Multimorbidity and tooth loss: the Brazilian National Health Survey, 2019

BACKGROUND: Little is known about the presence of two or more chronic conditions (multimorbidity) on tooth loss between adults and older adults. Understanding the mechanisms of multimorbidity on tooth loss is essential to inform policy development. This study aims to investigate the association between multimorbidity and severity of tooth loss in Brazilian adults and older adults. METHODS: We analysed data from a nationally representative sample of 88,531 Brazilian individuals aged 18 and over who participated in the 2019 Brazilian Health Survey. Tooth loss was the outcome by two different classifications: functional dentition (lost 1-12 teeth) and severe tooth loss (lost 23-32 teeth). The presence of multimorbidity was the main exposure and based on 13 self-reported doctor-diagnosed chronic diseases that were further categorised into two groups, i.e., ≥2 or ≥ 3 comorbidities. Sociodemographic covariates included sex, age, race, income, level of education and tobacco smoking and geographic region of residency. Multivariate logistic regression models estimated the OR (Odds Ratios) and 95%CI of the associations between multimorbidity and tooth loss. RESULTS: For 65,803 adults (aged 18 to 59), the presence of multimorbidity (≥2) was associated with 32% higher odds of having severe tooth loss (95% CI, 1.17; 1.49) and 33% lower odds of having functional dentition (95% CI, 0.60; 0.75). For the 22,728 older adults (aged 60 and older), multimorbidity (≥2) was associated with a 17% higher odds of severe tooth loss (95% CI, 1.06; 1.29) and 23% lower odds of having functional dentition (95% CI 0.70; 0.85). The sensitivity analysis, excluding hypertension, confirmed our findings. CONCLUSIONS: Brazilian adults and older adults with multimorbidity are more likely to have severe tooth loss and less likely to have functional dentition

Minimally processed fruit salad enriched with Lactobacillus acidophilus: Viability of anti-browning compounds in the preservation of color

Minimal processing promotes browning of some vegetal tissues due to cell membrane disruption, which results in the release of oxidative enzymes. This study evaluated the efficiency of citric acid, ascorbic acid, sodium metabisulfite and L-cysteine hydrochloride to retard enzymatic browning of minimally processed fruit salad and enriched this product with Lactobacillus acidophilus LA-5. Control treatment was fruit salad immersed in water. Polyphenol oxidase (PPO) and color (L*, a*, b*, index color - CI, browning index - BI, c*, and h°) were analyzed. The viability of L. acidophilus was also evaluated using Rogosa agar in fruit salads containing anti-browning compounds in higher concentrations. PPO presented a significant difference among control and fruit salad treated with ascorbic acid and L-cysteine hydrochloride, indicating the highest anti-browning activity of these compounds. The fruit color was affected by processing and storage time, with a reduction in the values of L* over time. Values of a*, c*, h° angle and CI indicated a predominance of red color in the fruit salad. Salads containing anti-browning compounds in higher concentrations presented viability of L. acidophilus above 7.43 log CFU/g up to the fifth day of storage, indicating that the product can be promised as probiotic. Thus, the fruit salad treated with anti-browning compounds has potential use as a probiotic carrier.Keywords: Fresh-cut fruits, color, ascorbic acid, vegetable matrix, probiotic culture

A less expensive NiMnGa based Heusler alloy for magnetic refrigeration

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)We present a study of the substitution of Mn by Cu on the compound Ni2Mn1-xCuxGa0.9Al0.1, showing that the substitution of a small amount of Al on the Ga site does not affect the magnetic and magnetocaloric potential compared to Ni-2(Mn,Cu)Ga alloy. The samples were prepared with 10% substitution of Al and with Cu concentrations of x = 0.0, 0.2, and 0.3. Magnetization measurements as a function of temperature performed from 10 to 400 K, with an applied field of 0.02 T showed a ferromagnetic state, with critical temperature T-c = 295 and 300 K for the samples with Cu, x = 0.2 and 0.3, respectively. For the sample without Cu, a complex behavior is observed at T-c = 370 K, with martensitic transition at 220 K and a premartensitic at 250 K. Analysis of x-rays diffractograms at room temperature show a L2(1) structure for x = 0.0, while for x = 0.2 a mixture of L2(1) and martensitic is present, and the sample with x = 0.3 it is in a fully martensitic phase. Heat capacity measurements were performed in order to calculate magnetocaloric effect in the samples. The results indicate that in Ni(Mn,Cu)Ga alloys, a partial substitution of Ga by Al still produce a high refrigerant capacity while reducing the costs of fabrication. (C) 2012 American Institute of Physics. [doi:10.1063/1.3675064]1117Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado do Rio de Janeiro (FAPERJ)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP

Using patient-reported outcome measures to evaluate care for patients with inflammatory chronic rheumatic disease

Objectives: Few countries integrate Patient-Reported Outcome Measures (PROMs) in routine performance assessment, and those that do focus on elective surgery. This study addresses the challenges of using PROMs to evaluate care in chronic conditions. We set out a modelling strategy to assess the extent to which changes over time in self-reported health status by patients with inflammatory chronic rheumatic disease are related to their biological drug therapy and Rheumatology centre primarily responsible for their care. Methods: Using data from the Portuguese Register of Rheumatic Diseases, we assess the health status using the Health Assessment Questionnaire-Disability Index (HAQ-DI) for rheumatic patients receiving biological drugs between 2000 and 2017. We employ a fixed effects model using the Least Squares Dummy Variables estimator. Results: Patients receiving infliximab or rituximab report lower health status than those on etanercept (the most common therapy) and patients in 4 of the 26 Rheumatology centres report higher health status than those at other centres. Conclusions: PROMs can be used for those with chronic conditions to provide the patient’s perspective about the impact on their health status of the choice of drug therapy and care provider. Care for chronic patients might be improved if healthcare organisations monitor PROMs and engage in performance assessment initiatives on a routine basis

Brazilian gamma detection device for sentinel lymph node biopsy

OBJECTIVE: To test the effectiveness of an intra-operative gamma detection Brazilian device (IPEN) on sentinel lymph node biopsy (SLNB) procedures. METHODS: Forty melanoma or breast cancer patients with indication for undergoing SLNB were studied. Lymphoscintigraphy was done 2 to 24 hours prior to surgery. Lymphatic mapping with vital dye and gamma detection were performed intraoperatively. For gamma detection Neoprobe ® 1500 was used followed by IPEN (equipment under test) in the first 20 patients and for the remaining half IPEN was used first to verify its ability to locate the sentinel node (SN). Measurements were taken from the radiopharmaceutical product injection site, from SN (in vivo and ex vivo) and from background. It was recorded if the SN was stained or not and if it was found easily by surgeon. RESULTS: There were 33 (82.5%) breast cancer and 7 (17.5%) melanoma patients. Ages varied from 21 to 68 year-old (median age of 46). Sex distribution was 35 (87.5%) women and 5 (12.5%) men. Sentinel node was found in all but one patient. There was no statistical difference between the reasons ex vivo/ background obtained with the measures of both equipments (p=0, 2583-ns). The SN was easily found by the surgeon with both devices. CONCLUSION: The SLNB was successfully performed using either equipment. It was possible to do SLNB with the Brazilian device developed by IPEN without prejudice for the patient.OBJETIVO: Testar a eficácia de equipamento de detecção gama intra-operatória (DGI) desenvolvido pelo IPEN (Brasil), em procedimentos de biópsia de linfonodo sentinela (BLS) no melanoma e no câncer de mama. MÉTODOS: Foram estudados 40 pacientes portadores de melanoma ou câncer de mama com indicação para realização de BLS.Todos pacientes foram submetidos à linfocintilografia e a BLS ocorreu entre 2 a 24 horas após a mesma. Concomitantemente à DGI, realizou-se o mapeamento linfático com corante vital. Foram feitas leituras com o equipamento convencional Neoprobe® 1500 e com o equipamento em teste (IPEN) dos valores de captação do sítio de injeção do radiofármaco, do LS in vivo e ex vivo e da captação de fundo. Foi registrado se o LS estava corado e se o cirurgião teve facilidade para encontrá-lo. Nos primeiros 20 pacientes utilizou-se o equipamento convencional e depois o de teste; nos outros 20, utilizou-se primeiro o equipamento em teste, com objetivo de verificar se o mesmo identificava primariamente o LS. RESULTADOS: Dos quarenta pacientes, 33 eram portadores de tumor de mama e sete de melanoma cutâneo; variação da idade: 21 a 68 anos (mediana= 46 anos); 35 mulheres e 5 homens. Em apenas um paciente o LS não foi encontrado, nem pela DGI nem pelo corante vital. Não houve diferença estatística entre as razões ex vivo/fundo obtidas com os dois equipamentos (p=0, 2583-ns). CONCLUSÃO: É possível realizar o procedimento de BLS com o equipamento brasileiro desenvolvido pelo IPEN, com facilidade e sem prejuízo para o paciente.Hospital Israelita Albert EinsteinIPENUniversidade Federal de São Paulo (UNIFESP)Faculdade de Medicina Anhembi-MorumbiUNIFESPSciEL

The costs of preventing and treating chagas disease in Colombia

Background: The objective of this study is to report the costs of Chagas disease in Colombia, in terms of vector disease control programmes and the costs of providing care to chronic Chagas disease patients with cardiomyopathy. Methods: Data were collected from Colombia in 2004. A retrospective review of costs for vector control programmes carried out in rural areas included 3,084 houses surveyed for infestation with triatomine bugs and 3,305 houses sprayed with insecticide. A total of 63 patient records from 3 different hospitals were selected for a retrospective review of resource use. Consensus methodology with local experts was used to estimate care seeking behaviour and to complement observed data on utilisation. Findings: The mean cost per house per entomological survey was $4.4 (in US$ of 2004), whereas the mean cost of spraying a house with insecticide was $27. The main cost driver of spraying was the price of the insecticide, which varied greatly. Treatment of a chronic Chagas disease patient costs between$46.4 and $7,981 per year in Colombia, depending on severity and the level of care used. Combining cost and utilisation estimates the expected cost of treatment per patient-year is$1,028, whereas lifetime costs averaged $11,619 per patient. Chronic Chagas disease patients have limited access to healthcare, with an estimated 22% of patients never seeking care. Conclusion: Chagas disease is a preventable condition that affects mostly poor populations living in rural areas. The mean costs of surveying houses for infestation and spraying infested houses were low in comparison to other studies and in line with treatment costs. Care seeking behaviour and the type of insurance affiliation seem to play a role in the facilities and type of care that patients use, thus raising concerns about equitable access to care. Preventing Chagas disease in Colombia would be cost-effective and could contribute to prevent inequalities in health and healthcare.Wellcome Trus

Metastatic potential of an aneurysmal bone cyst

Aneurysmal bone cysts (ABCs) are benign bone tumors consisting of blood-filled cavities lined by connective tissue septa. Recently, the hypothesis that ABCs are lesions reactive to local hemodynamics has been challenged after the discovery of specific recurrent chromosomal abnormalities. Multiple cases of malignant transformation of ABC into (osteo)sarcoma have been described, as well as a number of cases of telangiectatic osteosarcoma which had been misdiagnosed as ABC. We herewith document a case of a pelvic ABC metastatic to the lung, liver, and kidneys. Diagnosis was confirmed by the presence of a break in the USP6 gene, which is pathognomonic for ABC, in a pulmonary metastasis of our patient. Sarcomatous transformation as an explanation for this behavior was ruled out by demonstrating diploid DNA content in both the pulmonary lesion and the primary tumor