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OBJECTIVE: Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS: This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS: There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION: Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

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SUMMARY OBJECTIVE: Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS: This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS: There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION: Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy.

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A utilização da tecnologia CAD/CAM (computer aided design/computer aided manufacturing) e 3D (tridimensional) para reconstruções alveolares na implantodontia permite o planejamento pré-operatório detalhado, o design do resultado desejado do enxerto e a avaliação virtual do resultado em relação à reconstrução protética. Este trabalho objetiva detalhar a técnica cirúrgica de enxerto ósseo sintético confeccionado por meio dessa tecnologia, seguido da instalação de implantes osseointegráveis e reabilitação protética em um defeito ósseo na mandíbula. Paciente masculino, 22 anos, compareceu à clínica por avulsão dos elementos 32, 31, 41 e 42 com significativa perda óssea vertical de rebordo alveolar. Devido à extensa perda óssea, realizou-se enxerto em bloco prototipado impresso. O escaneamento intraoral e os arquivos de imagem gerados foram enviados ao centro de planejamento virtual. Primeiramente, foi realizada a cirurgia para instalação do enxerto em bloco. Após o período de cicatrização, foi realizada cirurgia para instalação de dois implantes osseointegráveis. Esperado o período de três meses a partir da instalação dos implantes, foi realizada a confecção de próteses provisórias fixas sobre implantes a fim de realizar o condicionamento dos tecidos moles peri-implantares e o carregamento progressivo dos implantes. O aumento do rebordo alveolar através do uso de enxerto em bloco impresso personalizado apresentou-se como uma técnica com inúmeras vantagens, por não necessitar de sítio doador, reduzir tempo cirúrgico e apresentar perfeita adaptação do bloco ao defeito ósseo, resultando em menor morbidade pós-operatória. Essa técnica é uma indicação para casos de defeitos ósseos severos, visando a otimizar o resultado e a propiciar menor desconforto ao paciente.

The use of the technology CAD/CAM (computer aided design/computer aided manufacturing) and 3D (three dimensional) to alveolar reconstructions in implant dentistry allows detailed preoperative planning, the design of the desired grafting result, and the virtual evaluation of the result in relation to the prosthetic reconstruction. This paper aims to details the synthetic bone graft made through this technology, followed by the installation of osseointegrated implants and prosthetic rehabilitation in a bone imperfection in the jaw. A 22-year-old man attended the clinic due to a tooth avulsion of the four lower incisors with significant vertical bone loss of alveolar ridge. Because of the extensive bone loss, it was made a prototyped printed block graft. The intraoral scan and the generated image files were sent to the virtual planning center. First, it was necessary a surgery to install the block graft. After the healing process, it was made a surgery to put two osseointegrated implants. Three months later, temporary fixed prostheses on implants were made to conditioning the peri-implant soft tissues and the progressive loading of the implants. The increase of the alveolar ridge using personalized printed block graft was presented as a technique with numerous advantages, since it does not require a donor site, reduces the surgical time and presents perfect adaptation of the block to the bone imperfection, resulting in a less postoperative morbidity. This technique is indicated to cases of severe bone imperfections, aims to optimize results, and provide less discomfort to the patient.

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This study aimed to evaluate the occurrence of mycotoxigenic fungi in fish farm water and mycotoxins in feeds for farmed tambaqui (Colossoma macropomum). A total of 40 samples of freshwater from fish farms and 16 samples of feed were collected and analyzed for microbiology. A total of five species of free-living fungi were identified in fish farms: Aspergillus fumigatus, Penicillium citrinum, P. implicatum, Fusarium oxysporum and Alternaria alternata. These fungi species were counted in water samples at 35.14 CFU mL-1 and 24.69 CFU mL-1 in the dry seasons. In all fish farms, there was a higher abundance of fungi species in the rainy season. During visits to the fish farmers, it was possible to verify poor feed storage conditions. Concerning mutations in blood cells, in tambaqui (C. macropomum), a total of 159 anomalies were found, and in Leptodactylus petersii, 299 anomalies were found, with higher incidences in conditions above 1.0 CFU mL-1 in log10(x+1) fungi and in the rainy season. The occurrence of mycotoxicological contamination was confirmed in 81.25% of the analyzed samples. The quantified mycotoxin was Fumonisins B1 + B2 (375 to 1418 µg kg-1). Pearson's correlation analysis showed a significant positive correlation between Fumonisins and feed samples (r = 0.83). There was also a significant positive correlation between the abundance of fungi in water and the quantification of Fumonisins (r = 0.79). Based on the results obtained, it can be concluded that free-living fungi can be used as bioindicators of water quality in fish farms. Consequently, the lack of good management practices caused microbiological contamination of the aquatic environment.

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The main aimed of this study was to evaluate the physicochemical parameters, abundance and density of cyanobacteria, determine their blooms and the ecotoxicological risk of their cyanotoxins in fish ponds water. This study was conducted out in 20 fish farms in Rondônia state (Brazilian Amazon), samplings were carried out in the rainy and dry seasons. The experiment was developed in a completely randomized factorial design 20 × 3 x 3 (20 fish farms, 3 ponds and 3 replications). Regarding the composition of qualitative samples, horizontal and vertical hauls were carried out on the water surface, quantitative samples was obtained using a plankton net (50 µm mesh opening). Meanwhile, with the use of a multiparametric probe, physicochemical analyzes in fish ponds water were carried out. Furthermore, the cyanobacteria found were classified taxonomically and its blooms were recorded. Finally, blood was collected from 60 Colossoma macropomum. Concerning the higher averages in the rainy season 6.13 mg L⁻1 of dissolved oxygen, 40.02 cm of transparency, 0.35 NO31⁻ of nitrate, 0.15 NO21⁻ of nitrite, 44.55 mg L⁻1 CaCO3 of alkalinity and 50.10 mg L⁻1 CaCO3 of hardness, while higher averages of pH, phosphate and phosphorus were found in the dry season. A total of 15 families and 29 species of cyanobacteria were identified in the different seasons. The families that showed the highest densities (rainy and dry seasons) were Microcystaceae (356 and 760 cells mL⁻1), Leptolyngbyaceae (126 and 287 cells mL⁻1) and Microcoleaceae (111 and 405 cells mL⁻1). The species that showed the highest densities were Microcystis aeruginosa (356 and 697 cells mL⁻1), Planktolyngbya limnetica (98 and 257 cells mL⁻1) and Planktothrix sp. (111 and 239 cells mL⁻1). There were significant Pearson's correlations (r > 0.85; p < 0.05) between family abundances and cyanotoxin volume between physicochemical water variables and seasonality. A total of 20 cyanobacteria blooms were recorded, all of which in the dry season showed an ecotoxicological risk. Concerning the assessment mutagenicity in fish blood cells, a total of 78 abnormalities per slide were observed. In the dry season, the expected volume of cyanotoxins in the ponds from fish farms F1 and F4 were above the quantification limit (>QL). Abundance and density of cyanobacteria and their blooms and cyanotoxins can be used as bioindicators of eutrophication and/or water quality and ecotoxicological risk in fish ponds.

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The main aimed of this study was to provide information on microplastics present in the freshwater of fish farm ponds. In addition, the study showes a relationship between the seasonal, spatial distribution and the amount of microplastics found. This study was conducted in 35 fish farms located in the Rondônia state, Brazil, the sample collects were carried out in the two Amazonian hydrological seasons (dry and rainy). The study was developed in a completely randomized factorial scheme 35 × 3 x 3 (35 fish farms, 3 ponds and 3 repetitions per ponds). Microplastic sampling was performed following a modified method based on National Oceanic and Atmospheric Administration (NOAA). Samples of 250 mL freshwater collected, which were deionized and pre-filtered through 6.0 mm mesh granulometric sieves. The average abundances of the different hydrological seasons were compared by Student's t-test, with differences statistically significant at p < 0.05. The microplastics were morphological categorized into fibers and colors blue, red or transparent. Microplastic contamination was confirmed in freshwater of 9 fish farming, with greater abundance of blue fibers and greater quantification in the rainy season. Fish farms P3, P4 and P6 had the highest quantifications of blue fiber in the two seasons (6 and 43, 19 and 56, 11 and 88 items mL-1, respectively). Almost all fish farms had a higher abundance of microplastics in the rainy season. It is important to highlight the prominence of microplastics in the blue fiber rainy season (286 items mL-1) compared to the dry season (58 items mL-1). Fish farms P3, P4 and P6 showed a strong positive correlation between the factors distance from the nearest urban area (r = 0.94, 0.79 and 0.97, respectively) and seasonality (r = 0.98, 0.77 and 0.96, respectively). Rainfall variations influenced the abundance of microplastics, especially of blue fibers. Fish farms are supplied with fresh water by rivers or streams, so it is possible that microplastics originate outside the fish farm, perhaps they were introduced due to high soil occupation, although surface runoff (of water contaminated by sewage) caused by heavy rains the most important factor. Therefore, one factor must be considered, surface runoff and groundwater contaminated by urban, agricultural and urban effluents may have contaminated rivers and streams and then contaminated the water in the fish farm ponds.

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In recent decades, waves of yellow fever virus (YFV) from the Amazon Rainforest have spread and caused outbreaks in other regions of Brazil, including the Cerrado, a savannah-like biome through which YFV usually moves before arriving at the Atlantic Forest. To identify the vectors involved in the maintenance of the virus in semiarid environments, an entomological survey was conducted after confirmation of yellow fever (YF) epizootics at the peak of the dry season in the Cerrado areas of the state of Minas Gerais. In total, 917 mosquitoes from 13 taxa were collected and tested for the presence of YFV. Interestingly, mosquitoes of the Sabethes genus represented 95% of the diurnal captured specimens, displaying a peak of biting activity never previously recorded, between 4:30 and 5:30 p.m. Molecular analysis identified three YFV-positive pools, two from Sabethes chloropterus-from which near-complete genomes were generated-and one from Sa. albiprivus, whose low viral load prevented sequencing. Sa. chloropterus was considered the primary vector due to the high number of copies of YFV RNA and the high relative abundance detected. Its bionomic characteristics allow its survival in dry places and dry time periods. For the first time in Brazil, Sa. albiprivus was found to be naturally infected with YFV and may have played a role as a secondary vector. Despite its high relative abundance, fewer copies of viral RNA were found, as well as a lower Minimum Infection Rate (MIR). Genomic and phylogeographic analysis showed that the virus clustered in the sub-lineage YFVPA-MG, which circulated in Pará in 2017 and then spread into other regions of the country. The results reported here contribute to the understanding of the epidemiology and mechanisms of YFV dispersion and maintenance, especially in adverse weather conditions. The intense viral circulation, even outside the seasonal period, increases the importance of surveillance and YFV vaccination to protect human populations in affected areas.

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BACKGROUND: In Brazil, the yellow fever virus (YFV) is maintained in a sylvatic cycle involving wild mosquitoes and non-human primates (NHPs). The virus is endemic to the Amazon region; however, waves of epidemic expansion reaching other Brazilian states sporadically occur, eventually causing spillovers to humans. OBJECTIVES: To report a surveillance effort that led to the first confirmation of YFV in NHPs in the state of Minas Gerais (MG), Southeast region, in 2021. METHODS: A surveillance network was created, encompassing the technology of smartphone applications and coordinated actions of several research institutions and health services to monitor and investigate NHP epizootics. FINDINGS: When alerts were spread through the network, samples from NHPs were collected and YFV infection confirmed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and genome sequencing at an interval of only 10 days. Near-complete genomes were generated using the Nanopore MinION sequencer. Phylogenetic analysis indicated that viral genomes were related to the South American genotype I, clustering with a genome detected in the Amazon region (state of Pará) in 2017, named YFVPA/MG sub-lineage. Fast YFV confirmation potentialised vaccination campaigns. MAIN CONCLUSIONS: A new YFV introduction was detected in MG 6 years after the beginning of the major outbreak reported in the state (2015-2018). The YFV strain was not related to the sub-lineages previously reported in MG. No human cases have been reported, suggesting the importance of coordinated surveillance of NHPs using available technologies and supporting laboratories to ensure a quick response and implementation of contingency measures to avoid YFV spillover to humans.

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Abstract Objectives: to assess the prevalence of rapid weight gain (RWG) in children born with normal weight and its association with overweight (OW) in four Latin America countries. Methods: cross-sectional study in children aged 0 to 5 from the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher in Brazil and the Encuesta Nacional de Demografía y Salud in Bolivia, Colombia and Peru,using a birth weight ≥2,500g. The outcome variable was OW, the exposure was RWG and breastfeeding (BF) was the adjustment variable. Prevalence, odds ratio and 95% confidence intervalwere estimated using multivariate logistic regression model. Results: there was a greater prevalence of RWG and BF at less than 6 months in Brazil, and a greater prevalence of OW in Brazil and Bolivia. The chances of OW when RWG was present and adjusted for BF were 6.1 times (CI95% = 3.8-9.7) in Brazil, 4.4 times (CI95% = 3.6-5.3) in Bolivia, 6.7 times (CI95% = 5.5-8.2) in Colombia, and 12.2 times in Peru (CI95% = 9.4-15.7) with a p < 0.001 for all countries. Conclusions: RWG in children with normal birth weight was associated with a greater chance of being OW in the four observed Latin America countries.

Resumo Objetivos: avaliar a prevalência do ganho rápido de peso (GRP) em crianças nascidas com peso normal e sua associação com o excesso de peso (EP) em quatro países da América Latina. Métodos: estudo transversal de inquéritos populacionais com crianças de 0 a 5 anos da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher no Brasil e da Encuesta Nacional de Demografía y Salud da Bolívia, Colômbia e Peru, selecionadas pelo peso ao nascer ≥2.500 gramas. A variável desfecho foi o EP; de exposição o GRP; e de ajuste a amamentação. Foram estimadas as prevalências, odds ratio e intervalo de confiança de 95% por regressão logística multivariada. Resultados: observou-se maior prevalência de GRP e tempo de amamentação menor do que 6 meses no Brasil e maior prevalência de EP no Brasil e Bolívia. As chances de EP quando GRP presente e ajustado por amamentação foram de 6,1 vezes (IC95% = 3,8-9,7) no Brasil; 4,4 vezes (IC95% = 3,6-5,3) na Bolívia; 6,7 vezes (IC95% = 5,5-8,2) na Colômbia; 12,2 vezes no Peru (IC95% = 9,4-15,7) e p<0,001 nos quatro países. Conclusões: o GRP em crianças nascidas com peso normal foi associado a maior chance de EP infantil nos quatro países da América Latina.

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OBJETIVO: Esta pesquisa analisou as representações sociais sobre a violência para mulheres em situação de rua na regional Centro-Sul da cidade de Belo Horizonte. MÉTODOS: Se trata de pesquisa qualitativa em que foram aplicados 22 questionários a mulheres em situação de rua e conduzidas entrevistas narrativas com três delas e a análise de dados foi a partir da análise de conteúdo. RESULTADOS: A análise de dados está construída a partir de três movimentos: (a) apresentação do contexto da pesquisa, (b) o perfil das participantes da pesquisa e (c) as categorias de análise conjugando os questionários e entrevistas feitas ­ a saber, violência e identidade de gênero, local de vida, de inserção social ou de proteção à violência?; a ocupação e a violência, a violência dos 'companheiros' e violência institucional. DISCUSSÃO: Identificou-se que a violência é algo presente no cotidiano das mulheres em situação de rua de Belo Horizonte, marcando diretamente as formas de pensar, sentir e agir destas mulheres. CONCLUSÃO: Entendemos que a violência dita e organiza formas de pensar, sentir e agir das mulheres em situação de rua, inclusive na necessidade de reconstruir e (re)visitar categorias previamente elaboradas para explicar processos que requerem, para além da teorização, a experiência de estar no mundo, frente aos fenômenos que significam e ressignificam as identidades, diante das estratégias que elas traçam em torno da violência e da forma de autopreservação.

OBJECTIVE: This paper analyzed the social representations of violence towards homeless women in the Center-South region of the city of Belo Horizonte/Brazil. METHODS: This is a qualitative research in which 22 questionnaires were applied to homeless women and narrative interviews were conducted with three of them and data analysis was based on content analysis. RESULTS: Data analysis is constructed from three movements: (a) presentation of the research context, (b) the profile of the research participants and (c) the categories of analysis combining the questionnaires and interviews carried out - namely, violence and gender identity, place of life, social insertion or protection from violence?; occupation and violence, 'companion' violence and institutional violence. DISCUSSION: It was identified that violence is something present in the daily lives of homeless women in Belo Horizonte, and it directly marks the ways of thinking, feeling and acting of these women. CONCLUSION: We understand that violence dictates and organizes ways of thinking, feeling and acting of women in street situations, including the need to reconstruct and (re)visit categories previously elaborated to explain processes that require, in addition to theorization, the experience of being in the world, facing the phenomena that signify and re-signify identities, in the face of the strategies they outline around violence and the form of self-preservation.

OBJETIVO: Este trabajo analizó las representaciones sociales de la violencia desde las mujeres en situación de calles en la región Centro-Sur de la ciudad de Belo Horizonte/Brasil. MÉTODOS: Es una investigación cualitativa en la que se aplicaron 22 cuestionarios a mujeres en situación de calle y se realizaron entrevistas narrativas con tres de ellas y el análisis de datos se basó en el análisis de contenido. RESULTADOS: El análisis de datos se construye a partir de tres movimientos: (a) presentación del contexto de investigación, b) el perfil de los participantes y c) las categorías de análisis que combinan los cuestionarios y entrevistas realizados, a saber, la violencia y la identidad de género, el lugar de vida, la inserción social o la protección contra la violencia?; la ocupación y la violencia, la violencia de "compañero" y la violencia institucional. DISCUSIÓN: Se identificó que la violencia es algo presente en la vida cotidiana de las mujeres en situación de calle en Belo Horizonte, marcando directamente las formas de pensar, sentir y actuar de estas mujeres. CONCLUSIÓN: Entendemos que la violencia dicta y organiza formas de pensar, sentir y actuar de las mujeres en situación de calle, incluyendo la necesidad de reconstruir y (re) visitar categorías previamente elaboradas para explicar procesos que requieren, además de teorización, la experiencia de estar en el mundo, frente a los fenómenos que significan y resignifican identidades, frente a las estrategias que esbozan en torno a la violencia y la forma de autopreservación.

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This study predicted dapaconazole clinical drug−drug interactions (DDIs) over the main Cytochrome P450 (CYP) isoenzymes using static (in vitro to in vivo extrapolation equation, IVIVE) and dynamic (PBPK model) approaches. The in vitro inhibition of main CYP450 isoenzymes by dapaconazole in a human liver microsome incubation medium was evaluated. A dapaconazole PBPK model (Simcyp version 20) in dogs was developed and qualified using observed data and was scaled up for humans. Static and dynamic models to predict DDIs following current FDA guidelines were applied. The in vitro dapaconazole inhibition was observed for all isoforms investigated, including CYP1A2 (IC50 of 3.68 µM), CYP2A6 (20.7 µM), 2C8 (104.1 µM), 2C9 (0.22 µM), 2C19 (0.05 µM), 2D6 (0.87 µM), and 3A4 (0.008−0.03 µM). The dynamic (PBPK) and static DDI mechanistic model-based analyses suggest that dapaconazole is a weak inhibitor (AUCR > 1.25 and <2) of CYP1A2 and CYP2C9, a moderate inhibitor (AUCR > 2 and <5) of CYP2C8 and CYP2D6, and a strong inhibitor (AUCR ≥ 5) of CYP2C19 and CYP3A, considering a clinical scenario. The results presented may be a useful guide for future in vivo and clinical dapaconazole studies.

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BACKGROUND In Brazil, the yellow fever virus (YFV) is maintained in a sylvatic cycle involving wild mosquitoes and non-human primates (NHPs). The virus is endemic to the Amazon region; however, waves of epidemic expansion reaching other Brazilian states sporadically occur, eventually causing spillovers to humans. OBJECTIVES To report a surveillance effort that led to the first confirmation of YFV in NHPs in the state of Minas Gerais (MG), Southeast region, in 2021. METHODS A surveillance network was created, encompassing the technology of smartphone applications and coordinated actions of several research institutions and health services to monitor and investigate NHP epizootics. FINDINGS When alerts were spread through the network, samples from NHPs were collected and YFV infection confirmed by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and genome sequencing at an interval of only 10 days. Near-complete genomes were generated using the Nanopore MinION sequencer. Phylogenetic analysis indicated that viral genomes were related to the South American genotype I, clustering with a genome detected in the Amazon region (state of Pará) in 2017, named YFVPA/MG sub-lineage. Fast YFV confirmation potentialised vaccination campaigns. MAIN CONCLUSIONS A new YFV introduction was detected in MG 6 years after the beginning of the major outbreak reported in the state (2015-2018). The YFV strain was not related to the sub-lineages previously reported in MG. No human cases have been reported, suggesting the importance of coordinated surveillance of NHPs using available technologies and supporting laboratories to ensure a quick response and implementation of contingency measures to avoid YFV spillover to humans.

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OBJECTIVE: To analyze the spatial distribution of the prevalence of leisure-time physical activity (LTPA) in a Brazilian urban area and its association with the characteristics of the physical and social environments. METHODS: A cross-sectional study conducted with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases from the years 2008-2010, in Belo Horizonte, state of Minas Gerais, Brazil. The outcome was the practice of LTPA and the independent variables were residential and population density, the density of places for physical activity, homicide rates, average family income, and health vulnerability index. The spatial scanning technique was employed to identify clusters with a high prevalence of PA at leisure time. The Mann-Whitney test was used to compare variables inside and outside the cluster. RESULTS: The sample included 5,779 participants, 33.3% (SE = 0.73) of whom reported sufficient PA during leisure time. We identified a significant cluster of a high prevalence of LTPA. After adjustments, the cluster presented a radius of 3,041.99 meters and 603 individuals, and 293 (48.6%) of them reported sufficient LTPA. The probability of performing sufficient LTPA in the cluster was 27% higher (PR = 1.27; p = 0.002) than in the coverage areas of primary healthcare units outside the cluster. There was a higher density of places for LTPA practice, higher population and residential density, and higher family income in the cluster. CONCLUSION: The results evidenced a cluster of high prevalence of LTPA in a privileged physical and socioeconomic environment in Belo Horizonte, even after adjustments, demonstrating that reducing inequalities can increase LTPA.

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Most patellar dislocations are associated with disruption of the proximal medial patellar restraints (PMPRs). The PMPRs comprise the medial patellofemoral ligament (MPFL) and medial quadriceps tendon-femoral ligament (MQTFL). Although isolated MPFL reconstruction is the most frequently performed procedure for the surgical management of recurrent dislocation, recent studies have shown that the MQTFL has a synergistic role with the MPFL in resisting lateral patellar displacement close to full extension. It has therefore been suggested that surgical techniques that gain the benefits of both proximal and distal PMPR biomechanical behavior may be best. This article describes an established technique for combined MPFL and MQTFL reconstruction using semitendinosus autograft.

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Data on the occurrence of cocaine (COC) and benzoylecgonine (BE) in marine environmental compartments are still limited, with few studies reporting superficial water contamination, mainly in tropical zones. In this sense, environmental data of these substances are essential to identify potential polluting sources, as well as their impact in costal ecosystems. The aim of this study was to evaluate the occurrence of COC and BE in seawater, sediment and mussels from a subtropical coastal zone (Santos Bay, São Paulo, Brazil), as well as to determine a field measured Bioaccumulation Factor (BAF). COC and BE were detected in all water samples in concentrations ranging from 1.91 ng·L-1 to 12.52 ng·L-1 and 9.88 ng·L-1 to 28.53 ng·L-1, respectively. In sediments, only COC was quantified in concentrations ranging from 0.94 ng·g-1 to 46.85 ng·g-1. Similarly, only COC was detected in tissues of mussels 0.914 µg·kg-1 to 4.58 µg·kg-1 (ww). The field-measured BAF ranged from 163 to 1454 (L·kg-1). Our results pointed out a widespread contamination by cocaine and its main human metabolite benzoylecgonine in Santos Bay. Mussels were able to accumulate COC in areas used by residents and tourists for bathing, fishing, and harvest, denoting concern to human health. Therefore, our data can be considered a preliminary assessment, which indicates the need to evaluate drugs (including illicit as COC) in environmental and seafood monitoring programs, in order to understand their risks on the ecosystem and human health.

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ABSTRACT: Objective: To analyze the spatial distribution of the prevalence of leisure-time physical activity (LTPA) in a Brazilian urban area and its association with the characteristics of the physical and social environments. Methods: A cross-sectional study conducted with data from the Surveillance System for Risk and Protective Factors for Chronic Diseases from the years 2008-2010, in Belo Horizonte, state of Minas Gerais, Brazil. The outcome was the practice of LTPA and the independent variables were residential and population density, the density of places for physical activity, homicide rates, average family income, and health vulnerability index. The spatial scanning technique was employed to identify clusters with a high prevalence of PA at leisure time. The Mann-Whitney test was used to compare variables inside and outside the cluster. Results: The sample included 5,779 participants, 33.3% (SE = 0.73) of whom reported sufficient PA during leisure time. We identified a significant cluster of a high prevalence of LTPA. After adjustments, the cluster presented a radius of 3,041.99 meters and 603 individuals, and 293 (48.6%) of them reported sufficient LTPA. The probability of performing sufficient LTPA in the cluster was 27% higher (PR = 1.27; p = 0.002) than in the coverage areas of primary healthcare units outside the cluster. There was a higher density of places for LTPA practice, higher population and residential density, and higher family income in the cluster. Conclusion: The results evidenced a cluster of high prevalence of LTPA in a privileged physical and socioeconomic environment in Belo Horizonte, even after adjustments, demonstrating that reducing inequalities can increase LTPA.

RESUMO: Objetivo: Analisar a distribuição espacial da prevalência da prática de atividade física (AF) no lazer suficiente em uma área urbana brasileira, no período de 2008 a 2010, e verificar se ela é influenciada por características dos ambientes físico e social. Métodos: Estudo transversal com dados do sistema de Vigilância de Fatores de Risco para doenças crônicas não transmissíveis, realizado em Belo Horizonte (MG), entre os anos 2008 e 2010. O desfecho foi a realização de AF no lazer e as exposições foram densidade residencial e populacional, densidade de locais de prática de AF no lazer, taxa de homicídio, renda familiar média e índice de vulnerabilidade da saúde. Foi empregada a técnica de varredura espacial para identificar clusters de alta prevalência de AF no lazer. Utilizou-se o teste de Mann-Whitney para comparar variáveis ambientais dentro e fora do cluster. Resultados: A amostra foi constituída de 5.779 participantes, dos quais 33,3% referiram praticar AF no lazer suficientemente. Identificou-se um cluster significativo de alta prevalência de prática de AF no lazer. Após ajustes, ele apresentou raio de 3.041,99 m e 603 indivíduos, dos quais 293 (48,6%) realizavam AF no lazer suficiente. A probabilidade de um indivíduo praticar AF no lazer suficiente no cluster foi 27% maior (razão de prevalência — RP = 1,27; p = 0,002) do que nas áreas de abrangência das unidades básicas de saúde não pertencentes a ele. Esse cluster teve maior densidade de locais para a prática de AF no lazer, maior densidade populacional e residencial e maior renda familiar. Conclusão: Constatou-se cluster de alta prevalência de AF no lazer em um contexto físico e econômico privilegiado de Belo Horizonte, o que demonstra que diminuir desigualdades pode aumentar a prática de AF no lazer.

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Objective The objective of the present study is to evaluate the impact evaluate the impact of an institutional protocol on a tertiary hospital for the prevention of venous thromboembolism in 2005 patients submitted to primary total knee arthroplasty (TKA). Methods Data from medical records of patients submitted TKA before ( n = 1,115) and after ( n = 890) the implementation of the institutional protocol, totaling 2,005 patients, were retrospectively reported. Demographics, comorbidities, and outcomes were analyzed. Results There was no significant change in the cases of deep venous thrombosis (DVT) (1.6% versus 2.4%; p = 0.211). There was an increase in cases of pulmonary embolism (PE) (0.2% versus 0.8% p = 0.049). Conclusion Despite the implementation of the prevention protocol, no reduction in the studied events was observed. The small global incidence makes further studies with larger series necessary to confirm or rule out these findings.

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Abstract Objective The objective of the present study is to evaluate the impact evaluate the impact of an institutional protocol on a tertiary hospital for the prevention of venous thromboembolism in 2005 patients submitted to primary total knee arthroplasty (TKA). Methods Data from medical records of patients submitted TKA before (n= 1,115) and after (n= 890) the implementation of the institutional protocol, totaling 2,005 patients, were retrospectively reported. Demographics, comorbidities, and outcomes were analyzed. Results There was no significant change in the cases of deep venous thrombosis (DVT) (1.6% versus 2.4%; p= 0.211). There was an increase in cases of pulmonary embolism (PE) (0.2% versus 0.8% p= 0.049). Conclusion Despite the implementation of the prevention protocol, no reduction in the studied events was observed. The small global incidence makes further studies with larger series necessary to confirm or rule out these findings.

Resumo Objetivo O objetivo do presente estudo é avaliar o impacto de um protocolo institucional em um hospital terciário na prevenção do tromboembolismo venoso em 2.005 pacientes submetidos a artroplastia total primária de joelho. Métodos Os dados dos prontuários de pacientes submetidos a artroplastia total do joelho antes (n= 1.115) e após (n= 890) a implantação do protocolo institucional, totalizando 2.005 pacientes, foram relatados retrospectivamente. Dados demográficos, comorbidades e desfechos foram analisados. Resultados Não houve alteração significativa nos casos de trombose venosa profunda (TVP) (1,6% versus 2,4%; p= 0,211). Houve um aumento nos casos de embolia pulmonar (EP) (0,2% versus 0,8%; p= 0,049). Conclusão Apesar da implementação do protocolo de prevenção, não houve redução nos eventos estudados. A pequena incidência global faz com que novos estudos, com séries maiores, sejam necessários para confirmar ou descartar esses achados.

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The maintenance of natural dentition under optimal function, health and aesthetics conditions is the main objective of dental treatments, but when therapeutic possibilities are exhausted, dental extractions become necessary. Bone remodeling due to post-extraction alveolar healing may result in volume changes in the region. This topic is common in renowned dentistry scientific publications and several researchers recommend tissue regenerative procedures and seek solutions minimize volume reduction. Among these procedures, the immediate installation of implants in post- extraction sockets without flap elevation is an alternative that guarantees functional and aesthetic benefits in the final result of the rehabilitation. This paper presents a clinical case that shows a practical and viable alternative therapy for adequate alveolar healing. In this clinical case, the use of immediate implants and personalized healing abutments with flowable resin composite reduced alveolar healing remodeling and allowed the preservation of the gingival architecture and to obtain an ideal emergency profile for performing the permanent prosthesis supported by implant.

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Abstract Objectives: to estimate the prevalence of maternal overweight and short stature in children at household level in Brazil, Bolivia, Colombia and Peru. Methods: a cross-sectional descriptive study. Population-based studies on children (0-5 years old) and women (15 to 49 years old) who participated in the Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher(National Survey on Children and Women Demography and Health) in Brazil and the Encuesta Nacional de Demografía y Salud, (National Survey on Demography and Health), in Bolivia, Colombia and Peru. Variables of interest: overweight mother and child with short stature, a double burden when both outcomes are present. Global prevalence and stratification, according to rural and urban areas and 95% confidence intervals, were estimated. Results: the global sample consisted of 26,506 households. The prevalence of double burden was 9.3% in Bolivia (CI95%= 8.3-10.4), 6.7% in Peru (CI95%=5.9-7.5), Colombia (3.2%; CI95%=2.8-3.6) and Brazil (2.2%; CI95%=1.4-3.2). The highest prevalence were observed in the rural areas in Bolivia (13% vs 6.5%; p<0.001) and Peru (11.9% vs 4.1%; p<0.001). Conclusions: the highest prevalence were registered in Peru and Bolivia, and the lowest in Brazil and Colombia.

Resumo Objetivos: estimar a prevalência de excesso de peso materno e baixa estatura infantil em nível domiciliar no Brasil, Bolívia, Colômbia e Peru. Métodos: estudo descritivo transversal. Utilizou-se estudos de base populacional de crianças (0-5 anos) e mulheres (15 a 49 anos) que participaram da Pesquisa Nacional de Demografia e Saúde da Criança e da Mulher, no Brasil, e da Encuesta Nacional de Demografía y Salud, na Bolívia, Colômbia e Peru. Variáveis de interesse: mãe com excesso de peso e filho com baixa estatura, sendo dupla carga quando presentes ambos os desfechos. Foi estimada a prevalência global e estratificada por área rural e urbana e os intervalos de confiança de 95%. Resultados: a amostra global foi composta de 26.506 domicílios. As prevalências de dupla carga foram na Bolívia 9,3% (IC95%= 8,3 - 10,4), no Peru 6,7% (IC95%= 5,9 - 7,5), Colômbia (3,2%; IC95%= 2,8 - 3,6) e Brasil (2,2%; IC95%= 1,4 - 3,2). As maiores prevalências foram mostradas nas áreas rurais da Bolívia (13% vs 6,5%; p < 0,001) e do Peru (11,9% vs 4,1%; p < 0,001). Conclusões: as mais altas prevalências foram registradas no Peru e Bolívia, e as menores no Brasil e Colômbia.

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