Does the use of intra-alveolar honey after lower third molar extraction reduce postoperative inflammatory complications? A systematic review and meta-analysis.

BACKGROUND: Protocols are currently being studied in preventing postoperative complications after exodontia. PURPOSE: This systematic review and meta-analysis aims to evaluate whether the application of intra-alveolar honey reduces inflammatory complications after the extraction of mandibular third molars (CRD 42.023.467.041). METHODS: Searches were carried out in six electronic databases. Clinical trials comparing intra-alveolar honey administration with non-intervention or placebo after mandibular third molar extraction were selected to assess their impact on postoperative inflammatory parameters. The Cochrane ROB 2 tool was used to assess the bias risk in included studies, Stata software to conduct a meta-analysis for quantitative synthesis, and the GRADE system to evaluate the certainty of the evidence. RESULTS: This systematic review included 5 studies with 330 participants, and two studies were included in the meta-analysis. The results of the meta-analysis demonstrated that postoperative pain on the second day [MD: - 1.05; 95% CI - 2 to - 0.1] and fifth day [MD: - 0.97; 95% CI - 1.97 to - 0.03] was lower in the honey group compared to the control group. Total analgesic consumption [MD: - 4.77; 95% CI - 6.73 to - 2.81] was also lower in patients in the intervention group. The descriptive results indicated that honey appears to be beneficial in controlling edema, reducing trismus, and improving healing after extraction of third molars. Alveolar osteitis showed inconclusive results. CONCLUSIONS: The use of intra-alveolar honey after extraction of mandibular third molars seem to be associated with pain reduction. For the other outcomes, the results remain uncertain.

Fatores associados ao homicídio de mulheres no Brasil, segundo raça/cor, 2016-2020 / Factors associated with homicides of women in Brazil, by race or colour, 2016-2020

Resumo O objetivo deste estudo é avaliar as taxas de homicídios contra mulheres residentes no Brasil, segundo unidades da federação e raça/cor, no período de 2016 a 2020. Trata-se de um estudo ecológico de tendência temporal. Foi realizada análise múltipla adotando-se modelo de regressão para dados longitudinais. No período, ocorreram no Brasil 20.405 homicídios de mulheres e as taxas padronizadas mostraram que as mulheres negras (6,1/100.000) apresentaram as maiores taxas, em comparação às brancas (3,4/100.000). O Brasil apresentou queda de 25,2% de 2016 a 2020. A taxa de homicídio variou de 4,7 mortes por 100 mil mulheres em 2016 para 3,5 em 2020, mas a tendência decrescente e estatisticamente significante foi observada nas taxas de mulheres negras e brancas. As variáveis IDH, taxa de analfabetismo e proporção de causas mal definidas apresentaram uma relação inversa e estatisticamente significante com as taxas de homicídio de mulheres. Nos anos de 2019 e 2020 houve uma diminuição da taxa média de homicídio em relação ao ano de 2016. Apesar do decrescimento na evolução temporal das taxas para negras e brancas, houve diferenças raciais importantes nos homicídios de mulheres, com piores resultados para as mulheres negras.

Abstract This ecological, time-trend study examined rates of homicide against women residing in Brazil, by state and race/colour, from 2016 to 2020, by performing. Multiple analysis by regression model on longitudinal data. During the study period, 20,405 homicides of women were recorded in Brazil. Standardised homicides rates were higher among black women (6.1/100,000) than among white women (3.4/100,000). From 2016 to 2020, rates decreased 25.2%, from 4.7 deaths per 100,000 women in 2016 to 3.5 in 2020, with a statistically significant downward trend among both black and white women. Statistically significant inverse relationships were found between female homicide rates and HDI, illiteracy rate and proportion of ill-defined causes. The average homicide rate decreased in 2019 and 2020, as compared with 2016. Despite the decreasing time trend in homicide rates for both black and white women, they differed substantially by race, with worse outcomes for black women.

Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 3. Suicide prevention hotlines

Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517

Recent Myocardial Infarction and Acute Heparin-Induced Thrombocytopenia: A Case Report on Perioperative Management of a Patient for Acute Limb Vascular Surgery.

The optimal alternative anticoagulation regimen for patients with heparin-induced thrombocytopenia (HIT) who need surgical procedures that involve higher levels of anticoagulation, usually performed under heparin, is not yet established. Argatroban has been reported as a safe alternative. Plasma levels and their anticoagulant effects follow a predictable profile. Also, it is easily monitored and its pharmacokinetic profile makes it suitable for patients with renal failure, as it undergoes hepatic elimination. However, its use as a substitute for heparin in HIT patients is not well-documented, especially in vascular surgery. We present a case of a successfully managed patient with acute HIT undergoing limb vascular surgery using anticoagulation with argatroban.

COVID-19 outbreaks among crew members in non-cruise vessels anchoring in Salvador, Brazil, 2021

BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has affected the maritime sector due to virus transmission onboard and traffic restrictions. However, reports of SARS-CoV-2 transmission on board have been mostly restricted to those occurring on cruise ships. OBJECTIVES To report COVID-19 outbreaks in eight non-cruise vessels and discuss measures to prevent and control the onboard transmission of SARS-CoV-2. METHODS We investigated outbreaks of COVID-19 on vessels anchoring in Baía de Todos-os-Santos, Salvador, Brazil, between February and November 2021. FINDINGS Most vessels were cargo ships that had docked several times before anchoring in Salvador (five had docked in ≥ 9 ports). The crew ranged from 22 to 63 members. The infection attack rate on each vessel ranged from 9.7 to 88.9%. The risk of symptomatic infection largely varied among the crew of each vessel (0 to 91.6%). Overall, the risk of developing COVID-19 signs and symptoms was lower among crew members vaccinated (age-adjusted risk ratio: 0.19; 95% confidence interval 0.06-0.65). SARS-CoV-2 variants not previously identified in Salvador were detected (C.14, B.1.617.2 and B.1.351). MAIN CONCLUSIONS Despite maritime guidelines to avert COVID-19 on board, outbreaks have happened. The multiple stopovers of non-cruise vessels during their routes may contribute to the spread of SARS-CoV-2 variants worldwide. Reducing the onboard transmission of SARS-CoV-2 depends on joint efforts by the crew and local health authorities and, equally important, achieving high vaccination coverage to prevent infections and illness.

Quality of recovery in elderly patients with postoperative delirium.

BACKGROUND: Our study aimed to evaluate quality of recovery in elderly patients with postoperative delirium (POD). SUBJECTS AND METHODS: An observational prospective study was conducted. Patients aged >60 submitted to elective surgery and admitted to Post Anesthesia Care Unit (PACU) in a tertiary hospital from May to July 2017 were included. POD was evaluated with the Nursing Delirium Screening Scale (NuDESC). Quality of recovery-15 (QoR-15) was used before (T0) and 24 h (T24) after surgery to assess quality of recovery. Data collection include patient's characteristics, respiratory events at the PACU, and other perioperative variables. The Chi-square, Fisher's exact, or Mann-Whitney U-tests were used for comparisons. RESULTS: Of a total of 235 patients, 12.3% developed POD at PACU. POD was more frequently in patients older than 80 years (P = 0.017), patients with neurological disease (P = 0.026), dementia (P = 0.026), peripheral vascular disease (P = 0.016), and diabetes mellitus (P = 0.037). At T0, there were no differences at median total QoR-15, whereas at T24, patients POD scored lower in 10 items (including "severe pain" with P = 0.001 and "nausea or vomiting" with P = 0.009) of QoR-15 and in total median lower scores (P = 0.001). POD patients stayed longer at PACU (P = 0.017) and they stayed longer at hospital (P = 0.002). CONCLUSIONS: POD patients were older and had more comorbidities. POD patients had lower QoR scores at T24 suggesting an adverse impact of delirium in postoperative quality of recovery. POD patients stayed for long in the PACU and at hospital.

Physiological and Operative Severity Score for the enumeration of Mortality and Morbidity (POSSUM) System for Outcome Prediction in Elderly Patients Undergoing Major Vascular Surgery.

OBJECTIVE: POSSUM system is widely used and validated for 30-day mortality and morbidity prediction. The aim of this study was to evaluate the performance of five POSSUM's equations (POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge) on predicting 30-day mortality and morbidity in elderly patients undergoing major elective vascular surgery. DESIGN: A retrospective longitudinal cohort study. SETTING: A study conducted at an University Hospital. PARTICIPANTS: 208 elderly patients (≥ 60 years) undergoing major elective vascular surgery. MEASUREMENTS: Data collected from the clinical files included patient's characteristics, diagnosis, surgery, comorbidities, parameters from POSSUM score, 30, 60 and 90-day mortality and 30-day morbidity. POSSUM system's goodness-of-fit for predicting mortality and morbidity was assessed by Hosmer-Lemeshow test (H-L T) and Standardized Mortality/Morbidity Ratio (SMR) and discriminative ability by the area under the ROC curves (ROC-AUC). Patients' average age was 70.8 years, 81% males. INTERVENTIONS: None. MAIN RESULTS: The overall 30-day mortality rate was 2.97% (n=6) and 30-day morbidity was 29.2% (n=59). POSSUM, P-POSSUM, V-POSSUM, V-POSSUM physiology and V-POSSUM Cambridge equation predicted an overall of 29.1, 4.43, 15.3, 21.9 and 13.5 deaths, respectively. POSSUM morbidity equation predicted 105.0 complications. H-LT p-values were 0.001, 0.164, 0.208, 0.011, 0.331 and <0.001, respectively. SMRs and 95% confidence interval (CI) were 0.21[0.04-0.37], 1.35[0.27-2.44], 0.39[0.08-0.71], 0.27[0.06-0.49], 0.44[0.09-0.80] and 0.56[0.42-0.71], respectively. ROC-AUC and 95% CI were 0.72[0.49-0.95], 0.72[0.49-0.95], 0.73[0.51-0.94], 0.69[0.50-0.89], 0.72[0.52-0.92] and 0.71[0.63-0.79], respectively. CONCLUSIONS: P-POSSUM had the best performance predicting 30-day mortality. All the other overestimated 30-day mortality. Prediction of morbidity was inadequate. POSSUM scoring models may not be robust tools for risk prediction in elderly patients undergoing major elective vascular surgery and need further calibration and discrimination.

Neoadjuvant chemotherapy followed by fast-track cytoreductive surgery plus short-course hyperthermic intraperitoneal chemotherapy (HIPEC) in advanced ovarian cancer: preliminary results of a promising all-in-one approach.

PURPOSE: Hyperthermic intraperitoneal chemotherapy (HIPEC) has been considered a promising treatment option for advanced or recurrent ovarian cancer, but there is no clear evidence based on randomized controlled trials to advocate this approach as a standard therapy. In this study, we aim to present the early outcomes and insights after an interim analysis of a pioneering clinical trial in Brazil. METHODS: This study was a cross-sectional analysis of early data from our ongoing clinical trial - an open-label, double-center, single-arm trial on the safety and efficacy of using HIPEC for advanced ovarian cancer (ClinicalTrials.gov: NCT02249013). A fast-track recovery strategy was also applied to improve patient outcomes. RESULTS: Nine patients with stage IIIB (n=1) or IIIC (n=8) epithelial malignancies were enrolled until February 2017. The median (range) serum CA125 level at diagnosis was 692 (223.7-6550) U/mL. The median number of preoperative cycles of intravenous (i.v.) chemotherapy was 3 (2-4), resulting in peritoneal cancer index scores of 9 (3-18) at the time of HIPEC. Time of restarting i.v. chemotherapy was 37 (33-50) days with all patients completing 6 cycles as planned. The median operation time was 395 (235-760) minutes, the length of hospital stay was 4 (3-10) days, and all the patients left the ICU on the morning after the procedure. Two patients experienced no postoperative complications, whereas 91% of the complications were minor G1/G2 events. Preliminary assessment also suggested no impairment of the patient's quality of life. CONCLUSION: Our comprehensive protocol might represent a promising all-in-one approach for advanced ovarian cancer. The patient recruitment for this trial is ongoing.

How cells of the immune system prepare the endometrium for implantation.

Characterized by its cyclical regeneration and differentiation, the endometrium is one of the most dynamic tissues of the human body. As a main player during implantation and later development of the embryo it has a unique and extremely important role in the survival of species. This study is a review of the current literature focused on the cyclical restructuring of the endometrium and the morphological and cellular alterations during the different phases of the reproductive cycle. These changes confer specific receptive capabilities for implantation to take place. The mechanism of implantation is addressed as well as possible receptivity obstacles that can influence this process. More specifically, we discuss the involvement of immune cells in the establishment of implantation and its consequences for a successful pregnancy. A deep knowledge of the mechanisms involved in the regulation and transformation of the endometrium and embryo implantation is essential to understand disorders that can influence fertility and women health.

A review of microbiological root canal sampling: updating an emerging picture / Uma revisão de amostragem microbiológica de canal radicular: atualizando um quadro emergente

The significance of microorganisms in root canals with regard to the aetiology of periapical infection and the need for crucial bacteria control during treatment are undeniable. In this study, we report and discuss a review of the literature on Microbiological Root Canal Sampling (MRS). The procedure is analyzed in detail, discussing its powers, limitations and the influence of sample collection procedures on the incidence of true and false positive results. Data sources: MEDLINE/PUBMED, B-On and library files of Oporto University were accessed. Selection: Papers were selected using the keywords: “root ca¬nal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. The references were selected under inclusion criteria such as English language, accessibility, relevance to the theme and scientific rigor. Conclusions: This review illustrated the absolute need to adhere to strict methodology procedures if valid samples are to be obtained. A combination of Culture and molecular identification approaches have confirmed the polymicrobial nature of endodontic infections with a predominance of anaerobic bacteria. Nucleic acid-based techniques provide significant additional information particularly regarding the not-yet-cultivable species of the microbial community, but greatly increase the budget of the procedure. Thus, assessment of the endodontic microflora, in the context of a polymicrobial biofilm ecosystem, and its relevance to endodontic treatments must rely in the complementariness of Culture and Metagenomics approaches as they are neither mutually exclusive nor competitive, but strongly complementary...

A importância de microrganismos em canais radiculares no que diz respeito à etiologia da infecção periapical e a necessidade de controlar bactérias durante o tratamento são incontestáveis. Neste estudo, relata-se e discute-se uma revisão da literatura sobre a amostragem microbiológica de canal radicular. O procedimento é analisado em detalhes, discutindo suas atribuições, limitações e influência de procedimentos de coleta de amostra sobre a incidência de verdadeiros e falsos resultados positivos. Fontes de dados: Foram usados MEDLINE/PubMed, B-On e arquivos da biblioteca da Universidade do Porto. Seleção: Os trabalhos foram selecionados utilizando as palavras-chave: “root canal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. As referências foram selecionadas de acordo com critérios de inclusão como o idioma inglês, acessibilidade, relevância para o tema e rigor científico. Conclusões: Esta revisão ilustrou a absoluta necessidade de aderir aos procedimentos metodológicos rigorosos se se pretende obter amostras válidas para análise. Uma combinação de cultura e abordagens de iden¬tificação molecular confirmaram a natureza polimicrobiana das infeções endodônticas com predominância de bactérias anaeróbias. Técnicas baseadas em ácidos nucleicos fornecem informação adicional significativa, particularmente em relação às espécies não cultiváveis da comunidade microbiana, mas aumentam muito o orçamento do procedimento. Assim, a avaliação da microflora endodôntica, no contexto de um ecossistema polimicrobiano em biofilme, e sua relevância para tratamentos endodônticos devem confiar na complementaridade entre a abordagem de cultura e de metagenômica, pois não são mutuamente exclusivas nem competitivas, mas fortemente complementares...

Estradiol and progesterone regulate the migration of mast cells from the periphery to the uterus and induce their maturation and degranulation.

BACKGROUND: Mast cells (MCs) have long been suspected as important players for implantation based on the fact that their degranulation causes the release of pivotal factors, e.g., histamine, MMPs, tryptase and VEGF, which are known to be involved in the attachment and posterior invasion of the embryo into the uterus. Moreover, MC degranulation correlates with angiogenesis during pregnancy. The number of MCs in the uterus has been shown to fluctuate during menstrual cycle in human and estrus cycle in rat and mouse indicating a hormonal influence on their recruitment from the periphery to the uterus. However, the mechanisms behind MC migration to the uterus are still unknown. METHODOLOGY/PRINCIPAL FINDINGS: We first utilized migration assays to show that MCs are able to migrate to the uterus and to the fetal-maternal interface upon up-regulation of the expression of chemokine receptors by hormonal changes. By using a model of ovariectomized animals, we provide clear evidences that also in vivo, estradiol and progesterone attract MC to the uterus and further provoke their maturation and degranulation. CONCLUSION/SIGNIFICANCE: We propose that estradiol and progesterone modulate the migration of MCs from the periphery to the uterus and their degranulation, which may prepare the uterus for implantation.

PD-1 but not CTLA-4 blockage abrogates the protective effect of regulatory T cells in a pregnancy murine model.

PROBLEM: Regulatory T cells (Treg) play an important role in fetal protection. They expand during normal pregnancy and protect paternal/fetal antigens from rejection by maternal effector cells. Accordingly, the transfer of Treg obtained from BALB/c-mated CBA/J females prevents abortion in DBA/2J-mated animals. The actual mechanism through which Treg mediate their protective effect is still inconclusive. Cytotoxic T lymphocyte antigen-4 (CTLA-4) and Programmed cell death 1 (PD-1) are some of known Treg-associated molecules; however, their role in Treg-mediated fetal protection in murine model has not been investigated. METHOD OF STUDY: Treg obtained from normal pregnant animals (NP; CBA/J x BALB/c) on day 14 were adoptively transferred into abortion-prone mice (AP; CBA/J x DBA/2J) intravenously on day 2 of pregnancy. An amount of 250 microg of either anti-PD-1 or anti-CTLA-4 mAb were injected intraperitoneally on days 0, 3, 6 and 9 of pregnancy. Controls received Treg + IgG or Treg + PBS. NP or AP treated with PBS served as additional controls. RESULTS: Blocking PD-1 abrogated the protective effect of Treg, resulting in a higher median abortion rate in comparison with the Treg/isotype-treated control while CTLA-4 blockage did not interfere with the protective effect of Treg. This was associated with a diminished number of vascular endothelial growth factor-A(+) cells, previously reported as stimulators of lymphocyte extravasation in preterm labor. CONCLUSION: Our data suggest PD-1 as an important mediator in Treg-induced fetal protection in the CBA/J x DBA/2J murine model.

Anatomical variations of the frontal sinus

An anatomical study of the frontal sinus in 100 macerated skulls. The study introduces an innovation on the literature by means of the measurement of the sinus's volume. All the found information in the literature attained to other aspects including the diameters of the sinus and the geometric area of the same. Objective: Evaluation of the measures of the frontal sinus frequently involved in cranial base surgeries and supraorbital craniotomies in order to help the surgical approaches that cross this anatomical route Methods: The measurement included: sagital, transverse and antero-posterior diameter acquired with a paquimeter and the volume obtained after filling the sinus with sand. Results: They are in accordance with the literature that shows the male's predominance in all measurements done.

Se presenta un estudio anatómico del seno frontal que fue realizado en 100 cráneos. El estudio introduce una novedad en la literatura, que es la medida volumétrica del seno frontal. Toda la literatura se refiere a otros aspectos, incluyendo los diámetros de los senos y su área geométrica. El objetivo del estudio fue estimar las medidas del seno frontal que con frecuencia hacen parte en las cirugías de la base del cráneo y en las craneotomías supraorbitarias, con la finalidad de facilitar las vías de acceso quirúrgico por estas regiones. Las medidas realizadas fueron: diámetro sagital, transversal y antero-posterior con un caliper, y el volumen fue obtenido llenando el seno con arena fina. Los resultados están de acuerdo con la literatura que demuestra un mayor predominio del sexo masculino en todas las medidas efectuadas.