Search

IntroductionHIV late presentation (LP) remains excessive in Europe. We aimed to analyze the factors associated with late presentation in the MSM population newly diagnosed with HIV in Portugal between 2014 and 2019.MethodsWe included 391 newly HIV-1 diagnosed Men who have Sex with Men (MSM), from the BESTHOPE project, in 17 countrywide Portuguese hospitals. The data included clinical and socio-behavioral questionnaires and the viral genomic sequence obtained in the drug resistance test before starting antiretrovirals (ARVs). HIV-1 subtypes and epidemiological surveillance mutations were determined using different bioinformatics tools. Logistic regression was used to estimate the association between predictor variables and late presentation (LP).ResultsThe median age was 31 years, 51% had a current income between 501–1,000 euros, 28% were migrants. 21% had never been tested for HIV before diagnosis, with 42.3% of MSM presenting LP. 60% were infected with subtype B strains. In the multivariate regression, increased age at diagnosis, higher income, lower frequency of screening, STI ever diagnosed and higher viral load were associated with LP.ConclusionOur study suggests that specific subgroups of the MSM population, such older MSM, with higher income and lower HIV testing frequency, are not being targeted by community and clinical screening services. Overall, targeted public health measures should be strengthened toward these subgroups, through strengthened primary care testing, expanded access to PrEP, information and promotion of HIV self-testing and more inclusive and accessible health services.

Health services, in particular pediatric units in a hospital, are increasingly committed to human well-being, on the one hand by researching more effective treatments, on the other hand by promoting emotional well-being for their patients, caregivers and professionals. The investment in making hospital environments and services more humane is evident in several studies and projects disseminated around the world. Even so, and despite these efforts, most people continue to have a negative feeling when they think of a hospital. For an institution whose main objective is to preserve and restore health, a negative impression or a feeling of discomfort can be seen as a factor of stress that does not contribute to the patients’ quick recovery. Although fear or stress reduction values are difficult to quantify, empirical evidence shows that there are intangible factors crucial for the patients’ recovery and well-being 1. This is an issue of increasing importance, therefore this paper will analyze how illustration can play a decisive role in the child’s perception and overall experience in hospital. It will also evaluate how illustrators and storytellers' commitment in creating a positive, playful and comfortable environment for patients and caregivers has been recognised by the whole community. The process of adapting an illustrated children’s picture book to a specific hospital area, its effectiveness and how it can reach other audiences, will be widely analyzed.

Introduction: Portugal has one of the highest mortality rates for people living with HIV (PLWHIV) in Europe. After antiretroviral therapy introduction, HIV-associated mortality declined, included the one associated with bloodstream infection (BSI). However it is still high, and European data are scarce . Therefore, characterizing BSI and defining prognostic factors may improve our approach. Methods: This was a 10-year retrospective study of predictive factors for 30-day and 3-year mortality in PLWHIV with BSI in a tertiary infectious diseases ward. Results: Of 2134 PLWHIV admissions, 145 (6.8%) had a BSI, mostly respiratory and catheter-related bacteremia and globally community-acquired. Nosocomial infections occurred in 42 (36%) cases, mostly caused by Enterococcus spp, Staphylococcus aureus, and Candida spp. PLWHIV with a BSI had higher 30-day mortality (27%) compared to those without a BSI (14%). APACHE II score, corticotherapy, and current intravenous drug use (IDU) had a prognostic impact on 30-day mortality. Three-year survival was 54% in PLWHIV with a BSI; a CD4

Abstract Aim Antiretroviral therapy (ART) development has reduced the severity of neurological complications of the human immunodeficiency virus (HIV), but they remain prevalent and need prompt recognition. Acute inflammatory demyelinating polyneuropathy (AIDP) is a rare complication of human immunodeficiency virus (HIV) infection that may appear at any stage of the disease. In this case, AIDP represents a late presentation of HIV infection. Methods Descriptive study. Patient data were collected from their medical records and by health assessment interviews. Results We report a case of a 52-year-old male with acute lower limb weakness. Given the suggestive clinical presentation of AIDP and a positive HIV test, intravenous immunoglobulin (IVIG) was administered along with antiretroviral therapy. Progressive weakness to the upper limbs, autonomic dysfunction, and pain was observed. The second regimen of IVIG plus corticosteroids was administered. Muscle strength improved after three weeks. Conclusions Screening for HIV in a patient with AIDP may provide a better outcome because of the early start of ART with good central nervous system penetration in HIV-infected patients.

This article aims to articulate the elementary algebraic knowledge developed by teachers and their conceptual profiles, according to Fiorentini, Miorim and Miguel (1993), Usiskin (1995), Lins and Gimenez (1997), Figueiredo (1997) and Lee (2001). We started from a bibliographic study to support the theoretical framework and the application of a questionnaire in order to identify the teachers' conceptions about teaching elementary algebra according to Lee. The natural articulation between concrete and everyday situations for students to visualize the application algebra, in different contexts, is fundamental for the construction of algebraic reasoning.With regard to the act of teaching algebra, it is necessary to bear in mind the object of study and move between the different semiotic records related to it, as pointed out by Duval (2009). As well as expanding the way of approaching algebra from severalpossible conceptions.

ObjectiveTo describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks.MethodsClinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses.ResultsIn Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (pfor–trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G.ConclusionOur molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.

This article focuses on bringing an analysis of the work of Wanderly (2000) that seeks to understand the relationship between globalization and Rurality beyond the point of view of Josefa Salete Barbosa Cavalcanti in her work in 2004 on the transformations of the rural world in modern societies where highlights what theory of local development seen. In view of this scenario, we highlight the concept of local development, according to Tauk-Santos, (1998), understood as a process of concertation / orchestration of the different social actors committed to the sustainable development of endogenous economic potential. With the current situation, we can see the result of the failure of traditional models of development based either on the understanding of the national state as the main agent that promotes development. The present analysis is part of a bibliographic research which seeks to understand the concept of local development from the perspective of the authors mentioned above as construction and transformations, with the firms, of the resources necessary for the production and innovation processes within the territories in the perspective of Urbanization.

Objetivo: A infeção no pós-operatório é considerada uma das mais importantes causas de morbi-mortalidade após transplante hepático. Poucos estudos analisam a incidência de culturas positivas do líquido de preservação do enxerto e o outcome dos respetivos recetores. Estudamos a incidência e o impacto clínico de infeção do líquido de preservação de orgão para transplante hepático. Métodos: Cultivamos o líquido de preservaãoo (Celsior®) em 225 transplantes de fígado durante quatro anos consecutivos; os recetores de alto risco foram submetidos a um protocolo de profilaxia antibiótica de infeção pós-transplante, durante 48 horas, que consistia numa cefalosporina de 3a geração e netilmicina. Resultados: Setenta líquidos de preservação foram considerados positivos com uma três patógenos identificados. Destes, 31% eram flora saprofítica da pele, porém, em 29 casos (41,1%), isolamos patógenos de alta virulência. Apenas oito doentes desenvolveram febre no pós-operatório devido ao microorganismo isolado no líquido de preservação. Conclusão: Foram identificadas culturas positivas em 31,1% dos casos, sendo que um terço corresponde a flora saprofítica da pele. Os nossos resultados não suportam a realização por rotina de cultura do líquido de preservação, desde que haja um regime profilático de antibióticos adequado.

After the elimination of dental caries lesions, some microorganisms may remain viable in the tooth structure. Thus, cavity disinfection is an important procedure. The aim of this study was to evaluate the effect of cavity disinfectants on the adhesion to dentin of permanent teeth. Sixty molars were ground flat and randomly assigned to six groups: control; chlorhexidine; Aloe vera; glutaraldehyde; EDTA; ethanol. Cavity disinfectants were applied, rinsed, and air-dried. The restorations were performed with the aid of polyethylene tubes. Shear bond strength, work to detachment, and shear modulus were evaluated. All data were statistically analyzed and the level of significance was set at 5%. The control group showed the lowest shear bond strength (8.34 ± 2.68 MPa). Aloe vera showed the lowest work to debonding (2284 J/m2) while chlorhexidine showed the highest (9347 J/m2). Regarding the shear modulus, ethanol, chlorhexidine, and EDTA presented similar values to the control group (216.11 kPa), and glutaraldehyde and Aloe vera presented values twice as high. The use of chlorhexidine, ethanol, EDTA, glutaraldehyde, and Aloe vera did not impair the adhesion established between the dentin of permanent teeth and composite resin. Even though there is a need for clinical studies to support these findings, all disinfectants seem to be good choices as pretreatment agents.

Oronasal fistula can persist after conventional secondary alveolar bone graft surgery, which may lead to functional issues, such as regurgitation of fluids from the oral to the nasal cavity. This manuscript describes a clinical case of a patient with a bilateral cleft lip and palate that underwent tongue graft surgery for closure of an oronasal fistula after three failed local mucosa flap surgeries. The multidisciplinary treatment was comprised of orthodontic treatment, mucosa and alveolar grafts for palate closure and aesthetic rehabilitation of the anterior maxillary teeth. Smile aesthetics were noticeably improved, enhancing the patient’s self-perception and confidence.

The Caries Management by Risk Assessment (CAMBRA) protocol consists of analyzing the patient’s profile by assessing the risk and protective factors and assigning a risk level to the patient to allow an individualized treatment plan, which combines restorative treatments with a preventive chemical therapy. This systematic review and critical appraisal aim to evaluate the effectiveness of the CAMBRA protocol in reducing the incidence of caries lesions and oral bacterial load. An electronic search was carried out in the Cochrane Library, PubMed, Web of Science, Scopus, and Embase databases. Clinical studies evaluating the incidence of dental caries lesions and/or the reduction of cariogenic bacterial load (Streptococcus mutans and/or Lactobacilli spp.), with at least an intervention group that follows the CAMBRA protocol and a control group published up until January 2022, were included. The methodological quality assessment of the included clinical studies was assessed through the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2). The quality of the case-control study was evaluated according to the Methodological Index for Non-Randomized Studies (ROBINS-I). There is currently no scientific evidence to recommend the integration of the CAMBRA protocol into clinical practice. The results reported by the studies included in the systematic review do not suggest a decrease in the incidence of dental caries lesions and/or bacterial load. There is a clear need for the development of new clinical studies with an adequate methodology and follow-up, both for the CAMBRA protocol and for its components individually.

Approximately 300 million people worldwide were living with chronic hepatitis B virus infection as of 2016, however, this number does not account for those who might be living with occult hepatitis B virus infection due to difficulty diagnosing this condition. The multiple genotypes and the ability of the hepatitis B virus to acquire mutations that down-regulate its expression make occult hepatitis B virus infection a very elusive diagnosis. This is especially worrisome when there is a need to start immunosuppressive therapies, since there is a risk of reactivation in undiagnosed patients. We present a case of female patient who was referred to the consultation because she was about to start chemotherapy with an anti-CD20 agent and had a positive anti-HBc and anti-HBs. During routine workup an occult hepatitis B virus infection was diagnosed. Upon further study mutations in the PreCore and Basal Core Promoter regions were identified, as well as, a double genotype D/C. Therapy with tenofovir was initiated before the patient was started on chemotherapy. This case highlights the importance of comprehensive studying of patients who present with apparently resolved chronic hepatitis B virus infection, especially when they are about to start immunosuppressive therapies. Keywords: Hepatitis B, Recombinant genotype, Occult, Immunosuppressive therapy

Direct pulp capping consists of a procedure in which a material is directly placed over the exposed pulp to maintain dental vitality. Although still widely used in clinical practice, previous in vitro studies found that the biomaterial Life® presented high cytotoxicity, leading to cell death. This study aimed to identify the Life® constituents responsible for its cytotoxic effects on odontoblast-like cells (MDPC-23). Aqueous medium conditioned with Life® was subjected to liquid–liquid extraction with ethyl acetate. After solvent removal, cells were treated with residues isolated from the organic and aqueous fractions. MTT and Trypan blue assays were carried out to evaluate the metabolic activity and cell death. The organic phase residue promoted a significant decrease in metabolic activity and increased cell death. On the contrary, no cytotoxic effects were observed with the mixture from the aqueous fraction. Spectroscopic and spectrometric methods allowed the identification of the toxic compounds. A mixture of the regioisomers ortho, para, and meta of N-ethyl-toluenesulfonamide was identified as the agent responsible for the toxicity of biomaterial Life® in MDPC-23 cells. These findings contribute to improving biomaterial research and development.

Introduction: Myringotomy for tube insertion is the most common otologic surgery. Otorrhea is a frequent complication of this procedure and, to prevent it, most surgeons strongly recommend avoiding contact with water as this is thought to adversely impact on post-operative quality of life. Objective: To understand the benefit of this recommendation. Methods: Observational study – retrospective cohort study comparing the incidence of post-operative otorrhea and its impact on patients’ quality of life, in two groups of patients comprising children under 10 years of age who underwent bilateral myringotomy and tube placement for chronic otitis media with effusion between May 2011 and May 2012. One group received water protection care after surgery, the other did not. Data was collected through telephonic interview, after one year of follow up (one year after the procedure). Water exposure without protection was considered the exposure event. Incidence of otorrhea and perceived impact on quality of life were the outcome measures. Results were compared after logistic regression. Results: We included 143 children: 116 were not exposed to water without protection and 27 were exposed. In the not exposed group 36.2% had at least one episode of otorrhea, compared to 40.0% of the exposed group. Odds ratio for otorrhea on exposed was 1.21 (95% CI 0.51–2.85, p = 0.6). Negative impact on quality of life was reported by parents of 48.2% on the not exposed children, compared to 40.7% on the exposed group. This difference was not significant (p = 0.5). Conclusion: We found that recommending water protection did not have beneficial effect on the incidence of otorrhea after myringotomy with tubes on chronic otitis media with effusion. However, such measures did not appear to have a negative impact on quality of life. This is a populational observational study with few cases (143 cases); these final statements would be better stated by a very large populational study with another large control group. Resumo: Introdução: A miringotomia para inserção de tubo de ventilação é a cirurgia otológica mais comum. Otorreia é uma complicação frequente deste procedimento e, para evita-la, a maioria dos cirurgiões recomenda evitar o contato com a água, pois acredita-se que isso possa afetar negativamente a qualidade de vida pós-operatória. Objetivo: Verificar o benefício dessa recomendação. Método: Estudo observacional - estudo de coorte retrospectivo, comparando a incidência de otorreia pós-operatória e seu impacto na qualidade de vida dos pacientes, em dois grupos de pacientes com crianças menores de 10 anos submetidas à miringotomia bilateral e colocação de tubo de ventilação para o tratamento de otite média crônica com efusão, entre maio de 2011 e maio de 2012. Um grupo recebeu cuidados de proteção contra a água após a cirurgia, o outro não. Os dados foram coletados através de entrevista telefônica, após um ano de seguimento (um ano após o procedimento). A exposição à água sem proteção foi considerada o evento de exposição. A incidência de otorreia e o impacto percebido na qualidade de vida foram as medidas de resultado. Os resultados foram comparados após a regressão logística. Resultados: Incluímos 143 crianças: 116 não foram expostas à água sem proteção e 27 foram expostas. No grupo não exposto, 36,2% apresentaram pelo menos um episódio de otorreia, em comparação com 40,0% do grupo exposto. A razão de chances (odds ratio) para otorreia no grupo exposto foi de 1,21 (IC 95%: 0,51-2,85, p = 0,6). O impacto negativo na qualidade de vida foi relatado pelos pais de 48,2% nas crianças não expostas, em comparação com 40,7% no grupo exposto. Essa diferença não foi significante (p = 0,5). Conclusão: Não verificamos um efeito benéfico sobre a incidência de otorreia ao recomendar a proteção contra a água após colocação de tubos de ventilação para otite média com efusão. Entretanto, tais medidas não parecem ter tido um impacto negativo na qualidade de vida. Keywords: Otitis media with effusion, Serous otitis media, Glue ear, Tympanostomy, Palavras-chave: Otite média com efusão, Otite média serosa, Tubos de ventilação, Timpanostomia

Esthetics is an increasing concern for patients, particularly in anterior teeth. The current approaches to manage the esthetic demands include options such as prosthodontic rehabilitation, orthodontic treatment, and direct restorations. Direct restorative procedures for anterior teeth have become a reliable alternative, since current composite materials can mimic teeth’s esthetics and function perfectly. This article describes two clinical cases of anterior esthetic rehabilitations where the direct reshaping of the four maxillary incisors was performed using the buccolingual layering technique with the help of a silicone index. In Case 1, a diastema closure was also performed, whereas in Case 2, the replacement of old restorations was also carried out. It was possible to achieve excellent final esthetic results in both cases, recovering the smile symmetry, and both patients were satisfied. The literature supports the use of direct restorations in the anterior region with very good long-term prognosis. It is a minimally invasive approach that is reversible, repairable, cost-effective, and when combined with layering techniques and adequate restorative materials, it is possible to achieve good esthetic and functional outcomes. However, regular maintenance appointments are mandatory, and all cases should be carefully planned to ensure predictable and long-lasting results.

Despite developments and advances in dental materials which allow for greater restorative performance, there are still challenges and questions regarding the formulation of new compositions and chemical reactions of materials used in restorative dentistry. The aim of this study was to assess and compare the mechanical and tribological characteristics of a bioactive resin, a composite resin, and a glass ionomer. Twenty specimens of each material were divided into two groups: one control group (n = 10), not subjected to thermocycling, and one test group (n = 10) submitted to thermocycling. The Vickers microhardness test was carried out and surface roughness was evaluated. The tribological sliding indentation test was chosen. The bioactive resin had the lowest hardness, followed by the composite resin, and the glass ionomer. The bioactive resin also showed greater resistance to fracture. For the tribological test, the wear rate was lower for the bioactive resin, followed by the composite resin, and the glass ionomer. The bioactive resin presented a smooth surface without visible cracks, while the other materials presented a brittle peeling of great portions of material. Thus, the bioactive resin performs better in relation to fracture toughness, wear rate and impact absorption than the composite resin and much better than the glass ionomer.

The laser ablation sector field inductively coupled plasma mass spectrometry (LA–SF–ICP-MS) U–Pb geochronological method is frequently used to date minerals, in particular zircon. In turn, baddeleyite is the ideal geochronometer when it comes to silica-undersaturated rocks, such as alkaline rock types. In this study, we describe a series of protocols to separate baddeleyite crystals and date them by the LA–SF–ICP-MS method in the Isotopic Geology Laboratory of the Geoscience Institute (University of Campinas), starting from sample crushing and milling and the calibration of the Wilfley table. The method includes the use of Kovdor and Phalaborwa primary and secondary reference materials, respectively. Laser operation conditions were spot size of 25 μm and ablation time of 60 s (20 for local blank and 40 for baddeleyite signal), at a fluence of 20 L per minute. Cretaceous alkaline rocks associated with the Paraná-Etendeka magmatic province were analyzed, comprising Jacupiranga, Pariquera-Açu, and Cananéia intrusions, all related to the Guapiara lineament. The results yielded concordant baddeleyite ages of 115–120 Ma for Jacupiranga carbonatite, around 110 Ma for Pariquera-Açu shonkinite, and 81 ± 2 Ma and 83 ± 0.4, respectively for baddeleyite and zircon from the Cananéia syenite. Despite the difficulties in baddeleyite separation, the LA–SF–ICP-MS U–Pb ages have proven to be robust for the young alkaline complexes related to the Serra do Mar Province, such as those occurring along the São Jerônimo-Curiuva Lineament, avoiding the concerns about thermal events that could reset, e.g. K–Ar and Ar–Ar systems. Field relations show a hierarchy of intrusive pulses and our data show that, temporarily, the Jacupiranga Complex is active in a younger time interval, 115 to 120 Ma, than previously established. • U–Pb baddeleyite crystallization ages of Jacupiranga Complex. • Cretaceous alkaline carbonatite of Jacupiranga Complex. • U–Pb baddeleyite and zircon crystallization ages of alkaline rocks from south of São Paulo state, Brazil. [ABSTRACT FROM AUTHOR]

Introduction: In Portugal, the prevalence of hepatitis A virus infection has decreased in the past decades, especially in young adults. The aim of this study was to detect the prevalence of antibody to hepatitis A virus in a population observed in our Travel Clinic. Material and Methods: Antibodies against hepatitis A, hepatitis B, hepatitis C and human immunodeficiency virus were tested using standard enzyme immunoassay in patients older than 18. The exclusion criteria were: prior vaccination for hepatitis A virus, previous diagnosis of infection with hepatitis B virus, hepatitis C virus and/or human immunodeficiency virus, foreign travelers and long-term expatriates. We applied an epidemiological survey and data was statistically analyzed with SPSS® 18.0. Results: In the 665 travelers studied, natural immunity to hepatitis A virus was present in 57.6% (n = 383). They were stratified into 8 age groups and for each one hepatitis A immunity was clarified: 5.0% (n = 1) in 18 - 25 years, 32.3% (n = 21) in 26 - 30 years, 40.9% (n = 47) in 31 - 35 years, 45.8% (n = 54) in 36 - 40 years, 68.7% (n = 79) in 41 - 45 years, 70.1% (n = 68) in 46 - 50 years, 80.8% (n = 63) in 51 - 55 years and 87.7% (n = 50) over 56 years old. In those who accepted further screening, positivity for hepatitis B core antibody was found in 0.6% (n = 3) travelers, hepatitis C virus infection in 1.1% (n = 6) and human immunodeficiency virus infection in 0.5% (n = 3) whose previous status was unknown. The most frequent travel destination was sub-Saharan Africa (72.6%; n = 483). Discussion: We found 49.1% (n = 260) travelers under 50 years old susceptible to hepatitis A virus infection and for those between 40 and 50 years, 30.7% (n = 65) still need vaccine protection. Conclusion: Across age groups there is a trend towards lower prevalence of hepatitis A virus antibody, in particular among youngsters, when compared with older Portuguese studies.

Pre-eruptive enamel lesions occur during tooth formation and include fluorosis, traumatic hypomineralization, and molar incisor hypomineralization. Minimally invasive treatment approaches, such as microabrasion, should be considered for these cases. This article presents a case series of three patients with pre-eruptive enamel defects in esthetically compromised tooth regions which were treated with the microabrasion technique: two fluorosis cases, moderate and advanced, and one hypomineralization case of traumatic etiology. In Cases 1 and 3, there was a significant improvement in esthetics with a total resolution of the enamel defects. However, a slight yellowish coloration may be detected at close observation. In Case 2 (advanced fluorosis), although there was no full resolution of the white spots, there was a clear improvement in esthetics. Microabrasion is a safe and effective, minimally invasive treatment for pre-eruptive enamel lesions. It does not require local anesthesia, it is less destructive than restorative interventions, and allows good esthetic outcomes with no significant postoperative sensitivity. Its efficacy is directly related to the lesions’ severity and depth. Although there are some limitations, further improvement can be achieved with dental bleaching. More invasive treatments might be considered if results are still unsatisfactory.

The surface smoothness of composite restorations affects not only their esthetic appearance but also other properties. Thus, rough surfaces can lead to staining, plaque accumulation, gingival irritation, recurrent caries, abrasiveness, wear kinetics, and tactile perception by the patient. The aim of this study was to evaluate the influence of irrigation during the finishing and polishing of composite resin restorations. A systematic search of the PubMed, Cochrane Library, EMBASE, Web of Science, and Clinical Trials databases was conducted. Papers published up to 11 February 2021 were considered. The quality of each study was assessed using the modified Consolidated Standards of Reporting Trials checklist for reporting in vitro studies on dental materials. No clinical studies were identified. Six in vitro studies were included, reporting changes in physical and esthetic properties. After performing a methodological quality assessment of the studies, some limitations were identified, the main limitation being the heterogeneous methodology across studies. The evidence resulting from this systematic review did not favor either wet or dry finishing/polishing procedures. There is a clear need for well-designed studies focusing on the comparison of dry/wet finishing/polishing with standard protocols to evaluate the differences among different materials and methods.

Background: Indirect restorations using composites with ceramic fillings can be an alternative to ceramic veneering and direct composite restorations for the treatment of posterior teeth. The aim of this study was the evaluation of the mechanical and tribological properties of a ceromer. Materials and Methods: Sixty specimens were produced and divided into two groups: one control group not submitted to thermocycling (n = 20) and one test group submitted to 5000 cycles of thermocycling (n = 40). The studied parameters were microhardness, surface roughness and the coefficient of friction (scratch test). Results: The ceromer exhibits a reduction of polymerization shrinkage, higher wear, and fracture resistance than the composite resins. The studied ceromer presented good mechanical properties, even after being submitted to thermocycling. Roughness was the property most affected, increasing 25.8%, microhardness decreased by 10.5% and the coefficient of friction increased by 4.2%. Conclusions: In certain situations, ceromers can be an alternative to composite resins and ceramics, providing an aesthetic, conservative and longevity option.

O nódulo tiroideu é um problema clínico muito frequente cuja pertinência clínica é a exclusão de malignidade, que pode representar 4% a 6,5% dos casos. A abordagem diagnóstica do nódulo tiroideu depende de características clínicas e ecográficas que vão determinar os nódulos elegíveis para citologia aspirativa de agulha fina – o resultado (1 em 6 possibilidades diagnósticas da classificação de Bethesda) vai ser fundamental na atitude terapêutica. Este é o relato das etapas de investigação de um nódulo tiroideu detetado acidentalmente, de citologia incerta (lesão folicular de significado indeterminado) que após cirurgia se constatou tratar-se de um microcarcinoma papilar da tiroideia.

Criança de 2 anos, sexo masculino, diagnóstico de otite média aguda bilateral, medicada inicialmente com amoxicilina + clavulanato 90 mg/kg/dia desde há 7 dias, internada por agravamento do quadro à esquerda, com edema e eritema retroauricular, apagamento do sulco retroauricular [...] Recebido: 07/09/2015 · Aceite: 7/01/2016

Apresentamos um caso clínico de tumor da parótida – carcinoma de células acinares – envolvendo o lobo superficial e profundo da parótida, tratado cirurgicamente por parotidectomia total e radioterapia adjuvante local e cervical. Escolhemos este caso pelo facto de o tumor envolver o lobo superficial e profundo da parótida, sem envolver o nervo facial, o que constituiu um desafio cirúrgico maior, que foi a remoção do tumor e da glândula preservando o nervo e todos os seus ramos. No Hospital CUF Descobertas, o tratamento dos doentes com cancro da cabeça e pescoço é assegurado pela colaboração multidisciplinar entre as especialidades de Otorrinolaringologia, Hemato-Oncologia e Radioterapia. Os tumores das glândulas salivares são um exemplo, como demonstrado no caso clínico apresentado. Recebido: 02/05/2017 - Aceite: 29/08/2017

This study focuses on the analysis of high-resolution seismic profiles, integrated with sedimentological, echosounder, SRTM and satellite image datasets, of the Brazilian continental shelf adjacent to the Rio Grande do Norte State, NE Brazil. Located in the northeast of Brazil, the State of Rio Grande do Norte is bounded by two main coastal and shelf systems: the eastern coastal-shelf, from the Sagi River to the Touros High, and the northern coastal-shelf, extending from Touros High to Tibau. This shelf represents a modern, highly dynamic mixed carbonate-siliciclastic system characterized by reduced width and shallow depths as compared with other parts of the Brazilian shelf. It has an average width of 40 km, the shelf-break lying at a depth of ~ 60 m. This shelf is subject to the full strength of the westerly South Equatorial current combined with high winds and moderate to high tides and waves. A sharply defined stratigraphic boundary, probably between the Pleistocene and Holocene deposits, is clearly to be observed in the seismic record. Incised-valleys extending from the main river mouths (e.g.the Potengi, Açu, and Apodi) to the shelf break dominate the area investigated and may indicate periods of lower sea level.Este estudo está direcionado ao conhecimento da plataforma continental brasileira adjacente ao Estado do Rio Grande do Norte, NE do Brasil, através da analise de perfis sismicos de alta resolução integrados a dados sedimentológicos, batimétricos, SRTM e imagens de satélites. O Estado do Rio Grande do Norte, localizado no nordeste do Brasil, apresenta dois sistemas costeiros-plataformais: Setor Este, do Rio Sagi (divisa PB-RN) ao Alto de Touros e Setor Norte, do Alto de Touros a Tibau (divisa RN-CE). Esta plataforma representa um sistema plataformal moderno misto (carbonático-siliciclástico), altamente dinâmico. É caracterizado por sua reduzida largura e águas rasas, quando comparado com outras partes da plataforma brasileira. A plataforma apresenta largura média de 40 km e a sua quebra encontra-se a profundidades médias de 60 m. A plataforma é sujeita a ação da corrente sul equatorial, combinada a ventos fortes e variação de maré moderada a alta e/ou ondas. Um limite estratigráfico fortemente definido, provavelmente entre os depósitos Pleistocênicos e Holocênicos, pode ser bem observado e vales incisos, estendendo-se a partir dos principais rios (como por ex., Potengi, Açu e Apodi) dominam a área investigada.

The presence of water ice on Mars is well established. Some featureson the planet point to the occurrence of processes similar to those that take place in periglacial areas of Earth. One of the clues for this is the existence of small-scale polygonal terrains. In this paper, we present a methodology that aims at the automated identification of polygonal patterns on high-spatial resolution images of the surface of Mars. In the context of the research project TERPOLI, this step will be complemented with a full characterization, in both geometric and topological terms, of thenetworks detected. In this manner, we hope to collect data that will lead to a better understanding of the conditions of formation of the polygons, and of their temporal evolution; namely, we intend to identify different groups of polygons and to compare them with terrestrial examples.

Introdução: Na rino-sinusite crónica com pólipos, ou polipose naso-sinusal, o olfacto está frequentemente afectado de forma significativa, e é reconhecido o impacto importante deste sintoma na qualidade vida. A resolução por cirurgia endonasal nos casos de resistência à terapêutica médica máxima é uma opção para minorar os sintomas, mas a sua extensão é alvo de controvérsia, sendo que uma cirurgia mais radical, como a nasalização, controla melhor a doença com menos recidivas, mas pode comprometer mais o olfacto. A decisão da extensão da cirurgia deve ser partilhada com o doente, devendo o esclarecimento informado ser tão completo quanto possível quanto às expectativas de controlo da doença como à resolução da hipósmia. Material e Métodos: Revisão bibliográfica e discussão por quadro de peritos. Resultados e Discussão: Baseando-nos em revisão de literatura, apresentamos uma proposta de elementos a incluir no esclarecimento cirúrgico, de modo a contemplar de forma abrangente as limitações da cirurgia no que diz respeito ao sintoma anósmia, bem como das diferentes opções e suas consequências quanto à sua radicalidade, focando a atenção no ponto de vista da ética médica. Conclusão: A decisão da extensão da cirurgia deve ser partilhada com o doente, devendo o esclarecimento informado ser tão completo quanto possível quanto às expectativas de controlo da doença como à resolução da hipósmia.

The presence of water ice on mars is well established. Some features on the planet point to the occurrence of processes similar to those that take place in periglacial areas of Earth. one of the clues for this is the existence of small-scale polygonal terrains. In this paper, we present a methodology that aims at the automated identification of polygonal patterns on high-spatial resolution images of the surface of mars. In the context of the research project TERpolI, this step will be complemented with a full characterization, in both geometric and topological terms, of the networks detected. In this manner, we hope to collect data that will lead to a better understanding of the conditions of formation of the polygons, and of their temporal evolution; namely, we intend to identify different groups of polygons and to compare them with terrestrial examples.