Tooth loss in individuals under periodontal maintenance therapy: 5-year prospective study.

BACKGROUND AND OBJECTIVE: Tooth loss (TL), one of the most visible results of the evolution of periodontitis, causes physiological and psychological impacts on a patient's life. This prospective study aimed to evaluate the incidence, underlying reasons and influence of risk predictors for the occurrence of TL in a program of periodontal maintenance therapy (PMT) over 5 years. METHODS: The sample comprised 212 individuals diagnosed with chronic moderate-severe periodontitis, who had finished active periodontal treatment, were incorporated in a PMT program. Individuals were divided in to two groups: 96 regular compliers (RC) and 116 irregular compliers (IC). Full-mouth periodontal examination was performed. Social, demographic, behavioral and biological variables of interest were collected at all PMT visits. The effect of risk predictors and confounders for TL, as well as the underlying reasons of TL, were assessed by univariate and multivariate analysis. RESULTS: TL was significantly lower among RC (0.12 teeth lost/year) in comparison to IC (0.36 teeth lost/year; p < 0.01). Individuals that were > 55 years old, males and smokers lost significantly more teeth in both groups (with IC > RC). The number of teeth lost due to periodontal reasons was significantly higher than TL for other reasons in both groups (p < 0.01). The final linear and logistic model for TL included: male gender, smoking, probing depth 4-6 mm in up to 10% of sites and irregular compliance. CONCLUSION: IC individuals undergoing PMT presented higher rates of TL when compared to RC individuals. Findings demonstrated the influence of irregular compliance and the importance of monitoring other risk predictors for TL such as smoking, male gender and severity of probing depth during PMT.

Prevalence of hiatal hernia by blinded multidetector CT in patients with idiopathic pulmonary fibrosis.

Hiatal hernia (HH) is associated with gastro-oesophageal reflux (GOR) and/or GOR disease and may contribute to idiopathic pulmonary fibrosis (IPF). We hypothesised that HH evaluated by computed tomography is more common in IPF than in asthma or chronic obstructive pulmonary disease (COPD), and correlates with abnormal GOR measured by pH probe testing. Rates of HH were compared in three cohorts, IPF (n=100), COPD (n=60) and asthma (n=24), and evaluated for inter-observer agreement. In IPF, symptoms and anti-reflux medications were correlated with diffusing capacity of the lung for carbon monoxide (D(L,CO)) and composite physiologic index (CPI). HH was correlated with pH probe testing in IPF patients (n=14). HH was higher in IPF (39%) than either COPD (13.3%, p=0.00009) or asthma (16.67%, p=0.0139). The HH inter-observer κ agreement was substantial in IPF (κ=0.78) and asthma (κ=0.86), and moderate in COPD (κ=0.42). In IPF, HH did not correlate with lung function, except in those on anti-reflux therapy, who had a better D(L,CO) (p<0.03) and CPI (p<0.04). HH correlated with GOR as measured by DeMeester scores (p<0.04). HH is more common in IPF than COPD or asthma. In an IPF cohort, HH correlated with higher DeMeester scores, confirming abnormal acid GOR. Presence of HH alone was not associated with decreased lung function.

Prevalence of respiratory symptoms in patients with achalasia.

Achalasia is a primary esophageal motor disorder that results in poor clearance of the esophagus. Although an esophagus filled with debris and undigested food should put these patients at risk for aspiration, the frequency with which the latter occurs has never been documented. In this study, we sought to determine the incidence of respiratory symptoms and complaints in patients with achalasia. A comprehensive symptom questionnaire was administered to 110 patients with achalasia presenting to the Swallowing Center at the University of Washington between 1994 and 2008 as part of their preoperative work-up. Questionnaires were analyzed for the frequency of respiratory complaints in addition to the more typical symptoms of dysphagia, regurgitation, and chest pain. Twenty-two achalasia patients with respiratory symptoms who had also undergone Heller myotomy and completed a post-op follow-up questionnaire were analyzed as a subset. Ninety-five patients (86%) complained of at least daily dysphagia. Fifty-one patients (40%) reported the occurrence of at least one respiratory symptom daily, including cough in 41 patients (37%), aspiration (the sensation of inhaling regurgitated esophagogastric material) in 34 patients (31%), hoarseness in 23 patients (21%), wheezing in 17 patients (15%), shortness of breath in 11 patients (10%), and sore throat in 13 patients (12%). Neither age nor gender differed between those with and those without respiratory symptoms. In the subset of patients with respiratory symptoms who had undergone Heller myotomy, respiratory symptoms improved in the majority after the procedure. Patients with achalasia experience respiratory symptoms with much greater frequency than the approximately 10% that was previously believed. Awareness of this association may be important in the workup and ultimate treatment of patients with this uncommon esophageal disorder.

The effects of duration and intensity of stimulation on total protein and mucin concentrations in resting and stimulated whole saliva.

The present investigation has characterized the influence of the duration and intensity of stimulation on the secretion pattern of total protein and salivary mucins MG1 and MG2 in whole saliva. Resting and stimulated whole saliva was collected from six healthy subjects on 2 consecutive days. Whole saliva was collected for 2 five-minute intervals under resting conditions followed by collection under masticatory stimulation induced by the chewing of parafilm (1 g) at 10 or 60 strokes/min for 15 min. Flow rates were different under the 2 levels of stimulation. The concentration of total protein was different in resting and stimulated whole saliva but was not affected by the duration or intensity of stimulation. Analysis of mucin concentrations determined by capture ELISAs revealed that the pattern of MG1 secretion was similar to that of total protein. The pattern of MG2 secretion was unique in that no differences were observed in the concentration of this mucin under resting and stimulated conditions. This study shows that the pattern of protein secretion in whole saliva does not reflect the combined pattern observed for protein secretion in parotid and submandibular/sublingual glands, and that the secretion patterns of MG1 and MG2 in whole saliva are quite different from one another.

MG2 and lactoferrin form a heterotypic complex in salivary secretions.

Protein-protein interactions are necessary for homeostasis to be maintained and for biological systems to be integrated. Heterotypic complexes occur in saliva, and a complex between MG2 and SIgA has been suggested to promote microbial clearance from the oral cavity. In this study, we used a peptide display library to investigate previously unrecognized heterotypic complexes involving MG2 and other proteins. The library was panned with MG2 12 times, and analyses of clones identified the sequence Ala-Leu-Leu-Cys-, which occurs in salivary lactoferrin. Blotting experiments confirmed that MG2 and lactoferrin form a heterotypic complex in vitro and in vivo. Periodate treatment of MG2 did not affect the interaction. A synthetic lactoferrin peptide containing the motif Ala-Leu-Leu-Cys-blocked the interaction between MG2 and lactoferrin, confirming the specificity of the interaction identified by panning. This complex may enhance the properties of these salivary components in the oral environment.

Prevalence of gallstones in a Brazilian population.

The objective of the present study was to determine the prevalence of gallstones in the population of Curitiba, Brazil. A total of 1000 persons was randomly recruited among individuals who were visiting two shopping centers of the city in order to represent the Brazilian population in relation to age and sex. The selected people underwent ultrasonographic examination of the upper abdomen immediately after a medical interview. Of the 1000 persons evaluated, 93 (9.3%) had gallstones (64 persons) or had been subjected to cholecystectomy due to cholelithiasis. The gallstone prevalence increased from 2.4% in persons of 20-29 years of age to 27.5% in persons of more than 70 years (chi2 = 37.29; P <0.001). The prevalence was 2.4 greater in females (12.9%) than in males (5.4%) (chi2 = 16.34; P <0.001). The prevalence increased with the number of pregnancies from 4% in nulliparous women, to 34.6% in persons with a history of six or more pregnancies (chi2 = 200.1; P <0,001). The prevalence also increased according to the body weight (chi2 = 30.08; P <0.001). There was no difference in the prevalence between individuals with diabetes mellitus and controls. It is concluded from this study that the prevalence of gallstones in the city of Curitiba is elevated.

Impactos do fogo sobre serpentes (Squamata) no Parque Nacional de Ilha Grande (PR/MS), Brasil / The impact of fire upon squamata snakes in the Ilha Grande National Park in the states of Paraná and Mato Grosso do Sul, Brazil / Implactos del fuego sobre serpientes (squamata) en el parque nacional de ilha grande (PR/MS), Brasil

Incêndios são ocorrências periódicas no Parque Nacional de Ilha Grande, e o fogo é um dos principais fatores de ameaça à sobrevivência da herpetofauna nessa unidade de conservação. Esse trabalho teve como objetivos descrever as reações das serpentes frente ao fogo, identificar as espécies atingidas pelos incêndios e correlacionar a natureza das lesões causadas pelo fogo. As atitudes das serpentes frente ao fogo foram determinadas pela descrição das reações comportamentais apresentadas pelos indivíduos avistados durante os incêndios. A determinação da causa da morte e das lesões foi realizada pela avaliação física e necroscópica dos animais feridos e mortos encontrados em áreas queimadas. As coletas foram realizadas em setembro de 2003, em pontos aleatórios, durante e imediatamente após os incêndios. Foram avistadas frente ao fogo, uma Bothrops moojeni, uma Philodryas patagoniensis e um colubrídeo não-identificado. Uma Micrurus lemniscatus foi encontrada viva apresentando queimaduras profundas e deficiência visual em decorrência das lesões térmicas. Foram coletados cadáveres de quatro B. moojeni, de um colubrídeo não-identificado, e de uma Tamnodynastes hypoconia. As B. moojeni e o colubrídeo não-identificado se encontravam carbonizados, enquanto a T. hypoconia apresentava sinais de afecção respiratória. Vestígios indicaram que os cadáveres das serpentes são uma importante fonte de recurso alimentar nos períodos pós-fogo. Incêndios de elevada intensidade e grandes extensões atingem diretamente serpentes no Parque, inclusive espécies de grande porte como a Bothrops moojeni. A morte de indivíduos pela ação do fogo pode contribuir para o declínio das espécies em longo prazo no Parque Nacional de Ilha Grande.

There are periodic occurrences of in the Ilha Grande National Park (South of Brazil), and it is one of the main menacing factors to the Herpetofauna survival in that conservation unit. The objectives of this study were to describe the snakes’reactions to fire, to identify the species affected by fires, and to correlate the nature of the lesions produced by fire. The reactions of the snakes toward fire were determined by the description of the behavior presented by the individuals observed during wildfires. The determination of mortality causes and correlated lesions were accomplished by physical and necroscopic evaluation of wounded and dead animals found in burned areas. The collections were accomplished in randomized points in September 2003, during - and immediately - after fire occurrences. Three snakes were observed during wildfires, one Bothrops moojeni, one Philodryas patagoniensis, and one non-identified colubrid. A Micrurus lemniscatus was found alive, presenting deep burns and visual deficiency due to thermal lesions. The corpses of four B. moojeni, one non-identified colubrid, and one Tamnodynastes hypoconia were collected. The four B. moojeni and the non-identified colubrid were carbonized. The T. hypoconia presented signs of respiratory illness. Vestiges indicated that snakes corpses are an important source of food in post-fire periods. Highly intense wildfires which cover large areas directly affect the Ilha Grande National Park snakes, including big species as B. moojeni. Individuals’ death due to fire action can contribute to the snakes species’ declining in the park in a long term basis.

Los incendios son ocurrencias periódicas en el Parque Nacional de Ilha Grande (sur de Brasil), y uno de los principales factores de amenaza a la supervivencia de la herpetofauna en esa unidad de conservación. Los objetivos de este trabajo fueron describir las reacciones de las serpientes al fuego, identificar las especies afectadas por los incendios y correlacionar la naturaleza de las lesiones causada por el fuego. Las actitudes de las serpientes frente al fuego fueron determinadas por la descripción de las reacciones de comportamiento presentadas por los individuos observados durante los incendios. La determinación de la causa muerte y lesiones se efectuó por evaluación física y necroscópica de los animales heridos y muertos encontrados en las áreas quemadas. Las colectas fueron realizadas en puntos aleatorios en septiembre de 2003, durante y inmediatamente después de las ocurrencias. Fueran avistadas frente al fuego, un Bothrops moojeni, un Philodryas patagoniensis y un colúbrido no identificado. Se encontró un Micrurus lemniscatus vivo, presentando quemaduras profundas y deficiencia visual, debido a las lesiones térmicas. Fueron colectados los cadáveres de cuatro Bothrops moojeni, de un colúbrido no identificado, y de un Tamnodynastes hypoconia. Los cuatro B. Moojeni y el colúbrido no identificado estaban carbonizados. El T. hypoconia presentaba signos de enfermedad respiratoria. Vestigios indicaron que los cadáveres son importante fuente de recurso alimenticio en los períodos posfuego. Los incendios de alta intensidad y gran extensión afectan las serpientes directamente en el Parque Nacional de Ilha Grande, incluso animales de talle grande como B. moojeni. La muerte de individuos por acción del fuego puede contribuir para la caída de las especies en el parque, a largo plazo.

Disposicao da veia interventricular anterior em relacao a ponte miocardica. / Anatomical relationship between the interventricular vein and the myocardial bridges

Os autores estudam a relacao entre a veia interventricular anterior e ponte miocardica Para o estudo, foram dissecados 50 coracoes colhidos em sala de necropsia. Destes, 29 (58%) apresentavam ponte miocardica sobre o ramo interventricular anterior da arteria coronaria esquerda. Em 27 deles a veia situouse sobre as fibras musculares da ponte, a esquerda da arteria interventricular anterior.Em apenas dois coracoes, um deles apresentando duas pontes, a veia tambem se dispos sob as fibras musculares. Os autores chamam a atencao para esta disposicao venosa, ate entao nao referida, quando discutem a importancia da ponte muscular como fator de isquemia miocardica e realcam a importancia destes dados de sintopia durante a cirurgia da revascularizacao do miocardio