Prevalence of Morphometric Vertebral Fractures After Bariatric Surgery and Its Relationship with Bone Mineral Density and Bone Markers.

BACKGROUND: Bariatric surgery (BS) can lead to bone loss and an increased fracture risk. METHODS: To determine the morphometric vertebral fracture (MVF) prevalence, and its relationship with bone mineral density (BMD), and biomarker's turnover after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG), we analyzed post-surgery X-rays of the spine in 80 patients (88% female, 51% RYGB, age 41.2 [6.8] years) from 117 participants' retrospective cohort (1-2 years, >2 and <5 years, and >5 years). We still analyzed body composition and BMD by dual-energy X-ray absorptiometry and bone parameters. RESULTS: MVF prevalence was 17.5% (14/80), with no statistical difference between groups (p = 0.210). RYGB group had a higher prevalence of secondary hyperparathyroidism (SHPT) (PTH ≥ 65 pg/ml; 18.4% vs 7.8%, respectively, p = 0.04), PTH (61.3 vs 49.5 pg/ml, p = 0.001), CTX (0.766 [0.29] ng/ml vs 0.453 [0.30] ng/ml, p = 0.037), and AP (101.3 [62.4] U/L vs 123.9 [60.9] U/L, p = 0.027) than the SG group. Up to 5 years postoperatively, RYGB had a lower total (1.200 [0.087] vs 1.236 [0.100] g/cm2, p = 0.02), femoral neck (1.034 [0.110] vs 1.267 [0.105], p = 0.005), and total femur BMD (1.256 [0.155] vs 1.323 [0.167], p = 0.002) than SG group. We found no statistically significant difference between the MFV (+) and MVF (-) groups regarding age, sex, BMI, surgery time, BMD, or bone and metabolic parameters, including leptin. CONCLUSION: We found a high prevalence of MVF after BS with no differences between RYGB and SG.

Clinical laboratory and dispersion pattern of COVID-19 in a family cluster in the social-distancing period.

INTRODUCTION: Since the first reports of coronavirus disease 2019 (COVID-19) in December 2019, the disease has spread worldwide. Different social isolation strategies have been adopted to reduce community transmission, but few studies have evaluated the pattern of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection in a family cluster during periods of isolation. We report an outbreak in 24 members of a family cluster during a period of social distancing. METHODOLOGY: We carried out an observational descriptive study of a family cluster infected with SARS-CoV-2 in Pernambuco, Northeast Brazil. Laboratory confirmation included RT-PCR of nasopharyngeal samples or IgM or IgG serology. RESULTS: The attack rates were 75% (19/24) based on laboratory-confirmed cases and 87.5% (21/24) including probable cases. The time of spread was 17 days from the first case. All patients had mild symptoms, requiring no hospitalization, and none of them died. The frequency of symptomatic, laboratory-confirmed patients was higher among adults (94%) than among children (50%); the paediatric age group also had a higher frequency of exposed individuals who remained negative for infection. Ground-glass opacities on chest computed tomography were present in all patients with reported dyspnoea. CONCLUSION: This study highlights a high risk of intrahousehold transmission from an index case, suggesting the need for (I) specific guidelines during periods of social distancing, (II) minimization of external exposures and, above all, (III) adoption of strict quarantine measures for suspected cases and family members to prevent outbreaks from spreading.

Violência obstétrica e os direitos da parturiente: o olhar do Poder Judiciário brasileiro / Obstetric violence and the parturient's rights: the glance from the Brazilian Judiciary / Violencia obstétrica y los derechos de la parturienta: la visión del Poder Judicial brasileño

O presente estudo investiga a violência obstétrica por meio de alguns julgados, observando a perspectiva do Judiciário brasileiro sobre o tema. Metodologia: trata-se de revisão de literatura, cuja pesquisa ocorreu entre junho de 2019 a janeiro de 2020. Para a contextualização e análise do problema, realizou-se levantamento bibliográfico, utilizando fontes científicas indexadas nas bases de dados Bireme, Latindex e Scielo. Os julgados analisados foram selecionados no sítio eletrônico Jusbrasil, cuja amostragem foi fruto dos resultados de busca pelo termo violência obstétrica. Cinco julgados foram selecionados como amostra para o desenvolvimento do artigo. Resultados: a violência obstétrica pode ser considerada espécie de violência de gênero, simbólica e institucional. Arraigada ao cotidiano feminino, em muitas circunstâncias, é naturalizada. Todavia, o aumento do acesso à informação, entre outros fatores, vem ocasionando mudança de postura, constatada pelo crescimento das denúncias e demandas judiciais. Contudo, do exame dos julgados foi possível identificar o desconhecimento dos magistrados sobre o tema, o que redunda, em algumas ocasiões, na mitigação de direitos pelo próprio Poder Judiciário. Conclusão: mesmo a despeito do debate sobre a violência contra as mulheres, a obstétrica ainda é pouco discutida e muito invisibilizada. Manifesta-se numa fase extremamente delicada, gravidez e parto, mitigando não apenas os direitos e a dignidade das parturientes, mas, igualmente, do nascituro. Ademais, a maior incidência dessa espécie de violência ainda são os ambientes hospitalares públicos, cujas usuárias, majoritariamente, são negras e pobres

The current study investigates the obstetric violence through judged cases, under the Judiciary's perspective about the theme. Methodology: it is a literature review study, whose research happened from June of 2019 to January of 2020. For contextualization and analysis of the problem, a bibliographic search was performed through indexed scientific sources in Bireme, Latindex, and Scielo database. The judges analyzed were selected in the website Jusbrasil, whose sampling was made through the results of search by the term obstetric violence. Five cases were selected as samples to the development of the article. Results: obstetric violence can be considered a type of gender, symbolic, and institutional violence. As it is rooted in the feminine everyday life, in many situations, it is naturalized. However, the increasing access to information, among other facts, has been causing a change in the attitude, proved through the growth of judicial complaints and demands. However, from the examination of the judges was possible to identify the lack of knowledge from magistrates about the theme, which results, in some occasions, in the mitigation of the rights by the own Judiciary Branch. Conclusion: even in spite of the debate about violence against women, obstetric care is still little discussed and greatly invisibilized. It is manifested in extremely delicate phases, pregnancy and childbirth, mitigating not only the rights and dignity of parturients, but, equally, of the unborn child. Moreover, the highest incidence of this type of violence are still the environment of public hospitals, which users are, mostly, black and poor.

El presente estudio investiga la violencia obstétrica a través de algunos jueces, observando la perspectiva del Poder Judicial brasileño sobre el tema. Metodología: esta es una revisión de la literatura, cuya investigación se llevó a cabo entre junio de 2019 y enero de 2020. Para la contextualización y el análisis del problema, se realizó una encuesta bibliográfica a través de fuentes científicas indexadas en las bases de datos Bireme, Latindex y Scielo. Los jueces analizados fueron seleccionados en el sitio web de Jusbrasil, cuyo muestreo se realizó a través de los resultados de búsqueda del término violencia obstétrica. Cinco fueron seleccionados como muestra para el desarrollo del artículo. Resultados: la violencia obstétrica puede considerarse un tipo de violencia de género, simbólica e institucional. Incrustado en la vida cotidiana de las mujeres, en muchas circunstancias, se naturaliza. Sin embargo, el aumento del acceso a la información, entre otros factores, ha provocado un cambio de actitud, evidenciado por el aumento de las denuncias y demandas judiciales. Sin embargo, a partir del examen de los jueces, fue posible identificar la falta de conocimiento de los magistrados sobre el tema, lo que a veces resulta en la mitigación de los derechos por parte del propio Poder Judicial. Conclusión: incluso a pesar del debate sobre la violencia contra las mujeres, la obstetricia todavía es poco discutida y muy invisible. Se manifiesta en una fase extremadamente delicada, el embarazo y el parto, mitigando no solo los derechos y la dignidad de las parturientas, sino también el feto. Además, la mayor incidencia de este tipo de violencia todavía se encuentra en entornos de hospitales públicos, cuyos usuarios son en su mayoría negros y pobres.

Pharmacologic management of pain in patients with Chikungunya: a guideline.

From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.

Pharmacologic management of pain in patients with Chikungunya: a guideline

Abstract From the arrival of Chikungunya virus in the Americas in 2013 until March 2016, approximately two million cases of the disease have been reported. In Brazil, the virus was identified in 2014 and thousands of people have been affected. The disease has high attack rates, infecting 50% of a population within a few months. Approximately 50% of infected people develop chronic symptoms lasting for months or years. Joint involvement is the main clinical manifestation of Chikungunya. It is characterized by swelling and intense pain that is poorly responsive to analgesics, both in the acute and chronic phase of the disease. This significantly compromises quality of life and may have immeasurable psychosocial and economic repercussions, constituting therefore, a serious public health problem requiring a targeted approach. Physicians are often not familiar with how to approach the management of pain, frequently prescribing limited analgesics, such as dipyrone, in sub-therapeutic doses. In addition, there are few published studies or guidelines on the approach to the treatment of pain in patients with Chikungunya. Some groups of specialists from different fields have thus developed a protocol for the pharmacologic treatment of Chikungunya-associated acute and chronic joint pain; this will be presented in this review.

Zika in Pernambuco: rewriting the first outbreak.

INTRODUCTION:: A Zika virus epidemic was registered in 2015 in Northeast Brazil. In the State of Pernambuco, thousands of classical cases transpired, and in the following months, neurological disturbances in adults and microcephaly in newborns emerged as complications. After the peak of the epidemic, the official system reported only four cases of Zika virus but over 100,000 cases of dengue virus. The vigilance system was unable to retrospectively estimate cases or to issue an alert to officially notified cases with possible inconsistence concerning specific arbovirosis diagnoses. METHODS:: To evaluate the frequency of different arbovirosis diagnoses based on clinical-epidemiologic criteria, from January to April 2015, we conducted a hospital-based cross-sectional study retrospectively analyzing suspected cases of arbovirosis. RESULTS:: Of 1 , 046 total suspected cases of arbovirus, 895 (86%) were classified as probable Zika virus cases, and 151 (14%) as probable dengue virus cases. The most frequent manifestations in probable Zika virus cases were exanthema (100%), pruritus (50.7%), fever (20.4%) and arthralgia (27.7%). CONCLUSIONS:: In contrast to the official data, during the peak months of the arbovirosis epidemic of 2015, most cases were compatible with Zika virus infections. Hospital-based studies, although retrospective and based on secondary data from clinical files, might provide a better estimate of the number of cases relative to currently available data, if derived from several urgent care units of representative areas of a city or state.This would partially retrospectively correct some inconsistences regarding official notifications.

Zika in Pernambuco: rewriting the first outbreak

Abstract INTRODUCTION: A Zika virus epidemic was registered in 2015 in Northeast Brazil. In the State of Pernambuco, thousands of classical cases transpired, and in the following months, neurological disturbances in adults and microcephaly in newborns emerged as complications. After the peak of the epidemic, the official system reported only four cases of Zika virus but over 100,000 cases of dengue virus. The vigilance system was unable to retrospectively estimate cases or to issue an alert to officially notified cases with possible inconsistence concerning specific arbovirosis diagnoses. METHODS: To evaluate the frequency of different arbovirosis diagnoses based on clinical-epidemiologic criteria, from January to April 2015, we conducted a hospital-based cross-sectional study retrospectively analyzing suspected cases of arbovirosis. RESULTS: Of 1 , 046 total suspected cases of arbovirus, 895 (86%) were classified as probable Zika virus cases, and 151 (14%) as probable dengue virus cases. The most frequent manifestations in probable Zika virus cases were exanthema (100%), pruritus (50.7%), fever (20.4%) and arthralgia (27.7%). CONCLUSIONS: In contrast to the official data, during the peak months of the arbovirosis epidemic of 2015, most cases were compatible with Zika virus infections. Hospital-based studies, although retrospective and based on secondary data from clinical files, might provide a better estimate of the number of cases relative to currently available data, if derived from several urgent care units of representative areas of a city or state.This would partially retrospectively correct some inconsistences regarding official notifications.

O atendimento da crise nos diversos componentes da rede de atenção psicossocial em Natal/RN / The crisis attention in the various components of psychosocial care network in Natal / RN / Atención a la crisis en los diversos componentes de la red de atención psicosocial en Natal/RN

O atendimento da crise é um dos problemas mais evidentes e de difícil manejo na atualidade. Além disso, é um dos eixos estratégicos e pilar de sustentação da reforma psiquiátrica. Em função disso realizamos uma investigação com o objetivo conhecer a configuração, funcionamento e modos de acolhimento na RAPS de Natal-RN. Entrevistamos 137 profissionais e gestores vinculados aos CAPS, SAMU, UPAs, Hospitais Gerais e Hospital Psiquiátrico. Identificamos diversos pontos de estrangulamento: número limitado de serviços que acolhem urgências; falta de comunicação entre equipes dos diferentes componentes; ausência de matriciamento com a atenção primária e de leitos de atenção integral nos hospitais gerais. Consideramos que o município apresenta capacidade limitada de responder às situações de crise e demandas emergenciais, a qual depende de uma boa articulação entre os componentes da RAPS e destes com os demais serviços de saúde, especialmente de urgência e emergência, da presença efetiva de leitos de atenção integral, além de integração eficaz com a rede de suporte social.(AU)

The crisis' treatment is one of the most evident problems in our days, and also one of the hardest to fix. Besides that, it's one of the pillars of the psychiatrical reform. Taking that in consideration, we realized an investigation with the objective of knowing the configuration, the operation and the ways of reception at the RAPS of Natal-RN. We interviewed 137 professionals connected to the following institutions: CAPS, SAMU, UPAs, Hospitais Gerais and Hospital Psiquiátrico. We identified many points strangulation: the limited number of services that concern to the urgent care,We identified many points strangulation: the limited number of services that concern to the urgent care, the lack of communication between the working-teams, the absence of specialist orientation in primary care and the lack of beds for full time caring in the general hospitals. We consider that the city presents a limited capacity to respond to a crisis situations and emergencial demands, that depend on a good articulation between the components of the RAPS and the other ones with the health system, specially the emergency ones, the effective presence of beds for full time care, and of the proper integration with the social support network.(AU)

La atención a la crisis es uno de los problemas más evidentes y difíciles de manejar en salud mental. Además, es uno de los pilares estratégicos de la reforma psiquiátrica. Estainvestigación fue hecha con el objetivo de conocer la configuración, modos de funcionamiento y de acogida en la RAPS de la ciudad de Natal, Brasil. Hemos entrevistado a 137 directivos y profesionales vinculados al CAPS, SAMU, UPAS, hospitales generales y hospital psiquiátrico. Se identificaron varios problemas: número limitado de servicios de emergencia, falta de comunicación entre los equipos de los diferentes componentes, ausencia de articulacion con la atención primaria y de camas de psiquiatria en los hospitales generales. Creemos que el municipio tiene una capacidad limitada para responder a las crisis y lasdemandas de emergencia, que depende de una buena relación entre los componentes de la RAPS y con otros servicios de salud, especialmente las salas de emergencia, la presencia efectiva de camas atención integral y efectiva integración con la red de apoyo social.(AU)

Mechanical evaluation of the influence of low-level laser therapy in secondary stability of implants in mice shinbones.

The present work evaluates mechanically the bone-implant attachment submitted or not to low-level laser therapy, with wavelength of 795 nm, in a continuous way, with power of 120 mW. The implant was placed in one of the shinbones of 24 mice, randomly distributed into two groups. The experimental group was submitted to six laser applications, divided into four points previously established, two lateral and two longitudinal, six times 8 J/cm2 with an interval of 2 days, totaling the dose of 48 J/cm2. The control group did not receive laser therapy. The interval between applications was 48 h and the irradiations began immediately after the end of the implant surgeries. The two groups were killed on the 14th day and a bone block of the area was removed where the implant was inserted. A torque machine was used to measure the torque needed for loosening the implants. A statistically significant difference was observed between the two groups. The experimental group presented larger difficulty for breaking up the implant interface with the bone block than the control group. It can be concluded that with the animal model and the protocol of irradiation present in this study, the laser therapy demonstrated capacity to increase the attachment bone implant.

Whole-body MR imaging for the evaluation of McCune-albright syndrome.

This paper is a detailed case study of a seven-year-old girl who developed precocious puberty. The young girl experienced bilateral breast enlargement, vaginal discharge, and multiple areas of "cafe-au-lait" pigmentation on the skin. The skeletal radiographs showed multiple bone lesions which were suggestive of polyostotic fibrous dysplasia. These findings were sufficient to establish the diagnosis of McCune-Albright syndrome. Whole-body MRI was used to assess the extent of the osseous lesions throughout the body. The MRI showed approximately the same number of osseous lesions compared to the skeletal radiographs. In addition, the MRI detected a cystic lesion localized in the pelvis that raised the possibility of an ovarian-follicular cyst. This case suggests that whole-body MRI might be a promising method for the evaluation and follow-up of polyostotic fibrous dysplasia, a disease with diffuse involvement of the musculoskeletal system.

Glass ionomer cement hardness after different materials for surface protection.

The aim of the present study was to evaluate the Knoop hardness of high viscous glass ionomer cement (GIC) Ketac Molar Easy Mix (3M ESPE, Saint Paul, USA) submitted to different types of compounds for surface protection. Sixty specimens of GIC were made in PVC molds with 7.5 mm diameter and 2.5 mm thickness. Divided in 6 groups: G1, Control (no protection); G2, Cavitine (Copal varnish); G3, Magic bond (Adhesive); G4, Adper Single Bond 2 (Single bottle adhesive); G5, Solid Petroleum Jelly; G6, Nail Varnish. The surface protection was applied after initial setting reaction. The specimens were immersed in deionized water, at 37 degrees C, for 24 h. The surfaces were polished in a rotation machine (Aropol 2V). The hardness test was accomplished in a Digital Microhardness tester HVS-100. In each specimen five indentations were done and repeated after 30 days and 4 months, under the same conditions. The results were submitted to Two-way ANOVA and Tukey Test. The only material that differed from the control group was the nail varnish (p < 0.001), with the other materials showing no significant difference from the control group. It was concluded that the best material for surface protection of GIC was the nail varnish, but because of possible harmful effects, petroleum jelly could be a better option.

Ancoragem ortodôntica: o uso de miniimplantes / Orthodontics anchoring: the usage of mini-implants

A ancoragem é um príncipio importante para o sucesso do tratamento ortodôntico e seu controle é fundamental para a obtenção dos resultados desejados. Os recursos de ancoragem mais utilizados comumente são limitados e muitas vezes dependem da colaboração do paciente.A ancoragem por implantes tem a grande vantagem de serem mais estáveis, sendo utilizada para a movimentação de dentes individualmente ou em grupo. Para que seja alcançado um resultado adequado, o uso de implantes no tratamento ortodôntico depende de um planejamento conjunto entre o ortodontista e o implantodontista. O objetivo deste trabalho é fazer uma revisão da literatura da importância e utilização desses implantes no tratamento ortodôntico.

The anchorage is an important factor for the success of the orthodontic treatment and its control is basic for the attainment of the desired results. The more used intra and extra-buccal resources of anchorage are limited and many times depend on the contribution of the patient. The anchor for implants has the great advantage of being always stable, being used for the handling of individual teeth or in groups. The use of implants in therapy orthodontic depends on a planning between the orthodontist and the implantodontist for adequate prognosis to be achieved in the planning. The aim of this work is to make a literature review of the importance and use of the dental implants in orthodontic treatment.

Avaliação de implantes osseointegráveis submetidos à função imediata comparados à função tardia / Evaluation of osseointegrated implants submitted to immediate function compared to late function

O objetivo deste estudo foi avaliar e comparar o comportamento clínico de implantes osseointegráveis ativados imediatamente após a cirurgia com implantes ativados após 90 dias de instalação. Foi realizado um estudo retrospectivo em 38 pacientes na faixa etária entre 30 e 80 anos, que receberam quatro ou cinco implantes do tipo cônico na mandíbula na região intermentoniana com ou sem função mastigatória imediata, sobre os quais foram confeccionadas próteses fixas de resina acrílica. Os pacientes foram distribuídos em dois grupos: grupo A - reabilitação oral com prótese fixa provisória imediatamente após a instalação dos implantes dentários, e grupo B - reabilitação oral com prótese fixa definitiva colocada 90 dias após a instalação dos implantes dentários. Os parâmetros resistência ao torque, dor e mobilidade dos implantes foram avaliados 180 dias após sua inserção. Foram observadas diferenças estatisticamente significativas em relação à perda dos implantes, sendo de 11% para o grupo A e 2% para o grupo B. Houve maior índice de insucesso nos implantes submetidos à função imediata.

The purpose of this study was to evaluate and compare the clinical behavior of osseointegrated implants with immediate function to implants activated 90 days after installation. A retrospective study was accomplished in 38 patients aged between 30 and 80 years-old, which received four or five tapered implants in the interforaminal area with or without immediate loading, on which stable, acrylic resin prostheses were fabricated. Patients were distributed in two groups: group A, oral rehabilitation with temporary stable prostheses immediately after installation and group B, oral rehabilitation with definitive stable prostheses installed 90 days after the implants installation. The resistance to torque, pain, and implant mobility were evaluated 180 days after surgical procedures. Statistically significant differences were observed in relation to implant loss, being 11% and 2% in groups A and B, respectively. Non-success failure rates were higher for implants underwent immediate function.