Qualidade de Vida, Saúde Geral e Ansiedade em pacientes com diferentes tipos e níveis de disfunção temporomandibular

Some studies reported in the literature that emotional factors and quality of life may be involved both in aetiology, as in the progression of Temporomandibular disorders (TMD). Proposition: The purpose of this study is to observe a possible association between different forms of anxiety, quality of life and general health of patients diagnosed as carriers of various types and levels of Temporomandibular Dysfunction. Methodology: The sample consisted of 60 patients diagnosed as carriers of TMJD origin of muscle, joint, or both, with different levels of severity (mild TMD, moderate and severe). The patients were diagnosed with TMD-RDC (Research Diagnostic Criteria) to assess the type of dysfunction (muscle or joint) and by the Protocol of Fonseca to verify the degree of dysfunction (mild, moderate or severe). To evaluate the psychosocial aspects were used three self-applied, with the purpose of obtaining information about the general health (General Health Questionnaire - GHQ), the type of anxiety (Trait Anxiety Inventory-State - STAI) and quality of life (World Health Organization Quality Of Life Short WHOQOL-brief). Results: There was a correlation between all indicators studied in several forms of TMD with varying degrees of commitment. Quality of life appeared linked to the type and the level of TMD: Muscular and Articular TMD (p = 0,037), Disk Displacement With Reduction (p = 0.01) and Mild TMD (p = 0.042). The General Health showed association with the level of TMD, with the exception of the stress factor (p = 0.78). For the analysis of the types and levels to Severe Muscular TMD had a statistically significant indicator of the quality of life (p = 0049). The anxiety only showed association with the level of TMD (p = 0,047 for anxiety-trait). Conclusion: Besides the limitations of the study, it was concluded that anxiety, quality of life and general health are important psychosocial indicators, which are linked to several forms of TMD in different levels of severity

Qualidade de vida, eficiência mastigatória e presença de disfunção temporomandibular em usuários de prótese parcial removível com arco dental curto inferior

Even nowadays there is in Brasil a large number of edentulous and a precarious financial condition of most of the population. In addition, World Health Organization aims for oral health, which consists on the maintenance of a natural dentition, functional and aesthetic composed of at least 20 teeth, without need of prosthetic intervention throughout life. From this and considering the lack of researches about the permanence of edentulous spaces in the oral cavity, and also avoiding overtreatment, this research has been proposed. Thus, the aim was to evaluate the effect of different lengths of the shortened lower dental arch in the presence or absence of a removable partial denture (RPD) on masticatory function, quality of life and occurrence of temporomandibular dysfunction. To achieve this goal, we compared the masticatory efficiency (colorimetric test), the oral comfort through the analysis of the impact of oral health in quality of life (OHIP-14), the presence of temporomandibular dysfunction (RDC/TMD) and the general quality of life (WHOQOL) of patients with shortened dental arches (SDA) (n=60), which is an arch with a reduction of teeth starting posteriorly, and patients with complete dental arch (Complete DA) (n = 34). The group of patients whit SDA was divided among PPR wears (PPD + SDA) (n = 17) and non-wears (n = 43). The population of this study consisted on patients who received or looked for treatment at the clinics of the Department of Dentistry of UFRN, from clinical analysis and records. The sample was chosen by convenience. For statistical analysis, it was a database in SPSS 17.0, followed by descriptive analysis with frequencies, absolute values, tests of central tendency and variability. The statistical tests used were chi-squared and analysis of variance as well as Tukey s post test, when applicable, all with a 95% confidence level. The results shown a prevalence of TMD of 47,1% among patients using PRP and 69,8% among those who didn t, but this result wasn t statistically significant. The mean of the results of masticatory efficiency, WHOQOL and OHIP didn t show association to the presence or absence of PPR and to the lower number of occlusal units of the patients (0, 1, 2 or more occlusal). The association only occurred among the different groups of SDA and the patients with complete dental arch. Taking into account the results, it could be observed that studied patients with low posterior support using lower PRP didn t have better masticatory efficiency, general quality of life, less impacts of their oral conditions in quality of life or not even less temporomandibular dysfunction or better masticatory efficiency when compared to those who didn t use the prosthesis

Disfunção sexual feminina e níveis dos hormônios esteroidais em mulheres obesas atendidas no ambulatório de cirurgia bariátrica do hospital universitário Onofre Lopes em Natal/RN

A disfunção sexual corresponde a alterações em uma ou mais fases da resposta sexual humana e apresenta maior prevalência na população feminina. Ademais, a participação de alguns fatores como obesidade e níveis dos hormônios esteroidais na disfunção sexual feminina (DSF) permanece incerta. O presente estudo deteve-se na análise da ocorrência de DSF numa população de mulheres portadoras de obesidade, cadastradas no Ambulatório de Cirurgia Bariátrica do Hospital Universitário Onofre Lopes, da Universidade Federal do Rio Grande do Norte, no município de Natal, RN. O estudo foi realizado em uma amostra composta por trinta e uma mulheres, com idade entre 20 e 50 anos, com índice de massa corpórea (IMC) > 30 Kg/m2. A todas as pacientes foi aplicado um questionário composto por uma seção com dados socio-econômicos, e outra abordando a saúde sexual feminina, sendo esta última correspondente ao Female Sexual Function Index (FSFI), para diagnóstico de DSF. A partir dessa caracterização, as pacientes foram reunidas nos grupos CD (pacientes com disfunção, n= 9) e SD (sem disfunção, n= 22). Para a análise do efeito da obesidade na DSF, as pacientes foram reunidas nos grupos 1 (6 pacientes com IMC grau I e II: entre 30 e 40 Kg/m2) e 2 (25 com IMC grau III: acima de 40). Para o estudo da participação dos hormônios esteroidais foram determinadas as concentrações séricas de cortisol, estradiol e dehidroepiandrosterona (DHEA) pelo método de quimiluminescência. A análise estatística dos dados foi realizada usando os testes ANOVA, MANOVA (Pillai), além de análise de Cluster. Para identificar as diferenças entre os domínios do FSFI, foi usado o teste T de Student. A significância considerada para todos os testes foi para p< 0,01. Das pacientes estudadas, 25,8% apresentaram DSF de acordo com o escore total do FSFI. A análise estatística posterior evidenciou que as diferenças ocorreram para os domínios desejo, excitação e orgasmo. Não foi encontrada relação da presença de DSF com os diferentes graus de obesidade ou com os níveis hormonais dos esteróides cortisol, estradiol ou DHEA. Contudo, foi encontrado aumento significativo nos níveis séricos de estradiol para o grupo 1, que corresponde ao de menor índice de IMC. Estes resultados mostram que a prevalência de DSF não diferiu entre os graus I,II e III de obesidade das pacientes deste estudo mas, quando presente, a disfunção ocorre nos domínios desejo, excitação e orgasmo. A maior concentração de estradiol encontrada nas pacientes de menor índice de IMC sugere uma possível relação entre as duas variáveis que precisa ser investigada em estudos futuros.

Prevalência da disfunção temporomandibular em estudantes de odontologia por meio de diferentes índices

The epidemiology of temporomandibular disorders varies widely in the literature. The aim of this study was to determine the prevalence of TMD in dental students of the Federal University of Rio Grande do Norte assessed by different indexes. The sample consisted of 101 individuals selected by a randomized process, whose general outline was systematic sampling. For evaluation of the signs and symptoms of TMD, an anamnestic index, Fonseca s protocol, and two clinical indexes, the RDC/TMD (Research Diagnostic Criteria for Temporomandibular Disorders), or standard index, and the Helkimo s Clinical Dysfunction Index were applied. Data were analyzed using the chi-square test and kappa, besides verifying the sensitivity and specificity (5% significance). The diagnosis of TMD by different indexes showed a variation in the prevalence between 72.3% (Helkimo s Clinical index), 64.4% (Fonseca s anamnestic index) and 35.6% (RDC/TMD). There was no statistical difference between the sexes for the RDC/TMD, although this difference was found for Fonseca s and Helkimo s indexes (p<0.05). The most frequent type of TMD were joint disorders (Groups II and III), and the subtypes disc displacement with reduction (17.8%) and arthralgia (15.8%). Most individuals showed a mild TMD (45.5%) for both indexes, Fonseca and Helkimo. When comparing the types of diagnoses, RDC/TMD with Fonseca and Helkimo, low agreement was found (k=0.17 and k= 0.35, respectively). A moderate correlation between the severity of TMD was obtained (kw= 0.53) for Fonseca s protocol and Helkimo s index. High sensitivity and low specificity were seen for both diagnoses compared to standard, resulting in excessive false positives. Within the limitations of the study, it was concluded that the prevalence of TMD can vary widely, depending on the index used for its diagnosis

Possible New Syndrome: Left Ventricular Noncompaction, Partial Agenesis of the Corpus Callosum, and Developmental Delay in a Brazilian Child

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Hipertrofia ventricular e mortalidade cardiovascular em pacientes de hemodiálise de baixo nível educacional

FUNDAMENTO: A hipertrofia ventricular esquerda é potente preditor de mortalidade em renais crônicos. Estudo prévio de nosso grupo mostrou que renais crônicos com menor escolaridade têm hipertrofia ventricular mais intensa. OBJETIVO: Ampliar estudo prévio e verificar se a hipertrofia ventricular esquerda pode justificar a associação entre escolaridade e mortalidade cardiovascular de pacientes em hemodiálise. MÉTODOS: Foram avaliados 113 pacientes entre janeiro de 2005 e março de 2008 e seguidos até outubro de 2010. Foram traçadas curvas de sobrevida comparando a mortalidade cardiovascular, e por todas as causas dos pacientes com escolaridade de até três anos (mediana da escolaridade) e pacientes com escolaridade igual ou superior a quatro anos. Foram construídos modelos múltiplos de Cox ajustados para as variáveis de confusão. RESULTADOS: Observou-se associação entre nível de escolaridade e hipertrofia ventricular. A diferença estatística de mortalidade de origem cardiovascular e por todas as causas entre os diferentes níveis de escolaridade ocorreu aos cinco anos e meio de seguimento. No modelo de Cox, a hipertrofia ventricular e a proteína-C reativa associaram-se à mortalidade por todas as causas e de origem cardiovascular. A etiologia da insuficiência renal associou-se à mortalidade por todas as causas e a creatinina associou-se à mortalidade de origem cardiovascular. A associação entre escolaridade e mortalidade perdeu significância estatística no modelo ajustado. CONCLUSÃO: Os resultados do presente trabalho confirmam estudo prévio e demonstram, ademais, que a maior mortalidade cardiovascular observada nos pacientes com menor escolaridade pôde ser explicada por fatores de risco de ordem bioquímica e de morfologia cardíaca.

Myocardial dysfunction with increased ventricular compliance in volume overload hypertrophy

The aim this study was to evaluate systolic and diastolic function in volume overload induced myocardial hypertrophy in rats.Volume overload myocardial hypertrophy was induced in thirteen male Wistar rats by creating infrarenal arteriovenous fistula (AVF). The results were compared with a SHAM operated group (n = 11). Eight weeks after surgery, tail-cuff blood pressure was recorded, then rats were sacrificed for isolated heart studies using Langendorffs preparation.AVF rats presented increased left and right ventricular weights, compared to controls. The increased normalized ventricular volume (V0/LVW, 0.141 +/- 0.035 mL/g vs. 0.267 +/- 0.071 mL/g, P < 0.001) in the AVF group indicated chamber dilation. Myocardial hydroxyproline concentration remained unchanged. There was a significant decrease in +dP/dt (3318 +/- 352 mm Hg s(-1) vs. 2769 +/- 399 mm Hg s(-1); P=0,002), end-systolic pressure-volume relation (246 +/- 56 mm Hg mL(-1) vs. 114 +/- 63 mm Hg mL(-1);, P < 0,001), and -dP/dt (1746 +/- 240 min Hg s(-1) vs. 1361 +/- 217 mm Hg s(-1), P < 0.001) in the AVF group, which presented increased ventricular compliance (Delta V-25: SHAM=0.172 +/- 0.05 mL vs. AVF=0.321 +/- 0.072 mL, P < 0.001) with preserved myocardial passive stiffness (Strain(25): SHAM=13.5 +/- 3.0% vs. AVF=12.3 +/- 1.9%, P > 0.05).We conclude that volume-overload induced hypertrophy causes myocardial systolic and diastolic dysfunction with increased ventricular compliance. These haemodynamic features help to explain the long-term compensatory phase of chronic volume overload before transition to overt congestive heart failure. (c) 2006 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Tobacco smoke-induced left ventricular remodelling is not associated with metalloproteinase-2 or -9 activation

Aim: To investigate the role of MMP-2 and MMP-9 in cardiac remodelling induced by tobacco smoke exposure in rats.Methods: Rats were allocated into two groups: C (n = 9): control animals; ETS (n = 9): exposed to tobacco smoke. After 4months, the animals underwent echocardiography, morphometric study and determination of MMP-2 and MMP-9 activity.Results: ETS rats had larger diastolic (C= 15.6 +/- 1.2 mm/kg, ETS = 18.0 +/- 0.9 mm/kg; p < 0.001) and systolic (C= 7.3 +/- 1.2 mm/kg, ETS = 9.2 0.9 mm/kg; p = 0.001) ventricular diameters adjusted for body weight. Fractional shortening (C= 53 +/- 4.8%, ETS = 48 +/- 3.3%; p = 0.031) and ejection fraction (C= 0. 89 +/- 0.03 5 ETS = 0. 86 +/- 0.02; p = 0.03 0) were smaller in the ETS group. Myocyte cross-sectional area (C= 245 8 mu m(2), ETS=253 8 mu m(2); p = 0.028) was higher in ETS rats. There were no differences in MNtP-2 (C=50 +/- 14%; ETS 43 +/- 11%, p 0.22 +/- 8) or MMP-9 (C=0.36 +/- 0.3%; ETS=0.62 +/- 0.3%, p=0.630) activity between the groups.Conclusion: MMP-2 and MMP-9 did not participate in the remodelling process induced by tobacco smoke exposure. (c) 2007 European Society of Cardiology. Published by Elsevier B.V. All rights reserved.

Influence of fluid volume variations on the calculated value of the left ventricular mass measured by echocardiogram in patients submitted to hemodialysis

The left ventricular mass (LVM) measurement is of major importance for renal patients, as ventricular hypertrophy is an important prognostic index. The echo-cardiogram of the ventricular mass is larger before than it is after hemodialysis, which can confuse data interpretation. The aim of this work is to study the influence of alterations in fluid volume on the variations in measurements of ventricular mass observed during the course of a hemodialysis. Sixteen patients with chronic renal insufficiency in hemodialysis were evaluated at the Dialysis Unit of the University Hospital-UNESP, Botucatu, São Paulo State. The left ventricular mass was calculated from echocardiograms taken before and after hemodialysis and simultaneous ultra-filtration (12 patients: UF GROUP) and before and after hemodialysis isovolemic phase with sequential ultra-filtration (10 patients: ISO GROUP). Six of these patients were submitted to measurements of left ventricular mass before and after hemodialysis in both isovolemic and simultaneous ultra-filtration procedures. In the UF group, there was significant reduction in the following parameters before and after dialysis: diastolic diameter from 54.0 +/- 6.0 mm to 45.6 +/- 7.6 mm; left ventricular mass from 342 +/- 114 g to 265 +/- 117 g; and its respective index (IMVE) from 214 +/- 68 g/m(2) to 168 +/- 71 g/m(2). The ISO group showed no statistically significant variation. The behavior of the variables of six patients submitted to both observations confirm these results. In conclusion, the variations in echocardiogram measurements of the left ventricular mass relating to hemodialysis appear to be induced by alterations of the volemic condition.

Dysautonomia and ventricular dysfunction in the indeterminate form of Chagas disease

Background: the associations between autonomic function and biventricular function in patients with the indeterminate form of Chagas disease remains to be elucidated.Methods: In 42 asymptornatic patients and 19 healthy volunteers, the autonomic function was assessed by time domain indices of heart rate variability (HRV), analyzed for 24 h; the right ventricular function was assessed by fraction area change, right ventricle shortening, and systolic excursion of the tricuspid valve; and the left ventricular function was assessed by ejection fraction and transmittal flow velocities. Data were expressed as mean SD or medians (including the lower quartile and upper quartile). Groups were compared by Student's t or Mann-Whitney U test. Autonomic and ventricular function were correlated by Pearson's or Spearman's correlation coefficient. The level of significance was 5%.Results: Right and left ventricular systolic function indexes were comparable between groups. Transmittal flow velocities were decreased in the Chagas disease group (p < 0.05). The patients presented impaired HRV as indicated by the values of SDNN-day (80 (64-99) ms vs. 98 (78-127) ms; p = 0.045), SDNNI-24 It (54 (43-71) vs. 65 (54-105) ms; p = 0.027), SDNNI-day (49 (42-64) vs. 67 (48-76) ms; p = 0.045), pNN50-day (2.2 (0.7-5)% vs. 10 (3-11)%; p = 0.033); and pNN50-24 It (3 (1-7)% vs. 12 (8-19)%; p = 0.013). There were no correlations between the left ventricular diastolic indices and autonomic dysfunctional indices (p > 0.05).Conclusion: Patients with the indeterminate form of Chagas disease have both dysautonomia, and left ventricular diastolic dysfunction. However, the right ventricular function is preserved. Importantly, ventricular diastolic dysfunction and dysautonomia. are independent phenomena. (c) 2005 Elsevier B.V.. All rights reserved.

Influence of the elevation of the left ventricular diastolic pressure on the values of the first temporal derivative of the ventricular pressure (dP/dt)

PURPOSE: To assess the effects of the elevation of the left ventricular end-diastolic pressure (LVEDP) on the value of the 1st temporal derivative of the ventricular pressure (dP/dt). METHODS: Nineteen anesthetized dogs were studied. The dogs were mechanically ventilated and underwent thoracotomy with parasympathetic nervous system block. The LVEDP was controlled with the use of a perfusion circuit connected to the left atrium and adjusted to the height of a reservoir. The elevation of the LVEDP was achieved by a sudden increase in the height of a reservoir filled with blood. Continuous recordings of the electrocardiogram, the aortic and ventricular pressures and the dP/dt were performed. RESULTS: Elevation of the LVEDP did not result in any variation of the heart rate (167±16.0bpm, before the procedure; 167±15.5bpm, after the procedure). All the other variables assessed, including systolic blood pressure (128±18.3mmHg and 150±21.5mmHg), diastolic blood pressure (98±16.9mmHg and 115±19.8mmHg), LVEDP (5.5±2.49 and 9.3±3.60mmHg), and dP/dt (4,855 ± 1,082 mmHg/s and 5,149±1,242mmHg/s) showed significant increases following the expansion of the ventricular cavity. Although the elevation of the dP/dt was statistically significant, 6 dogs curiously showed a decrease in the values of dP/dt. CONCLUSION: Sudden elevation of the LVEDP resulted in increased values of dP/dt; however, in some dogs, this response was not uniform.

Miocardiopatia diabética

A miocardiopatia diabética é uma doença do músculo cardíaco causada pelo diabetes mellitus e não relacionada às patologias vascular e valvular ou à hipertensão arterial sistêmica. Observações experimentais e clínicas têm demonstrado hipertrofia, necrose, apoptose e aumento do tecido intersticial miocárdico. Acredita-se que a miocardiopatia diabética seja decorrente de anormalidades metabólicas como hiperlipidemia, hiperinsulinemia e hiperglicemia, e de alterações do metabolismo cardíaco. Tais alterações podem causar aumento do estresse oxidativo, fibrose intersticial, perda celular e comprometimento do trânsito intracelular de íons e da homeostase do cálcio. Clinicamente, é possível a detecção de disfunção diastólica assintomática na fase inicial. No momento em que surgem os sinais e sintomas de insuficiência cardíaca, observamos disfunção diastólica isolada, sendo que o comprometimento da função sistólica, habitualmente, é tardio. O tratamento da miocardiopatia diabética com insuficiência cardíaca não difere das miocardiopatias de outras etiologias e deve seguir as diretrizes de acordo com o comprometimento da função ventricular, se diastólica isolada ou diastólica e sistólica.

A exposição crônica à fumaça do cigarro resulta em remodelação cardíaca e prejuízo da função ventricular em ratos

OBJETIVO: Determinar as alterações cardíacas estruturais e funcionais causadas pela exposição à fumaça do cigarro em ratos. MÉTODOS: Os animais foram aleatoriamente distribuídos em dois grupos: fumante (F), composto por 10 animais, expostos à fumaça do cigarro, na taxa de 40 cigarros/dia e controle (C), constituído por 10 animais não submetidos à exposição. Após 4 meses, os animais foram submetidos a estudo morfológico e funcional por meio do ecocardiograma. As variáveis estudadas foram analisadas pelo teste t ou pelo teste de Mann-Whitney. RESULTADOS: Os ratos fumantes apresentaram maior átrio esquerdo (F=4,2± 0,7mm; C=3,5±0,6mm; p<0,05), maiores diâmetros diastólicos (F=7,9±0,7mm; C=7,2±0,5mm; p<0,05) e sistólicos (F=4,1 ±0,5; C=3,4±0,5; p<0,05) do ventrículo esquerdo (VE). O índice de massa do VE foi maior nos animais fumantes (F=1,5 mg/kg± 0,2; C=1,3 mg/kg±0,2; p<0,05), e a fração de ejeção (F=0,85±0,03; C=0,89±0,03; p<0,05) e a fração de encurtamento (F=47,8 %±3,7; C=52,7%±4,6; p<0,05) maiores no grupo controle. Não foram identificadas diferenças nas variáveis de fluxo diastólico (onda E, na onda A e na relação E/A) transmitral. CONCLUSÃO: A exposição crônica à fumaça do cigarro resulta em remodelação cardíaca, com diminuição da capacidade funcional ventricular.