Salivary immunity in elderly individuals presented with Candida-related denture stomatitis

Objectives: Elderly individuals with Candida-related denture stomatitis (DS) present with a reduced defence against Candida albicans. This study evaluated levels of antimicrobial mediators in the elderly DS saliva and salivary neutrophils' activation characteristics compared with elderly and young without DS. Methods: Salivary peroxidases (SPO) and elastase activities (ELA), nitric oxide (NO), transforming growth factor beta (TGF-beta), IL-6 and CCL3 production were determined in saliva from elderly with or without DS, and young control individuals. TLR4, CXCR1, CD11b, CD16 and CD32 expression on salivary neutrophils were evaluated. Correlations between number and apoptosis rate of salivary neutrophils, enzymatic activities and cytokine levels were determined. Results: Elderly DS individuals exhibited the lowest SPO and ELA activities. Also, the activity of both enzymes was low in elderly without DS. Although both elderly groups showed higher salivary NO and TGF-beta levels compared to young control groups, elderly DS presented the highest salivary NO, TGF-beta, IL-6 and CCL3 levels. Decreased percentages of salivary TLR4(+) and CD16(+) neutrophils were detected in both elderly groups. Although these damages could influence the establishment and persistence of DS, the highest levels of salivary IL-6 and CCL3 in elderly DS could be preventing more serious complications.

WATER HOMEOSTASIS, FRAILTY AND COGNITIVE FUNCTION IN THE NURSING HOME

Objective: - To develop and test a practical clinical method to assess frailty in nursing homes; - To investigate the relationship between cognitive status of the elderly and the balance between water compartments of their body composition. Design and subjects: Cross-sectional study, conducted at two nursing homes in Boston-MA. Methods: Body mass and height (Ht) were evaluated to calculate BMI (body mass index, in Kg/m(2)). The cognitive decline was evaluated based on the scores obtained from the Mini-Mental State Examination (MMSE); The extracellular to total body water ratio (ECW/TBW) was calculated after the analysis of TBW from deuterium and tritium dilution and ECW from bromide dilution. Single-frequency BIA analysis data were investigated for resistance (R) and reactance (Xc), plotted in an R/Ht Xc/Ht graph (vectorial analysis-BIVA). The BIVA results of nursing home residents were compared against the data obtained from the NHANES Ill study. TBW and ECW values were compared with a group of free-living elderly volunteers. Results: The ECW/TBW was significantly higher in nursing home residents than in the free-living individuals. BIVA analysis showed significantly higher Xc/Ht values in the reference subjects. The MMSE did not present a significant correlation with ECW/TBW for either gender. Conclusion: We proposed the ECW/TBW ratio and BIVA as surrogate methods for the clinical assessment of frailty. We tested successfully both approaches with nursing home patients and free-living volunteers and compared them to a national data base. The advent of new, portable instruments will enable field tests to further validate our proposed "Frailty Factor" in future studies. We found no correlation between frailty and cognitive decline in the nursing home.

Shear bond strength between different materials bonded with two resin cements

Background: The aim of this study was to compare the shear bond strength between Ni-Cr alloy specimens bonded to air-abraded Ni-Cr, bur-abraded Ni-Cr, etched ceramic and etched enamel substrates using the resin cements RelyX ARC or Enforce. Materials and methods: Ni-Cr specimens were made and sandblasted with Al2O3 airborne-particles. Disc-shaped patterns were made for each of the four experimental substrates: Ni-Cr treated with Al2O3 airborne-particles, Ni-Cr treated with diamond bur abrasion, etched enamel and etched ceramic. Results: Significant differences in shear bond strength were found between the different materials and luting agents evaluated. The Ni-Cr alloy cylinders bonded to Ni-Cr surfaces sandblasted with 50 lm Al2O3 particles and bonded with Enforce achieved the highest bond strength when compared with other substrates (28.9 MPa, p < 0.05). Bur-abraded metal discs had lowest values, regardless the cement used (2.9 and 6.9 MPa for RelyX and Enforce, respectively). Etched enamel and etched ceramic had similar shear bond strengths within cement groups and performed better when RelyX was used. Conclusions: Bonding Ni-Cr to Ni-Cr and ceramic may result in similar and higher bond strength when compared to Ni-Cr/enamel bonding. For metal/metal bonding, higher shear bond strength was achieved with resin cement Enforce, and for metal/ceramic and metal/enamel bonding, RelyX had higher results.

Influence of artificial accelerated ageing on the colour stability of paints used for ocular prosthesis iris painting

Objectives: To evaluate the colour stability of paints used for ocular prosthesis iris painting submitted for accelerated artificial ageing (AAA). Materials and methods: Forty specimens of acrylic resin for sclera (16 x 2 mm) were made and separated into eight groups (n = 10) according to the type of paint (gouache, GP; oil, OP; acrylic AP; and composite resin for characterisation, CR) and the colours used (blue/brown). After drying (72 h), a new layer of colourless acrylic resin was applied and the initial colour readout was performed (Spectrophotometer PCB 6807). New colour readouts were performed after AAA, and Delta E was calculated. Results: Statistical analysis (two-way ANOVA-Bonferroni, p < 0.05) demonstrated that the brown colour showed lower Delta E means in comparison with the blue colour, with statistically significant difference for AP only. Blue colour showed no statistically significant difference with regard to the type of paint used. Brown AP showed lower Delta E than the other groups, with significant difference for OP and GP. GP showed greater alteration in Delta E for the brown colour, being statistically similar only to OP. Conclusions: Only the AP group for brown pigment shows clinically acceptable values for colour stability after AAA.

Determinants of cognitive performance among community dwelling older adults in an impoverished sub-district of Sao Paulo in Brazil

Determinants of cognitive performance in old age have received limited attention in Latin America. We investigated the association of socio-demographic and health-related variables with cognitive performance in a sample of older adults with limited educational experience living in a poor subdistrict of the city of Sao Paulo. This was a cross-sectional population-based study which included a sample of 384 seniors 65 years and older. Cognition was assessed by the Mini-Mental State Examination (MMSE) and the Brief Cognitive Screening Battery (BCSB) (episodic memory test with 10 pictures, verbal fluency (VF), Clock Drawing Test (CDT)). Results indicated that age, sex, schooling, depressive symptoms, and systolic blood pressure (SBP) level had a significant impact on the cognitive performance of the sample. Therefore, pharmacological and psychosocial interventions with a focus on improving mood and controlling hypertension may have beneficial effects on cognition among seniors with similar socio-demographic characteristics. (C) 2011 Elsevier Ireland Ltd. All rights reserved.

Asymptomatic nodules of the upper lip: report of a canalicular adenoma with immunoprofile presentation

Canalicular adenoma is an uncommon benign tumour that generally arises in the minor salivary glands of individuals over 60 years old. This study illustrates a case of canalicular adenoma in a 70-year-old female, presenting as two distinct asymptomatic nodules in the upper lip. Immunohistochemistry analysis was performed. Clinical features, management, histology and immunoprofile from this case and from the literature are discussed.

Evaluation of experimental cleanser solution of Ricinus communis: effect on soft denture liner properties

Objective: This study evaluated colour stability, hardness and roughness of soft denture liners after immersion in various cleansers. Materials and methods: Thirty specimens (14 mm x 4 mm) of Elite Soft Relining (ES) and Mucopren Soft (MS) were randomly immersed in distilled water at 37 degrees C, sodium hypochlorite 1%, and an experimental Ricinus communis solution (RC) for 7, 15 and 183 continuous days. Results: ANOVA (p < 0.05) and Tukey's test indicated that after T7 (mu =8.79 +/- 7.36); T15 (mu = 4.23 +/- 2.62) and T183 (mu = 8.78 +/- 3.16), MS presented a higher increase in hardness than ES. After T7, MS underwent an increase in roughness (mu = 0.09 +/- 0.80); ES underwent a decrease (mu = -0.08 +/- 0.16). RC caused the smallest variation in roughness. After T15, both materials presented an increase in roughness. After T183, ES (mu = -0.30 +/- 0.48) presented a higher roughness variation than MS (mu = -0.07 +/- 0.32). Hypochlorite caused an increase in roughness (mu = 0.02 +/- 0.19). Conclusion: After all periods ES presented higher colour alteration than MS; highest colour alteration was caused by hypochlorite. Both materials were more stable after immersion in RC.

AFFECTION IN ELDERLY CARE FROM THE NURSES' PERSPECTIVE

The objective of this study was to describe, from the nurses' perspective, the meaning of effective/affective care, the interference factors, and the learning promoted from dealing with elderly inpatients, as well as their perception of feeling ready or not to engage in caring. This qualitative study was performed with nurses from a hospital located in the Midwestern region of the State of Sao Paulo. The findings show that the meaning of providing effective/affective care involves knowing the client within his/her social framework, while it crosses the borders of sheer technical care and encompasses fulfilling the client's needs and requirements. Interferences in dealing with the elderly refer to those situations connected with the patients' conditions, work dynamics, and environmental and management adaptations. All surveys showed that despite feeling well prepared, nurses are aware of the need to study fields such as geriatrics and gerontology to a deeper extent. Complete and quality care is only possible if it includes techniques, knowledge and the ability to deal with others with patience and attention to detail.

Relationships between gender, age, family conditions, physical and mental health, and social isolation of elderly caregivers

Background: In an aging population an increasing number of elderly caregivers will be called upon to provide care over a long period, during which time they will be burdened both by caregiving and by the physiological effects of their own aging. Among them there will be more aged male caregivers, who will probably be less prepared than women to become caregivers. The aim of this study was to investigate the relationship between caregivers' gender, age, family income, living arrangements and social support as independent variables, and depressive symptoms, comorbidities, level of frailty, grip strength, walking speed and social isolation, as dependent variables. Methods: 176 elderly people (123 women) were selected from a sample of a population-based study on frailty (n = 900), who had cared for a spouse (79.3%) and/or parents (31.4%) in the past five years (mean age = 71.8 +/- 4.86 years; mean monthly family income in minimum wages = 4.64 +/- 5.14). The study used questionnaires and self-report scales, grip strength and walking speed tests. Results: 65% of participants evaluated caregiving as being very stressful. Univariate analyses of regression showed low family income as a risk factor for depression; being female and low perceived social support as a risk for comorbidities; being 80 years of age and above for low grip strength; and being male for social isolation indicated by discontinuity of activities and social roles. In multivariate analyses of regression, poverty arose as a risk factor for depression and being female for comorbidities. Conclusions: Gender roles, age, income and social support interacted with physical and emotional health, and with the continuity of social participation of elderly caregivers. Special attention must be given to male caregivers.

Bioelectrical impedance with different equations versus deuterium oxide dilution method for the inference of body composition in healthy older persons

There is no consensus regarding the accuracy of bioimpedance for the determination of body composition in older persons. This study aimed to compare the assessment of lean body mass of healthy older volunteers obtained by the deuterium dilution method (reference) with those obtained by two frequently used bioelectrical impedance formulas and one formula specifically developed for a Latin-American population. A cross-sectional study. Twenty one volunteers were studied, 12 women, with mean age 72 +/- 6.7 years. Urban community, Ribeiro Preto, Brazil. Fat free mass was determined, simultaneously, by the deuterium dilution method and bioelectrical impedance; results were compared. In bioelectrical impedance, body composition was calculated by the formulas of Deuremberg, Lukaski and Bolonchuck and Valencia et al. Lean body mass of the studied volunteers, as determined by bioelectrical impedance was 37.8 +/- 9.2 kg by the application of the Lukaski e Bolonchuk formula, 37.4 +/- 9.3 kg (Deuremberg) and 43.2 +/- 8.9 kg (Valencia et. al.). The results were significantly correlated to those obtained by the deuterium dilution method (41.6 +/- 9.3 Kg), with r=0.963, 0.932 and 0.971, respectively. Lean body mass obtained by the Valencia formula was the most accurate. In this study, lean body mass of older persons obtained by the bioelectrical impedance method showed good correlation with the values obtained by the deuterium dilution method. The formula of Valencia et al., developed for a Latin-American population, showed the best accuracy.

Dyslipidemia: evidence of efficacy of the pharmacological and non-pharmacological treatment in the elderly

The clinical decision to control risk factors for cardiovascular disease (CVD) in the elderly takes the followings into consideration: (1) the elderly life expectancy; (2) the elderly biological age and functional capacity; (3) the role of cardiovascular disease in the elderly group; (4) the prevalence of risk factors in the elderly; and (5) The effectiveness of treatment of risk factors in the elderly. A large number of studies showed the efficacy of secondary and primary prevention of dyslipidemia in the elderly. However, the only trial that included patients over 80 years was the Heart Protection Study (HPS). Statins are considered the first line therapy for lowering low-density lipoprotein cholesterol (LDL-C). Because lifestyle changes are very difficult to achieve, doctors in general tend to prescribe many drugs to control cardiovascular risk factors. However, healthy food consumption remains a cornerstone in primary and secondary cardiovascular prevention and should be implemented by everyone.

Is the History of Falls an Indicative of Greater Decline in Quadriceps Muscle Function and Postural Sway?

To evaluate whether a history of falls is directly related to the quadriceps muscular function and body sway, 26 elderly women were divided on the basis of the presence or absence of a history of falls. Evaluation of muscular power and anteroposterior and mediolateral displacements of center of pressure during consecutive stand and sit 5 times were performed. Fallers exhibited higher mediolateral displacement than nonfallers. No differences were observed for quadriceps power and for sit-to-stand time between groups (P<.05). The fall history was not related to the quadriceps muscular function or to the anteroposterior displacement during sit to stand.

ST Elevation Myocardial Infarction in the elderly

Acute coronary syndromes (ACS) are the leading causes of death in the elderly. The suspicion and diagnosis of ACS in this age group is more difficult, since typical angina is less frequent. The morbidity and mortality is greater in older age patients presenting ACS. Despite the higher prevalence and greater risk, elderly patients are underrepresented in major clinical trials from which evidence based recommendations are formulated. The authors describe, in this article, the challenges in the diagnosis and management of ST elevation myocardial infarction in the elderly, and discuss the available evidence.

The beta 2-Adrenoceptor Agonist Formoterol Improves Structural and Functional Regenerative Capacity of Skeletal Muscles From Aged Rat at the Early Stages of Postinjury

Skeletal muscles from old rats fail to completely regenerate following injury. This study investigated whether pharmacological stimulation of beta 2-adrenoceptors in aged muscles following injury could improve their regenerative capacity, focusing on myofiber size recovery. Young and aged rats were treated with a subcutaneous injection of beta 2-adrenergic agonist formoterol (2 mu g/kg/d) up to 10 and 21 days after soleus muscle injury. Formoterol-treated muscles from old rats evaluated at 10 and 21 days postinjury showed reduced inflammation and connective tissue but a similar number of regenerating myofibers of greater caliber when compared with their injured controls. Formoterol minimized the decrease in tetanic force and increased protein synthesis and mammalian target of rapamycin phosphorylation in old muscles at 10 days postinjury. Our results suggest that formoterol improves structural and functional regenerative capacity of regenerating skeletal muscles from aged rats by increasing protein synthesis via mammalian target of rapamycin activation. Furthermore, formoterol may have therapeutic benefits in recovery following muscle damage in senescent individuals.

Clinical and sociodemographic factors in a sample of older subjects experiencing depressive symptoms

Objectives This study aims to determine the frequency of clinically significant depressive symptoms (CSDS) in a community sample of older Brazilians and to examine their relationship with sociodemographic factors, cognitive and functional impairment (CFI), and medical illness. Methods A total of 1145 subjects aged 60?years or older living in the City of Ribeirao Preto, State of Sao Paulo, Brazil, were interviewed. The following instruments were used: a 10-item scale for screening of depressive symptoms in older people, the mini mental state examination, the Fuld Object Memory Evaluation, the Informant Questionnaire on Cognitive Decline in the Elderly, the Bayer Activities of Daily Living Scale, and a sociodemographic and clinical questionnaire. Results The frequency of CSDS was 15.7%. Logistic regression analysis indicated that being previously depressed, having CFI, having lower level of education, using psychotropics, and not engaging in physical exercise were related to CSDS. On the other hand, being a woman, older, medically ill, employed, or married was not associated with CSDS. Conclusions Consistent with previous reports, lower education, lack of physical activity, and CFI were significantly associated with higher frequencies of CSDS. Further investigations are necessary to clarify the occurrence of depression and possible modifiable factors in developing countries such as Brazil. Copyright (C) 2011 John Wiley & Sons, Ltd.