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Introducción: la Rinosinusitis Crónica se define como la inflamación crónica de la nariz y los senos paranasales por más de 12 semanas. La prevalencia varía entre el 5% - 30% de acuerdo con la zona geográfica según un estudio de carga de enfermedad (2012-2014), la prevalencia de las enfermedades respiratorias crónicas (rinitis y sinusitis crónica) varió entre el 10% y el 25%. Objetivo: establecer un conjunto de consideraciones basadas en consenso de expertos, para el diagnóstico y el tratamiento de la rinosinusitis crónica en pacientes adultos, en el contexto colombiano. Métodos: se llevó a cabo un consenso formal (Delphi y nominal). Se conformó un grupo de expertos, se definieron el alcance y las preguntas. Se realizaron dos rondas de calificación anónimas, y una discusión para las preguntas sin consenso. En las preguntas con opciones de uno a nueve, se consideró consenso con una mediana de uno a tres o de siete a nueve. En las preguntas tipo Likert, se consideró consenso un porcentaje igual o superior al 80% en acuerdos o desacuerdos. Resultados: se definieron y calificaron 18 preguntas, con la participación de 17 otorrinolaringólogos, de 8 ciudades colombianas, todos miembros de la Asociación Colombiana de Otorrinolaringología y con un promedio de experticia de 19.2 años (Desviación estándar [DE]: 10,2). Se obtuvieron 18 recomendaciones para el diagnóstico y el tratamiento de esta patología. Conclusiones: las recomendaciones emitidas por los expertos permiten orientar y estandarizar el diagnóstico y el tratamiento de la rinosinusitis crónica en adultos, en el contexto de los servicios de salud en Colombia.
Introduction: Chronic Rhinosinusitis is defined as chronic inflammation of the nose and paranasal sinuses for more than 12 weeks. The prevalence varies between 5% - 30% depending on the geographical area according to a disease burden study (2012-2014), the prevalence of chronic respiratory diseases (rhinitis and chronic sinusitis) varied between 10% - 25%. Objective: To establish a set of considerations based on expert consensus, for the diagnosis and treatment of chronic rhinosinusitis in adult patients, in the Colombian context. Methods: A formal consensus (Delphi and nominal) was carried out. A group of experts was formed, the scope and questions were defined. Two anonymous grading rounds were conducted, and a discussion for questions without consensus. In the Questions with options from one to nine were considered consensus with a median of one to three or seven to nine. In the Likert-type questions, a percentage equal to or greater than 80% in agreements or disagreements was considered consensus. Results: 18 questions were defined and scored, with the participation of 17 otorhinolaryngologists, from eight Colombian cities, all members of the Colombian Association of Otorhinolaryngology and with an average experience of 19.2 years (Standard desviation [SD]: 10.2). 18 recommendations were obtained for the diagnosis and treatment of this pathology. Conclusions: The recommendations issued by the experts allow to guide and standardize the diagnosis and treatment of chronic rhinosinusitis in adults, in the context of health services in Colombia.
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Humanos , Sinusite , Terapêutica , DiagnósticoRESUMO
Resumen: La pandemia por SARS-COV-2 ha generado muchos interrogantes sobre el comportamiento de enfermedades crónicas. Si bien se conoce que los pacientes con comorbilidades importantes tienen un mayor riesgo de complicaciones, no se conoce el comportamiento de enfermedades, como la enfermedad pulmonar obstructiva crónica (EPOC), en el período de pandemia y cuarentena por COVID-19. En este artículo, se realizó una revisión de la literatura sobre los principales aspectos teóricos para entender las posibles interacciones entre la infección por SARS-COV-2 y pacientes con patología respiratoria como la EPOC. Se revisaron los principales aspectos de las infecciones virales y su fisiopatología en la exacerbación de la enfermedad, sus mecanismos inflamatorios, y las condiciones que pueden aumentar el riesgo de infección y gravedad durante la pandemia por COVID-19. Además, se exploraron los aspectos relacionados a la cuarentena y su posible influencia sobre la exacerbación de la enfermedad. Finalmente, se exploraron los aspectos económicos relacionados con la exacerbación y su manejo asociado a la pandemia.
Abstract: The SARS-COV-2 pandemic has raised many questions about the behavior of chronic diseases. Although it is known that patients with significant comorbidities have a higher risk of complications, the behavior of diseases, such as chronic obstructive pulmonary disease (COPD), during the period of the COVID-19 pandemic and quarantine is not known. In this article, a literature review was carried out on the main theoretical aspects to understand the possible interactions between SARS-COV-2 infection and patients with respiratory pathology such as COPD. The main aspects of viral infections and their pathophysiology in the exacerbation of the disease, their inflammatory mechanisms, and the conditions that can increase the risk of infection and severity during the COVID-19 pandemic were reviewed. In addition, aspects related to quarantine and its possible influence on the exacerbation of the disease were explored. Finally, the economic aspects related to the exacerbation and its management associated with the pandemic were explored.
Resumo: A pandemia de SARS-COV-2 tem gerado muitos questionamentos sobre o comportamento das doenças crônicas. Embora se saiba que pacientes com comorbidades significativas apresentam risco aumentado de complicações, o comportamento de doenças como a doença pulmonar obstrutiva crónica (DPOC) não é conhecido. No período de pandemia e quarentena por COVID-19. Neste artigo, foi realizada urna revisão da literatura sobre os principais aspectos teóricos para compreender as possíveis interações entre a infecção por SARS-COV-2 e pacientes com patologia respiratória, como DPOC. Foram revisados os principais aspectos das infecções virais e sua fisiopatologia na exacerbação da doença, seus mecanismos inflamatórios e as condições que podem aumentar o risco de infecção e gravidade durante a pandemia COVID-19. Além disso, foram explorados aspectos relacionados à quarentena e sua possível influencia na exacerbação da doença. Por fim, foram explorados os aspectos económicos relacionados à exacerbação e sua gestão associada à pandemia.
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Background. Mexico City Metropolitan Area (MCMA) has the largest number of COVID-19 (coronavirus disease 2019) cases in Mexico and is at risk of exceeding its hospital capacity in early 2021. Methods. We used the Stanford-CIDE Coronavirus Simulation Model (SC-COSMO), a dynamic transmission model of COVID-19, to evaluate the effect of policies considering increased contacts during the end-of-year holidays, intensification of physical distancing, and school reopening on projected confirmed cases and deaths, hospital demand, and hospital capacity exceedance. Model parameters were derived from primary data, literature, and calibrated. Results. Following high levels of holiday contacts even with no in-person schooling, MCMA will have 0.9 million (95% prediction interval 0.3-1.6) additional COVID-19 cases between December 7, 2020, and March 7, 2021, and hospitalizations will peak at 26,000 (8,300-54,500) on January 25, 2021, with a 97% chance of exceeding COVID-19-specific capacity (9,667 beds). If MCMA were to control holiday contacts, the city could reopen in-person schools, provided they increase physical distancing with 0.5 million (0.2-0.9) additional cases and hospitalizations peaking at 12,000 (3,700-27,000) on January 19, 2021 (60% chance of exceedance). Conclusion. MCMA must increase COVID-19 hospital capacity under all scenarios considered. MCMA's ability to reopen schools in early 2021 depends on sustaining physical distancing and on controlling contacts during the end-of-year holiday.
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Resumen Introducción: Si bien se ha constatado la influencia negativa del síndrome de quemarse en el trabajo o Síndrome de Burnout (SB) en el desempeño laboral, aun los datos son elusivos respecto de su relación específica con la Satisfacción Laboral (SL) y Calidad de Vida Profesional (CVP) en el contexto de las profesiones asociadas a la salud pública. Objetivo: Analizar la asociación entre SB, SL y CVP, y algunas variables sociolaborales de 169 profesionales de la salud pública chilena. Materiales y métodos: Estrategia asociativa comparativa-transversal, aplicando el Inventario de Burnout de Maslach (MBI), la Escala de Satisfacción Laboral (S20/23), y el Cuestionario de Vida Profesional (CVP-35). Resultados: Un 10% de los trabajadores percibió altos niveles de SB, y una SL y CVP satisfactorias; un 88,8% medio/moderado. La edad cronológica, Motivación Intrínseca, Apoyo Directivo, estado civil y años de servicio explicaron el 33,5% de la variabilidad del Cansancio Emocional; y se plantean buenos predictores del SB. Conclusiones: Los datos reflejan una prevalencia media/moderada de SB, que puede ser entendida a la luz de la influencia insidiosa del síndrome. La edad cronológica y el estado civil se plantean como factores protectores. Se discuten los resultados en el contexto de la literatura existente.
Abstract Introduction: The negative influence of the burnout syndrome (BS) on work performance has been demonstrated. However, data are still elusive regarding its specific relationship with Job Satisfaction (JS) and Professional Quality of Life (ProQOL) in professions associated with public health. Objective: To analyze the association between BS, JS and ProQOL, and some socio-labor variables of 169 Chilean public health professionals. Materials and methods: A comparative cross-sectional associative study that applied the Maslach Burnout Inventory (MBI), the Labor Satisfaction Scale (S20/23), and the Professional Life Questionnaire (PLQ-35). Results: 10% of participants perceived high BS levels and satisfactory HS and ProQOL, while 88.8% of health professionals acknowledged medium/moderate levels. 33.5% of the variability in Emotional Fatigue could be explained by chronological age, Intrinsic Motivation, Management Support, marital status and years of service. Good BS predictors are suggested. Conclusions: The data reflect a medium/moderate prevalence of BS, which can be understood in light of the insidious influence of this syndrome. Chronological age and marital status are suggested as protective factors. The results are discussed in the context of current literature.
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Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Estresse Ocupacional , Esgotamento Psicológico , Qualidade de Vida , Pessoal de Saúde , Satisfação no EmpregoRESUMO
BACKGROUND: Symptomatic vasospasm (sVSP) is a common complication during the course of aneurysmal subarachnoid hemorrhage (aSAH). We aimed to evaluate the efficacy and accuracy of transcranial Doppler ultrasound (TCD), performed within the first 3 days of aSAH to predict the development of sVSP. METHODS: We performed a retrospective analysis of our institutional prospectively collected database of patients with aSAH. Patients with aSAH and World Federation of Neurosurgical Societies (WFNS) grades I-III were included in the analysis. A receiver operating characteristic (ROC) curve was generated to determine cut-off values for mean flow velocities (MFVs) in the middle cerebral artery (MCA) and anterior cerebral artery (ACA) bilaterally to predict sVSP. RESULTS: Fifty-one patients were included in the study. Mean age was 49.8 ± 10.2 years, and 84.3% (43 patients) were women. The accuracy of measured MFVs to predict sVSP was 0.79 [95% confidence interval (CI), 0.69-0.89] and 0.77 (95% CI, 0.64-0.91) for the MCA and the ACA, respectively. In the MCA, an MFV ≥ 74 cm/s was significantly associated with a six-fold increased risk of sVSP, achieving sensitivity greater than 70%. In the ACA, an MFV ≥ 64 cm/s was significantly associated with a nine-fold increased risk of sVSP. CONCLUSION: Early TCD evaluation of MFVs in the MCA and ACA is a useful tool to predict the development of sVSP in patients with acute aSAH.
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In developed countries, addressing the growing opioid addiction epidemic is focused on preventive measures, developing better overdose-reversal medications and designing newer strategies to treat addiction. Primary prescribers of the therapeutic use of opioids might play a definite role in the aetiology of the epidemics. Developing countries could be affected by similar issues; however, given that no updated statistics are available, it is possible that their populations undergo problems similar to those for which current data is available. Concerns have arisen regarding synthetic opioid tramadol which, given its fast and potent analgesic effects, low cost and easy availability is widely prescribed. A debate remains as to whether tramadol induces addictive effects like those of stronger analogues such as oxycodone or fentanyl. Here we present a case of tramadol dependence in an Ecuadorian patient and find that substance abuse can occur in normal individuals affected by chronic pain, otherwise treatable with standard methods.
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Analgésicos Opioides/efeitos adversos , Transtornos de Enxaqueca/tratamento farmacológico , Transtornos Relacionados ao Uso de Opioides/diagnóstico , Papel do Médico , Padrões de Prática Médica , Tramadol/efeitos adversos , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Países em Desenvolvimento , Equador , Humanos , Injeções Intramusculares , Masculino , Tramadol/administração & dosagem , Tramadol/uso terapêuticoRESUMO
BACKGROUND: Most of the literature describing morphological features of intracranial aneurysms (IAs) is from North-America, East-Asia, and Europe. There is limited data from South-America. We describe the epidemiologic and angiographic features of ruptured and unruptured IAs in a cohort of patients from Ecuador. METHODS: We conducted a retrospective analysis of prospectively acquired databases from 3 different tertiary hospitals over a 3-year period (2014-2017). In a per-patient basis, odd ratios (ORs) of ruptured presentation for each variable using a univariate logistic regression model were calculated. An aneurysm-based multivariate analysis was performed to calculate rupture ORs for each variable. RESULTS: Our sample included 557 patients with 761 IAs. Mean patient age was 52.2 years (range 18-82). Sixty-eight percent were women, and almost 90% presented with ruptured aneurysms and concomitant subarachnoid hemorrhage (SAH). Mean size of all the IAs was 6.4 mm ± 3.98 mm. Most IAs were located in anterior circulation (96.6%): 28.4% medial cerebral artery, 24.4% anterior cerebral artery or anterior communicating artery (ACOM), and 23.5% posterior communicating artery (PCOM). Only 6 basilar tip aneurysms (0.8%) were reported. In the adjusted analysis, aneurysms located in the ACOM (OR 1.89, 95% CI 1.29-2.78) and PCOM (OR 1.84, 95% CI 1.25-2.71), size larger than 5 mm (OR 2.84, 95% CI 2.04-3.93) and 7 mm (OR 2.28, 95% CI 1.64-3.19), and those with non-saccular morphology (OR 9.87, 95% CI 2.21-44.14) were significantly associated with ruptured presentation. CONCLUSIONS: The prevalence of posterior circulation IAs in Ecuador, particularly basilar tip aneurysms, is low when compared to previous reports from developed countries. In our sample, IAs greater than 5 mm (and ≥7 mm) in size, ACOM and PCOM locations, and IAs with nonsaccular morphologies (blister and fusiform) were significantly associated with SAH presentation.
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Aneurisma Roto/diagnóstico por imagem , Angiografia Cerebral/métodos , Artérias Cerebrais/diagnóstico por imagem , Aneurisma Intracraniano/diagnóstico por imagem , Hemorragia Subaracnóidea/diagnóstico por imagem , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Roto/epidemiologia , Angiografia Digital , Angiografia por Tomografia Computadorizada , Equador/epidemiologia , Feminino , Humanos , Aneurisma Intracraniano/epidemiologia , Angiografia por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Estudos Retrospectivos , Fatores de Risco , Hemorragia Subaracnóidea/epidemiologia , Fatores de Tempo , Adulto JovemRESUMO
Resumen El objetivo del presente estudio es analizar los niveles del síndrome de quemarse por el trabajo o Burnout (SB) y la percepción de calidad de vida profesional (CVP) en función de la tipología y/o estilos de personalidad de Torgensen (1 995) y algunas variables sociodemográficas y sociolaborales. Participaron 212 profesores de educación primaria. Se utilizó una estrategia asociativa de tipo comparativo transversal aplicando el Inventario de los Cinco Factores (NEO-FFI), el Cuestionario de Estar Quemado por el Trabajo (CESQT) y el Cuestionario de Vida Profesional (CVP-35). Se concluye que el estilo de personalidad está relacionada al SB, de modo que los profesores con personalidad Tipo Inseguro puntúan más alto en las escalas de Indolencia y Culpa; y los Tipo Empresario presentan mayor puntuación en la escala de Ilusión por el Trabajo y menor en la de Indolencia. Respecto al sexo, los hombres presentan mayores puntuaciones en las escalas de Indolencia y Culpa, mientras las mujeres obtienen mayores puntaciones en la de Ilusión por el Trabajo.
Abstract The main goal of the present study is to analyze the burnout syndrome levels (SB) and the perception of the professional quality of life (CVP) according to the typology and/or personality styles of Torgensen (1995) and some sociodemographic and socio-occupational variables. 212 primary school teachers participated. An associative strategy of transversal comparative type was used administering the Inventory of the Five Factors (NEO-FFI), the Questionnaire of Being Burned for Work (CESQT) and the Professional Life Questionnaire (CVP-35). It is concluded that the personality style is related to SB, being the teachers with Insecure Type personality, who score higher in the scales of Indolence and Guilt; and the Entrepreneurial Type who has the highest score in the motivation for Work scale and lowest in the Indolence scale. Regarding genders, men present higher scores in Indolence and Guilt, while women obtain higher scores in motivation for work.
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Resumen En la presente investigación se analiza la asociación entre sintomatología psicopatológica, estrategias de afrontamiento al estrés y variables sociodemográficas relacionadas con la vivencia de un desastre socionatural. En total, participaron 399 universitarios que completaron las escalas de los síntomas psicológicos (SCL-90-R), estrategias de afrontamientos (CSI) y una encuesta sociodemográfica. Se utilizó una estrategia asociativa-comparativa transversal y un diseño de grupos naturales. Los resultados indicaron la existencia de diferencias debidas al sexo en los síntomas psicopatológicos de somatización, depresión, y ansiedad, siendo las mujeres quienes puntuaron más alto. Se presentan diferencias con respecto a la valoración global del impacto producido por un aluvión en todas las dimensiones psicopatológicas, excepto en sensibilidad interpersonal; y los análisis de regresión múltiple mostraron que las dimensiones psicopatológicas son explicadas por alta retirada social y pensamiento desiderativo. Estos resultados sugieren que tanto las estrategias de afrontamiento al estrés como la presencia de niños en el núcleo familiar, la exposición a la violencia, el deterioro de la vivienda y la valoración de impacto, son potentes predictores de la sintomatología de la depresión, el índice sintomático general, la ansiedad, la somatización, la obsesión-compulsión y el total de síntomas positivos.
Resumo Na presente pesquisa, analisa-se a associação entre sintomatologia psicopatológica, estratégias de enfrentamento do estresse e variáveis sociodemográficas relacionadas com a vivência de um desastre socionatural. Em total, participaram 399 universitários que completaram as escalas dos sintomas psicológicos (SCL-90-R), estratégias de enfrentamentos (CSI) e um questionário sociodemográfico. Utilizou-se estratégia associativa-comparativa transversal e desenho de grupos naturais. Os resultados indicaram a existência de diferenças devido ao sexo nos sintomas psicopatológicos de somatização, depressão e ansiedade, sendo as mulheres as que pontuaram mais alto. Apresentam-se diferenças a respeito da valoração global do impacto produzido por um deslizamento de terra em todas as dimensões psicopatológicas, exceto em sensibilidade interpessoal; as análises de regressão múltipla mostraram que as dimensões psicopatológicas são explicadas por alta retirada social e pensamento desiderativo. Esses resultados sugerem que tanto as estratégias de enfrentamento do estresse quanto a presença de crianças no núcleo familiar, a exposição à violência, a deterioração da moradia e a valoração de impacto são potentes preditores da sintomatologia da depressão, do índice sintomático geral, da ansiedade, da somatização, da obsessão-compulsão e do total de sintomas positivos.
Abstract This paper aimed to analyze the association between psychopathological symptomatology, stress coping strategies and sociodemographic variables related to the experience of social disaster. 399 undergraduates completed the Psychological Symptom Scales (SCL-90-R), the Coping Strategies Inventory (CSI) and a sociodemographic survey. A cross-sectional associative-comparative strategy and a natural group design were used. The results indicated the existence of differences due to sex in the psychopathological symptoms of Somatization, Depression, and Anxiety, where women scored higher. There are differences regarding the global assessment of the impact caused by the flood in all psychopathological dimensions, except for Interpersonal Sensitivity. Multiple regression analyzes showed that the psychopathological dimensions are explained by high Social Withdrawal and Desiderative Thinking. These results suggest that not only stress coping strategies, but the presence of children in the family nucleus, exposure to violence, housing deterioration and impact assessment are potent predictors of symptoms of Depression, General Symptomatic Index, Anxiety, Somatization, Obsession-Compulsion, and Total Positive Symptoms.
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Humanos , Masculino , Feminino , Psicologia Clínica , Adaptação Psicológica , Sintomas Afetivos , Desastres NaturaisRESUMO
OBJECTIVE: To determine the effects of exercise training on sympathetic nerve activity in heart failure patients. METHODS: A systematic review was performed. An electronic search of MEDLINE, ProQuest, SciELO, SPORTDiscus, Rehabilitation and Sport Medicine Source, Cumulative Index to Nursing and Allied Health Literature, Tripdatabase, Science Direct and PEDrO was performed from their inception to February 2017. Clinical trials and quasi-experimental studies were considered for primary article selection. The studies should include patients diagnosed with chronic heart failure that performed exercise training for at least 4 weeks. Sympathetic nerve activity should be measured by microneurography before and after the intervention. The Cochrane Collaboration's Risk of Bias Tool was used to evaluate risk of bias, and the quality of evidence was rated following the GRADE approach. Standardized mean differences (SMD) were calculated for control and experimental groups. Meta-analysis was performed using the random effects model. RESULTS: Five trials were included. Overall, the trials had moderate risk of bias. The experimental group indicated a significant decrease in the number of bursts per minute (SMD -2.48; 95% CI -3.55 to -1.41) when compared to the control group. Meanwhile, a significant decrease was also observed in the prevalence of bursts per 100 beats in the experimental group when compared to the control group (SMD -2.66; 95% CI -3.64 to -1.69). CONCLUSION: Exercise training could be effective in reducing sympathetic nerve activity in patients with heart failure. The quality of evidence across the studies was moderate. Future studies are necessary to confirm these results.
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Exercício Físico/fisiologia , Insuficiência Cardíaca , Doença Crônica , HumanosRESUMO
En implantología existen diferentes etapas del diagnóstico que garantizan el estudio minucioso del caso. Conseguir una rehabilitación estética, funcional y biomecánicamente estable a largo plazo, que coincida con las expectativas del paciente es el deseo prioritario. El objetivo fue presentar un caso clínico con resultados exitosos por la adecuada planificación de la rehabilitación implantológica. Se presentó una paciente femenina de 53 años que perdió un incisivo central superior y el lateral adyacente presentaba discromía, gran pérdida ósea irrecuperable y vestibularización. Se llevaron a cabo cada una de las etapas del diagnóstico implantológico: confección de historia clínica, evaluación del estado de salud del paciente, toma de impresiones para el estudio de las relaciones intermaxilares en el articulador, confección de encerado diagnóstico y de férula quirúrgica y, finalmente, se realizó cirugía electiva y se colocó a nivel de 11 y 12 dos implantes; este último posextracción y ambos con carga inmediata. Se utilizó técnica de regeneración ósea y manejo de los tejidos blandos adecuadamente por ser una zona de alto compromiso estético, todo esto en una sola fase quirúrgica. Con esto se demostró que un diagnóstico y plan de tratamiento adecuados constituyen la clave de todo procedimiento implantológico(AU)
In dental implantology, there are different phases of diagnosis that provide a meticulous study of each case. Obtaining an esthetical, functional, biomechanical and long lasting rehabilitation that meets the patient´s expectations is our priority. This paper was intended to present a clinical case with successful results from an adequate planning of the implantological rehabilitation. A 53 years old female patient, who lost the11th tooth, had adjacent dischromy in the 12th tooth and significant bone loss and vestibularization. Every phase of the implant diagnosis were carried out: making of the medical history, the evaluation of the patient´s health, taking of maxillary impressions to study the intermaxillary ratios assisted by the articulator equipment, diagnostic waxing and surgical splint were made and, finally, elective surgery was performed to place two dental implants, one of them after removal and both with immediate charge. Bone regeneration technique and the gentle handling of soft tissues allowed making all this in a single surgical phase, since this is a highly compromised area from the esthetical viewpoint. It was proved that correct diagnosis and treatment are the key of every dental implant procedure(AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Implantes Dentários/efeitos adversos , Implantação Dentária/métodos , Reabilitação Bucal/efeitos adversos , Regeneração Óssea/fisiologiaRESUMO
It is believed that amyloid-ß peptide (Aß), in its aggregated-oligomeric state, constitutes one of the neurotoxic factors involved in the pathogenesis of Alzheimer's disease. With the objective of studying a potential role of the peptide on synaptic transmission, we studied the effect of soluble Aß(1-40) on synaptic transmission in rat hippocampal neurons. Neurons incubated with 500 nM of Aß(1-40) peptide for 3 days presented higher levels of intracellular calcium transients, as evaluated by fluorimetric techniques. These effects of Aß were time and concentration dependent and were accompanied by increases in glutamatergic (0.8±0.2 Hz to 2.9±0.6 Hz), but not GABAergic, transmission. The analysis of pharmacologically isolated currents in treated neurons showed increases in both AMPA- and NMDA-mediated currents as compared to control. The effects of the peptide on the frequency of synaptic currents correlated well with increases in the number of SV2 puncta and of FM1-43 destaining, suggesting a presynaptic locus for the peptide. The data also shows that application of either Aß or bicuculline alone for 24 h was without effects on neurotransmission. However, their co-application induced an increase in synaptic transmission which was accompanied by synchronous discharges reminiscent to those produced by pro-convulsive drugs, such as bicuculline. In conclusion, these results suggest that the soluble form of Aß(1-40) participates in the regulation of synaptic transmission increasing excitability and producing a pre-epileptogenic state in hippocampal neurons.
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Peptídeos beta-Amiloides/toxicidade , Epilepsia/induzido quimicamente , Epilepsia/fisiopatologia , Hipocampo/efeitos dos fármacos , Neurônios/efeitos dos fármacos , Fragmentos de Peptídeos/toxicidade , Transmissão Sináptica/efeitos dos fármacos , Animais , Feminino , Hipocampo/fisiologia , Humanos , Neurônios/fisiologia , Gravidez , Ratos , Ratos Sprague-Dawley , Solubilidade , Transmissão Sináptica/fisiologiaRESUMO
Alzheimer disease is a progressive neurodegenerative brain disorder that leads to major debilitating cognitive deficits. It is believed that the alterations capable of causing brain circuitry dysfunctions have a slow onset and that the full blown disease may take several years to develop. Therefore, it is important to understand the early, asymptomatic, and possible reversible states of the disease with the aim of proposing preventive and disease-modifying therapeutic strategies. It is largely unknown how amyloid beta-peptide (A beta), a principal agent in Alzheimer disease, affects synapses in brain neurons. In this study, we found that similar to other pore-forming neurotoxins, A beta induced a rapid increase in intracellular calcium and miniature currents, indicating an enhancement in vesicular transmitter release. Significantly, blockade of these effects by low extracellular calcium and a peptide known to act as an inhibitor of the A beta-induced pore prevented the delayed failure, indicating that A beta blocks neurotransmission by causing vesicular depletion. This new mechanism for A beta synaptic toxicity should provide an alternative pathway to search for small molecules that can antagonize these effects of A beta.
Assuntos
Peptídeos beta-Amiloides/metabolismo , Neurônios/fisiologia , Fragmentos de Peptídeos/metabolismo , Transmissão Sináptica/fisiologia , Vesículas Sinápticas/fisiologia , Peptídeos beta-Amiloides/farmacologia , Animais , Cálcio/metabolismo , Células Cultivadas , Ácido Glutâmico/metabolismo , Hipocampo/citologia , Humanos , Camundongos , Neurônios/patologia , Neurotoxinas/metabolismo , Neurotoxinas/farmacologia , Técnicas de Patch-Clamp , Fragmentos de Peptídeos/farmacologia , Terminações Pré-Sinápticas/efeitos dos fármacos , Terminações Pré-Sinápticas/fisiologia , Transmissão Sináptica/efeitos dos fármacos , Ácido gama-Aminobutírico/metabolismoRESUMO
Hyperalgesia and allodynia occur as a consequence of peripheral and central sensitization that follows sustained nociceptive activation. The cellular alterations associated to this state of nociceptive network hyperexcitability represent a form of neuronal plasticity, but they are not well understood because of its complexity in situ. In this study, after treating primary spinal neuron cultures with capsaicin (0.5-1 microM) for 48 h fluorimetric recordings were performed. The activation of TRPV1 receptors with capsaicin (0.5-1.0 microM) increased the frequency of calcium transients (0.03+/-0.002 Hz vs. 0.05+/-0.006 Hz, P<0.05), mediated by AMPAergic transmission, as well as the percent of neurons with activity (37+/-3% vs. 65+/-4%, P<0.05). The effect of capsaicin was long lasting and the neurons were found to be hyperfunctional and with increased levels of phosphorylated CREB (cAMP responsive element binding) even after 72 h of treatment with capsaicin (32+/-5% vs. 52+/-5%). The effect of capsaicin was blocked by capsazepine (1 microM), TTX (100 nM) and KN-62 (1 microM), but not by K252a (200 nM) or PD98059 (50 microM) indicating the involvement of TRPV1. The results suggest the participation of Ca2+, CaMKII and CREB on the prolonged enhancement of excitability following chronic exposure to capsaicin. Thus, it is likely that chronic TRPV1 activation is capable of inducing prolonged increases in neurotransmission mediated by glutamatergic receptors.
Assuntos
Cálcio/metabolismo , Capsaicina/análogos & derivados , Capsaicina/farmacologia , Neurônios/efeitos dos fármacos , Medula Espinal/citologia , Canais de Cátion TRPV/metabolismo , 6-Ciano-7-nitroquinoxalina-2,3-diona/farmacologia , Análise de Variância , Animais , Proteína de Ligação a CREB/metabolismo , Células Cultivadas , Relação Dose-Resposta a Droga , Interações Medicamentosas , Inibidores Enzimáticos/farmacologia , Antagonistas de Aminoácidos Excitatórios/farmacologia , Feminino , Humanos , Camundongos , Camundongos Endogâmicos C57BL , Gravidez , Rutênio Vermelho/farmacologia , Bloqueadores dos Canais de Sódio/farmacologia , Canais de Cátion TRPV/antagonistas & inibidores , Tetrodotoxina/farmacologiaRESUMO
Previous studies, using electrophysiological and fluorimetric analysis with a calcium sensitive dye, have shown that 5-7 DIV developing spinal cord neurons displayed high levels of glycinergic transmission. GABAergic and AMPAergic neurotransmission contributed much less to the overall transmission. Here, we show that culturing neurons in absence of a glia cell monolayer reduced the frequency of glycinergic spontaneous IPSCs (0.1 +/- 0.01 Hz), without altering the level of overall transmission (3 +/- 1.1 Hz). The predominant transmission was mediated by GABA(A) receptors (72% of total synaptic events). In addition, combination of bicuculline and CNQX blocked synaptically mediated calcium transients recorded with fluo-3. Furthermore, application of glycine revealed the presence of extrasynaptic receptors in these neurons (25 +/- 6 pA/pF). Culturing neurons on a glial cell monolayer increased the frequency of glycinergic currents (0.4 +/- 0.02 Hz), without changing the amplitude of the current (20 +/- 4 pA). The use of a glia-conditioned media reversed the effect of growing the neurons in a glia-deprived condition. These results indicate that the establishment of glycinergic transmission is dependent on the presence of a glia derived soluble factor. However, functional GlyRs were still able to insert in the neuronal membrane in a glia-independent manner.
Assuntos
Glicina/fisiologia , Neuroglia/fisiologia , Neurônios/fisiologia , Medula Espinal/fisiologia , Transmissão Sináptica/fisiologia , Animais , Células Cultivadas , Técnicas In Vitro , Camundongos , Camundongos Endogâmicos C57BL , Neuroglia/citologia , Neurônios/citologia , Neurônios/efeitos dos fármacos , Medula Espinal/citologia , Transmissão Sináptica/efeitos dos fármacosRESUMO
Se estudiaron 460 pacientes entre 15 y 74 años, de ambos sexos, residentes en el municipio de Santa Clara, para conocer la frecuencia y causas de mortalidad dentaria y su relación con la edad y el sexo. Los datos fueron recopilados de las historias clínicas del servicio de exodoncia de la Facultad de Estomatologiá del Instituto Superior de Ciencias Médicas de Villa Clara. Se obtuvo un promedio de 1,9 exodoncias por paciente y existe una relación estadística entre el promedio y la edad. El grupo dentario más afectado fue el de los molares. Las principales causas de extracción fueron las caríes dentales (54,5%) y las parodontopatías (26%). El promedio de pérdida dentaria anterior a las extraciones fue de 5,12 por paciente