RESUMO
An increasing number of elderly people in renal support is expected in the coming years. The objective of this study was to report the clinical and socio-demographic data of end-stage renal disease (ESRD) adult patients undergoing regular dialysis treatment comparing elderly (≥65 years old) and non-elderly subjects using data from the Brazilian Dialysis Registry database. The regional distribution of the sample was Southeast (48.8%), South (33.7), Northeast (13.1%), Midwest (5.1%), and North (0.1%). A total of 18,030 patients were included in the analysis with elderly patients accounting for 29.5% of the sample. The elderly patients were predominantly male, white, retired, and literate. Elderly ESRD patients had a slightly higher frequency of undernourishment and a lower frequency of obesity than the non-elderly adults. A higher frequency of elderly patients were from the South and Southeast regions. The dialysis treatment of patients from both groups was predominantly funded by the public system, but the percent of non-public funding was higher for the elderly group. The most used initial access in the elderly was the central venous catheter and hemodialysis was the main modality at the beginning of treatment (93.2%), as well as during maintenance therapy (91.8%). Advanced age was associated with greater use of central venous catheter in the first dialysis session. The survival of the elderly on dialysis was lower than that of the non-elderly early in the course of dialysis and this difference increased over time. This is yet the largest national epidemiological study of elderly people on chronic dialysis.
Assuntos
Falência Renal Crônica , Diálise Renal , Adulto , Idoso , Brasil/epidemiologia , Demografia , Humanos , Rim , Falência Renal Crônica/epidemiologia , Falência Renal Crônica/terapia , Masculino , Pessoa de Meia-IdadeRESUMO
An increasing number of elderly people in renal support is expected in the coming years. The objective of this study was to report the clinical and socio-demographic data of end-stage renal disease (ESRD) adult patients undergoing regular dialysis treatment comparing elderly (≥65 years old) and non-elderly subjects using data from the Brazilian Dialysis Registry database. The regional distribution of the sample was Southeast (48.8%), South (33.7), Northeast (13.1%), Midwest (5.1%), and North (0.1%). A total of 18,030 patients were included in the analysis with elderly patients accounting for 29.5% of the sample. The elderly patients were predominantly male, white, retired, and literate. Elderly ESRD patients had a slightly higher frequency of undernourishment and a lower frequency of obesity than the non-elderly adults. A higher frequency of elderly patients were from the South and Southeast regions. The dialysis treatment of patients from both groups was predominantly funded by the public system, but the percent of non-public funding was higher for the elderly group. The most used initial access in the elderly was the central venous catheter and hemodialysis was the main modality at the beginning of treatment (93.2%), as well as during maintenance therapy (91.8%). Advanced age was associated with greater use of central venous catheter in the first dialysis session. The survival of the elderly on dialysis was lower than that of the non-elderly early in the course of dialysis and this difference increased over time. This is yet the largest national epidemiological study of elderly people on chronic dialysis.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Idoso , Diálise Renal , Falência Renal Crônica/terapia , Falência Renal Crônica/epidemiologia , Brasil/epidemiologia , Demografia , RimRESUMO
The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P<0.001) and between mod-PET and mini-PET (P<0.01) but not between t-PET and mod-PET (P=0.746). The correlation of D/P creatinine with t-PET vs mod-PET was significant (r=0.387, P=0.009) but not that of t-PET vs mini-PET (r=0.088, P=0.241). Estimated bias was -0.029 (P=0.201) between t-PET and mod-PET, and 0.206 (P<0.001) between t-PET and mini-PET. D/D0 glucose differed between t-PET and mod-PET (P=0.003) and between mod-PET and mini-PET (P=0.002) but not between t-PET and mini-PET (P=0.885). The correlations of D/D0 glucose in t-PET vs mod-PET (r=-0.017, P=0.421) or t-PET vs mini-PET (r=0.152, P=0.609) were not significant. Estimated bias was 0.122 (P=0.026) between t-PET and mod-PET, and 0.122 (P=0.026) between t-PET and mini-PET. The significant correlation of D/P creatinine between t-PET and mod-PET suggested that the latter is a good alternative to t-PET. There was no such correlation between t-PET and mini-PET.
Assuntos
Falência Renal Crônica/terapia , Diálise Peritoneal/métodos , Transporte Biológico , Creatinina/sangue , Feminino , Glucose/análise , Humanos , Falência Renal Crônica/sangue , Masculino , Pessoa de Meia-Idade , Peritônio/metabolismoRESUMO
The peritoneal equilibration test (PET) is the most widespread method for assessing water and solute transport across the peritoneal membrane. This study compared three methods: traditional PET (t-PET), mini-PET, and modified PET (mod-PET). Non-diabetic adults (n=21) who had been on peritoneal dialysis (PD) for at least three months underwent t-PET (glucose 2.5%-4 h), mini-PET (glucose 3.86%-1 h), and mod-PET (glucose 3.86%-4 h) to determine dialysate-to-plasma concentration ratio (D/P) for creatinine and dialysate-to-baseline dialysate concentration ratio (D/D0) for glucose. Agreement between methods regarding D/P creatinine and D/D0 glucose was assessed using analysis of variance (ANOVA), Pearson's correlation coefficient, and Bland-Altman analysis. D/P creatinine differed between t-PET and mini-PET (P<0.001) and between mod-PET and mini-PET (P<0.01) but not between t-PET and mod-PET (P=0.746). The correlation of D/P creatinine with t-PET vs mod-PET was significant (r=0.387, P=0.009) but not that of t-PET vs mini-PET (r=0.088, P=0.241). Estimated bias was −0.029 (P=0.201) between t-PET and mod-PET, and 0.206 (P<0.001) between t-PET and mini-PET. D/D0 glucose differed between t-PET and mod-PET (P=0.003) and between mod-PET and mini-PET (P=0.002) but not between t-PET and mini-PET (P=0.885). The correlations of D/D0 glucose in t-PET vs mod-PET (r=−0.017, P=0.421) or t-PET vs mini-PET (r=0.152, P=0.609) were not significant. Estimated bias was 0.122 (P=0.026) between t-PET and mod-PET, and 0.122 (P=0.026) between t-PET and mini-PET. The significant correlation of D/P creatinine between t-PET and mod-PET suggested that the latter is a good alternative to t-PET. There was no such correlation between t-PET and mini-PET.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Diálise Peritoneal/métodos , Falência Renal Crônica/terapia , Peritônio/metabolismo , Transporte Biológico , Creatinina/sangue , Glucose/análise , Falência Renal Crônica/sangueRESUMO
Resistance to Mycobacterium tuberculosis is a reality worldwide, and its diagnosis continues to be difficult and time consuming. To face this challenge, the World Health Organization has recommended the use of rapid molecular tests. We evaluated the routine use (once a week) of a line probe assay (Genotype MTBDRplus) for early diagnosis of resistance and for assessment of the main related risk factors over 2 years. A total of 170 samples were tested: 15 (8.8%) were resistant, and multidrug resistance was detected in 10 (5.9%). The sensitivity profile took 3 weeks (2 weeks for culture and 1 week for rapid testing). Previous treatment for tuberculosis and the persistence of positive acid-fast smears after 4 months of supervised treatment were the major risk factors observed. The use of molecular tests enabled early diagnosis of drug-resistant bacilli and led to appropriate treatment of the disease. This information has the potential to interrupt the transmission chain of resistant M. tuberculosis.
Assuntos
DNA Bacteriano/genética , Técnicas de Genotipagem/métodos , Mycobacterium tuberculosis/genética , Tuberculose Resistente a Múltiplos Medicamentos/diagnóstico , Adulto , Antituberculosos/farmacologia , Técnicas Bacteriológicas/métodos , Brasil , Diagnóstico Precoce , Feminino , Humanos , Isoniazida/farmacologia , Masculino , Testes de Sensibilidade Microbiana , Mycobacterium tuberculosis/efeitos dos fármacos , Rifampina/farmacologia , Fatores de Risco , Sensibilidade e Especificidade , Tuberculose Resistente a Múltiplos Medicamentos/microbiologiaRESUMO
Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and plays a role in vascular calcification. We evaluated the relationship between osteoprotegerin levels and inflammatory markers, atherosclerosis, and mortality in patients with stages 3-5 chronic kidney disease. A total of 145 subjects (median age 61 years, 61% men; 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 54 patients with stages 3-5 chronic kidney disease) were studied. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23]) and inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6]), and the intima-media thickness (IMT) in the common carotid arteries were measured at baseline. Cardiac function was assessed by color tissue Doppler echocardiography. After 36 months follow-up, the survival rate by Kaplan-Meier analysis was significantly different according to OPG levels (χ 2=14.33; P=0.002). Increased OPG levels were positively associated with IL-6 (r=0.38, P<0.001), FGF-23 (r=0.26, P<0.001) and hsCRP (r=0.0.24, P=0.003). In addition, OPG was positively associated with troponin I (r=0.54, P<0.001) and IMT (r=0.39, P<0.0001). Finally, in Cox analysis, only OPG (HR=1.07, 95%CI=1.02-1.13) and hsCRP (HR=1.02, 95%CI=1.01-1.04) were independently associated with increased risk of death. These results suggested that elevated levels of serum OPG might be associated with atherosclerosis and all-cause mortality in patients with chronic kidney disease.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Aterosclerose/complicações , Osteoprotegerina/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Biomarcadores/sangue , Brasil/epidemiologia , Proteína C-Reativa/análise , Espessura Intima-Media Carotídea , Causas de Morte , Ecocardiografia Doppler/métodos , Fatores de Crescimento de Fibroblastos/análise , Testes de Função Cardíaca , /análise , Estimativa de Kaplan-Meier , Análise Multivariada , Risco , Índice de Gravidade de DoençaRESUMO
Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and plays a role in vascular calcification. We evaluated the relationship between osteoprotegerin levels and inflammatory markers, atherosclerosis, and mortality in patients with stages 3-5 chronic kidney disease. A total of 145 subjects (median age 61 years, 61% men; 36 patients on hemodialysis, 55 patients on peritoneal dialysis, and 54 patients with stages 3-5 chronic kidney disease) were studied. Clinical characteristics, markers of mineral metabolism (including fibroblast growth factor-23 [FGF-23]) and inflammation (high-sensitivity C-reactive protein [hsCRP] and interleukin-6 [IL-6]), and the intima-media thickness (IMT) in the common carotid arteries were measured at baseline. Cardiac function was assessed by color tissue Doppler echocardiography. After 36 months follow-up, the survival rate by Kaplan-Meier analysis was significantly different according to OPG levels (χ ² =14.33; P=0.002). Increased OPG levels were positively associated with IL-6 (r=0.38, P<0.001), FGF-23 (r=0.26, P<0.001) and hsCRP (r=0.0.24, P=0.003). In addition, OPG was positively associated with troponin I (r=0.54, P<0.001) and IMT (r=0.39, P<0.0001). Finally, in Cox analysis, only OPG (HR=1.07, 95%CI=1.02-1.13) and hsCRP (HR=1.02, 95%CI=1.01-1.04) were independently associated with increased risk of death. These results suggested that elevated levels of serum OPG might be associated with atherosclerosis and all-cause mortality in patients with chronic kidney disease.
Assuntos
Aterosclerose/complicações , Osteoprotegerina/sangue , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/mortalidade , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/sangue , Brasil/epidemiologia , Proteína C-Reativa/análise , Espessura Intima-Media Carotídea , Causas de Morte , Ecocardiografia Doppler/métodos , Feminino , Fator de Crescimento de Fibroblastos 23 , Fatores de Crescimento de Fibroblastos/análise , Testes de Função Cardíaca , Humanos , Interleucina-6/análise , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Risco , Índice de Gravidade de Doença , Adulto JovemRESUMO
The aim of this study was to determine the prevalence of burnout syndrome among Brazilian oral and maxillofacial surgeons and its relationship with socio-demographic, clinical, and habit variables. The sample of this study comprised 116 surgeons. The syndrome was quantified using the Maslach Burnout Inventory (General Survey), which defines burnout as the triad of high emotional exhaustion, high depersonalization, and low personal accomplishment. The criteria of Grunfeld et al. were used to evaluate the presence of the syndrome (17.2%). No significant differences between the surgeons diagnosed with and without the syndrome were observed according to age (P=0.804), sex (P=0.197), marital status (P=0.238), number of children (P=0.336), years of professional experience (P=0.102), patients attended per day (P=0.735), hours worked per week (P=0.350), use of alcohol (P=0.148), sports practice (P=0.243), hobbies (P=0.161), or vacation period per year (P=0.215). Significant differences occurred in the variables sex in the emotional exhaustion subscale (P=0.002) and use or not of alcohol in the personal accomplishment subscale (P=0.035). Burnout syndrome among Brazilian surgeons is average, showing a low personal accomplishment.
Assuntos
Esgotamento Profissional/epidemiologia , Cirurgia Ortognática , Cirurgiões/psicologia , Adulto , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Prevalência , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
O objetivo deste trabalho foi averiguar a melhor densidade de explantes e o melhor tipo de sistema de cultivo visando desenvolver um protocolo de micropropagação de baixo custo para a Carobinha. Foram realizados experimentos de multiplicação in vitro com quatro tipos de frascos: R.I.T.A. (50 explantes/frasco), erlenmayer, (50 explantes/frasco), potes tipo maionese (6 explantes/frasco) e cubetas (1 explante/frasco). O co-cultivo de explantes, tanto em meio sólido quanto em meio líquido (R.I.T.A.), promoveu maiores taxas de explantes com brotação e de sobrevivência. O sistema de imersão temporária proporcionou melhores índices de desenvolvimento, brotação, sobrevivência e altura dos explantes. Concluímos que biorreatores podem ser utilizados eficientemente para a micropropagação de carobinha.
The aim of this study was to identify the best explant density and the best cultivation system with the goal of developing a micropropagation protocol of low cost for "carobinha" (Jacaranda decurrens CHAM.). Experiments of in vitro multiplication were carried out using four flask types: R.I.T.A. (50 explants/flask), Erlenmeyer (50 explants/flask), mayonnaise pots (6 explants/flask) and cuvettes (1 explant/flask). The co-cultivation of explants, in both solid and liquid medium (R.I.T.A.), led explants to show higher sprouting and survival rates. The temporary immersion system provided better rates of development, sprouting, survival and height of explants. We concluded that bioreactors may be efficiently used for the micropropagation of "carobinha".
Assuntos
Produção Agrícola , Jacaranda caroba/análise , Reatores Biológicos/efeitos adversosRESUMO
Temporomandibular joint (TMJ) dislocation is defined as an excessive forward movement of the condyle beyond the articular eminence with complete separation of the articular surfaces and fixation in that position. The aim of this study was to describe a modified miniplate designed for treating chronic mandibular dislocations and evaluate the results of its placement in one patient, who was followed for 18 months. The treatment of chronic mandibular dislocation using this modified miniplate was shown to be efficient in relation to the postoperative maximal mouth opening, recurrence and articular function.
Assuntos
Placas Ósseas , Luxações Articulares/cirurgia , Côndilo Mandibular/cirurgia , Transtornos da Articulação Temporomandibular/cirurgia , Materiais Biocompatíveis/química , Cefalometria/métodos , Doença Crônica , Tomografia Computadorizada de Feixe Cônico/métodos , Feminino , Seguimentos , Humanos , Cápsula Articular/cirurgia , Miniaturização , Desenho de Prótese , Amplitude de Movimento Articular/fisiologia , Osso Temporal/diagnóstico por imagem , Titânio/químicaRESUMO
OBJECTIVE: Dietary sugar exposures induce an immediate drop of the plaque pH. Based on in vitro observations, it was hypothesized that oral bacteria may rapidly respond to this environmental change by increasing the activity or expression of alkali-generating pathways, such as the urease pathway. The objective of this exploratory in vivo study was to determine the short-term effect of a brief sucrose exposure on plaque and saliva urease activity and expression, and to relate this effect to caries experience. METHODS: Urease activity levels were measured in plaque and saliva samples collected from 20 children during fasting conditions and 30 min after rinsing with a sucrose solution. Streptococcus salivarius ureC-specific mRNA in saliva was quantified using real-time RT-PCR. The impact of host-related factors, such as age, gender, sugar consumption, salivary mutans streptococci levels and caries status on urease activity was evaluated. RESULTS: Plaque urease activity under fasting conditions was higher in subjects with low caries and mutans streptococci levels. This difference was not observed after the sucrose exposure. The response of urease to sucrose in vivo did not depend on caries experience or salivary mutans levels. Significant increase in urease activity of plaque and saliva after exposure to sucrose was observed only in the subjects who had low urease levels at baseline. CONCLUSIONS: The findings of this exploratory study suggest that plaque urease activity may have an important long-term influence in caries development but not during a cariogenic challenge.
Assuntos
Placa Dentária/enzimologia , Sacarose Alimentar/farmacologia , Saliva/enzimologia , Urease/análise , Fatores Etários , Proteínas de Bactérias/análise , Criança , Pré-Escolar , Contagem de Colônia Microbiana , Índice CPO , Jejum , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , RNA Bacteriano/análise , Saliva/microbiologia , Fatores Sexuais , Streptococcus/genética , Streptococcus mutans/isolamento & purificaçãoRESUMO
Hepatitis C (HCV) is not an uncommon feature in hemodialysis (HD) patients and may be a cause of systemic inflammation. Plasma cytokine interleukin-6 (IL-6) is mainly produced by circulating and peripheral cells and induces the hepatic synthesis of C-reactive protein (CRP), which is the main acute phase reactant. The aim of this study was to investigate the influence of HCV on two markers of systemic inflammation, serum CRP and IL-6, in HD patients. The study included 118 HD patients (47% males, age 47 +/- 13 years, 9% diabetics) who had been treated by standard HD for at least 6 months. The patients were divided into two groups depending on the presence (HCV+) or absence (HCV-) of serum antibodies against HCV. Serum albumin (S-Alb), plasma high sensitivity CRP (hsCRP), IL-6, and alanine aminotransferase (ALT) were measured and the values were compared with those for 22 healthy controls. Median hsCRP and IL-6 values and hsCRP/IL-6 ratio were: 3.5 vs 2.1 mg/l, P < 0.05; 4.3 vs 0.9 pg/ml, P < 0.0001, and 0.8 vs 2.7, P < 0.0001, for patients and controls, respectively. Age, gender, S-Alb, IL-6 and hsCRP did not differ between the HCV+ and HCV- patients. However, HCV+ patients had higher ALT (29 +/- 21 vs 21 +/- 25 IU/l) and had been on HD for a longer time (6.1 +/- 3.0 vs 4.0 +/- 2.0 years, P < 0.0001). Moreover, HCV+ patients had a significantly lower median hsCRP/IL-6 ratio (0.7 vs 0.9, P < 0.05) compared to the HCV- group. The lower hsCRP/IL-6 ratio in HCV+ patients than in HCV- patients suggests that hsCRP may be a less useful marker of inflammation in HCV+ patients and that a different cut-off value for hsCRP for this population of patients on HD may be required to define inflammation.
Assuntos
Proteína C-Reativa/análise , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/diagnóstico , Interleucina-6/sangue , Diálise Renal , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores/análise , Brasil , Estudos de Casos e Controles , Estudos de Coortes , Feminino , Hepatite C/sangue , Hepatite C/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Albumina Sérica/análiseRESUMO
Hepatitis C (HCV) is not an uncommon feature in hemodialysis (HD) patients and may be a cause of systemic inflammation. Plasma cytokine interleukin-6 (IL-6) is mainly produced by circulating and peripheral cells and induces the hepatic synthesis of C-reactive protein (CRP), which is the main acute phase reactant. The aim of this study was to investigate the influence of HCV on two markers of systemic inflammation, serum CRP and IL-6, in HD patients. The study included 118 HD patients (47 percent males, age 47 ± 13 years, 9 percent diabetics) who had been treated by standard HD for at least 6 months. The patients were divided into two groups depending on the presence (HCV+) or absence (HCV-) of serum antibodies against HCV. Serum albumin (S-Alb), plasma high sensitivity CRP (hsCRP), IL-6, and alanine aminotransferase (ALT) were measured and the values were compared with those for 22 healthy controls. Median hsCRP and IL-6 values and hsCRP/IL-6 ratio were: 3.5 vs 2.1 mg/l, P < 0.05; 4.3 vs 0.9 pg/ml, P < 0.0001, and 0.8 vs 2.7, P < 0.0001, for patients and controls, respectively. Age, gender, S-Alb, IL-6 and hsCRP did not differ between the HCV+ and HCV- patients. However, HCV+ patients had higher ALT (29 ± 21 vs 21 ± 25 IU/l) and had been on HD for a longer time (6.1 ± 3.0 vs 4.0 ± 2.0 years, P < 0.0001). Moreover, HCV+ patients had a significantly lower median hsCRP/IL-6 ratio (0.7 vs 0.9, P < 0.05) compared to the HCV- group. The lower hsCRP/IL-6 ratio in HCV+ patients than in HCV- patients suggests that hsCRP may be a less useful marker of inflammation in HCV+ patients and that a different cut-off value for hsCRP for this population of patients on HD may be required to define inflammation.
Assuntos
Adolescente , Adulto , Pessoa de Meia-Idade , Idoso de 80 Anos ou mais , Humanos , Masculino , Feminino , Proteína C-Reativa/análogos & derivados , Hepacivirus/imunologia , Anticorpos Anti-Hepatite C/sangue , Hepatite C/diagnóstico , /sangue , Diálise Renal/efeitos adversos , Brasil , Biomarcadores/análise , Estudos de Casos e Controles , Estudos de Coortes , Hepatite C/etiologia , Albumina Sérica/análiseRESUMO
The aim of the present study was to evaluate the colonization profile and clonal distribution of Streptococcus mutans isolated from oral cavities that presented coronal and root caries lesions. The isolation and biochemical identification of mutans streptococci were carried out by using saliva samples, dental plaque, and tissue from the caries lesions. In order to confirm their molecular identity, S. mutans and Streptococcus sobrinus were submitted to the PCR method, using specific primers for portions of the glucosyltransferase genes (gtfB and gtfI, respectively). The AP-PCR method was used to detect the genetic polymorphism of S. mutans strains. Among the isolated and identified species, S. mutans showed a significantly greater frequency of isolation (59.2%) than the other mutans streptococci. Each of the subjects harbored two to ten genotypes of S. mutans, randomly distributed in different sites. S. mutans genotypes showed no evidence of variability in colonizing noncarious and carious surfaces within the same individual, nor evidence of etiologic differences between coronal and root caries. This study showed that no particular genotype of S. mutans is uniquely associated with the initiation and progression of caries, and that root and coronal caries can emerge in the presence of a broad spectrum of S. mutans clones.
Assuntos
Cárie Dentária/microbiologia , Cárie Radicular/microbiologia , Streptococcus mutans/genética , Coroa do Dente/microbiologia , Idoso , Antígenos de Bactérias/análise , Proteínas de Bactérias/análise , Células Clonais , Placa Dentária/microbiologia , Feminino , Genótipo , Glucosiltransferases/análise , Humanos , Masculino , Pessoa de Meia-Idade , Polimorfismo Genético/genética , Proteínas/análise , Saliva/microbiologia , Streptococcus mutans/classificação , Streptococcus sobrinus/classificação , Streptococcus sobrinus/genéticaRESUMO
The purpose of the present report is to demonstrate the long-term efficacy and safety of heparin-induced extracorporeal lipoprotein precipitation (HELP) of LDL-c and fibrinogen in the management of familial hypercholesterolemia. From June 1992 to June 1998 a 22-year-old young male patient with familial hypercholesterolemia (double heterozygote for C660X and S305C) resistant to medication and diet and with symptomatic coronary artery disease (angina) was treated weekly with 90-min sessions of the HELP system. The patient had also been previously submitted to right coronary artery angioplasty. The efficacy of the method was evaluated by comparing the reduction of total cholesterol, LDL-c and fibrinogen before and after the sessions and before and after initiation of the study (data are reported as averages for each year). During the study, angina episodes disappeared and there were no detectable adverse effects of the treatment. Total cholesterol (TC), fibrinogen, and LDL-c decreased significantly after each session by 59.6, 66.1 and 64%, respectively. HDL-c showed a nonsignificant reduction of 20.4%. Comparative mean values pre- and post-treatment values in the study showed significant differences: TC (488 vs 188 mg/dl), LDL-c (416.4 vs 145 mg/dl), and fibrinogen (144.2 vs 57.4 mg/dl). There was no significant change in HDL-c level: 29.4 vs 23 mg/dl. These data show that the HELP system, even for a long period of time, is a safe and efficient mode of treatment of familial hypercholesterolemia and is associated with disappearance of angina symptoms.
Assuntos
Anticoagulantes/uso terapêutico , LDL-Colesterol/sangue , Circulação Extracorpórea , Heparina/uso terapêutico , Hiperlipoproteinemia Tipo II/terapia , Adulto , Precipitação Química , HDL-Colesterol/sangue , Teste de Esforço , Seguimentos , Heparina/sangue , Humanos , Hiperlipoproteinemia Tipo II/sangue , Masculino , Ultrassonografia DopplerRESUMO
The purpose of the present report is to demonstrate the long-term efficacy and safety of heparin-induced extracorporeal lipoprotein precipitation (HELP) of LDL-c and fibrinogen in the management of familial hypercholesterolemia. From June 1992 to June 1998 a 22-year-old young male patient with familial hypercholesterolemia (double heterozygote for C660X and S305C) resistant to medication and diet and with symptomatic coronary artery disease (angina) was treated weekly with 90-min sessions of the HELP system. The patient had also been previously submitted to right coronary artery angioplasty. The efficacy of the method was evaluated by comparing the reduction of total cholesterol, LDL-c and fibrinogen before and after the sessions and before and after initiation of the study (data are reported as averages for each year). During the study, angina episodes disappeared and there were no detectable adverse effects of the treatment. Total cholesterol (TC), fibrinogen, and LDL-c decreased significantly after each session by 59.6, 66.1 and 64 percent, respectively. HDL-c showed a nonsignificant reduction of 20.4 percent. Comparative mean values pre- and post-treatment values in the study showed significant differences: TC (488 vs 188 mg/dl), LDL-c (416.4 vs 145 mg/dl), and fibrinogen (144.2 vs 57.4 mg/dl). There was no significant change in HDL-c level: 29.4 vs 23 mg/dl. These data show that the HELP system, even for a long period of time, is a safe and efficient mode of treatment of familial hypercholesterolemia and is associated with disappearance of angina symptoms
Assuntos
Humanos , Masculino , Adulto , Anticoagulantes , LDL-Colesterol , Heparina , Hiperlipoproteinemia Tipo II , Precipitação Química , HDL-Colesterol , Teste de Esforço , Circulação Extracorpórea , Seguimentos , Heparina , Hiperlipoproteinemia Tipo II , Ultrassonografia DopplerRESUMO
The association between prevalence of hepatitis B serological markers and birthplace, in a study carried out in a small rural county of S. Paulo State, Brazil, suggests different risk factors for hepatitis B between migrants and nonmigrant populations. These two groups were compared with regard to the following variables: level of education, professional occupation, number of previous hospitalizations, past history of blood transfusions and type of dental treatment. Migrants, mainly those from other states of Brazil, showed a low-level of education, a high proportion of people employed in agricultural activities, a higher number of past hospitalizations and higher exposure to blood transfusion and to more aggressive dental procedures. Associations were observed between the prevalence of serological markers and the following variables: level of education, professional occupation, number of previous hospitalizations and type of dental procedures, even though the last two associations did not justify the higher prevalences observed among migrants. The different distribution of hepatitis B markers seems to be dependent on the migrants' worse socio-economic condition, demonstrated by their lower level of education and by the predominance of secondary occupations.
Assuntos
Hepatite B/epidemiologia , População Rural , Fatores Socioeconômicos , Brasil/epidemiologia , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/análise , Antígenos de Superfície da Hepatite B/análise , Humanos , PrevalênciaRESUMO
Distribution of hepatitis B serological markers according to people's birthplaces and area of residence (urban/rural) was studied as a part of a field epidemiological research project carried out in Cássia dos Coqueiros, a small rural community of S. Paulo State, Brazil. The total prevalence of HBV markers was 7.7%, with rural showing a higher risk than urban inhabitants (9.8% as against 4.9%, respectively). Analysis of prevalence according to people's birthplaces revealed the highest value among those from other Brazilian states (15.8%), followed by people from other municipalities of the State of S. Paulo (9.2%). Those born in Cássia dos Coqueiros and particularly in Ribeirão Preto (the main city of the area, located 80 kilometers away), showed the lowest values of prevalence (5.2% and 2.5%, respectively). The importance of studying people's birthplaces when field epidemiological studies on hepatitis B are carried out is stressed. This variable is considered to be capable of exercising an influence on the natural history of the disease in a community, and may even explain differences in the distribution of markers in apparently similar populations.
Assuntos
Hepatite B/epidemiologia , Características de Residência , População Rural , Adolescente , Adulto , Fatores Etários , Idoso , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Hepatite B/imunologia , Anticorpos Anti-Hepatite B/análise , Antígenos de Superfície da Hepatite B/análise , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , PrevalênciaRESUMO
Prevalence of three hepatitis B markers was measured by immunoassay techniques in small rural community of the State of S. Paulo, Brazil. Total prevalence was 7.74%, corresponding to values of 0.10%, 1.69% and 7.74% for HBsAg, anti-HBs and anti-HBc, respectively. The importance of anti-HBc determination in such studies is stressed. Comparisons between the low viral circulation observed in this area and high prevalences described in other rural communities may contribute to the raising of new hypothesis concerning alternative transmission mechanisms of hepatitis B.