Prevalence of Sleep-Disordered Breathing and Associations With Malocclusion in Children

STUDY OBJECTIVES:This study aimed to determine the prevalence of sleep-disordered breathing (SDB) and its association with malocclusion among children in Recife, Brazil. METHODS:This study included 390 children aged 7 to 8 years. The data comprised the measurement of body mass, orthodontic examination, and parental information required by the Sleep Disturbance Scale for Children. The statistics tools used were Pearson’s chi-square test and the Lemeshow test. RESULTS:Positively screened for SDB was found in 33.3% of the children, and the association with overjet was P = .007 (odds ratio [OR], 95%, confidence interval [CI]: 1.93). The association with anterior open bite was P = .008 (OR, 95% CI: 2.03), and the association with posterior crossbite was P = .001 (OR, 95% CI: 2.89). This report was unable to indicate an association between body mass index and SDB. The multivariate logistic regression model revealed that the anterior open bite (P = .002; OR, 95% CI: 2.34) and posterior crossbite (P = .014; OR, 95% CI: 2.79) had an association with positively screened for SDB. CONCLUSIONS:The results of this study indicated that the prevalence of SDB was high and highly associated with malocclusion. Since posterior crossbite and anterior open bite were associated with positively screened for SDB, early diagnosis and intervention may prevent and minimize adverse effects of SDB on individuals lives

Non-Invasive Methods and the Use of Infiltrating Resins for the Control of Caries Progression in Deciduous Teeth: A Systematic Review and Meta-Analysis

Objective: To evaluate the influence of non-invasive treatment associated with the use of infiltrating resin for managing caries lesions in primary teeth. Material and Methods: A systematic review was performed by selecting articles from 6 online databases, using a search algorithm and eligibility criteria for data extraction and data synthesis for the papers included. Clinical trials involving primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the outer dentin) were included, presenting full text and answering the study\u27s guiding question. This study used the RoB 2 tool for the risk of bias assessment and GRADE for certainty of evidence. Random effects meta-analyses were implemented, and lesion progression treatment effects were estimated through relative risk (RR) and associated 95% confidence intervals. Results: A total of 440 studies were found. After analyzing the inclusion criteria and removal of duplicates, eight studies were analyzed for quality evidence. Five of the eight studies included in this review contributed to the meta-analysis, all with some reflections regarding the risk of bias. Overall, the results of the meta-analysis showed that non-invasive treatment, when associated with the use of infiltrating resins, significantly reduced the risk of caries progression in relation to the treatment without this addition for follow-up periods ranging from 12 months to 2 years (RR 0.51 [0.40-0.65]). Conclusion: There is moderate certainty of evidence that the use of infiltrating resins associated with non-invasive treatments decreases the risk of caries progression in primary teeth with incipient caries lesions (1/2 of the enamel or 1/3 of the dentin outer) when combined with non-invasive control methods alone

Two Independent HIV Epidemics in Saint Petersburg, Russia Revealed by Molecular Epidemiology

The HIV epidemic in Russia, one of the world's fastest growing, has been concentrated mostly among people who inject drugs (PWID). We sought to explore the epidemiology of the epidemic in St. Petersburg by sampling from the highest risk groups of PWID and men who have sex with men (MSM) and use viral sequencing data to better understand the nature of the city's epidemic. Serological testing confirmed an HIV prevalence among PWID in excess of 40%. All but 1 of 110 PWID whose blood samples were tested for genetic diversity were infected by subtype A virus, specifically by the AFSU strain. The remaining person was infected with a CRF-06cpx recombinant. Analysis of pairwise genetic distance among all PWID studied revealed an average of 3.1% sequence divergence, suggesting clonal introduction of the AFSU strain and/or constraints on sequence divergence. The HIV prevalence was less than 10% among MSM. All 17 sequences from HIV-infected MSM were found to be a clade B virus with a much higher average sequence diversity of 15.7%. These findings suggest two independent epidemics with little overlap between the two highest at-risk populations, which will require different HIV prevention approaches

Perampanel as Precision Therapy in Rare Genetic Epilepsies

Objective: Perampanel, an antiseizure drug with AMPA-receptor antagonist properties, may have a targeted effect in genetic epilepsies with overwhelming glutamate receptor activation. Special interest holds epilepsies with loss of GABA inhibition (e.g. SCN1A), overactive excitatory neurons (e.g. SCN2A, SCN8A ), and variants in glutamate receptors (e.g. GRIN2A). We aimed to collect data from a large rare genetic epilepsy cohort treated with perampanel, to detect possible subgroups with high efficacy. Methods: A multicenter project based on the framework of NETRE (Network for Therapy in Rare Epilepsies), a web of pediatric neurologists treating rare epilepsies. Retrospective data from patients with genetic epilepsies treated with perampanel was collected. Outcome measures were responder rate (50% seizure reduction), and percentage of seizure reduction after 3 months of treatment. Subgroups of etiologies with high efficacy were identified. Results: 137 patients, with 79 different etiologies, aged 2 months-61 years (mean 15.48±9.9) were enrolled. The mean dosage was 6.45±2.47 mg, and treatment period was 2.0±1.78 years (1.5 months-8 years). 62 patients (44.9%) were treated for >2 years. 98 patients (71%) were responders, and 93 (67.4%) chose to continue therapy. The mean reduction in seizure frequency was 56.61±34.36%. 60 patients (43.5%) sustained over 75% reduction in seizure frequency, including 38 (27.5%) with > 90% reduction in seizure frequency. The following genes showed high treatment efficacy: SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, POLG1, POLG2, NEU1. 11/17 (64.7%) of patients with SCN1A, 35.3% of which had over 90% seizure reduction. Other etiologies remarkable for over 90% reduction in seizures were GNAO1 and PIGA. 14 patients had a CSWS EEG pattern and in 6 subjects perampanel reduced epileptiform activity. Significance: Perampanel demonstrated high safety and efficacy in patients with rare genetic epilepsies, especially in SCN1A, GNAO1, PIGA, PCDH19, SYNGAP1, CDKL5, NEU1 and POLG, suggesting a targeted effect related to glutamate transmission

ADOLESCÊNCIA, EDUCAÇÃO E INCLUSÃO: REPRESENTAÇÕES SOCIAIS DE ADOLESCENTES COM SÍNDROME DE DOWN EM PARES ESCOLARES

One's first social contacts beyond his family happens at school. How children and adolescents settle themselves at school influences their social relations during adulthood. Through a social inclusion perspective, this qualitative and interdisciplinary study aimed to get to know social representations developed by students regarding Down's Syndrome adolescents. Its basic referential theory was the Social Representation Theory. Data was collected through participant observation and semi-structured interviews with students who shared their classroom with adolescents with Down´s Syndrome. Data collected was submitted to methodological procedures of Speech Analysis, dialectically with Social Representation Theory. It was observed that relation between students with and without Down's Syndrome is positive and that the latter worries about how the former is treated by other people. Therefore, they stand for equity in adolescents with Down's Syndrome´s social relations. Nevertheless, the idea of capacitism was unveiled in representations, which is a great obstacle for inclusion.En la escuela, los primeros contactos sociales del individuo tienen lugar más allá del núcleo familiar. La forma en que los niños y adolescentes se establecen en la escuela influye en la forma en que construyen relaciones sociales en la edad adulta. A través de la perspectiva de la inclusión social, este estudio, de carácter cualitativo, con un enfoque interdisciplinario, tuvo como objetivo conocer las representaciones sociales elaboradas por pares escolares sobre el adolescente con Síndrome de Down. El marco teórico básico de esta investigación fue la Teoría de las Representaciones Sociales. La recolección de datos se realizó a partir de la observación participante y entrevistas semiestructuradas realizadas a estudiantes que asistían al aula con un adolescente con Síndrome de Down. Los contenidos recolectados fueron sometidos a los procedimientos metodológicos de Análisis del Discurso, basados ​​en una dialéctica con la Teoría de las Representaciones Sociales. Se observó que las relaciones entre pares son positivas y que se preocupan por la forma en que la sociedad los trata, por lo que defienden la equidad en las relaciones sociales con la persona con Síndrome de Down. Sin embargo, también se desveló el fenómeno del capacitismo, un gran obstáculo para el desafío de la inclusión social.Na escola acontecem os primeiros contatos sociais do indivíduo para além do núcleo familiar. O modo como as crianças e os adolescentes se estabelece na escola influencia como constroem as relações sociais na vida adulta. Através da perspectiva da inclusão social, esse estudo, de natureza qualitativa, com aporte interdisciplina, teve como objetivo conhecer as representações sociais elaboradas por pares escolares a respeito do adolescente com Síndrome de Down. O referencial teórico basilar para esta pesquisa foi a Teoria das Representações Sociais. A coleta de dados se deu com base na observação participante e em entrevistas semiestruturadas realizadas com estudantes que frequentavam sala de aula com uma adolescente com Síndrome de Down. Os conteúdos coletados foram submetidos aos procedimentos metodológicos da Análise do Discurso, a partir de uma dialética com a Teoria das Representações Sociais. Observou-se que as relações entre os pares são positivas e que se preocupam com o modo que a sociedade lida com eles, portanto, defendem a equidade nas relações sociais com a pessoa com Síndrome de Down. Entretanto, também desvelou-se o fenômeno do capacitismo, um grande obstáculo ao desafio da inclusão social

Effect of a natural extract of chicken combs with a high content of hyaluronic acid (Hyal-Joint®) on pain relief and quality of life in subjects with knee osteoarthritis: a pilot randomized double-blind placebo-controlled trial

<p>Abstract</p> <p>Background</p> <p>Intra-articular hyaluronic acid represents a substantive addition to the therapeutic armamentarium in knee osteoarthritis. We examined the effect of dietary supplementation with a natural extract of chicken combs with a high content of hyaluronic acid (60%) (Hyal-Joint^®) (active test product, AP) on pain and quality of life in subjects with osteoarthritis of the knee.</p> <p>Methods</p> <p>Twenty subjects aged ≥40 years with knee osteoarthritis (pain for at least 15 days in the previous month, symptoms present for ≥6 months, Kellgren/Lawrence score ≥2) participated in a randomized double-blind controlled trial. Ten subjects received AP (80 mg/day) and 10 placebo for 8 weeks. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and quality of life by the Short Form-36 (SF-36v2) were administered at baseline and after 4 and 8 weeks of treatment.</p> <p>Results</p> <p>WOMAC pain (primary efficacy variable) was similar in both study groups (mean [SD]) with 6.6 (4.0) points in the AP group and 6.4 (2.7) in the placebo group (<it>P </it>= 0.943). As compared with baseline, subjects in both groups showed statistically significant improvements in WOMAC pain, stiffness, physical function subscales, and in the aggregate score, but the magnitude of changes was higher in the AP group for WOMAC physical function (-13.1 [12.0] vs. -10.1 [8.6], <it>P </it>= 0.575) and total symptoms (-18.6 [16.8] vs. -15.8 [11.4], <it>P </it>= 0.694). At 4 weeks, statistically significant mean changes compared with baseline were observed in the SF-36v2 scales of role-physical, bodily pain, social functioning and role-emotional among subjects in the AP group, and in physical functioning, bodily pain, and social functioning in the placebo group. At 8 weeks, changes were significant for role-physical, bodily pain, and physical component summary in the AP group, and for physical functioning and role-emotional in the placebo arm. Changes in bodily pain and social functioning were of greater magnitude in subjects given AP.</p> <p>Conclusion</p> <p>This pilot clinical trial showed that daily supplementation with oral hyaluronic acid from a natural extract of chicken combs (Hyal-Joint^®) was useful to enhance several markers of quality of life in adults with osteoarthritis of the knee. The results warrant further study in larger sample sizes.</p

Respondent-Driven Sampling of Injection Drug Users in Two U.S.–Mexico Border Cities: Recruitment Dynamics and Impact on Estimates of HIV and Syphilis Prevalence

Respondent-driven sampling (RDS), a chain referral sampling approach, is increasingly used to recruit participants from hard-to-reach populations, such as injection drug users (IDUs). Using RDS, we recruited IDUs in Tijuana and Ciudad (Cd.) Juárez, two Mexican cities bordering San Diego, CA and El Paso, TX, respectively, and compared recruitment dynamics, reported network size, and estimates of HIV and syphilis prevalence. Between February and April 2005, we used RDS to recruit IDUs in Tijuana (15 seeds, 207 recruits) and Cd. Juárez (9 seeds, 197 recruits), Mexico for a cross-sectional study of behavioral and contextual factors associated with HIV, HCV and syphilis infections. All subjects provided informed consent, an anonymous interview, and a venous blood sample for serologic testing of HIV, HCV, HBV (Cd. Juárez only) and syphilis antibody. Log-linear models were used to analyze the association between the state of the recruiter and that of the recruitee in the referral chains, and population estimates of the presence of syphilis antibody were obtained, correcting for biased sampling using RDS-based estimators. Sampling of the targeted 200 recruits per city was achieved rapidly (2 months in Tijuana, 2 weeks in Cd. Juárez). After excluding seeds and missing data, the sample prevalence of HCV, HIV and syphilis were 96.6, 1.9 and 13.5% respectively in Tijuana, and 95.3, 4.1, and 2.7% respectively in Cd. Juárez (where HBV prevalence was 84.7%). Syphilis cases were clustered in recruitment trees. RDS-corrected estimates of syphilis antibody prevalence ranged from 12.8 to 26.8% in Tijuana and from 2.9 to 15.6% in Ciudad Juárez, depending on how recruitment patterns were modeled, and assumptions about how network size affected an individual’s probability of being included in the sample. RDS was an effective method to rapidly recruit IDUs in these cities. Although the frequency of HIV was low, syphilis prevalence was high, particularly in Tijuana. RDS-corrected estimates of syphilis prevalence were sensitive to model assumptions, suggesting that further validation of RDS is necessary

Mutations in the Neuronal Vesicular SNARE VAMP2 Affect Synaptic Membrane Fusion and Impair Human Neurodevelopment

VAMP2 encodes the vesicular SNARE protein VAMP2 (also called synaptobrevin-2). Together with its partners syntaxin-1A and synaptosomal-associated protein 25 (SNAP25), VAMP2 mediates fusion of synaptic vesicles to release neurotransmitters. VAMP2 is essential for vesicular exocytosis and activity-dependent neurotransmitter release. Here, we report five heterozygous de novo mutations in VAMP2 in unrelated individuals presenting with a neurodevelopmental disorder characterized by axial hypotonia (which had been present since birth), intellectual disability, and autistic features. In total, we identified two single-amino-acid deletions and three non-synonymous variants affecting conserved residues within the C terminus of the VAMP2 SNARE motif. Affected individuals carrying de novo non-synonymous variants involving the C-terminal region presented a more severe phenotype with additional neurological features, including central visual impairment, hyperkinetic movement disorder, and epilepsy or electroencephalography abnormalities. Reconstituted fusion involving a lipid-mixing assay indicated impairment in vesicle fusion as one of the possible associated disease mechanisms. The genetic synaptopathy caused by VAMP2 de novo mutations highlights the key roles of this gene in human brain development and function

Neural Substrate of Cold-Seeking Behavior in Endotoxin Shock

Systemic inflammation is a leading cause of hospital death. Mild systemic inflammation is accompanied by warmth-seeking behavior (and fever), whereas severe inflammation is associated with cold-seeking behavior (and hypothermia). Both behaviors are adaptive. Which brain structures mediate which behavior is unknown. The involvement of hypothalamic structures, namely, the preoptic area (POA), paraventricular nucleus (PVH), or dorsomedial nucleus (DMH), in thermoregulatory behaviors associated with endotoxin (lipopolysaccharide [LPS])-induced systemic inflammation was studied in rats. The rats were allowed to select their thermal environment by freely moving in a thermogradient apparatus. A low intravenous dose of Escherichia coli LPS (10 µg/kg) caused warmth-seeking behavior, whereas a high, shock-inducing dose (5,000 µg/kg) caused cold-seeking behavior. Bilateral electrocoagulation of the PVH or DMH, but not of the POA, prevented this cold-seeking response. Lesioning the DMH with ibotenic acid, an excitotoxin that destroys neuronal bodies but spares fibers of passage, also prevented LPS-induced cold-seeking behavior; lesioning the PVH with ibotenate did not affect it. Lesion of no structure affected cold-seeking behavior induced by heat exposure or by pharmacological stimulation of the transient receptor potential (TRP) vanilloid-1 channel (“warmth receptor”). Nor did any lesion affect warmth-seeking behavior induced by a low dose of LPS, cold exposure, or pharmacological stimulation of the TRP melastatin-8 (“cold receptor”). We conclude that LPS-induced cold-seeking response is mediated by neuronal bodies located in the DMH and neural fibers passing through the PVH. These are the first two landmarks on the map of the circuitry of cold-seeking behavior associated with endotoxin shock