Percepção profissional sobre tratamento endodôntico em sessão única e múltiplas sessões / Professional perception of single and multi-session endodontic treatment

Na odontologia a decisão do tratamento é exclusiva dos cirurgiões dentistas e suas percepções, incluindo filosofia de tratamento, fazendo com que a prática de novos conceitos, tratamentos ou técnicas dependam não apenas de sua lógica ou eficácia biológica. Sendo assim, este estudo teve como objetivo avaliar os parâmetros envolvidos na tomada de decisão de cirurgiões dentistas clínicos e especialistas para a realização do tratamento endodôntico em sessão única ou múltiplas sessões. Para tanto, este estudo contou com uma coleta de dados através de um questionário online, aplicado cirurgiões dentistas clínicos gerais e especialistas em endodontia. As respostas foram tabuladas e analisadas por meio de estatística descritiva. Os resultados revelaram que a maioria dos endodontistas e dos clínicos gerais prefere realizar tratamento endodôntico em sessão única, devido ao menor desperdício de material, além do melhor domínio da anatomia e tratamento em um único momento. O motivo mais comum para os endodontistas e clínicos gerais escolherem o tratamento com múltiplas visitas é para dentes com prognóstico duvidoso e os casos em que o profissional aguarda a remissão dos sintomas antes da obturação. Em conclusão, a maioria dos endodontistas e dos clínicos gerais preferiu realizar tratamento endodôntico em sessão única.

In dentistry, treatment decisions are made exclusively by dental surgeons and their perceptions, including treatment philosophy, which means that the practice of new concepts, treatments or techniques depends not only on their logic or biological efficacy. Therefore, the aim of this study was to evaluate the parameters involved in clinical and specialist dental surgeons' decision to carry out endodontic treatment in single or multiple sessions. To this end, data was collected using an online questionnaire administered to general dental surgeons and endodontic specialists. The answers were tabulated and analyzed using descriptive statistics. The results revealed that the majority of endodontists and general practitioners prefer to carry out endodontic treatment in a single session, due to less wastage of material, as well as better mastery of the anatomy and treatment at a single time. The most common reason for endodontists and general practitioners to choose treatment with multiple visits is for teeth with a doubtful prognosis and cases in which the professional is waiting for symptoms to remit before filling. In conclusion, the majority of endodontists and general practitioners preferred to carry out endodontic treatment in a single session.

Effectiveness of a protocol with antimicrobial photodynamic therapy for treating osteoradionecrosis: a retrospective study.

OBJECTIVE: To compare the treatment of osteoradionecrosis (ORN) using a protocol that incorporates antimicrobial photodynamic therapy with a conventional treatment protocol. METHODOLOGY: This retrospective study analyzed 55 patients diagnosed with ORN at a reference hospital between 2002 and 2021. Patients were treated using two different clinical protocols. Clinical treatment success was defined as the epithelialization of the ORN lesion, along with the absence of pain and local infection. RESULTS: A total of 53 ORN lesions were included, with a median development time of 30 months. The patient cohort was predominantly male (83.02%), with a median age of 58 years. The main causes of ORN were prosthetic trauma (28.30%) and dental extractions due to infection (32.07%). Good oral hygiene and hygiene of the lesion were identified as protective factors for achieving clinical success, with a significant correlation to lesion epithelialization (p ≤ 0.0001). ORN developed more rapidly in tumors of the oral cavity, with a median time of 8 months, compared to oropharyngeal tumors, which had a median time of 39 months (p = 0.01). CONCLUSION: The proposed treatment protocol, which includes antimicrobial photodynamic therapy, demonstrated greater effectiveness compared to the conventional protocol, achieving clinical success in 75% of the lesions analyzed in a shorter timeframe (p ≤ 0.0001). Additionally, maintaining proper oral and lesion hygiene is crucial for successful outcomes, and ORN develops more rapidly in patients with oral cavity tumors.

Proposal for the implementation and monitoring of a health care nursing protocol for patients with external ventricular drains.

OBJECTIVE: To structure a proposal for implementing and monitoring the nursing care protocol for the safety of adult patients with external ventricular drains. METHOD: Descriptive exploratory research based on Implementation Science, with intentional sampling. Carried out in a hospital complex in southern Brazil, between May and December 2022, in four stages: online questionnaire on knowledge of care for patients with external ventricular shunt for nurses; matrix of proposed indicators with key actors; self-instructional online course for nurses; synthesis of the existing protocol. Contextualized instructional design was used to develop the course. RESULTS: Six nurses from the operating room and intensive care unit participated, identifying knowledge gaps, pointing out the need for specific training; four key actors in the neurosurgery service defined six indicators. An online course was created and made available on the platform of the institution with two modules, including eight videos. Protocol synthesis was adapted to the standards of the institution's quality sector. CONCLUSION: A report regarding the implementation of the nursing care protocol for patients with external ventricular drains was delivered for the nurse who was the technical responsible. Future studies should evaluate the implementation and impacts it will generate. This model can be adapted by other institutions.

Adaptation and implementation of a Nursing care protocol for children in the Amazon Region.

OBJECTIVES: to describe the process of implementing an adapted protocol for pediatric nursing care in a health unit located in a municipality in the Amazon Region. METHODS: methodological research conducted in a basic health unit with four family health teams in the state of Rondônia, involving seven nursing professionals. Data collection occurred between October 2020 and April 2022, following the research phases: situational diagnosis, exploratory phase, protocol definition, implementation, and evaluation. RESULTS: the outcome was the adaptation and implementation of a nursing care protocol for children. FINAL CONSIDERATIONS: the adaptation and implementation process can be an effective approach to improving care, strengthening nursing as a profession with a solid foundation in scientific and clinical evidence. This facilitates early problem identification and appropriate guidance, leading to better health outcomes for children.

Revisión narrativa sobre Comité de Tumores de Oncología Torácica / Narrative Review of Multidisciplinary Thoracic Tumor Board

Introducción: Un Comité de Tumores de Oncología Torácica (CTOT) es un equipo mul- tidisciplinario que revisa casos de pacientes, discute enfoques terapéuticos y desarro- lla planes personalizados, considerando el tipo de cáncer, estadio, condición general y preferencias del paciente individual. Objetivos: Actualizar la evidencia y ofrecer pautas para la implementación o mejora de los CTOT, analizando factores clave como la preparación, estructura, registro de datos y medición de resultados. Resultados: La revisión narrativa destaca que el CTOT se conforma de un núcleo básico de especialidades (oncológica torácica, neumonología, cirugía torácica, oncología radiante, radiología intervencionista, diagnóstico por imágenes, medicina nuclear y anatomía patológica) y un equipo extendido que puede eventualmente ser citado a de- manda (ej: trabajadora social, médicos de cabecera, paliativos). La frecuencia de las reuniones es generalmente semanal, en función del volumen de casos, con opciones presenciales, virtuales y/o híbridas. Una infraestructura adecuada es crucial para el funcionamiento correcto y eficiente, incluyendo protocolos para la selección y la presentación de casos, normas claras para la dinámica de reuniones, un proceso de toma de decisiones basado en respeto y comunicación, y un sistema de documentación que garantice la confidencialidad. Además, se subraya la importancia de medir los resultados mediante indicadores de calidad. Conclusión: Un sistema eficiente en los CTOT permite la recopilación de datos y su uso en investigación y auditorías internas, lo que asegura un mejor manejo de los pacientes.

Introduction: A Thoracic Oncology Tumor Committee (CTOT) is a multidisciplinary team that reviews patient cases, discusses therapeutic approaches and develops personali- zed plans, considering the type of cancer, stage, general condition, and individual pa- tient preferences. Objectives: To update the evidence and provide guidelines for implementing or enhan- cing CTOTs, analyzing key factors including preparation, structure, data management and outcome evaluation. Results: The narrative review highlights that the CTOT is made up of a core group of specialties (thoracic oncology, pulmonology, thoracic surgery, radiation oncology, inter- ventional radiology, diagnostic imaging, nuclear medicine, and pathology) and an ex- tended team that may be called upon request (e.g., social worker, primary care physi- cians, palliative care). The frequency of meetings is generally weekly, depending on the volume of cases, with in-person, virtual, and/or hybrid options. An adequate infrastructure is crucial for proper and efficient functioning, including pro- tocols for case selection and presentation, clear rules for meeting dynamics, a deci- sion-making process based on respect and communication, and a documentation sys- tem that guarantees confidentiality. In addition, the importance of measuring results through quality indicators is stressed. Conclusion: An efficient system in CTOTs allows data collection and its use in research and internal audits, ensuring better patient management.

Protocolos para Avaliação Miofuncional Orofacial para Fissura Labiopalatina: revisão sistemática / Orofacial myofunctional assessment protocols for cleft lip and palate: systematic review / Protocolos de evaluación miofuncional orofacial para labio y paladar hendido: revisión sistemática

Introdução: Fissuras Labiopalatinas são malformações congênitas que acometem os lábios e/ou o palato e, comprometem outras estruturas e funções orofaciais. As alterações miofuncionais orofaciais causadas pelas fissuras são particulares da malformação e requerem uma avaliação completa e específica do sistema estomatognático. Objetivo: verificar protocolos utilizados para avaliação miofuncional orofacial nas fissuras labiopalatinas e averiguar as variáveis específicas para avaliação junto a esta malformação. Métodos: Esta revisão sistemática seguiu as recomendações do "Preferred Reporting Items for Systematic Reviews and Meta-Analyses", aprovada pela COMPESQ da instituição de ensino e registrada na PROSPERO. A estratégia de busca da revisão foi guiada pela estratégia "PICO". As pesquisas foram realizadas nas seguintes bases de dados (entre 2010 e maio de 2020): MEDLINE (PubMed), LILACS, Web of Science, EMBASE, CINAHL e Scielo. Foram incluídos estudos observacionais transversais, estudos de coorte, de controle de casos e ensaios clínicos, com instrumentos para avaliação miofuncional orofacial para Fissuras Labiopalatinas e nos idiomas inglês, espanhol e português. Para avaliação da qualidade dos estudos observacionais foi utilizado o "Study Quality Assessment Tools". Resultados:Foram incluídos três artigos com protocolos de avaliação miofuncional orofacial junto à população com fissuras labiopalatinas. As variáveis consideradas como específicas na comparação dos protocolos, foram: os lábios, língua, dentes, bochechas, palato duro, mobilidade labial e lingual. Conclusão: Esta revisão sistemática identificou três protocolos de avaliação da Motricidade Orofacial para indivíduos com fissura labiopalatina, que focaram na avaliação das estruturas dos lábios, língua, palato mole e duro, bochechas, dentes, e na mobilidade labial e lingual. A comparação dos itens frequentes com o protocolo AMIOFE-A, indicou a ausência de variáveis essenciais, como: a classificação da FLP, características das cicatrizes, avaliação do frênulo lingual, quantidade de dentes, presença e aspecto da úvula e das tonsilas palatinas, mobilidade do palato mole e da faringe, além de aspectos específicos da fala e da função velofaríngea. Recomenda-se a criação de um instrumento abrangente que avalie funções, estruturas, mobilidade, tonicidade e sensibilidade orofacial. Isso auxiliaria na elaboração de planejamentos terapêuticos precisos e na melhoria da qualidade das pesquisas. Além disso, futuros estudos devem padronizar as faixas etárias das amostras para permitir comparações mais precisas e protocolos amplamente aplicáveis. (AU)

Introduction: Cleft Lip and Palate are congenital malformations that affect the lips and/or palate and compromise other orofacial structures and functions. The orofacial myofunctional alterations caused by clefts are specific to the malformation and require a comprehensive and specific evaluation of the stomatognathic system. Objective: The objective of this systematic review is to identify the orofacial myofunctional assessment protocols for cleft lip and palate and to verify the specific variables for the assessment of this malformation. Methods: This systematic review followed the recommendations of the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses", approved by the COMPESQ of the educational institution and registered in PROSPERO. The search strategy for the review was guided by the "PICO" strategy. Searches were conducted in the following databases (between 2010 and May 2020): MEDLINE (PubMed), LILACS, Web of Science, EMBASE, CINAHL, and Scielo. Cross-sectional observational studies, cohort studies, case-control studies, and clinical trials were included, with instruments for orofacial myofunctional evaluation for cleft lip and palate in English, Spanish, and Portuguese languages. The "Study Quality Assessment Tools" were used to assess the quality of observational studies. Results: Three articles with protocols for orofacial myofunctional evaluation among the population with cleft lip and palate were included. The variables considered specific in the comparison of protocols were lips, tongue, teeth, cheeks, hard palate, labial, and lingual mobility. Conclusion: This systematic review identified three orofacial myofunctional assessment protocols for individuals with cleft lip and palate, focusing on the evaluation of the structures of the lips, tongue, soft and hard palate, cheeks, teeth, and labial and lingual mobility. The comparison of frequent items with the AMIOFE-A protocol indicated the absence of essential variables such as: FLP classification, scar characteristics, evaluation of the lingual frenulum, number of teeth, presence and appearance of the uvula and palatine tonsils, mobility of the soft palate and pharynx, as well as specific aspects of speech and velopharyngeal function. It is recommended to create a comprehensive instrument that assesses orofacial functions, structures, mobility, tonicity, and sensitivity. This would aid in the development of precise therapeutic plans and improve the quality of research. Furthermore, future studies should standardize the age ranges of samples to allow for more accurate comparisons and widely applicable protocols. (AU)

Introducción: La fisura labiopalatina es una malformación congénita que afecta a los labios y/o paladar y compromete otras estructuras y funciones orofaciales. Las alteraciones miofuncionales orofaciales causadas por las fisuras son específicas de la malformación y requieren una evaluación integral y específica del sistema estomatognático. Objetivo: Examinar los protocolos utilizados para la evaluación miofuncional orofacial en la fisura labiopalatina e investigar variables específicas para la evaluación en esta malformación. Métodos: Esta revisión sistemática siguió las recomendaciones de los "Preferred Reporting Items for Systematic Reviews and Meta-Analyses", aprobadas por el COMPESQ de la institución educativa y registradas en PROSPERO. La estrategia de búsqueda para la revisión fue guiada por la estrategia "PICO". Las búsquedas se realizaron en las siguientes bases de datos (entre 2010 y mayo de 2020): MEDLINE (PubMed), LILACS, Web of Science, EMBASE, CINAHL y Scielo. Se incluyeron estudios observacionales transversales, estudios de cohortes, estudios de casos y controles, y ensayos clínicos, con instrumentos para la evaluación miofuncional orofacial para la fisura labiopalatina en inglés, español y portugués. Se utilizaron las "Herramientas de Evaluación de la Calidad del Estudio" para evaluar la calidad de los estudios observacionales. Resultados: Se incluyeron tres artículos con protocolos para la evaluación miofuncional orofacial entre la población con fisura labiopalatina. Las variables consideradas específicas en la comparación de los protocolos fueron: labios, lengua, dientes, mejillas, paladar duro, movilidad labial y lingual. Conclusión: Esta revisión sistemática identificó tres protocolos de evaluación miofuncional orofacial para individuos con fisura labiopalatina, que se centraron en la evaluación de las estructuras de los labios, la lengua, el paladar blando y duro, las mejillas, los dientes y la movilidad labial y lingual. La comparación de los ítems frecuentes con el protocolo AMIOFE-A indicó la ausencia de variables esenciales, tales como: clasificación de FLP, características de las cicatrices, evaluación del frenillo lingual, cantidad de dientes, presencia y aspecto de la úvula y las amígdalas palatinas, movilidad del paladar blando y la faringe, además de aspectos específicos del habla y de la función velofaríngea. Se recomienda la creación de un instrumento integral que evalúe funciones orofaciales, estructuras, movilidad, tonicidad y sensibilidad. Esto ayudaría en la elaboración de planes terapéuticos precisos y en la mejora de la calidad de la investigación. Además, los estudios futuros deben estandarizar los rangos de edad de las muestras para permitir comparaciones más precisas y protocolos ampliamente aplicables. (AU)

[Implementation of an Early Discharge Protocol in Patients with ST-Segment Elevation Myocardial Infarction]. / Implementación de un protocolo de alta precoz en pacientes con infarto agudo al miocardio con supradesnivel del ST.

Clinical guidelines do not clearly define hospitalization time after primary angioplasty in ST-segment elevation myocardial infarction (STEMI). The hospitalization time should be tailored according to risk stratification. AIM: Evaluation of a local early discharge protocol to identify low-risk patients after primary angioplasty. METHODS: A local protocol was applied to all patients admitted to Las Higueras Hospital after primary angioplasty in the context of STEMI from the Health Service of Talcahuano (Those belonging to other Health Services were excluded). Those who met the established criteria were discharged < 48 hours. Clinical variables, comorbidities, angiographic characteristics, and the procedure, as well as intraoperative complications, mortality, and hospital readmission up to 6 months, were analyzed. RESULTS: A total of 51 patients were identified, with a mean age of 59.5 years and 25% female. The mean ischemia time was 5.5 hours with a risk profile that showed a mean GRACE score of 106 and a Zwolle risk score of 1.7. The mean length of stay was 1.7 days (40.8 h). There was only 1 readmission and no mortality events were registered up to 6 months of follow-up. CONCLUSION: The application of a protocol for early discharge after primary angioplasty allowed for shorter hospital stays without compromising patient safety in the medium term.

Multidisciplinary team training in postpartum hemorrhage: impact on the use of blood products.

Objective: Compare the number of puerperal women submitted to blood transfusion before and after the implementation of a care protocol for postpartum hemorrhage (PPH) with multidisciplinary team training. Methods: Cross-sectional study in a university hospital, analyzing births from 2015 to 2019, compared the use of blood products before and after the adoption of a PPH protocol with multidisciplinary training. Results: Between 2015 and 2019, there were 17,731 births, with 299 (1.7%) postpartum women receiving blood products and 278 postpartum women were considered for this analysis, 128 (0.7%) at Time 1 and 150 (0.8%) at Time 2. After the multiprofessional team training (T2), there was a difference in the complete use of the PPH protocol (use of oxytocin, misoprostol and tranexamic acid) (T1 = 5.1% x T2 = 49.5%, p≤0.0001). An individual categorized analysis revealed that, in the T2 period, there was lower use of blood component units per patient compared to T1 (Mann-Whitney, p=0.006). It should be noted that at T1 and T2, 54% and 24% respectively received two units of blood products. It is important to highlight that after the multidisciplinary team training for the PPH protocol, the goal of zero maternal death due to hemorrhage was reached. Conclusion: The adoption of a specific protocol for PPH, combined with the training of a multidisciplinary team, had an impact on the ability to identify women at high risk of hemorrhage, resulting in a decrease in the use of blood components.

Implementation of Basic Patient Safety Protocols: a quality improvement project.

OBJECTIVE: To analyze the effect of an improvement project on the implementation of Basic Patient Safety Protocols in Brazilian public hospitals. METHOD: This is an intervention study aimed at comparing measurements before-and-after the implementation of an improvement project in 35 public hospitals across three Brazilian regions, between July 2021 and September 2023. The intervention consisted of a set of activities to support the implementation of six Basic Patient Safety Protocols, with semimonthly collection of indicators. The data were analyzed using descriptive statistics, with the use of trend charts to demonstrate improvements, considering the first seven collection points as the baseline for comparisons. RESULTS: After the intervention period, all Patient Safety Protocols showed improvements in their indicators. The prevention of falls and safe surgery stood out, with a 73% reduction in prevalence and a 675% increase in adherence to the safe surgery checklist, respectively, compared to the group of hospitals. CONCLUSION: The improvement project had a positive effect on patient safety in the institutions, evidenced by the improvement in indicators of all analyzed protocols.

Structured respiratory physiotherapy protocol for resolution of atelectasis in pediatric intensive care.

Children are at higher risk of atelectasis due to their anatomical and physiological particularities. Several physiotherapy techniques are used to treat atelectasis, but only four studies cite methods in pediatric patients undergoing Invasive Mechanical Ventilation (IMV). The objective of this study was to evaluate the Structured Respiratory Physiotherapy Protocol (SRPP) for airway clearance and lung reexpansion for infants on IMV with atelectasis. This is a prospective study including 30 infants (mean ± standard deviation age 8.9 ± 8.0 months; weight 7.5 ± 3.0 kg; BMI 15.8 ± 1.6 kg/cm2 and IMV duration 7.7 ± 4.3 days). The sample was randomized into a Control Group (CG), which received routine physiotherapy, and an Intervention Group (IG), submitted to SRPP (postural drainage, mechanical thoracic vibration, manual hyperinflation, stretching of the accessory respiratory muscles, and functional positioning). Both groups were evaluated before and after physiotherapy for respiratory effort using the Wood Downes Score (WD) and pulmonary aeration using lung ultrasonography (Lung Ultrasound Score ‒ LUS). The outcome of the intervention was evaluated by the magnitude of the effect by the Hedges' g test [(small (0.2 < Hedges' g < 0.5), moderate (0.5 < Hedges' g < 0.8) and large (Hedges' g > 0.8) effects]. There were large within-group effects on the reduction of WD in the CG after intervention in both the CG (Hedges' g = -1.53) and IG (Hedges' g = -2.2). There was a moderate effect on LUS reduction in the CG (Hedges' g = -0.64) and a large effect on IG (Hedges' g = -1.88). This study has shown that the SRPP appears to be safe and may be effective in improving airway clearance and lung reexpansion in children on IMV with atelectasis.

Decannulation protocol in pediatric patients: case series study.

OBJECTIVE: The aim of this study was to describe the phases of a decannulation protocol and the results from its application in hospitalized children. METHODS: This is a retrospective, observational study. Data were collected from medical records of decannulated patients followed up in a pediatric hospital in Belo Horizonte, Minas Gerais between 2011 and 2021. RESULTS: Among the children followed up in the service (n=526), 23% (n=120) were successfully decannulated. Children aged between 2 months and 16 years, with a mean age of 4 years, 69% of whom were male, were evaluated. About 75% of the patients have tracheostomy due to upper airway obstruction and 60% of these due to acquired subglottic stenosis. At the beginning of the decannulation protocol, 5.5% of the patients had moderate oropharyngeal dysphagia, while 80.4% had normal swallowing. Correction in the upper airway pre-decannulation was performed in 39.5% of the patients, dilation in 63.8%, and endoscopic correction was performed in 55.3%. After performing the decannulation, none of the patients had complications. CONCLUSIONS: The described decannulation protocol is safe, since no complications such as death and need for recannulation happened.

Prospective trial of a uniform protocol for managing infants with neurogenic bladder.

INTRODUCTION: Since the Management of Myelomeningocele Study (MOMS) publication in 2011 we have designed a prospective protocol for surveillance of neurogenic bladder according to the Leal da Cruz categorization system (J Urol, 2015) that guides us on treatment. Our institution was the precursor of in-utero myelomeningocele (MMC) in Latin America, so our database was biased mostly for patients that underwent fetal surgery for MMC closure. We have demonstrated that in-utero MMC closure does not improve bladder function in opposition to the data from the urological branch of the MOMS study (10), but our control group was based on a historical cohort, before the onset of in-utero MMC repair in our division (15) Since 2018, we have identified an increasing number of referrals of postnatal operated MMC patients to our group just for urological follow up. We decided then to start this prospective protocol for all neurogenic patients and provide a contemporary database to record differences in early bladder function, presence of hydronephrosis and vesicoureteral reflux, treatment, initial outcome and indication of surgery among three mains groups (in-utero MMC repair, post-natal repair and miscellaneous other cases of neurogenic bladder). We want to present preliminary data of this cohort in the period of time 2018 to 2023 (5 years). There was not an exclusion criteria, all patients with neuropathic bladder were included in this study. MATERIALS AND METHODS: We evaluated our database of all neurogenic bladder (NB) patients aged <1 year who started urological treatment in our institution from 2018. We evaluated diagnosis, age at first visit, clinical data, prevalence of hydronephrosis and (vesicoureteral reflux) VUR, bladder pattern according to the Leal da Cruz categorization system (1), treatment, time of follow-up, number of clinical visits and (urodynamic evaluation) UE performed, final bladder status and surgeries performed. RESULTS: We identified 43 were aged <1 year with a mean age of 4.5 months (median 3.5) at first urological appointment. Diagnosis was myelomeningocele in 33 patients and miscellaneous in 10. From the MMC group, 24 were operated in-utero and 9 post-natal. The initial bladder pattern in the whole group showed 23 (53.5%) high risk, 11 normal (25.6%), 5 underactive bladder (11.6%) and 4 incontinent (9.3%). Mean follow-up was 24 months, mean age at last UE (cases with minimum of 2): 37 months, mean UE per patient: 2. At present, 28 patients perform clean intermittent catheterization (CIC), 23 with anticholinergics and 15 are only under surveillance. VUR was seen in 11/43 cases: 25.6%. Urological surgery has been performed in 4 patients: bladder augmentation in 3 and vesicostomy in 1. Bladder categorization for high-risk and normal patterns were respectively 62.5% and 25% for in utero and 44.4% and 22.2% for postnatal repair and detailed statistical analysis did not present statistical significance of in utero and postnatal groups. CONCLUSION: Our study can conclude in a contemporary prospective study the findings of elevated incidence of high-risk patterns irrespectively of in-utero or post-natal repair (62.5% and 44.4%). We acknowledge that even though this is not new information and besides the still limited follow up, this cohort is one of the very few that follow and compare in one single institution with comparable UE for in-utero and post-natal MMC repair population, having also a miscellaneous group of NB as a pictorial report of also a similar initial distribution of bladder patterns. We plan to report in the future in a larger cohort the continuation of this study.

Hipersensibilidade dentária cervical: protocolo clínico de aplicação do DSP Gluhem Desensitizer™ / Cervical dentinary hypersensitivity: clinical protocol for the application of DSP Gluhem Desensitizer™

O objetivo do presente estudo foi estabelecer um protocolo clínico de aplicação do produto DSP Desensitizer Gluhem em dentes com exposição radicular sem perda de estrutura dentária, e fazer uma análise dissertativa sobre o principal componente desse produto: glutaraldeído, no tratamento da hipersensibilidade dentinária. Para isso, a paciente apresentou-se à Clínica Odontológica da UFF| Niterói ­ RJ, queixando-se de sensibilidade intensa ao frio nos elementos 13 e 34. Primeiramente, foram coletadas informações durante a anamnese, e ao exame clínico foi observada recessão gengival e exposição radicular nesses elementos, porém não havia perda de estrutura dentária. Inicialmente foi feita a avaliação do nível de dor, com uso da Escala Analógica de Dor que pontua os níveis de dor de 0 a 10, sendo 0 "nenhuma dor' e 10 "pior dor possível". Após o questionamento, fez-se a secagem da região com jato de ar e aplicou-se o dessensibilizante Gluhem em solução por toda região cervical do elemento 13 até a margem gengival por 40 segundos com posterior secagem e lavagem com água. Também foi feita a aplicação da formulação em gel no elemento 34 seguindo o mesmo protocolo. A paciente não reagiu a dor após o protocolo. Conclui-se que o produto DSP Gluhem tanto na apresentação de solução como em gel atuaram efetivamente na sintomatologia dolorosa da HDC nas duas aplicações realizadas.

The objective of the present study was to establish a clinical protocol for the application of the product GSP Desensitizer Gluhem in teeth with root exposure without loss of tooth structure, and to carry out a dissertation analysis on the main component of this product: glutaraldehyde, in the treatment of dentin hypersensitivity. For this, the patient went to the Dental Clinic of UFF| Niterói - RJ, complaining of intense sensitivity to cold in elements 13 and 34. First, information was collected during the anamnesis, and the clinical examination showed gingival recession and root exposure in these elements, but there was no loss of tooth structure. Initially, the pain level was evaluated using the Analog Pain Scale, which scores pain levels from 0 to 10, with 0 being "no pain" and 10 "worst possible pain". After questioning, the region was dried with an air jet and the desensitizing Gluhem solution was applied throughout the entire cervical region of element 13 up to the gingival margin for 40 seconds with subsequent drying and washing with water. The gel formulation was also applied to element 34 following the same protocol. The patient did not react to pain after the protocol. It is concluded that the product DSP Gluhem, both in solution and in gel presentation, effectively acted on the painful symptomatology of HDC in the two applications performed.

Tratamiento de queloides del pabellón auricular: protocolo diseñado y utilizado. Experiencia clínica / Treatment of keloids of the auricle: protocol designed and used. Clinical experience

El pabellón auricular es un blanco frecuente de cicatrices queloideas; es a su vez una de las patologías de más difícil tratamiento, con un alto porcentaje de recidiva que genera un gran desafío para los médicos que la convierten en uno de los problemas clínicos más desafi antes. El queloide de pabellón auricular es común en la población joven especialmente de sexo femenino, y ocasiona graves secuelas estéticas y psicológicas. A pesar de los múltiples tratamientos descritos en la literatura para manejar el queloide de pabellón auricular, no existe un consenso de tratamiento con evidencia científi ca que aporte una efi cacia que supere el 80%. Presentamos el protocolo de tratamiento del Hospital Privado de Rosario para los queloides de pabellón auricular en los últimos 5 años con terapia combinada en 18 pacientes y 23 pabellones auriculares (5 casos bilaterales) que consta de 4 etapas: 1era etapa, resección quirúrgica de la masa queloidea; 2da etapa, radioterapia (braquiterapia alta tasa de dosis) dentro de las primeras 6 horas posresección; 3era etapa, presoterapia entre 24-30 mmHg con lámina acrílica termomoldeable, aplicación de gel y lámina de silicona; y fi nalmente la 4ta etapa, a las 4 semanas con infi ltración intralesional con triamcinolona + 5-fl uorouracilo

The ear is a frequent target of keloid scars. It is diffi cult pathology to treat with a high percentage of recurrence that generates a great challenge for plastic surgeons. Keloids of the ears are common in young population, especially females, causing serious aesthetic and psychological sequelae. Despite the multiple treatments described in the literature to manage keloids, there is no consensus on treatment with scientifi c evidence that provides an effi - cacy that exceeds 80%. We present our treatment protocol in the Plastic Surgery Department at the Hospital Privado Rosario for ear keloids in the last 5 years. Our protocol was done in 18 patients and 23 ears (5 bilateral cases) consisting of 4 stages: 1st stage, surgical resection of the keloid mass; 2nd stage, radiotherapy stage (high dose rate brachytherapy) with in the fi rst 6 hours post-resection; 3rd stage, pressotherapy stage between 24-30 mmHg with thermo-moldable acrylic sheet, application of gel and silicone sheet; and fi nally the 4th stage at 4 weeks with intralesional infi ltration with triamcinolone + 5-fl uorouracil.

Maintaining accuracy and expanding access: evaluating the efficacy of the Botucatu Abbreviated Breast MRI Protocol.

Objective: Our study evaluated the effectiveness of the Botucatu Abbreviated Protocol in breast magnetic resonance imaging (MRI) within Brazil's public healthcare system, focusing on its impact on patient access to MRI exams. Methods: This retrospective study involved 197 breast MRI exams of female patients over 18 years with histological breast carcinoma diagnosis, conducted at Hospital das Clínicas de Botucatu - UNESP between 2014 and 2018. Two experienced examiners prospectively and blindly analyzed the exams using an Integrated Picture Archiving and Communication System (PACS). They first evaluated the Botucatu Abbreviated Protocol, created from sequences of the complete protocol (PC), and after an average interval of 30 days, they reassessed the same 197 exams with the complete protocol. Dynamic and morphological characteristics of lesions were assessed according to BI-RADS 5th edition criteria. The study also analyzed the average number of monthly exams before and after the implementation of Botucatu Abbreviated Protocol. Results: The Botucatu Abbreviated Protocol showed high sensitivity (99% and 96%) and specificity (90.9% and 96%). There was a significant increase in the average monthly MRI exams from 6.62 to 23.8 post-implementation. Conclusion: The Botucatu Abbreviated Protocol proved effective in maintaining diagnostic accuracy and improving accessibility to breast MRI exams, particularly in the public healthcare setting.

Tratamiento de queloides del pabellón auricular: protocolo diseñado y utilizado. Experiencia clínica / Treatment of keloids of the auricle: protocol designed and used. Clinical experience

El pabellón auricular es un blanco frecuente de cicatrices queloideas; es a su vez una de las patologías de más difícil tratamiento, con un alto porcentaje de recidiva que genera un gran desafío para los médicos que la convierten en uno de los problemas clínicos más desafi antes. El queloide de pabellón auricular es común en la población joven especialmente de sexo femenino, y ocasiona graves secuelas estéticas y psicológicas. A pesar de los múltiples tratamientos descritos en la literatura para manejar el queloide de pabellón auricular, no existe un consenso de tratamiento con evidencia científi ca que aporte una efi cacia que supere el 80%. Presentamos el protocolo de tratamiento del Hospital Privado de Rosario para los queloides de pabellón auricular en los últimos 5 años con terapia combinada en 18 pacientes y 23 pabellones auriculares (5 casos bilaterales) que consta de 4 etapas: 1era etapa, resección quirúrgica de la masa queloidea; 2da etapa, radioterapia (braquiterapia alta tasa de dosis) dentro de las primeras 6 horas posresección; 3era etapa, presoterapia entre 24-30 mmHg con lámina acrílica termomoldeable, aplicación de gel y lámina de silicona; y fi nalmente la 4ta etapa, a las 4 semanas con infi ltración intralesional con triamcinolona + 5-fl uorouracilo

The ear is a frequent target of keloid scars. It is diffi cult pathology to treat with a high percentage of recurrence that generates a great challenge for plastic surgeons. Keloids of the ears are common in young population, especially females, causing serious aesthetic and psychological sequelae. Despite the multiple treatments described in the literature to manage keloids, there is no consensus on treatment with scientifi c evidence that provides an effi - cacy that exceeds 80%. We present our treatment protocol in the Plastic Surgery Department at the Hospital Privado Rosario for ear keloids in the last 5 years. Our protocol was done in 18 patients and 23 ears (5 bilateral cases) consisting of 4 stages: 1st stage, surgical resection of the keloid mass; 2nd stage, radiotherapy stage (high dose rate brachytherapy) with in the fi rst 6 hours post-resection; 3rd stage, pressotherapy stage between 24-30 mmHg with thermo-moldable acrylic sheet, application of gel and silicone sheet; and fi nally the 4th stage at 4 weeks with intralesional infi ltration with triamcinolone + 5-fl uorouracil

Doppler ultrasound protocol for patients with hidradenitis suppurativa.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic inflammatory disease that leads to the formation of nodules, abscesses and fistulas, with the formation of scars and fibrosis, causing significant impairment in patient quality of life. The diagnosis is clinical, using scores to classify the severity of the condition; currently the most recommended classification is the International Hidradenitis Suppurativa Severity Scoring System (IHS4). Doppler ultrasound has been used to complement the clinical evaluation of patients with HS. It is possible to observe subclinical lesions that change the staging, the severity of the case, and its treatment, either clinical or surgical. Correct treatment is essential to minimize the consequences of this disease for the patient. OBJECTIVE: To establish an outpatient protocol for the use of Doppler ultrasound in the care of patients with HS. METHODS: A narrative review of the literature was carried out on the use of Doppler ultrasound in patients with hidradenitis suppurativa; a referring protocol and technique orientations for imaging assessment in HS were created. RESULTS: Recommendation to perform ultrasound evaluation of symptomatic areas eight weeks after using antibiotics and four, 12, and 24 weeks after starting immunobiologicals; apply SOS-HS ultrasound severity classification. STUDY LIMITATIONS: The review did not cover all literature on ultrasound and HS; no systematic review was carried out, but rather a narrative one. CONCLUSIONS: The correct assessment of patients staging must be carried out using dermatological ultrasound to avoid progression to scars and fibrosis, which compromise patients quality of life.

Manejo odontológico de una paciente con síndrome de Apert / Dental management of a patient with Apert syndrome

El síndrome de Apert, marcado por la acrocéfalo-sindactilia, es una condición genética que genera deformidades dentofaciales incluyendo craneosinostosis, alteraciones faciales y malformaciones en extremidades. La mutación en el gen FGFR2, ya sea heredada o resultante de mutaciones esporádicas, desencadena esta compleja condición. La relevancia de abordar el síndrome de Apert se manifiesta no sólo en las implicaciones estéticas, sino también en su impacto en la salud oral. Romper con los paradigmas odontológicos actuales implica reconocer las particularidades de estos pacientes y proporcionar una atención especializada. La necesidad de una capacitación específica para los profesionales de la salud oral es evidente, permitiendo un enfoque integral que aborde la prevención y el tratamiento de las malformaciones craneofaciales asociadas. Superar los desafíos tradicionales implica adoptar una perspectiva inclusiva y personalizada en la atención odontológica. Esto no sólo mejora la calidad de vida de los pacientes con síndrome de Apert, sino que también destaca la importancia de una atención adaptada que trascienda los límites convencionales, ofreciendo soluciones innovadoras para las complejidades bucodentales asociadas a esta condición genética (AU)

Apert syndrome, marked by acrocephalosyndactyly, is a genetic condition that generates dentofacial deformities, including craniosynostosis, facial alterations and limb malformations. Mutation in the FGFR2 gene, whether inherited or resulting from sporadic mutations, triggers this complex condition. The relevance of addressing Apert syndrome is manifested not only in the aesthetic implications, but also in its impact on oral health. Breaking with current dental paradigms involves recognizing the particularities of these patients and providing specialized care. The need for specific training for dental health professionals is evident, allowing a comprehensive approach that addresses the prevention and treatment of associated craniofacial malformations. Overcoming traditional challenges means taking an inclusive and personalized perspective on dental care. This not only improves the quality of life of patients with Apert syndrome, but also highlights the importance of tailored care that transcends conventional boundaries, offering innovative solutions for the oral complexities associated with this genetic conditio (AU)

Construction of a Perioperative Care Protocol for Individuals with Intestinal Ostomies / Construção de protocolo de assistência perioperatória destinado às pessoas com estomia intestinal / Certificación de un protocolo de asistencia perioperatoria para personas con estomías intestinales

Objective: To develop a nursing protocol to guide perioperative care for individuals with intestinal ostomies. Method: A methodological study conducted between March and June 2022, using a quantitative approach. The study was divided into three stages: 1) an exploratory phase to determine the characteristics of the target population using a questionnaire; 2) the definition of perioperative recommendations based on Enhanced Recovery After Surgery® (ERAS); and 3) the creation of the protocol. Data analysis involved simple descriptive statistics. Results: Ten (10) patients responded preoperatively, while only six (6) responded postoperatively. Preoperative education was provided by nurses in 50% of cases. Findings showed an absence of ostomy site marking in 90% of cases, insufficient self-care in 60%, and postoperative complications in 60%, including edema, mucocutaneous separation, contact dermatitis, peristomal hernia, edge maceration, and granuloma. The proposed protocol consists of a care flowchart with four lines of follow-up within the institution and a consolidated framework with four key axes of perioperative nursing actions. Each axis includes sub-axes that detail specific guidelines to be implemented. Conclusion: The situational analysis of the target population and perioperative complications demonstrated the feasibility of developing a perioperative care protocol focused on the immediate preoperative, intraoperative, and postoperative phases. (AU)

Objetivo: Construir un protocolo de enfermería para guiar los cuidados perioperatorios de personas con ostomía intestinal. Método: Estudio metodológico realizado entre marzo y junio de 2022, con un enfoque cuantitativo. Este se segmentó en tres etapas: 1) Fase exploratoria para determinar las características del público objetivo mediante un cuestionario; 2) Definición de recomendaciones perioperatorias basadas en el Enhanced Recovery After Surgery®; y 3) Producción. El análisis de datos cuantitativos se basó en estadísticas descriptivas simples. Resultados: Diez (10) pacientes respondieron preoperatoriamente; postoperatoriamente, solo respondieron seis (06). La enseñanza preoperatoria fue realizada en un 50% por los enfermeros, existiendo ausencia de demarcación de ostomía (90%), autocuidado insuficiente (60%) y aparición de complicaciones postoperatorias (60%), tales como edema, desprendimiento mucocutáneo, dermatitis de contacto, hernia periestomal, maceración de bordes y granuloma. La propuesta estuvo compuesta por un flujo de atención con cuatro líneas de seguimiento en la institución y un consolidado con cuatro ejes de conducta de enfermería perioperatoria, cada eje del consolidado tiene subejes que detallan lineamientos a implementar. Conclusión: El análisis situacional del público objetivo y de las complicaciones perioperatorias demostró la viabilidad de construir un protocolo de atención perioperatoria, dirigido a las fases preoperatoria mediata, preoperatoria inmediata, intraoperatoria y postoperatoria. (AU)

Objetivo: Construir um protocolo de enfermagem para guiar a assistência perioperatória de pessoas com estomia intestinal. Método: Estudo metodológico realizado entre os meses de março a junho de 2022, com abordagem quantitativa. Este foi segmentado em três etapas: 1) fase exploratória para apurar características do público-alvo com aplicação de questionário; 2) definição das recomendações perioperatórias com base no Enhanced Recovery After Surgery®; 3) produção. A análise dos dados quantitativos contou com estatística descritiva simples. Resultados:Dez pacientes responderam no pré-operatório, no pós-operatório, somente seis responderam. Na assistência prestada às pessoas submetidas à confecção de estomia intestinal, o ensino pré-operatório pelo enfermeiro foi realizado para 50% dos casos, 90% relataram ausência da demarcação de estomia, 60% demonstraram autocuidado insuficiente e 60% a ocorrência de complicações pós-operatórias, tais como edema, descolamento mucocutâneo, dermatite de contato, hernia periestomal, maceração de bordas e granuloma. A proposta é composta de um fluxo assistencial com quatro linhas de seguimento na instituição e um consolidado com quatro eixos de condutas de enfermagem perioperatória, cada eixo do consolidado possui subeixos que pormenorizam diretrizes a serem implementadas. Conclusão: A análise situacional do público-alvo e das complicações perioperatórias demonstrou a factibilidade na construção de um protocolo de assistência perioperatória, visando às fases pré-operatório mediato, pré-operatório imediato, intraoperatório e pós-operatório. (AU)