Variations of oral anatomy and common oral lesions

Abstract Several topics related to the oral cavity are briefly addressed in this article, from anatomical variations that, when recognized, avoid unnecessary investigations, to diseases that affect exclusively the mouth, mucocutaneous diseases, as well as oral manifestations of systemic diseases. A complete clinical examination comprises the examination of the mouth, and this approach facilitates clinical practice, shortening the path to diagnosis in the outpatient clinic as well as with in-hospital patients. The objective of this article is to encourage the examination of the oral cavity as a useful tool in medical practice, helping to recognize diseases in this location.

Variations of oral anatomy and common oral lesions.

Several topics related to the oral cavity are briefly addressed in this article, from anatomical variations that, when recognized, avoid unnecessary investigations, to diseases that affect exclusively the mouth, mucocutaneous diseases, as well as oral manifestations of systemic diseases. A complete clinical examination comprises the examination of the mouth, and this approach facilitates clinical practice, shortening the path to diagnosis in the outpatient clinic as well as with in-hospital patients. The objective of this article is to encourage the examination of the oral cavity as a useful tool in medical practice, helping to recognize diseases in this location.

Subjective and Objective Measurements of the Facial Effects of Microdoses of Botulinum Toxin.

INTRODUCTION: Studies have suggested that botulinum toxin A may improve skin quality, and application protocols using hyper-diluted doses of botulinum toxin (microdosing) have been studied as a way to achieve therapeutic goals without fully paralyzing the targeted muscles. OBJECTIVES: To evaluate the effects of a combined protocol utilizing both the standard dosing and the microdosing of AbobotulinumtoxinA for the improvement of skin quality, measured by objective and subjective measurements. METHODS: Thirty patients were treated with botulinum toxin using both the standard technique and the microdosing technique. Objective (Sebumeter®, Mexameter® and digital dermoscopy pictures) and subjective (Global Aesthetic Improvement Scale and a clinical scale for evaluating the quality of facial skin) measurements of the effects in the treated areas were taken to assess the efficacy of the treatment. RESULTS: Digital dermoscopy showed a marked reduction of erythema and telangiectasias. Erythema and telangiectasias improved both on objective and subjective measurements. Skin oleosity, static rhytids, papules and pustules and enlarged pores improved on subjective measurements. Patient satisfaction was high (93%) despite the high rate of adverse events (56%). CONCLUSIONS: The combined application of standard doses and microdoses of AbobotulinumtoxinA is effective in improving the overall quality of facial skin. The effects on erythema and telangiectasias suggest that it is an effective treatment option for patients with erythematotelangiectatic rosacea. When applying microdoses of botulinum toxin in the lower and mid-face, the doses and pattern of injection should be customized for each patient to reduce the occurrence of adverse events.

A new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS).

BACKGROUND: The Skin Laxity Severity Scale for the buttocks was previously developed to separately assess buttock ptosis, a scalloped appearance of the skin, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. A more objective, faster and shorter version of this scale, to be evaluated visually, would be more feasible to apply in daily practice. OBJECTIVES: To present a new skin laxity scale for the buttocks: the Skin Laxity Visual Scale (SLVS). MATERIALS & METHODS: To establish the scale, investigators chose, by consensus, the most representative cases of each skin laxity grade. The images were graphically edited to better represent the degree of skin laxity identified in a previous study. Scale validity and reliability were assessed in two validation cycles, performed by eight dermatologists assessing 50 clinical cases. RESULTS: Overall, Kendall's, weighted-kappa, and intraclass correlation coefficients indicated very good reliability and consistent inter- and intra-rater agreement (p<0.001). The scale validity was confirmed by criteria validity tests (rs: 0.76, p<0.05). CONCLUSION: The SLVS for the buttocks is a reliable, reproducible, accurate and valid scale to identify skin laxity severity and its different features. It will very likely be an easy-to-use and convenient tool to appropriately assess improvement obtained with treatment and follow patients.

Buttocks' Skin Laxity Severity Scale.

BACKGROUND: Clinical scales are useful to assess skin laxity in different areas of the body. OBJECTIVE: To elaborate and validate a photonumeric scale to assess buttocks skin laxity. MATERIALS AND METHODS: The Buttocks' Skin Laxity Severity Scale (SLSS) was developed based on a sample of 120 patients. The SLSS validity and reliability were assessed in 2 validation cycles, performed by 8 dermatologists assessing 50 clinical cases. Both criteria and construct validity were tested. RESULTS: The Buttocks' SLSS is composed by 5 clinical aspects of skin laxity graded from absent (0) to severe (3): buttocks ptosis, skin scalloped appearance, infragluteal fold, localized fat on the lower third of the buttocks, and linear depressed lesions. Final skin laxity classification results from the sum of each item grade multiplied by its weight and varies from 0 to 24. Overall, Kendall, weighted kappa, and intraclass correlation coefficients indicated very good reliability and consistent interrater and intrarater agreement (p < .001). Cronbach alpha of 0.82 indicates high scale reliability. The scale validity was confirmed by criteria validity tests (rs: 0.72, p < .05). CONCLUSION: Buttocks' SLSS is a reliable and valid scale to identify skin laxity severity and its different features, and it is an accurate tool for clinical research.

Considerations on zero-degree cellulite.

Cellulite affects almost all women, and it is characterized by surface relief alterations, mainly located on the thighs and buttocks, and other areas. Whereas depressed lesions occur due to the presence of thick subcutaneous fibrous septa that pull the skin surface down, raised areas result from the projection of underlying fat to the skin surface. We support that the absence of cellulite can be defined as the ideal balance between the mechanical forces that act between the subcutaneous structures, such as fat and fibrous septa and muscles, and the overlying skin.

Consistency and reliability of the Brazilian Portuguese version of the Mini-Sleep Questionnaire in undergraduate students.

PURPOSE: Questionnaires are indispensable tools in epidemiologic studies and clinical surveys. Many questionnaires focusing on sleep disorders have been described in the literature. This cross-sectional study is aimed to assess the consistency and reliability of the Brazilian Portuguese Version of the Mini-Sleep Questionnaire (MSQ-BR). METHODS: Self-administered questionnaires were given to a sample of 1,108 undergraduate students. The variables collected were age, gender, socioeconomic level, and MSQ-BR scores. A subgroup of 53 students was randomly chosen to test the test-retest reliability of the instrument. Internal consistency of total MSQ-BR and its subscales (i.e., insomnia and hypersomnia) was evaluated using Cronbach's alpha coefficient. RESULTS: Our results showed good internal consistency of total MSQ-BR score, with a Cronbach's alpha value of 0.770. The insomnia subscale had an adequate internal consistency (Cronbach's alpha, 0.749). On the other hand, the hypersomnia subscale had moderate internal consistency (Cronbach's alpha, 0.624). The test-retest analysis showed good reliability of the instrument using Pearson's correlation coefficient. CONCLUSIONS: The MSQ-BR has adequate internal consistency and test-retest reliability. The MSQ-BR insomnia has adequate internal consistency for use as a separate application. However, the MSQ-BR hypersomnia demonstrated only moderate internal consistency for use as a separate application. Our intention was not to introduce modifications to the questionnaire, but to evaluate the reliability of total MSQ-BR and its subscales. Others studies are needed to assess the consistency of MSQ compared to other instruments.

Awareness of stroke risk factors and warning signs in southern Brazil / Avaliação de fatores de risco de doença cerebrovascular no sul do Brasil

OBJECTIVE: To evaluate the knowledge about stroke in Caxias do Sul. METHOD: A closed-ended, self-administered questionnaire was used to assess the knowledge about stroke among residents of Caxias do Sul. In order to verify variables associated to lack of knowledge we defined three main end points: (1) the inability to recognize that stroke is a disease that affects the brain; (2) insufficient knowledge of risk factors; (3) insufficient knowledge of signs and symptoms of acute stroke. RESULTS: A total of 952 subjects answered the questionnaire. Lower income and lower educational level were independent factors associated to inability to recognize that stroke affects the brain. Lower income and being under 50 years old were independent risk factors to lack of knowledge concerning stroke risk factors. Lower educational level was the unique risk factor for insufficient knowledge about stroke warning signs. CONCLUSION: There is a lack of knowledge about stroke in Caxias do Sul. People with lower socioeconomic status and lower education level should be the targets of educational campaigns.

OBJETIVO: Avaliar o conhecimento sobre doença cerebrovascular em Caxias do Sul. MÉTODO: Um questionário auto-administrado, com questões objetivas, foi utilizado para avaliar o conhecimento sobre doença cerebrovascuar em residentes de Caxias do Sul. A fim de verificar as variáveis associadas à falta de conhecimento, definiram-se três principais desfechos: (1) incapacidade de reconhechecer que o derrame é uma doença que afeta o cérebro; (2) conchecimento insuficiente sobre fatores de risco; (3) conhecimeto insuficiente sobre sinais e sintomas de acidente vascular encefálico. RESULTADOS: Um total de 952 sujeitos responderam o questionário. Menor renda e menor nível socioeconômico foram fatores independentes associados à incapacidade de reconhecer que derrame afeta o cérebro. Menor renda e ter menos que 50 anos de idade foram fatores independentes associados à conchecimento insuficiente sobre fatores de risco para doença cerebrovasculas. Menor nível educacional foi o único fator de risco independente associado à conhecimento insuficiente sobre sinais de alerta do acidente vascular encefálico. CONCLUSÃO: Há uma lacuna de conhecimento sobre doença cerebrovascular em Caxias do Sul. Pessoas com menor nível socioeconômico e menor nível educaional deveriam ser o alvo para campanhas educacionais.

O que os pacientes com acidente vascular encefálico sabem sobre sua doença? / What do the patients with stroke know about their disease?

Introdução: O acidente vascular encefálico (AVE) é uma das maiores causas de mortalidade e morbidade no Brasil e há pouco conhecimento sobre a doença entre a população, o que produz reflexos no tratamento e aumento da morbidade Objetivo: Investigar a percepção do paciente com acidente vascular encefálico (AVE) sobre sua doença. Metodologia: Foi conduzido um estudo qualitativo em pacientes em reabilitação por AVE. Foram realizadas entrevistas com roteiros semiestruturados contendo os seguintes tópicos: conhecimento dos fatores de risco e tratamento; percepção e reação no momento do início dos sintomas; e atitudes dos pacientes perante um novo quadro hipotético de AVE. Resultados: Apesar de alguns pacientes terem demonstrado conhecimento razoável sobre o que é AVE, alguns apresentaram total desconhecimento. Observou-se o desconhecimento da gravidade da doença na ocasião do AVE, resultando em demora na procura por auxílio médico. Falta de consciência sobre os fatores de risco e atitudes negativas dos familiares em relação aos sinais e sintomas também foram observadas. Conclusão: Este estudo demonstrou uma lacuna importante no conhecimento por parte dos pacientes realizando reabilitação para estas doenças, o que possivelmente contribui para a baixa adesão ao tratamento e à prevenção do AVE.

Introdução: Stroke is one of the major causes of mortality and morbidity in Brazil, but the knowledge about the disease is poor among the general population, which affects treatment adherence and increases morbidity. Aim: To investigate the perceptions of stroke patients of their disease. Methods: A qualitative study was conducted in patients recovering from stroke. Semi-structured interviews were carried out containing the following topics: knowledge of risk factors and treatment; perception and reaction at the onset of symptoms; and patient attitude toward a new hypothetical picture of stroke. Results: Although a few patients showed reasonable knowledge about what a stroke is, some showed utter lack of any knowledge. Unawareness of the severity of the disease at the onset of stroke was observed, resulting in delay to seek medical care. Lack of knowledge of risk factors and negative attitudes of family members regarding signs and symptoms were also observed. Conclusion: This study has demonstrated a significant lack of knowledge by patients in rehabilitation from stroke, which is likely to contribute to the poor adherence to treatment and prevention.

Awareness of stroke risk factors and warning signs in southern Brazil.

OBJECTIVE: To evaluate the knowledge about stroke in Caxias do Sul. METHOD: A closed-ended, self-administered questionnaire was used to assess the knowledge about stroke among residents of Caxias do Sul. In order to verify variables associated to lack of knowledge we defined three main end points: (1) the inability to recognize that stroke is a disease that affects the brain; (2) insufficient knowledge of risk factors; (3) insufficient knowledge of signs and symptoms of acute stroke. RESULTS: A total of 952 subjects answered the questionnaire. Lower income and lower educational level were independent factors associated to inability to recognize that stroke affects the brain. Lower income and being under 50 years old were independent risk factors to lack of knowledge concerning stroke risk factors. Lower educational level was the unique risk factor for insufficient knowledge about stroke warning signs. CONCLUSION: There is a lack of knowledge about stroke in Caxias do Sul. People with lower socioeconomic status and lower education level should be the targets of educational campaigns.

Awareness, attitudes and perceptions on epilepsy in Southern Brazil

OBJECTIVE: To verify awareness and attitudes toward epilepsy in Southern Brazil. METHOD: A questionnaire about familiarity with the disease, awareness and attitudes toward epileptics was applied to 832 inhabitants of Caxias do Sul. The answers were analyzed in three different groups: G1, non-university students; G2, university students up to the second year; and G3, university students with more than two years education and university graduates. RESULTS: University students and graduates are better informed regarding causes and treatment of epilepsy. Moreover, those interviewees present less negative attitudes toward epileptics. However, a large part of that group lacks some basic information on the disease. CONCLUSION: There is lack of information on epilepsy among Brazilians. Education campaigns should be carried out in order to clarify some aspects concerning epilepsy.

OBJETIVO: Verificar o conhecimento e as atitudes sobre epilepsia na população de Caxias do Sul. MÉTODO: Foi aplicado um questionário sobre familiaridade com a doença, conhecimentos e atitudes diante de um portador de epilepsia a 832 moradores da cidade. As respostas foram analisadas em três grupos distintos: G1, não-universitários; G2, universitários até o segundo ano; e G3, universitários com mais de dois anos e graduados. RESULTADOS: Os universitários e graduados possuem melhor conhecimento sobre causas e tratamento da epilepsia. Além disso, esses entrevistados apresentam menos atitudes negativas para com o portador de epilepsia. Entretanto, uma boa parte desse grupo apresenta falta de alguns conhecimentos básicos sobre a doença. CONCLUSÃO: Há falta de informação à população brasileira sobre epilepsia. Campanhas educacionais devem ser realizadas no intuito de desmistificar alguns aspectos concernentes à epilepsia.

Awareness, attitudes and perceptions on epilepsy in Southern Brazil.

OBJECTIVE: To verify awareness and attitudes toward epilepsy in Southern Brazil. METHOD: A questionnaire about familiarity with the disease, awareness and attitudes toward epileptics was applied to 832 inhabitants of Caxias do Sul. The answers were analyzed in three different groups: G1, non-university students; G2, university students up to the second year; and G3, university students with more than two years education and university graduates. RESULTS: University students and graduates are better informed regarding causes and treatment of epilepsy. Moreover, those interviewees present less negative attitudes toward epileptics. However, a large part of that group lacks some basic information on the disease. CONCLUSION: There is lack of information on epilepsy among Brazilians. Education campaigns should be carried out in order to clarify some aspects concerning epilepsy.