Determining the widths of the maxillary anterior teeth for esthetics: comparison of the Mondelli and Albers formulas, esthetic proportion, and golden ratio.

The purpose of this study was to compare various formulas for idealized proportions of the maxillary incisors to the actual dimensions of natural teeth. The Mondelli formula 1 (MF1), Mondelli formula 2 (MF2), Albers formula (AF), esthetic proportion (EP) for width and height of anterior teeth, and golden ratio (GR) were calculated for a total of 50 dental students (30 women and 20 men) who participated in the study. The following measurements were obtained directly in the participant's mouth with a digital caliper: the mesiodistal and incisogingival dimensions of the maxillary central incisors, lateral incisors, and canines; the intercanine distance; and the smile width. The participants were photographed, and the smile width was also measured on the photographs. The MF1 and MF2 were each calculated twice, using both direct measurements and photographic measurements. The projected central incisor widths calculated using the MF1, MF2, and AF were compared among themselves and against the actual measurements using analysis of variance and Fisher test for multiple comparisons (α = 0.05). The EP and GR were analyzed using descriptive statistics. There was a statistically significant difference between all of the widths projected by the formulas and the actual widths of the central incisors (P < 0.05). Whether calculated from a direct or a photographic measurement, the incisor widths projected by the MF1 and MF2 were statistically similar to each other (P > 0.05). The EP values were similar to those reported in the literature. Only 2% of the participants had an incisor width ratio (central incisor/lateral incisor) that matched the GR of 1.618, while 86% fell within the range of 1.2 to 1.4. Overall, the proportions calculated with the MF1, MF2, AF, EP, and GR did not exactly match the actual dimensions of natural teeth. The formulas and the proportions available in the literature can assist in esthetic planning, but the individual characteristics of each patient and expertise of the dentist should guide treatment for each case.

Working conditions in nursing in the face of Covid-19 from the perspective of precariousness.

OBJECTIVE: To investigate working conditions in nursing when facing the Covid-19 pandemic, in light of aspects of precarious work. METHODS: Cross-sectional study, with 131 nursing workers who worked against Covid-19 in hospitals in Alagoas State, Northeast Brazil. Data were collected online, using a workers' health assessment questionnaire. The Chi -Square or Fisher's Exact test and logistic regression were used. RESULTS: among nursing workers, 71% had precarious contracts, 33.6% reported extended working hours and 23.7% were union members. In the multivariable analysis, having little hospital experience was a predictor for poor employment (OR= 2.408; 95%CI= 1.051-5.518). The predictor variables for lengthening the working day were being a nurse (OR= 3.824; 95%CI= 1.274-11.483); overtime (OR= 3.668; 95%CI= 1.009-13.333) and inadequate number of workers (OR= 10.872; 95%CI= 3.409-34.675). Being a nursing technician was a predictor of being a union member (OR= 8.967; 95%CI=2.560-31.410). CONCLUSIONS: The pandemic has accentuated the precariousness of working conditions in nursing professionals, especially among nurses.

Práticas aplicadas nas escolas em situações de automutilação em adolescentes: protocolo de revisão de escopo / Practices applied in schools in situations of self-mutilation among adolescents: scope review protocol

OBJETIVO: Identificar as práticas aplicadas nas escolas em situações de autolesão não suicida em adolescentes. MÉTODO: A estratégia de busca será aplicada no Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Excerpta Medica Database (EMBASE/Elsevier); Cumulated Index in Nursing and Allied Health Literature (CINAHL/Ebsco); Scopus/Elsevier, Cochrane Library; Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) via Biblioteca Virtual em Saúde (BVS), Base de Dados de Enfermagem (BDENF); PsycINFO; Education Resources Information Center (ERIC); Web of Science Core Collection, Scientific Electronic Library Online (SCIELO), e na literatura cinzenta. Serão considerados artigos de pesquisas primárias, quantitativos e/ou qualitativos, sem limitações quanto à data da publicação e idioma. Os resultados serão inseridos no EndNote v.X9 e duplicatas serão removidas. O Rayyan QCRI20 será utilizado na seleção dos estudos. Esta será feita por dois revisores independentes de forma cega. Discordâncias serão resolvidas por consenso ou terceiro revisor. Será utilizado o diagrama de fluxo Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Os dados serão extraídos usando a ferramenta de extração na abordagem scoping review do Joanna Briggs Institute (JBI).

OBJECTIVE: Identify practices applied in schools in situations of non-suicidal self-injury in adolescents. METHOD: The search strategy will be applied in Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Excerpta Medica Database (EMBASE/Elsevier); Cumulated Index in Nursing and Allied Health Literature (CINAHL/Ebsco); Scopus/Elsevier, Cochrane Library; Latin America and the Caribbean Health Sciences Literature (LILACS) by Virtual Health Library (VHL), Nursing Database (BDENF); PsycINFO; Education Resources Information Center (ERIC); Web of Science Core Collection, Scientific Electronic Library Online (SCIELO), and gray literature. Primary, quantitative and/or qualitative research articles will be considered without restriction regarding publication date and language. Results will be entered into EndNote X9, and duplicates will be removed. The Rayyan QCRI20 will be used in the selection of studies. This will be done by two independent reviewers blindly. Disagreements will be resolved by consensus or a third reviewer. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flowchart will be used. Data will be extracted using the extraction tool in the JBI scoping review approach.

Working conditions in nursing in the face of Covid-19 from the perspective of precariousness / Condiciones de trabajo de la enfermería en el afrontamiento del Covid-19 bajo el prisma de la precarización / Condições de trabalho em enfermagem no enfrentamento da Covid-19 sob o prisma da precarização

ABSTRACT Objective: To investigate working conditions in nursing when facing the Covid-19 pandemic, in light of aspects of precarious work. Methods: Cross-sectional study, with 131 nursing workers who worked against Covid-19 in hospitals in Alagoas State, Northeast Brazil. Data were collected online, using a workers' health assessment questionnaire. The Chi -Square or Fisher's Exact test and logistic regression were used. Results: among nursing workers, 71% had precarious contracts, 33.6% reported extended working hours and 23.7% were union members. In the multivariable analysis, having little hospital experience was a predictor for poor employment (OR= 2.408; 95%CI= 1.051-5.518). The predictor variables for lengthening the working day were being a nurse (OR= 3.824; 95%CI= 1.274-11.483); overtime (OR= 3.668; 95%CI= 1.009-13.333) and inadequate number of workers (OR= 10.872; 95%CI= 3.409-34.675). Being a nursing technician was a predictor of being a union member (OR= 8.967; 95%CI=2.560-31.410). Conclusions: The pandemic has accentuated the precariousness of working conditions in nursing professionals, especially among nurses.

RESUMEN Objetivo: Investigar las condiciones de trabajo de la enfermería para el afrontamiento del Covid-19, según la visión de la precarización del trabajo. Métodos: Es un estudio transversal realizado entre 131 trabajadoras(es) de enfermería que actuaron contra el Covid-19 en hospitales de Alagoas, Brasil. Los datos se recogieron online mediante un cuestionario de la salud de los trabajadores, con la Prueba X2 o Exacto de Fisher y regresión logística. Resultados: El 71% tenía contratos precarios, 33,6% declaró jornadas laborales prolongadas y 23,7% estaba sindicado. En el análisis multivariado, tener poca experiencia hospitalaria fue un factor predictivo del empleo precario (OR= 2,408; IC95%= 1,051-5,518). Las variables predictoras de jornadas laborales extendidas fueron: ser enfermera(o) (OR= 3,824; IC95%=1,274-11,483); horas extraordinarias (OR= 3,668; IC95%= 1,009-13,333) y número inadecuado de trabajadores (OR= 10,872; IC95% =3,409-34,675). Ser técnica(o) de enfermería fue un factor predictivo de estar sindicado (OR= 8,967; IC 95%= 2,560-31,410). Conclusiones: La pandemia acentuó la precarización de las condiciones de trabajo en la enfermería, principalmente entre las(os) enfermeras(os).

RESUMO Objetivo: Investigar as condições de trabalho em enfermagem no enfrentamento da pandemia de Covid-19, à luz de aspectos da precarização do trabalho. Métodos: Estudo transversal, com 131 trabalhadoras(es) da enfermagem que atuaram contra a Covid-19 em hospitais alagoanos, no Nordeste brasileiro. Os dados foram coletados online, por questionário de avaliação da saúde dos trabalhadores. Utilizaram-se o teste do Qui-Quadrado ou Exato de Fisher e a regressão logística. Resultados: Entre as(os) trabalhadoras(es), 71% tiveram contratos precários, 33,6% referiram ao prolongamento da jornada e 23,7% eram sindicalizadas(os). Na análise multivariável, ter pouca experiência hospitalar foi preditor para o vínculo precário (OR= 2,408; IC95%= 1,051-5,518). As variáveis preditoras para o prolongamento da jornada foram: ser enfermeira(o) (OR= 3,824; IC95%= 1,274-11,483), horas extras (OR= 3,668; IC95%=1,009-13,333) e número inadequado de trabalhadoras(es) (OR= 10,872; IC95%= 3,409-34,675). Ser técnica(o) de enfermagem foi preditor para ser sindicalizada(o) (OR= 8,967; IC95%=2,560-31,410). Conclusões: A pandemia acentuou a precarização das condições de trabalho em enfermagem, principalmente entre as(os) enfermeiras(os).

O trabalho de Enfermagem a partir da experiência de enfermeiras da linha de frente contra Covid-19: na trilha da precarização / El trabajo de enfermería a partir de la experiencia de enfermeras de la línea de frente contra la Covid-19: en el rumbo de la precarización / Analysis of nursing work seen from the experiences of frontline nurses against Covid-19: on the path of precarization

A experiência de trabalhar no enfrentamento da Covid-19, em meio a um processo tenso, contraditório e com repercussões na própria saúde, constitui o contexto desta pesquisa, que tem o objetivo de entender o trabalho de Enfermagem na experiência de enfermeira(o)s da linha de frente contra a Covid-19, em Alagoas, Brasil. Trata-se de pesquisa qualitativa, com análise de conteúdo das histórias orais temáticas de seis enfermeiras que atuaram na linha de frente das cidades de Arapiraca e Maceió, estado de Alagoas, Brasil. As categorias temáticas que se destacaram na análise foram: desvalorização; ausência de estrutura física e de recursos para o trabalho; vínculo precário de trabalho; e relação entre sobrecarga, adoecimento e desgaste. Constatou-se que essas categorias compõem o que tem sido chamado de precarização do trabalho, já estabelecida anteriormente, mas amplificada na pandemia, a exemplo da experiência das trabalhadoras de Enfermagem.(AU)

La experiencia de trabajar en el enfrentamiento de la Covid-19, en el medio de un proceso tenso, contradictorio, con repercusiones sobre la propia salud, constituye el contexto de esta investigación, con el objetivo de entender el trabajo de enfermería en la experiencia de enfermeros(as) de la línea de frente contra la Covid-19, en Alagoas, Brasil. Se trata de una investigación cualitativa con análisis del contenido de las historias orales temáticas de 6 enfermeras que actuaron en la línea de frente en las ciudades de Arapiraca y Maceió, estado de Alagoas, Brasil. Las categorías temáticas que se destacaron en el análisis fueron: desvalorización, ausencia de estructura física y recursos para el trabajo, vínculo precario de trabajo y relación entre sobrecarga, ponerse enfermo y desgaste. Se constató que esas categorías componen lo que se ha denominado de precarización del trabajo, ya establecida anteriormente, pero amplificada en la pandemia, a ejemplo de la experiencia de las trabajadoras de enfermería.(AU)

The experience of working in the confrontation of Covid-19, amid tension, contradictions and impacts in the workers' health constitutes the context of this research, with the objective of understanding the nursing work in the experience of frontline nurses against Covid-19, in Alagoas, Brazil. This is a qualitative research, using content analysis of the thematic oral histories of 6 nurses, who worked on the frontline in the cities of Arapiraca and Maceió, state of Alagoas, Brazil. The thematic categories emerging from the analysis were: devaluation; lack of physical structure and resources for work; precarious work bond; and the relationship between overload, illness, and wear and tear. It was found that these categories are encompassed by the term work precarization, previously established, but amplified in the pandemic, following the experience of nursing workers.(AU)

The effects of TiO2 nanotubes on bond strength and radiopacity of a self-adhesive resin cement in self-curing mode / Os efeitos de nanotubos de TiO2 na resistência de união e radiopacidade de um cimento resinoso auto-adesivo no modo auto-polimerizável

Objective: The aim of this in vitro study w as t o analyze the influence of the titanium dioxide nanotubes i n a self-cure mode polymerization of a dual resin luting agent through push out bond strength and radiopacity tests. Material and Methods: After mixed with a commercial du al self-adhesive resin cement, three concentrations o f tit anium dioxide nanotubes (0.3, 0.6, and 0.9% by weight) we re analyzed in self-curing mode. T he bond strength to bovine root dentin and fi berglass posts was assessed with the push out bond str ength t est and was evaluated in three thirds (cervical, middle and apical) (n=10), followed by failure mode analysis (SEM), and the ISO standard 9917-2 was followed for radiopacity test (n=10). Data were statistically analyzed by one-way ANOVA test, followed by Tukey's test (α=0.05). Results: Reinforced self-adhesive resin cement with 0.6% titanium dioxide nanotubes showed significant difference compared to the control gr oup for push out test (p=0.00158). The modified groups did not s how significant difference among thirds (p=0.782). Radiopacity sh owed higher value for group w ith 0.9% titanium dioxide nanotubes in comparison w ith control group (p<0.001). Conclusion: The addition of titanium dioxide nanotubes to a self-adhesive resin cement increased the bond strength to dentin and radiopacity values in the self-cure polymerization mode (AU)

Objetivo: O objetivo deste estudo in vitro foi analisar a influência de nanotubos de dióxido de titânio na polimerização química de um agente cimentante resinoso dual através de testes de resistência à união e radiopacidade. Material e Métodos: Após misturado com um cimento resinoso auto-adesivo comercial, três concentrações de nanotubos de dióxido de titânio (0,3, 0,6 e 0,9% em peso) foram analisadas. A resistência da união para a dentina da raiz bovina e os pinos de fibra de vidro foi avaliada pelo teste de push-out e avaliada em três terços (cervical, médio e apical) (n = 10), seguido pelo análise de modo de falha (MEV) e a norma ISO 9917-2 foi seguido para teste de radiopacidade (n = 10). Os dados foram analisados estatisticamente pelo teste ANOVA um fator seguido do teste de Tukey (α = 0,05). Resultados: O cimento resinoso auto-adesivo reforçado com nanotubos de dióxido de titânio a 0,6% mostrou diferença significativa em comparação com o grupo controle para teste de push-out (p=0,00158). Os grupos modificados não mostraram diferença significativa entre os terços (p=0,782). A radiopacidade mostrou maior valor para o grupo com nanotubos de dióxido de titânio 0,9% em comparação com o grupo controle (p<0,001). Conclusão: A adição de nanotubos de dióxido de titânio a um cimento resinoso auto-adesivo aumentou a os valores de resistência de união à dentina e radiopacidade no modo de polimerização química do agente cimentante (AU)

Late discolouration of root-treated teeth and subsequent restorative retreatment: three case reports.

Root-filled teeth that receive ceramic veneers may experience subsequent coronal discolouration, which will likely negatively affect the quality of life of patients and their relationship with the clinician. This manuscript describes three cases of this undesirable aesthetic consequence in anterior teeth of young patients and the subsequent restorative reintervention, with satisfactory results. In all three reports, the root canal filling was performed using cements containing bismuth oxide that likely disassociated into reduced metallic crystals when in contact with LED light. The discolouration observed after veneer cementation was most likely caused by the accumulation of these bismuth metallic crystals. These cases highlight the importance of preventing this undesirable complication, which may also result in the potential subsequent further sacrifice of sound coronal dental structure, and the role of recall in aesthetically demanding clinical cases.

Growth/differentiation factor-15 (GDF-15) as a predictor of serious arrhythmic events in patients with nonischemic dilated cardiomyopathy.

INTRODUCTION: Cardiac biomarkers have been proposed as a new tool to improve risk stratification of serious arrhythmic events in patients with heart failure (HF) beyond estimates of left ventricular ejection fraction. Growth differentiation factor (GDF)-15, a stress-induced cytokine, has been found to correlate with markers of myocardial fibrosis and adverse clinical outcomes, but its role as a predictor of arrhythmic events in patients with nonischemic HF is uncertain. METHODS AND RESULTS: A prospective observational study was conducted in 148 nonischemic patients with HF who underwent comprehensive clinical and laboratory evaluation, including measurement of serum GDF-15. The study endpoints were serious arrhythmic events (which included appropriate implantable cardioverter-defibrillator therapy and sudden cardiac death) and all-cause mortality. Mean age of the cohort was 54.8 ± 12.7 years, and mean left ventricular ejection fraction (LVEF) was 27.4% ± 7.5%. During a mean follow-up time of 42 months, arrhythmic events occurred in 28 patients (19%), and 40 patients (27%) died. An increase in serum GDF-15 (log-transformed) correlated linearly with a higher risk of serious arrhythmic events (HR 1.14, 95% CI 1.01-1.28, p = 0.03) even after adjustment for other potential clinical predictors (HR 1.16, 95% CI 1.02-1.32, p = 0.02). GDF-15 was also strongly and independently associated with all-cause mortality (HR 1.17, 1.05-1.31, p = 0.004). CONCLUSION: In this cohort of nonischemic HF patients on optimized medical treatment, serum GDF-15 levels were independently associated with major arrhythmic events and overall mortality. This biomarker may add prognostic information to better stratify the risk of sudden death in this particular population.

Arritmias cardíacas em pacientes com COVID-19 / Cardiac arrhythmias in patients with COVID-19

Resumo Fundamento: A doença pelo novo coronavírus (COVID-19) está associada a manifestações clínicas cardiovasculares, incluindo a ocorrência de arritmias cardíacas. Objetivos: Avaliar a incidência de arritmias cardíacas (taquiarritmia atrial, bradiarritmia e taquicardia ventricular sustentada) e de parada cardiorrespiratória (PCR) em uma coorte de pacientes internados com COVID-19 em hospital universitário terciário. Métodos: Estudo de coorte retrospectivo realizado por meio de revisão dos registros de prontuário médico. Para comparação entre os grupos, foi considerado como estatisticamente significativo valor de P < 0,05. Resultados: Foram incluídos 241 pacientes consecutivos com diagnóstico de COVID-19 (idade média, 57,8 ± 15,0 anos; 51,5% homens; 80,5% de raça branca) e 35,3% com necessidade de ventilação mecânica invasiva (VM). A mortalidade geral foi de 26,6%, sendo de 58,8% entre aqueles em VM. Arritmias cardíacas ocorreram em 8,7% dos pacientes, sendo a mais comum taquiarritmia atrial (76,2%). Pacientes com arritmias apresentaram maior mortalidade, 52,4% versus 24,1% (p=0,005). Em análise multivariada, apenas a presença de insuficiência cardíaca foi associada a maior risco de arritmias ( hazard ratio , 11,9; IC 95%: 3,6-39,5; p<0,001). Durante a internação, 3,3% dos pacientes foram atendidos em PCR, com predomínio de ritmos não chocáveis. Todos os atendidos em PCR evoluíram com óbito durante a internação. Conclusão: A incidência de arritmias cardíacas em pacientes internados com COVID-19 em hospital terciário brasileiro foi de 8,7%, sendo a mais comum taquiarritmias atrial. A presença de insuficiência cardíaca foi associada a maior risco de arritmias. Pacientes com COVID-19 atendidos em PCR apresentam elevada mortalidade.

Abstract Background: The coronavirus disease 2019 (COVID-19) is associated with cardiovascular clinical manifestations, including cardiac arrhythmias. Objective: To assess the incidence of cardiac arrhythmias (atrial tachyarrhythmia, bradyarrhythmia, and sustained ventricular tachycardia) and cardiac arrest (CA) in a cohort of patients hospitalized with COVID-19 in a tertiary university-affiliated hospital. Methods: Cohort study with retrospective analysis of electronic medical records. For comparison between groups, a value of p <0.05 was considered statistically significant Results: We included 241 consecutive patients diagnosed with COVID-19 (mean age, 57.8 ± 15.0 years; 51.5% men; 80.5% white), 35.3% of whom received invasive mechanical ventilation (MV). The overall mortality was 26.6%, being 58.8% among those on MV. Cardiac arrhythmias were identified in 8.7% of the patients, the most common being atrial tachyarrhythmia (76.2%). Patients with arrhythmias had higher mortality (52.4% versus 24.1%, p = 0.005). On multivariate analysis, only the presence of heart failure (HF) was associated with a higher risk of arrhythmias (hazard ratio, 11.9; 95% CI: 3.6-39.5; p <0.001). During hospitalization, 3.3% of the patients experienced CA, with a predominance of non-shockable rhythms. All patients experiencing CA died during hospitalization. Conclusions: The incidence of cardiac arrhythmias in patients admitted with COVID-19 to a Brazilian tertiary hospital was 8.7%, and atrial tachyarrhythmia was the most common. Presence of HF was associated with an increased risk of arrhythmias. Patients with COVID-19 experiencing CA have high mortality.

Cardiac Arrhythmias in Patients with COVID-19. / Arritmias Cardíacas em Pacientes com COVID-19.

BACKGROUND: The coronavirus disease 2019 (COVID-19) is associated with cardiovascular clinical manifestations, including cardiac arrhythmias. OBJECTIVE: To assess the incidence of cardiac arrhythmias (atrial tachyarrhythmia, bradyarrhythmia, and sustained ventricular tachycardia) and cardiac arrest (CA) in a cohort of patients hospitalized with COVID-19 in a tertiary university-affiliated hospital. METHODS: Cohort study with retrospective analysis of electronic medical records. For comparison between groups, a value of p <0.05 was considered statistically significant. RESULTS: We included 241 consecutive patients diagnosed with COVID-19 (mean age, 57.8 ± 15.0 years; 51.5% men; 80.5% white), 35.3% of whom received invasive mechanical ventilation (MV). The overall mortality was 26.6%, being 58.8% among those on MV. Cardiac arrhythmias were identified in 8.7% of the patients, the most common being atrial tachyarrhythmia (76.2%). Patients with arrhythmias had higher mortality (52.4% versus 24.1%, p = 0.005). On multivariate analysis, only the presence of heart failure (HF) was associated with a higher risk of arrhythmias (hazard ratio, 11.9; 95% CI: 3.6-39.5; p <0.001). During hospitalization, 3.3% of the patients experienced CA, with a predominance of non-shockable rhythms. All patients experiencing CA died during hospitalization. CONCLUSIONS: The incidence of cardiac arrhythmias in patients admitted with COVID-19 to a Brazilian tertiary hospital was 8.7%, and atrial tachyarrhythmia was the most common. Presence of HF was associated with an increased risk of arrhythmias. Patients with COVID-19 experiencing CA have high mortality.

FUNDAMENTO: A doença pelo novo coronavírus (COVID-19) está associada a manifestações clínicas cardiovasculares, incluindo a ocorrência de arritmias cardíacas. OBJETIVOS: Avaliar a incidência de arritmias cardíacas (taquiarritmia atrial, bradiarritmia e taquicardia ventricular sustentada) e de parada cardiorrespiratória (PCR) em uma coorte de pacientes internados com COVID-19 em hospital universitário terciário. MÉTODOS: Estudo de coorte retrospectivo realizado por meio de revisão dos registros de prontuário médico. Para comparação entre os grupos, foi considerado como estatisticamente significativo valor de P < 0,05. RESULTADOS: Foram incluídos 241 pacientes consecutivos com diagnóstico de COVID-19 (idade média, 57,8 ± 15,0 anos; 51,5% homens; 80,5% de raça branca) e 35,3% com necessidade de ventilação mecânica invasiva (VM). A mortalidade geral foi de 26,6%, sendo de 58,8% entre aqueles em VM. Arritmias cardíacas ocorreram em 8,7% dos pacientes, sendo a mais comum taquiarritmia atrial (76,2%). Pacientes com arritmias apresentaram maior mortalidade, 52,4% versus 24,1% (p=0,005). Em análise multivariada, apenas a presença de insuficiência cardíaca foi associada a maior risco de arritmias ( hazard ratio , 11,9; IC 95%: 3,6-39,5; p<0,001). Durante a internação, 3,3% dos pacientes foram atendidos em PCR, com predomínio de ritmos não chocáveis. Todos os atendidos em PCR evoluíram com óbito durante a internação. CONCLUSÃO: A incidência de arritmias cardíacas em pacientes internados com COVID-19 em hospital terciário brasileiro foi de 8,7%, sendo a mais comum taquiarritmias atrial. A presença de insuficiência cardíaca foi associada a maior risco de arritmias. Pacientes com COVID-19 atendidos em PCR apresentam elevada mortalidade.

Development of purified cashew gum mucoadhesive buccal tablets containing nystatin for treatment of oral candidiasis.

OBJECTIVE: The objective of this work was to prepare mucoadhesive buccal tablets containing nystatin and purified cashew gum for the treatment of oral candidiasis. SIGNIFICANCE: Mucoadhesive buccal tablets containing the drug nystatin are an alternative to oral suspensions, which cause low therapeutic adherence to the treatment of oral candidiasis. Purified cashew gum has been studied as a diluent and mucoadhesive agent in tablets. METHODS: Two batches of mucoadhesive tablets were produced, MT1 and MT 2, containing purified cashew gum, nystatin (500,000 IU), flavoring agent and with or without the presence of lubricant agent. The average weight, mechanical properties, dose uniformity, drug release profile, mucoadhesive properties and antimicrobial activity against Candida albicans were evaluated. RESULTS: Tablets presented average weight of 329.1 ± 3.1 mg (MT1) and 334.6 ± 1.5 mg (MT2), hardness of 9.8 ± 0.8 KgF (MT1) and 8.3 ± 0.4 KgF (MT2), friability of 0.2% (MT1 and MT2), and dose uniformity of 102.20 ± 1.17% (MT1) and 99.06 ± 7.40% (MT2). MT1 and MT2 were able to swell, erode, release the drug and remain adhered to the pig's cheek up to 3 h for batch MT1 and 4 h for batch MT2, and the amount of nystatin released since the beginning of the test in both batches was sufficient to inhibit the growth of the fungus. CONCLUSIONS: Therefore, the proposed formulation proved to be very promising and met all the studied criteria, showing to be ideal for the treatment of oral candidiasis.

[Spatial and temporal patterns of mortality among motorcyclists in a State of the Brazilian Northeast in the 21st century]. / Padrões espaciais e temporais da mortalidade de motociclistas em estado do nordeste brasileiro no século XXI.

The scope of this work was to analyze the trend and distribution of mortality among motorcyclists in traffic accidents in the State of Alagoas. It involved an ecological study relating to all deaths resulting from motorcycle accidents in the state in the period from 2001 to 2015. Mortality data were obtained from the Mortality Information System (MIS). Mortality rates were calculated and stratified by gender. The joinpoint regression model was used for trend analysis and the Annual Percentage Variation (APV) was calculated with a significance rate of 5%. For the spatial analysis, local empirical Bayesian modeling and Moran statistics and spatial scanning statistics were applied. There were 1,458 deaths of motorcyclists in the period studied, 91.3% of which were men. Three temporal behaviors were observed in this population group: growth (2001-2005), stationary pattern (2005-2013) and decline from 2013 onwards. The highest rates were observed in the 'agreste' and 'sertão' regions of the state of Alagoas. Five spatial clusters were revealed with relation to general and male mortality, all located in the 'agreste' and 'sertão' hinterlands of Alagoas. The modeling showed a reduction of mortality from 2013 onwards and the spatial analysis revealed that the problem is more acute in the interior of the state.

Este trabalho objetivou analisar a tendência e a distribuição espacial da mortalidade de motociclistas em acidentes de transporte no estado de Alagoas. Trata-se de um estudo ecológico referente a todos os óbitos decorrentes de acidentes motociclísticos no estado no período 2001-2015. Os dados de mortalidade foram obtidos do Sistema de Informações sobre Mortalidade (SIM). As taxas de mortalidade foram calculadas e estratificadas por sexo. Para a análise de tendência, foi empregado o modelo de regressão por pontos de inflexão. Calculou-se a Variação Percentual Anual (VPA). Significância de 5%. Para a análise espacial, aplicou-se modelagem bayesiana empírica local, estatística de Moran e estatística de varredura espacial. Foram registrados 1.458 óbitos de motociclistas no período estudado, sendo 91,3% homens. Três comportamentos temporais foram observados nessa população: crescimento (2001-2005), padrão estacionário (2005-2013) e declínio a partir de 2013. As maiores taxas foram observadas no agreste e sertão. Cinco aglomerados espaciais foram evidenciados no que se refere à mortalidade geral e masculina, todos situados no agreste e sertão alagoanos. A modelagem mostrou redução da mortalidade a partir de 2013 e a análise espacial evidenciou que o problema é mais grave no interior do estado.

Updated birth prevalence and relative frequency of mucopolysaccharidoses across Brazilian regions.

The mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders caused by 11 enzyme deficiencies, classified into seven types. Data on the birth prevalence of each MPS type are available for only a few countries, and the totality of cases may be underestimated. To determine the epidemiological profile of MPS in each Brazilian region, we analyzed data collected between 1982 and 2019 by a national reference laboratory and identified 1,652 patients. Using data between 1994 and 2018, the birth prevalence (by 100,000 live births) for MPS was 1.57. MPS II was the most common type of MPS in Brazil, and its birth prevalence was 0.48 (0.94 considering only male births). Regarding the number of cases per region, MPS II was the most frequent in the North and Center-West (followed by MPS VI), and also in the Southeast (followed by MPS I); MPS I and MPS II were the most common types in the South; and MPS VI was the most common in the Northeast (followed by MPS II). The differences observed in the relative frequencies of MPS types across Brazilian regions are likely linked to founder effect, endogamy, and consanguinity, but other factors may be present and need further investigation.

Características das tentativas de suicídio atendidas pelo serviço de emergência pré-hospitalar: um estudo epidemiológico de corte transversal / The characteristics of suicide attempts assisted by first responders: a cross-sectional epidemiological study

RESUMO Objetivo: Descrever o perfil das vítimas de tentativas de suicídio atendidas pelo Corpo de Bombeiros de um município do semiárido brasileiro. Métodos: Estudo transversal contendo dados do atendimento a vítimas de tentativas de suicídio, realizado pelos bombeiros militares do estado de Alagoas, no período de 1º de janeiro de 2000 a 31 de dezembro de 2017. Foram selecionadas as variáveis: sexo, idade, desfecho, intoxicação, uso de álcool, transtorno mental, estação do ano, dia da semana, horário, natureza da ocorrência e tempo de resposta, de transporte e total. Foram utilizados os testes qui-quadrado, exato de Fisher e Kruskal-Wallis. Resultados: Foram atendidas 144 vítimas de tentativas de suicídio. A frequência de atendimentos entre homens (n = 73; 50,7%) e mulheres (n = 71; 49,3%) foi semelhante. As mulheres apresentaram idade mais jovem (p < 0,001) e utilizaram o método da intoxicação (p < 0,001) duas vezes mais que os homens. A presença de transtorno mental (p = 0,04) foi mais comum entre os homens e o tempo consumido durante o atendimento pré-hospitalar foi maior entre eles, indicando que, possivelmente, as tentativas de suicídio cometidas por homens demandam maiores cuidados durante a assistência realizada pelos bombeiros. Conclusões: O perfil das vítimas de tentativas de suicídio apresentou frequência semelhante entre homens e mulheres, sendo as mulheres mais jovens. Nas mulheres, observou-se predomínio de intoxicações. Em homens, os transtornos mentais foram mais prevalentes. Além disso, fazem-se necessários o reconhecimento precoce dos casos de tentativas de suicídio, as principais formas de atuação e o preenchimento adequado das fichas de atendimento pré-hospitalar.

ABSTRACT Objective: To describe the profile of suicide attempts assisted by the Fire Department of a Brazilian semi-arid municipality. Methods: This is a cross-sectional study, containing data of care provided to victims of suicide attempts, conducted by the military firefighters of the state of Alagoas, from January 1, 2000 to December 31, 2017. The following variables were selected: sex, age, outcome, intoxication, alcohol use, mental disorder, season of the year, day of the week, schedule, nature of occurrence, response time, transportation time and total time. The chi-square, Fisher's exact test and Kruskal-Wallis tests were used. Results: Between 2000 and 2017, 144 victims of suicide attempts were cared. The frequency of care between men (n = 73; 50,7%) and women (n = 71; 49,3%) was similar. The women showed younger age (p < 0,001) and used the intoxication method (p < 0,001) twice as often as the men. The presence of mental disorder (p = 0,04) was more common among the men and the time consumed during prehospital care was higher among them, indicating that, possibly, suicide attempts committed by men require greater care for the assistance provided by firefighters. Conclusions: The profile of victims of suicide attempts showed a similar frequency between men and women, with younger women. In women, there was a predominance of intoxications. Besides that, mental disorders were more prevalent. However, it is necessary to early recognition of cases of suicide attempts, the main forms of action and the adequate completion of pre-hospital care forms.

Transferrin isoelectric focusing for the investigation of congenital disorders of glycosylation: analysis of a ten-year experience in a Brazilian center / Isoeletrofocalização da transferrina para investigação das doenças congênitasda glicosilação: análise de dez anos de experiência de um centro brasileiro

Abstract Objectives: To characterize cases of suspected congenital disorders of glycosylation (CDG) investigated in a laboratory in southern Brazil using the transferrin isoelectric focusing TfIEF test from 2008 to 2017. Method: Observational, cross-sectional, retrospective study. The laboratory records of 1,546 individuals (median age = 36 months, 25-75 IQR = 10-108; males = 810) submitted to the TfIEF test during the period were reviewed. Results: Fifty-one individuals (3%) had an altered TfIEF pattern (5 ± 2.8 cases/year; median age = 24 months, 25-75 IQR = 11-57 months; males = 27, 53%). For 14 of them, data on diagnosis conclusion were available (classic galactosemia = 4; hereditary fructose intolerance = 4; peroxisomal diseases = 2; PMM2-CDG = 2; MPDU1-CDG = 1; SLC35A2-CDG = 1).Comparing the cases with the normal and altered TfIEF patterns, there was a higher prevalence of altered cases in the age group from 11 months to 3 years. There was an increase in the likelihood of change in TfIEF, especially in the presence of inverted nipples or liver disease. Conclusions: The data suggest that the investigation of a case with suspected CDG is a complex problem, being aggravated by the existence of other IEMs (inborn errors of metabolism) associated with altered TfIEF pattern and lack of access to confirmatory tests. The presence of inverted nipples and liver disease, especially in individuals aged 11 months to 3 years, should suggest the need for TfIEF investigation.

Resumo Objetivos: Caracterizar os casos com suspeita de CDG investigados em laboratório do sul do Brasil pelo exame de IEFTF de 2008 a 2017. Metodologia: Estudo observacional, transversal, retrospectivo. Foram revisadas as fichas laboratoriais de 1.546 indivíduos (mediana de idade = 36 meses, IQ 25-75 = 10-108; sexo masculino = 810) que fizeram o exame de IEFTF no período. Resultados: Cinquenta e um indivíduos (3%) apresentaram padrão alterado na IEFTF (5 ± 2,8 casos/ano; mediana de idade = 24 meses, IQ 25-75 = 11-57 meses; sexo masculino = 27, 53%). Para 14 deles, estavam disponíveis dados sobre a conclusão do diagnóstico (galactosemia clássica = 4; intolerância hereditária à frutose = 4; doenças peroxissomais = 2; PMM2-CDG = 2; MPDU1-CDG = 1; SLC35A2-CDG = 1). Comparando os casos com padrão normal e alterado na IEFTF, houve maior prevalência de casos alterados na faixa etária de 11 meses a 3 anos. Verificou-se um aumento na probabilidade de alteração na IEFTF principalmente na presença de mamilos invertidos ou de hepatopatia. Conclusões: Os nossos dados sugerem que a investigação de um caso com suspeita de CDG é complexa, é agravada pela existência de outros EIM associados a padrão alterado na IEFTF e pela falta de acesso a exames confirmatórios. A presença principalmente de mamilos invertidos e de hepatopatia em indivíduos na faixa etária de 11 meses a 3 anos deve sugerir a necessidade de investigação por IEFTF.

Effect of different intraradicular posts in the dimensions of root canal computed tomography images.

OBJECTIVES: To evaluate the effect of different intraradicular posts on the dimensions of computed tomography (CT) images in cone-beam and fan-beam equipment. MATERIALS AND METHODS: : A total of 15 root canals of bovine teeth were instrumented up to a file #50 and root-filled by the active lateral condensation technique. The teeth were randomly divided into three groups, according to the type of intraradicular post: 1) tight fiberglass post; 2) anatomical fiberglass post; and 3) metal post. The root canals were desobturated in 10 mm and tomographic images were acquired in two devices, a cone-beam and fan-beam equipment. Then, the intraradicular posts were cemented using an automix self-conditioning and self-adhesive resin cement, and the final acquisitions of the CT images were performed for analysis. The diameter of the canal was compared before and after cementation of the intraradicular posts. The t-test was used between the initial and final measurements of each tomograph and also between the cone-beam and fan-beam tomographs (α = 0.05). RESULTS: The anatomical fiberglass post presented the smallest dimensional change among the initial and final measurements, followed by the tight fiberglass post, with the metal post being the material that showed the most considerable dimensional difference in the cone-beam. CONCLUSION: All of the intraradicular posts used promoted a change in the size of the CT image. The fan-beam scanner promoted greater dimensional change in the images.

Correlation between mechanical properties and stabilization time of chemical bonds in glass-ionomer cements.

The objective was to evaluate the compressive strength (CS), diametral tensile strength (DTS), flexural strength (FS), and Knoop microhardness (KH) of different conventional restorative glass-ionomer cements (GICs) and to correlate these mechanical properties (MP) with the stabilization time (ST) of their chemical bonds. Eighteen GICs were tested: Bioglass [B], Chemfil Rock [CR], Equia Forte [EF], Gold Label 2 [GL2], Gold Label 9 [GL9], Glass Ionomer Cement II [GI], Ionglass [IG], Ion Z[ IZ], Ionomaster [IM], Ionofil Plus [IP], Ionostar Plus [IS], Ketac Molar Easymix [KM], Magic Glass [MG], Maxxion R [Ma], Riva Self Cure [R], Vidrion R [V], Vitro Fil [VF] and Vitro Molar [VM]. The mechanical strength tests were performed in a universal testing machine. KH readings were done with a diamond indenter. STs were examined by Fourier Transform Infrared spectroscopy (FTIR). Data were analyzed with ANOVA and Tukey test (p<0.05). The Spearman rank test was used to evaluate the dependence between the MPs and ST results. The highest MP values were EF, GL2, GL9, GI and KM and the lowest for MG, MA, B, VF and IM. The longest ST was for GL2 and the shortest was for B. ST correlated positively with MP. GICs with longer chemical bonds ST are generally stronger and the ST value obtained from FTIR was useful in predicting the strength of GICs tested.

Ceramic veneers on teeth with non-carious cervical lesions: case report and finite element analysis / Facetas cerâmicas em dentes com lesões cervicais não cariosas: relato de caso e análise de elementos finitos

On ceramic veneers rehabilitation, teeth with non-carious cervical lesions (NCCLs), especially premolars, are often involved. Preparation to remove deep NCCLs may lead to excessive wear and a less conservative approach, which goes against the current principles of minimal wear and maximum preservation. However, no evidence exists indicating which technique could avoid excessive wear during the dental preparation for veneers associated with NCCL. Thus, this study aimed to present an aesthetic treatment with ceramic veneers and follow-up of 24 months of a patient with various levels of NCCL severity; and to evaluate various wear protocols for dental veneers associated with NCCL via Finite Element Analysis (FEA) to guide and justify the clinical decision of the clinical case described. A 37-year-old male patient presented for treatment with wear on the anterior teeth and with NCCLs of various severity degrees on the posterior teeth. The treatment chosen was rehabilitation with ceramic veneers on teeth 15 to 25. The best restorative approach for the NCCL teeth was evaluated via an FEA, simulating various protocols and lesion depths while also calculating the percentage of tooth structure loss. Restoring the premolar's deeper NCCL with a composite resin core, before a ceramic veneer impression, presented better mechanical behavior in FEA and less tooth wear. For the 1.0 mm NCCL, beveling the lesion promoted good stress distribution, less invasive wear and an easier clinical procedure, as it did not involve a previous restorative procedure. It could be concluded that the restorative decision for premolars with NCCLs that will receive veneers should consider the set biomechanical behavior and especially the tooth structure wear necessary. For the case report presented, after two years of follow-up, no changes from the immediate result were observed, indicating that the cause of the lesions was eliminated, and that the treatment was effective, at least in the short-term. For FEA analysis, restoring the deeper NCCL prior to ceramic veneer impression, presented better mechanical behavior and less tooth wear. For the 1.0 mm NCCL, beveling the margin of the lesion generated the same good results

Na reabilitação com facetas cerâmicas, dentes com lesões cervicais não cariosas (LCNC), especialmente pré-molares, estão frequentemente envolvidos. O preparo para remover a LCNC pode levar a um desgaste excessivo e a uma abordagem menos conservadora, o que vai contra os princípios atuais de mínimo desgaste e máxima preservação. Entretanto, não existem evidências indicando qual técnica pode evitar o desgaste excessivo durante o preparo para facetas associado com LCNC. Portanto, esse artigo tem dois objetivos principais: 1) apresentar um tratamento estético com facetas cerâmicas e acompanhamento de 24 meses de um paciente com vários níveis de severidade de LCNC e 2) avaliar vários protocolos de preparo para facetas cerâmicas associadas com LCNC por meio do Método de Elementos Finitos (MEF) para guiar e justificar a decisão clínica do caso clínico descrito. Um paciente de 37 anos, gênero masculino, compareceu para tratamento com desgaste nos dentes anteriores e com LCNC com vários graus de severidade nos dentes posteriores. Optou-se pela reabilitação com facetas cerâmicas nos dentes 15 a 25. A melhor abordagem restauradora para os dentes com LCNC foi avaliada por MEF, simulando vários protocolos e profundidades de lesão, além disso foi calculada a porcentagem de estrutura dental perdida. Restaurar a LCNC profunda de um pré-molar com um núcleo de resina composta, antes da moldagem para faceta cerâmica, apresentou melhor comportamento mecânico em MEF e menos desgaste dental. Para a LCNC de 1 mm, biselar a lesão promoveu boa distribuição de tensões, um desgaste menos invasivo e um procedimento clínico mais fácil, já que não envolveu um procedimento restaurador prévio. Pode-se concluir que a decisão restauradora para pré-molares com LCNC que irão receber facetas deve considerar o comportamento biomecânico do conjunto e, principalmente, o desgaste de estrutura dental necessário. Para o caso apresentado, após 2 anos de acompanhamento, nenhuma mudança foi observada, indicando que a causa das lesões foi eliminada, e que o tratamento foi efetivo, ao menos no curto prazo. Para MEF, restaurar a LCNC antes da moldagem para facetas, apresentou melhor comportamento mecânico e menor desgaste dentário. Para a LCNC de 1,0 mm, fazer o bisel na margem da lesão levou aos mesmos bons resultados.

ST elevation myocardial infarction during head-up tilt testing.

We report a case of ST elevation myocardial infarction (STEMI) during head-up tilt testing (HUTT). A 54-year-old man was admitted to our emergency department after four episodes of syncope. Treadmill test and electrophysiological study were normal. During passive HUTT, the patient had inferolateral ST elevation. Coronary angiography showed two severe lesions in the right coronary artery and circumflex artery.

Yttria-stabilized tetragonal zirconia polycrystal/resin luting agent bond strength: Influence of Titanium dioxide nanotubes addition in both materials.

PURPOSE: To evaluate the shear bond strength (SBS) between Y-TZP and a resin luting agent, after 1 of 2 enhancing strategies with TiO2--nts was applied, either to the resin luting agent or the Y-TZP mass, in different concentrations. METHODS: In the Strategy TiO2-nts on ceramic, the resin luting agent Panavia F2.0™ (Kuraray) and an experimental Y-TZP with added concentrations of TiO2--nts (0%, 1%, 2%, and 5% vol/vol) and a commercial Y-TZP, comprised 5 different groups (n = 10). In the Strategy TiO2-nts on cement, the resin luting agent RelyX U200™ (3 M ESPE) was added with different concentrations of TiO2--nts (0%, 0.3%, 0.6%, 0.9% wt/wt) luted to a commercial Y-TZP, comprising 4 different groups (n = 10). The Y-TZP discs were included in acrylic bases, and a cylinder (3 × 3 mm) of the correspondent luting agent for each respective group was applied over them. After 24 h, specimens were subjected to SBS assessments in a universal testing machine. Field emission scanning electron microscopy and energy dispersive X-ray spectroscopy analyses were also performed on Y-TZP surfaces. Data were analyzed via analysis of variance and Tukey tests (α = 0.05). RESULTS: TiO2-nts on ceramic influenced the bond strength significantly, but not linearly; TiO2-nts on cement did not influence bond strength when analyzed separately, nor in comparison with the first. CONCLUSION: Y-TZP enhancements with TiO2-nts led to a higher SBS with Panavia F2.0, a 5% TiO2--nt concentration presented the highest bond strength. Modified Rely X U200 did not improve SBS.