Use of an arginine-enriched oral nutrition supplement in the healing of pressure ulcers in patients with spinal cord injuries : an observational study

Aim: Pressure ulcers are a serious secondary consequence of spinal cord injuries. The objective of the present study was to determine whether an arginine-containing nutritional supplement can reduce the healing time of pressure ulcers in people with spinal cord injuries compared with those not consuming the supplement until full wound healing.

Methods: Thirty-four spinal cord injured patients with a grade 2, 3 or 4 pressure ulcer were prescribed two 237 mL tetrapaks/day of a supplement containing additional protein, arginine, zinc and vitamin C. Pressure ulcer healing was assessed with the Pressure Ulcer Scale for Healing tool.

Results: Twenty patients consumed the nutritional supplement until full pressure ulcer healing had occurred, while 14 patients ceased consuming the supplement before full healing occurred because of intolerance, compliance or taste issues. A 2.5-fold greater rate of healing was observed in patients consuming the supplement until full healing compared with those who ceased taking the supplement (8.5 ± 1.1 weeks vs 20.9 ± 7.0 weeks respectively; P = 0.04). There were no significant differences in age, nutritional status, gender or reason for admission between groups. Comparison of healing rates in the group consuming the supplement to full wound healing against expected rates derived from the medical literature showed a significantly shorter time-to-healing (grade 3 pressure ulcer: 6.5 ± 0.8 weeks vs 18.2 weeks; grade 4: 11.4 ± 2.0 weeks vs 22.1 weeks; P < 0.001).

Conclusion: The present small-scale study demonstrated the potential for specialised wound healing nutritional supplements to shorten the time to pressure ulcer healing in spinal cord injured patients.

Oral language competence, young speakers and the Law

Purpose: This paper highlights the forensic implications of language impairment in 2 key (and overlapping) groups of young people: identified victims of maltreatment (abuse and/or neglect) and young offenders.

Method: Two lines of research pertaining to oral language competence and young people's interface with the law are considered: 1 regarding investigative interviewing with children as victims or witnesses in the context of serious allegations of sexual abuse, and the other pertaining to adolescent offenders as suspects, witnesses, or victims. The linguistic demands that forensic interviewing places on these young people are also considered. Literature concerning the impact of early maltreatment on early language acquisition is briefly reviewed, as is the role of theory of mind in relation to the requirements of investigative interviewing of children and adolescents.

Implications: High-risk young people (i.e., those who are subject to child protection orders because of suspected or confirmed maltreatment, and those who are engaged with the youth justice system) face an elevated risk for suboptimal language development but may need to draw on their language skills in high-stakes forensic interviews. Implications for early intervention policy and practice are identified, and the need for greater speech-language pathology advocacy and engagement in forensic interviewing research is emphasized.

Q-fever and Australian farmers: is the health system paying enough attention? A literature review

Introduction: Q-fever is caused by Coxiella burnetii, a Gram-negative bacterium and Rickettsia-like organism. Transmitted from wild and domestic animals to humans, the most common route is inhalation of contaminated dust; however the oral route can be considered as a second pathway. Aim: to understand the reasons behind not including farming workforce and their families in the national vaccinations program. Discussion: In 1977 Q-fever became a notifiable disease nationally. Australia is the only country to have a registered Q-fever vaccine. As a result of the cost of the vaccine, Department of Health and Ageing (DoHA) supply and subsidised program arrangements are based on the active cases count per year (by occupation), rather than for occupations that expose workers to high level of possible "risk". Conclusion: Australian farmers, farm managers, farm workers and their families need to be well educated about Q-fever and included in the national vaccination program.

O cuidador familiar de pessoa com doença de Alzheimer: história oral de vida

The aim of the present study was to understand the feelings and the difficulties faced by the family caregiver in the care of the person affected by Alzheimer`s Disease (AD). It is a descriptive, exploratory study with a qualitative approach, using the oral life history proposed by Bom Meihy as the method. Data collection was conducted in the Basic Health Unit of Candelaria, located in Natal -RN, with five collaborators that carry out the role of family caregivers for people affected by Alzheimer`s disease (AD) and are members of the Group "Caring for those who Care". Caregi vers who resided with the affected family member for at least one year were selected for the study, and as a collection tool, it was opted to use semi-structured interviews via a script of open questions, recorded by permission of the collaborators, then t ranscribed and subsequently returned to respondents for checking the contents described. To analyze the results, the collaborators narrative technique was used in conjuction with the specific literature on the subject.The discussions were organized around five themes inherent to the guiding questions, and defined as follows: the incorporation of the role of the family caregiver; life before and after assuming the role of caregiver, the caregiver`s feelings and attitudes after assuming the care, difficulti es in caring, participation of the group as a foundation for caregivers. The stories showed many difficulties in the daily routine of the caregivers, and also that their participation in the group "Caring for those who Care" helps them in maintaining the q uality of their lives. The results open possibilities for the construction of new forms of approach and care for the people who fulfill the role of family caregiver contributing to strengthening of subsidies that help them better face the daily difficulti es.This study helped shed light on the fact that being a family caregiver of a person affected by AD is a suffered, exhausting and stressful condition involving much self-denial in one´s life. The situation experienced by these collaborators is considered a public health issue, and thus highlights the urgency for governmental political -social actions, besides the programs of care and health promotion for this target group.

Análise de células t regulatórias foxp3+no líquen plano oral

T regulatory cells have the function of controlling immune responses and maintaining self-tolerance. The FoxP3 has been considered the most specific marker for Treg cells. The aiming of this paper was to evaluate the immunoexpression of FoxP3 in the inflammatory infiltrate from oral lichen planus (OLP) and to compare it with the infiltrate in fibrous inflammatory hyperplasia (FIH) and then, between reticular and erosive forms of OLP. The samples were composed by 32 cases of OLP (17 reticular and 15 erosive) beyond 10 cases of FIH that were submitted to immunohistochemistry staining for FoxP3. Localization of the staining was classified in underepithelial and intraepithelial and the amount of FoxP3+ cells was evaluated through cells counting in 10 consecutive fields, at 400x power magnification. The values were expressed in mean ± standart deviation, and submitted to statistical tests with 5% of significance level. It was observed a statistical significant difference in the amount of FoxP3+ Treg cells between the two combined forms of OLP (1,6 ± 2,2) and the FIH (0,5 ±0,4) (P<0,05). This maybe could be explained by immunological mechanism of OLP, which involves a permanent antigenic induction likely with consequent perpetuation of lesion, eliciting the proliferation and constant recruitment of Treg cells. Otherwise, FIH presents a different etiopathogenesis, in which there is also generation of a variable inflammatory infiltrate, however qualitatively distinct from that seen in OLP. The erosive form of OLP exhibited a greater number (1,7 ± 2,4) of FoxP3+ Treg cells than reticular form (1,5 ± 2,1). These alterations could have relation with the great disease activity verified in erosive OLP, or also, with abnormalities in the regulatory function of Treg cells that could cause the increase observed. Considering the capacity already well established in the literature, both about Treg cells in modulating immune responses, as in the oral mucosa in showing great potential for regeneration, it is suggested that the possibility of development and implantation of immunotherapeutic strategies that regulate the frequency and function of these cells, may help in future treatment of immune-mediated inflammatory diseases such as OLP

Chlorhexidine induces DNA damage in rat peripheral leukocytes and oral mucosal cells

Objective: Chlorhexidine digluconate is widely used in dental practice for decreasing plaque control, controlling gingivitis and disinfecting root canals. However, the undesirable effects of chlorhexidine digluconate regarding its genotoxicity are conflicting in the literature. Thus, the aim of this study was to investigate the genotoxicity of chlorhexidine digluconate in rat peripheral blood and oral mucosal cells by the single cell gel (comet) assay and micronucleus assay.Methods: Thirty male Wistar rats were distributed into three groups: negative control; experimental group orally treated with 0.5 ml of 0.12% chlorhexidine digluconate, twice daily, during 8 days; and positive control, which received 4-nitroquinoline 1-oxide at 0.5 g/l by drinking water.Results: A statistically significant increase of DNA damage was observed in leukocytes and oral mucosal cells of the chlorhexidine digluconate treated group, as assessed by the comet assay. However, no increase of micronucleated cells was detected in reticulocytes from peripheral blood cells.Conclusions: Taken together, the data indicate that chlorhexidine digluconate is able to induce primary DNA damage in leukocytes and in oral mucosal cells, but no chromosome breakage or loss in erythrocytes.

Planning for Immediate Loading of Implant-Supported Prostheses: Literature Review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.

Authorship, Collaboration, and Funding Trends in Implantology Literature: Analysis of Five Journals From 2005 to 2009

Purpose: To identify the trend of authorship in dental implant by exploring the prevalence of coauthored articles and to investigate the collaboration efforts, trends in funding involved in original articles, and their relationships. Materials: Articles published in the Clinical Oral Implants Research, International Journal of Oral & Maxillofacial Implants, Clinical Implant Dentistry and Related Research, Implant Dentistry, and Journal of Oral Implantology from 2005 to 2009 were reviewed. Nonoriginal articles were excluded. For each included articles, number of authors, collaboration efforts, and extramural funding were recorded. Descriptive and analytical statistics (alpha = 0.05), including logistic regression analysis and chi(2) test, were used. Results: From a total of 2085 articles, 1503 met the inclusion criteria. Publications with 5 or more authors increased over time (P = 0.813). The amount of collaboration among different disciplines, institutions, and countries all increased. The greatest increase of collaboration was seen among institutions (P = 0.09). Non-funding studies decreased over time (P = 0.031). There was a strong association between collaboration and funding for the manuscripts during the years studied (OR, 1.5). Conclusion: The number of authors per articles and collaborative studies increased over time in implant-related journals. Collaborative studies were more likely to be funded. (Implant Dent 2011;20:68-75)

Photoelastic Analysis of Stress Distribution in Oral Rehabilitation

The purpose of this study was to present a literature review about photoelasticity, a laboratory method for evaluation of implants prosthesis behavior. Fixed or removable prostheses function as levers on supporting teeth, allowing forces to cause tooth movement if not carefully planned. Hence, during treatment planning, the dentist must be aware of the biomechanics involved and prevent movement of supporting teeth, decreasing lever-type forces generated by these prosthesis. Photoelastic analysis has great applicability in restorative dentistry as it allows prediction and minimization of biomechanical critical points through modifications in treatment planning.

Slow-release fluoride devices: a literature review

Although the prevalence of caries has decreased dramatically over the past decades, it has become a polarised disease, with most of subjects presenting low caries levels and few individuals accounting for most of the caries affected surfaces. Thus it become evident for the need of clinical approaches directed at these high-risk patients, in order to overcome problems related to compliance and low attendance at dental care centres. Slow-release fluoride devices were developed based on the inverse relationship existing between intra-oral fluoride levels and dental caries experience. The two main types of slow-release devices - copolymer membrane type and glass bead - are addressed in the present review. A substantial number of studies have demonstrated that these devices are effective in raising intra-oral F concentrations at levels able to reduce enamel solubility, resulting in a caries-protective effect. Studies in animals and humans demonstrated that the use of these devices was able to also protect the occlusal surfaces, not normally protected by conventional fluoride regimens. However, retention rates have been shown to be the main problem related to these devices and still requires further improvements. Although the results of these studies are very promising, further randomised clinical trials are needed in order to validate the use of these devices in clinical practice. The concept of continuously providing low levels of intra-oral fluoride has great potential for caries prevention in high caries-risk groups.

Oral bisphosphonate-related osteonecrosis of the jaws in rheumatoid arthritis patients: a critical discussion and two case reports

Background: Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a clinical condition characterized by the presence of exposed bone in the maxillofacial region. Its pathogenesis is still undetermined, but may be associated with risk factors such as rheumatoid arthritis (RA). The aim of this paper is to report two unpublished cases of BRONJ in patients with RA and to conduct a literature review of similar clinical cases with a view to describe the main issues concerning these patients, including demographic characteristics and therapeutic approaches applied.Methods: Two case reports of BRONJ involving RA patients were discussedResults: Both patients were aging female taking alendronate for more than 3 years. Lesions were detected in stage II in posterior mandible with no clear trigger agent. The treatment applied consisted of antibiotics, oral rinses with chlorhexidine, drug discontinuation and surgical procedures. Complete healing of the lesions was achieved.Conclusions: This paper brings to light the necessity for rheumatologists to be aware of the potential risk to their patients of developing BRONJ and to work together with dentists for the prevention and early detection of the lesions. Although some features seem to link RA with oral BRONJ and act as synergistic effects, more studies should be developed to support the scientific bases for this hypothesis.

Epidemiological aspects of rheumatoid arthritis patients affected by oral bisphosphonate-related osteonecrosis of the jaws

This literature review aims to evaluate the epidemiologic profile of patients with rheumatoid arthritis (RA) that developed a bisphosphonate-related osteonecrosis that affect the jaws (BRONJ), including demographic aspects, as well as clinical and therapeutic issues. A search of PUBMED/MEDLINE, Scopus, and Cochrane databases from January 2003 to September 2011 was conducted with the objective of identifying publications that contained case reports regarding oral BRONJ in RA patients. Patients with RA who develop oral BRONJ are usually women above 60 years taking steroids and long-term alendronate. Most of them have osteoporosis, and lesions, triggered by dental procedures, are usually detected at stage II in the mandible. Although there is no accepted treatment protocol, these patients seem to have better outcomes with conservative approaches that include antibiotic therapy, chlorhexidine, and drug discontinuation.

Accurate Approach in the Treatment of Oral Bisphosphonate-Related Jaw Osteonecrosis

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is not completely understood and difficult to treat. Even though the occurrence of BRONJ is mainly related to the therapy with intravenous bisphosphonates (BPs), this article reports a case of long-term oral BP use and BRONJ occurrence. In addition, a literature review provides some additional information about BPs, BRONJ, and also a guideline for the prevention and treatment of BRONJ stages. A 79-year-old patient presented intense and persistent pain, purulent secretion, and exposed bone at the right side of the lower jaw. Thus, she was submitted to anamnesis, radiologic and tomographic examinations, and bacterial culture and sensitivity tests. These procedures were followed by surgical debridement of the bone and surrounding tissues/cyst and antibiotic prescription and histopathologic analysis of the fragments. Together, the examinations performed showed the occurrence of stage 2 BRONJ. Moreover, the antibiotic prescription, discontinuation of oral BP, and surgical procedures ensure that the patient had no more symptoms. Therefore, considering the presented case, we believe that an accurate approach is promising to diagnose and treat stage 2 BRONJ and other associated pathologic findings.

Oral drugs for hypertensive urgencies: systematic review and meta-analysis

CONTEXTO E OBJETIVO: Urgências hipertensivas são definidas como elevações graves na pressão arterial sem evidência de danos agudos ou progressivos a órgãos-alvo. A necessidade de tratamento é considerada urgente, mas permite um controle gradual, utilizando-se drogas orais ou sublinguais. Se o aumento na pressão arterial não está associado a risco de vida ou danos a órgãos alvo, o controle pressórico deve ser feito lentamente durante 24 horas. em relação às urgências hipertensivas, não é conhecida qual a classe de drogas anti-hipertensivas que promove os melhores resultados e há controvérsia em relação a quando e quais as drogas devem ser utilizadas nestas situações. O objetivo desta revisão foi avaliar a efetividade e a segurança de drogas orais para urgências hipertensivas. METODOS: Esta revisão sistemática da literatura foi desenvolvida no Centro Cochrane do Brasil, e na Disciplina de Medicina de Urgência e Medicina Baseada em Evidências da Universidade Federal de São Paulo (UNIFESP) - Escola Paulista de Medicina (Unifesp-EPM), de acordo com a metodologia da Colaboração Cochrane. RESULTADOS: Os 16 ensaios clínicos aleatórios selecionados incluíram 769 participantes e demonstraram um efeito superior dos inibidores da enzima conversora de angiotensina no tratamento da urgência hipertensiva, avaliada em 223 participantes. Os efeitos adversos mais frequentes para os bloqueadores de canal de cálcio foram cefaleia (35/206), rubor (17/172) e alterações do ritmo cardíaco (14/189); para os inibidores da enzima conversora de angiotensina, o efeito colateral mais frequente foi disgeusia (25/38). CONCLUSÕES: Há evidências importantes a favor do uso de inibidores da enzima conversora da angiotensina para o tratamento de urgências hipertensivas, quando comparados aos bloqueadores dos canais de cálcio, devido a maior efetividade e à menor frequência de efeitos adversos, como cefaléia e rubor facial.

Oral paracoccidioidomycosis: a study of 36 South American patients

Paracoccidioidomycosis (South American blastomycosis) is an uncommon, progressive systemic mycosis, virtually only seen in persons who have visited Latin America. Reports of oral lesions are extremely rare in the English-language literature. Thirty-six adults with oral lesions as the first sign of paracoccidioidomycosis are described; this appears to be the largest series in the dental literature. All had chronic proliferative mulberry-like ulcerated oral lesions; the diagnosis was confirmed histologically. The gingiva or alveolar process was the typical site, but lesions were also seen particularly on the palate and lip. Most of the patients proved to have detectable pulmonary involvement. Patients with lesions in the oropharynx, tongue, or floor of mouth all had confirmed pulmonary lesions.