Predicting intensive care unit-acquired weakness: A multilayer perceptron neural network approach.

In this editorial, we comment on the article by Wang and Long, published in a recent issue of the World Journal of Clinical Cases. The article addresses the challenge of predicting intensive care unit-acquired weakness (ICUAW), a neuromuscular disorder affecting critically ill patients, by employing a novel processing strategy based on repeated machine learning. The editorial presents a dataset comprising clinical, demographic, and laboratory variables from intensive care unit (ICU) patients and employs a multilayer perceptron neural network model to predict ICUAW. The authors also performed a feature importance analysis to identify the most relevant risk factors for ICUAW. This editorial contributes to the growing body of literature on predictive modeling in critical care, offering insights into the potential of machine learning approaches to improve patient outcomes and guide clinical decision-making in the ICU setting.

Factors Associated with the Extent of Clinical Attachment Loss in Periodontitis: A Multicenter Cross-Sectional Study.

Periodontitis has significant public health implications, affecting individuals' overall health, well-being, and quality of life. This study aimed to assess the risk factors associated with the extent of clinical attachment loss (CAL) in a population diagnosed with periodontitis. Six hundred and sixty-seven patients with different degrees of CAL (mild, n = 223; moderate, n = 256; and advanced, n = 188) were enrolled. Socio-demographics, lifestyle, microbiological profiles, specific immune response, obesity, and single-nucleotide polymorphism of the IL1 gene were determined. Unconditional logistic regression models were conducted to determine the factors associated with the extent of CAL. Aging, smoking, microbial factors, plaque index, and IgG2 antibodies against Aggregatibacter actinomycetemcomitans were associated with advanced CAL. IgG2 antibodies against A. actinomycetemcomitans (OR 1.50; CI 95% 1.23-1.81), plaque accumulation (OR 2.69; CI 95% 2.20-3.29), Porphyromonas gingivalis (OR 1.93; CI 95% 1.35-2.76), Tanerella forsythia (OR 1.88; CI 95%1.30-2.70), and current smoking (OR 1.94; CI 95% 1.31-2.87) were associated with advanced CAL. Gene IL polymorphisms, obesity, and stress were not associated with the extent of CAL. Aging, plaque accumulation, smoking, and having antibodies against A. actinomycetemcomitans were the most critical factors associated with advanced CAL. In contrast, obesity, stress, and gene polymorphisms were not associated with the extent of CAL.

PoCUS for the management of Fournier's gangrene in the emergency department: A case report.

Serious soft tissue infections in the spectrum of rapidly progressive necrosis of the fascia and subcutaneous tissue represent a clinical challenge in emergency department clinical practice. Fournier's gangrene (FG) is a presentation thereof that compromises the urogenital area. A low threshold of clinical suspicion complementary to laboratory evaluation and imaging is necessary to act rapidly and perform diagnostic and therapeutic surgical intervention for this condition. The present study reported the case of a 63-year-old woman who was admitted with buttock skin changes for 72 h. The diagnostic impression was septic shock due to FG. Point-of-care ultrasound (PoCUS) was performed, indicating free fluid in the muscle planes, discontinuity of the muscle fascia and the presence of gas in the subcutaneous cellular tissue. The patient was taken to surgery 2 h after admission. PoCUS was indicated to have an acceptable diagnostic performance that may optimize the care of this type of patient depending on the conditions of the emergency department and the availability of other resources.

Point­of­care ultrasound for the diagnosis of liver abscess in a patient with HIV in the emergency department: A case report.

A liver abscess is an entity that is rarely observed in the emergency department; therefore, it requires timely diagnosis by the clinicians who support this service. The early diagnosis of a liver abscess is challenging as variable and non-specific symptoms are present; furthermore, symptoms may differ in patients with human immunodeficiency virus (HIV) infection. To date, reports on the presentation of diagnostic ultrasound with point-of-care ultrasonography (PoCUS) are limited. The present case report study describes a patient diagnosed with HIV and the presence of a liver abscess confirmed by PoCUS performed in an emergency department. The patient presented with abdominal pain upon palpation in the right hypochondrium and in the thoracoabdominal area, which became more severe with inspiration. PoCUS revealed a hypodense intrahepatic image observed between segments VII and VI, with internal echoes suggestive of a liver abscess. Moreover, it was decided to perform tomography-guided percutaneous drainage of the liver abscess. Antibiotic treatment with ampicillin/sulbactam and IV metronidazole was also commenced. The patient presented clinical improvement and was discharged on the third day.

Accuracy of point­of­care ultrasonography in the diagnosis of necrotizing fasciitis: A case report.

Necrotizing fasciitis is a serious infectious condition that may compromise the patient's life. In the present case study, a 42-year-old male patient was reported. The condition manifested as the presence of subjective fever, general malaise, myalgia, non-productive cough, dysphagia and neck pain ~1 week prior to hospital admission. Vascular dissection was considered as the initial diagnostic suspicion, and thus, angiotomography of neck vessels was performed, ruling out aortic and neck vessel dissection. Radiology indicated negativity for aortic syndrome and cervical vascular disease, but the presence of cervical-mediastinal edema, lamellar fluid between muscular and fatty planes and posterior pulmonary atelectasis, absence of pleural fluid or consolidations, and tonsillar hypertrophy without abscesses. Due to the rapid evolution of the condition, the presence of dyspnea with the need for supplemental oxygen, and the disproportion between the intensity of the pain described by the patient and the external findings observed, the presence of necrotizing fasciitis was considered. Point-of-care ultrasonography was performed, indicating a cobblestone pattern of the subcutaneous cellular tissue, with diffuse thickening of the anterior cervical fascia and increased echogenicity with soft tissue edema posterior to the fascia. Magnetic resonance imaging confirmed the inflammatory findings in the fascia and other cervical soft tissues, without exhibiting any signs of necrosis, but with the presence of abscesses in the visceral and carotid space.

Dental and Maxillofacial Manifestations of Axenfeld-Rieger Syndrome: Presentation of a Case in a 5-Year-Old Girl.

In this case study, the dental and maxillofacial manifestations of a 5-year-old girl with Axenfeld-Rieger syndrome (ARS) are described. This syndrome is characterized by craniomaxillofacial, ocular, dental, and umbilical disorders. The patient presented ocular dyscoria and corectopia, iris abnormalities, midface hypoplasia with a thin upper lip, and a protruded lower lip. Hyperplastic maxillary labial frenulum, oligodontia, ghost teeth, bilateral Class III molar and canine relationship, and right posterior crossbite were also found. An everted umbilicus with redundant periumbilical skin was evident. Early diagnosis of ARS is essential to establishing preventive and corrective measures that provide a good quality of life for patients who suffer from this syndrome.

Mandibular Body Reconstruction Utilizing a Three-Dimensional Custom-Made Porous Titanium Plate: A Four-Year Follow-Up Clinical Report.

A clinical case of a 42-year-old woman patient, who had a mandibular reconstruction utilizing a three-dimensional (3D) custom-made porous titanium plate dental restoration, is presented. She showed a recurrence of a unicystic ameloblastoma involving the left hemimandible. The patient declined to be managed by a bone-free flap. A mandibular resection in the healthy areas was provided, followed by reconstruction utilizing a 3D custom-made porous titanium plate dental restoration with a hybrid dental prosthesis. The 3D rehabilitation was created considering slim tomodensitometric sections. The cutting guides and custom-created 3D plate were fabricated employing medical software via computer-aided design and fabricating with locations planned for healing abutments. The patient was contented with the rehabilitation, and the condition continued stable at the four-year follow-up.

A multilevel analysis of a randomized clinical trial comparing adjunctive moxifloxacin versus amoxicillin/metronidazole for the treatment of aggressive periodontitis.

BACKGROUND: It was documented that the clinical outcomes of mechanical periodontal treatment can fluctuate not merely concerning patients but equally among various tooth sites in the subject. This trial evaluates the clinical parameters related with the patient, tooth, and site that generate more changes in clinical attachment level (CAL) gain and probing depth (PD) reduction, using moxifloxacin (MOX) versus amoxicillin plus metronidazole (AMOX + ME) as adjuncts to scaling and root planing (SRP), in comparison to SRP only, post-therapy in generalized aggressive periodontitis (GAgP). MATERIALS AND METHODS: The analysis of this clinical trial included 6012 tooth sites at 1002 teeth in 36 patients; they were randomly assigned to three protocols: Systemically intake of MOX or AMOX + ME plus SRP, or SRP + placebo for 7 days. The clinical effect of the patient, tooth, and site characteristics, in terms of CAL gain and PD reduction, was explored using a multilevel linear model. P < 0.05 was statistically significant. RESULTS: Following 6 months of treatment, the differences between the groups were statistically significant, favoring the MOX and AMOX + ME protocols (P < 0.0001). Moreover, the multilevel model showed that adjunctive MOX, AMOX + ME, non-molar, and interproximal sites were the features that contribute significantly to CAL improvement, and PD decreases in GAgP (P ≤ 0.001 for all). CONCLUSION: The most relevant characteristics for the changes in CAL increase and PD diminution, after adjunctive antimicrobials, were ascribable to the features related to the tooth. MOX and AMOX + ME, non-multi-radicular-tooth, and interdental sites indicated superior clinical gains at the tooth and site levels in GAgP.

Relationship between physical activity, academic achievement, gender, and learning styles in students of a Latin American Dental School: A cross-sectional study.

BACKGROUND: Little is known about the inference that physical activity (PA) may have on academic performance and learning styles of Latin American dental students. MATERIALS AND METHODS: In this cross-sectional study, an administrative dataset and a voluntary university characterization provided information about PA and academic performance. Moreover, 218 dental students of the University of Antioquia in Colombia completed a structured questionnaire to identify their learning styles. To analyze the information obtained a Pearson correlation, and logistic and linear regression models were implemented. RESULTS: A total of 131 (60%) students informed being physically active (PA group), and 87 (40%) did not report PA (non-PA group). The results showed a high-grade point average (GPA) in the PA group (P = 0.01). The PA group showed a preference for the theorist and pragmatist learning styles with statistically significant differences between the groups (P = 0.004 and P < 0.0001, respectively). It was also observed a statistically significant Pearson positive correlation between the theorist style and higher GPA (r = 0.15; P = 0.04). The multivariate regression model showed that PA protects against lower means of GPA (odds ratio = 0.3; 95% confidence interval [CI]: 0.09-0.7, P = 0.01). Furthermore, the adjusted linear regression models also showed that PA protects against lower means of the theorist (ß= -0.15; 95% CI: -0.02 to - 0.002, P = 0.002) and pragmatist styles (ß= -0.18; 95% CI: -0.03 to - 0.006, P = 0.0006). Interestingly, men were statistically significant in all multivariable models. DISCUSSION: This study suggests that PA is associated with higher academic performance and the theorist and pragmatist styles. Male students were also more physically active; therefore, it is relevant to establish strategies to stimulate physical activities in dental students, especially in women, including extracurricular activities.

Learning styles of ethnic minority students: a matched case-control study in a dental school in Latin America / Estilos de aprendizaje en estudiantes de minorías étnicas: un estudio de casos y controles en una facultad de odontología en América Latina / Estilos de aprendizagem de estudantes de minorias étnicas: um estudo caso-controle em uma escola de odontologia da América Latina

Abstract Introduction and objective: Little is known about the learning styles of ethnic minorities in Latin American universities. The objective of this research was to identify the learning styles of the ethnic minorities attending a dental school. Moreover, their grade point averages were explored. Materials and methods: A total of 30 ethnic minority students were matched with 30 non-minority students. All the students took a systematized questionnaire to categorize their learning styles. Results: A strong association between ethnic minority students and low reflector style was observed in the multivariate model after adjusting for age, sex, and the current semester (OR=11; 95% CI=1.2-99; p=0.03). In addition, a relevant association between minority ethnic group and low theorist style was observed in the multivariate model after controlling for the same variables (OR= 4; 95% CI=1.2-11; p=0.02). Finally, a statistically significant difference was observed in the grade point averages of non-minority and minority groups, with the minority group having the lower averages (p=0.014). Conclusions: Ethnic minority students presented lower means for all learning styles compared to the control group. Similarly, their grade point averages were significantly inferior. These findings represent relevant precedents for creating educational strategies to improve the learning of ethnic minority groups in higher education in Latin America.

Resumen Introducción y objetivo: Poco se sabe sobre los estilos de aprendizaje de las minorías étnicas en las universidades latinoamericanas. El objetivo de esta investigación fue identificar los estilos de aprendizaje en las minorías étnicas de una facultad de odontología. Además, se exploró su promedio de calificaciones. Materiales y métodos: treinta estudiantes de minorías étnicas se parearon con treinta estudiantes de minorías no étnicas. Todos los estudiantes completaron un cuestionario sistematizado para clasificar sus estilos de aprendizaje. Resultados: En el modelo multivariado después de ajustar por las variables edad, sexo y semestre actual, se observó una fuerte asociación entre los estudiantes de minorías étnicas y un nivel bajo en el estilo reflector (OR= 11; 1.2-99, IC 95%; p= 0.03). Igualmente, después de controlar las mismas variables, se encontró una asociación relevante entre el grupo étnico minoritario y un nivel bajo en el estilo teórico (OR= 4; 1.2-11; IC 95%; p = 0.02). Además, se observaron diferencias estadísticamente significativas en el promedio de calificaciones entre los grupos, el cual fue menor en el grupo minoritario (p = 0.014). Conclusion: los estudiantes de minorías étnicas presentaron promedios más bajos para todos los estilos de aprendizaje en comparación con el grupo control. Del mismo modo, su promedio de calificaciones fue significativamente inferior. Estos hallazgos representan precedentes relevantes para crear estrategias educativas que favorezcan el aprendizaje de los grupos étnicos minoritarios en la educación superior en América Latina.

Resumo Introdução e objetivo: Pouco se sabe sobre os estilos de aprendizagem das minorias étnicas nas universidades latino-americanas. O objetivo desta pesquisa foi identificar os estilos de aprendizagem em minorias étnicas de uma faculdade de odontologia. Além disso, sua média de notas foi explorada. Materiais e métodos: Um total de trinta estudantes de minorias étnicas corresponde a trinta estudantes de minorias não étnicas. Todos os alunos preencheram um questionário sistematizado para classificar seus estilos de aprendizagem. Resultados: Observou-se forte associação entre os estudantes de minorias étnicas e o baixo estilo reflexivo no modelo multivariado após o ajuste para as variáveis idade, sexo e semestre atuais (OR = 11; 1,2-99, IC95%; p = 0,03) De maneira comparável, foi observada associação relevante entre o grupo étnico minoritário e o baixo estilo teórico no modelo multivariado, após o controle das mesmas variáveis (OR = 4; 1,2-11; IC95%; p = 0,02). Além disso, foram observadas diferenças estatisticamente significantes nas pontuações médias entre os grupos, sendo menor no grupo minoritário (p = 0,014). Conclusões: os estudantes das minorias étnicas apresentaram médias mais baixas para todos os estilos de aprendizagem em comparação ao grupo controle. Da mesma forma, a média de notas foi significativamente menor. Esses achados representam precedentes relevantes para a criação de estratégias educacionais que favoreçam a aprendizagem de grupos étnicos minoritários no ensino superior na América Latina.

Resistencia friccional entre brackets cerámicos y brackets de autoligado usando un análisis de elementos finitos / Frictional resistance between conventional ceramic brackets and self-ligating ceramic brackets using a finite element analysis / Resistência ao atrito entre braquetes cerâmicos e braçadeiras autoligáveis usando análise de elementos finitos

Resumen Introducción y objetivo: La fricción en la ortodoncia se produce por contacto directo entre el bracket, el alambre y la ligadura. La fricción reduce la eficiencia en los tratamientos de ortodoncia. Esta investigación comparó la resistencia a la fricción entre los brackets cerámicos convencionales y los brackets cerámicos de autoligado pasivos utilizando un método de elementos finitos (MEF). Materiales y métodos: Se realizó un total de 810 deslizamientos, combinando brackets cerámicos convencionales y autoligados, y alambres de ortodoncia de acero inoxidable, níquel-titanio y de la aleación β-titanio de 0.016 pulgadas, 0.017x0.025 pulgadas y 0.019 x0.025 pulgadas. La media máxima de resistencia a la fricción estática (MRF) se comparó entre las diferentes combinaciones de brackets, alambre, ligadura y angulación del bracket de 0 °, 7 ° y 13 °. Resultados: Las variables con el comportamiento de fricción más alto fueron 13 °, aleación β titanio, 0.017x0.025 pulgadas, y brackets cerámicos convencionales con ligaduras elásticas. Conclusión: MEF es una alternativa adecuada para la predicción de la MRF en varias combinaciones de brackets, alambres, ligaduras y angulaciones. El método permitió definir una menor resistencia a la fricción para los brackets de autoligado, así como una relación directa entre el aumento del ángulo y el área de contacto entre el bracket y el alambre, con valores más altos de resistencia al deslizamiento. Se estableció que un alambre de mayor calibre no implica un área de mayor contacto con el bracket.

Abstract Introduction and objective: Friction in orthodontics is produced by direct contact between the bracket, the wire, and the ligature. Friction reduces efficiency in orthodontic treatments. This research aims to compare the frictional resistance between conventional ceramic brackets and passive self-ligating ceramic brackets using a finite element method (FEM). Materials and methods: A total of 810 slidings were performed, combining conventional and self-ligating ceramic brackets, and stainless steel, nickel-titanium, and b-titanium alloy orthodontic wires of 0.016inch, 0.017x0.025inch, and 0.019x0.025inch. The maximum static frictional resistance (MSFR) mean was compared between the different brackets, wire, ligature, and bracket angulation combinations of 0°, 7°, and 13°. Results: The variables with the highest frictional behavior were 13°, b-titanium alloy, 0.017x0.025inch, and conventional ceramic brackets with an elastic ligatures. Conclusion: FEM is an adequate alternative for the prediction of MSRF in a various brackets, wire, ligating, and angulation combinations. The method allowed defining lower frictional resistance for self-ligating brackets, as well as a direct relationship between the increase in the angle and contact area between bracket and wire, with higher values of sliding resistance. It was established that a larger wire size does not imply a higher area of contact with the bracket.

Resumo Introdução e objetivo: O atrito na ortodontia é produzido pelo contato direto entre braquetes, fios e ligaduras. O atrito reduz a eficiência em tratamentos ortodônticos. Esta pesquisa tem como objetivo comparar a resistência ao atrito entre braquetes cerâmicos convencionais e braquetes cerâmicos autoligáveis paacero inoxidableivos usando um método de elementos finitos (MEF). Materiais e métodos: Foram realizados 810 deslizamentos de terra, combinando braquetes de cerâmica convencionais e autoligáveis e fios ortodônticos de aço inoxidável, liga de níquel-titânio e β-titânio em 0,016 polegadas, 0,017 x 0,025 polegadas e 0,019 0,025 polegadas. A máxima resistência média ao atrito estático (MRF) foi comparada entre as diferentes combinações de braquetes, fios, ligaduras e angulações de braquetes de 0 °, 7 ° e 13 °. Resultados: As variáveis com maior comportamento de atrito foram 13 °, liga β-titânio, 0,017x0,025 polegadas e braquetes cerâmicos convencionales com ligadura elástica. Conclusão: MEF é uma alternativa adequada para previsão de MRF em várias combinações de braquetes, fios, ligaduras e angulações. O método permitiu definir uma menor resistência ao atrito para braquetes autoligáveis, bem como uma relação direta entre o aumento do ângulo e a área de contato entre os braquetes e o fio, com maiores valores de resistência ao escorregamento. Foi estabelecido que um tamanho de cabo maior não implica uma área de contato mais alta com o suporte.

Frequency of physical inactivity and insufficient sleep, and their mixed effects on academic achievement in ethnic minority students: A matched case-control study in a dental school.

BACKGROUND: Ethnic minorities are underrepresented in health sciences programs in various nations. Furthermore, there is no known research studying the occurrence of physical inactivity (PI) and insufficient sleep (IS), and their effects on academic achievement (AA) in ethnic minority students (EMS) in higher education. OBJECTIVE: The objective of this study is to explore the occurrence of PI and IS, and their independent and mixed effects on AA in EMS of a dental school. MATERIALS AND METHODS: Thirty EMS and sixty non-EMSs were matched (1:2) in this case-control study. It was utilized as an administrative dataset that stores register related to the students. Moreover, the grade point average was considered an indicator of AA. Logistic regressions models were run, expressed in odds ratios, complemented by confidence intervals (CIs) of 95%. RESULTS: A total of 73% and 60% EMS were PI and slept insufficiently, respectively. The groups presented statistically significant differences (P < 0.0001) in physical activity, sleep, and AA, with inferior values for EMS. All unadjusted models showed that PS, IS, and low AA were strongly associated with EMS, demonstrating their independent effect. After controlling for PI and IS, the multivariate model for AA and EMS increased odds by 6.5 times (95%CI: 1.8-23;), indicating that EMS is strongly associated with low AA. Besides, PI and IS were also statistically significant higher (< 0.0001) in the model, demonstrating their mixed effect. CONCLUSIONS: This study found a higher occurrence of PI and IS in EMS. Besides, independent and mixed effects of these variables on low AA in EMS were very significant.

A Case Report of a Lingual Cyst Lined by Respiratory Epithelium in a Child.

The lingual cyst lined by respiratory epithelium is a rare pathology. It probably appears from the default of undifferentiated cells of the foregut during embryonic growth. This pathology is seen more often in males and children; however, only 5 patients younger than 4 years old have been reported. The pathophysiology and the management of this cyst were described in a 4-year-old girl. She presented with a soft mass on the dorsum of the tongue covered by normal mucosa, which existed since her birth, causing difficulty in eating, breathing, and talking. The magnetic resonance described a hyperintense image with an anteroposterior diameter of 27 mm, craniocaudal of 19 mm, and transversal of 26 mm in the midline groove of the tongue; the scintigraphy showed normality. The enucleation of the lesion was performed, eradicating the capsule of the cyst and obtaining a complete cleavage. The histopathologic examination defined a cyst lined predominantly by respiratory epithelium. Unlike in other cases, in this case their cystic lining and capsular constituents were contemplated considering the current histological recommendations. It is relevant to differentiate this pathology from other cysts with similar histological findings.

Antimicrobial resistance of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia in periodontitis patients.

OBJECTIVES: Administration of systemic antimicrobials as an adjunct to mechanical treatment of periodontitis and sites with adverse clinical results leads to improved outcomes. This study aimed to assess the antimicrobial susceptibility of Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis and Tannerella forsythia isolated from periodontitis patients to amoxicillin, metronidazole, azithromycin and moxifloxacin. METHODS: A total of 76 patients diagnosed with generalised periodontitis were included in the study. Subgingival samples were processed by culture. Etest was used to determine susceptibility to amoxicillin, metronidazole, azithromycin and moxifloxacin. RESULTS: A total of 141 isolates from 76 patients were evaluated, including 61 P. gingivalis, 43 T. forsythia and 37 A. actinomycetemcomitans. Etest results showed complete susceptibility of A. actinomycetemcomitans, P. gingivalis and T. forsythia to moxifloxacin. However, the isolates presented reduced susceptibility to the other antimicrobial agents investigated. Of the A. actinomycetemcomitans isolates, 70.3%, 40.5% and 89.2% were resistant to amoxicillin, azithromycin and metronidazole, respectively. The P. gingivalis samples showed relatively similar rates of resistance to amoxicillin (24.6%), azithromycin (21.3%) and metronidazole (24.6%). Similarly, 25.6%, 21.0% and 25.6% of the T. forsythia isolates were resistant to amoxicillin, azithromycin, and metronidazole, respectively. CONCLUSION: These findings show that moxifloxacin may be a promising antimicrobial agent against P. gingivalis, T. forsythia and A. actinomycetemcomitans for the treatment of periodontitis. However, amoxicillin, azithromycin and metronidazole were less effective, especially against A. actinomycetemcomitans in vitro.

Human papilloma virus genotypes in dysplasia and epithelial hyperplasia of oral cavity using the luminex xmap technology. A multicenter study

BACKGROUND: Oral cancer associated with high risk (HPV-HR) human papilloma virus (HPV) has been increasing. HPV-HR has been associated with epithelial dysplasia, however, little information exists on its frequency in epithelial hyperplasia lesions. The aim of this study is to compare HPV genotypes in dysplastic and hyperplastic lesions of oral cavity. MATERIAL AND METHODS: Two hundred and fifty oral lesions: 131 dysplasia and 119 hyperplasia from two regions of Colombia were evaluated. One hundred seventy-four coming from urban area and 104 from a high risk population to oral cancer from a rural area. HPV was identified by qPCR and Twenty-four HPVs genotypes were evaluated by Luminex(R) technology. Logistic regressions were performed to establish the associations between HPV infections with oral dysplasia. RESULTS: Twenty-eight percent (70/250) of the samples were positives for any HPV and HPV-HRs were more frequently than low risk HPVs. HPV-16 was the most detected genotype (16%) followed by HPV-31, 53, 18 and 45. HPV, HPV-HRs and HPV-16 were only associated with dysplasia in urban area; OR 3.28 (CI 95% 1.49-7.17), OR 7.94 (CI 95% 2.97-21.2) and OR 5.90 (CI 95% 2.05-17). Individuals in rural area showed more HPV and HPV-HRs infection in hyperplasic lesions than urban population. The majority of HPV+ lesions had multi-type of HPV (52/70) and the urban individuals showed more genotypes than rural population. CONCLUSIONS: HPV-.HRs are frequently found in hyperplastic and dysplastic epithelial lesions. HPV-HRs and HPV-16 were associated with dysplasia in urban population. Rural high risk population and urban population differ in the frequency and variety of HPV genotypes

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Maxillofacial management of dog bites injuries in an infant: A case report / Manejo maxillofacial por mordeduras de perro en un infante: Reporte de un caso / Manejo maxilofacial de mordidas de cães em criança: Relato de caso

Abstract Dog bites cause complex craniomaxillofacial injuries. Considering that the bite injuries are repeatedly situated on the face, dentist requires being well known with the therapy of animal bites. A three-year-old male child was attended as a victim of a Pit Bull terrier biting. The patient had multiple wounds at the level of the upper eyelid of the right eyeball, left hemisphere with the involvement of the auricular pavilion, wounds with multiple detachments on face and scalp, several abrasions and ecchymoses in the bilateral infraorbital and mouth region. The clinical intervention was completed in the first twenty-four hours after injury. The affected zones were cleaned and irrigated with saline solution, and the wounds were sutured in layers. Tetanus and anti-rabies vaccination, and antibiotic and analgesic were administered. On the fifth postoperative day, the stitches were removed, and the patient was discharged from the hospital. One week after the trauma, the child showed adequate wound curing absent of aggravation. Satisfactory aesthetic and functional results were achieved. Besides, in this case, the most relevant aspects of the management of dogs bites are presented.

Resumen Las mordeduras de perros causan lesiones craneomaxilofaciales complejas. Teniendo en cuenta que las lesiones por mordedura están situadas repetidamente en la cara, el odontólogo debe conocer la terapia que se debe realizar en el caso de mordeduras de animales. Un niño de tres años fue atendido como víctima de una mordedura de Pit Bull terrier. El paciente tenía múltiples heridas a nivel del párpado superior del globo ocular derecho, hemisferio izquierdo con afectación del pabellón auricular, heridas con múltiples desprendimientos en la cara y el cuero cabelludo, varias abrasiones y equimosis en la región bilateral infraorbitaria y bucal. La intervención clínica se completó en las primeras veinticuatro horas después de la lesión. Las zonas afectadas se limpiaron e irrigaron con solución salina, y las heridas se suturaron en capas. Se administraron vacuna antitetánica y antirrábica, antibióticos y analgésicos. En el quinto día postoperatorio, se retiraron los puntos de sutura y el paciente fue dado de alta del hospital. Una semana después del trauma, el niño mostró curación adecuada de la herida sin agravación. Se lograron resultados estéticos y funcionales satisfactorios. Además, en este caso, se presentan los aspectos más relevantes del manejo de las mordeduras de perros.

Resumo Mordidas de cães causam lesões craniomaxilofaciais complexas. Considerando que as lesões por mordidas são repetidamente situadas na face, um cirurgião oral e maxilofacial exige ser bem conhecido com a terapia de mordidas de animais. Um menino de três anos foi vítima de uma picada de um terrier de Pit Bull. O paciente apresentava múltiplas feridas no nível da pálpebra superior do globo ocular direito, hemisfério esquerdo com envolvimento do pavilhão auricular, feridas com múltiplos descolamentos na face e couro cabeludo, várias abrasões e equimoses na região infraorbital e boca bilateral. A intervenção clínica foi concluída nas primeiras vinte e quatro horas após a lesão. As zonas afetadas foram limpas e irrigadas com solução salina e as feridas foram suturadas em camadas. Vacinação antitetânica e anti-rábica e antibióticos e analgésicos foram administrados. No quinto dia de pós-operatório, os pontos foram retirados e a paciente recebeu alta do hospital. Uma semana após o trauma, a criança apresentou cura adequada da ferida, sem agravamento. Resultados estéticos e funcionais satisfatórios foram alcançados. Além disso, neste caso, são apresentados os aspectos mais relevantes no manejo das mordidas de cães.

Influence of Hyrax screw position on dental movement and cortical bone: A study of finite elements.

BACKGROUND: Rapid maxillary expansion (RME) has effects on the dental and periodontal structures of the parts involved, which vary according to the design and position of the expansion screw. The purpose of the study was to determine the optimal three-dimensional position of the Hyrax screw to obtain precise control of the dental movement and effect on the bone cortex using the finite element method (FEM). MATERIAL AND METHODS: RME was performed from the patient whom two Cone-Beam computerized tomography scans (CBCT) were obtained: T1 before expansion, and T2 three months after stabilization of RME. The FEM model was designed with T1 and of Hyrax photographs. FEM was obtained by comparing the simulation, T2, and clinical results. Three sagittal screw positions (anterior-middle-posterior) and vertical (upper-medium-low) were evaluated. RESULTS: A coronal- buccal displacement of premolars and first molars was found which decreased in the occlusal-apical direction, presenting different types of dental movement in the screw positions; besides, a tendency of translational movement in the posterior-high location was observed. In the posterior-high position a higher concentration of efforts and homogeneous deformations in the periodontal ligament and vestibular cortex of the cervical area of first molars, first and second premolars were observed, with variations according to the screw position and the distribution of stresses. CONCLUSIONS: The ideal location of the expansion screw for controlling dental movement and periodontal side effects was the high-posterior position. Key words:Maxillary expansion, dental movement, finite element analysis, orthodontic appliances.

Diagnosis and treatment for central Mucoepidermoid Carcinoma in the mandible: Report of a clinical case in a young patient.

A clinical case of a 13 year old male patient with a malignant tumor in the mandibular body area with two years of evolution and associated pain is reported. It was initially diagnosed as low grade central mucoepidermoid carcinoma through Hematoxylin and Eosin (H-E) staining in multiple biopsies. Considering the clinical and radiographic characteristics of the lesion, it was necessary to confirm the diagnosis through Periodic acid-Schiff (PAS). The treatment involved hemimandibulectomy, neck emptying, and complementary radiotherapy. This article aims to present a rare occurrence of this type of intraosseous malignant tumor of glandular origin in a young patient. Key words:Mucoepidermoid carcinoma, periodic acid Schiff reaction, pathology, surgery, radiotherapy.