Effect of Mobilization with Movement on Pain, Disability, and Range of Motion in Patients with Shoulder Pain and Movement Impairment: A Systematic Review and Meta-Analysis.

BACKGROUND: Shoulder pain is a disabling musculoskeletal disorder worldwide. Thus, it is important to identify interventions able to improve pain and disability. OBJECTIVE: To investigate the effects of mobilization with movement (MWM) on pain, disability, and range of motion in patients with shoulder pain and movement impairment. METHODS: A systematic search of different databases was performed. The systematic review protocol has been registered in PROSPERO (CRD42023404128). A random-effects model for meta-analysis was used to determine the mean difference (MD), standardized mean differences (SMD), and 95% confidence interval for the outcome of interest. RESULTS: Twenty-six studies were included. Of these, eighteen were included in the meta-analysis. MWM improved pain during movement with a moderate effect SMD of (-0.6; 95% confidence interval, -1.1 to -0.1, I2 = 0%; N = 66;) and shoulder abduction MD of (12.7°; 1.3 to 24.0; I2 = 73%; N = 90) compared to sham MWM in the short term (0-6 weeks). Combined MWM and conventional rehabilitation improved pain at rest, with a MD of (-1.2; -2.2 to -0.2; I2 = 61%; N = 100), and disability SMD of (-1.3; confidence interval -2.2 to -0.4; I2 = 87%; N = 185) compared to conventional rehabilitation alone in the short term. Combined MWM and conventional rehabilitation also resulted in improvement in shoulder abduction and external rotation. Compared to Maitland, MWM resulted in improvement in the shoulder abduction MD (20.4°; confidence interval 4.3 to 36.5; I2 = 89%; N = 130) in the short term. There is no information regarding long-term effects. CONCLUSION: Evidence suggests that MWM may reduce shoulder pain and restore shoulder range of motion and function. Our findings are promising, but the evidence is not strong enough to recommend it pragmatically.

Canine squamous cell carcinoma: Electrochemotherapy association with surgery and correlation with overall survival.

Squamous cell carcinoma (SCC) is an important malignancy in dogs, due to its incidence and clinical presentation, which can be of locally aggressive single or multiple lesions with a metastatic potential. The objective of this investigation was to evaluate SCC response to treatment, anatomopathological and immunohistochemical characteristics, disease-free interval and overall survival time. 54 dogs with histopathologically diagnosed SCC were included in this study. Their mean age was 9.16 years with a range of 1-14 years. Of the 54 animals in the study, 34 (65.4%) had white skin and white fur coats. There was a significant correlation between fur coat colour and the development of tumours in areas of sun exposure (p = .001). Animals with tumours in areas of the body exposed to the sun had longer overall survival time than animals with tumours in areas not associated with sun exposure (p = .001). Surgery combined with electrochemotherapy (ECT) yielded a survival rate 32% higher than using a surgical approach alone (HR = 0.32, p = .038, IC = 0.11-0.94). ECT, with or without surgery, had an objective response rate of 90.9%. Local lymph node and/or distant site metastasis at diagnosis, or at some point during follow-up, occurred in 34.6% (18/52) of animals. Animals with tumours in sun exposed locations had more aggressive histopathological characteristics but had longer overall survival time. This is probably due to individualised therapeutic treatment with both surgery and ECT.

Hacia el diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México.

OBJETIVO: Describir el proceso de diseño de Vida Saludable, un nuevo programa de estudios para la educación básica en México. Material y métodos. Se conformó un equipo de trabajo entre especialistas en salud y la Secretaría de Educación Pública. Se establecieron las bases científicas de Vida Saludable, se seleccionaron y evaluaron materiales para Vida Saludable, y se revisaron contenidos vigentes de salud incluidos en otras asignaturas. RESULTADOS: Alimentación, actividad física e higiene y limpieza fueron definidos como los tres ejes temáticos para Vida Saludable. Se aprobaron 3 de 228 insumos para usarse en Vida Saludable y 71.7% de los con-tenidos vigentes en educación básica sobre salud requieren ediciones. CONCLUSIONES: Vida Saludable es un parteaguas hacia la alfabetización en materia de salud en educación básica en México, que se alinea con la agenda global para preservar la salud humana y planetaria.

Analysis of the Degree of Information of Dental Surgeons about Antiresorptive Drugs According to the Time Since Graduation in Dentistry

ABSTRACT Objective: To determine the level of scientific information of dental surgeons who carry out their professional activities in Brazil about antiresorptive drugs and indicated pharmacological procedures aiming at the prevention of osteonecrosis of the jaws and the therapy of drug sequelae that may occur, considering the time since graduation in Dentistry. Material and Methods: This is a quantitative cross-sectional study in which 339 dentists were consulted using the virtual questionnaire containing topics of personal nature, elements contained in the anamnesis carried out and knowledge about antiresorptive drugs, including indications, adverse effects and treatments applied. Chi-square and Fisher's exact tests were performed to analyze associations of data described by absolute and relative frequencies with professionals' time since graduation. All analyses were performed using the R software, with a 5% significance level. Results: Those who revealed to have graduated for more than five years with the highest academic degree were those who demonstrated maximum knowledge of antiresorptive drugs or revealed that, somehow, they had information about them (p<0.05). Conclusion: Dental surgeons in Brazil who have more than five years since graduation have more scientific information about antiresorptive drugs and pharmacological procedures, which can positively contribute to the prevention of osteonecrosis of the jaws and treatment of drug sequelae that may occur.

Severe Quantitative Scale of Acanthosis Nigricans in Neck is Associated with Abdominal Obesity, HOMA-IR, and Hyperlipidemia in Obese Children from Mexico City: A Cross-Sectional Study.

Background: Acanthosis nigricans (AN) is a clinical sign that commonly occurs in obesity; however, its specificity and sensitivity have been controversial. It is unknown if AN severity degree can be a useful marker for cardiometabolic disorders screening. We suggest that the stratified analysis of AN severity degree in neck by Burke's scale could be a useful tool in the screening of cardiometabolic alterations in obese children. Objective: The aim of this study was the association of AN severity degree in neck by Burke's scale with anthropometric, biochemical, and inflammatory parameters in obese school-age children from Mexico City. Methods: A cross-sectional study was conducted, including 95 obese school-age children stratified by AN severity degree in neck by Burke's scale. Anthropometric and fasting biochemical measurements were determined. Variables were compared by x 2 test for frequencies and one-way ANOVA with Bonferroni posttest for continuous variables. Linear regression analysis adjusted by gender, BMI, and age was performed to evaluate the association between AN severity degree and cardiometabolic alterations. Statistical significance was set at p < 0.05. Results: As AN severity degree in neck by Burke's scale increased, diastolic blood pressure (p=0.001) and triglycerides (p=0.02) significantly increased and adiponectin significantly decreased (p=0.02). Positive associations between grade 3 AN and waist circumference, HOMA-IR, triglycerides, total cholesterol, and LDL cholesterol were observed. Conclusion: Our findings could be used to identify an easier clinical tool to prevent obesity progression and its complications in pediatrics. There are no similar studies.

Correlation Between Clinical and Pathological Findings of Liver Injury in 27 Patients With Lethal COVID-19 Infections in Brazil.

Liver test abnormalities are frequently observed in patients with coronavirus disease 2019 (COVID-19) and are associated with worse prognosis. However, information is limited about pathological changes in the liver in this infection, so the mechanism of liver injury is unclear. Here we describe liver histopathology and clinical correlates of 27 patients who died of COVID-19 in Manaus, Brazil. There was a high prevalence of liver injury (elevated alanine aminotransferase and aspartate aminotransferase in 44% and 48% of patients, respectively) in these patients. Histological analysis showed sinusoidal congestion and ischemic necrosis in more than 85% of the cases, but these appeared to be secondary to systemic rather than intrahepatic thrombotic events, as only 14% and 22% of samples were positive for CD61 (marker of platelet activation) and C4d (activated complement factor), respectively. Furthermore, the extent of these vascular findings did not correlate with the extent of transaminase elevations. Steatosis was present in 63% of patients, and portal inflammation was present in 52%. In most cases, hepatocytes expressed angiotensin-converting enzyme 2 (ACE2), which is responsible for binding and entry of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), even though this ectoenzyme was minimally expressed on hepatocytes in normal controls. However, SARS-CoV-2 staining was not observed. Most hepatocytes also expressed inositol 1,4,5-triphosphate receptor 3 (ITPR3), a calcium channel that becomes expressed in acute liver injury. Conclusion: The hepatocellular injury that commonly occurs in patients with severe COVID-19 is not due to the vascular events that contribute to pulmonary or cardiac damage. However, new expression of ACE2 and ITPR3 with concomitant inflammation and steatosis suggests that liver injury may result from inflammation, metabolic abnormalities, and perhaps direct viral injury.

Primary Antiphospholipid Syndrome with Livedo Reticularis is Linked to Female Sex and Stroke and Negatively Associated with Thyroid Disease.

AIMS: To study the clinical and laboratory findings between patients with primary Antiphospholipid Syndrome (pAPS) with and without LR. BACKGROUND: Livedo Reticularis (LR) is a common manifestation of Antiphospholipid Syndrome (APS). Although no previous study evaluated patients with and without LR. METHODS: A transversal study including 66 pAPS patients was performed. Demographical, anthropometric, medication use, antiphospholipid antibodies profile data were evaluated, and LR's clinical and laboratory features. Patients were subdivided into one of two groups: pAPS with LR and pAPS without LR. RESULTS: Both groups were alike concerning demographics and anthropometrics. Interestingly, the frequency of stroke (28.5 vs. 7.5%, p=0.04), as well as of Sneddon's syndrome (100 vs. 30.0%, p<0.0001), were higher in pAPS with LR than the other group. Conversely, patients in the pAPS without LR group had more thyroidopathy than those in the pAPS with LR group (80% vs. 50% %, p=0.03). CONCLUSION: Patients with pAPS and LR have more stroke and seem to be protected from thyroidopathy. Careful follow-up of these patients is therefore advised.

Activity of antifungal drugs and Brazilian red and green propolis extracted with different methodologies against oral isolates of Candida spp.

BACKGROUND: Oral candidiasis is an opportunistic disease caused by fungi of the Candida genus. The occurrence of Candida spp. resistance to the commercial antifungal drugs points to the search for alternative treatments. Propolis has been successfully used in the treatment of infectious diseases for centuries. It has been proposed that an ultrasound pretreatment in the propolis extraction protocol can enhance the concentrations of molecules with antimicrobial activities in the final extract. Thus, this study aimed to compare the antifungal activity against oral Candida spp. isolates of green and red propolis extracts submitted or not to an ultrasound pretreatment before the extraction procedure. METHODS: Candida spp. were isolated from denture stomatitis lesions and identified by sequencing. Oral Candida spp. isolates and reference strains were submitted to broth microdilution assays using commercial antifungals and Brazilian green and red propolis extracts submitted or not to an ultrasound pretreatment. Minimal Inhibitory Concentrations (MIC) and Minimal Fungicide Concentrations (MFC) were determined and biofilm formation interference was evaluated for resistant isolates. RESULTS: C. albicans, Candida tropicalis and Candida dubliniensis were isolated from denture stomatitis lesions. Growth inhibition was observed in all Candida isolates incubated with all green and red propolis extracts. At lower doses, red propolis extracts presented significant antifungal activity. The ultrasound pretreatment did not promote an increase in the antifungal activity of green or red propolis. Three isolates, which were highly resistant to fluconazole and itraconazole, were susceptible to low doses of red propolis extracts. These same three specimens had their biofilm formation inhibted by red propolis ethanolic extract. CONCLUSIONS: Thus, red propolis can be faced as a promising natural product to be used in the auxiliary antifungal therapy of denture stomatitis.

Factors related to the performance of elderly people in temporal ordering tests. / Fatores associados ao desempenho de idosos nos testes de ordenação temporal.

PURPOSE: To describe the performance of elderly individuals in Pitch Pattern Sequence (PPS) and Duration Pattern Sequence (DPS) tests and research related factors. METHODS: An observational, cross-sectional study conducted with elderly people aged 60 to 79 years. The participants underwent cognitive screening tests, interviews containing socio-demographic data and general health, as well as audiologic evaluation and temporal auditory processing (PPS and DPS) evaluation tests. A descriptive analysis of the association between the performance in temporal processing and the variables gender, age, level of education and audiometric alterations was conducted through multiple linear regression. RESULTS: 86 elderly people participated in the study, most of them female, with ages between 60 and 69. Male participants performed better in both tests as well as the participants with higher education, whereas no difference in performance was observed across the different age ranges. In the DPS, the participants with auditory alteration performed worse in relation to the ones with average frequencies of 0.5 to 4 kHz. CONCLUSION: The male gender and higher level of education were associated with better results in the temporal ordering tests, whereas auditory alteration was associated with worse performance only in the pitch pattern sequence test.

OBJETIVO: Investigar os fatores associados e descrever o desempenho no teste padrão de frequência e teste padrão de duração em idosos. MÉTODO: Estudo observacional, seccional, conduzido com idosos de 60 a 79 anos. Os participantes realizaram teste de rastreio cognitivo, entrevista contendo dados sociodemográficos e de saúde geral, avaliação audiológica e testes de avaliação do processamento auditivo temporal (padrão de frequência e padrão de duração). Foi conduzida análise descritiva da associação entre o desempenho nos testes de processamento temporal e as variáveis: sexo, idade, nível de escolaridade e alterações audiométricas, por meio da regressão linear múltipla. RESULTADOS: Participaram do estudo 86 idosos, sendo a maioria do sexo feminino, com idade entre 60 e 69 anos. O desempenho para ambos os testes foi melhor nos homens e nos idosos com maior nível de escolaridade e similar nas diferentes faixas etárias. No teste padrão de frequência, idosos com alteração auditiva apresentaram pior desempenho do que aqueles com média nas frequências de 0.5 a 4 kHz normal. CONCLUSÃO: O sexo masculino e maior nível de escolaridade estão associados ao melhor desempenho nos testes de ordenação temporal, enquanto a alteração audiométrica apresenta associação com o pior desempenho apenas no teste padrão de frequência.

Osteonecrosis in Primary Antiphospholipid Syndrome is Associated with Previous Glucocorticoid Use and Thrombocytopenia.

INTRODUCTION: The aim of this study was to investigate the frequency of avascular necrosis (AVN) and its associations with clinical and laboratory parameters in patients with primary antiphospholipid antibody syndrome (pAPS). METHODS: This was a cross-sectional study of 66 patients with pAPS who fulfilled the Sidney criteria for APS. Epidemiological and clinical data, and data on antiphospholipid antibodies were collected. Diagnosis of AVN was based on studies of magnetic resonance (MRI) images of affected bones. RESULTS: AVN was found in three of the 66 (4.5%) enrolled patients. Comparison of patients with pAPS with and without AVN showed that demographic data, comorbidities, and antiphospholipid antibodies profile were similar in both groups. Compared to patients without AVN, those with AVN had thrombocytopenia more frequently (66.7 vs. 7.9%) and used more glucocorticoids (100 vs. 35%). CONCLUSION: AVN is rare in patients with pAPS and may be associated with thrombocytopenia and previous glucocorticoid use.

Bone regeneration using Wollastonite/ß-TCP scaffolds implants in critical bone defect in rat calvaria.

In order to provide favorable conditions for bone regeneration, a lot of biomaterials have been developed and evaluated, worldwide. Composite biomaterials have gained notoriety, as they combine desirable properties of each isolated material. Thus, in this research, bone repair capacity of three developed formulations of ceramic scaffolds were evaluated histomorphometrically, after implantation. Scaffolds were based on wollastonite (W) andß-tricalcium phosphate (ß-TCP) composites in three different ratios (wt.%). ThirtyWistarrats were randomly assigned to three experimental groups: W-20 (20 W/80ß-TCP wt.%), W-60 (60 W/40ß-TCP wt.%), and W-80 (80 W/20ß-TCP wt.%), evaluated by optical microscopy at biological tests after 15 and 45 days of implantation. Throughout the study, the histological results evidenced that the scaffolds remained at the implantation site, were biocompatible and presented osteogenic potential. The percentage of neoformed mineralized tissue was more evident in the W-20 group (51%), at 45 days. The composite of the W-80 group showed more evident biodegradation than the biomaterials of the W-20 and W-60 groups. Thus, it is concluded that the scaffold containing 20 W/80ß-TCP (wt.%) promoted more evident bone formation, but all composites evaluated in this study showed notorious bioactivity and promising characteristics for clinical application.

Comparative Analysis of Continuous versus Reciprocating Instruments in Retreatment of Flat-oval Root Canals.

Introduction: Flat-oval root canals of incisors can be problematic in retreatments. This study assessed the efficacy of continuous and reciprocating rotation instruments in retreatment of flat-oval root canals in lower incisors via micro-computed tomography (micro-CT). File systems studied were ProTaper universal retreatment rotary system associated with ProTaper Next (PTUR+PTN), D-RaCe associated with iRaCe (DR+iR), Reciproc (REC), and WaveOne (WO). Materials and Methods: Thirty-two mandibular incisors with flat root canal were divided into 4 groups (n=8). The groups were initially prepared with PTN, iRaCe, REC, and WO, then instrumented, filled, and subjected to micro-CT analyses. All the canals were then retreated with the PTUR+PTN, DR+iR, REC, and WO, and then subjected to new micro-CT analysis which allowed quantification of residual filling material volume and change in the diameter of the root canal apical third. Endodontic retreatment time was also quantified. Data were analyzed with One-Way ANOVA and post hoc t tests. Results: None of the systems completely removed the filling material. The groups differed in terms of remnant filling material volume (PTUR+PTN=2.9±1.1 mm3; DR+iR=3.6±3.1 mm3; REC=4.9±1.9 mm3; WO=3.1±1.9 mm3) and retreatment time (PTUR+PTN=1:36±0:12 sec; DR+iR=0:57±0:13 sec; REC=2:10±0:44 sec; WO=2:03±0:31 sec), but had similar values in terms of change in apical root canal diameter (P>0.05). Conclusions: Based on this in vitro study, the type of endodontic instrument did not affect the diameter of the root canal apical third. However, PTUR with ProTaper Next had the lowest residual filling material volume and second lowest retreatment time, in flat-oval root canals in mandibular incisors.

NUMBER OF CASES OF VARICELLA AND HOSPITALIZATION IN A PEDIATRIC REFERENCE HOSPITAL IN BRAZIL AFTER INTRODUCING THE VACCINE.

OBJECTIVE: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. METHODS: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. RESULTS: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. CONCLUSIONS: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

Number of cases of varicella and hospitalization in a pediatric reference hospital in brazil after introducing the vaccine / Avaliação do número de casos e do perfil de internações por varicela em hospital pediátrico após a introdução da vacina

ABSTRACT Objective: To assess the number of cases and the profile of hospitalizations from varicella after the introduction of the measles, mumps, rubella and varicella combination vaccine in the public health system. Methods: Retrospective study in an infectious diseases pediatric hospital of reference in Southeast Brazil. The cases with a clinical diagnosis of varicella, from January 2011 to June 2016, were assessed from pediatricians' medical records. The hospitalizations were classified into a pre-vaccine group and post-vaccine group, based on the date the vaccine was introduced (September 2013). Both groups were compared by age, sex, time of hospitalization, reason for hospitalization, hospital complications, duration of intensive care, and clinical outcome. Results: A total of 830 hospitalizations were recorded; 543 in the pre-vaccine period and 287 in the post-vaccine period, a reduction of 47.1% (p<0.001). In both periods, a similar profile in the hospitalizations was noticed: majority male; aged between one to five years old; most complications due to secondary causes (mainly skin infections); main outcome was clinical improvement and discharge from the hospital. In the pre-vaccine period, six deaths were recorded and two were recorded in the post-vaccine period. Conclusions: The profile of the hospitalizations was expected to stay the same since this study did not compare vaccinated with unvaccinated children, but hospitalizations before and after the vaccine was introduced. In accordance with the medical literature, we found a significant fall in the number of hospitalizations from varicella.

RESUMO Objetivo: Avaliar o número de casos e o perfil das internações por varicela após a introdução da vacina quádrupla viral na rede pública. Métodos: Estudo retrospectivo conduzido em hospital pediátrico referência em doenças infectocontagiosas na Região Sudeste do Brasil. Foram avaliados os casos com diagnóstico clínico de varicela, registrados em prontuário por médico pediatra, de janeiro de 2011 até junho de 2016. As internações foram classificadas em grupo pré-vacinal e grupo pós-vacinal, com base na data de introdução da vacina (setembro de 2013). Os grupos foram comparados em relação a: faixa etária, sexo, tempo de hospitalização, causas da internação, complicações hospitalares, tempo da internação em terapia intensiva e desfecho clínico. Resultados: Foram documentadas 830 internações, 543 no período pré-vacinal e 287 no pós-vacinal, ocorrendo redução de 47,1% nas internações (p<0,001). Em ambos os períodos, notou-se um perfil similar das internações, predominantemente: sexo masculino; faixa etária de um a cinco anos; por causas secundárias (principalmente infecções de pele); evoluindo com melhora clínica e alta hospitalar. Em relação ao número de óbitos, ocorreram seis no período pré-vacinal e dois no pós-vacinal. Conclusões: A manutenção do perfil das internações era esperada, visto que o trabalho não comparou crianças vacinadas com não vacinadas, e sim internações pré e pós-vacinais. Observou-se, em concordância com a literatura, queda substancial no número de internações por varicela.

Impact of residual ridge anatomy on masticatory efficiency of conventional complete denture users / Impacto da anatomia do rebordo residual na eficiência mastigatória em usuários de próteses totais convencionais

ABSTRACT Objective: The aim of this cross-sectional study was to evaluate the anatomical characteristics of edentulous residual ridges in stone casts of complete dentures users and assess correlations with masticatory efficiency. Methods: The sample included 74 study casts, of which 37 were higher and 37 bottom. Measurements were performed using a drypoint compass and a transparent ruler. Arches and ridges of maxillae and mandibles were classified into small, medium, and large. Masticatory efficiency was obtained by the sieve method with the old prostheses and 3 months after placement of new prostheses. The correlations between the anatomical variables of the ridges and arches (height, width and size) and masticatory efficiency were verified by the Spearman correlation test. Significant differences in masticatory efficiencies were assessed by the Wilcoxon test. Results: People with larger maxillary alveolar ridge presented better masticatory performance with old and new dentures. There was no correlation between maxillary ridge width and size with masticatory efficiency, but a correlation was found between maxillary arch width and masticatory efficiency evaluated with the old dentures. Conclusions: With the new dentures, the correlation had a tendency for significance. For the mandible, no correlation was found between height, width, and size of the ridge or with width, length, and size of the arch and masticatory efficiency. In addition, there was no significant difference between masticatory efficiencies evaluated with the old and new prostheses. For the maxilla, ridge height and arch width influence masticatory efficiency. For the mandible, the anatomy had little influence on masticatory performance.

RESUMO Objetivo: Este estudo transversal objetivou avaliar as características anatômicas de rebordos residuais de usuários de próteses totais em gesso pedra e avaliar correlações com a eficiência mastigatória. Métodos: A amostra incluiu 74 modelos de estudo, sendo 37 superiores e 37 inferiores. As medidas foram realizadas com um compasso de ponta seca e régua transparente. Os arcos e rebordos da maxila e mandíbula foram classificados em pequenos, médios e grandes. A eficiência mastigatória foi obtida pelo método da peneira com as próteses antigas e 3 meses após a instalação das próteses novas. As correlações entre as variáveis anatômicas dos rebordos e arcos (altura, largura e tamanho) e a eficiência mastigatória foram verificadas pelo teste Spearman. Diferenças significativas nas eficiências mastigatórias foram avaliadas pelo teste de Wilcoxon. Resultados: Pessoas com crista alveolar maxilar alta apresentaram melhor desempenho mastigatório com próteses novas e antigas. Não houve correlação entre a largura e o tamanho da crista maxilar com a eficiência mastigatória, mas foi encontrada uma correlação entre a largura do arco maxilar e a eficiência mastigatória avaliadas com as próteses antigas. Para a mandíbula, não foi encontrada correlação entre altura, largura e tamanho da crista ou com largura, comprimento e tamanho do arco e eficiência mastigatória. Além disso, não houve diferença significativa entre as eficiências mastigatórias avaliadas com as próteses antigas e novas. Conclusão: Para a maxila, a altura da crista e a largura do arco influenciam a eficiência mastigatória. Para a mandíbula, a anatomia teve pouca influência no desempenho mastigatório.

uso probiótico no transtorno do espectro autista e na esquizofrenia: revisão narrativa da literatura / Probiotic use in autistic spectrum disorder and schizophrenia: narrative literature review

Introdução: devido à grande prevalência do transtorno do espectro autista (TEA) e da esquizofrenia e o caráter incapacitante dessas patologias, fez-se necessário o desenvolvimento de tratamentos cada vez mais eficientes e com menos efeitos adversos. Sendo a microbiota um regulador da inflamação e tendo esta um papel fundamental na gênese dos transtornos psiquiátricos, o uso de probióticos pode ser uma alternativa segura e com baixo custo para o tratamento complementar das doenças psiquiátricas. Objetivo: realizar uma revisão narrativa sobre a eficácia do uso de probióticos na redução de sintomas clínicos e gastrointestinais, assim como da segurança no tratamento do TEA e da esquizofrenia. Metodologia: revisão dos estudos em humanos que avaliaram os efeitos terapêuticos dos probióticos no TEA e esquizofrenia. Resultados: foram selecionados 13 estudos, sendo 8 sobre TEA e 5 sobre esquizofrenia, com total de 485 pacientes. As evidências apontam melhora dos sintomas gastrintestinais dos pacientes com TEA e esquizofrenia; entretanto, sem mudanças conclusivas dos sintomas psiquiátricos na esquizofrenia, associado a potencial benefício no TEA. Conclusão: essa revisão sugere que o uso de probióticos tem um potencial benefício nos sintomas comportamentais no TEA, associado à melhora dos sintomas gastrointestinais na esquizofrenia e TEA; entretanto, não se observou mudanças nos sintomas psiquiátricos da esquizofrenia.

Introduction: due to the high prevalence of autism spectrum disorder (ASD) and schizophrenia and the disabling nature of these pathologies, it has become necessary to develop increasingly efficient treatments with less adverse effects. As the microbiota is a regulator of inflammation and having a fundamental role in the genesis of psychiatric disorders, the use of probiotics may be a safe and low-cost alternative for the complementary treatment of psychiatric diseases. Objective: to perform a narrative review on the fficacy of probiotics use in reducing clinical and gastrointestinal symptoms, and adverse effects of the use of probiotics in the treatment of ASD and schizophrenia. Methodology: review of studies in humans that evaluated the therapeutic effects of probiotics on ASD and schizophrenia. Results: 13 studies were selected, 8 on TEA and 5 on schizophrenia, with a total of 485 patients. Evidence points to improvement in gastrointestinal symptoms in patients with ASD and schizophrenia; however, there were no conclusive changes in psychiatric symptoms in schizophrenia, associated with a potential benefit in ASD. Conclusion: This review suggests that the use of probiotics has a potential benefit in behavioral symptoms in ASD, associated with the improvement of gastrointestinal symptoms in schizophrenia and ASD; however, there were no changes in the psychiatric symptoms of schizophrenia.

Avaliação de polimorfismo da enzima citocromo P450 em pacientes com síndrome antifosfolípide e seu impacto no controle da anticoagulação / Evaluation of polymorphism of the cytochrome P450 enzyme in patients with antiphospholipid syndrome and its impact on anticoagulation control

Introdução: a Síndrome Antifosfolípide é caracterizada por eventos trombóticos e perdas gestacionais de repetição e é considerada a trombofilia adquirida mais comum. Quando não está associada a alguma doença do tecido conectivo é dita primária e seu tratamento é baseado em anticoagulação por longo período com warfarin. Isso requer controle rigoroso do tempo de protrombina realizada pela monitoração dos valores de INR para que se evite em um extremo o risco de sangramento e em outro o risco de trombose. Objetivo: realizar uma revisão daa literatura sobre polimorfismos genéticos da citocromo P450 na síndrome antifosfolipide. Metodologia: revisão narrativa da literatura. Resultados: embora investigações tenham identificado a influência de vários genes na resposta ao warfarin, a maioria das evidências sugere um papel mais importante para o polimorfismo de dois genes: o gene do citocromo P450(CYP)2C9 (CYP2C9) e o gene do complexo redutase epóxido vitamina K 1 (VKORC1). De fato, o warfarin é administrado como uma mistura racêmica de S ­ e R-warfarin e estes enantiômeros são extensivamente metabolizados no fígado por diferentes enzimas do citocromo P450(CYP), com a CYP2C9 servindo como a principal enzima no metabolismo da S-warfarin. Nesse sentido, a farmacogenética da terapia com warfarin é relevante para melhorar a segurança e a efetividade dessa terapia. Polimorfismos estruturais no gene CYP2C9 criam variantes alélicos que codificam enzimas com diferentes atividades catalíticas. As freqüências alélicas destes variantes diferem entre diferentes grupos étnicos, sem estudos no Brasil em pacientes com SAF. Conclusão: o conhecimento da presença de polimorfismos genéticos da citocromo P450 em usuários de warfarin é de fundamental importância. Desde que sangramentos ou alvos subterapeuticos podem advir da presença dessas alterações genéticas.

Introduction: antiphospholipid Syndrome is characterized by thrombotic events and repeated pregnancy losses and is considered the most common acquired thrombophilia. When it is not associated with any connective tissue disease, it is said to be primary and its treatment is based on long-term anticoagulation with warfarin. This requires strict control of the prothrombin time performed by monitoring the INR values to avoid the risk of bleeding at one extreme and the risk of thrombosis at the other. Objective: To perform a review of the literature on genetic polymorphisms of cytochrome P450 in antiphospholipid syndrome. Methods: narrative literature review Results: although investigations have identified the influence of several genes on the response to warfarin, most evidence suggests a more important role for the polymorphism of two genes: the cytochrome P450 (CYP) 2C9 (CYP2C9) gene and the reductase complex gene vitamin K 1 epoxide (VKORC1). In fact, warfarin is administered as a racemic mixture of S ­ and R-warfarin and these enantiomers are extensively metabolized in the liver by different enzymes of cytochrome P450 (CYP), with CYP2C9 serving as the main enzyme in the metabolism of S-warfarin . In this sense, the pharmacogenetics of warfarin therapy is relevant to improve the safety and effectiveness of this therapy. Structural polymorphisms in the CYP2C9 gene create allelic variants that encode enzymes with different catalytic activities. The allele frequencies of these variants differ between different ethnic groups, with no studies in Brazil in patients with APS. Conclusion: knowledge of the presence of genetic polymorphisms of cytochrome P450 in users of warfarin is of fundamental importance. Since bleeding or subtherapeutic targets may result from the presence of these genetic changes.

Efeito imediato da MWM de Mulligan em pacientes com dor no ombro / MWM Mulligan immediate effect on shoulder pain patients

Introdução: a dor no ombro leva a limitações e incapacidades entre adultos e idosos, merecendo atenção do fisioterapeuta. Objetivo: Avaliar o efeito imediato da técnica de Mulligan em pacientes com dor no ombro. Metodologia: trata-se de resultados preliminares de um ensaio clínico realizado entre julho de 2018 a julho de 2019. Pacientes com dor no ombro (n=44), de ambos os sexos, foram randomizados e submetidos a dois protocolos de tratamento: exercícios terapêuticos (n=22) e MWM de Mulligan (n=22), atendidos na Clínica Escola de Fisioterapia da UFBA. Todos os participantes responderam a um questionário clínico e sociodemográfico e realizaram avaliação da dor pela escala visual analógica (EVA) e algometria. Os pacientes foram tratados por dois fisioterapeutas experientes na área e, depois, foram reavaliados imediatamente. Resultados: mulheres predominaram, a média de idade foi de 56 anos no grupo Mulligan e 57 no grupo exercícios terapêuticos. Síndrome do manguito rotador predominou: 19 (86,4%) no grupo Mulligan e 15 (68%) no grupo exercícios. O ombro mais acometido foi o direito no Grupo Mulligan, (17 (77,3%); já no grupo exercícios, foi o esquerdo com 12 (55%). A cor negra foi a mais autorrelatada pelos pacientes, e poucos tinham o ensino superior completo. No grupo Mulligan, as ocupações mais informadas foram dona de casa, seguida de aposentados e autônomos. No grupo exercícios, não houve dona de casa, e sim mais aposentados e autônomos. Os dois grupos mostraram ser mais sedentários. Não houve diferença da dor pela EVA entre os grupos, antes e após o tratamento (p=0.79, p=0.56, respectivamente). Já a intensidade da dor mensurada pela algometria, tanto antes do tratamento (p=0.008) quanto depois do tratamento (p=0.04), foi diferente entre os grupos, com predomínio de melhora no grupo Exercícios. Conclusão: a MWM não foi mais eficaz que os exercícios terapêuticos na redução da dor do ombro, sendo que o exercício apresentou mais eficácia quando medido através da EVA e sem melhora significativa ao ser mensurada pela algometria após aplicação de uma única sessão de tratamento.

Introduction: shoulder pain leads to limitations and disabilities among adults and the elderly deserving attention from the physiotherapist. Objective: to evaluate the immediate effect of the Mulligan technique in patients with shoulder pain. Methodology: these are preliminary results of a clinical trial conducted from July 2018 to July 2019. Patients (n=44) with shoulder pain of both sexes were randomized and submitted to two treatment protocols: therapeutic exercises (n = 22) and Mulligan's MWM (n = 22) attended at the UFBA School of Physiotherapy Clinic. All participants answered a clinical and sociodemographic questionnaire and underwent pain assessment by visual analog scale (VAS) and algometry. The patients were treated by two experienced physiotherapists and then reassessed immediately. Results: women predominated, the average age was 56 years in the Mulligan group and 57 in the therapeutic exercises group. Rotator cuff syndrome predominated, 19 (86.4%) in the Mulligan group and 15 (68%) in the exercise group. The most affected shoulder was the right shoulder in the Mulligan Group (17 (77.3%), while in the exercise group was the left shoulder with 12 (55%).The black color was the most self-reported by the patients and few patients had higher education. In the Mulligan group the most informed occupations were housewife followed by retirees and self-employed. In the exercise group we had no housewife but more retired and self-employed. The two groups were more sedentary. There was no difference in VAS pain between the groups before and after treatment (p = 0.79, p = 0.56, respectively), while pain intensity measured by algometry both before treatment (p = 0.008) and after treatment (p = 0.04) was different between Conclusion: Mulligan's MWM was not more effective than exercise in reducing shoulder pain, and exercise was more effective when measured by VAS and without significant improvement when measured by algometry after applying a single treatment session.