Thiago Kreutz Grossmann

Hypertension—an emerging cardiovascular risk factor in HIV infection

Patients with HIV may have an increased risk of hypertension and cardiovascular disease (CVD). The objective of this study was to determine the prevalence and risk factors for hypertension in a population of HIV-infected patients at an HIV/AIDS clinic in southern Brazil. We reviewed medical records of 1009 HIV-infected patients aged 18 years or more in an urban HIV/AIDS clinic based in Porto Alegre, southern Brazil. Hypertension was defined according to the Eighth Joint National Committee criteria. The prevalence of hypertension in this study cohort was 22.5% (95% confidence interval, 20%-25.2%). Individuals were significantly older in the hypertensive group (P < .001). After adjustment using a Poisson regression model of all variables that presented P < .2 in the univariate analysis, the variables that were significantly associated with hypertension were only age ≥40 years and obesity. Also in this setting, dyslipidemia (P = .068) showed a tendency of association with hypertension. Compared with HIV-infected persons aged 18-39 years, those aged 40-59 years presented a 2-fold higher prevalence of hypertension (95% confidence interval, 1.2-3.3).The present study showed a high prevalence of hypertension among HIV-infected persons, similar to other studies, ranging from 13% to 45%, and also similar to the HIV-negative general population. Age and obesity were the factors associated with hypertension. Finally, the present study indicates a similar pattern of behavior and comorbidities for HIV-positive and -negative patients in relation to hypertension.

Cirurgia da articulação temporomandibular

JUSTIFICATIVA E OBJETIVOS: Realizar uma revisao a cerca das diferentes tecnicas cirurgicas empregadas nas disfuncoes da articulacao temporomandibular (ATM), bem como das suas indicacoes. CONTEUDO: Estudos, ao longo desses ultimos anos, tem tentado padronizar as diferentes tecnicas cirurgicas empregadas nas disfuncoes temporomandibulares (DTM), no intuito de definir quando e como emprega-las. Optam-se, primeiramente, por tecnicas pouco invasivas como manipulacao mandibular assistida com aumento de pressao hidrostatica, artrocentese a procedimentos mais complexos como artroscopia e cirurgia aberta da ATM na tentativa de aliviar ou eliminar o quadro de dor e disfuncao presentes. CONCLUSAO: A escolha quanto ao tratamento das DTM recai muito mais sobre a experiencia e manuseio do profissional, do que estudos cientificamente controlados O sucesso terapeutico aplicado a ATM depende, fundamentalmente, de um plano global de tratamento que envolve tanto terapeuticas conservadoras, clinicas, como cirurgicas propriamente ditas. A cirurgia realizada de forma isolada dificilmente proporcionara um sucesso terapeutico. Cada procedimento deveria ter a sua indicacao, baseada em criterios bem definidos. No entanto, faltam, ate o presente momento, estudos longitudinais e ensaios clinicos aleatorios que possam comparar a efetividade terapeutica de cada modalidade cirurgica.

Efficacy of entecavir and tenofovir in chronic hepatitis B under treatment in the public health system in southern Brazil

There are about 350 million hepatitis B virus (HBV) carriers worldwide and chronic HBV is considered a major public health problem. The objective of the present study was to assess the effectiveness of the nucleos(t)ide analogues tenofovir (TDF) and entecavir (ETV) in the treatment of chronic HBV. A cross-sectional study was carried out from March-December 2013, including all patients with chronic HBV, over 18 years of age, undergoing therapy through the public health system in southern Brazil. Only the data relating to the first treatments performed with TDF or ETV were considered. Retreatment, co-infection, transplanted or immunosuppressed patients were excluded. Six hundred and forty patients were evaluated, of which 336 (52.5%) received TDF and 165 (25.8%) ETV. The other 139 (21.7%) used various combinations of nucleos(t)ide analogues and were excluded. The negativation of viral load was observed in 87.3% and 78.8% and the negativation of hepatitis B e antigen was achieved in 79% and 72% of those treated with ETV or TDF, respectively. Negativation of hepatitis B surface antigen was not observed. There was no occurrence of adverse effects. This is a real-life study demonstrating that long-term treatment with ETV and TDF is both safe and effective.

O uso da estimulação elétrica nervosa transcutânea na disfunção temporomandibular

BACKGROUND AND OBJECTIVES: Temporomandibular joint dysfunction (TMJD) is a term to describe a group of diseases functionally affecting the masticatory system, especially masticatory muscles and the temporomandibular joint (TMJ). It has different etiologies and specific treatments, among them the transcutaneous electrical nerve stimulation (TENS). This article aimed at reviewing the scientific literature on the use of TENS in TMJD patients. CONTENTS: Epidemiological studies show that approximately 75% of people have some TMJD sign, while 33% have at least one symptom. Whenever possible, one should treat the cause of pain. When it is impossible to determine its etiology, one should start with less invasive and reversible procedures, especially for pain and muscle dysfunction. TENS therapy consists of administering electrical current to the skin surface, to relax hyperactive muscles and promote pain relief. CONCLUSION: Although there are controversies about the use of TENS to control chronic pain, its use for masticatory muscle pain is still relevant. However, an accurate diagnosis is needed to prevent its inadequate use. We still need controlled randomized studies including selected samples to homogenize the use of TENS in TMJD patients.

Neuralgia induzida por cavitação osteonecrótica

BACKGROUND AND OBJECTIVES: To review neuralgia inducing cavitational osteonecrosis (NICO), its differential diagnosis with regard to major facial pains as well as its management. CONTENTS: NICO is a disease with numerous causes, such as trauma, infections, use of local anesthetics with vasoconstrictors which decrease blood flow inside the bone, direct or indirect application of heavy metals and steroids after oral surgeries, use of nicotine and coagulation problems. The diagnosis is based on the clinical history associated to pain quality, duration and in general ineffective therapeutic response to different neuromodulators. Complementary exams are standard periapical X-rays of the area to be investigated, panoramic X-rays and CT, which may show or not unilocular radiolucent foci. Scintigraphy normally shows an area of increased uptake. Treatment may be clinical with anticoagulants, anabolic steroids or local antibiotic injection; or surgical promoting local bleeding by osteotomy or ostectomy, depending on NICO level and extension. CONCLUSION: The search for new drugs less detrimental for bone tissues and more information to dentists about NICO may help decreasing its incidence by establishing an earlier diagnosis, thus making different management techniques more effective.