Dietary amino acids and anthropometric indices: Tehran Lipid and Glucose Study

ABSTRACT Objective: Recent studies investigated the role of amino acids (AAs) in weight management. We aimed to determine the association between AAs and three-year change of anthropometric indices and incident obesity. Materials and methods: Height, weight, hip, and waist circumference (WC) were collected at baseline and follow up. Three-year changes in anthropometric indices and obesity incident according to body mass index (BMI) (overweight & obesity) and WC cutoffs (obesity-WC) were ascertained. Dietary intakes of AAs were collected at baseline, using a food frequency questionnaire. Data analyses were conducted on 4976 adult participants and two subsamples, including 1,570 and 2,918 subjects, for assessing the AAs relationship with 3-year changes on anthropometric indices and obesity incident. Results: Lysine and aspartic acid were positively associated with higher weight change, whereas acidic AAs, cysteine, and glutamic acid showed a negative correlation with weight change. Furthermore, a weak positive correlation was shown for alkaline AAs, lysine, and valine with WC; however, acidic AAs, tryptophan, cysteine, and glutamic acid were negatively associated with WC. Aromatic and acidic AAs also demonstrated a weak negative relation with changes in BAI. Phenylalanine and Aromatic AAs showed a negative association with overweight &obesity incidence adjusting for potential confounders. Each quartile increases the dietary lysine, arginine, alanine, methionine, aspartic acid, and alkaline AAs related to a greater risk of obesity-WC, while tryptophan, glutamic acid, proline, and acidic AAs associated with lower obesity-WC risk. Conclusion: Our results suggested that certain dietary AAs may potentially change anthropometric indices and risk of obesity incident.

Design of a Reminder and Recall System in a Contact Tracing Application to Support Coronavirus Booster Vaccination / 대한의료정보학회지

Objectives@#The rate of coronavirus disease 2019 (COVID-19) booster vaccination in Indonesia remains relatively low, representing 15.33% of the overall vaccination target as of April 2022. The implementation of a reminder and recall system has been shown to be effective in increasing vaccination rates. In prior research, reminders and recalls were sent through traditional media, such as mail, and had not yet been integrated into modern media, such as smartphone applications and (in particular) contact tracing applications. Therefore, the present study was conducted to design a reminder and recall system for the PeduliLindungi contact tracing application. @*Methods@#We used the design science research (DSR) methodology with three iterations. The first iteration produced a low-fidelity prototype (or wireframe), and the next yielded a high-fidelity (clickable) prototype. @*Results@#The final prototype included three main features: a reminder and recall mechanism, online registration for COVID-19 booster vaccination, and educational articles. The evaluation consisted of interviews in the first iteration, interviews and the System Usability Scale (SUS) questionnaire in the second, and the Post-Study System Usability Questionnaire (PSSUQ) in the third. The SUS value obtained in the second iteration was 71.6, indicating good (acceptable) results, while in the third iteration, the system usefulness, information quality, interface quality, and overall PSSUQ values were 2.456, 2.473, 2.230, and 2.397, respectively, indicating good quality of the resulting design. @*Conclusions@#This research contributes to two areas: implementation of a reminder and recall system in the PeduliLindungi contact tracing application and enhancement of contact tracing applications using DSR methodology.

Surgical Management of Extruded Fractured Instrument Beyond the Periapical Area: A Case Report with Two-year Follow-up

@#A fractured instrument is an undesirable endodontic mishap that can prevent complete root canal disinfection, thereby affecting the root canal treatment outcome. The present case discussed the surgical management of an extruded fractured barbed broach at the apical third of maxillary right first premolar. A 28-year-old female presented with an endodontic failure on tooth 14 and was diagnosed as previously root canal treated with symptomatic apical periodontitis. Radiographic examination revealed a straightline radiopacity structure that was 2 mm in length extruded from the apical root-end, suggesting a fractured instrument. The case was successfully managed through endodontic microsurgery. The present case emphasises the significance of cone-beam computed tomography as a valuable tool for diagnosis and investigation, while also offering supplementary information for the planning of surgical treatment.

Testes de provocação para urticárias crônicas induzidas: a experiência de um centro de referência e excelência em urticária - UCARE / Provocation tests for chronic inducible urticaria: the experience of a urticaria center of reference and excellence

Introdução: A urticária é determinada pela ativação de mastócitos que se apresenta por urticas, angioedema ou ambos. A urticária é classificada de acordo quanto a sua duração, em duas formas: aguda (UA < 6 semanas) e crônica (UC > 6 semanas). A UC compreende Urticária Crônica Espontânea (UCE) e Urticárias Crônicas Induzidas (UCInd). Entre as UCInd estão o dermografismo, urticária por pressão tardia (UPT), frio, calor, solar, aquagênica, colinérgica e urticária/angioedema vibratório. As UCInd podem ser diagnosticadas por meio da história clínica, exame físico e da reprodução das lesões através dos testes de provocação. Objetivo: Descrever o perfil dos testes de provocação positivos para UCInd realizados em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: Foram avaliados, retrospectivamente, os resultados dos testes de provocação para UCInd, realizados de dezembro de 2017 a setembro de 2021, de 114 pacientes que apresentavam história sugestiva de uma ou mais UCInd. Resultados: Dos 114 pacientes avaliados, oitenta e oito (77%) eram do sexo feminino e 26 (23%) do masculino. Foram diagnosticados, através de testes de provocação positivos: 65 dermografismos (FricTest® e/ou dermografômetro); 23 UPT (23 diagnosticados com o uso do dermografômetro e 11 também confirmados através do teste de Warin); 11 urticárias ao frio (temperaturas iguais ou inferiores a 27 °C) e 3 urticárias ao calor (temperaturas iguais ou superiores a 38 °C), todos diagnosticados com o TempTest® versão 4.0; 4 urticárias colinérgicas, diagnosticados através do Teste Modificado para Urticária Colinérgica - HUCFF-UFRJ e 1 urticária vibratória. Nenhum paciente apresentou teste positivo para urticária solar ou aquagênica. Sete pacientes foram negativos. Conclusão: Os testes de provocação, através do estímulo direto e seguro com o desencadeante, permitem ao médico avaliador e ao paciente a compreensão e a confirmação do estímulo causador da enfermidade em questão e seus limiares.

Introduction: Urticaria is determined by mast cell activation that presents as wheals, angioedema, or both. Urticaria is classified according to its duration into two forms: acute (< 6 weeks) and chronic (> 6 weeks). Chronic urticaria includes chronic spontaneous urticaria and chronic inducible urticaria. Chronic inducible urticarias include dermographism, delayed pressure urticaria, cold, heat, solar, aquagenic, cholinergic, and vibratory urticaria/angioedema. Chronic inducible urticaria can be diagnosed through clinical history, physical examination, and the reproduction of lesions through provocation tests. Objective: To describe the profile of positive provocation tests for chronic inducible urticaria performed at an urticaria center of reference and excellence (GA2LEN UCARE). Methods: We retrospectively evaluated the results of provocation tests performed between December 2017 and September 2021 in 114 patients with a history suggestive of one or more types of chronic inducible urticaria. Results: The sample included 88 (77%) female and 26 (23%) male patients. The following were diagnosed through positive provocation tests: 65 cases of dermographism (FricTest® and/or dermographometer); 23 cases of delayed pressure urticaria (all diagnosed with a dermographometer and 11 confirmed with the Warin test); 11 cases of cold urticaria (temperatures ≤ 27°C) and 3 cases of heat urticaria (temperatures ≥ 38°C), all diagnosed with TempTest® 4.0; 4 cases of cholinergic urticaria, all diagnosed with the Modified Test for Cholinergic Urticaria-HUCFFUFRJ, and 1 case of vibratory urticaria. No patient tested positive for solar or aquagenic urticaria. Seven patients have been negative. Conclusion: Provocation tests, which use direct and safe stimuli as triggers, allow physicians and patients to confirm the disease's causative stimulus and its thresholds.

Vacinação e exercício: imunologia em ação em tempos de pandemia / Vaccination and exercise: immunology in action in pandemic times

A COVID-19 é a enfermidade causada pelo SARS-CoV-2, descrita em 2019, em Wuhan. Desde então, causou a morte de milhões de pessoas. A doença caracteriza-se entre sintomas gripais e gastrointestinais, podendo evoluir com gravidade. A importância de compreender como melhorar a eficácia da vacinação levou à investigação de fatores que podem influenciar a resposta imune. A prática de exercícios foi identificada como um fator que pode melhorar a função imunológica e, portanto, ser um potencial adjuvante para respostas imunes. O treinamento crônico, ou altos níveis de atividade física durante um período prolongado (mês/ anos) e, separadamente, o exercício agudo ­ a realização de uma única sessão de exercício (minutos/horas), são dois segmentos relacionados à resposta imunológica ao exercício físico. O exercício agudo é conhecido por gerar efeitos de curto prazo sobre o sistema imune, mas parecem existir efeitos contrastantes entre sessões de exercícios moderados e exercícios prolongados. Na ausência de uma medicação profilática ou tratamento efetivo, a existência de vacinas e associação com a prática de exercícios, particularmente em populações em risco de disfunção imunológica, como idosos, deve ser estimulada. Assim, nesta revisão os autores buscam dissertar e hipotetizar sobre os efeitos do exercício nas respostas à vacinação. Enfim, a prática de exercícios se apresenta como adjuvante dos efeitos imunológicos sobre a vacinação, todavia, com o andamento da vacinação global para SARS-CoV-2, serão necessários estudos com acompanhamento regular para que possamos avaliar a correlação entre a atividade física e a resposta imunológica a estes imunizantes.

COVID-19 is a disease caused by SARS-CoV-2, which was first described in Wuhan in 2019. Since then, it has caused the death of millions of people. COVID-19 is characterized by flulike and gastrointestinal symptoms and may become severe. The importance of understanding how to improve vaccination effectiveness has led to the investigation of factors that may influence immune response. Exercise has been associated with improved immune function and, therefore, may be a potential adjuvant to vaccine-induced immune responses. Chronic training (high levels of physical activity over a prolonged period [months/ years]) or acute exercise alone (engaging in a single exercise session [minutes/hours)] are two segments related to the immune response to physical exercise. Acute exercise is known to have short-term effects on the immune system, but there seems to be contrasting effects between moderate exercise sessions and prolonged exercise. In the absence of prophylactic medication or effective treatment, vaccination plus exercise, particularly in populations at risk for immune dysfunction such as older adults, should be encouraged. Thus, in this review, we aimed to discuss and hypothesize the effects of exercise on vaccination responses. Exercise is presented as an adjuvant to improve the immunological effects of vaccination; however, as the COVID-19 vaccination advances worldwide, studies with regular monitoring will be necessary to evaluate the correlation between physical activity and the immune response to these vaccines.

Effect of autologous platelet-rich plasma for treatment of recurrent pregnancy loss: a randomized controlled trial

Objective@#Recurrent pregnancy loss (RPL) is a fertility problem for which no exact mechanism of abortion or efficient treatment has been described. This study was conducted between 2018 and 2019 to investigate the effectiveness of autologous platelet-rich plasma (PRP) in improving the live birth rate of women with RPL who required in vitro fertilization (IVF). @*Methods@#A total of 63 patients with at least two previous pregnancy losses and no specific cause detected for the RPL were included and randomly assigned into two groups (PRP and control). Intrauterine infusion of 0.5 mL of autologous PRP was performed 48 hours before embryo transfer in the PRP group. Women in the control group received standard treatment. @*Results@#Forty patients completed the study. The baseline and cycle characteristics of the participants did not differ significantly between the PRP and control groups. The clinical pregnancy rate was higher in the PRP group (35% vs. 20%, P=0.288). The live birth rate was 15% in the PRP group, but no live births were recorded in the control group (P=0.231). @*Conclusion@#This is the first study to show that intrauterine infusion of PRP in patients with RPL who undergo IVF may increase the chance of live birth.

Electromagnetic field exposure as a plausible approach to enhance the proliferation and differentiation of mesenchymal stem cells in clinically relevant scenarios / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

Mesenchymal stem/stromal cell (MSC)‍-based therapy has been regarded as one of the most revolutionary breakthroughs in the history of modern medicine owing to its myriad of immunoregulatory and regenerative properties. With the rapid progress in the fields of osteo- and musculoskeletal therapies, the demand for MSC-based treatment modalities is becoming increasingly prominent. In this endeavor, researchers around the world have devised new and innovative techniques to support the proliferation of MSCs while minimizing the loss of hallmark features of stem cells. One such example is electromagnetic field (EMF) exposure, which is an alternative approach with promising potential. In this review, we present a critical discourse on the efficiency, practicability, and limitations of some of the relevant methods, with insurmountable evidence backing the implementation of EMF as a feasible strategy for the clinically relevant expansion of MSCs.

Efficacy and Safety of Long-Term Methimazole versus Radioactive Iodine in the Treatment of Toxic Multinodular Goiter

Background@#This study compared the degree of sustained control of hyperthyroidism in patients with toxic multinodular goiter (TMNG) treated with long-term methimazole (LT-MMI) or radioactive iodine (RAI). @*Methods@#In this clinical trial, 130 untreated patients with TMNG were randomized to either LT-MMI or RAI treatment. Both groups were followed for 108 to 148 months, with median follow-up durations of 120 and 132 months in the LT-MMI and RAI groups, respectively. Both groups of patients were followed every 1 to 3 months in the first year and every 6 months thereafter. @*Results@#After excluding patients in whom the treatment modality was changed and those who were lost to follow-up, 53 patients in the LT-MMI group and 54 in the RAI group completed the study. At the end of the study period, 50 (96%) and 25 (46%) patients were euthyroid, and two (4%) and 25 (46%) were hypothyroid in LT-MMI and RAI groups, respectively. In the RAI group, four (8%) patients had subclinical hyperthyroidism. The mean time to euthyroidism was 4.3±1.3 months in LT-MMI patients and 16.3± 15.0 months in RAI recipients (P<0.001). Patients treated with LT-MMI spent 95.8%±5.9% of the 12-year study period in a euthyroid state, whereas this proportion was 72.4%±14.8% in the RAI-treated patients (P<0.001). No major treatment-related adverse events were observed in either group. @*Conclusion@#In patients with TMNG, LT-MMI therapy is superior to RAI treatment, as shown by the earlier achievement of euthyroidism and the longer duration of sustained normal serum thyrotropin.

A rare case of primary ovarian mesenchymal chondrosarcoma in pregnancy / 대한생식의학회지

Mesenchymal chondrosarcoma is a rare tumor that is more common in young people; it is an uncommon type of chondrosarcoma with a poor prognosis. In two-thirds of cases, it affects the bone, especially the spine. However, parts of the body other than the skeletal system are occasionally involved. These rarer types have a worse prognosis, with a high likelihood of metastasis and death. Due to the possible misdiagnosis of mesenchymal chondrosarcoma, the integrated use of imaging, immunohistochemistry, and pathology can be helpful.

Muito além do consultório: uma análise multifacetada da marcha em pacientes neurológicos / Beyond the office: a multifaceted gait analysis in neurological patients

Introdução: A marcha pode ser definida como um padrão cíclico, na postura bípede, que utiliza os membros inferiores para propulsão do corpo. No campo da Neurologia, a marcha no exame físico representa sinais na avaliação neurológica, que auxiliam no fechamento de diagnósticos. No ambiente clínico, em especial nos consultórios, o refinamento da avaliação da marcha fica restrita a experiência do clínico, pois o espaço muitas vezes é reduzido, o tempo inadequado para avaliação. Poucos relatos na literatura abordaram a referida questão. Objetivo: Discutir os principais pontos da análise de marcha de interesse dos neurologistas, no consultório. Metodologia: Nessa revisão narrativa, foram levantados 32 artigos e, aplicados os critérios de elegibilidade, foram selecionados 6 artigos. A avaliação da marcha no consultório deve respeitar critérios, pois pode acarretar vieses dos parâmetros da marcha e dificultar a análise global. Conclusão: Por isso, há necessidade de maiores discussões, no âmbito do consultório, para melhor avaliar os parâmetros da marcha. (AU)

Introduction: Gait can be defined as a cicle pattern in biped posture that use to lower limb to body propulse. In Neurology, the physical exam of gait represents a neurological signal. This fact can help in the diagnosis conclusion. In a clinical setting and medical office, the critical evaluation is restricted to the physician´s expertise. The space of doctor´s room is often reduced and inappropriate time for evaluation. Objective: This study aimed to discuss the main points of gait analysis in neurological outpatients. Methods: In this narrative review, 32 articles were analyzed, and after included criteria, 6 articles were selected. In neurology medical office must respected criteria to no promote bias of gait parameter and complicate global assessment. Conclusion: Therefore, there is a need for further discussions, within the scope to better assess the gait parameters. (AU)

Urticária e COVID-19: foco nesta manifestação clínica / Urticaria and COVID-19: focus on this clinical manifestation

Introdução: A urticária é uma doença caracterizada pelo desenvolvimento de urticas, angioedema ou ambos. Convencionalmente a urticária pode ser dividida, quanto a sua duração, em duas formas: aguda (UA), quando os sintomas duram menos de seis semanas, e crônica (UC), com seis semanas ou mais de evolução. A COVID-19, enfermidade causada pelo coronavírus SARSCoV- 2, foi inicialmente descrita no final de 2019. A doença se apresenta por sintomas gripais, pneumonia, síndrome respiratória aguda grave e diarreia. Entretanto, o conhecimento atual sugere que a doença seja considerada sistêmica. Objetivo: Descrever as características dos pacientes que apresentaram UA ou exacerbação de UC durante infecção por COVID-19, atendidos em um Centro de Referência e Excelência em Urticária (GA2LEN UCARE). Métodos: De março a agosto de 2020 foram atendidos 12 pacientes com UA ou exacerbação da UC, diagnosticados com COVID-19. Resultados: Dentre os doze pacientes, 11 (92%) eram femininos. Quatro (33%) apresentaram UA entre o 1-6° dia da doença. Oito pacientes (67%) apresentaram exacerbação de UC, precedendo sintomas da COVID-19. Dentre estes, 5 (71%) apresentaram angioedema. Um aspecto importante foi o curso benigno destes pacientes, sem necessidade de hospitalização. Conclusão: Apesar da COVID-19 definir-se por doença respiratória, é essencial o olhar atento e criterioso para outras manifestações clínicas, como as cutâneas, que podem se apresentar como sintomas isolados ou associados. A identificação desta condição pode levar a uma melhoria no diagnóstico e terapia da COVID-19, bem como a uma aplicação mais rápida de práticas de quarentena.

Introduction: Urticaria is a disease characterized by the development of wheals, angioedema, or both. Conventionally, urticaria can be divided, on the basis of duration, into two forms: acute (AU), when symptoms last less than 6 weeks, and chronic (CU), when they last 6 weeks or more. COVID-19, a disease caused by the SARS-CoV-2 coronavirus, was first described in late 2019. The disease may manifest as flu-like symptoms, pneumonia, severe acute respiratory syndrome, and diarrhea. However, current knowledge suggests that the disease is systemic. Objective: To describe the characteristics of patients who presented with AU or exacerbation of CU during infection, treated at a Urticaria Center of Referral and Excellence (GA2LEN UCARE). Methods: From March to August 2020, 12 patients with AU or CU exacerbation who were diagnosed with COVID-19 were treated. Results: Among the 12 patients, 11 (92%) were female. Four patients (33%) had AU between days 1 and 6 of the disease. Eight patients (67%) had CU exacerbation preceding symptoms of COVID-19. Among these, 5 (71%) had angioedema. An important aspect was the benign course of these patients, with no need for hospitalization. Conclusion: Although COVID-19 is defined by respiratory disease, it is essential to look carefully for other clinical manifestations, such as cutaneous symptoms, which can be isolated or associated. The identification of this condition can lead to an improvement in the diagnosis and therapy of COVID-19, as well as a faster application of quarantine practices.

A vibração focal na espasticidade de pacientes com patologias neurológicas: revisão / Focal vibration on the spasticity of patients with neurological injuries: review

Introdução: As injúrias neurológicas apresentam distúrbios de movimentos que prejudicam a funcionalidade e independência desses pacientes. A espasticidade é um dos distúrbios mais frequentes e acarreta complicações secundárias com interferência negativa nas funções físicas e motoras desempenhadas na vida cotidiana. O objetivo do presente estudo foi revisar na literatura evidências que expõem o efeito da vibração focal na espasticidade de pacientes com injúrias neurológicas. Metodologia: Realizou-se uma busca nas bases e banco de dados Pubmed, PEDro, Scopus e Web of Science utilizando os descritores "focal vibration" AND "spasticity" estipulando critérios de inclusão e de qualidades metodológicas. No total cinco artigos foram incluídos e compuseram a revisão. Resultados: Os resultados evidenciaram melhoras significativas na redução da espasticidade e em parâmetros funcionais que influenciam na qualidade de vida destes pacientes. Conclusão: Conclui-se então que a vibração focal é uma intervenção eficaz na redução da espasticidade de pacientes com injúrias neurológicas. (AU)

Introduction: Neurological injuries present movement disorders that impair the independence of these patients. Spasticity is one of the most frequent disorders and results in secondary complications with negative interference in physical and motor functions performed in daily life. The purpose of this study was to review evidence in the literature that exposes the effect of focal vibration on spasticity in patients with neurological injuries. Methodology: A search was performed in the databases Pubmed, PEDro, Scopus and Web of Science using the descriptors "focal vibration" AND "spasticity" stipulating inclusion criteria and methodological qualities. 5 articles were included and made up the review analysis. Results: The results showed significant improvements in the reduction of spasticity and in functional parameters that influence the quality of life of these patients. Conclusion: We concluded that the focal vibration is an effective intervention in reducing spasticity in patients with neurological injuries. (AU)

Reabilitação do polegar reimplantado: avaliação dos resultados funcionais em uma unidade de saúde no Rio de Janeiro / Rehabilitation of the replanted thumb: evaluation of functional results in a health unit in Rio de Janeiro

Introdução: O polegar é o dedo de maior importância funcional da mão, por isso a justificativa de reimplantação e reabilitação do mesmo. Objetivo: Realizar uma análise retrospectiva dos resultados, via revisão de prontuários de pacientes submetidos à reimplante de polegar, realizados pelo Serviço SOS-Reimplante do Hospital Estadual Adão Pereira Nunes. Metodologia: Trata-se de um estudo retrospectivo com amostra de conveniência, abrangendo o período entre janeiro de 2010 a dezembro de 2015, realizado através de prontuários de pacientes submetidos a processo de reimplante de polegar, atendidos no Serviço de Terapia Ocupacional/TO-Mão no Hospital estadual Adão Pereira Nunes, em Duque de Caxias, Rio de Janeiro. Foram coletadas informações sociodemográficas, além de força muscular, sensibilidade e tempo de reabilitação. Resultados: Foram revisados 63 prontuários de pacientes submetidos a procedimento de reimplante de polegar, na faixa etária de 18 a 65 anos. Quanto ao local do acidente, 76,1% dos casos foi decorrente de acidente de trabalho e 23,2% acidentes domésticos. Ao observamos à lateralidade da lesão, 92% dos pacientes eram destros, enquanto o polegar com maior número de lesões foi o esquerdo, com um total de 82,5% pacientes. Quanto ao nível da lesão, 25,3% pacientes sofreram lesão na falange proximal, 20,8% pacientes sofreram lesão na região da interfalangeana, e 53,9% dos pacientes apresentaram lesão na falange distal. Dentre os reencaminhados para nova avaliação, 28,5% pacientes, foram submetidos a outros procedimentos cirúrgicos. Houve ganho de força em global em 88,2% dos pacientes em de sensibilidade. Conclusão: A maioria dos pacientes que sofreram reimplante do polegar conseguiram obter ganho de força muscular e sensibilidade, conseguirem retornar as suas atividades laborais, com um tempo de reabilitação que variou de 4 a 14 meses. (AU)

Introduction: The thumb is the greatest functional finger of the hand, which is justifies its replantation and rehabilitation. Objective: To carry out a retrospective analysis of the medical records of patients undergoing thumb reimplantation, performed by the SOS-Reimplantation Service of the State Hospital Adão Pereira Nunes. Methodology: This is a retrospective study with a convenience sample, covering the period between January 2010 and December 2015, conducted thorough medical records of patients undergoing the process of thumb replantation, attended at the Occupational Therapy Service / TO - Hand at the Adão Pereira Nunes State Hospital, in Duque de Caxias, Rio de Janeiro. Sociodemographic information was collected, in addition to muscle strength, sensitivity, and rehabilitation time. Results: 63 medical records of patients who underwent thumb reimplantation procedure, aged 18 to 65 years, were reviewed. As for the accident site, 76.1% of the cases were due to occupational accidents and 23.2% to domestic accidents. When observing the laterality of the lesion, 92% of the patients were righthanded, while the thumb with the largest number of lesions was left, with a total of 82.5% patients. As for the level of the lesion, 25.3% of patients suffered an injury to the proximal phalanx, 20.8% of patients suffered an injury to the interphalangeal region, and 53.9% of the patients had lesions to the distal phalanx. Among those referred for further evaluation, 28.5% of patients underwent other surgical procedures. There was overall strength gain in 88.2% of patients in sensitivity. Conclusion: Most patients who underwent thumb reimplantation were able to obtain gains in muscle strength and sensitivity, being able to return to their work activities, with a rehabilitation time that varied from 4 to 14 months. (AU)

High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

High Incidence of Chronic Kidney Disease among Iranian Diabetic Adults: Using CKD-EPI and MDRD Equations for Estimated Glomerular Filtration Rate

Background@#To investigate the population based incidence rate of chronic kidney disease (CKD) and its potential risk factors among Iranian diabetic adults during over 14 years of follow-up. @*Methods@#Two different equations (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] and Modification of Diet in Renal Disease [MDRD]) were applied for the calculating the estimated glomerular filtration rate (eGFR). Among a total of 1,374 diabetic Tehranian adults, 797 and 680 individuals were eligible for CKD-EPI and MDRD analyses, respectively. CKD was defined as eGFR lower than 60 mL/min/1.73 m2. Multivariable Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CI) for all potential risk factors. @*Results@#The incidence rates (95% CI) of CKD per 1,000 person-years were 43.84 (39.49 to 48.66) and 55.80 (50.29 to 61.91) based on CKD-EPI and MDRD equations, respectively. Being older, a history of cardiovascular disease, and having lower levels of eGFR were significant risk factors in both equations. Moreover, in CKD-EPI, using glucose-lowering medications and hypertension, and in MDRD, female sex and fasting plasma glucose ≥10 mmol/L were also independent risk factors. Regarding the discrimination index, CKD-EPI equation showed a higher range of C-index for the predicted probability of incident CKD in the full-adjusted model, compared to MDRD equation (0.75 [0.72 to 0.77] vs. 0.69 [0.66 to 0.72]). @*Conclusion@#We found an incidence rate of more than 4%/year for CKD development among our Iranian diabetic population. Compared to MDRD, it can be suggested that CKD-EPI equation can be a better choice to use for prediction models of incident CKD among the Iranian diabetic populations.

The effects of cement space thickness and material type on marginal discrepancy of restoration / Efeitos da espessura do cimento e do tipo de material na discrepância marginal da restauração

Objetivo: Estudos demostraram que a zircônia monolítica um dos materiais restauradores desenvolvidos recentemente, resolveu vários problemas de restauração de zircônia. Portanto, a precisão marginal e o ajuste interno são necessários para o sucesso clinico e para a qualidade da restauração, e o espaço do cimento pode influenciar o ajuste marginal. Assim, o presente estudo teve como objetivo investigar os efeitos da espessura do cimento e o tipo de restauração na discrepância marginal. Material e métodos: foram usadas para fabricação de coroa total. Dois tipos de materiais incluindo Zirconia monolítica (Zolid) e Sintron foram usadas para produzir a coroa total. As amostras de cada grupo foram digitalizadas em laboratório dentário por um scanner 3D, projetadas e acessadas usando CAD-CAM. As amostras foram divididas em quatro grupos de cinco com espaço de 30 e 50 mícrons de cimento. Para avaliar a discrepância marginal, as coroas foram colocadas em seus respectivos dentes sem o uso de qualquer intermediário e examinados em micro-CT. Os dados foram avaliados pelo software SPSS. Resultados: Descobriu-se que a discrepância marginal do Sintron é maior que a discrepância da zircônia monolítica. Na verdade, a zircônia monolítica com espaço de 50 µm de cimento exibiu uma menor discrepância marginal, e o espaço de cimento do Sintron não influenciou significantemente na discrepância marginal. Conclusão: Concluiu-se que os tipos de material e o espaço do cimento influencia na discrepância marginal da restauração construída pelo fluxo digital (AU)

Objective: Studies demonstrated that as one of then ewly developed restorative materials, monolithic zirconia resolved several issues of zirconia restoration. Therefore, marginal accuracy and internal fit are necessary for clinical success and quality of restorations, and cement space may influence the marginal fit. Thus, the present research aimed to investigate the effects of the cement thickness and kind of restoration on the marginal discrepancy. Material and methods: In this study, 20 maxillary left first molars, prepared by DRSK Co., were used to fabricate a full crown. Two types of material included monolithic zirconia (Zolid) and Sintron were used to make a full crown. Samples from each group were scanned by dental laboratory 3D scanner and designed and processed using CAD-CAM. The samples were divided into four groups of five with 30-and 50- µm cement spaces. In order to assess the vertical marginal discrepancy, the crowns were fittedon their respective teeth without using any mediator and examined by a micro-CT scanner. Data were analyzed by SPSS software. Results: It has been found that marginal discrepancy in Sintron is higher than the discrepancy of monolithic zirconia. In fact, monolithic zirconia with 50-micron cement space exhibited the least marginal discrepancy and the cement space in Sintron did not significantly influence the marginal discrepancy. Conclusion: It has been concluded that the material kinds and cement space influence the restoration marginal discrepancy constructed by digital workflow (AU)

Urticárias crônicas induzidas: atualização do tema / Chronic inducible urticaria: topic update

A urticária é uma doença comum, determinada pela ativação de mastócitos que se apresenta por urticas, angioedema, ou ambos. Convencionou-se classificar a urticária, quanto a sua duração, em duas formas: aguda (UA) e crônica (UC). A urticária é definida como crônica quando persiste por 6 semanas ou mais. A urticária crônica compreende urticária crônica espontânea (UCE) e urticárias crônicas induzidas (UCInd), que incluem as urticárias físicas e não físicas. Estudos sugerem que a presença de UCInd associada a UCE está ligada a um pior prognóstico e duração da doença. Essa revisão tem por objetivo atualizar as informações disponíveis sobre a prevalência, quadros clínicos, métodos diagnósticos e tratamentos das UCInd por estímulos físicos ou não.

Urticaria is a common disease determined by the activation of mast cells that presents with urticaria, angioedema, or both. According to its duration, urticaria is classified into two forms: acute (AU) and chronic (CU). Urticaria is defined as CU when it persists for 6 weeks or more. CU consists of chronic spontaneous urticaria (CSU) and chronic inducible urticaria (CIndU), which includes physical and nonphysical urticarias. Studies suggest that the presence of both CIndU and CSU is linked to worse prognosis and longer duration of these diseases. This review aims to update available information on the prevalence, clinical manifestations, diagnostic methods, and treatments of CIndU by physical or nonphysical stimuli.

In Vitro Comparison of, Accuracy of Raypex 5 and Root ZXII Apex Locators, for Working Length Determination in Primary Teeth

Working length determination is a fundamental step in the endodontic treatment of primary and permanent teeth. Radiography is most commonly used for this purpose. However, it requires patient cooperation and is associated with adverse effects of radiation. Apex locators can serve as an efficient alternative for this purpose. We wanted to compare the accuracy of Root ZXII and Raypex 5 electronic apex locators for working length determination in primary teeth.METHODSThis in vitro study was performed on 154 canals of 58 extracted primary teeth. Access cavity was prepared, and a K-file was introduced into the canal until its tip was visible at the apex under a microscope. 0.5 mm was subtracted from this length to determine the actual working length. The canal length was then measured again using Root ZXII and Raypex 5 apex locators. The obtained values were compared with the actual value. Data was analysed using SPSS version 21 via paired t-test with intraclass correlation coefficient (ICC) at P<0.05 level of significance.RESULTSThe mean difference in values measured by Root ZXII and Raypex 5 and the actual working length was 0.77 ± 0.65 mm and 0.62 ± 0.58 mm, respectively. No significant difference existed in the accuracy of the two apex locators for determination of actual working length (P=0.54). The actual working length had a strong correlation with the values measured by Root ZXII (ICC=0.97) and Raypex 5 (ICC=0.95).CONCLUSIONSBoth apex locators have acceptable accuracy as an alternative to radiography for working length determination in primary teeth.