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Objective:  To describe the evolution of maternal mortality right after the establishment of maternal death committees in the region of the city of Ribeirão Preto, state of São Paulo, Brazil., Methods:  The present study describes the spatial and temporal distribution of maternal mortality frequencies and rates, using data from the state of São Paulo, the municipality of Ribeirão Preto, and its Regional Health Department (DRS-XIII) from 1998 to 2017. The present ecological study considered the maternal mortality and live birth frequencies made available by the Computer Science Department of the Brazilian Unified Health System (Departamento de Informática do Sistema Único de Saúde, DATASUS, in the Portuguese acronym)/Ministry of Health, which were grouped by year and political-administrative division (the state of São Paulo, the DRS-XIII, and the city of Ribeirão Preto). The maternal mortality rate (MMR) was calculated and presented through descriptive measures, graphs, and cartograms., Results:  The overall MMR observed for the city of Ribeirão Preto was of 39.1; for the DRS-XIII, it was of of 40.4; and for the state of São Paulo, it was of 43.8 for every 100 thousand live birhts. During this period, the MMR for the city of Ribeirão Preto ranged from 0% to 80% of the total maternal mortalities, and from 40.7% to 47.2% of live births in the DRS-XIII. The city of Ribeirao Preto had an MMR of 76.5 in 1998and 1999, which decreased progressively to 12.1 until the years of 2012 and 2013, and increased to 54.3 for every 100 thousand live births over the past 4 years. The state of São Paulo State had an MMR of 54.0 in 1998-1999, which varied throughout the study period, with values of 48.0 in 2008-2009, and 54.1 for every 100 thousand live births in 2016-2017. Several times before 2015, the city of Ribeirão Preto and the DRS-XIII reached the Millennium Goals. Recently, however, the MMR increased, which can be explained by the improvement in the surveillance of maternal mortality., Conclusion:  The present study describes a sharp decline in maternal death in the region of Ribeirão Preto by the end of 2012-2013, and a subsequent and distressing increase in recent years that needs to be fully faced., Competing Interests: The authors have no conflicts of interests to declare., (Federação Brasileira de Ginecologia e Obstetrícia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/).)

ABSTRACTObjective:To compare the accuracy of Mini-Mental State Examination (MMSE) and of the Montreal Cognitive Assessment (MoCA) in tracking mild cognitive impairment (MCI) and Alzheimer's Disease (AD)., Method: A Systematic review of the PubMed, Bireme, Science Direct, Cochrane Library, and PsycInfo databases was conducted. Using inclusion and exclusion criteria and staring with 1,629 articles, 34 articles were selected. The quality of the selected research was evaluated through the Quality Assessment of Diagnostic Accuracy Studies 2 tool (QUADAS-2)., Result: More than 80% of the articles showed MoCA to be superior to MMSE in discriminating between individuals with mild cognitive impairment and no cognitive impairment. The area under the curve varied from 0.71 to 0.99 for MoCA, and 0.43 to 0.94 for MMSE, when evaluating the ability to discriminate MCI in the cognitively healthy elderly individuals, and 0.87 to 0.99 and 0.67 to 0.99, respectively, when evaluating the detection of AD. The AUC mean value for MoCA was significantly larger compared to the MMSE in discriminating MCI from control [0.883 (CI 95% 0.855-0.912) vs MMSE 0.780 (CI 95% 0.740-0.820) p < 0.001]., Conclusion: The screening tool MoCA is superior to MMSE in the identification of MCI, and both tests were found to be accurate in the detection of AD.

Objective: To evaluate the applicability and the psychometric properties of Montreal Cognitive Assessment Brazilian Version (MoCA-BR) in the elderly, as well as comparing its accuracy as a tracking test for mild cognitive impairment (MCI) and mild Alzheimer's disease (AD) with the accuracy of Mini-Mental State Examination (MMSE)., Method: A transversal study was performed in 4 reference medical centers that care for the elderly. In all, 229 elderly participated in the study. To select the sample, the clinical history of the elderly, Pfeffer Functional Activities Questionnaire, and neuropsychological battery, apart from MMSE and MoCA-BR cognitive tests, were selected. The elderly were classified into control, MCI, and mild AD groups., Results: There was a significant statistical difference between the MoCA-BR scores of the elderly and the control group, MCI, and mild AD (p < 0.001). The Cronbach alpha for MoCA-BR was 0.77, indicating a good internal consistency. The test-retest reliability was elevated, with intraclass correlation coefficient (ICC) 0.91. The inter-examiner reliability was excellent (ICC 0.96). The area under curve of the receiver operating characteristics curve was 0.95, when evaluating the ability of MoCA-BR to discriminate between the elderly with cognitive impairment and cognitively healthy elderly., Conclusions: The results of the study show that the Brazilian version of MoCA is a reliable cognitive tracking tool and is accurate for the detection of MCI and early stage AD, with good applicability on the elderly with education equal to or more than 4 years and adequate to discriminate between cognitively healthy elderly, and those with MCI and mild, proving to be superior to MMSE in tracking MCI and similar to this test when tracking mild AD., (© 2019 S. Karger AG, Basel.)

Aims: To provide normative data for the Brazilian version of the Montreal Cognitive Assessment (MoCA-BR) and to measure the effect of sociodemographic variables on the cognitive performance of cognitively healthy elderly people., Methods: A sample of 110 cognitively healthy individuals, aged over 65 years, with at least 4 years of schooling were recruited from 3 health care centers for the elderly in Recife, Brazil. The cognitive performance was assessed using MoCA-BR., Results: The average score of these elderly people in the MoCA-BR was 23.2 ± 2.7. Their schooling correlated positively with the cognitive performance, with a Spearman's coefficient of 0.33 (p < 0.001). There was a statistically significant negative correlation between age and the cognitive performance (Spearman's rho = -0.19). The multiple linear regression model with the highest adjusted coefficient of determination was the one that included schooling and age (adjusted R2 = 0.127)., Conclusions: The cognitive performance of healthy elderly was evaluated and was strongly influenced by schooling and, to a lower degree, by age., (© 2018 S. Karger AG, Basel.)

The aim of this study was to evaluate the effect of cavity preparation with Er:YAG laser on dentin adjacent to restorations submitted to cariogenic challenge in situ, by subsuperficial microhardness analysis. Bovine incisors were sectioned, flattened, and polished, resulting in 40 dentin slabs. The slabs were randomly assigned to four groups (n = 10), according to the cavity preparation method: I-high-speed handpiece (control); II-Er:YAG laser (160 mJ; 3 Hz); III-Er:YAG laser (260 mJ; 3 Hz); IV-Er:YAG laser (300 mJ; 3Hz). Cavities were restored with composite resin, and the specimens were fixed in intra-oral appliances, which were worn by 10 volunteers for 14 days for simulating cariogenic challenge in situ. During the experimental period, 20% sucrose solution was dripped over each specimen 6 times a day. Samples were removed, sectioned, and examined for subsuperficial Knoop microhardness at 100, 200, and 300 μm from the restoration and at 30 μm from dentin surface. Split-plot analysis of variance showed no significant difference among the cavity preparation techniques (p = 0.1129), among distances (p = 0.9030), as well as no difference in the interaction between the main factors (p = 0.7338). It was concluded that the cavity preparation with Er:YAG laser did not influence on dentin microhardness submitted to cariogenic challenge in situ.

This study evaluated in vitro the effect of input power of CO2 laser, either associated or not to stannous fluoride (SnF2) gel, for the control of intrinsic erosion in primary teeth. One hundred four enamel slabs (3 × 3 × 2 mm) from human primary molars were flattened and polished. Adhesive tapes were placed on their surface leaving a window of 3 × 1 mm. Slabs were then cycled four times in 0.01 M hydrochloric acid (pH 2, 2 min) and in artificial saliva (2 h) for creation of erosive lesions. Specimens were randomly assigned into eight groups (n = 13) according to fluoride application [absent (control) or 0.4% stannous fluoride gel (SnF2)] and input power of CO2 laser [unlased (control), 0.5, 1.0 or 1.5 W]. The CO2 laser irradiation was performed in an ultra-pulse mode (100 μs of pulse duration), 4-mm working distance, for 10 s. Specimens were then submitted to further erosive episodes for 5 days and evaluated for enamel relative permeability. Fluoride did not show any protective effect for any of the laser-treated groups or control (p = 0.185). However, a significant effect was detected for input power of CO2 laser (p = 0.037). Tukey's test showed that there was a significant statistically difference between specimens irradiated with 0.5 and 1.5 W (p = 0.028). The input power of 0.5 W showed lower permeability. Variation of input power CO2 laser can influence enamel permeability, at the power of 1.5 W which promoted greater permeability.

The aim of this study was to evaluate the effect of industrialised foods and drinks on primary tooth enamel previously eroded with hydrochloric acid (HCl). The crowns of one hundred two specimens were subjected to an erosive challenge with HCl and randomly divided into six groups (n = 17): Chocolate Milk (Toddynho® - Pepsico) - negative control; Petit Suisse Yogurt (Danoninho® - Danone); Strawberry Yogurt (Vigor); Apple puree (Nestlé); Fermented Milk (Yakult® - Yakult); and Home Squeezed Style Orange Juice (del Valle) - positive control. The 28-day immersion cycles for the test products were performed twice daily and were interspersed with exposure of the test substrate to artificial saliva. Measurements of enamel surface microhardness (SMH) were performed initially, after immersion in HCl and at 7, 14, 21 and 28 days of experimentation. A two-way ANOVA, according to a split-plot design, followed by the sum of squares decomposition and Tukey's test, revealed a significant effect for the interaction between Foods and Drinks and Length of Exposure (p < 0.00001). Orange juice resulted in greater mineral loss of enamel after 28 days. None of the test products was associated with recovery of tooth enamel microhardness.

Objective: The aim of this study was to analyze social characteristics and stress as correlates of cigarette smoking in adolescence. The main intent was to identify elements that distinguish adolescents who had experimented with smoking and did not progress to regular smoking from those who became current smokers., Methods: Students at 10 high schools in the city of Ribeirão Preto, Brazil, completed a questionnaire based on an instrument employed in a similar large-scale study. The students were classified as never-smokers or experimenters. The experimenters were subcategorized as having become current smokers or nonprogressors. Analyses were performed using adjusted logistic models., Results: A total of 2,014 students (mean age, 16.2 ± 1.1 years; females, 53%) completed the questionnaire. We categorized 1,283 students (63.7%) as never-smokers, 244 (12.1%) as current smokers, and 487 (24.2%) as nonprogressors. We found that experimentation with smoking was associated with being held back a grade in school (OR = 1.80), alcohol intake (low/occasional, OR = 8.92; high/regular, OR = 2.64), illicit drug use (OR = 9.32), having a sibling or cousin who smokes (OR = 1.39), having a friend who smokes (OR = 2.08), and high levels of stress (in females only, OR = 1.32). Factors associated with an increased risk of transitioning from experimenter to current smoker were alcohol intake (low/occasional, OR = 3.28; high/regular, OR = 2.16), illicit drug use (OR = 3.61), and having a friend who smokes (OR = 7.20)., Conclusions: Current smoking was associated with a profile of socioeconomic correlates different from that associated with experimentation only. Our data (showing that current smoking was associated with having a friend who smokes, alcohol intake, and illicit drug use) suggest the need for comprehensive approaches to discourage substance use during adolescence.

Introduction: AIDS epidemic has given visibility to the incidence of tuberculosis, for being the most frequent opportunistic infection. It is known that individuals who are socially vulnerable are more susceptible to HIV transmission and tuberculosis as well., Objective: This study aims to conduct a geoepidemiological study on HIV/AIDS, AIDS-Tuberculosis co-infection and social vulnerability., Method: This is an ecological study using incidence rates and the human development index to produce thematic maps and a descriptive analysis of epidemiology. The records of reported cases of HIV/AIDS from 1982 to 2007 were used, considering as cases of AIDS-Tuberculosis those records that were positively diagnosed with tuberculosis and those records with unknown diagnosis of tuberculosis, but showing compatible signs and symptoms with tuberculosis (fever, cough, cachexia and asthenia)., Results: The maps allowed the identification of areas with social differences and different patterns of incidence of HIV/AIDS and AIDS-Tuberculosis; regional differences were similar to those found by Josué de Castro, in 1940; regions with higher human development index values also showed higher incidence HIV/AIDS and AIDS-Tuberculosis., Conclusion: The prevention of HIV infection must be geographically specific, given socioeconomic and cultural differences. Although official records show decline in AIDS-TB co-infection, treatment of cases of HIV/AIDS should observe the occurrence of opportunistic diseases, which should be notified and/or updated.

This study evaluates the bond strength of dentin prepared with Er:YAG laser or bur, after rewetting with chlorhexidine on long-term artificial saliva storage and thermocycling. One hundred and twenty human third molars were sectioned in order to expose the dentin surface (n = 10). The specimens were randomly divided in 12 groups according to treatment and aging: Er:YAG laser rewetting with deionized water (LW) and 24 h storage in artificial saliva (WC); LW and 6 months of artificial saliva storage + 12.000 thermocycling (6M), LW and 12 months of artificial saliva storage + 24.000 thermocycling (12M), Er:YAG laser rewetting with 2% chlorhexidine (LC) and WC, LC and 6M, LC and 12M, bur on high-speed turbine rewetting with deionized water (TW) and WC, TW6M, TW12M, bur on high-speed turbine + 2% chlorhexidine (TC) and WC, TC and 6M, TC and 12M. The specimens were etched with 35% phosphoric acid, washed, and dried with air. Single Bond 2 adhesive was applied and the samples were restored with a composite. Each tooth was sectioned in order to obtain 4 sticks, which were submitted to microtensile bond strength test (µTBS). The two-way ANOVA, showed no significant differences for the interaction between the factors and for the aging factor. Tukey 5% showed that the LC group had the lowest µTBS. The rewetting with chlorhexidine negatively influenced the bond strength of the preparation with the Er:YAG laser. The artificial saliva aging and thermocycling did not interfere with dentin bond strength., (Copyright © 2013 Wiley Periodicals, Inc.)

Objective: To investigate the impressions made by different styles of dress and appearance adopted by physicians on patients, medical students and other physicians in Brazil., Methods: Two hundred fifty nine patients, 119 students, and 99 physicians answered questions related to a panel of male and female physicians' pictures covering the following styles: white clothing; white coat; formal, informal, and casual garments; and surgical scrubs. They also reported their level of discomfort with a list of 20 items for professional appearance of both genders., Results: Most of the answers of the volunteers involved using white clothes or white coat, and in many situations the percentages of preference referred for these styles were close. Physicians and students preferred physicians wearing surgical scrubs for emergency visits, and doctors with informal style for discussing psychological problems with male professionals. Patients most often chose white clothing in response to questions. Regarding male professionals, all three groups reported high degree of discomfort for the use of shorts and bermuda shorts, multiple rings, facial piercing, sandals, extravagant hair color, long hair, and earrings. For females, high levels of discomfort were reported to shorts, blouses exposing the belly, facial piercing, multiple rings, extravagant hair color, and heavy makeup., Conclusion: Brazilian patients, physicians, and medical students form a better initial impression of physicians using clothing traditionally associated with the profession and exhibiting more conventional appearance. The use of entirely white garments appears to be a satisfactory option in this country., (Copyright © 2013 Elsevier Editora Ltda. All rights reserved.)

The concept of epidemiological intelligence, as a construction of information societies, goes beyond monitoring a list of diseases and the ability to elicit rapid responses. The concept should consider the complexity of the definition of epidemiology in the identification of this object of study without being limited to a set of actions in a single government sector. The activities of epidemiological intelligence include risk assessment, strategies for prevention and protection, subsystems of information, crisis management rooms, geographical analysis, etc. This concept contributes to the understanding of policies in health, in multisectorial and geopolitical dimensions, as regards the organization of services around public health emergencies, primary healthcare, as well as disasters. The activities of epidemiological intelligence should not be restricted to scientific research, but the researchers must beware of threats to public health. Lalonde's model enabled consideration of epidemiological intelligence as a way to restructure policies and share resources by creating communities of intelligence, whose purpose is primarily to deal with public health emergencies and disasters.

Objective: To identify clusters of the major occurrences of leprosy and their associated socioeconomic and demographic factors., Methods: Cases of leprosy that occurred between 1998 and 2007 in São José do Rio Preto (southeastern Brazil) were geocodified and the incidence rates were calculated by census tract. A socioeconomic classification score was obtained using principal component analysis of socioeconomic variables. Thematic maps to visualize the spatial distribution of the incidence of leprosy with respect to socioeconomic levels and demographic density were constructed using geostatistics., Results: While the incidence rate for the entire city was 10.4 cases per 100,000 inhabitants annually between 1998 and 2007, the incidence rates of individual census tracts were heterogeneous, with values that ranged from 0 to 26.9 cases per 100,000 inhabitants per year. Areas with a high leprosy incidence were associated with lower socioeconomic levels. There were identified clusters of leprosy cases, however there was no association between disease incidence and demographic density. There was a disparity between the places where the majority of ill people lived and the location of healthcare services., Conclusions: The spatial analysis techniques utilized identified the poorer neighborhoods of the city as the areas with the highest risk for the disease. These data show that health departments must prioritize politico-administrative policies to minimize the effects of social inequality and improve the standards of living, hygiene, and education of the population in order to reduce the incidence of leprosy.

This article estimates the impact of mortality from external causes on the human development index (HDI) along the Brazilian borderland from 2000 to 2005. Data obtained from Brazilian government agencies were combined using the methodology defined by the United Nations Development Program, revealing the HDI according to actual conditions. Subsequently, deaths from external causes were excluded in order to estimate their impact on the index, recalculating life expectancy using the technique of competing causes. HDI showed a gradual increase from North to South, with the most developed regions concentrated in the South, consistent with studies using other sets of economic indicators. By excluding mortality from external causes, the highest gains appeared in regions where the HDI (under actual conditions) were lower, and the magnitude of gains declined towards the South.

Objective: To investigate the usefulness of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) that were developed in English and translated to Brazilian Portuguese in patients with four distinct clinical conditions that can be accompanied by dyspnea., Methods: We translated, from English to Brazilian Portuguese, a list of 15 dyspnea descriptors reported in a study conducted in the USA. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated., Results: The use of this set of descriptors led to a solution with nine clusters, designated expiração (exhalation), fome de ar (air hunger), sufoco (suffocating), superficial (shallow), rápido (rapid), aperto (tight), falta de ar (shortness of breath), trabalho (work), and inspiração (inhalation). Overlapping of the descriptors was quite common among the patients, regardless of their clinical condition. Asthma, COPD, and heart failure were significantly associated with the inspiração cluster. Heart failure was also associated with the trabalho cluster, whereas obesity was not associated with any of the clusters., Conclusions: In our study sample, the application of dyspnea descriptors translated from English to Portuguese led to the identification of distinct clusters, some of which were similar to those identified in a study conducted in the USA. The translated descriptors were less useful than were those developed in Brazil regarding their ability to generate significant associations among the clinical conditions investigated here.

Objective: To develop a set of descriptive terms applied to the sensation of dyspnea (dyspnea descriptors) for use in Brazil and to investigate the usefulness of these descriptors in four distinct clinical conditions that can be accompanied by dyspnea., Methods: We collected 111 dyspnea descriptors from 67 patients and 10 health professionals. These descriptors were analyzed and reduced to 15 based on their frequency of use, similarity of meaning, and potential pathophysiological value. Those 15 descriptors were applied in 50 asthma patients, 50 COPD patients, 30 patients with heart failure, and 50 patients with class II or III obesity. The three best descriptors, as selected by the patients, were studied by cluster analysis. Potential associations between the identified clusters and the four clinical conditions were also investigated., Results: The use of this set of descriptors led to a solution with seven clusters, designated sufoco (suffocating), aperto (tight), rápido (rapid), fadiga (fatigue), abafado (stuffy), trabalho/inspiração (work/inhalation), and falta de ar (shortness of breath). Overlapping of descriptors was quite common among the patients, regardless of their clinical condition. Asthma was significantly associated with the sufoco and trabalho/inspiração clusters, whereas COPD and heart failure were associated with the sufoco, trabalho/inspiração, and falta de ar clusters. Obesity was associated only with the falta de ar cluster., Conclusions: In Brazil, patients who are accustomed to perceiving dyspnea employ various descriptors in order to describe the symptom, and these descriptors can be grouped into similar clusters. In our study sample, such clusters showed no usefulness in differentiating among the four clinical conditions evaluated.

This study aimed to evaluate the completeness of data on nine items included in both the certificate of live birth (CLB) and death certificate (DC), as well as the retrieval of data on early neonatal deaths. The study assessed live birth and early neonatal and fetal death records in municipalities in the Ribeirão Preto Region, São Paulo State, Brazil, from 2000 to 2007. Database matching for live births and deaths allowed retrieving data on early neonatal deaths. Data completion was good on the CLB and poor on the DC. Retrieval of data related to mortality was satisfactory, except for maternal schooling, number of live born children, and stillbirths. The findings highlight the need to improve completion of the DC and showed that the retrieval process improved the completeness of data from the database on early neonatal deaths. The use of reports on local investigation of deaths is recommended as a strategy to make mortality databases more complete.

Aims: The protein alpha1-microglobulin (alpha1-microg) is filtered by the glomeruli and fully reabsorbed by the proximal tubules, and tubulointerstitial injury compromises its reabsorption. The aim of this study was to determine which functional, morphological and inflammatory renal disorders associated with tubulointerstitial damage interfere with urinary excretion of alpha1-microg in patients with glomerulopathies., Patients and Methods: 38 patients (33.6 +/- 11.3 years) with primary or secondary glomerulopathies diagnosed by renal biopsies were studied. The urinary fractional excretion of alpha1-microg (FEalpha1-microg), the urinary monocyte chemoattractant protein-1/urinary creatinine (UMCP-1) index and 24-h proteinuria were determined. In the cortex of renal biopsies, the number of macrophages/104 microm2 of glomerular tuft (GT) and tubulointerstitial (TI) areas, the relative interstitial area (RCIA), and the relative interstitial fibrosis area (CIF) were measured. Results are reported as median and range and the Spearman non-parametric test was used to determine the correlations., Results: FEalpha1-microg was 0.165% (0.008% - 14,790.0%) in patients with glomerulopathies and 0.065% (0.010% - 0.150%) in the control group (p < 0.05; Mann-Whitney U-Test). FEalpha1-microg was correlated with creatinine clearance (r = -0.4396; p = 0.0358), UMCP-1 index (r = 0.5978; p < 0.0001), number of macrophages/TI area (r = 0.5634; p = 0.0034) and RCIA (r = 0.7436; p < 0.0001). However, FEa1-microg was not correlated with proteinuria (r = 0.1465; p = 0.5153) or with CIF (r = 0.0039; p = 0.98)., Conclusions: renal MCP-1 and the expansion and number of macrophages of the tubulointerstitial area participate in the increase of urinary excretion of alpha1-microg in patients with glomerulopathies. Although proteinuria and interstitial fibrosis have not been associated with this effect, the present study does not exclude some of these disorders in the pathophysiology of urinary excretion of alpha1-microg.

Objective: To assess the temporal and spatial evolution of the leprosy endemy in the state of São Paulo, Southeastern Brazil., Methods: This is an ecological-social study that used the number of leprosy cases reported to the Brazilian Ministry of Health from January 2004 to December 2006. Monthly series were generated in each regional health department, and their sequences were adjusted by a Markovian model for the leprosy detection coefficients. The detection coefficient with the number of cases accumulated in the period in each municipality was used to produce the spatial distribution of the endemy; a correlation analysis was carried out with the leprosy detection coefficients and the components of the Social Responsibility Index of the state of São Paulo., Results: Of the 645 municipalities of the state of São Paulo, 22 did not detect leprosy cases in the period. In the majority of regions, the endemy showed a decreasing trend; the time series presented random fluctuation around expected values. The decline was influenced by a generalized decrease in the detection coefficients at the end of 2005. There was a positive correlation between the detection coefficients and the components "schooling" and "longevity", of the Social Responsibility Index of the state of São Paulo, and a negative correlation with "wealth", another component of the same Index., Conclusions: The result of the time series analysis suggests that the endemy is on the decline in the majority of regions of the state of São Paulo, while the spatial analysis shows that the coefficients are high in the northern part of the state.

Background: Magnesium (Mg) use has the potential to promote bronchodilatation and to improve lung function in obstructive diseases. IV administration of Mg during exacerbations of chronic obstructive pulmonary disease (COPD) has led to improved peak flow. This study aimed to investigate the effects of acute IV Mg loading on respiratory parameters of stable COPD patients., Material/methods: This was a randomized, double-blind, placebo-controlled crossover study. Twenty-two male COPD patients (64+/-6 years old, FEV1: 49+/-20%) received an IV infusion of 2 g of magnesium sulfate or placebo on two distinct occasions. Spirometry and mouth maximal respiratory pressures were obtained before and 45 minutes after the infusions., Results: Mg use led to significant changes in functional respiratory capacity (-0.48 l, 95%CI: -0.96, -0.01), inspiratory capacity (0.21 l, 95%CI: 0.04, 0.37), maximal inspiratory pressure (10 cmH2O, 95%CI: 1.6, 18.4), and maximal expiratory capacity (10.7 cmH2O, 95%CI: 0.20, 21.2). The treatment was also associated with a marginally significant decrease in residual volume (-0.47 L, 95%CI: -0.96, 0.02, p=0.06)., Conclusions: Acute IV Mg loading in stable COPD patients was associated with a reduction in lung hyperinflation and improvement of respiratory muscle strength. The clinical potential for chronic magnesium supplementation in COPD deserves further investigation.

Objective: This study assessed the effect of the Er:YAG laser on enamel adjacent to restorations submitted to cariogenic challenge in situ, by microhardness analysis., Background Data: The influence of Er:YAG laser energy on secondary caries formation has been investigated in vitro. However, no research involving demineralization around cavities prepared with the Er:YAG laser under intra-oral conditions has yet been described., Materials and Methods: Slabs of enamel were randomly assigned to seven groups (n = 12), according to the cavity preparation technique: groups I, II, and III--Er:YAG laser, 250 mJ, at 2, 3, and 4 Hz, respectively; groups IV, V, and VI--350 mJ, at 2, 3, and 4 Hz, respectively; group VII--high-speed handpiece (control). Cavities were restored and the specimens were fixed in intra-oral appliances and worn by 12 volunteers for 14 d. Sucrose solution was applied to each slab 6 times/d. Samples were removed, sectioned, and examined for microhardness at 100, 200, and 300 microm (factor distance), and 30, 60, and 90 microm (factor depth), from the restoration and enamel surface, respectively., Results: Analysis of variance according to a split-plot model showed no difference among the cavity preparation techniques, among distances, or among depths, as well as no difference in the interaction between the factors of cavity preparation and distance. A significant difference was found in the interaction of cavity preparation and depth (p < 0.0001), as identified by contrast technique., Conclusion: The results revealed that the Er:YAG laser did not differ from conventional cavity preparation with regard to enamel microhardness.

Unlabelled: Dizziness is a symptom that affects the population world over, being more prevalent in the elderly due to the process of functional deterioration of the hearing and vestibular systems with aging., Aim: The objective of this study was to evaluate prospectively the effect of Vestibular Rehabilitation (VR) as treatment for labyrinth disease of vascular and metabolic origin in the quality of life of geriatric patients., Methods: The study was outlined as clinical-prospective, longitudinal, and observed, with the participation of 40 elder citizens of both genders, divided in 2 groups, dizziness of vascular or metabolic origin. The patients were evaluated and underwent VR - based on Cawthorne and Cooksey's protocol. The statistical analysis from the data was done through the t-Student test, the coefficients of Pearson and Spearman., Results: based on quality of life scales showed that the individuals treated and assessed improved after Vestibular Rehabilitation., Conclusion: we concluded that VR, based on the protocols of Cawthorne and Cooksey, could be beneficial to this population.

Objective: This study examines perceptions, and knowledge of how to promote oral healthcare among people caring for children with HIV/AIDS., Methods: A questionnaire was completed by people caring for children with HIV/AIDS, encompassing the quality of life (WHOQoL-bref); the socioeconomic stratification (BECC); and aspects related to oral health through the perception, care and promotion of oral health. Internal consistency was evaluated for the WHOQoL-bref domains, for the BECC questions and for the oral health questions. Cluster analysis was performed by WHOQoL-bref domain scores., Results: The alpha-Crombach statistics showed that the internal consistency quality progressed: 0.9101, 0.8027, and 0.6355, respectively, for WHOQoL-bref domains, for the ECC questions, and for the oral health questions. The cluster analysis generated two homogenous groups. There were descriptive relations between the quality of life scores and the BECC strata and the answers given for the oral health related themes; difficulties were reported in accessing dental care., Conclusions: The methodology and tools deployed by this survey showed consistency and coherence to the theoretical framework, contributing to the development of better healthcare for HIV+ children.

Purpose: This study investigated the correlations obtained by using the Egen Klassifikation (EK) and Barthel Index (BI) functional scales and respiratory function parameters in patients with Duchenne muscular dystrophy., Methods: Spirometry, maximal respiratory pressures, and arterial blood gases were analyzed and graded according to the EK and BI scales in 26 patients. They were classified as high or low risk for introduction of noninvasive ventilation according to the respiratory function., Results: The EK and BI scales significantly correlated with forced vital capacity, forced expiratory volume in 1 second, and maximal respiratory pressures. The worse the functional performance, the worse the respiratory measurements. The degree of correlation between the functional scales and each respiratory parameter was similar. An EK of 21 or higher predicted high risk for the introduction of noninvasive ventilation., Conclusions: EK and BI scales similarly correlated with the degree of respiratory involvement in Duchenne muscular dystrophy. The EK scale was superior in detecting subjects with a higher risk for introduction of noninvasive ventilation.

The objective of the present study was to investigate whether creatine (Cr) could attenuate the deleterious effects of high doses of dexamethasone (Dexa) on body mass, exercise performance, and respiratory variables of rodents. Forty-four Wistar rats performed incremental maximal exercise tests. They were then assigned to four groups: G1: subcutaneous (s.c.) and intraperitoneal (i.p.) saline; G2: s.c. saline and i.p. Cr (250 mg x kg(-1) x day(-1)); G3: s.c. Dexa (7.5 mg x kg(-1) x day(-1)) and i.p. saline; G4: s.c. Dexa and i.p. Cr. New exercise tests and analysis of the respiratory pattern under resting conditions and after stimulation with doxapram (2 mg/kg i.p.) were performed after 18 days. Post- minus pretreatment differences were compared between groups. G3 and G4 showed a significant impairment in body mass gain compared with G1 and G2 (P < 0.05) (G1: 65.3 +/- 26.1, G2: 93.1 +/- 27.4, G3: -18.4 +/- 20.1, G4: 9.8 +/- 23.1 kg x 10(-3)). Similar results were observed for maximal oxygen consumption (G1: 9.5 +/- 8.5, G2: 25.8 +/- 14.5, G3: -25.5 +/- 6.0, G4: -4.8 +/- 9.5 ml x kg(-1) x min(-1)) and test duration (G1: 43.0 +/- 45.0, G2: 72.0 +/- 59.5, G3: -165.0 +/- 60.6, G4: -48.0 +/- 48.5 s). Simultaneous use of Cr significantly attenuated the Dexa-induced impairment of the last two variables. Cr attenuated Dexa-induced gastrocnemius and diaphragm muscle weight losses and the atrophy of gastrocnemius type IIb fibers. Cr supplementation had only small effects on Dexa-induced respiratory changes. These results suggest that Cr may play a role in the prophylaxis or treatment of steroid-induced myopathy.

Background/aims: The urinary concentration of the monocyte chemoattractant protein-1 (uMCP-1) chemokine is increased in several proteinuric and/or inflammatory renal diseases. In the present study, we evaluated the association between uMCP-1 and renal function, proteinuria, glomerular and interstitial macrophage infiltration, and renal fibrosis in patients with primary and secondary glomerulopathies diagnosed by renal biopsy., Methods: Thirty-seven patients aged 32.6 +/- 7.7 years were studied. uMCP-1 was determined by ELISA. Renal macrophage expression (CD68 positive cells) is reported as number of macrophages/10(4) microm2 of the cortical tubulointerstitial (TI) area or of glomerular capillary tuft area. Cortical interstitial fibrosis was quantitated by PicroSirius red staining under polarized light by a computerized manner., Results: The uMCP-1 ratio (pg/ml/urinary creatinine mg/ml) was positively correlated (Spearman coefficient) with proteinuria (r = 0.4629; p < 0.005) and number of macrophages in the cortical TI area (r = 0.64; p = 0.0005), and negatively correlated with creatinine clearance (r = -0.4877; p < 0.001). The uMCP-1 ratio was not significantly correlated with number of macrophages/glomerular capillary tuft area (r = 0.27; p = 0.19) or with percent cortical interstitial fibrosis (r = 0.08; p = 0.62)., Conclusions: The uMCP-1 excretion is a biomarker of the inflammatory activity of the TI area, and does not reflect chronic interstitial damage., (2007 S. Karger AG, Basel)

The incidence of AIDS was described by an ecological study of Brazilian municipalities, considering cases reported from 1991 to 2000. An increasing incidence was observed in women and among individuals with a low educational level. São Paulo State had different epidemiological profiles when the State Capital was compared to other cities, with an overall 46% of reported cases in the Country; Pernambuco State had almost the same profile since the beginning of the epidemic in Brazil; In Santa Catarina State the category of intravenous drug users had the greatest exposure. The increasing number of cases reported under the category of unknown transmission showed the increased bias in measurement by the surveillance system.

Purpose: To evaluate dye penetration in adhesively bonded cervical amalgam restorations., Materials and Methods: The specimens were randomly divided into four groups and the adhesives Prime & Bond 2.1, Prime & Bond 2.1 Dual Cure, Scotchbond Multi Purpose Plus and Amalgambond Plus were tested. After being restored and polished, the teeth were thermocycled 1,000 times at temperatures varying between 5 degrees C +/- 2 degrees C and 55 degrees C +/- 2 degrees C. Statistical analysis was carried out using the Kruskal-Wallis test and multiple comparisons., Results: Scotchbond Multi-Purpose Plus demonstrated lower levels of microleakage in enamel and dentin. The dual adhesives were more effective than the "one bottle" adhesive.

This in situ study evaluated the microhardness of sound and demineralized enamel and dentin submitted to treatment with 10% carbamide peroxide for three weeks. A 10% carbamide peroxide bleaching agent--Opalescence/Ultradent (OPA)--was evaluated against a placebo agent (PLA). Two hundred and forty dental fragments--60 sound enamel fragments (SE), 60 demineralized enamel fragments (DE), 60 sound dentin fragments (SD) and 60 demineralized dentin fragments (DD)--were randomly fixed on the vestibular surface of the first superior molars and second superior premolars of 30 volunteers. The volunteers were divided into two groups that received bleaching or the placebo agent at different sequences and periods at a double blind 2 x 2 crossover study with a wash-out period of two weeks. Microhardness tests were performed on the enamel and dentin surface. The SE and DE submitted to treatment with OPA showed lower microhardness values than the SE and DE submitted to treatment with PLA. There were no statistical differences in microhardness values for SD and DD submitted to the treatment with OPA and PLA. The results suggest that treatment with 10% carbamide peroxide bleaching material for three weeks alters the enamel microhardness, although it does not seem to alter the dentin microhardness.

This study evaluated the surface roughness pattern of resin-based restorative materials during brushing preceded by a regimen that simulated a dynamic pH-cycling. Restoratives included two resin composites (Renamel Microfill and Charisma), two polyacid-modified composite resins (Compoglass-F and Dyract AP) and one resin-modified glass ionomer cement (Fuji II LC Improved). Twenty standardized cylindrical specimens of each material were prepared according to a randomized complete block design. After finishing and polishing, the average surface roughness (Ra) and profile-length ratio (LR) of the specimens were determined. The experimental units were subjected to a pH-cycling regimen, and then to 10,000 brushing strokes. New readings of both the Ra and LR parameters were obtained. The same protocol of pH-cycling, brushing simulation and surface roughness measurements were repeated 10 times. Data was analyzed using ANOVA according to split-plot design and Tukey's test. Results showed the pH-cycling followed by 10,000 brushing strokes provided a remarkable increase in Ra for all restorative materials except for Renamel. Throughout the brushing simulation, Renamel, Charisma, Compoglass-F and Dyract AP showed steady textures, whereas Fuji II LC Improved exhibited a progressive increase in surface roughness. Among the materials tested, Renamel presented the smoothest surface, followed by Charisma and Compoglass-F, which did not differ from each other except at the baseline. Dyract AP was different from both these materials except at the baseline. Fuji II LC Improved had the roughest surface texture.

This study visually compared the radiopacity of seven restorative materials (3 resin-modified glass-ionomer cements, 3 polyacid-modified composite resins, and 1 conventional glass-ionomer cement) to a sound tooth structure sample, and an aluminium stepwedge. All hybrid materials were more radiopaque, except for one resin-modified glass-ionomer cement, than both the tooth structure and conventional glass-ionomer cement.

The purpose of this in vitro study was to evaluate the dye penetration around amalgam restorations in dentin cavities by a quantitative test. Standardized circular cavities were prepared on the facial surface of 75 extracted human single-rooted teeth, and restored with dental amalgam. Different bonding/sealing treatments were used on the cavity walls before the restorations were placed. The specimens were thermo-cycled between 5 +/- 2 degrees C and 55 +/- 2 degrees C for 500 cycles with 1-minute dwell times, followed by immersion in a 2% methylene blue solution for 12 hours at 37 degrees C. The quantitative microleakage was evaluated by spectrophotometry and was expressed by microgram dye per tooth structure. The results showed that the use of bonded amalgam restorations was more effective in reducing microleakage.

Objective: The purpose of this study was to evaluate the effectiveness of various surface treatments for resin-modified glass-ionomer restorative materials by determining dye uptake spectrophotometrically., Method and Materials: Two hundred twenty-four specimens, 4.1 mm in diameter and 2.0 mm thick, were made of 3 materials: Vitremer, Fuji II LC, and Photac-Fil Aplicap. Specimens were divided into 15 groups. The positive and negative control specimens remained unprotected, while the experimental specimens were protected with Heliobond light-activated bonding resin, Colorama nail varnish, or surface coatings indicated by the manufacturers of the glass-ionomer materials: Finishing Gloss for Vitremer, Fuji Varnish for Fuji II LC, and Ketac Glaze for Photac-Fil. The disks were immersed in 0.05% methylene blue for 24 hours except for the negative control group, which was immersed in deionized water. After 24 hours, the disks were removed, washed, and individually placed in 1 mL of 65% nitric acid for 24 hours. The solutions were centrifuged and the spectrophotometric absorbance was determined at 606 nm. The dye uptake was expressed in micrograms of dye per milliliter, and the results were analyzed with the Kruskal-Wallis test., Results: There were no differences in dye uptake among the 3 resin-modified glass-ionomer restorative materials; however, all of them required surface protection., Conclusion: The best surface protection for the 3 evaluated materials was obtained with Heliobond light-activated bonding resin.

The purpose of this study was to evaluate the microleakage of six glass-ionomer composite resin hybrid materials compared with a glass-ionomer cement and a composite resin. Standardized class 5 dentin cavities were prepared on root surfaces of 240 extracted human teeth that were randomly assigned to eight groups and restored using the following restorative systems: (I) Vitremer, (II) Compoglass, (III) Photac-Fil Aplicap, (IV) Variglass, (V) Dyract, (VI) Fuji II LC, (VII) Ketac-Fil Aplicap, and (VIII) Z100. The teeth were thermocycled, placed in a 2% methylene blue solution, and sectioned with diamond disks. Dye penetration was scored on a scale of 0-3. Results showed no significant differences among groups VIII, IV, I, V, VI, III, and II. There were also no significant differences among groups VI, III, II, and VII.

Objective: This study was intended to quantify the marginal leakage of three glass-ionomer-resin composite hybrid materials and compare it with the leakage exhibited by a glass-ionomer cement and a bonded resin composite system., Method and Materials: Standardized Class V cavities were prepared on root surfaces of 105 extracted human teeth, randomly assigned to five groups of 21 each, and restored with either Ketac-Fil Aplicap, Z100/Scotchbond Multi-Purpose Plus, Vitremer, Photac-Fil Aplicap, or Dyract. The teeth were thermally stressed for 500 cycles and stained with methylene blue. The microleakage was quantified spectrophotometrically, and the data were statistically analyzed with Friedman's test., Results: There were no significant differences in microleakage among the five groups. Restorations of all tested materials showed some marginal leakage in Class V cavities., Conclusion: The microleakage performance of glass-ionomer-resin composite hybrid materials was similar to those of a conventional glass-ionomer and a bonded resin composite system.