Dithiothreitol reduces oxidative stress and necrosis caused by ultraviolet A radiation in L929 fibroblasts.

Ultraviolet A (UVA) radiation, present in sunlight, can induce cell redox imbalance leading to cellular damage and even cell death, compromising skin health. Here, we evaluated the in vitro antioxidant and photochemoprotective effect of dithiothreitol (DTT). DTT neutralized the free radicals 2,2-azino-bis(3-ethylbenzothiazoline-6-sulfonic acid) (ABTS·+), 2,2-diphenyl-1-picrylhydrazyl (DPPH·), and superoxide anion (O2·-) in in vitro assays, as well as the ferric ion (Fe3+) in the ferric reducing antioxidant power (FRAP) assay. We also evaluated the effect of DTT pre-treatment in L929 dermal fibroblasts and DTT (50 and 100 µM) led to greater cell viability following UVA-irradiation compared to cells that were untreated. Furthermore, the pre-treatment of cells with DTT prevented the increase of intracellular reactive oxygen species (ROS) production, including hydrogen peroxide (H2O2), lipid peroxidation, and DNA condensation, as well as the decrease in mitochondrial membrane potential (Δψm), that occurred following irradiation in untreated cells. The endogenous antioxidant system of cells was also improved in irradiated cells that were DTT pre-treated compared to the untreated cells, as the activity of the superoxide dismutase (SOD) and catalase (CAT) enzymes remained as high as non-irradiated cells, while the activity levels were depleted in the untreated irradiated cells. Furthermore, DTT reduced necrosis in UVA-irradiated fibroblasts. Together, these results showed that DTT may have promising use in the prevention of skin photoaging and photodamage induced by UVA, as it provided photochemoprotection against the harmful effects of this radiation, reducing oxidative stress and cell death, due mainly to its antioxidant capacity.

Effect of toothbrushing with conventional and whitening dentifrices on monolithic zirconia after finishing procedures.

PURPOSE: To evaluate the effect of toothbrushing with conventional and whitening dentifrices on the color difference (ΔE00), gloss (Δgloss), and surface roughness (SR) of stained stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP) after polishing or glazing. METHODS: Specimens were divided into four groups (n=20): C (control), S (staining), SG (staining and glazing) and SP (staining and polishing). 50,000 toothbrushing cycles were performed with conventional (n=10) and whitening (n= 10) dentifrice slurries. The ΔE00 and Δgloss were measured using a spectrophotometer and CIEDE2000 system while SR was measured by laser confocal microscope. The ΔE00 and Δgloss data were analyzed using 2-way ANOVA, and SR data were analyzed using the linear repeated measures model, with Bonferroni's complementary test (α= 0.05). RESULTS: The ΔE00 values were beyond the acceptability threshold and no differences were found among the groups. There was no difference among groups to Δgloss after toothbrushing with conventional dentifrice while SP presented the highest values of Δgloss after toothbrushing with whitening dentifrice. Conventional dentifrice decreased the SR of stained groups and whitening dentifrice decreased SR of S and SG. The toothbrushing with conventional and whitening dentifrices promoted color difference, but did not impair gloss and surface roughness of stained 5Y-TZP. CLINICAL SIGNIFICANCE: Monolithic zirconia has been routinely used for esthetic restorations, however the type of finishing procedures that is carried out on it must be taken into consideration, in addition to the fact that brushing can influence the color difference of the material as well as interfere with surface roughness and gloss.

Evaluation of Vertical Misfit and Torque Loss of Different Abutments for Tri-Channel Type Internal Connection Dental Implants After Mechanical Cycling.

The aim of this study was to evaluate the mechanical behavior of UCLA and Mini-conical abutments for implants with Tri-channel connections regarding torque loss and vertical misfit. Twenty 3-element metal-ceramic fixed partial dentures (FPD) supported by 2 implants were manufactured and divided into 2 groups (n = 10): UCLA (group 1) and Mini-conical Abutments (group 2). The evaluation of torque loss was carried out before and after mechanical cycling, while the vertical fit was evaluated throughout the different stages of manufacturing the prostheses, as well pre- and postcycling (300,000 cycles, 30 N). Statistical analyses of torque loss and vertical misfit were performed using the linear mixed effects model. Both groups showed torque loss after mechanical cycling (P < .05); however, there was no significant percentage differences between them (P = .795). Before cycling, the groups showed a significant difference in terms of vertical misfit values (P < .05); however, this difference was no long observed after cycling (P = .894). Both groups showed torque loss after the cycling test, with no significant difference (P > .05). There was no significant difference in vertical misfit after mechanical cycling; however, in group 1 (UCLA) there was accommodation of the implant-UCLA abutment interface, while group 2 (Mini-conical abutment) did not show changes in the interface with the implant after the test. Both groups behaved similarly regarding the torque loss of the prosthesis retention screws pre- and postmechanical cycling, with greater loss after the test.

Calf Circumference Predicts Falls in Older Adults on Hemodialysis.

OBJECTIVE: Older patients with chronic kidney disease (CKD) undergoing maintenance hemodialysis are at a higher risk of falling. However, there is no standard method to screen patients at higher risk. We have evaluated whether calf circumference (CC) measurement would be able to predict falls in this population. METHODS: This is a prospective study that enrolled patients aged ≥65 years on conventional hemodialysis, followed for 6 months. The presence of falls was associated with demographical, clinical, and biochemical data. Reduced CC was set at <34 cm for men and <33 cm for women. We evaluated physical status using Duke activity status index (DASI) and hand grip strength (HGS). RESULTS: Ninety-one patients were included (age 73.7 ± 5.4 years, 69.2% men, 56% with diabetes). Mean CC was 32.6 ± 3.7 cm, with a high prevalence of reduced CC (61.5%). During the follow-up, 13 falls were identified (1 had a fracture and died). These patients were older and heavier (P = .017 and P = .025, respectively). Most falls occurred in patients with sarcopenic obesity (BMI >27 kg/m2 plus reduced HGS or reduced CC). In a logistic regression model, reduced CC (hazard ratio (HR) 7.81, confidence interval (CI): 1.13-53.86, P = .037), higher age (HR 1.19, CI: 1.04-1.36, P = .011), and higher body weight (relative risk (RR) 1.13, CI: 1.04-1.22, P = .003) were independently associated with falls in a fully adjusted model. CONCLUSION: CC measurement, an easy and nonexpensive tool, was able to predict falls in older patients on HD. Further studies should test the inclusion of CC in a fall risk assessment in older patients on hemodialysis.

Antileishmanial effects of γCdcPLI, a phospholipase A2 inhibitor from Crotalus durissus collilineatus snake serum, on Leishmania (Leishmania) amazonensis.

BACKGROUND: Leishmaniasis, a neglected disease caused by the parasite Leishmania, is treated with drugs associated with high toxicity and limited efficacy, in addition to constant reports of the emergence of resistant parasites. In this context, snake serums emerge as good candidates since they are natural sources with the potential to yield novel drugs. OBJECTIVES: We aimed to show the antileishmanial effects of γCdcPLI, a phospholipase A2 inhibitor from Crotalus durissus collilineatus snake serum, against Leishmania (Leishmania) amazonensis. METHODS: Promastigotes forms were exposed to γCdcPLI, and we assessed the parasite viability and cell cycle, as well as invasion and proliferation assays. FINDINGS: Despite the low cytotoxicity effect on macrophages, our data indicate that γCdcPLI has a direct effect on parasites promoting an arrest in the G1 phase and reduction in the G2/M phase at the highest dose tested. Moreover, this PLA2 inhibitor reduced the parasite infectivity when promastigotes were pre-treated. Also, we demonstrated that the γCdcPLI treatment modulated the host cell environment impairing early and late steps of the parasitism. MAIN CONCLUSIONS: γCdcPLI is an interesting tool for the discovery of new essential targets on the parasite, as well as an alternative compound to improve the effectiveness of the leishmaniasis treatment.

Mechanical Properties, Wear Resistance, and Reliability of Two CAD-CAM Resin Matrix Ceramics.

Background and Objectives: There are limited data regarding the behavior of resin matrix ceramics for current CAD-CAM materials. Further studies may be beneficial and can help clinicians planning to use these materials during prosthodontic rehabilitation. The aim of this study was to evaluate and compare the flexural strength and strain distributions, filler content, wear, and reliability of two resin matrix ceramic CAD-CAM materials. Materials and Methods: Two resin matrix ceramics, Ambarino High-Class (AH) and Vita Enamic (VE), were tested for flexural strength (n = 24), wear (n = 10), and reliability (n = 18). Thermogravimetric analysis was used to determine the percentage of filler by weight, and digital image correlation (DIC) was used for strain analysis in flexural strength test. Reliability of each resin matrix ceramic was compared after accelerated lifetime testing of crowns using a two-parameter Weibull distribution. Data of flexural strength, wear, and thermogravimetry were analyzed by independent t-tests with significance level at 5%. Results: The results of DIC analysis were analyzed by a qualitative comparison between the images obtained. The materials tested showed different flexural strength (p < 0.05) and strain distributions. The filler content was the same as informed by manufacturers. No difference was observed in the wear or reliability analysis (p > 0.05). The flexural strength of material AH was superior to VE, and the strain distribution was compatible with this finding. Conclusions: The two resin matrix ceramics tested showed similar behavior in wear and reliability analysis. Both can provide safe use for dental crowns.

Influence of Torque on Platform Deformity of the Tri-Channel Implant: Two- and Three-Dimensional Analysis Using Micro-Computed Tomography.

Background and Objectives: The insertion of the dental implant in the bone is an essential step in prosthetic rehabilitation. The insertion torque has the potential to distort the prosthetic platform, which can cause future biomechanical problems with the continuous action of occlusal forces. The aim of this study is to evaluate different insertion torques in the deformation of tri-channel platform connections through two- and three-dimensional measurements with micro-CT. Materials and Methods: A total of 164 implants were divided into groups (platform diameter and type): 3.5, 3.75, and 4.3 mm NP (narrow platform), and 4.3 mm RP (regular platform). Each implant-platform group was then divided into four subgroups (n = 10) with different torques: T45 (45 Ncm), T80 (80 Ncm), T120 (120 Ncm), and T150 (150 Ncm). The implant-abutment-screw assemblies were scanned and the images obtained were analyzed. Results: A significant difference was observed for the linear and volume measures between the different platforms (p < 0.01) and the different implant insertion torques (p < 0.01). Qualitative analysis suggested a higher deformation resistance for the 3.75 NP compared to the 3.5 NP, and RP was more resistant compared to the NP. Conclusions: The 0.25 mm increment in the implant platform did not increase the resistance to the applied insertion torques; the 4.3 mm implant was significantly stronger compared to the 3.5 mm implant; and the proposed micro-CT analysis was considered valid for both the 2D and 3D analyses of micro-gaps, qualitatively and quantitatively.

Mitochondrial dysfunction on Leishmania (Leishmania) amazonensis induced by ketoconazole: insights into drug mode of action.

BACKGROUND: Leishmania parasites cause leishmaniasis that range from self-limiting cutaneous lesions to more serious forms of the disease. The search for potential drug targets focusing on biochemical and metabolic pathways revealed the sterol biosynthesis inhibitors (SBIs) as a promising approach. In this class of inhibitors is found ketoconazole, a classical inhibitor of 14α-methysterol 14-demethylase. OBJECTIVE: The present study aimed to better understand the biological response of Leishmania (Leishmania) amazonensis promastigotes at the cellular level after ketoconazole treatment. METHODS: Herein, techniques, such as fluorimetry, flow cytometry, fluorescence microscopy, electron and scanning microscopy were used to investigate the cellular structures and to identify organelles affected by ketoconazole treatment. FINDINGS: The study demonstrated, for the first time, the effect of ketoconazole on mitochondrion functioning and its probable relationship to cell cycle and death on L. (L.) amazonensis promastigotes (IFLA/BR/67/PH8 strain). MAIN CONCLUSIONS: Ketoconazole-induced mitochondrial damages led to hyperpolarisation of this single organelle and autophagic vacuoles formation, as a parasite survival strategy. These damages did not reflect directly on the parasite cell cycle, but drove the parasites to death, making them susceptible to ketoconazole treatment in in vitro models.

Shaping ability of new reciprocating or rotary instruments with two cross-sectional designs: An ex vivo study.

AIM: This study compared the shaping ability of four new reciprocating and rotary nickel-titanium instruments, with triangular or S-shaped cross-section, in the mesial canals of mandibular molars using micro-computed tomographic (micro-CT) evaluation. METHODOLOGY: Twenty-four extracted mandibular molars with Vertucci's class IV configuration in the mesial root were selected for this study. The teeth were matched in fours according to anatomic similarities as revealed by micro-CT and then distributed into four groups of 12 mesial canals each according to the instrumentation technique: Reciproc Blue, R-motion, VDW.Rotate and RaCe EVO. The final apical size of instrumentation was 30/0.04 for three systems and 25/08 for the Reciproc Blue instrument. Micro-CT scans were taken before and after preparation to evaluate the canal volume, area and unprepared surface areas, as well as the centring ability, and the canal: root width ratio. RESULTS: Preparation with all systems significantly increased the volume and area of the canals (p < .05). There were no significant differences between groups regarding the amount of unprepared areas in both the apical and full canal lengths (p > .05). Variation in the centre of gravity showed no significant difference between groups either (p > .05). The canal: root width ratio at levels 0 and 4 mm apically to the coronal canal opening was significantly increased by all systems (p < .01), with no significant differences between groups (p > .05). The canal width never exceeded 40% of the root width. CONCLUSIONS: Reciprocating or rotary instruments, with a triangular or an S-shaped cross-section, performed equally in shaping Vertucci's class IV mesial canals of mandibular molars.

School-based obesity interventions in the metropolitan area of Rio De Janeiro, Brazil: pooled analysis from five randomised studies.

School-based studies, despite the large number of studies conducted, have reported inconclusive results on obesity prevention. The sample size is a major constraint in such studies by requiring large samples. This pooled analysis overcomes this problem by analysing 5926 students (mean age 11·5 years) from five randomised school-based interventions. These studies focused on encouraging students to change their drinking and eating habits, and physical activities over the one school year, with monthly 1-h sessions in the classroom; culinary class aimed at developing cooking skills to increase healthy eating and attempts to family engagement. Pooled intention-to-treat analysis using linear mixed models accounted for school clusters. Control and intervention groups were balanced at baseline. The overall result was a non-significant change in BMI after one school year of positive changes in behaviours associated with obesity. Estimated mean BMI changed from 19·02 to 19·22 kg/m2 in the control group and from 19·08 to 19·32 kg/m2 in the intervention group (P value of change over time = 0·09). Subgroup analyses among those overweight or with obesity at baseline also did not show differences between intervention and control groups. The percentage of fat measured by bioimpedance indicated a small reduction in the control compared with intervention (P = 0·05). This large pooled analysis showed no effect on obesity measures, although promising results were observed about modifying behaviours associated with obesity.

Fatores associados ao óbito em casos confirmados de COVID-19 no estado do Rio de Janeiro.

BACKGROUND: COVID-19 can occur asymptomatically, as influenza-like illness, or as more severe forms, which characterize severe acute respiratory syndrome (SARS). Its mortality rate is higher in individuals over 80 years of age and in people with comorbidities, so these constitute the risk group for severe forms of the disease. We analyzed the factors associated with death in confirmed cases of COVID-19 in the state of Rio de Janeiro. This cross-sectional study evaluated the association between individual demographic, clinical, and epidemiological variables and the outcome (death) using data from the Unified Health System information systems. METHODS: We used the extreme boosting gradient (XGBoost) model to analyze the data, which uses decision trees weighted by the estimation difficulty. To evaluate the relevance of each independent variable, we used the SHapley Additive exPlanations (SHAP) metric. From the probabilities generated by the XGBoost model, we transformed the data to the logarithm of odds to estimate the odds ratio for each independent variable. RESULTS: This study showed that older individuals of black race/skin color with heart disease or diabetes who had dyspnea or fever were more likely to die. CONCLUSIONS: The early identification of patients who may progress to a more severe form of the disease can help improve the clinical management of patients with COVID-19 and is thus essential to reduce the lethality of the disease.

CF3-substituted diselenide modulatory effects on oxidative stress, induced by single and repeated morphine administrations, in susceptible tissues of mice.

Studies reveal that oxidative stress is associated with adverse effects of long-term morphine treatment. The m-trifluoromethyl-diphenyl diselenide (CF3) is a multi-target organoselenium compound that has antioxidant properties in different experimental models. This study aimed to investigate the CF3 effects against redox imbalance in peripheral and central tissues of mice, after single or multiple morphine doses. Swiss male mice received a single dose of morphine (5 mg/kg, s.c.) and CF3 (10 mg/kg, i.g.), or morphine was repeatedly injected (5 mg/kg, s.c.) and CF3 (10 mg/kg, i.g.) administered twice daily for 7 days. Oxidative stress was determined in the hippocampus, liver, and kidney. CF3 reversed the increase in reactive species caused by single and multiple morphine doses in the peripheral tissues. CF3 increased hepatic non-protein thiol levels and the superoxide dismutase (SOD) activity decreased by a single morphine dose. CF3 reversed the reduction in SOD activity in the kidney of mice repeatedly exposed to morphine. The study demonstrates that peripheral tissues were more susceptible than the hippocampus to oxidative stress induced by morphine in mice. The results show that CF3 modulated parameters of oxidative stress modified by single and multiple morphine administrations in peripheral and central tissues of mice.

Effect of ionizing radiation and cariogenic biofilm challenge on root-dentin caries.

OBJECTIVES: To evaluate the effect of ionizing radiation and cariogenic biofilm challenge using two continuous flow models, normal and reduced salivary flow, on the development of initial root-dentin caries lesions. MATERIALS AND METHODS: Microcosm biofilms were grown under two salivary flow rates (0.06 and 0.03 mL min-1) and exposed to 5% sucrose (3 × daily, 0.25 mL min-1, 6 min) dripped over non-irradiated and irradiated root-dentin blocks for up to 7 days. The vibration modes of root dentin, matrix/mineral (M/M), and carbonate/mineral (C/M) ratios were evaluated by FTIR. The mineral density was assessed by micro-CT. RESULTS: With normal salivary flow, FTIR revealed an increase in the organic matrix (amide III) and a decrease in the mineral phase (ν4, ν2 PO43-, AII + ν2 CO32-, C/M) in caries lesions. Irradiated dentin exhibited a reduction in the mineral phase (ν1, ν3 PO43-, ν2 CO32-, C/M). Differences in mineral densities were not significant. With reduced salivary flow, FTIR also revealed increased organic matrix (amide III) for irradiated caries lesions and decrease in mineral phase (v4, v2 PO43-, v2 CO32-, and C/M) in caries lesions. ν1, ν3 PO43- precipitated on the surface of irradiated dentin and a lower mineral density was observed. CONCLUSIONS: Initial caries lesions differed between non-irradiated and irradiated dentin and between normal and reduced salivary flow rates. Significant mineral loss with exposure of the organic matrix and low mineral density were observed for irradiated dentin with a reduced salivary flow rate. CLINICAL RELEVANCE: Ionizing radiation associated with a reduced salivary flow rate enhanced the progression of root-dentin caries.

Fluid overload after coronary artery bypass graft in patients on maintenance hemodialysis is associated with prolonged time on mechanical ventilation.

BACKGROUND: Fluid overload is a risk factor for morbidity, mortality, and prolonged ventilation time after surgery. Patients on maintenance hemodialysis might be at higher risk. We hypothesized that fluid accumulation would be directly associated with extended ventilation time in patients on hemodialysis, as compared to patients with chronic kidney disease not on dialysis (CKD3-4) and patients with normal renal function (reference group). METHODS: This is a prospective observational study that included patients submitted to isolated and elective coronary artery bypass surgery, divided in 3 groups according to time on mechanical ventilation: < 24 h, 24-48 h and > 48 h. The same observer followed patients daily from the surgery to the hospital discharge. Cumulative fluid balance was defined as the sum of daily fluid balance over the first 5 days following surgery. RESULTS: Patients requiring more than 48 h of ventilation (5.3%) had a lower estimated glomerular filtration rate, were more likely to be on maintenance dialysis, had longer anesthesia time, needed higher dobutamine and noradrenaline infusion following surgery, and had longer hospitalization stay. Multivariate analysis revealed that the fluid accumulation, scores of sequential organ failure assessment in the day following surgery, and the renal function (normal, chronic kidney disease not on dialysis and maintenance hemodialysis) were independently associated with time in mechanical ventilation. Among patients on hemodialysis, the time from the surgery to the first hemodialysis session also accounted for the time on mechanical ventilation. CONCLUSIONS: Fluid accumulation is an important risk factor for lengthening mechanical ventilation, particularly in patients on hemodialysis. Future studies are warranted to address the ideal timing for initiating dialysis in this scenario in an attempt to reduce fluid accumulation and avoid prolonged ventilation time and hospital stay.

Saliva as an alternative to blood in the determination of uremic state in adult patients with chronic kidney disease: a systematic review and meta-analysis.

OBJECTIVES: To assess whether salivary urea and creatinine levels accurately reflect their serum levels in blood samples of adults to detect chronic kidney disease. MATERIALS AND METHODS: A systematic review was conducted in eight electronic databases. The protocol was registered in PROSPERO. Only diagnostic test studies were included. The JBI critical appraisal tools assessed the risk of bias. A meta-analysis of proportions was performed. The GRADE tool assessed the quality of evidence and strength of recommendation across the studies included. RESULTS: Eight studies met the eligibility criteria and were included. Six studies assessed salivary urea, and six studies assessed salivary creatinine. All studies presented moderate risk of bias. The meta-analysis depicted an overall sensitivity of 93.3% (95% CI = 88.6; 97.9) for salivary creatinine levels and 87.5% (95% CI = 83.2; 91.8) for salivary urea levels, while the overall specificity was 87.1% (95% CI = 82.8; 91.3) and 83.2% (95% CI = 65.0; 101.4) for salivary creatinine and urea levels, respectively. The overall accuracy of salivary creatinine was 5.2 percentage points higher compared with salivary urea levels (90.8% vs. 85.6%). According to the GRADE tool, the analysed outcomes were classified as having low to moderate level of certainty. CONCLUSION: Compared with blood samples, salivary urea and creatinine levels presented high diagnostic values for chronic kidney disease screening, but should not be considered equivalent to levels obtained from blood at stages three, four, or five of the disease. CLINICAL SIGNIFICANCE: Chronic kidney disease patients could receive a clinically significant benefit from replacing blood with saliva for potentially monitoring renal function. Saliva collection presents greater simplicity, comfort, safety, and lower collection cost.

[Microcephaly and central nervous system findings associated with congenital Zika virus and other infectious etiologies in the state of Rio de Janeiro: crosssectional study, 2015 a 2017Microcefalia y alteraciones del sistema nervioso central relacionadas con la infección congénita por el virus del Zika y otras etiologías infecciosas en el Estado de Río de Janeiro: estudio transversal, 2015-2017]. / Microcefalia e alterações do sistema nervoso central relacionadas à infecção congênita pelo vírus Zika e outras etiologias infecciosas no estado do Rio de Janeiro: estudo transversal, 2015 a 2017.

OBJECTIVE: To describe the clinical and epidemiological profile of cases with confirmed microcephaly or central nervous system (CNS) findings associated with congenital Zika virus infection and other infectious etiologies in the state of Rio de Janeiro, Brazil, from November 2015 to July 2017. METHOD: A cross-sectional study was performed with 298 cases (as defined by the Ministry of Health) communicated to the Rio de Janeiro State Department of Health in the study period. Demographic, epidemiological, clinical, radiological, and laboratory variables were assessed. Descriptive bivariate and multivariable logistic regression analysis was used to determine the association between specific factors and death outcome. RESULTS: The median age of mothers was 24 years; 30.9% reported fever and 64.8% reported a rash during pregnancy. The median head circumference at birth was 29 cm, and median birth weight was 2 635 g. An etiological diagnosis of congenital Zika was made in 46.0%, whereas 13.8% were diagnosed with syphilis, toxoplasmosis, rubella, cytomegalovirus, and herpes simplex infections (STORCH), with predominance of syphilis, and 40.3% had an unspecified infectious agent. CNS findings other than microcephaly were observed in 88.3%, especially intracranial calcifications, ventriculomegaly, and brain atrophy. Overall lethality was 7.0% - 19.0% in laboratory confirmed Zika cases and 22.2% in toxoplasmosis cases. Multivariable analysis revealed birth weight as the main predictor of death. CONCLUSIONS: Despite the Zika epidemic, 13.8% of the studied cases were diagnosed with STORCH. The lethality and high frequency of neurological findings beyond microcephaly reflect severe infection, with impact on families and health care system.

OBJETIVO: Describir el perfil clínico-epidemiológico de los casos confirmados de microcefalia y de alteraciones del sistema nervioso central (SNC) relacionados con la infección congénita por el virus del Zika y otras etiologías infecciosas en el Estado de Río de Janeiro en el período comprendido entre noviembre del 2015 y julio del 2017. MÉTODOS: Se realizó un estudio transversal de 298 casos (según la definición del Ministerio de Salud) notificados a la Secretaría de Estado de Salud de Río de Janeiro en el período objeto de estudio. Se analizaron variables demográficas, epidemiológicas, clínicas, radiológicas y de laboratorio, con un análisis estadístico descriptivo bivariado y de regresión logística múltiple para estudio de los factores relacionados con la defunción. RESULTADOS: La edad mediana de las madres fue de 24 años; un 30,9% informó fiebre y un 64,8%, exantema durante la gestación. La mediana del perímetro cefálico al nacer fue de 29 cm y la del peso, de 2635 g. El diagnóstico etiológico fue de infección congénita por el virus del Zika en un 46,0%; sífilis, toxoplasmosis, rubéola, infección por citomegalovirus e infección por el virus del herpes simple (STORCH) en un 13,8%, con predominio de sífilis; e infección por un agente infeccioso no definido en un 40,3%. Se describieron alteraciones del SNC diferentes de microcefalia en un 88,3%, con predominio de calcificaciones cerebrales, ventriculomegalia y atrofia cerebral. La letalidad total alcanzó 7,0%; se confirmaron en el laboratorio 19,0% de los casos de infección por el virus del Zika y 22,2% de los casos de toxoplasmosis. En el análisis de regresión logística múltiple, el peso al nacer fue el principal pronóstico de defunción. CONCLUSIONES: A pesar de la epidemia de la infección por el virus del Zika, 13,8% de los casos fueron causados por STORCH. La letalidad y la elevada presencia de malformaciones neurológicas, además de microcefalia, muestran la gravedad de la infección y sus repercusiones para las familias y para el sistema de salud.

Association between Tooth Loss and Stroke: A Systematic Review.

This systematic review aims to evaluate the association between tooth loss and stroke. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. The PECO strategy was used to limit the eligibility criteria. The following databases were used on searches: PubMed, Scopus, Web of Science, The Cochrane Library, LILACS and OpenGrey. We included observational studies performed in adults (Population), in which patients with tooth loss (Exposition) and patients without tooth loss (Comparison) were observed to investigate the association between tooth loss and stroke (Outcome). After searches, the results were submitted to a selection process, followed by data extraction, quality assessment and risk of bias evaluation. The certainty of the evidence was evaluated through GRADE approach. A total of 925 potential studies were retrieved by the searches and 9 were included in this review. Seven of the included articles described an association between tooth loss and stroke. Low risk of bias and a low certainty of the evidence were identified to all studies. The certainty of the evidence may be associated with the observational nature of the included studies. Even though an association between tooth loss and stroke was suggested, the low strength of the current evidence indicated the need for further investigations with a better methodological design to conclude this question.

Effect of different grinding protocols on surface characteristics and fatigue behavior of yttria-stabilized zirconia polycrystalline: An in vitro study.

STATEMENT OF PROBLEM: Zirconia frameworks milled by computer-aided design and computer-aided manufacturing (CAD-CAM) often require clinical adjustments. In addition, zirconia prefabricated abutments can also require customization to achieve an adequate emergence profile. However, the influence of grinding adjustment on the surface characteristics and mechanical behavior of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and the best grinding protocol is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different grinding protocols on the surface characteristics, phase transformation, and mechanical behavior of Y-TZP for frameworks and implant abutments. MATERIAL AND METHODS: Bar-shaped specimens were fabricated according to ISO 6872-2016 and divided into 3 groups: GC (control, untreated), GA (grinding and finishing with medium and fine diamond rotary instruments using high-speed handpiece under constant water cooling), and GB (grinding and finishing with coarse and medium diamond rotary instruments, respectively, using slow-speed handpiece without water cooling). After specimen grinding, the topography and surface roughness were evaluated by using a laser confocal microscope, the Young modulus was measured by the impulse excitation technique, and crystallographic phase transformation was analyzed by X-ray diffraction. Specimens were then submitted to step-stress accelerated life testing (n=18). The surface roughness and Young modulus results were analyzed by 1-way ANOVA and the Tukey honestly significant difference test (α=.05). The data of step-stress accelerated life testing were analyzed by the survival probability considering the number of cycles and force until fracture. RESULTS: Statistically significant differences were found among groups considering surface roughness (GA>GB>GC) (P<.05) and Young modulus (GB>GA=GC) (P=.003). X-ray diffraction showed that grinding leads to phase transformation, GC showed only tetragonal phase, while GA and GB showed tetragonal and monoclinic phases. No statistically significant difference (P<.05) was found among groups submitted to the same loading profile when the survival probability was compared, but significant difference was found between the light and moderate loading (P=.002) and light and severe loading (P=.014) of GB when different loading profiles in each group were compared. CONCLUSIONS: Although grinding protocols affected surface characteristics and promoted phase transformation, the mechanical behavior of Y-TZP was not impaired. Therefore, both the grinding protocols tested can be safely used based on the evaluated properties.

Effectiveness of school-home intervention for adolescent obesity prevention: parallel school randomised study.

Many school-based interventions for obesity prevention have been proposed with positive changes in behaviour, but with unsatisfactory results on weight change. The objective was to verify the effectiveness of a combined school- and home-based obesity prevention programme on excessive weight gain in adolescents. Teachers delivered the school-based primary prevention programme to fifth- and sixth-graders (nine schools, forty-eight control classes, forty-nine intervention classes), which included encouraging healthy eating habits and physical activity. A subgroup of overweight or obese adolescents also received a home-based secondary prevention programme delivered by community health professionals. Schools were randomised to intervention or control group. Intent-to-treat analysis used mixed models for repeated continuous measures and considered the cluster effect. The main outcomes were changes in BMI and percentage body fat (%body fat) after one school-year of intervention and follow-up. Against our hypothesis, BMI increased more in the intervention group than in the control group (Δ = 0·3 kg/m2; P = 0·05) with a greater decrease in %body fat among boys (Δ = -0·6 %; P = 0·03) in the control group. The intervention group increased physical activity by 12·5 min per week compared with the control group. Female adolescents in the intervention group ate healthier items more frequently than in the control group. The subgroup that received both the school and home interventions had an increase in %body fat than in the control group (Δ = 0·89 %; P = 0·01). In the present study, a behavioural change led to a small increase in physical activity and healthy eating habits but also to an overall increase in food intake.

Effects of the Tailored Activity Program in Brazil (TAP-BR) for Persons With Dementia: A Randomized Pilot Trial.

OBJECTIVES: The objectives of this study were to evaluate the effects of the Tailored Activity Program-Brazilian version (TAP-BR), on behavioral symptoms and the quality of life (QOL) in persons with dementia, as well as on their caregivers, and on caregiver burden. MATERIALS AND METHODS: A 2-group randomized controlled trial with 30 dyads was conducted: the experimental group (n=15) received TAP-BR over 4 months, and a wait-list control group (n=15) received usual care. Dyads were recruited from the community of Santos City, Brazil. RESULTS: For persons with dementia, 50% were female individuals, the average age was 81.37 (±7.57), and the educational level was 9.97 (±5.32) years. For caregivers, 83.33% were female, the average age was 65.97 (±10.13), and the educational level was 12.10 (±4.44) years. At posttest, in comparison with the wait-list control group, experimental group caregivers reported greater reductions in number (P<0.001; Cohen d=0.93), frequency (P<0.001; Cohen d=1.12), and intensity (P<0.001; Cohen d=0.77) of the behavioral psychological symptoms of dementia, and caregiver distress (P<0.001; Cohen d=0.87). Caregivers also reported improvement in their own QOL (P<0.05; Cohen d=0.57) and that of the person with dementia (P<0.01; Cohen d=0.56); no differences were found in the ratings of QOL by the person with dementia themselves. CONCLUSIONS: The results provide compelling evidence that the TAP-BR is an effective strategy to support dementia caregivers in other cultures (cross-validation).