Metals used in maxillofacial surgery

The goal of maxillofacial surgery is to restore the shape and functionality of maxillofacial region. In the past years, there has been a tremendous progress in this field because of significant advances in biotechnology that provided innovative biomaterials to efficiently reconstruct the maxillofacial injured region. By using appropriate selection of the implant biomaterial, it is possible to reconstruct the native tissue, both in form and function. The ideal biomaterial should mimic native tissues regarding density, strength, and modulus of elasticity. Autografts are currently the gold standard for replacement of missing tissues, but synthetic biomaterials have been widely used because they eliminate the discomfort to take the replacement tissue from the donor site. Among synthetic biomaterials, different metals may be utilized to efficiently reconstruct the maxillofacial injured region. This article makes an effort to summarize the most important metals in use in maxillofacial surgery, and point out advantages and disadvantage of each typ

Retrospective analysis of the correlation between the facial biotype and the inclination of the upper canine cusp axis to the occlusal plane

Permanent maxillary canines are the second most frequently impacted teeth and the prevalence of this clinical condition is estimated to be 1-2% in the general population. The diagnosis of maxillary canine impaction should be based on both clinical and radiographic examinations. The aim of this study was to evaluate the presence of a correlation between the facial biotype and the inclination of the upper cusp axis. A correlation between the total radicular length of the lateral incisors was also evaluated, by comparing the side of impaction with the healthy side. Twenty three patients with a diagnosis of unilateral upper cusp impaction were recruited. For each patient, dental casts and radiographic material (panoramic radiographs and lateral cephalograms) were examined. Statistical analyses were done with Spearman's rank correlation coefficient or Spearman's rho (V). X-ray examinations demonstrated that canine impaction was associated to other dental anomalies (32% of the sample). The mean S angle measurements were 22.9° ± 4.1°, and mean values of the T angle were 34.7°± 4.0°. The mean distance “d” value was 14.6 mm ± 1.2 mm. The mean values of the angle between the upper cusp axis and the perpendicular-to-Fh plane were 20.8 °± 2.6°. Among the 23 subjects recruited, 5 showed values included in the range 25°-45° and 1 an inclination > 45°. The results obtained in the present study demonstrate a significant inverse correlation between the MM angle and the inclination of the upper cusp axis to the perpendicular-to-Fh plan

3D Survey and Data Processing of Bolivian Archaeology: The Ritual Receptacle from Tiwanaku

The archaeological site of Tiwanaku is among the most important examples of Bolivian archaeology and UNESCO World Heritage Site since 2000. This works reports a geomatic-based surveying and modelling methodology applied to a ritual receptacle excavated from the semi-subterranean temple in the archaeological complex. A high-resolution 3D survey was conducted through structured-light projection scanning and post-processing operations were carried out to emphasize surface details. Most of the operations were conducted in open-source software, with the aim to establish a quick and repeatable methodology to be applied to similar case studies. The final outputs, consisting of geometry projections (unrolled meshes), digitally enhanced surfaces and vector graphics can support the work of archaeologists in interpreting the iconography depicted on the receptacle and to conduct further studies to shed light about culture and religion of the civilization that inhabited Tiwanaku

Clinical insights on Tolosa Hunt syndrome: a multidisciplinary approach on neurological-related symptomatology in maxillofacial region

Background Tolosa–Hunt syndrome (THS) related neurological symptoms are described in literature as “unilateral”, “recurrent”, “episodic”, “intense”, “severe”, “lancinating” or “stabbing” pain on the upper face and forehead and may be misdiagnosed due to the similarity of few symptoms and a significant number of common characteristics between both conditions. Aims The aim of this brief report is to indicate some important clinical insights related to Tolosa Hunt syndrome, and to give a frank account on the multidisciplinary approach on neurological-related symptomatology in maxillofacial region. Methods We analysed a selection of patients with such clinical picture. To better describe the proper management of clinical cases, we report a 50-year-old female reporting an history of two years of recurrent, severe stabbing pain around the right eye, prominence of her cheek and forehead. Her general dentist first mistakenly diagnosed toothache and, thus, it was subsequently misdiagnosed the trigeminal neuropathy (TN). Results Reported exemplificative case presented a mild ptosis, diplopia of the right eye, corneal reflex loss, paresthesia and hyperesthesia of upper part of left side of face. Magnetic resonance imaging (MRI) findings were suggestive of THS. Complete resolution of symptoms was achieved with oral Prednisolone and constant monitoring of symptoms. Conclusion THS may be added to the long list of differential diagnosis of TN and general dentist and oral surgeons should be informed about such rare causes of facial pain through continued medical education programs

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

The inclusion of a chapter on pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (or PANDAS) is essential to provide a history of the disease and provide current information about its association with Streptococcus pyogenes (group A streptococci), tics, obsessive compulsive disorder (OCD) and its relationship to Sydenham chorea (SC), which is the neurologic manifestation of acute rheumatic fever. PANDAS has been misunderstood and confusing to doctors since its discovery, but the original group of the first 50 cases as described by Dr Susan Swedo (Swedo, et al., 1998) has a similarity to Sydenham chorea that distinguishes this initial group from tic and OCD cases. As this chapter will examine, the acute onset is an important feature of these disorders, as are their piano-playing choreiform movements, enuresis, night-time fears, separation anxiety, learning regression, and handwriting disabilities. The most current literature, which has been recently published in the Journal of Child and Adolescent Psychopharmacology (Murphy, et al., 2015b; Murphy, Parker-Athill, Lewin, Storch, & Mutch, 2015a; Toufexis, et al., 2015; Gerardi, Casadonte, Patel, & Murphy, 2015; Chang, et al., 2015), provides new insight into the clinical phenotype of PANDAS; namely, a subgroup of pediatric acute-onset neuropsychiatric syndrome (PANS), which has been proposed to have multiple etiologies, including those that are genetic and immunologic, and that present either with or without preceding infections, such as with Streptococcus pyogenes (Toufexis, et al., 2015). PANS is a subtype of obsessive compulsive disorder (OCD) that presents with an abrupt onset or exacerbation of neuropsychiatric symptoms (Murphy, et al., 2015b), including moderate or severe OCD. Elevated anti-streptococcal antibody titers tended to have higher OCD severity and the symptoms tended to lead to sudden and severe impairment, due to comorbidities, such as anxiety, behavioral regression, depression, and suicidality. Comorbid tics in PANS were associated with decline in school performance, visuomotor impairment, eating disorders, deterioration of handwriting skills, and lower quality of life, as compared to children without tics (Murphy, et al., 2015b). In addition, clinical evaluation of youth with PANS and PANDAS and recommendations for diagnosis were reported from the 2013 PANS conference held at Stanford University where a group of clinicians and researchers who were academicians with clinical and research interest in PANDAS and PANS (Chang, et al., 2015). PANDAS is clearly a subtype of PANS (Murphy, et al., 2015b; Murphy, Parker-Athill, Lewin, Storch, & Mutch, 2015a; Chang, et al., 2015) and not all PANS cases have an underlying streptococcal infection—but all PANDAS cases are associated with streptococcal infections, at least temporally. When these diseases appear, treatment with antibiotics can be successful, and a treatment trial of cefdinir by Murphy and colleagues indicated that therapy with cefdinir, a β lactam antibiotic, provided notable improvements in tic symptoms rated by the Yale Global Tic Severity Scale (YGTSS) and OCD symptoms rated by the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). However, the differences within the groups as a whole were not significant. β-lactam antibiotics have been proposed to be neuroprotective above and beyond their antibiotic efficacy (Murphy, Parker-Athill, Lewin, Storch, & Mutch, 2015a). Anti-neuronal autoantibodies against the brain in SC and PANDAS react with brain antigens including dopamine receptors (Cox, et al., 2013; Brimberg, et al., 2012), lysoganglioside (Kirvan, Swedo, Heuser, & Cunningham, 2003; Kirvan, Swedo, Snider, & Cunningham, 2006a), and tubulin (Kirvan, Cox, Swedo, & Cunningham, 2007), as well as the activation of the calcium calmodulin-dependent protein kinase II (CaM KII) in human neuronal cells (Kirvan, Swedo, Heuser, & Cunningham, 2003). Human anti-brain antibodies expressed in Tg mice targeted dopaminergic neurons and signaled the dopamine D2 receptor (D2R) (Cox, et al., 2013). Evidence strongly suggests that human anti-brain autoantibodies induced by Streptococcus pyogenes infections target the dopamine receptors (Cox, et al., 2013; Brimberg, et al., 2012) and that animal models immunized with the S. pyogenes antigen develop obsessive behaviors and movement problems, along with antibodies that react with the dopamine receptors and signal the CaMKII, similar to antibodies found in humans with SC and PANDAS (Brimberg, et al., 2012; Lotan, et al., 2014a)

Rapid increase of resistance to erythromycin and clindamycin in Streptococcus pyogenes in Italy, 1993-1995. The Italian Surveillance Group for Antimicrobial Resistance.

A survey of antibiotic resistance in Streptococcus pyogenes in Italy showed a sharp increase in erythromycin resistance. In 1993, the incidence of erythromycin-resistant strains was on average 5.1%, with marked variations by geographic area. Two years later, the incidence of these strains had registered a 1.5- to roughly 20-fold increase, with a mean value of 25.9%, exceeding 40% in three centers out of 13 and 30% in another four. For all the strains studied, normal levels of susceptibility to penicillin were reported

Role of macrophages in experimental group B streptococcal arthritis.

Septic arthritis is a clinical manifestation of group B Streptococcus (GBS) infection in both neonates and adults. Because macrophages are known to participate in tissue injury, the role of this cell population in GBS-induced arthritis was investigated. Mice were rendered monocytopenic by administration of etoposide, a drug that selectively depletes the monocyte/macrophage population and then injected with GBS (1 x 10(7) colony-forming units per mouse). Appearance of arthritis, mortality, GBS growth in the organs, and local and systemic cytokine production were examined. Etoposide-treated mice had a significantly less severe arthritis than control animals. Histopathological analysis of the joints confirmed clinical observations. Decreased joint levels of the proinflammatory cytokines interleukin 1 (IL-1) beta and IL-6 accompanied the less severe development of arthritis in monocytopenic mice. In contrast, mortality was increased in the etoposide-treated mice compared with controls. Monocytopenic mice exhibited elevated bacterial load in the blood and kidneys at all time points examined. These results indicate that lack of macrophages leads to less severe joint lesions, but also results in impaired clearance of bacteria, and consequent enhancement of mortality rates

Determinantes do endividamento e regulação: uma análise em operadoras de planos de saúde exclusivamente odontológicos

Purpose – This paper examines the determinants of debt levels of Brazilian dental health plan operators (OPS) under the National Supplementary Health Agency (ANS) regulation.Design/methodology/approach – It is an empirical article based on quantitative and causal research. The sample consisted of data from 2010 to 2018 available on the ANS website. The techniques of content analysis, descriptive statistics and panel regression were used for data analysis.Findings – We found that several variables related to the ANS regulation influence dental OPS debt levels. Furthermore, there are also several similarities between the two categories under analysis: dental cooperatives and group dentistry, despite the differences in the legal nature of such organizations.Research limitations/implications – The present study suffers from some limitations: (a) the sample investigated is restricted to OPS public data; and (b) regulation variables are limited due to the data available for calculation, despite our efforts to show otherwise.Originality/value – The present research offers a range of contributions to the literature on dental operators’ capital structure. Firstly, it emphasized the impact of regulation in dental operators’ financial decisions in Brazil. Moreover, it confirmed the important role of companies’ determinant variables of capital structure in explaining OPS debt levels. Lastly, the study introduced regulatory variables as determinants of OPS debt ratios.Objetivo – Analisar os determinantes do endividamento de operadoras de planos de saúde (OPS) exclusivamente odontológicos (EO), sob a perspectiva da regulação da Agência Nacional de Saúde Suplementar (ANS).Metodologia – Pesquisa quantitativa e causal. A amostra consistiu nas OPS cujos dados de 2010 a 2018 estavam disponíveis no site da ANS. Foram usadas para a análise dos dados as técnicas de análise de conteúdo, estatística descritiva e regressão com dados em painel.Conclusão – Constatou-se que diversas variáveis relacionadas à regulação da ANS influenciaram os níveis de endividamento das OPS odontológicas. Ademais, observaram-se várias semelhanças entre as duas categorias em análise (cooperativas odontológicas e odontologia de grupo), apesar das diferenças na natureza jurídica de tais organizações.Limitações – O estudo apresenta algumas limitações: (a) a amostra investigada restringe-se a dados públicos de OPS; e (b) as variáveis de regulação são limitadas devido aos dados disponíveis para cálculo.Originalidade / valor – Este artigo apresenta uma série de contribuições para a literatura sobre a estrutura de capital de OPS EO. Primeiramente, destacou-se o papel da regulação nas decisões financeiras das OPS no Brasil. Ademais, confirmou-se a importância de variáveis determinantes da estrutura de capital de empresas para explicar o endividamento das OPS. Por fim, foram propostas variáveis regulatórias como determinantes do endividamento dessas organizações

Os efeitos da pandemia de COVID-19 no desempenho econômico-financeiro das companhias abertas brasileiras

Purpose – The study aimed at analyzing the effects of the COVID-19 pandemic on the financial performance of Brazilian public companies listed on Brasil, Bolsa, Balcão (B3) in 2020. Design/methodology/approach – It is a quantitative and descriptive research. A final sample of the study consisted of 158 companies that simultaneously provided the quarterly data of interest (economic-financial and operational) on both the B3 website and the Economática® Platform, from 2019 to 2020. In order to analyze data, we employ the following techniques: content analysis, descriptive statistics, Kolmogorov-Smirnov test, Kendall correlation coefficient, Kruskal-Wallis test, Wilcoxon test and multiple regression. Findings – The results indicated the expected effects on the companies’ financial performance in the first two quarters of 2020: (1) reduction in market value and profitability; and (2) increase in activity cycles and indebtedness. In the following quarters, there was a reversal of these effects, with different proportions for companies in different sectors. Originality/value – It contributes to the literature on corporate finance in different aspects: (a) it presents a broad analysis of the effects of the COVID-19 pandemic on the different economic and financial dimensions of companies from different sectors; (b) discusses not only the effects of the pandemic, but also the reactions of companies and the economic and financial implications of these reactions; (c) analyzes external and internal information to companies to support conclusions; and (d) as it covers all quarters of 2020, it makes it possible to analyze the evolution of the impacts of the pandemic over the period. Objetivo – O objetivo da pesquisa apresentada neste artigo foi analisar os efeitos da pandemia de Covid-19 sobre o desempenho econômico-financeiro das companhias abertas brasileiras listadas na Brasil, Bolsa, Balcão (B3) em 2020. Design / metodologia / abordagem – Trata-se de uma pesquisa quantitativa e descritiva. A amostra consistiu em companhias abertas brasileiras, sendo que seus dados trimestrais de 2019 e 2020 foram coletados da Plataforma Economática® e da B3. Para a análise, foram usadas as seguintes técnicas: análise de conteúdo, estatística descritiva, teste de Kolmogorov-Smirnov, coeficiente de correlação de Kendall, teste de Kruskal-Wallis, teste de Wilcoxon e regressão múltipla. Resultados – A análise dos dados indicou os efeitos esperados no desempenho econômico-financeiro das companhias nos dois primeiros trimestres de 2020: (1) redução do valor de mercado e da rentabilidade; e (2) aumento dos ciclos de atividades e do endividamento. Nos trimestres seguintes, verificou-se uma reversão desses efeitos, mas que foram sentidos de diferentes formas pelas empresas dos diversos setores. Originalidade / valor – O estudo contribui para a literatura sobre finanças corporativas em diferentes aspectos: (a) apresenta uma ampla análise dos efeitos da pandemia de Covid-19 sobre as diferentes dimensões econômico-financeiras das companhias; (b) discute não apenas os efeitos da pandemia, mas também as reações das empresas e implicações econômico-financeiras dessas reações; (c) analisa informações externas e internas às empresas para subsidiar as conclusões; e (d) enfocam-se todos os trimenstres do ano de 2020, analisando a evolução da pandemia ao longo do período

Treatment of tuberculosis in a region with high drug resistance: Outcomes, drug resistance amplification and re-infection

Introduction: Emerging antituberculosis drug resistance is a serious threat for tuberculosis (TB) control, especially in Eastern European countries. Methods: We combined drug susceptibility results and molecular strain typing data with treatment outcome reports to assess the influence of drug resistance on TB treatment outcomes in a prospective cohort of patients from Abkhazia (Georgia). Patients received individualized treatment regimens based on drug susceptibility testing (DST) results. Definitions for antituberculosis drug resistance and treatment outcomes were in line with current WHO recommendations. First and second line DST, and molecular typing were performed in a supranational laboratory for Mycobacterium tuberculosis (MTB) strains from consecutive sputum smear-positive TB patients at baseline and during treatment. Results: At baseline, MTB strains were fully drug-susceptible in 189/326 (58.0%) of patients. Resistance to at least H or R (PDR-TB) and multidrug-resistance (MDR-TB) were found in 69/326 (21.2%) and 68/326 (20.9%) of strains, respectively. Three MDR-TB strains were also extensively resistant (XDR-TB). During treatment, 3/189 (1.6%) fully susceptible patients at baseline were re-infected with a MDR-TB strain and 2/58 (3.4%) PDR-TB patients became MDR-TB due to resistance amplification. 5/ 47 (10.6%) MDR- patients became XDR-TB during treatment. Treatment success was observed in 161/189 (85.2%), 54/69 (78.3%) and 22/68 (32.3%) of patients with fully drug susceptible, PDR- and MDR-TB, respectively. Development of ofloxacin resistance was significantly associated with a negative treatment outcome. Conclusion: In Abkhazia, a region with high prevalence of drug resistant TB, the use of individualized MDR-TB treatment regimens resulted in poor treatment outcomes and XDR-TB amplification. Nosocomial transmission of MDR-TB emphasizes the importance of infection control in hospitals