O papel dos diários intestinais na consulta de gastrenterologia / The role of bowel diaries in a "real-life" setting

ABSTRACT Background Despite the potential advantages of patients' self-recordings of bowel habits in lower digestive disorders, few studies evaluate the relevance of clinical information obtained through bowel diaries in clinical practice. Objective The main objective of this study was to evaluate the role of bowel diaries as an auxiliary diagnostic tool in lower gastrointestinal disorders consultations. Methods In this cross-sectional study, at the end of their gastroenterology consultation, patients were questioned about their bowel habits and gastrointestinal symptoms. The bowel diary was then filled by the patients at home for 2 weeks. The data collected from the clinical interview and from the bowel diaries were analyzed. Results Fifty-three patients participated in the study. Patients underestimated the number of their bowel movements (BM) in the interviews compared with the bowel diaries (P=0.007). There was a poor agreement between stool consistencies described in the interviews and recorded in the diaries (k=0.281). Patients overestimated their straining during evacuation in the interviews compared with the diaries (P=0.012). Regarding the subgroups' analysis, patients with proctological disorders described less BM in their interviews (P=0.033). Straining during evacuation was higher in the interviews of patients without proctological disorders (P=0.028) and in the interviews of more educated patients (P=0.028). Conclusion Overall, there were discrepancies between the clinical interview and the bowel diary regarding the number of BM, the stool consistency and straining. Bowel diaries are therefore a relevant instrument as a complement to the clinical interview to objectify patients' complaints and treat functional gastrointestinal disorders more adequately.

RESUMO Contexto: Apesar das potenciais vantagens do diário intestinal como complemento à entrevista clínica, raros estudos avaliam a relevância da informação clínica obtida a partir de diários intestinais na prática clínica. Objetivo Os principais objetivos deste estudo foram avaliar o papel do diário intestinal como ferramenta diagnóstica numa consulta dedicada a patologia digestiva baixa. Métodos Foi realizado um estudo transversal, num período de 3 meses, em que no final das consultas os pacientes foram entrevistados relativamente a dados demográficos, antecedentes clínicos e hábitos e sintomas intestinais. Em seguida, foi solicitado o auto-preenchimento de um diário intestinal durante 2 semanas. Foram comparadas as respostas obtidas na entrevista clínica com os registos dos diários intestinais. Resultados: Cinquenta e três pacientes participaram no estudo. A frequência de evacuações reportada nas entrevistas clínicas e nos diários intestinais dos pacientes foi significativamente diferente (P=0,007). Verificou-se apenas uma concordância mínima entre a consistência das fezes descrita nas entrevistas e registada nos diários (κ=0,281). Em relação ao esforço evacuatório os pacientes sobrestimaram o seu esforço ao evacuar nas entrevistas (P=0,012). Adicionalmente, verificou-se que pacientes com doenças proctológicas descreveram menos evacuações nas suas entrevistas (P=0,033). A descrição do esforço durante a evacuação foi superestimada nas entrevistas de pacientes sem distúrbios proctológicos (P=0,028) e de pacientes com um nível mais elevado de educação (P=0,028). Conclusão: Globalmente verificaram-se discrepâncias entre a entrevista clínica e o diário intestinal dos pacientes em relação ao número de dejeções, à consistência das fezes e ao esforço evacuatório. Assim, esta ferramenta revelou-se uma potencial mais-valia na prática clínica diária, permitindo objetivar as queixas e consequentemente tratar os pacientes de forma mais adequada.

Predictors associated with malocclusion in children with and without sleep disorders: a cross-sectional study

Abstract The aim of the present study was to investigate predictors of malocclusion in Brazilian schoolchildren eight to ten years of age based on a causal directed acyclic graph model. A cross-sectional study was conducted with 739 schoolchildren eight to ten years of age. Parents/guardians provided information on sleep disorders of the child (Sleep Disturbance Scale for Children) and family characteristics (Family Adaptability and Cohesion Evaluation Scale). The diagnosis of malocclusion was performed by four trained examiners using the Dental Aesthetic Index. Control variables were selected using a directed acyclic graph. Descriptive analysis was performed, followed by robust logistic regression analysis for complex samples (α = 5%). The following variables were associated with malocclusion in the final model: sleep disorders (OR = 2.61; 95%CI: 2.43-2.86), mouth breathing (OR = 1.04; 95%CI: 1.02-1.99), non-nutritive sucking habits (OR = 2.45; 95%CI: 2.37-4.85), and obesity (OR = 1.54; 95%CI: 1.02-2.33). Sociodemographic characteristics, family functioning, and premature tooth loss did not remain associated with malocclusion. Sleep disorders, mouth breathing, sucking habits, and obesity are predictors of malocclusion in schoolchildren eight to ten years of age.

Evaluation of the association between self-reported sleep bruxism and chronotype and sleep quality among dental students / Avaliação da associação entre cronotipo, qualidade do sono e autorrelato de bruxismo do sono entre estudantes universitários de Odontologia

ABSTRACT Background Sleep bruxism (BS) is defined as involuntary jaw movements characterized by grinding and clenching teeth. Objective To verify the association between chronotype, sleep quality, and self-reporting of BS in dental students. Method A cross-sectional study was conducted with 214 undergraduate dental students at a public university in northeast Brazil. The participants answered the Munich Chronotype Questionnaire for the identification of chronotype and another questionnaire regarding daily aspects to collect information about sleep quality, self-reported sleep bruxism, the use of sleeping pills, snoring, concentration during daily activities and energy upon waking. Results The prevalence of self-reported sleep bruxism was 11.0%. In the final model, the eveningness chronotype (OR = 23.00; 95% CI: 2.36-223.84, p = 0.007), habitual snoring (OR = 3.12; 95% CI: 1.31-7.39, p = 0.01) and low energy upon waking in the morning (OR = 2.37; 95% CI: 1.96-5.58, p = 0.040) were associated with self-reported sleep bruxism. Conclusion The evening chronotype, presence of snoring, and low energy when waking up in the morning influenced self-reporting of sleep bruxism among undergraduate dental students.

RESUMO Introdução O bruxismo do sono (BS) é definido como movimentos involuntários da mandíbula caracterizados por ranger e apertar os dentes. Objetivo Verificar se o cronotipo e a qualidade do sono estão associados ao autorrelato de BS em graduandos de Odontologia. Método Um estudo transversal com 214 estudantes de uma universidade pública do Nordeste do Brasil. Os participantes responderam ao Morningness-Eveningness Questionnaire para identificar os cronotipos e outro questionário sobre aspectos diários em que foram coletadas informações sobre qualidade do sono, autorrelato de bruxismo do sono, uso de pílulas para dormir, ronco, concentração nas atividades diárias, energia ao acordar. Resultados A prevalência de autorrelato do bruxismo do sono foi de 11,0%. No modelo final, o cronotipo noturno (OR = 23,00; 95% IC: 2.36-223.84, p = 0,007), o hábito de roncar (OR = 3,12; 95% IC: 1.31-7.39, p = 0,01) e o baixo nível de energia ao acordar pela manhã (OR = 2,37; 95% IC: 1.96-5.58, p = 0,04) estiveram associados com o autorrelato de BS. Conclusão O cronotipo noturno, a presença do ronco e a baixa energia ao se levantar pela manhã influenciaram o autorrelato de bruxismo do sono entre os estudantes de graduação em Odontologia.

Is the Wistar Rat a more Suitable Normotensive Control for SHR to Test Blood Pressure and Cardiac Structure and Function?

Abstract Background: There are divergences in the literature regarding the experimental model (Wistar-WIS or Wistar Kyoto-WKY) to be used as a Spontaneously Hypertensive Rat (SHR) control. The characterization of these models in terms of cardiovascular parameters provides researchers with important tools at the time of selection and application in scientific research. Objective: The aim of this study was to evaluate the use of WIS and WKY as a Spontaneously Hypertensive Rat (SHR) control by assessing the long-term behavior of blood pressure and cardiac structure and function in these strains. Methods: To this end, WIS, WKY, and SHR underwent longitudinal experiments. Blood pressure and body mass were measured every two weeks from the 8th to the 72nd. Echocardiographic analysis was performed in all groups with 16, 48, and 72 weeks of life. After having applied the normality test, the Two-Way ANOVA of repeated measures followed by the Tukey post hoc test was used. A significance level of 5% was established. Results: The WIS group showed higher body mass (p<0.05), while the WKY and SHR presented higher body mass variation over time (p<0.05). SHR exhibited increased values of systolic, diastolic, and mean blood pressure when compared to WKY and WIS, whereas the WKY generally showed higher values than WIS (p<0.05). Regarding the cardiac function, SHR showed reduced values, while the WKY presented an early decrease when compared to WIS with aging (p<0.05). Conclusion: WIS is a more suitable normotensive control for SHR than WKY in experiments to test blood pressure and cardiac structure and function.

Use of electronic devices, practice of sports, and awake bruxism in schoolchildren aged eight to ten years

Abstract The aim of the present study was to investigate whether possible awake bruxism (AB) is associated with the use of electronic devices and the practice of sports in schoolchildren aged eight to ten years. A cross-sectional study was conducted with 739 students in public and private schools in the city of Campina Grande, Brazil. Parents/guardians answered a questionnaire addressing sociodemographic data. The children answered questions about use of electronic devices, practice of sports, and AB. Statistical analysis involved robust logistic regression for complex samples (α = 5%). The prevalence of possible AB was 14.9%. Being female (OR = 1.71, 95%CI: 1.11-2.63), being the middle child (OR = 2.19, 95%CI: 1.14-3.88), having unmarried parents (OR = 1.73, 95%CI: 1.13-2.65), daily use of a cell phone/tablet/computer (OR = 1.82, 95%CI: 1.19-2.80), use of electronic devices for two or more hours per day (OR = 1.97, 95%CI: 1.35-2.86), and playing sports in and/or out of school (OR = 1.60, 95%CI: 1.18-2.52) remained associated with possible AB in the final model. The presence of possible AB was influenced by the use of electronic devices and the practice of sports among schoolchildren aged eight to ten years.

Impact of the COVID-19 pandemic on sleep quality and sleep bruxism in children eight to ten years of age

Abstract: This study aimed to determine the impact of the COVID-19 pandemic on sleep quality and possible sleep bruxism (SB) in children eight to ten years of age. The study hypothesis was that sleep disturbances influenced a higher occurrence of bruxism during the COVID-19 pandemic. A longitudinal study was conducted at two time points: in person prior to the COVID-19 pandemic (T1), and online during the pandemic (T2). The sample comprised 105 children. Parents/caregivers answered a questionnaire addressing sociodemographic characteristics, the use of electronic devices, reported (vs. clinical) SB, and the Sleep Disturbance Scale for Children (SDSC) at both T1 and T2. McNemar's and Wilcoxon's tests were used to compare SB and sleep disorders at both time points. Poisson regression analysis determined the relative risk (RR) among the variables, and the incidence of possible SB (p≤0.05). The comparison of the two time points (T1 and T2) revealed a significant increase in possible SB (p<0.01) and sleep disorders (p < 0.04). Children whose parents had a lower schooling level (RR: 2.67; 95%CI: 1.19-6.01), those with their own electronic devices (RR: 1.97; 95%CI: 1.09-2.50), and those with sleep disorders during the pandemic (RR: 1.74; 95%CI: 1.35-2.24) were at greater risk of developing SB during the pandemic. Moreover, the incidence of bruxism and sleep disorders was greater during the pandemic. The factors influencing SB incidence during the pandemic were a lower level of mothers' schooling, greater access to electronic devices, and the occurrence of sleep disorders.

Effects of β-hydroxy-β-methylbutyrate (hmb) and resistance training on body fat and lipid metabolism signaling pathways

ABSTRACT Excess body fat is a serious problem for increasing the risk of cardiovascular diseases such as obesity, compromising the health and quality of life of the population. In this sense, resistance training (RT) is type of physical exercise which improves body composition by increasing lean mass and reducing fat mass. RT in combination with nutrition (i.e. protein supplementation) is a key intervention to improve body fat metabolism and reducing obesity. Concerning protein supplementation, the β-hydroxy-β-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine that has demonstrated positive effects on body fat reduction. However, the effects of combining HMB supplementation with RT related to adipose tissue metabolic activity are controversial and warrant further investigation. This study analyzed the effects of HMB supplementation associated with RT on body fat concentration and lipid metabolism signaling pathways.

RESUMEN El exceso de grasa corporal es un problema grave que aumenta tu riesgo de enfermedades y problemas de salud, tales como enfermedad cardíaca, diabetes, presión arterial alta y ciertos tipos de cáncer. En este sentido, y dentro del ejercicio físico, el entrenamiento de resistencia (ER) es un tipo de entrenamiento con pesos que mejora la composición corporal aumentando la masa magra y perdiendo masa grasa. El ER asociado con la nutrición (ej. suplementación proteica) es una excelente intervención para mejorar el metabolismo de los lípidos al reducir la grasa corporal. En relación con la suplementación proteica el β-hidroxi-β-metilbutirato (HMB) es un metabolito del aminoácido de cadena ramificada esencial leucina que ha demostrado efectos positivos en la reducción de grasa corporal. Sin embargo, los efectos de la suplementación con HMB asociados con TR relacionados con la actividad metabólica del tejido adiposo son controvertidos y necesita la realización de investigaciones adicionales. Este estudio analizó los efectos de la suplementación con HMB asociados con TR en la concentración de grasa corporal y en las vías de señalización que participan en la regulación del metabolismo de los lípidos.

Hydrothermal Pretreatment as a Strategy for the Improvement of Sugarcane Bagasse Saccharification by Fungal Enzyme Blend

Abstract Obtaining low cost lignocellulolytic enzymes and efficient biomass pretreatment are key to increase the competitiveness of second-generation ethanol in comparison with fossil fuels. The enzymatic cocktail produced by the Chrysoporthe cubensis fungus as well as the mixture prepared with the cocktails of the Chrysoporthe cubensis and Penicillium pinophilum fungi have already proven to be efficient for hydrolyzing biomass pretreated with alkali. In this study, they were evaluated in saccharification of sugarcane bagasse pretreated with dilute acid or hot water at 121°C using an enzyme loading equal to 8 filter paper units per gram of biomass. The most promising results were obtained from the hydrolysis of biomass pretreated with hot water by the C. cubensis-P. pinophilum enzymes blend. In this condition, the glucose and xylose production were 25.2 g.L-1 and 4.6 g.L-1, respectively, that resulted in the conversion of 68% of glucan and 23% of xylan in only 48 hours. This study shows that the hydrothermal pretreatment is a promising alternative to improve the enzymes performance, produced by the fungi C. cubensis and P. pinophilum, in the sugarcane bagasse hydrolysis without the need of chemical compounds, generally used in the acid and alkali pretreatments. Furthermore, the hydrothermal pretreatment for 60 min allowed all cocktails applied to convert the cellulose efficiently with only 24 h of saccharification, which contributes to the energy savings employed in the process.

Physical Exercise and Regulation of Intracellular Calcium in Cardiomyocytes of Hypertensive Rats / Exercício Físico e Regulação de Cálcio Intracelular em Cardiomiócitos de Ratos Hipertensos

Abstract Background: Regulation of intracellular calcium (Ca2+) in cardiomyocytes is altered by hypertension; and aerobic exercise brings benefits to hypertensive individuals. Objective: To verify the effects of aerobic exercise training on contractility and intracellular calcium (Ca2+) transients of cardiomyocytes and on the expression of microRNA 214 (miR-214) in the left ventricle of spontaneously hypertensive rats (SHR). Methods: SHR and normotensive Wistar rats of 16 weeks were divided into 4 groups -sedentary hypertensive (SH); trained hypertensive (TH); sedentary normotensive (SN); and trained normotensive (TN). Animals of the TH and TN groups were subjected to treadmill running program, 5 days/week, 1 hour/day at 60-70% of maximum running velocity for 8 weeks. We adopted a p ≤ 0.05 as significance level for all comparisons. Results: Exercise training reduced systolic arterial pressure in hypertensive rats. In normotensive rats, exercise training reduced the time to 50% cell relaxation and the time to peak contraction and increased the time to 50% decay of the intracellular Ca2+ transients. In SHR, exercise increased the amplitude and reduced the time to 50% decay of Ca2+ transients. Exercise training increased the expression of miR-214 in hypertensive rats only. Conclusion: The aerobic training applied in this study increased the availability of intracellular Ca2+ and accelerated the sequestration of these ions in left ventricular myocytes of hypertensive rats, despite increased expression of miR-214 and maintenance of cell contractility.

Resumo Fundamento: A regulação intracelular de cálcio (Ca2+) em cardiomiócitos é alterada pela hipertensão, e o exercício físico aeróbico traz benefícios para hipertensos. Objetivo: Verificar os efeitos do treinamento físico aeróbico sobre a contratilidade e a concentração intracelular de Ca2+ transitória em miócitos e a expressão do microRNA 214 no ventrículo esquerdo (VE) de ratos espontaneamente hipertensos (SHR). Métodos: SHR e ratos Wistar normotensos com 16 semanas de idade foram divididos em 4 grupos de 13 animais cada: hipertenso sedentário (HS); hipertenso treinado (HT); normotenso sedentário (NS); normotenso treinado (NT). Os animais dos grupos HT e NT foram submetidos a um programa de treinamento progressivo de corrida em esteira, 5 dias/semana, 1 hora/dia, em intensidade de 60-70% da velocidade máxima de corrida, durante 8 semanas. Adotou-se p ≤ 0,05 como nível de significância em todas as comparações. Resultados: O treinamento físico reduziu a pressão arterial sistólica nos animais hipertensos. Nos animais normotensos, o treinamento físico reduziu o tempo para 50% de relaxamento celular e o tempo para o pico de contração celular, mas aumentou o tempo para 50% de decaimento da concentração intracelular de Ca2+ transitória. Nos animais SHR, o treinamento físico aumentou a amplitude e reduziu o tempo para 50% de decaimento da concentração intracelular de Ca2+ transitória, sem alterar a contratilidade celular. O treinamento físico aumentou a expressão do miR-214 apenas nos animais hipertensos. Conclusão: O treinamento aeróbico utilizado aumenta a disponibilidade e acelera o sequestro de Ca2+ intracelular em miócitos do VE de ratos hipertensos, apesar do aumento da expressão de miR-214 e da manutenção da contratilidade celular.

Marketing odontológico: análise de anúncios publicitários de acordo com código de ética / Dental marketing: analysis of advertising according of ethical code

Objetivo: avaliar os aspectos éticos relacionados à propaganda e publicidade veiculadas pelos cirurgiões-dentistas. Metodologia: estudo transversal que avaliou os anúncios publicitários de 40 consultórios e 17 clínicas odontológicas da cidade de Campina Grande, PB. Os anúncios foram analisados de acordo com o tipo de publicidade, com a especialidade apresentada pelo profissional ou clínica, com a apresentação de itens obrigatórios, itens permitidos e itens proibidos segundo as normas éticas da Resolução CFO- 118/2012. Os dados coletados foram registrados em formulário específico, inseridos em banco de dados do SPSS, versão 18.0 e apresentados por meio da estatística descritiva. Resultados: verificou-se que o meio de comunicação mais usado pelos profissionais da Odontologia é a placa, com 84,2%. Dentre os anúncios analisados, apenas 12,3% apresentavam todos os itens obrigatórios exigidos pelo Código de Ética Odontológica. O nome representativo da profissão "cirurgião-dentista" esteve presente em apenas 14,0% dos estabelecimentos pesquisados. Dentre os itens permitidos, informações sobre a área de atuação foram verificadas em 54,4% dos anúncios; entretanto, somente 3,5% dos anúncios apresentavam o título de especialidade. Quanto às infrações éticas, 5,3% dos anúncios apresentaram elementos proibidos pelo Código de Ética Odontológica, como imagens de "antes e depois" e modalidade de pagamento. Conclusões: os profissionais não estão respeitando as normas estabelecidas pelo Conselho Federal de Odontologia no que concerne à propaganda e publicidade.

Objective: the aim of this study was to evaluate ethical features concerning to advertising and publicity of dental establishments. Methodology: this cross-sectional study analyzed forty dental offices and seventeen dental clinics situated in Campina Grande, PB. Dental advertisements were surveyed according to the kind of publicity, dental specialty, mandatory items, elective items and banned items, according to CFO-118/2012 rule. Data were recorded in a specific form, entered into SPSS 18.0 database and presented using descriptive statistics. Results: the kind of publicity most prevalent on 84.2% dentistry establishments was signboard. Among analyzed announcements, just 12.3% show all mandatory items according Dental Code of Professional Conduct. The expression "cirurgiãodentista" (dentist) was present in a few 14.0% of surveyed ads. In case of elective items, occupation area informations were present in 54.4% of establishments, however only 3.5% of signboards present specialist titles. With regard to ethical violation, 5.3% of publicity exhibit some banned item, such as "before and after" and payment method. Conclusions: dentists are not complying rules preestablished by the Federal Council of Dentistry regarding the advertising and publicity.

Perfil descritivo de esclerose múltipla com início até os 16 anos nos pacientes de um centro de referência do estado de São Paulo / Descriptive profile of multiple sclerosis starting until the age of 16 in the reference center of the state of São Paulo / Perfil descriptivo de esclerosis múltiple con inicio hasta los 16 años de edad en los pacientes del centro de referencia del litoral de la provincia de São Paulo

OBJETIVO: Descrever o perfil de pacientes com esclerose múltipla iniciada até os 16 anos de idade no litoral do estado de São Paulo, Brasil. DESCRIÇÃO DOS CASOS: Análise retrospectiva das características dos pacientes que tiveram o episódio inicial de esclerose múltipla até os 16 anos. Nesta situação encontravam-se nove meninas e quatro meninos (7,1% da população total de esclerose múltipla da região). A idade média por ocasião do diagnóstico foi de 13,9 anos (variação entre 8 e 16), sendo a média atual de 19,5 anos (12 a 28). A apresentação inicial da doença foi: ataxia (quatro casos), neurite óptica (dois), motora cortical (dois), sensitiva cortical (dois), distonia (dois) e esclerose múltipla medular (um). Todos os pacientes iniciaram com a forma remitente-recorrente da esclerose múltipla e dois deles, atualmente, apresentam a forma progressiva secundária. COMENTÁRIOS: A esclerose múltipla com início até os 16 anos precisa ser adequadamente registrada e discutida entre pediatras, neurologistas e neuropediatras. Poucos médicos têm bom conhecimento desta condição e a demora no diagnóstico e no tratamento pode ter consequências devastadoras para essas crianças e adolescentes.

OBJECTIVE: To describe the profile of patients with multiple sclerosis starting at or before the age of 16 in the coastal region of the state of São Paulo, Brazil. CASES DESCRIPTION: Retrospective analysis of the characteristics of patients who presented the initial episode of multiple sclerosis at or before the age of 16. There were nine girls and four boys in this situation (7.1% of the total population with multiple sclerosis in such area). The average age at diagnosis was 13.9 years old (ranging from 8 to 16), and the current average age is 19.5 years old (12 to 28). The initial presentation was: ataxia (four cases), optic neuritis (two), cortical motor (two), cortical sensitive (two), dystonia (two), and spinal cord multiple sclerosis (one). All patients started with the relapsing-remitting form of the disease, and two of them now present a secondary progressive course. COMMENTS: Multiple sclerosis with onset at or before the age of 16 needs to be properly registered and discussed among pediatricians, neurologists, and neuropediatricians. Very few doctors have good knowledge about this condition, and delay in diagnosing and treating may have devastating consequences for the future of these children and adolescents.

OBJETIVO: Describir el perfil de los pacientes con esclerosis múltiple iniciada hasta los 16 años de edad, en la región del litoral de la provincia de São Paulo, Brasil. DESCRIPCIÓN DE LOS CASOS: Análisis retrospectivo, a partir de los registros médicos, de las características de los pacientes que tuvieron episodio inicial de esclerosis multiple hasta los 16 años de edad. Fueron nueve muchachas y cuatro muchachos en esta situación (7,1% de la población total de esclerosis multiple en la región). El promedio de edad en el momento del diagnóstico fue de 13,9 años (variación 8-16), siendo el promedio de edad actual de 19,5 años (12-28). La presentación inicial de la enfermedad fue ataxia (4 casos), neuritis óptica (2 casos), motora cortical (2 casos), sensitiva cortical (2 casos), distonía (2 casos) y esclerosis multiple medular (1 caso). Todos los pacientes iniciaron con la forma remitente-recurrente de la esclerosis multiple y dos de ellos ahora presentan la forma progresiva secundaria. COMENTARIOS: esclerosis multiple con inicio hasta los 16 años de edad necesita ser adecuadamente registrada y discutida entre pediatras, neurólogos y neuropediatras. Pocos médicos tienen buen conocimiento de esta condición y la demora en el diagnóstico y tratamiento pueden tener consecuencias devastadoras para estos niños y adolescentes.