Clinical Viability for Immediate Loading of Dental Implants: Part II-Treatment Alternatives

The treatment with implants aims to obtain a direct interface between bone and implant. The implant is kept load-free during 4 to 6 months in the 2-stage procedure, which is considered a requisite for osseointegration. However, this period is based on empirical principles and uncomfortable for patient. So, the immediate loading protocol was Suggested to submit implants to occlusal function after placement. This protocol has been applied for several conditions of edentulism. The aim of this study was to evaluate the treatment alternatives for immediate loading of complete and partial edentulous patients. In general, the studies have demonstrated high previsibility for rehabilitation of complete edentulous arches with full-arch, implant-supported prosthesis. The rehabilitation with immediate loading for maxillary overdenture is questionable because there is no longitudinal study in literature. The studies with partial edentulous arches have demonstrated high success rates for implants placed in the mandibular and maxillary anterior region. Additional care is recommended for posterior region mainly in the maxillary arch, and further studies are suggested to corroborate this treatment.

Technology assessment of wastewater treatment alternatives for compliance with deoxygenating wastes effluent standards : final report /

"Project 87/7012."

6-Sulfatoxymelatonin as a predictor of clinical outcome in depressive patients

Objectives This study established the value of the 6-sulfatoxymelatonin (aMT6s) urine concentration as a predictor of the therapeutic response to noradrenaline reuptake inhibitors in depressive patients. Methods Twenty-two women aged 18-60 years were selected. Depressive symptoms were assessed by using the Hamilton Depression Scale. Urine samples were collected at 0600-1200 h, 1200-1800 h, 1800-2400 h, and 2400-0600 h intervals, 1 day before and 1 day after starting on the nortriptyline treatment. Urine aMT6s concentration was analyzed by a one-way analysis of variance/Bonferroni test. Spearman`s rank correlation coefficient was used to analyze the correlation between depressive symptoms after 2 weeks of antidepressant treatment and the increase in aMT6s urine concentration. Results Higher and lower size effect groups were compared by independent Student`s t-tests. At baseline, the 2400- to 0600-h interval differed from all other intervals presenting a significantly higher aMT6s urine concentration. A significant difference in aMT6s urine concentrations was found 1 day after treatment in all four intervals. Higher size effect group had lower levels of depressive symptoms 2 weeks after the treatment. A positive correlation between depressive symptoms and the delta of aMT6s in the 2400-0600h interval was observed. Conclusion Our results reinforce the hypothesis that aMT6s excretion is a predictor of clinical outcome in depression, especially in regard to noradrenaline reuptake inhibitors. Copyright (C) 2011 John Wiley & Sons, Ltd.

Attitudes towards a maintenance (-agonist) treatment approach in high-dose benzodiazepine-dependent patients: a qualitative study

BACKGROUND High-dose benzodiazepine dependence constitutes a major clinical concern. Although withdrawal treatment is recommended, it is unsuccessful for a significant proportion of affected patients. More recently, a benzodiazepine maintenance approach has been suggested as an alternative for patients' failing discontinuation treatment. While there is some data supporting its effectiveness, patients' perceptions of such an intervention have not been investigated. METHODS An exploratory qualitative study was conducted among a sample of 41 high-dose benzodiazepine (BZD)-dependent patients, with long-term use defined as doses equivalent to more than 40 mg diazepam per day and/or otherwise problematic use, such as mixing substances, dose escalation, recreational use, or obtainment by illegal means. A qualitative content analysis approach was used to evaluate findings. RESULTS Participants generally favored a treatment discontinuation approach with abstinence from BZD as its ultimate aim, despite repeated failed attempts at withdrawal. A maintenance treatment approach with continued prescription of a slow-onset, long-acting agonist was viewed ambivalently, with responses ranging from positive and welcoming to rejection. Three overlapping themes of maintenance treatment were identified: "Only if I can try to discontinue…and please don't call it that," "More stability and less criminal activity…and that is why I would try it," and "No cure, no brain and no flash…and thus, just for everybody else!" CONCLUSIONS Some patients experienced slow-onset, long-acting BZDs as having stabilized their symptoms and viewed these BZDs as having helped avoid uncontrolled withdrawal and abstain from criminal activity. We therefore encourage clinicians to consider treatment alternatives if discontinuation strategies fail.

Substance abuse and the criminal justice system : a comprehensive state plan for treatment and community reintegration /

The plan was developed by a committee of leaders from the alcohol and substance abuse, and criminal justice fields: the Illinois Department of Alcoholism and Substance Abuse (DASA), Illinois Department of Corrections (DOC), Illinois Criminal Justice Information Authority (ICJIA), John Howard Association (JHA) and Treatment Alternatives for Special Clients (TASC).

Controlling transduction and replication of oncolytic adenoviruses

Despite progress in conventional cancer treatment regimes, metastatic disease essentially remains incurable and new treatment alternatives are needed. Virotherapy is a relatively novel approach in cancer treatment. It harnesses the natural ability of oncolytic viruses to kill the cells they proliferate in and to spread to neighboring cells, thereby amplifying the therapeutic effect of the initial input dose. The use of replicating, oncolytic viruses for cancer treatment necessitates introduction of various genetic modifications to the viral genome, thereby restraining replication exclusively to tumor cells and eventually obtaining selective eradication of the tumor without side effects to healthy tissue. Furthermore, various modifications can be applied to the viral capsid in hope of gaining effective transduction of target tissue. In other words, the entry of viruses into tumor tissue can be augmented by allowing the virus to utilize non-native receptors for entry. Genetic capsid modifications may also help to avoid some major hurdles in systemic delivery that ultimately lead to the rapid clearance of the virus from the blood and virus induced toxicity. In addition to genetic modifications that alter the phenotype of the virus, some pharmacologic agents may be utilized to enhance the virus entry to target site. Liver kupffer cells (KC) are responsible for the majority of viral clearance after systemic viral delivery and they play a major role in adenovirus induced acute toxicity. The therapeutic window could possibly be widened by transiently depleting KCs, allowing smaller viral input doses and diminishing KC related toxicity. The transductional efficacy of various capsid modified viruses was analyzed in vitro and in vivo in murine orthotopic breast cancer model. The effect of capsid modifications on the oncolytic efficacy, i.e. the ability of the viruses to kill cancer cells, was evaluated in vitro and in vivo in murine cancer models. We concluded that capsid modifications result in transductional enhancement, and that enhanced transduction translates into more potent oncolysis in vitro and in vivo. When KC depleting agents were used in vivo prior to viral injections, enhanced tumor transduction was seen, but this effect was not translated into enhanced antitumor activity. Transcriptional regulation of replicative oncolytic viruses is a prerequisite for virotherapy. Tumor or tissue specific promoters can be used to control the transcription of adenoviral early genes to gain cancer specific viral replication. Specific deletions in viral regions essential for virus replication in normal cells can further increase the safety by allowing viral genome replication in cancer cells featuring specific mutations. Genetically modified viruses were shown to be able to kill putative cancer stem cells that are thought to be responsible for post treatment relapses and metastasis. Further, pharmacologic intervention reduced viral replication and thereby might offer an additional safety switch in case viral replication related side effects are encountered.

Estudo da efetividade e segurança de um novo esquema posológico da solução saturada de iodeto de potássio no tratamento da esporotricose linfocutânea e cutânea fixa

Fundamentos: A primeira escolha para o tratamento da esporotricose cutânea é o itraconazol oral, contudo o aumento de casos ocorridos numa epidemia de transmissão zoonótica fez com que se buscassem alternativas efetivas e seguras de tratamento. Objetivo: Avaliar uma nova posologia do iodeto de potássio (KI) como alternativa para o tratamento das formas cutâneas limitadas da esporotricose. Métodos: Foram incluídos 102 pacientes com esporotricose, diagnosticados através do isolamento do Sporothrix sp. e divididos em dois grupos que receberam doses diferentes de KI: grupo A recebeu a dose anterior (média 4,83g/dia) e grupo B, a dose reduzida (média 2,52g/dia). Os critérios de cura se basearam em dados clínicos e sorológicos. Resultados: Setenta e nove pacientes (77,4%) obtiveram cura clínica, 70,6 e 84,3% respectivamente nos grupos A e B. Dezesseis pacientes (15,6%) perderam o seguimento e sete trocaram de medicamento: cinco no grupo A e dois no grupo B. A incidência de eventos adversos foi a mesma nos dois grupos (64,7%) com predomínio do gosto metálico (44%), seguido por intolerância gastrointestinal leve e erupção acneiforme (10,7% cada). Nenhum evento adverso grave ocorreu e não houve recidivas. A análise dos desfechos não demonstrou diferença estatisticamente significativa entre os grupos (p=0,9255). A melhora dos títulos sorológicos foi significativa em ambos grupos. Conclusões: O iodeto de potássio, sob a forma de solução saturada, administrado em dose e frequência reduzidas, pode ser usado como alternativa efetiva e segura para o tratamento da esporotricose cutânea. Através de análises estatísticas, a posologia habitual não demonstrou ser superior à proposta por este estudo. A sorologia para esporotricose pode ser utilizada como ferramenta valiosa para acompanhamento clínico destes pacientes.

Profils d'utilisation d'antipsychotiques en conditions réelles dans la population de personnes âgées démentes vivant à domicile : impact des interventions de communication de risque

Les antipsychotiques (APs) sont fréquemment prescrits pour les troubles comportementaux associés à la démence. Or, ces produits ont fait l'objet de trois mises en garde (2002, 2004, 2005) en raison d'une augmentation du risque d'événement cérébrovasculaire et de décès. L’objectif de ce mémoire est d’évaluer l'utilisation d’APs dans la population de personnes âgées démentes vivant à domicile, et de déterminer l’effet des mises en garde sur les profils observés. Une cohorte rétrospective de 10,969 personnes âgées démentes ayant débuté un traitement par AP entre le 1er janvier 2000 et le 31 décembre 2009 fut identifiée à partir des banques de données de la Régie de l'assurance maladie du Québec (RAMQ). Des séries chronologiques segmentées ont permis de quantifier l’effet des mises en garde sur l'utilisation d’APs. L'effet de la mise en garde de 2005 sur les caractéristiques des patients traités ainsi que sur les profils d'utilisation (dose et durée) a été évalué, respectivement par des modèles de régression logistique et de régression linéaire multivariés. Le taux délivrance d'APs atypiques a augmenté au cours du temps jusqu'à la mise en garde de 2005 pour ensuite diminuer de 8.96% (IC 95% : -11.91% – -6.02%). L'analyse par produit a révélé la même tendance pour la rispéridone, le seul AP approuvé au Canada pour les personnes âgées démentes. En revanche, le taux de délivrance de quétiapine, qui est hors-indication, a continué d'augmenter. Le taux d'initiation de traitement par APs a cependant diminué au cours du temps pour tous les produits. Les mises en garde ne semblent pas être associées avec un changement dans les caractéristiques des patients traités, ni avec les doses et durées d’utilisation. Le manque d'efficacité des mises en garde est probablement en partie lié à l'absence d'alternatives thérapeutiques pour le traitement des troubles psychologiques et comportementaux chez les patients atteints de démence.

Comparación farmacoeconómica (costo – utilidad / beneficio / efectividad) del Rituximab, con el tratamiento convencional para pacientes con Linfoma No Hodgkins

El Linfoma no Hodgkin es un cáncer maligno que tiene baja incidencia a nivel nacional pero altos costos en la atención catalogándose por su manejo como enfermedad de alto costo. El tratamiento de acuerdo a fase de tratamiento, clasificación histológica y respuesta a tratamiento se consideran las alternativas de tratamiento determinadas en guías clínicas en este trabajo se revisará el tratamiento con quimioterapia (CHOP) y el tratamiento con Rituximab + CHOP Objetivo: Evaluar comparativamente el tratamiento con quimioterapia y el Rituximab en cuanto a costo beneficio / utilidad /efectividad y el efecto de ambas terapias sobre la calidad de vida y carga de enfermedad, desde la perspectiva del marco normativo vigente y la aplicación del mismo en una EPS Resultados: en los análisis de costo beneficio, utilidad y efectividad, se evidenció que los costos del tratamiento del Rituximab superan los de quimioterapia, pero al comparar los resultados obtenidos mediante AVISA, y QALY, confirmaron los resultados evidenciados en literatura, siendo estas las variables más sensibles para determinación de protocolos de manejo de Linfoma No Hodgkin. Conclusiones: aunque el Rituximab es una buena opción terapéutica para el Linfoma No Hodgkin, los costos que se ocasionan por este medicamento sobrepasan la compensación recibida por estos usuarios, es necesario que las políticas públicas relacionen este tipo de análisis para adecuar los ingresos a los egresos y permitir el equilibrio económico de la atención, no permitir que por cuestiones de economía empresarial se tomen alternativas equivocas que pueden ir el menos cabo de la salud de los usuarios.

Diferencias en costo efectividad del cuidado paliativo domiciliario frente a la atención convencional hospitalaria para el manejo de enfermedades crónicas en fase terminal

En Colombia la dinámica poblacional ha experimentado cambios a través de los años; lo cual modifica las características epidemiológicas y los perfiles de morbimortalidad de la población, aumentando la incidencia y prevalencia de enfermedades crónicas de difícil pronóstico dentro de la población; siendo estos grupos etarios hacía quienes deben destinarse nuevas modalidades de atención y soporte paliativo. Se realizó una revisión sistemática de diversos artículos, clasificados con niveles de evidencia I y II; cuyas variables de análisis fueron: El lugar de fallecimiento del paciente, alivio de la sintomatología, nivel de satisfacción del paciente y sus cuidadores con los servicios recibidos, número de ingresos hospitalarios independientemente de la causa y días promedio de estancia hospitalaria. El 88% de los pacientes que fueron vinculados a la atención domiciliaria falleció en su hogar; el 68% refirió haber experimentado disminución en la intensidad de al menos 2 síntomas como resultado de la atención en casa. El nivel de satisfacción para el cuidado en casa puntuó 19 puntos porcentuales por encima de la calificación que obtuvo el manejo hospitalario. El 23% de los pacientes tratados en su hogar, requirió al menos una hospitalización durante el manejo; mostrando una disminución en el tiempo de estancia hospitalaria de 3.4 días promedio. El manejo paliativo domiciliario de pacientes crónicos en fase terminal, no sólo es una alternativa en la reducción de costos para el sistema de salud, sino que es un factor protector de tipo emocional que refleja también una importante disminución de los riesgos de la hospitalización.

Efeitos do ultrassom terapêutico sobre parâmetros morfométricos e clínicos e método de extração de metaloproteinases em sujeitos com úlceras venosas

Venous wounds cause physical, psychological and financial problems that impact the quality of life of patients. Treatment alternatives are investigated in order to reduce healthcare costs and improve quality of life of people affected by this problem. Physical resources, such as therapeutic ultrasound (US), are being considered in the treatment of ulcers as a potential healing agent. This study aimed to investigate the application of US as a treatment for venous ulcers. Subjects were divided into two groups: US group, where treatment consisted of 5 sessions of pulsed US (3 MHz, 1W/cm²) associated with compression and kinesiotherapy; and sham group, where individuals went through the same procedures, but with sham US therapy. Subjects were evaluated for wound size by planimetry and digital photography, visual analogue scale for pain, quality of life by the questionnaires SF- 36 and VEINES-QoL/Sym and enzymatic activity of metalloproteinases 2 and 9 by zymography. It was observed mean reduction in wound area of 41.58±53.8% for the US group and 63.47±37.2% for the placebo group, maintenance of quality of life scores in the US group and significant improvement (p<0.05) in the placebo group by VEINES questionnaire. It was observed decreased perception of pain in the placebo group. Sample feasibility for analysis of the protein activity of metalloproteinases 2 and 9 by zymography collected by swab method was also confirmed. Our data did not give us evidence to support the theory that the US accelerates healing of venous ulcers in a short-term analysis. However, we observed that standard care associated with compression therapy and kinesiotherapy were able to significantly shorten the progression of chronic venous ulcers

Terapêutica no carcinoma de células escamosas cutâneo em gatos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Condutas terapêuticas para tratamento da Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) e da Síndrome da Resistência das Vias Aéreas Superiores (SRVAS) com enfoque no Aparelho Anti-Ronco (AAR-ITO)

Os autores apresentam uma revisão da literatura referente às alternativas de tratamento cirúrgicas e não-cirúrgicas para a Síndrome da Apnéia e Hipopnéia Obstrutiva do Sono (SAHOS) e para a Síndrome da Resistência das Vias Aéreas superiores (SRVAS) com enfoque no princípio de ação e evolução dos aparelhos de avanço mandibular e, em particular, no mecanismo dinâmico de ação do Aparelho Anti-Ronco® (AAR-ITO).

N-acetylcysteine and vancomycin alone and in combination against staphylococci biofilm

Introduction: The ability of staphylococci to produce biofilm is an important virulence mechanism that allows bacteria both to adhere and to live on artificial surfaces and to resist to the host immune factors and antibiotics. Staphylococcal infections have become increasingly difficult to treat due their antibiotic resistance. Therefore, there is a continuous need for new and effective treatment alternatives against staphylococcal infections. The main goal of this study was to test N-acetylcysteine (NAC) and vancomycin alone and in combination against S. epidermidis and S. aureus biofilms. Methods: Biofilms were treated with NAC at minimum inhibitory concentration (MIC) and 10 × MIC concentrations and vancomycin at MIC and peak serum concentrations. Results: The use of NAC 10 × MIC alone showed a significant antibactericidal effect, promoting a 4-5 log10 CFU/ mL reduction in biofilm cells. The combination of NAC 10 × MIC with vancomycin (independently of the concentration used) reduced significantly the number of biofilm cells for all strains evaluated (5-6 log10). Conclusion: N-acetylcysteine associated to vancomycin can be a potential therapeutic strategy in the treatment of infections associated to biofilms of S. epidermidis or S. aureus.

Abordagem energética dos resíduos sólidos urbanos (RSU) na temática da educação ambiental no município de Cerqueira César - SP

Pós-graduação em Agronomia (Energia na Agricultura) - FCA