Apical and lateral accuracy of intraradicular impressions made using the indirect and direct technique at three different locations: A comparative in vitro analysis.

Background: There is limited literature available comparing the accuracy of intraradicular impressions made with a novel hybrid impression material using the indirect and direct technique at three different locations. Materials and Methods: For this comparative in vitro analysis, postspace was prepared in 15 recently extracted teeth and impressions made with vinyl polysiloxane, polyether (PE), vinyl polyether silicone (VPES), and pattern resin. Postpatterns obtained were re-seated on the teeth and longitudinally sectioned. A binocular microscope was used to measure apical and lateral discrepancies at three locations (L1, L2, and L3). L1 at the postcore junction, L2 at the middle of the post space, and L3, 2 mm short of the apical end. The data obtained were statistically analyzed using the Statistical Package for the Social Sciences (SPSS) software. One-way analysis of variance (ANOVA) (intergroup) followed by Tukey's post hoc test with P ≤ 0.05 was used. Results: The one-way ANOVA noted a highly significant difference at the apical location. Pattern resin had the highest apical discrepancy (151.93 ± 8.59 µm), whereas the lowest was with vinyl PE silicone (140.31 ± 11.46 µm). At L1, the highest discrepancy was seen with pattern resin (32.09 ± 2.31 µm), whereas the lowest was with the addition silicone (31.94 ± 2.54 µm). At L2, addition silicone (32.88 ± 2.81 µm) showed the highest discrepancy, whereas the lowest was with vinyl PE silicone (30.5 ± 8.79 µm). The PE group had the highest mean at the L3 location (31.38 ± 3.46 µm) and the lowest was with vinyl PE silicone (30.93 ± 2.25 µm). At all lateral locations, no significant difference was noted. Tukey's post hoc comparison showed a significant difference between pattern resin and VPES (11.62 µm) followed by pattern resin and addition silicone (11.47 µm) apically. Conclusion: The indirect technique using VPES or addition silicone is more accurate than the direct technique at the apical location.

Professional profile in veterinary oncology: A Brazilian nationwide survey.

INTRODUCTION: Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services. METHODS: A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data. RESULTS: This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection. CONCLUSION: The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents.

Can the combination of proanthocyanidin and vitamin E or palm oil effectively protect enamel against in vitro erosive and abrasive challenges?

OBJECTIVES: This study aimed to assess the effect of proanthocyanidin, palm oil and vitamin E against erosive and erosive+abrasive challenges in vitro after enamel pellicle formation in situ. METHODOLOGY: Bovine enamel blocks (n=84) were obtained and divided into the following treatment groups: negative control (NC) - deionized water; positive control (PC) - SnCl2/NaF/AmF-containing solution; palm oil (PO); 2% proanthocyanidin (P2); vitamin E (VitE); 2% proanthocyanidin+palm oil (P2PO); and 2% proanthocyanidin+vitamin E (P2VitE). For 5 days, one half of the sample from each group was subjected to erosion and the other half was subjected to erosion+abrasion. The acquired enamel pellicle (AEP) was pre-formed in situ for 30 minutes. The specimens were then treated in vitro with solutions (500 µl, 30s for each group). Subsequently, the blocks were left in the oral cavity for another hour to obtain the modified AEP. The blocks were immersed in 0.5% citric acid (pH=2.5) for 90s, 4×/day. AEP formation and treatment were carried out before the first and third erosive challenges, and after these challenges, abrasive cycles (15s) were performed on half of the samples. Enamel wear was quantified by profilometry and data were analyzed by two-way ANOVA and Tukey's test (p<0.05). RESULTS: All groups showed higher wear when exposed to erosion+abrasion than when exposed to erosion alone (p=0.0001). PO, P2VitE, P2, and P2PO showed enamel wear similar to the PC group, but only PC, PO and P2VitE differed from the NC group. The other groups behaved similarly to NC. CONCLUSION: It was concluded that the combination of proanthocyanidin and vitamin E was effective in reducing wear in the face of in vitro erosive and erosive+abrasive challenges.

Rhizosphere-associated microbiota of Canavalia ensiformis in sulfentrazone bioremediation.

The objective of this study was to determine the efficiency of the microbial rhizosphere (Canavalia ensiformis) in the phytoremediation of sulfentrazone using quantification methods (CO2 evolution, microbial biomass carbon, and metabolic quotient) and identification of bacteria (PCR-DGGE technique). The experiment was conducted in a completely randomized design, in a 2x4 factorial scheme, with four replications. The treatments were composed of rhizospheric soil (cultivated with C. ensiformis) and non-rhizosphere soil (uncultivated soil); and four levels of contamination by sulfentrazone (0, 200, 400, and 800 g ha-1 a.i.). The microbiota associated with the rhizosphere of C. ensiformis efficiently reduced sulfentrazone residues in the soil, with better performance at the dose of 200 g ha-1 a.i. Using the PCR-DGGE technique allowed the distinction of two profiles of bacteria in the rhizospheric activity of C. ensiformis. The second bacterial profile formed was more efficient in decontaminating soil contaminated with sulfentrazone residue. The microbiota associated with the rhizosphere of C. ensiformis has an efficient profile in decontaminating soils with residues equivalent to 200 g ha-1 a.i. the herbicide sulfentrazone.

Phytoremediation of soils contaminated with herbicide residues is a viable technique for decontamination of the environment.Canavalia ensiformis has an efficient profile in the decontamination of soils with residue equivalent to 200 g ha⁻¹ a.i. of the herbicide sulfentrazone.The PCR technique and microbial respiration used to analyze the diversity and estimate the bacterial population of a soil are viable tools to evaluate the phytoremediation potential of the microbiota associated with plant species.

How do replanted mangroves affect phosphorus dynamics in their soils?

Phosphorus is a limiting element for the productivity of mangroves, which in turn are important ecosystems in regulating nutrients cycle and climate change by sequestering carbon (C). Despite this, there is an intense process of degradation in these environments. In addition to providing socio-environmental services, mangrove replanting can also alter the dynamics of nutrients in soils. Therefore, this study aims to understand the changes in soil phosphorus (P) fractions after a mangrove restoration. Soil samples from an unvegetated area (NV), a mature mangrove (R) and 7 and 9 year old replanted mangroves at SE-Brazil (APA Guapi-mirim, Rio de Janeiro state) were collected and analyzed to characterize the redox conditions (Eh), pH, and iron (Fe) fractionation, Total Organic Carbon (TOC) contents and P fractionation (exchangeable P; P associated with reducible Fe and Mn oxyhydroxides; associated with Al silicates and hydroxides; associated with humic acids; associated with Ca and Mg; associated with humin). The results indicate an increase in TOC as the age of the mangrove restoration increases (from 8.6 to 17.9%). The pH values were significantly lower, reaching very acidic values, associated with an increase in Eh. Both parameters also showed strong seasonal variation, with a drop in Eh during the wet period (from 165% to -46%) and an increase in pH in the same period (from 6.0 to 6.7). Regarding P fractionation, the main P pool was organic P forms, which showed the highest concentrations in all studied sites. Unvegetated areas showed higher organic P forms (NV: 108.8 µg g-1) than vegetated areas (M7: 55.7 µg g-1, M9: 83.6 µg g-1, R: 87.3 µg g-1). Vegetated sites also showed lower levels of the PEx, PFeMn and Papatite fractions (total forest mean: 2.4 µg g-1, 5.8 µg g-1, 3.0 µg g-1, respectively). Besides no clear trend on P fractionation through seasons and forest age, pseudo-total P increased following the forest recovery (e.g. M7

From waste to soil: Technosols made with construction and demolition waste as a nature-based solution for land reclamation.

Population growth has driven an increased demand for solid construction materials, leading to higher amounts of construction and demolition waste (C&DW). Efficient strategies to manage this waste include reduction, reuse, and recycling. Technosols-soils engineered from recycled waste-can potentially help with environmental challenges. However, there is a critical need to explore the potential of Technosols constructed with C&DW for land reclamation, through the growth of native vegetation. The objective of this study was to investigate this potential by studying two Brazilian native tree species (Guazuma ulmifolia and Piptadenia gonoacantha). Technosols were created using C&DW, with and without organic compost and a liquid biofertilizer. A soil health index (SHI) was applied to evaluate the soil quality regarding physical, chemical, and biological indicators of Technosols compared to a control soil (Ferralsol). The results showed that P. gonoacantha plants presented the same height and total biomass in all treatments, while G. ulmifolia plants exhibited greater height and total biomass when grown in Technosols. The enhanced plant development in the Technosols was primarily associated with higher cation exchangeable capacity and nutrients concentration in plant tissues. Technosols with added compost provided higher fertility and total organic carbon. Additionally, Technosols presented higher SHI (∼0.68) compared to control (∼0.38) for both studied species. Our experiment reveals that construction and demolition waste (C&DW) have significant potential to form healthy Technosols capable of supporting the growth of native Brazilian trees. This approach offers a promising alternative for addressing C&DW disposal challenges while serving as a nature-based solution for land reclamation.

Seasonal drives on potentially toxic elements dynamics in a tropical estuary impacted by mine tailings.

This study investigates the impact of seasonality on estuarine soil geochemistry, focusing on redox-sensitive elements, particularly Fe, in a tropical estuary affected by Fe-rich mine tailings. We analyzed soil samples for variations in particle size, pH, redox potential (Eh), and the content of Fe, Mn, Cr, Cu, Ni, and Pb. Additionally, sequential extraction was employed to understand the fate of these elements. Results revealed dynamic changes in the soil geochemical environment, transitioning between near-neutral and suboxic/anoxic conditions in the wet season and slightly acidic to suboxic/oxic conditions in the dry season. During the wet season, fine particle deposition (83%) rich in Fe (50 g kg-1), primarily comprising crystalline Fe oxides, occurred significantly. Conversely, short-range ordered Fe oxides dominated during the dry season. Over consecutive wet/dry seasons, substantial losses of Fe (-55%), Mn (-41%), and other potentially toxic elements (Cr: -44%, Cu: -31%, Ni: -25%, Pb: -9%) were observed. Despite lower pseudo-total PTE contents, exchangeable PTEs associated with carbonate content increased over time (Cu: +188%, Ni: +557%, Pb: +99%). Modeling indicated climatic variables and short-range oxides substantially influenced PTE bioavailability, emphasizing the ephemeral Fe oxide control during the wet season and heightened ecological and health risks during the dry seasons.

How do soil processes control the provision of ecosystem services in coastal wetlands?

Coastal wetlands are known for their diverse ecosystems, yet their soil characteristics are often misunderstood and thought to be monotonous. These soils are frequently subjected to saline water saturation, leading to unique soil processes. However, the combination and intensity of these processes can vary considerably across different ecosystems. In this study, we hypothesize that these diverse soil processes not only govern the geochemical conditions in coastal ecosystems but also influence their ability to deliver ecosystem services. To test this hypothesis, we conducted soil analyses in mangroves, seagrass meadows, and hypersaline tidal flats along the Brazilian coast. We used key soil properties as indicators of soil processes and developed a conceptual model linking soil processes and soil-related ecosystem services in these environments. Under more anoxic conditions, the intense soil organic matter accumulation and sulfidization processes in mangroves evidence their significance in terms of climate regulation through organic carbon sequestration and contaminants immobilization. Similarly, pronounced sulfidization in seagrasses underscores their ability to immobilize contaminants. In contrast, hypersaline tidal flats soils exhibit increased intensities of salinization and calcification processes, leading to a high capacity for accumulating inorganic carbon as secondary carbonates (CaCO3), underscoring their role in climate regulation through inorganic carbon sequestration. Our findings show that contrary to previously thought coastal wetlands are far from monotonous, exhibiting significant variations in the types and intensities of soil processes, which in turn influence their capacity to deliver ecosystem services. This understanding is pivotal for guiding effective management strategies to enhance ecosystem services in coastal wetlands.

Efficacy of Continuous Lateral Rotation Therapy in Mechanically Ventilated Critically Ill Adults on Clinical Outcomes.

Background: This PICO-guided systematic review assessed continuous lateral rotation therapy (CLRT) versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, intensive care unit (ICU) and hospital stay duration as primary outcomes, and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events, as secondary outcomes. Methods: A systematic review followed PRISMA criteria (PROSPERO CRD42022384258). Searches spanned databases: MEDLINE/PubMed, EMBASE, Scopus, ScienceDirect, Cochrane, CINAHL and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized (RCT) and quasi-randomized trials, comparing CLRT (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane collaboration and GRADE tools. For the quasi-randomized trials, the ROBINS-I tool was used. Results: In 18 studies with 1.466 participants (intervention, n= 700, 47.7%; control, n= 766, 52.2%), CLRT was predominantly used for prophylactic purposes, with protocols varying from 10 to 24 hours/day. Meta-analysis (16 RCTs) favored CLRT for reduced mechanical ventilation duration (SMD -0.17 days, CI -0.29 to -0.04, p=0.008) and lower nosocomial pneumonia incidence (OR 0.39, CI 0.29 to 0.52, p<0.00001). CLRT showed no significant impact on mortality (OR 1.04, CI 0.80 to 1.34, p= 0.77), ICU stay (SMD -0.11 days, CI -0.25 to 0.02, p= 0.11), hospital stay (SMD -0.10 days, CI -0.31 to 0.11, p= 0.33) and incidence of pressure ulcers (OR 0.73, CI 0,34 to 1.60, p= 0.44). Conclusions: CLRT showed no significant difference in primary outcomes (mortality, ICU, and hospital stay duration) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on MV duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess CLRT effectiveness.

Contrasting plant-induced changes in heavy metals dynamics: Implications for phytoremediation strategies in estuarine wetlands.

Wetland plants play a crucial role in regulating soil geochemistry, influencing heavy metal (HM) speciation, bioavailability, and uptake, thus impacting phytoremediation potential. We hypothesized that variations in HM biogeochemistry within estuarine soils are controlled by distinct estuarine plant species. We evaluated the soils (pH, redox potential, rhizosphere pH, HM total concentration, and geochemical fractionation), plant parts (shoot and root), and iron plaques of three plants growing in an estuary affected by Fe-rich mine tailings. Though the integration of multiple plant and soil analysis, this work emphasizes the importance of considering geochemical pools of HM for predicting their fate. Apart from the predominance of HM associated with Fe oxides, Typha domingensis accumulated the highest Cr and Ni contents in their shoots (> 100 mg kg-1). In contrast, Hibiscus tiliaceus accumulated more Cu and Pb in their roots (> 50 mg kg-1). The differences in rhizosphere soil conditions and root bioturbation explained the different potentials between the plants by altering the soil dynamics and HM's bioavailability, ultimately affecting their uptake. This study suggests that Eleocharis acutangula is not suitable for phytoextraction or phytostabilization, whereas Typha domingensis shows potential for Cr and Ni phytoextraction. In addition, we first showed Hibiscus tiliaceus as a promising wood species for Cu and Pb phytostabilization.

Internações na infância por doenças do aparelho respiratório no Brasil de 2013 a 2022 / Hospitalizaciones infantiles por enfermedades del sistema respiratorio en Brasil de 2013 a 2022 / Hospitalizations during childhood due to respiratory system diseases in Brazil from 2013 to 2022

Introdução: As doenças do sistema respiratório se mostram como uma das causas mais preocupantes de internações hospitalares no país. Nessa perspectiva, o perfil das internações por doenças respiratórias em crianças permite observar os parâmetros desta problemática, fornecendo um conhecimento amplo acerca do processo saúde e doença nessa população. Objetivo: Analisar o perfil epidemiológico das internações hospitalares por causas do aparelho respiratório em crianças de 0 a 9 anos no Brasil e regiões, entre os anos de 2013 e 2022. Metodologia: Trata-se de um estudo ecológico, realizado no Brasil, a partir de dados secundários do Sistema de Informações Hospitalares. A população escolhida para este estudo foram crianças de 0 a 9 anos deidade. Os dados foram coletados em 26 de novembro de 2022. As variáveis dependentes do estudo são as internações de crianças de 0 a 9 anos por doenças do aparelho respiratório no Brasil e suas regiões. Já, como variáveis independentes, tem-se o tempo, do período de janeiro de 2013 a setembro de 2022, regiões e faixa etária. Resultados: Há uma tendência de queda das internações por causa respiratória até o ano de 2016, seguido de um crescimento gradativo até 2019. Entretanto, em 2020, a taxa de hospitalização reduziu drasticamente em todas as localidades. As regiões Sul, Norte e Centro-Oeste permaneceram com taxas maiores que o Brasil em todo o período estudado. A internação em menores de 1 ano representa o maior quantitativo de internações sendo a pneumonia a causa mais prevalente. Conclusões: As taxas de internação infantil por doenças respiratórias representam importante preocupação para saúde pública. Assim, destaca-se a relevância da efetividade da Atenção Primária à Saúde, que possui grande impacto no desfecho dos adoecimentos em crianças, especialmente das doenças respiratórias (AU).

Introduction: Respiratory system diseases are one of the most worrying causes of hospital admissions in the country. From this perspective, the profile of hospitalizations for respiratory diseases in children allows us to notice the parameters of this problem, providing a broad understanding of the health and disease process in this population.Objective: To analyze the epidemiological profile of hospital admissions due to respiratory causes in children aged 0 to 9 in Brazil and its regions between 2013 and 2022. Methodology: This is an ecological study held in Brazil using secondary data from the Hospital Information System. The population chosen for this study consisted of children aged 0 to 9. Data were collected on November 26, 2022. The dependent variables of this study are hospitalizations of children aged 0 to 9 due to respiratory diseases in Brazil and its regions. The independent variables are time, from January 2013 to September 2022, regions, and age group.Results: There was a downward trend in hospitalizations due to respiratory causes until 2016, followed by a gradual increase until 2019. Nonetheless, in 2020, the hospitalization rate fell dramatically in all locations. The South, North and Mid-West regions remained with higher rates than Brazil throughout the studied period. Hospitalization of children under 1 year old represents the largest number of admissions, with pneumonia being Revista Ciência Plural. 2024; 10(1): e31414 3the most prevalent cause.Conclusions: Hospitalization rates during childhood due to respiratory diseases represent a major public health concern. Thus, one can highlight the importance of the effectiveness of Primary Health Care, which has a major impact on the outcome of illnesses in children, especially respiratory diseases (AU).

Introducción: Las enfermedades del sistema respiratorio son una de lascausas más preocupantes de hospitalizaciones en el país. Desde esta perspectiva, el perfil de hospitalizaciones por enfermedades respiratorias en niños permite observar los parámetros de este problema, proporcionando una amplia comprensión del proceso de salud y enfermedad en esta población.Objetivo: Analizar el perfil epidemiológico de las internaciones por causas respiratorias en niños de 0 a 9 años en Brasil y sus regiones entre 2013 y 2022. Metodología: Se trata de un estudio ecológico conducido en Brasil a partir de datos secundarios del Sistema de Información Hospitalaria. La población elegida para este estudio fueron los niños de 0 a 9 años. Los datos se recogieron el 26 de noviembre de 2022. Las variables dependientes del estudio son las hospitalizaciones de niños de 0 a 9 años por enfermedades respiratorias en Brasil y sus regiones. Las variables independientes son el tiempo, de enero de 2013 a septiembre de 2022, las regiones y la franja etaria.Resultados: Se nota una tendencia a la baja de las hospitalizaciones por causas respiratorias hasta 2016, seguida de un aumento gradual hasta 2019. Sin embargo, en 2020, la tasa de hospitalización cayó drásticamente en todas las localidades. Las regiones Sur, Norte y Medio Oeste se mantuvieron con tasas másaltas que Brasil durante todo el período estudiado. Las hospitalizaciones en niños menores de 1 año representan el mayor número de internaciones, siendo la neumonía la causa más prevalente.Conclusiones: Las tasas de hospitalización infantil por enfermedades respiratorias representan un importante problema de salud pública. Así, se subraya la importancia de la eficacia de la Atención Primaria de Salud, que tiene un gran impacto en el resultado de las enfermedades en los niños, especialmente las respiratorias (AU).

Protocolo assistencial multidisciplinar: relato de caso de 225 dias de balão intra aórtico / Multidisciplinary care protocol: case report of 225 days of intra-aortic balloon pump

Este estudo aborda um caso extremamente raro de um paciente que passou 225 dias com um balão intra aórtico antes de receber um transplante cardíaco. Essa situação extraordinária destaca a importância da abordagem multiprofissional no cuidado de pacientes com desafios clínicos complexos. Além disso, oferece insights valiosos para a comunidade médica e científica, contribuindo para o aprimoramento das estratégias clínicas em um contexto desafiador. A insuficiência cardíaca (IC), uma condição em que o coração não consegue bombear sangue suficiente para atender às necessidades do corpo, afetando mais de 23 milhões de pessoas em todo o mundo, incluindo cerca de 2 milhões no Brasil. A IC é frequentemente causada por condições como doença arterial coronariana (DAC), hipertensão e diabetes, com influência adicional da doença de Chagas na América Latina. Pacientes com IC enfrentam desafios significativos que resultam frequentemente em hospitalizações recorrentes. Uma abordagem multiprofissional é essencial para o tratamento e gerenciamento eficaz da doença, dada a complexidade da patologia e suas comorbidades. Uma equipe multiprofissional reúne especialistas em saúde para fornecer uma abordagem abrangente e personalizada, auxiliando os pacientes na transição até o transplante cardíaco e na gestão contínua da condição, prevenindo complicações. A análise deste caso incomum, no qual o paciente encontrado por um longo período com um balão intraaórtico, destaca a importância crucial da abordagem multiprofissional no cuidado de pacientes com insuficiência cardíaca. Os resultados deste estudo têm o potencial de oferecer novas perspectivas e contribuições benéficas para a comunidade médica, promovendo o avanço das estratégias de tratamento em um contexto clínico notável.

Osteorradionecrose em paciente com insuficiência mitral em uso de anticoagulante antagonista de vitamina k: relato de caso

INTRODUÇÃO: A osteorradionecrose (ORN) é uma complicação associada ao tratamento radioterápico em região de cabeça e pescoço, caracteriza-se como a formação de osso necrótico e desvitalizado. Possui sinais e sintomas como dor, formação de fístula intra ou extraoral, exposição óssea, trismo, fratura patológica e sequestro ósseo. A proposta terapêutica mais eficaz é o debridamento ósseo e dos tecidos moles afetados associado a antibioticoterapia. A radioterapia reduz a vascularização do tecido, causando hipóxia e reduzindo sua capacidade de regeneração tecidual. Diante de um caso de trauma, a reparação não será efetiva e o tecido pode progredir para um tecido necrótico e desvitalizado. RELATO DE CASO: Paciente gênero feminino, 59 anos com diagnóstico de Insuficiência Mitral grave estágio D de provável etiologia reumática, fibrilação atrial em uso de anticoagulante antagonista de vitamina K, histórico de tratamento radioterápico de neoplasia de língua há oito anos e extração dentária recente. Como queixa principal, dor de difícil controle medicamentoso. Ao exame físico extraoral apresentava edema, hiperemia em região submandibular direita efístula com drenagem de exsudato purulento.No exame físico intraoral desdentada total superior e inferior sem uso de prótese dentáriacom presença de exposição óssea em rebordo alveolar de aproximadamente 5cm na região inferior anterior e posterior do lado direito. A hipótese diagnóstica foi de ORN. Conduta realizada em conjunto com equipe de cirurgia bucomaxilofacial de serviço externofoi debridamento de tecido ósseo necrótico em região de rebordo alveolar até região de parassínfise esquerda para remoção de tecido ósseo desvitalizado, antibioticoterapia e acompanhamento odontológico semanal com sessões de laserterapia de baixa potência e terapia fotodinâmica. Após a realização de cirurgia cardíaca para troca da valva paciente evoluiu com fratura patológica em mandíbula e foiencaminhada para ressecção parcial de mandíbulasob anestesia geral. No pós-operatório apresentoudiscreta assimetria facial, ausência de exposição óssea e regressão total da sintomatologia dolorosa. CONSIDERAÇÕESFINAIS: O manejo da ORN é considerado desafiador em pacientes tratados com radioterapia de cabeça e pescoço. O caso evidencia a importânciado diagnóstico e tratamento correto para evitar complicações tardias que reduzam a qualidade de vida. O cirurgião-dentista deve estar atento à prevenção dessa condição.

Manifestação bucal de intoxicação cumarínica em paciente cardiopata com miocardiopatia chagásica: relato de caso / Oral manifestation of coumarin intoxication in a heart disease patient with chagasic cardiomyopathy: case report

INTRODUÇÃO: Os anticoagulantes orais são administrados principalmente para prevenção de eventos tromboembólicos, o antagonista da Vitamina K (AVK) mais utilizado é a Varfarina, pertencente ao grupo dos cumarínicos. As diversas interações medicamentosas e alimentares podem aumentar sua biodisponibilidade sanguínea de forma a potencializar o seu efeito. O controle da anticoagulação deve ser realizado com a monitorização terapêuticado tempo de protrombina (TP) e aRazão Normalizada Internacional (RNI), cuja dose varia para cada indivíduo. A hemorragia é o efeito adverso mais comum do anticoagulante. Valores de RNI > 5 estão associados a risco de sangramento e a reversão do efeito do AVK pode ser conseguido com várias medidas, desde a simples suspensão da droga, a administração de vitamina K ou a administração de plasma fresco congelado (PFC) ou complexo protrombínico, de acordo com a urgência da situação. O sinal clínico mais frequente é o sangramento muco-cutâneo e, em casos de eventos traumáticos favorece a formação de equimose e hematomas. RELATO DE CASO: Paciente gênero masculino, 77 anos com diagnóstico de Miocardiopatia Chagásica com Insuficiência Cardíaca fração de ejeção reduzida (30%), em uso de anticoagulante antagonista de vitamina K, com histórico de queda da própria altura. Foi solicitada a interconsulta da equipe de odontologia, por sangramento ativo em cavidade oral e queixa de trauma por mordida. Ao exame físico extraoral paciente contactuante verbal, deambulante com auxílio, dieta via oral assistida e abertura mandibular preservada. No exame físico intraoral paciente desdentado superior em uso de prótese total e dentado parcial inferior em uso de prótese parcial removível, com presença de lesões arroxeadas em região de ventre lingual e assoalho bucal do lado direito e em região de dorso de língua com laceração característica de trauma por mordida do lado direito de aproximadamente 1 centímetro de diâmetro com relato de sintomatologia dolorosa. Solicitado o exame laboratorial com resultado de RNI 10.0. O diagnóstico foi hematoma como manifestação bucal de intoxicação cumarínica. Foi realizada laserterapia para analgesia e cicatrização do local traumatizado, e discussão com equipe médica que prescreveu três doses de vitamina K e duas bolsas de plasma para reversão do quadro. CONSIDERAÇÕES FINAIS: O caso apresenta a importância da avaliação odontológica para diagnóstico e tratamento imediato no contexto hospitalar e na atividade multiprofissional, além de reduzir possíveis complicações sistêmicas durante a internação.

Aesthetic treatment planning simplified using digital smile design: A case report.

Digital smile design (DSD) plays an essential role in the planning of aesthetic treatments. However, most digital smile designing software programmes are expensive and require specialised training and skill for effective implementation. This paper illustrates the use of Adobe Photoshop and Microsoft PowerPoint, which are economical and user friendly for planning aesthetics in a clinical case.

Zoonotic bacterial pathogens in bats samples around the world: a scoping review.

The aim of this scoping review was to describe the zoonotic bacterial pathogens already reported and their frequency in different bat species. Six databases were searched, without restriction on the year or location where the studies were carried out. Based on the inclusion and exclusion criteria, 146 studies that were published between 1964 and 2020 (most after 2005) were selected. In these studies, 102 zoonotic bacterial genera were described in different samples of fourteen bat families in 55 countries, suggesting the possible role of bats as hosts for these pathogens. The pathogens mainly identified in bats were Bartonella spp., Leptospira spp. and Staphylococcus spp. In conclusion, the information provided by this scoping review expands the knowledge about zoonotic bacterial pathogens already identified in bats, which can guide epidemiological surveillance policies for these pathogens in different countries.

Multifaceted Strategy Based on Automated Text Messaging After a Recent Heart Failure Admission: The MESSAGE-HF Randomized Clinical Trial.

Importance: Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem. Objective: To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization. Design, Setting, and Participants: This randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022. Intervention: Participants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team. Main Outcomes and Measures: The primary end point was change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed. Results: Of 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, -2.21; 95% CI, -3.67 to -0.74; P = .001; score difference at 180 days, -2.08; 95% CI, -3.59 to -0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26). Conclusions and Relevance: An intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome. Trial Registration: ClinicalTrials.gov Identifier: NCT04062461.

Multifaceted strategy based on automated text messaging after a recent heart failure admission: the MESSAGE-HF Randomized Clinical Trial

IMPORTANCE: Readmissions after an index heart failure (HF) hospitalization are a major contemporary health care problem. OBJECTIVE: To evaluate the feasibility and efficacy of an intensive telemonitoring strategy in the vulnerable period after an HF hospitalization. DESIGN, SETTING, AND PARTICIPANTS: This randomized clinical trial was conducted in 30 HF clinics in Brazil. Patients with left ventricular ejection fraction less than 40% and access to mobile phones were enrolled up to 30 days after an HF admission. Data were collected from July 2019 to July 2022. INTERVENTION: Participants were randomly assigned to a telemonitoring strategy or standard care. The telemonitoring group received 4 daily short message service text messages to optimize self-care, active engagement, and early intervention. Red flags based on feedback messages triggered automatic diuretic adjustment and/or a telephone call from the health care team. MAIN OUTCOMES AND MEASURES: The primary end point was change in N-terminal pro-brain natriuretic peptide (NT-proBNP) from baseline to 180 days. A hierarchical win-ratio analysis incorporating blindly adjudicated clinical events (cardiovascular deaths and HF hospitalization) and variation in NT-proBNP was also performed. RESULTS: Of 699 included patients, 460 (65.8%) were male, and the mean (SD) age was 61.2 (14.5) years. A total of 352 patients were randomly assigned to the telemonitoring strategy and 347 to standard care. Satisfaction with the telemonitoring strategy was excellent (net promoting score at 180 days, 78.5). HF self-care increased significantly in the telemonitoring group compared with the standard care group (score difference at 30 days, -2.21; 95% CI, -3.67 to -0.74; P = .001; score difference at 180 days, -2.08; 95% CI, -3.59 to -0.57; P = .004). Variation of NT-proBNP was similar in the telemonitoring group compared with the standard care group (telemonitoring: baseline, 2593 pg/mL; 95% CI, 2314-2923; 180 days, 1313 pg/mL; 95% CI, 1117-1543; standard care: baseline, 2396 pg/mL; 95% CI, 2122-2721; 180 days, 1319 pg/mL; 95% CI, 1114-1564; ratio of change, 0.92; 95% CI, 0.77-1.11; P = .39). Hierarchical analysis of the composite outcome demonstrated a similar number of wins in both groups (telemonitoring, 49 883 of 122 144 comparisons [40.8%]; standard care, 48 034 of 122 144 comparisons [39.3%]; win ratio, 1.04; 95% CI, 0.86-1.26). CONCLUSIONS and relevance: An intensive telemonitoring strategy applied in the vulnerable period after an HF admission was feasible, well-accepted, and increased scores of HF self-care but did not translate to reductions in NT-proBNP levels nor improvement in a composite hierarchical clinical outcome.

Cervical Intraepithelial Neoplasia grade 2 biopsy: Do p16INK4a and Ki-67 biomarkers contribute to the decision to treat? A cross-sectional study

ABSTRACT BACKGROUND: Managing cervical intraepithelial neoplasia grade 2 (CIN2) is challenging, considering the CIN2 regression rate, perinatal risks associated with excisional procedures, and insufficient well-established risk factors to predict progression. OBJECTIVES: To determine the ability of p16INK4a and Ki-67 staining in biopsies diagnosed with CIN2 to identify patients with higher-grade lesions (CIN3 or carcinoma). DESIGN AND SETTING: Cross-sectional study conducted at a referral center for treating uterine cervical lesions. METHODS: In 79 women, we analyzed the correlation of p16INK4a and Ki-67 expression in CIN2 biopsies with the presence of a higher-grade lesions, as determined via histopathology in surgical specimens from treated women or via two colposcopies and two cytological tests during follow-up for untreated women with at least a 6-month interval. The expression of these two biomarkers was verified by at least two independent pathologists and quantified using digital algorithms. RESULTS: Thirteen (16.8%) women with CIN2 biopsy exhibited higher-grade lesions on the surgical excision specimen or during follow-up. p16INK4a expression positively and negatively predicted the presence of higher-grade lesions in 17.19% and 86.67% patients, respectively. Ki-67 expression positively and negatively predicted the presence of higher-grade lesions in 40% and 88.24% patients, respectively. CONCLUSIONS: Negative p16INK4a and Ki67 immunohistochemical staining can assure absence of a higher-grade lesion in more than 85% of patients with CIN2 biopsies and can be used to prevent overtreatment of these patients. Positive IHC staining for p16INK4a and Ki-67 did not predict CIN3 in patients with CIN2 biopsies.

Relação entre medidas fornecidas por smartwatches e a identificação de síndrome da fragilidade em idosos: revisão de escopo / Relationship between measures provided by smartwatches and identification of frailty syndrome in older adults: a scoping review

Resumo Objetivo Esta Revisão de Escopo teve como objetivo descrever e mapear as medidas disponibilizadas pelos smartwatches como ferramenta para identificação da Síndrome de Fragilidade em idosos. Métodos Foram incluídos estudos publicados em qualquer idioma, sem restrição de data de publicação, que descrevessem o uso de medidas fornecidas por smartwatches na avaliação da Síndrome de Fragilidade e/ou seus critérios em idosos. Descritores em inglês para smartwatches, smartbands, Síndrome da Fragilidade e envelhecimento foram utilizados para desenvolver uma estratégia de busca abrangente, que foi então aplicada para pesquisar nas seguintes bases de dados: COCHRANE LIBRARY, EMBASE, SCOPUS, PUBMED/MEDLINE, LILACS, WEB OF SCIENCE e PEDRO. Resultados A busca inicial identificou um total de 156 artigos e foram identificados 2 artigos a partir da busca manual nas referências dos estudos elegíveis. Em seguida, foram incluídos 4 estudos que utilizaram medidas diárias de contagem de passos para síntese descritiva, e três dos quatro também utilizaram dados relacionados ao sono e FC para avaliar a fragilidade em idosos. Os resultados obtidos nesta revisão indicam que parâmetros derivados de smartwatches têm sido utilizados para identificar estágios de fragilidade em diferentes ambientes, sendo a maioria dos estudos associados a outras condições clínicas. Conclusão Os smartwatches são uma excelente ferramenta de monitoramento de fragilidade por meio de medições diárias de contagem de passos, dados de sono e frequência cardíaca. Os resultados obtidos com o uso desses dispositivos podem sugerir uma avaliação mais ampla dos idosos que enfrentam risco aumentado de desenvolver a Síndrome da Fragilidade.

Abstract Objective This scoping review aimed to describe and map the measures provided by smartwatches as a tool for identifying Frailty Syndrome in older adults. Methods Studies published in any language, without publication date restrictions, that described the use of measures provided by smartwatches in evaluating or identifying Frailty Syndrome and/or its criteria in older adults were included. English descriptors for smartwatches, smartbands, Frailty Syndrome and Older Adults were used to develop a comprehensive search strategy, which was then applied to search the following databases: COCHRANE LIBRARY, EMBASE, SCOPUS, PUBMED/MEDLINE, LILACS, WEB OF SCIENCE and PEDRO. Results The initial search identified a total of 156 articles and 2 articles were identified from the manual search in the references of eligible studies. Next, 4 studies that used daily step count measurements for descriptive synthesis were included, and three of the four also used sleep and heart rate data to assess frailty in older adults. The results obtained in this review indicate that parameters derived from smartwatches have been used to identify stages of frailty in different areas, with the majority of studies being associated with other clinical conditions. Conclusion Smartwatches are an excellent frailty monitoring tool through daily measurements of step count, sleep data and heart rate. The results obtained with the use of these devices may suggest a broader evaluation of older adults who face an increased risk of developing Frailty Syndrome.