Características sociodemográficas e epidemiológicas associadas com a infecção pelo vírus da imunodeficiência humana tipo 1 (HIV-1) em indivíduos expostos ao HIV-1 mas não infectados e em pacientes infectados pelo HIV-1, provenientes da população da região Sul do Brasil

The ability to control human immunodeficiency virus type 1 (HIV-1) infection and progression of the disease is regulated by host and viral factors. This cross-sectional study describes the socio-demographic and epidemiological characteristics associated with HIV-1 infection in 1,061 subjects attended in Londrina and region, south of Brazil: 136 healthy individuals (Group 1), 147 HIV-1-exposed but uninfected individuals (Group 2), 161 HIV-1-infected asymptomatic patients (Group 3), and 617 patients with AIDS (Group 4). Data were obtained by a standardized questionnaire and serological tests. The age of the individuals ranged from 15.1 to 79.5 years, 54.0% and 56.1% of the Groups 3 and 4 patients, respectively, were men. The major features of groups 2, 3, and 4 were a predominance of education level up to secondary school (55.8%, 60.2% and 62.4%, respectively), sexual route of exposure (88.4%, 87.0% and 82.0%, respectively), heterosexual behavior (91.8%, 75.2% and 83.7%, respectively), and previous sexually transmitted diseases (20.4%, 32.5%, and 38.1%, respectively). The patients with AIDS showed the highest rates of seropositivity for syphilis (25.6%), of anti-HCV (22.3%), and anti-HTLV I/II obtained by two serological screening tests (6.2% and 6.8%, respectively). The results documenting the predominant characteristics for HIV-1 infection among residents of Londrina and region, could be useful for the improvement of current HIV-1 prevention, monitoring and therapeutic programs targeted at this population.Este estudo transversal descreve as principais características sociodemográficas e epidemiológicas associadas com a infecção pelo HIV-1 em 1.061 indivíduos atendidos em Londrina e região, Sul do Brasil: 136 indivíduos saudáveis (Grupo 1), 147 indivíduos expostos ao HIV-1 mas não infectados (Grupo 2), 161 pacientes infectados pelo HIV-1 assintomáticos (Grupo 3) e 617 pacientes com aids (Grupo 4). Os dados foram obtidos pela aplicação de um questionário padronizado e realização de testes sorológicos. A idade dos indivíduos variou de 15,1 a 79,5 anos; 54,0% e 56,1% dos pacientes dos Grupos 3 e 4, respectivamente, eram homens. As principais características dos indivíduos dos Grupos 2, 3 e 4 foram o predomínio do nível educacional com até oito anos de escolaridade (58,8%, 60,2% e 62,4%, respectivamente), a via sexual de transmissão (88,4%, 87,0% e 82,0%, respectivamente), o comportamento heterossexual (91,8%, 75,2% e 83,7%, respectivamente) e antecedentes de doenças sexualmente transmissíveis (20,4%, 32,5% e 38,1%, respectivamente). Os pacientes com aids apresentaram os valores mais elevados de soropositividade para sífilis (25,6%), anti-HCV (22,3%) e anti-HTLV I/II em dois testes de triagem sorológica (6,2% e 6,8%, respectivamente). Os resultados documentando as características predominantes associadas com a infecção pelo HIV-1 observada nos indivíduos de Londrina e região, poderá ser útil na melhoria dos atuais programas de prevenção, monitoramento e de tratamento da infecção pelo HIV-1 dirigidos a esta população

Risk factors associated with cusp fractures in posterior permanent teeth—a cross-sectional study

Objectives: This cross-sectional study aimed to evaluate the frequency and risk factors associated with cusp fractures in posterior permanent teeth. Methods: Patients presented cusp fractures on posterior permanent teeth, clinically assessed in up to 7 days after the event, and requesting dental treatment at two public services were included in this cross-sectional study. Fractured teeth already treated, with antagonist absence, or with prosthesis (total or removable) were excluded. Demographic and clinical data were collected to draw the patient profiles and establish how teeth were affected individually. Statistical analysis was performed by the Fisher exact test, and uni- and multivariate logistic regression (α = 0.05). Results: One hundred and seventy-seven (177) patients from 16 to 66 years old (±41.56), from 1998 to 2016, were included in this study. Non-functional and lingual cusps presented a higher fracture than functional and buccal cusps, respectively. Fractures were more common in teeth with isthmus wider than 1/3 of the intercuspid distance and/or more than three restored surfaces. Teeth with endodontic treatment presented a higher subgingival fracture. On lingual cusps, fracture type and location were significantly associated, being that total fractures were 3.2 times more likely to occur than partial fractures, and subgingival were 3.62 times more likely to occur than supragingival fractures. Conclusion: Indications of classic protection on functional cusps (LUBL) was refuted since, generally, nonfunctional cusps fractured more than the functional cusps. However, upper pre-molars showed more fractures in functional cusps and lower molars presented more fractures on the nonfunctional cusps. In general, lingual cusps were the most fractured and were associated with a higher prevalence of severe fractures (total fractures at the subgingival level). Fractures were more common in teeth where the restoration had an isthmus wider than 1/3 of the intercuspid distance and/or involved more than three restored surfaces. Most of the patients did not show previous symptoms and signs. Overall, teeth with endodontic treatment presented a higher subgingival fracture

Associated factors and treatment options for sleep bruxism in children: an umbrella review

Data on clinical management options for sleep bruxism in the primary dentition are inconclusive. This umbrella review aimed to synthesize the available evidence from systematic reviews (SRs) on the associated factors and treatment approaches for clinical management of sleep bruxism in children. A search was conducted in the MEDLINE/PubMed, Web of Science, Embase, and OpenGrey databases up to March 2022. SRs published on sleep bruxism in children containing data on associated factors or treatment outcomes were included. The AMSTAR-2 tool was used to assess the methodological quality of SRs. The search identified 444 articles, of which six were included. Sleep conditions, respiratory changes, personality traits, and psychosocial factors were the associated factors commonly identified. Treatments included psychological and pharmacological therapies, occlusal devices, physical therapy, and surgical therapy. All SRs included presented a high risk of bias. Overlapping of the included studies was considered very high. The best evidence available to date for the management of sleep bruxism in children is based on associated factors, with sleep duration and conditions, respiratory changes, as well as personality traits and psychosocial factors being the most important factors commonly reported by studies. However, there is currently insufficient evidence to make recommendations for specific treatment options

Destabilizing Protein Polymorphisms in the Genetic Background Direct Phenotypic Expression of Mutant SOD1 Toxicity

Genetic background exerts a strong modulatory effect on the toxicity of aggregation-prone proteins in conformational diseases. In addition to influencing the misfolding and aggregation behavior of the mutant proteins, polymorphisms in putative modifier genes may affect the molecular processes leading to the disease phenotype. Mutations in SOD1 in a subset of familial amyotrophic lateral sclerosis (ALS) cases confer dominant but clinically variable toxicity, thought to be mediated by misfolding and aggregation of mutant SOD1 protein. While the mechanism of toxicity remains unknown, both the nature of the SOD1 mutation and the genetic background in which it is expressed appear important. To address this, we established a Caenorhabditis elegans model to systematically examine the aggregation behavior and genetic interactions of mutant forms of SOD1. Expression of three structurally distinct SOD1 mutants in C. elegans muscle cells resulted in the appearance of heterogeneous populations of aggregates and was associated with only mild cellular dysfunction. However, introduction of destabilizing temperature-sensitive mutations into the genetic background strongly enhanced the toxicity of SOD1 mutants, resulting in exposure of several deleterious phenotypes at permissive conditions in a manner dependent on the specific SOD1 mutation. The nature of the observed phenotype was dependent on the temperature-sensitive mutation present, while its penetrance reflected the specific combination of temperature-sensitive and SOD1 mutations. Thus, the specific toxic phenotypes of conformational disease may not be simply due to misfolding/aggregation toxicity of the causative mutant proteins, but may be defined by their genetic interactions with cellular pathways harboring mildly destabilizing missense alleles

Impact of COVID-19 on cardiovascular testing in the United States versus the rest of the world

Objectives: This study sought to quantify and compare the decline in volumes of cardiovascular procedures between the United States and non-US institutions during the early phase of the coronavirus disease-2019 (COVID-19) pandemic. Background: The COVID-19 pandemic has disrupted the care of many non-COVID-19 illnesses. Reductions in diagnostic cardiovascular testing around the world have led to concerns over the implications of reduced testing for cardiovascular disease (CVD) morbidity and mortality. Methods: Data were submitted to the INCAPS-COVID (International Atomic Energy Agency Non-Invasive Cardiology Protocols Study of COVID-19), a multinational registry comprising 909 institutions in 108 countries (including 155 facilities in 40 U.S. states), assessing the impact of the COVID-19 pandemic on volumes of diagnostic cardiovascular procedures. Data were obtained for April 2020 and compared with volumes of baseline procedures from March 2019. We compared laboratory characteristics, practices, and procedure volumes between U.S. and non-U.S. facilities and between U.S. geographic regions and identified factors associated with volume reduction in the United States. Results: Reductions in the volumes of procedures in the United States were similar to those in non-U.S. facilities (68% vs. 63%, respectively; p = 0.237), although U.S. facilities reported greater reductions in invasive coronary angiography (69% vs. 53%, respectively; p < 0.001). Significantly more U.S. facilities reported increased use of telehealth and patient screening measures than non-U.S. facilities, such as temperature checks, symptom screenings, and COVID-19 testing. Reductions in volumes of procedures differed between U.S. regions, with larger declines observed in the Northeast (76%) and Midwest (74%) than in the South (62%) and West (44%). Prevalence of COVID-19, staff redeployments, outpatient centers, and urban centers were associated with greater reductions in volume in U.S. facilities in a multivariable analysis. Conclusions: We observed marked reductions in U.S. cardiovascular testing in the early phase of the pandemic and significant variability between U.S. regions. The association between reductions of volumes and COVID-19 prevalence in the United States highlighted the need for proactive efforts to maintain access to cardiovascular testing in areas most affected by outbreaks of COVID-19 infection

Risk Factors Associated with Cusp Fractures in Posterior Permanent Teeth—A Cross-Sectional Study

Objectives: This cross-sectional study aimed to evaluate the frequency and risk factors associated with cusp fractures in posterior permanent teeth. Methods: Patients presented cusp fractures on posterior permanent teeth, clinically assessed in up to 7 days after the event, and requesting dental treatment at two public services were included in this cross-sectional study. Fractured teeth already treated, with antagonist absence, or with prosthesis (total or removable) were excluded. Demographic and clinical data were collected to draw the patient profiles and establish how teeth were affected individually. Statistical analysis was performed by the Fisher exact test, and uni- and multivariate logistic regression (α = 0.05). Results: One hundred and seventy-seven (177) patients from 16 to 66 years old (±41.56), from 1998 to 2016, were included in this study. Non-functional and lingual cusps presented a higher fracture than functional and buccal cusps, respectively. Fractures were more common in teeth with isthmus wider than 1/3 of the intercuspid distance and/or more than three restored surfaces. Teeth with endodontic treatment presented a higher subgingival fracture. On lingual cusps, fracture type and location were significantly associated, being that total fractures were 3.2 times more likely to occur than partial fractures, and subgingival were 3.62 times more likely to occur than supragingival fractures. Conclusion: Indications of classic protection on functional cusps (LUBL) was refuted since, generally, nonfunctional cusps fractured more than the functional cusps. However, upper pre-molars showed more fractures in functional cusps and lower molars presented more fractures on the nonfunctional cusps. In general, lingual cusps were the most fractured and were associated with a higher prevalence of severe fractures (total fractures at the subgingival level). Fractures were more common in teeth where the restoration had an isthmus wider than 1/3 of the intercuspid distance and/or involved more than three restored surfaces. Most of the patients did not show previous symptoms and signs. Overall, teeth with endodontic treatment presented a higher subgingival fracture

Effects of manufacturing methods on the survival rate of ceramic and indirect composite restorations: A systematic review and meta‐analysis

Objectives To evaluate the survival rate of ceramic and indirect composite inlays, onlays, and overlays manufactured according to different methods (CAD/CAM, pressable, and stratified). MEDLINE, EMBASE, and Cochrane Library databases were searched for published articles. Risk of bias, data extraction, subgroup analysis, meta‐analysis, and GRADE was performed. Materials and methods Prospective, retrospective, or RCT studies, without restriction of language, from 1983 to 2019, with follow‐up ≥5 years, reporting survival rates were screened independently by two reviewers in accordance with eligibility criteria. Results A total of 13 articles (12 for ceramic, one for indirect composite) met the inclusion criteria. No articles were included regarding crystalline ceramic. The estimated cumulative survival rate for CAD/CAM was 97% after 5 years and 89% after 10 years; for pressable was 95% after 5 years, and for stratified was 88% after 5 years and 93% after 10 years. Conclusions Regardless of the manufacturing method, vitreous ceramic inlays, onlays, and overlays showed high survival, providing evidence that these restorations are a safe treatment. Clinical relevance Vitreous ceramic inlays, onlays, and overlays showed high survival, regardless of the manufacturing method, providing evidence that these restorations are a safe treatment