Comparison of clinical features and drug therapies among European and Latin American patients with juvenile dermatomyositis

ObjectiveTo compare the demographic features, presenting manifestations, diagnostic investigations, disease course, and drug therapies of children with juvenile dermatomyositis (JDM) followed in Europe and Latin America.MethodsPatients were inception cohorts seen between 1980 and 2004 in 27 paediatric rheumatology centres. The following information was collected through the review of patient charts: sex; age at disease onset; date of disease onset and diagnosis; onset type; presenting clinical features; diagnostic investigations; course type; and medications received during disease course.ResultsFour hundred and ninety patients (65.5% females, mean onset age 7.0 years, mean disease duration 7.7 years) were included. Disease presentation was acute or insidious in 57.1% and 42.9% of the patients, respectively. The course type was monophasic in 41.3% of patients and chronic polycyclic or continuous in 58.6% of patients. The more common presenting manifestations were muscle weakness (84.9%), Gottron's papules (72.9%), heliotrope rash (62%), and malar rash (56.7%). Overall, the demographic and clinical features of the 2 continental cohorts were comparable. European patients received more frequently high-dose intravenous methylprednisolone, cyclosporine, cyclophosphamide, and azathioprine, while methotrexate and antimalarials medications were used more commonly by Latin American physicians.ConclusionThe demographic and clinical characteristics of JDM are similar in European and Latin American patients. We found, however, several differences in the use of medications between European and Latin American paediatric rheumatologists.

Dog culling and replacement in an area endemic for visceral leishmaniasis in Brazil

Measures employed to control visceral leishmaniasis in Brazil have focused on vector control by residual insecticide spraying and diagnosis of infection with elimination of positive dogs. We describe dog culling and replacement in a Brazilian endemic area (the Alvorada District, Aracatuba, SP) in order to better understand dog population dynamics when elimination of the dog reservoir is adopted as the main control measure. From August 2002 to July 2004, 60.9% of the estimated dog population for the area was culled with a mean age of 34 months old. The presence of anti-Leishmania sp. antibodies was recorded for only 26.7% of the euthanized canines. Replacement was observed in 38.8% of the cases, some of them by 2 or more dogs and in a mean time of 4 months. Dogs were replaced mostly by puppies of both sexes with a mean age of 6.8 months. From August 2002 to April 2005 we were able to follow-up 116 of these dogs, during a mean time of 8.7 months. Canine visceral leishmaniasis seropositivity by ELISA was observed in 42.2% of the followed dogs, 30.6% of which were already positive at the first evaluation. By the end of the follow-up period 37% of the dogs were submitted to euthanasia, with a mean age of 18.3 months. In the studied CVL endemic area of Brazil, euthanasia and the subsequent replacement ratio were high, increasing the dog population turnover and leading to a younger population that might be more susceptible to a variety of other infectious diseases in addition to CVL. Dog culling as a control strategy for VL should be reassessed. (C) 2008 Elsevier B.V. All rights reserved.

Cotton growth and boron distribution in the plant as affected by a temporary deficiency of boron

The knowledge of nutrient mobility is an important tool to define the best fertilizer management and diagnosis techniques. Patterns of boron (B) mobility in plants have been reviewed, but there is very little information on B distribution and mobility in cotton. An experiment was conducted to study plant growth and B distribution in cotton when the nutrient was applied in the nutrient solution or to the leaves, and when a temporary deficiency was imposed. Cotton (Gossypium hirsutum, Latifolia, cv. IAC 22) was grown in nutrient solutions where B was omitted or not for 15 days. Boron was applied to young or mature cotton leaves in some of the minus B treatments. Root growth decreased when the plants were transferred to B solutions, but there was a full recovery when B was replaced in the nutrient medium. Boron deficiency, even when temporary, reduced cotton shoot dry matter yields, plant height and flower and fruit set, and these could not be prevented by foliar application of B. Because of decreased dry matter production, leaves of deficient cotton plants actually showed higher B concentrations than non deficient leaves. This would be misleading when a mature leaf is sampled for diagnosis. If there is any B mobility in cotton phloem, it is very low.

The effect of CO 2 laser irradiation on failed implant surfaces

The aim of this investigation was to evaluate the cleaning effect of CO 2 on surface topography and composition of failed dental implant surfaces. Ten failed dental implants were retrieved from nine patients (mean age, 46.33 ± 5.81 years) as a result of early or late failure. The implants were divided into two parts: one side of the implant was irradiated with a CO 2 laser (test side), while the other side did not receive irradiation (control side). The CO 2 laser was operated at 1.2 W in a continuous wave for 40 seconds (40 J energy). The handpiece of the CO 2 laser was kept at a distance of 30 mm from the implant surface, resulting in a spot area of 0.031415 cm 2 (38.20 W/cm 2; 1559 J/cm 2) in scanning mode (cervical-apical). One unused dental implant was used as a negative control for both groups. All implant surfaces were examined by scanning electron mi croscopy (SEM) and energy-dispersive spectrometer x-ray (EDS) for element analysis. SEM showed that the surface of the test sides consisted of different degrees of organic residues, appearing mainly as dark stains similar to those observed on the control sides. None of the test surfaces presented alterations such as crater-like alterations, lava-like layers, or melting compared with the nonirradiated surfaces. Foreign elements such as carbon, oxygen, sodium, calcium, and aluminum were detected on both sides. These results suggest that CO 2 laser irradiation does not modify the implant surface, although the cleaning effect was not satisfactory.

Assessment of manipulation accuracy of digitized occlusal radiographic images--sub and over exposure.

The aim of this study was to evaluate whether digitized images obtained from occlusal radiographs taken with low or over dose of radiation could be improved with the aid of computer software for digital treatment. Thirteen occlusal radiographs of a dry skull were taken employing 13 different exposure times. The radiographs were digitized and then manipulated with the program for image editing. 143 evaluations were performed by specialists in dental radiology who classified radiographs as appropriate or not appropriate for interpretation. Test Z was used for statistical analysis of the data and the results showed that it is possible to manipulate digitized radiographic images taken with 75% of the ideal exposure time and to make them suitable for interpretation and diagnosis. Conversely, it was concluded that the over exposed images, 57.50% above the standard exposure time, were inadequate.

Improvement in clinical signs and cellular immunity of dogs with visceral leishmaniasis using the immunomodulator P-MAPA

This study investigated the immunotherapeutic potential of the protein aggregate magnesium-ammonium phospholinoleate-palmitoleate anhydride immuno-modulator (P-MAPA) on canine visceral leishmaniasis. Twenty mongrel dogs presenting clinical symptoms compatible with leishmaniasis and diagnosis confirmed by the detection of anti-leishmania antibodies were studied. Ten dogs received 15 doses of the immunomodulator (2.0mg/kg) intramuscularly, and 10 received saline as a placebo. Skin and peripheral blood samples were collected following administration of the immunomodulator. The groups were followed to observe for clinical signals of remission; parasite load in the skin biopsies using real-time PCR, the cytokines IL-2, IL-10 and IFN-γ in the supernatant of peripheral blood mononuclear cells stimulated in vitro with either total promastigote antigen or phytohemagglutinin measured by capture ELISA, and changes in CD4+ and CD8+ T cell subpopulations evaluated by flow cytometry. Comparison between the groups showed that treatment with the immunomodulator promoted improvement in clinical signs and a significant reduction in parasite load in the skin. In peripheral blood mononuclear cell cultures, supernatants showed a decrease in IL-10 levels and an increase in IL-2 and IFN-γ. An increase in CD8+ T cells was observed in peripheral blood. In addition, the in vitro leishmanicidal action of P-MAPA was investigated using 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) and no leishmanicidal activity was detected. These findings suggest that P-MAPA has potential as an immunotherapeutic drug in canine visceral leishmaniasis, since it assists in reestablishing partial immunocompetence of infected dogs. © 2013 Elsevier B.V.

Sobrevivênvia e sucesso de implantes osseointegrados com superfície tratada por ataque ácido: avaliação retrospectiva de 8 a 10 anos

Pós-graduação em Odontologia - FOAR

Nonalcoholic fatty liver disease and metabolic syndrome in postmenopausal women

Nonalcoholic fatty liver disease (NAFLD) is considered the most common cause of chronic liver disease in the Western countries. NAFLD includes a spectrum ranging from a simple steatosis to a nonalcoholic steatohepatitis (NASH) which is defined by the presence of inflammatory infiltrate, cellular necrosis, hepatocyte ballooning, and fibrosis and cirrhosis that can eventually develop into hepatocellular carcinoma. Studies emphasize the role of insulin resistance, oxidative stress, pro-inflammatory cytokines, adipokines in the development and progression of NAFLD. It seems to be independently associated with type II diabetes mellitus, increased triglycerides, decreased HDL-cholesterol, abdominal obesity and insulin resistance. These findings are in accordance with the criteria used in the diagnosis of metabolic syndrome (MetS). Here, we will discuss the current knowledge on the epidemiology, pathophysiology and diagnosis of NAFLD and the association of metabolic syndrome in postmenopausal women.

Nonlinear dynamics and control strategies: On a energy harvester vibrating system with a linear form to non-ideal motor torque

In this paper, we deal with the research of a vibrating model of an energy harvester device, including the nonlinearities in the model of the piezoelectric coupling and the non-ideal excitation. We show, using numerical simulations, in the analysis of the dynamic responses, that the harvested power is influenced by non-linear vibrations of the structure. Chaotic behavior was also observed, causing of the loss of energy throughout the simulation time. Using a perturbation technique, we find an approximate analytical solution for the non-ideal system. Then, we apply both two control techniques, to keep the considered system, into a stable condition. Both the State Dependent Ricatti Equation (SDRE) control as the feedback control by changing the energy of the oscillator, were efficient in controlling of the considered non-ideal system.

On nonlinear dynamics and control of a robotic arm with chaos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Greater expression of the human leukocyte antigen-G (HLA-G) and interleukin-17 (IL-17) in cervical intraepithelial neoplasia: analytical cross-sectional study

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Perda óssea em prótese sobre implante: revisão de literatura

One of the complications that concern prosthetists is bone loss peri-implant, because the success of dental implant treatment requires long-term maintenance of hard and soft tissues around the implant. Whereby the dental implants have not only the goal of restoring function, but also the aesthetics of the patient, the bone loss peri-implant can dramatically compromise the aesthetics of rehabilitation, particularly in anterior regions. The aim of this study was to analyze and reason, through literature review, the main factors that can cause bone loss in peri-implant and possible ways to prevent it.

Higienização em prótese sobre implante

With the advances of osseointegration principles, the use of implant-supported prosthesis has become a routine treatment option. The success of an implant is initially associated to the surgical technique, primary stability and absence of bacterial contamination on the implant site. Subsequently, the absence of mechanical trauma (overload) and peri-implantitis are sine qua non conditions to the longitudinal success of implant treatment. Therefore, the strict maintenance of oral hygiene is highly important to avoid biofilm accumulation around the implant and consequently to provide last-long implant-supported dentures. The clinician has the responsibility to supply a favorable prognosis to the patient so that the rehabilitation succeed. For this reason, during prosthesis fabrication the clinician should observe the design and emergency profile of the prosthesis, the peri-implant sulcus depth as well as the presence of motor or psychological impairment by the patient. Subjects with missing teeth and that will be submitted to the implant treatment should be motivated and adequate instructed regarding oral hygiene and its importance since the best option to obtain treatment longevity and consequently patient’s satisfaction is the prevention. Therefore, this study aimed to perform a literature review about the hygiene of implant-supported prosthesis.

Analysis of relevant factors in patients with oral and pharyngeal cancers

This study presented an epidemiological data of 177 medical records of patients affected by oral and pharyngeal cancers with prosthesis indication. The gender, age, sun exposure, disease diagnosis, cancer anatomic site, radiation treatment and type of prosthesis, death from oral and pharyngeal cancers were collected. Data were analyzed by summary measures and logistic regression analysis. The mean age of the patients was 62.7 years, and 46.8％ died between 52 and 62 years old. Most of the patients were male (74％), and 42％ died among them. Squamous cell carcinoma was the most prevalent cancer (75.1％) and 42.1％ of these patients died. The age, gender, diagnosis and the interaction of these factors exhibited strong association with the patients’ death (P<.05, Chi-square test). The multivariate odds ratios (OR) of the death were 0.40 for women and 0.39 for other pathologies versus male and squamous cell carcinoma, respectively. It was concluded that age, gender and diagnosis of cancer had significant effect on patients’ death.

Prevalence and Predictors of Potential Drug-Drug Interactions in the Elderly: A Cross-Sectional Study in the Brazilian Primary Public Health System

Purpose. The primary objective of this study was to investigate the prevalence of clinically important potential drug-drug interactions (DDIs) in elderly patients attending the public primary health care system in Brazil. The secondary objective was to investigate possible predictors of potential DDIs. Methods. A cross-sectional study was carried out in 5 Brazilian cities located in the Ourinhos Micro-region, Sao Paulo State, between November 2010 and April 2011. The selected sample was divided according to the presence (exposed) or absence (unexposed) of one or more potential DDIs (defined as the presence of a minimum 5-day overlap in supply of an interacting drug pair). Data were collected from medical prescriptions and patients' medical records. Potential DDIs (rated major or moderate) were identified using 4 DDI-checker programs. Logistic regression analysis was used to study potential DDI predictors. Results. The prevalence of clinically important potential DDIs found during the study period was 47.4%. Female sex (OR = 2.49 [95% CI 2.29-2.75]), diagnosis of = 3 diseases (OR = 6.43 [95% CI 3.25-12.44]), and diagnosis of hypertension (OR = 1.68 [95% CI 1.23-2.41]) were associated with potential DDIs. The adjusted OR increased from 0.90 [95% CI 0.82-1.03] in patients aged 60 - 64 years to 4.03 [95% CI 3.79 - 4.28] in those aged 75 years or older. Drug therapy regimens involving = 2 prescribers (OR = 1.39 [95% CI 1.17-1.67]), = 3 drugs (OR = 3.21 [95% CI 2.78-3.59]), = 2 ATC codes (OR = 1.19 [95% CI 1.12-1.29]), = 2 drugs acting on cytochrome P450 (OR = 2.24 [95% CI 2.07-2.46]), and ATC codes B (OR = 1.89 [95% CI 1.05-2.08]) and C (OR = 4.01 [95% CI 3.55-4.57]) were associated with potential DDIs. Conclusion. Special care should be taken with the prescription and therapeutic follow-up of patients who present characteristics identified as predictors. Knowledge of potential DDI predictors could aid in developing preventive practices and policies that allow public health services to better manage this situation.