Prosthetically Driven Alveolar Reconstructions: A Retrospective Study.

This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Prosthetically driven alveolar reconstructions: a retrospective study

Abstract This study aims to evaluate the post-extraction alveolar bone reconstruction amongst 12 patients exhibiting loss of buccal bone plate in a tooth of the anterior region of the maxilla using the prosthetically-driven alveolar reconstruction technique (PDAR). In PDAR, a partial fixed provisional prosthesis (PFPP [conventional or adhesive]) with a specially designed pontic maintains the clot in a mechanically stable position during alveolar regeneration. Moreover, the pontic design, in hourglass shape and located in the subgingival area, also prevents gingival margins from collapsing. Gingival recession was evaluated through the 6-month healing period. Cone beam computed tomography (CBCT) was performed 1 month before and 8 months after PDAR treatment. For the primary outcome, in the panoramic imaging, the central area of bone defect in each tooth was selected for linear measurements. Measurements of the vertical buccal bone gain and the gain in thickness in the alveolar bone crest were obtained 8 months after PDAR. Descriptive statistics and intraclass correlation coefficient analysis were conducted. After treatment, all patients showed bone formation (a mean vertical gain of 7.1±3.7 mm, associated with a horizontal mean gain of 4.5±1.4 mm in the alveolar bone crest). The intraclass correlation coefficient for the measurements performed using CBCT was 0.999. No gingival recession, greater than 1 mm, was observed. Lower-morbidity procedures without the use of biomaterials may be a useful in post-extraction alveolar ridge regeneration and/or preservation. PDAR promoted alveolar bone formation without flaps, grafts and membranes.

Resumo Este estudo teve como objetivo avaliar a reconstrução do osso alveolar após extração em 12 pacientes com perda da tábua óssea vestibular em dentes na região anterior da maxila usando a técnica da reconstrução alveolar proteticamente guiada (RAPG). Na RAPG, uma prótese parcial fixa provisória (PPFP [convencional ou adesiva]) com um pôntico com design específico mantém o coágulo numa posição mecanicamente estável. Além disso, o design do pôntico, com formato de ampulheta e localizado na área subgengival, também previne o colapso das margens gengivais. A recessão gengival foi avaliada durante o período de cicatrização de 6 meses. Tomografias computadorizadas cone beam (TCCB) foram feitas 1 mês antes e 8 meses após o tratamento com a RAPG. Para o desfecho primário, nas imagens panorâmicas, a área central do defeito ósseo em cada dente foi selecionada para as medições lineares. As medições do ganho vertical ósseo vestibular e do ganho em espessura na crista óssea alveolar foram realizadas. A análise estística descritiva e a análise do coeficiente de correlação intraclasse forma realizados. Após o tratamento, todos os pacientes apresentaram formação óssea (ganho vertical médio de 7,1±3,7 mm, associado a ganho horizontal médio de 4,5±1,4 mm na crista óssea alveolar). O coeficiente de correlação intraclasse foi de 0,999. Nenhuma retração gengival acima de 1 mm foi observada. Procedimentos com baixa morbidade sem o uso de biomateriais podem ser úteis na regeneração/preservação do rebordo após as extrações. A RAPG promove a formação do osso alveolar sem o uso de retalhos, enxertos e membranas.

A relação entre os profissionais da área odontológica e o plano de gerenciamento de resíduos de serviços de saúde / The relationship between dental professionals and the waste management plan of health services / La relación entre los profesionales de la odontología y el plan de gestión de residuos de servicios de salud

O presente artigo situa-se na linha de pesquisa do Curso de Especialização em Direitos Humanos e Saúde, oferecido pela Escola Nacional de Saúde Pública Sergio Arouca ­ Fundação Oswaldo Cruz, com foco na interseção entre o direito, a saúde e o ambiente. Trata-se de uma pesquisa bibliográfica, baseada no exame da legislação brasileira e de produções acadêmicas especificas a esse respeito. Seu objetivo é discutir a relação entre os profissionais da área odontológica e o plano de gerenciamento de resíduos de serviços de saúde. A relevância da pesquisa se encontra na hipótese de que a odontologia está enquadrada numa modalidade de prestação de serviços de saúde responsável pela produção de grande variedade de resíduos que acarretam diferentes tipos de riscos sanitários, sociais e ambientais, por conseguinte, necessita de dispositivos legais que fundamentem e legitimem o adequado gerenciamento dos resíduos odontológicos e, ao mesmo tempo, gere as condições para evitar comportamentos imperitos, imprudentes e negligentes por parte dos profissionais da área. (AU)

This article is located in the search line of Specialization in Health and Human Rights, offered by the National School of Public Health Sergio Arouca - Oswaldo Cruz Foundation, focusing on the intersection between law, health and the environment. This is a literature search, based on an examination of the Brazilian legislation and specific academic productions in this regard. Your goal is to discuss the relationship between dental professionals and waste management health services plan. The relevance of the research is the assumption that dentistry is framed in a mode of delivery of health services responsible for the production of wide range of waste that cause different types of health risks, social and environmental risks, therefore, requires legal provisions to justify and legitimize the proper management of dental waste and, at the same time, generate the conditions to avoid behaviors inexpert, reckless and negligent on the part of professionals. (AU)

Este artículo pertenece a una de las líneas temáticas del Curso de Especialización en Derechos Humanos y de Salud, ofrecido por la Escuela Nacional de Salud Pública Sergio Arouca ­ Fundación Oswaldo Cruz, con foco en la intersección entre el derecho, la salud y lo ambiental. Se trata de una búsqueda bibliográfica, en la que se examina la legislación brasileña y producciones académicas específicas. El objetivo es analizar las relaciones que se establecen entre los profesionales de la odontología y el plan de gestión de residuos de servicios de salud. La relevancia del tema radica en el hecho de que la actividad odontológica es prestadora de servicios sanitarios responsables por la producción de una amplia gama de residuos, asociados a diferentes tipos de riesgos sanitarios, sociales y ambientales y, por lo tanto, requiere de disposiciones legales justificar y legitimar la gestión adecuada de sus residuos y, al mismo tiempo, generar las condiciones para evitar comportamientos imperitos, imprudentes y negligentes por parte de los profesionales. (AU)

Câncer de Pele e Renda Familiar: um Estudo Ecológico / Skin Cancer and Family Income: an Ecological Study / Cáncer de Piel y Rendimiento Familiar: un Estudio Ecológico

Introdução: Recentemente, houve crescimento da incidência do câncer de pele. Radiação solar, história familiar, imunossupressão, pele clara e idade constituem fatores de risco da doença. Objetivo: Correlacionar a mortalidade do câncer de pele com variáveis socioeconômicas. Método: Estudo ecológico, utilizando a planilha de dados da incidência de radiação solar do projeto aquecedor solar de baixo custo (ASBC), e indicadores de condições de vida do Censo de 2010. Os dados foram exportados para o SPSS 14.0, para analisar a correlação (coeficiente de correlação de Spearman), e as variáveis foram comparadas. Resultados: Associações estatisticamente significantes ocorreram entre o coeficiente de mortalidade por câncer maligno de pele com a renda familiar média (r=-0,316, p<0,006) indicando que, quanto maior a renda, menor a mortalidade por neoplasia maligna, ocorrendo o mesmo com a proporção de óbitos evitáveis em menores de 4 anos (r=-0,292, p<0,01) e a proporção de mortes evitáveis entre 5 e 74 anos (r=-0,372, p<0,001). A proporção da população ganhando menos de 1/2 salário-mínimo (r=0,232, p<0,05) indica que, quanto maior a proporção populacional com renda inferior a 1/2 salário- -mínimo, maior será a mortalidade por neoplasia maligna, similar à proporção da população ganhando menos de 1/4 de salário-mínimo (r=0,229, p<0,05). Conclusão: Sendo um assunto de saúde pública intimamente relacionado à renda, o câncer de pele ainda carece de ações de prevenção primária e secundária.

Introduction: Recently, there has been an increase in the incidence of skin cancer. Solar radiation, family history, immunosuppression, fair skin and age are risk factors for the disease. Objective: To correlate skin cancer mortality with several socioeconomic variables. Method: An ecological study using the Solar Heating at Affordable (ASBC) Project Solar Radiation Incidence Worksheet, with indicators of living conditions from the 2010 Census. All the collected data were exported to SPSS 14.0, a tool where the correlation (Spearman correlation coefficient) was analyzed and the variables were compared. Results: Statistically significant associations between the mortality coefficient for malignant skin cancer, with mean family income (r=-0.316, p<0.006) were found, indicating that as high the income, lower is the mortality by malignant neoplasm, occurring the same with the proportion of avoidable deaths in children younger than 4 years (r=-0.292, p<0.01) and the proportion of avoidable deaths between 5 and 74 years (r=-0.372, p<0.001). The proportion of the population earning less than ½ minimum wage (r=0.232, p<0.05) indicates that as high the population proportion with income lower than ½ minimum wage, higher will be the mortality by malignant neoplasm, similar to the proportion of the population earning less than » of the minimum wage (r=0.229, p<0.05). Conclusion: Although is a public health issue closely related to income, skin cancer needs initiatives targeted to primary and secondary prevention of the disease.

Introducción: Recientemente, ha habido un aumento en la incidencia de cáncer de piel. La radiación solar, historia familiar, inmunosupresión, piel clara y la edad constituyen los factores de riesgo para esta enfermedad. Objetivo: Correlacionar la mortalidad por cáncer de piel con varias variables socioeconómicas. Método: Se realizo un estudio ecológico usando la base de datos de la incidencia de la radiación solar del proyecto calentador solar de bajo costo (ASBC), adicionando los indicadores del censo de 2010 relativos a las condiciones de vida. Todos los datos recolectados fueron exportados a SPSS 14.0, herramienta que analizó la correlación (coeficiente de correlación de Spearman) y comparar todas las variables de la base de datos. Resultados: Fueran encontró asociaciones estadísticamente significativas entre el coeficiente de mortalidad debido al cáncer maligno de la piel y el ingreso familiar promedio (r=-0,316, p<0,006), lo mismo ocurre con la proporción de muertes prevenibles en niños menores de 4 años de edad (r=-0,292, p<0,01) y la proporción de muertes prevenibles entre 5 y 74 años (r=-0,372, p<0,001). La proporción de la población que gana menos de 1/2 salario mínimo (r=0,232, p<0,05) indica que cuanto mayor es la proporción de la población con ingresos por debajo de 1/2 salario mínimo, mayor es la mortalidad por neoplasia maligna, similar a proporción de la población que gana menos de 1/4 del salario mínimo (r=0,229, p<0,05). Conclusión: A pesar de ser un problema de salud pública y estrechamente relacionado con los ingresos, el cáncer de piel todavía carece de acciones encaminadas a la prevención primaria y secundaria de la enfermedad.

The patient with epilepsy and medicolegal aspects: a view for the neurologist.

Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient's permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver's license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient's independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help.

The patient with epilepsy and medicolegal aspects: a view for the neurologist / O paciente com epilepsia e aspectos legais em saúde: uma visão para o Neurologista

ABSTRACT Patients with epilepsy face innumerable obstacles in daily life, related to work, permission to drive and interpersonal relationships, which require medical guidance. This paper reports a literature review based on scientific articles and civil and traffic system, as a way to resolve doubts about medical obligations in the patient's permission to drive and work. An employment agreement requires the contractor to guarantee safety conditions as well as requiring the patient, at the pre-employment medical examination, to let the physician know previous medical conditions, including epilepsy. More than 90% of patients with epilepsy omit this information during the application assessment, thus being subject to imputation of ideological falsehood crime as disposied on article 299 of Brazilian Penal Code. Medical confidentiality breaches may only occur in specific situations. In Brazil, the authorization and driver's license renewal is governed by the Brazilian Traffic Code (Federal Law n° 9503/1997). For patient evaluations, two groups are considered: those on antiepileptic medication and those on medication withdrawal. A favorable report from the attending physician is also required, in both categories. Seizures that occur exclusively during sleep, and focal aware events or prolonged aura are not differentiated from other seizure types disposed in the traffic law. It is the responsibility of the attending physician to analyze each patient individually to resolve conflicts between public safety and the individual patient's independence. A frank and honest doctor-patient relationship is essential for the patient to understand the public and individual consequences of epileptic seizures and to feel comfortable seeking medical help.

RESUMO O paciente com epilepsia enfrenta inúmeros impasses na vida diária, relacionados à autorização para dirigir e relações interpessoais, os quais requerem orientação médica. Este artigo apresenta revisão bibliográfica baseada em artigos científicos e nas legislações cível e de trânsito brasileiras, como forma de solucionar dúvidas que envolvam obrigações médicas na permissão do paciente para dirigir e trabalhar. A admissão do trabalhador exige que o contratante garanta condições de segurança, além da necessidade do paciente, no exame de admissão, informar ao médico as condições médicas prévias, inclusive a epilepsia. Mais de 90% dos pacientes com epilepsia omitem essas informações na avaliação de aptidão, podendo consequentemente, estarem sujeitos à imputação de crime de falsidade ideológica (artigo 299 do Código Penal brasileiro). A violação do sigilo médico pode ocorrer apenas em situações específicas. No Brasil, a autorização e a renovação da carteira de habilitação são regidas pelo Código de Trânsito (Lei Federal n° 9503/1997). Para avaliação dos pacientes, dois grupos são considerados: aqueles em uso de medicação antiepiléptica e aqueles em retirada de medicação. É também necessária a opinião favorável do médico assistente, em ambas as categorias. As convulsões que ocorrem exclusivamente durante o sono, eventos focais perceptivos ou com aura prolongada não são diferenciadas de outros tipos de crises no Código de Trânsito Brasileiro. É responsabilidade do médico assistente analisar cada caso para resolver conflitos entre segurança pública e independência do paciente. Um relacionamento médico-paciente franco e honesto é essencial para que o paciente entenda as consequências individuais e coletivas das crises epilépticas e se sinta à vontade para procurar ajuda médica.

Charcot's paradox.

Jean-Martin Charcot (1825-1893), considered the father of modern neurology, had a particular interest in pathology and learned to value anatomical findings. Among his main contributions is the use of the anatomo-clinical method in neurology. Although described as cold and impatient in his interpersonal relations, Charcot had a great affection for animals. He had two dogs in his home, which he called Carlo and Sigurd, and a little monkey, Rosalie. Despite his fascination with neuropathology and anatomo-clinical correlations, Charcot disapproved of studies using animal species other than humans, a seemingly paradoxical attitude. As a result, Charcot's human studies resulted in important advances in neurology as, prior to his research, anatomical observations of animals were extrapolated to humans, leading to conceptual errors.

Charcot's paradox / O paradoxo de Charcot

ABSTRACT Jean-Martin Charcot (1825-1893), considered the father of modern neurology, had a particular interest in pathology and learned to value anatomical findings. Among his main contributions is the use of the anatomo-clinical method in neurology. Although described as cold and impatient in his interpersonal relations, Charcot had a great affection for animals. He had two dogs in his home, which he called Carlo and Sigurd, and a little monkey, Rosalie. Despite his fascination with neuropathology and anatomo-clinical correlations, Charcot disapproved of studies using animal species other than humans, a seemingly paradoxical attitude. As a result, Charcot's human studies resulted in important advances in neurology as, prior to his research, anatomical observations of animals were extrapolated to humans, leading to conceptual errors.

RESUMO Jean-Martin Charcot (1825-1893), considerado o pai da neurologia moderna, teve sua formação direcionada para a patologia, aprendendo a valorizar achados anatômicos. Entre as principais contribuições de Charcot está o uso do método anatomoclínico aplicado à neurologia. Descrito como frio e impaciente em suas relações interpessoais, Charcot mostrava, no entanto, um grande afeto pelos animais. Ele tinha dois cachorros em sua residência, a quem chamou de Carlo e Sigurd, e uma pequena macaca, Rosalie. Apesar de sua fascinação com a neuropatologia e as correlações anatomoclínicas, Charcot foi contra estudos com outras espécies de animais que não humanos, o que pode parecer um paradoxo. Entretanto, seus estudos trouxeram avanços importantes para a Neurologia, uma vez que, antes de suas descobertas, as observações anatômicas dos animais eram extrapoladas para os humanos, levando a erros conceituais.

Olfactory impairment in frontotemporal dementia: A systematic review and meta-analysis.

Frontotemporal dementia (FTD) presents clinically in three variants: one behavioral and two with progressive primary aphasia - non-fluent/agrammatic and semantic. Defined by the degenerative process and cerebral atrophy, olfactory dysfunction occurs in up to 96% of previous FTD case series. OBJECTIVE: the present study aims to critically synthesize data about the relationship between FTD and olfactory impairment to analyze the usefulness of olfactory evaluation tests as a complementary element in early diagnosis. METHODS: a database search was performed using the keywords "olfactory OR smell OR olfaction AND frontotemporal dementia". We included studies that evaluated olfactory function in patients diagnosed with frontotemporal dementia, all subtypes, compared with age-matched healthy controls. For comparative purposes, the effect size was calculated using Cohen's D. The studies selected were categorized according to dementia variant and olfactory test type. A meta-analysis was performed using forest plots - homogeneity was evaluated by statistical tests (i2 and Cochran Q). RESULTS: ten articles met the inclusion criteria. Heterogeneity was classified as low for semantic dementia olfactory identification and behavioral variant olfactory discrimination groups (i2 = 0 and 3.4%, respectively) and as moderate for the behavioral variant olfactory identification group (i2 = 32.6%). CONCLUSION: patients with the frontotemporal dementia behavioral variant seem to present with alterations in odor identification, but with preserved discrimination. Scent identification also seems to be impaired in semantic dementia. Therefore, we conclude that olfactory evaluation in these patients is possibly impacted by cognitive alterations and not by sensory deficits. Application of olfactory tests may prove important in differentiating prodromal states from other types of dementia with more pronounced olfactory impairment.

A demência frontotemporal apresenta-se clinicamente em três variantes: uma comportamental e duas com afasia progressiva primária - não fluente/agramática e semântica. Definida pelo processo degenerativo e atrofia cerebral, apresenta uma prevalência de disfunção olfatória de até 96% em séries anteriores. OBJETIVO: o presente estudo objetiva sintetizar criticamente dados sobre a relação entre DFT e o comprometimento olfatório para analisar a utilidade dos testes de avaliação olfatória como elemento complementar no diagnóstico precoce. MÉTODOS: uma pesquisa de banco de dados foi realizada usando as palavras-chave "olfactory OR smell OR olfaction AND frontotemporal dementia". Foram incluídos estudos que avaliaram a função olfatória em pacientes com diagnóstico de demência frontotemporal, todos os subtipos, em comparação com controles saudáveis ​​pareados por idade. Para fins de comparação, o tamanho do efeito foi calculado usando D de Cohen. Os estudos selecionados foram separados por variante de demência e tipo de teste olfativo. Uma meta-análise foi realizada utilizando gráficos floresta - sua homogeneidade foi avaliada por testes estatísticos (i2 e Cochran Q). RESULTADOS: dez artigos preencheram os critérios de inclusão. A heterogeneidade foi classificada como baixa para os grupos de identificação olfatória em demência semântica e discriminação olfatória em variante comportamental (i2 = 0 e 3.4%, respectivamente) e moderada para identificação olfatória no grupo de variante comportamental (i2 = 32.6%). CONCLUSÃO: pacientes com variante comportamental de demência frontotemporal parecem apresentar alterações na identificação de odores, com discriminação preservada. A identificação de odores parece estar prejudicada, também, na demência semântica. Desta forma, concluímos que a avaliação olfatória nesses pacientes é possivelmente impactada por alterações cognitivas e não por déficits sensoriais propriamente. A aplicação de testes olfatórios pode ser importante na diferenciação de estados prodrômicos de outros tipos de demência com comprometimento olfatório mais pronunciado.

My Loved One Was Not an Organ Donor: Ethical Dilemmas for Family Members of Deceased Potential Donors When Making the Decision on Donation.

OBJECTIVE: The study focuses on the experience of family members of deceased potential donors in deciding to refuse donation when their loved one had expressed his or her wish in life not to donate organs and tissues for transplantation. METHOD: This is a qualitative study that uses social phenomenology as the theoretical reference, interviewing 8 family members of deceased potential donors. RESULTS: The family members' experiences were represented by the following categories: beliefs related to donation, fear in the face of the loved one's death, and the ethical dilemma of deciding to refuse the donation. The meaning of the refusal to donate was represented by the following categories: respect for the loved one's wishes and the family's peace of mind with the decision. CONCLUSIONS: The study shed light on the experience of family members of deceased potential donors in making the decision to refuse donation. The concerns that motivate refusal were elucidated and the meanings of the decision's intentionality were unveiled. The resulting knowledge about these families' experiences provides backing for experts in donation and transplantation who work in different realities, pointing to strategies for improving care for such family members.

Olfactory impairment in frontotemporal dementia: A systematic review and meta-analysis / Alterações olfatórias em Demência Frontotemporal: Revisão sistemática e meta-análise

ABSTRACT. Frontotemporal dementia (FTD) presents clinically in three variants: one behavioral and two with progressive primary aphasia - non-fluent/agrammatic and semantic. Defined by the degenerative process and cerebral atrophy, olfactory dysfunction occurs in up to 96% of previous FTD case series. Objective: the present study aims to critically synthesize data about the relationship between FTD and olfactory impairment to analyze the usefulness of olfactory evaluation tests as a complementary element in early diagnosis. Methods: a database search was performed using the keywords "olfactory OR smell OR olfaction AND frontotemporal dementia". We included studies that evaluated olfactory function in patients diagnosed with frontotemporal dementia, all subtypes, compared with age-matched healthy controls. For comparative purposes, the effect size was calculated using Cohen's D. The studies selected were categorized according to dementia variant and olfactory test type. A meta-analysis was performed using forest plots - homogeneity was evaluated by statistical tests (i2 and Cochran Q). Results: ten articles met the inclusion criteria. Heterogeneity was classified as low for semantic dementia olfactory identification and behavioral variant olfactory discrimination groups (i2 = 0 and 3.4%, respectively) and as moderate for the behavioral variant olfactory identification group (i2 = 32.6%). Conclusion: patients with the frontotemporal dementia behavioral variant seem to present with alterations in odor identification, but with preserved discrimination. Scent identification also seems to be impaired in semantic dementia. Therefore, we conclude that olfactory evaluation in these patients is possibly impacted by cognitive alterations and not by sensory deficits. Application of olfactory tests may prove important in differentiating prodromal states from other types of dementia with more pronounced olfactory impairment.

RESUMO. A demência frontotemporal apresenta-se clinicamente em três variantes: uma comportamental e duas com afasia progressiva primária - não fluente/agramática e semântica. Definida pelo processo degenerativo e atrofia cerebral, apresenta uma prevalência de disfunção olfatória de até 96% em séries anteriores. Objetivo: o presente estudo objetiva sintetizar criticamente dados sobre a relação entre DFT e o comprometimento olfatório para analisar a utilidade dos testes de avaliação olfatória como elemento complementar no diagnóstico precoce. Métodos: uma pesquisa de banco de dados foi realizada usando as palavras-chave "olfactory OR smell OR olfaction AND frontotemporal dementia". Foram incluídos estudos que avaliaram a função olfatória em pacientes com diagnóstico de demência frontotemporal, todos os subtipos, em comparação com controles saudáveis ​​pareados por idade. Para fins de comparação, o tamanho do efeito foi calculado usando D de Cohen. Os estudos selecionados foram separados por variante de demência e tipo de teste olfativo. Uma meta-análise foi realizada utilizando gráficos floresta - sua homogeneidade foi avaliada por testes estatísticos (i2 e Cochran Q). Resultados: dez artigos preencheram os critérios de inclusão. A heterogeneidade foi classificada como baixa para os grupos de identificação olfatória em demência semântica e discriminação olfatória em variante comportamental (i2 = 0 e 3.4%, respectivamente) e moderada para identificação olfatória no grupo de variante comportamental (i2 = 32.6%). Conclusão: pacientes com variante comportamental de demência frontotemporal parecem apresentar alterações na identificação de odores, com discriminação preservada. A identificação de odores parece estar prejudicada, também, na demência semântica. Desta forma, concluímos que a avaliação olfatória nesses pacientes é possivelmente impactada por alterações cognitivas e não por déficits sensoriais propriamente. A aplicação de testes olfatórios pode ser importante na diferenciação de estados prodrômicos de outros tipos de demência com comprometimento olfatório mais pronunciado.

Innovative thermal and acoustic insulation foam by using recycled ceramic shell and expandable styrofoam (EPS) wastes.

Ceramic foams were produced using ceramic shell (mullite source), an industrial solid waste from the precision casting process, and expandable styrofoams, EPS (d50 < 1 mm) as pore former, envisaging thermal and acoustic insulation applications. Physical, chemical, structural properties of the selected raw materials (wastes) were characterized. The influence of the amount and morphology of the EPS powder beads on the microstructure, thermal conductivity, acoustic absorption and compressive strength of ceramic shell foams were evaluated. Batches containing well mixed ceramic shell powder (d50 < 2 µm), EPS beads, in different proportions (from 10 to 70 vol%), were added as pore forming agent, and BonderPlus® (Na2SiO3 solution) were uniaxially pressed at 20 MPa, dried and fired in controlled conditions. The experimental results showed that homogeneous microstructures of elongated and interconnected pores with sizes between 115 and 1200 µm can be obtained. These connections exhibit a significant impact on the thermal/sound absorption properties, as a consequence of the interaction between air molecules within the pores through the passage of the thermal/sound wave. Ceramic shell foams (containing 70 vol% of EPS powder beads) featured porosities up to 77%, thermal conductivity of 0.061 W/mK, sound absorption coefficient of ∼0.9 (3 kHz), and excellent compressive strength ∼5.4 MPa. In addition, the use of ceramic shells wastes for the manufacture of acoustic and thermal insulators with suitable microstructural characteristics is a great sustainable opportunity, since with the use of this refractory waste, is possible to avoid the release to the atmosphere of about 3.1 kg of CO2 per kg of manufactured material.

Restless legs syndrome in Parkinson's disease and increased cardiovascular risk.

OBJECTIVE: Restless legs syndrome (RLS) is a disorder commonly found in patients with Parkinson's disease, with descriptions for both conditions impairing dopaminergic transmission in central nervous system. Previous studies in varied populations indicate an association between the presence of RLS and increased cardiovascular risk and, so far, there are no consistent studies of this association in Parkinson's disease. To analyze the influence of RLS on cardiovascular risk in patients with Parkinson's disease. METHODS: We reviewed the medical records of 202 patients diagnosed with Parkinson's disease and verified the presence of RLS, cardiovascular comorbidities, blood pressure measurements, lipid profiles and Framingham Risk Scores. RESULTS: Statistically significant higher values of total cholesterol were found for the RLS group (mean 216.6 mg/dL), as well as for LDL cholesterol (mean 145 mg/dL). No statistical difference was found among the other factors. CONCLUSION: Patients with Parkinson's disease and RLS have a higher prevalence of dyslipidemia than patients without RLS, suggesting a correlation between restless legs and hyperlipidemia. It is questioned whether the dopaminergic substrate is the main factor in the genesis of the syndrome, as even with the use of dopaminergic agonists by both groups, it was possible to observe differences between groups. The hypothesis of the real interference of the syndrome treatment as a protective factor for cardiovascular risk was generated.

Testes de rastreio para alterações psiquiátricas em esclerose múltipla - Revisão sistemática com metanálise / Screening tools for psychiatric disorders in multiple sclerosis - Systematic review and metanalysis

RESUMO Objetivo Realizar uma revisão sistemática com metanálise visando evidenciar as ferramentas de rastreio psiquiátrico mais adequadas na abordagem de pacientes adultos com esclerose múltipla avaliadas por estudos de acurácia diagnóstica. Métodos As bases de dados Medline, SciELO, PubMed e Lilacs foram utilizadas para pesquisa de artigos referentes ao tema proposto. Para essa busca, foram utilizados os termos " multiple sclerosis psychiatric symptoms " e " multiple sclerosis psychiatric screening ", sendo incluídos artigos na língua portuguesa e inglesa publicados entre 2007 e 2017. A qualidade dos estudos incluídos foi avaliada utilizando o método QUADAS. Uma metanálise foi conduzida com o auxílio do programa RevMan 5.3. Resultados Sete artigos foram selecionados para análise. A concordância dos revisores foi calculada com um kappa de 0,95. A maioria dos estudos selecionados realizou avaliação de ferramentas de rastreio para depressão, tendo apenas dois deles abordado a busca de transtornos de ansiedade. O rastreio de transtorno depressivo foi realizado a partir da avaliação de 11 instrumentos diferentes, enquanto o de ansiedade, por apenas dois. A maior parte dos testes analisados apresentou boa acurácia, e a ferramenta BAI foi a única com desempenho regular na análise da curva ROC (0,77 de área sob a curva). Os demais testes apresentaram desempenho bom ou excelente, cursando com mais de 83% na avaliação de área sob a curva. Conclusões As ferramentas HADS ( Hospital Anxiety and Depression Scale ), CESD ( Center for Epidemiological Scale - Depression ) e PHQ-9 ( Patient Health Questionnaire-9 ) parecem ser as mais indicadas para o rastreio psiquiátrico de pacientes com esclerose múltipla. Registro PROSPERO: CRD42017082741.

ABSTRACT Objective To conduct a systematic review with meta-analysis aimed to highlight the most appropriate psychiatric screening tools for clinical approach of multiple sclerosis adult patients evaluated by diagnostic accuracy studies. Methods Medline, SciELO, PubMed e Lilacs databases were searched using the terms "multiple sclerosis psychiatric symptoms" and "multiple sclerosis psychiatric screening" for articles related to the proposed theme. Articles in Portuguese and English language published between 2007 and 2017 were included. The quality of included studies was assessed using the QUADAS method. A meta-analysis was conducted using RevMan 5.3. Results Seven papers were selected for analysis. The reviewers' rating were in agreement with a 0.95 kappa. Most of the selected studies performed screening tools for depression, with only two of them addressing the search for anxiety disorders. Screening for depressive disorder was performed by the evaluation of 11 different instruments, while anxiety by only two. Most of the tests presented good accuracy - the BAI tool was the only one with a regular performance in the ROC analysis (0.77 AUC). The other tests presented with good or excellent performance, presenting more than 83% in the evaluation of AUC. Conclusions The HADS (Hospital Anxiety and Depression Scale), CESD (Center for Epidemiological Scale - Depression) and PHQ-9 (Patient Health Questionnaire-9) tools seem to be the most suitable for the psychiatric screening of patients with multiple sclerosis. PROSPERO registration: CRD42017082741.

Restless legs syndrome in Parkinson's disease and increased cardiovascular risk / Síndrome das pernas inquietas em doença de Parkinson e aumento do risco cardiovascular

ABSTRACT Restless legs syndrome (RLS) is a disorder commonly found in patients with Parkinson's disease, with descriptions for both conditions impairing dopaminergic transmission in central nervous system. Previous studies in varied populations indicate an association between the presence of RLS and increased cardiovascular risk and, so far, there are no consistent studies of this association in Parkinson's disease. Objective: To analyze the influence of RLS on cardiovascular risk in patients with Parkinson's disease. Methods: We reviewed the medical records of 202 patients diagnosed with Parkinson's disease and verified the presence of RLS, cardiovascular comorbidities, blood pressure measurements, lipid profiles and Framingham Risk Scores. Results: Statistically significant higher values of total cholesterol were found for the RLS group (mean 216.6 mg/dL), as well as for LDL cholesterol (mean 145 mg/dL). No statistical difference was found among the other factors. Conclusion: Patients with Parkinson's disease and RLS have a higher prevalence of dyslipidemia than patients without RLS, suggesting a correlation between restless legs and hyperlipidemia. It is questioned whether the dopaminergic substrate is the main factor in the genesis of the syndrome, as even with the use of dopaminergic agonists by both groups, it was possible to observe differences between groups. The hypothesis of the real interference of the syndrome treatment as a protective factor for cardiovascular risk was generated.

RESUMO Síndrome das pernas inquietas é um distúrbio comumente encontrado em pacientes com doença de Parkinson (DP), havendo descrições para ambas as condições de prejuízos na transmissão dopaminérgica no sistema nervoso central. Estudos prévios em populações diversas indicam associação entre a presença da síndrome e aumento do risco cardiovascular, não havendo, até o momento, pesquisas consistentes a respeito desta associação em DP. Objetivo: Analisar a influência da síndrome das pernas inquietas no risco cardiovascular em pacientes com DP. Métodos: Foram revisados prontuários de 202 pacientes com diagnóstico de DP e verificada a presença de síndrome das pernas inquietas, comorbidades cardiovasculares, aferições de pressão arterial, lipidograma e escore de Framingham. Resultados: Valores maiores e estatisticamente significativos de colesterol total foram encontrados para o grupo com pernas inquietas (média de 216.6 mg/dL), assim como para colesterol LDL (média de 145 mg/dL). Não foi encontrada diferença estatística entre os demais fatores. Conclusões: Pacientes com DP e síndrome das pernas inquietas têm maior prevalência de dislipidemia do que pacientes sem a síndrome, o que sugere correlação entre síndrome das pernas inquietas e hiperlipidemia. É posto em prova o substrato dopaminérgico como principal na gênese da síndrome, uma vez que, mesmo sob o uso de agonistas dopaminérgicos por ambos os grupos, foi possível observar diferenças entre os estratos. Gerada a hipótese da real interferência do tratamento da síndrome como fator de proteção para o risco cardiovascular.

Olfactory dysfunction in Alzheimer's disease Systematic review and meta-analysis.

Alzheimer's disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly. OBJECTIVE: To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis. METHODS: Databases were searched using the terms "olfactory OR smell OR olfaction AND alzheimer" for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out. RESULTS: Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis. CONCLUSION: Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

Neurodegenerativa, a doença de Alzheimer (DA) é um dos tipos mais prevalentes de demência, com frequência dobrando a cada 5 anos em idosos. OBJETIVO: Verificar a correlação entre DA e alterações olfatórias, identificando os domínios mais afetados e a possibilidade de utilização de testes olfatórios como complemento de diagnóstico precoce. MÉTODOS: Bases de dados foram acessadas utilizando os termos "olfactory OR smell OR olfaction AND alzheimer" buscando artigos relacionados ao tema proposto. Os estudos selecionados foram categorizados e avaliados em separado a depender do método de análise olfatória: identificação de odores, discriminação e reconhecimento e uma meta-análise foi realizada. RESULTADOS: Cinquenta e um artigos foram selecionado para análise. O tamanho do efeito da maioria dos estudos foi grande, assim como os valores sumários de cada categoria de análise olfatória. CONCLUSÃO: Entre os domínios olfatórios, excetuando memória, a identificação parece ser a mais alterada em DA. É possível explorar a possibilidade de adição de testes específico para avaliação de identificação de odores como um item na avaliação diagnóstica precoce. Registro PROSPERO: CRD42018089076.

Macroglossia, the first manifestation of systemic amyloidosis associated with multiple myeloma: Case report.

Amyloidosis is a group of diseases characterized by an irreversible and extracellular deposition of fibrillar, amorphous protein known as amyloid in different organs and tissues. Amyloid deposits may occur locally in tissues or may involve various organs, resulting in a wide range of clinical manifestations. Amyloidosis of the head and neck is rarely seen and can reflect some plasma cell dyscrasia that affects B lymphocytes. Deposition of amyloid on the tongue is very rare and accounts for less than 9% of all types of amyloidosis. Amyloid involvement of the tongue is almost always secondary to systemic amyloidosis. We report a 73-year-old female who presented with weight loss and macroglossia. Firstly, she was diagnosed only with amyloidosis of the tongue. Her general health condition was evaluated, revealing renal dysfunction, anemia, hypercalcemia, and hyperphosphatemia. The final diagnosis was systemic amyloidosis with multiple myeloma. The patient was referred for emergency hemodialysis and chemotherapy. Her condition progressed to congestive heart failure and recurrent urinary and respiratory infections. After 100 days from diagnosis, the patient died by pulmonary infection as a consequence of her weakened state of health. It is important to highlight role of the dentist especially oral pathologist to the evaluation of local alterations that may reflect systemic deterioration of patients.

Olfactory dysfunction in Alzheimer's disease: systematic review and meta-analysis / Alterações olfatórias em Doença de Alzheimer: revisão sistemática e meta-análise

Abstract Alzheimer's disease (AD), a neurodegenerative condition, is one of the most prevalent kinds of dementia, whose frequency doubles for every 5 years of age in elderly. Objective: To determine the correlation between AD and olfactory alterations, identifying the most affected domains and exploring the utility of olfactory tests for complementing early diagnosis. Methods: Databases were searched using the terms "olfactory OR smell OR olfaction AND alzheimer" for articles related to the proposed theme. The selected studies were categorized and evaluated separately depending on the method of analysis of the olfactory tests: identification of odors, discrimination and recognition, and a meta-analysis was carried out. Results: Fifty-one articles were selected for analysis. The effect size for most studies was large, as were the summary values for each category of individualized olfactory analysis. Conclusion: Among the olfactory domains, except memory, identification appears to be the most altered in AD. The possibility of including tests that specifically evaluate the identification of odors as an item in early diagnostic evaluation should be explored. PROSPERO registration: CRD42018089076.

Resumo Neurodegenerativa, a doença de Alzheimer (DA) é um dos tipos mais prevalentes de demência, com frequência dobrando a cada 5 anos em idosos. Objetivo: Verificar a correlação entre DA e alterações olfatórias, identificando os domínios mais afetados e a possibilidade de utilização de testes olfatórios como complemento de diagnóstico precoce. Métodos: Bases de dados foram acessadas utilizando os termos "olfactory OR smell OR olfaction AND alzheimer" buscando artigos relacionados ao tema proposto. Os estudos selecionados foram categorizados e avaliados em separado a depender do método de análise olfatória: identificação de odores, discriminação e reconhecimento e uma meta-análise foi realizada. Resultados: Cinquenta e um artigos foram selecionado para análise. O tamanho do efeito da maioria dos estudos foi grande, assim como os valores sumários de cada categoria de análise olfatória. Conclusão: Entre os domínios olfatórios, excetuando memória, a identificação parece ser a mais alterada em DA. É possível explorar a possibilidade de adição de testes específico para avaliação de identificação de odores como um item na avaliação diagnóstica precoce. Registro PROSPERO: CRD42018089076.

Bone Tissue Donation: Tendency and Hurdles.

INTRODUCTION: The aim of this study was to identify the percentage of bone tissue donation in a brain death situation and the tendency of donation rate of this tissue in an organ procurement organization in the county of Sao Paulo from 2001 to 2016. It is a retrospective and quantitative study, based on the Organ and Tissue Donation Term of donors who died of brain death between 2001 and 2016. METHODS: A logistic regression model was applied, and the odds of donation were identified throughout the years, regarding the odds ratio different from zero. Finally, it was measured the accuracy of the odds ratio through the confidence interval. RESULTS: The analysis has shown a significant change on the trend of bone donation (P < .001). In this case, the odds ratio was >1, indicating that the donation rate has increased. However, the percentage of growth is still considered low. CONCLUSIONS: The study evidences a growth trend regarding the donation of bone tissue, but the percentage is still too low to adequately meet the demand of patients who need this modality of therapeutic intervention. It is believed that educational campaigns of donation are not emphasizing the donation of tissues for transplantation, which may be directly impacting their consent rates.

Trend Analysis of Organ and Tissue Donation for Transplantation.

BACKGROUND: The goal of this study was to identify the tendency toward donations of tissue and organs from donors with brain death between 2001 and 2016 as registered by an organ procurement organization in São Paulo City. METHODS: This quantitative, retrospective, exploratory study encompassed all Tissue and Organ Donation Terms signed between 2001 and 2016. A logistic regression model was applied to verify whether there was an upward or downward trend in donation. RESULTS: After statistical analysis, a significant change trend was identified in skin, bones, valve, vessel, heart, lung, and pancreas donations, indicating an increase in the donation rate through the years. The donation rate did not show changes over the years for donations of liver, kidneys, and corneas. CONCLUSIONS: The decision-making process regarding organ and tissue donation is restricted not only to the dilemma of whether to donate but another question then arises as well: which organs and tissues are to be donated? The discrepancy between the authorization for organ donation and the authorization for tissue donation, as well as the option for one or another organ and/or tissue, must be thoroughly examined because these factors directly affect the number of transplants and acquirements effectively accomplished. These factors may be related to explaining to one's relatives aspects of the surgery, body reassembling, and usage of such organs and/or tissues. They may also be related to the lack of knowledge concerning organ donation and the symbolism represented by the organ and/or tissue, among other factors.