Resumo Fundamento No tratamento da fibrilação atrial (FA), a arritmia sustentada mais frequente, com ablação por cateter (ABL) ou cardioversão elétrica (CVE), o período periprocedimento é uma das fases mais críticas. Atualmente, o uso de novos anticoagulantes orais de ação direta (DOAC) é cada vez mais frequente, no entanto, no mundo real, ainda existem poucos dados de estudos sobre a incidência de trombo no átrio esquerdo (TrAE) ou contraste espontâneo denso (CE) no ecocardiograma transesofágico (ETE). Objetivo Analisar a prevalência de TrAE, por ETE, em pacientes em uso de DOAC submetidos à CVE/ABL. Secundariamente: avaliar a associação de comorbidades com a presença de trombos e CE. Métodos Estudo de coorte retrospectivo, unicêntrico, com pacientes do Ambulatório de Arritmia (InCor-HCFMUSP). Foram selecionados e analisados dados clínicos e ecocardiográficos no prontuário da instituição de pacientes com indicação de procedimentos e em uso de DOACs. Considerado um nível de significância de 5%. Resultados Foram incluídos 354 pacientes, no total de 400 procedimentos, de março de 2012-março de 2018. TrAE foi encontrado em 11 pacientes (2,8%), associado com idade avançada (p=0,007) e CHA2DS2-VASc maior (p<0,001). Foi encontrado CE no AE no procedimento antes da ETE em 29 pacientes (7,3%), com menor FEVE (p <0,038) e maior dimensão do AE (p <0,0001). Conclusão A incidência de TrAE e CE em pacientes em uso de DOAC no contexto de CVE/ABL de FA, embora pequena, não é desprezível. Pacientes com escore CHA2DS2-VASc maior, principalmente mais idosos e com diâmetro do AE maior, são mais propensos a esses achados ecocardiográficos.

Abstract Background In the treatment of atrial fibrillation (AF), the most frequently sustained arrhythmia, with catheter ablation (CA) or electrical cardioversion (ECV), the periprocedural period is one of the most critical phases. Currently, the use of new direct action oral anticoagulants (DOAC) is increasingly frequent; however, in the real world, there are still few data on studies on the thrombus incidence in the left atrium (TrLA) or dense spontaneous contrast (DSC) on transesophageal echocardiogram (TEE). Objective To evaluate the prevalence of events and association with risk factors in patients using DOACs. Primary objective: to analyze the prevalence of thrombus in the LA by TEE in patients using DOAC undergoing ECV/CA. Second, evaluate the association of comorbidities with the presence of thrombi and DSC. Methods Retrospective cohort, single-center study with patients followed at the Arrhythmia Outpatient Unit (InCor-HCFMUSP). Patients indicated for procedures and using DOACs were selected, and their clinical/echocardiographic data were analyzed. A significance level of 5% was considered. Results 354 patients were included, a total of 400 procedures, from March 2012-March 2018. Thrombus in the LA was found in 11 patients (2.8%), associated with advanced age (p=0.007) and higher CHA2DS2-VASc (p<0.001) score. DSC in the LA before TEE was found in 29 patients (7.3%), with lower LVEF (p<0.038) and greater LA dimension (p<0.0001). Conclusion The incidence of LA thrombus and DSC in patients using DOC in the context of AF ECV/CA, although small, is not negligible. Patients with higher CHA2DS2-VASc scores, especially older and with larger LA diameter, are more prone to these echocardiographic findings.

RESUMO Objetivo: Avaliar o consumo de fibras e analisar a sua relação com os fatores de risco cardiovascular em adolescentes portadores de lúpus eritematoso sistêmico juvenil. Métodos: Trata-se de um estudo transversal em que foram avaliados adolescentes com lúpus eritematoso sistêmico juvenil. O consumo alimentar foi avaliado pelo recordatório de 24 horas; o estado nutricional, classificado de acordo com o índice de massa corporal/idade, segundo o sexo; e a obesidade abdominal, analisada por meio da circunferência da cintura e razão cintura/estatura e do metabolismo glicídico e lipídico. Os dados foram analisados no Statistical Software for Professionals 14, e todas as análises estatísticas usaram erro alfa de 5%. Resultados: Foram avaliados 52 pacientes, com média de idade de 16,7±1,5 anos. O consumo inadequado de fibras ocorreu em 61,5% (n=32) dos adolescentes e evidenciou que a média das medidas da circunferência da cintura (81,4 vs. 75,5 cm; p=0,02), a relação cintura/estatura (0,51 vs. 0,47; p=0,02) e a pressão arterial sistólica (122,1 vs. 114,8 mmHg; p=0,03) foram maiores naqueles que tiveram consumo inadequado de fibras. Entre os fatores de risco cardiovascular avaliados, a relação cintura/estatura apresentou correlação negativa significante com consumo de fibras (r=-0,3; p=0,04). Ou seja, quanto maior o consumo de fibras, menor o valor da relação cintura/estatura. Conclusões: A baixa ingestão de fibras da dieta nos adolescentes com lúpus eritematoso sistêmico juvenil está relacionada com maior adiposidade abdominal e, consequentemente, com maior risco cardiovascular.

ABSTRACT Objective: To evaluate the fiber intake and the relationship with cardiovascular risk factors in adolescents with juvenile systemic lupus erythematosus. Methods: This is a cross-sectional in which adolescents with juvenile systemic lupus erythematosus were evaluated. The dietary consumption was assessed by the 24-hour recall; nutritional status was classified according to the Body Mass index/Age by Sex; abdominal obesity was assessed through waist circumference, waist-to-height ratio and glucose and lipid metabolism. The data were analyzed using Statistical Software for Professionals 14 and all statistical analyses used an alpha error of 5%. Results: 52 patients were evaluated, with a mean age of 16.7±1.5 years. Inadequate fiber consumption occurred in 61.5% (n=32) of them. Average of waist circumference measures (81.4 vs. 75.5 cm; p=0.02), waist-to-height ratio (0.51 vs. 0.47; p=0.02) and systolic blood pressure (122.1 vs. 114.8 mmHg; p=0.03) were higher in those who had inadequate fiber intake. Among the cardiovascular risk factors evaluated, the waist/height ratio showed a significant negative correlation with fiber consumption (r=-0.3; p=0.04), that is, the higher the fiber consumption, the lower the value of the waist ratio /stature. Conclusions: Low dietary fiber intake in adolescents with systemic lupus erythematosus juvenile is related to higher abdominal adiposity and consequently with increased cardiovascular risk.

INTRODUCTION: Eagle's syndrome is characterized by cervicopharyngeal signs and symptoms associated with elongation of the styloid apophysis. This elongation may occur through ossification of the stylohyoid ligament, or through growth of the apophysis due to osteogenesis triggered by a factor such as trauma. Elongation of the styloid apophysis may give rise to intense facial pain, headache, dysphagia, otalgia, buzzing sensations, and trismus. Precise diagnosis of the syndrome is difficult, and it is generally confounded by other manifestations of cervicopharyngeal pain. OBJECTIVE: To describe a case of Eagle's syndrome. CASE REPORT: A 53-year-old man reported lateral pain in his neck that had been present for 30 years. Computed tomography (CT) of the neck showed elongation and ossification of the styloid processes of the temporal bone, which was compatible with Eagle's syndrome. Surgery was performed for bilateral resection of the stylohyoid ligament by using a transoral and endoscopic access route. The patient continued to present pain laterally in the neck, predominantly on his left side. CT was performed again, which showed elongation of the styloid processes. The patient then underwent lateral cervicotomy with resection of the stylohyoid process, which partially resolved his painful condition. FINAL COMMENTS: Patients with Eagle's syndrome generally have a history of chronic pain. Appropriate knowledge of this disease is necessary for adequate treatment to be provided. The importance of diagnosing this uncommon and often unsuspected disease should be emphasized, given that correct clinical-surgical treatment is frequently delayed. The diagnosis of Eagle's syndrome is clinical and radiographic, and the definitive treatment in cases of difficult-to-control pain is surgical.

OBJETIVO: Avaliar um método estratégico nas aulas práticas, utilizando micro câmeras e monitores de vídeo para transmitir demonstrações da técnica operatória, comparando-o com o método de ensino aprendizagem clássico. METODOLOGIA: Foram aplicados 52 questionários direcionados aos alunos do 4º ano (grupo 1) submetidos a esta nova prática e aos do 3º ano (grupo 2) submetidos a metodologia de ensino tradicional. Este questionário também possibilitou detectar os principais problemas enfrentados pelos discentes durante o aprendizado desta etapa operatória. RESULTADOS: A fase de cirurgia de acesso foi considerada de difícil execução por ambos os grupos (G1- 30,8 % e G2- 34,6%), sendo a manobra de localização dos orifícios de entrada dos canais a etapa mais complicada. Quanto à avaliação da metodologia empregada no 3º ano, 23,1% dos alunos a consideraram excelente, 38,4% ótima, e 38,5% boa, ao passo que nenhum dos estudantes (0%) consideraram o método como regular, ruim ou péssimo. Uma menor ocorrência de erros (P<0,05), foi relatada pelos alunos do 3º ano (G1- 50% e G2- 34.6%). CONCLUSÃO: A nova estratégia de ensino favoreceu a aprendizagem, diminuiu a incidência de erros e foi considerada eficaz pelos alunos.

PURPOSE: To evaluate a strategic method of real time visual demonstration of the operatory procedures using an intraoral camera system and monitor videos, comparing them to those of conventional laboratory classes. METHODS: Fifty-two structured, multiple choice questionnaires were applied to undergraduate students of the 4th year (G1) and 3rd year (G2) submitted to the traditional and strategic teaching methods, respectively. These tests were also able to detect the main problems faced by the students during the training of this operatory phase. RESULTS: Students of both groups (G1- 30.8% and G2- 34.6%) considered the access cavity to be one of the most difficult phase of endodontic treatment. The results of the evaluation among the 3rd year students demonstrated that 23.1% graded the new method as excellent, 38.4% as very good and 38.5 % as good, whereas none of the students (0%) considered the method to be regular, bad or very bad. A minor accident occurrence (P<0.05) was reported by the 3rd year students (G1- 50% and G2- 34.6%). CONCLUSION: The new strategy was found to favor learning, reduce the incidence of errors and was appraised as efficient by the students.

Nitric oxide (NO) has been considered a key molecule in infammation. OBJECTIVE: The aim of this study was to evaluate the effect of treatment with L-NAME and sodium nitroprussiate, substances that inhibit and release NO, respectively, on tissue tolerance to endodontic irrigants. MATERIAL AND METHODS: The vital dye exudation method was used in a rat subcutaneous tissue model. Injections of 2% Evans blue were administered intravenously into the dorsal penial vein of 14 male rats (200-300 g). The NO inhibitor and donor substances were injected into the subcutaneous tissue in the dorsal region, forming two groups of animals: G1 was inoculated with L-NAME and G2 with sodium nitroprussiate. Both groups received injections of the test endodontic irrigants: acetic acid, 15% citric acid, 17% EDTA-T and saline (control). After 30 min, analysis of the extravasated dye was performed by light absorption spectrophotometry (620 nm). RESULTS: There was statistically signifcant difference (p<0.05) between groups 1 and 2 for all irrigants. L-NAME produced a less intense infammatory reaction and nitroprussiate intensifed this process. CONCLUSIONS: Independently of the administration of NO inhibitors and donors, EDTA-T produced the highest irritating potential in vital tissue among the tested irrigating solutions.

A tatuagem é definida como deposição de pigmento intencional ou acidental na pele. Os pigmentos têm sido associados a diversas dermatoses, como a dermatite de contato alérgica, a dermatite liquenoide e as reações fotoinduzidas, granulomatosas, sarcoídeas e pseudolinfomatosas. Enfocam-se os diversos tipos de reações aos pigmentos e a importância de reconhecê-los clinicamente. São relatados dois casos: um de dermatite liquenoide sobre o pigmento vermelho e outro de pseudolinfoma sobre os pigmentos vermelho e lilás e de reação fotoinduzida sobre o amarelo. A remoção geralmente requer múltiplos tratamentos, e a maioria não retira as cores completamente.

Tattoos are defined as the intentional or accidental deposit of pigment into the skin. These pigments have been associated with various dermatoses such as allergic contact dermatitis, lichenoid dermatitis, photoinduced reactions, and granulomatous, sarcoid and pseudolymphomatous reactions. The objective of this report was to describe the various types of reactions to pigments and the importance of recognizing them clinically. Two cases are reported: one of lichenoid dermatitis resulting from a reaction to the red pigment of a tattoo and the other of a pseudolymphoma resulting from a reaction to red and lilac pigments and a photo-induced reaction to a yellow pigment. Removal generally requires multiple forms of treatment, most of which fail to remove the colors completely.

Nos últimos 50 anos, foram publicados inúmeros estudos com a finalidade de comprovar se a dieta está relacionada à etiologia da acne. Embora existam estudos antigos, que são bem difundidos entre os dermatologistas e negam a associação entre acne e dieta, seu delineamento científico é pobre. Recentemente, novos artigos demonstraram evidências contrárias às publicações anteriores. Sendo assim, os autores realizaram esta revisão bibliográfica com o intuito de averiguar se a dieta influencia direta ou indiretamente um ou mais dos quatro pilares etiopatogênicos fundamentais da acne: (1) hiperproliferação dos queratinócitos basais, (2) aumento da produção sebácea, (3) colonização pelo Propionibacterium acnes e (4) inflamação.

Numerous studies were published over the last 50 years to investigate whether diet is associated with the etiology of acne. Although older studies well known by dermatologists that refute the association between acne and diet exist, their scientific foundation is weak. New articles have recently brought to light evidence contrary to previous findings. Therefore, we would like to investigate whether diet, directly or indirectly, influences one or more of the four fundamental etiopathogenic pillars of acne: (1) hyperproliferation of basal keratinocytes, (2) increase of sebaceous production, (3) colonization by Propionibacterium acnes, and (4) inflammation.

Mulher, 26 anos, com história de lesão eritêmato-escamosa no mamilo esquerdo, há dois anos. Era acompanhada pelo seu ginecologista como eczema crônico em uso de corticoide tópico, sem melhora. Encaminhada ao nosso serviço, realizou-se o diagnóstico de doença de Paget mamária associada ao carcinoma intraductal. Antes da quarta década de vida, a doença de Paget é rara, e, na grande maioria dos casos, está associada ao carcinoma mamário. Essa enfermidade constitui diagnóstico diferencial obrigatório do eczema do mamilo. O diagnóstico tardio, como no caso relatado, implica em pior prognóstico e aumento da morbidade, já que terapêutica mutilante é necessária.

A twenty-six-year-old woman with a two-year history of an erythematous, scaly lesion on the left nipple was being followed up by her gynecologist and treated using a topical corticoid for chronic eczema albeit with no improvement. She was referred to this department where a diagnosis of Paget's disease of the breast associated with a ductal carcinoma in situ was made. Paget's disease is uncommon prior to the fourth decade of life and the great majority of cases are associated with breast carcinomas. Differential diagnosis must be made between this condition and nipple eczema. As shown in the present case report, late diagnosis results in poor prognosis and higher morbidity since mutilating procedures then become necessary.

Durante a terapia endodôntica, a ação de limpeza é realizada com os instrumentos endodônticos auxiliada por substâncias químicas. Sendo assim, é importante que o endodontista conheça como são os instrumentos. Este trabalho visou avaliar a qualidade do acabamento de superfície de instrumentos endodônticos rotatórios por meio de microscopia eletrônica de varredura. Foram selecionados, 50 instrumentos endodônticos rotatórios nos números de 20, 25 e 30, das marcas Profile, Protaper, Race, Hero e K3 Endo, da forma como são encontradas no mercado e sem nenhum preparo prévio. Os instrumentos tiveram seus 3 milímetros finais fotomicrografados em microscópio eletrônico de varredura com ampliação de x190. As imagens foram avaliadas por três profissionais especialistas, e os resultados anotados em planilhas. A metodologia aplicada permitiu concluir que todos os instrumentos das marcas comerciais avaliadas apresentaram inadequações no acabamento da superfície. Cabe aclarar que, observando os critérios selecionados utilizados para avaliação a maioria das amostras apresentaram o mínimo de duas alterações e o máximo de sete por instrumento avaliado.

During endodontic therapy, cleaning of root canals is performed using endodontic files and auxiliary chemical substances, and it is important that the endodontist be familiar with the instruments used in daily practice. This study evaluated, under scanning electron microscopy (SEM), the quality of the surface finishing of unused rotary endodontic instruments. Fifty sizes 20, 25 and 30 rotary files from different commercial brands (ProFile, Protaper, Race, Hero and K3 Endo) were removed directly from their packages and had their final 3 mm examined with a scanning electron microscope at x190 magnification with no previous preparation. The images were evaluated by 3 skillful, calibrated, blinded observers according to the following criteria: cutting edge, debris, grooves, microcavities, tip shape, tip position, scraping and transition angle. Data were recorded in worksheets designed for the study. Irregular edges were observed in 50-100% of the files. Except for ProFile, all commercial brands presented surface debris in 100% of samples. Only Race files showed no grooves or microcavities. K3 Endo files presented the best tip centralization. Excetp for ProTaper files, all commercial brands presented blunt-cutting edges in 100% of samples. All types of files presented surface scraping. K3 Endo files and Protaper had a high percentage of transition angle. Based on the evaluation criteria used in the present study, most samples presented a minimum of 2 alterations and a maximum of 7 alterations per instrument. Under the tested conditions, the quality of the surface finishing of the examined instruments was not as expected, given that no instrument was free of imperfections and most of them presented at least 2 and up to 7 types of surface defects. These results suggest that the manufacturing process and the packaging conditions of rotary endodontic instruments are far from ideal.

OBJETIVO: Conhecer a prevalência do tabagismo e descrever o perfil e hábitos do consumo tabágico entre alunos da Universidade de Brasília. MÉTODOS: Responderam a um questionário adaptado sobre tabagismo, da Organização Mundial da Saúde, com perguntas dirigidas a fumantes, ex-fumantes e não fumantes, 1.341 alunos. Foram avaliados vinte cursos diferentes pertencentes às áreas de ciências da saúde, exatas e humanas. No momento da pesquisa, os universitários estavam cursando o segundo semestre letivo de 2003, devidamente matriculados no período diurno. RESULTADOS: A prevalência de tabagismo foi de 14,7%. Cerca de 80,8% dos alunos não eram fumantes e 4,5% foram classificados como ex-fumantes. Da amostra total, 57,3% eram homens. Não houve diferença estatisticamente significativa (p > 0,05) na prevalência de tabagismo entre os sexos ou períodos cursados. A média de idade da população estudada foi de 21,6 ± 3,6 anos, com idade média de início do tabagismo de 17 ± 2,8 anos. Os cursos de Geologia, Comunicação e História apresentaram as maiores prevalências de fumantes com 32,9%, 26,3% e 24,4%, respectivamente. Foi observado consumo médio de 7,5 cigarros por dia. O cigarro industrializado foi citado como o tipo de tabaco mais comumente utilizado entre os universitários (72,6%). CONCLUSÃO: Esta alta prevalência assemelha-se às de outros centros universitários e demanda políticas de controle do tabagismo nos meios universitários.

OBJECTIVE: To determine the prevalence of smoking and to describe the profile and smoking habits of students attending the Universidade de Brasília (University of Brasília) in Brasília, Brazil. METHODS: A total of 1341 students responded to a smoking questionnaire, adapted from the World Health Organization questionnaire, including questions directed at smokers, former smokers and nonsmokers. Twenty different courses in the areas of health, exact sciences and human sciences were evaluated. The students included in the study were duly enrolled in day courses and were evaluated during the second semester of 2003. RESULTS: The overall prevalence of smoking was 14.7%. Approximately 80.8% of the students were nonsmokers, and 4.5% were former smokers. In the study sample, 57.3% of the students were male. No significant difference (p > 0.05) in the prevalence of smoking was observed in terms of gender or class year. The mean age of the study population was 21.6 ± 3.6 years, and the mean age at which the smoking habit was acquired was 17 ± 2.8 years. The percentage of smokers was higher in the Geology, Communication, and History courses (32.9, 26.3 and 24.4%, respectively). Mean consumption was 7.5 cigarettes per day. The majority (72.6%) of the students used commercial cigarettes rather than other types of tobacco. CONCLUSION: The high prevalence of smoking observed in the present study is similar to that reported for other universities and indicates the need for smoking control policies in university environments.

Este experimento teve como objetivo avaliar in vitro os efeitos da interação entre soluções irrigantes desmineralizadoras (EDTA-T e ácido cítrico), medicação intracanal (NDP) e laser Er:YAG na permeabilidade dentinária. Foram utilizados 51 dentes unirradiculares extraídos que, após o preparo químico-cirúrgico, foram divididos em sete grupos experimentais: grupos I e II - irrigação final com solução de EDTA-T e ácido cítrico, respectivamente; grupos III e IV - irrigação final com EDTA-T e ácido cítrico, respectivamente, mais a associação entre solução irrigante e laser Er:YAG; grupos V e VI - irrigação final com EDTA-T e ácido cítrico, respectivamente, mais a associação entre medicação intracanal e laser Er:YAG, e grupo VII (controle) - irrigação final com água destilada. Os canais radiculares foram preenchidos com o corante rodamina B solubilizado na medicação de uso intracanal NDP. Após o período experimental, as amostras foram cortadas transversalmente para posterior leitura com o software ImageLab. A análise dos resultados permitiu concluir que existiram diferenças estatisticamente significantes (p < 0,05) quanto à penetração da solução corante-medicação intracanal nos diferentes grupos. Os grupos III e IV apresentaram menores valores de permeabilidade dentinária quando comparados aos outros e, finalmente, os melhores resultados foram obtidos quando da interação entre a solução irrigante desmineralizadora e a associação medicação intracanal/laser Er:YAG (grupos V e VI). Nesses, constatou-se que a diferença de penetração da solução corante-medicação intracanal no terço apical foi, em média, 29% maior do que nos demais grupos.

The purpose of this study was to evaluate in vitro the effects of different associations between irrigating solutions (EDTA-T and citric acid), intracanal medicament (NDP), and Er:YAG laser irradiation on dentin permeability. Fifty-one extracted single-rooted teeth were instrumented and divided into seven groups. Groups GI and GII had final irrigation with a demineralizing solution only (EDTA-T and citric acid, respectively). Groups GIII and GIV had final irrigation with EDTA-T and citric acid, respectively, plus an association of irrigating solution and Er:YAG laser. Groups GV and GVI had final irrigation with EDTA-T and citric acid, respectively, plus an association of intracanal medication and Er:YAG laser. Group GVII (control group) had final irrigation with distilled water. All root canals were filled with NDP associated with rhodamine B dye. After the experimental period, the samples were transversely cut into six 2.0 mm thick slices for subsequent reading using the ImageLab software. Analysis of the results allowed us to conclude that there were statistically significant differences (p < 0.05) between the groups as to the penetration of the dye-intracanal medication solution. Groups III and IV presented smaller values of dentinal permeability when compared to the other groups. The best results were obtained with the interaction between a demineralizing irrigating solution and the association of intracanal medicament and laser Er:YAG (groups V and VI). In these groups the observed penetration of the intracanal medicament plus dye solution in the apical third was, on average, 29% greater than in the other groups.