L4-L5-S1 human dermatomes: a clinical, electromyographical, imaging and surgical findings

There is substantial controversy in literature about human dermatomes. We studied L4, L5, and S1 inferior limb dermatomes by comparing clinical signs and symptoms with conduction studies, electromyographical data, neurosurgical findings, and imaging data from computerized tomography (CT) or magnetic resonance imaging (MRI). After analyzing 60 patients, we concluded that L4 is probably located in the medial aspect of the leg, L5 in the lateral aspect of the leg and foot dorsus, and S1 in the posterior aspect of the backside, tight, leg and plantar foot skin. This is the first time that these human dermatomes have been evaluated by combined analysis of clinical, electromyographical, neurosurgical, and imaging data.

Clinical and microbiological performance of resin-modified glass-ionomer liners after incomplete dentine caries removal

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Headache and Symptoms of Temporomandibular Disorder: An Epidemiological Study

Objectives.-A population-based cross-sectional study was conducted to estimate the prevalence of migraine, episodic tension-type headaches (ETTH), and chronic daily headaches (CDH), as well as the presence of symptoms of temporomandibular disorders (TMD) in the adult population.Background.-The potential comorbidity of headache syndromes and TMD has been established mostly based on clinic-based studies.Methods.-A representative sample of 1230 inhabitants (51.5% women) was interviewed by a validated phone survey. TMD symptoms were assessed through 5 questions, as recommended by the American Academy of Orofacial Pain, in an attempt to classify possible TMD. Primary headaches were diagnosed based on the International Classification of Headache Disorders.Results.-When at least 1 TMD symptom was reported, any headache happened in 56.5% vs 31.9% (P < .0001) in those with no symptoms. For 2 symptoms, figures were 65.1% vs 36.3% (P < .0001); for 3 or more symptoms, the difference was even more pronounced: 72.8% vs 37.9%. (P < .0001). Taking individuals without headache as the reference, the prevalence of at least 1 TMD symptom was increased in ETTH (prevalence ratio = 1.48, 95% confidence interval = 1.20-1.79), migraine (2.10, 1.80-2.47) and CDH (2.41, 1.84-3.17). At least 2 TMD symptoms also happened more frequently in migraine (4.4, 3.0-6.3), CDH (3.4; 1.5-7.6), and ETTH (2.1; 1.3-3.2), relative to individuals with no headaches. Finally, 3 or more TMD symptoms were also more common in migraine (6.2; 3.8-10.2) than in no headaches. Differences were significant for ETTH (2.7 1.5-4.8), and were numerically but not significant for CDH (2.3; 0.66-8.04).Conclusions.-Temporomandibular disorder symptoms are more common in migraine, ETTH, and CDH relative to individuals without headache. Magnitude of association is higher for migraine. Future studies should clarify the nature of the relationship.

Evaluation of different occlusal splints and counselling in the management of myofascial pain dysfunction

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effects of isoflavone on the learning and memory of women in menopause: a double-blind placebo-controlled study

Hormone decline is common to all women during aging and, associated with other factors, leads to cognitive impairment. Its replacement enhances cognitive performance, but not all women present a clinical and family or personal history that justifies its use, mainly women with a history of cancer. The aim of this study was to determine whether a daily oral dose of 80 mg of isoflavone extract for 4 months can produce benefits in women with low hormone levels, contributing to improvement in cognitive aspects. The sample comprised 50- to 65-year-old women whose menstruation had ceased at least 1 year before and who had not undergone hormone replacement. The volunteers were allocated to two groups of 19 individuals each, i.e., isoflavone and placebo. There was a weak correlation between menopause duration and low performance in the capacity to manipulate information (central executive). We observed an increase in the capacity to integrate information in the group treated with isoflavone, but no improvement in the capacity to form new memories. We did not observe differences between groups in terms of signs and symptoms suggestive of depression according to the Geriatric Depression Scale. Our results point to a possible beneficial effect of isoflavone on some abilities of the central executive. These effects could also contribute to minimizing the impact of memory impairment. Further research based on controlled clinical trials is necessary to reach consistent conclusions.

Acerola: importance, culture conditions, production and biochemical aspects

Origin and importance. Acerola, or Malpighia emarginata D. C., is native to the Caribbean islands, Central America and the Amazonian region. More recently, it has been introduced in subtropical areas (Asia, India and South America). The vitamin C produced by acerola is better absorbed by the human organism than synthetic ascorbic acid. Exportation of acerola crops is a potential alternative source of income in agricultural businesses. In Brazil, the commercial farming of acerola is quite recent. Climatic conditions. Acerola is a rustic plant. It can resist temperatures close to 0 degrees C, but it is well adapted to temperatures around 26 degrees C with rainfall between (1200 and 1600) mm per year. Fruit characteristics. Acerola fruit is drupaceous, whose form can vary from round to conic. When ripe, it can be red, purple or yellow. The fruit weight varies between (3 and 16) g. Maturation. Acerola fruit presents fast metabolic activity and its maturation occurs rapidly. When commercialised in ambient conditions, it requires fast transportation or the use of refrigerated containers to retard its respiration and metabolism partially. Production and productivity. Flowering and fruiting are typically in cycles associated with rain. Usually, they take place in 25-day cycles, up to 8 times per year. The plant can be propagated by cuttings, grafting or seedlings. Harvest. Fruits produced for markets needs to be harvested at its optimal maturation stage. For distant markets, they need to be packed in boxes and piled up in low layers; transportation should be done in refrigerated trucks in relatively high humid conditions. Biochemical constituents. Acerola is the most important natural source of vitamin C [(1000 to 4500) mg.100(-1) g of pulp], but it is also rich in pectin and pectolytic enzymes, carotenoids, plant fibre, vitamin B, thiamin, riboflavin, niacin, proteins and mineral salts. It has also shown active anti-fungal properties. Products and market. Acerola is used in the production of juice, soft drinks, gums and liqueurs. The USA and Europe are great potential markets. In Europe, acerola extracts are used to enrich pear or apple juices. In the USA, they are used in the pharmaceutical industry. Conclusions. The demand for acerola has increased significantly in recent years because of the relevance of vitamin C in human health, coupled with the use of ascorbic acid as an antioxidant in food and feed. Acerola fruit contains other significant components, which are likely to lead to a further increase in its production and trade all over the world.

Treatment of snoring and sleep apnea syndrome with a removable mandibular advancement device in patients without TMD

INTRODUCTION: Among the sleep disorders reported by the American Academy of Sleep, the most common is obstructive sleep apnea-hypopnea syndrome (OSAHS), which is caused by difficulties in air passage and complete interruption of air flow in the airway. This syndrome is associated with increased morbidity and mortality in apneic individuals. OBJECTIVE: It was the objective of this paper to evaluate a removable mandibular advancement device as it provides a noninvasive, straightforward treatment readily accepted by patients. METHODS: In this study, 15 patients without temporomandibular disorders (TMD) and with excessive daytime sleepiness or snoring were evaluated. Data were collected by means of: Polysomnography before and after placement of an intraoral appliance, analysis of TMD signs and symptoms using a patient history questionnaire, muscle and TMJ palpation. RESULTS: After treatment, the statistical analysis (t-test, and the before and after test) showed a mean reduction of 77.6% (p=0.001) in the apnea-hypopnea index, an increase in lowest oxyhemoglobin saturation (p=0.05), decrease in desaturation (p=0.05), decrease in micro-awakenings or EEG arousals (p=0.05) and highly significant improvement in daytime sleepiness (p=0.005), measured by the Epworth Sleepiness Scale. No TMD appeared during the monitoring period. CONCLUSION: The oral device developed in this study was considered effective for mild to moderate OSAHS.

Relationship between temporomandibular disorders and orthodontic treatment: a literature review

OBJETIVO: revisar a literatura mais atual, dos últimos 15 anos, em busca de estudos clínicos que relatem a relação entre a disfunção temporomandibular (DTM) e o tratamento ortodôntico e/ou a má oclusão. A intenção foi verificar se o tratamento ortodôntico aumentaria o aparecimento de sinais e sintomas de DTM, e se o tratamento ortodôntico seria um recurso para o tratamento ou prevenção dos sinais e sintomas de DTM. MÉTODOS: artigos dos tipos revisão de literatura, editorial, carta, estudo experimental em animais e comunicação foram excluídos dessa revisão. Foram incluídos artigos prospectivos, longitudinais, caso-controle ou retrospectivo com amostra maior, com relevante análise estatística. Estudos que abordassem deformidades e síndromes craniofaciais e tratamento por cirurgia ortognática também foram excluídos, bem como aqueles que relatassem apenas a associação entre má oclusão e DTM. RESULTADOS: foram encontrados 20 artigos relacionando Ortodontia à DTM, segundo os critérios adotados. Os estudos, então, associando sinais e sintomas de DTM ao tratamento ortodôntico apresentaram resultados heterogêneos. Alguns encontraram efeitos positivos do tratamento ortodôntico para os sinais e sintomas de DTM; entretanto, nenhum deles apresentou diferença estatisticamente significativa. CONCLUSÕES: todos os estudos citados nessa revisão de literatura relataram que o tratamento ortodôntico não forneceu risco ao desenvolvimento de sinais e sintomas de DTM, independentemente da técnica utilizada para tratamento, da exodontia ou não de pré-molares e do tipo de má oclusão previamente apresentada pelo paciente. Alguns estudos realizados com acompanhamento em longo prazo concluíram que o tratamento ortodôntico não seria preventivo ou uma modalidade de tratamento para DTM.

Solving the conundrum of Job: a probable biblical description of chronic renal failure with neurological symptoms

A doença descrita no livro bíblico de Jó é controversa, e tem interessado a teólogos, psiquiatras e dermatologistas, há tempos. Neste trabalho os autores apontam para evidências do diagnóstico de insuficiência renal crônica com alterações neurológicas.

Observation of initial clinical manifestations and repercussions from the treatment of 314 human injuries caused by black sea urchins (Echinometra lucunter) on the southeastern Brazilian coast

INTRODUÇÃO: Os acidentes causados por ouriços-do-mar são as ocorrências por animais marinhos mais comuns no país. O ouriço-do-mar preto (Echinometra lucunter) é a espécie que mais causa ferimentos em banhistas. MÉTODOS: Este trabalho registrou e estudou 314 agravos com ênfase nas manifestações clínicas iniciais observadas e suas implicações na terapêutica recomendada. RESULTADOS: Todos os acidentes foram causados pelo ouriço-do-mar preto e aconteceram em banhistas. As lesões e a dor foram associadas ao trauma causado pela penetração das espículas (não ocorreu inflamação ou dor imediata sem pressão sobre os pontos comprometidos). As complicações deste tipo de acidente, incluindo infecções e granulomas de corpo estranho, estão associadas com a permanência das espículas nos ferimentos. CONCLUSÕES: Foi confirmado o fato do acidente causado por esta espécie ser o mais comum no Brasil e apresentar caráter traumático, sendo a principal recomendação a retirada precoce dos espinhos para prevenção de complicações tardias como as infecções e formação de granulomas de corpo estranho.

Complicações psiquiátricas do uso crônico do álcool: síndrome de abstinência e outras doenças psiquiátricas

A síndrome de abstinência alcoólica é um quadro agudo, caracterizado por um conjunto de sinais e sintomas autolimitados, com gravidade variada, secundário à interrupção total ou parcial do consumo de álcool, podendo ser associado a inúmeros problemas clínicos e/ou outros transtornos psiquiátricos. O objetivo deste artigo é rever as principais complicações psiquiátricas secundárias à síndrome de abstinência alcoólica, como convulsões e delirium tremens, bem como algumas outras condições psiquiátricas associadas à dependência de álcool, como as síndromes de Wernicke Korsakoff e de Marchiava Bignami. Pretende-se, com isso, auxiliar no diagnóstico precoce e tratamento adequado, minimizando assim a morbidade e a mortalidade associadas a tais complicações.

TMD and GOHAI indices of Brazilian institutionalised and community-dwelling elderly

Considering the controversy in the literature regarding several aspects of temporomandibular dysfunction (TMD) in elderly populations and the absence of reliable data on elderly Brazilians in this field, this study consisted of an evaluation of TMD prevalence and the self-perception of oral health among institutionalised and community-dwelling elderly in Sao JosE dos Campos, Brazil.Two hundred and fifteen community-dwelling and 185 institutionalised elderly people were evaluated by the Helkimo anamnestic (Ai) and clinical dysfunction (Di) indices and answered a questionnaire using the Geriatric Oral Health Assessment Index (GOHAI).The major prevalence of TMD symptoms was for the Ai0 (symptom-free) group (69.5%), while the major prevalence of clinical signs was for the DiI (mild) group (56%). Women presented a higher AiII classification than men (chi(2) test, p = 0.049). Community-dwelling elderly presented a significantly lower Ai0 classification than the institutionalised ones (Two ratios equality test, p < 0.001). There was no relationship between the institutionalised status and the clinical dysfunction index for Di0 and DiIII classification (Two ratios equality test, p = 0.194 and 0.535 respectively). The institutionalised elderly presented greater (One-way anova = 0.005) self-perception of oral health (33.45) than did the community-dwelling group (32.66). There were only weak Pearson's correlations among the anamnestic (-33.0%) or clinical (-14.7%) findings by the TMD and GOHAI indices. Symptom-free (Ai0) institutionalised elderly presented better scores in all GOHAI dimensions and elderly representing an absence of clinical TMD signs (Di0) presented higher GOHAI physical dimension scores in both groups.The prevalence of TMD symptoms among this sample of elderly individuals was relatively low, self-perception of oral health was reasonable and a weak, inverse correlation was found between TMD signs and symptoms and elderly self-perception of oral health measured by the GOHAI index.

Conjunctival keratoacanthoma

Keratoacanthoma is a rapidly growing skin neoplasia that may stabilize or regress spontaneously. We describe here a case of conjunctival keratoacanthoma and comment about the clinical signs and symptoms and pathological findings.

Therapeutic response of benzodiazepine, orphenadrine citrate and occlusal splint association in TMD pain

Loss of function, muscle inflammation, and pain are some of the signs and symptoms of temporomandibular dysfunction (TMD). Pharmacological strategies to minimize the clinical manifestation of these disorders often focus on blocking or inhibiting the pain-causing symptom. Resources such as muscle-relaxants, anxiety-relief drugs, and splint therapy are often used to reduce muscular hyperactivity related to TMD muscle pain. This study compares the effect of a randomly ordered association of occlusal splint therapy (S), nonsteroid anti-inflammatory with a muscle-relaxant drug (orphenadrine citrate) (O), and an anxiety-relief drug (benzodiazepine) (B), to ease painful TMD muscle symptoms. Clinical and anamnestic analyses were recorded in accordance with the Helkimo TMD index and applied before and after treatments. Twenty-one group two Helkimo TMD adult female patients were treated, all of whom were subjected to the three random therapeutic associations proposed: SBO, BOS, and OSB. The same operator applied the three specific associations over a period of 21 days in the proposed sequence, seven days for each therapy. The results show that all the groups presented the best results in terms of relief from pain after the therapeutic association (28.5% showed a decrease and 47.6% showed an absence of symptoms). No significant difference was observed among association therapeutic protocols. Copyright © 2003 by CHROMA, Inc.

Use of sneaker rush and symptoms occurrence of skeletal muscle (SME) in Ballerina

Introduction: Technical literature shows high frequencies of injuries occurring in classical ballet dancers; however, only limited information about the permanent effects of chronic diseases are mentioned. Objective: To compare the presence of MSD among dancers who wear pointe shoes and those who do not. Methods: The research was conducted at the 27th Festival of Joinville in Santa Catarina. The study had the participation of 111 dancers, 88 of whom wore pointe shoes while 23 did not. Specific procedures were used to obtain information related to MSD and foot injuries caused by dancing. Results: The most affected parts were the knees (29.7% with pointe shoes versus 39% without), spine (26.4% with pointe shoes versus 22% without), and ankle/foot (20% with pointe shoes versus 12.2% without). Through odds ratio and respective confidence intervals (IC95%), the study identified protection factor in the knees (0.24; CI95% - 0.09-0.64) and legs (0.11; CI95% - 0.02-0.65) for dancers who wear pointe shoes. It was found that the risk of injuries in specific structures of the foot is significantly higher among those dancers. In this case, the appearance of bunions (9.74; CI95% - 1.25-75,99), calluses on the toes (3.46; CI95% - 1.29-9.27) and the association of the three (4.47; CI95% - 1.69-11.83) were those that showed an increased risk factor compared to dancers who do not stand en pointe. Conclusion: The use of pointe shoes in elite Brazilian dancers was associated to lower occurrence of MSD in the knee and leg, however it was strongly associated to foot injuries.