Abstract Background Subarachnoid hemorrhage (SAH) prognosis remains poor. Vasospasm mechanism might be associated with inflammation. Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) have been studied as inflammation markers and prognostic predictors. Objective We aimed to investigate NLR and PLR in admission as predictors of angiographic vasospasm and functional outcome at 6 months. Methods This cohort study included consecutive aneurysmal SAH patients admitted to a tertiary center. Complete blood count was recorded at admission before treatment. White blood cell count, neutrophil count, lymphocyte count, platelet count, NLR, and PLR were collected as independent variables. Vasospasm occurrence-modified Rankin scale (mRS), Glasgow outcome scale (GOS), and Hunt-Hess score at admission and at 6 months were recorded as dependent variables. Multivariable logistic regression models were used to adjust for potential confounding and to assess the independent prognostic value of NLR and PLR at admission. Results A total of 74.1% of the patients were female, with mean age of 55.6 ± 12.4 years. At admission, the median Hunt-Hess score was 2 (interquartile range [IQR] 1), and the median mFisher was 3 (IQR 1). Microsurgical clipping was the treatment for 66.2% of the patients. Angiographic vasospasm incidence was 16.5%. At 6 months, the median GOS was 4 (IQR 0.75), and the median mRS was 3 (IQR 1.5). Twenty-one patients (15.1%) died. Neutrophil-to-lymphocyte ratio and PLR levels did not differ between favorable and unfavorable (mRS > 2 or GOS < 4) functional outcomes. No variables were significantly associated with angiographic vasospasm. Conclusion Admission NLR and PLR presented no value for prediction of functional outcome or angiographic vasospasm risk. Further research is needed in this field.

Resumo Antecedentes O prognóstico da hemorragia subaracnoidea (HSA) permanece ruim. Vasoespasmo pode estar associado à inflamação. Razões neutrófilo-linfócito (NLR) e plaqueta-linfócito (PLR) têm sido estudadas como marcadores de inflamação e prognóstico. Objetivo Investigar NLR e PLR na admissão como preditores de vasoespasmo angiográfico e desfecho aos 6 meses. Métodos Este estudo de coorte incluiu pacientes consecutivos com HSA aneurismática de um centro terciário. Contagem de leucócitos, neutrófilos, linfócitos e plaquetas, proporção de neutrófilos para linfócitos e de plaquetas para linfócitos foram coletados como variáveis independentes. Ocorrência de vasoespasmo, escala de Rankin modificada, escala de desfecho de Glasgow e o escore de Hunt-Hess na admissão e 6 meses após a mesma foram registradas como variáveis dependentes. Modelos de regressão logística multivariável foram usados para ajustar potenciais fatores de confusão e avaliar valor prognóstico independente de NLR e PLR. Resultados Um total de 74,1% pacientes eram do sexo feminino, com idade média de 55,6 ± 12,4 anos. Na admissão, a pontuação média de Hunt-Hess foi de 2 (IQR 1) e a mediana de mFisher foi de 3 (IQR 1). Clipagem microcirúrgica foi o tratamento escolhido para 66,2% dos pacientes. A incidência de vasoespasmo angiográfico foi de 16,5%. Aos 6 meses, a escala de desfecho de Glasgow mediana era 4 (IQR 0,75) e a escala de Rankin modificada mediana era 3 (IQR 1,5). Vinte e um pacientes (15,1%) morreram. Os níveis de NLR e PLR não diferiram entre resultados funcionais favoráveis e desfavoráveis (mRS > 2 ou GOS < 4). Nenhuma variável foi significativamente associada ao vasoespasmo angiográfico. Conclusão Razão neutrófilo-linfócito e a PLR não apresentaram valor preditivo de desfecho funcional ou risco de vasoespasmo angiográfico. Mais pesquisas são necessárias neste campo.

Abstract Objective: To assess the predictive value of selected growth phenotypes for neonatal morbidity and mortality in preterm infants < 30 weeks and to compare them with INTERGROWTH-21st (IG21). Methods: Retrospective analysis of data from the Brazilian Neonatal Research Network (BNRN) database for very low birth weight (VLBW) at 20 public tertiary-care university hospitals. Outcome: the composite neonatal morbidity and mortality (CNMM) consisted of in-hospital death, oxygen use at 36 weeks, intraventricular hemorrhage grade 3 or 4, and Bell stage 2 or 3 necrotizing enterocolitis. Selected growth phenotypes: small-for-gestational-age (SGA) defined as being < 3rd (SGA3) or 10th (SGA10) percentiles of BW, and large-for-gestational-age (LGA) as being > 97th percentile of BW. Stunting as being < 3rd percentile of the length and wasting as being < 3rd percentile of BMI. Single and multiple log-binomial regression models were fitted to estimate the relative risks of CNMM, comparing them to IG21. Results: 4,072 infants were included. The adjusted relative risks of CNMM associated with selected growth phenotypes were (BNRN/IG21): 1.45 (0.92–2.31)/1.60 (1.27–2.02) for SGA; 0.90 (0.55–1.47)/1.05 (0.55–1.99) for LGA; 1.65 (1.08–2.51)/1.58 (1.28–1.96) for stunting; and 1.48 (1.02–2.17) for wasting. Agreement between the two references was variable. The growth phenotypes had good specificity (>95%) and positive predictive value (70-90%), with poor sensitivity and low negative predictive value. Conclusion: The BNRN phenotypes at birth differed markedly from the IG21 standard and showed poor accuracy in predicting adverse neonatal outcomes.

ABSTRACT Evaluating the effects of N and K supply on grapevines ( Vitis vinifera L.) and the techniques for nutritional diagnosis is of great importance for fertigation management of this crop. This study evaluated the effects of N and K fertigation on the soluble concentrations of NO 3 – and K + in the petiole sap and on the leaf chlorophyll index in drip irrigated ‘Syrah’ grapevine (from 17 June 2013 to 25 Nov 2014). The treatments consisted of five levels of N (0, 15, 30, 60 and 120 kg ha –1 ) and K 2 O (0, 15, 30, 60 and 120 kg ha –1 ), combined in an incomplete 5 2 factorial scheme in 13 combinations and arranged in randomized blocks with four replications. We determined NO 3 – and K + concentrations in petiole sap, leaf chlorophyll index, grapevine cluster mass and number per plant, mean grapevine cluster mass, and phenolic composition. High NO 3 – concentrations contributed positively to grapevine yield; however, increased K+ concentrations caused a negative response of sap. For 120 kg N ha –1 rate, NO 3 – in the sap and chlorophyll index showed higher values at the flowering stage, while high values for K + were observed during the grape-ripening stage.

ABSTRACT. Cohesive Oxisols are widely used for cultivating eucalyptus in the Coastal Tablelands of the northeastern region of Brazil. However, mechanization and plant cultivation in these soils are difficult because of their cohesive layers. Therefore, the objective of this study was to identify better combinations between tillage systems and types of fertilization to improve the physical attributes of cohesive soil, with the aim of improving eucalyptus growth. The experimental design was completely randomized in a 4 × 2 factorial scheme (soil preparation × fertilization). The tillage systems tested were: i) conventional tillage (CT) - one plowing combined with two harrowings, ii) minimum tillage (MT) - subsoiling down until 0.57 m depths in the planting line, iii) no-tillage type 1 (NT1) - planting in 0.3 m-deep pits, and iv) no-tillage type 2 (NT2) - planting in 0.6 m-deep pits. The types of fertilization tested were mineral (MF) and organic fertilization (OF). The diameter of the soil aggregates was reduced after being subjected to any combination of cohesive soils. Furthermore, OF provided the best levels of plant-available water, attenuating the adverse conditions of the cohesive layer. MT, NT1, and NT2 improved the soil physical attributes when compared to CT. Therefore, the combination of either NT1 or NT2 with OF, followed by the combination of either NT1 or NT2 with MF, was determined to be the best way to cultivate eucalyptus on cohesive soils.

ABSTRACT Consolidation tests give important insights into soil compactibility. However, it requires equipment that is not always available. The costal tablelands in Northeastern Brazil have extensive areas of cohesive soils where compaction is an expressive problem. This region is a prominent producer of food and fibers with cassava as one of the leading products. Part of the cassava is used for flour production, generating wastewater, which is often applied as organic fertilizer to the soil. This can affect the compaction properties of soil due to its dispersing-flocculating characteristics. Uniaxial-compression tests and mathematical models are the primary methods to measure or estimate soil compaction. This study measured soil compression with a centrifuge, seeking a simple-quick method. We used specific loads (stainless-steel cylinders: mass) and increasing G-force (weight) to simulate the pressure on the samples used in most consolidation apparatus. Soils, sampling layers, and the presence of cassava wastewater (manipueira) were also compared since they may affect compactibility-related attributes. Samples of a Gray Cohesive Argisol and Dystrocohesive Yellow Latosol (depths of 0-0.20 m and 0.20-0.40 m) from the Tablelands of the state of Bahia, Brazil, were used. Wastewater affected water-dispersible clay, aggregate stability, pH, ∆pH, flocculation, and organic carbon, thus influencing compactibility but not the moisture and maximum density measured by the Proctor test. Centrifugation caused lower density than the Proctor test. The results were close to those estimated by the mathematical models, thus considered a promising alternative to estimating consolidation. This method also provides insight into the root growth-limiting density and the moisture content that leads to it.

RESUMO Os testes de consolidação fornecem informações importantes sobre a compactabilidade do solo. No entanto, eles requerem equipamentos especiais, disponíveis em poucos laboratórios no Brasil. Esta região é uma proeminente produtora de alimentos e fibras em solos coesos. Esses solos apresentam problemas frequentes de compactação. Como a mandioca é um dos principais produtos, suas águas residuais (manipueira) são frequentemente utilizadas para adubação. Esse uso pode afetar a compactação devido à sua influência na dispersão-floculação de partículas. A compressão uniaxial e modelos matemáticos são as principais formas de medir ou estimar a compactação do solo. Aqui, a compressão foi medida com um teste alternativo de centrifugação usando amostras deformadas, buscando um método alternativo simples e rápido. Foram usadas cargas específicas (cilindros de aço inoxidável: massa) e força G crescente (peso) em centrífuga, para simular a pressão nas amostras usadas na maioria dos aparelhos de consolidação. Os solos, as camadas de amostragem e a presença de água residuária (manipueira) também foram comparados, pois podem afetar os atributos relacionados à compactabilidade. Foram utilizadas amostras de Argissolo Cinzento Coeso e Latossolo Amarelo Distrocoeso (profundidades de 0-0,20 m e 0,20-0,40 m), ambos provenientes dos Tabuleiros costeiros do estado da Bahia, Brasil. A água residual afetou o teor de argila dispersa em água, a estabilidade dos agregados, o pH, o ∆pH, a floculação e o teor de carbono orgânico, influenciando a compactabilidade, mas não a umidade e a densidade máxima medidas pelo teste de Proctor. Embora a centrifugação tenha proporcionado menor densidade do que o teste de Proctor, os resultados foram comparáveis àqueles estimados pelos modelos matemáticos. Este método também forneceu informações sobre a densidade, próxima aos valores que limitam o crescimento da raiz, e o teor de umidade que leva a essa densidade limitante.

ABSTRACT Brazilian semi-arid tropical is responsible for the production and export of fine table grapes, but the demand for phosphate fertilizers and other agricultural inputs increases the cost of production and threatens local water bodies by leaching of phosphorus (P). The objectives of this study were to quantify the organic and inorganic fractions of P and to determine chemical and microbiological attributes related to its mineralization in soils cultivated with vines in São Francisco Valley. It was hypothesized that P fractions and microbial activity would increase in areas fertilized with phosphate. Soil samples from vines were collected in cultivated areas and in fallow systems. P fractionation, macro-elements analysis, microbial biomass phosphorus (Pmic), and phosphatase enzyme activity were determined and correlated with each other and with the total proportion of synthesized glomalin. In both treatments, the inorganic P fractions exceeded the organic ones, and the total phosphorus available in those soils was associated with the most recalcitrant fractions, reducing risks of leaching of this element and contamination of water bodies. Pmic was higher in the winery areas due to the presence of phosphate fertilizers and organic matter, hence the activity of alkaline phosphatase enzymes and the production of total glomalin increased respectively in three and four evaluated areas, indicating that P-mineralized bacteria and arbuscular mycorrhizal fungi have been positively affected by the current agricultural system.

Abstract Microbialites are the most abundant life evidence in Precambrian sedimentary rocks. They are produced by microbial interaction activity and sedimentary processes reflecting paleoenvironmental conditions. The Ediacaran-Cambrian carbonate and siliciclastic successions in the Southern Amazon Craton in Central Brazil, provide a key opportunity to understand how the metazoan life coexisted with the microbial communities. The spatial and temporal distribution of microbialites as well as morphological and paleoenvironmental changes have been assessed, reinterpreting previous works and including new data from the Araras-Alto Paraguai and Corumbá basins. The deposition was controlled by subsidence and sea-level changes that affected these basins, considered extensions of epicontinental seas during the Gondwana assembly. The stromatolites are restricted to coastal deposits and experienced thriving flourishment intervals after the Marinoan Glaciation (635 Ma). Post-glacial transgression was marked by microbial colonization in shallow platforms represented by stratiform and giant domical stromatolites in the Araras-Alto Paraguai Basin. The continuity of the transgression generated a moderately deep aragonite sea at about 622 Ma. A progressive sea-level fall caused the implantation of coastal environments under greenhouse conditions with tidal flat and sabkha settings colonized by centimetric-scale stromatolites. The sea retreat was accompanied by progressive uplift, causing a moderate inversion of the basin and erosion of the succession until ~560 Ma with the deposition of the last preserved tidal flat deposits with the occurrence of thrombolites. The subsiding Corumbá Basin was the site of microbially-induced deposition of carbonates in a shallow platform connected to an offshore setting with the proliferation of metazoan straddling the Ediacaran-Cambrian boundary. Microbial communities were restricted to lagoon deposits during the Lower Cambrian transgression in the Araras-Alto Paraguai Basin and the last phase refers to the sea retreat towards southeast, developing a fluvial system connected with the arid and evaporitic tidal flats colonized by microbialites that lasted until the upper Cambrian. Except for the post-glacial stromatolites, the columnar and domal microbialite indicate that the coastal settings dominated the Ediacaran-Cambrian transition. The preservation of microbialites in the post-glacial intervals can be associated with the Mg-Ca-CO3 oversaturation in dolomitic platforms. The rapid calcification and ability to resist the dissolution and replacement have increased the stromatolites’ preservation potential reported here, where its well-preserved occurrence in tidal flats and sabkha occurs due to intense early diagenetic silicification. The change from carbonate accumulation to siliciclastic-rich environments contributed to the demise of microbially-induced strata. In general, the scarce coexistence between coastal stromatolite and metazoan-bearing marine deposits makes it challenging to establish a competitive relationship between these organisms, as previously postulated.

RESUMO Objetivos: Avaliar a reformatação tomográfica sagital do esterno por meio de parâmetros radiográficos inéditos (índices e ângulos), comparando-os entre os diferentes tipos de pectus e controles. Métodos: 44 pacientes com deformidades pectus e controles foram submetidos à TC do tórax para análise. Os tipos de pectus foram classificados em: pectus carinatum inferior (PCI), superior (PCS) e lateral (PCL), e pectus excavatum amplo (PEA) e localizado (PEL). Foram criados e mensurados os seguintes parâmetros tomográficos: (1) índice coluna-manúbrio-esterno (CME); (2) índice coluna-esterno (CE); (3) ângulo manúbrio-esternal (AME); (4) ângulo inferior do manúbrio (AIM); e (5) ângulo inferior do esterno (AIE). Foi realizada análise estatística entre os grupos pectus e controle, e entre os diferentes tipos de pectus. Resultados: Houve diferença significativa entre: a) pectus excavatum e pectus carinatum quando analisados os índices CME, CE, AIM e AIE; b) PEL e grupo controle para CME e AIE; c) PCL e PEL, e PCL e PEA para o CME; d) PEA e PCL para CE; e) PCI e PEL, e PCI e PEA para AIE; f) PCS e PEL, e PCS e PEA para AIM. Conclusões: Os índices e ângulos radiográficos criados forneceram parâmetros de diferenciação entre pacientes com diferentes tipos de pectus, e entre estes e controles. Nível de Evidência II, Estudos Prognósticos.

ABSTRACT Objective: To evaluate the sagittal tomographic reformatting of the sternum using unpublished radiographic parameters (indexes and angles), comparing them between the different types of pectus, and controls. Methods: 44 patients with pectus deformities and controls underwent chest CT for analysis. The types of pectus were classified into: inferior pectus carinatum (IPC), superior (SPC) and lateral (LPC), and broad (BPE) and localized pectus excavatum (LPE). The following tomographic parameters were created and measured: (1) spine-manubrium-sternum index (SMS); (2) column-sternum index (CSI); (3) manubrium-sternal angle (MSA); (4) inferior manubrium angle (IMA); and (5) inferior sternum angle (ISA). Statistical analysis was performed between the pectus and control groups, and between the different types of pectus. Results: There was a significant difference between: a) pectus excavatum and pectus carinatum when analyzing the SMS, CSI, MSA and ISA indexes. b) LPE and control group for SMS and ISA. c) LPC and LPE, and LPC and BPE for SMS; d) BPE and LPC for CSI; e) IPC and LPE, and IPC and BPE for ISA; f) SPC and LPE, and SPC and BPE for IMA. Conclusion: The radiographic indexes and angles created provided differentiation parameters between patients with different types of pectus, and between these and controls. Level of Evidence II, Prognostic Studies.

RESUMO Objetivo: Avaliar a reformatação sagital tomográfica do esterno por meio da análise de uma classificação do tipo de curvatura do corpo esternal nos diferentes tipos de pectus, comparando-os entre si e com indivíduos normais. Métodos: 50 controles e 167 pacientes submetidos à TC do tórax para análise da reconstrução sagital no plano mediano, sendo 89 com pectus carinatum (idade média, 12 ± 10 anos) e 78 com pectus excavatum (idade média, 14 ± 10 years). Os tipos clínicos de pectus foram classificados em: pectus carinatum superior, inferior e lateral, e pectus excavatum amplo ou localizado. Foram definidos os seguintes tipos de padrões esternais: curvo gradativo vertical; curvo gradativo posterior; curvo gradativo anterior; curvo terço proximal; curvo terço médio; curvo terço distal; retilíneo anterior; retilíneo vertical; e retilíneo posterior. Foi realizada análise estatística entre o grupo pectus e controle, e entre diferentes tipos de pectus. Resultados: Observamos pacientes com deformidades torácicas diferentes, mas com esternos com padrão de curvatura semelhante. Alguns tipos de curvatura esternal são significativamente mais frequentes em alguns tipos de pectus (p < 0,05). Em controles prevaleceram os tipos curvo gradativo vertical e retilíneo anterior (p < 0,05). Conclusão: Alguns tipos de curvatura esternal são mais frequentes que outras em determinados tipos de pectus e controles. Nível de Evidência II, Estudos prognósticos - investigação do efeito de característica de um paciente sobre o desfecho da doença.

ABSTRACT Objective: To analyze reformatted sagittal sternal tomography images and classify sternal body curvature types, and compare different types of pectus populations with one another and with normal individuals. Methods: In total, 50 controls and 167 pectus patients were selected for chest CT to analyze the median sagittal plane, of whom 89 had pectus carinatum (mean age, 12 ± 10 years) and 78 pectus excavatum (mean age, 14 ± 10 years). Clinical types of pectus were classified as inferior, superior, or lateral pectus carinatum, and localized or broad pectus excavatum. The following types of sternal patterns were defined: gradual vertical curve, gradual posterior curve, gradual anterior curve, proximal third curve, middle third curve, distal third curve, anterior rectilinear, vertical rectilinear, and posterior rectilinear. Statistical analyses were performed to compare the different types of pectus with one another and with the control group. Results: Patients with different thoracic deformities, but with similar sternal curvature patterns, were observed. Some types of sternal curvature were significantly more frequent in certain types of pectus (p < 0,05). The gradual vertical curve and anterior rectilinear types prevailed in controls (p < 0,05). Conclusion: Some sternal curvature patterns were more frequent than the others in certain types of pectus and the controls. Level of Evidence II, Prognostic studies - investigating the effect of a patient characteristic on the outcome of disease.

RESUMO Objetivo: O pectus excavatum é uma deformidade importante por comprometer a estética e causar distúrbios emocionais. A sua correção cirúrgica é bem estabelecida, mas o tratamento conservador é menos familiar. Investigamos os resultados de longo prazo do tratamento do pectus excavatum localizado (deformidade restrita a linha média e na linha mamilar) com uso de órtese e exercícios físicos específicos. Métodos: Selecionamos 115 pacientes (média de 12,8 anos) com seguimento mínimo de 36 meses, sendo avaliados mais de um ano após o término do tratamento e maturidade esquelética. Os resultados foram relacionados estatisticamente (qui-quadrado e Cochran-Mantel-Haenszel) com a flexibilidade da deformidade, a gravidade, o uso regular da órtese e a realização de exercícios específicos. Resultados: O tratamento foi bem-sucedido em 58% dos pacientes, mas quando o uso da órtese e os exercícios foram regulares em pacientes com deformidades flexíveis, essa taxa aumentou para 83% (p = 0,005). A gravidade e a adesão ao tratamento tiveram grande impacto no sucesso do tratamento (p = 0,009 e <0,001, respectivamente). Conclusão: O método de tratamento proposto foi eficaz para correção total ou parcial da deformidade em pacientes motivados acompanhados até a maturidade esquelética, principalmente quando a terapêutica foi iniciada precocemente em deformidades mais leves e flexíveis. Nível de Evidência V, Opinião do especialista.

ABSTRACT Objective: Pectus excavatum is a deformity that affects aesthetics and causes emotional disorders. Surgical correction is well established, but conservative treatment is less common. We investigated the long-term results of using a brace and performing specific physical exercises to treat localized pectus excavatum, a type of deformity in which the depressed area is restricted to the midline region along the nipple line. Methods: We selected 115 patients (mean age 12.8 years), with a minimum follow-up of 36 months, who were evaluated more than one year after the end of treatment and skeletal maturity. Results were correlated with deformity flexibility, severity, regular use of the device, and performance of specific exercises. The chi-square (χ2) and the Cochran-Mantel-Haenszel tests were used for statistical analysis. Results: Treatment was successful in 58% of patients, however, when exercises were performed and the brace was used regularly by patients with flexible deformities, the rate increased to 83% (p = 0.005). Severity and adherence to treatment greatly impacted successful treatment (p = 0.009 and < 0.001, respectively). Conclusion: The proposed treatment method was effective for correction or partial correction of the deformity in motivated patients followed up until skeletal maturity, especially when started early in milder and more flexible deformities. Level of Evidence V, Expert opinion.

RESUMO Objetivo: Estudar os resultados de longo prazo e com seguimento até a maturidade esquelética do tratamento do pectus excavatum amplo. Métodos: 84 crianças e adolescentes foram tratados com uma órtese que aplicacompressão nas saliências costais inferiores, associada a exercícios específicos. A deformidade foi classificada como ampla quando a depressão tem maior extensão e abrange uma área acima e abaixo da linha mamilar. Os resultados foram categorizados em ruim, regular ou bom, sendo correlacionados estatisticamente com a flexibilidade, a gravidade da deformidade e a adesão ao tratamento, com avaliação um ano após o fim do tratamento e na maturidade esquelética. Resultados: A idade média no início do tratamento foi de 13,7 anos e o seguimento médio foi de 25.7 meses após a suspensão do uso da órtese. 48% dos casos apresentaram sucesso com o tratamento, mas quando os exercícios e o uso da órtese foram regulares, esta taxa aumentou para 70% (p < 0,001). Os casos mais leves tiveram maior sucesso que os de maior gravidade (p = 0,007), mas a flexibilidade inicial não influenciou os resultados (p = 0,63). Conclusão: O tratamento do pectus excavatum amplo com o uso de órtese e exercícios apresentou bons resultados definitivos na maioria dos pacientes resilientes, em especial nos casos mais leves. Nível de Evidência V, Opinião do Especialista.

ABSTRACT Objective: This study aims the treatment results of broad pectus excavatum after a long-term follow-up and skeletal maturity. Methods: Eighty-four children and adolescents with broad-type pectus excavatum were selected for evaluation after treatment with a dynamic orthosis that applies compression to the lower rib projections and prescription of exercises. The broad pectus excavatum was defined as a deformity that the depressed area was greater and covered the area above and below the nipple line. All patients were evaluated for more than 1 year after the end of treatment and skeletal maturity. Post-treatment results were categorized as mild, moderate and severe. Statistic correlations between results and deformity flexibility, deformity severity, and adherence to treatment were assessed. Results: The mean age at the beginning of treatment was 13.3 years, and the follow-up duration was 25.7 months after suspension of orthosis use. Forty-eight percent of patients showed good results. With regular use of orthoses and performance of exercises, this rate increased to 70% (p < 0,001). Mild cases showed more success than severe cases (p = 0,007). Initial flexibility didn’t influence the results (p = 0,63). Conclusion: Treatment of broad pectus excavatum with orthoses and exercises led to good definitive results in most resilient patients, especially in those with mild deformities. Level of Evidence V, Expert Opinion.

Resumo O objetivo deste estudo clínico, é avaliar o impacto da desinfecção bucal completa (DBC) nos níveis de nitrito salivar e biomarcadores sistêmicos e sua correlação com a carga bacteriana subgengival total em pacientes obesos e não obesos com periodontite. No total, 94 pacientes (55 obesos e 39 não obesos) foram avaliados inicialmente, sete foram perdidos durante o estudo, resultando em 87 indivíduos ao final. Os resultados foram avaliados no início do estudo, 3, 6 e 9 meses após o tratamento periodontal por DBC. Os níveis de nitrito salivar foram determinados usando o reagente de Griess. Amostras de sangue foram coletadas para determinação da Proteína C Reativa (PCR), fosfatase alcalina e glicemia de jejum. A PCR em tempo real foi usada para determinar a carga bacteriana subgengival total. O protocolo de DBC resultou em níveis aumentados de nitrito salivar em 6 e 9 meses após o tratamento no grupo de não obesos (p <0,05). Em indivíduos obesos, o tratamento da DBC levou a um aumento nos níveis de nitrito salivar em 6 meses (p <0,05); no entanto, aos 9 meses, os níveis de nitrito voltaram aos níveis basais. Para ambos os grupos, os maiores valores de nitrito foram observados aos 6 meses. Além disso, em ambos os grupos, a DBC foi associada à diminuição dos biomarcadores relacionados à inflamação sistêmica e doenças cardiovasculares, como PCR (p <0,05) e fosfatase alcalina (p <0,05), e não teve impacto na glicemia de jejum. Este estudo demonstra que pacientes obesos com periodontite apresentam níveis de nitrito salivar semelhantes quando comparados a indivíduos não obesos. O protocolo de DBC resultou em aumentos nos níveis de nitrito salivar e foi associado a um impacto positivo nos biomarcadores sistêmicos, independentemente do status de obesidade.

Abstract The objective of this 9-month clinical study is to assess the impact of one-stage full-mouth disinfection (FMD) on salivary nitrite levels and systemic biomarkers and its correlation with total subgingival bacterial load in obese and non-obese patients with periodontitis. In total, 94 patients (55 obese and 39 non-obese) were initially evaluated, seven were lost during follow-up, resulting in 87 individuals at the end of the study. Outcomes were assessed at baseline, 3, 6, and 9 months post periodontal treatment by FMD. Salivary nitrite levels were determined using Griess reagent. Blood samples were collected to determine C-Reactive Protein (CRP), alkaline phosphatase and fasting blood glucose. Real-time PCR was used to determine the total subgingival bacterial load. FMD protocol resulted in increased salivary nitrite levels at 6- and 9-months post-treatment in the non-obese group (p<0.05). In obese individuals, FMD treatment led to an increase in salivary nitrite levels at 6 months (p<0.05); however, at 9 months, the nitrite levels returned to baseline levels. For both groups, the highest nitrite values were observed at 6 months. In addition, in both groups, FMD was associated with a decrease in biomarkers related to systemic inflammation and cardiovascular diseases, such as CRP (p<0.05) and alkaline phosphatase (p<0.05), and had no impact on the fasting blood glucose. This study demonstrates that obese patients with periodontitis present similar salivary nitrite levels when compared with non-obese individuals. FMD protocol resulted in increases in salivary nitrite levels and was associated with a positive impact on systemic biomarkers, regardless of obesity status.

Resumo Desastres naturais ocorrem desde os primordios, datando desde o surgimento do homem no planeta Terra, a cerca de 350 mil anos atrás. Estes tem modificado ecossistemas de forma a impactar aos mais variados tratos populacionais, qualidade de vida e outras atividades humanas. Desastres registrados no Brasil têm proporcionado significativas perdas, especialmente em áreas e regiões que concentram populações mais pobres e vulneráveis. Como hipótese, acreditamos que seja pertinente disseminação de informação sobre medidas prevenção e mitigação, específicas para cada vulnerabilidade identificada. A inserção de conhecimentos sobre gestão integrada de risco de desastres nas instituições de ensino superior apresenta-se como uma opção efetiva para a divulgação da cultura prevencionista e o fortalecimento de comunidades mais resilientes. Como objetivo geral buscar-se-á averiguar quais os fenômenos físicos naturais desencadeadores de desastres tem contribuído para retardar o desenvolvimento social e econômico. Tendo em vista que o estudo dos desastres é incipiente no país, optou-se por uma pesquisa exploratória e cujo sentido, teve o objetivo de nos proporcionar maior amplitude com o problema da pesquisa em epígrafe. No mundo contemporâneo é imprescindível que os gestores invistam em gestão de riscos e vulnerabilidades. Como sugestão, acredito que possamos levar este tema aos cursos de graduação, pós-graduação estrito e lato senso, para que todos tenham entendimento do assunto e possam disseminar de forma técnica científica as medidas estratégicas para mitigar os efeitos destrutivos dos fenômenos físicos naturais desencadeadores de desastres.

Abstract Natural disasters occurred since the emergence of man on planet Earth, about 350 thousands years ago. Its have been modified ecosystems in a way that can provide the most varied impacts population treatment, quality of life and others activities. Disasters in Brazil have led to significant losses, especially in areas and regions that concentrate the poorest and most vulnerable populations. As a hypothesis, we believe that it is pertinent to disseminate information on prevention and mitigation measures, specific to each identified vulnerability. The insertion of knowledge on integrated disaster risk management in higher education institutions presents itself as an effective option for the dissemination of prevention culture and the strengthening of more resilient communities. The general objective is to find out which natural physical phenomena have contributed to slowing down social and economic development. Given that the study of disasters is incipient in the country, we have opted for an exploratory research whose purpose was to provide us with greater scope with the problem of the research in question. In the contemporary world, it is essential that managers invest in risk and vulnerability management. As a suggestion, I believe that we can take this theme to the undergraduate, graduate and postgraduate courses strictly and broadly so that everyone has an understanding of the subject and can disseminate in a technical scientific way the strategic measures to mitigate the destructive effects of natural physical phenomena that trigger disasters.

Abstract Objective Obesity is a chronic disease that negatively affects an individual’s general and oral health. The present study aimed to compare the clinical and microbiological effects of non-surgical periodontal therapy with the full mouth disinfection (FMD) protocol on obese and non-obese individuals at 9 months post-therapy. Methodology This clinical study was first submitted and approved by the Ethics Committee. Fifty-five obese patients and 39 non-obese patients with periodontitis were evaluated. The full-mouth periodontal clinical parameters, clinical attachment level (CAL), probing depth (PD), gingival index (GI), and plaque index (PI), were monitored at baseline, 3, 6, and 9 months after periodontal treatment with full mouth disinfection (FMD) protocol. The mean count of Tannerella forsythia , Porphyromonas gingivalis , Treponema Denticola , and Aggregatibacter actinomycetemcomitans was determined by quantitative polymerase chain reaction on subgingival biofilm samples. Demographic data were assessed by Chi-square test. For clinical and microbiological parameters, two-factor repeated-measures ANOVA was used. Results In both groups, periodontal therapy using the one-stage full-mouth disinfection protocol significantly improved CAL, PD, GI, and PI (p<0.05). Obese and non-obese patients equally responded to non-surgical periodontal therapy (p>0.05). Microbial count found no major differences (p>0.05) between obese and non-obese individuals who had undergone non-surgical periodontal therapy. Conclusions Obesity did not affect the clinical and microbiological outcomes of non-surgical periodontal therapy.

RESUMO Objetivo: Avaliar a atuação odontológica em unidades de terapia intensiva. Métodos: Estudo observacional de enquete, por meio do envio de questionários via plataforma on-line de colaboração de pesquisa em terapia intensiva no Brasil (AMIBnet). A pesquisa foi realizada de junho a outubro de 2017. Os questionários, envolvendo 26 questões fechadas sobre os hospitais e a atuação odontológica nas unidades de terapia intensiva foram enviados para 4.569 profissionais de diversas especialidades atuantes nas unidades. Resultados: Obtivemos 203 questionários respondidos, resultando em uma taxa de resposta de 4,44%. A maior parte das respostas teve origem em unidades de terapia intensiva na Região Sudeste do país (46,8%). Hospitais públicos (37,9%) e privados (36,4%) tiveram participação semelhante nos resultados. Dos respondentes, 55% apontaram que um serviço de Odontologia à beira de leito estava presente, sendo prestado de maneiras diversas. Conclusão: Presença de Serviço de Odontologia e de treinamentos e protocolos de prestação de serviço em saúde bucal estiveram correlacionados. Os métodos de cuidados orais variaram sobremaneira entre as em unidades de terapia intensiva pesquisadas.

ABSTRACT Objective: To evaluate the practice of dentistry in intensive care units. Methods: An observational survey study was conducted in which questionnaires were sent via the online platform for collaboration in intensive care research in Brazil (AMIBnet). The study was carried out from June to October 2017. The questionnaires, which contained 26 closed questions about hospitals and dentistry practices in the intensive care units, were sent to 4,569 professionals from different specialties practicing in the units. Results: In total, 203 questionnaires were returned, resulting in a response rate of 4.44%. Most of the responses were from intensive care units in the Southeast region of the country (46.8%). Public hospitals (37.9%) and private hospitals (36.4%) had similar participation rates. Of the respondents, 55% indicated that a bedside dentistry service was present, and they were provided in different ways. Conclusion: The presence of dentistry services and oral health service delivery training and protocols were correlated. The oral care methods varied greatly among the intensive care units surveyed.