Estruturação do plano de imunização no combate a covid-19: (des)ordem nos acordos entre os poderes / Structuring the immunization plan to fight covid-19: (dis)order in agreements between the powers / Estructura del plan de inmunización para combatir el covid-19: (des)orden en acuerdos entre potencias

Objetivo: Fomentar o debate acerca da ordenação do plano de vacinação nacional, considerando os aspectos organizacionais entre união, estados e municípios. Métodos: Revisão de literatura, tendo como base os periódicos Cientific Electronic Library Online (SCIELO), Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) e Biblioteca Virtual de Saúde (BVS), usando como descritores: Pandemia, Vacina e Plano de Imunização. Com essa busca foram encontradas, inicialmente, 48 publicações. Após a realização da análise, foram incluídos 11 artigos científicos na revisão. Os textos foram submetidos à análise de conteúdo semântica. Resultados: Foram levantadas duas categorias: estratégias de combate a pandemia do covid-19 no Brasil, e a manipulação da sociedade civil e a desordem da cobertura vacinal. Conclusão: as reflexões aqui apresentadas podem contribuir para que os profissionais de enfermagem desenvolvam uma postura reflexiva frente a demanda vacinal, processo de planejamento e percepções da sociedade civil, podendo desencadear uma melhora na preparação para a educação em saúde. (AU)

Objective: To encourage the debate about the ordering of the national vaccination plan, considering the organizational aspects between the union, states and municipalities. Methods: Literature review, based on scientific journals Electronic Library Online (SCIELO), Coordination for the Improvement of Higher Education Personnel (CAPES) and Virtual Health Library (VHL), using as descriptors: Pandemia, Vaccine and Immunization Plan. With this search, 48 publications were initially found. After the analysis, 11 scientific articles were included in the review. The texts were subjected to semantic content analysis. Results: Two categories were raised: strategies to combat the covid-19 pandemic in Brazil, and the manipulation of civil society and the disorder of vaccination coverage. Conclusion: The reflections presented here can contribute for nursing professionals to develop a reflexive posture in face of the vaccine demand, planning process and civil society perceptions, which can trigger an improvement in the preparation for health education. (AU)

Objetivo: Fomentar el debate sobre la ordenación del plan nacional de vacunación, considerando los aspectos organizativos entre sindicato, estados y municipios. Métodos: Revisión de la literatura, con base en revistas científicas Biblioteca Electrónica en Línea (SCIELO), Coordinación para el Perfeccionamiento del Personal de Educación Superior (CAPES) y Biblioteca Virtual en Salud (BVS), utilizando como descriptores: Pandemia, Vacuna y Plan de Inmunización. Con esta búsqueda se encontraron inicialmente 48 publicaciones. Después del análisis, se incluyeron 11 artículos científicos en la revisión. Los textos fueron sometidos a análisis de contenido semántico. Resultados: Se plantearon dos categorías: estrategias para combatir la pandemia de covid-19 en Brasil y la manipulación de la sociedad civil y el desorden de la cobertura de vacunación. Conclusión: Las reflexiones aquí presentadas pueden contribuir para que los profesionales de enfermería desarrollen una postura reflexiva ante la demanda de vacunas, el proceso de planificación y las percepciones de la sociedad civil, lo que puede desencadenar una mejora en la preparación para la educación en salud. (AU)

Chondroitin Sulfate from Oreochromis niloticus Waste Reduces Leukocyte Influx in an Acute Peritonitis Model.

Oreochromis niloticus (tilapia) is one of the most cultivated fish species worldwide. Tilapia farming generates organic waste from fish removal processes in nurseries. Visceral waste can damage natural ecosystems. Therefore, the use of this material as a source of biomolecules helps reduce environmental impacts and improve pharmacological studies. Tilapia viscera were subjected to proteolysis and complexation with an ion-exchange resin. The obtained glycosaminoglycans were purified using ion exchange chromatography (DEAE-Sephacel). The electrophoretic profile and analysis of 1H/13C nuclear magnetic resonance (NMR) spectra allowed for the characterization of the compound as chondroitin sulfate and its sulfation position. This chondroitin was named CST. We tested the ability of CST to reduce leukocyte influx in acute peritonitis models induced by sodium thioglycolate and found a significant reduction in leukocyte migration to the peritoneal cavity, similar to the polymorphonuclear population of the three tested doses of CST. This study shows, for the first time, the potential of CST obtained from O. niloticus waste as an anti-inflammatory drug, thereby contributing to the expansion of the study of molecules with pharmacological functions.

Cardiovascular risk and cardiovascular risk factors in adolescents.

OBJECTIVES: to identify cardiovascular risk and cardiovascular risk factors in adolescents and verify correlations between these variables and biochemical markers, and between blood pressure percentiles, Body Mass Index, and biochemical markers. METHODS: a cross-sectional study, conducted at a Brazilian school, from August to September 2019, including 205 participants who were interviewed. After the interview, anthropometric assessments, including weight, height, arm circumference, blood pressure checking, and blood collection for laboratory tests were performed. Descriptive and inferential analysis using the chi-square test was conducted. RESULTS: a total of 18.5% had blood pressure percentiles >95%, 25.4% were overweight, and 25.9% were at very high cardiovascular risk. Statistically significant associations were found between cardiovascular risk and sex, Body Mass Index and blood pressure percentiles, and between blood pressure percentiles and triglycerides. CONCLUSIONS: high prevalence of risk factors among school adolescents reinforces the need for interventions for cardiovascular risk reduction in this population.

Tratamento com Invisalign® da má oclusão de Classe III subdivisão, utilizando dispositivo de ancoragem esquelética temporária / Invisalign® treatment of class III subdivision malocclusion using temporary skeletal anchorage device

O objetivo deste estudo foi relatar um caso de tratamento corretivo de má oclusão Classe III subdivisão e mordida cruzada utilizando alinhadores do Sistema Invisalign® com tempo total de tratamento de 2 anos e 9 meses. Paciente do sexo feminino, 24 anos, apresentava perfil facial reto com boa expressão e suporte labial, relação molar Classe III do lado esquerdo e ausência do primeiro molar inferior direito, com consequente desvio da linha média inferior. Além de mordida cruzada dos dentes anteriores na região dos incisivos laterais e segundos pré-molares, lado direito. Após uma fase inicial de 84 pares de alinhadores e ancoragem esquelética de mini-implantes, o paciente utilizou uma série de 20 alinhadores adicionais para finalização. O período de troca foi a cada 7 dias. Ao longo do tratamento, a prescrição de alinhadores mostrou-se eficiente em minimizar os efeitos colaterais tanto da mecânica ortodôntica quanto dos elásticos de Classe III. Ao final do tratamento, o paciente apresentou correção da má oclusão sem inclinação acentuada dos incisivos inferiores, como comumente evidenciado por outras prescrições de aparelhos relatadas na literatura atual. Considerando as características inerentes ao caso clínico aqui apresentado, a técnica dos alinhadores constituiu uma opção de tratamento corretivo para a classe III dentária, visando estabilidade e melhores resultados estéticos para o sorriso e a face.

The aim of this study was to report a case of corrective treatment of Class III subdivision malocclusion and crossbite using Invisalign® System aligners with a total treatment time of 2 years and 9 months. A 24-year-old female patient had a straight facial profile with good expression and lip support, a Class III molar relationship on the left side and absence of the right lower first molar, with consequent lower midline deviation. In addition to a crossbite of the anterior teeth in the region of the lateral incisors and second premolars, right side. After an initial phase of 84 pairs of aligners and skeletal mini-implant anchorage, the patient used a series of 20 additional aligners for completion. The changeover period was every 7 days. Throughout the treatment, the prescription of aligners proved to be efficient in minimizing the side effects of both orthodontic mechanics and Class III elastics. At the end of treatment, the patient exhibited malocclusion correction without marked lower incisor inclination, as commonly evidenced by other appliance prescriptions reported in the current literature. Considering the inherent characteristics of the clinical case presented here, the aligners technique constituted a corrective treatment option for Class III dental, aiming at stability and better aesthetic results for the smile and the face.

Cardiovascular risk and cardiovascular risk factors in adolescents / Risco cardiovascular e fatores de risco cardiovascular em adolescentes / Riesgo cardiovascular y factores de riesgo cardiovascular en adolescentes

ABSTRACT Objectives: to identify cardiovascular risk and cardiovascular risk factors in adolescents and verify correlations between these variables and biochemical markers, and between blood pressure percentiles, Body Mass Index, and biochemical markers. Methods: a cross-sectional study, conducted at a Brazilian school, from August to September 2019, including 205 participants who were interviewed. After the interview, anthropometric assessments, including weight, height, arm circumference, blood pressure checking, and blood collection for laboratory tests were performed. Descriptive and inferential analysis using the chi-square test was conducted. Results: a total of 18.5% had blood pressure percentiles >95%, 25.4% were overweight, and 25.9% were at very high cardiovascular risk. Statistically significant associations were found between cardiovascular risk and sex, Body Mass Index and blood pressure percentiles, and between blood pressure percentiles and triglycerides. Conclusions: high prevalence of risk factors among school adolescents reinforces the need for interventions for cardiovascular risk reduction in this population.

RESUMO Objetivos: identificar o risco cardiovascular e os fatores de risco cardiovascular em adolescentes e verificar correlações entre essas variáveis e marcadores bioquímicos, e entre percentis de pressão arterial, Índice de Massa Corporal e marcadores bioquímicos. Métodos: estudo transversal, realizado em escola brasileira, de agosto-setembro de 2019, incluindo 205 participantes que foram entrevistados. Após a entrevista, foram realizadas avaliações antropométricas, incluindo peso, altura, circunferência do braço, aferição da pressão arterial e coleta de sangue. Foi realizada análise descritiva e inferencial por meio do Teste do Qui-Quadrado. Resultados: 18,5% apresentavam percentis de pressão arterial>95%, 25,4% com sobrepeso e 25,9% com risco cardiovascular muito alto. Foram encontradas associações estatisticamente significativas entre risco cardiovascular e sexo, Índice de Massa Corporal e percentis de pressão arterial e entre percentis de pressão arterial e triglicérides. Conclusões: a alta prevalência de fatores de risco em adolescentes escolares reforça a necessidade de intervenções para redução do risco cardiovascular nessa população.

RESUMEN Objetivos: identificar riesgo cardiovascular y factores de riesgo cardiovascular en adolescentes y verificar las correlaciones entre estas variables y marcadores bioquímicos, y entre percentiles de presión arterial, Índice de Masa Corporal y marcadores bioquímicos. Métodos: estudio transversal, realizado en una escuela brasileña, de agosto a septiembre de 2019, que incluyó a 205 participantes que fueron entrevistados. Después de la entrevista, se realizaron evaluaciones antropométricas que incluyeron peso, talla, perímetro del brazo, medición de la presión arterial y extracción de sangre para pruebas de laboratorio. El análisis descriptivo e inferencial se realizó mediante la prueba de chi-cuadrado. Resultados: el 18,5% tenía percentiles de presión arterial>95%, el 25,4% tenía sobrepeso y el 25,9% tenía un riesgo cardiovascular muy alto.Se encontraron asociaciones estadísticamente significativas entre el riesgo cardiovascular y el sexo, el Índice de Masa Corporal y los percentiles de presión arterial, y entre los percentiles de presión arterial y los triglicéridos. Conclusiones: la alta prevalencia de factores de riesgo en estudiantes adolescentes refuerza la necesidad de intervenciones para reducir el riesgo cardiovascular en esta población.

Controle de formigas lava-pés: onde encontro informações? / Control of the fire ants: where do I find information?

As formigas lava-pés são facilmente encontradas em ambientes urbanos e, devido ao seu comportamento agressivo, ferroam suas vítimas, o que pode desencadear reações alérgicas graves ou até mesmo a morte do indivíduo. O controle dessas formigas ainda não é bem estabelecido, no entanto, é possível encontrar diversas alternativas de controle tanto na internet como na literatura. Sendo assim, o objetivo desse trabalho foi realizar um levantamento quantitativo acerca dos métodos de controle de lava-pés disponíveis nas diferentes mídias de divulgação. A pesquisa foi realizada nas plataformas do Google e YouTube para sites e vídeos, respectivamente, e Web of Science e Google Acadêmico para produções científicas, nos últimos 22 anos. Os termos utilizados na pesquisa foram “como controlar formigas lava-pés” em sites e vídeos e “fire ants, control, Brazil” para a busca bibliográfica. Os métodos sugeridos para o controle de formigas de fogo foram divididos em três categorias: caseiros, químicos e controle biológico. Um total de 38 publicações (18 sites, 12 vídeos e oito produções bibliográficas) que abordaram 18 métodos diferentes de controle foram registrados. Os métodos caseiros foram os mais citados (n = 39), seguido dos métodos químicos (n = 19) e controle biológico (n = 2). Dentre os sites encontrados, o uso de substâncias de origem vegetal (n = 7) foi o mais citado, já a maioria dos vídeos acessados sugeriram uma solução de vinagre com detergente (n = 5) e nas produções bibliográficas o uso de inseticidas (n = 4) foi mais recomendado. Houve participação de profissionais em 61% das publicações. Embora a internet seja um instrumento de pesquisa popular, é necessário atentar-se à confiabilidade das informações disponibilizadas, visto que o manuseio de determinados produtos pode ser nocivo à saúde e ao meio ambiente e em muitos casos ser totalmente ineficaz para o controle destas formigas.(AU)

The fire ants are easily found in urban environments, and because of their aggressive behavior, they sting their victims, which can trigger serious allergic reactions or even death. The control of these ants is still not well established, however, it is possible to find several control alternatives both in the internet and in the literature. Therefore, the objective of this work was to perform a quantitative survey on the methods of control of fire ants available in the different media of disclosure. The survey was conducted on Google and YouTube platforms for websites and videos, respectively, and Web of Science and Google Scholar for scientific productions, in the past 22 years. The terms used in the research were "how to control fire ants” in websites and videos and "fire ants, control, Brazil" for the bibliography search. The methods found were divided into three categories: homemade, chemical and biological control. A total of 38 publications (18 sites, 12 videos and eight bibliographic productions) that addressed 18 different methods of control were recorded. The homemade methods were the most cited (n = 39), followed by chemical methods (n = 19) and biological control (n = 2). Among the sites found, the use of substances of vegetable origin (n = 7) was the most cited, and most of the videos accessed suggested a solution of vinegar with detergent (n = 5) and in the bibliographical productions the use of insecticides (n = 4) was more recommended. There was participation of professionals in 61% of the publications. Although the internet is a popular research instrument, it is necessary to take into account the reliability of the information provided, since the handling of certain products can be harmful to health and the environment and in many cases be totally ineffective for the control of these ants.(AU)

Controle de formigas lava-pés: onde encontro informações? / Control of the fire ants: where do I find information?

As formigas lava-pés são facilmente encontradas em ambientes urbanos e, devido ao seu comportamento agressivo, ferroam suas vítimas, o que pode desencadear reações alérgicas graves ou até mesmo a morte do indivíduo. O controle dessas formigas ainda não é bem estabelecido, no entanto, é possível encontrar diversas alternativas de controle tanto na internet como na literatura. Sendo assim, o objetivo desse trabalho foi realizar um levantamento quantitativo acerca dos métodos de controle de lava-pés disponíveis nas diferentes mídias de divulgação. A pesquisa foi realizada nas plataformas do Google e YouTube para sites e vídeos, respectivamente, e Web of Science e Google Acadêmico para produções científicas, nos últimos 22 anos. Os termos utilizados na pesquisa foram “como controlar formigas lava-pés” em sites e vídeos e “fire ants, control, Brazil” para a busca bibliográfica. Os métodos sugeridos para o controle de formigas de fogo foram divididos em três categorias: caseiros, químicos e controle biológico. Um total de 38 publicações (18 sites, 12 vídeos e oito produções bibliográficas) que abordaram 18 métodos diferentes de controle foram registrados. Os métodos caseiros foram os mais citados (n = 39), seguido dos métodos químicos (n = 19) e controle biológico (n = 2). Dentre os sites encontrados, o uso de substâncias de origem vegetal (n = 7) foi o mais citado, já a maioria dos vídeos acessados sugeriram uma solução de vinagre com detergente (n = 5) e nas produções bibliográficas o uso de inseticidas (n = 4) foi mais recomendado. Houve participação de profissionais em 61% das publicações. Embora a internet seja um instrumento de pesquisa popular, é necessário atentar-se à confiabilidade das informações disponibilizadas, visto que o manuseio de determinados produtos pode ser nocivo à saúde e ao meio ambiente e em muitos casos ser totalmente ineficaz para o controle destas formigas.

The fire ants are easily found in urban environments, and because of their aggressive behavior, they sting their victims, which can trigger serious allergic reactions or even death. The control of these ants is still not well established, however, it is possible to find several control alternatives both in the internet and in the literature. Therefore, the objective of this work was to perform a quantitative survey on the methods of control of fire ants available in the different media of disclosure. The survey was conducted on Google and YouTube platforms for websites and videos, respectively, and Web of Science and Google Scholar for scientific productions, in the past 22 years. The terms used in the research were "how to control fire ants” in websites and videos and "fire ants, control, Brazil" for the bibliography search. The methods found were divided into three categories: homemade, chemical and biological control. A total of 38 publications (18 sites, 12 videos and eight bibliographic productions) that addressed 18 different methods of control were recorded. The homemade methods were the most cited (n = 39), followed by chemical methods (n = 19) and biological control (n = 2). Among the sites found, the use of substances of vegetable origin (n = 7) was the most cited, and most of the videos accessed suggested a solution of vinegar with detergent (n = 5) and in the bibliographical productions the use of insecticides (n = 4) was more recommended. There was participation of professionals in 61% of the publications. Although the internet is a popular research instrument, it is necessary to take into account the reliability of the information provided, since the handling of certain products can be harmful to health and the environment and in many cases be totally ineffective for the control of these ants.

Pregnancy-induced hypertension syndrome and cardiovascular risk / Síndrome hipertensiva gestacional e risco cardiovascular

Objective: to analyze the changes in life expectancy (LE) and disability-free life expectancy (DFLE) in São Paulo's elderly population to assess the occurrence of compression or expansion of morbidity, between 2000 and 2010. Methods: cross-sectional and population survey, based on official data for the city of São Paulo, Brazil, and data obtained from the Health, Well-Being and Aging Survey (SABE). Functional disability was defined as difficulty in performing at least one basic activity of daily living. The Sullivan method was used to calculate LE and DFLE for the years 2000 to 2010. Results: from 2000 to 2010, there was an increase in disabled life expectancy (DLE) in all age groups and both sexes. The proportion of years of life free of disability, at 60 years of age, decreased from 57.94% to 46.23% in women, and from 75.34% to 63.65% in men. At 75 years of age, this ratio decreased from 47.55% to 34.54% in women, and from 61.31% to 56.01% in men. Conclusion: the expansion of morbidity is an ongoing process in the elderly population of the municipality of São Paulo, in the period 2000-2010. These results can contribute to the development of preventive strategies and planning of adequate health services to future generations of seniors. .

Objetivo: caracterizar o perfil de risco cardiovascular em longo prazo de mulheres com história de síndrome hipertensiva da gestação (SHG) e compará-lo ao de mulheres com histórico de gestação normotensa. Métodos: este é um estudo de coorte retrospectivo que incluiu 60 mulheres que deram à luz na MEAC-UFC entre os anos de 1992 e 2002 (seguimento médio de 15,2 anos). O grupo de exposição (GE) foi composto por 30 mulheres em qualquer categoria de SHG, e o grupo de não exposição (GNE) compreendeu 30 mulheres sem história de patologia obstétrica. Foram avaliados os dados antropométricos e laboratoriais associados ao risco cardiovascular e calculados o escore Framingham (variáveis dependentes). Para variáveis quantitativas, foram usados o teste t de Student e o teste de Mann-Whitney. Para variáveis qualitativas, aplicou-se o teste exato de Fisher. Considerou-se a significância estatística como p<0,05. Resultados: GE apresentou valores mais altos de IMC (p=0,03, OR=1,13, IC 1,00-1,3), PAS (p=0,03, OR=1,03, IC 1,00-1,06), LDL-C (p=0,02, OR=1,02, IC 1,00-1,04) e glicose de jejum (p=0,02, OR=1,03, IC 1,00-1,07), além de valores mais altos no escore de Framingham (p=0,03, OR=1,09, IC 1,00-1,19). As mulheres em GE usaram medicamentos anti-hipertensivos com mais frequência (p=0,03, OR=5,2, IC 1,3-21,2). Conclusão: foi encontrado um perfil de risco cardiovascular desfavorável nas pacientes com história de SHG em comparação com as mulheres sem esse histórico. .

Influence of myofascial pain on the pressure pain threshold of masticatory muscles in women with migraine.

OBJECTIVE: To evaluate the influence of myofascial pain on the Pressure Pain Threshold (PPT) of masticatory muscles in women with migraine. METHODS: The sample comprised 101 women, ages ranging from 18 to 60 years, with an episodic migraine diagnosis previously confirmed by a neurologist. All patients were evaluated using Research Diagnostic Criteria for Temporomandibular Disorders to determine the presence of myofascial pain and were divided into 2 groups: group I (n=56), comprising women with a migraine, and group II (n=45), comprising women with a migraine and myofascial pain. Two more groups (49 asymptomatic women and 50 women with myofascial pain), matched for sex and race, obtained from a previous study, were added to this study. The PPT values of masseter and temporalis (anterior, middle, and posterior regions) muscles were recorded bilaterally using a pressure algometer. One-way analysis of variance and the Tukey test for pairwise comparisons were used in statistical analysis with a 5% significance level. RESULTS: We found that all groups had significantly lower PPT values compared with asymptomatic women, with lower values seen in group II (women with migraine and myofascial pain). Women with a migraine and myofascial pain showed significantly lower PPT values compared with women with a migraine only, and also when compared with women with myofascial pain only. DISCUSSION: Migraine, especially when accompanied by myofascial pain, reduces the PPT of masticatory muscles, suggesting the importance of masticatory muscle palpation during examination of patients with migraine.

Vitamin E does not prevent bone loss and induced anxiety in rats with ligature-induced periodontitis.

OBJECTIVE: The purpose of this study was to investigate the effect of vitamin E on alveolar bone loss (ABL) and anxiety in rats with ligature-induced experimental periodontitis (EP). MATERIAL AND METHODS: Wistar rats were subjected to ligature-induced EP and treated with vitamin E (500mg/kg, orally) for 9 days. Then anxiety was tested using the elevated plus-maze (EPM) test. All of the animals were euthanised by cervical dislocation on day 11. ABL was analysed morphometrically and histopathologically. Lipid peroxidation quantification, activity of the enzyme superoxide dismutase and immunohistochemistry to tumour necrosis factor-alpha (TNF-α) and inducible isoform of nitric oxide synthases (iNOS) were also tested. RESULTS: EP induced a marked inflammatory process and intense ABL. Treatment with vitamin E decreased inflammatory reaction, prevented malondialdehyde formation and reduced the immunoreactivity to iNOS, but did not decrease ABL. Vitamin E had an anxiogenic effect on rats with or without EP. CONCLUSIONS: Vitamin E may have potential to reduce oxidative damage and inflammatory response in EP but does not prevent ABL. Attention should be given to indiscriminate use of vitamin E due to the risk of causing anxiety in patients.

Are temporomandibular disorders and tinnitus associated?

The current study aimed to research the prevalence of temporomandibular disorders (TMD) in patients with subjective tinnitus, as compared to controls, and the association between symptoms of TMD, tinnitus, and chronic pain. Two hundred patients were divided into two groups, according to the presence (experimental) or not (control) of subjective tinnitus. The subgroups were determined according to the RDC/TMD criteria. The Pain Pressure Threshold (PPT) values of the masseter and temporalis muscles were recorded bilaterally, and a Visual Analog Scale (VAS) was used to address subjective pain. The most prevalent TMD subgroups in the tinnitus patients (p < 0.05) were myofascial pain with limited opening (39.0%), disc displacement with reduction (44.33%), and arthralgia (53.54%). The severity of tinnitus was significantly associated with the severity of chronic pain (p = .000). The PPT values were lower (p > 0.05), while the Visual Analog Scale (VAS) was statistically higher (p = .000) for the tinnitus patients. These results suggest that an association exists between TMD and subjective tinnitus.

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report.

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

Bilateral asymptomatic fibrous-ankylosis of the temporomandibular joint associated with rheumatoid arthritis: a case report

The American Academy of Orofacial Pain (AAOP) defines ankylosis of the temporomandibular joint (TMJ) as a restriction of movements due to intracapsular fibrous adhesions, fibrous changes in capsular ligaments (fibrous-ankylosis) and osseous mass formation resulting in the fusion of the articular components (osseous-ankylosis). The clinical features of the fibrous-ankylosis are severely limited mouth-opening capacity (limited range of motion during the opening), usually no pain and no joint sounds, marked deflection to the affected side and marked limitation of movement to the contralateral side. A variety of factors may cause TMJ ankylosis, such as trauma, local and systemic inflammatory conditions, neoplasms and TMJ infection. Rheumatoid arthritis (RA) is one of the systemic inflammatory conditions that affect the TMJ and can cause ankylosis. The aim of this study is to present a case of a female patient diagnosed with bilateral asymptomatic fibrous-ankylosis of the TMJ associated with asymptomatic rheumatoid arthritis. This case illustrates the importance of a comprehensive clinical examination and correct diagnosis of an unusual condition causing severe mouth opening limitation.

A Academia Americana de Dor Orofacial (AAOP) define anquilose da Articulação Temporomandibular (ATM) como restrição dos movimentos devido à adesão fibrosa intracapsular, alterações fibrosas nos ligamentos capsulares (fibroanquilose) e formação de massa óssea resultando na fusão dos componentes articulares (anquilose óssea). As características clínicas da Fibroanquilose são: capacidade severamente limitada de abertura bucal geralmente sem dor e sem ruídos articulares, com marcada deflexão para o lado afetado e marcada limitação de movimentos para o lado contralateral. Uma variedade de fatores pode causar anquilose da ATM, como trauma, condições inflamatórias locais e/ou sistêmicas, neoplasias e infecção na ATM. A artrite reumatóide (AR) é uma dessas condições sistêmicas inflamatórias que pode afetar a ATM e causar anquilose. O objetivo desse estudo é apresentar um caso de uma paciente, diagnosticada com Fibroanquilose da ATM bilateral e assintomática associada à AR. Esse caso ilustra a importância de um exame clínico bem realizado com exames complementares pode levar a um diagnóstico correto de Fibroanquilose da ATM e da importância do diagnóstico diferencial em casos de abertura bucal restrita.

Avaliação do impacto da presença de dor miofascial (rdc/tmd) no limiar de dor à pressão (ldp) da musculatura mastigatória em mulheres portadoras de enxaqueca / Impact of myofascial pain (rdc/tmd) on pressure pain thershold of masticatory muscles in women with migraine

O objetivo deste estudo foi avaliar o impacto da presença de dor miofascial, segundo o Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), no Limiar de Dor à Pressão (LDP) da musculatura mastigatória de mulheres portadoras de enxaqueca, fora da e durante a crise de enxaqueca. Adicionalmente, comparar índices de depressão e prevalência de apertamento dentário diurno e bruxismo do sono em mulheres com enxaqueca, com e sem o diagnóstico adicional de DTM. A amostra foi coletada no Ambulatório de Cefaléia do Hospital Geral de Fortaleza (HGF) e nas clínicas da Faculdade de Odontologia de Bauru da Universidade de São Paulo (FOB-USP), e foi composta por 101 voluntárias do sexo feminino, com idade variando entre 18 e 60 anos, com diagnóstico de enxaqueca previamente confirmado por neurologista. Para classificar as voluntárias em portadoras de DTM ou não, utilizou-se o RDC/TMD. Após aplicação do RDC/TMD, as voluntárias foram separadas em dois grupos: grupo I, pacientes portadoras de enxaqueca, sem DTM; e grupo II, pacientes portadoras de enxaqueca e DTM. Mais dois grupos (49 mulheres assintomáticas e 50 portadoras de dor miofascial) foram acrescentados ao estudo, utilizando-se dados originais e individuais de estudo previamente realizado com voluntárias brasileiras com características semelhantes a dos outros grupos obtidos neste estudo. Estes dois grupos foram utilizados para análise inicial do LDP. O LDP das voluntárias do grupo I e II foram avaliadas em dois momentos: inicialmente, na ausência de dor de origem cefálica, e durante uma crise de enxaqueca. As medições do LDP foram realizadas com a utilização de um algômetro, em 4 pontos localizados bilateralmente, nos músculos temporal (anterior, médio e posterior) e masséter (corpo). Para avaliação do índice de depressão, utilizou-se o Symptom Checklist 90 (SCL-90) do eixo II do RDC/TMD. Para o verificação da presença de apertamento dentário diurno utilizou-se o auto-relato e, para...

The objective of this study was to assess the impact of miofascial pain, according to the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD), on the pressure pain thershold (PPT) of masticatory muscles in women with migraine, during a migraine attack and in the absence of it. Moreover, the study compared depression scores, daytime clenching and sleep bruxism prevalence in women with migraine, with and without TMD. The sample comprised 101 women, with ages ranging from 18 to 60 years, with migraine diagnostic previously confirmed by a neurologist. All subjects were evaluated using RDC/TMD in order to determinate the presence of TMD, and were divided in two groups: group I, women with migraine, and group II, women with migraine and TMD. Two more groups (49 symptom-free women and 50 women with miofascial pain), matched for gender and race, which were obtained from a previously study, were added to this study. These two groups were used for initial analysis of PPT. PPT from groups I and II were measured in the during a migraine attack and in the absence of it. The PPT values of masseter and temporalis (anterior, middle and posterior regions) muscles were recorded bilaterally with a pressure algometer. Depression level was determinate by the SCL-90 from RDC/TMD axis II, and a self-reported questionnaire was used to detect parafunctional habits. One-way ANOVA, tukey test for pairwise comparisons, paired t-test, students t-test and chi-square, were used in statistical analysis with a 5% significance level. Women with migraine showed statistically lower PPT levels at all points tested, when compared with symptom-free women. Woman with migraine and TMD showed a tendency of decrease on PPT levels at all points tested, when compared with women with migraine. During a migraine attack, PPT levels were decreased in both groups. Women with migraine and TMD showed statistically higher depression levels and higher prevalence...

Effect of venlafaxine on bone loss associated with ligature-induced periodontitis in Wistar rats.

BACKGROUND: The present study investigated the effects of venlafaxine, an antidepressant drug with immunoregulatory properties on the inflammatory response and bone loss associated with experimental periodontal disease (EPD). MATERIALS AND METHODS: Wistar rats were subjected to a ligature placement around the second upper left molar. The treated groups received orally venlafaxine (10 or 50 mg/kg) one hour before the experimental periodontal disease induction and daily for 10 days. Vehicle-treated experimental periodontal disease and a sham-operated (SO) controls were included. Bone loss was analyzed morphometrically and histopathological analysis was based on cell influx, alveolar bone, and cementum integrity. Lipid peroxidation quantification and immunohistochemistry to TNF-alpha and iNOS were performed. RESULTS: Experimental periodontal disease rats showed an intense bone loss compared to SO ones (SO = 1.61 +/- 1.36; EPD = 4.47 +/- 1.98 mm, p < 0.001) and evidenced increased cellular infiltration and immunoreactivity for TNF-alpha and iNOS. Venlafaxine treatment while at low dose (10 mg/kg) afforded no significant protection against bone loss (3.25 +/- 1.26 mm), a high dose (50 mg/kg) caused significantly enhanced bone loss (6.81 +/- 3.31 mm, p < 0.05). Venlafaxine effectively decreased the lipid peroxidation but showed no significant change in TNF-alpha or iNOS immunoreactivity. CONCLUSION: The increased bone loss associated with high dose venlafaxine may possibly be a result of synaptic inhibition of serotonin uptake.

The immunosuppressant drug, thalidomide, improves hepatic alterations induced by a high-fat diet in mice.

BACKGROUND: Pro-inflammatory cytokines, such as tumour necrosis factor (TNF)-alpha, are known to be involved in the establishment of insulin resistance. Insulin resistance plays a key role in the development of obesity-related pathologies, such as type 2 diabetes and non-alcoholic fatty liver disease (NAFLD). The state of chronic inflammation associated with obesity led us to hypothesize that TNF-alpha blockade may have an effect on experimentally obese animals. AIMS: We studied the effects of thalidomide, an immunosuppressant and anti-TNF-alpha drug, on hepatic alterations that were induced by a high-fat diet (HFD) in mice. METHODS: Obesity was induced in Swiss mice using a HFD for 12 weeks. Thalidomide-treated animals received thalidomide i.p. (100 mg/kg/day, 10 days). Glucose, aspartate aminotransferases and alanine aminotransferases levels were assessed in the blood. Insulin and glucose tolerance tests were performed. The liver was excised for histological, triglyceride, gene and protein expression analyses. RESULTS: We found improvements in both the basal glucose blood levels and the response to insulin administration in the treated animals. The molecular analysis of insulin signalling revealed a restoration of the hepatic insulin receptor substrate (IRS)-1 and AKT phosphorylation. The hepatic expression of TNF-alpha was inhibited and the levels correlated with a significant reduction in the steatosis area. Other hepatic inflammatory markers, such as iNOS and suppressor of cytokine signalling (SOCS-3), were also reduced. CONCLUSIONS: We suggest that immunosuppressant drugs that target TNF-alpha and that may also contribute to reductions in the inflammatory markers that are associated with obesity could be a therapeutic option in NAFLD and type 2 diabetes.

Avaliação da sobrecarga do cuidador de crianças com paralisia cerebral através da escala Burden Interview / Assessment of the caregiver burden of children with cerebral palsy using the Burden Interview scale

OBJETIVOS: avaliar fatores que influenciam na sobrecarga dos cuidadores de crianças com paralisia cerebral. MÉTODOS: foram entrevistados 56 cuidadores de crianças com paralisia cerebral com idade entre um e 15 anos. Para avaliar a sobrecarga dos cuidadores foi utilizada a escala Burden Interview e foram coletados dados sobre nível socioeconômico da família, gravidade do comprometimento motor, diagnóstico topográfico e idade das crianças com paralisia cerebral. Para análise dos dados foram utilizados os testes Mann-Whitney e Kruskal-Wallis. RESULTADOS: um menor nível socioeconômico da família (p=0,03) e uma menor gravidade do comprometimento motor (p=0,05) das crianças com paralisia cerebral foram associados com maior sobrecarga do cuidador. Não houve diferença significativa em relação ao diagnóstico topográfico (p=0,71) e à idade das crianças com paralisia cerebral (p=0,35). CONCLUSÕES: o conhecimento de fatores que influenciam a sobrecarga dos cuidadores de crianças com paralisia cerebral é mais um dado a ser agregado no planejamento de atenção e intervenção a esse público específico.

OBJECTIVES: to evaluate factors that influence the caregiver burden of children with cerebral palsy. METHODS: 56 caregivers who worked with children with cerebral palsy aged between one and fifteen years old were evaluated. To evaluate the caregiver burden the Burden Interview scale was used, along with data on the social and economic circumstances of the children's families, the severity of motor impairment, topographic diagnosis and age of child. The Mann-Whitney and Kruskal-Wallis test were used for data analysis. RESULTS: poorer social and economic circumstances of the children's families (p=0.03) and a lower severity of motor impairment (p=0.05) in the child with cerebral palsy were associated to a heavier caregiver burden. There was no significant difference in the case of topographic diagnosis (p=0.71) and age of child with cerebral palsy (p=0.35). CONCLUSIONS: understanding the factors that influence the caregiver burden is one further factor that can assist care planning and intervention for this specific group.

Efecto de la condición corporal al parto y del nivel de alimentación sobre la involución uterina, actividad ovárica, preñez y la expresión hipotalámica y ovárica de los receptores de leptina en vacas doble propósito

A objeto de evaluar el efecto de la condición corporal al parto (CCAP) y del nivel de alimentación (NA) sobre la involución uterina (IU), actividad ovárica (AO), preñez (PR) y expresión de los receptores de leptina (EXPLEP) a nivel hipotalámico y ovárico en vacas postparto, se emplearon 27 vacas mestizas (Bos taurus x Bos indicus). Los animales fueron asignados al azar, con arreglo factorial 2x2, a uno de cuatro tratamientos (T). T1: CCAP baja (<2,5) + NA bajo (BCBA) (n=6); T2: CCAP baja (<2,5) + NA alto (BCAA) (n=7); T3: alta CCAP (>2,5) + bajo NA (ACBA) (n=7) y el T4: CCAP alta (>2,5) + NA alto (ACAA) (n=7). La dieta basal fue de heno de Cynodon nlemfluensis (8% proteína cruda; PC) y un suplemento (23%; PC), a una relación 70:30. Para evaluar IU se consideró: la característica de la secresión uterina (CSU), simetría de los cuernos uterinos (SCU), diámetro cervical (DC) y posición del útero (PU). La evaluación reproductiva se realizó semanalmente desde los 15 hasta los 45 días postparto (DPP), por palpación transrectal, ultrasonografía y progesterona (P4) en plasma. La AO fue evaluada a través de folículos ováricos (F), clasificados en clases: C1 (≤5 mm), C2(6-9 mm) y C3 (≥10 mm) y la presencia de cuerpos lúteos (CL). La PR fue comprobada a través de la palpación rectal, ultrasonido y P4. Cambios metabólicos energéticos fueron medidos, a través del colesterol total (COL) y fructosamina (FRTS) a los 3, 15, 30 y 45 DPP. La expresión hipotalámica y ovárica de los receptores de leptina (EXLEP) fue evaluada mediante la técnica de Western blot, empleando tejidos de 8 vacas sacrificadas a los 45 DPP. Los datos fueron analizados a través de un análisis de regresión multivariado multiple, ANAVAR para medidas repetidas en el tiempo, una regresión múltiple de Cox y una prueba de Kruskal y Wallis. Los resultados muestran correlación (P<0,05) entre T y C3 y entre C3 y CSU a los 22 al 30 DDP. Se obtuvo una correlación entre CL y CSU en el 37 DDP. C1 no estuvo asociado a T ni a IU. Hubo correlación significativa (P<0,01) entre las diferentes variables de IU (CSU, DC, SCU y PU). El análisis de regresión multivariado múltiple detectó efecto significativo (P<0,05) de T y DC sobre AO. La condición corporal postparto (CCPP) afectó AO (P<0,01). Cox para CL dependió (P<0,01) de CSU y SCU. El efecto de T sobre P4 acumulada fue significativa (P<0,01) y CCAP tuvo efecto significativo sobre P4 (P<0,05) desde el 30 DPP. FRTS fue diferente entre T (P<0,05) pero no entre períodos de muestreo. EXLEP para receptores hipotalámicos fue mayor para vacas con alta CCAP, independientemente del NA. PR fue diferente entre T (P<0,01). Valores de PR hasta los 120 DPP fueron: T3: 75%; T4: 60% vs. T2: 0% y T1: 20%. Se concluye que T afectó la IU (CSU, SCU) y la AO (clases foliculares y CL). Se evidenció un efecto de CCAP sobre la expresión de los receptores de leptina en el hipotálamo como uno de los mediadores en la regulación de la actividad ovárica. En consecuencia de lo anterior, hubo una mayor tasa de preñez antes de los 120 DPP, en los tratamientos con mejor CCAP.

Effect of Body Condition at Calving and Feeding Level on Uterine Involution, Ovarian Activity, Pregnancy and the Hypothalamic and Ovarian Expression of Leptin Receptors in Dual Purpose Cows Abstract To evaluate the effect of body condition at calving (BCAC) and different feeding levels (FL) on uterine involution (UI), ovarian activity (OA), pregnancy (PR), and hypothalamic and ovarian leptin receptor expression (LEPEXP) in postpartum cows, twenty seven crossbred cows (Bos taurus x Bos indicus) were randomly assigned in a 2 x 2 factorial design into four treatments (T): T1, low body condition (LBC; < 2.5) + low FL (LBCLFL; n = 6); T2, LBC (< 2.5) + high FL (LBCHFL; n = 7); T3, high BC (> 2.5) + low FL (HBCLFL; n = 7) and; T4, high BC (>2.5) + high FL (HBCHFL; N = 7). Basal diet was made of hay from Cynodon nlemfluensis (11% crude protein, CP) plus supplement (23% CP) at a 70:30 ratio. To assess uterine involution (UI), the following was considered: characteristic of uterine secretion (CUS), uterine horn simmetry (UHS), cervix diameter (CD), and uterine position (UP). Weekly, from 15 to 45 days postpartum (DPP), the reproductive tract was evaluated by transrectal palpation, ultrasonography, and RIA of plasma progesterone (P4). The OA was assessed through the ovarian follicles (OF), which were classified as : C1 (≤ 5 mm), C2 (6-9 mm), C3 (≥ 10 mm); and the presence of corpora lutea (CL). The PR was verified by rectal palpation, ultrasound, and P4. Metabolic changes were measured as total cholesterol (TC) and fructosamine (FRTS) at 3, 15, and 45 DPP. The hypotalamic and ovarian LEPEXP were determined by Western blot from tissue samples of 8 cows slaughtered at 45 DPP. Data were statistically analyzed by multivariate multiple regressions, ANOVA for repeated measurements on time, Cox’s multiple regression and a Kruskal and Wallis test. Results show a correlation between T and C3 and between C3 and CUS at 22 and 30 DPP. Also, a correlation was detected between CL and CUS at 37 DPP. No association between C1 and T or C1 and UI was found. The multivariate multiple regressions detected a significant effect (P<0.05) of T and CD on OA. The BCAC influenced OA (P < 0.01). Cox value for CL depended on CUS and UHS (P<0.01). The effect of T and BCAC over accumulated P4 was significant (P<0.05) and BCAC had an effect on P4 from 30 DPP. FRTS was different among T (P<0.05), but were not among sample times. The LEPEXP for hypothalamus was higher for cows with high BCAC, independently from FL. The PR was different among T (P<0.01). Values for PR at 120 DPP were: T3: 75% and T4: 60% vs T2: 0% and T1: 20%. In summary, T, BCAC, CUS and UHS exerted a positive effect on OA. The LEPEXP at the hypothalamus levels corroborated the response of BCAC on OA. Consequently, there was a high pregnancy rate before 120 DPP in T with better BCAC.