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Abstract: Introduction: maternal mortality can still be considered an important public health problem in our country, within the strategies implemented to reduce morbidity-mortality, the code mater is created for our intensive therapy, based on care algorithms, where a cornerstone is the early and timely diagnosis, gaining relevance the use of ultrasound as a diagnostic m ethod in severe obstetric patients. In our unit, an ultrasound protocol was developed aimed at the assessment of severe obstetric patients, called protocol in severe obstetric patient guided by ultrasound or POGGU protocol. Objective: to determine if the Poggu protocol is useful for diagnostic integration and management of these patients. Material and methods: retrospective, analytical cross-sectional study, 507 patients were included in a period of 7 years, where once the mater code was activated, they went to the evaluation in search of symptoms and cardinal signs, depending on these, proceeded to carry out point of care ultrasonography, determining classes of intervention, bivariate analysis was performed, Student's t or Mann-Whitney U tests were used for continuous and discrete quantitative variables and Pearson's χ2 test for categorical and nominal ones. Variables were correlated between the types of categories and point of care ultrasounds and finally a multivariate analysis of binary logistic regression adjusted for variables with statistical and clinical significance. Results: it was obtained that grades II, III, and IV showed an association, reaching significance against point of care ultrasonography, based on the diagnosis (grade II) in 65/35 in abdominal, with a p = 0.000; pulmonary of 81/19, with a p = 0.015; heart rate of 82/18, with a p = 0.022; large vessels and response to volume of 57/43, with a p = 0.000. A usefulness was found in providing additional information (grade III) with p = 0.000, and in which ultrasonography was decisive for management (grade IV) with p = 0.000, finally, in the logistic regression a result was obtained squared or adjusted R of 0.50, that is, 50%, with an omnibus of p = 0.0001, finding that there is a moderate relationship between degrees and cardiac point of care ultrasonography and great vessels with response to volume. Conclusions: 99.6% of our studied population survived being operated on with the POGGU protocol within the multidisciplinary rapid response care process code mater. In 97.2% of the patients, at least one ultrasound window was obtained for patient assessment, an important fact, since it tells us about the ease of its realization, its implementation is suggested when activating the mater code, not only as an option, if not essential (making it an integral part of the obstetric triage technical guideline, maternal code and obstetric immediate response team), the use of ultrasound should be considered as an essential part of the intensivist's work when assessing an obstetric patient serious.

Resumo: Introdução: a mortalidade materna ainda pode ser considerada um importante problema de saúde pública em nosso país, dentro das estratégias implementadas para reduzir a morbidade-mortalidade, é criado o código máter pela nossa unidade de terapia intensiva, com base em algoritmos de atendimento, onde uma pedra angular é o precoce e oportuno diagnóstico, ganhando relevância o uso do ultrassom como método diagnóstico em pacientes obstétricas graves Na nossa unidade foi desenvolvido um protocolo de ultrassom para avaliação de pacientes obstétricas graves, denominado protocolo de pacientes obstétricas graves guiado por ultrassom ou protocolo POGGU. Objetivo: determinar se o protocolo para pacientes obstétricas graves guiadas por ultrassom ou o protocolo POGGU é útil para integração diagnóstica e manejo dessas pacientes. Material e métodos: estudo retrospectivo, transversal, descritivo e analítico. Incluíram-se 507 pacientes obstétricas que receberam atendimento médico nas quais o código máter foi ativado no período de 2015 a 2022. Uma vez recolhidos os dados das planilhas de coleta, eles foram registrados no banco de dados do Excel, posteriormente, os resultados foram processados no pacote estatístico Statistical Package for the Social Sciences (SPSS), para Windows versão 26.0, utilizaram-se medidas de frequência relativa (frequências absolutas e percentuais) e de tendência central e dispersão (média e desvio padrão) conforme o caso, realizaram-se análise bivariada, para variáveis quantitativas contínuas e discretas foram utilizados os testes t de Student ou U de Mann-Whitney. Para variáveis categóricas e nominais, foi utilizado o teste χ2 de Pearson. Finalmente, realizou-se uma análise multivariado de regressão logística, a significância estatística foi estabelecida como p < 0.05 ou < 5%. Resultados: obteve-se que os graus II, III e IV apresentaram associação, alcançando significância em relação à ultrassonografia point-of-care, corroborando o diagnóstico (grau II) em 65/35 em abdominal, com p = 0.000; pulmonar de 81/19, com p = 0.015; cardíaco de 82/18, com um p = 0.022; grandes vasos e resposta a volume de 57/43, com p = 0.000. Encontrou-se uma utilidade em fornecer informações adicionais (grau III) com p = 0.000, e em que o ultrassom foi decisivo para o manejo (grau IV) com p = 0.000, finalmente, na regressão logística obteve-se como resultado um R quadrado ou ajustado de 0.50, ou seja, 50%, com um omnibus de p = 0.0001, constatando que existe uma relação moderada entre graus e o ultrassom point-of-care cardíaco e grandes vasos com resposta ao volume. Conclusões: 99.6% da nossa população de estudo sobreviveram sendo intervencionados com o protocolo POGGU dentro do processo multidisciplinar do código máter de cuidados de resposta rápida. Em 97.2% dos pacientes foi obtida pelo menos uma janela de ultrassom para avaliação do paciente, dado importante, pois nos fala da facilidade de sua realização, sua implementação é sugerida no momento de acionar o código máter, e não apenas como uma opção, senão essencial (tornando-se parte integrante das diretrizes técnicas de triagem obstétrica, código máter e equipe de resposta imediata obstétrica), o uso do ultrassom deve ser considerado como parte essencial do trabalho do médico intensivista na avaliação de um obstetra paciente grave.

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Glyphosate is a controversial herbicide. Its genotoxicity and presence in various ecosystems have been reported. The use of ascorbic acid and resveratrol could protect different organisms from glyphosate-induced genetic damage. In the present study, specific genetic damage induced by glyphosate was evaluated in erythrocytes of Oreochromis niloticus, Ambystoma mexicanum and human lymphocytes. Simultaneously, the antigenotoxic capacity of various concentrations of ascorbic acid and resveratrol was evaluated by means of pretreatment and simultaneous treatment protocols. The 0.03, 0.05 and 0.07 mM concentrations of glyphosate induced significant genotoxic activity (p < 0.05) in human lymphocytes and in erythrocytes of the species studied, and could cause genomic instability in these populations. The reduction in genetic damage observed in human lymphocytes exposed to high concentrations of glyphosate is only apparent: excessive genetic damage was associated with undetectable excessive tail migration length. A significant (p < 0.05) antigenotoxic effect of ascorbic acid and resveratrol was observed in all concentrations, organisms and protocols used. Both ascorbic acid and resveratrol play an important role in maintaining the integrity of DNA. Ascorbic acid in Oreochromis niloticus, Ambystoma mexicanum reduced glyphosate-induced genetic damage to a basal level. Therefore, our data indicate that these antioxidants could help preserve the integrity of the DNA of organisms exposed to glyphosate. The consumption of antioxidants is a useful tool against the genotoxicity of glyphosate.

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INTRODUCCIÓN: La pandemia de COVID-19 ha comportado una disminución de la consulta ginecológica al servicio de urgencia. OBJETIVO: Caracterizar las consultas en el servicio de urgencia ginecológica, evaluando la cantidad de hospitalizaciones, la necesidad de intervención quirúrgica y los factores de morbilidad, entre otros, comparado a la situación con la previa a la pandemia. MÉTODO: Se realizó un estudio de cohorte no concurrente de pacientes hospitalizadas tras una consulta espontánea al servicio de urgencia ginecológica entre las semanas 12 y 28 de 2019 y 2020 en el Hospital Clínico de la Pontificia Universidad Católica, en Santiago (Chile). Se determinaron distintos factores de morbilidad: diagnóstico de ingreso, intervención quirúrgica, complicación operatoria, días de hospitalización, hemoglobina/hematocrito de ingreso y necesidad de transfusión de unidades sanguíneas. RESULTADOS: Hubo 511 consultas al servicio de urgencia entre las semanas 12 y 28 del año 2019, en comparación con 196 el año 2020. En 2019 fueron hospitalizadas 103 mujeres, y en 2020 ingresaron 72 (odds ratio [OR]: 2.3). Disminuyó el ingreso por aborto retenido (24 vs. 12; p = 0.01), mientras que aumentó el ingreso por metrorragia posmenopáusica (9 vs 22; p = 0.01). No hubo cambio en las intervenciones quirúrgicas realizadas (86.4% vs. 84.7%; p = 0.7). Aumentaron los días de hospitalización (2.3 vs. 3.1; p < 0.0001) y la necesidad de transfusión sanguínea (2 vs. 7; p = 0.02; OR: 5.4; intervalo de confianza: 1.09-26). CONCLUSIONES: La pandemia de COVID-19 provocó una disminución en la consulta espontánea por patología ginecológica al servicio de urgencia, provocando un aumento en la relación consulta/ingreso y una mayor morbilidad en las pacientes hospitalizadas, caracterizada por una mayor necesidad de transfusión sanguínea y un aumento de los días de hospitalización.

INTRODUCTION: The COVID-19 pandemic has meant a decrease in gynecological visits to the emergency department. OBJECTIVE: To characterize the attending in the gynecological emergency service, evaluating the amount of admissions, hospitalizations, need for surgical intervention, morbidity factors, among others, compared to the pre-pandemic situation. METHOD: A non-concurrent cohort study of hospitalized patients was carried out through a spontaneous attending to the gynecological emergency service between weeks 12 and 28 of 2019 and 2020 at the Hospital Clínico of the Pontificia Universidad Católica, in Santiago (Chile). Different morbidity factors were measured: admission diagnosis, surgical intervention, surgical complication, hospital stay, admission hemoglobin, and need for transfusion of blood units. RESULTS: A total of 511 visitors to the emergency service were registered between weeks 12 and 28 of 2019, compared to 196 in 2020. In 2019 and 2020, 103 and 72 women were hospitalized respectively (odds ratio [OR]: 2.3). Admission for pregnancy loss decreased (24 vs. 12; p = 0.01), while admission for postmenopausal bleeding increased (9 vs. 22; p = 0.01). There was no change in the surgical interventions performed (86.4% vs. 84.7%; p = 0.7). The hospital stays increased (2.3 vs. 3.1; p < 0.0001) and the need for blood transfusion (2 vs. 7; p = 0.02; OR: 5.4; confidence interval: 1.09-26). CONCLUSIONS: The COVID-19 pandemic caused a decrease in spontaneous attending for gynecological pathology at the emergency service, causing an increase in the attend/admission ratio and greater morbidity in hospitalized patients characterized by a greater need for blood transfusion and an increase on the hospital stay.

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Resumen: El catéter en la arteria pulmonar (CAP) es un dispositivo utilizado en unidades de cuidados intensivos (UCI) para medir las presiones en el corazón y los vasos sanguíneos pulmonares como parte del monitoreo hemodinámico, principalmente en pacientes de cirugía cardiaca. El dispositivo USCOM se trata de una técnica no invasiva que utiliza la tecnología Doppler para obtener las medidas de volumen sistólico y sus derivados. Se realiza la siguiente comparación de medición de GC entre estos dos dispositivos en pacientes con choque séptico. Se realizó un estudio tipo observacional, prospectivo, longitudinal y comparativo en pacientes con choque séptico entre 18 y 60 años de edad ingresados en la UTI en el periodo de mayo-junio del 2017. Ante la disminución del uso del catéter de la arteria pulmonar debido a la controversia de no mejorar la mortalidad en los pacientes de las unidades de terapia intensiva (UTI), la colocación de dicho catéter ha caído en desuso; sin embargo, el GC medido por el catéter de Swan-Ganz sigue siendo el «estándar de oro¼ para la medición en tiempo real del GC y las resistencias sistémicas y pulmonares. La medición del GC por CAP versus USCOM se correlaciona de tal forma que puede emplearse en la medición por USCOM en un paciente con choque séptico, al cual no se le pretenda invadir para determinar sus condiciones hemodinámicas.

Abstract: The pulmonary artery catheter (CAP) is a device used in intensive care units (ICUs) to measure pressures in the heart and pulmonary blood vessels as part of hemodynamic monitoring primarily in cardiac surgery patients. The USCOM device is a non-invasive technique that uses Doppler technology to obtain measurements of systolic volume and its derivatives. The following CO measurement comparison is performed between these two devices in patients with septic shock. An observational, prospective, longitudinal and comparative study was conducted in patients with septic shock aged between 18 and 60 years admitted to intensive care in the period May-June 2017. In view of the decrease in the use of the pulmonary artery catheter due to the controversy of not improving the mortality in the patients of the Intensive Care Units, the placement of this catheter has fallen into disuse; however, cardiac output measured by the Swan Ganz catheter remains the «gold standard¼ for real-time measurement of cardiac output and systemic and pulmonary resistance. The CO measurement by PAC versus USCOM correlates, in such a way, that USCOM measurement can be used in a patient with septic shock, who is not expected to invade to determine their hemodynamic conditions.

Resumo: O cateter de artéria pulmonar (CAP) é um dispositivo utilizado em unidades de terapia intensiva (UTI) para medir as pressões nos vasos sanguíneos cardíacos e pulmonares, como parte da monitorização hemodinâmica, principalmente em pacientes submetidos a cirurgia cardíaca. O dispositivo USCOM é uma técnica não invasiva que utiliza a tecnologia Doppler para obter medidas do volume sistólico e seus derivados. A seguinte comparação da medição do DC é feita entre esses dois dispositivos em pacientes com choque séptico. Foi realizado um estudo observacional, prospectivo, longitudinal e comparativo em pacientes com choque séptico com idade entre 18 e 60 anos internados na unidade de terapia intensiva no período de maio a junho de 2017. Dada a diminuição do uso do cateter de artéria pulmonar devido à controvérsia de não melhorar a mortalidade nos pacientes das Unidades de Terapia Intensiva, a colocação do referido cateter caiu em desuso; no entanto, o débito cardíaco medido pelo cateter de Swan Ganz continua sendo o «padrão ouro¼ para a medição em tempo real do débito cardíaco e resistências sistêmicas e pulmonares. A medida do DC por CAP vs USCOM está correlacionada, de tal forma que a medida por USCOM pode ser usada em um paciente com choque séptico, que não se destina a invadir para determinar suas condições hemodinâmicas.

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INTRODUCTION: The aim of this study was to evaluate the effectiveness of peracetic acid (PAA) in cleaning root canals contaminated with Enterococcus faecalis. METHODS: Sixty first and second mandibular molars were used. Their mesiobuccal canals were prepared with the Reciproc System (VDW, Munich, Germany). The canals were irrigated with 10 mL saline during instrumentation. The teeth were randomly divided into 3 groups (n = 20), according to the irrigation solution to be used after instrumentation: group PAA (5 mL 1% PAA), group EDTA/sodium hypochlorite (NaOCl) (5 mL 17% EDTA followed by 5 mL 2.5% sodium hypochlorite), and group S (5 mL saline). Microbiological samples were collected before instrumentation and after final irrigation. Bacterial quantification was performed by counting the number of colony-forming units (CFUs/mL). The results were analyzed by the nonparametric Wilcoxon and Kruskal-Wallis tests. RESULTS: The 3 groups showed a significant reduction (P < .05) in CFUs/mL after final irrigation. PAA and NaOCl associated with EDTA produced a significantly higher reduction in CFUs/mL (P < .05) compared with saline. There was no statistically significant difference between PAA and EDTA + 2.5% NaOCl (P > .05). CONCLUSIONS: According to the results of the present study, the effectiveness of 1% PAA was similar to that of 17% EDTA + 2.5% NaOCl in cleaning curved root canals contaminated with E. faecalis.

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INTRODUCTION: The maximum removal of root canal filling material is essential for successful endodontic retreatment. The purpose of this study was to assess the efficacy of 2 reciprocating systems (Reciproc [VDW, Munich, Germany] and WaveOne [Dentsply Maillefer, Ballaigues, Switzerland]) compared with a nickel-titanium (NiTi) rotary system (ProTaper Universal Retreatment [Dentsply Maillefer]) in the removal of root canal filling material. METHODS: Sixty root canals of extracted human maxillary incisors were prepared using the NiTi ProTaper rotary system with the complementary use of a #40 K-type file and then obturated. The specimens were divided into 3 groups (n = 20) according to the system used for filling removal: group 1: instrument R25 of the Reciproc system, group 2: primary instrument of the WaveOne system, and group 3: NiTi rotary instruments of the ProTaper Universal Retreatment system. The teeth were cleaved longitudinally and photographed under a dental operating microscope with 5 × magnification. Images were transferred to a computer, and residual filling material was quantified using Image Tool software (University of Texas Health Science Center, San Antonio, TX). Results were compared using 1-way analysis of variance (P < .05). RESULTS: All teeth examined had filling remnants within the canal. No statistically significant difference (P > .05) in residual filling material was observed among the groups, with 4.30% in group 1, 2.98% in group 2, and 3.14% in group 3. CONCLUSIONS: The Reciproc and WaveOne reciprocating systems were as effective as the ProTaper Universal retreatment system for gutta-percha and sealer removal.

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Este estudo procurou revisar e analisar a literatura pertinente dos últimos anos (1996-2002) que determina a longetividade clínica das restaurações do tipo inlay/onlay de cerâmica e as características que influenciam no sucesso dessas restaurações. Podemos observar que essa técnica restauradora possui um bom índice de sucesso nos trabalhos de curta duração, embora o sucesso em longo prazo ainda não esteja bem estabelecido. Conclui-se que essa técnica ocupa um lugar de destaque na odontologia estética atual e que, com o contínuo desenvolvimento dos materiais cerâmicos, torna-se-á uma alternativa estética e funcional na restauração de dentes posteriores

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Este trabalho tem como objetivo discutir as principais indicações do sistema Procera All Ceram, como também, relatar um caso clínico realizado na clínica de especialização em Dentística Restauradora da Universidade do Estado do Rio de Janeiro (UERJ), onde foram confecionadoas um aponte fixa e duas facetas Procera, que estão sendo acompanhadas pelos autores

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