Conservative Management For Lingual Thyroid Ectopic.

Lingual thyroid gland is a rare clinical entity. The presence of an ectopic thyroid gland located at the base of the tongue may be presented with symptoms like dysphagia, dysphonia, and upper airway obstruction. We are introducing a case of an 8-year-old girl who had lingual thyroid that presented dysphagia and foreign body sensation in the throat. The diagnostic was reached with clinical examination, thyroid scintigraphy with Tc(99m) and ultrasound. A laryngoscopy was performed which confirmed a spherical mass at base of tongue. Investigation should include thyroid function tests. In this case we observed subclinical hypothyroidism. There are different types of surgical approaches for the treatment of this condition; however, the treatment with Levothyroxine Sodium allowed the stabilization of TSH levels and clinical improvement of symptoms in a follow-up of 2 years.

Dysphagia Progression And Swallowing Management In Parkinson's Disease: An Observational Study.

Dysphagia is relatively common in individuals with neurological disorders. To describe the swallowing management and investigate associated factors with swallowing in a case series of patients with Parkinson's disease. It is a long-term study with 24 patients. The patients were observed in a five-year period (2006-2011). They underwent Fiberoptic Endoscopic Evaluation of Swallowing, Functional Oral Intake Scale and therapeutic intervention every three months. In the therapeutic intervention they received orientation about exercises to improve swallowing. The Chi-square, Kruskal-Wallis and Fisher's tests were used. The period of time for improvement or worsening of swallowing was described by Kaplan-Meier analysis. During the follow-up, ten patients improved, five stayed the same and nine worsened their swallowing functionality. The median time for improvement was ten months. Prior to the worsening there was a median time of 33 months of follow-up. There was no associated factor with improvement or worsening of swallowing. The maneuvers frequently indicated in therapeutic intervention were: chin-tuck, bolus consistency, bolus effect, strengthening-tongue, multiple swallows and vocal exercises. The swallowing management was characterized by swallowing assessment every three months with indication of compensatory and rehabilitation maneuvers, aiming to maintain the oral feeding without risks. There was no associated factor with swallowing functionality in this case series.

Avaliação de técnicas de classificação digital de imagens landsat em diferentes padrões de cobertura da terra em Rondônia

Remotely sensed imagery has been widely used for land use/cover classification thanks to the periodic data acquisition and the widespread use of digital image processing systems offering a wide range of classification algorithms. The aim of this work was to evaluate some of the most commonly used supervised and unsupervised classification algorithms under different landscape patterns found in Rondônia, including (1) areas of mid-size farms, (2) fish-bone settlements and (3) a gradient of forest and Cerrado (Brazilian savannah). Comparison with a reference map based on the kappa statistics resulted in good to superior indicators (best results - K-means: k=0.68; k=0.77; k=0.64 and MaxVer: k=0.71; k=0.89; k=0.70 respectively for three areas mentioned). Results show that choosing a specific algorithm requires to take into account both its capacity to discriminate among various spectral signatures under different landscape patterns as well as a cost/benefit analysis considering the different steps performed by the operator performing a land cover/use map. it is suggested that a more systematic assessment of several options of implementation of a specific project is needed prior to beginning a land use/cover mapping job.

Comparative analysis of adverse events between infliximab and adalimumab in Crohn's disease management: a Brazilian single-centre experience

INTRODUCTION: Data is scarce regarding adverse events (AE) of biological therapy used in the management of Crohn's Disease (CD) among Brazilian patients. OBJECTIVES: To analyse AE prevalence and profile in patients with CD treated with Infliximab (IFX) or Adalimumab (ADA) and to verify whether there are differences between the two drugs. METHOD: Retrospective observational single-centre study of CD patients on biological therapy. Variables analysed: Demographic data, Montreal classification, biological agent administered, treatment duration, presence and type of AE and the need for treatment interruption. RESULTS: Forty-nine patients were analysed, 25 treated with ADA and 24 with IFX. The groups were homogeneous in relation to the variables studied. The average follow-up period for the group treated with ADA was 19.3 months and 21.8 months for the IFX group (p = 0.585). Overall, 40% (n = 10) of patients taking ADA had AE compared with 50% (n = 12) of IFX users (p = 0.571). There was a tendency towards higher incidence of cutaneous and infusion reactions in the IFX group and higher incidence of infections in the ADA treated group, although without significant difference. CONCLUSIONS: No difference was found in the AE prevalence and profile between ADA and IFX CD patients in the population studied.

Comparative analysis of the new guidelines and consensuses for the management of hypothyroidism, thyroid nodules, and differentiated thyroid cancer

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Modelo de inclusão digital para construção do conhecimento em qualidade de vida e atividade fisica

Universidade Estadual de Campinas. Faculdade de Educação Física

Clinical management for epidermolysis bullosa dystrophica

Epidermolysis bullosa (EB) consists of a group of genetic hereditary disorders in which patients frequently present fragile skin and mucosa that form blisters following minor trauma. More than 20 subtypes of EB have been recognized in the literature. Specific genetic mutations are well characterized for most the different EB subtypes and variants. The most common oral manifestations of EB are painful blisters affecting all the oral surfaces. Dental treatment for patients with EB consists of palliative therapy for its oral manifestations along with typical restorative and periodontal procedures. The aim of this article is to describe two dental clinical treatments of recessive dystrophic EB cases and their specific clinical manifestations. The psychological intervention required during the dental treatment of these patients is also presented.

Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects

OBJECTIVES: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure. MATERIAL AND METHODS: Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized pre-surgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05). RESULTS: As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm² in the test group and 2 mm² in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05). CONCLUSIONS: The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions.

Management of a complex dentoalveolar trauma: a case report

This paper describes the case of a 12-year-old male patient who presented a severe lateral luxation of the maxillary central incisors due to a bicycle fall. Treatment involved suture of the soft tissues lacerations, and repositioning and splinting of the injured teeth, followed by endodontic treatment and periodontal surgery. After a 2-year follow-up, clinical and radiographic evaluation revealed that the incisors presented satisfactory esthetic and functional demands.

Evaluation of the maxillary premolar roots dissociation using radiographic holders with conventional and digital radiography

This in vivo study evaluated the dissociation quality of maxillary premolar roots combining variations of vertical and horizontal angulations by using X-ray holders (Rinn -XCP), and made a comparison between two types of intraoral radiography systems - conventional film (Kodak Insight, Rochester, USA) and digital radiography (Kodak RVG 6100, Kodak, Rochester, USA). The study sample was comprised of 20 patients with a total of 20 maxillary premolars that were radiographed, using the paralleling angle technique (GP), with a 20º variation of the horizontal angle (GM) and 25º variation of the horizontal angle combined with 15º vertical angle (GMV). Each image was independently analyzed by two experienced examiners. These examiners assigned a score to the diagnostic capability of root dissociation and the measurement of the distance between the apexes. Statistical data was derived using the Wilcoxon Signed Rank test, Friedman and T test. The means of the measured distances between buccal and lingual root apexes were greater for the GMV, which ranged from 2.3 mm to 3.3 mm. A statistically significant difference was found between GM and GMV when compared to GP with p < 0.01. An established best diagnostic dissociation roots image was found in the GMV. These results support the use of the anterior X-ray holders which offer a better combined deviation (GMV) to dissociate maxillary premolar roots in both radiography systems.

Proposta educacional on-line sobre úlcera por pressão para alunos e profissionais de enfermagem

OBJETIVOS: Desenvolver uma proposta educacional on-line sobre o tema úlcera por pressão para alunos e profissionais de enfermagem. MÉTODOS: Pesquisa aplicada, de produção tecnológica, composta pelas etapas de concepção/ planejamento e desenvolvimento, caracterizadas por um conjunto de procedimentos, documentação, digitalização de informações e de imagens. Foram utilizados recursos computacionais didáticos interativos como: o Cybertutor e o Homem Virtual. RESULTADOS: Desenvolvimento de uma proposta educacional virtual sobre úlcera por pressão (UP) dividida em módulos de aprendizagem, contendo lista de discussão, estudos de casos e recursos didáticos, tais como fotos e o Homem Virtual. CONCLUSÕES: Utilizou-se de novas tecnologias educacionais, com a finalidade de promover o aprendizado sobre UP a estudantes de graduação de enfermagem e possibilitar a educação continuada de enfermeiros, uma vez que as UP representam um desafio aos profissionais da saúde e aos serviços de saúde.

Fire management and the nesting of Athene cunicularia (Aves, Strigidae) in grasslands in central Cerrado, Brazil

Fire management is a common practice in several reserves in the Cerrado, but its influences on bird reproduction remain unknown. In addition, the nesting biology of the Burrowing Owl (Athene cunicularia) has been studied in numerous environments, but not in tropical grasslands managed by fire. This study examined the effects of fire management on the nesting biology of A. cunicularia in Emas National Park, State of Goias, central Brazilian Cerrado. We compared the number of breeding pairs and their burrows in October and November 2009 at 15 study sites in grasslands managed by fire (firebreaks) and unmanaged grasslands adjacent to and distant from firebreaks. We visited active burrows two-four times and described the burrow entrances and sentinel sites and counted and observed adults and young. A total of 19 burrows were found at firebreaks. One and two burrows were found in grasslands adjacent to and distant from firebreaks, respectively. For all burrows found, one to three young reached the adult size, being able to fly and/or run in early November. The 22 burrows found were in the ground, associated or not with termite and ant nests. Most (86.4%) burrows had only one entrance. Only three burrows had two or three entrances. Structures used as sentinel perches by adults were mounds in front of the burrow entrances, termite nests, shrubs and trees. Most of these sentinel sites were shorter than 2 m high and located less than 10 m from the burrow entrance. At Emas National Park, firebreaks appear to provide more attractive conditions to the nesting of A. cunicularia than unmanaged grasslands, likely because of the short herbaceous stratum due to frequent burning of firebreaks. This study suggests that fire management provides suitable conditions for the successful reproduction of A. cunicularia in firebreaks at Emas National Park.

Reproducibility, reliability and validity of measurements obtained from Cecile3 digital models

The aim of this study was to determine the reproducibility, reliability and validity of measurements in digital models compared to plaster models. Fifteen pairs of plaster models were obtained from orthodontic patients with permanent dentition before treatment. These were digitized to be evaluated with the program Cécile3 v2.554.2 beta. Two examiners measured three times the mesiodistal width of all the teeth present, intercanine, interpremolar and intermolar distances, overjet and overbite. The plaster models were measured using a digital vernier. The t-Student test for paired samples and interclass correlation coefficient (ICC) were used for statistical analysis. The ICC of the digital models were 0.84 ± 0.15 (intra-examiner) and 0.80 ± 0.19 (inter-examiner). The average mean difference of the digital models was 0.23 ± 0.14 and 0.24 ± 0.11 for each examiner, respectively. When the two types of measurements were compared, the values obtained from the digital models were lower than those obtained from the plaster models (p < 0.05), although the differences were considered clinically insignificant (differences < 0.1 mm). The Cécile digital models are a clinically acceptable alternative for use in Orthodontics.

Evaluation of follicular lymphoid depletion in the Bursa of Fabricius: an alternative methodology using digital image analysis and artificial neural networks

Fifty Bursa of Fabricius (BF) were examined by conventional optical microscopy and digital images were acquired and processed using Matlab® 6.5 software. The Artificial Neuronal Network (ANN) was generated using Neuroshell® Classifier software and the optical and digital data were compared. The ANN was able to make a comparable classification of digital and optical scores. The use of ANN was able to classify correctly the majority of the follicles, reaching sensibility and specificity of 89% and 96%, respectively. When the follicles were scored and grouped in a binary fashion the sensibility increased to 90% and obtained the maximum value for the specificity of 92%. These results demonstrate that the use of digital image analysis and ANN is a useful tool for the pathological classification of the BF lymphoid depletion. In addition it provides objective results that allow measuring the dimension of the error in the diagnosis and classification therefore making comparison between databases feasible.

Contaminated sites and brownfield management State of art in Brazil and in Germany

Purpose - The aim of this paper is to briefly present aspects of public brownfield management policies from Brazilian and German points of view. Design methodology approach - The data collection method combined literature and documental research. The bibliography included Brazilian and German literature about brownfield management. The documental research includes Brazilian and German legislation and official documents published by CETESB, the Environmental Company of the State of São Paulo, Brazil. Furthermore, publications of German governmental research institutions have been integrated in the paper. Findings - In Brazil, despite the lack of a federal public policy, the State of São Paulo has approved specific rules to deal with contaminated sites. Topics that could be targets of scientific studies have been identified. Experiences in Germany show that it is essential to have political will and cooperation between the different political levels and technical disciplines. Partnerships between German and Brazilian universities would be welcome as there is a wide range of opportunities for academic post-graduation studies and research focusing on human resources capacitation in environmental management. Originality value - The paper makes an original contribution of exploring an area (brownfield management) that is at the forefront of discussion in academe and industry