Juliano Moreira : o brasileiro negro que influenciou profundamente a escola de Neurologia no Brasil

Juliano Moreira was a black Brazilian physician, well recognized for his role in the foundation of scientific psychiatry in Brazil; however, little is known about his influences on modern Neurology. Our aim is to highlight Moreira’s importance in the field of Neurology and his role in the development of scientific and medical societies in Brazil. We describe his contributions from his doctoral thesis in 1891 to his 27- year tenure as the director of the National Hospice for the Insane. We also review Moreira’s role in the foundation of societies including the Brazilian Academy of Sciences and the first Brazilian journal dedicated to Neuropsychiatry, concluding that Moreira was one of the most important influential figures for the development of Neurology in Brazil. In addition to his influences on various medical fields, Moreira distinguished himself as an impactful citizen who fought against racist and xenophobic medical theories of his time.Juliano Moreira foi um médico negro brasileiro reconhecido por seu papel na fundação da psiquiatria científica no Brasil; no entanto, pouco sabemos sobre sua influência na Neurologia moderna no país. Nosso objetivo é destacar a importância de Moreira no campo da Neurologia e seu papel no desenvolvimento de sociedades científicas e médicas no Brasil. Descrevemos suas contribuições desde sua tese de doutorado, em 1891, até a sua atuação durante 27 anos como diretor do Hospital Nacional de Alienados. Revisamos também o papel de Moreira na fundação de sociedades como a Academia Brasileira de Ciências, e da primeira revista brasileira dedicada à Neuropsiquiatria, concluindo que Moreira foi um dos mais importantes influenciadores para o desenvolvimento da Neurologia no Brasil. Além de sua ampla influência no campo da medicina, destacou-se como cidadão brasileiro, lutando contra teorias médicas racistas e xenófobas de seu tempo

Recursos tecnológicos destinados ao tratamento endodôntico de canais obliterados: relato de caso: Technological resources for the endodontic treatment of oblitered canals: case report

O tratamento endodôntico de dentes obliterados é sempre desafiador, com dificuldades inerentes à localização, acesso e avanço nos canais radiculares. O presente trabalho teve por objetivo apresentar o caso de um dente com extensa obliteração do canal radicular, em que foram utilizados os mais avançados recursos tecnológicos disponíveis em endodontia. Paciente de 28 anos, compareceu ao consultório com histórico de traumatismo dentário de subluxação há três anos no dente 21. Clinicamente apresentou-se sintomático, com coloração amarelada da coroa. Radiograficamente e na tomografia computadorizada de feixe cônico observou-se obliteração da câmara coronária e do canal radicular, com aumento do espaço do ligamento periodontal apical. Para localização da entrada do canal e avanço nos terços cervical e médio foram utilizados insertos ultrassônicos, todo o procedimento foi executado sob magnificação com o microscópio. Após a localização do canal utilizou-se limas C Pilot #06, #08 e #10 para patência apical e o preparo do canal foi realizado com instrumentos automatizados rotatórios Logic 2. A obturação foi executada pela técnica do cone único e cimento endodôntico biocerâmico Bio-C Sealer, seguido de selamento coronário foi com resina Bulk Fill SDR. Na proservação de 24 meses, a paciente apresentou-se com ausência de sinais e sintomas, e ao exame radiográfico, normalidade da região periapical, configurando êxito ao tratamento

Real-world experience of nintedanib for progressive fibrosing interstitial lung disease in the UK

Background Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting.Methods 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey.Results 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD.Conclusion We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting

May Measurement Month 2018: a pragmatic global screening campaign to raise awareness of blood pressure by the International Society of Hypertension

Aims Raised blood pressure (BP) is the biggest contributor to mortality and disease burden worldwide and fewer than half of those with hypertension are aware of it. May Measurement Month (MMM) is a global campaign set up in 2017, to raise awareness of high BP and as a pragmatic solution to a lack of formal screening worldwide. The 2018 campaign was expanded, aiming to include more participants and countries. Methods and results Eighty-nine countries participated in MMM 2018. Volunteers (≥18 years) were recruited through opportunistic sampling at a variety of screening sites. Each participant had three BP measurements and completed a questionnaire on demographic, lifestyle, and environmental factors. Hypertension was defined as a systolic BP ≥140 mmHg or diastolic BP ≥90 mmHg, or taking antihypertensive medication. In total, 74.9% of screenees provided three BP readings. Multiple imputation using chained equations was used to impute missing readings. 1 504 963 individuals (mean age 45.3 years; 52.4% female) were screened. After multiple imputation, 502 079 (33.4%) individuals had hypertension, of whom 59.5% were aware of their diagnosis and 55.3% were taking antihypertensive medication. Of those on medication, 60.0% were controlled and of all hypertensives, 33.2% were controlled. We detected 224 285 individuals with untreated hypertension and 111 214 individuals with inadequately treated (systolic BP ≥ 140 mmHg or diastolic BP ≥ 90 mmHg) hypertension. Conclusion May Measurement Month expanded significantly compared with 2017, including more participants in more countries. The campaign identified over 335 000 adults with untreated or inadequately treated hypertension. In the absence of systematic screening programmes, MMM was effective at raising awareness at least among these individuals at risk

Racial differences in systemic sclerosis disease presentation: a European Scleroderma Trials and Research group study

Objectives. Racial factors play a significant role in SSc. We evaluated differences in SSc presentations between white patients (WP), Asian patients (AP) and black patients (BP) and analysed the effects of geographical locations.Methods. SSc characteristics of patients from the EUSTAR cohort were cross-sectionally compared across racial groups using survival and multiple logistic regression analyses.Results. The study included 9162 WP, 341 AP and 181 BP. AP developed the first non-RP feature faster than WP but slower than BP. AP were less frequently anti-centromere (ACA; odds ratio (OR) = 0.4, P < 0.001) and more frequently anti-topoisomerase-I autoantibodies (ATA) positive (OR = 1.2, P = 0.068), while BP were less likely to be ACA and ATA positive than were WP [OR(ACA) = 0.3, P < 0.001; OR(ATA) = 0.5, P = 0.020]. AP had less often (OR = 0.7, P = 0.06) and BP more often (OR = 2.7, P < 0.001) diffuse skin involvement than had WP.AP and BP were more likely to have pulmonary hypertension [OR(AP) = 2.6, P < 0.001; OR(BP) = 2.7, P = 0.03 vs WP] and a reduced forced vital capacity [OR(AP) = 2.5, P < 0.001; OR(BP) = 2.4, P < 0.004] than were WP. AP more often had an impaired diffusing capacity of the lung than had BP and WP [OR(AP vs BP) = 1.9, P = 0.038; OR(AP vs WP) = 2.4, P < 0.001]. After RP onset, AP and BP had a higher hazard to die than had WP [hazard ratio (HR) (AP) = 1.6, P = 0.011; HR(BP) = 2.1, P < 0.001].Conclusion. Compared with WP, and mostly independent of geographical location, AP have a faster and earlier disease onset with high prevalences of ATA, pulmonary hypertension and forced vital capacity impairment and higher mortality. BP had the fastest disease onset, a high prevalence of diffuse skin involvement and nominally the highest mortality