Association between child's behaviour during first dental appointment and effectiveness of dental plaque removal by caregivers.

OBJECTIVE: To evaluate the association between the behaviour of children aged 1 to 4 years during their dental appointment and the effectiveness of dental plaque removal by caregivers. METHODS: This longitudinal study with intervention had the participation of 146 children (mean age = 34.89 months), 75 of whom (51.4%) showed positive behaviour (+ and ++) and 71 (48.6%), negative behaviour (- and - -). The children were evaluated at the first dental appointment, according to the Frankl scale. They were subjected to an assessment of oral conditions, and their plaque level was recorded (Quigley-Hein Index modified by Turesky) using the Evince® device. Caregivers received oral hygiene guidance. The dental plaque assessment was performed before giving the oral hygiene guidance and 14 days later. The statistical analysis included a descriptive assessment and the Wilcoxon test (p < 0.05). RESULTS: Mean dental plaque levels dropped significantly from the first to the second assessment (p < 0.001). The sample was divided according to the child's behaviour, observing that only the group of children with positive behaviour showed significantly less dental plaque in the second assessment (p < 0.001). CONCLUSION: The positive behaviour of children aged 1 to 4 years during the first dental appointments is associated with more effective dental plaque removal by caregivers.

Longitudinal evaluation of determinants of the clinical consequences of untreated dental caries in early childhood.

OBJECTIVES: This study aimed to evaluate whether the trajectory of family income, parental education and clinical variables are associated with the clinical consequences of untreated dental caries among children. METHODS: A prospective cohort study was conducted with 439 children between one and three years of age, evaluated at baseline and re-evaluated after three years. Sociodemographic and economic variables, untreated dental caries and biofilm were investigated both at baseline and at the 3-year follow-up. The pufa index (pulpal involvement, ulceration, fistula and abscess) was used to diagnose the clinical consequences of untreated dental caries. RESULTS: The prevalence of pufa ≥1 was 18.2% in the follow-up. The following variables were associated with a higher risk of clinical consequences of untreated dental caries: mother's low schooling level at baseline and follow-up (RR = 1.51; 95% CI: 1.04-2.18), incidence or baseline presence of biofilm (RR = 4.66; 95% CI: 2.02-10.74), cavitated dental caries at baseline (RR = 3.57; 95% CI:1.86 to 6.83) and incidence of cavitated dental caries (RR = 2.04; 95% CI: 1.24-3.35). CONCLUSION: Low maternal schooling level, biofilm, cavitated dental caries at baseline, and incidence of dental caries were the factors determining the consequences of untreated dental caries.

LeishCare®: A Software Designed for the Management of Individuals with Leishmaniases.

The aims of this study were to describe a smartphone app aimed at healthcare professionals who work in areas endemic for visceral and tegumentary leishmaniases, and to report the user's perception of the app in these areas. The software, called LeishCare®, has the following features: data registration, image filter to record the evolution of skin lesions using photos, calculation of a score set to identify the risk of death from visceral leishmaniasis, and guides to the diseases. LeishCare® was made available to healthcare professionals in endemic municipalities in Brazil, and the perception of potential users was evaluated at baseline and after 6 and 12 months. In the first meeting, 96 (94.1%) of the 102 professionals who knew the app reported positive expectations for its use. The installation of LeishCare® on the individual device and the evaluation of user perception were completed at 6 months with 16 users and at 12 months with 20 users. More than 90% of the professionals evaluated in both assessments found the information of the app useful. The features related to the calculation of visceral leishmaniasis severity score, and the guides to leishmaniases were the most frequently accessed. Users reported competence gain attributed to the app for all items evaluated. In conclusion, LeishCare® was found to be a promising tool to help healthcare professionals in endemic areas with leishmaniasis management.

Leucine-rich diet induces a shift in tumour metabolism from glycolytic towards oxidative phosphorylation, reducing glucose consumption and metastasis in Walker-256 tumour-bearing rats.

Leucine can stimulate protein synthesis in skeletal muscle, and recent studies have shown an increase in leucine-related mitochondrial biogenesis and oxidative phosphorylation capacity in muscle cells. However, leucine-related effects in tumour tissues are still poorly understood. Thus, we described the effects of leucine in both in vivo and in vitro models of a Walker-256 tumour. Tumour-bearing Wistar rats were randomly distributed into a control group (W; normoprotein diet) and leucine group (LW; leucine-rich diet [normoprotein + 3% leucine]). After 20 days of tumour evolution, the animals underwent 18-fludeoxyglucose positron emission computed tomography (18F-FDG PET-CT) imaging, and after euthanasia, fresh tumour biopsy samples were taken for oxygen consumption rate measurements (Oroboros Oxygraph), electron microscopy analysis and RNA and protein extraction. Our main results from the LW group showed no tumour size change, lower tumour glucose (18F-FDG) uptake, and reduced metastatic sites. Furthermore, leucine stimulated a shift in tumour metabolism from glycolytic towards oxidative phosphorylation, higher mRNA and protein expression of oxidative phosphorylation components, and enhanced mitochondrial density/area even though the leucine-treated tumour had a higher number of apoptotic nuclei with increased oxidative stress. In summary, a leucine-rich diet directed Walker-256 tumour metabolism to a less glycolytic phenotype profile in which these metabolic alterations were associated with a decrease in tumour aggressiveness and reduction in the number of metastatic sites in rats fed a diet supplemented with this branched-chain amino acid.

Vasculopatia livedóide: a propósito de um caso clínico / Livedoid vasculopathy: a clinical case proposition

A vasculopatia livedóide é uma dermatose crônica oclusiva dos vasos sanguíneos da derme, de caráter pauci-inflamatório ou não inflamatório, extremamente dolorosa. A etiologia não é totalmente esclarecida; estando associada a eventos pró-trombóticos. Caracterizada pela presença de lesões maculopapulares, eritêmato-purpúricas, nos membros inferiores, especialmente nos tornozelos e pés que ulceram gerando cicatrizes atróficas, denominadas atrofia branca. A histopatologia evidencia oclusão dos vasos da derme, devido à deposição de fibrina intravascular e presença de trombo intraluminal, além de hialinização segmentar e proliferação endotelial, há também, um infiltrado inflamatório perivascular discreto. Descrevemos um caso de vasculopatia livedóide evidenciando os achados histopatológicos encontrados na biópsia. (AU)

Livedoid vasculopathy is a chronic occlusive vasculopathy dermatosis, with a pauciinflammatory or noninflammatory characteristic, and is extremely painful. Its ethiology is not entirely known, being associated with pro-thrombotic events. Characterized by erythematous purpuric maculopapular lesions on the legs, especially on the ankles and feet, that ulcerates and heals with white atrophic scars, named atrophie blanche. Histopathology shows occlusion of dermal vases, segmental hyalinization and endothelial proliferation; there is also a discreet perivascular inflammatory infiltrate. We describe a case of livedoid vasculopathy showing the histopathological findings on the biopsy. (AU)

Coinfecção por leishmaniose visceral e vírus da imunodeficiência humana: uma evolução clínica desfavorável / Visceral leishmaniasis and human immunodeficiency virus co-infection, an unfavorable clinical outcome: case report

A leishmaniose visceral (LV) é uma zoonose endêmica na América Latina e 96% dos casos de LV são diagnosticados no Brasil. A coinfecção HIV-LV tem sido diagnosticada em áreas endêmicas e não endêmicas para LV. O aumento do número de casos de coinfecções em todo o mundo deve-se, em parte, à coincidência das áreas de circulação desses organismos. Deve-se ressaltar que a concomitância das duas infecções é potencialmente deletéria, portanto a associação dos dois patógenos constitui um desafio para o diagnóstico e controle da LV. A interação entre Leishmania e HIV é prejudicial, pois há o risco de progressão rápida de ambas as doenças por compartilharem mecanismos imunológicos semelhantes. Neste relato, é apresentado o caso de um paciente com infecção pelo HIV associada à LV, que evoluiu rapidamente para o óbito.