Pain measurement in TMD patients: evaluation of precision and sensitivity of different scales.

The aim of this study was to evaluate the precision and sensitivity of four different pain rating scales in 59 temporomandibular disorders (TMD) patients. The capacity of describing changes in symptoms during treatment was also addressed. All patients were asked to answer four pain scales: Visual Analogue Scale (VAS), Numerical Scale (NS), Behaviour Rating Scale (BRS) and Verbal Scale (VS). Two measurements were taken before any treatment. After beginning it, follow-ups and repeated measurements were taken 1 week, 15 days, and every month for 6 months. Statistical analysis showed significant differences (P < 0.05) for all scales, but the NS (P > 0.05), when the two initial measurements were analysed. Regarding the sensitivity, all pain scales demonstrated general symptom improvement of 30-50%, when initial and final figures were compared (P < 0.01). Also, the most significant improvement occurred in the first 2 months after beginning the management programme. Authors concluded that the NS was more accurate to measure reproducibility of pain. As for the capacity of expressing changes during the treatment, all scales demonstrated symptom decrease of 30-50% in a period of 6 months. Caution when analysing the results is recommended because of the subjective aspect of pain measurement, the absence of a 'gold standard' for comparison and the natural fluctuation of TMD symptoms.

Retinal changes and tumorigenesis in Ramon syndrome: follow-up of a Brazilian family.

We report on the clinical evolution of the Brazilian family with Ramon syndrome described by de Pina-Neto et al. [1986, Am J Med Genet 25:441-443]. Three members (patients IV-2, IV-18, and IV-19) have developed pigmentary changes in the retina and paleness of the optic disk. Patient IV-18 also has developed giant hypertrophy of the labia minora that, when examined histopathologically, was found to be due to neoplastic fibroblast and epithelial proliferation caused by a fibromatous process similar to that reported in the gingivae of the patients with this syndrome. Audiologic function of patient IV-2 was normal, and no skin lesions were detected. The articular signs and symptoms show that the affected relatives developed rheumatoid arthritis, which is currently inactive in patient IV-18, whereas patient IV-2 did not develop these alterations.

[Type 2 diabetic patients in a population sample from Ribeirão Preto area (São Paulo)]. / Estudo analítico de uma amostra populacional de diabéticos tipo II da região de Riberirão Preto (SP).

To characterize the prevalence of long term diabetic complications (macroangiopathy, retinopathy, nephropathy and neuropathy) and their possible relation to the degree of metabolic control and duration of diabetes, we studied a hospital-based brazilian population sample of 546 non-insulin dependent diabetic patients. The group was subjected to a standardized evaluation protocol, including clinical characterization of the patients and their disease, current therapy, degree of metabolic control and presence of diabetic complications. The studied sample is of adult age range (25 to 84 years), with mean duration of diabetes of 8.0 +/- 6.8 years. Obesity was observed in 72.6% of the group and 232 patients (43.3%) had diabetics among their relatives. 92 (18.4%) patients have been treated with diet only, whereas 170 (32.6%) also used oral hypoglycemic agents, and 226 (43.7%) were using NPH insulin therapy (81.4% with single daily dose). The mean annual levels of fasting blood glucose (187 +/- 68mg/dl), urine glucose (9.6 +/- 16.7g/day) and glycosylated hemoglobin (12.2 +/- 3.3%) of the group, permitted a classification of the patients in: a) good metabolic control (106 pat. = 19.4%); b) regular control (264 pat. = 48.4%) and c) poor metabolic control (176 pat. = 32.2%). The prevalences of microvascular and neuropathic complications was: retinopathy = 29.1%, nephropathy = 11.3% and neuropathy = 50.9%. The observed increase in the prevalence of the complications was progressive according to the duration of the diabetes. In all time intervals of duration of diabetes, neuropathy was the most frequently observed complication. The prevalence of complications was always higher in the poorly controlled group compared to the patients in good metabolic control.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of rose bengal staining test and rapid dark-adaptation test for the field assessment of vitamin A status of preschool children in Southern Brazil.

The objective of this study was to evaluate two of several methods presently available for assessing vitamin A status of marginally malnourished preschool children of socioeconomically deprived families in Southern Brazil. The rose bengal staining test and rapid dark-adaptation test were evaluated by comparing their results with conventional methods that require estimation of dietary intake of vitamin A equivalents and determination of plasma levels of retinol before and after an oral supplementation of 200 000 IU vitamin A. Results indicate that neither test evaluated is useful by itself. There was no significant correlation between the results of the rose bengal staining test and the plasma levels of retinol. Also, no significant correlation was observed between the rapid dark-adaptation time and the vitamin A status of the preschool children as determined by plasma-retinol levels before and after vitamin A supplementation.

Vitamin A status of young children in Southern Brazil.

A comprehensive survey was carried out to assess the vitamin A status of preschool children of poor migrant families in the periurban population of Ribeirao Preto, a typical agricultural town in the sugarcane and coffee region of the State of Sao Paulo in Southern Brazil. The intake of vitamin A and carotenoids from the rice and bean based diet of these children is considered low and appears to influence blood concentrations and liver reserves of this vitamin. With respect to plasma vitamin A, 1.8% of the children had a deficient level (less than 10 micrograms%), whereas 48.8% of the children had a low level (less than 20 micrograms%). Most children with inadequate plasma vitamin A (less than 20 micrograms%) responded positively to a massive dose of 200,000 IU vitamin A, suggesting that these children may be at risk of having low liver stores of vitamin A. Rose Bengal staining test and rapid dark adaptation time did not indicate definite signs of conjunctival xerosis and night blindness among these children. No ocular evidence of hypovitaminosis A was found in the children studied, but marginal or inadequate vitamin A status appears to be a common public health problem among young children in this region of Brazil.