Cell-Based Regenerative Endodontics for Treatment of Periapical Lesions: A Randomized, Controlled Phase I/II Clinical Trial.

A randomized controlled phase I/II clinical trial was designed to evaluate the safety and efficacy of encapsulated human umbilical cord mesenchymal stem cells in a plasma-derived biomaterial for regenerative endodontic procedures (REPs) in mature permanent teeth with apical lesions. The trial included 36 patients with mature incisors, canines, or mandibular premolars showing pulp necrosis and apical periodontitis. Patients were randomly and equally allocated between experimental (REP) or conventional root canal treatment (ENDO) groups. On the first visit, cavity access and mechanical preparation of the root canal were performed. Calcium hydroxide medication was used, and the cavity was sealed. Three weeks later, patients were treated following their assigned protocol of ENDO or REP. Clinical follow-up examinations were performed at 6 and 12 mo. Categorical variables were evaluated by Fisher's exact test. Quantitative variables were compared using the Mann-Whitney test. The evolution over time of the percentage of perfusion units and the dimensions of lesion and cortical compromise were explored. After the 12-mo follow-up, no adverse events were reported, and the patients showed 100% clinical efficacy in both groups. Interestingly, in the REP group, the perfusion unit percentage measured by laser Doppler flowmetry revealed an increase from 60.6% to 78.1% between baseline and 12-mo follow-up. Sensitivity tests revealed an increase of the positive pulp response in the REP group at 12-mo follow-up (from 6% to 56% on the cold test, from 0% to 28% on the hot test, and from 17% to 50% on the electrical test). We present the first clinical safety and efficacy evidence of the endodontic use of allogenic umbilical cord mesenchymal stem cells encapsulated in a plasma-derived biomaterial. The innovative approach, based on biological principles that promote dentin-pulp regeneration, presents a promising alternative for the treatment of periapical pathology (ClinicalTrials.gov NCT03102879).

Deficiencia de anticuerpos específicos en pacientes pediátricos con infecciones respiratorias recurrentes / Specific antibody deficiency in pediatric patients with recurrent respiratory infections

One of the most frequent consultations in pediatric immunology corresponds to patients with recurrent respiratory infections. The most frequent clinical conditions for what they consult are recurrent viral infections, recurrent acute otitis media, recurrent sinusitis and recurrent pneumonia. Approximately 10% of patients who consult for these conditions may have a specific antibody deficiency. Specific antibody deficiency is a type of primary immunodeficiency, which is classified within the humoral deficit group, where there is a failure in the immune response for polysaccharide antigens with normal immunoglobulin levels. The diagnosis must be made since 2 years old, when the immune system acquires the ability to present a humoral response to polysaccharide antigens. In an undetermined percentage of patients, the specific antibody deficit can be resolved with the maturity of the immune system and there are patients who require prolonged treatment with antibiotic prophylaxis and gamma globulin.

Una de las consultas más frecuentes en inmunología pediátrica corresponde a pacientes con infecciones respiratorias recurrentes. Los cuadros clínicos más frecuentes por lo que consultan son infecciones virales recurrentes, otitis media aguda recurrente, sinusitis recurrente y neumonía recurrente. Aproximadamente el 10% de los pacientes que consultan por estos cuadros puede presentar una deficiencia de anticuerpos específica. La deficiencia anticuerpo específica es un tipo de inmunodeficiencia primaria, que se clasifica dentro del grupo de déficit humorales, en donde existe una falla en la respuesta inmune para antígenos polisacáridos con niveles de inmunoglobulinas normales. El diagnóstico se debe realizar después de los 2 años que es cuando el sistema inmune adquiere la capacidad de presentar respuesta humoral a antígenos polisacáridos. En un porcentaje no determinado de pacientes, el déficit de anticuerpos específicos se puede resolver con la madurez del sistema inmunológico y existen pacientes que requieren tratamiento prolongado con profilaxis antibiótica y gamaglobulina.

Inorganic arsenic in food products on the Swedish market and a risk-based intake assessment.

Inorganic arsenic (iAs) and total arsenic (tAs) were determined in common food from the Swedish market. Special focus was on rice, fish and shellfish products. For the speciation of iAs the European standard EN:16802 based on anion exchange chromatography coupled to ICP-MS was used. The two market basket food groups cereals (including rice), and sweets and condiments (a mixed group of sugar, sweets, tomato ketchup and dressings), contained the highest iAs levels (means 9 and 7 µg iAs/kg), whereas other food groups, including fish, did not exceed 2 µg iAs/kg. Varying levels of iAs were found in separate samples of tomato ketchup, 2.4-26 µg/kg, and is suggested to be one reason of the rather high average level of iAs in the food group sweets and condiments. Some specific food products revealed iAs levels much higher, i.e. rice crackers 152 and Norway lobster 89 µg iAs/kg. The intake of iAs via food was estimated by data from two national consumption surveys, performed in 2010-11 (1797 adults) and 2003 (2259 children). The estimated median iAs intakes in adults and children were 0.047 and 0.095 µg/kg body weight and day, respectively. The iAs intake for rice eaters was about 1.4 times higher than for non-rice eaters. Validation of the consumption survey-based iAs intake, using food purchase and market basket data mainly from 2015, resulted in a per capita intake of a similar magnitude, i.e. 0.056 µg/kg body weight and day. The estimated cancer risk for adults using low-dose linear extrapolation is <1 per 100,000 per year.

Reproductive biology of Aechmea bracteata (Sw.) Griseb. (Bromelioideae: Bromeliaceae).

Individuals of Aechmea bracteata show inflorescences with red scape bracts and odourless, yellow, tubular diurnal flowers, with closely arranged sexual organs, producing a large amount of fruits. In order to investigate the reproductive system of this species, a suite of characters was assessed: phenology, floral morphology and biology, nectar production dynamics, and fruit and seed production and germination, as a result of controlled pollination crosses. The study was conducted during two flowering seasons in wild populations in Yucatán, Mexico. Results suggest an annual flowering pattern with one flowering peak; flowers were diurnal, showing partial dichogamy (protandry)-herkogamy, anthers and stigma become mature before floral aperture, which could lead to self-pollination, nectar is produced during anthesis, varying in volume and total sugar concentration during the day; fruits and seeds were produced in all experimental crosses (cross-pollination, obligated cross-pollination, assisted and unassisted selfing, geitonogamy and apomixis), as well as high percentage seed germination. Several species of Aechmea are reportedly self-compatible and autogamous, as suggested by results of selfing and non-assisted selfing crosses, but these results are negated by the presence of apomixis, indicating that the species is apomictic. This is the first report of this breeding system for subgenus Aechmea and the sixth for Bromeliaceae. Polyembryony is here suggested for the first time in this genus and family based on the fact that more seeds were recorded that expected based on ovule numbers. Finally, when performing experimental crosses, estimating reproductive success based on number of seeds is a better approach than number of fruits, due to the effect of pseudogamy.

[Moyamoya disease in a girl with Down syndrome. Report of one case]. / Síndrome moyamoya en paciente con síndrome de Down y déficit de antitrombina III.

Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. It can be primary or secondary to genetic syndromes such as Down syndrome. We report a seven year-old girl with a Down syndrome that presented with a disturbance of consciousness, seizures and a right hemiparesia at the age of five. Magnetic resonance imaging showed old cortical ischemic lesions in both cerebral hemispheres and a recent infarction in the territory of the left middle cerebral artery. Brain angiography showed a proximal stenosis of both medial cerebral arteries and a net of collateral vessels, consistent with the diagnosis of moyamoya syndrome. The patient had also an antithrombin III deficiency. Aspirin was indicated and a surgical correction was recommended. However, prior to the procedure, the patient had a new infarction in the territory of the right middle cerebral artery, which caused a severe disability.

Síndrome moyamoya en paciente con síndrome de Down y déficit de antitrombina III / Moyamoya disease in a girl with Down syndrome. Report of one case

Moyamoya disease is a unique chronic progressive cerebrovascular disease characterized by bilateral stenosis or occlusion of the arteries around the circle of Willis with prominent arterial collateral circulation. It can be primary or secondary to genetic syndromes such as Down syndrome. We report a seven year-old girl with a Down syndrome that presented with a disturbance of consciousness, seizures and a right hemiparesia at the age of five. Magnetic resonance imaging showed old cortical ischemic lesions in both cerebral hemispheres and a recent infarction in the territory of the ¡eft middle cerebral artery. Brain angiography showed a proximal stenosis of both medial cerebral arteries and a net of collateral vessels, consistent with the diagnosis of moyamoya syndrome. The patient had also an antithrombin III deficiency. Aspirin was indicated and a surgical correction was recommended. However, prior to the procedure, the patient had a new infarction in the territory of the right middle cerebral artery, which caused a severe disability.

[Mucolipidoses type IV in a patient with mapuche ancestry]. / Mucolipidosis tipo IV en una paciente con ancestros mapuches. Caso clínico.

We report a 7 year-old girl with mapuche ancestors, diagnosed as a cerebral palsy since infancy and on active rehabilitation. She acquired motor and cognitive skills at 3 years of age. At 5 years of age, a slow neurological deterioration started, associated to visual impairment. Optic atrophy was added to the typical neurological exam of ataxic cerebral palsy and the diagnosis was re-considered. Neuroimaging showed a slow and progressive atrophy of intracerebral structures and ultramicroscopy revealed intracytoplasmatic inclusions in conjunctiva and skin, compatible with mucolipidoses type IV (ML-IV). ML-IV must be included in the differential diagnosis of cerebral palsy associated with loss of acquired skills and progressive visual impairment. Electron microscopy of skin or conjunctiva is a useful diagnostic test. Suspicion of ML-IV must not be restricted to Ashkenazi Jewish population.

Mucolipidosis tipo IV en una paciente con ancestros mapuches: caso clínico / Mucolipidoses type IV in a patient with Mapuche ancestry

We report a 7 year-old girl with mapuche ancestors, diagnosed as a cerebral palsy since infancy and on active rehabilitation. She acquired motor and cognitive skills at 3 years of age. At 5 years of age, a slow neurological deterioration started, associated to visual impairment. Optic atrophy was added to the typical neurological exam ofataxic cerebral palsy and the diagnosis was re-considered. Neuroimaging showed a slow and progressive atrophy of intracerebral structures and ultramicroscopy revealed intracytoplasmatic inclusions in conjunctiva and skin, compatible with mucolipidoses type IV (ML-IV). ML-IV must be included in the differencial diagnosis of cerebral palsy associated with loss of acquired skills and progressive visual impairment. Electrón microscopy of skin or conjunctiva is a useful diagnostic test. Suspicion of ML-IV must not be restricted to Ashkenazi Jewish population.

Discopatías lumbares: patología, diagnósticos y tratamiento quirúrgico / Lumbar disc: pathology, diagnostic and surgical treatment

La patología raquídea lumbar degenerativa de la que es una parte la Hernia Discal, es una causa más frecuente de Síndrome Lumbociático. De los pacientes con esta entidad clínica alrededor del 90 por ciento mejora con tratamiento médico consistente en reposo, analgésico antiinflamatorios, fisioterapias, etc, indicado por diferentes especialistas. Sólo alrededor de un 10 por ciento de los pacientes tiene indicación quirúrgica, decisión que debe ser la resultante de una correcta evaluación clínica y de una adecuada correlación clínico radiológica. Por tratarse de una patología frecuente especialmente en nuestra época de gran experiencia física de tipo laboral y deportiva, con mayor incidencia en edades productivas de los pacientes, con un costo social alto y necesidad de una reincorporación precoz a sus actividades, es importante definir el rol del tratamiento quirúrgico, la oportunidad de su indicación, la técnica adecuada, su costo y resultados.

The Disc Hernia witch forms part of the Lumbar Spinal Degenerative Disease is the most frequent cause of the Lumbociatic Syndrome. Ninety percent of the patients with this syndrome get better with medical treatment consisting of rest, analgesics, anti inflammatory drugs, Physiotherapy , Kinesiotherapy, etc, indicated by different specialists. Only around 10 percent of the patients require surgery, decision that should be the result of a correct clinical evaluation and an adequate clinical radiological correlation. As it is a frequent syndrome specially in these days of great physical demand in work and sports, with a high rate of incidence in the productive age of the patients, a high social cost and the need of a pront returne to the work field, it is important to define the role of the surgical treatment, the adequate timing and technique and its cost and results.

Diagnóstico prenatal de teratoma sacrococcígeo, utilidad del ultrasonido y resonancia magnética / Sacrococcygeal teratoma prenatal diagnosis, utility of ultrasound and magnetic resonance image

El teratoma sacrococcígeo (TS) es una malformación de muy baja frecuencia y de alta letalidad. El objetivo de este trabajo es presentar un caso clínico de diagnóstico prenatal de teratoma sacrococcígeo, utilizando ultrasonido y resonancia magnética. Paciente de 21 semanas de gestación es enviada para segunda opinión a nuestro centro. Realizamos examen ultrasonográfico que reveló una lesión perineal quística predominante externa de gran tamaño, con componente presacro de menor volumen y escasos vasos sanguíneos en su pared, lo que sugiere el diagnóstico de teratoma quístico. Se realiza resonancia magnética que comprueba el diagnóstico de TS quístico predominantemente externo. El resto de la evaluación anatómica y hemodinámica fue normal. Evoluciona con aumento del tamaño de la lesión, sin complicaciones maternas o fetales. A las 38 semanas de gestación, se realiza operación cesárea que comprueba diagnóstico de TS, y a las 24 horas de vida se efectúa extirpación del tumor en su totalidad con resección del cóccix y parte del sacro, con plastía del defecto remanente. El diagnóstico prenatal de TS quístico, en nuestro caso, mediante el uso de ultrasonido y resonancia magnética permite por una parte predecir una evolución favorable durante la gestación, y por otra, posibilita el manejo multidisciplinario con interrupción programada y cirugía definitiva del TS.

Ehrlichiosis humana en Chile: evidencia serológica / Serologic evidence for human ehrlichiosis in Chile

Background: Ehrlichiosis is a non contagious infectious disease, mainly transmitted by thick bites. In 1998, this infection was detected in dogs, for the first time, in Chile. Aim: To establish if there is human exposure to Ehrlichia sp in Chile. Material and methods : Blood samples from 17 dogs with ehrlichiosis and 19 humans who had contact with them were studied to determine human exposure to Ehrlichia equi and Ehrlichia chaffeensis in Chile. Samples were analyzed by indirect inmunofluorecence and by polymerase chain reaction (PCR). Results: Six dogs had positive titers against both species of ehrlichia; 2 with titers of 1/256; 3 with titers over 1/512 to Ehrlichia equi and titers of 1/256, 1/128 and 1/64 to Ehrlichia chaffeensis respectively, and 1 with titers of 1/256 to Ehrlichia equi and titers of 1/128 to Ehrlichia chaffeensis. Two of the 19 humans, had positive titers against both antigens (1/128). PCR reactions were negative in both human and canine sera. Conclusions: These results confirm that human exposure to Ehrlichia sp. Epidemiological surveillance for human ehrlichiosis should be implemented in the country

Role of metabolism in arsenic toxicity.

In humans, as in most mammalian species, inorganic arsenic is methylated to methylarsonic acid (MMA) and dimethylarsinic acid (DMA) by alternating reduction of pentavalent arsenic to trivalent and addition of a methyl group from S-adenosylmethionine. The methylation of inorganic arsenic may be considered a detoxification mechanism, as the end metabolites, MMA and DMA, are less reactive with tissue constituents, less toxic, and more readily excreted in the urine than is inorganic arsenic, especially the trivalent form (AsIII, arsenite). The latter is highly reactive with tissue components, due to its strong affinity for sulfhydryl groups. Thus, following exposure to AsV the first step in the biotransformation, i.e. the reduction to AsIII, may be considered a bioactivation. Also, reactive intermediate metabolites of high toxicity, mainly MMAIII, may be formed and distributed to tissues. Low levels of MMAIII and DMAIII have been detected in urine of individuals chronically exposed to inorganic arsenic via drinking water. However, the contribution of MMAIIIand DMAIII to the toxicity observed after intake of inorganic arsenic by humans remains to be elucidated. The major route of excretion of arsenic is via the kidneys. Evaluation of the methylation of arsenic is mainly based on the relative amounts of the different metabolites in urine. On average human urine contains 10-30% inorganic arsenic, 10-20% MMA and 60-80% DMA.

Exposure to inorganic arsenic metabolites during early human development.

Because of the lack of data on the exposure to and toxic effects of inorganic arsenic during early human development, the transfer of arsenic to the fetus and suckling infant was studied in a native Andean population, living in the village San Antonio de los Cobres in the North west of Argentina, where the drinking water contains about 200 micrograms/liter. The concentration of arsenic in cord blood (median, 9 micrograms/liter) was almost as high as in maternal blood (median, 11 micrograms/liter), and there was a significant correlation between the two. Thus, at least in late gestation, arsenic is easily transferred to the fetus. The median concentration of arsenic in the placenta was 34 micrograms/kg, compared with 7 micrograms/kg previously reported for nonexposed women. Interestingly, essentially all arsenic in the blood plasma of both the newborns and their mothers was in the form of dimethylarsinic acid (DMA), the end product of inorganic arsenic metabolism. Similarly, about 90% of the arsenic in the urine of both the newborns and mothers in late gestation was present as DMA, compared with about 70% in nonpregnant women (p < 0.001). This may indicate that methylation of arsenic is increased during pregnancy and that DMA is the major form of arsenic transferred to the fetus. The increased methylation in late gestation was associated with lower arsenic concentrations in blood and higher concentrations in urine, compared with a few months postpartum. The arsenic concentrations in the urine of the infants decreased from about 80 micrograms/liter during the first 2 days of life to less than 30 micrograms/liter at 4.4 months (p = 0.025). This could be explained by the low concentrations of arsenic in the breast milk, about 3 micrograms/kg.

Metabolism of inorganic arsenic in children with chronic high arsenic exposure in northern Argentina.

This study concerns the metabolism of inorganic arsenic (As) in children in three villages in northern Argentina: San Antonio de los Cobres and Taco Pozo, each with about 200 microg As/l in the drinking water, and Rosario de Lerma, with 0.65 microg As/l. Findings show that the concentrations of As in the blood and urine of the children in the two As-rich villages were on average 9 and 380 microg/l, respectively, the highest ever recorded for children. The concentrations were about 10 and 30 times higher for blood and urine, respectively, than in Rosario de Lerma. Total As in urine was only slightly higher than the sum of metabolites of inorganic As (U-Asmet), i.e., inorganic As, methylarsonic acid (MMA), and dimethylarsinic acid (DMA); this shows that inorganic As was the main form of As ingested. In contrast to previous studies on urinary metabolites of inorganic As in various population groups, the children and women in the present study excreted very little MMA. Thus, there seems to be a polymorphism for the enzymes (methyltransferases) involved in the methylation of As. Interestingly, the children had a significantly higher percentage of inorganic As in urine than the women, about 50% versus 32%. Also, the percentage of inorganic As in the children is considerably higher than in previous studies on children (about 13% in the two studies available) and adults (about 15-25%) in other population groups. This may indicate that children are more sensitive to As-induced toxicity than adults, as the methylated metabolites bind less to tissue constituents than inorganic As. In the children, the percentage inorganic arsenic in urine decreased, and the percentage of DMA increased with increasing U-Asmet, indicating an induction of As methylation with increasing exposure.

Low-level arsenic excretion in breast milk of native Andean women exposed to high levels of arsenic in the drinking water.

OBJECTIVE: To investigate the excretion of arsenic in breast milk of lactating native Andean women living in a village in northwestern Argentina with high concentrations of arsenic in the drinking water (about 200 micrograms/l) and to assess the exposure of children to arsenic during the very first period of life. METHODS: The study included ten lactating women and two nursing babies. Hydride-generation atomic absorption spectrometry (HG-AAS) was used to determine the concentration of arsenic in samples of human milk, drinking water, blood, and urine. RESULTS: The concentrations of arsenic detected in maternal blood (total arsenic) and urine (metabolites of inorganic arsenic) were high, averaging 10 and 320 micrograms/l, respectively. In subjects without known exposure to arsenic the average concentrations found in blood and urine are 1-2 and about 10 micrograms/l, respectively. The metabolites of inorganic arsenic constituted more than 80% of the total arsenic in the urine, which shows that inorganic arsenic was the main form of arsenic ingested. The average concentration of arsenic detected in human milk was 2.3 micrograms/kg fresh weight (range 0.83-7.6 micrograms/kg). Although data on background levels of arsenic in human breast milk are scarce, the present concentrations seem to be slightly elevated. However, considering the high levels of arsenic exposure in the mothers, the total arsenic concentrations measured in human milk were low. In concordance with the low concentrations of arsenic found in the milk, the concentrations of arsenic metabolites measured in the urine of two of the nursing babies were low: 17 and 47 micrograms/l, respectively. CONCLUSIONS: The low concentrations of arsenic detected in the breast milk and urine of the two nursing babies in relation to the high level of maternal exposure to arsenic indicate that inorganic arsenic is not excreted in breast milk to any significant extent. This is a very important reason for long breast-feeding periods.

Osteogénesis imperfecta: diagnóstico prenatal / Osteogenesis imperfecta: prenatal diagnosis

Se presenta un caso clínico de osteogénesis imperfecta diagnosticado ecográficamente a las 35 semanas de gestación. Los elementos básicos del diagnóstico fueron la deformación y acortamiento del fémur, signos de fracturas costales y menor densidad ósea. Se interrumpe embarazo a las 38 semanas con operación cesárea, corroborándose el diagnóstico prenatal con estudios radiológicos postnatales

Consumo de alcohol en embarazadas bajo control: consultorios de Pirque y San Ramón / Alcohol consumption in over control pregnant women: Pirque and San Ramón primary attention center

El alcohol ingerido durante el embarazo actúa como teratógeno, según su cantidad provoca diversas malformaciones y alteraciones neurológicas en los hijos. Con la finalidad de investigar la cuantía del consumo de bedidas alcohólicas durante el primer control de embarazo en los Consultorios de Pirque y San Ramón se ideó aplicar una encuesta sobre consumo de alimentos mezclados con bebidas alcohólicas, lo que frecuentemente se da como recomendación en el embarazo. Se observó en San Ramón que el 63 por ciento de las embarazadas recibió esta recomendación y 19 por ciento consumió alcohol durante el embarazo, en Pirque 18 por ciento y 2,2 por ciento respectivamente. También en San Ramón la correlación entre ingestión previa y durante el embarazo es estadísticamente significativa, con r= 3,08 y p< 10-6, semejante a la correlación con la recomendación y con la pareja bebedora. Es urgente educar recoemndando la abstinencia de alcohol durante la gestación porque no existe dosis mínima establecida libre de daño fetal. El alcohol es una droga, no es alimento

A unique metabolism of inorganic arsenic in native Andean women.

The metabolism of inorganic arsenic (As) in native women in four Andean villages in north-western Argentina with elevated levels of As in the drinking water (2.5, 14, 31, and 200 micrograms/1, respectively) has been investigated. Collected foods contained 9-427 micrograms As/kg wet weight, with the highest concentrations in soup. Total As concentrations in blood were markedly elevated (median 7.6 micrograms/1) only in the village with the highest concentration in the drinking water. Group median concentrations of metabolites of inorganic As (inorganic As, methylarsonic acid (MMA) and dimethylarsinic acid (DMA)) in the urine varied between 14 and 256 micrograms/1. Urinary concentrations of total As were only slightly higher (18-258 micrograms/1), indicating that inorganic As was the main form of As ingested. In contrast to all other populations studied so far, arsenic was excreted in the urine mainly as inorganic As and DMA. There was very little MMA in the urine (overall median 2.2%, range 0.0-11%), which should be compared to 10-20% of the urinary arsenic in all other populations studied. This may indicate the existence of genetic polymorphism in the control of the methyltransferase activity involved in the methylation of As. Furthermore, the percentage of DMA in the urine was significantly higher in the village with 200 micrograms As/1 in the water, indicating an induction of the formation of DMA. Such an effect has not been observed in other studies on human subjects with elevated exposure to arsenic.