Telemedicine to Timor-Leste: implementing an international cardiac telehealth service during population dislocation, floods and COVID-19.

BACKGROUND: The East Timor Hearts Fund has provided cardiac services in Timor-Leste since 2010, conducting three clinics yearly. AIM: To develop collaborative telehealth services between Australia and Timor-Leste in the context of international border closures due to the COVID-19 pandemic. METHODS: Scoping discussions identified major challenges (structural, patient related and medical system related). At two pilot clinics, patient history, investigation and management were collated. Clinic metrics were compared with an index face-to-face clinic in February 2019. Post-clinic discussions identified areas of success and shortfall in the conduct of the telehealth clinics. RESULTS: Twenty-three patients were reviewed at the online telehealth clinics held onsite at Timorese medical facilities. Compared with an index 2019 clinic, there were markedly lower numbers of new referrals (2 vs 190 patients; 8.7% vs 59.4%). Patients seen at the online clinic were predominantly female (17/23; 73.9%) and Dili based (18/23; 78.3%), with a mean age of 25.9 ± 7.2 years. The majority (12/23; 52.2%) had isolated rheumatic mitral valve disease. Investigations including electrocardiography, pathology, echocardiography and 6-min walk tests were conducted in select patients. Medication advice was provided for 10 (43.5%) patients. Eleven (47.8%) patients were deemed to require urgent intervention. Post-clinic discussions indicated general satisfaction with telehealth clinics, although frustration at the current inability to provide interventional services was highlighted. CONCLUSION: Our pilot telehealth clinics indicate that capacity-building telemedicine can be rapidly implemented in an emergency setting internationally. Clinic design benefits from careful identification and resolution of challenges to optimise flow. Cardiac patients in Timor-Leste have a significant burden of disease amenable to intervention.

Vertical augmentation of the posterior atrophic mandible by interpositional grafts in a split-mouth design: a human tomography evaluation pilot study.

OBJECTIVE: Using computed tomography, to compare vertical and volumetric bone augmentation after interposition grafting with bovine bone mineral matrix (GEISTLICH BIO-OSS® ) or hydroxyapatite/tricalcium phosphate (STRAUMANN® BONECERAMIC) for atrophic posterior mandible reconstruction through segmental osteotomy. MATERIAL AND METHODS: Seven patients received interposition grafts in the posterior mandible for implant rehabilitation. The computed tomography cone beam images were analysed with OsiriX Imaging Software 6.5 (Pixmeo Geneva, Switzerland) in the pre-surgical period (T0), at 15 days post-surgery (T1) and at 180 days post-surgery (T2). The tomographic analysis was performed by a single trained and calibrated radiologist. Descriptive statistics and nonparametric methods were used to analyse the data. RESULTS: There was a significant difference in vertical and volume augmentation with both biomaterials using the technique (P < 0.05). There were no significant differences (P > 0.05) in volume change of the graft, bone volume augmentation, or augmentation of the maximum linear vertical distance between the two analysed biomaterials. CONCLUSIONS: The GEISTLICH BIO-OSS® and STRAUMANN® BONECERAMIC interposition grafts exhibited similar and sufficient dimensional stability and volume gain for short implants in the atrophic posterior mandible.

Intermittent administration of parathyroid hormone improves the repairing process of rat calvaria defects: A histomorphometric and radiodensitometric study.

BACKGROUND: The aim of this study was to evaluate the effects of intermittent treatment of parathyroid hormone (PTH (1-34)) on the bone regeneration of critically-sized rat calvarial bone defects. MATERIAL AND METHODS: Thirty-two male rats were trephined (4mm full-thickness diameter), in the central part of the parietal bones and divided into 2 groups of 16. The PTH group received subcutaneous injections of PTH (1-34) at 40µg/kg, 3 times a week and the control (CTL) group received the vehicle in the same regimen. The rats were sacrificed at 4 weeks post-treatment regimen, the parietal bones were extracted and samples were evaluated through histomorphometry and radiodensitometry. RESULTS: The histological observations showed that the PTH group presented more "island-like" new bone between the defect margins with fibrous tissues than did the CTL group. The PTH group significantly exhibited greater histologic bone formation than did the CTL group (1.5mm ±0.7; 1.9 mm ± 0.6, p<0.05/ for residual bone defect). The radiodensitometry analysis revealed significant differences among the PTH and CTL groups (2.1 Al eq. ±0.04; 1.8Al eq. ±0.06, p<0.05), demonstrating an increase in bone mineral density. The PTH treatment contributed to the bone formation with a higher amount of mineral and/or fibrous tissue when compared with the CTL group. CONCLUSIONS: The results suggest that it was possible to increase the process of bone regeneration by accelerating the healing process in rat calvarial defects through intermittent administration of the PTH treatment.

Anatomic variations and lesions of the mandibular canal detected by cone beam computed tomography.

PURPOSE: The mandibular canal is a significant anatomical structure in implant dentistry, and cone beam computed tomography (CBCT) is an important diagnostic image modality in this field of dentistry. The aim of this study was to evaluate the frequencies of anatomic variations and lesions affecting the mandibular canal in CBCT images of the mandible produced for dental implant planning. METHODS: This cross-sectional study evaluated a sample of 250 CBCT examinations (500 mandibular canals). The inclusion criterion was CBCT examinations of the mandible requested for dental implant planning. The presence of anatomic variations and lesions affecting the mandibular canal was evaluated in the CBCT examinations. Moreover, the buccolingual position of the mandibular canal was evaluated in the molar region and in the ramus region. The CBCT exams were evaluated by one observer. The data were analyzed using descriptive and analytical statistics. The one-way ANOVA test was employed to compare the age between the anatomic variations. A paired t test was used to compare the buccolingual position between the molar region and the ramus region. Differences were considered significant when p values were lower than 0.05. RESULTS: The anatomic variations detected were large-diameter mandibular incisive canal (51.6 %), ramification (12 %), and accessory mental foramen (3.2 %). No difference was observed in the age of the patients between the anatomic variations (p > 0.05). The identified lesions included hypomineralization of the canal walls (20.8 %), idiopathic osteosclerosis (8.8 %), osteolytic lesions (3.2 %), iatrogenic perforation of the mandibular canal (2.8 %), and fibro-osseous lesions (1.6 %). The distance between the mandibular canal and the vestibular cortical bone was higher in the molar region than in the ramus region (p < 0.05). CONCLUSIONS: Anatomic variations and lesions affecting the mandibular canal were common findings in the CBCT images of the mandible produced for dental implant planning. An awareness of these alterations is important for dentistry because some of them might require treatment, change oral surgery planning and difficult inferior alveolar nerve anesthetic block.

Human diprosopus: Case report of a rare congenital abnormality.

Diprosopus is a congenital anomaly in which partial or complete duplication of craniofacial structures occurs. Because it is rare, the mortality rate is high, and information concerning this anomaly is scarce. This study describes a case of human diprosopus in a 9-year-old male individual, who has severe complications associated with the central nervous, cardiovascular, respiratory, and digestive systems. Since birth, he has been monitored in a specialized hospital environment, where he has undergone several surgeries and multidisciplinary treatments. Regarding the craniofacial aspects, he had agenesis of the corpus callosum, floor of the nasal cavity, and floor of the anterior cranial fossa, in addition to the presence of bone dysplasia, ocular hypertelorism and cleft palate with nasal and oral teratoma. Regarding dental characteristics, the patient has duplication of the maxilla, mandible, tongue, and some teeth. After complementary imaging exams, several supernumerary teeth were found, with some being impacted and in complex regions, with an indication for extraction due to the risks of impaction, irruptive deviation, root resorption, and associated cystic or tumoral lesions. Because of the numerous complications, knowledge, and preparation of the entire team is necessary for the correct management of the case.

Is the computed tomography exam important for planning mini-implant installation?

Background: Mini-implants are devices used to provide absolute and temporary anchorage for tooth movement. Objectives: The present study was carried out to compare the use of periapical radiographs and computed tomography (CT) for planning mini-implants performed by orthodontists. Material and Methods: Five radiographs and five CT scans of premolars and molars regions. These were analyzed by ten Orthodontists. Initially (T1), the evaluators indicated the preferred location for the insertion of a mini-implant, as well as the diameter and length of the device, using only a periapical radiograph. After 30 days (T2), the same evaluation was performed. Sixty days later (T3), the orthodontists reassessed the radiographs in association with the CT scans. Finally, after 90 days (T4), the evaluation was performed with the same exams. The comparison of the chosen diameter and length of the mini-implants was performed using the Student's t-test. The evaluation of the chosen insertion sites was analyzed by the Wilcoxon test. For both tests, the level of significance was 5%. The kappa concordance test was also performed for the intra- and inter-examiner evaluations. Results: The results of the study showed substantial or perfect intra-examiner and reasonable to perfect inter-examiner agreement. Considering the length and diameter of the mini-implants, no statistical difference was found between the groups. Regarding the insertion site, more than 20% of the treatment plans were changed when the CT scan was associated. Conclusions: The results showed that the association of a CT scan with radiography frequently leads the professional to change the insertion point for the installation of mini-implants. Key words:Orthodontic anchorage procedures. Mini Dental Implants. Bone Screws. Cone-beam computed tomography. Periapical radiography.

Patient with McCune albright syndrome: Case report and 10 Years of follow-up imaging examination.

The McCune Albright syndrome (MAS) is a rare, multi-system disease composed of the triad of polyostotic fibrous dysplasia of bone (PFDB), café-au-lait skin hyperpigmentation, and endocrine disorders. The diagnosis involves clinical, biochemical and imaging findings, with dentistry playing an important role in MAS, since many patients present DFPO in the craniofacial bones, including the maxilla and mandible, and in view of their dental needs, the correct management of these patients is not only an essential but important area to be investigated. This report presents a case of a patient with McCune Albright Syndrome, the behavior of the disease over a period of 10 years and how imaging exams such as scintigraphy and tomography were important for planning the dental treatment of this patient, since they are fundamental allies for identification and evaluation of the progression and/or stability of the disease. Key words:Craniofacial fibrous dysplasia, cone-beam computed tomography, scintigraphy, imaging diagnosis.

Anatomic variations and lesions of the maxillary sinus detected in cone beam computed tomography for dental implants.

OBJECTIVE: To evaluate the presence of anatomic variations and lesions of the maxillary sinus in cone beam computed tomography (CBCT) of the maxilla required for dental implant planning. MATERIAL AND METHODS: This transversal prevalence study evaluated a sample of 500 consecutive CBCT exams. The inclusion criteria were CBCT exams of the maxilla required for dental implant planning. The CBCT exams were independently evaluated by two oral and maxillofacial radiologists who assessed the presence of anatomic variations and lesions of the maxillary sinus. As most of the CBCT exams did not allow the evaluation of the area close to the maxillary sinus roof, anatomic variations that take place at this site were not assessed. RESULTS: The anatomic variations detected were pneumatization (83.2%), antral septa (44.4%), hypoplasia (4.8%), and exostosis (2.6%). The identified lesions were mucosal thickening (≤3 mm in 54.8% and >3 mm in 62.6%), polypoid lesions (21.4%), discontinuity of the sinus floor (17.4%), air-fluid level (4.4%), bone thickening of the maxillary sinus wall (3.8%), antroliths (3.2%), discontinuity of the sinus lateral wall (2.6%), sinus opacification (1.8%), and foreign body (1.6%). CONCLUSION: Anatomic variations and lesions of the maxillary sinus were common findings in CBCT exams of the maxilla required for dental implant planning. As some of these conditions can modify dental implant planning and must require specialized treatment, its recognition is noteworthy in dental practice, and especially in implantology. The amount and significance of the anatomic variations and lesions detected in this study reinforces the importance of computed tomography in preoperative dental implant planning.

Stylohyoid syndrome: surgical approach.

The best-known cervicopharyngeal pain is Eagle syndrome, in which symptomatic elongation of the stylomandibular process occurs and may be accompanied by stylohyoid ligament calcification. Among the causes of elongation of the styloid process, the following may be mentioned: history of trauma, styloid ligament calcification, and formation of bony tissue in the insertion of the styloid ligament. When there is no history of trauma or surgery, it is called the stylohyoid syndrome. In the current study, the clinical case of 34-year-old woman is reported, complaining of pain in the region of the neck, without any history of neck surgery or trauma. A panoramic radiograph and computed tomographic scan showed bilateral elongation of the styloid process. Extraoral surgical intervention was the treatment of choice. It is important to point out that dentists should be aware of this condition to contribute to a better diagnosis and therapeutic procedure.

Impact of orthodontic correction of dental crowding with pre-molar extraction in the anterior mandible evaluated by cone-beam computed tomography.

INTRODUCTION: To evaluate, by cone-beam computed tomography (CBCT), the change in thickness and height of the alveolar bone and interdental septum in the anterior mandible after orthodontic treatment for dental crowding using tooth extraction. MATERIAL AND METHODS: The sample consisted of 48 mandibular incisors from adult patients who presented with Class I malocclusion and required orthodontic treatment with the extraction of mandibular premolars. CBCT images were taken before starting the treatment (T1) and three months after treatment (T2). The following measurements were evaluated: width and height of the alveolar bone and the interdental septum, the distance between the cementoenamel junction and the bone ridges (F-CEJ-MBC and L-CEJ-MBC), as well as the vertical positioning and inclination of the incisor, using the Lingual Plane as the reference point. The paired Student's t-test and Pearson correlation were used with a significance level of 5%. RESULTS: A significant increase was observed in the distance L-CEJ-MBC, which shows the appearance of bone dehiscence. The degree of dental crowding was not a risk factor for the development of dehiscence. The decrease in the incisor inclination and intrusion was related to the formation of dehiscence on the lingual surface. CONCLUSION: The variation in the incisor's inclination and intrusion during the treatment of dental crowding using tooth extraction are related to the formation of bone dehiscence on its lingual surface.

An Imaging Perspective to Multiple Calcifying Hyperplastic Dental Follicles - A Report of Three Cases.

Rationale: Multiple Calcifying Hyperplastic Dental Follicle (MCHDF) is an extremely rare condition and is characterised by multiple impacted permanent teeth, with enlarged dental follicles, containing calcifications. Cone-beam computed tomography (CBCT) is the ideal exam for the identification of this condition. Patient Concerns: The present study seeks to compare the behaviour of MCHDF in imaging exams of three clinical cases with their MCHDF imaging diagnoses, in which a change about tooth eruption was observed. Diagnosis: CBCT proved to be an important diagnostic tool for MCHDF, as it is able to identify these small calcifications, as well as measure the size of the follicle.Treatment Outcomes and Take. Away Lessons: With a consistent imaging diagnosis, less invasive treatments become a viable option for this condition, since functional and aesthetic involvement is common in these patients, who often tend to be quite young.

Temporal trend of tracheostomy in patients hospitalized in the Brazilian National Unified Health System from 2011 to 2020.

OBJECTIVE: to analyze the temporal trend in the tracheostomy use in patients hospitalized by the Sistema Único de Saúde in Brazil from 2011 to 2020. METHODS: ecological observational study with a quantitative approach and including the Brazilian population aged 20 or over that were admitted by Sistema único de Saúde and had a record of performing the tracheostomy procedure at any time during hospitalization. RESULTS: 113.569.570 Hospitalizations studied were identified 172.456 tracheostomies realized in Brazil (0,15%). The average tax of this procedure showed a downward trend during the study procedure. The highest tracheostomy rate was found in the southern region, and the most affected age group was 80 years old or more. The average rate of tracheostomy in males was 1.8 times higher than in females. The average mortality and lethality rates of admissions with tracheostomy were 3.36 and 28.57% in the period but showed a tendency to decrease in the period studied. The main causes associated with the performance of tracheostomy were respiratory, oncological, and external causes. Respiratory causes contributed to 73% of the total procedures performed in the analyzed period. CONCLUSION: the average mortality and lethality rates of hospitalizations with tracheostomy in Brazil were 3.36 and 28.57%, but showed a downward trend in the period.

Volumetric and linear evaluation of the sphenoidal sinus of a Brazilian population, in cone beam computed tomography.

The determination of sex from skeletal remains has been widely used in biological profile reconstruction since these are some of the last structures to perish after death. The sphenoid sinus is located deeply in the skull and is enveloped by diverse structures within the sphenoid body. It is, therefore, less predisposed to injuries and/or pathological changes. The aim of this study is to evaluate the possibility of determining sex in a Brazilian population by means of linear and volumetric measurements of the sphenoid sinus, in addition to identifying and quantifying the presence of extensions of this sinus in cone beam computed tomography (CBCT) scans. In total 268 CBCT scans were analysed, from patients aged between 22 and 70 years old, of which 145 were female, and 123 were male. The images, representative of a Brazilian population, were selected by a dental radiologist from a CBCT image bank. The volumetric measurements were made by means of the segmentation software ITK-SNAP 3.0® and the linear inferio-superior, latero-lateral and anteroposterior measurements, as well as the presence of extensions of the sphenoidal sinus, were made using the CS Imaging Software®. The results of this study suggested that when comparing men and women, there were no statistical differences in the linear measurements and extensions of the sphenoidal sinus, although the values were considerable in the extensions for the pterygoid processes and greater wings of the sphenoid bone, particularly in women. However, there was a statistically significant difference when the sphenoidal sinus volume was compared, as it was larger for men (11.364 mm³ ± 4.229 mm³) than for women (10.000 mm³ ± 3.615 mm³). In summary, the sphenoidal sinus volumetric measurements in CBCT exams are useful for determining the sex of unknown individuals.

New procedures for the confirmation of brain death in Brazil: results from the Central Estadual de Transplantes de Santa Catarina. / Novos procedimentos de confirmação da morte encefálica no Brasil: resultados da Central Estadual de Transplantes de Santa Catarina.

OBJECTIVE: To analyze the impact of Resolution 2.173/2017 of the Federal Council of Medicine on results from the Central Estadual de Transplantes de Santa Catarina. METHODS: This was a cross-sectional observational study of medical records of all patients (1,605) with suspected brain death notified to the Central Estadual de Transplantes de Santa Catarina; for this study, procedures to confirm this diagnosis were initiated between July 2016 and December 2017 and between January 2018 and June 2019. The median duration of the protocol in each period was considered for the comparison between the intervals. The collected data were transformed into rates (per million population). The mean rates for the periods before and after the implementation of the protocol were analyzed by Student's t-test, and qualitative variables were analyzed by Pearson's chi-squared test. RESULTS: The mean duration of brain death confirmation procedures decreased more than 1 hour in the second period compared to the first period, with statistical significance (p = 0.001). The rates of harvested livers and transplanted pancreas, the number of notifications by hospital size and the rate of cardiac arrest in the macro-region of the Itajaí Valley were significantly different between the two periods. CONCLUSION: In the period after the new resolution on brain death, there was a reduction in the duration for diagnosis. However, other indicators did not change significantly, providing evidence for the multidimensional nature of the organ transplantation process in Santa Catarina and the need for further studies to better understand and optimize the process.

OBJETIVO: Analisar o impacto da resolução 2.173/2017 do Conselho Federal de Medicina nos resultados da Central Estadual de Transplantes de Santa Catarina. MÉTODOS: Estudo observacional do tipo transversal, com dados de prontuário de todos os pacientes (1.605) com suspeita de morte encefálica notificados à Central Estadual de Transplantes de Santa Catarina e que iniciaram procedimentos para confirmação desse diagnóstico entre julho de 2016 e dezembro de 2017 e entre janeiro de 2018 e junho de 2019. A mediana do tempo de duração do protocolo em cada período foi considerada para a comparação entre os intervalos. Os dados coletados foram transformados em taxas (por milhão de população). As taxas médias dos períodos antes e depois da implantação do protocolo foram analisadas pelo teste t de Student, e as variáveis qualitativas foram analisadas pelo teste do qui-quadrado de Pearson. RESULTADOS: O tempo médio de duração dos procedimentos de confirmação de morte encefálica apresentou redução de mais de 1 hora no segundo período em relação ao primeiro, com significância estatística (p = 0,001). As taxas de fígados captados e de pâncreas transplantados, o número de notificações por porte hospitalar e a taxa de parada cardiorrespiratória na macrorregião do Vale do Itajaí também apresentaram diferenças com significância estatística na comparação entre os dois períodos. CONCLUSÃO: No período após a nova resolução sobre morte encefálica, houve redução do tempo de duração do diagnóstico. Contudo, outros indicadores não sofreram alteração significativa, evidenciando a natureza multidimensional do processo de transplante de órgãos em Santa Catarina e a necessidade de mais estudos para a melhor compreensão e otimização do processo.

Temporal Trend of Near Miss and its Regional Variations in Brazil from 2010 to 2018.

Cases of maternal near miss are those in which women survive severe maternal complications during pregnancy or the puerperium. This ecological study aimed to identify the temporal trend of near-miss cases in different regions of Brazil between 2010 and 2018, using data from the Hospital Information System (HIS) of the Unified Brazilian Health System (SUS, in the Portuguese acronym). Hospital admission records of women between 10 and 49 years old with diagnosis included in the 10th Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) and codes indicating near-miss events were selected. From 20,891,040 admissions due to obstetric causes, 766,249 (3.66%) near-miss cases were identified, and 31,475 women needed admission to the intensive care unit (ICU). The cases were found to be more predominant in black women over 35 years old from the North and Northeast regions. There was a trend of increase in near-miss rates of ∼ 13.5% a year during the period of the study. The trend presented a different behavior depending on the level of development of the region studied. The main causes of near miss were preeclampsia (47%), hemorrhage (24%), and sepsis (18%).

Casos de near miss materna são aqueles em que as mulheres sobrevivem a graves complicações maternas durante a gravidez ou o puerpério. Este estudo ecológico teve como objetivo identificar a tendência temporal de casos de near miss em diferentes regiões do Brasil entre 2010 e 2018, utilizando dados do Sistema de Informações Hospitalares (SIH) do Sistema Único de Saúde (SUS). Foram selecionados registros de internação de mulheres entre 10 e 49 anos com diagnóstico incluído na 10ª revisão da Classificação Internacional de Doenças e Problemas Relacionados à Saúde (CID-10) e códigos indicando eventos de near miss. Das 20.891.040 internações por causas obstétricas, 766.249 (3,66%) casos de near miss foram identificados, e 31.475 mulheres necessitaram de internação na unidade de terapia intensive (UTI). Constatou-se que os casos são mais predominantes em mulheres negras com mais de 35 anos da região Norte e Nordeste. Houve uma tendência de aumento nas taxas de near miss de aproximadamente 13,5% ao ano durante o período do estudo. A tendência apresentou um comportamento diferente, dependendo do nível de desenvolvimento da região estudada. As principais causas de near miss foram pré-eclâmpsia (47%), hemorragia (24%), e sepse (18%).

Bone changes in the mandibular incisors after orthodontic correction of dental crowding without extraction: A cone-beam computed tomographic evaluation.

PURPOSE: This study aimed to evaluate changes of the alveolar bone and interdental bone septum of the mandibular incisors through cone-beam computed tomography (CBCT) after orthodontic treatment of mandibular dental crowding without dental extraction. MATERIALS AND METHODS: The sample consisted of 64 CBCT images (32 pre-treatment and 32 post-treatment) from 32 adult patients with class I malocclusion and an average age of 23.0±3.9 years. The width and height of the alveolar bone and interdental septum, the distance between the cementoenamel junction (CEJ) and the facial and lingual bone crests, and the inclination of the mandibular incisors were measured. RESULTS: The distance between the CEJ and the marginal bone crest on the facial side increased significantly (P<0.05). An increased distance between the CEJ and the bone crest on the facial and lingual sides showed a correlation with the irregularity index (P<0.05); however, no significant association was observed with increasing mandibular incisor inclination (P>0.05). The change in the distance between the CEJ and the marginal bone crest on the facial side was correlated significantly with bone septum height (P<0.05). CONCLUSION: Bone dehiscence developed during the treatment of crowding without extraction only on the incisors' facial side. Increasing proclination of the mandibular incisor was not correlated with bone dehiscence. The degree of dental crowding assessed through the irregularity index was associated with the risk of developing bone dehiscence. The interdental septum reflected facial marginal bone loss in the mandibular incisors.

Case Reports of a New Method for Differential Diagnosis of Calcified Carotid Artery Atheroma.

Introduction. Early diagnosis of calcified atheromas may decrease morbidity and mortality caused by brain and cardiovascular diseases, in which atherosclerosis is the main etiological factor of these pathologies. Dental examinations with the aim of detecting this pathology have been in progress since 1981, such as panoramic radiography, considered the most widely studied method for this diagnosis. However, some limitations of this exam have been reported with reference to inability to visualize the cervical region and difficulty of establishing a precise diagnosis because of many structures and calcifications that have similar radiographic characteristics. Case Report. The present study to describe a dental radiographic technique for establishing the differential diagnosis of calcified atheromas regarding other calcifications and reporting 3 clinical cases that demonstrate its effectiveness in different clinical situations. Discussion. Manzi Projection can promote a differential diagnosis of calcified atheromas in dental practice and consequently subsidize the clinician for referring the patient to the physician.

Automated Identification of Dental Implants Using Artificial Intelligence.

PURPOSE: To develop and evaluate the accuracy of a computer-assisted system based on artificial intelligence for detecting and identifying dental implant brands using digital periapical radiographs. MATERIALS AND METHODS: A total of 1,800 digital periapical radiographs of dental implants from three distinct manufacturers (f1 = 600, f2 = 600, and f3 = 600) were split into training dataset (n = 1,440 [80%]) and testing dataset (n = 360 [20%]) groups. The images were evaluated by software developed by means of convolutional neural networks (CNN), with the aim of identifying the manufacturer of the dental implants contained in them. Accuracy, sensitivity, specificity, positive and negative predictive values, and the receiver operating characteristic (ROC) curve were calculated for detection and diagnostic performance of the CNN algorithm. RESULTS: At the final epoch (25), system accuracy values of 99.78% were obtained for group training data, 99.36% for group testing data, and 85.29% for validation data. The latter value corresponded to the actual accuracy of carrying out the system learning process. CONCLUSION: This study demonstrated the effectiveness of CNN for identifying dental implant manufacturers, which was proven to be a precise method of great clinical significance.

Risk rates of workplace accidents in Brazil: effect of the Accidental Prevention Factor (APF)? / Taxas de risco de acidentes de trabalho no Brasil: efeito do Fator Acidentário de Prevenção (FAP)?

Historically, the conflict of interests between employers and workers obliged the State to assume the role of regulating this relationship, instituting laws and overseeing the application of health and safety standards at work. The Accident Prevention Factor (FAP) is one of these guidelines. This article aims to analyze the correlations between the FAP and the risk rate for occupational accidents in Brazil in the period between 2006 and 2016. Ecological study, which analyzed the occupational accidents, registered in the Brazilian Social Security database in the period between 2006 and 2016. The analysis included the calculation of accident risk rates according to the Brazilian regions, divisions of the CNAE, reason/situation, ICD-10 chapters, sex and age. The comparison between results from the two periods was performed using the average risk rates from the two periods using Student t test, Spearman correlation and beta value. Basically, all rate series analyzed had a strong downward trend in the FAP period, contrary to what occurred in the immediately previous period.

A ocorrência de acidentes e de doenças relacionadas ao trabalho são expressões concretas da exposição dos trabalhadores aos riscos presentes no ambiente laboral. Historicamente o conflito de interesses entre empregadores e trabalhadores obrigou o Estado a assumir a função de regulação desta relação, instituindo leis e fiscalizando a aplicação das normas de saúde e segurança no trabalho. O Fator Acidentário de Prevenção (FAP) é uma dessas estratégias. O objetivo deste artigo é analisar a correlação entre as taxas de risco de acidentes de trabalho no Brasil antes (2006-2009) e depois (2010-2016) da vigência do FAP. Estudo ecológico com análise temporal de séries de taxas de acidentes de trabalho registrados nas bases de dados da Previdência Social no período 2006 e 2016. A análise incluiu o cálculo das taxas de risco de acidentes segundo grandes regiões brasileiras, divisões do CNAE, motivo/situação, capítulos do CID-10, sexo e idade. A comparação entre os resultados dos dois períodos foi realizada utilizando-se as taxas de risco médias com a aplicação do teste t de Student e da correlação de Spearman. Basicamente todas as séries de taxas analisadas obtiveram forte tendência de redução no período de vigência do FAP, ao contrário do que ocorreu no período imediatamente anterior.