Keratocystic odontogenic tumor: case report

Introdução: o tumor odontogênico ceratocístico (TOC) é uma lesão oral e maxilofacial relativamente comum que surge de restos da lâmina dental. Ele tem um comportamento agressivo, incluindo altas taxas de recorrência, crescimento rápido e extensão para os tecidos adjacentes. Várias modalidades de tratamento e, assim, diferentes taxas de recorrência após o tratamento, foram relatadas. Devido ao revestimento muito fino e friável, característica do tumor, a enucleação pode ser difícil e, por esta razão ele é associado com as maiores taxas de recorrência. Objetivo: o presente trabalho descreve um caso de um grande TOC no corpo mandibular, onde, devido à presença de um revestimento de espessura incomum, a remoção do tumor como uma peça única foi bem sucedida. Conclusão: o presente caso demonstra que TOC de grandes proporções podem ser tratados de maneira conservadora. Devido à possibilidade de recidiva em muitos anos após o tratamento inicial, acompanhamento a longo prazo é obrigatório. Palavras-chave: Tumor Odontogênico Queratocístico; Revestimento; Cirurgia Oral

Consenso da Sociedade Brasileira de Cefaleia sobre o tratamento da migrânea crônica

Chronic migraine poses a significant personal, social and economic burden and is characterized by headache present on 15 or more days per month for at least three months, with at least eight days of migrainous headache per month. It is frequently associated with analgesic or acute migraine medication overuse and this should not be overlooked. The present consensus was elaborated upon by a group of members of the Brazilian Headache Society in order to describe current evidence and to provide recommendations related to chronic migraine pharmacological and nonpharmacological treatment. Withdrawal strategies in medication overuse headache are also described, as well as treatment risks during pregnancy and breastfeeding. Oral topiramate and onabotulinum toxin A injections are the only treatments granted Class A recommendation, while valproate, gabapentin, and tizanidine received Class B recommendation, along with acupuncture. biofeedback, and mindfulness. The anti-CGRP or anti-CGRPr monoclonal antibodies, still unavailable in Brazil, are promising new drugs already approved elsewhere for migraine prophylactic treatment, the efficacy of which in chronic migraine is still to be definitively proven777509520A migrânea (enxaqueca) crônica determina uma carga pessoal, social e econômica significativa e é caracterizada por dor de cabeça presente em quinze ou mais dias por mês por ao menos três meses, com no mínimo oito dias de cefaleia migranosa a cada mês. É frequentemente associada ao uso excessivo de medicação analgésica ou antimigranosa aguda e isso não deve ser negligenciado. Este consenso foi elaborado por um grupo de membros da Sociedade Brasileira de Cefaleia, para descrever as evidências atualmente disponíveis e fornecer recomendações relacionadas ao tratamento farmacológico e não farmacológico da migrânea crônica. Estratégias de retirada na cefaleia por uso excessivo de medicamentos também são descritas, assim como os riscos dos tratamentos durante a gravidez e a amamentação. O topiramato oral e as injeções de toxina onabotulínica A são os únicos tratamentos que receberam a recomendação classe A, enquanto que o valproato, a gabapentina e a tizanidina receberam recomendação classe B, juntamente com acupuntura, biofeedback e mindfulness. Os anticorpos monoclonais anti-CGRP ou anti-CGRPr, ainda não disponíveis no Brasil, são novos fármacos promissores, já aprovados em outros países para o tratamento profilático da migrânea, cuja eficácia na migrânea crônica ainda está por ser definitivamente comprovad

2017 recommendations of the Brazilian Society of Rheumatology for the pharmacological treatment of rheumatoid arthritis

The objective of this document is to provide a comprehensive update of the recommendations of Brazilian Society of Rheumatology on drug treatment of rheumatoid arthritis (RA), based on a systematic literature review and on the opinion of a panel of rheumatologists. Four general principles and eleven recommendations were approved. General principles: RA treatment should (1) preferably consist of a multidisciplinary approach coordinated by a rheumatologist, (2) include counseling on lifestyle habits, strict control of comorbidities, and updates of the vaccination record, (3) be based on decisions shared by the patient and the physician after clarification about the disease and the available therapeutic options; (4) the goal is sustained clinical remission or, when this is not feasible, low disease activity. Recommendations: (1) the first line of treatment should be a csDMARD, started as soon as the diagnosis of RA is established; (2) methotrexate (MTX) is the first-choice csDMARD; (3) the combination of two or more csDMARDs, including MTX, may be used as the first line of treatment; (4) after failure of first-line therapy with MTX, the therapeutic strategies include combining MTX with another csDMARD (leflunomide), with two csDMARDs (hydroxychloroquine and sulfasalazine), or switching MTX for another csDMARD (leflunomide or sulfasalazine) alone; (5) after failure of two schemes with csDMARDs, a bDMARD may be preferably used or, alternatively a tsDMARD, preferably combined, in both cases, with a csDMARD; (6) the different bDMARDs in combination with MTX have similar efficacy, and therefore, the therapeutic choice should take into account the peculiarities of each drug in terms of safety and cost; (7) the combination of a bDMARD and MTX is preferred over the use of a bDMARD alone; (8) in case of failure of an initial treatment scheme with a bDMARD, a scheme with another bDMARD can be used; in cases of failure with a TNFi, a second bDMARD of the same class or with another mechanism of action is effective and safe; (9) tofacitinib can be used to treat RA after failure of bDMARD; (10) corticosteroids, preferably at low doses for the shortest possible time, should be considered during periods of disease activity, and the risk-benefit ratio should also be considered; (11) reducing or spacing out bDMARD doses is possible in patients in sustained remission

Expedição ao Sítio Histórico e Patrimônio Cultural Kalunga: um Relato de Experiência

The Kalunga Historical and Cultural Heritage Site (SHPCK) is located in the northeast of Goiás and is considered one of the best-preserved areas of native Cerrado in all of Brazil. This is due to local geographic characteristics and mainly to the sustainable character of agricultural production by the traditional peoples who inhabit the region. In addition to having a vast preserved territory, the Kalungas have unique traditional knowledge about local plants. Due to biodiversity, they have access to herbal plants that can be used in human and animal food. However, the number of species of toxic plants may also considered high. With this report we aim to describe the unique experience that was the Expedition to the Kalunga Historical and Cultural Site and Heritage, as well as to emphasize the importance of the toxic plants of the Cerrado and the appreciation of traditional knowledge.A Comunidade Quilombola Kalunga fixou-se no Sítio Patrimônio Histórico e Cultural Kalunga (SHPCK), localizado no nordeste do estado de Goiás, e é considerada uma das áreas mais bem preservadas de Cerrado nativo em todo o Brasil. Isso se deve à dificuldade de acesso, às características geográficas locais e também ao caráter sustentável da produção agropecuária do povo quilombola que habita a região. Além de possuírem vasto território preservado, os Kalungas detêm conhecimento tradicional singular sobre as plantas locais e, graças à biodiversidade do Cerrado, eles têm acesso a plantas fitoterápicas e que podem ser utilizadas na alimentação humana e animal. No entanto, o número de espécies de plantas tóxicas também pode ser considerado elevado. Com este relato, objetivamos descrever a experiência única que foi a Expedição ao Sítio e Patrimônio Histórico e Cultural Kalunga, assim como ressaltar a importância das plantas tóxicas do Cerrado e da valorização do conhecimento tradicional.A Comunidade Quilombola Kalunga fixou-se no Sítio Patrimônio Histórico e Cultural Kalunga (SHPCK), localizado no nordeste do estado de Goiás, e é considerada uma das áreas mais bem preservadas de Cerrado nativo em todo o Brasil. Isso se deve à dificuldade de acesso, às características geográficas locais e também ao caráter sustentável da produção agropecuária do povo quilombola que habita a região. Além de possuírem vasto território preservado, os Kalungas detêm conhecimento tradicional singular sobre as plantas locais e, graças à biodiversidade do Cerrado, eles têm acesso a plantas fitoterápicas e que podem ser utilizadas na alimentação humana e animal. No entanto, o número de espécies de plantas tóxicas também pode ser considerado elevado. Com este relato, objetivamos descrever a experiência única que foi a Expedição ao Sítio e Patrimônio Histórico e Cultural Kalunga, assim como ressaltar a importância das plantas tóxicas do Cerrado e da valorização do conhecimento tradicional

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Updated cardiovascular prevention guideline of the Brazilian Society of Cardiology: 2019

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