Study of transcranial photobiomodulation at 945-nm wavelength: anxiety and depression.

Transcranial photobiomodulation is an innovative method for the stimulation of neural activity which consists of the exposure of neural tissue to low-level light irradiance. In the present study, light-emitting diodes (LEDs) were used as light source due to their practicality and low cost. The objective was to analyze the effects of transcranial photobiomodulation using 945-nm LED in university students with anxiety and depression. Sample was composed of 22 individuals (17-25 years of age) divided into 2 groups of 11. LED group was treated with 945-nm LEDs for 1 min and 25 s (9.35 J/cm2), while in the placebo group, the device was off when placed in contact with the frontal bone for the same amount of time as in treatment group. Participants were evaluated at baseline and after 30 days with the hospital anxiety and depression scale (HADS), the faces test, the designs test, and the grip strength test. On the HADS for anxiety, the mean PAB, PAA, PhAB, and PhAA were 13.89 ± 3.55, 12.82 ± 3.18, 10.75 ± 2.49, and 6.66 ± 2.50 points, respectively. In the HADS for depression, the mean for the PDB group was 13.89 ± 3.55 points, in the PhDB group 12.82 ± 3.18 points, in the PDA group 10.75 ± 2.49 points, and in the PhDA group 6.66 ± 2.50 points. In the PA and PD groups, mean values of 8.0 ± 1.5 and 8.9 ± 1.26 scores were obtained, but did not reach significance; however, between PA and PhD analysis, a significance level of p = 0.0003 was obtained. The 945-nm LED transcranial photobiomodulation improves brain activity and may clinically decrease anxiety and depression.

The direct effects of a tropical natural humic substance to three aquatic species and its influence on their sensitivity to copper.

Few studies have been conducted so far into the effects of humic substances (HS) on aquatic organisms and their influence on the toxicity of chemical pollutants in the tropics. The aim of the present study was therefore to evaluate the direct effects of locally-derived tropical natural HS on the cladoceran Daphnia similis, the midge Chironomus xanthus and the fish Danio rerio. The influence of a HS concentration series on the acute toxicity of copper to these organisms was also assessed through laboratory toxicity testing. The HS did not exert direct acute effects on the test organisms, but long-term exposure to higher HS concentrations provoked a stress response (increase in feces production) to D. rerio and exerted effects on chironomid adult emergence and sex ratio. The biotic ligand model proved to be a useful tool in converting total copper concentrations to the appropriate bio-available fraction to which tropical aquatic organisms are exposed.

Study of transcranial therapy 904 nm in experimental model of stroke.

Cerebrovascular accidents (CVAs), commonly known as strokes, can damage the brain through vascular injuries caused by either blood vessel blockages (ischemic stroke) or ruptures (hemorrhagic stroke) which disrupt regular brain blood supply and can cause severe damage to the individual. The objective of the present study was to evaluate the effects of photobiomodulation with a light-emitting diode (LED) device (904 nm, 110 mW, 7 J/cm2) on neurogenesis, muscle resistance, and motor behavior in animals submitted to an experimental model of hemiplegia. The sample consisted of 30 Wistar rats, divided into two groups: control group (GC) and 904-nm LED-treated group (TG). All animals underwent stereotactic surgery for electrode implant and subsequent electrolytic injury to induce an ischemic stroke. TG was subjected to daily LED irradiation (904 nm, 110 mW, 7 J/cm2) for 63 s. Suspension test results indicate an improvement of TG muscle resistance when compared with baseline evaluation (BLT); a reduction in open-field freezing time and the number of fecal bolus pellets suggest diminished anxiety induced by 904-nm LED treatment on treatment days 7 and 21 (TG7 and TG21) compared with the baseline results; and lastly, histological analysis showed important signs of neurogenesis in TG in comparison to CG, especially on treatment days 7 and 21 (TG7 and TG21). In conclusion, the present study suggests that 904-nm LED irradiation may beneficially affect neurogenesis, muscle resistance, and animal motor behavior following ischemic CVA.

Intrathecal morphine therapy in the management of status dystonicus in neurodegeneration brain iron accumulation type 1.

Neurodegeneration with brain iron accumulation type 1 (NBIA-1) is a rare disorder characterized by progressive extrapyramidal dysfunction and dementia. NBIA-1 encompasses typical iron brain accumulation, mostly in the globus pallidus with secondary dementia, spasticity, rigidity, dystonia, and choreoathetosis. Treatment remains mostly symptomatic and is challenging. We present the case of a 14-year-old boy diagnosed with NBIA-1, presenting intractable progressive generalized dystonia leading to unresponsive status dystonicus (SD). The patient received a SynchroMed II (model 8637) programmable system pump (Medtronic®, Inc.) implant with an Ascenda intrathecal catheter for intrathecal morphine therapy (IMT). The initial dose of morphine was 1.0 mg/day. Overall, we observed no complications with IMT treatment and important improvement of the patient's motor function with stabilization of his incapacitating dystonia and his quality of life. On the Global Dystonia Severity Rating Scale, he presented 52% improvement, 30% improvement on the Unified Dystonia Rating Scale, and 38% improvement on the Fahn-Marsden Rating Scale after 10 months, when the dose was 1.7 mg/day. IMT should be considered as a potential palliative treatment in the management of intractable dystonia and SD secondary to NBIA-1.

Acute kidney injury in nonagenarians: clinical characteristics and mortality.

INTRODUCTION: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. METHODS: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. RESULTS: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. CONCLUSION: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

Analysis of the electromyographic activity of the ankle muscles on unstable proprioception devices with and without the use of shoes: A cross-sectional study.

INTRODUCTION: Proprioceptive exercises are performed in physiotherapy with the use of different unstable devices to improve joint stability using the mechanical and sensory properties of the ligaments, joint capsule and muscles surrounding the joint. However, the literature does not clearly show whether the use of foot wear increases or reduces muscle activity on different types of unstable devices. OBJECTIVE: Analyze the electromyographic activity of the ankle muscles on unstable proprioception devices and a stable surface with and without the use of shoes. METHODS: Thirty active, healthy men were submitted to warmup and familiarization of the devices prior to data collection. The order of data collection was chosen randomly by lots [on stable ground or unstable platforms (BOSU in the normal and inverted positions and proprioceptive disk) with or without the use of shoes]. The individuals remained balanced on these surfaces for 15 s. Biological signals were captured using surface electromyography for the evaluation of the activity of the tibialis anterior, gastrocnemius and fibularis longus muscles. RESULTS: No differences were found in the activation of the muscle in the comparison of the use and non-use of shoes (p > 0.05). The BOSU device in the normal position led to greater muscle activation than in the inverted position (p < 0.05). CONCLUSION: The use of shoes does not alter muscle activity of the ankle on the proprioceptive devices used in the present study. Moreover, these unstable devices each generate different muscle activities.

Impact of Enhanced Recovery After Bariatric Surgery (ERABS) Protocol in Reducing Length of Stay and Hospitalization Costs: the Experience of a Philanthropic Hospital in Brazil.

OVERVIEW: The global prevalence of obesity and increase in bariatric surgeries are burdening the healthcare system. Enhanced recovery postoperative protocols are associated with a reduction in hospitalization costs and length of stay (LOS) and may be an alternative to reduce public health expenses. OBJECTIVE: To assess the impact of implementing a customized Enhanced Recovery After Bariatric Surgery (ERABS) protocol on hospitalization costs (HC), LOS, and complication rates. SETTING: Santa Marcelina Hospital, São Paulo, Brazil. METHODS: A retrospective electronic health record analysis of patients who underwent laparoscopic Roux-en-Y gastric bypass or laparoscopic sleeve gastrectomy and who were cared for within a clinical pathway (CP) protocol (Jan. 2016-Aug. 2018) or after implementation of an ERABS protocol (Aug. 2018-Jun. 2019). The LOS, HC, and complication, readmission, and reoperation rates were compared between the two groups. RESULTS: Eighty-two patients were included in the study (CP, 56, 87.5% women; ERABS, 26, 92.3% women). Hospital LOS and total HC decreased significantly by 32.5% and 15.2%, respectively (both, p < 0.05), after implementation of ERABS. There were no significant differences in 30-day readmission, complication, or reoperation rates. CONCLUSION: The implementation of a standardized enhanced recovery program resulted in reduced LOS and HC without an increase in perioperative morbidity. The ERABS protocol is cost-effective and can help ease the healthcare burden.

Acute kidney injury in nonagenarians: clinical characteristics and mortality / Injúria renal aguda em nonagenários: características clínicas e mortalidade

Abstract Introduction: Nonagenarians constitute a rising percentage of inpatients, with acute kidney injury (AKI) being frequent in this population. Thus, it is important to analyze the clinical characteristics of this demographic and their impact on mortality. Methods: Retrospective study of nonagenarian patients with AKI at a tertiary hospital between 2013 and 2022. Only the latest hospital admission was considered, and patients with incomplete data were excluded. A logistic regression analysis was conducted to define risk factors for mortality. A p-value < 0.05 was considered statistically significant. Results: A total of 150 patients were included, with a median age of 93.0 years (91.2-95.0), and males accounting for 42.7% of the sample. Sepsis was the most common cause of AKI (53.3%), followed by dehydration/hypovolemia (17.7%), and heart failure (17.7%). ICU admission occurred in 39.3% of patients, mechanical ventilation in 14.7%, vasopressors use in 22.7% and renal replacement therapy (RRT) in 6.7%. Death occurred in 56.7% of patients. Dehydration/hypovolemia as an etiology of AKI was associated with a lower risk of mortality (OR 0.18; 95% CI 0.04-0.77, p = 0.020). KDIGO stage 3 (OR 3.15; 95% CI 1.17-8.47, p = 0.023), ICU admission (OR 12.27; 95% CI 3.03-49.74, p < 0.001), and oliguria (OR 5.77; 95% CI 1.98-16.85, p = 0.001) were associated with mortality. Conclusion: AKI nonagenarians had a high mortality rate, with AKI KDIGO stage 3, oliguria, and ICU admission being associated with death.

Resumo Introdução: Nonagenários constituem um percentual de pacientes internados em ascensão, sendo a injúria renal aguda (IRA) frequente nesses pacientes. Sendo assim, é importante analisar as características clínicas dessa população e seu impacto na mortalidade. Métodos: Estudo retrospectivo de pacientes nonagenários com IRA entre 2013 e 2022 em um hospital terciário. Apenas o último internamento foi considerado e pacientes com dados incompletos foram excluídos. Uma análise por regressão logística foi realizada para definir fatores de risco para mortalidade. Um valor de p < 0,05 foi considerado significativo. Resultados: Foram incluídos 150 pacientes com mediana de idade 93,0 anos (91,2-95,0) e sexo masculino em 42,7%. Sepse foi a causa mais comum de IRA (53,3%), seguida de desidratação/hipovolemia (17,7%) e insuficiência cardíaca (17,7%). Admissão na UTI ocorreu em 39,3% dos pacientes, ventilação mecânica em 14,7%, uso de vasopressores em 22,7% e realização de terapia renal substitutiva (TRS) em 6,7%. Óbito ocorreu em 56,7% dos pacientes. Desidratação/hipovolemia como etiologia da IRA foi associado a menor risco de mortalidade (OR 0,18; IC 95% 0,04-0,77, p = 0,020). Estágio KDIGO 3 (OR 3,15; IC 95% 1,17-8,47, p = 0,023), admissão na UTI (OR 12,27; IC 95% 3,03-49,74, p < 0,001) e oligúria (OR 5,77; IC 95% 1,98-16,85, p = 0,001) foram associados à mortalidade. Conclusão: Nonagenários com IRA apresentaram alta mortalidade e IRA KDIGO 3, oligúria e admissão na UTI foram associadas ao óbito.

Tolerance of Eugenia dysenterica to Aluminum: Germination and Plant Growth.

Native Cerrado plants are exposed to soils with low pH and high availability of Al. In this study, we measured the Al content in adult plants, and investigated the effects of various Al doses on germination and early development of Eugenia dysenterica plants. For germination tests, the seeds were soaked in Al solution and evaluated for twenty days in growth chambers. In a second experiment, young plants were cultivated in hydroponic systems with various Al concentrations to evaluate the morphological, anatomical and physiological characteristics of E. dysenterica. Anatomical changes and low germinative vigor were observed in seeds germinated in 600 and 800 µmol Al3+ L-1. In the hydroponic system, 200 µmol Al3+ L-1 stimulated root growth in young plants. The activity of antioxidant enzymes and the accumulation of phenolic compounds were greatest at the highest Al doses, preventing changes in gas exchange and chlorophyll a fluorescence. Starch grain accumulation was noted in plant cells exposed to 200 and 400 µmol Al3+ L-1. Adult E. dysenterica trees also accumulated Al in leaves, bark and seeds. These data suggest that E. dysenterica is tolerant to Al.

Acute exposure to water-soluble fractions of marine diesel oil: Evaluation of apoptosis and oxidative stress in an ascidian.

To understand the mechanisms involved in organisms' responses to toxicity from oil pollution, we studied the effect of acute exposure (24 h) to the marine water-soluble fraction of diesel oil (WFDO) on the ascidian Styela plicata. We evaluated the mortality and behavior by means of the siphon reflex, and the response of blood cells (hemocytes) contained in the pharynx, by means of the production of nitric oxide (NO) and reactive oxygen species (ROS), in addition to the activity of the antioxidant enzyme catalase (CAT). We also correlated oxidative stress with the activation of apoptotic pathways. No mortality occurred 24 h after the ascidians were exposed to 5% and 10% marine WFDO; however, the siphon reflex, a behavioral test based on the time that the animals took to close their siphons, increased. We also observed an inflammatory response, as estimated by the increase in the number of hemocytes in the pharynx. NO and ROS production and CAT activity were reduced, whereas caspase-3, a signaling molecule involved in apoptosis, was activated. This suggests that in ascidians acutely exposed to oil, another mechanism can occur in addition to oxidative stress. Another possibility is that WFDO may directly interact with cellular macromolecules and activate caspase-3, independently of generating oxidative stress. The results showed that components of diesel oil affected a marine organism, which showed reduced ROS production in the pharynx cells, including hemocytes, and activation of apoptotic pathways.

Effects of ozone on the pain and disability in patients with failed back surgery syndrome.

INTRODUCTION:: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. OBJECTIVE:: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. METHOD:: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. RESULTS:: The patients showed significant pain relief, but no improvement was observed in the functional scales. CONCLUSION:: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Antagonistic microorganisms and nitrogen fertilization in control of tomato southern blight

The present study assessed the efficacy of formulated biocontrol agents and nitrogen fertilization on southern blight control. Antagonism test in vitro was performed to assess the inhibitory activity of Bacillus methylotrophicus and Trichoderma asperellum against the growth of Sclerotium rolfsii. Tomato seedlings were transplanted into the substrate added with ammonium nitrate doses and inoculated with the formulated biocontrol agents Ônix (B. methylotrophicus) or Quality (T. asperellum). Subsequently, seedlings were inoculated with S. rolfsii. Plant mortality, shoot and root weight were assessed 11 days after the last inoculation. Agents had effective inhibitory activity against S. rolfsii; thus, they could reduce southern blight severity when combined with ammonium nitrate. However, plant mortality was not reduced by them.(AU)

Pain Relief in CRPS-II after Spinal Cord and Motor Cortex Simultaneous Dual Stimulation.

UNLABELLED: We describe a case of a 30-year-old woman who suffered a traumatic injury of the right brachial plexus, developing severe complex regional pain syndrome type II (CRPS-II). After clinical treatment failure, spinal cord stimulation (SCS) was indicated with initial positive pain control. However, after 2 years her pain progressively returned to almost baseline intensity before SCS. Additional motor cortex electrode implant was then proposed as a rescue therapy and connected to the same pulse generator. This method allowed simultaneous stimulation of the motor cortex and SCS in cycling mode with independent stimulation parameters in each site. At 2 years follow-up, the patient reported sustained improvement in pain with dual stimulation, reduction of painful crises, and improvement in quality of life. The encouraging results in this case suggests that this can be an option as add-on therapy over SCS as a possible rescue therapy in the management of CRPS-II. However, comparative studies must be performed in order to determine the effectiveness of this therapy. KEY WORDS: Chronic neuropathic pain, Complex regional pain syndrome Type II, brachial plexus injury, motor cortex stimulation, spinal cord stimulation.

Endonasal Endoscopic Pituitary Adenoma Resection in light of the COVID-19 Pandemic: A Technical Report

Introduction The endoscopic endonasal transsphenoidal approach (EETA) is routinely used to treat sellar and suprasellar tumors. It provides safe and direct access to tumors in these locations, with wide visualization of anatomical landmarks and great surgical results. With the COVID-19 pandemic, despite the high risk of transmission involved, various surgical procedures cannot be postponed due to their emergency. Case Report A 62-year-old female presented in the previous two months with headaches, followed by bilateral severe visual loss. In 2016, she was submitted to subtotal resection of a non-secretorymacroadenoma. Because of the progressive visual deficits, the EETA was used to the resect the pituitary adenoma. Technical Note We developed a low-cost adaptation to the surgical fields, covering the patient's head and superior trunk with a regular surgicalmicroscope bag with a tiny slit to enable the endoscope and surgical instruments to enter the nose, thus protecting the personnel in the operating room from the aerosolization of particles. This makes surgery safer for the surgical team and for the patient. Conclusion In view of the lack of literature on this subject, except for some reports of experiences from some services around the world, we describe the way we have adjusted the EETA in the context of the COVID-19 pandemic.

Accuracy of two cephalometric analyses in the treatment of patients with skeletal class III malocclusion.

The aim of the present study was to compare the treatment plan outlined from the diagnosis obtained by two different cephalometric analyses with the clinical decision made for surgical treatment of patients with skeletal Class III malocclusion. For this purpose, 82 skeletal Class III patients were evaluated, divided into three groups according to the surgical procedure performed for dentofacial deformity correction. Their preoperative cephalometric radiographs were submitted to McNamara and Steiner cephalometric analyses. The association of variables was evaluated by Kappa correlation (α=5%). The agreement between indication of surgical procedures performed based on clinical decision and surgical treatment indicated based on the evaluation of McNamara and Steiner cephalometric analyses were not significant (p=0.609 and p=0.544, respectively). McNamara and Steiner analyses showed reasonable agreement with each other as to the diagnosis, but did not agree with the clinical decision to treat skeletal CIII patients. Both tests were equally inaccurate in the indication of the surgical treatment.

Effects of ozone on the pain and disability in patients with failed back surgery syndrome / Efeitos do ozônio na dor e na incapacidade em pacientes com síndrome dolorosa pós-laminectomia

Summary Introduction: Low back pain is one of the painful disorders of higher prevalence. It has several etiologies and surgery may be indicated in the presence of neurological deficits or compression syndromes. However, in up to 40% of cases, patients develop worsening of pain and failed back surgery syndrome (FBSS), which is an important cause of chronic pain with high morbidity and disability. In the last two decades, ozone has been shown to be a new therapeutic option for FBSS due to its analgesic and anti-inflammatory properties. Objective: To evaluate the effect of ozone therapy on pain and disability in patients with failed back surgery syndrome. Method: We selected 19 patients undergoing epiduroscopy and injection of ozone. Patients were evaluated preoperatively and 21 days after the procedure, using the following instruments: Visual Analogue Scale (VAS), Brief Pain Inventory, Roland-Morris Questionnaire Disability, Oswestry Disability Index (ODI), Neuropathic Pain Symptom Inventory and Douleur Neuropathique 4. Results: The patients showed significant pain relief, but no improvement was observed in the functional scales. Conclusion: Our results suggest that epidural ozone therapy can be a treatment option in FBSS to reduce the intensity of the pain.

Resumo Introdução: A dor lombar é um dos distúrbios dolorosos de maior prevalência. Tem diversas etiologias e, na presença de déficits neurológicos ou síndromes compressivas, pode ser indicada cirurgia. Entretanto, em até 40% dos casos os pacientes podem evoluir com piora da dor e síndrome dolorosa pós-laminectomia (SDPL), que se constitui em uma importante causa de dor crônica com grande morbidade e incapacidade. Nas últimas duas décadas, o ozônio tem se mostrado uma nova opção terapêutica para a SDPL em virtude das suas propriedades analgésicas e anti-inflamatórias. Objetivo: Avaliar o efeito da ozonioterapia na dor e na incapacidade de pacientes com SDPL. Método: Foram selecionados 19 pacientes, submetidos a epiduroscopia e aplicação de ozônio. Os pacientes foram avaliados no pré-operatório e 21 dias após o procedimento, por meio de Escala Visual Analógica, Inventário Breve de Dor, Questionário Roland-Morris de Incapacidade, Oswestry Disability Scale, Inventário de Sintomas de Dor Neuropática e Questionário de Dor Neuropática. Resultados: Os pacientes apresentaram redução significante nos escores das escalas de avaliação de dor; porém, essa redução não foi observada na avaliação da incapacidade funcional. Conclusão: Os dados obtidos sugerem que a ozonioterapia epidural pode ser uma opção de manejo da SDPL na diminuição da intensidade da dor.

Accuracy of Two Cephalometric Analyses in the Treatment of Patients with Skeletal Class III Malocclusion

The aim of the present study was to compare the treatment plan outlined from the diagnosis obtained by two different cephalometric analyses with the clinical decision made for surgical treatment of patients with skeletal Class III malocclusion. For this purpose, 82 skeletal Class III patients were evaluated, divided into three groups according to the surgical procedure performed for dentofacial deformity correction. Their preoperative cephalometric radiographs were submitted to McNamara and Steiner cephalometric analyses. The association of variables was evaluated by Kappa correlation (α=5%). The agreement between indication of surgical procedures performed based on clinical decision and surgical treatment indicated based on the evaluation of McNamara and Steiner cephalometric analyses were not significant (p=0.609 and p=0.544, respectively). McNamara and Steiner analyses showed reasonable agreement with each other as to the diagnosis, but did not agree with the clinical decision to treat skeletal CIII patients. Both tests were equally inaccurate in the indication of the surgical treatment.

O objetivo deste trabalho foi comparar o plano de tratamento delineado a partir do diagnóstico obtido através de duas análises cefalométricas distintas, com a decisão clínica tomada para o tratamento cirúrgico de pacientes portadores de maloclusão classe III esquelética. Para isto foram avaliados 82 pacientes classe III esquelética, divididos em três grupos de acordo com o procedimento cirúrgico realizado para a correção da deformidade dentofacial. Suas radiografias cefalométricas pré-operatórias foram submetidas à análise cefalométrica de McNamara e de Steiner. A associação das variáveis foi avaliada pelo teste de correlação de Kappa (α=5%). A concordância entre a indicação do tratamento cirúrgico baseado na decisão clínica e o tratamento cirúrgico proposto a partir da avaliação das análises de McNamara e de Steiner não foi significante (p=0,6094 e p=0,5442,respectivamente). As análises de McNamara e de Steiner apresentaram concordância razoável entre si para o diagnóstico, porém não apresentam concordância com a decisão clínica para o tratamento de pacientes CIII esquelética, sendo as duas análises igualmente imprecisas na indicação do tratamento cirúrgico dos pacientes da amostra.