Visceral Leishmaniasis: A Case Report of a Challenging Diagnosis After Orthotopic Liver Transplantation.

Leishmaniasis is a disease caused by a protozoan and transmitted by sandfly species in several emerging countries. Visceral leishmaniasis is a serious complication, especially in immunosuppressed patients, and is uncommon after liver transplantation. We report the case of a 48-year-old female patient who underwent liver transplantation owing to polycystic liver disease. Six months after the procedure, she was hospitalized with diarrhea, acute kidney failure, and leukopenia. She had been off steroids for 3 months and was taking mycophenolate and tacrolimus. She had already been treated for cytomegalovirus, which was negative on admission. During hospitalization, fever, splenomegaly, ascites, and pancytopenia appeared. Serology for Leishmania by indirect immunofluorescence was negative. Then, bone biopsy and molecular testing for Leishmania diagnosed it as visceral leishmaniasis. Amphotericin therapy was initiated with resolution of fever after 4 days of treatment and gradual recovery from pancytopenia. This case highlights the challenge of early diagnosis of visceral leishmaniasis in liver transplant recipients with diarrhea and leukopenia, which can be caused by immunosuppression or more prevalent viral diseases. Late onset of fever, splenomegaly, and a first negative serologic test also made early diagnosis difficult. The aim of the report is to emphasize the suspicion of visceral leishmaniasis in symptomatic patients from emerging countries and to question the benefit of including protozoan screening in liver transplant donors and recipients in endemic areas.

Isotonic exercises and relaxing techniques in individuals with temporomandibular dysfunction.

Objective: The present study aimed to compare the clinical characteristics of volunteers with temporomandibular dysfunction before and after performing exercises with those of volunteers who only followed self-care guidelines.Methods: A parallel randomized controlled trial was performed. Individuals included underwent the intervention twice a week for one month, while the control group only followed self-care guidelines.Results: Twenty-three volunteers participated; however, during the study, four dropped out. At the end of the study, the degree of depression decreased in the volunteers in the intervention group.Conclusion: The level of pain decreased, but the improvement was not statistically significant and, therefore, could not be attributed to the intervention. It can be concluded that the strategies used to reduce pain in this study were not sufficient for clinical improvement in volunteers with temporomandibular dysfunction.

Neurophysiological aspects of isotonic exercises in temporomandibular joint dysfunction syndrome.

PURPOSE: The aim of the study was to investigate the electroneurophysiological aspects of volunteers with temporomandibular disorders before and after performing isotonic exercises for pain relief and self-care guidelines. METHODS: The study was a parallel controlled randomized controlled trial under protocol 1,680,920. The inclusion criteria were age between 18 and 60 years, muscle temporomandibular dysfunction with or without limitation of mouth opening and self-reported pain with scores between 4 and 10. The individuals were randomized into experimental group and control. Twenty-three volunteers participated in the study, most of then were female. Control group had 11 and experimental group 12 individuals. Dropouts occurred in both groups, two in the experimental group and three in the control group. Since there were an intergroup imbalance the power density was analysed just in experimental group. Electroencephalographic recording was performed before and after the interventions, using the 32-channel apparatus, with sample frequency of 600 Hz and impedance of 5 kΩ. The data were processed through the MATLAB computer program. The individual records filtered off-line, using bandpass between 0.5 and 50 Hz. Epochs of 1,710 ms were created and the calculation of the absolute power density calculated by means of the fast Fourier transform. The statistical approach was inferential and quantitative. RESULTS: The alpha power density analyzed presented a difference, but not significant, when compared in the two moments. CONCLUSION: According to this study, isotonic exercises performed to reduce pain provided a small increase in alpha power density in the left temporal, parietal and occipital regions.

Gastos públicos em serviços ambulatoriais de Fonoaudiologia no Brasil entre 2009 e 2018: bases de dados do DATASUS / Public spending on outpatient speech therapy services in Brazil between 2009 and 2018: DATASUS databases

RESUMO Objetivo Analisar os gastos públicos em saúde destinados aos serviços ambulatoriais em Fonoaudiologia nas cinco Regiões Federativas do Brasil. Métodos Trata-se de um estudo ecológico realizado por meio da busca de dados secundários disponíveis em uma plataforma virtual de domínio público, DATASUS (Departamento de Informática do Sistema Único de Saúde). Os dados coletados referiram-se aos valores aprovados para os procedimentos da Fonoaudiologia no período de 2009 a 2018 nas cinco Regiões Federativas. Adotou-se análise descritiva dos dados e exposição dos resultados em valores absolutos, relativos e taxas de crescimento. Resultados Verificou-se que o investimento médio em reais (R$), por ano, nos serviços de Fonoaudiologia no Brasil foi de, aproximadamente, R$ 223.952.639.232,00; sendo 47,2% dos recursos destinados à Região Sudeste. Dentre as grandes áreas de especialização, a Audiologia foi responsável por 95,4% do investimento, seguida pelas áreas da Linguagem (4,0%), Motricidade Orofacial (0,5%) e Voz (0,1%). Conclusão Os serviços fonoaudiológicos demandam considerável parcela dos recursos públicos, sendo a área da Audiologia responsável por quase metade desses gastos, seguida pelas grandes áreas da Linguagem, Motricidade Orofacial e Voz.

ABSTRACT Purpose To analyze public spending on health services to outpatient services in Speech Therapy in the five federative regions of Brazil. Methods This is an ecological study carried out through the search for secondary data available on a public domain virtual platform, DATASUS. The collected data refer to the values ​​approved for the Speech Therapy procedures in the period from 2009 to 2018 in the five federative regions. Descriptive analysis of data and exposure of results in absolute and relative values ​​and growth rates were adopted. Results It was found that the average investment in reais, per year, in speech therapy services in Brazil was approximately R$ 223,952,639,232.00, with 47.2% of the resources destined for the Southeast region. Among the major areas of specialization, Audiology accounted for 95.4% of the investment, followed by Language (4.0%), Orofacial Motricity (0.5%) and Voice (0.1%). Conclusion The findings indicate that speech therapy services demand a considerable portion of public resources, with the area of ​​Audiology being responsible for almost half of these expenses, followed by the large area of ​​Language, Orofacial Motricity and Voice.

CASE STUDY OF CONGENITAL ANOMALIES OF THE UPPER LIMB IN REFERENCE AMBULATORY CARE FACILITY.

OBJECTIVE: The epidemiological profile of congenital anomalies of the upper limbs (CAULs) is of major relevance to monitoring and planning. A study of this profile may reveal if there is prevalence of some specific type of malformation in comparison to a more comprehensive epidemiological sample. The Latin American Collaborative Study of Congenital Malformations (ECLAMC) has an extensive database, providing an excellent source of comparison. This study aims to evaluate the epidemiological profile of CAULs at the hand surgery department of the Hospital Federal da Lagoa (HFL) in Brazil, and compare it to the ECLAMC data. METHODS: We conducted a retrospective analysis of patients who underwent treatment at the pediatric outpatient hand surgery clinic. The sample universe consisted of 126 patients (4 of these patients presented with 2 simultaneous anomalies), totaling 130 malformations. RESULTS: The results demonstrated that the comparable pathologies have significantly similar incidence rates. It is worth noting the polydactylies (pre- and post-axial), where the percentile of incidence in the ECLAMC was higher. CONCLUSION: This study showed that the epidemiological profile of patients who underwent treatment at this hospital was equivalent to that found in the ECLAMC database. Level of evidence III, Retrospective epidemiological study.

OBJETIVO: O perfil epidemiológico das anomalias congênitas dos membros superiores (ACMS) é de suma relevância para monitoramento e planejamento. Um estudo nesse sentido pode revelar se há prevalência de algum tipo específico de malformação em comparação com amostra epidemiológica mais abrangente. O Estudo Colaborativo Latino Americano de Malformação Congênita (ECLAMC) tem uma extensa base de dados, que serve como excelente fonte de comparação. Este estudo tem por escopo avaliar o levantamento da casuística das ACMS no serviço de cirurgia da mão do Hospital Federal da Lagoa (HFL) e compará-la aos dados do ECLAMC. MÉTODOS: Foi realizada uma análise retrospectiva dos pacientes atendidos no ambulatório infantil de cirurgia da mão. O universo amostral foi de 126 pacientes (sendo que 4 pacientes apresentavam 2 anomalias simultaneamente), totalizando 130 malformações. RESULTADOS: Demonstrou-se que as patologias que puderam ser comparadas têm percentuais de incidência significativamente semelhantes. Cabe ressalvar as polidactilias (pré e pós-axiais), em que o percentil de incidência no ECLAMC foi maior. CONCLUSÃO: Este estudo evidenciou que o perfil epidemiológico dos pacientes atendidos neste hospital foi equivalente ao encontrado na base de dados do ECLAMC. Nível de evidência III, Estudo epidemiológico retrospectivo.

Case study of congenital anomalies of the upper limb in reference ambulatory care facility / Estudo de casos de anomalia congênita do membro superior em serviço ambulatorial de referência

ABSTRACT Objective: The epidemiological profile of congenital anomalies of the upper limbs (CAULs) is of major relevance to monitoring and planning. A study of this profile may reveal if there is prevalence of some specific type of malformation in comparison to a more comprehensive epidemiological sample. The Latin American Collaborative Study of Congenital Malformations (ECLAMC) has an extensive database, providing an excellent source of comparison. This study aims to evaluate the epidemiological profile of CAULs at the hand surgery department of the Hospital Federal da Lagoa (HFL) in Brazil, and compare it to the ECLAMC data. Methods: We conducted a retrospective analysis of patients who underwent treatment at the pediatric outpatient hand surgery clinic. The sample universe consisted of 126 patients (4 of these patients presented with 2 simultaneous anomalies), totaling 130 malformations. Results: The results demonstrated that the comparable pathologies have significantly similar incidence rates. It is worth noting the polydactylies (pre- and post-axial), where the percentile of incidence in the ECLAMC was higher. Conclusion: This study showed that the epidemiological profile of patients who underwent treatment at this hospital was equivalent to that found in the ECLAMC database. Level of evidence III, Retrospective epidemiological study.

RESUMO Objetivo: O perfil epidemiológico das anomalias congênitas dos membros superiores (ACMS) é de suma relevância para monitoramento e planejamento. Um estudo nesse sentido pode revelar se há prevalência de algum tipo específico de malformação em comparação com amostra epidemiológica mais abrangente. O Estudo Colaborativo Latino Americano de Malformação Congênita (ECLAMC) tem uma extensa base de dados, que serve como excelente fonte de comparação. Este estudo tem por escopo avaliar o levantamento da casuística das ACMS no serviço de cirurgia da mão do Hospital Federal da Lagoa (HFL) e compará-la aos dados do ECLAMC. Métodos: Foi realizada uma análise retrospectiva dos pacientes atendidos no ambulatório infantil de cirurgia da mão. O universo amostral foi de 126 pacientes (sendo que 4 pacientes apresentavam 2 anomalias simultaneamente), totalizando 130 malformações. Resultados: Demonstrou-se que as patologias que puderam ser comparadas têm percentuais de incidência significativamente semelhantes. Cabe ressalvar as polidactilias (pré e pós-axiais), em que o percentil de incidência no ECLAMC foi maior. Conclusão: Este estudo evidenciou que o perfil epidemiológico dos pacientes atendidos neste hospital foi equivalente ao encontrado na base de dados do ECLAMC. Nível de evidência III, Estudo epidemiológico retrospectivo.

Analgesic effect of cathodal transcranial current stimulation over right dorsolateral prefrontal cortex in subjects with muscular temporomandibular disorders: study protocol for a randomized controlled trial.

BACKGROUND: Temporomandibular disorders are a group of orofacial pain conditions that are commonly identified in the general population. Like many other chronic pain conditions, they can be associated with anxiety/depression, which can be related to changes in the activity of the dorsolateral prefrontal cortex. Some studies have demonstrated clinical improvement in subjects with chronic pain who are given therapeutic neuromodulation. Transcranial direct current stimulation is a noninvasive brain stimulation technique that allows the modulation of neuronal membranes. This therapy can enhance or inhibit action potential generation in cortical neurons. In some instances, medications acting in the central nervous system may be helpful despite their adverse side effects. It is important to determine if cathodal transcranial direct current stimulation over the dorsolateral prefrontal cortex, an area that modulates emotion and motor cortex excitability, has an analgesic effect on chronic temporomandibular disorders pain. METHOD/DESIGN: The investigators will run a randomized, controlled crossover double blind study with 15 chronic muscular temporomandibular disorder subjects. Each subject will undergo active (1 mA and 2 mA) and sham transcranial direct current stimulation. Inclusion criteria will be determined by the Research Diagnostic Criteria for Temporomandibular Disorders questionnaire, with subjects who have a pain visual analogic scale score of greater than 4/10 and whose pain has been present for the previous 6 months, and with a State-Trait Anxiety Inventory score of more than 42. The influence of transcranial direct current stimulation will be assessed through a visual analogic scale, quantitative sensory testing, quantitative electroencephalogram, and the State-Trait Anxiety Inventory score. DISCUSSION: Some studies have demonstrated a strong association between anxiety/depression and chronic pain, where one may be the cause of the other. This is especially true in chronic temporomandibular disorders, and breaking this cycle may have an effect over the symptoms and associated dysfunction. We believe that by inhibiting activity of the dorsolateral prefrontal cortex though cathodal transcranial direct current stimulation, there may be a change in both anxiety/depression and pain level. Transcranial direct current stimulation may emerge as a new tool to be considered for managing these patients. We envision that the information obtained from this study will provide a better understanding of the management of chronic temporomandibular disorders. TRIAL REGISTRATION: This trial was registered at clinicaltrials.gov on 24 May 2014 (Identifier: NCT02152267 ).

Profissionais da Área de Saúde como Voluntários de Pesquisa: Repensando a Metodologia / Health Professionals as Research Subjects: Rethinking the Approaches

A utilização de questionários pode assegurar oacesso a informações importantes na mudança decomportamentos. Objetivo: Descrever e discutir ametodologia e os instrumentos utilizados em pesquisas comprofissionais da área de Saúde. Material e Métodos: A partirde listas fornecidas por entidades de classe, profissionaisda área de saúde foram contatados pessoalmente e pelainternet para preenchimento do questionário de avaliação doconhecimento sobre procedimentos diagnósticos deneuroimagem e eletroneurofisiologia cortical em pacientescom distúrbios de linguagem. Resultados: não conseguimosacesso a 635 profissionais (97%) e, dos contatados comsucesso, 23 (3%) responderam o questionário utilizado.Dentre os que não participaram, 369 (56%) trabalhavam emhospitais, 66 (10%) não foram acessados, 66 (10%) oendereço se encontrava desatualizado, 41 (6%) tinhamnúmero de telefone errado, 37 (6%) atuavam em outraespecialidade, 30 (5%) estavam indisponíveis, 18 (3%)receberam e não responderam, 9 (1%) negaram opreenchimento. Conclusão: As dificuldades encontradasdurante a execução deste estudo proporcionam uma reflexãoacerca da construção de novos conhecimentos, uma vezque os profissionais envolvidos na prática clínica, e atémesmo na formação acadêmica, não se disponibilizam quandosolicitados a serem voluntários de pesquisa...

The use of questionnaires can ensure accessto important information concerning changing behavior.Objective: In this study we aimed to describe and discussthe methods and tools used in research involving healthprofessionals. Material and Methods: Health careprofessionals were contacted in person or through theinternet to fill out a questionnaire about their knowledge ondiagnostic procedures of neuroimaging and corticalelectroneurophysiology in children with language disorder.Results: A total of 635 professionals (97%) were nonrespondents,and 23 (3%) completed the questionnaires.Among those who did not participate, 369 (56%) worked inhospitals, 66 (10%) could not be reached, 66 (10%) had anoutdated address, 41 (6%) had the wrong phone number, 37(6%) worked with another specialty, 30 (5%) wereunavailable, 18 (3%) received the questionnaire but did notanswer it, and 9 (1%) declined. Conclusion: The difficultiesencountered during the execution of this study provide areflection on the production of new knowledge, sinceprofessionals involved in clinical practice and even inacademic education were not available when asked to beresearch subjects...

Hematological particularities and co-infections in injected drug users with AIDS

HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL-1 and lymphocyte <1000 µL-1 had CD4 count lower than 100 µL-1. In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.

Hematological particularities and co-infections in injected drug users with AIDS.

HIV patients infected through injected drug use have poorer prognosis than other groups. We evaluated the hematological alterations and rates of co-infections in injected drug use patients with AIDS. Injected drug use patients were younger, predominantly of male gender, and presented lower CD4, total lymphocyte, and platelet counts, but not neutrophil count, than control group. Injected drug use patients had a higher rate of hepatitis C and mycobacteria infection. Furthermore, all injected drug use patients with hemoglobin <10.0 g dL(-1) and lymphocyte <1000µL(-1) had CD4 count lower than 100µL(-1). In conclusion, HIV-infected injected drug use patients constitute a special group of patients, and hemoglobin concentration and lymphocyte count can be used as surrogate markers for disease severity.

Mycoparasitism studies of Trichoderma species against three phytopathogenic fungi: evaluation of antagonism and hydrolytic enzyme production.

Trichoderma spp. are used for biocontrol of several plant pathogens. However, their efficient interaction with the host needs to be accompanied by production of secondary metabolites and cell wall-degrading enzymes. Three parameters were evaluated after interaction between four Trichoderma species and plant-pathogenic fungi: Fusarium solani, Rhizoctonia solani and Sclerotinia sclerotiorum. Trichoderma harzianum and T. asperellum were the most effective antagonists against the pathogens. Most of the Trichoderma species produced toxic volatile metabolites, having significant effects on growth and development of the plant pathogens. When these species were grown in liquid cultures with cell walls from these plant pathogens, they produced and secreted ß-1,3-glucanase, NAGAse, chitinase, acid phosphatase, acid proteases and alginate lyase.

Transient elevation of ST-segment due to pneumothorax and pneumopericardium.

ST-segment elevation, observed in the critically ill patients, almost always raises the suspicion of ischemic heart disease. However, nonischemic myocardial and non-myocardial problems in these patients may also lead to ST-segment elevation. Pneumothorax and pneumopericardium have been rarely reported as a cause of transient ST-segment elevation. The authors report the case of a patient admitted to the emergency care unit because of a respiratory failure requiring mechanical ventilatory support. As the patient showed signs of clinical deterioration, a pneumothorax was clinically diagnosed. Chest radiography after thorax drainage also disclosed a pneumopericardium. The 12-lead electrocardiogram recorded before the thoracic drainage revealed an ST-segment elevation, which normalized after the surgical procedure. Ischemic myocardial biomarkers were negative. The authors call attention to the right-sided pneumothorax associated with pneumopericardium as an unusual cause of ST-segment elevation.

Biochemical and metabolic profiles of Trichoderma strains isolated from common bean crops in the Brazilian Cerrado, and potential antagonism against Sclerotinia sclerotiorum.

Some species of Trichoderma have successfully been used in the commercial biological control of fungal pathogens, e.g., Sclerotinia sclerotiorum, an economically important pathogen of common beans (Phaseolus vulgaris L.). The objectives of the present study were (1) to provide molecular characterization of Trichoderma strains isolated from the Brazilian Cerrado; (2) to assess the metabolic profile of each strain by means of Biolog FF Microplates; and (3) to evaluate the ability of each strain to antagonize S. sclerotiorum via the production of cell wall-degrading enzymes (CWDEs), volatile antibiotics, and dual-culture tests. Among 21 isolates, we identified 42.86% as Trichoderma asperellum, 33.33% as Trichoderma harzianum, 14.29% as Trichoderma tomentosum, 4.76% as Trichoderma koningiopsis, and 4.76% as Trichoderma erinaceum. Trichoderma asperellum showed the highest CWDE activity. However, no species secreted a specific group of CWDEs. Trichoderma asperellum 364/01, T. asperellum 483/02, and T. asperellum 356/02 exhibited high and medium specific activities for key enzymes in the mycoparasitic process, but a low capacity for antagonism. We observed no significant correlation between CWDE and antagonism, or between metabolic profile and antagonism. The diversity of Trichoderma species, and in particular of T. harzianum, was clearly reflected in their metabolic profiles. Our findings indicate that the selection of Trichoderma candidates for biological control should be based primarily on the environmental fitness of competitive isolates and the target pathogen.

Strongyloides stercoralis disseminated infection and schistosomiasis in an AIDS patient.

Strongyloides stercoralis hyperinfection syndrome is classically associated with impaired host response and implies in an overburden of larvae in its usual cycle. It has been recognized as a severe and potentially fatal condition in immunocompromised individuals, especially those using oral corticosteroids. Infection with Schistosoma mansoni not only increases the susceptibility to HIV infection, but also promotes progression to disease. The association of the most severe forms of strongyloidiasis and AIDS is scarcely described, even more when S. mansoni is also associated. The authors describe a case of a 34-year-old previously healthy male, admitted to the emergency department with a history of hematemesis associated with dyspnea, hemoptysis, and fever. He referred homosexual relations for 6 years. Physical examination showed an ill-looking patient, and was remarkable for tachycardia, tachypnea, diaphoresis, and pulse oximetry of 70% in room air. Lungs examination revealed the presence of rales in the left base. Chest radiography showed a diffuse and bilateral reticulo-nodular pattern. HIV serology was positive. Empirical antimicrobial therapy and corticosteroids were initiated. On the third day of hospitalization, petechiae appeared over the periumbilical area, but no further investigation was undertaken because the patient died soon after. The autopsy findings were compatible with S. stercoralis disseminated infection, a hepatic intestinal chronic form of schistosomiasis, and septic shock as the primary cause of death. The authors call attention to this infrequent association.

Hematological abnormalities in HIV-infected patients.

BACKGROUND: Anemia, neutropenia, and thrombocytopenia are commonly observed in HIV-infected patients. This study was undertaken to evaluate the prevalence of cytopenias and their association with CD4 count. Furthermore, the association of hemoglobin concentration with mortality was also investigated. METHODS: We reviewed the data of 701 HIV-infected patients followed at our institution. Blood cell counts, hemoglobin concentration, CD4 count, and viral load were recorded. We also recorded the mortality rate after 1 year in the groups with CD4 <200/µl and ≥ 200/µl according to hemoglobin concentration. RESULTS: Of the total patients, 37.5% had anemia; 61.1% (110/180) were in the low CD4 group and 29.4% (153/521) were in the high CD4 group (p<0.01). Mean neutrophil counts were 2.610 × 10(9)/l and 3.204 × 10(9)/l in the low CD4 and high CD4 groups, respectively (p<0.01); mean platelet counts were 218.639 × 10(9)/l and 234.807 × 10(9)/l for the low CD4 and the high CD4 groups, respectively (p=0.03). Patients whose hemoglobin concentration was below the median value had a higher death rate in both the low CD4 (14 vs. 4 deaths, p=0.013) and high CD4 (8 vs. 1 death, p=0.0158) groups. CONCLUSIONS: We found an association between CD4 count and hemoglobin level, neutrophil count, and platelet count, and that anemia was independently associated with a higher mortality.

Avaliação in vitro da fenda de contração depolimerização formada por diferentes resinascompostas universais / In vitro evaluation of polymerization shrinkagegap of different universal composite resins

Introdução: As resinas compostas representam hoje o principalmaterial restaurador de uso direto empregado na clínica odontológicadiária, contudo alguns aspectos relacionados ao material aindanecessitam ser mais bem compreendidos, entre os quais a contraçãode polimerização. Objetivo: Investigar a fenda de contração depolimerização formada por diferentes resinas compostas universais.Material e métodos: Compuseram os grupos testados oito marcascomerciais de compósitos, e foram confeccionados cinco corpos de provapara cada grupo, assim designados: G1 ? TPH Spectrum (Dentsply);G2 ? Esthet-X (Dentsply); G3 ? Opallis (FGM); G4 ? Filtek Z250 (3MEspe); G5 ? Natural Look (DFL); G6 ? Master Fill (Biodinâmica); G7? Filtek Z350 (3M Espe); G8 ? Filtek Supreme XT (3M Espe). Cadaresina composta foi inserida em uma matriz metálica de 7 mm de diâmetro interno e 2 mm de altura e prensada por duas placas devidro e matrizes de poliéster. Em seguida, elas foram fotoativadas emsomente uma das superfícies com o aparelho de luz halógena OptilightPlus (Gnatus), com intensidade de luz de 500 ± 10mW/cm2, seguindoseas recomendações dos respectivos fabricantes. Logo após os corposde prova foram polidos e, depois de 24 horas, levados ao microscópioeletrônico de varredura para mensuração da fenda de contração depolimerização, medida em quatro pontos da amostra, em posiçõescorrespondentes a 3, 6, 9 e 12 horas. Submeteram-se os resultados àanálise de variância e ao teste de Tukey ao nível de significância de 5%.Resultados: A maior média de fenda de contração de polimerizaçãofoi observada com o compósito Filtek Z350 (3M Espe), enquanto omenor valor médio foi associado à resina composta Natural Look (DFL).Conclusão: Diferenças nas matrizes orgânicas, bem como no conteúdode carga, interferiram significativamente na fenda de contração depolimerização de compósitos universais.

de prova foram polidos e, depois de 24 horas, levados ao microscópioeletrônico de varredura para mensuração da fenda de contração depolimerização, medida em quatro pontos da amostra, em posiçõescorrespondentes a 3, 6, 9 e 12 horas. Submeteram-se os resultados àanálise de variância e ao teste de Tukey ao nível de significância de 5%.Resultados: A maior média de fenda de contração de polimerizaçãofoi observada com o compósito Filtek Z350 (3M Espe), enquanto omenor valor médio foi associado à resina composta Natural Look (DFL).Conclusão: Diferenças nas matrizes orgânicas, bem como no conteúdode carga, interferiram significativamente na fenda de contração depolimerização de compósitos universais.AbstractIntroduction: Composite resins are the major direct restorative materialused in daily dental practice nowadays. However, some aspects of thismaterial need further investigation, such as polymerization shrinkage.Objective: To investigate the polymerization shrinkage gap of differentuniversal composite resins. Material and methods: Experimentalgroups comprised eight commercially available composite resins (n=5),as follows: G1 ? TPH Spectrum (Dentsply); G2 ? Esthet-X (Dentsply);G3 ? Opallis (FGM); G4 ? Filtek Z250 (3M Espe); G5 ? Natural Look(DFL); G6 ? Master Fill (Biodinamica); G7 ? Filtek Z350 (3M Espe);G8 ? Filtek Supreme XT (3M Espe). Each composite was inserted intoa circular brass mold (7-mm diameter; 2-mm height), covered with apolyester strip, and then pressed by two glass plates. Following, thespecimens were light-cured through only one of the surfaces by usinga conventional halogen light device (Optilight Plus, Gnatus), withlight intensity of 500 ± 10mW/cm2, according to the manufacturer?sinstructions. Then, the samples were polished, and, after 24 hours, thepolymerization shrinkage gaps were measured by scanning electronicmicroscopy. The measurements were performed at four points (3, 6,9, and 12 o?clock). Data were submitted to analysis of variance andTukey?s test with 5% of confidence level. Results: Filtek Z350 (3M Espe)showed the highest mean of polymerization shrinkage gap, while NaturalLook (DFL) presented the lowest mean. Conclusion: Differences in theorganic matrix, as well as in the filler content, significantly affected thepolymerization shrinkage gap of universal composite resins.

Tetrasomy 8 in a patient with chronic lymphocytic leukemia.

We report a case of a 47-year-old man diagnosed with chronic lymphocytic leukemia (CLL) with two extra copies of chromosome 8. Classical cytogenetic analysis by the immunostimulatory combination of DSP30 and interleukin 2 showed tetrasomy of chromosome 8 in 60% of the metaphase cells (48,XY,+8,+8[12]/46,XY[8]). Spectral karyotype analysis confirmed the abnormality previously seen by G banding. Additionally, interphase fluorescence in situ hybridization using an LSI CEP 8 probe performed on peripheral blood cells without any stimulant agent showed tetrasomy of chromosome 8 in 54% of analyzed cells (108 of 200). To our knowledge, tetrasomy 8 as the sole chromosomal abnormality in CLL has not been previously described. The prognostic significance of tetrasomy 8 in CLL remains to be elucidated. However, the patient has been followed up in the outpatient hospital since 2004 without any therapeutic intervention and has so far remained stable.

Comparação dos efeitos da cirurgia ortognática de avanço mandibular com ou sem mentoplastia de avanço nas posições do osso hioide, da língua e no tamanho da orofaringe / Comparison of the effects of the orthognathic surgery of the mandible advance with or without advance mentoplasty in the hyoid bone, of the tongue and the size of the oropharynx

Como a cirurgia ortognática de avanço mandibular pode trazer benefícios aos pacientes com má-oclusão Classe II esquelética, que são mais propensos a desenvolverem quadros de apneia e hipopneia obstrutiva do sono, esta pesquisa teve a finalidade de avaliar a influência da cirurgia de avanço mandibular com ou sem mentoplastia de avanço, no tamanho da orofaringe e nas posições do osso hioide e da língua. A amostra deste estudo constou de 40 telerradiografias cefalométricas laterais de indivíduos do gênero masculino ou feminino, portadores de classe II esquelética, que se submeteram à cirurgia ortognática de avanço mandibular associada ou não à mentoplastia de avanço. Destas radiografias, 20 retratavam o período pré-cirúrgico (T0) e 20 o pós-cirúrgico (T1). Em seguida, realizaram-se traçados e medições, avaliando-se as distâncias entre as marcações com um paquímetro digital. Verificaram-se diferenças estatisticamente significantes entre T0 e T1 quanto à posição lingual. Esta se apresentou posicionada mais inferior (P<0,05) e anteriormente, aumentando o tamanho da orofaringe (P<0,01). A avaliação do osso hioide, contudo, não mostrou diferenças estatisticamente significantes. Porém, em T1, 17 pacientes apresentaram o osso hioide em posição mais anterior e 12 em posição mais superior. Houve aumento do espaço aéreo da orofaringe com o posicionamento da língua mais ântero-inferior. O osso hioide se movimentou para frente e para cima, na maioria dos casos, apesar de não haver diferença estatística. Além disso, não houve diferenças entre os pacientes que se submeteram à cirurgia de avanço isolado ou associado à mentoplastia de avanço.

As orthognathic surgery of mandibular advancement can bring benefits to patients with skeletal Class II malocclusion, which are more prone to develop frameworks for obstructive sleep apneahypopnea sleep, this research had the purpose to evaluate the influence of surgery for mandibular advancement with or without mentoplasty in advance, the size of the oropharynx and the positions of the hyoid bone and tongue. The sample consisted of 40 lateral cephalometric teleradiographs individuals’ male or female, individuals with skeletal Class II, submitted to orthognathic surgery for mandibular advancement associated or not with mentoplasty in advance. These radiographs, 20 portrayed the pre-surgery (T0) and 20 post-surgery (T1). Then there were tracings and measurements, is evaluating the distances between the markings with a digital caliper. There were statistically significant differences between T0 and T1 on the tongue position. This is showing lower (P <0.05) and earlier, increasing the size of the oropharynx (P <0.01). The assessment of the hyoid bone, however, showed no statistically significant differences. However, in T1, 17 patients had the hyoid bone in place earlier and 12 more in a position higher. There were increasing the airspace of the oropharynx with the placement of language most antero-inferior. The hyoid bone is moved forward and upward, in most cases, although no statistical difference. Furthermore, there was no difference between patients who underwent the surgery in advance alone or associated with mentoplasty in advance.

Aspectos odontológicos en paciente portador del síndrome de Mobius: relato de caso / Dental aspects of a patient with Mobius syndrome: case report

El síndrome de Mobius se caracteriza por la parálisis congénita y no progresiva de los nervios craneanos facial y abducentes cuyas manifestaciones clínicas principales son la apariencia facial estática y poco expresiva, el estrabismo bilateral convergente y la hipoplasia de miembros, entre otras. En la cavidad bucal puede observarse micrognacia, implantación heterotrófica de la lengua, anquiloglosia, úvula bífida, fisura palatina y anomalías dentales. La etiología del síndrome de Mobius es poco conocida y algunos relatos de la literatura señalan, como la hipótesis más probable, una isquemia fetal transitoria, durante el período de formación de los núcleos craneanos. Los posibles factores causales de esta isquemia serian los de orden ambiental, los disturbios fisiopatológicos y genéticos, o el uso ilícito de drogas como el Misoprostol, durante la gestación. El presente trabajo relata el tratamiento odontológico realizado en una paciente portadora de este síndrome enfatizando las particularidades observadas durante la atención, en función de las características propias de esa entidad clínica

Mobius syndrome is characterized by congenital and non-progressive paralysis of the facial and abducent cranial nerves. The principal manifestations of this syndrome are lack of facial expression, convergent bilateral strabismus and hypoplastic members. The oral findings include micrognatia, heterotrophic implantation of the tongue, ankyloglossia, bifid uvula, cleft palate and dental anomalies. The etiology of Mobius syndrome is unknown and some reports relate, as a main cause, the transitory fetal ischemia during the formation of cranial nucleus. The factors that lead to this ischemia are from ambient, physiopathological or genetic disturbs and use of drugs like Misoprostol during the pregnancy. This paper reports the dental treatment of a female patient with Mobius syndrome, emphasizing the peculiarities observed due to the characteristics of this clinical entity

Heat induced changes to dental resin composites: a reference in forensic investigations?

The objective was to investigate color change and surface damage in dental resin composites exposed to high temperatures over different time intervals for comparative purposes. Samples were prepared using two resins - Z100(R) (R1) and Charisma (R2), heated at the following temperatures: 200 degrees C, 400 degrees C, 600 degrees C, 1000 degrees C, for 15, 30 and 45 min (n = 104 for each resin sample). Color (DeltaE) and brightness (DeltaL) changes were analyzed by spectrophotometry using the CIE Lab system and surface changes by Scanning Electron Microscopy (SEM). R1 showed more intense color changes after heat exposure than R2. DeltaL values were found to be the best parameter for evaluation of light and color change. A biphasic pattern after thermal exposure was detected, from dark brown to light white. SEM showed more intense alterations in R2 than in R1. These results indicate that the parameters observed in both resins are useful as a guide in forensic analyses.