Odontological assistance to Down Syndrome patients having congenital heart malformations

In this study the authors present the frequency and types of congenital heart malformations (CHM) among Down Syndrome (DS) patients emphasizing the prevention of infectious endocarditis (IE) with appropriate antibiotic prophylaxis (ABP). Out of 390 DS patients, 312 (80%) were considered free from any CHM. 78 (20%) presented some CHM; from these 11,54% (n=9) have more than one CHM; ABP to prevent IE was recommended for 41,03% (n=32). Ventricular septal defect was the most frequent CHM (20,51%, n=16). Dentists must know about the patients’ cardiologic diagnosis before a treatment that could cause bleeding, because they have to administer antibiotics to prevent IE. Although some CHM doesn’t need ABP, according to the protocol of the American Heart Association, there are systemic conditions in DS that are relevant to the prescription of antibiotics.

Effects of saccadic eye movements on postural control in older adults

Saccadic eye movements have been shown to affect posture by decreasing the magnitude of body sway in young adults. However, there is no evidence of how the search for visual information that occurs during eye movements affects postural control in older adults. The purpose of the present study was to determine the influence of saccadic eye movements on postural control in older adults while they stood on 2 different bases of support. Twelve older adults stood upright in 70-s trials under 2 stance conditions (wide and narrow) and 3 gaze conditions (fixation, saccadic eye movements at 0.5 Hz, and saccadic eye movements at 1.1 Hz). Head and trunk sway amplitude and mean sway frequency were measured in both the anterior/posterior (AP) and medial/lateral (ML) directions. The results showed that the amplitude of body sway was reduced during saccades compared with fixation, as previously observed in young adults. However, older adults exhibited similar sway amplitude and frequency in the AP direction under the wide and narrow stance conditions, which is different from observations in young adults, who display larger sway in a narrow stance compared with a wide stance while performing saccades. These results suggest that although older adults are affected by saccadic eye movements by a decrease in the amplitude of body sway, as observed in young adults, they present a more rigid postural control strategy that does not allow larger sway during a more challenging stance condition.

Past and present distribution, densities and movements of blue whales Balaenoptera musculus in the Southern Hemisphere and northern Indian Ocean

1. Blue whale locations in the Southern Hemisphere and northern Indian Ocean were obtained from catches (303 239), sightings (4383 records of ≥ 8058 whales), strandings (103), Discovery marks (2191) and recoveries (95), and acoustic recordings. 2. Sighting surveys included 7 480 450 km of effort plus 14 676 days with unmeasured effort. Groups usually consisted of solitary whales (65.2%) or pairs (24.6%); larger feeding aggregations of unassociated individuals were only rarely observed. Sighting rates (groups per 1000 km from many platform types) varied by four orders of magnitude and were lowest in the waters of Brazil, South Africa, the eastern tropical Pacific, Antarctica and South Georgia; higher in the Subantarctic and Peru; and highest around Indonesia, Sri Lanka, Chile, southern Australia and south of Madagascar. 3. Blue whales avoid the oligotrophic central gyres of the Indian, Pacific and Atlantic Oceans, but are more common where phytoplankton densities are high, and where there are dynamic oceanographic processes like upwelling and frontal meandering. 4. Compared with historical catches, the Antarctic (‘true’) subspecies is exceedingly rare and usually concentrated closer to the summer pack ice. In summer they are found throughout the Antarctic; in winter they migrate to southern Africa (although recent sightings there are rare) and to other northerly locations (based on acoustics), although some overwinter in the Antarctic. 5. Pygmy blue whales are found around the Indian Ocean and from southern Australia to New Zealand. At least four groupings are evident: northern Indian Ocean, from Madagascar to the Subantarctic, Indonesia to western and southern Australia, and from New Zealand northwards to the equator. Sighting rates are typically much higher than for Antarctic blue whales.

Movements of satellite-monitored humpback whales from New Caledonia

Knowledge of the local and migratory movements of humpback whales (Megaptera novaeangliae) from New Caledonia is very limited. To investigate this topic, we attached satellite-monitored tags to 12 whales off southern New Caledonia. Tag longevity ranged from 1 to 52 days (X = 22.5 days). Tagged whales generally moved to the south or southeast, with several spending time in a previously unknown seamount habitat named Antigonia before resuming movement, generally toward Norfolk Island or New Zealand. However, 1 female with a calf traveled the entire length of the western coast of New Caledonia (~450 km) and then west in the direction of the Chesterfield Reefs, a 19th century American (“Yankee”) whaling ground. None of the New Caledonia whales traveled to or toward eastern Australia, which is broadly consistent with the low rate of interchange observed from photo-identification comparisons between these 2 areas. The connections between New Caledonia and New Zealand, together with the relatively low numbers of whales seen in these places generally, support the idea that whales from these 2 areas constitute a single population that remains small and unrecovered.

Eastern temperate North Pacific offshore killer whales (Orcinus orca): Occurrence, movements, and insights into feeding ecology

Beginning in the late 1980s, large groups of previously unidentified killer whales (Orcinus orca) were sighted off the west coast of Vancouver Island and in the Queen Charlotte Islands, British Columbia. Scientists working in this region produced two killer whale photo-identification catalogues that included both transient (mammal-eating) whales and 65 individual whales that investigators believed represented a distinct killer whale community (Ford et al. 1992, Heise et al. 1993). It was thought that these killer whales maintained a generally offshore distribution and were provisionally termed “offshores”; a term that has since been used as a population identifier for the eastern temperate North Pacific offshore killer whale population. Then in September 1992, 75 unidentified whales entered the Strait of Juan de Fuca just south and east of Victoria, British Columbia (Walters et al. 1992). Although most of these whales had not been seen before, two were matched to killer whales in the Queen Charlotte photo-identification catalogue (Ford et al. 1992, Heise et al. 1993) and were thus listed as “offshore” killer whales. During a similar time period, other large groups of killer whales, previously unidentified, were also being sighted off Alaska and California (Dahlheim et al. 1997; Nancy Black and Alisa Schulman- Janiger, unpublished data, respectively).

Planning “Discrete” Movements Using a Continuous System: Insights from a Dynamic Field Theory of Movement Preparation

The timed-initiation paradigm developed by Ghez and colleagues (1997) has revealed two modes of motor planning: continuous and discrete. Continuous responding occurs when targets are separated by less than 60° of spatial angle, and discrete responding occurs when targets are separated by greater than 60°. Although these two modes are thought to reflect the operation of separable strategic planning systems, a new theory of movement preparation, the Dynamic Field Theory, suggests that two modes emerge flexibly from the same system. Experiment 1 replicated continuous and discrete performance using a task modified to allow for a critical test of the single system view. In Experiment 2, participants were allowed to correct their movements following movement initiation (the standard task does not allow corrections). Results showed continuous planning performance at large and small target separations. These results are consistent with the proposal that the two modes reflect the time-dependent “preshaping” of a single planning system.

HOME RANGES AND MOVEMENTS OF COYOTES IN THE NORTHERN CHIHUAHUAN DESERT

The coyote (Canis latrans) is among the most studied animals in North America. Because of its adaptability and success as a predator, the coyote has flourished and is still expanding its range. Coyotes can now be found throughout most of North America and south into Central America (Voight and Berg 1987). Studies in recent years have been extensive to understand the interrelationships of prey and coyotes (Shelton and Klindt 1974, Beckoff and Wells 1981), as well as demographic relationships (Davis et al. 1975, Knowlton and Stoddart 1978, Mitchell 1979, Bowen 1981) and feeding strategies (Todd and Keith 1976, Andelt et al. 1987, MacCracken and Hansen 1987, Gese et al. 1988a). With the advance of radio telemetry, researchers have investigated lifestyle characteristics spatially with home ranges or temporally with movements in relation to habitat requirements. Researchers have studied home ranges of coyotes in various regions of the United States (Livaitis and Shaw 1980, Andelt 1981, Springer 1982, Pyrah 1984, Gese et al. 1988a) and Canada (Bowen 1982). Some studies of home range were separated by season (Ozoga and Harger 1966) or relation to nearby food sources (Danner and Smith 1980). Home range analysis in relation to social interactions of coyotes has been either neglected, overlooked, or avoided. Gese et al. (1988a) recognized a transient class of coyote by home range size. Coyote social systems are very complex and can vary by season or locality in addition to some reports of group or pack systems (Hamlin and Schweitzer 1979, Beckoff and Wells 1981, Bowen 1981, Gese et al. 1988b). Coyotes maintain communication with conspecifics through vocal and olfactory signals (Lehner 1987, Bowen and McTaggert Cowan 1980). Social interactions may be by far the most complex and least understood aspect related to coyote ecology. Coyote movements can be related to many factors including food, water, cover, and social interactions. Movements in relation to food sources are well documented (Fitch 1948, Todd and Keith 1976, Danner and Smith 1980) although reports on movements in relation to water have not been reported, probably because of limited research in desert situations. There has been some mention of coyotes' movements in relation to cover (Wells and Beckoff 1982). The objectives of this study were to delineate annual and seasonal home ranges, movements, and habitat use of coyotes in the northern Chihuahuan desert.

PREPARATORY EMG ACTIVITY REVEALS A RAPID ADAPTATION PATTERN IN HUMANS PERFORMING LANDING MOVEMENTS IN BLINDFOLDED CONDITION

The main questions addressed in this work were whether and how adaptation to suppression of visual information occurs in a free-fall paradigm, and the extent to which vision availability influences the control of landing movements. The prelanding modulation of EMG timing and amplitude of four lower-limb muscles was investigated. Participants performed six consecutive drop-landings from four different heights in two experimental conditions: with and without vision. Experimental design precluded participants from estimating the height of the drop. Since cues provided by proprioceptive and vestibular information acquired during the first trials were processed, the nervous system rapidly adapted to the lack of visual information, and hence produced a motor output (i.e., prelanding EMG modulation) similar to that observed when performing the activity with vision available.

Regulatory variation in a TBX5 enhancer leads to isolated congenital heart disease

Recent studies have identified the genetic underpinnings of a growing number of diseases through targeted exome sequencing. However, this strategy ignores the large component of the genome that does not code for proteins, but is nonetheless biologically functional. To address the possible involvement of regulatory variation in congenital heart diseases (CHDs), we searched for regulatory mutations impacting the activity of TBX5, a dosage-dependent transcription factor with well-defined roles in the heart and limb development that has been associated with the HoltOram syndrome (hearthand syndrome), a condition that affects 1/100 000 newborns. Using a combination of genomics, bioinformatics and mouse genetic engineering, we scanned approximate to 700 kb of the TBX5 locus in search of cis-regulatory elements. We uncovered three enhancers that collectively recapitulate the endogenous expression pattern of TBX5 in the developing heart. We re-sequenced these enhancer elements in a cohort of non-syndromic patients with isolated atrial and/or ventricular septal defects, the predominant cardiac defects of the HoltOram syndrome, and identified a patient with a homozygous mutation in an enhancer approximate to 90 kb downstream of TBX5. Notably, we demonstrate that this single-base-pair mutation abrogates the ability of the enhancer to drive expression within the heart in vivo using both mouse and zebrafish transgenic models. Given the population-wide frequency of this variant, we estimate that 1/100 000 individuals would be homozygous for this variant, highlighting that a significant number of CHD associated with TBX5 dysfunction might arise from non-coding mutations in TBX5 heart enhancers, effectively decoupling the heart and hand phenotypes of the HoltOram syndrome.

Consensus Statement on Standard of Care for Congenital Myopathies

Recent progress in scientific research has facilitated accurate genetic and neuropathological diagnosis of congenital myopathies. However, given their relatively low incidence, congenital myopathies remain unfamiliar to the majority of care providers, and the levels of patient care are extremely variable. This consensus statement aims to provide care guidelines for congenital myopathies. The International Standard of Care Committee for Congenital Myopathies worked through frequent e-mail correspondences, periodic conference calls, 2 rounds of online surveys, and a 3-day workshop to achieve a consensus for diagnostic and clinical care recommendations. The committee includes 59 members from 10 medical disciplines. They are organized into 5 working groups: genetics/diagnosis, neurology, pulmonology, gastroenterology/nutrition/speech/oral care, and orthopedics/rehabilitation. In each care area the authors summarize the committee's recommendations for symptom assessments and therapeutic interventions. It is the committee's goal that through these recommendations, patients with congenital myopathies will receive optimal care and improve their disease outcome.

Rehabilitative management of swallowing and oral-motor movements in patients with tetanus of a public service in Brazil

When looking at developing countries, the prolonged intensive medical and nursing care required by many patients places extra demands on an already stretched healthcare budget. The purpose of this study was to verify the effectiveness of a systematic rehabilitative program for swallowing and oral-motor movements in intensive care unit patients with the diagnosis of tetanus. Forty-five patients who were clinically diagnosed with tetanus were included in the study. Participants were divided in two groups: Cl - consisted of 18 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2002 to December 2005, prior to the existence of a systematic swallowing and oral-motor intervention: GII - consisted of 27 tetanus patients who were consecutively admitted to the infectious disease ICU from January 2006 to December 2009 and were submitted to a specific rehabilitative management of swallowing and of the oral-motor movements. Results indicate that the proposed rehabilitative program reduced by approximately 50% the time patients remained in the ICU. The significant improvement observed in patients with tetanus who were submitted to the rehabilitative program for swallowing and oral-motor movements occurred in conjunction with a reduction in the amount of time necessary to reintroduce oral feeding, to decannulate and to remove the feeding tubes. In conclusion, swallowing/muscle exercise, in patients with severe/very severe tetanus, seem to promote the remission of muscle tension and seem to maximize functional swallowing. (C) 2012 Elsevier B.V. All rights reserved.

Home range, movements and diurnal roosts of the endangered thin-spined porcupine, Chaetomys subspinosus (Rodentia: Erethizontidae), in the Brazilian Atlantic Forest

Chaetomys subspinosus is the sole species within the Chaetomyinae subfamily of Caviomorph rodents. This poorly studied porcupine is restricted to the Atlantic Forest in eastern Brazil, where deforestation and habitat fragmentation threaten its survival. Data on the ranging and roosting behavior of C. subspinosus is fairly scarce as it is difficult to observe these behaviors in nature and, consequently, it is very rarely detected during field surveys. We monitored the home ranges of three radio-tagged females over the course of 1 year (2005-2006) and collected data on several aspects of their natural history including movement patterns and the use of diurnal roosts and latrines. The animals were monitored at Parque Estadual Paulo Cesar Vinha, a nature reserve dominated by restinga forests, a subtype of Atlantic Forest occurring on sandy soil. The estimated home range varied little between individuals and was relatively small (mean = 2.14 ha/individual and 1.09 ha/individual using minimum convex polygon and kernel methods, respectively). The animals travelled an average of 147 m/night (range: 21-324 m/night) between two consecutive day roosts. The day roosts were mostly located on vine and liana tangles in the canopy which also aid in connecting the canopy to adjacent trees or the forest floor. Latrines were mostly located near the ground in places heavily protected by spiny bromeliads or by other tangled vegetation. Our data suggests that C. subspinosus has the smallest range among all Neotropical Erethizontids which is likely due to its small size and strictly folivorous diet. Our data also helps explain why C. subspinosus is so difficult to observe in nature: researchers should focus on arboreal masses of tangled vegetation where individuals will normally rest during the day. (C) 2011 Deutsche Gesellschaft fur Saugetierkunde. Published by Elsevier GmbH. All rights reserved.

Birth prevalence and characteristics of congenital toxoplasmosis in Sergipe, North-east Brazil

Objectives To estimate, by neonatal screening, the birth prevalence of congenital toxoplasmosis among live-born infants in Sergipe state, Brazil, and to investigate the clinical features of affected infants. Methods Dried blood spot specimens obtained from 15 204 neonates were assayed for the presence of anti-T. gondii IgM antibodies. Duplicate retesting was done in infants with positive and borderline results. Confirmatory testing in peripheral blood samples consisted of testing for anti-T. gondii IgG and IgM in infants and mothers. Those with possible congenital toxoplasmosis were evaluated and followed up to a median age of 20 months. Congenital infection was confirmed in the presence of persisting anti-T. gondii IgG antibodies beyond 12 months of age. All infants with confirmed infection were treated with pyrimethamine, sulfadiazine and folinic acid for 1 year. Results Fifty-three infants had detectable IgM in dried blood spot specimens. Confirmatory testing was reactive in 39/50, of which, 38 completed follow-up. Six of 15 204 newborns were diagnosed with congenital toxoplasmosis, resulting in an estimated birth prevalence of four per 10 000 [CI 95% 1.48.0]. Four infants (67%) showed signs of congenital toxoplasmosis in their first year of life; three (75%) had retinochoroidal scars, and one had cerebral calcifications. Two infants remained asymptomatic until 20 months of age. Conclusions The birth prevalence of congenital toxoplasmosis is high in the Brazilian state of Sergipe, with most of the infants showing ocular lesions. Preventive measures are strongly warranted.

Evaluation of Surgical Treatment of Congenital Heart Disease in Patients Aged Above 16 Years

Background: The increasing number of children with evolving congenital heart diseases demands greater preparation of professionals and institutions that handle them. Objective: To describe the profile of patients aged over 16 years with congenital heart disease, who have undergone surgery, and analyze the risk factors that predict hospital mortality. Methods: One thousand five hundred twenty patients (mean age 27 +/- 13 years) were operated between January 1986 and December 2010. We performed a descriptive analysis of the epidemiological profile of the study population and analyzed risk factors for hospital mortality, considering the complexity score, the year in which surgery was performed, the procedure performed or not performed by the pediatric surgeon and reoperation. Results: There was a significant increase in the number of cases from the year 2000. The average complexity score was 5.4 and the septal defects represented 45% of cases. Overall mortality was 7.7% and most procedures (973 or 61.9%) with greater complexity were performed by pediatric surgeons. Complexity (OR 1.5), reoperation (OR 2.17) and pediatric surgeon (OR 0.28) were independent risk factors influencing mortality. Multivariate analysis showed that the year in which the surgery was performed (OR 1.03), the complexity (OR 1.44) and the pediatric surgeon (OR 0.28) influenced the result. Conclusion: There is an increasing number of patients aged 16 years which, despite the large number of simple cases, the most complex ones were referred to pediatric surgeons, who had lower mortality, especially in recent years. (Arq Bras Cardiol 2012;98(5):390-397)

Cytogenomic characterization of an unexpected 17.6 Mb 9p deletion associated to a 14.8 Mb 20p duplication in a dysmorphic patient with multiple congenital anomalies presenting a normal G-banding karyotype

We describe a female patient with developmental delay, dysmorphic features and multiple congenital anomalies who presented a normal G-banded karyotype at the 550-band resolution. Array and multiplex-ligation probe amplification (MLPA) techniques identified an unexpected large unbalanced genomic aberration: a 17.6 Mb deletion of 9p associated to a 14.8 Mb duplication of 20p. The deleted 9p genes, especially CER1 and FREM1, seem to be more relevant to the phenotype than the duplicated 20p genes. This study also shows the relevance of using molecular techniques to make an accurate diagnosis in patients with dysmorphic features and multiple anomalies suggestive of chromosome aberration, even if on G-banding their karyotype appears to be normal. Fluorescence in situ hybridization (FISH) was necessary to identify a masked balanced translocation in the patient's mother, indicating the importance of associating cytogenetic and molecular techniques in clinical genetics, given the implications for patient management and genetic counseling. (C) 2012 Elsevier B.V. All rights reserved.