Mandibular traumas by gunshot. A systematic review with meta-analysis and algorithm of treatment.

The treatment of mandibular fractures by gunshot ranges from late conservative repair to more aggressive early repair in a single stage. Treatments that preserve bony architecture as much as possible should be used, minimising patient morbidity and the complexity of future surgeries. The purpose of this study was to use a systematic review to determine which method of treatment was most effective for mandibular fractures by gunshot. Searches were conducted on Medline via PubMed, Scopus, Central Cochrane, and Sigle via Open Grey up to August 2019. Four studies were eligible to this systematic review, considering the previously establish inclusion and exclusion criteria. A total of 211 patients were evaluated. The mandibular body was the region more fractured followed by the symphyseal/parasymphyseal region. The closed treatment with intermaxillary fixation (IMF) was the most used followed by open surgery with internal rigid fixation (IRF) and external fixator. Considering the total adverse effects, the meta-analysis showed no statistically significant difference between the IMF and IRF groups (p=0.840), but IMF showed five times less infection and IRF six times less malunion. The algorithm was delineated from the types of injuries by gunshot, proposing forms of treatment from initial stabilisation to functional rehabilitation with implant-supported prostheses. The treatment of mandibular fractures by gunshot remains a challenge for surgeons. There was a statistically significant prevalence of success in the IRF group, however this group was also associated with a higher index of infection than the IMF group. New studies with high methodological quality and larger numbers of participants are needed to offer more safety for surgeons who treat patients with mandibular fractures by gunshot.

Branching Ratio Method for Assessing Optically Thin Conditions in Laser-Induced Plasmas.

The branching ratio method is usually used to evaluate the optical thinness conditions in laser-generated plasmas, which are important for the application of analytical methods such calibration free laser induced breakdown spectroscopy (CF-LIBS). In this communication, we warn on the possibility that in some circumstances, the branching-ratio method might give results close to the one characterizing optically thin plasma conditions, even in the presence of a substantial self-absorption for the transitions considered.

Recreational training improves cardiovascular adaptations, metabolic profile and mental health of elderly women with type-2 diabetes mellitus.

We investigated the effects of a recreational training (RET) protocol in elderly women with type-2 diabetes mellitus (T2DM). We hypothesized that non-conventional physical activities of RET protocol might improve clinical outcomes regarding cardiovascular function, metabolic profile and mental health as participants keep the adherence to the protocol during the 3-month follow-up. Cardiovascular parameters (heart rate, systolic and diastolic blood pressure), circulating biomarkers (glucose and lipids) and salivary cortisol were attenuated in response to exercise. RET also reduced anxiety and depression indexes. RET protocol constitutes a potential therapeutic approach for managing T2DM in elderly women.

Chemical composition, larvicidal and cytotoxic activity of Annona salzmannii (Annonaceae) seed oil

The seed oil of Annona salzmannii A. DC. was analyzed by GC-MS and 1H qNMR, revealing a mixture of unsaturated (80.5%) and saturated (18.7%) fatty acids. Linoleic (45.3%) and oleic (33.5%) acid were the major unsaturated fatty acids identified, while palmitic acid (14.3%) was the major saturated fatty acid. The larvicidal effects of A. salzmannii seed oil were evaluated against third-instar larvae of Aedes aegypti (Linn.). The oil exhibited moderate larvicidal activity, with a LC50 of 569.77 ppm (95% CI = 408.11 to 825.88 ppm). However, when the cytotoxic effects of the oil were evaluated, no expressive antiproliferative effects were observed in tumor cell lines B16-F10 (mouse melanoma), HepG2 (human hepatocellular carcinoma), K562 (human chronic myelocytic leukemia), HL-60 (human promyelocytic leukemia), and non-tumor cell line PBMC (peripheral blood mononuclear cells), with IC50 values > 50 µg·mL-1. This is the first study to evaluate the chemical composition, larvicidal and cytotoxic activity of A. salzmannii seed oil

Treatment of comminutive fractures by firearm projectiles with adapted wrist external fixator.

INTRODUCTION: Facial and mandibular aggression with gunshot wound (GSW) is highly complex and represents a challenge for the assistant surgical team because in addition to the inherent lethal potential, they have the capacity for destruction and mutilation caused by the high kinetic energy conferred to the firearm projectile. Among these lesions, comminutive mandibular fractures are difficult to treat because the anatomical planes are distorted, soft tissues are in severe disarrangement, and bone fragments are without periosteum, which, if opted for an open treatment, with internal fixation, favor the development of soft tissue infections, osteomyelitis, and suture dehiscence. The treatment of comminuted mandibular fractures with external fixator, widely used during the Second World War, represents a modality of treatment that minimizes the risks of failure, since it allows stabilization of the fractured mandible with minimal aggression to the soft tissues. OBJECTIVES: The objective of this study is to report three cases where surgical procedures were performed to treat comminuted mandible fractures with the adaptation of specific external orthopedic fixator for wrist.

Surgical Treatment of Posttraumatic Ophthalmoplegia Through the Reconstruction of the Lateral Orbital Wall.

Orbital fractures are injuries frequently related to traumas of the midface. These fractures can be associated with ocular lesions, ranging from small abrasions on the cornea to serious complications such as hyphema and ocular globe rupture. Diplopia and ophthalmoplegia are common findings in orbital fractures. They can be caused by mechanical factors as bone fragments or muscle imprisonment. The aim of this study was to report a case of a 40-year patient, male showing diplopia and ophthalmoplegia due to the orbital fracture. The patient was treated by general anesthesia. It was performed a supra orbital approach and the fragments were removed. A titanium mesh to restore the orbital anatomy was installed. After 40 days of follow-up, the patient has no aesthetic or functional complaints. In orbital traumas, the ophthalmological evaluation should be performed carefully aiming to avoid ocular sequelaes. In surgical patients, the surgery should be done as early as the clinical conditions permit, to restore the ocular function.

Queiloplastia primária unilateral através da técnica de Fisher / Unilateral primary lip repair by Fisher technique

Introdução: As fissuras labiais são alterações congênitas que decorrem da não fusão dos processos nasais medianos com os processos nasais laterais, sendo sua ocorrência em aproximadamente 1:550 nascidos vivos. Essas fissuras podem apresentar-se bilaterais ou unilaterais nos lábios e acompanhadas ou não de fenda palatina. A cirurgia primária para reparação do lábio fissurado unilateral vem sendo descrita por diversas técnicas na literatura e geralmente envolve rotações de retalho e deixam cicatrizes visíveis bem como encurtamento do vermelhão do lábio. A técnica de Fisher foi proposta para resultar em uma cicatriz menos visível, em linha reta na região do filtro labial, colocando-a em uma região mais anatômica e simplificando a cirurgia. O objetivo deste artigo é mostrar um caso clínico de queiloplastia primária unilateral, utilizando a técnica de Fisher. Relado de Caso: Paciente CDSS, 8 meses de idade, portador de fissura lábio-palatina unilateral do lado esquerdo. A cirurgia do lábio foi realizada em ambiente hospitalar sob anestesia geral e a técnica utilizada foi a de Fisher. No acompanhamento de 30 dias o paciente apresentou-se com uma cicatriz bastante discreta, posicionada simetricamente em relação ao filtro labial do lado oposto. Conclusão: A técnica de Fisher mostrase como ótima opção para o tratamento de fissuras labiais unilaterais, pois proporciona uma excelente estética, a técnica cirúrgica é relativamente simples e acompanhada de bons resultados funcionais

Introduction: Cleft lip is a congenital abnormality arising from no merger of the median nasal processes with the lateral nasal processes, and their occurrence is approximately 1 in 550 live births. These clefts may present bilateral or unilateral lips and with or without cleft palate. The primary surgery for repair of unilateral cleft lip has been described by several techniques in literature and usually involves retail rotations and leave visible scars and lip vermilion shortening. Fisher technique has been proposed to result in a less visible scar, straight in the philtrum region placing it in a more anatomical region and simplifying the surgery. The purpose of this article is to show a case of unilateral primary lip repair using the Fisher technique. Case Report: Patient CDSS 8 months old has an unilateral cleft lip and palate on the left side. The lip surgery was performed in a hospital under general anesthesia and the technique used was Fisher. In the following 30 days, the patient is presented with a very slight scar, positioned symmetrically in relation to the philtrum of the opposite side. Conclusion: Fisher technique is shown as great option for the treatment of unilateral cleft lip, it provides an excellent aesthetic, the surgery technique is relatively simple and accompanied by good functional results

Tratamento cirúrgico de macrostomia / Surgical Treatment of Macrostomia

A macrostomia é uma rara anomalia congênita, definida como alargamento da boca na região das comissuras orais. Pode-se apresentar na forma bilateral ou unilateral, e ocorre principalmente por uma falha na fusão dos processos maxilar e mandibular do primeiro arco branquial. Pode ocorrer isoladamente ou associada a diversas síndromes. Os principais problemas associados à macrostomia são alterações estéticas e dificuldades na deglutição e fonação. Relato de Caso: O objetivo deste trabalho é mostrar um caso clínico de um paciente de 3 anos de idade com macrostomia bilateral. Foi instituído tratamento cirúrgico sob anestesia geral em ambiente hospitalar. Foram realizadas incisões cutâneas e na mucosa oral, e realizado o fechamento em linha reta. O paciente evolui bem com cicatriz facial satisfatória e funções do esfincter oral reestabelecidas. Conclusão: A macrostomia é uma anomalia congênita que necessita de tratamento cirúrgico. O fechamento em linha reta apresentou bons resultados estéticos e funcionais... (AU)

Macrostomia is a rare congenital anomaly, defined as extending from the mouth in the region of the oral commissure. Can be present in bilateral or unilateral, and occurs mainly by a failure of fusion of the mandibular jaw processes of the first arch. Can occur alone or associated with several syndromes. The main problems associated with macrostomia are cosmetic changes and difficulties in swallowing and speech. Case Report: The objective of this study is to present a clinical case of a 3-year-old patient with bilateral macrostomia. Surgical treatment was instituted under general anesthesia in a hospital setting. They were carried out skin and oral mucosa incisions, and performed the closing straight line. The patient progressed well and satisfactory facial scar and functions of the re-established oral sphincter. Conclusion: Macrostomia is a congenital anomaly that requires surgical treatment. The closing straight line presented good cosmetic and functional results. had experienced some form of UME during their professional practice, of these, 86.2% have felt prepared to intervene when it occurred and 84.2% said they did not have equipment and drugs for emergencies in clinics. Therefore, professionals are not adequately trained and equipped to work in the event of an UME in his office... (AU)

Intoxicações por agrotóxicos: registros de um serviço sentinela de assistência toxicológica / Pesticide poisoning: records of a toxicological assistance sentinel service

Na vigilância das populações expostas a agrotóxicos, é relevante o protagonismo da rede nacional de centros de informação e assistência toxicológica para produção de dados confiáveis sobre as intoxicações. O objetivo do estudo foi caracterizar as intoxicações por agrotóxicos reportadas a um centro de assistência toxicológica do Paraná, por meio de análise retrospectiva de fichas epidemiológicas de Ocorrência Toxicológica de 1240 indivíduos com diagnóstico médico de intoxicação aguda ou crônica por agrotóxicos, registrados no período de 2003 a 2011. Foram verificados sexo e idade das vítimas, classificação química dos agrotóxicos, e circunstância, gravidade e desfecho dos eventos. Os dados foram tabulados em planilha no Software Excel 2007 e analisados por estatística descritiva simples. A média foi de 138 intoxicações/ano. O perfil das intoxicações apontou predomínio do sexo masculino e em idade produtiva; destaque para as profissões agrícolas e a presença de trabalho infantil e do idoso; alta incidência de intoxicação por inseticidas inibidores das colinesterases e maioria dos casos notificados por unidades hospitalares; maior percentual de intoxicações e óbitos na circunstância intencional; e maior proporção de cura. No entanto, elevadas taxas de internação em terapia intensiva e a letalidade indicaram gravidade dos casos.

In surveillance of populations exposed to pesticides is important the role of the national network information centers and toxicological assistance to produce reliable data on poisonings. The aim of the study was to characterize pesticide poisoning reported to a poison control center of Parana, through retrospective analysis of Toxicological Occurrence epidemiological forms of 1240 individuals with diagnosis of acute or chronic intoxication by pesticide from 2003 to 2011. Sex and age of the victims were checked, classification of chemical pesticides, circumstance, severity and outcome of events. Data were tabulated in Excel 2007 software spreadsheet and analyzed by simple descriptive statistics. The average was 138 poisoning/year. The profile of poisonings pointed predominance of working-age male; especially the agricultural professions and the presence of child and elderly labor; high incidence of poisoning by cholinesterase inhibitors insecticides and most cases were reported by hospitals; higher percentage of poisonings deaths in the intentional condition; and high cure proportion. However, high rates of admission to intensive care and lethality indicated severity of the cases.

Antitumor Properties of the leaf essential oil of Zornia brasiliensis.

Zornia brasiliensis, popularly known as "urinária", "urinana", and "carrapicho", is a medicinal plant used in Brazilian northeast folk medicine as a diuretic and against venereal diseases. The aim of this study was to investigate the chemical composition and antitumor potential of the leaf essential oil of Z. brasiliensis. The essential oil was obtained by hydrodistillation using a Clevenger-type apparatus and analyzed by GC-MS and GC-FID. Its composition was characterized by the presence of trans-nerolidol, germacrene D, trans-caryophyllene, α-humulene, and farnesene as major constituents. In vitro cytotoxicity of the essential oil and some of its major constituents (trans-nerolidol, trans-caryophyllene, and α-humulene) was evaluated for tumor cell lines from different histotypes using the Alamar blue assay. The essential oil, but not the constituents tested, presented promising cytotoxicity. Furthermore, mice inoculated with B16-F10 mouse melanoma were used to confirm its in vivo effectiveness. An in vivo antitumor study showed tumor growth inhibition rates of 1.68-38.61 % (50 and 100 mg/kg, respectively). In conclusion, the leaf essential oil of Z. brasiliensis presents trans-nerolidol, germacrene D, trans-caryophyllene, α-humulene, and farnesene as major constituents and is able to inhibit cell proliferation in cultures as well as in tumor growth in mice.

ent-Kaurane diterpenes from the stem bark of Annona vepretorum (Annonaceae) and cytotoxic evaluation.

This work describes a novel ent-kaurane diterpene, ent-3ß-hydroxy-kaur-16-en-19-al along with five known ent-kaurane diterpenes, ent-3ß,19-dihydroxy-kaur-16-eno, ent-3ß-hydroxy-kaur-16-eno, ent-3ß-acetoxy-kaur-16-eno, ent-3ß-hydroxy-kaurenoic acid and kaurenoic acid, as well as caryophyllene oxide, humulene epoxide II, ß-sitosterol, stigmasterol and campesterol from the stem bark of Annona vepretorum Mart. (Annonaceae). Cytotoxic activities towards tumor B16-F10, HepG2, K562 and HL60 and non-tumor PBMC cell lines were evaluated for ent-kaurane diterpenes. Among them, ent-3ß-hydroxy-kaur-16-en-19-al was the most active compound with higher cytotoxic effect over K562 cell line (IC50 of 2.49 µg/mL) and lower over B16-F10 cell line (IC50 of 21.02 µg/mL).

Antinociceptive and anti-inflammatory effects of electroacupuncture on experimental arthritis of the rat temporomandibular joint.

This study investigated the antinociceptive and anti-inflammatory effects of electroacupuncture (EA) on zymosan-induced acute arthritis of the rat temporomandibular joint (TMJ). Male Wistar rats were injected with saline or zymosan (control group; 2 mg) into the left TMJ. Low frequency EA (10 Hz, 30 min) was performed at acupoints (LI4, LI11, ST36, ST44) or sham points 2 h after or 1 h before zymosan administration. Mechanical hypernociception was accessed by the electronic Von Frey method after zymosan administration. Rats were sacrificed 6 h after zymosan administration and the joint was removed for histopathological analysis, myeloperoxidase activity assessment, vascular permeability observations, and immunohistochemical verification of inflammatory mediators. The results showed that EA inhibited zymosan-induced hypernociception, compared with the control group and with the sham group (p < 0.05). The results showed that EA inhibited inflammatory parameters such as neutrophil migration, vascular permeability, and tumour necrosis factor α (TNF-α), cyclooxygenase-2 (COX-2), and inducible nitric oxide synthase (iNOS) expression in the TMJ compared with the sham group (p < 0.05). Histopathological analysis showed that EA significantly inhibited edema and periarticular infiltration (p < 0.05) compared with the control and sham groups. EA at acupoints produced antinociceptive and anti-inflammatory effects on zymosan-induced arthritis in the rat TMJ.