Clinical and radiological study of swallowing in patients with deglutition disorders, classified into two age groups: adults and older people

BACKGROUND: The abnormalities of swallowing process have multifactor and complex etiologies. The videofluoroscopy has been pointed as the exam of greater utility in diagnostic investigation for these cases. This method, when preceded of an adequate anamnesis, can characterize conveniently the level of the dysfunction and usually identify the cause of abnormality with great precision. AIMS: To study the clinical complaints and findings of the videofluoroscopy examination in patients with deglutition disorders and no clinical evidence associated with neurological disorder, classified into two age groups: adults and older people, and to analyze: symptomatic manifestations, kinds of disorders (oropharyngeal or esophageal) and the capacity of clarifying the clinical complaints through the method of images. MATERIALS AND METHODS: Seventy patients with complaint of the capacity of deglutition were analyzed. They had no clinical evidence of associated neurological syndromes or disorders and were classified into two age groups: adults (GI)-- < or = 65 years (n = 36) and older (GII) > 65 years (n = 34). All patients were submitted to anamnesis to obtain the information about their complaints concerning deglutition. The complaints were characterized as high or low, according to their predominant location of manifestation. All the patients were submitted to videofluoroscopy of the deglutition; these alterations were characterized as oropharyngeal or esophageal. The capacity of clarifying the clinical complaints by videofluoroscopy was evaluated in both groups. RESULTS: Among the complaints analyzed, the only one in which the statistical analysis presented a significant difference between the groups was the complaint of heartburn, which occurred more often in the group GI-- eight patients (22.2%) and GII--one patient (2.9%). In the study of videofluoroscopy, it was observed a higher incidence in the oropharyngeal disorder in group GII--41.2% while in group GI--13.9%. As for the esophageal disorder, the incidence was similar in both groups GI - 35.3% and GII--33.3%. Nineteen patients (52.8%) in GI and 23 (67.6%) in GII had their complaints clarified through the videofluoroscopy. CONCLUSIONS: Under the conditions of this study, it can be concluded that: 1.The clinical complaints associated with the difficulty of deglutition occur at a similar frequency in adults and older people, with the exception of heartburn that occurs in larger number among adults; 2. Older people present a higher incidence of oropharyngeal deglutition problems; 3. The videofluoroscopy of the deglutition represents a method of great importance for the diagnosis, because it allows the identification of morphofunctional disorders that cannot be adequately identified by anamnesis; 4. The capacity of clarifying diagnosis of the videofluoroscopy of the deglutition is higher in the older people group.     

Effect of sodium hypochlorite on primary dentin--a scanning electron microscopy (SEM) evaluation

OBJECTIVE: The aim of this study was to evaluate the alterations of etched deciduous dentin when submitted to different time and concentrations of sodium hypochlorite (NaOCl), using scanning electron microscopy (SEM). MATERIAL AND METHODS: Forty deciduous anterior teeth were selected, cleaned and ground until expose a flat dentin area on the buccal surface. The specimens were randomly distributed into eight groups (n=5), according to dentin surface treatment (35% phosphoric acid etching for 7s--AE and/or NaOCl application), NaOCl solution concentration (5% or 10%), and time of application (0, 30, 60, and 120 s), as follows: G1: control (without AE and NaOCl); G2: only AE; G3, G4, and G5: AE+5% NaOCl for 30, 60, and 120 s, respectively; G6, G7, and G8: AE+10% NaOCl for 30, 60, and 120 s, respectively. All specimens were prepared for SEM analysis and the photomicrographs (three for each specimen) were classified according to a score as follow: 0: presence of smear layer (SL); 1: absence of SL+non-altered collagen fibrils; 2: absence of SL+collagen fibrils slightly altered; 3: absence of SL+collagen fibrils severely altered; and 4: absence of SL and absence of collagen fibrils. Data were submitted to Kruskal-Wallis and Mann-Whitney tests (p<0.05). RESULTS: All groups treated with NaOCl solution were significant different from G1 and G2, and showed alterations on the collagen fibrils network. Collagen complete removal was only observed when a 5% NaOCl solution was applied for 120 s and 10% NaOCl solution for 30, 60, and 120 s. CONCLUSIONS: The NaOCl action produced significant changes in the etched deciduous dentin. The higher NaOCl concentration, the lower the time required to completely removing the collagen fibrils network in deciduous dentin.     

Compressive strength recovery by composite onlays in primary teeth. Substrate treatment and luting agent effects

OBJECTIVES: To evaluate 1% NaOCl treatment and two resin luting agent effects on compressive strength recovery in composite onlays on primary teeth and to analyze the fractures type. METHODS: Forty sound primary molars crowns were prepared in the standard machine and randomly divided into four groups (n=10): G1 (1% NaOCl/ 30 min+EnForce); G2 (without 1% NaOCl EnForce); G3 (1% NaOCl/ 30 min+Rely X); G4 (without 1% NaOCl+Rely X). The onlays were made using Z250 composite on plaster models. Ten sound teeth were used as control group (CG). All groups were submitted to compression mechanic test in a universal test machine INSTRON at 1mm/min cross-head speed. After that, the data (kgf) were submitted to ANOVA test (alpha=0.05). Finally, the fracture types were classified in a crescent scale (1-5) related with severity degree and submitted to Fisher's Exact Test (p<0.05). Scanning electronic microscope analysis was done in order to illustrate the fractures sites. RESULTS: The values of compressive strength of experimental groups did not differ each others neither from control group (p>0.05). The results from fracture type showed that types 5 and 4 fractures (most severe) present the highest percentage to experimental groups. Conversely, the CG showed higher percentage of fracture types 2 and 3. CONCLUSIONS: This research found that the composite onlays recovered the compressive strength compared to sound teeth, regardless of the substrate treatment and cement agent used. Nevertheless, no group showed similar type of fractures to CG, which had more frequency of less severe fracture types.     

Leishmanicidal candidate LASSBio-1736, a cysteine protease inhibitor with favorable pharmacokinetics: low clearance and good distribution

Abstract

1.?LASSBio-1736 ((E)-1-4(trifluoromethyl) benzylidene)-5-(2-4-dichlorozoyl) carbonylhydrazine) is proposed to be an oral cysteine protease leishmanicidal inhibitor.

2.?This work aimed to investigate plasma pharmacokinetics, protein binding and tissue distribution of LASSBio-1736 in male Wistar rats.

3.?LASSBio-1736 was administered to male Wistar rats at doses of 3.2?mg/kg intravenously and 12.6?mg/kg oral and intraperitoneal. The individual plasma-concentration profiles were determined by HPLC-UV and evaluated by non-compartmental and population pharmacokinetic analysis (Monolix 2016R1, Lixoft). Tissue distribution was evaluated after iv injection of 3.2?mg/kg drug by non-compartmental approach.

4.?After intravenous administration, Vd_ss (1.79?L/kg), t _½ (23.1?h) and CL_tot (56.1?mL/h/kg) were determined, and they were statistically similar (α?=0.05) to oral and intraperitoneal pharmacokinetic parameters. The plasma profiles obtained after intravenous, oral and intraperitoneal administration of the compound were best fitted to a three-compartment and one-compartment open model with first-order absorption.

5.?The intraperitoneal and oral bioavailability were around 40 and 15%, respectively.

6.?Liver, spleen and skin tissues showed penetration of 340, 130 and 40%, respectively, with t _½ like plasma values.

7.?LASSBio-1736 protein binding was 95?±?2%.

8.?The t _½, CL_tot and tissue distribution of the compound agreed with the desired drug characteristics for leishmanicidal activity.     

The perception of hypertensive elderly patients regarding their health needs

Considering the prevalence of arterial hypertension among the elderly, the present study analyzes their perception of health needs, in a qualitative way, from focal groups with elderly users of Family Health Units. Data analysis was performed according to the hermeneutic-dialectical perspective and resulted in three nuclei of meaning: recognizing the possibility of having access to basic health care together with the desire to consume services of greater complexity and understanding the shortcomings of the State; attachment and welcoming as fundamental elements in the feelings of support and security and autonomy permeated by the tranquility to deal with the disease and the difficulties imposed by conditions inherent to the subjects' life style. Therefore, it is understood that the Family Health Strategy has been complying with its role in terms of the access to the healthcare system and regarding the professional-user attachment. However, health care continues to be centered on the disease rather than the individual.     

The Role of PAI-1 and Adiponectin on the Inflammatory State and Energy Balance in Obese Adolescents with Metabolic Syndrome

Obesity is a chronic inflammatory disease and is considered a risk factor for metabolic syndrome. In this study, 57 obese adolescents with and without metabolic syndrome underwent 1?year of weight loss therapy. At baseline, the metabolic syndrome (MS) patients presented higher values of PAI-1 than the non-metabolic syndrome patients (n-MS). After therapy, significant improvements in anthropometrics and biochemical, inflammatory, and neuroendocrine variables were observed in both groups. However, the n-MS group presented better results than the MS group. Indeed, we found positive correlations in both groups between PAI-1 and neuropeptide Y (NPY) and between PAI-1 and NPY/AgRP. Inflammatory biomarkers may thus play a role in energy balance. The clinical trial registration number is NCT01358773.     

Mini-Mental State Examination sentence writing among community-dwelling elderly adults in Brazil: text fluency and grammar complexity

ABSTRACT Background: In normal aging, the decrease in the syntactic complexity of written production is usually associated with cognitive deficits. This study was aimed to analyze the quality of older adults' textual production indicated by verbal fluency (number of words) and grammatical complexity (number of ideas) in relation to gender, age, schooling, and cognitive status. Methods: From a probabilistic sample of community-dwelling people aged 65 years and above (n = 900), 577 were selected on basis of their responses to the Mini-Mental State Examination (MMSE) sentence writing, which were submitted to content analysis; 323 were excluded as they left the item blank or performed illegible or not meaningful responses. Education adjusted cut-off scores for the MMSE were used to classify the participants as cognitively impaired or unimpaired. Total and subdomain MMSE scores were computed. Results: 40.56% of participants whose answers to the MMSE sentence were excluded from the analyses had cognitive impairment compared to 13.86% among those whose answers were included. The excluded participants were older and less educated. Women and those older than 80 years had the lowest scores in the MMSE. There was no statistically significant relationship between gender, age, schooling, and textual performance. There was a modest but significant correlation between number of words written and the scores in the Language subdomain. Conclusions: Results suggest the strong influence of schooling and age over MMSE sentence performance. Failing to write a sentence may suggest cognitive impairment, yet, instructions for the MMSE sentence, i.e. to produce a simple sentence, may limit its clinical interpretation.     

The meaning of home visits conducted by medicine and nursing students: a qualitative study with users of family health units

Home visits (HVs) are considered an important technology to comprehend and care for the population's health requirements. Therefore, they must be a part of the health professionals' education. This study seeks to analyze HVs performed by first-year medical and nursing students from the viewpoint of family health unit users. It is a qualitative study in which data are collected by means of semi-structured interviews with users who are visited by Marilia Medical School medical and nursing students. The interpretation of meaning method is used and is based on a hermeneutic-dialectic perspective. The users find it positive that the students go beyond the biological care of the body and focus on interpersonal interrelationships. Nevertheless, the users believe it is necessary to organize and plan HVs accordingly. It may thus be inferred that HVs elicit the interaction between humanized healthcare and its users. Planning and reinforcement of health actions must be continuously improved when planning and conducting home visits.     

Genetic diversity and clonal patterns among antibiotic-susceptible and -resistant Streptococcus pneumoniae colonizing children: day care centers as autonomous epidemiological units

Characterization by antibiotype of the 1,096 Streptococcus pneumoniae recovered from 2,111 nasopharyngeal samples of children attending 16 day care centers (DCCs) in Lisbon, Portugal, and molecular typing of 413 drug-resistant pneumococci (DRPn) and 89 fully drug-susceptible pneumococci (DSPn) has allowed several conclusions. (i) There was an increase in the frequency of DRPn colonizing children in DCCs from 40% in 1996 to 45% in 1997 to 50% in 1998. (ii) Drug resistance spread by cross-transmission of DRPn clones. A few (8 out of 57) DRPn clones were repeatedly isolated from a large number of children in several DCCs and during each period of surveillance, suggesting the epidemic nature of these clones, which included lineages representing internationally spread S. pneumoniae clones. (iii) Dissemination of resistance determinants among pneumococci colonizing the nasopharynx occurred. Association of identical pulsed-field gel electrophoresis patterns with diverse antibiotypes among pneumococci colonizing children suggests that the high prevalence of DRPn involves not only cross-transmission of resistant strains but also dispersal of resistance genes through recombinational mechanisms. (iv) DCCs are autonomous epidemiological units. Among the 413 DRPn, 57 different lineages were detected; these lineages were dispersed among the 16 DCCs to produce unique microbiological profiles for each of the DCCs. Higher genetic diversity and less sharing of clonal types were observed among the DSPn.