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1.
Med Oral Patol Oral Cir Bucal ; 29(4): e458-e467, 2024 Jul 01.
Artículo en Inglés | MEDLINE | ID: mdl-38907642

RESUMEN

BACKGROUND: Sutures have been the standard flap closure method of choice following mandibular third molar surgery but can lead to some complications. Tissue adhesives, including cyanoacrylate, have emerged as alternative flap closure method in this surgery to overcome such drawbacks. However, limited clinical trials can be found. Therefore, the aim of this clinical study was to compare two methods of flap closure in mandibular third molar surgery, cyanoacrylate and 4/0 silk sutures, by assessing post-operative outcome measures (pain, swelling, trismus, and healing) and patient-reported outcome measures (PROMs). MATERIAL AND METHODS: A randomized split-mouth clinical trial was designed, in which mandibular third molar (M3M) extractions were performed, where the control side flap was closed with 4/0 silk sutures and the test side flap with cyanoacrylate. Swelling, pain, trismus, healing, and PROMs were recorded post-operatively. These variables were analyzed by means of the nonparametric Mann-Whitney U test, using SPSS statistical software version 28.0.0 (IBM® SPSS®, Chicago, IL, USA). For all results, a 95% confidence interval was recorded (significance level p < 0.05, two-tailed). RESULTS: A total of 17 patients were recruited and 34 mandibular third molar extractions were performed. No statistically significant differences were found in terms of swelling, pain, trismus, healing, and PROMs between both groups (p<0.05). CONCLUSIONS: No statistically significant differences were found between flap closure with 4/0 silk sutures and cyanoacrylate, in terms of surgical post-operative outcomes and PROMs. However, further studies with larger sample sizes are required to be able to affirm it with greater certainty.


Asunto(s)
Cianoacrilatos , Mandíbula , Tercer Molar , Colgajos Quirúrgicos , Humanos , Tercer Molar/cirugía , Masculino , Femenino , Adulto , Cianoacrilatos/uso terapéutico , Mandíbula/cirugía , Adulto Joven , Suturas , Extracción Dental , Técnicas de Sutura
2.
Med Oral Patol Oral Cir Bucal ; 29(1): e44-e50, 2024 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-37992147

RESUMEN

BACKGROUND: Surgical extraction of the lower third molar (LTM) may trigger neurosensory injury of the inferior alveolar nerve, making extraction a real challenge. This study set out to assess whether is it possible to predict neurosensory alterations from preoperative imaging. MATERIAL AND METHODS: A total of 99 patients underwent 124 impacted lower third molar (ILTM) surgeries. Prior to surgery, panoramic and CBCT images were evaluated in an attempt to predict a neurosensory disturbance. Preoperative data (ILTM position, panoramic radiograph signs, inferior alveolar nerve (IAN) location and its contact with the ILTM roots) and intra/postoperative findings (extraction difficulty and sensitivity alterations) were recorded. Descriptive and bivariate data analysis was performed. Statistical comparison applied the chi-square test, Fisher test, and one-way ANOVA test. Statistical significance was established with a confidence interval (CI) of 95%. RESULTS: In 4.03% of cases, patients experienced neurosensory alterations. Of 124 ILTM positions in panoramic radiographs, 76 cases were considered to exhibit a potential neurosensory risk as they presented two or more types of superimposed relationships between ILTM and mandibular canal. Of these, alterations were reported in only three cases (3.95%). Of the 48 remaining ILTM images presenting only one sign, neurosensory alterations were observed in two cases (4.17%). No permanent alterations were recorded in any of the five cases observed. CONCLUSIONS: Within the limitations of the present study, prediction of neurosensory alterations prior to ILTM extraction by means of preoperative imaging did not show a significant statistical correlation with post-surgical incidence. Nevertheless, interruption of the canal´s white line (ICWL) or a diversion of the canal (DC) may predict an increased risk of IAN injury.


Asunto(s)
Diente Impactado , Traumatismos del Nervio Trigémino , Humanos , Tercer Molar/diagnóstico por imagen , Tercer Molar/cirugía , Estudios Prospectivos , Tomografía Computarizada de Haz Cónico , Cuidados Preoperatorios , Extracción Dental/efectos adversos , Diente Impactado/diagnóstico por imagen , Diente Impactado/cirugía , Diente Impactado/complicaciones , Radiografía Panorámica/efectos adversos , Radiografía Panorámica/métodos , Nervio Mandibular/diagnóstico por imagen , Traumatismos del Nervio Trigémino/etiología , Mandíbula
3.
Av. odontoestomatol ; 39(2)abr.-jun. 2023.
Artículo en Español | IBECS | ID: ibc-223393

RESUMEN

El propósito de esta revisión es resumir la virología del virus de la viruela del mono, su transmisión, epidemiología, manifestaciones clínicas, manifestaciones orales, tratamiento y las posibles implicaciones para los dentistas. Se analizan los riesgos de transmisión a trabajadores de la salud. Un paciente asintomático o con síntomas tempranos no específicos puede acudir a la clínica dental para tratamiento odontológico. Los pacientes contagiados asintomáticos o con contacto con el virus, si el tratamiento no es urgente, deben respetar 21 días de cuarentena tras la exposición. Las gotículas respiratorias y los aerosoles a los que estamos expuest os los odontólogos al atender a los pacientes son una de las principales vías de transmisión.Sin embargo, la profesión odontológica está preparada para este nuevo reto ya que aún estamos aplicando todas las medidas de prevención aprendidas con la pandemia de COVID-19 (mascarillas FFP2, gafas, guantes, ventilación, etc) (AU)


The purpose of this review is to summarize the virology of the monkeypox virus, transmission, epidemiology, clinical features, oral manifestations, treatment, and possible implications for dentists. The risks of transmission to health workers are analyzed. A patient with no symptoms or early non-specific symptoms may come to the dental clinic for treatment. These patients or those who have been in contact with the virus, if the treatment is not urgent, must wait 21 days after exposure, which is the quarantine time. Respiratory droplets and aerosols to which dentists are exposed when caring for patients are one of the main routes of transmission. The dental profession is prepared for this new challenge as we are still applying all the prevention measures learned from the COVID-19 pandemic (FFP2 masks, goggles, gloves, ventilation, etc.) (AU)


Asunto(s)
Humanos , Odontólogos , Mpox/tratamiento farmacológico , Mpox/epidemiología , Mpox/virología , Monkeypox virus , Transmisión de Enfermedad Infecciosa de Paciente a Profesional , Transmisión de Enfermedad Infecciosa
4.
Cient. dent. (Ed. impr.) ; 19(2): 91-101, may. - jun. - jul. - ago. 2022. ilus, tab
Artículo en Español | IBECS | ID: ibc-208291

RESUMEN

Introducción: El Síndrome de Boca Ardiente (SBA), cuya definición y fisiopatología continúan siendo un tema de debate actual, tampoco cuenta con unas pautas universalmente aceptadas para su tratamiento. Por ello, el objetivo del presente trabajo es presentar una valoración de los distintos tratamientos para el manejo clínico de los pacientes con SBA en base a la evidencia científica disponible, para que se valore su aplicación en cada caso concreto. Material y métodos: Se realizó una búsqueda en las bases de datos de PubMed (MEDLINE) y The Cochrane Library (Wiley) sobre los distintos tratamientos del SBA. Con los datos obtenidos respecto a la efectividad de cada modalidad terapéutica y los efectos adversos que produce, se han elaborado tres diferentes líneas de tratamiento. Resultados: En la primera línea de tratamiento encontramos los chicles, la LLLT (terapia con láser de baja potencia, en inglés), el protector lingual, la psicoterapia, clonazepam tópico, ALA (ácido alfa-lipoico, en inglés) y la Catauma. Conclusión: Hacen falta más investigaciones que brinden una orientación suficiente a los clínicos sobre las modalidades terapéuticas efectivas y que permitan establecer una correcta estrategia en el manejo del SBA (AU)


Introduction: The definition and pathophysiology of Burning Mouth Syndrome (BMS) remain a subject of ongoing debate, and there are no universally accepted guidelines for its treatment. Therefore, the objective of this paper is to present an assessment of the different treatments for the clinical management of patients with BMS on the basis of the available scientific evidence, so that their application in each specific case can be assessed. Material and methods: A search was carried out in the PubMed (MEDLINE) and The Cochrane Library (Wiley) databases on the different treatments for BMS. With the data obtained regarding the effectiveness of each therapeutic modality and the adverse effects it produces, three different lines of treatment have been developed. Results: The first line of treatment includes chewing gum, LLLT (low level laser therapy), tongue guard, psychotherapy, topical clonazepam, ALA (alpha lipoic acid) and Catauma. Conclusion: Further research is required to provide sufficient guidance to clinicians on effective therapeutic modalities and to establish a correct strategy in the management of BMS (AU)


Asunto(s)
Humanos , Síndrome de Boca Ardiente/terapia , Ensayos Clínicos como Asunto
5.
Cient. dent. (Ed. impr.) ; 19(2): 113-120, may. - jun. - jul. - ago. 2022. ilus
Artículo en Español | IBECS | ID: ibc-208293

RESUMEN

La extracción o pérdida dental supone la remodelación del alveolo y una pérdida progresiva del hueso alveolar residual. Esta disminución en altura, debido a la presencia delseno maxilar en el sector posterosuperior, puede comprometer la disponibilidad ósea adecuada para la colocación de implantes. Como solución a esto, surge la técnica de elevación de seno. En esta técnica, se emplean diversos materiales de injerto, entre los que se encuentran el betafosfatotricálcico (b-TCP). Este material presenta propiedades osteoconductivas y osteoinductivas. Además, se reabsorbe más fácil que otros sustitutos óseos y es fácilmente reemplazado por nuevo hueso. Se ha comparado su comportamiento clínico con otros materiales de injerto, sin encontrar diferencias significativas. Además, a 10 años, los implantes colocados en elevaciones de seno realizadas con b-TCP han mostrado altas tasas de supervivencia. Caso clínico. Se presenta el caso clínico de una paciente, mujer de 52 años de edad, sin antecedentes médicos de interés. Acude a consulta por dolor en el 26. Tras la exploración diagnóstica radiológica e intrabucal se aconsejó a la paciente la extracción del 26. Ocho meses después, y realizando un estudio con CBCT se informó a la paciente sobre la posibilidad de rehabilitación con implantes, previa cirugía de elevación sinusal. Se realizó la elevación sinusal con b-TCP como material de injerto. Pasados tres meses, se procedió a la colocación de tres implantes, adquiriendo estos una buena estabilidad primaria Discusión y conclusiones. Se utilizan diversos materiales de injerto en la técnica de elevación sinusal, injertos de hueso autólogo, xenoinjertos e injerto aloplásticos. Se ha comparado el comportamiento clínico del b-TCP con otros materiales de injerto sin mostrar diferencias significativas. Por otro lado, se ha estudiado un periodo de espera menor a 6 (AU)


Tooth extraction or loss involves alveolar remodelling and progressive loss of residual alveolar bone. This reduction in height, due to the presence of the maxillary sinus in the posterosuperior sector, can compromise adequate bone availability for implant placement. The sinus lift technique has emerged as a solution to this problem. In this technique, various grafting materials are used, including beta-phosphatidic acid (b-TCP). This material has osteoconductive and osteoinductive properties. In addition, it is more easily resorbed than other bone substitutes and is easily replaced by new bone. Its clinical behaviour has been compared with other graft materials, without finding significant differences. In addition, at 10 years, implants placed in sinus lifts performed with b-TCP have shown high survival rates. Clinical case: The clinical case of a 52-year-old female patient with no medical history of interest is presented. She went for consultation due to pain in tooth 26. Following the radiological and intraoral diagnostic examination, the patient was advised to have tooth 26 extracted. Eight months later, and after a CBCT study, the patient was informed about the possibility of rehabilitation with implants, following sinus lift surgery. The sinus lift was performed with b-TCP as graft material. After three months, three implants were placed, acquiring a good primary stability. Discussion and conclusions: different graft materials are used in the sinus lift technique, autologous bone grafts, xenografts and alloplastic grafts. The clinical performance of b-TCP has been compared with no significant differences found. Furthermore, a waiting period of less than 6 months has been studied for the placement of implants. These implants showed high primary stability and survival rates of 99-100%. Therefore, b-TCP is a safe material for sinus lifts and allows the placement of implants in a healing time of less than 6 months (AU)


Asunto(s)
Humanos , Femenino , Persona de Mediana Edad , Implantación Dental/métodos , Sustitutos de Huesos/administración & dosificación , Elevación del Piso del Seno Maxilar , Fosfatos de Calcio/administración & dosificación
6.
Med Oral Patol Oral Cir Bucal ; 27(3): e230-e237, 2022 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-35420067

RESUMEN

BACKGROUND: The diagnosis of oral melanotic lesions is, more often than not, challenging in the clinical practice due to the fact that there are several reasons which may cause an increase in pigmentation on localized or generalized areas. Among these, medication stands out. MATERIAL AND METHODS: In this work, we have carried out a review in the reference pharma database: Micromedex® followed by a review of the scientific published literature to analyse coincidences and possible discrepancies. RESULTS: Our findings show that there are several prescription drugs that can cause pigmented lesions in the oral mucosa. This must be known by clinicians in order to properly diagnose pigmented lesions. We have identified a set of 21 medicaments which cause these lesions, some of which are used frequently in the clinic, such as Metronidazole, Amitriptyline, conjugated oestrogens and Chlorhexidine gluconate. We also found discrepancies with the data published in specialized literature, some of which wasn't reflected in the Summary of Product Characteristics. CONCLUSIONS: Our work highlights the importance of the proper communication of adverse drug reactions (ADR) by health professionals in order to provide thorough and accurate information and diagnosis.


Asunto(s)
Mucosa Bucal , Úlceras Bucales , Humanos , Mucosa Bucal/patología , Pigmentación
7.
Rheumatol Int ; 41(8): 1419-1427, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-33656582

RESUMEN

The incidence of Pneumocystis jirovecii pneumonia (PJP) has increased over recent years in patients with systemic autoimmune rheumatic diseases (SARD). PJP prognosis is poor in those receiving immunosuppressive therapy and glucocorticoids in particular. Despite the effectiveness of cotrimoxazole against PJP, the risk of adverse effects remains significant, and no consensus has emerged regarding the need for PJP prophylaxis in SARD patients undergoing immunosuppressor therapies.Objective: To evaluate the efficacy and safety of cotrimoxazole prophylaxis against PJP in SARD adult patients receiving immunosuppressive therapies. Methods: We performed a systematic review, consulting MEDLINE, EMBASE, and Cochrane Library databases up to April 2020. Outcomes covered prevention of PJP, other infections, morbidity, mortality, and safety. The information obtained was summarized with a narrative review and results were tabulated. Of the 318 identified references, 8 were included. Two were randomized controlled trials and six observational studies. The quality of studies was moderate or low. Despite disparities in the cotrimoxazole prophylaxis regimens described, results were consistent in terms of efficacy, particularly with glucocorticoid doses > 20 mg/day. However, cotrimoxazole 400 mg/80 mg/day, prescribed three times/ week, or 200 mg/40 mg/day or in dose escalation, exhibited similar positive performances. Conversely, cotrimoxazole 400 mg/80 mg/day showed higher incidences of withdrawals and adverse effects. Cotrimoxazole prophylaxis against PJP exhibited efficacy in SARD, mainly in patients taking glucocorticoids ≥ 20 mg/day. All cotrimoxazole regimens exposed seemed equally efficacious, although, higher quality trials are needed. Adverse effects were observed 2 months after initiation, particularly with the 400 mg/80 mg/day regimen. Conversely, escalation dosing or 200 mg/40 mg/day regimens appeared better tolerated.


Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Inmunosupresores/uso terapéutico , Neumonía por Pneumocystis/prevención & control , Enfermedades Reumáticas/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/administración & dosificación , Adulto , Anciano , Antibacterianos/efectos adversos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pneumocystis carinii/efectos de los fármacos , Neumonía por Pneumocystis/inmunología , Combinación Trimetoprim y Sulfametoxazol/efectos adversos
8.
Guatem. pediátr. ; 1(2): 27-35, abr, 2015.
Artículo en Español | LILACS | ID: biblio-981158

RESUMEN

La desnutrición aguda es un problema grave de salud. Actualmente afecta a 52 millones de niños menores de cinco años con prevalencia de 8% a nivel mundial. el riesgo de muerte para niños con desnutrición aguda moderada y severa es de 3 y 9 veces más que los niños con un estado nutricional normal.


Asunto(s)
Preescolar , Desnutrición Aguda Severa , Hospitalización , Hospitales Públicos
9.
Br J Cancer ; 109(6): 1488-97, 2013 Sep 17.
Artículo en Inglés | MEDLINE | ID: mdl-23989944

RESUMEN

BACKGROUND: Recently, we produced a tumour antigen-presenting cells (TAPCells) vaccine using a melanoma cell lysate, called TRIMEL, as an antigen source and an activation factor. Tumour antigen-presenting cells induced immunological responses and increased melanoma patient survival. Herein, we investigated the effect of TAPCells loaded with prostate cancer cell lysates (PCCL) as an antigen source, and TRIMEL as a dendritic cell (DC) activation factor; which were co-injected with the Concholepas concholepas haemocyanin (CCH) as an adjuvant on castration-resistant prostate cancer (CRPC) patients. METHODS: The lysate mix capacity, for inducing T-cell activation, was analysed by flow cytometry and Elispot. Delayed-type hypersensitivity (DTH) reaction against PCCL, frequency of CD8(+) memory T cells (Tm) in blood and prostate-specific antigen (PSA) levels in serum were measured in treated patients. RESULTS: The lysate mix induced functional mature DCs that were capable of activating PCCL-specific T cells. No relevant adverse reactions were observed. Six out of 14 patients showed a significant decrease in levels of PSA. DTH(+) patients showed a prolonged PSA doubling-time after treatment. Expansion of functional central and effector CD8(+) Tm were detected. CONCLUSION: Treatment of CRPC patients with lysate-loaded TAPCells and CCH as an adjuvant is safe: generating biochemical and memory immune responses. However, the limited number of cases requires confirmation in a phase II clinical trial.


Asunto(s)
Vacunas contra el Cáncer/administración & dosificación , Vacunas contra el Cáncer/inmunología , Células Dendríticas/inmunología , Inmunoterapia Adoptiva/métodos , Neoplasias de la Próstata Resistentes a la Castración/inmunología , Neoplasias de la Próstata Resistentes a la Castración/terapia , Anciano , Anciano de 80 o más Años , Línea Celular Tumoral , Humanos , Activación de Linfocitos , Masculino , Persona de Mediana Edad , Linfocitos T Citotóxicos/inmunología
10.
Actas dermo-sifiliogr. (Ed. impr.) ; 104(3): 220-226, abr. 2013. tab
Artículo en Español | IBECS | ID: ibc-111591

RESUMEN

El melanoma lentiginoso acral (MLA) es el tipo de melanoma de localización acral más frecuente y suele diagnosticarse en estadios más avanzados que el resto de los tipos de melanoma. El objetivo de nuestro estudio fue conocer las características de presentación clínica del MLA. Material y métodos: Se realizó un estudio descriptivo observacional restrospectivo a partir de los pacientes recogidos en la base de datos del Instituto Valenciano de Oncología (IVO). Mediante encuestas telefónicas a los pacientes se recogieron las características de presentación de la lesión, en particular la presencia de los signos y síntomas incluidos en las reglas del ABCDE y de los 7 puntos de Glasgow, así como el retraso en el diagnóstico atribuible al paciente o al médico. Resultados: En una muestra final de 23 pacientes que pudieron responder finalmente a la encuesta se constató que el diagnóstico se demoró más de un año por un retraso en la consulta por parte del paciente en un 30,4%. Por otra parte, hubo una demora de más de un año atribuible al médico que no sospechó el diagnóstico en un 20% de los casos. Respecto a los motivos más frecuentes de consulta estos fueron: cambios en el tamaño, en el color, sangrado y herida que no cura. En un 20% de los casos que fueron evaluados por un médico la decisión de realizar el estudio histológico se demoró más de un año. Conclusiones: Existe un importante retraso en el diagnóstico del MLA debido tanto al paciente como al médico, lo que es achacable en parte a una falta de reconocimiento de los signos de alarma en lo que concierne al paciente y al personal sanitario. Las campañas preventivas del melanoma deberían poner más énfasis en la posible afectación de las palmas y sobre todo de las plantas (AU)


Background and objective: Acral lentiginous melanomas—the melanomas most commonly found on the Materials and methods: Retrospective, descriptive, observational study of cases recorded in the database of the Instituto Valenciano de Oncología. In telephone interviews the patients answered a questionnaire on the presenting features of the lesion, on the presence of signs and symptoms included in the Glasgow 7-point checklist and the ABCDEs of melanoma, and on diagnostic delay attributable to patient or physician. Results: In the interviews with the 23 patients who responded to the questionnaire, we detected a diagnostic delay of more than 1 year attributable to the patient (delay in seeking care) in 30.4% of the cases. Diagnostic delay of more than 1 year attributable to the physician (failure to suspect the diagnosis) was identified in 20%. The most frequent reasons for consulting a physician about a lesion were changes in size, changes in color, bleeding, or failure to heal. In 20% of the cases the evaluating physician did not order histology for over a year. Conclusions: Diagnostic delay is a significant problem in acral lentiginous melanoma and may be attributable either to patients or to physicians’ failure to recognize warning signs. Melanoma prevention campaigns should place more emphasis on the possibility of melanomas appearing on the palms and, particularly, on the soles (AU)


Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Melanoma/epidemiología , Entrevistas como Asunto/métodos , Entrevistas como Asunto , Estudios Retrospectivos , Encuestas Epidemiológicas/métodos , Teléfono/estadística & datos numéricos , Teléfono
11.
Actas Dermosifiliogr ; 104(3): 220-6, 2013 Apr.
Artículo en Inglés, Español | MEDLINE | ID: mdl-22959666

RESUMEN

BACKGROUND AND OBJECTIVE: Acral lentiginous melanomas -the melanomas most commonly found on the distal portions of the limbs- have usually reached more advanced stages than other types of melanoma when diagnosed. Our aim was to describe the clinical presentation of these tumors. MATERIALS AND METHODS: Retrospective, descriptive, observational study of cases recorded in the database of the Instituto Valenciano de Oncología. In telephone interviews the patients answered a questionnaire on the presenting features of the lesion, on the presence of signs and symptoms included in the Glasgow 7-point checklist and the ABCDEs of melanoma, and on diagnostic delay attributable to patient or physician. RESULTS: In the interviews with the 23 patients who responded to the questionnaire, we detected a diagnostic delay of more than 1 year attributable to the patient (delay in seeking care) in 30.4% of the cases. Diagnostic delay of more than 1 year attributable to the physician (failure to suspect the diagnosis) was identified in 20%. The most frequent reasons for consulting a physician about a lesion were changes in size, changes in color, bleeding, or failure to heal. In 20% of the cases the evaluating physician did not order histology for over a year. CONCLUSIONS: Diagnostic delay is a significant problem in acral lentiginous melanoma and may be attributable either to patients or to physicians' failure to recognize warning signs. Melanoma prevention campaigns should place more emphasis on the possibility of melanomas appearing on the palms and, particularly, on the soles.


Asunto(s)
Melanoma/patología , Neoplasias Cutáneas/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Pie , Mano , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Melanoma Cutáneo Maligno
12.
J Clin Rheumatol ; 15(7): 363-5, 2009 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-20009975

RESUMEN

We describe a patient with systemic onset juvenile idiopathic arthritis refractory to disease-modifying antirheumatic drugs, intravenous gamma globulin, and TNF inhibitors (etanercept and infliximab), in whom treatment with rituximab resulted in remission of systemic symptoms (rash and fever), a fall in erythrocyte sedimentation rate, C-reactive protein, and ferritin serum levels, with recovery in disability index and improvement of arthritis. A total of 4 cycles of rituximab were given over 18 months because of relapses. Since her last course, she remains stable and asymptomatic. To our knowledge, this is the first case reported on a long-lasting beneficial effect of rituximab in a patient with soJIA.


Asunto(s)
Anticuerpos Monoclonales/uso terapéutico , Antirreumáticos/uso terapéutico , Artritis Juvenil/tratamiento farmacológico , Inmunoglobulina G/uso terapéutico , Receptores del Factor de Necrosis Tumoral/uso terapéutico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Anticuerpos Monoclonales de Origen Murino , Artritis Juvenil/sangre , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Preescolar , Relación Dosis-Respuesta a Droga , Etanercept , Femenino , Humanos , Infliximab , Rituximab , Insuficiencia del Tratamiento , Resultado del Tratamiento
14.
Bone ; 40(1): 105-10, 2007 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-16934544

RESUMEN

The increase in lumbar spine BMD in response to Raloxifene (RLX), a selective estrogen receptor modulator, is smaller in magnitude compared to the response to treatment with estradiol (E2). The reasons for this observation are unclear. Estrogen has a potent effect on the production of proinflammatory cytokines which support osteoclastogenic and bone resorption. Therefore the different response to RLX may relate, at least in part, to a difference in the ability of RLX to modulate the production of proinflammatory cytokines which are abundant in the red marrow of the vertebrae. The aim of this study was to determine the effect of RLX and E2 both in vitro and ex vivo on the production of the pro-resorptive cytokine interleukin-1beta (IL-1beta) and its antagonist, interleukin-1 receptor antagonist (IL-1ra). We obtained samples of peripheral blood from (a) 10 untreated postmenopausal women with osteopenia (ages 53 to 72 years, mean 61 years), (b) 15 postmenopausal women (ages 52 to 72 years, mean 63 years) at baseline and after 6 months of RLX therapy (60 mg/day) and (c) 10 postmenopausal women (ages 60 to 75 years, mean 64 years) at baseline and 6 months after a single E2 implant (25 mg). Cultures of whole blood from the untreated women were incubated with RLX or 17beta-E2 at 1 pM, 100 pM, 10 nM and 1 microM concentrations. LPS-stimulated whole blood cultures from the raloxifene- and estradiol-treated women were prepared at baseline and at 6 months. IL-1beta and IL-1ra were measured by ELISA in the conditioned media. In vitro there was a significant dose-dependent decrease in IL-1beta and IL-1ra in response to 17beta-E2 (both P<0.0001) which was not apparent in response to RLX (both P>0.05). In ex vivo cultures from women receiving 6 months treatment with E2 implants, there was a significant decrease in IL-1beta (-36+/-8%, P=0.01) but no significant change in IL-1ra (+29+/-20%, P=0.3). There was no significant change in either IL-1beta or IL-1ra after 6 months RLX therapy (+20+/-14% and +12+/-10%, both P>0.05). We conclude that treatment with RLX, unlike estradiol does not modulate the production of the proinflammatory cytokines IL-1beta and IL-1ra using in vitro or ex vivo whole blood culture methods. This may account, at least in part for the reduced efficacy of RLX therapy compared to estrogen which has been observed in vivo on bone mineral density, bone turnover and reduction in fracture risk.


Asunto(s)
Enfermedades Óseas Metabólicas/inmunología , Estradiol/farmacología , Antagonistas de Estrógenos/farmacología , Proteína Antagonista del Receptor de Interleucina 1/metabolismo , Interleucina-1beta/metabolismo , Leucocitos Mononucleares/efectos de los fármacos , Clorhidrato de Raloxifeno/farmacología , Anciano , Estradiol/uso terapéutico , Antagonistas de Estrógenos/uso terapéutico , Estrógenos/farmacología , Estrógenos/uso terapéutico , Femenino , Humanos , Proteína Antagonista del Receptor de Interleucina 1/sangre , Interleucina-1beta/sangre , Leucocitos Mononucleares/inmunología , Persona de Mediana Edad , Posmenopausia , Clorhidrato de Raloxifeno/uso terapéutico
15.
Reumatol Clin ; 2 Suppl 1: S34-7, 2006 Mar.
Artículo en Español | MEDLINE | ID: mdl-21794360
16.
J Clin Densitom ; 8(3): 278-86, 2005.
Artículo en Inglés | MEDLINE | ID: mdl-16055957

RESUMEN

Few studies have compared quantitative ultrasound with bone mineral density (BMD) in monitoring response to therapy in osteoporosis. The aim of our study was to compare finger ultrasound variables and BMD for monitoring alendronate and estradiol therapy in postmenopausal women. We recruited 26 women aged 50 to 79 yr (mean: 65 yr) with osteoporosis; 18 patients received 10 mg/d of alendronate and 500 mg/d of calcium carbonate and 8 patients received 500 mg/d of calcium carbonate only. We recruited 21 hysterectomized postmenopausal women who were randomized to treatment or control. The treatment group received a 25-mg estradiol implant, which was replaced every 6 mo. The control group had a sham procedure. In the alendronate group, there were significant changes at 1 yr at the lumbar spine (p<0.05), bone transmission time (p<0.01), and pure speed of sound (p<0.001) and the changes continued into the second year. In the estradiol implant group, there were significant changes at 1 yr at the lumbar spine (p<0.001), the femoral neck (p<0.05), and the pure speed of sound (p<0.01). For alendronate, the signal-to-noise ratio was similar between the lumbar spine and bone transmission time (1.8 and 1.4) and greater than for the pure speed of sound and femoral neck (0.8 and 0.7); for estradiol, the signal-to-noise ratio was similar between the lumbar spine and femoral neck (2.0 and 1.5) and greater than for the pure speed of sound and bone transmission time (1.1 and 0.6). These results indicated that changes in finger ultrasound are similar in clinical utility to dual-energy X-ray absorptiometry measurements at the femoral neck for the monitoring of antiresorptive treatments for osteoporosis.


Asunto(s)
Alendronato/uso terapéutico , Conservadores de la Densidad Ósea/uso terapéutico , Densidad Ósea , Estradiol/uso terapéutico , Falanges de los Dedos de la Mano/diagnóstico por imagen , Osteoporosis Posmenopáusica/tratamiento farmacológico , Anciano , Carbonato de Calcio/uso terapéutico , Método Doble Ciego , Implantes de Medicamentos , Estradiol/administración & dosificación , Femenino , Cuello Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Histerectomía , Vértebras Lumbares/diagnóstico por imagen , Persona de Mediana Edad , Osteoporosis Posmenopáusica/diagnóstico por imagen , Radiografía , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Ultrasonografía
17.
BJOG ; 109(7): 812-20, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12135219

RESUMEN

OBJECTIVE: To evaluate the anabolic effect of oestrogen on bone by comparing the response of markers of bone formation (and resorption) and bone mineral density (BMD) to subcutaneous oestradiol implants. DESIGN: One year double-blind placebo controlled randomised study. SETTING: Clinical research unit within a teaching hospital. POPULATION: Twenty-one hysterectomised postmenopausal women were randomised to 25 mg oestradiol implants at baseline and at six months or to have a sham procedure at baseline and six months. METHODS: BMD and quantitative ultrasound (QUS) were assessed at baseline and one year. Bone alkaline phosphatase (bone ALP), procollagen type I N-terminal propeptide (PINP), osteocalcin (OC), free deoxypyridinoline (iFDPD), N-telopeptide of type I collagen (NTX), serum oestradiol and intact parathyroid hormone (PTH) were measured at baseline, 4, 8, 12 and 24 weeks. MAIN OUTCOME MEASURES: Percentage change markers of bone turnover and PTH and change in oestradiol levels over first six months and percentage of changes in DXA and QUS over one year. RESULTS: PINP, bone ALP and OC increased by 28%, 7% and 9%, respectively (P < 0.01) during the first four weeks of treatment and then decreased significantly. Lumbar spine (LS) and total hip (TH) BMD increased by 5.4% and 6.0% (P < 0.001), respectively, and femoral neck (FN) BMD by 3.7% (P < 0.05) during the first year of treatment compared with control subjects. The peak serum oestradiol level was achieved four weeks after implant insertion. Mean PTH levels increased significantly in subjects receiving subcutaneous oestradiol. CONCLUSION: Subcutaneous oestrogen exerted an apparent anabolic effect on bone, which was initially reflected by an increase in bone formation markers and later by a large increase in BMD.


Asunto(s)
Biomarcadores/sangre , Densidad Ósea/efectos de los fármacos , Remodelación Ósea/efectos de los fármacos , Estradiol/administración & dosificación , Administración Cutánea , Anciano , Fosfatasa Alcalina/sangre , Aminoácidos/sangre , Colágeno/sangre , Método Doble Ciego , Estradiol/metabolismo , Femenino , Humanos , Persona de Mediana Edad , Osteocalcina/sangre , Hormona Paratiroidea/sangre , Fragmentos de Péptidos/sangre , Posmenopausia/sangre , Procolágeno/sangre
18.
Am J Physiol Gastrointest Liver Physiol ; 280(6): G1331-40, 2001 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-11352828

RESUMEN

Ethanol (1-20% vol/vol) caused a dose-dependent reduction in the basal rate of acid formation in isolated rabbit gastric glands with a calculated EC(50) value of 4.5 +/- 0.2%. Ethanol also reduced ATP levels in isolated gastric glands and in cultured parietal cells (EC(50): 8.8 +/- 0.4% and 8.5 +/- 0.2%, respectively) and decreased both basal and forskolin-stimulated cAMP levels. In studies carried out in gastric gland microsomes, ethanol inhibited the hydrolytic activity of H+-K+-ATPase(EC(50): 8.5 +/- 0.6%), increased passive proton permeability (EC(50): 7.9%), and reduced H+-K+-ATPase-dependent proton transport (EC(50): 3%). Our results show that the inhibition of gastric acid secretion observed at low concentrations of ethanol (< or =5%) is mainly caused by the specific impairment of H+-K+-ATPase-dependent proton transport across cell membranes rather than inhibition of the hydrolytic activity of H+-K+-ATPase, reduction in the cellular content of ATP, or increase in the passive permeability of membranes to protons, although these changes, in combination, must be relevant at concentrations of ethanol > or =7%.


Asunto(s)
Etanol/farmacología , Ácido Gástrico/metabolismo , ATPasa Intercambiadora de Hidrógeno-Potásio/fisiología , Protones , Adenosina Trifosfato/metabolismo , Animales , Transporte Biológico/efectos de los fármacos , Transporte Biológico/fisiología , Células Cultivadas , Colorantes/farmacocinética , AMP Cíclico/metabolismo , Mucosa Gástrica/efectos de los fármacos , Mucosa Gástrica/metabolismo , Mucosa Gástrica/patología , Membranas Intracelulares/metabolismo , Masculino , Microsomas Hepáticos/metabolismo , Células Parietales Gástricas/efectos de los fármacos , Células Parietales Gástricas/metabolismo , Permeabilidad , Conejos , Azul de Tripano/farmacocinética
19.
Adolesc. latinoam ; 1(4): 209-21, dez. 1999. tab, graf
Artículo en Español, Portugués | LILACS | ID: lil-292044

RESUMEN

La pubertad es una etapa de la vida intermedia entre la infancia y la adultez, en la cual ocurren modificaciones fisiológicas sustanciales. La masa ósea varía a lo largo de la vida, observándose que llega a un desarrollo máximo alrededor de los 20 años a nivel de los cuerpos vertebrales. El riesgo de desarrollar osteorporosis en la vida futura dependerá de la cantidad y resistencia ósea máxima alcanzada por una persona al llagar a la adultez, como así también de la tasa de pérdida ósea subsecuente


Asunto(s)
Humanos , Adolescente , Osteoporosis , Adolescente
20.
Adolesc. latinoam ; 1(4): 209-21, dez. 1999. tab, graf
Artículo en Español, Portugués | BINACIS | ID: bin-9661

RESUMEN

La pubertad es una etapa de la vida intermedia entre la infancia y la adultez, en la cual ocurren modificaciones fisiológicas sustanciales. La masa ósea varía a lo largo de la vida, observándose que llega a un desarrollo máximo alrededor de los 20 años a nivel de los cuerpos vertebrales. El riesgo de desarrollar osteorporosis en la vida futura dependerá de la cantidad y resistencia ósea máxima alcanzada por una persona al llagar a la adultez, como así también de la tasa de pérdida ósea subsecuente(AU)


Asunto(s)
Humanos , Adolescente , Osteoporosis , Adolescente
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