Dysphagia and pulmonary complications in acute cerebrovascular disease: A retrospective observational study / Disfagia y complicaciones pulmonares en la enfermedad cerebrovascular aguda: estudio observacional retrospectivo

Introduction: Dysphagia is a common post-stroke complication, which may result in serious pulmonary sequelae. Early detection of dysphagia and aspiration risk can reduce morbidity, mortality and length of hospitalization. Objectives: This study aims to identify association between dysphagia and acute cerebrovascular disease, and evaluate the prevalence and impact of pulmonary complications on readmissions and mortality. Material and methods: Retrospective observational study based on 250 clinical records of patients with acute cerebrovascular disease: clinical history, neurological examination, imaging and Gugging Swallowing Screen in the first 48h. Patients were followed for 3 months via medical records to estimate 3-month mortality and readmissions. Results: Out of 250 clinical records analyzed, 102 (40.8%) were evaluated for dysphagia. The prevalence of dysphagia was 32.4%. The risk was higher in older patients (p<0.001), in severe stroke (p<0.001) and in the hemorrhagic subtype (p=0.008). An association was found with dysarthria and aphasia (p=0.003; p=0.017). Respiratory tract infections occurred in 14.4% of all patients (GUSS group 11.8% versus no GUSS group 16.2%), and in 75% of those with severe dysphagia (p<0.001). Mortality at 3 months was 24.2% in dysphagic patients, especially high in the severe dysphagia group (75%, p<0.001). Conclusions: The type of cerebrovascular disease, NIHSS and GCS scores, age, dysarthria, and aphasia were significant associated factors to dysphagia. The prevalence of respiratory tract infections was higher in patients with no GUSS record, and no statistical significance was observed in related readmissions. Mortality at 3 months was superior in the severe dysphagia group.(AU)

Introducción: La disfagia es una complicación frecuente posterior a un evento cerebrovascular, que puede provocar graves secuelas pulmonares. La detección temprana de la disfagia y el riesgo de aspiración puede reducir la morbilidad, la mortalidad y la duración de la hospitalización. Objetivos: Este estudio pretende identificar asociaciones entre la disfagia y la enfermedad cerebrovascular aguda, y evaluar la prevalencia y el impacto de las complicaciones pulmonares en los reingresos y en la mortalidad. Material y método: Estudio observacional retrospectivo basado en 250 historias clínicas de pacientes con enfermedad cerebrovascular aguda: historia clínica, examen neurológico, pruebas de imagen y Gugging Swallowing Screen (GUSS) en las primeras 48h. Los pacientes fueron seguidos durante 3 meses a través de las historias clínicas para estimar la mortalidad a los 3 meses y los reingresos. Resultados: De las 250 historias clínicas analizadas, 102 (40,8%) fueron evaluados por disfagia. La prevalencia de disfagia fue del 32,4%. El riesgo fue mayor en los pacientes de mayor edad (p<0,001), en el ictus grave (p<0,001) y en el subtipo hemorrágico (p=0,008). Se encontró asociación con la disartria y la afasia (p=0,003; p=0,017). Las infecciones del tracto respiratorio se produjeron en el 14,4% de todos los pacientes (grupo GUSS 11,8% vs. grupo sin GUSS 16,2%), y en el 75% de los que tenían disfagia grave (p<0,001). La mortalidad a los 3 meses fue del 24,2% en pacientes disfágicos, especialmente alta en el grupo de disfagia grave (75%; p<0,001). Conclusiones: El tipo de enfermedad cerebrovascular, las puntuaciones NIHSS y GCS, edad, disartria y afasia fueron factores asociados de forma significativa a la disfagia. La prevalencia de infecciones del tracto respiratorio fue mayor en los pacientes sin registro GUSS, y no se observó significación estadística en los reingresos relacionados. La mortalidad a los 3 meses fue superior en el grupo de disfagia grave.(AU)

Dysphagia and pulmonary complications in acute cerebrovascular disease: A retrospective observational study.

INTRODUCTION: Dysphagia is a common post-stroke complication, which may result in serious pulmonary sequelae. Early detection of dysphagia and aspiration risk can reduce morbidity, mortality and length of hospitalization. OBJECTIVES: This study aims to identify association between dysphagia and acute cerebrovascular disease, and evaluate the prevalence and impact of pulmonary complications on readmissions and mortality. MATERIAL AND METHODS: Retrospective observational study based on 250 clinical records of patients with acute cerebrovascular disease: clinical history, neurological examination, imaging and Gugging Swallowing Screen in the first 48h. Patients were followed for 3 months via medical records to estimate 3-month mortality and readmissions. RESULTS: Out of 250 clinical records analyzed, 102 (40.8%) were evaluated for dysphagia. The prevalence of dysphagia was 32.4%. The risk was higher in older patients (p<0.001), in severe stroke (p<0.001) and in the hemorrhagic subtype (p=0.008). An association was found with dysarthria and aphasia (p=0.003; p=0.017). Respiratory tract infections occurred in 14.4% of all patients (GUSS group 11.8% versus no GUSS group 16.2%), and in 75% of those with severe dysphagia (p<0.001). Mortality at 3 months was 24.2% in dysphagic patients, especially high in the severe dysphagia group (75%, p<0.001). CONCLUSIONS: The type of cerebrovascular disease, NIHSS and GCS scores, age, dysarthria, and aphasia were significant associated factors to dysphagia. The prevalence of respiratory tract infections was higher in patients with no GUSS record, and no statistical significance was observed in related readmissions. Mortality at 3 months was superior in the severe dysphagia group.

Torsional behaviour of Reciproc and Reciproc blue instruments associated with their martensitic transformation temperatures.

AIM: To compare the martensitic transformation temperatures and torsional resistance behaviour of classic M-Wire Reciproc and Reciproc blue files (VDW, Munich, Germany). METHODOLOGY: M-Wire classic Reciproc R25 and Reciproc blue R25 instruments were used. Transformation temperatures were determined by differential scanning calorimetry (DSC-DSC 60, Shimadzu, Kyoto, Japan). Three samples with approximately 20 mg of each system were cooled to -120 °C and then heated to 100 °C and then cooled to -100 °C at a rate of 10 °C min-1 . The maximum torque values and angular deflection until fracture of new instruments (n = 10) were measured according to ISO 3630-1. Results were analysed statistically using the Student's t-test at a significance level of P < 0.05. RESULTS: DSC results revealed the absence of martensitic transformation for Reciproc instruments in the temperature range analysed. In both systems, the instruments were composed of a mixture of R-phase and austenite at room temperature. After torsional tests, Reciproc blue had significantly lower values for mean maximum torque at rupture (P < 0.05), although the angular deflection values were significantly higher than the Reciproc classic group (P < 0.05). CONCLUSIONS: Both Reciproc and Reciproc blue instruments were composed of a mixture of R-phase and austenite. Reciproc Blue instruments had a greater angle of rotation to fracture but a lower torque to failure than M-Wire Reciproc instruments.

Enfermedad Pulmonar Obstructiva Crónica: validación del cuestionario IPAG y dispositivo PIKO-6(R), en las Unidades de Atención Primaria de Salud de Portugal / Chronic Obstructive Pulmonary Disease: validation of IPAG questionnaire and PIKO-6(R) device, in Portuguese Primary Health Care Units

Introducción: La Enfermedad Pulmonar Obstructiva Crónica (EPOC) es una causa importante de morbilidad y mortalidad en todo el mundo, generalmente no se diagnostica hasta etapas avanzadas de la enfermedad. En Portugal, el estudio de la Carga Portuguesa de Enfermedad Pulmonar Obstructiva (BOLD) ha estimado una prevalencia de 14,2% en adultos mayores de 40 años, con un 86,8% de infradiagnóstico. El uso de herramientas simples de cribado en Atención Primaria de Salud (APS) puede aumentar el número de pacientes identificados en riesgo de desarrollar EPOC. Objetivos: Validar un cuestionario de EPOC y determinar la exactitud diagnóstica de una relación FEV1/FEV6de la mini-espirometría con respecto a una prueba de espirometría diagnóstica como un instrumento de tamizaje a la EPOC en Atención Primaria. Métodos: Se seleccionaron pacientes de más de 40 años de 4 unidades de APS diferentes. Se aplicó el cuestionario IPAG y se realizaron pruebas con el dispositivo PIKO-6(R). Los resultados se compararon con la espirometría. Resultados. Se analizaron datos de 471 sujetos (235 hombres, con una edad media de 60,1 ± 10,9 años). Se diagnosticaron cincuenta y siete (12,1%) casos de EPOC. La sensibilidad y especificidad fueron, respectivamente, 84,1% y 49,9% para el cuestionario del IPAG; 61,4% y 93,7% para PIKO-6(R)y 45,6% y 96,5% para IPAG + PIKO-6(R). La mejor zona bajo la curva que se encontró con la combinación IPAG + PIKO-6(R) fue del 73%. Conclusión: El cuestionario IPAG y el dispositivo PIKO-6(R) son herramientas útiles para la detección de la EPOC y podrían utilizarse en combinación. Se debe realizar una espirometría confirmatoria en presencia de resultados positivos de IPAG y/o PIKO-6(R) Estas herramientas podrían ser útiles para disminuir el infradiagnóstico de EPOC

Introduction: Chronic Obstructive Pulmonary Disease (COPD) is a major cause of morbidity and mortality worldwide, usually not diagnosed until advanced stages of the disease. In Portugal, the Portuguese Burden of Obstructive Lung Disease (BOLD) study has estimated a prevalence of 14.2% in adults over 40 years, with 86.8% of under-diagnosis. The use of simple screening tools in Primary Health Care (PHC) can increase the number of identified patients at risk of developing COPD. Objectives: To validate a COPD questionnaire and determine the diagnostic accuracy of a FEV1/FEV6 ratio from mini-spirometry relative to a diagnostic spirometry test as a screening tolls to COPD in Primary Care. Methods: Patients aged over 40 years were selected from 4 different PHC units. It was applied the IPAG questionnaire and tests with PIKO-6(R) device were performed. The results were then compared with spirometry. Results. Data from 471 subjects were analysed (235 men; mean age 60.1±10.9 years).Fifty seven (12.1%) cases of COPD were diagnosed. The sensitivity and specificity were, respectively, 84.1% and 49.9% for the IPAG questionnaire; 61.4% and 93.7% for the PIKO-6(R) and 45.6% and 96.5% for the IPAG+PIKO-6(R). The best area under the curve that was found with the IPAG+ PIKO-6(R) combination was 73%. Conclusion: The IPAG questionnaire and PIKO-6(R) device are useful COPD screening tools and could be used in combination. A confirmatory spirometry should be carried out in the presence of positive results from IPAG and/or PIKO-6(R) . These tools could be useful to diminish COPD underdiagnosis

In Vitro Antimicrobial and Antiproliferative Activity of Amphipterygium adstringens.

Amphipterygium adstringens is a plant widely used in Mexican traditional medicine for its known anti-inflammatory and antiulcer properties. In this work, we evaluated the in vitro antimicrobial and antiproliferative activities of the methanolic extract of A. adstringens against oral pathogens such as Streptococcus mutans, Porphyromonas gingivalis, Aggregatibacter actinomycetemcomitans, Candida albicans, and Candida dubliniensis, using microdilution (MIC) and agar diffusion methods (MBC), and the antiproliferative activity evaluating total growth inhibition (TGI) by staining the protein content with sulforhodamine B (SRB), using nine human cancer cell lines. Crude extract (CE) of A. adstringens showed some degree of activity against one or more of the strains with a MIC from 0.125 mg/mL to 63 mg/mL and MBC from 1.6 to 6.3 mg/mL and cytotoxic activity, particularly against NCI-ADR/RES, an ovarian cell line expressing multiple resistance drugs phenotype. The CE is a complex mixture of possible multitarget metabolites that could be responsible for both antimicrobial and antiproliferative activities, and further investigation is required to elucidate the identity of active compounds. Nevertheless the CE itself is useful in the development of new antimicrobial treatment based on natural products to prevent oral diseases and as alternative natural source for cancer treatment and prevention.

Asian genotypes of dengue virus 4 in Brazil.

Dengue virus, commonly transmitted by mosquitoes, causes a human disease of significant social impact and presents a serious public health problem in Brazil. This report describes the unusual emergence of DENV-4 in northern Brazil after a nearly 30-year-long absence. DENV-4 genotype I is of Asian origin and was identified in the serum of patients receiving treatment at a hospital serving the Salvador area (Brazilian state of Bahia). The identification of dengue virus serotypes through molecular and phylogenetic analysis is essential for predicting disease severity or fatal illness, principally in endemic countries such as Brazil.

Physical and mechanical properties of a thermomechanically treated NiTi wire used in the manufacture of rotary endodontic instruments.

AIM: To compare physical and mechanical properties of one conventional and one thermomechanically treated nickel-titanium (NiTi) wire used to manufacture rotary endodontic instruments. METHODOLOGY: Two NiTi wires 1.0 mm in diameter were characterized; one of them, C-wire (CW), was processed in the conventional manner, and the other, termed M-Wire (MW), received an additional heat treatment according to the manufacturer. Chemical composition was determined by energy-dispersive X-ray spectroscopy, phase constitution by XRD and the transformation temperatures by DSC. Tensile loading/unloading tests and Vickers microhardness measurements were performed to assess the mechanical behaviour. Data were analysed using analysis of variance (α = 0.05). RESULTS: The two wires showed approximately the same chemical composition, close to the 1 : 1 atomic ratio, and the ß-phase was the predominant phase present. B19' martensite and the R-phase were found in MW, in agreement with the higher transformation temperatures found in this wire compared with CW, whose transformation temperatures were below room temperature. Average Vickers microhardness values were similar for MW and CW (P = 0.91). The stress at the transformation plateau in the tensile load-unload curves was lower and more uniform in the M-Wire, which also showed the smallest stress hysteresis and apparent elastic modulus. CONCLUSIONS: The M-Wire had physical and mechanical properties that can render endodontic instruments more flexible and fatigue resistant than those made with conventionally processed NiTi wires.

Antimicrobial potential of some plant extracts against Candida species.

The increase in the resistance to antimicrobial drugs in use has attracted the attention of the scientific community, and medicinal plants have been extensively studied as alternative agents for the prevention of infections. The Candida genus yeast can become an opportunistic pathogen causing disease in immunosuppressive hosts. The purpose of this study was to evaluate dichloromethane and methanol extracts from Mentha piperita, Rosmarinus officinalis, Arrabidaea chica, Tabebuia avellanedae, Punica granatum and Syzygium cumini against Candida species through the analysis of Minimum Inhibitory Concentration (MIC). Results presented activity of these extracts against Candida species, especially the methanol extract.

Bases farmacológicas e toxicológicas potenciais do óleo essencial de Mentha spp / Potential pharmacological and toxicological basis of the essential oil from Mentha spp

During the past few years, interest in the potential clinical and pharmacological basis of the efficacy and safety of herbal medicines has increased greatly, due to widespread domestic self-medication with these agents. Some authors have analyzed the use of Mentha ssp. in the pharmacological industry. The essential oil from Mentha spp. is used to treat discomfort of the gastrointestinal tract, irritable bowel syndrome, myalgia and neuralgia, as well as oral mucosal inflammation, and also as an expectorant, an antimicrobial and an ingredient in many analgesic creams. The essential oil also contains chemical compounds that are associated with side effects such as nausea, vomiting, allergic reactions, flushing and headaches. Therefore, the purpose of the present review was to examine the literature on the efficacy and safety of the possible clinical and pharmacological uses of the essential oil from Mentha spp. in human beings.

Nas últimas décadas, houve um aumento crescente no interesse sobre as bases clínicas e farmacológicas potenciais em relação à eficácia e a segurança das drogas produzidas de plantas medicinais, devido à automedicação destes agentes. Diversos autores avaliaram o óleo essencial de Mentha spp., devido a sua larga utilização na indústria farmacológica. O óleo essencial de Mentha spp. componente de muitos analgésicos e com atividade antimicrobiana, é usado para tratamentos nos desconfortos gastrintestinais e dutos biliares superiores, Síndrome de Bowel, expectorante, mialgia e neuralgia, bem como na inflamação oral da mucosa. No entanto, esse óleo contém compostos químicos que apresentam efeitos colaterais tais como náusea, vômito, reações alérgicas e dores de cabeça. O objetivo desta revisão atual foi avaliar dados da literatura específica sobre a possível utilização, eficácia e segurança clínica e farmacológica do óleo essencial de Mentha spp. em seres humanos.

Arbitrary nonlinearities in convective population dynamics with small diffusion.

Convective counterparts of variants of the nonlinear Fisher equation which describes reaction diffusion systems in population dynamics are studied with the help of an analytic prescription and shown to lead to interesting consequences for the evolution of population densities. The initial-value problem is solved explicitly for some cases, and for others it is shown how to find traveling-wave solutions analytically. The effect of adding diffusion to the convective equations is first studied through exact analysis through a piecewise linear representation of the nonlinearity. Using an appropriate small parameter suggested by that analysis, a perturbative treatment is developed to treat the case in which the convective evolution is augmented by a small amount of diffusion.

[Hyperosmolar coma in diabetes (author's transl)]. / Das hyperosmolare Koma beim Diabetes.

Diabetic hyperosmolar coma is characterized by the appearance of a diabetic metabolic state in middle age, lack of ketosis, osmolarity of the plasma greater than 350 milliosmoles, psychic and neurological disturbances, increased occurrence of secondary diseases, arterial thromboses, azotemia. The mortality is 30-60%. The pathogenesis is still uncertain in many respects, consequently the suggestions for therapy are varied. The authors have found the following procedure useful: rapid compensation of sodium deficit, restoration of water balance, normalization of the composition of body fluids by reference to continuous laboratory investigation.