Cochlear Implants after Meningitis and Otosclerosis: A Comparison between Cochlear Ossification and Speech Perception Tests.

(1) Background: Performance after Cochlear Implantation (CI) can vary depending on numerous factors. This study aims to investigate how meningitis or otosclerosis can influence CI performance. (2) Methods: Retrospective analysis of CI performance in patients with etiological diagnosis of meningitis or otosclerosis, comparing the etiologies and analyzing the image findings, along with electrode array insertion status and technique. (3) Results: Speech recognition in CI patients with otosclerosis improves faster than in patients with meningitis. Other features such as radiological findings, degree of cochlear ossification, surgical technique used and total or partial insertion of electrodes do not seem to be directly related to speech recognition test performance. (4) Conclusions: Patients should be warned that their postoperative results have a strong correlation with the disease that caused their hearing loss and that, in cases of meningitis, a longer duration of speech-language training may be necessary to reach satisfactory results.

Is the facial bone wall critical to achieving esthetic outcomes in immediate implant placement with immediate restoration? A systematic review.

BACKGROUND: Rehabilitation in the anterior region requires specific conditions for success, such as the presence of papilla, emergence profile, and balance between pink and white esthetic. OBJECTIVES: This systematic review aimed to evaluate the esthetic risk associated with immediate implant placement with immediate restoration in the anterior superior area, where the facial bone plate may be absent or deficient. MATERIAL AND METHODS: The search was done in PubMed, Embase, Cochrane, Lilacs, Scopus, Scielo, and Google Scholar databases. The investigation involved clinical studies and observational studies published between January 2012 and July 2023. Studies were excluded if there was less than 12-month follow-up, no immediate restoration or facial defect, heavy smokers, or systemic disease. The risk of bias was assessed using the ROBINS-I and Modified-Cochrane RoB tools. RESULTS: Twelve studies were included in this systematic review. The thinner the facial plate, the higher the alveolus's risk of gingival recession or shrinkage. There was an increased interproximal recession when the thin phenotype was associated with flap surgery. An increase in pink esthetic score (PES) was reached when immediate implant placement (IIP) and immediate restoration were done. Soft tissue augmentation achieved more gingival-level stability. Regardless of the initial phenotype, an esthetic outcome was delivered. The risk of bias was high in 1 study and moderate in 3 studies. CONCLUSION: It is possible to conclude that esthetic results and increased final PES or patient satisfaction index in IIP treatments associated with immediate restoration could be obtained even in buccal bone wall defects or gingival recession, regardless of their extension.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial.

OBJECTIVE: To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C < -1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). MATERIALS AND METHODS: After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. RESULTS: There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p < 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p = 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. CONCLUSION: High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

OBJETIVO: Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C < −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). MATERIAIS E MéTODOS: Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. RESULTADOS: Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p < 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p = 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. CONCLUSãO: Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.

"Catheter Hole Support": A Novel Technique for Increasing Guide Catheter Support.

Percutaneous coronary interventions (PCI) in the setting of tortuosity, calcification, and some types of coronary takeoffs can be challenging. In such cases, the choice of strategies that promote optimal catheter support is essential for the success of the procedure, by facilitating the delivery of the equipment. We have developed a new support technique: "Catheter Hole Support Technique" is a simple, low-cost, and widely available technique that effectively increases catheter support and system stability. To perform the technique, all that is needed is a hole in the catheter at the right spot, made by a 22G needle and a 0.018″ shapeable tip support guidewire. We report the steps of this new technique in a successful Right Coronary Artery (RCA) PCI, in the context of a non-ST-elevation myocardial infarction (NSTEMI).

Historical perspective of vaginal hysterectomy: the resilience of art and evidence-based medicine in the age of technology.

OBJECTIVE: The aim of this study was to describe, from a historical perspective, the relevance, resilience and outcomes of vaginal hysterectomy (VH) in gynecology in the age of technological scenario. METHODS: The authors searched records from January 2011 to January 2021 on the following databases: Medline, EMBASE, and CENTRAL (The Cochrane Library) for combinations of the terms "vaginal hysterectomy," "outcomes" AND "history"; and before that period, if the search had historical relevance. INCLUSION CRITERIA: randomized clinical trials; hysterectomy performed for benign gynecological conditions; and VH outcomes compared with Abdominal Hysterectomy (AH), Laparoscopic Hysterectomy (LH) or Robotic Hysterectomy (RH). RESULTS: The VH combines sequences of reproducible techniques which have been developed over the years to safely and effectively overcome the limitations of difficult cases of vaginal extirpation from the uterus. CONCLUSION: The authors support endoscopic surgical approaches in complex surgery for benign indications, urogynecology, and gynecologic oncology when appropriate. However, what makes the gynecological surgeon different from the general surgeon is the vaginal access. It is essential to continue to train residents in vaginal surgical skills and provide safe and cost-effective patient care. The art of technology is the resilience of keeping only the patient at the center of innovation.

Efficacy of Sacrospinous Fixation or Uterosacral Ligament Suspension for Pelvic Organ Prolapse in Stages III and IV: Randomized Clinical Trial / Eficácia da fixação sacroespinhal ou da suspensão do ligamento útero-sacro no prolapso de órgãos pélvicos nos estágios III e IV: Ensaio clínico randomizado

Abstract Objective To evaluate the efficacy and outcomes of the surgical treatment for pelvic organ prolapse (POP) in stages III and IV by sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (USLS) by comparing anatomical and subjective cure rates and quality-of-life parameters (through the version validated for the Portuguese language of the Prolapse Quality of Life [P-QoL] questionnaire) under two definitions: genital prolapse Ba, Bp, and C< −1 (stage I) and Ba, Bp, and C ≤ 0 (stage II). Materials and Methods After we obtained approval from the Ethics Committee (under CAAE 0833/06) and registered the study in ClinicalTrials.gov (NCT 01347021), 51 patients were randomized into two groups: the USLS group (N = 26) and the SSLF group (N = 25), with follow-up 6 and 12 months after the procedures. Results There was a significant improvement in the P-QoL score and anatomical measurements of all compartments in both groups after 12 months (p< 0.001). The anatomical cure rates in the USLS and SSLF groups, considering stage 1, were of 34.6% and 40% (anterior) respectively; of 100% both for groups (apical); and of 73.1% and 92% (posterior) respectively. The rates of adverse outcomes were of 42% (N = 11) and 36% (N = 11) for the USLS and SSLF groups respectively (p= 0.654), and those outcomes were excessive bleeding, bladder perforation (intraoperative) or gluteal pain, and urinary infection (postoperative), among others, without differences between the groups. Conclusion High cure rates in all compartments were observed according to the anatomical criterion (stage I), without differences in P-QoL scores and complications either with USLS or SSLF for the surgical treatment of accentuated POP.

Resumo Objetivo Avaliar a eficácia e os resultados do tratamento cirúrgico para prolapso de órgãos pélvicos (POP) nos estágios III e IV, por meio da técnica de fixação do ligamento sacroespinal (FLSE) ou suspensão do ligamento útero-sacro (SLUS), ao comparar os índices de cura anatômicos, subjetivos, e os parâmetros de qualidade de vida (por meio do questionário Prolapse Quality of Life [P-QoL] validado para a língua portuguesa) sob duas definições: prolapso genital Ba, Bp e C< −1 (estágio I) e Ba, Bp e C ≤ 0 (estágio II). Materiais e Métodos Após aprovação do Comitê de Ética (CAAE 0833/06) e registro no ClinicalTrials.gov (NCT 01347021), 51 pacientes foram randomizadas em dois grupos: grupo SLUS (N = 26) e (2) grupo FLSE (N = 25), com seguimento de 6 e 12 meses. Resultados Houve melhora significativa nas pontuações no P-QoL e nas medidas anatômicas de todos os compartimentos em ambos os grupos após 12 meses (p< 0,001). As taxas de cura anatômica nos grupos SLUS e FLSE , considerando o estágio 1, foram de 34,6% e 40% (anterior), respectivamente; de 100% em ambos os grupos (apical); e de 73,1% e 92% (posterior), respectivamente. As taxas de resultados adversos foram de 42% (N = 11) e 36% (N = 11), respectivamente, nos grupos SLUS e FLSE (p= 0,654), e elas foram sangramento excessivo, perfuração da bexiga (intraoperatória) ou dor glútea, e infecção urinária (pós-operatória), entre outras, sem diferenças entre os grupos. Conclusão Altas taxas de cura em todos os compartimentos foram observadas segundo critério anatômico (estágio I), sem diferença quanto às pontuações no P-QoL e às complicações tanto com SLUS quanto com FLSE para o tratamento cirúrgico de POP acentuado.

Evaluation of Bone Response to a Nano HA Implant Surface on Sinus Lifting Procedures: Study in Rabbits.

The aim of this study was to evaluate the bone response to two different implant surfaces on sinus lift procedures in rabbits. Bilateral sinus lifting with inorganic bovine bone associated with collagen membrane and immediate implantation were performed in 16 rabbits. Custom mini-implants were randomly installed in the prepared sites: one side received a double acid-etched (DAE) surface and the other a nano-hydroxyapatite (NHA) surface. The animals were euthanized 30 and 60 days after surgery, and biopsies were collected for microtomographic and histomorphometric analysis. After 30 days, no intra- and inter-group statistical differences were observed in microtomographic analysis, while at 60 days, bone analysis showed statistically significant differences between groups (p < 0.05) for all the evaluated parameters. Histomorphometric analysis showed, after 30 days, mean % of Bone-to-Implant Contact (BIC) for DAE and NHA of 31.70 ± 10.42% vs. 40.60 ± 10.22% (p > 0.05), respectively; for % of Bone Area Fraction Occupancy (BAFO), mean values were 45.43 ± 3.597% for DAE and 57.04 ± 5.537% for NHA (p < 0.05). After 60 days, mean %BIC and %BAFO for DAE and NHA implants were statistically significant (p < 0.05). The NHA surface showed superior biological features compared to the DAE treatment, promoting higher bone formation around the implants in an experimental model of bone repair in a grafted area.

Effects of the COVID-19 Pandemic on Gynecological Health: An Integrative Review.

OBJECTIVE: To analyze the existing scientific literature to find out if the coronavirus disease 2019 (COVID-19) pandemic has an effect on gynecological health. SEARCH STRATEGY: We performed an integrative review of articles published between April 2020 and April 2021 on the PubMed, SciELO, and LILACS databases, using COVID-19 and the following relevant terms: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; and Urogynecology. SELECTION CRITERIA: Among the eligible studies found, editorials and primary research articles, which describe the dynamics between severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection (the cause of the COVID-19 pandemic) and gynecological health, were included. DATA COLLECTION AND ANALYSIS: Through qualitative synthesis, data were extracted from the included publications and from guidelines of national and international societies of gynecology. MAIN RESULTS: The 34 publications included in the present study showed that some factors of the SARS-CoV-2 infection, and, consequently, the COVID-19 pandemic, might be associated with menstrual abnormalities, effects on contraception, alterations in steroid hormones, changes in urogynecological care, effects on women's mental health, and negative impact on violence against women. CONCLUSION: The COVID-19 pandemic has significantly impacted the health of women. The scientific community encourages the development of recommendations for specialized care for women and strategies to prevent and respond to violence during and after the COVID-19 pandemic.

OBJETIVO: Analisar a literatura científica existente para saber se a pandemia de doença do coronavírus 2019 (coronavirus disease 2019, COVID-19, em inglês) afeta a saúde ginecológica. ESTRATéGIA DE PESQUISA: Realizou-se revisão integrativa de artigos publicados entre abril de 2020 e abril de 2021 nas bases de dados PubMed, SciELO e LILACS, utilizando COVID-19 e os seguintes termos: Menstrual change; Ovarian function; Violence against women; Contraception; HPV; Mental health; e Urogynecology. CRITéRIO DE SELEçãO: Entre os estudos elegíveis encontrados, foram incluídos editoriais e artigos de pesquisa que descrevem a dinâmica entre a infecção por coronavírus da síndrome respiratória aguda grave (severe acute respiratory syndrome coronavirus, SARS-CoV-2, em inglês), a causa da pandemia de COVID-19, e a saúde ginecológica. COLETA E ANáLISE DE DADOS: Por meio de síntese qualitativa, os dados foram extraídos das publicações incluídas e de diretrizes de sociedades nacionais e internacionais de ginecologia. RESULTADOS PRINCIPAIS: As 34 publicações incluídas no estudo mostraram que alguns fatores da infecção por SARS-CoV-2, e, consequentemente, da pandemia de COVID-19, podem estar associados a alterações menstruais, influências na contracepção, alterações em hormônios esteroides, adaptações na assistência uroginecológica, influência na saúde mental da mulher, e impacto negativo na violência contra a mulher. CONCLUSãO: A pandemia de COVID-19 teve um impacto significativo na saúde das mulheres. A comunidade científica incentiva o desenvolvimento de recomendações para o atendimento especializado a mulheres, e estratégias para prevenir e combater a violência durante e após a pandemia de COVID-19.

Myocardial function reclassification: Echocardiographic strain patterns in patients with chronic Chagas cardiomyopathy and intraventricular dyssynchrony.

BACKGROUND: We aimed to identify, among Chronic Chagas Cardiomyopathy (CCC) patients with left ventricular dysfunction (LVD) and non-left bundle branch block (non-LBBB), subgroups with different functional and mechanical patterns of global longitudinal strain (GLS) and intraventricular dyssynchrony (IVD) at rest and after exercise stress test, and reclassify them using a new echocardiographic approach. METHODOLOGY: In this single-center cross-sectional study, 40 patients with CCC, left ventricular ejection fraction (LVEF) ≤ 35% and non-LBBB underwent rest echocardiography and then treadmill exercise stress echocardiography with GLS and IVD analysis. The sample was divided into four groups, based on GLS and IVD significant variation between rest and exercise: GLS + IVD+ (9 patients); GLS + IVD- (9 patients); GLS-IVD+ (10 patients); GLS-IVD- (10 patients). RESULTS: At rest, median LVEF was 28% (21.3%-33%) and GLS (-7% (-5%/-9.3%), were not different among groups. The average response of GLS was an increase of 0.74% over rest values, and the average response of IVD was a decrease of 6.9 ms. Group GLS-IVD+ presented more dyssynchrony at rest (p = 0.01). Left atrial (LA) volume (higher in GLS-IVD-) (p = 0.022) and TAPSE (higher in GLS + IVD+) (p = 0.015) were also different among groups at baseline. Of the 40 patients evaluated, 27 (67.5%) had very severe LVD (GLS < -8%). In addition, among these patients, 11 patients had contractile reserve after undergoing stress echocardiography. CONCLUSIONS: In patients with CCC, severe LVD and non-LBBB, the evaluation of GLS and IVD between rest and exercise was able to reclassify myocardial function and to identify subgroups with contractile reserve and significant dyssynchronopathy.

Síndrome de Kearns Sayre - relato de caso / Kearns Sayre Syndrome - case report

A Síndrome de Kearns Sayre (SKS) é uma miopatia de origem mitocondrial rara. Caracterizase pela tríade de oftalmoplegia externa, retinose pigmentar e acometimento do sistema de condução cardíaco, descrita em 1958. O objetivo deste relato de caso é descrever um caso de SKS e discutir achados clínicos com ênfase no acometimento cardíaco. Paciente J.A., masculino, 35 anos, com sintomas iniciais de diplopia, estrabismo e ptose. Evoluiu com alteração da motricidade ocular extrínseca, retinopatia pigmentosa e fraqueza muscular difusa o que levou à hipótese de SKS. O diagnóstico definitivo foi feito através de biópsia do bíceps que revelou padrão miopático mitocondrial. Em seguida, encaminhado para investigação de distúrbio de condução. Em primeira consulta evidenciado eletrocardiograma com ritmo sinusal, BAV 1° grau, bloqueio de ramo esquerdo, pausa sinusal e ritmo juncional de 40 bpm. Ecocardiograma com FE 62% e contratilidade preservada. Indicado implante de marcapasso (MP) atrioventricular. Atualmente, com necessidade de 100% de pacing ventricular sem escape ventricular e fibrilação atrial paroxística em anticoagulação. Desde então, segue em acompanhamento ambulatorial. A SKS é uma doença genética relacionada a mutação do DNA mitocondrial. As mitocôndrias são responsáveis pela produção de ATP e fornecimento de energia para diversas funções metabólicas. Por isso, tecidos com alto gasto energético, são os mais acometidos em tais anomalias genéticas. As manifestações cardiológicas ocorrem em 57% dos casos. As alterações eletrocardiográficas mais comuns são bloqueio divisional anterossuperior e bloqueio de ramo direito. Tipicamente ocorre progressão para bloqueio atrioventricular avançado. Morte súbita está associada em até 20% dos casos. A Sociedade Europeia, em sua diretriz de estimulação cardíaca artificial 2021, orienta implante de MP diante do achado de prolongamento de intervalo PR e evidência de bloqueio atrioventricular de qualquer grau, bloqueio de ramo ou bloqueio fascicular. A SKS é uma doença incomum e com repercussão clínica importante. Se negligenciada, o acometimento cardíaco é potencialmente fatal. Assim, cabe ao cardiologista estar atento ao momento ideal de indicação de MP.

Histologic and histomorphometric analysis of two biomaterials of xenogenous origin for maxillary sinus elevation: a clinical study.

Objective: This study analyzed two xenogenous biomaterials based on deproteinized bovine bone mineral applied for maxillary sinus elevation. Method and materials: Fourteen patients were submitted to maxillary sinus augmentation with one of the following biomaterials: Criteria Lumina Bone Porous (test group) or Geistlich Bio-Oss (control group), both of large granules (1 to 2 mm). After 6 months, trephine biopsies were collected at the time of implant placement: 27 samples (11 patients) in the test group; 7 samples (3 patients) in the control group. Biopsies were analyzed by descriptive histology and histomorphometry, in which the percentages of newly formed bone, residual biomaterial particles, and connective tissue were evaluated. Results: Histomorphometry showed means for test and control groups, respectively, of 32.41% ± 9.42% and 26.59% ± 4.88% for newly formed bone, 22.89% ± 4.58% and 25.00% ± 4.81% for residual biomaterial, and 44.70% ± 9.54% and 48.41% ± 3.36% for connective tissue. There were no differences between groups (P > .05). Conclusion: This study concluded that Criteria Lumina Bone Porous presented similar histologic and histomorphometric characteristics to Geistlich Bio-Oss 6 months after sinus elevation surgery, identifying the tested biomaterial as an interesting alternative for bone augmentation in the maxillary sinus.

Multiple sessions of antimicrobial photodynamic therapy associated with surgical periodontal treatment in patients with chronic periodontitis.

BACKGROUND: This double-blind, randomized, controlled clinical trial assessed the efficacy of multiple sessions of antimicrobial photodynamic therapy (aPDT) as an adjunct to surgical periodontal treatment (ST) in patients with severe chronic periodontitis (SCP). METHODS: Sixteen patients with SCP were treated with aPDT+ST (test group, TG) or ST only (control group, CG), in a split-mouth design. aPDT was applied at 0, 2, 7, and 14 postoperative days only in TG. All patients were followed up for 90 days after surgery. The following clinical and microbiological parameters were assessed: clinical attachment level (CAL), probing depth (PD), gingival recession (GR), bleeding on probing (BOP), plaque index (PI), and count of 40 subgingival microbial species (checkerboard DNA-DNA hybridization). Data were collected at baseline (preintervention), at 60 days (30 days after the end of non-surgical therapy), and at 150 days (90 days after surgery). RESULTS: A significant reduction in PD was observed at 150 days for the TG, when compared with the CG (P Ë‚ 0.05). CAL gain was significantly higher in the TG at 60 and 150 days (P Ë‚ 0.05). Changes in the subgingival microbiota were similar between the groups (P Ëƒ 0.05), but the TG revealed a larger number of bacteria associated with periodontal disease at the end of the experiment compared with the CG (P < 0.05). CONCLUSION: Multiple sessions of aPDT as an adjunct to surgical periodontal treatment significantly improved clinical parameters at 90 postoperative days.

Surgical Treatment for Stress Urinary Incontinence in Women: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare surgical treatments for stress urinary incontinence in terms of efficiency and complications. DATA SOURCES: We searched the MEDLINE and COCHRANE databases using the terms stress urinary incontinence, surgical treatment for stress urinary incontinence and sling. SELECTION OF STUDIES: Forty-eight studies were selected, which amounted to a total of 6,881 patients with scores equal to or higher than 3 in the Jadad scale. DATA COLLECTION: Each study was read by one of the authors, added to a standardized table and checked by a second author. We extracted data on intervention details, follow-up time, the results of treatment and adverse events. DATA SYNTHESIS: Comparing retropubic versus transobturator slings, the former was superior for both objective (odds ratio [OR], 1.27; 95% confidence interval [CI], 1.05-1.54) and subjective (OR, 1.23; 95% CI, 1.02-1.48) cures. Between minislings versus other slings, there was a difference favoring other slings for subjective cure (OR, 0.58; 95% CI, 0.39-0.86). Between pubovaginal sling versus Burch surgery, there was a difference for both objective (OR, 2.04; 95% CI, 1.50-2.77) and subjective (OR, 1.64; 95% CI, 1.10-2.44) cures, favoring pubovaginal sling. There was no difference in the groups: midurethral slings versus Burch, pubovaginal sling versus midurethral slings, transobturator slings, minislings versus other slings (objective cure). Retropubic and pubovaginal slings are more retentionist. Retropubic slings have more bladder perforation, and transobturator slings, more leg and groin pain, neurological lesion and vaginal perforation. CONCLUSION: Pubovaginal slings are superior to Burch colposuspension surgery but exhibit more retention. Retropubic slings are superior to transobturator slings, with more adverse events. Other slings are superior to minislings in the subjective aspect. There was no difference in the comparisons between midurethral slings versus Burch colposuspension surgery, pubovaginal versus midurethral slings, and inside-out versus outside-in transobturator slings.

OBJETIVO: comparar tratamentos cirúrgicos para incontinência urinária de esforço (IUE), quanto à eficiência e complicações, por meio de revisão sistemática seguida de metanálise. FONTE DOS DADOS: Fizemos busca nas bases de dados MEDLINE e COCHRANE, utilizando os termos stress urinary incontinence, surgical treatment for stress urinary incontinence e sling. SELEçãO DOS ESTUDOS: Selecionamos 48 estudos, totalizando 6.881 pacientes com pontuação igual ou maior do que 3 na escala de Jadad. COLETA DE DADOS: Cada estudo foi lido por um autor, colocado em tabela, e checado por outro autor. Extraímos dados como detalhes das intervenções, tempo de seguimento, resultados do tratamento e eventos adversos. SíNTESE DOS DADOS: Não houve diferença nas comparações: sling de uretra média versus cirurgia de Burch, quanto às curas objetiva (razão de chances [RC]: 1,29; intervalo de confiança de 95% [IC95%]: 0,76­2,20) e subjetiva (RC: 1,16; IC95%: 0,67­2,00); sling de uretra média transobturatório outside-in versus inside-out quanto às curas objetiva (RC: 0,78; IC95%: 0,45­1,35) e subjetiva (RC: 0,83; IC95%: 0,58­1,18); sling pubovaginal e de uretra média quanto à cura objetiva (RC: 1,64; IC 95%: 0,52­5,15). Comparando sling retropúbico com transobturatório, o retropúbico foi superior quanto às curas objetiva (RC: 1,27; IC95%: 1,05­1,54) e subjetiva (RC: 1,23; IC95%: 1,02­1,48). Entre minislings e outros slings, houve diferença favorável a outros slings quanto à cura subjetiva (RC: 0,58; IC95%: 0,39­0,86) mas não quanto à cura objetiva (RC: 0,72; IC95%: 0,47­1,10). No grupo sling pubovaginal e Burch, houve diferença quanto à cura objetiva (RC: 2,04; IC95%: 1,50­2,77) e subjetiva (RC: 1,64; IC95%: 1,10­2,44). Slings de uretra média apresentam mais erosão, enquanto a cirurgia de Burch tem mais complicações na ferida operatória e infecção do trato urinário. Slings retropúbicos e pubovaginais são mais retencionistas. Slings retropúbicos estão mais associados a lesão vascular, hematomas e perfuração vesical, e transobturatórios, à dor na perna e virilha, lesão neurológica e perfuração vaginal. CONCLUSãO: Slings pubovaginais são superiores à cirurgia de Burch, porém mais retencionistas. Slings retropúbicos são superiores aos transobturatórios, embora tenham mais eventos adversos. Outros slings são superiores aos minislings em relação ao aspecto subjetivo. Não houve diferença nas comparações entre slings de uretra média e cirurgia de Burch, slings pubovaginais, transobturatórios inside-out e inside-in.

A cohort study of cardiac resynchronization therapy in patients with chronic Chagas cardiomyopathy.

Aims: Cardiac resynchronization therapy (CRT) is an established procedure for patients with heart failure. However, trials evaluating its efficacy did not include patients with chronic Chagas cardiomyopathy (CCC). We aimed to assess the role of CRT in a cohort of patients with CCC. Methods and results: This retrospective study compared the outcomes of CCC patients who underwent CRT with those of dilated (DCM) and ischaemic cardiomyopathies (ICM). The primary endpoint was all-cause mortality and the secondary endpoints were the rate of non-advanced New York Heart Association (NYHA) class 12 months after CRT and echocardiographic changes evaluated at least 6 months after CRT. There were 115 patients in the CCC group, 177 with DCM, and 134 with ICM. The annual mortality rates were 25.4%, 10.4%, and 11.3%, respectively (P < 0.001). Multivariate analysis adjusted for potential confounders showed that the CCC group had a two-fold [hazard ratio 2.34 (1.47-3.71), P < 0.001] higher risk of death compared to the DCM group. The rate of non-advanced NYHA class 12 months after CRT was significantly higher in non-CCC groups than in the CCC group (DCM 74.0% vs. ICM 73.9% vs. 56.5%, P < 0.001). Chronic Chagas cardiomyopathy and ICM patients had no improvement in the echocardiographic evaluation, but patients in the DCM group had an increase in left ventricular ejection fraction and a decrease in left ventricular end-diastolic diameter. Conclusion: This study showed that CCC patients submitted to CRT have worse prognosis compared to patients with DCM and ICM who undergo CRT. Studies comparing CCC patients with and without CRT are warranted.

Effect of surgical periodontal treatment associated to antimicrobial photodynamic therapy on chronic periodontitis: A randomized controlled clinical trial.

AIM: This randomized controlled clinical trial evaluated the effects of an adjunctive single application of antimicrobial photodynamic therapy (aPDT) in Surgical Periodontal Treatment (ST) in patients with severe chronic periodontitis (SCP). MATERIAL AND METHODS: In a split-mouth design, 20 patients with SCP were treated with aPDT+ST (Test Group, TG) or ST only (Control Group, CG). aPDT was applied in a single episode, using a diode laser and a phenothiazine photosensitizer. All patients were monitored until 90 days after surgical therapy. Levels of 40 subgingival species were measured by checkerboard DNA-DNA hybridization at baseline, 60 and 150 days. Clinical and microbiological parameters were evaluated. RESULTS: In deep periodontal pockets depth (PPD ≥5 mm), Test Group presented a significantly higher decrease in PPD than Control Group at 90 days after surgical therapy (p < .05). Test Group also demonstrated significantly less periodontal pathogens of red complex (Treponema denticola) (p < .05). CONCLUSION: A single episode of aPDT used in adjunct to open flap debridement of the root surface in the surgical treatment of SCP: i) significantly improved clinical periodontal parameters; ii) eliminates periodontal pathogens of the red complex more effectively (NCT02734784).

Memórias de uma história: a psicologia social em São Paulo / Memories of a history: social psychology in São Paulo

A Psicologia Social no Brasil passou por transformações relacionadas à reflexão crítica de sua produção, à assunção de nova postura acerca do lugar do conhecimento e ao questionamento do papel dos intelectuais frente à realidade latino-americana. A partir do método fenomenológico, resgatou-se a memória dos atores sociais diante da busca pela identidade da Psicologia Social em São Paulo, sobretudo nas décadas de 1960 e 1970. Por meio de entrevistas, recuperaram-se os principais autores e as teorias que influenciaram tais reflexões, ao mesmo tempo em que a narrativa pessoal, introduz-nos ao universo das dificuldades e conquistas experimentadas. Mostrou-se recorrente nos relatos a importância de se reavivar o papel daqueles que assumiram o lugar de bandeirantes desse sentir, pensar e agir que se inaugurava. Ademais, como consequência dos movimentos da memória, apresentou-se uma releitura das práticas do psicólogo social, apartir da contemporaneidade, e dos desafios que se impõe ao fazer acadêmico, hoje.(AU)

Social Psychology in Brazil has gone through changes related to a critical reflection of its production, to the assumption of a new stance about the place of knowledge, and the intellectual’s questioning role before the Latin-American social reality. Through the phenomenological method, we recovered the social authors’ memory before the search of an identity of Social Psychology in São Paulo, especially in the 1960s and 1970s. Through interviews, the main authors and theories, which influenced such reflections, were recovered, at the same time in which the personal narratives lead us to the universe of the difficulties and the achievements experimented in the period. The report recurrently shows the importance of reviving the role of those who assumed the position of settlers of such way to feel, think and act. Moreover, as a consequence of the motion of memory, we presented a reinterpretation of the social psychologist’s practices in contemporaneity, and the challenges imposed to the academic work nowadays.(AU)