Occlusal force, masticatory cycles and mandibular flexure of subjects with different facial types

Orientador: Renata Cunha Matheus Rodrigues GarciaDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A força de mordida pode influenciar o desenvolvimento da função mastigatória e conseqüentemente a terapêutica reabilitadora. Uma vez que a variabilidade associada a este indicador pode estar correlacionada com aspectos intrínsecos ao organismo como a morfologia facial vertical, faz-se necessário estabelecer qual a influência deste aspecto morfológico na força máxima de mordida e em respostas funcionais associadas à função muscular. Assim, a proposta deste estudo foi verificar a força máxima de mordida, os tipos de ciclos mastigatórios e a deflexão mandibular medial de indivíduos com diferentes padrões faciais verticais. Para tanto, 78 voluntários saudáveis, completamente dentados, foram classificados por meio da análise cefalométrica de Ricketts, de acordo com o tipo facial em 3 grupos: G1- Braquifacial; G2- Mesofacial; e G3- Dolicofacial. A força máxima de mordida (FMM) foi mensurada por meio de transdutores de força, posicionados na região dos primeiros molares, durante apertamento isométrico por 7 segundos. Os tipos de ciclos mastigatórios formados durante a mastigação de um material teste, foram avaliados no plano frontal por meio do método eletromagnético de registro do traçado mandibular, utilizando-se um cinesiógrafo. A deflexão mandibular medial (DMM) foi verificada por meio da análise da distância intermolar dos primeiros molares contra-laterais registrados com silicone de adição nas posições de repouso relativo, abertura e protrusão máxima. Os dados de FMM e DMM foram submetidos à análise de variância e Tukey pos hoc (a=0,05). A força máxima de mordida diferiu (P<0,0001) entre os três grupos, sendo que os indivíduos do G1 apresentaram a maior força de mordida, seguidos respectivamente por G2 e G3. No plano frontal foi observada uma predominância de ciclos mastigatórios tipo lágrima para G1 e do tipo hemioval nos demais grupos. A deflexão mandibular medial na abertura máxima diferiu (P<0,0001) entre os três grupos faciais, sendo que G1 apresentou os maiores valores, seguido respectivamente por G2 e G3. Na protrusão, a deflexão medial mandibular foi significativamente menor (P<0,0001) para G3, sendo que G1 e G2 não diferiram entre si. Nas condições em que este estudo foi realizado, conclui-se que a morfologia facial vertical influenciou o padrão funcional muscular, assim como a cinética do movimento mastigatório e a deflexão mandibular medialAbstract: Bite force can influence the development of the masticatory function and consequently the rehabilitation therapeutics. The high variability of this muscular function indicator can be associated to intrinsic aspects of the stomatognathic system such as the vertical facial morphology. However, the influence of this morphology on the maximum bite force and functional responses associated to muscular function are still not established. Thus, the purpose of this study was to verify the maximum occlusal force, the masticatory cycle patterns and the medial mandibular flexure in subjects with different facial types. Seventy-eight healthy and completely dentate subjects were classified by Rickets¿ cephalometric analysis in accordance to the facial type into 3 groups: G1- Brachyfacial; G2- Mesofacial; e G3- Dolichofacial. The maximum occlusal force (MOF) was measured by means of force transducers located on the first molars region, during isometric clenching for 7 seconds. The types of masticatory cycles formed during the mastication of an artificial test material were evaluated on the frontal plane by the electromagnetic jaw-tracking method, using a kinesiograph. The medial mandibular flexure (MMF) was registered with addition silicone in the maximum opening and protrusion positions. MMF was determined by analysis of the distance between the occlusal surfaces of the contralateral first molars. Data of MOF and MMF were analyzed by ANOVA followed by Tukey pos hoc (a= .05). Measurements of maximum occlusal force were different (P <.0001) among groups, with G1 presenting the highest values, followed by G2 and G3, respectively. Considering the frontal plane, there was a predominance of tear drop cycles for G1 and hemi-oval type from the two other groups. The medial mandibular flexure of maximum opening showed significant differences among all facial groups (P <.0001). The highest value occurred in G1, followed by G2 and G3, respectively. The mandibular flexure of protrusion was significantly small on G3 group (P <.0001), additionally there were no differences between G1 and G2. Within the conditions of this study, we concluded that vertical facial morphology influenced the muscular functional patterns as well as the masticatory movement kinetic and the medial mandibular flexureMestradoProtese DentalMestre em Clínica Odontológic

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Modificatoria del art. 341 del código procesal penal en función a la intervención del agente especial en los delitos contra la administración pública

La presente investigación requiere la modificación del art. 341 del código procesal penal en función a la intervención del agente especial en los delitos contra la administración pública, así mismo se requiere tomar en cuenta que no es lo mismo un agente encubierto que un agente especial pues el primero es, según una interpretación literal del código procesal penal, un representante de la policía nacional del Perú, subordinado a las decisiones del representante del ministerio público, mientras que el segundo es solamente un ciudadano que por su condición de cercanía con los investigados es requerido para, junto con el agente encubierto, recopilar información incriminatoria, para ello la investigación tiene como objetivo general determinar el objeto jurídico de la modificar del art. 341 del CPP, para establecer la intervención del agente especial en los delitos contra la administración pública, teniendo en cuenta que si modifica el art. 341 del CPP entonces se establece que existe una intervención del agente especial en los delitos contra la administración pública, es así que se aplicó la encuesta como medio de recolección de datos, con la facultad de llegar a una solución frente al problema planteado.TesisCiencias jurídica

Diseño de un sistema de costos por procesos para la toma de decisiones en la empresa Establo Maico S. R. Ltda. Lambayeque, año 2017-2018

El informe de investigación tiene como eje central el estudio a la empresa Establo Maico S. R. Ltda. cuya actividad principal y generadora de sus ingresos es la producción de leche de ganado vacuno, dicha empresa se encuentra ubicada en el sector Las Delicias, distrito de Reque, Ciudad de Chiclayo. A través de esta investigación, se logra identificar las problemáticas de esta empresa, que no deja de ser algo común para las empresas de este mismo sector económico, siendo de importancia la identificación de métodos y herramientas que permitan identificar los costos de producción y el manejo eficaz de los mismos para lograr una mayor rentabilidad a través de la toma de decisiones basadas en información fidedigna y útil obtenida de los estados Financieros de la empresa. Se propone entonces, a través de la identificación de esta necesidad empresarial, diseñar un sistema de costos de Producción por Procesos, fundamentando la misma en la variedad de procesos que se tienen que llevar a cabo para obtener el producto final. Hacer uso de herramientas de estudio, lleva al personal involucrado en dichos procesos y más aún al líder de la entidad, en este caso el gerente o dueño a conocer del giro del negocio y evaluar el manejo de los recursos con que cuenta su empresa para ser rentable, analizando factores cuantitativos y cualitativos que lleven a un resultado confiable. Dicha acción se dirige a la importancia que tiene la contabilidad de costos dentro de la contabilidad general de la empresa y a la importancia de un diseño de costos por procesos implementado que concuerde con la realidad de la misma. La interrelación de los costos y la toma de decisiones es fundamental para toda empresa en el mundo empresarial, que cada vez se vuelve más competitiva y exigente en la calidad, variedad y precios

Percutaneous occlusion of patent ductus arteriosus with rashkind umbrella device

Se realizó el cierre del ductus arterioso persistente en 13 pacientes mujeres, edad promedio 14 ± 15 años, usando un oclusor de paraguas de Rashkind, colocado a través de una vena. Siete paraguas de 12 mm, y cinco de 17 mm, fueron colocados exitosamente en el ductus (diámetro 3.89 ± 1.5 mm). Se suspendió un procedimiento, porque el ductus fue muy grande para el paraguas de 12 mm. Otro caso presentó una hemólisis severa después del cierre percutáneo del ductus. Se tuvo que recurrir a la cirugía para extraer el paraguas y cerrar el ductus por ligadura. No se presentó ninguna embolización del dispositivo. En el aortograma inmediato postoclusión (15'), se observó shunt residual en cuatro casos (30%). Dos pacientes tuvieron un seguimiento promedio de 24 meses de ecocardiografía Doppler y seis pacientes de cinco meses. Las complicaciones fueron: hemólisis y hematoma, el tiempo promedio del cateterismo fue de 161 ± 60 min, y de fluoroscopia 34 ± 10 min. El cierre percutáneo del ductus arterioso usando el paraguas de Rashkind, es un método seguro y efectivo de manejo no quirúrgico, con baja morbilidad y nula mortalidad.Percutaneous occlusion of Patent Ductus Arteriosus (P DA) was performed in thirteen female patients, average age 14 ± 15 years. A Rashkind "umbrella" occluder was inserted through a central vein. Seven occluders of 12 mm, and five of 17 mm were successfully inserted in the ductus (3.89 ± 1.5 mm diameter). In one patient the procedure was stopped because P DA was bigger than the 12 mm selected occluder. A second patient has severe hemolysis following the percutaneous closure of P DA. Further surgical procedures were necessary for occluder withdrawal and ligation of PDA. No embolization was observed in any of the cases. Fifteen-minute post-occlusion control aortography showed persistent shunt in four cases (30%). Patients’ follow-up with echo-doppler tests were done in two patients with an average of 24 months of observation and other Six patients underwent a follow-up of five months. More frequent complications were: hemolysis and hematoma. Average time for performing transcatheter occlusion was 161 ± 60 minutes and 34 ± 10 minutes for fluoroscopy procedure. Percutaneous closure of P DA using Rashkind "umbrella" occluder is a safe and effective method, with Iow morbidity and no mortality, for nonsurgical management of this pathology

Proteome and Peptidome of Human Acquired Enamel Pellicle on Deciduous Teeth

Understanding the composition and structure of the acquired enamel pellicle (AEP) has been a major goal in oral biology. Our lab has conducted studies on the composition of AEP formed on permanent enamel. The exhaustive exploration has provided a comprehensive identification of more than 100 proteins from AEP formed on permanent enamel. The AEP formed on deciduous enamel has not been subjected to the same biochemical characterization scrutiny as that of permanent enamel, despite the fact that deciduous enamel is structurally different from permanent enamel. We hypothesized that the AEP proteome and peptidome formed on deciduous enamel may also be composed of unique proteins, some of which may not be common with AEP of permanent enamel explored previously. Pellicle material was collected from 10 children (aged 18&amp;#8211;54 months) and subjected to mass spectrometry analysis. A total of 76 pellicle proteins were identified from the deciduous pellicle proteome. In addition, 38 natural occurring AEP peptides were identified from 10 proteins, suggesting that primary AEP proteome/peptidome presents a unique proteome composition. This is the first study to provide a comprehensive investigation of in vivo AEP formed on deciduous enamel