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This systematic review evaluated the features of the progression of experimentally induced gingivitis and peri-implant mucositis in humans. Included were studies that evaluated clinical, immunological, or microbiological responses between experimentally induced gingivitis and peri-implant mucositis in periodontally healthy patients. A total of 887 articles were initially identified, but only 12 were included in the final analysis. Implants accumulate less biofilm and suffer the most heterogeneous alterations in the microbiota, in the abstinence of oral hygiene, compared with the tooth. Interestingly, although dental implants presented less biofilm accumulation, the peri-implant mucosa showed a more exacerbated clinical response than the gingival tissue. The risk of bias of the selected studies was moderate to low, with one study presenting serious risk. The progression events of peri-implant mucositis were similar to those of experimental gingivitis but led to a different host response. This review was registered in the PROSPERO database CRD420201 123360.

Made available in DSpace on 2022-05-01T10:19:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-01-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Implant-related infections at the early healing period are considered one of the main risk factors in implant failure. Designing coatings that control bacterial adhesion and have cell stimulatory behavior remains a challenging strategy for dental implants. Here, we used plasma electrolytic oxidation (PEO) to produce antimicrobial coatings on commercially pure titanium (cpTi) using bioactive elements (calcium and phosphorus) and different copper (Cu) sources: copper acetate (CuAc), copper sulfate (CuS), and copper oxide (CuO); coatings containing only Ca and P (CaP) served as controls. Cu sources drove differential physical and chemical surface features of PEO coatings, resulting in tailorable release kinetics with a sustained Cu ion release over 10 weeks. The antibacterial effects of Cu-containing coatings were roughness-dependent. CuAc coating exhibited optimal properties in terms of its hydrophilicity, pores density, and limited surface roughness, which provided the most robust antibacterial activity combined with appropriate responses of human primary stem cells and angiogenic cells. Our data indicate that Cu source selection largely determines the functionality of Cu-containing PEO coatings regarding their antibacterial efficacy and cytocompatibility. Department of Prosthodontics and Periodontology Piracicaba Dental School University of Campinas (UNICAMP) Faculdade de Ciências Odontológicas (FCO) Dental Research Division Guarulhos University Laboratory of Technological Plasmas Institute of Science and Technology São Paulo State University (UNESP) Regenerative Biomaterials Dentistry Radboudumc Laboratory of Technological Plasmas Institute of Science and Technology São Paulo State University (UNESP) CAPES: 001 FAPESP: 2017/01320-0 FAPESP: 2018/14117-0 CNPq: 304853/2018-60

Background: The management of type 2 diabetes mellitus (T2DM) requires a complex and organized care that includes patient lifestyle change. Additionally, emotional well-being is an important part of self-management, and it may impair the individual’s adherence. Therefore, equipping them with the necessary coping and self-care techniques may be an important step in managing diabetes. Objective: to evaluate the effect of interventions using established based-mindfulness protocols on glycemic control of individuals T2DM. Methods: Data sources: Two electronic databases (PubMed and EMBASE) were searched from inception to December 2019. We limited our search to published studies in the English, Spanish and Portuguese language. Study selection: Randomized clinical trials that assessed the effects of mindfulness in individuals with T2DM were selected. Data extraction: Two authors independently assessed risk of bias and extracted data from the included trials. Data were pooled using inverse-variance random-effects meta-analyses. The quality of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system. Results: Four randomized trials were included. There were no differences in blood glucose change (mean difference between groups (MD) -0.73mg/dl; 95% CI, -10.49; 9.02; I2 =0%; very low quality of evidence) or glycated hemoglobin (MD 0.05%; 95%CI -0.22 to 0.32; I2 =29%; very low quality of evidence). Conclusions: Although the quality of current evidence is very low, our findings suggest that established protocols involving mindfulness has no effect on blood glucose or glycated hemoglobin in individuals with T2DM. Indeed, largescale trials are needed to evaluate the contribution of mindfulness on glycemic control in the clinical practice.

Introduction: All-trans retinoic acid (ATRA, tretinoin) is the main drug used in the treatment of acute promyelocytic leukemia (APL). Despite its impressive activity against APL, the same could not...

The rise in musculoskeletal disorders has prompted medical experts to devise novel effective alternatives to treat complicated orthopedic conditions. The ever-expanding field of regenerative medicine has allowed researchers to appreciate the therapeutic value of bone marrow-derived biological products, such as the bone marrow aspirate (BMA) clot, a potent orthobiologic which has often been dismissed and regarded as a technical complication. Numerous in vitro and in vivo studies have contributed to the expansion of medical knowledge, revealing optimistic results concerning the application of autologous bone marrow towards various impactful disorders. The bone marrow accommodates a diverse family of cell populations and a rich secretome; therefore, autologous BMA-derived products such as the “BMA Matrix”, may represent a safe and viable approach, able to reduce the costs and some drawbacks linked to the expansion of bone marrow. BMA provides —it eliminates many hurdles associated with its preparation, especially in regards to regulatory compliance. The BMA Matrix represents a suitable alternative, indicated for the enhancement of tissue repair mechanisms by modulating inflammation and acting as a natural biological scaffold as well as a reservoir of cytokines and growth factors that support cell activity. Although promising, more clinical studies are warranted in order to further clarify the efficacy of this strategy.

Orthobiologics continue to gain popularity in many areas of medical science, especially in the field of regenerative medicine. Platelet-rich plasma derivatives are orthobiologic tools of particular interest. These biologic products can be obtained via centrifugation of a patient's whole blood and the components can then be subsequently isolated, concentrated and ultimately administered into injured tissues, particularly in areas where standard healing is disrupted. The elevated concentration of platelets above the basal value enables accelerated growth of various tissues with minimal side effects. The application of autologous orthobiologics is a relatively new biotechnology undergoing expansion which continues to reveal optimistic results in the stimulation and enhanced healing of various sorts of tissue injuries. The local release of growth factors and cytokines contained in platelet alpha granules accelerates and ameliorates tissue repair processes, mimicking and supporting standard wound healing. This effect is greatly enhanced upon combination with the fibrinolytic system, which are essential for complete regeneration. Fibrinolytic reactions can dictate proper cellular recruitment of certain cell populations such as mesenchymal stem cells and other immunomodulatory agents. Additionally, these reactions also control proteolytic activity in areas of wound healing and regenerative processes of mesodermal tissues including bone, cartilage, and muscle, which makes it particularly valuable for musculoskeletal health, for instance. Although many investigations have demonstrated significant results with platelet-rich plasma derivatives, further studies are still warranted.

To analyze association between climatic-environmental conditions and occurrence of compulsorily notifiable diseases and health problems, in the state of Espírito Santo, Brazil, 2011-2015.This was an ecological study of municipality clusters calculated based on cases confirmed on the Notifiable Health Conditions Information System for the period 2011-2015.Notifications were more frequent among females (51.1%); people of brown race/skin color (31.7%); in the 20-49 year age group (48.1%) and in the Metropolitan Health Region (60.3%). The factors associated with health problems were ambulatory care sensitive conditions (p-value0.001); education development index (p-value0.001); temperature (p-value=0.019) and degree of urbanization (p-value=0.004). Diseases were associated with population density (p-value0.001); temperature (p-value0.001), humidity (p-value0.001) and altitude (p-value=0.005).Health problems were positively associated with ambulatory care sensitive conditions, the education development index and temperature; but negatively associated with degree of urbanization. Diseases were positively associated with the factors mentioned.Analisar a associação das condições climático-ambientais e a ocorrência das doenças e agravos de notificação compulsória no estado do Espírito Santo, Brasil.Estudo ecológico dos agregados municipais calculados a partir de casos confirmados no Sistema de Informação de Agravos de Notificação (Sinan) para o período 2011-2015.As notificações foram mais frequentes no sexo feminino (51,1%), raça/cor da pele parda (31,7%), faixa etária de 20-49 anos (48,1%) e região metropolitana de saúde (60,3%). Os fatores associados aos agravos foram as condições sensíveis à Atenção Básica (p-valor0,001), o índice de desenvolvimento de educação (p-valor0,001), a temperatura (p-valor=0,019) e o grau de urbanização (p-valor=0,004). As doenças estiveram associadas a densidade populacional (p-valor0,001), temperatura (p-valor0,001), umidade (p-valor0,001) e altitude (p-valor=0,005).Os agravos associaram-se positivamente às condições sensíveis à Atenção Básica, índice de desenvolvimento da educação e temperatura; e negativamente ao grau de urbanização. As doenças associaram-se positivamente aos fatores citados.Analizar la asociación de las condiciones climáticas-ambientales y la ocurrencia de enfermedades y trastornos de notificación obligatoria en el estado de Espírito Santo, Brasil.Estudio ecológico de los agregados municipales, a partir de casos confirmados en el Sistema de Información de Agravamientos de Notificación, período 2011-2015.Las notificaciones fueron más frecuentes en el sexo femenino (51,1%); raza/ color de piel parda (31,7%); de 20-49 años (48,1%) y región metropolitana de salud (60,3%). Los factores asociados a los agravamientos fueron sensibles a la atención primaria (p0,001); los índices de desarrollo educativo (p0,001); la temperatura (p=0,019) y el grado de urbanización (p=0,004). Los agravamientos estuvieron asociados con la densidad de población (p0,001); la temperatura (p0,001), la humedad (p0,001) y la altitud (p=0,005).Los agravamientos se asociaron positivamente con las condiciones sensibles a la atención primaria, con el índice de desarrollo educativo y la temperatura; y negativamente con el grado de urbanización. Las enfermedades se asociaron positivamente con los factores mencionados.

Objectives To test the role of exopolysaccharide (EPS) polymers matrix to modulate the composition/virulence of biofilms growing on titanium (Ti) surfaces, the effect on antibiotic susceptibility, and whether a dual-targeting therapy approach for disrupted EPS matrix could improve the antimicrobial effect. Materials and methods A microcosm biofilm model using human saliva as inoculum was used, and the microbial composition was assessed by checkerboard DNA-DNA hybridization. EPS-enriched biofilms virulence was tested using fibroblast monolayer. Povidone-iodine (PI) was used as EPS-targeting agent followed by amoxicillin + metronidazole antibiotic to reduce bacterial biomass using an in situ model. Results An EPS-enriched environment, obtained by sucrose exposure, promoted bacterial accumulation and led to a dysbiosis on biofilms, favoring the growth of Streptococcus, Fusobacterium, and Campylobacter species and even strict anaerobic species related to peri-implant infections, such as Porphyromonas gingivalis and Tannerella forsythia (~3-fold increase). EPS-enriched biofilm transitioned from a commensal aerobic to a pathogenic anaerobic profile. EPS increased biofilm virulence promoting higher host cell damage and reduced antimicrobial susceptibility, but the use of a dual-targeting approach with PI pre-treatment disrupted EPS matrix scaffold, increasing antibiotic effect on in situ biofilms. Conclusion Altogether, our data provide new insights of how EPS matrix creates an environment that favors putative pathogens growth and shed light to a promising approach that uses matrix disruption as initial step to potentially improve implant-related infections treatment.

Background Vorapaxar as an adjunct to dual antiplatelet therapy ( DAPT ) reduces thrombotic events in patients with prior myocardial infarction at the expense of increased bleeding. Withdrawal of aspirin has emerged as a bleeding reduction strategy. The pharmacodynamic effects of vorapaxar with potent P2Y 12 inhibitors as well as the impact of dropping aspirin is unexplored and represented the aim of the VORA‐PRATIC (Vorapaxar Therapy in Patients With Prior Myocardial Infarction Treated With Newer Generation P2Y 12 Receptor Inhibitors Prasugrel and Ticagrelor) study. Methods and Results Post–myocardial infarction patients (n=130) on standard DAPT (aspirin+prasugrel or ticagrelor) were randomized to 1 of 3 arms: (1) triple therapy: aspirin+prasugrel/ticagrelor+vorapaxar; (2) dual therapy (drop aspirin): prasugrel/ticagrelor+vorapaxar; (3) DAPT : aspirin+prasugrel/ticagrelor. Pharmacodynamic assessments were performed at 3 time points (baseline and 7 and 30 days). Vorapaxar reduced CAT (collagen‐ADP‐TRAP)–induced platelet aggregation, a marker of platelet‐mediated global thrombogenicity (triple therapy versus DAPT at 30 days: mean difference=–27; 95% CI ,–35 to –19; P DAPT at 30 days: mean difference=–15; 95% CI ,–23 to –7; P P P 12 reactivity. Markers sensitive to aspirin‐induced effects increased ( P Conclusions In post–myocardial infarction patients treated with potent P2Y 12 inhibitors, vorapaxar reduces platelet‐driven global thrombogenicity, an effect that persisted, albeit attenuated, in the absence of aspirin and without affecting markers of P2Y 12 reactivity or clot kinetics. The clinical implications of these PD observations warrant future investigation. Registration URL : https://www.clini​caltr​ials.gov . Unique identifier: NCT 02545933.

Made available in DSpace on 2020-12-12T02:13:53Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-11-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Centro Nacional de Pesquisa em Energia e Materiais Laboratório Nacional de Nanotecnologia Universidade Estadual de Campinas Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas Hypothesis: Although bioactive glass (BG) particle coatings were previously developed by different methods, poor particle adhesion to surfaces and reduced biological effects because of glass crystallization have limited their biomedical applications. To overcome this problem, we have untangled, for the first time, plasma electrolytic oxidation (PEO) as a new pathway for the synthesis of bioactive glass-based coating (PEO-BG) on titanium (Ti) materials. Experiments: Electrolyte solution with bioactive elements (Na2SiO3-5H2O, C4H6O4Ca, NaNO3, and C3H7Na2O6P) was used as a precursor source to obtain a 45S5 bioglass-like composition on a Ti surface by PEO. Subsequently, the PEO-BG coating was investigated with respect to its surface, mechanical, tribological, electrochemical, microbiological, and biological properties, compared with those of machined and sandblasted/acid-etched control surfaces. Findings: PEO treatment produced a coating with complex surface topography, Ti crystalline phases, superhydrophilic status, chemical composition, and oxide layer similar to that of 45S5-BG (~45.0Si, 24.5 Ca, 24.5Na, 6.0P w/v%). PEO-BG enhanced Ti mechanical and tribological properties with higher corrosion resistance. Furthermore, PEO-BG had a positive influence in polymicrobial biofilms, by reducing pathogenic bacterial associated with biofilm-related infections. PEO-BG also showed higher adsorption of blood plasma proteins without cytotoxic effects on human cells, and thus may be considered a promising biocompatible approach for biomedical implants. Department of Prosthodontics and Periodontology Piracicaba Dental School University of Campinas (UNICAMP), Av. Limeira, 901 Oral Health and Diagnostic Sciences Department Division of Periodontology University of Connecticut School of Dental Medicine, 263 Farmington Avenue Department of Dental Materials and Prosthodontics School of Dentistry at Araraquara São Paulo State University (UNESP), R. Humaitá, 1680 Institute of Physics Gleb Wataghin University of Campinas (UNICAMP) Cidade Universitária Zeferino Vaz, arão Geraldo Laboratory of Technological Plasmas Institute of Science and Technology São Paulo State University (UNESP), Av. Três de Março, 511 Department of Mechanical Engineering University of São Paulo (USP), Trabalhador São Carlense, 400 Department of Periodontology Dental Research Division Guarulhos University, Eng Prestes Maia, 88 Department of Dental Materials and Prosthodontics School of Dentistry at Araraquara São Paulo State University (UNESP), R. Humaitá, 1680 Laboratory of Technological Plasmas Institute of Science and Technology São Paulo State University (UNESP), Av. Três de Março, 511 FAPESP: 2018/04630-2 Fundo de Apoio ao Ensino, à Pesquisa e Extensão, Universidade Estadual de Campinas: 3164/18

Some say that all diseases begin in the gut. Interestingly, this concept is actually quite old, since it is attributed to the Ancient Greek physician Hippocrates, who proposed the hypothesis nearly 2500 years ago. The continuous breakthroughs in modern medicine have transformed our classic understanding of the gastrointestinal tract (GIT) and human health. Although the gut microbiota (GMB) has proven to be a core component of human health under standard metabolic conditions, there is now also a strong link connecting the composition and function of the GMB to the development of numerous diseases, especially the ones of musculoskeletal nature. The symbiotic microbes that reside in the gastrointestinal tract are very sensitive to biochemical stimuli and may respond in many different ways depending on the nature of these biological signals. Certain variables such as nutrition and physical modulation can either enhance or disrupt the equilibrium between the various species of gut microbes. In fact, fat-rich diets can cause dysbiosis, which decreases the number of protective bacteria and compromises the integrity of the epithelial barrier in the GIT. Overgrowth of pathogenic microbes then release higher quantities of toxic metabolites into the circulatory system, especially the pro-inflammatory cytokines detected in osteoarthritis (OA), thereby promoting inflammation and the initiation of many disease processes throughout the body. Although many studies link OA with GMB perturbations, further research is still needed.

BACKGROUND Because sucrose may change the composition of biofilms formed on dental surfaces, the aim of this study was to evaluate in situ the effect of this dietary sugar on biofilm formation on titanium surface. METHODS In this blind, crossover, in situ study, 10 volunteers wore, in 3 phases of 7 days each, a palatal appliance containing titanium specimens. In each phase, the specimens were treated extraorally with 20% sucrose solution at a frequency of 4 or 8 times per day. As control, no treatment was rendered (0×). At the end of each phase, the biofilms were collected for biochemical analysis of biofilm wet weight (biomass), protein concentration, soluble (S-EPS), and insoluble (I-EPS) extracellular polysaccharides and intracellular polysaccharides (IPS), and for microbiologic analysis by checkerboard DNA-DNA hybridization (for levels and proportions of 40 bacterial species). Biochemical data were analyzed by linear regression and microbiological findings by Friedman and Dunn tests (α = .05). RESULTS A positive significant linear relationship was found among sucrose exposure (0×, 4×, and 8×) and biomass, S-EPS, I-EPS and IPS (p < 0.05). The biofilms treated with sucrose (4× and/or 8×) presented higher mean total levels of the 40 bacterial species evaluated, higher proportions of red complex species and lower proportions of the host-compatible green complex species, in comparison with the control group (p < 0.05). CONCLUSION The findings of the present study suggest that daily sucrose exposure has a harmful effect on the composition of biofilms formed on titanium surfaces.

The aim of this study is to assess the impact of oral health on the quality of life of patients who underwent conservative or surgical treatment for mandibular condylar fracture. A retrospective study was conducted, and 24 patients with condylar fracture were selected and underwent surgical or conservative treatment. Oral Health Impact Profile-14 (OHIP-14) was utilized to evaluate the patients. The angles of condylar fracture were measured in panoramic and Towne radiographs using the ImageJ software, and the results were compared to the results of the OHIP-14 questionnaire. Condylar fractures had a negative impact on the patients' quality of life in pretreatment assessment. After conservative and surgical treatments, the condylar fracture had a low impact on the patients' quality of life. Greater fracture alignment was obtained in patients treated by open reduction. A low level of correlation was observed between fracture alignment and changes in OHIP-14 of the patients studied. In conclusion, the study showed a significant improvement in the quality of life in the post-treatment period of the sample assessed. However, in patients selected for this study, no difference was found in the quality of life between the surgically and conservatively treated groups.

Streptococci from the mitis group (represented mainly by Streptococcus mitis, Streptococcus oralis, Streptococcus sanguinis, and Streptococcus gordonii) form robust biofilms with Candida albicans in different experimental models. These microorganisms have been found in polymicrobial biofilms forming on titanium biomaterial surfaces in humans with peri-implant disease. The purpose of this work was to study mutualistic interactions in biofilms forming on titanium and their effect on the adjacent mucosa, using a relevant infection model. Single and mixed biofilms of C. albicans and each Streptococcus species were grown on titanium disks. Bacterial and fungal biovolume and biomass were quantified in these biofilms. Organotypic mucosal constructs were exposed to preformed titanium surface biofilms to test their effect on secretion of proinflammatory cytokines and cell damage. C. albicans promoted bacterial biofilms of all mitis Streptococcus species on titanium surfaces. This relationship was mutualistic since all bacterial species upregulated the efg1 hypha-associated gene in C. albicans. Mixed biofilms caused increased tissue damage but did not increase proinflammatory cytokine responses compared to biofilms comprising Candida alone. Interestingly, spent culture medium from tissues exposed to titanium biofilms suppressed Candida growth on titanium surfaces. IMPORTANCE Our findings provide new insights into the cross-kingdom interaction between C. albicans and Streptococcus species representative of the mitis group. These microorganisms colonize titanium-based dental implant materials, but little is known about their ability to cause inflammation and damage of the adjacent mucosal tissues. Using an in vitro biomaterial-mucosal interface infection model, we showed that mixed biofilms of each species with C. albicans enhance tissue damage. One possible mechanism for this effect is the increased fungal hypha-associated virulence gene expression we observed in mixed biofilms with these species. Interestingly, we also found that the interaction of multispecies biofilms with organotypic mucosal surfaces led to the release of growth-suppressing mediators of Candida, which may represent a homeostatic defense mechanism of the oral mucosa against fungal overgrowth. Thus, our findings provide novel insights into biofilms on biomaterials that may play an important role in the pathogenesis of mucosal infections around titanium implants.

This work aims to develop, characterize, and evaluate the anticancer activity of solid lipid nanoparticles (SLN) containing doxorubicin (DOX), an antitumoral from the antracycline class, and sclareol (SC), a lipophilic labdene diterpene (SLN-DOX-SC). The SLN were characterized by Differential Scanning Calorimetry (DSC), X-ray Diffraction (XRD), Small Angle X-ray Diffraction (SAXS), in vitro release, transmission electron microscopy, and polarized light microscopy. Evaluation of cell viability was performed in two cell cultures: MCF-7 (human breast cancer) and 4T1 (murine breast cancer). The SLN showed a size in the range of 128 nm, negative zeta potential, DOX encapsulation efficiency (EE) of 99%, and drug loading (DL) of 66 mg/g. Characterization of the formulation by DSC, XRD, and SAXS revealed the presence of DOX inside the nanoparticles of SLN and suggested increased expulsion/release of this drug when associated with SC. The release profiles revealed that the SLN-DOX-SC showed controlled release of DOX at pH 7.4 with enhanced drug release at low pH, useful for cancer treatment. The SLN-DOX-SC demonstrated to be more effective than the free DOX against 4T1 cells. So, the developed SLN efficiently encapsulate DOX and SC and show good potential as an alternative for cancer treatment.

Hyperparathyroidism (HPT) is an endocrine metabolic disorder characterized by increased secretion of parathyroid hormone. Untreated secondary HPT leads to renal osteodystrophy (ROD). Facial skeletal abnormalities in patients with ROD are rare. The purpose of this paper is to report a conservative surgical approach of exuberant osteitis fibrosa lesions in patient with chronic kidney disease. A 24-year-old female was referred to maxillofacial surgery department with giants ROD affecting palate, maxilla, and mandible, resulting in esthetic and functional impairment. The pathogeneses and multidisciplinary management of ROD are discussed with a brief literature review. Eight years after the conservative treatment of exuberant jaw lesions, no noticeable bone changes were observed in the patient. A multidisciplinary therapy is essential for correct diagnosis of ROD and optimal multimodality treatment. The conservative management was an efficient alternative for the success of the case reported.

The aim of this study was to evaluate the clinical performance of silorane-based composite restorations applied after different surface treatments. This controlled and randomized clinical trial included 26 patients with class I restoration indications. The teeth were randomly assigned to the following treatments: control 1/G1, silorane specific self-etching adhesive (P90 self-etch primer and bond) + silorane-based composite resin (Filtek™ P90 low shrink posterior restorative); G2, 37% phosphoric acid + silorane specific self-etching adhesive + silorane-based composite resin; G3, blasting with aluminum oxide + silorane specific self-etching adhesive + silorane-based composite resin; and control 2/G4, self-etching adhesive (Adper™ SE Plus self-etch adhesive) + dimethacrylate-based composite resin (Filtek™ P60 posterior restorative). The clinical performance was evaluated at baseline and after 1 year. A total of 141 restorations were made and evaluated. For all clinical criteria evaluated, no significant difference was found between the surface treatments at baseline and after 1 year (p > 0.05). After 1 year, only the group with 37% phosphoric acid + silorane specific self-etching adhesive (G2) showed a significant reduction in marginal adaptation (p

OBJECTIVE To evaluate the effect of titanium (Ti) particles and ions on oral biofilm growth and composition. BACKGROUND Particles and ions of Ti released from dental implants can trigger unfavorable biological responses in human cells. However, their effect on oral biofilms composition has not been tested. METHODS In this blind in situ study, volunteers wore a palatal appliance containing Ti disks for 7 days to allow biofilm formation. Disks were then collected and biofilms were treated, in vitro, with Ti particles (0.75% and 1%), ions (10 and 20 ppm), or a combination of both (1% particles + 20 ppm ions). Biofilms exposed only to medium was used as control group. After 24 hours, biofilms were collected and analyzed by checkerboard DNA-DNA hybridization. Direct effects of Ti particles and ions on biofilm/cellular morphology were evaluated by transmission electron microscopy (TEM). RESULTS Ti particles affected biofilm composition, increasing population of four bacterial species (P

Background Oral health-related quality of life (OHRQoL) has important implications for the clinical practice of dentistry and dental research and should contribute to professional judgment about restorative treatments and prosthetic replacement in patients who had reduced dentitions. The aim was to compare the OHRQoL among adults (35–44 years) categorized according to different definitions of reduced dentition and considering the use (or non-use) of dental prosthesis. Methods This study used data from a probabilistic sample of adults in Sao Paulo, Brazil, 2015. OHRQoL was based on none items of Oral Impacts on Daily Performance (OIDP) index, as prevalence (at least one impact) and extent (the number of items with non-zero score). We used different criteria to assess dentition status: (1) Shortened Dental Arch (SDA): having 3–5 natural occlusal units (OUs) in posterior teeth and intact anterior region; (2) hierarchical functional classification system: a five-level stepwise classification of dentition; and (3) presence of ≥21 teeth. The use or nonuse of dental prosthesis was recorded. Negative binomial regression models involved the adjustment for social determinants of health. Results Nearly half (53.1%) of the 5753 participating adults had at least one oral health issue impacting OHRQoL. OIDP prevalence in adults with SDA did not differ from those with more OUs (PR = 1.02; 95%CI 0.91–1.13). Individuals with non-functional dentition had worse OHRQoL regardless of their use of a dental prosthesis. Adults with fewer than 21 remaining teeth, ranked significantly higher in OIDP extent, regardless of dental prosthesis use (PR = 1.38; 95%CI 1.16–1.63 with prosthesis; PR = 1.62; 95%CI 1.19–2.20 without dental prosthesis). Conclusions Individuals with more missing teeth reported worse OHRQoL regardless of using a dental prosthesis. Preserving a functional dentition, even with missing teeth, is compatible with OHRQoL.

The platelet inhibitory effects induced by oral P2YThis was a prospective, randomized, double-blind, placebo-controlled pharmacodynamic study conducted in patients undergoing primary percutaneous coronary intervention (n=50) who were randomized to treatment with either cangrelor or matching placebo (bolus followed by 2-hour infusion). All patients received ticagrelor 180-mg loading dose administered as crushed tablets at the time of cangrelor/placebo bolus administration. Pharmacodynamic analyses were performed at 8 time points. Pharmacodynamic effects were measured as P2YCompared with placebo, cangrelor was associated with reduced P2YIn patients undergoing primary percutaneous coronary intervention, cangrelor is an effective strategy to bridge the gap in platelet inhibition associated with the use of oral P2YURL: https://www.clinicaltrials.gov . Unique identifier: NCT03247738.

Investigation during 11-month period was performed to study the presence of caffeine in the Lis River in Leiria Town in Portugal, and a monitoring during 9-month period was realized to check the contribution of the human pollution of two wastewater treatment plants (WWTPs) that discharge their effluents to the studied river. The samples were collected in five sampling points along the river and in two influents and two effluents of the studied WWTPs. Caffeine was detected in all ninety-one collected samples. The caffeine concentration ranged from 25.3 to 321 ng/L in the river samples, from 112 to 1927 ng/L in the WWTP effluents, and from 9478 to 83,901 ng/L in the WWTP influents. The highest concentration in the river was detected in the two sampling points located after the effluent discharge points and reached 315 and 321 ng/L. Risk assessment was performed for three trophic levels using the risk quotient calculation and revealed that caffeine do not cause toxic effect on Daphnia magna and on fish but could be possibly toxic to algae. The results proved that caffeine can be an effective indicator of human-born pollution., The authors received funding from the EU and FCT/UEFISCDI/FORMAS for funding, in the frame of the collaborative international consortium REWATER financed under the ERA-NET Cofund WaterWorks2015 Call. This ERA-NET is an integral part of the 2016 Joint Activities developed by the Water Challenges for a Changing World Joint Programme Initiative (Water JPI). This work was also supported by UID/QUI/50006/2019 with funding from FCT/MCTES through national funds.

Background Oral health-related quality of life may be influenced by a series of characteristics. Considering the multidimensional character of quality of life, these impacts should be evaluated in the context of the physical, psychological, and social domains. Aim To evaluate the impact of clinical and perceived oral health problems on oral health-related quality of life in its different domains. Design Clinical exams were conducted on a representative cross-sectional sample of 12-year-old children in Brazil. The instrument Oral Impacts on Daily Performance (OIDP) was used to evaluate the quality of life in relation to oral health. Descriptive, bivariate, and multiple hierarchical analyses were conducted. Results Of the 7328 children studied, 2577 (33.5%) presented oral health-related impacts on quality of life. Clinical and perceived conditions of oral health were associated with the presence of overall impacts in the physical, psychological, and social dimensions of oral health-related quality of life. Furthermore, Family income was associated with overall impacts and the level of motivation to use dental health services was associated with the physical dimension. Conclusions The clinical and perceived conditions of oral health in Brazilian 12-year-olds were associated with a negative impact on oral health-related quality of life.

Pleomorphic adenoma (PA) is the most common benign salivary gland neoplasm, and its malignant transformation rarely occurs. Diagnosis is based on clinical features of local or regional malignancy or distant metastasis, and histological identification of invasion and cellular atypia. Buccal fat pad, also called Bichat fat pad, is an excellent option to create tissue coverage over surgically treated areas, providing great blood supply. Thus, this study aims to report a surgical treatment of a patient who reported to the Oral and Maxillofacial Surgery and Traumatology service of a hospital in the city of Fortaleza, presenting a large lesion in the right side of the palate. Clinical examination revealed a nodular volume increase with smooth surface, sessile insertion, firm to palpation and coloration similar to the mucosa, no pain complaints, and 2 years of evolution. Orthopantomographic examination did not reveal alterations in the adjacent anatomical structures. After clinical and radiographic evaluation, an incisional biopsy was performed and histopathological diagnosis was PA. Patient was submitted to surgery for tumor excision with narrow surgical margins, including oral lining mucosa to reduce recurrence chances. In the same surgical act, after the excision of the lesion, the right buccal fat pad pedicle flap was sutured onto the residual mucosa in order to act as a framework for re-epithelialization of the palatal mucosa, phenomenon of metaplasia, and reduction of patient's morbidity. Surgical piece obtained was sent to anatomopathological study, confirming initial diagnosis. After 12-month follow-up, patient is esthetically and functionally rehabilitated, and satisfied with clinical and surgical plans executed.

BACKGROUND The diagnosis of dengue is complex. Until recently, only specialised laboratories were able to confirm dengue infection. However, this has changed with the newly available immunochromatographic rapid tests. Early diagnosis is of great interest, and point-of-care rapid tests have been increasingly used in Brazil. Most of those tests have not undergone validation in the Brazilian population. In this context, we decided to evaluate a rapid test introduced in the Federal District (FD). OBJECTIVES To estimate the accuracy and reliability of the SD Bioeasy Dengue Duo rapid test and its components to detect dengue infections in a consecutive sample of symptomatic residents in the FD, Brazil. METHODS In total, 1353 venous blood samples were collected between 2013 and 2014. Two hundred and six positive samples (cases) and 246 negative samples (non cases) were required for sensitivity and specificity estimation, respectively; for agreement evaluation, we used 401 samples. The reference standard used was a composite of MAC-ELISA, virus isolation and real-time polymerase chain reaction (RT-qPCR). The evaluation was conducted prospectively under field conditions in the public health units of the FD. FINDINGS The results for the overall accuracy of the rapid test (NS1/IgM combined) showed 76% sensitivity and 98% specificity. The sensitivity for the NS1 component (67%) was better than that for the IgM component (35%). The positive likelihood ratio was 46, and the negative likelihood ratio was 0.24. The reliability of the test (NS1/IgM combined) demonstrated crude agreement of 98% (Kappa index 0.94). MAIN CONCLUSIONS The present phase III, large-scale validation study demonstrates that the rapid test SD Bioeasy Dengue Duo has moderate sensitivity (NS1/IgM combined) and high specificity. Therefore, the test is useful in confirming the diagnosis of dengue, but not enough to rule out the diagnosis. Our results also suggest that Dengue virus (DENV) viral load estimated through the RT-qPCR and antibody level measured through the MAC-ELISA could have had a direct influence on the accuracy of the rapid test.

BACKGROUND The use of dental care services contributes to the improvement of children's healthy behaviors, reducing the prevalence of future dental problems. In this way, the purpose of this study was to describe the use of dental care service during early childhood and the possible socioeconomic inequalities in this use. DESIGN Data from the Brazilian Oral Health Survey (SB Brasil, 2010) were used. Interviews with the children's parents and clinical examinations with the children were conducted in a 5-year-old representative sample. Descriptive, bivariate and multiple hierarchical statistical analyses were applied. RESULTS Of the 7241 children included, 3812 (53.2%) had used dental care services at least once in their lifetimes, and 1872 (48.8%) had used services for check-up/prevention. The use of dental services was greater among children with a higher family income (P < 0.05). The use of check-ups was lower among children with non-White skin color (Black and Browns) and among those who did not live in state capitals (P < 0.05). Clinical conditions and self-perception were also associated with the use (P < 0.05). CONCLUSION Socioeconomic differences in the general use of dental care and in its use for check-ups were identified during early childhood, indicating the presence of inequalities.

The neural crest (NC) is one of the most fascinating structures during embryonic development. Unique to vertebrate embryos, these cells give rise to important components of the craniofacial skeleton, such as the jaws and skull, as well as melanocytes and ganglia of the peripheral nervous system. Worldwide, several groups have been studying NC development and specifically in the Latin America (LA) they have been growing in numbers since the 1990s. It is important for the world to recognize the contributions of LA researchers on the knowledge of NC development, as it can stimulate networking and improvement in the field. We developed a database of LA publications on NC development using ORCID and PUBMED as search engines. We thoroughly describe all of the contributions from LA, collected in five major topics on NC development mechanisms: i) induction and specification; ii) migration; iii) differentiation; iv) adult NC; and, v) neurocristopathies. Further analysis was done to correlate each LA country with topics and animal models, and to access collaboration between LA countries. We observed that some LA countries have made important contributions to the comprehension of NC development. Interestingly, some LA countries have a topic and an animal model as their strength; in addition, collaboration between LA countries is almost inexistent. This review will help LA NC research to be acknowledged, and to facilitate networking between students and researchers worldwide.

BACKGROUND Citric acid (CA) has been suggested as an effective antimicrobial agent against biofilms formed on titanium. However, the antimicrobial effect of CA in biofilms formed in the oral environment and its effects on the physical properties of titanium surface remain unknown. Therefore, this study evaluated the antimicrobial effect of CA on in situ biofilm, whether this treatment favors the bacteria recolonization and its effect on the electrochemical properties of titanium. METHODS In the in situ test, volunteers wore a palatal appliance containing titanium discs. After 7 days, the discs (N = 21) were exposed in vitro to the following treatments: immersion in 0.9% sodium chloride (control); 40% CA immersion; and 40% CA rubbing. Afterwards, these discs (N = 18) were exposed in vitro to new bacterial adhesion with Streptococcus sanguinis. New discs (N = 18) without biofilm were exposed to the treatments and subjected to electrochemical tests and surface characterization. Data were analyzed by one-way ANOVA followed by Tukey's HSD test. RESULTS The CA groups showed a significant reduction (≈ 5-log reduction) in the biofilm formed in situ compared with the control group (p

This study evaluated whether the use of dental services of the Unified Health System (SUS) by elderly Brazilians is equitable. Individual data collected by qualified professionals during the national oral health survey (2010) and contextual data from DATASUS and IBGE were used. The dependent variable was the type of service used: SUS and others. Multilevel analyses were conducted using logistic regression (α=5%) (OR/CI 95%) using SPSS 24.0. A total of 6,303 elderly people were included and the prevalence of dental service use in SUS was 30%. Associated contextual factors were: access to bathroom and running water (1.54/1.19-2.00) and the dental care index (1.41/1.10-1.81); the individual factors were: age (0.77/0.66-0.90), years of schooling (1.83/1.53-2.20), family income (2.57/2.20-3.01), reason for last dental visit (0.75/0.60-0.93), decayed teeth total (1.26/1.08-1.48), plugged teeth total (0.63/0.54-0.74), dental prosthesis use (2.23/1.91-2.59), dental pain (1.36/1.11-1.67), self-perception of the need for dental treatment (1.20/1.12-1.51) and need for dental prosthesis (1.38/1.20-1.59). Dental service from SUS has been equitable, however it is necessary to organize the working process, enabling its use in a regular and preventive manner, thereby seeking universality and comprehensiveness.Avaliou-se, entre idosos brasileiros, se o uso dos serviços odontológicos provenientes do Sistema Único de Saúde (SUS) é equânime. Utilizaram-se dados individuais de exames conduzidos por profissionais calibrados do levantamento nacional de saúde bucal (2010) e dados contextuais originários do DATASUS e do IBGE. A variável dependente foi o tipo de serviço utilizado: SUS e Outros. Foram conduzidas análises multiníveis através de regressão logística (α = 5%) (OR/IC 95%), através do SPSS 24.0. Participaram 6.303 idosos, a prevalência do uso no SUS foi de 30%, os fatores contextuais associados foram o acesso a banheiro e a água encanada (1,54/1,19-2,00) e o índice de cuidados odontológicos (1,41/1,10-1,81); já os individuais: idade (0,77/0,66-0,90), anos de estudo (1,83/1,53-2,20), renda familiar (2,57/2,20-3,01), motivo da última consulta (0,75/0,60-0,93), no de dentes cariados (1,26/1,08-1,48), no de dentes obturados (0,63/0,54-0,74), uso de próteses (2,23/1,91-2,59), dor de dente (1,36/1.11-1,67), autopercepção da necessidade de tratamento odontológico (1,20/1,12-1,51) e da necessidade de próteses (1,38/1,20-159). O uso no SUS tem sido equânime, porém é preciso organizar o processo de trabalho, viabilizando tal uso de forma regular e preventiva buscando a universalidade e a integralidade.

INTRODUCTION:The aim of this study was quantify annexin A1 expression in macrophages and cluster of differentiation 4 (CD4) + and cluster of differentiation 8 (CD8)+ T cells from the skin of patients with cutaneous leishmaniasis (n=55) and correlate with histopathological aspects.METHODS:Infecting species were identified by polymerase chain reaction-restriction fragment length polymorphism, and expression of annexin A1 was analyzed by immunofluorescence.RESULTS:All patients (n = 55) were infected with Leishmania braziliensis . Annexin A1 was expressed more abundantly in CD163 + macrophages in infected skin (p < 0.0001) than in uninfected skin. In addition, macrophages in necrotic exudative reaction lesions expressed annexin A1 at higher levels than those observed in granulomatous (p < 0.01) and cellular lesions p < 0.05). This difference might be due to the need to clear both parasites and necrotic tissue from necrotic lesions. CD4 + cells in cellular lesions expressed annexin A1 more abundantly than did those in necrotic (p < 0.05) and granulomatous lesions (p < 0.01). Expression in CD8 + T cells followed the same trend. These differences might be due to the pervasiveness of lymphohistiocytic and plasmacytic infiltrate in cellular lesions.CONCLUSIONS:Annexin A1 is differentially expressed in CD163 + macrophages and T cells depending on the histopathological features of Leishmania -infected skin, which might affect cell activation.

BACKGROUND Gastroesophageal reflux (GER) and pulmonary aspiration are frequent in patients in the ICU. The presence of pepsin in airways seems to be the link between them. However, pepsin isoforms A (gastric specific) and C (pneumocyte potentially derived) need to be distinguished. This study aimed to evaluate GER patterns and to determine the presence of pepsin A and C in tracheal secretions of critically ill children receiving mechanical ventilation. METHODS All patients underwent combined multichannel intraluminal impedance-pH (MII-pH) monitoring. Tracheal secretion samples were collected to determine the presence of pepsin. Pepsin A and C were evaluated by Western blot. MII-pH parameters analyzed were number of total GER episodes (NGER); acid, weakly acidic, and weakly alkaline GER episodes; and proximal and distal GER episodes. RESULTS Thirty-four patients (median age, 4 months; range, 1-174 months) were included. MII-pH monitoring detected 2,172 GER episodes (77.0% were weakly acidic; 71.7% were proximal). The median NGER episodes per patient was 59.5 (25th-75th percentile, 20.3-85.3). Weakly acidic GER episodes per patient were significantly more frequent than acid GER episodes per patient (median [25th-75th percentile], 43.5 [20.3-68.3] vs 1.0 [0-13.8], respectively; P .001). Only three patients had an altered acid reflux index (44.9%, 12.7%, and 13.6%) while not taking antacid drugs. Pepsin A was found in 100% of samples and pepsin C in 76.5%. CONCLUSIONS The majority of GER episodes of children in the ICU were proximal and weakly acidic. All patients had aspiration of gastric contents as detected by pepsin A in tracheal fluid. A specific pepsin assay should be performed to establish gastropulmonary aspiration because pepsin C was found in > 70% of samples.

OBJECTIVE To examine whether demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care are associated with users’ dissatisfaction with such are.METHODS Cross-sectional study of 781 people who required dental care in Montes Claros, MG, Southeastern Brazil, in 2012, a city with of medium-sized population situated in the North of Minas Gerais. Household interviews were conducted to assess the users’ dissatisfaction with dental care (dependent variable), demographic, socioeconomic conditions, oral health subjectivity and characterization of dental care (independent variables). Sample calculation was used for the finite population, with estimates made for proportions of dissatisfaction in 50.0% of the population, a 5.0% error margin, a non-response rate of 5.0% and a 2.0% design effect. Logistic regression was used, and the odds ratio was calculated with a 5% significance level and 95% confidence intervals.RESULTS Of the interviewed individuals, 9.0% (7.9%, with correction for design effect) were dissatisfied with the care provided. These were associated with lower educational level; negative self-assessment of oral health; perception that the care provider was unable to give dental care; negative evaluation of the way the patient was treated, the cleanliness of the rooms, based on the examination rooms and the toilets, and the size of the waiting and examination rooms.CONCLUSIONS The rate of dissatisfaction with dental care was low. This dissatisfaction was associated with socioeconomic conditions, subjectivity of oral health, skill of the health professionals relating to the professional-patient relationship and facility infrastructure. Educational interventions are suggested that aim at improving the quality of care among professionals by responsible agencies as is improving the infrastructure of the care units.

OBJECTIVE: To identify the prevalence and the severity of malocclusions and to analyze factors associated with the need for orthodontic treatment of Brazilian adolescents. METHODS: This exploratory, cross-sectional study was carried out based on secondary data from the national epidemiological survey on oral health in Brazil (2002-2003). Socio-demographic conditions, self-perception, and the existence and degree of malocclusion, using the Dental Aesthetic Index, were evaluated in 16,833 adolescent Brazilians selected by probabilistic sample by conglomerates. The dependent variable need orthodontic treatment was estimated from the severity of malocclusion. The magnitude and direction of the association in bivariate and multivariate analyzes from a Robust Poisson regression was estimated. RESULTS: The majority of the adolescents needed orthodontic treatment (53.2%). In the multivariate analysis, the prevalence of the need for orthodontic treatment was larger among females, non-whites, those that perceived a need for treatment, and those that perceived their appearance as normal, bad, or very bad. The need for orthodontic treatment was smaller among those that lived in the Northeast and Central West macro-regions compared to those living in Southeast Brazil and it was also smaller among those that perceived their chewing to be normal or their oral health to be bad or very bad. CONCLUSIONS: There was a high prevalence of orthodontic treatment need among adolescents in Brazil and this need was associated with demographic and subjective issues. The high prevalence of orthodontic needs in adolescents is a challenge to the goals of Brazil's universal public health system. OBJETIVO: Identificar a prevalência e a gravidade das más oclusões e fatores associados com a necessidade de tratamento ortodôntico dos adolescentes brasileiros. MÉTODOS: Estudo transversal feito com base nos dados da pesquisa epidemiológica nacional em saúde bucal no Brasil (2002-2003). Condições sociodemográficas, autopercepção, existência e nível de gravidade da má oclusão, com o uso do Índice de Estética Dentária, foram avaliados em 16.833 adolescentes brasileiros selecionados por amostra probabilística por conglomerados. A variável dependente necessidade de tratamento ortodôntico foi estimada a partir da gravidade da má oclusão. A magnitude e a direção das associações nas análises bivariada e multivariada foram estimadas pela regressão de Poisson. RESULTADOS: A maioria dos adolescentes apresentou necessidade de tratamento ortodôntico (53,2%). Na análise multivariada, a prevalência da necessidade de tratamento ortodôntico foi maior entre as mulheres, os não brancos, aqueles que autopercebiam a necessidade de tratamento e aqueles que autopercebiam sua aparência como normal, ruim ou muito ruim. A necessidade de tratamento ortodôntico foi menor entre aqueles que viviam nas regiões Nordeste e Centro-Oeste em comparação com aqueles da Sudeste e também menor entre aqueles que autopercebiam sua mastigação como normal e sua saúde bucal como ruim ou muito ruim. CONCLUSÕES: O estudo identificou uma prevalência elevada da necessidade de tratamento ortodôntico em adolescentes no Brasil, associada com questões demográficas e subjetivas de saúde bucal. A alta prevalência de necessidades ortodônticas entre adolescentes é um desafio para o Sistema Único de Saúde (SUS) do Brasil.

Untreated dental caries can compromise oral health-related quality of life (OHRQoL). However, it is not clear which specific daily activities related to OHRQoL are compromised by the presence of this problem. Therefore, the purpose of this study was to identify which specific daily activities are affected by the presence of untreated dental caries using a representative sample of Brazilian children.A cross-sectional study using a representative sample of Brazilian children (12 years of age) was conducted. The presence of untreated dental caries was assessed using the "decayed - D" component of the DMFT (decayed, missing, and filled teeth) index. Clinical exams were conducted by trained and calibrated dentists. The daily activities were evaluated using the survey Oral Impacts on Daily Performance (OIDP), considering items and domains. Descriptive, bivariate, and multiple analyses were conducted (α = 0.05).A total of 7,247 children were included, and 39.9 percent had at least one tooth with untreated dental caries, with 33.5 percent experiencing an impact on at least one of the OIDP activities. This study identified a greater chance of the presence of untreated dental caries in children having an impact on the psychological domain (P = 0.006), as well as on the "difficulty eating" (P = 0.007), and "difficulty sleeping" (P = 0.023) items.The presence of untreated dental caries among Brazilian children was associated with an impact on specific daily activities (difficulty eating and sleeping) and the psychological domain of OHRQoL.

Oral rehabilitation with dental prosthesis was mandated by national oral health policy in Brazil, due to the high prevalence of total teeth loss and low use of dental prosthesis among the elderly. There is a pressing need to assess the impact of this rehabilitation policy. An attempt was therefore made to investigate if the dental service used was one of the factors associated with the use of total dental prosthesis among the elderly. To achieve this, a cross-sectional study using a probabilistic sample of elderly (60 years and above) urban-area residents of a small city was conducted by qualified examiners. Descriptive, bivariate and multiple (logistic regression/odds ratio - OR) analyses were conducted on 287 elderly people, of which 186 (64.8%) used dental prosthesis. The use of total dental prosthesis was associated with a higher probability of being attended by private dental services (OR = 4.19; p0.001) and the presence of lesions on the palate (OR = 7.52; p = 0.002). Conversely, it was associated with lower probability in ages greater than or equal to 73 years (OR = 0.52; p = 0.023) and among those with impairment of OHIP-14 (OR = 0.20; p = 0.002) in the physical disability dimension. The use of total dental prosthesis was associated with the type of dental service used by the elderly, it being greater among private service users.A reabilitação protética foi prevista pela política nacional de saúde bucal em função da alta prevalência de perda de todos os dentes e do baixo uso de prótese dentária entre idosos. Há necessidade de se avaliar o impacto dessa política de reabilitação. Portanto, objetivou-se investigar se o tipo de serviço odontológico utilizado foi um dos fatores associados ao uso de prótese dentária total entre idosos. Trata-se de um estudo transversal conduzido em uma amostra probabilística de idosos (60 anos ou mais) residentes na zona urbana de um município brasileiro de pequeno porte populacional por examinadores calibrados. Realizaram-se análises descritiva, bivariada e múltipla (Regressão logística - odds ratio - OR). Participaram 287 idosos, destes, 186 (64,8%) faziam uso de prótese dentária total. O uso de prótese dentária total foi associado a maiores chances de uso de serviços odontológicos supletivos ou particulares (OR = 4,19; p0,001) e a presença de lesão no palato (OR = 7,52; p = 0,002) e, também, a menores chances em idades maiores ou iguais a 73 anos (OR = 0,52; p = 0,023) e entre os com comprometimento na dimensão incapacidade física do OHIP-14 (OR = 0,20; p = 0,002). O uso de prótese dentária total foi associado ao tipo de serviço odontológico entre idosos, sendo maior o uso entre usuários dos serviços supletivos ou particulares.

The scope of this study was to evaluate dissatisfaction with dental services among dentate and edentulous elderly Brazilians and its association with contextual and individual variables. The data from the National Oral Health Survey conducted in 2010 and contextual variables related to cities were used. Descriptive, bivariate and multilevel analysis was conducted among 1,989 elderly individuals. Of these, 11.2% of dentate and 22.1% of edentulous elderly people were dissatisfied. Among the dentate individuals, dissatisfaction was associated with contextual variables (location of municipality, human development index, GINI Index, the presence of Dental Specialty Centers and the coverage of oral health in public service) and persons related to health care and oral health conditions. For the edentulous individuals, no associated contextual variables were identified. Only the motive for the use of the service and satisfaction with teeth and mouth were associated with dissatisfaction with dental services. A considerable prevalence of dissatisfaction with the services was identified, being higher among edentulous elderly Brazilians. Among dentate elderly Brazilians, an association with contextual variables was detected.Avaliou-se a insatisfação com os serviços odontológicos entre idosos brasileiros dentados e edentados e sua associação com variáveis contextuais e individuais. Foram utilizados os dados do Levantamento Nacional de Saúde bucal realizado em 2010 e dados contextuais referentes aos municípios. Análises descritivas, bivariadas e multinível foram realizadas. Incluiu-se 1.989 idosos. Destes, 11,2% dos idosos dentados e 22,1% dos edentados estavam insatisfeitos. Entre os dentados, a insatisfação foi associada com variáveis contextuais (localização do município, índice de desenvolvimento humano, Índice de GINI, presença de Centro de Especialidades Odontológicas e cobertura das equipes de saúde bucal) e individuais pertencentes à atenção à saúde e condições de saúde bucal. Para os idosos edentados, não foi identificado associação com variáveis contextuais. Apenas o motivo do uso do serviço e a satisfação com dentes e boca foram associados. Identificou-se uma prevalência considerável de insatisfação com os serviços, sendo maior entre os idosos edentados. Entre os idosos dentados, foi observado associação com variáveis contextuais.

Breast cancer (BC) is the most frequent malignancy among women worldwide and has been associated with high mortality because of the late treatment of the disease. Our group has proposed a selective ablation of breast cancer cells by the use of magnetic fields assisted by magnetic nanoparticles. The principle is to increase the conductivity of tumoral tissue by the use of a bioconjugated "nanoparticle-antibody" that recognizes specific antigens on the surface of the cancer cells. The aim of this study was to evaluate the c-erbB-2 antigen in breast cancer cells of type BT-474, MCF-7, and MDA-MB-231 as a possible target for the use of magnetic nanoparticles coupled to a specific Monoclonal Antibody (Mab). Quantitative real-time polymerase chain reaction and flow cytometry were used to estimate the relative expressions of the c-erbB-2 gene and the c-erbB-2 antigen in the cell lines, respectively. A covalent union of magnetic nanoparticles to anti c-erbB-2 Mab was used to develop the bioconjugate. Fluorescence microscopy was used to determine the cells that were tagged by the bioconjugate. The results show a well-differentiated relative expression of c-erbB-2 in the studied cell lines and are qualitatively in agreement with the fluorescent marking by the magnetic nanoparticles. The selected breast cancer cells appear to be suitable for experimental evaluation of selective targeting by magnetic nanoparticles.

Aims In this work, it was sought to determine if there was synergism between doxorubicin (DOX), a well-known antineoplastic, and sclareol (SC), a diterpene from natural origin, in breast cancer treatment. Moreover, it was investigated if their co-loading in the same nanocarrier would result in a gain of activity and/or a toxicity diminishment. Main methods The synergism of the DOX:SC combination was evaluated in MDA-MB-231 and 4T1 cells. A nanostructured lipid carrier (NLC) co-encapsulating DOX and SC in their synergistic molar ratio was prepared and characterised, in terms of mean diameter, zeta potential, DOX encapsulation efficiency, small angle X-ray scattering, differential scanning calorimetry, and polarised light microscopy for further intravenous administration. The anticancer activity of the combination, free and encapsulated, was evaluated in 4T1-tumour bearing mice. Key findings It was determined that DOX:SC combination at the molar ratio 1:1.9 presents better synergistic anticancer activity than the molar ratio 1:7.5 in vitro. DOX:SC-loaded NLC (NLC-DOX-SC) improved in vitro cytotoxic and in vivo antitumour activity compared to free DOX. Although NLC-DOX-SC and free DOX:SC, at the synergistic molar ratio, showed similar activity in the in vivo study, the free combination provoked body weight loss, behaviour alterations and haematological toxicity in the animals, while this was not observed for NLC-DOX-SC. Significance This work shows that SC and DOX present synergistic anticancer activity for breast cancer treatment whereas NLC-DOX-SC was a feasible alternative to attain the benefits posed by DOX:SC combination but with none to fewer side effects.

Statement of problem Rhythmic masticatory muscle activity, including sleep bruxism (SB), can be induced in healthy individuals by experimental esophageal acidification, which plays an important role in the pathogenesis of gastroesophageal reflux disease (GERD). However, no robust evidence supports the association between SB and GERD. Purpose The purpose of this study was to investigate the association between SB and GERD. Material and methods Forty-five individuals were eligible to participate in this observational transversal study at the Gastroenterology Service of the Clinical Hospital of Porto Alegre, Brazil. The participants were classified into 2 groups, those with and without GERD, according to the Montreal Criteria and pH-metry/endoscopy findings. The diagnosis of SB was not assessed in a sleep laboratory but was based on self-report plus clinical inspection, according to the minimal diagnostic criteria of the American Academy of Sleep Medicine. The Lipp Stress Symptom Inventory was used to evaluate self-perceived stress. Univariate and multiple logistic regression analyses were performed with SB as dependent variable and GERD, sex, age, body mass index, and stress as predictors (α=.05; 90% power). Results The study population included individuals with SB without GERD (13.3%) and individuals with SB with GERD (31.1%). In participants with GERD, the prevalence of SB was 73.7%. Only the variable GERD was significantly associated with SB ( P =.017; odds ratio 6.58; 95% confidence interval 1.40-30.98), although adjusted for stress and age. Conclusions Sleep bruxism is prevalent in GERD patients, and GERD is highly associated with SB.

This cross-sectional, population-based study evaluated contextual and individual determinants on the oral health-related quality of life in older Brazilians. Data from the National Survey of Oral Health were used. The sample was selected by multi-stage probability cluster sampling, with probability proportional to size. The Oral Impacts on Daily Performance (OIDP) was used to evaluate oral health-related quality of life (OHRQoL). Contextual variables of municipalities and individual variables of older people were included. Descriptive, bivariate and multilevel analyses were conducted. Of the sample of 7619 older Brazilians, 45.7% was impacted by at least one of the OIDP items. The item impact average was 1.2 (95% CI 1.04–1.37). The impact on OHRQoL was lower in older Brazilians residents in municipalities with the highest value of the GINI index (contextual variable) (p = 0.007), among edentulous people (p = 0.001) and dental prosthesis users (p

Objective To describe the prevalence of dental pain in Brazilian preschoolers, as well as its associated factors, considering a representative sample of that population group in Brazil. Methods Cross-sectional study that used the analytical data from national oral health survey (SB Brazil) carried out in 2010. A representative sample of Brazilian preschoolers aged 5 years was considered. Interviews were carried out (answered by parents/tutors), as well as clinical examinations in children. Descriptive, bivariate and mutiple analyzes were performed, described in odds ratios and 95% confidence interval (OR/95%CI). Results 7280 preschoolers were included. Of these, 1520 (21.1%) had dental pain in the last 6 months. The chance of the occurrence of dental pain was higher among those who used dental services (1.51/1.02–2.23), with tooth decay (3.08/2.08–4.56), that self-perceveid the need for dental treatment (3.96/2.48–6.34), whose parents reported dissatisfaction by children with their teeth and mouth (1.47/1.04–2.10) and those who reported impact of oral problems on quality of life (5.76/3.90–8.49). Conclusions The prevalence of dental pain among Brazilian preschool children was relatively high, being associated with the use of dental services and the normative and subjective oral health status.

The scope of this study was to identify if the absence of functional dentition (FD) is associated with a lack of commitment to oral functions/daily activities among Brazilian adults. For this purpose, data from the National Survey of Oral Health (referred to as SB Brasil 2010) was used. FD was evaluated by the criterion proposed by the WHO (at least 20 teeth in the mouth). The Oral Impacts on Daily Performance (OIDP) questionnaire was used to evaluate daily activities/oral functions. Descriptive, bivariate (chi-squared) and multiple (logistic regression) analysis was conducted, and the odds ratio estimated with a 95% confidence interval (OR/CI95%). The research evaluated 9,564 adults, of which 2,200 adults (20.5%) were considered to have poor FD, and at least one of the daily activities/oral functions evaluated had an impact among 55% of adults. The lack of FD between adults was associated (p ≤ 0.05) with the impact on speech (1.88/1.33-2.64) and being ashamed to smile or talk (1.35/1.00-1.83). A considerable prevalence of lack of FD was identified, this absence being associated with the lack of commitment to the daily activities/oral functions. Dental rehabilitation of patients with a lack of FD should consider the restoration of these lost oral functions (speech and being ashamed to smile or talk).Objetivou-se identificar se a falta de dentição funcional (DF) está associada com o comprometimento das funções bucais/atividades diárias entre adultos brasileiros. Para isto, foram utilizados dados da Pesquisa Nacional de Saúde Bucal - SB Brasil 2010. A DF foi avaliada pelo critério proposto pela Organização Mundial de Saúde (pelo menos 20 dentes na boca). O instrumento Impactos Odontológicos nos Desempenhos Diários (IODD) foi utilizado para avaliar as atividades diárias/funções bucais. Análises descritivas, bivariadas (Qui-quadrado) e múltiplas (Regressão Logística) foram realizadas, sendo estimado o odds ratio e o intervalo de confiança 95% (OR/IC95%). Foram incluídos e avaliados 9564 adultos. Foram considerados sem DF 2200 adultos (20,5%). Tiveram impacto em pelo menos uma das atividades diárias/funções bucais avaliadas, 55,0% dos adultos. A falta de DF entre adultos foi associada (p ≤ 0,05) com o impacto na fala (1,88/1,33-2,64) e vergonha ao sorrir ou falar (1,35/1,00-1,83). Uma prevalência considerável de falta de DF foi identificada, esta ausência foi associada às atividades diárias/funções bucais (fala e vergonha ao sorrir e falar). A reabilitação dentária de pacientes sem DF deve considerar a devolução destas funções bucais perdidas (fala e vergonha ao sorrir ou falar).

The prevalence of dissatisfaction with dental services and its association with normative and subjective oral health conditions among adult Brazilians was evaluated. This cross-sectional study used data from the last Brazilian National Oral Health Survey (SBBrasil), conducted in 2010. It was considered a representative sample of the adult Brazilian population. Data were analyzed by descriptive, univariate and multiple statistics (OR / 95% CI), with correction by the design effect. Among the 4539 adults included in the study, 614 (13.4%) reported dissatisfaction with dental services. Dissatisfaction was higher among adults who had any decayed teeth (1.61 / 1.06; 2.44), adults who were dissatisfied with their teeth and mouth (2.36 / 1.39; 4.02) and adults who had reported toothache in the previous six months (1.99 / 1.29, 3.07). The conclusion drawn was that the prevalence of dissatisfaction with dental services among Brazilian adults was low and associated to normative and subjective oral health conditions.Avaliou-se a prevalência da insatisfação com os serviços odontológicos e sua associação com condições normativas e subjetivas de saúde bucal entre adultos brasileiros. Trata-se de um estudo transversal que utilizou dados do inquérito nacional de saúde bucal (SB Brasil) realizado em 2010. Considerou-se uma amostra representativa da população adulta brasileira. Foram conduzidas análises descritivas, bivariadas e múltiplas (OR/IC 95%) com correção pelo efeito desenho. Dentre os 4.539 adultos incluídos, 614 (13,4%) relataram a insatisfação com os serviços odontológicos utilizados. A insatisfação foi maior entre aqueles que apresentavam algum dente cariado (1,61/1,06 ; 2,44), que estavam insatisfeitos com seus dentes e boca (2,36/1,39 ; 4,02) e que haviam relatado dor de dente nos últimos 6 meses (1,99/1,29 ; 3,07). Conclui-se que a prevalência da insatisfação com os serviços odontológicos entre adultos brasileiros foi baixa e esteve associada a condições normativas e subjetivas de saúde bucal.

This study aimed to evaluate the prevalence and distribution profile of malocclusion in Brazilian preschoolers and its association with macro-region, housing, gender, and self-reported race. In total, 6,855 children aged five years participating in the National Oral Health Survey (called SB Brasil 2010) were analyzed. Malocclusion was diagnosed according to the Foster and Hamilton index. We conducted descriptive, bivariate and multiple regression analyses (PR/CI95%). We identified that 63.2% of children had at least one of the occlusal problems evaluated: canines' key (22.9%), overjet (32.9%), overbite (34.6%), and posterior crossbite (18.7%) and, thus, were considered with malocclusion. Higher probability of the presence of malocclusion was identified among the residents of the Midwest (1.08/95%CI 1.01-1.15), Northeast (1.21/95%CI 1.14-1.28), Southeast (1.27/95%CI 1.20-1.34) and South (1.34/95%CI 1.26-1.42) regions when compared to residents in the North. It was also higher among female children (1.06/95% CI 1.02-1.09). No associations were identified concerning race and location of the municipality (capital/no capital). A high prevalence of malocclusion was identified in Brazilian preschoolers, and it was associated with gender and the macro-region. These findings may contribute to expanded public policies and greater access to treatment for this population.Objetivou-se avaliar a prevalência e o padrão de distribuição da má oclusão em pré-escolares brasileiros e sua associação com macrorregião, local de moradia, sexo e raça autodeclarada. Foram analisados dados de 6.855 crianças de 5 anos participantes do SB Brasil 2010. No levantamento, a má oclusão foi diagnosticada segundo o Índice de Foster e Hamilton. Conduziu-se análises descritivas, bivariadas e múltiplas (RP/IC95%). Identificou-se que 63,2% das crianças possuíam ao menos um dos problemas oclusais avaliados: chave de caninos (22,9%), sobressaliência (32,9%), sobremordida (34,6%), e mordida cruzada posterior (18,7%) e, portanto, foram considerados com má oclusão. Maior chance da presença de má oclusão foi identificada entre os residentes das regiões Centro-Oeste (1,08/IC95%-1,01-1,15), Nordeste (1,21/IC95%-1,14-1,28), Sudeste (1,27/IC95%-1,20-1,34) e Sul (1,34/IC95%-1,26-1,42), quando comparados aos residentes na região Norte. Foi maior também entre as crianças do sexo feminino (1,06/IC95%-1,02-1,09). Identificou-se elevada prevalência de má oclusão em pré-escolares brasileiros, sendo esta associada ao sexo e à macrorregião de moradia. Tais achados podem contribuir na ampliação de políticas públicas e no acesso ao tratamento para esta população.

The scope of this study was to identify factors associated with lack of access to dental services. It involved a cross-sectional study and a probabilistic complex sample by conglomerates in two stages with 857 participants over 18 years of age in a large city. Multiple analyses by means of logistic and multivariate regression in decision trees were made. The lack of access to dental services was considered a dependent variable. It was identified that 10.3% did not have access. In the multiple and multivariate analyses an association with age was verified and in the logistic regression a greater possibility of lack of access was found for each year of increased age, among those with the lowest per capita income and those who ranked appearance of teeth and gums as "fair/poor/very poor." The lack of access to dental services was greater among the most socially vulnerable. There is a pressing need to increase the allocation of public resources to promote health education and provide knowledge about how to access services when they are needed, focusing on dental care as a human right and ensuring that lack of access does not occur as users get older or among those with low income and also those dissatisfied with their oral appearance.Objetivou-se identificar fatores associados à falta de acesso aos serviços odontológicos. Estudo transversal, amostra complexa probabilística por conglomerados em dois estágios de 857 participantes, com mais de 18 anos em um município de grande porte populacional. Foram feitas análises múltiplas através da regressão logística e multivariada em árvores de decisão. Considerou-se como variável dependente o acesso aos serviços odontológicos. Identificou-se que 10,3% não obtiveram acesso. Nas análises múltipla e multivariada constataram-se associação com a idade, na regressão logística constatou-se maior chance de falta de acesso a cada ano de idade incrementado, entre aqueles com menor renda per capita e entre os que classificaram a aparência dos dentes e gengivas como “regular/ruim/péssima”. A falta de acesso aos serviços odontológicos é maior entre os mais vulneráveis socialmente. Há necessidade de incremento na alocação de recursos públicos que promovam educação em saúde e gere conhecimento sobre como acessar os serviços quando necessitar, tendo em foco os cuidados odontológicos como um direito humano e que possibilitem que não ocorra a falta de acesso à medida que os usuários envelhecem ou entre os com baixa renda e também os insatisfeitos com a aparência bucal.

A calcium (Ca) prerinse before a fluoride (F) rinse has been shown to increase oral F levels. We tested the anticaries effect of this combination in a dose-response in situ caries model. In a double-blind, crossover experiment, 10 volunteers carried enamel slabs in palatal appliances for 14 days, during which they rinsed twice/day with one of four rinse combinations: (1) a placebo prerinse (150 mM sodium lactate) followed by a distilled water rinse (negative control); (2) a placebo prerinse followed by a 250 ppm F rinse; (3) a placebo prerinse followed by a 1,000 ppm F rinse, or (4) a Ca prerinse (150 mM Ca, as calcium lactate) followed by a 250 ppm F rinse. Sucrose solution was dripped onto the slabs 8×/day to simulate a high cariogenic challenge. The percent surface hardness loss (%SHL) was significantly lower in the Ca prerinse used with the 250 ppm F rinse group (%SHL = 38.0 ± 21.0) when compared with the F rinse alone (%SHL = 59.5 ± 24.1) and similar to the 1,000 ppm F rinse group (%SHL = 42.0 ± 18.3). Compared with the 250 ppm F rinse, the Ca prerinse increased biofilm fluid F only twice (nonsignificant). However, it greatly increased F in biofilm solids (∼22×). The Ca prerinse had little effect on loosely or firmly bound enamel F. The results showed an increased level of protection against demineralization by the use of a Ca prerinse, which seems to be caused by the enhancement of F concentration in the biofilm.

Although achalasia is a rare disorder in children, its symptom may mimic common childhood diseases. This study aimed to assess the diagnosis and management of achalasia in children and adolescents in a Brazilian single center during a 12-year period. Patients with achalasia were identified from a database built during the period of January 2000–January 2012 from a Pediatric Gastroenterology reference center. Information regarding demographic data, clinical symptoms, diagnosis, treatment, and long-term follow-up were described. Thirteen patients were studied; median age was 7 (1–14) years. Most frequent symptoms were vomiting (84.6 %) and dysphagia (69.2 %). Weight loss occurred in 46.0 % of patients and chronic cough in 46.1 %. Associated disorders were Down’s syndrome, Allgrove syndrome, and congenital central hypoventilation syndrome. Achalasia was misdiagnosed with anorexia nervosa. Six patients were previously treated as having gastroesophageal reflux disease and asthma. Five patients had pneumatic balloon dilation as initial therapy whereas five had esophageal myotomy. Finally, 11 patients had surgical therapy with a favorable follow-up. Achalasia symptoms may mimic common diseases in children, and therefore, may delay the diagnosis. This study emphasizes the importance of the clinical symptoms for the diagnosis of achalasia, mainly in those cases with associated disorders.

Objective To determine the prevalence of p 53 expression in cytologic smear collected by the RS Balloon in high-risk individuals, and test its yield in the cytologic screening of squamous cell carcinoma of the esophagus (SCCE). Study Design Asymptomatic individuals at risk for SCCE underwent esophageal exfoliative cytology with the RS Balloon immediately followed by upper gastrointestinal endoscopy with biopsies of unstained areas after iodine mucosal staining of the esophagus. For each patient, cytologic expression ofp53 was compared with the worst endoscopic biopsy diagnosis and the histologic expression ofp53. Results One hundred seventy-one individuals were submitted to the study's protocol. There were 8 lost cases (4.7%) due to inadequate cytologic samples. The final sample consisted of 163 individuals where 150 were male (92 % ), mean age of 52.6 ± 12.0 years old. There were 3 cases of dysplasia/SCCE. Immunohistochemical expression of p53 protein was positive in 38 patients (23.6%), with basal layer expression in 29 (76.3%), middle layer expression in 8 (21.1%) and supeficial layer in 1 (2. 6% ) . All patients with dysplasia/SCCE had positive immunohistochemical expression of p53 protein. Immunocytochemical expression of p53 protein in cytologic smear was negative in all cytology samples. Conclusion The negative results of immunocytochemical expression of p53 protein suggest that its use does not contribute to improving the performance of conventional cytology of the esophagus in the screening for SCCE and its precursor lesions.

We tested whether gastro-oesophageal pressure gradient is augmented in sliding hiatal hernia and the yield of oesophageal manometry in diagnosing sliding hiatal hernia.Patients with equivalent body mass index were categorised according to manometry and endoscopy in groups: (1) no sliding hiatal hernia (n=147); (2) sliding hiatal hernia solely at endoscopy (n=46); and (3) sliding hiatal hernia at manometry (n=22). The yield of manometry was assessed taking endoscopy as referential.Gastro-oesophageal pressure gradient was similar between groups both at inspiration (13.3+/-5.7 mm Hg vs. 13.6+/-5.4 mm Hg vs. 12.6+/-4.4 mm Hg; P=0.874) or expiration (5.1+/-3.8 mm Hg vs. 5.2+/-3.6 mm Hg vs. 5.1+/-3.7 mm Hg; P=0.767). Group 3 patients were older than those of groups 1 and 2 (59+/-10 vs. 42+/-15 vs. 45+/-13 years; P0.001). Sliding hiatal hernia was larger when characterised by manometry than at endoscopy [4 cm (2.25-4.75) vs. 2 cm (2-3); P0.001]. Manometry showed sensitivity of 28% (95%CI 19-40%), specificity of 97% (95%CI 93-99%) and positive predictive value of 82% (95%CI 63-92%) in diagnosing sliding hiatal hernia.By using manometry in patients with equivalent body mass index, sliding hiatal hernia presence and size are related with age rather than gastro-oesophageal pressure gradient. This technique may be clinically useful when positive for sliding hiatal hernia.

Olfactory groove meningiomas (OGM) account for 4.5% of all intracranial meningiomas. We report 21 patients with OGMs. Tumors were operated on using three surgical approaches: bifrontal (7 patients), fronto-pterional (11 patients) and fronto-orbital (3 patients). Total tumor removal (Simpson Grade 1) was achieved in 13 patients and Simpson II in 8 patients. Perioperative mortality was 4.76%. The average size of the OGM was 4.3 ± 1.1 cm. The overall recurrence rate was 19%. We preferred to use the pterional approach, which provides quick access to the tumor with less brain exposure. It also allows complete drainage of cisternal cerebrospinal fluid, providing a good level of brain relaxation during surgery. However, for long, thin tumors, hemostasis can be difficult using this approach.

Reflux symptoms are common in pregnancy, but their association with fat ingestion is unclear.To investigate an association of dietary fats with heartburn and regurgitation in pregnancy.This is a prospective study in which 89 pregnant women (gestational age 34 +/- 4 weeks) attending a low-risk prenatal outpatient clinic were asked to provide information on the frequency they experienced heartburn and regurgitation. Fat ingestion was estimated by means of a 24-h diet record. Symptomatic patients were compared with those with no reflux symptoms (n = 20).Heartburn once a week or more often occurred in 56 of the 89 patients (63%). The ingested amount of polyunsaturated fatty acids was higher in patients with heartburn (11.2 +/- 6.4 vs. 7.7 +/- 3.5 mg; P = 0.022) than in controls after adjusting for age, gain weight during pregnancy, ingestion of caffeine and vitamin C, and total energetic intake. The ingestion of monounsaturated fatty acids was higher in patients with heartburn, but with a borderline statistical significance (16.1 +/- 11 vs. 11.8 +/- 6.5 mg; P = 0.061). No association was observed between the consumption of fats and regurgitation.This study suggests that heartburn in the third trimester of pregnancy is associated with the ingestion of polyunsaturated fatty acids.