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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

To evaluate the technical success of conventional TMJ arthrocentesis in cadavers, using the tragal-lateral canthus line as an anatomical reference for the puncture points. Ten formalin-treated and 8 fresh cadavers were submitted to the arthrocentesis. A point located 10 mm anteriorly and 2 mm inferiorly to the beginning of the tragal-lateral canthus line (A) and another point 20 mm anteriorly and 10 mm inferiorly (B) were demarked on the cadavers’ skin. Following, 1 mL of methylene blue solution was injected through the needle at point A, and then another needle was placed at point B. Saline solution was injected through the first needle, identifying a free flow of bluish solution. Concerning the formalin-treated cadavers, TMJ arthrocentesis was not successfully performed in any case (0%). In the fresh cadavers, the procedure was properly conducted bilaterally in only one case (12.5%) and unilaterally in 3 cases (37.5%), 2 on the left side (25.0%) and one on the right (12.5%). The traditional points related to the tragal-lateral canthus line seemed not to be accurate references for the insertion of the needles in conventional TMJ arthrocentesis when 1 mL of solution is used initially and the maximum mouth opening is not achieved.

O absenteísmo por doenças é reconhecido como um problema de saúde pública mundial, tendo grandes impactos econômicos e sociais. Ademais, informações a respeito destas condições em bombeiros, políciais e outros profissionais de serviços armados são muito escassas. Desta forma, o presente estudo teve como objetivo analisar os afastamentos odontológicos do quadro de servidores da Polícia Militar do Estado de São Paulo em 2017. Para isso, foram coletados os dados demográficos, funcionais e relacionados ao tipo de afastamento (plataforma logística SIGs – Saúde) para cálculo das razões de chances entre as variáveis sócio-demográficas e funcionais e convalescença (afastamentos de até 10 dias). Foi calculado também o índice de gravidade, de frequência e de duração média das ausências odontológicas, bem como o comparativo com os afastamentos por motivos médicos no mesmo período. Foram identificados 80.928 afastamentos relacionados a condições bucais. As características funcionais, sócio-demográficas e da doença odontológica estiveram associadas a convalescença, ou seja, policiais acima de 50 anos, do interior de SP e afastados por lesões de cárie, condições pulpares ou doença periodontal estiveram associados à presença de afastamento de até 10 dias. Na Polícia Militar, em 2017, houve uma média de perda de serviço de 2h/pessoa/ano exclusivamente por motivo odontológico. A duração média das ausências foi de 2,21 dias. Assim, parece que quanto maior a idade e mais distante da capital paulista, maior o número de dias de absenteísmo. Ademais, o envelhecimento no contexto ocupacional é um forte fator para o absenteísmo. Cárie e doença periodontal também estão altamente relacionadas ao absenteísmo quando comparadas às demais doenças odontológicas.

Among the most common symptoms of COVID-19 is taste dysfunction, which has a ranging clinical presentation. As well as its pathophysiology remains to be unclear, there is not enough information about the efficacy and safety of the available treatments. This study aims to report a series of cases using PBMT for the management of COVID-19-related taste impairment.8 female and 2 male patients sought medical help for taste impairment (either partially or completely) after COVID-19 infection. Photobiomodulation therapy (PBMT) on the tongue mucosa was then proposed but with 3 different protocols. Taste perception at baseline and before every laser session was evaluated using a visual analog scale. Irrespective of the PBMT protocol, taste recovery was noted in all cases but with varying degrees of improvement.given the high prevalence rates of taste dysfunction in COVID-19 patients and the lack of information about the available treatments, PBMT seems to be a promising therapeutic modality but not dependent on the total number of laser sessions and the interval between them. The choice of the most suitable laser protocol as well as the knowledge of the exact photonic mechanisms, however, need to be better studied.

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.

Objective:Adverse health effects including cognitive impairment have been described in older adults with benzodiazepine misuse, although the literature about this issue is scarce. The present study...

Objective: To carry out morphometric, topographic, incidence analysis of retromolar foramina in dry adult human mandibles, and relate the findings to Dental practice. Methods: 265 mandibles were evaluated simultaneously by two researchers. With the aid of metal wires, each retromolar foramen was classified regarding diameter. Foramina with a diameter smaller than 0.5mm were not taken into account. Results: Retromolar foramina were observed in 23.4% of cases, with a higher bilateral incidence (with distinction of both antimeres), and up to 4 of them located in the same mandible. Furthermore, most foramina had a diameter between 0.5 and 1mm. Conclusion: The retromolar foramina are clinically relevant findings and should never be underestimated by clinicians. RESUMO Objetivo: Realizar análises morfométrica, topográfica e de incidência de forames retromolares em mandíbulas humanas maceradas de adultos, correlacionando os achados com a prática clínica odontológica. Métodos: 265 mandíbulas foram avaliadas simultaneamente por dois observadores. Com o auxílio de fios de metal, cada forame retromolar foi classificado quanto ao diâmetro. Forames inferiores a 0.5mm não foram contabilizados. Resultados: Observaram-se forames retromolares em 23.4% dos casos, com maior incidência bilateral (com distinção dos antímeros) e podendo ocorrer em número de até 4 em uma mesma peça anatômica. Além do mais, a grande maioria apresentou diâmetro entre 0.5 e 1mm. Conclusão: Os forames retromolares são achados consistentes e clinicamente relevantes, não devendo ser subestimados pelos clínicos.

Background and objective Dual diagnosis is the coexistence of an addictive disorder and another mental disorder. The objective is to estimate cravings and self-reported quality of life in a sample of patients with alcoholic dependence, with or without dual pathology, who attend an outpatient treatment centre. Patients and method A cross-sectional study of 112 patients (56 dual and 56 non-dual), diagnosed with alcohol dependence according to DSM- IV -TR. The presence of cravings is determined by the Multidimensional Alcohol Craving Scale and quality of life through the SF-36 Health Questionnaire. Results There are no statistically significant differences in cravings in either subgroup; the latter tend to refer to lower alcohol cravings than non-dual patients. The dual patients have a worse quality of life in all categories evaluated, highlighting a worse quality of life in the categories: social function, emotional role, vitality and general health. Females present a lower quality of life emphasizing those of social function and emotional role. No differences were detected in relation to cravings between the 2 groups. Conclusions In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, we should consider focusing on the evaluation of cravings and quality of life. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, it is necessary to consider cravings and quality of life, since these parameters are important for the evaluation of patients with alcohol dependence.

Resumen Fundamentos y objetivo Enfermedad dual es la coexistencia al mismo tiempo de un trastorno adictivo y otro trastorno mental. El objetivo es estimar el craving y la calidad de vida autopercibida en una muestra de pacientes con dependencia alcoholica, con o sin enfermedad dual, que acuden a un centro de tratamiento ambulatorio. Pacientes y metodo Estudio transversal de 112 pacientes (56 duales y 56 no duales) diagnosticados de dependencia de alcohol segun el DSM- IV -TR. Se determina la presencia de craving mediante la Escala Multidimensional de Craving de Alcohol y la calidad de vida mediante el Cuestionario de Salud SF-36. Resultados No existen diferencias estadisticamente significativas en el craving entre ambos subgrupos; los duales tienden a referir menor craving de alcohol que los pacientes no duales. Los duales tienen una peor calidad de vida en todas las categorias evaluadas, destacando una peor calidad de vida en las categorias: funcion social, rol emocional, vitalidad y salud general. El sexo femenino presenta una menor calidad de vida, destacando las categorias de funcion social y rol emocional. No se detectan diferencias en relacion al craving entre los 2 grupos. Conclusiones Para realizar un correcto abordaje clinico y terapeutico de los pacientes con dependencia alcoholica se debe plantear evaluar el craving y la calidad de vida, puesto que son parametros importantes para la evaluacion del paciente con dependencia alcoholica. Ademas, el craving es un parametro propio de la dependencia alcoholica, no de la dualidad.

Although the treatment and management options for perianal abscess vary considerably, most cases require incision and drainage. Whatever the clinical approach selected, it is imperative to monitor patients to identify postoperative signs and symptoms which suggest treatment failure or further complications, such as sepsis, recurrent abscess, and fistula formation. Considering the debate on the role of postoperative antibiotic therapy for patients with perianal abscess and the significant discomfort caused by the infection, the present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were used after incision and drainage of a simple perianal abscess. Within 5 days, there was no sign or symptom of both infection and inflammation, and after 3 months, no fistulous pathways or perianal collections were present. According to the current case report, the combination of aPDT and PBMT following incision and drainage of perianal abscess may be a smart strategy for infection resolution and prevention of late complications.

Background. Cannabis is the most widely used illegal drug in the world. Both an early cannabis use onset and the amount used contribute to the risk of suffering mental disorders in adulthood. Objective. Review longitudinal studies conducted on adolescents associating early cannabis use with the subsequent occurrence of mental disorders. Method. A search was conducted in PubMed until December 2016, focusing on longitudinal researches and prioritizing studies that clearly distinguished between an early and late onset of cannabis use. To achieve the objective, the word “cannabis” was used in combination with the main psychiatric diseases. A manual search of articles that appeared in the references was also conducted. Results. Fifteen studies met the inclusion criteria, but only five studies discriminated clearly between early and late onset of cannabis use. An association was found between early onset of cannabis use and mental disorders, particularly psychosis. The information regarding affective and anxiety disorders is more controversial. Discussion and conclusion. Early onset of cannabis use is associated with mental disorders, especially psychosis. Prevention plans for cannabis use in adolescents should be developed in order to decrease the risk of mental disorders.

Several neurobiological factors are related to opiate-use disorder (OUD), and among them, neurotrophins have a relevant role. Brain-derived neurotrophic factor (BDNF) is a central neurotrophin involved in many neuronal processes, and it has been related to several psychiatric diseases and addictive disorders. BDNF can be measured in plasma and serum; its levels may reflect BDNF concentrations in the central nervous system (CNS) and, indirectly, CNS processes. Hence, peripheral BDNF could be a biomarker in clinical practice. This manuscript explores the findings about peripheral BDNF and OUD in humans. Opiates induce neurotoxicity in the CNS, which may be correlated with modifications in BDNF expression. Thus, basal levels of peripheral BDNF in OUD patients may be altered, which could be modified with abstinence. Also, opiates may modify epigenetic processes that may be associated with peripheral concentrations of BDNF, and in this line, withdrawal could reflect recovering processes in the CNS. Additionally, treatment modifies the peripheral concentrations of BDNF, but the clinical implications of those changes are yet not elucidated. No specific conclusion can be performed and more investigation in this area is necessary to elucidate the real potential of peripheral BDNF as a biomarker.

Vitamin D deficiency has been linked with schizophrenia. We aimed to determine whether patients with a first episode of psychosis (FEP) had lower vitamin D levels compared with controls considering their final diagnosis. We conducted a cross-sectional study determining 25-hydroxyvitamin D blood levels. 25-Hydroxyvitamin D levels were considered optimum at 20 ng/mL or greater. A group of 45 adult patients with FEP and a group of 22 healthy controls matched for age were recruited. The patient group was subdivided in two final diagnosis groups (schizophrenia versus other psychoses) after a 6-month follow-up. Average vitamin D values were deficient for FEP patients, especially those 22 with a final diagnosis of schizophrenia. These results relating vitamin D and schizophrenia generate interest to further examine this association.

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm2, 30 mW, illuminated area 0.04 cm2, 7.5 J/cm2, 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p

Background Patients with Down syndrome (DS) present functional and anatomical alterations that may negatively impact their health and quality of life. Down syndrome patients have been shown to have a high prevalence of temporomandibular disorder (TMD), but little is known about the diagnosis, treatment and prevention in these individuals. Objective To evaluate the impact of a home-based multidisciplinary programme on muscular TMD in DS adults. Methods After being diagnosed with TMD-related masticatory muscle disorder, 20 adult men and 20 adult women with DS received an educational material with instructions on how to perform daily home facial self-massage and exercises for orofacial and masticatory muscles. Participants were also provided with educational information on TMD. Those who failed to perform at least 50% of the programme (23 days) were considered non-adherent. Oral parafunctional behaviours, facial pressure-pain threshold and maximum mouth opening were assessed at baseline and after the intervention. Results Twenty-five patients adhered to the programme as opposed to 15 non-adherent patients. Statistically significant improvements in all parameters were observed among adherent patients, except for the number of parafunctions. Conclusion The proposed home-based multidisciplinary programme seemed to be effective in improving some aspects related to muscular TMD in DS adults.

OBJETIVOS Analizar diferencias sociodemográficas y clínicas entre consumo de cocaína vs. speedball (cocaína+heroína) en pacientes de una sala de consumo de drogas inyectadas. MÉTODOS Estudio transversal realizado en una sala de consumo de drogas inyectadas admnistrándose una entrevista semiestructarada a todos los pacientes. Se recogían datos sociodemográficos y clínicos, haciendo énfasis en diferencias entre el consumo de cocaína o de speedball y en síntomas de la esfera psicótica. RESULTADOS Hubo 1111 usos de la sala que se relacionaban con uso de cocaína o de speedball, el 89.8% fueron hombres. La edad promedio fue 40.47±5.33. Las diferencias entre uso de cocaína y de speedball se relacionaban principalmente con: sexo (p

Objetivos Identificar la prevalencia y evaluar las características clínicas del insomnio en una muestra de pacientes TDAH adultos con Patología Dual. Material y métodos La muestra la forman 252 pacientes adultos con TDAH remitidos para evaluación diagnóstica al Programa de TDAH del Hospital Universitari Vall d’Hebron. Se realizó una evaluación clínica y psicodiagnóstica, administrándose las escalas SCID-I y SCID-II, CAARS, ADHD Rating Scale y WURS. Igualmente se realizó una evaluación clínica del insomnio complementada con la administración de dos escalas específicas: la Insomnia Severity Index (ISI) y la Pittsburgh Sleep Quality Index (PSQI). Resultados y conclusiones La presencia de insomnio en pacientes adultos con TDAH presentaba una asociación estadísticamente significativa (11.6% vs. 4.3%; p

Introducción Hay pocos estudios sobre uso de antipsicóticos en pacientes que presentan trastornos psicóticos y uso de sustancias comórbidos (psicosis duales) a pesar de ser una presentación frecuente en los centros de atención de estos pacientes (1). En relación a antipsicóticos modernos, la literatura científica es escasa a pesar que los nuevos antipsicóticos (como la cariprazina) tienen perfiles prometedores en el manejo de psicosis duales. Objetivos Se describe una serie de casos de pacientes con trastornos psicóticos y uso de sustancias asociados a quienes se les ha prescrito cariprazina. Métodos Series de casos Resultados 7 casos con una edad media de 38.719.32 años. La cariprazina fue prescrita en todos los casos para manejo de síntomas psicóticos o por presencia de síntomas extrapiramidales secundarios a otros antipsicóticos. En general hubo buena tolerancia, un caso tuvo acatisia y otro caso tuvo náuseas y cefalea. La dosis media de cariprazina fue 3.640.80. En relación al uso de sustancias, parece no aumentar el consumo de sustancias, y al contrario algunos casos disminuyeron o llegaron a abstinencia. Conclusiones La cariprazina parece eficaz en el manejo de síntomas psicóticos en pacientes con trastornos psicóticos duales. Asimismo, parece tener utilidad clínica en el manejo del consumo de sustancias. Aún así, es necesario más investigación. 1. Beckmann D et al. Substance-induced Psychosis in Youth. Child Adolesc Psychiatr Clin N Am. 2020;29(1):131-143. doi: 10.1016/j.chc.2019.08.006.

Drug dependence is a neuropsychiatric condition that involves genetic, epigenetic and environmental factors. Allele-specific methylation (ASM) is a common and stable epigenetic mechanism that involves genetic variants correlating with differential levels of methylation at CpG sites. We selected 182 single-nucleotide polymorphisms (SNPs) described to influence cis ASM in human brain regions to evaluate their possible contribution to drug dependence susceptibility. We performed a case-control association study in a discovery sample of 578 drug-dependent patients (including 428 cocaine-dependent subjects) and 656 controls from Spain, and then, we followed-up the significant associations in an independent sample of 1,119 cases (including 589 cocaine-dependent subjects) and 1,092 controls. In the discovery sample, we identified five nominal associations, one of them replicated in the follow-up sample (rs6020251). The pooled analysis revealed an association between drug dependence and rs6020251 but also rs11585570, both overcoming the Bonferroni correction for multiple testing. We performed the same analysis considering only cocaine-dependent patients and obtained similar results. The rs6020251 variant correlates with differential methylation levels of cg17974185 and lies in the first intron of the CTNNBL1 gene, in a genomic region with multiple histone marks related to enhancer and promoter regions in brain. Rs11585570 is an eQTL in brain and blood for the SCP2 and ECHDC2 genes and correlates with differential methylation of cg27535305 and cg13461509, located in the promoter regions of both genes. To conclude, using an approach that combines genetic and epigenetic data, we highlighted the CTNNBL1, SCP2 and ECHDC2 genes as potential contributors to drug dependence susceptibility.

Objetivos: Estudiar las diferencias en la gravedad de la adicción, variables clínicas y afectación en la calidad de vida en personas con Trastorno por Consumo de Cannabis en función de si presentan o no un Trastorno de Ansiedad comórbido. Métodos y materiales: Se realizó una evaluación psicológica completa siguiendo un protocolo estandarizado a los pacientes que acudieron a tratamiento al CAS Vall d’Hebron. Se evaluó la presencia de Trastorno por Consumo de Cannabis y Trastorno de Ansiedad mediante la entrevista diagnóstica SCID-I. Se recogieron variables sociodemográficas y se evaluó la gravedad de la adicción (EuropASI) y variables clínicas mediante cuestionarios autoaplicados (BDI, STAI, SF-36, Barrat y FIDI). Resultados: 446 pacientes fueron diagnosticados de Trastorno por Consumo de Cannabis de los cuales 53 (11.8%) cumplieron criterios para Trastorno de Ansiedad en el momento de la evaluación. En relación a la gravedad de la adicción, se observaron diferencias significativas en las áreas familiar y psicológica, presentando una mayor gravedad los pacientes con Trastorno de Ansiedad. Asimismo, los pacientes con Trastorno de Ansiedad presentaron mayor deterioro en el componente mental de la calidad de vida que los pacientes sin Trastorno de Ansiedad. Por otro lado, los pacientes sin Trastorno de Ansiedad presentaron significativamente más síntomas depresivos. Conclusiones: La presencia de un Trastorno de Ansiedad comórbido al Trastorno por Consumo de Cannabis se relaciona con una mayor gravedad a nivel psicológico y familiar y una mayor repercusión en el componente mental de la calidad de vida del paciente. Se sugiere realizar investigaciones futuras longitudinales para estudiar la evolución.

INTRODUCTION Impulsivity and Alexithymia are related to substance use disorders (SUD) as risk factors (1,2), several cognitive skills are implied in both traits (1,2). However, few researches are published on their mutual relationship in SUD patients. OBJECTIVES To describe the correlations between alexithymia and impulsivity in SUD patients. METHODS Patients with SUD (according to DSM-5) were evaluated with invited to participate in an addiction treatment Ad-Hoc questionnaire, Toronto Alexithymia Scale-20 (TAS-20), Barratt impulsivity scales (BIS-11) and Dickamn functional dysfunctional impulsivity scale (FIDI) were performed in all patients. RESULTS 93 patients completed the full evaluation, the total score of TAS-20 was significantly related to total scores of BIS-11 and FIDI. Analyzing subscales, Difficulty Describing Feelings subscale describe better the association between total TAS-20 scores and impulsivity, and it may be the link between dysfunctional impulsivity and alexithymia. Externally-Oriented Thinking subscale was fewer correlated to any BIS-11 factor compared to the other subscales of TAS-20. Interestingly, cognitive impulsivity is not related to total TAS-20 scores and the TAS-20 subscales. CONCLUSIONS Alexythimia and impulsivity are related in SUD (especially some subfactors are better associated), and hence these relations should be considered when conducting therapeutic approaches. REFERENCIAS 1. Morie KP, Yip SW, Nich C, Hunkele K, Carroll KM, Potenza MN. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-248 2. Shishido H, Gaher RM, Simons JS. I don't know how I feel, therefore I act: alexithymia, urgency, and alcohol problems. Addict Behav. 2013;38(4):2014-7. doi: 10.1016/j.addbeh.2012.12.014.

Introducción: El alcohol es la sustancia más consumida en España y la que motiva más consultas en centros de adicciones. En 2017, el 91,2% de la población consumió alcohol alguna vez en la vida y el 62.7% en el último mes. El 7,4% de la población consume alcohol diariamente(1). Para mejorar la asistencia de estos pacientes es prioritario un estudio sociodemográfico de la muestra poblacional. Objetivo: Describir la población de pacientes con TUS alcohol que acuden a un centro de adicciones en Barcelona. Metodología: Análisis descriptivo de variables sociodemográficas, clínicas y de tratamiento de pacientes que consultan por uso de alcohol en un centro de adicciones ambulatorio en Barcelona. Resultados: 224pacientes participaron en el estudio (176hombres; 51.6 años). En los últimos 6 meses ha habido10 abandonos de tratamiento, 3altas médicas y 22nuevas incorporaciones. El 44.2% han tenido buena evolución frente al 55,8% si se tienen como referencia los controles de orina. Las sustancias consumidas con el alcohol: nicotina 34,82%, cocaína 18,75%, cannabis14,29%, hipnosedantes 3,12% y opiáceos 0,89%. El 58,93% padecían patología dual: trastornos del estado de ánimo 25,45%, trastornos de ansiedad 6,25%, trastornos adaptativos 16,52%, trastornos de la esfera psicótica 6,25%, TBP 3,57%, TDAH 2,67%, TCA 2,67%, ludopatía 1,34%, deterioro cognitivo y/o discapacidad intelectual 1,78% y trastornos de la personalidad 6,25%. Conclusiones: El policonsumo de sustancias es lo más frecuente. Más de la mitad de los pacientes que acuden a tratamiento por TUS OH padecen además otro trastorno psiquiátrico comórbido, siendo los más prevalentes los trastornos del estado de ánimo, los trastornos adaptativos y los trastornos de ansiedad. Cabe destacar la baja prevalencia comórbida de ludopatía, lo que puede atribuirse a un infradiagnóstico de los profesionales. Bibliografía: 1. Ministerio de Sanidad, Consumo y Bienestar social. (2019). Observatorio Español de las Drogas y las Adicciones. Informe EDADES 2019. Recuperado de: http://www.pnsd.mscbs.gob.es/profesionales/sistemasInformacion/sistemaInformacion/pdf/2019_Informe_EDADES.pdf

Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words:Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.

Purpose of review The current review summarizes recent evidence on the impact of type-2 diabetes mellitus (T2DM) on implant dentistry, highlighting the behavior of peri-implant bone. Recent findings There is no definitive information on the development and course of peri-implant bone loss associated with T2DM; however, poorly controlled T2DM patients present worse outcomes. Nevertheless, dental implants may be a successful therapy for these patients in a manner similar to healthy individuals, when glycemic levels and oral hygiene are strictly maintained. Summary The most recent literature on the impact of T2DM on peri-implant bone loss was reviewed to evaluate the feasibility of dental implant therapy over the time for these patients.

To compare alcohol and other drugs abuse, state impulsivity, craving and the relationship between craving and impulsivity in alcohol-dependent patients with or without dual disorder attending to an alcohol treatment center in Cadiz town.An observational, descriptive and transversal study performed on 112 alcohol dependent patient sample who were seeking treatment in ARCA outpatient treatment center in Cadiz. The sample was divided in two groups, according to present dual diagnosis or not. The sample was assessed with an AdHoc sociodemographic and clinical questionnaire and specific scales and interviews that included: 5.0 Mini International Neuropsychiatric Interview results (MINI), State Impulsivity Scale (SIS), and Multidimensional Alcohol Craving Scale (MACS).The prevalence of dual diagnosis was 50%, being the most prevalent disorders: Current and recurrent Major Depressive Episode Mood Disorder, Current Dysthymic Mood Disorder, Panic Disorder and Anxiety Disorder. 52,7% of the total sample had a positive result on the State Impulsivity Scale. No statistically significant results were found on the Craving Scale (neither in the score or in the sub-sections). A relationship between craving and impulsivity were found for all groups and researched items.As a relationship between craving and impulsivity was observed, these aspects should be considered as main factors for the treatment and evolution of alcohol- dependent patients.

Oral lesions related to the novel Coronavirus Disease 2019 (COVID-19) have been increasingly described; however, clinical and epidemiological information is still scant. Although a diversity of therapeutic strategies for the management of these lesions are present in the literature, one can note a lack of standardization and doubtful effectiveness. Thus, the present study aimed to report a series of cases in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for orofacial lesions in patients suffering from COVID-19. It was noted, in all cases, a marked improvement in tissue repair and pain relief within a few days; moreover, the patients recovered their orofacial functions satisfactorily. Based on the present series of cases and having in mind the conspicuous lack of information on the different aspects of COVID-19, the protocol which combined aPDT with PMBT seemed to be effective in the management of COVID-19-related orofacial lesions.

O presente estudo visa identificar os fatores determinantes da decisão de compra de núcleo mineral por parte dos criadores de gado de corte confinado no Centro Oeste. Para tanto, desenvolveu-se uma pesquisa quantitativa descritiva, realizada através da aplicação de questionários estruturados a 83 confinadores de gado da região Centro-Oeste do Brasil. Após a coleta dos dados e caracterização da amostra, foram realizadas regressão logística binária e análise de cluster. Concluiu-se que, os dados não permitem a identificação prévia de influência dos atributos de compra selecionados (agilidade de entrega, acompanhamento técnico, confiança da marca, nível de garantia, indicação da marca por um amigo, prazo de pagamento, preço do produto, indicação de marca por técnico, relacionamento com o representante e resultado de desempenho) na decisão de compra e uso de núcleos minerais (grãos inteiros ou tradicional) na dieta de bovinos de corte confinados. A análise de agrupamento de tipos específicos de gestores obteve respostas que não estão relacionadas, não permitindo a distinção entre os grupos. Os resultados abrem um novo ponto de análise para o comportamento de compra para a produção: a busca pela padronização dos processos e entendimento do perfil do produtor.

The present study aimed to assess the impact of low-level laser (LLL) on low salivary flow rate in patients undergoing radiochemotherapy (RT-CT) for head and neck cancer.LLL has shown efficiency in preventing hyposalivation in patients under different pathological conditions, including those undergoing RT-CT.During all RT-CT, 17 patients received laser therapy and 10 received clinical care only. An Indium-Gallium-Aluminum-Phosphorus diode laser was punctually used for intraoral (660 nm, 40 mW, 10 J/cm(2), illuminated area 0.04 cm(2), 10 sec) and extraoral irradiation (780 nm, 15 mW, 3.8 J/cm(2), illuminated area 0.04 cm(2), 10 sec), three times a week and on alternate days, for a total of 21 sessions. Unstimulated salivary flow rate was assessed before the first RT session (N0), at the 15th RT session (N15), at the last RT session (Nf), and at 30 (N30) and 90 days after the end of the oncologic treatment (N90).At N15, Nf, and N30, patients treated with LLL showed significantly higher averages of salivary flow rate when compared with patients receiving clinical care only.LLL seems to be an efficient tool for mitigation of salivary hypofunction in patients undergoing RT for head and neck cancer.

Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer. Resumo Objetivo: Avaliar o impacto do laser de baixa potência na prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. Materiais e Métodos: Treze pacientes receberam laserterapia e dez receberam cuidados clínicos. Utilizou-se um InGaAlP laser diodo para aplicação intraoral (comprimento de onda de 660 nm, 40 mW de potência e dose média de 10 J/cm2) e extraoral (comprimento de onda de 780 nm, 15 mW de potência e dose média de 3,7 J/cm2), três vezes por semana, em dias alternados. Sialometrias estimulada e não estimulada foram realizadas antes da primeira sessão de radioterapia e quimioterapia (N0) e 30 dias após o final do tratamento (N30). Resultados: Em N30, os pacientes submetidos à laserterapia apresentaram médias estatisticamente maiores de fluxo salivar estimulado (p = 0,0131) e não estimulado (p = 0,0143), em comparação com os pacientes que receberam apenas cuidados clínicos. Conclusão: A laserterapia de baixa potência realizada concomitantemente a radioterapia e quimioterapia foi capaz de mitigar a hipofunção das glândulas salivares em pacientes portadores de câncer de cabeça e pescoço após o tratamento oncológico.

Alexithymia is related to a higher severity of substance use disorders (SUD); however, few longitudinal studies have been performed on how alexithymia impacts treatment outcomes. This study aims to evaluate alexithymia as a factor that could influence retention and the time of the first relapse in a one-year follow-up in an outpatient treatment center for SUD. In total, 126 SUD outpatients (74.60% males; M age = 43.71, SD = 14.61 years) were evaluated at baseline with an AdHoc questionnaire for sociodemographic variables, the European Addiction Severity Index (EuropASI), the Semi-structured Clinical Interview for Axis I and Axis II Disorders of the DSM-IV, and the Toronto Alexithymia Scale (TAS-20). The prevalence of alexithymia was 41.3% and the mean score of TAS-20, was 57.27 (SD = 12.84). At baseline, alexithymia was related to a lower education level, cannabis use disorder, the psychological item of EuropASI, and mood spectrum disorders. In the Kaplan-Meier analysis, SUD patients with alexithymia were in treatment for less time and presented earlier relapses than non-alexithymic patients. In the Cox regression, alexithymia was only associated with less time in treatment. Therefore, alexithymia may have an important role in the outcomes of SUD treatment, and hence, therapeutic approaches for SUD that cover emotional impairments associated with alexithymia should be investigated and developed.

Introduccion. La lamotrigina es un antiepileptico aprobado como estabilizador del animo para la prevencion de episodios depresivos en el trastorno bipolar. Entre sus reacciones adversas puede presentar sintomatologia maniforme inducida, a pesar de ser un efecto adverso de caracter idiosincratico y baja incidencia. Caso clinico. Presentamos el caso de una paciente de 58 anos, con diagnostico de trastorno bipolar desde su juventud y que, a lo largo de la evolucion de su patologia, ha precisado multiples esquemas terapeuticos. Tras un cambio farmacologico de litio a lamotrigina en dosis ascendentes progresivas, presenta descompensacion maniforme, concordante temporalmente con el inicio de la lamotrigina y que se acentua con el aumento de la dosis. La sintomatologia desaparece al retirar la lamotrigina y realizar un abordaje farmacologico. Al evaluar el caso segun los criterios de causalidad de Naranjo et al, encontramos un resultado posible. Conclusion. Aunque se ha documentado previamente sintomatologia maniforme inducida por lamotrigina, es importante tener en cuenta este efecto adverso, dada la repercusion a nivel afectivo y conductual. Son necesarios mas estudios para entender la relacion bilateral de este efecto desde un punto de vista clinico y neurobiologico.

One of the most important complications of radiotherapy (RT) for head-and-neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, which mostly arises from tooth extractions. The ORN treatment still represents a great challenge; therefore, the prevention is of paramount importance. Thus, the present study aimed to evaluate retrospectively a perioperative systemic antibiotic therapy protocol for the prevention of ORN following tooth extraction in head-and-neck patients post-3D conformal RT.A retrospective medical record review was performed considering HNC patients submitted to RT in the period between 2008 and 2019. They necessarily received oral antibiotic therapy with Clindamycin 300 mg every 8 h for 10 days, with the first dose 3 days before the tooth extraction.Forty-nine patients met the study criteria, with a total of 107 teeth extracted. Regarding the 47 patients who did not develop ORN, 103 tooth extractions were identified (96.3%). Only two patients developed ORN at two adjacent teeth sites (3.7%).The proposed perioperative systemic antibiotic therapy protocol seems to be efficient to prevent ORN following tooth extraction in postirradiated HNC patients.