Predictive value for malignancy in the finding of microcalcifications on ultrasonography of thyroid nodules

Background. The am of this study was to determine the predictive value for malignancy of microcalcifications determined by ultrasonography in thyroid nodules. Methods. One hundred seventy-seven nodules were prospectively studied by ultrasonography and compared with their fine-needle aspirative biopsy. The association between the presence and type of calcification and cytologic findings was verified through the chi-square test or likelihood ratio. Results. Thirty nodules showed calcification, of which 17 had fine calcifications, 3 had fine and gross calcifications, and 10 had only coarse calcification. Seven (41.18%) of 17 fine calcified nodules were malignant on cytology, 8 (47.06%) were benign, 1 (5,88%) was indeterminate, and 1 was suspect for malignancy. We found statistical significance between the presence of fine calcifications and malignancy (p =.001) and, in the 13 malignant nodule group, 8 (61.50%) had fine calcifications. Conclusion. This study suggests that microcalcifications were highly specific for malignancy and were present in 61% of the malignant nodules. (c) 2008 Wiley Periodicals, Inc.

Ductus venosus Doppler and postnatal outcomes in fetuses with absent or reversed end-diastolic flow in the umbilical arteries

Objective: To evaluate the relationship between ductus venosus Doppler findings on the day of delivery and postnatal outcomes in pregnancies with absent or reversed end-diastolic (ARED) flow in the umbilical arteries. Study design: Postnatal outcomes of 103 newborns of pregnancies with a diagnosis of ARED flow on Doppler velocimetry of the umbilical arteries were analyzed retrospectively between January 1997 and December 2004. Single pregnancies and fetuses without malformations were included. The cases were divided into two groups according to the flow during atrial contraction (a-wave) in the ductus venosus on the day of delivery: group A, 20 cases with absent or reversed flow in the ductus venosus and group B, 83 cases with positive flow. The results were analyzed statistically using the chi-square test, Fisher`s exact test and the Mann-Whitney U test with the level of significance set at 5%. Results: All newborns were delivered by cesarean section. Gestational age was similar in the two groups (group A: 30 weeks and group B: 30.9 weeks, P = 0.23). Absent or reversed ductus venosus flow was associated with the following adverse postnatal outcomes: lower birthweight (P < 0.001), lower Apgar scores in the first (P = 0.001) and fifth minute (P = 0.001), a higher frequency of orotracheal intubation (P = 0.001) and pH at birth less than 7.20 (P < 0.001), pulmonary hemorrhage (P = 0.03), thrombocytopenia (P = 0.02), hypoglycemia (P = 0.01), intracranial hemorrhage (P = 0.02), and postnatal death (P = 0.007). Conclusion: The study of ductus venosus flow may provide additional information regarding the best time for interruption of pregnancies with ARED flow in the umbilical arteries characterized by extreme prematurity. (C) 2008 Elsevier Ireland Ltd. All rights reserved.

Oral lesions in 166 patients with cutaneous psoriasis: A controlled study

Objectives. This study was aimed to test if the frequency of oral lesions bears statistical correlation or not with the condition of cutaneous psoriasis. Study design. Two groups were examined, one made up of 166 patients with skin psoriasis and the other with the same number of individuals with a negative history of skin diseases (control group), matched by age, race, and sex. Patients with psoriasis were grouped according to their having localized or generalized forms of the disease. The oral mucosa was thoroughly examined in both groups. Data were analyzed using chi-square test, Fisher`s test, the odds ratio (OR) with a 95% confidence interval (CI), and the Ryan-Holm step-down Bonferroni procedure. The overall significance was set at P <= 0.05. Results. The oral lesions significantly associated with psoriasis were fissured tongue (FT, OR=2.7; 95% CI: 1.3-5.6), and geographic tongue (GT, OR=5.0; 95% CI: 1.5-16.8). Other factors analyzed, such as topical and/or systemic medication for treatment of psoriasis versus nontreated patients, and localized versus generalized forms of psoriasis presented no statistical association with the frequency of FT or GT lesions (P > 0.05). Conclusions. Patients with psoriasis presented no specific oral lesion different from those seen in the control group. Although further investigation is warranted to establish whether or not either FT or GT can be characterized as an oral expression of psoriasis, the present investigation did find for both these types of lesions that the frequency of each bore a statistically significant relation with the presence of cutaneous psoriasis.

Group psychotherapy: An additional approach to burning mouth syndrome

Introduction: Glossodynia or burning mouth syndrome (BMS) is a common and poorly understood disorder. Its treatment is uncertain. Otherwise, there is some evidence of the importance of psychological factors in the genesis of this disease. Objectives: Verify the usefulness of group psychotherapy as an adjuvant therapeutic method in the treatment of BMS. Casuistics and Methods: The study group consisted of 64 consecutive patients with a clinical diagnosis of BMS seen at the Stomatology Outpatient Clinic, ENT Department, Sao Paulo University Medical School, between May 2002 and May 2007. All the patients were submitted to physical examination, laboratorial screening tests, psychological assessment (Crown-Crisp Experimental Inventory), and answered a short form of the McGill Pain Questionnaire. Only 44 patients who did not show any abnormality in the protocol exams entered the study. Twenty-four of them underwent group psychotherapy. Twenty patients received placebo. Chi-square test was applied to compare the results of treatment with or without psychotherapy. Results: There were 15 men and 29 women in the study group. Tongue burning was the main complaint of the patients. Improvement of symptoms was reported by 17 (70.8%) of the patients undergoing psychotherapy, while among those who did not eight (40%) had improvement of symptoms (P=.04). Conclusion: Psychological assessment demonstrated a close correlation between symptoms and psychological factors, suggesting that group psychotherapy is an important alternative to conventional treatment methods. (C) 2009 Elsevier Inc. All rights reserved.

ONSET OF ELECTRICAL ACTIVITY OF PATELLAR STABILIZER MUSCLES IN SUBJECTS WITH PATELLOFEMORAL PAIN

Objective: To asses the onset (%) of patella stabilizer muscles during maximal isometric contraction exercises (MIC) in individuals with and without signs of patellofemoral pain syndrome (PFPS) in open (OKC) and closed (CKC) kinetic chain exercises, Method: Assessments were carried out on 22 women; ten with no complains of anterior knee pain, and 12 with PFPS signs during MIC in OKC and CKC with the knee flexed at 90 degrees. The onset of the electromyographic activity of the vastus mediallis obliquus (VMO), vastus lateralis obliquus (VLO) and vastus lateralis longus (VLL) was identified by means of an algorithm in the Myosystem Br 1 software. The statistical analysis used was Chi-Square test and student`s t test, which are both tests with a level of significance at 5%. Results: The VMO and VLO muscles presented a greater onset compared to the VLL during OKC exercises for both groups and for the PFPS group without CCF No differences were observed between the groups. Conclusion: CKC and OKC exercises seem to benefit the synchronism of the musculature that supposedly benefits the patella stabilizer musculature, and can be recommended in physiotherapeutic treatment programs.

High levels of anxiety and depression have a negative effect on quality of life of women with chronic pelvic pain

Chronic pelvic pain (CPP) is a common and complex disease whose cause is often clinically inexplicable, with consequent difficulty in diagnosis and treatment. Patients with CPP have high levels of anxiety and depression, with a consequent impairment of their quality of life. The objective of this study was to determine the prevalence of anxiety and depression and their impact on the quality of life of women with CPP. A cross-sectional controlled study was conducted on 52 patients with CPP and 54 women without pain. Depression and anxiety were evaluated by the Hospital Anxiety and Depression Scale, and quality of life was evaluated by the World Health Organization Quality of life Whoqol-bref questionnaire. Data were analysed statistically by the Mann-Whitney U-test, the Fisher exact test, chi-square test and Spearman correlation test. The prevalence of anxiety was 73% and 37% in the CPP and control groups, respectively, and the prevalence of depression was 40% and 30% respectively. Significant differences between groups were observed in the physical, psychological and social domains. Patients with higher anxiety and depression scores present lower quality of life scores. The fact that DPC is a syndromic complex, many patients enter a chronic cycle of search for improvement of medical symptoms. The constant presence of pain may be responsible for affective changes in dynamics, family, social and sexual. Initially the person is facing the loss of a healthy body and active, to a state of dependence and limitations. In this study, patients with higher scores of anxiety and depression scores had lower quality of life and patients with lower scores of anxiety and depression had scores of quality of life. These results show that perhaps the depression and anxiety may be related to the negative impact on quality of life of these patients. In view of this association, we emphasise the importance of a specific approach to the treatment of anxiety and depression together with clinical treatment to improve the quality of life of these patients.

The 434(G > C) polymorphism in the eosinophil cationic protein gene and its association with tissue eosinophilia in oral squamous cell carcinomas

Objective: The aim of this study was to investigate the prevalence of the Eosinophil cationic protein (ECP)-gene polymorphism 434(G > C) in oral squamous cell carcinoma (OSCC) patients and its association with tumor-associated tissue eosinophilia (TATE), demographic, clinical, and microscopic variables. Methods: The ECP genotypes of 165 healthy individuals and 157 OSCC patients were detected by PCR-RFLP analysis after cleavage of the amplified DNA sequence with enzyme PstI. TATE was obtained by morphometric analysis. Chi-square test or Fisher`s exact test was used to analyze the association of ECP-gene polymorphism 434(G > C) with TATE, demographic, clinical, and microscopic variables in OSCC patients. Disease-free survival and overall survival were calculated by the Kaplan-Meier product-limit actuarial method and the comparison of the survival curves were performed using log rank test. Results: Most of healthy individuals (53.33%) and OSCC patients (57.97%) were heterozygous for the ECP 434(G > C) polymorphism. Based on numerical differences, our results showed that OSCC patients with intense TATE and at least one C allele had a higher frequency of bilateral neck dissection, local recurrence, vascular embolization, involved resection margins, and postoperative radiotherapy. No statistically significant differences on survival rates were found in OSCC patients presenting different ECP 434(G > C) genotypes. Conclusions: These results suggest a tendency towards a poor clinical outcome in OSCC patients with intense TATE and 434GC/CC genotypes, probably due to an ECP genetic variant with altered cytotoxic activity.

Prevalence of Upper Cervical Vertebrae Anomalies in Patients With Cleft Lip and/or Palate and Noncleft Patients

Objectives: To investigate the prevalence of upper cervical vertebrae anomalies in patients with isolated cleft lip, isolated cleft palate, and complete cleft lip and palate, as well as to compare the prevalence of these anomalies between groups, between genders, and with noncleft patients. Design: Retrospective cross-sectional study of randomly selected patients. Setting: Radiology Section, Hospital for Rehabilitation of Craniofacial Anomalies and Department of Orthodontics, Bauru School of Dentistry, University of Sao Paulo, Sao Paulo, Brazil. Participants: The sample comprised 300 lateral cephalograms of cleft patients, aged 12 to 13 years, of both genders, from the files of the Hospital for Rehabilitation of Craniofacial Anomalies-University of Sao Paulo and 300 lateral cephalograms from noncleft patients of the Department of Orthodontics, Bauru School of Dentistry. Cephalograms of patients with syndromes were not included. Method: Radiographs were interpreted on a film viewer by a single examiner; the profiles of vertebrae were traced on acetate paper, and cervical vertebrae anomalies were registered and categorized into posterior arch deficiencies, fusion, and association of both. Main Outcome Measures: Statistical comparison of groups using the chi-square test. Results: In the cleft group, 38.67% of the patients had cervical vertebrae anomalies. Of those in the noncleft sample, 31% showed anomalies of the cervical spine. This difference was statistically significant. There was no statistically significant difference when the types of clefts were compared with each other or when both genders were compared in both samples. Conclusions: This study confirms the association between clefts and cervical anomalies. Additional research on this topic is necessary.

Agenesis of maxillary lateral incisors and associated dental anomalies

Introduction: The objectives of this study were to evaluate the prevalence of dental anomalies in patients with agenesis of maxillary lateral incisors and to compare the findings with the prevalence of these anomalies in the general population. Methods: A sample of 126 patients, aged 7 to 35 years, with agenesis of at least 1 maxillary lateral incisor was selected. Panoramic and periapical radiographs and dental casts were used to analyze other associated dental anomalies, including agenesis of other permanent teeth, ectopia of unerupted permanent teeth, microdontia of maxillary lateral incisors, and supernumerary teeth. The occurrence of these anomalies was compared with prevalence data previously reported for the general population. Statistical testing was performed with the chi-square test (P<0.05) and the odds ratio. Results: Patients with maxillary lateral incisor agenesis had a significantly increased prevalence rate of permanent tooth agenesis (18.2%), excluding the third molars. The occurrence of third-molar agenesis in a subgroup aged 14 years or older (n = 76) was 35.5%. The frequencies of maxillary second premolar agenesis (10.3%), mandibular second premolar agenesis (7.9%), microdontia of maxillary lateral incisors (38.8%), and distoangulation of mandibular second premolars (3.9%) were significantly increased in our sample compared with the general population. In a subgroup of patients aged 10 years or older (n = 115), the prevalence of palatally displaced canines was elevated (5.2%). The prevalences of mesioangulation of mandibular second molars and supernumerary teeth were not higher in the sample. Conclusions: Permanent tooth agenesis, maxillary lateral incisor microdontia, palatally displaced canines, and distoangulation of mandibular second premolars are frequently associated with maxillary lateral incisor agenesis, providing additional evidence of a genetic interrelationship in the causes of these dental anomalies. (Am J Orthod Dentofacial Orthop 2010;137:732.e1-732.e6)

Relationship between breastfeeding duration and prevalence of posterior crossbite in the deciduous dentition

Introduction: This cross-sectional retrospective epidemiologic study assessed the relationship between exclusive breastfeeding duration and the prevalence of posterior crossbite in the deciduous dentition. Methods: Clinical examinations were performed in 1377 Brazilian children (690 boys, 687 girls), 3 to 6 years old, from 11 public schools in Sao Paulo, Brazil. Based on questionnaires answered by the parents, the children were classified into 4 groups according to the duration of exclusive breastfeeding: G1, never (119 subjects); G2, less than 6 months (720 subjects); G3, 6 to 12 months (312 subjects); and G4, more than 12 months (226 subjects). The statistical analyses included the chi-square test (P < 0.05) and the odds ratio. Results: The posterior crossbite was observed in 31.1%, 22.4%, 8.3%, and 2.2% of the children, in groups G1, G2, G3, and G4, respectively. The results showed a statistically significant relationship between exclusive breastfeeding duration and the prevalence of posterior crossbite. Conclusions: Children who were breastfed for more than 12 months had a 20-fold lower risk for the development of posterior crossbite compared with children who were never breastfed and a 5-fold lower risk compared with those breastfed between 6 and 12 months. (Am J Orthod Dentofacial Orthop 2010; 137:54-8)

Dental Erosion in a Group of 12- and 16-year-old Brazilian Schoolchildren

Purpose: This study`s purpose was to assess the prevalence of dental erosion in adolescents and to investigate the association between erosion and sociodemographic characteristics. Methods: This study consisted of a single center cluster random sample of 414 adolescents (12 and 16 years old) of both genders from private and public schools in Bauru, Sao Paulo, Brazil. Two previously calibrated examiners (kappa=0.85) used the O`Brien (7994) index for assessment of dental erosion on the buccal and palatal surfaces of the permanent maxillary incisors and on the occlusal surfaces of the permanent first molars. Data on gender, type of school, and mean family income were collected by a questionnaire completed by the adolescents. Descriptive statistics were applied to the data, and the associations between erosion and sociodemographic variables were investigated by chi-square test (P<0.05). Results: The prevalence of dental erosion was 20% (N=83), with only enamel being involved (score 1). The labial surface was the most affected (16%). There were no significant differences between the presence of erosion and gender, type of school, and mean family income. Conclusions: The results indicate that dental erosion restricted to enamel was observed among adolescents in Bauru/Brazil, and there was no correlation between this condition and sociodemographic factors. (Pediatr Dent 201733:23-8) Received August 7, 2009 1 Last Revision October 13, 2009 I Accepted October 14, 2009

Microtensile vs Microshear Bond Strength of All-in-One Adhesives to Unground Enamel

Purpose To determine the bond strength to unground enamel of all in one adhesives in comparison with an etch and rinse system and to compare the reliability of microtensile and microshear methods in providing such measurements Materials and Methods The bonding procedure was performed on enamel of 64 extracted molars The tested all in one adhesives were Bond Force (Tokuyama), AdheSE One (Ivoclar Vivadent) and Xeno V (Dentsply) Prime&Bond NT (Dentsply) served as control Microtensile specimens were obtained from 4 teeth per group Twelve teeth per group were used for microshear testing Microtensile specimens that failed prior to testing were included in statistical calculations, they were assigned the lowest value measured in the respective group Failure modes were observed under light microscope and classified (cohesive within substrates, adhesive mixed) Statistically significant differences in bond strength were assessed among the adhesives within each testing method and between microshear and microtensile data for each adhesive Failure mode distributions were compared using the chi square test Results All in-one adhesives had similar microshear and microtensile bond strengths In both testing methods, the etch and rinse system achieved the strongest bond For all adhesives significantly higher bond strengths were measured with the microshear test In microtensile testing specimens bonded with the etch and rinse adhesive exhibited a significantly different distribution of failure modes The coefficients of variation were extremely high for microtensile bond strength data, particularly of all in one adhesives Conclusion The adhesive potential to intact enamel of recently introduced all in-one adhesives was inferior to that of an etch and rinse system When testing bond strength to enamel of all in one adhesives, microshear testing may be a more accurate method than microtensile

Craniocervical posture and hyoid bone position in children with mild and moderate asthma and mouth breathing

Introduction The objective of the present study was to assess the craniocervical posture and the positioning of the hyoid bone in children with asthma who are mouth breathers compared to non-asthma controls. Methods The study was conducted on 56 children, 28 of them with mild (n = 15) and moderate (n = 13) asthma (14 girls aged 10 79 +/- 1 31 years and 14 boys aged 9 79 +/- 1.12 years), matched for sex, height, weight and age with 28 non-asthma children who are not mouth breathers The sample size was calculated considering a confidence interval of 95% and a prevalence of 4% of asthma in Latin America. Eighteen variables were analyzed in two radiographs (latero-lateral teleradiography and lateral cervical spine radiography), both obtained with the head in a natural position The independent t-test was used to compare means values and the chi-square test to compare percentage values (p < 0 05) Intraclass correlation coefficient (ICC) was used to verify reliability. Results. The Craniovertebral Angle (CVA) was found to be significantly smaller in asthma than in control children (106.38 +/- 766 vs. 111 21 +/- 7.40. p = 0 02) and the frequency of asthma children with an absent or inverted hyoid triangle was found to be significantly higher compared to non-asthma children (36% vs 7%, p = 0.0001). The values of the inclination angles of the superior cervical spine in relation to the horizontal plane were significantly higher in moderate than in mild asthma children (CVT/Hor 85 10 +/- 725 vs. 90 92 +/- 6.69, p = 0 04 and C1/Hor. 80 93 +/- 5.56 vs 85 00 +/- 4 20, p = 0 04) Conclusions These findings revealed that asthma children presented higher head extension and a higher frequency of changes in hyoid bone position compared to non-asthma children and that greater the asthma severity greater the extension of the upper cervical spine. (C) 2010 Elsevier Ireland Ltd. All rights reserved.

Estado nutricional e estilo de vida em vegetarianos e onívoros, Grande Vitória-ES

Objetivo: Descrever e analisar o estado nutricional e aspectos do estilo de vida de vegetarianos e onívoros residentes na Grande Vitória/ES, na faixa etária de 35 a 64 anos de idade. Material E Métodos: Trata-se de estudo observacional híbrido de casos prevalentes com avaliação retrospectiva da exposição. Os grupos de expostos (134) e não expostos à dieta onívora típica ocidental (67) foram determinados no início da investigação. Foram coletados dados antropométricos, bioquímicos, de atividade física e alimentação através de questionário e 3 recordatórios de 24 horas e diagnosticados sobrepeso, Razão Cintura Quadril (RCQ) inadequada e hipercolesterolemia. Colesterol total e frações, triglicerídeos, ácido úrico, sódio e potássio urinários foram comparados entre os grupos, através do teste t de Student. Foi usado o teste qui-quadrado para comparar proporções, com =0,05. Resultados: Foram encontradas diferenças significativas em relação à ocupação. Duração da atividade física e tempo assistindo televisão e/ou utilizando computador foram maiores entre os onívoros. Os vegetarianos relataram práticas alimentares mais saudáveis e menor consumo de lipídios, proteínas e sódio. Os onívoros apresentaram maior risco de sobrepeso, RCQ inadequada e hipercolesterolemia (valores de P<0,0001). HDL-colesterol não foi diferente nos grupos. Conclusão: Os vegetarianos apresentaram perfil nutricional mais adequado e menor risco para os agravos crônicos estudados, apesar de pequena diferença no padrão de atividade física regular entre os grupos estudados.

Tuberculose na população privada de liberdade: características clínicas e epidemiológicas relacionadas à doença

Introdução: Há cerca de duas décadas, a tuberculose (TB) foi considerada pela Organização Mundial de Saúde (OMS) como uma doença em estado de emergência em todo o mundo. Atualmente, apesar de todas as ações de controle da doença, ainda trata-se de um importante problema de saúde pública, apresentando forte relação com questões socioeconômicas, o que acarreta no maior adoecimento em grupos específicos, tais como a população privada de liberdade. Os dados de tuberculose em populações vulneráveis podem atingir índices ainda mais altos e por isso preocupante. Objetivos: Analisar as características clínicas e epidemiológicas associadas com os desfechos do tratamento da tuberculose na população privada de liberdade do Brasil, registrado no Sistema de Informação de Agravos de Notificação (SINAN), de 2007 a 2011; conhecer a taxa de incidência e de mortalidade por tuberculose na população privada de liberdade do Espírito Santo, de julho de 2009 a julho de 2010; e identificar as características clínicas e epidemiológicas dos casos diagnosticados de tuberculose na população privada de liberdade do Espírito Santo, de julho de 2009 a julho de 2010. Métodos: A população do estudo consistiu em presos diagnosticados com tuberculose identificados através do SINAN, entre janeiro de 2007 e dezembro de 2011 e dos casos diagnosticados de tuberculose na população prisional do Espírito Santo no período de 1º de julho de 2009 a 30 de junho de 2010. O teste de qui-quadrado de Pearson e o modelo de regressão polinomial foram utilizados na analise, além de estatística descritiva, por meio de tabelas e gráficos. Resultados: Em relação pacientes com TB na população privada de liberdade do Brasil, nota-se que os presos que abandonaram o tratamento eram mais jovens (P <0,001), com menor escolaridade (P <0,001) e maior probabilidade de alcoolismo (P < 0,001), eram mais propensos a ter TB recorrente ou recidiva (P < 0,001) e eles não estavam sob tratamento diretamente observado (TDO) (P < 0,001), comparados com aqueles que completaram o tratamento da tuberculose. Aqueles que morreram de tuberculose tendem a ter idade ⩾ 43 anos (P < 0,001) e alcoolistas (P < 0,001), também eram mais propensos a tipo de tratamento desconhecido (P <0,001) e apresentar tuberculose pulmonar e tuberculose extrapulmonar (TBEP). Presos que desenvolveram tuberculose multidroga resistente (TB-MDR) foram mais propensos a 9 experiência de recorrência de TB, retorno após abandono e transferência de local de tratamento. Além disso, observou-se 167 casos de tuberculose (taxa de incidência de 1962,6 por 100 mil presos) no Espírito Santo. O sexo masculino apresentou maior número de pacientes, assim como a faixa etária de 25 a 36 anos e a forma clínica pulmonar. Destaca-se que 109 (65,3%) pacientes tiveram alta por cura, ocorrendo dois óbitos durante o período, sendo a taxa de mortalidade por tuberculose de 11,7 por 100 mil presos. A maior incidência da tuberculose foi em pacientes localizados nas unidades prisionais da Região Metropolitana e um pequeno número de casos ocorreu em outros locais externos às unidades prisionais. Conclusão: Nossos resultados destacam a necessidade de melhorar as políticas de controle da TB nas penitenciárias, bem como os desfechos do tratamento de presos a fim de impedir a transmissão para outros presos, seus familiares e profissionais de saúde.