Nonalcoholic fatty liver disease: biomarkers as diagnostic tools for liver damage assessment in adult patients from Argentina.

BACKGROUND: Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease whose prevalence has been increasing constantly and linked to the global obesity epidemic. The NAFLD histologic spectrum ranges from simple steatosis to nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis and hepatocellular carcinoma. Liver biopsy is the only reliable means to diagnose and stage NASH, but its invasive nature limits its use. Therefore, the prediction of hepatic injury by means of the development of new noninvasive tests represents a growing medical need. Our aim was to evaluate matrix deposition and cell-death markers, which correlate with liver injury in an NAFLD patient cohort. PATIENTS AND METHODS: Liver biopsies and serum from 34 NAFLD adult patients were analyzed. Histological parameters were evaluated. Matrix deposition [hyaluronic acid (HA) and tissue inhibitor of matrix metalloproteinase inhibitor-1 (TIMP-1)] and cell-death markers [cytokeratin-18 (M65) and caspase-cleaved cytokeratin-18 (M30)] were measured in serum samples. RESULTS: HA showed an association with fibrosis severity (P=0.03) and M30 with steatosis (P=0.013), inflammation (P=0.004), and fibrosis severity (P=0.04). In contrast, TIMP-1 and M65 showed no association with any histological parameter of liver injury. The evaluation of diagnostic accuracy showed good performance as less invasive markers of significant fibrosis of both HA (area under the receiver operating characteristic curve: 0.928) and M30 (area under the receiver operating characteristic curve: 0.848). CONCLUSION: Biomarkers are essential tools that may provide a quick and accurate diagnosis for patients with life-threatening NAFLD and NASH. HA and M30, together or determined sequentially, have been found to be straightforward tests that may be sufficient to predict significant fibrosis even in a primary care center of an underdeveloped country.

Effect of a Titanium Tetrafluoride Varnish in the Prevention and Treatment of Carious Lesions in the Permanent Teeth of Children Living in a Fluoridated Region: Protocol for a Randomized Controlled Trial.

BACKGROUND: Titanium tetrafluoride (TiF4) has regained interest due to new formulations that have been shown to be more effective against tooth demineralization than sodium fluoride (NaF) formulations in vitro and in situ. OBJECTIVE: The aim of this study is to evaluate the effect of two types of varnishes (4% TiF4 and a commercial 5% NaF) on the prevention of carious lesions and the treatment of noncavitated enamel carious lesions in the permanent teeth of children living in a fluoridated area. METHODS: This randomized, controlled, parallel and single-blind clinical trial involves 63 children, 6-7 years old, living in Bauru, São Paulo, Brazil. Children were selected according to their caries activity (ie, presence of at least 1 tooth with a Nyvad score of 1) and randomly divided into the following treatment categories: 4% TiF4 varnish (2.45 % F-, pH 1, FGM); 5% NaF varnish (2.26% F-, pH 5, Duraphat, Colgate) and control (placebo varnish, pH 5, FGM). The varnishes will be applied on all permanent teeth, once a week for 4 weeks and they will be reapplied only once 6 and 12 months after the study begins. Two calibrated examiners will carry out the clinical examination (International Caries Detection and Assessment System [ICDAS] and Nyvad indexes, kappa>.8) at baseline, before the first application, after the 1st, 6th, 12th, and 18th month of the study begins. Furthermore, quantitative fluorescence changes will be measured using Quantitative Light-Induced Fluorescence (QLF). The degree of patient satisfaction with the treatment will also be computed. The data will undergo statistical analysis (P<.05). RESULTS: This ongoing study is funded by funding agencies from Brazil (São Paulo Research Foundation, FAPESP-015/14149-1, and National Council for Scientific and Technological Development, CNPq-401313/2016-6). We expect to confirm the efficacy of TiF4 on the prevention and treatment of carious lesions by comparing it to NaF varnish. The subjects are under 1 month evaluation and the dropout was about 8%. No differences between the treatments have been detected at the first month so far (P>.05). CONCLUSIONS: If our hypothesis is confirmed, TiF4 varnish can be marketed and applied at the individual level and used in community programs to control dental caries. TRIAL REGISTRATION: Brazilian Clinical Trials Registry: RBR-5VWJ4Y; http://www.ensaiosclinicos.gov.br/rg/?q=RBR-5VWJ4Y (Archived by WebCite at http://www.webcitation.org/6wUurEnm7).

In vitro assessment of artificial saliva formulations on initial enamel erosion remineralization.

OBJECTIVES: Various formulations of artificial saliva are present in the literature and little guidance is available on the standardization of type of saliva for use in in vitro protocols for erosive studies. The aim of this study was to evaluate the remineralizing capacity of different formulations of artificial saliva on initial enamel erosive lesion. METHODS: Bovine enamel blocks were subjected to short-term acidic exposure by immersion in citric acid 0.05 M (pH 2.5) for 15s, resulting in surface softening without tissue loss. Then 90 selected eroded enamel blocks were randomly and equally divided into 6 groups according to saliva formulation (n=15): Saliva 1 (contain mucin); Saliva 2 (Saliva 1 without mucin); Saliva 3; Saliva 4; Saliva 5 (contain sodium carboxymethyl cellulose) and control (C) (deionized water). After demineralization enamel blocks were subjected to remineralization by immersion in the saliva's formulations for 2h. Enamel remineralization was measured by superficial hardness test (% superficial hardness change). The data were tested using ANOVA and Tukey's test (p<0.05). RESULTS: All the tested formulations of artificial saliva resulted in significantly higher enamel remineralization compared to control (p<0.001). Saliva 3 showed higher percentage of enamel remineralization than Saliva 5 (p<0.05). CONCLUSIONS: Besides the variety of artificial saliva for erosion in vitro protocols, all the formulations tested were able to partially remineralize initial erosive lesions.

Estudio etnográfico de las experiencias de sanar y enfermar en mujeres Mapuche Huilliche del Sector Sur de San Juan de la Costa / Ethnographic study of the experiences of healing and illness in women Mapuche Huilliche of Sector San Juan de la Costa

La presente investigación tiene como objetivo comprender los principales factores socioculturales y sanitarios que motivan a las mujeres Mapuche Huilliche del sector sur de San Juan de la Costa a solucionar sus problemas de salud en la medicina occidental o en la medicina tradicional de su cultura. Para lograr los objetivos planteados se diseñó un proyecto de investigación cualitativa de tipo etnográfica, cuya recopilación de datos fue a través de un trabajo de campo integrando técnicas de recolección de datos adecuadas como entrevistas etnográficas y Focus Group, las cuales fueron analizadas a través del método de Spradley. La selección de la muestra se realizó considerando personas del sexo femenino pertenecientes a tres comunidades indígenas del sector sur de San Juan de la Costa, provincia de Osorno, Chile. Tomando en cuenta estos criterios se identificaron a los informantes claves mediante la técnica de variación máxima definida por Flick, integrando casos en donde nos percatamos que poseían visiones diferentes respecto al tema de investigación dentro de cada comunidad. Finalmente se realizó un total de siete entrevistas en profundidad y un Focus Group. Al llevar a cabo el análisis de los resultados surgieron cuatro temas principales "Percepciones frente a la medicina mapuche","Percepciones frente a la medicina occidental", "Mujer Mapuche Huilliche" y "Pertenencia cultural", cada uno de los cuales involucró variados subtemas. Dentro de los resultados se destaca como factor principal de decisión frente al sistema de salud occidental y Mapuche Huilliche, el significado de salud y enfermedad atribuido por su cultura y las condiciones geográficas de aislamiento en las que se encuentran insertas. La etapa final se realizó teniendo como base la Teoría de Madelaine Leininger y su modelo del Sol naciente, integrando los diferentes factores observados en las comunidades que dan forma a su cultura al momento de optar por la medicina occidental o medicina ...