The effects of informed consent format on preoperative anxiety in patients undergoing inferior third molar surgery

Objectives: To evaluate the effect of informed consent format on preoperative anxiety of patients.Material and Methods: We performed a prospective study (91 patients) undergoing lower third molar extraction. Patients were distributed into three groups. Informed consent for surgery was obtained through a written document, an oral interview or a video recording. Afterwards, patients were asked about their anxiety level and the effect the informed consent had had on it. Results: Whereas the information conveyed both in oral and written formats relieved the patient to some extent (in a scale of -3 to +3) 0.97±1.21 and 0.29±0.97, respectively), the video recording increased patient’s anxiety in a statistically significant way (in a scale of -3 to +3, -0.57±1.43). The difference obtained between the values obtained in oral and written information was not statistically significant.Discussion: The most adequate format, according to our study, would be the oral format. Key words:Anxiety, satisfaction, third molar surgery, Spielberger State-Trait Anxiety Inventory.     

Prevalence of antibodies against Rickettsia conorii,Babesia canis,Ehrlichia canis,and Anaplasma phagocytophilum antigens in dogs from the Stretto di Messina area (Italy)

The aims of this study were to determine the seroprevalence for Rickettsia conorii, Ehrlichia canis, Anaplasma phagocytophilum, and Babesia canis in outdoor-kennelled dogs (n = 249) from the Stretto di Messina (Italy) and to compare seroprevalence in 2 public shelters and 4 privately-owned kennels where different tick-preventive measures were implemented in order to focus on the specific sanitary risk posed by public shelters in southern Italy for tick-borne pathogens. R. conorii (72%) and B. canis (70%) were the most prevalent infections when compared to E. canis (46%) and A. phagocytophilum (38%). Seroprevalence for R. conorii, E. canis, and A. phagocytophilum was significantly higher in public shelters than in private kennels. However, B. canis seropositivity was similar in both types of kennels. In addition, in private kennels where a regular ectocide treatment was carried out by means of spot-on devices, dogs did not present E. canis and A. phagocytophilum antibodies. One hundred fifty-one dogs out of 249 (61%) were seropositive to more than one pathogen with R. conorii and B. canis the most common ones. Coinfections were more frequently found in public-shelter dogs. This study demonstrated high seroprevalences against R. conorii, B. canis, E. canis, and A. phagocytophilum in kennelled dogs from both coastal sites of the Stretto di Messina and the importance of regular tick-bite prevention by means of individual spot-on devices.     

Middle rectal artery: myth or reality? Retrospective study with CT angiography and digital subtraction angiography

This work aimed to study the prevalence and radiologic anatomy of the middle rectal artery (MRA) using computed tomographic angiography (CTA) and digital subtraction angiography (DSA). The retrospective study (October 2010–February 2012) focused in 167 male patients with prostate enlargement (mean age 64.7 years, range 47–81 years) who underwent selective pelvic arterial embolization for the relief of lower urinary tract symptoms. All patients underwent CTA previously to DSA to evaluate the vascular anatomy of the pelvis and to plan the treatment. MRAs were identified and classified according to their origin, trajectory, termination and relationship with surrounding arteries. We found MRAs in 60 (35.9 %) patients (23.9 % of pelvic sides, n = 80) and of those, 20 (12 %) had bilateral MRAs; 24 MRAs (30 %) were independent of neighbouring arteries and 56 MRAs (70 %) had common origins with prostatic arteries (prostato-rectal trunk). The most frequent MRA origin was the internal pudendal artery (60 %, n = 48), followed by the inferior gluteal artery (21.3 %, n = 17) and common gluteal-pudendal trunk (16.2 %, n = 13). In 2 patients the MRA originated from the obturator artery (2.5 %). Anastomoses to the superior rectal and inferior mesenteric arteries were found in 87.5 % of cases (n = 70). We concluded that MRAs are anatomical variants present in less than half of male patients; have variable origins and frequently share common origins with prostatic arteries. Their correct identification is likely to contribute to improve interventional radiology procedures and prostatic or rectal surgeries.     

Brazilian version of the instrument of environmental assessment Craig Hospital Inventory of Environmental Factors (CHIEF): translation,cross-cultural adaptation and reliability

Background:

Environmental factors are essential for the characterization of human functioning and disability; however, the shortage of standardized instruments to assess environmental factors has limited the design of scientific investigations directed at identifying barriers to and facilitators of social participation of people with disabilities.

Objectives

: To translate to Brazilian Portuguese, cross-culturally adapt, and verify the reliability of an environmental assessment questionnaire, entitled Craig Hospital Inventory of Environmental Factors (CHIEF).

Method

: The questionnaire was translated to Portuguese, analyzed, translated back to English, and compared with the original version. The final version (CHIEF-BR) was submitted to 47 caregivers of children and adolescents with cerebral palsy (CP). The intra-rater reliability was tested using quadratic kappa and intraclass correlation coefficients (ICC), through interviews of 23 caregivers drawn from the total sample, on two occasions 10 days apart.

Results

: During submission of the questionnaires, it was observed that examples were needed in order to facilitate the understanding of the questions related to the politics sub-scale. Quadratic kappa showed that test-retest reliability of each question varied from 0.28 to 1.0 for the frequency score and from 0.30 to 0.98 for the magnitude score. Intraclass correlation coefficients for total scores showed high consistency indices (ICC≥0.92) for test-retest.

Conclusion

: The Brazilian version of the CHIEF was reproducible and applicable to the study sample. It may serve as an instrument to characterize the environmental barriers as well as a way to document the effects of interventions aimed at minimizing the impact of such barriers on the participation of children and adolescents with CP.     

Anti-Giardia activity of phenolic-rich essential oils: effects of Thymbra capitata, Origanum virens, Thymus zygis subsp. sylvestris, and Lippia graveolens on trophozoites growth, viability, adherence, and ultrastructure

The present work evaluates the anti-Giardia activity of phenolic-rich essential oils obtained from Thymbra capitata, Origanum virens, Thymus zygis subsp. sylvestris chemotype thymol, and Lippia graveolens aromatic plants. The effects were evaluated on parasite growth, cell viability adherence, and morphology. The tested essential oils inhibited the growth of Giardia lamblia. T. capitata essential oil is the most active followed by O. virens, T. zygis subsp. sylvestris, and L. graveolens oils. The tested essential oils at IC50 (71–257) μg/ml inhibited parasite adherence (p < 0.001) since the first hour of incubation and were able to kill almost 50% of the parasites population in a time-dependent manner. The main ultrastructural alterations promoted by essential oils were deformations in typical trophozoite appearance, often roundly shape, irregular dorsal and ventral surface, presence of membrane blebs, electrodense precipitates in cytoplasm and nuclei, and internalization of flagella and ventral disc. Our data suggest that essential oils induced cell death probably by processes associated to the loss of osmoregulation caused by plasmatic membrane alterations. Experiments revealed that the essential oils did not present cytotoxic effects in mammalian cells. In conclusion, T. capitata, O. virens, T. zygis subsp. sylvestris chemotype thymol, and L. graveolens essential oils have antigiardial activity in vitro and seem to have potential for the treatment of the parasitic disease caused by the protozoan G. lamblia.     

Serotonin decreases the production of Th1/Th17 cytokines and elevates the frequency of regulatory CD4+ T‐cell subsets in multiple sclerosis patients

Excessive levels of proinflammatory cytokines in the CNS are associated with reduced serotonin (5‐HT) synthesis, a neurotransmitter with diverse immune effects. In this study, we evaluated the ability of exogenous 5‐HT to modulate the T‐cell behavior of patients with MS, a demyelinating autoimmune disease mediated by Th1 and Th17 cytokines. Here, 5‐HT attenuated, in vitro, T‐cell proliferation and Th1 and Th17 cytokines production in cell cultures from MS patients. Additionally, 5‐HT reduced IFN‐γ and IL‐17 release by CD8⁺ T cells. By contrast, 5‐HT increased IL‐10 production by CD4⁺ T cells from MS patients. A more accurate analysis of these IL‐10‐secreting CD4⁺ T cells revealed that 5‐HT favors the expansion of FoxP3⁺CD39⁺ regulatory T cells (Tregs) and type 1 regulatory T cells. Notably, this neurotransmitter also elevated the frequency of Treg17 cells, a novel regulatory T‐cell subset. The effect of 5‐HT in upregulating CD39⁺ Treg and Treg17 cells was inversely correlated with the number of active brain lesions. Finally, in addition to directly reducing cytokine production by purified Th1 and Th17 cells, 5‐HT enhanced in vitro Treg function. In summary, our data suggest that serotonin may play a protective role in the pathogenesis of MS.