Systemic and oral health status of older adult inpatients in an intensive care unit / Avaliação da condição sistêmica e oral de idosos internados em uma unidade de terapia intensiva

Objective: To assess the systemic and oral health status of geriatric patients hospitalized in an intensive care unit (ICU). Methods: A cross-sectional descriptive study of a convenience sample of 78 older ICU inpatients. A single calibrated examiner collected demographic and clinical data by analyzing patients' records and assessing their oral cavities. Descriptive data analysis was performed to a 5.00% significance level. All patients provided informed consent and were conscious during the oral health assessment. Results: The mean age was 77.69 years and 51.28% of the sample were male. The main reasons patients were admitted to the ICU investigated were postoperative conditions (23.08%) and cardiac abnormalities (20.51%). Systemic arterial hypertension (69.23%) was the most prevalent comorbidity and patients were being treated with anticoagulants (57.69%) and antimicrobials (53.85%). Most patients did not receive oral care (64.10%), while 29.49% of them received it only once, and 57.69% were denture users. The mean decayed, missing, and filled teeth index was 23.74 (17.44 missing teeth, on average) and majorities had tongue biofilm (71.79%) and unsatisfactory oral hygiene during their time in hospital (84.62%). Conclusion: The oral status of hospitalized geriatric patients was characterized by poor hygiene and edentulism

Objetivos: Avaliar o estado de saúde sistêmica e oral de pacientes geriátricos internados em uma unidade de terapia intensiva (UTI). Metodologia: Estudo transversal descritivo, com amostra de conveniência de 78 idosos internados na UTI. Um único examinador calibrado coletou dados demográficos e clínicos, analisando os registros dos pacientes e avaliando as suas cavidades orais. A análise descritiva dos dados foi realizada com nível de significância de 5,00%. Todos os pacientes forneceram consentimento informado e estavam conscientes durante a avaliação da saúde oral. Resultados: A média de idade foi de 77,69 anos e 51,28% da amostra era do sexo masculino. Os principais motivos de internação dos pacientes na UTI investigados foram condições pósoperatórias (23,08%) e alterações cardíacas (20,51%). A hipertensão arterial sistêmica (69,23%) foi a comorbidade mais prevalente, e os pacientes estavam sendo tratados com anticoagulantes (57,69%) e antimicrobianos (53,85%). A maioria dos pacientes não recebeu cuidados orais (64,10%), enquanto 29,49% deles os receberam apenas uma vez e 57,69% eram usuários de próteses dentárias. O índice médio de dentes cariados, perdidos e obturados foi de 23,74 (17,44 dentes ausentes, em média) e a maioria apresentou biofilme lingual (71,79%) e higiene oral insatisfatória durante a internação (84,62%). Conclusão: A condição oral dos pacientes geriátricos hospitalizados foi caracterizada por má higiene e edentulismo.

Microbiological analysis of tongue dorsum coating in patients hospitalized in ICU / Análise microbiológica da saburra em dorso lingual de pacientes internados em UTI

ABSTRACT Objective: ssess quantitatively and qualitatively tongue coating microbiota in ICU patients. Methods: Analytical observational study, convenience sample comprising 65 patients was included for medical report analysis and collection of general data, tongue coating assessment through visual inspection and microbiological sample collection for further laboratory analysis. The collection was performed by a single examiner using a sterile swab introduced and rubbing the posterior portion of the tongue close to the oropharynx. Results: Most patients (60%) belonged to the female sex, at mean age of 74.2 years. The main reasons for hospitalization were lung issues (26.2%) - prevailing associated comorbidities were diabetes (43.1%) and high blood pressure (66.2%). The mean length of stay in the ICU was one day. All patients presented tongue dorsum coating. There were Candida albicans (37%), Streptococcus parasanguinis (26.1%) and Streptococcus mitis (32.6%) in 1/3 of lingual extension. Streptococcus mitis (p=0,0265) was the most prevalent species. Conclusion: There was no significance between the amount of coating and number of observed species, although all assessed patients had presented coating. The most prevalent microorganisms were Candida albicans, Streptococcus parasanguinis and Streptococcus mitis.

RESUMO Objetivo: Avaliar quantitativa e qualitativamente a microbiota da saburra lingual em pacientes internados em UTI. Métodos: Estudo observacional analítico, amostra de conveniência composta por 65 pacientes para análise de laudo médico e coleta de dados gerais, avaliação da saburra lingual por inspeção visual e coleta de amostra microbiológica para posterior análise laboratorial. A coleta foi realizada por um único examinador por meio de swab estéril introduzida e fricção na porção posterior de língua próxima à orofaringe. Resultados: A maioria dos pacientes (60%) pertencia ao sexo feminino, com média de idade de 74,2 anos. Os principais motivos de internação foram problemas pulmonares (26,2%) - as comorbidades associadas predominantes foram diabetes (43,1%) e hipertensão arterial (66,2%). O tempo de internação médio na UTI foi de um dia. Todos os pacientes apresentavam saburra do dorso da língua. Havia Candida albicans (37%), Streptococcus parasanguinis (26,1%) e Streptococcus mitis (32,6%) em 1/3 da extensão lingual. Streptococcus mitis (p=0,0265) foi a espécie mais prevalente. Conclusões: Não houve significância entre a quantidade de recobrimento e o número de espécies observadas, embora todos os pacientes avaliados tenham apresentado recobrimento. Os microrganismos mais prevalentes foram Candida albicans, Streptococcus parasanguinis e Streptococcus mitis.

Grafting Area Reduction in Peyronie's Disease Surgery: Comparative Assessment Between Double Y Vs iGrafter APP Using 3D-Printed Penile Models.

BACKGROUND: The use of plaque incision and graft techniques (PIG) for the treatment of severe Peyronie's disease (PD), may lead to erectile dysfunction (ED); graft size is 1 of the contributing factors for post-PIG ED. Recently the iGrafter software APP was introduced using a mathematical algorithm to distribute the incisions along the penile length resulting in a smaller grafting area. AIM: Compare 2 PIG techniques, the Double-Y(DY) and iGrafter, in 3 main aspects: (i) Total grafting area; (ii) The variation in calculating the grafting to be used; (iii) time to perform the PIG. METHODS: Six urologists with expertise in sexual medicine performed both techniques twice using four 3-D validated training models for PD with a standard 60° uniplanar dorsal curvature. OUTCOMES: The graft areas and operative partial and total time for each step of the operation were recorded for each procedure. Unpaired t-test and the coefficient of variation for graft area across surgeons was calculated comparing both techniques. RESULTS: For all surgeons, the use of iGrafter resulted in 2 grafts, for the DY technique in 1 graft. Overall, TT for the iGrafter was significantly longer than for DY technique (49.4 ± 11 vs 40.7 ± 5.7 minute; P = .02), The iGrafter grafting area was significantly smaller (11.6 ± 1.2 vs 23.3 ± 5.4 cm2; P: .01), representing a 50.2% area reduction when compared to the DY. The variation of graft area, using the iGrafter also yielded a more consistent graft across all surgeons (CV = 10.56% vs 23.28%). CLINICAL SIGNIFICANCE: The iGrafter, when compared to DY technique, reduced the graft area by 50%, which potentially means less erectile dysfunction. STRENGTHS AND LIMITATIONS: Our study eliminates anatomical variations found in a real clinical case making it possible to compare surgical techniques with the same penile anatomy. However, the 3D-printed model cannot replicate the living human tissue property preventing a simulation close to actual surgery. CONCLUSION: The use of the iGrafter software for PIG surgery has shown to be a promising technique for severe PD management resulting in smaller graft size (about 50% smaller when compared to the DY), although it might be more time-consuming. Tourchi A, Nascimento B, de Freita Miranda A, et al. Grafting Area Reduction in Peyronie's Disease Surgery: Comparative Assessment Between Double Y Vs iGrafter APP Using 3D-Printed Penile Models. J Sex Med 2022;19:669-675.

Severe disseminated clinical presentation of monkeypox virus infection in an immunosuppressed patient: first death report in Brazil

ABSTRACT Since May 2022, the number of monkeypox virus infections has sharply increased in countries where the disease has not been previously endemic. At present, most reports refer to low-severity cases. Herein, we present a severe case of the disease with disseminated skin lesions that progressed to death in an immunosuppressed patient in Belo Horizonte, Minas Gerais, Brazil.

Perfil da saúde bucal, nutricional e cognitiva de idosos / Oral, nutritional and cognitive health profile of elderly / Perfil de salud oral, nutricional y cognitiva de los ancianos

O envelhecimento populacional desafia a sociedade em compreensões mais amplas sobre o processo de envelhecer. O objetivo deste estudo foi descrever possíveis associações entre parâmetros de estado nutricional, bucal, psicológico e cognitivo em idosos. Trata-se de uma pesquisa transversal e exploratória que avaliou 15 idosos (M=69 anos; DP=±6,97) residentes na comunidade e participantes de um grupo de intervenções cognitivas. Na análise estatística, optou-se pelo teste Qui-Quadrado para variáveis categóricas e Mann-Whitney ou Kruskal-Wallis para variáveis quantitativas discretas (p≤0,005). Observou-se correlação positiva entre circunferência da panturrilha e desempenho cognitivo global, e correlações negativas entre circunferência de panturrilha e sintomas depressivos, assim como entre qualidade de vida e número de dentes perdidos. Conclui-se destacando a relevância de estudos como estes que avaliam diferentes parâmetros para uma compreensão mais ampla da saúde dos idosos.

Population aging challenges society in broader understandings of the aging process. This study aimed to describe possible associations between parameters of nutritional, oral, psychological and cognitive status in the elderly. This is a cross-sectional and exploratory study that evaluated 15 elderly (M = 69 years; SD = ± 6.97) community residents and participants in a group of cognitive interventions. In the statistical analysis, we chose the Chi-Square test for categorical variables and Mann-Whitney or Kruskal-Wallis for discrete quantitative variables (p≤0.005). There was a positive correlation between calf circumference and global cognitive performance, and negative correlations between calf circumference and depressive symptoms; also, between the quality of life and number of missing teeth. It is concluded highlighting the relevance of studies like these that evaluate different parameters for a broader understanding of the health of the elderly.

El envejecimiento de la población desafía a la sociedad en una comprensión más amplia del proceso de envejecimiento. El objetivo de este estudio fue describir posibles asociaciones entre parámetros de estado nutricional, oral, psicológico y cognitivo en ancianos. Este es un estudio transversal y exploratorio que evaluó a 15 personas mayores (M = 69 años; DE = ± 6,97) residentes de la comunidad y participantes en un grupo de intervenciones cognitivas. En el análisis estadístico, elegimos la prueba de Chi-Cuadrado para variables categóricas y Mann-Whitney o Kruskal-Wallis para variables cuantitativas discretas (p≤0.005). Hubo correlación positiva entre la circunferencia de la pantorrilla y el rendimiento cognitivo global, y correlaciones negativas entre la circunferencia de la pantorrilla y los síntomas depresivos, así como entre calidad de vida y número de dientes faltantes. Se concluye destacando la relevancia de estudios como estos que evalúan diferentes parámetros para una comprensión más amplia de la salud de los ancianos.

Penile shortening complaints in males with erectile dysfunction: a narrative review on penile lengthening procedures during penile prosthesis surgery.

Patients complaining of short penile length pose a challenge in urology practice. Those men who present seeking penile lengthening surgery usually overestimate 'normal' penile length, and may in often cases relate their penile length with the degree of masculinity and self-esteem. Penile prosthetic devices are the gold standard treatment of erectile dysfunction (ED) after failure of conservative options. Penile shortening is the most prevalent long-term complaint after successful inflatable penile prosthesis (IPP) placement. This has a significant impact on patient's overall satisfaction and quality of life. Using PubMed, we performed a thorough literature review of the current procedures of preservation or enhancement of penile length as well as reported perioperative protocols in patients undergoing penile prosthesis (PP) insertion. Keywords used were "penile lengthening", "penile enhancement", "penile girth", "inflatable penile prosthesis" and "glans augmentation". Several surgical techniques can be offered in the setting of penile shortening concurrently with PP insertion, e.g., sub-coronal approach of PP placement, sliding technique, modified sliding technique (MoST), multiple-slide technique (MuST), and tunica mesh expansion procedure (TMEP). Adjuvant techniques can also improve subjective penile length include, ventral phalloplasty, suprapubic lipectomy, suspensory ligament release and use of expanding penile implants. Preoperative protocols including use of a vacuum erectile device, traction therapy also seem to improve postoperative outcomes, minimizing postoperative pain, and encouraging the early device use. Currently, there is no consensus among experts on a particular lengthening procedure or when they can be performed to optimize outcomes. Furthermore, it is imperative to set proper expectations before surgery, with extensive patient and partner counseling. When used in the properly selected patient, penile lengthening procedures show promising results with minimal complication rates.

3D-Printed Flexible Penile Model Simulator for Plaque Incision and Graft for Peyronie's Disease.

INTRODUCTION: Plaque incision and graft (PIG) is suggested for the treatment of significant Peyronie's disease (PD), but most surgeons perform very few PIG surgeries annually, and the number of PD cases requiring PIG is inadequate to maintain the necessary skills and completely master the procedure. AIM: To develop and validate a new 3D-printed model of a curved penis and graft to simulate PIG surgery. This is the first PIG surgical training simulator described in the medical literature. METHODS: A 3D-printed model of the corpora cavernosa with a 60-degree curvature and an associated urethra was created using a flexible filament of thermoplastic polyurethane. Twenty-two urologists from Brazil were recruited to perform simulated surgery on the 3D model. The participants included 12 senior-level and 10 trainee-level urologists. MAIN OUTCOME MEASURES: Evaluation of the device was based on a 15-item questionnaire using a 5-point Likert-type scale for each item. RESULTS: Each participant performed one simulated surgery with the 3D-printed model. All participants agreed that the simulation should be implemented into training programs. Participants ranked all content validity components ≥4.41 and all face validity components ≥3.83. The mean usability score was 4.25, and the overall experience scores were 4.75 (senior) and 5.0 (trainee). CONCLUSION: Senior and trainee urologists evaluated this first reported simulated PIG training model for penile curvature correction as an acceptable tool for training and maintaining necessary PIG skills. This model may improve PIG training and surgeon skill, thereby improving patient safety and outcomes. A Miranda. 3D-Printed Flexible Penile Model Simulator for Plaque Incision and Graft for Peyronie's Disease. Sex Med 2021;9:100318.

Deep vein thrombosis in noncritically ill patients with coronavirus disease 2019 pneumonia: deep vein thrombosis in nonintensive care unit patients.

BACKGROUND: Venous thromboembolic events have been one of the main causes of mortality among hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia. The aim of our study was to describe the prevalence of deep vein thrombosis (DVT) in noncritically ill patients with COVID-19 pneumonia and correlate such observations with the thromboprophylaxis received. METHODS: We performed a prospective cohort study of 67 patients admitted to the hospital for COVID-19 pneumonia. The diagnosis was confirmed using polymerase chain reaction testing of nasopharyngeal specimens. The deep veins were examined using compression duplex ultrasonography with the transducer on B-mode. The patients were separated into two groups for statistical analysis: those receiving low-molecular-weight heparin prophylaxis and those receiving intermediate or complete anticoagulation treatment. Risk analysis and logistic regression were performed. RESULTS: Of the 67 patients, 57 were included in the present study after applying the inclusion and exclusion criteria; 49.1% were women, and the patient mean age was 71.3 years. All 57 patients had undergone compression duplex ultrasonography. Of these 57 patients, 6 were diagnosed with DVT, for an in-hospital rate of DVT in patients with COVID-19 pneumonia of 10.5%. All the patients who had presented with DVT had been receiving low-molecular-weight heparin prophylaxis. The patients receiving prophylactic anticoagulation treatment had a greater risk of DVT (16.21%; 95% confidence interval, 0.04-0.28; P = .056) compared with those receiving intermediate or complete anticoagulation treatment. We also found a protective factor for DVT in the intermediate or complete anticoagulation treatment group (odds ratio, 0.19; 95% confidence interval, 0.08-0.46; P < .05). CONCLUSIONS: Noncritically ill, hospitalized patients with COVID-19 pneumonia have a high risk of DVT despite receipt of correct, standard thromboprophylaxis.

Profile of facial trauma in older adults cared for at a tertiary hospital of the Brazilian Federal District / Perfil do trauma de face em idosos atendidos em Hospital terciário do Distrito Federal

OBJECTIVES: The phenomenon of population aging and the remarkable inclusion of older adults in the economically active population has increased their participation in injuries and accidents, including facial trauma. The purpose of this study was to analyze the prevalence, etiology, and treatment of facial trauma in the older population of the Brazilian Federal District, as well as the gender, etiology, type of trauma, and treatment strategy regarding different age groups (60­69 years, 70­79 years, and 80 years or older). METHODS: This is a retrospective quantitative descriptive study using electronic medical records (Trackcare system) of older patients (aged ≥ 60 years) assisted at the Emergency Department of a tertiary hospital of the Federal District between 2016 and 2017 due to facial trauma. RESULTS: Out of 2382 records of patients with facial trauma, 139 (5.8%) were aged over 60 years. The main causes of facial trauma were falls, both in male and female patients. Facial contusion was the main diagnosis of facial trauma (25.2%), followed by fractures of the jaw (16.5%) and zygomatic complex (15.8%). Conservative treatment was the most common strategy adopted in the Emergency Department of Oral and Maxillofacial Surgery and Traumatology. CONCLUSIONS: This study showed a high prevalence of facial trauma in the geriatric population. Etiological factors such as falls and car accidents were highlighted in the studied groups. Conservative treatment and local guidelines were the preferred therapeutic approaches. Owing to the growth trend of the older population in the upcoming decades, exposure to risk factors for facial trauma tends to grow, thus requiring greater attention and specific knowledge from health professionals.

OBJETIVO: O envelhecimento da população e a inclusão marcante dos idosos na parcela economicamente ativa vêm aumentando a participação deles em traumatismos e acidentes, incluindo os que ocorrem na face. O objetivo deste trabalho foi analisar a prevalência, a etiologia e o tratamento do traumatismo de face na população idosa do Distrito Federal, assim como nas diferentes faixas etárias (60 ­ 69, 70 ­ 79 e 80 e mais), em relação a sexo, etiologia, tipo de trauma e tratamento. METODOLOGIA: Trata-se de estudo retrospectivo descritivo quantitativo, que utilizou prontuários eletrônicos (Sistema Trackcare) de pacientes idosos (≥ 60 anos) atendidos no pronto-socorro de hospital terciário do Distrito Federal, durante os anos de 2016 e 2017, por traumatismo de face. RESULTADOS: Do total de 2.382 prontuários de pacientes com traumatismo de face, 139 (5,8%) foram de idosos. O principal fator responsável pelo traumatismo na face foi a queda, tanto no sexo masculino como no feminino. A contusão na face foi o principal diagnóstico de traumatismo nessa região (25,2%), seguido por fratura de mandíbula (16,5%) e fratura do complexo zigomático (15,8%). O tratamento conservador foi o mais adotado no serviço de pronto-socorro de Cirurgia e Traumatologia Bucomaxilofacial. CONCLUSÕES: O presente estudo evidenciou uma elevada prevalência de traumas de face na população geriátrica. Fatores etiológicos como quedas e acidentes automobilísticos tiveram destaques nos grupos estudados. O tratamento conservador e orientações locais foram as condutas terapêuticas adotadas preferencialmente. Devido à tendência de crescimento da população idosa nas próximas décadas, bem como o perfil ativo que os idosos estão assumindo, a exposição a fatores de risco para traumas faciais tende a crescer, exigindo-se assim maior atenção e conhecimento específico por parte dos profissionais de saúde..

Dihomooxacalix[4]arene-Based Fluorescent Receptors for Anion and Organic Ion Pair Recognition.

Fluorescent dihomooxacalix[4]arene-based receptors 5a-5c, bearing two naphthyl(thio)ureido groups at the lower rim via a butyl spacer, were synthesised and obtained in the cone conformation in solution. The X-ray crystal structures of 1,3- (5a) and 3,4-dinaphthylurea (5b) derivatives are reported. Their binding properties towards several anions of different geometries were assessed by 1H-NMR, UV-Vis absorption and fluorescence titrations. Structural and energetic insights of the naphthylurea 5a and 5b complexes were also obtained using quantum mechanical calculations. The data showed that all receptors follow the same trend, the association constants increase with the anion basicity, and the strongest complexes were obtained with F-, followed by the oxoanions AcO- and BzO-. Proximal urea 5b is a better anion receptor compared to distal urea 5a, and both are more efficient than thiourea 5c. Compounds 5a and 5b were also investigated as heteroditopic receptors for biologically relevant alkylammonium salts, such as the neurotransmitter γ-aminobutyric acid (GABA·HCl) and the betaine deoxycarnitine·HCl. Chiral recognition towards the guest sec-butylamine·HCl was also tested, and a 5:2 selectivity for (R)-sec-BuNH3+·Cl- towards (P) or (M) enantiomers of the inherently chiral receptor 5a was shown. Based on DFT calculations, the complex [(S)-sec-BuNH3+·Cl-/(M)-5a] was indicated as the more stable.

Prevalence of dental trauma in disabled persons seen at the dental clinic for special-needs patients of the Catholic University of Brasília (UCB) / Prevalência de traumatismo dentário em pacientes com deficiência atendidos na clínica de pacientes especiais da Universidade Católica de Brasília (UCB)

Introduction: In Brazil, dental trauma (DT) is considered a public health problem. However, few studies in the literature report the prevalence of DT in disabled persons (DP). Objective: The aim of this study was to assess the prevalence of DT among DP seen at the Dental Clinic for Special-Needs Patients (COPE) of the Catholic University of Brasília. Material and method: A retrospective, descriptive study analyzing 73 medical charts of DP seen at the COPE between 2014 and 2016 was conducted. Clinical and sociodemographic data were collected. The t-test was used to check for significant differences between the categories of the variables analyzed. The Statistical Package for Social Sciences (SPSS), version 23.0 (IBM Corporation, Armonk, NY, USA) was used for all statistical analyses (p < 0.05). Result: A DT prevalence of 33/73 (45.2%) was found among DP. The predominant type of fracture was crown fracture (26/33-78.8%). The majority of patients were over 20 years old (63/73 - 86.3%), at a proportion significantly higher than those for the other age categories (p < 0.008). The patients in the sample had a variety of diseases, predominantly in the following categories: mental (22/73- 30.1%), multiple (19/73-26%), and systemic (14/73-19.2%). Conclusion: A high prevalence of DT was found in DP, with the majority of cases being related to mental and multiple diseases. Further research is needed to assess the prevalence of DT in this patient group throughout the Federal District.

Introdução: No Brasil, o traumatismo dentário (TD) é considerado um problema de saúde pública. No entanto, poucos estudos na literatura relatam a prevalência de TD em pessoas com deficiência (PD). Objetivo: O objetivo deste trabalho foi avaliar a prevalência de TD em PD atendidas na Clínica de Pacientes Especiais da Universidade Católica de Brasília (COPE). Material e método: Este estudo seguiu um delineamento descritivo e retrospectivo, e foi realizado por meio da análise de 73 prontuários de PD atendidas na COPE entre 2014 e 2016. Foram coletados dados sociodemográficos e clínicos. O teste t foi utilizado entre as proporções para determinar se houve diferenças significativas entre as categorias das variáveis analisadas. O programa "Statistical Package for Social Sciences" (SPSS), versão 23.0 (IBM Corporation, Armonk, NY, EUA) foi utilizado nas análises (p<0,05). Resultado: Encontrou-se uma prevalência de TD de 33/73 (45,2%) entre os PD. A fratura predominante foi a do tipo coronária, com uma frequência de 26/33 (78,8%). A maioria dos pacientes tinha acima de 20 anos, com uma frequência de 63/73 (86,3%), significativamente maior do que as frequências das outras categorias (p < 0,008). Os pacientes da amostra apresentavam doenças variadas, sendo as mais prevalentes as das categorias mental, com frequência de 22/73 (30,1%), múltipla com 19/73 (26%), e sistêmica com 14/73 (19,2%). Conclusão: Foi encontrada uma alta prevalência de TD em PD, sendo a maioria dos casos relacionados a doenças mentais e múltiplas. Futuras pesquisas são necessárias para avaliar a prevalência de TD nesse grupo de pacientes em todo o Distrito Federal.

The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis

ABSTRACT Purpose: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation. Materials and Methods: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis. The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy. Results: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29μm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood. Conclusion: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.

The prostate after castration and hormone replacement in a rat model: structural and ultrastructural analysis.

PURPOSE: To evaluate if late hormonal replacement is able to recover the prostatic tissue modified by androgenic deprivation. MATERIALS AND METHODS: 24 rats were assigned into a Sham group; an androgen deficient group, submitted to bilateral orchiectomy (Orch); and a group submitted to bilateral orchiectomy followed by testosterone replacement therapy (Orch+T). After 60 days from surgery blood was collected for determination of testosterone levels and the ventral prostate was collected for quantitative and qualitative microscopic analysis. The acinar epithelium height, the number of mast cells per field, and the densities of collagen fibers and acinar lumen were analyzed by stereological methods under light microscopy. The muscle fibers and types of collagen fibers were qualitatively assessed by scanning electron microscopy and polarization microscopy. RESULTS: Hormone depletion (in group Orch) and return to normal levels (in group Orch+T) were effective as verified by serum testosterone analysis. The androgen deprivation promoted several alterations in the prostate: the acinar epithelium height diminished from 16.58±0.47 to 11.48±0.29µm; the number of mast cells per field presented increased from 0.45±0.07 to 2.83±0.25; collagen fibers density increased from 5.83±0.92 to 24.70±1.56%; and acinar lumen density decreased from 36.78±2.14 to 16.47±1.31%. Smooth muscle was also increased in Orch animals, and type I collagen fibers became more predominant in these animals. With the exception of the densities of collagen fibers and acinar lumen, in animals receiving testosterone replacement therapy all parameters became statistically similar to Sham. Collagen fibers density became lower and acinar lumen density became higher in Orch+T animals, when compared to Sham. This is the first study to demonstrate a relation between mast cells and testosterone levels in the prostate. This cells have been implicated in prostatic cancer and benign hyperplasia, although its specific role is not understood. CONCLUSION: Testosterone deprivation promotes major changes in the prostate of rats. The hormonal replacement therapy was effective in reversing these alterations.

Atuação odontológica em UTI: a importância da Periodontia na qualidade de saúde do paciente crítico / Dental practice in ICU: the importance of periodontics in critical patient care quality

A pneumonia nosocomial é uma doença sistêmica que acomete o paciente no ambiente hospitalar após 48 horas da sua admissão, principalmente nas unidades de terapia intensiva (UTIs). O acúmulo de biofilme dentário, saburra lingual e processos inflamatórios decorrentes da presença de doença periodontal podem contribuir para a formação de reserva microbiana associada à pneumonia nosocomial. A prevenção da pneumonia nosocomial é muito importante para garantir a saúde do paciente. O uso de clorexidina 0,12% para a higienização de língua, dentes e mucosas é um grande aliado na redução de bactérias, prevenindo o aparecimento de infecções nos pacientes internados, além do combate das mesmas, como a pneumonia nosocomial. O treinamento da equipe de enfermagem para realização dessas manobras, assim como para entender a importância da relação entre saúde bucal e infecções respiratórias, deve ser reforçado, visto que parece ser deficiente. A presença do cirurgião-dentista em uma equipe multidisciplinar de UTI é indispensável. Sua presença parece ser mais importante na equipe de coordenação, para o treinamento e capacitação dos profissionais ali envolvidos, além da realização de procedimentos mais complexos, como exodontia e raspagem e alisamento coronorradicular.

Nosocomial pneumonia is a systemic disease that affects the inpatient after 48 hours of admission, especially in intensive care units (ICUs). The dental plaque accumulation, tongue coating and inflammatory processes arising from the presence of periodontal disease may contribute to the formation of microbial reservatories associated with nosocomial pneumonia. Prevention of nosocomial pneumonia is very important to ensure the health of the patient. The use of 0.12% chlorhexidine for tongue, teeth and also mucosal cleaning is important to reduce bacteria and to prevent the appearance of infections in hospitalized patients, such as nosocomial pneumonia. The training of nursing staff to perform these procedures, as well as to understand the importance of the relationship between oral health and respiratory infections, should be strengthened, since it appears to be defi cient. The presence of the dentist in multidisciplinary ICU team is indispensable. Because the practitioner can coordinate a team for training and qualification of professionals involved there, in addition to performing more complex procedures such as tooth extraction and scaling and root planning.

Penile prosthesis implant with bi-triangular excision and graft for surgical therapy of Peyronie's disease: A case report.

We present a case of a 65-year-old man, who presented with moderate erectile dysfunction and a dorsal penile deviation of 60° caused by Peyronie's disease. The patient underwent bi-triangularshaped plaque excision, followed by grafting and implantation of inflatable penile prosthesis. Complete penile straightening, without mechanical or geometric abnormalities, was achieved using bi-triangular excision and grafting. Postoperatively, the patient reported high satisfaction with the results and could perform sexual intercourse naturally. This novel technique corrects any degree of penile curvature, permits malleable and semi-rigid penile prosthesis implantation, avoids penile length loss, and eliminates additional incisions. To our knowledge, this case is the first in the literature in which the bi-triangular technique was successfully used for penile prosthesis implantation secondary to Peyronie's disease. This new technique appears to be a good solution to correct penile curvature during penile prosthesis implantation for the treatment of Peyronie's disease associated with erectile dysfunction.

Practical Computerized Solution for Incision and Grafting in Peyronie's Disease.

INTRODUCTION: Penile curvature correction with plaque incision and graft (PIG) increases the risk of erectile dysfunction (ED) and is associated with mechanical and geometric abnormalities. AIMS: The aim of this study was to create and validate a new PIG technique using minimum graft area to correct simple or complex penile curvature with or without hourglass deformity, while avoiding mechanical and geometric abnormalities. METHODS: Using our cotton fabric model, we created a mathematic solution for PIG with no residual defects. This was applied in nine men who had sufficient penile rigidity while penetrating their respective partners. They underwent fascia lata patch corporoplasty using the new developed technique (iPad [Apple Corp, Palo Alto, CA, USA] app: iGrafter). Subjects answered the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire preoperatively and at the end of follow-up. MAIN OUTCOME MEASURES: The main outcome measures used were patient demographics, erectile function, residual curvature, patient satisfaction, graft area, and complications. RESULTS: After a mean follow-up of 17.8 months, no significant complication was noted. Complete penile straightening was achieved in all patients. The short side of the penis increased a mean of 3 cm in length, and the mean graft area was 12.4 cm(2). At the end of the follow-up, three patients developed recurrent deformity. One patient presented severe fibrosis in the corpora cavernosa and severe ED. There was no significant difference between the mean preoperative and postoperative IIEF-5 scores (20.6 vs 19.4, respectively). At the end of follow-up, all patients were able to have sexual intercourse (two with and seven without pharmacological aid). Eight of the nine patients were satisfied with the surgical result. CONCLUSION: Penile curvature surgical correction using the iGrafter seems to be an efficient and safe procedure, which uses minimum graft area and preserves erectile function after penile rectification, without resulting in residual deformities. Further research is needed to confirm the efficacy of this procedure.

A geometric model of plaque incision and graft for Peyronie's disease with geometric analyses of different techniques.

INTRODUCTION: A surgical approach with plaque incision and graft (PIG) to correct Peyronie's disease is the best method for complex, large deviations. However, the geometric and mechanical consequences of this intervention are poorly understood. AIM: The aim of this study was to analyze the geometric and mechanical consequences of PIG on penile straighten surgery. METHOD: A tridimensional penile simile model with a curvature of 85° was created to test all of the most common PIG techniques. PIG with double-Y, H-shape, and Egydio techniques were used to rectify the curved penile model. MAIN OUTCOME MEASUREMENTS: The results that differed from a rectified cylinder shape were highlighted. RESULTS: All of the analyzed techniques created a geometric distortion that could be linked to poor surgical results. We suggest a new technique to resolve these abnormalities. CONCLUSION: Current techniques designed to correct penile deviation using PIG present geometric and mechanical imperfections with potential consequences to the postoperative success rate. The new technique proposed in this report could be a possible solution to solve the geometric distortion caused by PIG.

Four-arm single docking full robotic surgery for low rectal cancer: techniques and post-operative outcomes / Cirurgia totalmente robótica para o tratamento do câncer do reto distal: técnicas e resultados do pós-operatório imediato

BACKGROUND: laparoscopic rectal surgery has not yet achieved a high penetration rate because of its steep learning curve and its relatively high conversion rate. Robotic rectal resection represents the main indication of the use of the robotic platform in colorectal surgery. The aim of this study was to present an early experience with robotic surgery to treat mid and low rectal cancer focusing on the technique and early postoperative outcomes. METHODS: from December 2012 to October 2013, a total of 16 patients with colorectal diseases were operated on using a four-arm single docking full robotic procedure (daVinci Si Surgical System). The treatment of six consecutive patients who underwent robotic rectal cancer surgery for mid or low rectal adenocarcinoma was prospectively analyzed regarding technique standardization, pathological findings and postoperative outcomes. RESULTS: there were no conversions and one intraoperative complication. The mean operative time was 245 min (180-360 min). The mean console time was 170 min (110-240 min). All patients underwent a standardized totally robotic rectal dissection. There were no mortality or urinary dysfunction and one complication (postoperative ileo-16%). The median length of hospital stay was 6 (4-11 days). The median number of lymph nodes harvested was 22 (7-38), and distal and circumferential resection margins were negative in all specimen. R0 resection was achieved in all cases and complete total mesorectal excision in five specimen and nearly complete in one. CONCLUSION: standardized robotic rectal surgery is a promising alternative to treat patients with mid or low rectal cancer and is expected to overcome the low penetration rate of laparoscopic surgery in this field. This technique was successfully performed in six patients with excellent immediate postoperative and pathological results. Additional studies in a large series of patients are necessary to confirm those advantages. (AU)

INTRODUÇÃO: a utilização da cirurgia videolaparoscópica para o tratamento do câncer do reto ainda não apresentou uma alta penetração devido a longa curva de aprendizado e a uma taxa de conversão relativamente alta. A ressecção retal robótica é a principal indicação para o uso da plataforma robótica na cirurgia colorretal. O objetivo desse estudo é apresentar as técnicas e os resultados pós-operatórios imediatos com o uso da cirurgia robótica para o tratamento do câncer do reto distal. PACIENTES E MÉTODOS: no período de dezembro de 2012 a outubro de 2013 foram operados 16 pacientes com patologias colorretais utilizando o robô daVinci SI Surgical System. O tratamento de 6 consecutivos pacientes portadores de câncer do reto do terço médio e do terço inferior foram prospectivamente avaliados quanto a sistematização técnica, achados patológicos e evolução pós-operatória. RESULTADOS: não houve conversão e ocorreu uma complicação intraoperatória. A duração média das operações foi de 245 minutos (180-360 minutos) e o tempo médio do uso do console foi de 170 minutos (110-240 minutos). Ocorreu uma complicação pós-operatória (Íleo) e não houveram nenhuma disfunção urinária ou mortalidade. A duração média da internação hospitalar foi de 6 dias (4-11 dias). O número médio de linfonodos examinados foi de 22 (7-38) e todas as peças tinham margens distal e circunferencial negativas. Ressecção RO foi observada em todos os casos e o grau de excisão total do mesorreto foi completo em 5 peças e quase completo em uma. CONCLUSÃO: cirurgia robótica sistematizada esta tendo uma crescente aceitação e é uma ótima alternativa para o tratamento dos pacientes com câncer do reto distal. Esta tecnologia foi utilizada em 6 pacientes com excelentes resultados não só na recuperação pós-operatória imediata como também nos achados da avaliação patológica. Grandes series randomizadas são importantes para confirmar as possíveis vantagens dessa nova tecnologia. (AU)

Preventive and surgical intervention in patient with cerebral palsy: case report

Introduction: Cerebral palsy is defined as a non-progressive brain disorder of movement and posture. The patient is characterized by mental and motor disabilities, sensory impairments of vision and hearing, besides having seizures and contraction joints. Objective: To address a multidisciplinary dental intervention in a patient, leucoderma, 11 years-old, with cerebral palsy who attended the Special Patients Clinic of the Catholic University of Brasilia, Brazil. Case report: Clinical interventions to promote oral health, emphasizing the responsible guidelines regarding oral hygiene techniques, and surgical procedures such as extractions of deciduous teeth #75, #85, #63 (phase 1) and ulectomy in the region of teeth #24 and #25 (phase 2) were performed. Conclusion: The multidisciplinary assistance targeted to the oral health of the patient with cerebral palsy can be considered as an important strategy for promoting the health and quality of life in this population group.

Atendimento odontológico domiciliar aos idosos: uma necessidade na prática multidisciplinar em saúde: revisão de literatura / Home dental care for the elderly: a need in health multidisciplinary practice: literature review

O atendimento odontológico domiciliar direcionado aos idosos semi e dependentes é conjunto de ações preventivas e de mínima intervenção que visam promover a saúde bucal e orientar familiares e cuidadores. É considerada uma estratégia educativa e assistencial de saúde cuja finalidade é intervir, de maneira multidisciplinar, no processo saúde-doença de idosos vulneráveis. Este estudo tem como objetivo abordar a prática odontológica domiciliar, enfatizando as principais alterações sistêmicas e possíveis repercussões na cavidade bucal, a necessidade de participação efetiva do cirurgião-dentista e orientações de promoção de saúde bucal que possam auxiliar nas condutas dos familiares, cuidadores e profissionais envolvidos com esse tipo de atendimento. Foram realizadas busca e análise de artigos científicos e bases de dados bibliográficos sobre a prática odontológica domiciliar em idosos. Na estratégia de busca foram empregados os termos: assistência domiciliar, odontogeriatria, odontologia domiciliar, idoso fragilizado e saúde bucal. Adotaram-se como critérios de inclusão: artigos publicados em português; artigos indexados nas bases de dados LILACS e SciELO; artigos publicados no período de 2000 a 2011 e legislação federal sobre o assunto, totalizando 36 referências. Concluiu-se que existe grande necessidade dessa atividade odontológica em domicílio a ser executada de maneira capacitada por odontogeriatras com formação gerontológica que possam contribuir na humanização do atendimento e promoção do bem-estar e qualidade de vida desses idosos.

Home dental service for semi and dependent elderly is a set of preventive actions and minimal intervention aimed at establishing the promotion of oral health and guidance to families and caregivers. It is considered an educational strategy and health care whose purpose is to provide multidisciplinary intervention in the health-disease process of vulnerable elderly. This report aimed to approach home dental practice, emphasizing the main systemic changes and possible repercussions in the oral cavity, the need for effective participation of surgeon-dentist and guidelines to promote oral health that may help family members, caregivers and professionals involved with this type of care. Scientific articles and bibliographic databases on the dental practice-based study in the elderly were searched and analyzed. Search strategy terms were: home care, geriatric dentistry, dental home care, frail elderly, oral health. Inclusion criteria were: published articles in Portuguese; articles indexed in the databases LILACS and SciELO; articles published from 2000 to 2011 and federal laws on the subject, totaling 36 references. It was concluded that there is a great need of home dental activity to be performed by skilled geriatric dentists with geriatric training that can contribute in humanizing care and promote well-being and quality of life for elderly people.