Can Impression Procedures Affect Certain Vital Functions of Edentulous Patients? A Clinical Study.

PURPOSE: The most suitable treatment conditions and timing for medically unstable patients with severe systemic diseases about to undergo invasive dental treatment are well documented in the literature; however, no medical guides or recommendations identify these conditions for noninvasive dental treatments in such patients. The aim of this clinical study was to determine the effect of impression procedures on arterial oxygen saturation (AOS) and pulse rates (PRs) of edentulous subjects. MATERIALS AND METHODS: A total of 28 Caucasian edentulous participants (15 females, 13 males) were included in the study. Pulse oximetry recordings (150 seconds) were performed for each participant at three stages; recording at rest (CON), during mandibular impressions (MANIs), and maxillary impressions (MAXIs). The mean values of PR, AOS, and event scores (ESs) indicating desaturation were obtained from the records. The comparisons of mean PR and AOS values were performed with the Bonferroni-corrected Wilcoxon-signed ranks test. The ESs were analyzed with the McNemar Test. RESULTS: The mean AOS values of MANI and MAXI did not display significant changes when compared with CON; however, the ESs obtained in both MANI and MAXI were significantly higher than those of CON (p = 0.008, p = 0.004). In addition, mean PR values obtained in MAXI were significantly higher than CON (p = 0.009). CONCLUSIONS: According to the results of this clinical study, the impression procedures may affect the PR values and lead to desaturation events in edentulous patients; however, further studies evaluating blood gas levels, which indicate precise AOS values, are necessary to support the results of this study.

The Role of Analgesia in the Identification and Treatment of Digestive Tract Lesions: A Randomized, Prospective, Double-Blind Study.

The association of sedation with analgesia in endoscopic procedures represents the ideal combination of anesthetic drugs, which allows these exploratory procedures to be carried out safely, in an outpatient setting. The aim of this study is to compare the results of the use of simple Propofol or Propofol associated with Fentanyl in order to ensure optimal sedation necessary for the detection of benign or malignant lesions of the digestive tract. In this study, 80 patients aged between 18 and 80 years were included, 40 in Group 1 who were administered Propofol alone and 40 in Group 2 in which Propofol was administered associated with Fentanyl. The onset of anesthetic sleep was 19.3±5.1 seconds in Lot 2 versus 29.6±9.1 seconds in Lot 1. The average dose of Propofol used was 203.6±82.8 mg in Lot 1 and in Lot 2 it was lower, 166.3±8.3mg. Cardio respiratory changes were more frequent in Lot 2. The wake-up time was 3.2±1.2 minutes in Lot 1 as a result of the administration of Propofol alone and 7±1.4 minutes in Lot 2. The discharge time was equal for patients in both groups. The degree of postanesthesia safisfaction was 10 for all patients from Lot 2, due to the analgesia provided by the administration of Fentanyl. The use of Propofol associated with Fentanyl in gastrointestinal endoscopic procedures is associated with a rapid recovery of cognitive function at the time of discharge and minimal adverse events, ensuring optimal conditions of analgesia and stability of vital functions.

Influence of general anaesthesia on the brainstem. / Influencia de la anestesia general sobre el tronco encefálico.

The exact role of the brainstem in the control of body functions is not yet well known and the same applies to the influence of general anaesthesia on brainstem functions. Nevertheless in all general anaesthesia the anaesthesiologist should be aware of the interaction of anaesthetic drugs and brainstem function in relation to whole body homeostasis. As a result of this interaction there will be changes in consciousness, protective reflexes, breathing pattern, heart rate, temperature or arterial blood pressure to name a few. Brainstem function can be explored using three different approaches: clinically, analyzing changes in brain electric activity or using neuroimaging techniques. With the aim of providing the clinician anaesthesiologist with a global view of the interaction between the anaesthetic state and homeostatic changes related to brainstem function, the present review article addresses the influence of anaesthetic drug effects on brainstem function through clinical exploration of cranial nerves and reflexes, analysis of electric signals such as electroencephalographic changes and what it is known about brainstem through the use of imaging techniques, more specifically functional magnetic resonance imaging.

New pharmacological approaches against chronic bowel and bladder problems in paralytics.

Spinal cord injury (SCI) leads generally to an irreversible loss of sensory functions and voluntary motor control below injury level. Cures that could repair SCI and/or restore voluntary walking have not been yet developed nor commercialized. Beyond the well-known loss of walking capabilities, most SCI patients experience also a plethora of motor problems and health concerns including specific bladder and bowel dysfunctions. Indeed, chronic constipation and urinary retention, two significant life-threatening complications, are typically found in patients suffering of traumatic (e.g., falls or car accidents) or non-traumatic SCI (e.g., multiple sclerosis, spinal tumors). Secondary health concerns associated with these dysfunctions include hemorrhoids, abdominal distention, altered visceral sensitivity, hydronephrosis, kidney failure, urinary tract infections, sepsis and, in some cases, cardiac arrest. Consequently, individuals with chronic SCI are forced to regularly seek emergency and critical care treatments when some of these conditions occur or become intolerable. Increasing evidence supports the existence of a novel experimental approach that may be capable of preventing the occurrence or severity of bladder and bowel problems. Indeed, recent findings in animal models of SCI have revealed that, despite paraplegia or tetraplegia, it remains possible to elicit episodes of micturition and defecation by acting pharmacologically or electrically upon specialized lumbosacral neuronal networks, namely the spinal or sacral micturition center (SMC) and lumbosacral defecation center (LDC). Daily activation of SMC and LDC neurons could potentially become, new classes of minimally invasive treatments (i.e., if orally active) against these dysfunctions and their many life-threatening complications.

New avenues for reducing intensive care needs in patients with chronic spinal cord injury.

Relatively soon after their accident, patients suffering a spinal cord injury (SCI) begin generally experiencing the development of significant, often life-threatening secondary complications. Many of which are associated with chronic physical inactivity-related immune function problems and increasing susceptibility to infection that repeatedly requires intensive care treatment. Therapies capable of repairing the spinal cord or restoring ambulation would normally prevent many of these problems but, as of now, there is no cure for SCI. Thus, management strategies and antibiotics remain the standard of care although antimicrobial resistance constitutes a significant challenge for patients with chronic SCI facing recurrent infections of the urinary tract and respiratory systems. Identifying alternative therapies capable of safe and potent actions upon these serious health concerns should therefore be considered a priority. This editorial presents some of the novel approaches currently in development for the prevention of specific infections after SCI. Among them, brain-permeable small molecule therapeutics acting centrally on spinal cord circuits that can augment respiratory capabilities or bladder functions. If eventually approved by regulatory authorities, some of these new avenues may potentially become clinically-relevant therapies capable of indirectly preventing the occurrence and/or severity of these life-threatening complications in people with paraplegic or tetraplegic injuries.

Response of vital functions, Apgar and cortisol in the prognosis of vigor against neonatal factors of lambs / Resposta das funções vitais, de Apgar e cortisol no prognóstico de vigor frente a fatores neonatais de cordeiros

The management of lambs during the neonatal period has been studied in several researches due to the vital and hormonal organic adaptations undergone by the calf after birth. However, gender, number of pups and type of delivery play an important role in understanding neonatal vigor. The study of these groups with the monitoring of clinical evolution and cortisol metabolism becomes an indispensable subsidy for a better understanding of this neonatal phase, aiming to minimize the losses generated. The objective of this study was to evaluate the influence of gender, number of pups and type of delivery in the prognosis of neonatal vigor of lambs through clinical and cortisol diagnosis. Thirty crossbred Santa Inês lambs with Dorper in the neonatal phase were divided into three groups: male and female, number of pups (single and twin) and type of delivery (eutocic and dystocic). In each group, clinical evaluation of heart and respiratory rate, rectal temperature, Apgar score and weight were performed; and with the exception of cortisol, all evaluations were performed at fifteen and sixty minutes, as well as at twelve and twenty-four hours. In addition, blood samples were collected for cortisol dosage obtained in two moments at fifteen and sixty minutes using the radioimmunoassay technique. Among the three experimental groups related to lamb vigor, the heart rate was the only one that showed lower mean values (P<0.05) at twenty-four hours in the male group 90.00±20.20bpm, twins 96.44±20.02bpm and eutocic 93.25±18.11bpm. Differences in respiratory rate values were observed in the eutocic group (64.00±14.75mpm) at twenty-four hours. In the group of males there was a significant reduction in body temperature during the evaluation moments (P<0.05). Lambs from the group of twins showed lower body weight during the evaluations. At both times the analysis of serum cortisol was less than at sixty minutes. It was concluded that soon after the birth there were marked changes in the physiological parameters and weight of Santa Inês lambs, but were not enough to cause negative effects on the vigor of the neonates, indicating the occurrence of effective neonatal adaptation capacity in this species.(AU)

O manejo dos cordeiros durante o período neonatal tem sido objeto de estudo em diversas pesquisas devido às adaptações orgânicas vitais e hormonais sofridas pela cria após o parto. Todavia, o gênero, número de filhotes e o tipo de parto parecem desempenhar um papel importante para melhor compreensão do vigor neonatal. Além disso, o estudo destes grupos com o acompanhamento da evolução clínica e do metabolismo do cortisol torna-se um subsidio indispensável para melhor compreensão dessa fase neonatal, visando minimizar as perdas geradas. Dessa forma, o objetivo do presente trabalho foi avaliar a influência do gênero, número de filhotes e tipo de parto na apresentação do vigor neonatal dos cordeiros através do diagnostico clinico e de cortisol. Foram utilizados trinta cordeiros mestiços da raça Santa Inês com Dorper em fase neonatal divididos em três grupos: gênero (macho e fêmea), número de filhotes (único e gemelar) e tipo de parto (eutócico e distócico). Em cada grupo, foi realizada a avaliação clínica da frequência cardíaca e respiratória, temperatura retal, escore Apgar e peso; e com a exceção do cortisol, todas as avaliações foram realizadas aos quinze e sessenta minutos, como também às doze e vinte e quatro horas. Adicionalmente, procedeu-se com a coleta de amostras de sangue total para dosagem de cortisol obtida em dois momentos aos quinze e sessenta minutos através da técnica de radioimunoensaio. Dentre os três grupos experimentais relacionados com vigor dos cordeiros, a frequência cardíaca foi a única que evidenciou menores médias (P<0,05) às vinte e quatro horas no grupo dos machos 90,00±20,20bpm, gêmeos 96,44±20,02bpm e eutócicos 93,25±18,11bpm. Observou-se no grupo eutócico diferenças nos valores da frequência respiratória de 64,00±14,75mpm às vinte e quatro horas. No grupo dos machos houve redução significativa na temperatura corpórea durante os momentos de avaliação (P<0,05). Cordeiros do grupo de gêmeos demonstraram menor peso corpóreo durante as avaliações. Em ambos momentos a análise do cortisol sérico demonstrou se menor aos sessenta minutos. Pôde se concluir que logo após o parto ocorreram alterações marcantes nos parâmetros fisiológicos e peso de cordeiros Santa Inês, porém não foram suficientes para causar efeitos negativos sobre o vigor dos neonatos, indicando a ocorrência de efetiva capacidade de adaptação neonatal nesta espécie.(AU)

Long term dietary deficiency in steers: vital functions and T3 and IGF-1 relationships / Carência alimentar prolongada em garrotes: funções vitais e suas relações com os teores de T3 e IGF-1

To evaluate the influence of diets with different degrees of energy deficiency on the hormonal profile and vital functions, 12 steers were randomly distributed into 3 groups of 4 animals. For 140 days, each group received (G1) a diet to promote a weight gain of 900gr/day (17.7 Mcal/d DE and 13% CP), (G2) 80% of the maintenance requirements (5.8 Mcal/d DE and 7% CP), or (G3) 60% of the maintenance requirements (4.7 Mcal/d DE and 5% CP). In G2 and G3, the energy deficit caused a marked decrease in the heart rate and respiratory rate and a reduction in the blood levels of Insulin like growth factor-1 (IGF-1) and triiodothyronine (T3). The decrease in heart rate, respiratory movement and, to a lesser extent, reduction of the rectal temperature, reflected the low status of energy and was negatively impacted by the low levels of T3. There was a strong correlation between the hormones T3 and IGF-1 (r=0.833). There were also strong correlations between T3 and HR (r=0.701), T3 and RR (r=0.632), IGF-1 and HR (r=0.731), and IGF-1 and RR (r=0.679). There were intermediate correlations between T3 and TºC (r=0.484), T3 and insulin (r=0.506), IGF-1 and insulin (r=0.517), and IGF-1 and TºC (r=0.548). This study showed the influence of a long period of providing an energy-deficient diet on animal performance, correlating hormonal status and vital functions in growing cattle. The results indicated that the evaluated parameters represent an important tool for the early detection of dietary deficiency...

Para avaliar a influência de dietas deficientes de energia sobre o perfil hormonal e as funções vitais em bovinos, 12 garrotes foram aleatoriamente distribuídos em três grupos com quatro animais para receber por 140 dias, as seguintes dietas: (G1) adequada, para ganho de peso de 900g/dia (17,7 Mcal/d de ED e 13% de PB); (G2) 80% dos requerimentos de mantença (5,8 Mcal/d de ED e 7% de PB); e (G3) 60% desses requerimentos (4,7 Mcal/d de ED e 5% de PB). O déficit energético provocou nos grupos G2 e G3 acentuada diminuição da frequência cardíaca e da frequência respiratória além da redução nos teores sanguíneos de IGF-1 e T3. A diminuição do número de batimentos cardíacos, movimentos respiratórios e em menor grau a queda na temperatura retal refletiram o baixo status energético imprimido e foram influenciados negativamente pelos baixos teores de T3. Houve correlação de alta intensidade entre os hormônios T3 e IGF-1 (r=0,833). As correlações entre os hormônios T3 e IGF-1 e as funções vital exibiram altas e médias intensidades. Houve elevada correlação entre T3 e FC (r=0,701), T3 e FR (r=0,632), IGF-1 e FC (r=0,731), IGF-1 e FC (r=0,679). Houve média correlação entre T3 e TºC (r=0,484), T3 e insulina (r=0,506), IGF-1 e insulina (r=0,517) e IGF-1 e TºC (r=0,548). O presente trabalho apontou a influência do longo período do oferecimento de dietas deficientes em energia sobre o desempenho animal correlacionando o perfil hormonal e as funções vitais nos bovinos em crescimento. Os resultados indicaram que os parâmetros avaliados podem ser uma ferramenta importante na detecção precoce da carência nutricional...