Causa de mortalidade materna na região metropolitana I no triênio 2013-2015, Belém, PA / Cause for maternal mortality in the metropolitan region I in the 2013-2015 trien, Belém, PA / Causa de mortalidad materna en la región metropolitana I en el trienio 2013-2015, Belém, PA

Objetivo: estudo sobre a ocorrência de óbitos maternos na região metropolitana de Belém no período de janeiro de 2013 a dezembro de 2015. Método: Trata-se de uma abordagem epidemiológica, descritiva, quantitativa, retrospectiva e documental. Incluindo: óbitos classificados como morte materna por causas obstétricas diretas e indiretas. Sendo excluído: óbitos classificados como acidentais. Por intermédio da estatística descritiva. Resultado: No período de janeiro de 2013 a dezembro de 2015, foram declarados 53 óbitos em 2013, 45 óbitos maternos no ano de 2014 e 40 óbitos em 2015. Os dados identificaram uma razão de mortalidade materna de 160,3 no ano de 2013, 136,0 no ano de 2014 e 121,9 em 2015. Conclusão: A morte materna na região metropolitana I é caracterizada por RMM acima do recomendado pela OMS, evidenciando a necessidade de atenção integral e de qualidade à saúde da gestante, desde o pré-natal até o puerpério, no Estado do Pará.(AU)

Objective: a study on the occurrence of maternal deaths in the metropolitan region of Belém from January 2013 to December 2015. Method: This is an epidemiological, descriptive, quantitative, retrospective and documentary approach. Including: deaths classified as maternal deaths from direct and indirect obstetric causes. Being excluded: deaths classified as accidental. By means of descriptive statistics. Outcome: From January 2013 to December 2015, 53 deaths were reported in 2013, 45 maternal deaths in 2014 and 40 deaths in 2015. The data identified a maternal mortality ratio of 160.3 in the year 2013, 136.0 in 2014 and 121.9 in 2015. Conclusion: Maternal death in the metropolitan region I is characterized by MMR above that recommended by the WHO, evidencing the need for integral attention and quality to the health of the pregnant woman, to the puerperium in the state of Pará.(AU)

Objetivo: Estudio sobre la ocurrencia de muertes maternas en la región metropolitana de Belém en el período de enero de 2013 a diciembre de 2015. Método: Se trata de un abordaje epidemiológico, descriptivo, cuantitativo, retrospectivo y documental. Incluyendo: óbitos clasificados como muerte materna por causas obstétricas directas e indirectas. Si se excluye: muertes clasificadas como accidentales. Por medio de la estadística descriptiva. Resultado: En el período de enero de 2013 a diciembre de 2015, se declararon 53 muertes en 2013, 45 muertes maternas en el año 2014 y 40 muertes en 2015. Los datos identificaron una razón de mortalidad materna de 160,3 en el año 2013, En el año 2014 y 121,9 en 2015. Conclusión: La muerte materna en la región metropolitana I se caracteriza por RMM por encima de lo recomendado por la OMS, evidenciando la necesidad de atención integral y de calidad a la salud de la gestante, desde el preescolar, -natal hasta el puerperio, en el Estado de Pará.(AU)

Influence of plasma cleaning procedure on the interaction between soft tissue and abutments: a randomized controlled histologic study.

INTRODUCTION: Plasma application can lead to an improved adhesion between soft tissue and abutments and promotes cell spreading. OBJECTIVE: A triple-blinded randomized controlled clinical trial was performed to in vivo test the effect of cleaning abutment titanium surfaces with plasma of argon on cell adhesion and collagen fiber orientation at an early healing time. MATERIAL AND METHODS: Thirty healthy patients with 30 submerged implants, at the second surgery, randomly received either a specially designed abutment with no additional treatment (as they come from industry; control group, G1) or cleaned by plasma of argon (test group, G2). Two weeks thereafter, a small biopsy including abutment and soft tissues around the abutment was performed. Abutments were analyzed using scanning electron microscopy to assess cell adhesion to the abutment surface. Outcome measures were the following: percentage of area occupied by cells, the presence or absence of cells, aspect of adhered cells, and the presence of contaminants. At the same time, the soft tissue histological analysis evaluated density and orientation of collagen fibers. Statistical analysis was performed using the Kolmogorov-Smirnov normality test and Levene variance homogeneity test. Data were analyzed using a nonparametric ranking test. The associations between the different qualitative variables were studied using Pearson's chi-squared test. The Mann-Whitney U-test (for two independent samples) was applied for quantitative variables. RESULTS: Mean percentages of area occupied by cells were 15.14% (range 2.91-44.27) and 33.75% (range 2.37-68.4) for G1 and G2, respectively. Differences were close to significance (P = 0.089). The proportion of samples presenting adhered cells was homogeneous between the two groups (P = 0.142). In all cases, cells presented a flattened aspect, but not in three cases in the G2; in 17 cases, cells were efficiently adhered, and in 11 cases, cells presented filopodia with no statistical differences between groups (P > 0.05). No case from G2 showed contamination with cocobacteria with statistical differences between groups (P = 0.006). Collagen fiber density was higher in the basal, medial, and coronal area of G2 compared to G1 with a statistical difference in the internal area (P < 0.05). The orientation of the fibers varied according to the coordinate area with oblique fibers predominant in G2 than in G1. CONCLUSION: Plasma of argon may promote cell adhesion and positively influence collagen fiber orientation. A greater sample is necessary to confirm these preliminary results.

Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study

BACKGROUND: Extensive literature exists about the use of the BFP in the treatment of oral defects but, to our knowledge, no article refers to the use of the BFP as a substitute of the membrane barriers for treatment of periimplant bone defects. The aim was to evaluate the use of the buccal fat pad as a coating material for bone grafting in the peri-implant bone defect regeneration of immediate implants placed in the posterior maxilla. MATERIAL AND METHODS: A preliminary prospective study of patients involving immediate implants in which the buccal fat pad was used as a coating material to peri-implant bone defects was carried out. The outcome measures assessed were: postoperative pain and swelling, complications related to buccal fat pad surgery, implant survival and success rates and peri-implant marginal bone loss at 12 months of prosthetic loading. RESULTS: Twenty-seven patients (17 women and 10 men) with a mean age of 55.3 ± 8.9 years, and a total of 43 implants were included. Two-thirds of the patients reported either no pain or only mild intensity pain and moderate inflammation, two days after surgery. Post-operative period was well tolerated by the patients and no serious complications occurred. None wound dehiscence occurred. Implant survival and success rates were 97.6% and the average marginal bone loss 1 year after loading was 0.58 ± 0.27 mm. CONCLUSIONS: Within the limits of this preliminary study, the use of the buccal fat pad as a coating material for bone grafting in peri-implant bone defects placed in the upper posterior maxilla was a well-tolerated technique by patients; high implant success rate was achieved with a minimal peri-implant marginal bone loss at 12 months of prosthetic loading

Use of buccal fat pad to repair post-extraction peri-implant bone defects in the posterior maxilla. A preliminary prospective study.

BACKGROUND: Extensive literature exists about the use of the BFP in the treatment of oral defects but, to our knowledge, no article refers to the use of the BFP as a substitute of the membrane barriers for treatment of peri-implant bone defects. The aim was to evaluate the use of the buccal fat pad as a coating material for bone grafting in the peri-implant bone defect regeneration of immediate implants placed in the posterior maxilla. MATERIAL AND METHODS: A preliminary prospective study of patients involving immediate implants in which the buccal fat pad was used as a coating material to peri-implant bone defects was carried out. The outcome measures assessed were: postoperative pain and swelling, complications related to buccal fat pad surgery, implant survival and success rates and peri-implant marginal bone loss at 12 months of prosthetic loading. RESULTS: Twenty-seven patients (17 women and 10 men) with a mean age of 55.3 ± 8.9 years, and a total of 43 implants were included. Two-thirds of the patients reported either no pain or only mild intensity pain and moderate inflammation, two days after surgery. Post-operative period was well tolerated by the patients and no serious complications occurred. None wound dehiscence occurred. Implant survival and success rates were 97.6% and the average marginal bone loss 1 year after loading was 0.58 ± 0.27 mm. CONCLUSIONS: Within the limits of this preliminary study, the use of the buccal fat pad as a coating material for bone grafting in peri-implant bone defects placed in the upper posterior maxilla was a well-tolerated technique by patients; high implant success rate was achieved with a minimal peri-implant marginal bone loss at 12 months of prosthetic loading.

Angiotensin II-independent angiotensin-(1-7) formation in rat hippocampus: involvement of thimet oligopeptidase.

The involvement and relevance of the renin-angiotensin system have been established clearly in cardiovascular diseases, and renin-angiotensin system involvement has also been investigated extensively in the central nervous system. Angiotensin II acts classically by binding to the AT1 and AT2 receptors. However, other pathways within the renin-angiotensin system have been described more recently, such as one in which angiotensin-(1-7) (Ang-(1-7)) binds to the receptor Mas. In the central nervous system specifically, it has been reported that this heptapeptide is involved in learning and memory processes that occur in central limbic regions, such as the hippocampus. Therefore, this prompted us to investigate the possible role of the Ang-(1-7)-receptor Mas pathway in epileptic seizures, which are also known to recruit limbic areas. In the present study, we show that Ang-(1-7) is the main metabolite of angiotensin I in rat hippocampi, and, strikingly, that thimet oligopeptidase is the main enzyme involved in the generation of Ang-(1-7). Furthermore, elevations in the levels of thimet oligopeptidase, Ang-(1-7), and of receptor Mas transcripts are observed in chronically stimulated epileptic rats, which suggest that the thimet oligopeptidase-Ang-(1-7)-receptor Mas axis may have a functional relevance in the pathophysiology of these animals. In summary, our data, which describe a new preferential biochemical pathway for the generation of Ang-(1-7) in the central nervous system and an increase in the levels of various elements of the related thimet oligopeptidase-Ang-(1-7)-receptor Mas pathway, unveil potential new roles of the renin-angiotensin system in central nervous system pathophysiology.

Effectiveness of psychoeducation for depression: a systematic review.

OBJECTIVE: Pharmacological treatment is considered indispensable to major depressive disorder. In spite of this, a significant number of patients do not respond adequately to treatment based only on medication, presenting high relapse and recurrence rates. Therefore, psychosocial interventions, such as psychoeducation, have been increasingly recognized as an essential component in the treatment of depression, associated with pharmacological strategies. Thus, the aim of the present systematic review was to evaluate the effectiveness of psychoeducation for patients with unipolar depression, analyzing the evidence from the literature. METHOD: Searches were undertaken from April to October 2012 in LILACS, PsycINFO, PubMed, SCOPUS and ISI Web of Knowledge with keywords including 'psychoeducation', 'psychoeducational intervention' and 'depression', with no restriction regarding publishing dates. RESULTS: Fifteen studies were included in the review, 13 of which evaluated the effectiveness of psychoeducation for patients with depression: 10 papers evaluated in-person psychoeducation approaches and three papers evaluated long-distance approaches. In addition to these 13 papers, one evaluated psychoeducational interventions for patients' families and patients' responses and another evaluated psychoeducational interventions for patients' families and families' responses. Findings suggest that increased knowledge about depression and its treatment is associated with better prognosis in depression, as well as with the reduction of the psychosocial burden for the family. CONCLUSIONS: Psychoeducation is a psychosocial treatment that has been well documented as an adjunct to pharmacological therapy. However, there are only a few studies regarding its effectiveness on adult patients with major depressive disorder. Although the publications in this area are still very limited, the articles selected in this review suggest that psychoeducation is effective in improving the clinical course, treatment adherence, and psychosocial functioning of depressive patients.

A nonionic porphyrin as a noninterfering DNA antibacterial agent.

The increasing interest in clinical bacterial photodynamic inactivation has led to the search for photosensitizers with higher bactericidal efficiency and less side effects on the surrounding tissues. We present a novel nonionic porphyrin, the 5,10,15-tris(2,6-dichlorophenyl)-20-[4-N-(6-amino-hexyl)sulfonamido)phenyl]-porphyrin (ACS769F4) with substantial improvements in the efficiency of nonionic sensitizers. This porphyrin causes eradication of both Escherichia coli and Staphylococcus aureus by the photodynamic effect but in higher concentrations compared with 5,10,15,20-tetrakis (4-N,N,N-trimethylammoniumphenyl)-porphyrin p-tosylate (TTAP(4+)), a known bactericidal tetracationic porphyrin. More important, under such conditions, ACS769F4 proved to be harmless to two mammalian cells lines (human embryonic and baby hamster kidney), causing no reduction in their viability or negative impact on their cytoskeleton, despite its accumulation in cellular structures. On the contrary, TTAP(4+) is shown to accumulate in the nucleus of mammalian cells, in association to DNA, causing chromatin condensation after exposure to light. Furthermore, dark incubation with TTAP(4+) was shown to have a deleterious effect on the microtubule network. Based on its bactericidal efficiency, also observed without exposure to light, and on the low tendency to be harmful or genotoxic to mammalian cells, ACS769F4 should be looked at as an interesting photosensitizer to be evaluated for clinical purposes.

Modified LEAD System distractor to prevent tilting during alveolar distraction in the mandibular symphyseal region.

This report describes a simple modification of the LEAD System distractor that prevents tilting of the distractor rod, and consequent deviation of distraction direction, during alveolar distraction in the mandibular symphysis region.

Cemento-ossifying mandibular fibroma: a presentation of two cases and review of the literature.

We present two clinical cases of radiolucent mandibular lesions in young women that simulated chronic periapical infectious pathology. The detection of both cases was fortuitous since they were totally asymptomatic. Diagnosis was reached in one case (upon periapical surgery and anatomo-pathologic study) after endodontic treatment and after verifying non-resolution of affected periapical area. The other case was an extensive lesion, which involved the periapices of the four inferior incisors in which surgery was directly performed upon verifying pulp vitality of these teeth. After surgery endodontic treatment was performed on the teeth that had lost their vitality. In both cases the histopathologic tests revealed the presence of a cemento-ossifying fibroma, the initial clinical and radiographic diagnosis of which could easily be overlooked.

Fibroma cemento-osificante mandibular: Presentación de dos casos y revisión de la literatura / Cemento-ossifying mandibular fibroma: a presentation of two cases and rewiev of the literature

Presentamos dos casos clínicos de lesiones radiotransparentes mandibulares en mujeres jóvenes, que simularon patología infecciosa crónica periapical. En ambos el hallazgo fue casual puesto que no produjeron ningún tipo de Estomatología. En un caso se llegó al diagnóstico (tras la cirugía periapical y el estudio anatomo-patológico) después de realizar la endodoncia del diente implicado y comprobar la no resolución del área periapical. En el otro caso, cuya lesión abarcaba el periápice de los 4 incisivos inferiores, se realizó directamente la cirugía tras comprobar la vitalidad pulpar positiva de estos dientes. Con posterioridad a la intervención quirúrgica se realizó la endodoncia de los dientes que habían perdido la vitalidad.En ambos casos el examen histopatológico, mostró la presencia de un fibroma cemento osificante, cuyo diagnóstico inicial clínico y radiográfico, en ocasiones, puede pasar desapercibido. (AU)