Resumo Objetivos: O trabalho tem por objetivo avaliar o conhecimento, práticas e atitudes do pediatra em relação à promoção de saúde oral, cuidados orais, cáries e lesões orais em crianças. Métodos: Tratou-se de um estudo transversal, realizado com pediatras do Estado de Alagoas, Brasil. Os dados foram recolhidos no período entre março e junho de 2019, por meio de um questionário respondido por 134 pediatras. Resultados: Embora 91% da amostra tenha relatado orientar o início da escovagem dentária após a erupção do primeiro dente, apenas 10,4% dos pediatras orientam o uso do dentifrício com base em evidência (contendo pelo menos 1000 ppm de flúor). Em relação à orientação dietética, 71% da amostra admitiu alertar sobre o consumo excessivo de alimentos açucarados, porém apenas 28,4% da amostra reconheceu a sacarose (açúcar da cana) como o carboidrato mais cariogénico da dieta. A maior parte da amostra (59,7%) afirmou reconhecer os primeiros sinais de surgimento de cárie, embora apenas 10% tenham classificado a presença de manchas brancas como um sinal precoce da doença. Conclusões: Os conhecimentos, atitudes e práticas dos pediatras em relação à saúde oral torna-se imprescindível para que estes profissionais possam pautar a sua conduta clínica com base em evidências científicas

Abstract Objectives: The study aimed to evaluate the pediatrician’s knowledge, practices, and attitudes regarding oral health promotion, oral care, caries, and oral lesions in children. Methods: This cross-sectional study was carried out with pediatricians from the State of Alagoas, Brazil. Data were collected between March and June 2019 through a questionnaire answered by 134 pediatricians. Results: Although 91% of the sample reported that they recommended starting toothbrushing after the first tooth eruption, only 10.4% recommended using toothpaste based on evidence (containing at least 1000 ppm of fluoride). Regarding dietary advice, 71% of the sample admitted warning about excessive consumption of sugary foods, but only 28.4% recognized sucrose (cane sugar) as the most cariogenic carbohydrate in the diet. Most of the sample (59.7%) claimed to recognize the first signs of caries, although only 10% classified the presence of white spots as an early sign of the disease. Conclusions: Pediatricians’ knowledge, attitudes, and practices regarding oral health are essential to guide their clinical conduct based on scientific evidence.

Resumen La fluorosis dental es una anomalía en el desarrollo del esmalte debido a la excesiva ingesta de flúor durante la formación de los tejidos dentales, y se caracteriza principalmente por la hipomineralización y mayor porosidad de la estructura del esmalte. Muchas veces las manchas ocasionadas por la fluorosis dental pueden comprometer la estética del paciente y afectar su autoestima. En años recientes ha sido desarrollado una nueva generación de materiales odontológicos conocida como infiltrantes resinosos, que básicamente son resinas de baja viscosidad que infiltran y paralizan la progresión de las lesiones cariosas incipientes no cavitadas. Cuando infiltrantes resinosos han sido utilizados para detener las lesiones cariosas se ha verificado que también producen cambios en la apariencia de la mancha blanca, atenuándola o tornándola imperceptible. El presente artículo describe un reporte de caso del uso de infiltrantes resinosos para tratamiento estético de lesiones de manchas blancas ocasionadas por fluorosis.

Abstract Dental fluorosis is an abnormality in the development of enamel due to the excessive intake of fluoride during formation of dental tissues, mainly characterized by hypomineralization and increased porosity of the enamel structure. Oftenly the spots caused by dental fluorosis can compromise the aesthetics of the patient and affect their self-esteem. In recent years a new generation of dental materials has been developed, known as resin infiltrants, which are basically low viscosity resins that infiltrate and paralyze the progression of incipient non cavitated carious lesions. When resin infiltrants have been used to stop carious lesions it has been verified that they also produce changes in the appearance of white spots, masking or making them imperceptible. The present article describes a case report of the use of resin infiltrants for aesthetic treatment of white spot lesions caused by fluorosis.

Abstract Multiple Sclerosis (MS) is the most common neurodegenerative disease among young adults. Diagnosis and monitoring of MS is performed with T2-weighted or T2 FLAIR magnetic resonance imaging, where MS lesions appear as hyperintense spots in the white matter. In recent years, multiple algorithms have been proposed to detect these lesions with varying success rates, which greatly depend on the amount of a priori information required by each algorithm, such as the use of an atlas or the involvement of an expert to guide the segmentation process. In this work, a fully automatic method that does not rely on a priori anatomical information is proposed and evaluated. The proposed algorithm is based on an over-segmentation in superpixels and their classification by means of Gauss-Markov Measure Fields (GMMF). The main advantage of the over-segmentation is that it preserves the borders between tissues, while the GMMF classifier is robust to noise and computationally efficient. The proposed segmentation is then applied in two stages: first to segment the brain region and then to detect hyperintense spots within the brain. The proposed method is evaluated with synthetic images from BrainWeb, as well as real images from MS patients. The proposed method produces competitive results with respect to other algorithms in the state of the art, without requiring user assistance nor anatomical prior information.

Resumen La Esclerosis Múltiple (MS) es una de las enfermedades neurodegenerativas más comunes en adultos jóvenes. El diagnóstico y su monitoreo se realiza generalmente mediante imágenes de resonancia magnética T2 o T2 FLAIR, donde se observan regiones hiperintensas relacionadas a lesiones cerebrales causadas por la MS. En años recientes, múltiples algoritmos han sido propuestos para detectar estas lesiones con diferentes tasas de éxito las cuales dependen en gran medida de la cantidad de información a priori que requiere cada algoritmo, como el uso de un atlas o el involucramiento de un experto que guíe el proceso de segmentación. En este trabajo, se propone un método automático independiente de información anatómica. El algoritmo propuesto está basado en una sobresegmentación en superpixeles y su clasificación mediante un proceso de Campos Aleatorios de Markov de Medidas Gaussianas (GMMF). La principal ventaja de la sobresegmentación es que preserva bordes entre tejidos, además que tiene un costo reducido en tiempo de ejecución, mientras que el clasificador GMMF es robusto a ruido y computacionalmente eficiente. La segmentación propuesta es aplicada en dos etapas: primero para segmentar el cerebro y después para detectar las lesiones en él. El método propuesto es evaluado usando imágenes sintéticas de BrainWeb, así como también imágenes reales de pacientes con MS. Con respecto a los resultados, el método propuesto muestra un desempeño competitivo respecto a otros métodos en el estado del arte, tomando en cuenta que éste no requiere de asistencia o información a priori.

RESUMO A importância do correto diagnóstico, planejamento e tratamento das manchas dentárias é de suma importância durante uma reabilitação estética. As exigências estéticas têm se tornado cada vez mais recorrentes na sociedade atual e as restaurações diretas de resina composta são indicadas graças aos grandes avanços e crescente melhoramento dos sistemas adesivos e das resinas compostas. O objetivo deste trabalho é relatar um caso clínico, onde foi realizado uma reabilitação oral estética envolvendo facetas diretas de resina composta associada ao clareamento dental. Paciente C. S. M do sexo feminino, 21 anos de idade, sem doenças sistêmicas, compareceu a clínica odontológica da Faculdade Morgana Potrich Eirelli (FAMP) queixando-se de estética insatisfatória nos dentes, após anamnese criteriosa, exame clínico intra e extra oral detalhados foi observado a presença de mancha branca nos dentes anteriores superiores, lisa, brilhante, sem a presença de tecido amolecido, bem delimitada e localizada na região cervical. Através dessas características e de uma anamenese criteriosa chegou-se ao diagnóstico de lesões de cárie inativa na vestibular dos dentes anteriores superiores. Após o planejamento e a aprovação da paciente, o tratamento iniciou-se, sendo indicado a confecção de facetas de resina composta associada ao clareamento dental para melhores resultados estético. Os resultados alcançados foram satisfatórios, atendendo as exigências estéticas e a satisfação da paciente, através de um correto diagnóstico, estudo e planejamento adequado para o caso.

ABSTRACT The importance of correct diagnosis, planning and treatment of dental spots is extremely important during aesthetic rehabilitation. Aesthetic requirements have become increasingly common in current society, and direct composite resin restorations are indicated due to the great advancement and increasing improvements of adhesive systems and composite resins. This work presents the clinical case of an oral aesthetic rehabilitation involving direct composite resin veneers associated with dental bleaching. The patient CSM, female, 21 years old, without systemic diseases, attended the dental clinic of the Morgana Potrich Eirelli College (FAMP) complaining of the unsatisfactory aesthetic appearance of her teeth. After careful anamnesis and detailed intraoral and extraoral examination, we identified the presence of a white spot on the upper anterior teeth. The spot was smooth and shiny, did not have soft tissue, and was well delimited and located in the cervical region. These characteristics led to the diagnosis of inactive carious lesions in the facial surface of the upper anterior teeth. After the treatment planning and its approval by the patient, the treatment started. The composite resin veneers associated with dental bleaching were indicated for better aesthetic results. The results achieved were satisfactory and met the patient’s aesthetic requirements by means of a correct diagnosis, study, and adequate planning for the case.

RESUMO O líquen plano é uma doença inflamatória crônica que envolve pele e mucosa, acometendo frequentemente a cavidade bucal. Os objetivos deste estudo são relatar um caso de líquen plano oral (LPO) com manifestações cutâneas e discutir os aspectos clínicos e histopatológicos, bem como o tratamento estabelecido. Relatamos o caso de uma mulher, 61 anos de idade, leucoderma, que foi encaminhada para avaliação de lesões brancas na mucosa bucal. Ao exame intraoral, foram observadas múltiplas lesões brancas com aspecto estriado em mucosa jugal, língua e rebordo; ao exame extraoral, lesões de aspecto descamativo no braço, manchas brancas nas pernas e unhas distróficas nos pés. Com base na biópsia das lesões bucais e na análise histopatológica, o diagnóstico de LPO foi confirmado. A paciente foi submetida ao tratamento com propionato de clobetasol em creme (0,5 mg) e orientada a fazer a aplicação na área afetada, uma a duas vezes ao dia, durante quatro semanas. No acompanhamento clínico após um mês e 15 dias, pôde-se analisar a melhora das lesões. Por se tratar de uma doença com etiopatogênese ainda pouco reconhecida, vários fatores podem possibilitar o desenvolvimento dessa condição. Dessa forma, é imprescindível o olhar clínico do cirurgião-dentista para o tratamento mais eficaz.

ABSTRACT Lichen planus is a chronic inflammatory disease involving the skin and mucosa, which often affects the oral cavity. The objective of this study is to report a case of oral lichen planus (OLP) with cutaneous manifestations and to discuss the clinical, histopathological aspects and the established treatment. A 61-years-old female white patient was referred for evaluation of white lesions in the oral mucosa. In the intraoral examination, multiple white lesions with striated appearance were observed in the jugal mucosa, tongue and border. The extraoral examination revealed scaly lesions on the arm, white spots on the legs, and nail dystrophy on feet. Based on biopsy of the oral lesions and the histopathological analysis, the diagnosis of OLP was confirmed. The patient underwent treatment with clobetasol propionate topical cream (0.5 mg), and was instructed to apply it to affected area, once or twice a day for four weeks. In the clinical follow-up after one month and 15 days, the improvement of the lesions could be analyzed. As OLP is a disease with an etiopathogenesis that is still poorly recognized, several factors may enable the development of this condition. Therefore, the dentist's clinical view is essential for the most effective treatment.

RESUMEN El liquen plano es una enfermedad inflamatoria crónica que involucra piel y mucosa, con frecuencia de la cavidad bucal. Los objetivos de este estudio son reportar un caso de liquen plano oral (LPO) con manifestaciones cutáneas y discutir sus aspectos clínicos e histopatológico, así como el tratamiento establecido. Reportamos el caso de una mujer de 61 años de edad, raza blanca, que fue remitida para evaluación de lesiones blancas en la mucosa bucal. En el examen intraoral se observaron lesiones blancas múltiples estriadas en mucosa yugal, lengua y cresta; en el examen extraoral, lesiones descamativas en el brazo, manchas blancas en las piernas y uñas distróficas en los pies. Basándose en la biopsia de las lesiones bucales y en el análisis histopatológico, el diagnóstico de LPO se confirmó. La paciente fue sometida a tratamiento con propionato de clobetasol crema (0,5 mg) y aconsejada a aplicar el medicamento sobre el área afectada, una o dos veces al día, por cuatro semanas. En el seguimiento clínico, al cabo de un mes y 15 días, fue posible analizar la mejoría de las lesiones. Por tratarse de una enfermedad de etiología todavía poco conocida, varios factores pueden favorecer su desarrollo. Así, el ojo clínico del cirujano dentista es imprescindible para un tratamiento más efectivo.

Abstract Objective: The aim of this in vitro study was to determine the effects of remineralization promoting agents containing casein phosphopeptide-stabilized amorphous calcium phosphate (CPP-ACP), or CPP-ACP in combination with fluoride (CPP-ACPF) on artificial white spot lesions (WSLs) after 6 and 12 weeks. Methodology: White spot lesions were created on 123 sectioned premolars (246 specimens) with a demineralization solution during a 96 hours pH-cycling regime. Two experimental groups were created: a CPP-ACP group (Tooth Mousse™), and a CPP-ACPF group (Mi Paste Plus™). Additionally, two control groups were created, one using only a conventional toothpaste (1450 ppm fluoride) and another one without any working agents. All teeth were also daily brushed with the conventional toothpaste except the second control group. Tooth Mousse™ and Mi Paste Plus™ were applied for 180 seconds every day. The volume of demineralization was measured with transverse microradiography. Six lesion characteristics regarding the lesion depth and mineral content of WSLs were also determined. Results: The application of CPP-ACP and CPP-ACPF had a significant regenerative effect on the WSLs. Compared to Control group 1 and 2 the volume of demineralization after 6 weeks decreased significantly for CPP-ACP (respectively p<0.001 and p<0.001) and CPP-ACPF (respectively p=0.001 and p=0.003). The same trend was observed after 12 weeks. For the CPP-ACPF group, WSL dimensions decreased significantly between 6 and 12 weeks follow-up (p=0.012). The lesion depth reduced significantly after application of CPP-ACP and CPP-ACPF but increased significantly in the Control groups. Mineral content increased for CPP-ACP and CPP-ACPF after an application period of 12 weeks, but this was only significant for CPP-ACP. Conclusions: Long-term use of CPP-ACP and CPP-ACPF in combination with a conventional tooth paste shows beneficial effects in the recovery of in vitro subsurface caries lesions.

As pigmentações negras do esmalte se devem à coloração extrínseca e estão associadas com problemas estéticos. O objetivo é apresentar dois casos clínicos de crianças com pigmentações extrínsecas negras do esmalte dentário, com ênfase no tipo de tratamento e no acompanhamento. Trata-se de um paciente de 5 anos de idade que utilizava constantemente sulfato ferroso para tratamento de anemia por deficiência de ferro; e outro paciente de 12 anos de idade com diabetes mellitus tipo 1 e dermatomiosite. No primeiro caso observou-se a presença de pigmentações negras extrínsecas nos dentes decíduos e nos primeiros molares permanentes, principalmente nas superfícies lingual e vestibular na região cervical e terço médio, além de lesões de cárie incipientes nas superfícies oclusais dos molares e manchas brancas ativas nos primeiros molares permanentes. No segundo caso, havia pigmentações negras extrínsecas na região cervical das superfícies lisas dos dentes decíduos e permanentes. No primeiro caso, foi realizado tratamento para remoção das pigmentações negras e polimento dos dentes por meio de profilaxia profissional com creme dental abrasivo que contém pedra pomes microgranulada. Houve uma melhora no aspecto clínico a partir da segunda sessão e finalizado na quinta sessão. Para o caso 2, observou-se dificuldade na remoção de manchas pigmentadas na região cervical e risco de sangramento gengival. Uma vez que a criança necessitava de antibiótico profilático, optamos pelo controle diário de biofilme e não remoção pela profilaxia profissional, uma vez que o paciente não se queixava do impacto estético. Conclui-se que as pigmentações negras extrínsecas podem ser observadas facilmente em crianças, e ainda que haja um comprometimento estético, não traz danos à manutenção da saúde bucal. Cabe ressaltar que não está claro como sua presença na superfície dentária reduz a suscetibilidade à cárie. Além disso, a escolha do tratamento sempre deverá ser baseada no risco-benefício para o paciente.

Dark enamel pigments are due to extrinsic staining and associated with aesthetic problems. The objective is to present two cases of children with black extrinsic pigmentation in the tooth enamel, with emphasis on the type of treatment and monitoring. This is a 5-year-old patient of who constantly used ferrous sulfate to treat anemia by iron deficiency, and another 12-year-old patient with type 1 diabetes and dermatomyositis. In the first case, we observed the presence of black extrinsic pigments in the primary teeth and the first permanent molars, especially in the lingual and vestibular part in the cervical region and middle third, together with incipient caries lesions on the occlusal surfaces of molars and active white spots on the first permanent molars. In the second case, there were strange black pigmentation in the cervical region of the smooth surfaces of the primary and permanent teeth. In the first case, the treatment performed was to remove black pigments and polishing the teeth by means of professional prophylaxis and using an abrasive toothpaste containing micro-granules of pumice. There was an improvement in the clinical aspect from the second session and the treatment ended at the fifth session. For the second case, we observed difficulty to remove the pigmented spots in the cervical region, together with the risk of bleeding gums. When the child needed prophylactic antibiotics, we opted for the daily control of the biofilm and it was not removed by professional cleaning, because the patient did not complain about the aesthetic impact. As conclusions, the extrinsic black pigments can be easily observed in children, and despite its aesthetic effect, it does damage oral health. It should be noted that it is unclear how their presence on the tooth surface reduces susceptibility to caries or tooth decay. In addition, the choice of treatment should always be based on the relation risk-benefit for the patient.

Los pigmentos de esmalte negro se deben a la tinción extrínseca y están asociados con problemas estéticos. El objetivo es presentar dos casos clínicos de niños con pigmentaciones extrínsecas negras del esmalte dental, con énfasis en el tipo de tratamiento y el seguimiento. Se trata de un paciente de 5 años de edad, que utilizaba constantemente sulfato ferroso para el tratamiento de la anemia por deficiencia de hierro, y otro paciente de 12 años de edad con diabetes mellitus tipo 1 y dermatomiositis. En el primer caso se observó la presencia de pigmentos extrínsecos negros en los dientes primarios y los primeros molares permanentes, principalmente en la parte lingual y vestibular en la región cervical y tercio medio; además de lesiones de caries incipientes en las superficies oclusales de los molares y manchas blancas activas en los primeros molares permanentes. En el segundo caso, había pigmentaciones negras extrañas en la región cervical de las superficies lisas de los dientes primarios y permanentes. En el caso 1, se realizó el tratamiento para eliminar los pigmentos negros y el pulido de los dientes por medio de una profilaxis profesional con crema dental abrasiva que contiene microgránulos de piedra pómez. Hubo una mejora en el aspecto clínico a partir de la segunda sesión y se finalizó en la quinta sesión. Para el caso 2, se observó dificultad en la eliminación de manchas pigmentadas en la región cervical y el riesgo de sangrado de las encías. Una vez que el niño necesitaba antibióticos profilácticos, optamos por el control diario de la biopelícula y no se eliminó por la limpieza profesional, ya que el paciente no se quejaba del impacto estético. Se concluye que los pigmentos negros extrínsecos pueden observarse fácilmente en los niños, y aunque haya un efecto estético, no hace daños al mantenimiento de la salud bucal. Cabe señalar que no está claro cómo su presencia en la superficie del diente reduce susceptibilidad a la caries. Además, la elección del tratamiento siempre se debe basar en el beneficio-riesgo para el paciente.

The development of white spot lesions (WSLS) is a significant risk associated with orthodontic treatment when oral hygiene is poor. Fixed orthodontic appliances transform procedures of conventional oral hygiene more difficult and increase the number of sites plaque retention. While prevalence values vary, the data are sufficient to consider the demineralization as a important problem, making prevention during treatment one of the major clinical challenges. The purpose of this paper is review to date the available literature regarding the etiology, prevention and treatment of white spots associated with orthodontic treatment with dental braces.

El desarrollo de lesiones de mancha blanca (WSLs) es un riesgo significativo asociado con el tratamiento de ortodoncia cuando la higiene oral es deficiente. Aparatos de ortodoncia fijos transforman los procedimientos de higiene oral convencionales más difíciles y aumentan el número de sitios de retención de placa. Si bien los valores de prevalencia son variados, los datos son suficientes para considerar la desmineralización como un problema importante, haciendo de la prevención durante el tratamiento uno de los mayores desafíos clínicos. El propósito de este trabajo es realizar una revisión actualizada de la literatura disponible respecto a la etiología, prevención y tratamiento de manchas blancas asociadas al tratamiento de ortodoncia con aparatología fija.

Brucellosis caused by Brucella abortus infection is a contagious zoonotic disease that causes abortions in cows, as well as joint and reproductive alterations in bulls. This study reports that eight (1.92%) out of a total of 469 aborted bovine fetuses analysed in a time frame of nine years were caused by B. abortus infection. The diagnosis was based on macroscopic, histological, microbiological, serological, immunohistochemical, and molecular findings. The gestational age of the fetuses studied ranged from 6 to 9 months. The main gross findings were purulent discharge from the nasal cavity, trachea and bronchi; pleural and pericardial fibrin deposits; and non-collapsed lungs with white spots in the parenchyma, and red areas in the apical lobes. Intercotyledonary areas of three placentas examined exhibited reddened areas, and the cotyledons exhibited well-defined, yellowish-white round areas with thickened walls on their surface. Microscopically, the most frequently observed lesions were necrosuppurative bronchopneumonia, interstitial pneumonia, and necrosuppurative placentitis with areas of vasculitis, mineralization, and thrombosis. Brucella abortus was isolated from fetal tissues of seven of the nine cases investigated. Immunohistochemical tests were positive in four cases, and PCR detected B. abortus genetic material in three cases. Infection by B. abortus should be considered a possible cause of abortion in cattle in southern Brazil.

La brucelosis causada por Brucella abortus es una enfermedad zoonótica contagiosa que causa abortos en las vacas, así como alteraciones articulares y reproductivos en los toros. En 469 fetos bovinos abortados analizados en un período de nueve años, nueve (1,92%) se debieron a B. abortus infección. El diagnóstico se basó en los estudios de lesiones macroscópicas, histológicas, microbiológicas, serológicas, inmunohistoquímicas y hallazgos moleculares. La edad gestacional de los fetos osciló de 6 a 9 meses. Los principales hallazgos macroscópicos se caracterizaron por una descarga de pus en la cavidad nasal, tráquea y bronquios, y depósitos de fibrina pleural y pericárdico, además de los pulmones se han observado manchas blancas en el parénquima y las zonas rojas en los lóbulos apicales. En la región intercotiledonaria de tres placentas examinadas, hubo áreas enrojecidas intercaladas con zonas redondas de color amarillo-blanco bien definidos, con paredes engrosadas en la superficie de los cotiledones. Microscópicamente se observó bronconeumonía necrosupurativa, neumonía intersticial y placentitis necrosupurativa con áreas de vasculitis, la mineralización, y la trombosis. Brucella abortus fue aislado de los tejidos fetales de siete de los nueve casos investigados. La prueba de inmunohistoquímica fue positiva en cuatro casos, y la PCR amplifica el material genético de las bacterias en tres. La infección con B. abortus tiene que ser considerado como una posible causa de aborto en el ganado en el sur de Brasil.

Objective To compare preventive effect on dental caries of two frequencies of fluoridated varnish (FV) applications and a group given brushing instructions and using fluoridated toothpaste. Materials and Methods Follow-up study of 203 children attending an elementary school in the municipality of Tláhuac, Mexico City. The children were followed for 22 months. The students were randomly assigned to one of the following groups: 1) brushing instructions with fluoridated toothpaste, 2) FV every six months, 3) three FV applications per week per year. The FV contained fluorosilane (1000 ppm F) and NaF dentifrice (1450 ppm F). The DMFT-caries index and the presence of white spots were recorded (ICDAS, International Caries Detection and Assessment System). Results At baseline, the mean age of the children was 9.3 (SD 0.76) years, white lesions 0.63 (SD 1.48) and DMFT =0.70 (SD 1.11). Averages of the initial and final DMFT scores in the three groups were 0.67 and 1.17 for the toothpaste group, 0.77 and 1.46 for FV twice a year group, and 0.67 y 1.03 for the three-applications-FV group. According to the results of the GEE (Generalized-Estimating Equations) model, there were no significant differences in the rate of white lesions or the increase of the DMFT index. The results for the DMFT were: for bi-annual applications of FV, RR=1.24 (p=0.178) and for the three consecutive applications of FV, RR=0.83, (p=0.298) in comparison with the brushing-instructions group using fluoridated toothpaste, among the three treatment groups, controlling for age, sex, and initial-caries index in primary teeth and brushing frequency. Conclusions Schoolchildren showed a low incidence of caries using any of the three preventive regimens applied.

Objetivo Comparar el efecto preventivo de caries dental de dos frecuencias de aplicación de barniz fluorado (BF) con un grupo que utilizó instrucciones de cepillado con dentífrico fluorado. Materiales y Método Se siguieron durante 22 meses a 203 niños de una escuela primaria en la delegación Tláhuac, Ciudad de México, quienes fueron asignados aleatoriamente a uno de los siguientes grupos: 1) instrucciones de cepillado con dentífrico fluorado 3 veces al año, 2) BF semestral, 3) BF tres aplicaciones semanales al año. El BF contenía fluorosilano (1000 ppm F), el dentífrico NaF (1450 ppm F). Se registró el índice de caries CPOD y la presencia de manchas blancas usando los criterios del ICDAS (International Caries Detection and Assessment System). Resultados Al inicio del estudio, el promedio de edad fue 9,3 (DE 0,76) años, el promedio de lesiones blancas 0,63 (DE 1,48) y del CPOD 0,70 (DE 1,11). CPOD inicial y final en los tres grupos fueron: instrucciones de cepillado usando dentífrico fluorado 0,67 y 1,17, BF semestral 0,77 y 1,46 y grupo BF 3 aplicaciones 0,67 y 1,03, respectivamente.. De acuerdo a los resultados del modelo GEE (Generalized Estimating Equations), no se detectaron diferencias significativas en el incremento de lesiones blancas o en el CPOD para el índice de caries (CPOD) entre los tres grupo; para el CPOD las aplicaciones semestrales mostraron RR=1,24 (p=0,178) y para 3 aplicaciones RR=0,83, (p=0,298), comparando con el grupo de instrucciones de cepillado con dentífrico fluorado, controlando por edad, sexo, cpod inicial y frecuencia de cepillado. Conclusiones Los escolares mostraron una baja incidencia de caries utilizando cualquiera de los tres regímenes preventivos aplicados.

Objetivo Comparar el efecto preventivo de caries dental de dos frecuencias de aplicación de barniz fluorado (BF) con un grupo que utilizó instrucciones de cepillado con dentífrico fluorado. Materiales y Método Se siguieron durante 22 meses a 203 niños de una escuela primaria en la delegación Tláhuac, Ciudad de México, quienes fueron asignados aleatoriamente a uno de los siguientes grupos: 1) instrucciones de cepillado con dentífrico fluorado 3 veces al año, 2) BF semestral, 3) BF tres aplicaciones semanales al año. El BF contenía fluorosilano (1000 ppm F), el dentífrico NaF (1450 ppm F). Se registró el índice de caries CPOD y la presencia de manchas blancas usando los criterios del ICDAS (International Caries Detection and Assessment System). Resultados Al inicio del estudio, el promedio de edad fue 9,3 (DE 0,76) años, el promedio de lesiones blancas 0,63 (DE 1,48) y del CPOD 0,70 (DE 1,11). CPOD inicial y final en los tres grupos fueron: instrucciones de cepillado usando dentífrico fluorado 0,67 y 1,17, BF semestral 0,77 y 1,46 y grupo BF 3 aplicaciones 0,67 y 1,03, respectivamente.. De acuerdo a los resultados del modelo GEE (Generalized Estimating Equations), no se detectaron diferencias significativas en el incremento de lesiones blancas o en el CPOD para el índice de caries (CPOD) entre los tres grupo; para el CPOD las aplicaciones semestrales mostraron RR=1,24 (p=0,178) y para 3 aplicaciones RR=0,83, (p=0,298), comparando con el grupo de instrucciones de cepillado con dentífrico fluorado, controlando por edad, sexo, cpod inicial y frecuencia de cepillado. Conclusiones Los escolares mostraron una baja incidencia de caries utilizando cualquiera de los tres regímenes preventivos aplicados.

Objective To compare preventive effect on dental caries of two frequencies of fluoridated varnish (FV) applications and a group given brushing instructions and using fluoridated toothpaste. Materials and Methods Follow-up study of 203 children attending an elementary school in the municipality of Tláhuac, Mexico City. The children were followed for 22 months. The students were randomly assigned to one of the following groups: 1) brushing instructions with fluoridated toothpaste, 2) FV every six months, 3) three FV applications per week per year. The FV contained fluorosilane (1000 ppm F) and NaF dentifrice (1450 ppm F). The DMFT-caries index and the presence of white spots were recorded (ICDAS, International Caries Detection and Assessment System). Results At baseline, the mean age of the children was 9.3 (SD 0.76) years, white lesions 0.63 (SD 1.48) and DMFT =0.70 (SD 1.11). Averages of the initial and final DMFT scores in the three groups were 0.67 and 1.17 for the toothpaste group, 0.77 and 1.46 for FV twice a year group, and 0.67 y 1.03 for the three-applications-FV group. According to the results of the GEE (Generalized-Estimating Equations) model, there were no significant differences in the rate of white lesions or the increase of the DMFT index. The results for the DMFT were: for bi-annual applications of FV, RR=1.24 (p=0.178) and for the three consecutive applications of FV, RR=0.83, (p=0.298) in comparison with the brushing-instructions group using fluoridated toothpaste, among the three treatment groups, controlling for age, sex, and initial-caries index in primary teeth and brushing frequency. Conclusions Schoolchildren showed a low incidence of caries using any of the three preventive regimens applied.

Dentre os parasitas que acometem os suínos, Ascaris suumdestaca-se como o mais impactante nos sistemas de criação. Seu monitoramento pode ser realizado durante o abate dos animais, por meio da identificação de “milk spots” ou manchas de leite presentes no fígado, decorrentes da sua migração larval. Entretanto devido ao fato da infecção ocorrer no rebanho normalmente de forma subclínica, a presença desse parasita na produção industrial de suínos vem sendo negligenciada. O objetivo do estudo foi avaliar a ocorrência de manchas de leite no fígado de animais abatidos na micro-região de Ponte Nova, na Zona da Mata de Minas Gerais - Brasil, e associar tais lesões com a época do ano, tamanho do rebanho e local de origem dos animais. Foram avaliados 1.069 lotes, totalizando 108.073 animais. Os dados foram extraídos do Serviço de Inspeção Federal, e eram referentes aos animais abatidos, durante o período de janeiro de 2011 a junho de 2013. Do total de animais abatidos, 10.535 (9,75%) foram positivos para a lesão. Portanto, veterinários e produtores devem ser alertados quanto à ineficiência dos protocolos de vermifugação utilizados e a necessidade do desenvolvimento e/ou revisão de estratégias de controle para este parasita na produção.

Among the parasites that affect pigs, Ascaris suum stands out for causing the greatest losses to livestock production systems. This parasite can be monitored during the slaughter of animals through the identification of “milk spots” or white patches on the liver caused by its larval migration. However, infection in the herd is usually subclinical, which is why the presence of this parasite in industrial pig production has been overlooked. The aim of the study was therefore to evaluate the occurrence of milk spots on the liver of animals slaughtered in the micro-region of Ponte Nova in the Zona da Mata - Minas Gerais, Brazil, and to associate these lesions with the time of year, herd size and source of origin of the animals. An evaluation was made of 1,069 lots, totaling 108,073 animals, based on data extracted from the Federal Inspection Service. The animals were slaughtered during the period of January 2011 to June 2013. Out of the total number of slaughtered animals, 10,535 (9.75%) tested positive for these lesions. Therefore, veterinarians and producers should be warned about the inefficiency of the deworming protocols that are used, and the need to develop and/or review control strategies for this parasite in production systems.

RESUMOObjetivo:Foi determinada a prevalência de lesões similares as da síndrome dos pontos brancos evanescentes (MEWDS) diagnosticados à angiografia, traçando um perfil epidemiológico e destacando os principais aspectos angiográficos encontrados. O objetivo final visa a atentar o examinador menos experiente para identificação desta entidade clínica, muitas vezes subdiagnosticada, além de tranquilizar o paciente acerca do prognóstico da doença.Método:Estudo transversal de todas as angiografias fluorescentes realizadas no período de julho de 2006 a outubro de 2012 (total de 6.111 exames), provenientes dos atendimentos de emergência oftalmológica seguidos de análise angiográfica. Assim, os casos diagnosticados como MEWDS foram estudados no que compete às diferentes manifestações angiográficas desta doença.Resultados:Dentre as 6.111 angiografias analisadas, de pacientes provenientes da emergência, foram detectados 15 casos de MEWDS, com perfil epidemiológico de idade variando entre 13 e 42 anos, sendo 9 homens (60%) e 6 mulheres (40%). Os aspectos angiográficos mais encontrados foram os pontos hiperfluorescentes difusos, pontos hiperfluorescentes associados a manchas hiperfluorescentes em média periferia, e aspecto foveal granulado, este último em aproximadamente metade dos casos (46%).Conclusão:MEWDS possui bom prognóstico pela involução espontânea e dificilmente é diagnosticada, devido ao retardo do acesso do paciente ao atendimento oftalmológico e, principalmente, à angiografia, que evidencia melhor as lesões. Este estudo tornou-se possível em virtude da facilidade do acesso à emergência oftalmológica privada, além de avaliação por oftalmologista experiente e da complementação diagnóstica pela angiofluoresceinografia. O fechamento deste diagnóstico permite tranquilizar o paciente acerca da boa evolução do quadro, além de afastar causas de baixa visual de mau prognóstico.

ABSTRACTPurpose:To characterize multiple evanescent white dot syndrome (MEWDS)-like lesions as diagnosed by clinical exam and fluorescein angiography (FA) to build an epidemiological profile of this disease and highlight the most common angiographical aspects. It is important to emphasize the existence of this syndrome and improve patients’ information about the natural good course of this disease.Methods:A cross-sectional study including all FA performed from July 2006 to October 2012 (6,111 exams analyzed) in patients at our ophthalmic emergency department, with analysis of the different angiographic aspects of the MEWDS-diagnosed cases.Results:Among the 6,111 angiographies analyzed, 15 MEWDS cases were detected; the patients ranged in age from 13 to 42 years old, and the male/female ratio was 60% to 40% (nine male and six female). The most common FA aspects included hyperfluorescent dots, dots and spots in the retinal mid-periphery, and foveal granularity in 46% of the cases.Conclusions:MEWDS has a good prognosis, with spontaneous involution, which makes it difficult to diagnose because of the delayed access to ophthalmological assistance, in special FA examination, which highlights the lesions. This study was possible due to the quick access facility at a private ophthalmic emergency department and examination by an experienced ophthalmologist, along with complementary diagnosis by FA and better perception of the patients, thus ensuring good prognosis.

Se realizó la infección experimental de doce cerdos con aproximadamente 100.000 huevos infectivos de Toxocara cati. Los huevos de T. cati utilizados en la inoculación fueron recolectados de heces felinas. Otro grupo de tres cerdos no infectados se utilizó como control. Grupos de cerdos infectados se eutanaciaron a los 7,14,21 y 28 días posinoculación (pi). Se tomaron muestras de tejidos para digestión y evaluación de cambios histopatológicos en la etapa temprana de la infección. El número de larvas recuperadas de los pulmones se incrementó en los días 7 y 14 pi, recuperándose también los días 21 y 28 pi. Se encontraron larvas de T. cati en los linfonódulos del intestino delgado y grueso los días 7,14 y 28 pi y los días 7,14,21 y 28 pi respectivamente. En los restantes tejidos estudiados o no se recuperaron larvas o los valores fueron menores a una larva por gramo de tejido. La respuesta patológica observada en el hígado y los pulmones a los 7 y 14 días posinoculación, mostró en la superficie del hígado manchas blancas y en los pulmones áreas de consolidación. Los pulmones presentaron una reacción inflamatoria con presencia de larva en el centro en el día 28 pi. En el hígado se observó una hepatitis periportal y perilobular. Los linfonódulos del intestino presentaron una linfoadenitis eosinofílica con un centro reactivo conteniendo formas parasitarias en algunos de ello. En ninguno de los tejidos se observó la típica reacción granulomatosa. El rol de los restantes tejidos examinados fue de menor significancia. Queda evidenciada la importancia de éste parasito como un agente etiológico que desarrolla la enfermedad en hospederos paraténicos.

Experimental inoculations of approximately 100,000 infective Toxocara cati larval eggs were done in twelve pigs. The T. cati eggs used for inoculation were collected from cat's feces. Another group of three pigs served as an uninfected control. Groups of infected pigs were euthanized at seven, 14, 21, and 28 days post-inoculation (dpi). Tissue samples were taken for digestion and histopathology changes in early phase. The number of larvae recovered from the lungs peaked at seven and 14 dpi and were also present at 21, and 28 dpi. Larvae of T. cati were present in the lymph nodes of the small and large intestine at seven, 14, and 28 dpi and at seven, 14, 21, and 28 dpi respectively. In other studied tissues, no larvae or less than one larva per gram was detected. The pathological response observed in the liver and lungs at seven and 14 dpi, showed white spots on the liver surface and areas of consolidation were observed in the lungs. The lungs showed an inflammatory reaction with larvae in center at 28 dpi. In the liver we observed periportal and perilobular hepatitis. The lymph nodes of the intestines displayed eosinophil lymphadenitis with reactive centers containing parasitic forms in some of them. The granulomatous reaction was not observed in any tissues. The role of the other examined tissues had less significance. The relevance of this parasite as an etiological agent that leads to disease in paratenic hosts is evident.

Introduction: The type 1 neurofibromatosis or Von Recklinghausen's neurofibromatosis is the more frequent neurocutaneous disorder, present in approximately 1 of each 3000 persons. It is a genetic syndrome with an autosomal dominant way of transmission. Criteria for the clinical diagnosis were made in 1988, from two or more spots of white coffee color larger than 5 millimeters diameter in postpubertal subjects, two or more neurofibroma of any type or a plexiform neurofibroma, axillary freckles or in the inguinal region, optical glioma; two or more Lisch's nodules, bone lesions such as sphenoid dysplasia or a thin cortex of large bones with or without pseudoarthrosis, as well as a first grade relative blood relation diagnosed with type 1 neurofibromatosis. Objective: To present the operative behavior of patients presenting with type 1 neurofibromatosis. Clinical case: IRA white male patient aged 71 with a pathologic history of type 1 neurofibromatosis diagnosed from 15 years old with a left heart insufficiency, high blood pressure and chronic auricular fibrillation with a normal ventricular response. Diagnosis of lumbar neurofibroma was made carrying out a total exeresis of the lesion. Conclusions: The peri-anesthetic conduction of patient diagnosed with Von Recklinghausen's disease is a challenge for the anesthesiologist.

Introducción: La neurofibromatosis tipo 1 o neurofibromatosis de Von Recklinghausen es el trastorno neurocutáneo más frecuente, presentándose aproximadamente en 1 de cada 3000 personas. Es un síndrome genético que se transmite de manera autosómica dominante. Los criterios para el diagnóstico clínico se establecieron desde 1988, a partir de dos o más manchas color café con leche de más de cinco milímetros de diámetro en individuos pospuberales; dos o más neurofibromas de cualquier tipo o un neurofibromas plexiforme; pecas axilares o en región inguinal; glioma óptico; dos o más nódulos de Lisch; lesiones óseas tales como displasia de esfenoides o afinamiento de la corteza de los huesos largos, con o sin pseudoartrosis; así como un familiar de primer grado de consanguinidad con el diagnóstico de neurofibromatosis tipo 1. Objetivo Presentar la conducta perioperatoria de los pacientes portadores de neurofibromatosis tipo 1. Caso clínico IRA masculino, blanco de 71 años con antecedentes patológicos de neurofibromatosis tipo 1 diagnosticada desde los 15 años, insuficiencia cardíaca izquierda, hipertensión arterial y fibrilación auricular crónica con respuesta ventricular normal. Se diagnostica neurofibroma lumbar, se realizó exéresis total de la lesión. Conclusiones: resulta un desafío para el anestesiólogo la conducción peri anestésica del paciente con enfermedad de Von Recklinghausen.