Tesofensine, a novel antiobesity drug, silences GABAergic hypothalamic neurons.

Obesity is a major global health epidemic that has adverse effects on both the people affected as well as the cost to society. Several anti-obesity drugs that target GLP-1 receptors have recently come to the market. Here, we describe the effects of tesofensine, a novel anti-obesity drug that acts as a triple monoamine neurotransmitter reuptake inhibitor. Using various techniques, we investigated its effects on weight loss and underlying neuronal mechanisms in mice and rats. These include behavioral tasks, DeepLabCut videotaped analysis, electrophysiological ensemble recordings, optogenetic activation, and chemogenetic silencing of GABAergic neurons in the Lateral Hypothalamus (LH). We found that tesofensine induces a greater weight loss in obese rats than lean rats, while differentially modulating the neuronal ensembles and population activity in LH. In Vgat-ChR2 and Vgat-IRES-cre transgenic mice, we found for the first time that tesofensine inhibited a subset of LH GABAergic neurons, reducing their ability to promote feeding behavior, and chemogenetically silencing them enhanced tesofensine's food-suppressing effects. Unlike phentermine, a dopaminergic appetite suppressant, tesofensine causes few, if any, head-weaving stereotypy at therapeutic doses. Most importantly, we found that tesofensine prolonged the weight loss induced by 5-HTP, a serotonin precursor, and blocked the body weight rebound that often occurs after weight loss. Behavioral studies on rats with the tastant sucrose indicated that tesofensine's appetite suppressant effects are independent of taste aversion and do not directly affect the perception of sweetness or palatability of sucrose. In summary, our data provide new insights into the effects of tesofensine on weight loss and the underlying neuronal mechanisms, suggesting that tesofensine may be an effective treatment for obesity and that it may be a valuable adjunct to other appetite suppressants to prevent body weight rebound.

Efficacy of a public promotion program on children's oral health / Eficácia de um programa público de promoção de saúde bucal em crianças

Abstract Objective: To assess the efficacy of the Baby's Mouth early dental care prevention and promotion program in preventing oral diseases (caries, gingivitis, or malocclusions) in children attended since 2010. Methods: This was a cross-sectional and cohort study that assessed 252 children between 36 and 60 months of age in both sexes. The children were divided into three groups: G1: effective participants of the program from birth; G2: children who have stopped participating for more than 24 months, and G3: children who have never attended a prevention program. The evaluation was carried out in two stages: first, an interview with the mothers and, afterwards, a clinical children examination to assess the presence of caries, gingivitis, and malocclusion. The chi-squared test was used for statistical analysis between groups (p < 0.05). Results: The diseases assessed were: caries (G1: 5.9%, G2: 54.7%, G3: 70%), gingivitis (G1: 8.3%, G2: 17.9%, G3: 40.5%), and malocclusion (G1: 22.6%; G2: 28.6%; G3: 50%). For gingivitis, there was no significant difference when comparing G1 and G2 (p = 0.107), but it was significant between G1 and G3 (p < 0.001). Regarding malocclusion, a statistically significant relationship was observed (p = 0.004) among all groups. Conclusion: The prevention and promotion program in public oral health was effective in preventing caries disease, gingivitis, and malocclusion in children under 5 years of age.

Resumo Objetivo: Avaliar a eficácia do programa de prevenção e promoção de cuidados dentários precoce da boca do bebê, a fim de prevenir doenças bucais (cáries, gengivite ou má oclusões) em crianças atendidas desde 2010. Métodos: Estudo transversal e de coorte com avaliação de 252 crianças entre 36 e 60 meses de idade de ambos os sexos. As crianças foram divididas em dois grupos: G1: participantes efetivos do programa a partir do nascimento; G2: crianças que pararam de participar por mais de 24 meses do programa; e G3: crianças que nunca participaram de um programa de prevenção. A avaliação foi feita em dois estágios: entrevista com as mães e, depois, um exame clínico nas crianças para analisar cáries, gengivite e oclusão. Foi utilizado o teste qui-quadrado para análise estatística entre os grupos (p < 0,05). Resultados: As doenças analisadas foram: cáries (G1: 5,9%, G2: 54,7%, G3: 70%), gengivite (G1: 8,3%, G2: 17,9%, G3: 40,5%) e má oclusão (G1: 22,6%; G2: 28,6%; G3: 50%). Para gengivite, não houve diferença significativa ao comparar G1 e G2 (p = 0,107), porém a diferença foi extremamente significativa entre G1 e G3 (p < 0,001). Nas oclusões, houve uma relação estatisticamente significativa (p = 0,004) entre todos os grupos. Conclusão: O programa de prevenção e promoção de saúde bucal pública foi efetivo na prevenção de cáries, gengivite e má oclusão em crianças com menos de cinco anos de idade.

Efficacy of a public promotion program on children's oral health.

OBJECTIVE: To assess the efficacy of the Baby's Mouth early dental care prevention and promotion program in preventing oral diseases (caries, gingivitis, or malocclusions) in children attended since 2010. METHODS: This was a cross-sectional and cohort study that assessed 252 children between 36 and 60 months of age in both sexes. The children were divided into three groups: G1: effective participants of the program from birth; G2: children who have stopped participating for more than 24 months, and G3: children who have never attended a prevention program. The evaluation was carried out in two stages: first, an interview with the mothers and, afterwards, a clinical children examination to assess the presence of caries, gingivitis, and malocclusion. The chi-squared test was used for statistical analysis between groups (p<0.05). RESULTS: The diseases assessed were: caries (G1: 5.9%, G2: 54.7%, G3: 70%), gingivitis (G1: 8.3%, G2: 17.9%, G3: 40.5%), and malocclusion (G1: 22.6%; G2: 28.6%; G3: 50%). For gingivitis, there was no significant difference when comparing G1 and G2 (p=0.107), but it was significant between G1 and G3 (p<0.001). Regarding malocclusion, a statistically significant relationship was observed (p=0.004) among all groups. CONCLUSION: The prevention and promotion program in public oral health was effective in preventing caries disease, gingivitis, and malocclusion in children under 5 years of age.

Headaches and pain referred to the teeth: frequency and potential neurophysiologic mechanisms

Objective: To assess frequency of pain referred to the teeth in occipital neuralgia, migraine and tension-type headache. Material and methods: 153 patients presenting with bruxing behavior and craniomandibular disorders (CMDs). Clinical examination, questionnaires, palpation, criteria for CMDs, bruxing behavior (BB), occipital neuralgia (ON), migraine (MIG), tension-type headache (TTH) and pain referred to the teeth. Results: Mean ages in the ON, MIG and TTH patients and controls were about 38.0, 37.0, 33.0 and 36.6 years, respectively (p = 0.17). The frequencies of dental pains in the subgroups ON and MIG were 37.1% and 25% (p = 0.52), ON and TTH, 37.1% and 18.6% (p = 0.03), ON and Controls 37.1% and 6.7% (p = 0.006), MIG and TTH 25% and 18.6% (p = 0.51), MIG and Controls 25% and 6.6% (p = 0.16) and TTH and controls 18.6% and 6.7% (p = 0.15). The frequencies of pain referred to the teeth decreased from the ON to the MIG, and then to the TTH and Control groups (x-square for independence p < 0.002, x-square for trends p < 0.001). Conclusion: The ON subgroup demonstrated the highest frequency of dental pain referred to the teeth. This frequency increased with the severity of pain. Neurophysiological mechanisms may explain higher frequency of referred pain associated with the severity of headache.

A comprehensive method to classify subgroups of bruxers in temporomandibular disorders (TMDs) individuals: frequency, clinical and psychological implications

Introduction: Bruxism is an oral pnenomenon described as a parafunctional activity involving nocturnal and/or diurnal tooth clenching and/or grinding which may cause teeth wearing, fatigue, pain in the muscles and temporomandibular joints and limitations in mandibular movements. Objective: To classify bruxers in four different subgroups. Material and methods: Evaluation of 162 individuals presenting temporomandibular disorders (TMDs) referred consecutively over a period of six years. Chief complaint, history of signs/symptoms and clinical examination were used to gather data. Individuals were classified as TMDs if they were seeking active treatment for the following complaints: pain in the masticatory muscles and/or temporomandibular joints (TMJs), difficulties to perform normal jaw movements, tenderness to palpation of muscle and joints, joint noises and. Patients were classified as mild, moderate, severe and extreme bruxers if they presented 3 to 5, 6 to 10, 11 to 15 or 16 to 25 signs and symptoms of bruxing behavior, respectively. Data was submitted to Chi-square for independence and Fisher's exact test (p < 0.05).(=30). Results: Frequencies of 16.1%, 29.6%, 31.5% and 22.8% of mild, moderate, severe and extreme bruxing behavior were found in this study. Moderate and severe bruxing behavior occurred more frequently than mild and extreme bruxing behavior (p < 0.0001). Conclusion: The four groups of bruxers occurred more or less frequently in this study and mild and extreme bruxing behavior demonstrated the lowest frequencies of such behavior.

Dores dentárias de origem muscular em indivíduos com distúrbios crâniomandibulares e controles: estudo comparativo / Dental pains of muscle origin in craniomandibular disorders individuals and controls: a comparison study

JUSTIFICATIVA E OBJETIVOS: As dores referidas para os dentes ocorrem frequentemente na região orofacial e constituem um desafio diagnóstico para o clínico.Os objetivos deste estudo foram analisar a frequência de dores dentais de origem muscular e os dentes afetados mais frequentemente. MÉTODO: As fichas clínicas completas de 258 pacientes com distúrbios crâniomandibulares (DCM) encaminhados consecutivamente durante 8 anos foram avaliadas. Os dados foram obtidos com base na queixa principal, história dos sinais e sintomas descrição da dor,palpação muscular e critérios para DCM, bruxismo e dores referidas para os dentes. RESULTADOS: A frequência de dores nos dentes foi de 19,4% no grupo DCM e de 7,5% no grupo controle(p = 0,11). A frequência de dores dentais referidas aumentou do grupo CMD com bruxismo moderado para os grupos intenso e extremo (p = 0,47, p = 0,18), mas as diferenças não foram significativas. As dores dentais foram mais frequentes no arco superior (18,2%) do que no inferior (12,4%) e nos molares superiores e inferiores do que nos outros grupos de dentes. Trinta e três indivíduos relataram um total de 94 dentes superiores com dor e 24 sujeitos, 79 dentes inferiores com dor (p = 0,85). CONCLUSÃO: As dores musculares referidas aos dentes ocorrem com frequência em indivíduos com DCM.Os dentes superiores e o grupo de molares apresentaram dor com mais frequência do que os outros grupos de dentes.A frequência de dores dentais de origem muscular foi maior em bruxismos graves e extremos e tais dores são causa comum de dor de dente de origem não dental.

BACKGROUND AND OBJECTIVES: Pain referred to the teeth occurs frequently in the orofacial region and constitutes a diagnostic challenge for the dental practitioner. The goals of this study were to analyze the frequency of muscle pain referred to the teeth and the frequency of teeth affected more frequently.METHOD: Complete clinical charts of 258 CMD subjects referred consecutively during an eight-year period were assessed. Data were obtained based on the chief complaint, history of signs and symptoms, pain description, muscle palpation and criteria for CMD, bruxism and muscle pain referred to the teeth. RESULTS: The frequency of pain referred to the teeth was about 19.4% in the CMD group and 7.5% in the control group (p = 0.11). The frequency of pain referred to the teeth increased in the CMD group with moderate bruxism to the intense and extreme groups (p = 0.47, p= 0.18), but the differences were not significant. Pain referred to the teeth was more frequent in the upper arch(18.2%) than in the lower (12.4%) and in the upper and lower molars than in other groups of teeth. Thirty three individuals reported a total of 94 upper teeth with pain and 24 subjects, 79 lower teeth with pain (p = 0.85).CONCLUSION: Muscle pain referred to the teeth occur frequently in CMD individuals. Upper teeth and themolars group presented pain more frequently than other groups of teeth. The frequency of muscle pain referred to the teeth was higher in intense and extreme bruxers and such pain is a common cause of tooth pain of non-dental origin.

Antidepressant use, pain severity and pain at multiple sites in patients with bruxism / Uso de antidepressives, intensidade da dor e dor em locais múltiplos em pacientes com bruxismo

OBJECTIVE: The aim of this study was to compare the duration, pain severity, painful complaints and antidepressant use in patients with craniomandibular disorders (CMDs) and bruxing and control subjects. MATERIAL AND METHODS: Clinical evaluation, questionnaires for pain, bruxism and antidepressant use, self-report of signs and symptoms and history regarding pain and muscle palpation were used to evaluate 389 patients presenting with CMDs and bruxing behavior and 69 controls. RESULTS: The mean age of the experimental group was 33.3 years...

OBJETIVOS: Comparar a duração, a severidade da dor, sua ocorrência em locais múltiplos e o uso de antidepressivos por pacientes com distúrbios craniomandibulares (DCMs) e bruxismo com indivíduos de um grupo controle. MATERIAIS E MÉTODOS: Avaliação clínica; questionários sobre dor, bruxismo e uso de antidepressivos; autorrelato de sinais e sintomas; e histórico relacionado à dor e palpação muscular em 389 indivíduos com DCMs e bruxismo e 69 controles. RESULTADOS: A idade média do grupo experimental foi de 33,3 anos...

Evaluación de la iniciativa puntos vida a nivel nacional y elaboración de propuesta metodológica para completar los instrumentos para la evaluación del diseño curricular de la carrera de medicina de la universidad Juan Misael Saracho (AU) / ss

Concienciar a través de la estrategia PUNTOS VIDA, a la población en general sobre las Enfermedades no Transmisibles, sus factores de riesgo y sus complicaciones

Outcomes of treatment with custom-made temporomandibular joint total joint prostheses and maxillomandibular counter-clockwise rotation.

The first 25 consecutive patients with high occlusal plane angulation, dysfunction, and pain who were treated with temporomandibular joint (TMJ) total joint prostheses and simultaneous maxillomandibular counterclockwise rotation were evaluated before surgery (T1), immediately after surgery (T2), and at the longest follow-up (T3) for surgical movements and long-term stability. Subjective ratings were used for patients' facial pain/headache, TMJ pain, jaw function, diet, and disability, and objective functional changes were determined by measuring maximum incisal opening and lateral excursive movements. Results showed that the areas of greatest surgical change included an average decrease in the occlusal plane of 13.3 degrees with advancement at point B of 13.4 mm and at the genial tubercles of 16.3 mm. At longest follow-up, relapse was 0.7 degrees, 0.8 mm, and 1.2 mm, respectively, with no statistically significant changes. Significant subjective pain and dysfunction improvements were observed (P ≤ 0.001). Maximum incisal opening increased, but lateral excursion decreased. Those who had two or more previous TMJ surgeries showed greater levels of dysfunction at T1 and T3 than those who had one or no previous surgeries, but otherwise patients presented similar amounts of absolute changes. In conclusion, end-stage TMJ patients can achieve significant improvement in their pain, dysfunction, dentofacial deformity, and airway problems in one operation with TMJ reconstruction and mandibular advancement using TMJ custom-made total joint prostheses and simultaneous maxillary osteotomies for maxillomandibular counter-clockwise rotation.

Maltrato y o violencia: fenómeno de estudio en centros de enseñanza asistenciales: internado rotatorio de medicina gestión 2005-2006 / Abuse and or violence: fenomeno study schools care: medical internship revolving Management 2005-2006

Pregunta de investigación ¿Cual es la magnitud y los tipos de maltrato y/o violencia que se ejercen en los centros de enseñanza asistencial desde la perspectiva de los estudiantes de último año de la carrera de Medicina durante la gestión 2005-2006?. Objetivo. Establecer la magnitud y tipos de maltrato y/o violencia en los centros de enseñanza asistencial desde la perspectiva de los estudiantes de último año de la carrera de Medicina, de la Universidad Mayor de San Andres (UMSA) en la ciudad de La Paz - gestión 2005-2006. Diseño. Descriptivo de corte transversal. Lugar. Centros de enseñanza asistenciales, hospitales de segundo y tercer nivel. Población. Estudiantes de la carrera de Medicina que cursaron el internado rotatorio, muestra de 125 estudiantes. Material y Método. Se aplico el cuestionario a 125 estudiantes que concluyeron el internado rotatorio de la Facultad de Medicina de la UMSA, durante la gestión de 2005-2006. Se aplico 20 preguntas para investigar la relación con el personal de salud del centro asistencial de enseñanza, tipos de conductas de maltrato y/o violencia percibidos y su repercución en el rendimiento académico y la comunicación docente asistencial-interno. La evaluación cualitativa se valoró como nunca = 1, rara vez = 2, algunas veces = 3, con bastante Frecuencia = 4, muy frecuentemente = 5. Resultados y Conclusiones. Los internos de la carrera de Medicina, durante el desarrollo del internado rotatorio, percibieron agresión hacia su persona, señalando como presuntos agresores a las enfermeras y médicos de planta, la razón fue el exceso de trabajo, el tipo de conducta agresiva fue la PSICOLOGICA, SEXUAL y FISICO, motivados por abuso de poder y complejo de superioridad, el lugar fue la sala de visita y quirófano, la medidas de afrontamiento a conductas agresivas...

Research Question What is the magnitude and which are the types of abuse and/ or violence committed in the centres of assisting teaching from the perspective of last year medical students during the academic year 2005-2006?OBJECTIVETo establish the magnitude and types of abuse and/or violence in the assisting teaching centres from the perspective of last year medical students of Universidad Mayor de San Andrés (UMSA) in La Paz – academic year 2005-2006...

Prevalencia de factores de riesgo asociado a diabetes mellitus tipo 2 en población mayor de 20 años en los servicios de salud de II y III nivel del área urbana yrural en Bolivia - 2007 / Prevalence of risk factors associated with diabetes mellitus type 2 in population aged 20 years in health services II and III level in urban and Rural Bolivia - 2007

Pregunta de Investigacion¿ Cual es la prevalencia de algunos factores de riesgo asociados a Diabetes Mellitus tipo 2 en población mayor de 20 años que acude a los servicios de salud urbano y rural de II y III nivel en Bolivia? Objetivo General Identificación de la prevalencia de factores de riesgo metabólico asociados a Diabetes Mellitus tipo 2 en población que acuda a los servicios de salud de Hospitales de II y III nivel del área urbana y rural de Bolivia. Diseño de Investigacion Descriptivo, de corte transversal (Aleatorio). Lugar Servicios de salud, hospitales de II y III nivel de área urbana y rural en Bolivia. Población. Selección aleatoria de población mayor de 20 años de ambos sexos, que acuda a los servicios de salud de hospitales de III y II nivel de área urbana y rural en Bolivia Material Y Métodos En 3679 pacientes seleccionados aleatoriamente, se realizó una encuesta con preguntas estructuradas para determinar factores sociales y étnicos, hábitos tóxicos. Posteriormente un examen físico con la medición del índice de masa corporal, presión arterial y perímetro abdominal. Además se practicó el test de glicemia basal en ayunas. Resultados Participaron de este estudio un total de 3679 personas, entre los 19 a 98 años de edad, 1387 varones (37,7%) y 2292 mujeres (62.3%), de los mismos: 2637, (71,7%) que se auto identifican como originarios y mestizos, 421 (11,4%) se consideran raza blanca, 89 (2.4%) se reconocen como de origen afro boliviano y 532 (14.5%)...

Principios generales de localización de las neumonías mediante la radiología de tórax / Localization general principles by means of pneumonia the thorax radiology

La neumonía o infección del parénquima pulmonar es una de las enfermedades que afecta más frecuente el sistema respiratorio, ocasiona un gran número de muertes y alrededor del 10 por ciento de los ingresos a hospitalización. La condensación pulmonar originada por el exudado inflamatorio, con afectación además de las paredes alveolares y los espacios intersticiales son fácilmente localizables mediante estudios radiológicos. Existen principios generales de localización pero dispersos en la gran cantidad de literatura existente, en la presente revisión nos proponemos concentrarlos para que sean útiles en la práctica médica

Distúrbios internos articulares: a influência do bruxismo pesado sobre distúrbios articulares específicos / Internal joint derangements: the influence of severe buxism on specific joint disorders

Abordamos neste artigo a caracterização do bruxismo pesado, suas diferenças clínicas em relação aos distúrbios internos articulares e as implicações com o diagnóstico e tratamento

A clinical comparison of internal joint disorders in patients presenting disk-attachment pain: prevalence, characterization, and severity of bruxing behavior.

This study clinically documents the presence of disk-attachment pain (DAP) related to the severity of bruxism and to the prevalence of internal joint disorders in patients and controls. The sample consisted of 394 temporomandibular disorder (TMD) and bruxing behavior patients and 104 nonbruxer control subjects. The TMD group was subdivided in a group of 109 disk-attachment pain patients and 285 bruxing behavior-nonDAP groups. The second reference group was a sample of 104 nonbruxing behavior subjects. Comprehensive evaluations (including history of signs and symptoms), use of questionnaires, clinical examination, palpation of muscles and joints, classification of bruxing behavior by the degree of severity, and diagnostic tests were performed in patients and controls. There was a prevalence of disk-attachment pain in the group of TMD and bruxing behavior patients. The degree of jaw opening was lower in the DAP group as compared to the TMD/bruxism-nonDAP group and controls. The mean Visual Analog Scale (VAS) value for the joint pain complaints was slightly elevated in the DAP group as compared to the TMD/bruxism-nonDAP group. Specific masticatory disorders including difficulties to open, pain on opening, chewing pain, fatigue on chewing, jaw deviation to opening, and change to a soft diet, were significantly more prevalent in the DAP group as compared to the other reference groups. Our conclusions are based upon a review of the literature and on the results of this study: a. DAP is a relatively well defined stage of internal joint derangement (IJD); and b. compared to other groups, DAP patients as a subgroup are relatively more impaired by their masticatory and other functional disorders. This study provides strong support to other studies and demonstrates that DAP is a well-differentiated and severe internal joint disorder.

Hostility in TMD/bruxism patients and controls: a clinical comparison study and preliminary results.

This study involved a group of 110 TMD/bruxing behavior patients (30 mild, 40 moderate, and 40 severe bruxers) which was compared to a group of 40 nonTMD/nonbruxer controls, with the objective to test the alternative hypothesis that, regarding hostility, there were significant differences between these groups. The mean age in the group of TMD/bruxers was 31.81 years (SD: 11.2, range 14-61) and in the control group was 30.03 (SD: 10.96, range 16-66). Patients were initially classified as presenting TMD and bruxing behavior according to previous criteria. The Cook-Medley Inventory and the Beck Depression Inventory were used to assess levels of hostility and depression, respectively, in bruxers and controls. There were no statistically significant differences in the levels of depression between the three groups of bruxers. However, the difference between the groups of bruxers and controls reached significance (unpaired t test P<0.001). Our results indicated that there was not statistically and significant difference in the levels of hostility between the three groups of bruxers and between the mild group of bruxers and control group. However, there were statistically and significant differences in the level of hostility between the moderate group of bruxers and the control group (P<0.01), and between the severe group of bruxers and the control group (P<0.05). When bruxers were classified into two groups: one presenting minimal to mild depression (N:31) and the other presenting moderate to severe depression (N:19), the group presenting moderate to severe depression demonstrated a level of hostility of about 23.36. The group presenting minimal to mild depression demonstrated a level of hostility of about 17.32, and this difference was statistically significant (unpaired t test, P<0.0004). These results suggest that in these subgroups of TMD/bruxers, increased depression corresponds to increased hostility and provides support for previous investigations indicating that there is a relationship between hostility and bruxism (but only in the groups with moderate and severe bruxism).

Estudio de mercado de la fuerza laboral del sector salud / Market study of the work force of the health sector

En este documento se pone a disposición del personal de salud, de los investigadores y del público en general, el resultado de un estudio sobre la estructura y composición del mercado laboral directamente relacionado con el fomento y el cuidado de la salud boliviana.

Estudio de mercado de la fuerza laboral del sector salud / I study of market of the labor force of the sector health

Contiene: Introduccion; justificacion; antecedentes; objetivos; objetivo general; objetivos especificos; resultados esperados, disponibilidad de RR.HH formacion de RR.HH situacion actual de los RR.HH en el sector salud; sistema de regulalcion laboral y profesional en el sector salud; organizaciones de profesionales en salud, conflictos y negociaciones colectivas; metodologia, tipo de estudio; ambito de estudio; universo; unidades de investigacion; marco teorico; observatorio de RR.HH gestion de RR.HH; mercado laboral; impacto de las reformas sectoriales en salud, la reforma de salud en Bolivia; resultado de estudio, disponibilidad de RR.HH formacion de RR.HH situacion actual de RR.HH en el mercado; sistema de regulacion laboral y profesional en el sector salud; organizaciones de profesionales y trabajajdores en salud; conflictos y negociaciones colectivas; conclusiones, referencias bibliograficas; anexos