Reducing Mortality and Morbidity in Children with Severe Combined Immunodeficiency in Switzerland: the Role of Newborn Screening.

Newborn screening (NBS) for severe combined immunodeficiency (SCID) has been introduced in various countries with the aim of reducing morbidity and mortality. However, studies analyzing outcomes before and after the implementation of NBS programs remain limited. This study sought to compare the outcomes of SCID patients identified through Switzerland's national SCID NBS program, introduced in January 2019, with those of a historical cohort diagnosed between 2007 and 2019. The study included seven patients (32%) identified through NBS, and 15 (68%) born before NBS implementation and diagnosed based on clinical signs. Children in the NBS group were younger at diagnosis (median age 9 days vs 9 months, P = .002) and at hematopoietic stem cell transplantation (HSCT, median age 5 months vs 11 months, P = .003) compared to the clinical group. The NBS group had a lower incidence of infections before HSCT (29% vs 93%, P = .004). Although not statistically significant, the overall survival rate on last follow-up was higher in the NBS group (86% vs 67%, P = .62). Importantly, patients with active infections undergoing HSCT had a significantly lower overall survival probability compared to those without (P = .01). In conclusion, the introduction of NBS in Switzerland has led to earlier and often asymptomatic diagnosis of affected children, enabling timely intervention, infection prevention, and prompt treatment. These factors have contributed to higher survival rates in the NBS group. These findings underscore the critical importance of NBS for SCID, offering potential life-saving benefits through early detection and intervention.

Prevalence of Overweight and Associated Factors in a Male Prison Population in the Extreme South of Brazil: A Cross-Sectional Study.

Background: This cross-sectional study serves as a first Brazilian inventory about overweight as a marker for metabolic health and risk factor to develop noncommunicable chronic diseases in prison populations. The prevalence of overweight, and its associated factors in prisoners of the Fifth Regional State Penitentiary of Rio Grande do Sul (5th DPR) in the extreme South of Brazil were investigated using a precoded questionnaire with sociodemographic, behavioral, and health questions, applied to proportional stratified random sampled prisoners. Methods: Five hundred eighty male prisoners (70%) in the closed regime agreed to answer the questionnaire and allowed anthropomorphic body measurement, carried out by trained scientists. We used bivariate Pearson's chi-squared test and adjusted multinomial logistic regression for analyses. Results: Considering that the studied incarcerated population is young (mean age 33 years) it is concerning that already 43.6% of them are overweight, report regular sweets and sugary soft drink consumption (77.7%, and 81.4%, respectively), 60.2% are smokers, and 19.4% are at elevated risk to develop cardiovascular diseases. Further, 13.8% of the respondents reported a diagnosis of hypertension, 4.9% hypercholesterolemia, and 2.7% diabetes mellitus type 2. Among those who reported not smoking, excess weight was almost four times higher (prevalence ratio: 3.79; 95% confidence interval: 2.61-5.50). Conclusions: Our study suggests that the prison environment promotes modifiable risk factors for chronic diseases. These data deserve attention and intervention, aiming to prevent and reduce the current levels of excess weight.

The Visceral Adiposity Index Is a Better Predictor of Excess Visceral Fat in Military Pilots: A Cross-sectional Observational Study.

INTRODUCTION: Visceral adipose tissue (VAT) is related to cardiometabolic risk. Estimating it using the visceral adiposity index (VAI) could identify this risk in the Brazilian Air Force (BAF) aviator population. The aim here is to verify the predictive capacity of the VAI for identifying visceral fat areas compared to traditional obesity indicators in BAF pilots. MATERIALS AND METHODS: Forty male BAF pilots were recruited. The study was conducted in two stages: the first applied a structured questionnaire to characterize the sample and identify sedentary behavior and the second obtained nutritional, anthropometric, and body composition data, carrying out biochemical and magnetic resonance imaging tests and investigating physical activity level in this stage. The comparison of the predictive capacity of the VAI with that of other adiposity indicators (body mass index [BMI], waist circumference, waist-height ratio, waist-hip ratio, and neck circumference) for detecting increased VAT and the determination of the optimal cutoff points for the different adiposity indicators were carried out using receiving operating characteristic (ROC) curves. An association was verified between the adiposity indicators and excess visceral fat using Poisson regression analysis with robust variance. RESULTS: The VAI presented a better predictive capacity for VAT (area under the ROC curve = 0.941), while the BMI did not present diagnostic accuracy (95% CI < 0.5). The strength of the association with high visceral fat was also greater for the VAI than for the other indicators evaluated. CONCLUSIONS: The VAI was shown to be a better predictor of excess VAT in relation to the other indicators studied. As it is a more easy-access and lower-cost technique than resonance, it enables greater applicability in tracing and monitoring the visceral obesity of a large contingent of military personnel.

Intercorrência na instalação de miniparafuso buccal shelf ­ relato de caso / Complication in the buccal shelf miniscrew installation ­ case report

Resumo A utilização de apoio dentário como ancoragem ortodôntica, usado no tratamento ortodôntico corretivo convencional, pode interferir no bom funcionamento da mecânica aplicada, pois os dentes que são usados como apoio podem sofrer deslocamentos. Atualmente, o uso de mini-implantes, dentre eles o buccal shelf, tem sido cada vez mais comum, visto que reduzem as chances de possíveis efeitos colaterais decorrentes da mecânica, pois o apoio deixa de ser dentário e passa a ser esquelético. Apesar da baixa taxa de insucesso, de acordo com a literatura, a dificuldade de acesso e determinação individual da melhor área da instalação desse tipo de miniparafuso devem ser minuciosamente avaliadas, além de verificadas as condições ósseas, evitando-se assim os riscos de má inserção. Esse artigo apresenta um caso de instalação de um miniparafuso extra-alveolar tipo buccal shelf em que o dispositivo acabou por ser inserido em uma trajetória inadequada, ocasionando um processo inflamatório agudo. Após a remoção do miniparafuso extra-alveolar, uma nova instalação foi realizada orientada por tomografia computadorizada de feixe cônico e houve a conclusão bem-sucedida do tratamento ortodôntico.(AU)

Abstract The use of dental support as orthodontic anchorage, used in conventional corrective orthodontic treatment, may interfere in the proper functioning of the applied mechanics, because the teeth that are used as support may suffer displacement. Nowadays, the use of miniimplants, among them buccal-shelf, has been increasingly used, as they reduce the chances of possible side effects resulting from the mechanics, because the support ceases to be dental and becomes skeletal. Despite low failure rate, according to the literature, difficulty of access and individual determination of the best area of installation of this type of miniscrew should be thoroughly evaluated, in addition to verification of bone conditions, thus avoiding the risk of poor insertion. This article presents a case of installation of an extra-alveolar miniscrew buccal-shelf type in which the device ended up being inserted in an inadequate trajectory, causing an acute inflammatory process. After removal of the extra-alveolar mini-screw, a new installation was performed guided by cone-beam computed tomography, and the orthodontic treatment was successfully concluded. (AU)

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background Complex percutaneous coronary intervention (PCI) is associated with higher ischemic risk, which can be mitigated by long-term dual antiplatelet therapy (DAPT). However, concomitant high bleeding risk (HBR) may be present, making it unclear whether short- or long-term DAPT should be prioritized. Objectives This study investigated the effects of ischemic (by PCI complexity) and bleeding (by PRECISE-DAPT [PRE dicting bleeding Complications in patients undergoing stent Implantation and Sub sequent Dual Anti Platelet Therapy] score) risks on clinical outcomes and on the impact of DAPT duration after coronary stenting. Methods Complex PCI was defined as ≥3 stents implanted and/or ≥3 lesions treated, bifurcation stenting and/or stent length >60 mm, and/or chronic total occlusion revascularization. Ischemic and bleeding outcomes in high (≥25) or non-high (<25) PRECISE-DAPT strata were evaluated based on randomly allocated duration of DAPT. Results Among 14,963 patients from 8 randomized trials, 3,118 underwent complex PCI and experienced a higher rate of ischemic, but not bleeding, events. Long-term DAPT in non-HBR patients reduced ischemic events in both complex (absolute risk difference: −3.86%; 95% confidence interval: −7.71 to +0.06) and noncomplex PCI strata (absolute risk difference: −1.14%; 95% confidence interval: −2.26 to −0.02), but not among HBR patients, regardless of complex PCI features. The bleeding risk according to the Thrombolysis In Myocardial Infarction scale was increased by long-term DAPT only in HBR patients, regardless of PCI complexity. Conclusions Patients who underwent complex PCI had a higher risk of ischemic events, but benefitted from long-term DAPT only if HBR features were not present. These data suggested that when concordant, bleeding, more than ischemic risk, should inform decision-making on the duration of DAPT. (AU)

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial.

BACKGROUND: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. METHODS: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. RESULTS: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ±â€¯8.4 vs 24.7 ±â€¯8.6, P < .01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P = .15). Secondary end points did not differ between groups after follow-up. CONCLUSIONS: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death.

Evaluation of diagnostic criteria and cut-off points to predict underweight among adolescents from the Brazilian semiarid region / Avaliação de critérios diagnósticos e pontos de corte para predição de baixo peso em adolescentes do semiárido brasileiro

Abstract Objectives: to evaluate diagnostic criteria and to propose arm and calf circumference cutoff points to predict underweight in adolescents aged 13-19 years in two Brazilian municipalities of the semiarid region. Methods: underweight was defined as a Body Mass Index (BMI) of less than two z-scores, according to World Health Organization criteria (2007). Measurements of arm and calf circumferences were compared to BMI, and the diagnostic criteria for low-weight prediction were evaluated with the area under the Receiver Operating Characteristic (ROC) curve, coefficients of sensitivity, specificity, predictive values, kappa and diagnostic odds ratios. Results: the prevalence of underweight was 4.2% (CI95%= 3.3-5.0). The cutoff points for arm circumference were 22.1 cm (adolescents of both genders aged 13-15 years), and 25.1 cm and 24.0 cm, respectively, for males and females aged 16-19 years. The cutoff points for calf circumference were 30.0 cm in the first group and 31.8 cm and 31.0 cm, respectively, in the second age group. Conclusions: both anthropometric indicators analyzed evidenced a reasonable to excellent diagnostic capacity to predict underweight among adolescents.

Resumo Objetivos: avaliar critérios diagnósticos e propor pontos de corte para circunferência do braço e circunferência da panturrilha para predição de baixo peso em adolescentes de 13 a 19 anos de dois municípios do semiárido brasileiro. Métodos: o baixo peso foi definido como índice de massa corporal (IMC) menor que menos dois escores-zpelas curvas da Organização Mundial da Saúde (2007). As medidas das circunferências de braço e de panturrilha foram comparadas ao IMC, avaliando-se os critérios diagnósticos para predição de baixo peso pela área sob a curva ROC (receiver operating characteristic), coeficientes de sensibilidade, especificidade, valores preditivos, kappa e razão de odds diagnóstica. Resultados: a prevalência de baixo peso foi de 4,2% (IC95% 3,3-5,0). Os pontos de corte para circunferência do braço foram de 22,1 cm (adolescentes de 13 a 15 anos de ambos os sexos) e de 25,1 cm e 24,0 cm, respectivamente, para o sexo masculino e feminino, de 16 a 19 anos. Para circunferência da panturrilha, os pontos de corte foram de 30,0 cm no primeiro grupo e de 31,8 cm e 31,0 cm, respectivamente, no segundo grupo etário. Conclusão: os dois indicadores antropométricos analisados apresentaram capacidade diagnóstica de razoável à excelente para predizer baixo peso em adolescentes.

Diagnostic properties and cutoff points for overweight prediction through anthropometric indicators in adolescents from Caracol, Piauí, Brazil, 2011. / Propriedades diagnósticas e pontos de corte para predição de excesso de peso por indicadores antropométricos em adolescentes de Caracol, Piauí, 2011.

OBJECTIVE: to assess the diagnostic criteria and propose cutoff points for waist circumference (WC), arm circumference (AC), leg circumference (LC) and waist/height ratio (WHR) for overweight prediction in adolescents. METHODS: a census with all individuals aged 13-19 years old (N=1,075) from the municipality of Caracol-PI, Brazil was carried out; overweight was defined as body mass index (BMI) above one z-score, according to the criterion of the World Health Organization. RESULTS: the cutoff points (in centimeters) of WC, AC, LC and WHR for overweight prediction were, respectively, 76.4, 26.4, 34.0 and 0.460 in males, and 74.6, 27.0, 34.5 and 0.475 in females; the area under the ROC curve was above 0.70 (males) and 0.90 (females). CONCLUSION: the anthropometric indicators assessed reached satisfactory diagnostic values for overweight prediction in adolescents from the Brazilian semi-arid region.

Propriedades diagnósticas e pontos de corte para predição de excesso de peso por indicadores antropométricos em adolescentes de Caracol, Piauí, 2011 / Propiedades de diagnóstico y puntos de corte para la predicción de exceso de peso por indicadores antropométricos en adolescentes del Caracol, Piauí, Brasil, 2011 / Diagnostic properties and cutoff points for overweight prediction through anthropometric indicators in adolescents from Caracol, Piauí, Brazil, 2011

Objetivo: avaliar critérios diagnósticos e propor pontos de corte para as circunferências da cintura (CC), do braço (CB) e da perna (CP) e relação cintura/altura (RCA), para a predição de excesso de peso em adolescentes. Métodos: censo com todos os indivíduos na idade de 13-19 anos (N=1.075) do município de Caracol-PI, Brasil; o excesso de peso foi definido como índice de massa corporal (IMC) acima de um escore-z, conforme critério da Organização Mundial da Saúde. Resultados: os pontos de corte (em centímetros) de CC, CB, CP e RCA para predizer excesso de peso foram, respectivamente, 76,4, 26,4, 34,0 e 0,460 para o sexo masculino, e 74,6, 27,0, 34,5 e 0,475 para o feminino; a área sob a curva ROC ficou acima de 0,70 (sexo masculino) e de 0,90 (sexo feminino). Conclusão: os indicadores antropométricos examinados atingiram valores diagnósticos satisfatórios para predição de excesso de peso em adolescentes do semiárido brasileiro.

Objetivo: probar los criterios diagnósticos y proponer puntos de corte para la circunferencia de cintura (CC), brazo (CB), pierna (CP) y cintura/altura (RCA) para predicción de exceso de peso en adolescentes. Métodos: censo con todos los individuos de 13 a 19 años de edad (N=1.075) del municipio de Caracol-PI, Brasil; el exceso de peso se define como un índice de masa corporal (IMC) por encima de uno escore-z, conforme criterio de la Organización Mundial de la Salud. Resultados: los puntos de corte (en cm) de CC, CB, CP y RCA fueron, respectivamente, de 76,4, 26,4, 34,0 y 0,460 para el sexo masculino, y de 74,6, 27,0, 34,5 y 0,475 para el sexo femenino; el área bajo la curva ROC se situó por encima de 0,70 (sexo masculino) y de 0,90 (sexo femenino). Conclusión: los indicadores antropométricos analizados alcanzaron valores diagnósticos satisfactorios para predicción de exceso de peso en adolescentes del semiárido brasileiro.

Objective: to assess the diagnostic criteria and propose cutoff points for waist circumference (WC), arm circumference (AC), leg circumference (LC) and waist/height ratio (WHR) for overweight prediction in adolescents. Methods: a census with all individuals aged 13-19 years old (N=1,075) from the municipality of Caracol-PI, Brazil was carried out; overweight was defined as body mass index (BMI) above one z-score, according to the criterion of the World Health Organization. Results: the cutoff points (in centimeters) of WC, AC, LC and WHR for overweight prediction were, respectively, 76.4, 26.4, 34.0 and 0.460 in males, and 74.6, 27.0, 34.5 and 0.475 in females; the area under the ROC curve was above 0.70 (males) and 0.90 (females). Conclusion: the anthropometric indicators assessed reached satisfactory diagnostic values for overweight prediction in adolescents from the Brazilian semi-arid region.

Abordagem do câncer de mama masculino na atenção primária: revisão da literatura sobre aspectos epidemiológicos, fatores de risco, manifestações clínicas e encaminhamento precoce ao especialista / Male breast cancer in primary health care: review about epidemiology, risk factors, clinical manifestations and early referral to the specialist

O câncer de mama masculino é uma doença rara que representa cerca de 1% de todos os cânceres em homens. A etiologia é desconhecida, porém, existem fatores de risco associados tais como a susceptibilidade genética, endócrina, ocupacional, obesidade, exposição à radiação e a fatores ambientais, dentre outros. A apresentação clínica mais comum é a presença de nódulo doloroso, geralmente subareolar. A raridade da doença e o baixo índice de suspeição clínica, tanto de médicos quanto de pacientes, faz com que exista um longo atraso no diagnóstico da doença, com consequente demora do encaminhamento ao especialista, levando a piora no prognóstico do paciente. Deste modo, foi realizada uma revisão de literatura acerca do tema, com ênfase na abordagem do câncer de mama masculino na atenção primária, dentro dos aspectos epidemiológicos, fatores de risco, manifestações clínicas e encaminhamento precoce ao especialista no intuito de capacitar profissionais de saúde, consequentemente, aumentar a suspeita clínica desta neoplasia. Foram utilizados literatura médica nacional e internacional de base e artigos científicos em língua estrangeira (inglês), publicados no período compreendido entre 2000 a 2017, buscados nas seguintes bibliotecas eletrônicas: PUBMED e SCIELO com as palavras chaves: Atenção primaria, Saúde do homem; Neoplasia de mama masculina; Epidemiologia; Fatores de risco; Sinais e sintomas

Male breast cancer is a rare disease. It is 1% of all cancers in men. The etiology is unknown, but it is associated to risk factors, like genetic susceptibility, endocrine, obesity, occupational, radiation exposure and environmental factors, among others. The most commom clinical presentation is the presence of a painful nodule, frequently localized to the subareolar region. The rarity of the disease and the low rate of clinical suspicion, of both physicians and patients, cause along delay in the diagnosis of the disease, with consequent delay of the referral to the specialist, leading to worsening of the patient's prognosis. This review of the literature aims to describe male breast cancer, with emphasis on its approach in primary care, the epidemiological aspects, risk factors, clinical manifestations and early referral to the specialist. The purpose of this study is to train health professionals and increase the good clinical approach and suspicion of this neoplasm. We used national and international medical literature and scientific articles in English and Portuguese languages, published between 2000 and 2017, searched in the following electronic libraries: PUBMED and SCIELO with the keywords: Primary health care; Men's health; Male Breast Neoplasms; Epidemiology; Risk factors; Signals and symptoms

Prevalência de casos de insuficiência renal crônica (IRC) atendidos pelo Serviço de Atendimento Móvel de Urgência de Rio Verde, Goiás / Prevalence of chronic renal insufficiency (CRI) cases in the Emergency Mobile Care Service of Rio Verde, Goiás

Introdução: a Insuficiência renal crônica (IRC) é definida como uma condição fisiopatológica com perda progressiva e irreversível da função renal. A perda superior a 75% da taxa de filtração glomerular resulta em uma instabilidade hídrica e eletrolítica. Objetivo: avaliar a prevalência de casos de insuficiência renal crônica na cidade de Rio Verde-Goiás que foram atendidos pelo Serviço Médico de Atendimento de Urgência de Rio Verde, Goiás (SAMU/RV). Método: trata-se de um estudo epidemiológico, transversal e documental, realizado através de consulta ao banco de dados do SAMU/RV referente ao período 2014-2015. Resultado e Discussão: a prevalência de IRC foi de 41,20% em 2014 e 38,20% em 2015, em relação aos outros atendimentos realizados pelo SAMU/Rio Verde por queixas nefrológicas nessa mesma data. Conclusão: Os resultados indicaram alta prevalência de casos de atendimento de IRC pelo SAMU/RV no período de 2014-2015. (AU)

Introduction: Chronic renal failure (CRF) is defined as a pathophysiological condition with progressive and irreversible loss of renal function. Loss greater than 75% of the glomerular filtration rate results in water and electrolyte instability. Objective: In this way, the study sought to evaluate the prevalence of chronic renal failure in the city of Rio Verde-Goiás, which was attended by the Emergency Medical Service of Rio Verde, Goiás (SAMU/RV). Method: This is an epidemiological, cross-sectional and documentary study, carried out by consulting the SAMU/RV database for the period 2014-2015. Results and Discussion: the prevalence of CRI was 41.20% in 2014 and 38.20% in 2015, in relation to the other visits performed by SAMU/Rio Verde for nephrological complaints at the same date. Conclusion: The results indicated a high prevalence of cases of CKI care by the SAMU/RV in the period 2014-2015. (AU)

[Overweight among young people in a city in the Brazilian semiarid region: a population-based study]. / Excesso de peso entre jovens de um município do semiárido brasileiro: estudo de base populacional.

The scope of this article is to measure the prevalence and identify factors associated with excess weight among young people living in the city of Caracol, Piaui, Brazil. Qualified interviewers applied a standardized questionnaire and assessed the anthropometric measurements of all young people (13 to 19 years of age) in their households. The questionnaires sought information on demographic, socioeconomic and behavioral characteristics. The outcome was overweight in young people (BMI > 1 z score) calculated on the basis of body mass index (BMI) and classified in accordance with the new parameters of the World Health Organization. Poisson regression with robust adjustment of variance was used for the statistical analysis. Of the 1,088 young people studied, 10.5% were overweight. The occurrence of the outcome varied from 6% for young people belonging to the second income quartile to 19% for adolescents with a height deficit for their age. Even with the prevalence of overweight being below the national average in the semiarid region, the factors associated with their occurrence are already equal to the other areas of Brazil and there is a pressing need for early intervention aimed at preventing and reducing the current overweight levels.

Estudo das proporções dentárias utilizando os métodos de Bolton e Levin / Study of dental proportions using the Bolton Analysis and Levin scale

O anseio por um sorriso estético vem sendo cada vez mais o motivo pelo qual os pacientes procuram o tratamento odontológico. Para que os objetivos estéticos sejam alcançados, existem alguns princípios que auxiliam os profissionais da área a restabelecer a harmonia estética do sorriso de seus pacientes. As discrepâncias de tamanho dentário nos dentes anterossuperiores afetam a estética do sorriso, podendo causar a falta de uma relação de proporcionalidade entre eles, evidenciada pela presença de diastemas múltiplos no segmento estético anterior do arco. O diagnóstico da alteração de dimensão mésio-distal dentária deve ser realizado antes do tratamento ortodôntico pelo emprego da Análise de Bolton para a previsibilidade do tratamento. Para a correção dessas alterações, torna-se necessária uma interdisciplinaridade entre a Ortodontia e a Dentística Restauradora, em que, para a finalização satisfatória do tratamento ortodôntico. Foi utilizado a proporção áurea, aplicada às Grades de Levin, restabelecendo a estética do sorriso.

Most patients who search for dental care are interested on aesthetic improvement of their smile. In order to achieve a harmonic smile, there are some principles that guide dental professionals to restore dental aesthetics. The discrepancies related to the size and position of the anterior-superior teeth affect the esthetic of the smile. As there is no proportional relation between the teeth, it could determine the presence of multiple diastemas in this segment. Regarding the treatment plan, the analysis of dimensional changes in mesio-distal tooth size should be performed before orthodontic treatment, using the Bolton analysis for treatment predictability. After the analysis, if there is any discrepancy between the positioning of teeth and presence of diastema, a multidisciplinary intervention is necessary. It is possible to achieve esthetic results through a multidisciplinary approach with Orthodontics and Restorative Dentistry. For a satisfactory result of the treatment, the Levin scale, which is based on the Golden Proportion, was used to restore aesthetics.

Excesso de peso entre jovens de um município do semiárido brasileiro: estudo de base populacional / Overweight among young people in a city in the Brazilian semiarid region: a population-based study

Resumo O objetivo deste artigo é medir a prevalência e identificar fatores associados ao excesso de peso entre jovens residentes no município de Caracol - PI. Através de questionário padronizado e medidas antropométricas de todos os jovens, nos domicílios. Investigaram-se características demográficas, socioeconômicas e comportamentais. O desfecho foi o excesso de peso nos jovens (IMC > 1 escore z), calculado a partir do índice de massa corpórea (IMC) e classificado conforme as novas curvas da Organização Mundial da Saúde. Na análise estatística, utilizou-se regressão de Poisson com ajuste robusto de variância. Dos 1088 jovens estudados, 10,5% apresentaram excesso de peso. A ocorrência do desfecho variou de 6% para os jovens pertencentes ao segundo quartil de renda a 19% para os jovens com déficit de altura para idade. Mesmo com a prevalência de excesso de peso ainda se mostrando abaixo da média nacional no semiárido, os fatores associados a sua ocorrência já se igualam aos das demais regiões do Brasil e parece evidente a necessidade de intervenção precoce visando à prevenção e à redução desses níveis atuais.

Abstract The scope of this article is to measure the prevalence and identify factors associated with excess weight among young people living in the city of Caracol, Piaui, Brazil. Qualified interviewers applied a standardized questionnaire and assessed the anthropometric measurements of all young people (13 to 19 years of age) in their households. The questionnaires sought information on demographic, socioeconomic and behavioral characteristics. The outcome was overweight in young people (BMI > 1 z score) calculated on the basis of body mass index (BMI) and classified in accordance with the new parameters of the World Health Organization. Poisson regression with robust adjustment of variance was used for the statistical analysis. Of the 1,088 young people studied, 10.5% were overweight. The occurrence of the outcome varied from 6% for young people belonging to the second income quartile to 19% for adolescents with a height deficit for their age. Even with the prevalence of overweight being below the national average in the semiarid region, the factors associated with their occurrence are already equal to the other areas of Brazil and there is a pressing need for early intervention aimed at preventing and reducing the current overweight levels.

Tratamento da má oclusão de Classe III e mordida cruzada posterior unilateral utilizando a técnica multiloop edgewise archwire (meaw) – relato de caso / Treatment of Class III malocclusion and posterior unilateral crossbite using the multiloop edgewise archwire technique (meaw) – case report

A mordida cruzada posterior é caracterizada pela deficiência do arco superior e relação anormal transversal entre os dentes posteriores superiores e inferiores. Algumas vezes, assimetrias dos arcos superior ou inferior estão presentes. A má oclusão de Classe III, mesmo sendo considerada uma doença de baixa prevalência, é caracterizada pela maxila retraída em relação à mandíbula. Quando as duas más oclusões estão presentes no indivíduo, a complexidade do tratamento ortodôntico exigido é proporcional ao grau de severidade da má oclusão. O presente trabalho apresenta o tratamento de uma paciente de 22 anos e 5 meses de idade, que procurou tratamento ortodôntico com a queixa principal de apinhamento na região anterior inferior. Ao exame clínico, observou-se que a paciente apresentava perfil labial côncavo, assimetria facial, giroversões, apinhamento inferior, mordida cruzada posterior unilateral esquerda, desvio da linha média dentária inferior e má oclusão Classe III com subdivisão direita. Para a correção desta má oclusão complexa foi utilizada a técnica multiloop edgewise archwire (MEAW). Durante o tratamento, o arco superior foi expandido e o arco inferior contraído. Ao fim do tratamento, foi observado restabelecimento da oclusão e da estética.

Posterior cross bite is characterized by the deficiency of the upper arch and abnormal relationship between upper and lower posterior teeth. Sometimes, asymmetries in the upper or lower arch are present. Class III malocclusion, despite considered a low-prevalence disease, is characterized by the retraction of the maxilla in relation to the mandible. When these both malocclusions are present in the same individual, the complexity of the required orthodontic treatment is proportional to the severity of malocclusion. This paper presents the treatment of a patient, 22 years old, who looked foward for orthodontic treatment with the chief complaint of crowding in the lower anterior region. During examination it was verified that the patient had a concave profile lip, facial asymmetry, rotations, anterior mandibular crowding, left unilateral posterior cross bite, lower dental midline shift and Class III malocclusion with right subdivision. In order to correct dental occlusion the multiloop technique edgewise archwire (MEAW) was used. During the treatment, the maxillary arch was expanded and the lower arch was contracted. At the end of treatment occlusion and aesthetics were restored.

Depressão, uso de drogas, ideação e tentativa de suicídio entre estudantes de enfermagem / Depression, drug addiction, ideation and suicide attempt among nursery students / Depresión, uso de medicamentos, ideación e intento de suicidio entre estudiantes de enfermería

Objetivo: avaliar a influência da depressão no uso de drogas, ideação suicida e tentativa de suicídio entre estudantes de Enfermagem. Método: estudo transversal, exploratório, descritivo com abordagem quantitativa. A amostra foi constituída por 179 estudantes do curso de Enfermagem. Os dados foram coletados a partir dos questionários teste de triagem do envolvimento com álcool, tabaco e outras substâncias, Inventário de depressão e Escala de ideação suicida de Beck. Os dados foram codificados e digitados no Excel 2010 e para a análise descritiva foi realizado cálculo de frequência absoluta e relativa. Resultados: identificou-se que 19 (10,6%) estudantes apresentam sintomas depressivos, 17 (9,5%) história de ideação suicida e 11 (6,1%) dos estudantes já tentaram suicídio e o uso de álcool na vida desses estudantes de Enfermagem prevaleceu em 154 (86,0%). Conclusão: o estudo mostra a necessidade de criação de estratégias para os universitários devido a sua condição de vulnerabilidade.(AU)

Objective: to evaluate the influence of the depression at the drug addiction, ideation and suicide attempt among nursery students. Method: transversal, exploratory and descriptive study with quantitative approach. The sample was constituted by 179 students from the nursery course. Data were collected from the query screening test of the alcoholic involvement, cigarette and other substances, depression inventory and Beck's suicidal ideation scale. Data were coded and typed on Excel 2010 and to the descriptive analysis was conducted a calculation of absolute and relative frequency. Results: was identified that 19 (10.6%) students present depressive symptoms, 17 (9.5%) suicidal ideation history and 11 (6.1%) of the student have already tried suicide and the alcoholic use on their lives prevailed in 154 (86.0%). Conclusion: the study shows the necessity to create strategies to the academics due to their vulnerability condition.(AU)

Objetivo: evaluar la influencia de la depresión en el consumo de drogas, ideación suicida e intentos de suicidio entre los estudiantes de enfermería. Método: estúdio transversal, exploratório, descritivo con enfoque quantitativo. La muestra estuvo constituida por 179 estudiantes del curso de enfermería. Se recogieron datos de los cuestionarios de la prueba de detección implicación con el alcohol, tabaco y otras sustancias, la depresión y la escala de inventario ideación suicida de Beck. Los datos se codificaron y se introdujeron en Excel 2010 y para el análisis descriptivo se realizó el cálculo de la frecuencia absoluta y relativa. Resultados: se encontró que 19 (10,6%), los estudiantes tienen síntomas depresivos, 17 (9,5%) historia de ideación suicida y 11 (6,1%) de los estudiantes han intentado suicidarse y el uso de alcohol en la vida de los estudiantes enfermería se impuso en 154 (86,0%). Conclusión: el estudio muestra la necesidad de crear estrategias para la universidad debido a su condición de vulnerabilidad.(AU)

Correção da má oclusão Esquelética de Classe III de Angle com corticotomia e tração reversa de maxila com máscara facial ancorada em miniplacas: relato de caso / Treatment of skeletal Class III malocclusion with corticotomy and reverse traction of maxilla with facial mask anchored to miniplates: a case report

A má oclusão de Classe III, de acordo com o sistema de classificação preconizado por Angle, muito embora seja uma das menos prevalentes, é considerada a de maior complexidade quanto ao tratamento. A abordagem terapêutica pode ser instituída durante o crescimento facial, por meio de aparelhos ortopédicos, preferencialmente entre o final da dentição decídua e o início da dentição mista. Entretanto, antes e após esta fase, os movimentos ortopédicos dos ossos são acompanhados pelos movimentos dentários, considerando o apoio dentário superior. A ancoragem esquelética, por meio de miniplacas, tem sido sugerida como dispositivos que potencializam a força ortopédica nos casos com retração de maxila. A corticotomia tem sido utilizada como meio de favorecer o movimento dentário, com pouca indicação para o movimento esquelético, sobretudo, na protração da maxila com máscara facial. O objetivo desse trabalho é apresentar um caso clínico de uma menina tratada na dentição permanente com má oclusão de Classe III, com mordida cruzada anterior e retração de maxila por meio de máscara facial conectada a miniplacas instaladas na região lateral à cavidade nasal. A corticotomia bilateral horizontal foi realizada previamente à tração. Após seis meses de tratamento, houve a correção da má oclusão com avanço de maxila e melhora do perfil facial. A abordagem ortopédica de tração reversa associada à ancoragem esquelética e corticotomia mostrou-se efetiva e rápida.

Angle’s Class III malocclusion, although it is considered the malocclusion with the lowest prevalence, it is the most complex regarding treatment. Therapeutic approach may be instituted during facial growth through orthopedic appliances, preferably between the end of primary teeth and early mixed dentition. However, before and after this phase, the orthopedic bone movements are accompanied by tooth movements, considering the upper dental support. Skeletal anchorage using miniplates, has been suggested as a device that may enhance orthopedic force in cases with jaw retraction. Corticotomy has been used as a method to perform tooth movement, with little indication for skeletal movement, especially in maxillary protraction with facial mask. The aim of this paper is to present a clinical case of a girl treated in the permanent dentition with Class III malocclusion with anterior cross bite and jaw retraction through a face mask connected to mini-plates installed in the lateral nasal cavity. The horizontal bilateral corticotomy was performed before traction. After six months of treatment, the correction of malocclusion with maxillary advancement and improvement of facial profile was achieved. The approach of orthopedic protraction associated with skeletal anchorage and corticotomy has proven to be effective and fast.

Avaliação da severidade das más oclusões em indivíduos com má oclusão de Classe II 1ª Divisão tratados com o aparelho extrabucal modificado de Thurow / Evaluation of malocclusion severity using the modified Thurow extraoral appliance in subjects with Class II division 1 malocclusion

Os índices normativos são ferramentas de diagnóstico e de avaliação terapêutica muito importantes, pois possuem grande valia para o planejamento ortodôntico e a compreensão dos resultados obtidos. Dentre os índices validados, o Dental Aesthetic Index (DAI) pode avaliar a necessidade de tratamento ortodôntico e seus resultados, o qual aborda componentes estéticos e da oclusão dentária. Os indivíduos com má oclusão de Classe II, 1ª divisão, em crescimento, ocupam o primeiro lugar em busca do tratamento ortodôntico-ortopédico, parte com protrusão maxilar. O aparelho extraoral tem mostrado, ao longo dos anos, uma boa opção devido à possibilidade de promover alterações esqueléticas corrigindo o posicionamento da maxila, como o aparelho de Thurow modificado. Este estudo retrospectivo avaliou, por meio do Índice Dental Estético, as mudanças oclusais em 15 casos tratados por meio do aparelho de Thurow modificado. Houve uma diminuição significativa da severidade da má oclusão com a redução do escore DAI 4 de 87% para 0% do total de casos tratados. Conclui-se que o aparelho modificado de Thurow é eficiente no tratamento da má oclusão de Classe II, 1ª divisão, principalmente pela redução do overjet e melhoria da relação molar.

Normative indexes are very important diagnostic and therapeutic evaluation tools, since they have great value in orthodontic planning and understanding of orthodontic treatment results. Among the validated indexes, Dental Aesthetic Index (DAI) can evaluate the need for orthodontic treatment and its results, using occlusal and aesthetic components. Class II division 1 malocclusion cases, in growing patients, are the first in search for orthopedic-orthodontic treatment, of them with maxillary protrusion. Over the years the extraoral appliance has proved to be a good option due to the possibility of promoting skeletal changes by correcting the positioning of the bone bases, likewise, the Modified Thurow Extraoral Appliance. This retrospective study has evaluated, through the Dental Aesthetic Index, occlusal modifications in 15 cases treated with modified Thurow’s appliance. There was a significant reduction in malocclusion severity, with a modification of DAI score reducing from 87% to 0% of DAI score 4. It was concluded that modified Thurow’s appliance is efficient in Class II division 1 malocclusion, mainly in overjet reduction and improvement of molar relationship.

Detection of Plasmodium falciparum and Plasmodium vivax subclinical infection in non-endemic region: implications for blood transfusion and malaria epidemiology.

BACKGROUND: In Brazil, malaria is endemic in the Amazon River basin and non-endemic in the extra-Amazon region, which includes areas of São Paulo state. In this state, a number of autochthonous cases of malaria occur annually, and the prevalence of subclinical infection is unknown. Asymptomatic infections may remain undetected, maintaining transmission of the pathogen, including by blood transfusion. In these report it has been described subclinical Plasmodium infection in blood donors from a blood transfusion centre in São Paulo, Brazil. METHODS: In this cross-sectional study, representative samples of blood were obtained from 1,108 healthy blood donors at the Fundação Pró-Sangue Hemocentro de São Paulo, the main blood transfusion centre in São Paulo. Malaria exposure was defined by the home region (exposed: forest region; non-exposed: non-forest region). Real-time PCR was used to detect Plasmodium falciparum and Plasmodium vivax. Subclinical malaria cases were geo-referenced. RESULTS: Eighty-four (7.41%) blood donors tested positive for Plasmodium; 57 of these were infected by P. falciparum, 25 by P. vivax, and 2 by both. The prevalence of P. falciparum and P. vivax was 5.14 and 2.26, respectively. The overall prevalence ratio (PR) was 3.23 (95% confidence interval (CI) 2.03, 5.13); P. falciparum PR was 16.11 (95% CI 5.87, 44.21) and P. vivax PR was 0.47 (95% CI 0.2, 1.12). Plasmodium falciparum subclinical malaria infection in the Atlantic Forest domain was present in the mountain regions while P. vivax infection was observed in cities from forest-surrounded areas. CONCLUSIONS: The presence of Plasmodium in healthy blood donors from a region known as non-endemic, which is important in the context of transfusion biosafety, was described. Infected recipients may become asymptomatic carriers and a reservoir for parasites, maintaining their transmission. Furthermore, P. falciparum PR was positively associated with the forest environment, and P. vivax was associated with forest fragmentation.