Retroviruses are described as a risk factor for chronic neuropathy. However, it is still unknown if they can work as amyotrophic lateral sclerosis triggers. Over the years, some cases of this association have been described with heterogenous disclosures. This study aimed to report a case of HIV and ALS-like neuropathy and briefly discuss peculiarities of clinical aspects, such as physiopathology and treatment options. The patient underwent neurological examination associated with blood tests, electromyography, analysis of cerebrospinal fluid, and imaging studies. A non-systematic review was performed in major databases regarding the topic. The case presented mixed upper and lower motor neuron signs and was framed as a probable case of ALS following the present criteria. After a short follow-up and viral load cleansing, neurological stabilization was achieved.

Abstract Context Different intermittent fasting (IF) protocols have been proven to be efficient in improving cardiometabolic markers, but further research is needed to examine whether or not combining IF regimens plus physical exercise is superior to control diets (ie, nonfasting eating) plus physical exercise in this setting. Objective The aim of this study was to determine whether or not combining IF plus exercise interventions is more favorable than a control diet plus exercise for improving cardiometabolic health outcomes. Data Source PubMed, Scopus, and Web of Science were comprehensively searched until April 2023. Data Extraction Electronic databases were searched for clinical trials that determined the effect of IF plus exercise vs a control diet plus exercise on body weight, lipid profile (high-density lipoprotein [HDL], low-density lipoprotein [LDL], triglycerides, and total cholesterol), and systolic and diastolic blood pressure (SBP and DBP, respectively). Analyses were conducted for IF plus exercise vs a nonfasting diet plus exercise to calculate weighted mean differences (WMDs). Data Analysis The meta-analysis included a total of 14 studies, with a total sample of 360 adults with or without obesity. The duration ranged from 4 to 52 weeks. IF plus exercise decreased body weight (WMD = –1.83 kg; P = 0.001), LDL (WMD = –5.35 mg/dL; P = 0.03), and SBP (WMD = –2.99 mm Hg; P = 0.003) significantly more than a control diet plus exercise. HDL (WMD = 1.57 mg/dL; P = 0.4) and total cholesterol (WMD = –2.24 mg/dL; P = 0.3) did not change significantly for IF plus exercise vs a control diet plus exercise, but there was a trend for reducing triglycerides (WMD = –13.13 mg/dL; P = 0.07) and DBP (WMD = 2.13 mm Hg; P = 0.05), which shows clinical magnitude. Conclusion IF plus exercise improved some cardiometabolic outcomes (body weight, blood pressure, and lipid profile) compared with a control diet plus exercise. Systematic Review Registration PROSPERO registration no. CRD42023423878.

Although the link between gut microbiota and obesity is increasingly reported, the pathophysiological mechanisms and clinical outcomes are still under debate. This overview of human and animal data addresses several pathophysiologic mechanisms, dietary habits, exercise and probiotic and symbiotic supplementation in the fields of gut microbiota and obesity. Overall, obesity impairs gut microbiota composition due to factors that may be linked to the onset of the disease, such as excessive consumption of high-energy foods, sugars and fats, as well as a low fiber intake and physical inactivity. Conversely, low-energy diets, physical exercise, and probiotic and prebiotic supplementations can enhance gut microbiota in patients with obesity, in addition to improving cardiometabolic markers. As for perspectives, further research is warranted to ascertain proper dietary manipulation, physical exercise protocols and dosing regimens of probiotics. Regarding the latter, the effects on indicators of obesity are clinically modest, and hence skepticism must be exercised.

Eccentric instruments have been proposed as more effective and less time-consuming for endodontic instrumentation. To compare biomechanical outcomes of different instrumentation systems and time undertaken for instrumentation in resin prototypes. Sixty standardized prototypes of mandibular second primary molars were instrumented according to the following systems: K-files, ProTaper Next (PTN), XP-endo Shaper (XPS), XP-endo Finisher (XPF), XP-Clean (XPC), and Sequence Baby File (SBF; n = 10/each). Irrigation was performed with saline with simultaneous aspiration, and time spent was recorded. The prototypes were micro-CT-scanned before and after the instrumentation, and image sets were reconstructed and registered. Non-instrumented areas, accumulated debris, removed root material volume, and canal transportation were quantified. Data were analyzed through ANOVA, the Kruskal-Wallis test, and the Wilcoxon signed-rank test (α = 5%). K-files and SBF resulted in more instrumentation time (p < .05). SBF, XPC and PTN removed less root dentine (p < .05), but PTN left more untouched areas (p < .05). Accumulated debris were lower for XPC and SBF (p < .05). Canal transportation was similar among the groups. Rotary systems reduced instrumentation time, whereas SBF and XPC resulted in more conservative instrumentation, with less debris accumulation and non-instrumented areas. A dedicated paediatric endodontic system (SBF) outperformed eccentric instruments in terms of effectiveness.

Osseodensification is a technique that involves compressing bone using specialized drilling instruments to increase bone–implant contact. The present study aimed to evaluate the structure of a xenograft bone (XB) wall created within an implantation site and how it affects the initial stability of dental implants. Six segments of pig ribs, representing low-density bone, were used in the experiment. Four different drilling conditions were created for each section using a tapered bur system associated with bovine xenograft bone: clockwise (cutting mode—CW) or counterclockwise (densification mode—CCW). The bone samples were then placed individually in microtomography equipment to define a volume of interest (VOI) 50% larger than the osteotomy. Mathematical calculations of bone volume, trabecular thickness and separation, and total porosity were performed. An implant with a diameter of 4.0 mm and a length of 11.5 mm was then inserted into each osteotomy. The final insertion torque (IT) and resonance frequency analysis/implant stability quotient (ISQ) values were recorded. The groups were compared using ANOVA and Tukey’s post hoc test. The results show that the use of xenograft bone produced densification at the apex region, with higher bone volume and trabecular thickness, and reduced trabecular separation compared with the CW group (p &lt; 0.05). The CW + XB group demonstrated a similar porosity to the CCW group and similar values of IT and ISQ (p &gt; 0.05). Compared with the other groups, CCW + XB exhibited the lowest percentual porosity and the highest values of IT and ISQ (p &lt; 0.05). We concluded that the use of a xenograft bone wall before implant placement can improve the primary stability of dental implants.

IntroductionThis study used a correlative multianalytical approach to investigate the bacteriologic conditions in the apical root canal system of treated teeth with or without apical periodontitis and their correlation with the technical quality of the previous root canal obturation and the presence and volume of apical periodontitis lesions. MethodsRoot apexes were obtained from recently extracted root canal–treated teeth with (n = 23) and without (n = 22) apical periodontitis lesions as demonstrated by cone-beam computed tomographic examination. The root apexes were sectioned and subjected to micro–computed tomographic (micro-CT) scanning. The specimens were cryopulverized, and DNA extracted from the powder was used as a template in real-time polymerase chain reaction assays to quantify total bacteria and members of the Streptococcus genus and Actinobacteria phylum. The bacteriologic findings were compared between the 2 groups and also evaluated for associations with cone-beam computed tomographic and micro–computed tomographic data. ResultsBacteria were detected in all apical canal samples except 1. The mean counts of total bacteria, streptococci, and actinobacteria did not differ significantly between teeth with or without apical periodontitis (P > .05). Streptococcus levels were significantly lower by 80% in the apical canals of teeth with small lesions compared with those without lesions (P < .05). The limit of filling >2 mm short was significantly associated with more total bacterial counts compared with canals filled 0–2 mm short (P < .05). An adequate coronal restoration was significantly associated with lesser counts of Streptococcus (P < .05). ConclusionsComparable bacterial loads were observed in the apical canal system of treated teeth with and without apical periodontitis, suggesting that factors other than only the total bacterial levels may also influence the development and progression of apical periodontitis. Bacteria were found in the apical canal in virtually all cases with a high prevalence of streptococci and actinobacteria. Streptococci counts were significantly higher in the apical canal of teeth with inadequate restorations and teeth with no lesions. Underfilled canals showed higher bacterial counts.

Blueberries and cranberries are berry fruits with the highest number of randomized clinical trials (RCTs) focusing on blood pressure (BP). This systematic review and meta-analysis of RCTs analyzed the effects of blueberry and cranberry supplementation alone and in concert with systolic BP (SBP) and diastolic BP (DBP) in patients with cardiometabolic diseases. The searches were performed until August 2023 in the following databases: PubMed, Scopus, Web of Science, Cochrane, and Embase. Studies that examined the effects of blueberry or cranberry intake/supplementation were included. The risk of bias was evaluated using the Rob 2 scale. A meta-analysis was performed to estimate the effects of blueberry and cranberry supplementation on BP levels in patients with cardiometabolic diseases. A total of 17 articles were included, from which two found significant results from blueberry and/or cranberry supplementation in reducing BP. Pooled results revealed statistically non-significant reductions of -0.81 mm Hg for SBP (95% confidence interval [CI]: -2.26, 0.63; I2  = 0%) and -0.15 mm Hg for DBP (95% CI: -1.36, 1.05; I2  = 27%). Blueberry and/or cranberry supplementation had neutral effects on SBP and DBP in patients with cardiometabolic diseases, regardless of duration or age. Further high-quality studies are needed to firmly establish clinical efficacy.

Introduction: Low serum B vitamin levels are potentially causally related to these prevalent mental symptoms. Because of this, cobalamin—vitamin B12—is crucial for producing myelin and neurotransmitters. Additionally, subacute combined degeneration (SCD) is one of the consequences of B12 deficiency. Symptomatology often is paraplegia, spasticity, and contractures which are typically progressive. In addition, as the disease advances, they experience a distal sensorimotor loss that ascends proximally and causes spastic quadriparesis and generalized hypoesthesia. Case Report: Male, 33 years old, with a history of a fall in December 2015, when pain and discomfort started in the left lower limb. A year ago, she evolved with paraparesis, loss of sphincter control, sensory changes in the extremities of the limbs and sensory level at T10, in addition to a report of visual disturbance in the left eye. At that time, the dosage of vitamin B12 was very low—50 pg/mL (reference above 300 pg/mL). On physical examination: extrapyramidal syndrome with hypoesthesia at the distal level. Bilateral Hoffmann’s sign, spastic paraparesis, hyperreflexia in the lower limbs, clonus in the feet, and loss of sphincter control. Sensitive level at T10. Magnetic resonance imaging (MRI) showed cervical dorsal lumbar spinal cord and cone with hypersignal focus on the lateral and posterior cords and skull hypersignal focus in the topography of the corticospinal tracts, suggestive of combined subacute degeneration. Conclusion: Vitamin B12 deficiency, in addition to other pathologies, is also found in SCD. When treated early, these alterations found in the imaging exam can be resolved without signs of atrophy. Thus, neuroimaging plays a relevant role in the diagnosis, complementing the clinic.

Study Design: Original Article. Objective: The surgical treatment of mandibular fractures has undergone several changes over the past 100 years, since the use of wires and intermaxillary fixation, until today where most of the fractures are treated with internal fixation using plates and screws. For the correct use of this hardware, the surgeon must have adequate knowledge of jaw anatomy to prevent complications during the insertion of screws like in fractures of the mandibular body and angle, when the screws of the plate installed in the compression zone can damage the inferior alveolar nerve within the mandibular canal. Methods: To minimize this complication, 66 hemimandibles of adult patients were analyzed in CT scans and manipulated with Dental Slice® software, (BioParts®, Brazil) and measured the shortest distance from the inferior cortex of the mandibular canal to the inferior cortex of the mandibular body during the path of the inferior alveolar nerve, since the mandibular foramen until the mental foramen. Results: The result obtained showed a wide variation of the shortest distance measured (3.52 mm–11.5 mm) with an average of 7.99 mm. Conclusion: The conclusion demonstrated a minimum distance of 3.52 mm below the cortical mandibular canal to the lower border of the mandible and should be considered as a safety margin during the application of fixing the material in the region of the mandibular body.

The study aimed to compare the efficacy of XP-endo Finisher and Passive Ultrasonic Irrigation (PUI) in removing hard tissue debris from curved canals. Thirty-four mandibular molars with Vertucci's type II mesial canals were scanned in microcomputed tomography before and after preparation with HyFlex EDM, and accumulated hard tissue debris was quantified. Subsequently, the teeth were randomly divided into two groups according to the supplementary procedure: PUI with the Ultra-X insert or XP-endo Finisher. After the intervention, the specimens underwent another scanning. Two separate analyses were conducted, one for the total canal and another for the isthmus area. Unpaired and paired T-tests were used for inter- and intergroup comparisons, with a significance level set at 5%. Both supplementary methods reduced the amount of debris compared to the initial volume. Remarkably, the XP-endo Finisher achieved a significantly higher percentage of debris removal (71% for the total canal and 74% for the isthmus areas) compared to PUI (41% for the total canal and 52% for the isthmus area) (P < 0.05). Both supplementary approaches reduced the amount of hard tissue debris from canal preparation, still XP-endo Finisher showed a higher reduction compared to PUI (p < 0.05). None of the supplementary methods rendered canals completely free of hard tissue debris. However, the supplementary approach with XP-endo Finisher resulted in lower levels of hard tissue debris than PUI in curved canals with isthmuses.