Tomographic study of Jaw bone changes in patients with bisphosphonate-related osteonecrosis

Bisphosphonates (BP) are synthetic pyrophosphate-like substances with antiresorptive properties and specifically affect osteoclastic activity. In 2007, the American Association of Oral and Maxillofacial Surgeons (AAOMS) defined diagnostic criteria for Osteonecrosis of the Jaws Associated with Bisphosponates (BRONJ). BRONJ is mainly diagnosed by clinical features, but the detection of early bone changes by imaging may help prevent and better understand the disease. The objective of this study was to evaluate maxillary changes in CBCT in patients using BP. All included patients were diagnosed with osteonecrosis and received bisphosphonate drugs in the last ten years. All imaging examinations were obtained by I-CAT and 3D Accuitomo. The multiplanar reconstructions were analyzed by an examiner without knowledge of the clinical aspects and location of the lesions. The study sample consisted of 21 patients, the majority of the sample represented patients with cancer (76.2%), the other patients had osteoporosis (23.8%). Only four patients (19.04%) received alendronate, while intravenous bisphosphonates, such as zoledronate and pamidronate, represented the treatment of most of our sample. Most of our patients presented stage 1 and 2 MRONJ (85.7%), whose lesions were mainly observed in the mandible (52.4%). Fifty-seven percent of the patients had at least one bone change. In BRONJ, bone changes vary between exposed and non-exposed areas and one aspect of the study was: persistent extraction cavities in the BRONJ lesion region and high frequency of periodontal ligament space widening in areas that are not involved in BRONJ lesions. This reflects the very important role of dental and periodontal diseases in the pathophysiology of BRONJ. Thus, preventive measures should be prioritized for patients exposed to anti-resorptive drugs

Contribuição da radiografia panorâmica no diagnóstico de calcificação de ateroma de carótida: relato de caso e revisão da literatura

ResumoAs calcificações vasculares são comuns em pacientes com lesões ateroscleróticas avançadas, ocorrendo mais em indivíduos de idade avançada, reduzindo a distensão e luz dos vasos sanguíneos, gerando hipertensão. Ateromas podem levar a cardiopatia, a qual está diretamente associada à ocorrência de acidente vascular cerebral. Calcificações nos ateromas de carótida podem ser detectadas incidentalmente nas radiografias panorâmicas odontológicas, porém a associação entre a presença das imagens e o diagnóstico ainda representa um desafio. Neste artigo relatamos o achado incidental de ateromas de carótida na radiografia panorâmica de um paciente masculino de 73 anos. A radiografia apresentava imagem radiopaca com grande dimensão e localização atípica de ateroma de carótida, representando um desafio para o diagnóstico. A despeito dos achados radiográficos exuberantes o paciente apresentou estenose inferior a 50% no exame ultrassonográfico. Assim, revisamos a literatura sobre a precisão da radiografia panorâmica no diagnóstico e a necessidade de encaminhamento do paciente para investigações adicionais.AbstractVascular calcifications are common in patients with advanced atherosclerotic lesions. Most frequent in older adults, they reduce distension and decrease the lumen of blood vessels causing hypertension. Atheroma can lead to heart disease and is directly associated with the occurrence of cerebral vascular accident. Calcifications of the carotid atheroma can be detected as incidental findings on panoramic radiographs for evaluation, but the association between the presence of the images and the diagnosis is still a challenge for the clinician. We report the incidental finding of carotid atheroma on panoramic radiography of a 73 year‐old male. The radiography showed a radiopaque image with large and atypical location of carotid atheroma, representing a challenge to diagnose. Despite the significant radiographic findings, the stenosis observed on ultrasonography was smaller than 50%. Hence, we review the literature about the accuracy of panoramic radiography in the diagnosis and the need for further investigation

EXPERIENCIAS EDUCATIVAS DEL EQUIPO DE SALUD EN UNIDAD GINECO-OBSTÉTRICA

We report the experience of the health team under the mediation of the nurse in the operation of groups of guidance about health promoting during pregnancy and postpartum, for inpatients at the Gynecology-Obstetrics Unit of a public hospital in Rio Grande do Sul. In this scenario, the nurse is a reference to the team because he/she links education with health. There were conducted 49 guidance meetings involving 54 women, 34 mothers and 136 accompanying persons, besides the health professionals’ team and nursing students. What stands out in these group activities the opportunity to clarify doubts and perform health education on the health-illness process, self-care and care for the newborn. It hasbecome a tool for health promotion and a provider of autonomy linked to self-care.Relata la experiencia del equipo de salud bajo la mediación del enfermero en la operacionalización de grupos de orientaciones sobre promoción de salud en la gestación y puerperio a las pacientes internadas en Unidad Gineco-Obstétrica de hospital público en Rio Grande del Sur. En ese escenario, el enfermero es referencia para el equipo por articular la educación para la salud. Fueron realizados 49 encuentros de orientaciones en que participaron 54 gestantes, 34 acompañantes y 136 puérperas, además de los profesionales del equipo de salud y académicos de enfermería. Se destaca en estas actividades grupales oportunidad para el esclarecimiento de dudas y educación en salud sobre el proceso saludenfermedad, cuidados de sí y con el recién-nacido, volviéndose instrumento de promoción de la salud y proveedor deautonomía relacionada al auto-cuidado.Relata a experiência da equipe de saúde sob a mediação do enfermeiro na operacionalização de grupos deorientações sobre promoção de saúde na gestação e puerpério às pacientes internadas em Unidade Gineco-Obstétrica dehospital público no Rio Grande do Sul. Nesse cenário, o enfermeiro é referência para a equipe por articular a educação para asaúde. Foram realizados 49 encontros de orientações em que participaram 54 gestantes, 34 acompanhantes e 136 puérperas,além dos profissionais da equipe de saúde e acadêmicos de enfermagem. Destaca-se nestas atividades grupais oportunidadepara o esclarecimento de dúvidas e educação em saúde sobre o processo saúde-doença, cuidados de si e com o recémnascido,tornando-se instrumento de promoção da saúde e provedor de autonomia relacionada ao autocuidado

Exercise training prior to myocardial infarction attenuates cardiac deterioration and cardiomyocyte dysfunction in rats

OBJECTIVES: The present study was performed to investigate 1) whether aerobic exercise training prior to myocardial infarction would prevent cardiac dysfunction and structural deterioration and 2) whether the potential cardiac benefits of aerobic exercise training would be associated with preserved morphological and contractile properties of cardiomyocytes in post-infarct remodeled myocardium. METHODS: Male Wistar rats underwent an aerobic exercise training protocol for eight weeks. The rats were then assigned to sham surgery (SHAM), sedentary lifestyle and myocardial infarction or exercise training and myocardial infarction groups and were evaluated 15 days after the surgery. Left ventricular tissue was analyzed histologically, and the contractile function of isolated myocytes was measured. Student's t-test was used to analyze infarct size and ventricular wall thickness, and the other parameters were analyzed by the Kruskal-Wallis test followed by Dunn's test or a one-way analysis of variance followed by Tukey's test (

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Morphometric evaluation of bone regeneration in segmental mandibular bone defects filled with bovine bone xenografts in a split-mouth rabbit model

BACKGROUND: Bovine bone grafts have been widely used in dentistry for guided tissue regeneration and can support new bone formation in direct contact with the graft. The aim of this study was to compare the morphometric and bone density changes after using two different bovine bone graft blocks in segmental osseous defects in the mandible of rabbits following different postoperative periods. MATERIAL AND METHODS: Critical size segmental defects were surgically created bilaterally in the jaw of 18 rabbits. The defects were filled with either deproteinized bovine bone mineral with 10% collagen (DBBM-C; BioOss Collagen®), lyophilized bovine medullary bone (LBMB; Orthogen®), or left untreated according to a split-mouth design. Animals were sacrificed after 3 or 6 months of healing. The hemimandibles were scanned ex vivo using a high-resolution (19 μm) microcomputed tomography. Morphometric and bone density parameters were calculated in the region of the defect using CT-Analyser (Bruker). Initial graft blocks were used as baseline. RESULTS: DBBM-C presented a denser microarchitecture, in comparison to LBMB at baseline. DBBM-C and LBMB grafted regions showed a similar progressive remodeling, with a significant decrease in structure complexity and maintenance of bone volume fraction during the postoperative follow-up periods. Both graft materials showed an enhanced bone replacement and more complex structure compared to untreated defects. The apparent fusion between the graft and host bone was observed only in the defects filled with LBMB. CONCLUSION: LBMB grafts showed a similar behavior as DBBM-C regarding structural remodeling. In LBMB samples, apparent integration between the host bone and the graft was present.status: publishe