Trunk Control Test as a Main Predictor of the Modified Barthel Index Score at Discharge From Intensive Post-acute Stroke Rehabilitation: Results From a Multicenter Italian Study.

OBJECTIVES: To verify whether trunk control test (TCT) upon admission to intensive inpatient post-stroke rehabilitation, combined with other confounding variables, is independently associated with discharge mBI. DESIGN: Multicentric retrospective observational cohort study. SETTING: Two Italian inpatient rehabilitation units. PARTICIPANTS: A total of 220 post-stroke adult patients, within 30 days from the acute event, were consecutively enrolled. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The outcome measure considered was the modified Barthel Index (mBI), one of the most widely recommended tools for assessing stroke rehabilitation functional outcomes. RESULTS: All variables collected at admission and significantly associated with mBI at discharge in the univariate analysis (TCT, mBI at admission, pre-stroke modified Rankin Scale [mRS], sex, age, communication ability, time from the event, Cumulative Illness Rating Scale, bladder catheter, and pressure ulcers) entered the multivariate analysis. TCT, mBI at admission, premorbid disability (mRS), communication ability and pressure ulcers (P<.001) independently predicted discharge mBI (adjusted R2=68.5%). Concerning the role of TCT, the model with all covariates and without TCT presented an R2 of 65.1%. On the other side, the model with the TCT only presented an R2 of 53.1%. Finally, with the inclusion of both TCT and all covariates, the model showed an R2 increase up to 68.5%. CONCLUSIONS: TCT, with other features suggesting functional/clinical complexity, collected upon admission to post-acute intensive inpatient stroke rehabilitation, independently predicted discharge mBI.

Factors influencing trunk control recovery after intensive rehabilitation in post-stroke patients: a multicentre prospective study.

BACKGROUND: Trunk control plays a crucial role in the stroke rehabilitation, but it is unclear which factors could influence the trunk control after an intensive rehabilitation treatment. OBJECTIVES: To study which demographic, clinical and functional variables could predict the recovery of trunk control after intensive post-stroke inpatient rehabilitation. METHODS: Subjects with acute, first-ever stroke were enrolled and clinical and data were collected at admission and discharge. The primary outcome was considered the trunk control measured by the Trunk Control Test (TCT). The data were analyzed by a univariate and multivariate logistic regressions. RESULTS: Two hundred forty-one post-stroke patients were included. All baseline variables significantly associated to TCT at discharge in the univariate analysis (i.e. gender, NIHSS neglect item at admission, presence of several complexity markers, TCT total score at admission, NIHSS total score, pre-stroke modified Rankin Scale, Fugl-Meyer Assessment motor and sensitivity score) were entered in the multivariate analysis. The multivariate regression showed that age (p = .003), admission NIHSS total score (p = .001), admission TCT total score (p < .001) and presence of depression (p = .027) independently influenced the TCT total score at discharge (R2 = 61.2%). CONCLUSIONS: Age, admission neurological impairment (NIHSS total score), trunk control at the admission (TCT total score), and presence of depression independently influenced the TCT at discharge. These factors should be carefully assessed at the baseline to plan a tailoring rehabilitation treatment achieving the best trunk control performance at discharge.

Immune Maturation Effects on Viral Neutralization and Avidity of Hyperimmunized Equine Anti-SARS-CoV-2 Sera.

Mass-vaccination against COVID-19 is still a distant goal for most low-to-middle income countries. The experience gained through decades producing polyclonal immunotherapeutics (such as antivenoms) in many of those countries is being redirected to develop similar products able to neutralize SARS-CoV-2 infection. In this study we analyzed the biological activity (viral neutralization or NtAb) and immunochemical properties of hyperimmune horses' sera (HHS) obtained during initial immunization (I) and posterior re-immunization (R) cycles using the RBD domain of the SARS-CoV-2 spike protein as antigen. HHS at the end of the R cycle showed higher NtAb titers when compared to those after the I cycle (35,585 vs. 7000 mean NtAb, respectively). Moreover, this increase paralleled an increase in avidity (95.2% to 65.2% mean avidity units, respectively). The results presented herein are relevant for manufacturers of these therapeutic tools against COVID-19.

Fully Automated Screening of a Combinatorial Library to Avoid False Positives: Application to Tetanus Toxoid Ligand Identification.

Peptide ligands are widely used in protein purification by affinity chromatography. Here, we applied a fully automated two-stage library screening method that avoids false positive peptidyl-bead selection and applied it to tetanus toxoid purification. The first library screening was performed using only sulforhodamine (a fluorescent dye), and fluorescent beads were isolated automatically by flow cytometry and discarded. A second screening was then performed with the rest of the library, using the target protein (tetanus toxoid)-rhodamine conjugate. This time, fluorescent beads were isolated, and peptide sequences were identified by matrix-assisted laser desorption/ionization tandem mass spectrometry. Those appearing with greater frequency were synthesized and immobilized on agarose to evaluate a range of chromatographic purification conditions. The affinity matrix PTx1-agarose (Ac-Leu-Arg-Val-Tyr-His-Gly-Gly-Ala-Gly-Lys-agarose) showed the best performance when 20 mM sodium phosphate, 0.05% Tween 20, pH 5.9 as adsorption buffer and 100 mM Tris-HCl, 100 mM NaCl, pH 8.0 as elution buffer were used. A pure tetanus toxoid (Ttx) was loaded on a chromatographic column filled with the PTx1 matrix, and 96% adsorption was achieved, with a K d of 9.18 ± 0.07 nmol/L and a q m of 1.31 ± 0.029 µmol Ttx/mL matrix. Next, a Clostridium tetani culture supernatant treated with formaldehyde (to obtain the toxoid) was applied as a sample. The sodium dodecyl sulfate polyacrylamide gel electrophoresis analysis showed a band, identified by electrospray ionization mass spectrometry as the Ttx, that appeared only in the elution fraction, where an S-layer protein was also detected.

Use of a phosphopeptide as a ligand to purify phospholipase A2 from the venom of Crotalus durisuss terrificus by affinity chromatography.

The venom of Crotalus durissus terrificus (Cdt) is a source of a wide variety of toxins, some of them with interesting pharmacological applications. Of these toxins, the phospholipase A2 (PLA2) subunit of crotoxin (Ctx) has been studied for its potential as an antiviral and antibacterial agent. Peptides have proven useful ligands for the purification of numerous molecules, including antibodies, toxins, enzymes and other proteins. Here, we sought to use a phosphopeptide (P-Lys) as a ligand for PLA2 purification. P-Lys was synthesized in solid phase on Rink-Amide-ChemMatrix resin, immobilized on NHS-agarose, and then evaluated as a chromatographic matrix. Under the best conditions, total protein adsorption reached 39% and only the eluate fraction presented PLA2 activity. Analysis of the eluate by SDS-PAGE showed three bands, one corresponding to the molecular weight of PLA2 (14 kDa). Said bands were analyzed by mass spectrometry and identified as PLA2 and its multimers. The final product showed a purity of over 90%. In addition, slightly changing the process conditions also allowed the isolation of crotamine.

Development and implementation of a stroke rehabilitation integrated care pathway in an Italian no profit institution: an observational study.

BACKGROUND: To standardize assessment and coordinate processes in stroke rehabilitation, an integrated care pathway (ICP) was developed in an Italian Rehabilitation and Research Institution by a knowledge-translation interdisciplinary process, from evidence-based guidelines to rehabilitation practice. The ICP was implemented in two pilot Tuscan rehabilitation Centers. AIM: The purpose of this study was to describe ICP development and assess the ICP effects on postacute stroke inpatient rehabilitation outcomes. DESIGN: Prospective observational study, before and after comparison. SETTING: Two Tuscan inpatient rehabilitation centers. POPULATION: Patients accessing either centers for intensive rehabilitation after acute stroke. METHODS: Two cohorts were prospectively recruited before (2015-2017) and after (2018) implementation of the pathway. The primary outcome was change in activities of daily living disability, assessed by the modified Barthel Index (mBI) from admission to discharge. Secondary outcomes included length of stay (LOS), adverse outcomes, and changes in communication ability, trunk control, pain, ambulation, bladder catheter (Y/N), bedsores (Y/N). RESULTS: In 2015-2017, 443 postacute stroke patients (mean age 77±11 years, 47% women), while in 2018, 84 patients (mean age 76±13 years, 61% women) were admitted to the two facilities. Comparing the 2018 vs. the 2015-17 cohort, the mean mBI increase was not substantially different (26 vs. 24 points), nor were LOS (37±18 vs. 36±16 days), adverse outcomes, discharge destination, and improvement of ambulation, pain, and communication (P>0.05). Instead, a significantly higher improvement of trunk control (trunk control test: 69.6±33.2 vs. 79.0±31.3, P=0.019), and a higher percentage of bedsore resolution (13% vs. 5%, P=0.033), and bladder catheter removal (37% vs. 17% P<0.001) were observed in 2018 vs. 2015-2017. CONCLUSIONS: Compared to prior practice, ICP was associated to improvement of trunk control recovery, bladder catheter removal, and bedsores resolution. Further ICP implementation on a larger scale is needed to verify improvements of stroke inpatient rehabilitation outcomes. CLINICAL REHABILITATION IMPACT: An evidence-based stroke rehabilitation ICP was interdisciplinary developed and implemented in two rehabilitation centers of a multicenter Italian health group. ICP implementation as to inpatient intensive postacute stroke rehabilitation was associated to improved trunk control recovery, bladder catheter removal, and bedsore resolution. Further ICP implementation will allow multicenter studies and quality benchmarking.

An effective, simple and low-cost pretreatment for culture clarification in tetanus toxoid production.

Chemically inactivated tetanus toxin (tetanus toxoid, TT), purified from cultures of a virulent Clostridium tetani strain, is the active pharmaceutical ingredient of anti-tetanus vaccines. Culture clarification for TT production and is usually performed by filtration-based techniques. Final clarification of the culture supernatant is achieved by passage through 0.2 µm pore size filtering membranes. Large particles removal (primary clarification) before final filtration (secondary clarification) reduces costs of the overall clarification process. With this aim, chitosan-induced particle aggregation was assessed as an alternative for primary clarification. Three chitosan variants were tested with similar results. Optimal clarification of culture supernatant was achieved by the addition of 8 mg chitosan per l of culture. Extrapolation analysis of filter sizing results indicate that 100 l of chitosan-treated supernatant can be finally filtered with a 0.6 m2 normal filtration cartridge of 0.45 + 0.2 µm pore size. The clarified material is compatible with current standard downstream processing techniques for TT purification. Thus, chitosan-induced particle aggregation is a suitable operation for primary clarification.

Predictors of recovering ambulation after hip fracture inpatient rehabilitation.

BACKGROUND: Despite progress in surgery and care, hip fracture (HF) remains a catastrophic event, burdened with high risk of mortality and disability. This study aims at identifying predictors of recovering ambulation after intensive inpatient rehabilitation within the Tuscany Region HF rehabilitation pathway. METHODS: All HF patients referred from acute care to the two Massa-Carrara Rehabilitation facilities January 2015-June 2017 were enrolled. Comorbidity Total Score (CIRS) defined high- or low-care setting referral. Recovery of ambulation, with or without aid, (assessed by SAHFE) was the primary outcome. Personal data, comorbidity, cognitive (MMSe) and pre-fracture function (mRANKIN) were recorded on admission. Outcomes included hospital readmission, length of stay (LOS) and home discharge. Urinary catheter, bedsores, disability (modified Barthel Index-mBI), communication disability (CDS), trunk control (TCT), pain (NRS), and ambulation were recorded (admission-discharge). RESULTS: Of 352 patients enrolled (age 83.9 ± 7.1; 80% women), 1 died and 6 were readmitted to acute-care hospital; 97% patients referred to high-care, and 64% referred to low-care, presented moderate-high comorbidity on admission. Median LOS was 22 days; 95% patients were discharged back home; daily functional gain (mBIscore/LOS) was 1.3 ± 0.7. Patients who recovered ambulation on discharge were 84%. Older age, higher comorbidity, bladder catheter, impaired trunk control, worse cognitive and functional status on admission, and pre-fracture disability were associated to poor outcome, but only higher comorbidity and impaired communication on admission predicted failure to recover ambulation on discharge. CONCLUSION: In HF patients entitled to intensive inpatient rehabilitation, moderate-high comorbidity and impaired communication are frequent findings and predict rehabilitation failure.

OMV-based vaccine formulations against Shiga toxin producing Escherichia coli strains are both protective in mice and immunogenic in calves.

Strains of Shiga toxin-producing Escherichia coli (STEC) can cause the severe Hemolytic Uremic Syndrome (HUS). Shiga toxins are protein toxins that bind and kill microvascular cells, damaging vital organs. No specific therapeutics or vaccines have been licensed for use in humans yet. The most common route of infection is by consumption of dairy or farm products contaminated with STEC. Domestic cattle colonized by STEC strains represent the main reservoir, and thus a source of contamination. Outer Membrane Vesicles (OMV) obtained after detergent treatment of gram-negative bacteria have been used over the past decades for producing many licensed vaccines. These nanoparticles are not only multi-antigenic in nature but also potent immunopotentiators and immunomodulators. Formulations based on chemical-inactivated OMV (OMVi) obtained from a virulent STEC strain (O157:H7 serotype) were found to protect against pathogenicity in a murine model and to be immunogenic in calves. These initial studies suggest that STEC-derived OMV has a potential for the formulation of both human and veterinary vaccines.

Natural Snake Venom Inhibitors and their Pharmaceutical Uses: Challenges and Possibilities.

Nowadays, treatment with specific antivenins is considered the only cure for snakebites accidents. However, access to antivenom obstructs the successful implementation of the World Health Organization international guidelines. In the last few years, natural organic compounds, peptides, and proteins with the ability to inhibit snake toxins and obtained from different sources such as plant extracts and animal blood have been proposed as antivenoms. In this work, we will focus on the inhibitors of the main venom toxins, phospholipases A2 and metalloproteinases, and their application as novel antivenoms.

A study of facial pattern in patients with fanconi anemia.

OBJECTIVE: This study is aimed to evaluate craniofacial features in patients with Fanconi anemia (FA) through cephalometric analysis and to classify the facial growth pattern to observe possible facial discrepancies. DESIGN: This is a cross-sectional study which employed a quantitative approach to compare linear and angular measurements of cephalometric analysis in lateral teleradiographic images of a clinical type sample of patients with FA. A retrospective cephalometric study was performed using cephalometric analyses of Ricketts and Steiner; growth patterns according to Ricketts' vertical growth pattern (VERT index) were also analyzed. PATIENTS: Fifty patients diagnosed with FA who were undergoing anti-aplasia treatment at the outpatient Hematology service at the Federal University of Paraná, Curitiba, Brazil were included in the study. INTERVENTIONS: The patients were evaluated in the School of Dentistry of the Pontifical Catholic University of Paraná (PUCPR), Curitiba, Brazil. Exclusion criteria included patients who had used or were using growth hormone medication, had undergone bone marrow transplant, or had been previously subjected to dental treatment. MAIN OUTCOME MEASURES: Cephalometric points were plotted in order to set up linear and angular cephalometric measurements. Angular and linear measurements from 17 factors proposed by Ricketts' cephalometric analysis were assessed. RESULTS: Dolicofacial appearance was observed in 52% of individuals; braquifacial in 28%, and mesofacial in 20%. Significant maxillary/mandibular discrepancy was observed. It was concluded that upon anteroposterior evaluation of facial bone structures, the FA sample presented smaller median measurements in most variables evaluated; it also presented mandibular micrognathism and mainly dolicofacial vertical growth pattern. These findings, together with other features such as skin pigmentation and microphthalmia, may lead to a possible recognition of a FA condition from a patient's facial features.

Avaliação do conhecimento de adolescentes gestantes sobre saúde bucal do bebê / Evaluation of pregnant adolescent women's knowledge about their baby's oral health

Objetivo: Verificar o conhecimento de adolescentes gestantes sobre saúde bucal dos bebês. Materiais e Métodos: Foram entrevistadas 80 adolescentes gestantes (13 -18 anos) que realizaram consultas pré-natais na cidade de Joinville SC, no período de Setembro/2011 até Junho/2012. Os dados obtidos foram analisados para a obtenção dos resultados em forma de estatística descritiva. Aplicou-se o teste do qui-quadrado com significância s p<0,05 para o cruzamento do nível socioeconômico com a transmissibilidade da cárie, momento da erupção dental, inicio da higiene bucal e momento da primeira consulta odontológica do bebê. Resultados: Constatou-se que a idade média das entrevistadas foi 15,5 anos. Dentre elas 47,5% moravam com o pai do bebê; 18,75% eram solteiras e 33,75% casadas, todas de nível socioeconômico baixo, com renda entre 2 a 3 salários mínimos, com média de 4,25 pessoas morando na casa. Quanto ao conhecimento sobre a saúde bucal dos bebês, a maioria desconhecia o que é cárie precoce da infância (96,25%); a sua transmissibilidade (63,75%); o momento da erupção dental do bebê (58,75%). A maioria, 95% das gestantes, pretendia amamentar, e dentre estas, 78,75% deram alguma importância à amamentação. A condição socioeconômica apresentou diferença estatisticamente significante no conhecimento sobre transmissibilidade da cárie, momento ideal para realizar a primeira visita ao dentista e erupção dos dentes. Conclusão: As adolescentes gestantes desconhecem sobre a saúde bucal do bebê indicando necessidade de um programa de saúde bucal na instituição avaliada.(AU)

Aim: To verify the knowledge of pregnant adolescent women about the oral health of babies. Materials and Methods: The present study interviewed 80 pregnant adolescents (13 to 18 years of age) who had had prenatal visits in the city of Joinville, Brazil, from September, 2011 to June, 2012. The data were analyzed by obtaining results in the form of descriptive statistics. The Chi-squared test was applied considering a significance level of 5% (p<0.05) in an attempt to compare the mother's socioeconomic level with the transmissibility of dental caries, the moment of tooth eruption, the beginning of oral hygiene, and the baby's first dental appointment. Results: The pregnant women's average age was 15.5 years; 47.5% were living with the baby's father; 18.75% were single; 33.75% were married, all mothers were of a low socioeconomic level, with an income of 2-3 minimum wages, and with an average of 4.25 people living in the same house. As regards the mother's knowledge about the oral health of their babies, the majority did not know what were early childhood caries (96.25%), their transmissibility (63.75%), nor the moment of tooth eruption in their babies (58.75%). Most of the mothers (95%) intended to breastfeed, among them, 78.75% gave some importance to breastfeeding. The socioeconomic condition of the pregnant women showed a statistically significant difference in the knowledge of the transmissibility of caries, the ideal moment for the first dental appointment, and tooth eruption. Conclusion: The pregnant adolescents were unaware of the baby's oral health, thus indicating the need for an special oral health program in the evaluated institution.(AU)

Antivenenos ofídicos: comparación del desempeño de dos métodos de obtención / Snake Antivenoms: Performance Comparison of Two Preparation Methods

INTRODUCCIÓN: Los sueros antiofídicos pueden prepararse por precipitación de suero o plasma equino hiperinmune con sulfato de amonio o con ácido caprílico. OBJETIVO:Comparar el rendimiento de ambos métodos. MATERIALES Y MÉTODOS: Las inmunoglobulinas se precipitaron con sulfato de amonio, y la albúmina con ácido caprílico. El nivel de anticuerpos en la preparación final se midió por el método de ELISA. RESULTADOS: El ácido caprílico al 3...

INTRODUCTION: Antivenom sera can be prepared by precipitation of hyperimmune equine serum or plasma with ammonium sulfate or caprylic acid. OBJECTIVE:To compare the performance of both methods. METHODS:The immunoglobulins were precipitated with ammonium sulfate, and the albumin with caprylic acid. The antibody level in the final preparation was measured by ELISA. RESULTS: The 3...

Antivenenos ofídicos: comparación del desempeño de dos métodos de obtención / Snake Antivenoms: Performance Comparison of Two Preparation Methods

INTRODUCCION: Los sueros antiofídicos pueden prepararse por precipitación de suero o plasma equino hiperinmune con sulfato de amonio o con ácido caprílico. OBJETIVO:Comparar el rendimiento de ambos métodos. MATERIALES Y METODOS: Las inmunoglobulinas se precipitaron con sulfato de amonio, y la albúmina con ácido caprílico. El nivel de anticuerpos en la preparación final se midió por el método de ELISA. RESULTADOS: El ácido caprílico al 3...(AU)

INTRODUCTION: Antivenom sera can be prepared by precipitation of hyperimmune equine serum or plasma with ammonium sulfate or caprylic acid. OBJECTIVE:To compare the performance of both methods. METHODS:The immunoglobulins were precipitated with ammonium sulfate, and the albumin with caprylic acid. The antibody level in the final preparation was measured by ELISA. RESULTS: The 3...(AU)

Lymphoepithelial cysts of oral mucosa: two cases in different regions.

Lymphoepithelial cyst of the oral cavity is a rare cystic lesion that presents as an asymptomatic, well-circumscribed, yellowish small submucosal nodule covered by normal overlying mucosa, usually located in the floor of the mouth or in the ventral or posterolateral surface of the tongue. Histopathological examination reveals a cyst lined by a stratified squamous epithelium surrounded by lymphoid tissue. In this paper, we report two cases of oral lymphoepithelial cyst, one on the anterior floor of the mouth and another on the posterior lateral tongue. In both cases, the patients were women aged approximately 50 years and the lesions were treated by local surgical excision, with no evidence of recurrence after 2 years of follow-up.

Retrospective study of 25 cases of keratocystic odontogenic tumor: epidemiology and treatment.

AIM: Keratocystic odontogenic tumor (KOT) is a benign odontogenic neoplasm with locally aggressive behavior and high recurrence rates. It is associated with nevoid basal cell carcinoma syndrome which usually has a more rapid growth. The aim of the study is to report the experience of our service on diagnosis and treatment of KOT. MATERIALS AND METHODS: Twenty-five cases of KOT were diagnosed between the years of 1989 and 2006. Demographic data was collected as well as diagnose and treatment. RESULTS: Fifty-six percent were female with a mean age of 33 years old. Seventy percent occurred in mandibula and all received surgical treatment, associate or not with adjuvant therapy, such as cryotherapy and Carnoy's solution. Recidive was observed in 48% of cases with a mean period of time of 18 months. CONCLUSION: Our data analysis showed the importance of previous diagnosis before enucleation procedure and long-term follow-up for recurrence early detection. Recurrence incidence is more frequent on first year after diagnosis. CLINICAL SIGNIFICANCE: KOT is a benign tumor with local aggressive behavior and therefore its treatment must consider the high index of recidive. Reports of protocol treatment should raise new discussion to decrease recurrence rates.

Association of Glycemic Indexes, Hyposalivation, and Xerostomia Type 1 Diabetic Patients / Asociación de los Índices de Glucemia, Hiposalivación y Xerostomía en Pacientes Diabéticos Tipo 1

The aim of this study was to assess the relationship between glycemic control of type 1 diabetic (DM1) patients and hyposalivation and xerostomia. This observational transversal study used a quantitative approach with a sample of 25 DM1 patients enrolled at the Diabetes Association of Joinville (ADIJO) in 2008. Variables assessed were sialometry through stimulated salivary flow, complaints of xerostomia, and testing for glycemic control: fasting capillary glycemia (FCG) and glycated hemoglobin (HbA1c). The Mann-Whitney U test, chi-square test, and Fisher's exact test were used to verify a possible association among the variables. Most subjects (64 percent; 16/25) showed concomitant hyposalivation and xerostomia. No significant statistical difference between glycemic control (FCG and HbA1c), hyposalivation, and xerostomia (p=0.54) was found. A high prevalence of hyposalivation and xerostomia was found to be more closely related to higher FCG values at the moment of blood testing than to higher values of HbA1c.

El objetivo de este estudio fue evaluar la relación entre el control glucémico de los pacientes diabéticos tipo 1 (DM1) e hiposalivación y xerostomía. Este estudio observacional de cohorte transversal utilizó un enfoque cuantitativo con una muestra de 25 pacientes con DM1 inscritos en la Asociación de Diabetes de Joinville (ADIJO) el 2008. Las variables evaluadas fueron sialometría a través del flujo salival estimulado, quejas de la xerostomía, y las pruebas para el control glucémico: glucosa capilar en ayunas (GCA) y hemoglobina glicosilada (HbA1c). Se utilizaron las pruebas de Mann-Whitney, chi-cuadrado y exacta de Fisher para verificar una posible asociación entre las variables. La mayoría de los sujetos (64 por ciento, 16/25) mostró hiposalivación concomitante y xerostomía. No se observaron diferencias estadísticamente significativas entre el control glucémico (GCA y HbA1c), hiposalivación y xerostomía (p=0,54). Una alta prevalencia de hiposalivación y xerostomía se encontró estrechamente relacionada con los valores altos de GCA mas que con valores altos de HbA1c en el momento del análisis sanguíneo.

Frequência das lesões bucais diagnosticadas no Centro de Especialidades Odontológicas de Tubarão (SC) / Frequency of oral lesions diagnosed at the Dental Specialties Center of Tubarão (SC)

Introdução: Estudos epidemiológicos das doenças bucais caracterizam as populações averiguadas e proporcionam referenciais para a elaboração de estratégias de tratamento e prevenção. Objetivo: Determinar a freqüência das lesões bucais mais comuns e o perfil epidemiológico dos pacientes atendidos no Centro de Especialidades Odontológicas do município de Tubarão (SC) entre os anos 2003 e 2008. Material e métodos: Foi feito um trabalho retrospectivo, por meio da análise de um banco de dados preexistentes de todos os indivíduos atendidos no serviço, desde a sua implantação. As variáveis sexo, idade, procedência, presença de lesão bucal, realização de biópsia e resultado anatomopatológico foram levantadas, armazenadas em uma planilha de Excel e submetidas a análise estatística descritiva, efetuando-se a correlação das variáveis e a determinação da freqüência de cada lesão. Resultados: Dos 140 pacientes, 89 eram mulheres e 51 homens. A idade variou de 4 a 81 anos, com media de 47,2 anos. Do total de pacientes, 121 apresentaram lesão bucal no momento da consulta, e cinco tinham duas lesões diferentes e concomitantes, totalizando 126 lesões. Treze não possuíam nenhuma lesão bucal no momento do exame clinico, seis queixaram-se de xerostomia e quatro de hipossalivação com algum outro tipo de lesão também, porém nenhum exame complementar foi efetuado para determinar alteração no fluxo salivar. Realizaram-se 54 biopsias para confirmação diagnóstica. Quanto ás lesões, 97,6% tinham características de benignidade; as mais freqüentes foram candidose (14,3%), hiperplasia fibrosa inflamatória (12,7%), mucocele (9,5%) e fibroma (5,6%). Foram confirmados três casos de neoplasia maligna; todos eram carcinoma escamocelular. Conclusão: Constatou-se que 86,4% dos pacientes apresentaram lesão bucal no momento da consulta, e as lesões benignas apareceram em quase 98% dos casos. A candidose bucal foi a lesão mais prevalente, seguida da hiperplasia fibrosa inflamatória. Em relação ao perfil epidemiológico dos indivíduos assistidos, aproximadamente 64% pertenciam ao gênero feminino, com idade média de 47 anos

Introduction: Epidemiological studies of different oral diseases characterize the studied populations and provide references for the development of treatment and prevention strategies. Aim: To determine both the frequency of the most common oral lesions and the epidemiological profile of patients treated at the Dental Specialties Center (DSC) of the city of TubarÒo / SC, from 2003 to 2008. Material and methods: A retrospective study was performed, by analyzing a preexisting databank of all patients treated at the center, since its implementation. The following variables were studied: sex, age, origin, presence of oral lesions, biopsy to confirm the diagnosis, and pathology results. Then, data were stored in an Excel worksheet and submitted to statistical descriptive analysis, through the correlation among variables and determining the frequency of each lesion. Results: From 140 patients, 89 were female and 51 male. Age ranged from 4 to 81 years, with an average age of 47.2 years. Considering the total number of patients, 121 presented an oral lesion at the time of the appointment. Five patients showed two different and concomitant lesions, totaling 126 lesions. Thirteen patients did not present any oral lesion at clinical examination. Six patients complained about xerostomia and 04 about hyposalivation with some other concomitant lesion, but no additional examination was performed to determine changes in salivary flow. A total of 54 biopsies was performed for diagnostic confirmation. 97.6% of the lesions were benign, among which oral candidosis (14.3%), inflammatory fibrous hyperplasia (12.7%), mucocelis (9.5%), and fibroma (5.6%) were the most frequent. Three cases of malignant neoplasia were found, all confirmed as squamous cell carcinoma. Conclusion: Most of the patients (86.4%) showed an oral lesion at the time of the appointment, and the benign lesions totalized almost 98% of the cases. Oral candidiasis was the most prevalent lesion, followed by inflammatory fibrous hyperplasia. Concerning to the epidemiological profile of the treated patients, approximately 64% were female, with a mean age of 47 years-old

Oral and maxillofacial manifestations of familial adenomatous polyposis (Gardner's syndrome): a report of two cases.

AIM: The aim of this case report is to emphasize the importance of an early diagnosis of Gardner's syndrome through the detection of lesions appearing in the oral and maxillofacial area as well as to present two cases of the disease. BACKGROUND: Gardner's syndrome is an autosomal dominant disease characterized by gastrointestinal polyps that develop in the colon as well as in the stomach and upper intestine, along with multiple osteomas, skin, and soft tissue tumors. Cutaneous findings may include desmoid tumors, epidermoid cysts, and other benign tumors. Early diagnosis and therapy of the disease are critical because polyps have a 100% risk of undergoing malignant transformation. Craniomaxillofacial manifestations (osteoma formation, tooth impaction, diffuse opacities in the skull, mandible and maxilla, scalp tumors) usually precede polyposis. REPORT: Case 1: Gardner's syndrome was diagnosed in a 25-year-old Caucasian man who was referred by his endodontist for evaluation of an uncommon radiographic image in the mandibular molar area. Further investigation revealed a familial adenomatous polyposis (FAP) complicated by adenocarcinoma of the colon. A colectomy and an ileorectal anastomosis were performed. Case 2: A 12-year-old Caucasian girl, who is a niece of the patient described in Case 1, presented with progressive difficulty with mouth opening but no complaints of digestive problems. Radiographic examination revealed multiple radiopacities in the maxilla, mandible left temporomandibular joint, and in the left mandibular angle. Multiple impacted teeth were present. A colonoscopy was suggested, but the patient's parents decided to continue the investigation and treatment with their own physician in their home town. SUMMARY: Since an early diagnosis is essential and general dental practitioners may be the first healthcare professionals to suspect the diagnosis, it is important for them to be familiar with the features of Gardner's syndrome.

Influência do controle glicêmico na experiência de cárie e doença periodontal em pacientes diabéticos tipo 1 / Influence of glycemic control on the experience of caries and periodontal disease in type 1 diabetic patients

O diabetes mellitus é uma desordem metabólica crônica caracterizada por hiperglicemia em resposta a uma insuficiência total ou relativa de insulina. É considerada, pela Organização Mundial da Saúde, uma epidemia global que atinge aproximadamente 194 milhões de pessoas no mundo, e tem sido, frequentemente, associada à doença periodontal e cárie dentária. O objetivo deste estudo foi investigar a experiência de cárie e doença periodontal (gengivite) em pacientes portadores de diabetes mellitus tipo 1 (DM1), que representam aproximadamente 10% do grupo de indivíduos portadores de diabetes mellitus, comparando com um grupo de pacientes controle, não diabéticos (NDM). A amostra foi constituída por 25 pacientes DM1 (G1) e 25 pacientes NDM (GC), pareados por sexo e idade. Foram avaliados os índices de dentes cariados, perdidos e obturados (CPO-D), índice de placa visível (IPV), índice de sangramento gengival (ISG), fluxo salivar e frequência de escovação, correlacionados com a hemoglobina glicosilada e glicemia capilar em jejum, e comparados com o GC. Os resultados do teste de Mann-Whitney mostraram não existir diferença estatisticamente significativa (p>0,05) entre os valores médios do CPO-D entre os dois grupos. Quando comparados os valores referentes à escovação e fluxo salivar (testes do Qui-Quadrado e Mann-Whitney), e IPV e ISG (teste t de Student para amostras independentes), não houve diferença significativa entre os dois grupos (p>0,05). Quando foram correlacionados os dados do ISG, IPV, CPO-D e fluxo salivar com os valores da hemoglobina glicosilada e glicemia capilar em jejum e fluxo salivar, os resultados do teste Mann-Whitney não foram estatisticamente significativos (p>0,05). De acordo com a amostra pesquisada, não existiu diferença entre a experiência de cárie e doença periodontal (gengivite) entre os grupos estudados.