Influence of Population Size, the Human Development Index and the Gross Domestic Product on Mortality by COVID-19 in the Southeast Region of Brazil.

We evaluated the influence of population size (POP), HDI (Human Development Index) and GDP (gross domestic product) on the COVID-19 pandemic in the Southeast region of Brazil, between February 2020 and May 2021. METHODS: Cases, deaths, incidence coefficient, mortality rate and lethality rate were compared among states. The cities were divided into strata according to POP, GDP, and HDI. Data were compared by Welch's ANOVA, nonlinear polynomial regression, and Spearman's correlation test (rS). RESULTS: The highest incidence coefficient (p < 0.0001) and mortality rate (p < 0.05) were observed in the states of Espírito Santo and Rio de Janeiro, respectively. Until the 45th week, the higher the POP, the higher the mortality rate (p < 0.01), with no differences in the remaining period (p > 0.05). There was a strong positive correlation between POP size and the number of cases (rS = 0.92, p < 0.0001) and deaths (rS = 0.88, p < 0.0001). The incidence coefficient and mortality rate were lower (p < 0.0001) for low GDP cities. Both coefficients were higher in high- and very high HDI cities (p < 0.0001). The lethality rate was higher in the state of Rio de Janeiro (p < 0.0001), in large cities (p < 0.0001), in cities with medium GDP (p < 0.0001), and in those with high HDI (p < 0.05). CONCLUSIONS: Both incidence and mortality were affected by time, with minimal influence of POP, GDP and HDI.

Important blood pressure changes in clinical practice: narrative literature review / Alterações importantes na pressão arterial na prática clínica: revisão narrativa de literatura

ABSTRACT The aim of this study was to emphasize the importance of monitoring vital signs, especially blood pressure, during dental care. Through a narrative review, the changes in blood pressure that may occur during outpatient procedures and the measures to be taken were discussed. The available literature was consulted in databases (PubMed, Scielo, Web of Science and Google Scholar), complemented by the analysis of the bibliographic references included and updated until April 2021. The keywords were used: "Anamnesis", "Arterial Pressure", "Arterial Hypertension", "Hypertensive Crisis", "Risk factors", "Stroke", "Subclavian Theft Syndrome" and "Atherosclerosis". It was concluded that care should be applied to all patients, but mainly to those over 50, hypertensive or not, with hypercholesterolemia, diabetes, anxious and fearful. All vital signs must be monitored, including the pain score. The situations of anxiety, pain and fear are triggers for changes in blood pressure even in normotensive patients as in controlled hypertensive patients. The blood pressure measurement, in the first consultation, must be performed in both arms and repeated annually or whenever there is a change in the patient's health status. In all other consultations, blood pressure control, as well as the assessment of all vital signs, must be performed before, during, after the procedure and before discharge. In the face of any major change, it is necessary to assess the risk/benefit ratio of the continuity of the procedure, so that risks to patients are avoided or minimized, as well as for the necessary referrals to be made.

RESUMO O objetivo deste trabalho foi enfatizar a importância da monitorização dos sinais vitais, particularmente da pressão arterial durante o atendimento odontológico. Por meio de uma revisão narrativa foram discutidas as alterações pressóricas que podem ocorrer durante procedimentos ambulatoriais e as medidas a serem tomadas. A literatura disponível foi consultada em bancos de dados (PubMed, Scielo, Web of Science e Google Scholar), complementada analisando as referências bibliográficas incluídas e atualizada até Abril de 2021. Foram usadas as palavras-chave: Anamnese, Pressão Arterial, Hipertensão Arterial, Crise Hipertensiva, Fatores de Risco, Acidente Vascular Cerebral, Síndrome do Roubo da Subclávia e Aterosclerose. Foi concluído que os cuidados devem ser aplicados em todos os pacientes mas em especial naqueles com idades superiores a 50 anos, hipertensos ou não, com hipercolesterolemia, diabetes, ansiosos e medrosos. Todos os sinais vitais devem ser monitorados, dentre eles, o score de dor. As situações de ansiedade, dor e medo são gatilhos para alterações pressóricas tanto em pacientes normotensos como nos hipertensos controlados. A aferição da pressão arterial, já na primeira consulta, deve ser realizada em ambos os braços e repetida anualmente ou sempre que houver modificação no quadro de saúde do paciente. Em todas as demais consultas, o controle pressórico como também a avaliação de todos os sinais vitais, deve ser no pré-, trans-, pós-procedimento e antes da alta. Diante de qualquer alteração importante, a relação risco/benefício da continuidade do procedimento precisa ser avaliada, para que seja evitado ou minimizado os riscos aos pacientes bem como para realizar os encaminhamentos necessários.

The effect of a hydroxyapatite impregnated PCL membrane in rat subcritical calvarial bone defects.

OBJECTIVE: The present study evaluated the effect of polymeric-nanofibers membranes impregnated with microparticulate hydroxyapatite (HA) in the subcritical calvarial bone defects (SCBD) healing. DESIGN: PCL membranes with and without HA were obtained by electrospinning. SCBD were perforated (3.3mm) in left and right sides of 36 rat calvarias. The right-side SBCD of 18 animals was filled with HA mixed with blood clot and blood clot at the contralateral side. The remaining animals received PCL+HA membrane at the right-side SCBD and PCL membrane at the contralateral side. Animals were killed after 30, 60 and 90days after surgery. Bone defect volume (in mm3) was measured by tomography (CBCT). Qualitative histological analysis and SBCD area (in mm2) were measured. Quantitative data were submitted to Kruskal-Wallis/Dunn tests. RESULTS: Reduction of SBCD volume was observed in all treatments but PCL. Association with HA significantly improved bone healing induced by PCL and blood clot. PCL+HA induced the lowest SBCD volume at 60 and 90days. Complete bone healing was not observed even at 90days in SCBD treated with blood clot. In every period, more bone formation was observed for SCBD treated with membranes. CONCLUSIONS: We concluded that both PCL membrane and HA were able to improve bone healing.