EVALUATION OF MANAGEMENT OF PATIENTS WITH OSTEOPOROTIC FRACTURES BY ORTHOPEDIC RESIDENTS: A CROSS-SECTIONAL OBSERVATIONAL STUDY.

Objective: To assess whether residents (R1, R2, or R3 - according to the year of residency) of a tertiary orthopedic service investigate, treat and/or refer the patient with osteoporotic fracture for osteoporosis (OP) treatment and whether this learning is improved over the years of residency. Methods: Residents answered diagnostic and therapeutic questions related to a clinical case of osteoporotic fracture (OF) in 4 settings, which were initial care in the emergency room, at discharge, during outpatient follow-up at 3 and 6 months. Responses were compared between years of residency. Results: Twenty R1, 21 R2, and 19 R3 raised the questions. One resident treated osteoporosis in R1, two in R2, and four in R3. Seventy-five percent of R1, 90.5% of R2, and 68% of R3 referred patients for OP treatment. Over the years, there has been improved prescribing lab tests for osteoporosis (p = 0.028), with 52.6% of third-year residents prescribing adequate lab tests. In the same period, 100% of R3 correctly prescribed prophylaxis for deep vein thrombosis (p = 0.001). Conclusion: There is learning, but not enough, for secondary prevention of FO. Level of Evidence I; Prospective Comparative Study.

Objetivo: Avaliar se residentes (R1, R2 ou R3 - de acordo com o ano de residência) de um serviço ortopédico terciário, investigam, tratam e/ou encaminham o paciente com fratura osteoporótica para tratamento de osteoporose (OP) e se esse aprendizado é melhorado ao longo dos anos de residência. Métodos: Os residentes responderam a questões diagnósticas e terapêuticas relacionadas a um caso clínico de fratura osteoporótica (OF) em 4 cenários, que foram o atendimento inicial no pronto-socorro, no momento da alta hospitalar, durante o acompanhamento ambulatorial em 3 e 6 meses. As respostas foram comparadas entre os anos de residência. Resultado: Vinte R1, 21 R2 e 19 R3 levantaram as questões. Um residente tratou osteoporose em R1, dois em R2 e quatro em R3. Setenta e cinco por cento de R1, 90,5% de R2 e 68% de R3 encaminharam pacientes para tratamento com OP. Há melhora na prescrição de exames laboratoriais para investigação de osteoporose ao longo dos anos (p = 0,028) com 52,6% dos residentes do terceiro ano que prescrevem exames laboratoriais adequados. No mesmo período, 100% de R3 prescreveram corretamente a profilaxia para trombose venosa profunda (p = 0,001). Conclusão: Há aprendizado, porém insuficiente, para a prevenção secundária da FO. Nível de Evidência I; Estudo Prospectivo Comparativo.

Evaluation of management of patients with osteoporotic fractures by orthopedic residents: a cross-sectional observational study / Avaliação do manejo de pacientes com fraturas osteoporóticas por residentes de ortopedia: um estudo transversal observacional

ABSTRACT Objective: To assess whether residents (R1, R2, or R3 - according to the year of residency) of a tertiary orthopedic service investigate, treat and/or refer the patient with osteoporotic fracture for osteoporosis (OP) treatment and whether this learning is improved over the years of residency. Methods: Residents answered diagnostic and therapeutic questions related to a clinical case of osteoporotic fracture (OF) in 4 settings, which were initial care in the emergency room, at discharge, during outpatient follow-up at 3 and 6 months. Responses were compared between years of residency. Results: Twenty R1, 21 R2, and 19 R3 raised the questions. One resident treated osteoporosis in R1, two in R2, and four in R3. Seventy-five percent of R1, 90.5% of R2, and 68% of R3 referred patients for OP treatment. Over the years, there has been improved prescribing lab tests for osteoporosis (p = 0.028), with 52.6% of third-year residents prescribing adequate lab tests. In the same period, 100% of R3 correctly prescribed prophylaxis for deep vein thrombosis (p = 0.001). Conclusion: There is learning, but not enough, for secondary prevention of FO. Level of Evidence I; Prospective Comparative Study.

RESUMO Objetivo: Avaliar se residentes (R1, R2 ou R3 - de acordo com o ano de residência) de um serviço ortopédico terciário, investigam, tratam e/ou encaminham o paciente com fratura osteoporótica para tratamento de osteoporose (OP) e se esse aprendizado é melhorado ao longo dos anos de residência. Métodos: Os residentes responderam a questões diagnósticas e terapêuticas relacionadas a um caso clínico de fratura osteoporótica (OF) em 4 cenários, que foram o atendimento inicial no pronto-socorro, no momento da alta hospitalar, durante o acompanhamento ambulatorial em 3 e 6 meses. As respostas foram comparadas entre os anos de residência. Resultado: Vinte R1, 21 R2 e 19 R3 levantaram as questões. Um residente tratou osteoporose em R1, dois em R2 e quatro em R3. Setenta e cinco por cento de R1, 90,5% de R2 e 68% de R3 encaminharam pacientes para tratamento com OP. Há melhora na prescrição de exames laboratoriais para investigação de osteoporose ao longo dos anos (p = 0,028) com 52,6% dos residentes do terceiro ano que prescrevem exames laboratoriais adequados. No mesmo período, 100% de R3 prescreveram corretamente a profilaxia para trombose venosa profunda (p = 0,001). Conclusão: Há aprendizado, porém insuficiente, para a prevenção secundária da FO. Nível de Evidência I; Estudo Prospectivo Comparativo.

Obstructive sleep apnea, sleep duration and chronic kidney disease in patients with coronary artery disease.

BACKGROUND: Limited evidence is available addressing the potential role of sleep disorders on renal function. Here, we aimed to explore the associations of obstructive sleep apnea (OSA) and sleep duration (SD) with renal function in subjects with high cardiovascular risk. METHODS: Consecutive subjects with coronary artery disease (CAD) underwent clinical evaluation, sleep study to define OSA and one-week wrist actigraphy to objectively measure SD. OSA was defined by an apnea-hypopnea index (AHI) of ≥15 events/hour. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI equation. We analyzed the associations of OSA and SD with continuous eGFR values and according to the presence of CKD (eGFR<60 mL/min/1.73 m2) after adjusting for multiple confounding factors. RESULTS: We studied 242 subjects (62.8% men). The frequency of OSA was 55.4% and the median SD was 412.8 (363.4-457.25) min. There was no difference in the eGFRs between participants with and without OSA (69.3 ± 19.1 vs. 74.6 ± 19.3 mL/min/1.73 m2, p = 0.72) and the rate of eGFR <60 mL/min/1.73 m2 (34.3% vs. 25.9%; p = 0.21). Similarly, we did not find differences in patients in eGFR for those with SD ≥ 6 h versus SD < 6 h (72.5 ± 20.3 vs. 71.4 ± 19.1 mL/min/1.73 m2, p = 0.72). In the linear regression analysis, AHI was independently associated with an eGFR<60 mL/min/1.73 m2 in the unadjusted model [-0.15 (-0.27 to -0.04)], (P = 0.01), but not in the adjusted models. Analyses of continuous SD or the stratification in SD ≥ 6 h or <6 h also revealed neutral results on eGFR. CONCLUSION: OSA severity and SD were not independently associated with CKD in subjects with CAD.

Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence.

OBJECTIVES: To investigate the relationship between coronavirus disease 2019 (COVID-19) and obesity in critically ill patients admitted to the intensive care unit (ICU). METHODS: We systematically searched PubMed, SCOPUS, Embase, LILACS, and Web of Science for studies published up to April 27, 2020. The outcome of interest was composite poor outcome, comprising mortality and severe COVID-19. We used a standardized data extraction form to collect information from published reports of eligible studies. Heterogeneity and publication bias were assessed using I2 statistic and funnel plots, respectively. RESULTS: Nine studies including 6577 patients were selected for evaluation. The COVID-19 patients were 59.80% male and had comorbidities such as hypertension (51.51%), diabetes (30.3%), cardiovascular disease (16.66%), lung disease (15.99%), renal disease (7.49%), cancer (5.07%), and immunosuppression (1.8%). For patients with severe complications, the overall pooled event rates were 56.2% (random; 95% CI: 35.3-75.1; p = 0.015; I2 = 71.461) for obesity, 23.6% (random; 95% CI: 17.9-30.5; p = 0.000; I2 = 87.705) for type 2 diabetes, 45.9% (random; 95% CI: 38.0-53.9; p = 0.000; I2 = 90.152) for hypertension, 20.0% (random; 95% CI: 7.9-42.0; p = 0.000; I2 = 94.577) for smoking, 21.6% (random; 95% CI: 14.1-31.4%; p = 0.000, I2 = 92.983) for lung diseases, and 20.6% (random; 95% CI: 15.2-27.5; p = 0.000, I2 = 85.735) for cardiovascular diseases. DISCUSSION: This systematic review indicated the relationship between obesity, ICU admission, severe COVID-19, and disease progression in patients with COVID-19. Obese patients with hypertension, type 2 diabetes, smoking habit, lung disease, and/or cardiovascular disease should be cared for with increased attention.

ALVEOLAR BONE PATTERN AND SALIVARY LEPTIN LEVELS AMONG PREMENOPAUSAL OBESE WOMEN.

BACKGROUND: Systemic bone loss may lead to more severe periodontal destruction, decreasing local bone mineral density. AIM: A cross-sectional designed was performed to study associations among alveolar bone pattern, salivary leptin concentrations, and clinical periodontal status in premenopausal obese and eutrophic women. METHODS: Thirty morbid obese (G1) and 30 normal-weight (G2) women were included. Anthropometric and periodontal measurements (probing depth - PD, clinical attachment levels - CAL, presence of calculus, bleeding on probing -BOP, and plaque accumulation) were assessed. OHIP-14 was used for assessment of oral health impact on quality of life. Panoramic radiography was used to obtain the panoramic mandibular index (PMI), mandibular cortical index (MCI), and mental index (MI). Intraoral periapical (PA) radiography was taken to measure the total trabecular bone volume. Leptin was measured in saliva of fasted overnight women. RESULTS: Groups 1 and 2 differed in all anthropometric aspects, but height. Pocket depth, calculus, BOP, and plaque index were worse in G1. No differences between groups were found considering OHIP. Normal-weight subjects showed higher proportion of dense bone trabeculae than obese subjects for pre-molars, but not for molars. Mental and panoramic mandibular indexes did not differ and were in normal level. Leptin concentration was dependent only on BMI. CONCLUSION: Obesity affected the periodontal conditions, the alveolar bone pattern, and the salivary leptin concentration.

Alveolar bone pattern and salivary leptin levels among premenopausal obese women / Padrão ósseo alveolar e níveis salivares de leptina entre mulheres obesas na pré-menopausa

ABSTRACT Background: Systemic bone loss may lead to more severe periodontal destruction, decreasing local bone mineral density. Aim: A cross-sectional designed was performed to study associations among alveolar bone pattern, salivary leptin concentrations, and clinical periodontal status in premenopausal obese and eutrophic women. Methods: Thirty morbid obese (G1) and 30 normal-weight (G2) women were included. Anthropometric and periodontal measurements (probing depth - PD, clinical attachment levels - CAL, presence of calculus, bleeding on probing -BOP, and plaque accumulation) were assessed. OHIP-14 was used for assessment of oral health impact on quality of life. Panoramic radiography was used to obtain the panoramic mandibular index (PMI), mandibular cortical index (MCI), and mental index (MI). Intraoral periapical (PA) radiography was taken to measure the total trabecular bone volume. Leptin was measured in saliva of fasted overnight women. Results: Groups 1 and 2 differed in all anthropometric aspects, but height. Pocket depth, calculus, BOP, and plaque index were worse in G1. No differences between groups were found considering OHIP. Normal-weight subjects showed higher proportion of dense bone trabeculae than obese subjects for pre-molars, but not for molars. Mental and panoramic mandibular indexes did not differ and were in normal level. Leptin concentration was dependent only on BMI. Conclusion: Obesity affected the periodontal conditions, the alveolar bone pattern, and the salivary leptin concentration.

RESUMO Racional: A perda óssea sistêmica pode levar à destruição periodontal mais severa, diminuindo a densidade mineral óssea local. Objetivo: Investigar as associações entre padrão ósseo alveolar, concentrações de leptina salivar e estado periodontal em mulheres obesas na pré-menopausa e eutróficas. Métodos: Foram avaliadas 30 mulheres com obesidade mórbida (G1) e 30 com peso normal (G2). Foram analisadas as medidas antropométricas e periodontais (profundidade de sondagem - PS, nível clínico de inserção - NCI, presença de cálculo, sangramento à sondagem - SS e acúmulo de placa). O impacto da saúde bucal na qualidade de vida foi mensurado por meio do questionário OHIP-14. Radiografia panorâmica foi utilizada para obter o índice mandibular panorâmico (PMI), índice cortical mandibular (MCI) e índice mental (MI); já a radiografia periapical intraoral (AF) para medir o volume ósseo trabecular total. A leptina salivar foi coletada no período da manhã com a paciente em jejum. Resultados: Os grupos 1 e 2 diferiram em todos os aspectos antropométricos, exceto em estatura. Profundidade de bolsa, cálculo, SS e índice de placa foram piores no G1. Não foram encontradas diferenças entre os grupos considerando o OHIP. Indivíduos com peso normal apresentaram maior proporção de trabéculas ósseas densas do que os obesos para pré-molares, mas não para molares. Índices radiomorfométricos não diferiram entre os grupos e estavam dentro de valores normais. A concentração de leptina esteve associada ao IMC. Conclusão: A obesidade afetou as condições periodontais, o padrão ósseo alveolar e a concentração de leptina salivar.

Association of metabolic syndrome with oral and systemic conditions in morbidly obese patients

Aim: This study aimed to evaluate oral and systemic conditions in morbidly obese patients with and without metabolic syndrome (MS) prior to bariatric surgery. Methods: One hundred patients were included and equally divided into two groups: G1 - with MS (n = 50) and G2 - without MS (n = 50). MS was diagnosed in patients presenting at least three of five signs: abdominal obesity, high triglyceride level, low high-density lipoprotein cholesterol (HDL-C) level, hypertension, and altered fasting glycemia. Variables analyzed included the patients' age, sex, body mass index (BMI), waist-to-hip ratio (WHR), and number of missing teeth. Both BMI and WHR were used to evaluate the risk of developing cardiovascular disease (RCVD). Mann-Whitney, Chi-squared, t test, hierarchical multiple linear regression and binary logistic regression models were used in statistical analyses (p<0.05). Results: There were no group-wise differences in sex (p=0.631) and BMI (p=0.200); however, the WHR (p=0.009), age (p=0.0001), and number of missing teeth (p=0.0003) were higher in G1. Obese patients with MS who were candidates for bariatric surgery presented higher RCVD than obese patients without MS (p=0.019). Binary logistic regression revealed patient age [adjusted OR=1.05, 95% CI=1.00-1.11, p=0.042] and number of missing teeth [adjusted OR=1.17, 95% CI=1.04-1.31, p=0.013] to be significant predictors of MS. Conclusion: Morbidly obese patients with MS had worse oral and systemic conditions than those without MS, regarding WHR, RCDV and number of missing teeth

Weight loss after bariatric surgery and periodontal changes: a 12-month prospective study.

BACKGROUND: Several longitudinal studies have explored the association of obesity and weight gain with periodontal disease. However, the effect of weight loss on periodontal tissues remains unclear. OBJECTIVE: To explore whether weight loss after bariatric surgery was associated with changes in periodontal measures over 12 months. SETTING: Two public hospitals in São Paulo, Brazil. METHODS: We used data from 110 morbidly obese patients (body mass index [BMI]>40 kg/m2 or≥35 kg/m2 with co-morbid conditions) who underwent bariatric surgery between April 2011 and March 2013. Data on demographic factors, BMI, smoking habits, and glucose levels were extracted from medical records preoperatively and after 6 and 12 months postsurgery. A full-mouth periodontal examination was conducted by trained examiners to assess probing pocket depth, clinical attachment loss, and bleeding on probing (BOP) at baseline and 6 and 12 months after surgery. Data were analyzed using linear mixed-effects models. RESULTS: BMI was not significantly related to the proportion of sites with BOP at baseline, but it was negatively associated with the rate of change in the proportion of sites with BOP. The greater the BMI loss, the higher the proportion of sites with BOP, particularly 6 months after surgery. However, BMI was not associated with baseline probing pocket depth and clinical attachment loss or rates of changes in these periodontal outcomes. CONCLUSION: The findings suggest that weight loss was associated with increased gingival bleeding, showing a peak at 6 months after bariatric surgery. Periodontal pocketing and attachment loss remained unchanged during the study period.

Presence of Serum Ferritin before and after Bariatric Surgery: Analysis in Dentate and Edentulous Patients.

Society has changed its own lifestyle, specially its eating habits and physical activities, leading to excessive weight and a sedentary behavior, which has contributed to obesity increase. Bariatric surgery is the most effective treatment to obesity, allowing weight loss and its maintenance. However, it has been related high levels of iron deficiency after surgery. A person's nutritional status might be affected by total or partial tooth loss. The aim of this longitudinal prospective cohort study was to evaluate the levels of serum ferritin before and after bariatric surgery and to identify if there is a relation with tooth loss. The sample was composed of 50 patients selected and assisted at Amaral Carvalho Hospital, located in Jaú city, Brazil. The use and necessity of prosthesis, dental absence or presence, and serum ferritin dosage were evaluated. Student's t test, Univariate analysis, Chi-square and Odds Ratio were adopted (p<0.05). There was no significant difference regarding the serum ferritin levels between dentate and edentulous patients prior to surgery (p = 0.436). After surgery, the serum ferritin levels were higher in edentulous patients (prosthesis users) when compared to the pre-surgical levels, and the post-surgical levels presented significant difference regarding the dentate patients (p = 0.024). It can be concluded that rehabilitated patients in postoperative period showed better levels of serum ferritin after surgical intervention.

Periodontal Status in Morbidly Obese Patients With and Without Obstructive Sleep Apnea Syndrome Risk: A Cross-Sectional Study.

BACKGROUND: This cross-sectional study aims to investigate the correlation between obstructive sleep apnea syndrome (OSAS) risk with periodontal disease and anthropometric measures in Class III obese patients. METHODS: Anthropometric measurements were taken from 108 patients of both sexes, aged 30 to 60 years. The Berlin questionnaire (Bq) and the Epworth sleepiness scale (ESS) were applied to determine the risk for OSAS. Full-mouth periodontal status was determined by probing depth, clinical attachment level, gingival bleeding index, and the presence of calculus. Unpaired Student t, χ(2), Fisher exact, and Mann-Whitney U tests were applied to analyze the differences between high and low risk for OSAS groups. RESULTS: Overall, 81.5% of the patients showed high risk for OSAS, 46.3% had excessive daytime sleepiness, 41.5% were positive for both the Bq and ESS, and 97.2% had periodontal disease (periodontitis = 85.2% and gingivitis = 60.2%). Patients with periodontal disease showed high risk for OSAS (82.9%) and ESS (45.7%). However, there was no influence of periodontal disease on OSAS risk. Periodontitis was not associated with the ESS (odds ratio [OR] = 1.84, 95% confidence interval [CI] = 0.54 to 6.26) or Bq (OR = 0.87, 95% CI = 0.10 to 7.84), nor was gingivitis associated with the ESS (OR = 1.25, 95% CI = 0.48 to 3.25) or Bq (OR = 0.23, 95% CI = 0.03 to 1.84). Waist circumference (P = 0.03), neck circumference (NC, P <0.001), and the percentage of predicted NC (PPNC, P <0.001) were significantly larger in the patients at high risk for OSAS than in those at low risk for OSAS. Daytime sleepiness was also associated with NC (P = 0.02) and PPNC (P = 0.02). CONCLUSION: There was no association between periodontal disease and OSAS risk in Class III obese patients, but OSAS risk was associated with both NC and PPNC.

Gastroesophageal reflux, dental erosion, and halitosis in epidemiological surveys: a systematic review.

In published studies, it has been suggested that dental wear is associated with gastroesophageal reflux disease (GERD). This systematic review was carried out to evaluate the association of GERD, dental erosion, and halitosis and to compare the indices adopted in epidemiological surveys. The Medline database (until October, 2011) was searched systematically to identify studies evaluating the prevalence of oral alterations, such as dental erosion and halitosis, in patients with GERD symptoms. Two reviewers analyzed all reports and the selected studies were evaluated according to the quality of evidence, using the validated Newcastle-Ottawa Quality Assessment Scale. Full-text copies of a total of 32 publications were obtained in duplicate. Sixteen publications were identified among the citations in the Bibliographic lists of studies that fulfilled the exclusion/inclusion criteria and quality of evidence. The relationship between dental erosion and GERD patients was significant in only seven studies. According to three studies, halitosis could be one of several extraesophageal symptoms or manifestations in GERD patients. In one study, it was found that the mucosa of GERD patients was significantly more acidic in comparison with that of the control group. This systematic review showed that there is a relationship between GERD and oral diseases (dental erosion and halitosis). The epidemiological surveys used different indices to analyze GERD and dental erosion. Further research could investigate the best method for assessing the two diseases.

Idade de segregação do lenho juvenil e adulto pela variação da massa específica de açoita-cavalo / Estimating the age of demarcation of young and mature wood in açoita-cavalo

O presente trabalho teve como objetivo estimar a idade de segregação do lenho de Luehea divaricata Mart. (açoita-cavalo) por meio da variação radial da massa específica. Para o desenvolvimento do estudo, foram coletadas dez árvores de duas regiões do Estado do Rio Grande do Sul. Foi retirado um disco por árvore, com aproximadamente 2cm de espessura a 0,10m de altura do tronco. De cada disco, retirou-se, com auxílio de uma serra-fita, uma bagueta central de 2,0cm de largura, bem orientada no sentido radial, incluindo a medula no centro, dividiu-se então a bagueta em duas amostras "A" e "B". A massa específica foi obtida da relação entre peso seco e volume úmido. O volume úmido foi determinado de acordo com a norma ASTM D 2395 - 93, 1995. A segregação dos lenhos foi encontrada por regressão linear simples dos dados de variação da massa específica no sentido medula-casca. Foi feita uma regressão linear na faixa crescente dos dados e outra na faixa decrescente. A intersecção das retas extrapoladas foi adotada como idade de segregação. Os resultados obtidos mostraram que o lenho de açoita-cavalo segrega em aproximadamente 26 anos para a região da Depressão Central e 23 anos para a região da Encosta Superior do Nordeste. Nos dados de variação de massa específica, foi feita uma análise de variância multifatorial. Constatou-se que há diferença significativa entre lenhos e entre regiões. Por outro lado, as amostras A e B de cada árvore não foram estatisticamente diferentes entre si.

This study aims to estimate the age of segregation of young and mature wood of Luehea divaricata Mart., using the radial variation of specific gravity. To the development of this study were collected ten trees from two regions of the state of Rio Grande do Sul. Discs with thickness of 2cm at 0.1m of height from the base of the trunk were used. From each disk, with the aid of a band saw, a central ribbon 2.0cm wide, and oriented in the radial direction was taken, including the pith, then splitted into two samples "A" and "B". The specific gravity was calculated as ratio between dry weight and wet volume. The wet volume was determined according to ASTM D 2395 - 93, 1997. The age of segregation was found by simple linear regression of the data of variation of specific gravity from pith to bark. The intersection of extrapolated lines was adopted as the age of segregation. The results showed that the wood segregates in 26 year for the region of Central Depression and in 23 years for the Northeast Upper Hillside. Was made a multifactorial analysis of variance in the specific gravity data, showing that there are statistical difference between regions and woods. However, there are no statistical difference between samples.