Recuperando o guia incisal de um paciente com bruxismo - Relato de caso

O objetivo do presente relato de caso clínico foi descrever a reabilitação estética e funcional dos incisivos anteriores superiores de um paciente com bruxismo. Paciente do gênero masculino, 23 anos de idade, bruxoma, procurou tratamento para os dentes anteriores superiores devido aos diastemas dentários e também por causa dos comprimentos reduzidos dos incisivos centrais superiores. Para isso, foi realizada a gengivoplastia e osteotomia na região dos incisivos centrais superiores com o objetivo de melhorar as posições dos contornos gengivais e aumentar o comprimento desses dentes. Após 90 dias, o clareamento dentário foi realizado. Depois de 1 mês as facetas de resina composta foram confeccionadas nos incisivos centrais superiores. Durante o tratamento as necessidades e perspectivas do paciente foram levadas em consideração para alcançar o sucesso clínico. Após a conclusão dos procedimentos, o resultado fi nal foi satisfatório. Portanto, um plano de tratamento integrado se mostrou de extrema valia, principalmente quando o paciente é devidamente esclarecido das opções disponíveis de tratamento e colabora com o mesmo

SUPLEMENTAÇÃO COM Bacillus toyonensis MODULA A PRODUÇÃO DE ANTICORPOS EM CAMUNDONGOS SENSIBILIZADOS COM ANTÍGENOS DE Leishmania (Leishmania) infatum chagasi

The aim of this study was to evaluate the effect of supplementation with the probiotic Bacillus toyonensis on the production of IgG, IgG1 and IgG2a antibodies against Leishmania (Leishmania) infantum chagasi antigens. Twenty-four female albino BALB/c mice, 21 days old, were immunized experimentally against L. (L.) infantum chagasi, divided into three experimental groups. Group A received no supplementation, group B was continuously supplemented until day 56 and in group C the probiotic was administered seven days before and seven days after each immunization for the same period. The experiment was conducted until day 84. Seroconversion was used to evaluate the humoral immune response. During the supplementation, all the animals presented total IgG seroconversion against the antigen used, without statistical difference (p>0.05) between the groups. In the isotype analysis, the group supplemented with probiotic in the continuous period presented seroconversion results of the upper IgG2a / IgG1 ray when compared to the control group (1.8 times) and to that supplemented seven days before and seven days after supplementation (1.2 times) on day 70, keeping their titre superior to the groups in question until the end of the experiment (1.2 times on day 84). Based on these results, it can observed a greater ability of the supplemented group to continuously modulate favorably the humoral immune response and to maintain the production of IgG2a isotype antibodies against the antigen in question.Keywords: Canine leishmaniasis; probiotic; immune response.O estudo teve como objetivo avaliar o efeito da suplementação com o probiótico Bacillus toyonensis na cinética da produção de anticorpos IgG, IgG1 e IgG2a contra antígenos de Leishmania (Leishmania) infatum chagasi. Foram utilizados 24 camundongos BALB/c, fêmeas, tendo em média 21 dias de idade, sensibilizados experimentalmente contra L. (L.) infantum chagasi, divididos em três grupos experimentais. O grupo A não recebeu suplementação, o grupo B foi suplementado de forma contínua até o dia 56 e no grupo C o probiótico foi administrado sete dias antes e sete dias após cada sensibilização, pelo mesmo período. O experimento foi conduzido até o dia 84. Foi utilizada a soroconversão para avaliação da resposta imune humoral. Durante a suplementação todos os animais apresentaram soroconversão de IgG total contra o antígeno utilizado, sem ser identificada diferença estatística (p<0,05) entre os grupos. Na análise de isotipagem, o grupo suplementado com probiótico no período contínuo apresentou resultados de soroconversão da razão IgG2a/IgG1 superior quando comparado ao grupo controle (1,8 vezes) e ao suplementado sete dias antes e sete dias após a suplementação (1,2 vezes) no dia 70, mantendo o seu título superior aos grupos em questão até o final do experimento (1,2 vezes no dia 84). Com base nesses resultados, pode-se observar maior habilidade do grupo suplementado continuamente modular favoravelmente a resposta imune humoral e manter a produção de anticorpos do isotipo IgG2a contra o antígeno em questão.Palavras-chave: Leishmaniose canina, probiótico, resposta imunológica

Itinerário terapêutico percorrido por famílias de crianças com amiotrofia espinhal: Uma série de casos

INTRODUÇÃO: A Atrofia Muscular Espinhal é uma doença genética autossômica recessiva causada pela degeneração dos neurônios motores localizados no corno anterior da medula e que ocasiona alterações progressivas em vários órgãos e sistemas. Do surgimento dos primeiros sintomas até a confirmação diagnóstica dessa modificação genética, existe um caminho a ser percorrido pela criança e sua família, percurso esse que tenta solucionar os problemas de saúde da criança, sendo chamado itinerário terapêutico e está diretamente ligado ao prognóstico dessas crianças. OBJETIVO: Conhecer o itinerário terapêutico das famílias de crianças com Amiotrofia Espinhal. METODOLOGIA: Estudo de casos múltiplos de caráter qualitativo realizado com familiares de crianças com AME que teve como instrumentos de coleta um questionário socioeconômico, entrevista semiestruturada e método de análise de conteúdo. RESULTADOS: Foram entrevistadas 2 mães, com idades de 18 e 35 anos, uma solteira e a outra casada, ambas com ensino médio completo e renda familiar de 1 salário mínimo. As entrevistas analisaram 3 três categorias: A Descoberta da doença, A Adaptação Familiar e Vivendo com a condição, em que observamos que a descoberta da doença ocorreu devido uma complicação respiratória da doença, a aceitação e adaptação familiar foi difícil, principalmente para as mães, pelo medo e insegurança no cuidar da criança, as mesmas referem que suas vidas mudaram completamente, sendo adaptadas a condição das crianças que necessitam de acompanhamento multidisciplinar, sendo essa sua atual rotina. CONCLUSÃO. A Amiotrofia Espinhal ainda é uma condição genética que apresenta um atraso em sua detecção em seu diagnóstico precoce em crianças com Amiotrofia Espinhal é imprescindível para um bom prognóstico e o acompanhamento com a equipe multidisciplinar é indispensável, para que todas essas variantes em conjunto deem uma melhor qualidade de vida para esses pacientes

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Production and evaluation of a recombinant SeM protein for Strangles´ control

Strangles is a contagious disease of the upper respiratory tract of horses caused by Streptococcus equi subsp. equi. Asymptomatic carriers responsible for maintaining the infection in the herd can only be detected by serological or microbiological methods and vaccines used for the control of the disease induce levels of protection generally not exceeding 50%. Considering that S. equi SeM protein is considered the most promising antigen to protect against the disease, this research aimed to produce and evaluate as antigen for vaccines and for ELISA, a recombinant S. equi SeM protein (rSeM). rSeM was produced by cloning and expression in Escherichia coli and purified by affinity chromatography. To test its immunogenicity isogenic female Balb-c mice 4-6 weeks-old were randomly divided and inoculated with 1 / 20th of the estimated dose of the vaccine for horses by the SC route, on days 0 and 21 of the experiment. One group was vaccinated with 250mL (12 mg mL-1) of rSeM without adjuvant, another with 300mL of vaccine containing 12 mg mL-1 of rSeM plus 20% of aluminiun hydroxide, two other groups were vaccinated with two commercial bacterins against Strangles, other two groups were vaccinated with the same commercial vaccines containing 12 mg mL-1 of rSeM and the remaining group was inoculated with a bacterin produced with a field strain. The control group was inoculated the same dose of sterile saline. Blood samples were collected from the retro-orbital venous plexus on days 0, 21, 42. The antibodies were titrated by ELISA using rSeM as antigen. rSeM was immunogenic for mice with a protection index of 100%. For the standardization of an ELISA, groups of 20 negative, vaccinated and positive animals were used. Using as Cut-off the mean plus two SD of the Optical Densities of the negatives, the test showed 100% sensitivity and specificity.A Adenite Eqüina é uma enfermidade contagiosa do trato respiratório superior dos eqüídeos causada por Streptococcus equi subesp. equi. Animais portadores assintomáticos responsáveis pela permanência da infecção nos rebanhos só podem ser detectados por métodos microbiológicos ou sorológicos e as vacinas utilizadas no controle da doença induzem níveis de proteção geralmente não superiores a 50 %. Considerando que a proteína SeM de S. equi é o antígeno mais promissor na proteção contra a doença, este trabalho objetivou produzir a proteína SeM recombinante de S. equi, visando sua utilização como antígeno em vacinas e em ELISA. Proteína SeM recombinante (rSeM) foi produzida mediante a clonagem e expressão em Escherichia coli e purificada por cromatografia de afinidade. Para testar sua capacidade imunogênica, vacinas elaboradas com rSeM foram aplicadas a camundongos. Fêmeas Balb/c isogênicas com 4-6 semanas foram divididas aleatoriamente e inoculadas por via SC com 1/20 da dose vacinal estimada para cavalos, nos dias 0 e 21 do experimento. Um grupo foi vacinado com 250 mL (12 mg mL-1) de proteína recombinante sem adjuvante, outro com 300 mL de vacina contendo 12 mg mL-1 rSeM adicionada de 20% de hidróxido de alumínio, outros dois grupos com duas bacterinas comerciais contra Adenite Eqüina; dois grupos com as vacinas comerciais, acrescidas de 12 mg mL-1 de rSeM e o grupo restante com uma bacterina contendo cepas de campo. O grupo controle foi inoculado com o mesmo volume de solução salina estéril. Coletou-se sangue por punção do plexo venoso retro-ocular nos dias 0, 21 e 42. Os anticorpos foram titulados por ELISA utilizando a proteína rSeM como antígeno. A rSeM foi imunogênica em camundongos com índices de proteção de 100%. Para a padronização de um ELISA, utilizaram-se grupos de 20 soros equinos de animais negativos, vacinados e positivos. Utilizando um ponto de corte de média das densidades ópticas dos soros negativos acrescidos de dois desvios padrão, o teste teve 100% de sensibilidade e especificidade