Mercury in the brain (tumor tissues) and in markers (hair and blood) of exposure in Western Amazonia patients.

BACKGROUND: Central nervous system tumors (CNSTs) represent the second most frequent form of malignant tumors in childhood and the second leading cause of death associated with neurological diseases, affecting individuals of all age groups. In adults, CNSTs are the sixth most common cause of death in patients with malignant tumors. Additionally, the brain is the most sensitive and studied organ for mercury (Hg) toxicity. METHOD: We studied total Hg (THg) in tissue samples (of benign and malignant CNSTs) and explored its associations with THg in exposure markers (hair and blood) from 65 patients (40 females and 25 males) who underwent surgical treatment. RESULTS: No statistically significant differences were found in THg concentrations in brain tumors or in blood and hair from these patients (classified as malignant/benign or glioma/non-glioma); also, there were no statistically significant differences between males and females. However, statistically significant correlations were found between THg in CNSTs and in hair (rs = 0.4967; p = 0.0001) and in blood (rs = 0.4702; p = 0.0058); but no significant correlations were found between THg in hair and blood (rs = 0.1229; p = 0.5332). In the Western Amazon, with endemic exposure to fish-methylmercury, these urban patients were low to moderate fish consumers; THg concentrations in blood (median: 0.645 µg.L-1; range: 8.01-21.02 µg.L-1; n = 56) and hair (median: 0.686 µg.g-1; range: 0.01-10.02 µg.g-1; n = 65) were relatively low, whereas THg levels in brain tumors (median: 8.194 ng.g-1; range: <0.10-69.16 ng.g-1; n = 65) were within range of published studies in brain autopsies. Additionally, no statistically significant correlations (p = 0.4828) were observed between frequency of fish consumption and THg in the brain. CONCLUSION: Although no significant THg concentrations in the type of brain tumors (benign versus malignant) were found, the significantly positive correlation between markers of THg exposure (hair and blood) and THg in the brain tissues indicates its usefulness as a marker/proxy for brain-THg load. These findings confirm the value of using hair and blood as constructs of THg in the brain of exposed populations.

Full-arch implant-supported rehabilitations: A prospective study comparing porcelain-veneered zirconia frameworks to monolithic zirconia.

OBJECTIVES: To evaluate the performance of two types of zirconia frameworks. MATERIAL AND METHODS: From 2014 to 2016, in a prospective clinical trial, 150 patients were rehabilitated with 83 and 110 implant-supported, screw-retained, full-arch ceramic-veneered zirconia (PVZ) rehabilitations and monolithic zirconia with porcelain veneering limited to buccal (MZ) rehabilitations, respectively. Patients were consecutively enlisted according to pre-defined inclusion criteria and evaluated on 4 months intervals. A Kaplan-Meier estimator was adopted, and the log-rank test and Wilcoxon test used to test differences in survival and successful function in the two different groups. RESULTS: The average follow-up time (±SD) and implant success rate was 608.80 ± 172.52 days with 99.53% implant success for the PVZ group and 552.63 ± 197.57 days with 99.83% success for the MZ group. According to the Kaplan-Meier estimator, the mean cumulative survival rate at the 2-year follow-up for framework fracture, major chipping, minor chipping, or any of the former combined to occur was 0.99, 0.95, 0.93 and 0.85 for the PVZ group (n = 18) and 0.99, 0.95, 0.95 and 0.89 for the MZ group (n = 15). No significant differences were found between the two groups. CONCLUSIONS: Results suggest zirconia as a suitable material for frameworks in full-arch implant-supported rehabilitations. Both groups presented a low incidence of technical complications. When comparing the two different designs, the MZ group presented a lower technical complication rate, thus presenting itself as a viable alternative for full-arch implant-supported rehabilitations. Further clinical studies with longer follow-ups (5 years) should be performed to evaluate the long-term stability of such rehabilitations.

Motivação para Mudança no Uso de Substâncias entre Usuários de Drogas Encaminhados pela Justiça / Motivación para el Cambio de la Conducta Adictiva entre Consumidores de Drogas Enviadas por la Justicia / Motivation for Change in Substances Use among Drug Users Referred by the Justice System

Resumo O projeto Justiça Terapêutica, que encaminha para tratamento pessoas com dependência de substâncias psicoativas que cometeram crimes, tem ganhado destaque no Brasil. Este estudo teve como objetivo avaliar os estágios de motivação em pessoas encaminhadas pela justiça para tratamento de dependência de substâncias psicotrópicas. A amostra foi constituída por 120 pessoas que estavam em tratamento CAPSAD e internados em Comunidades Terapêuticas, na cidade de Porto Velho, Rondônia. Os indivíduos foram alocados em dois grupos para comparação da motivação para mudança de comportamento: um formado por pessoas encaminhadas pela justiça (Grupo Justiça) e o outro constituído por pessoas que estavam em tratamento por qualquer outro motivo, exceto encaminhamento judicial (Grupo Outros). Foram utilizados para avaliar as variáveis de motivação dos grupos a Escala URICA para substâncias Ilícitas, Régua de Prontidão e Prontidão para Mudança. Os resultados demonstraram que não foram encontradas diferenças estatisticamente significativas na motivação das pessoas encaminhadas pela justiça e as pessoas encaminhadas pelas formas de indicação mais usuais para tratamento. Ressalta-se a importância de avaliar a motivação em todas as fases do tratamento, em vista da melhor adesão e sucesso terapêutico das pessoas com problemas com a justiça e com o uso de substâncias.

Resumen El proyecto Justicia Terapéutica hacia delante para tratar a personas con dependencia de sustancias psicoactivas que cometieron crímenes ha ganado importancia en Brasil. Este estudio tuvo como objetivo evaluar las etapas de la motivación en las personas enviadas por la justicia para el tratamiento de la dependencia de sustâncias psicotrópicas. La muestra fue de 120 personas que estaban siendo tratados en el CAPS-AD y em Comunidades Terapéuticas en la ciudad de Porto Velho, Rondonia. Los individuos fueron divididos en dos grupos, uno formado por personas enviadas por la justicia (Grupo de Justicia) y otro formado por personas que estaban siendo tratados por cualquier otra razón, excepto la remisión judicial (otro grupo), para comparar entre los grupos motivación para cambiar comportamiento. Se utilizó para evaluar las variables de motivación de los grupos URICA Escala ilícito Regla de Preparación y disposición para el cambio. Los resultados mostraron que hubo diferencias estadísticamente significativas en la motivación de las personas enviadas por la justicia y las personas enviadas por las formas de indicación es más tratamientos habituales. Hacemos hincapié en la importancia de evaluar la motivación en todas las etapas del tratamiento, con el fin de una mejor adherencia y el éxito terapéutico de las personas con problemas con la ley y el uso de sustancias.

Abstract The Therapeutic Justice project, which refers people with psychoactive substance dependence who committed crimes for treatment, has gained prominence in Brazil. This study aimed to evaluate the stages of motivation in people referred by the justice system for the treatment of psychotropic substance dependence. The sample consisted of 120 people who were being treated in CAPS-AD and Therapeutic Communities in the city of Porto Velho, Rondônia, Brazil. The individuals were divided into two groups, one formed by people referred by the justice system (Justice System Group) and another made up of people who were being treated for any other reason (Others Group), to compare the motivation to change behavior between the groups. The URICA Scale for Illicit Substances, the Readiness Ruler and Readiness for Change were used to evaluate the motivation variables of the groups. The results showed that there were no statistically significant differences in motivation between the people referred by the justice system and the people with other more usual forms of indication for treatment. The importance of assessing the motivation during all stages of treatment is emphasized, aiming for better adherence and therapeutic success of people with problems with the law and the use of substances.

An association between temporomandibular disorder and gum chewing.

This single center, randomized, small study sought to investigate the prevalence and frequency of chewing gum consumption, and whether there is a relationship between these factors and the presence of symptoms associated with temporomandibular disorder (TMD). Subjects were divided into 7 groups based on their parafunctional oral habits. Of these, subjects who chewed gum were divided into 5 subgroups (A-E) based on their gum chewing habits. Group A chewed gum <1 hour/day (n = 12), Group B chewed gum 1-2 hours/day (n = 11), Group C chewed gum 3 hours/day (n = 6), and Group D chewed gum >3 hours at a time (n = 8); the frequency of gum chewing in Groups A-D was once a week. Group E subjects chewed gum 1-3 times/week for at least 1 hour each occurrence (n = 2). Sixty-three percent of the subjects in Group D reported TMD symptoms of arthralgia and myofascial pain. Thirty-three percent of the subjects in Group C showed symptoms of arthralgia. Eighty-three percent of the subjects in Group A and 27% in Group B reported myofascial pain. All subjects in Group E reported masseter hypertrophy. The remaining 2 groups were Group F, subjects that didn't chew gum but had other parafunctional oral habits (n = 2), and Group G, subjects who didn't have parafunctional oral habits (n = 12).

Sustained clearance of Mansonella ozzardi infection after treatment with ivermectin in the Brazilian Amazon.

Therapy for mansonelliasis is challenging because there is no standard drug recommended for its treatment. This non-randomized study was conducted to evaluate the effectiveness of a single dose of 0.15 mg/kg of ivermectin to reduce Mansonella ozzardi microfilaraemia in infected persons. A total of 74 patients were studied within the municipality of Lábrea, which is located in Amazonas State, Brazil. The patients were treated with ivermectin after detection of the parasite by blood examination. Significant microfilaraemia reduction was observed and its residual effect was maintained for at least 12 months. There was no significant change in the laboratory blood count, hepatic metabolites, and nitrogen-bounding compound excreta dosage values that could compromise the use of this drug, demonstrating that ivermectin has a low toxicity level.

Total and methyl-mercury in hair and milk of mothers living in the city of Porto Velho and in villages along the Rio Madeira, Amazon, Brazil.

High fish consumption and extended breastfeeding are hallmarks of traditional lifestyle in Western Amazonia. We studied sources of mercury exposure, fish-methylmercury (meHg) and dental-amalgam filling, in 75 urban and 82 rural lactating mothers. Total mercury was determined in all samples while meHg concentrations were determined in subsamples of milk (45) and hair (27) of urban mothers living in Porto Velho (PV) and in hair (46) and milk (37) of mothers living in traditional communities (TC) of the Rio Madeira. The TC mothers showed significantly higher median hair-Hg concentrations (8.2µgg(-1)) than PV mothers (1.3µgg(-1)). Median total Hg in milk of PV mothers (0.36ngg(-1)) was significantly lower (p=0.0000) than that found in milk of TC mothers (2.30ngg(-1)). The median meHg concentrations in milk of TC mothers were also significantly higher (1.0ngg(-1)) than in milk of PV mothers (0.07ngg(-1)). For urban mothers with low fish consumption rates (and relatively higher dental amalgam fillings) the proportion of inorganic Hg in milk was higher (85%) than in TC (62%). In TC mothers 51% of breast milk Hg concentrations were above 2ngg(-1) (world median concentrations), contrasting with 8% in PV mothers. Despite this, there was no significant correlation between total Hg concentrations in milk and either amalgam filling or daily fish consumption. Socioeconomic changes occurring in Western Amazonia are causing changes in fish-eating habits of urban mothers. However, traditional lifestyle and attendant high fish consumption in riverine populations can still impact total Hg and methylmercury concentrations in mothers' milk and hair.

Vitreous pharmacokinetics and retinal safety of intravitreal preserved versus non-preserved triamcinolone acetonide in rabbit eyes.

PURPOSE: To compare the intravitreal pharmacokinetic profile of a triamcinolone acetonide formulation containing the preservative benzyl alcohol (TA-BA) versus a preservative-free triamcinolone acetonide formulation (TA-PF), and evaluate potential signs of toxicity to the retina. METHODS: A total of 60 New Zealand male white rabbits, divided into two groups, were studied. In the TA-BA group, 30 rabbits received an intravitreal injection of TA-BA (4 mg/0.1 ml) into the right eye. In the TA-PF group, 30 rabbits received an intravitreal injection of TA-PF (4 mg/0.1 ml) into the right eye. The intravitreal drug levels were determined in 25 animals from each group by high-performance liquid chromatography (HPLC). The potential for toxicity associated with the intravitreal triamcinolone injections was evaluated in five randomly selected animals from each group by electroretinography (ERG) and by light microscopy. RESULTS: Median intravitreal concentrations of TA-BA (µg/ml) were 1903.1, 1213.0, 857.8, 442.0, 248.6 at 3, 7, 14, 21 and 28 days after injection. Intravitreal concentrations of TA-PF (µg/ml) were 1032.9, 570.1, 516.6, 347.9, 102.8 at 3, 7, 14, 21 and 28 days after injection. The median intravitreal triamcinolone concentration was significantly higher in the TA-BA compared to the TA-PF group at 7 days post-injection (p < 0.05). There was no significant difference between the two groups in median triamcinolone concentration at the other time points evaluated. There was no evidence of toxic effects on the retina in either group based on ERG or histological analyses. CONCLUSIONS: Following a single intravitreal injection, the median concentration of triamcinolone acetonide is significantly higher in the TA-BA compared to the TA-PF group at 7 days post-injection. No toxic reactions in the retina were observed in either group.

Fatores que influenciam a realização do exame preventivo do câncer cérvico-uterino em Porto Velho, Estado de Rondônia, Brasil / Factors influencing the implementation of cervical cancer screening in Porto Velho, Rondônia State,Brazil

O câncer do colo uterino é um importante problema de saúde pública no Brasil e sua identificação precoce aumenta consideravelmente a probabilidade de cura. O principal instrumento utilizado na detecção precoce deste câncer é o exame Papanicolau. O objetivo deste estudo foi analisar fatores biopsicossociais que interferem na realização do exame preventivo do câncer do colo do útero entre mulheres do Município de Porto Velho, Estado de Rondônia, com ênfase na prática religiosa. Aplicou-se questionário individual mediante visita domiciliar e realizaram-se entrevistas semiestruturadas em igrejas locais onde são realizados exames preventivos mensalmente. A amostra foi de 227 mulheres, dentre as quais 82,8 por cento declararam já ter realizado alguma vez o exame. A etnia, o estado civil, o grau de instrução, a profissão e a religião não foram detectados como significativos para a não realização do exame preventivo. Há preferência entre as participantes pela realização do exame preventivo nas igrejas, pois estas oferecem um espaço físico e social de acolhimento. Políticas intersetoriais neste sentido podem ser desenvolvidas para aumentar as taxas de cobertura do exame.

Cervical cancer is a major public health problem in Brazil, and its early detection greatly increases the likelihood of cure. The main tool for the early detection of cervical cancer is the Papanicolaou smear (Pap smear). The aim of the present study was to analyze the biopsychosocial factors that affect the performance of cervical cancer screening tests among women in the municipality of Porto Velho, Rondônia State, Brazil, with an emphasis on religious practices. An individual questionnaire was applied during home visits, and semi-structured interviews were conducted in local churches where preventive screening is performed monthly. The sample consisted of 227 women of whom 82.8 per cent had previously undergone the test. Ethnicity,marital status, schooling, occupation and religion were not considered significant factors for the execution of preventive screening in the women. There was a preference among the participants towards performing the screening tests at the churches because they offer a physically and socially welcoming space. Therefore, intersectoral policies can be developed to increase the test’s coverage rates.