The effect of facial fractures on mouth opening range: a case series

Introduction: Facial fractures can result in limitation of mouth opening range, which consequently leads to functional impairments. Objective: To identify the influence of facial fractures and their corrective surgery on mouth opening range. Material and methods: Consecutive patients submitted to maxillofacial surgery had their mouth opening range measured at four different moments: preoperative (T0), immediate post-operative (within 24 hours afteroperation) (T1), one-week post-operative (T2) and one-month postoperative (T3). Eighteen subjects composed the sample, majorly represented by male gender, fractures caused by direct trauma as in traffic accidents, age among 21-30 years old and presenting mandible fracture. Results: Mouth opening at T0 demonstrated a mean value of 26.63 mm, T1 decreased to a mean of 22.59 mm, T2 mean value evolved to 26.42 mm and T3 displayed mean value of34.57 mm. Statistical evaluation demonstrated overall significance forthe comparison among all different periods, particularly for isolated mandible fractures, except between T0 and T2. Conclusion: It can be suggested that fracture itself and surgery for its correction have a negative effect on mouth opening range; however, the capacity of mouth opening presents signs of recovery since the first post-operative week, with notable progression until one month after surgery.Introduction: Facial fractures can result in limitation of mouth opening range, which consequently leads to functional impairments. Objective: To identify the influence of facial fractures and their corrective surgery on mouth opening range. Material and methods: Consecutive patients submitted to maxillofacial surgery had their mouth opening range measured at four different moments: preoperative (T0), immediate post-operative (within 24 hours afteroperation) (T1), one-week post-operative (T2) and one-month postoperative (T3). Eighteen subjects composed the sample, majorly represented by male gender, fractures caused by direct trauma as in traffic accidents, age among 21-30 years old and presenting mandible fracture. Results: Mouth opening at T0 demonstrated a mean value of 26.63 mm, T1 decreased to a mean of 22.59 mm, T2 mean value evolved to 26.42 mm and T3 displayed mean value of34.57 mm. Statistical evaluation demonstrated overall significance forthe comparison among all different periods, particularly for isolated mandible fractures, except between T0 and T2. Conclusion: It can be suggested that fracture itself and surgery for its correction have a negative effect on mouth opening range; however, the capacity of mouth opening presents signs of recovery since the first post-operative week, with notable progression until one month after surgery

Can different stages of leprosy treatment influence the profile of oral health? Oral status in leprosy

The aim of study was to evaluate the oral health status, salivary flow and halitosis among individuals diagnosed with leprosy as compared with healthy subjects. A sample of 160 individuals was allocated into four groups, as follows: (G1) individuals with complete leprosy treatment; (G2) individuals diagnosed with leprosy and under multi-drug therapy; (G3) individuals diagnosed with leprosy not yet under treatment; and (G4) healthy individuals. Then individuals were submitted to periodontal clinical examination (visible plaque index, bleeding index, depth of probing and clinical attachment level); DMFT index (decayed-missing-filled teeth index); evaluation of salivary flow and halitosis using a halimeter equipment (Interscan Corp, Chatsworth, CA, USA). The data were analyzed using Kruskal-Wallis and chi-square tests. The mean DMFT was found to be higher than 6.6, which is considered very high, with no significant difference between groups (P>0.05). As for salivary flow, 76.2% of the subjects presented normal flow rates, while 10% and 13.7% showed low and very low salivary flow rates, respectively, with hyposalivation being mostly observed in Groups 1 and 2. The highest prevalence of noticeable odor was found in healthy individuals (G4), and the most prevalent periodontal diagnosis was gingivitis (63.1%) in Group 3 (individuals with leprosy not yet under multi-drug therapy) followed by periodontitis (25%) in Group 1 (individuals who had completed leprosy treatment). It was observed that individuals with a history of leprosy present poor oral health similar to that of systemically healthy individuals

Pleomorphic ademona of minor salivary glands in uncommon sites: a case series

Pleomorphic adenoma (AP) is the most common tumor of the salivary glands, classified as a benign mixed tumor with the involvement of epithelial, myoepithelial and mesenchymal components. This type of tumor affects primarily affects the parotid glands, with a small percentage of cases involving minor salivary glands. In this study, two cases of PA with unusual location, palate and upper lip are presented. The clinical and histopathological characteristics of the tumors as well as the therapeutic management adopted are discussed.O adenoma pleomórfico (AP) é o tumor mais comum das glândulas salivares, sendo classificado como um tumor benigno de natureza mista, com participação de componentes epiteliais, mioepiteliais e mesenquimais. Este tipo de tumor afeta primariamente as glândulas parótidas, sendo que apenas uma pequena parcela dos casos apresenta envolvimento das glândulas salivares menores. Neste estudo, são apresentados dois casos de AP com localizações atípicas: palato e lábio superior. As características clínicas e histopatológicas dos tumores, bem como os manejos terapêuticos adotados são discutidas

Pneumonia adquirida na comunidade: aspectos etiopatogênicos, métodos diagnósticos e condutas terapêuticas

A pneumonia adquirida na comunidade (PAC) consiste em uma infecção pulmonar aguda infecciosa que acomete indivíduos fora do ambiente hospitalar ou de demais centros de saúde. Etiologicamente, sabe-se que a PAC pode ser causada por vírus, bactérias ou fungos, estando associada a uma ampla gama de microrganismos patogênicos, o que caracteriza a sua apresentação como típica ou atípica. Em virtude da sua variedade etiológica, a epidemiologia é variada e a incidência depende de diversos fatores. Sua patogênese envolve uma complexa interação entre os agentes etiológicos, os fatores imunes do hospedeiro e os fatores ambientais. Todavia, sabe-se que decorre da microaspiração dos patógenos, os quais atingem as vias aéreas inferiores e desencadeiam uma resposta inflamatória exuberante, levando à consolidação pulmonar, o que compromete a eficiência da troca gasosa alveolar. As manifestações clínicas decorrentes da PAC são amplas e variam de paciente para paciente e conforme a apresentação e gravidade da doença. Contudo, a sintomatologia clássica cursa com dispneia, tosse produtiva e febre. No que tange ao diagnóstico, este é, frequentemente, clínico, baseado na história de evolução da doença e no exame físico. Comumente, utiliza-se métodos para confirmação diagnóstica, como exames laboratoriais e exames de imagem, em especial a radiografia de tórax. Tais exames ajudam coletivamente a confirmar a presença de uma pneumonia, avaliando sua gravidade e, em alguns casos, identificando o patógeno causador, o que aumenta as chances de sucesso terapêutico. Ademais, escores de gravidade da doença são, usualmente, utilizados, como o Pneumonia Severity Index (PSI) e o CURB-65, os quais auxiliam na determinação do nível em que o tratamento será realizado, considerando que pode ser ambulatorial ou hospitalar. O manejo terapêutico é imprescindível, a fim de evitar evolução do quadro e piora progressiva da função pulmonar, o qual é realizado com esquemas antimicrobianos, a depender da suspeita do agente etiológico, da gravidade do quadro e das comorbidades de cada paciente

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%, p 465 years, diagnosis of cirrhosis, and abnormal hemoglobin levels/platelet counts prior to treatment were associated with serious adverse events. CONCLUSION: Although serious adverse events rates were higher in this infected population, sustained viral response rates were similar to those reported for other patient cohorts.Univ Sao Paulo, Fac Med, Dept Molestias Infecciosas & Parasitarias, Sao Paulo, SP, BrazilUniv Fed Rio de Janeiro, Rio De Janeiro, RJ, BrazilCtr Referencia & Treinamento DST Aids, Sao Paulo, SP, BrazilCDH, Rio De Janeiro, RJ, BrazilHosp Fed Servidores Estado Rio de Janeiro HFSE, Setor Gastrohepatol, Rio De Janeiro, RJ, BrazilUniv Sao Paulo, Fac Med, Dept Gastroenterol & Hepatol, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilUniv Sao Paulo, FMRP, Dept Clin Med, Div Gastroenterol, Sao Paulo, SP, Brazil| Univ Fed do Maranhao UFMA, HUPD, Ctr Pesquisa Clin, Sao Luis, MA, BrazilUniv Fed Estado Rio de Janeiro UNIRIO, Disciplina Clin Med & Gastroenterol, Rio De Janeiro, RJ, BrazilUniv Fed Rio do Grande Sul UFRGS, Dept Med Interna, Porto Alegre, RS, BrazilUniv Fed Espirito Santo, Ambulatorio HIV AIDS Hepatites Virais, Vitoria, ES, BrazilSMS, Ctr Orientacao & Aconselhamento, Foz Do Iguacu, PR, BrazilUniv Estado Rio de Janeiro UERJ, Serv Gastroenterol, Rio De Janeiro, RJ, BrazilIMT, Lab Virol LIM 52, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, Disciplina Gastroenterol, EPM, Sao Paulo, SP, BrazilUniv Fed Sao Paulo UNIFESP, EPM, Disciplina Infectol, Sao Paulo, SP, BrazilWeb of Scienc

Effectiveness and safety of first-generation protease inhibitors in real-world patients with hepatitis C virus genotype 1 infection in Brazil: a multicenter study

OBJECTIVE: To evaluate the effectiveness and safety of first-generation protease inhibitors for the treatment of genotype 1 hepatitis C virus-infected patients at Brazilian reference centers. METHODS: This multicenter cross-sectional study included hepatitis C virus genotype 1 monoinfected patients treated with Peg-interferon, ribavirin, and either boceprevir (n=158) or telaprevir (n=557) between July 2013 and April 2014 at 15 reference centers in Brazil. Demographic, clinical, virological, and adverse events data were collected during treatment and follow-up. RESULTS: Of the 715 patients, 59% had cirrhosis and 67.1% were treatment-experienced. Based on intention-to-treat analysis, the overall sustained viral response was 56.6%, with similar effectiveness in both groups (51.9% for boceprevir and 58% for telaprevir, p=0.190). Serious adverse events occurred in 44.2% of patients, and six deaths (0.8%) were recorded. Cirrhotic patients had lower sustained viral response rates than non-cirrhotic patients (46.9% vs. 70.6%,

Effect of stress as a factor alone or associated with the ingestion of alcohol on periodontal disease. And, the impact of stress-periodontitis association in the Central Nervous System and lipid profile

Orientação: Profa. Dra. Sheila Cavalca CortelliCoorientação: Prof. Dr. Alex Semenoff SegundoTese (Doutorado) - Universidade de Taubaté, Programa de Pós-graduação em Odontologia,Taubaté, 2010.Made available in DSpace on 2019-06-18T14:34:13Z (GMT). No. of bitstreams: 1 Alessandra Nogueira Porto.pdf: 1482495 bytes, checksum: 0593b26ddef6e49c3802b10301f5256f (MD5) Previous issue date: 2010Resumo: A relação do estresse com a Odontologia e mais especificamente com a Periodontia não é recente. E, além do estresse, outros problemas sistêmicos têm sido associados com a condição bucal. Objetivos: os objetivos destes estudos em ratos foram: 1) Analisar o impacto de dois modelos de estresse crônico na modulação da doença periodontal; 2) Avaliar o efeito da ingestão de álcool etílico associado ao estresse crônico na gravidade da periodontite induzida; 3) Avaliar o efeito da periodontite associada a estresse crônico sobre o sistema nervoso central (SNC); 4) Avaliar o efeito de dois modelos de estresse associados à periodontite sobre o perfil lipídico. Método: Para analisar o impacto do estresse crônico na modulação da doença periodontal (estudo 1) foi realizado o ensaio de estresse físico e estresse variável e após dez dias a periodontite foi induzida por ligadura nos grupos específicos. Decorridos sessenta dias os animais foram submetidos à eutanásia para análise histológica de perda de inserção e reabsorção óssea. Para o estudo 2 selecionou-se 24 animais adultos Lewis os quais foram divididos aleatoriamente em três grupos (n=8/grupo): GAL– álcool + ligadura, GASL- álcool + estresse físico crônico + ligadura e GCN- controle negativo. Após a divisão, os animais GAL e GASL foram submetidos à ingestão de álcool etílico a 20% ad libitum e GCN recebeu água ad libitum, durante sessenta dias. No dia seguinte ao início da ingestão de álcool etílico pelos respectivos grupos foi realizado o procedimento de indução da doença periodontal, exceto no grupo GCN. O estudo 3 hipotetizou que a indução de periodontite por ligadura em ratas estressadas afetaria a resposta do SNC. Selecionaram-se 48 animais Wistar divididos aleatoriamente em quatro grupos (n=12/grupo): GLSP– ligadura + estresse físico crônico, GLSV- ligadura + estresse variável crônico, GL- ligadura e GCN- controle negativo. Iniciou-se o ensaio de estresse físico (SP) e estresse variável (SV) e após dez dias a periodontite foi induzida por ligadura nos grupos específicos. Decorridos cinquenta dias da colocação da ligadura, um examinador cegado submeteu os animais aos testes comportamentais de labirinto em cruz elevado e campo aberto. Por sua vez, o estudo 4 comparou o efeito de dois modelos de estresse crônico associado à periodontite induzida por ligadura, sobre parâmetros parciais do perfil lipídico. Selecionaram-se 48 animais adultos Wistar, divididos aleatoriamente em quatro grupos: GPSL - estresse físico crônico, GVSL - estresse variável crônico, GL - ligadura e GC – controle negativo. Realizou-se o estresse físico e estresse variável durante sessenta dias. Decorridos dez dias do início do ensaio de estresse, a periodontite foi induzida por ligadura nos grupos específicos. E, decorridos sessenta dias do experimento foi realizado a punção sanguínea a vácuo. Foi realizado a análise dos parâmetros: VLDL, HDL, triglicérides e colesterol. Compararam-se as médias do perfil lipídico dos grupos experimentais utilizando-se análise de Variância (ANOVA) e o teste Tuckey para as comparações entre os grupos. Todos os testes tiveram um nível de significância de 5%. Resultados: No estudo 1, no lado da indução por ligadura, o estresse físico apresentou perda de inserção e óssea significativamente maiores que o estresse variável, controle positivo e controle negativo (testes ANOVA e Bonferroni; p < 0,05). A análise dos dados no estudo 2 (ANOVA e Tuckey; p< 0,05) demonstrou que o grupo com maior destruição periodontal foi o grupo que consumiu álcool associado a ligadura (GAL), seguido pelo grupo de animais estressados que também consumiu álcool associado a ligadura. O grupo controle negativo (GCN) exibiu a melhor condição periodontal. O parâmetro da análise do estudo 3 foi para o campo aberto o número de segmentos centrais e periféricos percorridos, o número de vezes que o animal se manteve em duas patas sem apoio e a quantidade de auto-limpeza (coçar o nariz). Para o labirinto em cruz o número de entradas nos braços, assim como o tempo de permanência nos respectivos locais foram observados. A análise pelos testes ANOVA e Tuckey (p<0,05), não revelou diferenças estatisticamente significativas entre os grupos considerando-se o teste neurológico campo aberto (p<0,05), demonstrando ausência de alterações do SNC. Os resultados obtidos no estudo 4 para o parâmetro lipídico colesterol, o grupo estresse variável + ligadura (VSL) mostrou-se com menor média, confirmando diferenças estatísticas em relação aos grupos ligadura (GL) e controle negativo (GC). O grupo estresse físico + ligadura (PSL) apresentou-se com ausência de diferenças estatísticas comparado aos demais grupos; o parâmetro triglicerídeos obteve a maior média para o controle negativo (GC) comparativamente a estresse variável + ligadura (VSL) e estresse físico + ligadura (PSL). O VLDL apresentou-se sem diferenças estatísticas entre o estresse físico (PSL) e estresse variável (VSL); situação semelhante entre ligadura (GL) e controle negativo (GC). O VSL apresentou o menor valor médio para VLDL e obteve diferenças estatísticas comparado com os ligadura (GL) e controle negativo (GC). O parâmetro HDL demonstrou ausência de diferenças estatísticas entre os grupos. Conclusões: Conclui-se no estudo 1 que o estresse físico proporcionou maior destruição periodontal. No estudo 2, os fatores álcool–estresse não pareceram ter efeito sinérgico uma vez que o grupo exposto isoladamente ao álcool apresentou a pior condição periodontal. Embora quando associados os fatores estresse/periodontite não tenham afetado o SNC no estudo 3, isoladamente a indução de periodontite por ligadura teve efeito sobre o mesmo. Finalmente, de forma geral parece que o estresse associado à periodontite induzida foi capaz de diminuir indicadores em parâmetros lipídicos.Abstract: The relationship of stress with the dental and more specifically to Periodontics is not recent. And, in addition to stress, other systemic problems have been associated with oral health condition. The aims of this animal studies were: 1) analyze the impact of two models of chronic stress in the modulation of periodontal disease, 2) evaluate the effect of alcohol consumption associated with chronic stress on the severity of induced periodontitis, 3) evaluate the effect of chronic stressassociated periodontitis on the central nervous system (CNS), and 4) evaluate the effect of two models of periodontitis-associated stress on the lipid profile. Method: To analyze the impact of chronic stress in the modulation of periodontitis (study 1), we tested the physical stress and variable stress in specific groups after ten days of periodontitis, induced by ligation. The animals were euthanized after sixty days for histological analysis of attachment loss and bone loss. The second study involved selection of 24 adult animals Lewis, which were divided randomly into three groups (n = 8/group): GAL-alcohol + ligature, GASL-alcohol + stress physical chronic + ligature and group GCN - negative control group. The GAL and GASL animals were subjected to ingestion of 20% ethyl alcohol ad libitum for sixty days, while the GCN animals received water ad libitum for sixty days. The procedure for induction of periodontal disease was carried out the day after initiation of alcohol intake (or water for the GCN group). The third study was designed to test the hypothesis that ligature stress-induced periodontitis in rats affects responses of the CNS. We divided 48 animal Wistar randomly into four groups (n = 12/group): GLSP-ligature + physical stress chronic; GLSV-ligature + variable stress chronic; GL-ligature and GCNnegative control. Physical stress (PS) and variable stress (VS) were initiated after ten days of ligation-induced periodontitis. After fifty days of ligature, an examiner blinded to the experimental groups performed elevated-plus-maze and open-field behavioral tests on the rats. The fourth study compared the effect of two models of chronic stress associated with periodontitis induced in rats on partial parameters of the lipid profile. We randomly divided 48 adult animals Wistar into four groups: GPSL— ligature + physical stress chronic; GVSL — ligature + variable stress chronic; GL — ligature and GCN — control negative. These groups were subjected to physical stress and variable stress for sixty days. After the first ten days of the stress test, periodontitis was induced by ligature in the specified groups. After sixty days of experimentation, the animals blood punctures were performed under a vacuum. The analysis of the parameters, including: VLDL, HDL, triglycerides and cholesterol. The averages of the lipid profiles of the experimental groups were compared using analysis of variance (ANOVA) and the Tuckey test was used for the comparisons between groups. All tests had a significance level of 5%. Result: Study 1 On the ligature induced periodontitis side, physical stress presented significantly greater histological attachment loss and also greater bone loss (p< 0.05) than variable stress, positive control and negative control (test ANOVA and Bonferroni; p< 0.05). Study 2 the data were analyzed (ANOVA and Tuckey; p< 0.05), the group with greater periodontal destruction revealed by analysis of the parameters histological attachment loss and bone loss was the group alcohol associated with ligation (GAL), followed by alcohol group associated with stress and ligature (GASL) and negative control group (GCN). Study 3 The number of central and peripheral segments flown, the number of times the animal stood on two legs without support and the amount of self-cleaning (itchy nose) were used as analysis parameters for the open-field test. The number of arm entries and the time spent on sites were measured for the maze test. The data were analyzed by ANOVA and Tuckey (p< 0.05). Our analysis showed no statistically significant differences between the groups in the neurological openfield test (p< 0.05), indicating that stress-induced periodontitis did not affect the CNS performance of these animals. Although these findings indicate that factors associated with stress and periodontitis did not affect the CNS in isolation. Study 4 The lipid parameters and cholesterol were significantly lower in the variable stress group than in the ligature and negative control groups. The physical stress group was not statistically different from the other groups. The triglyceride level was highest for the negative control group and statistically different from the levels in groups variable stress and physical stress. The physical stress group had the lowest triglyceride level, which was statistically different from that of the negative control group. There was no statistical difference between physical stress and variable stress with respect to VLDL; a similar finding was obtained for ligature and negative control. The variable stress group had the lowest VLDL level, which was statistically different from those of the ligature and negative control groups. HDL showed no statistical differences between groups. Conclusion: Study 1 it may be concluded that physical stress modulated the response pattern to experimentally induced periodontitis in rats since greater periodontal breakdown was observed in the ligature side. Study 2 Alcoholstress factors appear to have synergistic no effect when combined since the group exposed to alcohol alone had the worst condition. Although these findings indicate that factors associated with stress and periodontitis did not affect the CNS (Study 3) in isolation, the ligature induction of periodontitis did affect the CNS. In conclusion, despite the limitations of the methodology, it seems that the stress model variable associated with periodontitis improved lipid parameters in the study

Effects of two chronic stress models on ligature-induced periodontitis in Wistar rats

Objectives: The present study aims at comparing the effects of physical and variable chronic stress on ligature-induced periodontitis in rats.Design: Forty-eight adult Wistar rats were randomly assigned to four groups (n = 12): physical stress, variable stress, positive control and negative control. The models of physical stress were immobilization and immobilization associated with exposure to cold. The models of variable stress were exposure to intermittent light, 24 h isolation, oral cavity examination, crowded environment, smell of blood and noise. After 10 days of physical or variable stress animals underwent experimental induction of periodontal disease in one oral side. Positive control also underwent experimental induction of periodontal disease on the 10th day. Negative control did not receive any type of intervention. At the end of the experimental period (60 days), all animals were euthanized. After routine laboratory processing, images of the histological sections were digitised and submitted to histometric measurement using two parameters: histologic attachment loss and bone loss.Results: Histological attachment loss and bone loss were greater (p < 0.05) in the physical stress group than in the other groups (variable stress, positive and negative control groups). on the non-periodontitis side, these same histological parameters did not significantly differ amongst groups.Conclusions: Physical stress negatively modulated the response pattern to experimentally induced periodontitis in rats. (C) 2011 Elsevier Ltd. All rights reserved