Ricardo José Fittipaldi-Fernandez1, Idiberto José Zotarelli-Filho2,3, Marcelo Falcão de Santana4,5, João Henrique Felicio de Lima6, Fernando Santos Silva Bastos4,5, Newton Teixeira dos Santos7 1.      Endogastro Rio Clinic, Rio de Janeiro/RJ, Brazil.2.      FACERES – Faculty of Medicine of Sao Jose do Rio Preto/SP, Brazil.3.      Zotarelli-Filho Scientific Work, Sao Jose do Rio Preto/SP, Brazil.4.      IFEC-Instituto Falcão de Endoscopia e Cirurgia (Falcão Institute of Endoscopy and Surgery), Salvador/BA, Brazil.5.      EBMSP-Escola Bahiana de Medicina e Saúde Pública (Bahiana School of Medicine and Public Health), Salvador/BA, Brazil.6.      Endobatel–Digestive endoscopy, Universidade Federal do Paraná-UFPR (Federal University of Paraná), Curitiba/PR, Brazil.7.      NT Santos Serviços médicos (NT Santos-Medical services), Rio de Janeiro/RJ, Brazil.

Aims: This study to evaluate the efficacy and complications of Argon Plasma Coagulation (APC) therapy to treat post-RYGB weight regain compared to a sham control group. Methods: 41 Patients with minimum regain of 10 kg and minimal postoperative time of 36 months was randomized into two groups. Results: In the APC group (n=21), the mean initial weight 100.4 kg, and mean regained weight of 24.94 kg. In the Sham group (n=20), the mean initial weight of 103.65 kg, and mean regained weight of 25.18 kg. Only happened anastomosis stenosis after the first APC session. The comparative results between the APC versus the Sham were percentage recovered weight loss (63.95 x-2.65), weight loss in kg (15.02 x-0.57), percentage total weight loss (14.46 x-0.62), % excess weight loss (54.32 x-2.34), and BMI reduction (5.38 x-0.21), with a p<0.0001 for all the comparisons. There was a significant reduction in the APC group of HbA1c (5.66% to 4.96%) and triglycerides (153.20mg/dL to 132.20mg/dL). Conclusion: This study proves that APC outlet pouch reduction is much superior compared to sham in promoting weight loss for patients that presented weight regain after de RYGB.

Introduction: Currently, 30% of the world's population is overweight or obese. Roux-en-Y gastric bypass (BGYR) and vertical gastrectomy are the most commonly performed techniques in Brazil and worldwide. Objective: Conduct a meta-analysis of the results of using argon plasma coagulation (APC), suture (SUT), and surgery (SUR), to clarify the safety and efficacy of using argon plasma to other procedures. Methods: The quality of the evidence was classified as high, moderate, low, or very low, according to the risk of bias. The Variance (α2) and One-Way (ANOVA) test were applied, adopting the α level less than 0.05 with a statistically significant difference for the 95% CI. The value of R-sq (R2) was analyzed to discover the imprecision or heterogeneity of the analyzes. Results: A total of 34 studies were found, eight to APC, twenty to SUT, and six to SUR. For relapsed weight loss (RWL), the means for APC, SUT, and SUR were respectively 19.39 ± 10.94, 26.06 ± 16.71, and 17.05 ± 9.85, and for SR, the means were respectively 89.75 ± 16.75, 86.80 ± 11.44, and 76.00 ± 21.57. There was a small difference between the values of APC averages with SUT and SUR, both in relation to RWL and SR, with p>0.05, with a high association (R2 ≥ 50%). Conclusion: It was shown that the APC technique showed excellent results in terms of RWL and SR compared to the other techniques, with no statistically significant difference. Thus, the results of the APC strongly point to its potential use.

Objective: To carry out an epidemiological analysis characterizing the type and location of the injury, severity based on recovery time, game position, and injury for hours of exposure. Methods: Data collection was carried out in the sub 15, sub 17, and sub 20 categories and verified records made by the medical team of the club, which was trained to use the F-MARC form (a form of the medical research center of the International Football Federation-FIFA) at the beginning of the season. To perform the data analysis, the GraphPad Prism software was used. All variables were analyzed using the Kolmogorov-Smirnov test. Results: In relation to the 129 athletes monitored during the season, 62 athletes presented some injury during the season, presenting 42.2 injuries for every 1000 hours of play, the Sub 15 category was the one with the highest incidence of injury, followed by the Sub17 and U20. The average time of leave after injury was 3.65 ± 4.2 weeks, the Defenders were the ones with the highest injury rate. There were 27 articular injuries (43.54%), 25 muscle injuries (40.32%), 9 bone injuries (15.41%), and one pathological injury (1.61%), and the most affected regions were ankle and knee. Conclusion: It is concluded that the moment of the game is the moment when the greatest number of injuries occurs, having a greater incidence in the athletes of the category Sub 15, the Defenders suffered more injuries and the Lower Limbs were more affected, mainly by articular traumas.

Beatriz Colovati Saccardo1, Camila Saggioro Paulucci¹,  Pedro Saggioro Paulucci 1, Heloisa Dias Sanson¹, Otávio Carbone Ruy¹, Durval Ribas Filho1,2, Ana Valéria Garcia Ramirez2,5, Idiberto José Zotarelli Filho2,3,4 1.      FAMECA, Faculty of Medicine of Catanduva - Padre Albino University Center, Catanduva/SP, Brazil.2.      Associação Brasileira de Nutrologia (ABRAN)/Brazilian Association of Nutrology, Catanduva/SP, Brazil.3.      FACERES – Faculdade de Medicina de São José do Rio Preto/SP, Brazil.4.      Zotarelli-Filho Scientific Work, São José do Rio Preto/SP, Brazil.5.      Ana Valeria Ramirez Clínica- Clinic of Nutrition and Health Science, São José do Rio Preto SP, Brazil.  Corresponding Author: Dr. Idiberto José Zotarelli Filho, MsC, Ph.D. FACERES- Medical School, São José do Rio Preto SP, Brazil; email: [email protected]  

Introduction: Fractures of the zygomatic-maxillary complex (ZMC) are common facial fractures. Annually 5.8 million people die from trauma worldwide. According to WHO data, head and face injuries can account for half of traumatic deaths. Objective: To analyze the success rates of fracture stability of the ZMC, incidences of complications and aesthetic satisfaction after 1-point fixation. Methods: This study followed the rules of PRISMA, with publications from 2010 to 2020. The Chi-Square Test and the Poisson's Probability Test were performed in relation to the occurrence of complications Low = 1, Moderate = 2 and NO = 0, adopting the α-level less than 0.05 with a statistical difference for 95% CI. The R-sq (R2) value was also analyzed among the complications variables. Results: The results of these studies showed in a general way that the use of 1-point fixation presented good results in the short, medium and long term, showing fracture stability, with or without open reduction. Complication rates were low and patients' satisfaction with aesthetics was considerable. Conclusion: The success rate of the 1-point fixation procedure for the zygomatic-maxillary complex is high, with minimal complications. Keywords: Zygomatic-maxillary complex. 1-point fixation. Fracture stability. Complications. Aesthetics.

Introduction: In March 2020, the new coronavirus (COVID-19) spread throughout the world, causing respiratory disease and deaths, especially in risk groups such as the elderly, pregnant women, immunocompromised people, and others. The World Health Organization (WHO; WHO, English) declared, on January 30, 2020, that the outbreak of the disease caused by COVID-19 constitutes a Public Health Emergency of international importance. 6,287,771 cases of COVID-19 (93,246 new compared to the previous day) and 379,941 deaths (3,621 new compared to the previous day) were confirmed worldwide by June 3, 2020. In the Region of the Americas, 1,036,155 people who were infected with the new coronavirus recovered, according to data from June 3, 2020. In Brazil, on January 22, 2020, the Center for Emergency Operations in Public Health for COVID-19 has activated, a strategy provided for in the National Response Plan to Public Health Emergencies of the Ministry of Health (MH). Objective: To present, using a systematic review, the main considerations about the existing actions for notification, registration, investigation, management, and adoption of preventive measures on SARS-CoV-2 in Severe Acute Respiratory Syndrome (SARS). Methods: The present study followed a systematic review model. After literary search criteria using the MeSH terms, a total of 58 clinical studies were compared and submitted to eligibility analysis and, after that, 26 studies were selected, following the rules of PRISMA. The search strategy was carried out in the databases PubMed, Embase, Ovid and Cochrane Library, Web Of Science, ScienceDirect Journals (Elsevier), Scopus (Elsevier), OneFile. Main findings and Conclusion: It is recommended that patients diagnosed with SARS be hospitalized and that the cases identified with the symptoms of severity are admitted to an intensive care bed. These symptoms are persistent hemodynamic instability (blood pressure that did not respond to volume replacement (30 mL/kg in the first 3 hours), indicating the use of vasoactive amine, signs, and symptoms of respiratory failure, including hypoxemia (PaO2 below 60 mmHg) in need supplementation of oxygen to maintain arterial oxygen saturation above 90%, evolution to other organic disorders, such as acute renal failure and neurological dysfunction. It was defined that the clinical criteria for hospital discharge should take into account the improvement of the clinical picture, the absence of tachydyspnea and hypoxia, the absence of O2 supplementation for at least 24 hours, hemodynamic stability, good oral acceptance and absence of fever. Prophylactic use of antibiotics has not recommended, but use should be considered suspect of associated bacterial infection. Keywords: COVID-19. SARS-CoV-2. Severe Acute Respiratory Syndrome. Acute Respiratory Distress Syndrome. Prevention.

Among psychiatric dermatoses, neurotic excoriation is characterized by the patient's confession of causing lesions on the skin itself, without presenting a basic dermatological disease. The theme has been gaining prominence since the incorporation of the diagnosis in the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-5, APA 2014). However, it was found that the subject has been scarcely addressed in the literature since not all cases are diagnosed and this pathology has more than one denomination (excoriation disorder, pathological palpation of the skin, neurodermatitis, dermatotillomania, and psychogenic excoriation). Therefore, the present study addressed the main clinical findings in research studies, through a systematic review, on neurotic excoriation, in addition to valuing the importance of psychological aspects in etiopathogenesis. Keywords: Neurotic excoriation. Excoriation disorder. Itching. Skin picking. Dermatotillomania.

The objective of this work was to approach a freehand restorative technique for class IV in composite resin. The procedure was performed on a mannequin containing elements 12, 11,21 and 22, the technique was performed on element 21, the same was provided with the ready preparation, vestibular bevel, the resins of choice were DA3, BA3, EA2 e CT all from Z350 - 3M, as each contains different chromas. Today for restorations on teeth older than 3M it is the good option on the market, with the patent for nanoparticulate resins. The professional must learn the rules of aesthetics of natural teeth for the use of these materials. Treating that natural teeth are polychromatic, while composite resins are monochromatic. Given the existence of a wide variety of resins and technical possibilities, the following text proposes a clinical sequence of reconstruction of anterior teeth with compromised incisal angle due to fracture. The stratification with composite resin favors the naturalness so desired by the patient, because the invisibility of the restoration is achieved, leaving the smile more harmonious and beautiful, which certainly improves self-esteem. With the evolution of adhesive dentistry, it is possible to perform aesthetic procedures with greater longevity and naturalness already mentioned.  Keywords: Restoration. Composite resin. Anterior teeth. Class IV anterior teeth. Direct restorative technique. 

AIM: To analyze the results regarding weight loss and complications with Spatz3® adjustable intragastric balloon (IGB) in Brazil. METHODS: In this randomized prospective study were included patients that were submitted to Spatz3® adjustable IGB treatment between October 2016 to June 2018 in a private clinic in Rio de Janeiro/Brazil. The patients presented a minimum body mass index (BMI) of 27kg/m². Were analyzed the complications of Spatz3® treatment and BMI reduction, percentage of total weight loss (%TWL) and % of excess weight loss (%EWL). RESULTS: 180 patients underwent implant Spatz3® balloon in the period. The patients were randomly separated in one group the Spatz balloon kept the same volume (600 mL) during all the treatment (Control Group), and adjustment group with 250 mL more. The complications were 16.14%. No death or major complications happened in the study. The BMI decreased from 39.51 to 32.84 kg/m² (p<0.0001), body weight decreased from 111.87 to 90.28 kg (p<0.0001) and excess weight diminished from 41.55 to 22.99kg (p<0.0001). The adjustment resulted in a further mean weight loss of 4,35kg (-8 to 17.6kg) and the moment of the procedure was 7.12±1.63 months. The upward adjustment group doesn´t have a higher %TWL, %EWL or a higher BMI reduction when compared to the control group (p=0.4413, p=0,9245, p=0.2729, respectively).CONCLUSION: This study shows that Spatz3® IGB treatment is an effective procedure for weight reduction, without mortality but with higher morbidity rates when compared to tradition IGBs. The upward adjustment efficacy still needs to be confirmed.

Introduction: In the context of robotic surgery (RS), approximately 1.5 million robotic surgeries have been performed worldwide in the past decade. In Brazil, prostate cancer is the second most common among men (behind only non-melanoma skin cancer). In absolute values and considering both sexes, it is the fourth most common type and the second most incident among men. Objective: Therefore, the present study aimed to present, through a systematic review, the main approaches to RS as a minimally invasive procedure for the prostate. Methods: After literary search criteria with the use of Mesh terms were used the main databases such as Pubmed, Medline, Bireme, EBSCO, Scielo, etc., a total of 55 papers that were submitted to the eligibility analysis were cross-checked and after that 20 studies were selected, following the rules of systematic review-PRISMA. Results and Conclusion: The scientific evidence reported points to some potential benefits of robotically assisted surgery compared to open surgery and laparoscopic surgery. The outcomes related to less blood loss and consequently less need for blood transfusion, as well as the preservation of sexual function seem to be the most significant advantages in relation to comparators. Better urinary continence and shorter hospital stay due to lower rates of perioperative complications are also reported in the studies. Keywords: Robotic surgery. Minimally invasive surgery. Prostate cancer. Prostatectomy.

Introduction: The term growth hormone secretagogues (GHS) encompasses compounds that were developed to increase growth release of growth hormone (GH). GHSs include growth hormone receptor secretagogue agonists (GHS-R), whose natural ligand is ghrelin, and growth hormone releasing hormone (GHRH) agonists, to which GHRH binds as a native ligand. In the context of selective androgen receptor modulators (SARM), the presence of a Toll-IL-1 receptor domain (TIR) predicts a role for SARMs in innate immunity. SARMs are an emerging class of therapies aimed at cachexia, sarcopenia and hypogonadism or treatment of stress urinary incontinence, osteoporosis, breast cancer and Duchenne muscular dystrophy. Objective: To present the state-of-the-art scientific evidence in humans on the use of growth hormone secretagogues, SARM and antagonists. Methods: Experimental and clinical studies were included (case reports, retrospective, prospective, randomized studies and systematic review) with qualitative and/or quantitative analysis. For further specifications, the description “Clinical Trail” for refinement was added during the research, following the rules of the systematic review-PRISMA. Of 384 articles, a total of 80 articles were evaluated in full and 58 were included and discussed in this study. Results and conclusion: Several clinical trials have been conducted and completed to assess the safety and efficacy of GHS for the diagnosis and / or treatment of GH deficiency. Over the past two decades, scientists' efforts have focused on the discovery and biological characterization of new tissue-specific SARM to promote the beneficial effects of androgens with greatly reduced undesirable side effects. In this regard, numerous studies with SARM of different structures have been reported. Despite evidenced clinical and preclinical studies, no SARM has yet received full clinical approval. Keywords: Growth hormone secretagogues. Peptides. SARM. Antagonists. Clinical Studies.