Use of cannabis medicine for the treatment of spasticity-associated pain / O uso da medicina canábica para tratamento da dor associada à espasticidade

ABSTRACT BACKGROUND AND OBJECTIVES: Spasticity refers to the increase of resistance to joint passive movement according to its angular velocity. It is part of the triad of the pyramidal syndrome, along with the exacerbation of myotatic reflexes and muscle weakness, and is present in several lesions of the central nervous system, either in the spinal cord or brain. Pain associated with spasticity is caused by muscle spasms, activation of trigger points, joint deformities, interference with the position of body segments, and difficulty in movement control. For a more precise therapeutic intervention, the detailed physical examination of the locomotor system and spasticity can be completed by using specific spasticity evaluation scales. Multiple sclerosis (MS) is the clinical condition for which there are the greatest number of studies using cannabi-noids to control spasticity. The objective of this study was to perform a literature review of the possible role of cannabinoid drugs in the control of spasticity and the pain associated with it. CONTENTS: The literature shows moderate evidence that the combined use of 9-tetrahydrocannabinol and cannabidiol increases the number of people reporting improvement in spasticity. CONCLUSION: It is possible to believe that the complaint of musculoskeletal pain associated with spasticity accompanies this improvement with the use of nabiximols, but there are still gaps in the literature for this specific topic.

RESUMO JUSTIFICATIVA E OBJETIVOS: A espasticidade refere-se ao aumento da resistência ao movimento passivo articular conforme a sua velocidade angular. Ela faz parte da tríade da síndrome piramidal, junto com a exacerbação de reflexos miotáticos e fraqueza muscular, e está presente em diversas lesões do sistema nervoso central, de topografia medular ou encefálica. A dor associada à espasticidade é causada pelos espasmos musculares, ativação de pontos-gatilho, deformidades articulares, interferência na posição dos segmentos corporais e dificuldade para o controle do movimento. Para uma intervenção terapêutica mais precisa, o exame físico detalhado do aparelho locomotor e da espasticidade pode ser completado pelo uso de escalas de avaliação específicas. A esclerose múltipla é a condição clínica para a qual há maior número de estudos com uso de canabinoides para o controle da espasticidade. O objetivo deste estudo foi realizar uma revisão da literatura sobre o possível papel dos fármacos canabinoides no controle da espasticidade e da dor associada a ela. CONTEÚDO: Há na literatura evidências moderadas de que o uso combinado de 9-tetrahidrocanabinol e canabidiol aumenta o número de pessoas que relatam melhora da espasticidade. CONCLUSÃO: É possível acreditar que a queixa de dor musculoesquelética associada à espasticidade acompanhe essa melhora com uso de nabiximol, mas ainda há lacunas na literatura para esse tópico específico.

Oxidative Stress in the Protection and Injury of the Lacrimal Gland and the Ocular Surface: are There Perspectives for Therapeutics?

Oxidative stress (OS) is a major disruption in the physiology of the lacrimal functional unit (LFU). Antioxidant enzymes have dual protective activities: antioxidant and antimicrobial activities. Peroxidases have been indistinctly used as markers of the secretory activity of the LFU and implicated in the pathophysiology, diagnosis and treatment of dry eye disease (DED), even though they comprise a large family of enzymes that includes lactoperoxidase (LPO) and glutathione peroxidase (GPO), among others. Assays to measure and correlate OS with other local LFU phenomena have methodological limitations. Studies implicate molecules and reactions involved in OS as markers of homeostasis, and other studies identify them as part of the physiopathology of diseases. Despite these conflicting concepts and observations, it is clear that OS is influential in the development of DED. Moreover, many antioxidant strategies have been proposed for its treatment, including calorie restriction to nutritional supplementation. This review offers a critical analysis of the biological mechanisms, diagnostic outcomes, drug use, dietary supplements, and life habits that implicate the influence of OS on DED.

Fucoxanthin Holds Potential to Become a Drug Adjuvant in Breast Cancer Treatment: Evidence from 2D and 3D Cell Cultures.

Fucoxanthin (Fx) is a carotenoid derived from marine organisms that exhibits anticancer activities. However, its role as a potential drug adjuvant in breast cancer (BC) treatment is still poorly explored. Firstly, this study investigated the cytotoxic effects of Fx alone and combined with doxorubicin (Dox) and cisplatin (Cis) on a panel of 2D-cultured BC cell lines (MCF7, SKBR3 and MDA-MB-231) and one non-tumoral cell line (MCF12A). Fucoxanthin induced cytotoxicity against all the cell lines and potentiated Dox cytotoxic effects towards the SKBR3 and MDA-MB-231 cells. The combination triggering the highest cytotoxicity (Fx 10 µM + Dox 1 µM in MDA-MB-231) additionally showed significant induction of cell death and genotoxic effects, relative to control. In sequence, the same combination was tested on 3D cultures using a multi-endpoint approach involving bioactivity assays and microscopy techniques. Similar to 2D cultures, the combination of Fx and Dox showed higher cytotoxic effects on 3D cultures compared to the isolated compounds. Furthermore, this combination increased the number of apoptotic cells, decreased cell proliferation, and caused structural and ultrastructural damages on the 3D models. Overall, our findings suggest Fx has potential to become an adjuvant for Dox chemotherapy regimens in BC treatment.

Nutrition Therapy, Glucose Control, and Brain Metabolism in Traumatic Brain Injury: A Multimodal Monitoring Approach.

The goal of neurocritical care in patients with traumatic brain injury (TBI) is to prevent secondary brain damage. Pathophysiological mechanisms lead to loss of body mass, negative nitrogen balance, dysglycemia, and cerebral metabolic dysfunction. All of these complications have been shown to impact outcomes. Therapeutic options are available that prevent or mitigate their negative impact. Nutrition therapy, glucose control, and multimodality monitoring with cerebral microdialysis (CMD) can be applied as an integrated approach to optimize systemic immune and organ function as well as adequate substrate delivery to the brain. CMD allows real-time bedside monitoring of aspects of brain energy metabolism, by measuring specific metabolites in the extracellular fluid of brain tissue. Sequential monitoring of brain glucose and lactate/pyruvate ratio may reveal pathologic processes that lead to imbalances in supply and demand. Early recognition of these patterns may help individualize cerebral perfusion targets and systemic glucose control following TBI. In this direction, recent consensus statements have provided guidelines and recommendations for CMD applications in neurocritical care. In this review, we summarize data from clinical research on patients with severe TBI focused on a multimodal approach to evaluate aspects of nutrition therapy, such as timing and route; aspects of systemic glucose management, such as intensive vs. moderate control; and finally, aspects of cerebral metabolism. Research and clinical applications of CMD to better understand the interplay between substrate supply, glycemic variations, insulin therapy, and their effects on the brain metabolic profile were also reviewed. Novel mechanistic hypotheses in the interpretation of brain biomarkers were also discussed. Finally, we offer an integrated approach that includes nutritional and brain metabolic monitoring to manage severe TBI patients.

Drug resistance in glioblastoma and cytotoxicity of seaweed compounds, alone and in combination with anticancer drugs: A mini review.

BACKGROUND: Glioblastomas (GBM) are one of the most aggressive tumor of the central nervous system with an average life expectancy of only 1-2 years after diagnosis, even with the use of advanced treatments with surgery, radiation, and chemotherapy. There are several anticancer drugs with alkylating properties that have been used in the therapy of malignant gliomas. Temozolomide (TMZ) is one of them, widely used even in combination with ionizing radiation. However, the main disadvantage of using these types of drugs in the treatment of GBM is the development of cancer drug resistance. Research of bioactive compounds with anticancer activity has been heavily explored. PURPOSE: This review focuses on a carotenoid and a phlorotannin present in seaweed, namely fucoxanthin and phloroglucinol, and their anticancer activity against glioblastoma. The combination of natural compounds with conventional drugs is also discussed. CONCLUSION: Several natural compounds existing in seaweeds, such as fucoxanthin and phoroglucinol, have shown cytotoxic activity in models in vitro and in vivo, acting through different molecular mechanisms, such as antioxidant, antiproliferative, DNA damage/DNA repair, proapoptotic, antiangiogenic and antimetastic. Within the scope of interactions with conventional drugs, there are evidences that some seaweed compounds could be used to potentiate the action of anticancer drugs. However, their effects and mechanisms of action, alone or in combination with anticancer drugs, namely TMZ, in glioblastoma cell, still few explored and require more attention due to the unquestionable high potential of these marine compounds.

Comparison among adjuvant treatments for primary pterygium: a network meta-analysis.

PURPOSE: Pterygium is a frequent ocular disease, where the major challenge is the high level of recurrence after its surgical removal. We performed a network meta-analysis to identify, among several adjuvant treatments for primary pterygium, which is the best to prevent recurrence. METHODS: A search was conducted using PubMed, Scientific Electronic Library Online, Latin American and Caribbean Centre on Health Sciences and Cochrane Eyes and Vision Group Trials Register between 1993 and 2015 for randomisedclinical trials (RCTs) comparing adjuvant treatments following primary pterygium surgery. RESULTS: 24 RCTs that studied 1815 eyes of 1668 patients were included and allowed direct and indirect comparison among 14 interventions through network meta-analysis. The rank from the best to worse treatment to prevent recurrence is: conjunctival autograft + ciclosporin 0.05% eye drops, bare sclera + intraoperativemitomycin C (MMC) <0.02%, bare sclera + beta therapy (2500 cGy single dose), conjunctival autograft + beta therapy (1000 cGy single dose), bare sclera + MMC 0.02% eye drops, conjunctival autograft, bare sclera + intraoperative MMC >0.02%, bare sclera + ciclosporin 0.05% eye drops, bare sclera + intraoperative 5-fluorouracil 5%, amniotic membrane transplantation, bare sclera + intraoperative MMC 0.02%, conjunctival autograft + bevacizumab 0.05% eye drops, bare sclera + bevacizumab 0.05% eye drops and bare sclera alone. CONCLUSION: The best adjuvant treatment to prevent recurrence after primary pterygium surgery is the association of conjunctival autograft and ciclosporin 0.05% eye drops. Bare sclera technique alone should be discontinued since it is associated with high recurrence rates.

Adequação Proteica versus Estado Nutricional de Pacientes Oncológicos Adultos em Unidade de Terapia Intensiva / Protein Adequacy versus Nutritional Status of Adult Oncology Patients in Intensive Care Unit / Protein Adecuado contra el Estado Nutricional de Pacientes Adultos en Oncología en la Unidad de Cuidados Intensivos

Introdução: A nutrição adequada pode reduzir as complicações, o tempo de internação hospitalar e melhorar os desfechos clínicos dos pacientes. Objetivo: Avaliar a adequação da prescrição proteica na terapia nutricional enteral para pacientes oncológicos e comparar a prescrição nutricional proteica com as recomendações específicas disponíveis para oncologia, segundo a literatura atual. Método: Trata-se de um estudo quantitativo retrospectivo. Os dados da pesquisa foram obtidos por meio do mapa de uso diário pela nutricionista. Resultados: 54% dos pacientes eram mulheres, 41% das mulheres tinham câncer de mama e 21% dos homens, câncer de pulmão. Pelo NRS 2002, o escore de risco nutricional 3 foi prevalente em adultos e idosos de ambos os sexos. Adultos eutróficos representaram 64% e idosos desnutridos, 50%. A exigência proteica média para adultos eutróficos foi de 1,5 g ptn/kg; para desnutridos, 2,1 g ptn/kg; para sobrepeso, 1,4 g ptn/kg; e para o obesos, 1,8 g ptn/kg. Para a desnutrição em idosos, a exigência proteica média foi de 1,4 g ptn/kg; para eutróficos, 1,5 g ptn/kg; e para obesos, 1,5 g ptn/kg. Nenhum resultado avaliado apresentou significância estatística. Conclusão:A malignidade da doença de base, a idade e a presença do risco nutricional sugerem maior necessidade de incrementar o quantitativo de aporte nutricional. Evidencia-se também a necessidade da utilização de módulos de proteína para adequar a prescrição nutricional principalmente aos pacientes obesos.

Introduction: Adequate nutrition can reduce complications, length of hospital stay, and improve patient outcomes. Objective: To evaluate the adequacy of the protein prescription in enteral nutritional therapy for cancer patients and to compare the protein nutritional prescription with the specific recommendations available for oncology, according to the current literature. Method: This is a retrospective quantitative study. The data of the research were obtained through the map of daily use by the Nutritionist. Results:54% of the patients were women and 46% were men. 41% of women had breast cancer and 21% of men had lung cancer. The nutritional risk score 3 was prevalent in adults and the elderly, of both sexes. Eutrophic adults accounted for 64% and undernourished elderly 50%. The average protein requirement for eutrophic adults was 1.5 g ptn/kg; for malnourished 2.1 g ptn/kg; for overweight 1.4 g ptn/kg and for the obese 1.8 g ptn/kg. For malnutrition in the elderly, the mean protein requirement was 1.4 g ptn/kg, for eutrophic 1.5 g ptn/kg and for obese 1.5 g ptn/kg. No evaluated result presented statistical significance. Conclusion: The malignancy of the underlying disease, age and the presence of nutritional risk suggest greater need to increase the amount of nutritional supply. It highlights the need to use protein modules to adjust nutritional prescription, especially to obese patients.

Introducción: La nutrición adecuada puede reducir las complicaciones, el tiempo de internación hospitalaria y mejorar los resultados clínicos de los pacientes.Objetivo: Evaluar la adecuación de la prescripción proteica en la terapia nutricional enteral para pacientes oncológicos y comparar la prescripción nutricional proteica con las recomendaciones específicas disponibles para oncología, según la literatura actual. Método: Se trata de un estudio cuantitativo retrospectivo. Los datos de la encuesta fueron obtenidos a través del mapa de uso diario por la Nutricionista. Resultados: 54% de los pacientes eran mujeres y el 46% eran hombres. El 41% de las mujeres tenían cáncer de mama y el 21% de los hombres de cáncer de pulmón. La puntuación de riesgo nutricional 3 fue prevalente en adultos y ancianos, de ambos sexos. Los adultos eutróficos representaron el 64% y los ancianos desnutridos 50%. La exigencia proteica media para adultos eutróficos fue de 1,5 g ptn/kg; desnutridos 2,1 g ptn/kg; sobrepeso 1,4 g ptn/kg y el obesos 1,8 g ptn/kg. Para la desnutrición en ancianos, la exigencia proteica media fue de 1,4 g ptn/kg, eutróficos 1,5 g ptn/kg y para obesos 1,5 g ptn/kg. Ningún resultado evaluado presenta significancia estadística. Conclusión: La malignidad de la enfermedad subyacente, la edad y la presencia de riesgo nutricional sugieren mayor necesidad de incrementar el cuantitativo de suministro nutricional. Se evidencia también la necesidad de la utilización de módulos de proteina para adecuar la prescripción nutricional, principalmente en los pacientes obesos.

Cost comparison of kidney transplant versus dialysis in Brazil.

This study aimed to compare the direct medical costs of renal transplantation and renal replacement therapies, specifically hemodialysis and peritoneal dialysis, from the perspective of the Brazilian Unified National Health System (SUS). Renal replacement therapies costs were based on data published in the literature. Cost items for kidney transplant were identified in a private hospital based on procedure codes used for charging the SUS, and other items were taken from the literature. In the four years covered by the study, cadaver kidney transplant generated per-patient savings of BRL 37,000 and BRL 74,000 compared to hemodialysis and peritoneal dialysis, respectively. Savings were even greater with living donor kidney transplant: BRL 46,000 and BRL 82,000 compared to hemodialysis and peritoneal dialysis, respectively. This result, together with survival and quality-of-life analyses, characterizes kidney transplant as the best clinical and financial alternative, thus supporting public policies for organ transplants in Brazil.

Uma comparação dos custos do transplante renal em relação às diálises no Brasil / Cost comparison of kidney transplant versus dialysis in Brazil / Una comparación de los costes del trasplante renal en relación con las diálisis en Brasil

Resumo: O objetivo do presente estudo foi comparar os custos médicos diretos do transplante renal e das terapias renais substitutivas, especificamente a hemodiálise e a diálise peritoneal, sob a perspectiva do Sistema Único de Saúde (SUS). Os custos das terapias renais substitutivas foram extraídos de informações publicadas na literatura. Os itens de custo previstos do transplante renal foram identificados em um hospital privado mediante coleta dos códigos dos procedimentos utilizados para a cobrança do SUS e os demais itens extraídos da literatura. O resultado desta pesquisa indica que, no período dos quatro anos coberto por este estudo, o transplante renal de doador falecido gera uma economia, por paciente, de R$ 37 mil e R$ 74 mil em relação à hemodiálise e à diálise peritoneal, respectivamente. Quanto ao transplante renal de doador vivo, as economias são ainda maiores: R$ 46 mil e R$ 82 mil em relação à hemodiálise e à diálise peritoneal, respectivamente. Este resultado, aliado a análises de sobrevida e qualidade de vida, pode caracterizar o transplante renal como a melhor alternativa do ponto de vista financeiro e clínico, auxiliando na formulação de políticas públicas relacionadas com os transplantes de órgãos no Brasil.

Abstract: This study aimed to compare the direct medical costs of renal transplantation and renal replacement therapies, specifically hemodialysis and peritoneal dialysis, from the perspective of the Brazilian Unified National Health System (SUS). Renal replacement therapies costs were based on data published in the literature. Cost items for kidney transplant were identified in a private hospital based on procedure codes used for charging the SUS, and other items were taken from the literature. In the four years covered by the study, cadaver kidney transplant generated per-patient savings of BRL 37,000 and BRL 74,000 compared to hemodialysis and peritoneal dialysis, respectively. Savings were even greater with living donor kidney transplant: BRL 46,000 and BRL 82,000 compared to hemodialysis and peritoneal dialysis, respectively. This result, together with survival and quality-of-life analyses, characterizes kidney transplant as the best clinical and financial alternative, thus supporting public policies for organ transplants in Brazil.

Resumen: El objetivo del presente estudio fue comparar los costes médicos directos del trasplante renal y de las terapias renales substitutivas, específicamente la hemodiálisis y la diálisis peritoneal, bajo la perspectiva del Sistema Único de Salud (SUS). Los costes de las terapias renales substitutivas se extrajeron de información publicada en la literatura. Los ítems de coste previstos del trasplante renal se identificaron en un hospital privado, a partir de la recogida de códigos de procedimientos utilizados para el cobro del SUS y los demás ítems extraídos de la literatura. El resultado de esta investigación indica que, en el período de los 4 años cubierto por este estudio, el trasplante renal del donante fallecido genera un ahorro, por paciente, de R$ 37 mil y R$ 74 mil en relación al hemodiálisis y al diálisis peritoneal, respectivamente. En cuanto al trasplante renal del donante vivo, los ahorros son incluso mayores: R$ 46 mil y R$ 82 mil, en relación a la hemodiálisis y a la diálisis peritoneal, respectivamente. Este resultado, junto con análisis de supervivencia y calidad de vida, puede caracterizar el trasplante renal como la mejor alternativa desde el punto de vista financiero y clínico, auxiliando en la formulación de políticas públicas relacionadas con los trasplantes de órganos en Brasil.

Topical Brazilian propolis improves corneal wound healing and inflammation in rats following alkali burns.

BACKGROUND: The objective of this study was to investigate the effects of the Brazilian Scaptotrigona sp propolis, a widely used folk medicine, in corneal wound healing and inflammation. METHODS: Corneal epithelial defects of 1 mm in diameter were made in the right eyes of Wistar male adult rats by cauterization with silver nitrate sticks. Subsequently, they were divided in two groups (n = 40 rats/group): Brazilian propolis (BP) group was topically treated with a microemulsion containing 1% Brazilian propolis; vehicle (VH) group received the same formulation without propolis. The epithelial defect area was photographed and measured at t = 0 (wound induction), and after 12, 24, 48 and 120 h of treatment. The inflammatory response was evaluated based on counting of neutrophils. Epithelial regeneration rates were determined based on Ki-67 expression in basal epithelial cells. Comparisons were made using the Kruskal-Wallis and the Mann-Whitney U test. RESULTS: The BP group presented both smaller epithelial defect areas at 12, 24 and 48 h and fewer corneal infiltrating neutrophils at 24 and 48 h (P < 0.01) than the VH group. These effects were associated with more pervasive Ki-67 staining in the BP group at 12 and 24 h (P < 0.05). CONCLUSIONS: Topically applied BP accelerated wound healing and reduced the inflammatory response to silver nitrate-induced corneal alkali burns in rats.

Development and validation of a GC-MS method for the evaluation of 17 endocrine disruptor compounds, including phytoestrogens and sitosterol, in coastal waters - their spatial and seasonal levels in Porto costal region (Portugal).

A gas chromatography with mass spectrometric detection (GC-MS) method was developed and optimized for the determination of 17 endocrine disrupting compounds (EDCs) in coastal water samples. The evaluated EDCs were from different origins and included estrogens, bisphenol A, alkylphenolethoxylates, alkylphenols, phytoestrogens and sitosterol (SITO). The EDCs were extracted from samples using Oasis HLB (Hydrophilic-Lipophilic Balance) cartridges and derivatized with N,O-bis(trimethylsilyl)trifluoroacetamide (BSTFA) added with 1% trimethylchlorosilane (TMCS). The validation parameters revealed that this method was highly specific for all assayed compounds (>99%) and the linearity of the calibration curves showed a correlation higher than 0.99. The detection limits were at low ng/L level and the recovery rates were higher than 70%. The performance of the method was checked using coastal water samples taken every 2 months during 2009-2010 from the Douro River estuary and the Porto coastline (Portugal). These data revealed that approximately 98.0% of the analyzed compounds showed levels above their limits of detection (LODs). The measured estrogens (2-20 ng/L) and industrial pollutants (up to 1.1 µg/L) were in biologic hazardous concentrations. Besides, a clear seasonal pattern of fluctuation was established for phytoestrogens and SITO. The physicochemical data, namely the amounts of nitrates, nitrites and phosphorous, confirmed the low water quality of this area.

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery.

PURPOSE: To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. METHODS: Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. RESULTS: Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). CONCLUSION: The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

Conjunctival inflammation in patients under topical glaucoma treatment with indication to surgery / Inflamação conjuntival em pacientes em tratamento tópico para glaucoma com indicação de cirurgia

PURPOSE: To compare the frequency of conjunctival HLA-DR expression (a surrogate marker for inflammation) in eyes treated with topical prostaglandin analogues versus eyes treated with other topical antiglaucomatous drugs. METHODS: Patients diagnosed with primary open-angle glaucoma presenting indication for trabeculectomy were divided in groups according to the use or not of prostaglandin analogues. All subjects were treated with the maximum tolerated dose of antiglaucomatous drugs until the date of the surgery. At the beginning of the surgical procedure, a 5 x 5 mm biopsy of the bulbar conjunctiva was collected, incubated with monoclonal anti-HLA-DR antibody and processed for histological analysis. RESULTS: Of the 31 eyes included (31 patients), 25 were under topical prostaglandin analogues (Group 1) and six under other topical pharmacological agents (Group 2). Fourteen eyes of Group 1 (56%) and three of Group 2 (50 %) were positive for the inflammatory marker HLA-DR (P=1.0). The percentage of stained cells ranged from 15.49 to 48.09% (median: 27.61) in Group 1, and from 18.35 to 28 (median: 20.71) in Group 2, with no differences statistically significant (p=0.33). CONCLUSION: The use of prostaglandin analogues did not increase conjunctival expression of HLA-DR compared to other topical antiglaucomatous agents.

OBJETIVO: Comparar a frequência da expressão conjuntival de HLA-DR (marcador inflamatório) em olhos tratados com análogos de prostaglandinas de uso tópico com a frequência em olhos tratados com outros medicamentos. MÉTODOS: Pacientes com glaucoma primário de ângulo aberto apresentando indicação de trabeculectomia foram agrupados segundo o uso ou não de análogos de prostaglandinas. Todos os participantes foram tratados com medicação máxima tolerada até o momento da cirurgia. Ao início do procedimento cirúrgico, uma biópsia de 5 x 5 mm da conjuntiva bulbar foi coletada, incubada com anticorpo monoclonal anti-HLA-DR e processada para análise histológica RESULTADOS: Dentre os 31 olhos incluídos (31 pacientes), 25 estavam em uso de análogos de prostaglandinas (Grupo 1) e seis em uso de outros agentes antiglaucomatosos (Grupo 2). Quatorze olhos do Grupo 1 (56%) e três do Grupo 2 (50%) apresentaram positividade para o marcador HLA-DR (p=1,0). A porcentagem de células coradas variou de 15,49 a 48,09% (mediana: 27,61%) no Grupo 1 e de 18,35 a 28% (mediana: 20,71%) no Grupo 2, com diferenças não estatisticamente significativas (p=0,33). CONCLUSÃO: O uso de análogos de prostaglandinas não aumenta a expressão conjuntival de HLA-DR comparado com outros medicamentos tópicos para o tratamento de glaucoma.

All-ceramic crowns over single implant zircon abutment. Influence of young's modulus on mechanics.

PURPOSE: The aim of this study was to evaluate the influence of different Young moduli of the ceramic crown on the distribution of tensions in the region of the abutment-crown interface by making use of 2D finite element analysis. MATERIALS: Two representative models of a sagittally sectioned maxilla were built through AutoCad program showing an implant in the region of the upper central incisor and were restored by means of IPS e.max Press or Procera AllCeram on zircon abutment. Numerical analysis (Ansys 10.0) was performed under 2 loading conditions (50 N): on the lingual face, at 45 degrees with the implant's long axis (L1) and perpendicular to the incisal edge (L2). The von Mises equivalent stress (σvM) and maximum principal stress (σmax) were obtained. RESULTS: It was noticed that, independent of the restoring system, the maximum σvM values were in the incisal region of the cementation interface for both loading conditions. The IPS e.max Press system showed higher σvM on the adhesive interface with higher L1 influence. The same behavior was also observed as regards the σmax variation. CONCLUSIONS: It was concluded that a restoring system with a lower Young modulus shows higher stress concentration on the abutment-crown interface when cemented on an abutment with a high Young modulus. Thus, IPS e.max Press system provides higher stress concentration in the resin cement layer than Procera AllCeram system, suggesting that the resin cement layer shows lower failure risk when the Procera crown is used.

Distribution of endocrine disruptors in the Mondego River estuary, Portugal.

Recent studies in the Mondego River estuary demonstrated signs of pollution in the area, but the nature of the contamination remains unexplored. Because there seems to be any studies in that zone checking for the simultaneous presence of xenoestrogenic endocrine disrupting compounds, either of animal (estradiol and estrone), vegetal (daidzein, genistein and biochanin A), pharmaceutical (17alpha-ethynylestradiol) or industrial (bisphenol A, 4-octylphenol, 4-nonylphenol) origins, the main objective of this study was to investigate their presence, in every year season and at eight points along the estuarine gradient. For this propose, water samples (2 L) were collected in high and low tides, preconcentrated in the Oasis HLB cartridges and cleaned in silica cartridges before their analysis by HPLC-DAD and GC-MS. The current data showed the absence of contamination by animal or pharmaceutical estrogens and by alkylphenols, but demonstrated the presence of high levels of phytoestrogens (up to 1.1 mug/L) and of bisphenol A (up to 880.0 ng/L). Because these two chemicals existed in high environmental concentrations in the most upstream sampling station, and taking in account that these pollutants may additively contribute to endocrine disruption, namely on fish, it was concluded that at least this particularly area of the Mondego estuary deserves continuous monitoring programmes.

Spatial distribution and quantification of endocrine-disrupting chemicals in Sado River estuary, Portugal.

The important Portuguese Sado River estuary has never been investigated for the presence of potentially endocrine-disrupting chemicals (EDCs), such as natural estrogens (estradiol, estrone), pharmaceutical estrogens (17alpha-ethynylestradiol), phytoestrogens (daidzein, genistein and biochanin A), or industrial chemicals (4-octylphenol, 4-nonylphenol, and bisphenol A). Thus, the main objective of this study was to evaluate their presence at 13 sampling points distributed between both the industrial and the natural reserve areas of the estuary, zones 1 and 2, respectively. For that, water samples collected in summer and winter were processed by solid phase extraction and analyzed by high-performance liquid chromatography with photodiode array detection and gas chromatography-mass spectroscopy. Results showed that estrone, ethynylestradiol, all the aforementioned phytoestrogens as well as bisphenol A and 4-octylphenol were found in zone 1. In zone 2, neither estrogens nor 4-OP were found. However, in the same zone, daidzein (500 ng/L) and genistein (320 ng/L) attained their highest levels in summer, whereas biochanin A peaked in winter (170 ng/L). Furthermore, bisphenol A was also found in some areas of zone 2, but showed similar concentrations in both surveys (about 220 ng/L). This study demonstrated that the Sado River estuary had low EDCs levels, suggesting that the Sado's high hydrodynamic activity may be involved in the dilution of local pollution. It was suggested that at the current levels of concentrations, all assayed EDCs are unlikely to individually cause endocrine disruption in local animals. However, under a continuous exposure scenario, an additive and/or synergistic action of the estrogenic chemicals load can not be excluded, and so, continuous monitoring is advisable.

Prosthetic transfer impression accuracy evaluation for osseointegrated implants.

PURPOSE: : The objective of this study was to evaluate and compare 3 impression techniques for osseointegrated implant transfer procedures. MATERIALS AND METHODS: : (1) Group Splinted with Acrylic Resin (SAR), impression with square copings splinted with prefabricated autopolymerizing acrylic resin bar; (2) Group Splinted with Light-Curing Resin (SLR), impression with square copings splinted with prefabricated light-curing composite resin bar; (3). Group Independent Air-abraded (IAA), impression with independent square coping aluminum oxide air-abraded. Impression procedures were performed with polyether material, and the data obtained was compared with a control group. These were characterized by metal matrix (MM) measurement values of the implants inclination positions at 90 and 65 degrees in relation to the matrix surface. Readings of analogs and implant inclinations were assessed randomly through graphic computation AutoCAD software. Experimental groups angular deviation with MM were submitted to analysis of variance and means were compared through Tukey's test (P < 0.05). RESULTS: : There was no statistical significant difference between SAR and SLR experimental groups and MM for vertical and angulated implants. Group IAA presented a statistically significant difference for angulated implants. CONCLUSION: : It was concluded within the limitations of this study, that SAR and SLR produced more accurate casts than IAA technique, which presented inferior results.

Endarterectomia carotídea sob bloqueio loco-regional / Carotid endarterectomy under locoregional anesthesia

OBJETIVO: Os autores objetivam descrever os resultados nas cirurgias de endarterectomia carotídea, utilizando-se anestesia loco-regional, emprego seletivo de shunt e proteção farmacológica intra-operatória. MÉTODO: Foram estudados doentes submetidos à endarterectomia carotídea sob bloqueio loco-regional, no Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), no período de março de 1996 a maio de 2004. Este estudo é composto de 119 endarterectomias (108 doentes), sendo 69 doentes (63,8 por cento) do sexo masculino e 39 (36,2 por cento) do sexo feminino. A idade média foi de 63 anos, variando entre 43 e 83 anos. A indicação da operação foi estenose sintomática em 60 doentes (55,5 por cento) e assintomática em 48 (44,5 por cento). Foi realizada avaliação, por imagem, pelo eco-Doppler colorido e arteriografia. RESULTADOS: Foram excluídos do trabalho cinco doentes nos quais foi necessária a conversão para a anestesia geral por intolerância à colocação do clampe carotídeo. Dos 103 doentes submetidos a 114 endarterectomias, utilizamos um shunt em quatro cirurgias (3,5 por cento), em função da intolerância do paciente à colocação do clampe carotídeo durante o ato cirúrgico. Utilizou-se remendo em 19 (16,6 por cento) cirurgias. A mortalidade no período pós-operatório imediato ocorreu em três doentes (2,6 por cento), todos em decorrência de acidente vascular cerebral. Um doente (0,87 por cento) apresentou acidente vascular isquêmico menor, e um (0,87 por cento) doente apresentou síndrome de hiperperfusão, que evoluiu com acidente vascular cerebral hemorrágico. Esse doente foi submetido à drenagem do hematoma cerebral, com recuperação total do déficit neurológico. No pós-operatório tardio, houve reestenose ou oclusão em quatro doentes (5,3 por cento). CONCLUSÃO: A endarterectomia carotídea pode ser realizada com segurança no doente em vigília, utilizando-se o shunt seletivamente, com a utilização de fármaco-proteção cerebral. O bom...

OBJECTIVE: The purpose of this study is to evaluate the results of carotid endarterectomy performed under locoregional anesthesia with invraoperative cerebral protection and selective shunting. METHOD: We reviewed 107 patients who underwent carotid endarterectomy under locoregional anesthesia, at Hospital das Clínicas da Universidade Estadual de Campinas (UNICAMP), between March 1996 and May 2004. This study is composed of 119 endarterectomies (108 patients), being 69 male (63.8 percent) and 39 female (36.2 percent). Mean age was 63 years, ranging from 43 to 83 years. Surgery was performed to treat symptomatic stenosis in 60 patients (55.5 percent) and asymptomatic stenosis in 48 patients (44.5 percent). All patients were assessed by color-flow duplex scanning and arteriography. RESULTS: Five patients were excluded from the study, since they required conversion to general anesthesia due to intolerance to carotid clamping. Of the 103 patients submitted to 114 endarterectomies, a shunt was inserted in four patients (3.5 percent), due to the patient's intolerance to carotid clamping during the surgery. A patch was applied in 19 patients (16.6 percent). Mortality rate in the immediate postoperative period was 2.6 percent (three patients), all due to vascular cerebral accident. One patient (0.87 percent) presented a lower ischemic cerebral vascular accident, and one patient (0.87 percent) presented hyperfusion syndrome, which progressed to a hemorrhagic cerebral vascular accident. This patient was submitted to aspiration of the cerebral hematoma, with full recovery of the neurological deficit. In the late postoperative period, there was restenosis or occlusion in four patients (5.3 percent). CONCLUSION: Carotid endarterectomy can be safely performed in the awake patient, by selective shunting and cerebral protection. Good outcome and low morbidity and mortality rate bring a differential in the treatment of the carotid disease.