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OBJECTIVE: To assess the diagnostic validity of ICDAS clinical criteria on 3D dental models from intraoral scanning. METHODS: This is a retrospective analysis on part of the baseline sample collected in a cohort study and included 73 participants (12-19 years) from Denmark and Greece. The assessment was made by visual inspection, and then by visual inspection associated with radiographs. All participants were scanned with TRIOS 4 which uses white light to obtain the 3D models with tooth color, as well as blue light source (415 nm) for fluorescence. The 3D models' evaluation was conducted using tooth-color texture and subsequently fluorescence. Two scores were obtained for the 3D model examination: i) ICDAS based on tooth-color information; ii) ICDAS based on tooth-color information supplemented with fluorescence. For the analysis, weighted kappa, sensitivity (SE), specificity (SP) and accuracy (ACC) were calculated. RESULTS: Regarding all lesions the values for SE, SP, and ACC were respectively 0.804, 0.801, and 0.802 for tooth-color, and 0.819, 0.808, and 0.810 for tooth-color supplemented with fluorescence. In terms of accuracy parameters for moderate-extensive lesions, the values for SE, SP, and ACC for tooth color were 0.709, 0.948, and 0.944, while for fluorescence they were 0.815, 0.937, and 0.934. CONCLUSION: Caries assessment with ICDAS criteria on 3D dental models produces reliable scores. Visual caries analysis using 3D models demonstrates commendable diagnostic accuracy and reasonable consistency with traditional methods. The use of intraoral scanners may be beneficial in evaluating occlusal caries. CLINICAL SIGNIFICANCE: The importance of this study is to prove the diagnostic accuracy of caries lesions diagnosis made using and intraoral scanner and to offer greater confidence to professionals who use this diagnosis tool in their daily clinical practice. Intraoral scanners demonstrate to be an accurate tool for diagnosing occlusal caries.
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Introduction The International Caries Classification and Management System (ICCMS) was developed to standardise caries diagnosis, risk assessment and treatment decisions based on overall evidence. To evaluate its criteria in practice, a clinical trial assessed professionals' perceptions of two caries management systems.Methods A perception questionnaire was administered to two groups: one using ICCMS criteria and the other based on professional experience criteria (non-ICCMS group). The online questionnaire included quantitative scale questions to measure effort and satisfaction and two open-ended questions to collect the positive and negative perceptions of dentists by using either criteria system. The questionnaires were administered six months after the study's implementation.Results Both groups showed high levels of effort and satisfaction. Professionals using ICCMS reported more positive perceptions by citing improved diagnosis (71.4%) and standardised patient care (43%). However, they also noted negative aspects, such as increased number of questionnaires and records (58%), longer clinical sessions (43%) and higher rates of patient absenteeism (29%).Conclusion Professionals who used the ICCMS had a positive outlook on the system, with benefits seen in diagnosis and patient monitoring. However, there is room for improvement in terms of automation and simplification to enhance the professional use of the system in the clinical setting.
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Background: Patients with hematological malignancies (HM) frequently present thrombocytopenia and higher risk of bleeding. Although transfusion is associated with higher risk of adverse events and poor outcomes, prophylactic transfusion of platelets is a common practice to prevent hemorrhagic complications. Thromboelastometry has been considered a better predictor for bleeding than isolated platelet counts in different settings. In early stages of sepsis, hypercoagulability may occur due to higher fibrinogen levels. Objectives: To evaluate the behavior of coagulation in patients with HM who develop sepsis and to verify whether a higher concentration of fibrinogen is associated with a proportional increase in maximum clot firmness (MCF) even in the presence of severe thrombocytopenia. Methods: We performed a unicentric analytical cross-sectional study with 60 adult patients with HM and severe thrombocytopenia, of whom 30 had sepsis (sepsis group) and 30 had no infections (control group). Coagulation conventional tests and specific coagulation tests, including thromboelastometry, were performed. The main outcome evaluated was MCF. Results: Higher levels of fibrinogen and MCF were found in sepsis group. Both fibrinogen and platelets contributed to MCF. The relative contribution of fibrin was significantly higher (60.5 ± 12.8% vs 43.6 ± 9.7%; P < .001) and that of platelets was significantly lower (39.5 ± 12.8% vs 56.4 ± 9.7%; P < .001) in the sepsis group compared with the control group. Conclusion: Patients with sepsis and HM presented higher concentrations of fibrinogen than uninfected patients, resulting in greater MCF amplitudes even in the presence of thrombocytopenia.
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The aim of this manuscript is to describe a hybrid care model to paediatricpatients on a virtual basis for dental treatment before conducting an in-person surveillance by using combined nasal/oral swabbing (NOS).This longitudinal study used a convenience sample of paediatric patients and members of the dental team from an undergraduate paediatric dentistry clinic at the University of São Paulo School of Dentistry during the COVID-19 pandemic. Firstly, parents werecontacted and teledentistry was used for screening children who need dental treatment. Appointments were scheduled once a week for two months, in which a pre-COVID-19 screening was performed. Dental team and children's parents completed a questionnaire addressing COVID-19-related symptoms. Members of the dental team and children were tested for COVID-19 before entering the dental clinic, by NOS and RT-PCR screening.Ninety-three individuals were enrolled and all of them completed the electronic questionnaire on symptoms and had NOS collected weekly, totalising 241 pairs of swabs. No participant reported COVID-19 symptomsbefore entering the clinic for treatment. Only one child tested positive in the third week of sampling. The hybrid care model associated with molecular testing for asymptomatics provided a safe clinical environment regarding the transmission of SARS-CoV-2 (AU).
El propósito de este manuscrito es describir un modelo híbrido de atención odontológica, a través de una plataforma virtual que precede a la realización de vigilancia molecular presencial mediante hisopado nasal/oral combinado, en pacientes pediátricos. Eneste estudio longitudinal se utilizó una muestra de conveniencia de pacientes pediátricos y miembros del equipo odontológico en la clínica de pregrado de la Facultad de Odontología de la Universidade de São Paulo durante la pandemia de COVID-19. En primerlugar, se contactó con los padres y se utilizó la consulta virtual para seleccionar a los niños que requerían tratamiento odontológico. Se programaron citas una vez a la semana durante dos meses, en las que se realizó el cribado previo a COVID-19. El equipo dental y los padres de los niños rellenaron un cuestionario en el que se abordaban los síntomas relacionados con la COVID-19. A continuación, los miembros del equipo dental y los niños fueron sometidos a pruebas de detección de COVID-19 antes de entrar en la clínica para atendimiento mediante cribado con hisopo nasal/oral y RT-PCR. Se inscribieron 93 personas, todas las cuales cumplimentaron el cuestionario electrónico sobre síntomas y se les recogieron muestras semanalmente, con un total de 241 pares dehisopos. Ningún participante declaró síntomas de COVID-19 antes de entrar en la clínica para recibir tratamiento. Sólo un niño dio positivo en la tercera semana de toma de muestras. El modelo de tratamiento híbrido unido a las pruebas moleculares para asintomáticos proporcionó un entorno clínico seguro con respecto a la transmisión del SARS-CoV-2 (AU).
O objetivo deste manuscrito é descrever um modelo de atendimento odontológico híbrido, por meio de uma plataforma virtual anterior a realização de uma vigilância molecular presencial usando esfregaço combinado nasal/oral, em pacientes pediátricos. Este estudo longitudinal utilizou uma amostra de conveniência de pacientes pediátricos e membros da equipe odontológica na clínica de graduação da Faculdade de Odontologia da Universidade de São Paulo durante a pandemia COVID-19. Primeiro, os pais foram contactados e a consulta virtual foi utilizada para o rastreio de crianças que necessitavam de tratamento odontológico. Foram agendadas consultas uma vez por semana durante dois meses, nas quais foi realizado um rastreio pré-COVID-19. A equipe odontológica e os pais das crianças preencheram um questionário que abordava os sintomas relacionados com a COVID-19. Em sequência, os membros da equipe odontológica e as crianças foram testados para o COVID-19 antes de entrarem na clínica para atendimento, através do rastreio com esfregaço nasal/oral e RT-PCR. Noventa e três indivíduos foram inscritos e todos eles preencheram o questionário eletrônico sobre os sintomas e tiveram amostras coletadas semanalmente, totalizando 241 pares de cotonetes. Nenhum participante comunicou sintomas de COVID-19 antes de entrar na clínica para tratamento. Apenas uma criança testou positivo na terceira semana de amostragem. O modelo de tratamento híbrido associado a testes moleculares para assintomática proporcionou um ambiente clínico seguro no que diz respeito à transmissão da SARS-CoV-2 (AU).
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Surveys and QuestionnairesABSTRACT
To evaluate the feasibility of performing needle arthroscopy of the scapulohumeral joint and bicipital bursa in standing horses by using the thoracic limbs of euthanized horses. To that purpose, this experimental study was designed. Ten thoracic limbs, five left and five right from euthanized horses were retained in an upright position to simulate a standing horse. The craniolateral and lateral scapulohumeral arthroscopic portals were used to access the articular structures. A third (caudal) portal was also identified and described. The degree of difficulty in accessing the articular space and the optic maneuverability within the joint were compared between portals. The needle arthroscopy image lacks in quality, but the procedure was considered useful as a diagnostic aid for examination of the scapulohumeral joint of horses. Needle arthroscopy of the bicipital bursa was not possible. Needle arthroscopy has a great diagnostic potential for lesions in the scapulohumeral joint of horses. A new access (caudal) to the scapulohumeral joint of horses has been identified.
Subject(s)
Arthroscopy , Shoulder Joint , Animals , Arthroscopy/veterinary , Bursa, Synovial/surgery , Euthanasia, Animal , Forelimb/surgery , HorsesABSTRACT
Venomous snakebites are relatively rare in Portugal. Pediatric victims present with greater severity and are at risk of fatal complications. Clinical management protocols are the gold standard of care worldwide. We report two cases of venomous adder bites in pediatric patients. Based on a literature review we also discuss the clinical management and present a treatment protocol that ensures multidisciplinary and updated practice by medical teams.
A mordedura de ofídio venenoso é uma situação rara em Portugal. Quando ocorre em idade pediátrica apresenta maior gravidade e risco de complicações fatais. A actuação protocolada constitui o gold standard of care nos centros internacionais. Neste artigo apresentamos dois casos clínicos de mordedura de ofídio venenoso em idade pediátrica. Baseados na literatura actual, discutimos a actuação clínica tomada e expomos uma proposta de protocolo de actuação hospitalar que visa uma intervenção multidisciplinar e actualizada das equipas médicas envolvidas.
Subject(s)
Snake Bites/diagnosis , Snake Bites/therapy , Adolescent , Child , Clinical Protocols , Emergency Treatment , Hospitals , Humans , MaleABSTRACT
As minifábricas de beneficiamento de amêndoa de castanha de caju participam de forma significativa na geração de renda nos estados nordestinos, absorvendo grande quantidade de mão-de-obra. Ganhos importantes, tanto qualitativos, quanto quantitativos do produto final, ocorrem em relação à grande empresa (indústria tradicional). Contudo, isto se deve ao processamento manual da amêndoa. Teve como objetivo avaliar as características microbiológicas de etapas e produtos de minifábrica. Constatou-se que os produtos apresentam níveis baixos de contaminantes microbiológicos sendo, assim, adequados à comercialização; entretanto, o processo ainda deve sofrer pequenos ajustes para aumentar a qualidade dos produtos.