Avaliação do conhecimento de dentistas de um município de Minas Gerais sobre o atendimento de pacientes com doença renal crônica

Introduction: patients with chronic kidney disease (CKD) are more susceptible to infections and bleeding and can manifest various oral alterations, making it essential that the dental surgeon has the necessary knowledge to adapt their conduct to the particularities presented by these patients and to communicate with the team of nephrology responsible for them. However, there are still insecurities and doubts on the part of professionals regarding the attitudes that should be taken when providing care to individuals with CKD, especially regarding whether or not to adopt the prophylaxis protocol for infective endocarditis. Objective: to evaluate, through the application of a questionnaire, the knowledge and behavior of dentists working in the city of Juiz de Fora when providing care to patients with CKD on hemodialysis. Material and Methods: study with a quantitative, observational, cross-sectional and analytical approach, carried out with 100 dentists working in the city of Juiz de Fora (MG) from April to September 2022. Results: 100 dentists composed the sample. Of these, 37% would not feel comfortable performing invasive dental procedures in chronic kidney patients (CKP) on hemodialysis and 87% would request some complementary laboratory test prior to performing these procedures; 83% consider it important to contact the patient's nephrologist to obtain detailed information about their systemic condition and apply this in their clinical routine; 56% correctly identified the oral alterations most commonly found in individuals with CKD undergoing hemodialysis; 77% would prescribe antibiotic prophylaxis for CKP in hemodialysis in the face of invasive procedures, while 22% would prescribe it for non-invasive procedures. Conclusion: most dentists incorrectly prescribes antibiotic prophylaxis for chronic kidney patients, which demonstrates unfamiliarity of the actual protocol for using this therapy. In addition, a number of dentists feel insecure when assisting them and are unaware of the oral alterations most commonly found in CKP.Introdução: Pacientes com doença renal crônica (DRC) apresentam uma maior suscetibilidade a infecções e sangramentos e podem manifestar variadas alterações bucais. Por isso, é essencial que o cirurgião-dentista possua os conhecimentos necessários para adequar suas condutas às particularidades apresentadas por esses pacientes. Objetivo: Avaliar, por meio da aplicação de um questionário, os conhecimentos e as condutas dos cirurgiões-dentistas atuantes no município de Juiz de Fora, Minas Gerais, ao prestarem atendimento a pacientes com DRC em hemodiálise. Material e Métodos: Estudo com abordagem quantitativa, de caráter observacional, transversal e analítico, realizado com 100 cirurgiões-dentistas atuantes no município de Juiz de Fora no período de abril a setembro de 2022. Resultados: 100 dentistas compuseram a amostra. Destes, 37% não se sentiriam confortáveis para realizarem procedimentos odontológicos invasivos em pacientes renais crônicos (PRC) em hemodiálise e 87% solicitariam algum exame laboratorial complementar previamente à realização desses procedimentos; 83% consideram importante o contato com o nefrologista do paciente para a obtenção de informações detalhadas acerca de sua condição sistêmica e aplicam isso em sua rotina clínica; 56% identificaram de forma correta as alterações bucais mais comumente encontradas em indivíduos com DRC em hemodiálise; 77% prescreveriam profilaxia antibiótica para PRC em hemodiálise diante de procedimentos invasivos, enquanto 22% prescreveriam para procedimentos não invasivos. Conclusão: A maioria dos cirurgiões-dentistas prescreve erroneamente a profilaxia antibiótica para PRC, o que demonstra desconhecimento do protocolo atual de emprego dessa terapia. Além disso, uma parcela dos profissionais se sente insegura ao atender esses pacientes. Portanto, evidencia-se a defasagem existente no conhecimento dos cirurgiões-dentistas quanto ao atendimento de pacientes com DRC, destacando-se a necessidade de dar maior enfoque a esse tema nas universidades e programas de pós-graduação, a fim de formar profissionais melhor capacitados para o atendimento dessa parcela da população

Why Are Outcomes Different for Registry Patients Enrolled Prospectively and Retrospectively? Insights from the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF).

Background: Retrospective and prospective observational studies are designed to reflect real-world evidence on clinical practice, but can yield conflicting results. The GARFIELD-AF Registry includes both methods of enrolment and allows analysis of differences in patient characteristics and outcomes that may result. Methods and Results: Patients with atrial fibrillation (AF) and ≥1 risk factor for stroke at diagnosis of AF were recruited either retrospectively (n = 5069) or prospectively (n = 5501) from 19 countries and then followed prospectively. The retrospectively enrolled cohort comprised patients with established AF (for a least 6, and up to 24 months before enrolment), who were identified retrospectively (and baseline and partial follow-up data were collected from the emedical records) and then followed prospectively between 0-18 months (such that the total time of follow-up was 24 months; data collection Dec-2009 and Oct-2010). In the prospectively enrolled cohort, patients with newly diagnosed AF (≤6 weeks after diagnosis) were recruited between Mar-2010 and Oct-2011 and were followed for 24 months after enrolment. Differences between the cohorts were observed in clinical characteristics, including type of AF, stroke prevention strategies, and event rates. More patients in the retrospectively identified cohort received vitamin K antagonists (62.1% vs. 53.2%) and fewer received non-vitamin K oral anticoagulants (1.8% vs . 4.2%). All-cause mortality rates per 100 person-years during the prospective follow-up (starting the first study visit up to 1 year) were significantly lower in the retrospective than prospectively identified cohort (3.04 [95% CI 2.51 to 3.67] vs . 4.05 [95% CI 3.53 to 4.63]; p = 0.016). Conclusions: Interpretations of data from registries that aim to evaluate the characteristics and outcomes of patients with AF must take account of differences in registry design and the impact of recall bias and survivorship bias that is incurred with retrospective enrolment. Clinical Trial Registration: - URL: http://www.clinicaltrials.gov . Unique identifier for GARFIELD-AF (NCT01090362)

Síndrome do dente trincado: uma revisão de literatura

Many studies have been carried out about cracked teeth in an attempt to describe the symptoms associated with this condition, the diagnostic process of clefts, as well as the possible forms of treatment and the prognosis for these teeth. The present work aims to study, through a literature review, the means used for diagnosis, the clinical and radiographic aspects and the possibilities of treatment of the cracked tooth syndrome (SDT). Due to the difficulty in making the diagnosis, it is recommended that different examination methods be associated. The signs and symptoms of SDT are very diverse, varying according to the dental structures involved and may resemble other clinical conditions, which makes the diagnostic process even more complex. Most clefts are not visible on conventional radiography, and radiographic aspects are expressed through periodontal changes resulting from fractures at a more advanced stage. However, through cone beam computed tomography it is possible to identify the crack and assess its depth and extension. There are several treatment possibilities for cracked teeth, and clinical success and a favorable prognosis are directly related to early diagnosis and intervention. Therefore, it is essential that the dentist know the characteristics associated with the syndrome and be able to identify them. More prospective, well-documented, controlled clinical studies with long-term follow-up are needed to develop different treatment protocols for different clinical conditions, allowing the management of SDT in a safe and appropriate way.Muitos estudos têm sido realizados acerca de dentes trincados na tentativa de descrever a sintomatologia associada a esta condição, o processo diagnóstico das fissuras, bem como as possíveis formas de tratamento e o prognóstico para esses dentes. O presente trabalho tem como objetivo estudar, por meio de uma revisão de literatura, os meios utilizados para diagnóstico, os aspectos clínicos e radiográficos e as possibilidades de tratamento da síndrome do dente trincado (SDT). Devido à dificuldade em realizar o diagnóstico, é recomendado que diferentes métodos de exame sejam associados. Os sinais e sintomas da SDT são muito diversos, variando de acordo com as estruturas dentais envolvidas e podendo se assemelhar a outras condições clínicas, o que torna ainda mais complexo o processo diagnóstico. A maioria das fissuras não são visíveis na radiografia convencional, e os aspectos radiográficos se expressam através de alterações periodontais decorrentes de fraturas em um estágio mais avançado. No entanto, através da tomografia computadorizada de feixe cônico é possível identificar a fissura e avaliar sua profundidade e extensão. Diversas são as possibilidades de tratamento para dentes trincados, e o sucesso clínico e um prognóstico favorável estão diretamente relacionados ao diagnóstico e à intervenção precoces. Por isso, é essencial que o cirurgião-dentista conheça e saiba identificar quais são as características associadas à síndrome. Mais estudos clínicos prospectivos, bem documentados, controlados e com acompanhamento de longo prazo são necessários para que sejam desenvolvidos diferentes protocolos de tratamento para diferentes condições clínicas, permitindo o manejo da SDT de forma segura e apropriada

Resumos concluídos - Ciências Biológicas

Resumos concluídos - Ciências Biológica

Proceedings Of The 23Rd Paediatric Rheumatology European Society Congress: Part Two

PubMe

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83-7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97-2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14-1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25-1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable

Respiratory support in patients with severe COVID-19 in the International Severe Acute Respiratory and Emerging Infection (ISARIC) COVID-19 study: a prospective, multinational, observational study

Background: Up to 30% of hospitalised patients with COVID-19 require advanced respiratory support, including high-flow nasal cannulas (HFNC), non-invasive mechanical ventilation (NIV), or invasive mechanical ventilation (IMV). We aimed to describe the clinical characteristics, outcomes and risk factors for failing non-invasive respiratory support in patients treated with severe COVID-19 during the first two years of the pandemic in high-income countries (HICs) and low middle-income countries (LMICs). Methods: This is a multinational, multicentre, prospective cohort study embedded in the ISARIC-WHO COVID-19 Clinical Characterisation Protocol. Patients with laboratory-confirmed SARS-CoV-2 infection who required hospital admission were recruited prospectively. Patients treated with HFNC, NIV, or IMV within the first 24 h of hospital admission were included in this study. Descriptive statistics, random forest, and logistic regression analyses were used to describe clinical characteristics and compare clinical outcomes among patients treated with the different types of advanced respiratory support. Results: A total of 66,565 patients were included in this study. Overall, 82.6% of patients were treated in HIC, and 40.6% were admitted to the hospital during the first pandemic wave. During the first 24 h after hospital admission, patients in HICs were more frequently treated with HFNC (48.0%), followed by NIV (38.6%) and IMV (13.4%). In contrast, patients admitted in lower- and middle-income countries (LMICs) were less frequently treated with HFNC (16.1%) and the majority received IMV (59.1%). The failure rate of non-invasive respiratory support (i.e. HFNC or NIV) was 15.5%, of which 71.2% were from HIC and 28.8% from LMIC. The variables most strongly associated with non-invasive ventilation failure, defined as progression to IMV, were high leukocyte counts at hospital admission (OR [95%CI]; 5.86 [4.83–7.10]), treatment in an LMIC (OR [95%CI]; 2.04 [1.97–2.11]), and tachypnoea at hospital admission (OR [95%CI]; 1.16 [1.14–1.18]). Patients who failed HFNC/NIV had a higher 28-day fatality ratio (OR [95%CI]; 1.27 [1.25–1.30]). Conclusions: In the present international cohort, the most frequently used advanced respiratory support was the HFNC. However, IMV was used more often in LMIC. Higher leucocyte count, tachypnoea, and treatment in LMIC were risk factors for HFNC/NIV failure. HFNC/NIV failure was related to worse clinical outcomes, such as 28-day mortality. Trial registration This is a prospective observational study; therefore, no health care interventions were applied to participants, and trial registration is not applicable