Influence of orthodontic-surgical treatment on signs and symptoms of temporomandibular dysfunction in subjects with dentofacial deformities

OBJETIVO: Verificar se o tratamento ortodôntico-cirúrgico acarreta modificações nos sinais e sintomas de disfunção temporomandibular em indivíduos com deformidades dentofaciais. MÉTODOS: Participaram do estudo 20 pacientes de ambos os gêneros (idades entre 15 e 44 anos), com diferentes características dento-oclusais e faciais, submetidos a osteotomias mandibulares e/ou maxilares. Todos os pacientes apresentavam pelo menos um sinal ou sintoma de disfunção temporomandibular, verificado por meio de entrevista e de avaliação clínica realizada pré e após 30 a 60 dias da cirurgia ortognática. Nesta última buscou-se dor à palpação dos músculos mastigatórios, cervicais e da articulação temporomandibular; foi realizada ausculta das articulações temporomandibulares e mediu-se movimentos mandibulares. RESULTADOS: Quanto aos sintomas investigados na entrevista, os resultados demonstraram que após a cirurgia ortognática houve redução de todos os sintomas. No que diz respeito aos movimentos mandibulares, observou-se significante diminuição da abertura da boca no pós-operatório e pouca variação nas medidas de lateralidade mandibular. Em relação à presença de dor à palpação, notou-se diminuição da dor para os músculos cervicais. CONCLUSÃO: O tratamento ortodôntico-cirúrgico acarretou, em curto prazo, diminuição dos sintomas investigados e dos sinais clínicos de dor à palpação na musculatura cervical e redução da abertura da boca em pacientes com deformidades dentofaciais. Registro de ensaio clínico: 083578.PURPOSE: To verifying whether orthodontic-surgical treatment results in modification on the signs and symptoms of temporomandibular dysfunction in individuals with dentofacial deformities. METHODS: Twenty patients of both genders (ages between 15 and 44 years) with different dental-occlusion and facial characteristics, submitted to mandibular and/or maxillary osteotomy, participated in this study. All patients presented at least one sign or symptom of temporomandibular dysfunction, verified through interview and clinical evaluation carried out before and after 30 to 60 days of the orthognathic surgery. The final evaluation investigated the presence of pain on palpation of masticatory and cervical muscles, and temporomandibular joint pain; auscultation of the temporomandibular joints was performed, and jaw movements were measured. RESULTS: All symptoms investigated in the interview decreased after the orthognathic surgery. Regarding mandibular movements, there was a significant decrease in postoperative mandibular opening, and little variation was observed in measures of lateral excursions. It was also noticed a decrease of pain in cervical muscles. CONCLUSION: The orthodontic-surgical treatment resulted in short term decrease of the investigated symptoms and clinical signs of pain in cervical muscles, and reduction of mandibular opening in patients with dentofacial deformities.Clinical trials register: 083578

The evolving SARS-CoV-2 epidemic in Africa: Insights from rapidly expanding genomic surveillance

INTRODUCTION Investment in Africa over the past year with regard to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sequencing has led to a massive increase in the number of sequences, which, to date, exceeds 100,000 sequences generated to track the pandemic on the continent. These sequences have profoundly affected how public health officials in Africa have navigated the COVID-19 pandemic. RATIONALE We demonstrate how the first 100,000 SARS-CoV-2 sequences from Africa have helped monitor the epidemic on the continent, how genomic surveillance expanded over the course of the pandemic, and how we adapted our sequencing methods to deal with an evolving virus. Finally, we also examine how viral lineages have spread across the continent in a phylogeographic framework to gain insights into the underlying temporal and spatial transmission dynamics for several variants of concern (VOCs). RESULTS Our results indicate that the number of countries in Africa that can sequence the virus within their own borders is growing and that this is coupled with a shorter turnaround time from the time of sampling to sequence submission. Ongoing evolution necessitated the continual updating of primer sets, and, as a result, eight primer sets were designed in tandem with viral evolution and used to ensure effective sequencing of the virus. The pandemic unfolded through multiple waves of infection that were each driven by distinct genetic lineages, with B.1-like ancestral strains associated with the first pandemic wave of infections in 2020. Successive waves on the continent were fueled by different VOCs, with Alpha and Beta cocirculating in distinct spatial patterns during the second wave and Delta and Omicron affecting the whole continent during the third and fourth waves, respectively. Phylogeographic reconstruction points toward distinct differences in viral importation and exportation patterns associated with the Alpha, Beta, Delta, and Omicron variants and subvariants, when considering both Africa versus the rest of the world and viral dissemination within the continent. Our epidemiological and phylogenetic inferences therefore underscore the heterogeneous nature of the pandemic on the continent and highlight key insights and challenges, for instance, recognizing the limitations of low testing proportions. We also highlight the early warning capacity that genomic surveillance in Africa has had for the rest of the world with the detection of new lineages and variants, the most recent being the characterization of various Omicron subvariants. CONCLUSION Sustained investment for diagnostics and genomic surveillance in Africa is needed as the virus continues to evolve. This is important not only to help combat SARS-CoV-2 on the continent but also because it can be used as a platform to help address the many emerging and reemerging infectious disease threats in Africa. In particular, capacity building for local sequencing within countries or within the continent should be prioritized because this is generally associated with shorter turnaround times, providing the most benefit to local public health authorities tasked with pandemic response and mitigation and allowing for the fastest reaction to localized outbreaks. These investments are crucial for pandemic preparedness and response and will serve the health of the continent well into the 21st century