PURPOSE: This study evaluated the use of adding morphine to bupivacaine in spinal anesthesia for pain control in patients who underwent an open hemorrhoidectomy. METHODS: Forty patients were prospectively selected for an open hemorrhoidectomy at the same institution and were randomized into two groups of 20 patients each: group 1 had a spinal with 7 mg of heavy bupivacaine associated with 80 microg of morphine (0.2 mg/mL). Group 2 had a spinal with 7 mg of heavy bupivacaine associated with distilled water, achieving the same volume of spinal infusion as that of group 1. Both groups were prescribed the same pain control medicine during the postoperative period. Pain scores were evaluated at the anesthetic recovery room and at 3, 6, 12, and 24 hours after surgery. Postoperative complications, including pruritus, nausea, headaches, and urinary retention, were also recorded. RESULTS: There were no anthropometric statistical differences between the two groups. Pain in the anesthetic recovery room and 3 hours after surgery was similar for both groups. However, pain was better controlled in group 1 at 6 and 12 hours after surgery. Although pain was better controlled for group 1 after 24 hours of surgery, the difference between the groups didn't achieved statistical significance. Complications were more common in group 1. Six patients (6/20) presented coetaneous pruritus and 3 with (3/20) urinary retention. CONCLUSION: A hemorrhoidectomy under a spinal with morphine provides better pain control between 6 and 12 hours after surgery. However, postoperative complications, including cutaneous pruritus (30%) and urinary retention (15%), should be considered as a negative side of this procedure.
Anesthesia* ; Anesthesia, Spinal ; Bupivacaine ; Headache ; Hemorrhoidectomy* ; Humans ; Infusions, Spinal ; Morphine* ; Nausea ; Pain, Postoperative ; Postoperative Complications* ; Postoperative Period ; Prospective Studies* ; Pruritus ; Recovery Room ; Urinary Retention ; Water

Purpose: This cross-sectional study evaluated and categorized the tomographic sagittal root position (SRP) of the maxillary anterior teeth in a Brazilian population. Materials and Methods: Cone-beam computed tomographic scans of 420 maxillary anterior teeth of 70 patients (35 men and 35 women, mean age 25.2±5.9 years) were evaluated. The SRP was classified as class I, II, III, or IV. In class I, the root is positioned against the buccal cortical plate; in class II, the root is centered in the middle of the alveolar housing; in class III, the root is positioned against the palatal cortical plate; and in class IV, at least two-thirds of the root engage both the buccal and palatal cortical plates. Results: In total, 274 teeth (65.2%) were class I, 39 (9.3%) were class II, 3 (0.7%) were class III, and 104 (24.8%) were class IV. The frequency distribution over the teeth groups was different from the overall analysis. Important differences were found in the frequencies of classes I, II, and IV compared to other populations. Sex was not associated with the SRP classes (P=0.307). Age distribution was significantly different over the classes (P=0.004). Conclusion The findings of this study on the distribution of SRP classes among the Brazilian population compared to other populations demonstrate that the SRP should be analyzed on a case-by-case basis for an accurate treatment plan in the maxillary anterior area.Keywords:Cone-Beam Computed Tomography; Tooth Socket; Alveolar Process; Dental Implants

Methods: We evaluated 758 lateral cervical radiographs. One medical student and one spine surgeon (i.e., measured ×2 within 4 weeks) independently measured the parameters obtaining 5,850 values. Standard error of measurement (SEm) and minimum detectable change (MDC) were calculated for each parameter. The accuracy and reliability of the Cobb angle measurements were calculated for the different types of angles: cervical lordosis, prosthesis angle, segmental angle with two bone surfaces (SABB), and segmental angle with one bone and one metal surface. Reliability was determined with intraclass correlation coefficient (ICC). Results: SEm was 1.8° and MDC was 5.0° for the Cobb angle, with an intraobserver/interobserver ICC of 0.958/0.886. All the different subtypes of Cobb angles had an ICC higher than 0.950, except SABB (intraobserver/interobserver ICC of 0.922/0.716). The most accurate and reliable measurement was for KLT. Conclusions This study provides normative data on SEm and MDC for Cobb angles, T1S, KLT, OCI, and cSVA in cervical lateral radiographs. Reliability was excellent for all parameters except SABB (e.g., good).

OBJECTIVE: To quantify, for each activation, the effect of preactivations of differing distribution and intensity on the neutral position of T-loops (7-mm height), specifically the horizontal force, moment to force (M/F) ratio, and load to deflection ratio. METHODS: A total 100 loops measuring 0.017 x 0.025 inches in cross-section were divided into two groups (n = 50 each) according to composition, either stainless steel or beta-titanium. The two groups were further divided into five subgroups, 10 loops each, corresponding to the five preactivations tested: preactivations with occlusal distribution (0degrees, 20degrees, and 40degrees), gingival distribution (20degrees), and occlusal-gingival distribution (40degrees). The loops were subjected to a total activation of 6-mm with 0.5-mm iterations. Statistical analysis was performed using comprised ANOVA and Bonferoni multiple comparison tests, with a significance level of 5%. RESULTS: The location and intensity of preactivation influenced the force intensity. For the M/F ratio, the highest value achieved without preactivation was lower than the height of the loop. Without preactivation, the M/F ratio increased with activation, while the opposite effect was observed with preactivation. The increase in the M/F ratio was greater when the preactivation distribution was partially or fully gingival. CONCLUSIONS: Depending on the preactivation distribution, displacement of uprights is higher or lower than the activation, which is a factor to consider in clinical practice.
Analysis of Variance ; Stainless Steel*

  Balneology in Europe has a long tradition. The therapeutic effects of water or steam baths have been used in almost all its territory since early times, first as a purely empiric exercise but in our times with a remarkable progress on its scientific basis. Depending of geographic or cultural circumstances hydrotherapeutic modalities developed in different ways. However the contribution of the Greek Medicine for its roots and of the Roman Empire for the spread of its use must be enhanced.   During the two last centuries we assisted of a growing interest and knowledge of the properties and therapeutic principles of balneology and their action mechanisms, including: physical (hydrostatic, hydrodynamic, thermal), chemical, biologic and psychological factors.   Currently European Balneology progresses remarkably. European Medical professionals aimed several goals to build this progress. Among them we may refer: the establishment of principles and definitions; a manual of good practice; the development of research; the improvement of education on this field; the awareness of public authorities and of the population.   We may say that in the last ten years we really got significant achievements.   We managed to create new cooperation opportunities by the creation of a Balneology Group within the UEMS (European Union of Specialist Doctors) that is also working together with the ISMH. We start several studies trying to know the different realities of Balneology in our European countries. We are also working on the consensus for a common lexicon and taxonomy in Balneology. Some important papers on this were already published and accepted by ISMH leaders. We also assist of the publication of a significant number of scientific studies, namely randomized controlled trials. Many of them with high quality standards.   Nevertheless the difficulties research is in fact improving. We should mention and praise the financial support of institutions specifically created to sponsor scientific studies on the thermal field, like for instance the French “AFreth” or the Italian “FoRST”.   Balneology Education needs to be better standardised in European terms so that we may built a common curriculum and walk towards an European Medical Board that could among other tasks to be able to certify Specialized Doctors on Balneology.   Balneology has a wide scope of interventions which include prevention, treatment and rehabilitation of a large number of health conditions.   We hope that its progress may benefit a greater number of people. Europe should contribute to this important goal.

Purpose: While regurgitation is a common and often benign phenomenon in infants and younger children, it can also be a presenting symptom of gastroesophageal reflux disease (GERD). If untreated, GERD can lead to dangerous or lifelong complications.Clinical practice guidelines (CPGs) have been published to inform clinical diagnosis and management of pediatric GERD, but to date there has been no comprehensive review of guideline quality or methodological rigor. Methods: A systematic literature search was performed, and a total of eight CPGs pertaining to pediatric GERD were identified. These CPGs were evaluated using the Appraisal of Guidelines for Research and Evaluation instrument. Results: Three CPGs were found to be “high” quality, with 5 of 6 domains scoring >60%, one “average” quality, with 4 of 6 domains meeting that threshold, and the remaining four “low” quality. Conclusion Areas of strength among the CPGs included “Scope and Purpose” and “Clarity and Presentation,” as they tended to be well-written and easily understood. Areas in need of improvement were “Stakeholder Involvement,” “Rigor of Development,” and “Applicability,” suggesting these CPGs may not be appropriate for all patients or providers. This analysis found that while strong CPGs pertaining to the diagnosis and treatment of pediatric GERD exist, many published guidelines lack methodological rigor and broad applicability.

Background: The most consistently identified mortality determinants for the new coronavirus 2019 (COVID-19) infection are aging, male sex, cardiovascular/respiratory diseases, and cancer. They were determined from heterogeneous cohorts that included patients with different disease severity and previous conditions. The main goal of this study was to determine if activities of daily living (ADL) dependence measured by Barthel’s index could be a predictor for COVID-19 mortality. Methods: A prospective cohort study was performed with a consecutive sample of 340 COVID-19 patients representing patients from all over the northern region of Portugal from October 2020 to March 2021. Mortality risk factors were determined after controlling for demographics, ADL dependence, admission time, comorbidities, clinical manifestations, and delay-time for diagnosis. Central tendency measures were used to analyze continuous variables and absolute numbers (proportions) for categorical variables. For univariable analysis, we used t test, chi-square test, or Fisher exact test as appropriate (α=0.05). Multivariable analysis was performed using logistic regression. IBM SPSS version 27 statistical software was used for data analysis. Results: The cohort included 340 patients (55.3% females) with a mean age of 80.6±11.0 years. The mortality rate was 19.7%. Univariate analysis revealed that aging, ADL dependence, pneumonia, and dementia were associated with mortality and that dyslipidemia and obesity were associated with survival. In multivariable analysis, dyslipidemia (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.17–0.71) was independently associated with survival. Age ≥86 years (pooled OR, 2.239; 95% CI, 1.100–4.559), pneumonia (pooled OR, 3.00; 95% CI, 1.362–6.606), and ADL dependence (pooled OR, 6.296; 95% CI, 1.795–22.088) were significantly related to mortality (receiver operating characteristic area under the curve, 82.1%; p<0.001). Conclusion ADL dependence, aging, and pneumonia are three main predictors for COVID-19 mortality in an elderly population.

Purpose: The advent of proteomics provides new opportunities to investigate the molecular mechanisms underlying male infertility. The selection of relevant targets based on a single analysis is not always feasible, due to the growing number of proteomic studies with conflicting results. Thus, this study aimed to systematically review investigations comparing the sperm proteome of normozoospermic and infertile men to define a panel of proteins with the potential to be used to evaluate sperm quality. Materials and Methods: A literature search was conducted on PubMed, Web of Science, and Scopus databases following the PRISMA guidelines. To identify proteins systematically reported, first the studies were divided by condition into four groups (asthenozoospermia, low motility, unexplained infertility, and infertility related to risk factors) and then, all studies were analysed simultaneously (poor sperm quality). To gain molecular insights regarding identified proteins, additional searches were performed within the Human Protein Atlas, Mouse Genome Informatics, UniProt, and PubMed databases. Results: Thirty-two studies were included and divided into 4 sub-analysis groups. A total of 2752 proteins were collected, of which 38, 1, 3 and 2 were indicated as potential markers for asthenozoospermia, low motility, unexplained infertility and infertility related to risk factors, respectively, and 58 for poor sperm quality. Among the identified proteins, ACR, ACRBP, ACRV1, ACTL9, AKAP4, ATG3, CCT2, CFAP276, CFAP52, FAM209A, GGH, HPRT1, LYZL4, PRDX6, PRSS37, REEP6, ROPN1B, SPACA3, SOD1, SPEM1, SPESP1, SPINK2, TEKT5, and ZPBP were highlighted due to their roles in male reproductive tissues, association with infertility phenotypes or participation in specific biological functions in spermatozoa. Conclusions Sperm proteomics allows the identification of protein markers with the potential to overcome limitations in male infertility diagnosis and to understand changes in sperm function at the molecular level. This study provides a reliable list of systematically reported proteins that could be potential targets for further basic and clinical studies.

Transanal endoscopic microsurgery is considered a safe, appropriate, and minimally invasive approach, and complications after endoscopic microsurgery are rare. We report a case of sepsis and pneumoretroperitoneum after resection of a rectal lateral spreading tumor. The patient presented with rectal mucous discharge. Colonoscopy revealed a rectal lateral spreading tumor. The patient underwent an endoscopic transanal resection of the lesion. He presented with sepsis of the abdominal focus, and imaging tests revealed pneumoretroperitoneum. A new surgical intervention was performed with a loop colostomy. Despite the existence of other reports on pneumoretroperitoneum after transanal endoscopic microsurgery, what draws attention to this case is the association with sepsis.
Colonoscopy ; Colostomy ; Humans ; Microsurgery ; Retropneumoperitoneum* ; Sepsis* ; Transanal Endoscopic Microsurgery

Cryptosporidium and Giardia are 2 protozoan parasites responsible for waterborne diseases outbreaks worldwide. In order to assess the prevalence of these protozoans in drinking water samples in the northern part of Portugal and the risk of human infection, we have established a long term program aiming at pinpointing the sources of surface water, drinking water, and environmental contamination, working with the water-supply industry. Total 43 sources of drinking water samples were selected, and a total of 167 samples were analyzed using the Method 1623. Sensitivity assays regarding the genetic characterization by PCR and sequencing of the genes, 18S SSU rRNA, for Cryptosporidium spp. and beta,-giardin for G. duodenalis were set in the laboratory. According to the defined criteria, molecular analysis was performed over 4 samples. Environmental stages of the protozoa were detected in 25.7% (43 out of 167) of the water samples, 8.4% (14 out of 167) with cysts of Giardia, 10.2% (17 out of 167) with oocysts of Cryptosporidium and 7.2% (12 out of 167) for both species. The mean concentrations were 0.1-12.7 oocysts of Cryptosporidium spp. per 10 L and 0.1-108.3 cysts of Giardia duodenalis per 10 L. Our results suggest that the efficiency in drinking water plants must be ameliorated in their efficiency in reducing the levels of contamination. We suggest the implementation of systematic monitoring programs for both protozoa. To authors' knowledge, this is the first report evaluating the concentration of environmental stages of Cryptosporidium and Giardia in drinking water samples in the northern part of Portugal.
Animals ; Cryptosporidium/*isolation & purification ; Cytoskeletal Proteins/genetics ; DNA, Protozoan/chemistry/genetics ; DNA, Ribosomal/chemistry/genetics ; Genes, rRNA ; Giardia lamblia/*isolation & purification ; Humans ; Molecular Sequence Data ; Polymerase Chain Reaction ; Portugal ; Protozoan Proteins/genetics ; RNA, Protozoan/genetics ; RNA, Ribosomal, 18S/genetics ; Risk Assessment ; Sequence Analysis, DNA ; Water/*parasitology