Relative incidence of interstitial lung diseases in Brazil.

OBJECTIVE: To assess the relative frequency of incident cases of interstitial lung diseases (ILDs) in Brazil. METHODS: This was a retrospective survey of new cases of ILD in six referral centers between January of 2013 and January of 2020. The diagnosis of ILD followed the criteria suggested by international bodies or was made through multidisciplinary discussion (MDD). The condition was characterized as unclassifiable ILD when there was no specific final diagnosis following MDD or when there was disagreement between clinical, radiological, or histological data. RESULTS: The sample comprised 1,406 patients (mean age = 61 ± 14 years), and 764 (54%) were female. Of the 747 cases exposed to hypersensitivity pneumonitis (HP)-related antigens, 327 (44%) had a final diagnosis of HP. A family history of ILD was reported in 8% of cases. HRCT findings were indicative of fibrosis in 74% of cases, including honeycombing, in 21%. Relevant autoantibodies were detected in 33% of cases. Transbronchial biopsy was performed in 23% of patients, and surgical lung biopsy, in 17%. The final diagnoses were: connective tissue disease-associated ILD (in 27%), HP (in 23%), idiopathic pulmonary fibrosis (in 14%), unclassifiable ILD (in 10%), and sarcoidosis (in 6%). Diagnoses varied significantly among centers (c2 = 312.4; p < 0.001). CONCLUSIONS: Our findings show that connective tissue disease-associated ILD is the most common ILD in Brazil, followed by HP. These results highlight the need for close collaboration between pulmonologists and rheumatologists, the importance of detailed questioning of patients in regard with potential exposure to antigens, and the need for public health campaigns to stress the importance of avoiding such exposure.

Antimicrobial and antibiofilm activity of highly soluble polypyrrole against methicillin-resistant Staphylococcus aureus.

AIMS: The purpose was to evaluate the antimicrobial activity of highly soluble polypyrrole (Hs-PPy), alone or combined with oxacillin, as well as its antibiofilm potential against methicillin-resistant Staphylococcus aureus strains. Furthermore, the in silico inhibitory mechanism in efflux pumps was also investigated. METHODS AND RESULTS: Ten clinical isolates of methicillin-resistant Staphylococcus aureus (MRSA) and two reference strains were used. Antimicrobial activity was determined by broth microdilution, and the combination effect with oxacillin was evaluated by the checkerboard assay. The biofilm formation capacity of MRSA and the interference of Hs-PPy were evaluated. The inhibitory action of Hs-PPy on the efflux pump was evaluated in silico through molecular docking. Hs-PPy showed activity against the isolates, with inhibitory action between 62.5 and 125 µg ml-1 and bactericidal action at 62.5 µg ml-1, as well as synergism in association with oxacillin. The isolates ranged from moderate to strong biofilm producers, and Hs-PPy interfered with the formation of this structure, but not with mature biofilm. There was no in silico interaction with the efflux protein EmrD, the closest homolog to NorA. CONCLUSIONS: Hs-PPy interferes with biofilm formation by MRSA, has synergistic potential, and is an efflux pump inhibitor.

Osteoradionecrosis in a Torus Mandibularis Treated by Antimicrobial Photodynamic Therapy: A Case Report.

Background: Osteoradionecrosis (ORN) of the jaws is a late complication after radiotherapy to head and neck cancer. Objective: To describe a rare case of ORN of the torus mandibularis that was successfully managed exclusively with antimicrobial photodynamic therapy (aPDT). Case report: A 72-year-old man presented an exposed necrotic bone observed in the torus mandibularis, extending to the lingual alveolar ridge with no edema nor suppuration. The treatment provided a noninvasive treatment leading to spontaneous sequestrectomy of the torus in 2 weeks with complete mucosal repair in 5 weeks and absence of lesion signs and/or symptoms even after 6 months of follow-up. Conclusions: The aPDT indicated to be a satisfactory treatment for ORN affecting torus mandibularis, a region with surgical limitations, avoiding surgery.

Pan-intestinal capsule endoscopy as first-line procedure in patients with suspected mid or lower gastrointestinal bleeding.

BACKGROUND: Pan-intestinal capsule endoscopy (PCE) evaluates the small bowel and colon noninvasively. This study evaluated diagnostic accuracy and safety of PCE vs. colonoscopy as first-line examination in suspected mid-lower gastrointestinal bleeding (MLGIB). METHODS: In this prospective, single-center, single-blinded cohort study, consecutive patients with suspected MLGIB underwent PCE followed by same-day colonoscopy. Diagnostic accuracy for potentially hemorrhagic lesions (PHLs; combined diagnosis by PCE + colonoscopy) and incidence of adverse events were assessed. RESULTS: 100 patients were included (median age 70 [range 18-92] years; 65% female). PHLs were diagnosed in 46 patients, including small-bowel and/or colon angioectasias in 32. PCE correctly identified 54 individuals without PHLs, and 95.7% (44/46) of those with PHLs vs. 50.0% (23/46) for colonoscopy (P<0.01). PHLs were detected by PCE alone in 65.2% (30/46), both examinations in 28.3% (13/46), and colonoscopy alone in 6.5% (3/46). PHLs were diagnosed at the ileocolonic region in 28% of patients, with PCE diagnosing 25/28 cases (89.3%) and colonoscopy diagnosing 23/28 (82.1%; P=0.13). Interventional procedures were performed at colonoscopy in 13/81 patients with iron-deficiency anemia (16.0%) vs. 6/19 patients with overt bleeding (31.6%; P<0.01). No significant adverse events occurred with PCE vs. 2% with colonoscopy. CONCLUSIONS: In patients with MLGIB, PCE avoided further invasive procedures in >50% of patients. PCE was safe and more effective than colonoscopy in identifying PHL both in the small bowel and colon. These results support the potential use of PCE as first-line examination in patients with suspected MLGIB.

Pre-gestational overweight and polyunsaturated fatty acids in human milk: theoretical causality model. / Excesso de peso pré-gestacional e ácidos graxos poli-insaturados no leite humano: modelo teórico de causalidade.

A number of studies have focused on the evaluation of the relationship between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. However, given the complexity of potentially confounding risk factors, the use of graphical tools is recommended to identify possible biases. This article aims to propose a theoretical model of causality using the directed acyclic graph between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. Methods: An extensive literature review was performed to identify variables with causal relationships with exposure and/or outcome. The choice of variables for adjustment followed the graphic algorithm that comprises six criteria for selecting a minimum set of potentially confounding variables. Socioeconomic conditions, interpartum interval, maternal age and food consumption pattern were the variables that would have to be adjusted in order to estimate the total effect of pre-pregnancy overweight on polyunsaturated fatty acids content in human milk. The minimum set of variables found in the present study can be used in the analysis of other studies that evaluate this association.

Inúmeros estudos têm se detido na avaliação da associação entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Todavia, diante da complexidade de fatores de risco potencialmente confundidores, é recomendável a utilização de ferramentas gráficas para identificar possíveis vieses. O objetivo deste artigo é propor um modelo teórico de causalidade utilizando o gráfico acíclico direcionado entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Foi realizada ampla revisão da literatura para identificar as variáveis com relações causais com a exposição e/ou desfecho. A escolha das variáveis para ajuste seguiu o algoritmo gráfico que compreende seis critérios para a seleção de um conjunto mínimo de variáveis potencialmente confundidoras. Condições socioeconômicas, intervalo interpartal, idade materna e padrão de consumo alimentar foram as variáveis ajustadas a fim de se estimar o efeito total do excesso de peso pré-gestacional sobre o conteúdo dos ácidos graxos poli-insaturados no leite humano. O conjunto mínimo de variáveis encontrado pelo presente estudo pode ser utilizado na análise de outros estudos que avaliem essa associação.

Chimeric proteins of Mycoplasma hyopneumoniae as vaccine and preclinical model for immunological evaluation.

Mycoplasma hyopneumoniae (M. hyopneumoniae) is a primary agent of porcine enzootic pneumonia, a disease that causes significant economic losses to pig farming worldwide. Commercial vaccines induce partial protection, evidencing the need for a new vaccine against M. hyopneumoniae. In our work, three chimeric proteins were constructed, composed of potentially immunogenic domains from M. hyopneumoniae proteins. We designed three chimeric proteins (Q1, Q2, and Q3) based on bioinformatics analysis that identified five potential proteins with immunogenic potential (MHP418, MHP372, MHP199, P97, and MHP0461). The chimeric proteins were inoculated in the murine model to evaluate the immune response. The mice vaccinated with the chimeras presented IgG and IgG1 against proteins of M. hyopneumoniae. There was induction of IgG in mice immunized with Q3 starting from 30 days post-vaccination, and groups Q1 and Q2 showed induction at 45 days. Mice of the group immunized with Q3 showed the production of IgA. In addition, the mice inoculated with chimeric proteins showed a proinflammatory cytokine response; Q1 demonstrated higher levels of TNF, IL-6, IL2, and IL-17. In contrast, animals immunized with Q2 showed an increase in the concentrations of TNF, IL-6, and IL-4, whereas those immunized with Q3 exhibited an increase in the concentrations of TNF, IL-6, IL-10, and IL-4. The results of the present study indicate that these three chimeric proteins can be used in future vaccine trials with swine because of the promising antigenicity.

Nutritional composition of human milk and its association with maternal and perinatal factors / Composição nutricional do leite humano e sua associação com fatores maternos e perinatais

ABSTRACT Objective: The objective of this study was to evaluate the influence of maternal and perinatal factors on the nutritional composition of human milk. Methods: A cross-sectional study was conducted between November 2018 and January 2020, with 181 donors selected in Tertiary Health Units of the Unified Health System — from one collection station and five Human Milk Banks. Data were collected through a standardized questionnaire. To be fit to be a donor in a Human Milk Banks and produce mature milk were the eligibility criteria to participate in the study. We excluded milk samples with Dornic acidity above 8° D. The dependent variables were the macronutrients of human milk (i.e., carbohydrates, proteins, lipids, and total energy), that were analyzed using spectroscopy with the Miris Human Milk Analyzer™. The maternal and perinatal factors were the independent variables. Results: Women with pre-gestational obesity and gestational weight gain above the recommendation showed a lower protein concentration compared to eutrophic women (median=0.8, interquartile range (IQR): 0.7-0.9 vs. median=0.8, and IQR: 0.8-1.0) and those with adequate gestational weight gain (median=0.8, IQR: 0.7-0.9 vs. median=0.9, and IQR: 0.8-1.0), respectively. The other analyzed factors (i.e., maternal habits, comorbidities, and perinatal factors) were not associated with the nutritional composition of human milk. Conclusions: The assessment of factors associated with the nutritional composition of human milk is extremely important to assist postpartum care. Pre-gestational obesity and inadequate gestational weight gain were the only factors statistically associated with the nutritional composition of human milk as they impacted its protein content.

RESUMO Objetivo: Avaliar a influência de fatores maternos e perinatais na composição nutricional do leite humano. Métodos: Estudo transversal, realizado entre novembro de 2018 e janeiro de 2020, com 181 doadoras selecionadas em Unidades Terciárias de Saúde do Sistema Único de Saúde de um Posto de Coleta e cinco Bancos de Leite Humano. Foram coletados dados das variáveis maternas e dos recém-nascidos por meio de questionário padronizado. Estar apta para ser doadora em um Banco de Leite Humano e produzir leite maduro foram os critérios de elegibilidade para participar do estudo. As amostras de leite com acidez Dornic acima de 8° D foram excluídas. Os macronutrientes do leite humano, variáveis dependentes (carboidratos, proteínas, lipídeos, energia total) foram analisados pela técnica de espectroscopia de transmissão no infravermelho médio com o Miris Human Milk Analyzer™. Os fatores maternos e perinatais foram as variáveis independentes. Resultados: Mulheres com obesidade pré-gestacional e ganho de peso gestacional acima do recomendado apresentaram menor concentração proteica em relação às eutróficas (mediana=0,8, intervalo interquartil [IQR]: 0,7-0,9 vs. mediana=0,8, IQR: 0,8-1,0) e aquelas com ganho de peso gestacional adequado (mediana=0,8, IQR: 0,7-0,9 vs. mediana=0,9, IQR: 0,8-1,0), respectivamente. Os demais fatores analisados (hábitos maternos, comorbidades, fatores perinatais) não se associaram com a composição nutricional do leite humano. Conclusões: A avaliação dos fatores associados à composição nutricional do leite humano é de extrema importância para auxiliar os cuidados pós-parto. A obesidade pré-gestacional e o ganho de peso gestacional inadequado foram os únicos fatores estatisticamente associados com a composição nutricional do leite humano por terem impactado o seu teor de proteína.

Relative incidence of interstitial lung diseases in Brazil / Incidência relativa de doenças pulmonares intersticiais no Brasil

ABSTRACT Objective: To assess the relative frequency of incident cases of interstitial lung diseases (ILDs) in Brazil. Methods: This was a retrospective survey of new cases of ILD in six referral centers between January of 2013 and January of 2020. The diagnosis of ILD followed the criteria suggested by international bodies or was made through multidisciplinary discussion (MDD). The condition was characterized as unclassifiable ILD when there was no specific final diagnosis following MDD or when there was disagreement between clinical, radiological, or histological data. Results: The sample comprised 1,406 patients (mean age = 61 ± 14 years), and 764 (54%) were female. Of the 747 cases exposed to hypersensitivity pneumonitis (HP)-related antigens, 327 (44%) had a final diagnosis of HP. A family history of ILD was reported in 8% of cases. HRCT findings were indicative of fibrosis in 74% of cases, including honeycombing, in 21%. Relevant autoantibodies were detected in 33% of cases. Transbronchial biopsy was performed in 23% of patients, and surgical lung biopsy, in 17%. The final diagnoses were: connective tissue disease-associated ILD (in 27%), HP (in 23%), idiopathic pulmonary fibrosis (in 14%), unclassifiable ILD (in 10%), and sarcoidosis (in 6%). Diagnoses varied significantly among centers (c2 = 312.4; p < 0.001). Conclusions: Our findings show that connective tissue disease-associated ILD is the most common ILD in Brazil, followed by HP. These results highlight the need for close collaboration between pulmonologists and rheumatologists, the importance of detailed questioning of patients in regard with potential exposure to antigens, and the need for public health campaigns to stress the importance of avoiding such exposure.

RESUMO Objetivo: Avaliar a frequência relativa de casos incidentes de doenças pulmonares intersticiais (DPI) no Brasil. Métodos: Levantamento retrospectivo de casos novos de DPI em seis centros de referência entre janeiro de 2013 e janeiro de 2020. O diagnóstico de DPI seguiu os critérios sugeridos por órgãos internacionais ou foi feito por meio de discussão multidisciplinar (DMD). A condição foi caracterizada como DPI não classificável quando não houve um diagnóstico final específico após a DMD ou houve discordância entre dados clínicos, radiológicos ou histológicos. Resultados: A amostra foi composta por 1.406 pacientes (média de idade = 61 ± 14 anos), sendo 764 (54%) do sexo feminino. Dos 747 casos expostos a antígenos para pneumonite de hipersensibilidade (PH), 327 (44%) tiveram diagnóstico final de PH. Houve relato de história familiar de DPI em 8% dos casos. Os achados de TCAR foram indicativos de fibrose em 74% dos casos, incluindo faveolamento, em 21%. Autoanticorpos relevantes foram detectados em 33% dos casos. Biópsia transbrônquica foi realizada em 23% dos pacientes, e biópsia pulmonar cirúrgica, em 17%. Os diagnósticos finais foram: DPI associada à doença do tecido conjuntivo (em 27%), PH (em 23%), fibrose pulmonar idiopática (em 14%), DPI não classificável (em 10%) e sarcoidose (em 6%). Os diagnósticos variaram significativamente entre os centros (c2 = 312,4; p < 0,001). Conclusões: Nossos achados mostram que DPI associada à doença do tecido conjuntivo é a DPI mais comum no Brasil, seguida pela PH. Esses resultados destacam a necessidade de uma estreita colaboração entre pneumologistas e reumatologistas, a importância de fazer perguntas detalhadas aos pacientes a respeito da potencial exposição a antígenos e a necessidade de campanhas de saúde pública destinadas a enfatizar a importância de evitar essa exposição.

Excesso de peso pré-gestacional e ácidos graxos poli-insaturados no leite humano: modelo teórico de causalidade / Pre-gestational overweight and polyunsaturated fatty acids in human milk: theoretical causality model

Resumo Inúmeros estudos têm se detido na avaliação da associação entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Todavia, diante da complexidade de fatores de risco potencialmente confundidores, é recomendável a utilização de ferramentas gráficas para identificar possíveis vieses. O objetivo deste artigo é propor um modelo teórico de causalidade utilizando o gráfico acíclico direcionado entre o excesso de peso pré-gestacional e os ácidos graxos poli-insaturados no leite humano. Foi realizada ampla revisão da literatura para identificar as variáveis com relações causais com a exposição e/ou desfecho. A escolha das variáveis para ajuste seguiu o algoritmo gráfico que compreende seis critérios para a seleção de um conjunto mínimo de variáveis potencialmente confundidoras. Condições socioeconômicas, intervalo interpartal, idade materna e padrão de consumo alimentar foram as variáveis ajustadas a fim de se estimar o efeito total do excesso de peso pré-gestacional sobre o conteúdo dos ácidos graxos poli-insaturados no leite humano. O conjunto mínimo de variáveis encontrado pelo presente estudo pode ser utilizado na análise de outros estudos que avaliem essa associação.

Abstract A number of studies have focused on the evaluation of the relationship between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. However, given the complexity of potentially confounding risk factors, the use of graphical tools is recommended to identify possible biases. This article aims to propose a theoretical model of causality using the directed acyclic graph between pre-pregnancy overweight and polyunsaturated fatty acids content in human milk. Methods: An extensive literature review was performed to identify variables with causal relationships with exposure and/or outcome. The choice of variables for adjustment followed the graphic algorithm that comprises six criteria for selecting a minimum set of potentially confounding variables. Socioeconomic conditions, interpartum interval, maternal age and food consumption pattern were the variables that would have to be adjusted in order to estimate the total effect of pre-pregnancy overweight on polyunsaturated fatty acids content in human milk. The minimum set of variables found in the present study can be used in the analysis of other studies that evaluate this association.

3D printing technology to produce intraoral stents for head and neck radiotherapy: A scoping review.

INTRODUCTION: Radiotherapy remains one of the main treatments for head and neck cancer; however, it is accompanied by acute and chronic adverse effects. Use of three-dimensional (3D) oral stents to modulate radiation intensity to specific target areas have been developed to minimize these adverse effects. This study aimed to present a scoping review of studies published on 3D printing of oral stents and their clinical applicability. METHODS: MEDLINE/Pubmed, Scopus, Web of Science and CENTRAL Cochrane data bases were searched, studies selected, and data collected by three independent reviewers up to December 2022. The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-analysis-Extension for Scoping Reviews (PRISMA-ScR). RESULTS: The search resulted in 404 studies and 5 articles fulfilled the eligibility criteria and were considered for this review. Three-dimensional printed intraoral stents were produced for 56 patients with indication for radiotherapy. 3D-printed stents were well-tolerated by all tested patients and demonstrated great reproducibility of maxillomandibular relation, required less time for production and lower cost to manufacture. Two studies showed great protection of healthy tissues with 3D-printed stents during radiotherapy. CONCLUSIONS: Three-dimensional printing is promising for production of intraoral stents, however, more studies are needed to improve the technique and further investigate the safety and prevention of oral toxicities from radiotherapy.

Gingival cyst of the adult.

The gingival cyst of the adult (GCA) is a rare odontogenic cyst, consisting of 0.3% of all odontogenic cysts. This case report, based on CARE guidelines for case reports, aims to present a case of a 52-year-old female patient with a symptomatic translucent nodule in the upper left anterior gingiva, measuring approximately 6mm. Excisional biopsy was performed, and the histological examination revealed multiple cystic cavities lined by the squamous epithelium of varying thickness with focal areas of nodular thickenings. The presence of clusters of cells with clear cytoplasm within epithelial thickenings was observed. PAS staining was negative in clear cells. The diagnosis of the GCA was established. Despite its rarity, GCA should be considered in the differential diagnosis of gingival lesions. Conservative surgical treatment proved to be effective, with no signs of recurrence.

Atenção Básica e produção de saúde na Amazônia: perfil e condições de saúde no município de Manicoré

Os cuidados em saúde na Amazônia possuem singularidades, não só pela diversidade de seu território, mas pela pluralidade de suas gentes. Nesse sentido, o objetivo deste estudo foi analisar o perfil dos usuários que acessam a atenção básica de saúde no município de Manicoré, Amazonas, descrevendo os seus fatores socioeconômicos e demográficos. Trata-se, assim, de um estudo transversal, do tipo descritivo com abordagem quantitativa sobre o perfil de saúde e condições de vida dessa população. Entre os resultados mais relevantes destacam-se: alto índice de gravidez na adolescência; elevado quantitativo de gestantes com as consultas pré-natais consideradas inadequadas; elevada taxa de partos cesáreos; elevado número de notificações de doenças infecciosas e parasitárias e a diminuição da cobertura da Estratégia de Saúde da Família. A análise levantada neste estudo teve como base os dados registrados nos sistemas de informações considerando-se os dados epidemiológicos da cobertura da Estratégia de Saúde da Família, bem como dos demais registros produzidos nas diversas portas de entrada da rede de saúde do município de Manicoré, os quais devem ser entendidos de forma ampla alinhados com as diretrizes dos programas e metas estabelecidas pelo Ministério da Saúde. O papel do controle social na discussão das prioridades deve estar, portanto, alinhado com as principais dificuldades enfrentadas no município, as quais devem ser materializadas nos planos de saúde.

Osteoradionecrosis treatment in head and neck cancer patients: An overview of systematic reviews.

AIMS: Evaluate the existing evidence of osteoradionecrosis (ORN) treatment in adults with head and neck cancer, the methodological quality and the evidence grade within systematic reviews (SRs). METHODS: An extensive systematic literature search of SRs that addressed ORN in head and neck cancer patients was conducted with screening of eligible studies, data extraction, methodological (AMSTAR 2) and evidence quality assessment (GRADE) of the SRs by independent and calibrated authors. RESULTS: A total of six SRs were enrolled. Based primarily on studies from the 1990s, there is critically low- or moderate-quality evidence that hyperbaric oxygen therapy (HBO) improves ORN healing. From 2005 onward, evidence has been discovered in relation to treatment with pentoxifylline and tocopherol (PENTO). The SRs indicate that the management of ORN with PENTO appears to be promising. The greatest rates of healing are seen in mild and moderate stages of ORN. However, the quality of evidence regarding PENTO, surgery and other treatments remains critically low. CONCLUSION: There is no standardized protocol to treat ORN. PENTO appears to be the most promising conservative treatment; however, the current level of evidence regarding PENTO is still critically low. More robust clinical studies are needed to establish the best treatment for ORN.

Reply to comment on "Ultrasonographic scores for ileal Crohn's disease assessment: better, worse or the same as contrast­enhanced ultrasound?

We read the comments by Nylund K et al. regarding our paper "Ultrasonographic scores for ileal Crohn's disease assessment: Better, worse or the same as contrast­enhanced ultrasound?". Intestinal ultrasound has become one of the most valuable developments in the past decade, a non-invasive, well-tolerated exam, with an easy repeatability, and absence of sedation, ionizing radiation, or preparation. Particularly for inflammatory bowel disease, where there is a lack of agreement of patient's symptoms with disease activity, in an era where the paradigm of mucosal healing is changing to transmural healing, and with the emergence of several therapies leading to repeated imaging surveillance, it is essential to highlight the role of intestinal ultrasound. Although intestinal ultrasound is an increasingly used tool to monitor inflammatory bowel disease activity, there is no widely accepted reproducible activity index, since the methodology for the development of the scores was shown to be insufficient in most studies and none have been adequately validated (Bots et al., J Crohns Colitis 12:920-9, 2018). In our study, we showed that the contrast-enhanced ultrasound (CEUS) peak enhancement derived from the time-intensity curve (TIC) is a promising non-invasive emerging method with a good accuracy to correlate clinical and endoscopic activity in the terminal ileum, superior to intestinal ultrasound scores relying on bowel wall thickness and colour Doppler.

Acesso transconjutival com cantotomia lateral para abordagem do completo orbito-zigomático-maxilar: relato de caso / Transconjutival access with side cantotomy to approach the orbito-zygomatic-maxillary complex: case report

Objetivo: relatar um caso clínico, embasando os aspectos relativos à técnica cirúrgica transconjutival com cantotomia lateral como tratamento para fratura de COZM. Relato de caso: Paciente, gênero masculino, compareceu ao Serviço de Cirurgia e Traumatologia Bucomaxilofacial do Hospital Geral do Estado (HGE), vítima de acidente motociclístico, apresentando distopia ocular, degrau ósseo em rebordo infraorbitário direito, perda de projeção malar direita, abertura bucal limitada com desvio ipsilateral e distopia oclusal com sinais sugestivos de fratura do complexo-orbito-zigomático-maxilar direito, juntamente com fratura complexa da mandíbula. A abordagem cirúrgica para acessar o COZM contou com a técnica de incisão transconjuntival com cantotomia lateral para uma melhor visualização dos cotos ósseos fraturados. Considerações finais: a escolha por esse tipo de acesso resultou em uma abordagem cirúrgica bem-sucedida, proporcionando segurança na visualização do campo cirúrgico para posterior reabilitação do paciente, estabelecendo uma devolutiva estética e funcional, cicatriz imperceptível e consequentemente um melhor prognóstico para o paciente.(AU)

Objective: to report a clinical case, basing the aspects related to the transconjunctival surgical technique with lateral canthotomy as a treatment for COZM fracture. Case report: Patient, male gender, attended the Oral and Maxillofacial Surgery and Traumatology Service of the General Hospital of the State (HGE), victim of a motorcycle accident, presenting ocular dystopia, bone step in the right infraorbital ridge, loss of right malar projection, mouth opening limited with ipsilateral deviation and occlusal dystopia with signs suggestive of a fracture of the right orbito-zygomatico-maxillary complex along with a complex fracture of the mandible. The surgical approach to access the contoured COZM with the transconjunctival incision technique with lateral canthotomy for better visualization of the fractured bone stumps. Final considerations: the choice for this type of access resulted in a successful behavioral approach, providing security in the experience of the respiratory field for subsequent rehabilitation of the patient, establishing a devolutionary and functional aesthetics, imperceptible healing and, consequently, a better prognosis for the patient.(AU)

Effects of calcium chloride substitution on the physicochemical properties of Minas Frescal cheese.

The aim in this research paper was to investigate the effect of using calcium monophosphate (MCP) and MCP mixed with commercial phosphates salts, in total or partial replacement of calcium chloride (CaCl2) in the manufacture of Minas Frescal cheese. Initially, model cheeses were made to perform the rheological analysis during the coagulation process. Of these, the five best treatments were chosen to carry out the production of Minas Frescal cheese, used only CaCl2 and MCP, and partial replacements of MCP + polyphosphate, MCP + potassium monophosphate (MKP) and MCP. The cheeses showed no significant difference in physicochemical composition, yield and syneresis, however, the cheese with partial replacement of CaCl2 by MCP + polyphosphate and MCP + MKP showed the highest hardness values, like the control. This demonstrates that it is possible to replace calcium chloride without significant changes in the physicochemical characteristics and yield of Minas Frescal cheese, and it is still possible to modulate the hardness of the cheese produced according to the type of calcium/phosphate source used. This allows the industry to replace the source of calcium in the manufacture of Minas Frescal cheese according to the desired hardness.

Contributions of a Rehabilitation Nursing Program in the Self-Care of Women Undergoing Breast Surgery.

BACKGROUND: Although surgical treatments for breast cancer have exhibited advanced interventions, axillary lymph node dissection can limit functionality and compromise women's self-care. This study aims to assess the effectiveness of a rehabilitation nursing program in improving self-care performance in women undergoing breast surgery with axillary lymph node dissection. METHODS: This quantitative, quasi-experimental study involved 48 women recruited from a main hospital between 2018 and 2019. The participants completed a three-month rehabilitation program at home. The evaluation instrument used was the DASH questionnaire. This study was not registered. RESULTS: The functionality of the upper limb ipsilateral to the surgery improved significantly (p < 0.001) after the implementation of the program, influencing the participants' capacity for self-care, including washing/drying their hair, washing their back, and wearing a shirt. The average DASH total score increased from 54.4 to 8.1 after the program. CONCLUSIONS: The rehabilitation nursing program positively influenced the participants' self-care ability. Incorporating rehabilitation nursing programs into breast cancer treatment can improve self-care performance and the overall quality of patients' lives. This study was not registered.

Caracterización de adolescentes lesionados por armas blancas en región tóraco-abdominal / Adolescents' characterization injured by steels in tóraco-abdominal region

Introducción: El trauma intencional por arma blanca, que ocasiona lesiones potencialmente fatales, constituye una de las causas de atención médica frecuente en el Servicio de Urgencias. Objetivo: Caracterizar a adolescentes con lesiones por armas blancas en región tóraco-abdominal. Métodos: Se realizó un estudio observacional, descriptivo, de corte transversal en 94 pacientes con lesiones tóraco-abdominales por arma blanca ingresados en el Hospital Pediátrico Juan Manuel Márquez en el período comprendido desde enero del 2016 hasta diciembre del 2020. Las variables estudiadas fueron: edad, sexo, tipo de heridas y localización, lesiones ocasionadas, procedimientos quirúrgicos realizados, complicaciones y casuística según los años estudiados. Resultados: El sexo masculino fue el más frecuente (92,6 por ciento) y las edades entre 15 y 18 años (87,2 por ciento). Predominaron las heridas de tipo no penetrantes (60,7 por ciento) y la localización torácica (59,8 por ciento). En las lesiones penetrantes predominó el neumotórax abierto (31 por ciento). Los procedimientos quirúrgicos más realizados fueron la sutura de herida traumática (100 por ciento) y la pleurostomía (44,8 por ciento). Entre las complicaciones presentadas prevalecieron la neumonía (35,2 por ciento) y la infección de la herida traumática (17,6 por ciento). El 2019 fue el año con mayor número de casos (25,5 por ciento). Conclusiones: Los adolescentes con lesiones tóraco-abdominales por arma blanca se caracterizan, en general, por ser varones entre 15 y 18 años. Las heridas de tipo no penetrante en tórax constituyen la lesión fundamental y la sutura de heridas es el procedimiento quirúrgico más empleado. La complicación más frecuente es la neumonía(AU)

Introduction: Intentional stab wound trauma, which causes potentially fatal injuries, is one of the causes for frequent medical attention in the emergency department. Objective: To characterize adolescents with stab wounds in the thoracoabdominal region. Methods: An observational, descriptive and cross-sectional study was conducted in 94 patients with thoracoabdominal stab wounds admitted to Hospital Pediátrico Juan Manuel Márquez from January 2016 to December 2020. The variables studied were age, sex, wound type and location, caused injuries, performed surgical procedures, complications and casuistry according to the studied years. Results: The male sex was the most frequent (92.6 percent), together with ages between 15 and 18 years (87.2 percent). Nonpenetrating injuries (60.7 percent) and the thoracic location (59.8 percent) predominated. Among penetrating injuries, open pneumothorax (31 percent) dominated. The most frequently performed surgical procedures were traumatic wound suturing (100 percent) and pleurostomy (44.8 percent). Among the complications, pneumonia (35.2 percent) and traumatic wound infection (17.6 percent) prevailed. 2019 was the year with the highest number of cases (25.5 percent). Conclusions: Adolescents with thoracoabdominal stab wounds were generally characterized as males at ages between 15 and 18 years. Nonpenetrating thoracic wounds are the main injuries and wound suturing is the most frequently used surgical procedure. The most frequent complication is pneumonia(AU)

Influence of Environmental Exposure to Steel Waste on Endocrine Dysregulation and PER3 Gene Polymorphisms.

OBJECTIVE: To evaluate the association between environmental exposure to the following chemical substances: cadmium (Cd), lead (Pb), nickel (Ni), manganese (Mn), benzene (BZN), and toluene (TLN), and Period Circadian Regulator 3 (PER3) gene variable number of tandem repeats (VNTR) polymorphisms, according to chronotype in a population living in a steel residue-contaminated area. METHODS: This assessment comprises a study conducted from 2017 to 2019 with 159 participants who completed health, work, and Pittsburgh sleep scale questionnaires. Cd, Pb, Ni, Mn, BZN, and TLN concentrations in blood and urine were determined by Graphite Furnace Atomic Absorption Spectrometry (GFAAS) and Headspace Gas Chromatography (GC), and genotyping was carried out using Polymerase Chain Reaction (PCR). RESULTS: A total of 47% of the participants were afternoon chronotype, 42% were indifferent, and 11% were morning chronotype. Insomnia and excessive sleepiness were associated with the indifferent chronotype, while higher urinary manganese levels were associated with the morning chronotype (Kruskal-Wallis chi-square = 9.16; p < 0.01). In turn, the evening chronotype was associated with poorer sleep quality, higher lead levels in blood, and BZN and TLN levels in urine (χ2 = 11.20; p < 0.01) in non-occupationally exposed individuals (χ2 = 6.98; p < 0.01) as well as the highest BZN (χ2 = 9.66; p < 0.01) and TLN (χ2 = 5.71; p < 0.01) levels detected in residents from the influence zone 2 (far from the slag). CONCLUSION: Mn, Pb, benzene, and toluene contaminants may have influenced the different chronotypes found in the steel residue-exposed population.