Active search strategies, clinicoimmunobiological determinants and training for implementation research confirm hidden endemic leprosy in inner São Paulo, Brazil.

BACKGROUND: This study evaluates implementation strategies for leprosy diagnosis based on responses to a Leprosy Suspicion Questionnaire (LSQ), and analyzes immunoepidemiological aspects and follow-up of individuals living in a presumptively nonendemic area in Brazil. METHODOLOGY/PRINCIPAL FINDINGS: Quasi-experimental study based on LSQ throughout Jardinópolis town by community health agents, theoretical-practical trainings for primary care teams, dermatoneurological examination, anti-PGL-I serology, RLEP-PCR, and spatial epidemiology. A Leprosy Group (LG, n = 64) and Non-Leprosy Group (NLG, n = 415) were established. Overall, 3,241 LSQs were distributed; 1,054 (32.5%) LSQ were positive for signs/symptoms (LSQ+). Among LSQ+ respondents, Q2-Tingling (pricking)? (11.8%); Q4-Spots on the skin? (11.7%); Q7-Pain in the nerves? (11.6%); Q1-Numbness in your hands and/or feet? (10.7%) and Q8-Swelling of hands and feet? (8.5%) were most frequently reported symptoms. We evaluated 479 (14.8%) individuals and diagnosed 64 new cases, a general new case detection rate (NCDR) of 13.4%; 60 were among 300 LSQ+ (NCDR-20%), while 4 were among 179 LSQ negative (NCDR-2.23%). In LG, Q7(65%), Q2(60%), Q1(45%), Q4(40%) and Q8(25%) were most frequent. All 2x2 crossings of these 5 questions showed a relative risk for leprosy ranging from 3 to 5.8 compared with NLG. All patients were multibacillary and presented hypochromatic macules with loss of sensation. LG anti-PGL-I titers were higher than NLG, while 8.9% were positive for RLEP-PCR. The leprosy cases and anti-PGL-I spatial mappings demonstrated the disease spread across the town. CONCLUSIONS/SIGNIFICANCE: Implementation actions, primarily LSQ administration focused on neurological symptoms, indicate hidden endemic leprosy in a nonendemic Brazilian state.

Clinical Manifestation, Dermoscopy, and Scanning Electron Microscopy in Two Cases of Contagious Ecthyma (Orf Nodule).

Orf is a highly contagious skin disease commonly seen in goats and sheep that can be transmitted to people who have direct contact with infected animals. Here, we report the clinical manifestation, dermoscopy, and scanning electron microscopy in two women who developed skin lesions on their hands after handling goats with wounds in the udders. Human orf is usually self-limiting and no specific treatment is needed.

Association between bruxism, alcoholand tobacco use among brazilian students / Relação entre bruxismo e consumo de álcool e tabaco em estudantes brasileiros

Diferentes fatores que afetam o sistema nervoso central são considerados de risco para o bruxismo. Universitários não são imunes ao bruxismo, consumo de álcool e uso de tabaco apesar de sua formação e responsabilidade social. Avaliou-se a associação entre bruxismo, consumo de álcool e tabaco entre graduandos de Odontologia. Foram voluntários 180 estudantes (17-29 anos) da Faculdade de Odontologia de Araçatuba/ UNESP, divididos entre aqueles com e sem bruxismo, com base em critérios clínicos validados realizados por quatro examinadores com luz natural e espátula de madeira. Bruxismo foi registrado nas seguintes categorias: sem facetas de desgaste; facetas no esmalte; facetas na dentina; facetas em metade da coroa e facetas em mais de 2/ 3 da coroa. Auto-questionário validado para o consumo de álcool e tabaco, com 29 perguntas foi respondido pelos dois grupos. Teste T e Exato de Fischer foram aplicados. Bruxismo foi mais frequente entre tabagistas, tanto em homens (68,4%) como mulheres (56,8%). Entre os indivíduos com bruxismo, 82,6% relataram que gostariam de parar de fumar e aqueles que anteriormente tentaram (76,4%) sentiram-se mais estressados ao parar. O consumo de álcool também foi mais frequente no grupo com bruxismo (66,5% no gênero feminino e 73,5% no masculino). 88,4% relataram consumir álcool “para lidar com o estresse de forma adequada”. Resultados sugerem associação positiva entre bruxismo, consumo de álcool e tabagismo

The etiology of bruxism is not well defined. Different factors affecting the central nervous system are considered as risk factors for bruxism. Dental students are not immune to the bruxism, alcohol consumption and tobacco use, despite their training, knowledge of its effects and social responsibility. The purpose of this study was to evaluate the association between bruxism, alcohol consumption and tobacco use among Brazilian dental students. Participants were chosen among 180, 17-29 year-old students at the UNESP’s Dentistry School – Araçatuba Campus. They were divided into those with and without bruxism on the basis at validated clinical criteria. The clinical examinations were carried out by four standardized examiners (Intraexaminer and Interexaminer Unweighted kappa= 0.82, Weighted kappa= 0.89, respectively), in the clinic, with daylight and a tongue depressor. Bruxism was registered with the following categories: no wear facets, wear facets in enamel, dentine wear facets, facets wear half of the crown and wear facets more than 2/3 of the tooth crown. A self report validated questionnaire for alcohol consumption and tobacco use with 29 questions was completed by both groups. Fischer exact test and T-test were used and Odds Ratio and Confidence Interval was estimated. Bruxism was more frequent among cigarette smokers both in men (68.4%) and in women (56.8%). Among all respondents in this group, 82.6% reported that they would like to quit smoking and those who have tried previously to quit (76.4%) found it made them more stressed. Drinker was more frequent in the group with bruxism also (66.5% of the female and 73.5% of the male). 88.4% reported drinking alcohol because it “allows dealing with stress in an adequate way”. Results suggest a positive association between bruxism and alcohol consumption and tobacco use

Parafunctionalactivities in brazilian children and adolescent / Prevalência de hábitos parafuncionais em crianças e adolescentes brasileiros

O crescimento craniofacial é o resultado da interação de mecanismos genéticos, hormonais e neurológicos, influenciados pela ação do meio ambiente e da função. As variações das funções normais de respiração, mastigação, deglutição, sucção e fonação, podem, devido à sua interdependência morfofuncional com o crescimento da face, resultar em má oclusões, as quais exercem papel determinante na conformação óssea e neuromuscular do sistema estomatognático. A prevenção e interceptação dos hábitos parafuncionais é de fundamental importância para o desenvolvimento físico e emocional da criança. O propósito deste trabalho foi determinar a prevalência de hábitos parafuncionais em alunos do ensino fundamental do Colégio Ipê de Assis (Assis, SP). No presente estudo foi aplicado questionário proposto pelo Núcleo de Diagnóstico e Tratamento das DTMs da Faculdade de Odontologia de Araçatuba, Unesp. O universo e a amostra foram compostos pelos 80 alunos do ensino fundamental do Colégio Ipê de Assis (Assis, SP). A execução do projeto foi autorizada pelo Comitê de Ética em Pesquisa da Faculdade de Odontologia de Araçatuba/Unesp.Todos os responsáveis pelos alunos receberam instrução arespeito da pesquisa quanto à preservação de identidade e prestação de esclarecimentos em caso de dúvida. Ademais, foi solicitado que assinassem otermo de consentimento esclarecido, a fim de viabilizar a participação dos alunos. Os alunos (10 a 14 anos0 foram classificados em dois grupos: Grupo I – gênero feminino e Grupo II - gênero masculino. Além disso, os Grupos I e II foram classificados segundo as séries em curso e os hábitos bucais apresentados. Entre os hábitos parafuncionais detectados, mascar chiclete foi o hábito mais prevalente para ambos os grupos (72,2% no Grupo I e 78,5% no Grupo II) e em todos os anos, seguido de apoiar a mão no queixo (69,5% para o Grupo I e 67% para o Grupo II). Morder a língua foi o hábito menos prevalente no Grupo II e dormir de bruços no Grupo I. A alta...

The etiology of TMD in children and adolescents is considered multifactorial and has been related to parafunctional habits.The objective of this research was to determine the prevalence of parafunctional habits in elementary school students of “Colégio Ipê de Assis” (Assis, SP - Brazil). In the present research was administered questionnaire (15 questions) proposed by the Center for Diagnosis and Treatment of TMD, School of Dentistry of Araçatuba, UNESP. The sample was composed of 80 elementary school students of the “Colégio Ipê de Assis” (Assis, SP - Brazil). The project was approved by the Ethics Committee in Research of the School of Dentistry of Araçatuba/ UNESP. All parents and responsible of the students received instruction about the research and preservation of identity and provide clarification if in doubt. Beyond that, they were requested to sign the informed consent in order to facilitate the participation of students. Females comprised 47,5% and males 52,5%, with age ranging from 10 to 14. The students were classified into two groups as follows: Group I-female, Group II- male. In addition, brazilian students from Groups I and II were classified according to type of oral habits presented. All students presented a parafunctional habit. Among the parafunctional habits chewing gum was the most common in both groups (72.2%, Group I and 78.5%, Group II) followed by resting chin on hand for both genders (69,5% for Group I and 67% for Group II). Tongue biting (5%) was less founded in Group II and stomach sleeping in Group I. The results obtained show the necessity of carring out preventive programs. Beside, resources of Health should increase preventive treatments

Sinais e sintomas na Síndrome de Costen associada a desordens temporomandibulares: relato de caso clínico / Signs and symptoms in Costen’s Syndrome in association with TMD: report of clinic case

Definida como um conjunto de sinais e sintomas auditivos em pacientes portadores de DTM, a Síndrome de Costen é caracterizada por sensação de plenitude auricular, hipoacusia, zumbido, otalgia e vertigem com nistagmo. Herpes, glossodinia, neuralgia glossofaringeal e trismo também podem estar associados. A Síndrome de Costen parece ter predileção pelo sexo feminino e na quarta década de vida. O acompanhamento multiprofissional desses pacientes é imperativo no seu reconhecimento e no estabelecimento de terapêutica eficaz. Relatou-se caso clínico de paciente com Síndrome de Costen cujo tratamento consistiu na orientação sobre a etiologia da desordem e sessões semanais de acupuntura. As características clínicas que levaram ao diagnóstico e plano de tratamento, bem como a eficácia da acupuntura como terapêutica de suporte também foram discutidas

Costen’s syndrome is defined as a set of auditory signs and symptoms in patients with TMD. It is characterized by ear fullness, hearing loss, tinnitus, ear pain and vertigo with nystagmus.It has predilection for females and fourth decade of life. The multidisciplinary monitoring of these patients is imperative in its recognition and the establishment of effective therapy. In this paper we report a case of Costen’s Syndrome patient whose treatment consisted of advice on the etiology of the disorder and weekly sessions of acupuncture. The clinical features that led to the diagnosis and treatment plan, and the effectiveness of acupuncture as supportive therapy were also discussed