Associações bidirecionais entre doença periodontal, fadiga e atividade física

Introdução e objetivos: As sensações de fadiga podem ser decorrentes de doenças crônicas, como câncer, diabetes e artrite reumatoide, que por sua vez também estão associadas à inexistência de exercício ou inatividade física. Da mesma forma, a doença periodontal vem apresentando associações com várias doenças sistêmicas. O presente trabalho tem como objetivo: 1) Avaliar se a doença periodontal pode agir como preditor de risco para as sensações de fadiga; 2) Avaliar se atividade física auto reportada tem efeito protetor na ocorrência de doença periodontal. Metodologia: dois estudos de cunho transversal foram aninhados a um estudo de coorte de base populacional conduzido com adultos de 35 anos ou mais que moram na cidade Porto Alegre, Rio Grande do Sul. Exames periodontais de profundidade de sondagem (PS), sangramento à sondagem (SS), e perda de inserção (PI) foram realizados utilizando um protocolo de exame de 4 sítios por dente, em todos os dentes presentes em 287 indivíduos que foram avaliados no exame de seguimento. A mensuração de fadiga foi realizada através da sub escala de vitalidade do questionário genérico de avaliação de qualidade de vida SF-36 (SF-36 VT). Atividade física foi avaliada através do Questionário de Atividade Física Internacional (IPAQ). Modelos de regressão logística múltiplos foram aplicados para avaliar as associações entre as variáveis periodontais e fadiga, e entre atividade física e periodontite. Resultados: com relação à associação entre doença periodontal e fadiga, a porcentagem de indivíduos com fadiga entre os que apresentavam periodontite (20.2%) e aqueles sem periodontite (21.4%) foi muito similar. Modelos ajustados para sexo, fumo e artrite não demonstraram associações significativas entre periodontite e fadiga. No que tange à análise da associação entre atividade física e doença periodontal, indivíduos fisicamente ativos tiveram uma chance significativamente menor de apresentar periodontite severa (OR=0.51; 95%CI: 0.28-0.93) após o ajuste para as variáveis idade, cor da pele, status socioeconômico e fumo. A redução na chance também foi observada para indivíduos que apresentavam PS ≥5mm em 1 dente ou mais (OR=0.41; 95%CI: 0.21-0.79). Quando PI foi considerado o único desfecho periodontal, não foram observadas diferenças significativas, indicando que a atividade física pode agir sobre o componente inflamatório da periodontite. Conclusão: nenhuma associação foi encontrada entre os parâmetros periodontais e fadiga neste estudo. A investigação de uma suposta influência da periodontite nas sensações de fadiga em outras populações deve ser encorajada, pois existem mecanismos plausíveis para esta associação. Por outro lado, a atividade física parece agir como fator protetor para a doença periodontal, reforçando a efetividade de atividades físicas de rotina na prevenção primária e secundária de doenças crônicas devido ao seu efeito anti-inflamatório.Introduction and aim: Fatigue sensations may arise due to chronic diseases, like as from cancer, diabetes and rheumatoid arthritis. These chronic conditions in turn are associated with lack of exercise or physical inactivity. In the same way, periodontal disease has been associated with several systemic chronic diseases. The present work has the purpose of: 1) to test the hypothesis that periodontal disease may act as an independent risk indicator for fatigue; and 2) to assess the association between physical activity and clinical parameters of periodontitis in a sample of Brazilian adults. Methods: two cross-sectional studies were nested to a population-based cohort study conducted with adults 35 years and older living in Porto Alegre, Brazil. Periodontal probing depth (PPD), bleeding on probing (BOP), and clinical attachment loss (CAL) were assessed in four sites/tooth in all present teeth in 287 individuals evaluated at the follow-up examination. Fatigue was assessed by the Short Form-36 vitality subscale (SF-36 VT) and physical activity was assessed by the International Physical Activity Questionnaire (IPAQ). Multiple logistic regression models were applied to assess the associations between periodontal variables and fatigue, and for the associations between physical activity and periodontitis. Results: with regard to the association between periodontal disease and fatigue, the percentage of individuals with fatigue among those with (20.2%) and without (21.4%) periodontitis was very similar. Multiple logistic regression models adjusted for sex, smoking and arthritis demonstrated no significant associations between periodontitis and fatigue. With relation to the association between physical activity and periodontitis, after adjusting for age, skin color, socioeconomic status and smoking, physically active individuals had a significantly smaller chance of having severe periodontitis (OR=0.51; 95%CI: 0.28-0.93). The reduction in the odds was also observed for PPD ≥5mm in ≥1 tooth (OR=0.41; 95%CI: 0.21-0.79). When CAL alone was considered the periodontal outcome, no significant associations were found, indicating that PA may act at the inflammatory component of periodontitis. Conclusion: No associations between periodontal disease parameters and fatigue were found in this study. The investigation of a supposed burden of periodontitis in fatigue in other populations is still encouraged, since there are plausible mechanisms for this association. On the other hand, physical activity may act as a protective factor for periodontal disease. This study strengths the effectiveness of routine physical activity in the primary and secondary prevention of chronic diseases throughout improving inflammation

Validation of self-reported history of root canal treatment in a southern Brazilian subpopulation

The aim of this study was to assess self-reported history of root canal treatment (SRHRCT) as a method for detecting the presence of root canal treatment (RCT) and apical periodontitis (AP) in a southern Brazilian subpopulation. In this cross-sectional study, 136 military police officers from the city of Porto Alegre, Brazil, were included. The participants were interviewed and full-mouth periapical radiographs were taken. A calibrated examiner determined the presence of RCT and AP by applying standardized criteria. The diagnostic accuracy of SRHRCT was calculated separately for RCT and AP. Accuracy, sensitivity, specificity, positive and negative predictive values (+PV and -PV), efficiency, and positive and negative likelihood ratios (+LR and -LR) were estimated. The mean age of the participants was 34.1 ± 10.4 years and 88.2% were males. Overall, SRHRCT demonstrated high sensitivity and specificity for RCT, but not for AP: sensitivity (RCT = 0.960, AP = 0.757) and specificity (RCT = 0.835, AP = 0.631). The estimated values for PV and LR were: +PV (RCT=0.777, AP=0.396), -PV (RCT = 0.972, AP = 0.890), +LR (RCT = 5.853, AP = 2.057), and -LR (RCT = 0.046, AP = 0.383). SRHRCT proved to be a good predictor of the presence of RCT, but a weak predictor of AP in this subpopulation

Molecular epidemiology of sisal bole rot disease suggests a potential phytosanitary crisis in Brazilian production areas

Sisal bole rot disease is the major phytosanitary problem of Agave plantations in Brazil. The disease is caused by a cryptic species of Aspergillus: A. welwitschiae. To date, the only way to diagnose the disease was to observe external symptoms, visible only when the plant is already compromised, or through the isolation and sequencing of the pathogen, which requires cutting the entire plant for bole tissue sampling. We developed a new primer set based on a unique gene region of A. welwitschiae, which can detect the phytopathogenic strains through PCR directly from sisal leaves. Using the new marker to study the main sisal-producing areas in Brazil, we discovered a troublesome situation. The main producing areas of this crop had a pathogen incidence of 78%–88%. The dispersion index indicates a regular spatial pattern for disease distribution, suggesting that the use of contaminated suckers to establish new fields may be the main disease-spreading mechanism. Altogether, the high incidence of the pathogen, the unavailability of clean plants, the unpredictability of disease progression, and the low investment capacity of farmers reveal the vulnerability of this sector to a potential phytosanitary crisis. By correlating the disease symptomatology with soil nutritional traits, we suggest that higher potassium availability might decrease visual symptoms, while phosphorus may have the opposite effect. Also, we observe a potential cultivar effect, suggesting that common sisal may be more susceptible than hybrid cultivars (especially H400). This new molecular tool is a significant advance for understanding the disease, enabling the implementation of a monitoring program and studies that may lead to pathogen control strategies and changes in the Brazilian production model

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Diretriz da Sociedade Brasileira de Cardiologia sobre Diagnóstico e Tratamento de Pacientes com Cardiomiopatia da Doença de Chagas

This guideline aimed to update the concepts and formulate the standards of conduct and scientific evidence that support them, regarding the diagnosis and treatment of the Cardiomyopathy of Chagas disease, with special emphasis on the rationality base that supported it.  Chagas disease in the 21st century maintains an epidemiological pattern of endemicity in 21 Latin American countries. Researchers and managers from endemic and non-endemic countries point to the need to adopt comprehensive public health policies to effectively control the interhuman transmission of T. cruzi infection, and to obtain an optimized level of care for already infected individuals, focusing on diagnostic and therapeutic opportunistic opportunities.   Pathogenic and pathophysiological mechanisms of the Cardiomyopathy of Chagas disease were revisited after in-depth updating and the notion that necrosis and fibrosis are stimulated by tissue parasitic persistence and adverse immune reaction, as fundamental mechanisms, assisted by autonomic and microvascular disorders, was well established. Some of them have recently formed potential targets of therapies.  The natural history of the acute and chronic phases was reviewed, with enhancement for oral transmission, indeterminate form and chronic syndromes. Recent meta-analyses of observational studies have estimated the risk of evolution from acute and indeterminate forms and mortality after chronic cardiomyopathy. Therapeutic approaches applicable to individuals with Indeterminate form of Chagas disease were specifically addressed. All methods to detect structural and/or functional alterations with various cardiac imaging techniques were also reviewed, with recommendations for use in various clinical scenarios. Mortality risk stratification based on the Rassi score, with recent studies of its application, was complemented by methods that detect myocardial fibrosis.  The current methodology for etiological diagnosis and the consequent implications of trypanonomic treatment deserved a comprehensive and in-depth approach. Also the treatment of patients at risk or with heart failure, arrhythmias and thromboembolic events, based on pharmacological and complementary resources, received special attention. Additional chapters supported the conducts applicable to several special contexts, including t. cruzi/HIV co-infection, risk during surgeries, in pregnant women, in the reactivation of infection after heart transplantation, and others.     Finally, two chapters of great social significance, addressing the structuring of specialized services to care for individuals with the Cardiomyopathy of Chagas disease, and reviewing the concepts of severe heart disease and its medical-labor implications completed this guideline.Esta diretriz teve como objetivo principal atualizar os conceitos e formular as normas de conduta e evidências científicas que as suportam, quanto ao diagnóstico e tratamento da CDC, com especial ênfase na base de racionalidade que a embasou. A DC no século XXI mantém padrão epidemiológico de endemicidade em 21 países da América Latina. Investigadores e gestores de países endêmicos e não endêmicos indigitam a necessidade de se adotarem políticas abrangentes, de saúde pública, para controle eficaz da transmissão inter-humanos da infecção pelo T. cruzi, e obter-se nível otimizado de atendimento aos indivíduos já infectados, com foco em oportunização diagnóstica e terapêutica. Mecanismos patogênicos e fisiopatológicos da CDC foram revisitados após atualização aprofundada e ficou bem consolidada a noção de que necrose e fibrose sejam estimuladas pela persistência parasitária tissular e reação imune adversa, como mecanismos fundamentais, coadjuvados por distúrbios autonômicos e microvasculares. Alguns deles recentemente constituíram alvos potenciais de terapêuticas. A história natural das fases aguda e crônica foi revista, com realce para a transmissão oral, a forma indeterminada e as síndromes crônicas. Metanálises recentes de estudos observacionais estimaram o risco de evolução a partir das formas aguda e indeterminada e de mortalidade após instalação da cardiomiopatia crônica. Condutas terapêuticas aplicáveis aos indivíduos com a FIDC foram abordadas especificamente. Todos os métodos para detectar alterações estruturais e/ou funcionais com variadas técnicas de imageamento cardíaco também foram revisados, com recomendações de uso nos vários cenários clínicos. Estratificação de risco de mortalidade fundamentada no escore de Rassi, com estudos recentes de sua aplicação, foi complementada por métodos que detectam fibrose miocárdica. A metodologia atual para diagnóstico etiológico e as consequentes implicações do tratamento tripanossomicida mereceram enfoque abrangente e aprofundado. Também o tratamento de pacientes em risco ou com insuficiência cardíaca, arritmias e eventos tromboembólicos, baseado em recursos farmacológicos e complementares, recebeu especial atenção. Capítulos suplementares subsidiaram as condutas aplicáveis a diversos contextos especiais, entre eles o da co-infecção por T. cruzi/HIV, risco durante cirurgias, em grávidas, na reativação da infecção após transplante cardíacos, e outros.    Por fim, dois capítulos de grande significado social, abordando a estruturação de serviços especializados para atendimento aos indivíduos com a CDC, e revisando os conceitos de cardiopatia grave e suas implicações médico-trabalhistas completaram esta diretriz.&nbsp

Studies of the mass composition of cosmic rays and proton-proton interaction cross-sections at ultra-high energies with the Pierre Auger Observatory

In this work, we present an estimate of the cosmic-ray mass composition from the distributions of the depth of the shower maximum (Xmax) measured by the fluorescence detector of the Pierre Auger Observatory. We discuss the sensitivity of the mass composition measurements to the uncertainties in the properties of the hadronic interactions, particularly in the predictions of the particle interaction cross-sections. For this purpose, we adjust the fractions of cosmic-ray mass groups to fit the data with Xmax distributions from air shower simulations. We modify the proton-proton cross-sections at ultra-high energies, and the corresponding air shower simulations with rescaled nucleus-air cross-sections are obtained via Glauber theory. We compare the energy-dependent composition of ultra-high-energy cosmic rays obtained for the different extrapolations of the proton-proton cross-sections from low-energy accelerator data

Study of downward Terrestrial Gamma-ray Flashes with the surface detector of the Pierre Auger Observatory

The surface detector (SD) of the Pierre Auger Observatory, consisting of 1660 water-Cherenkov detectors (WCDs), covers 3000 km2 in the Argentinian pampa. Thanks to the high efficiency of WCDs in detecting gamma rays, it represents a unique instrument for studying downward Terrestrial Gamma-ray Flashes (TGFs) over a large area. Peculiar events, likely related to downward TGFs, were detected at the Auger Observatory. Their experimental signature and time evolution are very different from those of a shower produced by an ultrahigh-energy cosmic ray. They happen in coincidence with low thunderclouds and lightning, and their large deposited energy at the ground is compatible with that of a standard downward TGF with the source a few kilometers above the ground. A new trigger algorithm to increase the TGF-like event statistics was installed in the whole array. The study of the performance of the new trigger system during the lightning season is ongoing and will provide a handle to develop improved algorithms to implement in the Auger upgraded electronic boards. The available data sample, even if small, can give important clues about the TGF production models, in particular, the shape of WCD signals. Moreover, the SD allows us to observe more than one point in the TGF beam, providing information on the emission angle