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Made available in DSpace on 2020-12-12T02:45:02Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-08-01 Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Objective: To evaluate the phenotypic features of the masticatory biomechanics in atypical subjects with Down syndrome (DS). Its influence was analysed on sleep disorders, body adiposity and its risks, and some physicochemical properties of saliva. Methods: Seventy subjects were enrolled to assess masticatory biomechanical function and divided into two groups: DS and control groups. Electrical activities of the masseter and temporal muscles (at rest and in maximum voluntary clench-MVC), maximum bite force-MBF and maximum mouth opening-MMO were investigated. Among the atypical subjects, just 24 participants underwent the anthropometry, the polysomnography II and the saliva testing (salivary flow rate-SFR, buffer capacity-BC and salivary cortisol levels, morning/SC-AM and night/SC-PM). Results: MVC and MBF values showed high statistical significance in the control group (P

Made available in DSpace on 2020-12-12T02:40:14Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-12-01 The aim of the present study was to evaluate intra-day (test) and inter-day (re-test) reliability of surface electromyography (sEMG) signals of the masseter and temporal muscles in patients with Down syndrome (DS). We determined the reliability of sEMG variables in 33 patients with DS. EMG signals were recorded at rest as well as during maximum voluntary clenching and maximum habitual intercuspation (MHI). The signals were analyzed considering the amplitude in the root mean square (RMS), mean frequency (MNF), median frequency (MDF) and approximate entropy (ApEn). The intraclass correlation (ICC2,1) for the three trials recorded during MHI in the two sessions (test and retest) revealed excellent intra-session and inter-session reliability (ICC2,1 = 0.76 to 0.97) for all sEMG variables and muscles. In the rest position, excellent reliability was found for RMS and ApEn (ICC2,1 = 0.75 to 1.00) and good to excellent reliability was found for MDF and MNF (ICC2,1 = 0.64 to 0.93). The intra-session (test) and inter-session (re-test) analyses demonstrated the reliability of nonlinear sEMG variables of the masticatory muscles in adults with Down Syndrome. Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) Institute of Science and Technology São José dos Campos Campus São Paulo State University–UNESP Nove de Julho University Centro Universitário de Anápolis - UniEvangélica Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) Institute of Science and Technology São José dos Campos Campus São Paulo State University–UNESP

Questions Does walking training combined with transcranial direct current stimulation (tDCS) improve walking (ie, speed, cadence and step length) and reduce falls and freezing, compared with no/sham intervention, in people with Parkinson's disease? Is walking training combined with tDCS superior to walking training alone? Are any benefits carried over to social participation and/or maintained beyond the intervention period? Design A systematic review with meta-analyses of randomised clinical trials. Participants Ambulatory adults with a clinical diagnosis of Parkinson's disease. Intervention tDCS combined with walking training. Outcome measures Primary outcomes were walking speed, cadence and step length. Secondary outcomes were number of falls, fear of falling, freezing of gait and social participation. Results Five trials involving 117 participants were included. The mean PEDro score of the included trials was 8 out of 10. Participants undertook training for 30 to 60 minutes, two to three times per week, on average for 4 weeks. Moderate-quality evidence indicated that the addition of tDCS to walking training produced negligible additional benefit over the effect of walking training alone on walking speed (MD −0.01 m/s, 95% CI −0.05 to 0.04), step length (MD 1.2 cm, 95% CI −1.2 to 3.5) or cadence (MD −3 steps/minute, 95% CI −6 to 1). No evidence was identified with which to estimate the effect of the addition of tDCS to walking training on freezing of gait, falls and social participation. Conclusion The addition of tDCS to walking training provided no clinically important benefits on walking in ambulatory people with Parkinson's disease. Registration PROSPERO CRD42020162908.

Background The timely identification of a cluster is a critical requirement for infection prevention and control (IPC) departments because these events may represent transmission of pathogens within the health care setting. Given the issues with manual review of hospital infections, a surveillance system to detect clusters in health care settings must use automated data capture, validated statistical methods, and include all significant pathogens, antimicrobial susceptibility patterns, patient care locations, and health care teams. Methods We describe the use of SaTScan statistical software to identify clusters, WHONET software to manage microbiology laboratory data, and electronic health record data to create a comprehensive outbreak detection system in our hospital. We also evaluated the system using the Centers for Disease Control and Prevention's guidelines. Results During an 8-month surveillance time period, 168 clusters were detected, 45 of which met criteria for investigation, and 6 were considered transmission events. The system was felt to be flexible, timely, accepted by the department and hospital, useful, and sensitive, but it required significant resources and has a low positive predictive value. Conclusions WHONET-SaTScan is a useful addition to a robust IPC program. Although the resources required were significant, this prospective, real-time cluster detection surveillance system represents an improvement over historical methods. We detected several episodes of transmission which would have eluded us previously, and allowed us to focus infection prevention efforts and improve patient safety.

Made available in DSpace on 2019-10-06T17:07:17Z (GMT). No. of bitstreams: 0 Previous issue date: 2019-04-11 Background: There are many comorbidities associated with Down syndrome (DS), including obstructive sleep apnea (OSA) and masticatory muscle alteration. Muscular hypotonia, in particular, of the masticatory and oropharyngeal muscles is one of the main characteristics of individuals with DS, resulting in impairments of speech, swallowing, and mastication in these individuals. In addition, total or partial obstruction of the airways during sleep can occur due to pharyngeal hypotonia, leading to snoring and to OSA. This progressive respiratory disorder is associated with a high risk of morbidity and mortality in individuals with DS. The aim of this research is to assess the therapeutic effects of surface neuromuscular electrical stimulation (NMES), the mastication apparatus (MA), and a mandibular advancement oral appliance (OA m ) with an embedded thermosensitive microchip on the functions of masticatory muscles (bilateral masseter and temporal muscles), physiological sleep variables, and salivary parameters in adult patients with DS. Methods: The patients with DS will be randomly selected and divided into three groups (DS-NMES, DS-MA, and DS-OA m ) with a minimum of 10 patients in each group. A thermosensitive microchip will be embedded in the OA m to record its compliance. The therapeutic effects on masticatory muscle function will be investigated through electromyography, a caliper, and a force-transducer device; the sleep variables, in turn, will be evaluated by means of polysomnography. The physicochemical and microbiological properties of the saliva will also be analyzed, including the salivary flow, viscosity, buffer capacity, cortisol levels (susceptibility to psychological and/or physical stress), and Pseudomonas aeruginosa levels (risk of aspiration pneumonia) in these patients. The methods determined for this study will be carried out prior to and after 2 months of the recommended therapies. Discussion: The primary outcomes would be the improvement and/or reestablishment of the function of masticatory muscles and the physiological sleep variables in this target public since individuals with DS commonly present generalized muscular hypotonia and dysfunction of the oropharyngeal musculature. As a secondary outcome indicator, the impact of the applied therapies (NMES, MA, and OA m ) on the salivary microbiological and physicochemical properties in DS individuals will also be assessed. Furthermore, the compliance of OA m usage will be measured through a thermosensitive microchip. Trial registration: Registro Brasileiro de Ensaios Clínicos, RBR-3qp5np. Registered on 20 February 2018. Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) Institute of Science and Technology São José Dos Campos Campus São Paulo State University - UNESP, R: Esperança 265 Metropolitan University of Santos University Center of Anápolis - UniEvangélica Nove de Julho University Hospital Do Servidor Público Estadual de São Paulo (IAMSPE-HSPE) Discipline of Pediatric Dentistry Institute of Science and Technology Center of Biosciences Applied to Patients with Special Health Care Needs (CEBAPE) Institute of Science and Technology São José Dos Campos Campus São Paulo State University - UNESP, R: Esperança 265

Since the first reported epidemic of dengue in Pemba, the capital of Cabo Delgado province, in 1984–1985, no further cases have been reported in Mozambique. In March 2014, the Provincial Health Directorate of Cabo Delgado reported a suspected dengue outbreak in Pemba, associated with a recent increase in the frequency of patients with nonmalarial febrile illness. An investigation conducted between March and June detected a total of 193 clinically suspected dengue patients in Pemba and Nampula, the capital of neighboring Nampula Province. Dengue virus-type 2 (DENV-2) was detected by reverse transcriptase polymerase chain reaction in sera from three patients, and 97 others were classified as probable cases based on the presence of DENV nonstructural protein 1 antigen or anti-DENV immunoglobulin M antibody. Entomological investigations demonstrated the presence of Aedes aegypti mosquitos in both Pemba and Nampula cities.

An outbreak of dengue and high densities of Aedes aegypti were reported in 2014 in northern Mozambique, suggesting an increased risk for other arboviruses such as chikungunya virus (CHIKV) in this region. The aim of this study was to investigate the occurrence of CHIKV during an outbreak of dengue virus (DENV) in Pemba city in northern Mozambique in 2014. Febrile patients (n = 146) seeking medical attention at the Pemba Provincial Hospital between March and April 2014 were enrolled in this study. Blood samples from each participant were tested for chikungunya and DENV RNA, IgM and IgG antibodies using PCR and ELISA, respectively. The median age of the patients was 26 years (interquartile range: 20-34 years), and 52.7% (77/146) were female. We found that 7.0% (8/114) of the patients were positive for CHIKV IgM and 31.5% (46/146) presented with CHIKV IgG antibodies. DENV IgM and IgG antibodies were detected in 38.3% (46/120) and 28.2% (33/117) of the patients, respectively. This study is the first investigation regarding the occurrence of CHIKV in the north of Mozambique over the last 60 years and our data suggest that Mozambicans had been silently exposed to the virus in this part of the country, indicating that not only DENV but also CHIKV is an arbovirus to consider in febrile patients seeking medical attention in northern Mozambique.

To the Editor: In sub-Saharan Africa, febrile patients are often assumed to have, and are treated for, malaria, but when tested, many are malaria-negative. Because emerging diseases, such as chikungunya virus (CHIKV) and dengue virus (DENV) infections, cause outbreaks around the world (1–3), the importance of these pathogens has become more evident. However, low-income countries have limited epidemiologic data on alternative diagnoses to malaria (4,5) and poor laboratory capacity (1), which restrict further diagnostic investigations. An early study in Mozambique during the 1980s found antibodies to Rift Valley fever virus (RVFV) in 2% of pregnant women (6). More recently, a RVFV seroprevalence of 36.9% among cattle in the Maputo Province was shown in 2010–2011 (7). Furthermore, the movement of humans from rural areas to major cities, particularly to the capital of Maputo, might affect human illnesses and disease pattern of zoonotic viruses (3). We conducted a pilot study on CHIKV, DENV, hantavirus, RVFV, and West Nile virus (WNV) epidemiology in Mozambique. Ethical approval (registration no. IRB00002657) was granted by the National Bioethics Committee in Mozambique and by the Regional Ethical Review Board at Karolinska Institutet, Stockholm, Sweden (permit no. 2012/974–31/3). During 2012–2013, a total of 78 febrile patients were prospectively enrolled when they sought medical attention at the Polana Canico Health Center and Mavalane Health Center (catchment area 4,663 km2, estimated population 46,184 inhabitants) in the suburban area of Maputo city. All included patients answered a questionnaire and were initially screened for malaria by blood smear light microscopy; 15 were positive for malaria (Table). Patients’ median age was 29 years (37 years for seropositive patients) and ranged from 5 to 78 years. Forty-six (59%) were female. Fifty-eight (74%) reported recent exposure to mosquitoes. None of these persons had a history of international travel, and none had received a yellow fever vaccination. Table Results of screening for viral antibodies and malaria parasites in 78 febrile patients, Maputo, Mozambique, 2012–2013* Sixty (77%) patients provided paired acute- and convalescent-phase blood samples, with a minimum of 14 days (median 33 days) between samples. Serum samples were sent to the Public Health Agency of Sweden and blindly screened at a titer of 1:20 for IgG to CHIKV, DENV, hantavirus, RVFV, and WNV by using in-house indirect immunofluorescence assays as described for DENV by Vene et al. (8). Screening for IgG was done on convalescent-phase serum samples or, when those were not available, on acute-phase serum samples. Further immunofluorescence analyses for titer increases were performed for patients for whom paired serum samples were available and screening results were positive for IgG; however, no titer increases were found. Serum from admittance were tested for DENV IgM and WNV IgM by using commercial assays according to manufacturers’ instructions (Panbio Dengue IgM Capture ELISA E-DEN01M/E-DEN01M05, Standard Diagnostics, Inc., Yongin-si, South Korea; Serion ELISA classic ESR14M West Nile Virus IgM, Institut Virion/Serion GmbH, Wurzburg, Germany); 2 samples were positive for DENV IgM but none for WNV IgM. All acute serum samples were screened by using 1-step real-time reverse transcription PCR for CHIKV, RVFV, WNV (in-house validated assays), and DENV (9). Results were negative for viral RNA. Twenty-three (29%) of the 78 patients had a positive serology result from acute- or convalescent-phase serum samples for >1 of the tested viral pathogens (Table). The main finding was CHIKV IgG in 15 (19%) patients. Ten (13%) patients had positive results for DENV, including 2 DENV IgM–positive samples. The seroepidemiologic findings in this pilot study in Maputo strongly suggest possible and neglected alternative causes of febrile illness in Mozambique. Antibodies to CHIKV were found in 19% of the patients, which was a novel finding for Mozambique but corresponded well with other reports on the spread of CHIKV in tropical and subtropical areas of the world (2,3). DENV antibodies were present in 13% of the study population, representing a new finding in southern Mozambique; previous outbreaks have been reported from the northern part of the country (5). The median age of the seropositive patients (37 years) was higher than for the group as a whole (29 years), which might reflect increased exposure to zoonotic viruses over time. One patient was IgG positive for RVFV, a potentially emerging cause of fever in Mozambique, especially in view of recent reports of RVFV in cattle (7). The samples positive for both DENV and WNV IgG could represent previous independent infections with these viruses, co-infection, or cross-reactivity, which are common for flavivirus IgG (10). Overall, results indicate that exposure to vectorborne viruses in persons living in suburban areas of Maputo city is frequent, suggesting that infections with CHIKV, DENV, and RVFV infection should be considered as alternative diagnoses for patients with febrile illness in these settings. On the basis of these results, more extensive research is planned on the epidemiology of zoonotic viral infections in Mozambique.

Background Rift Valley fever virus (RVFV) remains heavily neglected in humans in Mozambique, even though recent outbreaks were reported in neighboring countries in humans and several cases of RVFV in cattle were reported in several districts in Mozambique. Findings We conducted a cross sectional study during and after severe flooding that occurred in 2013 in Mozambique. Paired acute and convalescent serum samples were tested from febrile patients attending a primary health care unit in a suburban area of Maputo city for the presence of IgG and IgM antibodies against Rift Valley fever virus (RVFV) using enzyme-linked immunosorbent assay (ELISA). Seroconversion of IgG anti-RVFV was observed in 5 % (10/200) of convalescent patients and specific IgM anti-RVFV was detected in one acute patient (0.5 %; 1/200). All sera from acute patient tested negative by real time PCR. Conclusion In conclusion, our results suggest that RVF represent an important but neglected cause of febrile illness following periods of flooding in southern Mozambique.

Aim The purpose of this article is to report on the five-year follow-up of a case involving treatment of gingival recession with a subepithelial connective tissue graft prior to orthodontic tooth movement. Background Gingival recession has a global prevalence that varies from 3 to 100 perpcent depending on the population studied and the method of analysis. In addition, the frequency of recession seems to be positively correlated with age. Planned orthodontic tooth movement is not necessarily an etiological factor for gingival recession, so long as it does not move the tooth out of its alveolar process. When the tooth is shifted without adequate biomechanical control, bone dehiscence can develop, and the recession can occur as a consequence of the orthodontic treatment. Case Description A 19.6-year-old female patient was referred for orthodontic treatment due to severe anterior-inferior dental crowding and a mandibular right lateral incisor in linguoverson and 4.0 mm of gingival recession on the labial surface. Normal gingival architecture was restored with a subepithelial connective tissue graft used to cover the 4.0 mm defect, after which orthodontic treatment repositioned the malposed incisor into its correct occlusal alignment. Individualized torque was applied to the mandibular right central incisor during the orthodontic treatment. The patient was reevaluated five years after completion of the orthodontic treatment. Results At the five-year recall appointment, the patient exhibited normal tooth alignment and generalized normal gingival architecture; however, 2 mm of gingival recession was noted on the graft site. Summary This case demonstrated that periodontal surgical correction of facial gingival recession with a subepithelial graft may be performed prior to initiating orthodontic treatment. Clinical Significance The interdisciplinary association between orthodontics and periodontics contributes to good prognosis and acquisition or maintenance of the periodontal tissue health, masticatory function, esthetics, and patient satisfaction. The subepithelial connective tissue graft placed prior to the orthodontic movement showed satisfactory results five years after completion of the orthodontic treatment. Citation Tanaka OM, Avila ALR, Silva GM, Añez MCG, Taffarel IP. The Effects of Orthodontic Movement on a Subepithelial Connective Tissue Graft in the Treatment of Gingival Recession. J Contemp Dent Pract [Internet]. 2010 December; 11(6):073-079. Available from: http://www.thejcdp. com/journal/view/volume11-issue6-tanaka

Background In the last two decades, chikungunya virus (CHIKV) has rapidly expanded to several geographical areas, causing frequent outbreaks in sub-Saharan Africa, South East Asia, South America, and Europe. Therefore, the disease remains heavily neglected in Mozambique, and no recent study has been conducted. Methods Between January and September 2013, acute febrile patients with no other evident cause of fever and attending a health center in a suburban area of Maputo city, Mozambique, were consecutively invited to participate. Paired acute and convalescent serum samples were requested from each participant. Convalescent samples were initially screened for anti-CHIKV IgG using a commercial indirect immunofluorescence test, and if positive, the corresponding acute sample was screened using the same test. Results Four hundred patients were enrolled. The median age of study participants was 26 years (IQR: 21–33 years) and 57.5% (224/391) were female. Paired blood samples were obtained from 209 patients, of which 26.4% (55/208) were presented anti-CHIKV IgG antibodies in the convalescent sample. Seroconversion or a four-fold titer rise was confirmed in 9 (4.3%) patients. Conclusion The results of this study strongly suggest that CHIKV is circulating in southern Mozambique. We recommend that CHIKV should be considered in the differential diagnosis of acute febrile illness in Mozambique and that systematic surveillance for CHIKV should be implemented., Author Summary Chikungunya virus (CHIKV) is an emerging arbovirus that remains heavily neglected in Mozambique, and no recent study has been conducted. Between January and September 2013, four hundred acute febrile patients with no other evident cause of fever and attending a health center in a suburban area of Maputo city, Mozambique, were consecutively invited to participate. Paired acute and convalescent serum samples were drawn from each participant. Convalescent samples were initially screened for anti-CHIKV IgG, and if positive the corresponding acute sample was screened using the same test. Of the 209 patients from which paired samples was obtained, 26.4% (55/208) presented anti-CHIKV IgG antibodies in the convalescent sample. Seroconversion or a four-fold titer rise was confirmed in 9 (4.3%) patients. Overall our findings demonstrate that CHIKV is circulating in southern Mozambique and suggest that CHIKV should be considered in the differential diagnosis of acute febrile illness.

Epithelial-myoepithelial carcinoma (EMC) is a rare tumor with predilection for the major salivary glands, mainly the parotid gland. It is a tumor of low grade malignancy, and despite its tendency to local recurrence with low metastatic potential, rare cases of EMC may have an aggressive behavior with distant metastasis. Treatment consists primarily of complete surgical resection whenever possible followed by radiotherapy (RT) in an attempt to prevent local recurrence. The authors describe two cases of patients with EMC from the parotid gland. Despite treatment and good local response both later developed pulmonary metastases, and also later cerebral metastization. In the sequence of these clinical cases, a literature review is made.

Background In Sub-Saharan Africa, including Mozambique, acute bacterial meningitis (ABM) represents a main cause of childhood mortality. The burden of ABM is seriously underestimated because of the poor performance of culture sampling, the primary method of ABM surveillance in the region. Low quality cerebrospinal fluid (CSF) samples and frequent consumption of antibiotics prior to sample collection lead to a high rate of false-negative results. To our knowledge, this study is the first to determine the frequency of ABM in Mozambique using real-time polymerase chain reaction (qPCR) and to compare results to those of culture sampling. Method Between March 2013 and March 2014, CSF samples were collected at 3 regional hospitals from patients under 5 years of age, who met World Health Organization case definition criteria for ABM. Macroscopic examination, cytochemical study, culture, and qPCR were performed on all samples. Results A total of 369 CSF samples were collected from children clinically suspected of ABM. qPCR showed a significantly higher detection rate of ABM-causing pathogens when compared to culture (52.3% [193/369] versus 7.3% [27/369], p = 0.000). The frequency of Streptococcus pneumoniae, Haemophilus influenzae, group B Streptococci, and Neisseria meningitidis were 32.8% (121⁄369), 12.2%, (45⁄369), 3.0% (16⁄369) and 4.3% (11⁄369), respectively, significantly higher compared to that obtained on culture (p < 0.001 for each). Conclusion Our findings demonstrate that culture is less effective for the diagnosis of ABM than qPCR. The common use of culture rather than qPCR to identify ABM results in serious underestimation of the burden of the disease, and our findings strongly suggest that qPCR should be incorporated into surveillance activities for ABM. In addition, our data showed that S. pneumoniae represents the most common cause of ABM in children under 5 years of age.