Periodontitis and systemic parameters in chronic kidney disease: Systematic review and meta-analysis.

OBJECTIVE: To perform a systematic review with meta-analysis to assess recent scientific evidence on the association between periodontitis and systemic parameters/conditions in individuals with chronic kidney disease (CKD). MATERIALS AND METHODS: The search for studies was performed in MedLine/PubMed, Scopus, Web of Science, and BIREME databases. Reference lists of selected articles were also searched. Studies with different epidemiological designs evaluating the influence of exposure to periodontitis on serum markers and mortality in individuals with CKD were eligible for inclusion. Three independent reviewers performed the article selection and data extraction. The assessment of methodological quality used the adapted Newcastle Ottawa Scale. Random effects meta-analysis was performed to calculate association measurements and 95% confidence intervals. RESULTS: In total, 3053 records were identified in the database search, with only 25 studies meeting the eligibility criteria and, of these, 10 studies contributed data for meta-analysis. Using a random-effects model, periodontitis was associated with hypoalbuminemia (PRunadjusted = 2.47; 95%CI:1.43-4.26), with high levels of C-reactive protein (PRunadjusted = 1.35; 95%CI%:1.12-1.64), death from cardiovascular disease (RRunadjusted = 2.29; 95%CI:1.67-3.15) and death from all causes (RRunadjusted = 1.73; 95%CI:1.32-2.27). CONCLUSIONS: The findings of this review validated a positive association between periodontitis and serum markers and mortality data in individuals with CKD.

Orofacial myofunctional assessment and quality of life of individuals with Parkinson's disease.

OBJECTIVES: To characterize orofacial myofunctional structures of elders with Parkinson's disease (PD) and examine the relationship with the stages of PD, pharmacotherapy, and quality of life. METHODS: PD Group with 45 elders and a control group (CG) of 10 healthy elders of both sexes were included (60-86 years). Structured interviews, medical records, and clinical examination gathered information on health aspects such as the use of drugs, Hoehn & Yahr stages 1-4, and oral health status. The Mini-Mental State Examination, Parkinson's Disease Questionnaire, and Orofacial Myofunctional Evaluation with Scores for Elders were applied. RESULTS: Better oral health status was found in participants diagnosed as Hoehn & Yahr stage 1 compared to the later stages. OMES-Elders scores for appearance/posture, mobility, breathing, and speech functions were different between groups, and decreased overall OMES-Elders was observed across the Hoehn & Yahr stages. A higher number of masticatory cycles was required for chewing and ingestion of the test food in the PD group compared to CG (p < .05). Significant differences were found in the mobility and daily living activities domains and an overall score of QoL between the Hoehn & Yahr stages 1 and 4, and worst orofacial functioning was accompanied by the worst self-perception of QoL in the communication domain (rho = -0.32; p = .034). The use of xerogenic drugs did not affect the OMES-Elders swallowing domain. CONCLUSION: Worse dental condition and performance of orofacial functions was observed in the elders with PD as the disease progresses, and poorer orofacial performance negatively affects their perception of communication skills.

Parathyroid hormone and phosphorus overload in uremia: impact on cardiovascular system.

BACKGROUND: Cardiac remodeling in uremia is characterized by left ventricular hypertrophy, interstitial fibrosis and microvascular disease. Cardiovascular disease is the leading cause of death in uremic patients, but coronary events alone are not the prevalent cause, sudden death and heart failure are. We studied the cardiac remodeling in experimental uremia, evaluating the isolated effect of parathyroid hormone (PTH) and phosphorus. METHODS: Wistar rats were submitted to parathyroidectomy (PTx) and 5/6 nephrectomy (Nx); they also received vehicle (V) and PTH at normal (nPTH) or high (hPTH) doses. They were fed with a poor-phosphorus (pP) or rich-phosphorus (rP) diet and were divided into the following groups: 'Sham': G1 (V+normal-phosphorus diet (np)) and 'Nx+PTx': G2 (nPTH+pP), G3 (nPTH+rP), G4 (hPTH+pP) and G5 (hPTH+rP). After 8 weeks, biochemical analysis, myocardium morphometry and arteriolar morphological analysis were performed. In addition, using immunohistochemical analysis, we evaluated angiotensin II, α-actin, transforming growth factor-beta (TGF-ß) and nitrotyrosine, as well as fibroblast growth factor-23 (FGF-23), fibroblast growth factor receptor-1 (FGFR-1) and runt-related transcription factor-2 (Runx-2) expression. RESULTS: Nx animals presented higher serum creatinine levels as well as arterial hypertension. Higher PTH levels were associated with myocardial hypertrophy and fibrosis as well as a higher coronary lesion score. High PTH animals also presented a higher myocardial expression of TGF-ß, angiotensin II, FGF-23 and nitrotyrosine and a lower expression of α-actin. Phosphorus overload was associated with higher serum FGF-23 levels and Runx-2, as well as myocardial hypertrophy. FGFR-1 was positive in the cardiomyocytes of all groups as well as in calcified coronaries of G4 and G5 whereas Runx-2 was positive in G3, G4 and G5. CONCLUSION: In uremia, PTH and phosphorus overload are both independently associated with major changes related to the cardiac remodeling process, emphasizing the need for a better control of these factors in chronic kidney disease.

Vascular calcification by conventional X-ray and mortality in a cohort of predominantly African descent hemodialysis patients.

BACKGROUND/OBJECTIVE: There is a lack of studies describing the prevalence of vascular calcification (VC) and its association with mortality in maintenance hemodialysis (MHD) patients of African descent. We investigated if a VC score based on the number of calcified vascular beds was associated with mortality in MHD patients. METHODS: We analyzed data from 211 MHD patients enrolled from January 2010 to January 2011 in the prospective cohort study, "The Prospective Study of the Prognosis of Chronic Hemodialysis Patients (PROHEMO)," developed in Salvador, BA, Brazil. VC was evaluated using radiographs of the hands, abdomen, hip, and chest; the score was calculated by the number of calcified sites as 0 (absence of calcification), 1 (one calcified site), 2 (two sites), 3 (⩾3 sites). We used Cox's regression to estimate the hazard ratio (HR) and 95% confidence interval (CI) of associations between VC and mortality with adjustments for age and comorbidities. RESULTS: VC was detected in 114 (54.0%) patients; 37 (17.5%) with a VC score = 1; 21 (10%) with VC score = 2 and 56 (26.5%) with VC score = 3. Compared with VC score = 0, the adjusted hazard of death was 2.67 (95% CI: 1.12, 6.33) for patients with VC score = 1; HR = 2.89 (95% CI: 0.95, 7.63) for VC score = 2; and HR = 3.27 (95% CI: 1.47, 7.28) for VC score = 3. CONCLUSION: The present study in an African descent MHD population provides support for the VC score based on conventional radiography as a prediction tool for the clinical practice. As shown, the VC score was monotonically and independently associated with mortality.

The bone histology spectrum in experimental renal failure: adverse effects of phosphate and parathyroid hormone disturbances.

Bone disease is a common disorder of bone remodeling and mineral metabolism, which affects patients with chronic kidney disease. Minor changes in the serum level of a given mineral can trigger compensatory mechanisms, making it difficult to evaluate the role of mineral disturbances in isolation. The objective of this study was to determine the isolated effects that phosphate and parathyroid hormone (PTH) have on bone tissue in rats. Male Wistar rats were subjected to parathyroidectomy and 5/6 nephrectomy or were sham-operated. Rats were fed diets in which the phosphate content was low, normal, or high. Some rats received infusion of PTH at a physiological rate, some received infusion of PTH at a supraphysiological rate, and some received infusion of vehicle only. All nephrectomized rats developed moderate renal failure. High phosphate intake decreased bone volume, and this effect was more pronounced in animals with dietary phosphate overload that received PTH infusion at a physiological rate. Phosphate overload induced hyperphosphatemia, hypocalcemia, and changes in bone microarchitecture. PTH at a supraphysiological rate minimized the phosphate-induced osteopenia. These data indicate that the management of uremia requires proper control of dietary phosphate, together with PTH adjustment, in order to ensure adequate bone remodeling.

Is drooling secondary to a swallowing disorder in patients with Parkinson's disease?

Drooling is a common manifestation in Parkinson's disease (PD). It causes psychosocial difficulties and can result in aspiration and chest infection. Previous studies point to an association between swallowing problems and sialorrhea. The aim of this study was to determine if drooling is associated with dysphagia in PD patients. Sixteen PD patients with diurnal drooling were assessed using a modified barium swallowing with videofluoroscopy, and a drooling score. Changes in the oral stage of swallowing were seen in 100% of the patients; and in the pharyngeal stage, in 94% of the patients. The results showed a correlation between the drooling scale score and the level of dysphagia (-0.426; p<0.05). Patients with the worst dysphagia had the worst drooling.

[Consensus on Perioperative Transesophageal Echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology]. / Consenso sobre Ecocardiografia Transesofágica Perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia.

Through the Life Cycle of Intraoperative Transesophageal Echocardiography (ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardiovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force to standardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesiologists and echocardiographers based on scientific evidence from the Society of Cardiovascular Anesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society of Cardiology.

Distribution and phylogenetics of whiteflies and their endosymbiont relationships after the Mediterranean species invasion in Brazil.

The Bemisia tabaci is a polyphagous insect and a successful vector of plant viruses. B. tabaci is a species complex and in Brazil native species from the New World (NW) group, as well as the invasive species, Middle East-Asia Minor 1 (MEAM1) and Mediterranean (MED) were reported. For better understanding the distribution of the different species four years after the Mediterranean species invasion in Brazil, whiteflies were collected from 237 locations throughout the country between the years of 2013 and 2017, species were identified and the facultative endosymbionts detected. The survey revealed that MEAM1 was the prevalent species found on major crops across Brazil. It is the only species present in North, Northwestern and Central Brazil and was associated with virus-infected plants. MED was found in five States from Southeast to South regions, infesting mainly ornamental plants and was not associated with virus-infected plants. The prevalent endosymbionts identified in MEAM1 were Hamiltonella and Rickettsia; and the mtCOI analysis revealed low genetic diversity for MEAM1. In contrast, several different endosymbionts were identified in MED including Hamiltonella, Rickettsia, Wolbachia and Arsenophonus; and two distinct genetic groups were found based on the mtCOI analysis. Monitoring the distribution of the whiteflies species in Brazil is essential for proper management of this pest.

Trophic Niche Differentiation in Rodents and Marsupials Revealed by Stable Isotopes.

Tropical rainforests support the greatest diversity of small mammals in the world, yet we have little understanding about the mechanisms that promote the coexistence of species. Diet partitioning can favor coexistence by lessening competition, and interspecific differences in body size and habitat use are usually proposed to be associated with trophic divergence. However, the use of classic dietary methods (e.g. stomach contents) is challenging in small mammals, particularly in community-level studies, thus we used stable isotopes (δ13C and δ15N) to infer about trophic niche. We investigated i) how trophic niche is partitioned among rodent and marsupial species in three Atlantic forest sites and ii) if interspecific body size and locomotor habit inequalities can constitute mechanisms underlying the isotopic niche partitioning. We found that rodents occupied a broad isotopic niche space with species distributed in different trophic levels and relying on diverse basal carbon sources (C3 and C4 plants). Surprisingly, on the other hand, marsupials showed a narrow isotopic niche, both in δ13C and δ15N dimensions, which is partially overlapped with rodents, contradicting their description as omnivores and generalists proposed classic dietary studies. Although body mass differences did not explained the divergence in isotopic values among species, groups of species with different locomotor habit presented clear differences in the position of the isotopic niche space, indicating that the use of different forest strata can favor trophic niche partitioning in small mammals communities. We suggest that anthropogenic impacts, such as habitat modification (logging, harvesting), can simplify the vertical structure of ecosystems and collapse the diversity of basal resources, which might affect negatively small mammals communities in Atlantic forests.

Effects of auriculopalpebral nerve block on ocular parameters in dogs

The objective of this study was to compare the effects of two local anesthetics used on auriculopalpebral block on eyelid akinesia, tear production, intraocular pressure (IOP) and tear break-up time (TBUT) in conscious dogs. A blind, randomized, prospective study was conducted to determine the effects of auriculopalpebral block using ropivacaine 0.75% and bupivacaine 0.5% in 12 healthy non-brachycephalic dogs (24 eyes). Threat response and eyelid reflex tests, Schirmer tear test (STT), IOP and tear break-up time were conducted before blockage and at 30, 60, 120, 240 and 360 minutes after application. A difference was observed between the values found at 30, 60, 120 and 240 minutes compared to baseline for threat response and eyelid reflex tests in the two groups evaluated, proving eyelid akinesia after blockages. No difference was found for STT, IOP and TBUT between baseline values and post-anesthesia times or between groups. It was possible to conclude that ropivacaine and bupivacaine on auriculopalpebral block in conscious dogs promoted eyelid akinesia for at least 240 minutes, not altering ocular physiological parameters of tear production, intraocular pressure, and tear break-up time after blockages.

New karyologycal data and cytotaxonomic considerations on small mammals from Santa Virgínia (Parque Estadual da Serra do Mar, Atlantic Forest, Brazil).

Atlantic Forest, in the eastern coast of Brazil, is a hotspot of biodiversity of mammals, and Parque Estadual da Serra do Mar (PESM) is the largest continuous area of this biome. Here, we characterized the karyotype composition of the small mammals from Santa Virgínia, a region in the northern part of PESM. Specimens were collected from July 2008 to September 2009. We identified 17 species (13 rodents and 4 marsupials) from which 7 exhibited species-specific karyotypes, illustrating the importance of karyotype information in cytotaxonomy. We report for first time the karyotype of Monodelphis scalops (Thomas, 1888) and two new records for PESM: Akodon montensis Thomas, 1913 and Brucepattersonius soricinus Hershkovitz, 1998. Cytogenetic polymorphisms were detected for some species trapped in the area. Our results show the importance of Santa Virgínia / PESM in addressing studies for the conservation of small mammal wildlife in the Atlantic Forest.

Brazilian Registry of Bone Biopsy (REBRABO): design, data elements and methodology.

INTRODUCTION: Mineral bone disorder (MBD) is a common condition in chronic kidney disease (CKD) patients and causes significant morbidity and mortality. Data involving prevalence of alterations in bone histological patterns, impact of different treatments and its repercussion in outcomes, such as bone fractures, hospitalization, cardiovascular disease and mortality, are scarce. Data bank registry can be a valuable tool to understand epidemiological aspects of MBD CKD. The Brazilian Registry of Bone Biopsy (REBRABO) will be a national registry, coordinating by the Brazilian Society of Nephrology - Committee of MBD-CKD. OBJECTIVE: To describe REBRABO's design, elements of data and methodology. METHODS: Will be an online national observational and multicentric data registry divided in two phases (retrospective, 1st phase) and prospective (2nd phase), including information from bone tissue histomorphometric analysis and demographics, clinical and laboratorial data from CKD-MBD patients. RESULTS: The REBRABO's first phase will explore data on demographics, clinical, laboratorial and bone histomorphometric analysis data from January/1986 to December/2013. The first RESULTS are expected in early 2015. CONCLUSION: Studies in the field of CKD-MBD are needed, particularly those analyzing its prevalence, associations between demographic, clinical, histological parameters, and major outcomes. The REBRABO will be a unique retrospective and prospective research platform including bone biopsy data in CKD-MBD patients.

First cytogenetic information for Drymoreomys albimaculatus (Rodentia, Cricetidae), a recently described genus from Brazilian Atlantic Forest.

The recently described taxon Drymoreomys albimaculatus is endemic to the Brazilian Atlantic Forest and its biology and genetics are still poorly known. Herein, we present, for the first time, the karyotype of the species using classical and molecular cytogenetics, which showed 2n=62, FN=62, and interstitial telomeric signals at the sex chromosomes. Nuclear and mitochondrial DNA sequences from the two karyotyped individuals verify the taxonomic identity as the recently described Drymoreomys albimaculatus and confirm the relationship of the species with other Oryzomyini. Additionally, external morphological information is provided.

Persistence of bone and mineral disorders 2 years after successful kidney transplantation.

BACKGROUND: Studies that have conducted bone biopsies after kidney transplantation are scarce, and the results are conflicting. METHODS: We evaluate the bone histomorphometry, in vitro proliferation, and alkaline phosphatase expression in osteoblasts isolated from bone biopsies from 27 kidney transplant patients. The patients had preserved renal function and were treated with the same immunosuppressive therapy, receiving a minimum dose of corticosteroids. RESULTS: The biochemical analysis revealed that 41% of the patients presented with hypercalcemia, 26% presented with hypophosphatemia, and hypovitaminosis D was detected in 63%. The histomorphometric analysis showed a reduced trabecular number and increased trabecular separation, mineral apposition rate, and mineralization lag time, as well as higher osteoid surface, osteoblastic surface, resorption surface, and osteoclastic surface and a lower mineralizing surface, compared with the controls. Based on the TMV classification, bone turnover was normal in 48%, high in 26%, and low in 26% of patients. Bone mineralization was delayed in 48% of the patients, and 58% of the patients with hypovitaminosis D presented with delayed bone mineralization. Bone volume was low in 37% of the patients. The osteoblasts from patients exhibited a higher degree of proliferation compared with those from controls. CONCLUSION: Eight-two percent of our patients presented with alterations in at least one of the TMV parameters. Persistence of hyperparathyroidism, hypovitaminosis D, and immunosuppressive drugs may have influenced osteoblast function, which would explain many of the bone alterations found in these patients.

Consenso sobre Ecocardiografia Transesofágica Perioperatória da Sociedade Brasileira de Anestesiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia / Consensus on Perioperative Transesophageal Echocardiography of the BrazilianSociety of Anesthesiology and the Department of Cardiovascular Image of theBrazilian Society of Cardiology

RESUMO A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transe-sofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascularda Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma forc ̧a-tarefa para normatizar afeitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocar-diografistas brasileiros com base nas evidências científicas da Sociedade dos AnestesiologistasCardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileirade Cardiologia.

ABSTRACT Through the Life Cycle of Intraoperative Transesophageal Echocardiography(ETTI/SBA) the Brazilian Society of Anesthesiology, together with the Department of Cardi-ovascular Image of the Brazilian Society of Cardiology (DIC/SBC), createded a task force tostandardize the use of intraoperative transesophageal echocardiography by Brazilian anesthesi-ologists and echocardiographers based on scientific evidence from the Society of CardiovascularAnesthesiologists/American Society of Echocardiography (SCA/ASE) and the Brazilian Society ofCardiology.

Consenso sobre Ecocardiografia transesofágica perioperatória da Sociedade Brasileira de Anestiologia e do Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia / Consensus on perioperative transesophageal echocardiography of the Brazilian Society of Anesthesiology and the Department of Cardiovascular Image of the Brazilian Society of Cardiology

A Sociedade Brasileira de Anestesiologia, pelo Núcleo Vida de Ecocardiografia Transesofágica Intraoperatória (ETTI/SBA) juntamente com o Departamento de Imagem Cardiovascular da Sociedade Brasileira de Cardiologia (DIC/SBC), fez uma força-tarefa para normatizar a feitura da ecocardiografia transesofágica intraoperatória para os anestesiologistas e ecocardiografistas brasileiros com base nas evidências científicas da Sociedade dos Anestesiologistas Cardiovasculares/Sociedade Americana de Ecocardiografia (SCA/ASE) e da Sociedade Brasileira de Cardiologia

Hypercalcemia and acute kidney injury caused by abuse of a parenteral veterinary compound containing vitamins A, D, and E.

A previously healthy 19 year-old male presented to the hospital with anorexia, nausea, and vomiting. Laboratory studies were significant for hypercalcemia (peak calcium value of 14.8 mg/dL) and acute kidney injury (peak serum creatinine of 2.88 mg/dL). He admitted to using a parenteral formulation of vitamins A, D and E restricted for veterinary use containing 20,000,000 IU of vitamin A; 5,000,000 IU of vitamin D3; and 6,800 IU of vitamin E per 100 mL vial. The patient stated to have used close to 300 mL of the product over the preceding year. Interestingly, the young man was not interested in the massive amounts of vitamins that the product contained; he was only after the local effects of the oily vehicle. The swelling produced by the injection resulted in a silicone-like effect, which gave the impression of bigger muscles. Nevertheless, the product was absorbed and caused hypervitaminosis. The serum level of 25(OH) vitamin D was clearly elevated at 150 ng/mL (reference range from 30 to 60 ng/mL), but in most published cases of vitamin D toxicity, serum levels have been well above 200 ng/mL. His PTH level was undetectable and other potential causes of hypercalcemia were excluded. Therefore, we posit that the severity of the hypercalcemia observed in this case was the result of a synergistic effect of vitamins A and D. The patient was treated with normal saline, furosemide and zolendronic acid, with rapid normalization of calcium levels and renal function.

Secondary hyperparathyroidism status in Brazil: Brazilian census of parathyroidectomy.

INTRODUCTION: Secondary hyperparathyroidism (SHP) is a common and serious complication of chronic kidney disease (CKD), with a negative impact on morbidity and mortality. Despite advances in the clinical management of SHP, treatment failure still occurs in a significant number of patients. In such cases, parathyroidectomy (PTx) is indicated. OBJECTIVE: To have an overview of the prevalence of severe SHP and of its surgical treatment in hemodialysis (HD) patients in Brazil. METHODS: This was an observational and descriptive study. Data were obtained from questionnaires posted to 660 dialysis units (DU). RESULTS: Results are expressed in absolute values and percentages, or means and standard deviation, as appropriate. 226 (34%) DU answered the questionnaire, providing data about 32,264 HD patients. The prevalence rate of severe SHP (PTH > 1,000 pg/mL) was 10.7 % (n = 3,463). 68 hospitals countrywide perform PTX. Around 40% of them are university centers. 49 (21.7%) DU reported not to have a specialized medical center to refer their patients with severe SHP. 74 (33%) DU reported that the time interval between surgery indication and its performance was over 6 months. The main recognized obstacles to surgery performance were: difficulty to perform the preoperative exams, lack of head and neck surgeons and the long waiting time. CONCLUSIONS: Although severe SHP is highly prevalent in Brazil, a significant number of patients do not have access to PTx. Better public health policies and liaison between nephrologists and head and neck surgeons are urgently required to change this reality.