Expansão rápida de maxila assistida cirurgicamente utilizando piezo surgery / Surgically assisted rapid maxillary expansion using piezo surgery

A atresia maxilar é caracterizada pelas irregularidades nas dimensões verticais do paciente, sendo essa a principal causa das mordidas cruzadas posteriores unilaterais e bilaterais. O tratamento de crianças e adolescentes consiste na Expansão Rápida de Maxila (ERM), enquanto os pacientes que atingiram a maturidade óssea exigem um tratamento ortocirúrgico, por meio da Expansão Rápida de Maxila Cirurgicamente Assistida (ERMCA). A ERMCA fundamenta-se na combinação de tratamentos cirúrgicos e ortodônticos, no qual a etapa cirúrgica compreende osteotomias que visam anular a resistência das articulações craniofaciais, as mesmas podem ser realizadas com brocas, serras e por um dispositivo elétrico denominado Piezo Surgery. O objetivo deste trabalho é relatar um caso clínico de expansão rápida de maxila cirurgicamente assistida, realizada por meio de acesso minimamente invasivo e auxílio da Piezo Surgery. Paciente do sexo masculino, 31 anos, encaminhado pelo ortodontista, compareceu ao serviço de Cirurgia e Traumatologia Buco-Maxilo-Facial do Hospital Otorrinos, apresentando palato ogival, atresia maxilar e mordida anterior topo a topo. Sendo assim, com base nas características clínicas e etária do paciente, o tratamento proposto foi a ERMCA associada a ativação diária do dispositivo Hyrax, seguida de acompanhamento ortodontico até a obtenção do diastema interincisal desejado. Esse procedimento demonstrou resultados satisfatórios, com maior conforto pós-operatório, descruzamento maxilar posterior e melhora na respiração, resultando no restabelecimento da oclusão, função e estética, evidenciando assim o sucesso do tratamento e da execução cirúrgica

CISTO ÓSSEO TRAUMÁTICO EM CORPO MANDIBULAR: : UM RELATO DE DOIS CASOS

Introdução: O cisto ósseo traumático é uma lesão intraóssea rara e assintomática, caracterizada por cavidade sem revestimento epitelial, sendo classificado como um pseudocisto.  A sua descoberta é realizada por meio de achados radiográficos de rotina. O objetivo deste trabalho é relatar dois casos clínicos de cisto ósseo traumático em mandíbula. Desenvolvimento: Caso 1: paciente gênero masculino, 17 anos, portando exame radiográfico com imagem radiotransparente em corpo mandibular, assintomático ao exame físico. Ao exame tomográfico, observou-se região hipodensa em corpo mandibular (ápices dentários 47/48) e o mesmo foi submetido a curetagem total da lesão, observou-se loja óssea com ausência de cápsula e discreto sangramento, confirmando hipótese diagnóstica de COT. Caso 2: paciente gênero feminino, 15 anos, portando exame radiográfico de rotina com imagem semelhante, assintomática ao exame físico. Ao exame tomográfico, notou-se região hipodensa em corpo mandibular (ápices dentários 44/45), sendo essa submetida a curetagem total da lesão, com características semelhantes. Os casos apontam neoformação óssea ao acompanhamento radiográfico. Considerações finais: Conclui-se ser primordial o diagnóstico clínico-radiográfico de lesões intraósseas para melhor conduta terapêutica, sendo consenso na literatura os excelentes resultados a longo prazo da curetagem das paredes ósseas como tratamento

Pollen spectrum of honey of Apis mellifera L. and stingless bees (Hymenoptera: Apidae) from the semi-arid region of Bahia State, Brazil

Pollen in honey reflects its botanical origin and melissopalynology is used to identify origin, type, and quantities of pollen grains of the botanical species visited by bees. This study aimed to identify the pollen spectrum of honeys from Apis mellifera and stingless bees produced in the semi-arid region of Bahia, Brazil. We analysed 78 honey samples, which were submitted to the acetolysis process for identification and quantification of pollen types. Fabaceae, Asteraceae and Euphorbiaceae were the most predominant families in pollen types. For Fabaceae, the most representative pollen types were Chamaecrista 1, Mimosa caesalpiniifolia, Mimosa pudica, Mimosa tenuiflora, Prosopis and Senna. The results indicate that the flora explored by the bees to collect nectar is diverse in the semi-arid region of Bahia and the honeys analysed were classified as multifloral.info:eu-repo/semantics/publishedVersio

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

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 understanding 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,5,6,7 vast areas of the tropics remain understudied.8,9,10,11 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 underrepresented in biodiversity databases.13,14,15 To worsen this situation, human-induced modifications16,17 may eliminate pieces of the Amazon's biodiversity puzzle before we can use them to understand how ecological communities 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 organism 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 neglected 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 lost

Por uma história social dos trabalhadores do mar: questões lançadas às listas de matrículas de tripulações mercantes em Portugal e seus domínios (1807-1808)

Em uma publicação recente, transcrevemos um conjunto significativo de listas de matrículas da marinha mercante lusa para os anos de 1807 e 1808, documentação sob a custódia do Arquivo Nacional da Torre do Tombo. Além da transcrição, o artigo apresentou a fonte e suas potencialidades e elencou diversas indagações que, na perspectiva da história social, podem ter respostas ensaiadas a partir da consulta a essas fontes seriais. Nossa intenção, agora, é apresentar algumas reflexões que permitam avançar na resposta a essas mesmas questões, como por quê os estudos sobre a demografia de Portugal no século XVIII estão atrelados ao contingente de trabalhadores marítimos ofertado ao mar no período de nosso recorte, entre outras possibilidades apresentadas pela fonte.En una publicación reciente, hemos transcrito un importante conjunto de listas de matrícula de la marina mercante portuguesa de los años 1807 y 1808, documentación bajo la custodia del Archivo Nacional de Torre do Tombo. Además de la transcripción, el artículo presentó la fuente y su potencial y enumeró varias preguntas que, desde la perspectiva de la Historia Social, pueden tener respuestas ensayadas a partir de la consulta con estas fuentes seriadas. Nuestra intención, ahora, es presentar algunas reflexiones que permitan avanzar en la respuesta a estas mismas preguntas, como por ejemplo por qué los estudios sobre la demografía de Portugal en el siglo XVIII están vinculados al contingente de trabajadores marítimos ofrecidos al mar en el período de nuestro recorte, entre otras posibilidades presentadas por la fuente.In a recent publication, we have transcribed a significant set, from 1807 and 1808, of Portuguese merchant navy’s enrolment lists, documentation from the National Archives of Torre do Tombo. Besides the transcription, this article presents the source, and its potential, and listed several questions that, from a Social History perspective, may have some responses essayed from these serial sources’ consultation. Now, we intend to introduce some reflections that allow us to advance in the answer to these questions, such as, why the studies about Portugal’s demography in the 18th century are associated with the contingent of maritime workers in the selected period, among other possibilities cited by the source

Development and validation of the MMCD score to predict kidney replacement therapy in COVID-19 patients

Abstract Background Acute kidney injury (AKI) is frequently associated with COVID-19, and the need for kidney replacement therapy (KRT) is considered an indicator of disease severity. This study aimed to develop a prognostic score for predicting the need for KRT in hospitalised COVID-19 patients, and to assess the incidence of AKI and KRT requirement. Methods This study is part of a multicentre cohort, the Brazilian COVID-19 Registry. A total of 5212 adult COVID-19 patients were included between March/2020 and September/2020. Variable selection was performed using generalised additive models (GAM), and least absolute shrinkage and selection operator (LASSO) regression was used for score derivation. Accuracy was assessed using the area under the receiver operating characteristic curve (AUC-ROC). Results The median age of the model-derivation cohort was 59 (IQR 47–70) years, 54.5% were men, 34.3% required ICU admission, 20.9% evolved with AKI, 9.3% required KRT, and 15.1% died during hospitalisation. The temporal validation cohort had similar age, sex, ICU admission, AKI, required KRT distribution and in-hospital mortality. The geographic validation cohort had similar age and sex; however, this cohort had higher rates of ICU admission, AKI, need for KRT and in-hospital mortality. Four predictors of the need for KRT were identified using GAM: need for mechanical ventilation, male sex, higher creatinine at hospital presentation and diabetes. The MMCD score had excellent discrimination in derivation (AUROC 0.929, 95% CI 0.918–0.939) and validation (temporal AUROC 0.927, 95% CI 0.911–0.941; geographic AUROC 0.819, 95% CI 0.792–0.845) cohorts and good overall performance (Brier score: 0.057, 0.056 and 0.122, respectively). The score is implemented in a freely available online risk calculator ( https://www.mmcdscore.com/ ). Conclusions The use of the MMCD score to predict the need for KRT may assist healthcare workers in identifying hospitalised COVID-19 patients who may require more intensive monitoring, and can be useful for resource allocation

Clinical characteristics and outcomes of hospital-manifested COVID-19 among Brazilians

ABSTRACT: Objectives: To analyze the clinical characteristics and outcomes of admitted patients with the hospital- versus community-manifested COVID-19 and to evaluate the risk factors related to mortality in the first population. Methods: This retrospective cohort included consecutive adult patients with COVID-19, hospitalized between March and September 2020. The demographic data, clinical characteristics, and outcomes were extracted from medical records. Patients with hospital-manifested COVID-19 (study group) and those with community-manifested COVID-19 (control group) were matched by the propensity score model. Logistic regression models were used to verify the risk factors for mortality in the study group. Results: Among 7,710 hospitalized patients who had COVID-19, 7.2% developed symptoms while admitted for other reasons. Patients with hospital-manifested COVID-19 had a higher prevalence of cancer (19.2% vs 10.8%) and alcoholism (8.8% vs 2.8%) than patients with community-manifested COVID-19 and also had a higher rate of intensive care unit requirement (45.1% vs 35.2%), sepsis (23.8% vs 14.5%), and death (35.8% vs 22.5%) (P <0.05 for all). The factors independently associated with increased mortality in the study group were increasing age, male sex, number of comorbidities, and cancer. Conclusion: Hospital-manifested COVID-19 was associated with increased mortality. Increasing age, male sex, number of comorbidities, and cancer were independent predictors of mortality among those with hospital-manifested COVID-19 disease

Implementation of a Brazilian Cardioprotective Nutritional (BALANCE) Program for improvement on quality of diet and secondary prevention of cardiovascular events: A randomized, multicenter trial

Background: Appropriate dietary recommendations represent a key part of secondary prevention in cardiovascular disease (CVD). We evaluated the effectiveness of the implementation of a nutritional program on quality of diet, cardiovascular events, and death in patients with established CVD. Methods: In this open-label, multicenter trial conducted in 35 sites in Brazil, we randomly assigned (1:1) patients aged 45 years or older to receive either the BALANCE Program (experimental group) or conventional nutrition advice (control group). The BALANCE Program included a unique nutritional education strategy to implement recommendations from guidelines, adapted to the use of affordable and regional foods. Adherence to diet was evaluated by the modified Alternative Healthy Eating Index. The primary end point was a composite of all-cause mortality, cardiovascular death, cardiac arrest, myocardial infarction, stroke, myocardial revascularization, amputation, or hospitalization for unstable angina. Secondary end points included biochemical and anthropometric data, and blood pressure levels. Results: From March 5, 2013, to Abril 7, 2015, a total of 2534 eligible patients were randomly assigned to either the BALANCE Program group (n = 1,266) or the control group (n = 1,268) and were followed up for a median of 3.5 years. In total, 235 (9.3%) participants had been lost to follow-up. After 3 years of follow-up, mean modified Alternative Healthy Eating Index (scale 0-70) was only slightly higher in the BALANCE group versus the control group (26.2 ± 8.4 vs 24.7 ± 8.6, P <.01), mainly due to a 0.5-serving/d greater intake of fruits and of vegetables in the BALANCE group. Primary end point events occurred in 236 participants (18.8%) in the BALANCE group and in 207 participants (16.4%) in the control group (hazard ratio, 1.15; 95% CI 0.95-1.38; P =.15). Secondary end points did not differ between groups after follow-up. Conclusions: The BALANCE Program only slightly improved adherence to a healthy diet in patients with established CVD and had no significant effect on the incidence of cardiovascular events or death. © 2019 The Author