Educação em saúde bucal direcionada a adultos com cardiopatias congênitas / Oral health education directed to adults with congenital heart disease

O diagnóstico das cardiopatias congênitas engloba várias anormalidades anatômicas do coração e das grandes artérias ainda no período fetal. Os métodos de tratamento modernos são direcionados principalmente para o reparo cirúrgico desses defeitos estruturais. Essas abordagens de tratamento são consideravelmente prolongadoras da vida, mas principalmente não curativas, resultando em resíduos e sequelas cardiovasculares persistentes ao longo da vida como, por exemplo, shunts residuais, lesões valvulares ou implantação de materiais protéticos, causando um risco inerente de endocardite infecciosa nesses pacientes na fase adulta. Assim, a saúde bucal em pacientes com cardiopatia congênita ganha particular importância. Metodologia: Este estudo é uma revisão integrativa da literatura que envolveu as seguintes etapas: identificação do tema, busca na literatura, seleção dos estudos com base em critérios de inclusão pré-estabelecidos, análise e compilação dos dados e apresentação dos resultados. Foram incluídos artigos publicados em inglês e que abordassem tratamento odontológico em adultos com cardiopatia congênita, artigos online e disponíveis na íntegra. Discussão: Vários estudos descrevem cenários que podem levar a um aumento da prevalência de problemas de saúde bucal em pacientes com cardiopatias congênitas, implicando em um efeito sistêmico importante. Implementar ações preventivas relacionadas à prevenção da cárie e doença periodontal e realizar a profilaxia antibiótica adequada são recomendações para abordar o risco elevado de endocardite infecciosa. Conclusão: Como o número de pacientes com cardiopatias congênitas atingindo a idade adulta está aumentando, devido a melhorias nos cuidados médicos e cirúrgicos, medidas simples como uma boa educação sobre higiene oral e profilaxia antibiótica pré-procedimentos odontológicos têm forte impacto positivo na prevenção da endocardite infecciosa nesse grupo de pacientes.

PK11195 inhibits mitophagy targeting the F1Fo-ATPsynthase in Bcl-2 knock-down cells.

The pharmacological agent 1-(2-Chlorophenyl-N-methylpropyl)-3-isoquinolinecarboxamide (PK11195) is the prototypical ligand of the 18-kDa Translocator Protein (TSPO) but at µM concentrations deactivates the oncoprotein Bcl-2 increasing the efficiency of chemotherapeutic agents and promoting the Ca2+-dependent macro-autophagy (or autophagy). In this paper, we report that PK11195, in HeLa cells, modifies the mitochondria-targeted type of autophagy--hereafter referred to as mitophagy--and the associated resizing of the mitochondrial network but does so exclusively in absence of the oncoprotein Bcl-2 (Bcl-2 Kd cells). This is consequence of a "side" targeting of the mitochondrial F1Fo-ATPsynthase enzyme, since identical outcome is mimicked by the antibiotic Oligomycin, of which PK11195 matches the effect on: i) mitochondrial membrane potential (ΔΨm), ii) ATP homeostasis and iii) Reactive Oxygen Species (ROS) generation. Taken together, these data highlight a novel TSPO-independent biological effect for PK11195 and provide evidences for a hitherto uncovered Bcl-2-dependent role of the F1Fo-ATPsynthase in mitochondrial quality control.

Relationship between major adverse cardiac events and angiographic findings in dialysis patients.

BACKGROUND: In dialysis patients, coronary angiography (CA) predicts major adverse coronary events (MACE) better than non-invasive tests. The aim of this study was to investigate in such patients the relationship between coronary atherosclerotic damage shown by angiography and MACE, during an average follow-up period of more than 5 years. PATIENTS AND METHODS: Coronary angiography was performed in 63 dialysis patients (mean age 56 ± 12 years, 49 men); 37 subjects awaiting kidney transplantation had no history of cardiac disease, whereas the remaining 26 patients had clinical evidence of coronary artery disease (CAD). During a follow-up period of 62 ± 20 months (range 12-109), all the MACE were recorded. Statistical analysis was carried out by dividing the patients into two groups, those who had MACE (MACE group) and those who were free of cardiac events (FCE group). Severe CAD on CA was defined as luminal stenosis ≥ 75% in at least one vessel. Logistic regression analysis and Cox regression analysis were carried out in order to evaluate which variable was associated with MACE. RESULTS: At the end of follow-up, 17 subjects had MACE and severe CAD was shown in the epicardial arteries of 31 patients (49%). Compared to the FCE group, the MACE group had older age (65 ± 10 vs 53 ± 11 years, P = 0.002), lower diastolic blood pressure (79 ± 7 vs 85 ± 7 mmHg, P = 0.0037), higher prevalence of CAD (82 vs 30%, P = 0.0002) and cerebrovascular disease (41 vs 15%, P = 0.0278). Coronary artery damage was higher in the MACE group than in the FCE group. Logistic and Cox regression analyses showed that age was the only variable independently associated with MACE (OR 1.109 95% CI 1.022-1.204, P = 0.0133, hazard ratio 1.066 95% CI 1.010-1.125, P = 0.02, respectively). After removal of age from the model, MACE were independently associated with haemodynamic stenosis of coronary arteries (OR 7.429 95% CI 1.829-30.173, P = 0.005, hazard ratio 5.992 95% CI 1.655-21.698, P = 0.006, respectively). Event-free survival was much better in the 37 renal transplant candidates with no history of CAD than in the 26 patients who had clinical evidence of CAD. CONCLUSIONS: This observational study confirms that in dialysis patients coronary atherosclerotic damage shown by angiography is strongly related to MACE and that age and severe CAD are major risk factors for MACE.

[Treatment of uremia in frail elderly patients: the issue of prolonged conservative management]. / L'anziano fragile e la terapia dell'uremia: il tema della terapia conservativa prolungata.

The chronic use of renal replacement therapy in frail elderly patients sometimes provides no tangible benefits and may even have a negative fallout on their quality of life, making prolonged conservative management a reasonable option. However, this is mostly a feeling, since very few papers have addressed this issue and there is no evidence-based medicine related to it. On the other hand, ethical issues are extraordinarily relevant and in this clinical setting extend beyond topics such as end-of-life care and advance care planning. It is evident that clinical decision-making in frail elderly patients with endstage renal disease may be very difficult and needs to be supported by ad hoc clinical trials. In the meantime, the ethical issues must be discussed in society.

Low-dosage ibopamine treatment in progressive renal failure: a long-term multicentre trial.

A multicentre trial (11 nephrology centres) was carried out to test the effects of ibopamine, an orally active dopamine-like drug, on the progression of chronic renal failure. For a 2-year period 189 chronic renal failure patients (serum creatinine level 1.5-4.0 mg/dl) were observed. They were homogeneous for basic nephropathy, degree of residual renal function, blood pressure, and proteinuria. The patients were randomly divided into two groups: 96 took ibopamine at a dosage of 100 mg/day (group A) and 93 served as controls (group B). All were on a low-protein diet (mean 0.8 g/kg body weight). By the end of the observation period, the rate of decrease of the renal function indexes in time proved significantly slower (1.8 times) in group A than in group B. The survival curves for renal function (pre-established end points were creatinine level increases equal to or > 20% and equal to or > 40% of the basal values) proved significantly better (p < 0.02 and p < 0.002 respectively) in group A than in group B. The mean plasma creatinine values rose by 17% in group A and by 36% in group B. The creatinine clearance decreased by 5% in treated patients and by 14% in the controls. Statistical analysis ruled out any possible centre effect. The trial suggests that low-dosage ibopamine administration may be used as a valid and safe pharmacological adjunct for retarding the progression of renal failure in patients with mild or moderate chronic renal impairment.

Effect of dietary manipulation on the lipid abnormalities in patients with chronic renal failure.

Disorders of lipid metabolism could play an important role in mediating the progression of chronic renal disease toward uremia. The hypothesis of the nephrotoxicity of lipids has been considered in a large population of patients on long-term dietary protein restriction. In our experience, there is no evidence that lipid disorders may accelerate the progression of renal disease. Hypercholesterolemia and/or hypertriglyceridemia are probably only some of the many factors affecting the prognosis of renal disease. Dietary protein restriction seems to be effective in maintaining normal or only slightly elevated serum lipids in patients with early renal failure, even after years of dietary treatment, despite the natural progression of renal functional deterioration. Moreover, this dietary regimen has a favorable effect on lipid composition of erythrocyte membrane when compared with those of patients on a free diet.