RESUMO
Inflammation is a necessary step in response to injuries, being vital in restoring homeostasis and facilitating tissue healing. Among the cells that play a crucial role in inflammatory responses, stromal cells, including fibroblasts, have an undeniable significance in fine-tuning the magnitude of mediators that directly affect hyper-inflammatory responses and tissue destruction. Fibroblasts, the dominant cells in the gingival connective tissue, are a very heterogeneous population of cells, and more recently they have been receiving well deserved attention as central players and often the 'principal dancers' of many pathological processes ranging from inflammation and fibrosis to altered immunity and cancer. The goal of the current investigation is to dive into the exact role of the stromal fibroblast and the responsible mechanistic factors involved in both regulation and dysregulation of the inflammatory responses. This article reviews the most recent literature on how fibroblasts, in their different activation states or subtypes, play a crucial role in contributing to inflammatory outcomes. We will focus on recent findings on inflammatory diseases. We will also provide connections regarding the stromal-immune relationship, which supports the idea of fibroblast coming out from the 'ensemble' of cell types to the protagonist role in immunometabolism and inflammaging. Additionally, we discuss the current advances in variation of fibroblast nomenclature and division into clusters with their own suggested function and particularities in gene expression. Here, we provide a perspective for the periodontal implications, discussing the fibroblast role in the infection-driven and inflammatory mediated diseases such as periodontitis.
Assuntos
Periodontite , Humanos , Periodontite/patologia , Inflamação , Gengiva/patologia , Cicatrização , FibroblastosRESUMO
Abstract Inflammation is a necessary step in response to injuries, being vital in restoring homeostasis and facilitating tissue healing. Among the cells that play a crucial role in inflammatory responses, stromal cells, including fibroblasts, have an undeniable significance in fine-tuning the magnitude of mediators that directly affect hyper-inflammatory responses and tissue destruction. Fibroblasts, the dominant cells in the gingival connective tissue, are a very heterogeneous population of cells, and more recently they have been receiving well deserved attention as central players and often the 'principal dancers' of many pathological processes ranging from inflammation and fibrosis to altered immunity and cancer. The goal of the current investigation is to dive into the exact role of the stromal fibroblast and the responsible mechanistic factors involved in both regulation and dysregulation of the inflammatory responses. This article reviews the most recent literature on how fibroblasts, in their different activation states or subtypes, play a crucial role in contributing to inflammatory outcomes. We will focus on recent findings on inflammatory diseases. We will also provide connections regarding the stromal-immune relationship, which supports the idea of fibroblast coming out from the 'ensemble' of cell types to the protagonist role in immunometabolism and inflammaging. Additionally, we discuss the current advances in variation of fibroblast nomenclature and division into clusters with their own suggested function and particularities in gene expression. Here, we provide a perspective for the periodontal implications, discussing the fibroblast role in the infection-driven and inflammatory mediated diseases such as periodontitis.
RESUMO
The gastrinomas are rare functional neuroendocrine neoplasms, most are localized to the duodenum (70-90%) or the pancreas (2-30%), but less common ectopic sites have been reported. The primary hepatic gastrinoma is extremely rare, with less tan 40 cases reported in the medical literature. Its low incidence and its non specific clinical presentation make it a difficult disease to diagnose. Providing a timely diagnosis the patient can be treated by surgical resection with high chances of success. The objective of this paper is to describe a case of primary hepatic gastrinoma in Mexico, successfully treated by right liver segmentectomy.
Los gastrinomas son neoplasias neuroendocrinas funcionales raras, y la mayoría se localizan en el duodeno (70-90%) o en el páncreas (2-30%), pero también existen otras localizaciones ectópicas poco comunes. El gastrinoma hepático primario es extremadamente raro, con menos de 40 casos reportados en la literatura médica. Su baja incidencia y su presentación clínica inespecífica lo convierten en una enfermedad difícil de diagnosticar. Al realizar un diagnóstico oportuno puede ser tratado mediante resección quirúrgica con altas posibilidades de éxito. El objetivo de este trabajo es presentar un caso clínico de gastrinoma hepático primario en México, tratado de manera exitosa mediante segmentectomía hepática derecha.
Assuntos
Gastrinoma , Neoplasias Pancreáticas , Gastrinoma/diagnóstico por imagem , Gastrinoma/cirurgia , Hospitais , Humanos , Fígado , México , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/cirurgiaRESUMO
Objective: In this study, expression of Interleukin-2, Interleukin-4, Interleukin-10 and transforming growth factor beta in diffuse and intestinal type gastric cancers from Mexican patients was assessed for use as markers of malignancy. Methods: A total of 30 biopsies from gastric adenocarcinomas, 60% diffuse, 20% intestinal and 20% mixed in type, were studied by immunohistochemistry. Results: Regarding expression of cytokines, 23% were positive for IL-2, 26.7% for IL-4, 16.6% for IL-10 and none for TGF-ß. There were found Significant statistically stage differences were noted.For example, for stages I-II 100% were IL-2 positive (p = 0.009), 87.5% were IL-4 positive (p = 0.005) and 100.0% IL-10 positive (p = 0.009). Young women were more likely to suffer gastric adenocarcinoma. In biopsies of male patients with gastric cancer, there was an increased expression of IL-2 and in biopsies from female patients in IL4. There was significantly greater detection of IL-4 and IL-10 expression in stages I and II than in stages III and IV. It was also found that IL-4, IL-10 had a higher positive expression in patients biopsies with low-level differentiations than patients with well differentiated gastric cancer in which cases were undetected. Conclusions: These results suggest that positive expression of IL-4 and IL-10 may be useful as a molecular marker to distinguish stage I and II diffuse gastric cancers which can be more readily controlled.
RESUMO
BACKGROUND: Even in expert hands, there can be serious complications when performing an endoscopic retrograde cholangiopancreatography. The most frequent complications are pancreatitis, cholangitis, bleeding, perforation, and acute cholecystitis. The hepatic subcapsular haematoma is a rare complication, with few cases described worldwide. OBJECTIVE: A case is presented of an extremely rare complication of endoscopic retrograde cholangiopancreatography, which required surgical treatment for its resolution without success. This is second case of mortality reported in the literature. CLINICAL CASE: Female patient of 30 years old, with indication for endoscopic retrograde cholangiopancreatography due to benign strictures. A hydro-pneumatic dilation and stent placement of 2 gauge 10 fr was performed. She presented abdominal pain after the procedure and significant decline in haemoglobin with no evidence of haemodynamic instability so an abdominal tomography scan was performed, showing no evidence of liver injury. The patient was haemodynamic unstable within 72 h. A laparotomy was required for damage control, with fatal outcome in the intensive care unit due to multiple organ failure. CONCLUSION: Subcapsular hepatic haematoma after endoscopic retrograde cholangiopancreatography is a rare complication, with few cases reported in the literature. Treatment described in the literature is conservative, resulting in a satisfactory resolution.
Assuntos
Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Hematoma/cirurgia , Fígado/cirurgia , Complicações Pós-Operatórias/cirurgia , Abdome Agudo/etiologia , Adulto , Colo/irrigação sanguínea , Ducto Colédoco/patologia , Ducto Colédoco/cirurgia , Doenças do Ducto Colédoco/cirurgia , Constrição Patológica , Reações Falso-Negativas , Evolução Fatal , Feminino , Hematoma/etiologia , Hemoperitônio/etiologia , Humanos , Isquemia/etiologia , Laparotomia , Fígado/lesões , Insuficiência de Múltiplos Órgãos/etiologia , Complicações Pós-Operatórias/etiologia , Choque Hemorrágico/etiologia , Stents , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In 2010, Health Canada, the equivalent to the FDA, reported that the risk of uterine perforation caused by levonorgestrel intrauterine device (IUD) is very serious, warning that its use had increased the number of uterine perforation. CLINICAL CASE: A 33 years old patient in who was placed three years before a levonorgestrel IUD; She presented evolution of 10 days with pain in hypogastric and both flanks and chronic constipation of two years; in exploration: moderate abdominal distention, IUD strings were not visible in uterine cervix. With translocated IUD diagnosis, a tomography was performed, finding IUD in abdominal cavity and ureter pyelocalyceal bilateral ectasia; preoperative plasma concentration of levonorgestrel 5.1 nmol/L, leukocytosis of 11,000 cells/mm3, and 20-30 erythrocytes in urine exam. Laparoscopic resection of omentum attached to IUD translocated was performed. One month after surgery plasma levonorgestrel in 0.3 nmol/L, normal urinalysis and hematic cytometry and resolution of the urinary tract ectasia. CONCLUSIONS: devices translocated with levonorgestrel, must be removed because the inflammatory reaction caused and the perforation of hollow viscera likelihood, with possibility to produce digestive tract and urinary tract ectasia by its pharmacologic action on smooth muscle.
Assuntos
Migração de Corpo Estranho/cirurgia , Dispositivos Intrauterinos Medicados/efeitos adversos , Levanogestrel/administração & dosagem , Adulto , Remoção de Dispositivo , Dilatação Patológica/etiologia , Feminino , Humanos , Cálices Renais/patologia , Pelve Renal/patologia , Laparoscopia/métodos , Tomografia/métodos , Ureter/patologiaRESUMO
BACKGROUND: It has been found that the cholesterol and triglyceride values are higher in preeclampsia than in normal pregnancy, even though it is unclear whether these levels are related to the severity. The aim of this study was to determine the correlation between dyslipidemia and severity in preeclampsia. METHODS: Comparative cross-sectional study in 200 patients, 100 with normal pregnancy and 100 with preeclampsia. The age, gynecological and obstetric history, total cholesterol and triglycerides were identified. Descriptive statistics were used: Student's t test for comparing the group of patients with preeclampsia and normal pregnancies, and ANOVA and odds ratio for the subanalysis of mild and severe preeclampsia. RESULTS: No statistically significant differences in age or cholesterol were found. Triglycerides showed a statistically significant difference: they were higher in relation to the severity of preeclampsia (normal pregnancy: 245 mg; mild preeclampsia: 308 mg; severe preeclampsia: 349 mg). CONCLUSIONS: Elevated levels of cholesterol and triglycerides in patients with preeclampsia showed no consistent relationship with the severity of preeclampsia.
Introducción: se ha identificado que los valores del colesterol y los triglicéridos (TG) son más altos en la preeclampsia que en el embarazo normal; sin embargo, aún no está claro si estos niveles tienen relación con la gravedad del proceso. El objetivo del estudio fue determinar si existe relación entre la dislipidemia y la gravedad en la preeclampsia. Métodos: estudio transversal comparativo en 200 pacientes, 100 con embarazo normal y 100 con preeclampsia. Se identificó edad, antecedentes ginecoobstétricos, colesterol total y TG. Se utilizó estadística descriptiva: t de Student para comparar el grupo de pacientes con preeclampsia y embarazos normales, y ANOVA y razón de momios para el subanálisis de preeclampsia leve y severa. Resultados: no se encontraron diferencias estadísticamente significativas en edad, ni en colesterol. Los TG presentaron una diferencia estadísticamente significativa: fueron más altos en relación con la gravedad de la preeclampsia (embarazo normal 245 mg, preeclampsia leve 308 mg y preeclampsia severa 349 mg). Conclusión: los niveles elevados de colesterol y TG en pacientes con preeclampsia no demostraron consistencia en relación con la gravedad de la preeclampsia.
Assuntos
Dislipidemias/complicações , Pré-Eclâmpsia , Adulto , Colesterol/sangue , Estudos Transversais , Dislipidemias/sangue , Feminino , Humanos , Pré-Eclâmpsia/sangue , Gravidez , Índice de Gravidade de Doença , Triglicerídeos/sangueRESUMO
Animal venoms are rich sources of ligands for studying ion channels and other pharmacological targets. Proteomic analyses of the soluble venom from the Mexican scorpion Vaejovis mexicanus smithi showed that it contains more than 200 different components. Among them, a 36-residue peptide with a molecular mass of 3864 Da (named Vm24) was shown to be a potent blocker of Kv1.3 of human lymphocytes (K(d) â¼ 3 pM). The three-dimensional solution structure of Vm24 was determined by nuclear magnetic resonance, showing the peptide folds into a distorted cystine-stabilized α/ß motif consisting of a single-turn α-helix and a three-stranded antiparallel ß-sheet, stabilized by four disulfide bridges. The disulfide pairs are formed between Cys6 and Cys26, Cys12 and Cys31, Cys16 and Cys33, and Cys21 and Cys36. Sequence analyses identified Vm24 as the first example of a new subfamily of α-type K(+) channel blockers (systematic number α-KTx 23.1). Comparison with other Kv1.3 blockers isolated from scorpions suggests a number of structural features that could explain the remarkable affinity and specificity of Vm24 toward Kv1.3 channels of lymphocytes.
Assuntos
Canal de Potássio Kv1.3/antagonistas & inibidores , Bloqueadores dos Canais de Potássio/farmacologia , Venenos de Escorpião/química , Venenos de Escorpião/farmacologia , Linfócitos T/efeitos dos fármacos , Motivos de Aminoácidos , Animais , Dissulfetos/química , Avaliação Pré-Clínica de Medicamentos/métodos , Humanos , Espectroscopia de Ressonância Magnética , Camundongos , Modelos Moleculares , Peptídeos/síntese química , Peptídeos/química , Peptídeos/farmacologia , Filogenia , Conformação Proteica , Venenos de Escorpião/síntese química , Escorpiões/químicaRESUMO
Endothelial dysfunction is a fundamental characteristic in the physiopathology of preeclampsia. Currently, a series of markers which explain endothelial dysfunction have been identified. The recognition of endothelial dysfunction has been used to realize an early diagnosis of preeclampsia, as soon as the classification of a possible prognosis. Nevertheless the detection of these markers is not accessible to the majority of hospitable centers that treat patients with preeclampsia. One indirect marker of endothelial dysfunction with a greater accessibility is the assessment of peripheral blood smear. Several studies had proved the presence of endothelial dysfunction by identification of red blood cells crenated in peripheral blood smear led us also to measure the impact in the evolution of the disease.
Assuntos
Pré-Eclâmpsia/sangue , Complicações Cardiovasculares na Gravidez/sangue , Doenças Vasculares/sangue , Doenças Vasculares/complicações , Feminino , Humanos , Gravidez , Complicações Cardiovasculares na Gravidez/patologia , Doenças Vasculares/patologiaRESUMO
Se exponen consideraciones útiles sobre el tratamiento de la fiebre en el niño en el nivel de atención primaria de salud, haciendo referencia a aspectos esenciales, tales como: definición, fisiopatología, clasificación, signos de alarma y cómo tomar la temperatura, así como también aspectos básicos a tener en cuenta en el tratamiento de la entidad. Al constituir la fiebre uno de los motivos más frecuentes de atención al niño, se destaca la importancia de su correcta valoración por todo el personal que se enfrenta a la siempre preocupante situación del niño febril. Además, se enfatiza en el pesquisaje de una infección bacteriana severa a todo niño que acuda al facultativo con fiebre. Se hace referencia a algunos protocolos de trabajos nacionales e internacionales para el tratamiento al niño febril. Finalmente se hacen consideraciones sobre la importancia de entrenar no solamente al personal de la salud que atiende a los niños, sino también a los familiares y a los cuidadores del niño febril, así como algunas recomendaciones y sugerencias basadas en la bibliografía revisada y en nuestra propia experiencia en la práctica clínica.
Useful considerations on the treatment of fever in the child at the primary health care level were exposed, making reference to essential aspects, such as: definition, physiopathology, classification, alarm signs, how to take the temperature, as well as other basic aspects to be taken into account in the treatment of the entity. On having fever, one of the most frequent reasons to give attention to the child, it was stressed the importance of its correct assessment by all the personnel facing the increasingly worrying situation of the febrile child. Moreover, emphasis was made on the screening of a severe bacterial infection in every child with fever visiting the physician. Reference was made to some national and international working protocols for the treatment of the febrile child. Finally, some considerations were made on the importance of training not only the health personnel providing attention to the children, but also the relatives and care givers of the febrile child. Recommendations and suggestions based on the reviewed bibliography and on our experience in clinical practice were also exposed.
Assuntos
Humanos , Criança , Infecções Bacterianas , Febre/classificação , Febre/fisiopatologia , Febre/terapia , Atenção Primária à SaúdeRESUMO
Se hace un breve resumen de la historia de la visita médica al hogar en Cuba, y se señala su evolución en las diferentes formas organizativas de la atención primaria en la etapa revolucionaria. Se enumeran las ventajas de las visitas médicas al hogar, su necesidad como componente fundamental e insustituible de la atención a los pacientes, y como complemento necesario del trabajo en el consultorio. Se exponen los motivos de la visita al hogar: enfermedades agudas, procesos crónicos, discapacidades, evaluar el entorno familiar e higiénico-epidemiológico del paciente, los ingresos domiciliarios, las altas hospitalarias precoces, y los pacientes con enfermedades terminales o con afecciones dispensarizadas, entre otros Se presenta un grupo de orientaciones para el desarrollo exitoso de la visita médica al hogar.
Assuntos
Humanos , Masculino , Feminino , Saúde da Família , Visita Domiciliar , Relações Profissional-FamíliaRESUMO
Se realizó una revisión sobre diferentes estudios publicados acerca de los problemas de salud que enfrenta el Médico de Familia en su práctica. Los problemas de salud en la atención primaria son múltiples y variados, según muestran los resultados de estudios que ejemplifican el perfil de la práctica del Médico de Familia, donde se encuentra una elevada incidencia de enfermedades agudas -muchas de ellas de carácter transitorio y curación espontánea- y una alta prevalencia de enfermedades crónicas, trastornos de la conducta, alteraciones del funcionamiento familiar y problemas higiénico-ambientales. Se requiere una preparación acorde con la problemática de salud que el médico va a enfrentar en su trabajo.
Assuntos
Humanos , Atenção Primária à SaúdeRESUMO
Se pretende mediante el presente trabajo proporcionar un grupo importante de elementos a tener en cuenta para confeccionar una adecuada receta médica. El prescribir una receta es un acto médico legal que debe ser llenado en todos sus acápites y de una manera correcta, lo cual contribuirá a una mejor atención al paciente.
Assuntos
Humanos , Preparações Farmacêuticas , Preparações FarmacêuticasRESUMO
La remisión médica es un documento médico legal que de no ser confeccionado adecuadamente puede afectar la calidad de la atención médica. Es por ello que las presentes recomendaciones pretenden proporcionar un formato útil para este fin.
Assuntos
Encaminhamento e ConsultaRESUMO
Se realizó un estudio descriptivo y retrospectivo en el municipio 10 de Octubre, con la finalidad de conocer el comportamiento de las afecciones cardiovasculares en niños y adolescentes, así como su repercusión en la salud reproductiva en la adolescencia. Se encontró que la cardiopatía congénita más frecuente fue la comunicación interventricular, seguida de la comunicación interauricular y de la persistencia del conducto arterioso. El mayor porcentaje de niños cardiópatas no está operado y se ubicaron en los grupos de edades de 1 a 4 años y de 5 a 19. Hubo un 17,5 por ciento de cardiopatías congénitas graves. Existió un pobre registro de las restantes afecciones cardiovasculares. No se presentó embarazo en las adolescentes portadoras de estas entidades. Las cardiopatías fueron la principal causa de mortalidad dentro del total de las anomalías congénitas y la mortalidad fue de un 20 por ciento
Assuntos
Humanos , Adolescente , Cardiopatias Congênitas/epidemiologia , Reprodução , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Se realizó un estudio descriptivo y retrospectivo con la finalidad de conocer la relación entre las infecciones respiratorias agudas con algunos factores asociados seleccionados en lactantes, durante el trienio 2001-2003, en el área de salud del Policlínico Docente 30 de Noviembre, del municipio 10 de Octubre. La incidencia de estas enfermedades en el mencionado período fue de 933 x 1 000. Se encontró que la mayoría de los infantes exhibió un adecuado estado inmunológico y nutricional, así como también que no tenían historia de alergia respiratoria. La institucionalización de estos niños no influyó en la aparición de estas enfermedades, y el tratamiento que predominó fue el sintomático
Assuntos
Humanos , Lactente , Infecções Respiratórias , Fatores de Risco , Epidemiologia Descritiva , Estudos RetrospectivosRESUMO
Se efectuó un estudio descriptivo y retrospectivo con la finalidad de conocer el comportamiento de la mortalidad infantil en el policlínico docente "30 de Noviembre" durante el decenio 1985-1994. El universo de estudio estuvo conformado por los 29 fallecidos menores de un año ocurridos en el período referido en dicha área de salud. Se calculó la tasa de mortalidad infantil en sus diferentes componentes en cada año motivo de estudio. Se encontró que la tasa de mortalidad infantil en nuestra área tiene un comportamiento cíclico, que la mortalidad neonatal precoz fue la que más fallecidos aportó y que las principales causas de muerte fueron la sepsis, bajo peso al nacer y la hipoxia. Se enfatiza en la importancia de establecer un Plan de Medidas encaminado a disminuir la mortalidad infantil del área