Type IV hypersensitivity associated with restorative materials: Clinical report and systematic literature review.

STATEMENT OF PROBLEM: Type IV hypersensitivity reactions (Type IV HR) are immune responses mediated by antigen-specific effector T cells. PURPOSE: The purpose of this clinical report and systematic review was to report the clinicopathological features of Type IV HR in the oral mucosa and to present a systematic literature review of case reports and case series of individuals with Type IV HR in the oral mucosa related to contact with dental materials. MATERIAL AND METHODS: The presented clinical lesions were melanotic macules with burning that affected the internal labial mucosa in contact with composite resin veneer crowns. Histopathological and immunohistochemical analysis of the lesion was performed. The systematic literature review was performed based on a search in 4 electronic databases (PubMed/MEDLINE, Scopus, Web of Science, and Ovid). RESULTS: Immunohistochemistry showed positivity for CD4, CD8, CD20, CD3, tryptase, and CD117. After conservative treatment, the patient reported improvement of symptoms, and a decrease in the number of inflammatory cells was verified. Twenty-one articles were included in the review. Unlike the present patient, the authors of all the articles recommended radical treatment with the removal of the dental material. CONCLUSIONS: Type IV HR in oral mucosa is rare, and the assessment of clinical and histopathological characteristics is essential to perform an accurate diagnosis and provide appropriate treatment.

Mutations in PCYT1A cause spondylometaphyseal dysplasia with cone-rod dystrophy.

Spondylometaphyseal dysplasia with cone-rod dystrophy is a rare autosomal-recessive disorder characterized by severe short stature, progressive lower-limb bowing, flattened vertebral bodies, metaphyseal involvement, and visual impairment caused by cone-rod dystrophy. Whole-exome sequencing of four individuals affected by this disorder from two Brazilian families identified two previously unreported homozygous mutations in PCYT1A. This gene encodes the alpha isoform of the phosphate cytidylyltransferase 1 choline enzyme, which is responsible for converting phosphocholine into cytidine diphosphate-choline, a key intermediate step in the phosphatidylcholine biosynthesis pathway. A different enzymatic defect in this pathway has been previously associated with a muscular dystrophy with mitochondrial structural abnormalities that does not have cartilage and/or bone or retinal involvement. Thus, the deregulation of the phosphatidylcholine pathway may play a role in multiple genetic diseases in humans, and further studies are necessary to uncover its precise pathogenic mechanisms and the entirety of its phenotypic spectrum.

Further evidence of the importance of RIT1 in Noonan syndrome.

Noonan syndrome (NS) is an autosomal dominant disorder consisting of short stature, short and/or webbed neck, distinctive facial features, cardiac abnormalities, cryptorchidism, and coagulation defects. NS exhibits genetic heterogeneity, associated with mutated genes that participate in RAS-mitogen-activated protein kinase signal transduction. Recently, a new gene (RIT1) was discovered as the causative gene in 17 of 180 Japanese individuals who were negative for the previously known genes for NS and were studied using exome sequencing (four patients), followed by Sanger sequencing (13 patients). The present study used the same technique in 70 Brazilian patients with NS and identified six with RIT1 missense mutations. Thus, we confirm that RIT1 is responsible for approximately 10% of the patients negative for mutations in the previously known genes. The phenotype includes a high frequency of high birth weight, relative macrocephaly, left ventricular hypertrophy, and ectodermal findings, such as curly hair, hyperpigmentation, and wrinkled palms and soles. Short stature and pectus deformity were less frequent. The majority of patients with a RIT1 mutation did not show apparent intellectual disability. Because of the relatively high frequency of mutations in RIT1 among patients with NS and its occurrence in different populations, we suggest that it should be added to the list of genes included in panels for the molecular diagnosis of NS through targeted next-generation sequencing.

Comparison of epidural and systemic tramadol for analgesia following ovariohysterectomy.

The objective of the study was to compare epidural and systemic tramadol for postoperative analgesia in bitches undergoing ovariohysterectomy. Twenty animals, randomly divided into two groups, received either epidural (EPI) or intramuscular (IM) tramadol (2 mg/kg) 30 min before anesthetic induction. Analgesia, sedation, cardiorespiratory parameters, end-tidal isoflurane, blood catecholamines and cortisol, and arterial blood gases were measured at different time points up to 24 hr after agent administration. There were no differences between the two groups regarding cardiorespiratory parameters, end-tidal isoflurane, and pain scores. Two dogs in the IM and one in the EPI group required supplemental analgesia. Cortisol was increased (P<0.05) at 120 min (3.59 µg/dL and 3.27 µg/dL in the IM and EPI groups, respectively) and 240 min (2.45 µg/dL and 2.54 µg/dL in the IM and EPI groups, respectively) compared to baseline. Norepinephrine was also increased (P<0.05) at 120 min in both groups compared to baseline values. Epinephrine values were higher (P<0.05) in the IM group compared with the EPI group at 50 min, 120 min, and 1,440 min after tramadol administration. Epidural tramadol is a safe analgesic, but does not appear to have improved analgesic effects compared with IM administration.

The use of different doses of metamizol for post-operative analgesia in dogs.

OBJECTIVE: To evaluate the post-operative analgesic effect of metamizol (dipyrone) administered intravenously at three different doses (15 mg kg(-1), 25 mg kg(-1) and 35 mg kg(-1)) compared to placebo in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, comparative, randomized, blinded trial. ANIMALS: Forty healthy bitches, aged 1-6 years, weighing 10-35 kg METHODS: The animals were randomly divided into four groups and received their respective treatments immediately after surgery: placebo group (0.9% saline solution), D15 group (metamizol 15 mg kg(-1) IV), D25 group (metamizol 25 mg kg(-1) IV), D35 group (metamizol 35 mg kg(-1) IV). The following variables were measured: sedation, pulse rate (PR), respiratory rate (f(R)), arterial blood pressure (ABP), plasma catecholamines, serum cortisol, blood urea nitrogen (BUN) and creatinine metabolites, albumin, alanine aminotransferase (ALT), alkaline phosphatase (ALP), hemogram, platelet counts and level of analgesia which was assessed by visual analog (VAS), descriptive and behavioral scales. Patients were monitored for 48 hours after the administration of the analgesic agent. Rescue analgesia (tramadol, 2 mg kg(-1), intramuscularly) was provided for animals with pain scores ≥4, as determined by the VAS or descriptive scale. RESULTS: The D25 and D35 groups showed equivalent post-operative analgesia, as shown by decreased pain scores, according to the three different pain scales, and fewer animals that required rescue analgesia. Significantly lower serum cortisol concentrations were observed in the D25 and D35 groups when compared to the placebo and D15 groups. No hematologic, renal, hepatic or clinical adverse effects were observed during the treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Metamizol administered intravenously at 25 or 35 mg kg(-1) can provide adequate post-operative analgesia in bitches undergoing ovariohysterectomy.

Occupational exposure to acid mists and periodontal attachment loss.

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as >or= 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss >or= 4mm at any time (prevalence ratio, PR(adjusted) = 2.17), past (PR(adjusted) = 2.11), and over 6 years of exposure (PR(adjusted) = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Epidural anesthesia with bupivacaine, bupivacaine and fentanyl, or bupivacaine and sufentanil during intravenous administration of propofol for ovariohysterectomy in dogs.

OBJECTIVE: To compare cardiovascular and systemic effects and analgesia during the postoperative period of epidural anesthesia performed with bupivacaine alone or with fentanyl or sufentanil in bitches maintained at a light plane of anesthesia with continuous infusion of propofol. STUDY DESIGN: Prospective randomized masked clinical trial. ANIMALS: 30 female dogs of various breeds. PROCEDURES: Dogs were allocated into 3 groups of 10 each. One group received fentanyl (2 microg/kg [0.91 microg/lb]) and bupivacaine (1 mg/kg [0.45 mg/lb]), 1 group received sufentanil (1 microg/kg) and bupivacaine (1 mg/kg), and 1 group received bupivacaine (1 mg/kg). All dogs received acepromazine (0.1 mg/kg [0.045 mg/lb]) and continuous infusion of propofol for sedation. The agents were administered into the lumbosacral space and diluted in saline (0.9% NaCl) solution to a total volume of 0.36 mL/kg (0.164 mL/lb). Cardiac and respiratory rates, arterial blood pressures, pH, and blood gases were evaluated. Analgesia, sedation level, serum cortisol concentrations, and plasma catecholamine concentrations were measured regularly for 6 hours. RESULTS: No important changes in cardiovascular, respiratory, or sedation variables were observed. Degree of analgesia in the postoperative period was higher in the sufentanil group, although use of fentanyl and bupivacaine also resulted in a sufficient level of analgesia. CONCLUSIONS AND CLINICAL RELEVANCE: Use of the 3 anesthetic techniques permitted ovariohysterectomy with sufficient analgesia and acceptable neuroendocrine modulation of pain with minimal adverse effects.

The effect of combined therapy (ultrasound and interferential current) on pain and sleep in fibromyalgia.

Multidisciplinary treatment has proven to be the best therapeutic option to fibromyalgia (FM) and physiotherapy has an important role in this approach. Considering the controversial results of electrotherapy in this condition, the aim of this study was to assess the effects of combined therapy with pulsed ultrasound and interferential current (CTPI) on pain and sleep in FM. Seventeen patients fulfilling FM criteria were divided into two groups, CTPI and SHAM, and submitted to pain and sleep evaluations. Pain was evaluated by body map (BM) of the painful areas; quantification of pain intensity by visual analog scale (VAS); tender point (TP) count and tenderness threshold (TT). Sleep was assessed by inventory and polysomnography (PSG). After 12 sessions of CTPI or SHAM procedure, patients were evaluated by the same initial protocol. After treatment, CTPI group showed, before and after sleep, subjective improvement of pain in terms of number (BM) and intensity (VAS) of painful areas (P<0.001, both); as well as objective improvement, with decrease in TP count and increase in TT (P<0.001, both). Subjective sleep improvements observed after CTPI treatment included decrease in morning fatigue and in non-refreshing sleep complaint (P<0.001, both). Objectively, PSG in this group showed decrease in sleep latency (P<0.001) and in the percentage of stage 1 (P<0.001), increase in the percentage of slow wave sleep (P<0.001) and in sleep cycle count (P<0.001). Decrease in arousal index (P<0.001), number of sleep stage changes (P<0.05) and wake time after sleep onset (P<0.05), were also observed and no difference regarding pain or sleep parameters were verified after SHAM procedure. This study shows that CTPI can be an effective therapeutic approach for pain and sleep manifestations in FM.

Afferent pain pathways: a neuroanatomical review.

Painful experience is a complex entity made up of sensory, affective, motivational and cognitive dimensions. The neural mechanisms involved in pain perception acts in a serial and a parallel way, discriminating and locating the original stimulus and also integrating the affective feeling, involved in a special situation, with previous memories. This review examines the concepts of nociception, acute and chronic pain, and also describes the afferent pathways involved in reception, segmental processing and encephalic projection of pain stimulus. The interaction model of the cerebral cortex areas and their functional characteristics are also discussed.

Occupational exposure to acid mists and periodontal attachment loss / Exposição ocupacional a névoas ácidas e perda de inserção periodontal

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as > 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss > 4mm at any time (prevalence ratio, PRadjusted = 2.17), past (PRadjusted = 2.11), and over 6 years of exposure (PRadjusted = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.

Este estudo investigou a hipótese de que a exposição ocupacional a névoas ácidas está associada positivamente à doença periodontal, avaliada através da perda de inserção periodontal. O estudo foi conduzido com 530 trabalhadores do sexo masculino de uma metalúrgica. Os dados foram obtidos por meio de entrevistas individuais e de exames clínicos odontológicos. A perda de inserção periodontal foi avaliada durante a sondagem e definida em > 4mm, em pelo menos um dente. Uma matriz de exposição ocupacional foi utilizada para avaliação da exposição. A exposição a névoas ácidas foi associada positivamente à perda de inserção periodontal > 4mm para a ocorrência da exposição em algum momento (RPajustada = 2,17), exposição passada (RPajustada = 2,11) e duração da exposição maior que seis anos (RPajustada = 1,77), independentemente da idade, consumo de álcool e tabagismo; estes resultados foram observados apenas entre os trabalhadores que não usavam o fio dental. A exposição a névoas ácidas é um fator de risco potencial para a perda de inserção periodontal e são necessários outros estudos que utilizem desenhos longitudinais e medidas de exposição mais acuradas.

Occupational exposure to acid mists and periodontal attachment loss / Exposição ocupacional a névoas ácidas e perda de inserção periodontal

This study investigated the hypotheses that occupational exposure to acid mists is positively associated with periodontal disease, assessed by periodontal attachment loss. The study sample included 530 male workers at a metal processing factory. Data were obtained from interviews and oral examinations. Periodontal attachment loss was defined as > 4mm at probing, in at least one tooth. A job exposure matrix was utilized for exposure evaluation. Exposure to acid mists was positively associated with periodontal attachment loss > 4mm at any time (prevalence ratio, PRadjusted = 2.17), past (PRadjusted = 2.11), and over 6 years of exposure (PRadjusted = 1.77), independently of age, alcohol consumption, and smoking, and these results were limited to workers who did not use dental floss. Exposure to acid mists is a potential risk factor for periodontal attachment loss, and further studies are needed, using longitudinal designs and more accurate exposure measures.(AU)

Este estudo investigou a hipótese de que a exposição ocupacional a névoas ácidas está associada positivamente à doença periodontal, avaliada através da perda de inserção periodontal. O estudo foi conduzido com 530 trabalhadores do sexo masculino de uma metalúrgica. Os dados foram obtidos por meio de entrevistas individuais e de exames clínicos odontológicos. A perda de inserção periodontal foi avaliada durante a sondagem e definida em > 4mm, em pelo menos um dente. Uma matriz de exposição ocupacional foi utilizada para avaliação da exposição. A exposição a névoas ácidas foi associada positivamente à perda de inserção periodontal > 4mm para a ocorrência da exposição em algum momento (RPajustada = 2,17), exposição passada (RPajustada = 2,11) e duração da exposição maior que seis anos (RPajustada = 1,77), independentemente da idade, consumo de álcool e tabagismo; estes resultados foram observados apenas entre os trabalhadores que não usavam o fio dental. A exposição a névoas ácidas é um fator de risco potencial para a perda de inserção periodontal e são necessários outros estudos que utilizem desenhos longitudinais e medidas de exposição mais acuradas.(AU)

Estudo da marcha em idosos: resultados preliminares / Ederly gait

Os objetivos deste estudo piloto foram avaliar parâmetros tempo-espaciais da marcha de idosos brasileiros e comparar o valor médio da velocidade confortável da marcha com um banco de dados estrangeiro (de Oberg) de parâmetros básicos da marcha. Metodologia: Foram estudados 15 voluntários saudáveis (8 homens, 7 mulheres) dos 60 aos 79 anos de idade. As medidas foram realizadas no playground dos prédios onde residiam. A velocidade da marcha foi medida para uma distância de 6 m; o comprimento do passo, a largura da passada e o ângulo dos pés foram medidos a partir de impressões plantares. A cadência foi calculada a partir da velocidade da marcha e do comprimento do passo. Conclusão: O menor valor da velocidade da marcha encontrado para os nossos idosos (apesar da casuística pequena), quando confrontado com os dados de Oberg, sugere a importância de estudos completos para suprir a falta de dados normativos de parâmetros da marcha para a população brasileira.