Microcephaly as a risk factor for dental alterations: A case-control study.

OBJECTIVE: This study aimed to assess whether microcephaly is a risk factor for alterations in the chronology and sequence of tooth eruption and for developmental defects of enamel. MATHERIALS AND METHODS: In this case-control study, 81 children aged 30-36 months, including 40 normoreactive children and 41 with microcephaly, were submitted to oral clinical examination to determine the frequency of alterations in the chronology and sequence of tooth eruption and developmental enamel defects. The sample was matched for sex and age (1:1) and allocated to the case (presence of dental alterations) and control (absence of dental alterations) groups. Gestational age, birthweight and socioeconomic characteristics were also analyzed. Chi-square test and Fisher's exact test were applied (α = 0.05). RESULTS: Microcephaly was significantly associated with delayed tooth eruption, alterations in the sequence of tooth eruption, and defects in dental enamel (p < 0.001). Low birthweight also showed a significant association with this alterations (p < 0.005) and prematurity was associated with defects in enamel development (p < 0.005). CONCLUSION: Microcephaly is a risk factor for alterations in the tooth eruption process and enamel formation in primary teeth.

Association of congenital Zika syndrome with dental alterations in children with microcephaly.

The effects of congenital Zika syndrome (CZS) on the tooth development of infected children are not well known. The aim of this study was to analyze the association of CZS with dental alterations in children with microcephaly seen at a referral hospital in Rio Grande do Norte, Brazil. The chronology and sequence of tooth eruption and the presence of dental alterations were evaluated by a single calibrated examiner (kappa > 0.80) in 62 children aged 7 to 35 months with microcephaly associated with CZS and other congenital infections. Medical data of the mother and child were collected from the records and the parents responded to a socioeconomic questionnaire. Descriptive analysis and Fisher's exact test were used (5% significance level). The mean age of the children was 26.4 months (SD = 7.52). The mean weight and head circumference at birth were 2,593 g (SD = 0.60) and 29.6 cm (SD = 2.48), respectively. Microcephaly was associated with congenital Zika virus infection in 79% of cases and with other congenital infections in 21%. No significant association was found between CZS and alterations in the chronology (p = 1.00) or sequence of tooth eruption (p = 0.16) or changes in enamel development (p = 1.00). In conclusion, children with microcephaly exhibit a delay and alterations in the sequence of tooth eruption of primary teeth, as well as developmental defects of enamel, which are not associated with Zika virus infection.

Development and characterization of thermopressed polyvinyl alcohol films for buccal delivery of benznidazole.

Given that oral preparations of benznidazole (BZN) have demonstrated limited efficacy in the treatment of Chagas' disease due to pharmacokinetic or toxicological problems, the development of buccal polymeric films was purposed in this study. These systems ensure high patient acceptability and direct access to the systemic circulation, improving drug bioavailability and toxicological profile. Polymer films were prepared through a thermopressing method by mixing BZN and polyvinyl alcohol (PVAL). In some preparations, propylene glycol (PG) and thymol (TM) were also included as plasticizer and chemical absorption enhancer, respectively. Morphology, X-ray diffraction, spectroscopic, thermal, mechanical, and water uptake properties, as well as ex vivo permeability studies, were performed to characterize the film formulations. BZN remained stable and in an amorphous form over 90 days. The addition of PG and TM improved the mechanical properties of the films, making them soft, flexible and tear-resistant. Also, these additives increased the water sorption rate of the films at 50 and 75% relative humidity and the TM increased the film erosion properties and drug permeability (close to 6×) compared to control. It was hypothesized that the permeability improvement of thymol-based films that follow a drug release profile through erosion is also associated with the inhibition of the crystallization of BNZ when the film is in contact with the buccal mucosa. Once the thymol has previously demonstrated a significant in vivo and in vitro trypanocidal action and even improved film characteristics, these systems may be considered promising for Chagas' disease treatment.

Transbuccal Delivery of Isoniazid: Ex Vivo Permeability and Drug-Surfactant Interaction Studies.

The oral administration of isoniazid (INH) may lead to discontinuation of tuberculosis treatment due to drug-related hepatotoxicity events, and thus, the transbuccal delivery of this drug was investigated, for the first time, as an alternative administration route. Ex vivo permeability assays were performed in Franz-type diffusion chambers, applying INH alone and in combination with sodium dodecyl sulfate (SDS) and sodium taurocholate (ST). After confirming the formation of micelle structures by dynamic light scattering analysis, UV-visible spectroscopy and zeta potential analyses were used to investigate drug-micelle interactions. In zeta potential analyses, no electrostatical interactions were identified for both surfactants in saliva buffer pH 6.8. Spectrophotometric analyses, in turn, indicated chemical interactions between INH and SDS in both pH values (2.0 and 6.8) whereas no interaction between the drug and ST was observed. Despite the interaction between SDS and drug, this surfactant increased the buccal transport rate of INH by approximately 11 times when compared with the control. In contrast, ST did not increase the drug permeability. The INH retention in SDS-treated mucosa was significantly higher when compared with the control and an effect on intercellular lipids was suggested. In vivo studies are needed to confirm the high INH absorption found here. Grapical abstract.

Transbuccal delivery of metal complexes of isoniazid as an alternative to overcome antimicrobial resistance problems.

In isolated isoniazid (INH)-resistant strains, deletion or mutations in thekatGgene have been identified, which result in loss of catalase-peroxidase activity. This enzyme plays a key role in the activation of this prodrug. As an alternative, the coordination of the INH to metal complexes has been purposed to activate it regardless of enzyme functionality. Although pentacyanido(isoniazid)ferrate(II) complexes have shown to be effective against resistant strains of Mycobacterium tuberculosis, low oral bioavailability was found. In this context, buccal mucosa was selected as an alternative route to the metal complex delivery. Moreover, oral manifestations of tuberculosis(TB) have been observed in some patients, particularly when resistant strains are present, and no therapeutic options are currently available on the market. Pentacyanidoferrate (PCF-INH) and Prussian-blue (PB-INH) complexes were initially prepared and characterized, followed by buccal permeability studies in Franz-type diffusion cells. The electrochemical potential of the complexes demonstrated their ability to self-activate. Job's method suggested the presence of structural defects in PB-INH complexes, which was correlated with permeability results. In fact, PB-INH showed a higher dissociation rate in salt-rich aqueous medium and thus a high transport rate of INH through the buccal mucosa. Its passage through the tissue would not be possible due to the high molecular size. PCF-INH, in turn, presented a lower dissociation rate in the salt-rich aqueous medium, justifying its slower transport rate through the tissue. Taken together, these results suggest that INH-based metal complexes may be efficiently administered through the buccal route, impacting on both oral bioavailability and microbial resistance.

Transbuccal delivery of benznidazole associated with monoterpenes: permeation studies and mechanistic insights.

Benznidazole (BZN) represents the only drug currently available for the treatment of Chagas disease in most endemic countries. When administered orally, high doses are required due to its extensive hepatic metabolism and its toxicity represents the main reason for treatment withdrawals. Because of these complications, transbuccal administration of BZN was investigated. This route avoids the first-pass hepatic metabolism and presents high permeability, with direct access to the systemic circulation. BZN was applied on porcine buccal mucosa after pretreatment with pure eugenol, carvacrol or limonene. Thermal (DSC) and spectroscopic (FT-IR) analyzes were performed to investigate the mechanisms of drug absorption enhancement. The permeability coefficient values of BZN increased 2.6, 2.9 and 4.9-fold after pretreatment with eugenol, carvacrol and limonene, respectively. The lag time, in turn, was shortened in the pretreated samples. The DSC and FT-IR analyzes suggested that transport of BZN through the buccal mucosa is associated with log P and size of monoterpenes. Limonene, the most effective absorption enhancer, contributed to greater interaction with non-polar domains of the buccal epithelium. Overall, BZN showed to be efficiently transported through the buccal route, but in vivo pharmacokinetic studies should be performed to confirm these findings.

Abordagem ao período pós-operatório inicial no transplante de fígado: um ponto de vista institucional / Approach to the liver transplant early postoperative period: an institutional standpoint

RESUMO O programa de transplante de fígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específica. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática para estimular o debate entre diferentes equipes dedicadas, o que tem potencial de permitir a introdução de novas ideias e, possivelmente, melhorar o padrão de cuidados em cada instituição.

ABSTRACT The liver transplant program in our center started in 1992, and post-liver transplant patients are still admitted to the intensive care unit. For the intensive care physician, a learning curve started then, skills were acquired, and a specific practice was established. Throughout this time, several concepts changed, improving the care of these patients. The practical approach varies between liver transplant centers, according to local specificities. Hence, we wanted to present our routine practice to stimulate the debate between dedicated teams, which can allow the introduction of new ideas and potentially improve each local standard of care.

Angle Class II, Division 2 Malocclusion and Association with Late Eruption

Objective: To verify the dental age of individuals with Angle Class II, division 2 malocclusion. Material and Methods: The sample consisted of 200 panoramic radiographs of schoolchildren from the city of Fortaleza in the state of Ceará, in the northeast of Brazil. These radiographs were divided into two groups (N=100): a Control group comprising radiographs of patients with normal occlusion and a CIID2 group comprising radiographs of patients with an Angle Class II, division 2 malocclusion. The Demirjian method was used to identify dental age. All the radiographs were evaluated by a sole duly trained and calibrated technician. The Kappa coefficient for inter-annotator agreement was 0.98 based on the criteria of eruption stage of each tooth. Statistical analysis was performed using the Chi-squared test, Student's t-test and the Mann-Whitney test, with a level of significance of 5%. Results: There was a significant statistical difference between the dental ages of the groups tested. The CIID2 group had a lower dental age than the control group, signifying late eruption in patients with an Angle Class II, division 2 malocclusion. Conclusion: Patients with an Angle Class II, division 2 malocclusion had a lower dental age than patients with normal occlusion, suggesting that orthodontic treatment should be delayed. The first molars, second pre-molars and canines suffered late eruption.

Approach to the liver transplant early postoperative period: an institutional standpoint. / Abordagem ao período pós-operatório inicial no transplante de fígado: um ponto de vista institucional.

The liver transplant program in our center started in 1992, and post-liver transplant patients are still admitted to the intensive care unit. For the intensive care physician, a learning curve started then, skills were acquired, and a specific practice was established. Throughout this time, several concepts changed, improving the care of these patients. The practical approach varies between liver transplant centers, according to local specificities. Hence, we wanted to present our routine practice to stimulate the debate between dedicated teams, which can allow the introduction of new ideas and potentially improve each local standard of care.

O programa de transplante de fígado teve início em nosso centro em 1992, e pacientes em pós-operatório de transplante hepático ainda são admitidos à unidade de terapia intensiva. Uma curva de aprendizado do médico intensivista teve então início, com aquisição de habilidades e estabelecimento de uma prática específica. Contudo, muitos dos conceitos se modificaram com o tempo, o que conduziu a uma melhora nos cuidados proporcionados a esses pacientes. A abordagem prática varia entre diferentes centros de transplante de fígado, segundo especificidades locais. Assim, ensejamos apresentar nossa prática para estimular o debate entre diferentes equipes dedicadas, o que tem potencial de permitir a introdução de novas ideias e, possivelmente, melhorar o padrão de cuidados em cada instituição.

Características oclusais de bebês com microcefalia associada ao vírus Zika / Occlusal characteristics of babies with microcephaly associated with the Zika virus

Introdução: A microcefalia em um nascido vivo é definida como uma anomalia em que perímetro cefálico (PC) está abaixo do padrão de curvas apropriadas para idade e gênero. A etiologia pode envolver anormalidades genéticas, síndromes, distúrbios metabólicos, teratógenos, infecções pré-natal, perinatal e pós-natal. Porém, essa malformação tornouse muito mais prevalente com o surto recente do vírus Zika. Objetivos: Estudar o padrão de oclusão em bebês com microcefalia associada ao vírus Zika (MZV). Metodologia: O artigo 1 foi um estudo transversal que incluiu pacientes com diagnóstico de MZV (40) entre 30 e 36 meses e um grupo controle com bebês saudáveis (40), aleatoriamente selecionadas com as mesmas características sociodemográficas. A análise estatística utilizou análise descritiva, o teste qui-quadrado de Pearson e a regressão logística multivariada. O artigo 2 foi um relato de casos clínicos com infecção no segundo trimestre da gestação. O artigo 3 foi um relato de casos clínicos com infecção no primeiro trimestre da gestação. Resultados: Foi demonstrado uma prevalência significativamente maior de maloclusões em bebês MZV em comparação ao grupo controle (artigo 1). Pacientes com MZV possuíram maior probabilidade de apresentar irrupção tardia (p < 0,001), formato da arcada superior e inferior atrésico (p < 0,001), overjet acentuado (p < 0,001) e mordida cruzada posterior (p= 0,004) (artigo 1). Também foi demostrado ocorrência de irrupção tardia, hipodontia, tendência a crescimento vertical, perfil convexo, comprometimento do tônus muscular, incompetência de selamento labial, mordida aberta e desvio de linha média (artigos 2 e 3). Conclusões: Conclui-se que existe uma maior probabilidade de irrupção tardia e prevalência maior de maloclusões em bebês MZV, dentre elas o formato da arcada superior e inferior atrésico, overjet acentuado e mordida cruzada posterior. Comprometimento muscular também foi encontrado. Além disso, o período de infecção pelo vírus parece determinar a gravidade das características encontradas (AU).

Introduction: Microcephaly in a live birth is defined as an anomaly in which head circumference (HC) is below the standard for age and gender appropriate curves. The etiology may involve genetic abnormalities, syndromes, metabolic disorders, teratogens, prenatal, perinatal and postnatal infections. However, this malformation has become much more prevalent with the recent emergence of the Zika virus. Objectives: To determine the prevalence of malocclusion among infants with Zika virus-associated microcephaly (MZV) and to describe the most common malocclusion characteristics in this population (Article 1); to identify differences in univiteline twins with and without Zika virus-associated microcephaly infection during the second trimester of gestation (Article 2); to describe the dentoskeletal changes in two infants who were infected with the Zika virus during the first trimester of gestation (Article 3). Method: Article 1 was a cross-sectional study which included patients diagnosed with MZV (40) between 30 and 36 months and a comparison group with healthy babies (40), randomly selected with the same sociodemographic characteristics. The statistical analysis used descriptive analysis, Pearson's chi-squared test and multivariate logistic regression. Articles 2 and 3 are case reports, one with infection in the second trimester of pregnancy and another in the first, respectively. Results: In article 1, a significantly higher prevalence of malocclusions in MZV infants was demonstrated in comparison to the control group (p<0.001). Patients with MZV were more likely to have late eruption (p<0.001), atresic upper and lower arch (p<0.001), marked overjet (p<0.001), and posterior crossbite (p=0.004). In article 2, muscular impairment was the most striking feature for the twin with microcephaly. In article 3, late eruption, hypodontia, tendency to vertical growth, convex profile, muscle tone impairment, incompetence to seal the lips, open bite, midline deviation and atresic arches were demonstrated. Conclusions: It is concluded that there is a greater probability of late eruption and higher prevalence of malocclusions in MZV infants, with atresic upper and lower arch, overjet and posterior crossbite among them (Article 1). In addition, the infection period of the virus seems to determine the severity of the characteristics found: less occurrence of dental problems and maintenance of neuromuscular changes can be determined when in the second trimester (Article 2); but when infection occurs in the first trimester, dento-skeletal impairment is greater along with the associated functional alterations (Article 3) (AU).

Biomonitoring of gasoline station attendants exposed to benzene: Effect of gender.

Women are employed in increasing numbers as gasoline station attendants, a work category with risk of exposure to benzene. We have assessed the effect of gender on biomarkers of occupational benzene exposure. Gasoline station attendants (20 men and 20 women) and 40 control individuals (20 men and 20 women) with no history of occupational benzene exposure were evaluated. Benzene exposure was monitoring by environmental and biological measurements. Urinary trans,trans-muconic acid levels, well-known genetic and hematological alterations linked to benzene exposure, and non-cancer effects on the immune, hepatic, and renal systems were investigated. Our results suggest a potential effect of gender on some effects of occupational benzene exposure, particularly the hematological parameters and trans,trans-muconic acid levels. Despite limitations of our study, our findings provide important considerations about occupational exposure of women to benzene and may contribute to the development of occupational protection standards.

Biodiesel from soybean promotes cell proliferation in vitro.

Toxicological responses of exhaust emissions of biodiesel are different due to variation in methods of generation and the tested biological models. A chemical profile was generated using ICP-MS and GC-MS for the biodiesel samples obtained in Brazil. A cytotoxicity assay and cytokine secretion experiments were evaluated in human bronchial epithelial cells (BEAS-2B). Cells were exposed to polar (acetone) and nonpolar (hexane) extracts from particles obtained from fuel exhaust: fossil diesel (B5), pure soybean biodiesel (B100), soybean biodiesel with additive (B100A) and ethanol additive (EtOH). Biodiesel and its additives exhibited higher organic and inorganic constituents on particles when compared to B5. The biodiesel extracts did not exert any toxic effect at concentrations 10, 25, 50, 75, and 100µgmL(-1). In fact quite the opposite, a cell proliferation effect induced by the B100 and B100A extracts is reported. A small increase in concentrations of inflammatory mediators (Interleukin-6, IL-6; and Interleukin-8, IL-8) in the medium of biodiesel-treated cells was observed, however, no statistical difference was found. An interesting finding indicates that the presence of metals in the nonpolar (hexane) fraction of biodiesel fuel (B100) represses cytokine release in lung cells. This was revealed by the use of the metal chelator. Results suggest that metals associated with biodiesel's organic constituents might play a significant role in molecular mechanisms associated to cellular proliferation and immune responses.

Particle pollution in Rio de Janeiro, Brazil: increase and decrease of pro-inflammatory cytokines IL-6 and IL-8 in human lung cells.

Particle pollution from urban and industrialized regions in Rio de Janeiro (RJ), Brazil was analyzed for toxic and pro-inflammatory (cytokines: IL-6, IL-8, IL-10) responses in human bronchial epithelial cells. Trace elements contribution was studied. Airborne particulate matter was collected at: three industrial sites Ind-1 (PM10) and Ind-2a and 2b (PM2.5); Centro urban area (PM10) and two rural sites (PM2.5, PM10). PM10 acetone extracts were toxic and did not elicit cytokine release; aqueous extracts were less toxic and stimulated the release of IL-6 and IL-8. PM2.5 aqueous extracts from Ind-2 decreased the release of IL-6 and IL-8. Zinc concentration was higher at the industrial and rural reference sites (Ref-1-2) although metals were not associated to cytokines changes. These results demonstrate that PM from RJ can either increase or decrease cytokine secretion in vitro while being site specific and time dependent.

Diferenças entre critérios normativos e autopercebidos na identificação da necessidade de tratamento ortodôntico, satisfação com a aparência e mastigação em adolescentes / Differences between normative criteria and autopercebidos in identifying the need for orthodontic treatment, satisfaction with appearance and chewing in adolescents

Tratamentos ortodônticos são realizados na expectativa de melhorar a aparência e função mastigatória dos indivíduos e geralmente são indicados por meio de critérios clínicos, não levando, algumas vezes, em consideração a percepção do indivíduo. O objetivo desse estudo foi avaliar a relação entre as necessidades ortodônticas tecnicamente definidas (critérios normativos) e a satisfação com a aparência, mastigação e necessidade de tratamento percebida em um grupo de adolescentes. Foi realizado um estudo transversal com 215 alunos entre 15 e 19 anos foi realizado no Instituto Federal de Educação, Ciência e Tecnologia (IFRN). Questionário na forma de entrevista estruturada foi aplicado aos indivíduos com perguntas a respeito da satisfação com a aparência, satisfação com a mastigação e percepção quanto à necessidade de tratamento ortodôntico. Um único examinador, treinado e calibrado, coletou os dados normativos de necessidade de tratamento ortodôntico através de critérios estabelecidos pelo Índice Dental Estético (DAI). Os resultados demostram que existe associação significativa entre o escore do DAI e a percepção do participante quanto à necessidade de tratamento ortodôntico (p < 0,001), satisfação com a aparência (p = 0,003) e satisfação com a mastigação (p = 0,047). Os alunos que possuíam necessidade normativa de tratamento se perceberam mais com problemas. Quando as características oclusais foram analisadas separadamente, uma maior quantidade de problemas estava associada à necessidade percebida pelo paciente e à satisfação com a aparência, dentre eles o apinhamento, a irregularidade da maxila, a irregularidade da mandíbula e o trespasse maxilar acentuado (p< 0,05). Na análise com a satisfação com a mastigação, foi encontrada associação apenas com a mordida aberta (p= 0,003). Esses achados demostram uma tendência dos indivíduos de relacionar os problemas oclusais mais à estética, tornando esse aspecto bastante relevante ao tratamento ortodôntico. (AU)

Orthodontic treatments are performed in the expectation of improving the appearance and masticatory function of individuals, and are usually indicated by clinical criteria, not taking into account the individual's perception. The aim of this study was to evaluate the relationship between orthodontic needs technically defined (normative criteria) and satisfaction regarding appearance, satisfaction regarding mastication and perceived need for treatment in a group of teenagers. A cross-sectional study with 215 students aged between 15 and 19 years was held at the Instituto Federal de Educação, Ciência e Tecnologia (IFRN). A questionnaire in the form of a structured interview was applied, with questions about satisfaction with appearance, satisfaction with mastication and perception of the need for orthodontic treatment. A single examiner ­ who was trained and calibrated ­ collected the normative data of need for orthodontic treatment via criteria established by the Dental Aesthetic Index (DAI). The results demonstrated a significant association between the DAI score and a patient's perception of the need for orthodontic treatment (p <0.001), satisfaction regarding appearance (p= 0.003) and satisfaction regarding mastication (p= 0.047). It was more common for students who had a normative need for treatment to perceive problems in themselves. When the occlusal characteristics were analyzed separately, a larger amount of problems was associated to the perceived need by the patient and to satisfaction regarding appearance, including dental crowding, irregularity of the maxilla, irregularity of the jaw and overjet (p <0, 05). In the analysis of satisfaction with mastication, it was only found association with the open bite (p = 0.003). These findings demonstrate a tendency of individuals to relate occlusal problems more to aesthetics, making this aspect essential to orthodontic treatment. (AU)

Chemical composition, sources, solubility, and transport of aerosol trace elements in a tropical region.

Aerosol particle samples (PM10) were collected at urban, industrial and rural sites located in Rio de Janeiro, Brazil, between October 2008 and September 2009. Aerosol samples for each site were analyzed for total and soluble metals, water-soluble ions, carboxylic acids, and water-soluble organic carbon (WSOC). The results showed that the mean PM10 concentrations were 34 µg m(-3); 47 µg m(-3) and 71 µg m(-3) at the rural, urban and industrial sites, respectively. An increase in the average concentration of these particles due to air stagnation was observed during the period from May to September for all sites, and an increase in hospitalization for respiratory problems was also reported. On average, the anions species represented 4 to 14% of total content, while cations species corresponded to 1 to 11% and 7.5% for WSOC. The overall metal content at the industrial site was nearly the double that at the rural site. The concentrations of the studied species are influenced mainly by site location and the specific characteristics present at each site. However, higher concentrations of some species were observed on particular dates and were probably due to biomass burning and African dust events. The acid/aqueous percentiles showed that the most efficiently extracted metals from the aqueous phase were V and Ni (40%), while Al and Fe represented a lower percentage (<3%). Analysis of the aqueous fraction provides important information about the bioavailability of metals that is associated with the inflammatory process in the lungs.

Percepção da administração tópica ocular de drogas: vaporização x gotas / Topical drug administration perception: spray x eyedrop

OBJETIVO: Avaliar por questionário qual o nível de dificuldade para aplicação tópica de medicações oculares: vaporização ou gotas através da observação do paciente e qual método foi tecnicamente melhor utilizado para aplicação de drogas tópicas oculares. MÉTODOS: A pesquisa foi realizada no decorrer de 2008 e 2009 no ambulatório de oftalmologia da Policlínica Ronaldo Gazolla. Foi utilizado um frasco de colírio e um de vaporizador com solução de carboximetilcelulose sódica a 0,5 por cento. Cada participante aplicou em um dos olhos a solução por vaporização ou instilação de gotas através de um processo randomizado. Foi perguntado ao paciente questões pré-formuladas sobre a praticidade de ambos os métodos. RESULTADOS: Considerando o grau de dificuldade de administração tópica ocular: 36 por cento acharam difícil ou muito difícil a vaporização e 14 por cento a instilação de colírio. As dificuldades descritas pelos pacientes foram relatadas por 64 por cento dos pacientes para vaporização e por 34 por cento para aplicação de colírio (p= 0,0027). Já 42 por cento dos pacientes necessitaram de mais de uma instilação para aplicação do colírio, enquanto 36 por cento dos pacientes precisaram de mais de uma aplicação para que a droga vaporizada tivesse contato com o olho (p= 0,49). Em 56 por cento dos pacientes houve toque da ponta do colírio com os cílios, já com o vaporizador não houve toque (p=0,0001). CONCLUSÃO: A vaporização foi o método mais seguro para evitar a contaminação do frasco. A maior facilidade percebida pelos pacientes ao instilar o colírio em relação a vaporização foi devido a terem apoiado a ponta do frasco nos tecidos oculares.

OBJECTIVE:Evaluate how difficult it is to apply ocular topical medications based on patient observation and answers to a questionnaire. Eye drops were compared to vaporization. METHODS: The study was performed in 2008 and 2009 in Policlinica Ronaldo Gazolla ophthalmological ambulatory. An eyedropper and a vaporizer with carboximetilcelulose 0,5 percent were used. Each individual tested applied randomly on one of their eyes an eye drop or vaporization. The patients had to answer questions about the practice concerning both forms of topical eye drug application. RESULTS: 36 percent informed that it was difficult or very difficult to vaporize and 14 percent to use eye drops. Problems described by patients were considered by 64 percent for vaporization and by 34 percent for topical eye drop use (p= 0,0027). 42 percent of the patients needed more than one eye drop application to have eye drop contact , while 36 percent of the patients needed more than one application of vaporization in order to get drug eye contact (p= 0,49). In 56 percent of patients there were an eyedropper tip contact with cilia, however there was not contact when the medicine was vaporized (p=0,0001). CONCLUSION: Vaporization was the safest method to avoid topical ocular drug contamination by manipulation; the greater facility noticed for patients when they administered eye drops was achieved using eye tissues as an eyedropper support.

Sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal: early experience.

PURPOSE: This study was conducted to assess the feasibility of the sentinel lymph node procedure in patients with epidermoid carcinoma of the anal canal. METHODS: Between February 2001 and November 2002, 14 patients with epidermoid carcinoma of the anal canal and no clinical evidence of inguinal involvement were prospectively enrolled in the study. The sentinel lymph node procedure consisted of a combination of preoperative lymphoscintigraphy with technetium 99m dextran 500 injected around the tumor and intraoperative detection of the sentinel node with a gamma probe. Patent blue V dye was also injected at the periphery of the tumor to facilitate direct identification of the blue-stained lymph node. After removal, the sentinel node was studied by hematoxylin and eosin staining and immunohistochemistry for pancytokeratins (antigen A1 and A3). RESULTS: Detection and removal of sentinel lymph nodes was possible in all patients. There was no correlation between tumor size and pattern of lymphatic drainage to the groin. Tumors located in the midline of the anal canal gave rise to bilateral sentinel nodes in eight of nine cases. In total, 23 sentinel lymph nodes were removed. One patient (7.1 percent) had a node identified as positive for metastatic carcinoma on immunohistochemical staining. Surgical complications were minimal. CONCLUSIONS: The standardized technique was safe and highly effective in sampling inguinal sentinel lymph nodes in carcinoma of the anal canal. It also proved to be useful as an instrument to detect micrometastatic deposits in clinically normal nodes. Our early results suggest the sentinel lymph node procedure may have a role in guiding a more selective approach for patients with anal cancer. Additional studies in a larger patient population to determine the sensitivity and specificity of this method are warranted.

Consenso brasileiro de osteoporose 2002 / Brazilian consensus on osteoporosis 2002

Objetivo: estabelecer diretrizes para o diagnóstico precoce, prevenção e tratamento da osteoporose. Métodos: representantes das diferentes especialidades que estudam e trabalham com os diferentes aspectos da osteoporose participaram deste consenso, no qual estabeleceram estas diretrizes baseados em uma revisão sistemática da literatura buscando evidências científicas consistentes. Os trabalhos foram selecionados pela sua metodologia, desenho, medidas adequadas e validade dos resultados contemplando procedimentos diagnósticos, preventivos e terapêuticos. Resultados: Após extensa discussão os participantes produziram um texto básico sujeito a correções posteriores, e revisões até a aprovação final

Detecção do linfonodo sentinela em câncer da mama: comparação entre métodos / Sentinel lymph node detection in breast cancer: comparison between methods

Objetivos: avaliar a eficiência da cintilografia mamária, do detector manual de raios gama (probe) e do corante azul vital para a localização do linfonodo sentinela (LNS), estabelecendo a sensibilidade, o valor preditivo negativo (VPN) e a acurácia do mapeamento do LNS. Métodos: neste estudo estão incluídas 88 pacientes com câncer de mama atendidas consecutivamente e com axila clinicamente negativa. Foi utilizado o radiofármaco tecnécio ligado ao colóide dextran 500 (Dextran 99mTc), para cintilografia pré-operatória, realizada em 58 pacientes, e detecção transoperatória com o probe em 53 pacientes. Destas, 47 tiveram as contagens de irradiação gama anotadas e também o intervalo de tempo decorrido entre a injeção e a cirurgia. Foram empregados 2 mL do corante vital Bleu Patente V, injetado em torno do tumor, 5 minutos antes da incisão cirúrgica na axila em todos os casos. O LNS foi avaliado por congelação em 77 casos e todos pela coloração por hematoxilina e eosina. Resultados: a linfocintilografia, realizada em 58 casos, foi útil em 62,1 por cento, sendo que em nove ocorreu mapeamento de dois linfonodos, e com o probe foram confirmados 45 casos (84,9 por cento) dos 53 avaliados. Das 47 com anotação de contagens de raios gama e do tempo decorrido da injeção do radiofármaco até a cirurgia, constituíram-se dois grupos para análise, o grupo dia (27 casos) e o grupo outro dia (20 casos), que se mostraram diferentes, com significância estatística, tanto no tempo decorrido quanto nas contagens de raios gama, porém sem interferência nos resultados de detecção do LNS. A associação do probe e do corante azul resultou em sucesso nos 53 casos avaliados, assim como em 32 dos 35 casos em que só o corante foi usado. A média de idade das pacientes foi 58 anos. Quarenta e uma pacientes tiveram linfonodos axilares com metástase e apenas duas com LNS falsamente negativo, dando sensibilidade de 95,3 por cento, VPN de 95,5 por cento e acurácia de 97,6. Conclusões: o mapeamento do LNS é factível tanto com o uso do tecnécio, aplicado com intervalo variável de 3:00 a 17:00 horas, quanto com o azul vital. Com a associação dos métodos a eficácia foi de 100 por cento. A confirmação histopatológica, em 97,6 por cento dos LNS negativos, torna real a possibilidade de evitar a linfadenectomia nestes casos