Autologous fibrin glue versus sutures for conjunctival autograft in primary pterygium: a randomized clinical trial.

PURPOSE: To describe and compare the autologous fibrin glue and traditional sutures for conjunctival graft attachment in patients undergoing primary pterygium excision surgery. METHOD: A randomized clinical trial included patients who underwent pterygium surgery with conjunctival autologous graft (CAG). Using randomization, a single-trained surgeon performed graft fixation with autologous glue or sutures. The glue was prepared immediately before the surgery, using the patient's blood components. After centrifugation, the plasma was collected and enhanced with calcium gluconate. Postoperative assessments were performed on Days 1, 7, 21, 30 and 180. The study evaluated postoperative edema and pain and complications. The mean surgical time was compared. Recurrence of the pterygium was assessed 6 months postoperatively. RESULTS: The study evaluated 61 eyes. Thirty-three eyes underwent pterygium surgery using the glue technique, and 28 underwent the traditional suture technique. Fifty-one patients (83.60%) had successful graft adhered to at the end of follow-up. Ten patients (10/33) lost their graft in the glue group, and only 69.70% maintained graft presence in the fourth week versus 100% of the patients in the suture group (p = 0.001). Pain scores were lower in the glue group, and clinical edema was significantly higher. There was no significant difference in graft retraction or the presence of granuloma, necrosis or postoperative infection. CONCLUSION: Autologous fibrin glue is an affordable option for CAG fixation in particular contexts where commercial fibrin glue is unavailable, and it could offer advantages compared to sutures. A higher graft loss rate was observed and might be related to topical anesthesia, and improvements to the technique are needed. CLINICALTRIALS: gov Identifier: NCT04151017. https://clinicaltrials.gov/ct2/show/NCT04151017?term=20170467&draw=1&rank=1 .

Asma brônquica: conduta na emergência pediátrica / Bronchial asthma ­ management in the pediatric emergency

A asma é uma das doenças crônicas mais comuns na infância e seu correto manejo no serviço de emergência é de suma importância. Face a uma crise de asma, a conduta irá depender dos sinais de alarme e da idade do paciente, sendo ela dividida em crianças maiores e menores de 5 anos.

Asthma is one of the most common chronic diseases in children. In the emergency room, the correct management can save a patient's life. When facing an asthma flare-up, the treatment will depend on the warning signs and the patient's age group, either older or younger than 5 years old.

Hipersensibilidade dentinária cervical: em busca de um tratamento eficaz / Dentin hypersensitivity: in search of an effective treatment

O conhecimento da etiologia de qualquer doença ou condição é primordial para um tratamento seguro e efetivo. Esta revisão da literatura tem por finalidade mostrar algumas opções para se tratar a hipersensibilidade dentinária (Hsdc). A perda de esmalte e do cemento na região cervical e consequente exposição dos túbulos dentinários levam a uma condição dolorosa e de desconforto para o paciente, denominada de Hsdc. Essa perda de estrutura dentária ocorre em virtude de formação de lesões cervicais por processos de recessão gengival, abrasão, erosão, abfração ou pela associação de dois ou mais fatores. Alguns tratamentos apresentados não são eficazes, porém há terapias efetivas, como: aplicação de oxalato de potássio, cloreto de estrôncio, vernizes fluorados, fluoreto de sódio, soluções de hidróxido de cálcio, cimento de ionômero de vidro, laser, dentifrícios dessensibilizantes, sistemas adesivos e procedimentos restauradores. Portanto, a identificação e a remoção dos fatores etiológicos são essenciais ao sucesso do tratamento da Hsdc quando associadas à obliteração dos túbulos dentinários, tendo-se como resultado a efetiva redução do movimento do fluido dentro dos mesmos e a diminuição da dor.

The knowledge of the etiology of any disease or condition is paramount to a safe and effective treatment. This literature review aims to show some options to treat dentine hypersensitivity (Hsdc). The loss of cervical enamel and cementum exposure of tubules leads to a painful condition and patient discomfort, called Hsdc. this loss of tooth structure occurs due to formation of cervical lesions in cases of gingival recession, abrasion, erosion, or abfraction by the association of two or more factors. Some treatments are not effective, but there are effective therapies, such as: application of ferric oxalate, potassium oxalate, potassium nitrate, fluoride varnish, solutions of calcium phosphate, adhesives and Bonding procedures. Therefore, the identification and removal of etiological factors is essential to successful treatment of Hsdc normally associated to tubules obliterate and consequent reduction of fluid motion within the dentin.