Causes of death in individuals with lifetime major depression: a comprehensive machine learning analysis from a community-based autopsy center.

BACKGROUND: Depression can be associated with increased mortality and morbidity, but no studies have investigated the specific causes of death based on autopsy reports. Autopsy studies can yield valuable and detailed information on pathological ailments or underreported conditions. This study aimed to compare autopsy-confirmed causes of death (CoD) between individuals diagnosed with major depressive disorder (MDD) and matched controls. We also analyzed subgroups within our MDD sample, including late-life depression and recurrent depression. We further investigated whether machine learning (ML) algorithms could distinguish MDD and each subgroup from controls based on their CoD. METHODS: We conducted a comprehensive analysis of CoD in individuals who died from nontraumatic causes. The diagnosis of lifetime MDD was ascertained based on the DSM-5 criteria using information from a structured interview with a knowledgeable informant. Eleven established ML algorithms were used to differentiate MDD individuals from controls by simultaneously analyzing different disease category groups to account for multiple tests. The McNemar test was further used to compare paired nominal data. RESULTS: The initial dataset included records of 1,102 individuals, among whom 232 (21.1%) had a lifetime diagnosis of MDD. Each MDD individual was strictly paired with a control non-psychiatric counterpart. In the MDD group, the most common CoD were circulatory (67.2%), respiratory (13.4%), digestive (6.0%), and cancer (5.6%). Despite employing a range of ML models, we could not find distinctive CoD patterns that could reliably distinguish individuals with MDD from individuals in the control group (average accuracy: 50.6%; accuracy range: 39-59%). These findings were consistent even when considering factors within the MDD group, such as late-life or recurrent MDD. When comparing groups with paired nominal tests, no differences were found for circulatory (p=0.450), respiratory (p=0.790), digestive (p=1.000), or cancer (p=0.855) CoD. CONCLUSIONS: Our analysis revealed that autopsy-confirmed CoD exhibited remarkable similarity between individuals with depression and their matched controls, underscoring the existing heterogeneity in the literature. Future research should prioritize more severe manifestations of depression and larger sample sizes, particularly in the context of CoD related to cancer.

Intensive versus less intensive blood pressure targets after mechanical thrombectomy in acute ischemic stroke: a systematic review and network meta-analysis.

Hemodynamic management, specifically blood pressure, is essential to reduce mortality and preserve functional capacity. However, the literature is uncertain about the best blood pressure target to be adopted after performing mechanical thrombectomy in patients with acute ischemic stroke. Randomized clinical trials that compared blood pressure goals after mechanical thrombectomy were searched in the following databases: MEDLINE/PubMed, Embase, Scopus, Biomedcentral, and Cochrane Library. The last search was on September 19, 2023. The results obtained were used to construct network meta-analyses. A total of 1556 participants were enrolled from 4 randomized controlled trials (OPTIMAL-BP, ENCHANTED2/MT, BP-TARGET, BEST-II). The last article was not included in the network meta-analysis because it did not have common blood pressure targets. The outcomes compared were: mRS (modified Rankin scale), eTICI/mTICI scale scores, symptomatic and any intracerebral hemorrhage, post-intervention NIHSS, and post-intervention infarct volume. The outcomes using the mRS scale showed that better outcomes were reached with less intensive blood pressure targets when comparing < 120 mmHg vs. ≤ 180 mmHg, OR: 0.71 (95% CI 0.54 - 0.94), in the outcome of mRS 0-1. And for the mRS 0-2 outcome with comparisons < 120 mmHg vs. ≤ 180 mmHg, with OR: 0.59 (95% CI 0.44 - 0.77) and < 140 mmHg vs. ≤ 180 mmHg, with OR: 0.61 (95% CI 0.41 - 0.89). In patients with large vessel occlusion treated with mechanical thrombectomy and who achieved good reperfusion, intensive blood pressure lowering is not effective and might be harmful respect to non intensive blood pressure control in recanalized patients.

The Role of Life Stages in the Sensitivity of Hediste diversicolor to Nanoplastics: A Case Study with Poly(Methyl)Methacrylate (PMMA).

The presence of plastic particles in oceans has been recognized as a major environmental concern. The decrease in particle size increases their ability to directly interact with biota, with particles in the nanometer size range (nanoplastics-NPs) displaying a higher ability to penetrate biological membranes, which increases with the decrease in particle size. This study aimed to evaluate the role of life stages in the effects of poly(methyl)methacrylate (PMMA) NPs on the polychaete Hediste diversicolor, a key species in the marine food web and nutrient cycle. Thus, behavioral (burrowing activity in clean and spiked sediment) and biochemical endpoints (neurotransmission, energy reserves, antioxidant defenses, and oxidative damage) were assessed in juvenile and adult organisms after 10 days of exposure to spiked sediment (between 0.5 and 128 mg PMMA NPs/Kg sediment). Overall, the results show that H. diversicolor is sensitive to the presence of PMMA NPs. In juveniles, exposed organisms took longer to burrow in sediment, with significant differences from the controls being observed at all tested concentrations when the test was performed with clean sediment, whereas in PMMA NP-spiked sediment, effects were only found at the concentrations 8, 32, and 128 mg PMMA NPs/Kg sediment. Adults displayed lower sensitivity, with differences to controls being found, for both sediment types, at 8, 32, and 128 mg PMMA NPs/Kg sediment. In terms of Acetylcholinesterase, used as a marker of effects on neurotransmission, juveniles and adults displayed opposite trends, with exposed juveniles displaying increased activity (suggesting apoptosis), whereas in adults, overall decreased activity was found. Energy-related parameters revealed a generally similar pattern (increase in exposed organisms) and higher sensitivity in juveniles (significant effects even at the lower concentrations). NPs also demonstrated the ability to increase antioxidant defenses (higher in juveniles), with oxidative damage only being found in terms of protein carbonylation (all tested NPs conditions) in juveniles. Overall, the data reveal the potential of PMMA NPs to affect behavior and induce toxic effects in H. diversicolor, with greater effects in juveniles.

Encapsulated Mesenchymal Stromal Cells as Cyclic Providers of Immunomodulatory Secretomes: A Living on-Demand Delivery System.

The stimulation of mesenchymal stromal cells (MSCs) with inflammatory molecules is often used to boost their therapeutic effect. Prolonged exposure to inflammatory molecules has been explored to improve their action because MSCs therapies seem to be improved transiently with such stimuli. However, the possibility of cyclically stimulating MSCs to recover their optimized therapeutic potential is still to be elucidated, although the efficacy of cell-based therapies may be dependent on the ability to readapt to the relapse pathological conditions. Here, the response of MSCs, encapsulated in alginate hydrogels and cultured for 22 d, is explored using three different regimes: single, continuous, and intermittent stimulation with IFNγ. Exposure to IFNγ leads to a decrease in the secretion of IL-10, which is cyclically countered by IFNγ weaning. Conditioned media collected at different stages of pulsatile stimulation show an immunomodulatory potential toward macrophages, which directly correlates with IL-10 concentration in media. To understand whether the correlation between cyclic stimulation of MSCs and other biological actions can be observed, the effect on endothelial cells is studied, showcasing an overall modest influence on tube formation. Overall, the results describe the response of encapsulated MSCs to unusual pulsatile simulation regimens, exploring encapsulated MSCs as a living on-demand release system of tailored secretomes with recoverable immunomodulatory action.

Erosive Effect of Analgesics on Primary Tooth Enamel - An in Vitro Study

Abstract Objective: To evaluate in vitro erosive effect of analgesics on primary tooth enamel. Material and Methods: The pH and the titratable acidity measurements of the medicines were performed in triplicate using a digital pH meter. Enamel slabs of primary teeth flat and polished were selected by initial surface microhardness analysis. Medications were selected and specimens were assigned into five groups (n=12): Dalsy; Magnopyrol; Paracetamol; Tylenol; and distilled water (negative control). Specimens were immersed in 5 ml of each group solution for 30 min, 4x/day for three days and stored in artificial saliva at 37 °C between immersions and at night. Final microhardness was determined. The data were submitted to Oneway ANOVA and Tukey's test. Scanning electron microscopy (SEM) analysis was performed in three specimens of each group. Results: Medicines showed acidic pH and mean values of titratable acidity ranged from 1.46 to 11.66 ml of 0.1N NaOH. The mineral loss of Magnopyrol was statistically significant in relation to the control group (p<0.01). Magnopyrol showed higher values when compared to Tylenol (p<0.05). SEM images displayed microstructure alterations in the Paracetamol group. Conclusion: Despite the low pH values, only Magnopyrol showed greater enamel softening. Paracetamol demonstrated morphological changes in primary tooth enamel (AU).

Parents' Emotional and Social Experiences of Caring a Child with Cleft Lip and/or Palate

ABSTRACT Objective: To evaluate the emotional and social experiences of parents or caregivers of children with cleft lip and/or palate (CL/P) in a city in the Northeastern of Brazil. Material and Methods: A quantitative and cross-sectional study was conducted among parents or caregivers of children with CL/P by interviews based on a questionnaire. Interviews were conducted during the First Smile Project in Sobral, Ceará, Brazil. All participants (n=41) agreed to participate in the interview and signed an informed consent. The data was analyzed in SPSS software version 22.0. Results: The majority of participants were female (87.2%), with a mean age of 37 years, with a low level of education and low family income. The great majority (90.2%) of the parents were not prenatally diagnosed to have CL/P babies. Of those interviewed, 56.1% mentioned that the first diagnosis of cleft lip and palate was not presented by the professionals in a clarifying way to the family. Fear (36.6%) and sadness (19.5%) were the main feelings experienced when the child was diagnosed with fissure. Feeding (48.8%) was pointed out as the main concern in caring for a child with CL/P. Conclusion: The parents and caregivers interviewed faced important emotional and social problems that must be addressed by the professional team that assists the child with CL/P.

Mental health in medical students during COVID-19 quarantine: a comprehensive analysis across year-classes

OBJECTIVES: The COVID-19 pandemic brought abrupt changes when quarantine measures were implemented. Most medical students had distance learning as their main content delivery mode, but in clerkship (fifth and sixth years), in-person activities were maintained under new protocols. These different modes may have affected student mental health. This study examines mental burden and empathy in medical students during the beginning of the COVID-19 pandemic according to the year of attendance. METHODS: All students attending first to the sixth year in the same medical school were invited to participate. The Hospital Anxiety and Depression Scale (HADS), the Self-Reporting Questionnaire (SRQ-20), the Interpersonal Reactivity Index (IRI), and the Mindful Attention Awareness Scale (MAAS) were provided. RESULTS: HADS scores for Anxiety and Depression (n=347) were 9.8±4.3 and 7.1±3.6, respectively; the SRQ-20 (n=373) score was 8.1±4.5; all scores were negatively correlated with the year of attendance. IRI (n=373) scores were: 2.6±0.5 (Empathic Concern), 2.7±0.7 (Perspective Taking), 2.5±0.9 (Fantasy), and 1.7±0.7 (Personal Distress). Fantasy was negatively correlated with the year of attendance. MAAS scores were positively correlated with the year of attendance. Worse mental health scores were found for first-year students across all scales. CONCLUSIONS: We found high levels of mental burden in medical students in the early period of the COVID-19 pandemic, especially in first-year students, who may have fewer resources to deal with stress. Moreover, as they entered college a short time before the pandemic, they were unable to experience academic life fully or create important new social support networks to deal with adversities.

Freud e a prevenção: um percurso de controvérsias / Freud and prevention: a controversial trajectory

O termo prevenção em saúde vem sendo utilizado desde a mudança no paradigma médico com certa frequência dentro e fora do campo da medicina. Entretanto, ao se debater esse conceito fora desse campo, torna-se necessário trazer algumas particularidades em questões atravessadas pelo tempo e espaço em que se dão. Este artigo problematiza a ideia de prevenção no pensamento de Freud. Assim, investigam-se, a partir de uma revisão dos seus escritos, os diversos empregos e concepções que ele faz dos termos prevenção e profilaxia. Com origem nos textos de 1896, passando por outros textos em 1910, 1913, 1926, 1934 até os artigos mais tardios de 1937, destacam-se suas principais elaborações sobre a temática, marcadas por uma flutuação de posicionamentos referentes às possibilidades e limites de uma prática psicanalítica de caráter preventivo. Para auxiliar na articulação utilizamos também escritos de outros psicanalistas sobre o tema, com o objetivo de reatualizar o debate da noção de prevenção em psicanálise.(AU)

The term health prevention has been used since the medical paradigm shift quite often within and outside the field of medicine. However, when discussing this concept outside of the field, it is necessary to bring some particularities in question with regards to the time and space in which they occur. The present paper discusses the idea of prevention in Freud's thinking. Thus, from a review of his writings, the various uses and conceptions he makes of the terms prevention and prophylaxis are investigated. Originating in the 1896 texts and going through others in 1910, 1913, 1926, 1934 until the later articles of 1937, his main elaborations on the subject are highlighted, marked by a fluctuation of positions regarding the possibilities and limits of a preventive psychoanalytic practice. To assist in the articulation we will also use writings of other psychoanalysts on the subject, with the aim of updating the debate on the notion of prevention in psychoanalys.(AU)

Parents and caregivers' knowledge and attitudes toward children's toothbrushing

Introduction: Fluoride prevents tooth decay, but especially in young children, it is important to balance the anticaries effect of fluoride toothpastes versus the risk of dental fluorosis. Objective: The aim of this study was to analyze parents' and caregivers' knowledge and attitudes toward their children's toothbrushing habits from 12 to 71 months of age, as well as to verify their knowledge about fluoride and toothpastes' dispensed amount. Methods: A semi-structured interview script was applied to a convenience sample of parents and caregivers (n = 63) at the Pediatric Dentistry Clinic of a public university. Respondents were asked to simulate the amount of toothpaste used in their children's brushing. Results were presented with absolute and relative frequencies. Results: Regarding their children's toothbrushing, 49.2% performed oral hygiene of their children; 31.7% mentioned that their children brushed under adult supervision; and 19.1% said their children brushed alone. When asked if they had already received guidance regarding the adequate amount of toothpaste to be dispensed, 54% stated they were never oriented. In 74.6% of cases, the amount dispensed exceeded the recommended dose for preschoolers. In addition, 57.1% reported that the toothpaste is within the reach of the child. Of the respondents, 66.7% pointed out the role of fluoride in caries prevention, and 73% were unaware of its toxicity. Conclusion: In general, parents had good oral hygiene practices with their children. However, most respondents did not use the appropriate amount of toothpaste for their children's age and were unaware of fluoride toxicity, although they could identify its purpose.

Introdução: O flúor pode prevenir a cárie dentária, porém, especialmente em crianças menores, é importante equilibrar o efeito anticárie dos dentifrícios fluoretados versus o risco de fluorose dentária. Objetivo: O objetivo deste estudo foi analisar o conhecimento e atitudes de pais e cuidadores sobre os hábitos de escovação de seus filhos de 12 a 71 meses de idade, bem como verificar seu conhecimento sobre flúor e quantidade utilizada de creme dental. Métodos: Um roteiro de entrevista semi-estruturado foi aplicado a uma amostra de conveniência de pais e cuidadores (n=63) na Clínica de Odontopediatria de uma universidade pública. Solicitou-se que os entrevistados simulassem a quantidade de creme dental utilizada na escovação de seus filhos. Os resultados foram apresentados de forma descritiva com frequências absolutas e relativas. Resultados: Quanto à supervisão da escovação, 49,2% realizavam a higienização de seus filhos; 31,7% mencionaram que as próprias crianças escovavam sob supervisão de um adulto, e 19,1% responderam que seus filhos escovavam sozinhos. Quando perguntados como aprenderam a dispensar dentifrício na escova, 54% afirmaram que nunca foram orientados. Em 74,6% dos casos, a quantidade dispensada superou a dose recomendada para pré-escolares. Ademais, 57,1% relataram que o dentifrício fica ao alcance da criança. Dos entrevistados, 66,7% apontaram o papel do flúor na prevenção da cárie e 73% desconheciam sua toxicidade. Conclusão: Em geral, os entrevistados praticavam bons hábitos de escovação em seus filhos. Entretanto, a maioria da amostra estudada não utilizou a quantidade apropriada de dentifrício para a idade e desconhecia a toxicidade do flúor, apesar de identificar sua finalidade.

Extraction and purification of RNA from human carious dentine: an approach to enable bacterial gene expression studies / Extração e purificação de RNA proveniente de dentina humana cariada: uma abordagem para viabilizar estudos de expressão gênica

Background: RNA isolation from bacteria within dentine caries lesions could be difficult due to reduced amount of collectable biomass and high mRNA instability. Attempting to overcome this challenge we describe one protocol developed to extract and purify total RNA from dentine lesions. Objective: customize a bacterial RNA extraction and purification method from human carious dentine. Methods: quantity and purity of extracted RNA were measured with a microvolume UV-VIS spectrophotometer, RNA integrity was assessed by standard denaturing agarose gel electrophoresis and images were captured under ultraviolet light with camera and analyzed. DNase treatment removed genomic DNA and an additional step of purification was carried out in silica spin column. Results: final yield (ng/µl) was 67.01 ± 22.33, absorbance ratio A260/A280 = 2.0 ± 0.07 and RNA integrity were obtained. The purified samples were reversely transcribed and the expression of atpD and fabM gene from Streptococcus mutans analyzed by quantitative real-time PCR. Conclusion: the extraction methodology developed produced high-quality RNA from dentine microbiota for transcriptional analysis.

Introdução: o isolamento de RNA de bactérias dentro de lesões de dentina cariada pode ser difícil devido à quantidade reduzida de biomassa e alta instabilidade de mRNA. Na tentativa de superar esse desafio, descrevemos um protocolo desenvolvido para extrair e purificar o RNA total das lesões dentinárias. Objetivo: personalizar um método de extração e purificação de RNA bacteriano a partir da dentina cariada humana. Métodos: a quantidade e a pureza do RNA extraído foram medidas com um espectrofotômetro UV-VIS de microvolume, a integridade do RNA foi avaliada por eletroforese em gel de agarose desnaturante padrão e as imagens foram capturadas sob luz ultravioleta e analisadas. O tratamento com DNase removeu o DNA genômico e uma etapa adicional de purificação foi realizada em coluna de spin de sílica. Resultados: o rendimento final (ng / µl) foi de 67,01 ± 22,33, a razão de absorbância A260 / A280 = 2,0 ± 0,07 e a integridade do RNA foram obtidas. As amostras purificadas foram transcritas reversamente e a expressão do gene atpD e fabM de Streptococcus mutans analisadas por PCR quantitativo em tempo real (RT-qPCR). Conclusão: a metodologia de extração desenvolvida produziu RNA de alta qualidade da microbiota dentinária para análises transcricionais.

Risco, detecção e prevenção: sobre a contribuição da psicanálise no trabalho institucional com crianças desnutridas / Risk, detection and prevention: on the contribution of psychoanalysis in institutional work with malnourished children / Riesgo, detección y prevención: sobre la contribución del psicoanálisis para el trabajo institucional con niños desnutridos

O presente trabalho testemunha a experiência clínico-institucional no setor de intervenção psicanalítica do Instituto da Primeira Infância, situado na cidade de Fortaleza - Ceará, cujo ofício se dirige a famílias em condições de vulnerabilidade social e, em particular, a crianças que apresentam estado de desnutrição. Partindo de uma contextualização crítica das noções de vulnerabilidade e risco, o artigo tem como objetivo apresentar um dispositivo institucional voltado para a detecção e prevenção de risco psíquico, orientado pelas contribuições advindas da teoria psicanalítica sobre a constituição psíquica e, mais recentemente, da clínica com bebês. Destaca-se um caso clínico acompanhado pelo setor.

The present study testifies to the clinical-institutional experience in the psychoanalytic intervention sector of the Institute of Early Childhood, located in the city of Fortaleza - Ceará, whose office is addressed to families in conditions of social vulnerability and, in particular, malnutrition. Starting from a critical context of vulnerability and risk notions, this article aims to present an institutional device focused on the detection and prevention of psychological risk, guided by contributions from the psychoanalytic theory of the psychic constitution and, more recently, the clinic with babies. We highlight one clinical case followed by the sector.

El presente trabajo és un testigo de la experiencia clínico-institucional en el sector de intervención psicoanalítica del Instituto de la Primera Infancia, ubicado en la ciudad de Fortaleza - Ceará, que recibe familias en condiciones de vulnerabilidad social y, en particular, niños afectados por la desnutrición. Desde una contextualización crítica de las nociones de vulnerabilidad y riesgo, el artículo tiene como objetivo presentar un dispositivo institucional orientado hacia la detección y prevención de los posibles riesgos psíquicos, aportado por las contribuciones originadas en la teoría psicoanalítica acerca de la constitución psíquica y, más recientemente, de la clínica con bebés. Presentase un caso clínico acompañado por el sector.

Angústia e vergonha na clínica psicanalítica em situações de pobreza e outras vulnerabilidades / Anguish and shame in the psychoanalytic clinic in poverty situations and other vulnerabilities / Angustia y vergüenza en la clínica psicoanalítica en situaciones de pobreza y otras vulnerabilidades

Este trabalho se propõe lançar questões sob as condições de possibilidade de um trabalho analítico em contextos de privações diversas, caracterizados como contextos de vulnerabilidade, mediante dois operadores teóricos - a angústia e a vergonha. Diante das experiências de pesquisas anteriores com enfoque na constituição psíquica e no trabalho clínico-institucional com crianças desnutridas, deu-se a necessidade de desenvolver alguns apontamentos teóricos que nos ajudam a operar nesse trabalho. A realidade das famílias atendidas pela ONG Instituto da Primeira Infância - IPREDE, em Fortaleza-CE, é permeada pela convivência com a violência e com as dificuldades em relação às condições de vida que têm e o que podem oferecer aos filhos. Aliamos a nossa discussão analítica as contribuições que podem ser feitas por outros campos de saber, como a sociologia e a economia, buscando cada vez mais respeitar a complexidade dos fenômenos sociais e dos rearranjos que os sujeitos fazem para neles se encaixarem. Através da leitura freudiana da angústia, das novas proposições sobre uma metapsicologia da vergonha e da teoria do trauma de Ferenczi, buscamos entender o que pode a psicanálise nesses contextos ditos vulneráveis. Essa é uma questão sempre complexa, mas percebemos que clínica não é sinônimo apenas de consultório, mas também de espaços de expressão do sujeito do inconsciente, independentemente do lugar físico e da situação social na qual o sujeito se encontra.

This paper proposes to launch questions under the conditions of possibility of an analytical work in contexts of various deprivations, characterized as contexts of vulnerability, through two theoretical operators - anguish and shame. Given the experiences of previous research with a focus on the psychic constitution and the clinical-institutional work with undernourished children, it was necessary to develop some theoretical notes that help us to operate in this work. The reality of the families assisted by the NGO Institute of Early Childhood - IPREDE, in Fortaleza-CE, is permeated by the coexistence with violence and the difficulties in relation to the conditions of life that they have and what they can offer their children. We attach our analytical discussion to the contributions that can be made by other fields of knowledge, such as sociology and economics, seeking to increasingly respect the complexity of the social phenomena and the rearrangements that the subjects make to fit them. Through the Freudian reading of anguish, new propositions about a metapsychology of shame and the theory of trauma of Ferenczi, we seek to understand what can psychoanalysis in these so-called vulnerable contexts. This is an always complex question, but we realize that clinical is not synonymous only with the office, but also with spaces of expression of the subject of the unconscious, regardless of the physical place and social situation to which the subject is.

Este trabajo se propone lanzar cuestiones bajo las condiciones de posibilidad de un trabajo analítico en contextos de privaciones diversas, caracterizados como contextos de vulnerabilidad, mediante dos operadores teóricos - la angustia y la vergüenza. Ante las experiencias de investigaciones anteriores con enfoque en la constitución psíquica y en el trabajo clínico-institucional con niños desnutridos, se dio la necesidad de desarrollar algunos apuntes teóricos que nos ayudan a operar en ese trabajo. La realidad de las familias atendidas por la ONG Instituto de la Primera Infancia - IPREDE, en Fortaleza-CE, está impregnada por la convivencia con la violencia y con las dificultades en relación a las condiciones de vida que tiene y lo que pueden ofrecer a los hijos. Al igual que nuestra discusión analítica las contribuciones que pueden ser hechas por otros campos de saber, como la sociología y la economía, buscando cada vez más respetar la complejidad de los fenómenos sociales y de los reajustes que los sujetos hacen para encajar en ellos. A través de la lectura freudiana de la angustia, de las nuevas proposiciones sobre una metapsicología de la vergüenza y de la teoría del trauma de Ferenczi, buscamos entender lo que puede el psicoanálisis en esos contextos llamados vulnerables. Esta es una cuestión siempre compleja, pero percibimos que clínica no es sinónimo sólo de consultorio, pero también de espacios de expresión del sujeto del inconsciente, independientemente del lugar físico y de la situación social a la que el sujeto se encuentra.

Bruxismo infantil e sua associação com fatores psicológicos ­ revisão sistemática da literatura / Bruxism in children and its association with psychological factors - a systematic review of literature

O bruxismo compreende uma atividade parafuncional caracterizado pelo ato de ranger ou apertar os dentes de forma voluntária e/ou involuntariamente, ocorrendo durante o período diurno e/ou noturno, podendo acarretar vários prejuízos ao sistema estomatognático. Diversos são os fatores etiológicos que podem estar associados a esta desordem, como fatores locais, sistêmicos, hereditários, psicossociais e comportamentais. Pesquisadores têm sugerido que fatores comportamentais, como estresse, ansiedade e traços de personalidade se sobressaem a fatores locais. Portanto, o objetivo deste estudo foi realizar uma revisão sistemática da literatura a fim de avaliar se há relação entre bruxismo e fatores psicológicos em crianças. Foram realizados levantamentos nas bases de dados: PubMed, BVS Biblioteca Virtual em Saúde e SciELO no período de fevereiro de 2007 a setembro de 2017. Os descritores utilizados foram "bruxism", "children", "stress", "anxiety", "pshychological factors". Sendo assim, 97 publicações foram identificadas na busca inicial. Após aplicação dos critérios de inclusão e exclusão, a amostra final foi composta por sete estudos. Houve evidência significativa de uma associação entre estresse, ansiedade e fatores psicológicos com o bruxismo infantil. Porém, ainda existe uma enorme necessidade de estudos bem delineados e com metodologias padronizadas a fim de verificar a associação entre o bruxismo e fatores psicológicos.

Bruxism comprises a parafunctional activity characterized by the act of grinding or clenching the teeth voluntarily and/or involuntarily, occurring during the day and / or night, and may cause several damages to the stomatognathic system. Several etiological factors may be associated with this disorder, such as local, systemic, hereditary, psychosocial and behavioral factors. Researchers have suggested that behavioral factors such as stress, anxiety, and personality traits stand out from local factors. Therefore, the aim of this study was to perform a systematic review of the literature in order to evaluate if there is a relation between bruxism and psychological factors in children. Data were collected in the databases: PubMed, BVS Virtual Health Library and SciELO from February 2007 to September 2017. The descriptors used were "bruxism", "children", "stress", "anxiety" and "pshychological factors". Thus, 97 publications were identified in the initial search. After applying the inclusion and exclusion criteria, the final sample consisted of seven studies. There was significant evidence of an association between stress, anxiety, and psychological factors with infant bruxism. However, there is still a great need for well-designed studies with standardized methodologies in order to verify the association between bruxism and psychological factors.

Sustained relief of obstructive symptoms for the remaining life of patients following placement of an expandable metal stent for malignant colorectal obstruction / Mejoría mantenida durante el resto de la vida de los síntomas obstructivos en pacientes con obstrucciones malignas colorrectales trás la colocación de prótesis metálicas expandibles

Background: self-expanding metal stents are currently being used as a definitive palliative treatment for malignant colorectal obstruction in patients with incurable disease. Few studies have followed large numbers of patients from stent placement until death, and those few have reported conflicting results in the long-term clinical outcome data. Aims: this study evaluated the clinical effectiveness of stent placement for malignant colorectal obstruction throughout the patients’ lives and related factors affecting stent patency, clinical success and complications. Methods: this was a multicentre, retrospective study of 89 consecutive patients who had undergone attempted expandable stent placement for symptomatic malignant colorectal obstruction during a 10-year period. Data were collected to analyse the sustained relief of obstructive symptoms throughout the patients’ lives, as well as the technical success, immediate clinical success, stent patency, complications, reinterventions, survival, prognostic factors associated with stent patency and long-term clinical efficacy and risk factors for complications. Results: technical and immediate clinical success were achieved in 95.5% and 91.0% of patients, respectively. A total of 68 out of 89 patients (76.4%) maintained relief of obstruction from stent implantation until death without reintervention. Twenty patients (22.5%) had complications including perforation (n = 4; 4.5%), stent obstruction (n = 8; 9.0%), migration (n = 5; 5.6%) and haemorrhage (n = 3; 3.4%). Stent-related mortality was seen in 1 patient (1.1%). The estimated median survival and estimated mean stent patency were 87.0 and 322.7 days, respectively. In total, 12 of the initial 89 patients (13.5%) needed a colostomy for long-term relief of the obstructive symptoms. Univariate and multivariate analysis detected no significant prognostic factors associated with stent patency, longterm clinical efficacy and risk factors for complications; however, the multivariate logistic model revealed a non-significant trend by which the use of chemotherapy was a risk factor for migration (OR = 11.89; p = 0.06). Conclusions: for palliation of incurable malignant colorectal obstruction, expandable stents can provide sustained relief of obstruction in approximately 75% of patients. The procedure is associated with acceptable morbidity, need for reintervention and minimal mortality(AU)

Surface degradation of composite resins by acidic medicines and ph-cycling

This study evaluated the effects of acidic medicines (Dimetapp® and Claritin®), under pH-cycling conditions, on the surface degradation of four composite resins (microhybrid: TPH, Concept, Opallis and Nanofilled: Supreme). Thirty disc-shaped specimens (Ø = 5.0 mm / thickness = 2.0 mm) of each composite were randomly assigned to 3 groups (n = 10): a control and two experimental groups, according to the acidic medicines evaluated. The specimens were finished and polished with aluminum oxide discs, and the surface roughness was measured by using a profilometer. After the specimens were submitted to a pH-cycling regimen and immersion in acidic medicines for 12 days, the surface roughness was measured again. Two specimens for each material and group were analyzed by scanning electron microscopy (SEM) before and after pH-cycling. Data were analyzed by the Student's-t test, ANOVA, Duncan's multiple range test and paired t-test (α=0.05). Significant increase in roughness was found only for TPH in the control group and TPH and Supreme immersed in Claritin® (p<0.05). SEM analyses showed that the 4 composite resins underwent erosion and surface degradation after being subjected to the experimental conditions. In conclusion, although the roughness was slightly affected, the pH-cycling and acidic medicines caused surface degradation of the composite resins evaluated. Titratable acidity seemed to play a more crucial role on surface degradation of composite resins than pH.

Percepções e atitudes de responsáveis por crianças frente ao uso de medicamentos infantis e sua relação com cárie e erosão dentária / Perceptions and attitudes among parents and guardians on the use of pediatric medicines and their cariogenic and erosive potential

Este estudo avaliou as percepções e atitudes de responsáveis por crianças sobre os potenciais cariogênico e erosivo de medicamentos infantis. Foram realizadas entrevistas sobre a associação do uso de medicamentos infantis com cárie e erosão dentária, bem como os cuidados com a higiene bucal após sua ingestão. Do total de responsáveis com entrevista completa (n=86), 24 (27,9 por cento) consideraram os medicamentos infantis ácidos, 51 (59,3 por cento) amargos e 56 (65,1 por cento) doces; porém, apenas 16 (28,6 por cento) destes últimos realizavam higiene bucal das crianças após utilização (Exato de Fisher; p>0,05). Além disso, apenas 18 (20,9 por cento) responsáveis realizavam esta prática, dos quais 8 (44,4 por cento) haviam recebido orientação prévia sobre higiene bucal (Exato de Fisher; p<0,05). A associação entre uso de medicamentos e cárie dental ou defeitos na estrutura dos dentes foi apontada por 61 (70,9 por cento) entrevistados, dos quais 24 (39,3 por cento) justificaram tal associação em função da presença de açúcar nas formulações. Apesar dos responsáveis considerarem os medicamentos doces e relacionarem seu uso à presença de cárie e defeitos na estrutura dental, grande parte destes não realiza higiene bucal em seus filhos após o uso desses fármacos e não consegue estabelecer claramente a relação de causa e efeito existente em tal associação.

The study assesses the perceptions of parents/guardians on the use of pediatric medicines and their cariogenic/erosive potential, interviewing them on the relationship between the use of pediatric medicines and cavities/dental erosion, as well as oral hygiene procedures after the medication. Among the interviewed parents/guardians (n=86), 24 (27.9 percent) mentioned the sour taste of pediatric medication, 51 (59.3 percent) the bitter taste, and 56 (65.1 percent) considered them sweet, although only 16 (28.6 percent) of these parents/guardians brushed their children's teeth after the medication (Fisher's Exact; p>0.05). Moreover, only 18 (20.9 percent) of the parents/guardians performed oral hygiene practices after the medication, of whom 8 (44.4 percent) received previous instructions (Fisher's Exact; p<0.05). The association between taking medications and dental caries or structural dental defects was mentioned by 61 (70.9 percent) of the parents/guardians, with 24 (39.3 percent) of them justifying this association through the presence of sugar in the formulations. Although parents/guardians consider medicines to be sweet substances and relate their use to dental caries and tooth structure flaws, most of them do not brush their children's teeth after taking medications and are unable to establish a clear cause/effect relationship for this association.

Avaliação psicométrica dos questionários de qualidade de vida: EORTC QL Q-C30 e FACT-B, em pacientes com câncer

A avaliação da Qualidade de Vida em pacientes oncológicos, tem sido uma grande aliada nos tratamentos de câncer, pois pode oferecer subsídios para orientar condutas e possibilitar um tratamento mais humano e digno a estes pacientes. Para este estudo foram escolhidos instrumentos que contemplassem os aspectos multidimensionais da Qualidade de Vida, tendo por objetivo, aplicar uma versão traduzida dos questionários da European Organization for Research and Treatment of Cancer (EORTC QLQ C-30) e o questionário, Functional Assessment of Cancer Therapy -Breast (FACT-B) em pacientes com câncer gástrico e de mama, respectivamente, fazendo uma análise psicométrica dos mesmos para verificar sua utilidade como instrumentos de avaliação de Qualidade de Vida em pacientes oncológicos. A técnica para a estimativa de precisão e consistência interna escolhida para os questionários foi o coeficiente alfa de Cronbach. Através da aplicação deste foram obtidos os seguintes resultados: para o questionário EORTC QLQ-C30 o coeficiente alfa foi de alfa=081, que é considerado um ótimo coeficiente, indicando uma ótima congruência dos itens avaliados mostrando também que de uma forma geral este questionário consegue medir o construto qualidade de vida em pacientes oncológicos; para o questionário FACT -B, o coeficiente alfa foi de alfa=0,90 considerado um excelente coeficiente, mostra que este questionário possui uma excelente consistência interna, sendo um instrumento confiável para se mensurar a qualidade de vida de pacientes com câncer de mama (AU)