RESUMEN
Introducción: El edentulismo parcial es una condición final a la presencia de caries dental relacionado con diversos factores sociales, demográficos y culturales. Actualmente, existen escasos estudios que valoren el estado de edentulismo parcial y su asociación con el nivel socioeconómico-cultural. Objetivo: Determinar la frecuencia del tipo de edentulismo parcial bimaxilar según la Clase de Kennedy y su posible asociación con el nivel socioeconómico-cultural en los pacientes de la clínica de la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos del año 2016. Material y Métodos: Estudio descriptivo, observacional y transversal. La muestra estuvo conformada por 100 pacientes adultos edéntulos parciales seleccionados aleatoriamente que fueron evaluados mediante una encuesta y un examen clínico oral. La encuesta estuvo conformada por los datos sobre el nivel socioeconómico-cultural. El examen clínico se evaluó con un odontograma para determinar el tipo de edentulismo según la clasificación de Kennedy. Resultados: El tipo de edentulismo parcial más frecuente fue la Clase III de Kennedy en la arcada maxilar (50 por ciento) y en la mandibular (49 por ciento), los portadores pertenecían en gran medida al nivel socioeconómico-cultural medio (83 por ciento). No se evidenció una asociación estadísticamente significativa entre el nivel socioeconómico-cultural y el tipo de edentulismo parcial según la Clase de Kennedy en ambas arcadas dentarias. Conclusiones: En la población estudiada existe una mayor frecuencia de edentulismo parcial bimaxilar Clase III de Kennedy y una preponderancia del nivel socioeconómico-cultural medio. Sin embargo, no existe asociación entre el tipo de edentulismo parcial según la Clase de Kennedy y el nivel socioeconómico-cultural(AU)
Introduction: Partial edentulism is a final condition to the presence of dental caries related to various social, demographic and cultural factors. Currently, there are few studies that assess the state of partial edentulism and its association with the socioeconomic cultural level. Objective: To determine the frequency of the type of bimaxillary partial edentulism according to Kennedy´s Class and its possible association with the socioeconomic cultural level in patients treated in the clinic of the Faculty of Dentistry of the National University of San Marcos in 2016. Material and methods: A descriptive, observational and cross-sectional study was conducted. The sample consisted of 100 randomly selected partial edentulous adult patients who were evaluated by means of a survey and an oral clinical examination. The survey was made up of the data that relate socioeconomic cultural level. The clinical examination was evaluated with an odontogram to determine the type of edentulism according to Kennedy´s classification. Results: The most frequent type of partial edentulism was Kennedy's Class III in the maxillary arch (50 percent) and in the mandible (49 percent), which was mainly present in patients that belonged to the average socioeconomic cultural level (83 percent). There was no statistically significant association between the socioeconomic cultural level and the type of partial edentulism according to Kennedy´s Class in both dental arches. Conclusions: In the studied population, there is a greater frequency of partial bimaxilar edentulism according to Kennedy's Class III and a preponderance of the socioeconomic cultural level. However, there is no association between the type of partial edentulism according to Kennedy´s Class and the socioeconomic cultural level(AU)
Asunto(s)
Humanos , Masculino , Femenino , Arcada Parcialmente Edéntula/etiología , Arcada Parcialmente Edéntula/psicología , Arcada Parcialmente Edéntula/epidemiología , Clase Social , Epidemiología Descriptiva , Estudios Transversales , Estudio ObservacionalAsunto(s)
Atrofia Bulboespinal Ligada al X/genética , Receptores Androgénicos/genética , Expansión de Repetición de Trinucleótido/genética , Atrofia Bulboespinal Ligada al X/fisiopatología , Exones/genética , Hormonas/metabolismo , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana EdadRESUMEN
We report the case of a 54-year-old right-handed man who presented with a 2-year history of progressive upper-limb weakness with mild dysarthria and prominent involuntary perioral abnormal movements that were characterized as fasciculations. Electromyography disclosed motor neuron disease. The diagnosis of Kennedy's disease was established by polymerase chain reaction. Perioral abnormal movements and fasciculations may represent important clinical clues to the diagnosis of Kennedy's disease, particularly when associated with proximal muscle atrophy and gynecomastia. In suspected cases, genetic testing for elevated CAG repeats in the androgen receptor Xq12 gene is warranted.
Asunto(s)
Atrofia Bulboespinal Ligada al X/genética , Fasciculación/genética , Atrofia Muscular/genética , Atrofia Bulboespinal Ligada al X/complicaciones , Atrofia Bulboespinal Ligada al X/diagnóstico , Electromiografía/métodos , Fasciculación/diagnóstico , Fasciculación/etiología , Pruebas Genéticas , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa/métodosRESUMEN
ABSTRACT The X-linked spinal and bulbar muscular atrophy (Kennedy's disease) is a rare X-linked, recessive, lower motor neuron disease, characterized by weakness, atrophy, and fasciculations of the appendicular and bulbar muscle. The disease is caused by an expansion of the CAG repetition in the androgen receptor gene. Patients with Kennedy's disease have more than 39 CAG repetitions. We report a case of 57-year-old man, resident of Monte Dourado (PA, Brazil) who complained of brachiocrural paresis evolving for 3 years along with fasciculations and tremors of extremities. In addition, he also developed dysarthria, dysphagia, and sexual dysfunction. The patient clinical picture included gait impairment, global hyporeflexia, proximal muscle atrophy of upper limbs, deviation of the uvula to right during phonation and tongue atrophy with fasciculations. The patient reported that about 30 years ago he had undergone gynecomastia surgery. His electroneuromyography suggested spinal muscular atrophy, and nuclear magnetic resonance imaging showed tapering of the cervical and thoracic spinal cord. Patient's creatine kinase level was elevated. In view of the findings, an exam was requested to investigate Kennedy's disease. The exam identified 46 CAG repetitions in the androgen receptor gene, which confirmed the diagnostic suspicion. This was the first case of Kennedy's disease diagnosed and described in the Brazilian Amazon. To our knowledge only other four papers were published on this disease in Brazilian patients. A brief review is also provided on etiopathogenic, clinical and diagnostic aspects.
RESUMO A atrofia muscular bulboespinhal ligada ao cromossomo X (doença de Kennedy) é uma rara doença de neurônio motor inferior, recessiva, ligada ao X, e caracterizada por fraqueza, atrofia e fasciculações da musculatura apendicular e bulbar. É causada por uma expansão da repetição CAG no gene do receptor de androgênio. Pacientes com doença de Kennedy apresentam mais de 39 repetições CAG. O paciente deste relato era do sexo masculino, 57 anos, morador de Monte Dourado (PA, Brasil), com queixa de paresia braquiocrural há 3 anos, acompanhada de fasciculações e tremores de extremidades. Em seguida, ele desenvolveu disartria, disfagia e disfunção sexual. Também apresentava comprometimento da marcha, hiporreflexia global, atrofia muscular proximal dos membros superiores, desvio da úvula para direita à fonação e atrofia de língua com fasciculações. Foi realizada cirurgia para tratamento de ginecomastia há 30 anos. A eletroneuromiografia sugeriu quadro de atrofia muscular espinhal. Imagens de ressonância magnética demonstraram afilamento da medula espinhal cervical e torácica. A creatina quinase estava elevada. Diante dos achados, solicitou-se investigação para doença de Kennedy, e foram identificadas 46 repetições CAG no gene do receptor de androgênio, o que confirmou a suspeita diagnóstica. Este foi o primeiro caso de doença de Kennedy diagnosticado e descrito na Amazônia brasileira. Existem, além deste relato, apenas outros quatro trabalhos publicados sobre a doença em pacientes do Brasil. Também realizamos breve revisão de aspectos etiopatogênicos, clínicos e diagnósticos.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Atrofia Bulboespinal Ligada al X/diagnóstico , Brasil/epidemiología , Familia , Bosques , Atrofia Bulboespinal Ligada al X/genética , Atrofia Bulboespinal Ligada al X/epidemiología , Enfermedades AsintomáticasRESUMEN
RESUMEN: La irrupción de los implantes óseo integrados y su posterior validación, a comienzos de los años '80, aportó sin duda un utilísimo recurso en la rehabilitación oral. Lamentablemente, en gran medida debido a los costes económicos involucrados, a pesar de alentadores augurios, no han devenido en una alternativa terapéutica concreta para la gran mayoría de los pacientes desdentados. El edentulismo parcial de maxilas, clases Kennedy I y II, con remanencia de todos o parte de los dientes del sextante 2, en su mayoría casos de sustancial complejidad, léase clases III del Índice Diagnóstico Prostodóntico, genera un desafío protésico a solventar en relación a la retención y satisfacción estética de los pacientes. Presentamos en este reporte dos de estos casos, rehabilitados mediante prótesis metálicas "convencionales", en los cuales creemos logramos conjugar acertadamente ambas variables, combinando complejos retentivos RMC y facetas retentivas friccionales.
ABSTRACT The emergence of osseointegrated implants and their further validation, at the beginning of the 80's, contributed undoubtedly to oral rehabilitation as a very useful resource. Unfortunately, mainly because of the economic costs involved and despite an encouraging initial augury, they have not become in a specific therapeutic alternative for the vast majority of edentulous patients. Partial edentulism of maxillae, Kennedy's class I, & II, with all or a few teeth remaining at the sextant 2, mostly class III PDI, substantially compromised denture-supporting anatomy, generate a prosthetic challenge to overcome regarding retention and aesthetic satisfaction of these patients. In this report, we display two of them, which we believe have been successfully managed in order to fulfill both variables, by means of "conventional" removable metallic prostheses combining MGR's clasps and frictional retentive facets.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Arcada Parcialmente Edéntula/rehabilitación , Dentadura Parcial Removible , Arcada Parcialmente Edéntula/diagnósticoRESUMEN
INTRODUCTION: The use of removable partial denture (RPD) is considered as low-cost and common treatment option to rehabilitate edentulous areas. AIM: This study aimed to investigate the epidemiological data of patients rehabilitated with removable partial denture (RPD) in order to assess treatment survival rate and failures. MATERIALS AND METHODS: Epidemiological data and medical records of patients treated with RPD between 2007 and 2012 at the RPD discipline of a Brazilian University (Aracatuba Dental School- UNESP) were evaluated as well as dental records of patients who underwent RPD treatments (fabrication or repairs) between 2000 and 2010. Factors such as gender, age, presence of systemic disease, main complaint, edentulous arch, period and cause of denture replacement and the prosthesis characteristics were recorded. The chi-square test was used to assess the differences between the variables and the Kaplan Meyer to assess the survival of the RPDs evaluated. RESULTS: A total of 324 maxillary RPD and 432 mandibular RPD were fabricated. Most of the patients were women aging 41 to 60-year-old. The number of mandibular RPD Kennedy class I (26%) was statistically higher for the maxillary arch (p<.05). There was no association between main complaint to gender or the presence of systemic disease. The lingual plate was the most common major connector used in the mandible (32%). The main reason for altering the design of replaced RPDs were changes during treatment plan. CONCLUSION: The number of patients who require RPD is large; most of RPDs are Kennedy Class I. A good treatment plan is very important for achieving a positive treatment outcome, and it is strictly related to the survival rate.
RESUMEN
PURPOSE: This study investigated the number and Kennedy Classification of the edentulous arches in patients treated at the Removable Partial Denture (RPD) Clinics of the Fluminense Federal University School of Dentistry (FO-UFF) in Rio de Janeiro, Brazil, from 2005 to 2010. MATERIALS AND METHODS: A cross-sectional retrospective survey was conducted on patient record charts to identify gender, age, number, and location of the edentulous arches, and Kennedy Class type. RESULTS: One hundred and forty-six patients were analyzed for this study (96 [65.8%] women and 50 [34.2%] men). Two hundred and ninety-two arches were analyzed: 74 arches (25%) were found with intact dentitions, 18 (6.1%) were edentulous arches, and 200 (68.8%) were partially edentulous arches. Ninety-one patients (62.3%) needed oral rehabilitation with RPDs on one arch and 55 (37.7%) in both arches. One hundred and eight (53.2%) partially edentulous mandibles and 92 (46.8%) partially edentulous maxillae were found. Kennedy Class I was more frequent in the mandibular arch (58 patients; 29%) whereas Kennedy Class III was more frequent in the maxillary arch (40 patients; 20%). Patients aged between 51 and 60 years presented the highest percentage of partially edentulous arches (33.6%). CONCLUSION: Mandibular Kennedy Class I and maxillary Kennedy Class III presented the highest frequency in patients treated at the FO-UFF. These results are in agreement with previous studies that evaluated the different Kennedy classes in partially edentulous arches.
Asunto(s)
Arco Dental/patología , Implantación Dental , Dentadura Parcial Removible/estadística & datos numéricos , Arcada Parcialmente Edéntula/epidemiología , Mandíbula/patología , Maxilar/patología , Prostodoncia , Adulto , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Arco Dental/cirugía , Femenino , Hospitales Universitarios , Humanos , Arcada Parcialmente Edéntula/cirugía , Masculino , Mandíbula/cirugía , Maxilar/cirugía , Persona de Mediana Edad , Estudios Retrospectivos , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: Candida remains an important cause of late-onset infection in preterm infants. Mortality and neurodevelopmental outcome of extremely low birth weight (ELBW) infants enrolled in the Candida study were evaluated based on infection status. STUDY DESIGN: ELBW infants born at Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) centers between March 2004 and July 2007 who were screened for suspected sepsis were eligible for inclusion in the Candida study. Primary outcome data for neurodevelopmental impairment (NDI) or death were available for 1317 of the 1515 infants (87%) enrolled in the Candida study. The Bayley Scales of Infant Development-II or -III was administered at 18 months' adjusted age. A secondary comparison was performed with 864 infants enrolled in the NRN Generic Database during the same cohort who were never screened for sepsis and therefore not eligible for the Candida study. RESULTS: Among ELBW infants enrolled in the Candida study, 31% with Candida and 31% with late-onset non-Candida sepsis had NDI at 18 months. Infants with Candida sepsis and/or meningitis had an increased risk of death and were more likely to have the composite outcome of death and/or NDI compared with uninfected infants in adjusted analysis. Compared with infants in the NRN registry never screened for sepsis, overall risk for death were similar but those with Candida infection were more likely to have NDI (OR 1.83, 95% CI 1.01-3.33, P = .047). CONCLUSIONS: In this cohort of ELBW infants, those with infection and/or meningitis were at increased risk for death and/or NDI. This risk was highest among those with Candida sepsis and/or meningitis.
Asunto(s)
Candidiasis/complicaciones , Recien Nacido con Peso al Nacer Extremadamente Bajo/crecimiento & desarrollo , Candida , Candidiasis/mortalidad , Bases de Datos Factuales , Discapacidades del Desarrollo/diagnóstico , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro/crecimiento & desarrollo , Enfermedades del Prematuro , Masculino , Meningitis Fúngica/diagnóstico , Estudios Prospectivos , Factores de Riesgo , Sepsis/diagnóstico , Sepsis/microbiologíaRESUMEN
OBJECTIVE: To determine whether early hyperoxemia in neonates with severe perinatal acidemia is associated with the development of hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN: We identified 120 infants at ≥ 36 weeks gestational age with perinatal acidosis born at Parkland Hospital who qualified for a screening neurologic exam for cooling therapy. Based on a PaO2 measurement during the first hour of life, the cohort was divided into infants with hyperoxemia (PaO2 >100 mmHg) and those without hyperoxemia (PaO2 ≤ 100 mmHg). The rate of moderate-severe encephalopathy was compared between the groups using χ(2) analysis, as well as multiple logistic regression, taking into account baseline characteristics and confounding variables. RESULTS: Thirty-six infants (30%) had an initial PaO2 >100 mmHg. Infants with and without hyperoxemia had similar baseline maternal and infant characteristics. Infants with hyperoxemia had a higher incidence of HIE than those without hyperoxemia (58% vs 27%; P = .003). Admission hyperoxemia was associated with a higher risk of HIE (OR, 4; 95% CI, 1.4-10.5; adjusted P = .01). Among the neonates with moderate-severe HIE during the first 6 hours of life, those with hyperoxemia had a higher incidence of abnormal brain magnetic resonance imaging results, consistent with hypoxic ischemic injury, compared with those without hyperoxemia (79% vs 33%; P = .015). CONCLUSION: In neonates with perinatal acidemia, admission hyperoxemia is associated with a higher incidence of HIE. Among neonates with HIE, admission hyperoxemia is associated with abnormal brain magnetic resonance imaging findings. The judicious use of oxygen during and after resuscitation is warranted.
Asunto(s)
Asfixia/diagnóstico , Hipoxia-Isquemia Encefálica/diagnóstico , Adulto , Asfixia/complicaciones , Femenino , Humanos , Hipoxia/diagnóstico , Hipoxia-Isquemia Encefálica/complicaciones , Recién Nacido , Imagen por Resonancia Magnética , Edad Materna , Modelos Estadísticos , Tamizaje Neonatal/métodos , Oxígeno/metabolismo , Oxígeno/uso terapéutico , Análisis de Regresión , Resucitación , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To study tremor in patients with X-linked recessive spinobulbar muscular atrophy or Kennedy's disease. METHODS: Ten patients (from 7 families) with a genetic diagnosis of Kennedy's disease were screened for the presence of tremor using a standardized clinical protocol and followed up at a neurology outpatient clinic. All index patients were genotyped and showed an expanded allele in the androgen receptor gene. RESULTS: Mean patient age was 37.6 years and mean number of CAG repeats 47 (44-53). Tremor was present in 8 (80 percent) patients and was predominantly postural hand tremor. Alcohol responsiveness was detected in 7 (88 percent) patients with tremor, who all responded well to treatment with a β-blocker (propranolol). CONCLUSION: Tremor is a common feature in patients with Kennedy's disease and has characteristics similar to those of essential tremor.
Asunto(s)
Adulto , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Atrofia Bulboespinal Ligada al X/fisiopatología , Temblor/fisiopatología , Edad de Inicio , Antagonistas Adrenérgicos beta/administración & dosificación , Debilidad Muscular/fisiopatología , Propranolol/administración & dosificación , Temblor/tratamiento farmacológicoRESUMEN
The aim of this study was to show the anatomical alterations of the urethrovesical junction (UVJ) and proximal urethra (PU) carried out after Kelly-Kennedy type surgery. It was determined, by transvulvar ultrasonographic, of the UVJ and the PU the measures of the vertical and horizontal distances of the UVJ (DVUVJ and DHUVJ), pubourethral distance (DPU) and of the PU, in the pre-operative period and 30 days after the surgery for handling of patients with stress incontinence. It was concluded that the employed surgery promoted significant improvement of the degrees of stress incontinence, cure of cystocele and of retocele in all the patients. In relation to the lower board of the pubic simphisis, surgey moved the vertical position of UVJ, in the cranial direction, in the rest position, significantly, reducing its mobility in the effort. It also reduced DHUVJ, so much in rest as in effort. Furthermore, it promoted a reduction of PUD in the rest position, creating smaller mobility in effort, in statistically significant figures, as well as an increase in the length of PU, both in rest and the effort.
Este trabalho tem por objetivo mostrar as alterações anatômicas da junção uretrovesical (JUV) e da uretra proximal (UP) decorrentes da cirurgia do tipo Kelly-Kennedy. Foram determinadas por ultra-sonografia transvulvar da JUV e da UP as medidas da distância vertical e horizontal da JUV (DVJUV e DHJUV), distância pubouretral (DPU) e da UP, no período pré-operatório e 30 dias após a cirurgia para tratamento de pacientes com Incontinência Urinária de Esforço (IUE). Os autores concluíram que a cirurgia empregada promoveu melhora significativa dos graus de IUE, cura da cistocele e da retocele em todas as pacientes. Em relação ao bordo inferior da sínfise púbica, houve uma modificação da posição vertical da JUV, no sentido cranial, na situação de repouso, reduzindo significativamente sua mobilidade no esforço, ao passo que, na horizontal, observou-se uma redução da DHJUV, tanto no repouso quanto no esforço. Ainda ficou caracterizada uma redução da DPU na situação de repouso, ocasionando menor mobilidade ao esforço, em valores estatisticamente significantes, assim como um aumento no comprimento da UP, no repouso e no esforço.
RESUMEN
The aim of this study was to show the anatomical alterations of the urethrovesical junction (UVJ) and proximal urethra (PU) carried out after Kelly-Kennedy type surgery. It was determined, by transvulvar ultrasonographic, of the UVJ and the PU the measures of the vertical and horizontal distances of the UVJ (DVUVJ and DHUVJ), pubourethral distance (DPU) and of the PU, in the pre-operative period and 30 days after the surgery for handling of patients with stress incontinence. It was concluded that the employed surgery promoted significant improvement of the degrees of stress incontinence, cure of cystocele and of retocele in all the patients. In relation to the lower board of the pubic simphisis, surgey moved the vertical position of UVJ, in the cranial direction, in the rest position, significantly, reducing its mobility in the effort. It also reduced DHUVJ, so much in rest as in effort. Furthermore, it promoted a reduction of PUD in the rest position, creating smaller mobility in effort, in statistically significant figures, as well as an increase in the length of PU, both in rest and the effort.
Este trabalho tem por objetivo mostrar as alterações anatômicas da junção uretrovesical (JUV) e da uretra proximal (UP) decorrentes da cirurgia do tipo Kelly-Kennedy. Foram determinadas por ultra-sonografia transvulvar da JUV e da UP as medidas da distância vertical e horizontal da JUV (DVJUV e DHJUV), distância pubouretral (DPU) e da UP, no período pré-operatório e 30 dias após a cirurgia para tratamento de pacientes com Incontinência Urinária de Esforço (IUE). Os autores concluíram que a cirurgia empregada promoveu melhora significativa dos graus de IUE, cura da cistocele e da retocele em todas as pacientes. Em relação ao bordo inferior da sínfise púbica, houve uma modificação da posição vertical da JUV, no sentido cranial, na situação de repouso, reduzindo significativamente sua mobilidade no esforço, ao passo que, na horizontal, observou-se uma redução da DHJUV, tanto no repouso quanto no esforço. Ainda ficou caracterizada uma redução da DPU na situação de repouso, ocasionando menor mobilidade ao esforço, em valores estatisticamente significantes, assim como um aumento no comprimento da UP, no repouso e no esforço.