Infectious Diseases and Secondary Antibody Deficiency in Patients from a Mesoregion of São Paulo State, Brazil.

Our aim was to determine the secondary antibody deficiency (SAD) profiles of patients in a mesoregion of São Paulo state, Brazil, focusing on infectious diseases. Demographic characteristics, and clinical and laboratory data were obtained from electronic files; infections were classified as organ-specific and graded as mild, moderate, life-threatening, and fatal. Non-Hodgkin's lymphoma (NHL) accounted for 30% of patients, nephrotic syndrome (NS) 25%, chronic lymphocyte leukemia 20%, and multiple myeloma 15%. Patients with NS were younger than those in other groups, and hypo-γ-globulinemia was detected in 94.1%, IgG < 400 mg/dL in 60.0%, IgA < 40 mg/dL in 55.0%, and CD19 < 20 cells/mm3 in 30.0%. One hundred and one infections were found; 82.1% were classified as mild or moderate, 7.9% as life-threatening, and 3.0% as fatal. Respiratory tract infections were more prevalent (41.5%), and pneumonia accounted for 19.8%. Lower levels of infections were found in patients with NS compared with NHL (p = 0.0001). Most patients progressed to hypo-γ-globulinemia and SAD after treatment with immunosuppressants, and mild and moderate infections were predominant. These therapies are increasing in patients with different diseases; therefore, monitoring hypo-γ-globulinemia and infections may help to identify patients at high risk for severe complications, antibiotic prophylaxis or treatment, and immunoglobulin replacement.

Treating Syndromic Craniosynostosis with Monobloc Facial Bipartition and Internal Distractor Devices: Destigmatizing the Syndromic Face.

Monobloc and facial bipartition combined with distraction osteogenesis (MFBDO) has gained popularity over the past several years as a treatment of syndromic craniosynostosis, in part because this surgical technique effectively removes many stigmatic clinical features associated with the syndromic face. The objective of this study is to detail the surgical planning used to achieve medialization of the orbits and describe the authors' experience using MFBDO to destigmatize the syndromic face. By using MFBDO, hypertelorism, vertical orbital dystopia, and downslanting of the palpebral fissure were surgically corrected in all patients, thereby destigmatizing the syndromic face.

Late Primary Palatoplasty in Skeletally Mature Patients: Obstacles and Outcomes.

BACKGROUND: As the performance of late primary palatoplasty for skeletally mature patients remains controversial, there is little data available regarding speech outcomes for this patient population. The purpose of this study therefore is to identify and evaluate the impact of speech outcomes following late palate repair on skeletally mature patients. METHODS: A retrospective study was performed on 19 consecutive skeletally mature patients who underwent late primary palate repair between 2010 and 2018. Speech assessment was performed preoperatively, between 3 and 6 months postoperatively, and then after 6 months postoperatively. Levels for hypernasality, oral pressure, and audible nasal air emission were scored and recorded.Patients were stratified by age, gender, presence of postoperative fistula, and Veau cleft type, in order to determine the impact of each variable on final speech outcomes. The Kruskal-Wallis test was used to compare the preoperative speech assessment with the postoperative speech outcomes, and the Mann-Whitney test was used to analyze the impact of the above variables on final speech outcomes. RESULTS: Our data showed overall postoperative speech improvement for all tested variables. Patients without postoperative fistula presented better results in oral pressure than those patients with postoperative fistula (P < 0.05). None of the other tested variables presented a significant negative impact on speech outcomes. CONCLUSION: Late primary palatoplasty significantly improves speech outcomes for skeletally mature patients. Fistula has a negative impact on oral pressure.

Efeito da mepivacaína 2% nos parâmetros cardiovasculares em cirurgias de terceiros molares / The 2% mepivacaine in the cardiovascular system in third molar surgeries / Efecto de la mepivacaína 2% en los parámetros cardiovasculares en cirugías de terceros molares

Ao serem administrados, os Anestésicos Locais e Vasoconstritores (VC) iniciam os processos de absorção e eliminação, passando pela circulação sanguínea podendo atingir níveis tóxicos ou induzir alterações cardiovasculares. Objetivou-se avaliar o comportamento da atividade cardiovascular nas cirurgias para a remoção de terceiros molares utilizando a mepivacaína 2% com adrenalina na concentração de 1:100.000 em um período de até 120 min após a injeção anestésica. Trata-se de um estudo longitudinal, interventivo com caráter quantitativo e descritivo, com dados mensuráveis para análise e interpretação, realizado com pacientes da disciplina de clínica cirúrgica do curso de odontologia da UniCatólica. Os resultados obtidos foram analisados através do teste de normalidade de Kolmogorov-Smirnov e comparados ao longo do trans-operatório pelos testes ANOVA para medidas repetidas seguidas do pós-teste de Bonferroni ou Friedman seguido do pós-teste de Dunn adotando um nível de 5% de significância (p < 0,05). O procedimento com o anestésico utilizado não provocou alterações na Pressão Arterial Sistólica (PAS) (p=0,712), Pressão Arterial Diastólica (PAD) (p=0,098) bem como da diferença de PAS e PAD (p=0,546). Na Frequência Cardíaca (FC) houve diferença significante nos tempos de 10 min (p=0,013) e 120 min (p=0,013). Já na Saturação Periférica O2 (SPO2) houve diferença estatística significante nos tempos da 1ª visita (p=0,001), 0 (p=0,001), 5 (p=0,001) e 20 (p=0,001). Conclui-se assim, que o anestésico local pode ser utilizado em pacientes normotensivos durante a realização de procedimentos cirúrgicos odontológicos, e este leve aumento na FC e SPO2 pode estar relacionado à ansiedade e/ou ao estresse emocional dos pacientes(AU)

When injected into the tissues, Local Anesthetics and Vasoconstrictors (VC) initiate the process of absorption and elimination, passing through the bloodstream to reach toxic levels or induce cardiovascular changes. The aim of this study was to evaluate the behavior of cardiovascular activity in the surgeries for the removal of third molars using mepivacaine 2% with adrenaline at a concentration of 1: 100,000 in a period of up to 120 min after the anesthetic injection. It is a longitudinal, interventional study with a quantitative and descriptive character, with measurable data for analysis and interpretation, carried out with patients of the discipline of surgical clinic of the dentistry course of the UniCatólica. The results obtained were analyzed using the normality test of Kolmogorov-Smirnov and compared during the trans-operative period by ANOVA for repeated measurements followed by the Bonferroni or Friedman post-test followed by the Dunn post-test adopting a 5% level of significance (p <0.05). The procedure with the anesthetic used did not cause changes in systolic blood pressure (SBP) (p = 0.712), diastolic blood pressure (DBP) (p = 0.098) as well as SBP and DBP difference (p = 0.546). In heart rate (HR) there was a significant difference in the time of 10 min (p = 0.013) and 120 min (p = 0.013). In the O2 Peripheral Saturation (SPO2) there was a statistically significant difference at the time of the first visit (p = 0.001), 0 (p = 0.001), 5 (p = 0.001) and 20 (p = 0.001). It is concluded that the local anesthetic can be used in normotensive patients during dental surgical procedures, and this slight increase in HR and SPO2 may be related to the anxiety and / or emotional stress of the patients(AU)

Al ser administrados, los anestésicos locales y vasoconstrictores (VC) inician los procesos de absorción y eliminación, pasando por la circulación sanguínea pudiendo alcanzar niveles tóxicos o inducir alteraciones cardiovasculares. Se objetivó evaluar el comportamiento de la actividad cardiovascular en las cirugías para la remoción de terceros molares utilizando la mepivacaína 2% con adrenalina en la concentración de 1: 100.000 en un período de hasta 120 minutos después de la inyección anestésica. Se trata de un estudio longitudinal, interventivo con carácter cuantitativo y descriptivo, con datos mensurables para análisis e interpretación, realizado con pacientes de la disciplina de clínica quirúrgica del curso de odontología de la UniCatólica. Los resultados obtenidos fueron analizados a través del test de normalidad de Kolmogorov-Smirnov y comparados a lo largo del trans-operatorio por las pruebas ANOVA para medidas repetidas seguidas del post-test de Bonferroni o Friedman seguido del post-test de Dunn adoptando un nivel del 5% de significancia (p <0,05). El procedimiento con el anestésico utilizado no provocó cambios en la presión arterial sistólica (PAS) (p = 0,712), presión arterial diastólica (PAD) (p = 0,098), así como de la diferencia de PAS y PAD (p = 0,546). En la Frecuencia Cardiaca (FC) hubo diferencia significante en los tiempos de 10 min (p = 0,013) y 120 min (p = 0,013). En la Saturación Periférica O2 (SPO2) hubo diferencia estadística significante en los tiempos de la 1ª visita (p = 0,001), 0 (p = 0,001), 5 (p = 0,001) y 20 (p = 0,001). Se concluye así que el anestésico local puede ser utilizado en pacientes normotensivos durante la realización de procedimientos quirúrgicos odontológicos, y este leve aumento en la FC y SPO2 puede estar relacionado a la ansiedad y / o al estrés emocional de los pacientes(AU)

Serious Complications After Le Fort III Distraction Osteogenesis in Syndromic Craniosynostosis: Evolution of Preventive and Therapeutic Strategies.

BACKGROUND: There is a paucity of studies that report complication rates following a subcranial Le Fort III advancement using distraction osteogenesis. The purpose of this study was to identify and describe serious postoperative complications following Le Fort III advancement with distraction osteogenesis, and provide strategies to assist in the resolution of these complications. METHODS: An observational retrospective study was performed on consecutive patients with Apert, Crouzon, or Pfeiffer syndromes (n = 16) who underwent Le Fort III advancement using distraction osteogenesis between 2008 and 2017. Serious complications were defined as frontal bone loss, cerebrospinal fluid leak, meningitis, seizures, or major blood loss (ie, massive transfusion within the first postoperative day). RESULTS: Three (18.7%) patients presented serious complications, namely cerebrospinal fluid leak (n = 1; 6.2%), seizures (n = 1; 6.2%) due to a halo-type device trans-pin intracranial migration, and major blood loss (n = 1; 6.2%). Adopting well-delineated interventions, all of these complications were resolved without fatality. CONCLUSION: A Le Fort III advancement has a significant morbidity rate, with 3 of our patients (18.7%) in this study presenting serious complications. Appropriate management reduced this morbidity, and all complications were resolved without fatality.