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Brazil is undergoing an epidemic of syphilis. In the pregnancy-puerperal cycle, syphilis has a high incidence and is considered a public health problem. This study aimed to perform the temporal and incidence analysis of gestational and congenital syphilis cases in 28 municipalities in the northwest region of the state of São Paulo. This was an observational, epidemiological, ecological study carried out with secondary data collected between 2010 and 2017 in public databases of SINAN and SINASC. The reported cases of gestational/congenital syphilis were described according to sociodemographic variables and chi-square association tests were applied at a significance level of 5%. There were 350 cases of gestational syphilis and 164 cases of congenital syphilis; the average vertical transmission rate was 44.09%; partners had low adherence to treatment; and 86.59% pregnant women attended prenatal care. It can be concluded that vertical transmission rate of syphilis is high, and few partners of pregnant women adhere to the treatment.

Urethral obstruction is always an emergency for male ferrets and can lead to hyperkalemia. Surgical treatment under general anesthesia can be required. Untreated hyperkalemia before anesthetic induction can be fatal. A 2-year-old, 1.01 kg, neutered male ferret (Mustela putorius furo) was presented for lethargy, hematuria, and stranguria. Radiographs revealed urolithiasis involving the bladder and urethra. When presented for anesthesia, the ferret had hyperkalemia. Before anesthesia, the potassium was normalized rapidly through a combination of saline, dextrose, insulin, and terbutaline. Terbutaline was added to the therapeutic regime as a result of persistent hyperkalemia. Severe hypotension developed during anesthesia which can be partially attributed to the peripheral vasodilatory effect of terbutaline. Hypoglycemia developed as a result of failure to monitor blood glucose level frequently during surgery and suboptimal regime used for insulin and dextrose. Potassium level in a hyperkalemic ferret can be normalized before anesthesia with a combination of therapeutic agents like saline, sodium bicarbonate, insulin, and dextrose. In a case of persistent hyperkalemia, terbutaline can be added to the therapeutic plan. It is important that blood pressure and blood glucose level are monitored closely to prevent hypotension possibly due to terbutaline and hypoglycemia as a result of insulin. The purpose of this report is to describe a case of a ferret with hyperkalemia that needed rapid correction before anesthesia.

Ovonic threshold switching (OTS) selector is a promising candidate to suppress the sneak current paths in emerging memory arrays, but there is still a gap between its performance and the rigorous requirement from memory devices, especially its endurance improvement is hindered by insufficient understanding of the mechanism. In this work, cycling induced degradation of GeSe-based OTS selectors is studied with electrical characterization techniques. The existence of metastable state between the on- and off-state during cycling is observed and statistically analyzed alongside with the gradual off-state leakage current increase. Such metastable degradation may be attributed to the generation of unstable Ge-Ge bonds that might be induced by element segregation, which is also responsible for the higher off-state leakage current in GeSe selectors after large cycling or with higher Ge component. This work provides experimental guidance for optimizing OTS selectors.

The goal of pronunciation teaching should be to enable learners to develop intelligible pronunciation and, in order to do this, it is important to teach perception and production of the most relevant segmental and suprasegmental features of pronunciation, considering specific groups of learners (CELCE-MURCIA et al. , 2010). Technology has played an important role in pronunciation teaching, and the applications developed for pronunciation instruction enable learners not only to engage in pronunciation activities, but to have access to a greater variety of input and immediate feedback. Having this in mind, this study aimed at analyzing the content, the pronunciation teaching steps, the features, and usability resources of pronunciation apps. In order to guide the analysis, a framework was developed based on literature related to the areas of pronunciation teaching and of Mobile Assisted Language Learning (MALL). The results showed that there is a tendency for the apps analyzed to focus more on segmentals. All of them offer description and analysis, listening discrimination, and controlled practice of the pronunciation features, as well as feedback. However, they were limited in terms of guided and communicative practice, of Automated Speech Recognition (ASR), and of variety of input.

Cystic adenomyosis is an unusual form of adenomyosis, characterized by a well-circumscribed cavitated endometrial gland and stroma, ≥ 1 cm in diameter, located within the myometrium. Few cases have been reported in the gynecological literature, with confusing naming such as: juvenile cystic adenomyosis, cystic myometrial lesions, cystic adenomyoma or juvenile adenomyotic cysts. The current preferred terminology is accessory cavitated uterine mass /or malformation (ACUM). We report here the cases of two 17 and 18 -year-old nulliparous women, who complained of severe dysmenorrhea early after the onset of menarche, with none or partial efficiency of medical treatment. MRI findings, with a follow-up in one case and surgical treatment in both cases, are described with an emphasis on physiopathology. The typical MR appearance is a large well-circumscribed round mass within the external myometrium, composed by an inner cystic hemorrhagic layer surrounded by a thick fibrous crown. The first-line treatment is laparoscopic surgery with mass resection. This typical MRI pattern must be a part of the knowledge of the radiologists.

Health indices are important to measurement of the presence and severity of diseases. The objective of this study was to perform a literature review about malocclusion indices and analyze their applications in the public health field. The research was performed by consulting Pubmed, SciELO, Web of Science, Scopus, Bireme and Embase databases, using the following terms: public health, epidemiological methods, indices, epidemiological surveys, preventive dentistry, malocclusion, and orthodontics. Publications on the development and use of malocclusion indices in clinical and epidemiological studies were included, without restrictions of methodology and language. Fifty-two indices and their variations were identified. Of these, most were intended for individual assessments and their use in public health was difficult due to the requirements for their application, including the need for specialists, plaster models analysis, complementary exams such as cephalometric radiographs and photographs, specific equipment, the need for longitudinal monitoring of cases, and exclusively objective or subjective assessments. Some malocclusion indices present positive aspects and partially evaluate physical, functional, psychological, and social conditions. However, it is still challenging to find a unanimous index that fulfills the requirements for assessing the severity, treatment need, and impact of malocclusions on the individual’s quality of life with applicability in public health.

O objetivo do estudo foi analisar o conhecimento dos estudantes de Odontologia acerca da prescrição medicamentosa. Trata-se de um estudo transversal e quantitativo, realizado com estudantes do último semestre do curso de Odontologia de uma instituição pública de ensino superior. Para a realização do estudo, uma folha em branco com a palavra “Receita” no cabeçalho foi fornecida aos estudantes para que uma prescrição medicamentosa fosse realizada da forma que julgassem pertinente. Os pesquisadores desenvolveram um instrumento para a análise dos documentos em questão. Em seguida, os dados foram tabulados para posterior análise das variáveis. Os resultados foram apresentados em frequências absolutas e percentuais. Para verificação do conhecimento dos estudantes acerca das subdivisões dos documentos empregou-se o Teste Binomial de duas proporções, com nível de significância de 5%. Observou-se que em 85,56% das prescrições a adscrição não estava presente. Em 64,44% das receitas, a identificação do paciente não estava presente, e o carimbo não foi utilizado em 67,78%. Conclui-se que parte das prescrições analisadas estavam em desacordo em alguns elementos formais necessários no documento.

The objective was evaluate the oral hygiene practices, the periodontal condition and the edentulism of the person with visual impairment. This is a cross-sectional quantitative study in which the study population was a visually impaired person from an Institute for the blind of a medium-sized municipality. The variables studied were: gender, level and type of visual impairment, frequency of oral brushing and methods used for oral hygiene, periodontal situation and use and need of dental prosthesis. The participants of the study (n = 47), 70.2% were males, with a mean age of 47.2 ± 14.1 years. Regarding toothbrushing, 66.0% stated that they brush their teeth more than twice a day, but dental floss is never used by 51.1% of the interviewees. When comparing the use of dental prosthesis with flossing, a statistically significant difference was found (p = 0.043). The same is observed in relation to the CPI score, in which a statistically significant value (p = 0.000) was found. The correlation coefficient was statistically significant, of moderate strength (r = 0.681) at the intersection of the CPI Score with the Prosthesis Use Score. Although people with visual impairments frequently perform oral hygiene practices, dental hygiene is often out of date due to the lack of flossing. This lag is due to the lack of public policies aimed at this population. This fact reflects negatively on the oral health conditions of these patients, who presented teeth with periodontal problems and a high prevalence of edentulism. Keywords: Vision Disorders. Oral Hygiene. Periodontal Index. ResumoO objetivo foi avaliar as práticas de higiene bucal, a condição periodontal e o edentulismo das pessoas com deficiência visual. Trata-se de um estudo quantitativo, de caráter transversal, no qual a população de estudo foram pessoas portadoras de deficiência visual, de um Instituto para cegos de um munícipio de médio porte. As variáveis pesquisadas foram: gênero, nível e tipo de deficiência visual, frequência de escovação bucal e métodos utilizados de higiene bucal, situação periodontal e uso e necessidade de prótese dentária. Dos participantes do estudo (n=47), 70,2% são do sexo masculino, com uma média de idade de 47,2 ± 14,1 anos. Em relação à escovação 66,0% afirmaram que escovam os dentes mais de duas vezes ao dia, porém o fio dental nunca é utilizado por 51,1% dos entrevistados. Quando comparados o uso de prótese dentária com o uso do fio dental, foi encontrada diferença estatisticamente (p=0,043). O mesmo é observado em relação ao escore CPI, no qual foi encontrado valor estatisticamente significante (p=0,000). O coeficiente de correlação foi estatisticamente significativo, de força moderada (r=0,681) no cruzamento do Score CPI com o Score Uso de Prótese. Apesar das pessoas com deficiência visual realizarem as práticas de higiene bucal com frequência, esta se encontra defasada devido à falta do uso do fio dental. Essa defasagem se da devido à falta de políticas públicas voltadas para essa população. Fato este que reflete negativamente nas condições de saúde bucal desses pacientes, que apresentaram dentes com problemas periodontais e uma alta prevalência de edentulismo. Palavras-chave: Transtornos da Visão. Higiene Bucal. Índice Periodontal.

The control of dental plaque by chemical means can be a valuable auxiliary resource for individuals who have difficulties in performing dental plaque control through regular oral hygiene procedures. The aim of this study was to evaluate the effect of chlorhexidine and fluorine varnishes on the levels of Streptococcus mutans (S. mutans) present in the dental biofilm and on the dental plaque index. The study was carried out in a sample comprised thirty-nine schoolchildren between 13 and 15 years of age, distributed into 2 groups. Group I received a single layer of varnish with chlorhexidine and thymol on the maxillary right first molar. Group II received the application of varnish with fluoride following the same methodology. S. mutans count and dental plaque index recording were performed 7 days before the application and 7, 15 and 30 days after the treatment. It was observed that chlorhexidine and fluoride varnishes significantly reduced the number of S. mutans in dental plaque for 30 days (p

Background To evaluate potential associations between spinopelvic parameters and the biochemical composition of lumbar intervertebral discs using quantitative magnetic resonance imaging in asymptomatic young adults. Methods Our study group comprised 93 asymptomatic volunteers aged 20-40 years (49 women and 44 men). Lumbar spine T2-weighted images and T2 relaxometry were acquired on a 1.5T MRI scanner. Spinopelvic parameters including sacral slope, pelvic tilt, pelvic incidence, lumbar lordosis, thoracic kyphosis, thoracolumbar alignment, sagittal vertical axis, spinosacral angle, C2 pelvic angle, and T1S1 and L1S1 length were measured on panoramic spine radiographs. Results Lumbar lordosis decrease correlates with discrete dehydration of nucleus pulposus at all lumbar levels. Also low values of sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis and spinosacral angle were associated with decrease of T2 relaxation times on annulus fibrosus. Conclusions In conclusion, spinopelvic parameters presented a discrete association with lumbar disc composition and water content.

Education is one of the areas which has been most impacted by the COVID-19 pandemic, as the social distancing measures adopted by governments affected 90% of the student population worldwide. The solution found by many educational institutions, including in the Brazilian context, was to adopt Emergency Remote Education (ERE), despite the challenges related to the access to internet and digital technological resources, and the lack of teacher training regarding their use. Having this in mind, this article aims at discussing the concept of ERE, as well as to present and discuss digital technological resources such as platforms and apps which may be used by language teachers to support their pedagogical practice, promoting language development through interaction, increase motivation and learner's autonomy. The article ends presenting the development of a digital story as an activity that may be accomplished through the use of apps.

To compare a reusable hysteroscopic morcellator and standard resectoscopes in the hysteroscopic management of uterine polyps.Single-center randomized prospective single-blind trial (resectoscope-morcellator study).Centre Médico-chirurgical Obstétrique teaching hospital, Strasbourg University Hospitals, France.All patients presenting with a single endometrial polyp of size 1 cm or larger.After consent, the patients were randomized into 2 groups: hysteroscopic morcellation (HM) group or standard resection (SR) group. Office-based review hysteroscopy was performed 6 weeks to 8 weeks after surgery. Primary end point: time of morcellation or resection.total operating time (minutes), volume of fluid used (mL), fluid deficit (mL), number of morcellator or resectoscope insertions, operator comfort (visual analog scale: 0 to 10) and quality of vision (0 to 5), perioperative complications, completeness of resection, need to convert to another technique, pain assessment (visual analog scale), and length of hospitalization. At review hysteroscopy, we noted whether the resection or morcellation had been effective and if synechiae were present or absent. Statistical analyses followed Bayesian methods.Ninety patients were randomized: 45 in the HM group and 45 in the SR group. The average size of polyps at hysteroscopy was 13.3 mm. Morcellation time was lower than resection time (6.1 minutes vs 9 minutes; p [HMSR] = .996). This also applied to total operating time (12.7 minutes vs 15.6 minutes; p [HMSR] = .985), number of device insertions (1.50 vs 6; p [HMSR] .999), volume of fluid used (766.9 mL vs 1118.9 mL; p [HMSR] = .994), and fluid deficit (60.2 mL vs 169.8 mL; p [HMSR] = .989). Operator comfort was better in the HM group (8.4 vs 7.4; p [HMSR] = .999) as was visualization (4 vs 3.7; p [HMSR] = .911, highly probable). Operative complications were higher in the SR group (5 vs 0; p [HMSR] = .989]. One patient in the SR group died after surgery owing to an anesthetic complication (anaphylactic shock complicated by pulmonary embolism). No differences were noted between the groups for pain assessment, length of hospitalization, and outcome on review hysteroscopy.The reusable morcellator is quicker, uses less fluid with less deficit and fewer introductory maneuvers, and offers better comfort and visualization than the resectoscope while being as effective for the hysteroscopic treatment of uterine polyps.

Esse estudo propõe a busca de aproximações do esporte dentro da Base Nacional Comum Curricular (BNCC) em uma perspectiva do contexto do lazer. A BNCC foi construída com uma visão de formação dos sujeitos voltados para atender o mercado de trabalho que tenciona com visão de esporte na perspectiva de uma educação para o lazer. Como percurso metodológico, fizemos uma pesquisa eminentemente qualitativa. Compreendemos que seja relevante a educação para o lazer, como incentivo a ambientes de aprendizagem de valores que contrapõe o modelo predominante existente nas aulas. Diante disso, propomos os Jogos Desportivos Coletivos (JDC), ao privilegiar o jogo, como ferramenta de aprendizagem de modalidades esportivas, dando ênfase ao diálogo, a participação, a ações coletivas em uma interface com o esporte enquanto atividade do contexto do lazer dentro da BNCC.

A 12-year girl presented with a firm well‑defined swelling in her left maxilla. Radiologically, there was a well-circumscribed, unilocular radiolucency with dimension about 35 × 30 mm, and related to the crown of the unerupted permanent left canine. The computed tomography (CT) reveled an extensive lesion elevating the floor of maxillary sinus. Then, it was performed aspirations, incisional biopsy, decompression, and enucleation of the lesion. The diagnosis was compatible with adenomatoid odontogenic tumor. The treatment of this lesion is the entire removal. So, the patient was evaluated periodically, completing 3 years of following up. New CT were taken at 5 and 22 months post-operative, showing the complete regression of the cavity where the lesion was.

PurposeAlthough active learning methodologies are recognized as an effective means to achieve expected educational demands, in practice, the teaching and learning processes are still widely characterized by traditional pedagogy aspects. As a result, teaching innovations in science, technology, engineering and math (STEM) education are carried out in isolation in specific disciplines, programs or departments. To addresses these challenges and to stimulate useful teaching innovations, this study aims to propose the capability maturity model to active learning (CMMAL) for assessing the maturity level of active learning methodologies in higher education institutions (HEIs).Design/methodology/approachThe CMMAL provides inputs for planning and decision-making, identifying variables such as the current state of teaching and learning processes, project management, team development, allocation of resources and infrastructure and the choice of evaluation and assessment methods. From the relevant literature, the primary aspects that impact on active learning were identified and incorporated into the structure of the model. Next, a survey was performed with 295 STEM professors and experts validating the scope of the model proposed.FindingsThe findings demonstrated the contribution of the CMMAL mainly to (1) assess the maturity levels of active methodologies in higher education and (2) stimulate the institutionalization of active learning practices in HEIs to minimize some problems related to the dissemination of new teaching practices.Practical implicationsThe primary practical and academic contribution of our study is the proposition of an artifact with a scope compatible with the need of the HEIs for the implementation of active learning methodologies. This paper presents a different perspective of current literature in active learning in STEM education, introducing a model that contributes to open the dialogue with HEIs interested in better understand and improve the performance in student-centered pedagogy.Originality/valueThe model also informs and leads to specific recommendations for HEIs seeking to enhance the performance of and alter the culture around active learning methodologies.

Purpose:To analyze the anthropometric and physiological characteristics of competitive 15- to 16-year-old young male road cyclists and scale them according to a dichotomous category of successful/unsuccessful riders.Methods:A total of 103 15- to 16-year-old male road cyclists competing in the Italian national under 17 category performed a laboratory incremental exercise test during the in-season period. Age, height, body mass, body mass index, peak height velocity, and absolute and relative power output at 2 mmol/L and 4 mmol/L of blood lactate concentration were compared between 2 subgroups, including those scoring at least 1 point (successful, n = 70) and those that did not score points (unsuccessful, n = 61) in the general season ranking.Results:Successful and unsuccessful riders did not differ anthropometrically. Successful riders recorded significantly higher absolute and relative power output at 2 mmol/L and 4 mmol/L of blood lactate concentration compared with unsuccessful riders. Successful riders were also significantly older and had advanced biological maturation compared with their unsuccessful counterparts.Conclusion:Power associated with blood lactate profiles, together with chronological age and peak height velocity, plays an important role in determining race results in under 17 road cycling. Physiological tests could be helpful for coaches to measure these performance predictors.

Introduction: The zygomatic complex is integral to the facial contour, protection of the eye and other facial structures, and dental occlusion. Its importance in facial function and aesthetics requires high quality outcomes of the treatment. Case presentation: This paper reports the case of a 46-year-old man who had an occupational accident resulting in extensive facial trauma and zygomatic fractures. The patient presented with hyposphagma, palpable step in the area of the infraorbital rim, paresthesia of the right infraorbital nerve, flattening of zygomatic prominence, abrasion of the chin and nose, a 7-cm laceration in the midface region, ecchymosis in the palate, and alteration in the dental occlusion without limitation of mouth opening. Computed tomography (CT) confirmed the zygomatic complex fractures. The treatment was reduction and fixation with plates and screws. CT was used throughout the treatment period as an essential diagnostic tool for accurate fracture assessment and classification, formulation of the surgical plan, and postoperative evaluation. Conclusion: This case study illustrated the correct use of CT for improved and efficient treatment of traumatic injury of the zygoma, an anatomical area where restoration of function and aesthetics is challenging. The patient signed a written informed consent statement for publication.

Background NPHS2 gene variants are associated with focal segmental glomerulosclerosis (FSGS) and steroid-resistant nephrotic syndrome (SRNS). In this study, the prevalence of NPHS2 variants p.R229Q, p.A242V, and p.R138Q was investigated in patients with familial or sporadic FSGS. Materials and methods The sample consisted of 40 children and 70 adults diagnosed with FSGS confirmed by renal biopsy. Clinical and laboratory parameters were evaluated. Genotyping for the three single nucleotide polymorphisms (SNPs) was performed by real-time polymerase chain reaction: two variants in exon 5 (p.R229Q and p.A242V) and one in exon 3 (p.R138Q). Variants were correlated with ethnicity, clinical presentation, treatment response, and renal outcomes. Results Among the 40 children analyzed, 20% had familial and 80% sporadic FSGS and among adults, 4.3% had familial and 95.7% sporadic FSGS, respectively. Overall, SRNS was found in 70% of adults and 90% in children. Among children, variants were detected in 2 (5%) with sporadic FSGS, p.R229Q and p.A242V in 1 each. Among adults, variants were present in 9 (12.9%) patients, all with sporadic FSGS, p.R229Q in 4 and p.A242V in 5. No patient had the p.R138Q variant. Among adults, a trend of higher proteinuria at the end of follow-up (p = 0.06) was found in patients carrying a variant. There was no significant association between NPHS2 variants with the clinical presentation, dependence on immunosuppressive treatment, or renal outcomes. Regarding ethnicity, all patients carrying the p.R229Q variant were White, while 67% of carriers of the p.A242V variant were Black. Conclusion In these patients with familial or sporadic FSGS, the prevalence of p.R229Q and p.A242V variants in children was 5% and in adults 12.9%. More studies of patients with FSGS could better define a strategy for genetic analysis and therapeutic management.

Objetivo: analisar a dispensação de medicamentos na atenção primária do Sistema Único de Saúde em um município do Estado de São Paulo. Metodologia: realizou-se análise documental dos boletins de movimentação de medicamentos das farmácias das 19 Unidades Básicas de Saúde do município de Araçatuba-SP, sede do Departamento Regional de Saúde II-SP, durante 12 meses. Os medicamentos foram agregados segundo o sistema de classificação Anatomical Therapeutic Chemical e ação farmacológica. Analisou-se o total de medicamentos dispensados e o saldo final dos principais tipos de fármacos. Resultados: foram dispensados 60.479.959 medicamentos, sendo 53,10% antibióticos, 15,42% anti-hipertensivos, 5,09% antidepressivos, 4,81% hipoglicemiantes, 3,16% ansiolíticos, 2,82% complexos vitamínicos e minerais, 2,17% antipsicóticos, 1,99% analgésicos, dentre outros tipos (11,45%). Permaneceram disponíveis 8.778.863 medicamentos, sendo os anti-hipertensivos, antidepressivos e ansiolíticos os que representam a maior proporção entre estes. Os antibióticos apresentaram a menor proporção de unidades disponíveis, com aproximadamente 2%. Os hipoglicemiantes apresentaram maior diversidade de fármacos sem unidades disponíveis para dispensação. Conclusão: os principais tipos de medicamentos dispensados foram antibióticos, anti-hipertensivos, antidepressivos e hipoglicemiantes. A dispensação de medicamentos foi satisfatória, considerando que mesmo os medicamentos que não apresentaram saldo residual positivo foram substituídos por outros de propriedades farmacológicas similares.

To carry out a systematic review based on the analysis of national and international publications in the scientific literature about the occurrence of oral manifestations in patients with anorexia and bulimia nervosa. We searched for evidence in the PubMed, Scopus, Web of Science, VHL Regional Portal, and Embase databases. We included case–control studies that analyzed oral manifestations such as dental caries, periodontitis, malocclusion, dental erosion, and soft-tissue lesions in individuals of both sexes with anorexia and bulimia nervosa. The method for quality assessment of each study was according to Downs and Black criteria. We identified 1958 studies. Excluding repeated studies, 1045 papers remained. We removed those that did not approach the theme proposed and applied the exclusion criteria, leaving 66 surveys. We analyzed abstracts in duplicate, excluding those with inconsistent results, or which were biased or unclear, and those that did not meet the standards established. The final number of studies was six; all of them dealt with the question of oral manifestations found in patients with anorexia and bulimia nervosa, and presented validity and consistency in their methodological structure and results.

Made available in DSpace on 2019-10-03T17:32:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-01. Added 1 bitstream(s) on 2019-10-04T16:21:07Z : No. of bitstreams: 1 S2176-94512019000200073.pdf: 543178 bytes, checksum: f22ee9fb22c18d9ba085a4884766bf2e (MD5) RESUMOIntrodução:o tratamento ortodôntico visa à saúde bucal e ao reestabelecimento da função como objetivo final; no entanto, os efeitos psicológicos e sociais acabam sendo o principal motivo da procura pelo tratamento.Objetivo: determinar a associação entre a qualidade de vida relacionada à saúde bucal (QVRSB), a necessidade de tratamento ortodôntico e o bullying entre os adolescentes.Métodos: trata-se de um estudo epidemiológico transversal. Para avaliar a má oclusão, foi utilizado o Dental Aesthetic Index. O instrumento Oral Health Impact Profile-14 foi utilizado para analisar a QVRSB. O questionário Kidscape foi utilizado para verificar os casos de bullying. Também foram incluídas as variáveis: tratamento ortodôntico prévio e desejo de corrigir os dentes para melhorar a aparência. A análise multivariada foi realizada por meio de regressão logística, considerando-se a qualidade de vida ruim como variável resposta.Resultados:815 adolescentes participaram da pesquisa. Houve associação, estatisticamente significativa, entre a qualidade de vida relacionada à saúde bucal e as variáveis: tratamento ortodôntico prévio (p= 0,0270), desejo de corrigir os dentes (p< 0,0001), sexo (p= 0,0309), bullying (p< 0,0001), frequência de episódios de bullying (p= 0,0170) e consequências do bullying (p< 0,0001). Foram considerados como fatores de risco para uma QVRSB ruim os adolescentes que não realizaram tratamento ortodôntico prévio a esse estudo (OR= 2,191) e aqueles que revelaram consequências negativas relacionadas aos episódios de bullying (OR= 3,042).Conclusão: a necessidade de tratamento ortodôntico não foi associada à qualidade de vida relacionada à saúde bucal, já o bullying e o tratamento ortodôntico prévio tiveram associação estatisticamente significativa com essa variável. ABSTRACTIntroduction:Orthodontic treatment aims at oral health and restoration of function as main objectives, however, psychological and social effects end up being the main reason for the demand for treatment.Objective: To determine the association between the oral health-related quality of life (OHRQoL), the need for orthodontic treatment and bullying among Brazilian teenagers.Methods: This was a cross-sectional epidemiological study. To assess the malocclusion, the Dental Aesthetic Index was used. And the Oral Health Impact Profile-14 was used to analyze the OHRQoL. The Kidscape questionnaire was used to investigate cases of bullying. The following variables were also included: previous orthodontic treatment and a desire to fix the teeth to improve one’s appearance. Multivariate analysis was performed using logistic regression considering the poor OHRQoL as a response variable.Results: 815 teenagers participated in the study. There was a statistically significant association between oral health-related quality of life and the variables: previous orthodontic treatment (p= 0.0270), desire to fix the teeth (p< 0.0001), sex (p= 0.0309), history of being a victim of bullying (p< 0.0001), frequency of bullying episodes (p= 0.0170), and consequences of bullying (p< 0.0001). The following were considered as risk factors for poor OHRQoL: lack of previous orthodontic treatment (OR = 2.191) and negative consequences of bullying (OR = 3.042).Conclusion: The need for orthodontic treatment was not associated with the OHRQoL; however, bullying and previous orthodontic treatment had a statistically significant association with this variable. Universidade Estadual Paulista Programa de Pós-graduação em Odontologia Preventiva e Social Universidade Estadual Paulista Instituto de Biociências Departamento de Bioestatística Universidade Estadual Paulista Programa de Pós-graduação em Odontologia Preventiva e Social Universidade Estadual Paulista Instituto de Biociências Departamento de Bioestatística

RESUMEN Objetivo Identificar alteraciones auditivas en estudiantes de odontología y evaluar el nivel de conocimiento con relación a la pérdida auditiva inducida por ruido. Metodología Estudio transversal, se realizaron encuestas a estudiantes del tercer año curso diurno y cuarto año del curso nocturno de estomatología. Las variables estudiadas: trastornos auditivos y conocimiento sobre PAIR (pérdida auditiva inducida por ruido). Resultados Muestran la presencia de trastornos auditivos en 14,8% de los estudiantes, de los que 7,4% recibieron tratamiento. El 28,4% había realizado exámenes audio métricos. De los estudiantes, 24,6% tenían familiares con problemas de audición; 11,1% enfermedades preexistentes;49,3% necesitan repetición durante una conver-sación;34,4% estaba irritado en el ambiente de clases prácticas y consideraban las piezas de mano de alta rotación el instrumento más ruidoso; el 75,3% refirió usar audífonos y un 72,1% por más de 5 años. En relación a los resultados sobre conocimientos 93,8% afirmaron que el dentista es un profesional con riesgo de pérdida auditiva por ruido, pero el 83,9% no había recibido orientación sobre el PAIR. Respecto al protector auricular 77,7% lo conocía, pero sólo 3,7% lo había usado. Conclusión Los estudiantes de estomatología presentaron alteraciones auditivas inducidas por el ruido, y consideraban el local de las clases prácticas un ambiente ruidoso; es necesario un mayor conocimiento en los alumnos de las consecuencias negativas del ruido en la salud y la utilización de medidas de prevención para evitar la pérdida de la audición a largo plazo. ABSTRACT Objective To identify auditory alterations in dentistry students and evaluate the level of knowledge in relation to noise-induced hearing loss. Materials and Methods Cross-sectional study. Surveys applied to third-year students of the day school, and fourth-year students of the night stomatology school. The variables studied were auditory disorders and knowledge about NIHL (noise-induced hearing loss). Results Hearing disorders were found in 14.8% of the students, of whom 7.4% were receiving treatment. Audiometric examinations were performed in 28.4% of the students. It was also found that 24.6% of the students had relatives with hearing problems; 11.1% had pre-existing conditions; 49.3% needed repetition during a conversation; 34.4% felt irritated during practical classes and considered high rotation hand pieces to be the noisiest instrument; and 75.3% reported using hearing aids (72.1% for more than 5 years). With regard to knowledge, 93.8% said that dentists are professionals at risk of hearing loss due to noise, but 83.9% had not received guidance on NIHL. Regarding the hearing protector, 77.7% knew about it, but only 3.7% had used it. Conclusion Stomatology students have noise-induced hearing loss, and also considered that the places where practical classes are given are a noisy environment. More knowledge is needed in students about the negative consequences of noise in health and the use of preventive measures to avoid hearing loss in the long term.

Objective: To evaluate the association between fetal growth restriction (FGR) and maternal hemodynamic parameters using multivariable analysis, adjusting for major confounding factors, such as hypertensive disorders of pregnancy (pre-eclampsia and gestational hypertension). Methods: A prospective cohort study was conducted between January 2013 and April 2016. Two cohorts of patients were recruited, between 24 and 39 weeks of gestation, in a high-risk outpatient setting. These cohorts comprised 49 appropriate-for-gestational-age singleton fetuses and 93 that were FGR (abdominal circumference (AC) at recruitment in the second half of pregnancy ≤ 10th percentile with a previous normal AC at 20–22 weeks). Maternal echocardiography was performed at the time of enrolment and included hemodynamic parameters of systolic and diastolic function and cardiac remodeling indices. Data were analyzed using a multivariable generalized linear model to estimate the association of FGR with maternal hemodynamic parameters after adjusting for significant confounding factors. Results: In the multivariable analysis, after adjustment for hypertensive disorders of pregnancy and smoking, FGR was associated with a 14% increase in maternal total vascular resistance, 16% reduction in cardiac output, 13% reduction in left ventricular mass and 11% reduction in heart rate; similar results were observed for the corresponding indexed parameters. Hypertensive disorders of pregnancy in the absence of FGR were associated with a 25% increase in total vascular resistance, 16% increase in left ventricular mass and 14% reduction in diastolic function; similar results were observed for the corresponding indexed parameters. Conclusion: FGR is significantly and independently associated with several maternal hemodynamic parameters, even after adjustment for major confounding factors, such as hypertensive disorders of pregnancy. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

We report a patient with autism-like deficits in emotional connectedness, executive dysfunction, and ataxia beginning at age 39. He had compound heterozygous variants in SPG7 (A510V and 1552+1 G>T ...

Resumo Fundamento A estratificação de risco para morte súbita (MS) na cardiomiopatia hipertrófica (CMH) baseia-se em algoritmos distintos propostos pela diretriz norte-americana, ACCF/AHA 2011 e europeia, ESC 2014. Objetivo Analisar o modelo ESC 2014 na determinação do risco de MS e indicação de cardiodesfibrilador implantável (CDI) em prevenção primária na CMH por meio de confrontação com a normativa norte-americana. Métodos Foi avaliada uma coorte de pacientes com CMH, calculado o escore ESC HCM-Risk-SCD e analisada a concordância dos critérios de indicação de CDI entre as duas diretrizes pelo coeficiente de Kappa. O nível de significância adotado nas análises estatísticas foi de 5%. Resultados Em 90 pacientes consecutivos, seguidos por 6±3 anos, o escore calculado foi de 3,2±2,5%. Os preditores que mais contribuíram para o cálculo nas faixas de baixo (1,88% [1,42-2,67]), médio (5,17% [4,89-5,70]) e alto risco (7,82% [7,06-9,19]) foram espessura parietal máxima do ventrículo esquerdo (1,60% [1,25-2,02] ; 3,20% [3,18-3,36] ; 4,46% [4,07-5,09]), diâmetro do átrio esquerdo (0,97% [0,83-1,21]; 1,86% [1,67-2,40]; 2,48% [2,21-3,51]) e idade (-0,91% [0,8-1,13]; -1,90% [1,12-2,03]; -2,34% [1,49-2,73]). O modelo europeu reduziu as recomendações de CDI em 32 (36%) pacientes. Entre os 43 (48%) em classe IIa pela ACCF/AHA , 8 (18%) migraram para IIb e 24 (56%) para III. Baixa concordância foi identificada entre as duas sistematizações, Kappa = 0,355, p = 0,0001. Dos 8 (9%) pacientes com MS ou choque apropriado, 4 (50%) atingiram indicação IIa pela ACCF/AHA , mas nenhum pela ESC . Conclusão Baixa concordância foi identificada entre as diretrizes analisadas. O novo modelo reduziu as indicações de CDI, notadamente em classe IIa, mas deixou desprotegida a totalidade de pacientes com MS ou choque apropriado. (Arq Bras Cardiol. 2020; 115(2):197-204) Abstract Background Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) is based on different algorithms proposed by the 2011 ACCF/AHA and 2014 ESC guidelines. Objective To analyze the 2014 ESC model for SCD risk stratification and primary prevention ICD (implantable cardioverter defibrillator) in HCM in comparison to the North American guideline. Methods An HCM cohort was evaluated and the ESC HCM-Risk SCD score was calculated. Agreement of ICD recommendations criteria between the two guidelines was analyzed with Kappa coefficient. P

This study aims to present an alternative technique with the use of a transobturator hybrid sling (autologous fascia lata with a synthetic sling) in two patients with complex urethral diverticulum (CUD), urinary stress incontinence (SUI) and a large incisional infraumbilical hernia. Staged procedures could be performed, but considering the risk of persistence or worsening SUI, and no standard management strategy of SUI associated with CUD; simultaneous treatment was proposed. It is preferable to use autologous materials in such cases. However, the presence of incisional hernia protruded with its content covering the suprapubic area prohibits the retropubic sling technique due to visceral lesion risk. The diverticulum and SUI were repairs in the same surgery using a hybrid transobturator. The technique used for obtaining the fascia lata followed the literature, and a 6 cm segment was acquired. The patients were re-prepared in a lithotomy fashion, and diverticulectomy was performed. The segment of fascia lata was fixed to the mesh and sling was manipulated so that its middle part (fascia) rested directly below the urethra. After 6 months post-operatively, patients referred significant improvement in urinary symptoms. Patients have not had any storage symptoms, International Consultation on Incontinence Questionnaire - Short Form = zero, no SUI, and have not had any mesh-related complications. In conclusion, the present study evaluated a new technique for the treatment of CUD with SUI in a particular clinical scenario. Other studies with extended follow-up periods and larger sample sizes should be performed in this subset of patients.

This study delivers the importance-performance analysis of the information and communication technology (ICT) driven solutions among small and family-owned hotels (SFH) in Croatia. The analysis reflects the opinions of owners of 21 SFH, all of which are members of the National Association of Family and Small Hotels (OMH). The findings demonstrated the existence of a significant gap between the perception of the importance of specific innovations and actual hotel performances. In most cases, hotel performances are rated significantly lower than the perceived importance of particular innovation, which indicate that resources should be better and more wisely allocated. In some cases, hotels do not recognise the benefits of ICTs used or are not satisfied with the results. The primary constraint for higher integration of the ICTs within this sample is the lack of financial resources. The study reveals the importance-performance gaps within the perception of technological innovations in the SFHs, elaborates on potential constraints for more substantial reliance on ICTs and discusses the possible implications. Finally, the study provides recommendations for future research.

The appropriation of technologies in education must consider the specificities of each knowledge field and propose the demand for its pedagogical use. In distance learning (DL), which relies on the use of technologies, the reflection on the use of this resource becomes fundamental. Processes, methodologies and materials are usually standardised due to time and production costs. It is necessary to identify an intermediate point in this standardisation that takes into account the specificities of the knowledge fields. This study aims to discuss the pedagogical practices in DL considered appropriate to the knowledge fields, in the appropriate combination of contents, technologies and pedagogical practices. The methodology adopted is qualitative, using survey as a data collection tool. In conclusion, this article indicates that there are, actually, more effective teaching practices for each knowledge field. There are still recommendations in order to study deeply the real learning in each teaching practice. Keywords: Higher education, distance learning, pedagogical practices, education technology, TPACK.

Aims: The purpose of this study was to perform a systematic review of the literature on the different fixation methods available for sagittal ramus split osteotomy associated with mandibular advancement tested in vitro to evaluate stability of each method. Study Design: Systematic review. Methodology: Following the PRISMA model for systematic reviews, a query was made in the PubMed, Bireme and Cochrane Library databases, identifying articles that reported the different fixation methods for sagittal ramus split osteotomy for mandibular advancement. Results: A total of 352 articles were identified, 11 papers of which, after evaluation in relation to the inclusion and exclusion criteria, were systematically reviewed. Conclusion: Sagittal ramus split osteotomy is a technique performed for the treatment of mandibular discrepancies in which the methods for fixation of the segments are quite varied. In view of the biomechanical studies, the hybrid technique is the most indicated method, while miniplates with monocortical screws present less stability.

Overfitting and long training time are two fundamental challenges in multilayered neural network learning and deep learning in particular. Dropout and batch normalization are two well-recognized approaches to tackle these challenges. While both approaches share overlapping design principles, numerous research results have shown that they have unique strengths to improve deep learning. Many tools simplify these two approaches as a simple function call, allowing flexible stacking to form deep learning architectures. Although their usage guidelines are available, unfortunately no well-defined set of rules or comprehensive studies to investigate them concerning data input, network configurations, learning efficiency, and accuracy. It is not clear when users should consider using dropout and/or batch normalization, and how they should be combined (or used alternatively) to achieve optimized deep learning outcomes. In this paper we conduct an empirical study to investigate the effect of dropout and batch normalization on training deep learning models. We use multilayered dense neural networks and convolutional neural networks (CNN) as the deep learning models, and mix dropout and batch normalization to design different architectures and subsequently observe their performance in terms of training and test CPU time, number of parameters in the model (as a proxy for model size), and classification accuracy. The interplay between network structures, dropout, and batch normalization, allow us to conclude when and how dropout and batch normalization should be considered in deep learning. The empirical study quantified the increase in training time when dropout and batch normalization are used, as well as the increase in prediction time (important for constrained environments, such as smartphones and low-powered IoT devices). It showed that a non-adaptive optimizer (e.g. SGD) can outperform adaptive optimizers, but only at the cost of a significant amount of training times to perform hyperparameter tuning, while an adaptive optimizer (e.g. RMSProp) performs well without much tuning. Finally, it showed that dropout and batch normalization should be used in CNNs only with caution and experimentation (when in doubt and short on time to experiment, use only batch normalization).

Resumo Objetivou analisar o conhecimento e a atitude das gestantes de alto risco sobre a zika. Trata-se de um estudo transversal, quantitativo, com amostra de 201 gestantes de alto risco, que realizam pré-natal no Ambulatório Médico de Especialidades. Aplicou-se um instrumento auto administrado, aplicados após a consulta com o médico. Os critérios de inclusão utilizados foram a presença das gestantes no dia da entrevista e seu consentimento de participação. Os de exclusão as que não aceitaram participar e não estarem realizando o pré natal no período do estudo. Para análise de dados, utilizou-se qui-quadrado e exato de Fisher, nos softwares Epi info 7.1 e Bioestat 5.0. Das gestantes, 76% acreditavam que, em seu bairro, é provável a infecção pelo vírus e utilizam medidas para controlar a proliferação do mosquito, como não deixar água parada (n = 154). Em relação ao conhecimento, houve associação entre a zika e a microcefalia (p ≤ 0,0001) e o apontamento da necessidade de mais informações (p = 0,0439). Para impedir o contágio, 76% não tomaram nenhuma atitude; houve, ainda, associação entre a necessidade de conhecimento sobre o assunto e as ações realizadas no combate ao vírus (p = 0,0049). Conclui-se que o conhecimento e a atitude das gestantes sobre a zika é falho. Abstract Objective was to analyze the knowledge and attitude of high risk pregnant women about zika. This is a cross-sectional study, quantitative, with a sample of 201 high risk women who perform prenatal the Ambulatory Medical Specialties. A self-administered instrument, was applied after consultation with the doctor. Inclusion criteria were the presence of pregnant women on the day of the interview and their consent to participate. Exclusion criteria were those who did not agree to participate and were not performing prenatal care during the study period. For the data analysis we used chi square and fisher exact, in software Epi info 7.1 and Bioestat 5.0. Of the pregnant women, 76% believed that their neighborhood was likely to be infected by the virus and used measures to control mosquito proliferation, such as not leaving standing water (n = 154). In relation to knowledge, there was an association between Zika and microcephaly (p≤ 0.0001) and the need for more information (p = 0.0439). To prevent infection, 76% took no action, there was an association between the need for knowledge about the subject and the actions taken to combat the virus (p = 0.0049). We conclude that pregnant women’s knowledge and attitude about zika is failed.

Objetivo: Relatar caso de doença de von Willebrand (DVW) do tipo 3 com níveis de antígeno de Von Willebrand (FVW:Ag) falsamente elevados pela presença de fator reumatoide (FR). Metodologia: Dados obtidos por meio de entrevista clínica em consulta ambulatorial no Hemocentro de São José do Rio Preto e revisão de prontuário eletrônico, após autorização prévia do paciente. Relato de caso: Homem, 63 anos, hipertenso, portador de hepatite C tratada (RNA-HCV não detectável) e de artrite reumatóide (AR), encaminhado ao nosso serviço para acompanhamento de doença de von Willebrand do tipo 3. O paciente realizava seguimento em outro serviço, sendo admitido no Hemocentro de São José do Rio Preto em 2020. No documento de encaminhamento, os testes FVW:Ag e atividade do cofator de ristocetina (FVW:Rco) encontravam-se em níveis indetectáveis e a dosagem do FVIII reduzida, corroborando com a classificação de DVW tipo 3. Na sua admissão, foi solicitada nova coleta de exames, na qual a dosagem FVW:Ag realizada por método de imunoturbidimetria foi de 158% (referência 50-160%), ao passo que os testes FVW:Rco e FVIII:C mantiveram o mesmo padrão encontrado no momento do diagnóstico. Realizados exames laboratoriais complementares, tal como a dosagem de FR, por ensaio imunoturbidimétrico, cujo resultado foi de 378 UI/mL (referência 0-14 UI/mL). Paciente relatou que não estava realizando acompanhamento reumatológico de AR. Considerada, dessa forma, a detecção e a dosagem elevada do FVW:Ag como secundária a presença do fator reumatoide. Discussão: O tipo 3 é uma apresentação rara da DVW que representa menos de 5% dos casos dessa patologia. O referido tipo tem padrão autossômico recessivo e apresenta como manifestações clínicas sangramentos que envolvem tecido subcutâneo e articulações, tal como ocorre nas hemofilias. Laboratorialmente é caracterizado por níveis indetectáveis de FVW:Ag e níveis muito baixos de FVIII, bem como pela ausência de aglutinação no teste FVW:Rco. Um dos métodos de detecção de FVW:Ag é a imunoturbidimetria. Nesse método, microesferas de látex revestidas por uma ligação covalente com anticorpos específicos do FVW são misturadas ao plasma pobre em plaquetas, cujo nível FVW se quer avaliar, de modo a gerar uma reação antígeno-anticorpo e a aglutinação das microesferas. Esse fenômeno propicia o aumento da turbidez da solução que é mensurado por fotometria e reflete a quantidade de FVW presente no plasma. A imunoturbidimetria consiste em um ensaio de análise rápido e é utilizado também no diagnóstico da AR, visto a possibilidade da detecção do FR por esse método. Nesse contexto, pacientes com AR podem, pela presença do FR, apresentar aglutinação das micropartículas de látex e aumento da turbidez da mistura no ensaio predito, superestimando, assim, a dosagem de FVW:Ag. Conclusão: A presença de elevados níveis de FR pode colaborar para uma falsa avaliação quantitativa do FVW:Ag pelo ensaio imunoturbidimétrico. Assim, quando há desproporção entre função e antígeno de FVW, é importante descartar esta interferência do FR, tornando o diagnóstico e classificação da DVW mais precisos.

Objetivo Relatar um caso de anemia hemolitica autoimune secundaria a hepatite C do Hospital de Base de Sao Jose do Rio Preto. Metodologia Os dados foram obtidos de forma sistematica por meio de entrevista e revisao do prontuario. Relato de caso Paciente feminino, 57 anos, com historico previo de drogadicao, encaminhada ao servico do Hospital de Base devido oclusao aortoiliaca para avaliacao e abordagem da cirurgia vascular. Solicitado reserva transfusional para ato cirurgico, e ao ser realizado testes pre transfusionais evidenciado: Pesquisa de anticorpos irregulares positiva, teste de Coombs positivo com presenca de anticorpos da classe IgG, IgM e da fracao C3d. Solicitado entao, avaliacao da hematologia que realizou os seguintes exames de triagem: Hb: 11,16 g/dL Ht: 30,2% RDW: 18,8 VCM: 103 fL HCM: 38 pg Leucocitos: 11.750/mm3 Plaquetas: 161.000/mm3, reticulocito corrigido: 4,7%, Bilirrubina total: 0,36 mg/dL (indireta: 0,19 mg/dL), haptoglobina: 1 mg/dL, provas reumatologicas negativas, sorologia positiva para anti HVC com deteccao de carga viral de 287.000 UI/mL. Discussao Anemias hemoliticas autoimunes sao caracterizadas por producao de anticorpos contra os proprios eritrocitos. Elas sao classificadas a depender da temperatura em que os anticorpos se ligam aos eritrocitos. Na anemia hemolitica ao frio a temperatura otima de reacao ocorre entre 0-4°C e ela corresponde por cerca de 25% dos casos. Ja na anemia hemolitica a quente a temperatura otima de reacao ocorre aos 37°C. Na anemia hemolitica mista o plasma possuira anticorpos quentes (IgG) e frios (IgM). As anemias hemoliticas podem ser primarias (idiopatica) ou secundarias a diversas causas como: uso de farmacos, neoplasia, disturbios linfoproliferativos, reumatologicos ou infecciosos. O quadro clinico decorre principalmente dos sintomas relacionados a anemia. As anemia hemolitica autoimune quente e as mista possuem boa resposta a corticoterapia diferentemente dos casos de anemia hemolitica a frio. Nos casos secundarios o tratamento principal deve ser direcionado a doenca subjacente. Conclusao Ao nos depararmos com quadro sugestivos de anemia hemolitica autoimune sempre devemos atentar para investigacao de causas secundarias. No caso descrito acima foi possivel identificar associacao com o virus C e com isso um tratamento direcionado ao fator subjacente podera levar ao controle e ate a resolucao do quadro de hemolise.

Objetivo: Relatar um caso de Linfoma/ Leucemia de Células T do Adulto (ATLL) do Hospital de Base de São José do Rio Preto (HB-SJRP). Metodologia: Os dados foram obtidos por revisão do prontuário, após autorização prévia do paciente. Relato de caso: Paciente do sexo feminino, 41 anos, sem comorbidades prévia, iniciou um quadro de dores ósseas acompanhado de perda de peso. Nos exames demonstrava hipercalcemia, lesões ósseas e linfocitose em sangue periférico (23 mil linfócitos). Realizada lâmina de sangue periférico com presença de linfócitos em formato de flores (Flower Cells). Solicitado sorologias que veio com HTLV I e II reagente. Prosseguimos investigação com Citometria de Fluxo (CF) de sangue periférico que demonstrou a presença de 84,2% de células de linhagem T maduras e anômalas, que expressam os antígenos CD3 de membrana, CD4, TCR alfa/beta, CD5, CD2 e CD25, em associação com ausência de CD7 e CD26. Solicitado tomografia computadorizada por emissão de pósitrons (PET-CT), com o seguinte resultado: hipermetabolismo em lesões ósseas (maior SUV em mandíbula à direita: 6,6) e baço. Com tais achados fizemos a hipótese diagnóstica de Linfoma/Leucemia de Células T do adulto - Fase Aguda. Proposto tratamento quimioterápico com DaEPOCH (Dose Ajustada de Etoposídeo, Prednisolona, Vincristina, Ciclofosfamida e Doxorrubicina). Após 1 ciclo paciente apresentou progressão clínica com hipercalcemia e aumento de linfocitose. Optado por trocar esquema terapêutico para DHAP (Dexametasona, Citarabina e Cisplatina), sendo realizado 2 ciclos. Como paciente mantinha episódios de hipercalcemia e piora da linfocitose foi optado por realizar nova CF que demonstrava presença de 8,6% de linfócitos T maduros e anômalos e novo PET-CT onde mantinha hipercaptação em lesões ósseas e baço, sem alterações significativas em relação ao exame anterior. Dessa forma, optado por iniciar nova quimioterapia de salvamento com GEMOX (Gemcitabina e Oxaliplatina), feito 1 ciclo. Logo após evoluiu com hipercalcemia sintomática com necessidade de hemodiálise para controle. Diante deste cenário, paciente com franca progressão clínica e laboratorial, com queda de status performance, refratária a múltiplas linhas de quimioterapia foi optado em conjunto com familiares por cuidados paliativos. Discussão: A ATLL é uma neoplasia linfoproliferativa rara de células T maduras CD4 e CD25 positivas causada pela infecção do HTLV tipo I. Apresenta maior incidência no Japão, Caribe, América Central, África Intertropical e Romênia. Esta patologia apresenta subtipos clínicos: forma aguda, crônica, linfomatosa e smoldering. As formas aguda e linfomatosa apresentam um dos piores prognósticos de todos os Linfomas Não Hodgkin. Por ser uma doença rara e de apresentação heterogênea há controvérsias sobre o esquema quimioterápico e a necessidade de uso de antivirais. Além disso, há um resposta frustra as linhas de tratamentos sugeridas. Conclusão: A ATLL é uma patologia rara associada a infecção pelo vírus HTLV-I. A importância do seu reconhecimento estão relacionados a sua agressividade e aos desafios terapêuticos.

Objetivo Relatar um caso de Leucemia Linfocitica Cronica (LLC) familiar em acompanhamento com a equipe de Hematologia do Hospital de Base de Sao Jose do Rio Preto (HB de SJRP). Metodologia: Dados obtidos de forma sistematica por entrevista e revisao de prontuario. Relato de caso Feminino, 79 anos, primeira consulta com Hematologia do HB de SJRP em janeiro de 2018 devido a adinamia e inapetencia; hemograma de dezembro de 2017: Hb 11 g/dL/ Ht 34,5 % / Leucocitos 21100 mm3/ Linfocitos 17302 mm3/ Plaquetas 317000 mm3; solicitados exames gerais de investigacao de linfocitose - sem alteracoes dignas de nota. Retorna em maio de 2018 com Hb: 11,7 g/dl / Ht: 36,4 % / Leucocitos: 31500 mm3/Linfocitos 26775 mm3/ Plaquetas 238000/mm3. Solicitado - em julho de 2018 - a Imunofenotipagem de sangue periferico, com presenca de 74,5% de celulas de linhagem B maduras, clonais, que coexpressam os antigenos CD19, CD5 e CD23, em associacao aos antigenos CD20 e imunoglobulina de cadeia leve kappa, ambos de baixa intensidade, e negatividade para o antigeno CD79b, compativel com diagnostico de LLC. A paciente citada possui filha, 60 anos, a qual passou por consulta com a Hematologia do HB de SJRP em junho de 2021, devido a alteracao do hemograma; negava; apresentava hemograma: Hb 12 g/dL / Ht 35,8% / Leucocitos 41900 mm3/ Linfocitos 33600 mm3/ Plaquetas 197000 mm3 e exames gerais sem alteracoes relevantes. Foi solicitada Imunofenotipagem de sangue periferico com presenca de 72% de celulas de linhagem B maduras, clonais, que coexpressam os antigenos CD19 e CD5, em associacao aos antigenos CD23, CD200, CD20 de baixa intensidade e imunoglobulina de cadeia leve kappa de baixa intensidade, e negatividade para o antigeno CD79b, compativel com LLC. Discussao A LLC e uma neoplasia composta por pequenas celulas B maduras, que coexpressam CD5 e CD23, associados a uma contagem de linfocitos B monoclonais > 5.109/L em sangue periferico. Sua incidencia anual e de 5 casos para cada 100.000/ano; a media de idade e de aproximadamente 70 anos, podendo estar presentes em adultos jovens, tendo predominância masculina. E a leucemia mais comum nos paises ocidentais e rara nos paises asiaticos; estes achados juntos com relatos de casos familiares indicam uma base genetica que predispoe a esta doenca. Uma vez que a LLC e incomum, quando pelo menos dois membros da familia possuem LLC, esta e considerada LLC familiar. Os estudos nao mostram diferenca de idade ao diagnostico entre LLC familiar e esporadica; foi encontrado maior proporcao de mulheres com LLC familiar. Nao ha relacao com pior prognostico em pacientes com LLC familiar em comparacao a LLC esporadica, porem, aquela parece estar associada a formas mais indolentes da doenca. Conclusao Ha agregacao familiar importante na LLC, com evidencias apontando maior importância da heranca genica que os ambientes compartilhados para desenvolvimento da doenca. No entanto, a falha em identificar uma mutacao especifica com grande efeito sugere que variantes geneticas comuns com menores efeitos, ou multiplos genes raros, com grandes efeitos, sao responsaveis pelo risco familiar. Avancos nos metodos genomicos de grande escala possibilitarao o reconhecimento desses genes, que causam susceptibilidade para LLC e outras doencas linfoproliferativas, o que promovera maior conhecimento das vias etiologicas que levam a LLC familiar e esporadica, possibilitando melhor abordagem diagnostica e terapeutica desta entidade.

Objective To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. Design Prospective cohort study using a registry. Setting Nineteen French surgical centres. Population A total of 2309 women participated between 2017 and 2019. Methods A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures Serious complications and subsequent reoperations for POP recurrence. Results The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. Conclusions Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. Tweetable abstract Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.

Made available in DSpace on 2022-05-01T10:18:59Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-12-15 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Aims: To investigate the effect of resistance training-RT on glycemia, expression of the glucose transporter-GLUT4, bone mineral density-BMD, and microstructural and biomechanical properties of osteopenic rat bones in neonatal streptozotocin-induced diabetes. Main methods: Sixty-four 5-day-old male rats were divided into two groups: control and diabetic rats injected with vehicle or streptozotocin, respectively. After 55 days, densitometric analysis-DA of the tibia was performed. These groups were subdivided into four subgroups: non-osteopenic control-CN, osteopenic control-OC, non-osteopenic diabetic-DM, and osteopenic diabetic-OD. The OC and OD groups were suspended by their tails for 21 days to promote osteopenia in the hindlimb; subsequently, a second DA was performed. The rats were subdivided into eight subgroups: sedentary control-SC, sedentary osteopenic control-SOC, exercised control-EC, exercised osteopenic control-EOC, sedentary diabetic-SD, sedentary osteopenic diabetic-SOD, exercised diabetic-ED, and exercised osteopenic diabetic-EOD. For RT, the rats climbed a ladder with weights secured to their tails for 12 weeks. After RT, a third DA was performed, and blood samples, muscles, and tibias were assessed to measure glycemia, insulinemia, GLUT4 content, bone maximum strength, fracture energy, extrinsic stiffness, BMD, cancellous bone area, trabecular number, and trabecular width. Key findings: After RT, glycemia, GLUT4 content, BMD, and bone microstructural and biomechanical properties were improved in diabetic rats (osteopenic and non-osteopenic). However, RT had no effect on these parameters in the EC and SC groups. Significance: These results suggest that RT improves GLUT4 content, BMD, and microstructural and biomechanical properties of bone in osteopenic and non-osteopenic diabetic rats and is effective in controlling glycemia. Programa de Pós-graduação Multicêntrico em Ciências Fisiológicas PPGMCF SBFis São Paulo State University (UNESP) School of Dentistry Department of Preventive and Restorative Dentistry São Paulo State University (UNESP) School of Dentistry Department of Physiology and Biophysics São Paulo Institute of Biomedical Sciences USP Programa de Pós-graduação Multicêntrico em Ciências Fisiológicas PPGMCF SBFis São Paulo State University (UNESP) School of Dentistry Department of Preventive and Restorative Dentistry São Paulo State University (UNESP) School of Dentistry FAPESP: 2010/14755-5

NOTCH1/FBXW7 (N/F) mutational status at diagnosis is employed for T-cell lymphoblastic lymphoma (T-LBL) patients’ stratification in the international protocol LBL 2018. Our aim was to validate the prognostic role of Minimal Disseminated Disease (MDD) alone and in combination with N/F mutational status in a large retrospective series of LBL pediatric patients. MDD was analyzed in 132 bone marrow and/or peripheral blood samples by flow cytometry. Mutations in N/F genes were analyzed on 58 T-LBL tumor biopsies. Using the previously established cut-off of 3%, the four-year progression-free survival (PFS) was 57% for stage I–III patients with MDD ≥ 3% versus 80% for patients with MDD inferior to cut-off (p = 0.068). We found a significant worsening in the four-year PFS for nonmutated (51 ± 12%) compared to mutated patients (100%, p = 0.0013). Combining MDD and N/F mutational status in a subgroup of available cases, we found a statistically significant difference in the four-year PFS for different risk groups (p = 0.0012). Overall, our results demonstrate that N/F mutational status has a more relevant prognostic value than MDD at diagnosis. However, the combination of N/F mutations with MDD analysis could identify patients with very aggressive disease, which might benefit from a more intensive treatment.

We present a novel mobile robot manipulator named BALTO, which can precisely and autonomously disinfect critical items of buildings, yet be easily deployed in different environments by non-expert operators. Conventional approaches based on greedy disinfection actions can be dangerous for surrounding humans, or provide non-controlled coverage of critical items such as door-handles, push-bars or switches. Other robotic solutions providing precision disinfection can require time-consuming geometric and semantic mapping of the environment, placement of non-natural landmarks, or the presence of an operator on-site for programming to adapt to the use case. Our approach is different: we integrate preliminary knowledge of the building within the robot control system itself, using Building Information Modelling (BIM) data readily available from modern construction processes. BIM models completely describe a building and its components with the corresponding geometric and semantic data. We use these data to provide the robot with the components to disinfect and their location, as well as the description of the environment in which it operates, without requiring any prior mapping procedure. Precise disinfection actions are enabled by an automatic calibration procedure based on a learned 3D model of the target. We finally present results of experiments performed in operational environment that verify the effectiveness of our proposed solution.

Acute decompensated heart failure (ADHF) is the leading cause of hospitalization in patients aged 65 years or older, and most of them present with congestion. The use of hydrochlorothiazide (HCTZ) may increase the response to loop diuretics. To evaluate the effect of adding HCTZ to furosemide on congestion and symptoms in patients with ADHF. This randomized clinical trial compared HCTZ 50 mg versus placebo for 3 days in patients with ADHF and signs of congestion. The primary outcome of the study was daily weight reduction. Secondary outcomes were change in creatinine, need for vasoactive drugs, change in natriuretic peptides, congestion score, dyspnea, thirst, and length of stay. Fifty-one patients were randomized-26 to the HCTZ group and 25 to the placebo group. There was an increment of 0.73 kg/day towards additional weight reduction in the HCTZ group (HCTZ: - 1.78 ± 1.08 kg/day vs placebo: - 1.05 ± 1.51 kg/day; p = 0.062). In post hoc analysis, the HCTZ group demonstrated significant weight reduction for every 40 mg of intravenous furosemide (HCTZ: - 0.74 ± 0.47 kg/40 mg vs placebo: - 0.33 ± 0.80 kg/40 mg; p = 0.032). There was a trend to increase in creatinine in the HCTZ group (HCTZ: 0.50 ± 0.37 vs placebo: 0.27 ± 0.40; p = 0.05) but no significant difference in onset of acute renal failure (HCTZ: 58% vs placebo: 41%; p = 0.38). No differences were found in the remaining outcomes. Adding hydrochlorothiazide to usual treatment of patients with acute decompensated heart failure did not cause significant difference in daily body weight reduction compared to placebo. In analysis adjusted to the dose of intravenous furosemide, adding HCTZ 50 mg to furosemide resulted in a significant synergistic effect on weight loss.Trial registration: The Brazilian Clinical Trials Registry (ReBEC), a publically accessible primary register that participates in the World Health Organization International Clinical Trial Registry Platform; number RBR-5qkn8h. Registered in 23/07/2019 (retrospectively), http://www.ensaiosclinicos.gov.br/rg/RBR-5qkn8h/ .

Background Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a common enzyme deficiency, prevalent in many malaria-endemic countries. G6PD-deficient individuals are susceptible to hemolysis during oxidative stress, which can occur from exposure to certain medications, including 8-aminoquinolines used to treat Plasmodium vivax malaria. Accordingly, access to point-of-care (POC) G6PD testing in Brazil is critical for safe treatment of P. vivax malaria. Methodology/Principal findings This study evaluated the performance of the semi-quantitative, POC STANDARD G6PD Test (SD Biosensor, Republic of Korea). Participants were recruited at clinics and through an enriched sample in Manaus and Porto Velho, Brazil. G6PD and hemoglobin measurements were obtained from capillary samples at the POC using the STANDARD and HemoCue 201+ (HemoCue AB, Sweden) tests. A thick blood slide was prepared for malaria microscopy. At the laboratories, the STANDARD and HemoCue tests were repeated on venous samples and a quantitative spectrophotometric G6PD reference assay was performed (Pointe Scientific, Canton, MI). G6PD was also assessed by fluorescent spot test. In Manaus, a complete blood count was performed. Samples were analyzed from 1,736 participants. In comparison to spectrophotometry, the STANDARD G6PD Test performed equivalently in determining G6PD status in venous and capillary specimens under varied operating temperatures. Using the manufacturer-recommended reference value thresholds, the test’s sensitivity at the, Author summary G6PD deficiency affects an estimated 500 million people worldwide and is prevalent in many malaria-endemic settings. People with G6PD deficiency are at risk of hemolysis when exposed to certain medications, including 8-aminoquinoline drugs used to treat Plasmodium vivax malaria. Increased access to testing for G6PD deficiency at or near the point of care is critical for expanding the safe treatment of P. vivax malaria. In this study, we aimed to evaluate the performance of a point-of-care, semi-quantitative test for G6PD deficiency, the STANDARD G6PD Test, in a malaria-endemic setting in Brazil. The test was evaluated on both capillary and venous blood samples across a broad range of operating temperatures. The findings show that the STANDARD G6PD Test performed equivalently to the reference test in its ability to diagnose G6PD deficiency at the point of care. The STANDARD G6PD Test is a promising tool to aid in detecting G6PD deficiency at the point of care in Brazil.

Background Point-of-care glucose-6-phosphate dehydrogenase (G6PD) testing has the potential to make the use of radical treatment for vivax malaria safer and more effective. Widespread use of G6PD tests as part of malaria case management has been limited, in part due to due concerns regarding product usability, user training, and supervision. This study seeks to assess how well end users can understand the Standard™ G6PD Test (SD Biosensor, Suwon, South Korea) workflow, result output, and label after training. This will ultimately help inform test registration and introduction. Methods Potential G6PD test users who provide malaria case management at three sites in Brazil, Ethiopia, and India were trained on the use of the SD Biosensor Standard G6PD Test and assessed based on their ability to understand the test workflow and interpret results. The assessment was done through a questionnaire, designed to assess product usability against key technical product specifications and fulfill regulatory evidence requirements. Any participant who obtained 85% or above correct responses to the questionnaire was considered to adequately comprehend how to use and interpret the test. Results Forty-five participants, including malaria microscopists, laboratory staff, nurses, and community health workers took part in the study. Seventy-eight percent of all participants in the study (35/45) obtained passing scores on the assessment with minimal training. Responses to the multiple-choice questions indicate that most participants understood well the test intended use, safety claims, and warnings. The greatest source of error regarding the test was around the correct operating temperature. Most test results were also read and interpreted correctly, with the haemoglobin measurement being a more problematic output to interpret than the G6PD measurement. Conclusions These data results show how a standardized tool can be used to assess a user’s ability to run a point-of-care diagnostic and interpret results. When applied to the SD Biosensor Standard G6PD Test, this tool demonstrates that a range of users across multiple contexts can use the test and suggests improvements to the test instructions and training that can improve product usability, increase user comprehension, and ultimately contribute to more widespread effective use of point-of-care G6PD tests. Trial registration: NCT04033640

Introducción: entre las maloclusiones, la mordida cruzada es la de mayor prevalencia entre los niños en edad preescolar y se considera la principal depreciadora del sistema estomatognático, con un alto riesgo de desarrollar secuelas musculoesqueléticas irreparables en la edad adulta. Por lo tanto, es fundamental elegir un tratamiento eficaz que no requiera la cooperación directa del paciente y que utilice técnicas simples de ortodoncia. El objetivo de este artículo es informar la eficacia del tratamiento de rehabilitación neuroclusal (RNO) con la técnica de las pistas directas de Planas en la corrección temprana de la mordida cruzada posterior y el seguimiento de su estabilidad oclusal durante siete años. Presentación del caso: niña de 4 años de edad, que usó biberón, diagnosticada con mordida cruzada posterior funcional unilateral izquierda y desviación de la línea media. Para el tratamiento de la rno, se realizaron los ajustes oclusales en los dientes 63, 64 y 65, y después de la desprogramación neuromuscular, se confeccionaron las pistas directas de Planas en los dientes cruzados. Después de 29 días, se corrigió la mordida y se hicieron ajustes oclusales para proporcionar una mayor armonía oclusal. Hubo monitoreamiento cada seis meses durante siete años para verificar el equilibrio y la estabilidad del tratamiento. Conclusiones: a RNO con el uso de pista directa de Planas fue eficaz para corregir la mordida cruzada posterior con una técnica simple y de bajo costo que puede ejecutar el clínico general. Introduction: Among malocclusions, that of cross-bite is the most prevalent among preschool children and is considered to be the main depreciator of the stomatognathic system and is further linked to a high risk of developing irreversible musculoskeletal sequelae in adulthood. Thus, it is important to choose an effective treatment early on that does not require the direct cooperation of the patient and that utilizes simple orthodontic techniques in its execution. The objective of this study was to report the efficacy of the Neuroclusal Rehabilitation (RNO) treatment, with the Planas Direct Tracks technique in a case of early treatment of posterior crossbite, and the follow up of its occlusal stability for seven years. Case presentation: a 4-year-old female patient, who was bottle-fed, was diagnosed with a left unilateral functional posterior crossbite and midline deviation. For the treatment of RNO, occlusal adjustments were made on the teeth 63, 64 and 65 and after neuromuscular deprogramming, the Direct Planks were made in the crossed teeth. After 29 days, the bite was corrected, and occlusal adjustments were made in order to provide greater occlusal harmony. Monitoring and evaluation took place every six months for seven years in order to verify the balance and stability of the treatment. Conclusion: the RNO treatment with the use of Planas Direct Tracks is an effective solution for the correction of posterior crossbite using a simple, low-cost technique that can be performed by general practitioners. Introdução: entre as más oclusões, a mordida cruzada é a de maior prevalência entre as crianças em idade pré-escolar, e se considera a principal depreciadora do sistema estomatognático, com um alto risco de desenvolver sequelas musculoesqueléticas irreparáveis na idade adulta. Portanto, é fundamental escolher um tratamento eficaz que não requeira a cooperação direta do paciente e que utilize técnicas simples de ortodontia em sua execução. O objetivo deste estudo foi informar a eficácia do tratamento de Reabilitação Neuroclusal (RNO), com a técnica das Pistas Diretas de Planas na correção precoce da mordida cruzada posterior e o seguimento de sua estabilidade oclusal durante 7 anos. Apresentação do caso: paciente de sexo feminino de 4 anos de idade, que usou mamadeira, diagnosticada com mordida cruzada posterior funcional unilateral esquerda e desvio da linha média. Para o tratamento da rno, se realizaram os ajustes oclusais nos dentes 63, 64 e 65, depois da desprogramação neuromuscular, se confeccionaram as Pistas Diretas de Planas nos dentes cruzados. Depois de 29 dias, se corrigiu a mordida e se fizeram ajustes oclusais para proporcionar uma maior harmonia oclusal. O monitoramento se rea- lizou cada seis meses por 7 anos para verificar o equilíbrio e a estabilidade do tratamento. Conclusões: a rno com o uso de Pista Direta Planas foi eficaz para a correção da mordida cruzada posterior com uma técnica simples, de baixo custo que pode ser realizada pelo clínico geral