Airway Phenotypes and Nocturnal Wearing of Dentures in Elders with Sleep Apnea

The objective of this study was to examine to what extent the anatomic characteristics of the upper airway can influence the effect of nocturnal wearing of dentures on the sleep of edentulous elders with untreated sleep apnea. This study used the data from a randomized crossover clinical trial and an exploratory approach to address its objectives. Cone beam computed tomography scans of 65 edentulous individuals (female, n = 37; male, n = 28; mean ± SD age, 74.54 ± 6.42 y) with untreated obstructive sleep apnea (OSA) were used to identify anatomic variables. Polysomnography data were collected by means of one portable overnight recording. The respiratory variable values, including apnea-hypopnea index (AHI), with and without denture worn during sleep were used to calculate the change. Statistical analyses included multiple linear regressions, cluster analysis, and binary logistic regressions. A receiver operator characteristic curve was used to illustrate the accuracy of the statistical model. The regression model explained 15.8% (R²) of AHI change. An increase in the lateral dimension of the minimum cross-sectional area was associated with a decrease in AHI, oxygen desaturation index, and respiratory arousal index changes (P ≤ 0.041). Furthermore, an increase in the length of the hypopharynx was associated with an increase in AHI and oxygen desaturation index changes (P ≤ 0.027). An increase in the lateral dimension of the minimum cross-sectional area of the upper airway was associated with a decreased likelihood of being in the group having a worsened AHI (odds ratio = 0.85; 95% CI, 0.76 to 0.95; P = 0.006). An increase in the length of the oropharynx was associated with an increased likelihood of having increased AHI (odds ratio = 1.10; 95% CI, 1.01 to 1.20; P = 0.026). The nocturnal aggravation of respiratory variables in edentulous individuals with OSA who wear dentures at night can be linked to certain anatomic characteristics of the upper airway. Replication of these findings may open novel avenues for personalized advice regarding nocturnal wearing of dentures in edentulous individuals with OSA (ClinicalTrials.gov: NCT01868295).

Reliability of CT Angiography in Cerebral Vasospasm: A Systematic Review of the Literature and an Inter- and Intraobserver Study

BACKGROUND AND PURPOSE

Computed tomography angiography offers a non-invasive alternative to DSA for the assessment of cerebral vasospasm following subarachnoid hemorrhage but there is limited evidence regarding its reliability. Our aim was to perform a systematic review (Part I) and to assess (Part II) the inter- and intraobserver reliability of CTA in the diagnosis of cerebral vasospasm.

MATERIALS AND METHODS

In Part I, articles reporting the reliability of CTA up to May 2018 were systematically searched and evaluated. In Part II, 11 raters independently graded 17 arterial segments in each of 50 patients with SAH for the presence of vasospasm using a 4-category scale. Raters were additionally asked to judge the presence of any moderate/severe vasospasm (≥ 50% narrowing) and whether findings would justify augmentation of medical treatment or conventional angiography ± balloon angioplasty. Four raters took part in the intraobserver reliability study.

RESULTS

In Part I, the systematic review revealed few studies with heterogeneous vasospasm definitions. In Part II, we found interrater reliability to be moderate at best (κ ≤ 0.6), even when results were stratified according to specialty and experience. Intrarater reliability was substantial (κ > 0.6) in 3/4 readers. In the per arterial segment analysis, substantial agreement was reached only for the middle cerebral arteries, and only when senior raters' judgments were dichotomized (presence or absence of ≥50% narrowing). Agreement on the medical or angiographic management of vasospasm based on CTA alone was less than substantial (κ ≤ 0.6).

CONCLUSIONS

The diagnosis of vasospasm using CTA alone was not sufficiently repeatable among observers to support its general use to guide decisions in the clinical management of patients with SAH.

Chemical characterization and antimicrobial activity of Campomanesia aurea against three strains of Listeria monocytogenes

The essential oil (EO) composition of leaves of Campomanesia aurea was analyzed by GC-MS. The plant was collected in April (EOA) and October (EOO) in São Francisco de Assis/RS. The essential oils were obtained by hydrodistillation in a modified Clevenger apparatus. The yields were 4.44% in April, and 6.15%, in October. Thirty-one compounds were identified in EOA, accounting for 96.87% of the total, and twenty-eight compounds were identified in EOO, accounting for 99.46% of the total. For EOA, the major identified monoterpene was p-cymene (8.33%) and the major identified sesquiterpene was α-cadinol (10.72%), while regarding EOO the major identified monoterpene was repeatedly Terpinolene (3.43%), whereas the major identified sesquiterpene was α-cadinol (12.79%). The antibacterial activity of the essential oil was evaluated against the three Listeria monocytogenes from the American Type Culture Collection (strains ATCC 7644, 19114 and 13932). The essential oil showed a MIC of 10 mg/mL against the strains ATCC 7644 and 19114, with bacteriostatic effect of 20 mg/mL and a MIC of 20 mg/mL for ATCC 13932. Regarding the antibiofilm activity, o EOO showed the best results with an inhibition of 90% in the sessile growth with an applied concentration of 4.0 mg/mL.

[Guidelines for methacholine provocation testing]

Bronchial challenge with the direct bronchoconstrictor agent methacholine is commonly used for the diagnosis of asthma. The "Lung Function" thematic group of the French Pulmonology Society (SPLF) elaborated a series of guidelines for the performance and the interpretation of methacholine challenge testing, based on French clinical guideline methodology. Specifically, guidelines are provided with regard to the choice of judgment criteria, the management of deep inspirations, and the role of methacholine bronchial challenge in the care of asthma, exercise-induced asthma, and professional asthma.

Purification of an Immunoadjuvant Saponin Fraction from Quillaja brasiliensis Leaves by Reversed-Phase Silica Gel Chromatography

Saponins include a large variety of molecules that find several applications in pharmacology. The use of Quillaja saponaria saponins as immunological adjuvants in vaccines is of interest due to their capacity to stimulate both humoral and cellular responses. The congener species Q. brasiliensis has saponins with chemical similarities and adjuvant activity comparable to that of Q. saponaria fraction Quil-A^®, with additional advantages of showing lower toxicity and reduced hemolytic activity. Here we describe in detail the methods for preparing the aqueous extract from Q. brasiliensis leaves, as well as the purification of the bioactive saponin fraction QB-90 using silica reversed-phase chromatography.

Papel do agente comunitário de saúde no controle do estoque domiciliar de medicamentos em comunidades atendidas pela estratégia de saúde da família

O objetivo deste estudo foi avaliar o estoque domiciliar de medicamentos em comunidades atendidas pela Estratégia de Saúde da Família (ESF) em município localizado no Sul do Brasil. Foram amostrados 10% dos domicílios de cinco ESF. Os dados foram coletados por Agentes Comunitários de Saúde (ACS) através de questionário adaptado. A idade média dos entrevistados foi de 42 anos e dos moradores foi de 16 anos, destes 51% eram mulheres. Foi observada renda de 1 a 3 salários mínimos (69,1%), e escolaridade de 0 a 4 anos de estudo (42%). Dos domicílios visitados, 98,7% apresentavam pelo menos um medicamento estocado. Dos 533 lugares de guarda averiguados, 43,5% estava exposto ao calor, 39,6% a umidade, 16,5% a luz. Dos 2.717 medicamentos encontrados, 6,9% estavam vencidos, 35,3% não estavam dentro da embalagem secundária, quando esta se aplica, 67,9% não continham a presença de bula. Os fármacos analgésicos foram os mais prevalentes no estoque (21%). Os resultados nos levam a concluir que há necessidade de equipe multiprofissional para a promoção de saúde e a racionalização dos estoques domiciliares de medicamentos, sendo que o ACS é um profissional indispensável para a promoção do uso racional de medicamentos.

Analysis of pharmaceutical assistance in the Taquari Valley, Rio Grande do Sul: profile of service users and access to medication

Pharmaceutical assistance concerns actions developed by the pharmacist and other professionals with the purpose of promoting, protecting and restoring health. Medications are an essential tool in this process that focuses on the access to, and the rational use of, drugs. This study is aimed at evaluating the Pharmaceutical Assistance provided by Municipal Health Offices in the Taquari Valley, Rio Grande do Sul. For this purpose, 2,794 users of public pharmacies were interviewed and data was analyzed using descriptive statistics. The users of the public pharmacies were mainly female and individuals with low educational level and income. On average, 2.41 drugs were prescribed per medical prescription and 1.72 of these were procured. Out of the total medicines prescribed, 76.5% were listed in the municipal standard drug list (SDL). Medication was prescribed by its generic name in 81.8% of the prescriptions. Antibiotics and injections were prescribed in 11.9% and 4.0% of the prescriptions, respectively. Users' access to information is partial, which can impair adherence to the treatment. Thus, it is possible to conclude that review of the service is necessary for it to be effective.

Adjuvant activity of Quillaja brasiliensis saponins on the immune responses to bovine herpesvirus type 1 in mice

The chemical characterization of aqueous extracts (AE) of barks, leaves and branches and the saponin fraction denominated QB-90 obtained from Quillaja brasiliensis, a native species from Southern Brazil, show remarkable similarities to Quillaja saponaria saponins which are known as adjuvants in vaccine formulations. In vivo toxicity assays of AE and QB-90 showed not to be lethal for mice in doses ranging from 50 to 1600 microg and 50-400 microg, respectively. Experimental vaccines prepared with bovine herpesvirus type 1 (BHV-1) antigen and either AE (barks 100 microg, leaves 400 microg, branches 400 microg) or QB-90 (100 microg) were able to enhance the immune responses of mice in a comparable manner to saponins from Q. saponaria (QuilA, 100 microg). BHV-1 specific IgG, IgG1 and IgG2a antibody levels in serum were also significantly enhanced by AE, QB-90 and QuilA compared to control group (p<0.05). These results showed that AE and QB-90 from Q. brasiliensis are potential candidates as adjuvants in vaccines.

Constituents from leaves of Quillaja brasiliensis

A new abietane diterpene, the 19-O-beta-D-glucopyranoside of 16-hydroxylambertic acid was isolated from the leaves of Quillaja brasiliensis together with a known prosapogenin (3-O-beta-D-glucuronopyranosyl-quillaic acid), quercetin, and rutin. The new compound was identified by chemical and spectroscopic methods.

Comparative evaluation of the efficacy and safety of two doses of terbinafine (500 and 1000 mg day-1) in the treatment of cutaneous or lymphocutaneous sporotrichosis. Vergleichende Bewertung der Wirksamkeit und Sicherheit zweier Terbinafin-Dosierungen (500 und 1000 mg/Tag) in der Therapie der kutanen und lymphokutanen Sporotrichose

The aim of this study was to evaluate the safety and efficacy of oral terbinafine (500 and 1000 mg day(-1)) in the treatment of cutaneous or lymphocutaneous sporotrichosis. A culture for Sporothrix schenckii was required for inclusion into this multicentre, randomized, double-blind, parallel-group study. Patients received either 250 mg b.i.d. or 500 mg b.i.d. oral terbinafine for up to a maximum of 24 weeks and were assessed up to 24 weeks post-treatment. The main efficacy outcome measure was cure, defined as no lesion and absence of adenopathy at the end of follow-up. Adverse events (AEs), laboratory tests, vital signs and ophthalmological examinations were also assessed. Sixty-three patients (14-85 years of age) were treated with 500 mg day(-1) (n = 28) or 1000 mg day(-1) terbinafine (n = 35). The majority of patients were cured after 12-24 weeks of treatment, and the response was dose-dependent throughout the study and at the end of follow-up. The cure rate was significantly higher in patients treated with 1000 mg day(-1) terbinafine compared with those treated with 500 mg day(-1) terbinafine (87% vs. 52%, respectively; P = 0.004). There were no cases of relapse after 24 weeks of follow-up in the 1000 mg day(-1) terbinafine group, compared with six relapses in the terbinafine 500 mg day(-1) group. Terbinafine was well tolerated and the frequency of drug-related AEs was slightly higher in the 1000 mg treatment group. Both doses of terbinafine were well-tolerated and effective for the treatment of sporotrichosis. The 1000 mg day(-1) terbinafine dose was more efficacious than 500 mg day(-1) in the treatment of cutaneous or lymphocutaneous sporotrichosis.

Reliability of a quantification imaging system using magnetic resonance images to measure cartilage thickness and volume in human normal and osteoarthritic knees

OBJECTIVE

The aim of this study was to evaluate the reliability of a software tool that assesses knee cartilage volumes using magnetic resonance (MR) images. The objectives were to assess measurement reliability by: (1) determining the differences between readings of the same image made by the same reader 2 weeks apart (test-retest reliability), (2) determining the differences between the readings of the same image made by different readers (between-reader agreement), and (3) determining the differences between the cartilage volume readings obtained from two MR images of the same knee image acquired a few hours apart (patient positioning reliability).

METHODS

Forty-eight MR examinations of the knee from normal subjects, patients with different stages of symptomatic knee osteoarthritis (OA), and a subset of duplicate images were independently and blindly quantified by three readers using the imaging system. The following cartilage areas were analyzed to compute volumes: global cartilage, medial and lateral compartments, and medial and lateral femoral condyles.

RESULTS

Between-reader agreement of measurements was excellent, as shown by intra-class correlation (ICC) coefficients ranging from 0.958 to 0.997 for global cartilage (P<0.0001), 0.974 to 0.998 for the compartments (P<0.0001), and 0.943 to 0.999 for the condyles(P<0.0001). Test-retest reliability of within-reader data was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001). Patient positioning reliability was also excellent, with Pearson correlation coefficients ranging from 0.978 to 0.999 (P<0.0001).

CONCLUSIONS

The results of this study establish the reliability of this MR imaging system. Test-retest reliability, between-reader agreement, and patient positioning reliability were all extremely high. This study represents a first step in the overall validation of an imaging system designed to follow progression of human knee OA.

Analysis of pressure distribution at the body-seat interface in able-bodied and paraplegic subjects using a deformable active contour algorithm

In this paper, a semi-automatic method for segmenting pressure distribution image-based data at the body-seat interface is presented. The purpose of this work was to estimate the surface and the load supported by the ischial tuberosity (IT) region. The proposed method involves three steps: (1) detecting the IT region using a pressure-distribution image gradient; (2) estimating the contour of the IT region by an iterative active contour algorithm and finally (3) estimating the percentage of the surface and the weight-bearing of the IT region in a group of able-bodied (AB) and spinal-cord injury (SCI) subjects. It was found in this study that the weight bearing on the IT for the spinal-cord injured group is distributed on half the surface in comparison with the AB group or the powered wheelchair users groups. The findings of this study provide insights concerning pressure distribution in sitting for the paraplegic and able-bodied.

Fluvoxamine treatment of a child with severe PDD: a single case study

Recent reports suggest that selective serotonin reuptake inhibitors (SSRIs) are useful in the treatment of individuals with autism and other pervasive developmental disorders. We report on a single case study of the use of fluvoxamine with a 7-year-old Caucasian girl with severe pervasive developmental disorder. Our findings indicate that fluvoxamine was significantly effective in reducing stereotypical, repetitive behaviors, anxiety, and aggression and in improving prelinguistic and social behaviors. Our results indicate that the use of the SSRIs as a platform for the long-term habilitation of these children should be considered, but further studies are required to establish the efficiency of fluvoxamine for the treatment of children with autism.

pH-controlled inclusion and release of oxyanions by dendrimers bearing methyl orange moieties

We report the synthesis of POPAM dendrimers, bearing up to 64 chromophores at their periphery. For these dendrimers, a radiotracer technique was used to study the liquid-liquid partition of pertechnetate and (14)C-labeled nucleotides in trichloromethane-aqueous systems. Inclusion and release of guest molecules can be controlled by changing the pH. The extraction efficacy increases with rising generation number.

Naltrexone treatment of dementia with severe self-injurious behaviors: a single case study

The results of studies of the opiate antagonist Naltrexone (NLTX) in the treatment of self-injurious behavior (SIB) in various psychiatric populations have been equivocal. The majority of studies has relied on small samples, many of which lacked scientific rigor and none of which occurred in a nursing facility. The present study investigates the use of NLTX on a patient with severe SIB who resides in a nursing facility. The patient is a 38-year-old male with a history of heavy drug and alcohol abuse. He has been in either a state hospital or nursing facility since age 21. The patient overdosed on alcohol and drugs in 1990, which led to a prolonged coma with organic brain damage.

Enzymatic removal of phenols from aqueous solutions by Coprinus cinereus peroxidase and hydrogen peroxide

The fungal enzyme Coprinus cinereus peroxidase (CIP) can be used for the removal of toxic phenols from water. After treating aqueous solutions of phenols with CIP and H2O2 the phenols polymerized and precipitated. The decrease in phenol concentration was investigated for 10 different phenols. At neutral pH, the investigated phenols were in general removed with high efficiency.

[A rare cause of bone pain in children: primary hyperparathyroidism caused by adenoma]

BACKGROUND

Primary hyperparathyroidism is rare in children and adolescents. Bone changes may produce pain in the back or extremities, but this is rarely the first symptom of the disease.

CASE REPORT

A 13 year-old girl suffered from pain in the back and lower extremities. Progressive bilateral genu valgum appeared. One year later, she became lame because of the deformity. ECG showed cardiac arrhythmia with atrial extra systoles. The serum calcium concentrations were 3.36 and 3.8 mmol/l, phosphate 0.76 mmol/l and alkaline phosphatases 6,612 U/I (N: 90-300). Urinary excretion of calcium was 17 and 26 mg/kg/day and the renal tubular reabsorption of phosphate was 77%. Radiological studies revealed resorption of subperiosteal bone, best seen along the margins of the phalanges, demineralization of the skull vault, bilateral coxa vara and zones of calcification on knee metaphyses. The serum concentration of parathyroid hormone (PTH) was 1,066 pg/ml (N: 10-55) and that of 1-25(OH)2D3 was 125 ng/ml (N: 20-80). Ultrasonography showed a heterogeneous mass, 23 x 15 mm, suggesting a parathyroid adenoma. This adenoma was independent of the left inferior parathyroid. It was removed and the biochemical findings gradually returned to normal. Bone demineralization also disappeared and the knee deformities were surgically corrected 9 months later.

CONCLUSIONS

Bone changes may occasionally cause severe pain, indicating demineralization and hypercalcemia: hyperparathyroidism is one cause of such changes.