Percurso e resultados da terapia fonoaudiológica na síndrome de Prader-Willi (SPW): relato de caso

O objetivo deste estudo foi descrever o percurso e os resultados da terapia fonoaudiológica na síndrome de Prader-Willi, por meio do estudo longitudinal do caso de uma criança de 8 anos de idade, do gênero masculino, ao longo de quatro anos de terapia fonoaudiológica em uma clínica-escola. Foram realizadas filmagens de sessões de terapia e análise documental de informações dos prontuários referentes à anamnese, avaliação e relatórios terapêuticos fonoaudiológicos e avaliações multidisciplinares. A criança apresentou características típicas da síndrome de Prader-Willi como obesidade, hiperfagia, ansiedade, problemas de comportamento e auto-agressões. em avaliação fonoaudiológica foram observados hipotonia orofacial, sialorréia, voz hipernasal, alterações cognitivas, dificuldades de compreensão oral, comunicação por meio de gestos e produção de palavras isoladas ininteligíveis. Inicialmente, a terapia fonoaudiológica teve o objetivo principal de promover o desenvolvimento da linguagem com ênfase na interação social por meio de atividades lúdicas. Com a evolução do caso o direcionamento principal passou a ser o desenvolvimento de habilidades conversacionais e narrativas. Foram observadas evoluções quanto à manutenção da atenção, brincadeira simbólica, contato social e comportamento. Além disso, houve aumento do vocabulário, evolução quanto à compreensão oral e desenvolvimento de habilidades narrativas. Dessa maneira, a intervenção fonoaudiológica em caso de síndrome de Prader-Willi foi eficaz em diferentes níveis, no que se refere às habilidades fonológicas, sintáticas, lexicais e pragmáticas da linguagem

Sensibilidade de indicadores da desnutrição protéico-energética em cirróticos com vários graus de disfunção hepatocelular

OBJETIVO: A sensibilidade de indicadores antropométricos e laboratoriais, na detecção da desnutrição protéico-energética de cirróticos foi estudada em 117 adultos, com gravidades (Child-Pugh), Child A (18), B (42) e C (57). RESULTADOS: Os indicadores antropométricos mais alterados foram: a circunferência braquial 61%, a prega cutânea tricipital 55% e a prega cutânea subescapular 53%, e os laboratoriais: albumina 93% e hemoglobina 90%. Com a combinação de indicadores circunferência braquial + prega cutânea subescapular + albumina ou hemoglobina, alcançaram-se 29% de déficit, valor idêntico ao da associação apenas de circunferência braquial + prega cutânea subescapular. Essa combinação (circunferência braquial e prega cutânea subescapular) detectou 63% de desnutrição protéico-energética, com predominância das formas moderada e grave em todos os graus Child. CONCLUSÃO: A desnutrição protéico-energética na cirrose hepática é predominantemente protéica, podendo ser caracterizada por indicadores laboratoriais (mais sensíveis) ou, com maior especificidade, pela circunferência braquial, embora inespecífica à discriminação da gravidade da desnutrição protéico-energética entre os grupos Child B e C.

Desfazendo mitos para minimizar o preconceito sobre a sexualidade de pessoas com deficiências

Este texto aborda a presença de idéias preconceituosas sobre a sexualidade de pessoas com deficiência discorrendo, de modo critico e reflexivo, sobre diversos mitos, tais como: (1) pessoas com deficiência são assexuadas: não têm sentimentos, pensamentos e necessidades sexuais; (2) pessoas com deficiência são hiperssexuadas: seus desejos são incontroláveis e exacerbados; (3) pessoas com deficiência são pouco atraentes, indesejáveis e incapazes para manter um relacionamento amoroso e sexual; (4) pessoas com deficiência não conseguem usufruir o sexo normal e têm disfunções sexuais relacionadas ao desejo, à excitação e ao orgasmo; (5) a reprodução para pessoas com deficiência é sempre problemática porque são pessoas estéreis, geram filhos com deficiência ou não têm condições de cuidar deles. A crença nesses mitos revela um modo preconceituoso de compreender a sexualidade de pessoas com deficiência como sendo desviante a partir de padrões definidores de normalidade e isso se torna um obstáculo para a vida afetiva e sexual plena daqueles que são estigmatizados pela deficiência. Esclarecer esses mitos é um modo de superar a discriminação social e sexual que prejudica os ideais de uma sociedade inclusiva.

Reabilitação neuropsicológica pediátrica

A neuropsicologia investiga a expressão comportamental das disfunções cerebrais, isto é, a interação entre estruturas cerebrais preservadas e prejudicadas e as funções cognitivas, tais como linguagem, memória, atenção e outras. A neuropsicologia pediátrica possui especificidades: maturação, estratégias cognitivas, ensino formal e cultura, e características intrínsecas à reorganização cerebral. O objetivo da reabilitação neuropsicológica é estabelecer estratégias para adaptação de funções cognitivas afetadas em relação às demandas do ambiente da criança. A reabilitação cognitiva pediátrica auxilia crianças com deficiência mental, epilepsia, traumatismo craniencefálico, síndromes autísticas, tumores cerebrais, paralisia cerebral, etc. Programas de reabilitação neuropsicológica podem ser voltados para dificuldades acadêmicas ou para funções cognitivas. A investigação da efetividade de programas de reabilitação depende de diversos fatores. O neuropsicólogo deve contribuir para o desenvolvimento de novas estratégias de reabilitação cognitiva, ser qualificado para o uso das mesmas e partilhar, com a equipe interdisciplinar, as técnicas e experiências efetivas.

Ontogenetic variation in skull shape of Thrichomys apereoides (Rodentia : Echimyidae)

The pattern of change in shape during postnatal development in skulls of punare (Thrichomys apereoides) skulls, was studied by geometric morphometric techniques. Skull shape observed in T. apereoides varied both with size and age, but variation in size explains most of the overall change in shape. Differences in shape observed among the eight age categories showed that main changes in shape occurred principally between the first and second age categories. Among the other age classes, changes became less pronounced leading to elongation of the snout and the mid-face and narrowing of the basicranium. The change in global shape resulted in lateral compression of the skull. Despite the high level of integration observed, localized transformations dominated the ontogenetic changes in shape indicating the presence of two large scale cranium components-the orofacial and the basicranial region. The ontogenetic pattern in this species seems to follow the same trends observed in the initial phases of development.

Clinical evaluation of tinnitus in patients with sleep bruxism: prevalence and characteristics

Evaluation of the prevalence and characteristics of tinnitus in a Brazilian series of sleep bruxism patients. In this descriptive study, 100 patients (80 women and 20 men) were selected through the self-report of grinding teeth during sleep, confirmed by room mate or family member. They were evaluated according to a systematized approach: a questionnaire for orofacial pain and the Portuguese version of the Research Diagnostic Criteria for Temporomandibular Disorders. The patients were divided into two groups: group A, 54 patients with complaint of tinnitus and group B, 46 patients without tinnitus complaint. The mean age was 37.85 (13-66 years) and 34.02 years (20-59 years), respectively, for groups A and B (P = 0.1164). There was statistically significant difference between the two groups, with higher prevalence for the group A, in relation to: presence of chronic facial pain (P = 0.0007); number of areas painful to palpation in the masticatory and cervical muscles (P = 0.0032); myofascial pain in the masticatory muscles (P = 0.0003); absence of teeth without prosthetic replacement (P = 0.0145) and indices of depression (P = 0.0234). Structural alterations of the TMJ, like disc displacement and vertical dimension loss did not differ for the two groups. Tinnitus frequency was higher in patients with sleep bruxism and chronic facial pain. Myofascial pain, number of areas painful to palpation in the masticatory and cervical muscles, higher levels of depression and tooth absence without prosthetic replacement were more frequent in the group with tinnitus.

Oral clefts and vitamin supplementation

Objectives: the evidence linking low levels of folic acid and orofacial clefting (OFC) is presently equivocal, There is stronger evidence for the role of folic acid supplementation in protection against the occurrence and recurrence of neural tube defects. The present investigation tested the hypotheses that cleft lip, cleft palate, or both are inversely associated with maternal intake of dietary and supplemental vitamins during the periconceptional period and first 4 months of pregnancy in a Brazilian population.Design: A population-based, case-control study of cleft lip with or without cleft palate (CL(P)) and isolated cleft palate (CP) in a Brazilian population. in structured interviews, case histories were taken from the mothers of a consecutive sample of 450 infants born with nonsyndromic OFC,Results: Mothers who had children with CL(P) were less likely to have been supplemented during the periconceptional period. The statistical significance of the difference in prevalence of the use of supplements between mothers of patients and of controls was greater for the CL(P) group: p < .05 for CP and p < .001 for CL(P). Multivariate analysis confirmed this finding of a protective effect for both types of orofacial cleft,Conclusions: the use of vitamin supplements in the first 4 months of pregnancy was suggestive of a protective effect against the occurrence of CP and CL(P) in this population, the significance of an association between multivitamin supplementation and OFC and the possible role of gene/environment interaction are discussed.

Overlay removable partial dentures for a patient with ectodermal dysplasia: A clinical report

The orofacial characteristics of ectodermal dysplasia include anodontia or hypodontia, hypoplastic conical teeth, underdevelopment of the alveolar ridges, frontal bossing, a depressed nasal bridge, protuberant lips, and hypotrichosis. Patients with this disease often need complex prosthetic treatment. The options for a definitive treatment plan may include fixed, removable, or implant-supported prostheses, singly or in combination. However, financial constraints and other priorities can prevent patients from choosing the most desirable treatment. This clinical report describes the diagnosis and treatment of ectodermal dysplasia in an 18-year-old man. The treatment included interim removable partial dentures fabricated to establish an acceptable therapeutic occlusal vertical dimension, followed by definitive overlay removable partial dentures and composite restorations.

Myofascial Pain Syndrome as a Contributing Factor in Patients with Chronic Headaches

Objectives: The purpose of this study was to evaluate the prevalence of active and latent trigger points [TrPs], as well as analyze the prevalence of different types of headaches in chronic headache patients. The active and latent TrPs in muscles of orofacial and cervical regions were also evaluated. Methods: There were 290 subjects who participated in this study. Trigger points were identified according to Simons et al.'s diagnostic criteria. Trigger points were considered active if subjects recognized the evoked referred pain as their familiar headache. If the evoked referred pain was not recognized as the familiar headache, the TrPs were considered latent. Differential diagnosis for headache was performed on the basis of International Headache Society criteria. Results: Trigger points could be diagnosed in 77 percent of patients and, in 89 percent of these, active TrPs were found. Muscle tenderness could be observed in 22 percent of patients, and only 1 percent patients were muscle-pain-free. The headache diagnosis showed that 26 percent had tension-type headache, 13 percent had migraine, and 61 percent had combined episodes of tension-type headache and migraine. The highest number of TrPs were found in temporalis [N = 159], masseter [N = 126], and occiptofrontalis [N = 113] muscles. Active TrPs were more frequent in temporalis and occiptofrontalis muscles. Conclusions: Subjects with chronic headaches had a higher prevalence of TrPs, and headache complaints could be reproduced during stimulation of active TrPs that were localized more frequently in temporalis and occiptofrontalis muscles. The presence of TrPs may be a contributing factor in the initiation and/or perpetuation of chronic headaches.

Chewing in temporomandibular disorder patients: an exploratory study of an association with some psychological variables

Aims: To compare kinematic parameters (ie, amplitude, velocity, cycle frequency) of chewing and pain characteristics in a group of female myofascial temporomandibular disorder (TMD) patients with an age-matched control female group, and to study correlations between psychological variables and kinematic variables of chewing. Methods: Twenty-nine female participants were recruited. All participants were categorized according to the Research Diagnostic Criteria for TMD (RDC/TMD) into control (n = 14, mean age 28.9 years, SD 5.0 years) or TMD (n = 15, mean age 31.3 years, SD 10.7) groups. Jaw movements were recorded during free gum chewing and chewing standardized for timing. Patients completed the Depression, Anxiety, and Stress Scales (DASS-42), the Pain Catastrophizing Scale (PCS), the Fear of Pain Questionnaire-III (FPQ-III), and the Pain Self-Efficacy Questionnaire (PSEQ). Statistical analyses involved evaluation for group differences, and correlations between kinematic variables and psychological questionnaire scores (eg, depression, anxiety, stress) and pain intensity ratings. Results: Velocity and amplitude of standardized (but not free) chewing were significantly greater (P < .05) in the TMD group than the control group. There were significant (P < .05) positive correlations between pain intensity ratings and velocity and amplitude of standardized chewing but not free chewing. There were significant (P < .05) positive correlations between depression and jaw amplitude and stress and jaw velocity for standardized but not free chewing. Conclusion: This exploratory study has provided data suggesting that psychological factors, manifesting in depression and stress, play a role in influencing the association between pain and motor activity. J OROFAC PAIN 2011;25:56-67

Chronic consumption of fructose rich soft drinks alters tissue lipids of rats

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

TRATAMENTO DA HIPERTENSAO ARTERIAL LEVE E MODERADA COM FOSINOPRIL. COMPARACAO DE EFEITOS ADVERSOS COM OUTROS ANTI-HIPERTENSIVOS

Purpose - To evaluate the adverse reactions of fosinopril with other antihypertensives used as monotherapy. Methods - Out-patients (n = 2,568) with diagnostic of mild to moderate hypertension, diastolic blood pressure (DBP) 95-115 mmHg, with no antihypertensive treatment for 15 days, were included to treatment initially with fosinopril (F) 10mg, once daily, for six weeks. After this period, patients with DBP >95mmHg had the dosage, once daily, increased to 20 mg, while the others were maintained with the same dosage for six more weeks. Adverse reactions of 822 patients treated as monotherapy were grouped as absent, musculoskeletal, cardiovascular, cough, gastrointestinal, neurological, genital-urinary dysfunctions and dermatological and compared with 1,568 with F. Monotherapy consist in α-methyldopa (100 patients); β-blocker (129); calcium blocker (106); diuretic (394); and another ACE inhibitors (93). Results - At the end of the period without treatment, the blood pressure (BP), 165 ± 16/105 ± 7 mmHg decreased significantly at 6(th) week to 144 ± 15/91 ± 9 mmHg (p < 0.05 vs week 0) with further lowering to 139 ± 13/86 ± 7 mmHg till the end of 12(th) week. BP response (DBP ≤90 mmHg) was obtained in 89% of the patients with F. Absence of adverse reactions were ≥70% in patients with F compared to other drugs. Conclusion - Fosinopril has demonstrated therapeutic efficacy and less adverse reactions compared to antihypertensives used previously as monotherapy.

The deep mycoses in HIV infection

The deep mycoses are uncommon infections, usually acquired from the inhalation or ingestion of fungal spores, sometimes from the soil in areas of endemicity, such as in the Americas and south-east Asia, or from decaying vegetable matter. They are also seen in immunocompromised persons and, increasingly, in HIV-infected persons. Respiratory involvement is frequent, with granuloma formation, and mucocutaneous involvement may be seen. Oral lesions of the deep mycoses are typically chronic but non-specific, though nodular or ulcerative appearances are common. Person-to-person transmission is rare. In HIV disease, the most common orofacial involvement of deep mycoses has been in histoplasmosis, cryptococcosis, aspergillosis and zygomycosis. Diagnosis is usually confirmed by lesional biopsy although culture may also be valuable. Treatment is with amphotericin or an azole.

The structure of the human temporomandibular joint disc: A scanning electron microscopy study

The articular disc of the temporomandibular joint was studied in fetuses (16 to 39 weeks of intrauterine life), infants (up to 4 months of age), dentulous adults (aged 30 to 39 years), and completely edentulous adults (aged 60 to 69 years) by scanning electron microscopy. The constituent bundles of collagen fibers were stratified and were oriented anteroposteriorly, laterolaterally, and obliquely in the middle portion of the disc. A ring of laterolateral bundles constituted the main feature of the thick posterior portion. In the anterior portion of the disc, the fibers were anteroposteriorly and obliquely oriented. On the superior and inferior surfaces of the disc, a thin layer of perpendicularly arranged collagen fibers covered the underlying, thick, laterolateral oriented collagen fibers.

A study of different calcification areas in newly formed bone 8 weeks after insertion of dental implants in rabbit tibias

In orofacial implantology there are many types of implants for the different systems. Among these is the implant surface type, e.g., a screw type, cylindrical and laminar. Furthermore, the implants are different in their dimensions, their metal composition, their surface condition, such as smooth, grit or layered surfaces and in their methods of application. Two different self-tapping implants, one smooth and the other grit-blasted, are screwed into the bone, and another one with a plasma of titanium coating, which is also in a screw form but with greater spaces between the screw threads are compared. The greatest amount of bone deposition in the bone/implant interface was encountered in the latter one, the smooth surfaced implant being in second place. All of these systems can alter the implant healing process and to demonstrate this, we injected bone markers in the rabbits over different periods of time so as to observe the different areas of bone deposition in the tibias where the implants had been inserted. The bone tracers used were Alizarin, Calcein and Xylenol-orange. The amount of deposition was calculated by using the method of surface morphometry.