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The effect of systemic antibiotics on the microbial profile of extracrevicular sites after periodontal treatment is currently the subject of research. This study evaluated the microbiological effects on different oral cavity sites of scaling and root planing (SRP) combined with antimicrobial chemical control in the treatment of periodontitis. Sixty subjects were randomly assigned to receive SRP alone or combined with metronidazole (MTZ) + amoxicillin (AMX) for 14 days, with or without chlorhexidine mouth rinse (CHX) for 60 days. Microbiological samples were evaluated by checkerboard DNA-DNA hybridization until 180 days post therapy. The adjunctive use of antibiotics plus CHX significantly reduced the mean proportions of red complex species from subgingival biofilm and saliva (p < 0.05). Furthermore, the analysis of all intraoral niches showed a significantly lower mean proportion of the red complex species in the same group. In conclusion, the concomitant use of antimicrobial chemical control (systemic and local) demonstrated a beneficial effect on the composition of the oral microbiota.
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BACKGROUND AND AIMS: Several studies have been performed in vitro and in animals showing that propolis (a resin made by bees) has excellent anti-inflammatory properties, but no study has been performed in patients with chronic kidney disease (CKD) on hemodialysis (HD). The present study aimed to evaluate the effects of propolis supplementation on inflammatory markers in patients with CKD on HD. METHODS: This is a longitudinal, double-blind, placebo-controlled trial with patients randomized into two groups: propolis (4 capsules of 100 mg/day containing concentrated and standardized dry EPP-AF® green propolis extract) or placebo (4 capsules of 100 mg/day containing microcrystalline cellulose, magnesium stearate and colloidal silicon dioxide) for two months. Routine parameters were analyzed using commercial kits. The plasma levels of inflammatory cytokines were evaluated by flow luminometry. RESULTS: Forty-one patients completed the follow-up, 21 patients in the propolis group (45 ± 12 years, 13 women, BMI, 22.8 ± 3.7 kg/m2) and 20 in the placebo group (45.5 ± 14 years, 13 women, BMI, 24.8 ± 6.8 kg/m2). The obtained data revealed that the intervention with propolis significantly reduced the serum levels of tumour necrosis factor α (TNFα) (p = 0.009) as well as had the tendency to reduce the levels of macrophage inflammatory protein-1ß (MIP-1ß) (p = 0.07). There were no significant differences in the placebo group. CONCLUSION: Short-term EPP-AF® propolis dry extract 400 mg/day supplementation seems to mitigate inflammation, reducing the plasma levels of TNFα and MIP-1ß in patients with CKD on HD. This study was registered at clinicaltrials.gov (NCT04411758).
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Própole , Insuficiência Renal Crônica , Humanos , Feminino , Própole/farmacologia , Própole/uso terapêutico , Fator de Necrose Tumoral alfa , Quimiocina CCL4/uso terapêutico , Inflamação/tratamento farmacológico , Diálise Renal , Insuficiência Renal Crônica/tratamento farmacológico , Método Duplo-CegoRESUMO
The oral cavity harbors hundreds of microorganisms that may be uncontrolled and provoke several diseases. In this sense, periodontitis is a complex multifactorial disease with an essential microbial component in its etiology. Periodontal treatment involves mechanical control of the supra- and subgingival biofilm, but not all patients respond predictably to treatment. In this way, the biofilm chemical control helps in the reduction of periodontal pathogens during treatment or in the delay of bacterial re-colonization after scaling and root planning. Several products have been studied as adjunctive therapy and have shown promising results. Therefore, the present article reviews the biological effects of propolis, aloe vera, green tea, cranberry, calendula, myrrha and salvia that may support their use in the control of subgingival biofilm in patients with periodontitis. All the natural products cited above showed exciting results against microorganisms related to oral diseases, mainly periodontitis. These substances also have anti-inflammatory and antioxidant activities. The natural agents propolis, aloe vera, green tea, cranberry, calendula, myrrha and salvia demonstrated potential to be used as oral hygiene products, based on their antimicrobial and anti-inflammatory actions.
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This educational review article aims to provide information on the central nervous system (CNS) infectious and parasitic diseases that frequently cause seizures and acquired epilepsy in the developing world. We explain the difficulties in defining acute symptomatic seizures, which are common in patients with meningitis, viral encephalitis, malaria, and neurocysticercosis, most of which are associated with increased mortality and morbidity, including subsequent epilepsy. Geographic location determines the common causes of infectious and parasitic diseases in a particular region. Management issues encompass prompt treatment of acute symptomatic seizures and the underlying CNS infection, correction of associated predisposing factors, and decisions regarding the appropriate choice and duration of antiseizure therapy. Although healthcare provider education, to recognize and diagnose seizures and epilepsy related to these diseases, is a feasible objective to save lives, prevention of CNS infections and infestations is the only definitive way forward to reduce the burden of epilepsy in developing countries.
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Doenças Transmissíveis , Encefalite Viral , Epilepsia , Neurocisticercose , Doenças Transmissíveis/complicações , Encefalite Viral/complicações , Epilepsia/complicações , Epilepsia/etiologia , Humanos , Neurocisticercose/complicações , Neurocisticercose/epidemiologia , Convulsões/complicações , Convulsões/etiologiaRESUMO
The development of oral biofilm models has been extremely important to study the specific role of most microbial species at the early stages of periodontitis. The current knowledge on monospecies or multispecies biofilms originates mainly from the observation of in vitro dynamic or static biofilm model systems, which were engineered to mimic clinical oral conditions. In the last few decades, mounting evidence has confirmed that biofilms are the major form of bacterial lifestyle, and more importantly, that microorganisms dwelling in sessile mixed-species aggregates display completely different phenotypes and physiological characteristics than when living in planktonic pure cultures. Interspecies interactions within these communities, mediated by chemical communication systems, have been shown to affect biofilm physiology and increase antimicrobial resistance by up to 1000 fold. These aspects reinforce the importance of developing multispecies biofilm models to better understand and control biofilms. Literature reports demonstrate that while monospecies models are still most commonly used in caries research, authors have used different multispecies models to study periodontal diseases. Periodontitis is a polymicrobial biofilm-dependent disease mainly associated with Porphyromonas gingivalis, Tannerella forsythia, and Treponema denticola. Interestingly, these species hardly adhere to substrates commonly used for biofilm formation, which makes multispecies models essential for an accurate analysis of periodontitis-related biofilms. The multispecies models currently available are generally composed of 6-10 species, but a more recent 34-species model was developed to better examine the dynamics within oral biofilms. The complexity of such polymicrobial biofilm models mimics more consistently the oral microbiome and different aspects of the oral environment. Collectively, the evidence on multispecies biofilm models described herein may support future studies on the use of antimicrobials for biofilm control as well as provide research opportunities to expand the current knowledge on interspecies interactions. The present manuscript reviews the most recent updates on in vitro biofilm model systems for periodontitis.
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Periodontite , Treponema denticola , Biofilmes , Humanos , Plâncton , Porphyromonas gingivalis/genética , Treponema denticola/genéticaRESUMO
Depression is the most frequent psychiatric comorbidity seen in mesial temporal lobe epilepsy (MTLE) patients with hippocampal sclerosis (HS). Moreover, the HS is the most frequent pathological hallmark in MTLE-HS. Although there is a well-documented hippocampal volumetric reduction in imaging studies of patients with major depressive disorder, in epilepsy with comorbid depression, the true role of the hippocampus is not entirely understood. This study aimed to verify if patients with unilateral MTLE-HS and the co-occurrence of depression have differences in neuronal density of the hippocampal sectors CA1-CA4. For this purpose, we used a histopathological approach. This was a pioneering study with patients having both clinical disorders. However, we found no difference in hippocampal neuronal density when depression co-occurs in patients with epilepsy. In this series, CA1 had the lowest counting in both groups, and HS ILAE Type 1 was the most prevalent. More studies using histological assessments are needed to clarify the physiopathology of depression in MTLE-HS.
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Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.
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Abstract Recurrent stress fractures rarely affect the same athlete. We present the case of a female triathlete who suffered multiple stress fractures in both tibias, the right fibula, and the left femoral neck. Conservative treatment was instituted in all episodes, with rest, reduced training load, and physical therapy rehabilitation. The relative energy deficiency in sport syndrome, along with an eating disorder, training overload, and osteopenia, was identified as a risk factor. Although rare, multiple stress fractures can occur in female triathletes. These patients must be screened for risk factors associated with biomechanics, nutrition, and training to develop an effective prevention and treatment program.
Resumo Fraturas por estresse recorrentes num mesmo atleta são raras. Apresentamos o caso de uma triatleta que sofreu múltiplas fraturas por estresse na tíbia bilateral, na fíbula direita e no colo femoral esquerdo. O tratamento conservador foi instituído em todos os episódios, com repouso, redução da carga de treino e reabilitação fisioterápica. Foi identificada como fator de risco a síndrome da deficiência energética relativa no esporte, com distúrbio alimentar, sobrecarga de treino e osteopenia. Mesmo que seja raro, múltiplas fraturas por estresse podem ocorrer em mulheres triatletas, nas quais é importante avaliar os fatores de risco associados à biomecânica, nutrição e ao treinamento para arquitetar um programa de prevenção e tratamento efetivos.
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Humanos , Feminino , Adulto , Tíbia/lesões , Fraturas de Estresse , Fatores de Risco , Modalidades de Fisioterapia , Extremidade Inferior , Síndrome da Tríade da Mulher Atleta , AtletasRESUMO
La leishmaniasis es una enfermedad causada por un protozoo de la especie Leishmania chagasi. Se transmite por la picadura de las hembras del insecto vector infectado, un mosquito de la especie Lutzomyia longipalpis, conocido popularmente como mosquito de la paja. Con una amplia distribución geográfica, Brasil es responsable del 96% de los casos notificados en las Américas. Es una zoonosis de evolución crónica, con afectación sistémica y, si no se trata, puede provocar la muerte hasta en un 90% de los casos. En los perros, considerada el principal reservorio urbano del agente etiológico, la leishmaniasis visceral canina es una enfermedad que causa gran sufrimiento a los animales afectados, guardianes y contactos. Las manifestaciones clínicas dependen intrínsecamente del tipo de respuesta inmune que presente su hospedador, que pueden aparecer desde tres meses hasta varios años después de la infección y en ocasiones son inespecíficas. El diagnóstico de laboratorio de la leishmaniasis visceral canina se basa en la tríada de métodos serológicos, parasitológicos y moleculares y es fundamental para la definición de las etapas de la enfermedad y la elección del tratamiento adecuado. Los principales objetivos del tratamiento son reducir la carga parasitaria del perro, neutralizar su capacidad infecciosa, restablecer adecuadamente su respuesta inmunitaria, promover la mejoría clínica...(AU)
Leishmaniasis is a disease caused by a protozoan of the species Leishmania chagasi. It is transmitted by the bite of females of the infected vector insect, the sandfly known popularly as the straw mosquito; In Brazil, the main species responsible for transmission is Lutzomyia longipalpis. In Brazil, the disease has a wide geographical distribution and is responsible for 96% of reported cases in the Americas. It is a chronic evolutionary zoonosis with systemic involvement and, if left untreated, can lead to death in up to 90% of cases. In dogs, considered the main urban reservoir of the etiological agent, CVL is a disease that causes great suffering to affected animals, tutors and contactants. The clinical manifestations of CVL depend intrinsically on the type of immune response presented by its host. Clinical signs may appear from three months to several years after infection and are sometimes nonspecific. The laboratory diagnosis of CVL is based on the triad of serological, parasitological and molecular methods and is essential for staging the disease and choosing the appropriate treatment. Treatment aims to reduce the dog's parasitic load, neutralizing its infectious capacity, properly restoring its immune response, promoting clinical improvement and preventing relapses. The aim of this paper was to present a review of the expository literature on the epidemiological aspects...(AU)
A leishmaniose é uma doença causada por um protozoário da espécie Leishmania chagasi. É transmitida pela picada de fêmeas do inseto vetor infectado, um flebotomíneo da espécie Lutzomyia longipalpis, conhecido popularmente como mosquito palha. De ampla distribuição geográfica, o Brasil é responsável por 96% dos casos notificados nas Américas. Trata-se de uma zoonose de evolução crônica, com acometimento sistêmico e, se não tratada, pode levar a óbito até 90% dos casos. No cão, considerado o principal reservatório urbano do agente etiológico, a leishmaniose visceral canina é uma enfermidade que provoca grande sofrimento aos animais acometidos, tutores e contactantes. As manifestações clínicas dependem intrinsecamente do tipo de resposta imunológica apresentada pelo seu hospedeiro, podendo surgir de três meses até vários anos após a infecção e são, por vezes, inespecíficas. O diagnóstico laboratorial da leishmaniose visceral canina baseia-se na tríade de métodos sorológicos, parasitológicos e moleculares e é essencial para o estadiamento da doença e escolha do tratamento adequado. O tratamento possui como principais objetivos reduzir a carga parasitária do cão, neutralizando a sua capacidade infectante, restaurando adequadamente a sua resposta imune, promovendo a melhora clínica e prevenindo recaídas. O objetivo com esse trabalho foi apresentar uma revisão de literatura expositiva...(AU)
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Animais , Cães , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/terapia , Leishmaniose Visceral/veterinária , Leishmania infantum/isolamento & purificação , PsychodidaeRESUMO
La leishmaniasis es una enfermedad causada por un protozoo de la especie Leishmania chagasi. Se transmite por la picadura de las hembras del insecto vector infectado, un mosquito de la especie Lutzomyia longipalpis, conocido popularmente como mosquito de la paja. Con una amplia distribución geográfica, Brasil es responsable del 96% de los casos notificados en las Américas. Es una zoonosis de evolución crónica, con afectación sistémica y, si no se trata, puede provocar la muerte hasta en un 90% de los casos. En los perros, considerada el principal reservorio urbano del agente etiológico, la leishmaniasis visceral canina es una enfermedad que causa gran sufrimiento a los animales afectados, guardianes y contactos. Las manifestaciones clínicas dependen intrínsecamente del tipo de respuesta inmune que presente su hospedador, que pueden aparecer desde tres meses hasta varios años después de la infección y en ocasiones son inespecíficas. El diagnóstico de laboratorio de la leishmaniasis visceral canina se basa en la tríada de métodos serológicos, parasitológicos y moleculares y es fundamental para la definición de las etapas de la enfermedad y la elección del tratamiento adecuado. Los principales objetivos del tratamiento son reducir la carga parasitaria del perro, neutralizar su capacidad infecciosa, restablecer adecuadamente su respuesta inmunitaria, promover la mejoría clínica...
Leishmaniasis is a disease caused by a protozoan of the species Leishmania chagasi. It is transmitted by the bite of females of the infected vector insect, the sandfly known popularly as the straw mosquito; In Brazil, the main species responsible for transmission is Lutzomyia longipalpis. In Brazil, the disease has a wide geographical distribution and is responsible for 96% of reported cases in the Americas. It is a chronic evolutionary zoonosis with systemic involvement and, if left untreated, can lead to death in up to 90% of cases. In dogs, considered the main urban reservoir of the etiological agent, CVL is a disease that causes great suffering to affected animals, tutors and contactants. The clinical manifestations of CVL depend intrinsically on the type of immune response presented by its host. Clinical signs may appear from three months to several years after infection and are sometimes nonspecific. The laboratory diagnosis of CVL is based on the triad of serological, parasitological and molecular methods and is essential for staging the disease and choosing the appropriate treatment. Treatment aims to reduce the dog's parasitic load, neutralizing its infectious capacity, properly restoring its immune response, promoting clinical improvement and preventing relapses. The aim of this paper was to present a review of the expository literature on the epidemiological aspects...
A leishmaniose é uma doença causada por um protozoário da espécie Leishmania chagasi. É transmitida pela picada de fêmeas do inseto vetor infectado, um flebotomíneo da espécie Lutzomyia longipalpis, conhecido popularmente como mosquito palha. De ampla distribuição geográfica, o Brasil é responsável por 96% dos casos notificados nas Américas. Trata-se de uma zoonose de evolução crônica, com acometimento sistêmico e, se não tratada, pode levar a óbito até 90% dos casos. No cão, considerado o principal reservatório urbano do agente etiológico, a leishmaniose visceral canina é uma enfermidade que provoca grande sofrimento aos animais acometidos, tutores e contactantes. As manifestações clínicas dependem intrinsecamente do tipo de resposta imunológica apresentada pelo seu hospedeiro, podendo surgir de três meses até vários anos após a infecção e são, por vezes, inespecíficas. O diagnóstico laboratorial da leishmaniose visceral canina baseia-se na tríade de métodos sorológicos, parasitológicos e moleculares e é essencial para o estadiamento da doença e escolha do tratamento adequado. O tratamento possui como principais objetivos reduzir a carga parasitária do cão, neutralizando a sua capacidade infectante, restaurando adequadamente a sua resposta imune, promovendo a melhora clínica e prevenindo recaídas. O objetivo com esse trabalho foi apresentar uma revisão de literatura expositiva...
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Animais , Cães , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/terapia , Leishmaniose Visceral/veterinária , Leishmania infantum/isolamento & purificação , PsychodidaeRESUMO
Neurocysticercosis is a neglected and usually poverty-related disease of high public importance. The mechanisms by which the calcified lesions cause epilepsy are not known, but have been attributed to residual perilesional gliosis or an inflammatory process. This case shows that an inflammatory response to a calcified granuloma may be associated with the development of epilepsy. The increase in glutamate and kinin B1 (pro-epileptogenic) receptors added by reduced expression of kinin B2 (anti-epileptogenic) receptors may explain the chronic epileptogenesis associated with the lesion, corroborating the hypothesis of inflammatory mechanisms involved in the pathophysiology of epilepsy in these patients.
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Epilepsia Resistente a Medicamentos , Neurocisticercose , Biomarcadores , Criança , Epilepsia Resistente a Medicamentos/diagnóstico , Epilepsia Resistente a Medicamentos/etiologia , Epilepsia Resistente a Medicamentos/imunologia , Eletroencefalografia , Feminino , Humanos , Imuno-Histoquímica , Imageamento por Ressonância Magnética , Neurocisticercose/complicações , Neurocisticercose/diagnóstico , Neurocisticercose/imunologia , Neurocisticercose/patologiaRESUMO
Although catatonia is a well-known psychiatric syndrome, there are many possible systemic and neurological etiologies. The aim of this case report was to present a case of a patient with cerebral venous sinus thrombosis and infarction in which catatonia was the clinical manifestation of a possible nonconvulsive status epilepticus. To our knowledge, only one such case has been reported in the literature, which had a simplified diagnostic investigation. It is important to correctly recognize the organic cause underlying catatonia in order to treat the patient as soon as possible thereby improving outcome. Therefore, physicians need to update their knowledge on catatonia, recognizing that it can be part of a psychiatric or neurologic condition.
Embora a catatonia seja uma síndrome psiquiátrica bem conhecida, existem várias etiologias possíveis, tanto sistêmicas quanto neurológicas. O objetivo deste relato de caso é apresentar um quadro de trombose venosa central com infarto venoso em que a catatonia foi a manifestação clínica de um possível status não convulsivo. Na concepção dos autores, apenas um caso é encontrado na literatura, porém com uma propedêutica simplificada. É importante o correto reconhecimento das causas orgânicas que podem estar causando a catatonia para que sejam corrigidas assim que possível, melhorando o prognóstico do paciente. Além disso, os médicos precisam atualizar seus conhecimentos sobre a catatonia, uma vez que ela pode ser parte tanto de uma condição psiquiátrica quanto neurológica.
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ABSTRACT Although catatonia is a well-known psychiatric syndrome, there are many possible systemic and neurological etiologies. The aim of this case report was to present a case of a patient with cerebral venous sinus thrombosis and infarction in which catatonia was the clinical manifestation of a possible nonconvulsive status epilepticus. To our knowledge, only one such case has been reported in the literature, which had a simplified diagnostic investigation. It is important to correctly recognize the organic cause underlying catatonia in order to treat the patient as soon as possible thereby improving outcome. Therefore, physicians need to update their knowledge on catatonia, recognizing that it can be part of a psychiatric or neurologic condition.
RESUMO Embora a catatonia seja uma síndrome psiquiátrica bem conhecida, existem várias etiologias possíveis, tanto sistêmicas quanto neurológicas. O objetivo deste relato de caso é apresentar um quadro de trombose venosa central com infarto venoso em que a catatonia foi a manifestação clínica de um possível status não convulsivo. Na concepção dos autores, apenas um caso é encontrado na literatura, porém com uma propedêutica simplificada. É importante o correto reconhecimento das causas orgânicas que podem estar causando a catatonia para que sejam corrigidas assim que possível, melhorando o prognóstico do paciente. Além disso, os médicos precisam atualizar seus conhecimentos sobre a catatonia, uma vez que ela pode ser parte tanto de uma condição psiquiátrica quanto neurológica.
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Humanos , Trombose dos Seios Intracranianos , Estado Epiléptico , Catatonia , Infarto EncefálicoRESUMO
Gluconacetobacter diazotrophicus is a nitrogen-fixing, endophytic bacterium that has the potential to promote plant growth and increase yield. Genetically modified strains might get more benefits to host plants, including through expression of useful proteins, such as Cry toxins from B. thuringiensis, or enzymes involved in phytohormone production, proteins with antagonistic activity for phytopathogens, or that improve nutrient utilization by the plant. For that, expression systems for G. diazotrophicus are needed, which requires active promoters fused to foreign (or innate) genes. This article describes the construction of a G. diazotrophicus PAL5 promoter library using a promoter-less lacZ-bearing vector, and the identification of six active promoters through ß-galactosidase activity assays, sequencing and localization in the bacterial genome. The characterized promoters, which are located on distinct regions of the bacterial genome and encoding either sense or antisense transcripts, present variable expression strengths and might be used in the future for expressing useful proteins.
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Técnicas Genéticas , Genoma Bacteriano/genética , Gluconacetobacter/genética , Plasmídeos/genética , Regiões Promotoras Genéticas/genética , Biblioteca Gênica , Reguladores de Crescimento de Plantas/metabolismo , Plantas/microbiologia , beta-Galactosidase/metabolismoRESUMO
Autoimmune limbic encephalitis (ALE) associated with systemic lupus erythematosus (SLE) is a rare entity with few reports in the literature to date. In general, ALE associated with SLE has a satisfactory response to immunosuppressive treatment (RIT), but the pathogenesis of this association is poorly understood and may include an autoimmunity component. We report a case study describing the diagnosis and management of limbic encephalitis in a patient with active Systemic Lupus Erythematosus disease (SLE) and past medical history of cancer (endometrial adenocarcinoma in 2004 and papillary urothelial carcinoma in 2011 with curative treatment), followed over a one-year period. We discuss the possible association between limbic encephalitis and all past neoplastic and immune-mediated conditions of this patient. In this particularly case, autoimmunity was the most relevant factor associated with limbic encephalitis given negative neoplastic screening. Moreover, a good response was observed to immunotherapy, not seen with paraneoplastic limbic encephalitis, which is associated with poor response. In this case, the association of ALE with SLE is possible, since laboratory testing disclosed lupic activity and the patient had involvement of other systems (such as hematologic) during the period. However, the presence of other surface membrane antibodies are possible in the search for alternative etiologies.
Encefalite Límbica Autoimune (EL) associada a lúpus eritematoso sistêmico (LES) é uma entidade rara, com poucos relatos na literatura até o momento. Em geral, EL associada com LES tem uma resposta satisfatória ao tratamento imunossupressor, mas a patogênese desta associação é pouco compreendida e pode incluir um componente de autoimunidade. Descrevemos em um estudo de caso o diagnóstico e o tratamento empregado na encefalite límbica ocorrida no contexto de uma paciente com LES ativo e história pregressa de doenças neoplásicas (adenocarcinoma endometrial em 2004 e carcinoma papilar urotelial em 2011 ambos com o tratamento curativo), a qual foi seguida durante um ano. Discutimos uma possível associação de encefalite límbica e todos os antecedentes neoplásicos e imunomediados desta paciente. Neste caso em particular, a autoimunidade é o fator mais relevante relacionado com a encefalite límbica devido a uma triagem neoplásica negativa. Além disso, houve uma grande resposta com a imunossupressão, o que não é visto na encefalite límbica paraneoplásica, mais relacionada com uma má resposta. Neste caso, a associação de EL com LES é possível, uma vez que testes laboratoriais confirmaram a atividade lúpica, bem como a paciente apresentava envolvimento de outros sistemas (como hematológico) neste interim. No entanto, a presença de outros anticorpos de superfície da membrana é possível em busca de diferentes etiologias.
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Humanos , Encefalite Límbica , Lúpus Eritematoso Sistêmico , NeoplasiasRESUMO
Multiple sclerosis (MS) shows distinct clinical courses. Experimental autoimmune encephalomyelitis (EAE), a model to study multiple sclerosis, can be induced by different protocols, which show distinct cytokine and antibody production. The factors involved in this heterogeneity remain unclear. The relevance of MOG concentration in triggering a regulatory response in the chronic model of EAE is imprecise. The aim of this study was investigate if 100 or 300 µg of MOG(35-55) could induce different EAE profiles. Modifications in the concentration of MOG were able to change the patterns of chemokines, cytokines, percentage of cells, inflammatory infiltrate and the development of a regulatory response. However, these changes were unable to modify the intensity of response, which explains the chronic progression of the disease in both concentrations. The results presented in this study contribute to understanding the intricate mechanisms that trigger EAE and provide insights into the pathogenesis of various forms of MS.
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Encéfalo/imunologia , Encefalomielite Autoimune Experimental/imunologia , Inflamação/imunologia , Glicoproteína Mielina-Oligodendrócito/administração & dosagem , Medula Espinal/imunologia , Animais , Encéfalo/patologia , Quimiocinas/análise , Modelos Animais de Doenças , Encefalomielite Autoimune Experimental/patologia , Feminino , Citometria de Fluxo , Camundongos , Camundongos Endogâmicos C57BL , Medula Espinal/patologia , Estatísticas não ParamétricasRESUMO
PURPOSE OF THE STUDY: The aims of this study were to determine the percentage of women with epilepsy (WWE) taking folic acid (FA) in an outpatient epilepsy tertiary hospital at São Paulo, Brazil, and to identify the possible predictors of adherence. METHOD: Five hundred seventy-six medical records of patients followed in our service were reviewed. Sixty-six WWE using antiepileptic drugs with age between 16 and 52, sexually active but not in menopausal period, not pregnant, and not sterilized or with vasectomized partners underwent direct interviews with a prestructured questionnaire. Logistic regression with clinical and demographic variables using a stepwise method was performed to identify predictable variables of folate use. RESULTS: We found 42.40% of FA intake. Hormonal contraceptive method use was an independent variable negatively associated with adherence to folate. Additionally, educational level was an independent variable positively associated with adherence to folate in WWE above 35years of age. CONCLUSION: We found low folate adherence. Improved planning pre-conception for WWE should improve rates of effective folate supplementation.
Assuntos
Epilepsia/tratamento farmacológico , Ácido Fólico/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Vitaminas/uso terapêutico , Adolescente , Adulto , Anticonvulsivantes/efeitos adversos , Anticonvulsivantes/uso terapêutico , Brasil/epidemiologia , Anticoncepcionais Orais Hormonais , Escolaridade , Epilepsia/epidemiologia , Feminino , Ácido Fólico/administração & dosagem , Humanos , Pessoa de Meia-Idade , Fatores de Risco , Inquéritos e Questionários , Teratogênicos , Centros de Atenção Terciária , Vitaminas/administração & dosagem , Adulto JovemRESUMO
Autoimmune limbic encephalitis (ALE) associated with systemic lupus erythematosus (SLE) is a rare entity with few reports in the literature to date. In general, ALE associated with SLE has a satisfactory response to immunosuppressive treatment (RIT), but the pathogenesis of this association is poorly understood and may include an autoimmunity component. We report a case study describing the diagnosis and management of limbic encephalitis in a patient with active Systemic Lupus Erythematosus disease (SLE) and past medical history of cancer (endometrial adenocarcinoma in 2004 and papillary urothelial carcinoma in 2011 with curative treatment), followed over a one-year period. We discuss the possible association between limbic encephalitis and all past neoplastic and immune-mediated conditions of this patient. In this particularly case, autoimmunity was the most relevant factor associated with limbic encephalitis given negative neoplastic screening. Moreover, a good response was observed to immunotherapy, not seen with paraneoplastic limbic encephalitis, which is associated with poor response. In this case, the association of ALE with SLE is possible, since laboratory testing disclosed lupic activity and the patient had involvement of other systems (such as hematologic) during the period. However, the presence of other surface membrane antibodies are possible in the search for alternative etiologies.
Encefalite Límbica Autoimune (EL) associada a lúpus eritematoso sistêmico (LES) é uma entidade rara, com poucos relatos na literatura até o momento. Em geral, EL associada com LES tem uma resposta satisfatória ao tratamento imunossupressor, mas a patogênese desta associação é pouco compreendida e pode incluir um componente de autoimunidade. Descrevemos em um estudo de caso o diagnóstico e o tratamento empregado na encefalite límbica ocorrida no contexto de uma paciente com LES ativo e história pregressa de doenças neoplásicas (adenocarcinoma endometrial em 2004 e carcinoma papilar urotelial em 2011 ambos com o tratamento curativo), a qual foi seguida durante um ano. Discutimos uma possível associação de encefalite límbica e todos os antecedentes neoplásicos e imunomediados desta paciente. Neste caso em particular, a autoimunidade é o fator mais relevante relacionado com a encefalite límbica devido a uma triagem neoplásica negativa. Além disso, houve uma grande resposta com a imunossupressão, o que não é visto na encefalite límbica paraneoplásica, mais relacionada com uma má resposta. Neste caso, a associação de EL com LES é possível, uma vez que testes laboratoriais confirmaram a atividade lúpica, bem como a paciente apresentava envolvimento de outros sistemas (como hematológico) neste interim. No entanto, a presença de outros anticorpos de superfície da membrana é possível em busca de diferentes etiologias.
RESUMO
A case of transverse sinus thrombosis is described in an adolescent male with antecedent meningomyelocele corrected by surgery, and ventriculo-peritoneal derivation. Four months before the occurrence of thrombosis, he presented with bilateral otitis media and mastoiditis, and was treated with antibiotic. Magnetic resonance images were not obtained before referral to our hospital. The patient received full anticoagulation and his clinical course was uneventful. He remains asymptomatic under outpatient surveillance till this report. The aim of reporting the case is to emphasize the role of otologic infections in the origin of intracranial thrombotic phenomena, and highlights the findings of magnetic resonance venography for characterization of intracranial sinus thrombosis.