Osteonecrosis de maxilares asociada al uso de bifosfonatos: revisión de 491 casos

En los últimos años, el número de pacientes que presenta osteonecrosis maxilar asociada al uso de bifosfonatos (BIONJ) se ha incrementado. Esto es debido al aumento en el consumo de bifosfonatos, los cuales se asocian al tratamiento de carcinomas con metástasis óseas, mieloma múltiple, osteoporosis, osteopenia y enfermedades metabólicas como la enfermedad de Paget. Objetivo: Analizar el número de casos de pacientes que han desarrollado osteonecrosis de maxilares asociado al uso de bifosfonatos, publicados desde Junio del año 2006 hasta Abril 2010. Método: En esta revisión, se consultaron las bases de datos Pubmed-Medline, Scielo e Índice Médico Español, incluyendo límites en la búsqueda, para recopilar los casos de BIONJ que se hayan publicado desde el año 2006 hasta la actualidad. Los artículos seleccionados presentaban casos, en los cuales los pacientes que recibían bifosfonatos desarrollaban BIONJ. Resultados: Se encontraron 491 casos de BIONJ en total, de ellos 49,3% eran mujeres, 32% hombres y 18,7% no se establecía el género. La mayoría de estos casos se presentaron en la mandíbula y asociados particularment al ácido zolendrónico. Conclusiones: En los próximos años se espera que el número de pacientes que desarrollen esta complicación vaya en aumento, en particular en mujeres, a las cuales se les indica cada vez más esta medicación para el tratamiento de la osteoporosis.

Maxillary dentigerous cyst and supernumerary tooth. Is it a frequent association?

Dentigerous cysts, also known as follicular cysts, are a relatively common pathology in our field. They are associated with unerupted or semi-erupted teeth and are usually not related to supernumerary teeth. OBJECTIVE: To describe a dentigerous cyst case associated to a supernumerary tooth. CASE-REPORT: A large-sized dentigerous cyst is described, associated with a supernumerary tooth, affecting the whole maxillary anterior area. Appropriate treatment consists of performing root canals and a Partsch II procedure with a cystectomy, extracting the unerupted teeth, carrying out an apicoectomy and retro-filling the affected teeth. The defect is filled with a bone xenograft. Possible therapeutic alternatives and the connection between the dentigerous cysts and supernumerary teeth are considered in the discussion.

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

Nutrimetabolomics fingerprinting to identify biomarkers of bread exposure in a free-living population from the PREDIMED study cohort

Bread is one of the most widely consumed foods. Its impact on human health is currently of special interest for researchers. We aimed to identify biomarkers of bread consumption by applying a nutrimetabolomic approach to a free-living population. An untargeted HPLC q-TOF-MS and multivariate analysis was applied to human urine from 155 subjects stratified by habitual bread consumption in three groups: non-consumers of bread (n = 56), white-bread consumers (n = 48) and whole-grain bread consumers (n = 51). The most differential metabolites (variable importance for projection ≥1.5) included compounds originating from cereal plant phytochemicals such as benzoxazinoids and alkylresorcinol metabolites, and compounds produced by gut microbiota (such as enterolactones, hydroxybenzoic and dihydroferulic acid metabolites). Pyrraline, riboflavin, 3-indolecarboxylic acid glucuronide, 2,8-dihydroxyquinoline glucuronide and N-α-acetylcitrulline were also tentatively identified. In order to combine multiple metabolites in a model to predict bread consumption, a stepwise logistic regression analysis was used. Receiver operating curves were constructed to evaluate the global performance of individual metabolites and their combination. The area under the curve values [AUC (95 % CI)] of combined models ranged from 77.8 % (69.1 86.4 %) to 93.7 % (89.4 98.1 %), whereas the AUC for the metabolites included in the models had weak values when they were evaluated individually: from 58.1 % (46.6 69.7 %) to 78.4 % (69.8 87.1 %). Our study showed that a daily bread intake significantly impacted on the urinary metabolome, despite being examined under uncontrolled free-living conditions. We further concluded that a combination of several biomarkers of exposure is better than a single biomarker for the predictive ability of discriminative analysis.

Nutrimetabolomics fingerprinting to identify biomarkers of bread exposure in a free-living population from the PREDIMED study cohort

Bread is one of the most widely consumed foods. Its impact on human health is currently of special interest for researchers. We aimed to identify biomarkers of bread consumption by applying a nutrimetabolomic approach to a free-living population. An untargeted HPLC q-TOF-MS and multivariate analysis was applied to human urine from 155 subjects stratified by habitual bread consumption in three groups: non-consumers of bread (n = 56), white-bread consumers (n = 48) and whole-grain bread consumers (n = 51). The most differential metabolites (variable importance for projection ≥1.5) included compounds originating from cereal plant phytochemicals such as benzoxazinoids and alkylresorcinol metabolites, and compounds produced by gut microbiota (such as enterolactones, hydroxybenzoic and dihydroferulic acid metabolites). Pyrraline, riboflavin, 3-indolecarboxylic acid glucuronide, 2,8-dihydroxyquinoline glucuronide and N-α-acetylcitrulline were also tentatively identified. In order to combine multiple metabolites in a model to predict bread consumption, a stepwise logistic regression analysis was used. Receiver operating curves were constructed to evaluate the global performance of individual metabolites and their combination. The area under the curve values [AUC (95 % CI)] of combined models ranged from 77.8 % (69.1 86.4 %) to 93.7 % (89.4 98.1 %), whereas the AUC for the metabolites included in the models had weak values when they were evaluated individually: from 58.1 % (46.6 69.7 %) to 78.4 % (69.8 87.1 %). Our study showed that a daily bread intake significantly impacted on the urinary metabolome, despite being examined under uncontrolled free-living conditions. We further concluded that a combination of several biomarkers of exposure is better than a single biomarker for the predictive ability of discriminative analysis.

Otimização dos parâmetros de produção de hidrolisados protéicos enzimáticos utilizando pescado de baixo valor comercial

The enzymatic modification of proteins has been widely studied with the aim of add value to low commercial value fish. The objective of this work was to evaluate and optimize the parameters involved in the production process of an enzymatic protein hydrolyzed with high protein content. The results showed that for Alcalase the most significant parameters were temperature, pH and substrate concentration and for Flavourzyme were pH, substrate concentration and enzyme concentration. It was obtained for Alcalase a predictive model for the recovered nitrogen and for Flavourzyme a predictive model for the hydrolysis degree.

Influência da ação das enzimas alcalase e flavourzyme no grau de hidrólise das proteínas de carne de frango

To study the action of Alcalase and Flavourzyme on the proteins of chicken meat, the influence of the substrate concentration [S], enzyme concentration [E] and hydrolysis time on the degree of hydrolysis (DH) of the proteins was evaluated. The highest DH for breast meat was obtained with a [S] of 3.3% (w/v), with a [E] of 6% (w/w) and reaction time of 90 min, for both enzymes. For thigh meat the conditions to get the highest DH were: [S] of 5% (w/v), [E] of 8% (w/w) and a reaction time of 120 min, for both enzymes.

Funcionalidade de hidrolisados proteicos de cabrinha (Prionotus punctatus) obtidos a partir de diferentes proteases microbianas

The objective of this work was to study the influence of enzymes Alcalase, Flavourzyme and Novozym in the functional properties of hydrolysates of Bluewing searobin (Prionotus punctatus) minced. The hydrolysates of Bluewing searobin were evaluated for the chemical composition and the functional properties. The Novozym enzyme presented greater specific activity differing significantly from the enzymes Alcalase and Flavourzyme. The hydrolysates of Bluewing searobin presented protein content above of 87% and excellent solubility, capacity of water retention, capacity of oil retention and emulsifying capacity.

Efeito da concentração de enzima e de substrato no grau de hidrólise e nas propriedades funcionais de hidrolisados proteicos de corvina (Micropogonias furnieri)

The objective of this work was to obtain hydrolysates with different degrees of hydrolysis using Alcalase 2.4L® and to evaluate the effect of the enzyme [E] and substrate [S] concentration on the functional properties of the hydrolysates. It was obtained hydrolysates with hydrolysis degree values ranging from 12.2 to 43.7%. The values of solubility and water holding capacity were similar for the greater number of the hydrolysates with minimum values in the pH 5.0. The hydrolysis degree showed direct relationship with the solubility and indirect with the water holding capacity, oil holding capacity, emulsifying capacity and foaming capacity.

Investigação eletroquímica e calorimétrica da interação de novos agentes antitumorais biscatiônicos com DNA

Biscationic amidines bind in the DNA minor groove and present biological activity against a range of infectious diseases. Two new biscationic compounds (bis-α,ω-S-thioureido, amino and sulfide analogues) were synthesized in good yields and fully characterized, and their interaction with DNA was also investigated. Isothermal titration calorimetry (ITC) was used to measure the thermodynamic properties of binding interactions between DNA and these ligands. A double stranded calf thymus DNA immobilized on an electrode surface was used to study the possible DNA-interacting abilities of these compounds towards dsDNA in situ. A remarkable interaction of these compounds with DNA was demonstrated and their potential application as anticancer agents was furthered.

BIOFILMS BASED ON CANIHUA FLOUR (Chenopodium Pallidicaule): DESIGN AND CHARACTERIZATION

This work aims to (1) produce and characterize the flour obtained from two varieties of canihua, cupi and illpa-inia, and (2) evaluate the ability of these flours to form biofilms. The flours produced contain proteins, starches, lipids, organic substances containing phenol groups, and high percentages of unsaturated fatty acids. Films produced from the illpa variety presented lower water vapor permeability and larger Young’s modulus values than the films formed from the cupi variety. Both films were yellowish and displayed a high light blocking ability (as compared with polyethylene films), which can be attributed to the presence of phenolic compounds. Furthermore, they showed lesser solubility and water permeability than other polysaccharide films, which may be the result of the higher protein (12%–13.8%) and lipid (11%) contents in canihua flours, as well as the formation of a larger number of S–S bonds. On the other hand, these films presented a single vitreous transition temperature at low temperatures (< 0 °C), crystallization of the A and Vh types, and an additional diffraction peak at 2 = 7.5º, ascribed to the presence of essential fatty acids in canihua flour. Canihua flour can form films with adequate properties and shows promise for potential applications in food packaging, because it acts as a good barrier to incident ultraviolet light.

Reacción a Moniliophthora roreri en Theobroma spp. en Caquetá, Colombia

El objetivo de este estudio fue evaluar in situ la reacción de 50 materiales genéticos de tres especies de Theobroma(T. cacao, T. grandiflorum y T. bicolor) a la inoculación controlada de tres aislados autóctonos de Moniliophthora roreri (agente causal de la moniliasis del cacao) en el Departamento de Caquetá (Amazonia colombiana). Las variables incidencia de la enfermedad (IMr), severidad externa (SE) y severidad interna (SI), se evaluaron nueve semanas después de la inoculación de mazorcas de 2 a 3 meses de edad con una suspensión de esporas de 1,2 x 105 esporas/mL. La enfermedad se evidenció en las tres especies de Theobroma, sin embargo, ésta no se presentó en 13 de los 50 materiales genéticos evaluados, representados así: seis T. grandiflorum, cinco T. bicolor y dos T. cacao. Los materiales genéticos de T. bicolor y T. grandiflorum fueron los menos afectados comparados con los de T. cacao. Se encontraron diferencias significativas para IMr, SE y SI entre las tres especies de Theobroma y entre los 50 materiales genéticos. Diferencias significativas entre los aislados solo ocurrieron para SE. La incidencia y la severidad de la enfermedad entre materiales genéticos, fueron influenciadas por el patógeno aislado. Los materiales genéticos con menor reacción a M. roreri pueden ser utilizados en programas de mejoramiento por resistencia a la moniliasis.

Transtornos psiquiátricos menores e procura por cuidados em estudantes de Medicina

A carreira médica pode desencadear alterações patológicas na saúde mental, que podem ter início já na graduação. O objetivo deste estudo foi identificar a prevalência de Transtornos Psiquiátricos Menores (TPMe) e a procura por ajuda em estudantes de um curso de Medicina. Trata-se de um estudo transversal, com uma população de 343 estudantes da primeira à quarta série, maiores de 18 anos. Foram realizadas entrevistas, em salas de aula, por meio de dois questionários estruturados, o Self Reporting Questionnaire (SRQ-20) e outro elaborado pelos autores. Análises descritiva, univariada, bivariada e estatística foram utilizadas mediante o programa Microsoft Excel. Os resultados evidenciaram que, entre os acadêmicos com TPMe, 41,6% (a maioria) moravam sozinhos e 75% eram mulheres. Entre os acometidos, 59,2% não conheciam qualquer programa e apenas 9,1% procuraram ajuda. O uso de medicamento foi duas vezes mais prevalente em mulheres com TPMe do que em homens, sendo antidepressivos e ansiolíticos os mais usados. A prevalência de 26,1% de TPMe nos alunos, associada a baixa procura por cuidados e a relatos de automedicação, demonstra a inefetividade dos atuais programas de apoio.

Arquivamento e comunicação de imagens radiológicas na formação médica online

O estudo investiga as possibilidades de utilização dos recursos de arquivamento e comunicação de imagens nas salas de aula e à distância no processo de formação médica através da telemedicina. Discutem-se as possibilidades de usar programas de informática que reproduzem os recursos de diferentes meios de diagnóstico por imagem como ferramenta didática nas aulas de telemedicina, por meio do acesso a imagens radiológicas utilizando sistemas de informática para fins de emissão de laudos à distância na formação médica. Avaliou-se a apresentação de imagens digitais nas salas de aula dos cursos de saúde a partir da experiência de residentes em formação que atuam na modalidade online, por meio de questionários aplicados com especialistas e residentes que atuam no caso relatado no estudo. Os aspectos de formação docente dos médicos, especialmente para atuar em ambientes online, definição de metodologias de avaliação, interação entre os sujeitos envolvidos foram avaliados para considerar a possibilidade de usar a experiência em cursos de Medicina como um meio de educação à distância (EAD) utilizando Arquivamento e Comunicação de Imagens (PACS)

Avaliação do estágio de urgências clínicas em uma unidade de pronto atendimento sob a perspectiva dos alunos

INTRODUÇÃO: O curso de Medicina da Faculdade de Ciências Médicas e da Saúde (FCMS) da PUC-SP de Sorocaba passou por mudanças em seu modelo curricular, motivadas por vários fatores, entre eles a instituição das Diretrizes Curriculares Nacionais para o curso de Medicina (DCN), que resultou numa ampliação dos cenários da prática. Desde 2011, o estágio de urgências clínicas, do sexto ano, passou a ser realizado também em uma Unidade de Pronto Atendimento (UPA). OBJETIVOS: Avaliar o estágio na UPA sob a perspectiva discente. MATERIAL E MÉTODOS: O instrumento de avaliação foi composto por um questionário semiestruturado, aplicado aos alunos do ano de 2012. RESULTADOS: Os alunos consideraram positivo o fato de ser um cenário prático, com grande volume de pacientes e com acompanhamento do professor. Chamou a atenção o grande número de pacientes que solicitam atestados para justificar falta ao trabalho, além dos quadros de lombalgia, dor torácica e dor abdominal e as doenças respiratórias. Entre os pontos negativos, destacaram a curta duração do estágio e o pequeno número de salas para atendimento. CONCLUSÃO: A inserção do aluno no nível secundário da atenção às urgências, em uma Unidade de Pronto Atendimento, mostrou-se como mais uma possibilidade para o ensino de urgência na graduação médica e de aspecto fundamental, dada a organização do sistema de saúde.