The effect of rapid maxillary expansion in children: a meta-analysis / Efeito da expansão rápida da maxila em crianças: uma metanálise

Abstract Introduction: Craniofacial growth is modified by chronic mouth breathing. Rapid maxillary expansion leads to separation of the mid-palatal suture, improving the occlusion and the upper airway size. Aim: Systematically evaluate scientific articles on the effects of rapid maxillary expansion on airway dimensions and classify the quality of the evidence of the information. Methods: Searches on PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE, as well as in the grey literature were performed. The articles found were selected and evaluated both for the risk of bias (ROBINS-I) and for the quality of evidence (GRADE). Results: Of the 309 works found, 26 papers were selected for full reading, of which 22 were excluded. Data compilation and analysis were performed in four papers, two being controlled non-randomized clinical trials and two non-randomized and uncontrolled clinical trials. No randomized clinical trial was found. Conclusions: The meta-analysis found an increase in the internasal and inter-zygomatic distances and oropharyngeal volume after rapid maxillary expansion, which, together with clinical findings, makes the recommendation favorable to the intervention. The quality of the evidence for each outcome was considered very low.

Resumo Introdução: O crescimento craniofacial é modificado pela respiração oral crônica. A expansão rápida da maxila promove a separação da sutura palatino mediana, melhora a oclusão e a dimensão da via aérea superior. Objetivo: Avaliar de forma sistematizada os artigos científicos dos efeitos da expansão rápida da maxila sob as dimensões das vias aéreas e classificar a qualidade da evidência das informações. Método: Foi feita a busca nas plataformas Pubmed, Lilacs, Embase, Scopus, Web of Science e Cochrane, bem como a literatura cinzenta. Os artigos foram selecionados e avaliados quanto aos riscos de viés (ROBINS-I), e feita a avaliação da qualidade da evidência (GRADE). Resultados: De 309 estudos encontrados, 26 artigos foram selecionados para leitura completa, dos quais 22 excluídos, restaram 4 artigos para a análise e compilamento de dados, dois ensaios clínicos não randomizados controlados e dois ensaios clínicos não randomizados e não controlados. Nenhum ensaio clínico randomizado foi encontrado. Conclusões: As metanálises mostraram aumento de distância internasal, interzigomática e volume orofaríngeo após a expansão rápida da maxila, o que, juntamente aos achados clínicos, torna a recomendação favorável à intervenção. A qualidade da evidência de cada desfecho foi considerada muito baixa.

The effect of rapid maxillary expansion in children: a meta-analysis.

INTRODUCTION: Craniofacial growth is modified by chronic mouth breathing. Rapid maxillary expansion leads to separation of the mid-palatal suture, improving the occlusion and the upper airway size. AIM: Systematically evaluate scientific articles on the effects of rapid maxillary expansion on airway dimensions and classify the quality of the evidence of the information. METHODS: Searches on PUBMED, LILACS, EMBASE, SCOPUS, WEB OF SCIENCE and COCHRANE, as well as in the grey literature were performed. The articles found were selected and evaluated both for the risk of bias (ROBINS-I) and for the quality of evidence (GRADE). RESULTS: Of the 309 works found, 26 papers were selected for full reading, of which 22 were excluded. Data compilation and analysis were performed in four papers, two being controlled non-randomized clinical trials and two non-randomized and uncontrolled clinical trials. No randomized clinical trial was found. CONCLUSIONS: The meta-analysis found an increase in the internasal and inter-zygomatic distances and oropharyngeal volume after rapid maxillary expansion, which, together with clinical findings, makes the recommendation favorable to the intervention. The quality of the evidence for each outcome was considered very low.

A survey on computer-assisted Parkinson's Disease diagnosis.

BACKGROUND AND OBJECTIVE: In this work, we present a systematic review concerning the recent enabling technologies as a tool to the diagnosis, treatment and better quality of life of patients diagnosed with Parkinson's Disease (PD), as well as an analysis of future trends on new approaches to this end. METHODS: In this review, we compile a number of works published at some well-established databases, such as Science Direct, IEEEXplore, PubMed, Plos One, Multidisciplinary Digital Publishing Institute (MDPI), Association for Computing Machinery (ACM), Springer and Hindawi Publishing Corporation. Each selected work has been carefully analyzed in order to identify its objective, methodology and results. RESULTS: The review showed the majority of works make use of signal-based data, which are often acquired by means of sensors. Also, we have observed the increasing number of works that employ virtual reality and e-health monitoring systems to increase the life quality of PD patients. Despite the different approaches found in the literature, almost all of them make use of some sort of machine learning mechanism to aid the automatic PD diagnosis. CONCLUSIONS: The main focus of this survey is to consider computer-assisted diagnosis, and how effective they can be when handling the problem of PD identification. Also, the main contribution of this review is to consider very recent works only, mainly from 2015 and 2016.

Handwritten dynamics assessment through convolutional neural networks: An application to Parkinson's disease identification.

BACKGROUND AND OBJECTIVE: Parkinson's disease (PD) is considered a degenerative disorder that affects the motor system, which may cause tremors, micrography, and the freezing of gait. Although PD is related to the lack of dopamine, the triggering process of its development is not fully understood yet. METHODS: In this work, we introduce convolutional neural networks to learn features from images produced by handwritten dynamics, which capture different information during the individual's assessment. Additionally, we make available a dataset composed of images and signal-based data to foster the research related to computer-aided PD diagnosis. RESULTS: The proposed approach was compared against raw data and texture-based descriptors, showing suitable results, mainly in the context of early stage detection, with results nearly to 95%. CONCLUSIONS: The analysis of handwritten dynamics using deep learning techniques showed to be useful for automatic Parkinson's disease identification, as well as it can outperform handcrafted features.

Automatic frontal sinus recognition in computed tomography images for person identification.

In many cases of person identification the use of biometric features obtained from the hard tissues of the human body, such as teeth and bones, may be the only option. This paper presents a new method of person identification based on frontal sinus features, extracted from computed tomography (CT) images of the skull. In this method, the frontal sinus is automatically segmented in the CT image using an algorithm developed in this work. Next, shape features are extracted from both hemispheres of the segmented frontal sinus by using BAS (Beam Angle Statistics) method. Finally, L2 distance is used in order to recognize the frontal sinus and identify the person. The novel frontal sinus recognition method obtained 77.25% of identification accuracy when applied on a dataset composed of 310 CT images obtained from 31 people, and the automatic frontal sinus segmentation in CT images obtained a mean Cohen Kappa coefficient equal to 0.8852 when compared to the ground truth (manual segmentation).

A new computer vision-based approach to aid the diagnosis of Parkinson's disease.

BACKGROUND AND OBJECTIVE: Even today, pointing out an exam that can diagnose a patient with Parkinson's disease (PD) accurately enough is not an easy task. Although a number of techniques have been used in search for a more precise method, detecting such illness and measuring its level of severity early enough to postpone its side effects are not straightforward. In this work, after reviewing a considerable number of works, we conclude that only a few techniques address the problem of PD recognition by means of micrography using computer vision techniques. Therefore, we consider the problem of aiding automatic PD diagnosis by means of spirals and meanders filled out in forms, which are then compared with the template for feature extraction. METHODS: In our work, both the template and the drawings are identified and separated automatically using image processing techniques, thus needing no user intervention. Since we have no registered images, the idea is to obtain a suitable representation of both template and drawings using the very same approach for all images in a fast and accurate approach. RESULTS: The results have shown that we can obtain very reasonable recognition rates (around ≈67%), with the most accurate class being the one represented by the patients, which outnumbered the control individuals in the proposed dataset. CONCLUSIONS: The proposed approach seemed to be suitable for aiding in automatic PD diagnosis by means of computer vision and machine learning techniques. Also, meander images play an important role, leading to higher accuracies than spiral images. We also observed that the main problem in detecting PD is the patients in the early stages, who can draw near-perfect objects, which are very similar to the ones made by control patients.

Edema agudo de pulmão de pressão negativa como complicação grave de síndrome de apneia obstrutiva do sono em crianças. Relatos de casos / Acute negative pressure lung oedema as a severe complication of obstructive sleep apnea syndrome in children. Case reports

Introdução: A síndrome de apneia-hipopneia obstrutiva do sono está relacionada a complicações cardiorrespiratórias. O conhecimento de sua fisiopatologia e possíveis complicações pode ajudar a reduzir sua morbimortalidade. Objetivos: Relatar casos de pacientes com distúrbios respiratórios obstrutivos do sono que apresentaram complicações cardiopulmonares com necessidade de tratamento em unidade de terapia intensiva. Casos: Relatamos dois casos de crianças sem diagnóstico prévio de SAHOS que deram entrada no serviço de emergência com o quadro clínico de complicação cardiopulmonar e necessidade de internação em UTI, com melhora clínica após adenotonsilectomia. Em um terceiro caso houve descompensação cardiopulmonar no pós-operatório imediato de adenotonsilectomia. Conclusões: Pediatras e otorrinolaringologistas devem estar atentos às manifestações clínicas mais graves da síndrome de apneia-hipopneia obstrutiva do sono. Um encaminhamento precoce para tratamento e cuidados pré e pós-operatórios são essenciais para evitar complicações graves.

Oral stomatitis induced by endogenous progesterone: Case report.

Oral stomatitis induced by endogenous progesterone is a rare clinical condition which may be associated with cutaneous involvement. That is probably due to the peak of progesterone production during the luteal phase of the menstrual cycle. In the present case report, a 21-year-old patient displayed recurrent ulcerative lesions located on the buccal mucosa or the upper lip, on a monthly basis since the age of 15. Such lesions would always manifest themselves on the second day until the end of the menstrual cycle.

Oro-genital lichen planus: report of two cases.

Lichen planus is a common mucocutaneous disease. However, lichen planus with concomitant oral and genital involvement is a rare condition that requires multidisciplinary intervention for appropriate diagnosis. In this study, we reported two cases of oro-genital lichen planus in a man and a woman. Analyses of oral and genital lesions were clinically and histopathologically compatible with lichen planus. This description highlights the importance of patients presenting oral lichen planus be routinely required to undergo further medical examination in order to investigate putative genital mucosal involvement. These lesions have the potential to progress to neoplasia. Therefore, medical and dentistry professionals should be aware of this condition.

Atualizacão em síndrome da apnéia obstrutiva do sono na infância / Update in obstructive sleep apnea syndrome in children

A prevalência de SAOS em criancas é de 0,7-3 por cento, com pico de incidência nos pré-escolares. Fatores anatômicos (obstrucão nasal severa, más-formacões craniofaciais, hipertrofia do tecido linfático da faringe, anomalias laríngeas, etc.) e funcionais (doencas neuromusculares) predispõem à SAOS na infância. A principal causa da SAOS em criancas é a hipertrofia adenotonsilar. As manifestacões clínicas mais comuns são: ronco noturno, pausas respiratórias, sono agitado e respiracão bucal. A oximetria de pulso noturna, a gravacão em áudio ou vídeo dos ruídos respiratórios noturnos e a polissonografia breve diurna são métodos úteis para triagem dos casos suspeitos de SAOS em criancas, e o padrão-ouro para diagnóstico é a polissonografia em laboratório de sono durante uma noite inteira. Ao contrário dos adultos com SAOS, as criancas costumam apresentar: menos despertares associados aos eventos de apnéia, maior número de apnéias/hipopnéias durante o sono REM e dessaturacão mais acentuada da oxihemoglobina mesmo nas apnéias de curta duracão. O tratamento da SAOS pode ser cirúrgico (adenotonsilectomia, correcão de anomalias craniofaciais, traqueostomia) ou clínico (higiene do sono, pressão positiva contínua nas vias aéreas - CPAP).

Update in obstructive sleep apnea syndrome in children.

The prevalence of OSAS in children is 0.7-3%, with peak incidence in pre-schoolers. It is characterised by partial or complete upper airway obstruction during sleep, causing intermittent hypoxia. Both anatomical (severe nasal obstruction, craniofacial anomalies, hypertrophy of the pharyngeal lymphoid tissue, laryngeal anomalies, etc.) and functional factors (neuromuscular diseases) predispose to OSAS during childhood. The main cause of OSAS in children in adenotonsillar hypertrophy. The most common clinical manifestations of OSAS are: nocturnal snoring, respiratory pauses, restless sleep and mouth breathing. Nocturnal pulse oximetry, nocturnal noise audio/videotape recording and nap polysomnography are useful tools for screening suspected cases of OSAS in children, and the gold-standard for diagnosis is overnight polysomnography in the sleep laboratory. On the contrary of SAOS adults, children usually present: less arousals associated to apnea events, more numerous apneas/hypopneas during REM sleep, and more significant oxyhemoglobin desaturation even in short apneas. The treatment of OSAS may be surgical (adenotonsillectomy, craniofacial abnormalities correction, tracheostomy) or clinical (sleep hygiene, continuous positive airway pressure--CPAP).