Periodontal Diseases in Patients with Special Health Care Needs

A wide variation of people with an impairment or disability requires a “special care dentistry” once their general manifestations directly act in the oral cavity. This target public is inserted into the following categories: neuromotor disability, sensory disability, mental disorder, infecto-contagious diseases, chronic systemic diseases, and systemic conditions. Among the several oral illnesses found in these groups, periodontal diseases have been the most frequent, becoming a major challenge for the dental practitioners. Thus, we described the microbiological, histopathological, and clinical features of periodontal diseases in each “special health care needs” group. Advances in “Omic” technologies have suggested the application of molecular biology methods to assess the genomics (genes), proteomics (proteins), transcriptomics (mRNA), and metabolomics (metabolites) aspects of periodontal diseases. These researches aim to promote a better understanding of the mechanisms involved in the pathogenesis and in the identification of new biomarkers of periodontal diseases that help in diagnosis of periodontal diseases and in tissue responses after treatments of gingivitis and periodontitis. As an alternative therapy, some bioactive materials and photobiomodulation may be indicated once they strongly stimulate the periodontal tissue regeneration, attenuate the inflammatory processes, and/or promote the reconstruction of the microstructure of the periodontium

Effect of Photobiomodulation Therapy Associated With Biphasic Phosphate Calcium on Bone Repair: A Histomorphometric Study in Rats

Background: This study aimed to investigate the effects of photobiomodulation therapy associate with biphasic calcium phosphate on calvaria critical defects in rats. Methods: Forty-eight (90days old) adult male rats (Rattus norvegicus, Albinus variation, Wistar) received critical defects with 5 mm in diameter were made on their skull and were randomly assigned into the groups: C-blood clot, B-biphasic calcium phosphate, L-photobiomodulation therapy and B+L-biphasic calcium phosphate+photobiomodulation therapy. A low-level GaAlAs was applied in a single dose tran-surgically, in a wavelength 660 nm, total dense energy density of 45 J/cm2. At 30 and 60 days, animals from each group were euthanized. Histological and histomorphometric analyzes were performed.  Results: In 30 days, almost all specimens (C, L, B and B+L) showed bone neoformation areas in regions near the borders of the surgical defect. In 60 days, in many specimens (C, L, B, B+L), it was possible to see a narrow neoformed bone structure along almost the whole extension of the surgical defect, though being thinner than the original calvary bone.  Data were recorded as mean ± standard deviation, after normality was tested, suitable statistical test was applied (α= 5%). At 60 days, there was a statistically significant difference when comparing the proportion of neoformation area between group L (0.52%±0.13) and B+L (0.20%±0.08). Group L showed a difference compared with all the groups when comparing the remaining distance between de edges of neoformed bone (C×L, p=0.0431; B×L, p=0.0386; L×B+L, p=0.0352), demonstrating a great defect closure.  Conclusions: Our findings suggest that photobiomodulation therapy applied at 45 J/cm² resulted in the highest percentage of bone neoformation area after 60 days, although biphasic calcium phosphate exerts some osteogenic activity during bone repair, photobiomodulation therapy is not able to modulate this process

Lurasidone in the Treatment of Bipolar Depression: : Systematic Review of Systematic Reviews

Copyright © 2017 Michele Fornaro et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Introduction. A burgeoning number of systematic reviews considering lurasidone in the treatment of bipolar depression have occurred since its Food and Drug Administration extended approval in 2013. While a paucity of available quantitative evidence still precludes preliminary meta-analysis on the matter, the present quality assessment of systematic review of systematic reviews, nonetheless, aims at highlighting current essential information on the topic. Methods. Both published and unpublished systematic reviews about lurasidone mono- or adjunctive therapy in the treatment of bipolar depression were searched by two independent authors inquiring PubMed/Cochrane/Embase/Scopus from inception until October 2016. Results. Twelve included systematic reviews were of moderate-to-high quality and consistent in covering the handful of RCTs available to date, suggesting the promising efficacy, safety, and tolerability profile of lurasidone. Concordance on the drug profile seems to be corroborated by a steadily increasing number of convergent qualitative reports on the matter. Limitations. Publication, sponsorship, language, citation, and measurement biases. Conclusions. Despite being preliminary in nature, this overview stipulates the effectiveness of lurasidone in the acute treatment of Type I bipolar depression overall. As outlined by most of the reviewed evidence, recommendations for future research should include further controlled trials of extended duration.Peer reviewe

Upper limb motor rehabilitation impacts white matter microstructure in multiple sclerosis

Upper limb impairments can occur in patients with multiple sclerosis, affecting daily living activities; however there is at present no definite agreement on the best rehabilitation treatment strategy to pursue. Moreover, motor training has been shown to induce changes in white matter architecture in healthy subjects.This study aimed at evaluating the motor behavioral and white matter microstructural changes following a 2-month upper limb motor rehabilitation treatment based on task-oriented exercises in patients with multiple sclerosis.Thirty patients (18 females and 12 males; age. = 43.3. ±. 8.7. years) in a stable phase of the disease presenting with mild or moderate upper limb sensorimotor deficits were randomized into two groups of 15 patients each. Both groups underwent twenty 1-hour treatment sessions, three times a week. The "treatment group" received an active motor rehabilitation treatment, based on voluntary exercises including task-oriented exercises, while the "control group" underwent passive mobilization of the shoulder, elbow, wrist and fingers.Before and after the rehabilitation protocols, motor performance was evaluated in all patients with standard tests. Additionally, finger motor performance accuracy was assessed by an engineered glove.In the same sessions, every patient underwent diffusion tensor imaging to obtain parametric maps of fractional anisotropy, mean diffusivity, axial diffusivity, and radial diffusivity. The mean value of each parameter was separately calculated within regions of interest including the fiber bundles connecting brain areas involved in voluntary movement control: the corpus callosum, the corticospinal tracts and the superior longitudinal fasciculi.The two rehabilitation protocols induced similar effects on unimanual motor performance, but the bimanual coordination task revealed that the residual coordination abilities were maintained in the treated patients while they significantly worsened in the control group (p. = 0.002). Further, in the treatment group white matter integrity in the corpus callosum and corticospinal tracts was preserved while a microstructural integrity worsening was found in the control group (fractional anisotropy of the corpus callosum and corticospinal tracts: p. = 0.033 and p. = 0.022; radial diffusivity of the corpus callosum and corticospinal tracts: p. = 0.004 and p. = 0.008). Conversely, a significant increase of radial diffusivity was observed in the superior longitudinal fasciculi in both groups (p. = 0.02), indicating lack of treatment effects on this structure, showing damage progression likely due to a demyelination process.All these findings indicate the importance of administering, when possible, a rehabilitation treatment consisting of voluntary movements. We also demonstrated that the beneficial effects of a rehabilitation treatment are task-dependent and selective in their target; this becomes crucial towards the implementation of tailored rehabilitative approaches. © 2013 The Authors

Anti-Black racism in clinical supervision:asynchronous simulated encounters facilitate reflective practice

Background: Racist interactions in clinical practice remain a pervasive reality for Black healthcare providers. We sought to develop a framework to inform supervisors' actions when confronting racism in clinical practice and protecting trainees under their oversight.Methods: We conducted a qualitative study in which experienced supervisors responded to seven short, videotaped interactions between: 1) Black trainees and a simulated patient (SP) in a racist role; 2) the trainees and their respective supervisors; and 3) the trainees and their supervisors together with the SP. The clinical exchanges exemplified different types of racist (entrenching) or antiracist (uprooting) behaviors by the supervisors. After viewing each clip, participants wrote their reflections confidentially; they later joined a structured debriefing together. We used thematic analysis to identify supervisors' behavioral patterns when confronting racist interactions.Results: Based on the input of 52 participants recruited into five two-hour-long sessions, we categorized the behaviors of supervisors facing anti-Black racial injuries involving learners under their oversight. We organized supervisor behaviors into five interlocking domains, each with a range of possible themes: 1) Joining: from conciliatory to confrontational in communicating with the aggressor; 2) Explicitness: from avoiding to naming racism; 3) Ownership: from individual to shared responsibility of the event and the response to it; 4) Involving: from excusing to including the aggrieved party when confronting the aggressor; and 5) Stance: from protective to paternalistic in supporting the learner's autonomy.Conclusions: Our qualitative findings can provide a framework for facilitated discussion toward reflective practice among healthcare providers who may have experienced, witnessed, or intervened in anti-Black racist interactions. They can also help medical educators to inform faculty development to fight anti-Black racism in clinical practice. The video materials we developed are available for viewing and download and can be used or adapted as springboards for reflective discussion or faculty development activities. </p

Vector-borne diseases in Brazil: climate change and future warming scenarios

Climate change affects human health either directly or indirectly, and related impacts are complex, non-linear, and depend on several variables. The various climate change impacts on health include a change in the spatial distribution of vector-borne diseases. In this regard, this study presents and discusses changes in the spatial distribution of climate suitability for visceral leishmaniasis, yellow fever and malaria in Brazil, in different global warming scenarios. Maximum entropy (MaxEnt) was used to construct climate suitability models in warming scenarios. Models were based in climate variables generated by the Eta-HadGEM2 ES regional model, in the baseline period 1965-2005 and RCP8.5 scenario, representing global warming levels of 1,5ºC (2011-2040), 2,0ºC (2041-2070) and 4,0ºC (2071-2099). The three diseases studied are largely influenced by climate and showed different distribution patterns within the country. In global warming scenarios, visceral leishmaniasis found more favorable climate conditions in the Southeastern and Southern regions of Brazil, while climate in the Northern and Center-West regions gradually became more favorable to yellow fever. In malaria scenarios, an increase in favorable climate conditions to its high incidence was observed in the Atlantic Forest, where currently extra-Amazonian cases occur. The scenarios presented herein represent different possible consequences for the health sector in terms of adopting (or not) different measures to mitigate climate change in Brazil, such as reducing the emission of greenhouse gases.  Climate change affects human health either directly or indirectly, and related impacts are complex, non-linear, and depend on several variables. The various climate change impacts on health include a change in the spatial distribution of vector-borne diseases. In this regard, this study presents and discusses changes in the spatial distribution of climate suitability for visceral leishmaniasis, yellow fever and malaria in Brazil, in different global warming scenarios. Maximum entropy (MaxEnt) was used to construct climate suitability models in warming scenarios. Models were based in climate variables generated by the Eta-HadGEM2 ES regional model, in the baseline period 1965-2005 and RCP8.5 scenario, representing global warming levels of 1,5ºC (2011-2040), 2,0ºC (2041-2070) and 4,0ºC (2071-2099). The three diseases studied are largely influenced by climate and showed different distribution patterns within the country. In global warming scenarios, visceral leishmaniasis found more favorable climate conditions in the Southeastern and Southern regions of Brazil, while climate in the Northern and Center-West regions gradually became more favorable to yellow fever. In malaria scenarios, an increase in favorable climate conditions to its high incidence was observed in the Atlantic Forest, where currently extra-Amazonian cases occur. The scenarios presented herein represent different possible consequences for the health sector in terms of adopting (or not) different measures to mitigate climate change in Brazil, such as reducing the emission of greenhouse gases. Â

Targeted disruption of inducible nitric oxide synthase protects against aging, S-nitrosation, and insulin resistance in muscle of male mice

Accumulating evidence has demonstrated that S-nitrosation of proteins plays a critical role in several human diseases. Here, we explored the role of inducible nitric oxide synthase (iNOS) in the S-nitrosation of proteins involved in the early steps of the insulin-signaling pathway and insulin resistance in the skeletal muscle of aged mice. Aging increased iNOS expression and S-nitrosation of major proteins involved in insulin signaling, thereby reducing insulin sensitivity in skeletal muscle. Conversely, aged iNOS-null mice were protected from S-nitrosation–induced insulin resistance. Moreover, pharmacological treatment with an iNOS inhibitor and acute exercise reduced iNOS-induced S-nitrosation and increased insulin sensitivity in the muscle of aged animals. These findings indicate that the insulin resistance observed in aged mice is mainly mediated through the S-nitrosation of the insulin-signaling pathway

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Energy Estimation of Cosmic Rays with the Engineering Radio Array of the Pierre Auger Observatory

The Auger Engineering Radio Array (AERA) is part of the Pierre Auger Observatory and is used to detect the radio emission of cosmic-ray air showers. These observations are compared to the data of the surface detector stations of the Observatory, which provide well-calibrated information on the cosmic-ray energies and arrival directions. The response of the radio stations in the 30 to 80 MHz regime has been thoroughly calibrated to enable the reconstruction of the incoming electric field. For the latter, the energy deposit per area is determined from the radio pulses at each observer position and is interpolated using a two-dimensional function that takes into account signal asymmetries due to interference between the geomagnetic and charge-excess emission components. The spatial integral over the signal distribution gives a direct measurement of the energy transferred from the primary cosmic ray into radio emission in the AERA frequency range. We measure 15.8 MeV of radiation energy for a 1 EeV air shower arriving perpendicularly to the geomagnetic field. This radiation energy -- corrected for geometrical effects -- is used as a cosmic-ray energy estimator. Performing an absolute energy calibration against the surface-detector information, we observe that this radio-energy estimator scales quadratically with the cosmic-ray energy as expected for coherent emission. We find an energy resolution of the radio reconstruction of 22% for the data set and 17% for a high-quality subset containing only events with at least five radio stations with signal.Comment: Replaced with published version. Added journal reference and DO