RESUMEN

AIM: Ectopic eruption of the first permanent molar (EFUPM) is defined as its local disturbed eruptive behaviour, positioning too mesially against the distal aspect of the second upper primary molar during the developing mixed dentition. The EFUPM prevalence is up to 6% and affects both genders equally. The present study aimed to perform a scoping review to collect the most relevant studies published in the last 30 years and focused on the different strategies, traditional and novel, for treating irreversible uni- or bilateral EFUPM in children. This review also aimed to make recommendations and map the gaps in this clinical topic. METHODS: An electronic and manual search was conducted in five databases according to previously established eligibility criteria, using different combinations of keywords, MeSH terms, and Boolean operators. Titles, abstracts, and full-text articles were screened and selected by pre-calibrated reviewers. A data charting was also accomplished for summarising the overview of the evidence. CONCLUSION: Paediatric dentists must learn to diagnose and treat this condition early in order to allow the prevention of future malocclusions and other clinical sequelae. Practitioners have at their disposal a variety of corrective options available for the successful resolution of EFUPM.

Asunto(s)

Maloclusión , Erupción Ectópica de Dientes , Adolescente , Niño , Dentición Mixta , Femenino , Humanos , Masculino , Maloclusión/terapia , Maxilar , Diente Molar , Erupción Ectópica de Dientes/epidemiología , Erupción Ectópica de Dientes/terapia

RESUMEN

AIM: During the last three decades, fluoride varnishes have been recognised as effective strategies for caries prevention in the young-child population and have contributed to a decrease in its prevalence worldwide. The present study aimed to assess in vitro the level of cytotoxicity and genotoxicity in human primary pulp fibroblasts (DPFs) of two NaF varnishes. MATERIALS AND METHODS: Four experimental assays were carried out (MTS, Mitotracker® system [mitochondrial function and morphology], Live/Dead®, and Comet) to assess the morphology, viability, and genotoxicity of two NaF varnishes (Duraphat® and Clinpro White®, both at two different concentrations). The essays were conducted on cultured pulp fibroblasts, grouped in four experimental and two control groups. Collected data were analysed by one-way ANOVA followed by the post hoc Bonferroni test. RESULTS: Some morphological changes of DPFs could be detected after the NaFVs stimulation. Most DPFs incubated in Duraphat (22.6 mg/L) maintained their morphological characteristics, except for a small decrease in cell size and shorter cytoplasmic projections (filopodia); DPFs treated with Clinpro White Varnish (22.6 mg/L) presented a morphology and size similar to the control group. DPFs exposed to Duraphat (113 mg/L) exhibited significant morphological alterations with considerable cell size increases and DPFs treated with Clinpro White Varnish (113 mg/L) showed a slight cell size increase without noticeable morphological anomalies. The Duraphat (22.6 mg/L) and Clinpro White Varnish (22.6 mg/L) groups promoted 31% and 35% cell proliferation, respectively, whereas DPFs proliferation with Duraphat (113 mg/L) decreased up to 59%, and cell proliferation with Clinpro White Varnish (113 mg/L) was similar to that of control. CONCLUSION: All tested varnishes induced changes in the fibroblastic mitochondria. In general, Duraphat was less biocompatible and caused a change in the number of mitochondria compared to Clinpro White Varnish.

Asunto(s)

Caries Dental , Fluoruros Tópicos , Cariostáticos/toxicidad , Esmalte Dental , Fluoruros Tópicos/toxicidad , Humanos , Sodio , Fluoruro de Sodio/toxicidad

RESUMEN

BACKGROUND: The objective of this study was to describe the bacterial communities associated with pediatric patients with endodontic infections of temporal teeth by targeting the 16S rRNA gene using pyrosequencing. MATERIAL AND METHODS: Microbiological samples were obtained from the lower primary molars of thirteen 13 pediatric patients with dental infections. An aspiration method for microbiological sampling was used. The identification of microbiota employing the pyrosequencing method by targeting the 16S gene was performed. RESULTS: Ribosomal 16S RNA gene sequences were amplified, obtaining a total of 16,182 sequences from 13 primary infected molars (13 different individuals) by pyrosequencing. Bacteroidetes phyla (35.15%) were the most abundant followed by Firmicutes (33.3%) and Fusobacteria (10.05%); the presence of specific pathogenic bacteria was determined as well. CONCLUSIONS: The infected root canal of primary teeth contains a high diversity of anaerobic bacteria, and Bacteroidetes, Firmicutes, and Fusobacteria phyla were the most abundant; Prevotella and Streptococcus genera were the most prevalent.

Asunto(s)

Bacterias , Bacteroidetes/genética , Niño , Humanos , ARN Ribosómico 16S , Análisis de Secuencia de ADN , Diente Primario

RESUMEN

Objetivo: Describir las causas de muerte en pacientes con virus de inmunodeficiencia humana (VIH), ingresados en el Hospital Vargas de Caracas (HVC) durante el período enero a diciembre de 2017. Materiales y Métodos: Se realizó un estudio retrospectivo, que incluyó a todos los pacientes fallecidos infectados por VIH en el HVC. Se calcularon frecuencias relativas y absolutas, medidas de tendencia central utilizando el programa SPSS Statistics. Resultados: Durante el período estudiado, fallecieron 32 pacientes con VIH, de estos últimos solo se obtuvo acceso a través del departamento de archivos médicos a 23 historias ya que las 9 restantes no pudieron ser localizadas para su revisión. El 73,9 % de la muestra estuvo representado por el sexo masculino con una edad media de 36,78 años, el 73,9 % no tenían antecedente de comorbilidades asociadas; el 73,9 % tenía menos de un año de diagnóstico y 60,9 % no recibían terapia antiretroviral. El 95,7 % de las muertes estuvieron asociadas a síndrome de inmunodeficiencia humana (SIDA). Las causas de muerte más frecuentes fueron tuberculosis pulmonar y extrapulmonar (40,9 % de la muestra) seguida de encefalitis por Toxoplasma gondii e histoplasmosis diseminada. Conclusiones: Los pacientes fallecidos tenían una edad media de 36 años, con estadio de SIDA avanzado y tuberculosis como causa principal de muerte.

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Objective: To describe the causes of death in patients with human immunodeficiency virus (HIV), admitted to the Vargas Hospital of Caracas (VHC) during the period January to December 2017. Materials and Methods: A retrospective study was carried out, which included all deceased patients infected with HIV in the VHC. Relative and absolute frequencies, measures of central tendency were calculated and the statistical program SPSS Statistics was applied. Results: During the period studied, 32 patients with HIV died, we only had access to 23 medical records since the remaining 9 could not be located for review. 73.9 % of the sample was represented by the male sex with an average age of 36.78 years, 73.9 % had no history of associated comorbidities; 73.9 % had less than one year of diagnosis and 60.9 % did not receive antiretroviral therapy. 95.7 % of the deaths were associated with Human Immunodeficiency Syndrome (AIDS). Pulmonary and extrapulmonary tuberculosis was the most representative sample with 40.9 % followed by toxoplasmic encephalitis and disseminated histoplasmosis.Conclusions: The deceased patients had an average age of 36 years, with stage of advanced AIDS and tuberculosis as their main cause of death.

RESUMEN

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Asunto(s)

Atención Dental para Niños/métodos , Complejo de Eisenmenger , Gingivitis/terapia , Anestesia Local , Niño , Caries Dental/complicaciones , Caries Dental/terapia , Complejo de Eisenmenger/complicaciones , Femenino , Gingivitis/complicaciones , Humanos , Respiración por la Boca/complicaciones , Sobremordida

RESUMEN

Propofol infusion syndrome (PRIS) is a rare syndrome originally described in critically ill children undergoing long-term (> 48 h) propofol infusion at high doses (> 4 mg/kg/h). Severe metabolic acidosis, rhabdomyolysis, renal failure and fatal cardiac failure are the features. Herein, we present a case of a newborn who developed PRIS after a single bolus dose of propofol at 3.2 mg/kg/do, developing rhabdomyolysis and severe metabolic acidosis, with a successful outcome after medical therapy.

RESUMEN

AIM To evaluate the effectiveness of a Video Eyeglasses/Earphones System (VEES) as distracting device in reducing anxiety in children during dental procedures carried out under local anaesthesia. MATERIALS AND METHODS: In this crossover clinical trial, 36 Frankl scale II and III children aged 5-8 years received different dental procedures in two sessions, with and without the VEES system. In the control visit, they were not exposed to this distraction stimulus, but traditional non-aversive behaviour management was applied. Each dental session was divided into four phases (explanation, anaesthetic injection, rubber-dam/clamp placement, and high-speed hand piece work for 5 min). Pain in each treatment phase was assessed by the following measurements: the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Pulse rate, and oxygen saturation measurements were employed to evaluate the state of anxiety. Comparison of the outcomes of two interventions were statistically analysed through the Wilcoxon Signed-rank Test. RESULTS: There were no statistical differences between the results of the two interventions (VEES vs. no VEES/behavioural management) during the four treatment phases on assessment by any of the measurements employed. CONCLUSIONS: The VEES method was not more effective than traditional non-aversive behavioural techniques for reducing anxiety and pain perception in children undergoing dental treatment.

Asunto(s)

Ansiedad al Tratamiento Odontológico/prevención & control , Atención Dental para Niños/métodos , Dispositivos de Protección de los Oídos , Anteojos , Niño , Estudios Cruzados , Femenino , Humanos , Masculino , México , Dimensión del Dolor

RESUMEN

Os carrapatos estão envolvidos em processos biológicos de uma grande variedade de organismos patogênicos. O gênero Amblyomma é o de maior importância médica, com a espécie Amblyomma sculptum Berlese, 1888 envolvida no ciclo de transmissão da febre maculosa brasileira (FMB). Neste estudo, objetivou-se a validação molecular para uma diferenciação na característica morfométrica e no tamanho de idiossoma de larvas de duas espécies de carrapatos, Amblyomma dubitatum Neumann, 1899 e A. sculptum. Larvas não alimentadas foram coletadas em duas áreas de transmissão para FMB, por meio da técnica de armadilha atrativa de CO2. Foram identificadas em nível de espécie por morfometria comparativa, análise molecular por PCR e sequenciamento genômico, com validação pela análise de concordância pelo teste Kappa. As larvas de A. dubitatum apresentaram um comprimento significativamente maior que as larvas de A. sculptum. Embora nenhuma outra espécie do gênero Amblyomma tenha sido testada neste estudo, essa técnica poderá ser utilizada nos locais onde levantamentos acarológicos prévios, baseados nos estádios de ninfa e adultos, indicaram a presença de apenas A. sculptum e A. dubitatum, geralmente mantidos por capivaras. Digno de nota, essa condição é muito comum ao longo das áreas endêmicas para FMB na região Sudeste do Brasil.(AU)

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Ticks are involved in biological processes of a wide variety of pathogenic organisms. The genus Amblyomma presents the greatest medical importance, with the species Amblyomma sculptum Berlese, 1888 involved in the transmission cycle of Brazilian Spotted Fever (BSF). In this study, we performed a molecular validation of the morphometric differentiation based on the idiosomal length of the larvae of A. dubitatum and A. sculptum. Unfed larvae were collected in two BSF-transmission areas, using the attractive CO2 trap technique. Larvae were identified at the species level by comparative morphometry, molecular analysis by PCR and genomic sequencing, with validation through agreement analysis by the Kappa test. The larvae of A. dubitatum showed a significantly longer idiosomal length than A. sculptum larvae. Although no other species of the genus Amblyomma has been tested in this study, this technique can be applied to places where previous acarological surveillances based on adult and nymphal ticks stages have indicated the presence of only A. sculptum and A. dubitatum, usually sustained by capybaras. Noteworthy, this condition is very common among many BSF-endemic areas in southeastern Brazil.(AU)

Asunto(s)

Animales , Ixodidae/clasificación , Ixodidae/genética , Fiebre Maculosa de las Montañas Rocosas , Roedores/parasitología

RESUMEN

Os carrapatos estão envolvidos em processos biológicos de uma grande variedade de organismos patogênicos. O gênero Amblyomma é o de maior importância médica, com a espécie Amblyomma sculptum Berlese, 1888 envolvida no ciclo de transmissão da febre maculosa brasileira (FMB). Neste estudo, objetivou-se a validação molecular para uma diferenciação na característica morfométrica e no tamanho de idiossoma de larvas de duas espécies de carrapatos, Amblyomma dubitatum Neumann, 1899 e A. sculptum. Larvas não alimentadas foram coletadas em duas áreas de transmissão para FMB, por meio da técnica de armadilha atrativa de CO2. Foram identificadas em nível de espécie por morfometria comparativa, análise molecular por PCR e sequenciamento genômico, com validação pela análise de concordância pelo teste Kappa. As larvas de A. dubitatum apresentaram um comprimento significativamente maior que as larvas de A. sculptum. Embora nenhuma outra espécie do gênero Amblyomma tenha sido testada neste estudo, essa técnica poderá ser utilizada nos locais onde levantamentos acarológicos prévios, baseados nos estádios de ninfa e adultos, indicaram a presença de apenas A. sculptum e A. dubitatum, geralmente mantidos por capivaras. Digno de nota, essa condição é muito comum ao longo das áreas endêmicas para FMB na região Sudeste do Brasil.(AU)

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Ticks are involved in biological processes of a wide variety of pathogenic organisms. The genus Amblyomma presents the greatest medical importance, with the species Amblyomma sculptum Berlese, 1888 involved in the transmission cycle of Brazilian Spotted Fever (BSF). In this study, we performed a molecular validation of the morphometric differentiation based on the idiosomal length of the larvae of A. dubitatum and A. sculptum. Unfed larvae were collected in two BSF-transmission areas, using the attractive CO2 trap technique. Larvae were identified at the species level by comparative morphometry, molecular analysis by PCR and genomic sequencing, with validation through agreement analysis by the Kappa test. The larvae of A. dubitatum showed a significantly longer idiosomal length than A. sculptum larvae. Although no other species of the genus Amblyomma has been tested in this study, this technique can be applied to places where previous acarological surveillances based on adult and nymphal ticks stages have indicated the presence of only A. sculptum and A. dubitatum, usually sustained by capybaras. Noteworthy, this condition is very common among many BSF-endemic areas in southeastern Brazil.(AU)

Asunto(s)

Animales , Ixodidae/clasificación , Ixodidae/genética , Fiebre Maculosa de las Montañas Rocosas , Roedores/parasitología

RESUMEN

AIM: The aim of this article was to describe the essential concepts of the split-mouth design, its underlying assumptions, advantages, limitations, statistical considerations, and possible applications in Paediatric Dentistry clinical investigation. DISCUSSION: In Paediatric Dentistry clinical investigation, and as part of randomised controlled trials, the split-mouth design is commonly used. The design is characterised by subdividing the child's dentition into halves (right and left), where two different treatment modalities are assigned to one side randomly, in order to allow further outcome evaluation. Each participant acts as their own control by making within- patient rather than between-patient comparisons, thus diminishing inter-subject variability and increasing study accuracy and power. However, the main problem with this design comprises the potential contamination of the treatment effect from one side to the other, or the "carry-across effect"; likewise, this design is not indicated when the oral disease to be treated is not symmetrically distributed (e.g. severity) in the mouth of children. Thus, in spite of its advantages, the split-mouth design can only be applied in a limited number of strictly selected cases. CONCLUSION: In order to obtain valid and reliable data from split mouth design studies, it is necessary to evaluate the risk of carry-across effect as well as to carefully analise and select adequate inclusion criteria, sample-size calculation and method of statistical analysis.

Asunto(s)

Ensayos Clínicos como Asunto , Odontología Pediátrica , Proyectos de Investigación , Humanos , Tamaño de la Muestra

RESUMEN

Conventional approaches to bone regeneration rarely use multiwall carbon nanotubes (MWCNTs) but instead use polymeric matrices filled with hydroxyapatite, calcium phosphates and bioactive glasses. In this study, we prepared composites of MWCNTs/polycaprolactone (PCL) for bone regeneration as follows: (a) MWCNTs randomly dispersed on PCL, (b) MWCNTs aligned with an electrical field to determine if the orientation favors the growing of human dental pulp stem cells (HDPSCs), and (c) MWCNTs modified with ß-glycerol phosphate (BGP) to analyze its osteogenic potential. Raman spectroscopy confirmed the presence of MWCNTs and BGP on PCL, whereas the increase in crystallinity by the addition of MWCNTs to PCL was confirmed by X-ray diffraction and differential scanning calorimetry. A higher elastic modulus (608 ± 4.3 MPa), maximum stress (42 ± 6.1 MPa) and electrical conductivity (1.67 × 10(-7) S/m) were observed in non-aligned MWCNTs compared with the pristine PCL. Cell viability at 14 days was similar in all samples according to the live/dead assay, but the 21 day cell proliferation, measured by MTT was higher in MWCNTs aligned with BGP. Von Kossa and Alizarin red showed larger amounts of mineral deposits on MWCNTs aligned with BGP, indicating that at 21 days, this scaffold promotes osteogenic differentiation of HDPSCs.

Asunto(s)

Regeneración Ósea , Pulpa Dental/citología , Nanotubos de Carbono/química , Poliésteres/química , Células Madre/citología , Andamios del Tejido/química , Adolescente , Adulto , Huesos/citología , Huesos/fisiología , Técnicas de Cultivo de Célula/instrumentación , Técnicas de Cultivo de Célula/métodos , Células Cultivadas , Pulpa Dental/fisiología , Humanos , Ensayo de Materiales , Osteogénesis/fisiología , Células Madre/fisiología , Ingeniería de Tejidos/instrumentación , Ingeniería de Tejidos/métodos , Adulto Joven

RESUMEN

AIM: The objective of this study was to evaluate the efficacy of subcutaneous (SC) sedation using midazolam with and without ketamine in non-cooperative pediatric patients undergoing dental treatment. STUDY DESIGN: A prospective, randomized, controlled, double-blind, crossover pilot clinical trial was carried out in 13 children, aged between 17-46 months, ASA l, Frankl 1. Two sedation schemes were administered SC: Midazolam alone (M), and a combination of Midazolam-Ketamine (MK). Both regimens were administered to the same patient in two consecutive treatment sessions, in accordance with a random assignment. Overall behavior, movement, and crying were assessed according to the modified Houpt scale. Heart rate, blood pressure, blood oxygen saturation, and possible side effects were also monitored. RESULTS: The percentage of non-crying children was always higher in the treatment with MK compared with the treatment with M, but without a significant statistical difference. Regarding variable body movement, the percentage of children without movement was higher in the MK group, although only up to minute 10; no significant differences were found at 20, 30, and 40 minutes, and from minute 40, body movement was lower in the M group. CONCLUSIONS: Midazolam alone and the midazolam-ketamine combination administered subcutaneously resulted in a safe and efficient pharmacological method for providing moderate sedation to non-cooperative pediatric patients undergoing dental treatment.

Asunto(s)

Anestesia Dental/métodos , Anestésicos Combinados/administración & dosificación , Anestésicos Disociativos/administración & dosificación , Sedación Consciente/métodos , Hipnóticos y Sedantes/administración & dosificación , Ketamina/administración & dosificación , Midazolam/administración & dosificación , Presión Sanguínea/efectos de los fármacos , Conducta Infantil/efectos de los fármacos , Preescolar , Conducta Cooperativa , Estudios Cruzados , Llanto , Atención Dental para Niños , Método Doble Ciego , Frecuencia Cardíaca/efectos de los fármacos , Humanos , Lactante , Infusiones Subcutáneas , Actividad Motora/efectos de los fármacos , Oxígeno/sangre , Proyectos Piloto , Estudios Prospectivos , Factores de Tiempo

RESUMEN

AIM: To assess the effect of the daily ingestion of a mixture of probiotics on the amount of Streptococcus mutans in the oral cavity of preschool-age patients with a high risk of caries. MATERIALS AND METHODS: Forty patients, aged between 4 and 6 years, with a high risk of dental caries were included in this pilot study. Patients were randomly assigned to two study groups: the Experimental Group (A) included patients who brushed their teeth and used fluoridated toothpaste in addition to consuming probiotics daily, and the Control Group (B) inclused patients who brushed their teeth and used fluoridated toothpaste but did not consume probiotics. Using the CariScreen, the microorganism count was determined at different times: baseline, 7, 14, 21 and 30 days. To identify the differences between both groups, a Mann-Whitney U test was performed, with a significance level of 0.05. RESULTS: It was observed that both groups showed similar microbial counts at the beginning of the trial (p>0.05), and a significant decrease in the count at the end of the study was found in the experimental group (p<0.05) 15 days after suspending ingestion. CONCLUSION: We found a significant reduction of RLU values in preschool children who ingested the tested probiotics in relation to the baseline values and 15 days after ceasing consumption.

Asunto(s)

Boca/microbiología , Probióticos/uso terapéutico , Streptococcus mutans/efectos de los fármacos , Carga Bacteriana/efectos de los fármacos , Cariostáticos/uso terapéutico , Niño , Preescolar , Susceptibilidad a Caries Dentarias/efectos de los fármacos , Femenino , Fluoruros/uso terapéutico , Estudios de Seguimiento , Humanos , Incisivo/microbiología , Masculino , Diente Molar/microbiología , Proyectos Piloto , Placebos , Streptococcus/clasificación , Streptococcus oralis/fisiología , Cepillado Dental/métodos , Pastas de Dientes/uso terapéutico

RESUMEN

PURPOSE: We report the response rate in children older than 18 months with stage 4 Neuroblastoma, using a modified dose-intensive, response-adaptive, induction mN7 protocol. METHODS: From 2005 to 2012, 24 patients were treated with the mN7 protocol. Phase 1 included five MSKCC N7 cycles and surgery and two high-dose cyclophosphamide-topotecan (HD-CT) cycles for those who did not achieve complete remission (CR) and negative bone marrow (BM) minimal residual disease (MRD) status (CR+MRD-). Phase 2 consisted of myeloablative doses of topotecan, thiotepa and carboplatin plus hyperfractionated RT. Phase 3 included isotretinoin and 3F8 immunotherapy plus GM-CSF. BM MRD was monitored using GD2 synthase, PHOX2B and cyclin D1 mRNAs. RESULTS: After 3 cycles, all patients showed BM complete histological clearance and 6 (25 %) were MRD-. Twenty of 21 s-look surgeries achieved macroscopic complete resection. After 5 cycles and surgery, (123)I-MIBG scan was negative in 15 (62.5 %) cases, BM disease by histology was negative in 23 (96 %) and 10 (42 %) patients were MRD-. Twelve (50 %) pts were in CR, 2 in very good partial response (VGPR), 9 partial response (PR) and one had progressive disease. With 2 HD-CT extra cycles, 17 (71 %) pts achieved CR+MRD- status moving to phase 2. Overall and event-free survival at 3 years for the 17 patients who achieved CR+MRD- is 65 and 53 %, respectively, median follow-up 47 months. Seven (29 %) patients never achieved CR+MRD-. Univariate Cox regression analysis shows CR+MRD- status after mN7 induction as the only statistically significant prognostic factor to predict overall survival. CONCLUSIONS: mN7 induction regimen produced a CR+MRD- rate of 71 %. CR+MRD- status following induction was the only predictive marker of long-term survival.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Médula Ósea/patología , Neoplasias Encefálicas/tratamiento farmacológico , Quimioterapia de Consolidación/métodos , Quimioterapia de Inducción/métodos , Neuroblastoma/tratamiento farmacológico , Procedimientos Neuroquirúrgicos , Carboplatino/administración & dosificación , Niño , Preescolar , Cisplatino/administración & dosificación , Estudios de Cohortes , Ciclofosfamida/administración & dosificación , Supervivencia sin Enfermedad , Doxorrubicina/administración & dosificación , Etopósido/administración & dosificación , Femenino , Humanos , Inmunoterapia , Lactante , Isotretinoína/administración & dosificación , Masculino , Terapia Neoadyuvante , Estadificación de Neoplasias , Neuroblastoma/patología , Proyectos Piloto , Estudios Prospectivos , Radioterapia , Tiotepa/administración & dosificación , Topotecan/administración & dosificación , Resultado del Tratamiento , Vincristina/administración & dosificación

RESUMEN

This study compared the analgesic and anti-inflammatory efficacy, trismus control, and tolerability of the combination of lysine clonixinate and tramadol (LCT) versus tramadol (T) alone after surgical removal of impacted mandibular third molars. This study was a double-blind, randomized clinical trial, including two study groups of 20 patients each, who exhibited acute pain subsequent to surgical extraction of two mandibular third molars. Pain intensity was quantified over a 96-h period using a visual analogue scale and a 5-point verbal rating scale. Secondary indicators of analgesic and anti-inflammatory efficacy, trismus control, and tolerability were determined. Patients administered LCT exhibited better therapeutic effects that those administered T. Fifty percent of patients in the LCT group rated this therapy as 'excellent analgesia' compared with only 10% in the T group. The onset of the analgesic effect of LCT was significantly faster, without any therapeutic failures. There were no significant differences between the groups with regard to anti-inflammatory effect or trismus. The results of this study suggest that the postsurgical analgesic efficacy of LCT in combination (LC 125 mg + T 25 mg) is superior to that obtained with T alone, administered at the standard dose of 50 mg, for up to 96 h after the extraction of both impacted mandibular third molars.

Asunto(s)

Analgésicos Opioides/uso terapéutico , Analgésicos/uso terapéutico , Clonixina/análogos & derivados , Lisina/análogos & derivados , Tercer Molar/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Diente Impactado/cirugía , Tramadol/uso terapéutico , Adulto , Clonixina/uso terapéutico , Método Doble Ciego , Quimioterapia Combinada , Femenino , Humanos , Lisina/uso terapéutico , Masculino , Manejo del Dolor , Dimensión del Dolor , Resultado del Tratamiento , Trismo/prevención & control

RESUMEN

In the genus Entamoeba, actin reorganization is necessary for cyst differentiation; however, its role is still unknown. The aim of this work was to investigate the role of actin and encystation-related proteins during Entamoeba invadens encystation. Studied proteins were actin, RhoA, a small GTPase involved through its effectors in the rearrangement of the actin cytoskeleton; Rab11, a protein involved in the transport of encystation vesicles; and enolase, as an encystment vesicles marker. Results showed a high level of polymerized actin accompanied by increased levels of RhoA-GTP during cell rounding and loss of vacuoles. Cytochalasin D, an actin polymerization inhibitor, and Y27632, an inhibitor of RhoA activity, reduced encystment in 80%. These inhibitors also blocked cell rounding, disposal of vacuoles, and the proper formation of the cysts wall. At later times, F-actin and Rab11 colocalized with enolase, suggesting that Rab11 could participate in the transport of the cyst wall components through the F-actin cytoskeleton. These results suggest that actin cytoskeleton rearrangement is playing a decisive role in determining cell morphology changes and helping with the transport of cell wall components to the cell surface during encystment of E. invadens.

Asunto(s)

Actinas/metabolismo , Entamoeba/crecimiento & desarrollo , Entamoeba/metabolismo , Proteínas Protozoarias/metabolismo , Proteínas de Unión al GTP rab/metabolismo , Proteína de Unión al GTP rhoA/metabolismo , Actinas/genética , Secuencia de Aminoácidos , Animales , Citoesqueleto/metabolismo , Citoesqueleto/ultraestructura , Entamoeba/genética , Humanos , Datos de Secuencia Molecular , Proteínas Protozoarias/genética , Homología de Secuencia de Aminoácido , Vacuolas/metabolismo , Vacuolas/ultraestructura , Proteínas de Unión al GTP rab/genética , Proteína de Unión al GTP rhoA/genética

RESUMEN

Cytoskeleton remodeling can be regulated, among other mechanisms, by lysine acetylation. The role of acetylation on cytoskeletal and other proteins of Entamoeba histolytica has been poorly studied. Dynamic rearrangements of the actin cytoskeleton are crucial for amebic motility and capping formation, processes that may be effective means of evading the host immune response. Here we report the possible effect of acetylation on the actin cytoskeleton dynamics and in vivo virulence of E. histolytica. Using western blot, immunoprecipitation, microscopy assays, and in silico analysis, we show results that strongly suggest that the increase in Aspirin-induced cytoplasm proteins acetylation reduced cell movement and capping formation, likely as a consequence of alterations in the structuration of the actin cytoskeleton. Additionally, intrahepatic inoculation of Aspirin-treated trophozoites in hamsters resulted in severe impairment of the amebic virulence. Taken together, these results suggest an important role for lysine acetylation in amebic invasiveness and virulence.

Asunto(s)

Citoesqueleto de Actina/metabolismo , Entamoeba histolytica/metabolismo , Entamoeba histolytica/patogenicidad , Lisina/metabolismo , Acetilación/efectos de los fármacos , Citoesqueleto de Actina/efectos de los fármacos , Actinas/metabolismo , Secuencia de Aminoácidos , Animales , Aspirina/farmacología , Sitios de Unión , Cricetinae , Citocalasina D/farmacología , Entamoeba histolytica/crecimiento & desarrollo , Entamoeba histolytica/ultraestructura , Masculino , Simulación del Acoplamiento Molecular , Datos de Secuencia Molecular , Movimiento/efectos de los fármacos , Parásitos/efectos de los fármacos , Parásitos/crecimiento & desarrollo , Polimerizacion/efectos de los fármacos , Trofozoítos/efectos de los fármacos , Trofozoítos/crecimiento & desarrollo , Trofozoítos/ultraestructura , Virulencia

RESUMEN

Introducción: El Ministerio de Salud del Perú atiende a población que no cuenta con seguro social y carece de un programa nacional de diálisis, por lo que la atención es limitada a hospitales que cuentan con centros de diálisis. Objetivos: Determinar la mortalidad en la primera hospitalización de pacientes incidentes de diálisis en una población sin seguro social. Diseño: Estudio descriptivo. Lugar: Hospital Nacional 2 de Mayo, Lima, Perú. Participantes: Pacientes con enfermedad renal crónica. Intervenciones: Se estudió a los pacientes que iniciaron diálisis desde enero hasta diciembre del 2012. Para describir se utilizó promedios, porcentajes, desviaciones estándar. Principales medidas de resultados: Características clínicas de los pacientes que iniciaron diálisis. Resultados: Se estudió 105 pacientes con edad promedio de 55,5 años; el 62,9% fue hombre. La etiología más frecuente fue la etiología no filiada (39,1%), seguido de la nefropatía diabética (31,4%). El 71,7% no se atendió previamente en este hospital. El 46,7% conoció su diagnóstico de enfermedad renal crónica durante su hospitalización y 75,2% supo que requería diálisis durante su hospitalización. El 80% no había tenido evaluación nefrológica previa, 89% ingresó por emergencia, con una estancia hospitalaria promedio de 16 días. El catéter venoso central transitorio fue el acceso vascular más usado (96,2%). Las principales indicaciones de diálisis fueron: encefalopatía urémica (59,1%) y acidosis metabólica severa (39,1%). El 23,3% falleció durante su primera hospitalización. Conclusiones: El control prediálisis de los pacientes es deficiente. Cerca de un cuarto de ellos muere durante su primera hospitalización.

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Introduction: The Health Ministry attends Peruvian population without social security and without a national dialysis program. Attention is limited to a few hospitals with dialysis centers. objectives: To determine mortality in the first hospitalization for dialysis in a population without social security. design: Descriptive study. Setting: Hospital Nacional Dos de Mayo, Lima, Peru. Patients: Patients with chronic renal disease. Interventions: We studied patients who started dialysis from January to December, 2012. We described averages, percentages, standard deviations. Main outcome measures: Clinical characteristics of patients starting dialysis. results: In 105 patients studied mean age was 55.5 years, 62.9% were men. Most common etiology was not determined (39.1%) followed by diabetic nephropathy (31.4%); 71.7% were not previously attended at our hospital; 46.7% knew their diagnosis of chronic kidney disease, 75.2% learned he required dialysis during hospitalization; 80% had no previous nephrology evaluation, 89% was admitted by emergency, with a mean hospital stay of 16 days. Transient central venous catheter was the most used vascular access (96.2%). Main indications for dialysis were uremic encephalopathy (59.1%) and severe metabolic acidosis (39.1%); 23.3% died during their first hospitalization. Conclusions: Patients’ pre dialysis control was poor. About a quarter of them died during their first hospitalization.

RESUMEN

Knowledge and lessons from past accidental exposures in radiotherapy are very helpful in finding safety provisions to prevent recurrence. Disseminating lessons is necessary but not sufficient. There may be additional latent risks for other accidental exposures, which have not been reported or have not occurred, but are possible and may occur in the future if not identified, analyzed, and prevented by safety provisions. Proactive methods are available for anticipating and quantifying risk from potential event sequences. In this work, proactive methods, successfully used in industry, have been adapted and used in radiotherapy. Risk matrix is a tool that can be used in individual hospitals to classify event sequences in levels of risk. As with any anticipative method, the risk matrix involves a systematic search for potential risks; that is, any situation that can cause an accidental exposure. The method contributes new insights: The application of the risk matrix approach has identified that another group of less catastrophic but still severe single-patient events may have a higher probability, resulting in higher risk. The use of the risk matrix approach for safety assessment in individual hospitals would provide an opportunity for self-evaluation and managing the safety measures that are most suitable to the hospital's own conditions.

Asunto(s)

Exposición a Riesgos Ambientales/prevención & control , Seguridad del Paciente , Radioterapia/efectos adversos , Medición de Riesgo/métodos , Humanos , Funciones de Verosimilitud

RESUMEN

Infective endocarditis is a serious and uncommon condition affecting the endocardium. Less than 10% of these cases are of fungal origin. A growing number of individuals are at high risk, due to insertion of central venous catheters, total parenteral nutrition and prolonged exposure to broad-spectrum antibiotics, even without previous heart diseases. We retrospectively analysed the records of six children with Candida endocarditis, reviewing the comorbidities, clinical outcome, and treatment. The antifungal agents used were amphotericin B, 5-fluorocytosine and fluconazole. Patients underwent surgical excision of vegetation, five tricuspid valve repairs and one mitral valve replacement. There were no hospital deaths, and one child needed a new valvuloplasty one year later. The mean follow up was five years, and all have good valvular function without recurrent endocarditis. A combination of synergistic long-term antifungal treatment and early surgical intervention is recommended.

Asunto(s)

Candidiasis , Endocarditis , Candidiasis/diagnóstico , Candidiasis/terapia , Preescolar , Endocarditis/diagnóstico , Endocarditis/terapia , Femenino , Humanos , Lactante , Masculino , Estudios Retrospectivos