Dental and composite resin discoloration induced by different hydraulic calcium silicate-based cements: two-year in vitro assessment

Abstract Few long-term studies assess the discoloration induced by hydraulic calcium silicate-based cement on dental structures. In addition, as far as we know, no long-term study has assessed the discoloration induced by these cement on composite resin. Objective This in vitro study aimed to assess, during a period of two years, the discoloration potential of different hydraulic calcium silicate-based cements (hCSCs) on the enamel/dentin structure and composite resin restoration. Methodology A total of 40 enamel/dentin discs were obtained from bovine incisors, and 40 composite resin discs (10 mm in diameter × 2 mm thick) were fabricated. A 0.8 mm-deep cavity was made in the center of each disc and filled with the following hCSCs (n=10): Original MTA (Angelus); MTA Repair HP (Angelus); NeoMTA Plus (Avalon); and Biodentine (Septodont). An initial color measurement was performed (T0 - baseline). After 7, 15, 30, 45, 90, 300 days, and two years, new color measurements were performed to determine the color (ΔE00), lightness (ΔL'), chroma (ΔC'), hue differences (ΔH'), and whiteness index (WID). Results For enamel/dentin, the ΔE00 was significant among groups and periods (p<0.05). NeoMTA Plus had the greatest ΔE00. The NeoMTA Plus group had the greatest ΔE00 after two years for composite resin. Significant reduction in lightness was observed for all groups after two years (p<0.05). The most significant WID values were observed after 30 days for Biodentine (enamel/dentin) and MTA Repair HP groups (composite resin) (p<0.05). Conclusions The hCSCs changed the colorimetric behavior of both substrates, leading to greater darkening over time. The Bi2O3 in the Original MTA seems relevant in the short periods of color change assessment.

Pelvic inflammatory disease hospitalizations in Brazil: time trend from 2000 to 2019 / Internações por doença inflamatória pélvica no Brasil: tendência temporal de 2000 a 2019

Abstract Objectives: to evaluate the temporal trend of hospitalizations for pelvic infammatory disease in Brazil and its regions between 2000 and 2019. Methods: longitudinal ecological study with data from the Hospital Information System. The analysis of temporal trends in hospitalization rates by age group was performed using segmented linear regression (joinpoint regression). Both annual percent change total and by age groups were estimated for Brazil and each region. Results: Brazil had an average reduction of 5.2% per year in the period and the age groups most affected were 20 to 29 and 30 to 39 years. North region had the highest rates and South and Southeast regions, the lowest. Midwest region had the largest annual average reduction (8.1%), followed by the Northeast (5.7%), Southeast (5.0%), North (4.6%) and South (4.3 %). The only age group that showed a significant increase was that of 10 to 19 years in the Southeast in the period from 2008 to 2019 (0.9%) and in the Northeast in the period from 2014 to 2019 (3.3%). Conclusions: hospitalization due to pelvic infammatory disease has significantly decreased in Brazil. The increase observed for adolescents in the Southeast and Northeast in the most recent period points to problems in the prevention and control of sexually transmitted infections in this age group.

Resumo Objetivos: avaliar a tendência temporal de internações por doença infamatória pélvica no Brasil e regiões entre 2000 e 2019. Métodos: estudo ecológico longitudinal com dados do Sistema de Informações Hospitalares. A análise das tendências temporais das taxas de internação hospitalar por faixas etárias foi feita por regressão linear segmentada (joinpoint regression). Foram estimadas variações percentuais anuais gerais e por faixas etárias para o Brasil e cada região. Resultados: o Brasil teve uma redução média de 5,2% ao ano no período e as faixas etárias mais afetadas foram 20 a 29 e 30 a 39 anos. A região Norte apresentou as maiores taxas e as regiões Sul e Sudeste as menores. A região Centro-Oeste teve a maior redução média anual (8,1%), seguida das regiões Nordeste (5,7%), Sudeste (5,0%), Norte (4,6%) e Sul (4,3%). A única faixa etária que apresentou um aumento significativo foi a de 10 a 19 anos nas regiões Sudeste no período de 2008 a 2019 (0,9%) e no Nordeste no período de 2014 a 2019 (3,3%). Conclusões: a internação hospitalar por doença infamatória pélvica reduziu no Brasil de forma importante. O aumento verificado para adolescentes no Sudeste e Nordeste no período mais recente aponta para problemas na prevenção e controle das infecções sexualmente transmissíveis nesta faixa etária.

O papel da ultrassonografia na doença trofoblástica gestacional / The role of ultrasonography in gestational trophoblastic disease

A doença trofoblástica gestacional (DTG) agrupa um conjunto de anomalias do desenvolvimento trofoblástico, que incluem formas clínicas benignas como a mola hidatiforme completa e parcial, o nódulo do sítio placentário atípico e o sítio trofoblástico exagerado, e malignas, caracterizando a neoplasia trofoblástica gestacional (NTG). De modo geral, seu diagnóstico precoce antecipa complicações clínicas que podem estar associadas a near miss obstétrico. Diante da suspeição clínica, é a ultrassonografia (US) precoce o exame de escolha pa ra o diagnóstico, associado à dosagem sérica de gonadotrofina coriônica humana, capaz de minimizar a ocorrência de complicações clínicas associadas à gravidez molar. Nos casos de NTG, é a US também de grande valia para estadiamento, avaliação de prognóstico e acompanhamento da mulher tratada para DTG. Este estudo faz uma revisão sobre o papel da US na DTG, sendo importante para familiarizar os tocoginecologistas com essa doença e salientar o papel da US consoante as melhores práticas clínicas.(AU)

Gestational trophoblastic disease (GTD) includes a set of trophoblastic developmental anomalies, which include benign forms such as complete and partial hydatidiform mole, atypical placental site nodule and exaggerated trophoblastic site, and malignant forms, characterizing gestational trophoblastic neoplasia (GTN). In general, its early diagnosis anticipates clinical complications that could be associated with obstetric near miss. In view of clinical suspicion, early ultrasonography (US) and serum levels of human chorionic gonadotropin are the best diagnostic screening techniques, able to minimizing the occurrence of medical complications associated with molar pregnancy. In cases of GTN, US is also of great value for staging, assessment of prognosis and follow-up of women treated for GTN. This study reviews the role of US in GTD, being important to familiarize tocogynecologists with this disease and highlight the role of US according to best clinical practices to minimize the morbidity of these patients and maximize the remission rates of this disease.(AU)

Associação entre segregação residencial racial e mortalidade por homicídio nos municípios de Minas Gerais, Brasil / Association between racial residential segregation and homicide mortality in municipalities in Minas Gerais, Brazil

Resumo O objetivo desse artigo é avaliar a associação entre segregação residencial racial e mortalidade por homicídios em Minas Gerais (MG). Trata-se de estudo ecológico, com os municípios de MG como unidades de análise. O desfecho foi óbitos por homicídio ocorridos de 2008 a 2012 e a exposição a medida de segregação residencial índice de interação racial, estimada para 2010 a partir dos dados do censo demográfico; outras covariáveis foram renda média per capita e índice de Gini. As variáveis foram apresentadas em mapas temáticos e a associação entre elas foi investigada por modelos hierárquicos bayesianos. Houve associação negativa entre o índice de interação racial e a mortalidade por homicídios (coeficiente=-1,787; IC95%=-2,459; -1,119), em modelo ajustado pela renda per capita. Os municípios de MG com maior interação racial tiveram em média uma menor mortalidade por homicídios.

Abstract This article aims to evaluate the association between racial residential segregation and homicide mortality in the state of Minas Gerais (MG), Brazil. We conducted an ecological study in which the units of analysis were municipalities in MG. The outcome was homicide deaths between 2008 and 2012 and the exposure variable was residential segregation measured using the racial interaction index, calculated using data from the 2010 Demographic Census. The covariables were per capita family income and the Gini index. The variables were presented in tables and thematic maps and associations were measured using Bayesian hierarchical models. The results of the model adjusted for per capita family income showed a negative association between the racial interaction index and homicide mortality (coefficient=-1.787; 95%CI=-2.459; -1.119). Homicide mortality was lower in municipalities with higher levels of racial interaction.

Collagen Type III as a Possible Blood Biomarker of Fibrosis in Equine Endometrium.

Collagen pathological deposition in equine endometrium (endometrosis) is responsible for infertility. Kenney and Doig's endometrial biopsy histopathological classification is the gold standard method for endometrosis evaluation, whereby blood biomarkers identification would be less invasive and could provide additional information regarding endometrosis diagnosis and fertility prognosis. This study aimed to identify blood biomarkers for endometrosis diagnosis (42 mares were used in experiment 1), and fertility assessment (50 mares were used in experiment 2). Reproductive examination, endometrial biopsy histopathological classification (Kenney and Doig) and blood collection were performed. Endometrium and serum collagen type I (COL1) and type III (COL3), and hydroxyproline concentrations were measured (ELISA). Serum COL3 cut-off value of 60.9 ng/mL allowed healthy endometria (category I) differentiation from endometria with degenerative/fibrotic lesions (categories IIA, IIB or III) with 100% specificity and 75.9% sensitivity. This cut-off value enabled category I + IIA differentiation from IIB + III (76% specificity, 81% sensitivity), and category III differentiation from others (65% specificity, 92.3% sensitivity). COL1 and hydroxyproline were not valid as blood biomarkers. Serum COL3 cut-off value of 146 ng/mL differentiated fertile from infertile mares (82.4% specificity, 55.6% sensitivity), and was not correlated with mares' age. Only COL3 may prove useful as a diagnostic aid in mares with endometrial fibrosis and as a fertility indicator.

Immunogenicity, safety, and antiphospholipid antibodies after SARS-CoV-2 vaccine in patients with primary antiphospholipid syndrome.

OBJECTIVE: Coronavirus disease 19 (COVID-19) has an increased risk of coagulopathy with high frequency of antiphospholipid antibodies (aPL). Recent reports of thrombosis associated with adenovirus-based vaccines raised concern that SARS-CoV-2 immunization in primary antiphospholipid syndrome (PAPS) patients may trigger clotting complications. Our objectives were to assess immunogenicity, safety, and aPL production in PAPS patients, after vaccinating with Sinovac-CoronaVac, an inactivated virus vaccine against COVID-19. METHODS: This prospective controlled phase-4 study of PAPS patients and a control group (CG) consisted of a two-dose Sinovac-CoronaVac (D0/D28) and blood collection before vaccination (D0), at D28 and 6 weeks after second dose (D69) for immunogenicity/aPL levels. Outcomes were seroconversion (SC) rates of anti-SARS-CoV-2 S1/S2 IgG and/or neutralizing antibodies (NAb) at D28/D69 in naïve participants. Safety and aPL production were also assessed. RESULTS: We included 44 PAPS patients (31 naïve) and 132 CG (108 naïve) with comparable age (p=0.982) and sex (p>0.999). At D69, both groups had high and comparable SC (83.9% vs. 93.5%, p=0.092), as well as NAb positivity (77.4% vs. 78.7%, p=0.440), and NAb-activity (64.3% vs. 60.9%, p=0.689). Thrombotic events up to 6 months or other moderate/severe side effects were not observed. PAPS patients remained with stable aPL levels throughout the study at D0 vs. D28 vs. D69: anticardiolipin (aCL) IgG (p=0.058) and IgM (p=0.091); anti-beta-2 glycoprotein I (aß2GPI) IgG (p=0.513) and IgM (p=0.468). CONCLUSION: We provided novel evidence that Sinovac-CoronaVac has high immunogenicity and safety profile in PAPS. Furthermore, Sinovac-CoronaVac did not trigger thrombosis nor induced changes in aPL production.

Segregação Residencial Racial e Mortalidade por Câncer do Colo do Útero nas Regiões de Saúde do Brasil / Segregación Residencial Racial y Mortalidad por Cáncer del Cuello Uterino en las Regiones de Salud de Brasil / Racial Residential Segregation and Cervical Cancer Mortality in Health Regions of Brazil

Introdução: O câncer do colo do útero (CCU) é um dos mais frequentes em mulheres e tem sido relacionado a baixos níveis de desenvolvimento. Objetivo: Investigar a associação entre a taxa de mortalidade padronizada por CCU e a segregação residencial racial. Método: Estudo ecológico que teve como unidade de análise as 438 Regiões de Saúde do Brasil em 2010. O desfecho foi a taxa de mortalidade por CCU em mulheres, padronizada por idade, por 100 mil mulheres. A exposição de interesse foi o Índice de Interação Racial (IIR), uma medida de segregação residencial da dimensão uniformidade, estimada a partir de dados do Censo Demográfico 2010 agregados por setores censitários. O Índice de Desenvolvimento Humano (IDH) foi covariável de controle. A associação entre as variáveis foi analisada por modelo de regressão linear. Resultados: A taxa de mortalidade por CCU teve os maiores valores nas Regiões de Saúde do Norte e do Centro-Oeste, e os menores no Sul e no Sudeste, padrão diferente do IDH e do IIR, com valores menores no Norte e no Nordeste e maiores no Sul e no Sudeste. O IIR teve associação negativa com a taxa de mortalidade; no modelo ajustado pelo IDH, cada aumento de 0,1 no IIR esteve associado à diminuição de 0,6 óbitos por 100 mil mulheres. Conclusão: A segregação residencial racial está associada à mortalidade por CCU. Os indicadores de segregação residencial deveriam ser considerados para inclusão em futuros estudos epidemiológicos como importantes determinantes contextuais do processo saúde-doença

Introduction: Cervical cancer (CC) is one of the most common cancers in women and has been associated with low levels of development. Objective: To investigate the association between standardized CC mortality rate and racial residential segregation. Method: An ecological study that had as unit of analysis the 438 Health Regions in Brazil in 2010. The outcome was the mortality rate by CC in women, standardized by age, per 100,000 women. The exposure of interest was the Racial Interaction Index (RII), a measure of residential segregation in the uniformity dimension, estimated from 2010 Census data aggregated by census tracts. The Human Development Index (HDI) was a control covariate. The association between variables was analyzed using a linear regression model. Results: The mortality rate due to CC had the highest values in the health regions of the North and Midwest and the lowest in the South and Southeast, a pattern different from the HDI and RII, with lower numbers in the North and Northeast and higher in the South and Southeast. The RII had a negative association with the mortality rate; in the model adjusted by the HDI, each increase of 0.1 in the RII was associated with a decrease of 0.6 deaths per 100,000 women. Conclusion: Residential racial segregation is associated with mortality by CC. Residential segregation indicators should be considered for inclusion in future epidemiological studies outcomes as important contextual determinants of the health-disease process

Introducción: El cáncer de cuello uterino (CCU) es uno de los más frecuentes en las mujeres y se ha relacionado con bajos niveles de desarrollo. Objetivo: Investigar la asociación entre la tasa de mortalidad estandarizada de CCU y la segregación racial residencial. Método: Estudio ecológico que tuvo como unidad de análisis las 438 Regiones de Salud de Brasil en 2010. El resultado fue la tasa de mortalidad por CCU en mujeres, estandarizada por edad, por 100.000 mujeres. La exposición de interés fue el Índice de Interacción Racial (IIR), una medida de segregación residencial en la dimensión de uniformidad, estimada a partir de los datos del censo de 2010 agregados por secciones censales. El Índice de Desarrollo Humano (IDH) fue una covariable de control. La asociación entre variables se analizó mediante un modelo de regresión lineal. Resultados: La tasa de mortalidad por CCU tuvo los valores más altos en las Regiones de Salud del Norte y el Medio Oeste y los más bajos en el Sur y el Sudeste, un patrón diferente al del IDH y el IIR, con valores más bajos en el Norte y el Noreste y más altos en el Sur y el Sudeste. El IIR se asoció negativamente con la tasa de mortalidad; en el modelo ajustado por el IDH, cada aumento de 0,1 en el IIR se asoció con una disminución de 0,6 muertes por cada 100.000 mujeres. Conclusión: La segregación racial residencial está asociada con la mortalidad por CCU. Los indicadores de segregación residencial deberían considerarse para su inclusión en futuros estudios epidemiológicos como importantes determinantes contextuales del proceso salud-enfermedad

Association of individual aortic leaflet calcification on paravalvular regurgitation and conduction abnormalities with self-expanding trans-catheter aortic valve insertion.

BACKGROUND: Complication rates of paravalvular aortic regurgitation (PVR) and permanent pacemaker insertion remain high in patients undergoing trans-catheter aortic valve insertion for severe aortic stenosis. The spatial distribution of calcium between individual aortic valve leaflets, and its potential role in these complications is gaining interest. We aimed to assess the accuracy of individual aortic valve leaflet calcium quantification, and to determine its effect on the frequency of these complications. METHODS: This was a retrospective study of 251 patients who underwent trans-catheter aortic valve insertion using the Evolut RTM valve. The off-line Terarecon software platform was used for Agatston scoring the short axis views. RESULTS: There was a correlation between the sum of the individual leaflet and the total aortic valve calcium score. There was a univariate association between an increase [per 100 Agatston unit (AU)] in both right coronary leaflet (RCL) and left coronary leaflet (LCL) calcium with the risk of PVR. There was an association between an increase in LCL calcium score (per 100 AU) and need for post-implantation balloon aortic valvuloplasty (BAV). There was no association between individual leaflet calcification on the risk of permanent pacemaker insertion. CONCLUSIONS: This study supports the idea that a quantifiable and reproducible method of individual valve leaflet calcification score may serve as an independent risk factor for paravalvular regurgitation, beyond visual assessment of asymmetry. However, the same may not be true of spatial calcium distribution and permanent pacemaker implantation (PPI).

AORTIC ARCH VARIANT AND COMMON CAROTID ARTERY AGENESIS.

An 83-year-old woman with a history of ileocecal appendix cancer underwent a staging thoracic-abdominal-pelvic computed tomography. Two extremely rare anatomic variants were identified: the right vertebral artery presented an anomalous origin from the aortic arch distal to the left subclavian artery and a retro-esophageal course; right common carotid artery agenesis.

Avaliação da Ação de Vigilância à Morbi-mortalidade Infantil na periferia de Belo Horizonte, Minas Gerais / Assessment of child Morbidity and Mortality in the Outskirts of Belo Horizonte in the State of Minas Gerais

OBJETIVOS: avaliar a Ação de Vigilância à Morbi-mortalidade Infantil no Centro de Saúde (CS) São Marcos e verificar a associação entre critérios de risco - baixo peso ao nascer (RNBP), mães não escolarizadas e/ou adolescentes - e variáveis como crescimento e aleitamento materno. MÉTODOS: estudo analítico tipo coorte prospectivo. Os recém-nascidos (RN) de risco, nascidos entre janeiro de 1996 a dezembro de 1998, foram observados quanto à utilização do CS após busca ativa, comparando-os com controles. Após 12 meses, verificou-se a sua evolução em relação ao crescimento e duração da amamentação. RESULTADOS: foram identificados 199 RN de risco, os quais apresentaram maior procura do CS. Foram acompanhados 131 riscos e 88 controles. Não houve diferença da duração da amamentação entre os grupos. Ao final do acompanhamento, os RNBP apresentavam menores pesos e comprimentos.(p <0,01). Registraram-se 17 óbitos, a maioria neonatal. O risco relativo de óbito para os RNBP no primeiro ano foi 69,81. CONCLUSÕES: a Ação de Vigilância à Morbi-Mortalidade Infantil representou avanço ao implementar estratégias de identificação, captação e acompanhamento de crianças de risco. Todavia, os esforços devem buscar atuação mais precoce e ampla, principalmente para os RNBP