Strategies for Preventing and Treating Oral Mucosal Infections Associated with Removable Dentures: A Scoping Review

Oral infections occur due to contact between biofilm rich in Candida albicans formed on the inner surface of complete dentures and the mucosa. This study investigated historical advances in the prevention and treatment of oral mucosal infection and identified gaps in the literature. Bibliographic research was conducted, looking at PubMed, Embase, Web of Science, and Scopus, where 935 articles were found. After removing duplicates and excluding articles by reading the title and abstract, 131 articles were selected for full reading and 104 articles were included. Another 38 articles were added from the gray literature. This review followed the PRISMA-ScR guidelines. The historical period described ranges from 1969 to 2023, in which, during the 21st century, in vitro and in vivo studies became more common and, from 2010 to 2023, the number of randomized controlled trials increased. Among the various approaches tested are the incorporation of antimicrobial products into prosthetic materials, the improvement of oral and denture hygiene protocols, the development of synthetic and natural products for the chemical control of microorganisms, and intervention with local or systemic antimicrobial agents. Studies report good results with brushing combined with sodium hypochlorite, and new disinfectant solutions and products incorporated into prosthetic materials are promising.

Effectiveness of photo-ozone therapy against equine Pythium insidiosum

Cutaneous pythiosis is a life-threatening infectious disease. Low-level laser therapy (LLLT) and ozone (O3) have been used individually in the treatment of infected wounds. The goals of the study were a) to characterize the antimicrobial action of the photo-ozone therapy (LLLT-O3) against equine Pythium insidiosum, and b) to assess the cytotoxic potential of the LLLT-O3 in keratinocytes. Specimens of pathogen were isolated from 10 horses. After culturing, 120 hyphae plugs were distributed among four groups (n=30 hyphae plugs/group): LLLT (laser irradiation for 160 sec;), O3 (exposition to O3 for 15 min;), LLLT-O3 (LLLT and O3 treatments in sequence) and control (untreated plugs). The hyphae growth was measured during the first 14 days post-treatment. Where there was an absence of hyphae growth, the plug was recultured for an additional 7 days. The cytotoxic potential of the treatments against HaCaT keratinocytes was assessed by colorimetric assays. The LLLT-O3 and O3 treatments inactivated, respectively, 92.3% (28/30) and 30% (9/30) of the samples. No growth was detected after 7 days reculture of inactivated hyphae plugs on new media. Hyphae growth was visualized in 100% of the control and LLLT hyphae plugs. The viability of HaCaT cells was not affected by the isolated treatments (LLLT and O3), while the LLLT-O3 showed slight cytotoxic effect (20%) when compared to the control group (P<0.05). Photo-ozone therapy inactivated equine P. insidiosum hyphae with minimal cytotoxicity in skin cells in vitro.

Relation between the risk factors for the severity of denture stomatitis and quality of life of complete edentulous individuals: a cross-sectional study

OBJECTIVE

To assess the association between risk factors for developing denture stomatitis (DS) and oral health-related quality of life (OHRQoL) in complete denture wearers.

METHODOLOGY

Participants of both sexes, wearing complete dentures, were classified using the modified Newton classification for the absence or the severity of DS and allocated to groups Normal or zero, IA, IB, II, and III. Lifestyle, oral and denture history, and medication use were assessed using specific questionnaires; clinical parameters such as anatomical characteristics of support were evaluated with the Kapur classification; salivary flow (SF) was calculated by the volume of unstimulated saliva per minute; and microbial load was determined by counting colony forming units (CFU) of target microorganisms present in the biofilm collected from dentures and palate. OHIP-EDENT assessed the OHRQoL. Kendall's tau_b and Spearman tests were applied with a significance level of 5%.

RESULTS

184 patients (143 female and 41 male) aged 65.5 ± 6.8 years were evaluated. Positive correlations were found for sex (women; p=0.013, r=0.16), individuals who started to consume alcoholic beverages as a young adult (18-27 years) (p=0.008, r=0.22), CFU of Candida spp. (p<0.001, r=0.27 denture; p<0.001, r=0.31 palate); Candida albicans (p=0.004, r=0.22 denture; p=0.003, r=0.25 palate), and Candida glabrata (p=0.004, r=0.22 denture; p=0.001, r=0.27 palate). Moreover, negative correlations with DS were found for CFU of Staphylococcus spp. (p=0.004, r=-0.20 palate) and enterobacteria (p=0.002, r=-0.24 palate), as well as a negative correlation between SF (p=0.009, r=-0.193) and DS. The CFU of Staphylococcus spp. and enterobacteria on the palate significantly correlated with OHRQoL.

CONCLUSION

Being female, consuming alcoholic beverages as a young adult, CFU of Candida spp., Candida albicans, Candida glabrata, and salivary flow may be the most significant risk factors for DS. The microbial load of Staphylococcus spp. and enterobacteria seems to influence the quality of life for complete denture wearers.

Electrical carotid sinus nerve stimulation attenuates experimental colitis induced by acetic acid in rats

AIMS

The carotid bodies are sensors that detect physiological signals and convey them to the central nervous system, where the stimuli are processed inducing reflexes through efferent pathways. Recent studies have demonstrated that electrical stimulation of the carotid sinus nerve (CSN) triggers the anti-inflammatory reflex under different conditions. However, whether this electrical stimulation attenuates colitis was never examined. This study aimed to evaluate if the electrical CSN stimulation attenuates the experimental colitis induced by intrarectal administration of acetic acid in rats.

METHODS

Electrodes were implanted around the CSN to stimulate the CSN, and a catheter was inserted into the left femoral artery to record the arterial pressure. The observation of hypotensive responses confirmed the effectiveness of the electrical CNS stimulation. This maneuver was followed by a 4 % acetic acid or saline administered intrarectally. After 24 h, colons were segmented into distal and proximal parts for macroscopy, histological and biochemical assessment.

KEY FINDINGS

As expected, the electrical CSN stimulation was effective in decreasing arterial pressure in saline and colitis rats. Moreover, electrical CSN stimulation effectively reduced colonic tissue lesions, colitis scores, and histopathologic parameters associated with colitis. In addition, the CSN stimulation also reduced the colonic mucosa pro-inflammatory cytokine interleukin-1 beta, and increased the anti-inflammatory interleukin-10, in rats submitted to colitis.

SIGNIFICANCE

These findings indicated that electrical CSN stimulation breaks the vicious cycle of local colon inflammation in colitis, which might contribute to its better outcome.

Effect of Hygiene Protocols on the Mechanical and Physical Properties of Two 3D-Printed Denture Resins Characterized by Extrinsic Pigmentation as Well as the Mixed Biofilm Formed on the Surface

To assess the effect of hygiene protocols and time on the physical-mechanical properties and colony-forming units (CFU) of Candida albicans, Staphylococcus aureus, and Streptococcus mutans on 3D-printed denture resins (SmartPrint and Yller) with extrinsic pigmentation compared to conventional resin (CR). The protocols were evaluated: brushing (B), brushing and immersion in water (W), 0.25% sodium hypochlorite (SH), and 0.15% triclosan (T), simulating 0, 1, 3, and 5 years. The data were analyzed by ANOVA with repeated measurements, ANOVA (Three-way) and Tukey's post-test, generalized linear model with Bonferroni adjustment, and ANOVA (Two-way) and Tukey's post-test (α = 0.05). The protocols influenced color (p = 0.036) and Knoop hardness (p < 0.001). Surface roughness was influenced by protocols/resin (p < 0.001) and time/resin (p = 0.001), and flexural strength by time/protocols (p = 0.014). C. albicans showed interactions with all factors (p = 0.033). Staphylococcus aureus was affected by protocols (p < 0.001). Streptococcus mutans exhibited no count for SH and T (p < 0.001). Yller resin showed more color changes. The 3D-printed resins displayed lower microhardness, increased roughness, and decreased flexural strength compared to CR with all protocols in a simulated period of 5 years. The indication of printed resins should be restricted to less than 3 years.

Risk factors and immunological biomarkers in denture stomatitis: An observational cross-sectional study

OBJECTIVE

Assess risk factors, local and systemic immunological biomarkers in healthy individuals and with Denture Stomatitis (DS).

DESIGN

For this observational transversal study, 27 participants without DS (Group 0), 24 with moderate DS (Group 1), and 25 with severe DS (Group 2) were assessed for sociodemographic, behavioral, and clinical parameters, microbial load of Candida spp., Staphylococcus spp., Streptococcus mutans, Pseudomonas spp., and enterobacteria, and cytokine and C-reactive protein levels. ANOVA, Fisher's exact, Kruskal-Wallis, Mann-Whitney, Wilcoxon and Pearson's chi-square tests were used for data analysis (α = 0.05).

RESULTS

Group 1 had a significantly higher mean age compared to the other groups (P = 0.018), but no correlation was identified between age and DS (P = 0.830; r = 0.025). No significant differences were found among the groups for other sociodemographic and behavioral characteristics. Group 1 had significantly older upper and lower dentures; however, no correlation was identified between age of upper (P = 0.522; r = 0.075) and lower (P = 0.143; r = 0.195) dentures and DS. The microbial load of Candida albicans on the dentures (P = 0.035) and Candida spp. on the palate (P = 0.008) of the groups 1 and 2 was higher than group 0. Group 1 and 2 had higher Candida spp. counts on denture (P = 0.003) than group 0. There was no difference among groups for bacterial analyzed. Group 1 showed higher and Group 2 intermediate salivary levels of IL-6 compared to Group 0. There was no difference in the C-reactive protein levels among groups.

CONCLUSIONS

Microbial load of Candida spp. is the factor with the strongest relationship with DS, with capacity for local signaling through IL-6.

Analysis of microbial communities of ocular prostheses and anophthalmic sockets using 16S rRNA gene sequencing

Ocular prostheses are liable to host microbial adhesion, which can favor conjunctival inflammation. Knowing the microbiota of the ocular prosthesis and anophthalmic socket is important for predicting infection-related pathogens. This study evaluated the microbiota of the prostheses and anophthalmic sockets of six individuals by 16S rRNA sequencing. The microbial abundance and diversity were analyzed using the Operational Taxonomic Units at the genus level. Forty-seven phyla, capturing 1,258 named genera, were recorded in the sample set. In both sites, the most frequent genera were Fusobacterium, Staphylococcus, Prevotella, and Streptococcus. The microbial abundance was higher for the anophthalmic socket than for the prosthesis. Alpha diversity showed no significant differences in bacterial richness or diversity between sites. Although the microbial abundance in the anophthalmic socket was higher, both sites had similar microbiota with high diversity and low dominance among the genera.

Effect of a Hygiene Protocol on Denture-Related Stomatitis Remission, Local Inflammatory Factors, and Hemodynamic Responses by Arterial Pressure

Denture-related stomatitis (DRS) is frequent oral inflammation in complete denture wearers. This study evaluated the effect of a hygiene protocol on DRS remission, local inflammatory factors, and hemodynamic responses. Thirty-three individuals were enrolled in the study. The outcomes were measured before and after 10 days of a hygiene protocol treatment consisting of brushing the palate with a soft brush and water and denture brushing with a denture-specific brush and mild soap, as well as immersion of the denture for 20 min in a 0.25% sodium hypochlorite solution. Data were analyzed by paired Wilcoxon for biofilm removal and CFU count of microorganisms. The paired T test was used to assess salivary MUC 1, cytokines, and arterial pressure (p < 0.05). A significant difference was found in the DRS degree (p < 0.001), biofilm (p < 0.001), microbial load of Candida spp. (p < 0.001), Gram-negative (p < 0.004), Staphylococcus spp. (p < 0.001), and S. mutans (p < 0.001) of the denture, and S. mutans (p < 0.001) of the palate after use of the protocol. The salivary flow (p = 0.2) and pH (p = 0.97) did not change; there was an increase of MUC 1 (p = 0.049) and a decrease in IL-6 (p = 0.038), IL-2 (p = 0.04), IL-10 (p = 0.041), and IFNγ (p = 0.04). There was also a decrease in systolic (p = 0.012) and mean arterial pressure (p = 0.02). The current hygiene protocol reduced the inflammation degree of DRS and promoted an improvement of local inflammatory factors and a reduction in the systolic arterial pressure of the patients.

Effect of Denture Hygiene Protocols on Patient Satisfaction, Oral Health-Related Quality Of Life, and Salivary Parameters: A Randomized Clinical Trial

PURPOSE

This randomized controlled trial compared four denture hygiene protocols in terms of patient satisfaction, oral health-related quality of life (OHRQoL), and salivary parameters in complete denture wearers with denture stomatitis.

MATERIAL AND METHODS

For this randomized, double-blind controlled clinical trial, 108 participants were assigned to soak their dentures in one of the following solutions: (1) 0.25% sodium hypochlorite (positive control), (2) 0.15% Triclosan, (3) denture disinfecting tablets, or (4) denture disinfecting tablets plus palatine mucosa brushing solution. The outcomes of patient satisfaction, OHRQoL, and salivary parameters (salivary flow rate and pH) were measured at baseline and after 10 days. Results were compared by Kruskal-Wallis, between-group by the Dunn test, and Wilcoxon tests between times (α = 0.05).

RESULTS

After the hygiene protocols, and when compared with baseline, the overall patient satisfaction, maxillary denture satisfaction, maxillary denture comfort, and maxillary denture retention were ameliorated. A significant improvement was noted in OHRQoL in 3 of 4 domains evaluated (orofacial pain and discomfort, masticatory discomfort and disability, and psychological disability and discomfort). The salivary flow rate (unstimulated and stimulated); and pH were not significantly affected at the times evaluated.

CONCLUSIONS

Complete denture wearers may feel more satisfied with their complete dentures when treated for denture stomatitis. The tested treatments lead to similar improvement in terms of patient satisfaction and OHRQoL. This article is protected by copyright. All rights reserved.

Effect of short-term increase in occlusal vertical dimension on masticatory muscle electrical activities and pressure-to-pain threshold: A crossover clinical study

STATEMENT OF PROBLEM

Increasing the occlusal vertical dimension (OVD) is a common procedure in clinical practice. However, few studies have assessed the short-term influence of an increased OVD on the masticatory muscles.

PURPOSE

The purpose of this crossover clinical study was to investigate the effect of increased OVD on the electrical activity of masticatory muscles and the pressure-to-pain threshold (PPT) in asymptomatic participants.

MATERIAL AND METHODS

Twenty asymptomatic participants (22.7 ±2.39 years of age; 10 men, 10 women) were submitted to an increase in OVD by using interocclusal devices of different thicknesses (3- and 6-mm) for 24 hours. Masticatory muscle activity was assessed with electromyography (EMG), expressed in microvolts (μV), while the participants masticated 2 pieces of latex of different consistency (latex S and H) with and without the device. The PPT was measured with a digital algometer before and after the mastication. The results were assessed by using analysis of variance (ANOVA) and the Tukey honestly significant difference (HSD) test (α=.05).

RESULTS

The change of OVD did not significantly affect the electrical activity of the muscles. The latex of hard consistency (latex H) showed higher electrical activity values than the soft texture (latex S). For the working side anterior temporal muscle, a change in the PPT was detected on the day the 6-mm-device was inserted, but for the other muscles, device thickness and latex mastication did not change the PPT.

CONCLUSIONS

For a short time, an increase in occlusal vertical dimension did not affect the electrical activity in the masticatory muscles or pressure-to-pain threshold in asymptomatic participants.

Electrodialytic treatment of secondary mining resources for raw materials extraction: Reactor design assessment

The sustainability of mining activities is compromised due to the high amounts of mining residues generated that have to be disposed of, often in open dams, that may cause environmental deterioration, e.g. release of toxic elements to water supplies. These residues are, however, secondary resources of raw materials. In the case of Panasqueira mine, they even are a source of tungsten, considered a critical raw material. The present work aims to assess the electrodialytic process efficiency for raw materials extraction from Panasqueira mine residues. Experiments were performed with 2 and 3-compartment electrodialytic reactors, applying current intensities between 50 and 100 mA, from 4 to 14 days, and sample suspensions enhanced with NaCl or effluent. Additionally, control experiments with no current application were carried out. The results showed that a 3-compartment reactor operating at 100 mA, with NaCl as supporting electrolyte, presented the highest extraction of copper (13%), tin (10%), tungsten (13%) and arsenic (63%).

Electrodialytic removal of tungsten and arsenic from secondary mine resources - Deep eutectic solvents enhancement

Tungsten is a critical raw material for European and U.S. economies. Tungsten mine residues, usually considered an environmental burden due to e.g. arsenic content, are also secondary tungsten resources. The electrodialytic (ED) process and deep eutectic solvents (DES) have been successfully and independently applied for the extraction of metals from different complex environmental matrices. In this study a proof of concept demonstrates that coupling DES in a two-compartment ED set-up enhances the removal and separation of arsenic and tungsten from Panasqueira mine secondary resources. Choline chloride with malonic acid (1:2), and choline chloride with oxalic acid (1:1) were the DES that in batch extracted the average maximum contents of arsenic (16%) and tungsten (9%) from the residues. However, when ED was operated at a current intensity of 100 mA for 4 days, the extraction yields increased 22% for arsenic and 11% for tungsten, comparing to the tests with no current. From the total arsenic and tungsten extracted, 82% and 77% respectively were successfully removed from the matrix compartment, as they electromigrated to the anolyte compartment, from where these elements can be further separated. This achievement potentiates circular economy, as the final treated residue could be incorporated in construction materials production, mitigating current environmental problems in both mining and construction sectors.

Sustainability of construction materials: Electrodialytic technology as a tool for mortars production

The reduction of tap water consumption in all activity sectors, including the building industry, is crucial to the sustainability of water resources. Effluents from wastewater treatment plants have the potential to replace freshwater in the construction sector but they contain a critical mixture of impurities, which hampers their use in mortars production. In this work, the viability of using effluent as an alternative to potable water for the production of mortars, after electrodialytic treatment, was assessed. Electrodialytic technology (ED-T) is a proven technique for decontamination of porous and aqueous matrices. ED-T experiments were conducted with 500 mL of effluent for 6, 12 and 24 h, with a current intensity of 25 mA. The results showed that after ED-T 6 h, the removal efficiencies of critical components were above 85% of their initial concentrations. Mortar properties such as setting time, workability, flexural strength, compressive strength and morphology were obtained for 100% effluent and tap water/effluent mixtures (50:50) with and without ED-T pre-treatment. The mortars with the ED-T treated effluent showed similar initial setting times and workability, higher flexural and compressive strength compared to the mortars reference.

Comparing a tablet computer and paper forms for assessing patient-reported outcomes in edentulous patients

PURPOSE

The aim of this study was to determine whether two methods of documentation, print and electronic forms, for the assessment of patient-reported outcomes (PRO) in complete denture wearers provide comparable results. The study also quantified the time needed for filling the forms by each method.

MATERIALS AND METHODS

Thirty participants enrolled in a university clinic answered two forms (a questionnaire for denture satisfaction and OHIP-EDENT). They provided answers with two application methods in a random order, with a one-month interval between them: (1) electronic forms on a tablet computer; and (2) print forms. The methods were compared in terms of mean results, correlation/agreement, internal consistency, and spent time.

RESULTS

Mean results for both methods were similar for each denture satisfaction item (100-mm VAS) and OHIP-EDENT summary score. Both questionnaires presented good internal consistency regardless of the application method (Cronbach's α=0.86 or higher). Correlation and agreement between the methods regarding specific items was at least moderate for the majority of cases. Mean time for the electronic and print forms were 9.2 and 8.5 minutes, respectively (paired t test, P=.06, non-significant).

CONCLUSION

The electronic method is comparable to print forms for the assessment of important PRO of prosthetic treatment for edentulism, considering the results and time needed. Findings suggest the viability of replacing print forms with a tablet for applying the tested inventories in clinical trials.

Preliminary In Vitro Study on O-Ring Wear in Mini-Implant-Retained Overdentures

This preliminary in vitro study evaluated the simulated retention force of O-rings used for mini-implant overdenture treatment and the effect of mechanical fatigue corresponding to 6 months of wear. A mandibular overdenture analog device was attached to two mini-implants and underwent a tensile strength test before and after the application of insertion-removal and simulated masticatory cycles. Insertion-removal cycles led to a retention loss of 24%, whereas masticatory cycles did not influence retention. Micro-CT scans showed minor deformation following mechanical cycling, but the changes were milder than those observed in similar clinical specimens. Both experimental loading methods led to physical changes in the O-rings, which explains in part the similar clinically observed wear.

Antihypertensive Efficacy of Amlodipine and Losartan after Two ‘Missed’ Doses in Patients with Mild to Moderate Essential Hypertension

We compared the effects of amlodipine (5 − 10 mg, n = 94) and losartan (50 − 100 mg, n = 94) on the lowering of blood pressure (BP) at steady state and after two missed doses, as well as on tolerability. This was a randomized, double-blind study of 12 weeks of active treatment followed by 2 days of placebo treatment. Twenty-four-hour ambulatory blood pressure monitoring and office BP measurements were performed at baseline, week 12 and after the 2-day drug holiday. After 12 weeks, amlodipine was significantly more effective than losartan in reducing both 24-h systolic blood pressure (SBP) (−18.0 versus −10.8 mmHg) and diastolic blood pressure (DBP) (−10.6 versus −8.0 mmHg). While mean SBP and DBP for both treatments increased comparably during the drug holiday, BP values remained significantly lower than baseline for both treatments. The superior BP-lowering effect of amlodipine compared with losartan was maintained during the drug holiday.

Kisspeptin regulates tuberoinfundibular dopaminergic neurones and prolactin secretion in an oestradiol-dependent manner in male and female rats

Prolactin (PRL) secretion is inhibited by hypothalamic dopamine. Kisspeptin controls luteinising hormone (LH) secretion and is also involved in PRL regulation. We further investigated the effect of kisspeptin-10 (Kp-10) on the activity of tuberoinfundibular dopaminergic (TIDA) neurones and the role of oestradiol (E2 ) in this mechanism. Female and male rats were injected with i.c.v. Kp-10 and evaluated for PRL release and the activity of dopamine terminals in the median eminence (ME) and neurointermediate lobe of the pituitary (NIL). Kp-10 at the doses of 0.6 and 3 nmol increased plasma PRL and decreased 4-dihydroxyphenylacetic acid (DOPAC) levels in the ME and NIL of ovariectomised (OVX), E2 -treated rats but had no effect in OVX. In gonad-intact males, 3 nmol Kp-10 increased PRL secretion and decreased DOPAC levels in the ME but not in the NIL. Castrated males treated with either testosterone or E2 also displayed increased PRL secretion and reduced ME DOPAC in response to Kp-10, whereas castrated rats receiving oil or dihydrotestosterone were unresponsive. By contrast, the LH response to Kp-10 was not E2 -dependent in either females or males. Additionally, immunohistochemical double-labelling demonstrated that TIDA neurones of male rats contain oestrogen receptor (ER)-α, with a higher proportion of neurones expressing ERα than in dioestrous females. The dopaminergic neurones of periventricular hypothalamic nucleus displayed much lower ERα expression. Thus, TIDA neurones express ERα in male and female rats, and kisspeptin increases PRL secretion through inhibition of TIDA neurones in an E2 -dependent manner in both sexes. These findings provide new evidence about the role of kisspeptin in the regulation of dopamine and PRL.

Desafios da atuação dos psicólogos nos CREAS do Rio Grande do Norte

O presente estudo objetiva discutir os aspectos contextuais que condicionam e possibilitam a prática profissional do psicólogo no campo da Assistência Social, utilizando como recorte a fala dos psicólogos que atuam nos Centros de Referência Especializados de Assistência Social (CREAS) do estado do Rio Grande do Norte (RN). Coloca-se em debate a atuação do psicólogo nesses espaços, pensando a sua contribuição na consolidação da política pública em questão. A análise dos dados demonstra a necessidade da construção de uma identidade do psicólogo como trabalhador social, apontando para a importância de mudanças no corpo conceitual e técnico da Psicologia.

Método simplificado versus convencional de confecção de próteses totais: práticas adotadas pelos Cirurgiões-Dentistas

Introdução: A fim de reduzir custos e tempo clínico envolvidos com o tratamento, Dentistas têm utilizado métodos simplificados, omitindo ou abreviando partes da técnica de confecção das próteses totais. Objetivo: Levantar as práticas utilizadas pelos Cirurgiões-Dentistas para a confecção de próteses totais. Material e método: Os dados foram levantados por meio de um formulário eletrônico contendo perguntas relativas ao perfil e aos procedimentos clínicos utilizados, a fim de quantificar o uso de métodos simplificados e convencionais, bem como para determinar a relação com o perfil desses profissionais. Os resultados foram analisados por meio de análise de Aglomerados. Resultado: As respostas foram dadas, em sua maioria, por homens, tendo a prática clínica como sua principal fonte de renda e clínica privada ou conveniada como ambiente principal de trabalho (n=119). Grande parte dos entrevistados relatou realizar duas moldagens por arcada, utilização de articulador semiajustável com arco facial, determinação de plano oclusal por meio de guias anatômicos, utilização de meios métricos para análise da dimensão vertical de oclusão e determinação direta da relação cêntrica. O próprio Cirurgião-Dentista relatou ser o responsável na fase de seleção de dentes. A estatística identificou dois Aglomerados, com base nas características demográficas e na prática clínica, sendo um grupo formado por generalistas adeptos de perfis mais simplificados e outro formado por profissionais mais especializados em prótese que realizam técnicas convencionais. Conclusão: A adoção de técnicas simplificadas é associada àqueles Dentistas com perfil mais generalista, enquanto protesistas tendem a trabalhar mais de acordo com a Academia.

A randomised trial of a simplified method for complete denture fabrication: patient perception and quality

Complete denture fabrication involves a series of complex technical procedures. Nevertheless, simplified methods may be as effective as conventional ones albeit the lesser use of time and resources, without disadvantage for the patient. This study compared a simplified method for complete denture fabrication to a conventional protocol in terms of oral health-related quality of life (OHRQoL), patient satisfaction and denture quality. Forty-two edentulous patients requesting treatment with complete dentures were randomly allocated into two study groups. Group S received dentures fabricated by a simplified method and Group C received conventionally fabricated dentures. Before interventions and after three and 6 months following insertion, OHRQoL and patient satisfaction were analysed by specific instruments. A prosthodontist assessed denture quality 3 months after delivery. Groups presented no difference for OHRQoL, denture quality and general satisfaction. Differences regarding patient satisfaction with some aspects of the dentures were found after 3 months (S > C), but were insignificant at 6 months. It was concluded that the simplified method is able to produce dentures of a quality comparable to those produced by the conventional method, influencing OHRQoL and patient satisfaction similarly.

Effect of occlusal splint thickness on electrical masticatory muscle activity during rest and clenching

The extent of separation between the maxillary and mandibular teeth in the fabrication of interocclusal splints designed to achieve efficiency and muscle relaxation is controversial and undefined in the literature. Based on this premise, the aim of this study was to evaluate the effect of interocclusal splint thicknesses of 3 and 6 millimeters on the electrical activity of the anterior temporal and masseter muscles during rest and dental clenching. Twenty asymptomatic individuals (10 males and 10 females) were selected using the Research Diagnostic Criteria (RDC). Electromyography (EMG) was performed both with and without the 3- and 6-mm splints using the Bio EMG software package, which recorded values given in microvolts (µV). The results, which were assessed using analysis of variance (ANOVA) to a 5% significance level (p < 0.05), showed increased electrical activity of the masticatory muscles during dental clenching compared with at rest, with greater activity in the masseter muscle. The electrical activity did not differ according to the thickness of the splints or between males and females. We can conclude that both splint thicknesses are effective in treating muscle hyperactivity given their similar clinical behavior for asymptomatic individuals.

Cholinesterase inhibition and behavioral toxicity of carbofuran on Oreochromis niloticus early life stages

Nile tilapia Oreochromis niloticus at 9 days post-hatch were exposed in semi-static experiments to the carbamate insecticide carbofuran, which is applied in agricultural systems in Brazil. Although the molecular mechanism of carbofuran toxicity is well known, a detailed understanding of the ecological mechanisms through which carbofuran effects can propagate towards higher levels of biological organization in fish is incomplete. Mortality rates were quantified for larvae exposed for 96 h to 8.3, 40.6, 69.9, 140, 297 and 397 μg/L carbofuran, and the LC(50) 96 h was 214.7 μg/L. In addition, the biochemical biomarker cholinesterase inhibition and behavioral biomarkers related to vision, swimming, prey capture and predator avoidance were quantified in individual larvae, as well as their growth in weight. The behavioral parameters were quantified by analysis of digitally recorded videos of individual larvae within appropriate experimental setups. The activity of the enzyme cholinesterase decreased after exposure to carbofuran with a lowest observed effects concentration (LOEC) of 69.9 μg/L. Visual acuity deficits were detected after carbofuran exposure with a LOEC of 40.6 μg/L. Swimming speed decreased with carbofuran exposure, with a LOEC of 397.6 μg/L. The number of attacks to prey (Daphnia magna nauplii) decreased in larvae exposed to carbofuran, with a LOEC of 397.6 μg/L. Growth in weight was significantly reduced in a dose dependent manner, and all carbofuran groups exhibited a statistically significant decrease in growth when compared to controls (p<0.05). The number of predator attacks necessary to capture larvae decreased after exposure to carbofuran, and the LOEC was 69.9 μg/L. These results show that exposure of sensitive early life stages of tilapia O. niloticus to sublethal concentrations of carbofuran can affect fundamental aspects of fish larval ecology that are relevant to recruitment of fish populations, and that can be better understood by the application of behavioral biomarkers.

Activity of hypothalamic dopaminergic neurones during the day of oestrus: involvement in prolactin secretion

A secretory surge of prolactin occurs on the afternoon of oestrus in cycling rats. Pituitary prolactin is inhibited by dopamine. We evaluated the activity of the neuroendocrine dopaminergic neurones during oestrus and dioestrus, as determined by dopaminergic activity in the median eminence and neurointermediate lobe of the pituitary, as well as Fos-related antigen expression in tyrosine hydroxylase (TH)-immunoreactive (ir) neurones of the arcuate nucleus (ARC) and periventricular nucleus (Pe). During oestrus, the 4-dihydroxyphenylacetic acid/dopamine ratio in the median eminence decreased at 16.00 h, coinciding with the increase in plasma prolactin levels. Similarly, the expression of Fos-related antigen in TH-ir neurones of Pe and rostral-, dorsomedial- and caudal-ARC also decreased at 16.00 h. On dioestrus, 4-dihydroxyphenylacetic acid/dopamine ratio in the median eminence and Fos-related antigen expression in TH-ir neurones of Pe and rostral-ARC decreased at 18.00 h, whereas prolactin levels were unaltered. No variation in dopaminergic activity was found in the neurointermediate lobe of the pituitary on either oestrus or dioestrus. The number of TH-ir neurones in the ARC and parameters of dopaminergic activity were found to be generally lower on oestrus compared to dioestrus. The transitory decrease in the activity of neuroendocrine dopaminergic neurones temporally associated with the prolactin surge on the afternoon of oestrus suggests a role for dopamine in the generation of the oestrous prolactin surge.

Influence of autonomic neuropathy upon left ventricular dysfunction in insulin-dependent diabetic patients

BACKGROUND

Diabetic cardiomyopathy is a well-defined complication of diabetes that occurs in the absence of ischemic, vascular, and hypertensive disease.

HYPOTHESIS

The study was undertaken to test the relationship among autonomic neuropathy (AN), 24-h blood pressure (BP) profile, and left ventricular function.

METHODS

Nineteen type-1 diabetic patients underwent autonomic tests and echocardiographic examination. Patients were divided according to the presence (AN+) or absence (AN-) of AN.

RESULTS

In the AN+ group (n = 8), the E/A ratio at echo was lower than in the AN- group (n = 11) (1.1 +/- 0.3 vs. 1.6 +/- 0.3; p < 0.005). Systolic and diastolic BP reductions during sleep were smaller in the AN+ than in the AN- group (6.6 +/- 6.6 vs. 13.0 +/- 4.3%; p < 0.03 for systolic and 12.8 +/- 6.8 vs. 20.0 +/- 4.0% for diastolic BP reduction; p < 0.03, respectively). Considering all patients, the E/A ratio correlated inversely with awake diastolic BP (r - 0.63; p = 0.005); sleep systolic BP (r - 0.48; p = 0.04), and sleep diastolic BP (r - 0.67; p = 0.002). The AN correlated with diastolic interventricular septum thickness (r 0.57; p = 0.01), sleep systolic BP (r 0.45; p = 0.05), sleep diastolic BP (r 0.54; p = 0.02), and correlated inversely with systolic and diastolic sleep BP reduction (r - 0.49; p = 0.03 and r - 0.67; p = 0.002, respectively). Finally, E/A ratio and AN score correlated between themselves (r - 0.6; p = 0.005).

CONCLUSION

Our results suggest that left ventricular diastolic dysfunction may be detected very early in type-1 diabetic patients with AN. Parasympathetic lesion and nocturnal elevations in BP could be the link between AN and diastolic ventricular dysfunction.

Electroremediation of straw and co-combustion ash under acidic conditions

Biomass, such as wood and straw, is currently used in EU as a renewable energy source for energy production and this application is expected to rise in coming years. Combined heat and power installations produce fly ash, which is considered hazardous waste. The fly ash management issue should be addressed before biomass combustion is considered a truly sustainable technology. The electrodialytic process is a remediation technique able to assist the management of fly ash. For this work, straw and co-combustion of wood ash are briefly characterized and their electrodialytic treatment is carried out under acidic conditions. Straw ashes presented high removal rates for Ca, Cu, Cr and particularly for Cd, which has been reduced to a level bellow the established by Danish regulations. Acidification also induced a high dissolution and a lower pH of the ash. Fly ash from co-combustion of wood presents similarities with wood ash alone. However, further characterization should be carried out before any comparison regarding applicable legislation. Under acidic conditions, the electrodialytic treatment was not effective for the co-combustion wood ash. The heavy metals appeared in the least soluble fraction of this ash and lowering the pH of such an alkaline material does not mean sustainability and may hinder its reuse.

Effect of occlusion on joint sounds in asymptomatic individuals

Occlusion is a predisposing factor for Temporomandibular Dysfunctions (TMD) of the joint, whose first sign and/or symptom is usually joint sound. To verify the effect of occlusion on joint sounds, temporomandibular joints (TMJ) were analyzed in 78 asymptomatic individuals with various dental conditions. Electrosonography was used to determine the intensity of the vibration in the temporomandibular joint (TMJ) on opening and closing the mouth. Transducers (piezoelectric accelerometer) were placed on the right and left joints. Results were tabled and analyzed using the Kruskal-Wallis test (a=0.05). It was concluded that TMJ vibration in partly edentulous individuals from Kennedy classes I, II and III is statistically higher than in dentate and fully edentulous subjects.

Modeling of electrodialytic and dialytic removal of Cr, Cu and As from CCA-treated wood chips

A one-dimensional model is developed for simulating the electrodialytic and dialytic treatment of a saturated bed of wood chips containing chromium, copper and arsenic. The movement of Cr, Cu and As is mathematically modeled taking into account the diffusion transport resulting from the concentration gradients of their compounds and the electromigration of their ionic, simple and complex species during the operation. The model also includes the electromigration of the non-contaminant principal ionic species in the system, H(+) and OH(-), proceeding from the electrolysis at the electrodes, Na(+) and NO(3)(-) used as electrolyte solutions in the electrode compartments, and oxalate ions and protons incorporated with the oxalic acid solution during wood chips incubation. The model simulation also takes into account that OH(-) generated on the cathode, during electrodialytic remediation, is periodically neutralized by addition of nitric acid in the cathode compartment. The anion and cation-exchange membranes are simply represented as ionic filters that preclude the transport of co-ions (the cations and anions respectively) with the exception of H(+), which is retarded but considered to pass through the anion-exchange membrane.

Relationship between Cu and Zn extractable foliar contents and BCR sequential extraction in soil treated with organic amendments

The application of organic wastes to soils, such as municipal solid waste compost (MSWC) or treated urban sewage sludge (USS) is a current practice for maintaining soil organic matter, reclaiming degraded soils and supplying plant nutrients. Since USS and MSWC may contain organic contaminants, heavy metals or pathogens, this practice represents a potential problem to the environment. In the case of heavy metals both bioavailability and toxicity seems to be critically dependent on the chemical form of the element. In this work, a pot experiment was carried out with different levels of MSWC and USS, as well as an inorganic solution of Cu and Zn. The aim was to obtain information about their bioavailability, mobility and toxicity and correlation among the different soil extracted fractions (F1--Exchangeable metal associated with carbonated phases, F2--Reducible metal or associated with Fe and Mn oxides, F3--Oxidizable metal bound to organic matter) with the Cu and Zn foliar (Cu(F) and Zn(F)) and pseudo totals contents (Cu(Ptotal) and Zn(Ptotal)), using the BCR sequential and aqua regia extraction procedure. Both of these methods were adequate to predict the Cu and Zn available to the plant, as high values on the Cu(F)-Cu(sigma123), Cu(F)-Cu(Ptotal), Zn(F)-Zn(sigma123) and Zn(F)-Zn(Ptotal) correlations were verified. Copper bounded mainly to F3, while Zn bounded to F1, F2 and F3 fractions and the regression analysis revelled that Cu and Zn ryegrass absorption were made mainly on F1 and F3 for Cu and F1 for Zn.

Renal risk and renoprotection among ethnic groups with type 2 diabetic nephropathy: a post hoc analysis of RENAAL

Type 2 diabetes is becoming the leading cause of end-stage renal disease (ESRD) worldwide. Prevalence of ESRD and the antihypertensive response to renin-angiotensin system intervention are suggested to vary among different ethnicities. The Reduction in Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL) study, which included different ethnic groups, demonstrated a renoprotective effect of losartan. A post hoc analysis from RENAAL was performed where we examined in each ethnic group the ESRD risk, identified independent predictors for ESRD, effect of degree of baseline albuminuria, effect of 6-month antiproteinuric response to therapy on ESRD, and renoprotective effect of losartan assessed by albuminuria reduction and ESRD. Baseline albuminuria was the strongest predictor for ESRD in every ethnic group. Albuminuria reduction was associated with reduced risk of ESRD while losartan reduced albuminuria in every ethnic group. When accounting for independent predictors of ESRD, losartan exhibited renoprotection in all ethnic groups. In this type 2 diabetic population with nephropathy, baseline albuminuria is the predominant risk parameter for ESRD; early antiproteinuric effect of losartan predicts long-term renoprotection; and losartan appears to be renoprotective in all ethnic groups. Since the RENAAL study was not powered to determine ethnic responses, these results underline the need for prospective trials where the aim is renal protection among different ethnic groups.

Removal of organic contaminants from soils by an electrokinetic process: the case of atrazine. Experimental and modeling

The atrazine behaviour in soils when submitted to an electric field was studied and the applicability of the electrokinetic process in atrazine soil remediation was evaluated. Two polluted soils were used, respectively with and without atrazine residues, being the last one spiked. Four electrokinetic experiments were carried out at a laboratory scale. Determination of atrazine residues were performed by enzyme-linked immunosorbent assay (ELISA). The results show that the electrokinetic process is able to remove efficiently atrazine in soil solution, mainly towards the anode compartment: Estimations show that 30-50% of its initial amount is removed from the soil within the first 24h. A one-dimensional model is developed for simulating the electrokinetic treatment of a saturated soil containing atrazine. The movement of atrazine is modelized taking into account the diffusion transport resulting from atrazine concentration gradients and the reversed electro-osmotic flow at acidic soil pH.

Relationship between microalbuminuria and cardiac structural changes in mild hypertensive patients

The aim of this study was to determine the relationship between urinary albumin excretion (UAE), cardiac structural changes upon echocardiography and 24-h ambulatory blood pressure (ABPM) levels. Twenty mild hypertensive patients (mean age 56.8 +/- 9.6 years) were evaluated. After 2 weeks of a washout period of all antihypertensive drugs, all patients underwent an echocardiographic evaluation, a 24-h ABPM and an overnight urine collection. Systolic and diastolic blood pressure during 24-h ABPM was 145 +/- 14/91 +/- 10 mmHg (daytime) and 130 +/- 14/76 +/- 8 mmHg (nighttime), respectively. Seven (35%) patients presented UAE > or = 15 microg/min, and for the whole group, the geometric mean value for UAE was 10.2 x// 3.86 microg/min. Cardiac measurements showed mean values of interventricular septum thickness (IVS) of 11 +/- 2.3 mm, left ventricular posterior wall thickness (PWT) of 10 +/- 2.0 mm, left ventricular mass (LVM) of 165 +/- 52 g, and left ventricular mass index (LVMI) of 99 +/- 31 g/m2. A forward stepwise regression model indicated that blood pressure levels did not influence UAE. Significant correlations were observed between UAE and cardiac structural parameters such as IVS (r = 0.71, P<0.001), PWT (r = 0.64, P<0.005), LVM (r = 0.65, P<0.005) and LVMI (r = 0.57, P<0.01). Compared with normoalbuminuric patients, those who had microalbuminuria presented higher values of all cardiac parameters measured. The predictive positive and negative values of UAE > or = 15 microg/min for the presence of geometric cardiac abnormalities were 75 and 91.6%. These data indicate that microalbuminuria in essential hypertension represents an early marker of cardiac structural damage.

[Manidipine in the treatment of stage I and II essential hypertension patients with overweight or android obesity. A Brazilian multicentre study of efficacy, tolerability and metabolic effects]

OBJECTIVE

To evaluate the efficacy, metabolic effects and tolerability of manidipine used in the treatment of stage I and II essential hypertensive patients with overweight or android obesity.

METHODS

By an open-label, non comparative protocol in 11 Brazilian clinical research centers 102 hypertensive patients of both sexes with over weight or central obesity were treated with manidipine 10 to 20mg once daily for 12 weeks. Blood pressure, heart rate and adverse events were monitored. Fasting plasma glucose, total, HDL and LDL-cholesterol and triglicerides were determined at both placebo period and end of active treatment. Also in 12 patients, insulin sensitivity index was evaluated during placebo and manidipine treatment.

RESULTS

Blood pressure was reduced from 159+/-15 / 102+/-5mmHg to 141+/-15 / 90+/-8mmHg with the treatment without any noticeable change in heart rate. Manidipine-efficacy rate was 71.9% with 51.1% of blood pressure normalization. No significant changes in metabolic parameters were noticed. Tolerability to manidipine was very high and at the last visit 87.1% of the treated patients were free of any adverse event.

CONCLUSION

Manidipine is an adequate, highly effective, exempt of metabolic effects and safe option for treatment of stage I and II essential hypertensive patients with overweight or android obesity.

Treatment of obesity hypertension and diabetes syndrome

Obesity has been shown to be an independent risk factor for coronary heart disease. The insulin resistance associated with obesity contributes to the development of other cardiovascular risk factors, including dyslipidemia, hypertension, and type 2 diabetes. The coexistence of hypertension and diabetes increases the risk for macrovascular and microvascular complications, thus predisposing patients to cardiac death, congestive heart failure, coronary heart disease, cerebral and peripheral vascular diseases, nephropathy, and retinopathy. Body weight reduction increases insulin sensitivity and improves both blood glucose and blood pressure control. Metformin therapy also improves insulin sensitivity and has been associated with decreases in cardiovascular events in obese diabetic patients. Antihypertensive treatment in diabetics decreases cardiovascular mortality and slows the decline in glomerular function. However, pharmacological treatment should take into account the effects of the antihypertensive agents on insulin sensitivity and lipid profile. Diuretics and beta-blockers are reported to reduce insulin sensitivity and increase triglyceride levels, whereas calcium channel blockers are metabolically neutral and ACE inhibitors increase insulin sensitivity. For the high-risk hypertensive diabetic patients, ACE inhibition has proven to confer additional renal and vascular protection. Because hypertension and glycemic control are very important determinants of cardiovascular outcome in obese diabetic hypertensive patients, weight reduction, physical exercise, and a combination of antihypertensive and insulin sensitizers agents are strongly recommended to achieve target blood pressure and glucose levels.

Ultrasonography for the evaluation of visceral fat and cardiovascular risk

Visceral fat accumulation is associated with increased cardiovascular risk. Clinical evaluation of visceral fat is limited because of the lack of reliable and low-cost methods. To assess the correlation between ultrasonography and computed tomography (CT) for the evaluation of visceral fat, 101 obese women, age 50.5+/-7.7 years with a body mass index of 39.2+/-5.4 kg/m(2), were submitted to ultrasonograph and CT scans. Visceral fat measured by ultrasonography, 1 cm above the umbilical knot, showed a high correlation with CT-determined visceral fat (r=0.67, P<0.0001). The ultrasonograph method showed good reproducibility with an intra-observer variation coefficient of <2%. Both ultrasonograph and CT visceral fat values were correlated with fasting insulin (r=0.29 and r=0.27, P<0.01) and plasma glucose 2 hours after oral glucose load (r=0.22 and r=0.34, P<0.05), indicating that ultrasonography is a useful method to evaluate cardiovascular risk. A significant correlation was also found between visceral fat by CT and serum sodium (r=0.18, P<0.05). A ultrasonograph-determined visceral-to-subcutaneous fat ratio of 2.50 was established as a cutoff value to define patients with abdominal visceral obesity. This value also identified patients with higher levels of plasma glucose, serum insulin and triglycerides and lower levels of HDL-cholesterol, which are metabolic abnormalities characteristic of the metabolic syndrome. Our data demonstrate that ultrasonography is a precise and reliable method for evaluation of visceral fat and identification of patients with adverse metabolic profile.

Removal of Cu, Pb and Zn in an applied electric field in calcareous and non-calcareous soils

The pH dependency of the removal of Cu, Zn and Pb by electrodialytic soil remediation from different industrially polluted soils was examined. From 18 experiments performed with five different soils, it was found that the order of mobilization due to a pH decrease was Zn>Cu>Pb. It was found, too, that each of the elements was removed at higher soil pH in calcareous soils (about 12% carbonates) than in soils with a carbonate content of less than 3.7%. In soils rich in carbonates, precipitation of heavy metal carbonates is an important retention mechanism and the heavy metal carbonates are dissolved at higher pH values than the pH at which heavy metals are desorbed in non-calcareous soils. Thus, the relation between the soil pH and the mobility of the heavy metal in the electric field is not only dependent on the heavy metal in focus, but also on the fraction of the heavy metal precipitated as carbonates.

Distribution of cardiac geometric patterns on echocardiography in essential hypertension. Impact of two criteria of stratification

PURPOSE

To evaluate 2 left ventricular mass index (LVMI) normality criteria for the prevalence of left ventricular geometric patterns in a hypertensive population ( HT ).

METHODS

544 essential hypertensive patients, were evaluated by echocardiography, and different left ventricular hypertrophy criteria were applied: 1 - classic : men - 134 g/m2 and women - 110 g/m2; 2- obtained from the 95th percentil of LVMI from a normotensive population (NT).

RESULTS

The prevalence of 4 left ventricular geometric patterns, respectively for criteria 1 and 2, were: normal geometry - 47.7% and 39.3%; concentric remodelying - 25.4% and 14.3%; concentric hypertrophy - 18.4% and 27.7% and excentric hypertrophy - 8.8% and 16.7%, which confered abnormal geometry to 52.6% and 60.7% of hypertensive. The comparative analysis between NT and normal geometry hypertensive group according to criteria 1, detected significative stuctural differences,"( *p < 0.05):LVMI- 78.4 +/- 1.50 vs 85.9 +/-0.95 g/m2 *; posterior wall thickness -8.5 +/- 0.1 vs 8.9 +/- 0.05 mm*; left atrium - 33.3 +/- 0.41 vs 34.7 +/- 0.30 mm *. With criteria 2, significative structural differences between the 2 groups were not observed.

CONCLUSION

The use of a reference population based criteria, increased the abnormal left ventricular geometry prevalence in hypertensive patients and seemed more appropriate for left ventricular hypertrophy detection and risk stratification.

The losartan renal protection study--rationale, study design and baseline characteristics of RENAAL (Reduction of Endpoints in NIDDM with the Angiotensin II Antagonist Losartan)

The RENAAL Study is a double-blind, placebo-controlled trial to evaluate the renal protective effects of losartan in Type 2 diabetic patients with nephropathy. The study has enrolled 1513 patients and is expected to continue for 3.5 years after the last patient has been entered. Eligible patients must have a urinary albumin:creatinine ratio of at least 300 mg/g and serum creatinine between 1.3 to 3.0 mg/dL. Eligible hypertensive or normotensive patients are randomised to receive either losartan or placebo, in addition to their existing antihypertensive therapy. Medications that block angiotensin production or action, are excluded. The primary endpoint is a composite of the time to first event of doubling of serum creatinine, end-stage renal disease, or death; secondary endpoints include cardiovascular events, progression of renal disease, and changes in proteinuria; tertiary endpoints include quality of life, healthcare resource utilisation, and amputations. Patients include Caucasians (48.6%), Blacks (15.2%), Asians (16.7%), and Hispanics (18.2%). Baseline urinary albumin:creatinine ratio and serum creatinine levels average 1867 mg/g and 1.9 mg/dL, respectively. Mean systolic and diastolic blood pressures are 153 and 82 mmHg, respectively. RENAAL will document whether blockade of the AII receptor with losartan produces clinical benefits in patients with Type 2 diabetes and nephropathy.

Effect of blood glucose on left ventricular mass in patients with hypertension and type 2 diabetes mellitus

The aim of our prospective study was to evaluate the influence of blood glucose (BG) on left ventricular mass and diastolic function in patients with hypertension and type 2 diabetes mellitus (DM). Fifty-six hypertensive patients with type 2 DM and 26 healthy controls were investigated. They were submitted to echocardiography (ECHO) with Doppler and we calculated the mean of their fasting BG values, office blood pressure (OBP), cholesterol and fractions, and triglycerides during the previous 4 years. The diabetic patients were then followed-up for 1 year with OBP, fasting BG, and lipids measured every 2 months. After this period, the patients were again submitted to ECHO and in 22 patients (group I [GI]), reductions greater than 10% in left ventricular mass index (LVMI) were observed (122 +/- 35 v 89 +/- 23 g/m2, P < .01), whereas increases greater than 10% (group II [GII], n = 17) (94 +/- 18 v 115 +/- 27 g/m2, P < .01) or no changes (group III [GIII], n = 17) (98 +/- 16 v 99 +/- 18 g/m2, NS) in LVMI were detected in the remaining patients. The OBP values did not change during the follow-up. In GI the reduction of LVMI was associated with a BG fall from 178 +/- 36 to 147 +/- 30 mg/dL (P < .01) and a correlation was observed between BG and LVMI percent variations (delta) (r = 0.48, P < .01). No important changes in left ventricular diastolic function were observed during the follow-up. We concluded that the improvement in glycemic control may contribute to LVH regression in hypertensive patients with type 2 DM.

Blood pressure and sympathetic activity in normotensive aviators during short-haul fixed-wings flights

BACKGROUND

In order to evaluate the impact of in-flight stress on BP and sympathetic activity during a short fixed-wing flight, we have studied 18 healthy and normotensive commercial captain aviators, aged 37.5 +/- 4.9 yr.

METHODS

The protocol consisted of a 120-min flight period, divided into segments of pre-flight, take off, mid-cruise, approach and landing, and a 120-min control period. In both flight and control periods, all subjects underwent BP monitoring, heart rate recording and urine collection for catecholamines.

RESULTS

Systolic and diastolic BP (SBP/DBP) were higher during the flight, as a whole, when compared with the control period (134 +/- 11 vs. 121 +/- 8 mmHg, p < 0.05 and 84 +/- 8 vs. 76 +/- 9 mmHg, p < 0.05, respectively). During the flight period, SBP increased in the pre-flight, take-off, approach and landing segments, whereas DBP increased in the take-off, mid-cruise, approach and landing segments. Heart rate did not change in any flight segment. Urinary catecholamines increased during the flight period in comparison to control period 0.20 (0.10 1.8) mg x mg-1 creatinine vs. 0.10 (0.10-1.0) mg x mg-1 creatinine; p < 0.05).

CONCLUSION

We conclude that inflight stress increases BP of the normotensive aviators by sympathetic activation during short-haul flights.

Angiotensin II antagonists for hypertension: are there differences in efficacy?

We compared the antihypertensive efficacy of available drugs in the new angiotensin-II-antagonist (AIIA) class. The antihypertensive efficacy of losartan, valsartan, irbesartan, and candesartan was evaluated from randomized controlled trials (RCT) by performing a metaanalysis of 43 published RCT. These trials involved AIIA compared with placebo, other antihypertensive classes, and direct comparisons between AIIA. A weighted-average for diastolic and systolic blood pressure reduction with AIIA monotherapy, dose titration, and with addition of low-dose hydrochlorothiazide (HCTZ) were calculated. Weighted-average responder rates were also determined. The metaanalysis assessed a total of 11,281 patients. The absolute weighted-average reductions in diastolic (8.2 to 8.9 mm Hg) and systolic (10.4 to 11.8 mm Hg) blood pressure reductions (not placebo-corrected) for AIIA monotherapy were comparable for all AIIA. Responder rates for AIIA monotherapy were 48% to 55%. Dose titration resulted in slightly greater blood pressure reduction and an increase in responder rates to 53% to 63%. AIIA/hydrochlorothiazide combinations produced substantially greater reduction in systolic (16.1 to 20.6 mm Hg) and diastolic (9.9 to 13.6 mm Hg) blood pressure reductions than AIIA monotherapy and responder rates for AIIA/HCTZ combinations were 56% to 70%. This comprehensive analysis shows comparable antihypertensive efficacy within the AIIA class, a near-flat AIIA-dose response when titrating from starting to maximum recommended dose, and substantial potentiation of the antihypertensive effect with addition of HCTZ.

Intima-media thickness evaluation by B-mode ultrasound. Correlation with blood pressure levels and cardiac structures

The aim of this study was to analyze the thickness of the intima-media complex (IMC) using a noninvasive method. The carotid and femoral common arteries were evaluated by noninvasive B-mode ultrasound in 63 normotensive and in 52 hypertensive subjects and the thickness of the IMC was tested for correlation with blood pressure, cardiac structures and several clinical and biological parameters. The IMC was thicker in hypertensive than in normotensive subjects (0.67 +/- 0.13 and 0.62 +/- 0.16 vs 0.54 +/- 0.09 and 0.52 +/- 0.11 mm, respectively, P<0.0001). In normotensive patients, the simple linear regression showed significant correlations between IMC and age, body mass index and 24-h systolic blood pressure for both the carotid and femoral arteries. In hypertensives the carotid IMC was correlated with age and 24-h systolic blood pressure while femoral IMC was correlated only with 24-h diastolic blood pressure. Forward stepwise regression showed that age, body mass index and 24-h systolic blood pressure influenced the carotid IMC relationship (r2 = 0.39) in normotensives. On the other hand, the femoral IMC relationship was influenced by 24-h systolic blood pressure and age (r2 = 0.40). In hypertensives, age and 24-h systolic blood pressure were the most important determinants of carotid IMC (r2 = 0.37), while femoral IMC was influenced only by 24-h diastolic blood pressure (r2 = 0.10). There was an association between carotid IMC and echocardiographic findings in normotensives, while in hypertensives only the left posterior wall and interventricular septum were associated with femoral IMC. We conclude that age and blood pressure influence the intima-media thickness, while echocardiographic changes are associated with the IMC.

Guidelines for treatment of hypertension in Latin America: the Brazilian experience

Treatment of hypertension in most countries of Latin America, in general, follows the recommendations of guidelines generated by both: the National Institute of Health of the United States of America (Joint National Committee) and the World Health Organization together with the International Society of Hypertension. Few countries of Latin America, as Brazil, in the last years have generated their own guidelines for detection, evaluation and treatment of hypertension. Its described the brazilian experience in generates and distributes a guideline for treatment of hypertensive. It is also discussed the difficulties and the needs to a successfully implement the recommendations of guideline for treatment of chronic diseases, such as hypertension.

Risk of linear growth retardation during the first two years of life: a new approach

OBJECTIVE

Estimate the risk of linear growth retardation during the first two years of life as a result of household social vulnerability.

SETTING

Families who participated in the National Supplementary Feeding Program in the Health Units of the metropolitan area of the city of São Paulo, Brazil.

SUBJECTS

Four hundred and thirty-one index-babies, weighing more than 2500 grams and who had at least one young sibling under the age of five who participated in the Program for a minimum of two years.

DESIGN

The index-babies were divided into two cohorts: 74.9% coming from 'non-stunted families' (those with normal height siblings) and 25.1% from 'stunted families' (those with stunted siblings). The study design allowed the observation of growth patterns over a period of time and over a childhood growth range. It also allowed the estimation of the stunting and the recovery probabilities at each moment, not only within a given age range. The transition probabilities between 'stunted' and 'non-stunted' index-babies were estimated. The relative risk ratio (RR) was also calculated.

RESULTS

The prevalence of stunting in the index-babies at 12 and 24 months of age was significantly greater in 'stunted families' (P < 0.001). Probabilities of becoming stunted began to differ from the fourth month on (confidence intervals non-superposed), and were higher for index-babies from 'stunted families'. The recovery probability of a stunted child was smaller in the 'stunted families' cohort after the 12th month of age. From the third month on, the (RR) was always above 1.5.

CONCLUSION

The family context exposes children to failure in growth in the first two years of life when there are already stunted children in the household.

A randomised, double-blind trial comparing mibefradil and amlodipine: two long-acting calcium antagonists with similar efficacy but different tolerability profiles. Mibefradil International Study Group

OBJECTIVE

To compare the efficacy and tolerability of mibefradil and amlodipine in patients with uncomplicated mild-to-moderate essential hypertension.

DESIGN

A double-blind, randomised, parallel group multicentre trial.

METHODS

239 patients received 50 mg mibefradil or 5 mg amlodipine for 4 weeks, followed by a forced titration to 100 mg mibefradil or 10 mg amlodipine for an additional 8 weeks. Patients then entered a 4-week withdrawal period either on therapy or switched to placebo.

RESULTS

Statistically equivalent reductions in trough sitting diastolic blood pressure (SDBP) were observed after 12 weeks of once-daily treatment with 50/100 mg mibefradil (-11.5 +/- 8.2 mm Hg) and 5/10 mg amlodipine (-13.2 +/- 7.9 mm Hg). The number of patients with normalised SDBP (< or = 90 mm Hg) increased 23.3% in the mibefradil group and 19.5% in the amlodipine group (approximately 74% in both groups). Patients on mibefradil or amlodipine during the withdrawal period had significantly larger decreases in SDBP than those on placebo. Patients on mibefradil had a decrease in heart rate of 5.5 bpm. Patients on amlodipine had no change in heart rate; however, cessation of amlodipine was associated with a decrease in heart rate.

CONCLUSIONS

Mibefradil was as effective as amlodipine in reducing BP; both compounds were effective treatments of hypertension.

Role of substance P in blood pressure regulation in salt-dependent experimental hypertension

The participation of substance P in the pathogenesis of five models of experimental hypertension, ie, DOCA-salt, subtotal nephrectomy, one-kidney-one clip renovascular, two-kidney-one clip renovascular, and spontaneous hypertension, was evaluated via an acute infusion of a newly synthesized potent, specific nonpeptide antagonist of substance P at the NK-1 receptor, the agent CP 96,345. In conscious unrestrained rats, CP 96,345 induced significant and sustained increases in mean arterial pressure of DOCA-salt, subtotal nephrectomy, and one-kidney-one clip renovascular hypertensive rats but only small and nonsignificant changes in blood pressure of two-kidney-one clip renovascular and spontaneously hypertensive rats. CP 96,345 had no effect on the blood pressure of sham-treated controls and Wistar-Kyoto rats. This NK-1 receptor antagonist did not significantly affect the heart rate of any experimental model studied. The data suggest that endogenous substance P may act as a partial counterregulatory mechanism against vasoconstriction in models of salt-dependent hypertension.

Altered blood pressure profile, autonomic neuropathy and nephropathy in insulin-dependent diabetic patients

To evaluate the relationship between autonomic neuropathy (AN) and nephropathy we measured 24-h blood pressure (BP) and overnight urinary albumin excretion (UAE) in 38 patients with insulin dependent diabetes mellitus (IDDM). Autonomic function was evaluated by the heart rate response to deep breathing. Valsalva maneuver, heart rate at rest and BP variation with posture. Sympathetic cutaneous reflex was also tested in both inferior and superior limbs. Patients with mean day diastolic BP (DDBP) < or = 90 mmHg without AN (N = 15) compared to 12 normal controls had similar BP values, but compared to those with DDBP < or = 90 mmHg and AN (N = 12) they had lower night diastolic BP (NDBP) (66 +/- 4.8 vs 72 +/- 8.8 mmHg: p < 0.05) and UAE (9.8 +/- 2.3 vs 107.2 +/- 3.5 micrograms/min; p < 0.001). No difference in DDBP was observed between these two diabetic groups (80 +/- 3.9 vs 83 +/- 6.1 mmHg). Of the 11 patients with DDBP > 90 mmHg, only three were free of AN and only two of the eight with AN where free of diabetic nephropathy. The percentage day/night changes in systolic BP were lower in patients with AN (13 vs 7.9%; p < 0.05) and were inversely related to autonomic score, used as an index of the degree of autonomic dysfunction (r = -0.48; p < 0.01) and to UAE (r = -0.39; p < 0.05). Furthermore, UAE correlated with autonomic score (r = 0.69; p < 0.0001) and with NDBP (r = 0.44; p < 0.01). Our results show that AN in IDDM patients is associated with a reduced nocturnal fall in BP and suggest a pathogenic role of autonomic dysfunction in the development of diabetic nephropathy, possibly favoring both BP elevation during the night and increases in intraglomerular pressure.