Recomendações para o enfrentamento da pandemia de COVID-19 em Instituições de Longa Permanência para Idosos: rapid review / Recommendations for managing COVID-19 pandemic in long-term care facilities for the older people: a rapid review

Resumo Introdução O controle da disseminação do coronavírus em Instituições de Longa Permanência para Idosos (ILPI) é considerado um desafio, uma vez que os idosos fazem parte do grupo de risco e apresentam prognóstico bastante desfavorável e também alta letalidade. Objetivo Conduzir uma rapid review para mapear e sintetizar a literatura sobre medidas de enfrentamento de Coronavirus Disease-2019 (COVID-19) em ILPI. Método Foi realizada uma Rapid review, e as buscas foram conduzidas nas bases de dados eletrônicas Biblioteca Cochrane, Web of Science, Scopus, Scielo, Medline/Pubmed e Google Scholar. Foram incluídas publicações a partir de 2019, nos idiomas português, inglês ou espanhol. A seleção das publicações ocorreu em duas etapas: leitura dos títulos/resumos; e leitura na íntegra de todas as publicações selecionadas. As recomendações para enfrentamento da COVID-19 em Instituições de Longa Permanência para Idosos foram extraídas e agrupadas de acordo com o conteúdo. Resultados Foram selecionadas 59 publicações que descreviam recomendações referentes aos temas: controle da disseminação do vírus; formação / educação continuada dos trabalhadores responsáveis pelo cuidado ao idoso; bem como o cuidado no contexto da pandemia: residentes, trabalhadores e familiares, e planejamento e gerenciamento de ações para o enfrentamento. Conclusão As recomendações para o enfrentamento da COVID-19 demandam comportamentos para evitar a disseminação do vírus, adaptações nas dinâmicas de cuidado e de convivência nas instituições, planejamento de ações específicas e suporte familiar, institucional e do Estado para assegurar a proteção da saúde física e psicossocial dos idosos e trabalhadores.

Abstract Background Controlling the spread of the coronavirus in Long-Term Care Facilities for older adults is considered a challenge, since this group have a very unfavorable prognosis and also high lethality. Objective To conduct a rapid review of guidelines to manage COVID-19 in Long-Term Care Facilities for older adults. Method A Rapid review was carried out, searches were conducted in the electronic databases Cochrane Library, Web of Science, Scopus, Scielo and Medline/Pubmed. Publications from 2019 were included, in Portuguese, English, or Spanish. The selection of publications took place in two stages: reading the titles/abstracts and reading in full all selected publications by two independent researchers. Guidelines for managing COVID-19 in LCTFs were extracted and grouped according to content. Results 59 publications were selected describing guidelines regarding control of the spread of the virus; training/continuing education of staff responsible for caring for the elderly residents; care addressing residents, staff and family during the pandemic and planning and management of actions to manage the disease. Conclusion Guidelines for managing COVID-19 demand for behaviors to prevent the spread of the virus and adaptations in the dynamics of care and the coexistence inside facilities. They also require planning for specific actions that include family, institutional and State support so the protection of physical and psychosocial health of the elderly residents and staff is ensured.

Maxillary suture expansion: A mouse model to explore the molecular effects of mechanically-induced bone remodeling.

The aim of this study was to analyze the effect of rapid maxillary expansion (RME) on hard tissues. Opening loops bonded to the first and second maxillary molars on both sides were used to apply distracting forces of 0.28 N, 0.42 N and 0.56 N at the midpalatal suture for 7 and 14 days. Microcomputed tomography (MicroCT), histomorphometry and quantitative polymerase chain reaction (qPCR) analysis were performed to evaluate RME effectiveness, midpalatal suture remodeling, cell counting of osteoblasts, osteoclasts and chondrocytes and the expression of bone remodeling markers, respectively. All forces at the two different time points resulted in similar RME and enhanced of bone remodeling. Accordingly, increased number of osteoblasts and reduced chondrocytes counting and no difference in osteoclasts were seen after all RME protocols. RME yielded increased expression of bone remodeling markers as osteocalcin (Ocn), dentin matrix acidic phosphoprotein-1 (Dmp1), runt-related transcription factor 2 (Runx2), collagen type I Alpha 1 (Col1a1), alkaline phosphatase (ALP), receptor activator of nuclear factor kappa B (RANK), receptor activator of nuclear factor kappa B ligand (Rankl), osteoprotegerin (Opg), cathepsin K (Ctsk), matrix metalloproteinases 9 and 13 (Mmp9 and 13), transforming growth fator beta 1, 2 and 3 (Tgfb 1, Tgfb 2 and Tgfb3), bone morphogenetic protein 2 (Bmp-2), sclerostin (Sost), beta-catenin-like protein 1 (Ctnnbl) and Wnt signaling pathways 3, 3a and 5a (Wnt 3, Wnt 3a and Wnt 5a). These findings characterize the cellular changes and potential molecular pathways involved in RME, proving the reliability of this protocol as a model for mechanical-induced bone remodeling.

The First-Year Follow-Up of a Cleft Lip and Palate Patient Treated With Nasoalveolar Molding (NAM).

The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient's lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

The first-year follow-up of a cleft lip and palate patient treated with nasoalveolar molding (NAM)

Abstract The objectives of pre-surgical orthopedics are to allow surgical repair with minimal tension of the involved tissues and less restriction to the craniofacial growth. The aim of this study was to evaluate the benefits of nasoalveolar model (NAM) as a pre-operative therapy in a patient with bilateral cleft lip and palate followed by labioplasty and palatoplasty. A 15-day-old patient underwent orthopedic treatment with NAM. After pre-operative treatment, retraction of the pre-maxilla was observed with reduction of the fissure. Due to the successful effects of NAM treatment the patient had a one-step surgery for lip correction. Six months later, due to lip pressure the fissure was further decreased. After six months, the patient underwent palatoplasty. Both surgeries contributed to the remaining closure of the fissure, which were reduced by half compared to the end of pre-operative treatment. The uses of NAM as a pre-operative treatment approached the alveolar segments, centralized the pre-maxilla, decreased the cleft palate resulting in a marked improvement of the arch and provide superior surgical results. In addition, it allows the primary repair of the patient's lip with asymmetric bilateral fissure in only one-step surgery; in consequence, it will reduce treatment morbidity and decrease cost of treatment.

Resumo Os objetivos da ortopedia pré-cirúrgica são permitir a correção cirúrgica com mínima tensão dos tecidos envolvidos e menor restrição ao crescimento craniofacial. O objetivo deste estudo foi avaliar os benefícios do modelo nasoalveolar (NAM) como terapia pré-operatória em um paciente com fissura labiopalatina bilateral seguida de labioplastia e palatoplastia. Um paciente de 15 dias de idade foi submetido a tratamento ortopédico com NAM. Após o tratamento pré-operatório, observou-se retração da pré-maxila com redução da fissura. Devido aos efeitos bem-sucedidos do tratamento com NAM, o paciente realizou a cirurgia em um único tempo cirúrgico para correção dos lábios. Seis meses após verificou-se a continuidade da redução da fissura devido à pressão labial. Após dozes meses, o paciente foi submetido à palatoplastia. Ambas as cirurgias contribuíram para o fechamento remanescente da fissura, que foram reduzidas pela metade em comparação com o final do tratamento pré-operatório. O uso do NAM como tratamento pré-operatório proporcionou a aproximação dos segmentos alveolares, centralização da pré-maxila, diminuição da fissura palatina, resultando em melhora acentuada do arco, resultando em procedimentos cirúrgicos mais eficazes. Além disso, permitiu o reparo primário do lábio do paciente com fissura bilateral assimétrica em apenas uma cirurgia; em conseqüência, reduzindo a morbidade do tratamento e diminuição dos custos do tratamento.