Efficacy of digital radiography for detecting a second mesiobuccal canal adjacent to unfilled or filled canals.

The aim of this study was to assess the diagnostic accuracy of digital periapical radiography for the detection of the second mesiobuccal (MB2) canal when the adjacent canals are unfilled or filled with gutta percha. Forty human maxillary first molars were selected, 20 of which had an MB2 canal. The presence or absence of the MB2 canal was confirmed using microcomputed tomography. Digital periapical radiographs of each tooth were obtained from 3 horizontal angles before and after the adjacent root canals were filled with gutta percha. Three experienced oral radiologists evaluated all images and indicated the presence or absence of the MB2 canal using a confidence scale of 5 points. To assess intraobserver and interobserver agreement, weighted kappa coefficients were calculated. The diagnostic test (sensitivity, specificity, and accuracy) and area under the receiver operating characteristic curve (Az) values were calculated and compared between groups (n = 40): radiographs of the first molars with unfilled adjacent canals and radiographs of the same teeth with filled adjacent canals. For all observers, intraobserver reproducibility ranged from substantial (0.70) to almost perfect (0.86), and interobserver reproducibility ranged from fair (0.39) to substantial (0.67). Similar values of specificity and Az for the detection of the MB2 canal were observed with unfilled and filled adjacent canals. The sensitivity and accuracy were slightly greater when the adjacent root canals were filled with gutta percha. Detection of the MB2 canal on digital periapical radiographs can be challenging even when obtained at varying horizontal angles, and the presence of gutta percha does not influence the detection.

Effects of diode laser irradiation and fibroblast growth factor on periodontal healing of replanted teeth after extended extra-oral dry time.

AIM: The search for effective protocols to reduce the incidence of root resorption and allow periodontal ligament repair is still challenging, given the unpredictable outcome of late tooth replantation. The aim of this study was to assess the effects of both high-power diode laser irradiation (DL) and basic fibroblast growth factor (FGF) on the periodontal healing of replanted teeth after extended extra-oral dry time. METHODS: Maxillary incisors of 50 male rats were extracted and assigned to three experimental and two control groups (n = 10). DL: root surfaces treated with DL (810 nm, continuous mode, 1.0 W, 30 s), FGF: topical application of FGF gel to the root surface and in the alveolar wound, DL + FGF: DL and topical application of FGF gel, C+: no treatment after extraction and immediate replantation and C-: no treatment after extraction and replantation after 60 min. In the experimental groups, the specimens were kept dry for 60 min, the pulps were removed and the canals were filled with calcium hydroxide paste prior to tooth replantation. The animals were euthanized after 60 days. The specimens were processed for radiographic, histological and immunohistochemical analyses. RESULTS: The radiographic analysis showed fewer resorptive areas in DL + FGF (P < 0.05). The histological and immunohistochemical analyses showed that the DL group had lower mean values of ankylosis, replacement and inflammatory resorption when compared to C-, not differing statistically from C+. DL + FGF produced significantly more collagen fibers (type I and type III) than C-, not differing from C+ in the case of type I fibers (P < 0.05). CONCLUSIONS: DL, with or without FGF, reduced the occurrence of external root resorption and ankylosis. Periodontal healing was favored and some fiber reinsertion occurred only when FGF was used.

Long-term hospital care needs after Bothrops atrox envenomation with hemorrhagic stroke in the Brazilian Amazon: 'From social to physical death' - A case report.

Hemorrhagic stroke is a severe complication reported in cases of Bothrops atrox snakebite envenomation. We report an unusual case of a patient who evolved with an intracranial hemorrhagic stroke and was in a coma for more than five years in a tertiary hospital located in Manaus, Amazonas. 52-year-old man, carpenter, resident in the rural area of the municipality of Tabatinga, located 1106 km from Manaus, capital of Amazonas, Brazil, victim of an accident involving Bothrops atrox evolution with cardiorespiratory arrest, acute kidney injury and hemorrhagic stroke. After 43 days of hospitalization in the ICU, he was transferred to the ward, without contact with the environment and family, sent for home treatment, however, without acceptance by family members. During a long hospital stay for a period of 6 years, totally dependent on special care, in a flexed position, using a tracheostomy and mechanical ventilation, diagnosed and treated for hospital infections throughout his hospitalization, he died due to bacterial pneumonia. Losses of autonomy can result in an individual being completely disconnected from social life - a "social death before physical death".

Photobiomodulation Therapy to Treat Snakebites Caused by Bothrops atrox: A Randomized Clinical Trial.

Importance: Bothrops venom acts almost immediately at the bite site and causes tissue damage. Objective: To investigate the feasibility and explore the safety and efficacy of low-level laser therapy (LLLT) in reducing the local manifestations of B atrox envenomations. Design, Setting, and Participants: This was a double-blind randomized clinical trial conducted at Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, Brazil. A total of 60 adult participants were included from November 2020 to March 2022, with 30 in each group. Baseline characteristics on admission were similarly distributed between groups. Data analysis was performed from August to December 2022. Intervention: The intervention group received LLLT combined with regular antivenom treatment. The laser used was a gallium arsenide laser with 4 infrared laser emitters and 4 red laser emitters, 4 J/cm2 for 40 seconds at each application point. Main Outcomes and Measures: Feasibility was assessed by eligibility, recruitment, and retention rates; protocol fidelity; and patients' acceptability. The primary efficacy outcome of this study was myolysis estimated by the value of creatine kinase (U/L) on the third day of follow-up. Secondary efficacy outcomes were (1) pain intensity, (2) circumference measurement ratio, (3) extent of edema, (4) difference between the bite site temperature and that of the contralateral limb, (5) need for the use of analgesics, (6) frequency of secondary infections, and (7) necrosis. These outcomes were measured 48 hours after admission. Disability assessment was carried out from 4 to 6 months after patients' discharge. P values for outcomes were adjusted with Bonferroni correction. Results: A total of 60 patients (mean [SD] age, 43.2 [15.3] years; 8 female individuals [13%] and 52 male individuals [87%]) were included. The study was feasible, and patient retention and acceptability were high. Creatine kinase was significantly lower in the LLLT group (mean [SD], 163.7 [160.0] U/L) 48 hours after admission in relation to the comparator (412.4 [441.3] U/L) (P = .03). Mean (SD) pain intensity (2.9 [2.7] vs 5.0 [2.4]; P = .004), circumference measurement ratio (6.6% [6.6%] vs 17.1% [11.6%]; P < .001), and edema extent (25.8 [15.0] vs 40.1 [22.7] cm; P = .002) were significantly lower in the LLLT group in relation to the comparator. No difference was observed between the groups regarding the mean difference between the bite site temperature and the contralateral limb. Secondary infections, necrosis, disability outcomes, and the frequency of need for analgesics were similar in both groups. No adverse event was observed. Conclusions and Relevance: The data from this randomized clinical trial suggest that the use of LLLT was feasible and safe in a hospital setting and effective in reducing muscle damage and the local inflammatory process caused by B atrox envenomations. Trial Registration: Brazilian Registry of Clinical Trials Identifier: RBR-4qw4vf.

Alternative Postoperative Analgesia Technique for Peripheral Vascular Revascularization: A Case Report.

Peripheral arterial disease (PAD) patients often require surgical peripheral vascular revascularization (PVR), in which postoperative pain management can be challenging. This case report details a 43-year-old female patient with PAD who underwent urgent femoral popliteal bypass with an inverted ipsilateral great saphenous vein and left femoral endarterectomy. Due to contraindications for neuraxial anesthesia and the necessity for continuous anticoagulation, the procedure was performed under general anesthesia (GA) and an unconventional technique with intraoperative perineural catheter (PC) placement to guarantee adequate postoperative analgesia. The surgeon inserted the PC in the vicinity of the femoral nerve under direct visualization before surgical closure. Postoperative analgesia was successfully managed, demonstrating the effectiveness of this approach as part of a multimodal analgesia strategy. This case report suggests that such a technique, supervised by an anesthesiologist and supported by a multidisciplinary team, can provide effective postoperative pain control in PAD patients without interrupting perioperative anticoagulation. Formal protocols for similar procedures can arise, incorporating this analgesic option.

Bradycardia in a pediatric population after sugammadex administration: case series.

Sugammadex is a distinctive neuromuscular reversal drug that acts by encapsulating the neuromuscular relaxant molecule and dislodging it from its site of action. Sugammadex has been approved for pediatric patients over 2 years of age. Although arrhythmias have been reported, there is no report of adverse effects in healthy children, such as severe bradycardia requiring intervention. We report two cases of severe bradycardia immediately after the administration of sugammadex in healthy children. Our aim is to alert to the occurrence of one of the most severe adverse effects of sugammadex, in the healthy pediatric population as well.

Snakebite envenomations and access to treatment in communities of two indigenous areas of the Western Brazilian Amazon: A cross-sectional study.

BACKGROUND: The indigenous populations of Brazil present poor health indicators and a disproportionate prevalence and case-fatality rate of neglected tropical diseases, including snakebite envenomations (SBEs). This study aims to estimate access to medical care for SBEs and analyze the barriers that prevent victims from accessing healthcare in indigenous communities in two health districts located in the Western Brazilian Amazon. METHODOLOGY/PRINCIPAL FINDINGS: This cross-sectional study used semi-structured interviews to collect data from individuals who experienced SBEs in the Upper Rio Solimões and Upper Rio Negro indigenous health districts. Of the 187 participants, 164 (87.7%) reported that they had access to healthcare and received assistance in a hospital in the urban area of the municipalities. Frequency was 95.4% in the Upper Rio Solimões SIHD, and 69.6% in the Upper Rio Negro SIHD (P<0.0001). The study found that the availability of indigenous medicine as the only choice in the village was the main reason for not accessing healthcare (75%), followed by a lack of financial resources and means of transportation (28.1%). Four deaths were reported from SBEs, resulting in a case-fatality rate of 2.1%. CONCLUSIONS/SIGNIFICANCE: In the study areas, there are records of SBE patients who did not receive medical attention. Availability of pre-hospital emergency transport using motorboats, a greater number of hospitals and better navigability of the Solimões River and its tributaries would make access easier for indigenous people living in the region of the Upper Solimões River. The implementation of cross-cultural hospital care needs to be considered in order to reduce the resistance of indigenous populations in relation to seeking treatment for SBEs.

Prospecting Local Treatments Used in Conjunction with Antivenom Administration Following Envenomation Caused by Animals: A Systematic Review.

Envenomation caused by venomous animals may trigger significant local complications such as pain, edema, localized hemorrhage, and tissue necrosis, in addition to complications such as dermonecrosis, myonecrosis, and even amputations. This systematic review aims to evaluate scientific evidence on therapies used to target local effects caused by envenomation. The PubMed, MEDLINE, and LILACS databases were used to perform a literature search on the topic. The review was based on studies that cited procedures performed on local injuries following envenomation with the aim of being an adjuvant therapeutic strategy. The literature regarding local treatments used following envenomation reports the use of several alternative methods and/or therapies. The venomous animals found in the search were snakes (82.05%), insects (2.56%), spiders (2.56%), scorpions (2.56%), and others (jellyfish, centipede, sea urchin-10.26%). In regard to the treatments, the use of tourniquets, corticosteroids, antihistamines, and cryotherapy is questionable, as well as the use of plants and oils. Low-intensity lasers stand out as a possible therapeutic tool for these injuries. Local complications can progress to serious conditions and may result in physical disabilities and sequelae. This study compiled information on adjuvant therapeutic measures and underscores the importance of more robust scientific evidence for recommendations that act on local effects together with the antivenom.

Dental caries related to quality of life in two Brazilian adolescent groups: a cross-sectional randomised study.

OBJECTIVES: To analyse dental caries-related quality of life (QoL) in adolescent (15-19-year-old) subjects in a suburban area (SA) and a downtown area (DA) of Bauru, São Paulo, Brazil, in 2009. METHODS: This was a cross-sectional, randomised study. The sample consisted of 185 and 147 adolescents from the SA and DA, respectively. The caries index used was that for decayed, missing and filled teeth (DMFT) (World Health Organization criteria). The 14-item Oral Health Impact Profile (OHIP-14) was used to assess QoL. The non-parametric Mann-Whitney test, Spearman's correlation coefficient and chi-squared test were used in the statistical analysis. RESULTS: The DMFT index, Significant Caries (SiC) Index and percentage of caries-free students were similar (P > .05) between these populations, but findings on the Care Index differed (P < 0.05). There was a correlation between the DMFT index and OHIP-14 score in SA subjects (mean DMFT index = 3.01) in the dimensions of physical pain (r = 0.25; P < 0.01) and psychological disability (r = 0.17; P = 0.02). The DMFT index in DA subjects (mean DMFT index = 2.95) showed a correlation with functional limitation (r = 0.19; P = 0.02). The correlation in SA subjects between the caries component (mean = 1.22) of the DMFT index and OHIP-14 was significant only for the physical pain dimension (r = 0.16; P = 0.03). In DA subjects, correlations between the caries component (mean = 0.37) and all dimensions of OHIP-14 were statistically significant (P < 0.05). CONCLUSIONS: Despite the similarities in means in the DMFT index, the SiC Index and the caries-free percentage of subjects in both localities, access to dental treatment proved to be less effective for SA adolescents. Physical pain and psychological disability were the most frequent negative manifestations of impact on QoL. The SA adolescents were more negatively affected by dental caries in terms of QoL.

Root surface treatment using diode laser in delayed tooth replantation: radiographic and histomorphometric analyses in rats.

UNLABELLED: BACKGROUND AIM: The aim of this study was to evaluate, by radiographic and histomorphometric analyses, the effects of high-power diode laser irradiation on the root surfaces of delayed replanted rat teeth. MATERIAL AND METHODS: Maxillary right incisors were extracted from 60 Wistar rats and kept dry for 60 min. Subsequently, the root canals were prepared and filled with calcium hydroxide paste. According to the root surface treatment before the replantation, the teeth were assigned to four groups (n = 15): G1 (negative control) - no root surface treatment; G2 (positive control) - treated with 2% sodium fluoride solution; G3 - irradiated with a high-power diode laser (810 nm, continuous mode, 1.0 W, 30 s); and G4 - irradiated with a diode laser using the same parameters as those used for G3 but in pulsed mode. The rats were euthanized after 15, 30, and 60 days of replantation. The specimens were digitally radiographed and processed for histomorphometric analysis to determine the average root resorption areas and to evaluate the histological events. RESULTS: The percentage of root resorption was in the following order: G1 > G2 > G4 > G3. Both histomorphometric and radiographic analyses showed significantly lower means (P < 0.05) of the occurrence of root resorption in the irradiated groups (G3 and G4) when compared to the control groups (G1 and G2). Replacement resorption and ankylosis were observed in histological sections only after 30 and 60 days; however, such events were not observed in G3. CONCLUSION: Root surface treatments with high-powered diode laser irradiation prior to delayed replantation reduced the occurrence of external root resorption compared to no treatment or sodium fluoride treatment at up to 60 days.

Case Report: Late-Onset Pneumonitis after Apoica pallida (Insecta: Hymenoptera) Sting with Anaphylactic Reaction in the Brazilian Amazon.

Hymenopteran venoms, inoculated during stings by ants, bees, and wasps, are the most frequent cause of an IgE-mediated systemic hypersensitivity reaction in adults, which is a key process in drastic manifestations of anaphylaxis. Respiratory involvement is usually caused by pulmonary edema but is rarely described as including interstitial pneumonitis or acute respiratory distress syndrome. Here, we describe a case of severe allergic reaction after a sting by Apoica pallens with late-onset pulmonary involvement, including signs of vasoplegia (pleural effusion) and interstitial pneumonitis with mild rhabdomyolysis. The presence of late onset of pulmonary involvement after a severe allergic reaction after a sting by A. pallens shows the importance of keeping a patient with severe reactions under medical care for a minimum of 5 days to avoid serious late complications outside the hospital environment.

Validation of a Culturally Relevant Snakebite Envenomation Clinical Practice Guideline in Brazil.

Snakebite envenoming (SBE) is a neglected tropical disease with significant global morbidity and mortality. Even when antivenom is available in low-resource areas, health workers do not receive adequate training to manage SBEs. This study aims to develop and validate a clinical practice guideline (CPG) for SBE management across Brazil. A panel of expert judges with academic and/or technical expertise in SBE management performed content validation. The content validity index (CVI) score was 90% for CPG objectives, 89% for structure and presentation and 92% for relevance and classified the CPG as valid. A semantic validation was performed by analyzing focus group discussions with doctors and nurses from three municipalities of the Brazilian Amazon, after a 5-day meeting during which the CPG was presented. Two central themes emerged: knowledge acquired during the meeting and recommendations for improving the CPG. Based on these results, the CPG was revised into a final version. This study presents the successful development and validation process of a CPG for SBE management, which is targeted to a specific low-resource, high-burden setting. This development and validation process can be adapted to other settings and/or other neglected tropical diseases.

[General anesthesia combined with erector spinae plane block for ductus arteriosus closure: two case reports]. / Anestesia geral associada a bloqueio do plano do músculo eretor da espinha para encerramento de persistência de canal arterial: dois relatos de caso.

BACKGROUND: Failure of ductus arteriosus closure in preterm neonates results in a left-to-right shunt that leads to variable severities of hemodynamic and respiratory distress. When medical therapy fails, surgical ligation via left lateral thoracotomy remains an alternative approach and can be performed in the operating room or at the bedside with a low mortality rate. Opioid-based anesthesia is a frequent choice among anesthesiologists who manage patent ductus arteriosus cases based on the suppression of the stress response and maintenance of hemodynamic stability. This rationale suggests that regional anesthesia may also be an advantageous technique and may benefit earlier weaning from ventilation. Blocking afferent signals before incision may also modulate the long-term consequences of altered sensory perception and pain responses. CASE REPORT: We present two cases of general anesthesia combined with erector spinae plane block as part of multimodal anesthesia in premature twins undergoing patent ductus arteriosus closure. DISCUSSION: In these cases, the use of erector spinae plane block combined with general anesthesia was efficient to minimize the negative impact of surgery and allowed a reduction in the amount of intraoperative opioid use for patent ductus arteriosus closure.

Licochalcone a Exhibits Leishmanicidal Activity in vitro and in Experimental Model of Leishmania (Leishmania) Infantum.

The efficacy of Licochalcone A (LicoA) and its two analogs were reported against Leishmania (Leishmania) amazonensis and Leishmania (Leishmania) infantum in vitro, and in experimental model of L. (L.) infantum in vitro. Initially, LicoA and its analogs were screened against promastigote forms of L. (L.) amazonensis. LicoA was the most active compound, with IC50 values of 20.26 and 3.88 µM at 24 and 48 h, respectively. Against amastigote forms, the IC50 value of LicoA was 36.84 µM at 48 h. In the next step, the effectivity of LicoA was evaluated in vitro against promastigote and amastigote forms of L. (L.) infantum. Results demonstrated that LicoA exhibited leishmanicidal activity in vitro against promastigote forms with IC50 values of 41.10 and 12.47 µM at 24 and 48 h, respectively; against amastigote forms the IC50 value was 29.58 µM at 48 h. Assessment of cytotoxicity demonstrated that LicoA exhibited moderate mammalian cytotoxicity against peritoneal murine macrophages; the CC50 value was 123.21 µM at 48 h and showed about 30% of hemolytic activity at concentration of 400 µM. L. (L.) infantum-infected hamsters and treated with LicoA at 50 mg/kg for eight consecutive days was able to significantly reduce the parasite burden in both liver and spleen in 43.67 and 39.81%, respectively, when compared with negative control group. These findings suggest that chalcone-type flavonoids can be a promising class of natural products to be considered in the search of new, safe, and effective compounds capable to treat canine visceral leishmaniosis (CVL).

Bradycardia in a pediatric population after sugammadex administration: case series

Abstract Sugammadex is a distinctive neuromuscular reversal drug that acts by encapsulating the neuromuscular relaxant molecule and dislodging it from its site of action. Sugammadex has been approved for pediatric patients over 2 years of age. Although arrhythmias have been reported, there is no report of adverse effects in healthy children, such as severe bradycardia requiring intervention. We report two cases of severe bradycardia immediately after the administration of sugammadex in healthy children. Our aim is to alert to the occurrence of one of the most severe adverse effects of sugammadex, in the healthy pediatric population as well.

História em quadrinhos para educação em saúde bucal: construção, validação e análise da eficácia / Comics for oral health education: construction, validation, and analysis of efficacy

As tecnologias ilustradas tem sido um artifício amplamente utilizado para a educação em saúde bucal, sendo as histórias em quadrinhos um formato ainda pouco explorado no que se refere à validação e análise da sua eficácia para com o público-alvo. Este estudo objetivou avaliar a efetividade de uma história em quadrinhos no processo de educação em saúde bucal a crianças entre 06 e 12 anos atendidas na clínica de Odontopediatria de uma policlínica odontológica na Amazônia brasileira. Uma revista em quadrinhos lúdico-educativa foi confeccionada, validada e incorporada em um kit contendo 01 escova dental, 01 fio dental e 01 creme dental. Posteriormente foi aplicado um questionário com os pais (N=50), antes e depois da entrega dos kits, que avaliava os cuidados de higiene bucal da criança e as impressões sobre o impacto dos quadrinhos sobre a higiene bucal de seus filhos. Os resultados foram analisados descritivamente, por meio de frequências absolutas e porcentagens sendo usado o teste de McNemar (p<0,05). Verificou-se o aumento de 55,32% das crianças que passaram a usar o fio dental após implementação metodológica. Constatou-se, ainda, não haver diferença estatística entre a frequência de escovação após a entrega do kit (p=0.873), havendo, entretanto, aumento significativo na frequência do uso do fio dental entre as crianças avaliadas (p=0.0401). Os quadrinhos mostraram-se estatisticamente eficazes no aumento da frequência do uso do fio dental, tendo a HQ uma boa aceitação tanto das crianças como dos pais.

Illustrated media has been a widely used device for oral health education, with comics being a format that is still under explored in terms of validation and analysis of their effectiveness towards the target audience. This study aimed to evaluate the effectiveness of a comic book in the process of oral health education to children between 6 and 12 years of age attended at the pediatric dentistry clinic of a dental polyclinic in the Brazilian Amazon. A playful-educational comic book was made, validated, and incorporated into a kit containing 01 toothbrush, 01 floss, and 01 toothpaste. Subsequently, a questionnaire was applied with the parents (N=50), before and after the delivery of the kits, which evaluated the child's oral hygiene care and the impressions on the impact of the comics on the oral hygiene of their children. The results were analyzed descriptively, through absolute frequencies and percentages using the McNemar test (p<0.05). There was an increase of 55.32% of the children who started flossing after methodological implementation. It was also found that there was no statistical difference between the frequency of brushing after delivery of the kit (p=0.873), but there was a significant increase in the frequency of flossing among the children evaluated (p=0.0401). The comics were statistically effective in increasing the frequency of flossing, with comic books having a good acceptance of both children and parents.

Fiber intake, constipation, and overweight among adolescents living in Sao Paulo City.

OBJECTIVE: This study evaluated the dietary fiber intake of adolescents in the metropolitan area of Sao Paulo city and any association between low dietary fiber intake with constipation and overweight. METHODS: In total, 716 adolescents were included within the study, of whom 314 attended private school and 402 attended public school. Evaluation of fiber intake was based on a 24-h daily intake record and a frequency questionnaire. Data concerning bowel movements and height and weight measurements were also taken. RESULTS: Fiber consumption, below that recommended ("age + 5"), was found in 61.8% and 41.4% (P = 0.000) of girls attending private and public schools, respectively, and in 44.1% and 25.6% of boys (P = 0.001). Adolescents who did not eat beans on more than 4 d/wk presented a higher risk of fiber intake below that recommended (age + 5; P < 0.05), with odds ratios ranging from 10.4 to 14.2 according gender and private or public schooling. Dietary fiber intake below that recommended was associated with a greater risk (P < 0.05) toward overweight in students attending public schooling (odds ratios 2.84 and 2.95 for males and females, respectively). Low dietary fiber intake was not associated with constipation. CONCLUSION: Intake of beans more than four times per week is associated with the appropriate level of fiber intake. Dietary fiber intake below the recommendation was not associated with constipation but was associated with being overweight among those students attending public schooling.

Tratamento alternativo para dentes traumatizados com reabsorção radicular inflamatória: 4 anos de acompanhamento / Alternative treatment for traumatized teeth with inflammatory root resorption: 4 years follow-up / Tratamiento alternativo para dientes traumatizados con reabsorción radicular inflamatoria: 4 años de seguimiento

Objetivo: Este relato descreve o tratamento de um incisivo central superior previamente traumatizado, afetado pela reabsorção radicular inflamatória interna / externa. Método: Trata-se do relato de caso de um paciente com 12 anos de idade que relatou um trauma de queda um ano antes da consulta, causando fratura da coroa e luxação intrusiva no incisivo central superior direito. Os exames clínicos verificaram sensibilidade à percussão e descoloração da coroa. Radiograficamente, as áreas radiolúcidas sugeriram reabsorção radicular inflamatória (no terço da raiz cervical) e lesão periapical. Resultados: O tratamento endodôntico foi realizado, com uma pasta de hidróxido de cálcio com paramonoclorofenol canforado inserida no canal radicular por 2 meses. Quando uma barreira calcificada na área apical foi observada radiograficamente, toda a raiz foi obturada com agregado de trióxido mineral (MTA). O dente foi acompanhado por 4 anos, mostrando regressão dos sintomas, cicatrização por reabsorção e também aumento no comprimento radicular. Conclusão: O presente caso mostrou que o tratamento endodôntico associado ao MTA promoveu a remodelação óssea da área periapical e paralisou a reabsorção.

Objective: This report describes the treatment of a previously traumatized central central incisor affected by internal/external inflammatory root resorption. Method: This is the case report of a 12-year-old patient who reported a fall trauma one year before the consultation, causing crown fracture and intrusive dislocation in the right upper central incisor. Clinical examinations verified sensitivity to percussion and discoloration of the crown. Radiographically, radiolucent areas suggested inflammatory root resorption (in the third of the cervical root) and periapical lesion. Results: Endodontic treatment was performed with a calcium hydroxide paste with canouted paramonochlorophenol inserted into the root canal for 2 months. When a calcified barrier in the apical area was observed radiographically, the entire root was computed with mineral trioxide aggregate (MTA). The tooth was followed for 4 years, showing regression of symptoms, healing by resorption and also increase in root length. Conclusion: The present case showed that endodontic treatment associated with MTA promoted bone remodeling of the periapical area and paralyzed resorption.

Objetivo: Este informe describe el tratamiento de un incisivo central central previamente traumatizado afectado por la resorción de raíz inflamatoria interna/externa. Método: Este es el informe del caso de un paciente de 12 años que reportó un trauma de caída un año antes de la consulta, causando fractura de corona y dislocación intrusiva en el incisivo central superior derecho. Los exámenes clínicos verificaron la sensibilidad a la percusión y la decoloración de la corona. Radiográficamente, las áreas radiolúcidas sugirieron resorción inflamatoria de la raíz (en la tercera de la raíz cervical) y lesión periapical. Resultados: El tratamiento endodóntico se realizó con una pasta de hidróxido de calcio con paramonoclorofenol canouted insertado en el conducto radicular durante 2 meses. Cuando se observó radiográficamente una barrera calcificada en el área apical, toda la raíz se calculó con el agregado de trióxido mineral (MTA). El diente fue seguido durante 4 años, mostrando regresión de los síntomas, curación por resorción y también aumento en la longitud de la raíz. Conclusión: El presente caso mostró que el tratamiento endodóntico asociado con la MTA promovía la remodelación ósea de la zona periapical y la resorción paralizada.

General anesthesia combined with erector spinae plane block for ductus arteriosus closure: two case reports / Anestesia geral associada a bloqueio do plano do músculo eretor da espinha para encerramento de persistência de canal arterial: dois relatos de caso

Abstract Background: Failure of ductus arteriosus closure in preterm neonates results in a left-to-right shunt that leads to variable severities of hemodynamic and respiratory distress. When medical therapy fails, surgical ligation via left lateral thoracotomy remains an alternative approach and can be performed in the operating room or at the bedside with a low mortality rate. Opioid-based anesthesia is a frequent choice among anesthesiologists who manage patent ductus arteriosus cases based on the suppression of the stress response and maintenance of hemodynamic stability. This rationale suggests that regional anesthesia may also be an advantageous technique and may benefit earlier weaning from ventilation. Blocking afferent signals before incision may also modulate the long-term consequences of altered sensory perception and pain responses. Case report: We present two cases of general anesthesia combined with erector spinae plane block as part of multimodal anesthesia in premature twins undergoing patent ductus arteriosus closure. Discussion: In these cases, the use of erector spine plane block combined with general anesthesia was efficient to minimize the negative impact of surgery and allowed a reduction in the amount of intraoperative opioid use for patent ductus arteriosus closure.

Resumo Justificativa: A persistência do canal arterial em neonatos prematuros resulta em shunt esquerdo-direito com alterações hemodinâmicas e desconforto respiratório de gravidade variável. Quando o tratamento clínico não é bem sucedido, o fechamento cirúrgico via toracotomia lateral esquerda continua sendo a abordagem alternativa, e pode ser realizado no centro cirúrgico ou à beira leito com baixa taxa de mortalidade. A anestesia baseada em opioides é frequentemente escolhida pelos anestesiologistas nos casos de fechamento de canal arterial devido à supressão de resposta ao estresse e manutenção da estabilidade hemodinâmica. Essa justificativa sugere que a anestesia regional também pode ser uma técnica vantajosa e que promove desmame mais precoce do ventilador. O bloqueio dos estímulos aferentes antes da incisão também pode modular os efeitos no longo-prazo, tanto da percepção sensorial quanto das respostas à dor. Relato de caso: Apresentamos dois casos de anestesia geral associada a bloqueio do plano do músculo eretor da espinha como parte de anestesia multimodal em gêmeos prematuros submetidos a fechamento de canal arterial persistente. Discussão: Nos dois casos descritos, o bloqueio do plano do músculo eretor da espinha associado à anestesia geral foi eficiente para minimizar o impacto negativo da cirurgia, e possibilitou a redução na quantidade de opioide usado durante cirurgia para fechamento de persistência canal arterial.

Prevalência e complicações das lesões dentárias traumáticas / Prevalence and consequences of traumatic dental injuries

Introdução: os traumatismos dentários precisam ser corretamente diagnosticados e tratados desde o primeiro atendimento, com a finalidade de minimizar as alterações tardias que poderão complicar o tratamento endodôntico. Objetivo: avaliar a prevalência dos traumatismos dentários na dentição permanente e apresentar as principais alterações subsequentes a estes. Metodologia: foi realizado um estudo observacional da prevalência de traumatismo dentário na dentição permanente e da ocorrência de possíveis complicações endodônticas pós-traumáticas, por meio do acompanhamento clínico e radiográfico dos pacientes atendidos na disciplina de Endodontia Clínica da Faculdade de Odontologia da Universidade Federal da Bahia, no período de 2012 a 2016. Resultados: os dados obtidos foram tabulados e a análise dos resultados incluiu distribuição de frequência e teste Qui-quadrado com nível de significância de 5%. A amostra compreendeu 178 dentes de 89 pacientes, sendo a sua maioria do gênero masculino (54%). A faixa etária mais prevalente foi dos 11 aos 20 anos de idade. A maxila foi a região mais afetada, sendo os dentes anteriores os mais acometidos (83%). A queda foi o fator etiológico predominante (61%) e a fratura coronária não complicada foi o tipo de trauma mais prevalente (23,2%), seguido da luxação lateral (19,7%) e da avulsão (17,7%). A necrose da polpa foi a complicação endodôntica mais frequente (42,7%), seguida da reabsorção radicular externa com 18,3%. Conclusão: pôde-se observar uma alta ocorrência das complicações pós-traumáticas, sendo necessário o tratamento e o acompanhamento criterioso desses pacientes com o intuito de evitar a perda dentária.

Introduction: dental trauma needs to be correctly diagnosed and treated from the first visit, in order to minimize late changes that may complicate endodontic treatment. Objective: To evaluate the prevalence of dental trauma in permanent dentition and to present the main subsequent changes. Metodology: an observational study of the prevalence of dental trauma in permanent dentition and the occurrence of possible post-traumatic endodontic complications was carried out through clinical and radiographic follow-up of patients treated at the Clinical Endodontics discipline of the Federal University School of Dentistry. Bahia, from 2012 to 2016. Results: the data obtained were tabulated and the analysis of the results included frequency distribution and Chi-square test with a significance level of 5%. The sample comprised 178 teeth from 89 patients, most of them male (54%). The most prevalent age group was from 11 to 20 years old. The maxilla was the most affected region, with the anterior teeth being the most affected (83%). Fall was the predominant etiological factor (61%) and uncomplicated coronary fracture was the most prevalent type of trauma (23.2%), followed by lateral dislocation (19.7%) and avulsion (17.7%). . Pulp necrosis was the most common endodontic complication (42.7%), followed by external root resorption with 18.3%. Conclusion: it was observed a high occurrence of post-traumatic complications, requiring the treatment and careful monitoring of these patients in order to prevent tooth loss.