Long-term follow-up of inactive occlusal caries lesions: 4-5-year results.

OBJECTIVE: To assess the clinical behavior of inactive caries lesion on the occlusal sites of permanent molars over 4-5 years and to estimate the risk for progression of caries-inactive sites compared with sound ones. METHODS: Clinical examinations were conducted at baseline (n = 258) and after 4-5 years and included the recording of dental plaque and dental caries at the occlusal surfaces and the eruption stage of each permanent molar. RESULTS: One hudred ninety-three schoolchildren were followed (response rate of 74.8%), totalizing 1152 teeth. Of the children, 30.6% (n = 59) presented at least one molar containing an active lesion, filling, or that had been extracted; according to the activity criterion, inactive lesions presented around a twofold increased risk for caries progression than sound surfaces (OR = 2.34 95%CI = 1.51-3.62). Thirteen percent (n = 25) of the children presented at least one molar progressing to dentine cavity, filling, or extraction; according to the severity criterion, inactive caries lesions presented a significantly higher risk for progression when compared with sound surfaces (OR = 2.69, 95% CI = 1.50-4.83). CONCLUSION: The vast majority of lesions (85-90%) identified as inactive enamel caries at baseline did not progress over 4-5 years. Despite this fact, it was possible to detect an increased risk for caries progression in caries-inactive occlusal sites compared with the sound ones. CLINICAL RELEVANCE: Considering the low progression rates, inactive caries lesions do not need a specific caries-controlling treatment and should be monitored longitudinally in the same manner as sound surfaces.

One-year evaluation of inactive occlusal enamel lesions in children and adolescents.

OBJECTIVES: The aims of this study were to compare caries incidence and progression on sound occlusal surfaces and on surfaces presenting inactive enamel lesions in children and adolescents over 1 year and to estimate the risk of caries incidence and progression on these surfaces. METHODS: This prospective cohort study followed 200 7-15-year-old caries-inactive schoolchildren over 1 year. Stage of eruption, occlusal plaque, and occlusal caries were recorded on permanent molars. Statistical analysis was performed using generalized estimating equations with a logistic link function. RESULTS: Twenty-two children (11 %) presented "caries progression" (at least one active lesion on molar teeth). At site level, no difference was observed in caries incidence and progression between sites classified either sound (2.6 %) or with inactive enamel lesion (3.9 %) at the baseline examination (χ (2) test, p = 0.48). Adjusted for plaque, stage of eruption, type of molar and dental arch, inactive enamel lesions presented a similar risk for caries progression than sound occlusal surfaces (OR = 0.98, 95 % CI = 0.40-2.38). CONCLUSION: Within the limitations of this study, no difference was observed in caries incidence, progression, and risk on sound occlusal sites in comparison with sites presenting inactive enamel lesions. CLINICAL RELEVANCE: Occlusal surfaces harboring inactive caries lesions did not require additional attention than the one normally given to sound occlusal surfaces over a 1-year period.

Influence of eruption stage and biofilm accumulation on occlusal caries in permanent molars: a generalized estimating equations logistic approach.

The aim of this study was to estimate the independent effects of biofilm accumulation and eruption stage on the occurrence of active caries lesions on occlusal surfaces of permanent molars. The sample consisted of 298 schoolchildren (6-15 years) who were examined by a calibrated examiner at a dental unit, using artificial light, a dental mirror and a WHO probe. The occurrence of visible biofilm on occlusal surfaces and the eruption stage of each permanent molar were recorded. After professional prophylaxis and air drying, the occlusal surfaces were classified as sound, caries-inactive or caries-active. To evaluate the association of eruption stage and biofilm accumulation with active caries lesions, a logistic regression model was used. Since data were clustered, odds ratios were obtained using generalized estimating equations with a logistic link function. 1,779 permanent molars were examined. All eruption stages were associated with active caries lesions. After adjustment for biofilm accumulation and type of molar, molars with occlusal surfaces partially exposed to the oral cavity were 63.6 times more susceptible to caries activity than molars with full occlusion (95% CI = 22.0-183.7). After adjustment for eruption stage and type of molar, teeth with a high degree of biofilm accumulation were 14.5 times more susceptible to caries activity than those without visible biofilm accumulation (95% CI = 6.5-32.4). No association between active caries and hardly detectable biofilm was found in this population. The present study found that the eruption stage of permanent molars is strongly associated with active caries lesions, adjusted for biofilm accumulation and type of molar.

European ancestry and cutaneous melanoma in Southern Brazil.

BACKGROUND: Similar to other countries, incidence and mortality rates for cutaneous melanoma (CM) are increasing in Brazil. Resulting from centuries of ethnic mixture, the skin of the Brazilian population presents all phototypes, being progressively lighter following the increase of the latitude toward the South, where the highest incidence of melanoma is observed. Studies from the United States and Argentina in whites suggest that European ancestry could represent an important risk factor for CM in those regions. METHODS: Questionnaires from a case-control study involving 119 melanoma patients and 177 controls were reviewed for age, gender, phototype, sun exposure, photoprotection and ancestry. The patients reported the countries of ancestry of their grandparents. Data were tabulated and converted into scores that would reflect the proportion of ancestry for each country in individuals. RESULTS: Patients with German and Italian ancestry presented higher risk for CM [odds ratio (OR), 3.5; 95% confidence interval (95% CI), 1.8-6.7 and OR, 9.7; 95% CI, 3.9-24.2, respectively]. Conversely, Brazilian indigenous ancestry showed a protective effect for the development of the disease, with an OR of 0.16 (95% CI, 0.04-0.7). CONCLUSIONS: Some European ancestries, especially German and Italian, seem to be associated to a higher risk of CM in this sample from Southern Brazil. On the other hand, Brazilian indigenous ancestry presented as a protection factor against developing the tumour.

Quality of life and sexuality in chronic dialysis female patients.

Patients in end-stage renal disease (ESRD) present reduced quality of life (QOL) and impaired sexual function. Previous studies have mostly addressed male sexual dysfunction. This was a cross-sectional controlled study that applied a general and the World Health Organization Quality of Life-bref questionnaires to assess demographic, marital, and sexual conditions, and QOL in 86 healthy women aged 18 or more years (Group 1), and 38 female ESRD patients on dialysis for at least 2 months (Group 2). The effect of several explanatory variables upon QOL components was estimated. Quality of life was lower in Group 2 -- overall, and on physical and environment domains. To undergo dialysis and to be poorly educated negatively affected the QOL. Yet age, a stable marital relationship or being sexually active had no effect. Female patients undergoing chronic dialysis had lower QOL and were significantly more sexually dysfunctional than comparable healthy women. Decline in sexual function had no effect on the QOL.

No gender difference in effectiveness of smoking cessation treatment in a Brazilian real-life setting.

BACKGROUND: The clinical effectiveness of pharmacotherapy for smoking cessation in real-life settings has yet to be evaluated. OBJECTIVES: To assess the effectiveness of bupropion in general clinical practice for smoking cessation and to identify predictors of failure. METHODS: In an open, non-randomised study, smokers were recruited at the Smoking Cessation Clinics, Hospital Sao Lucas, Porto Alegre, Brazil. Subjects participated in a motivational group meeting, completed a standardised questionnaire and Fagerstrom test, and had their vital signs and exhaled CO registered. All participants received a prescription of bupropion and the same cognitive behaviour therapy. They attended eight weekly individual sessions, then monthly until the sixth month and a final session at month 12. The primary outcome measure was the rate of abstinence at 12 months. The predictor factors studied were sex, age, educational level, nicotine dependence, previous attempts and comorbidities. RESULTS: Among 253 smokers (62.5% females), abstinence rates at 6 months were 20.8% for males and 22.7% for females. The success rates dropped to 13.9% and 14.3% for males and females, respectively. CONCLUSIONS: Cognitive therapy plus bupropion for smoking cessation in real-life clinics in Brazil were similar to the efficacy found in clinical trials. No significant gender differences in success rates were found.

cGMP-dependent protein kinase mediates stimulation of L-type calcium current by cGMP in rabbit atrial cells.

OBJECTIVES: cGMP has been shown to exert both stimulatory and inhibitory effects on cardiac L-type calcium current (I(Ca)). The physiological role of cGMP in regulation of cardiac activity is still controversial. cGMP may be of importance in regulation of I(Ca) in atrial cells. The present study was focused on the role of cGMP in the modulation of I(Ca) in rabbit atrial cells. METHODS: Enzymatically isolated adult rabbit atrial cells were used to measure I(Ca) using whole cell voltage clamp. Expressed levels of cGMP-dependent protein kinase (PKG) were determined by Western blotting using PKG specific antibody in homogenates from atrial and ventricular cells. RESULTS: Nitrosoglutathione (GSNO), a nitric oxide donor that stimulates soluble guanylyl-cyclase to elevate cGMP levels increased I(Ca) while soluble G-cyclase inhibitors, ODQ or methylene blue inhibited I(Ca). Intracellular application of 8BrcGMP increased I(Ca) and blocked the inhibitory effect of methylene blue. KT-5823, an inhibitor of PKG inhibited I(Ca) and the stimulatory effect of GSNO was completely blocked ODQ or KT-5823. Inhibition of cAMP dependent protein kinase (PKA) by the 6-22 peptide completely blocked the stimulation of I(Ca) by the beta-agonist isoproterenol but not by GSNO. The potency of isoproterenol to stimulate I(Ca) was very high for atrial cells (EC(50) 2.4+/-0.6 nM) and only 100 nM isoproterenol was required to stimulate I(Ca) maximally (21.4+/-0.7 pA/pF) to a level (23.8+/-1.6 pA/pF) achieved with the inclusion of 100 microM cAMP in the pipette solution. GSNO produced an additive effect on I(Ca) already stimulated by either 10 microM isobutylmethylxanthine (phosphodiesterase inhibitor) or a low concentration (1 nM) isoproterenol but failed to produce any effect on I(Ca) maximally stimulated by 100 nM isoproterenol. Inhibition of PKG by KT-5823 significantly decreased the efficacy of isoproterenol and the maximal I(Ca) achieved with 100 nM isoproterenol was decreased to 8.2+/-0.6 pA/pF in the presence of KT-5823. Western blot analysis showed much higher expression of PKG in atrial cells compared to ventricular cells. CONCLUSIONS: These findings suggest that stimulatory effects of cGMP on I(Ca) in rabbit atrial cells are likely to be mediated via PKG dependent phosphorylation of calcium channels or associated proteins and that the effects of cGMP are not antagonistic to cAMP. PKG is highly expressed in atrial cells and PKG dependent phosphorylation may be necessary for maintaining basal I(Ca) and fully stimulating I(Ca) by beta-adrenergic activation in atrial cells.

A prevalence survey of nosocomial infection in a Brazilian hospital.

A study to determine the prevalence of hospital-acquired infection was undertaken in the Irmandade Santa Casa de Misericórdia de Porto Alegre Hospital in Brazil. The study was carried out in selected clinical areas of the hospital over a one-year period from 1987 to 1988. Of 397 patients surveyed, infections were present in 168 (42.3%); 53 (13.4%) were hospital acquired and 115 (29%) community acquired. The commonest infections involved the lower respiratory tract (30%), bacteraemias (24.4%) and the urinary tract (10%). A high prevalence of infection was encountered in the intensive care units.

Hospital-acquired infections among surgical patients in a Brazilian hospital.

A historical cohort study was conducted among surgical patients in a large general hospital in Porto Alegre, Brazil between March 1992 and May 1993. Data were collected by means of a retrospective chart review, which followed a standardized method based on the systematic review of all clinical and laboratory information available in the hospital records. The criteria for diagnosis of all hospital-acquired infections (HAIs) were based on those from the Centers for Disease Control, Atlanta. In total, 890 HAIs were detected among the 4199 patients included in the cohort. The incidence rate of HAIs for all sites combined was 21.20%. Incidence rates ranged from 2.95% for bloodstream infections to 8.65% for surgical wound infections. The overall incidence density was 16.32 HAIs per 1000 patient-days. Incidence densities ranged from 2.03 for bloodstream infections to 7.46 per 1000 patient-days for surgical wound infections. The median incubation period for surgical wound infections was seven days, and 29.4% of these infections were detected at post-discharge. Gram-negative bacteria were the most common organisms implicated in HAIs.

Risk factors for bleeding in major abdominal surgery using heparin thromboprophylaxis.

BACKGROUND: Patients undergoing major abdominal surgery are at risk of both bleeding and thrombotic complications and usually receive heparin thromboprophylaxis. PATIENTS AND METHODS: Risk factors for perioperative bleeding were examined in 3,809 patients in a double-blind, randomized trial investigating heparin thromboprophylaxis. The risk factors were modeled by logistic regression, and a risk score was calculated using the significant factors in the model. RESULTS: Bleeding was associated with the following factors in the model, given as adjusted odds ratios (ORa [95% confidence interval]): male sex (ORa 1.68 [1.21 to 2.34] P = 0.003), malignancy (ORa 1.69 [1.21 to 2.34] P = 0.008), gynecological surgery (ORa 1.62 [1.12 to 2.35] P = 0.011), and complex surgery (ORa 2.7 [2.02 to 3.62] P < 0.001). The risk of excessive bleeding for 0, 1, 2, and 3 risk factors was 2%, 6%, 11%, and 21%, respectively. CONCLUSIONS: The recognition of patients with these risk factors associated with perioperative bleeding should result in increased vigilance and may lead to modification of surgical and medical therapy.

Evaluation of a program for long-term treatment of Duchenne muscular dystrophy. Experience at the University Hospitals of Cleveland.

One hundred and forty-four boys who had Duchenne muscular dystrophy were managed at a single center between 1953 and 1994 and were followed for a mean of 8.9 years. The long duration of follow-up provided an opportunity to examine the effects of physical therapy and orthopaedic treatment on contractures of the lower extremities and on the duration of the ability to walk. Contractures of the lower extremities were controlled best when patients were managed with a combination of daily passive stretching exercises, prescribed periods of standing and walking, tenotomy of the Achilles tendon, posterior tibial-tendon transfer, and application of knee-ankle-foot orthoses. Approximately two years after bracing, the severity of the contracture of the heel cords was similar in the patients who had had an operation and those who had not. By the fourth year after bracing, however, the patients who had had an operation had less severe contractures than those who had had bracing alone. Five to seven years after the operation and bracing, control of contractures was still good, especially for the patients who had had posterior tibial-tendon transfer. Contracture of the knee was well controlled five to seven years after bracing in all patients who had had bracing, with or without an operation. The program enabled the patients who had been managed with bracing to walk until a mean age of 13.6 years. After loss of the ability to walk with bracing, the ability to stand continued for an additional two years with use of orthoses. The findings of the present study demonstrate the value of traditional methods of operative treatment and bracing for controlling contractures of the lower extremities in patients who have Duchenne muscular dystrophy and for prolonging their ability to walk.

Predicting the success of reambulation in patients with Duchenne muscular dystrophy.

We used biochemical and clinical variables to develop a method to predict the expected duration of independent walking following surgery and bracing in patients with Duchenne muscular dystrophy. Data from the records of fifty patients were analyzed by linear and multiple regression. The most useful factors, applied in combination, in predicting the duration of walking ability after bracing were: percentage of residual muscle strength, vital capacity, creatinine coefficient, motivation of the patient at the time of bracing, and decrease in creatinine coefficient in the two years prior to bracing. This system uses readily available variables to predict the response to bracing in patients with Duchenne muscular dystrophy. Improvement in the criteria for the selection of patients for surgery and bracing is important in view of the economic cost as well as the demands on the time and energy of these children and their parents.

A model study of propagation of early afterdepolarizations.

Early afterdepolarizations (EAD's) are irregularities of the cardiac action potential that interrupt or retard repolarization. EAD's have been linked to the development of specific types of cardiac arrhythmias, however, the mechanism underlying the development of these arrhythmias remains unclear. We implemented a two-element kinetic model of the ventricular action potential to investigate a potentially arrhythmogenic form of triggered activity. By approximating EAD's by a sinusoidal driving force, we were able to study the effects of interelement coupling resistivity and sinusoidal frequency and amplitude on the triggering of action potentials. We demonstrated EAD's in a ventricular action potential model by altering the potassium and calcium channels to simulate experimental conditions under which EAD's occur. We also found that triggered activity depends critically on the frequency and amplitude of the driving force and also on the degree of cellular uncoupling between the elements. Our results suggest that triggered activity (due to EAD's) may be suppressed by drugs that improve coupling in unhealthy tissue, or ones that prevent EAD formation by inhibiting calcium channels.

A study of the sexual behavior of teenagers in south Brazil.

A study of sexual behavior among teenagers was carried out in a random sample of 884 second degree school (high school) students of Porto Alegre (South Brazil) by means of a self-report questionnaire. The students' ages ranged from 13 to 22 years old, and 59% of them were females. The students believed themselves well-informed about physiologic phenomena involved in human reproduction (95.2%; 95% confidence interval (CI):93.5-96.5) and sexually transmitted diseases (STD) (82.1%; 95% CI:79.1-84.7). In addition, 42.4% (95% CI:39.0-45.8) said that they has had a sexual relationship. However, 51.5% (95% CI:45.9-57.0) did not use contraceptive precautions systematically, and 12% (95% CI:7.2-19.0) of girls had already undergone an abortion. Considering these results, it is important to stimulate programs for sexual education strictly focused on teenagers.

Serial isokinetic evaluations used for a patient with scapuloperoneal muscular dystrophy. A case report.

This article reports the reversal of an atypical rapid decline in muscle strength experienced by a patient with scapuloperoneal muscular dystrophy by modulating his excessive daily physical activity. This process was aided by our monitoring the strength of the quadriceps femoris and hamstring muscles using an isokinetic dynamometer. Serial torque values for muscle strength were compared as the total daily physical activity was decreased systematically. The torque values for thigh muscle strength increased as the subject's total work load was decreased. A complete management program for neuromuscular patients should include specified amounts of daily physical activity, rest, and therapeutic exercise.

Modeling triggered cardiac activity: an analysis of the interactions between potassium blockade, rhythm pauses, and cellular coupling.

It is known that under certain conditions, a combination of potassium channel blockade, sympathetic nervous activity, and pauses in sinus rhythm can increase the occurrence of cardiac arrhythmias. Although the arrhythmogenic interactions of these three factors are not completely understood, it is believed that the associated arrhythmias may be initiated by afterpotentials via a process that we refer to as propagated triggered activity. Using a two-cell computational model of ventricular action potential kinetics, we simulate nonuniform potassium blockade, sympathetic nervous activity, and pauses in sinus rhythm under conditions of hypokalemia. Under these conditions, the two-cell model suggests that (1) the arrhythmogenic interactions of potassium blockade and sympathetic nervous activity are highly dependent on heart rate; (2) triggered activity induced by potassium blockade would most likely occur during a pause in sinus rhythm; (3) during a sufficiently large pause in sinus rhythm, potassium blockade can induce triggered activity at normal levels of sympathetic activity; and (4) potassium blockade can increase the probability of triggered activity only if heart rate falls within a critical range. We also show that during pauses in sinus rhythm, two-cell triggering interactions between potassium blockade and sympathetic activity closely parallel the parametric displacement of the dynamic instability underlying the afterpotentials. Our results indicate that the behavior of the triggering mechanism studied here is consistent with that of pause-induced arrhythmias.

Pulmonary Aspergillus niger intracavitary colonization. Report of 23 cases and a review of the literature.

In this study we have compared clinical data obtained from 40 reported cases of pulmonary Aspergillus niger intracavitary colonization in the literature and those of our series 23 cases. Additionaly six of our cases have been summarized. Our findings revealed a similar occurrence of male sex, active tuberculosis, diabetes mellitus, systemic oxalosis, and lethal outcome in both groups. In conclusion, A. niger is not the most frequent causative agent of saprophytic aspergillosis neither is the most pathogenic species of Aspergillus. Despite that, when pulmonary A. niger intracavitary colonization is associated with diabetes the prognosis is generaly poor, probably due to acute oxalosis.

Assessing the antimicrobial prescription request process in a teaching hospital in Brazil: regulations and training.

It is known that antimicrobials are often prescribed inappropriately. One method used to deal with this problem is to regulate antimicrobial use by monitoring prescriptions. We report a study of physician compliance with the request for antibiotic process which was prepared and reviewed by a special infection control committee in our hospital the Nosocomial Infection Prevention Service (SCIH). The objective of this study was to identify the profile of inappropriate requests for restricted therapeutic antimicrobials used at Nossa Senhora da Conceição Hospital (HNSC), in Porto Alegre, Brazil. All 3,389 requests for therapeutic antimicrobials made between May 20, and October 31, 1996, were assessed and classified as appropriate and inappropriate. We determined that 17. 8% of the requests were inappropriate (a total of 720 errors). These were categorized according to 12 reasons for inappropriateness. Of these, the 3 most frequent inappropriate requests were deviation from standard use (26.73%), inappropriate length of treatment (23. 19%), and unfounded justification (13.61%). The reasons for inappropriateness were also arranged in three categories considering the following aspects: I. technical (59%); II. compatibility with the institutional program (32.36%), and III. administrative (8.61%). The 720 requests that were initially rejected were evaluated to see how antibiotic use was affected. In approximately 400 (55%), the forms could be appropriately modified after discussion with the physician. We conclude from this study that most of the inappropriate requests for antimicrobials in our hospital can be remedied by educating the staff since the errors were largely technical in nature. Thus, the SCIH should focus more on its role as an educational rather than as a regulatory body. By expanding this educational role, we anticipate improved physician compliance with our guidelines, and more appropriate antimicrobial prescribing and usage.

Exercise participation in a frail elderly population.

A low-intensity exercise demonstration project was developed jointly by researchers, social service practitioners, and program participants to actively involve frail older people in their own health maintenance. This article describes this collaborative process and its impact on the success of the health promotion program, which was conducted at three senior centers serving a low-income, urban elderly population. Participants were predominantly sedentary women over age 70 with multiple chronic conditions. The program was conducted with peer leaders to facilitate its continuation after the research demonstration phase. In addition to positive health outcomes related to functional mobility, blood pressure maintenance, and overall well-being, this intervention was successful in sustaining active participation in regular physical activity through the use of peer leaders selected by the program participants. The planning, implementation, and outcomes of this project illustrate the benefits and challenges of combining research and practice perspectives in conducting health promotion interventions with older populations.

[Demand of community health services in the periphery of a metropolitan area]. / Demanda de serviço de saúde comunitária na periferia de área metropolitana.

The content of 4,319 consultations in primary health care representing 7% of all consultations from March, 1985 to March, 1986 at the Murialdo Health Center, was analyzed. The health center is located in the outskirts of Porto Alegre, RS (Brazil). Woman represented 67% of the total demand. Most consultations were for children under 10 years of age (37%) and woman of childbearing age (21%). The first twenty reasons for the visit corresponded to 63% of the total, and the most common reason for visiting the health center was for renewal of prescriptions and/or ordering medication (9.3%). Of all the diagnoses, the first twenty accounted for 62% of the total number of patients and the most frequent were: hypertension (8.8%), upper respiratory tract infection (7.8%), and immunization (5.5%). Prescription and administration of medication were the most common actions performed. Referrals resulted in 7.3% of the visits. Of these, 5% were sent to other providers within the Murialdo service. Only 0.6% were referred for hospitalization. These findings, combined with others which describe aspects of morbimortality not easily measured in studies of spontaneous demand for medical services, should help in the planning of primary health care services and in the training of health personnel.