RESUMO
AIMS: This study looks to assess the oral health status in the study subjects and to quantify the prevalence of WHO defined HIV-related oral stage 3 and 4 lesions (HIV-OL) as those conditions are indicating need for treatment independently of CD4 count. METHODS: This quantitative screening study used both structured questionnaire and clinical examination to determine the prevalence of HIV-OL in 83 adults living with HIV randomly selected from a list of service users at a community based HIV organization. RESULTS: The screening revealed a 40 % (95%-CI: 30-51%) prevalence of HIV-OL in this population where 71 are under Antiretroviral Therapy (ART). Most frequent HIV-OL found were persistent oral candidiasis (19% prevalence), and acute necrotizing gingivitis/stomatitis (18% prevalence) Prevalence of HIV-OL was correlating with CD4 count. Patients with multiple HIV-OL have a mean of 133 CD4 cells/µl, patients with a single HIV-OL have 327 CD4 cells/µl and patients without HIV-OL do have a mean of 457CD4 cells/µl (ANOVA-p=0.002). 6 of 12 patients not taking ART yet were found to have stage 3 or 4 HIV-OL. 46 (55%) of the study population had poor or very poor oral hygiene and 29 (35%) had never had an oral examination, 36 (43%) had attended only for extraction. Only 4 of 54 patients who had previously accessed oral health care have revealed their HIV status to the dentist at that time. CONCLUSIONS: Wider access to oral healthcare is required for people living with HIV in Kathmandu Valley/Nepal. In this setting HIV-OL are still an important consideration in assessing patients living with HIV, which can have decisive therapeutic implications. Stage 3 and 4 conditions are, independently of CD4 count, indication to start ART without delay in people living with HIV.
RESUMO
The effects of adrenomedullin in the regulation of myocardial contractility were investigated in the rat. In papillary muscles (n=6), adrenomedullin (0.1 to 10 nM) failed to show contractile effects. NO (nitric oxide) synthase inhibition with N(G)-nitro-L-arginine (L-NOARG) did not unmask any inotropic effect of adrenomedullin. The positive inotropic effect of isoprenaline (0. 01 nM to 10 microM) was identical after adrenomedullin, after L-NOARG, and after L-NOARG plus adrenomedullin (n=6 each). In field-stimulated rat ventricular myocytes, adrenomedullin (1, 10, and 100 nM; n=4 each) had impact neither on cell shortening nor on Ca(2+) transients. In isolated constant-flow perfused hearts (7.3+/-0.3 ml/min), adrenomedullin (1 nM, n=9; 10 nM, n=7) induced significant coronary vasodilation (-28%, -50%). In conclusion, adrenomedullin is a potent coronary vasodilator, but has no significant effects on myocardial contractility in the rat.