Clinical correlation between automated vision screening under cycloplegia and retinoscopy in young children / Correlação clínica entre triagem visual automatizada sob cicloplegia e retinoscopia em crianças pequenas

ABSTRACT Purpose: To evaluate the clinical performance of the Spot Vision Screener and establish clinical correlations between automated screening and retinoscopy following induction of cycloplegia in preverbal children. Methods: In this prospective, cross-sectional study, children aged 6-36 months were evaluated using the Spot Vision Screener. A complete ophthalmologic examination, including cycloplegic refraction assessment, was performed, followed by repeat spot vision screening and retinoscopy in all cases to establish correlations regarding hypermetropia, myopia, and astigmatism following induction of induction cycloplegia. Results: The study included 185 children. The sensitivity of the automated screener after cycloplegia was 100% (95%CI: 85.18-100%), and specificity was 87.04% (95%CI: 80.87-91.79%). Positive and negative predictive values were 52.27% (42.36-62.01%) and 100%, respectively. Compared to retinoscopy, the Spot Vision Screener overestimated spherical values by 0.62 D (95%CI: 0.56-0.69) in the right eye and by 0.60 (95%CI: 0.54-0.66) in the left eye and cylindrical values by -0.38 D in the right eye (95%CI: -0.42--0.33) and by -0.39 D in the left eye (95%CI: -0.43--0.34). For overall spherical and cylindrical values, the difference was 0.61 D (95%CI: 0.57-0.65) and -0.38 D (95%CI: -0.41--0.35) in the left and right eyes, respectively. Conclusion: A substantial correlation was found between retinoscopy and objective data captured by the device. This shows that technology can be used in conjunction, reaching a more accurate diagnosis and identifying amblyopia risk factors as early as possible. Photoscreening may make a difference at the population level for early screening and intervention.

RESUMO Objetivo: Avaliar o desempenho clínico do Spot Vision Screener e estabelecer correlações clínicas entre a triagem automatizada e a retinoscopia após indução de cicloplegia em crianças pré-verbais. Métodos: Neste estudo transversal prospectivo, crianças de 6 a 36 meses foram avaliadas usando o Spot Vision Screener. O exame oftalmológico completo, incluindo refração cicloplégica, foi então realizado, seguido de repetição da triagem automatizada e retinoscopia em todos os casos, a fim de estabelecer correlações quanto à hipermetropia, miopia e astigmatismo após a indução de cicloplegia. Resultados: O estudo incluiu 185 crianças. A sensibilidade do dispositivo de triagem automática após cicloplegia foi de 100% (IC 95%: 85,18-100%) e a especificidade foi de 87,04% (IC 95%: 80,87-91,79%). Os valores preditivos positivos e negativos foram de 52,27% (42,36 - 62,01%) e 100%, respectivamente. Em comparação com a retinoscopia, o Spot Vision Screener superestimou os valores esféricos em 0,62 D (IC 95%: 0,56 - 0,69) no olho direito e em 0,60 (IC 95%: 0,54 - 0,66) no olho esquerdo e os valores cilíndricos em -0,38 D (IC 95%: -0,42 a -0,33) no olho direito e por -0,39 D (IC 95%: -0,43 a -0,34) no olho esquerdo. A diferença para os valores esféricos e cilíndricos de forma geral foi de 0,61 D (IC 95%: 0,57 - 0,65) e -0,38 D (IC 95%: -0,41 a -0,35), respectivamente. Conclusão: Foi encontrada correlação substancial entre a retinoscopia e os dados objetivos captados pelo dispositivo. Isso mostra que a tecnologia pode ser usada em conjunto, contribuindo para um diagnóstico mais preciso e identificando os fatores de risco de ambliopia o mais precocemente possível. A técnica automatizada pode fazer a diferença em nível populacional para triagem e intervenção precoce.

OCT to identify macular changes not clinically detectable in elderly patients with cataract.

PURPOSE: To demonstrate the importance of optical coherence tomography (OCT) in identifying macular changes not detected at clinical examination preceding cataract surgery in patients older than 60 years. SETTING: Hospital Oftalmológico Visão Laser, Santos, São Paulo, Brazil. DESING: Prospective case series. METHODS: Patients older than 60 years were selected for this cross-sectional prospective study conducted during preoperative examination for cataract surgery. Eyes with a previous diagnosis or clinical evidence of macular disease or with media opacity preventing OCT from being performed were excluded from the study. All the study participants underwent OCT and were then divided into 2 groups: patients with macular changes and patients without macular changes found on OCT. RESULTS: Of 364 eyes screened (212 patients), 300 eyes (180 patients) were included in the study. OCT identified macular changes in 40 eyes (13.3%), with age-related macular degeneration being found in 13 eyes (4.3%), epiretinal membrane in 12 eyes (4%), intraretinal fluid in 12 eyes (4%), and macular hole in 3 eyes (1%). In the group with macular changes, the mean age was 74.4 ± 6.3 years compared with 70.4 ± 6.7 years for those without changes ( P < .001). CONCLUSIONS: OCT proved an effective method for identifying macular diseases not detected at clinical evaluation before cataract surgery. Therefore, the relevance of performing OCT in these cases was confirmed and should be taken into consideration, particularly when evaluating patients older than 60 years.

Clinical correlation between automated vision screening under cycloplegia and retinoscopy in young children.

PURPOSE: To evaluate the clinical performance of the Spot Vision Screener and establish clinical correlations between automated screening and retinoscopy following induction of cycloplegia in preverbal children. METHODS: In this prospective, cross-sectional study, children aged 6-36 months were evaluated using the Spot Vision Screener. A complete ophthalmologic examination, including cycloplegic refraction assessment, was performed, followed by repeat spot vision screening and retinoscopy in all cases to establish correlations regarding hypermetropia, myopia, and astigmatism following induction of induction cycloplegia. RESULTS: The study included 185 children. The sensitivity of the automated screener after cycloplegia was 100% (95%CI: 85.18-100%), and specificity was 87.04% (95%CI: 80.87-91.79%). Positive and negative predictive values were 52.27% (42.36-62.01%) and 100%, respectively. Compared to retinoscopy, the Spot Vision Screener overestimated spherical values by 0.62 D (95%CI: 0.56-0.69) in the right eye and by 0.60 (95%CI: 0.54-0.66) in the left eye and cylindrical values by -0.38 D in the right eye (95%CI: -0.42--0.33) and by -0.39 D in the left eye (95%CI: -0.43--0.34). For overall spherical and cylindrical values, the difference was 0.61 D (95%CI: 0.57-0.65) and -0.38 D (95%CI: -0.41--0.35) in the left and right eyes, respectively. CONCLUSION: A substantial correlation was found between retinoscopy and objective data captured by the device. This shows that technology can be used in conjunction, reaching a more accurate diagnosis and identifying amblyopia risk factors as early as possible. Photoscreening may make a difference at the population level for early screening and intervention.

Correlation between fatigue and quality of life self-reported by adolescents with cerebral palsy.

OBJECTIVES: to investigate the correlation between fatigue and quality of life in adolescents with cerebral palsy who are susceptible to more significant fatigue and lower quality of life. METHODS: cross-sectional study conducted with 101 adolescents with cerebral palsy. Instruments such as the Pediatric Quality of Life Inventory and Gross Motor Function Classification System were used, and Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests were applied. RESULTS: older adolescents self-reported higher fatigue levels, and female adolescents, quadriplegic, with worse motor function, older, and not attending school had lower quality of life scores. Higher fatigue levels correlated with lower quality of life in all domains (p<0.01), especially in tiredness (general and mental) and functioning (social, academic, and psychosocial). CONCLUSIONS: fatigue correlated negatively with the quality of life of adolescents with cerebral palsy, showing that the higher the level of fatigue, the more compromised is the adolescents' life.

Nevo azul agminado sobre cicatrizes de acne: coincidência ou relação fisiopatológica? / Agminated blue nevus over acne scars: coincidence or pathophysiological relationship?

Nevo azul é uma lesão benigna originada de melanócitos dérmicos contendo grande quantidade de melanina. A variante agminada apresenta-se como um agrupamento de lesões de nevo azul com distribuição linear ou blaschkoide. Relatamos dois casos de pacientes com nevo azul agminado que surgiu sobre cicatrizes prévias de acne, sendo a dermatoscopia de grande auxílio para diagnóstico diferencial. Esta é a primeira ocorrência relatada de nevo azul agminado sobre cicatrizes prévias, o que pode ter ocorrido ao acaso ou em decorrência do processo de remodelamento do colágeno, próprio do processo cicatricial.

Blue nevus is a benign lesion arising from dermal melanocytes containing large amounts of melanin. The agminated variant presents a cluster of blue nevus lesions with linear or blaschkoid distribution. We report two cases of patients with agminated blue nevus that developed on previous acne scars, and dermoscopy helped a lot in the differential diagnosis. This is the first occurrence found in the literature of agminated blue nevus that appeared on a previous scar,

Correlation between fatigue and quality of life self-reported by adolescents with cerebral palsy / Correlación entre fatiga y calidad de vida de autoinformes de adolescentes con parálisis cerebral / Correlação entre fadiga e qualidade de vida autorrelatadas por adolescentes com paralisia cerebral

ABSTRACT Objectives: to investigate the correlation between fatigue and quality of life in adolescents with cerebral palsy who are susceptible to more significant fatigue and lower quality of life. Methods: cross-sectional study conducted with 101 adolescents with cerebral palsy. Instruments such as the Pediatric Quality of Life Inventory and Gross Motor Function Classification System were used, and Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests were applied. Results: older adolescents self-reported higher fatigue levels, and female adolescents, quadriplegic, with worse motor function, older, and not attending school had lower quality of life scores. Higher fatigue levels correlated with lower quality of life in all domains (p<0.01), especially in tiredness (general and mental) and functioning (social, academic, and psychosocial). Conclusions: fatigue correlated negatively with the quality of life of adolescents with cerebral palsy, showing that the higher the level of fatigue, the more compromised is the adolescents' life.

RESUMEN Objetivos: investigar correlación entre fatiga y calidad de vida en adolescentes con parálisis cerebral y susceptibles a mayor fatiga y a menor calidad de vida. Métodos: estudio transversal conducido con 101 adolescentes con parálisis cerebral. Utilizado los instrumentos Pediatric Quality of Life Inventory y Gross Motor Function Classification System. Aplicadas las pruebas de Kolmogorov-Smirnov, Mann-Whitney y de Spearman. Resultados: adolescentes mayores informaron mayor nivel de fatiga; y adolescentes del sexo femenino, cuadripléjicos, con peor función motora, mayores y que no frecuentaban escuela presentaron menores escores de calidad de vida. Mayor nivel de fatiga se correlacionó con menor calidad de vida en todos los dominios (p<0,01), principalmente en agotamiento (general y mental) y en función (social, escolar y psicosocial). Conclusiones: la fatiga se correlacionó negativamente con la calidad de vida de adolescentes con parálisis cerebral, mostrando que, cuanto mayor el nivel de fatiga, más comprometida es la vida de los adolescentes.

RESUMO Objetivos: investigar a correlação entre fadiga e qualidade de vida em adolescentes com paralisia cerebral e suscetíveis à maior fadiga e à menor qualidade de vida. Métodos: estudo transversal conduzido com 101 adolescentes com paralisia cerebral. Utilizaram-se os instrumentos Pediatric Quality of Life Inventory e Gross Motor Function Classification System. Aplicaram-se os testes de Kolmogorov-Smirnov, Mann-Whitney e de Spearman. Resultados: adolescentes mais velhos autorrelataram maior nível de fadiga; e adolescentes do sexo feminino, quadriplégicos, com pior função motora, mais velhos e que não frequentavam escola apresentaram menores escores de qualidade de vida. Maior nível de fadiga correlacionou-se com menor qualidade de vida em todos os domínios (p<0,01), principalmente em cansaço (geral e mental) e em função (social, escolar e psicossocial). Conclusões: a fadiga correlacionou-se negativamente com a qualidade de vida de adolescentes com paralisia cerebral, mostrando que, quanto maior o nível de fadiga, mais comprometida é a vida dos adolescentes.

As consequências irreversíveis do diagnóstico tardio de macroadenoma de hipófise em paciente jovem / The irreversible consequences of late diagnosis of pituitary macroadenoma in a young patient

Resumo Os tumores de hipófise representam aproximadamente 15% de todos os tumores cerebrais e dependendo do tamanho, pressionam o quiasma óptico, resultando em comprometimento da função visual que se manifesta como defeitos no campo visual, diminuição da acuidade visual e da visão das cores. O objetivo do presente estudo foi relatar um caso de macroadenoma de hipófise com compressão do quiasma óptico e defeito no campo visual, tratado inicialmente como glaucoma, levando a um diagnóstico e tratamento tardio.

Abstract Pituitary tumors represent approximately 15% of all brain tumors and depending on size, pressure optic chiasma, resulting in impaired visual func-tion that manifests itself as defective in the visual field, decreased acuity visual and color vision. The ob-jetive of the present study was to report a case of pitui-tary macroadenoma with compression of optical chiasma and visual field de-fect, initially treated as glaucoma, leading to a late diagnosis and treatment.

Quality of life of adolescents with cerebral palsy: agreement between self-report and caregiver's report.

METHOD: to assess the quality of life (QOL) of adolescents with cerebral palsy (CP) by self-report and by the caregiver's report, and to analyze the agreement between these reports.cross-sectional study conducted with 101 adolescents with CP and 101 caregivers. Both answered the Pediatric Quality of Life Inventory (PedsQL), module 4.0 - Generic (PedsQL 4.0) and module 3.0 - PC (PedsQL 3.0). Agreement between reports was analyzed using the Mann-Whitney test and the intra-class correlation coefficient (ICC) (p<0.05). RESULTS: the lowest scores were in physical health, school activities and fatigue in the self-report. The lowest scores were in physical health and daily activities, in the caregivers' report. Perceptions among adolescents and caregivers differed in physical health, movement and equilibrium, daily and school activities, with a lower score for caregivers in all of them. The agreement between the self-report and the caregivers' report was poor (ICC<0.44) and in both instruments, the caregivers' report was less optimistic. CONCLUSION: physical health is the most impaired domain of the QOL of adolescents with CP, both in the self-report and in the caregivers' report. However, there is poor agreement between these reports, emphasizing that the use of the caregivers' report should be cautious.

Quality of life of adolescents with cerebral palsy: agreement between self-report and caregiver's report* / Qualidade de vida de adolescentes com paralisia cerebral: concordância entre autorrelato e relato do cuidador / Calidad de vida de adolescentes con parálisis cerebral: concordancia entre el autorrelato e el relato del cuidador

Objective: to assess the quality of life (QOL) of adolescents with cerebral palsy (CP) by self-report and by the caregiver's report, and to analyze the agreement between these reports. Method: cross-sectional study conducted with 101 adolescents with CP and 101 caregivers. Both answered the Pediatric Quality of Life Inventory (PedsQL), module 4.0 - Generic (PedsQL 4.0) and module 3.0 - PC (PedsQL 3.0). Agreement between reports was analyzed using the Mann-Whitney test and the intra-class correlation coefficient (ICC) (p<0.05). Results: the lowest scores were in physical health, school activities and fatigue in the self-report. The lowest scores were in physical health and daily activities, in the caregivers' report. Perceptions among adolescents and caregivers differed in physical health, movement and equilibrium, daily and school activities, with a lower score for caregivers in all of them. The agreement between the self-report and the caregivers' report was poor (ICC<0.44) and in both instruments, the caregivers' report was less optimistic. Conclusion: physical health is the most impaired domain of the QOL of adolescents with CP, both in the self-report and in the caregivers' report. However, there is poor agreement between these reports, emphasizing that the use of the caregivers' report should be cautious.

Objetivo: avaliar a qualidade de vida (QV) de adolescentes com paralisia cerebral (PC) pelo autorrelato e pelo relato do cuidador, e analisar a concordância entre estes relatos. Método: estudo transversal conduzido com 101 adolescentes com PC e 101 cuidadores. Ambos responderam o Pediatric Quality of Life Inventory (PedsQL), módulo 4.0 - Genérico (PedsQL 4.0) e módulo 3.0 - PC (PedsQL 3.0). A concordância entre os relatos foi analisada pelo teste de Mann-Whitney e pelo coeficiente de correlação intra classe (ICC) (p<0.05). Resultados: no autorrelato os menores escores foram em saúde física, atividades escolares e fadiga. No relato dos cuidadores as menores pontuações foram em saúde física e atividades cotidianas. As percepções entre adolescentes e cuidadores divergiram em saúde física, movimento e equilíbrio, atividades cotidianas e escolares, com menor escore dos cuidadores em todos eles. A concordância entre o autorrelato e o relato dos cuidadores foi pobre (ICC<0.44), e em ambos instrumentos o relato dos cuidadores foi menos otimista. Conclusão: a saúde física é o domínio mais prejudicado da QV de adolescentes com PC, tanto no autorrelato quanto no relato dos cuidadores. Porém há pobre concordância entre estes relatos, ressaltando que o uso do relato dos cuidadores deve ser cauteloso.

Objetivo: evaluar la calidad de vida (CV) de adolescentes con parálisis cerebral (PC) a partir del autorrelato y del relato del cuidador, y analizar la concordancia entre esos relatos. Método: estudio transversal, llevado a cabo con 101 adolescentes con PC y 101 cuidadores. Ambos contestaron el Pediatric Quality of Life Inventory (PedsQL), módulo 4.0 - Genérico (PedsQL 4.0) e módulo 3.0 - PC (PedsQL 3.0). La concordancia entre los relatos se analizó por el test de Mann-Whitney e por el coeficiente de correlación intra clase (ICC) (p<0.05). Resultados: en el autorrelato, los puntajes más bajos se dieron en salud física, actividades escolares y fatiga. En el relato de los cuidadores, los puntajes más bajos se dieron en salud física y actividades cotidianas. Las percepciones de los adolescentes y los cuidadores fueron divergentes en salud física, movimiento y equilibrio, actividades cotidianas y escolares, con un puntaje más bajo por parte de los cuidadores en todos esos rubros. La concordancia entre el autorrelato y el relato de los cuidadores fue pobre (ICC<0.44), y en ambos instrumentos el relato de los cuidadores fue menos optimista. Conclusión: la salud física es el dominio más perjudicado de la CV de los adolescentes con PC, tanto en el autorrelato como en el relato de los cuidadores. Sin embargo, la concordancia entre los dos relatos es deficiente, razón por la cual, el relato de los cuidadores debe realizarse con cautela.

Is it possible to obtain nanodispersions with jaboticaba peel's extract using low energy methods and absence of any high cost equipment?

Jaboticaba (Myrciaria cauliflora) is considered a "super fruit" due to its remarkable phenolic content and antioxidant capacity. Despite the great potential of its peels, to our knowledge the investigation of novel nanostructured systems with this natural raw material, still considered an industrial residue, is scarce. The present study aimed to obtain nanodispersions with its peel's extract through a low energy method. Antioxidant assays were performed, showing positive results for DPPH (IC50 = 0.89 µg/mL) and FRAP (225.53 µmol equivalent ferrous sulphate/g). The chemical characterization in terms of flavonoids (2.56%) and total monomeric anthocyanins (0.80%) contents were also performed. Overall, the nanodispersion prepared with the non-ionic surfactant polysorbate 85 and the hydroalcoholic extract standardized in ellagic acid (129 µg/mL) presented the best properties regarding particle size distribution and zeta potential. Thus, it opens perspectives for the generation of novel food-grade nanodispersions through an ecofriendly approach that is in accordance to sustainable concepts.

Extract from byproduct Psidium guajava standardized in ellagic acid: additivation of the in vitro photoprotective efficacy of a cosmetic formulation

ABSTRACT The fruits of guava, Psidium guajava L., Myrtaceae, are cultivated as food and used in agroindustries, generating byproducts or waste that represent environmental problems and require adequate destination. However, these byproducts present high levels of secondary metabolites and have been awakened interest regarding to its reusing. The extract was standardized in ellagic acid concentration by high performance liquid chromatography. The additivation capacity in the in vitro photoprotective efficacy of guava byproduct extract standardized in ellagic acid was verified as a result of its incorporation in cosmetic formulations, comparing it with a standard product. The extract presented synergy with the chemical UV filter (ethylhexyl methoxycinnamate), enhancing the solar protection factor of the phytocosmetic in 17.99%. Besides that, it was possible to show its antioxidant activity and the presence of secondary metabolites such as phenols and flavonoids. According to the results, it is possible to claim that the extract from the guava's agroindustrial byproducts present potential to be studied and reused, applying on the development of innovative products intended to the photoprotection care.

Patterns of periodontal disease progression based on linear mixed models of clinical attachment loss.

AIM: The goal of the present longitudinal cohort study was to examine patterns of periodontal disease progression at progressing sites and subjects defined based on linear mixed models (LMM) of clinical attachment loss (CAL). MATERIALS AND METHODS: A total of 113 periodontally healthy and 302 periodontitis subjects had their CAL calculated bimonthly for 12 months. LMMs were fitted for each site and the predicted CAL levels used to categorize their progression state. Participants were grouped based on the number of progressing sites into unchanged, transitional and active subjects. Patterns of periodontal disease progression were explored using descriptive statistics. RESULTS: Progression occurred primarily at molars (50% of progressing sites) and inter-proximal sites (72%), affected a higher proportion of deep than shallow sites (2.7% versus 0.7%), and pocketing was the main mode of progression (49%). We found a low level of agreement (47%) between the LMM and traditional approaches to determine progression such as change in CAL ≥3 mm. Fourteen per cent of subjects were classified as active and among those 93% had periodontitis. The annual mean rate of progression for the active subjects was 0.35 mm/year. CONCLUSION: Progressing sites and subjects defined based on LMMs presented patterns of disease progression similar to those previously reported in the literature.

MEDICIÓN DE LA ADHERENCIA AL LAVADO DE MANOS, SEGÚN LOS CINCO MOMENTOS DE LA OMS / MEASUREMENT OF HANDWASHING ADHERENCE, ACCORDING TO FIVE MOMENTS OF THE WHO

El contacto con objetos y personas en el entorno hospitalario favorece la propagación de gérmenes que amenazan a los pacientes; el lavado de manos es una estrategia clave para prevenir infecciones. En este estudio, transversal y cuantitativo, se midió la adherencia al lavado de manos en personal ambulatorio y de urgencias de Assbasalud ESE, según los cinco Momentos de la Higiene de las Manos de la OMS, y se evaluó el impacto después de impartir capacitación. Lo anterior se realizó en tres fases: precapacitación, capacitación y poscapacitación, las cuales contaron con el aval del Comité de Calidad de la IPS. En la formación se tuvieron en cuenta las etapas de la higiene de manos, el uso de esmaltes y joyas y la pertinencia de las sustancias empleadas para la asepsia. La adherencia obtenida al lavado de manos en la primera fase fue del 61,8% y en la segunda, del 78,3%. Estos resultados son positivos con relación a estudios internacionales. Se concluye que el lavado de manos, valorado en 78,3% durante el cuarto trimestre de 2013, es una excelente estrategia para prevenir infecciones hospitalarias.

Contact with objects and people in the hospital environment promotes the spread of germs that threaten patients; hand washing is a key strategy to prevent infections. Adherence to hand washing of health care officials was measured according to the Five Moments of Hand Hygiene of the WHO (World Health Organization). This transversal and quantitative study evaluated the adherence to hand washing in outpatient and emergency personnel of Assbasalud ESE, as well as the impact after receiving training. It was conducted in three phases: pre-training, training and post-training. The final sample was 128 employees in nine bank suite's (30%). The adhesion measurement was approved by the Executive Quality Committee of Assbasalud ESE. The factors that were evaluated were: hand hygiene, use of nail polish and use of jewels, as well as the relevance of the substances used for aseptic. The overall adherence of hand washing in phase one was of 61.8% and for the second phase, of 78.3%. These are positive results with reference to national and international studies. It was concluded that hand washing, valued at 67.1% during the third quarter of 2013, is an excellent strategy to reinforce patient safety and to prevent hospital infections.

Efecto de un programa de ejercicios respiratorios y aeróbicos en medio acuático versus terrestre para adultos mayores / The effects of a respiratory and aerobic exercises program in an aquatic environment versus a land environment for elderly people

Introducción: El envejecimiento causa múltiples cambios estructurales y fisiológicos en el sistema respiratorio, lo cual predispone al desarrollo de condiciones patológicas propias de esta etapa de la vida. Eventualmente los ejercicios respiratorios son realizados en tierra, sin embargo se cree que el medio acuático ofrece mejores resultados por sus propiedades físicas favoreciendo el movimiento y la expansibilidad torácica. Objetivo: Describir el efecto de un programa de ejercicios respiratorios y aeróbicos en medio acuático versus terrestre en adultos mayores. Métodos: Estudio cuasi-experimental, longitudinal-prospectivo. Se incluyeron 28 adultos mayores de 60 años distribuidos en dos grupos: acuático y terrestre, quienes recibieron por igual un programa de ejercicios respiratorios y aeróbicos durante 10 semanas. Se realizaron mediciones antes y después de culminar el programa en la expansibilidad torácica (cirtometría), capacidad aeróbica (test de caminata 6 minutos) y calidad de vida (cuestionario WHOQOL-BREF). Resultados: Mejoría estadísticamente significativa en la expansibilidad torácica en ambos grupos, con incrementos mayores en el grupo de agua (antes 4.9±0.3; después 5.2±0.3 p<0.001). Cambios positivos de la calidad de vida en los cuatro dominios del grupo acuático: dominio psicológico (antes 58.9±11.7; después 69.3±8.0 p=0.005), salud física (antes 57.2±6.1; después 62.6±7.4 p=0.057), relaciones sociales (antes 51.3±17.8; después 65.7±7.8 p=0.009) y ambiente (antes 57.6±8.7; después 69.7±7.8 p<0.001); los datos sugieren deterioro en la dimensión salud física en el grupo terrestre (antes 65.4±12.1; después 61.2±3.0, p=0.409). No hubo diferencias estadísticamente significativas en la capacidad aeróbica entre los grupos. Conclusiones: Un programa de ejercicios respiratorios y aeróbicos realizado en medio acuático y terrestre demostró un aumento significativo en la expansibilidad torácica. Sin embargo, el medio acuático podría ser el más recomendado, ya que se observó mayor incremento en la expansibilidad torácica y mejoría en la percepción de la calidad de vida.

Introduction: Aging causes multiple structural and physiological changes in our respiratory system, which predisposes the development of pathological conditions related to this life stage. Respiratory exercises are commonly performed on ground, nevertheless it is believed that the aquatic environment provides better results due to its physical properties that favors the movement and thoracic expansion. Objective: To describe the effect of a respiratory and aerobic program exercises in an aquatic environment versus a land environment for elderly people. Methods: Quasi-experimental study, longitudinal-prospective. 28 elderly than 60 years old were included and were distributed in two groups: aquatic and land, both groups received equitably a respiratory and aerobic exercise program during 10 weeks. Measurements were made before and after the program in the thoracic expansion (cirtometry), aerobic capacity (six minute walk test) and quality of life (WHOQOL-BREF questionnaire). Results: A statistically significant improvement in the thoracic expansion in both groups, with higher increases in the aquatic group (before 4.9±0.3; after 5.2±0.3 p<0.001). Life quality improvement in its four domains in the aquatic group: psychological domain (before 58.9±11.7; after 69.3±8.0, p=0.005), physical health (before 57.2±6.1; after 62.6±7.4 p=0.057), social relationships (before 51.3±17.8; after 65.7±7.8, p=0.009) and environment (before 57.6±8.7; after 69.7±7.8, p<0.001); the data suggest a deterioration of the physical health dimension in the land group (before 65.4±12.1; after 61.2±3.0 p=0.409). There were not statistically significant differences in aerobic capacity between the groups. Conclusions: A respiratory and aerobic program exercises made in an aquatic and land environment showed a significant increase in thoracic expansion. Nevertheless, the aquatic environment might be the most recommended, as it showed a greater increase in thoracic expansion and an increased perception of quality of life by the participants.

Modelling changes in clinical attachment loss to classify periodontal disease progression.

AIM: The goal of this study was to identify progressing periodontal sites by applying linear mixed models (LMM) to longitudinal measurements of clinical attachment loss (CAL). METHODS: Ninety-three periodontally healthy and 236 periodontitis subjects had their CAL measured bi-monthly for 12 months. The proportions of sites demonstrating increases in CAL from baseline above specified thresholds were calculated for each visit. The proportions of sites reversing from the progressing state were also computed. LMM were fitted for each tooth site and the predicted CAL levels used to categorize sites regarding progression or regression. The threshold for progression was established based on the model-estimated error in predictions. RESULTS: Over 12 months, 21.2%, 2.8% and 0.3% of sites progressed, according to thresholds of 1, 2 and 3 mm of CAL increase. However, on average, 42.0%, 64.4% and 77.7% of progressing sites for the different thresholds reversed in subsequent visits. Conversely, 97.1%, 76.9% and 23.1% of sites classified as progressing using LMM had observed CAL increases above 1, 2 and 3 mm after 12 months, whereas mean rates of reversal were 10.6%, 30.2% and 53.0% respectively. CONCLUSION: LMM accounted for several sources of error in longitudinal CAL measurement, providing an improved method for classifying progressing sites.

The Human Microbiome Project strategy for comprehensive sampling of the human microbiome and why it matters.

The Human Microbiome Project used rigorous good clinical practice standards to complete comprehensive body site sampling in healthy 18- to 40-yr-old adults, creating an unparalleled reference set of microbiome specimens. To ensure that specimens represented minimally perturbed microbiomes, we first screened potential participants using exclusion criteria based on health history, including the presence of systemic diseases (e.g., hypertension, cancer, or immunodeficiency or autoimmune disorders), use of potential immunomodulators, and recent use of antibiotics or probiotics. Subsequent physical examinations excluded individuals based on body mass index (BMI), cutaneous lesions, and oral health. We screened 554 individuals to enroll 300 (149 men and 151 women, mean age 26 yr, mean BMI 24 kg/m, 20.0% racial minority, and 10.7% Hispanic). We obtained specimens from the oral cavity, nares, skin, gastrointestinal tract, and vagina (15 specimens from men and 18 from women). The study evaluated longitudinal changes in an individual's microbiome by sampling 279 participants twice (mean 212 d after the first sampling; range 30-359 d) and 100 individuals 3 times (mean 72 d after the second sampling; range 30-224 d). This sampling strategy yielded 11,174 primary specimens, from which 12,479 DNA samples were submitted to 4 centers for metagenomic sequencing. Our clinical design and well-defined reference cohort has laid a foundation for microbiome research.

Alveolar bone measurement precision for phosphor-plate images.

OBJECTIVES: The aim was to demonstrate methods for determining measurement precision and to determine the precision of alveolar bone measurements made with a vacuum-coupled positioning device and phosphor plate images. STUDY DESIGN: Subjects were rigidly attached to the x-ray tube by means of a vacuum coupling device and custom cross-arch bite plates. Original and repeat radiographs (taken within minutes of each other) were obtained of the mandibular posterior teeth of 51 subjects, and cementoenamel junction-alveolar crest (CEJ-AC) distances were measured on both sets of images. In addition, x-ray transmission (radiodensity) and AC height differences were determined by subtracting one image from the other. Image subtractions and measurements were performed twice. Based on duplicate measurements, the root mean square standard deviation (precision) and least significant change (LSC) were calculated. LSC is the magnitude of change in a measurement needed to indicate that a true biologic change has occurred. RESULTS: The LSCs were 4% for x-ray transmission, 0.49 mm for CEJ-AC distance, and 0.06 mm for crest height. CONCLUSION: The LSCs for our CEJ-AC and x-ray transmission measurements were similar to what has been previously reported. The LSC for AC height (determined with image subtraction) was <0.1 mm. Compared with findings from earlier studies, this represents a highly precise measurement of AC height. The methods demonstrated for calculating LSC can be used by investigators to determine how large changes in radiographic measurements need to be before the changes can be considered to be (with 95% confidence) true biologic changes and not noise (i.e., equipment/observer error).