Mandibular bone depressions located on the lingual/buccal aspect of the mandibular ramus are the rarest variants of the so-called Stafne's bone cavities, or major salivary gland-related depressions, with only 17 cases reported in the literature including both clinical cases and archaeological specimens. We report the case of a 14-year-old male patient who sought clinical assistance complaining of a hard expansion on the lower left premolar-molar region. Apart from a unilocular radiolucent lesion between the lower left second premolar and first molar, a panoramic radiograph showed another radiolucent lesion located in the right mandibular ramus, at the level of the mandibular foramen. Computed tomography (CT) revealed an expansile lesion in the left mandibular body, later diagnosed as a simple bone cyst through surgical exploration. The three-dimensional CT volume rendering reconstructed image showed that the second lesion, located on the lingual aspect of the ascending ramus, was an actual cortical bone defect, which was diagnosed as a mandibular ramus-related Stafne's bone cavity. Considering the young age of the patient, the size of the defect, the recognizedly slow development of mandibular bone defects and, above all, the location of the bone defect under discussion, we believe it to have a congenital rather than a developmental origin (i.e. it was caused by a focal failure during intramembranous ossification of the mandible). If this is the case, mandibular bone depressions should not be seen exclusively as salivary gland-related bone defects.

The medical literature has shown that the inhabitants of the Amazon region are highly affected by hepatitis B and delta viruses infection, but this has never been studied in Indian children by age group. A study of the prevalence of serological markers of hepatitis B and delta viruses in Indian children aged 0 to 14 years living in the PIX was carried out. This Park is located in Central Brazil, a region which is in the transition between the savannab to the south and the Amazon jungle to the north. To determine the prevalence of HBV and HDV markers in Indian children and to characterize the route of HBV transmission in this region. Out of the 17 tribes living in the PIX, two--the Caiabi and the Txucarramãe--were chosen because both live in the North part of the Park, but have quite different ways of life. The overall prevalence of HBV serum markers was: HBsAg, 4.5%; anti-HBs, 39.6%; anti-HBc, 44.1%; any marker of HBV, 47.3%; and anti-HDV, 0.0%. However, a striking difference in the prevalence of hepatitis B markers was observed between the two tribes: younger Caiabi children were much less affected than the Txucarramãe ones. The prevalence of HBsAg in fertile women was 12%, being anti-HBe positive. Our data suggest that HBV infection is highly prevalent among Indian children living in this Indigenous Park and vertical infection is not an important route of transmission in either tribes.

To review existing definitions of prolonged mechanical ventilation in children. DESIGN: Review of the literature. SETTING: Not applicable. PATIENTS: Pediatric patients under mechanical ventilation. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS:We searched the literature for original research on prolonged mechanical ventilation in children using the PubMed, Embase, and Cochrane Library databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed, and we extracted patient characteristics, duration of mechanical ventilation, outcomes, and associated complications. We identified 30 articles for qualitative analysis and found a wide variety of definitions, varying from 48 hours to 6 months. The most frequently used definitions of prolonged mechanical ventilation were greater than 7 days, greater than 14 days, and greater than 21 days. There was no highquality evidence of a definition for prolonged mechanical ventilation in children. CONCLUSIONS:There is limited evidence to determine the definition of prolonged mechanical ventilation in children. The variety of definitions is a sign of the need for a consensus definition of pediatric prolonged mechanical ventilation.

Female adolescents with NAFLD showed a significantly different metabolic behaviour than males.

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BackgroundThe Hepatitis Delta Virus (HDV) can increase the incidence of fulminant hepatitis. For this infection occurs, the host must also be infected with Hepatitis B Virus. Previous studies demonstrated the endemicity and near exclusivity of this infection in the Amazon region, and as a consequence of the difficulty in accessing this area we used dried blood spots (DBS) in sample collection. The aims of this study were to investigate the presence of recombination, to analyze the epidemiology, ancestry and evolutionary pressures on HDV in Brazil.MethodsBlood samples from 50 individuals were collected using dried-blood spots (DBS 903, Whatman), and sent via regular mail to Retrovirology Laboratory from Federal University of São Paulo, where the samples were processed. In the analysis the following software were used: PhyML, RDP, BEAST, jModelTest and CODEML.ResultsOur results confirm the prevalence of HDV-3 in the Amazon region of Brazil, with the absence of inter-genotypic recombination. It was identified a positive selection in probable epitopes of HDV on B lymphocytes that might indicate that the virus is changing to escape the humoral response of the host. The analysis of the time of the most common ancestor demonstrated the exponential growth of this virus in late 1970s that lasted until 1995, after which it remained constant. It was also observed a probable founder effect in two cities, which demonstrate the need to focus on prevention methods against HBV/HDV infection.ConclusionWe confirmed the prevalence of HDV-3 in the Amazon region of Brazil, without inter-genotypic recombination. The analysis of the time of the most common ancestor showed that this infection remain constant in the studied area. Taking into account the probable founder effect established in the cities of Rio Branco and Porto Velho, a focus on preventive methods is recommended against these infections.

A mandíbula é o único osso móvel da face e participa de funções básicas como mastigação, fonação e deglutição, além de participar da manutenção da oclusão dentária ocupando juntamente com a maxila a maior porção óssea do esqueleto facial 1 .Devido a sua topografia, anatomia e projeção no terço inferior da face, é freqüentemente atingida por traumas podendo resultar em fraturas, principalmente em acidentes de trânsito, agressões, quedas ou acidentes esportivos 10 .As fraturas mandibulares podem levar à deformidades, sejam por deslocamentos ou perdas ósse-as não-restauradas, com alterações de oclusão dentária ou da articulação temporomandibular (ATM). Quando não identificadas ou tratadas adequadamente, estas lesões podem levar à seqüelas graves, tanto estéticas como funcionais 1,6,11 .Este estudo tem como objetivo avaliar 166 pacientes consecutivos com fraturas de mandíbula atendidos e tratados no setor de Trauma de Face da disciplina de Cirurgia Plástica da UNIFESP-EPM, distribuídos conforme o sexo, idade, etiologia, localização das fraturas, técnicas de tratamento e complicações pós-operatórias. PACIENTES E MÉTODOForam estudados 166 pacientes consecutivos, vítimas de trauma mandibular (em um total de 267 fraturas), atendidos e tratados na disciplina de Cirurgia Plástica da UNIFESP/EPM no período de janeiro de 1991 a março de 1996.Os pacientes foram analisados através do levantamento de prontuários, avaliação das radiografias do pré e pós-operatório e através das Fichas de Trauma, específicas do setor de Trauma de Face da Cirurgia Plástica da UNIFESP / EPM. Foram então agrupados segundo o sexo, faixa etária, lesões associadas, tratamento e complicações pós-operatórias. RESULTADOSDo total de pacientes, encontramos 135 homens (81,3%) e 31 mulheres (18,7%), em um índice masculino/feminino de 4,3:1 (gráfico 1).A faixa etária variou de 1 ano e 4 meses a 59 anos (média de 27,11). As idades foram agrupadas em décadas, e a faixa etária mais acometida foi dos 20 aos 29 anos (42,8%), e a menos dos 50 aos 59 (4,8%) (gráfico 2).A etiologia mais freqüente de fraturas de mandíbula neste estudo foi relacionada aos acidentes de trânsito (81 casos -48,8%), em que 41,6% envolviam veículos de transporte e 7,2% atropelamento; seguido das quedas (44 casos -26,5) e agressões (39 casos -23,5%). Somente dois pacientes sofreram acidentes esportivos (gráfico 3). As diferentes etimologias dos acidentes de trânsito e agressões encontram-se na tabela 1.Foram identificadas 267 fraturas nos 166 pacientes tratados (1,6 fraturas/paciente), sendo que 86 pacientes (51,8%) apresentavam fraturas úni-cas e 80 pacientes (48,2%) fraturas múltiplas, com média de 2,2 fraturas/paciente no último grupo.A região do corpo da mandíbula foi a mais atingida (76 fraturas -28,5%), seguida do côndilo (71 fraturas -26,6%), região sinfisária (53 fraturas -19,9%), ângulo (38 fraturas -14,2%), e alveolar isoladamente (5 fraturas -1,9%). A região menos atingida foi o processo coronóide (3 fraturas -1,1%) (figura 1).Correlacionamos as fraturas de mandíbula com outras le...

Objective: to evaluate food intake, occurrence of energy-protein malnutrition and anemia, and intestinal iron absorption in children with chronic liver disease.