Impact of environmental conditions on the ripening of Queijo de Évora PDO cheese.

"Queijo de Évora" is a traditional Portuguese cheese from raw ewe's milk and granted with PDO label. It is ripened traditionally in rooms with empirical control of temperature and humidity. Nowadays, almost all cheese factories use rooms with temperature and humidity control, but still a significant heterogeneity among cheeses is acknowledged due to unequal distribution of environmental conditions. This paper discusses the influence of the environmental conditions on the ripening of Queijo de Évora, including the application of computational fluid dynamics in steady state conditions. Experimental data was obtained in cheeses ripened along the traditional ripening cycle, in different locations. A significant influence of environmental conditions was observed, especially air velocity and humidity, affecting physical-chemical, microbiological and sensory characteristics. Locations with higher air velocity, presented cheeses with lower moisture content, higher mesophilic bacteria count, darker appearance and higher number of holes. Locations with higher humidity presented cheeses with lower scores on some sensorial parameters like appearance, firmness and intensity of odor. The results of computational fluid dynamics made possible the identification of areas in and around the cheese stacks were the air distribution is less than adequate or uneven, which may influence the evolution of cheese during ripening.

Constipation, antiepileptic drugs, and gingivitis in children and adolescents with cerebral palsy.

BACKGROUND: Cerebral palsy (CP) individuals present with epilepsy, which requires the use of antiepileptic drug (AED). HYPOTHESIS: Since an inflammatory response may contribute to epileptogenesis, the hypothesis tested was that constipation would be associated with gingivitis and the use of AED in children and adolescents (CA) with CP. DESIGN: A comparative study was conducted with 101 CA aged 5-17 years (10.8 ± 4.9), classified as constipated (G1; n = 57) or not constipated (G2; n = 44). Clinical patterns, AED used, body mass index (BMI), fluid intake, toilet transfer, and gingival condition were evaluated. Student's t test, chi-squared test, and logistic regression analysis were performed (α = 0.05). RESULTS: There were no differences between groups regarding gender (P = 0.531), age (P = 0.227), BMI (P = 0.437), and fluid intake (P = 0.346). G1, however, presented a higher percentage of quadriplegic individuals (P < 0.001), dependency for toilet transfer (P < 0.001), the presence of gingivitis (P = 0.020), and the use of AED polytherapy (P < 0.001) compared to G2. Constipation was associated with quadriplegic CA, using GABA as AED (P = 0.002). CONCLUSIONS: Mucosal inflammation evidenced by constipation and gingivitis is associated with the most neurologically compromised CAs under the use of GABA AED.

Relationship Between Occlusal Features and Enzyme Replacement Therapy in Patients With Mucopolysaccharidoses.

PURPOSE: The aim of this study was to describe the relation between occlusal features and enzyme replacement therapy in patients with mucopolysaccharidoses. MATERIALS AND METHODS: A cross-sectional study was conducted. The sample consisted of 20 patients with mucopolysaccharidoses, 10 of whom were undergoing treatment at a hospital in northeast Brazil. Occlusal features were evaluated by clinical examination and panoramic radiography. A structured questionnaire was administered to evaluate the dental care of each patient. Pearson χ2, Fisher exact, and Mann-Whitney tests were used for data analysis, with a level of significance of 5%. RESULTS: Marked overjet (75%) and anterior open bite (70%) were the most frequent occlusal alterations, and 15% had Class III disorders. Radiography visualized the presence of impacted teeth (75%) and prolonged retention of deciduous teeth (65%). Patients with enzyme replacement therapy had a lower average maximum protrusion (P = .033). A total of 75% of mothers said they had not been advised to take their children to the dentist and 10% of children had never been to the dentist. CONCLUSION: Patients with mucopolysaccharidoses exhibited notable occlusal alterations, especially marked overjet and anterior open bite. Enzyme replacement therapy seems to influence the maximum protrusion of patients.

Alterations in the primary teeth of children with microcephaly in Northeast Brazil: a comparative study.

BACKGROUND: The outbreak of microcephaly between 2015 and 2017 in Brazil created an international public health emergency. AIM: This study sought to evaluate the chronology, sequence of eruption, and the presence of anomalies amongst children with microcephaly compared with normoreactive children. DESIGN: A comparative study of 108 children aged 0-2 years attending public services was conducted. The microcephaly group (MG; n = 54) and the nonmicrocephaly group (NMG; n = 54) were matched by age, gender, and family income at a 1 : 1 ratio. Erupted teeth and the presence of anomalies were evaluated and compared. Chi-square tests, Pearson's correlations, Fisher's exact tests, and Student's t-tests were applied (α = 0.05). RESULTS: No between-group differences were found with regard to gender (P = 0.560) or age (P = 0.529). The MG presented with a higher percentage of alterations in eruption sequence, opacity, self-injury, and delayed eruption compared with the NMG (P < 0.05). The MG was more likely to exhibit changes in tooth eruption sequence (OR = 12.23, 95% CIs = 3.25-46.03, P < 0.001), delayed eruption (OR = 23.12; 95% CIs = 7.09-75.40, P < 0.001), and opacity (n = 12.19, 95% CIs = 1.44-103.28, P = 0.022) than the NMG. CONCLUSION: Children with microcephaly present with greater delays in chronology, alterations in eruption sequence, and enamel defects than normoreactive children.

Efficacy of photobiomodulation therapy on masseter thickness and oral health-related quality of life in children with spastic cerebral palsy.

The study aimed to evaluate the efficacy of photobiomodulation therapy (PBMT) on bilateral masseter muscle thickness and amplitude of mouth opening in children with spastic cerebral palsy (CP), and the impact on their oral health-related quality of life (OHRQOL). Three groups were included: experimental CP group (EG: n = 26 with oral complaints), positive control CP group (PCG: n = 26 without complaints), and negative control group (NCG: n = 26 without CP). In the EG, the masseter muscles on both sides were irradiated with an infrared low-level Ga-Al-As laser (λ = 808 ± 3 nm, 120 mW) using a 3 J/cm2 energy dose per site, with a 20 s exposure time per site (spot area: 4 mm2; irradiance: 3 W/cm2; energy delivery per point: 2.4 J) six times over six consecutive weeks. Masseter thickness, assessed through ultrasonography, and the amplitude of mouth opening were measured in the EG before and after six applications of PBMT and once in the PCG and NCG. The Parental-Caregiver Perception Questionnaire (P-CPQ) was used to evaluate OHRQOL. ANOVA, chi-square, t tests, and multilevel linear regression were used for statistical analysis. In the EG, the study results revealed average increments of 0.77 (0.08) millimeter in masseter thickness (P < 0.05) and 7.39 (0.58) millimeter for mouth opening (P < 0.05) and reduction in all P-CPQ domains (P < 0.001), except for social well-being. The six applications of PBMT increased masseter thickness and mouth opening amplitude and reduced the impact of spastic CP on OHRQOL.

Inflammatory markers in saliva as indicators of gingival inflammation in cerebral palsy children with and without cervical motor control.

AIM: To evaluate the relation among gingival inflammation, salivary osmolality, levels of IL-1ß, IL-6, IL-8, TNF-α, and s-IgA concentrations in children with spastic CP with or without cervical motor control in a cross-sectional study. DESIGN: Unstimulated whole saliva and the gingival index were collected in 37 and 34 CP children with and without cervical motor control, respectively. The data were dichotomized as follows: (=0) absence of gingival inflammation and (≥0.1) presence of gingival inflammation. RESULTS: The group without cervical control presented statistically higher mean values of salivary osmolality, s-IgA, and cytokines. In addition, statistically positive correlation between the gingival index and salivary cytokines was observed in the group with cervical control. Salivary osmolality, salivary cytokines, and s-IgA from both groups presented a significant positive correlation. Significant differences (P = 0.00336) in the values of salivary osmolality were observed between the CP individuals with (93.9 ± 32.7) and without gingival inflammation (74.4 ± 16.6). ROC analysis was performed, and values of salivary osmolality >80 indicated a sensitivity of 0.54 and a specificity of 0.79. CONCLUSIONS: Children without cervical motor control presented a more pronounced oral inflammatory status that was characterized by higher levels of cytokines.

Gingivitis and salivary osmolality in children with cerebral palsy.

AIM: To investigate the influence of salivary osmolality on the occurrence of gingivitis in children with cerebral palsy (CP). DESIGN: A total of 82 children with spastic CP were included in this cross-sectional study. Oral motor performance and gingival conditions were evaluated. Unstimulated saliva was collected using cotton swabs, and salivary osmolality was measured using a freezing point depression osmometer. Spearman's coefficient, receiver operating characteristic (ROC), and multiple logistic regression analyses were performed. RESULTS: Strong correlation (r > 0.7) was determined among salivary osmolality, salivary flow rate, visible plaque, dental calculus, and the occurrence of gingivitis. The area under the ROC to predict the influence of salivary osmolality on the occurrence of gingivitis was 0.88 (95% CI 0.81-0.96; P < 0.001). The cutoff value of 84.5 for salivary osmolality presented good sensitivity and specificity, both higher than 77%. The proportion of children presenting salivary osmolality ≤84.5 mOsm/kgH2 O and gingivitis was 22.5%, whereas for the group presenting osmolality >84.5 mOsm/kgH2 O, the proportion of children with gingivitis was 77.5%. Salivary osmolality above 84.5 increased the likelihood of gingivitis fivefold, whereas each additional 0.1 mL of salivary flow reduced the likelihood of gingivitis by 97%. CONCLUSION: Gingivitis occurs more frequently in children with CP showing increased values of salivary osmolality.

Platelet function in malignant hematological disorders.

PURPOSE OF REVIEW: In this article, we summarize the current knowledge on new roles played by platelets and their interactions with blood components, and their possible implications in malignant hematological disorders. RECENT FINDINGS: Recent reports in the literature are revealing that platelets are important partners in different aspects of physiology and pathophysiology beyond hemostasis and thrombosis, including but not restricted to inflammation, cancer or host defense. Moreover, several studies suggest that platelet interactions with other blood cells could regulate functional and biochemical responses of each other. Finally, platelet alterations in number as well as in function have been observed in different hematological disorders related with the action of treatments. SUMMARY: Common complications of leukemia are bleeding and thrombosis, in which the number and activity of platelets undoubtedly play an important role. Probably related with their apparent structural simplicity compared with other hematological cells, the interest in platelets in malignant hematological disorders has been mainly restricted to the determination of the number of circulating platelets. However, different studies have demonstrated that numbers of platelets between 6 and 80 × 10(9) platelets/l are a poor indicator of the risk of bleeding, as this number does not give any information on the functional activity of these platelets.

Oral motor assessment in individuals with Moebius syndrome.

BACKGROUND: Moebius syndrome (MS) is a rare congenital condition that is characterised by facial hypomimia and congenital strabismus caused by complete or partial impairment of the 6th and 7th cranial nerves. MS may be further associated with other nerves or malformations, mainly involving the extremities. The objective of this study was to quantify the decrease in oral motor performance in people with MS compared with normoreactive individuals using the Oral Motor Assessment Scale (OMAS). METHODS: The study group comprised 33 subjects between the ages of 2 and 20 years (average age: 10 ± 5 years) with MS along with 46 age- and gender-matched control subjects. RESULTS: The study group displayed a lower average functional score than the control group (P < 0.0001). A significant lack of lip closure (P = 0.03) and anterior lingual seal during swallowing (P = 0.03) occurred in the study group; in most cases, the individuals with MS were classified as 'subfunctional'. In addition, individuals with MS in the older age group displayed better functional scores than those in the younger group (P = 0.05). CONCLUSIONS: Functional damage to oral motor function in individuals with MS is evident, but differs among patients with respect to severity and the movements that are compromised. However, overall, improvements in the functional patterns of these individuals can be observed as they mature in age.

The administration of a loading dose of aspirin to patients presenting with acute myocardial infarction while receiving chronic aspirin treatment reduces thromboxane A2-dependent platelet reactivity.

Abstract The optimal dose of aspirin for patients presenting with acute myocardial infarction (AMI) while receiving chronic aspirin therapy has not been clearly established. We evaluated whether continued treatment with 100 mg of aspirin or a loading dose (200-500 mg) influences thromboxane A2 (TX) suppression or platelet reactivity. Sixty-four consecutive patients with AMI and 98 healthy subjects (82 aspirin-free and 16 receiving 100 mg daily for a week) were evaluated. Treatment was at the discretion of the attending physician. Collagen (1 µg/ml)-induced TX synthesis, (14)C-serotonin-release, platelet aggregation, and the PFA-100 assay were evaluated. The platelet TX synthesis of patients receiving a loading dose of aspirin was sixfold lower than that of patients receiving 100 mg of aspirin (p<0.005). This was associated with marked reductions in (14)C-serotonin-release and arachidonic-acid-induced aggregation and an increase in the PFA-100 closure time (p<0.01). Categorization of patients according to their TX synthesis (<95% or ≥ 95% inhibition vs. healthy aspirin-free subjects) revealed that 8% of the patients treated with loading doses had a poor response (<95% inhibition) vs. 53% of those treated with 100 mg (p<0.001). Patients with lower TX inhibition had higher serum NT-Pro-BNP (p<0.005), a marker of poor left ventricular systolic function. Administration of a loading dose of aspirin to patients with AMI during existing chronic aspirin treatment induced greater reductions in platelet TX synthesis and TX-dependent platelet reactivity than the continued treatment alone.

Patients with mucopolysaccharidosis have tendencies towards vertical facial growth.

PURPOSE: Studies addressing the changes in craniofacial morphology of patients with mucopolysaccharidosis (MPS) are important for a better understanding of the progression of this disease. The present objective was to identify major cephalometric abnormalities in these patients. MATERIALS AND METHODS: This was a cross-sectional case-and-control study. The sample was composed of 2 types of study subjects (patients with MPS and normal subjects). The outcome variables were numerous cephalometric elements that measure facial height, dental positioning, facial growth pattern, and mandibular and maxillary positioning. The Student t test was used to compare the mean angular and linear measurements of the case and control groups and the level of significance was set at a P value less than .05. The Bonferroni method was used for adjustment of the P value (P<.003 was deemed significant). RESULTS: The control group consisted of randomly selected subjects matched to the patients with MPS for the demographic variables of gender and age. Seventeen patients with MPS were evaluated (64.7% female). The mean age of the sample was 13.29 years. One patient had MPS I, 8 had MPS IV, and 8 had MPS VI. The results showed important differences between groups in angular measurements (angle formed by the line between the sella and nasion [SN] and the plane of the gonion and gnathion, angle formed by the intersection of the gnathion point and the SN line, angle formed by the intersection of the long axis of the lower incisor with the line between the nasion and the B point, angle formed by the intersection of the long axes of the upper and lower incisors, and angle formed by the Frankfort horizontal plane with the mandibular plane) and linear measurements (condyle to A point, condyle to gnathion, pro-nasal ( Pn) point to the line between the pogonion and upper incisor, and the nearest point of the anterior half of the soft palate to the posterior pharyngeal wall). The angle formed by the SN line with the plane between the gonion and the gnathion and the distance from the condyle to the A point showed meaningful differences after Bonferroni adjustment. CONCLUSION: Patients with MPS present a tendency toward vertical growth that results in a dolichocephalic facial pattern. In addition, a smaller nasopharyngeal space was observed, a factor that might be responsible for the mouth breathing observed in these patients.

Assessment of platelet function in acute ischemic stroke patients previously treated with aspirin.

BACKGROUND: Platelet inhibition measured by platelet function tests could be critical to understand the reasons for early recurrence and to guide therapeutic recommendations. We assess the platelet function during the acute phase of ischemic stroke in patients pretreated with aspirin who continue their treatment with aspirin only, are started on clopidogrel only, or add clopidogrel to aspirin. METHODS: Sixty-four patients were taking aspirin before the stroke. Depending on the administered antiplatelet, 3 groups were defined: ASA: patients who continued on aspirin orally or intravenous acetylsalicylate of lysine, n = 30; CLO: patients who discontinued aspirin and were started on clopidogrel, n = 16; and ASA + CLO: patients who were prescribed both aspirin and clopidogrel, n = 10. Collagen-induced thromboxane A2 (TXA2) synthesis, ADP (adenosine diphosphate)-induced aggregation, and occlusion time (PF-100) were measured. RESULTS: CLO group only had a marked elevation of TXA2 (17.44 ± 15.62 ng/mL, P = .000) and a shortening of the platelet function analyzer (PFA)-100 closure time (157.13 ± 88 seconds, P = .047) compared with the other 2 groups (ASA: TXA2, .62 ± 1.59 ng/mL; ASA + CLO: TXA2 1.79 ± 4.59 ng/mL). They achieved a small (13%) but significant reduction of ADP-induced aggregation (87.00 ± 23.06 mm, P = .008) compared with the ASA group (102.82 ± 22.38 seconds). CONCLUSIONS: Stopping aspirin intake within the first 72 hours of the acute stroke drastically increases TXA2 synthesis. During the same time window, the freshly prescribed clopidogrel manages to reduce the ADP-induced aggregation only slightly (13%). This study offers analytic proof that the common practice of replacing aspirin with clopidogrel does not leave stroke patients fully protected during the first days after an ischemic stroke. Possible solutions could be to preserve aspirin during a few days or to use loading doses of clopidogrel at hospital admission.

Assessing salivary osmolality as a caries risk indicator in cerebral palsy children.

BACKGROUND: Salivary osmolality reflects the hydration status of individuals with cerebral palsy (CP) necessary for an adequate unstimulated salivary flow rate. AIM: To investigate whether salivary osmolality could serve as a potential indicator of caries risk in children with spastic CP by displaying a stronger association with caries occurrence than salivary flow rate. DESIGN: The convenience sample consisted of 65 children with CP aged 6-13 years old. Unstimulated whole saliva was collected using cotton roll, and salivary osmolality was measured using a freezing point depression osmometer. The children's oral motor performance was evaluated during the feeding process using the Oral Motor Assessment Scale. Caries occurrence was also evaluated according the World Health Organization criteria. RESULTS: Motor skills were significantly associated with caries experience. Regarding the salivary parameters, osmolality presented a stronger association with caries experience than did the salivary flow rate. Children with worse oral motor performance presented a higher rate of caries occurrence. CONCLUSION: Osmolality exhibited a stronger association with caries occurrence than did salivary flow rate. This parameter, therefore, could be a potential caries risk indicator for spastic cerebral palsy children.

Evaluating Student Clerkship Performance Using Multiple Assessment Components.

Introduction: Family medicine clerkships utilize a broad set of objectives. The scope of these objectives cannot be measured by one assessment alone. Using multiple assessments aimed at measuring different objectives may provide more holistic evaluation of students. A further concern is to ensure longitudinal accuracy of assessments. In this study, we sought to better understand the relevance and validity of different assessment tools used in family medicine clerkships. Methods: We retrospectively correlated family medicine clerkship students' scores across different assessments to evaluate the strengths of the correlations, between the different assessment tools. We defined ρ<0.3 as weak, ρ>0.3 to ρ<0.5 as moderate, and ρ>0.5 as high correlation. Results: We compared individual assessment scores for 267 students for analysis. The correlation of the clinical evaluation was 0.165 (P<.01); with case-based short-answer questions it was 0.153 (P<.01); and with objective structured clinical examinations it was -0.246 (P<0.01). Conclusion: Overall low levels of correlations between our assessments are expected, as they are each designed to measure different objectives. The relatively higher correlation between component scores supports convergent validity while correlations closer to zero suggest discriminant validity. Unexpectedly, comparing the multiple-choice questions and objective, structured clinical encounter (OSCE) assessments, we found higher correlation, although we believe these should measure disparate objectives. We replaced our in-house multiple-choice questions with a nationally-standardized exam and preliminary analysis shows the expected weaker correlation with the OSCE assessment, suggesting periodic correlations between assessments may be useful.

Increased salivary immunoglobulin A and reduced α-amylase activity in whole saliva from spastic cerebral palsy individuals.

BACKGROUND: Salivary immunoglobulin A (SIgA) together with innate defenses such as α-amylase, provides the 'first line of defense' against pathogens present at mucosal surfaces. This study aimed to evaluate salivary α-amylase and immunoglobulin A (IgA) in whole saliva of spastic cerebral palsy (CP) individuals. METHODS: Whole saliva was collected from 22 CP and 24 sibling volunteers with no neurological damage control groups (CG) (aged 7-14 years). The salivary flow rate, total protein and SIgA concentrations, and α-amylase activity were determined. RESULTS: The CP group presented higher salivary flow rate (35%) and lower total protein concentration (18%) compared with the CG (P ≤ 0.05). CPG had higher absolute (68%, µg SIgA/ml) and relative (55%, µg SIgA/mg prot and 108%, µg SIgA/min) concentrations of IgA compared with the CG (P ≤ 0.05). CPG had lower relative α-amylase activity (15% mg malt/mg prot and 33%, mg malt/min) compared with the CG (P ≤ 0.05). CONCLUSION: This study concluded that CP individuals presented alterations in the profile of salivary proteins involved in the defense system of the oral cavity.

Oral manifestations of systemic alterations in early childhood.

AIM: This study aimed to describe certain common oral manifestations during early childhood that should be known by the pediatric dental surgeon. BACKGROUND: The correct diagnosis and treatment of oral manifestations during early childhood is important for children's development. The pediatric dentist is responsible for maintaining oral health in children, since they change constantly during their development and growth. CASE REPORT: Four cases of oral lesions are described, in which the diagnosis and related approach for each one is reported. The first was an acute primary herpetic gingivostomatitis, the second, pseudomembranous candidiasis, the third, chickenpox and the last was molluscum. CONCLUSION: Professionals who treat children in this age group must be able to diagnose and treat common oral manifestations when necessary and should refer the child to a pediatrician for effective treatment if the presence of any systemic alteration is suspected. CLINICAL SIGNIFICANCE: Pathognomonic signs of the most common oral manifestations in early childhood should be known by dentists to improve early diagnosis and proper management.

Impact of LAB from Serpa PDO Cheese in Cheese Models: Towards the Development of an Autochthonous Starter Culture.

Serpa is a protected designation of origin (PDO) cheese produced with raw ewes' milk and coagulated with Cynara cardunculus. Legislation does not allow for milk pasteurization and starter culture inoculation. Although natural Serpa's rich microbiota allows for the development of a unique organoleptic profile, it also suggests high heterogeneity. This raises issues in the final sensory and safety properties, leading to several losses in the sector. A possible solution to overcoming these issues is the development of an autochthonous starter culture. In the present work, some Serpa cheese Lactic acid bacteria (LAB)-isolated microorganisms, previously selected based on their safety, technological and protective performance, were tested in laboratory-scale cheeses. Their acidification, proteolysis (protein and peptide profile, nitrogen fractions, free amino acids (FAA)), and volatiles generation (volatile fatty acids (VFA) and esters) potential was investigated. Significant differences were found in all parameters analyzed, showing a considerable strain effect. Successive statistical analyses were performed to compare cheese models and Serpa PDO cheese. The strains L. plantarum PL1 and PL2 and the PL1 and L. paracasei PC mix were selected as the most promising, resulting in a closer lipolytic and proteolytic profile of Serpa PDO cheese. In future work, these inocula will be produced at a pilot scale and tested at the cheese level to validate their application.

Oral motor performance in spastic cerebral palsy individuals: are hydration and nutritional status associated?

BACKGROUND: Previous studies reported alterations in salivary parameters in cerebral palsy (CP) individuals; however, none of these considered oral motor performance as possibly responsible for these conditions. The aim of this study was to investigate the influence of oral motor performance on the nutritional status and salivary parameters in individuals with CP. METHODS: Forty-three individuals aged 11-19 years-old, with spastic CP were included in this study. Oral motor performance was evaluated using the Oral Motor Assessment Scale, which classified the individuals into two groups: subfunctional or functional. Unstimulated saliva was collected and the flow rate was calculated (ml/min). Salivary osmolality was measured using a freezing point depression osmometer. Blood samples were collected to evaluate complete blood count, total protein, albumin/globulin ratio and transferrin levels. RESULTS: The subfunctional (n = 21) and the functional group (n = 22) did not differ regarding sex (P = 0.193), however the functional group was older (P = 0.023) and had a higher mean BMI (P < 0.001). The subfunctional CP group presented a reduction in salivary flow rate (36.4%) (P < 0.01) and an increase in salivary osmolality (35.5%) (P < 0.001) compared to the functional group. Slightly lower values for red blood cells (millions/mm(3) ) (P < 0.001), hemoglobin (g/dl) (P < 0.009), hematocrit (%) (P = 0.001), number of platelets (N/mm(3) ), total protein (g/dl) and albumin/globulin ratio (P = 0.003 and P = 0.036, respectively) were determined for the subfunctional group, but within the normal range of normality. CONCLUSION: Cerebral palsy individuals appear to present impaired adequate hydration due to compromised oral motor performance.