RESUMO
AIM: The aim of this study was to assess the levels and diagnostic accuracy of a set of potential biomarkers of periodontal tissue metabolism in gingival crevicular fluid (GCF) from patients with chronic periodontitis (CP) and asymptomatic apical periodontitis ( AAP). MATERIALS AND METHODS: Thirty one GCF samples from 11 CP patients, 44 GCF samples from 38 AAP patients and 31 GCF samples from 13 healthy volunteers were obtained (N = 106). Matrix metalloproteinases (MMPs) -2 and -9 were determined by zymography; levels of MMP-8 by ELISA and IFMA and MPO by ELISA. IL-1, IL-6, TNFα, DKK-1, Osteonectin, Periostin, TRAP-5 and OPG were determined by a multiplex quantitative panel. Statistical analysis was performed using linear mixed-effects models. RESULTS: The MMP-9 and MMP-8 were higher in CP, followed by AAP, versus healthy individuals (p < 0.05). ProMMP-2, MPO, IL-1, IL-6, PTN, TRAP-5 and OPG were significantly higher in CP when compared with AAP and healthy patients (p < 0.05). The highest diagnostic accuracies were observed for ProMMP-2, ProMMP-9, MMP-8 and TRAP-5 (AUC > 0.97) in CP, and for the active form of MMP-9 and MMP-8 (AUC > 0.90) in AAP. CONCLUSION: Gingival crevicular fluid composition is modified by CP and AAP. MMP-9 and MMP-8 show diagnostic potential for CP and AAP, whereas MMP-2 and TRAP-5 are useful only for CP.
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Periodontite Crônica , Adulto , Biomarcadores , Feminino , Líquido do Sulco Gengival , Humanos , Interleucina-1 , Interleucina-6 , Masculino , Pessoa de Meia-Idade , PeriodontiteRESUMO
PURPOSE: Central venous catheterization is a standard procedure in intensive care therapy. In developing countries, this intervention is frequently performed by physicians in training and without the availability of ultrasound guidance. Purpose of this study was to determine the incidence and potential risk factors for mechanical complications during central venous catheterization in an intensive care setting performed by a mixed group of practitioners without the use of adjunct ultrasound. METHODS: Prospective observational cohort study in a university teaching hospital. Three hundred critically ill patients requiring their first central venous catheter insertion were enrolled. All patients were observed for 24 hours for mechanical complications (pneumothorax, hemothorax, arterial puncture, incorrect tip position, cardiac dysrhythmia, and/or subcutaneous hematoma). Potential associations with mechanical complications were adjusted using multivariable analysis. Main outcome was the cumulative incidence of mechanical complications. RESULTS: The incidence of mechanical complications was 17% (n = 51). After covariate adjustment, the number of punctures was significantly related to mechanical complications. Compared with 1 puncture, 3 or more attempts were significantly associated with mechanical complications (odds ratio 3.62 [95% confidence interval 1.34-9.8]; P = .011). Experience of the operator was not associated with mechanical complications. CONCLUSIONS: The incidence of mechanical complications is affected by the number of punctures performed. After adjustment, the risk increases substantially with more than 3 attempts. Limiting the number of attempts, appropriate supervision and the use of ultrasound guidance when available are recommended for the further reduction in mechanical complications of central venous catheterization.
Assuntos
Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/métodos , Cuidados Críticos , Estado Terminal/terapia , Feminino , Humanos , Incidência , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/lesões , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Punções , Ultrassonografia de IntervençãoRESUMO
Introducción: Los síntomas laringofaríngeos (SLF) son comunes en anestesia. La incidencia de morbilidad laringofaríngea varía en la literatura. Objetivos: Determinar la incidencia de SLF al usar máscara laríngea y tubo endotraqueal en la primera y a las 24h posoperatorias y estimar la asociación de factores de riesgo. Métodos: Estudio de cohorte cerrada que incluyó 451 pacientes. Se indagó la presencia de odinofagia, disfonía y disfagia. Se utilizaron modelos marginales para estimar asociación con variables en estudio. Resultados: La incidencia de SLF durante la primera y 24h posoperatorias fue del 26 y del 13%, respectivamente. A las 24 h, la incidencia disminuyó significativamente. Conclusiones: La incidencia en un centro hospitalario colombiano de SLF en cirugía ambulatoria es importante. Existen diferencias en la reducción con el tubo endotraqueal y la máscara laríngea en el tiempo.
Introduction: To determine cumulative incidence of sore throat complaints (STCs) which occur with the insertion of the laryngeal mask (LM) and endotracheal tube (ETT) during the first hour and 24 hours after elective surgery. In addition, to establish risk factors associated with its occurrence. Methods: In a cohort study, a total of 451 patients scheduled for elective non-cardiac surgery were included consecutively for 6 months (ASA I-II-III, >18 years old) who underwent LM or ETT airway management for general anesthesia. Through a questionnaire with indirect and direct questions the presence of sore throat, hoarseness, dysphagia and the composite endpoint STCs were assessed one and 24 hours after surgery. Marginal models were used to identify risk factors. Results:We found an incidence of STCs of 26.8% and 13.5% at first and 24 postoperative hours respectively. At first hour, they were classified as sore throat (23.9%), hoarseness (6.7%) and dysphagia (6.4%). Each compound was not mutually exclusive. At 24 hours of follow up, incidence of STCs and its compounds decreases significantly but differently to ETT and LM. STCs were associated with female gender (OR=1.53 95%CI 1.00-2.37, p=0.05), ETT intubation (OR=4.20 95%CI 2.19-8.04, p<0.01) and bloodstain on airway device at extubation (OR=2.00 95%CI 1.18-3.36, p<0.01). Conclusions: The incidence of STCs remains important. There are differences in the pattern of reduction between ETT and LM over time and this study confirms risk factors for postoperative STCs like use of ETT, presence of blood during the airway device extraction and female gender.
Assuntos
HumanosRESUMO
AIM: Matrix metalloproteinases (MMP)-13 can initiate bone resorption and activate proMMP-9 in vitro, and both these MMPs have been widely implicated in tissue destruction associated with chronic periodontitis. We studied whether MMP-13 activity and TIMP-1 levels in gingival crevicular fluid (GCF) associated with progression of chronic periodontitis assessed clinically and by measuring carboxy-terminal telopeptide of collagen I (ICTP) levels. We additionally addressed whether MMP-13 could potentiate gelatinase activation in diseased gingival tissue. MATERIALS AND METHODS: In this prospective study, GCF samples from subjects undergoing clinical progression of chronic periodontitis and healthy controls were screened for ICTP levels, MMP-13 activity and TIMP-1. Diseased gingival explants were cultured, treated or not with MMP-13 with or without adding CL-82198, a synthetic MMP-13 selective inhibitor, and assayed by gelatin zymography and densitometric analysis. RESULTS: Active sites demonstrated increased ICTP levels and MMP-13 activity (p<0.05) in progression subjects. The MMP-9 activation rate was elevated in MMP-13-treated explants (p<0.05) and MMP-13 inhibitor prevented MMP-9 activation. CONCLUSIONS: MMP-13 could be implicated in the degradation of soft and hard supporting tissues and proMMP-9 activation during progression of chronic periodontitis. MMP-13 and -9 can potentially form an activation cascade overcoming the protective TIMP-1 shield, which may become useful for diagnostic aims and a target for drug development.
Assuntos
Periodontite Crônica/enzimologia , Metaloproteinase 13 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Adulto , Estudos de Casos e Controles , Colágeno Tipo I/análise , Progressão da Doença , Ativação Enzimática , Precursores Enzimáticos/metabolismo , Feminino , Líquido do Sulco Gengival/enzimologia , Humanos , Hidrólise , Masculino , Inibidores de Metaloproteinases de Matriz , Pessoa de Meia-Idade , Peptídeos/análise , Estudos Prospectivos , Inibidor Tecidual de Metaloproteinase-1/análiseRESUMO
We assessed the impact of long-term fluvastatin treatment on adverse atherosclerotic cardiac events (cardiac death, myocardial infarction, and revascularization excluding repeat interventions due to restenosis in the first 6 months) in 847 patients (fluvastatin [n = 417] or placebo [n = 430]) with average cholesterol levels treated with stents in the Lescol Intervention Prevention Study (LIPS). During the 4-year follow-up period, fluvastatin significantly decreased total cholesterol and low-density lipoprotein cholesterol levels and decreased the risk of first adverse atherosclerotic cardiac events by 30% compared with placebo (95% confidence interval -49 to -3.4, p = 0.03).