Streptococcus pneumoniae prevalence in nasopharynx, oropharynx and gingival sulcus in Brazilian adults:A preliminary study.

AIM: This study aimed to evaluate the prevalence of S. pneumoniae colonization in three different sites in healthy adults: nasopharynx, oropharynx and gingival sulcus. METHODS: Two-hundred and sixty five adults, aged 20-60 years, who attended dental clinics in one public university (n = 106) and one military institution (n = 159) were enrolled in this study. Pneumococcal detection was performed by direct culture (DC) and PCR for lytA gene after a broth enrichment step. Capsular types were determined by sequential multiplex PCR. RESULTS: We identified 18 (6.8%) pneumococcal carriers among 265 adults by PCR, but only one (0.4%) pneumococcal strain was isolated by DC method. Oropharynx (17; 6.4%) was the main source of S. pneumoniae. Colonization of gingival sulcus and nasopharynx was found in 4 (1.5%) and 2 (0.8%) adults, respectively. Nine distinct capsular types were detected from 9 adults and co-colonization with 2 serotypes was confirmed in 4 (1.5%) subjects. Factors associated with carriage were being females, low level of schooling, non-military and regular medication. We observed a low (6.8%) pneumococcal carriage prevalence, but oropharyngeal samples yielded more sensitive results, especially by the PCR-based detection methodology. CONCLUSION: Gingival sulcus was found to be a possible reservoir for S. pneumoniae independently of the oropharynx or nasopharynx colonization.

Early- and late-onset psoriasis: a cross-sectional clinical and immunocytochemical investigation.

BACKGROUND: There is accumulating evidence that early-onset psoriasis (EOP; presenting at or before 40 years of age) and late-onset psoriasis (LOP; presenting after 40 years of age) are different diseases. OBJECTIVES: We aimed to identify potential clinical and immunocytochemical differences between EOP and LOP. METHODS: We assessed immunocytochemistry in involved (PP) skin and uninvolved skin (n = 31) and demographics, psoriasis phenotype and psychological parameters (n = 340) in a cross-sectional study. RESULTS: Immunocytochemistry revealed (17 EOP, 14 LOP) a greater lymphocytic infiltrate in PP skin of EOP compared with LOP (P = 0·03), with a higher epidermal CD4+ : CD8+ ratio in LOP (1·3) compared with EOP (0·5) (P = 0·002). In 340 patients with psoriasis (278 EOP, 62 LOP), we found an association with a positive first or second degree family history of psoriasis [62·0% vs. 35·6%, adjusted odds ratio (OR) 8·32, 95% confidence interval (CI) 1·90-36·52] and a higher likelihood of having parents with EOP (adjusted OR 10·34, 95% CI 1·32-81·83) in the EOP group. Patients with EOP were more likely to have received biological therapy (13·3% EOP vs. 3·5% LOP, P = 0·042), while patients with LOP had a higher likelihood of having type 2 diabetes (adjusted OR 3·43, 95% CI 1·004-11·691) and autoimmune thyroiditis (adjusted OR 5·05, 95% CI 1·62-15·7). Patients with LOP also had greater anxiety than patients with EOP (mean Hospital Anxiety and Depression Scale-A score LOP 8 ± 5, EOP 5 ± 5; P = 0·006). CONCLUSIONS: Our findings provide further evidence for the difference between EOP and LOP.

Successful use of dapsone for the management of circinate balanitis.

Circinate balanitis is the commonest cutaneous manifestation of reactive arthritis (Reiter syndrome), but can also occur independently. Topical corticosteroid therapy is the most commonly used treatment, and topical calcineurin inhibitors have also been used successfully. We report a case of a 20-year-old man who presented with discrete erythematous patches with slightly raised keratotic annular borders on his glans penis. He also developed geographic tongue and severe arthritis. A clinical diagnosis of circinate balanitis was made, which was supported by the psoriasiform features on skin biopsy. The patient failed to respond to topical 0.05% clobetasol propionate cream, but a novel approach using a combination of dapsone and topical 0.1% tacrolimus ointment successfully cleared his rash.

Molecular characterization of Anthurium genotypes by using DNA fingerprinting and SPAR markers.

We characterized single primer amplification reaction (SPAR) molecular markers from 20 genotypes of Anthurium andraeanum Lind., including 3 from commercial varieties and 17 from 2 communities in the State of Espírito Santo, Brazil. Twenty-four SPAR, consisting of 7 random amplified polymorphic DNA and 17 inter-simple sequence repeat markers were used to estimate the genetic diversity of 20 Anthurium accessions. The set of SPAR markers generated 288 bands and showed an average polymorphism percentage of 93.39%, ranging from 71.43 to 100%. The polymorphism information content (PIC) of the random amplified polymorphic DNA primers averaged 0.364 and ranged from 0.258 to 0.490. Primer OPF 06 showed the lowest PIC, while OPAM 14 was the highest. The average PIC of the inter-simple sequence repeat primers was 0.299, with values ranging from 0.196 to 0.401. Primer UBC 845 had the lowest PIC (0.196), while primer UCB 810 had the highest (0.401). By using the complement of Jaccard's similarity index and unweighted pair group method with arithmetic mean clustering, 5 clusters were formed with a cophenetic correlation coefficient of 0.8093, indicating an acceptable clustering consistency. However, no genotype clustering patterns agreed with the morphological data. The Anthurium genotypes investigated in this study are a germplasm source for conservational research and may be used in improvement programs for this species.

Aesthetic and functional rehabilitation of child using mock-up combined with stratified technique.

BACKGROUND: The loss of the vertical dimension of occlusion in children with quickly progressing early childhood caries hinders the aesthetic rehabilitation of primary incisors. Minimally invasive restorations using chemical-mechanical caries removal methods preserve sound dental tissue and maintains the health of the pulp. This is the treatment of choice for children and allows crown reconstruction of the primary incisors without the need for endodontic treatment. The resources employed in the rehabilitation process range from biological restorations to direct and indirect crowns with or without the aid of a celluloid matrix. CASE REPORT: The aim of this study was to describe a case of maxillary incisor rehabilitation in a female patient aged two years five months using a mock-up combined with the stratified technique and Planas' direct tracks. After a 26-month follow-up period only a little fracture of the reconstructed incisor had occurred. CLINICAL IMPLICATIONS: In the case described, neuro-occlusal and functional rehabilitation enabled the establishment of satisfactory aesthetics in the primary incisors.

Bioarchaeology aids the cultural understanding of six characters in search of their agency (Tarquinia, ninth-seventh century BC, central Italy).

Etruria contained one of the great early urban civilisations in the Italian peninsula during the first millennium BC, much studied from a cultural, humanities-based, perspective, but relatively little with scientific data, and rarely in combination. We have addressed the unusual location of twenty inhumations found in the sacred heart of the Etruscan city of Tarquinia, focusing on six of these as illustrative, contrasting with the typical contemporary cremations found in cemeteries on the edge of the city. The cultural evidence suggests that the six skeletons were also distinctive in their ritualization and memorialisation. Focusing on the six, as a representative sample, the scientific evidence of osteoarchaeology, isotopic compositions, and ancient DNA has established that these appear to show mobility, diversity and violence through an integrated bioarchaeological approach. The combination of multiple lines of evidence makes major strides towards a deeper understanding of the role of these extraordinary individuals in the life of the early city of Etruria.

Measuring the impact of quality of life of children treated for orofacial clefts: a case-control study.

OBJECTIVE: The aim of this study was to assess the quality of life (QoL) of children previously treated for cleft lip and/or palate (CL/P) and compare with non-cleft children. METHOD: A case-control study with 70 children between 5 and 12 years old was carried out. The case group consisted of 35 individuals previously treated for non-syndromic CL/P and presently receiving assessment at a rehabilitation hospital in Brazil. The children had received primary surgical treatment for CL/P reconstruction during early childhood. The control group consisted of 35 healthy children selected to ensure close similarity to the cleft group in age, gender and socioeconomic status. QoL was measured using the AUQEI questionnaire. RESULTS: Cleft lip and palate had no significant influence on the QoL in children (p = 0.44). A higher percentage of the cleft lip and palate group of children reported a lower QoL than the cleft lip or cleft palate groups. Gender had no significant difference on the quality of life in CL/P children (p = 0.2) and in control group (p = 1.0). CONCLUSION: The QoL in children with CL/P was found to be similar to the non-cleft group. Our results confirm that clefts repaired during earlier childhood associated with a health care program, including psychological support, is beneficial for CL/P children.

Does surgical timing affect the rapidity of recovery in deep pain-entire non-ambulatory dogs with thoracolumbar intervertebral disk extrusion?

OBJECTIVE: To investigate whether the delay between onset of neurological signs and spinal cord decompression affects the time to recovery in non-ambulatory paraparetic/paraplegic dogs with deep pain perception affected by thoracolumbar intervertebral disc extrusion. MATERIALS AND METHODS: Data on non-ambulatory dogs with preserved deep pain perception in both hindlimbs and surgically treated for thoracolumbar intervertebral disc extrusion were prospectively collected from three referral hospitals. Cox proportional hazards regression was used to explore the relationship of time until restoration of independent ambulation with age, weight, preoperative use of anti-inflammatory drugs, delay between onset of inability to walk and arrival at the clinic, time between presentation and spinal surgery and surgery time. RESULTS: One hundred and fifty-one dogs were included. Median time from admission to surgery, including imaging, was 180 (interquartile range, 65.4 to 240) minutes. All dogs were operated within 72 hours. Follow-up was available for all 151 dogs and ranged from 1 to 21 months. All but three dogs, which were all grade IV at presentation, recovered the ability to ambulate. In both univariable and multivariable models, only duration of surgery and neurological (Frankel) grade at presentation were significantly associated with the rapidity of recovery of ambulation. CLINICAL SIGNIFICANCE: Delay between onset of clinical signs and presentation and time between presentation and spinal surgery was not associated with the rapidity of recovery of ambulation in dogs surgically treated for thoracolumbar intervertebral disc extrusion. These results should be evaluated in the context of a limited range of delay since only 14.5% dogs had a delay ≥6.5 hours. Duration of surgery and neurological grade at presentation were significantly associated with rapidity of recovery of ambulation.

Digital acrometastases as first sign of hepatocellular carcinoma.

Digital acrometastases as a primary presentation of hepatocellular carcinoma (HCC) is rare. A 66-year-old man with no history of malignancy presented to the plastic surgery department with two skin lesions, one on the bridge of his nose and one on distal phalanx of left little finger. A working diagnosis of cutaneous metastases was made. Immediately prior to admission for excision of these lesions he was admitted with right upper quadrant pain and a jaundiced discolouration of the skin. The lesions were excised as planned and histopathological examination revealed metastatic HCC. A subsequent magnetic resonance imaging showed a lobulated mass consistent with primary HCC.

Occlusal contact in children with Temporomandibular Disorders. A pilot study.

AIM: The aim of the present study was to perform a comparative analysis of occlusal contact points in children with and without signs and symptoms of Temporomandibular Disorders (TMD). STUDY DESIGN: Cross-sectional study. One hundred fifty children between 6 and 14 years of age were evaluated using the Helkimo questionnaire and a clinical exam. The occlusal contact points in each child were recorded during maximal intercuspation with the aid of carbon strips. Digital photographs were taken of the upper and lower arches before and after recording the occlusal contacts. The number of contact points between sides were compared and recorded on individual charts (occlusograms). STATISTICS: Student's t-test and Pearson's chi-square test were used for the statistical analysis, with the level of significance set at 0.05, which revealed no statistically significant differences between genders. The Student's t-test revealed a statistically significant difference in the mean number of occlusal contact points between the participants with and without TMD, with a higher number of contact points among those without TMD. There was no significant difference between sides. RESULTS The results of this study show a difference in the number of occlusal contact points in centric occlusion between children with and without TMD. CONCLUSION Regardless of the degree of severity, the number of occlusal contact points is lower among children with TMD.

Clinical and radiographic study of chemical-mechanical removal of caries using Papacárie: 24-month follow up.

BACKGROUND: The chemical-mechanical removal of caries involves the chemical softening of the infected dentin, following by the mechanical removal of the softened tissue using non-cutting manual instruments. Papacárie (Fórmula&Açao, Sao Paulo, Brazil) is a product in gel form used for the chemical-mechanical softening of the affected tissue. OBJECTIVE: The purpose of the present study was to evaluate the effectiveness of Papacárie. METHODS: Clinical and radiographic evaluations were performed on 14 young permanent molars treated with Papacárie and restored with glass ionomer cement (VitroMolar DFL Ind. Com LTDA, Rio de Janeiro, Brazil) 24 months following intervention. RESULTS: Success was achieved in 13 of the 14 cases. CONCLUSION: Papacárie was effective in the treatment of carious lesions and constitutes a conservative alternative that offers benefits to patients.

Inorganic polyphosphate inhibits an aspartic protease-like activity in the eggs of Rhodnius prolixus (Stahl) and impairs yolk mobilization in vitro.

Inorganic polyphosphate (poly P) is a polymer of phosphate residues that has been shown to act as modulator of some vertebrate cathepsins. In the egg yolk granules of Rhodnius prolixus, a cathepsin D is the main protease involved in yolk mobilization and is dependent on an activation by acid phosphatases. In this study, we showed a possible role of poly P stored inside yolk granules on the inhibition of cathepsin D and arrest of yolk mobilization during early embryogenesis of these insects. Enzymatic assays detected poly P stores inside the eggs of R. prolixus. We observed that micromolar poly P concentrations inhibited cathepsin D proteolytic activity using both synthetic peptides and homogenates of egg yolk as substrates. Poly P was a substrate for Rhodnius acid phosphatase and also a strong competitive inhibitor of a pNPPase activity. Fusion events have been suggested as important steps towards acid phosphatase transport to yolk granules. We observed that poly P levels in those compartments were reduced after in vitro fusion assays and that the remaining poly P did not have the same cathepsin D inhibition activity after fusion. Our results are consistent with the hypothesis that poly P is a cathepsin D inhibitor and a substrate for acid phosphatase inside yolk granules. It is possible that, once activated, acid phosphatase might degrade poly P, allowing cathepsin D to initiate yolk proteolysis. We, therefore, suggest that degradation of poly P might represent a new step toward yolk mobilization during embryogenesis of R. prolixus.

Effects of metformin and short-term lifestyle modification on the improvement of male hypogonadism associated with metabolic syndrome.

AIM: The metabolic syndrome is associated with male hypogonadism, but specific studies about the mechanisms and treatment of the testosterone deficit are scanty. The aim of this study was to evaluate the effects of metformin combined with diet and physical activity on the testicular function of men with metabolic syndrome. METHODS: Thirty-five men (40.4 ± 13.3 years old) with metabolic syndrome were evaluated before and after a four-month period of therapy with metformin 850 mg twice daily, associated with a balanced normocaloric diet and subtle improvement in physical activity. The subjects were divided in two groups: 21 males with normal plasma testosterone levels (≥ 300 ng/dL) and 14 males with low plasma testosterone levels (< 300 ng/dL). RESULTS: There was a significant decrease in fasting insulin levels and HOMA-IR after treatment (P = 0.01 and P = 0.06), which was more pronounced in the hypogonadic group (for the effect of absence or presence of hypogonadism, P = 0.04). The mean total and free testosterone levels increased significantly after treatment in both groups, similarly. The increase in FSH levels was more pronounced in the hypogonadic group than in the eugonadic group. CONCLUSION: In this series of males with metabolic syndrome, treatment with metformin associated with healthy dietary modifications and a mild physical activity increment resulted in significant improvement of insulin sensitivity and increase in total and free testosterone levels, regardless of the presence of hypogonadism.

Polyphosphate polymers during early embryogenesis of Periplaneta americana.

Inorganic polyphosphates (PolyP) are linear polymers of phosphate (Pi) residues linked by high-energy phosphoanhydride bonds. Despite a wide distribution, their role during insect embryogenesis has not been examined so far. In this study, we show the mobilization of PolyP polymers during the embryogenesis of the cockroach Periplaneta americana. PolyP was detected by enzymatic and fluorimetric assays and found to accumulate in two main sizes by agarose gel electrophoresis. Confocal microscopy showed their presence in small vesicles. In addition, X-ray microanalysis of small vesicles showed considerable amounts of calcium, sodium and magnesium, suggesting an association of PolyP with these elements. Variations of the free Ca+2, Pi and PolyP levels were observed during the first days of embryogenesis. Our results are consistent with the hypothesis that phosphate ions modulate PolyP variation and that PolyP hydrolysis result in increasing free Ca+2 levels. This is the first investigation of PolyP metabolism during embryogenesis of an insect and might shed light on the mechanisms involving Pi storage and homeostasis during this period. We suggest that PolyP, mainly stored in small vesicles, might be involved in the functional control of Ca+2 and Pi homeostasis during early embryogenesis of P. Americana.