Consistency of safety and efficacy of new oral anticoagulants across subgroups of patients with atrial fibrillation.

AIMS: The well-known limitations of vitamin K antagonists (VKA) led to development of new oral anticoagulants (NOAC) in non-valvular atrial fibrillation (NVAF). The aim of this meta-analysis was to determine the consistency of treatment effects of NOAC irrespective of age, comorbidities, or prior VKA exposure. METHODS AND RESULTS: All randomized, controlled phase III trials comparing NOAC to VKA up to October 2012 were eligible provided their results (stroke/systemic embolism (SSE) and major bleeding (MB)) were reported according to age (≤ or >75 years), renal function, CHADS2 score, presence of diabetes mellitus or heart failure, prior VKA use or previous cerebrovascular events. Interactions were considered significant at p <0.05. Three studies (50,578 patients) were included, respectively evaluating apixaban, rivaroxaban, and dabigatran versus warfarin. A trend towards interaction with heart failure (p = 0.08) was observed with respect to SSE reduction, this being greater in patients not presenting heart failure (RR = 0.76 [0.67-0.86]) than in those with heart failure (RR = 0.90 [0.78-1.04]); Significant interaction (p = 0.01) with CHADS2 score was observed, NOAC achieving a greater reduction in bleeding risk in patients with a score of 0-1 (RR 0.67 CI 0.57-0.79) than in those with a score ≥2 (RR 0.85 CI 0.74-0.98). Comparison of MB in patients with (RR 0.97 CI 0.79-1.18) and without (RR 0.76 CI 0.65-0.88) diabetes mellitus showed a similar trend (p = 0.06). No other interactions were found. All subgroups derived benefit from NOA in terms of SSE or MB reduction. CONCLUSIONS: NOAC appeared to be more effective and safer than VKA in reducing SSE or MB irrespective of patient comorbidities. Thromboembolism risk, evaluated by CHADS2 score and, to a lesser extent, diabetes mellitus modified the treatment effects of NOAC without complete loss of benefit with respect to MB reduction.

Clinical features of oral lichen planus. A retrospective study of 65 cases

Objectives: To describe the clinical features of patients diagnosed with oral lichen planus (OLP) and to establish the prevalence of its malignant transformation in our setting. Study design: A retrospective study was made of 65 patients clinically and histologically diagnosed with OLP in the Service of Oral Surgery (Dental Clinic of the University of Barcelona, Spain) in the period 1990-2005. A descriptive and bivariate statistical analysis was made. Results: The mean patient age was 59 years (SD ± 14.9). Most of the patients (61%) were women, and the most frequent location of the lesions was the buccal mucosa (90.8%). White forms of OLP were noted in 66% of the cases, and 46.2% of the patients reported symptoms of some kind. The patients diagnosed with diabetes mellitus (20%) showed a larger proportion of red lesions (p=0.088). No statistically significant association was observed between chronic liver disease and the OLP lesion types or symptoms. Two cases of squamous cell carcinoma were identified in two patients previously or simultaneously diagnosed with OLP. A statistically significant correlation was observed between dysplastic changes / malignization of the lesions and smoking habit (p=0.019). An association to alcohol abuse was also noted, though in this case statistical significance was not reached (p=0.085). Conclusions: The clinical features of our study population were similar to those described in other studies. Diabetic patients with OLP were seen to be more susceptible to the development of atrophic-erosive lesions. Smokers and/or patients with alcohol abuse in turn showed a greater tendency to develop dysplastic changes / malignization in the histopathological study of the lesions

Molecular Markers of Oral Lichen Planus

Oral lichen planus (OLP) is a chronic inflammatory mucosal disease and is detected in between 0.5% - 2.2% of the population. WHO has defined OLP as a potentially precancerous disorder, representing a generalized state associated with a significantly increased risk of cancer. However, only 0.5 – 2.9% of OLP lesions will progress to cancer. Currently, there are no prognostic markers to identify the lesions at increased risk for malignant transformation. The main aim of these studies was to identify cellular and molecular markers in order to understand the pathogenesis of atrophic OLP and its progression towards malignancy. Selected markers for cell proliferation, adhesion, apoptosis, and lymphocytic infiltration were assessed by immunohistochemistry in addition to static cytometry analyses for DNA content. DNA quantification of epithelial cells in 82 biopsy samples derived from atrophic lichen planus showed altered DNA content in 41% of the samples. DNA content was associated with proliferation activity, topoisomerase IIalpha, desmocollin-1 and infection with human papillomavirus. CD27+ and CD38+ lymphocytes were detected in inflammatory cell infiltrate, indicating an abnormal homing of B cells from blood circulation to tissue. Physiologic cell death, apoptosis, is frequently seen in OLP, but its pathways are unknown. Here it was shown that caspases 2 and 12 were up-regulated in OLP, indicating that intracellular apoptosis, rather than an external causal factor, is triggering apoptosis. However, this thesis could not identify any singular prognostic marker of malignancy in OLP. Thus, every OLP patient should receive regular follow-up care to identify cancer risk patients at an early stage.

Graft materials in oral surgery: revision

Oral implantology is a common procedure in dentistry, especially for fully or partially edentulous patients. The implants must be placed in the best location from both the aesthetic and functional point of view. Because of this it is increasingly more frequent to resort to regeneration techniques that use substitutes of the bone itself, in order to be able to insert the implants in the most appropriate location. Material and Methodology: A review was performed on the literature from the last ten years based on the following search limitations: "graft materials', 'allograft', 'xenograft', 'autologous graft" and 'dentistry". Results: 241 works were obtained that after reading their respective summaries, they were reduced to 38, and 9 previous works were included in order to summarize the concepts. Discussion: Autologous grafts are the 'gold standard' of the bone regeneration. They have obvious advantages, but they also have drawbacks. This is why allogeneic and xenogeneic tissues are used. The former because of their clear similarity with the recipient's tissue and the latter due to their wide availability. Given that these grafts also have drawbacks, the industry has developed synthetic materials that have properties similar to those of human bone tissue. However, as of today, the ideal material to substitute human bone has not yet been found. In recent years the tendency has been to combine these synthetic materials with the patient's own bone, which is extracted during drilling in implant placement, with bone marrow aspiration, or with bone morphogenetic proteins. Thus the intention is to equip these substances with the osteogenic capacity. Conclusions: There is currently no ideal graft material, with the exception of those materials that come directly from the patient. We hope that in the coming years we will have products that will allow us to perform rehabilitations with better results and provide a better quality of life for our patients, especially those who have more complex situations to resolve, like the patients that are operated on for head and neck cancer

Determinação de etanol e voláteis relacionados em sangue e fluido oral por microextração em fase sólida em headspace associada à cromatografia gasosa com detector de ionização em chama

The aim of this study was to validate a method for the determination of acethaldehyde, methanol, ethanol, acetone and isopropanol employing solid-phase microextraction associated to gas chromatography with flame ionization detection. The operational conditions of SPME were optimized by response surface analysis. The calibration curves for all compounds were linear with r² > 0.9973. Accuracy (89.1-109.0%), intra-assay precision (1.8-8.5%) and inter-assay precision (2.2-8.2%) were acceptable. The quantification limit was 50 µg/mL. The method was applied to the meaurement of ethanol in blood and oral fluid of a group of volunteers. Oral fluid ethanol concentrations were not directly correlated with blood concentrations.

Produção de micropartículas de alginato contendo Flavobacterium columnare inativada pelo método de emulsão para vacinação de peixes por via oral

Alginate microparticles were prepared by an emulsion method aiming oral controlled release of antigens to fish. The effects of emulsification temperature and impeller type on particle morphology, average diameter, and size distribution were evaluated. Microparticles contaning formalin-killed Flavobacterium columnare cells (a model antigen) were prepared and characterized regarding bacterial release and particle stability when exposed to Nile tilapia (Oreochromis niloticus) typical gastrointestinal conditions. This methodology allowed the production of microparticles containing up to 14.3 g/L of bacterin, stable at a pH range from 2.0 to 9.0 for 12 h and smaller than 35 μm.

Efeito da suplementação nutricional com glicina e glutamina, por via oral, na cicatrização colônica em coelhos

OBJETIVO: Avaliar o efeito de dois aminoácidos, glicina e glutamina, na epitelização da mucosa colônica, tamanho da área de cicatriz, fibroplasia e resistência tênsil da anastomose intestinal, após colectomia parcial e anastomose término-terminal. MÉTODOS: Quarenta e cinco coelhos adultos, com idade entre 24 e 28 semanas, do sexo masculino, com peso inicial médio de 2.362 g, foram distribuídos aleatoriamente, de forma dupla desconhecida, em cinco grupos, de acordo com o tipo de suplemento. Dois animais morreram em cada grupo por causas diversas. Os grupos de coelhos foram assim distribuídos: Grupo 1 - (n = 9) receberam suplementação alimentar com glutamina durante sete dias antes e cinco dias após a operação; Grupo 2 - (n = 9) receberam suplementação alimentar com glicina durante sete dias antes e cinco dias após a operação; Grupo 3 - (n = 9) receberam suplementação alimentar com glutamina durante cinco dias após a operação; Grupo 4 - (n = 9) receberam suplementação alimentar com glicina durante cinco dias após a operação; Grupo 5 - (n = 9) não receberam suplementação alimentar. A resistência da anastomose foi medida por meio de pressão de ruptura por insuflação de ar intraluminar. RESULTADOS: O Grupo 2 foi o único grupo que apresentou valores de ruptura superiores aos do Grupo 5 (p < 0,05). Não houve diferença entre os grupos quanto aos aspectos histológicos estudados. CONCLUSÃO: A suplementação oral com glicina, no período pré e pós-operatório, aumenta a resistência tênsil anastomótica colônica após colectomia parcial em coelhos.

Fístulas orocutâneas após cirurgia de câncer da cavidade oral: fatores de risco

OBJETIVO: Quantificar as fístulas após cirurgia de câncer da cavidade oral e identificar fatores de risco. MÉTODOS: Estudo retrospectivo, interessando pacientes submetidos à cirurgia. Seguimento pós-operatório mínimo de dois anos. Variáveis estudadas: sexo, comorbidades, tabagismo, etilismo, risco anestésico e pulmonar, estadiamento clínico, linfadenectomia cervical, tratamento radioterápico, acidentes cirúrgicos, infecção ou deiscência de ferida operatória, seroma ou hematoma de sítio cirúrgico, infecção respiratória no pós-operatório, tipo de cirurgia e reconstrução realizadas. RESULTADOS: Estudados 159 pacientes. Ocorreu fístula orocutânea em 30,3% (48 pacientes). Pacientes T3 tiveram fístula em 16% dos casos, T4 em 40,3% e naqueles estádio T1 ou T2, 26,6% e 1,8% respectivamente (p=0,0138). Os casos N+ evoluíram com fístula em 22.9% (N2c com 42,8%, p=0,0136), os com radioterapia pré-operatória em 63,6% (p=0,0346). Aqueles com infecção de sítio cirúrgico em 47,3% (p=0,0146) e aqueles com deiscência de ferida operatória em 53,7% (p=0,0030). O índice de fístula foi de 60% nos retalhos regionais mucocutâneos, de 39,2% nos miocutâneos e de 12,5% com retalho microcirúrgico (p=0,0286). CONCLUSÃO: O índice de fístulas foi de 30,3%. Foram estatisticamente significativos para ocorrência de fístulas: estádio T, linfadenectomia cervical bilateral, radioterapia pré ou pós-operatória, infecção e deiscência de ferida operatória, e o uso de retalhos para reconstrução.

Citologia Hormonal do Trato Urinário Baixo e da Vagina de Mulheres na Pós-menopausa, antes e durante Estrogenioterapia Oral e Transdérmica

Objetivo: avaliar a ação dos estrogênios por via oral ou transdérmica nas células do trato urinário baixo e da vagina, em mulheres menopausadas. Métodos: foram incluídas 25 mulheres na pós-menopausa, nas quais se estudaram os efeitos citológicos da terapia de reposição hormonal estrogênica, por via oral e por via transdérmica, sobre as células da vagina e do sedimento urinário. As pacientes foram distribuídas aleatoriamente em 2 grupos: Grupo I, constituído por 14 mulheres que receberam 0,625 mg de estrogênio conjugado eqüino associado a 5 mg de acetato de medroxiprogesterona, por via oral, diariamente sem intervalo por três meses, e Grupo II, formado por 11 mulheres que fizeram uso de 17-beta-estradiol matricial na dose de 50 mig, por via transdérmica, semanalmente, associado a 5 mg de acetato de medroxiprogesterona diariamente por três meses. As amostras urinárias foram obtidas do jato inicial da primeira urina da manhã, após asseio dos genitais, em frascos estéreis fornecidos pelo laboratório. A urina foi centrifugada e o esfregaço realizado a partir do sedimento urinário. Os esfregaços da vagina e do sedimento urinário foram imediatamente fixados em álcool absoluto e corados pelo método de Shorr. Resultados: observou-se que nas pacientes que utilizaram a via oral, houve maturação das células da vagina (o índice se elevou de 45,4 a 65,5 com dois meses de tratamento, permanecendo praticamente constante (62,0) a seguir. Quanto às células urinárias, não houve variação do valor de maturação (56,4 antes da medicação e 60,4 no final do período). Ao examinarmos tanto as células da urina quanto da vagina de pacientes que utilizaram a via transdérmica, notou-se que houve resposta satisfatória. Conclusão: com estes resultados podemos sugerir que os estrogênios, quando administrados por via transdérmica, estão associados à resposta satisfatória quanto ao trofismo tanto na vagina quanto na uretra. No entanto, quando se utiliza a via oral, nem sempre este resultado pode ser observado.

Nitroglicerina transdérmica versus nifedipina oral para inibição do trabalho de parto prematuro: ensaio clínico randomizado

OBJETIVO: comparar a efetividade da nitroglicerina transdérmica com a nifedipina oral na inibição do trabalho de parto prematuro. MÉTODOS: foi realizado um ensaio clínico com 50 mulheres em trabalho de parto prematuro, randomizadas em dois grupos, 24 para nifedipina oral (20 mg) e 26 para nitroglicerina transdérmica (patch 10 mg). Foram selecionadas as pacientes com gestação única, entre a 24ª e 34ª semanas e diagnóstico de trabalho de parto prematuro. Foram excluídas pacientes com malformações fetais e com doenças clínicas ou obstétricas. As variáveis analisadas foram tocólise efetiva, tempo necessário para tocólise, frequência de recorrência, progressão para parto prematuro e efeitos colaterais. RESULTADOS: a eficácia da tocólise nas primeiras 12 horas foi semelhante entre os grupos (nitroglicerina: 84,6% versus nifedipina: 87,5%; p=0,5). A média do tempo para tocólise também foi semelhante (6,6 versus 5,8 horas; p=0,3). Não houve diferença entre os grupos quanto à recorrência de parto prematuro (26,9 versus 16,7%; p=0,3) e nem na frequência de parto prematuro dentro de 48 horas (15,4 versus 12,5%; p=0,5). Entretanto, a frequência de cefaleia foi significativamente maior no grupo que usou nitroglicerina (30,8 versus 8,3%; p=0,04). CONCLUSÕES: a nitroglicerina transdérmica apresentou efetividade semelhante à nifedipina oral para inibição do trabalho de parto prematuro nas primeiras 48 horas, porém com maior frequência de cefaleia.

A importância do teste de tolerância à glicose oral no diagnóstico da intolerância à glicose e diabetes mellitus do tipo 2 em mulheres com síndrome dos ovários policísticos

OBJETIVO: Avaliar a importância do teste de tolerância à glicose oral (TTGO) no diagnóstico da intolerância à glicose (IG) e diabetes mellitus do tipo 2 (DM-2) em mulheres com SOP. MÉTODOS: Estudo retrospectivo em que foram incluídas 247 pacientes portadoras de SOP, selecionadas de forma aleatória. O diagnóstico de IG foi obtido por meio do TTGO de duas horas com 75 gramas de glicose de acordo com os critérios do World Health Organization (WHO) (IG: glicemia plasmática aos 120 minutos >140 mg/dL e <200 mg/dL); e o de DM-2 tanto pelo TTGO (DM: glicemia plasmática aos 120 minutos >200 mg/dL) quanto pela glicemia de jejum segundo os critérios da American Diabetes Association (glicemia de jejum alterada: glicemia plasmática >100 e <126 mg/dL; DM: glicemia de jejum >126 mg/dL). Para comparar o TTGO com a glicemia de jejum foi aplicado o modelo de regressão logística para medidas repetidas. Para a análise das características clínicas e bioquímicas das pacientes com e sem IG e/ou DM-2 foi utilizada a ANOVA seguida do teste de Tukey. O valor p<0,05 foi considerado estatisticamente significante. RESULTADOS: As pacientes com SOP apresentaram média etária de 24,8±6,3 e índice de massa corpórea (IMC) entre 18,3 e 54,9 kg/m² (32,5±7,6). O percentual de pacientes obesas foi de 64%, de sobrepeso 18,6%, e peso saudável 17,4%. O TTGO identificou 14 casos de DM-2 (5,7%), enquanto a glicemia de jejum detectou somente três casos (1,2%), sendo que a frequência destes distúrbios foi maior com o aumento da idade e IMC. CONCLUSÕES: Os resultados do presente estudo demonstram a superioridade do TTGO em relação à glicemia de jejum em diagnosticar DM-2 em mulheres jovens com SOP e deve ser realizado neste grupo de pacientes.

Induction of labor with titrated oral misoprostol solution versus oxytocin in term pregnancy: randomized controlled trial

PURPOSE: To evaluate the effectiveness and the safety of orally administered misoprostol in comparison to intravenously infused oxytocin for labor induction in term pregnant women. METHODS: Between 2008 and 2010, a total of 285 term pregnant women whom were candidate for vaginal delivery were assessed for eligibility to enter the study. Twenty five patients were excluded for different reasons; and 260 included women were randomly assigned to one of the two groups according to the method of treatment, misoprostol or oxytocin. The misoprostol group received 25 µg every 2 hours for up to 24 hours for induction. The oxytocin group received an infusion of 10 IU which was gradually increased. The time from induction to delivery and induction to the beginning of the active phase and successful inductions within 12, 18, and 24 hours were recorded. The trial is registered at irct.ir, number IRCT2012061910068N1. RESULTS: Failure of induction, leading to caesarean section was around 38.3% in the oxytocin group and significantly higher than that of the misoprostol group (20.3%) (p<0.001). Despite the more prevalent failure in the oxytocin group, the mean time intervals from induction to active phase and labor of this group were both significantly less than the misoprostol group (10.1±6.1 and 13.2±7.7 versus 12.9±5.4 and 15.6±5.1 hours respectively, both p-values were <0.05). Maternal and fetal complications were comparable between groups except gastrointestinal symptoms which were encountered more frequently in the misoprostol (10.9 versus 3.9%, p=0.03). CONCLUSIONS: Misoprostol is a safe and effective drug with low complications for the induction of labor. Failure is seen less with misoprostol and caesarean sections are less frequently indicated as compared to oxytocin.

Effect of oral administration of Propionibacterium acnes on growth performance, DTH response and anti-OVA titers in goat kids

Immunostimulants are susbstances that stimuli the response of effector cells to activate the immune response such as antigen uptake, cytokine release or antibody response. These substances can increase resistence to infection by different types of microorganisms, reducing dependence of antibiotics used in livestock animals. Recent reports have demonstrated the positive effect of Propionibacterium acnes (P. acnes) to control animal diseases. In this study, we evaluated the effect of the non-specific immunostimulant P. acnes on immunological functions and growth performance in goat kids. Twenty five goat kids served as control group (A) and another 25 animals received P. acnes being the experimental group (B). Kids were challenged with ovalbumin (OVA) to assess humoral immunity. To assess in vivo cell immunity, delayed type hypersensitivity (DTH) test with phytohemagglutinin (PHA) was used, clinical signs and body weight were recorded each week until 9 weeks of age when the experiment ended. Blood samples were obtained to analyze serum proteins fractions and anti-OVA specific antibodies. No clinical signs of disease and no differences (p>0.05) on body weight between groups were recorded (7.32±0.81 kg in group A, 7.13±0.65 kg in group B). Goat kids from group B had more total protein (59.8±5g/l) and albumin levels (32.8±3.3g/l) than goat kids from group A (56.6±5.7 g/l, 29.6±3.9 g/l respectively) (p<0.05). DTH response in goat kids from group B on day 42 was higher (p<0.05) than group A. At day 63, goat kids from group receiving P. acnes had higher percentage (85.4) of anti-OVA IgM titers (p<0.05) than control group (57.7). In conclusion, the results showed that oral administration of P. acnes to goat kids improved some aspects of the immune system of the animals and it could be used to control goat diseases.