Estudo busca novos tratamentos para a esquistossomose

Um estudo liderado pelo Instituto Oswaldo Cruz (IOC/Fiocruz) em parceria com instituições britânicas abre portas para o desenvolvimento de novos tratamentos para a esquistossomose.

Pesquisa avança no desenvolvimento de terapia para febre amarela

Considerada altamente segura, a vacina contra a febre amarela salva milhares de vidas anualmente, especialmente durante surtos da doença. No entanto, nem sempre a cobertura vacinal na população é total e há determinados grupos que não podem receber o imunizante por causa de possíveis reações adversas, como gestantes, idosos, pessoas com sistema imunológico debilitado ou que têm alergias a elementos do ovo (um dos compostos da vacina).

Questioning Established Theories and Treatment Methods Related to Iron and Other Metal Metabolic Changes, Affecting All Major Diseases and Billions of Patients.

The medical and scientific literature is dominated by highly cited historical theories and findings [...].

Terapia de reemplazo renal continua. Presentación de un caso / Continuous renal replacement therapy. Case report

RESUMEN La insuficiencia renal aguda es definida como la pérdida de función del riñón ocasionada por diversas causas, entre ellas infección e ingesta de fármacos. Esta entidad tiene alta morbilidad y mortalidad en las unidades de cuidados críticos. El tratamiento de la misma va desde la propia protección renal hasta la sustitución artificial de las funciones del riñón lesionado. En la actualidad la terapia de reemplazo renal continua se ha utilizado como soporte renal, y ofrece mayor estabilidad clínica a los pacientes más inestables. En esta revisión se comentan conceptos, indicaciones y los más recientes estudios que validan el uso de esta terapéutica, así como el método de programación que se utilizó en un paciente con diagnóstico de una leptospirosis icterohemorrágica (síndrome de Weil), que estuvo en shock séptico con disfunción multiorgánica, donde se empleó esta terapia con resultados satisfactorios (AU).

ABSTRACT Acute kidney failure is defined as the loss of kidney function caused by various causes, including infection and drug intake. This entity has high morbidity and mortality in critical care units. Treatment ranges from renal protection to artificial replacement of the functions of the injured kidney. Currently, continuous renal replacement therapy has been used as renal support, and offers greater clinical stability to the most unstable patients. In this review, authors discuss concepts, indications and the most recent studies that validate the use of this therapeutic, as well as the programming method that was used in a patient with diagnosis of icteric-hemorrhagic leptospirosis (Weil syndrome), who was in septic shock with multiorgan dysfunction, where this therapy was used with satisfactory results (AU).

Biomodulina T: una nueva opción terapéutica contra la COVID-19 / Biomodulin T: a new therapeutic option against COVID-19

RESUMEN Para potenciar la inmunidad en personas con deterioro gradual del sistema inmune, causado por el envejecimiento o por padecer diferentes comorbilidades, el Grupo de las Industrias Biotecnológica y Farmacéutica de Cuba (BioCubaFarma) ha introducido el producto Biomodulina T. Este se ha utilizado, además, como parte del protocolo de prevención y para el tratamiento de pacientes positivos al SARS-CoV-2. La inmunidad dependiente del timo, incluida la inmunidad de células T y la producción de anticuerpos, disminuye con el tamaño del órgano en los adultos, lo que se conoce como "inmunosenescencia". La Biomodulina T es un extracto diafiltrado de timo de ternera; tiene una acción citorrestauradora e inmunomoduladora, que ha demostrado su eficacia en diferentes grupos de riesgo, dentro de los cuales los ancianos ocupan un lugar especial. En la actual situación epidemiológica nacional e internacional su inclusión en los protocolos de actuación es clave. El uso de este medicamento en un grupo vulnerable, como los ancianos, representa un horizonte esperanzador en tanto se avanza en la producción de vacunas nacionales que sean seguras y eficaces (AU).

ABSTRACT To boost immunity in people with gradual deterioration of the immune system, caused by aging or suffering from different comorbidities, the Group of the Biotechnology and Pharmaceutical Industries of Cuba (Biotechnology Farma) has introduced the product Biomodulin T. This has also been used as part of the prevention protocol and for the treatment of patients positive to SARS-CoV-2. Thymus-dependent immunity, including T-cell immunity and antibody production, decreases with organ size in adults, which is known as "immunosenescence." Biomodulin T is a diafiltered extract of veal thymus; it has a cytorestaurative and immunomodulatory action, which has demonstrated its effectiveness in different risk groups, within which elder people occupy a special place. In the current national and international epidemiological situation its inclusion in the protocols of action is significant. The use of this medication in a vulnerable group, such as elder people, represents a hopeful horizon as progress is made in the production of safe and effective national vaccines (AU).

Multicenter retrospective analysis of clinicopathological features and prognosis of oral tongue squamous cell carcinoma in adolescent and young adult patients.

ABSTRACT: The aim of this study is to report the differences in clinicopathological features of oral tongue squamous cell carcinoma (OTSCC) and survival between adolescent and young adult (AYA) patients and elderly patients and to find the prognosticators. The medical records of 101 AYA patients and 175 control patients with OTSCC who underwent surgery were reviewed. Variables related to prognosis and their clinicopathological associations were analyzed. The 5-year overall survival (5y-OS) rates of AYA and control patients with stage I and II OTSCC were 94.4% and 89.6% (P = .353), respectively, and their 5-year disease-free survival (5y-DFS) rates were 82.0% and 76.6%, respectively (P = .476). The 5y-OS rates of patients with stages III and IV OTSCC were 83.3% and 66.7% (P = .333), respectively, and their 5y-DFS rates were 75.0% and 57.1% (P = .335), respectively. Logistic regression analysis revealed that there was no significant clinicopathological difference in AYA and control group. Furthermore, there was no significant difference in 5y-OS rates between patients who underwent elective neck dissection (END) and those who underwent therapeutic neck dissection (TND) in both group (P = 0.717 and 0.688). Overall, the present study revealed the clinicopathological features and prognosis of OTSCC were similar in AYA patients and elderly patients. Moreover, as there was no significant difference in OS between patients who underwent END and those who underwent TND in AYA and control groups, our results suggest that the indication for END in AYA patients with clinical N0 OTSCC is similar to that for elderly patients.

Conductas suicidas en adolescentes: factores de riesgo, fisiopatología y el uso de litio como terapia preventiva / SUICIDAL BEHAVIOURS IN ADOLESCENTS: RISK FACTORS, PATHOPHYSIOLOGY, AND THE USE OF LITHIUM AS A PREVENTIVE THERAPY

El suicidio en adolescentes representa una problemática de salud de suma importancia en la sociedad. El presente trabajo analiza los factores de riesgo asociados a la conducta suicida, sus correlaciones fisiopatológicas y su tratamiento con carbonato de litio. Los factores de riesgo asociados incluyen: el estrés, las crisis vitales propias de la población de estudio, y factores externos como el uso de pantallas y consumo de medios de comunicación. A su vez, las patologías psiquiátricas de base, en especial el trastorno depresivo mayor, se relacionan de manera positiva con conductas suicidas en adolescentes. Las conductas suicidas estarían vinculadas con cambios morfológicos y moleculares en el sistema nervioso. Los estados proinflamatorios mediados principalmente por la enzima glucógeno sintasa quinasa 3 beta (GSK3 ), se observarían con mayor frecuencia en sujetos con conductas suicidas. A su vez, la disminución de la expresión del factor neurotrófico derivado del cerebro (BDNF) a nivel central predispondría a mayor incidencia de suicidio. La alteración del tono serotoninérgico central sería otro factor de riesgo de suicidio en adolescentes. Las alteraciones serotoninérgicas se vincularían con conductas suicidas de tipo violentas, agresivas e impulsivas, con alta prevalencia en población adolescente. El presente trabajo muestra que el efecto anti-suicida del litio estaría mediado por la inhibición de la GSK3 , como así también por el aumento del tono serotoninérgico. De esta forma el litio disminuiría el estado proinflamatorio central, generaría un aumento de BDNF (con incremento de la supervivencia neuronal), con la subsecuente modulación de la respuesta serotoninérgica. Dada la alta prevalencia de suicidio en dicha población, es necesario contar con opciones terapéuticas eficaces y seguras, respaldados por ensayos clínicos que respalden su uso.

Suicide in adolescents represents a critical health problem in society. The present work analyzes the risk factors associated with suicidal behavior, their pathophysiological correlations, and their treatment with lithium carbonate. Associated risk factors include stress, vital crises typical of the study population, and external factors such as the use of screens and consumption of communication media. In turn, primary psychiatric pathologies, especially major depressive disorder, are positively related to suicidal behaviors in adolescents. Suicidal behaviors would be linked to morphological and molecular changes in the nervous system. Pro-inflammatory states mediated mainly by the enzyme glycogen synthase kinase 3 beta (GSK3 ) would be observed more frequently in subjects with suicidal behaviors. In turn, decreased expression of brain-derived neurotrophic factor (BDNF) at the central level would predispose to a higher incidence of suicide. The alteration of the central serotonergic tone would be another risk factor for suicide in adolescents. Serotonergic alterations would be associated with violent, aggressive and impulsive suicidal behaviors, with a high prevalence in the adolescent population.The anti-suicidal effect of lithium might be mediated by the inhibition of GSK3 , as well as the increase in serotonergic tone. In this way, lithium might decrease the central pro-inflammatory state, generate an increase in BDNF (with increased neuronal survival), and subsequently modify the serotonergic response. Given the high prevalence of suicide in this population, it is necessary to have effective and safe therapeutic options supported by clinical trials that support their use.

Therapeutic assessment as an interventional model of psychological evaluation: case study / Avaliação terapêutica como um modelo interventivo de avaliação psicológica: estudo de caso / La evaluación terapéutica como modelo intervencionista de evaluación psicológica: estudio de caso

Therapeutic Assessment is a model of psychological evaluation that adopts a collaborative approach and a semi-structured systematization to the extent that it has well-defined steps. Considering its intervention nature, Therapeutic Assessment seeks to bring about positive changes in the lives of clients and/or people close to them. The present study aimed to evaluate how the Therapeutic Assessment process presented therapeutic consequences, using the case study as a research method. The description of the results was based on the assistance of a client using the Therapeutic Assessment model. The findings corroborate the hypotheses related to the therapeutic benefits of the Therapeutic Assessment, providing the clients with increased self-knowledge and self-reflection and changes in the way they deal with difficult situations. We conclude that more research on Therapeutic Assessment should be developed to verify other possible benefits of the model. (Au)

A Avaliação Terapêutica é um modelo de avaliação psicológica que adota uma abordagem colaborativa e uma sistematização semiestruturada na medida em que possui etapas bem definidas. Considerando seu caráter interventivo, a Avaliação Terapêutica busca proporcionar mudanças positivas na vida dos clientes e/ou de pessoas próximas a ele. O presente estudo objetivou avaliar de que maneira o processo de Avaliação Terapêutica apresentou consequências terapêuticas, utilizando-se o estudo de caso como método de investigação. A descrição dos resultados orientou-se por meio do atendimento de uma cliente utilizando o modelo de Avaliação Terapêutica. Os achados corroboram com as hipóteses relacionadas aos benefícios terapêuticos da Avaliação Terapêutica, possibilitando à cliente aumento do autoconhecimento e da autorreflexão e mudanças na sua maneira de lidar com situações difíceis. Conclui-se que mais pesquisas sobre Avaliação Terapêutica devem ser desenvolvidas para se verificar outros possíveis benefícios do modelo. (AU)

La Evaluación Terapéutica es un modelo de evaluación psicológica que adopta un enfoque colaborativo y una sistematización semiestructura, visto que cuenta con etapas bien definidas. Considerando su carácter intervencionista, la Evaluación Terapéutica busca proporcionar cambios positivos en la vida de los clientes y/o de personas cercanas a él. El presente estudio objetivó evaluar de qué manera el proceso de Evaluación Terapéutica presenta consecuencias terapéuticas, utilizando el estudio de caso como método de investigación. La descripción de los resultados se orientó por la atención de una cliente, utilizando el modelo de Evaluación Terapéutica. Los hallazgos corroboran con las hipótesis relacionadas con los beneficios terapéuticos de la Evaluación Terapéutica, posibilitando al cliente el aumento del autoconocimiento, de la autorreflexión y cambios en su manera de lidiar con situaciones difíciles. Se concluye que se deben desarrollar más investigaciones sobre Evaluación Terapéutica para verificar otros posibles beneficios del modelo. (AU)

Extracellular vesicles from in vivo liver tissue accelerate recovery of liver necrosis induced by carbon tetrachloride.

Extracellular vesicles (EVs) are nano-sized vesicles composed of proteolipid bilayers carrying various molecular signatures of the cells. As mediators of intercellular communications, EVs have gained great attention as new therapeutic agents in the field of nanomedicine. Therefore, many studies have explored the roles of cell-derived EVs isolated from cultured hepatocytes or stem cells as inducer of liver proliferation and regeneration under various pathological circumstances. However, study investigating the role of EVs directly isolated from liver tissue has not been performed. Herein, to understand the pathophysiological role and to investigate the therapeutic potential of in vivo liver EVs, we isolated EVs from both normal and carbon tetrachloride (CCl4)-induced damaged in vivo liver tissues. The in vivo EVs purified from liver tissues display typical features of EVs including spherical morphology, nano-size, and enrichment of tetraspanins. Interestingly, administration of both normal and damaged liver EVs significantly accelerated the recovery of liver tissue from CCl4-induced hepatic necrosis. This restorative action was through the induction of hepatocyte growth factor at the site of the injury. These results suggest that not only normal liver EVs but also damaged liver EVs play important pathophysiological roles of maintaining homeostasis after tissue damage. Our study, therefore, provides new insight into potentially developing in vivo EV-based therapeutics for preventing and treating liver diseases.

Preclinical efficacy and clinical safety of clinical-grade nebulized allogenic adipose mesenchymal stromal cells-derived extracellular vesicles.

Mesenchymal stromal cell-derived extracellular vesicles (MSC-EVs) turn out to be a promising source of cell-free therapy. Here, we investigated the biodistribution and effect of nebulized human adipose-derived MSC-EVs (haMSC-EVs) in the preclinical lung injury model and explored the safety of nebulized haMSC-EVs in healthy volunteers. DiR-labelled haMSC-EVs were used to explore the distribution of nebulized haMSC-EVs in the murine model. Pseudomonas aeruginosa-induced murine lung injury model was established, and survival rate, as well as WBC counts, histology, IL-6, TNF-α and IL-10 levels in bronchoalveolar lavage fluid (BALF) were measured to explore the optimal therapeutic dose of haMSC-EVs through the nebulized route. Twenty-four healthy volunteers were involved and received the haMSC-EVs once, ranging from 2 × 108 particles to 16 × 108 particles (MEXVT study, NCT04313647). Nebulizing haMSC-EVs improved survival rate to 80% at 96 h in P. aeruginosa-induced murine lung injury model by decreasing lung inflammation and histological severity. All volunteers tolerated the haMSC-EVs nebulization well, and no serious adverse events were observed from starting nebulization to the 7th day after nebulization. These findings suggest that nebulized haMSC-EVs could be a promising therapeutic strategy, offering preliminary evidence to promote the future clinical applications of nebulized haMSC-EVs in lung injury diseases.

Ginkgolide B­mediated therapeutic effects on perioperative neurocognitive dysfunction are associated with the inhibition of iNOS­mediated production of NO.

Perioperative neurocognitive dysfunction (PND) is a prevalent neurological complication after anesthesia and surgery. Ginkgolide B (GB) has been suggested to improve lipopolysaccharide­induced learning and memory impairment. The present study aimed to investigate whether GB serves a protective role against PND by inhibiting inducible nitric oxide synthase (iNOS) and nitric oxide (NO). Abdominal surgery was performed on 10­ to 12­week­old male C57BL/6 mice under isoflurane anesthesia. Prior to surgery, 1400W (a specific iNOS inhibitor) and GB were administered via intraperitoneal injection. Open field and fear conditioning tests were conducted to assess cognitive function on postoperative days 1 and 3. Biochemical assays were performed to evaluate alterations in NO, malondialdehyde (MDA) and superoxide dismutase (SOD) levels. Western blotting was performed to measure iNOS expression in the hippocampus on postoperative day 1. In addition, hematoxylin and eosin staining was performed to detect the neuronal morphology in the hippocampus. Following treatment with 1400W or GB, surgery­induced cognitive dysfunction was improved. Compared with the control group, the surgery group exhibited significant overproduction of iNOS and MDA in the hippocampus on postoperative day 1. Higher levels of NO were also detected in the hippocampus and prefrontal cortex of the surgery group on postoperative day 1. Furthermore, pretreatment with 1400W or GB significantly inhibited the surgery­induced elevation of NO and MDA in brain tissues. Moreover, GB pretreatment significantly inhibited surgery­induced downregulation of SOD and upregulation of iNOS. Surgery­induced increases in neuronal loss and the Bax/Bcl­2 ratio in the hippocampus were significantly inhibited by pretreatment with GB. Collectively, the results of the present study demonstrated that the therapeutic effects of GB on PND were associated with inhibition of iNOS­induced NO production, increased SOD, and the alleviation of neuronal loss and apoptosis.

Efectividad de la hipnoterapia en pacientes deprimidos / Effectiveness of hypnotherapy in depressed patients

RESUMEN Introducción: la depresión es uno de los problemas de salud que más afecta a los seres humanos a nivel mundial. En Cuba, un elevado número de personas padece este flagelo, sin distinción de razas, sexos u otras categorías. Objetivo: evaluar la efectividad de la hipnosis como modalidad terapéutica en pacientes deprimidos. Materiales y métodos: se realizó un estudio explicativo de tipo experimental de comparación de grupo pre-post prueba en 30 pacientes con trastornos depresivos; 15 de ellos se atendieron con hipnoterapia (grupo estudio) y otros 15 mediante terapia racional emotiva conductual (grupo control). Por la importancia para enriquecer la investigación, se definió como variable independiente el tratamiento empleado según el grupo, y como variables dependientes la respuesta psicológica antidepresiva y ansiolítica. Los datos se procesaron cuantitativa y cualitativamente. Se empleó la prueba de las probabilidades exactas de Fisher y la t de Student para validar la significación del cambio. Resultados: en términos de evolución clínica, la hipnoterapia fue efectiva, ya que el 93,3 % de los pacientes mejoraron significativamente en comparación con los resultados obtenidos con la terapia conductual racional emotiva, dados en un 73,33 %. Conclusión: la hipnoterapia es tan efectiva como la terapia racional emotiva conductual, y si bien no hubo diferencias significativas por los resultados del estadígrafo matemático empleado, sí las hubo desde el punto de vista práctico y clínico, pues evolucionaron más rápido los pacientes del grupo estudio que los del grupo control (AU).

ABSTRACT Introduction: depression is one of the health problems more affecting the human being around the world. A high number of persons suffers this scourge, without distinction of race, sex or any other category. Objective: to assess hypnosis effectiveness as a therapeutic modality in depressed patients. Materials and methods: an experimental-kind explanatory study was carried out comparing a group of 30 patients with depressive disorders before and after test; 15 of them were treated with hypnotherapy (study group) and 15 with rational emotive behavioral therapy (control group). For the importance of enriching the research the treatment used according to each group was defined as independent variable and the anxiolytic and anti-depressive psychological answer. Data were quantitative and qualitatively processed. Fisher's exact test and T student test were used to validate the change significance. Results: in terms of clinical evolution, hypnotherapy was effective, since 93.3% of patients significantly improved in comparison to the results achieved with the rational emotive behavioral therapy, reaching 73.33%. Conclusions: hypnotherapy is as effective as rational emotive behavioral therapy, and although there were not significant differences due to the results of the used mathematical statistic, there they were from the practical and clinical point of view, because the patients from the study group improved faster than the ones in the control group AU).

Clinical Perspectives of Theranostics.

Theranostics is a precision medicine which integrates diagnostic nuclear medicine and radionuclide therapy for various cancers throughout body using suitable tracers and treatment that target specific biological pathways or receptors. This review covers traditional theranostics for thyroid cancer and pheochromocytoma with radioiodine compounds. In addition, recent theranostics of radioimmunotherapy for non-Hodgkin lymphoma, and treatment of bone metastasis using bone seeking radiopharmaceuticals are described. Furthermore, new radiopharmaceuticals for prostatic cancer and pancreatic cancer have been added. Of particular, F-18 Fluoro-2-Deoxyglucose (FDG) Positron Emission Tomography (PET) is often used for treatment monitoring and estimating patient outcome. A recent clinical study highlighted the ability of alpha-radiotherapy with high linear energy transfer (LET) to overcome treatment resistance to beta--particle therapy. Theranostics will become an ever-increasing part of clinical nuclear medicine.

Efeito do laser de baixa intensidade como coadjuvante na reparação óssea de dente com perfuração radicular e lesão perirradicular: relato de caso clínico, com 12 anos de acompanhamento / Effect of low intensity laser supporting bone repair on a tooth with root perforation and periradicular lesion: case report and 12 years follow-up

Introdução: O laser em baixa intensidade apresenta propriedades que podem ser efetivas no tratamento endodôntico, como a capacidade reparadora, a atuação antimicrobiana e o auxílio à proliferação celular. Objetivo: Descrever, por meio do relato de um caso clínico, a ação do laser em baixa intensidade como coadjuvante na reparação óssea de uma perfuração radicular e lesão perirradicular em um elemento dentário com canais tratados, sendo realizado retratamento endodôntico apenas do canal mesiovestibular, utilizando-se hidróxido de cálcio como medicação intracanal e laser em baixa intensidade. Os demais canais não foram submetidos a retratamento, apesar de apresentarem lesão perirradicular. Resultados: O laser em baixa intensidade mostrou-se efetivo como auxiliar no processo de reparação óssea restituindo, ad integrum, o osso interradicular e as lesões perirradiculares das raízes mesial e distal após acompanhamento de 12 anos. Conclusões: O laser em baixa intensidade pode ser utilizado como coadjuvante ao tratamento de perfurações, demonstrando sucesso em longo prazo (AU).

Introduction: Low intensity laser has properties that may be effective in endodontic treatment, such as restorative capacity, antimicrobial performance and cell proliferation. Methods: This report describes the action of low intensity laser as an adjunct to bone repair of a root perforation and peri-radicular lesion in a tooth submitted to endodontic treatment, in which endodontic retreatment was performed only in the mesiobuccal canal using calcium hydroxide as intracanal medication and low level laser. The other canals were not submitted to retreatment, in spite of having peri-radicular lesions. Results: The low-intensity laser was effective as an adjunct to the bone repair process, restoring ad-integrum, interradicular bone and the peri-radicular lesions of the mesial and distal roots, after 12 years of follow-up. Conclusion: The laser at low intensity can be used as a coadjuvant to the treatment of perforations, demonstrating long-term success (AU).

Acessos endodônticos: o que todo endodontista deve saber / Endodontic accesses: what every endodontist should know

Introdução: Os acessos endodônticos minimamente invasivos (AEMI) surgiram com o intuito de, por meio da preservação de estrutura dentária, manter a resistência à fratura de dentes tratados endodonticamente. A partir do primeiro estudo, em 2010, vários trabalhos foram desenvolvidos buscando entender qual a influência dos AEMI na resistência à fratura de dentes tratados endodonticamente. No entanto, interferências coronárias causadas pelos AEMI poderiam prejudicar a realização dos procedimentos subsequentes à cavidade de acesso, como a localização, instrumentação, limpeza, descontaminação e obturação dos canais radiculares. Objetivo: Com base nessa premissa, a presente revisão teve como objetivo responder algumas perguntas para que o clínico entenda quais são as principais modalidades de AEMI, os impactos da sua abordagem no tratamento endodôntico e o verdadeiro papel do tratamento endodôntico na perda dos elementos dentários. Resultados: Considerando os dados disponíveis até o presente momento, faltam evidências robustas para apoiar a alegação de que os AEMIs preservem a resistência à fratura dos elementos tratados endodonticamente melhor do que nos dentes acessados de maneira tradicional. Além disso, cavidades de acesso minimamente invasivas podem interferir em outras etapas do tratamento endodôntico, podendo torná-lo imprevisível. Conclusão: Dessa forma, pode-se concluir que há uma falta de evidências que apoiem a utilização de cavidades de acesso minimamente invasivas na prática clínica de rotina e/ou no processo de formação de alunos de graduação e pós-graduação (AU).

Introduction: Minimally invasive access cavities emerged aiming to maintain the fracture resistance of endodontically treated teeth through the preservation of dental structure. Starting with the first study in 2010, several others were developed to evaluate the influence of minimally invasive access cavities in the fracture resistance of endodontically treated teeth. However, the coronal interference caused by those access cavities could impair the subsequent procedures of root canal treatment, such as the location, instrumentation, cleaning, disinfection and filling of the root canals. Objective: Based on this premise, the aim of the present review was to answer some questions so that the clinician knows the main modalities of minimally invasive access cavities, the impacts of this approach and the real role of endodontic treatment in the tooth loss. Results: Considering the available data, there is a lack of robust evidence in literature to support the claim that the minimally invasive access cavities preserve the fracture resistance of endodontically treated teeth better than the traditional one. In addition, these access cavities can interfere in other stages of endodontic treatment, making it unpredictable. Conclusion: Thus, it can be concluded that there is a lack of evidence to support the use of minimally invasive access cavities in routine clinical practice and/or in the process of training undergraduate and graduate students (AU).

Tratamiento ayurveda (Virechana y Basti) y cambios de la microbiota intestinal a nivel de Phylum y especie / Ayurveda Treatment (Virechana and Basti) and Changes of Intestinal Microbiota at Phyla and Species Level

Introducción: Se han analizado terapias ayurvédicas y prácticas médicas para un grupo de pacientes en Japón. La característica del tratamiento ayurvédico es una desintoxicación con una gran cantidad de tratamiento con aceite mediante un masaje con aceite en la superficie del cuerpo y una terapia de purificación con ghee o aceite de hierbas especialmente preparado. Los cambios de la microbiota intestinal durante estos tratamientos no han sido bien estudiados. Mé- LA PRENSA MÉDICA ARGENTINA Ayurveda Treatment (Virechana and Basti) and Changes of Intestinal Microbiota at Phyla and Species Level 79 V.107/Nº 2 todo: Los participantes fueron reclutados de la Clínica Hatai Ayurveda en Tokio. La terapia de Virechana, una terapia de purificación o la terapia de Basti (decocción y enema de aceite) se llevó a cabo en 13 pacientes con diversas manifestaciones. Todos los participantes proporcionaron el detalle de su estilo de vida, hábitos dietéticos, enfermedades pasadas y presentes mediante el cuestionario, y se registró la condición precisa durante la admisión al final del campamento. Se tomaron muestras fecales a la entrada, durante el tratamiento, al alta y tres semanas después para analizar la microbiota intestinal por el gen seqyebcubg 16srRNA. Resultados: el peso corporal disminuyó aproximadamente un 5% con la terapia de Virechana, mientras que no ocurrió con Basti, pero la grasa corporal aumentó un 4% (2,2 kg) en promedio en ambos grupos. Varias manifestaciones clínicas de los participantes mejoraron, especialmente en una erupción cutánea y un cambio atópico. El paciente deprimido también remitió mejoras en sus ganas de vivir. En su mayoría son vegetarianos y tenían más Bacteroides (48.09 ± 7.51%), Firmicutes (38.27 ± 10.82%) y Actinobacteria (3.30 ± 3.58%) que los omnívoros que tenían más Proteobacteria (10.73 ± 4.75%), Fusobacteria (2.40 ± 6.25%) y cianobacterias (0,09 ± 0,24%). Cuando los grupos se dividieron por el consumo de aceite, los usuarios de ghee mostraron más Fusobacterium y menos Firmicutes y Actinobacteria. La terapia con Virechana provocó cambios notables en la microbiota después del pretratamiento, como la disminución de Firmicutes y el aumento de Proteobacterias. A nivel género-especie, destacan el aumento de Enterobacteriaceae y la pérdida de Akkermansia municiphila. Niruha Basti y Matra Basti disminuyeron Firmicutes y aumentaron Proteobacteria (p = 0.096). Fusobacterium también aumentó. Después del alta, la Proteobateria se mantuvo alta, pero Firmicutes regresó al 30% en promedio, oscilando entre el 25% y el 50%. Tres semanas después, la variedad aumentó con Fusobacterium, Verrucomicrobia, Tenericutes y Lentisphaerae. La variedad de especies también aumentó tres semanas después. Conclusión: Varias quejas de los participantes mejoraron por el tratamiento ayurvédico con una gran cantidad de tratamiento de aceite por masaje de aceite de superficie corporal y terapia de purga. Causó cambios en la microbiota intestinal y los metabolitos bacterianos pueden afectar las lesiones cutáneas y la salud mental como la sensación depresiva