Introduction

The success of a restorative treatment is closely linked to the degree of surface polishing, which can prevent issues such as secondary caries, discoloration, microleakage, and fractures. The choice of finishing and polishing techniques is essential to ensure the durability and aesthetic quality of composite resin restorations.

Objective:
This study aimed to compare different finishing and polishing techniques for composite resin restorations by evaluating the resulting surface roughness.

Methods:
A 24-year-old female patient presented to the Comprehensive Dentistry Clinic at UNIBRA with complaints of darkened and unsatisfactory dental restorations. The proposed treatment included three main stages: gingival contouring, tooth whitening, and the replacement of the restorations.

Initially, gingival contouring was performed, followed by a 21-day healing period. Tooth whitening was carried out using a combined technique with 35% hydrogen peroxide in-office and 16% carbamide peroxide at home. After whitening, the restorations of teeth 11 and 21 were replaced using specific procedures, including preparation, shade selection, adhesive application, resin layering, occlusal adjustment, and finishing and polishing.

Results:
The multidisciplinary treatment significantly improved the patient's smile aesthetics. Gingival contouring achieved a harmonious gingival margin, tooth whitening delivered the desired brightness, and the new composite resin restorations provided a more natural and satisfactory appearance in terms of color and shape.

Conclusions:
The multidisciplinary approach was essential for the aesthetic harmonization of the patient’s smile, resulting in an outcome that was satisfactory for both the patient and the professionals involved. The integrated treatment contributed to the patient's well-being and underscored the importance of combined techniques to achieve high-quality aesthetic results.

Introduction: Leukemia, particularly acute lymphoblastic leukemia (ALL), is the most common cancer among children and adolescents in Brazil, significantly impacting the Unified Health System (SUS). This study aims to analyze the epidemiological profile of hospitalizations for leukemia in the SUS from 2021 to 2024, considering age, sex, and hospitalization characteristics, to support improvements in care strategies and public policies for pediatric cancer in Brazil. Methods: This cross-sectional study used data from the DATASUS platform. The variables analyzed included the total number of hospitalizations for neoplasms and leukemia in Brazil, segmented by age group (0-19 years) and sex, from 2021 to 2024. Results: From 2021 to 2024, hospitalizations for neoplasms among children and adolescents in Brazil increased. In 2021, there were 60,280 admissions, with 35.08% due to leukemia, predominantly among males (12,424 cases), and in the age group of 1-4 years (6,657 admissions). In 2022, admissions rose to 61,865, with 34.59% of these for leukemia, maintaining the same sex and age patterns. In 2023, there were 64,684 admissions, of which 33.37% were for leukemia, with males (12,560 cases) and the 5-9 age group predominating. In 2024, until November, 62,814 admissions were recorded, 34.02% for leukemia, again with males and the 1-4 age group prevailing. Conclusions: The persistently high rate of leukemia-related hospitalizations among children and adolescents in Brazil, predominantly in males and in the 1-4 age group, emphasizes the need for strengthened early diagnosis and treatment efforts in the SUS. The increasing hospitalization trend from 2021 to 2024 highlights the urgency of improving public policies and the importance of an integrated approach to pediatric cancer care in Brazil.

Introduction: According to the World Health Organization, cardiovascular diseases are the leading cause of death globally, accounting for 31% of all deaths worldwide in 2016. In Brazil, Acute Myocardial Infarction stands out as the leading cause of mortality among cardiac pathologies in the country. Thus, it is crucial to identify the epidemiological profile of deaths to diagnose the challenges faced by the Brazilian healthcare system and to target public health measures toward the groups most affected by this condition. Methods: A cross-sectional, descriptive, and retrospective study was conducted on deaths caused by Acute Myocardial Infarction between January 2014 and December 2023 in Brazil. Secondary data were collected from the Department of Information and Informatics of the Unified Health System. Results: Between 2014 and 2023, 931,983 deaths from Acute Myocardial Infarction were recorded in Brazil, with an average of 93,198.3 deaths per year and minimal fluctuation in annual mortality rates. The most affected age group was 80 years and older, accounting for 26.74% of total deaths. Men were 145% more affected than women, while the most vulnerable population groups were White and Brown individuals, representing 51.84% and 37.03% of deaths, respectively. Additionally, approximately 50% of deaths occurred in hospital settings. Conclusions: A high number of deaths from Acute Myocardial Infarction has been observed in the past decade in Brazil. The annual average number of deaths, combined with the low fluctuation in mortality rates over the years, and the prevalence of hospital-based deaths, indicates significant public health challenges in addressing the high mortality associated with this condition. Furthermore, the epidemiological profile of patients—elderly White or Brown men aged 80 years or older—highlights the most vulnerable group to Acute Myocardial Infarction. It is therefore of utmost importance to direct collective health measures toward this population group.

Introduction: Data from the Brazilian surveillance system (Vigitel 2022) show that cardiovascular diseases account for about 28% of annual deaths in Brazil, while obesity (OB) impacts over 22% of the adult population. The relationship between atherosclerosis (AS) and OB is complex and bidirectional, with each condition exacerbating the other. Therefore, understanding their distribution and interaction in Brazil over time is essential to developing effective prevention strategies.

Methods: A time series analysis was performed based on public and secondary data obtained from the Datasus platform. The analysis examined hospital admissions for OB and AS and their distribution across Brazilian macroregions. Data were analyzed in ten-year intervals to compare the decades 2004–2013 and 2014–2023, aiming to identify temporal and regional trends.

Results: Between 2004 and 2013, Brazil recorded 62,511 hospitalizations for OB and 96,935 for AS. From 2014 to 2023, OB admissions rose to 107,272, reflecting a 71.60% increase compared to the previous decade. For AS, 232,524 hospitalizations were reported, indicating a 139.9% increase. Geographically, the South and Southeast regions accounted for most of these admissions in the earlier period, representing 81.88% of OB and 72.76% of AS cases. This pattern persisted in the subsequent decade, with these regions comprising 87.14% of OB and 68.20% of AS hospitalizations.

Conclusions: The increase in hospitalizations related to OB and AS over the past 20 years reflects not only a shift in the health profile of the Brazilian population but also the influence of socioeconomic and behavioral factors, such as greater consumption of ultra-processed foods and a sedentary lifestyle. The concentration of cases in highly industrialized regions, such as the South and Southeast, underscores the need for public policies to promote healthy habits and address regional health disparities.

Introduction: According to Brazil's National Cancer Institute, lung cancer had become one of the leading causes of preventable deaths by the end of the 20th century. However, malignant neoplasms of the bronchi and lungs remain one of the primary causes of mortality in Brazil. Therefore, it is necessary to study the epidemiological profile of these patients to develop better public health policies targeting the main at-risk group. Methods: This is a retrospective epidemiological study on deaths caused by malignant neoplasms of the bronchi and lungs in Brazil between January 2014 and December 2023. Secondary data were collected and analyzed from the Department of Information and Informatics of the Unified Health System. Results: Between 2014 and 2023, 282,647 deaths were recorded due to malignant neoplasms of the bronchi and lungs in Brazil, with the highest number (31,150) reported in 2023. The most affected group were individuals aged 60 to 79 years, accounting for approximately 60% of total deaths nationwide. Men were 1.3 times more affected than women, and white individuals (60.29%) were the most affected by the neoplasm. Conclusions: The results highlight that, despite being preventable, lung cancer continues to affect thousands of Brazilians as of 2023. The epidemiological profile derived from the patterns and trends of this neoplasm over the years indicates a higher prevalence of deaths among white men aged 60 to 79 years. This characteristic may be associated with the accumulation of predisposing factors over the years and the specific risk factors for this group, such as smoking. By outlining the profile of these deaths, it becomes possible to design better prevention and treatment policies targeting the most vulnerable group affected by this type of cancer.

Introduction:

hMPV is an emerging respiratory pathogen that has increasingly been recognized as a result of advancements in molecular diagnostics, thereby enhancing the detection and characterization of the agent. Those with a severe form of the disease are typically either paediatric/elderly or immunocompromised. hMPV-associated pneumonia in immunocompetent adults remains largely unexplored. This paper reviews a case of severe hMPV-associated community-acquired pneumonia in an immunocompetent adult and examines different chest CT findings in comparison to those in respiratory syncytial virus infections.

Methods:

We describe a case of 68-year-old immunocompetent male who had hMPV-induced CAP that was confirmed by multiplex RT-PCR. The etiology of the imaging findings is determined. Moreover, the study retrospectively assessed CT-scans of 10 hMPV-positive patients presenting with pulmonary symptoms. Comparing them with those from 13 patients with RSV-related pneumonia can help outline imaging differences and establish a time course of the hMPV-related pneumonia.

Results/Discussion:

The case showed bilateral ground-glass opacities and consolidations consistent with viral pneumonia. Early molecular diagnostics allowed for precise pathogen identification, guiding appropriate treatment and reducing unnecessary antibiotic use. Retrospective analysis demonstrated that hMPV pneumonia typically exhibits asymmetric findings, including ground-glass opacities, consolidations, nodular opacities, and bronchial wall thickening. Conversely, RSV pneumonia showed more symmetric bilateral interstitial involvement. Over time, hMPV-related interstitial pneumonia transitioned into bronchitis or bronchiolitis before resolving.

These findings highlight the need for hMPV-specific diagnostic testing and imaging in clinical workflows, which will improve management and reduce inappropriate antibiotic usage. Further research is necessary to better differentiate hMPV and RSV, guiding prevention and therapeutic strategies.

Acetabular fracture is a challenging and an uncommon fracture for radiologist and orthopaedics. The prevalence rate for young patients is 80% in road traffic accidents, with an incidence of 3 patients/ 1,00,000/ year. This case report showcases the recovery of 60-year-old male farmer by occupation suffering from acetabular fracture following a history of a road traffic accident and a medical history of diabetes following open reduction internal fixation with acetabular plate and screw. The patient underwent a structured physiotherapy exercise protocol for 2 weeks. On examination, the active range of motion of the affected side hip flexion was 10 degrees and that of hip abduction was 20 degrees, while that of knee flexion was 20 degrees in the supine position. The range of motion of the affected side ankle was in a normal, functional range of motion. This was assessed using a goniometer. Pain was assessed using a numerical pain rating scale, where the patient rated 4 out of 10 during movement and 1 out of 10 at rest.

Furthermore, 3D CT of the pelvis with both hip joints showed a communated displaced fracture in the posterior column of left acetabulum. Two bony fragments measuring 10x4mm and 7x3.7mm were noted in the left hip joint space.

The positive result of this case highlights the significance of incorporating physiotherapy into the postoperative treatment of patients with diabetes and fractures. This helps improve functional recovery and decreases the likelihood of long-term disability.

A 77-year-old man, who underwent PCI 11 times in all three branches for unstable angina pectoris and who was taking SGLT2 inhibitor for diabetes mellitus, visited our emergency department because he felt chest strangulation when walking uphill. A 12-lead ECG showed a new ST elevation of more than 0.1 mV at V3~5, and transthoracic echocardiography showed mild hypokinesis in the intermediate posterior wall. Blood tests showed 448 pg/ml of NT-proBNP and that troponin T was slightly elevated at 0.056 mg/ml, leading to a diagnosis of non-ST-segment elevation acute myocardial infarction. The patient was urgently admitted to the hospital with a plan to perform PCI within 24 hours of arrival. After admission, he was prohibited from food intake and started on continuous saline infusion. On the second day, CAG was performed, and 90% stenosis was found in the left coronary artery Seg. 13. During PCI at the same site, the patient went into shock vitals, with urinary ketones 4+ and metabolic acidosis, and was diagnosed with euglycemic diabetic ketoacidosis (EDKA). The acid–base balance was normalized by continuous intravenous small-dose insulin infusion and glucose loading, and the administration of hypertensive drug was terminated on the fifth day of the disease. SGLT2 inhibitors are known to be cardioprotective and renal-protective, and are currently used in many patients. Three days prior to surgery for the withdrawal of SGLT2 inhibitors is recommended, but it is difficult to ensure a sufficient withdrawal period in emergency surgery. There are few case reports of EDKA occurring in this manner, and we report this case with a discussion of the literature.

INTRODUCTION: Limited treatment options exist for patients with thymic epithelial tumors (TETs); this disease progresses even after platinum-based chemotherapy. Only a few prospective studies have investigated potential therapies in this setting. Recent studies have reported that PD-L1 is expressed in up to 70% of patients with TETs. The median progression-free survival even with pembrolizumab was 6.1 months in these relapsed refractory thymomas. However, we present a case of relapsed thymoma with longer PFS benefits using pembrolizumab.

DESCRIPTION

A 54-year-old female was initially diagnosed with locally advanced thymic carcinoma in Jan 2020. She received 3 cycles of gemcitabine + cisplatin followed by concurrent chemoradiation 66Gy/33# with weekly cisplatin. She developed dilated cardiomyopathy and was started on cardiac medications. She had very minimal disease progression in Jan 2021 and was started on OMCT with Tab Endoxan and Tab Methotrexate. After 6 months, due to further metastatic disease progression, she received 9 cycles of Nabpaclitaxel+carboplatin on 4.10.2021.

In Oct 2021, PET CT showed new metastatic nodes in the mediastinum, an interval increase in pericardial effusion and bilateral pleural effusion. She was initiated on pembrolizumab 3 times weekly (from 16/11/2021). After 3 cycles, she had a partial response and was clinically better. She went on to receive 15 cycles, lasting almost 1 year, of pembrolizumab. She further developed oligoprogression in her lymph nodes and hence received 40GY/10 fractions of IMRT. On further disease progression, she was administeredLenvatinib and capecitabine tabs. Finally, she succumbed to illness after 52 months of diagnosis.

CONCLUSION:

Pembrolizumab has shown encouraging antitumor activity in patients with advanced TET. Given the high incidence of autoimmunity, additional studies are needed to identify those who can benefit from pembrolizumab without immune-related adverse events. The median survival of patients with stage 4 thymic carcinoma is around 20-24months; however, this canprolonged to a greater extent with immunotherapy.

Introduction:

Left ventricular hypertrabeculation, also known as left ventricular non-compaction cardiomyopathy, is a rare myocardial condition characterized by deep trabeculations with implications for cardiac function.

Method:

The aim of this clinical case is to highlight the late diagnosis of left ventricular hypertrabeculation in a patient with non-specific symptoms, emphasizing the importance of continuous monitoring and advanced imaging evaluations for early detection of the disease. The patient, a 47-year-old woman, without any important medical history or cardiac risk factors, presented with fatigue, dyspnea during mild exertion, dizziness, and palpitations. The patient's SCORE2 score was 3.3%.

Results:

After a routine clinical examination, which showed cardiomegaly, the electrocardiogram revealed a rightward electrical axis with frequent ventricular extrasystoles showing severity criteria (R/T phenomena), QRs morphology in V1, V2, and fragmented complexes in aVR. Ventricular monomorphic ectopic beats were frequently recorded on 24-hour ECG Holter monitoring. Suspecting cardiomyopathy, transthoracic echocardiography identified biventricular dilation and visible trabecular formations along the lateral and apical walls, moving synchronously with the myocardium, with blood flow detected in the intratrabecular spaces on Color Doppler, as well as left ventricular systolic dysfunction. The suspicion of left ventricular hypertrabeculation (previously known as non-compaction cardiomyopathy) was confirmed by cardiac magnetic resonance imaging. Under the specific four pillars of heart failure treatment, the evolution was good. In addition, antiarrhythmic treatment with amiodarone was initiated.

Conclusion:

This case underscores the diagnostic challenges posed by left ventricular hypertrabeculation and underscores the value of integrating clinical findings with advanced imaging techniques. Early identification and appropriate management of this rare condition are essential to prevent disease progression and improve patient outcomes.