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Agitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD.A naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration.IL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. 'Effect of time', where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time.Results suggest that IL could be a safe and effective option to manage agitation in PD.

Background: Medial column instability is a frequent finding in patients with flatfeet and hallux valgus, within others. The etiology of hallux valgus is multifactorial, and medial ray axial rotation has been mentioned as having an individual role. Our objective was to design a novel cadaveric foot model where we could re-create through progressive medial column ligament damage some components of a hallux valgus deformity. Methods: Ten fresh-frozen lower leg specimens were used, and fluorescent markers were attached in a multisegment foot model. Constant axial load and cyclic tibial rotation (to simulate foot pronation) were applied, including pull on the flexor hallucis longus tendon (FHL). We first damaged the intercuneiform (C1-C2) ligaments, second the naviculocuneiform (NC) ligaments, and third the first tarsometatarsal ligaments, leaving the plantar ligaments unharmed. Bony axial and coronal alignment was measured after each ligament damage. Statistical analysis was performed. Results: A significant increase in pronation of multiple segments was observed after sectioning the NC ligaments. Damaging the tarsometatarsal ligament generated small supination and varus changes mainly in the medial ray. No significant change was observed in axial or frontal plane alignment after damaging the C1-C2 ligaments. The FHL pull exerted a small valgus change in segments of the first ray. Discussion: In this biomechanical cadaveric model, the naviculocuneiform joint was the most important one responsible for pronation of the medial column. Bone pronation occurs along the whole medial column, not isolated to a certain joint. Flexor hallucis longus pull appears to play some role in frontal plane alignment, but not in bone rotation. This model will be of great help to further study medial column instability as one of the factors influencing medial column pronation and its relevance in pathologies like hallux valgus. Clinical Relevance: This cadaveric model suggests a possible influence of medial column instability in first metatarsal pronation. With a thorough understanding of a condition’s origin, better treatment strategies can be developed.

Introduction: Aesthetic applications of botulinum toxin type A (BoNT-A) may lead to some complications, including unwanted muscle paralysis. Moreover, BoNT-A effects may last several months, and there is no medical intervention so far to accelerate muscle function recovery. Case Report: A female patient with a movement disorder of the mimic muscles resulting from BoNT-A injections received daily sessions of photobiomodulation therapy (PBMT). A fast improvement in both facial asymmetry and muscle function was noted within a few weeks. After nine weeks, almost complete recovery was achieved. Conclusion: According to the current case, PMBT seems to be an effective intervention to accelerate muscle function recovery following BoNT-A use.

El lenguaje escrito como medio de comunicación e intercambio de información ha tomado gran importancia en la sociedad y más aún con el desarrollo de la tecnología. El presente trabajo tiene como objetivo generar factores que contribuyan en la comprensión del lenguaje escrito en estudiantes con hipoacusia. La metodología tiene un enfoque mixto, descriptivo y de campo, orientada en el análisis e interpretación de los resultados de forma cualitativa y cuantitativa, en los cuales se observaron un déficit en el nivel de las destrezas que implica el manejo del lenguaje verbal de tipo escrito. El aporte principal de la propuesta es crear un software educativo que facilite el logro de las competencias del lenguaje escrito en las niñas, niños y jóvenes que poseen discapacidad auditiva.

The anatomical territory where the neuromuscular junctions are grouped corresponds to the innervation zone (IZ). This can be located in-vivo using high-density electromyography and voluntary muscle contractions. However, in patients with motor impairment, the use of contractions imposed by electrical stimulation (ES) could be an alternative. The present study has two aims: Firstly, to describe the location of the IZ in-vivo of the medial gastrocnemius (MG) using imposed contractions by ES. Secondly, to compare the usefulness of M-waves and H-reflexes to localize the IZs. Twenty-four volunteers participated (age: 21.2 ± 1.5 years). ES was elicited in the tibial nerve to obtain M-waves and H-reflexes in the MG. The evaluators used these responses to localize the IZs relative to anatomical landmarks. M-wave and H-reflex IZ frequency identification were compared. The IZs of the MG were mostly located in the cephalocaudal direction, at 39.7% of the leg length and 34% of the knee’s condylar width. The IZs were most frequently identified in the M-wave (83.33%, 22/24) compared to the H-reflex (8.33%, 2/24) (p > 0.001). Imposed contractions revealed that the IZ of the MG is located at 39.7% of the leg length. To locate the IZs of the MG muscle, the M-wave is more useful than the H-reflex.

To evaluate the effectiveness of the use of adjuvant ozone therapy in the healing process of wounds resulting from periodontal and peri-implant surgical procedures by answering the following focused question: "Can adjuvant ozone therapy improve wound healing outcomes related to periodontal and peri-implant surgical procedures?".MEDLINE (via PubMed), EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched, without language restriction, for peer-reviewed articles published until 23 March 2022, in addition to manual search. Only controlled clinical trials (randomized or not) were considered. The risk of bias was evaluated by the Cochrane risk-of-bias tool for RCTs - version 1 (RoB1). Data were pooled into evidence tables and a descriptive summary was presented.Of the 107 potentially eligible records, only seven studies were included. Four addressed free/deepithelialized gingival grafts with a palatal donor area, two evaluated implant sites, and one comprised gingivectomy and gingivoplasty. A total of 225 patients were evaluated in the included studies, considering control and test groups (ozone and other adjuvant therapies for comparison). Ozone therapy had a positive effect on outcomes directly or indirectly related to periodontal/peri-implant surgical wound healing. Furthermore, it could also increase the stability of immediately loaded single implants installed in the posterior mandible.In general, ozone therapy seems to both accelerate the healing processes of periodontal/peri-implant wounds and increase the secondary stability of dental implants; however, considering the limited evidence available and the risk of bias in the included studies (none classified as low risk), a definitive conclusion cannot be drawn.

Background COVID-19 has hindered hepatitis C virus (HCV) and HIV screening, particularly in marginalised groups, who have some of the highest rates of these conditions and lowest rates of COVID-19 vaccination. We assessed the acceptability of combining HCV testing with COVID-19 vaccination in a centre for addiction services (CAS) in Barcelona and a mobile testing unit (MTU) in Madrid, Spain. Methods From 28/09/2021 to 30/06/2022, 187 adults from marginalised populations were offered HCV antibody (Ab) testing along with COVID-19 vaccination. If HCV Ab+, they were tested for HCV-RNA. MTU participants were also screened for HIV. HCV-RNA+ and HIV+ participants were offered treatment. Data were analysed descriptively. Results Findings show how of the 86 CAS participants: 80 (93%) had been previously vaccinated for COVID-19, of whom 72 (90%) had the full first round schedule; none had a COVID-19 vaccine booster and all received a COVID-19 vaccine; 54 (62.8%) were tested for HCV Ab, of whom 17 (31.5%) were positive, of whom all were tested for HCV-RNA and none were positive. Of the 101 MTU participants: none had been vaccinated for COVID-19 and all received a COVID-19 vaccine; all were tested for HCV Ab and HIV and 15 (14.9%) and 9 (8.9%) were positive, respectively; of those HCV Ab+, 9 (60%) were HCV-RNA+, of whom 8 (88.9%) have started treatment; 5 (55.6%) of those HIV+ had abandoned antiretroviral therapy, of whom 3 (60%) have re-started it. Conclusions The intervention was accepted by 54 (62.8%) CAS participants and all MTU participants and can be used in marginalised communities.

Cannabis and synthetic cannabinoids (SC) are related to several neuropsychiatric symptoms and disorders, especially psychotic symptoms and disorders. Interestingly, catatonia-like symptoms associated with cannabis and SC have been generally neglected in research and scarcely described despite the clinical repercussions. Hence, this review aims to analyze current clinical publications on catatonia induced by cannabis or SC in a systematized way.

To assess the impact of different types of anesthesia on the outcomes of arthrocentesis of the TMJ.Electronic databases were searched to identify peer-reviewed studies, followed by reference list search and further hand-searching. Randomized clinical trials and controlled studies were considered for inclusion when comparing at least two anesthetic approaches. The risk of bias was assessed using the Cochrane risk of bias tool.Of a total of 506 potentially eligible studies, only a randomized controlled clinical trial and an observational study were included. The former compared some outcomes of arthrocentesis under local and general anesthesia and the latter under sedation and general anesthesia. Moreover, both studies were judged as "high risk of bias."In general, there appears to be a slight trend toward better outcomes of arthrocentesis for internal TMJ derangements (Wilkes grades I to III) when performed under general anesthesia; however, given that the available evidence is remarkably limited and a high risk of bias was detected within the included studies, a definitive statement cannot be made.

Introduction: Improving the knowledge and attitudes of people facing an opioid overdose is one of the key prevention measures for reducing overdose occurrence and severity. In this respect, the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS) have been developed and validated in English to assess and improve knowledge and attitudes of opioid users and their families and care providers, in case of an overdose. Here, the OOKS and OOAS scales have been translated into French, Spanish, and German, and the different versions of the 2 scales have been assessed regarding their psychometric properties. Methods: The translation procedure of the scales was based on the international recommendations, including a back translation by a native English speaker. Subsequently, 80 (Spain: 29, France: 27, Germany: 24) former or current heroin users, aged from 20 to 61 years (M = 39.4 ± 9.23), completed the OOKS and OOAS versions of their native language, in test-retest, without specific between-assessment training. Internal consistency was assessed using Cronbach’s α, while test-retest reliability was assessed using intraclass correlation coefficient (ICC). The correlation between the OOKS and OOAS scores of a same language was assessed using Spearman’s (ρ) coefficient. Results: Internal consistency of the OOKS was found to be good to very good, with Cronbach’s α ranging from 0.62 to 0.87. Test-retest reliability was also very good, with ICCs ranging from 0.71 to 0.82. However, results were less reliable for the OOAS, as internal consistency was questionable to acceptable, with Cronbach’s α ranging from 0.12 to 0.63, while test-retest ICCs were very good for the French (0.91) and Spanish (0.99) versions and barely acceptable for the German version (0.41). No significant correlation was found between the OOKS and OOAS scores, irrespective of the version concerned. Conclusion: While satisfactory results were found for the 3 versions of the OOKS, results on the OOAS were relatively inconsistent, suggesting a possible gap between knowledge and attitudes on overdose among opioid users.

Ayahuasca is a psychotropic infusion prepared by boiling the bark of Amazonian plants and has many psychopharmacological effects not fully understood. Some of those effects are used as treatment for different diseases. However, the side effects of ayahuasca, including ayahuasca-induced psychosis, are an important issue. Here we report the case of a patient who had a psychotic episode after taking ayahuasca and who was successfully treated with antipsychotic medication. Given the current spread of ayahuasca consumption in developed societies, the present case highlights the need for better understanding and regulation of the social-legal condition of ayahuasca and the need for further research. Additionally, psycho-education seems advisable in order to create awareness of the potential risks of the use of ayahuasca.

Temporomandibular joint (TMJ) arthrocentesis is considered an effective and minimally invasive procedure for certain conditions related to temporomandibular disorders. The ideal irrigation volume for arthrocentesis lavage has not yet been defined. Therefore, the aim of this study was to evaluate the efficacy of different saline solution volumes in removing methylene blue from the TMJ space of fresh human cadavers. Nineteen cadavers were selected and 1ml of 10μM methylene blue solution was injected into the upper joint space unilaterally. Conventional arthrocentesis was then conducted by infusion of 300ml of 0.9% saline solution, collecting a 1-ml sample from the drained quantity for every 25ml injected. Finally, the samples were assayed by measuring photo absorbance of the methylene blue solution. There was a statistically significant difference between the irrigation volumes regarding the removal of methylene blue solution from the joint space (P0.001), specifically between the first 25 ml and 200 ml (P=0.014), 225 ml (P=0.001), 250 ml (P0.001), and 275 ml (P=0.001). Based on this ex vivo study, a 25-ml perfusion volume appears to be sufficient for joint lavage in conventional arthrocentesis of the TMJ.

To assess the efficacy of silver diamine fluoride (SDF) and sodium fluoride (NaF) in inhibiting enamel erosion in primary teeth. 80 primary canine teeth were immersed for 24 h in 2% NaF, 10% SDF, or distilled water. Afterward, some of them underwent a 10-min acid challenge using either 1% or 10% citric acid while others did not. Specimens selected for negative controls were immersed in distilled water but not exposed to the acids, whereas those selected for positive controls were not only immersed in distilled water, but also exposed to the acids. Following, 3-mL samples were collected for calcium and phosphorus analysis by an atomic emission spectrometer. 1% acid caused higher phosphorus loss in the positive control group than in the others (no differences between them). Regarding 10% acid, the SDF group showed lower phosphorus loss compared to the positive control and NaF groups. From calcium loss analysis, SDF and NaF groups presented no significant difference when compared to the positive control groups after both acidic challenges. Considering phosphorus loss values, 10% SDF seems to be effective in inhibiting enamel erosion after 1% and 10% citric acid challenges, whereas 2% NaF only after 1% citric acid challenge. Regarding calcium loss values, both fluoride agents seem to have no impact on inhibiting enamel erosion after 1% and 10% citric acid challenges.

Purpose The purpose of this study was to investigate the impact of radiotherapy on mandibular bone tissue in head and neck cancer patients through an analysis of pixel intensity and fractal dimension values on digital panoramic radiographs. Materials and methods Thirty patients with radiographic records from before and after 3-dimensional (3D) conformational radiotherapy were selected. A single examiner carried out digital analyses of pixel intensity values and fractal dimensions, with the areas of interest unilaterally located in the right angle medullary region of the mandible below the mandibular canal and posterior to the molar region. Results Statistically significant decreases were observed in the mean pixel intensity (P=0.0368) and fractal dimension (P=0.0495) values after radiotherapy. Conclusion The results suggest that 3D conformational radiotherapy for head and neck cancer negatively affected the trabecular microarchitecture and mandibular bone mass.

Resumen: El presente artículo tiene por objetivo indagar en el concepto de investigación-creación y su aplicabilidad dentro la antropología, orientándola hacia la creación de artefactos plástico-sensoriales como generación válida de conocimiento. Para ello, se presenta, en primer lugar, una revisión bibliográfica que busca contribuir a la articulación de un campo de experimentación metodológica dentro de la antropología, en la que destacan su carácter interdisciplinario y el diálogo con otros saberes provenientes de la sociología, el diseño y las artes mediales. En segundo lugar, se presenta y discute críticamente el concepto de investigación-creación, indicándose su pertinencia para llevar a cabo investigaciones cuyos resultados vayan más allá de lo textual, al tiempo que se producen conocimientos que se inscriben en artefactos plástico-sensoriales. Se proponen, a su vez, tres dimensiones interconectadas para comprender un proceso de investigación-creación desde la antropología: una metodológica, referida a la creación de registros o datos durante el trabajo de campo; una curatorial, con la que se apunta a las combinatorias posibles del material recopilado; y una tercera dimensión pública, enfocada en la circulación y agencia de los resultados de estas investigaciones-creaciones. Para finalizar, este artículo indaga y describe un caso de estudio etnográfico con familiares de personas privadas de su libertad en Chile, un proceso de investigación-creación colaborativo que tuvo como resultado una instalación sonora. Abstract: The purpose of this article is to explore the concept of research-creation and its applicability within anthropology, focusing on the creation of plastic-sensorial artifacts as a valid source of knowledge. To this end, we first present a bibliographical review to contribute to the articulation of a field of methodological experimentation within anthropology, highlighting its interdisciplinary nature and the dialogue with other knowledge from sociology, design, and media arts. Next, we present and critically discuss the concept of research-creation, indicating its relevance in conducting research whose results go beyond the textual, while producing knowledge that is inscribed in plastic-sensory artifacts. Three interconnected dimensions are proposed to understand a process of research-creation from anthropology: a methodological one, referring to the creation of records or data during fieldwork; a curatorial one, concerning at the possible combinations of the collected material; and a third public dimension, focusing on the circulation and agency of the outcomes of these research-creations. Finally, we investigate and describe an ethnographic case study with family members of people deprived of their liberty in Chile, a collaborative research-creation process that culminated in a sound installation. Resumo: Este artigo tem o objetivo de questionar o conceito de pesquisa-criação e sua aplicabilidade na antropologia, orientando-a à criação de artefatos plástico-sensoriais como geração válida de conhecimento. Para isso, é apresentada, em primeiro lugar, uma revisão bibliográfica que pretende contribuir para articular um campo de experimentação metodológica dentro da antropologia, na qual são destacados seu caráter interdisciplinar e o diálogo com outros saberes provenientes da sociologia, do desenho e das artes da nova midia. Em segundo lugar, é apresentado e discutido criticamente o conceito de pesquisa-criação, indicando sua pertinência para realizar pesquisas cujos resultados vão mais além do textual, ao mesmo tempo que são produzidos conhecimentos que são vinculados a artefatos plástico-sensoriais. São propostas, por sua vez, três dimensões interconectadas para compreender um processo de pesquisa-criação a partir da antropologia: uma metodológica, referida à criação de registros ou dados durante o trabalho de campo; uma curatorial, com a qual se aponta às combinações possíveis do material coletado; e uma terceira dimensão, focada na circulação e agência dos resultados dessas pesquisas-criações. Para finalizar, neste artigo, é descrito e questionado um caso de estudo etnográfico com familiares de pessoas privadas de liberdade no Chile, um processo de pesquisa-criação colaborativo que teve como resultado uma instalação sonora.

The instantaneous spatial representation of electrical propagation produced by muscle contraction may introduce bias in surface electromyographical (sEMG) activation maps. Here, we described the effect of instantaneous spatial representation (sEMG segmentation) on embedded fuzzy topological polyhedrons and image features extracted from sEMG activation maps. We analyzed 73,008 topographic sEMG activation maps from seven healthy participants (age 21.4 ± 1.5 years and body mass 74.5 ± 8.5 kg) who performed submaximal isometric plantar flexions with 64 surface electrodes placed over the medial gastrocnemius muscle. Window lengths of 50, 100, 150, 250, 500, and 1,000 ms and overlap of 0, 25, 50, 75, and 90% to change sEMG map generation were tested in a factorial design (grid search). The Shannon entropy and volume of global embedded tri-dimensional geometries (polyhedron projections), and the Shannon entropy, location of the center (LoC), and image moments of maps were analyzed. The polyhedron volume increased when the overlap was 75%. Entropy decreased when the overlap was 75% and when the window length was 500 ms. The LoC in the x-axis, entropy, and the histogram moments of maps showed effects for overlap (p < 0.001), while the LoC in the y-axis and entropy showed effects for both overlap and window length (p < 0.001). In conclusion, the instantaneous sEMG maps are first affected by outer parameters of the overlap, followed by the length of the window. Thus, choosing the window length and overlap parameters can introduce bias in sEMG activation maps, resulting in distorted regional muscle activation.

Introduction: Thrombocytopenia is usually seen after allogeneic hematopoietic stem cell transplantation (HSCT) and may favor the development of oral bleeding, infections, and ulcerations. Case Report: A patient with chronic myelomonocytic leukemia had been submitted to allogeneic HSCT. Within a few days, she developed severe thrombocytopenia and an extensive ulcerative area comprising both lips, which bled spontaneously, as well as smaller ulcers on the tongue mucosa. The lesions were managed using a combination of phototherapies (photobiomodulation and antimicrobial photodynamic therapies), totalizing 4 laser sessions. After 4 days, there was an important reduction in the severity of the lesions, with spontaneous disappearance of the crusts and reepithelization. Conclusion: The proposed combination of phototherapies would be a suitable therapeutic modality for the management of oral lesions related to platelet disorders induced by oncologic treatments.

Although phototherapies have been used to manage nipple lesions and pain in breastfeeding women, there is no information on alternative therapies treating puerperal mastitis-associated breast abscess. The current study aimed to present a case in which adjuvant photobiomodulation therapy was used for a breast abscess developed as a complication of puerperal mastitis. Despite receiving antibiotic therapy, exudate drainage, surgical cleaning, and drain placement, after 11 days, the patient was still experiencing pain and there were marked inflammation signs on the region. Fifteen sessions of photobiomodulation therapy were then proposed. Pain relief was achieved after 3 laser sessions and wound healing after 15 laser sessions. According to the current case, photobiomodulation therapy seems to be a valuable adjuvant therapeutic modality for puerperal mastitis-associated breast abscess. A pesar de que las fototerapias han sido utilizadas para controlar lesiones mamilares y como analgésicos en mujeres que amamantan, no hay información sobre terapias alternativas para el control de abscesos mamarios asociados a mastitis puerperal. El presente estudio tuvo como objetivo presentar un caso en que la terapia de biofotomodulación fue propuesta como terapia adyuvante en el control de un absceso mamario asociado a mastitis puerperal. A pesar de que la paceinte recibió fototerapia terapia antibiótica, drenaje del exudado, limpieza quirúrgica y colocación de un drenaje, después de 11 días, todavía presentaba dolor y tenía señales inflamatorias acentuadas en la región. Entonces fueron propuestas quince sesiones de terapia de biofotomodulación. Una analgesia completa fue relatada después de 3 sesiones de laser y, después de 15 sesiones, el reparo completo de la lesión fue observado. De acuerdo con el presente caso, la terapia de fotobiomodulación parece ser una valiosa modalidad terapéutica adyuvante para el control del absceso mamario asociado a una mastitis puerperal. Embora as fototerapias tenham sido utilizadas para o manejo de lesões mamilares e analgesia em mulheres que amamentam, não há informações sobre terapias alternativas para o manejo de abscesso mamário associado a mastite puerperal. O presente estudo teve como objetivo apresentar um caso em que a terapia de fotobiomodulação foi proposta como terapia coadjuvante no manejo de um abscesso mamário associado à mastite puerperal. Apesar de ter recebido antibioticoterapia, drenagem de exsudato, limpeza cirúrgica e colocação de dreno, após 11 dias a paciente ainda apresentava dor e a inflamação na região persistia. Foram então propostas quinze sessões de terapia de fotobiomodulação. A completa analgesia foi referida após 3 sessões de laser e, após 15 sessões, o reparo completo da lesão foi observado. De acordo com o presente caso, a terapia de fotobiomodulação parece ser uma valiosa modalidade terapêutica adjuvante para o manejo do abscesso mamário associado à mastite puerperal.

The Santiago of Chile subway system is nowadays one of the most used means of transportation in the city, therefore many passengers with reduced mobility prefer it. However, in the subway lines, we can find different vertical gaps that are generated between the train and the platform. These vertical gaps makes it difficult for passengers with reduced mobility to get on and off the train, by generating a change in their gait, affecting their stability. This stability can be represented by different variables such as the rejection and damping force, the travel ranges of each step component, and the area generated by these travel ranges. The objective of this paper is to study, experimentally, the effect of vertical gaps on the gait and stability of passengers with reduced mobility in the train-platform space of subway stations. For this purpose, the construction of full-scale experiments representing the train-platform transition was carried out at the Human Dynamics Laboratory of the Universidad de los Andes. To obtain the data, a Bertec force plate and Bertec Acquire 4 software were used, which allows, to obtain the force in the z-axis and the pressure centers in the x-axis and y-axis. The results show that the higher the vertical gap, the higher the instability in passengers with reduced mobility. In addition, it was also observed how passengers with reduced mobility change their gait strategy when having to face vertical gaps greater than 11 cm, since they changed the angle of inclination with which people position their foot when descending, to be able to do the process with greater stability. It is hoped that future experiments will expand the scope of this type of study, by implementing more instrumentation and a larger number of participants.

Background Substance use disorders (SUD) often co-occur with attention deficit hyperactivity disorder (ADHD). Although the short-term effects of some specific interventions have been investigated in randomized clinical trials, little is known about the long-term clinical course of treatment-seeking SUD patients with comorbid ADHD. Aims This paper presents the protocol and baseline clinical characteristics of the International Naturalistic Cohort Study of ADHD and SUD (INCAS) designed and conducted by the International Collaboration on ADHD and Substance Abuse (ICASA) foundation. The overall aim of INCAS is to investigate the treatment modalities provided to treatment-seeking SUD patients with comorbid ADHD, and to describe the clinical course and identify predictors for treatment outcomes. This ongoing study employs a multicentre observational prospective cohort design. Treatment-seeking adult SUD patients with comorbid ADHD are recruited, at 12 study sites in nine different countries. During the follow-up period of nine months, data is collected through patient files, interviews, and self-rating scales, targeting a broad range of cognitive and clinical symptom domains, at baseline, four weeks, three months and nine months. Results A clinically representative sample of 578 patients (137 females, 441 males) was enrolled during the recruitment period (June 2017-May 2021). At baseline, the sample had a mean age (SD) of 36.7 years (11.0); 47.5% were inpatients and 52.5% outpatients; The most prevalent SUDs were with alcohol 54.2%, stimulants 43.6%, cannabis 33.1%, and opioids 14.5%. Patients reported previous treatments for SUD in 71.1% and for ADHD in 56.9%. Other comorbid mental disorders were present in 61.4% of the sample: major depression 31.5%, post-traumatic stress disorder 12.1%, borderline personality disorder 10.2%. Conclusions The first baseline results of this international cohort study speak to its feasibility. Data show that many SUD patients with comorbid ADHD had never received treatment for their ADHD prior to enrolment in the study. Future reports on this study will identify the course and potential predictors for successful pharmaceutical and psychological treatment outcomes. Trial registration ISRCTN15998989 20/12/2019.

Este artigo apresenta a Política Pública de Educação Ambiental (PPEA) do Ibama no Estado de Sergipe (Ibama-SE) a partir do Sistema Brasileiro de Monitoramento e Avaliação de Políticas Públicas de Educação Ambiental - MonitoraEA. A metodologia utilizada foi análise documental e entrevistas com os servidores públicos do Ibama-SE. O objetivo geral da PPEA do Ibama-SE é promover o engajamento da sociedade na conservação, recuperação e melhoria do meio ambiente

Introduction: Fixed drug eruption (FDE), a very specific adverse drug reaction and one of the most common types of drug eruption, generally resolves spontaneously within 7-10 days upon withdrawal of the causative agent; however, extensive and severe cases may also require systemic drug therapy. The present study aimed to report a case in which a broad spectrum of severe, painful lesions of FDE was managed with photobiomodulation therapy (PBMT). Case Report:A 31-year-old Caucasian woman presented with many extremely painful mucocutaneous lesions of FDE which had arisen 8 days before, following a long period of hospitalization. The lesions were not responsive to either corticosteroids or analgesics within 5 days, and then seven daily sessions of PBMT were proposed. Pain alleviation was achieved on the 1st day of PBMT, and the lesions showed an advanced course of healing on the 3rd day. Within 7 days of PBMT, the lesions were almost completely repaired. In a 3-month follow-up period, no relapse of any FDE lesion was reported. Conclusion: PBMT may be a promising strategy for the management of painful lesions of FDE refractory to conventional medication therapy. However, further studies are needed to confirm this hypothesis.

Olfactory dysfunction is commonly seen in COVID-19 patients; however, little is known about the pathophysiology and management. The present study aimed to report a series of cases in which three protocols of intranasal photobiomodulation therapy (PBMT) were used for COVID-19-related olfactory dysfunction. Irrespective of the PBMT protocol, olfaction recovery was noted in all cases but with varying degrees of improvement. Although intranasal PBMT seems to be a promising therapeutic modality, more research is demanded to identify the most suitable protocol.

This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.

Hypoplastic left heart syndrome consists of several structural abnormalities in the left side of the heart and may be associated with a hereditary genetic cause, possibly related to the connexin gene GJA1; however, only a few studies have investigated it. The present study aimed to analyse the expression of connexin-43 in the cardiac muscle of hypoplastic left heart syndrome children by Western blot method and confocal laser scanning microscopy. For that, tissue samples were taken during corrective surgery to treat heart defects. Patients of control group (8) presented any type of heart defect not related to hypoplastic left heart syndrome, connexin-43, or its gene and those of hypoplastic left heart syndrome group (9) presented this disease singly, without any other associated congenital diseases. By means of confocal laser scanning microscopy, it was noticed no connexin-43 qualitative differences in positioning and location pattern between both groups. From Western blot analysis, the connexin-43 expression did not show a statistically significant difference (p = 0.0571) as well. Within the limits of this study, it is suggested that cardiomyocytes of hypoplastic left heart syndrome children are similar in connexin-43 location, distribution, and structural and conformational patterns to those of children with heart defects not related to this protein and its genes.

Objective: The objective of this study was to compare psychiatric comorbidity and consumption-related variables in ADHD patients seeking treatment for cocaine, cannabis, or both. Method: Assessment was conducted using European Addiction Severity Index (EuropASI), Conners’ Adult ADHD Diagnostic Interview (CAADID), Structured Clinical Interview for DSM Disorders (SCID), Adult Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Barratt Impulsiveness Scale-11 (BIS-11), and FIDI, with statistical analyses of analysis of variance (ANOVA), Student’s t test, chi-square test, and multinomial regression model. Results: In total, 1,538 patients with substance use disorder (SUD) were evaluated for ADHD; 239 (15.5%) had ADHD, with cannabis 41, cannabis/cocaine 36, and cocaine 74. Men represented 80%, with mean age of 32.9 ± 10 years. Significant variables were—in bivariate analysis—more years of cannabis use in cannabis group and younger age for cocaine use disorder in cannabis/cocaine group, and—in multivariate analysis—lifetime anxiety disorder and younger age at onset of any SUD in cannabis group and working affected scale in cannabis and polysubstance use in cannabis/cocaine group. Conclusion: Groups with cannabis use had higher severity. ADHD features were similar in all groups. The assessment of ADHD and comorbid disorders is important.

O objetivo deste estudo foi propor um novo Sistema de Identificação Odonto-legal para a Polícia Militar do Estado de São Paulo (PMESP) baseado no protocolo DVI (Disaster Victim Identification) da INTERPOL (International Criminal Police Organization). Para comparar a percepção sobre o preenchimento e interpretação dos dados, 10 oficiais dentistas preencheram a ficha odonto-legal (FOL) em uso atualmente na PMESP e a nova ficha baseada na da INTERPOL. Também, um questionário estruturado sobre a nova FOL foi respondido por um perito criminal cirurgião-dentista do Núcleo de Odontologia Legal do Instituto Médico-Legal (IML) da Superintendência da Polícia Técnico Científica (SPTC) do Estado de São Paulo. Após a análise dos dados, constatou-se que a nova FOL proposta com base no protocolo da INTERPOL parece ser de preenchimento simples e interpretação mais fácil que a atualmente utilizada, além de ser mais rápida e precisa, atendendo a parâmetros aceitos internacionalmente. Ademais, o exame imaginológico (radiografia do tipo panorâmica) foi citado como sendo muito importante na elaboração da FOL. This study aimed to propose a new Dental Forensic Identification System for the Military Police of the State of São Paulo (PMESP) based on the DVI (Identification of Victims of Disasters) protocol of INTERPOL (International Criminal Police Organization). In order to compare the perception about the filling and interpretation, 10 dental officers completed the dental-legal form (FOL) in use currently at the PMESP and the new form based on the INTERPOL’s protocol. A structured questionnaire about the new FOL was also answered by a criminal expert dentist of the Forensic Dentistry Nucleus of the Legal Medicine Institute (IML) of the Superintendence of the Scientific Technical Police (SPTC) of the State of São Paulo. After analyzing the data collected, it was suggested that the new form proposed based on the INTERPOL’s protocol is simpler to complete and easier to interpret than the form currently used, besides being faster and more accurate, meeting internationally accepted parameters. Furthermore, the imaging exam (panoramic radiography) was mentioned as a very important tool in the elaboration of the FOL. El objetivo de este estudio fue proponer un nuevo Sistema de Identificación Odontológico-Forense a la Policía Militar del Estado de São Paulo (PMESP) basado en el protocolo DVI (Disaster Victim Identification) de la INTERPOL (Organización Internacional de Policía Criminal). Con el fin de comparar la percepción sobre el llenado e interpretación de datos, 10 odontólogos completaron el formulario odontologico-legal (FOL) actualmente en uso en el PMESP y el nuevo formulario basado en la INTERPOL. Además, un cuestionario estructurado sobre el nuevo FOL fue contestado por un odontólogo especialista en criminalística del Núcleo de Odontología Forense del Instituto de Medicina Legal (IML) de la Superintendencia de la Policía Técnica Científica (SPTC) del Estado de São Paulo. Luego de analizar los datos recolectados por la investigación, se encontró que el nuevo FOL propuesto en base al protocolo de la INTERPOL parece ser sencillo de llenar y más fácil de interpretar que lo que se usa actualmente, además de ser más rápido y preciso, cumpliendo con parámetros aceptados internacionalmente. Lo examen de imagen (radiografía panorámica) fue mencionado también como muy importante en la elaboración de la FOL.

Background: Hepatitis C virus (HCV) management is a challenge in patients with substance use disorder (SUD). This study aimed to describe an HCV screening and linkage to care program in SUD patients, and analyze the characteristics of this population in relation to HCV infection, particularly the impact of psychiatric comorbidities (dual diagnosis). Methods: This study was a prospective clinical cohort study using a collaborative, multidisciplinary model to offer HCV care (screening, diagnosis, and therapy) to individuals with SUD attending a dedicated hospital clinic. The characteristics of the participants, prevalence of HCV infection, percentage who started therapy, and adherence to treatment were compared according to the patients’ consumption characteristics and presence of dual diagnosis. HCV screening, diagnosis, treatment initiation, and sustained virologic response were analyzed. Results: 528 individuals attended the center (November 2018–June 2019) and 401 (76%) accepted screening. In total, 112 (28%) were anti-HCV-positive and 42 (10%) had detectable HCV RNA, but only 20 of the latter started HCV therapy. Among the 253 (63%) patients with a dual diagnosis, there were no differences in HCV infection prevalence versus patients with SUD alone ( p = 0.28). Dual diagnosis did not lead to a higher risk of HCV infection or interfere with linkage to care or treatment. Conclusion: This study found a high prevalence of dual diagnosis and HCV infection in SUD patients, but dual diagnosis was not associated with an increased risk of acquiring HCV or more complex access to care. Despite use of a multidisciplinary management approach, considerable barriers to HCV care remain in this population that would need more specific focus.

The treatment of rheumatoid arthritis (RA), an inflammatory autoimmune disease of chronic nature, consists of medications, exercises, patient education on the disease, and rest. Unfortunately, many drugs used for RA have been recently recognized to induce oral manifestations due to either immunosuppression or antiproliferative effects. Thus, the present study reports a case of a patient who was receiving multiple medications (methotrexate, leflunomide, and sodium risedronate) for RA and developed an extensive lip ulcerative lesion not responsive to previous treatments. The lesion management was performed using only a combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT), totalizing three laser sessions. Within 4 days, the patient no longer complained of pain and the lesion presented an advanced healing aspect. According to the current case, the combination of PBMT and aPDT seems to be a suitable alternative for the management of oral lesions in patients taking medications for RA. La artritis reumatoide (AR) es una enfermedad inflamatoria autoinmune de naturaleza crónica, cuyo tratamiento consiste en medicamentos, ejercicios y en educar al paciente sobre la enfermedad y el reposo necesario. Sin embargo, se ha reconocido recientemente que muchos fármacos utilizados para tratar la AR ocasionan manifestaciones orales debido a sus efectos inmunosupresores o antiproliferativos. El presente estudio reporta el caso de un paciente que estaba recibiendo múltiples medicamentos (metotrexato, leflunomida y risedronato de sodio) para la AR y desarrolló una lesión ulcerosa labial extensa que no respondió a tratamientos previos. Se optó por una combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana, totalizando tres sesiones de láser. A los 4 días, el paciente ya no se quejaba de dolor y la lesión presentaba aspecto de cicatrización avanzado. Los resultados sugieren que la combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana parece ser una alternativa adecuada para el manejo de lesiones orales en pacientes que utilizan medicamentos para tratar la AR. O tratamento da artrite reumatoide (AR), uma doença inflamatória autoimune de natureza crônica, consiste em medicamentos, exercícios, instrução ao paciente sobre a doença e repouso. Infelizmente, muitos medicamentos utilizados para AR recentemente foram associados a manifestações orais por imunossupressão ou efeitos antiproliferativos. Assim, o presente estudo relata o caso de um paciente que estava recebendo vários medicamentos (metotrexato, leflunomida e risedronato de sódio) para AR e desenvolveu uma lesão ulcerativa labial extensa não responsiva a tratamentos prévios. O manejo da lesão foi realizado apenas com a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana, totalizando três sessões de laser. Em 4 dias, a paciente não se queixava mais de dor e a lesão apresentava aspecto de cicatrização avançado. De acordo com o caso atual, a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana parece ser uma alternativa adequada para o manejo de lesões orais em pacientes em uso de medicamentos para AR.

Many oral signs and symptoms related to the novel coronavirus disease (COVID-19) have been reported; however, both prevalence and etiology are still undetermined. Since the clinical features of the oral lesions seen in COVID-19 are highly heterogeneous and the treatments differ considerably in the literature, the present study aimed to report a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for extensive lip lesions in a patient suffering from COVID-19. Within 4 days and without any systemic drug administration, after two sessions of aPDT and one session of PBMT, the lip lesions were completely healed, and the patient recovered her orofacial functions satisfactorily. According to the current case report and taking into consideration the evident lack of information about many aspects of COVID-19 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related lip lesions; however, more studies are necessary.

Localizado no terço médio da face, o corpo adiposo da bochecha é uma estrutura adiposa arredondada, biconvexa e delimitada por uma cápsula fina. Indivíduos com volume excessivo do corpo adiposo da bochecha podem apresentar uma aparência infantil ou de que estão em sobrepeso, porém a excisão cirúrgica é capaz de esculpir os ângulos faciais e melhorar a estética da face como um todo. Apesar deste procedimento (também conhecido como “bichectomia”) ter se tornado muito popular nos dias de hoje, as evidências e os estudos que fornecem detalhes técnicos são bastante limitados. Desta forma, a presente revisão narrativa da literatura teve como objetivo compilar o máximo de informações relativas à excisão do corpo adiposo da bochecha com finalidade de recontorno estético da face. De acordo com os estudos levantados, o manejo cirúrgico do corpo adiposo da bochecha pode ser considerado um procedimento relativamente simples e que apresenta ótimos resultados estéticos quando bem indicado e realizado por profissional experiente na técnica. Entretanto, considerando a carência de evidências científicas de alto nível principalmente relacionadas aos efeitos em longo prazo, estudos bem delineados e com seguimento apropriado são ainda necessários para maiores esclarecimentos e fundamentação da técnica no cotidiano clínico.

In hematopoietic cell transplants (HCT) patients, opportunistic fungal infections – especially candidiasis - are typical and, due to the immunosuppressed condition, severe and fatal clinical conditions may occur. Many antifungal agents are used for treating candidiasis; however, there are non-responsive, drug-resistant cases in which alternative antimicrobial therapies are strongly needed. The present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) was used for extensive oral pseudomembranous candidiasis not responsive to micafungin in a patient undergoing HCT. Thus, 0.01 % methylene blue solution was applied for 3 min onto the infected area, followed by 660-nm laser irradiation. Within 72 h, there was neither a symptom nor a sign of the fungal infection. According to the current case report, aPDT seems to be highly effective for HCT patients presenting oral candidiasis not responsive to micafungin; however, further studies are necessary.

Osteoradionecrosis (ORN) is considered one of the most severe complications of radiotherapy (RT). Treatment modalities for ORN may vary considerably, including conservative or surgical procedures. Recently, alternative managements such as the combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT) have also yielded promising results in patients presenting ORN or delayed healing post-RT. Herein, it is reported a case of ORN manifested as an oral fistula on the mandibular alveolar mucosa in which a combination of PBMT and aPDT was used every 15 days for six weeks. A laser device with an optical fiber was introduced into the fistula for light delivery. Seven days after the first laser session, it was noted complete resolution of both edema and erythema; after six weeks, the ORN fistula was no longer present. According to the current case, the combination of PBMT and aPDT with an optical fiber to deliver the laser light seems to be a suitable alternative for restricted areas such as fistula paths.

INTRODUCCIÓN La alexitimia es prevalente en pacientes con trastorno por uso de sustancias (TUS); sin embargo, su impacto en la adherencia y las recaídas no se ha establecido de forma clara. Además, el instrumento Gold Estándar para la medicación de alexitimia (Escala de Alexitimia de Toronto de 20 ítems – TAS-20) no ha sido validada para población española con TUS. OBJETIVOS PResnetar resultados de estudio longitudinal sobre el imapcto de la alexitimia en la adherencia y las reca´dis en pacientes con TUS. Asimismo, presentar estudio de características psicométricas de la TAS-20 en población española con TUS. MÉTODOS Se realizó un estudio longitudinal a 12 meses en un centro ambulatorio de tratamientos de adicciones incluyendo pacientes españoles con TUS, siendo valorada la alexitimia de forma basal y valorándose el momento de recaída y adherencia al tratamiento en su seguimiento. Además un análisis confirmatorio factorial fue realizado para valorar las características psicométricas de la TAS-20. RESULTADOS 126 pacientes fueron reclutados, siendo la alexitimia prevalente en e4sta población. Además, los pacientes con alexitimia presentaban recaídas más tempranas y una peor adherencia. Por otro lado, la TAS-20 presenta unas características psicométricas adecuadas para la evaluación de la alexitmia en población española con TUS. CONCLUSIONES La alexitmia tiene una relación importante con el TUS, siendo un factor relacionado con las recaídas y adherencia. Por ello, la evaluación de la misma es importante desde el punto de vista clínico, siendo la TAS-20 una herramienta válida para su medición en esta población.

Background: Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms. Methodology: We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed. Results: Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22). Conclusions: Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders.

The aim of the present transversal study was to evaluate the clinical and biochemical salivary parameters of children with and without erosive tooth wear (ETW). The study population was children aged 4 to 9 years. A trained and calibrated examiner (kappa value for intraexaminer reliability = 0.89) classified the children into ETW (n = 24) and control groups (n = 24), and applied the O’Brien index. The salivary flow rate was initially evaluated by stimulated sialometry (paraffin chewing). Afterwards, the collected saliva was submitted to biochemical analyses of pH, uric acid, total buffering capacity, ferric-reducing antioxidant power, reduced glutathione, calcium, and phosphorus. Among the ETW children, 20 (83%) had dental lesions restricted to enamel, and 4 (17%) presented lesions affecting both enamel and dentin. A statistically significant difference between the groups was obtained only for the pH values (t-test; p = 0.004), with averages of 7.31 and 7.56 for the control and the ETW groups, respectively. Considering the parameters evaluated in general, it is suggested that the salivary profile of children with ETW does not differ considerably from that of children without ETW. However, the pH mean value seems to be slightly higher in ETW children, but is still within the normal physiological range.

Introduction The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity. Methods The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level. Results A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up. At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model. Conclusion These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.