Avaliação clínica e radiográfica das complicações técnicas em próteses sobre implantes

The evaluation criteria of the cases treated with dental implants are based on clinical and radiographic tests. In this context it is important to conduct research to determine prognosis of different types of prosthetic rehabilitation and determination of the main problems affecting this type of treatment. Thus, the objective of this study was to assess the prosthetic conditions of individuals rehabilitated with implant-supported prosthesis. In this cross-sectional study 153 patients were treated, accounting for a sample of 509 implants. The failures were observed by clinical and radiographic examination. The results showed that the fracture (0.2%) loss (0.4%) and loosening of the screws (3.3%) were failures are less frequent. The fracture structures as the resin (12.4%), porcelain (5.5%) and metallic (1.5%), loss of resin that covers the screw (23.8%) and loss of retention overdentures on implants (18.6%) had a higher occurrence. The failure of adaptation between the abutment and the implant (6.9%) and especially between the prosthesis and the abutment (25.4%) had a high prevalence and, when related to other parameters showed a significant association, particularly with the cemented prosthesis (OR = 6.79). It can be concluded that to minimize the appearance of failures, protocols must be observed from diagnosis to the settlement and control of prostheses on implants, particularly with respect to technical steps of the making of the prosthesis and care in radiographic evaluating the fit between their components

Injúria renal aguda em unidade de terapia intensiva: estudo prospectivo sobre a incidência, fatores de risco e mortalidade

OBJETIVO: Comparar características clínicas e evolução de pacientes com e sem injúria renal aguda adquirida em unidade de terapia intensiva geral de um hospital universitário terciário e identificar fatores de risco associados ao desenvolvimento de injúria renal aguda e à mortalidade. MÉTODOS: Estudo prospectivo observacional com 564 pacientes acompanhados diariamente durante a internação em unidade de terapia intensiva geral do Hospital das Clínicas da Faculdade de Medicina de Botucatu por 2 anos consecutivos (de maio de 2008 a maio de 2010), divididos em 2 grupos: com injúria renal aguda adquirida (G1) e sem injúria renal aguda adquirida (G2). RESULTADOS: A incidência de injúria renal aguda foi 25,5%. Os grupos diferiram quanto à etiologia da admissão em unidade de terapia intensiva (sepse: G1:41,6% x G2:24,1%, p<0,0001 e pós operatório neurológico 13,8% x 38,1%, p<0,0001), idade (56,8±15,9 x 49,8± 17,8 anos, p< 0,0001), APACHE II (21,9±6,9 x 14,1±4,6, p<0,0001), ventilação mecânica (89,2 x 69,1%, p<0,0001) e uso de drogas vasoativas (78,3 x 56,1%, p<0,0001). Com relação aos fatores de risco e às comorbidades, os grupos foram diferentes quanto à presença de diabetes mellitus, insuficiência cardíaca congestiva, insuficiência renal crônica e uso de anti-inflamatórios não hormonais (28,2 x 19,7%, p=0,03; 23,6 x 11,6%, p=0,0002, 21,5 x 11,5%, p< 0,0001 e 23,5 x 7,1%, p<0,0001, respectivamente). O tempo de internação e a mortalidade foram superiores nos pacientes que adquiriram injúria renal aguda (6,6 ± 2,7 x 12,9± 5,6 dias p<0,0001 e 62,5 x 16,4%, p<0,0001). À análise multivariada foram identificados como fatores de risco para injúria renal aguda, idade>55 anos, APACHE II>16, creatinina (cr) basal>1,2 e uso de anti-inflamatórios não hormonais (OR=1,36 IC:1,22-1,85, OR=1,2 IC:1,11-1,33, OR=5,2 IC:2,3-11,6 e OR=2,15 IC:1,1-4,2, respectivamente) e a injúria renal aguda esteve independentemente associada ao maior tempo de internação e à mortalidade (OR=1,18 IC:1,05-1,26 e OR=1,24 IC:1,09-1,99 respectivamente). À análise da curva de sobrevida, após 30 dias de internação, a mortalidade foi de 83,3% no G1 e 45,2% no G2 (p<0,0001). CONCLUSÃO: A incidência de injúria renal aguda é elevada em unidade de terapia intensiva, os fatores de riscos independentes para adquirir injúria renal aguda são idade >55 anos, APACHE II>16, Cr basal >1,2 e uso de anti-inflamatórios não hormonais e a injúria renal aguda é fator de risco independente para o maior tempo de permanência em unidade de terapia intensiva e mortalidade.

Risk factors for Hospital-Acquired Pneumonia in nonventilated adults

Although most recent publications focus on Ventilator-associated Pneumonia, Non-Ventilator-associated Hospital-acquired pneumonia (NVHAP) is still worrisome. We studied risk factors for NVHAP among patients admitted to a small teaching hospital. Sixty-six NVHAP case patients and 66 controls admitted to the hospital from November 2005 through November 2006 were enrolled in a case-control study. Variables under investigation included: demographic characteristics, comorbidities, procedures, invasive devices and use of medications (Sedatives, Antacids, Steroids and Antimicrobials). Univariate and multivariable analysis (hierarchical models of logistic regression) were performed. The incidence of NVHAP in our hospital was 0.68% (1.02 per 1,000 patients-day). Results from multivariable analysis identified risk factors for NVHAP: age (Odds Ratio[OR]=1.03, 95% Confidence Interval[CI]=1.01-1.05, p=0.002), use of Antacids (OR=5.29, 95%CI=1.89-4.79, p=0.001) and Central Nervous System disease (OR=3.13, 95%CI=1.24-7.93, p=0.02). Although our findings are coherent with previous reports, the association of Antacids with NVHAP recalls a controversial issue in the physiopathology of Hospital-Acquired Pneumonia, with possible implications for preventive strategies.

Indicadores antropométricos e as doenças crônicas não transmissíveis em mulheres na pós-menopausa da região Sudeste do Brasil

OBJETIVO: avaliar a influência dos indicadores antropométricos sobre os marcadores de risco cardiovascular e metabólico para doenças crônicas não-transmissíveis em mulheres na pós-menopausa. MÉTODOS: realizou-se estudo clínico transversal, com 120 mulheres sedentárias na pós-menopausa (com idades entre 45 e 70 anos e última menstruação há, pelo menos, 12 meses). Foram excluídas as diabéticas insulino-dependentes e usuárias de estatinas ou terapia hormonal até seis meses prévios. Para avaliação antropométrica, foram obtidos peso, estatura, índice de massa corpórea (IMC=peso/altura²) e circunferência da cintura (CC). As variáveis metabólicas avaliadas foram colesterol total (CT), HDL, LDL, triglicérides (TG), glicemia e insulina, para os cálculos do índice aterogênico plasmático (IAP) e resistência insulínica (Homeostasis model assessment-insulin resistance, HOMA-IR). Na análise estatística, utilizara-se análise de variância one-way (ANOVA) e Odds Ratio (OR). RESULTADOS: os dados médios caracterizaram amostra com sobrepeso, com obesidade central e dislipidêmica. Sobrepeso e obesidade estiveram presentes em 77,1% e deposição central de gordura ocorreu em 87,3% das participantes. Os valores médios de CT, LDL e TG estavam acima do recomendável em 67,8, 55,9 e 45,8% das mulheres, respectivamente, com HDL abaixo dos valores adequados em 40,7%. Valores de CC >88 cm ocorreram em 14,8% das mulheres eutróficas, 62,5% no grupo com sobrepeso e 100% nas obesas (p>0,05). Os valores médios de IAP, TG e HOMA-IR aumentaram significativamente com o aumento do IMC e da CC, enquanto que o HDL diminuiu (p<0,05). Na presença da CC >88 cm, encontrou-se risco de 5,8 (IC95%=2,3-14,8), 2,61 (IC95%=1,2-5,78), 3,4 (IC95%=1,2-9,7) e 3,6 (IC95%=1,3-10,3) para HDL reduzido, hipertrigliceridemia, IAP elevado e resistência a insulina, respectivamente (p<0,05). O IMC >30 kg/m² associou-se apenas com HDL reduzido (OR=3,1; IC95%=1,44-6,85). CONCLUSÕES: a associação de duas medidas antropométricas (CC e IMC) foi eficiente para adequado diagnóstico de obesidade relacionada a alterações metabólicas em mulheres na pós-menopausa. Contudo, a simples avaliação da CC pode ser indicativo do risco cardiovascular e metabólico das doenças crônicas não transmissíveis.

Metabolic syndrome and its associated risk factors in Brazilian postmenopausal women

Objective To evaluate the prevalence of metabolic syndrome (MetS) and its associated risk factors in Brazilian postmenopausal women.Methods In this cross-sectional study, a total of 368 postmenopausal women, aged 40-75 years, seeking health care at a public outpatient center in Southeastern Brazil, were included. According to the US National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines, MetS was diagnosed in subjects with three or more of the following: waist circumference >= 88 cm, blood pressure >= 130/85 mHg, triglycerides >= 150 mg/dl, high density lipoprotein cholesterol <50 mg/dl and glucose >= 110 mg/dl. Data on past medical history, tobacco use, anthropometric indicators, and values of C-reactive protein (CRP) were collected. Multivariate analysis, using a logistic regression model (odds ratio, OR) was used to evaluate the influence of various simultaneous MetS risk factors.Results The prevalence of having at least three, four and five MetS diagnostic criteria were met in 39.6%, 16.8% and 3.8% of the cases, respectively. The most prevalent risk factor was abdominal obesity, affecting 62.5% of women. The risk of MetS increased with a personal history of diabetes (OR 5.95, 95% confidence interval (CI) 2.82-12.54), hypertension (OR 4.52, 95% CI 2.89-7.08), cardiovascular disease (OR 2.16, 95% CI 1.18-3.94) and high CRP (>1 mg/dl) (OR 3.35, 95% CI 1.65-6.79). Plasma CRP levels increased with the number of MetS components present. Age, time since menopause and smoking had no influence, while hormone therapy reduced MetS risk (OR 0.64, 95% CI 0.42-0.97).Conclusion Metabolic syndrome was highly prevalent among Brazilian postmenopausal women seeking gynecologic health care. Abdominal obesity, diabetes, hypertension and high CRP were strong MetS predictors and hormone therapy appeared to play a protective role for this condition.

Prevalência e fatores de risco para transtornos mentais comuns entre estudantes de medicina

OBJETIVO: Estimar a prevalência de transtornos mentais comuns entre estudantes de medicina e respectivos fatores de risco. MÉTODOS: Estudo transversal realizado com 551 universitários de um curso de medicina de Botucatu, SP. Utilizou-se questionário auto-aplicável investigando aspectos sócio demográficos, relacionados ao curso e o Self Reporting Questionnaire. Para análise dos dados empregaram-se os testes de qui-quadrado e regressão logística. RESULTADOS: Participaram 82,6% dos alunos matriculados no curso, predominando mulheres (61%), jovens (60% 20-23 anos), procedentes de outros municípios (99%). A prevalência de transtornos mentais comuns foi de 44,7% associando-se independentemente a: dificuldade para fazer amigos (RC=2,0), avaliação ruim sobre desempenho escolar (RC=1,7), pensar em abandonar o curso (RC=5,0), não receber o apoio emocional de que necessita (RC=4,6). Embora na primeira análise a prevalência tenha se mostrado associada ao ano do curso, esta associação não se manteve na análise multivariada. CONCLUSÕES: A prevalência de transtornos mentais comuns mostrou-se elevada entre os estudantes de medicina, associando-se a variáveis relacionadas à rede de apoio. As experiências emocionalmente tensas como o contato com pacientes graves, formação de grupos, entre outras, vividas nos últimos anos do curso, são provavelmente potentes estressores, especialmente para sujeitos com uma rede de apoio considerada deficiente. Sugere-se que instituições formadoras estejam atentas a esse fato, estabelecendo intervenções voltadas ao acolhimento e ao cuidado com o sofrimento dos estudantes.

Progression of articular and extraarticular damage in oligoarticular juvenile idiopathic arthritis

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

Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers

Objective: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g.Methods: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression.Results: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth.Conclusion: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.

A Brazilian registry of juvenile dermatomyositis: onset features and classification of 189 cases

ObjectiveTo describe onset features, classification and treatment of juvenile dermatomyositis (JDM) and juvenile polymyositis (JPM) from a multicentre registry.MethodsInclusion criteria were onset age lower than 18 years and a diagnosis of any idiopathic inflammatory myopathy (IIM) by attending physician. Bohan & Peter (1975) criteria categorisation was established by a scoring algorithm to define JDM and JPM based oil clinical protocol data.ResultsOf the 189 cases included, 178 were classified as JDM, 9 as JPM (19.8: 1) and 2 did not fit the criteria; 6.9% had features of chronic arthritis and connective tissue disease overlap. Diagnosis classification agreement occurred in 66.1%. Medial? onset age was 7 years, median follow-up duration was 3.6 years. Malignancy was described in 2 (1.1%) cases. Muscle weakness occurred in 95.8%; heliotrope rash 83.5%; Gottron plaques 83.1%; 92% had at least one abnormal muscle enzyme result. Muscle biopsy performed in 74.6% was abnormal in 91.5% and electromyogram performed in 39.2% resulted abnormal in 93.2%. Logistic regression analysis was done in 66 cases with all parameters assessed and only aldolase resulted significant, as independent variable for definite JDM (OR=5.4, 95%CI 1.2-24.4, p=0.03). Regarding treatment, 97.9% received steroids; 72% had in addition at least one: methotrexate (75.7%), hydroxychloroquine (64.7%), cyclosporine A (20.6%), IV immunoglobulin (20.6%), azathioprine (10.3%) or cyclophosphamide (9.6%). In this series 24.3% developed calcinosis and mortality rate was 4.2%.ConclusionEvaluation of predefined criteria set for a valid diagnosis indicated aldolase as the most important parameter associated with de, methotrexate combination, was the most indicated treatment.

Eventos adversos após vacinação contra influenza em idosos, Distrito de Campinas, SP, 2000

Há poucos dados sistematizados sobre eventos adversos da vacina contra influenza no Brasil. Este trabalho visou identificar estes eventos em população acima de 60 anos que compareceu à Campanha Nacional de Vacinação do Idoso, em Distrito de Campinas, SP, em 2000. Foi realizada entrevista para relato de sintomas gerais e locais, com nexo temporal após a aplicação do imunobiológico, em amostra aleatória sistemática da população (n=206). Registraram-se 20,38% (IC 14,87-25,88) dos indivíduos com um ou mais sintomas, sendo a dor no local da vacina, a mais freqüente 12,6% (IC 8,09-17,15). Ajustou-se um modelo de regressão logística múltipla, tendo como variável dependente, a ocorrência de pelo menos um evento adverso. A variável independente que se mostrou associada às reações adversas foi o sexo (feminino) (OR=5,89 e IC 2,08-16,68). Os achados deste estudo reafirmam a pequena reatogenicidade da vacina contra a influenza.

Comparison of decompressive surgery, electroacupuncture, and decompressive surgery followed by electroacupuncture for the treatment of dogs with intervertebral disk disease with long-standing severe neurologic deficits

Objective To compare the effects of decompressive surgery (DSX), electroacupuncture (EAP), and DSX followed by EAP (DSX + EAP) for the treatment of thoracolumbar intervertebral disk disease (IVDD) in dogs with severe neurologic deficits of > 48 hours' duration.Design Retrospective case series and prospective clinical trial.Animals-40 dogs between 3 and 6 yEAPs old and weighing between 10 and 20 kg (22 and 44 lb) with long-standing (>48 hours) clinical signs of severe neurologic disease attributable to thoracolumbar IVDD.Procedures Thoracolumbar medullar injury was classified on the basis of neurologic signs by use of a scale ranging from 1 (least severe) to 5 (most severe). The DSX dogs (n = 10) were retrospectively selected from those that underwent DSX for the treatment of thoracolumbar IVDD. In addition, 19 dogs received EAP alone and 11 dogs underwent DSX followed by EAP (DSX + EAP). Outcome was considered a clinical success when a dog initially classified as grade 4 or 5 was classified as grade 1 or 2 within 6 months after the end of treatment.Results The proportion of dogs with clinical success was significantly higher for dogs that underwent EAP (15/19) than for dogs that underwent DSX (4/10); the proportion of dogs with clinical success for dogs that underwent DSX + EAP was intermediate (8/11).Conclusions and Clinical Relevance EAP was more effective than DSX for recovery of ambulation and improvement in neurologic deficits in dogs with long-standing severe deficits attributable to thoracolumbar IVDD. (J Am Vet Med Assoc 2010;236:1225-1229)

Fatores de risco associados à infecção por Toxoplasma gondii em ovinos e caprinos no estado de Pernambuco

Objetivou-se com este estudo investigar a participação de Toxoplasma gondii em falhas reprodutivas em pequenos ruminantes de criatórios situados na Zona da Mata e no Agreste do Estado de Pernambuco e que apresentavam histórico de distúrbios reprodutivos. Foram selecionadas 12 propriedades das quais se coletaram amostras de 262 animais, sendo 167 caprinos e 95 ovinos. Realizou-se a pesquisa de anticorpos anti-Toxoplasma gondii, utilizando-se a técnica da Imunofluorescência Indireta (RIFI). Foram aplicados questionários investigativos nas propriedades visitadas para identificar os fatores de risco associados à infecção. em 100% das propriedades foram encontrados animais soropositivos. Para T. gondii, das 167 amostras de soro caprino analisadas, 31,7% foram positivas, enquanto que na espécie ovina, das 95 amostras, 16,9% foram positivas. Para a espécie ovina, não foram observadas associações significativas. Para os caprinos, houve associação significativa (p<0,05) para as variáveis: manejo intensivo (OR=2,40), exploração leiteira (OR=2,10), animais procedentes de outros estados (OR=7,89) e monta natural (OR=5,69). Conclui-se que a infecção pelo T. gondii encontra-se disseminada nos rebanhos de caprinos e ovinos estudados e que medidas sanitárias devem ser adotadas para controlar os fatores de risco identificados neste estudo.

Periodontal Tissue Engineering After Tooth Replantation

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

In vitro effect of low-level laser on odontoblast-like cells

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

PDGF-B gene therapy accelerates bone engineering and oral implant osseointegration

Platelet-derived growth factor-BB (PDGF-BB) stimulates repair of healing-impaired chronic wounds such as diabetic ulcers and periodontal lesions. However, limitations in predictability of tissue regeneration occur due, in part, to transient growth factor bioavailability in vivo. Here, we report that gene delivery of PDGF-B stimulates repair of oral implant extraction socket defects. Alveolar ridge defects were created in rats and were treated at the time of titanium implant installation with a collagen matrix containing an adenoviral (Ad) vector encoding PDGF-B (5.5 x 10(8) or 5.5 x 10(9) pfu ml (1)), Ad encoding luciferase (Ad-Luc; 5.5 x 10(9) pfu ml (1); control) or recombinant human PDGF-BB protein (rhPDGF-BB, 0.3 mg ml (1)). Bone repair and osseointegration were measured through backscattered scanning electron microscopy, histomorphometry, microcomputed tomography and biomechanical assessments. Furthermore, a panel of local and systemic safety assessments was performed. Results indicated that bone repair was accelerated by Ad-PDGF-B and rhPDGF-BB delivery compared with Ad-Luc, with the high dose of Ad-PDGF-B more effective than the low dose. No significant dissemination of the vector construct or alteration of systemic parameters was noted. In summary, gene delivery of Ad-PDGF-B shows regenerative and safety capabilities for bone tissue engineering and osseointegration in alveolar bone defects comparable with rhPDGF-BB protein delivery in vivo. Gene Therapy (2010) 17, 95-104; doi: 10.1038/gt.2009.117; published online 10 September 2009