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Introducción: La periodontitis apical asintomática es de los diagnósticos endodónticos más comunes que se presentan en la población mundial. Consiste en la afectación del tejido periapical como resultado de la activación de mecanismos de inflamación, los que incluyen lisis y reabsorción de tejidos de soporte como cemento, ligamento y hueso alveolar. El signo patognomónico de la periodontitis apical es la presencia de radiolucidez periapical, resultado de la destrucción de los tejidos periapicales. Su principal tratamiento abarca el manejo endodóntico convencional cuyo objetivo es la eliminación de los irritantes locales dentro del conducto radicular. Sin embargo, cuando se desarrollan lesiones de gran tamaño es necesario complementar con terapias que aceleren la reparación, una de ellas la descompresión, la cual a partir de la reducción de la presión intralesión e intraósea con lo que favorece la formación de tejido fibroso, conectivo y óseo. Objetivo: Describir la técnica de descompresión intraconducto en el manejo de lesiones periapicales de gran tamaño. Presentación del caso: Paciente de 33 años de edad, con diagnóstico de periodontitis apical asintomática y evaluación tomográfica de lesión periapical de gran tamaño (67,5 UH) manejado con terapia endodóntica convencional y descomprensión intraconducto como terapia coadyuvante. Posterior a la restauración se realizaron controles clínicos y radiográficos. A los 24 meses se evidenció reparación de los tejidos involucrados con restauración del espacio del ligamento periodontal. Conclusiones: En este caso, la terapia descomprensiva fue una alternativa en el manejo de una lesión periapical de gran tamaño, que permitió regular la presión intraósea y facilitar la regeneración del tejido óseo, evitando la intervención quirúrgica siendo así más confortante para el paciente(AU)
Introduction: Asymptomatic apical periodontitis is one of the most common endodontic disorders diagnosed in the world population. It consists in damage to the periapical tissue due to activation of inflammation mechanisms, including lysis and resorption of support tissues like cementum, ligament and alveolar bone. The pathognomonic sign of apical periodontitis is the presence of periapical radiolucency due to the destruction of periapical tissue. Its main treatment includes conventional endodontic management aimed at removing local irritants from the root canal. However, when large lesions develop, it is necessary to complement the conventional treatment with therapies speeding up the repair process, such as decompression, which reduces intralesion and intraosseous pressure, fostering the formation of fibrous, connective and bone tissue. Objective: Describe the use of intracanal decompression technique in the management of large periapical lesions. Case presentation: A case is presented of a 33-year-old patient diagnosed with asymptomatic apical periodontitis and a tomographic evaluation of a large periapical lesion (67.5 UH) treated with conventional endodontic therapy and intracanal decompression as adjuvant therapy. Restoration was followed by clinical and radiographic controls. At 24 months it was observed that the tissues involved had been repaired and the periodontal ligament space restored. Conclusions: The use of decompressive therapy as an alternative in the management of a large periapical lesion, made it possible to regulate intraosseous pressure and facilitate bone tissue regeneration, relieving the patient from the discomforts of a surgical intervention(AU)
Assuntos
Humanos , Masculino , Adulto , Periodontite Periapical/diagnóstico , Descompressão/métodos , Tecido Periapical , Procedimentos Cirúrgicos OperatóriosRESUMO
We report the draft genome sequences of Leptolyngbya sp. strain 7M and Leptolyngbya sp. strain 15MV, isolated from Miravalles Thermal Spring, Costa Rica. The thermophilic cyanobacteria exhibit unique diversity features that provide insight into the adaptation and evolution of phototrophic microorganisms in geothermal habitats.
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AIM: To evaluate the ability of interleukin (IL)-15 to control T cell functions through its influence on CD30 and OX40 expressing cells in Celiac Disease (CD). In peripheral blood (PB), by examining the expression of OX40 in conventional effectors cells and T cells with a phenotypic specialization of regulatory cells [CD4+CD25high forkhead box protein 3 (Foxp3)+], and the co stimulation of IFN-γ and IL-4 production within CD30 and OX40 positive subsets of T cells. At the duodenal mucosa, by assessing the expression of CD30 and OX40 in intraepithelial (IE) and lamina propria (LP) lymphocytes (IEL, LPL). PATIENTS AND METHODS: PB and duodenal mucosal biopsies were obtained from 38 patients with classic CD (Cel) and 38 healthy controls (HC). Analysis of cell surface and/or intracellular antigens was performed in anti-CD3-treated PB mononuclear cells (PBMC) before and after treatment with recombinant IL-15 (rIL-15), and in IE and LP cellular suspensions prepared from duodenal biopsies pre-treated with/without rIL-15. RESULTS: A subpopulation of CD3+OX40+ T blasts was induced in Cel and HC by a 3days treatment of PBMC with anti-CD3 and decreased its size thereafter, regardless of the presence of rIL-15. However, the addition of rIL-15 to T blasts distinctively induced the survival of T cells with a regulatory phenotype that expresses OX40 antigen in Cel (p<0.05). Celiac patients showed higher frequencies of IFN-γ-producing CD3+CD30+ blasts before and after treatment with rIL-15 (p<0.05, vs. HC). IL-15 increased the frequencies of CD3+CD30+ LPL (HC: p<0.05, Cel: p<0.05) but not of CD3+OX40+ LPL, and CD30 or OX40 positive IEL. CONCLUSIONS: The distinctive control of OX40+ cells with a T regulatory phenotype mediated by the influence of IL-15 comes out as new function of this cytokine in the context of CD. The higher production of IFN-γ by a subpopulation of peripheral CD3+CD30+ cells contributes to the type I biased immune response.
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Doença Celíaca/imunologia , Interleucina-15/imunologia , Antígeno Ki-1/imunologia , Ligante OX40/imunologia , Linfócitos T Reguladores/imunologia , Adulto , Idoso , Complexo CD3/imunologia , Duodeno/imunologia , Feminino , Humanos , Interferon gama/biossíntese , Interferon gama/imunologia , Interleucina-15/uso terapêutico , Interleucina-4/biossíntese , Interleucina-4/imunologia , Mucosa Intestinal/imunologia , Masculino , Pessoa de Meia-Idade , Mucosa/citologia , Mucosa/imunologia , Proteínas Recombinantes/uso terapêutico , Adulto JovemRESUMO
Interleukin (IL)-15 and CD30 may be associated with the ongoing intestinal immunologic activation in celiac disease (CD). We studied duodenal biopsies and blood samples of patients with active CD (Cel) and controls in order to determine the regulatory role proposed for CD30(+) T cells in this Th1-driven disease and the potential influences of IL-15 on CD30 expression. We detected that a CD30(+) T-cell subpopulation persists longer in Cel after a 5 day incubation with anti-CD3 antibody than in controls (p = 0.0063). CD30 upregulation by IL-15 in T blasts was greater in Cel than in controls (p = 0.0062). At the mucosal compartment, the CD30 antigen was examined by immunohistochemistry and quantified on isolated lamina propria (LP) and epithelial T cells by flow cytometry. For Cel and controls, similar mean percentages of CD3(+)CD30(+) intraepithelial T cells (5.88 vs. 5.51, p = ns) and LP T cells (7.38 vs. 7.49, p = ns) were observed at baseline and after in vitro gliadin challenge of duodenal biopsy samples. Our study demonstrates the occurrence of potentially important alterations of the immune response at the peripheral compartment. Our findings also allow us to speculate that a negative effect of soluble mediators at the mucosal compartment might counteract the latent influence of IL-15 on CD30 expression precluding a more severe course of active CD.
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Doença Celíaca/imunologia , Doença Celíaca/patologia , Regulação da Expressão Gênica , Interleucina-15/metabolismo , Antígeno Ki-1/metabolismo , Adulto , Idoso , Biópsia , Doença Celíaca/metabolismo , Duodeno/imunologia , Duodeno/metabolismo , Feminino , Humanos , Interleucina-15/genética , Mucosa Intestinal/citologia , Mucosa Intestinal/imunologia , Mucosa Intestinal/metabolismo , Antígeno Ki-1/genética , Ativação Linfocitária , Masculino , Pessoa de Meia-Idade , Linfócitos T/imunologia , Adulto JovemRESUMO
BACKGROUND: The importance of enteric viral infections in HIV-related diarrhea is uncertain. Human caliciviruses have emerged as a leading cause of acute diarrhea worldwide. OBJECTIVES: To evaluate the importance of calicivirus infections in HIV-related diarrhea. Study design 151 fecal samples collected from children and adults infected with HIV, with and without diarrhea, were examined. In addition, 89 fecal samples from non HIV-infected children and adults were also tested. Samples were analyzed by RT-PCR using primer sets specific to Norovirus genogroup I or genogroup II as well as primers designed to react with both Noroviruses and Sapovirus genus. RESULTS: Viruses were detected with equal frequencies in stools from HIV infected and non-infected adults (12%). However, specimens from HIV infected children were more likely than those of HIV-negative children to have caliciviruses (51% versus 24%, P<0.05). Viral infections were not significantly associated with diarrhea neither in children nor in adults, regardless of HIV status. Viruses genetically related to the common Lordsdale virus (Norovirus genogroup II) and London/92 virus (Sapovirus) clusters were detected circulating among children. CONCLUSIONS: These results suggest that caliciviruses may be an important opportunistic pathogen in children infected with HIV.
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Infecções por Caliciviridae/complicações , Caliciviridae/isolamento & purificação , Diarreia/virologia , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adulto , Caliciviridae/classificação , Infecções por Caliciviridae/virologia , Pré-Escolar , DNA Viral/química , Diarreia/complicações , Fezes/virologia , Humanos , Lactente , Recém-Nascido , Pessoa de Meia-Idade , Dados de Sequência Molecular , RNA Viral/análise , RNA Viral/genética , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Análise de Sequência de DNA , VenezuelaRESUMO
BACKGROUND: Information is lacking on the effects of hormone replacement therapy in women with diabetes, especially during moderate chronic hyperglycemia. OBJECTIVES: To study the effects of HRT on the lipid profile and the low density lipoprotein subclass distribution in women with type 2 diabetes under satisfactory and non-satisfactory glycemic control. METHODS: Fifty-four postmenopausal women after a 6 week run-in diet were randomized to receive either placebo (HbA1c < 8%, n = 13; HbA1c > 8%, n = 17) or HRT (HbA1c < 8%, n = 11; HbA1c > 8%, n = 13) for 12 weeks. HRT consisted of cyclical conjugated estrogens 0.625 mg/day plus medrogestone 5 mg/day. At the beginning and at the end of each treatment period the LDL subclass distribution was estimated by density gradient ultracentrifugation. RESULTS: At the baseline and during the study, the HbA1c level was significantly higher in hyperglycemic patients than in the near-normoglycemic controls (baseline 10.2 +/- 2.9 vs. 6.5 +/- 0.7%, P < 0.01). They showed a trend for higher total and LDL cholesterol, triglycerides and lower high density lipoprotein-cholesterol compared to near-normoglycemic controls, as well as significantly higher triglyceride concentrations in very low density lipoprotein, intermediate density lipoprotein and LDL-1 particles and cholesterol content in LDL-1 and -2 particles. HRT decreased LDL-cholesterol in both groups. In the normoglycemic patients a small increase in HbA1c was observed (6.5 +/- 0.7 vs. 7.4 +/- 1%, P = 0.04). In all cases, HRT did not modify the proportion of LDL represented by denser LDLs. CONCLUSIONS: HRT did not modify the LDL subclass distribution, even in the presence of moderate chronic hyperglycemia in women with type 2 diabetes.
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Apolipoproteínas B/efeitos dos fármacos , Doenças Cardiovasculares/prevenção & controle , Diabetes Mellitus Tipo 2/complicações , Estrogênios Conjugados (USP)/administração & dosagem , Terapia de Reposição Hormonal/efeitos adversos , Lipoproteínas LDL/efeitos dos fármacos , Medrogestona/administração & dosagem , Idoso , Apolipoproteínas B/análise , Glicemia , Doenças Cardiovasculares/etiologia , Diabetes Mellitus Tipo 2/diagnóstico , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Hiperglicemia/diagnóstico , Hiperglicemia/etiologia , Lipoproteínas LDL/análise , Pessoa de Meia-Idade , Pós-Menopausa , Probabilidade , Valores de Referência , Resultado do TratamentoRESUMO
Hyperlipidemia is common in type 2 diabetic patients and is an independent risk factor for cardiovascular disease. The aim of this trial was to evaluate the efficacy and safety of once-daily atorvastatin 10-80 mg for the treatment of hyperlipidemia in type 2 diabetics with plasma low-density lipoprotein cholesterol (LDL-C) levels exceeding 3.4 mmol/l (130 mg/dl). One hundred and two patients met the study criteria and received 10 mg/day atorvastatin. Patients who reached the target LDL-C level of
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Anticolesterolemiantes/uso terapêutico , Diabetes Mellitus Tipo 2/complicações , Ácidos Heptanoicos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipidemias/tratamento farmacológico , Pirróis/uso terapêutico , Anticolesterolemiantes/efeitos adversos , Atorvastatina , Feminino , Ácidos Heptanoicos/efeitos adversos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Hiperlipidemias/sangue , Hiperlipidemias/complicações , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade , Pirróis/efeitos adversosRESUMO
PURPOSE: The purpose of this study was to measure the level of diabetes knowledge in a representative group of Mexican individuals with diabetes and to identify the factors that influence it. METHODS: A validated questionnaire was administered to 570 outpatients; 11.2% had Type 1 diabetes, 36.4% had Type 2 diabetes treated with insulin, and 52.2% had Type 2 diabetes treated with oral agents. Samples for HbA1c determination also were obtained. RESULTS: The percentage of correct answers in each section of the questionnaire was low. Type 1 patients had the highest scores, followed by the insulin-treated Type 2 patients; those with chronic complications also had high scores. Educational background, attendance at diabetes courses, age, and HbA1c concentration were the main predictors of knowledge. Attendance at courses was influenced by the severity of the disease. CONCLUSIONS: The amount of patient knowledge about diabetes-related issues was low in this representative Mexican population. The educational efforts were focused on those with the worst metabolic control and/or with diabetes complications.
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Diabetes Mellitus/prevenção & controle , Avaliação Educacional , Conhecimentos, Atitudes e Prática em Saúde , Atitude Frente a Saúde , Diabetes Mellitus/sangue , Diabetes Mellitus/psicologia , Feminino , Hemoglobinas Glicadas/análise , Humanos , Masculino , México , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Índice de Gravidade de Doença , Inquéritos e QuestionáriosRESUMO
The apolipoprotein E4 allele is associated in industrialized countries with an elevated LDL cholesterol concentration and an increased cardiovascular risk. Our purpose in this study was to assess the influence of the genetic variation at the APOE gene locus on the lipid profile of a Native American rural population. We examined plasma lipid levels and the common apo E alleles in 142 healthy randomly selected adults living in their native communities in western Mexico. Their age was 38+/-17 years and the BMI 25.7+/-4.5 kg/m2. Plasma cholesterol, triglycerides, LDL C and HDL C were 165+/-29.6, 126+/-83, 98+/-26 and 42+/-12.7 mg/dl respectively. Ninety-one per cent of the subjects had Lp(a) concentrations below 20 mg/dl and 30% had levels lower than 2 mg/dl. The most common APOE genotype was E3/3 (63%), followed by E3/4 (30.1%). The prevalence of the E2 allele was very low (2.3%). No difference was observed in LDL C concentrations between the E3/E3 and E3/E4 subjects; however carriers of the E2/3 genotype had lower LDL C levels. Similar results were obtained for cholesterol and apo B levels. In summary, the increased LDL C levels associated with the E4 allele in previous studies were not observed in a population with non-westernized habits. Environmental factors, such as diet and lifestyle, could outweigh the hypercholesterolemic predisposition resulting from the presence of the apo E4 allele.
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Alelos , Apolipoproteínas E/genética , Indígenas Norte-Americanos/genética , Estilo de Vida , Lipídeos/sangue , Adulto , Apolipoproteína E4 , Apolipoproteínas E/sangue , Feminino , Genótipo , Humanos , Hipercolesterolemia/sangue , Hipercolesterolemia/etnologia , Hipercolesterolemia/genética , Masculino , México/epidemiologia , Distribuição Aleatória , Valores de Referência , Fatores de Risco , População RuralRESUMO
OBJECTIVE: To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea-metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments. METHODS: One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run-in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a 3-week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks. RESULTS: Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 +/- 2.4 vs. 11.3 +/- 3.9 mmol/l, p = 0.05), HbA1c (11.1 +/- 3.4 vs. 10.3 +/- 2.5%, P = 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 +/- 2.9 vs. 8.2 +/- 2.3 mmol/l, p < 0.01), HbA1c (11.7 +/- 2.9 vs. 9.4 +/- 2.7%, p < 0.01) and plasma cholesterol. No change in insulin secretion resulted from insulin and acarbose treatment. CONCLUSIONS: Acarbose decreases blood glucose in secondary failure to sulphonylurea-metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.