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A reabilitação de maxilas atróficas representa desafio complexo, levando à busca de abordagens inovadoras. Procedimentos convencionais, como levantamento de seio maxilar, têm limitações, impulsionando o interesse em implantes zigomáticos. Contudo, complicações persistem, especialmente em áreas de concavidade acentuada. Este relato de caso visa demonstrar a eficácia de uma abordagem cirúrgica inovadora, combinando implantes zigomáticos e transnasais, para superar as limitações anatômicas e alcançar resultados estéticos e funcionais satisfatórios. Paciente de 58 anos, sexo feminino, desdentada total, foi submetida à reabilitação no Instituto Rosenvaldo Moreira, devido à atrofia maxilar pronunciada. Foram propostos dois planos de tratamento, envolvendo implantes zigomáticos e transnasais. A cirurgia, realizada em ambiente ambulatorial sob sedação intravenosa e anestesia local, incluiu a instalação sequencial de implantes transnasais e zigomáticos, com especial atenção à usinagem do terço cervical para prevenir complicações. A abordagem cirúrgica empregada, combinando implantes zigomáticos e transnasais, revelou-se eficaz na reabilitação da maxila atrófica. A usinagem cuidadosa contribuiu para evitar complicações, evidenciando estabilidade e ausência de inflamações peri-implantares no acompanhamento de um ano. Este relato oferece uma contribuição valiosa, destacando a viabilidade e sucesso dessa abordagem inovadora em situações desafiadoras de atrofia maxilar na implantodontia.

The rehabilitation of atrophic jaws represents a complex challenge, leading to the search for innovative approaches. Conventional procedures, such as sinus lifts, have limitations, driving interest in zygomatic implants. However, complications persist, especially in areas of pronounced concavity. This case report aims to demonstrate the effectiveness of an innovative surgical approach, combining zygomatic and transnasal implants, to overcome anatomical limitations and achieve satisfactory aesthetic and functional results. A 58-year-old female patient, completely toothless, underwent rehabilitation at the Instituto Rosenvaldo Moreira, due to pronounced maxillary atrophy. Two treatment plans were proposed, involving zygomatic and transnasal implants. The surgery, performed in an outpatient setting under intravenous sedation and local anesthesia, included the sequential installation of transnasal and zygomatic implants, with special attention to machining the cervical third to prevent complications. The surgical approach used, combining zygomatic and transnasal implants, proved to be effective in the rehabilitation of the atrophic maxilla. Careful machining helped to avoid complications, demonstrating stability and absence of peri-implant inflammation in the one-year follow-up. This report offers a valuable contribution, highlighting the feasibility and success of this innovative approach in challenging situations of maxillary atrophy in implant dentistry.

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BACKGROUND: Removal of third molars often leads to complications such as pain, swelling, and trismus, impacting patient quality of life. Various strategies including cryotherapy, different suture techniques, and chlorhexidine are employed to mitigate these effects. However, the effectiveness of these interventions is still debated, as clinical trials present inconsistent and contrasting results. This study aims to assess the certainty of evidence from systematic reviews and meta-analyses regarding the effects of these interventions on clinical outcomes and patient quality of life following third molar surgery. MATERIAL AND METHODS: This evidence mapping followed the Global Evidence Mapping Initiative and PRISMA guidelines, utilizing databases such as PubMed, Embase, Cochrane, Web of Science, and Google Scholar until February 2024. Methodological quality was assessed via AMSTAR-2 and the effects of these interventions on outcomes of interest were classified as "beneficial", "probably beneficial", "harmful", "no effect", or "inconclusive". Findings were mapped using the PyMeta platform. RESULTS: Thirteen studies were reviewed. All systematic reviews evaluated the effects of these interventions on clinical outcomes following third molar surgery, but none assessed the impact on patient quality of life. Cryotherapy was classified as probably beneficial for reducing pain and swelling within the first 72 hours post-surgery. Secondary surgical wound closure was effective in reducing pain, swelling, and trismus during the first postoperative week, but it did not mitigate the risk of bleeding, infection, or alveolitis. Chlorhexidine, especially when used as a mouthwash, is effective in preventing postoperative alveolitis. However, most reviews (76.9%) were rated as "critically low" methodological quality. CONCLUSIONS: Although the potential benefits of cryotherapy, secondary surgical wound closure, and chlorhexidine on clinical outcomes, this study revealed a predominantly low quality of evidence from systematic reviews and meta-analyses. Moreover, further research should expand investigations into the patient-centered outcomes to better guide clinical practice.

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OBJECTIVE: This study aims to map the literature on screening, diagnosis, treatment and outcomes of developmental dysplasia of the hip (DDH) in the Brazilian population aged 0-18 years, to describe regional variations in its presentation and management. DESIGN: Scoping review. DATA SOURCES: PubMed/MEDLINE, Web of Science, Scopus, "Biblioteca Virtual em Saúde" and "Biblioteca Digital Brasileira de Teses e Dissertações". The journals, Revista Brasileira Ortopedia and Acta Ortopédica Brasileira, were manually searched for non-indexed issues. Databases were searched from their inception to February 2024. ELIGIBILITY CRITERIA: This scoping review included studies on Brazilian patients aged 0-18 years diagnosed with or being assessed for DDH. No language or date restrictions were applied. DATA EXTRACTION AND SYNTHESIS: Studies were assessed based on title, authors, publication year, study design, sample size, level of evidence, region of Brazil and healthcare setting (public or private). The articles were then analysed across four categories: screening, diagnosis, treatment and outcomes. RESULTS: 52 studies, published between 1951 and 2023, were included. Reported prevalence rates ranged from 0.75 to 56.4 cases per 1000 children. No study examined the effectiveness of specific screening programmes or compared their outcomes. The most common diagnostic methods were the Ortolani manoeuvre and ultrasonography using the Graf method. Of the 27 articles on treatment, 17 focused exclusively on surgical interventions, with the Salter osteotomy being the most frequent procedure. CONCLUSIONS: There should be a greater focus on understanding the prevalence of DDH in Brazil, the availability of ultrasound devices and trained operators, and the follow-up of conservative treatments. More information on DDH in Brazil is essential for designing and implementing effective screening and treatment programmes. Future research should be done to understand the prevalence of the disease, optimal forms of screening and early treatment.

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INTRODUCTION: Hydrocephalus is a common condition in childhood, often treated with ventriculoperitoneal shunts (VPS). Endoscopic third ventriculostomy (ETV) has emerged as an effective alternative, and the addition of choroid plexus coagulation (CPC) is believed to enhance its success, particularly in children under 6 months. METHODS: In this observational study, a retrospective analysis was conducted on 167 pediatric patients who underwent ETV, with and without CPC, at the Hospital da Restauração in Pernambuco. The primary outcome was to evaluate the success rates of ETV and ETV + CPC at immediate postoperative or outcome at discharge and 6-month follow-up. Statistical analyses, including chi-square, univariate, and multivariate logistic regression, were employed to assess correlations between dependent and independent variables. RESULTS: ETV + CPC showed a significantly higher success rate in the immediate postoperative period (91%) compared to ETV alone (75%) (p = 0.007). After 6 months, success rates were similar for both groups (67% for ETV + CPC and 66% for ETV), with no significant difference (p = 0.855). Univariate and multivariate analyses revealed that the type of surgery (ETV + CPC vs. ETV) was a significant predictor of immediate postoperative success (OR 2.81, 95%CI 1.18-6.72, p = 0.020). Age and sex did not correlate significantly with surgical outcomes. CONCLUSION: The addition of CPC to ETV significantly enhances immediate postoperative success in young children with hydrocephalus. Although long-term outcomes equalized, these findings suggest that CPC can be a valuable adjunct in optimizing short-term results.

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INTRODUCTION: Headache is common among patients diagnosed with pituitary adenoma (PA). There are still controversies regarding the headache presentation, pathophysiology and outcome after treatment in these patients. OBJECTIVES: To determine the prevalence of headache among patients with PA, describe their phenotypes and identify precipitating factors. Also, to evaluate prospectively if PA treatment leads to headache improvement. METHODS: Treatment-naïve adult patients with PA were included. A questionnaire based on the beta version of the International Classification of Headache Disorders 3rd edition was created to classify the headaches. Patients submitted to surgery or medical treatment were reevaluated at least three to six months after treatment. RESULTS: Headache during the previous 3 months was present in 62% of the 104 patients. The most prevalent phenotypes were migraine and tension-type headache. Trigeminal autonomic cephalalgias (TACs) were observed only in prolactinoma patients. Both genders presented headache at similar rates (64% in females and 58% in males) but patients with headache were younger (41.5 ± 13.8 vs. 56.8 ± 13.6 years). Tumor characteristics were not determinant of headache. Patients with acromegaly that presented headache had higher GH levels. Headache was more frequent in prolactinomas (83%) than in NFPA (52%). After disease remission or control, resolution of headache was observed in 83%, 50% and 33% of the NFPA, somatotropinomas and prolactinomas, respectively. CONCLUSIONS: Migraine and tension-type are the most common headache phenotypes in PA patients, and TACs were only observed in prolactinomas. Also, headache was more common in prolactinomas than in NFPA. GH levels were higher in patients with acromegaly that presented headache. Surgical and medical treatments completely resolve the headaches in 50% of the patients.

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BACKGROUND: This study aims to evaluate the effectiveness, safety, and impact on health-related quality of life (HQoL) of a fully oral shortened regimen for Rifampicin-Resistant/Multidrug-Resistant Tuberculosis (RR/MDR-TB) over 9 to 12 months under programmatic conditions. METHODS: A prospective cohort study was conducted on an all-oral modified Shortened Treatment Regimen (mSTR) comprising linezolid (Lzd), bedaquiline (Bdq), levofloxacin (Lfx), clofazimine (Cfz), and cycloserine (Cs). Patients with RR/MDR-TB were enrolled between January and December 2022 across seven drug-resistant TB units in the Dominican Republic. RESULTS: A total of 113 patients were enrolled, with 87% achieving culture conversion at two months. Treatment outcomes revealed that 79% of patients were successfully treated and didn't relapse six months after the end of the treatment, 14% were lost to follow-up during the treatment, 6% deceased, and one experienced treatment failure due to Adverse Drug Reactions (ADRs). Adverse events of Special interest (AESI) were common, with 82% of patients experiencing at least one AE with high proportion of QT interval prolongation, elevated transaminases, and anemia. A total of 12% of the patients experiencing Serious Adverse Events (SAEs). Improvement in HQoL dimensions was noted throughout treatment, with the EQ-VAS score increasing by an average of 15.5 by treatment end. CONCLUSION: The high treatment success rate of the 5-drug mSTR facilitated the adaptation and integration of a shortened treatment regimen lasting 9 to 12 months in routine care in Dominican Republic. SAEs were -rare. Although AESI were frequent, they were manageable in most cases. Continuous monitoring, particularly with regard to the use of Lzd and Bdq, is crucial to effectively mitigating risks. Since September 2023, this short all oral treatment regimen is the recommended approach for patients with RR/MDR-TB in the Dominican Republic.

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INTRODUCTION: Differentiated service delivery (DSD) models have been widely implemented for patients in stable HIV care. However, DSD has rarely been offered to newly diagnosed patients. We assessed the effectiveness of early fast-track care during a period of severe civil unrest in Port-au-Prince, Haiti. METHODS: We conducted a pilot randomized trial among adults presenting with early HIV disease to determine whether early fast-track care (8-12 weeks after same-day HIV testing and antiretroviral therapy [ART] initiation) was associated with superior outcomes compared with standard (deferred eligibility for fast-track care). All participants received tenofovir/lamivudine/dolutegravir (TLD), and HIV-1 RNA <200 copies/ml was required prior to initiating fast-track care. The primary outcome was 48-week HIV-1 RNA <200 copies/ml, with intention-to-treat analysis. RESULTS: From December 2020 to August 2022, 245 participants were randomized to standard (n = 116) and early fast-track (n = 129) groups. All initiated TLD on the day of HIV diagnosis. In the early fast-track group, one (0.8%) died, 12 (9.3%) were internally displaced/emigrated, five (3.9%) were lost-to-follow-up (LTFU), two (1.6%) had a gap in care/later return, one (0.8%) was transferred and 108 (83.7%) were retained; 88 (68.2%) received 48-week viral load testing and 80 (90.9% of tested; 62.0% of randomized) had HIV-1 RNA <200 copies/ml. In the standard group, two (1.7%) died, six (5.2%) were internally displaced/emigrated, three (2.6%) were LTFU, one (0.9%) had a gap in care/later return, one (0.9%) was transferred and 103 (88.8%) were retained; 78 (67.2%) received 48-week viral load testing and 66 (84.6% of tested; 56.9% of randomized) had HIV-1 RNA <200 copies/ml. By design, the sample size of this pilot study was too small to provide definitive evidence of treatment effect, but the primary outcome was numerically higher in the early fast-track group (62.0% vs. 56.9%; RD: 0.051: 95% CI: -0.072, 0.174). CONCLUSIONS: Early fast-track care was associated with high levels of viral suppression among adults initiating same-day TLD, despite severe civil unrest in Haiti. Completion of 48-week viral load testing was suboptimal, due to the need for participants to leave Port-au-Prince during peak periods of gang-related violence, and the lack of availability of viral load testing for those receiving non-facility-based ART.

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BACKGROUND: Gestational diabetes is one of the most prevalent diseases in pregnancy, with an incidence of 5 to 18% in Brazil, and is associated with high morbidity rates. The first-line treatment is insulin, although some recent studies have indicated that metformin might also be effective. Metformin is safe in pregnancy and appears to produce better results than insulin, including reduced gestational weight gain (GWG) and smaller gestational-age newborns. Few studies have been conducted on this topic in low- and middle-income countries. METHODS: We designed an open randomized controlled trial comparing two treatments for pregnant women with type II diabetes mellitus (DM) and gestational diabetes (DMG): the metformin group (intervention) and the insulin group (as a routine service). The primary outcome is glycemic control. The secondary outcomes are GWG, the occurrence of hypertensive syndromes, macrosomia, and neonatal hypoglycemia. The sample will comprise 92 pregnant women, 46 per group. The inclusion criteria will be GDM or type II DM requiring medication for glycemic control, singleton pregnancy, and gestational age under 34 weeks. The exclusion criteria will be current treatment with any medication for glycemic control, type I DM, and intolerance to the study medications (metformin or insulin). Women will be routinely followed during antenatal care, childbirth, and the postpartum period. Statistical analyses will include the intention-to-treat approach and a comparison between the two groups. DISCUSSION: Considering the Brazilian socioeconomic reality and the safety of metformin demonstrated in previous trials, we expect that the MevIP study will demonstrate that metformin is an adequate and appropriate medication for GDM treatment in the Brazilian population, representing an alternative to insulin for GDM. TRIAL REGISTRATION: This protocol has been registered prospectively in ReBEC under the ID RBR-3j3cktx in August 11, 2023.

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BACKGROUND: In patients with persistent atrial fibrillation (AF), addition of posterior wall isolation (PWI) to pulmonary vein isolation (PVI) is controversial. OBJECTIVE: Compare PVI plus PWI versus PVI alone in patients with persistent AF. METHODS: We searched PubMed (by MEDLINE), Embase, LILACS, CENTRAL (by Cochrane Library), and Clinicaltrials.gov databases for randomized trials comparing PVI + PWI and PVI alone in persistent AF. The outcomes were: (i) AF recurrence; (ii) composite of recurrent atrial arrhythmias (i.e., AF, atrial tachycardia, or atrial flutter); (iii) major clinical complications (i.e., pericardial effusion or tamponade, sinus node dysfunction, or atrioesophageal fistula); (iv) mean ablation time. Risk of bias and quality of evidence were evaluated using the Cochrane Risk of Bias 2.0 tool and GRADE, respectively. Statistical significance was set at 5%, and subgroup and sensitivity analyses were performed. RESULTS: We included eight studies and 1119 patients, of which 561 underwent PVI + PWI. During follow-up (12 - 24 months), recurrence of AF was significantly reduced with adjunctive PWI (RR 0.66, 95% CI 0.44-0.98). Composite of recurrent atrial arrhythmias did not differ significantly (RR 0.83, 95% CI 0.65-1.06). Major clinical complications (RR 0.81, 95% CI 0.42-1.58) were similar, with PVI alone having a shorter mean procedure time (mean difference -23.37 minutes, 95% CI -30.23, -16.50). CONCLUSION: Adjunctive PWI appears to be effective in improving recurrent AF, but not recurrence of all atrial arrhythmias. Procedure time was longer with PVI + PWI without significant change in overall safety. Further studies should focus on long-term benefit.

FUNDAMENTO: Em pacientes com fibrilação atrial (FA) persistente, a realização do isolamento da parede posterior (IPP) além do isolamento das veias pulmonares (IVP) é controversa. OBJETIVO: Comparar IVP mais IPP versus IVP exclusivo em pacientes com FA persistente. MÉTODOS: Trata-se de uma revisão sistemática conduzida nas bases de dados PubMed (MEDLINE), Embase, LILACS, CENTRAL (Cochrane Library), e Clinicaltrials.gov por ensaios clínicos randomizados comparando IVP + IPP e IVP exclusivo e FA persistente. Os desfechos foram (i) recorrência de FA; (ii) recorrência de arritmias atriais, isto é, FA, taquicardia atrial, ou flutter atrial); (iii) complicações clínicas importantes (isto é, derrame ou tamponamento pericárdico; disfunção do nó sinusal ou fístula atrioesofágica); (iv) tempo médio de ablação. O risco de viés e a qualidade da evidência foram avaliados usando a ferramenta Cochrane de avaliação de risco de viés (RoB 2.0) e o GRADE, respectivamente. A significância estatística foi estabelecida em 5%, e análises por subgrupos e de sensibilidade foram realizadas. RESULTADOS: Foram incluídos oito estudos e 1119 pacientes, dos quais 561 se submeteram a IVP+IPP. Durante o seguimento (12-24 meses), a recorrência de FA foi significativamente diminuída com IPP adjuvante (RR 0,66; IC 95%; 0,44-0,98). O composto de arritmias atriais recorrentes não difere significativamente (RR 0,83, IC 95% 0,65- 1,06). As complicações clínicas maiores (RR 0,81, IC95% 0,42-1,58) foram similares, e o IVP exclusivo foi associado a um tempo médio mais curto de procedimento (diferença média -23,37 minutos, IC 95% -30,23, -16,50). CONCLUSÃO: O IPP adjuvante parece efetivo em melhorar FA recorrente, mas não a recorrência de todas as arritmias atriais. O tempo de procedimento foi mais longo com IVP + IPP sem mudança significativa na segurança global. Mais estudos são necessários para investigar os benefícios em longo prazo.

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BACKGROUND: Previous studies have shown that women with coronary artery disease (CAD) are less likely to undergo angiography and have less favorable outcomes after percutaneous coronary intervention (PCI). OBJECTIVES: Assess the outcomes of women with acute coronary syndrome (ACS) and stable CAD (lesion>50%) treated with contemporary PCI using DES. METHODS: Observational, longitudinal cohort study with prospective follow-up included all female patients ≥ 18 years admitted at a tertiary public cardiovascular center in Brazil from January 2019 to December 2020. The level of significance adopted in the statistical analysis was 5%. RESULTS: 1146 women (average age 65 years) underwent guideline-recommended PCI. Risk factors were frequent (hypertension: 88%, dyslipidemia: 85%, diabetes: 47.5%), and 69% were admitted due to ACS. Radial access was used in 59% of patients; 1516 vessels were treated with 1725 stents implanted (1.5 stents/patient). PCI was successful in 97.7%, in-hospital death occurred in 1.2%, peri-procedural MI in 3.6%, and TIA in 0.4%. Predictors of in-hospital major adverse cardiac and cerebrovascular events (MACCE): previous stroke (OR: 2.97; CI: 1.06-7.15; p= 0.023), CKD (OR: 3.11; CI: 1.49-6.20; p= 0.002), and at least one procedural failure during PCI (OR: 10.2; CI: 1.17-5.9; p<0.001). The average follow-up was 576.2 days in 1047 patients. All-cause mortality occurred in 5.3%, cardiac death in 3.5%, recurrent ACS in 8%, and additional revascularization procedures in 5.5%. The predictors for MACCE during FU were hospital admission for ACS for the index PCI (OR: 1.58; HR: 1.06-2.35; p=0.023) and the presence of MACCE during hospitalization (OR: 6.66; HR: 2.42- 18.3; p< 0.001). CONCLUSION: In this pioneering study involving 1146 patients treated by contemporary PCI and followed for almost 2 years, we obtained very encouraging in-hospital and mid-term results.

FUNDAMENTO: Estudos prévios demonstram que mulheres com doença arterial coronariana (DAC) são menos submetidas a angiografia e apresentam resultados menos favoráveis após intervenção coronariana percutânea (ICP). OBJETIVOS: Avaliar os resultados de mulheres com síndrome coronariana aguda (SCA) e DAC estável (lesão>50%) tratadas com ICP contemporânea usando stents liberadores de drogas. MÉTODOS: Estudo de coorte observacional, longitudinal, com acompanhamento prospectivo, que incluiu todas as pacientes do sexo feminino > 18 anos admitidas em centro cardiológico público terciário no Brasil, no período de janeiro de 2019 a dezembro de 2020. RESULTADOS: 1146 mulheres (idade média de 65 anos) foram submetidas à ICP recomendada pela diretriz. Os fatores de risco foram frequentes (hipertensão: 88%, dislipidemia: 85%, diabetes: 47,5%) e 69% foram internadas devido à SCA. O acesso radial foi usado em 59% das pacientes; 1516 vasos foram tratados com 1725 stents implantados (1,5 stents/paciente). A ICP foi bem-sucedida em 97,7%, a morte intra-hospitalar ocorreu em 1,2%, IM periprocedimento em 3,6% e ataque isquêmico transitório em 0,4%. Preditores de eventos adversos cardíacos e cerebrovasculares maiores (ECCAM) intra-hospitalares: acidente vascular cerebral prévio (OR: 2,97; IC: 1,06-7,15; p = 0,023), DRC (OR: 3,11; IC: 1,49-6,20; p = 0,002) e pelo menos uma falha de procedimento durante ICP (OR: 10,2; IC: 1,17-5,9; p < 0,001). O acompanhamento médio foi de 576,2 dias em 1.047 pacientes. Mortalidade por todas as causas ocorreu em 5,3%, morte cardíaca em 3,5%, nova SCA em 8% e necessidade de nova revascularização em 5,5%. Os preditores de ECCM durante o seguimento foram admissão por SCA (retirar índice ICP) e a presença de ECCM durante a hospitalização (OR: 6,66; HR: 2,42-18,3; p< 0,001). CONCLUSÃO: Neste estudo pioneiro envolvendo 1146 pacientes tratados por ICP contemporânea e acompanhados por quase 2 anos, obtivemos resultados hospitalares e de médio prazo muito encorajadores.

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Systemic lupus erythematosus is a clinically heterogeneous autoimmune disease that frequently affects young women. The risk of cardiovascular events is higher in patients with this disease than in the general population. In this study, we report a patient who developed a left ventricular pseudoaneurysm with no etiological factor other than systemic lupus erythematosus. Dor ventriculoplasty and mitral ring replacement were performed as surgical treatment. The case is shared because of the rarity of left ventricular pseudoaneurysm due to systemic lupus erythematosus and successful pseudoaneurysm repair.

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In this paper, the authors describe a simplified technique for concomitant left atrial posterior box isolation for atrial fibrillation using a standard non-irrigated bipolar radiofrequency clamp without opening the left atrium.

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INTRODUCTION: Rheumatic heart disease remains a public health problem, especially in developing countries. The mitral valve (MV) is the main affected cardiac structure, requiring intervention in many cases. The discussion of which is the best option - repair or replacement - is still a controversy. OBJECTIVE: To compare the survival of patients with rheumatic MV submitted to replacement or repair. METHODS: We systematically reviewed the English literature through PubMed®, Literatura Latino-Americana e do Caribe em Ciências da Saúde (or LILACS), Scientific Electronic Library Online (or SciELO), and Google Scholar between January 2021 and February 2022, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (or PRISMA) methodology. Articles with a sample of at least 30 patients who underwent MV replacement or repair were included. RESULTS: Six studies including 2874 patients were analyzed. Most of the patients were female (2001; 69.6%) with a ratio of 2.3:1. The ages ranged from 11 to 66 years. The mean follow-up varied from six to 106 months. In the MV repair group, mortality was 2.5% (62 of 2473) and reoperation was 3.7% (93 of 2473), while in the MV replacement group, mortality was 8.2% (106 of 1291), and 3.6% (54 of 1475) of the patients required reoperation. The patient's survival was similar (85% for repair and 87% for replacement). The main complications post-MV repair or replacement were stroke (1.8%; 2.5%) and endocarditis (0.5%; 1.3%). CONCLUSION: The MV repair had lower mortality and fewer complications compared to MV replacement. Reoperation rate and survival are similar.

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BACKGROUND: Patients with long coronary lesions undergoing primary percutaneous coronary intervention (pPCI) have higher rates of adverse clinical events. Both stent length and stent overlap are associated with worse outcomes; however, data comparing very long stent (VLS) to overlapping stents (OSs) are limited, particularly during pPCI. This study aimed to compare the impact of a single VLS versus ≥2 OSs on clinical outcomes in a multicenter registry of patients undergoing pPCI. METHODS: This study included patients with ST-segment elevation myocardial infarction (STEMI) who underwent pPCI using a single VLS (≥38 mm) or ≥2 OS (total stent length, ≥38 mm) in the culprit lesion. After propensity score matching based on tortuosity, calcification, Killip class, culprit lesion length ≥40 mm, and culprit vessel, the final cohort for analysis was selected. The primary endpoint was a combination of mortality and target lesion failure (reinfarction, stent thrombosis, or new revascularization) at 2 years. RESULTS: Among 647 consecutive STEMI patients who underwent pPCI between March 2016 and September 2022, 353 received VLS and 294 received OSs. After propensity score matching, 264 patients remained (132 in each group). The occurrence of the primary outcome (VLS: 12.9 vs. OS: 15.9%; P = 0.86), all-cause mortality (VLS: 7.6 vs. OS: 9.8%; P = 0.51), and target lesion failure (VLS: 8.3 vs. OS: 6.8, P = 0.64) were similar between the 2 groups. CONCLUSIONS: In this cohort of real-world patients with STEMI undergoing pPCI, we found no significant difference in outcomes between VLS and OSs. Both strategies are reasonable treatment options for STEMI patients.

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PURPOSE: To examine the relationship between endoluminal and pathologic complete response after chemoradiotherapy for rectal cancer and identify predictors of a pathologic complete response. METHOD: The anatomic pathology reports of 102 consecutive patients with rectal cancer who underwent neoadjuvant chemoradiotherapy followed by proctectomy between 2013 and 2017 were reviewed for the presence or absence of endoluminal complete response. The presence of endoluminal complete response was compared with the anatomopathological stage. The residual lesion area was compared with the final pathologic stage to identify predictors of complete response. RESULTS: Of 102 patients, 20 (19.6 %) achieved a pathologic complete response (ypT0N0). Of these, 9 (45 %) did not achieve an endoluminal complete response. The presence of endoluminal complete response had a sensitivity of 55.00 %, specificity of 96.34 %, and accuracy of 88.24 % to identify ypT0N0. The presence of endoluminal complete response, residual lesion area ≤ 4 cm2, and tumor located in the mid-rectum were associated with pathologic complete response (ypT0N0). CONCLUSION: Almost half of the patients who had a pathologic complete response did not achieve an endoluminal complete response. Tumors located in the mid-rectum with a residual size of ≤ 4 cm2 and the presence of endoluminal complete response were significantly associated with the achievement of ypT0N0.

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PURPOSE: To identify the prognostic variables related to the survival of patients operated on for adenocarcinoma of the rectum who underwent preoperative radiochemotherapy (RCT). METHODS: We studied 70 patients from the Discipline of Surgical Gastroenterology at Escola Paulista de Medicina from 2000 to 2019, with rectal cancer located up to 10 cm from the anal verge and with stages II or III, submitted to preoperative RCT and curative surgery (R0) and with follow-up of at least 12 months. Clinical restaging was performed four to six weeks after the end of neoadjuvant treatment to characterize the degree of clinical tumor regression. Surgery by laparotomy or videolaparoscopy was performed six to 12 weeks after RCT. Primary endpoint were: overall survival (OS), disease-free survival (DFS), metastasis-free survival (MSS), and neoplasm-specific survival (SEN). These were compared with gender, age, carcinoembryonic antigen (CEA) dosage, distance from the tumor to the anal verge, radiation dose, radiotherapy-surgery interval, clinical regression, type of surgery, pT and pN TNM stage tumor, number of nodes, circumferential resection margin, and complete pathological response. Survival was assessed by Kaplan-Meier curves. Univariate and multivariate Cox analyses were calculated to identify factors associated with survival outcomes. RESULTS: The mean follow-up time was 62 months. The pathological complete response rate was 18.6%. Univariate cox regression showed a significant relationship of CEA equal to or greater than 4 ng/mL with DFS and MFS, pT3/pT4 staging with DFS, MFS and SEN, pN1/N2 with DFS, MFS and SEN and stages II and III with DFS and MFS. Multivariate regression found that CEA, pT, and pN staging are independent prognostic factors for DFS, MFS, and SEN. CONCLUSION: Carcinoembryonic antigen level prior to radiotherapy, pT staging and pN staging were independent prognostic factors for survival in patients with rectal adenocarcinoma who are treated with preoperative radiochemotherapy.

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INTRODUCTION: Urinary Tract Infections (UTIs) are a significant health problem worldwide, especially among women. methenamine hippurate has been proposed as a preventive measure against recurrent UTIs. This updated systematic review and meta-analysis aimed to evaluate the effectiveness of methenamine hippurate in preventing UTIs, incorporating the latest research findings and employing trial sequential analysis to assess the robustness of the evidence. MATERIALS AND METHODS: A systematic review was conducted across MEDLINE, Embase, Scopus, Cochrane, and Google Scholar up to March 2024 for randomized controlled trials comparing methenamine hippurate with placebo or antibiotic in adult women with a history of recurrent, confirmed UTIs. Key outcomes included symptomatic UTIs as primary outcome and positive urine culture, asymptomatic bacteriuria and adverse effects as secondary outcomes. It is important to state that asymptomatic UTIs with negative urine cultures were not adequately accounted for in the studies; therefore, this outcome was excluded from our meta-analysis. Additionally, adverse effects related to antibiotic resistance were not described in the studies, so only the adverse effects of the medications themselves were considered. The risk of bias was evaluated using the Cochrane Risk of Bias 2, and statistical analysis was conducted using RStudio software. RESULTS: We retrieved 5 articles, encompassing 216 patients in the methenamine group and 205 patients in the control group (Antibiotic). Our analysis revealed non-inferiority in the rate of symptomatic UTI episodes between the two groups (RR 1.15; 95%CI 0.96,1.38; p = 0.41; I2 = 0%). Similarly, there were no notable distinctions in the rate of positive urine cultures (RR 1.20; 95CI 0.91, 1.57; p = 0.25; I2 = 28%), and the rate of adverse effects (RR 0.98; 95CI 0.86, 1.12; p = 0.35; I2 = 9%). However, we observed a decreased frequency of asymptomatic bacteriuria in the control group (RR 1.91; 95CI 1.29, 2.81; p = 0.0001; I2 = 0%). In trial sequential analysis, existing studies were not able to achieve the futility boundaries. CONCLUSIONS: Overall, our meta-analysis provides evidence supporting methenamine hippurate as an effective, non-inferior and safe prophylactic option for preventing recurrent UTIs in adult women, as demonstrated by the current evidence base. Nevertheless, more RCTs are necessary to achieve the futility boundaries in trial sequential analysis.

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BACKGROUND: Multimodal rehabilitation has shown good results in adults with temporomandibular disorder (TMD), but there is still doubt regarding the protocol's ideal format (face-to-face or online), and its effectiveness among adolescents. The purpose of this study is to describe a randomized clinical trial protocol of face-to-face and online multimodal rehabilitation, in adolescents with TMD, and to determine its effects on pain, peripheral oxygenation of the masseter muscle, and mandibular range of motion, kinesiophobia and parafunction. METHODS: A randomized, controlled clinical trial, blinded to statistical analyses, will be carried out, involving 26 adolescents, diagnosed with TMD. After randomization, the participants will be allocated into two groups: (1) telerehabilitation and (2) face-to-face treatment groups. Each group will undergo an initial assessment, followed by three treatment sessions, reassessment, and follow-up. Appointments and reassessments will be face-to-face, with instruments validated and adapted for adolescent age groups. The intervention protocol also aims at practicality, ease of execution, and strategies for the patient to easily self-manage and perform independently, adapted for face-to-face or online formats. The Diagnostic Criteria for Temporomandibular Disorders, physical and psychosocial aspects, algometry, near-infrared spectroscopy, and the Tampa scale for kinesiophobia will be used to assess the outcomes. DISCUSSION: It is expected that this study will contribute to online and face-to-face assessments and demonstrate the differences in the practice of rehabilitation of adolescents with TMD. Data will be published after the study is completed, and if the benefits are proven, care modalities may be implemented. TRIAL REGISTRATION: REBEC-RBR-5scd5tm, UTN code: U1111-1288-4495 . Registered on 19 May 2023.

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BACKGROUND: Sodium‒glucose cotransporter 2 (SGLT2) inhibitors have been included in heart failure (HF) guidelines because of their benefits in reducing mortality and hospitalization rates. However, the timing and benefits of initiating SGLT2 inhibitors in patients after myocardial infarction (MI) remain controversial. Therefore, we aimed to perform a systematic review and meta-analysis comparing SGLT2 inhibitors with placebo in patients with MI. METHODS: We performed a systematic review and meta-analysis to determine the impact of SGLT2 inhibitors in patients with recent or previous MI. We systematically searched PubMed, Cochrane, and Embase for RCTs comparing SGLT2 inhibitors versus placebo in patients with MI. The primary outcome was (1) HF hospitalization. In this analysis, we also included the following secondary outcomes: (2) major adverse cardiovascular events (MACE) defined as a composite of cardiovascular (CV) death, MI or stroke; and (3) all-cause mortality. A subgroup analysis was conducted for the primary outcome, comparing patients who had experienced an MI more than 8 weeks prior to study enrolment (previous MI) versus those who had experienced an MI within the preceding 8 weeks (acute MI). Risk ratios (RRs) and 95% confidence intervals (CIs) were pooled with a random effects model. RESULTS: Our meta-analysis included 10 RCTs comprising 22,266 patients, of whom 11,339 (51.2%) had type 2 diabetes. The mean age was 62 years, and the median follow-up was 21 months. According to the pooled analysis, HF hospitalization rates were lower in patients on SGLT2 inhibitors compared with placebo (RR 0.77; 95% CI 0.69, 0.85; p < 0.001)). Differences in MACE were also observed in favor of SGLT2 inhibitors versus placebo (RR 0.88; 95% CI 0.79, 0.97; p = 0.012). There was no statistically significant difference in all-cause mortality between the groups (RR 0.88; 95% CI 0.78, 1.00; p = 0.058). Benefits of SGLT2 inhibitors for the primary outcome were consistent regardless of the timing of last MI, with no treatment by subgroup interaction (p for interaction = 0.56). CONCLUSION: In this meta-analysis of patients who experienced MI, the administration of SGLT2 inhibitors was associated with lower rates of hospitalization for HF. In addition, the treatment effect of SGLT2 inhibitors was consistent regardless of whether they were started in the recent versus previous MI setting.

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The aim of this study was to assess the impact of orthodontic treatment with orthodontic aligners (OAs) and fixed appliances (FAs) on oral health-related quality of life (OHRQoL). This parallel randomized clinical trial included 40 male and female patients aged 13 to 35 years diagnosed with Angle's Class I malocclusion. Participants were assigned to two groups: OA (n = 20) and FA (n = 20). OHRQoL was assessed using the Brazilian OHIP-14, which was administered before treatment (T0), at 1 month (T1), 6 months (T2), and 12 months (T3) after treatment initiation. Data were analyzed using the independent t test, the chi-square test, the Mann-Whitney test, and Friedman test (p < 0.05). FAs had a significantly (p < 0.05) higher impact on OHRQoL at T1 in terms of functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, and overall score. Within-group comparison showed higher scores for the FA group in comparison to the OA group. Functional limitation scores were higher at T1 than at T0 (p = 0.034), while physical pain scores were higher at T1 compared to T0 (p = 0.034) and T2 (p = 0.010). Psychological discomfort scores were higher at T1 than at T2 (p = 0.015). Physical disability scores were higher at T1 compared to T0 (p = 0.008). Overall scores were higher at T1 than at T2 (p = 0.003). No significant changes were observed in the OA within-group comparison. Patients treated with OAs had less impact on OHRQoL compared to those treated with FAs in the first month. There was no difference between the groups at the 6-month follow-up.