Health-Related Quality of Life in Women with Breast Cancer Undergoing Chemotherapy in Brazil.

INTRODUCTION: Breast cancer (BC) is an austere public health problem, representing the most incident and prevalent malignancy among women worldwide. OBJECTIVE: To evaluate the health-related quality of life of women with breast cancer undergoing initial and final stages of chemotherapy treatment. METHODS: It was descriptive, correlational, analytical, prospective cross-sectional study that included 80 women diagnosed with breast cancer undergoing chemotherapy treatment. Health-related quality of life was assessed in two phases. The first one was on the initial day of the treatment and the second, 120 days after started the chemotherapy. RESULTS: Eighty adult women were part of the study, whose average age was 52.54. Overall quality of life decreased due to chemotherapy. It was noted the negative impact that the emotional role, the sexual function and the concern about hair loss on health-related quality of life. It was observed that fatigue, nausea and vomiting, appetite loss, diarrhea were frequent symptoms in comparison between the phases. Sexual function and satisfaction were dissatisfying and worsened during chemotherapy. CONCLUSION: The quality of life related to the health of patients is negatively influenced during chemotherapy treatment, hence, requiring interventions in oncology and research in this sphere.

Characteristic and quantifiable COVID-19-like abnormalities in CT- and PET/CT-imaged lungs of SARS-CoV-2-infected crab-eating macaques (Macaca fascicularis)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing an exponentially increasing number of coronavirus disease 19 (COVID-19) cases globally. Prioritization of medical countermeasures for evaluation in randomized clinical trials is critically hindered by the lack of COVID-19 animal models that enable accurate, quantifiable, and reproducible measurement of COVID-19 pulmonary disease free from observer bias. We first used serial computed tomography (CT) to demonstrate that bilateral intrabronchial instillation of SARS-CoV-2 into crab-eating macaques (Macaca fascicularis) results in mild-to-moderate lung abnormalities qualitatively characteristic of subclinical or mild-to-moderate COVID-19 (e.g., ground-glass opacities with or without reticulation, paving, or alveolar consolidation, peri-bronchial thickening, linear opacities) at typical locations (peripheral>central, posterior and dependent, bilateral, multi-lobar). We then used positron emission tomography (PET) analysis to demonstrate increased FDG uptake in the CT-defined lung abnormalities and regional lymph nodes. PET/CT imaging findings appeared in all macaques as early as 2 days post-exposure, variably progressed, and subsequently resolved by 6-12 days post-exposure. Finally, we applied operator-independent, semi-automatic quantification of the volume and radiodensity of CT abnormalities as a possible primary endpoint for immediate and objective efficacy testing of candidate medical countermeasures.

Carotid-artery cochlear dehiscence

Changes in course of the internal carotid artery (ICA) are uncommon, and dehiscence of the carotid canal with cochlea may occur. A 48-year-old female individual with pulsatile tinnitus. No other otologic symptoms observed. Otolaryngologic examination and audiometric test with normal results. Computed tomography (CT) scan of the mastoid bones showed dehiscence of cochlea with ICA on the right side. An option for monitored observation was made after analysis of the risks and undefined results of surgery. Patient maintained clinical and audiometric profile. Carotid-artery cochlear dehiscence is a condition that must be known, remembered and investigated, because it may mimic other otologic pathologies. Knowledge about it prevents serious complications that can be difficult to reverse.

Genetic polymorphisms underlying the skeletal Class III phenotype.

INTRODUCTION: Our goal was to verify the association between candidate polymorphisms and skeletal Class III malocclusion in a well-characterized homogeneous sample set. METHODS: Thirty-five single-nucleotide polymorphisms were studied from 10 candidate loci in 54 Class III subjects and 120 controls. Skeletal Class III characteristics included ANB angle less than 0°, SNB angle greater than 83° (mandibular prognathism), SNA angle less than 79° (maxillary deficiency), Class III molar relationship, and negative overjet. Inclusion criteria for the controls were ANB angle between 0° and 4°, Class I molar relationship, and normal overjet. Chi-square and Fisher exact tests and principal component (PC) analysis were used to determine overrepresentation of marker alleles with alpha of 0.05. Odds ratios and 95% confidence intervals were calculated. RESULTS: MYO1H (rs10850110 AG) (P = 0.001) with PC2 and between FGF10 (rs593307 A

Cultural adaptation and the Clavien-Dindo surgical complications classification translated to Brazilian Portuguese.

OBJECTIVE: to generate a translated and validated version of the Clavien-Dindo Classification of Surgical Complications (CDC) to Brazilian Portuguese (CDC-BR). METHODS: the process of translation and adaptation followed the guideline of Beaton et al., 2000. We divided 76 participating surgeons, in different levels of experience, from the Department Surgery of the Hospital de Clínicas de Porto Alegre, into two groups: Group I applied the original version (CDC, n=36);r Group II used the modified version (CDC-BR, n=40). Each group classified 15 clinical cases of surgical complications. We compared performance between the groups (Mann-Whitney test) relating to the level of experience of the surgeon (Kruskal-Wallis test), considering p value <0.05 as significant. RESULTS: the performance of the Group II (CDC-BR) was higher, with 85% accuracy, compared with 79% of Group I (CDC), p-value =0.012. The performance of the groups as for surgeons experience displayed p=0.171 for Group I, p=0.528 for Group II, and p=0.135 for overall performance. CONCLUSION: we produced a translated and validated version of the CDC for Brazilian Portuguese. The instrument will be a useful tool in the production of evidence on surgical outcomes. OBJETIVO: gerar uma versão traduzida e validada da Classificação de Complicações Cirúrgicas de Clavien-Dindo (CCD) para o Português-Brasileiro (CCD-BR). MÉTODOS: o processo de tradução e adaptação seguiu a diretriz de Beaton et al., de 2000. Formaram-se dois grupos, Grupo I, que utilizou a versão original (CCD, n=36) testado em relação ao Grupo II, com a versão modificada (CCD-BR, n=40), com um total de 76 cirurgiões participantes em níveis de experiência distintos do Departamento de Cirurgia do Hospital de Clínicas de Porto Alegre. Quinze casos clínicos de complicações cirúrgicas foram classificados em cada grupo. Comparou-se o desempenho entre grupos (teste de Mann-Whitney) relacionando ao nível de experiência dos cirurgiões (teste de Kruskal-Wallis). Valor de p<0,05 como significativo. RESULTADOS: o desempenho do Grupo II (CCD-BR) foi superior, com 85% de acertos, contra 79% do Grupo I (CCD), p-valor=0,012 do teste de Mann-Whitney. O desempenho dos grupos em relação à experiência dos cirurgiões foi p-valor=0,171 para o Grupo I, p-valor=0,528 para o Grupo II, e p-valor=0,135 para o desempenho geral, teste de Kruskal-Wallis. CONCLUSÃO: foi produzida uma versão traduzida e validada da CCD para o Português-Brasileiro. O instrumento produzido será ferramenta útil na produção de evidências sobre os resultados cirúrgicos.

Cultural adaptation and the Clavien-Dindo surgical complications classification translated to Brazilian Portuguese / Adaptação cultural e teste da escala de complicações cirúrgicas de Clavien-Dindo traduzida para o Português do Brasil

ABSTRACT Objective: to generate a translated and validated version of the Clavien-Dindo Classification of Surgical Complications (CDC) to Brazilian Portuguese (CDC-BR). Methods: the process of translation and adaptation followed the guideline of Beaton et al., 2000. We divided 76 participating surgeons, in different levels of experience, from the Department Surgery of the Hospital de Clínicas de Porto Alegre, into two groups: Group I applied the original version (CDC, n=36);r Group II used the modified version (CDC-BR, n=40). Each group classified 15 clinical cases of surgical complications. We compared performance between the groups (Mann-Whitney test) relating to the level of experience of the surgeon (Kruskal-Wallis test), considering p value <0.05 as significant. Results: the performance of the Group II (CDC-BR) was higher, with 85% accuracy, compared with 79% of Group I (CDC), p-value =0.012. The performance of the groups as for surgeons experience displayed p=0.171 for Group I, p=0.528 for Group II, and p=0.135 for overall performance. Conclusion: we produced a translated and validated version of the CDC for Brazilian Portuguese. The instrument will be a useful tool in the production of evidence on surgical outcomes.

RESUMO Objetivo: gerar uma versão traduzida e validada da Classificação de Complicações Cirúrgicas de Clavien-Dindo (CCD) para o Português-Brasileiro (CCD-BR). Métodos: o processo de tradução e adaptação seguiu a diretriz de Beaton et al., de 2000. Formaram-se dois grupos, Grupo I, que utilizou a versão original (CCD, n=36) testado em relação ao Grupo II, com a versão modificada (CCD-BR, n=40), com um total de 76 cirurgiões participantes em níveis de experiência distintos do Departamento de Cirurgia do Hospital de Clínicas de Porto Alegre. Quinze casos clínicos de complicações cirúrgicas foram classificados em cada grupo. Comparou-se o desempenho entre grupos (teste de Mann-Whitney) relacionando ao nível de experiência dos cirurgiões (teste de Kruskal-Wallis). Valor de p<0,05 como significativo. Resultados: o desempenho do Grupo II (CCD-BR) foi superior, com 85% de acertos, contra 79% do Grupo I (CCD), p-valor=0,012 do teste de Mann-Whitney. O desempenho dos grupos em relação à experiência dos cirurgiões foi p-valor=0,171 para o Grupo I, p-valor=0,528 para o Grupo II, e p-valor=0,135 para o desempenho geral, teste de Kruskal-Wallis. Conclusão: foi produzida uma versão traduzida e validada da CCD para o Português-Brasileiro. O instrumento produzido será ferramenta útil na produção de evidências sobre os resultados cirúrgicos.

Toxicity in food flavorings at the cellular level associated with each other at different doses / Toxicidade em nível celular de aromatizantes alimentares associados entre si em diferentes doses

This study aimed to examine the cytotoxicity and genotoxicity of synthetic flavorings, nature identical, Chocolate, Strawberry and Condensed Milk. This evaluation was performed in root meristem cells of Allium cepa L., in exposure times of 24 and 48 hours and using doses of 0.2; 0.4 and 0.6 mL, in combination, in which one of the three doses of a flavoring was combined with a different dose of one of the two other flavor additives studied. Roots were fixed in Carnoy's solution, hydrolyzed in hydrochloric acid, stained with acetic orcein and then analyzed, under light microscopy, 5,000 cells for each treatment. For data analysis, it was used Chi-square test at 5%. All the treatments with combinations between the flavorings Chocolate/Strawberry and Strawberry/Condensed Milk reduced, in both exposure times considered, cell division of A. cepa roots, proving to be cytotoxic. In turn, the treatments with the association of Chocolate/Condensed Milk did not change significantly the mitotic index of the cells analyzed. The Strawberry flavoring was the most cytotoxic among the additives tested. None of the evaluated associations was genotoxic under the study conditions.

Objetivou-se nesta pesquisa avaliar a citoxicidade e genotoxicidade de aromatizantes alimentares sintéticos de chocolate, morango e leite condensado. Esta avaliação ocorreu por meio das células meristemáticas de raízes de A. cepa L., nos tempos de exposição de 24 e 48h e nas doses de 0,2; 0,4 e 0,6 mL, em associação, em que para uma das três doses de um dos aromatizantes associou-se uma dose diferente de um dos outros dois aditivos de aroma em estudo. Em seguida, as raízes foram fixadas em solução de Carnoy, hidrolisadas em ácido clorídrico e coradas com orceína acética. Analisaram-se, em microscópio óptico, 5.000 células para cada grupo tratamento, e utilizou-se o teste estatístico Qui-quadrado a 5% para análise dos dados. A partir dos resultados, verificou-se que todos os tratamentos decorrentes das associações entre chocolate/morango e morango/leite condensado reduziram, nos dois tempos de exposição considerados, a divisão celular das raízes A. cepa, mostrando-se citotóxicos. Já os tratamentos provenientes da associação chocolate/leite condensado não alteraram de forma significativa os índices mitóticos das células do tecido em análise. Foi possível inferir que o aditivo de morango foi o mais citotóxico dos aditivos em estudo. Nenhuma das associações avaliadas foi genotóxica nestas condições de estudo.

Late nephrologist referral and mortality assotiation in dialytic patients.

INTRODUCTION: Chronic kidney disease is defined by the progressive loss of renal function. Interventions in early stages significantly improve the prognosis of patients with chronic kidney disease, reducing the mortality, and many studies show that early nephrologist referral reduces the mortality rate. OBJECTIVE: To analyze the characteristics of the patients in dialysis and the time between the first consultation in the dialysis clinic and the beginning of the dialytic program. METHODS: It was made a cohort retrospective study with two analysis axis: the social and epidemiological characteristics of the patients in hemodialysis and the time between the first consultation in the clinic and the beginning of the dialytic program. Analytical and descriptive methods where used to compare these data with the early referral and the mortality 12 months after the dialysis onset. RESULTS: One hundred and one patients were analyzed. The mortality rate of the early and lately referred patients was 47.8% and 20.5%, respectively (HR = 2.38; IC = 1.06-5.36; p = 0.035). Concerning the patients which initiated the dialysis with catheter and arteriovenous fistula, the mortality was respectively 51.4% and 10.3% (HR = 4.61; IC = 1,54-13,75; p = 0.006). CONCLUSION: The referral timing was predominantly late. The late referral was associated with a greater mortality. Other variables associated with a greater mortality were age of 70 or more, presence of diabetes and the use of catheter by the dialysis onset.

Encaminhamento tardio ao nefrologista e a associação com mortalidade em pacientes em hemodiálise / Late nephrologist referral and mortality assotiation in dialytic patients

Introdução: A doença renal crônica (DRC) caracteriza-se pela perda progressiva da função renal. Intervenções em estágios iniciais melhoram significativamente o prognóstico dos pacientes com DRC e vários estudos mostram que o encaminhamento precoce (EP) ao nefrologista reduz a taxa de mortalidade. Objetivo: Analisar o perfil dos pacientes em diálise e o tempo transcorrido entre a primeira consulta na unidade de diálise e o início do programa dialítico. Métodos: Foi realizado um estudo de coorte retrospectivo com dois eixos de análise: perfil socioepidemiológico e clínico dos pacientes em hemodiálise e o tempo transcorrido entre a primeira consulta na unidade de diálise e o início do programa dialítico. Utilizaram-se métodos analíticos para comparar estes dados com o EP e com a mortalidade em 12 meses após o início da diálise. Resultados: Foram analisados 111 pacientes. A taxa de mortalidade dos pacientes encaminhados tardiamente e precocemente foi, respectivamente, de 47,8% e 20,5% (razão de risco [HR] = 2,38; intervalo de confiança [IC] = 1,06-5,36; p = 0,035). Os pacientes que iniciaram a diálise por cateter e fístula arteriovenosa (FAV) tiveram mortalidade, respectivamente, de 51,4% e 10,3% (HR = 4,61; IC = 1,54-13,75; p = 0,006). Conclusão: O tempo de encaminhamento foi predominantemente tardio. Foi demonstrado que o encaminhamento tardio (ET) esteve relacionado a maior mortalidade. Outros fatores associados a maior mortalidade foram a idade maior ou igual a 70 anos, presença de DM e uso de cateter ao início da diálise. .

Introduction: Chronic kidney disease is defined by the progressive loss of renal function. Interventions in early stages significantly improve the prognosis of patients with chronic kidney disease, reducing the mortality, and many studies show that early nephrologist referral reduces the mortality rate. Objective: To analyze the characteristics of the patients in dialysis and the time between the first consultation in the dialysis clinic and the beginning of the dialytic program. Methods: It was made a cohort retrospective study with two analysis axis: the social and epidemiological characteristics of the patients in hemodialysis and the time between the first consultation in the clinic and the beginning of the dialytic program. Analytical and descriptive methods where used to compare these data with the early referral and the mortality 12 months after the dialysis onset. Results: One hundred and one patients were analized. The mortality rate of the early and lately referred patients was 47.8% and 20.5%, respectively (HR = 2.38; IC = 1.06-5.36; p = 0.035). Concerning the patients which initiated the dialysis with catheter and arteriovenous fistula, the mortality was respectively 51.4% and 10.3% (HR = 4.61; IC = 1,54-13,75; p = 0.006). Conclusion: The referral timing was predominantly late. The late referral was associated with a greater mortality. Other variables associated with a greater mortality were age of 70 or more, presence of diabetes and the use of catheter by the dialysis onset. .

MDR1/ABCB1 gene polymorphisms in patients with chronic myeloid leukemia

BACKGROUND: Tyrosine kinase inhibitors (TKIs) are the recommended treatment for patients with chronic myeloid leukemia (CML). The MDR1/ABCB1 gene plays a role in resistance to a wide spectrum of drugs, including TKIs. However, the association of MDR1/ABCB1 gene polymorphisms (SNPs) such as C1236T, G2677T/A, and C3435T with the clinical therapeutic evolution of CML has been poorly studied. We investigated these gene polymorphisms in CML-patients treated with imatinib, nilotinib and/or dasatinib. METHODS: ABCB1-SNPs were studied in 22 CML-patients in the chronic phase (CP) and 2 CML-patients in blast crisis (BC), all of whom were treated with TKIs, and compared with 25 healthy controls using nested-PCR and sequencing techniques. RESULTS: Seventeen different haplotypes were identified: 7 only in controls, 6 only in CML-patients, and the remaining 4 in both groups. The distribution ratios of homozygous TT-variants present on each exon between controls and CML-patients were 2.9 for exon 12, and 0.32 for the other 2 exons. Heterozygous T-variants were observed in all controls (100%) and 75% of CML-patients. Wt-haplotype (CC-GG-CC) was observed in 6 CML-patients (25%). In this wt-group, two were treated with nilotinib and reached a major molecular response. The remaining 4 cases had either a minimal or null molecular response, or developed bone marrow aplasia. CONCLUSION: Our results suggest that SNPs of the MDR1/ABCB1 gene could help to characterize the prognosis and the clinical-therapeutic evolution of CML-patients treated with TKIs. Wt-haplotype could be associated with a higher risk of developing CML, and a worse clinical-therapeutic evolution.

Socioeconomic, Familiar and Clinical Variables associated to Caries increment in Schoolchildren Participating in a Dental Health Program

To evaluate socioeconomic, familiar and clinical risk variables associated to caries increment in the children's permanent dentition from seven to 10 years participating in a dental health program.Material and Methods:A sample of 301 children from nine public schools participated in the æAlways Smiling ProgramÆ took part in this study. They were evaluated for dental caries through dmft and DMF-T indexes along 2 years, and their parents completed a socio-environmental questionnaire containing questions on their income, education and family environment. Survival analysis using Kaplan-Meier method was used to evaluate the effect of the independent variables on caries increment.Results:We verified that socio-environmental variables were not associated with caries increment, while children with experience in primary dentition were 1.5 times more likely to develop caries in permanent dentition compared to those who did not have this experience.Conclusion:Schoolchildren presenting dental caries in primary dentition on baseline had higher risk of developing caries in permanent dentition and this variable should be taken in consideration by managers of dental health programs when prioritizing groups with higher care needs...

Qualidade de três tipos de cimentos de ionômeros de vidro utilizados em Postos de Saúde Pública: um estudo in vitro / Quality of three ionomers cements used in Public Health Service: an in vitro study

A resistência à tração diametral (TD) é um requisito essencial para o sucesso clínico das restaurações. Dessa forma, este estudo objetivou avaliar a resistência à TD de três tipos cimentos ionômero de vidro (CIV) em comparação com uma resina composta, todos utilizados em seis postos de saúde pública do município de Duque de Caxias/RJ. O TD foi realizado em uma máquina universal com uma célula de carga de 200 Kgf. Os valores médios de resistência à TD, em MPa, foram: 11,46 (CIV A), 10 (CIV B), 31 (CIV C) e 38,13 (Resina). Os resultados foram analisados pelos testes Anova e Turkey (p < 0,05). Concluiu-se que os CIVs apresentaram resistência à TD semelhante entre eles, porém inferior à resina, mas ainda sendo uma ótima opção para restauração preconizada pelo Serviço Público de Saúde (SUS).

The diametric tensile strength (DT) is a prerequisite for clinical success of restoration. Thus, this study aimed to evaluate the resistance of DT of three types of glass ionomer cements (IO) for restorative, and compare with a composite resin. Eight samples of each material were using by bipartite matrices. All of the materials were used according to manufacturers. The DT test was performed using a universal testing machine with a load of 200 kgf. The results were analyzed using Anova and Turkey (p <0.05). Mean values for resistance to DT in MPa were: 11.46 (IO A), 10 (IO B), 31 (IO C) and 38.13 (Resin composite). We concluded that IO showed similar DT among themselves.

Agentes antimicrobianos nos sistemas adesivos / Quality of three ionomers cements used in Public Health Service: an in vitro study

A resistência à tração diametral (TD) é um requisito essencial para o sucesso clínico das restaurações. Dessa forma, este estudo objetivou avaliar a resistência à TD de três tipos cimentos ionômero de vidro (CIV) em comparação com uma resina composta, todos utilizados em seis postos de saúde pública do município de Duque de Caxias/RJ. O TD foi realizado em uma máquina universal com uma célula de carga de 200 Kgf. Os valores médios de resistência à TD, em MPa, foram: 11,46 (CIV A), 10 (CIV B), 31 (CIV C) e 38,13 (Resina). Os resultados foram analisados pelos testes Anova e Turkey (p < 0,05). Concluiu-se que os CIVs apresentaram resistência à TD semelhante entre eles, porém inferior à resina, mas ainda sendo uma ótima opção para restauração preconizada pelo Serviço Público de Saúde (SUS).

The diametric tensile strength (DT) is a prerequisite for clinical success of restoration. Thus, this study aimed to evaluate the resistance of DT of three types of glass ionomer cements (IO) for restorative, and compare with a composite resin. Eight samples of each material were using by bipartite matrices. All of the materials were used according to manufacturers. The DT test was performed using a universal testing machine with a load of 200 kgf. The results were analyzed using Anova and Turkey (p <0.05). Mean values for resistance to DT in MPa were: 11.46 (IO A), 10 (IO B), 31 (IO C) and 38.13 (Resin composite). We concluded that IO showed similar DT among themselves.

Genetic association for caries susceptibility among cleft lip and/or palate individuals.

AIM: To evaluate the association of the polymorphisms in the TGFB3 gene (rs2268626), and the BMP4 gene (rs17563) with dental caries in two different groups (noncleft group and oral cleft group) from a cleft center located at Rio de Janeiro, Brazil. MATERIALS AND METHODS: A total of 486 unrelated children and adolescents with or without caries were evaluated using a cohort design. Data on oral health habits was obtained through a questionnaire and caries data was collected by clinical examination. Genotyping of the selected polymorphisms for TGFB3 and BMP4 were carried out by real-time PCR using the TaqMan assay method from a genomic DNA isolated from buccal epithelial cells of all children and adolescents. RESULTS: No association was found between BMP4 polymorphism and caries among individuals from both groups. For TGFB3 polymorphism, significant differences were observed for allele and genotype frequencies between caries free and caries affected individuals in oral cleft group (p = 0.013 and 0.006 for allele and genotype frequencies respectively). CONCLUSION: Our findings provide evidence suggesting that TGFB3 may be involved in caries susceptibility in oral cleft group. CLINICAL SIGNIFICANCE: In the future, the possibility of identifying genes related to caries susceptibility can lead to counseling of the individual that carries gene alterations, with the aim of working on preventive measures for caries as well as bioengineering treatments.

The impact of nonsyndromic oral clefts on family quality of life.

This study aimed to assess the impact of nonsyndromic oral cleft (NSOC) on families' quality of life (QoL) using the Brazilian version of the Family Impact Scale (B-FIS). A hospital-based case-control study was conducted with NSOC cases and unaffected controls recruited at Dental Clinic in Federal University. The mean B-FIS scores were 10.32 (SD 6.53) and 5.04 (SD 4.73), while the median scores were 9.00 and 3.50 (p < .05 Wilcoxon test), respectively, in case and control group. The "parental/family activity" subscale had the highest impact average score in case (5.62 SD 3.76) and control group (3.00 SD 3.08) (p < .05 Mann-Whitney test). The types of cleft with the most impact were cleft lip (12.00 SD 8.98) and cleft lip with cleft palate (11.06 SD 6.74). NSOC affects the QoL of families with children who have this condition; however, there were no remarkable differences between the groups.

Tratamento estético da columela nasal: columela oculta e columela pendente / Aesthetic treatment of retracted and hanging nasal columellas

Os autores revelam, no presente trabalho, suas abordagens frente às alterações estéticas da columela nasal, mais observadas em sua prática clínica, a columela oculta e a columela pendente. Para a columela oculta os autores descrevem o uso de um retalho condro-mucopericondral do septo nasal como escolha preferencial. Para o tratamento da columela pendente os autores utilizam as abordagens, direta e indireta, descritas por Randall, nos casos leves a moderados, e para os casos mais acentuados utilizam uma associação de táticas além de uma modificação do que é descrito por Armstrong e Joseph. Suas opções de tratamento são confrontadas com o que há descrito na literatura da especialidade e seus resultados comparativos são apresentados.

This study discusses approaches for aesthetic correction of nasal columellas, i.e. retracted and hanging columellas, most commonly observed in clinical practice. We describe a chondral-mucoperichondrial nasal septal flap and direct or indirect approaches described by Randall as our preferred procedures to correct retracted and mild to moderate hanging columella, respectively. A combination of procedures is used in more severe cases, in addition to modified Armstrong and Joseph's approaches. These treatment options are compared to other literature reports on this specialty.

Mastopexia com implantes: uso sistemático dos retalhos de base inferior de Ribeiro / Mastopexy combined with augmentation: systematic use of Ribeiro's inferiorly-based flaps

Introduction: In the last few decades, mastopexy has been a much discussed topic among plastic surgery specialists. Mastopexy associated with augmentation improves breast projection and ptosis correction. However, several authors have reported a high incidence of complications; the most feared being the extrusion of the implants. The use of Ribeiro's inferiorly-based flaps can be a good alternative to increase the safety of the procedure. Methods: Twenty-five consecutive patients who underwent augmentation-associated mastopexy using the inverted-T technique and Ribeiro's type I and type III inferiorly-based flaps between 2008 and 2011 were analyzed. The cases were assessed with regard to patients'age, type of surgery, purpose of the surgery, simple or associated procedure, follow-up period, positioning of the implants, type of implants, type of flaps, rate of complications and rate of revision surgeries. Results: The mean age of the patients was 39.5 years; 92% of the surgeries were performed for cosmetic reasons; 72% of the surgeries were primary procedures and 80% were associated procedures. In 24% of the cases, the patients exhibited grade 11 ptosis and 76% exhibited grade III ptosis. The follow-up period ranged from 3 months to 48 months. Two patients (8%) exhibited slight distress at the junction of the inverted-T, which was resolved with conservative treatment. No complications, such as seroma, hematoma, necrosis of the nipple-areola complex, infection, or implant loss, were observed. Moreover, no revision surgeries due to unsatisfactory results were necessary. Conclusion: The systematic use of Ribeiro's inferiorly-based flaps can help increase the safety of the procedure and yield good results.

Introdução: A mastopexia tem sido muito discutida entre os especialistas nas últimas décadas. Mastopexia associada a implantes possibilita melhorar a projeção mamária e a correção da ptose. Vários autores relatam grande incidência de complicações, sendo a mais temida a extrusão dos implantes. O uso dos retalhos de base inferior de Ribeiro pode ser uma boa alternativa para aumentar a segurança do procedimento. Método: Foram analisados 25 casos consecutivos de mastopexia com implantes em T-invertido e uso de retalhos de base inferior de Ribeiro dos tipos I e III, operados entre 2008 e 2011. Os casos foram avaliados quanto a idade das pacientes, tipo de cirurgia, motivação, procedimento simples ou associado, tempo de seguimento, posição dos implantes, tipo de implante, tipo de retalho, e índice de complicações e de reoperações. Resultados: A média de idade das pacientesfoi de 39,5 anos, 92% das cirurgias foram por motivação estética, 72% das cirurgias foram primárias e 80%, associadas. Em 24% dos casos, as pacientes apresentavam ptose grau II e em 76%, grau III. O período de seguimento variou de 3 meses a 48 meses. Duas (8%) pacientes apresentaram pequenos sofrimentos na junção do T-invertido, tratados de maneira conservadora. Não foram observadas complicações como seromas, hematomas, necrose do complexo areolopapilar, infecções, perda dos implantes, tampouco foram necessárias reoperações por resultados insastifatórios. Conclusões: O uso sistemático dos retalhos de base inferior de Ribeiro pode auxiliar a aumentar a segurança do procedimento, permitindo a obtenção de bons resultados.

Association of breastfeeding, pacifier use, breathing pattern and malocclusions in preschoolers.

OBJECTIVE: To evaluate the association of breastfeeding duration, pacifier use and nasal air flow with occlusal disorders among children. METHODS: This cross-sectional observational study included 138 children aged 4 and 5 years selected in all the daycare centers of the city of Campo Limpo Paulista, Brazil. Questionnaires were applied to mothers to identify total duration of exclusive breastfeeding and non-nutritive sucking. The independent variables were: Sucking (pacifier, bottle, finger), breastfeeding duration and nasal air flow. The dependent variables were: Open bite, crossbite, overjet, overbite, diastema and maxillary deficiency. Frequency distribution calculations were performed, a chi-square test, the Fisher exact test and, after that, stepwise logistic regression were used for statistical analysis, and the level of significance was set at 5%. RESULTS: The use of a pacifier was the most deleterious factor and increased chances of having open bite in 33.3 times, marked overjet in 2.77 times and posterior crossbite in 5.26 times. CONCLUSION: There was a significant association between non-nutritive sucking, particularly the use of a pacifier, and occlusal disorders. These findings are important to plan the treatment of preschoolers.

Avaliação da qualidade de vida de idosos atendidos em um ambulatório de Geriatria da região nordeste do Brasil / Quality of life assessment in elderly assisted in a geriatrics ambulatory in the Northeast region of Brazil

JUSTIFICATIVA E OBJETIVOS: O envelhecimento humano e suas consequências sempre foram motivos de preocupações,devido à incapacidade funcional associada. Atualmente, o envelhecimento global da população tem aumentado. Surgem, assim,desafios relacionados à qualidade de vida (QV) dos idosos, uma vez que o processo de envelhecimento envolve o impacto do estado de saúde sobre a capacidade do indivíduo viver plenamente.O objetivo deste estudo foi determinar a QV em idosos atendidos em ambulatório de Geriatria.MÉTODO: Foi realizado estudo transversal avaliando os idosos atendidos no Programa de Apoio Integral ao Aposentado do Governo do Estado do Maranhão, sendo a QV avaliada pelos instrumentos do Grupo de Qualidade de Vida da Organização Mundial de Saúde (WHOQOL-Old e WHOQOL-Abreviado). A prevalência de sintomas depressivos foi determinada através da Escala Geriátrica de Depressão(EGD). Na análise estatística, foi utilizado o pacote estatístico SPSS, 14.0, com aplicação do coeficiente de correlação de Spearman (rho) para as variáveis numéricas e testes não paramétricos apropriados, considerando as diferenças significantes se p < 0,05.RESULTADOS: Foram entrevistados 102 idosos com idade variando de 60 a 91 anos com média de 71,5 ± 6,6 anos. A maioria era do sexo feminino (71,6%), casados (64,8%), brancos(62,7%), residentes em casa própria (94,1%) e aposentados(87,3%). QV associou-se de forma significativa com o sexo feminino,ser divorciado e branco. Apresentou correlação negativa com idade avançada e sintomas depressivos.CONCLUSÃO: QV associou-se de forma positiva com idosas,divorciadas e brancas. Sintomas depressivos e idade avançada associaram-se com piores pontuações.

BACKGROUND AND OBJECTIVES: Human ageing and its consequences have always been grounds for concern, related to the associated functional incapacity. Currently, the global ageing of the population has increased. Therefore, the challenges related to the quality of life of elderly increased, because the ageing process is related to the impact of health conditions on the ability of the individual to live fully. This study intended to determine the quality of life (QOL) of elderly outpatients of a Geriatrics Service. METHOD: Cross-sectional study was carried out by assessing the elderly attended in the support program for retirees of the Government of the state of Maranhão. Quality of life was assessed with the use of the instruments WHOQOL-old and WHOQOL-bref. The prevalence of depression was determined by the Geriatric Depression Scale (GDS). As statistical analysis, the statistical package SPSS 14 2.0 was used, with application ofSpearman's rank correlation coefficient (Rho) for numeric variables, and appropriate non-parametric tests, considering the differences significant if p < 0.05. RESULTS: One hundred and two elderly with ages ranging from 60 to 91 years with a median age of 71.5 ± 6.6 years were evaluated. Most of them were females (71.6%), married (64.8%),white (62.7%), residing at their own house (94.1%) and in retirement (87.3%). QOL was meaningfully associated with female sex, being divorced and being white. It was negatively correlatedto advanced age and depression. CONCLUSION: QOL obtained better scores for female, divorced and white persons. Depression and advanced age were correlated to the worst scores.

Association of breastfeeding, pacifier use, breathing pattern and malocclusions in preschoolers

OBJECTIVE: To evaluate the association of breastfeeding duration, pacifier use and nasal air flow with occlusal disorders among children. METHODS: This cross-sectional observational study included 138 children aged 4 and 5 years selected in all the daycare centers of the city of Campo Limpo Paulista, Brazil. Questionnaires were applied to mothers to identify total duration of exclusive breastfeeding and non-nutritive sucking. The independent variables were: Sucking (pacifier, bottle, finger), breastfeeding duration and nasal air flow. The dependent variables were: Open bite, crossbite, overjet, overbite, diastema and maxillary deficiency. Frequency distribution calculations were performed, a chi-square test, the Fisher exact test and, after that, stepwise logistic regression were used for statistical analysis, and the level of significance was set at 5%. RESULTS: The use of a pacifier was the most deleterious factor and increased chances of having open bite in 33.3 times, marked overjet in 2.77 times and posterior crossbite in 5.26 times. CONCLUSION: There was a significant association between non-nutritive sucking, particularly the use of a pacifier, and occlusal disorders. These findings are important to plan the treatment of preschoolers.

OBJETIVO: avaliar a associação do tempo de amamentação natural, tempo de uso de chupeta e aeração nasal em relação a problemas oclusais em crianças. MÉTODOS: foi realizado um estudo observacional transversal com universo de 138 crianças entre 4 e 5 anos, de creches de Campo Limpo Paulista/SP. Foram aplicados questionários às mães com o intuito de identificar o tempo de amamentação natural total e exclusiva e hábitos deletérios. Utilizaram-se as variáveis independentes hábitos deletérios (chupeta, mamadeira e dedo), tempo de amamentação natural e aeração nasal; e as variáveis dependentes mordida aberta, mordida cruzada, overjet, sobremordida, presença de diastema e atresia. Foram realizados cálculos das distribuições das frequências, teste de associação do qui-quadrado, exato de Fisher e, em seguida, regressão logística pelo método de stepwise, utilizando nível de significância de 5%. RESULTADOS: o uso de chupeta foi considerado o mais prejudicial dos hábitos deletérios, aumentando em 33,3 vezes a chance de mordida aberta; 2,77 vezes a chance de apresentar overjet acentuado e 5,26 vezes as chances de apresentar mordida cruzada posterior. CONCLUSÃO: houve uma forte associação entre hábitos deletérios (especialmente o tempo de uso de chupeta) e problemas oclusais, sendo esse fato importante no planejamento do tratamento de pacientes pré-escolares.