Inflammatory markers in saliva for diagnosis of sepsis of hospitalizes patients.

BACKGROUND: Inflammatory/immunological serum markers are useful for the early detection of organ dysfunction, helping the diagnosis of sepsis. Although the detection of blood biomarkers is a standard practice, the use of noninvasive samples (eg saliva) would be beneficial. AIM: To investigate the saliva of hospitalized patients with and without sepsis and identify the levels of inflammatory markers such as C-reactive protein (CRP), procalcitonin (PCT), interleukin 6 (IL-6) and nitric oxide (NO). METHODS: Saliva samples were collected from 26 patients in intensive care unit with diagnosis of sepsis and from 26 without sepsis (control). The levels of CRP were determined by using latex agglutination test, whereas those of procalcitonin and IL-6 by ELISA and NO by the Griess reaction. RESULTS: Of 26 patients with sepsis, 14 were males (54%) with a mean age of 63.81 ± 3.48 years. The control group had the same distribution for gender, with mean age 65.04 ± 4.07 years. Sepsis group showed higher salivary concentrations of CRP, PCT, IL-6 and NO, with only levels of IL-6 being statistically different (P = .0001). CONCLUSIONS: Patients with sepsis had significantly higher levels of IL-6 in their saliva, suggesting that this biological sample could be useful in the diagnosis of this condition.

Impact of Oral Care and Antisepsis on the Prevalence of Ventilator-Associated Pneumonia.

PURPOSE: This study aimed to evaluate the impact of oral care and use of chlorhexidine gluconate on the prevention of ventilator-associated pneumonia (VAP) in patients admitted to an intensive care unit (ICU). MATERIALS AND METHODS: An evaluation was performed on 229 patients admitted to ICU in 2012 (before implementation of oral care protocol) and 329 in 2013 (after the protocol). Oral care was based on the removal of secretions from the oral cavity with 0.12% chlorhexidine solution for brushing and sterile gauze for cleaning before a new aspiration. The cases of VAP were evaluated by observing respiratory signs, radiological changes, and culture and laboratory results. The following data were also analysed: gender, length hospital of stay, mechanical ventilation, use of antibiotics and aetiological agent of infection. RESULTS: There was a tendency towards lower risk of development of VAP after application of oral care protocol (odds ratio = 0.64-95% CI: 0.39-1.04). There was also a reduction in the incidence of early pneumonia (up to 72 h of hospitalisation). With regard to the aetiological agent of infections, although Gram-negative bacteria predominated in the two periods studied, there was a decrease in the cases of Staphylococcus aureus infection. CONCLUSION: Oral care protocol has statistically significantly reduced the risk of developing early VAP in ICU patients, thus demonstrating the importance of multidisciplinary teamwork for hospitalised patients.

Proteínas ósseas morfogenéticas em cirurgia de levantamento do seio maxilar / Bone morphogenetic proteins on surgery of maxillary sinus lifting

Introdução: A técnica cirúrgica de levantamento do seio maxilar é indicada nos casos de reabsorção óssea do processo alveolar da maxila na região posterior, que pode inviabilizar a instalação de implantes osseointegrados. Vários materiais de enxertia óssea podem ser associados à técnica cirúrgica com resultados previsíveis e comprovação científica de longos anos. Um dos materiais, substitutos ósseos, utilizado mais recentemente associado à técnica de levantamento do seio maxilar e que vêm apresentando resultados promissores são as proteínas ósseas morfogenéticas (BMPs). As BMPs são polipeptídeos multifuncionais que atuam na cicatrização óssea e no reparo de fraturas devido às suas propriedades osteoindutivas. O uso das BMPs associado à técnica cirúrgica de levantamento do seio maxilar constitui uma nova alternativa para os indivíduos que não querem ser submetidos à cirurgia para remoção de enxerto ósseo autógeno. Objetivo: Realizar uma revisão da literatura sobre o uso das BMPs como material de enxertia associado à técnica cirúrgica de levantamento do seio maxilar. Método: Empregando-se os termos BMP AND sinus lift ; rhBMP-2 ANDsinus lift; BMP AND maxillary sinus floor augmentation; rhBMP-2 AND maxillary sinus floor augmentation como palavras chave, foram selecionados artigos na base de dados Pubmed, publicados entre os anos de 2011 e 2016 na língua inglesa. Conclusão: O uso associado das BMPs com diferentes materiais de enxertia constitui uma alternativa eficaz nos procedimentos cirúrgicos de levantamento do seio maxilar. Todavia, novos estudos clínicos, principalmente estudos prospectivos randomizados, precisam ser realizados para avaliar a eficácia das BMPs como substituto ósseo (AU)

Introduction: The surgical technique of sinus floor elevation is indicated in the presence of severe maxillary atrophy, which can interfere with implant fixation. There are many biomaterials for the use of bone graft that can be associated with good results and scientific proof, and surgical techniques withpredictable results for many years. One of the materials, bone grafts that can be associated with the sinus floor elevation and have been introduced with high levels of success is the bone morphogenetic protein (BMPs). The BMPs are functional polypeptides that are involved in the bone healingbecause of the osteoinductive property.Theuse of the BMPs with maxillary sinus floor augmentation is a new alternative for the individuals who do not want to be submit to surgery for autogenous graft. Aims: Review and discussabout the use of BMPs,as a grafting, associated with the surgical technique for maxillary sinus floor augmentation and furthermore, to know about the indications, success rate (predictability) and the limitations. Method: Using the terms BMP AND sinus lift; rhBMP-2 AND sinus lift; BMP AND maxillary sinus floor augmentation; rhBMP-2 AND maxillary sinus floor augmentation as key words, the articles were selected in the data basePubmed, and published between the years 2011 to 2016. Conclusion: The use of BMPs with differents graft materials could be a good alternativein the maxillary sinus floor augmentation. However, it would be necessary perform more randomized clinical trials, to evaluate the efficacy of BMPs like a bone substitute.(AU)