Zika virus congenital microcephaly severity classification and the association of severity with neuropsychomotor development.

BACKGROUND: Zika virus infection during pregnancy is linked to birth defects, most notably microcephaly, which is associated with neurodevelopmental delays. OBJECTIVE: The goals of the study were to propose a method for severity classification of congenital microcephaly based on neuroradiologic findings of MRI scans, and to investigate the association of severity with neuropsychomotor developmental scores. We also propose a semi-automated method for MRI-based severity classification of microcephaly. MATERIALS AND METHODS: We conducted a cross-sectional investigation of 42 infants born with congenital Zika infection. Bayley Scales of Infant and Toddler Development III (Bayley-III) developmental evaluations and MRI scans were carried out at ages 13-39 months (mean: 24.8 months; standard deviation [SD]: 5.8 months). The severity score was generated based on neuroradiologist evaluations of brain malformations. Next, we established a distribution of Zika virus-microcephaly severity score including mild, moderate and severe and investigated the association of severity with neuropsychomotor developmental scores. Finally, we propose a simplified semi-automated procedure for estimating the severity score based only on volumetric measures. RESULTS: The results showed a correlation of r=0.89 (P<0.001) between the Zika virus-microcephaly severity score and the semi-automated method. The trimester of infection did not correlate with the semi-automated method. Neuropsychomotor development correlated with the severity classification based on the radiologic readings and semi-automated method; the more severe the imaging scores, the lower the neuropsychomotor developmental scores. CONCLUSION: These severity classification methods can be used to evaluate severity of microcephaly and possible association with developmental consequences. The semi-automated methods thus provide an alternative for predicting severity of microcephaly based on only one MRI sequence.

Epilepsy after congenital zika virus infection: EEG and neuroimaging features.

PURPOSE: To describe epilepsy after congenital Zika virus infection (ZIKV) and its relationship with structural neuroimaging findings. METHODS: This was a cross-sectional study in children (aged 13-42 months) who were born with microcephaly due to ZIKV infection between 2015-2017. Patients underwent a brain imaging scan (magnetic resonance) and a video-EEG study. RESULTS: Among the patients (n = 43), 55.8 % were male, 88.4 % were born at term, mean head circumference at the birth was 29.7 ± 1.8 cm, and 44.8 % were infected in the first trimester of pregnancy. Neuroimaging was moderately abnormal in 30.2 % and severely abnormal in 46.5 % of patients. Early seizures (<6 months of age) were observed in 41.9 %. EEG background was abnormal when asleep or awake in 72.1 % and during sleep in 62.8 %. The interictal epileptogenic activity was recorded on 41/43 of the EEGs and was predominantly multifocal (62.8 %). An ictal EEG was obtained in 22 patients and 31.8 % had more than one seizure type. Sleep EEG (background) patterns, interictal epileptogenic activity (p = 0.046), interictal discharge localization (p = 0.015), type of ictal epileptogenic activity (p = 0.002), and localization of ictal discharge (p = 0.024) were significantly different between neuroimaging groups. The mild neuroimaging group had a higher chance of having more frequently normal sleep EEG patterns, no interictal epileptogenic activity and a further increase in the probability of walking without limitations, and less neurodevelopment delay. CONCLUSION: In patients with congenital Zika virus syndrome, epilepsy tended to be early and refractory. EEG features correlated with degree of neuroimaging abnormalities.

Linear measurement accuracy of CBCT panoramic reconstructions: experimental study with dry human mandibles.

INTRODUCTION: Studies on software accuracy of reformatted panoramic computed tomography (CT) images are scarce. OBJECTIVES: The aim of this study was to evaluate the software accuracy of reformatted panoramic views from cone-beam computed tomography (CBCT). METHODS: Ten dry mandibles were scanned using CBCT with different voxel sizes. Following the reconstruction of panoramic views with three different software, horizontal and vertical linear measurements were performed using the electronic rules of each software. Measurements of the corresponding dry mandibles were taken with a digital caliper and defined as the gold standard. RESULTS: There were no statistically significant differences in linear distances among the dry mandibles and reformatted panoramic CT views. The relative error ranged from 1.3 to 8.0%, depending on the software and voxel size. CONCLUSIONS: The linear measurements on reformatted panoramic views are reliable.

Migration of Oxidized Cellulose to the Ventricle as a Complication of Endoscopic Third Ventriculostomy: A Case Report

Endoscopic third ventriculostomy (ETV) is an increasingly common neurosurgical procedure. Hemostatic agentes (porcine gelatin and oxidized cellulose) are normally placed to plug the cortical hole after ETV to avoid cerebral spinal fluid leakage, subdural hygroma, and hemorrhage. Here we report the case of a 6-year-old boy with hydrocephalus who underwent ETV and which oxidized cellulose was placed to plug the cortical hole.Magnetic resonance imaging of the head performed 3 months after the procedure showed the presence of oxidized cellulose in the ventricle. After an unsuccessful attempt to remove the cellulose, it was decided that the patient should be kept under observation. Twoyears later, the child is in good health and without any complaints. Hemostatic agents (especially oxidized cellulose) used on the cortical hole after ETV can migrate to the ventricle and compromise the procedure. Follow-up should be performedfor such patients, and the main focus should be on not causing further injury.

Tratamento cirúrgico de anquilose temporo-mandibular utilizando o disco articular como material de interposição / Ankylosis temporomandibular surgical treatment using disc as joint filing of material

A anquilose da articulação temporomandibular (A.T.M) é à união do complexo disco-côndilo à superfície articular do osso temporal. A anquilose da A.T.M possui etiologia multifatorial, sendo trauma associada a fratura condilar a causa mais comum. A anquilose causa diversos distúrbios funcionais nos pacientes acometidos, principalmente limitação de abertura bucal reduzindo a capacidade de mastigar. O diagnóstico é feito pela correlação dos aspectos clínicos e imaginológicos. Existem diversos relatos na literatura sobre o tratamento e a abordagem cirúrgica para anquilose da A.T.M, porém o primordial é remover totalmente a massa anquilótica. O objetivo do presente artigo é relatar um caso de tratamento cirúrgico da anquilose da ATM, com interposição do próprio disco articular, devolvendo ao paciente as funções importantes relacionadas à movimentação mandibular

The ankylosis of the temporomandibular joint (TMJ) is the union of the complex disk-condyle to the articular surface of the temporal bone. Ankylosis of the TMJ has a multifactorial etiology, trauma associated with condylar fractures the most common cause. The ankylosis cause various functional disorders in affected patients, especially mouth opening limitation reducing the ability to chew. The diagnosis is made by the correlation of clinical and imaging aspects. There are several reports in the literature on the treatment and surgical approach for ankylosis of TMJ, but the primary is fully remove the anquilótica mass. The objective of this study is to report a case of surgical treatment of TMJ ankylosis, with interposition of the articular disc itself, returning to the patient the important functions related to mandibular movement

Dimensional error of three-dimensional images generated by different software.

The aim of this study was to evaluate the accuracy of three-dimensional (3D) reconstructions generated by different software, computed tomography (CT) scanners and slice thicknesses. Ten human dry mandibles were scanned by CT and cone beam CT (CBCT). Digital files were processed in different software systems and 3D reconstructions were performed. Linear measures were made and compared. The results showed significant differences in linear distances between the human dry mandibles and their 3D reconstructions. The relative error from CBCT images ranged from 3.10 to 4.82% and from 3.40 to 5.92% in CT images. It is important to consider that the performance of the software is not just related to the algorithm used, but mostly with its handling, that can facilitate or not the measurement by the operator. In conclusion, the discrepancies were not greater than 0.58 mm, so they should not affect the image quality.

Tratamento de defeitos alveolares verticais pela técnica de distração osteogênica / Treatment of vertical alveolar defects by means of osteogenic distraction technique

Introdução: a reconstrução alveolar de defeitos ósseos verticais ainda constitui um desafio dentro da Implantodontia. Dentre as diversas técnicas empregadas para a correção de tais defeitos, está a distração osteogênica, a qual tem sido descrita como uma técnica empregada para ganho de tecido ósseo e tecidos moles, sobretudo em cirurgias para reconstrução de rebordos alveolares mandibulares e maxilares, com a finalidade de permitir a instalação de implantes osseointegrados bem posicionados e com maior previsibilidade de sucesso quando submetidos a cargas funcionais. Objetivo: o propósito desse estudo foi avaliar a efetividade do procedimento em dois pacientes tratados pela técnica de distração osteogênica alveolar Relato de caso: os casos clínicos foram avaliados quanto ao ganho ósseo através de exame clínico e radiográfico, pré e pós-distração. Resultados: em ambos os casos, constatou-se, ao final do tratamento, ganho ósseo suficiente para posterior reabilitação com implantes. Conclusão: o sucesso relatado na literatura e nos casos apresentados comprova a eficiência da técnica e sua viabilidade clínica.

Introduction: Alveolar reconstruction of vertical bone defects remains a daunting challenge in implant dentistry. Among the various techniques used to correct such defects is distraction osteogenesis (DO), which has been described as a technique used to gain bone and soft tissues, especially in surgeries for reconstruction of mandibular and maxillary alveolar ridges to allow the placement of dental implants in a favorable position and with greater success predictability when subjected to functional loads. Objective: The purpose of this studywas to evaluate the effectiveness of DO in two patients treated with the technique of alveolar distraction osteogenesis. Case report: The clinical cases were evaluated for bone gain through clinical and radiographic examination, pre- and post-distraction. Results: At the end of treatment, both cases had gained sufficient bone as to enable subsequent rehabilitation with implants. Conclusions: The success rate reported in the literature and in the cases presented here prove the efficiency of the technique and its clinical feasibility.

Morphometry MRI in the differential diagnosis of parkinsonian syndromes.

This study evaluates the diagnostic value of morphometric magnetic resonance imaging (MRI) in the differential diagnosis among Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). We studied 21 PD cases, 11 MSA-c, 8 MSA-p and 20 PSP cases. Midbrain area (Ams), pons area (Apn), middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP) were measured using MRI. Comparisons were made between PD, MSA-p, MSA-c and PSP. Apn, MCP and SCP morphometry dimensions presented differences among groups. Ams below 105 mm(2) and SCP smaller than 3 mm were the most predictive measures of PSP (sensitivity 95.0 and 80.0%, respectively). For the group of MSA-c patients, Apn area below 315 mm(2) showed good specificity and positive predictive value (93.8% and 72.7%, respectively). In conclusion, dimensions and cut off values obtained from routine MRI can differentiate between PD, PSP and MSA-c with good sensitivity, specificity and accuracy.

Morphometry MRI in the differential diagnosis of parkinsonian syndromes / Morfometria por ressonância magnética no diagnóstico diferencial das síndromes parkinsonianas

This study evaluates the diagnostic value of morphometric magnetic resonance imaging (MRI) in the differential diagnosis among Parkinson's disease (PD), progressive supranuclear palsy (PSP) and multiple system atrophy (MSA). We studied 21 PD cases, 11 MSA-c, 8 MSA-p and 20 PSP cases. Midbrain area (Ams), pons area (Apn), middle cerebellar peduncle (MCP) and superior cerebellar peduncle (SCP) were measured using MRI. Comparisons were made between PD, MSA-p, MSA-c and PSP. Apn, MCP and SCP morphometry dimensions presented differences among groups. Ams below 105 mm² and SCP smaller than 3 mmwere the most predictive measures of PSP (sensitivity 95.0 and 80.0 percent, respectively). For the group of MSA-c patients, Apn area below 315 mm² showed good specificity and positive predictive value (93.8 percent and 72.7 percent, respectively). In conclusion, dimensions and cut off values obtained from routine MRI can differentiate between PD, PSP and MSA-c with good sensitivity, specificity and accuracy.

Morfometria pela ressonância magnética (RM) no diagnóstico diferencial entre doença de Parkinson (DP), paralisia supranuclear progressiva (PSP) e atrofia de múltiplos sistemas (AMS). Este estudo avaliou a RM no diagnóstico diferencial de 21 casos com DP, 11 AMS-c, 8 AMS-p e 20 com PSP. A área sagital do mesencéfalo (Ams), área sagital da ponte (Apn), largura do pedúnculo cerebelar médio (PCM) e pedúnculo cerebelar superior (PCS) foram medidas pela RM e realizadas comparações entre destes pacientes. A Ams <105 mm² e a largura média do PCS <3 mm foram preditivas para PSP (sensibilidade de 95,0 e 80,0 por cento, respectivamente). Nos casos de AMS-c a área pontina <315 mm² apresentou boa especificidade e valor preditivo positivo para o diagnóstico (93,8 por cento e 72,7 por cento). Em conclusão, as dimensões e valores de cortes obtidos a partir da RM podem diferenciar PD, PSP e AMS-c, com sensibilidade, especificidade e precisão.

Sleep disturbances and brain MRI morphometry in Parkinson's disease, multiple system atrophy and progressive supranuclear palsy - a comparative study.

Despite common reports in Parkinson's disease (PD), in other parkinsonian syndromes, sleep disturbances have been less frequently described. This study evaluated and compared sleep disturbances in patients with PD, multiple system atrophy (MSA) and progressive supranuclear palsy (PSP) and analyzed associations with brain magnetic resonance imaging (MRI) morphometry. This was a cross-sectional study of 16 PD cases, 13 MSA, 14 PSP and 12 control. Sleep disturbances were evaluated by Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), Restless Legs Scale and Berlin questionnaire. Pons area, midbrain area, medial cerebellar peduncle (MCP) width, and superior cerebellar peduncle width were measured using MRI. Poor quality sleep, risk of obstructive sleep apnea (OSA) and restless legs syndrome (RLS) were detected in all groups. Patients with MSA showed higher risk of OSA and less frequent RLS. In MSA, a correlation between PSQI scores and Hoehn and Yahr stage was observed (p<0.05). In PSP, RLS was frequent (57%) and related with reduced sleep duration and efficiency. In PD, excessive daytime sleepiness was related to atrophy of the MCP (p=0.01). RLS was more frequent in PD and PSP, and in PSP, was associated with reduced sleep efficiency and sleep duration. Brain morphometry abnormalities were found in connection with excessive daytime sleepiness and risk of OSA in PD and PSP suggesting widespread degeneration of brainstem sleep structures on the basis of sleep abnormalities in these patients.

Hábitos de higiene bucal e dieta de adolescentes de escolas públicas e privadas em Salvador, Bahia / Habits of oral hygiene and diet of adolescents of public and private schools in Salvador, Bahia

Objetivo: Obter informações acerca desses hábitos. Material e métodos: Aplicou-se um questionário estruturado para 1035 adolescentes de escolas públicas e privadas no município de Salvador-Bahia. Os dados foram consolidados no SPSS, versão 7.5. Resultados: Segundo os resultados, as razões pelas quais eles escovam os dentes são: revenção de cárie (54,8%) ou outras doenças (14,7%), higiene (43,9%), hálito bom (33,2%), estética (19,7%) e convívio social (3,3%). A maioria (98,5%), escova os dentes todos os dias, e destes, 67,4% escova três ou mais vezes ao dia. Quanto ao uso do fio dental, 33,8% não o utilizam e dos 66,2% que relataram usá-lo, 51,5% o fazem de vez em quando. Relativo à dieta 58% responderam que lancham mais de três vezes ao dia e dentre os alimentos mais consumidos estão os doces, salgadinhos e refrigerantes. Conclusão: Concluímos que os adolescentes relataram boa rotina de escovação, entretanto o uso do fio dental não se constitui em um hábito. Os alimentos consumidos são altamente cariogênicos e a freqüência de consumo é alta. É imprescindível, desse modo, o desenvolvimento de programas de promoção de saúde bucal paraesse grupo populacional.

Objective: Thus, the proposal of this work was to get information about these habits. Material and methods: A structuralized questionnaire was applied to 1035 adolescents of public and private schools in the city of Salvador-Bahia. The data had been consolidated in the SPSS, version 7.5.Results: According to the results, the reasons for which they brush teeth are: prevention of caries (54,8%) or other oral diseases (14,7%), hygiene (43,9%), good breath (33,2%), aesthetic (19,7%) and social conviviality (3,3%). The majority (98,5%), brushes teeth every day, and of these, 67.4% brush three or more times on a day. 33.8% do not use dental wireand 66.2% of those that had told to use it, 51.5% only do it sometimes. Relative to diet, 58% answered that they eat snacks more than tree times a day and among the consumed foods most of them are the candies, chips and soda. Conclusion: We conclude that the adolescents had a goodroutine of teeth brushing; however the use of the dental wire does not consist in a habit. The consumed foods are of high cariogenic potential and the consumption frequency is high. It is essential, in this way, the development of programs to promote oral health for this population group.

Horizontal gaze palsy with progressive scoliosis: CT and MR findings.

Horizontal gaze palsy with progressive scoliosis (HGPPS) is a rare congenital disorder characterized by absence of conjugate horizontal eye movements and progressive scoliosis developing in childhood and adolescence. We present a child with clinical and neuroimaging findings typical of HGPPS. CT and MRI of the brain demonstrated pons hypoplasia, absence of the facial colliculi, butterfly configuration of the medulla and a deep midline pontine cleft. We briefly discuss the imaging aspects of this rare entity in light of the current literature.

Profilaxia antimicrobiana pré-operatória: avaliação dos critérios empregados por cirurgiões-dentistas na cidade de Salvador-Ba / Prior surgical antibiotic prophylaxis: evaluation of criterions used by dentists, in Salvador-Ba

A prescrição de antimicrobianos é necessária quando da realização de inúmeros procedimentos odontológicos. No entanto, o uso indiscriminado destes medicamentos pode trazer conseqüencias negativas, com risco para a saúde do paciente e a geração de microorganismos resistentes. Existe uma grande variação de protocolos recomendados, mas pouca base científica para as recomendações. O modo de tratar as infecções é frequentemente empírico, gerando muitas vezes prescrições inadequadas. O objetivo deste estudo foi avaliar os critérios utilizados por uma amostra de cirurgiões-dentistas, da cidade de Salvador-BA, quanto à prescrição de antimicrobianos de forma profilática, antes da intervenção cirúrgica, e determinar quais as drogas mais empregadas e sob qual regime terapêutico. Para isso, foram aplicados questionários a profissionais que atuam nas áreas de clínica geral, cirurgia e traumatologia bucomaxilofacial, endodontia e periodontia. No total foram avaliados 103 questionários. Os resultados revelaram que a amoxicilina é o antimicrobiano de primeira escolha para a maioria dos profissionais e que apenas 33 por cento dos entrevistados empregam corretamente o protocolo de profilaxia antibiótica pré-operatória, segundo a American Heart Association (AHA)