Salivary immunoglobulin levels and periodontal indices in Brazilian children with and without type 1 diabetes.

This cross-sectional study evaluated the association between salivary immunoglobulins, plaque index, and gingival index in Brazilian children with and without type 1 diabetes mellitus (DM1). The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for the reporting of observational studies was followed. The DM1 group had 38 children, and an equal number of volunteers matched by sex and age were recruited as controls. Clinical examination was performed for plaque index and gingival index determination. Non-stimulated whole saliva was collected. Concentrations of IgA, IgG, and IgM were determined by ELISA test. Data were tested by the Kolmogorov-Smirnov, Mann-Whitney, and Spearman tests and a multiple linear regression model (p<0.05) was performed. Gingival index was higher in the Control (DM1: 0.16±0.17; Control: 0.24±0.23, p=0.040). In DM1, there was a correlation between IgA and age (rho=0.371, p=0.024), IgM and IgG (rho=0.459, p=0.007), and IgM and gingival index (rho=0.394, p=0.014). In DM1, multiple linear regression showed that age (p=0.041; ß=0.363), gingival index (p=0.041; ß=0.398), and plaque index (p=0.008; ß=-0.506) were good predictors of IgA levels in saliva. Thus, IgA was the only researched immunoglobulin that was directly associated with plaque and gingival indices in Brazilian children with DM1, but not in control subjects.

Infrared spectroscopy for fast screening of diabetes and periodontitis.

SIGNIFICANCE: FT-IR is an important and emerging tool, providing information related to the biochemical composition of biofluids. It is important to demonstrate that there is an efficacy in separating healthy and diseased groups, helping to establish FT-IR uses as fast screening tool. AIM: Via saliva diagnosis evaluate the accuracy of FT-IR associate with machine learning model for classification among healthy (control group), diabetic (D) and periodontitis (P) patients and the association of both diseases (DP). APPROACH: Eighty patients diagnosed with diabetes and periodontitis through conventional methods were recruited and allocated in one of the four groups. Saliva samples were collected from participants of each group (n = 20) and were processed using Bruker Alpha II spectrometer in a FT-IR spectral fingerprint region between 600 and-1800 cm-1, followed by data preprocessing and analysis using machine learning tools. RESULTS: Various FTI-R peaks were detectable and attributed to specific vibrational modes, which were classified based on confusion matrices showed in paired groups. The highest true positive rates (TPR) appeared between groups C vs D (93.5 % ± 2.7 %), groups C vs. DP (89.2 % ± 4.1 %), and groups D and P (90.4 % ± 3.2 %). However, P vs DP presented higher TPR for DP (84.1 % ±3.1 %) while D vs. DP the highest rate for DP was 81.7 % ± 4.3 %. Analyzing all groups together, the TPR decreased. CONCLUSION: The system used is portable and robust and can be widely used in clinical environments and hospitals as a new diagnostic technique. Studies in our groups are being conducted to solidify and expand data analysis methods with friendly language for healthcare professionals. It was possible to classify healthy patients in a range of 78-93 % of accuracy. Range over 80 % of accuracy between periodontitis and diabetes were observed. A general classification model with lower TPR instead of a pairwise classification would only have advantages in scenarios where no prior patient information is available regarding diabetes and periodontitis status.

Repercussões da pandemia de Covid-19 na alimentação, no estilo de vida e no cuidado com a saúde bucal em uma população pediátrica Brasileira / Repercussions of the Covid-19 pandemic on food, lifestyle, and oral health care in a Brazilian pediatric population

Objetivo: avaliar o impacto da pandemia de COVID-19 durante o isolamento mais rígido (lockdown) nos hábitos alimentares, no estilo de vida e na higiene bucal de crianças atendidas na clínica de Odontopediatria do Curso de Odontologia da Universidade Federal do Ceará. Métodos: foi realizado um estudo observacional transversal, em que foram entrevistados 50 pais e/ou responsáveis legais de crianças de 3-9 anos de idade. O questionário aplicado, composto por 47 questões, incluiu a versão traduzida em português do Brasil do Índice de Qualidade da Dieta Mediterrânea em Crianças e Adolescentes (KIDMED). Os dados foram tabulados no Microsoft Excel® e exportados para o software SPSS versão 20.0. Após categorização, as análises foram realizadas, utilizando os testes de Qui-quadrado de Pearson ou Exato de Fisher (p<0,05) e expressos em forma de frequência absoluta e percentual. Resultados: durante o lockdown, as crianças apresentaram altas porcentagens para consumo de açúcares fermentados (37; 74,0%), sedentarismo (36; 72,0%) e cuidados adequados com a higiene oral, incluindo uso de dentifrício fluoretado (49; 98,9%) e escovação noturna (41; 82,0%). Ademais, observou-se manutenção/aumento da variação do número de refeições estatisticamente significativo para as crianças que aumentaram a ingestão de alimentos açucarados (p=0,003) e tornaram-se sedentárias (p=0,022). Conclusões: apesar da dieta mais açucarada durante o lockdown, sugere-se um controle do risco de cárie, visto que a maioria das crianças manteve bons hábitos de higiene oral. Entretanto, tais hábitos alimentares aliados ao sedentarismo expõem o indivíduo ao risco de condições sistêmicas importantes, como obesidade e diabetes tipo 2.

Objective: to evaluate the impact of the COVID-19 pandemic during the stricter isolation (lockdown) on eating habits, lifestyle, and oral hygiene of children treated at the Pediatric Dentistry clinic of the Dentistry course at the Federal University of Ceará. Methods: a cross-sectional observational study was carried out, in which 50 parents and/or legal guardians of children aged 3-9 years were interviewed. The applied questionnaire consisting of 56 questions included the Brazilian Portuguese version of the Quality Index of the Mediterranean Diet in Children and Adolescents (KIDMED). Data were tabulated in Microsoft Excel® and exported to SPSS version 20.0 software. After categorization, analyzes were performed using Pearson's Chi-square or Fisher's exact tests (p<0.05) and expressed as absolute and percentage frequencies. Results: children showed a high percentage of consumption of fermented sugars (37; 74.0%), a sedentary lifestyle (36; 72.0%), and adequate care with oral hygiene, including the use of fluoride toothpaste (49; 98.9%), and night brushing (41; 82.0%) during the lockdown. Furthermore, a statistically significant maintenance/increase in the variation in the number of meals was observed for children who increased their intake of sugary foods (p=0.003) and became sedentary (p=0.022). Conclusions: despite the sugary diet during the lockdown, control of the risk of caries is suggested since most children maintained good oral hygiene habits. However, such eating habits combined with a sedentary lifestyle expose the individual to the risk of important systemic conditions, such as obesity and type 2 diabetes.

Dental treatment before surgery in a patient with cleft lip and palate: case report / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Introduction: orofacial clefts are common congenital malformations with an important social, psychological, and economic impact. The treatment of this condition may include different surgical procedures that previously require an adequate oral condition. Case report: we report a case of dental treatment before palatoplasty in a male patient of 17 years-old with bilateral cleft lip and palate and lesion in the jugal mucosa. Final considerations: the adequacy of the oral environment is a fundamental step in the treatment of patients with orofacial clefts and aims to restore oral health regardless of the degree of complexity of the dental treatment through the reduction of the pathogenic microbiota, elimination of retentive niches, instructions on diet and adequate oral hygiene and constant patient motivation.

Objetivos: as fissuras orofaciais são malformações congênitas comuns, com importante impacto social, psicológico e econômico. O tratamento dessa condição pode incluir vários procedimentos cirúrgicos que requerem previamente uma adequada condição bucal. Relato de caso: Relatamos o caso de tratamento odontológico prévio a palatoplastia em um paciente do gênero masculino de 17 anos de idade, com fissura transforame incisivo bilateral e lesão em mucosa jugal. Considerações finais: A adequação do meio bucal é uma etapa fundamental no tratamento de pacientes com fissuras orofaciais e visa restabelecer a saúde bucal independente do grau de complexidade do tratamento odontológico por meio da redução da microbiota patogênica, eliminação de nichos retentivos, orientações sobre dieta e higiene bucal adequada e motivação constante do paciente.

Severe polyhydramnios as neonatal presentation of Bartter's syndrome type IV / Polihidrâmnios grave como manifestação neonatal da síndrome de Bartter tipo IV

Abstract Introduction: Bartter's syndrome comprises a heterogeneous group of inherited salt-losing tubulopathies. There are two forms of clinical presentation: classical and neonatal, the most severe type. Types I and II account for most of the neonatal cases. Types III and V are usually less severe. Characteristically Bartter's syndrome type IV is a saltlosing nephropathy with mild to severe neonatal symptoms, with a specific feature - sensorineural deafness. Bartter's syndrome type IV is the least common of all recessive types of the disease. Description: the first reported case of a Portuguese child with neurosensorial deafness, polyuria, polydipsia and failure to thrive, born prematurely due to severe polyhydramnios, with the G47R mutation in the BSND gene that causes Bartter's syndrome type IV. Discussion: there are few published cases of BS type IV due to this mutation and those reported mostly have moderate clinical manifestations which begin later in life. The poor phenotype-genotype relationship combined with the rarity of this syndrome usually precludes an antenatal diagnosis. In the presence of a severe polyhydramnios case, with no fetal malformation detected, normal karyotype and after maternal disease exclusion, autosomal recessive diseases, including tubulopathies, should always be suspected.

Resumo Introdução: a síndrome de Bartter inclui um grupo heterogéneo de tubulopatias hereditárias perdedoras de sal. Existem duas formas de apresentação clínica: clássica e neonatal, a forma mais grave. Os tipo I e II representam a maioria dos casos neonatais. Os tipos III e V são geralmente menos graves. Caracteristicamente, a síndrome de Bartter tipo IV é uma nefropatia perdedora de sal com sintomas neonatais ligeiros a graves, com um aspeto especí- fico - surdez neurossensorial. A síndrome de Bartter tipo IV é o tipo menos comum das formas recessivas da doença. Descrição: relatamos o primeiro caso de uma criança portuguesa, com surdez neurossensorial, poliúria, polidipsia e restrição de crescimento, nascida prematuramente devido a polihidrâmnios grave, homozigótica para a mutação G47R do gene BSND, responsável pela síndrome de Bartter tipo IV. Discussão: são raros os casos publicados sobre síndrome de Bartter tipo IV atribuída a esta mutação, e a maioria referem-se a diagnósticos mais tardios, com manifestações clínicas ligeiras. A fraca correlação fenótipo-genótipo combinada com a raridade desta síndrome tornam o diagnóstico pré-natal desafiante. Perante um caso de polihidrâmnios grave em um feto sem malformações aparentes, cariótipo normal e após exclusão de patologia materna, as doenças autossómicas recessivas, incluindo as tubulopatias, devem ser sempre consideradas.

Bruxism in children and adolescents with cerebral palsy / Bruxismo em crianças e adolescentes com paralisia cerebral

This study aims to summarize the existing evidence from primary studies in order to answer the following question: "are children and adolescents with cerebral palsy (CP) frequently affected by bruxism?". For such, databases Web of Science, Medline (via PubMed), Lilacs, SciELO, Scopus and Wiley Online Library were used, with the keywords "Cerebral Palsy" and "Bruxism" alone and in combination, without the restriction of the publication date. The search included all articles published until May 2020. A total of 229 publications were found, of which 12 were selected, after careful analysis. Retrospective data analyses, cross-sectional studies and observational casecontrol studies published in English and with samples composed of children and/or adolescents were included. Case reports, literature reviews and studies whose sample consisted of adults-only were excluded. In the evaluated studies, bruxism was present in all samples with cerebral palsy. However, oral signs and symptoms resulting from this parafunction were reported only in three studies, in which the presence of dental wear and pain was evaluated. Therefore, bruxism in children and adolescents with cerebral palsy is a frequent oral condition, however, knowledge about the associated and risk factors for the occurrence of this problem in these patients remains limited.

Esse estudo tem como objetivo resumir as evidências existentes de estudos primários, a fim responder à seguinte questão: "crianças e adolescentes com paralisia cerebral (PC) são frequentemente afetados pelo bruxismo?". Para tal, foram realizadas buscas nas bases de dados Web of Science, Medline (via PubMed), Lilacs, SciELO, Scopus and Wiley Online Library, utilizando os descritores "Paralisia Cerebral" e "Bruxismo" em inglês, e de forma associada, sem que houvesse delimitação de intervalo de tempo. A busca incluiu todos os artigos publicados até maio de 2020. Foi encontrado um total de 229 publicações, das quais foram selecionadas 12, após análise criteriosa das mesmas. Foram incluídas análises retrospectivas de dados, estudos transversais e estudos observacionais de caso-controle publicados em inglês e com amostras compostas por crianças e/ou adolescentes. Foram excluídos os relatos de casos, as revisões de literatura e os estudos cuja amostra era composta apenas por adultos. Nos estudos avaliados, o bruxismo esteve presente em todas as amostras com paralisia cerebral. Contudo, sinais e sintomas orais, decorrentes dessa para função foram relatados apenas em três estudos, nos quais se avaliou presença de desgastes dentários e dor. Assim sendo, o bruxismo em crianças e adolescentes com paralisia cerebral é uma condição oral frequente, no entanto, o conhecimento sobre os fatores associados e os fatores de risco para a ocorrência desse problema nesses pacientes permanece limitado.

Salivary immunoglobulins (A, G, and M) in type 1 diabetes mellitus patients: A PROSPERO-registered systematic review and meta-analysis.

OBJECTIVE: To assess the difference in the salivary levels of immunoglobulins between patients with type 1 diabetes mellitus (DM1) and healthy controls. DESIGN: This systematic review was registered on the PROSPERO (CRD42020159198) database. All references were cross-checked and the risk of bias assessment was conducted using the Newcastle-Ottawa Scale. The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach was used to appraise the quality of evidence. The standardized mean difference and Cohen's d as the effect size were used in the meta-analysis. I-square statistics was used to estimate heterogeneity. Analysis was performed using the RevMan® software (p < 0.05) with a 95 % confidence interval. RESULTS: Of the total 92 articles, 9 were selected for this study. The meta-analysis included 333 DM1 patients and 325 healthy controls. DM1 patients showed a significant reduction in salivary flow (p = 0.0008; Cohen's d= -0.19, CI 95 %= -0.33, -0.05), although not significant enough to modify the IgA concentration (p = 0.120; Cohen's d = 0.58, CI 95 %= -0.15, 1.32). However, DM1 increased IgA concentration by reducing salivary flow (Cohen's d = 0.84; CI 95 % = 0.36, 1.32), with a strong estimate of effect (p = 0.0006). Regarding IgG, no significant change was noted with DM1 in the patient's saliva (p = 0.420). Furthermore, there was no significant variation in the salivary IgM levels (p = 0.300). CONCLUSIONS: The data suggest that the salivary levels of the evaluated immunoglobulins do not seem to be altered in DM1 patients when compared to that in healthy controls. However, the increase in IgA salivary concentration was dependent on total protein estimation.

Alterações do perfil ocupacional da população em situação de sem-abrigo na cidade de Leiria / Changes in the occupational profile of the homeless population at the city of Leiria

Introdução:O conceito de pessoa em situação de rua, também designado por pessoa em situação de sem-abrigo, representa qualquer indivíduo que esteja destituído de uma habitação e privado dos bens essenciais. Isto acarreta problemas a nível físico, psicossocial e emocional, podendo alterar os hábitos, rotinas e papéis destes indivíduos. Objetivo: Conhecer e descrever as alterações do perfil de saúde, em concreto do perfil ocupacional, da população em situação de sem-abrigo na cidade de Leiria, antes e na atual situação. Métodos: Estudo de caso descritivo, de abordagem qualitativa, com recurso à recolha de dados por entrevista semiestruturada. A análise de conteúdo foi efetuada por meio do software webQDA de apoio à análise de dados qualitativos num ambiente colaborativo e distribuído. Amostra: Quatro indivíduos na situação de sem-abrigo residentes na cidade de Leiria, agregados ao Centro de Acolhimento de Leiria. Resultados/Conclusão: São identificadas alterações de Papéis e Contextos e Ambientes nos indivíduos em situação de sem-abrigo, onde se destacam a perda de papéis sociais e de relações familiares, as condições habitacionais precárias e o recurso continuado a apoios sociais. Sobrepõe-se a destruturação das rotinas o que conduz ao desequilíbrio ocupacional

Introduction: The homeless person concept represents any individual who is deprived of a habitation and essential needs. These facts increase physical, psychosocial and emotional problems and may modify the habits, the routines and the roles of these individuals. Objective: To know and describe the changes in the occupational profile of the homeless population in the city of Leiria, before and in the current situation. Methods: Descriptive case study, with a qualitative approach, using data collection by semi-structured interview. Content analysis was performed using webQDA software to support qualitative data analysis in a collaborative and distributed environment.Sample: Four homeless people, residents in the city of Leiria, added to the Centro de Acolhimento de Leiria. Results/Conclusion: Changes in Roles and Contexts/Environments are identified in homeless individuals, in which the loss of social roles and family relationships, poor housing conditions and continued use of social support are highlighted. It overlaps the