Vestibulo-ocular reflex dynamics with head-impulses discriminates Usher patients type 1 and 2.

Usher Syndrome classification takes into account the absence of vestibular function but its correlation with genotype is not well characterized. We intend to investigate whether video Head Impulse Test (vHIT) is useful in screening and to differentiate Usher Syndrome types. 29 Usher patients (USH) with a genetically confirmed diagnosis and 30 healthy controls were studied with vHIT and dizziness handicap inventory questionnaire (DHI). Statistical significant differences between USH1, USH2 and controls were found in the vestibulo-ocular-reflex (VOR) gain of all SCCs, with USH1 patients consistently presenting smaller gains. VOR gain of the right lateral SCC could discriminate controls from USH1, and USH2 from USH1 with an overall diagnostic accuracy of 90%. USH1 DHI correlated with VOR (ρ = - 0,971, p = 0.001). Occurrence rate of covert and overt lateral semicircular canals refixation saccades (RS) was significantly different between groups, being higher in USH1 patients (p < 0.001). USH1 peak velocity of covert and overt saccades was higher for lateral semicircular canals (p < 0.05 and p = 0.001) compared with USH2 and controls. Covert saccades occurrence rate for horizontal SCCs could discriminate USH1 from USH2 patients and controls with a diagnostic accuracy of 85%. vHIT is a fast and non-invasive instrument which allowed us to screen and distinguish Usher patients from controls with a high precision. Importantly, its use allowed further discrimination between USH1 from USH2 groups. Moreover, VOR gain seems to correlate with vertigo-related quality of life in more severe phenotypes.

Barbell Technique for Three-Dimensional Bone Augmentation.

Introduction: Appositional bone augmentation is considered a challenging surgical problem to correct for the deficient alveolar ridge. To overcome this challenge, a novel concept was recently published called "Barbell Technique." This technique has been used more commonly for horizontal bone augmentation. To our knowledge, this is the first report on using the Barbell Technique for vertical bone augmentation. Case Report. This report describes and demonstrates the clinical feasibility of the use of this concept in the reconstruction of a tridimensional alveolar ridge defect in the anterior maxilla. Due to the severity of the defect, both hard and soft tissue deficiencies required augmentation. The first surgery involved a soft tissue grafting procedure while in the second surgical procedure, hard tissue augment was performed using the Barbell device to provide both vertical and horizontal support for the hard tissue graft. The donor material consisted of equal volume of xenograft and autogenous bone used to fill the defect and covered with a collagen barrier membrane. After a healing period of 9 months, the site was reopened. Bone formation clinically verified the correction of alveolar bone contour and volume permitted placement of two titanium implants after the removal of Barbell device. Conclusion: This case report demonstrates successful vertical and horizontal bone augmentation of a critical size defect in the anterior maxilla, correcting both hard and soft tissue contours, and providing the tissues needed to support dental implants in the anterior maxilla.

Efficacy of Duddingtonia flagrans (Bioverm®) on the biological control of buffalo gastrointestinal nematodes.

We evaluated the efficacy of Bioverm®, a commercial product containing Duddingtonia flagrans, on the control of buffalo (Bubalus bubalis) gastrointestinal nematodes. We randomly divided 12 buffaloes into two groups of six animals. In the treated group, each animal received a Bioverm®`s single dose of 1g (105 chlamydospores of D. flagrans) to 10 kg of live weight; in the control group, each animal received 1g of corn bran for each 10 kg of live weight as a placebo. Fecal samples were individually collected from 12, 24, 36, 48, 60 and 72 h after treatments. To examine 1) viability of chlamydospores passed through the gastrointestinal tract, 2 g of faeces and 1000 infective larvae (L3) were added to Petri dishes with 2% water-agar, and 2) to examine larval predation by D. flagrans during fecal cultures, 2000 L3 were added. In the Petri dishes, were observed significant reductions (p < 0.01) in the treated group after 48 (56.7%) and 60 h (91.5%). In the fecal cultures, significant reductions (p < 0.01) occurred in the treated group from 36 h (75%), with larval reduction up to 72 h. High larval predation rate occurred 60 h after Bioverm® administration. Bioverm® maintained viability and predation capacity after passage through the buffalo's gastrointestinal tract, showing efficacy on gastrointestinal nematodes.

Long-term evaluation (up to 7 years) of the use of a collagen matrix to treat gingival recession associated with noncarious cervical lesion: Report of two cases.

INTRODUCTION: Gingival recession (GR) is a relevant clinical condition due to its high prevalence worldwide, which leads to aesthetic demands and dentin hypersensitivity. Collagen matrices have been associated with different designs of coronally advanced flaps (CAFs) to treat GR defects. However, the literature lacks long-term follow-up of this treatment option. The aim of this study is to present the long-term follow-up (up to 7 years) of two GR defects (associated or not with noncarious cervical lesion) treated with a CAF and a collagen matrix (CM). CASE PRESENTATION: Case 1 underwent a CAF associated with a CM to treat a single GR defect. After 7 years, Case 1 presented with 3 mm of recession reduction, which corresponds with the 85.7% of root coverage. Case 2 presented two GR defects associated with noncarious cervical lesions (NCCLs). The NCCLs were partially restored with resin composite and then underwent a modified CAF for multiple defects and a CM. After 5 years of follow-up, Case 2 presented with 1.5 and 2.5 mm of recession reduction, which corresponds with the average 83.3% defect coverage. CONCLUSION: These two cases may show that CMs can provide long-term stable outcomes in the treatment of GR defects. Why is this case new information? One of the cases is the first one to describe a 7 years of follow-up after CAF+CM to treat gingival recession defects. What are the keys to successful management of this case? Correct material handling. Adequate restorative protocol and surgical technique. What are the primary limitations to success in this case? Diagnose Patient compliance.

The Portuguese version of the visual vertigo analog scale

Abstract Objectives: Visual vertigo occurs after a vestibular disorder compromising daily living. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a self-administered questionnaire without Portuguese version. To perform the translation, cross cultural adaptation, and validation of VVAS from English to Portuguese. Methods: Prospective study involving the translation and cross-cultural adaptation of the VVAS into the Portuguese language, according to recognized guidelines. It was completed by 63 healthy controls and 198 participants with vestibulopathy who also completed the Dizziness Handicap Inventory (DHI) to further explore the link between DHI and VVAS. Groups were compared for severity of visual vertigo and VVAS reliability and internal consistency were tested. Results: The VVAS score was significantly higher in vestibular group (p < 0.001). A Cronbach's α of 0.9 confirmed the valid internally consistent of the applied version. The severity score of VVAS showed a positive strong correlation with DHI (p < 0.0001). Conclusion: The present Portuguese translation of the scale showed satisfactory properties for the assessment of self-perceived and severity of visual vertigo in a significant group of vestibular Portuguese patients. Level of evidence: 2.

The Portuguese version of the visual vertigo analog scale.

OBJECTIVES: Visual vertigo occurs after a vestibular disorder compromising daily living. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a self-administered questionnaire without Portuguese version. To perform the translation, cross cultural adaptation, and validation of VVAS from English to Portuguese. METHODS: Prospective study involving the translation and cross-cultural adaptation of the VVAS into the Portuguese language, according to recognized guidelines. It was completed by 63 healthy controls and 198 participants with vestibulopathy who also completed the Dizziness Handicap Inventory (DHI) to further explore the link between DHI and VVAS. Groups were compared for severity of visual vertigo and VVAS reliability and internal consistency were tested. RESULTS: The VVAS score was significantly higher in vestibular group (p < 0.001). A Cronbach's α of 0.9 confirmed the valid internally consistent of the applied version. The severity score of VVAS showed a positive strong correlation with DHI (p < 0.0001). CONCLUSION: The present Portuguese translation of the scale showed satisfactory properties for the assessment of self-perceived and severity of visual vertigo in a significant group of vestibular Portuguese patients.

Maxillary Sinus Elevation Using the Bone Ring Technique with Immediate Implantation: A Case Report.

Compared to other areas of the oral cavity, an edentulous posterior maxilla poses a unique challenge for implant placement. The most important aspect to consider is the maxillary sinus. This paper describes a case in which the bone ring technique was used to raise the floor of the maxillary sinus, followed by immediate implantation. A 37-year-old woman presented with a ridge defect in the left maxilla and the absence of teeth 26 and 27 (FDI tooth-numbering system) on the same side. The treatment plan involved the extraction of tooth 25, periodontal regeneration on the distal face of tooth 24, and concomitant raising of the maxillary sinus (using the bone ring technique) with simultaneous implantation. The bone ring technique promotes bone augmentation, raises the maxillary sinus, and reduces the surgical time, surgical costs, and length of the rehabilitation period. In the case presented herein, bone tissue stability around the implants, ridge maintenance, and gingival margin stability were found at the 1-year follow-up after rehabilitation.

Decreased activity of piriform cortex and orbitofrontal hyperactivation in Usher Syndrome, a human disorder of ciliary dysfunction.

Usher syndrome (USH) is a condition characterized by ciliary dysfunction leading to retinal degeneration and hearing/vestibular loss. Putative olfactory deficits in humans have been documented at the psychophysical level and remain to be proven at the neurophysiological level. Thus, we aimed to study USH olfactory impairment using functional magnetic resonance imaging. We analyzed differences in whole-brain responses between 27 USH patients and 26 healthy participants during an olfactory detection task with a bimodal odorant (n-butanol). The main research question was whether between-group differences could be identified using a conservative whole-brain approach and in a ROI-based approach in key olfactory brain regions. Results indicated higher olfactory thresholds in USH patients, thereby confirming the hypothesis of reduced olfactory acuity. Importantly, we found decreased BOLD activity for USH patients in response to odorant stimulation in the right piriform cortex, while right orbitofrontal cortex showed increased activity. We also found decreased activity in other higher-level regions in a whole brain approach. We suggest that the hyper activation in the orbitofrontal cortex possibly occurs as a compensatory mechanism after the under-recruitment of the piriform cortex. This study suggests that olfactory deficits in USH can be objectively assessed using functional neuroimaging which reveals differential patterns of activity both in low- and high-level regions of the olfactory network.

Tratamento de mucosite periimplantar pela técnica de enxerto gengival livre: relato de caso / Treatment of peri-implant mucositis through free gingival graft technique: case report

A Mucosite peri-implantar é considerada a precursora da peri-implantite, ela é uma lesão inflamatória da mucosa peri-implantar na ausência de perda óssea marginal contínua. O objetivo desse relato de caso, foi descrever o tratamento da mucosite periimplantar através da cirurgia de enxerto gengival livre. Foi proposto, portanto, um tratamento reabilitador envolvendo uma abordagem multidisciplinar de forma a resgatar e restabelecer estética, função e bem-estar através do enxerto gengival livre para melhorar as características de mucosa e viabilizar uma previsibilidade de uma prótese definitiva implantosuportada em condições teciduais mais estáveis. O uso do EGL para aumento da gengiva queratinizada na cirurgia de implantes em paciente idosos é uma solução prática e segura para a manutenção da saúde periodontal ao redor do implante... (AU)

Peri-implant mucositis is considered the precursor of peri-implantitis, it is an inflammatory lesion of the peri-implant mucosa in the absence of continuous marginal bone loss. The purpose of this case report was to describe the treatment of peri-implant mucositis through free gingival graft surgery. Therefore, a rehabilitation treatment involving a multidisciplinary approach was proposed in order to rescue and reestablish aesthetics, function and well-being through the free gingival graft to improve the characteristics of the mucosa and enable a predictability of a permanent implant prosthesis under more stable tissue conditions. The use of EGL to increase keratinized gingiva in implant surgery in elderly patients is a practical and safe solution for maintaining periodontal health around the implant... (AU)

Efficacy of medium chain triglyceride oil dietary supplementation in reducing seizure frequency in dogs with idiopathic epilepsy without cluster seizures: a non-blinded, prospective clinical trial.

BACKGROUND: Despite appropriate antiseizure drug (ASD) treatment, around two-thirds of dogs with idiopathic epilepsy (IE) have seizures long-term and 20-30per cent of affected dogs remain poorly controlled. METHODS: The current study aim is to test in a field trial the efficacy and tolerability of a commercially available diet enriched with 6.5per cent medium chain triglyceride (MCT) oil in dogs (n=21) with at least a tier 1 idiopathic epilepsy diagnosis, without cluster seizures, in 10 veterinary practices across Europe. Each dog's quality of life (QoL), ataxia, sedation and frequency and severity of seizures were recorded by owners throughout the study. RESULTS: The mean seizure frequency per month, averaged over the entire 84-day study, significantly (P=0.04) decreased 32per cent compared with the baseline monthly seizure frequency recorded during the month immediately before feeding the diet. Similarly, the seizure days rate (days/month) also declined (P<0.001) by 42per cent. QoL was reported as very good to excellent (>8.5/10) in 20 of the 21 dogs before starting the diet and this remained unchanged during the trial. CONCLUSIONS: This study demonstrates the use of a diet enriched with MCTs as an adjunct to ASD treatment may have some antiseizure properties for dogs diagnosed with IE, as demonstrated in previous studies.

Isolated hypoglossal palsy, a rare complication of Epstein-Barr virus infection / Parálisis aislada del nervio hipogloso: una complicación infrecuente de la infección por virus de Epstein-Barr

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Evidence for impaired olfactory function and structural brain integrity in a disorder of ciliary function, Usher syndrome.

Diseases involving cilia dysfunction, such as Usher Syndrome (USH), often involve visual and auditory loss. Psychophysical evidence has suggested that this may also hold true for the peripheral olfactory domain. Here we aimed to go a step further by attempting to establish relations between the integrity of cortical structures and olfactory function in this condition. We investigated olfactory function for USH types 1 (USH1) and 2 (USH2). Bilateral olfactory bulb (OB) volume and olfactory sulcus (OS) depth were also analysed. Thirty-three controls with no previous olfactory deficits were age, sex and handedness-matched to 32 USH patients (11 USH1, 21 USH2). A butanol detection threshold test was performed to measure olfactory function. For OB volume and OS depth, morphometric measurements were performed using magnetic resonance imaging (MRI) based on detailed segmentation by three independent operators. Averaged values across these were used for the statistical analyses. Total intracranial volume was estimated using Freesurfer to account for head size variability. Olfactory threshold was significantly lower in controls when compared to USH, USH1, and USH2. OS depth was found to be shallower in both hemispheres in USH patients when compared with the control group. OB volume was not significantly different between control and USH groups, or respective subgroups. Nevertheless, butanol threshold was negatively correlated with the left OB volume for the USH type 1 subgroup. The main effect of OS depth reduction was found to be mainly due to the comparison between USH2 and controls. Our results provide evidence for morphometric changes and olfactory dysfunction in patients with USH. This correlated with a reduction in left OB volume in the USH1 subgroup, the most severe USH phenotype. The main effect of reduced OS depth was found to stem mainly from USH2 raising questions regarding a possible complex interaction between sensory olfactory loss and central cortical changes in this disease.

[Evaluation of The Medical Board Exam in Portugal]. / Avaliação do Exame Final do Internato Médico em Portugal.

INTRODUCTION: There is a high heterogeneity in the structure of postgraduate medical training evaluation worldwide. However, in contrast to other countries, there have been no scientific studies of the final medical board examination, in Portugal. The present study aimed to evaluate the adequacy of the medical board examination including its validity as measured by its association with medical school grade average and national seriation examination. MATERIAL AND METHODS: Cross-sectional, observational study. We analyzed the final results on the medical board examination of 2439 physicians, across 47 specialties, who completed their training in 2016 and 2017, using measures of central tendency and variability. We assessed the association between these grades and the national exam to initiate residency, and the grade average in Medical School. RESULTS: Measures of central tendency and variability, and consequent shape measures, revealed that the distribution of the scores of the final medical board exam is extremely negatively asymmetric and leptokurtic. A positive association was also found between the results in this exam and the score on national exam to initiate residency, and the grade average in Medical School. CONCLUSION: Although the medical board examination was, in general, positively associated with scores on the national exam to initiate residency, and the mean final Medical School grades, thus indicating its potential validity, our results demonstrate that this exam presents no satisfactory discriminative capacity. Therefore, there is room to improve the actual postgraduate medical examination model, including changes in its classification system and potentially consider other assessment models.

Introdução: Existe uma elevada heterogeneidade na estrutura da avaliação da formação médica pós-graduada a nível mundial. No entanto, contrastando com outros países, não existem estudos científicos em Portugal que tenham avaliado o modelo da avaliação final da especialidade. O presente estudo pretendeu avaliar a adequação do exame do final da especialidade aos seus propósitos; aí incluída a sua validade enquanto consubstanciada na relação com a prova nacional de seriação e média final de curso de medicina. Material e Métodos: Estudo transversal, observacional. Foram analisadas com recurso a medidas de tendência central e variabilidade, as notas na avaliação final da especialidade de 2439 médicos, de 47 especialidades, que terminaram a sua formação em 2016 e 2017. Tendo em vista a sua validação cruzada, foram também avaliadas as correlações com a média final de curso e a nota na prova nacional de seriação. Resultados: Das medidas de tendência central e variabilidade, e consequentes medidas de formato, resulta que a distribuição das pontuações do exame final de especialidade se apresenta com uma forma manifestamente assimétrica negativa e leptocúrtica. No geral, verificou-se a existência de uma associação positiva entre a avaliação final da especialidade e a média de curso e a prova nacional de seriação. Conclusão: Apesar de positivamente associado, no geral, com a média de curso e a prova nacional de seriação, o que indica a sua potencial validade, os resultados demonstram que a avaliação final de especialidade não apresenta uma capacidade discriminativa satisfatória. Deste modo, existe oportunidade para melhoria do modelo atual, nomeadamente através da alteração ao seu sistema de classificação e considerando outros modelos de exame.