Major clinical outcomes and analysis of the risk of bias of the advances in cervicofacial liposculture: a systematic review

  Introduction: In the context of liposculpture, cervicofacial liposuction involves the application of negative pressure through a hollow cannula in the subcutaneous plane to gently avulse fat cells and accurately sculpt unwanted fat deposits on the face and neck. Furthermore, lipo contouring provides a versatile tool in the facial surgeon's arsenal to achieve the desired facial profile. In 2020, approximately 15.5 million cosmetic procedures were performed in the United States alone. Objective: A systematic review was carried out on the main clinical results, presenting studies on the risk of bias, and the advances in facial and cervical liposculpture as an important aesthetic tool for the dental surgeon. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The search was carried out from November 2021 to February 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. Results: 64 articles were found involving liposculpture. A total of 32 articles were fully evaluated and 14 were included and developed in the present study. Considering the Cochrane tool for risk of bias, the overall assessment did not result in significant risk of bias studies. The Funnel Plot showed symmetrical behavior. Twenty-five studies did not meet the GRADE. Most patients who were involved in the studies showed improvements in facial augmentation and contouring. In patients with loss of facial volume, high-density fat transfer with the facial injection of SVF-gel resulted in significantly higher improvement scores and better patient satisfaction. Conclusion: According to the main clinical studies selected in the present study, cervicofacial liposculpture proved to be safe and effective. In patients with loss of facial volume, high-density fat transfer with a facial injection of SVF-gel resulted in significantly higher improvement scores and better patient satisfaction. Still, the results of the studies showed that the level of self-confidence and mental health-related quality of life can be significantly improved after facial lipofilling treatment

Avaliação da efetividade da estimulação neural elétrica por microcorrente (MENS) na dor muscular em pacientes com desordem temporomandibular

The effect of Microcurrent Electrical Nerve Stimulation (MENS) was evaluated and compared with occlusal splint therapy in temporomandibular disorders (TMD) patients with muscle pain. Twenty TMD patients were divided into four groups. One received occlusal splint therapy and MENS (I); other received splints and placebo MENS (II); the third, only MENS (III) and the last group, placebo MENS (IV). Sensitivity derived from muscle palpation was evaluated using a visual analogue scale. Results were submitted to analysis of variance (pA efetividade da Estimulação Neural Elétrica por Microcorrente (MENS) foi avaliada e comparada à terapia por Placas Oclusais em pacientes com desordens temporomandibulares (DTM) de origem muscular. Vinte pacientes foram divididos em quatro grupos. Um recebeu a terapia por placas interoclusais e MENS (I); outro, placas e MENS placebo (II), o terceiro, somente MENS (III) e o último grupo, MENS placebo (IV). Os resultados obtidos foram submetidos a uma análise de variância (

Presence of p-synephrine in teas commercialized in Porto Alegre (RS/Brazil)

Citrus aurantium (bitter orange) is characterized by the presence of p-synephrine, an amine structurally and pharmacologically related to ephedrine. Besides the same adverse effects as ephedrine, nowadays it is believed that altered levels of p-synephrine can be associated to the occurrence of migraine and cluster headaches. Leaves and fruits of this species are highly commercialized in form of teas and herbal preparations, but without taking into account the risks associated with its use. This work describes a survey of teas and herbal preparations containing C. aurantium, commercialized in Porto Alegre (RS/Brazil), in order to verify the presence of p-synephrine. Comparing with the mean amount available in the supermarkets, around 20% of the teas and 10% of the herbal preparations declared the presence of C. aurantium in their labels. In a sampling of 15 teas and 2 herbal preparations selected for the analysis, the presence of p-synephrine was characterized in all samples, with levels between 0.0040 to 0.2308%, leading to a caution that even being natural products, they are not free of adverse effects.Citrus aurantium (laranjeira-azeda) é caracterizada pela presença de p-sinefrina, amina estrutural e farmacologicamente similar à efedrina. Além de poder causar efeitos adversos similares aos da efedrina, atualmente acredita-se que níveis endógenos alterados de p-sinefrina possam estar associados à causa da enxaqueca. Folhas e frutos desta espécie são largamente comercializados na forma de chá e em preparados de erva-mate, sem que sejam considerados os riscos associados ao seu uso. Neste sentido, este trabalho descreve uma pesquisa em chás e preparados de erva-mate comercializados em Porto Alegre, para verificar a presença de C. aurantium e p-sinefrina. Comparando com a quantidade média disponível nas prateleiras dos supermercados, cerca de 20% dos chás e 10% dos preparados de erva-mate declaravam nos rótulos conter C. aurantium. De uma amostragem de 15 chás e 2 preparados de erva-mate selecionados para análise, em todos foi caracterizada a presença de p-sinefrina com níveis variando de 0,0040 a 0,2308%, levando ao alerta de que mesmo sendo naturais, estes produtos podem não ser destituídos de reações adversas

Morte Súbita em Doença de Chagas

A Doença de Chagas atinge milhões de pessoas na América Latina e a evolução para cardiopatia crônica tem como seu principal desfecho a morte súbita cardíaca (MSC). Neste artigo, revisamos, sob a luz da medicina baseada em evidências, os principais aspectos sobre marcadores prognósticos clínicos e de imagem (especificamente a análise da fibrose em ressonância magnética) e terapêutica existente no tratamento e prevenção da MSC, como terapia farmacológica, evidências sobre dispositivos implantáveis e tratamento invasivo de arritmias ventriculares.

Gender differences in biochemical markers and oxidative stress of rats after 28 days oral exposure to a mixture used for weight loss containing p-synephrine, ephedrine, salicin, and caffeine

A associação de p-sinefrina, efedrina, salicina, e cafeína em suplementos alimentares e produtos para perda de peso é muito utilizada em todo o mundo, embora a efedrina tenha sido proibida em muitos países. O objetivo deste estudo foi avaliar o perfil de toxicidade à exposição oral de 28 dias à associação de p-sinefrina, efedrina, salicina e cafeína (na proporção de 10:4:6:80 m/m respectivamente) em ratos Wistar machos e fêmeas. Diariamente, os animais foram observados quanto ao peso corporal, sinais de toxicidade, morbidade e mortalidade. Após 28 dias, os animais foram sacrificados e o sangue coletado para avaliações hematológicas, bioquímicas e de estresse oxidativo. Não se observaram sinais clínicos de toxicidade, tampouco perda significativa de peso, mortes, ou quaisquer alterações significativas nos parâmetros hematológicos. Biomarcadores do estresse oxidativo e bioquímicos mostraram peroxidação lipídica, danos renais e hepáticos (p < 0,05; ANOVA/Bonferroni) em ratos machos (100 e 150 mg/kg) e a redução (p < 0,05; ANOVA/Bonferroni) nos níveis de glutationa reduzida (GSH) em todos os grupos de machos tratados. Nas fêmeas, não houve indícios de estresse oxidativo, nem alterações bioquímicas. O diferente perfil de toxicidade entre os gêneros sugere influência hormonal nos efeitos de mistura administrada. A associação testada pode alterar o estado oxidativo e promover danos renais e hepáticos.The association of p-synephrine, ephedrine, salicin, and caffeine in dietary supplements and weight loss products is very common worldwide, even though ephedrine has been prohibited in many countries. The aim of this study was to evaluate a 28-day oral exposure toxicity profile of p-synephrine, ephedrine, salicin, and caffeine mixture (10:4:6:80 w/w respectively) in male and female Wistar rats. Body weight and signs of toxicity, morbidity, and mortality were observed daily. After 28 days, animals were euthanized and blood collected for hematological, biochemical, and oxidative stress evaluation. No clinical signs of toxicity, significant weight loss or deaths occurred, nor were there any significant alterations in hematological parameters. Biochemical and oxidative stress biomarkers showed lipid peroxidation, and hepatic and renal damage (p < 0.05; ANOVA/Bonferroni) in male rats (100 and 150 mg/kg) and a reduction (p < 0.05; ANOVA/Bonferroni) in glutathione (GSH) levels in all male groups. Female groups displayed no indications of oxidative stress or biochemical alterations. The different toxicity profile displayed by male and female rats suggests a hormonal influence on mixture effects. Results demonstrated that the tested mixture can alter oxidative status and promote renal and hepatic damages

Major clinical evidence of cervicofacial liposculpture: a concise systematic review

Introduction: Liposculpture (LS) can complement cervicofacial aging surgery. Modern trends in face sculpting are expanding and adipose tissue transfer can result in optimal esthetic effects with minimally invasive techniques. Facial LS focuses on repositioning adipose tissue and increasing facial transition zones. This is accomplished using internal suspension sutures as well as with autologous fat grafting. Objective: To carry out a concise systematic review of the main clinical considerations and advances in facial and cervical liposculpture as an important aesthetic tool for dental surgeons. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The search was carried out from November 2021 to February 2022 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: Fifty articles were found involving facial liposculpture. A total of 30 articles were fully evaluated and 16 were included and developed in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 10 studies at high risk of bias and 4 studies that did not meet the GRADE. Most patients who were involved in the studies showed improvements in facial augmentation and contouring. In patients with loss of facial volume, high-density fat transfer with SVF-gel facial injection resulted in significantly higher improvement scores and better patient satisfaction, with an improved/much improved esthetic appearance being observed. As a follow-up analysis of the studies, at an average of six months after completion, most patients were satisfied with the results. All procedures were well tolerated. Conclusion: According to the main clinical studies selected in the present study, cervicofacial liposculpture proved to be advantageous, with safety and efficacy

Pré-excitação ventricular como causa de disfunção ventricular esquerda parcialmente reversível com ablação da via anômala.

A pré-excitação ventricular é causa rara de cardiomiopatia induzida ou mediada por arritmias. As vias acessórias à direita, especificamente com padrão de bloqueio de ramo esquerdo podem causar disfunção ventricular, pela ativação ventricular anormal resultante da condução anterógrada pela VA pode causar dessincronismo atrioventricular, interventricular e intraventricular, com contração assíncrona da parede ventricular e regurgitação mitral. Descrevemos uma paciente assintomática, com eletrocardiograma exibindo pré-excitação ventricular, padrão de BRE e disfunção ventricular sistólica moderada. Estudo eletrofisiológico demonstrou via acessória de localização anterior e com período refratário anterógrado de 600ms, realizando-se ablação por radiofrequência com sucesso e significativa melhora da função ventricular

Effectiveness of phototherapy incorporated into an exercise program for osteoarthritis of the knee: study protocol for a randomized controlled trial

BACKGROUND: Osteoarthritis is a chronic disease with a multifactor etiology involving changes in bone alignment, cartilage, and other structures necessary to joint stability. There is a need to investigate therapeutic resources that combine different wavelengths as well as different light sources (low-level laser therapy and light-emitting diode therapy) in the same apparatus for the treatment of osteoarthritis. The aim of the proposed study is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for individuals with osteoarthritis of the knee. METHODS/DESIGN: A double-blind, controlled, randomized clinical trial will be conducted involving patients with osteoarthritis of the knee. Evaluations will be performed using functional questionnaires before and after the treatment protocols, in a reserved room with only the evaluator and participant present, and no time constraints placed on the answers or evaluations. The following functional tests will also be performed: stabilometry (balance assessment), dynamometry (muscle strength of gluteus medius and quadriceps), algometry (pain threshold), fleximeter (range of motion), timed up-and-go test (functional mobility), and the functional reach test. The participants will then be allocated to three groups through a randomization process using opaque envelopes: exercise program, exercise program + phototherapy, or exercise program + placebo phototherapy, all of which will last for eight weeks. DISCUSSION: The purpose of this randomized clinical trial is to analyze the effect of the incorporation of phototherapy into a therapeutic exercise program for osteoarthritis of the knee. The study will support the practice based on evidence to the use of phototherapy in individuals with a diagnosis of osteoarthritis of the knee. Data will be published after the study is completed. TRIAL REGISTRATION: The protocol for this study has been submitted to Clinical Trials, registration number NCT02102347, on 29 March 2014

Characterization of Caatinga vegetation and diet of steers in the "Sertão" of Pernambuco, Brazil

O objetivo deste trabalho foi avaliar a composição botânica, a disponibilidade e a qualidade da forragem e da dieta de animais fistulados alimentados na Caatinga, no período chuvoso, em Pernambuco. Avaliaram-se a composição botânica e a disponibilidade de fitomassa dos estratos herbáceo, arbustivo e arbóreo, nos meses de março e junho. A avaliação da qualidade da forragem foi feita por meio da análise bromatológica, realizada em todos os meses do período chuvoso. Foram encontradas 67 espécies, das quais 28 herbáceas, 20 arbustivas e 19 arbóreas. Destas, 19 foram encontradas na dieta dos animais. A disponibilidade de fitomassa do componente herbáceo variou de 1.369 kg ha-1 de matéria seca (MS), em março, para 452 kg ha-1 de MS em junho. A disponibilidade do estrato arbustivo aproximou-se do herbáceo, enquanto o componente arbóreo contribuiu com apenas 178 kg ha-1 de MS. Apesar de a disponibilidade de fitomassa ser relativamente alta, apenas uma pequena porcentagem do material encontrado pode ser considerada como forragem. Foi observada baixa digestibilidade da proteína, provavelmente em conseqüência do alto teor em lignina.The objective of this work was to evaluate the botanical composition, the availability and quality of the fodder and diet of fistulated animals fed in an area of Caatinga, during the rainy season, in Pernambuco State, Brazil. Evaluations of botanical composition and fodder availability of herbaceous, arbustive and arboreous extracts were made in March and June. Fodder quality evaluation was performed through chemical analysis during the wet period. Sixty-seven species were found: 28 herbaceous, 20 arbustive and 18 arboreal; from these species, 19 were found in the animals diet. The fitomass availability from the herbaceous component varied from 1,369 kg ha-1 of dry matter (DM) in March, to 452 kg ha-1 of DM in June. The availability of the arbustive extract layer was close to the herbaceous, while the arboreal component contributed with only 178 kg ha-1 of DM. Despite the relatively high fitomass availability, only a small percentage was considered as fodder from the material found. It was observed a low digestion of the protein, probably due to high levels of lignin