Pain perception and expectation related to interradicular mini-implants insertion: a systematic review and meta-analysis.

OBJECTIVES: The aim of this systematic review was to compare the expectation and perception of pain reported by patients before and after the installation of interradicular mini-implants. MATERIALS AND METHODS: Electronic search was performed in six databases. Inclusion criteria were randomized controlled trials (RCTs) or non-randomized controlled clinical trials (nRCTs); studies using mini-implants in the interradicular region; assessment of pain intensity by visual analogue or numerical scale. The risk of bias assessment was based on the Rob 2 tool and Robins-I. RESULTS: A total of 1566 articles were retrieved, and 21 met the eligibility criteria. Six were classified as high risk, one as critical and the other one as uncertain, according to the Robins-I tool. In articles evaluated by the Rob2 tool, ten were classified as serious risk and three as moderate risk. A meta-analysis was also performed. Weighted means were calculated among the studies using the random-effects model and forest plots were generated. Heterogeneity was assessed through the Q test and I2 statistics. It was observed, with moderate evidence, that on a scale of 0 to 10, the pain expectation (effect size 4.75) is higher than that effectively pain generated by the procedure (effect size 1.94). CONCLUSION: Pain expectation was greater than that actually generated by the procedure, being almost non-existent 7 days postoperatively. CLINICAL RELEVANCE: This study may help the clinician to reassure the patient regarding the sensations that could be experienced during and after the installation.

A relação entre o comprometimento motor e os sintomas depressivos na doença de Parkinson / The relationship between motor impairment and depressive symptoms in Parkinson's disease

Trata-se de um estudo transversal retrospectivo que incluiu 27 pessoas com doença de Parkinson (DP), diagnosticados por neurologista. O objetivo do estudo foi analisar o tipo de correlação entre o grau de comprometimento motor e grau de depressão em pessoas com DP, tendo como hipótese que quanto maior o grau de comprometimento motor proporcionado pela doença, maior o grau de depressão. Foram utilizados os instrumentos Inventário de Depressão de Beck (BDI II) para a medida de sintomas depressivos e do grau de depressão, e a escala Hoehn & Yahr foi aplicada para identificação do grau de comprometimento motor. Foram excluídos indivíduos que não preencheram um dos instrumentos do estudo, selecionando apenas as pessoas com DP que preencheram ambos os instrumentos. Verificou-se uma correlação positiva e significativa entre os resultados do BDI -II e a escala Hoehn & Yahr modificada (r = 0,41, p = 0,035). O estudo identificou, portanto, uma associação crescente e positiva entre o grau de comprometimento motor das pessoas com DP e a presença de sintomas de depressão. Com isso, foi possível concluir que, uma pessoa com DP e maior grau de comprometimento motor, tende a apresentar maior número de sintomas depressivos e, consequentemente maior grau de depressão e vice-versa. Portanto, deve-se dedicar maior atenção à saúde mental dos casos em que a doença se expressa com maior comprometimento motor.

This is a retrospective cross-sectional study that included 27 people with Parkinson's disease (PD), diagnosed by a neurologist. The objective of the study was to analyze the type of correlation between the degree of physical impairment and degree of depression in people with PD, having as hypothesis that the greater the degree of physical impairment provided by the disease, the greater the degree of depression. The Beck Depression Inventory (BDI II) was used to measure depressive symptoms and the degree of depression, and the modified Hoehn & Yahr scale was applied to identify the degree of physical impairment. Individuals who did not complete one of the study instruments were excluded, selecting only those people with PD who completed both instruments. A positive and significant correlation can be verified between the results of the BDI -II and the Hoehn & Yahr scale (r = 0.41, p = 0.035). The study identified, therefore, an increasing and positive association between the degree of motor impairment of people with PD and the presence of symptoms of depression. With this, it was possible to conclude that, a person with PD and a higher degree of motor impairment, tends to present a higher number of depressive symptoms and, consequently, a higher level of depression and vice versa. Thus, the more physically compromised the person with PD is, the greater the association with a more severe depression. Therefore, greater attention should be paid to mental health in cases in which the disease is expressed with greater physical impairment.

Flood-pulse and trophic position modulate mercury concentrations in fishes from an Amazon floodplain lake.

Mercury (Hg) bioaccumulation can be influenced by biological characteristics (e.g., trophic position) and environmental changes (e.g., seasonal flood-pulse), as it can create site conditions conducive to methylation and alter the availability of food to biota. This study aimed to relate total mercury (THg) and methylmercury (MeHg) concentrations in fishes of an Amazonian lake (Catalão Lake) to their dietary changes during different hydrological seasons (rising-, high-, falling-, and low-water). Levels of THg, MeHg, and stable isotopes of nitrogen and carbon (δ15N and δ13C) were determined in the muscles of six fish species: Rhytiodus microlepis, Hemiodus sp., Triportheus albus, Anodus elongatus, Pellona flavipinnis and Acestrorhynchus falcirostris. Triportheusalbus, an omnivorous fish, showed a significant relationship between Hg concentrations and δ13C signatures (negative regression; THg: p = 0.0001 and MeHg: p = 0.0002), as well as between Hg and δ15N signatures (positive regression; THg: p = 0.003 and MeHg: p = 0.021), indicating that changes in feeding habits influenced the Hg concentrations in this species. The herbivorous R. microlepis presented the highest MeHg concentrations during the high-water season, reflecting Hg methylation in its diet (macrophyte roots) during flooded season. The piscivorous A. falcirostris had the lowest THg concentrations during this season because of lower prey availability. Slopes of the regressions between the Hg concentrations and δ15N values followed the sequence of rising- < high- < falling-water seasons (THg: 0.06 < 0.11< 0.15; MeHg: 0.07 < 0.10 < 0.17), indicating that the difference between the THg and MeHg concentrations observed for lower- and higher-trophic-level fish increased during the falling-water season, resulting in trophic biomagnification. The present study shows that feeding habit and the flood-pulse influence mercury concentrations in the muscle of fishes from Catalão Lake.

Mercury Concentrations in Four Marine Fishery Resources from Rio de Janeiro Coast, SW Atlantic, and Potential Human Health Risk Via Fish Consumption.

Mercury (Hg) contamination has caused ecological and socioeconomic problems worldwide. One of the main Hg contamination routes by the human populations is through fish ingestion. Herein, we analyzed the total Hg concentrations (THg) in highly consumed marine fish species: Brazilian flathead Percophis brasiliensis, Atlantic bigeye Priacanthus arenatus, Stripped weakfish Cynoscion guatucupa, and Jamaica weakfish C. jamaicensis. The specimens were collected from fishing landings off the Rio de Janeiro, SW Atlantic. Additionally, we calculate the estimated weekly intakes (EWI) and the maximum amount of fish (MAF) that can be safely ingested, both based on the provisional tolerable weekly intake (PTWI). The highest THg concentrations were recorded in P. brasiliensis with a mean of 340.59 µg/kg (dry weight) and the lowest in P. arenatus (115.75 µg/kg). THg concentrations were positively related to the δ15N ratios indicating an increase in contamination with trophic level. All samples showed THg concentrations below the established limits by Brazilian and international regulation. Hg intake via human fish consumption does not exceed the PTWI. The EWI varied from 1.41% (P. arenatus size class I) to 11.52% (P. brasiliensis class II) of the PTWI, while the estimated EWI for "fish consumers" varied between 8.35 and 68.07% PTWI. The MAF estimated for an adult (70 kg) could safely consume between 1277.85 and 7075.50 g/week. This study is an important baseline for monitoring and future comparisons. Therefore, it is important to maintain monitoring of mercury levels in fish species in different marine regions, especially those species most consumed by humans.

Total tin (TSn) biomagnification: Evaluating organotin trophic flow and dispersion using hepatic TSn concentrations and stable isotope (C, N) data of nektonic organisms from Brazil.

A previous investigation of our research team has demonstrated the suitability of using hepatic total tin (ΣSn) concentrations for evaluating dolphin exposure to organotins (OTs). The present study develops the previous technique into three different approaches that comprise data: (1) on hepatic ΣSn concentrations of 121 Guiana dolphins (Sotalia guianensis) from five different coastal areas (CAs): (2) on ΣSn, δ13C and δ15N for 40 dolphins from Rio de Janeiro state (RJ), including ten different delphinid species; as well as (3) on hepatic ΣSn concentrations and δ15N values on 31 individuals from five different fish species from Sepetiba Bay (SB, Rio de Janeiro-RJ, Brazil). Hepatic ΣSn concentrations of Guiana dolphins from Guanabara Bay (GB, RJ) were significantly higher than those found in other four CAs from S and SE Brazilian regions. Significant positive correlations were found between ΣSn concentrations and δ13C data in delphinid species, demonstrating a coast-ocean gradient in dolphin exposure to OTs in RJ state. Significant and positive correlations were observed between ΣSn concentrations and both δ15N and Trophic Position (TP) values of fish, as well as high values were found for Trophic Magnification Factor (TMF = 3.03) and Trophic Magnification Slope (TMS = 0.14), demonstrating OT biomagnification in SB ichthyofauna.

Influence of canine vertical position on smile esthetic perceptions by orthodontists and laypersons.

INTRODUCTION: Our objectives were to verify the impact of alterations in the vertical position of the maxillary canines in smile esthetic perceptions and to determine whether exposure of the gingival margins directly affects laypersons' and orthodontists' perceptions. METHODS: A smile photograph of a male subject showing gingival zeniths was selected, and the canine vertical positions were symmetrically modified in increments of 0.5 mm, creating 4 new images varying from 1.0 mm of intrusion to 1.0 mm of extrusion, with and without gingival exposure. The total of 10 images were evaluated by 60 orthodontists and 60 laypersons, who determined the level of attractiveness of each smile on a visual analog scale. RESULTS: For both orthodontists and laypersons, the canine vertical position modifications had a statistically significant influence (P <0.0001), and the gingival exposure had no significant influence on the smile esthetic evaluations. CONCLUSIONS: For both groups of evaluators, the most attractive smiles were the standard smile and the smiles with 0.5 mm of intrusion. The less attractive smiles were those with 1.0 mm of extrusion and 1.0 mm of intrusion. Orthodontists were more critical in their assessments. There were no differences in the esthetic evaluations of smiles with and without gingival margin exposure for both groups of evaluators.

Perfil da gestante encarcerada em penitenciárias brasileira: importância da assistência à saúde da mulher / Pregnant incarcerated profile in the brazilian prison: the importance of assistance to women's health

Objetivo ­ Avaliar a saúde da mulher encarcerada em uma penitenciária brasileira, por meio da revisão de prontuários. Métodos ­ Trata-se de um estudo retrospectivo e descritivo sobre a atenção à saúde da mulher encarcerada de uma penitenciária, o qual foram acompanhadas em uma unidade básica de saúde, no interior do Estado de São Paulo. Resultados ­ Participaram desse estudo 71 prontuários de mulheres gestantes encarceradas que foram acompanhadas de 2009 a março de 2014. E foram revisados. Foi identificado que a faixa etária da maioria das mulheres estudadas estava entre 18 a 28 anos (74%) e que tiveram início da vida sexual entre 12 a 22 anos (88%), com um a três parceiros sexuais no período de três meses (79%). O número de gestações entre as mulheres estudadas foi de uma a três (55%), sendo que 15% eram primigestas. Conclusões ­ Notou-se que, os números de consultas de pré-natal foram de uma a quatro consultas (78%), o que está abaixo do preconizado pelo Ministério da Saúde. Eram usuárias de tabaco, drogas ilícitas como maconha e cocaína, e também portadoras de doenças sexualmente transmissíveis. O estudo revelou a importância de se conhecer a saúde da mulher encarcerada, por se tratar de uma população marginalizada e jovem, sendo necessário fornecer subsídios para o resgate da cidadania dessa população e criar projetos e planos de educação e promoção em saúde mais fortalecidos e que tenham continuidade.

Objective ­ To evaluate the health of women incarcerated in a brazilian penitentiary, through chart review. Methods ­ This a retrospective and descriptive on the health care of incarcerated women of a penitentiary who were followed at a basic health unit in the state of São Paulo. Results ­ Participated in this study a total of 71 records of women incarcerated pregnant women who were followed from 2009 to March 2014. And were reviewed. It was identified that the age of most of the women studied were between 18-28 years (74%) and who had onset of sexual activity between 12-22 years (88%), with one to three sexual partners in the three months ( 79%). The number of pregnancies among the women studied was between one and three (55%), and 15% were primiparous. Conclusions ­ It is noticed that the numbers of prenatal consultations were one to four (78%), which is below the recommended by the Ministry of Health. They were tobacco users, illegal drugs such as marijuana and cocaine, as well as carriers sexually transmitted diseases. The study revealed the importance of knowing the health of incarcerated women, because it is a marginalized young people, being necessary to provide subsidies for the recovery of citizenship of this population and create more strengthened projects and health education and promotion plans and that is maintained.

Sexually coercive male chimpanzees sire more offspring.

In sexually reproducing animals, male and female reproductive strategies often conflict. In some species, males use aggression to overcome female choice, but debate persists over the extent to which this strategy is successful. Previous studies of male aggression toward females among wild chimpanzees have yielded contradictory results about the relationship between aggression and mating behavior. Critically, however, copulation frequency in primates is not always predictive of reproductive success. We analyzed a 17-year sample of behavioral and genetic data from the Kasekela chimpanzee (Pan troglodytes schweinfurthii) community in Gombe National Park, Tanzania, to test the hypothesis that male aggression toward females increases male reproductive success. We examined the effect of male aggression toward females during ovarian cycling, including periods when the females were sexually receptive (swollen) and periods when they were not. We found that, after controlling for confounding factors, male aggression during a female's swollen periods was positively correlated with copulation frequency. However, aggression toward swollen females was not predictive of paternity. Instead, aggression by high-ranking males toward females during their nonswollen periods was positively associated with likelihood of paternity. This indicates that long-term patterns of intimidation allow high-ranking males to increase their reproductive success, supporting the sexual coercion hypothesis. To our knowledge, this is the first study to present genetic evidence of sexual coercion as an adaptive strategy in a social mammal.

Space-time prospective surveillance based on Knox local statistics.

We studied a surveillance system to prospectively monitor the emergence of space-time clusters in point pattern of disease events. Its aim is to detect a cluster as soon as possible after its emergence, and it is also desired to keep the rate of false alarms at a controlled level. The method is a modification from a previous proposal based on a local version of the Knox statistic and which examined a retrospective surveillance scenario, looking for the earliest time in the past that change could have been deemed to occur. We modify this method to take into account the prospective case, being able then to fix the serious difficulties found by other authors. We evaluated the surveillance system in several scenarios, including without and with emerging clusters, checking distributional assumptions, and assessing performance impacts of different emergence times, shapes, extent, and intensity of the emerging clusters. Our conclusion is that the space-time surveillance system based on local Knox statistics is very efficient in its statistical properties, and it is appealing to epidemiologists and public health officials because it is simple to use and easily understandable. This makes it a promising candidate to practical use by public health official agencies.

Imputation of confidential data sets with spatial locations using disease mapping models.

Data that include fine geographic information, such as census tract or street block identifiers, can be difficult to release as public use files. Fine geography provides information that ill-intentioned data users can use to identify individuals. We propose to release data with simulated geographies, so as to enable spatial analyses while reducing disclosure risks. We fit disease mapping models that predict areal-level counts from attributes in the file and sample new locations based on the estimated models. We illustrate this approach using data on causes of death in North Carolina, including evaluations of the disclosure risks and analytic validity that can result from releasing synthetic geographies.

Budesonide quantification by HPLC coupled to atmospheric pressure photoionization (APPI) tandem mass spectrometry. Application to a comparative systemic bioavailability of two budesonide formulations in healthy volunteers.

In the present study, a novel, fast, sensitive and robust method to quantify budesonide in human plasma using 3-keto-desogestrel as the internal standard (IS) is described. The analyte and the IS were extracted from human plasma by liquid-liquid extraction (LLE) using ether. Extracted samples were analyzed by high performance liquid chromatography coupled to Atmospheric pressure photoionization tandem mass spectrometry (HPLC-APPI-MS/MS). Chromatography was performed isocratically on a C18, 5 µm analytical column. The temperature of the autosampler was kept at 6 °C and the run time was 4.00 min. A linear calibration curve over the range 7.5-1000 pg ml⁻¹ was obtained and the lowest concentration quantified was 7.5 pg ml⁻¹, demonstrating acceptable accuracy and precision. This analytical method was applied in a relative bioavailability study in order to compare a test budesonide 64 µg/dose nasal spray formulation vs. a reference 64 µg/dose nasal spray formulation (Budecort Aqua) in 48 volunteers of both sexes. The study was conducted in an open randomized two-period crossover design and with a one-week washout period. Plasma samples were obtained over a 14 h interval. Since the 90% CI for both C(max), AUC(last) and AUC(0-inf) were within the 80-125% interval proposed by the Food and Drug Administration and ANVISA, it was concluded that budesonide 64 µg/dose nasal spray was bioequivalent to Budecort Acqua® 64 µg/dose nasal spray, according to both the rate and extent of absorption.