Preschool Language Outcomes following Perinatal Hypoxic-Ischemic Encephalopathy in the Age of Therapeutic Hypothermia.

Early studies following perinatal hypoxic-ischemic encephalopathy (HIE) suggested expressive language deficits and academic difficulties, but there is only limited detailed study of language development in this population since the widespread adoption of therapeutic hypothermia (TH). Expressive and receptive language testing was performed as part of a larger battery with 45 children with a mean age of 26 months following perinatal HIE treated with TH. Overall cohort outcomes as well as the effects of gender, estimated household income, initial pH and base excess, and pattern of injury on neonatal brain MRI were assessed. The cohort overall demonstrated expressive language subscore, visual-reception subscore, and early learning composite scores significantly below test norms, with relative sparing of receptive language subscores. Poorer expressive language manifested as decreased vocabulary size and shorter utterances. Expressive language subscores showed a significant gender effect, and estimated socioeconomic status showed a significant effect on both receptive and expressive language subscores. Initial blood gas markers and modified Sarnat scoring did not show a significant effect on language subscores. Binarized MRI abnormality predicted a significant effect on both receptive and expressive language subscores; the presence of specific cortical/subcortical abnormalities predicted receptive language deficits. Overall, the language development profile of children following HIE in the era of hypothermia shows a relative strength in receptive language. Gender and socioeconomic status predominantly predict expressive language deficits; abnormalities detectable on MRI predominantly predict receptive language deficits.

Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study.

OBJECTIVE: To investigate whether patients' skin color could exert an influence on the dentist's decision-making for treatment, in four different cities in Brazil. MATERIAL AND METHODS: Lists of dentists were obtained and the sample selection was performed systematically. Two questionnaires were produced for the same clinical case, but the images were digitally manipulated to obtain a patient with a black and a white skin color. Dentists were free to choose treatment without any restrictions, including the financial aspects. A random sequence (white or black) was generated which was placed at random in sealed, opaque envelopes. Dentists were questioned about the decision on the treatment of a severely decayed tooth and an ill-adapted amalgam restoration. RESULTS: A total of 636 dentists agreed to participate in the study. After adjustments (multinomial logistic regression), it was observed that the black patient with a decayed tooth had a 50% lower risk of being referred for prosthetic treatment (p = 0.023) and a 99% higher risk of receiving a composite resin restoration, compared to the white patient (p = 0.027). No differences were observed regarding recommendation for tooth extraction (p = 0.657). In relation to an ill-adapted amalgam, the black patient had less risk of receiving a referral replacement with composite resin (0.09 95%CI [0.01-0.82]) and finishing and polishing (0.11 5%CI [0.01-0.99]) compared with the white patient. CONCLUSION: Patient skin color influenced the dentist's choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures. CLINICAL SIGNIFICANCE: Skin color played an important role in dentists' treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.

Gender inequalities in the dental science: An analysis of high impact publications.

OBJECTIVE: To assess the participation of women in publications of dental journals with a high impact factor. METHODS: Articles published in 2016, 2011, and 2006 in 10 dental journals chosen for their highest impact factors in each dental fields were included in this research. Articles-related variables collected included the country of origin of each author, the type of study, and gender of the researchers. Gender was examined through PubMed, Scopus, ResearchGate, and respective affiliated institutions. Furthermore, a website designed to discover the gender of names was used when the previous alternatives were not conclusive. Forward stepwise Poisson regression models were used for data analysis. RESULTS: A total of 3365 studies were included in the first authorship analysis and 3398 in analysis related to last authorship. The prevalence of women as first authors was 37.2% (confidence interval (CI) 95% 34.5-37.5) and as last authors was 22.6% (CI 95% 21.3-23.9). Having a woman as the last author increased the presence of women in the first author position in scientific dental articles by 16% (prevalence ratio = 1.16, CI 95% [1.04-1.29]). The year of publication, journal, and region of the author were associated with an increase in the prevalence of women as last authors. From 2006 to 2016, the prevalence of women as last authors increased by 61%. Despite these trends, women were still underrepresented in science in the evaluated period. CONCLUSIONS: There are meaningful gender inequalities in publications of scientific dental papers. Encouraging women to lead research groups can reduce the inequities observed in the present study.

Early neurodevelopmental outcome in preterm posthemorrhagic ventricular dilatation and hydrocephalus: Neonatal ICU Network Neurobehavioral Scale and imaging predict 3-6-month motor quotients and Capute Scales.

OBJECTIVE: Brain injury remains a serious complication of prematurity. Almost half of infants with severe intraventricular hemorrhage (IVH) develop posthemorrhagic ventricular dilatation (PHVD) and 20% need surgery for posthemorrhagic hydrocephalus (PHH). This population is associated with an increased risk of later neurodevelopmental disability, but there is uncertainty about which radiological and examination features predict later disability. In this study the authors sought to devise and describe a novel combination of neurobehavioral examination and imaging for prediction of neurodevelopmental disability among preterm infants with PHVD and PHH. METHODS: The study patients were preterm infants (< 36 weeks gestation) with IVH and PHVD, with or without PHH. Ventricular index (VI), anterior horn width (AHW), thalamooccipital distance (TOD), ventricle/brain (V/B) ratio, and resistive indices (RIs) were recorded on the head ultrasound (HUS) just prior to surgery, or the HUS capturing the worst PHVD when surgery was not indicated. The posterior fossa was assessed with MRI. Neonatal ICU Network Neurobehavioral Scale (NNNS) examinations were performed at term age equivalent for each infant. A neurodevelopmental assessment using the Capute Scales (Capute Cognitive Adaptive Test [CAT] scores and Capute Clinical Linguistic Auditory Milestone Scale [CLAMS] scores) and a motor quotient (MQ) assessment were performed between 3 and 6 months of age corrected for degree of prematurity (corrected age). MQs < 50 reflect moderate to severe delays in early motor milestone attainment, CAT scores < 85 reflect delays in early visual and problem-solving abilities, and CLAMS scores < 85 reflect delays in early language. RESULTS: Twenty-one infants underwent assessments that included imaging and NNNS examinations, Capute Scales assessments, and MQs. NNNS nonoptimal reflexes (NOR) and hypertonicity subscores and AHW were associated with MQs < 50: NOR subscore OR 2.46 (95% CI 1.15-37.6, p = 0.034), hypertonicity subscore OR 1.68 (95% CI 1.04-3.78, p = 0.037), and AHW OR 1.13 (95% CI 1.01-1.39, p = 0.041). PVHI, cystic changes, and neurosurgical intervention were associated with CAT scores < 85: PVHI OR 9.2 (95% CI 1.2-73.2, p = 0.037); cystic changes OR 12.0 (95% CI 1.0-141.3, p = 0.048), and neurosurgical intervention OR 11.2 (95% CI 1.0-120.4, p = 0.046). Every 1-SD increase in the NOR subscore was associated with an increase in odds of a CAT score < 85, OR 4.0 (95% CI 1.0-15.0, p = 0.044). Worse NNNS NOR subscores were associated with early language delay: for a 1-SD increase in NOR subscore, there was an increase in the odds of a CLAMS score < 85, OR 19.5 (95% CI 1.3-303, p = 0.034). CONCLUSIONS: In former preterm children with severe IVH and PHVD, neonatal neurological examination findings and imaging features are associated with delays at 3-6 months in motor milestones, visual and problem-solving abilities, and language.

A simplified technique for fabricating complete dentures for patients with Parkinson's disease: a case report / Técnica simplificada como alternativa para confecção de próteses totais para paciente com Doença de Parkinson: relato de caso

BACKGROUND AND OBJECTIVE: Parkinson's disease is a neurological disorder that affects 1% of individuals aged 60 years and older. The associated symptoms can impose limitations on the available dental treatment options. CASE DESCRIPTION: This case report follows the CARE guidelines and presents an adapted and simplified technique to fabricate complete dentures for a 74-year-old male edentulous patient with Parkinson's disease. This modified technique enabled the fabrication of complete dentures in 4 clinical sessions of approximately 40 minutes. The first session involved manufacturing a preliminary impression with fast-setting alginate. The base plates and occlusal rims were then adjusted for artificial teeth arrangement during the second session. The final prosthesis was completed in the third session, which involved a teeth try-in and fabrication of a functional impression with low-melting thermoplastic material and polyether. Finally, denture installation was performed in the fourth session and follow-up consisted of 3 weekly sessions. DISCUSSION: Considering that the treatment provided satisfactory aesthetics and function, mastication and socialization benefits, and improved the self-esteem and well-being of the older patient with Parkinson's disease, the authors suggest this adapted and simplified technique for fabricating complete dentures. (AU)

JUSTIFICATIVA E OBJETIVO: A doença de Parkinson é uma desordem neurológica que afeta 1% dos indivíduos com 60 anos ou mais. Os sintomas associados podem impor limitações nas opções de tratamento odontológico disponíveis. DESCRIÇÃO DO CASO: Este relato de caso segue o protocolo CARE e apresenta uma adaptação da técnica simplificada para confecção de novas próteses totais, para um paciente edêntulo, do sexo masculino, de 74 anos com doença de Parkinson. Essa técnica modificada possibilita a confecção de próteses totais em quatro sessões clínicas de aproximadamente 40 minutos. A primeira sessão envolveu uma moldagem preliminar com alginato de presa rápida. As placas articulares com rodetes de cera foram ajustadas para montagem dos dentes artificiais durante a segunda sessão. A prótese definitiva foi concluída na terceira sessão, que envolveu a prova dos dentes e moldagem funcional com material termoplástico de baixa fusão e poliéter. Por fim, a instalação da prótese foi realizada na quarta sessão e o acompanhamento consistiu em três sessões semanais. DISCUSSÃO: Considerando que o tratamento proporcionou estética e função satisfatórias, benefícios mastigatórios e de socialização, melhora da autoestima e bem-estar do idoso com doença de Parkinson, os autores sugerem o uso da adaptação da técnica simplificada para confecção de prótese total. (AU)

Vector aspects in risk areas for sylvatic yellow fever in the state of Mato Grosso do Sul, Brazil

Epizootics and yellow fever epidemics in 2008 in Brazil, Paraguay and Argentina marked a significant progression of the disease further south in the continent affecting non-vaccinated human populations. The state of Mato Grosso do Sul is located between the tropical endemic region and the subtropical epidemic region and, despite being an area recommended for vaccination since the 1980s, human and animal cases of the disease are still registered. The purpose of this study was to present the results of entomological surveys of probable sites of infection (PSI) geographically describing these areas regarding human cases and disease suspicion reported in 2008. Thirteen locations in nine municipalities were investigated. A total of 305 females of the genus Haemagogus and Sabethes and five specimens of Aedes albopictus were obtained. The genus Haemagogus was more abundant but Sabethes presented twice as many species (3 x 6) and higher distribution within the collection points. The most abundant species was Hg. janthinomys, with 102 individuals in one location. The other species found were: Hg. leucocelaenus, Hg. spegazzinii, Sa. albiprivus, Sa. belisarioi, Sa. chloropterus, Sa. glaucodaemun, Sa. intermedius and Sa. soperi. It was not possible to identify predominant species in relation to environmental and geographical characteristics of the collection points. Of the nine human cases, eight corresponded to persons not resident in the State, seven of them tourists. MS features a large diversity of rural and wildlife tourist attractions where the yellow fever vectors described in this work are present. In this sense, the monitoring of vaccination coverage and flow of non-vaccinated people through the area are crucial to controlling the disease.