Prenatal diagnosis of coarctation: Impact on early and late cardiovascular outcome.

BACKGROUND: Prenatal diagnosis (PND) of aortic coarctation (AoCo) has been associated with a significant improvement in early results, but there is limited information on the long-term cardiovascular outcome. METHODS: We studied 103 patients with simple AoCo, operated in the neonatal period, with a median follow-up of 8,5 years (2 to 23,7 years), with 47% followed for over 10 years. PND was made in 35%. The primary aim was to determine the short and long-term cardiovascular impact of PND of AoCo. RESULTS: Neonates with PND had less preoperative neonatal complications, with only 2,8% incidence of a composite preoperative severe morbidity course, compared to 28% in the postnatal group. PND patients underwent surgery 8 days earlier and had a shorter length of stay in ICU. PND did not impact the incidence of post-operative complications. On the long-term, prevalence of hypertension, left ventricular hypertrophy and rate of recoarctation were not influenced by PND. The PND group had mean 24 h diastolic BP 9 mmHg lower and mean daytime diastolic BP 11 mmHg lower. In the final multivariable model, PND was the single independent variable correlating with daytime diastolic BP. CONCLUSION: PND of AoCo effectively leads to a better pre-operative course with less pre-operative morbidity. We found no significant differences in immediate post-operative cardiovascular outcomes. A better initial course of patients with PND does not have a major long-term impact on cardiovascular outcomes, nevertheless, at late follow-up PND patients had lower diastolic BP values on ambulatory monitoring, which may have an impact on long-term cardiovascular risk.

Treatment of complex iatrogenic common hepatic duct injury following laparoscopic cholecystectomy.

We report the case of a woman in her 40s, with no significant medical history, submitted to a laparoscopic cholecystectomy in our institution for symptomatic gallbladder lithiasis. On postoperative day 4, she presented to our emergency room with severe abdominal pain and elevated inflammatory markers. Abdominal CT scan revealed a mass filled with liquid and air in the gallbladder fossa. Surgical exploration was performed revealing a major common hepatic duct iatrogenic injury, which was managed using suture over a T-tube. Three months after surgery, cholangiography showed a biliary stenosis, and a biodegradable stent was inserted through percutaneous transhepatic access. The difficulties in the management of this condition and its outcomes are discussed in this report.

Geochemistry and mineralogy of auriferous tailings deposits and their potential for reuse in Nova Lima Region, Brazil.

Since the mid-nineteenth century, gold ores, mainly hosted in sulfides, have been processed at metallurgical plants located in Nova Lima, Brazil. The generated wastes have been accumulated over the years in tailings dams or in piles. These materials represent wasted from old circuits, as well as from plants still in production. In this study, geochemical, mineralogical, 3D modelling, and metallurgical analyses wastes were carried out to evaluate potential reuse of these wastes. The performed characterization detected residues of very fine grain size containing sulfides and oxides. The wastes show high grades of Au hosted in different minerals. In addition to Au, samples contain S, Fe, Zn, Pb, Sc, Si, and As. The 3D modelling for spatial definition of Au was performed using ordinary kriging with dimensional variograms. The results indicated the occurrence of Au enrichment zones and allowed to reveal the most attractive tailing deposits in terms of Au content. Metallurgical tests showed recovery of 70% of Au and suggested other potential reuse of the wastes, such as aggregates for the civil construction sector and recovery of other metals. The present work highlights the importance of an integrative characterization within the scope of the circular economy and the value of tailings in the production chain of the mineral sector.

Diastolic Function and Left Atrial Strain in Young Patients with History of Aortic Coarctation Repair.

Aortic coarctation (AoCo) leads to long-term sequelae that may impair heart function. Data regarding new echocardiographic function parameters such as atrial strain, in affected patients, are scarce. This study aims to describe these parameters in AoCo patients and define their association with severity measures. 53 AoCo patients and 31 healthy controls, aged 12-40 years, were evaluated. Effectively corrected AoCo (cAoCo) was defined as aortic trans-isthmic corrected Doppler gradient (Dgrad) ≤ 20 mmHg (n = 36), and recoarctation (rAoCo) as Dgrad > 20 mmHg (n = 17). Dependent variables were: E/E'; atrial reservoir strain (Ares); and atrial conduit strain (Acd). T-tests/Mann-Whitney U tests were used to compare these among groups. Multivariable regression was used to test correlation with systolic blood pressure (SBP), indexed LV mass (ILVM), Dgrad, and the ratio between the narrowest diameter of aortic arch and aorta at diaphragm level (Aoratio). In cAoCo and rAoCo patients, E/E' was higher (p < 0.001), Ares, and Acd were lower (p < 0.001 for both) comparing with controls. Acd was higher in cAoCo than rAoCo (p = 0.045). Higher Ares was associated with higher Aoratio (p = 0.002), and lower Acd with higher Dgrad (0.014). EF and GLS were not different among groups. Young patients with effectively corrected aortic coarctation have persistent changes in diastolic function parameters (E/E' and atrial strain), and these are affected by anatomical sequelae. These patients' physiology is closer to patients with recoarctation, than to healthy individuals. This provides rationale for a stronger prevention, and treatment, of arterial dysfunction and high left ventricular afterload in these patients.

Tratamiento integral en odontopediatría para hipoplasia maxilar y erupción ectópica de primeros molares superiores permanentes / Tratamento integral em odontopediatria para hipoplasia maxilar e erupção ectópica de primeiros molares superiores permanentes / Integral pediatric dentistry treatment for maxillary hypoplasia and ectopic eruption of permanent upper first molars

La erupción dental ocurre cuando el diente se mueve desde su posición no funcional hasta la oclusión en la cavidad bucal. Este proceso depende de varios factores para que suceda sin alteraciones. La erupción ectópica de los primeros molares permanentes es común en la dentición mixta y requiere tratamiento inmediato por odontopediatría. Su principal causa es un maxilar hipoplásico, causando una reabsorción atípica más rápida de lo normal apresurando la exfoliación de molares primarios y llevando a una la perdida de espacio en al arco superior y el apiñamiento. Objetivo: presentar el tratamiento integral en odontopediatría para corregir la hipoplasia maxilar. Reporte de caso: Paciente asintomático de sexo femenino de 6 años asiste por primera vez a consulta odontológica en el 2019. Al examen clínico y en las ayudas diagnósticas se observa relación esquelética clase III por maxilar hipoplásico con discrepancia dentoalveolar moderada y erupción ectópica de los primeros molares superiores permanentes. Se inicia tratamiento de expansión maxilar con Hyrax y máscara facial. luego ocurre la pérdida prematura de 55 y 65, por lo que se mesializan los molares permanentes. En 2020 se instala péndulo óseo-soportado. Al año del seguimiento se observa corrección de la vía de erupción de los primeros molares permanentes. Conclusión: El tratamiento para la erupción ectópica de los primeros molares superiores permanentes debe planease de forma integral logrando objetivos en cada periodo de tratamiento para evitar complicaciones en el futuro.

A erupção dentária ocorre quando o dente se move de sua posição não funcional até a sua oclusão na cavidade bucal. Este processo depende de vários fatores para que ocorra sem alterações. A erupção ectópica dos primeiros molares permanentes é comum na dentição mista e requer tratamento imediato por um odontopediatra. A principal causa é um maxilar hipoplásico, causando uma reabsorção atípica mais rápida, acelerando a exfoliação dos molares decíduos, levando a uma perda de espaço no arco superior e ao apinhamento. Objetivo: Apresentar o tratamento integral em odontopediatria para correção da hipoplasia maxilar. Relato de caso: Paciente assintomático, sexo feminino, 6 anos, compareceu pela primeira vez a consulta odontológica em 2019. No exame clínico e nos exames diagnósticos se observou relação esquelética classe III por maxilar hipoplásico com discrepância dentoalveolar moderada, e erupção ectópica dos primeiros molares superiores permanentes. Iniciou-se o tratamento de expansão maxilar com Hyrax e máscara facial. Logo ocorreu a perda precoce do 55 e 65, devido os molares permanentes estarem mesializados. Em 2020 instalou-se o péndulo ósseo-suportado. No ano seguinte observou-se a correção da via de erupção dos primeiros molares permanentes. Conclusão: O tratamento para a erupção ectópica dos primeiros molares superiores permanentes deve-se planejar de forma integral visando atingir objetivos em cada período de tratamento para evitar complicações no futuro.

Dental eruption occurs when the tooth moves from the non-functional position to occlusion in the oral cavity. This process depends on several factors to avoid alterations. The ectopic eruption of the first permanent molars is usual in the mixed dentition and requires immediate treatment by pediatric dentistry. The main cause is a hypoplastic maxilla, causing atypical resorption, faster than normal, hastening the exfoliation of temporal molars and leading to loss space in the upper arch and crowding. Objective: Show an integral pediatric dentistry treatment to correct maxillary hypoplasia. Case report: A 6-year-old asymptomatic female patient with class III skeletal relationship, due to hypoplastic maxilla with moderate dentoalveolar discrepancy and ectopic eruption of the first permanent upper molars. She was attended by pediatric dentistry for first time in 2019 and maxillary expansion treatment began with Hyrax and facial mask. Then occur the premature loss of 55 and 65 tooth and the permanent molars moved mesially. In 2020, a bone-supported pendulum was installed. One year after following up, the correction of eruption of the first permanent molars was observed. Conclusion: The treatment for the ectopic eruption of the first permanent upper molars must be planned in an integral way, achieving objectives in each period to avoid complications in the future

Cervical inflammatory mass: a very late complication following neonatal oesophagocoloplasty for oesophageal atresia.

We report the case of a man in his 40s who presented to our emergency department with a history of fever and a red, swollen and painful neck mass. Shortly following his birth, a congenital oesophageal atresia had been managed surgically with colonic interposition graft. Contrast CT of the neck revealed filling and distention of a colic stump with content of stasis and infection. The patient received intravenous piperacillin/tazobactam and parenteral nutrition. One week later, an upper digestive endoscopy was performed revealing an inflammatory-looking pseudopolypoid area immediately below the anastomosis, at the level of the proximal portion of the colon, which seemed to correspond to a complicated diverticulum with inflammation. The difficulties in reaching a definitive diagnosis and management of this condition are discussed.

Importance of an echocardiogram in the evaluation of ataxia.

We present the case of a boy in his middle childhood with gait ataxia and loss of reflexes with a 1-year onset. He had a background of an autism spectrum disorder but was otherwise healthy. A paediatric cardiology assessment was requested to investigate possible cardiac involvement associated to his neurological symptoms. Even though he had no cardiac symptoms and a normal electrocardiography, the echocardiogram revealed severe asymmetric left ventricle hypertrophy consistent with hypertrophic cardiomyopathy. This prompted genetic testing and the diagnosis of Friedreich's ataxia was confirmed.

Double aortic arch: an elusive diagnosis in a child with CHD.

An 18-month-old male with pulmonary atresia and ventricular septal defect presented with stridor after neonatal systemic-to-pulmonary artery shunt surgery, that persisted on follow-up. CT angiography revealed a vascular ring with balanced double aortic arch.

Accelerated idioventricular rhythm in a healthy newborn: frightening but non-threatening.

Accelerated idioventricular rhythm is a rare but benign form of ventricular tachycardia which might be challenging to differentiate from other more worrisome forms. We present the case of a healthy newborn diagnosed with an accelerated idioventricular rhythm which is spontaneously terminated without the need for medical therapy.

Psychological Distress Symptoms and Resilience Assets in Adolescents in Residential Care.

Most studies with institutionalised children and adolescents focus on evaluating the impact of negative life events on emotional development. However, few have investigated the relationship between resilience assets and the teenagers' psychopathological problems. The purpose of the present study was to investigate differences in psychological distress symptoms and in resilience assets in institutionalised and non-institutionalised adolescents. A total of 266 adolescents aged between 12 and 19 years old took part in the study (60.5% female): 125 lived in residential care and 144 resided with their families. Results found a significant and inverse relation between psychopathology and the perception of individual resilience assets, specifically with self-efficacy and self-awareness in the community sample, and with empathy in the institutionalised sample. Overall, and regardless of the age group, adolescents in residential care tend to perceive themselves as significantly less resilient in perceived self-efficacy and empathy, and they report fewer goals and aspirations for the future. The importance of promoting mental health and resilience assets in adolescents, particularly in those in residential care, is discussed. This can be achieved through early interventions that may prevent emotional suffering and deviant life paths, with transgenerational repercussions.

The Influence of Atrial Strain on Functional Capacity in Patients with the Fontan Circulation.

Speckle-tracking echocardiography has been used to assess atrial function. This analysis is feasible in univentricular hearts. The aim of this study was to characterize the relationship between atrial strain and functional capacity in the Fontan circulation. Apical four-chamber echocardiographic loops of 39 Fontan patients were reviewed. The dominant atrium was assessed for active (εact), conduit (εcon), and reservoir (εres) strain and εact/εres ratio. Cardiopulmonary exercise test was performed on the same day and oxygen uptake (VO2) at ventilatory threshold (VT) and peak VO2 were chosen as the dependent variables. Statistical analysis was performed using SPSS® version 23. Unpaired t test was used for binomial and continuous variable correlation; single and multivariable linear regression were used for continuous variable correlation. Statistical significance was defined as p value < 0.05. VO2 at VT as a percentage of predicted VO2 was 36.8% (SD 10.7). Peak VO2 was 64.7% (SD 18.9) of the predicted value. In univariate analysis, both were associated with age, atrioventricular regurgitation, ejection fraction, εres, εcon, and εact/εres. In multivariate regression, higher VO2 at VT and peak VO2 were associated with younger age (p = 0.003 and p = 0.001, respectively) and higher εcon (p = 0.026 and p = 0.020). Evaluation of heart function is difficult in the Fontan circulation, hindered by complex ventricular morphology and lack of normative data. VO2 provides a good surrogate. Atrial strain parameters are compromised in these patients and associated with VO2. Therefore, whenever possible, atrial strain should be measured as it may provide a new method of risk stratification.

Predictive values of breast imaging reporting and data system category 3 breast masses submitted to percutaneous biopsy by ultrasonography / Valores preditivos dos nódulos mamários categoria 3 pelo sistema de laudos e registro de dados de imagem da mama submetidos à biópsia percutânea por ultrassonografia

Introduction: Breast Imaging Reporting and Data System (BI-RADS) classification allows standardization of breast masses findings, with a recommendation for individualized management. Because of their high frequency, masses classified as 3, probably benign, arouse interest in improving their characterization and in establishing the most appropriate behavior. Objective: Firstly, to demonstrate the positive and negative predictive values of the BI-RADS 3 classification of solid masses submitted to percutaneous biopsy by ultrasonography. Secondly, to suggest a different ultrasound follow-up conduct in these findings. Methods: We retrospectively studied 480 BI-RADS 3 masses, submitted to a biopsy under vacuum or core biopsy, with a conclusive histopathological result considered the gold standard. Results: From 480 masses in 396 patients, 473 were benign and 7 malignant. The positive predictive value for malignancy of category 3 masses was 1.5% (7/480), and the negative predictive value was 98.5%. Conclusion: In view of the low probability of cancer, it is recommended the performance of directed ultrasonography (second look) of masses classified as BI-RADS 3 performed by a specialist in breast radiology before the indication of an invasive procedure, what would substantially reduce the number of unnecessary biopsies, patient's anxiety, as well as costs and possible related complications. This will increase the possibility for the specialist to spend more time on really necessary and targeted examinations, better defining cases of follow-up (annual or biannual) of the indication of investigation in specific cases.

Introdução: A classificação do Breast Imaging Reporting and Data System (BI-RADS) permite a padronização dos achados das massas mamárias, com recomendação para o manejo individualizado. Por causa de sua alta frequência, massas classificadas como 3, provavelmente benignas, despertam interesse em melhorar sua caracterização e em estabelecer o comportamento mais adequado. Objetivo: P rimeiramente, d emonstrar o s v alores p reditivos p ositivos e n egativos d a c lassificação d e m assas s ólidas B I-RADS 3 submetidos a biópsia percutânea por ultrassonografia. Em segundo lugar, sugerir conduta de acompanhamento por ultrassonografia diferente nesses achados. Metodologia: Estudamos, retrospectivamente, 480 massas BI-RADS 3, submetidas a biópsia a vácuo ou corebiopsia, com resultado histopatológico conclusivo considerado padrão-ouro. Resultados: De 480 massas em 396 pacientes, 473 eram benignas e 7 malignas. O valor preditivo positivo para malignidade de categoria 3 foi de 1,5% (7/480) e o valor preditivo negativo foi de 98,5%. Conclusão: Em vista da baixa probabilidade de câncer, recomenda-se a realização de ultrassonografia direcionada (second look) de massas classificadas como BI-RADS 3 por especialista em radiologia da mama antes da indicação de um procedimento invasivo, o que reduziria substancialmente o número de biópsias desnecessárias, ansiedade do paciente, bem como possíveis complicações. Isso aumentará a possibilidade de o especialista passar mais tempo em exames realmente necessários e direcionados, definindo melhor os casos de acompanhamento (anual ou semestral) da indicação da investigação em casos específicos.

Prenatal thrombosis of the ductus arteriosus.

Spontaneous thrombus in the ductus arteriosus, without associated ductal aneurysm, is a rare condition. We report successful management with clinical and echocardiographic follow-up in a newborn with prenatal diagnosis.

Determination of Ciprofloxacin in Pharmaceutical Formulations Using HPLC Method with UV Detection.

A simple, specific, accurate and rapid reversed phase high performance liquid chromatographic method was validated for the determination of the content of ciprofloxacin in three pharmaceuticals forms: generic, similar and compounded. The results of the validation showed that the method was highly efficient for quantification of ciprofloxacin in the matrices evaluated. The recovery rates were between 97.4 to 104.3 %, and the relative standard deviations were lower than 5 % for repeatability, and lower than 5.15 % for intermediate precision. The limits of detection, quantification and practical, were 0.11, 0.35 and 1.56 µg/ml, respectively. All compounded samples were approved with in the quality control; however, one generic and one similar sample presented above allowed level.

Utilização de implantes osseointegrados como ancoragem em ortodontia

A utilização de implantes como recurso de ancoragem ampliou as possibilidades terapêuticas em ortodontia. Através de revisão de literatura, são descritos nesse trabalho: a biologia da osseointegração, fisiologia óssea e biomecânica, os principais tipos de implantes utilizados como ancoragem, suas vantagens e desvantagens, técnicas de confecção para a guia cirúrgica de implantes para ancoragem, e os requisitos protéticos para implantes em que serão realizadas próteses posteriormente. O relato de caso ilustra um tratamento coordenado entre a Ortodontia, Implantodontia e Prótese. Foi realizada a compensação dento-alveolar de uma paciente classe III, com edentulismo posterior inferior, através da retração e da intrusão dos dentes anteriores ancoradas em implantes bilaterais de molares e pré-molares. A adequação dos espaços presentes na arcada superior permitiu a realização de implantes na região de incisivos laterais. O perfil da paciente sofreu significativa melhoria. Os implantes osseointegrados são uma importante ferramenta na terapia ortodôntica atual