Odontoma composto erupcionado em área estética de Maxila – relato de caso/ Compound odontoma erupted in esthetic area of Maxilla - case report

Introdução: O odontoma é o tipo mais comum de tumor odontogênico, porém, casos erupcionados na cavidade oral são pouco descritos na literatura. Objetivo: Relatar um caso clínico de um odontoma composto erupcionado associado a canino e incisivo lateral inclusos, em paciente atendida no Núcleo de Diagnóstico Bucal – NDB da UFES e realizar uma revisão de literatura acerca dos casos de odontomas erupcionados relatados. Metodologia: Consiste em um estudo descritivo individual do tipo relato de caso obtido a partir de dados de prontuário odontológico, incluindo imagens clínicas e radiográficas; e de uma revisão de literatura nas bases de dados bibliográficos Bireme e PUBMED, utilizando a palavra-chave “odontoma erupcionado” e “erupted odontoma”. Relato do Caso: Paciente do sexo feminino, 24 anos, com queixa estética relacionada a estruturas semelhantes a dentículos na região anterior direita da maxila. Por meio de exames clínico e de imagem foi diagnosticado um odontoma composto erupcionado na região de incisivo lateral e canino, que se encontravam inclusos. Foi realizada a enucleação do odontoma e a paciente foi encaminhada ao ortodontista para avaliação dos dentes inclusos e da possibilidade de tracionamento dos mesmos, ou da indicação de exodontia com posterior reabilitação com implantes dentários. Conclusão: O odontoma erupcionado é raro e pouco descrito na literatura. Seu mecanismo de erupção permanece incerto. Suas características clínicas e radiográficas são patognomônicas. Geralmente é assintomático. O diagnóstico precoce e o tratamento adequado podem evitar transtornos oclusais e complicações infecciosas. A literatura é unânime em indicar a enucleação cirúrgica do odontoma erupcionado, apresentando um prognóstico excelente. É muito frequente sua associação a dentes inclusos, o que exige uma abordagem adicional no destino destes dentes

Terapêuticas Promissoras para o Controle da Obesidade: uma Revisão Abrangente

This study examines promising therapeutics for obesity control, addressing a variety of innovative and integrated approaches. Initially, the potential of pharmacological therapies, such as GLP-1 receptor agonists and SGLT-2 inhibitors, is highlighted, showcasing their effectiveness in weight reduction and improved glycemic control. Furthermore, the growing interest in interventions centered on the intestinal microbiota is emphasized, elucidating how manipulating bacterial composition can influence metabolism and contribute to weight loss. Another notable aspect is the role of metabolic modulation therapies, such as blood flow restriction during exercise, with evidence indicating improvements in neural reactivity to food stimuli in obese individuals. Following this, behavioral strategies and psychological therapies, including cognitive-behavioral therapy and the promotion of healthy eating habits, are discussed as essential elements in the sustainable control of obesity over time. In addition to pharmacological approaches, microbiota modulation, and behavioral strategies, this study underscores the need for a holistic understanding of obesity. The importance of incorporating personalized interventions, considering genetic, metabolic, and socioeconomic factors influencing an individual's response to proposed therapeutics, is emphasized. Adopting a patient-centered approach, the study highlights the necessity for continuous care and support over time, acknowledging the complexity of obesity control. In this regard, the research emphasizes not only the effectiveness of therapeutics but also the need for an integrated and personalized approach to comprehensively address this health challenge. Finally, the importance of a multidisciplinary approach is emphasized, integrating different therapeutics to optimize outcomes in obesity control. The combination of pharmacological interventions, microbiota modulation, behavioral strategies, and psychological support emerges as a comprehensive and promising approach to tackle this global health challenge.Este trabalho examina terapêuticas promissoras para o controle da obesidade, abordando uma variedade de abordagens inovadoras e integradas. Inicialmente, destaca-se o potencial das terapias farmacológicas, como os agonistas do receptor GLP-1 e os inibidores de SGLT-2, que demonstraram eficácia na redução de peso e melhor controle glicêmico. Além disso, enfoca-se o crescente interesse em intervenções centradas na microbiota intestinal, destacando como a manipulação da composição bacteriana pode influenciar o metabolismo e contribuir para a perda de peso. Outro ponto de destaque é o papel das terapias de modulação metabólica, como a restrição de fluxo sanguíneo durante o exercício, que apresenta evidências de melhorias na reatividade neural a estímulos alimentares em indivíduos obesos. Em seguida, são discutidas estratégias comportamentais e terapias psicológicas, incluindo a terapia cognitivo-comportamental e a promoção de hábitos alimentares saudáveis, como elementos essenciais no controle sustentável da obesidade ao longo do tempo. Além das abordagens farmacológicas, modulação microbiota e estratégias comportamentais, este trabalho enfatiza a necessidade de uma compreensão holística da obesidade. Destaca-se a importância de incorporar intervenções personalizadas, levando em consideração fatores genéticos, metabólicos e socioeconômicos que podem influenciar a resposta do indivíduo às terapêuticas propostas. Ao adotar uma abordagem centrada no paciente, o trabalho enfatiza a necessidade de um cuidado contínuo e suporte ao longo do tempo, reconhecendo a complexidade do controle da obesidade. Nesse sentido, a pesquisa destaca não apenas a eficácia das terapêuticas, mas também a necessidade de uma abordagem integrada e personalizada para enfrentar esse desafio de saúde de forma abrangente. Por fim, destaca-se a importância de uma abordagem multidisciplinar, integrando diferentes terapêuticas para otimizar os resultados no controle da obesidade. A combinação de intervenções farmacológicas, modulação microbiota, estratégias comportamentais e apoio psicológico emerge como uma abordagem abrangente e promissora para enfrentar esse desafio de saúde global

Abordagens Terapêuticas no Transtorno do Espectro Autista: Uma Revisão Atualizada

This scientific review stands out for providing a comprehensive and updated approach to therapies applied in Autism Spectrum Disorders (ASD). Given the complex and diverse nature of ASD, it becomes imperative to thoroughly analyze the available therapeutic strategies for a deeper and more effective understanding of this condition. The autistic spectrum encompasses a variety of symptoms and challenges, and this study aims to offer a holistic view of therapeutic practices, ranging from intensive behavioral interventions to pharmacological modalities, thus providing a comprehensive overview of the current landscape. Not only does it highlight the diversity of therapeutic approaches available, but it also emphasizes the crucial importance of personalized and early intervention. Recognizing the heterogeneity of the autistic spectrum, the review underscores how therapeutic strategies tailored to individual patient characteristics can be fundamental in maximizing results. This customization not only acknowledges the uniqueness of each individual but also underscores the need for a multifaceted and integrative approach in the treatment of ASD. Exploring the latest findings and developments in the field, this study goes beyond consolidating existing information; it seeks to foster a critical reflection on current therapeutic practices in ASD. In doing so, the work provides valuable insights for healthcare professionals, researchers, and families, promoting a deeper understanding of therapeutic strategies and, consequently, contributing to the ongoing improvement of the quality of life for individuals with ASD.  Esta revisão científica oferece uma abordagem abrangente e atualizada sobre as terapias aplicadas em Transtornos do Espectro Autista (TEA). Dada a natureza complexa e diversificada do TEA, torna-se imperativo analisar minuciosamente as estratégias terapêuticas disponíveis para uma compreensão mais profunda e eficaz dessa condição. O espectro autista abrange uma variedade de sintomas e desafios, e este estudo visa oferecer uma visão holística das práticas terapêuticas, desde intervenções comportamentais intensivas até modalidades farmacológicas, proporcionando assim um panorama abrangente do cenário atual. Destaca-se não apenas a diversidade de abordagens terapêuticas disponíveis, mas também enfatiza a importância crucial da intervenção personalizada e precoce. Reconhecendo a heterogeneidade do espectro autista, a revisão salienta como estratégias terapêuticas adaptadas às características individuais dos pacientes podem ser fundamentais para maximizar os resultados. Essa personalização não apenas reconhece a singularidade de cada indivíduo, mas também destaca a necessidade de uma abordagem multifacetada e integrativa no tratamento do TEA. Explorando as últimas descobertas e desenvolvimentos na área, este estudo não se limita a consolidar informações existentes, mas busca fomentar uma reflexão crítica sobre as práticas terapêuticas atuais em TEA. Ao fazer isso, o trabalho oferece insights valiosos para profissionais de saúde, pesquisadores e familiares, promovendo uma compreensão mais profunda das estratégias terapêuticas e, consequentemente, contribuindo para a melhoria contínua da qualidade de vida de indivíduos com TEA

Efeito da Analgesia Preventiva na Redução da Dor Pós-Operatória: Uma Análise Abrangente

This article explores the significant intersection between anesthesia and chronic pain therapy in cancer patients, highlighting the importance of these approaches in the context of treating various neoplastic conditions. Anesthesia plays a crucial role in surgical procedures and therapeutic interventions, requiring a comprehensive analysis of available options to ensure the safety and comfort of patients. When considering different anesthetic techniques, the goal is to provide healthcare professionals with an in-depth understanding of the latest and most effective strategies, taking into account factors such as postoperative recovery and acute pain management. The choice of anesthetic approach in cancer patients is multifaceted, influenced by variables such as the type of intervention, the patient's overall health, and the specificities of the neoplastic condition. In this context, the comparative analysis of different anesthetic techniques, such as regional and general approaches, becomes essential to ensure treatment effectiveness and minimize adverse impacts. Furthermore, chronic pain therapy in cancer patients is a complex challenge that requires an integrated approach. This article examines various therapeutic modalities, from pharmacological interventions to non-pharmacological methods, with the aim of providing valuable insights to optimize chronic pain management and improve post-treatment quality of life. Understanding the complexities and nuances of these therapies is essential to ensure comprehensive and personalized care for cancer patients, emphasizing the importance of a holistic approach in managing chronic pain in an oncological context. Finally, this article seeks to consolidate up-to-date information on anesthesia and chronic pain therapy in cancer patients, offering a critical review of available scientific literature. The goal is to contribute to the continuous development of clinical practices in this area, promoting the effectiveness of procedures and improving the quality of life for patients facing this challenging condition.Este artigo explora a significativa interseção entre a anestesia e a terapia de dor crônica em pacientes oncológicos, destacando a importância dessas abordagens no contexto do tratamento de diversas condições neoplásicas. A anestesia desempenha um papel crucial em procedimentos cirúrgicos e intervenções terapêuticas, exigindo uma análise abrangente das opções disponíveis para garantir a segurança e o conforto dos pacientes. Ao considerar diferentes técnicas anestésicas, o objetivo é fornecer aos profissionais de saúde uma visão aprofundada das estratégias mais recentes e eficazes, levando em conta fatores como a recuperação pós-operatória e o manejo da dor aguda. A escolha da abordagem anestésica em pacientes oncológicos é multifacetada, influenciada por variáveis como o tipo de intervenção, estado de saúde geral do paciente e especificidades da condição neoplásica. Neste contexto, a análise comparativa de diferentes técnicas anestésicas, como abordagens regionais e gerais, torna-se essencial para garantir a eficácia do tratamento e minimizar os impactos adversos. Além disso, a terapia de dor crônica em pacientes oncológicos é um desafio complexo que requer uma abordagem integrada. Este artigo examina diversas modalidades terapêuticas, desde intervenções farmacológicas até métodos não farmacológicos, com o intuito de fornecer insights valiosos para otimizar o manejo da dor crônica e melhorar a qualidade de vida pós-tratamento. A compreensão das complexidades e nuances dessas terapias é essencial para garantir um cuidado abrangente e personalizado aos pacientes oncológicos, destacando a importância de uma abordagem holística na gestão da dor crônica em contexto oncológico. Por fim, este artigo busca consolidar informações atualizadas sobre anestesia e terapia de dor crônica em pacientes oncológicos, oferecendo uma revisão crítica da literatura científica disponível. O objetivo é contribuir para o desenvolvimento contínuo das práticas clínicas nessa área, promovendo a eficácia dos procedimentos e a melhoria da qualidade de vida para os pacientes que enfrentam essa condição desafiadora. &nbsp

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

DIAGNÓSTICO DAS ÁREAS VERDES PÚBLICAS DO BAIRRO POTENGI, NATAL/RN

Este estudo teve por objetivo diagnosticar as principais áreas verdes do bairro Potengi, localizado na Região Administrativa Norte de Natal-RN. A metodologia adotada consistiu, principalmente, de levantamentos bibliográfico e documental e, posteriormente, de pesquisa de campo, por meio da qual foi possível se visitar ruas, praças, canteiros e passeios públicos do bairro. A detecção das áreas verdes se deu inicialmente com o uso do google Earth. Os resultados apontaram que as áreas verdes do bairro Potengi estão em torno de 2,20 km² de extensão, correspondendo a uma taxa de 27,54% do território da região. As principais praças e canteiros visitados dispõem de árvores de pequeno a médio portes. Conclui-se que as áreas verdes públicas do bairro Potengi estão concentradas basicamente nas praças e canteiros centrais das principais ruas e avenidas. O percentual de arborização do bairro apresenta-se pouco significativo, requerendo com isso um maior envolvimento das populações locais e do poder público no sentido de se ampliar a arborização dos passeios públicos, visto que a presença de áreas verdes no espaço urbano é fator de extrema relevância para o bem-estar da população. Além disso, devido a importância das áreas verdes para a melhoria da qualidade de vida, o estudo constatou, ainda, a falta de investimento público no que tange a manutenção e revitalização das áreas verdes públicas

NEOTROPICAL CARNIVORES: a data set on carnivore distribution in the Neotropics

Mammalian carnivores are considered a key group in maintaining ecological health and can indicate potential ecological integrity in landscapes where they occur. Carnivores also hold high conservation value and their habitat requirements can guide management and conservation plans. The order Carnivora has 84 species from 8 families in the Neotropical region: Canidae; Felidae; Mephitidae; Mustelidae; Otariidae; Phocidae; Procyonidae; and Ursidae. Herein, we include published and unpublished data on native terrestrial Neotropical carnivores (Canidae; Felidae; Mephitidae; Mustelidae; Procyonidae; and Ursidae). NEOTROPICAL CARNIVORES is a publicly available data set that includes 99,605 data entries from 35,511 unique georeferenced coordinates. Detection/non-detection and quantitative data were obtained from 1818 to 2018 by researchers, governmental agencies, non-governmental organizations, and private consultants. Data were collected using several methods including camera trapping, museum collections, roadkill, line transect, and opportunistic records. Literature (peer-reviewed and grey literature) from Portuguese, Spanish and English were incorporated in this compilation. Most of the data set consists of detection data entries (n = 79,343; 79.7%) but also includes non-detection data (n = 20,262; 20.3%). Of those, 43.3% also include count data (n = 43,151). The information available in NEOTROPICAL CARNIVORES will contribute to macroecological, ecological, and conservation questions in multiple spatio-temporal perspectives. As carnivores play key roles in trophic interactions, a better understanding of their distribution and habitat requirements are essential to establish conservation management plans and safeguard the future ecological health of Neotropical ecosystems. Our data paper, combined with other large-scale data sets, has great potential to clarify species distribution and related ecological processes within the Neotropics. There are no copyright restrictions and no restriction for using data from this data paper, as long as the data paper is cited as the source of the information used. We also request that users inform us of how they intend to use the data