Salivary markers of oxidative stress and periodontal pathogens in patients with periodontitis from Santander, Colombia. / Marcadores salivales de estrés oxidativo y agentes patógenos periodontales en pacientes con periodontitis en Santander, Colombia

INTRODUCTION: Periodontitis affects more than 20% of the Latin American population. Oxidative markers are associated with greater progression of periodontitis; therefore, its role in pathogenesis should be studied. OBJECTIVE: To determine the prevalence of the main oral bacteria and viruses associated with periodontitis and estimate the total antioxidant capacity and lipid peroxidation in saliva from patients with periodontitis. MATERIALS AND METHODS: We conducted systemically a cross-sectional study in 101 healthy subjects, 87 of whom had been diagnosed with periodontitis (P), according to the criteria of the Centers of Disease Control and Prevention and the American Academy of Periodontology, and 14 without periodontal pockets as controls (C). In subgingival samples, major viruses and dental pathogenic bacteria were identified using PCR techniques. The levels of total antioxidant capacity and malon-di-aldehyde (MDA) were determined by spectrophotometry in samples of unstimulated saliva. RESULTS: The mean of periodontal depth pocket and clinical attachment loss in patients with periodontitis was 5.6 ± 1.7 and 6.1 ± 3.1 mm, respectively. The most prevalent microorganisms were Aggregatibacter actinomycetemcomitans (32.5%) and Porphyromonas gingivalis (18.6%). The patients from rural areas showed a higher percentage of A. actinomycetemcomitans (urban: 17.9% vs. rural: 48.9%, p=0.0018). In patients with periodontitis, the frequency of EBV, HSV1 and 2, and HCMV genes was 2.3%. Periodontitis patients had higher levels of MDA (P: 2.1 ± 1.5; C: 0.46 ± 0.3 µmol/g protein; p=0.0001) and total antioxidant capacity (P: 0.32 ± 0.2; C: 0.15 ± 0.1 mM; p< 0.0036). Oxidative markers showed no modifications due to the presence of periodontopathic bacteria. CONCLUSIONS: Aggregatibacter actinomycetemcomitans was the most prevalent bacteria; its presence did not modify the levels of oxidative markers in the saliva of patients with periodontitis.

Introducción. La periodontitis afecta a más del 20 % de la población latinoamericana. La presencia de marcadores de estrés oxidativo se asocia con una mayor progresión de periodontitis, por lo que su rol en la patogenia debe estudiarse. Objetivo. Determinar la prevalencia de las principales bacterias y virus asociados con la periodontitis y estimar la capacidad antioxidante total y la peroxidación de lípidos en la saliva de los pacientes con periodontitis. Materiales y métodos. Se hizo un estudio transversal en 87 sujetos sanos diagnosticados con periodontitis (P) según los criterios de los Centers of Disease Control and Prevention y la American Academy of Periodontology y 14 sujetos sin enfermedad periodontal como grupo control (C). En las muestras subgingivales se identificaron los principales virus y bacterias mediante técnicas de PCR. Los niveles de capacidad antioxidante total y malon-di-aldehído (MDA) se establecieron mediante espectrofotometría en muestras de saliva no estimulada. Resultados. Las medias de profundidad del sondaje y del nivel de inserción clínico periodontal en pacientes con periodontitis fueron 5,6 ± 1,7 y 6,1 ± 3,1 mm, respectivamente. Los microorganismos más prevalentes fueron Aggregatibacter actinomycetemcomitans (32,5 %) y Porphyromonas gingivalis (18,6 %). Los pacientes de áreas rurales registraron un mayor porcentaje de A. actinomycetemcomitans (urbano: 17,9 % Vs. rural: 48,9 %; p=0,0018). La frecuencia de los genes EBV, HSV1 y 2, y HCMV fue de 2,3 %. En pacientes con periodontitis se evidenciaron mayores niveles de MDA (P: 2,1 ± 1,5; C: 0,46 ± 0,3 µmol/g proteína; p=0,0001) y capacidad antioxidante total (P: 0,32 ± 0,2; C: 0,15 ± 0,1 mM; p<0,0036). La presencia de bacterias periodontales patógenas no modificó los marcadores oxidativos. Conclusiones. Aggregatibacter actinomycetemcomitans fue el agente patógeno mas prevalente. Su presencia no modificó los niveles de marcadores oxidativos en la saliva de los pacientes con periodontitis.

Potential Role of Antioxidants as Adjunctive Therapy in Chagas Disease.

Chagas disease (CD) is one of the most important neglected tropical diseases in the American continent. Host-derived nitroxidative stress in response to Trypanosoma cruzi infection can induce tissue damage contributing to the progression of Chagas disease. Antioxidant supplementation has been suggested as adjuvant therapy to current treatment. In this article, we synthesize and discuss the current evidence regarding the use of antioxidants as adjunctive compounds to fight harmful reactive oxygen species and lower the tissue oxidative damage during progression of chronic Chagas disease. Several antioxidants evaluated in recent studies have shown potential benefits for the control of oxidative stress in the host's tissues. Melatonin, resveratrol, the combination of vitamin C/vitamin E (vitC/vitE) or curcumin/benznidazole, and mitochondria-targeted antioxidants seem to be beneficial in reducing plasma and cardiac levels of lipid peroxidation products. Nevertheless, further research is needed to validate beneficial effects of antioxidant therapies in Chagas disease.

Cardiac-specific overexpression of thioredoxin 1 attenuates mitochondrial and myocardial dysfunction in septic mice.

Sepsis-induced myocardial dysfunction is associated with increased oxidative stress and mitochondrial dysfunction. Current evidence suggests a protective role of thioredoxin-1 (Trx1) in the pathogenesis of cardiovascular diseases. However, it is unknown yet a putative role of Trx1 in sepsis-induced myocardial dysfunction, in which oxidative stress is an underlying cause. Transgenic male mice with Trx1 cardiac-specific overexpression (Trx1-Tg) and its wild-type control (wt) were subjected to cecal ligation and puncture or sham surgery. After 6, 18, and 24h, cardiac contractility, antioxidant enzymes, protein oxidation, and mitochondrial function were evaluated. Trx1 overexpression improved the average life expectancy (Trx1-Tg: 36, wt: 28h; p=0.0204). Sepsis induced a decrease in left ventricular developed pressure in both groups, while the contractile reserve, estimated as the response to ß-adrenergic stimulus, was higher in Trx1-Tg in relation to wt, after 6h of the procedure. Trx1 overexpression attenuated complex I inhibition, protein carbonylation, and loss of membrane potential, and preserved Mn superoxide dismutase activity at 24h. Ultrastructural alterations in mitochondrial cristae were accompanied by reduced optic atrophy 1 (OPA1) fusion protein, and activation of dynamin-related protein 1 (Drp1) (fission protein) in wt mice at 24h, suggesting mitochondrial fusion/fission imbalance. PGC-1α gene expression showed a 2.5-fold increase in Trx1-Tg at 24h, suggesting mitochondrial biogenesis induction. Autophagy, demonstrated by electron microscopy and increased LC3-II/LC3-I ratio, was observed earlier in Trx1-Tg. In conclusion, Trx1 overexpression extends antioxidant protection, attenuates mitochondrial damage, and activates mitochondrial turnover (mitophagy and biogenesis), preserves contractile reserve and prolongs survival during sepsis.

Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad / Drug prescription patterns in patients attended at a middle- and high-complexity level institution

Objetivo Determinar los patrones de prescripción de medicamentos ambulatorios autorizados en pacientes afiliados a una EPS y atendidos por IPS de mediano y alto nivel de complejidad. Métodos Se realizo un estudio analítico transversal donde se evaluaron las prescripciones de medicamentos en 331 IPS de segundo y tercer nivel de complejidad en 27 departamentos durante el 2006. Resultados Se analizaron 38 863 prescripciones de medicamentos de 3 663 pacientes. El 61,4 por ciento de estas provienen de IPS de tercer nivel de complejidad y principalmente de pacientes afiliados al régimen contributivo. El promedio de medicamentos por formula medica fue de 2,2 (IC 95 por ciento: 2,1 a 2,2 por ciento), la proporción de antibióticos por fórmula médica del 29,2 por ciento (IC 95 por ciento: 28,7-29,6), de medicamentos POS del 64,2 por ciento (IC 95 por ciento 63,7-64,6 por ciento) y de inyectables del 22,1 por ciento (IC 95 por ciento 21,7-25,5 por ciento). Más de la mitad de los medicamentos, 62,1 por ciento (IC 95 por ciento 61,5-62,7 por ciento), corresponden a agentes anti-infecciosos, antineoplasicos y del tracto alimentario .El consumo de medicamentos fue de 8,39 Dosis Diarias Definidas (DDD) /1 000 usuarios/día y el costo por DDD fue de $ 5 216 Conclusión Este análisis permitió identificar medicamentos cuya frecuencia de formulación no se correlaciono con el perfil epidemiológico como agentes inmunomoduladores y hormona de crecimiento. Existen diferencias en la frecuencia y cantidad de DDD de medicamentos autorizados por régimen de afiliación lo cual pude ser evidencia de barreras de acceso a los medicamentos en la población.

Objective Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. Methods This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. Results 38 863 prescriptions for 3 663 patients’ medication were analysed. 61,4 percent came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 percent CI), the percentage of antibiotics formulated by prescription was 29,2 percent (28,7-29,6 95 percent CI), essential prescribed medicines accounted for 64,2 percent (63,7-64,6 95 percent CI) and injectable medicines was 22,1 percent (21,7-25,5 percent). More than half the medications (62,1 percent; 61,5-62,7 95 percent CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90 percent consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. Conclusions This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

[Drug prescription patterns in patients attended at a middle- and high-complexity level institution]. / Prescripción de medicamentos en pacientes atendidos en instituciones de mediano y alto nivel de complejidad.

OBJECTIVE: Determining prescription patterns for outpatient medication authorised for patients affiliated to an EPS and assisted by medium- and high-level complexity IPS. METHODS: This was a cross-sectional study where medication prescription was evaluated in 331 second- and third-level complexity hospitals from 27 Colombian departments during 2006. RESULTS: 38 863 prescriptions for 3 663 patients' medication were analysed. 61,4 % came from third-level complexity hospitals, mainly for patients affiliated to contribution-based regimes. Average prescribed medication per person was 2,2 (2,1-2,2 95 % CI), the percentage of antibiotics formulated by prescription was 29,2 % (28,7-29,6 95 % CI), essential prescribed medicines accounted for 64,2 % (63,7-64,6 95 % CI) and injectable medicines was 22,1 % (21,7-25,5 %). More than half the medications (62,1 %; 61,5-62,7 95 % CI) were in ATC groups such as anti-infectious agents, immunomodulating agents and medications for the alimentary and metabolic tract. DU90% consisted of 64 medications, medication consumption being 8,39 daily de-fined doses (DDD)/1 000 patients, costing 5 216 Colombian pesos per DDD. CONCLUSIONS: This analysis led to identifying medications whose formulation frequency did not correlate with an epidemiologic profile as immunomudulator and growth-hormone (somatotropin) agents. There were differences in the frequency and quantity of DDD medications authorised by type of affiliation which could thus be providing evidence of obstacles to the population having access to drugs/medicaments.

Using systematic reviews for evidence-based health promotion: basic methodology issues

Systematic reviews and evidence-based recommendations are becoming increasingly important for decision-making in health and medicine. Systematic reviews of population-health interventions are challenging and methods will continue evolving. This paper provides an overview of how evidence-based approaches in public health and health promotion are being reviewed to provide a basis for Colombian Guide to Health Promotion, analysing limitations and recommendations for future reviews.

La importancia de las revisiones sistemáticas y de las recomendaciones basadas en la evidencia está aumentando cada vez más, para la toma de decisiones en salud y medicina. Las revisiones sistemáticas de intervenciones poblacionales están aun en crecimiento y sus métodos en continuo desarrollo. Este artículo provee una mirada de cómo una aproximación de salud publica y promoción de la salud basada en la evidencia es útil para la formulación de guías nacionales en promoción de la salud; analizando sus limitaciones y recomendaciones para futuras revisiones.

Using systematic reviews for evidence-based health promotion: basic methodology issues.

Systematic reviews and evidence-based recommendations are becoming increasingly important for decision-making in health and medicine. Systematic reviews of population-health interventions are challenging and methods will continue evolving. This paper provides an overview of how evidence-based approaches in public health and health promotion are being reviewed to provide a basis for Colombian Guide to Health Promotion, analysing limitations and recommendations for future reviews.