Value of Surgical and Nonsurgical Treatment for Sleep Apnea: A Closer Look at Health Care Utilization.

OBJECTIVE: To determine how surgery, continuous positive airway pressure (CPAP), and no treatment impact health care utilization in patients who have obstructive sleep apnea (OSA). STUDY DESIGN: This is a retrospective cohort study of patients between the ages of 18 and 65 that were diagnosed with OSA (9th International Classification of Diseases) from January 2007 to December 2015. Data were collected over 2 years, and prediction models were generated to evaluate trends over time. SETTING: A population-based study using real-world data and insurance databases. METHODS: A total of 4,978,649 participants were identified, all with at least 25 months of continuous enrollment. Patients with previous soft tissue procedures not approved for OSA (nasal surgery), or without continuous insurance coverage were excluded. A total of 18,050 patients underwent surgery, 1,054,578 were untreated, and 799,370 received CPAP. IBM Marketscan Research database was utilized to describe patient-specific clinical utilization, and expenditures, across outpatient, and inpatient services, and medication prescriptions. RESULTS: When the cost of the intervention was eliminated in the 2-year follow-up, the monthly payments of group 1 (surgery) were significantly less than group 3 (CPAP) in overall, inpatient, outpatient, and pharmaceutical payments (p < .001). The surgery group was associated with less cumulative payments compared to the other 2 groups when the cost of the intervention (CPAP or surgery) was eliminated in all comorbidities and age groups. CONCLUSION: Treating OSA with surgery can lessen overall health care utilization compared to no treatment and CPAP.

Delayed administration of Trichilia catigua A. Juss. Ethyl-acetate fraction after cerebral ischemia prevents spatial memory deficits, decreases oxidative stress, and impacts neural plasticity in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Trichilia catigua A. Juss (Meliaceae) is used in Brazilian folk medicine to alleviate fatigue and emotional stress and improve memory. Previous studies from our laboratory reported that an ethyl-acetate fraction (EAF) of T. catigua that was given before cerebral ischemia in vivo prevented memory loss and reduced oxidative stress and neuroinflammation. Despite the value of these findings of a neuroprotective effect of T. catigua, treatment that was given immediately before or immediately after ischemia limits its clinical relevance. Thus, unknown is whether T. catigua possesses a specific time window of efficacy (TWE) when administered postischemia. AIM OF THE STUDY: Given continuity to previous studies, we investigated whether an EAF of T. catigua maintains its neuroprotective properties if treatment begins at different time windows of efficacy after ischemia. We also evaluated, for the first time, whether T. catigua possesses neuroplasticity/neurotrophic properties. MATERIAL AND METHODS: Rats were subjected to transient global brain ischemia (TGCI) and then given a single dose of the EAF (400 mg/kg) or vehicle (1 ml/kg) orally 1, 4, or 6 h postischemia. The levels of protein PCG, GSH, and GSSG, and activity of SOD and CAT were assayed as markers of oxidative stress on the day after ischemia. In another experiment, naive rats underwent spatial learning training in a radial maze task and then subjected to TGCI. Delayed treatment with the EAF began 4 or 6 h later and continued for 7 days. Retrograde memory performance was assessed 10, 17, and 24 days postischemia. Afterward, brains were examined for neurodegeneration and neuronal dendritic morphology in the hippocampus and cerebral cortex. Another group received the EAF at 4 h of reperfusion, and 4 days later their brains were examined for GFAP and Iba-1 immunoreactivity. Lastly, ischemic rats received the EAF 4 h after ischemia and neural plasticity-related proteins, BDNF, SYN, PSD 95, and NeuN were measured in the hippocampus 7 and 14 days after ischemia. RESULTS: A single EAF administration 1, 4, or 6 h postischemia alleviated oxidative stress that was caused by ischemia, expressed as a reduction of the amount of the PCG and GSSG, normalization of the GSH/GSSG ratio, and the restoration of SOD activity. Ischemia caused the persistent loss of memory (i.e., amnesia), an outcome that was consistently ameliorated by treatment with the EAF that was initiated 4 or 6 h postischemia. The 4 h delay in EAF treatment positively impacted dendritic morphology in neurons that survived ischemia. TGCI reduced BDNF, SYN, PSD-95, and NeuN protein levels in the hippocampus and cerebral cortex. The EAF normalized SYN and PSD-95 protein levels. Ischemia-induced neurodegeneration and glial cell activation were not prevented by EAF treatment. CONCLUSION: The present study corroborates prior data that demonstrated the neuroprotective potential of T. catigua and extends these data by showing that the delayed administration of EAF postischemia effectively prevented memory impairment and decreased oxidative stress, dendritic deterioration, and synaptic protein loss within a TWE that ranged from 1 to 6 h. This specific TWE in preclinical research may have clinical relevance by suggesting the possible utility of this plant for the development of neuroprotective strategies in the setting of ischemic brain diseases. Another innovative finding of the present study was the possible neurotrophic/neuroplastic properties of T. catigua.

Medidas antropométricas associadas ao tempo de encarceramento de pessoas privadas de liberdade / Medidas antropométricas relacionadas con el tiempo de encarcelamiento de personas privadas de la libertad / Anthropometric measures associated with incarceration length of persons deprived of their liberty

Resumo Objetivo Analisar as medidas antropométricas associadas ao tempo de encarceramento de pessoas privadas de liberdade. Métodos Estudo transversal, realizado com 220 homens privados de liberdade. Os dados foram coletados por meio de instrumento que abrangia informações do encarceramento atual, sociodemográficas e das condições de vida antes do encarceramento, além de aferição de medidas antropométricas. Utilizaram-se estatística descritiva, testes de associações e ajuste de modelos de regressão logística binária controlados pelo tempo de encarceramento (até 1ano e mais de 1ano). Resultados Houve associação significativa entre o tempo de encarceramento e a circunferência abdominal (RC de 0,41; IC95%0,16-0,97). Os resultados da correlação de Spearman apontaram que, à medida que aumentou o tempo de encarceramento, as medidas antropométricas diminuíram, com relação negativa de fraca magnitude e significativa apenas para o índice de conicidade (r=-0,1648; p=0,0144). Os modelos ajustados controlados pelo tempo de encarceramento mostraram associações significativas com idade em anos (RC de 1,08; IC95%=1,04;1,12) e circunferência abdominal; idade (RC de 1,08; IC95%1,04-1,12) e razão cintura e estatura; e idade (RC de 1,10; IC95%1,06-1,14), anos de estudo (RC de 2,17; IC95%1,10-4,26) e possuir parceiro(a) (RC de 0,46; IC95%0,22-0,93) com o índice de conicidade. Conclusão À medida que aumenta o tempo de encarceramento, há redução das medidas antropométricas das pessoas privadas de liberdade. As variáveis antropométricas influenciam diretamente no desenvolvimento de doenças crônicas não transmissíveis e devem ser monitoradas para elaboração de estratégias que minimizem os riscos e os agravos à saúde dessa população vulnerável.

Resumen Objetivo Analizar las medidas antropométricas relacionadas con el tiempo de encarcelamiento de personas privadas de la libertad. Métodos Estudio transversal, realizado con 220 hombres privados de la libertad. Los datos fueron recopilados mediante un instrumento que incluía información del encarcelamiento actual, sociodemográfica y de las condiciones de vida antes del encarcelamiento, además de la comparación de medidas antropométricas. Se utilizó estadística descriptiva, pruebas de asociación y ajuste de modelos de regresión logística binaria controlados por el tiempo de encarcelamiento (hasta 1 año y más de 1 año). Resultados Hubo asociación significativa entre el tiempo de encarcelamiento y la circunferencia abdominal (RC de 0,41; IC95%0,16-0,97). Los resultados de la correlación de Spearman indicaron que, a media que aumentaba el tiempo de encarcelamiento, las medidas antropométricas disminuían, con relación negativa de escasa magnitud y significativa para el índice de conicidad (r=-0,1648; p=0,0144). Los modelos ajustados controlados por el tiempo de encarcelamiento mostraron asociaciones significativas con la edad en años (RC de 1,08; IC95%=1,04;1,12) y circunferencia abdominal; edad (RC de 1,08; IC95%1,04-1,12) y razón de cintura y estatura; y edad (RC de 1,10; IC95%1,06-1,14), años de estudio (RC de 2,17; IC95%1,10-4,26) y tener pareja (RC de 0,46; IC95%0,22-0,93) con el índice de conicidad. Conclusión A medida que aumenta el tiempo de encarcelamiento, hay una reducción de las medidas antropométricas de las personas privadas de la libertad. Las variables antropométricas influyen directamente en el desarrollo de enfermedades crónicas no transmisibles y deben controlarse para la elaboración de estrategias que minimicen los riesgos y los agravios a la salud de esta población vulnerable.

Abstract Objective To analyze the anthropometric measures associated with incarceration length of people deprived of their liberty. Methods This is a cross-sectional study carried out with 220 men deprived of their liberty. Data were collected using an instrument that included information on current incarceration, sociodemographic information and living conditions before incarceration, in addition to measuring anthropometric measures. Descriptive statistics, association tests and adjustment of binary logistic regression models controlled by incarceration length (up to 1 year and more than 1 year) were used. Results There was a significant association between incarceration length and abdominal circumference (OR 0.41; 95%CI 0.16-0.97). The results of Spearman's correlation showed that, as the incarceration length increased, the anthropometric measures decreased, with a negative relationship of weak magnitude and significant only for the conicity index (r=-0.1648; p=0.0144). Adjusted models controlled for incarceration length showed significant associations with age in years (OR 1.08; 95%CI=1.04;1.12) and abdominal circumference; age (OR 1.08; 95%CI 1.04-1.12) and waist-to-height ratio; and age (OR 1.10; 95%CI 1.06-1.14), years of education (OR 2.17; 95%CI 1.10-4.26) and having a partner (OR 0 .46; 95%CI0.22-0.93) with the conicity index. Conclusion As incarceration length increases, there is a reduction in the anthropometric measures of persons deprived of their liberty. Anthropometric variables directly influence the development of non-communicable chronic diseases and must be monitored to develop strategies that minimize the risks and health problems of this vulnerable population.

Technique for Darkening of Extracted Teeth Simulating Pulpal Necrosis Discoloration.

Background: The use of discolored teeth is required to test whitening products, and it is difficult to obtain them, given their scarcity. Objective: To present a technique for in vitro darkening of extracted teeth simulating pulpal necrosis discoloration. Materials and Methods: Hemolysates I and II from human blood were subjected or not to laser irradiation (442 nm) for 1 h. The concentration of oxyhemoglobin (O2Hb) was analyzed by ultraviolet/visible spectroscopy, and the conversion of O2Hb to methemoglobin (MetHb) by transmission spectroscopy was assessed immediately and after 3 and 40 days. For darkening evaluation, bovine incisors were divided into two groups (n = 25), and their pulp chambers were filled with hemolysate solution II (HSII) and hemolysate II solution + laser (HSII+L). After storage in artificial saliva for 40 days at 37°C, color changes were measured by a colorimeter and ΔE was compared with the NBS parameters. Data were analyzed using a mixed linear model (α=5%). Results: HSII+L presented the lowest O2Hb and higher MetHb. The conversion of O2Hb to MetHb in HSII+L was 42% higher than in HSII. Both groups were effective in darkening the teeth, according to the NBS. Darkening stabilized from day 35. HSII promoted a marked color difference. Conclusion: The proposed technique was effective in darkening the extracted teeth simulating necrosis discoloration for in vitro models.

Accuracy of three-dimensional soft tissue profile prediction in orthognathic surgery.

PURPOSE: To evaluate the accuracy of three-dimensional (3D) soft tissue prediction in bimaxillary orthognathic surgery. METHODS: Cone-beam computed tomographs of 88 patients with class II (n = 46) and class III (n = 42) malocclusions, who underwent bimaxillary orthognathic surgery, were included in this retrospective study. 3D soft tissue prediction and postoperative outcome were compared by using ten landmarks of facial soft tissues. Patients' sex and age were also assessed. Results were analyzed using a mixed model methodology (p < 0.05). RESULTS: The success criterion adopted was a mean discrepancy of < 2 mm. Most mandibular landmarks indicated a tendency for underprediction with a downward direction in class II patients, with some values > 2 mm. In class III, there was overprediction with a downward direction for the mandibular landmarks, with values < 2 mm. More accurate results were found in female and older patients. CONCLUSIONS: 3D surgical planning showed clinically acceptable results for predicting soft tissues in patients undergoing bimaxillary orthognathic surgery, with more accurate results for class III patients. Although some differences were found when age and sex were interacted, a consistent association between these variables could not be stated. These results support the clinician, as accuracy can provide a strong guide to the surgeon when planning surgical orthodontic treatment.

Perioperative Antibiotic Use in Sleep Surgery: Clinical Relevance.

OBJECTIVE: Upper airway surgery is a common therapeutic approach recommended for patients with obstructive sleep apnea (OSA) to decrease disease burden. We aimed to evaluate the effect of perioperative antibiotic prescription on complication rates. STUDY DESIGN: Retrospective cohort (national database). SETTING: Tertiary referral center. METHODS: This is a retrospective study of a large national health care insurance database (Truven MarketScan) from 2007 to 2015. Subjects diagnosed with OSA who had uvulopalatopharyngoplasty (UPPP) were included and stratified in single versus multilevel surgery. Other variables included smoking, age, sex, antibiotic prescription, and comorbidities based on the Elixhauser index. Evaluated outcomes were postoperative bleeding, intubation, pneumonia, superficial surgical site infection, tracheostomy, and hospital readmission. A multivariate regression model was created to assess each complication. RESULTS: A total of 5,798,528 subjects received a diagnosis of OSA, of which 39,916 were >18 years old and underwent UPPP, either alone or with additional procedures. The mean age was 43 years, and 73.4% were male. Antibiotic prescription was associated with less bleeding in UPPP alone, UPPP with nasal surgery, and UPPP with nasal and tongue surgery (P < .001, P < .001, and P = .006, respectively). It was also associated with a lower prevalence of surgical site infection, pneumonia, tracheostomy, intubation, and hospital readmission (P < .001). On a multivariate model, antibiotic prescription was significantly associated with a decreased rate of complications. CONCLUSIONS: Although former studies recommended against the use of antibiotics after tonsillectomy, our results suggest that antibiotic prescription after UPPP for OSA was associated with less bleeding, surgical site infection, pneumonia, intubation, tracheostomy, and hospital readmission 30 days postoperatively.

How does bimaxillary orthognathic surgery change dimensions of maxillary sinuses and pharyngeal airway space?

OBJECTIVES: To assess changes in the maxillary sinus (MS) and pharyngeal airway space (PAS) after bimaxillary orthognathic surgery using cone-beam computed tomography (CBCT). MATERIALS AND METHODS: The CBCT scans of 48 patients were divided into two groups: group 1: maxillary advancement and mandibular setback (n = 24); group 2: maxillomandibular advancement (n = 24). The CBCTs were acquired 1 to 2 months preoperatively and 6 to 8 months postoperatively. A kappa test was used to determine intra- and interexaminer agreement. Area, volume, and linear measurements of MSs and PASs obtained before and after surgery were compared using a mixed model (P < .05). RESULTS: All variables of the MS showed significant postsurgical reductions in both groups, except the MS length, which showed a significant increase in group 2. Volume and minimum axial area of PAS showed statistically significant postsurgical increases in both groups (P < .05). CONCLUSIONS: Despite the reduction in the MS and the increase in the PAS, results indicated that the airway was not negatively affected after maxillomandibular advancement and maxillary advancement with mandibular setback.

The effect of inadequate access to peri-implant hygiene on marginal bone level. A 4-year cohort prospective study.

OBJECTIVE: The objective of this four-year cohort prospective study was to evaluate the effect of inadequate access to peri-implant hygiene on marginal bone level (MBL). MATERIAL AND METHODS: Forty-one partially edentulous patients (16 males and 25 females, aged 49.8 ± 11.9 years) who had implants with at least one year in function were selected. Patients were clinically and radiographically evaluated at three different times: baseline (T0), 2-year (T1), and 4-year (T2) follow-up intervals. At baseline, implants were classified and allocated into two groups: those presenting adequate access (ACC) and inadequate access (no-ACC) to peri-implant hygiene. A linear mixed-effects model for clustered longitudinal data was used to analyze MBL, probing depth (PD), plaque index (PI), and bleeding on probing (BoP). RESULTS: Of 131 implants, 74 were considered as having ACC, and 57 as having no-ACC at T0. Implants in the no-ACC group presented a statistically greater mean MBL measurement at T2 than implants in the ACC group (p = .011). In the no-ACC group, a significant reduction in PD from T0 to T1 (p = .019) and from T0 to T2 (p = .010) was observed. Regardless of the group, PI significantly increased at both T1 (p = .00001) and T2 (p = .00004). Regardless of time, the prevalence of BoP was significantly higher in the no-ACC group than in the ACC group (p = .012). CONCLUSION: Inadequate access to peri-implant hygiene frequently resulted in more peri-implant inflammation and MBL over time. Proper accessibility to peri-implant hygiene should be carefully considered during planning of implant restoration, and patients properly motivated into maintenance care.

Accuracy of 3D virtual surgical planning for maxillary positioning and orientation in orthognathic surgery.

OBJECTIVE: This retrospective and observational study evaluated the accuracy of a 3D virtual surgical planning (VSP) for the maxillary positioning and orientation in patients undergoing bimaxillary orthognathic surgery, comparing the planned and postoperative outcomes. SETTING AND SAMPLE POPULATION: Seventy consecutive patients of both sexes, who were submitted to bimaxillary orthognathic surgery between 2015 and 2019 were included in our study. MATERIAL AND METHODS: The patients were evaluated by fusing preoperative planning and postoperative outcome using cone-beam computed tomography scan evaluation. Three-dimensional VSP and postoperative outcomes were compared by using three linear and three angular measurements. The main outcome interest was the difference between the VSP movement, and the surgical movement obtained. The success criterion adopted was a mean linear difference of <2 mm and a mean angular difference of <4°. RESULTS: Results were analysed using a linear mixed model with fixed and random effects, at α = .05. No significant statistical differences were found for linear and angular measurements between the planned and postsurgical outcomes (P > .05). All overlapping points presented values within the range considered clinically irrelevant (<2 mm; <1°). CONCLUSIONS: Three-dimensional VSP was executed with a high degree of accuracy. When comparing the planned and postsurgical outcomes, all overlapping points presented values within the range considered clinically irrelevant.

Correlation between age, gender, and the number of diagnoses of temporomandibular disorders through magnetic resonance imaging: A retrospective observational study.

OBJECTIVE: The aim of this study was to evaluate the correlation among age, gender and the number of temporomandibular disorder (TMD) findings. METHODS: The records from 228 patients with TMD were analyzed for the presence of these findings: morphological changes, disc displacement with reduction (DDWR) and without reduction (DDWOR), bone edema, effusion, and avascular necrosis. Statistical analyses were conducted using multinomial regression with a 5% significance level. RESULTS: DDWR was the most frequent finding. Group 1 was composed of 94 patients (41.22%), Group 2, of 67 patients (29.38%), and Group 3, of 67 patients (29.38%). Men were significantly less likely to belong to Group 3 than women (p = 0.5517). Older patients were slightly more likely to fall in Groups 2 and 3 than in Group 1. DISCUSSION: Women were shown to be more susceptible to developing a higher number of concomitant conditions than men, and the number of findings tended to increase with age.

Effervescent Glutamine Formulation Improves the Beneficial Effects of Antiretroviral Therapies on Immune Function in HIV/AIDS Carrier Patients.

The impact of oral supplementation with an effervescent glutamine formulation on the beneficial effects of antiretroviral therapies was evaluated in people living with HIV/AIDS. For this purpose, 12 HIV/AIDS carrier patients with CD4+ T cell counts <500, and who had received the same antiretroviral therapy for at least 1 year before starting this investigation were selected. The patients were required to dissolve the effervescent glutamine formulation (supplied in sachets) in water immediately before oral ingestion (12.4 g), once a day, after lunch or after dinner during 30 days. CD4+ T cell counts, complete blood cell counts, serum cytokines, and amino acids levels were quantified; biochemical and toxicological measurements were performed. The numbers of CD4+ T cells were increased (P < .05), and the serum C-reactive protein levels decreased (P < .01) after the administration of effervescent glutamine formulation. Serum levels of interferon-gamma inducible protein-10, RANTES, and macrophage inflammatory protein-1ß were decreased after the treatment with effervescent glutamine formulation. No changes were observed in the serum levels of amino acids, hematological, toxicological, and biochemical parameters. In conclusion, the treatment during 30 days with effervescent glutamine formulation was well tolerated, promoted reduction of inflammation, and improved the beneficial effects of antiretroviral therapies in HIV/AIDS carrier patients.

Effect of ultraviolet (UV-C) radiation on spores and biofilms of Alicyclobacillus spp. in industrialized orange juice.

Bacteria of the genus Alicyclobacillus pose serious quality problems for the juice processing industries that have sought effective alternatives for its control. The present study evaluated the effect of UV-C radiation on the reduction of spores and biofilm formation of Alicyclobacillus spp. on stainless steel and rubber surfaces using industrialized orange juice as a culture medium. Four reference Alicyclobacillus spp. species and different UV-C dosages were investigated. After exposed for 20 min (16.8 kJ/m2) to UV-C, the spores of Alicyclobacillus acidoterrestris, Alicyclobacillus herbarius, and Alicyclobacillus cycloheptanicus decreased drastically more of 4 log CFU/mL, with counts below the detection limit of the method (<1.7 log CFU/mL), while the Alicyclobacillus acidocaldarius spores were more sensitive to UV-C, once this spore reduction was observed within 15 min (12.6 kJ/m2). Morphological changes in the Alicyclobacillus acidoterrestris spores were observed by scanning electron microscopy. A reduction of biofilm formation was observed for all UV-C treatments, and the higher reductions (approximately 2 log CFU/mL) were found for the Alicyclobacillus acidocaldarius species after 30 min (26.2 kJ/m2), on the stainless steel and rubber surfaces. The results suggest that UV-C can be used to reduce the biofilm formation and could be a promising alternative for controlling Alicyclobacillus spp. spores in industrialized orange juice.

Risk factors for suicidal behavior in a university population in Brazil: A retrospective study.

The present study aimed to evaluate whether variables related to personal and academic characteristics, past history, habits, and addictions were associated with suicidal behavior. Medical records of patients attending the Outpatient Psychiatry Department at the State University of Maringá between July 2016 and December 2017 were included in this retrospective study. The studied population was divided into two groups: 80 employees and 158 students. After performing the univariate analysis using Pearson's chi-square test or Fischer's exact test, the variables with p < 0.30 were included in a multivariate analysis using the binary logistic regression's backward stepwise method. The covariates 'childhood and adolescence maltreatment' and 'treatment phase' were highlighted. The first variable acts as a predictor of suicide attempt, increasing its likelihood by 9.86 times in employees and 5.62 times in students. On the other hand, the treatment phase represents a risk in patients in the adjustment phase and it serves as a predictor of SITBs in employees and students, increasing its likelihood by 7.68 and 8.66 times, respectively.

Three-dimensional alterations in pharyngeal airspace, soft palate, and hyoid bone of class II and class III patients submitted to bimaxillary orthognathic surgery: A retrospective study.

INTRODUCTION: The aim of this retrospective study was to evaluate changes in pharyngeal airway space (PAS), soft palate, and hyoid bone position after bimaxillary orthognathic surgery in skeletal Class II and Class III patients. METHODS: Patients were divided into Group 1: Class III patients who underwent maxillary osteotomies and mandibular setback surgery (N = 43); and Group 2: Class II patients who underwent maxillomandibular advancement surgery (N = 36). Cone beam computed tomography (CBCT) images were acquired one month before and six to eight months after orthognathic surgery. PAS area, volume and minimum axial area (MAA), soft-palate morphology, and hyoid bone position measurements obtained before and after orthognathic surgery were compared using the Gamma family test (p ≤ 0.10). RESULTS: In Class II group the maxillomandibular advancement surgery significantly increased the PAS area, volume, and MAA and significantly affected hyoid bone position and soft-palate morphology. In Class III group, maxillary osteotomies and mandibular setback also showed increase in PAS area, however without statistically significant values for most of the evaluated measurements. CONCLUSION: The results of the present study indicate that PAS and related structures are expected to be improved in Class II patients submitted to bimaxillary surgery, and they are not negatively affected by bimaxillary surgery in Class III patients.

Correlation between clinical variables and magnetic resonance imaging findings in symptomatic patients with chronic temporomandibular articular disc displacement with reduction: A retrospective analytical study.

Objective: To correlate the clinical aspects of symptomatic patients with chronic articular disc displacement with reduction with alterations in the articular disc (AD) morphology and sagittal position. Methods: Records from 109 patients were selected that included data on AD morphology and sagittal position as determined by MRI. According to the MRI results, the sagittal position and AD morphology with opened and closed mouth were correlated with many clinical variables. Results: More than half of the patients studied were female, and the biconcave and hemiconvex morphologies were most common. Thirty-four patients (31.3%) presented with restricted maximum interincisal distance (MID). The biplanar morphology was associated with eccentric bruxism and MID (p < 0.05). Visual analog scale (VAS) scores between 2 and 7 were shown to be risk factors (p < 0.05). Conclusion: The mouth position can influence AD morphology and eccentric bruxism. VAS scores and unknown etiology were risk factors.

Ethyl-acetate fraction of Trichilia catigua protects against oxidative stress and neuroinflammation after cerebral ischemia/reperfusion.

ETHNOPHARMACOLOGICAL RELEVANCE: Trichilia catigua A. Juss (Meliaceae) preparations have been used in folk medicine to alleviate fatigue, stress, and improve memory. Antinociceptive, antiinflammatory, and in vitro neuroprotective effects have been observed in animals. Cerebral ischemia/reperfusion (I/R) leads to severe neuropsychological deficits that are largely associated with oxidative stress, inflammation and neurodegeneration. We reported previously that an ethyl-acetate fraction (EAF) of T. catigua reduced brain ischemia-induced learning and memory impairments in the absence of histological protection. AIM OF THE STUDY: Continuing those studies, here we aimed to investigate the antioxidant and antiinflammatory properties of T. catigua in an in vivo model of I/R. MATERIAL AND METHODS: Rats were subjected to 15 min of brain ischemia (4-VO model) followed by up to 15 days of reperfusion. Vehicle was given by gavage 30 min before ischemia and at 1 h of reperfusion. In a first experiment, brain ischemia-induced changes in oxidative stress markers, i.e., reduced glutathione (GSH), oxidized glutathione (GSSG), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA), and protein carbonyl groups (PCGs) were measured on days 1, 3, and 5 post-ischemia. Similar time course analysis was done for neuroinflammation markers, i.e., microglia (OX42 immunorreactivity) and astrocytes (GFAP immunorreactivity), in the hippocampus. In a second experiment, the time points at which these markers of oxidative stress and neuroinflammation peaked were used to test the effects of T. catigua (400 mg/kg, p.o.). RESULTS: Oxidative stress markers peaked on day 1 post-ischemia. GSH decreased (-23.2%) while GSSG increased (+ 71.1%), which yielded a significant reduction in the GSH/GSSG ratio (-39.1%). The activity of CAT was largely reduced by ischemia (-54.6% to -65.1%), while the concentration of PCG almost doubled in the brain of ischemic rats (+99.10%) in comparison to sham. Treatment with the EAF of T. catigua normalized these changes in oxidative markers to the control levels (GSH: +27.5%; GSSG: -23.8%; GSH/GSSG: +44.6%; PCG: -80.3%). In the hippocampus, neuroinflammation markers peaked on day 5 post-ischemia, with microglial and astrocytic responses increasing to 54.8% and 37.1%, respectively. The elevation in glial cells response was completely prevented by EAF. CONCLUSION: These results demonstrate that T. catigua has both antioxidant and antiinflammatory activities after transient global cerebral ischemia in rats, which may contribute to the previously reported memory protective effect of T. catigua.

Fatores associados e predição da retinopatia da prematuridade / Retinopathy of prematurity: associated factors and prediction

Resumo Introdução A retinopatia da prematuridade (ROP) é uma doença vasoproliferativa, que afeta a retina das crianças que nascem prematuramente; assim, este estudo propôs identificar fatores associados e predizer a retinopatia na prematuridade. Método Realizou-se um estudo transversal, com recém-nascidos prematuros, dividindo-os em dois grupos: com e sem retinopatia. As variáveis foram categorizadas por meio do teste da razão de verossimilhança e as variáveis que obtiveram p-valores menores que 0,2 foram analisadas por um modelo logístico múltiplo. A capacidade de predição do modelo foi realizada por meio da construção da curva ROC. Resultados Dos 296 recém-nascidos, 32 (10,81%) apresentaram retinopatia. No modelo logístico, as variáveis que apresentaram fator de risco foram idade gestacional ≤ 30 semanas (p-valor=0,0214), peso ao nascer ≤ 1.250 gramas (p-valor=0,0013) e escore Apgar no primeiro minuto < 7 (p-valor=0,0352). A curva ROC com sensibilidade 0,771 e especificidade 0,774 evidenciou o modelo com precisão de 0,8448 e ponto de probabilidade de 0,79. Conclusões Este modelo pode ser usado para predição de retinopatia em recém-nascidos prematuros com um fator de risco de 0,79, destacando que estes necessitam de maior atenção.

Abstract Introduction Retinopathy of prematurity (ROP) is a vasoproliferative disease that affects the retina of prematurely born children. Therefore, this study proposed to identify associated factors and to predict retinopathy in prematurity. Method A cross-sectional study including preterm newborns divided into two groups: with and without retinopathy. The variables were categorized using the likelihood ratio test, and the variables with p-values less than 0.2 were analyzed by a multiple logistic model. The model used the construction of a Receiver Operating Characteristic (ROC) curve as predicting tool. Results Of the 296 newborns, 32 (10.81%) had retinopathy. The following variables represented a risk factor according to the logistic model: gestational age ≤ 30 weeks (p-value = 0.0214), birth weight ≤ 1250 grams (p-value = 0.0013) and Apgar score at 1 minute <7 (p-value = 0.0352). The ROC curve with sensitivity of 0.771 and specificity of 0.774 was a precise model, showing accuracy of 0.8448 and a probability point of 0.79. Conclusions This model can be used to predict retinopathy in premature newborns with a risk factor of 0.79, emphasizing that the need for additional attention.

Prevalence of Streptococcus agalactiae colonization in pregnant women from the 18th Health Region of Paraná State.

Introduction The aim of this study was to determine the prevalence of GBS colonization in pregnant women in a public health service. Methods A study of 496 pregnant women at 35-37 gestational weeks was conducted from September 2011 to March 2014 in 21 municipalities of the 18th Health Region of Paraná State. Vaginal and anorectal samples of each woman were plated on sheep blood agar, and in HPTH and Todd-Hewitt enrichment broths. Results Of the 496 pregnant women, 141 (28.4%) were positive for GBS based on the combination of the three culture media with vaginal and anorectal samples. The prevalence was 23.7% for vaginal samples and 21.9% for anorectal ones. Among the variables analyzed in this study, only urinary infection was a significant factor (0.026) associated with GBS colonization in women. Conclusions Based on these results, health units should performs universal screening of pregnant women and hospitals should provide adequate prophylaxis, when indicated.

Impact of HBV and HCV coinfection on CD4 cells among HIV-infected patients: a longitudinal retrospective study.

INTRODUCTION: The impact of hepatitis B virus (HBV) and hepatitis C virus (HCV) coinfection on CD4 cells in patients with human immunodeficiency virus (HIV) is unclear. We aimed to examine the impact of HBV and HCV coinfection on CD4 cell count and CD4/CD8 ratio in adults with HIV. METHODOLOGY: We conducted a longitudinal retrospective study in Brazil between January 1, 2002, and June 30, 2016, including 205 patients with HIV monoinfection, 37 with HIV-HBV coinfection, 35 with HIV-HCV coinfection, and 62 with HIV-HCV (48 HCV genotype 1 and 14 HCV genotype 3). RESULTS: Median duration of follow-up was 2,327 (interquartile range: 1,159-3,319) days. An increased CD4 cell count and CD4/CD8 ratio over time was observed in all groups receiving combined antiretroviral therapy (cART). Patients with HIV-HBV or HIV-HCV coinfection and those with HIV monoinfection, showed comparable CD4 cell counts and CD4/CD8 ratios during pre-ART. There was also no statistically significant difference in CD4/CD8 ratio between HIV-HBV or HIV-HCV coinfection groups and the HIV monoinfection group during follow-up on cART. However, CD4 cell counts were significantly lower in HIV-HCV patients than in HIV monoinfection patients during follow-up on cART. HIV patients with HCV genotype 3 coinfection showed significantly lower CD4/CD8 ratio during follow-up on cART than those coinfected with HCV genotype 1 coinfection. No statistically significant effect of coinfection was observed on the efficacy of cART. CONCLUSIONS: HIV-infected patients are more likely to show better immunological responses to cART when they are not coinfected with HCV.