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The aim of this study was to test two low-level laser therapy protocols by evaluating pain control, swelling and trismus in the postoperative period of lower third molar surgeries. This was a randomized, double-blind, placebo-controlled, crossover trial. Patients presenting two symmetrically impacted mandibular third molars were included. One side was randomly assigned for LLLT applied immediately after surgery (T1) and then after 24 (T2) and 48 hours (T3) (Protocol A). The other side received LLLT applied immediately after surgery and placebo after 24 and 48 hours (Protocol B). LLLT was given by intraoral application (660nm, 5 J/cm2, 10 s, 20 mW, 4 points) followed by extraoral application (789 nm, 30 J/cm2, 20 s, 60 mW, 8 points). The placebo application was similar to that of the experimental side but with laser simulation. The primary outcomes were pain control, swelling and trismus intensity at T1, T2, T3 and 7 days after surgery (T4). Data were analyzedbyANOVArepeated measures and Wilcoxon test (p<.05). The final sample consisted of 21 patients (42 teeth). There were no statistical differences for pain level between protocols A and B over time (p= .909), although the amount of analgesic medication was lower with protocol A at T2 (p=.022). There were no differences in swelling (p=.958) or trismus (p=.837) between the protocols used over time. Both protocols performed similarly for pain control, swelling and trismus. Therefore, for practical reasons, a single laser application in the immediate postoperative period could be indicated for the management of postoperative discomfort in lower third molar surgery., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (Sociedad Argentina de Investigación Odontológica.)

Polar regions are among the most affected areas by the current global warming. In the Southern Hemisphere (SH), impacts of a warmer climate include decrease in sea-ice extent, changes in oceanic and in atmospheric circulation. Recently, some of these impacts were reinforced by the positive phase of the Southern Annular Mode (SAM). SAM is the dominant mode of variability of the SH extratropical climate and manifests as a "ring-shape" regular pattern of atmospheric mean sea level pressure (MSLP) with opposite sign between mid and high SH latitudes. Over the last three decades, SAM has presented a positive trend, and some studies associate it to stratospheric ozone depletion and to an increase in greenhouse gases concentration. As this debate is still open, climate models constitute useful tools to understand the SH variability in future scenarios. Here we use monthly MSLP outputs from the Brazilian Earth System Model (BESM) to examine SAM temporal and spatial behavior in future climate scenarios compared to the historical period. Our results for the BESM simulations suggest that the mean spatial pattern of SAM does not change with global warming, but an increase in the radiative forcing may reinforce positive SAM values obtained for the historical period.

Aim: There are no studies comparing tests performed at home with those carried out in the laboratory, using the same device. The only studies that have been performed have compared the device used at home with the standard polygraph used in the laboratory. The purpose of this study was therefore to verify the accuracy of the home diagnosis of obstructive sleep apnea syndrome (OSAS) via unassisted type 2 portable polysomnography, compared with polysomnography using the same equipment in a sleep laboratory., Methods: To avoid any possible order effect on the apnea-hypopnea index (AHI), we randomly created two groups of 20-total 40 patients, according to the test sequence. One of the groups had the first test at home and the second test in the laboratory (H-L); the other group had the first test in the laboratory and the second at home (L-H). The second test always took place on the night immediately following the first test. All polysomnographic monitoring was undertaken with the same equipment, an Embletta X100 system (Embla, Natus Inc., Middleton, USA). The Embletta X100 is a portable polygraph that records eleven polygraph signs: (1) electroencephalogram C4/A; (2) electroencephalogram O2/M1; (3) submental EMG; (4) electrooculogram of the right side; (5) nasal cannula (air flow); (6) respiratory effort against a plethysmographic chest strap; (7) respiratory effort against an abdominal plethysmographic belt; (8) heart rate; (9) saturation of oxyhemoglobin; (10) snoring; and (11) body position., Results: There was no difference in sleep efficiency between the group monitored in the laboratory and the group tested at home (p = 0.30). There was no difference in total sleep time (p = 0.11) or sleep latency (p = 0.52), or in the latency in phases N2 and N3 between the monitoring in the laboratory and at home (N2 p = 0.24; N3 p = 0.09). Some differences occurred regarding the PSG that took place at home, with longer duration of wake after sleep onset (WASO) and longer latency for REM sleep, due to failure of the patient to start the monitoring by pressing the "events" button on the device. In the distribution of sleep phases, there was no difference between the group monitored in the laboratory and the group tested at home., Conclusion: Results from home sleep monitoring correlate well with the laboratory "gold standard" and may be an option for diagnosing OSAS in selected patients., (© 2021. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

The hepatic lipase plays a central role in the lipid metabolism, catalyzing the hydrolysis of phospholipids, monoglycerides, diglycerides, and triglycerides, and acyl-CoA. It is also implied in the conversion of very low-density lipoprotein and intermediate density lipoprotein to low density lipoproteins. As a consequence, the gene encoding the hepatic lipase (LIPC) is associated with several diseases derived from the imbalance of lipids that are in general derived from the interaction between life styles and genetic architecture. Therefore, it is interesting to understand more about the characteristics of the microevolutionary processes affecting genes that, like LIPC, have a role in nutrition and lipid metabolism in human populations. We explored the selection signatures on LIPC in 26 populations, detecting three regions under recent positive selection.

Background There is a scarcity of knowledge as to whether rates of myocardial reperfusion use and 30-day mortality for patients with ST-segment-elevation myocardial infarction are similar among patients using the Brazilian Public Health System (SUS) and those using the private healthcare system. Methods and Results A total of 707 patients were analyzed using the VICTIM (Via Crucis for the Treatment of Myocardial Infarction) register database; 589 patients from the SUS and 118 from the private network with ST-segment-elevation myocardial infarction, who attended hospitals with the capacity to perform primary percutaneous coronary intervention (PCI) were investigated. The timeline, rates of use of PCI, and the 30-day probability of death were investigated, comparing the SUS patients to those in the private system. The mean time between symptom onset and arrival at the PCI hospital was higher for SUS patients compared with users of the private system (25.4±36.5 versus 9.0±21 hours; P <0.001, respectively). Rates of primary PCI were low in both groups, but significantly lower for the SUS patients (45% versus 78%; P <0.001). The 30-day mortality rate of SUS patients was 11.9% and of private patients was 5.9% ( P =0.04). In the fully adjusted model, the odds ratio for 30-day mortality for the SUS patients was higher (odds ratio, 2.96; 95% CI, 1.15-7.61; P =0.02). Conclusions The delay in reaching a PCI hospital was almost 3 times higher for the SUS patients. Primary PCI was underused in both groups, especially in the SUS patients. The SUS patients were more likely to die during the 30-day follow-up.

Recent paleoclimatic studies suggest that changes in the tropical rainbelt across the Atlantic Ocean during the past two millennia are linked to a latitudinal shift of the Intertropical Convergence Zone (ITCZ) driven by the Northern Hemisphere (NH) climate. However, little is known regarding other potential drivers that can affect tropical Atlantic rainfall, mainly due to the scarcity of adequate and high-resolution records. In this study, we fill this gap by reconstructing precipitation changes in Northeastern Brazil during the last 2,300 years from a high-resolution lake record of hydrogen isotope compositions of plant waxes. We find that regional precipitation along the coastal area of South America was not solely governed by north-south displacements of the ITCZ due to changes in NH climate, but also by the contraction and expansion of the tropical rainbelt due to variations in sea surface temperature and southeast trade winds in the tropical South Atlantic Basin.

Objective: The aim of the present study was to validate The Tucson Children's Assessment of Sleep Apnea Study (TuCASA) questionnaire for use in the Brazilian population., Methods: Of the total 62 children who participated in the present study (27 girls), aged 4 to 11 years, 45 (72.6%) had sleep-disordered breathing (SDB) diagnosed by polysomnography, while 17 (27.4%) had no sleep disorders. Translation, back-translation, and pretesting were previously performed. The final Portuguese-language version of TuCASA was administered to the participants from May 2012 to August 2013. The interviewer was blinded to presence or absence of SDB. Cronbach's alpha for the overall scale (with 95% CI) and the effect of excluding any items were evaluated., Results: There was no difference among TuCASA items/score and the presence of SDB with either age or gender. The TuCASA had a Cronbach's alpha coefficient of 0.726 (95% CI 0.614 to 0.817), which denotes satisfactory internal consistency - a finding reinforced by evaluation of the effect of item exclusion on the questionnaire. Convergent validity was also satisfactory, in as much as most correlations were positive and significant., Conclusion: The translated version of the TuCASA questionnaire was validated for Brazilian populations and proved to be a reliable, validated instrument that can be used in clinical practice for evaluation of children with symptoms of SDB., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Climate indices based on sea surface temperature (SST) can synthesize information related to physical processes that describe change and variability in continental precipitation from floods to droughts. The South Atlantic Subtropical Dipole index (SASD) is based on the distribution of SST in the South Atlantic and fits these criteria. It represents the dominant mode of variability of SST in the South Atlantic, which is modulated by changes in the position and intensity of the South Atlantic Subtropical High. Here we reconstructed an index of the South Atlantic Ocean SST (SASD-like) for the past twelve thousand years (the Holocene period) based on proxy-data. This has great scientific implications and important socio-economic ramifications because of its ability to infer variability of precipitation and moisture over South America where past climate data is limited. For the first time a reconstructed index based on proxy data on opposite sides of the SASD-like mode is able to capture, in the South Atlantic, the significant cold events in the Northern Hemisphere at 12.9-11.6 kyr BP and 8.6-8.0 ky BP. These events are related, using a transient model simulation, to precipitation changes over South America.

Objective: The use of unstructured play as an intervention to help children cope with the stress of a hospitalization period was tested in this randomized clinical trial., Methods: Urinary cortisol (a stress marker) was examined in 53 pediatric patients hospitalized for respiratory diseases in a public hospital, divided into two groups that did or did not play., Results: Boys and girls from the play group, 7-11 years old, showed a decrease in cortisol levels after participating in play activities. In younger participants (4-7 years old) the intervention did not seem as efficient, probably because in this group maturity levels may have influenced how children cognitively engaged in play as a coping strategy., Conclusions: The study showed the importance of using interventions that consider age ranges and gender in enhancing coping strategies, as well as the importance of such techniques that are employed by occupational therapists since they are professionals with expertise in the use of activities as therapeutic instruments.

Objective: To investigate the prevalence of sleep disorders in a sample of children from a public hospital in the city of São Paulo, Brazil., Method: 330 children, who came to the clinical laboratory, were consecutively investigated for sleep disorders, using the sleep disturbance scale for children. Gender, age, and social/economical classification were considered., Results: Sleep disordered breathing (SDB) showed higher prevalence in our sample (55%) than in data found in the literature. Prevalence of sleep hyperhydrosis (SHY) was 27% considering the whole sample. Boys and children in age range 7.1 to 11 years old showed higher prevalence for SDB as well as children belonging to lower social/economic classifications who were also more prevalent for disorders in the transition of sleep-wakefulness., Conclusion: Sleep disorders were highly prevailing in our study, mostly SDB and SHY which were exceedingly more prevalent in boys in relation to international literature.

Background: The identification of breathing patterns in healthy elderly individuals and changes in the respiratory system related to the normal aging process is important to detect and prevent respiratory dysfunction., Objectives: To assess and compare respiratory function between adults and elderly individuals according to baseline conditions., Methods: Nineteen adults aged 20-59 years (group 1), 12 elderly aged 60-69 years (group 2) and 12 elderly above 69 years of age (group 3) who were all nonsmokers, untrained and with normal pulmonary function tests were studied using calibrated respiratory inductive plethysmography to assess tidal volume (Vt), respiratory frequency (f), minute ventilation, mean inspiratory flow [Vt/inspiratory time (Ti)], inspiratory duty cycle (Ti/total cycle time), labored breathing index (an asynchrony index measurement), percentage of rib cage motion and abdominal motion. Measurements of the maximal inspiratory pressure (MIP), maximal expiratory pressure and transcutaneous oxygen saturation were also obtained., Results: The MIP was statistically significantly lower in group 2 (54.58 +/- 32.37 cm H2O) and group 3 (54.58 +/- 33.61 cm H2O) compared to group 1 (92.11 +/- 43.22 cm H2O; p = 0.037). There were no significant differences between the groups regarding breathing patterns, respiratory variables and thoracoabdominal motion. No statistically significant differences between groups 2 and 3 were found for any of the investigated variables., Conclusion: These findings suggest that the aging process of the respiratory system reduces the inspiratory muscle strength but does not have a significant impact on breathing pattern variables., (Copyright 2009 S. Karger AG, Basel.)

Two daily school periods are mandatory in Brazil owing to a shortage of academic facilities, which can decrease cognitive performance, especially in children with sleep-disordered breathing. This study aimed to verify the influence of starting time to school on cognition, comparing children with sleep disorders and normal children. Cognition was assessed in 79 children with sleep-disordered breathing, 468 children with nonrespiratory sleep disorders, and 633 normal control children. We analyzed total sleep time, starting time to school (morning or afternoon), and grades. First grade morning students with sleep-disordered breathing had 8.04 higher odds for cognitive dysfunction than normal children. For children with sleep-disordered breathing, second and third grade morning students had higher odds for cognitive dysfunction than those who studied in the afternoon (3.69 and 4.07). Fourth grade morning students had 8.27 higher odds for cognitive dysfunction than first grade children. In conclusion, sleep-disordered breathing, grades, and starting time to school interact to affect cognition in Brazilian children.

Sixteen cases of acinic cell carcinoma (ACC) of salivary glands were studied and their different clinicopathologic aspects were analysed. ACC occurred more frequently in the 5th and 6th decades of life, and was seen exclusively in major salivary glands. The main complaint of the patients was the presence of a mass, and the majority of the tumors were Stage III and IV when first seen in our institution. The tumors were divided into three histologic grades based on cellular pleomorphism, mitotic activity, and necrosis. This study showed correlation between prognosis and grading. Other important factors in the prognosis were the type of treatment and the duration of symptoms. Surgical resection with free margins is the treatment of choice.