Evaluation of quality of life in patients with type 2 diabetes Mellitus with symptomatic distal symmetric polyneuropathy / Avaliação da qualidade de vida em doentes com diabetes Mellitus tipo 2 com polineuropatia simétrica distal sintomática

INTRO/BACKGROUND The complications of Diabetes Mellitus (DM) are traditionally categorized as micro and macrovascular disorders. Among them, diabetic polyneuropathy (DPN) is one of the most common, presenting with or without associated neuropathic pain, and its morbidity exerts a significant impact on the quality of life (QOL) of these patients. About 50% of individuals with type 2 DM (T2DM) suffer from this condition and the distal symmetric polyneuropathy (DSPN) constitutes its most frequent clinical form.  OBJECTIVE: To demonstrate the effect of symptomatic DSPN on the QOL of T2DM patients in a sample of the Brazilian population, correlating clinical and electrophysiological findings, besides comparing the results obtained by the Medical Outcomes Study Questionaire 36-Item Short Form Health Survey (SF-36) among patients with painful and non-painful diabetic DSPN. METHODS: This study comprised 25 outpatients with DSPN and T2DM submitted to a detailed anamnesis to identify clinical and demographic characteristics, besides comorbidities and complications of DM. Clinical evaluation was performed through neurological physical examination, in addition to specific scales for neuropathy as the Neuropathy Disability Score (NDS). In order to assess the health-related quality of life (HRQoL) of these patients, the SF-36 translated and adapted for the Brazilian population was applied. Nerve conduction study (NCS) was performed for the examined nerves (motor part of peroneal nerve and sensory part of the sural nerve). The following parameters were assessed: motor conduction velocity (MCV), amplitude of the compound muscle action potentials (CMAP) and amplitude of the sensory nerve action potentials (SNAP). RESULTS: Role Physical (RP) domain of SF-36 was significantly related to some of the clinical and electrophysiological factors measured. RP had an inverse and significant relationship with the NDS values (Rho: -0.44), showing the impact of neuropathy severity on these patients’ QOL. The sural nerve SNAP and peroneal nerve MCV showed a significant and positive relationship with RP (Rho: 0,52 and 0,36, respectively). The Mental Health (MH) domain showed a statistically significant difference between those patients with pain and without pain (p = 0.002), and patients without pain had higher mean values, as well as a higher minimum and maximum value. The Role Emotional (RE) domain also showed a significant difference between patients with and without pain, and patients with pain had a lower mean value (p = 0.04). For all other domains, patients with pain showed lower mean values than those without pain, however without statistical difference in the test performed. Between DM complications, only nephropathy presented statistically different RP scores from those without nephropathy (p = 0.02). CONCLUSION: There was a significant inverse relationship between the severity of DSPN and the QOL of the evaluated patients, as evidenced by lower values in the SF-36 specific RP domain, as polyneuropathy becomes more severe. This domain also presented significantly lower values in patients with associated nephropathy. The presence of pain negatively affected the QOL of patients with painful DPN, who presented significantly lower mean values in the MH and RE domains when compared to patients without pain

Effect of amount of biomaterial used for maxillary sinus lift on volume maintenance of grafts

Regardless of the kind of biomaterial used for the graft, it is clear that, over time, the graft undergoes dimensional changes that could influence the final bone volume obtained, which could alter the stability of the installed implants. The aim of the present study was to compared and correlated the graft behavior with the amount (in grams) of xenogeneic and alloplastic biomaterials used in grafts for maxillary sinus lift. This retrospective cohort study used 148 CBCT images of 74 grafts from 68 maxillary sinuses lift patients in a university, post-graduate clinic. The weights of biomaterials, categorized in intervals according to amount used, were correlated with the graft volumes at V1 (10 days) and V2 (180 days). Kruskal-Wallis test was used to evaluate the possible bias effect of weight on graft maintenance. Mean weights of biomaterials used were: Bio-Oss Small® (1.58g); Bio-Oss Large® (1.35g); Endobon® (0.72g); BoneCeramic®+Emdogaim® (0.96g); Cerasorb® (1.13g) and Osteogen® (2.70g). No significant differences (p>0.05). Were found for the influence of these mean amounts in graft maintenance: Bio-Oss Small® (18); Bio-Oss Large® (10); Endobon® (17); BoneCeramic®+Emdogaim® (10); Cerasorb® (11); and Osteogen® (08) at V1 and V2. However, when biomaterials were categorized by intervals, all Cerasorb® interval groups showed statistically significant differences (p<0.001) in graft volume at V2. The amounts of the biomaterials used could influence the final volume; depending on the biomaterial characteristics. Implant installation was possible with all studied grafts, although graft volume shrinkage should be considered when selecting biomaterial for sinus lift

Neuropathic Pain Treatment: Still a Challenge

Neuropathic pain (NP) is the result of a series of conditions caused by diseases or lesions to the somatosensory system. Due to the better understanding of NP pathophysiology previously unexplored therapies have been used with encouraging results. In this group, acetyl-L-carnitine, alpha-lipoic-acid, cannabinoids, clonidine, EMA401, botulinum toxin type A and new voltage-gated sodium channel blockers, can be included. Besides, changing paradigms may occur with the advent of optogenetics and a better understanding of epigenetic regulation. We reviewed the published literature on the pharmacological treatment of NP. Despite the interesting results, randomized controlled trials are demanded the majority of the therapies previously mentioned. In spite of several studies for the relief of NP, pain control continues being a challenge

Sarcoma intimal de artéria pulmonar: um diagnóstico diferencial do tromboembolismo pulmonar crônico Intimal sarcoma of the pulmonary artery: a differential diagnosis of chronic pulmonary thromboembolism

O sarcoma intimal de artéria pulmonar é um tumor raro e potencialmente letal, de diagnóstico difícil e, muitas vezes, tardio. Os sinais e sintomas clínicos são inespecíficos, simulando com frequência o tromboembolismo pulmonar crônico (TEPC). Apresentamos o caso de um homem de 45 anos em tratamento de TEPC associado com hipertensão arterial pulmonar e cor pulmonale crônico, sem resposta ao uso de anticoagulantes e sildenafil. Ressaltamos as dificuldades para o diagnóstico do sarcoma intimal de artéria pulmonar, a necessidade de se pesquisar essa neoplasia no diagnóstico diferencial do TEPC e a utilização sistemática de critérios para a adequada indicação dos novos medicamentos para a hipertensão arterial pulmonar.<br>Intimal sarcoma of the pulmonary artery is a rare and potentially lethal tumor, the diagnosis of which is difficult and therefore frequently delayed. The clinical signs and symptoms are nonspecific, often mimicking chronic pulmonary thromboembolism (CPTE). We report the case of a 45-year-old male under treatment for CPTE associated with pulmonary arterial hypertension and chronic cor pulmonale. There was no response to treatment with anticoagulants and sildenafil. We emphasize the difficulties in diagnosing intimal sarcoma of the pulmonary artery, the need to investigate this neoplasm in the differential diagnosis of CPTE and the systematic use of criteria for the appropriate prescription of new medications for pulmonary artery hypertension

Burden and attitude to resistant and refractory migraine

Background: New treatments are currently offering new opportunities and challenges in clinical management and research in the migraine field. There is the need of homogenous criteria to identify candidates for treatment escalation as well as of reliable criteria to identify refractoriness to treatment. To overcome those issues, the European Headache Federation (EHF) issued a Consensus document to propose criteria to approach difficult-to-treat migraine patients in a standar

AMAZONIA CAMTRAP: A data set of mammal, bird, and reptile species recorded with camera traps in the Amazon forest

The Amazon forest has the highest biodiversity on Earth. However, information on Amazonian vertebrate diversity is still deficient and scattered across the published, peer-reviewed, and gray literature and in unpublished raw data. Camera traps are an effective non-invasive method of surveying vertebrates, applicable to different scales of time and space. In this study, we organized and standardized camera trap records from different Amazon regions to compile the most extensive data set of inventories of mammal, bird, and reptile species ever assembled for the area. The complete data set comprises 154,123 records of 317 species (185 birds, 119 mammals, and 13 reptiles) gathered from surveys from the Amazonian portion of eight countries (Brazil, Bolivia, Colombia, Ecuador, French Guiana, Peru, Suriname, and Venezuela). The most frequently recorded species per taxa were: mammals: Cuniculus paca (11,907 records); birds: Pauxi tuberosa (3713 records); and reptiles: Tupinambis teguixin (716 records). The information detailed in this data paper opens up opportunities for new ecological studies at different spatial and temporal scales, allowing for a more accurate evaluation of the effects of habitat loss, fragmentation, climate change, and other human-mediated defaunation processes in one of the most important and threatened tropical environments in the world. The data set is not copyright restricted; please cite this data paper when using its data in publications and we also request that researchers and educators inform us of how they are using these data

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans—anteaters, sloths, and armadillos—have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, 10 anteaters, and 6 sloths. Our data set includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the southern United States, Mexico, and Caribbean countries at the northern portion of the Neotropics, to the austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n = 5,941), and Cyclopes sp. have the fewest (n = 240). The armadillo species with the most data is Dasypus novemcinctus (n = 11,588), and the fewest data are recorded for Calyptophractus retusus (n = 33). With regard to sloth species, Bradypus variegatus has the most records (n = 962), and Bradypus pygmaeus has the fewest (n = 12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other data sets of Neotropical Series that will become available very soon (i.e., Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans data set. Please cite this data paper when using its data in publications. We also request that researchers and teachers inform us of how they are using these data

NEOTROPICAL ALIEN MAMMALS: a data set of occurrence and abundance of alien mammals in the Neotropics

Biological invasion is one of the main threats to native biodiversity. For a species to become invasive, it must be voluntarily or involuntarily introduced by humans into a nonnative habitat. Mammals were among first taxa to be introduced worldwide for game, meat, and labor, yet the number of species introduced in the Neotropics remains unknown. In this data set, we make available occurrence and abundance data on mammal species that (1) transposed a geographical barrier and (2) were voluntarily or involuntarily introduced by humans into the Neotropics. Our data set is composed of 73,738 historical and current georeferenced records on alien mammal species of which around 96% correspond to occurrence data on 77 species belonging to eight orders and 26 families. Data cover 26 continental countries in the Neotropics, ranging from Mexico and its frontier regions (southern Florida and coastal-central Florida in the southeast United States) to Argentina, Paraguay, Chile, and Uruguay, and the 13 countries of Caribbean islands. Our data set also includes neotropical species (e.g., Callithrix sp., Myocastor coypus, Nasua nasua) considered alien in particular areas of Neotropics. The most numerous species in terms of records are from Bos sp. (n = 37,782), Sus scrofa (n = 6,730), and Canis familiaris (n = 10,084); 17 species were represented by only one record (e.g., Syncerus caffer, Cervus timorensis, Cervus unicolor, Canis latrans). Primates have the highest number of species in the data set (n = 20 species), partly because of uncertainties regarding taxonomic identification of the genera Callithrix, which includes the species Callithrix aurita, Callithrix flaviceps, Callithrix geoffroyi, Callithrix jacchus, Callithrix kuhlii, Callithrix penicillata, and their hybrids. This unique data set will be a valuable source of information on invasion risk assessments, biodiversity redistribution and conservation-related research. There are no copyright restrictions. Please cite this data paper when using the data in publications. We also request that researchers and teachers inform us on how they are using the data