Influence of Environmental Factors on the Presence and Severity of Molar Incisor Hypomineralization

Objective: To assess the association between environmental factors during pregnancy and early childhood with the presence and severity of Molar Incisor Hipomineralization (MIH). Material and Methods: This cross-sectional study was conducted with 120 patients between 7 and 14 years of age. MIH was evaluated according to EAPD criteria. Data collected included the child’s medical history and the mother’s health. Chi-square and logistic regression were performed to determine any statistical evidence of the environmental factors, with the significance level set at 5%. Results: The participants were divided into groups with MIH (n=60) and without MIH (n=60), with average ages of 9.9 (±1.9) and 9.7 (±1.7) years, respectively. There was a statistically significant difference between intercurrences during pregnancy (OR=3.55; IC95%=1.35-10.57) and medication taken by the child (OR=3.01; IC95%=1.74-8.42) and the presence of MIH. In addition, other variables were also associated with the MIH (p≤0.05). However, there was no association with variables and degree of MIH severity (p>0.05). Conclusion: The use of medications in childhood and complications during pregnancy can be association to the presence of MIH. However, these factors do not interaction to MIH severity

Alternatives for establishing a surgical airway during the COVID-19 pandemic

Currently doctors and health professionals are facing a challenging pandemic caused by a new strain called 2019 Novel Coronavirus (COVID-19). Human infection with COVID-19 does not yet have the clinical spectrum fully described, and the pattern of lethality, mortality, infectivity and transmissibility is not known with precision. There is no specific vaccine or medication available. Treatment is supportive and nonspecific. In Brazil, as in the rest of the world, the number of COVID-19 cases has grown alarmingly, leading to an increase in the number of hospitalizations as well as in mortality from the disease. Currently, the states with the highest number of cases are, respectively, São Paulo, Rio de Janeiro, Distrito Federal and Ceará. The objective of this work is to offer alternatives in order to guide surgeons regarding the surgical management of the airways in patients with suspicion and / or confirmation for COVID-19 infection

Alternativas para o estabelecimento de via aérea cirúrgica durante a pandemia de COVID-19

RESUMO Atualmente médicos e profissionais da saúde encontram-se frente a uma pandemia desafiadora causada por uma nova cepa denominada 2019 Novel Coronavírus (COVID-19). A infecção humana pelo COVID-19 ainda não tem o espectro clínico completamente descrito, bem como não se sabe com precisão o padrão de letalidade, mortalidade, infectividade e transmissibilidade. Não há vacina ou medicamento específico disponível. O tratamento é de suporte e inespecífico. No Brasil, assim como no restante do mundo o número de casos de COVID-19 tem crescido de maneira alarmante levando a um aumento do número de internações assim como da mortalidade pela doença. Atualmente os estados com maior número de casos são, respectivamente, São Paulo, Rio de Janeiro, Distrito Federal e Ceará. O objetivo deste trabalho é oferecer alternativas a fim de orientar cirurgiões quanto ao manejo cirúrgico das vias aéreas em pacientes com suspeita e/ou confirmação para infecção pelo COVID-19

Efficacy of Ivermectin, FenbendazoIe, Mebendazole and Mebendazole combined with Piperazine Citrate, in the control of cyathostomes of Mangalarga Paulista equids

The anthelmintic efficacy of Ivermectin, Fenbendazole, Mebendazole and Mebendazole combined with Piperazine Citrate for the control of cyathostomes of Mangalarga Paulista equids were analyzed. In all cases of positive eggs per gram (epg) counts before and after treatment, pure populations of cyathostome larvae with eight gut cells in faecal cultures were consistently observed. The percentages of efficacy were evaluated between the 7th and 72nd days post-treatment. Confronting the epg mean values of Ivermectin in respect of the others anthelmintics, significant differences were found between the 7th and 57th days; Fenbendazole and Mebendazole did not show significant differences during the experiment. The association of Mebendazole combined with Piperazine Citrate indicated a significantly higher efficacy than Fenbendazole and Mebendazole between the 7th and 30th days.Através de estudo comparativo, objetivou-se avaliar a eficiência anti-helmíntica de Ivermectina, de Fenbendaole, de Mebendazole e de Mebendazole associado ao Citrato de Piperazina, no controle de ciatostomíneos de equinos da raça Mangalarga Paulista. As coproculturas realizadas antes e após os tratamentos levaram consistentemente ao encontro de populações puras de ciatostomíneos com oito células intestinais. Os percentuais de eficácia foram avaliados do 7º ao 72º dias pós-tratamento. Comparando os valores médios de opg de Ivermectina em relação aos outros anti-helmínticos, observou-se diferença significante do 7º ao 57º dias: Fenbendazole e Mebendazole não mostraram diferenças significantes durante o experimento. A combinação de Mebendazole associado ao Citrato de Piperazina foi significantemente superior ao Fenbendazole e ao Mebendazole do 7º ao 30º dias

Mitral valve repair by Double Teflon technique: cardiac remodeling analysis by tridimensional echocardiography

INTRODUÇÃO: A plastia valvar mitral é o tratamento de escolha para a insuficiência mitral, porém a literatura é escassa em relação ao comportamento do átrio e ventrículo esquerdos após a plastia mitral sem utilização de anéis protéticos. OBJETIVO: Analisar a morfologia e a função cardíaca de indivíduos submetidos à plastia valvar mitral pela técnica de Duplo Teflon, por meio da ecocardiografia tridimensional. MÉTODOS: Foram incluídos 14 pacientes com insuficiência mitral mixomatosa, submetidos à plastia mitral pela técnica de Duplo Teflon. Treze pacientes encontravam-se em classe III/IV. Os pacientes foram avaliados nos períodos pré-operatório, pós-operatório imediato (POI), 6 meses e 1 ano após a plastia mitral. Foi utilizado teste de análise de variância de medidas repetidas para o estudo estatístico, sendo considerado estatisticamente significante P<0,05. RESULTADOS: A análise dos volumes sistólicos, atrial e ventricular demonstrou redução volumétrica significativa entre POI e 1 ano (P=0,028 e P=0,020, respectivamente). Entre o pré-operatório e 1 ano, houve redução média de 19,9% e 15,4% nos volumes atrial e ventricular, respectivamente. Os volumes diastólicos atrial e ventricular apresentaram redução significativa no POI (P<0,001 e P=0,024, respectivamente), permanecendo estáveis ao longo do estudo. Houve aumento na fração de ejeção do átrio esquerdo após 6 meses (P<0,001), porém não houve variação na função ventricular esquerda. CONCLUSÕES: Os pacientes submetidos à plastia valvar mitral por meio da técnica de Duplo Teflon apresentaram remodelamento reverso do átrio esquerdo e do ventrículo esquerdo. Esta redução nos volumes cavitários esteve associada à melhora da função atrial esquerda durante o estudo.INTRODUCTION: Mitral valve repair is the treatment of choice to correct mitral insufficiency. Although the literature related to left atrial and ventricular behavior after mitral repair without use of prosthetic rings is scarce. OBJECTIVE: To analyze cardiac morphology and function using real time tridimensional echocardiography in individuals submitted to mitral valve repair with Double Teflon technique. METHODS: Were included 14 patients with mixomatous mitral valve insufficiency that were submitted to mitral valve repair with the Double Teflon technique. Of them, 13 patients were in class III/IV. Patients were evaluated in preoperative period, immediate postoperative period, 6 months and 1 year after mitral repair. Statistic analysis was made by repeated measures ANOVA test and was considered statistically significant P < 0.05. RESULTS: The analysis of systolic volumes, atrial and ventricular, demonstrated a significant volumetric reduction between immediate postoperative period and 1 year (P=0.028 and P=0.020, respectively). Between preoperative period and 1 year, there was a mean reduction in atrial and ventricle volumes of 19.9% and 15.4%, respectively. Atrial and ventricle diastolic volumes presented a significant reduction in immediate postoperative period (P <0.001 and P =0.024, respectively), remaining stable during the study. There was an increase in left atrial ejection fraction after 6 months (P<0.001), although there was no significant variation in left ventricle ejection fraction. CONCLUSIONS: Patients submitted to mitral valve repair by the Double Teflon technique demonstrated a left atrial and ventricle reverse remodeling. These reductions were associated with an improvement in left atrial function during the study.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

¿Se puede vivir sin la válvula tricúspide? Relato de dos casos de supervivencia de largo plazo

Tricuspid infective endocarditis is rare. Usually occurs associated with the use of drugs or invasive procedures such as hemodialysis, catheters, and pacemakers. Severe injuries may required surgical treatment with complete tricuspid resection with or without immediate replacement. Two cases are reported, both without valve replacement for over 15 and 20 years, respectively, they had later symptoms of heart failure. Volume overload masked the ventricular dysfunction. Determining the strain was important for early detection of ventricular dysfunction. Tricuspid resection without replacement can be used on a temporary basis, being recommended the prosthetic implant as early as possible, to preserve ventricular function.La endocarditis infecciosa tricúspide es poco frecuente. Habitualmente ocurre asociada al uso de drogas o procedimientos invasivos como hemodiálisis, catéteres y marcapasos. Las lesiones graves pueden necesitar tratamiento quirúrgico con resección tricúspide total, con o sin reemplazo inmediato. A continuación se relatan dos casos sin reemplazo valvular por más de 15 y 20 años. Presentaron síntomas de insuficiencia cardíaca tardíamente. La sobrecarga volumétrica enmascaró la disfunción ventricular siendo el strain importante para la detección precoz de la disfunción ventricular. La resección tricúspide sin reemplazo puede utilizarse con carácter temporal, siendo recomendable el implante de prótesis lo más precozmente posible para preservar la función ventricular

Anesthetic Management of a Brown Bear (Ursus arctos) Captive Undergoing Incisional Biopsy of a Skin Nodule

Background: The brown bear (Ursus arctos) is considered one of the largest terrestrial carnivores, native from temperate forest regions of North America, Europe and Asia. In Brazil, they are founded in captivity and their safe capture and immobilization are obtained with one effective anesthesia for management and surgical and diagnostic procedures. Some anesthetic protocols are described for these purposes, however, there is a lack for data on the anesthetic and adverse effects they have on bears when used. The aim of this case is to report the use and effects of the association of dexmedetomidine with tiletamine and zolazepam in the chemical containment of a captive adult brown bear.Case: A 33-year-old female brown bear, weighing 100 kg, belonging to the Zoobotanic Park of Teresina, Piauí, Brazil, was chemically immobilized for an incisional biopsy of a cutaneous nodule with 1.0 cm diameter in the right face region. The anesthetic protocol included 6 μg/kg of dexmedetomidine associated with 3 mg/kg of tiletamine and zolazepam, administered intramuscularly by dart into the gluteal region of the right pelvic limb. The animal showed moderate ataxia at 5 min and assumed sternal decubitus 7 min after anesthetic administration. The bear's degree of sedation was considered adequate and safe to perform the biopsy at 10 min after administration. Heart rate (47 ± 3 bpm), respiratory rate (17 ± 2 mpm) and rectal temperature (38.7 ± 0.1ºC) were monitored. The bear remained immobile and unconscious throughout the procedure, with intense muscle relaxation, bilateral eyeball rotation, absent lateral palpebral reflex and mild medial reflex and without nystagmus. Complementary sedative doses were not necessary. At the beginning of anesthetic recovery, the bear received 6 µg/kg of atipamezole, intramuscularly. After 25 min of administration of atipamezole, the animal showed signs of recovery in the level of consciousness and reactivity to external stimuli, and assumed the quadrupedal position at 60 min after reverser application.Discussion: Even in captivity, the bears behavior is unpredictable and attack can occur, causing trauma or death to people. For this, the chemical immobilization is important to keep safety of everyone. This procedure was performed using blowgun-assisted darts thrown by a staff member who had experience in using this method, who darted accurately and effectively. The latency time observed after administration of the anesthetic protocol used is similar to reported in other studies with bears that also received intramuscular dexmedetomidine and tiletamine and zolazepam and showed intense muscle relaxation and immobility. The doses used contributed to the absence of bradycardia and hypoventilation and, performing the procedure in the morning, when the temperature is milder in the city, minimized the chance of hyperthermia and thermal stress in the animal, not requiring body cooling. The use of dexmedetomidine in chemical containment protocols for short and minimally invasive procedures allows the subsequent use of its antagonist, atipamezole, contributing to a shorter recovery time, return of the animal’s degree of consciousness and lower incidence of ataxia after assuming a quadrupedal position. The anesthetic protocol used was considered efficient, providing a quick and gentle chemical containment, adequate anesthetic plan and good anesthetic recovery in an adult brown bear from captivity.Keywords:atipamezole, dexmedetomidine, wildlife.Título: Manejo anestésico de um urso pardo (Ursus arctos) cativo submetido a biópsia incisional de nódulo cutâneoDescritores: atipamezole, dexmedetomidine, animais selvagens

Punica granatum L. protects mice against hexavalent chromium-induced genotoxicity

This study investigated the chemoprotective effects of Punica granatum L. (Punicaceae) fruits alcoholic extract (PGE) on mice exposed to hexavalent chromium [Cr(VI)]. Animals were pretreated with PGE (25, 50 or 75 mg/kg/day) for 10 days and subsequently exposed to a sub-lethal dose of Cr(VI) (30 mg/kg). The frequency of micronucleated polychromatic erythrocytes in the bone marrow was investigated and the Cr(VI) levels were measured in the kidneys, liver and plasm. For the survival analysis, mice were previously treated with PGE for 10 days and exposed to a single lethal dose of Cr(VI) (50 mg/kg). Exposure to a sub-lethal dose of Cr(VI) induced a significant increase in the frequency of micronucleated cells. However, the prophylactic treatment with PGE led to a reduction of 44.5% (25 mg/kg), 86.3% (50 mg/kg) and 64.2% (75 mg/kg) in the incidence of micronuclei. In addition, the 50 mg/kg dose of PGE produced a higher chemoprotective effect, since the survival rate was 90%, when compared to that of the non-treated group. In these animals, reduced amounts of chromium were detected in the biological materials, in comparison with the other groups. Taken together, the results demonstrated that PGE exerts a protective effect against Cr(VI)-induced genotoxicity.Este estudo investigou os efeitos quimioprotetores do extrato alcoólico dos frutos da Punica granatum L. (Punicaceae) (EPG) em camundongos expostos ao cromo hexavalente [Cr(VI)]. Os animais foram pré-tratados com o EPG (25, 50 ou 75 mg/kg/dia) durante 10 dias e subsequentemente expostos a uma dose subletal de Cr(VI) (30 mg/kg). A frequência de eritrócitos policromáticos micronucleados na medula óssea foi investigada e os níveis de Cr(VI) foram quantificados nos rins, fígado e plasma. Para a análise de sobrevida, os camundongos foram previamente tratados com EPG durante 10 dias e expostos a única dose letal de Cr(VI) (50 mg/kg). A exposição à dose subletal de Cr(VI) induziu aumento significativo na frequência de células micronucleadas. Entretanto, o tratamento profilático com EPG levou à redução de 44,5% (25 mg/kg), 86,3% (50 mg/kg) e 64,2% (75 mg/kg) na incidência de micronúcleo. Além disso, a dose de 50 mg/kg de EPG produziu maior efeito quimioprotetor, uma vez que a taxa de sobrevivência foi de 90%, quando comparada àquela do grupo não tratado. Nesses animais, quantidades reduzidas de cromo foram detectadas nos materiais biológicos, em comparação com os outros grupos. Em conjunto, os resultados demonstram que o EPG exerce efeito protetor contra a genotoxicidade induzida pelo Cr(VI)

Alternativas para o estabelecimento de via aérea cirúrgica durante a pandemia de COVID-19

Atualmente médicos e profissionais da saúde encontram-se frente a uma pandemia desafiadora causada por uma nova cepa denominada 2019 Novel Coronavírus (COVID-19). A infecção humana pelo COVID-19 ainda não tem o espectro clínico completamente descrito, bem como não se sabe com precisão o padrão de letalidade, mortalidade, infectividade e transmissibilidade. Não há vacina ou medicamento específico disponível. O tratamento é de suporte e inespecífico. No Brasil, assim como no restante do mundo o número de casos de COVID-19 tem crescido de maneira alarmante levando a um aumento do número de internações assim como da mortalidade pela doença. Atualmente os estados com maior número de casos são, respectivamente, São Paulo, Rio de Janeiro, Distrito Federal e Ceará. O objetivo deste trabalho é oferecer alternativas a fim de orientar cirurgiões quanto ao manejo cirúrgico das vias aéreas em pacientes com suspeita e/ou confirmação para infecção pelo COVID-19