MANIFESTAÇÕES OROFACIAIS DA DISPLASIA CLEIDOCRANIANA: UMA REVISÃO DE LITERATURA

O objetivo deste artigo é descrever os aspectos gerais e as principais manifestações orofaciais da Displasia Cleidocraniana, elencando a importância do Cirurgião-dentista no diagnóstico precoce. Trata-se de uma revisão integrativa, em que foram selecionados artigos científicos indexados no SCIELO, LILACS e MEDLINE/PUBMED. As principais alterações encontradas nos indivíduos que apresentam esta displasia são a presença de dentes supranumerários, o atraso na erupção da dentição permanente, a hipoplasia ou aplasia da clavícula, o nariz largo e o fechamento tardio das fontanelas, que proporciona ao crânio uma aparência achatada e explica a face característica braquicefálica. O Cirurgião-dentista é um dos primeiros profissionais a ser procurado por conta da prevalência das alterações bucais, que são os primeiros sinais percebidos pelo paciente ou familiar. Ressalta-se a importância deste profissional para o reconhecimento inicial dos sinais clínicos da Displasia Cleidocraniana, o que contribui para o diagnóstico precoce influenciando diretamente no tratamento e na qualidade de vida, devolvendo saúde e bem-estar para o indivíduo. The objective of this article is to describe the general aspects and the main orofacial manifestations of Cleidocranial Dysplasia, listing the importance of the dentist in the early diagnosis. This is an integrative review, in which scientific articles indexed in SCIELO, LILACS and MEDLINE/PUBMED were selected. The main alterations found in individuals with this dysplasia are the presence of supernumerary teeth, the delay in the eruption of the permanent dentition, the hypoplasia or aplasia of the clavicle, the wide nose and the late closure of the fontanelles, which gives the skull a flattened appearance and explains the characteristic brachycephalic face. The dental surgeon is one of the first professionals to be sought out due to the prevalence of oral alterations, which are the first signs noticed by the patient or family member. The importance of this professional is emphasized for the initial recognition of the clinical signs of Cleidocranial Dysplasia, which contributes to the early diagnosis, directly influencing the treatment and quality of life, restoring health and well-being to the individual

Mente e memória : uma exploração multidisciplinar da doença de Alzheimer.

AD is a neurodegenerative disease and is one of the leading causes of death globally, accounting for more than 4% of deaths in 2016. The dementia-related death rate from AD was more than 45 per 100,000 in a 2013 European study. The prevalence of atypical AD, most common in individuals under 65 years of age, ranges from 15-65/100,000, with some patients experiencing visual or motor difficulties, executive dysfunction, and other symptoms. The pathogenesis of AD is linked to the presence of clusters of extracellular amyloid beta (Aβ) protein, known as neuritic plaques, and tangles of hyperphosphorylated tau proteins. These plaques are formed from amyloid precursor protein (APP) by the action of enzymes, while neurofibrillary tangles consist mainly of hyperphosphorylated tau protein. The relationship between Aβ and tau is synergistic in neurotoxicity, with evidence that Aβ can trigger the formation of tau tangles. Biometals such as iron, copper and zinc have also been linked to AD, with dysregulation of these metals contributing to nervous system toxicity. Genetic factors, including the APOE gene and mutations in the APP, PSEN-1, and PSEN-2 genes, also play an important role in AD. The presence of the APOE ε4 allele significantly increases the risk of developing the disease. Mutations in the APP gene are associated with an accumulation of Aβ, while mutations in PSEN-1 and PSEN-2 affect Aβ production. Clinical manifestations include memory loss, depression, anxiety, language disorders and other cognitive and behavioral changes. The phase of AD varies from preclinical to severe, progressively affecting the patient's daily functioning. Diagnosis combines clinical assessment, neuropsychological tests and biomarkers such as tau protein, Aβ42 and brain imaging. Treatment involves medications such as acetylcholinesterase inhibitors and memantine, as well as therapies being studied that target Aβ proteins. Healthy lifestyles, such as physical activity and diet, also play an important role in preventing and treating AD.La EA es una enfermedad neurodegenerativa y es una de las principales causas de muerte a nivel mundial, representando más del 4% de las muertes en 2016. La tasa de mortalidad relacionada con la demencia por EA fue de más de 45 por 100.000 en un estudio europeo de 2013. La prevalencia de la EA atípica, más común en personas menores de 65 años, oscila entre 15 y 65/100.000, y algunos pacientes experimentan dificultades visuales o motoras, disfunción ejecutiva y otros síntomas. La patogénesis de la EA está relacionada con la presencia de grupos de proteína beta amiloide extracelular (Aβ), conocidas como placas neuríticas, y ovillos de proteínas tau hiperfosforiladas. Estas placas se forman a partir de la proteína precursora de amiloide (APP) por la acción de enzimas, mientras que los ovillos neurofibrilares están formados principalmente por proteína tau hiperfosforilada. La relación entre Aβ y tau es sinérgica en la neurotoxicidad, con evidencia de que Aβ puede desencadenar la formación de ovillos de tau. Biometales como el hierro, el cobre y el zinc también se han relacionado con la EA, y la desregulación de estos metales contribuye a la toxicidad del sistema nervioso. Los factores genéticos, incluido el gen APOE y las mutaciones en los genes APP, PSEN-1 y PSEN-2, también desempeñan un papel importante en la EA. La presencia del alelo APOE ε4 aumenta significativamente el riesgo de desarrollar la enfermedad. Las mutaciones en el gen APP se asocian con una acumulación de Aβ, mientras que las mutaciones en PSEN-1 y PSEN-2 afectan la producción de Aβ. Las manifestaciones clínicas incluyen pérdida de memoria, depresión, ansiedad, trastornos del lenguaje y otros cambios cognitivos y conductuales. La fase de la EA varía desde preclínica hasta grave, afectando progresivamente el funcionamiento diario del paciente. El diagnóstico combina la evaluación clínica, pruebas neuropsicológicas y biomarcadores como la proteína tau, el Aβ42 y las imágenes cerebrales. El tratamiento incluye medicamentos como inhibidores de la acetilcolinesterasa y memantina, así como terapias en estudio dirigidas a las proteínas Aβ. Los estilos de vida saludables, como la actividad física y la dieta, también desempeñan un papel importante en la prevención y el tratamiento de la EA.A DA é uma doença neurodegenerativa, sendo uma das principais causas de morte global, respondendo por mais de 4% das mortes em 2016. A taxa de mortalidade relacionada à demência da DA foi de mais de 45 por 100.000 em um estudo europeu de 2013. A prevalência da DA atípica, mais comum em indivíduos com menos de 65 anos, varia entre 15-65/100.000, com alguns pacientes apresentando dificuldades visuais ou motoras, disfunção executiva e outros sintomas. A patogênese da DA está ligada à presença de aglomerados de proteína beta-amiloide (Aβ) extracelular, conhecidos como placas neuríticas, e emaranhados de proteínas tau hiperfosforiladas. Essas placas são formadas a partir da proteína precursora de amiloide (APP) por ação de enzimas, enquanto os emaranhados neurofibrilares consistem principalmente de proteína tau hiperfosforilada. A relação entre Aβ e tau é sinérgica na neurotoxicidade, com evidências de que o Aβ pode desencadear a formação de emaranhados de tau. Biometais como ferro, cobre e zinco também foram associados à DA, com a desregulação desses metais contribuindo para a toxicidade do sistema nervoso. Fatores genéticos, incluindo o gene APOE e mutações nos genes APP, PSEN-1 e PSEN-2, também desempenham um papel importante na DA. A presença do alelo APOE ε4 aumenta significativamente o risco de desenvolver a doença. Mutações no gene APP estão associadas a um acúmulo de Aβ, enquanto mutações em PSEN-1 e PSEN-2 afetam a produção de Aβ. As manifestações clínicas incluem perda de memória, depressão, ansiedade, distúrbios de linguagem e outras alterações cognitivas e comportamentais. A fase da DA varia de pré-clínica a grave, afetando progressivamente o funcionamento diário do paciente. O diagnóstico combina avaliação clínica, testes neuropsicológicos e biomarcadores, como proteína tau, Aβ42 e imagens cerebrais. O tratamento envolve medicamentos como inibidores da acetilcolinesterase e memantina, além de terapias em estudo que visam as proteínas Aβ. Estilos de vida saudáveis, como atividade física e dieta, também desempenham um papel importante na prevenção e tratamento da DA

Cardiovascular Statistics - Brazil 2021.

This is the 2021 edition of the Cardiovascular Statistics – Brazil , a multi-institutional effort to periodically provide updated information on the epidemiology of heart diseases and stroke in Brazil. The report incorporates official statistics provided by the Brazilian Ministry of Health and other government agencies, by the GBD project led by the IHME of the University of Washington, as well as data generated by other sources and scientific studies, such as cohorts and registries, on CVDs and their risk factors. The document is directed to researchers, clinicians, patients, healthcare policy makers, media professionals, the public, and others who seek comprehensive national data available on heart disease and stroke

Photography-based taxonomy is inadequate, unnecessary, and potentially harmful for biological sciences

The question whether taxonomic descriptions naming new animal species without type specimen(s) deposited in collections should be accepted for publication by scientific journals and allowed by the Code has already been discussed in Zootaxa (Dubois & Nemésio 2007; Donegan 2008, 2009; Nemésio 2009a–b; Dubois 2009; Gentile & Snell 2009; Minelli 2009; Cianferoni & Bartolozzi 2016; Amorim et al. 2016). This question was again raised in a letter supported by 35 signatories published in the journal Nature (Pape et al. 2016) on 15 September 2016. On 25 September 2016, the following rebuttal (strictly limited to 300 words as per the editorial rules of Nature) was submitted to Nature, which on 18 October 2016 refused to publish it. As we think this problem is a very important one for zoological taxonomy, this text is published here exactly as submitted to Nature, followed by the list of the 493 taxonomists and collection-based researchers who signed it in the short time span from 20 September to 6 October 2016

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK.

BACKGROUND: A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. METHODS: This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. FINDINGS: Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0-75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4-97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8-80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3-4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. INTERPRETATION: ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials. FUNDING: UK Research and Innovation, National Institutes for Health Research (NIHR), Coalition for Epidemic Preparedness Innovations, Bill & Melinda Gates Foundation, Lemann Foundation, Rede D'Or, Brava and Telles Foundation, NIHR Oxford Biomedical Research Centre, Thames Valley and South Midland's NIHR Clinical Research Network, and AstraZeneca

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK

Background A safe and efficacious vaccine against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), if deployed with high coverage, could contribute to the control of the COVID-19 pandemic. We evaluated the safety and efficacy of the ChAdOx1 nCoV-19 vaccine in a pooled interim analysis of four trials. Methods This analysis includes data from four ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa. Participants aged 18 years and older were randomly assigned (1:1) to ChAdOx1 nCoV-19 vaccine or control (meningococcal group A, C, W, and Y conjugate vaccine or saline). Participants in the ChAdOx1 nCoV-19 group received two doses containing 5 × 1010 viral particles (standard dose; SD/SD cohort); a subset in the UK trial received a half dose as their first dose (low dose) and a standard dose as their second dose (LD/SD cohort). The primary efficacy analysis included symptomatic COVID-19 in seronegative participants with a nucleic acid amplification test-positive swab more than 14 days after a second dose of vaccine. Participants were analysed according to treatment received, with data cutoff on Nov 4, 2020. Vaccine efficacy was calculated as 1 - relative risk derived from a robust Poisson regression model adjusted for age. Studies are registered at ISRCTN89951424 and ClinicalTrials.gov, NCT04324606, NCT04400838, and NCT04444674. Findings Between April 23 and Nov 4, 2020, 23 848 participants were enrolled and 11 636 participants (7548 in the UK, 4088 in Brazil) were included in the interim primary efficacy analysis. In participants who received two standard doses, vaccine efficacy was 62·1% (95% CI 41·0–75·7; 27 [0·6%] of 4440 in the ChAdOx1 nCoV-19 group vs71 [1·6%] of 4455 in the control group) and in participants who received a low dose followed by a standard dose, efficacy was 90·0% (67·4–97·0; three [0·2%] of 1367 vs 30 [2·2%] of 1374; pinteraction=0·010). Overall vaccine efficacy across both groups was 70·4% (95·8% CI 54·8–80·6; 30 [0·5%] of 5807 vs 101 [1·7%] of 5829). From 21 days after the first dose, there were ten cases hospitalised for COVID-19, all in the control arm; two were classified as severe COVID-19, including one death. There were 74 341 person-months of safety follow-up (median 3·4 months, IQR 1·3–4·8): 175 severe adverse events occurred in 168 participants, 84 events in the ChAdOx1 nCoV-19 group and 91 in the control group. Three events were classified as possibly related to a vaccine: one in the ChAdOx1 nCoV-19 group, one in the control group, and one in a participant who remains masked to group allocation. Interpretation ChAdOx1 nCoV-19 has an acceptable safety profile and has been found to be efficacious against symptomatic COVID-19 in this interim analysis of ongoing clinical trials

Freqüência de pólipos em doentes operados de câncer colorretal Frequency of adenomatous polyps after surgical resection of colorectal cancer

Introdução - Estudos epidemiológicos e gênicos mostram que os pólipos colônicos do tipo adenoma são lesões pré-neoplásicas. O seguimento de um paciente com câncer colorretal visa principalmente o diagnóstico e retirada de pólipos adenomatosos. Objetivo - Estudar a freqüência do aparecimento de pólipos adenomatosos em doentes com câncer colorretal em acompanhamento clínico após ressecção tumoral. Casuística e Métodos - Foi estudada, retrospectivamente, a freqüência de pólipos do tipo adenoma em 68 pacientes com idade média de 59 anos, submetidos a cirurgia curativa para tratamento de câncer colorretal e a colonoscopia de controle. Resultados - A incidência de pólipos adenomatosos foi de 18%, sendo maior acima de 45 anos (20%) e no cólon esquerdo (38%). Em relação ao tipo histológico, 61% eram tubulares, 22% vilosos e 17% túbulo-vilosos. Discussão - Assim como em outros relatos da literatura, a incidência de pólipos foi superior em indivíduos com mais de 45 anos, sendo em mais da metade do tipo tubular. A freqüência de pólipos foi maior nos dois primeiros anos de acompanhamento.<br>Introduction - Epidemiologic and molecular biologic studies have already demonstrated that adenomatous colonic polyps are precancerous diseases. The main indication of the colonoscopy in the surveillance of colorectal cancer treated patients is the diagnosis and resection of adenomatous polyps. Aim - To study the frequency of adenomatous polyps after surgically resection of colorectal cancer. Material and Methods - Sixty eight patients, mean age 59 years old, with total resection of colorectal cancer, submitted to various colonoscopies during the follow up were studied retrospectively. The histological type and the characteristics of the polyp were described. Results - The frequency of polyps was 18%, being higher in the patients with more than 45 years (20%). The site of the polyps was in the left colon in 38% of the patients with cancer. The histological type of adenomas was tubular in 61%, villous in 22% and mixed in 17%. Discussion - As described by other authors, the incidence of polyps were higher after 45 years old and more than a half of them were tubular. The frequency of polyps was higher in the first two years of follow up