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OBJECTIVE: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019. METHODS: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula. RESULTS: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27). CONCLUSION: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.

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OBJECTIVES: To evaluate the potential of laser-microtextured abutments (LMAs) compared to machined abutments (MAs) in peri-implant clinical and radiographic outcomes. MATERIALS AND METHODS: Eligible studies consisted of randomized clinical trials (RCTs) retrieved from MEDLINE, Web of Science, Scopus, and Embase databases. The study adhered to the PRISMA statement, and the protocol was registered at the PROSPERO (registration number CRD42023443112). The risk of bias was evaluated according to version 2 of the Cochrane risk of bias tool (RoB 2). Meta-analyses were performed using random effect models. Afterward, the GRADE approach was used to determine the certainty of evidence. RESULTS: Four RCTs were included from a total of 2,876 studies. LMAs had lower peri-implant sulcus depth at 6-8 weeks (WMD: -0.69 mm; 95% CI: -0.97, -0.40; p = 0.15, I2 = 53%) and at one year (WMD: -0.75 mm; 95% CI: -1.41, -0.09; p = 0.09, I2 = 65%), but the certainty of evidence was low. In addition, the marginal bone loss favored the LMAs group (WMD: -0.29 mm; 95% CI: -0.36, -0.21; p = 0.69, I2 = 0%) with moderate evidence. There were fewer sites with bleeding on probing in the LMAs group (WMD: -1.10; 95% CI: -1.43, -0.77; p = 0.88, i2 = 0%). There was no statistical difference between groups for the modified gingival index and modified plaque index. Furthermore, all studies were classified as having some concerns risk of bias. CONCLUSIONS: There was low to moderate certainty evidence that LMAs can favor peri-implant clinical and radiographic parameters compared to MAs. CLINICAL RELEVANCE: Laser-microtextured abutments may benefit peri-implant clinical and radiographic outcomes.

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BACKGROUND: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. OBJECTIVE: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. METHODS: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. OUTCOMES: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. CONCLUSION: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.

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ABSTRACT Background: Driving pressure has been suggested to be the main driver of ventilator-induced lung injury and mortality in observational studies of acute respiratory distress syndrome. Whether a driving pressure-limiting strategy can improve clinical outcomes is unclear. Objective: To describe the protocol and statistical analysis plan that will be used to test whether a driving pressure-limiting strategy including positive end-expiratory pressure titration according to the best respiratory compliance and reduction in tidal volume is superior to a standard strategy involving the use of the ARDSNet low-positive end-expiratory pressure table in terms of increasing the number of ventilator-free days in patients with acute respiratory distress syndrome due to community-acquired pneumonia. Methods: The ventilator STrAtegy for coMmunIty acquired pNeumoniA (STAMINA) study is a randomized, multicenter, open-label trial that compares a driving pressure-limiting strategy to the ARDSnet low-positive end-expiratory pressure table in patients with moderate-to-severe acute respiratory distress syndrome due to community-acquired pneumonia admitted to intensive care units. We expect to recruit 500 patients from 20 Brazilian and 2 Colombian intensive care units. They will be randomized to a driving pressure-limiting strategy group or to a standard strategy using the ARDSNet low-positive end-expiratory pressure table. In the driving pressure-limiting strategy group, positive end-expiratory pressure will be titrated according to the best respiratory system compliance. Outcomes: The primary outcome is the number of ventilator-free days within 28 days. The secondary outcomes are in-hospital and intensive care unit mortality and the need for rescue therapies such as extracorporeal life support, recruitment maneuvers and inhaled nitric oxide. Conclusion: STAMINA is designed to provide evidence on whether a driving pressure-limiting strategy is superior to the ARDSNet low-positive end-expiratory pressure table strategy for increasing the number of ventilator-free days within 28 days in patients with moderate-to-severe acute respiratory distress syndrome. Here, we describe the rationale, design and status of the trial.

RESUMO Contexto: Em estudos observacionais sobre a síndrome do desconforto respiratório agudo, sugeriu-se que a driving pressure é o principal fator de lesão pulmonar induzida por ventilador e de mortalidade. Não está claro se uma estratégia de limitação da driving pressure pode melhorar os desfechos clínicos. Objetivo: Descrever o protocolo e o plano de análise estatística que serão usados para testar se uma estratégia de limitação da driving pressure envolvendo a titulação da pressão positiva expiratória final de acordo com a melhor complacência respiratória e a redução do volume corrente é superior a uma estratégia padrão envolvendo o uso da tabela de pressão positiva expiratória final baixa do protocolo ARDSNet, em termos de aumento do número de dias sem ventilador em pacientes com síndrome do desconforto respiratório agudo devido à pneumonia adquirida na comunidade. Métodos: O estudo STAMINA (ventilator STrAtegy for coMmunIty acquired pNeumoniA) é randomizado, multicêntrico e aberto e compara uma estratégia de limitação da driving pressure com a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet em pacientes com síndrome do desconforto respiratório agudo moderada a grave devido à pneumonia adquirida na comunidade internados em unidades de terapia intensiva. Esperamos recrutar 500 pacientes de 20 unidades de terapia intensiva brasileiras e duas colombianas. Eles serão randomizados para um grupo da estratégia de limitação da driving pressure ou para um grupo de estratégia padrão usando a tabela de pressão positiva expiratória final baixa do protocolo ARDSnet. No grupo da estratégia de limitação da driving pressure, a pressão positiva expiratória final será titulada de acordo com a melhor complacência do sistema respiratório. Desfechos: O desfecho primário é o número de dias sem ventilador em 28 dias. Os desfechos secundários são a mortalidade hospitalar e na unidade de terapia intensiva e a necessidade de terapias de resgate, como suporte de vida extracorpóreo, manobras de recrutamento e óxido nítrico inalado. Conclusão: O STAMINA foi projetado para fornecer evidências sobre se uma estratégia de limitação da driving pressure é superior à estratégia da tabela de pressão positiva expiratória final baixa do protocolo ARDSnet para aumentar o número de dias sem ventilador em 28 dias em pacientes com síndrome do desconforto respiratório agudo moderada a grave. Aqui, descrevemos a justificativa, o desenho e o status do estudo.

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ABSTRACT Objective: To assess whether the respiratory oxygenation index (ROX index) measured after the start of high-flow nasal cannula oxygen therapy can help identify the need for intubation in patients with acute respiratory failure due to coronavirus disease 2019. Methods: This retrospective, observational, multicenter study was conducted at the intensive care units of six Brazilian hospitals from March to December 2020. The primary outcome was the need for intubation up to 7 days after starting the high-flow nasal cannula. Results: A total of 444 patients were included in the study, and 261 (58.7%) were subjected to intubation. An analysis of the area under the receiver operating characteristic curve (AUROC) showed that the ability to discriminate between successful and failed high-flow nasal cannula oxygen therapy within 7 days was greater for the ROX index measured at 24 hours (AUROC 0.80; 95%CI 0.76 - 0.84). The median interval between high-flow nasal cannula initiation and intubation was 24 hours (24 - 72), and the most accurate predictor of intubation obtained before 24 hours was the ROX index measured at 12 hours (AUROC 0.75; 95%CI 0.70 - 0.79). Kaplan-Meier curves revealed a greater probability of intubation within 7 days in patients with a ROX index ≤ 5.54 at 12 hours (hazard ratio 3.07; 95%CI 2.24 - 4.20) and ≤ 5.96 at 24 hours (hazard ratio 5.15; 95%CI 3.65 - 7.27). Conclusion: The ROX index can aid in the early identification of patients with acute respiratory failure due to COVID-19 who will progress to the failure of high-flow nasal cannula supportive therapy and the need for intubation.

RESUMO Objetivo: Avaliar se o índice de oxigenação respiratória medido após o início da terapia de oxigênio com cânula nasal de alto fluxo pode ajudar a identificar a necessidade de intubação em pacientes com insuficiência respiratória aguda devido à COVID-19. Métodos: Este estudo retrospectivo, observacional e multicêntrico foi realizado nas unidades de terapia intensiva de seis hospitais brasileiros, de março a dezembro de 2020. O desfecho primário foi a necessidade de intubação até 7 dias após o início da cânula nasal de alto fluxo. Resultados: O estudo incluiu 444 pacientes; 261 (58,7%) foram submetidos à intubação. Uma análise da área sob a curva receiver operating characteristic (ASC ROC) mostrou que a capacidade de discriminar entre o sucesso e o fracasso da oxigenoterapia com cânula nasal de alto fluxo dentro de 7 dias foi maior para o índice de oxigenação respiratória medido em 24 horas (ASC ROC 0,80; IC95% 0,76 - 0,84). O intervalo médio entre o início da cânula nasal de alto fluxo e a intubação foi de 24 horas (24 - 72), e o preditor mais preciso de intubação obtido antes de 24 horas foi o índice de oxigenação respiratória medido em 12 horas (ASC ROC 0,75; IC95% 0,70 - 0,79). As curvas de Kaplan-Meier revelaram maior probabilidade de intubação em 7 dias em pacientes com índice de oxigenação respiratória ≤ 5,54 em 12 horas (razão de risco 3,07; IC95% 2,24 - 4,20) e ≤ 5,96 em 24 horas (razão de risco 5,15; IC95% 3,65 - 7,27). Conclusões: O índice de oxigenação respiratória pode ajudar na identificação precoce de pacientes com insuficiência respiratória aguda devido à COVID-19 que evoluirão para o fracasso da terapia de suporte com cânula nasal de alto fluxo e a necessidade de intubação.

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OBJECTIVE: This study evaluated Temporomandibular Disorder (TMD) in individuals with Spinal Cord Injuries (SCI) compared to individuals without physical disabilities. DESIGN: Cross-sectional. SETTING: International Fair of Technologies in Rehabilitation and Accessibility (REATECH) and School of Dentistry at the University of São Paulo (USP), Brazil. PARTICIPANTS: In total, 19 patients with SCI and 19 patients without SCI (36.9 ± 11.4 years old) were examined by a calibrated examiner. METHODS: using the following parameters: cervical spine mobility, palpation of muscle groups of the head and neck, functional manipulation of the lateral and medial pterygoids, and joint palpation (Diagnostic Criteria). The pattern and amplitude of mandibular movements were determined during screening using the Helkimo index. STATISTICAL ANALYSES: Student's t-test, chi-square, Fisher's exact and Shapiro-Wilk test were used. RESULTS: The groups did not differ in the presence of noise, pain, temporomandibular joint palpation, locking, dislocation, jaw pain, muscle sensitivity, or in pain, mobility of the cervical spine and functional manipulation. With respect to the jaw mobility index, the groups differed in range of movement (P = 0.020) and maximum right lateral movement (P = 0.007), with the worst values in the SCI group. The groups also differed in relation to lateral flexion in cervical mobility, in which the group without SCI presented better results (P = 0.046). CONCLUSION: The Spinal Cord Injuries group showed higher levels of TMD in terms of range of movement, lateral flexion, and maximum right lateral movement, than the individuals without physical disabilities, demonstrating a clinical significance between cervical and mandibular disability in this group.

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AIM: To compare tissue changes at implant sites previously treated with two biomaterials for alveolar ridge preservation (ARP) in the aesthetic zone, 1 year after restoration. MATERIALS AND METHODS: Sixty-six participants were treated with ARP using demineralized bovine bone mineral (DBBM) or DBBM +10% of collagen (DBBM-C), both covered with a collagen matrix (CM). Dental implants were placed, and definitive crowns were installed. Silicon impressions were taken before tooth extraction (T0), 2 weeks after crown insertion (T1) and 1 year after restoration (T2). Mid-facial mucosal level change (MLC), soft tissue thickness changes (TT), and marginal bone loss (MBL) were analysed using inter-group comparisons. RESULTS: Fifty-four participants were included in the analysis. The mid-facial level change between T0-T1 and T1-T2 showed no statistical difference between DBBM and DBBM-C. Between T0 and T1 for soft tissue thickness, DBBM performed significantly better at 3 and 5 mm below the mucosal margin. From T1 to T2, no significant differences between groups were found at any level for soft tissue thickness and MBL. CONCLUSION: At the aesthetic zone, advanced recession from tooth extraction to crown placement can be expected at sites treated with ARP regardless of biomaterial used. However, after crown insertion, tissue stability can be predicted.

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Parkinson's disease (PD) is a chronic neurodegenerative disease whose motor symptoms are accompanied by an exaggerated power in the alpha-beta (7-35Hz) band and an increased synchronization of neurons encompassing the cortex-basal ganglia-thalamus network. Currently, deep brain stimulation (DBS) is used as an effective therapy for reducing the excessive power and synchrony observed in brain circuits, thereby ameliorating the PD symptoms. In the present study, we used a biologically plausible computational model of cortex-basal ganglia-thalamus network, which represents both healthy and PD conditions, to systematically investigate the effects of DBS frequency on the model outputs. DBS was applied to the subthalamic nucleus (STN) at different stimulation frequencies (40Hz to 300Hz). Spike train variability and spectral power in the 7-35Hz band were measured from the several nuclei represented in the model. In addition, the magnitude squared coherence between the nuclei was assessed. An increased DBS frequency tended to produce interspike intervals (ISIs) with higher variability as compared to PD condition. Also, DBS significantly reduced the alpha-beta power for almost all brain nuclei. The median of the magnitude-squared coherence matrix (which is a metric of global network synchronization) decreased significantly with the increase of DBS frequency.

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Rationale: Evidence from observational studies suggests that driving pressure is strongly associated with pulmonary injury and mortality, regardless of positive end-expiratory pressure (PEEP) levels, tidal volume, or plateau pressure. Therefore, it is possible that targeting driving pressure may improve the safety of ventilation strategies for patients with acute respiratory distress syndrome (ARDS). However, the clinical effects of a driving pressure-limited strategy for ARDS has not been assessed in randomized controlled trials.Objectives: To evaluate the feasibility of testing a driving pressure-limited strategy in comparison with a conventional lung-protective ventilation strategy in patients with ARDS and a baseline driving pressure of ≥13 cm H2O.Methods: This was a randomized, controlled, nonblinded trial that included 31 patients with ARDS who were on invasive mechanical ventilation and had a driving pressure of ≥13 cm H2O. Patients allocated to the driving pressure-limited strategy were ventilated with volume-controlled or pressure-support ventilation modes, with tidal volume titrated to 4-8 ml/kg of predicted body weight (PBW), aiming at a driving pressure of 10 cm H2O, or the lowest possible. Patients in the control group were ventilated according to the ARDSNet (Acute Respiratory Distress Syndrome Network) protocol, using a tidal volume of 6 ml/kg PBW, which was allowed to be set down to 4 ml/kg PBW if the plateau pressure was >30 cm H2O. The primary endpoint was the driving pressure on Days 1-3.Results: Sixteen patients were randomized to the driving pressure-limited group and 15 were randomized to the conventional strategy group. All patients were considered in analyses. Most of the patients had mild ARDS with a mean arterial oxygen tension/fraction of inspired oxygen ratio of 215 (standard deviation [SD] = 95). The baseline driving pressure was 15.0 cm H2O (SD = 2.6) in both groups. In comparison with the conventional strategy, driving pressure from the first hour to the third day was 4.6 cm H2O lower in the driving pressure-limited group (95% confidence interval [CI], 6.5 to 2.8; P < 0.001). From the first hour up to the third day, tidal volume in the driving pressure-limited strategy group was kept lower than in the control group (mean difference [ml/kg of PBW], 1.3; 95% CI, 1.7 to 0.9; P < 0.001). We did not find statistically significant differences in the incidence of severe acidosis (pH < 7.10) within 7 days (absolute difference -12.1; 95% CI, -41.5 to -17.3) or any clinical secondary endpoint.Conclusions: In patients with ARDS, a trial assessing the effects of a driving pressure-limited strategy using very low tidal volumes versus a conventional ventilation strategy on clinical outcomes is feasible.Clinical trial registered with ClinicalTrials.gov (NCT02365038).

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Waterfowl hunting in Argentina is a profitable industry that attracts hunters from all over the world. Most hunting occurs as high-end hunting tourism, through which registered outfitters service predominantly foreign clients on private lands. Lead pollution from hunting ammunition is increasingly recognized as a significant local problem, impacting wildlife, aquatic and terrestrial habitats, and extending to vulnerable human rural communities. Regulatory frameworks that restrict lead shot use are a budding success story but remain challenged by their constrained geographic range and limited compliance rooted in unavailable nontoxic ammunition. Changes in hunting practices in Argentina are long overdue.

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Wild aquatic birds are the major reservoir of influenza A virus. Cloacal swabs and feces samples (n = 6595) were collected from 62 bird species in Argentina from 2006 to 2016 and screened for influenza A virus. Full genome sequencing of 15 influenza isolates from 6 waterfowl species revealed subtypes combinations that were previously described in South America (H1N1, H4N2, H4N6 (n = 3), H5N3, H6N2 (n = 4), and H10N7 (n = 2)), and new ones not previously identified in the region (H4N8, H7N7 and H7N9). Notably, the internal gene segments of all 15 Argentine isolates belonged to the South American lineage, showing a divergent evolution of these viruses in the Southern Hemisphere. Time-scaled phylogenies indicated that South American gene segments diverged between ~ 30 and ~ 140 years ago from the most closely related influenza lineages, which include the avian North American (PB1, HA, NA, MP, and NS-B) and Eurasian lineage (PB2), and the equine H3N8 lineage (PA, NP, and NS-A). Phylogenetic analyses of the hemagglutinin and neuraminidase gene segments of the H4, H6, and N8 subtypes revealed recent introductions and reassortment between viruses from the Northern and Southern Hemispheres in the Americas. Remarkably and despite evidence of recent hemagglutinin and neuraminidase subtype introductions, the phylogenetic composition of internal gene constellation of these influenza A viruses has remained unchanged. Considering the extended time and the number of sampled species of the current study, and the paucity of previously available data, our results contribute to a better understanding of the ecology and evolution of influenza virus in South America.

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Fraser syndrome (FS) is a rare recessive autosomal genetic disorder characterized by multisystemic malformations typically comprising cryptophthalmos, syndactyly, and renal defects. We report the case of a 16-year-old patient who exhibited facial asymmetry, short roots, hypodontia, and malocclusion. Oral rehabilitation included orthodontics, exodontia, and osseointegrated dental implants to improve the patient's self-esteem and eating function. We suggest short roots and hypodontia assessment in patients with FS.

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Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.

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The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

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Abstract The purpose of this cross-sectional study was to investigate the effect of different forms of periodontal diseases on Oral Health-Related Quality of Life (OHRQoL). Fifty-two patients with Aggressive Periodontitis (AP) or Chronic Periodontitis (CP) were included: nine patients with Localized Aggressive Periodontitis (LAP), thirty-three patients with Generalized Aggressive Periodontitis (GAP) and ten patients with Generalized Chronic Periodontitis (GCP). Oral Health Impact Profile questionnaires (OHIP-14) were distributed after a clinical examination that measured the following periodontal parameters: tooth loss, bleeding on probing (BoP), probing depth (PD), gingival recession (REC) and clinical attachment level (CAL). The global OHIP-14 score means were 10.6 for LAP, 16.5 for GAP, and 17.5 for GCP. A statistically significant difference (p < 0.01) was observed between the LAP group and the other two groups. There was significantly less bleeding and recession in the LAP group than in the patients with the generalized forms of periodontitis. LAP, GAP and GCP have an impact on patient quality of life when measured using the OHIP-14. Patients with GAP and GCP had poorer OHRQoL than LAP patients.

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Abstract Given the growing trend towards medical indications for continuous use of anticoagulants, the number of patients on these medications continues to rise. The management of patients on oral anticoagulants requiring oral surgical procedures has aroused much controversy. Changes in an anticoagulation regimen are associated with an increased risk of thromboembolism. However, it seems logical and advantageous for the patients' health if surgery could be performed without any change to the anticoagulation therapy. In dentistry, high-power lasers have been poorly explored in this field. The hemostatic properties of high-power lasers could be helpful during oral soft tissue surgeries in anticoagulated patients. The aim of this study was to compare bleeding time in anticoagulated rats after lingual frenectomy performed with a scalpel or diode laser with bleeding time in healthy animals. Twenty-four male Wistar rats were assigned to four groups (n = 6): (CS) Control-Scalpel Surgery; (AS) Anticoagulated-Scalpel Surgery; (CL) Control-Laser (diode laser 810 nm/1.5 W) Surgery; and (AL) Anticoagulated-Laser Surgery (diode laser 810 nm/1.5 W). Warfarin administration was used to induce anticoagulation. Blood was blotted every 30 seconds with filter paper until bleeding stopped to verify bleeding time. Two blinded researchers performed the surgeries and collected the bleeding time data. Diode laser surgery led to complete hemostasis in rats during and after lingual frenectomy. Zero bleeding was assessed during surgeries and after diode laser surgeries in anticoagulated rats. Laser-induced hemostasis offered an alternative solution to the controversial issue of intraoperative and postoperative bleeding control in patients on anticoagulation therapy.

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The development of a biodegradable material with antimicrobial properties for local applications is required in the prevention and treatment of infectious diseases. The objective of this study was to produce blends of poly-L-lactide acid (PLLA) synthetic polymer associated with several antimicrobials, as an alternative in the prevention and treatment of infections, as well as to evaluate its cytotoxicity, release of antimicrobials and inhibit bacteria growth. Blends of PLLA added with 20% Amoxicillin, Metronidazole, Clindamycin or Azithromicyn were used to produce Films (F) or Meshs (M) by casting and electrospinning methods, respectively. Standardized discs of the films and meshs were stored in buffer solutions (pH 5 or 7.4) and aliquots were analyzed by high performance chromatography (HPLC) during 168 hours. Cytotoxicity on human gingival fibroblasts was tested after 24, 48 and 72h by MTT reaction. The antimicrobial capacity was determined against P. gingivalis and S. pyogenes. The specimens were weighed after 3 and 6 months of storage for degradation analysis. SEM was performed to control interfaces and degradation. Antimicrobials presented a continuous and exponential drug release. Analysis showed that both M and F were able to inhibit S. pyogenes and P. gingivalis growth, indicating the release of active antimicrobial agents. The products were not toxic to the fibroblasts. Amoxicillin-film showed more degradation than PLLA at both pHs (p < 0.05), whereas Azithromycin-meshes were more degraded than PLLA at pH 7.4 (p < 0.05). PLLA association with antimicrobials is biocompatible and may represent a potential tool for the local delivery of antimicrobials.

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The pollution of wetlands by lead derived from waterfowl hunting with lead shot was investigated. We determined soil pellet density and Pb concentration in soil, water and vegetation in natural wetlands and rice fields in central-eastern Santa Fe province, Argentina. Pellet density varied greatly among hunting sites (between 5.5-141 pellets/m(2)) and pellets were present in some control sites. Soil Pb concentration in most hunting sites (approximately 10-20 mg kg(-1)) was not much higher than in control sites (~5-10 mg kg(-1)), with the exception of the site with highest pellet density, which also had a high Pb soil concentration. In water, on the other hand, Pb concentration was similar in all sites (~4-7 µg L(-1)), both control and hunting, and higher than reference values for aquatic media. Lead was also present in vegetation, including grasses and rice crops, in almost all cases. Most soil-collection sites were slightly acidic, and were frequently flooded. These results strongly suggest that metallic Pb from spent shot is oxidized and dissolved due to wetland conditions. Thus, the pollutant is readily mobilized and distributed across all wetland areas, effectively homogenizing its concentration in locations with and without hunting activities. The replacement of lead by nontoxic materials in pellets appears to be the only effective way to prevent Pb pollution in wetlands.

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Numerous experiments under controlled conditions and extensive investigation of waterfowl die-offs have demonstrated that exposure to lead from spent gunshot is highly detrimental to the health of waterfowl. However, few studies have focused on examining the more subtle sub-lethal effects of lead toxicity on ducks in non-experimental settings. In our study, the health of ducks exposed to varying amounts of lead under natural conditions was assessed by correlating individual lead exposure with relevant indices of health. Based on hunter-killed wild ducks in Argentina, we measured spleen mass, body condition, examined bone marrow smears, and determined Ca and P in bone tissue. In free-ranging live-trapped ducks we determined basic hematology and aminolevulinic acid dehydratase activity. Using multivariate analyses, we found that, when controlling for the potential confounding effect of site type, year, duck species, body mass and age, lead levels in the liver were negatively associated with body condition and spleen mass. Spleen mass was also lower in ducks with higher lead levels in their bones. In live ducks, high blood lead levels were associated with low packed cell volume and red cell morphologic abnormalities. These findings suggest that, despite the lack of recorded lead-induced mortality in the region, lead exposure results in less conspicuous but still significant impacts on the health of ducks, which could have serious implications for their conservation. Moreover, this evidence further supports the need for urgently banning lead shot in the region.

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The objective of this study is to report a clinical case of maxillary sinus with lyophilized, xenogeneic graft, in which, despite a large perforation of the sinus membrane, the surgery was not aborted and the results of histological examinations indicate bone neoformation in the surgical area. Results. This case showed that the biomaterials evaluated in this study and the procedure used to place them proved to be biocompatible and presented high osteogenic potential, leading to a successful surgery and osseointegration implant. Conclusion. Positioning Schneider's membrane and filling it with the graft biomaterial helped to achieve the desired osteoconduction and proliferation of bone cells even though the patient had a large perforation of the sinus membrane.