Immunohistochemical Expression of Matrix Metalloprotease-2 and Matrix Metalloprotease-9 in the Disks of Patients with Temporomandibular Joint Dysfunction

Purpose Matrix metalloproteases (MMPs) are tissue-remodeling enzymes that function during the remodeling process, such as in immune-inflammatory diseases. Metalloprotease-2 (MMP-2) and metalloprotease-9 (MMP-9) are gelatinases that degrade several types of extracellular matrix collagen. It is hypothesized that in temporomandibular joint (TMJ) dysfunction, MMP-2 and MMP-9 expression levels may be elevated. Therefore, the objective of this study is to determine the association of MMP-2 and MMP-9 expression with temporomandibular joint dysfunction using an immunohistochemical approach to evaluate the joint disk. Material and Methods A total of 45 human temporomandibular joint samples were collected, with 36 samples in the test group (patients with anterior disk displacement with reduction (n = 29) and without reduction (n = 7)) and nine samples in the control group. The immunostaining of the TMJ disks was statistically compared between the groups (P \u3c 0.05). Results There was a statistically significant difference for the area of MMP-2 immunostaining between the control group and the displacement disks with reduction group (ADDwR) (P = 0.048) and between the groups with disk displacement and without reduction (ADDwoR) (P = 0.029). The expression of MMP-2 was significantly elevated in the ADDwoR group. Conclusion No statistically significant difference was found between the variable area of MMP-9 expression in the disk with and without disk displacement, as determined by immunohistochemical analysis. However, there was an elevation of MMP-2 expression in the disks of patients with displacement and without reduction (more severe alteration)

Interleukin-6 Expression in Disc Derangement of Human Temporomandibular Joint and Association with Osteoarthrosis

The inflammatory process is a coordinated response that protects host after infection or trauma, involving several molecular reactions. Once the inflammation is closely linked to the process of destruction of the temporomandibular joint, this study aims to examine, by immunohistochemistry, the expression of interleukin-6 (IL-6), an important inflammatory marker, in temporomandibular articular discs of patients with anterior disc displacement with (ADDwR) and without reduction (ADDwoR) and its association with osteoarthrosis (OA). Thirty-eight (n = 38) articular discs were divided into two cutoffs: 1) analysis 1: 4 control (acute pathology), 17 ADDwR, 17 ADDwoR; and 2) analysis 2: without OA (n = 21) and with OA (n = 17). The area of immunostaining was compared statistically between groups (p \u3c 0.05). In the disc samples, no significant differences were observed between the groups ADDwR and ADDwoR, and with and without OA, in respect to the expression of IL-6 by immunohistochemical examination. Future studies should be conducted with a larger sample size, which could clarify the association of the inflammatory mediator IL-6 with temporomandibular joint dysfunction

Diagnóstico de muerte encefálica en pediatría: nuevo protocolo nacional para el cese irreversible de las funciones encefálicas (Resolución Nº 716/2019. Ley 24.747)

A partir de la sanción de la ley Nacional N.º 27447, conocida popularmente como “Ley Justina”, se genera un nuevo Protocolo para el diagnóstico de cese irreversible de las funciones encefálicas. Nuestro Hospital, a través del servicio de Terapia Intensiva, tuvo la oportunidad de participar en su confección. El protocolo consta de criterios de inclusión, periodos de evaluación, métodos auxiliares y la consideración de cómo arribar al diagnóstico en diferentes situaciones especiales. Los cambios más importantes se realizaron en la edad pediátrica, donde se logró acortar los tiempos de evaluación para arribar a un diagnóstico de certeza, acortando la espera familiar.From the enactment of National Law No. 27447, popularly known as the Justina law, a new Protocol for the Diagnosis of Irreversible Cessation of Encephalic Functions was created. Our Hospital, through the Intensive Care Service, had the opportunity to participate in its preparation. The protocol consists of inclusion criteria, evaluation periods, ancillary methods and the consideration of how to arrive at the diagnosis in different special situations. The most important changes were made in the pediatric age where the evaluation times were shortened to arrive at a diagnosis of certainty, shortening the family wait

FasL Expression in Articular Discs of Human Temporomandibular Joint and Association with Osteoarthrosis

Background Apoptosis is a programme of cell death which does not induce an inflammatory response. Recent previous research has suggested a correlation between temporomandibular internal derangement and apoptosis. Fas ligand (FasL) is an apoptosis‐inducing factor, known to trigger apoptosis through distinct signal pathways. This study aims to examine, by immunohistochemistry, the expression of FasL in temporomandibular joint (TMJ) articular discs of patients with anterior disc displacement with reduction (ADDwR) and without reduction (ADDwoR) in patients with and without osteoarthrosis (OA). Methods Forty‐two (n = 42) TMJ articular discs were divided into two cut‐offs: (i) 8 control, 17 ADDwR, 17 ADDwoR, and (ii) without OA (n = 25) and with OA (n = 17). The area of immunostaining was compared statistically between groups (P \u3c 0.05). Results Statistically significant differences were found in the expression of FasL in TMJ discs between the three groups (P = 0.001). ADDwR presented significant higher FasL expression when compared with ADDwoR (P \u3c 0.001). Significant higher FasL expression was observed in the group without OA (P = 0.001). All patients without OA presented ADDwR, while all the patients with OA presented ADDwoR. Conclusion A higher area of in situ immunostaining of FasL was found in temporomandibular discs with reduction, which is the less severe condition. Moreover, a reduced expression of FasL in the discs of patients with osteoarthrosis was found, suggesting that some aspects of apoptosis might underlie the progression of TMJ disorders

Agrotóxicos e saúde: realidade e desafios para mudança de práticas na agricultura.

Este artigo apresenta os resultados de uma pesquisa que teve como objetivo principal caracterizar o contexto e as práticas relacionadas ao uso de agrotóxicos entre agricultores residentes na Serrinha do Mendanha, comunidade agrícola situada em Campo Grande, município do Rio de Janeiro. A proposta metodológica teve uma abordagem qualitativa, sendo a principal fonte de dados a aplicação de questionário semiestruturado. Participaram da pesquisa 38 agricultores familiares. O perfil socioeconômico mostra uma realidade de idosos no trabalho agrícola, percentuais expressivos de analfabetismo e baixa renda. O uso de agrotóxicos é uma rotina para essas famílias. Apesar de existir uma naturalização do uso, a maioria dos informantes acredita que agrotóxicos podem afetar sua saúde, apresenta preocupação com o consumidor e gostaria de conhecer formas alternativas de cultivo. Tais achados apontam para a possibilidade de busca de mudança de práticas. Não se trata de repasse de conhecimento, pois este tipo de informação de alguma forma eles já possuem. Trata–se de desenvolver estratégias objetivando a minimização dos riscos ou mesmo o desuso de agrotóxicos na lavoura

TREINAMENTO DE FORÇA E RESISTÊNCIA MUSCULAR RESPIRATÓRIA NA DISTROFIA MUSCULAR DE DUCHENNE: REVISÃO NARRATIVA DA LITERATURA

Duchenne muscular dystrophy (DMD) is a hereditary progressive disease that causes musculoskeletal degradation due to lack and/or decrease of dystrophin protein, due to deficiency of the DMD gene located in the Xp21 region presenting the first signs between the third and fifth year of life with progressive muscle weakening, evolving to the respiratory musculature and cardiac failure. In this context, physiotherapy minimizes musculoskeletal impairment, assists in the maintenance of cardiovascular and respiratory functions and, together with early respiratory muscle training (MRT), assists in increasing respiratory strength and endurance. Therefore, the aim of this study was to discuss DMD and the effects of MRT with a focus on the use of the PowerBreathe ® (PB) device, in addition to enriching the literature related to the theme, through a narrative review of the literature. The review was made in the scientific databases Scielo, Pubmed, Lilacs, VHL and Google Scholar using descriptors: Duchenne muscular dystrophy, PowerBreathe®, Threshold® IMT, respiratory muscle training and endurance in portuguese and endurance between 2001 and 2019. This review showed the effectiveness of physiotherapy in patients with DMD and early treatment, which aims to maintain motor and respiratory function; and that the most commonly used equipment for TMR in general is Threshold® IMT. In addition, it points to the scarcity of specific studies on the use of CP in DMD; suggesting more research that can elucidate the direct benefits of this device to patients with DMD.La distrofia muscular de Duchenne (DMD) es una enfermedad hereditaria progresiva que provoca degradación musculoesquelética por falta y/o disminución de la proteína distrofina, debido a la deficiencia del gen DMD localizado en la región Xp21 presentando los primeros signos entre el tercer y quinto año de vida con debilitamiento muscular progresivo, evolucionando a la musculatura respiratoria e insuficiencia cardíaca. En este contexto, la fisioterapia minimiza el deterioro musculoesquelético, ayuda en el mantenimiento de las funciones cardiovasculares y respiratorias y, junto con el entrenamiento muscular respiratorio temprano (MRT), ayuda a aumentar la fuerza respiratoria y la resistencia. Por lo tanto, el objetivo de este estudio fue discutir la DMD y los efectos de la MRT con un enfoque en el uso del dispositivo PowerBreathe ® (PB), además de enriquecer la literatura relacionada con el tema, a través de una revisión narrativa de la literatura. La revisión se realizó en las bases de datos científicas Scielo, Pubmed, Lilacs, VHL y Google Scholar utilizando los descriptores: Distrofia muscular de Duchenne, PowerBreathe®, Umbral® IMT, entrenamiento muscular respiratorio y resistencia en portugués y resistencia entre 2001 y 2019. Esta revisión mostró la efectividad de la fisioterapia en pacientes con DMD y tratamiento temprano, que tiene como objetivo mantener la función motora y respiratoria; y que el equipo más utilizado para la TMR en general es Threshold® IMT.A distrofia muscular de Duchenne (DMD) é uma doença progressiva hereditária que causa degradação musculoesquelético decorrente da falta e/ou diminuição da proteína distrofina, devido a deficiência do gene DMD localizado na região Xp21apresentando os primeiros sinais entre o terceiro e quinto ano de vida com progressivo enfraquecimento muscular, evoluindo para a musculatura respiratória e falência cardíaca. Neste contexto, a fisioterapia minimiza o comprometimento musculoesquelético, auxilia na manutenção das funções cardiovascular e respiratória e em conjunto com o treinamento muscular respiratório (TMR) precoce, auxilia no incremento de força e endurance respiratória. Assim sendo, o objetivo deste estudo foi discorrer sobre a DMD e os efeitos do TMR com enfoque no uso do dispositivo PowerBreathe® (PB), além de enriquecer a literatura relacionada ao tema, por meio de uma revisão narrativa da literatura. A revisão foi feita nas bases de dados científicos Scielo, Pubmed, Lilacs, BVS e Google Acadêmico utilizando descritores: distrofia muscular de Duchenne, PowerBreathe®, Threshold® IMT, treinamento muscular respiratório e endurance nas línguas portuguesa e inglesa entre os anos de 2001 a 2019. Esta revisão evidenciou a efetividade da fisioterapia nos pacientes com DMD e do tratamento precoce, que visa manter a função motora e respiratória; e que o equipamento mais utilizado para o TMR de um modo geral é o Threshold® IMT. Além disso, aponta para a escassez de estudos específicos sobre uso do PB na DMD; sugerindo mais pesquisas que possam elucidar os benefícios diretos desse dispositivo aos pacientes com DMD

A multicenter study on the clinical characteristics and outcomes among children with moderate to severe abusive head trauma

Introduction: We aimed to identify clinical characteristics, risk factors for diagnosis, and describe outcomes among children with AHT.Methods: We performed an observational cohort study in tertiary care hospitals from 14 countries across Asia and Ibero-America. We included patients \u3c5 years old who were admitted to participating pediatric intensive care units (PICUs) with moderate to severe traumatic brain injury (TBI). We performed descriptive analysis and multivariable logistic regression for risk factors of AHT.Results: 47 (12%) out of 392 patients were diagnosed with AHT. Compared to those with accidental injuries, children with AHT were more frequently \u3c 2 years old (42, 89.4% vs 133, 38.6%, p \u3c 0.001), more likely to arrive by private transportation (25, 53.2%, vs 88, 25.7%, p \u3c 0.001), but less likely to have multiple injuries (14, 29.8% vs 158, 45.8%, p = 0.038). The AHT group was more likely to suffer subdural hemorrhage (SDH) (39, 83.0% vs 89, 25.8%, p \u3c 0.001), require antiepileptic medications (41, 87.2% vs 209, 60.6%, p \u3c 0.001), and neurosurgical interventions (27, 57.40% vs 143, 41.40%, p = 0.038). Mortality, PICU length of stay, and functional outcomes at 3 months were similar in both groups. In the multivariable logistic regression, age \u3c2 years old (aOR 8.44, 95%CI 3.07-23.2), presence of seizures (aOR 3.43, 95%CI 1.60-7.36), and presence of SDH (aOR 9.58, 95%CI 4.10-22.39) were independently associated with AHT.Conclusions: AHT diagnosis represented 12% of our TBI cohort. Overall, children with AHT required more neurosurgical interventions and the use of anti-epileptic medications. Children younger than 2 years and with SDH were independently associated with a diagnosis of AHT

Initial dysnatremia and clinical outcomes in pediatric traumatic brain injury: A multicenter observational study

Purpose: We aimed to investigate the association between initial dysnatremia (hyponatremia and hypernatremia) and in-hospital mortality, as well as between initial dysnatremia and functional outcomes, among children with traumatic brain injury (TBI).Method: We performed a multicenter observational study among 26 pediatric intensive care units from January 2014 to August 2022. We recruited children with TBI under 18 years of age who presented to participating sites within 24 h of injury. We compared demographics and clinical characteristics between children with initial hyponatremia and eu-natremia and between those with initial hypernatremia and eu-natremia. We defined poor functional outcome as a discharge Pediatric Cerebral Performance Category (PCPC) score of moderate, severe disability, coma, and death, or an increase of at least 2 categories from baseline. We performed multivariable logistic regression for mortality and poor PCPC outcome.Results: Among 648 children, 84 (13.0%) and 42 (6.5%) presented with hyponatremia and hypernatremia, respectively. We observed fewer 14-day ventilation-free days between those with initial hyponatremia [7.0 (interquartile range (IQR) = 0.0-11.0)] and initial hypernatremia [0.0 (IQR = 0.0-10.0)], compared to eu-natremia [9.0 (IQR = 4.0-12.0); p = 0.006 and p \u3c 0.001]. We observed fewer 14-day ICU-free days between those with initial hyponatremia [3.0 (IQR = 0.0-9.0)] and initial hypernatremia [0.0 (IQR = 0.0-3.0)], compared to eu-natremia [7.0 (IQR = 0.0-11.0); p = 0.006 and p \u3c 0.001]. After adjusting for age, severity, and sex, presenting hyponatremia was associated with in-hospital mortality [adjusted odds ratio (aOR) = 2.47, 95% confidence interval (CI) = 1.31-4.66, p = 0.005] and poor outcome (aOR = 1.67, 95% CI = 1.01-2.76, p = 0.045). After adjustment, initial hypernatremia was associated with mortality (aOR = 5.91, 95% CI = 2.85-12.25, p \u3c 0.001) and poor outcome (aOR = 3.00, 95% CI = 1.50-5.98, p = 0.002).Conclusion: Among children with TBI, presenting dysnatremia was associated with in-hospital mortality and poor functional outcome, particularly hypernatremia. Future research should investigate longitudinal sodium measurements in pediatric TBI and their association with clinical outcomes