[Hereditary bradykinin angioedema. Case report]. / Angioedema hereditario por bradicinina. Reporte de Caso.

INTRODUCTION: Hereditary angioedema is an autosomal dominant genetic disease, associated with increased levels of bradykinin. It is classified into 3 types according to the C1-INH enzyme. The diagnosis is clinical and laboratory. Its treatment is divided into short- and long-term and crisis prophylaxis. CASE REPORT: 40-year-old female patient who came to the emergency service for labial edema without resolution with corticosteroids. The tests for IgE, C4 and C1 esterase inhibitors had a low result. She currently uses danazol prophylactically and fresh frozen plasma in crises. CONCLUSIONS: Since it is a disease that considerably affects the quality of life, hereditary angioedema must be diagnosed and an effective treatment plan made to prevent or reduce its complications.

INTRODUCCIÓN: El angioedema hereditario es una enfermedad genética autosómica dominante, asociada con aumento de las concentraciones de bradicinina. Se clasifica en tres tipos, de acuerdo con la enzima C1-INH. El diagnóstico se establece por las manifestaciones clínicas y los estudios de laboratorio. El tratamiento consiste profilaxis a corto y largo plazo, y protocolo para el control de las crisis. REPORTE DEL CASO: Paciente femenina de 40 años, que acudió al servicio de Urgencias por edema labial, sin reacción al tratamiento con corticosteroides. Se detectaron concentraciones bajas de IgE, C4 e inhibidores de la esterasa C1. Se estableció el diagnóstico de angioedema hereditario. Actualmente se mantiene en tratamiento profiláctico con danazol y plasma fresco congelado para el control de las crisis. CONCLUSIONES: El angioedema hereditario es una enfermedad que afecta considerablemente la calidad de vida; por tanto, debe diagnosticarse de forma oportuna y establecer un plan de tratamiento eficaz, con la intención de prevenir o reducir las complicaciones.

Mandibular asymmetry retreatment with minimal presurgical orthodontic preparation and fully customized lingual orthodontics: A case report with new possibilities using blender open-source software.

New possibilities such as Surgery-first and Minimal Presurgical Orthodontics have become extra alternatives for patients, orthodontists, and oral and maxillofacial surgeons, with immediate facial improvements, reduced preparation time, and shorter treatment time. The purpose of this case report was to demonstrate the retreatment of a female patient, dissatisfied with the instability of the compensatory orthodontic treatment, chin deviation, and forward inclination of the maxillary incisors, which was successfully treated with Minimal Presurgical Orthodontic approach associated with customized lingual brackets and virtual planning on the open-source Blender 3D software, where the post-surgical maxillary lingual brackets were also designed. Orthodontic preparation was performed in 5 months. After surgery, orthodontic treatment was finished with the aid of mini-implants and miniplates. The total treatment time was 18 months. Great facial and occlusal results were obtained and the patient was satisfied. Overall, all treatment steps were performed following a digital workflow and open-source software. It is possible to conclude that Minimal Presurgical Orthodontic Preparation was an excellent alternative for the retreatment of this patient with mandibular asymmetry and increased treatment expectations. Additionally, the surgical planning and design of lingual braces with open-source software can be considered useful and low-cost alternatives for orthodontists.

COVID-19 Pandemic Factors and Depressive Symptoms Among Primary Care Workers in São Paulo, Brazil, October and November 2020.

Objectives. To investigate associations between COVID-19-related factors and depressive symptoms among primary care workers (PCWs) in São Paulo, Brazil, and to compare the prevalence of probable depression among PCWs before and during the pandemic. Methods. In a random sample of primary care clinics, we examined 6 pandemic-related factors among 828 PCWs. We used multivariate Poisson regression with robust variance to estimate prevalence ratios for probable depression. We assessed the prevalence of probable depression in PCWs before and during the pandemic in 2 comparable studies. Results. Adjusted prevalence ratios were substantial for insufficient personal protective equipment; experiences of discrimination, violence, or harassment; and lack of family support. Comparisons between PCWs before and during the pandemic showed that the prevalence of probable depression among physicians, nurses, and nursing assistants was higher during the pandemic and that the prevalence among community health workers was higher before the pandemic. Conclusions. Our findings indicate domains that may be crucial to mitigating depression among PCWs but that, with the exception of personal protective equipment, have not previously been examined in this population. It is crucial that governments and communities address discriminatory behaviors against PCWs, promote their well-being at work, and foster family support. (Am J Public Health. 2022;112(5):786-794. https://doi.org/10.2105/AJPH.2022.306723).

A patient with Camurati-Engelmann disease presenting bilateral TMJ ankylosis: A case report.

Camurati-Engelmann Disease (CED), also known as progressive diaphyseal dysplasia, is a rare congenital disorder inherited in an autosomal-dominant pattern, most commonly affecting the skull and diaphysis of long tubular bones. Clinical symptoms start in early age and include ostealgia, muscle atrophy and weakness in the lower limbs, generalized fatigue in addition to gait disturbances (Garcia Armario and Lebron, 2011, Andreu-Arasa et al., 2019; Fyrgiola et al., 2017; Damiá and García Gómez, 2017; Mwasamwaja et al., 2018). CED is believed to be caused by mutation in the gene coding for Transforming Growth Factor ß-1 (TGFß-1) (Fyrgiola et al. 2017). This article presents a rare clinical case of CED, with bilaterally hypertrophic articular apparatus and subsequent ankylosis. A 33-year-old male is reported with temporomandibular joint (TMJ) ankylosis, bone pain, generalized muscle weakness, abnormal gait and bulging eyes. Diagnosis of CED was based on genetic mapping performed by genetist. Upon clinical and radiological examination, a massive bony mass in the condyloid and coronoid was discovered and treatment of choice was surgical resection and installation of bilateral stock articular prostheses.

Avaliação cardiorrespiratória e de sedação da associação de dexmedetomidina-butorfanol-midazolam ou detomidina-butorfanol-midazolam em catetos (Pecari tajacu) / Cardiorespiratory and sedation evaluation of the combination of dexmedetomidine-butorphanol-midazolam or detomidine butorphanol-midazolam in collared peccaries (Pecari tajacu)

A presente pesquisa comparou os efeitos cardiorrespiratórios, hemogasométricos e sedativos da associação midazolam (0,41mg/kg) e butorfanol (0,31mg/kg) acrescida de detomidina (157µg/kg) (DTMB) ou dexmedetomidina (36µg/kg) (DXMB) em catetos. Catetos adultos (n=20) foram distribuídos em dois grupos, DTMB ou DXMB. As variáveis (FC, f, PAM, SpO2, EtCO2 e TR) foram avaliadas após aplicação dos fármacos. A sedação foi avaliada por meio de escala analógica visual, relaxamento muscular, postura e resposta auditiva. Foi realizada ANOVA, seguida de teste t pareado (paramétricos) e teste de Mann-Whitney rank-sum test (não paramétricos), com P<0,05. Não foi observada diferença estatística entre os grupos para o período de latência. Observou-se diferença significativa entre grupos para as variáveis f, PAM e SpO2, com maiores valores para DTMB, e EtCO2, com maiores valores para DXMB. Os dois grupos apresentaram redução da FC e da concentração de lactato, bem como aumento da concentração de bicarbonato. A SpO2 permaneceu abaixo de 90%, durante todo o período experimental, nos dois grupos estudados. Os animais dos dois grupos apresentaram sedação profunda e relaxamento muscular máximo. Conclui-se que os dois protocolos testados proporcionaram adequada sedação, podendo ser indicados para contenção química de catetos adultos.(AU)

The study compared the cardiorespiratory, hemogasometric and sedative effects of the combination of midazolam (0.41mg/kg) and butorphanol (0.31mg/kg) plus detomidine (157µg/kg) (DTMB) or dexmedetomidine (36µg/kg) (DXMB) in collared peccaries. Collared peccaries (n= 20) were divided into two groups, either DTMB or DXMB. The variables (FC, f, PAM, SpO2, EtCO2 and TR) were evaluated after application of the drugs. Sedation was assessed by visual analogue scale, muscle relaxation, posture and auditory response. ANOVA followed by paired t-test (parametric) and Mann Whitney Rank Sum Test (non-parametric) with P< 0.05 were performed. No statistical difference was observed for the latency period. A significant increase was observed between groups for the variables f, PAM and SpO2 with higher values for DTMB and EtCO2 with higher values for DXMB. The two groups presented a reduction in HR and lactate concentration, and an increase in bicarbonate concentration. SpO2 remained below 90% throughout the experiment in both groups. The animals of the two groups presented deep sedation and maximum muscle relaxation. It is concluded that the two protocols tested provided adequate sedation and could be indicated for chemical containment of collared peccaries.(AU)

Mandible condyle osteochondroma: clinical case report / Osteocondroma do côndilo da mandíbula: relato de caso clínico

ABSTRACT Osteochondroma is one of the most common benign bone tumours. However, it a rare in the mandibular condyle. Depending on the symptoms and duration of the osteochondroma, the management ranges from excision of the tumor alone to condylectomy along with tumor excision. This paper presents a case of Osteochondroma after surgical treatment affecting the mandible of a 39-year-old man and highlights the diagnosis, surgical procedures and 3-year follow-up period. At the clinical examination, the patient presented severe mandibular lateral deviation to the right, left side disocclusion with a slight oral opening limitation, dental abrasion compatible with bruxism and class III. After 3-year follow-up 3 years later revealed that the surgical management posed was successful for Osteochondroma and the patient is currently under regular review.

RESUMO Osteocondroma é um dos tumores ósseos mais comuns, mas raramente acomete o côndilo mandibular. Dependendo dos sintomas e duração do Osteocondroma o manejo da lesão pode variar desde a excisão do tumor até a realização da condilectomia com a remoção do tumor. O objetivo deste trabalho é relatar um caso clínico de Osteocondroma acometendo o côndilo da mandíbula em um paciente de 39 anos de idade, ressaltando as etapas para a realização do diagnóstico, procedimentos cirúrgicos e follow-up de 3 anos. Ao exame clínico observou-se severo desvio mandibular para o lado direito, desoclusão do lado esquerdo, abertura de boca reduzida, abrasão dentária compatível com bruxismo e classe III. Após a realização de tratamento cirúrgico e o período de acompanhamento de 3 anos foi possível observar a resolução do caso em imagens de tomografia computadorizada de feixe cônico. Conclusão: Pode-se concluir que a terapia proposta resultou em sucesso e o paciente continua em acompanhamento periódico.

Cartogenina associada à microperfuração do osso subcondral na reparação da cartilagem articular em equinos / Kartogenin associated to micro of the subchondral bone in the joint cartilage repair in horses

A reconstituição da cartilagem articular danificada por doenças de desenvolvimento, trauma e osteoartrite tem sido um grande desafio na veterinária. O objetivo do presente estudo foi avaliar o uso da cartogenina, uma molécula capaz de induzir diferenciação de células mesenquimais em condrócitos, associado ou não à técnica de microfratura na reparação de defeitos condrais induzidos na tróclea femoral de equinos. Foram utilizados seis equinos pesando em média (±DP) 342±1,58kg, com idade de 7,2±1,30 anos e escore corporal de 7,1±0,75, os quais foram submetidos à videoartroscopia para indução da lesão condral de 1cm2 na tróclea lateral do fêmur e à realização da técnica de microperfuração do osso subcondral de ambos os joelhos. Foram realizadas quatro aplicações semanais com 20µM de cartogenina intra-articular em um dos joelhos (grupo tratado) e solução de ringer com lactato na articulação contralateral (grupo controle). Os animais foram submetidos a avaliações física, radiográfica, ultrassonográfica, por um período de 60 dias. Não houve qualquer diferença estatística entre as articulações tratadas e as controle. A terapia com cartogenina, segundo protocolo utilizado, não produziu melhora clínica em lesões osteocondrais induzidas e tratadas com microperfurações na tróclea lateral do fêmur em equinos.(AU)

Articular cartilage reconstruction is still a challenge in Veterinary Medicine. The aim was to evaluate the therapeutic effects of kartogenin, a small molecule that promotes chondrocyte differentiation, in the repair of induced chondral defects pretreated with subchondral drilling. Six horses with a mean (± SD) weight of 342 ± 1.58Kg, aging 7.2 ± 1.30 years, and with a mean 7.1 ± 0.75 body score condition were used. In both stifles, a 1cm2 chondral defect was induced in the lateral femoral trochlea followed by treatment with subchondral drilling. Four intra-articular injections with kartogenin (20mM) were performed weekly in one stifle (treated group). The same procedure using saline solution was performed in the contralateral joint (control group). Clinical, radiographic, ultrasound evaluations were performed for a period of 60 days. No statistical differences were detected between groups in any of the studied variables. Although kartogenin has shown to improve articular cartilage repair in laboratory animal models, the same was not observed in this equine model. In conclusion, the kartogenin therapy, according to the used protocol, did not promote any clinical benefit in equine femoral trochlear defects pretreated with subcondral drilling.(AU)

Lingual Short Split: A Bilateral Sagittal Split Osteotomy Technique Modification.

The technique of sagittal split osteotomy of the mandibular ramus is an established technique that has been evolving over the years, with significant improvements regarding stability, better bone contact between the segments, and possibilities of osteosynthesis. However, paresthesia is common in the postoperatory, sometimes permanent, and undesirable fractures in the subcondylar region can occur leading to longer operative time and extraoral scars. The short lingual split technique is an easy technique that simplifies the horizontal osteotomy of the ramus and decreases the risk of undesirable fractures with a neurosensitive recovery of patients in a much shorter time because of minor trauma and nerve manipulation during the execution.

Treatment of primary aldosteronism is associated with a reduction in the severity of obstructive sleep apnoea.

Obstructive sleep apnoea (OSA) is known to commonly co-exist with primary aldosteronism (PA), but it is unknown if treatment of PA improves sleep apnoea parameters in these patients. We therefore aimed to determine whether specific medical or surgical treatment of PA improves OSA, as measured by the apnoea-hypopnoea index (AHI). We recruited patients undergoing diagnostic workup for PA if they had symptoms suggestive of OSA. Patients with confirmed PA underwent polysomnography (PSG) at baseline and again at least 3 months after specific treatment for PA. Of 34 patients with PA, 7 (21%) had no evidence of OSA (AHI <5), 9 (26%) had mild (AHI ⩾5 and <15), 8 (24%) moderate (AHI ⩾15 and <30) and 10 (29%) severe OSA (AHI ⩾30). Body mass index tertile, neck circumference and 24 h urinary sodium correlated with the AHI. Twenty patients had repeat PSG performed after treatment for PA (mineralocorticoid receptor antagonists in 13 with bilateral PA and adrenalectomy in 7 with unilateral PA). In this group the median (s.d.) AHI reduced from 22.5 (14.7) to 12.3 (12.1) (P=0.02). Neck circumference reduced with PA treatment (41.6 vs 41.2 cm, P=0.012). OSA is common in patients with primary aldosteronism and may improve with specific therapy for this disease. Aldosterone and sodium-mediated fluid retention in the upper airways and neck region may be a potential mechanism for this relationship.

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses.

We investigated the thermal, electrical and mechanical antinociceptive and physiological effects (heart rate, respiratory rate, arterial blood pressure, head height and abdominal auscultation score), and pharmacokinetics, of 0.5 mg/kg of the injectable formulation (ORAL) or nanoparticulated methadone (NANO) given orally, in six adult mares, using a crossover, blind and prospective design. Repeated-measure models were used to compare parametric data between and within treatments, followed by Tukey's test. Nonparametric data were analysed with Wilcoxon signed-rank, adjusted by Bonferroni tests. Blood samples were also collected up to 6 h after dosing for plasma drug quantification by LC-MS/MS. Methadone pharmacokinetic parameters were determined by noncompartmental and compartmental approaches. There were no differences in pharmacodynamic parameters. No statistical differences were observed in the pharmacokinetic parameters from noncompartmental analysis for both groups, except a significant decrease in peak plasma concentration, increase in apparent volume of distribution per fraction absorbed (Vdss /F) and increased mean residence time (MRT) for NANO. One-compartment open model with first order elimination best described the pharmacokinetic profiles for both groups. Neither ORAL nor NANO administered orally to horses produced antinociception. The nanoencapsulated formulation of methadone given orally to horses did not improve methadone pharmacokinetic parameters or increased systemic body exposure to methadone.

Irrigation canals in Melo creek basin (Rio Espera and Capela Nova municipalities, Minas Gerais, Brazil): habitats to Biomphalaria (Gastropoda: Planorbidae) and potential spread of schistosomiasis / Canais de irrigação na bacia do ribeirão do Melo (Municípios de Rio Espera e Capela Nova, Minas Gerais, Brasil): habitats para a proliferação de Biomphalaria (Gastropoda: Planorbidae) e potencial disseminação da esquistossomose

Abstract This study analyzed the presence of Biomphalaria in Melo creek basin, Minas Gerais state, and its relationship to irrigation canals. Seventeen of these canals were used to determine a limnological, morphological and hydrological characterization during an annual seasonal cycle. Biomphalaria samples were sent to René Rachou Research Center/FIOCRUZ for identification and parasitological examination. Six canals were identified as breeding areas for mollusks and in one of them it was registered the coexistence of B. tenagophila (first report to this basin) and B. glabrata species. Results indicated that the low flow rate and speed of water flow were the main characteristics that contributed to this specific growth of the mollusks in the area. These hydraulic characteristics were created due to anthropogenic action through the canalization of lotic areas in Melo creek, which allowed ideal ecological conditions to Biomphalaria outbreak. The results emphasize the need of adequate handling and constant monitoring of the hydrographic basin, subject to inadequate phytosanitary conditions, aiming to prevent the occurrence and propagation of schistosomiasis.

Resumo Neste estudo avaliou-se a presença de espécies de Biomphalaria na bacia do Ribeirão do Melo, municípios de Rio Espera e Capela Nova, sudeste do estado de Minas Gerais, e sua relação com os canais de irrigação presentes na região. Em 17 desses canais foi realizada uma caracterização limnológica, morfológica e hidrológica durante um ciclo sazonal anual. Espécimes de Biomphalaria foram coletados e encaminhados ao Centro de Pesquisas René Rachou/FIOCRUZ (Belo Horizonte, MG) para identificação e exame parasitológico. Dos 17 canais estudados, foram identificados seis como criadouros do caramujo, sendo que em um dos canais coexistiam as espécies B. tenagophila (primeiro registro para a bacia) e B. glabrata. Os resultados indicaram que a baixa vazão e a velocidade do fluxo foram os fatores que contribuíram para a ocorrência pontual dos caramujos na bacia. Estas características hidrológicas foram modificadas por ação antropogênica, através da canalização de trechos lóticos do ribeirão do Melo. Os resultados destacam a necessidade do manejo adequado e monitoramento constante da bacia hidrográfica, sujeita a condições sanitárias inadequadas, como forma de prevenção da ocorrência e propagação da esquistossomose.

Irrigation canals in Melo creek basin (Rio Espera and Capela Nova municipalities, Minas Gerais, Brazil): habitats to Biomphalaria (Gastropoda: Planorbidae) and potential spread of schistosomiasis.

This study analyzed the presence of Biomphalaria in Melo creek basin, Minas Gerais state, and its relationship to irrigation canals. Seventeen of these canals were used to determine a limnological, morphological and hydrological characterization during an annual seasonal cycle. Biomphalaria samples were sent to René Rachou Research Center/FIOCRUZ for identification and parasitological examination. Six canals were identified as breeding areas for mollusks and in one of them it was registered the coexistence of B. tenagophila (first report to this basin) and B. glabrata species. Results indicated that the low flow rate and speed of water flow were the main characteristics that contributed to this specific growth of the mollusks in the area. These hydraulic characteristics were created due to anthropogenic action through the canalization of lotic areas in Melo creek, which allowed ideal ecological conditions to Biomphalaria outbreak. The results emphasize the need of adequate handling and constant monitoring of the hydrographic basin, subject to inadequate phytosanitary conditions, aiming to prevent the occurrence and propagation of schistosomiasis.

Salt, aldosterone and hypertension.

Clinical studies have shown that aldosterone and salt are independently related to hypertension, cardiovascular morbidity and mortality. More recently, studies in humans have demonstrated that, similarly to animals, endogenous aldosterone and dietary salt intake have not only separate, but also combined effects to accelerate target-organ deterioration. The aldosterone-salt interaction has important clinical implications, because combined effects of both can be minimized, if not avoided, by reducing salt intake. This interaction could also be interrupted by blocking the effects of aldosterone, with use of mineralocorticoid receptor antagonists, or by reducing aldosterone effects by adrenalectomy, in patients with aldosterone producing adenoma. Furthermore, aldosterone reduction or blockade may reduce salt appetite.

Profiling the clinical presentation of diagnostic characteristics of a sample of symptomatic TMD patients.

BACKGROUND: Temporomandibular disorder (TMD) patients might present a number of concurrent clinical diagnoses that may be clustered according to their similarity. Profiling patients' clinical presentations can be useful for better understanding the behavior of TMD and for providing appropriate treatment planning. The aim of this study was to simultaneously classify symptomatic patients diagnosed with a variety of subtypes of TMD into homogenous groups based on their clinical presentation and occurrence of comorbidities. METHODS: Clinical records of 357 consecutive TMD patients seeking treatment in a private specialized clinic were included in the study sample. Patients presenting multiple subtypes of TMD diagnosed simultaneously were categorized according to the AAOP criteria. Descriptive statistics and two-step cluster analysis were used to characterize the clinical presentation of these patients based on the primary and secondary clinical diagnoses. RESULTS: The most common diagnoses were localized masticatory muscle pain (n = 125) and disc displacement without reduction (n = 104). Comorbidity was identified in 288 patients. The automatic selection of an optimal number of clusters included 100% of cases, generating an initial 6-cluster solution and a final 4-cluster solution. The interpretation of within-group ranking of the importance of variables in the clustering solutions resulted in the following characterization of clusters: chronic facial pain (n = 36), acute muscle pain (n = 125), acute articular pain (n = 75) and chronic articular impairment (n = 121). CONCLUSION: Subgroups of acute and chronic TMD patients seeking treatment can be identified using clustering methods to provide a better understanding of the clinical presentation of TMD when multiple diagnosis are present. Classifying patients into identifiable symptomatic profiles would help clinicians to estimate how common a disorder is within a population of TMD patients and understand the probability of certain pattern of clinical complaints.

Factors affecting the aldosterone/renin ratio.

Although the aldosterone/renin ratio (ARR) is the most reliable screening test for primary aldo-steronism, false positives and negatives occur. Dietary salt restriction, concomitant malignant or renovascular hypertension, pregnancy and treatment with diuretics (including spironolactone), dihydropyridine calcium blockers, angiotensin converting enzyme inhibitors, and angiotensin receptor antagonists can produce false negatives by stimulating renin. We recently reported selective serotonin reuptake inhibitors lower the ratio. Because potassium regulates aldosterone, uncorrected hypokalemia can lead to false negatives. Beta-blockers, alpha-methyldopa, clonidine, and nonsteroidal anti-inflammatory drugs suppress renin, raising the ARR with potential for false positives. False positives may occur in patients with renal dysfunction or advancing age. We recently showed that (1) females have higher ratios than males, and (2) false positive ratios can occur during the luteal menstrual phase and while taking an oral ethynylestradiol/drospirenone (but not implanted subdermal etonogestrel) contraceptive, but only if calculated using direct renin concentration and not plasma renin activity. Where feasible, diuretics should be ceased at least 6 weeks and other interfering medications at least 2 before ARR measurement, substituting noninterfering agents (e. g., verapamil slow-release±hydralazine and prazosin or doxazosin) were required. Hypokalemia should be corrected and a liberal salt diet encouraged. Collecting blood midmorning from seated patients following 2-4 h upright posture improves sensitivity. The ARR is a screening test only and should be repeated once or more before deciding whether to proceed to confirmatory suppression testing. Liquid chromatography-tandem mass spectrometry aldosterone assays represent a major advance towards addressing inaccuracies inherent in other available methods.

Non-dipping pattern relates to endothelial dysfunction in patients with uncontrolled resistant hypertension.

Resistant hypertension (RHTN) includes both patients whose blood pressure (BP) is uncontrolled on three or more medications (uncontrolled RHTN (UCRH)) and patients whose BP is controlled with use of four or more drugs (controlled RHTN (CRH)). It is unknown whether endothelial function and nocturnal drop demonstrate a similar pattern in patients with CRH and UCRH. We examined circadian BP patterns and vascular function in these patients. In all, 40 CRH and 26 UCRH patients, and 25 normotensives underwent biochemical testing, ambulatory BP monitoring, determination of brachial artery responses to endothelial-dependent (flow-mediated; dilation (FMD)) and independent (nitroglycerin mediated) stimuli. The nighttime drop in systolic BP (SBP) and diastolic BP (DBP) was less pronounced in UCRH than in CRH (SBP, 1.9±1.6 versus 4.9±1.7%; DBP, 7.5±1.8 versus 10.9±1.8%, UCRH and CRH, respectively; P<0.05). FMD was greater in control group compared with RHTN patients. Patients with UCRH had significantly impaired FMD compared with CRH (5.9±2.3% versus 7.1±5.1%; P<0.0001). Therefore, UCRH patients have less nocturnal dipping and a more impaired endothelial response compared with CRH patients. These findings suggest that important differences among patients with RHTN may allow identify subgroups with increased cardiovascular risk.

Comparative study between atropine and hyoscine-N-butylbromide for reversal of detomidine induced bradycardia in horses.

REASONS FOR PERFORMING STUDY: Bradycardia may be implicated as a cause of cardiovascular instability during anaesthesia. HYPOTHESIS: Hyoscine would induce positive chronotropism of shorter duration than atropine, without adversely impairing intestinal motility in detomidine sedated horses. METHODS: Ten minutes after detomidine (0.02 mg/kg bwt, i.v.), physiological saline (control), atropine (0.02 mg/kg bwt) or hyoscine (0.2 mg/kg bwt) were randomly administered i.v. to 6 horses, allowing one week intervals between treatments. Investigators blinded to the treatments monitored cardiopulmonary data and intestinal auscultation for 90 min and 24 h after detomidine, respectively. Gastrointestinal transit was assessed for 96 h via chromium detection in dry faeces. RESULTS: Detomidine significantly decreased heart rate (HR) and cardiac index (CI) from baseline for 30 and 60 min, respectively (control). Mean ± s.d. HR increased significantly 5 min after atropine (79 ± 5 beats/min) and hyoscine (75 ± 8 beats/min). After this time, HR was significantly higher after atropine in comparison to other treatments, while hyoscine resulted in intermediate values (lower than atropine but higher than controls). Hyoscine and atropine resulted in significantly higher CI than controls for 5 and 20 min, respectively; but this effect coincided with significant hypertension (mean arterial pressures >180 mmHg). Auscultation scores decreased from baseline in all treatments. Time to return to auscultation scores ≥12 (medians) did not differ between hyoscine (4 h) and controls (4 h) but atropine resulted in significantly longer time (10 h). Atropine induced colic in one horse. Gastrointestinal transit times did not differ between treatments. CONCLUSION: Hyoscine is a shorter acting positive chronotropic agent than atropine, but does not potentiate the impairment in intestinal motility induced by detomidine. Because of severe hypertension, routine use of anticholinergics combined with detomidine is not recommended. POTENTIAL RELEVANCE: Hyoscine may represent an alternative to atropine for treating bradycardia.

Labioplastia helicoidal como tratamento de lábio duplo / Elliptical excision for double lip treatment

O lábio duplo é uma anomalia caracterizada por crescimento de tecido hiperplásico acometendo na maioria das vezes o lábio superior, resultando em uma deformidade que se torna evidente quando o paciente sorri e durante a fala, ocasionando interferências na fonética e mastigação, afetando, em alguns casos, psicologicamente o paciente. Esta deformidade pode ser congênita ou adquirida, e não tem predileção por idade, raça ou gênero. O tratamento cirúrgico é indicado nos casos onde o paciente apresenta comprometimento funcional ou solicite, por motivos estéticos. Neste trabalho é descrito um caso de labio duplo adquirido onde foi feita a remoção cirúrgica através de labioplastia helicoidal, solucionando assim a deformidade estética.

The double lip is an abnormality characterized by hyperplasic tissue growth, affecting mostly the upper lip, resulting in a deformity that becomes evident when the patient smiles and during speech. It may cause interference with phonetics and mastication, in some cases affecting the patient psychologically. This deformity can be congenital or acquired and has no predilection for age, race or gender. Surgical treatment is indicated in cases where the patient is functionally compromised or requests it for aesthetic reasons. This paper describes a case of acquired double lip where surgical removal was performed by elliptical excision, thus solving the aesthetic deformity. KEY WORDS: Lip, Deformity, Maxillofacil Surgery.

Unilateral adrenalectomy improves urinary protein excretion but does not abolish its relationship to sodium excretion in patients with aldosterone-producing adenoma.

Experimental and human data suggest that adverse cardiovascular (CV) and renal effects of aldosterone excess are dependent on concomitant dietary salt intake. Increased urinary protein (Uprot) is an early sign of nephropathy independently associated with CV risk. We have previously reported a positive association between Uprot and urinary sodium (UNa) in patients with hyperaldosteronism, but not in patients with normal aldosterone levels. We aimed to determine whether Uprot is related to UNa in patients with aldosterone-producing adenoma (APA) and whether the degree of Uprot and strength of this relationship is reduced following correction of hyperaldosteronism. Subjects with APA (n=24) underwent measurement of 24 h Uprot and UNa before and after unilateral adrenalectomy (follow-up 15.0±11.9 months). Following surgery, mean clinic systolic blood pressure fell (150.4±18.2 vs 134.5±14.5 mm Hg, P=0.0008), despite a reduction in number of antihypertensive medications, and Uprot (211.2±101.6 vs 106.0±41.8 mg per day, P<0.0001) decreased. There was a positive correlation between Uprot and UNa both before (r=0.5477, P=0.0056) and after (r=0.5097, P=0.0109) adrenalectomy. Changes in UNa independently predicted Uprot reduction (P=0.0189). These findings suggest that both aldosterone levels and dietary salt contribute to renal damage, and that once glomerular damage occurs it is not completely resolved following correction of hyperaldosteronism. Our study suggests that treatment strategies based on reduction of aldosterone effects, by adrenalectomy or mineralocorticoid receptor blockade, in conjunction with low-salt diet would provide additional target-organ protection in patients with primary aldosteronism.

Characteristics of resistant hypertension: ageing, body mass index, hyperaldosteronism, cardiac hypertrophy and vascular stiffness.

Resistant hypertension (RHTN) includes patients whose blood pressure (BP) is controlled with the use of four or more antihypertensive medications, and is referred to as 'controlled resistant hypertension' (CRH). While specifically comparing patients with CRH and uncontrolled resistant hypertension (UCRH), we hoped to identify distinguishing characteristics that would provide insight into factors contributing to resistance to antihypertensive therapies. RHTN patients were identified as controlled (CRH, n=43) or uncontrolled (UCRH, n=47). No statistical differences were observed between the CRH and UCRH subgroups with respect to age and gender. The body mass index, aldosterone-renin ratio and pulse wave velocity (PWV) were significantly higher in UCRH patients. Although both subgroups showed increased cardiac mass, left ventricular mass index was significantly higher in UCRH compared with CRH patients. Multivariate linear regression analysis indicated that PWV was significantly dependent on age in both UCRH and CRH patients; however, the influence of ageing was more pronounced in the former subgroup. Older age, greater vascular stiffness, higher aldosterone levels and greater left ventricular hypertrophy were significantly associated with lack of BP control in patients with RHTN. These findings suggest important possibilities in terms of preventing and better treating RHTN.