Developing Cardio-Oncology Programs in the New Era: Beyond Ventricular Dysfunction Due to Cancer Treatments.

Cardiovascular disease is a common problem in cancer patients that is becoming more widely recognized. This may be a consequence of prior cardiovascular risk factors but could also be secondary to the anticancer treatments. With the goal of offering a multidisciplinary approach to guaranteeing optimal cancer therapy and the early detection of related cardiac diseases, and in light of the recent ESC Cardio-Oncology Guideline recommendations, we developed a Cardio-Oncology unit devoted to the prevention and management of these specific complications. This document brings together important aspects to consider for the development and organization of a Cardio-Oncology program through our own experience and the current evidence.

Perfil Epidemiológico e Fatores Relacionados ao Câncer de Cavidade Oral em Adultos Jovens Brasileiros e sua Relação com o Óbito, 1985-2017 / Epidemiological Profile and Factors Related to Oral Cavity Cancer in young Brazilian Adults and its Relationship with Death, 1985-2017 / Perfil Epidemiológico y Factores Relacionados con el Cáncer de Cavidad Oral en Adultos Jóvenes Brasileños y su Relación con la Muerte, 1985-2017

Introdução: A incidência do câncer de cavidade oral entre adultos jovens tem crescido ao longo dos últimos anos, não estando clara a etiologia e a patogênese da neoplasia nesse grupo. Objetivo: Descrever o perfil dos adultos jovens brasileiros diagnosticados com carcinoma de células escamosas (CCE) em cavidade oral e a relação com o óbito entre 1985 e 2017. Método: Estudo transversal de base hospitalar, com indivíduos de 19 a 40 anos, diagnosticados com CCE a partir dos Registros Hospitalares de Câncer do Brasil. Foi realizada a análise descritiva e calculados o teste qui-quadrado, a razão de prevalência (RP) e a regressão logística com intervalo de confiança de 95%. Resultados: Foram elegíveis 1.761 casos de CCE em adultos jovens no período em estudo. O maior número de casos se concentrou na faixa etária de 31≥40 anos (79,80%), homens (71,90%), brancos (50,20%), moradores da Região Sudeste (36,40%), sem companheiro (58,00%) e com o ensino fundamental completo (63,40%). A maioria apresentava hábitos tabagistas (61,60%) e etilistas (56,70%), 18,50% eram profissionais da agricultura/aquicultura e 40,70% relataram histórico familiar de câncer. Foram diagnosticados em estádio avançado 68,10% e 25,50% dos casos foram a óbito. Os casos diagnosticados na língua foram os mais frequentes (42,40%) e apresentaram RP=2,638 (IC95% 2,050-3,394) vezes maior para óbito em relação aos casos no lábio e após ajuste, a odds ratio para esse local aumentou para 7,832 (IC95% 2,625-23,374, p<0,0001). Conclusão: O CCE nessa população necessita de maior atenção para reduzir a incidência e a letalidade desse problema de saúde pública

Introduction: The incidence of oral cavity cancer among young adults has grown over the past few years, and the etiology and pathogenesis of the neoplasm in this group is unclear. Objective: To describe the profile of Brazilian young adults diagnosed with squamous cell carcinoma (SCC) in the oral cavity and the relationship with death between 1985 and 2017. Method: Hospital-based cross-sectional study with individuals, aged 19 to 40, diagnosed with SCC from the Brazilian Cancer Hospital Records. Descriptive analysis was performed and chi-square test, prevalence ratio (PR) and logistic regression were calculated with 95% confidence interval. Results: 1,761 cases of SCC in young adults were retrieved during the study period. The highest number of cases was concentrated in the age group of 31≥40 years (79.80%), males (71.90%), white (50.20%), residents of the Southeast region (36.40%), without partner (58.00%) and completed elementary education (63.40%). 61.60% were smokers, 56.70%, alcoholics, 18.50%, agriculture/aquaculture professionals and 40.70% reported family cancer history. 68.10% were diagnosed at an advanced stage and about 25.50% of the cases died. Cases in the tongue were the most frequent (42.40%) with PR=2.638 (95%CI 2.050-3.394) times higher for death compared to cases in the lip and after adjustment, the odds ratio increased to 7.832 (CI95% 2.625-23.374, p<0.0001). Conclusion: It is necessary to pay more attention to the population with SCC, in order to reduce the incidence and lethality of this public health problem

Introducción: La incidencia de cáncer de cavidad oral entre adultos jóvenes ha aumentado en los últimos años y la etiología y patogenia de la neoplasia en este grupo no está clara. Objetivo: Describir el perfil de los jóvenes adultos brasileños diagnosticados de carcinoma epidermoide (CCE) en la cavidad oral y la relación con la muerte entre 1985 y 2017. Método: Estudio transversal hospitalario con individuos de 19 a 40 años, diagnosticados de CCE a partir de los registros hospitalarios oncológicos de Brasil. Se realizó análisis descriptivo, y se calculó la prueba de chi-cuadrado, razón de prevalencia (RP) y regresión logística con un intervalo de confianza del 95%. Resultados: Un total de 1.761 casos de CCE en adultos jóvenes fueron elegibles durante el período de estudio. El mayor número de casos se concentró en el grupo de edad de 31≥40 años (79,80%), hombres (71,90%), blancos (50,20%), residentes del Sureste (36,40%), sin pareja (58,00%) y con educación básica (63,40%). La mayoría (61,60%) tenía hábito de fumar y beber (56,70%), el 18,50% eran profesionales de la agricultura/acuicultura y el 40,70% referían antecedentes familiares de cáncer. El 68,10% fueron diagnosticados en estadio avanzado y alrededor del 25,50% de los casos fallecieron. Los casos con localización en la lengua fueron los más frecuentes (42,40%) y presentaron RP=2,638 (IC 95% 2,050-3,394) veces mayor para muerte en comparación con los casos en el labio y luego del ajuste, la odds ratio para esta localización aumentó 7,832 (IC95% 2,625 ­23,374, p<0,0001). Conclusión: El CCE en esta población necesita más atención para reducir la incidencia y la letalidad de este problema de salud pública

Enfrentamento do luto por perda familiar pela covid-19: estratégias de curto e longo prazo / Afrontamiento del duelo por pérdida familiar debido a covid-19: estrategias de corto y largo plazo / Coping with mourning for family loss due to covid-19: short and long-term strategies

Resumo Objetivo: conhecer as estratégias que podem auxiliar pessoas enlutadas pela morte de familiares pela covid-19 a lidarem com a perda. Metodologia: revisão narrativa realizada na plataforma PubCovid-19 por meio dos descritores "death" "bereavement", "grief" e "mourning". Foram incluídos dez artigos. Resultados: as estratégias encontradas dizem respeito à adoção de chamadas telefônicas, à gravação de áudios, à elaboração de cartas e à seleção das fotos, as quais são classificadas como imediatas e de longo prazo, focadas no cuidado com a saúde mental, a qual pode ser afetada pela depressão e pelos distúrbios psicológicos. Conclusões: urge que sejam criados programas de aconselhamento que ofereçam, aos parentes dos falecidos pela covid-19, um atendimento holístico, humanizado, contínuo, com foco na saúde mental.

Resumen Objetivo: conocer las estrategias que pueden ayudar a las personas en duelo por la muerte de miembro de la familia por la covid-19 para afrontar la pérdida. Metodología: revisión narrativa realizada en la plataforma PubCovid-19 por medio de los descriptores "death; "mourning"; "Covid-19"; "coping strategies". Se incluyeron diez artículos. Resultados: las estrategias encontradas se relacionan con la adopción de llamadas telefónicas, grabación de audios, cartas y fotos, las que se clasifican como inmediatas y a largo plazo centradas en la atención de la salud mental, la que puede ser afectada por la depresión y los trastornos psicológicos. Conclusiones: es urgente la creación de programas de asesoramiento para los familiares de los fallecidos por la covid-19, con el fin de ofrecer una atención integral, humanizada y continua, con un enfoque en la salud mental.

Abstract Objective: To explore the strategies that can help individuals mourning a family member's death from Covid-19 to cope with the loss. Method: We carried out a narrative review on the PubCovid-19 platform using the descriptors "death," "mourning," "Covid-19," and "coping strategies." Ten articles were included. Results: The strategies found are phone calls, audio recording, letters, and photos, classified as immediate and long-term. These strategies are focused on mental health, which can be adversely affected by depression and psychological disorders. Conclusions: Creating counseling programs for the relatives of those who died from Covid-19 is urgent. They must offer comprehensive, humanized, and continuous mental health care.

Clonal relationship in multisited mucosa-associated lymphoid tissue lymphomas: a single-centre experience.

Clonal heterogeneity in multisited or recurrent lymphoid neoplasms is a phenomenon that has been increasingly studied in recent years. However, in mucosa-associated lymphoid tissue (MALT) lymphomas it remains largely unexplored. Patients diagnosed at our institution with multisited MALT lymphoma, from January 2009 to October 2018, were studied. Molecular studies were performed for the detection of clonally rearranged immunoglobulin by polymerase chain reaction.In all, 91 patients were included. Of those, 28 had a multisited disease and in 16 clonality studies were done. In eight cases, multifocal involvement was synchronous and in eight metachronous. Patients with non-gastric gastrointestinal tract involvement tended to disseminate within the same tract, without observing other specific dissemination patterns. Four cases (25%) had clonal heterogeneity at the different organs involved. All patients with late relapses (two patients) had different clones. The majority of patients with multisited MALT lymphomas presented with the same clone in the different involved organs, identifying a different clone in those with late relapses. These patients could represent de novo neoplasms, rather than a relapse. This could mean that some individuals might have a genetic predisposition to develop this type of lymphoma and it could also have clinical implications regarding therapeutic decisions.

Clinical outcome and prognostic factors of patients with Richter syndrome: real-world study of the Spanish Chronic Lymphocytic Leukemia Study Group (GELLC).

Richter syndrome (RS) is an uncommon evolution of chronic lymphocytic leukaemia (CLL) with a dismal prognosis. Clinical-biological features predicting outcome and best therapeutic approach for these patients remain to be established. In this study, 128 patients with RS, including 112 diffuse large B-cell lymphoma (DLBCL)-type RS, 15 Hodgkin lymphoma (HL)-type RS, and one plasmablastic lymphoma, were identified in 11 centres of the Spanish CLL Study Group (GELLC). The median overall survival (OS) was 5·9 months for DLBCL-type RS and 30·8 months for HL-type RS. Eastern Cooperative Oncology Group Performance Status, haemoglobin level, platelet count, serum lactate dehydrogenase and ß2-microglobulin levels, tumour protein p53 (TP53) abnormalities in the CLL clone concomitant to RS, number of prior therapies, and clonal relationship between CLL and RS, were associated with OS in patients with DLBCL-type RS. A platelet count of <100 × 109 /l, prior CLL therapy (0 vs. ≥1), and presence of TP53 alterations maintained an independent prognostic impact in the multivariate analysis. Patients without any of these factors had a better clinical outcome, with a median OS of 75·3 months, while patients with one or two or more of these factors presented a median OS of 25·5 and 3 months, respectively. Although OS of patients with RS is generally poor, a proportion of patients achieved prolonged survival. Treatment of RS remains a medical need, and further therapeutic approaches with novel therapies are warranted.

Effect of a Face-Aging Mobile App-Based Intervention on Skin Cancer Protection Behavior in Secondary Schools in Brazil: A Cluster-Randomized Clinical Trial.

Importance: Because exposure to UV radiation early in life is an important risk factor for melanoma development, reducing UV exposure in children and adolescents is of paramount importance. New interventions are urgently required. Objective: To determine the effect of the free face-aging mobile app Sunface on the skin cancer protection behavior of adolescents. Design, Setting, and Participants: This cluster-randomized clinical trial included a single intervention and a 6-month follow-up from February 1 to November 30, 2018. Randomization was performed on the class level in 52 school classes within 8 public secondary schools (grades 9-12) in Itauna, Southeast Brazil. Data were analyzed from May 1 to October 10, 2019. Interventions: In a classroom seminar delivered by medical students, adolescents' selfies were altered by the app to show UV effects on their future faces and were shown in front of their class, accompanied by information about UV protection. Information about relevant parameters was collected via anonymous questionnaires before and 3 and 6 months after the intervention. Main Outcomes and Measures: The primary end point of the study was the difference in daily sunscreen use at 6 months of follow-up. Secondary end points included the difference in daily sunscreen use at 3 months of follow-up, at least 1 skin self-examination within 6 months, and at least 1 tanning session in the preceding 30 days. All analyses were predefined and based on intention to treat. Cluster effects were taken into account. Results: Participants included 1573 pupils (812 girls [51.6%] and 761 boys [48.4%]; mean [SD] age, 15.9 [1.3] years) from 52 school classes. Daily sunscreen use increased from 110 of 734 pupils (15.0%) to 139 of 607 (22.9%; P < .001) at the 6-month follow-up in the intervention group. The proportion of pupils performing at least 1 skin self-examination in the intervention group rose from 184 of 734 (25.1%) to 300 of 607 (49.4%; P < .001). Use of tanning decreased from 138 of 734 pupils (18.8%) to 92 of 607 (15.2%; P = .04). No significant changes were observed in the control group. The intervention was more effective for female students (number needed to treat for the primary end point: 8 for girls and 31 for boys). Conclusions and Relevance: These findings suggest that interventions based on face-aging apps may increase skin cancer protection behavior in Brazilian adolescents. Further studies are required to maximize the effect and to investigate the generalizability of the effects. Trial Registration: ClinicalTrials.gov Identifier: NCT03178240.

Validation of the NCCN-IPI and the GELTAMO-IPI for diffuse large B-Cell lymphoma treated with R-CHOP in a large cohort of patients from a single institution.

The discriminative power of International Prognostic Index (IPI) in diffuse large B-cell lymphoma (DLBCL) decreased with the addition of rituximab to chemotherapy. The National Comprehensive Cancer Network (NCCN)-IPI and the Grupo Español de Linfomas y Trasplante Autólogo de Médula Ósea (GELTAMO)-IPI were developed to improve the risk prediction for DLBCL patients. We aim to validate the NCCN-IPI and GELTAMO-IPI in a large and homogeneous cohort of 337 DLBCL patients treated with curative intent with R-CHOP/R-CHOP-like immunochemotherapy. The IPI stratifies patients in two independent risk groups and the estimated 5-year overall survival (OS) of the high-risk (HR) group was 43%. NCCN-IPI discriminated four risk groups and GELTAMO-IPI three risk groups of patients. The predicted 5-year OS of the HR group was 38% and 29%, respectively. NCCN-IPI and GELTAMO-IPI are more accurate prognostic indices than IPI in DBLCL patients treated with immunochemotherapy. GELTAMO-IPI demonstrated enhanced discrimination than NCCN-IPI for the higher-risk population.

Long-term outcome comparing histological grades of follicular lymphoma patients treated with immunochemotherapy as first-line therapy: A retrospective analysis from two institutions.

OBJECTIVES: To clarify the impact of histological grades in follicular lymphoma. METHODS: We retrospectively analysed 250 patients diagnosed with FL treated with chemoimmunotherapy: 188 patients were grades 1-2 and 62 grade 3A. RESULTS: In our series, grade 3A FL patients were older, higher proportion of localised disease and lower bone marrow infiltration at diagnosis comparing grades 1-2 FL patients. Estimated six-year progression-free survival and time to progression showed no differences between both groups [grade 3A: 56% (95%CI: 39%-73%) and 51% (95%CI: 41%-61%) vs grades 1-2:55% (95%CI: 46%-63%) and 57% (95%CI: 49%-65%), P = .782 and P = .521, respectively]. Estimated six-year overall survival was lower, 76% (95%CI: 64%-88%) for the grade 3A group than grades 1-2 83% (95%CI: 77%-89%); P = .044. In addition to that, cumulative incidence curves of death not related to lymphoma at 10 years between groups were as follows: [0.26 (95%CI: 0.25-0.27) and 0.05 (95%CI: 0.04-0.06) for G3AFL and G1-2FL, respectively], P = .010. Grade 3A FL showed in PFS curve no relapses after 6 years. These results were absolutely reproduced in 199 patients receiving R-CHOP regimen as induction. CONCLUSIONS: Our results indicate similar long-term outcomes in terms of progression-free survival and time to progression in grades 1-2 and 3A. No relapses were observed in G3AFL group after 6 years.

Clinicopathologic features and prognostic significance of CD30 expression in de novo diffuse large B-cell lymphoma (DLBCL): results in a homogeneous series from a single institution.

Introduction: The present study evaluates CD30 expression by immunohistochemistry (IHQ) in 216 patients with de novo DLBCL.Methods: CD30 expression was assessed retrospectively in all cases by IHQ. More than >0% and >20% of CD30 expression in the malignant cells were used as a cut-off for positivity. Survival was analysed in 176 patients treated with R-CHOP/R-CHOP-like regimens.Results: CD30 expression >0% was found in 66 (31%) patients, and >20% in 41 (19%). Younger patients <60 years (p = 0.03), good performance status (p = 0.04), and non-GCB subtype (p = 0.004) correlated with CD30 expression. No significant differences were found in overall survival and progression-free survival (PFS), although there was a trend towards better PFS in CD30-positive patients (p = 0.07). Among 7 patients with Epstein-Barr virus (EBV)-positive-DLBCL, CD30 was expressed in 71%, and 2-year PFS significantly inferior compared with CD30-positive EBV-negative-DLBCL patients (p = 0.01).Conclusion: CD30 is expressed in 30% of DLBCL patients, in whom targeted therapy with an anti-CD30 monoclonal antibody could be explored. CD30 is expressed more frequently younger patients, with better performance status and in the non-GCB subtype and its expression trends towards a better PFS. No significant differences regarding characteristics at diagnosis or prognosis were found between groups with different cut-off for positivity.

Implicações sociais e de saúde que acometem pessoas enlutadas pela morte de familiares por covid-19 / Implicaciones sociales y de salud que afectan las personas en luto por la muerte de familiares por la covid-19 / Social and health implications that affect people bereaved by the death of family members by covid-19

Objetivo: conhecer as implicações sociais e para a saúde que acometem pessoas enlutadas pela morte de familiares vítimas da COVID-19. Método: trata-se de revisão narrativa realizada na plataforma PubCovid-19. Resultados: foi desenvolvido um quadro apresentando as características das dez publicações segundo título, autoria, ano de publicação, país e periódico. Conclusão: as implicações sociais e de saúde que acometem pessoas enlutadas pela morte de familiares por COVID-19 decorrem do distanciamento social que gera a impossibilidade da realização de rituais de despedida prejudicando a vivência normal do luto, levando ao luto complicado e ao possível adoecimento psíquico.

Objetivo: conocer las implicaciones sociales y para la salud que afectan a las personas en luto por la muerte de familiares víctimas de COVID-19. Método: esta es una revisión narrativa realizada en la plataforma PubCovid-19. Resultados: se elaboró un cuadro que presenta las características de las diez publicaciones por título, autoría, año de publicación, país y periódico. Conclusión: las implicaciones sociales y para la salud que afectan a las personas en luto por la muerte de familiares por la COVID-19 se derivan del distanciamiento social que genera la imposibilidad de realizar los rituales de despedida, perjudicando la vivencia normal del luto, provocando el complicado luto y la posible enfermedad psíquica.

Objective: to know the social and health implications that affect people bereaved by the death of relatives who were victims of COVID-19. Method: this is a narrative review carried out on the PubCovid-19 platform. Results: a chart was developed presenting the characteristics of the ten publications by title, authorship, year of publication, country and journal. Conclusion: the social and health implications that affect people bereaved by the death of family members by COVID-19 derive from the social distancing that generates the impossibility of performing farewell rituals, damaging the normal experience of mourning, leading to complicated mourning and possible psychic illness.

A skin cancer prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised controlled trial.

INTRODUCTION: The incidence of melanoma is increasing faster than any other major cancer both in Brazil and worldwide. The Southeast of Brazil has especially high incidences of melanoma, and early detection is low. Exposure to UV radiation represents a primary risk factor for developing melanoma. Increasing attractiveness is a major motivation for adolescents for tanning. A medical student-delivered intervention that harnesses the broad availability of mobile phones as well as adolescents' interest in their appearance may represent a novel method to improve skin cancer prevention. METHODS AND ANALYSIS: We developed a free mobile app (Sunface), which will be implemented in at least 30 secondary school classes, each with 21 students (at least 30 classes with 21 students for control) in February 2018 in Southeast Brazil via a novel method called mirroring. In a 45 min classroom seminar, the students' altered three-dimensional selfies on tablets are 'mirrored' via a projector in front of their entire class, showing the effects of unprotected UV exposure on their future faces. External block randomisation via computer is performed on the class level with a 1:1 allocation. Sociodemographic data, as well as skin type, ancestry, UV protection behaviour and its predictors are measured via a paper-pencil questionnaire before as well as at 3 and 6 months postintervention. The primary end point is the group difference in the 30-day prevalence of daily sunscreen use at a 6-month follow-up. Secondary end points include (1) the difference in daily sunscreen use at a 3-month follow-up, (2) if a self-skin examination in accordance with the ABCDE rule was performed within the 6-month follow-up and (3) the number of tanning sessions. ETHICS AND DISSEMINATION: Ethical approval was obtained from the ethics committee of the University of Itauna. Results will be disseminated at conferences and in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT03178240; Pre-results.

A smoking prevention photoageing intervention for secondary schools in Brazil delivered by medical students: protocol for a randomised trial.

INTRODUCTION: Most smokers start smoking during their early adolescence, often with the idea that smoking is glamorous; the dramatic health consequences are too far in the future to fathom. We recently designed and tested an intervention that takes advantage of the broad availability of mobile phones as well as adolescents' interest in their appearance. A free photoageing mobile app (Smokerface) was implemented by medical students in secondary schools via a novel method called mirroring. The pupils' altered three-dimensional selfies on tablets were 'mirrored' via a projector in front of their whole grade. This is the first randomised trial to measure the effectiveness of the mirroring approach on smoking behaviour in secondary schools. METHODS AND ANALYSIS: The mirroring intervention, which lasts 45 min, is implemented by Brazilian medical students in at least 35 secondary school classes with 21 participants each (at least 35 classes with 21 participants for control) in February 2018 in the city of Itauna, Brazil. External block randomisation via computer is performed on the class level with a 1:1 allocation. In addition to sociodemographic data, smoking behaviour is measured via a paper-pencil questionnaire before, 3 and 6 months postintervention plus a random carbon monoxide breathing test at baseline and end line. The primary outcome is cigarette smoking in the past week at 6 months follow-up. Smoking behaviour (smoking onset, quitting) and effects on the different genders are studied as secondary outcomes. Analysis is by intention to treat. ETHICS AND DISSEMINATION: Ethical approval is obtained from the ethics committee of the University of Itauna in Brazil. Results will be disseminated at conferences, in peer-reviewed journals, throughout the Education Against Tobacco network social media channels and on our websites. TRIAL REGISTRATION NUMBER: NCT03178227.

Chronic lymphocytic leukemia with isochromosome 17q: An aggressive subgroup associated with TP53 mutations and complex karyotypes.

Although i(17q) [i(17q)] is frequently detected in hematological malignancies, few studies have assessed its clinical role in chronic lymphocytic leukemia (CLL). We recruited a cohort of 22 CLL patients with i(17q) and described their biological characteristics, mutational status of the genes TP53 and IGHV and genomic complexity. Furthermore, we analyzed the impact of the type of cytogenetic anomaly bearing the TP53 defect on the outcome of CLL patients and compared the progression-free survival (PFS) and overall survival (OS) of i(17q) cases with those of a group of 38 CLL patients harboring other 17p aberrations. We detected IGHV somatic hypermutation in all assessed patients, and TP53 mutations were observed in 71.4% of the cases. Patients with i(17q) were more commonly associated with complex karyotypes (CK) and tended to have a poorer OS than patients with other anomalies affecting 17p13 (median OS, 44 vs 120 months, P = 0.084). Regarding chromosomal alterations, significant differences in the median OS were found among groups (P = 0.044). In conclusion, our findings provide new insights regarding i(17q) in CLL and show a subgroup with adverse prognostic features.

An alternative specimen preparation technique for 3-point bending tests on dual-cured dental resin cements / Técnica alternativa de confecção de espécimes para testes de flexão de 3 pontos em cimentos de resina dentária de dupla ativação

The proper mechanical properties of resin cements are essential to the longevity of indirect restoration, whereas the 3-point bending test is recommended for measuring the flexural strength. The ISO 4049 specification requires light-curing of specimens in three consecutive points; however, this approach cannot be used for dual-cured resin cements. The aim of this study was to investigate the effect of two different specimen preparation techniques on the flexural strength and elastic modulus of experimental dual-cured resin cements immediately or 5 after minutes light curing. Experimental dual-cured resin cements were formulated, and the specimens of these cements were confectioned with the dimension of ISO 4049 specification. Light-activation was performed at one or three points immediately or 5 minutes after the insertion of cement into the matrix (n=7), resulting in four experimental conditions (2 methods × 2 moments of light-activation). The three-point bending test was performed and the values of the flexural strength and elastic modulus were recorded. Data were individually analyzed using 2-way ANOVA followed by the Tukey's post hoc test (P<0.05). Regardless of the points of light-activation, the specimens that were light-cured at 3 points showed the highest values of flexural strength. Only for light-activation at 1 point did the time before the light-activation affect the elastic modulus, whereas delayed light-activation had the highest values. In conclusion, the number of lightcuring points on specimen preparation for the 3-point bending test seems to affect the mechanical properties of dual-cured resin cements.

Cimentos resinosos com propriedades mecânicas adequadas são essenciais para a longevidade de restaurações indiretas, sendo que o ensaio de flexão de 3 pontos é recomendado para mensurar a resistência flexural. A especificação ISO 4049 requer a fotoativação das amostras em três pontos consecutivos, entretanto, esta abordagem não pode ser usada para cimentos resinosos duais. O objetivo deste estudo foi investigar o efeito e duas diferentes técnicas de preparo de amostras na resistência flexural e módulo de elasticidade de cimentos resinosos duais experimentais fotoativados imediatamente ou após 5 minutos. Cimentos resinosos duais experimentais foram formulados, e amostras destes cimentos foram confeccionadas com as dimensões da especificação ISO 4049. A fotoativação foi realizada em um ou três pontos imediatamente ou após 5 minutos da inserção do cimento na matriz (n=7), resultando em quatro condições experimentais (2 métodos × 2 tempos antes da fotoativação). O teste de flexão de três pontos foi realizado e os valores de resistência flexural e módulo de elasticidade mensurados. Os dados foram individualmente analisados por ANOVA de dois fatores seguido pelo teste de Tukey (P<0,05). Em relação aos pontos de fotoativação, as amostras que foram fotoativadas em três pontos mostraram os maiores valores de resistência flexural. Apenas para a fotoativação em um ponto, o tempo antes da fotoativação afetou o módulo de elasticidade, sendo que a fotoativação tardia apresentou maiores valores. Em conclusão, o número de pontos de fotoativação no preparo das amostras para teste de flexão de 3 pontos parece afetar as propriedades mecânicas dos cimentos resinosos.

[Diagnosis and treatment of iron deficiency, with or without anemia, before and after bariatric surgery]. / Diagnóstico y tratamiento del déficit de hierro, con o sin anemia, pre y poscirugía bariátrica.

Bariatric surgery (BS) is an increasingly used therapeutic option for severe obesity which allows patients to achieve sustained weight loss over time and resolution or improvement in most associated pathological conditions. Major mid- and long-term complications of BS include iron deficiency and iron-deficient anemia, which may occur in up to 50% of cases and significantly impair patient quality of life. These changes may be present before surgery. The aim of this review was to prepare schemes for diagnosis and treatment of iron deficiency and iron-deficient anemia before and after bariatric surgery.

Oxidative stress parameters as biomarkers of risk factor for diabetic foot among the patients with type 2 diabetes

The aim of this study was to determine whether plasma levels of carbonylated proteins, total antioxidant capacity (TAC) and reduced protein thiols could be suitable biomarkers of risk factors for diabetic foot. Individuals with type 2 diabetes with normal protective sensation (normal foot group) vs. loss of protective sensation and/or signs of peripheral arterial disease and/or foot deformities and/or history of ulcers and/or neuropathic fractures and/or amputation (diabetic foot group) were compared. The diabetic foot group showed higher carbonylated protein levels (P = 0.0457) and lower levels of TAC (P = 0.0148) and reduced protein thiols (P = 0.0088), compared with the normal foot group. In general, several other parameters of risk of diabetes complication (blood levels of glycated hemoglobin, glucose and cholesterol, duration of diabetes, body mass index and waist circumference) showed a tendency of higher values in the diabetic foot group. The results suggest that the plasma levels of carbonylated proteins, TAC and reduced protein thiols could furnish information about the risk of diabetic foot, considering that the changes in these biomarkers were associated with the loss of sensitivity and foot ulcerations.

Comparative study of tramadol combined with dexamethasone and diclofenac sodium in third-molar surgery.

The aim of this randomized, double-blind clinical trial was to investigate the effect of preemptive analgesia with a combination of tramadol+dexamethasone or tramadol+diclofenac sodium. The study included 30 patients (age range: 16-30 years), who were randomly assigned to 2 groups by the split-mouth method. Postoperative pain was assessed with a visual analogue scale at 4, 6, 12, 24, and 48 h postoperatively (p.o.h.). Swelling was measured at 48 p.o.h. Maximal interincisor distance was measured at 48 p.o.h. and 7 postoperative days (p.o.d.). Significant differences in postoperative pain intensity were detected between the drug combinations at 4, 6, and 12p.o.h., suggesting the importance of preemptive analgesia. Patients treated with tramadol+dexamethasone showed lower pain scores compared to the tramadol+diclofenac sodium combination, larger postoperative mouth opening, and less swelling. The tramadol+dexamethasone combination also was more effective than tramadol+diclofenac sodium at reducing inflammation.

Criteria for the request of preoperative tests among oral and maxillofacial surgeons.

OBJECTIVE: The aim of this study was to analyze the criteria employed for the requesting of preoperative tests among maxillofacial surgeons. MATERIALS AND METHODS: Thirty maxillofacial surgeons working in Aracaju (Brazil) received a questionnaire to fill out. The study inquired about the practice of requesting preoperative tests for healthy patients scheduled to undergo elective surgery. RESULTS: Most of the surgeons interviewed requested tests that are not recommended for the case in question. The highest frequency of requests was a complete blood count, coagulation test, blood glucose test and chest radiograph. CONCLUSION: The absence of strict rules for the requesting of preoperative tests causes uncertainty and a lack of criteria regarding pre-surgical conduct. It was not possible to clearly define the criteria used by surgeons for requesting such tests, as the clinical characteristics of the hypothetical case presented suggest a smaller number of tests.

Grupos de conversa: saúde da pessoa idosa na estratégia saúde da família / Conversation groups: health of the elderly in the family health strategy

A Política Nacional de Saúde da Pessoa Idosa aponta a importância de: divulgação dos direitos da pessoa idosa; promoção do envelhecimento ativo e saudável; formação permanente dos profissionais de saúde e apoio ao desenvolvimento de estudos e pesquisas. São relatados resultados parciais do desenvolvimento de uma experiência de extensão universitária realizada em parceria e com a colaboração da rede de atenção básica. Dentre as atividades realizadas, objetivou-se desenvolver um processo grupal de promoção à saúde com pessoas idosas, tendo em vista o envelhecimento ativo e a qualidade de vida dessa população. Observou-se que as atividades em grupo consistiram em um espaço privilegiado para a constituição de redes de apoio, estabelecimento e ampliação de vínculos afetivos; reflexão e conscientização das determinações do processo saúde-doença; organização e mobilização para o efetivo controle social; além de ser um espaço de ensino-aprendizagem, orientação, intervenção e educação em saúde.

The Brazilian Policy on Health of the Elderly indicates the importance of: the publishing of the rights of the elderly; the promotion of the active and healthy aging; the continuing health workforce education, and the support on the development of studies and research. The effects of an extent experience carried out with the partnership and the collaboration of primary care services are presented and discussed. It aimed at the development of health promotion activities with elderly, pointing towards the active aging and the quality of life of this population. It was possible to observe that the group activities consisted in an exceptional opportunity for the constitution of social support networks, for the establishment and widening of emotional bonds; reflection and consciousness upon health and illness determinants; group organization and mobilization towards effective popular participation; besides the health educational opportunity provided to all involved.