Uso de Fibrina Rica em Plaquetas (PRF) como adjuvante na prevenção e tratamento da osteonecrose medicamentosa dos maxilares.

A Osteonecrose dos maxilares associada ao uso de medicamentos (OMAM) é uma patologia causada pelo uso de medicamentos antirreabsortivos e/ou antiangiogénicos como os bifosfonatos e o Denosumab, utilizados tanto para o tratamento da osteoporose ou de outras patologias osteoesqueléticas, e para o tratamento de doenças oncológicas. A OMAM pode se manifestar em doentes que tenham sido sujeitos a terapêutica de uma destas classes farmacoterapêuticas e que cumpra os critérios de diagnóstico estabelecidos pela AAOMS (American Association of Oral and Maxillofacial Surgeons). O diagnóstico é maioritariamente clínico, sendo no entanto, vantajoso, o apoio de exames complementares de diagnóstico. A sua etiologia permanece consensual e os mecanismos envolvidos ainda são desconhecidos apesar de alguns fatores de riscos já terem sido evidenciados cientificamente. É essencial investir na prevenção e no tratamento desta patologia. Novas terapias adjuvantes têm sido relatadas na ultima década acerca do tratamento da OMAM, sendo uma delas o uso de PRF. O objetivo desta revisão é avaliar a eficácia do PRF na prevenção e no tratamento da OMAM, e suas eventuais complicações, na população à risco, quando submetida à atos cirúrgicos orais. A pesquisa bibliográfica deste trabalho foi realizada através da base de dados PubMed, que resultou numa seleção de 14 artigos. O PRF é um material que permite a melhor cicatrização dos tecidos, reduzindo o risco de contaminação e de dor pós-operatória. Esta terapia apresenta alguns resultados promissores, porém mais estudos controlados randomizados são necessários para efetivar esta técnica.Medication-Related Osteonecrosis of Jaws (MRONJ) is a pathology caused by the use of anti-resorptive and/or antiangiogenic drugs such as bisphosphonates and denosumab, used both for the treatment of osteoporosis or other osteo-skeletal pathologies, and the treatment of oncological diseases. The MRONJ can manifest in patients who have been treated with one of these pharmacotherapeutic classes and who meet the diagnostic criteria established by the AAOMS (American Association of Oral and Maxillofacial Surgeons). The diagnosis is mostly clinical, however, it is advantageous to have the support of exams diagnostic supplements. Its etiology remains consensual and the mechanisms involved are still unknown despite the fact that some risk factors have already been scientifically evidenced. It is essential to invest in the prevention and treatment of this pathology. New adjuvant therapies have been reported in the last decade regarding the treatment of MRONJ, one of them being the use of PRF. The objective of this review is to evaluate the effectiveness of PRF in the prevention and treatment of AOMAM, and its possible complications, in the population at risk, when submitted to oral surgical procedures. The bibliographic research of this work was carried out through the PubMed database, which resulted in a selection of 14 articles. PRF is a material that allows for better tissue healing, reducing the risk of contamination and postoperative pain. This therapy has some promising results, but more randomized controlled trials are needed to implement this technique

Mouthwash use and oral cancer: a systematic review and meta-analysis

OBJECTIVE: This study aimed to investigate the effect of mouthwash use on the development of oral cancer. METHODS: Observational studies with adult/older adult populations that have examined the association between mouthwash use and oral cancer were included. Electronic search was performed in July 2022, with no time or language restrictions. PubMed/Medline, Embase, and Web of Science databases were used, and the search was extended to theses and dissertations libraries, Google Scholar, reference lists, and other sources. Methodological quality was assessed using the Newcastle-Ottawa Scale and quantitative data synthesis was performed by random effects meta-analysis, with different subgroup analyses and meta-regression. This revision was registered in Prospero (CRD42020143307). RESULTS: Of the 4,094 studies identified in the search, 15 case-control studies were included in the review, totaling 6,515 cases and 17,037 controls. The meta-analysis included 17 measures of effect from 15 case-control studies. The pooled OR was 1.00 (95%CI: 0.79–1.26, n = 17 studies), but it was 2.58 (95%CI: 1.38–4.82, n = 2 studies) among those who had used mouthwashes three times or more times a day, and 1.30 (95%CI: 1.10–1.54, n = 4 studies) among those who had used mouthwashes for more than 40 years. CONCLUSIONS: We f ound e vidence t hat a h igh f requency o f m outhwash u se m ay b e associated with an increased risk of oral cancer. However, despite the biological plausibility for this association, we suggest caution upon interpretation of our findings due to the few number of studies that have investigated the mouthwash use frequency, which should be considered. Therefore, we recommend that future studies assess, in detail, the frequency, duration, and content of mouthwashes to increase the strength of evidence for a possible dose-response effect of mouthwashes on oral cancer risk

Condutas emergenciais em casos de lesões luxativas em dentes decíduos – uma revisão de literatura

INTRODUÇÃO: Na Odontopediatria são frequentes os casos de urgências relacionadas ao traumatismo dentário, pois as atividades que mais causam riscos para a integridade física são praticadas por crianças e adolescentes. OBJETIVO: Revisar a literatura sobre as condutas emergenciais em casos de lesões luxativas em dentes decíduos, especificamente sobre suas características clínicas e radiográficas, bem como suas complicações.  METODOLOGIA: Foram utilizados 30 artigos encontrados nas bases de dados: PubMed, Scielo e Google Scholar, os quais foram publicados entre os anos de 2017 e 2023. Foram incluídos artigos nas línguas portuguesa (Brasil) e inglesa. Foram excluídas dissertações, trabalhos de conclusão de curso e estudos que envolvessem traumatismo dental em adultos. DISCUSSÃO: As lesões luxativas referem-se a traumas dentários na qual ocorre a mobilidade do elemento, mas sem apresentar avulsão completa ou fratura. O tempo decorrido até ao atendimento emergencial e o protocolo seguido para tratar as lesões dentárias são fatores fundamentais que podem determinar seu prognóstico e o resultado do tratamento. Quanto mais rápido e eficaz for o atendimento emergencial, maiores serão as chances de sucesso na recuperação do dente afetado. CONCLUSÃO: Com diagnóstico preciso e tratamento adequado, é possível manter o dente traumatizado na cavidade bucal, evitando procedimentos invasivos e preservando a função dos dentes decíduos, o que resulta na melhoria da qualidade de vida da criança

Atuação do profissional de odontologia em tempo da Covid-19: revisão narrativa

Introdução: A pandemia da covid-19 resultou em mudanças significativas no atendimento odontológico, tornando essencial a adoção de novas medidas de biossegurança no ambiente de trabalho. Objetivo: Contextualizar a atuação do profissional de odontologia em tempo de pandemia da covid-19 e isolamento social, bem como os desafios enfrentados e os protocolos de biossegurança na prestação de serviços odontológicos. Métodos: Trata-se de uma revisão narrativa consultando os bancos de dados da Os dados foram coletados, na Scientific Eletronic Library Online (SciELO), Literatura Latino-Americana e do Caribe em Ciências da Saúde (Lilacs), Rede de Revistas Científicas da América Latina e Caribe, Espanha e Portugal (RedaLyc), Biblioteca Virtual da Saúde (BVS) e Biblioteca Nacional de Medicina dos Estados Unidos (PubMed/ Medline). Resultados: De acordo com os estudos analisados, foram adotadas medidas de biossegurança mais rigorosas para o atendimento odontológico, devido ao alto risco de contaminação do ambiente, como: uso de luvas, máscaras, aventais, óculos de proteção e gorros, medidas de distanciamento, desinfecção do ambiente de trabalho hipoclorito de sódio 0,1% ou álcool isopropílico 70% e se possível utilização de raio ultravioleta, esterilização dos equipamentos e instrumentos cirúrgicos com ácido peracético e  algumas mudanças foram adotadas como a triagem dos pacientes com risco de transmissão do vírus Sars-Cov-2, restrição de atendimentos. Cirurgiões dentistas tiveram que lidar com a diminuição da renda e maiores níveis de ansiedade e depressão. Conclusões: Atualização e divulgação dos protocolos de biossegurança são de suma importância para o desenvolvimento das atividades Odontológicas durante e após a pandemia para evitar a contaminação da equipe e do paciente. Os profissionais de odontologia apresentaram medo de morrer pela infecção do Sars-Cov-2

Amides from Piper as a Diuretic: Behind the Ethnopharmacological Uses of Piper glabratum Kunth

Several species of the genus Piper are known in Brazilian folk medicine as having diuretic activity. So, we propose to investigate the acute diuretic activity and the possible toxic effects of Piper glabratum Kunth, popularly known as false Jaborandi. Additionally, we propose to check whether there is any correlation between the biological activities of the crude extract (MEPG) and its 2-methoxy-4,5-methylenedioxy-trans-cinnamoyl-pyrrolidine (MMCP) in Wistar rats. The MEPG was fractioned by chromatography column and the MMCP was identified by analyses of 1 H and 13 C RMN spectral data and correlations. Both MEPG and MMCP were assayed for diuretic activity. The preparations obtained were orally administered in a single dose to rats. The urine excretion, pH, density, conductivity, and content of Na + , K + , Cl − , and HCO 3 − were measured in the urine of saline-loaded animals. Additionally, acute toxicity of the extract was also evaluated. MMCP at doses of 30 mg/kg was able to increase the urine volume, pH, and HCO 3 − excretion. Moreover, high dosage of MEPG showed important liver toxicity and elevated mortality when injected intraperitoneally. The results indicate that the MMCP shows important diuretic properties when administered in Wistar rats. Additionally, MEPG can induce important acute toxicity if given in high doses

NEW ARRANGEMENTS IN TIMES OF COVID-19: REMOTE SUPPORT TO CARE FOR CHILDREN WITH AUTISM SPECTRUM DISORDER

Mesmo no contexto de pandemia e restrições de contato pelo distanciamento social, há a necessidade da continuidade das terapias por via remota ou telemedicina, para treinamento e supervisão de pais na implementação de estratégias de ensino e a continuidade de medidas terapêuticas. O objetivo deste trabalho é discutir alternativas para atenuar os efeitos do distanciamento social sobre o tratamento de crianças com Transtorno do Espectro Autista (TEA). Nessa discussão, propomos maneiras de o analista do comportamento auxiliar as famílias por via remota. Especificamente, abordamos recursos e atividades que podem facilitar aos pais e cuidadores a implementação da nova rotina vivenciada no ambiente domiciliar em períodos de quarentena e distanciamento social. São apontados detalhes nessa implementação, como os cuidados com a organização do ambiente de ensino, o manejo dos reforçadores, a eleição da rotina utilizada, a construção dessa rotina, bem como a sua implementação. Sugerimos um roteiro com algumas perguntas de monitoramento da orientação on-line e finalizamos abordando o Behavior Skill Training para o treinamento e o acompanhamento dos pais na implementação dessas estratégias. O atendimento remoto por meio de orientação parental na intervenção de Análise do Comportamento Aplicada ao autismo não é algo novo, mas absolutamente necessário em tempos de COVID-19.Palavras-chave: pandemia, Transtorno do Espectro Autista, orientação de pais, rotina visual, telemedicina. Even in the context of a pandemic with contact restrictions due to social distancing, therapies must continue remotely or by telemedicine, focusing on training and supervision of parents towards implementing instructional strategies as well as keeping therapeutic measures. The purpose of the present paper is to discuss alternatives to mitigate the effects of social distancing on the treatment of children with Autistic Spectrum Disorders (ASD), including how the behavior analyst may help families remotely. It specifically addresses resources and activities that may assist parents and caretakers with the implementation of a new routine in the household during this period of quarantine and social distancing. The details of such implementation are presented, such as cautions to be taken while organizing the teaching environment, managing reinforcers, selecting, building, and executing a routine. As a suggestion, a guideline with a few questions for monitoring on-line guidance is presented. To conclude, the paper approaches Behavior Skill Training for training and monitoring parents while implementing such strategies. Remote therapy through parental guidance in Applied Behavioral Analysis interventions is nothing new, but absolutely essential in COVID-19 times.Keywords: pandemic, Autism Spectrum Disorder, parental guidance, visual routine, telemedicine

Intentional creation of carbon-rich dark earth soils in the Amazon

Fertile soil known as Amazonian dark earth is central to the debate over the size and ecological impact of ancient human populations in the Amazon. Dark earth is typically associated with human occupation, but it is uncertain whether it was created intentionally. Dark earth may also be a substantial carbon sink, but its spatial extent and carbon inventory are unknown. We demonstrate spatial and compositional similarities between ancient and modern dark earth and document modern Indigenous practices that enrich soil, which we use to propose a model for the formation of ancient dark earth. This comparison suggests that ancient Amazonians managed soil to improve fertility and increase crop productivity. These practices also sequestered and stored carbon in the soil for centuries, and we show that some ancient sites contain as much carbon as the above-ground rainforest biomass. Our results demonstrate the intentional creation of dark earth and highlight the value of Indigenous knowledge for sustainable rainforest management

Guidance on noncorticosteroid systemic immunomodulatory therapy in noninfectious uveitis: fundamentals of care for uveitis (focus) initiative

Topic: An international, expert-led consensus initiative to develop systematic, evidence-based recommendations for the treatment of noninfectious uveitis in the era of biologics. Clinical Relevance: The availability of biologic agents for the treatment of human eye disease has altered practice patterns for the management of noninfectious uveitis. Current guidelines are insufficient to assure optimal use of noncorticosteroid systemic immunomodulatory agents. Methods: An international expert steering committee comprising 9 uveitis specialists (including both ophthalmologists and rheumatologists) identified clinical questions and, together with 6 bibliographic fellows trained in uveitis, conducted a Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol systematic reviewof the literature (English language studies from January 1996 through June 2016; Medline [OVID], the Central Cochrane library, EMBASE,CINAHL,SCOPUS,BIOSIS, andWeb of Science). Publications included randomized controlled trials, prospective and retrospective studies with sufficient follow-up, case series with 15 cases or more, peer-reviewed articles, and hand-searched conference abstracts from key conferences. The proposed statements were circulated among 130 international uveitis experts for review.Atotal of 44 globally representativegroupmembersmet in late 2016 to refine these guidelines using a modified Delphi technique and assigned Oxford levels of evidence. Results: In total, 10 questions were addressed resulting in 21 evidence-based guidance statements covering the following topics: when to start noncorticosteroid immunomodulatory therapy, including both biologic and nonbiologic agents; what data to collect before treatment; when to modify or withdraw treatment; how to select agents based on individual efficacy and safety profiles; and evidence in specific uveitic conditions. Shared decision-making, communication among providers and safety monitoring also were addressed as part of the recommendations. Pharmacoeconomic considerations were not addressed. Conclusions: Consensus guidelines were developed based on published literature, expert opinion, and practical experience to bridge the gap between clinical needs and medical evidence to support the treatment of patients with noninfectious uveitis with noncorticosteroid immunomodulatory agents