Efficacy of Ketoprofen With or Without Omeprazole for Pain And Inflammation Control After Third Molar Removal.

In view of the gastrointestinal problems generated by the ketoprofen use, the ketoprofen association with omeprazole is available on the market. However, this association efficacy in acute pain control has not been established. Bilateral extraction of lower third molars in similar positions is currently the most used model for the evaluation and investigation of the efficacy and pharmacological effects of new compounds for the treatment of acute postoperative pain. The randomized and crossover study consisted in evaluating the clinical efficacy of therapy performed by ketoprofen 100 mg (twice daily-b.i.d.) versus ketoprofen 200 mg + omeprazole 20 mg (once daily-q.d.) to pain, swelling and trismus control in the bilateral extraction model of lower third molars in similar positions in two different appointments, in 50 volunteers. Volunteers reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study when they took the combination of ketoprofen 200 mg + omeprazole 20 mg (q.d.). Following administration of both study drugs, no gastrointestinal adverse reactions were reported by volunteers. Furthermore, the evaluations of the drugs in pain control by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg (q.d.). For swelling and trismus control, the treatments presented similar results. In conclusion, when volunteers took ketoprofen 200 mg + omeprazole 20 mg (q.d.), they reported significantly less postoperative pain at various post-surgical periods and consumed less rescue analgesic medication throughout the study compared with ketoprofen 100 mg (b.i.d).

IMPACT OF VITAMIN D AND CALCIUM DEFICIENCY IN THE BONES OF PATIENTS UNDERGOING BARIATRIC SURGERY: A SYSTEMATIC REVIEW.

Introduction: Bariatric surgery is considered the most effective tool in the control and treatment of severe obesity, but patients undergoing this procedure are at increased risk of developing nutritional deficiencies by limiting the intake and absorption of many nutrients. Objective: To assess the impact of vitamin D deficiency and calcium in bone in patients after gastric bypass in Roux-en-Y, pointing directly at the type of administration, doses and effects after surgery. Method: Was conducted a systematic review with articles related to the topic of the last 10 years searched in PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo and Cochrane using the headings "bariatric surgery", "bone", "obesity", "vitamin D '', "calcium" AND "absorption". Exclusion criteria to research on animals, smokers, pregnant women and patient treated with bisphosphonates. Results: Five articles were included in this review. All refer that bariatric surgery can lead to nutritional deficiencies and poor absorption of fats and fat-soluble vitamins and other micronutrients such as calcium. Conclusion: Patients submitted to RYGB should make use of multivitamins and minerals especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment and control of risk factors are essential to prevent complications after this operation.

Introdução: A cirurgia bariátrica é considerada o tratamento mais eficaz no controle e tratamento da obesidade severa; porém, indivíduos submetidos a este procedimento apresentam maior risco de desenvolver deficiências nutricionais pela limitação na ingestão e absorção de muitos nutrientes. Objetivo: Avaliar o impacto da deficiência de vitamina D e do cálcio ósseo de pacientes após gastroplastia em Y-de-Roux, relacionando tipo de administração, dose e efeito pós-cirúrgico. Método: Realizou-se revisão sistemática com artigos relacionados ao tema dos últimos 10 anos e pesquisados na PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo e Cochrane usando os descritores "bariatric surgery", "bone", "obesity", " vitamin D'', "calcium'' AND "absortion". Foram excluídos os estudos em animais, fumantes, grávidas ou gestantes e indivíduos que ingeriram bisfosfonatos. Resutados: Foram incluídos ao final cinco artigos. Todos referem que a cirurgia bariátrica pode levar à deficiências nutricionais como má absorção de gorduras, vitaminas lipossolúveis, micronutrientes e cálcio. Conclusão: Os pacientes submetidos ao RYGB devem fazer uso de polivitamínicos e minerais principalmente a vitamina D e o cálcio para evitar fraturas ósseas. Monitoramento, tratamento e controle dos fatores de risco são essenciais para prevenir estas complicações após a operação.

Comparação da eficácia clínica do cetoprofeno, associado ou não ao omeprazol, no controle da dor, edema e trismo em exodontias de terceiros molares inferiores / Comparison of the clinical efficacy of ketoprofen, associated or not with omeprazole, in the control of pain, swelling and trismus in lower third molar removal

A prescrição do cetoprofeno pode gerar reações adversas, como por exemplo, problemas gastrintestinais. Devido a este fato há disponível no mercado a associação do cetoprofeno com omeprazol. Porém, a eficácia desta associação no controle agudo da dor ainda não foi estabelecida. Portanto, nos propusemos a avaliar a eficácia clínica da terapia realizada com comprimidos de cetoprofeno 100 mg duas vezes ao dia versus a terapia realizada com o cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, ambos administrados durante 4 dias, por via enteral, no controle da dor, edema e trismo no modelo de extração bilateral de terceiros molares inferiores em posições semelhantes e em dois momentos cirúrgicos distintos. Este estudo randomizado, duplo-cego e cruzado foi composto por 50 voluntários com idade média de 24 ± 5 anos. Foi utilizado o teste t pareado para os dados paramétricos expressos em média ± desvio padrão e o teste de Wilcoxon para os dados não paramétricos expressos em mediana ± intervalo interquartil. O nível de significância adotado foi de 5%. Quando os voluntários utilizaram cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia, relataram significativamente menos dor em vários períodos pós-cirúrgicos e consumiram menos medicação de socorro (paracetamol 750 mg) em comparação a quando utilizaram cetoprofeno 100 mg duas vezes ao dia. Além disso, as avaliações dos medicamentos no controle da dor pós-cirúrgica por parte dos voluntários foram significativamente mais favoráveis à combinação cetoprofeno 200 mg + omeprazol 20 mg. Para o controle do edema e trismo, os tratamentos farmacológicos apresentaram resultados semelhantes. Após a análise dos resultados concluímos que cetoprofeno 200 mg + omeprazol 20 mg uma vez ao dia apresentou melhores resultados no controle da dor após extrações de terceiros molares inferiores quando comparado ao cetoprofeno de 100 mg duas vezes ao dia.(AU)

In view of the gastrointestinal problems generated by the use of ketoprofen, the association of ketoprofen with omeprazole is available on the market. However, the efficacy of this association in the acute control of pain has not been established. Therefore, the objective of the present study was to evaluate the clinical efficacy of therapy performed with ketoprofen 100 mg twice daily versus therapy performed with ketoprofen 200 mg + omeprazole 20 mg once daily, both administered enterally to control pain, swelling and trismus in the bilateral extraction model of lower third molars in similar positions in two different appointments. The present randomized, double-blind, crossover study consisted of 50 volunteers with a mean age of 24 ± 5 years. The paired t test was used for the parametric data expressed as mean ± standard deviation and the Wilcoxon test for non-parametric data expressed as median ± interquartile range. The level of significance was 5%. When volunteers took ketoprofen 200 mg + omeprazole 20 mg once daily, they reported significantly less postoperative pain at various post-operative periods and consumed less rescue analgesic medication (acetaminophen 750 mg) throughout the study compared to ketoprofen 100 mg twice daily. In addition, the evaluations of the drugs in the control of postoperative pain by the volunteers were significantly favorable to ketoprofen 200 mg + omeprazole 20 mg once daily as compared with ketoprofen twice daily. For the control of swelling and trismus, the treatments presented similar results. Therefore, it can be concluded that ketoprofen 200 mg + omeprazole 20 mg once daily presented better results in postoperative pain control after extractions of the lower third molars when compared to ketoprofen 100 mg twice daily.(AU)

IMPACT OF VITAMIN D AND CALCIUM DEFICIENCY IN THE BONES OF PATIENTS UNDERGOING BARIATRIC SURGERY: A SYSTEMATIC REVIEW / IMPACTO DA DEFICIÊNCIA DA VITAMINA D E CÁLCIO EM OSSOS DE PACIENTES SUBMETIDOS À CIRURGIA BARIÁTRICA: UMA REVISÃO SISTEMÁTICA

ABSTRACT Introduction: Bariatric surgery is considered the most effective tool in the control and treatment of severe obesity, but patients undergoing this procedure are at increased risk of developing nutritional deficiencies by limiting the intake and absorption of many nutrients. Objective: To assess the impact of vitamin D deficiency and calcium in bone in patients after gastric bypass in Roux-en-Y, pointing directly at the type of administration, doses and effects after surgery. Method: Was conducted a systematic review with articles related to the topic of the last 10 years searched in PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo and Cochrane using the headings "bariatric surgery", "bone", "obesity", "vitamin D '', "calcium" AND "absorption". Exclusion criteria to research on animals, smokers, pregnant women and patient treated with bisphosphonates. Results: Five articles were included in this review. All refer that bariatric surgery can lead to nutritional deficiencies and poor absorption of fats and fat-soluble vitamins and other micronutrients such as calcium. Conclusion: Patients submitted to RYGB should make use of multivitamins and minerals especially vitamin D and calcium to prevent bone fractures. Monitoring, treatment and control of risk factors are essential to prevent complications after this operation.

RESUMO Introdução: A cirurgia bariátrica é considerada o tratamento mais eficaz no controle e tratamento da obesidade severa; porém, indivíduos submetidos a este procedimento apresentam maior risco de desenvolver deficiências nutricionais pela limitação na ingestão e absorção de muitos nutrientes. Objetivo: Avaliar o impacto da deficiência de vitamina D e do cálcio ósseo de pacientes após gastroplastia em Y-de-Roux, relacionando tipo de administração, dose e efeito pós-cirúrgico. Método: Realizou-se revisão sistemática com artigos relacionados ao tema dos últimos 10 anos e pesquisados na PubMed (US National Library of Medicine National Institutes of Health, Medline, Lilacs, Scielo e Cochrane usando os descritores "bariatric surgery", "bone", "obesity", " vitamin D'', "calcium'' AND "absortion". Foram excluídos os estudos em animais, fumantes, grávidas ou gestantes e indivíduos que ingeriram bisfosfonatos. Resultados: Foram incluídos ao final cinco artigos. Todos referem que a cirurgia bariátrica pode levar à deficiências nutricionais como má absorção de gorduras, vitaminas lipossolúveis, micronutrientes e cálcio. Conclusão: Os pacientes submetidos ao RYGB devem fazer uso de polivitamínicos e minerais principalmente a vitamina D e o cálcio para evitar fraturas ósseas. Monitoramento, tratamento e controle dos fatores de risco são essenciais para prevenir estas complicações após a operação.

Class III Malocclusion Surgical-Orthodontic Treatment.

The aim of the present case report is to describe the orthodontic-surgical treatment of a 17-year-and-9-month-old female patient with a Class III malocclusion, poor facial esthetics, and mandibular and chin protrusion. She had significant anteroposterior and transverse discrepancies, a concave profile, and strained lip closure. Intraorally, she had a negative overjet of 5 mm and an overbite of 5 mm. The treatment objectives were to correct the malocclusion, and facial esthetic and also return the correct function. The surgical procedures included a Le Fort I osteotomy for expansion, advancement, impaction, and rotation of the maxilla to correct the occlusal plane inclination. There was 2 mm of impaction of the anterior portion of the maxilla and 5 mm of extrusion in the posterior region. A bilateral sagittal split osteotomy was performed in order to allow counterclockwise rotation of the mandible and anterior projection of the chin, accompanying the maxillary occlusal plane. Rigid internal fixation was used without any intermaxillary fixation. It was concluded that these procedures were very effective in producing a pleasing facial esthetic result, showing stability 7 years posttreatment.