EVALUATION OF A LARYNGEAL MASK AIRWAY AS AN ALTERNATIVE TO OROTRACHEAL INTUBATION FOR MAINTAINING AIRWAY PATENCY DURING INHALANT ANESTHESIA UNDER SPONTANEOUS VENTILATION IN CAPYBARAS (HYDROCHOERUS HYDROCHAERIS).

Orotracheal intubation carries greater difficulty in rodents than in most domestic species. The human laryngeal mask airway (LMA) was compared with an endotracheal tube (ETtube) for maintaining airway patency in anesthetized capybaras (Hydrochoerus hydrochaeris). Six capybaras (24-52 kg) were remotely darted with intramuscular ketamine, midazolam, and acepromazine on two occasions (≥7-day intervals). After isoflurane mask induction for random placement of an ETtube or a LMA during each episode, anesthesia was maintained with isoflurane in oxygen under spontaneous ventilation for 90-120 min. Computed tomography of the pharynx and larynx was performed in two of six animals and three of six animals with the ETtube and LMA, respectively. End-tidal isoflurane [median (range)] was not significantly different between ETtube [0.6% (0.5-1.5%)] and LMA [0.6% (0.4-0.9%)]. Heart rate [67 ± 11 beats/min (ETtube) and 67 ± 18 beats/min (LMA)], mean arterial pressure [74 ± 13 mm Hg (ETtube) and 74 ± 14 mm Hg (LMA)], arterial CO2 tension [41 ± 2 mm Hg (ETtube) and 43 ± 4 mm Hg (LMA)], and arterial O2 tension [360 ± 59 mm Hg (ETtube) and 360 ± 63 mm Hg (LMA)] were not significantly different between treatment groups. Computed tomography showed gas in the esophagus with the LMA (three of three animals); the fit of the LMA to the larynx was adequate in two of three animals and fair in one of three animals. Recovery from anesthesia was uneventful. The LMA is a feasible alternative to the ETtube for maintaining airway patency during inhalant anesthesia in spontaneously breathing capybaras. However, the LMA may be dislodged during movement of the animal.

Topical application of lidocaine or bupivacaine in the healing of surgical wounds in dogs.

PURPOSE: To analyze the anesthetic drugs interference with wound healing when used in the surgical bed. METHODS: Macro and microscopic aspects of healing of surgical wounds were evaluated after instillation of topical anesthetics without vasoconstrictor or saline solution 0.9% as control in the transsurgical period. Thirty dogs, males and females were divided into two experimental groups. In both groups, two circular punch lesions of 6 mm diameter were performed in the abdomen. In group 1, lidocaine was instilled in one of the lesions and saline solution in the contralateral lesion. In group 2 the procedure was repeated with the use of bupivacaine. The macroscopic assessment of the lesions was performed on the first, third and tenth postoperative day. The excisional biopsy was performed on the tenth day and the samples were submitted for histopathological examination. RESULTS: The macroscopic analysis had a significant difference between groups. Microscopic analysis was not significant between groups. CONCLUSIONS: The topical application of lidocaine and bupivacaine in the surgical wound is feasible and it does not influence skin healing. The benefit of such a practice, which has been the subject of other studies, seems to outweigh the risks.

Electrocardiographic markers of myocardial conduction and repolarization in Boxer dogs / Marcadores eletrocardiográficos de condução e repolarização miocárdica em cães da raça Boxer

ABSTRACT: Electrocardiographic markers have been used in people to classify arrhythmogenic risk. The aims of this study were to investigate electrocardiographic markers of conduction and repolarization in Boxers and non-Boxer dogs, and compare such findings between groups. Ten-lead standard electrocardiograms of Boxer dogs and non-Boxers recorded from 2015 to 2018 were retrospectively reviewed. Dogs >/ 4 years of age and weighing > 20kg were included. Animals with valvular insufficiencies, congenital cardiopathies, cardiac dilation, suspected systolic dysfunction, biphasic T-wave, bundle branch blocks, and those receiving antiarrhythmics were excluded. Electrocardiographic markers of conduction, QRS duration (QRSd) and dispersion (QRSD), and repolarization (corrected QT interval, Tpeak-Tend, JT and JTpeak), as well as derived indices, were measured. Two hundred dogs met the inclusion/exclusion requirements, including 97 Boxers (8.1±2.5 years old; 30±7kg) and 103 non-Boxer (8.8±2.5 years old, 30±8kg). QRSd and QRSD, and repolarization markers in lead II and left precordial lead V4 were considered similar between groups. Dispersion of late repolarization on lead rV2, Tpeak-Tend interval, was considered longer in Boxers (45±8ms vs 38±10ms, P=0.01). The Tpeak-Tend/JTpeak and the JTpeak/JT also differed between groups. Our results indicate that the dispersion of myocardial late repolarization in lead rV2 is slower in Boxers than other dog breeds.(AU)

Marcadores eletrocardiográficos têm sido estudados em seres humanos para estratificação do risco arritmogênico. Os objetivos deste estudo foram investigar os marcadores eletrocardiográficos de condução e repolarização miocárdica em Boxers e em cães de outras raças, e comparar tais resultados entre os grupos. Para tal, a eletrocardiografia convencional de 10 derivações registradas de 2015 a 2018 foram avaliadas de maneira retrospectiva. Cães com idade igual ou superior a 4 anos e pesando > 20kg foram incluídos. Animais com insuficiência valvar, cardiopatias congênitas, dilatação cardíaca, suspeita de disfunção sistólica, onda T bifásica, bloqueio(s) de ramo(s), ou aqueles que recebiam antiarrítmicos foram excluídos. Variáveis eletrocardiográficas de condução, como a duração e dispersão do complexo QRS (QRSd e QRSD, respectivamente), e repolarização (intervalo QT corrigido, Tpico-Tfinal, JT e JTpico), bem como índices derivados, foram mensurados. Duzentos cães que se adequaram aos critérios de inclusão/exclusão foram incluídos, 97 Boxers (8,1±2,5 anos; 30±7kg) e 103 não Boxers (8,8±2,5 anos; 30±8kg). O QRSd e o QRSD, e os marcadores de repolarização nas derivações II e V4 foram similares entre os grupos. O marcador de dispersão da repolarização tardia na derivação rV2, Tpico-Tfinal, foi considerado mais longo no Boxers (45±8ms vs 38±10ms, P=0.01). O Tpico-Tfinal/JTpico e o JTpico/JT também diferiram entre os grupos. Nossos resultados indicam que a dispersão da repolarização miocárdica tardia na derivação precordial direita, rV2, é mais lenta no Boxer do que nas outras raças.(AU)

Topical application of lidocaine or bupivacaine in the healing of surgical wounds in dogs

Abstract Purpose: To analyze the anesthetic drugs interference with wound healing when used in the surgical bed. Methods: Macro and microscopic aspects of healing of surgical wounds were evaluated after instillation of topical anesthetics without vasoconstrictor or saline solution 0.9% as control in the transsurgical period. Thirty dogs, males and females were divided into two experimental groups. In both groups, two circular punch lesions of 6 mm diameter were performed in the abdomen. In group 1, lidocaine was instilled in one of the lesions and saline solution in the contralateral lesion. In group 2 the procedure was repeated with the use of bupivacaine. The macroscopic assessment of the lesions was performed on the first, third and tenth postoperative day. The excisional biopsy was performed on the tenth day and the samples were submitted for histopathological examination. Results: The macroscopic analysis had a significant difference between groups. Microscopic analysis was not significant between groups. Conclusions: The topical application of lidocaine and bupivacaine in the surgical wound is feasible and it does not influence skin healing. The benefit of such a practice, which has been the subject of other studies, seems to outweigh the risks.

Selective Hepatitis B Birth-Dose Vaccination in São Tomé and Príncipe: A Program Assessment and Cost-Effectiveness Study.

São Tomé and Príncipe (STP) uses a selective hepatitis B birth-dose vaccination (HepB-BD) strategy targeting infants born to mothers who test positive for hepatitis B virus (HBV) surface antigen. We conducted a field assessment and economic analysis of the HepB-BD strategy to provide evidence to guide development of cost-effective policies to prevent perinatal HBV transmission in STP. We interviewed national stakeholders and key informants to understand policies, knowledge, and practices related to HepB-BD, vaccine management, and data recording/reporting. Cost-effectiveness of the existing strategy was compared with an alternate approach of universal HepB-BD to all newborns using a decision analytic model. Incremental cost-effectiveness ratios (ICERs) were calculated in 2015 USD per HBV-associated death and per chronic HBV case prevented, from the STP health-care system perspective. We found that STP lacked national or facility-specific written policies and procedures related to HepB-BD. Timely HepB-BD to eligible newborns was considered a high priority, although timeliness of HepB-BD was not monitored. Compared with the existing selective vaccination strategy, universal HepB-BD would result in a 19% decrease in chronic HBV infections per year at overall cost savings of approximately 44% (savings of USD 5,441 each year). We estimate an ICER of USD 5,012 saved per HBV-associated death averted. The existing selective HepB-BD strategy in STP could be improved through documentation of policies, procedures, and timeliness of HepB-BD. Expansion to universal newborn HepB-BD without maternal screening is feasible and could result in cost savings if actual implementation costs and effectiveness fall within the ranges modeled.

Prognostic value of coupling interval, prematurity index and heart rate variability in Boxer dogs / Valor prognóstico do intervalo de acoplamento, índice de prematuridade e variabilidade da frequência cardíaca em cães da raça Boxer

Boxer dogs with arrhythmogenic right ventricular cardiomyopathy (ARVC) can experience sudden cardiac death regardless of presence/absence of clinical signs. The aims of this retrospective study were two-fold: 1) to investigate the coupling interval (CI) and prematurity index (PI) of ventricular arrhythmias (VA), and the heart rate variability (HRV) in Boxers, and 2) to evaluate their impact on overall survival time. The first 24-hour Holter 36 client-owned Boxer dogs meeting inclusion/exclusion criteria were evaluated for the number, morphology, site of origin, complexity, CI and PI, of ventricular premature complexes (VPCs), and time domain HRV. The effect on survival was assessed, considering the presence/absence of ventricular tachycardia (VT), and syncope. All-cause mortality was considered as the end-point, with median survival times being obtained by Kaplan-Meier analyses and compared by log-rank test. Polymorphic VPCs were more common in symptomatic dogs than asymptomatic. VPCs in dogs with VT were less premature, due to the influence of heart rate on PI despite comparable CI. The PI and mean heart rate (HRme) were significantly different between VT and non-VT dogs but did not discriminate adequately between groups as standalone tests. Median survival time was shorter in Boxer dogs with VT (463 vs 1645 days, HR: 4.31, P=0.03). The HRV parameters, SDNN and SDANN, were both associated with prognosis. The CI and PI were not demonstrated to be prognostic surrogates in Boxer dogs with VA. HRme≥112bpm is 100% sensitive but only 46% specific for detecting VT in Boxers on the 24-hour Holter. Presence of VT, SDNN≤245ms, or SDANN≤134ms at the time of the first 24-hour Holter was associated with a shorter survival.(AU)

Cães da raça Boxer com cardiomiopatia arritmogênica do ventrículo direito (CAVD) podem apresentar morte súbita independentemente da presença/ausência de sinais clínicos. Os objetivos desse estudo retrospectivo foram: 1) investigar o intervalo de acoplamento (IA) e o índice de prematuridade (IP) das arritmias ventriculares e a variabilidade da frequência cardíaca (VFC) em Boxers, e 2) avaliar o impacto de tais características sob o tempo de sobrevida global. O primeiro Holter de 24 horas de 36 Boxers selecionados para os critérios de inclusão/exclusão foram avaliados para o número, morfologia, local de origem, complexidade, IA e IP dos complexos ventriculares prematuros (CVPs) e da VFC no domínio do tempo. O efeito na sobrevida foi avaliado, considerado a presença/ausência de taquicardia ventricular (TV), e síncope. O desfecho final foi a mortalidade global, com o tempo de sobrevida mediano sendo obtido pela análise de Kaplan-Meier e comparado pelo teste de log-rank. CVPs polimórficos foram mais comuns em cães sintomáticos. Os CVPs em Boxers com TV foram menos prematuros, devido à influência da frequência cardíaca (FC) sobre o IP, apesar de IA comparáveis. O IP e a FC média diferiram entre os cães com TV e os sem, mas não discriminam adequadamente os grupos como variáveis isoladas. A sobrevida global foi menor nos cães com TV (463 dias vs 1645 dias, HR=4,31, P=0,03). Os parâmetros da VFC, SDNN e SDANN, foram associados ao prognóstico. O IA e o IP não possuem valor prognóstico em Boxers com arritmias ventriculares. A FC média ≥112bpm é 100% sensível, mas apenas 46% específica para detectar Boxers com TV no Holter de 24 horas. A presença de TV, SDNN≤245ms, ou SDANN≤134ms no momento do primeiro Holter de 24 horas estão associados a menor sobrevida global no Boxer.(AU)

Comparison between total intravenous anesthesia with propofol and intermittent bolus of tiletamine-zolazepam in capuchin monkey (Sapajus apella) / Comparação entre anestesia total intravenosa com propofol e bolus intermitente de tiletamina-zolazepam em macaco-prego (Sapajus apella)

Dissociative anesthesia results in stressful and long recovery periods in monkeys and use of injectable anesthetics in medical research has to be refined. Propofol has promoted more pleasure wake up from anesthesia. The objectives of this study were to investigate the use of intravenous anesthetic propofol, establishing the required infusion rate to maintain surgical anesthetic level and comparing it to tiletamine-zolazepam anesthesia in Sapajus apella. Eight healthy capuchin monkeys, premedicated with midazolam and meperidine, were anesthetized with propofol (PRO) or tiletamine-zolazepam (TZ) during 60 minutes. Propofol was infused continually and rate was titrated to effect and tiletamine-zolazepam was given at 5mg/kg IV bolus initially and repeated at 2.5mg/kg IV bolus as required. Cardiopulmonary parameters, arterial blood gases, cortisol, lactate and quality and times to recovery were determined. Recovery quality was superior in PRO. Ventral recumbency (PRO = 43.0±21.4 vs TZ = 219.3±139.7 min) and normal ambulation (PRO = 93±27.1 vs TZ = 493.7±47.8 min) were faster in PRO (p<0.05). Cardiopulmonary effects did not have marked differences between groups. Median for induction doses of propofol was 5.9mg/kg, varying from 4.7 to 6.7mg/kg, Mean infusion rate was 0.37±0.11mg/kg/min, varying during the one-hour period. In TZ, two animals required three and five extra doses. Compared to tiletamine-zolazepam, minor post-anesthetic adverse events should be expected with propofol anesthesia due to the faster and superior anesthetic recovery. (AU)

A anestesia dissociativa em primatas resulta em recuperação anestésica lenta e estressante, e, portanto, o uso de anestesia injetável em pesquisas médicas precisa ser refinado. Por outro lado, o propofol promove recuperação mais suave. Os objetivos desse estudo foram investigar o uso do anestésico intravenoso propofol, estabelecer a taxa de infusão contínua necessária para manter anestesia cirúrgica, e comparar tal técnica com a dissociativa tiletamina-zolazepam em Sapajus apella. Oito macacos-prego saudáveis foram pré-medicados com midazolam e meperidina, e posteriormente anestesiados com propofol (PRO) ou tiletamina-zolazepam (TZ) durante 60 minutos. O propofol foi administrado em infusão contínua, e a taxa foi titulada ao efeito, já a tiletamina-zolazepam foi administrada em 5mg/kg IV como bolus inicial, e repiques de 2,5mg/kg IV conforme necessário. Os parâmetros cardiopulmonares, hemogasometria arterial, cortisol, e lactato, além da qualidade e duração da recuperação anestésica foram determinados. A qualidade da recuperação anestésica foi superior em PRO. O tempo para atingir decúbito ventral (PRO = 43,0±21,4 vs TZ = 219,3±139,7 min) e ambulação normal (PRO = 93±27,1 vs TZ = 493,7±47,8 min) foram mais rápidos em PRO (p<0,05). As variáveis cardiopulmonares não diferiram entre os grupos. A mediana para dose de indução com propofol foi de 5,9mg/kg, variando de 4,7 a 6,7mg/kg. A taxa de infusão contínua média de propofol foi de 0,37±0,11mg/kg/min, variando ao longo dos 60 minutos. Em TZ, dois animais necessitaram de três e cinco repiques. Comparado à tiletamina-zolazepam, menos efeitos adversos pós-anestésicos devem ser esperados com o propofol, devido à recuperação mais suave e rápida.(AU)

Sedative and electrocardiographic effects of low dose dexmedetomidine in healthy cats / Efeitos sedativos e eletrocardiográficos da baixa dose de dexmedetomidina em gatos saudáveis

In feline veterinary practice sedation is often needed to perform diagnostic or minimally invasive procedures, minimize stress, and facilitate handling. The mortality rate of cats undergoing sedation is significantly higher than dogs, so it is fundamental that the sedatives provide good cardiovascular stability. Dexmedetomidine (DEX) is an α2-adrenergic receptor agonist utilized in cats to provide sedation and analgesia, although studies have been utilized high doses, and markedly hemodynamic impairments were reported. The aim of this study was to prospectively investigate how the sedative and electrocardiographic effects of a low dose of DEX performing in cats. Eleven healthy cats were recruited; baseline sedative score, systolic arterial pressure, electrocardiography, and vasovagal tonus index (VVTI) were assessed, and repeated after ten minutes of DEX 5μg/kg intramuscularly (IM). A smooth sedation was noticed, and emesis and sialorrhea were common adverse effects, observed on average seven minutes after IM injection. Furthermore, electrocardiographic effects of a low dose of DEX mainly include decreases on heart rate, and increases on T-wave amplitude. The augmentation on VVTI and appearance of respiratory sinus arrhythmia, as well as sinus bradycardia in some cats, suggesting that DEX enhances parasympathetic tonus in healthy cats, and therefore will be best avoid in patients at risk for bradycardia.(AU)

Na rotina clínica da medicina veterinária felina a sedação é frequentemente requerida para realização de procedimentos diagnósticos ou minimamente invasivos, para minimizar o estresse e facilitar o manuseio dos pacientes. A taxa de mortalidade de gatos submetidos à sedação é mais elevada do que em cães, por esse motivo, é fundamental que os sedativos confiram estabilidade hemodinâmica. A dexmedetomidina (DEX) é um α2-agonista utilizado em felinos para promover sedação e analgesia, porém os estudos têm utilizado doses elevadas, e com isso prejuízos hemodinâmicos importantes foram relatados. O objetivo desta investigação foi avaliar os efeitos sedativos e eletrocardiográficos da baixa dose de DEX em gatos. Para tal, onze felinos saudáveis foram recrutados, foram obtidos valores basais para escore de sedação, pressão arterial sistólica e eletrocardiografia, além do índice de tônus vaso vagal (ITVV). Após dez minutos da aplicação intramuscular (IM) de DEX 5μg/kg todos os exames foram repetidos. Após a DEX, sedação suave foi detectada, e a êmese e sialorreia foram efeitos adversos comuns, observados em média 7 minutos após a injeção IM. Ademais, os principais efeitos eletrocardiográficos foram redução na frequência cardíaca e aumento na amplitude da onda T. O ITVV mais elevado e surgimento de arritmia sinusal respiratória, bem como bradicardia sinusal em alguns gatos, sugerem que a DEX eleva o tônus parassimpático, e por esse motivo deve ser utilizada com cautela em pacientes com predisposição à bradicardia.(AU)

Dexmedetomidine low dose followed by constant rate infusion and antagonism by atipamezole in isoflurane-anesthetized cats: an echocardiographic study.

OBJECTIVE: To investigate the effects of a low dose of dexmedetomidine (DEX) followed by constant rate infusion (CRI) and reversal with atipamezole on systolic and diastolic functions in isoflurane-anesthetized healthy cats. STUDY DESIGN: Prospective cohort study. ANIMALS: A group of 11 client-owned adult cats. METHODS: Baseline transthoracic echocardiography (TTE) was performed, followed by intramuscular (IM) administration of DEX (5 µg kg-1). After 10 minutes, sedation was scored, adverse effects were recorded and another TTE performed. Approximately 40 minutes after DEX administration, anesthesia was induced by isoflurane mask and maintained with 1.2% end-tidal isoflurane and DEX CRI (1 µg kg-1 hour-1) for 80 minutes. Physiological variables were recorded every 10 minutes, and TTE was repeated 10, 30 and 60 minutes after the start of anesthesia. CRI was stopped, atipamezole (30 µg kg-1) was administered IM and a final TTE was performed after 10 minutes. Repeated measures over time were submitted to one-way analysis of variance or Kruskal-Wallis test according to data distribution; significance was assumed at p < 0.05. RESULTS: After DEX premedication, mild sedation and a slight but significant increase in systolic arterial pressure occurred, and vomiting was a common adverse effect. The cardiac output (CO) and heart rate decreased during anesthesia, with no changes after administration of atipamezole. Trivial valvular insufficiencies were commonly seen after DEX premedication and during CRI. Myocardial radial and longitudinal systolic functions were not affected by sedation or by anesthesia. The late phase of diastole on both right and left ventricles was affected by isoflurane-DEX CRI. Global left ventricular myocardial performance was not impaired. CONCLUSIONS: and clinical relevance Decreased CO and late diastolic impairment were observed in healthy cats administered a low dose of DEX for premedication followed by anesthesia with isoflurane and DEX CRI.

Polymorphism, coupling interval and prematurity index in dogs with degenerative mitral valve disease and ventricular arrhythmias.

Ventricular arrhythmias (VA) are a recognized concern in dogs with degenerative mitral valve disease (DMVD). The coupling interval (CI) and the prematurity index (PI) have been shown to accurately differentiate between benign and malignant VA in people, where ventricular arrhythmias are known to be associated with an increased risk of development of signs of heart failure or sudden death. In this study, we characterized ventricular arrhythmias in dogs with symptomatic and asymptomatic DMVD. Seventy dogs with naturally-occurring DMVD and ventricular arrhythmias were retrospectively studied. A cross-sectional investigation including dogs with either symptomatic (stages C/D; n = 41) or asymptomatic (stages B1/B2; n = 29) DMVD was performed. Electrocardiographic tracings were reviewed to calculate both the CI and PI. In eight dogs these indices were compared with those obtained from both a Holter recording and a standard ECG tracing and no statistical differences were found (CI, p = 0.97; PI, p = 0.17). Even though CI and PI were determined in all animals enrolled in the study, VPC characteristics were only compared between symptomatic and asymptomatic dogs when a 24-h Holter recording was available (n = 49). The PI was different (p = 0.01) between symptomatic (0.65 ± 0.17) and asymptomatic (0.56 ± 0.18) dogs, but CI was considered similar (p = 0.91). Also, the symptomatic dogs had more polymorphic VPC (p = 0.002) and supraventricular arrhythmias (p = 0.0002) than the asymptomatic animals. Polymorphism, and repeating patterns of ventricular premature complexes, were characteristics frequently present in overtly symptomatic animals affected by mitral endocardiosis.

Determinação do risco periodontal em usuários de antipsicóticos típicos / Determination of periodontal risk in patients under typical antipsychotic medications

Objetivo: avaliar o risco periodontal de portadores de transtorno mental e comportamental assistidos no Núcleo Docente Assistencial de Odontologia e Saúde Mental, vinculado ao Hospital Juliano Moreira, em Salvador. Material e métodos: 40 pacientes ( >= 18 anos) foram classificados em baixo, moderado e alto risco periodontal, por meio do polígono do risco preconizado por Lang & Tonetti (2003). Através do teste Qui-quadrado, foi calculada a associação entre o risco periodontal e idade, sexo, raça/etnia, escolaridade, renda mensal, índice de placa visível e modelo assistencial psiquiátrico. Resultados: 25% da amostra apresentou baixo risco periodontal, 35% médio risco e 40% alto risco. Após análise bivariada, o índice de placa foi a variável associada com alto risco periodontal. Conclusão: entre os portadores de transtornos mentais e comportamentais, usuários de antipsicóticos típicos, a maioria apresentou alta prevalência de médio e alto risco periodontal, e o alto risco periodontal teve associação com o elevado índice de placa ( >= 40%), não havendo correlação com as variáveis socioeconômicas e com o modelo assistencial psiquiátrico. Esses resultados podem subsidiar a implantação de ações de promoção, restauração e manutenção da saúde bucal dos pacientes psiquiátricos assistidos nas diferentes modalidades terapêuticas.

Objective: to evaluate the periodontal risk in patients with mental and behavioral disorders in Teaching Core Care Dentistry and Mental Health linked to Juliano Moreira Hospital, Bahia, Brazil and its association with age, gender, race/ethnicity, education level, monthly income, visible plaque index and model psychiatric care. Material and methods: 40 patients ( >= 18 years) were classified as low, moderate and high periodontal risk, through risk polygon by Lang & Tonetti (2003), and the association between periodontal risk and age, gender, race/ethnicity, education level, monthly income, visible plaque index and psychiatric assistencial model were calculated. Results: 25% of the sample presented a low periodontal risk, 35% medium risk and 40% high risk. After the bivariate analysis the plaque index was the variable associated with high periodontal risk. Conclusion: among patients with mental and behavioral disorders, users of typical antipsychotics, the majority showed high prevalence of medium and high risk periodontal and high periodontal risk was associated with the high plaque index ( >= 40%), there was no correlation between socioeconomic variables and the psychiatric assistencial model. These results may support the implementation of actions for the promotion, restoration and maintenance of oral health of psychiatric patients, assisted in different therapeutic modalities.

Recessões gengivais e lesões cervicais não cariosas: relato de caso clínico / Gingival recessions and non-carious cervical lesions: case report

As recessões gengivais e as lesões cervicais não cariosas estão frequentemente associadas e possuem fatores etiológicos em comum. Estas alterações com frequência levam o paciente a procurar atendimento odontológico para resolver problemas estéticos do sorriso e queixas de hipersensibilidade dentinária. As opções terapêuticas podem incluir a prevenção dos fatores etiológicos, ajustes oclusais, restaurações das lesões cervicais e cirurgias de recobrimento radicular. O objetivo do presente estudo foi relatar um caso clínico abordando o tratamento cirúrgico de uma recessão gengival associada a lesão cervical não cariosa, discutindo as indicações do recobrimento radicular, utilizando enxerto de tecido conjuntivo e retalho posicionado coronalmente. O tratamento foi realizado em pré-molar inferior esquerdo (unidade 3.4), que apresentava lesão cervical não cariosa associada à recessão gengival classe I de Miller. Após um ano de acompanhamento, a paciente relatou resolução da hipersensibilidade dentinária e os parâmetros clínicos avaliados demonstraram recobrimento radicular satisfatório e saúde periodontal. Esse relato de caso demonstrou que a técnica utilizada apresenta resultados positivos no recobrimento radicular de recessões gengivais classe I de Miller associadas a lesões cervicais não cariosas pouco profundas, corroborando com os estudos encontrados na literatura...

Gingival recession and non-carious cervical lesions are often associated and have etiologic factors in common. These changes often lead patients to seek dental care to solve a esthetic problems and complaints smile of dentinal hypersensitivity. Therapeutic options may include prevention of etiologic factors, occlusal adjustments, restoration of cervical lesions and root coverage surgery. The aim of this study was to report a case addressing the surgical treatment of gingival recession associated with non-carious cervical lesion, discussing the indications of root coverage using connective tissue graft and coronally positioned flap. The treatment was performed in a left lower premolar (unit 3.4), which showed no carious cervical lesions associated with gingival Miller class I recession. After one year of follow up, the patient reported resolution of dentin hypersensitivity and clinical parameters evaluated showed satisfactory root coverage and periodontal health. This case report demonstrated that the technique shows positive results in root coverage of gingival recessions Miller class I associated with shallow non-carious cervical lesions, corroborating the studies found in the literature...

Continuous infusion of propofol or intermittent bolus of tiletamine-zolazepam in squirrel monkeys (Saimiri sciureus).

OBJECTIVE: To investigate an infusion of propofol for anesthesia in comparison to tiletamine-zolazepam anesthesia, evaluating physiological variables and recovery in squirrel monkeys. STUDY DESIGN: Prospective non-blinded randomized study. ANIMALS: Eight healthy squirrel monkeys (Saimiri sciureus), aged 3 years and weighing 0.340-0.695 kg. METHODS: Premedication was intramuscular midazolam (0.5 mg) and meperidine (4 mg). Anesthesia was induced with intravenous (IV) propofol (4 mg kg(-1)  minute(-1) ) and maintained with propofol starting at 0.4 mg kg(-1)  minute(-1) (PRO, n = 4) or IV tiletamine-zolazepam (5 mg kg(-1) ) and maintained with supplementary doses of TZ (TZ, n = 4). Cardiopulmonary variables were measured continuously. Arterial blood gases and lactate concentration were measured at the end of anesthesia. Quality and times of recovery were determined. Repeatedly measured data for significant differences were tested between groups with t-test and within groups by anova. RESULTS: Median time for induction of anesthesia in PRO was 180 seconds. Mean maintenance infusion rate of propofol was 0.43 ± 0.05 mg kg(-1)  minute(-1) , varying during the 1 hour period. One monkey died after administration of TZ; others required 1, 4, or 8 supplemental doses. Cardiopulmonary variables were similar between groups, but hypotension was recorded. Recovery times to ventral recumbency in PRO (32 ± 17 minutes) and TZ (84 ± 11 minutes) and normal ambulation in PRO (58 ± 22 minutes) and TZ (358 ± 109minutes) were significantly different (p < 0.05). Recovery quality was superior in PRO, with less ataxia and fewer unsuccessful attempts to stand. Lactate concentration was not different between treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiopulmonary variables were similar between protocols, aside from the higher incidence of hypotension in PRO, indicating that further studies with a larger number of animals are required. Compared to tiletamine-zolazepam, propofol anesthesia provided faster and superior anesthetic recovery in these animals.

Continuous infusion of propofol or intermittent bolus of tiletamine-zolazepam in feline night monkeys (Aotus infulatus).

BACKGROUND: Although commonly used, dissociative anesthesia results in unsatisfactory and long recovery periods. The intravenous anesthetic propofol seems to be the most advantageous solution. The objectives of this study were to investigate the required infusion rate of propofol to maintain surgical anesthesia and to compare it to tiletamine-zolazepam in Aotus infulatus. METHODS: Eight healthy feline night monkeys were anesthetized with propofol (PRO) or tiletamine-zolazepam (TZ) during 60 minutes. Cardiopulmonary parameters, arterial blood gases and lactate and quality and times to recovery were determined. RESULTS: Mean infusion rate of propofol was 0.53 ± 0.10 mg/kg/minute. Cardiopulmonary effects did not show marked differences between groups. Times for hanging, ventral recumbency, and normal ambulation were lower in PRO. Establishment of desirable anesthetic depth was easier, recovery quality was superior, and lactate levels were lower in PRO. CONCLUSIONS: Compared with tiletamine-zolazepam, minor post-anesthetic adverse events should be expected with propofol anesthesia, as well as faster and better anesthetic recovery.

Diagnóstico das doenças peri-implantares: uma abordagem clínica / Diagnoses of periimplant diseases – A clinical approach

Os parâmetros clínicos e radiográficos estão sendo amplamente utilizados no diagnóstico das doenças peri-implantares. O exame dos tecidos peri-implantares através desses parâmetros permite a detecção de sinais e sintomas da mucosite peri-implantar e da peri-implantite. Além disso, os estudos atuais mostram um aumento na prevalência dessas alterações, o que sugere a necessidade de um diagnóstico precoce. Os parâmetros clínicos que podem ser utilizados neste diagnóstico são os índices de placa, gengival e de sangramento, a profundidade de sondagem, a posição da margem gengival, o nível de inserção clínica, a presença ou ausência de supuração, a quantidade de mucosa queratinizada, o teste de mobilidade e a verificação de perda óssea radiográfica. O objetivo deste estudo foi, através de uma revisão da literatura sobre os parâmetros clínicos e radiográficos, discutir e indicar quais os índices que podem ser utilizados na prática clínica diária a fim de diagnosticar as doenças peri-implantares.

Clinical and radiographic parameters have been widely used on periimplant diseases diagnoses. Peri-implant examination, through these parameters, allows detection of signs and symptoms of Peri-implant Mucositis and Peri-implantitis. Moreover, several studies have shown an increase in the prevalence of those diseases suggesting a necessity for early diagnoses. Peri-implant plaque index, gingival and bleeding index, probing deep, gingival margin position, clinical attachment level, presence or absence of suppuration, keratinized mucosa, mobility test, and radiographic peri-implant bone loss are the most commonly used parameters in peri-implant disease diagnosis. The aim of this literature review is to describe clinical and radiographic parameters, and to discuss and indicate which parameters can be used to diagnose peri-implant diseases.

A prototype for cartographic human body analysis.

A cartographic-oriented model uses algebraic map operations to perform spatial analysis of medical data relative to the human body. A prototype system uses 3D visualization techniques to deliver analysis results. A prototype implementation suggests the model might provide the basis for a medical application tool that introduces new information insight.

A Saúde bucal em portadores de transtornos mentais / e comportamentais / The oral health of mental and behaviour disturbance patients

Os pacientes especiais ou portadores de necessidades especiais são indivíduos que apresentam desvios no padrão de normalidade de sua condição física, mental, orgânica e/ou desocialização. Essa condição pode ser de caráter transitório -gestação - ou permanente - retardo mental profundo. Os portadores de transtornos mentais e comportamentais podem ser incluídos na classificação dos pacientes especiais porquena sua grande maioria apresentam comprometimento intelectual e motor e requerem assistência temporária ou definitiva. As doenças bucais mais prevalentes nestes pacientes são a cárie e a doença periodontal, sendo esta última decorrente de problemas de ordem local, geral, podendo também estar modulada, pela utilização rotineira de medicamentos psico ativos,destacando-se o santiconvulsivantes. A saúde bucal desses indivíduos,independente do modelo assistencial psiquiátrico ao qual estão submetidos, deve ser avaliada criteriosa e periodicamente,haja vista que a condição bucal interfere na saúde mental. Os programas de saúde bucal que são implementados para esses pacientes com necessidades especiais, visam a sua motivação para um controle mecânico efetivo da placa bacteriana, pelos próprios pacientes, mas, quando estes apresentam alguma deficiência motora, os pais/ responsáveis ou o corpo de enfermagem das instituições especializadas, assumem tal responsabilidade. Determinados casos clínicos requerem a eliminação da placa bacteriana por meios químicos, através de substancias antimicrobianas. As perspectivas futuras apontam para a possibilidade da atenção odontológica vir a ser rotina nocontexto assistencial à saúde mental, considerando-se não apenas as peculiaridades desta população especial, como ao paradigma de assistência manicomial, como uma opção de tratamento para indivíduos com patologias mentais específicas

A saúde bucal dos pacientes geriátricos / Oral health elderly

O envelhecimento da população mundial nas últimas décadas provocou uma reformulação dos padrões dos serviços de saúde para assegurar o bem estar desses indivíduos. A odontologia geriátrica é o ramo da odontologia responsável pela prevenção e atendimento das necessidades bucais dos idosos e, para proporcionar um atendimento integral a esses pacientes, são necessários os conhecimentos das alterações fisiológicas, patológicas e psico-sociais dessa faixa etária. Este trabalho tem como objetivo uma revisão literária sobre o atendimento especializado e o tratamento das alterações bucais mais frequêntes nessa idade.

Medicina periodontal e as alterações na gestação periodontal / Medicine and disease in pregnant woman

Revisão de literatura abordando as alterações que ocorrem durante o período gestacional,d estacando as modificações fisiológicas, as suas repercussões orais e particulamente as que ocorrem no periodonto; com as suas características clínicas e microbiológicas.

Menopausa ou climatério e o aparecimento das doenças periodontais / Menopause or climacteric and the appearing of the periodontal disease

O presente trabalho buscou conhecer a correlação entre a doença periodontal e as alterações hormonais detectadas no período da menopausa e climatério. A maioria dos autores correlatados atribui a exacerbação dos sinais clínicos da periodontite na menopausa à diminuição ou cessação da atividade ovariana e da produção de hormônios gonadotróficos, pricipalmente o estrógeno e a progesterona. As principais manifestações clínicas encontradas na cavidade bucal são a perda óssea alveolar decorrente da osteoporose, levando a mobilidade dentária, dor, desconforto, ardência, secura e altarção degustativa; sendo também relatada a presença da gengivoestomatite da menopausa. Os profissionais de saúde bucal devem conhecer esses problemas que afligem as mulheres e estabelecer uma correta terapia, promovendo e mantendo a saúde bucal e, particularmente, a periodontal através do diagnóstico correto e da conscientização das pacientes