Terapia descompresiva en el manejo no quirúrgico de lesiones perirradiculares de gran tamaño / Decompressive therapy in the non-surgical management of large periradicular lesions

Introducción: La periodontitis apical asintomática es de los diagnósticos endodónticos más comunes que se presentan en la población mundial. Consiste en la afectación del tejido periapical como resultado de la activación de mecanismos de inflamación, los que incluyen lisis y reabsorción de tejidos de soporte como cemento, ligamento y hueso alveolar. El signo patognomónico de la periodontitis apical es la presencia de radiolucidez periapical, resultado de la destrucción de los tejidos periapicales. Su principal tratamiento abarca el manejo endodóntico convencional cuyo objetivo es la eliminación de los irritantes locales dentro del conducto radicular. Sin embargo, cuando se desarrollan lesiones de gran tamaño es necesario complementar con terapias que aceleren la reparación, una de ellas la descompresión, la cual a partir de la reducción de la presión intralesión e intraósea con lo que favorece la formación de tejido fibroso, conectivo y óseo. Objetivo: Describir la técnica de descompresión intraconducto en el manejo de lesiones periapicales de gran tamaño. Presentación del caso: Paciente de 33 años de edad, con diagnóstico de periodontitis apical asintomática y evaluación tomográfica de lesión periapical de gran tamaño (67,5 UH) manejado con terapia endodóntica convencional y descomprensión intraconducto como terapia coadyuvante. Posterior a la restauración se realizaron controles clínicos y radiográficos. A los 24 meses se evidenció reparación de los tejidos involucrados con restauración del espacio del ligamento periodontal. Conclusiones: En este caso, la terapia descomprensiva fue una alternativa en el manejo de una lesión periapical de gran tamaño, que permitió regular la presión intraósea y facilitar la regeneración del tejido óseo, evitando la intervención quirúrgica siendo así más confortante para el paciente(AU)

Introduction: Asymptomatic apical periodontitis is one of the most common endodontic disorders diagnosed in the world population. It consists in damage to the periapical tissue due to activation of inflammation mechanisms, including lysis and resorption of support tissues like cementum, ligament and alveolar bone. The pathognomonic sign of apical periodontitis is the presence of periapical radiolucency due to the destruction of periapical tissue. Its main treatment includes conventional endodontic management aimed at removing local irritants from the root canal. However, when large lesions develop, it is necessary to complement the conventional treatment with therapies speeding up the repair process, such as decompression, which reduces intralesion and intraosseous pressure, fostering the formation of fibrous, connective and bone tissue. Objective: Describe the use of intracanal decompression technique in the management of large periapical lesions. Case presentation: A case is presented of a 33-year-old patient diagnosed with asymptomatic apical periodontitis and a tomographic evaluation of a large periapical lesion (67.5 UH) treated with conventional endodontic therapy and intracanal decompression as adjuvant therapy. Restoration was followed by clinical and radiographic controls. At 24 months it was observed that the tissues involved had been repaired and the periodontal ligament space restored. Conclusions: The use of decompressive therapy as an alternative in the management of a large periapical lesion, made it possible to regulate intraosseous pressure and facilitate bone tissue regeneration, relieving the patient from the discomforts of a surgical intervention(AU)

Effects of estrogen/medrogestone therapy on the apoprotein B-containing lipoproteins in postmenopausal women with type 2 diabetes mellitus under satisfactory and non-satisfactory glycemic control.

BACKGROUND: Information is lacking on the effects of hormone replacement therapy in women with diabetes, especially during moderate chronic hyperglycemia. OBJECTIVES: To study the effects of HRT on the lipid profile and the low density lipoprotein subclass distribution in women with type 2 diabetes under satisfactory and non-satisfactory glycemic control. METHODS: Fifty-four postmenopausal women after a 6 week run-in diet were randomized to receive either placebo (HbA1c < 8%, n = 13; HbA1c > 8%, n = 17) or HRT (HbA1c < 8%, n = 11; HbA1c > 8%, n = 13) for 12 weeks. HRT consisted of cyclical conjugated estrogens 0.625 mg/day plus medrogestone 5 mg/day. At the beginning and at the end of each treatment period the LDL subclass distribution was estimated by density gradient ultracentrifugation. RESULTS: At the baseline and during the study, the HbA1c level was significantly higher in hyperglycemic patients than in the near-normoglycemic controls (baseline 10.2 +/- 2.9 vs. 6.5 +/- 0.7%, P < 0.01). They showed a trend for higher total and LDL cholesterol, triglycerides and lower high density lipoprotein-cholesterol compared to near-normoglycemic controls, as well as significantly higher triglyceride concentrations in very low density lipoprotein, intermediate density lipoprotein and LDL-1 particles and cholesterol content in LDL-1 and -2 particles. HRT decreased LDL-cholesterol in both groups. In the normoglycemic patients a small increase in HbA1c was observed (6.5 +/- 0.7 vs. 7.4 +/- 1%, P = 0.04). In all cases, HRT did not modify the proportion of LDL represented by denser LDLs. CONCLUSIONS: HRT did not modify the LDL subclass distribution, even in the presence of moderate chronic hyperglycemia in women with type 2 diabetes.

Efficacy and safety of atorvastatin in hyperlipidemic, type 2 diabetic patients. A 34-week, multicenter, open-label study.

Hyperlipidemia is common in type 2 diabetic patients and is an independent risk factor for cardiovascular disease. The aim of this trial was to evaluate the efficacy and safety of once-daily atorvastatin 10-80 mg for the treatment of hyperlipidemia in type 2 diabetics with plasma low-density lipoprotein cholesterol (LDL-C) levels exceeding 3.4 mmol/l (130 mg/dl). One hundred and two patients met the study criteria and received 10 mg/day atorvastatin. Patients who reached the target LDL-C level of

Diabetes knowledge and its determinants in a Mexican population.

PURPOSE: The purpose of this study was to measure the level of diabetes knowledge in a representative group of Mexican individuals with diabetes and to identify the factors that influence it. METHODS: A validated questionnaire was administered to 570 outpatients; 11.2% had Type 1 diabetes, 36.4% had Type 2 diabetes treated with insulin, and 52.2% had Type 2 diabetes treated with oral agents. Samples for HbA1c determination also were obtained. RESULTS: The percentage of correct answers in each section of the questionnaire was low. Type 1 patients had the highest scores, followed by the insulin-treated Type 2 patients; those with chronic complications also had high scores. Educational background, attendance at diabetes courses, age, and HbA1c concentration were the main predictors of knowledge. Attendance at courses was influenced by the severity of the disease. CONCLUSIONS: The amount of patient knowledge about diabetes-related issues was low in this representative Mexican population. The educational efforts were focused on those with the worst metabolic control and/or with diabetes complications.

The apolipoprotein E4 allele is not associated with an abnormal lipid profile in a Native American population following its traditional lifestyle.

The apolipoprotein E4 allele is associated in industrialized countries with an elevated LDL cholesterol concentration and an increased cardiovascular risk. Our purpose in this study was to assess the influence of the genetic variation at the APOE gene locus on the lipid profile of a Native American rural population. We examined plasma lipid levels and the common apo E alleles in 142 healthy randomly selected adults living in their native communities in western Mexico. Their age was 38+/-17 years and the BMI 25.7+/-4.5 kg/m2. Plasma cholesterol, triglycerides, LDL C and HDL C were 165+/-29.6, 126+/-83, 98+/-26 and 42+/-12.7 mg/dl respectively. Ninety-one per cent of the subjects had Lp(a) concentrations below 20 mg/dl and 30% had levels lower than 2 mg/dl. The most common APOE genotype was E3/3 (63%), followed by E3/4 (30.1%). The prevalence of the E2 allele was very low (2.3%). No difference was observed in LDL C concentrations between the E3/E3 and E3/E4 subjects; however carriers of the E2/3 genotype had lower LDL C levels. Similar results were obtained for cholesterol and apo B levels. In summary, the increased LDL C levels associated with the E4 allele in previous studies were not observed in a population with non-westernized habits. Environmental factors, such as diet and lifestyle, could outweigh the hypercholesterolemic predisposition resulting from the presence of the apo E4 allele.

Acarbose vs. bedtime NPH insulin in the treatment of secondary failures to sulphonylurea-metformin therapy in type 2 diabetes mellitus.

OBJECTIVE: To evaluate the efficacy of acarbose in the treatment of secondary failures to sulphonylurea-metformin therapy, its comparison against bedtime NPH insulin, and to measure the changes in postprandial metabolism resulting from both treatments. METHODS: One hundred type 2 diabetic patients in a secondary failure were included. The study begun with a run-in diet period of 6 weeks, in which an isocaloric diet was prescribed. Only subjects who continued hyperglycaemic were randomly assigned to placebo and acarbose (n = 17) or bedtime NPH insulin (n = 12). Acarbose (300 mg/day) or placebo were administered using a randomized, double blind, crossover design. Treatment periods of 3 months were separated by a 3-week washout period. Insulin was administered during 3 months. At the beginning and the end of each treatment period, an i.v. glucose tolerance test and a meal test were performed. Safety tests were done every 4 weeks. RESULTS: Acarbose resulted in a small but significant improvement in fasting plasma glucose (13.5 +/- 2.4 vs. 11.3 +/- 3.9 mmol/l, p = 0.05), HbA1c (11.1 +/- 3.4 vs. 10.3 +/- 2.5%, P = 0.3) and in a decreased plasma glucose during the meal test. Bedtime insulin significantly decreased fasting plasma glucose (13.1 +/- 2.9 vs. 8.2 +/- 2.3 mmol/l, p < 0.01), HbA1c (11.7 +/- 2.9 vs. 9.4 +/- 2.7%, p < 0.01) and plasma cholesterol. No change in insulin secretion resulted from insulin and acarbose treatment. CONCLUSIONS: Acarbose decreases blood glucose in secondary failure to sulphonylurea-metformin therapy; however, the decrease is not enough to reach the desired metabolic control. Bedtime NPH insulin is, by far, a more effective alternative.