Early Abortions and Congenital Malformations: A Comparison Between Agricultural and Nonagricultural Areas in the State of São Paulo/Brazil.

INTRODUCTION: Areas with higher agricultural production have higher rates of abortion and malformation, probable related to pesticides. OBJECTIVE: To compare the rates of early abortion and fetal malformation in agricultural and nonagricultural areas. METHOD: A survey was carried out on fetal deaths in children weighing less than 500 g or gestational age less than 22 weeks and fetal malformations in live births. RESULTS: From 1996 to 2018, there was an increase in the rates of abortion and, albeit to a lesser extent, malformation. The areas of greater agricultural production have higher rates of fetal mortality and malformation than the others. CONCLUSIONS: The study suggests that areas with higher use of pesticides have higher rates of abortion and fetal malformations than the others, requiring further observational studies, reducing confounders inherent to the ecological study.

Corrosion resistance assessment of nickel-titanium endodontic files with and without heat treatment.

OBJECTIVES: The aim of this study was to evaluate the corrosion resistance of heat-treated (Reciproc and WaveOne) and non-heat-treated (ProTaper and Mtwo) superelastic nickel-titanium endodontic files when immersed in a 5.25% sodium hypochlorite solution. MATERIALS AND METHODS: Anodic polarization curves were obtained with potential sweeps that began at the open circuit potential or corrosion potential (Ecorr). The pitting potential (Epit) was identified on the anodic polarization curve as the potential at which a sudden increase in current was observed. The micromorphology of the 28 tested files was analyzed before and after the electrochemical assay using scanning electron microscope (SEM). The data were analyzed using 1-way analysis of variance with the post hoc Bonferroni test (for Ecorr) and the Student t-test for independent samples (for Epit). RESULTS: The mean Ecorr values were 0.506 V for ProTaper, 0.348 V for Mtwo, 0.542 V for Reciproc, and 0.321 V for WaveOne files. Only WaveOne and Protaper files exhibited pitting corrosion, with Epit values of 0.879 V and 0.904 V, respectively. On the SEM images of the ProTaper and WaveOne files, cavities suggestive of pitting corrosion were detected. CONCLUSIONS: Signs of corrosion were observed in both heat-treated and non-heat-treated files. Of the evaluated files, WaveOne (a heat-treated file) and ProTaper (a non-heat-treated file) exhibited the lowest corrosion resistance.

Death risk and the importance of clinical features in elderly people with COVID-19 using the Random Forest Algorithm / Previsão de óbito e importância de características clínicas em idosos com COVID-19 utilizando o Algoritmo Random Forest

Abstract Objectives: train a Random Forest (RF) classifier to estimate death risk in elderly people (over 60 years old) diagnosed with COVID-19 in Pernambuco. A "feature" of this classifier, called feature importance, was used to identify the attributes (main risk factors) related to the outcome (cure or death) through gaining information. Methods: data from confirmed cases of COVID-19 was obtained between February 13 and June 19, 2020, in Pernambuco, Brazil. The K-fold Cross Validation algorithm (K=10) assessed RF performance and the importance of clinical features. Results: the RF algorithm correctly classified 78.33% of the elderly people, with AUC of 0.839. Advanced age was the factor representing the highest risk of death. The main comorbidity and symptom were cardiovascular disease and oxygen saturation ≤ 95%, respectively. Conclusion: this study applied the RF classifier to predict risk of death and identified the main clinical features related to this outcome in elderly people with COVID-19 in the state of Pernambuco.

Resumo Objetivos: treinar um classificador do tipo Random Forest (RF) para estimar o risco de óbito em idosos (com mais de 60 anos) diagnosticados com COVID-19 em Pernambuco. Uma "feature" deste classificador, chamada feature_importance, foi usada para identificar os atributos (principais fatores de risco) relacionados com o desfecho final (cura ou óbito) através do ganho de informação. Métodos: dados dos casos confirmados de COVID-19foram obtidos entre os dias 13 de fevereiro e 19 de junho de 2020, em Pernambuco, Brasil. O algoritmo K-fold Cross Validation, com K=10, foi usado para avaliar tanto o desempenho do RF quanto a importância das características clínicas. Resultados: o algoritmo RF classificou corretamente 78,33% dos idosos, com AUC de 0,839. A idade avançada é o fator que representa maior risco de evolução para óbito. Além disso, a principal comorbidade e sintoma também identificados, foram, respectivamente, doença cardiovascular e saturação de oxigênio ≤95%. Conclusão: este trabalho se dedicou à aplicação do classificador RF para previsão de óbito e identificou as principais características clínicas relacionadas com este desfecho em idosos com COVID-19 no estado de Pernambuco.

Criminal liability of medical professionals in the São Paulo State Court of Appeals.

Objective To collect criminal justice data involving medical professionals in the São Paulo State Court of Appeals and to establish the number of criminal proceedings involving said professionals, the content of the accusations and the conviction rate per specialty. Methods A keyword search was carried out in the State Appellate Court case law website with the term "medical error" for decisions rendered from January 1st, 2011 to December 31st, 2016, and the subject "criminal law" was selected. Results A total of 34 cases met the inclusion criteria and were analyzed. Lower court's convictions accounted to 73.5% of the cases, with a slight tendency towards increase over the years. The number of cases per medical specialty was ten cases of clinical emergency, eight of obstetrics, seven of surgery, three of pediatrics (one case was related to pediatrics and obstetrics), two of orthopedic surgery, two of clinical director, one anesthesiologist and one nonemergency internal medicine physician. Among these cases, 6 were related to bodily injury, 26 to homicide and 2 criminal contempt. Conclusion The physicians most exposed to medical error were from surgical specialties, probably due to the higher rate of complications associated with the procedures, and emergency physicians, professionals who need greater qualification.

Association of CXCL13 serum level and ultrasonographic findings of joints in patients with systemic lupus erythematosus and Jaccoud's arthropathy.

Objectives The objective of this paper is to perform an ultrasonography (US) analysis of hands and wrists in two groups of patients with systemic lupus erythematosus (SLE), with and without Jaccoud's arthropathy, matched by age and disease duration and to correlate them with levels of CXCL13 clinical features, laboratory tests and disease activity score. Methods Sixty-four patients with SLE were enrolled, 32 with and 32 without Jaccoud's arthropathy. Each patient underwent physical examination, laboratory tests (including CXCL13 by ELISA) and bilateral US. Synovial hypertrophy, tenosynovitis and erosions were evaluated according to a semiquantitative grading system with a 0-3 rating. US findings were correlated with serum levels of CXCL13, other serological parameters and disease activity index. Results Synovitis was found in 25/64 patients (39%) and tenosynovitis in 14/64 (22%). These findings were more frequent in SLE patients with Jaccoud's arthropathy, particularly tenosynovitis ( p = 0.002) and synovitis ( p = 0.01). Median serum level of CXCL13 was 20.16 pg/ml in the whole population (23.21 pg/ml in the Jaccoud's arthropathy group and 11.48 pg/ml in the group without). There was an association between the presence of disease activity and high level of CXCL13 ( p = 0.004). However, no association was found between high levels of CXCL13 and "arthritis" in SLEDAI, swollen joints on physical examination or synovitis on US. Conclusions US findings in joints of SLE patients with Jaccoud's arthropathy confirm that synovitis and tenosynovitis are common in these patients. In addition, serum level of CXCL13 is associated with disease activity in SLE but does not seem to be a biomarker for arthritis in these patients.

Criminal liability of medical professionals in the São Paulo State Court of Appeals / Responsabilização penal do médico no Tribunal de Justiça do Estado de São Paulo

ABSTRACT Objective To collect criminal justice data involving medical professionals in the São Paulo State Court of Appeals and to establish the number of criminal proceedings involving said professionals, the content of the accusations and the conviction rate per specialty. Methods A keyword search was carried out in the State Appellate Court case law website with the term "medical error" for decisions rendered from January 1st, 2011 to December 31st, 2016, and the subject "criminal law" was selected. Results A total of 34 cases met the inclusion criteria and were analyzed. Lower court's convictions accounted to 73.5% of the cases, with a slight tendency towards increase over the years. The number of cases per medical specialty was ten cases of clinical emergency, eight of obstetrics, seven of surgery, three of pediatrics (one case was related to pediatrics and obstetrics), two of orthopedic surgery, two of clinical director, one anesthesiologist and one nonemergency internal medicine physician. Among these cases, 6 were related to bodily injury, 26 to homicide and 2 criminal contempt. Conclusion The physicians most exposed to medical error were from surgical specialties, probably due to the higher rate of complications associated with the procedures, and emergency physicians, professionals who need greater qualification.

RESUMO Objetivo Realizar um levantamento de dados na esfera penal envolvendo médicos no Tribunal de Justiça do Estado de São Paulo e estabelecer o número de processos penais que os envolveu, verificando o teor das acusações e a frequência das condenações, levando-se em consideração as especialidades em que eles atuavam. Métodos Foi realizada pesquisa por palavra-chave na área de jurisprudência do site do Tribunal de Justiça do Estado de São Paulo com o termo "medical error" para as decisões proferidas de 1° de janeiro de 2011 até 31 de dezembro de 2016, sendo selecionado o assunto "direito penal". Resultados Foram encontrados e analisados 34 processos que corresponderam ao critério de inclusão. Houve 73,5% de condenação em primeira instância, observando-se discreta tendência de aumento no decorrer dos anos. O número de processos, de acordo com a especialidade médica, foi dez casos de emergência clínica, oito de obstetrícia, sete de cirurgia, três de pediatria (sendo que em um caso se referia a pediatria junto de obstetrícia), dois de ortopedia, dois de diretor clínico, um de anestesista e um de clínico não emergencista. Dentre estes casos, 6 se referiam à lesão corporal, 26 a homicídio e 2 a crime de desobediência. Conclusão Os médicos mais expostos a erros médicos foram os das especialidades cirúrgicas, provavelmente devido ao maior índice de complicações associadas ao procedimento, e os emergencistas, necessitando de uma maior capacitação destes profissionais.

Vaginal progesterone decreases preterm birth and neonatal morbidity and mortality in women with a twin gestation and a short cervix: an updated meta-analysis of individual patient data.

OBJECTIVE: To assess the efficacy of vaginal progesterone for the prevention of preterm birth and neonatal morbidity and mortality in asymptomatic women with a twin gestation and a sonographic short cervix (cervical length ≤ 25 mm) in the mid-trimester. METHODS: This was an updated systematic review and meta-analysis of individual patient data (IPD) from randomized controlled trials comparing vaginal progesterone with placebo/no treatment in women with a twin gestation and a mid-trimester sonographic cervical length ≤ 25 mm. MEDLINE, EMBASE, POPLINE, CINAHL and LILACS (all from inception to 31 December 2016), the Cochrane Central Register of Controlled Trials, Research Registers of ongoing trials, Google Scholar, conference proceedings and reference lists of identified studies were searched. The primary outcome measure was preterm birth < 33 weeks' gestation. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated. RESULTS: IPD were available for 303 women (159 assigned to vaginal progesterone and 144 assigned to placebo/no treatment) and their 606 fetuses/infants from six randomized controlled trials. One study, which included women with a cervical length between 20 and 25 mm, provided 74% of the total sample size of the IPD meta-analysis. Vaginal progesterone, compared with placebo/no treatment, was associated with a statistically significant reduction in the risk of preterm birth < 33 weeks' gestation (31.4% vs 43.1%; RR, 0.69 (95% CI, 0.51-0.93); moderate-quality evidence). Moreover, vaginal progesterone administration was associated with a significant decrease in the risk of preterm birth < 35, < 34, < 32 and < 30 weeks' gestation (RRs ranging from 0.47 to 0.83), neonatal death (RR, 0.53 (95% CI, 0.35-0.81)), respiratory distress syndrome (RR, 0.70 (95% CI, 0.56-0.89)), composite neonatal morbidity and mortality (RR, 0.61 (95% CI, 0.34-0.98)), use of mechanical ventilation (RR, 0.54 (95% CI, 0.36-0.81)) and birth weight < 1500 g (RR, 0.53 (95% CI, 0.35-0.80)) (all moderate-quality evidence). There were no significant differences in neurodevelopmental outcomes at 4-5 years of age between the vaginal progesterone and placebo groups. CONCLUSION: Administration of vaginal progesterone to asymptomatic women with a twin gestation and a sonographic short cervix in the mid-trimester reduces the risk of preterm birth occurring at < 30 to < 35 gestational weeks, neonatal mortality and some measures of neonatal morbidity, without any demonstrable deleterious effects on childhood neurodevelopment. Published 2017. This article is a U.S. Government work and is in the public domain in the USA.

Vaginal progesterone decreases preterm birth ≤ 34 weeks of gestation in women with a singleton pregnancy and a short cervix: an updated meta-analysis including data from the OPPTIMUM study.

OBJECTIVE: To evaluate the efficacy of vaginal progesterone administration for preventing preterm birth and perinatal morbidity and mortality in asymptomatic women with a singleton gestation and a mid-trimester sonographic cervical length (CL) ≤ 25 mm. METHODS: This was an updated systematic review and meta-analysis of randomized controlled trials comparing the use of vaginal progesterone to placebo/no treatment in women with a singleton gestation and a mid-trimester sonographic CL ≤ 25 mm. Electronic databases, from their inception to May 2016, bibliographies and conference proceedings were searched. The primary outcome measure was preterm birth ≤ 34 weeks of gestation or fetal death. Two reviewers independently selected studies, assessed the risk of bias and extracted the data. Pooled relative risks (RRs) with 95% confidence intervals (CI) were calculated. RESULTS: Five trials involving 974 women were included. A meta-analysis, including data from the OPPTIMUM study, showed that vaginal progesterone significantly decreased the risk of preterm birth ≤ 34 weeks of gestation or fetal death compared to placebo (18.1% vs 27.5%; RR, 0.66 (95% CI, 0.52-0.83); P = 0.0005; five studies; 974 women). Meta-analyses of data from four trials (723 women) showed that vaginal progesterone administration was associated with a statistically significant reduction in the risk of preterm birth occurring at < 28 to < 36 gestational weeks (RRs from 0.51 to 0.79), respiratory distress syndrome (RR, 0.47 (95% CI, 0.27-0.81)), composite neonatal morbidity and mortality (RR, 0.59 (95% CI, 0.38-0.91)), birth weight < 1500 g (RR, 0.52 (95% CI, 0.34-0.81)) and admission to the neonatal intensive care unit (RR, 0.67 (95% CI, 0.50-0.91)). There were no significant differences in neurodevelopmental outcomes at 2 years of age between the vaginal progesterone and placebo groups. CONCLUSION: This updated systematic review and meta-analysis reaffirms that vaginal progesterone reduces the risk of preterm birth and neonatal morbidity and mortality in women with a singleton gestation and a mid-trimester CL ≤ 25 mm, without any deleterious effects on neurodevelopmental outcome. Clinicians should continue to perform universal transvaginal CL screening at 18-24 weeks of gestation in women with a singleton gestation and to offer vaginal progesterone to those with a CL ≤ 25 mm. Published 2016. This article is a U.S. Government work and is in the public domain in the USA.

Slow transit constipation and lower urinary tract dysfunction.

INTRODUCTION: Many theories have been proposed for the coexistence of constipation and lower urinary tract dysfunction (LUTD), such as bladder compression from a distended rectum and stimulation of sacral reflexes from a full rectum. In these cases, successful treatment of constipation should result in resolution of bladder symptoms. Some children have refractory constipation and others respond well to treatment, but once treatment is discontinued most children relapse back into their constipation. This may indicate the existence of a defect in colon motility, with a persistent peristalsis problem. The existence of a common neuromuscular disorder should be the base for both bladder and bowel dysfunction (BBD). OBJECTIVE: To study colonic transit time (CTT) in children and adolescents with refractory constipation and lower urinary tract symptoms (LUTS). MATERIALS AND METHODS: A total of 15 children (mean age 9.7 years) with refractory constipation and LUTS were evaluated with: standardized medical history; physical examination; bladder and bowel diaries; Bristol stool scale; Rome III criteria; Dysfunctional Voiding Scoring System (DVSS); ultrasound examination of the kidneys and urinary tract, and measurement of rectal diameter; urodynamic evaluation; and a CTT study using radiopaque markers. RESULTS: Urodynamic features were abnormal in 13 out of 15 children: 10 (66.7%) presented with detrusor overactivity (DO) and voiding dysfunction (VD), two (16.7%) had isolated DO, and one (8.3%) had a VD. The CTT study was abnormal in 12 out of 15 children: nine (60%) presented with slow transit constipation, three (20%) had outlet obstruction, and three (20%) had a normal CTT study. When comparing CTT and LUTD, nine (100%) children with slow transit constipation (STC) and three (50%) with no STC had DO (P = 0.04). Seven (77.8%) children with STC and three (50%) with no STC had VD (P = 0.29). The DVSS scores ranged from 6 to 21. The subgroup with STC had a DVSS score that was significantly higher than that of the subgroup with noF STC (Figure). DISCUSSION: The present study showed a high prevalence of STC in children and adolescents with refractory constipation and LUTS. This was in accordance with previous studies that have demonstrated a rate of 50-60% of STC in children with refractory constipation. In addition, DO was found to be associated with STC, which raises the chance for the existence of a common neuromuscular disorder to be the base for both bladder and bowel dysmotility. The limitation of this study was the number of participants. CONCLUSIONS: The present study demonstrated an association between DO and STC.

Bioavailability of pollutants in bacterial communities of Rodrigo de Freitas Lagoon, Rio de Janeiro, Brazil.

Processes involving heavy metals and other contaminants continue to present unsolved environmental questions. To advance the understanding of geochemical processes that involve the bioavailability of contaminants, cores where collected in the Rodrigo de Freitas lagoon, and analyzed for bacterial activity and metal concentrations. Results would suggest an extremely reducing environment where organic substances seem to be the predominant agents responsible for this geochemical process. Analytical data showed sulphate reduction to be the main agent driving this process, since this kind of bacteria was found to be active in all of the samples analyzed. Esterase enzyme production did not signal the influence of heavy metals and hydrocarbon concentrations and heavy metals were found to be unavailable for biota. However, correlation between results for bacterial biomass and the potentially mobile percentage of the total Ni concentrations would suggest a negative impact.

Estudo do efeito in vitro e in vivo da apigenina em Leishmania amazonensis / Study of the in vitro and in vivo effect of apigenin in leishmania amazonensis

A leishmaniose ainda é uma das doenças mais negligenciadas do mundo. Ela está presente nos cinco continentes e é endêmica em 98 países, com 350 milhões de pessoas vivendo em zonas de risco e mais de 12 milhões de pessoas infectadas. Compreende um complexo de doenças causadas por mais de 20 espécies do gênero Leishmania. No Brasil, a Leishmania amazonensis é uma espécie dermotrópica importante. Apesar do progresso na compreensão da bioquímica e biologia deste parasito, este conhecimento ainda não tem refletido na descoberta de novos e eficazes agentes quimioterápicos contra a doença. O tratamento atual é insatisfatório, com altas taxas de toxidez e ineficácia, e não há vacina humana licenciada. A pesquisa de novos medicamentos, a partir de fontes naturais, é amplamente utilizada como uma abordagem bem sucedida na detecção de compostos para o tratamento de doenças parasitárias. Compostos puros obtidos de plantas, como certos flavonoides, exibem atividade antiprotozoária. A apigenina é uma flavona bioativa, abundantemente presente em frutas,ervas e legumes, que mostrou atividade leishmanicida. A apigenina inibiu o crescimento celular de ambas as formas evolutivas de L. amazonensis de maneira dose-dependente. Este efeito inibitório, em promastigotas, foi igual a 74 por cento após 24 h de tratamento com 96 miM de apigenina e, em amastigotas intracelulares, foi igual a 71 por cento após 72 h de tratamento com 12miM do composto. O IC50/24 h em promastigotas foi 23,68 M e o IC50/72 h em amastigotas foi 4,33 miM. Observou-se que a apigenina foi capaz de induzir o aumento nos níveis de EROnos promastigotas e nos macrófagos infectados com L. amazonensis...

Leishmaniasis is still one of the most neglected diseases in the world. It is present on fivecontinents and is endemic in 98 countries, with 350 million people living in areas at risk andmore than 12 million people infected. Comprises a complex of diseases caused by over 20species of the genus Leishmania. In Brazil, Leishmania amazonensis is an importantdermotropic specie. Despite progress in understanding the biochemistry and biology of thisparasite, this knowledge has not been reflected in the discovery of new and effectivechemotherapeutic agents against the disease. The current treatment is unsatisfactory, withhigh toxicity and ineffectiveness, and there is no licensed human vaccine. The research ofnew drugs from natural sources is widely used as a successful approach in detectingcompounds for the treatment of parasitic diseases. Pure compounds obtained from plants,such as certain flavonoids, exhibit antiprotozoal activity. Apigenin is a bioactive flavone,abundantly present in fruits, herbs and vegetables, which showed leishmanicidal activity.Apigenin inhibited cell growth of both forms of L. amazonensis in dose-dependent manner.This inhibitory effect on promastigotes was equal to 74 percent after 24 h of treatment with 96miMapigenin and on intracellular amastigotes was equal to 71 percent after 72 h of treatment with 12 miM of the compound. The IC50/24 h) in promastigotes was 23.68 miM and the IC50/72 h inamastigotes was 4.33 miM. It was observed that apigenin was able to induce increased levels ofROS in treated promastigotes and L. amazonensis-infected macrophages...

Systemic sarcoidosis induced by etanercept: first Brazilian case report / Sarcoidose sistemica induzida por etanercepte: primeiro relato de caso brasileiro

The antagonists of tumor necrosis factor alpha (TNF-α) are increasingly being used in the treatment of inflammatory and autoimmune diseases. Several adverse effects of these drugs have been reported, including the paradoxical development of sarcoidosis, especially with the use of etanercept. We present the first Brazilian case report of systemic sarcoidosis induced by etanercept and a literature review.

Os medicamentos antagonistas do fator de necrose tumoral alfa (TNF-α) estão sendo cada vez mais utilizados no tratamento de doenças inflamatórias e autoimunes. Efeitos adversos desses medicamentos vem sendo relatados, incluindo o desenvolvimento paradoxal de sarcoidose, principalmente com o uso do etanercepte. Apresentamos o primeiro relato de caso brasileiro de sarcoidose sistêmica induzida por etanercepte e uma revisão da literatura.

Caracterização química e metalográfica dos aços inoxidáveis de implantes removidos de pacientes / Chemical and metallographic characterization of stainless steel in implants removed from patients

OBJETIVO: Este trabalho estudou a composição química e metalográfica (microestrutura, tamanho de grão, teor de inclusões) de aços inoxidáveis austeníticos, desenvolvidos para aplicações como biomateriais, utilizados na fabricação de implantes ortopédicos. MÉTODO: Foram analisados doze implantes removidos de pacientes afetados por quadro inflamatório. As análises químicas foram desenvolvidas pelas técnicas Espectrometria de Emissão Ótica e Microanálise por Dispersão de Energia (EDS) e o tamanho de grão foi determinado por microscopia ótica e Microscopia Eletrônica de Varredura (MEV) conforme norma ASTM E 1382 97. RESULTADOS: Observou-se que, todos os implantes apresentavam tamanho de grão superior ao recomendado pela norma, constatou-se também a presença de ferrita delta em dez dos doze implantes removidos, que de acordo com a norma ASTM F138-92 não deveriam ser percebidas microscopicamente com um aumento de 100 vezes. CONCLUSÕES: Em oito casos existe forte indicação de que as inflamações foram desencadeadas pela corrosão por pite. Nivel de Evidência III, Revisão sistemática de Estudos .

OBJECTIVE: This study examines the chemical and metallographic composition (microstructure, grain size, inclusion content) of austenitic stainless steel developed as biomaterials for used in the manufacture of orthopedic implants. METHOD: An analysis was carried out of twelve implants removed from patients affected by inflammation. Chemical analyses were carried out using Optical Emission Spectrometry and Energy Dispersive Microanalysis (EDS), and the grain size was determined by optical microscopy and scanning electron microscopy (SEM) according to ASTM Standard E 1382 97. RESULTS: It was observed that all the implants had a larger grain size than is recommended by the Standard. The presence of delta ferrite was also observed in ten of the twelve implants removed, which according to ASTM Standard F138-92, should not be perceived microscopically under magnification of 100x. CONCLUSIONS: In eight cases, there is a strong indication that the inflammation was triggered by pitting corrosion. Level of Evidence: Level III, Systematic review of studies.

Analgesia de parto e febre materna: revisão baseada em evidências / Labor analgesia and maternal fever: evidence-based review

A ocorrência de febre durante o trabalho de parto leva a suspeitar de algum quadro infeccioso, principalmente corioamnite. Atualmente, a anestesia peridural durante o trabalho de parto vem sendo associada à febre materna na ausência de infecção, resultando inevitavelmente na administração de antibióticos para mãe e neonato. Após selecionar os bancos de dados Medline/Pubmed, LILACS/SciELO e biblioteca Cochrane à procura de artigos nacionais, internacionais e das melhores evidências científicas disponíveis para pesquisa, observamos que, apesar de ser clara a associação entre febre e anestesia peridural, a associação entre febre e anestesia combinada ainda não está estabelecida. A causa deste aumento da temperatura materna produzida pela peridural permanece desconhecida, mas acredita-se que ocorra uma alteração na termorregulação. Não existem evidências de que este aumento da temperatura produza efeitos deletérios para mãe e concepto, entretanto, a presença de febre pode levar a investigações dispensáveis de infecção e prescrição desnecessária de antibióticos. Portanto, é importante conhecer a associação entre analgesia e aumento de temperatura durante o trabalho de parto, que deve ser levada em conta para diminuir a administração desnecessária de antibióticos.

Fever during labor leads to suspicion of infection, mainly chrorioamnionitis. Epidural anesthesia during labor is currently associated with maternal fever in the absence of infection, inevitably resulting in the administration of antibiotics to the mother and fetus. A search on Medline/Pubmed, LILACS/Scielo and Cochrane Library databases was conducted for articles published in Brazil and abroad aiming at identifying the best scientific evidence available on this matter. Despite the clear association between fever and epidural anesthesia, the association between fever and combined anesthesia still needs to be established. The mechanism of this increase in maternal temperature produced by epidural anesthesia is to be clarified; however, an alteration is believed to occur in maternal thermoregulation. There is no evidence that this increase in temperature produces harmful effects on the mother or infant; nevertheless, the presence of fever may lead to an unnecessary investigation for infection and prescription of antibiotics. Therefore, it is important to be aware of the association between analgesia and elevated body temperature during labor, which should be taken into account in order to minimize the unnecessary use of antibiotics.

Ester de cianocrilato (Super Bonder®) e sutura tradicional na implantodontia: relato de casos clínicos / Cyanocrylate esther (Super Bonder®) and standart suture in buccal implant: clinical cases reports

O artigo descreve dois casos clínicos de pacientes submetidos à cirurgia para inserção de implantes osseointegráveis e enxerto ósseo, onde foi utilizado éster de cianocrilato (Super Bonder®) como sutura. Alternativas técnicas e protocolos cirúrgicos menos invasivos minimizam as intercorrências pós-operatórias e são resultados do avanço tecnológico em biomateriais. Os resultados observados neste estudo confirmam as vantagens do uso do adesivo biológico sintético como sutura em tecidos operados que não estejam sob tensão ou sangramento profuso. Quando comparados com a sutura tradicional com fio de seda e agulha, o uso do ester de cianocrilato despendeu menor tempo cirúrgico para o fechamento da ferida, houve melhor aceitação do paciente e menor aderência de placa bacteriana no local operado.

This article describes two clinical reports of patients submitted to osteointegrated implants and bone exert with cyanocrilate ester (Super Bonder®) as suture. Less invasive tactics and cirurgic protocols minimize pos operative complications and come from biomaterials innovations. Our results confirm the advantage of tissue adhesives as suture in wounds with no tissue tensor or bloodiness. When compared to traditional nylon suture, the cyanocrilate ester dispend less operative time, patient compliance and less bacterial placa adherence in chirurgic wound.

Validation of tissue microarray technology in malignant peripheral nerve sheath tumours.

BACKGROUND: It has been suggested that the donor tissue cores used in tissue microarrays (TMAs) may not be representative of the whole tissue section. AIM: To validate the use of TMA technology in the study of malignant peripheral nerve sheath tumours (MPNSTs). METHODS: A TMA was constructed containing five independent core biopsy samples of 14 formalin-fixed, paraffin-embedded MPNSTs. The immunohistochemical (IHC) results of the five cores from the same tissue block on TMA were compared with readings from whole sections using two antibodies: anti-Ki-67 and anti-S-100. Digital image analysis was performed to calculate the percentage of positive stain areas. The agreement between IHC results obtained with TMA cores and whole sections was assessed using the kappa statistic. RESULTS: There was good to very good agreement between IHC results for whole and TMA sections from MPNSTs. In relation to S-100, very good agreement (92% agreement; kappa = 0.77) was observed using a minimum of four TMA cores. Staining results for Ki-67 from at least four readable TMA cores were the same as those for the whole section in 86% of cases, with good agreement, using weighted kappa statistics (kappa = 0.63). CONCLUSIONS: This study indicates that the TMA technique can be used in the IHC study of MPNSTs, even with the use of heterogeneous markers such as S-100 protein.

Predicting preterm delivery in asymptomatic patients with prior preterm delivery by measurement of cervical length and phosphorylated insulin-like growth factor-binding protein-1.

OBJECTIVE: To evaluate the efficacy of cervical length measurement in combination with a bedside assessment of phosphorylated insulin-like growth factor-binding protein-1 (phIGFBP-1) as a predictor of preterm delivery in asymptomatic pregnant women with a history of preterm birth. METHODS: Cervical length was measured using transvaginal sonography at 22-24 weeks of gestation in 105 singleton pregnancies and a rapid strip test was performed to detect phIGFBP-1 in cervical secretions from 24 to 34 weeks. Receiver-operating characteristics (ROC) curves were constructed to compare the performance of phIGFBP-1 at different gestational ages, and cervical length at 22-24 weeks, in predicting preterm delivery. RESULTS: The rate of spontaneous delivery before 37 and 34 weeks was 23.8% and 11.4%, respectively. Women with cervical lengths less than 20 mm had a risk of spontaneous preterm delivery before 34 and 37 weeks of 43.5% and 69.6%, respectively. The performance of phIGFBP-1 levels as a predictor of preterm delivery was significantly higher when the test was carried out at 30 weeks' gestation. Cervical assessment in combination with phIGFBP-1 at 30 weeks had the steepest ROC curve (area under the curve=0.93; 95% CI, 0.88-0.98, P<0.001). CONCLUSION: Both cervical length and phIGFBP-1 measurement are useful in the prediction of preterm delivery in patients with a history of preterm birth and the combined method of measuring cervical length at 22-24 weeks and phIGFBP-1 at 30 weeks improves upon either method used alone.

Adenoma pleomorfo de glândulas salivares menores no lábio superior / Pleomorphic adenoma of minor salivary glands in the upper lip

Adenoma pleomorfo é o tumor benigno mais comum de glândulas salivares, acometendo preferencialmente as glândulas parótidas e as submandibulares. Este trabalho tem como objetivo relatar o caso clínico de um paciente com 25 anos de idade, sexo masculino, feoderma, o qual apresentava uma lesão assintomática, ulcerada na pele do lábio superior. Notou-se uma lesão nodular, bem delimitada, móvel, firme à palpação e discretamente ulcerada, sendo que a mucosa labial superior apresentava-se intacta. Com o exame citológico inconclusivo, foi realizada a remoção cirúrgica da lesão com margem de segurança, com resultado anátomo-patológico de adenoma pleomorfo de glândulas salivares menores