ABSTRACT Introduction: Brazil faced a catastrophic situation in the coronavirus pandemic. Due to the high risk of contamination and spread of COVID-19, dentist have been attending only urgency and emergency services in Brazil at the beginning of the pandemic. Objective: This research aimed to evaluate the psychological and financial impacts caused by the coronavirus pandemic in Brazilian orthodontists. Methods: This population-based cross-sectional study collected demographic data and mental health measurements from 404 orthodontists. Depression, anxiety, insomnia, and distress were evaluated through Brazilian versions of the 9-item Patient Health Questionnaire (9-PHQ), the 7-item Generalized Anxiety Disorder scale and Mini-Tracking (GAD), the 7-item Insomnia Severity Index (ISI), and the 22-item Impact of Event Scale-Revised (IES-R), respectively. The demographic data of the sample was described using descriptive statistics. The data was analyzed according to sex, professional status, and economic income. Comparisons were performed using Chi-square tests, Mann-Whitney U tests, and Kruskal-Wallis followed by post-hoc tests. Results: Females, graduate students, and lower incomes subgroups showed higher levels of depression, anxiety, insomnia, and distress. Most orthodontists showed moderate to extreme financial and professional concerns during the pandemic. Conclusion: The coronavirus pandemic negatively affected the psychological health and increased the financial concerns of the Brazilian orthodontists, mainly female, graduate students, and with income below 10k participants.

RESUMO Introdução: O Brasil enfrentou uma situação catastrófica durante a pandemia do coronavírus. Devido ao alto risco de contaminação e disseminação do vírus da COVID-19, os cirurgiões-dentistas passaram a realizar apenas atendimentos de urgência ou emergência no início da pandemia. Objetivo: O presente estudo teve como objetivo avaliar o impacto financeiro e psicológico causado pela pandemia do coronavírus nos ortodontistas brasileiros. Métodos: Este estudo transversal de base populacional coletou os dados demográficos e o impacto da pandemia em 404 ortodontistas. Depressão, ansiedade, insônia e angústia foram avaliadas, respectivamente, por meio da versão em português do Questionário de Saúde do Paciente (PHQ-9), do módulo de transtorno de ansiedade generalizada (GAD) do Mini-Tracking (GAD/Mini-Tracking), do Índice de Severidade de Insônia (ISI) e o do Impact of Events Scale-Revised (IES-R). As características demográficas da amostra foram apresentadas por meio de estatística descritiva. Os dados foram analisados de acordo com o sexo, situação profissional e renda econômica. As comparações foram realizadas utilizando os testes de Qui-quadrado, Mann-Whitney U e Kruskal-Wallis, seguidos de testes post-hoc (p<0,05). Resultados: Mulheres, estudantes de pós-graduação e profissionais com menores rendas apresentaram níveis mais altos de depressão, ansiedade, insônia e angústia. A maioria dos ortodontistas mostrou preocupação financeira e profissional moderada a extrema durante a pandemia. Conclusão: A pandemia do coronavírus afetou negativamente a saúde psicológica dos ortodontistas brasileiros e aumentou as preocupações financeiras desses profissionais. As mulheres, os estudantes de pós-graduação e os participantes com renda mensal menor que R$10 mil foram os grupos mais afetados.

RESUMO Introdução: A probabilidade de melhoria do espaço aéreo superior (EAS) com cirurgia ortognática deve ser considerada durante a decisão do tratamento ortodôntico-cirúrgico, proporcionando não somente um benefício estético, mas também funcional, para o paciente. Objetivo: O objetivo do presente estudo foi avaliar as alterações 3D no espaço das vias aéreas superiores após a cirurgia de avanço maxilomandibular (AMM). Métodos: Foi realizada uma análise retrospectiva de 56 pacientes, 21 homens e 35 mulheres, com média de idade de 35,8 ± 10,7 anos, submetidos a AMM. Foram obtidas tomografias computadorizadas de feixe cônico (TCFC) pré- e pós-operatórias para cada paciente, e as alterações no EAS foram comparadas usando o software Dolphin Imaging v. 11.7. Foram medidos dois parâmetros do espaço aéreo faríngeo (EAF): volume das vias aéreas (VVA) e área axial mínima (AAM). Foi utilizado o teste t pareado para comparar os dados entre T0 e T1, com nível de significância de 5%. Resultados: Houve um aumento estatisticamente significativo no EAS. A cirurgia de avanço bimaxilar aumentou o volume das vias aéreas (VVA) e a área axial mínima (AAM) em média 73,6 ± 74,75% e 113,5 ± 123,87%, respectivamente. Conclusão: A cirurgia de AMM tende a causar o aumento significativo do EAS; no entanto, esse aumento é altamente variável.

ABSTRACT Introduction: The probability of improvement in the upper airway space (UAS) with orthognathic surgery should be considered during the surgical-orthodontic treatment decision, providing not only an esthetic, but also a functional benefit for the patient. Objective: The purpose of this study was to evaluate the 3D changes in the upper airway space after maxillomandibular advancement surgery (MMA). Methods: A retrospective analysis of 56 patients, 21 male and 35 female, with a mean age of 35.8 ± 10.7 years, who underwent MMA was performed. Pre- and postoperative cone-beam computed tomography scans (CBCT) were obtained for each patient, and the changes in the UAS were compared using Dolphin Imaging 11.7 software. Two parameters of the pharyngeal airway space (PAS) were measured: airway volume (AV) and minimum axial area (MAA). Paired t-test was used to compare the data between T0 and T1, at 5% significance level. Results: There was a statistically significant increase in the UAS. Bimaxillary advancement surgery increased the AV and the MAA, on average, by 73.6 ± 74.75% and 113.5 ± 123.87%, respectively. Conclusion: MMA surgery tends to cause significant increase in the UAS; however, this increase is largely variable.

Abstract A prospective and descriptive study was carried out in the Oncology Unit of the Hospital General de la Secretaria de Salud in 10 patients diagnosed with soft tissue sarcomas, corroborated by histopathology, who had already undergone one or more surgeries and have been treated several times with radio- and chemotherapy. The patients had tumors larger than 5 cm in diameter and had completed laboratory and imaging exams. The radiotherapy was administered in the modality of hypofractionation, which consists of a smaller number of sessions, with the dose/session being higher than the standard, administered twice a week. The dose was 4,000 cGy in four weeks (eight sessions), using photons of cobalt 60 with the Phoenix® equipment, and depending on the tumor’s location the procedure was done in an individualized way, leaving a lapse of three weeks during which they were clinically assessed in order to plan the overdose of 2,000 cGy in two weeks (ten sessions). Patients were transferred to radiotherapy as soon as possible, in order to receive the first dose of radiation between 60-90 minutes after the procedure was completed. There were no deaths attributable to the procedure.

Resumen En la Unidad de Oncología del Hospital General de la Secretaría de Salud se realizó un estudio de tipo prospectivo y descriptivo en 10 pacientes con diagnóstico de sarcoma de partes blandas corroborado por histopatología, que ya habían sido sometidos a una o más cirugías y multitratados con radioterapia y quimioterapia. Los elegidos tenían tumoraciones de más de 5 cm y exámenes de laboratorio e imagenología completos. La radioterapia se administró en la modalidad de hipofraccionamiento, el cual consiste en un número menor de sesiones, siendo la dosis por sesión mayor a la estándar, administrándose dos veces por semana. La dosis fue de 4,000 cGy en cuatro semanas (ocho sesiones), empleando fotones de cobalto 60 con el equipo Phoenix®, y dependiendo de la localización tumoral la planeación se realizó en forma individualizada, dejando un lapso de tres semanas durante las cuales se llevaron a cabo valoraciones clínicas y planeación de sobredosis de 2,000 cGy en dos semanas (diez sesiones). Los pacientes fueron trasladados a radioterapia a la mayor brevedad posible, con objeto de recibir la primera dosis de radiación entre los 60-90 minutos después de terminado el procedimiento. No hubo fallecimientos atribuibles al procedimiento.

Abstract: Purpose: The authors wish to present an original case of a gunshot wound to the left ventricle with bullet migration, as well as to discuss the necessity of adequate medical treatment of such unique cases. Due to the enhanced caliber and power of modern weapons, gunshot wounds to the chest cavity are occurring with greater frequency and fatality worldwide. The survival of those gunshot victims who do make it to the hospital depends on the efficacy of EMT treatment, and rapid emergency response time via ambulance or helicopter transport. With enhanced training of paramedics and emergency response staff who are able to provide quick and effective treatment to these patients, as well as the rise of technological advancements, the prognosis of these victims has improved.

Resumen: Objetivo: Presentar un caso de herida penetrante del corazón con migración del proyectil y comentar los criterios actuales para el manejo de este tipo de pacientes. Las heridas por proyectil de arma de fuego penetrantes a tórax cada día son más frecuentes en todo el mundo y traen aparejada una mortalidad considerable, ya que el calibre y el poder de las armas también son actualmente más letales. Los heridos que logran llegar vivos al hospital están generalmente supeditados a la atención paramédica-médica precoz en la ambulancia o helicóptero y al tiempo que dure el traslado al hospital. Gracias al personal entrenado para manejar estos problemas en lapsos muy breves y a los adelantos tecnológicos para contribuir a valorar la situación, el pronóstico de estos heridos ha mejorado.

We are presenting a case of a 78-year-old patient with a bronchogenic cyst (BC) which was located between two mediastinum spaces and even though the anomaly, the patient was asymptomatic. The patient presented with persistent retrosternal pain and the thoracic x-ray wrongly interpreted the presence of "cardiomegaly". The computed tomography showed that the BC was pressing the heart forward, which could have been the cause of the original symptoms. Bronchogenic cysts are rare and infrequent congenital aberrations. The respiratory system develops from a ventral diverticulum of the foregut during the seventh week of gestation. The pharynx and esophagus are originated from the caudal region of this structure. The BC will develop from cells that separate from the initial tracheobronchial tree conserving the characteristics of the bronchial respiratory epithelium. Most of the BC are located in the thorax, either in the mediastinum or in the pulmonary parenchyma, but there are also very rare reports of BC in atypical locations. A secondary purpose of this review is to discuss the pathology, embryology and clinical pictures of these rare occurrences. According to their size and location, they will require the expertise of physicians of different specialties. The exact incidence of the BC is not known, since there are asymptomatic cases that eventually are found through autopsies or in patients that were asymptomatic during variable periods of time or had been detected through an incidental thoracic radiography or other imageology studies. In the reviewed literature the oldest case reported was a male that presented symptoms at 72 years of age. In this article the patient is a 78-year-old male that presented symptoms at that age. We can conclude that this patient is the case reported in the literature that remained asymptomatic for the longest period of time. The patient had surgery and the BC was extracted; the patient is in stable condition and asymptomatic.

El objetivo de la presente comunicación es presentar el caso de un paciente de 78 años con quiste broncogénico (QB) que ocupaba dos espacios mediastinales; no obstante el tamaño de la anomalía, no había presentado sintomatología. Inició el cuadro clínico con dolor retroesternal discreto, pero persistente. Se le realizó radiografía de tórax en la cual se interpretó erróneamente la presencia de "cardiomegalia". La tomografía computarizada mostró que el QB oprimía el corazón hacia adelante, lo que seguramente originó el síntoma inicial. Los QB son malformaciones congénitas poco frecuentes. El sistema respiratorio se origina a partir de un brote ventral del intestino primitivo durante la séptima semana de gestación. Los QB se organizan a partir de células que se separan del brote respiratorio inicial conservando las características del epitelio respiratorio. La mayoría de los QB se localizan en el tórax, ya sea en el mediastino o en el parénquima pulmonar, existiendo con mucha menor frecuencia casos en localizaciones atípicas. Otro de los objetivos es llamar la atención acerca de esta patología tan poco frecuente, su embriogénesis y los cuadros clínicos extraordinariamente variados que se originan de acuerdo con su tamaño y localización, de suerte tal que puede involucrar a médicos de muy distintas especialidades. La incidencia de los QB se desconoce, pueden ser asintomáticos durante toda la vida y ser eventualmente hallazgos de autopsia. Otros más permanecen asintomáticos durante períodos variables hasta iniciar el cuadro clínico, o bien, pueden ser descubiertos en forma incidental por estudios de imagenología. Se hizo una revisión de la literatura, principalmente la publicada por instituciones reconocidas a nivel mundial, habiendo encontrado que el caso registrado con mayor edad al iniciar la sintomatología fue de 72 años. El paciente que presentamos en esta comunicación tenía 78 años al empezar a presentar dolor retroesternal, situación que lo constituye como el caso reportado en la literatura mundial que ha permanecido durante más años asintomático. Fue operado; habiendo extraído el tumor, se encuentra bien y asintomático.