/h (6.1-19.3) were included. Adenotonsillar obstruction was found in 33 cases (89%) as an isolated entity or as part of a multi-level obstruction. These children were treated with adenotonsillectomy (n = 28), adenoidectomy (n = 3), or tonsillectomy (n = 2). The remaining four patients received non-surgical treatment. Pre-postoperative polysomnographic data in 22 patients showed a significant improvement in oAHI from 8.6/h (6.7-20.7) to 1.0/h (0.6-2.0) (P = 0.001). Only two of these 22 children had residual OSAS (oAHI ≥ 5/h), indicating a success rate of 91%. CONCLUSIONS: Based on UA findings during DISE, a non-surgical treatment was proposed for 11% of children. A 91% success rate was obtained in those treated with (adeno)tonsillectomy. These data suggest that DISE may be helpful to identify patients most likely to benefit from UA surgery.

A cross-sectional analysis of otitis media with effusion in children with Down syndrome.

UNLABELLED: Children with Down syndrome are at risk to develop otitis media with effusion (OME). We performed a retrospective and cross-sectional analysis to evaluate the prevalence of OME in children with Down syndrome (DS) for consecutive age categories between 6 months and 12 years. Clinical and audiometric data were available for 107 children followed in a multidisciplinary Down team. A high prevalence of OME was found at the age of 1 year (66.7 %), with a second peak prevalence of 60 % at 6-7 years. A declining trend was observed in children ≥8 years. Overall, 52.3 % of DS children had either OME or ventilation tubes at the time of evaluation. Hearing thresholds were significantly higher in children with bilateral OME (median 36.7 decibel hearing level (dB HL), range 26.7-46.1) compared to those with at least one normally ventilated middle ear (median 28.3 dB HL, range 22.8-3.3), p = 0.013. CONCLUSION: We found a high prevalence of OME in children with Down syndrome, with a peak of ≥60 % around 1 and 6-7 years. A declining trend is seen in older children. Mild to moderate hearing loss was present in children with bilateral OME.

An unusual tumour causing neonatal respiratory distress.

PROBLEM: We present the case of a term neonate referred shortly after birth because of breathing and feeding difficulties. METHODOLOGY: Fiber-endoscopic examination of the nasal cavity showed a pendulating mass in the nasopharynx. RESULTS: A complete surgical resection was performed and the baby recovered completely. Microscopic examination of the mass showed an overlying non-keratinized squamous cell lining with an atypical cell population in some fragments. Histological features were compatible with a high-grade epithelial tumour like a midline carcinoma, but a final diagnosis of a salivary gland anlage tumour was established. CONCLUSION: Flexible fiber endoscopy is the method of choice for examining the nasal passages and oropharynx in neonates with respiratory distress. Congenital salivary gland anlage tumour is a rare cause of neonatal nasal obstruction; it is benign and complete excision results in a cure. Histologically, it may mimic a malignant tumour owing to the high mitotic index.

Morbimortalidade de adolescentes com HIV/Aids em serviçode referência no sul do Brasil / Morbimortality of adolescents who have HIV/Aids in a reference centre in the south of Brazil

Com o avanço da epidemia da aids no Brasil, evidenciou-se uma tendência à juvenização do seu perfil epidemiológico, ou seja, a distribuiçãodos casos de aids na população de adolescentes. Objetivo: caracterizar a morbimortalidade de adolescentes com HIV/aids que foram atendidos no Hospital Universitário de Santa Maria (HUSM/RS/Brasil), no período de 1993 a 2011. Métodos: estudo descritivo, documental, retrospectivo, com abordagem quantitativa. Os prontuários do HUSM foram a fonte de informação de dados. A população do estudo foi de 45 adolescentes com HIV/aids, na faixa etáriade 13 a 19 anos, segundo critério etário estabelecido pelo Programa Nacional de DST/Aids do Brasil. Resultados: desta população, 60% eram meninas,48% de 13 a 14 anos, em 66,7% a transmissão foi vertical, 44,4% tiveram diagnóstico até os 5 anos de idade, 46,7% tiveram de quatro a seis consultas no último ano, 49% foram assíduos, 84,4% faziam uso de antirretrovirais, 92,2% com esquema duplo, 44,7% há mais de 9 anos, 60% já haviam tido doença oportunista, e 75,6%, internação hospitalar. Foram notificados dois óbitos. Conclusão: evidenciou-se a fragilidade clínica pelo comprometimentoimunológico e doenças oportunistas, pela necessidade de acompanhamento clínico, laboratorial e medicamentoso permanentes, pela demanda de adesão aotratamento e exposição a efeitos adversos, o que indica a necessidade de integralidade na atenção à saúde dos adolescentes, com o compromisso de atenderàs demandas específicas da condição sorológica e da fase de crescimento e desenvolvimento

The advancement of the aids epidemic in Brazil showed a youngest tendency with its epidemiological profile, in others words, the distributionof aids cases in adolescents. Objective: to characterize morbidity and mortality of adolescents with HIV/aids who were treated in the University Hospital of Santa Maria (UHSM/RS/Brazil), from 1993 to 2011. Methods: descriptive, documental, retrospective study with quantitative approach. The source of data information was patients'records at UHSM. Study population was of 45 adolescents with HIV/aids, aged 13 to 19, according age criteria established by Brazilian National STD/Aids Program. Results: from this population, 60% were girls, 48% aged 13-14 years old, in 66.7% infection was vertical,44.4% were diagnosed until 5 years old, 46.7% had four to six consults in the last year, 49% were assiduous, 84,4% were taking antiretroviral, 92,2% withdouble scheme, 44.7% were older than 9 years old, 60% already had opportunist illness, and 75.6%, were admitted in a hospital before. Two deaths were notified. Conclusion: it was evidenced clinical fragility through immunological compromise and opportunist illnesses, through need of permanent clinical,laboratorial and drug monitoring, for the demand of adherence to treatment and exposure to adverse effects, which indicates the need of integrality in healthcare to adolescents in commitment to answer serological condition and the growing and the development phase'specific demands.

Deletion of C/EBP homologous protein (Chop) in C57Bl/6 mice dissociates obesity from insulin resistance.

AIMS/HYPOTHESIS: Endoplasmic reticulum (ER) stress has been implicated in the development of type 2 diabetes, via effects on obesity, insulin resistance and pancreatic beta cell health. C/EBP homologous protein (CHOP) is induced by ER stress and has a central role in apoptotic execution pathways triggered by ER stress. The aim of this study was to characterise the role of CHOP in obesity and insulin resistance. METHODS: Metabolic studies were performed in Chop ( -/- ) and wild-type C57Bl/6 mice, and included euglycaemic-hyperinsulinaemic clamps and indirect calorimetry. The inflammatory state of liver and adipose tissue was determined by quantitative RT-PCR, immunohistology and macrophage cultures. Viability and absence of ER stress in islets of Langerhans was determined by electron microscopy, islet culture and quantitative RT-PCR. RESULTS: Systemic deletion of Chop induced abdominal obesity and hepatic steatosis. Despite marked obesity, Chop ( -/- ) mice had preserved normal glucose tolerance and insulin sensitivity. This discrepancy was accompanied by lower levels of pro-inflammatory cytokines and less infiltration of immune cells into fat and liver. CONCLUSIONS/INTERPRETATION: These observations suggest that insulin resistance is not induced by fat accumulation per se, but rather by the inflammation induced by ectopic fat. CHOP may play a key role in the crosstalk between excessive fat deposition and induction of inflammation-mediated insulin resistance.

Specific medical and surgical treatment for chronic inflammatory diseases in children.

Treatment for chronic inflammatory conditions in children should take into account the specific pathophysiological and clinical processes underlying these disorders. These guidelines provide a framework for both the medical and surgical treatment of chronic inflammatory diseases such as otitis media, allergic rhinitis and chronic rhinosinusitis, chronic inflammation of tonsils and adenoids, and laryngitis. In addition, the role of vaccinations and immunomodulatory therapies is discussed. Whenever possible, the evidence levels for specific treatments comply with the Oxford Levels of Evidence.

Plerixafor for PBSC mobilisation in myeloma patients with advanced renal failure: safety and efficacy data in a series of 21 patients from Europe and the USA.

We describe 20 patients with myeloma and 1 with primary amyloidosis from 15 centres, all with advanced renal failure, most of whom had PBSC mobilised using plerixafor following previous failed mobilisation by conventional means (plerixafor used up-front for 4 patients). For 15 patients, the plerixafor dose was reduced to 0.16 mg/kg/day, with a subsequent dose increase in one case to 0.24 mg/kg/day. The remaining six patients received a standard plerixafor dosage at 0.24 mg/kg/day. Scheduling of plerixafor and apheresis around dialysis was generally straightforward. Following plerixafor administration, all patients underwent apheresis. A median CD34+ cell dose of 4.6 × 10(6) per kg was achieved after 1 (n=7), 2 (n=10), 3 (n=3) or 4 (n=1) aphereses. Only one patient failed to achieve a sufficient cell dose for transplant: she subsequently underwent delayed re-mobilisation using G-CSF with plerixafor 0.24 mg/kg/day, resulting in a CD34+ cell dose of 2.12 × 10(6)/kg. Sixteen patients experienced no plerixafor toxicities; five had mild-to-moderate gastrointestinal symptoms that did not prevent apheresis. Fifteen patients have progressed to autologous transplant, of whom 12 remain alive without disease progression. Two patients recovered endogenous renal function post autograft, and a third underwent successful renal transplantation. Plerixafor is highly effective in mobilising PBSC in this difficult patient group.

Fatores associados à não adesão ao tratamento antirretroviral em adultos acima de 50 anos que têm HIV/Aids / Factors associated to non adherence to antirretroviral treatment in adults above 50 years old who have HIV/Aids

Introdução: a tecnologia medicamentosa implicou na redução da morbimortalidade das pessoas que têm HIV/aids. Os níveis de adesão ao uso dos antirretrovirais influenciam no sucesso ou não do tratamento. Considera-se a adesão como o maior determinante da resposta terapêutica, entretanto, não está estabelecido um método padronizado para sua avaliação. Objetivo: identificar os fatores associados à não adesão ao tratamento antirretroviral em adultos acima de 50 anos que têm aids. Método: delineamento transversal com uma população de 72 pacientes. A coleta de dados foi desenvolvida após aprovação do comitê de ética, com entrevista estruturada, no período de abril/2009 a outubro/2010. Foi realizada análise bivariada, cruzando o desfecho (adesão ao TARV) com as variáveis comportamentais de classificação de não aderentes. Resultados: a prevalência de não adesão foi de 29,2%. Os fatores associados à não adesão foram: conhecimento sobre carga viral e motivo do tratamento; bebidas alcoólicas; efeitos colaterais; coincidência entre o horário de trabalho e o de ingerir alguma dose do medicamento; tempo de acompanhamento no Serviço; comparecimento nas consultas; e necessidade de que alguém acompanhe o paciente ao Serviço. Conclusão: estes fatores implicam na saúde do paciente e estão associados ao cuidado de si, a fim de minimizar possibilidades de adoecimento, e ao cuidado do outro, no que se refere ao potencial de transmissão da infecção em nível coletivo.

Drug technology implied on morbidity and mortality reduction of people who have HIV/aids. Levels of adherence to antiretroviral use influenceson treatment's success or not. Adherence is considered as the biggest determinant as therapeutic response, however there's not a standard method established for its evaluation. Objective: to identify factors associated to the non-adherence to antiretroviral treatment in adults above 50 years old who have aids.Method: cross-sectional design with a population of 72 patients. Data collection was developed, after ethics committee approval, with structured interview,from April/2009 to October/2010. It was developed bi-varied analysis, crossing the result (adherence to ARVT) with behavioral varies of non-adherence classifications. Results: non-adherence prevalence was of 29,2%. Factors associated to non-adherence were: knowledge about viral load and treatment motive;alcoholic beverage; side effects; coincidence between work time and time to ingest any medicine dose; assistance time in the Service; frequency to consults;and necessity of someone that takes one to the Service. Conclusion: these factors imply on patient's health and it's going to be associated on caring for oneself,in order to minimize illness possibilities, and caring for the other, referring to infection transmission potential on collective level.

Auditory neuropathy/dyssynchrony as a cause of failed neonatal hearing screening.

The prevalence of auditory neuropathy/dyssynchrony (AN/AD) is not exactly known. We retrospectively analysed the prevalence of this condition among 135 infants who failed a neonatal screening. Hearing screening was performed by automated auditory brainstem responses (AABR). Unilateral presence of click-evoked oto-acoustic emissions with absent auditory brainstem responses was found in 4 infants. Magnetic resonance imaging of the posterior fossa showed an aplasia/hypoplasia of the ipsilateral cochlear nerve in these 4 cases. The prevalence of AN/AD was 19% in infants with confirmed hearing loss. Our findings underscore the role of AABR in neonatal hearing screening.

Rede de apoio de mulheres que têm HIV: implicações na profilaxia da transmissão vertical / Support web to women who have HIV/Aids: vertical transmission prophylaxis implications

Casos notificados de aids entre mulheres demonstram-se crescentes, e com a possibilidade de gestação há aumento do risco de transmissão vertical do HIV. Objetivo: descrever as implicações das relações sociais das mulheres que têm HIV/aids no seu cotidiano de cuidado na profilaxia da transmissão vertical. Métodos: pesquisa qualitativa, descritivo-exploratória. Utilizada Dinâmica de Criatividade e Sensibilidade - Mapa Falante, com gestantes e puérperas que têm HIV/aids. Realizou-se em um hospital de ensino no interior do Rio Grande do Sul em setembro de 2010. Análise dos dados por meio da análise de conteúdo. Resultados: aponta-se a restrição da rede social das mulheres, centrando suas relações na figura materna e nos filhos,cuidando ou sendo cuidada, e na ausência do companheiro no cotidiano de cuidado das mulheres. O caminho para realizar o tratamento demonstra-selinear. As mulheres sofrem preconceito e discriminação. Conclusão: vislumbra-se uma abordagem assistencial multiprofissional a fim de contemplar asdemandas expressas pelas mulheres. Necessidade de inclusão do companheiro na assistência durante o período gravídico-puerperal, expansão da rede de apoio primária.

Reported cases of women with aids are growing, the possibility of pregnancy increases the risk of HIV vertical transmission. Objective: to describe the implications among social relationships of women with HIV/aids in their daily care routine on the prophylaxis of vertical transmission. Methods: qualitative, descriptive exploratory research. A Criativity and Sensibility Activity was used - Speaking Map, with pregnants and new moms that have HIV/aids. It was held in a teaching hospital in Rio Grande do Sul on September 2010. The data analysis was done through Content Analysis. Results: there's a restriction in the social web of these women, their relationships are centered in being a mother and taking care of their children with the partner absence. The way to go through with the treatment seems to be straight. Women suffer prejudice and discrimination. Conclusion: the multiprofessional approach for assistence is seen as a way to take care of the needs expressed by the women. There is a need to include the partner in the pregnancy care, expanding the primary support web.

Identificación cefalométrica del biotipo dolicofacial a tavés de la altura de la rama, de la altura facial posterior y del valor del ángulo goníaco / Cephalometric identification of the dolichofacial biotype through the ramus height, posterior facial height and the goniac angle value

El propósito de este trabajo es el análisis de tres de los factores del polígono de Bjork-Karabal en pacientes con biotipo dolicofacial. Esto nos permitirá predecir y visualizar con menor cantidad de medidas cefalométricas, las respuestas a los procedimientos terapéuticos, evitando emprender caminos erróneos que deberían ser cambiados en el transcurso del tratamiento. En particular, concluimos que es posible caracterizar el biotipo dólico mediante las medidas del ángulo goníaco, de la altura facial posterior y de la altura de la rama.

Identificación cefalométrica del biotipo dolicofacial a tavés de la altura de la rama, de la altura facial posterior y del valor del ángulo goníaco / Cephalometric identification of the dolichofacial biotype through the ramus height, posterior facial height and the goniac angle value

El propósito de este trabajo es el análisis de tres de los factores del polígono de Bjork-Karabal en pacientes con biotipo dolicofacial. Esto nos permitirá predecir y visualizar con menor cantidad de medidas cefalométricas, las respuestas a los procedimientos terapéuticos, evitando emprender caminos erróneos que deberían ser cambiados en el transcurso del tratamiento. En particular, concluimos que es posible caracterizar el biotipo dólico mediante las medidas del ángulo goníaco, de la altura facial posterior y de la altura de la rama.(AU)

Pasado, presente y futuro de los arcos / Past, present and future of archwires

El objetivo de este trabajo es poder brindar al profesional una guía acerca de los diferentes metales, tanto tradicionales como exóticos, y sus propiedades, para permitir la elección de los arcos según las necesidades de cada tratamiento, no teniendo que seguir siempre una prescripción determinada.

Pasado, presente y futuro de los arcos / Past, present and future of archwires

El objetivo de este trabajo es poder brindar al profesional una guía acerca de los diferentes metales, tanto tradicionales como exóticos, y sus propiedades, para permitir la elección de los arcos según las necesidades de cada tratamiento, no teniendo que seguir siempre una prescripción determinada.(AU)

Optimization of allogeneic transplant conditioning: not the time for dogma.

Numerous reduced-intensity conditioning regimens for allogeneic hematopoietic cell transplantation are currently being explored, primarily in older patients and in individuals with comorbid conditions who are not eligible for conventional myeloablative conditioning regimens. There is agreement that these approaches have reduced early transplant-related (non-relapse) toxicity and mortality. It is unclear, however, whether these strategies improve long-term survival. Furthermore, as most trials with reduced-intensity regimens have enrolled older patients and patients with comorbid conditions, it is not appropriate to compare the results of these trials to those obtained with more conventional approaches. It remains to be determined whether younger patients, and patients without comorbid conditions, will derive significant long-term benefits from reduced-intensity regimens when compared to conventional strategies. It may be that the different approaches are complementary and in the end will preferentially serve specific patient populations based on age, comorbid conditions and malignancy type. To determine the role of reduced-intensity approaches, controlled prospective trials are needed, with enrolled patients being stratified according to comorbid conditions, disease characteristics, pre-transplant therapy and source of stem cells, at a minimum.

Caninos retenidos / Impacted canines

La relativa frecuencia de caninos retendios y su posible prevención mediante el diagnóstico temprano y la intervención precoz, cuando no se observa la reabsorción del canino temporario, nos ha llevado a realizar una actualización, mediante una búsqueda bibliográfica, para transmitirla al odontólogo general y al odontopediatra, quienes deben conocer los métodos de diagnóstico y los procedimientos terapéuticos relativamente sencillo que hacen posibleque erupcionen en la arcada dentaria y si esto no fuera posible, derivarlo al ortodoncista, quien por procedimientos ortodóntico-quirúrgicos tratará de ubicarlo en su posición correcta

Caninos retenidos / Impacted canines

La relativa frecuencia de caninos retendios y su posible prevención mediante el diagnóstico temprano y la intervención precoz, cuando no se observa la reabsorción del canino temporario, nos ha llevado a realizar una actualización, mediante una búsqueda bibliográfica, para transmitirla al odontólogo general y al odontopediatra, quienes deben conocer los métodos de diagnóstico y los procedimientos terapéuticos relativamente sencillo que hacen posibleque erupcionen en la arcada dentaria y si esto no fuera posible, derivarlo al ortodoncista, quien por procedimientos ortodóntico-quirúrgicos tratará de ubicarlo en su posición correcta (AU)

Caninos retenidos / Impacted canines

La relativa frecuencia de caninos retendios y su posible prevención mediante el diagnóstico temprano y la intervención precoz, cuando no se observa la reabsorción del canino temporario, nos ha llevado a realizar una actualización, mediante una búsqueda bibliográfica, para transmitirla al odontólogo general y al odontopediatra, quienes deben conocer los métodos de diagnóstico y los procedimientos terapéuticos relativamente sencillo que hacen posibleque erupcionen en la arcada dentaria y si esto no fuera posible, derivarlo al ortodoncista, quien por procedimientos ortodóntico-quirúrgicos tratará de ubicarlo en su posición correcta (AU)