Occurrence of red complex microorganisms and Aggregatibacter actinomycetemcomitans in patients with diabetes.

AIM: The aim of the present study was to analyze the occurrence of Porphyromonas gingivalis (P. gingivalis), Tannerella forsythia (T. forsythia), Treponema denticola (T. denticola), and Aggregatibacter actinomycetemcomitans (A. actinomycetemcomitans) in patients with diabetes. METHODS: Periodontal and diabetic parameters and subgingival biofilm samples were obtained from 60 patients with diabetes and 62 patients without diabetes. By using polymerase chain reaction, the prevalence of red complex microorganisms (P. gingivalis, T. forsythia, and T. denticola) and A. actinomycetemcomitans were determined. Descriptive and non-parametric statistical analyses between groups were performed (Kruskal-Wallis, Mann-Whitney U-test, and Fisher's exact test). RESULTS: Patients with diabetes presented significantly higher periodontal attachment loss levels compared to patients without diabetes. Red complex microorganisms were detected in lower frequencies in patients with diabetes. The detection of A. actinomycetemcomitans was higher in patients with diabetes and periodontitis compared to systemically-healthy patients without periodontitis (P < 0.05). P. gingivalis was associated with periodontitis in non-diabetic patients (P < 0.05), whereas A. actinomycetemcomitans was associated with periodontitis in diabetic patients (P < 0.05). CONCLUSIONS: The findings of the present study indicate that there might be differences in the subgingival microbiota between diabetic and non-diabetic patients. In addition, P. gingivalis and A. actinomycetemcomitans were associated with periodontitis in patients without diabetes and patients with diabetes, respectively.

Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial.

Current evidence suggests that periodontal infection may aggravate diabetes control. The aim of this study was to determine the changes in the frequency with which Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans were detected in patients with diabetes with the use of non-surgical therapy plus azithromycin in a randomized clinical trial. One hundred and five (105) patients with diabetes and chronic periodontitis were randomly assigned to three treatment groups: subgingival mechanical therapy with azithromycin, subgingival mechanical therapy with placebo and supragingival prophylaxis with azithromycin. Complete periodontal clinical examinations and detection of periodontal pathogens using polymerase chain reaction were carried out at baseline, 3, 6 and 9 months after periodontal therapy. The frequency with which Porphyromonas gingivalis, Treponemadenticola and Aggregatibacter actinomycetemcomitans were detected decreased at 3 months in all groups. Tannerella forsythia increased after3 months in all groups. All organisms had similar frequencies at 9 months in all groups. Subgingival mechanical therapy with adjunctive azithromycin had no additional effect on the frequency with which the periodontal pathogens investigated were detected in patients with diabetes.

Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial

Evidencia actual sugiere que la infección periodontal puede agravar el control de la diabetes. El objetivo de este estudiofue determinar los cambios en la frecuencia de detección de porphyromonas gingivalis, Tannerella forsythia, Treponema denticola y Aggregatibacter actinomycetemcomitans en pacientes con diabetes con el uso de terapia mecánica no quirúrgica mas azitromicina en un estudio clínico controlado aleatorizado.Ciento cinco pacientes (105) con diabetes y perio -dontitis fueron asignados aleatoriamente en tres grupos: terapiamecánica mas azitromicina, terapia mecánica mas placebo y profilaxis supragingival mas azitromicina. Un análisis periodontal completo y detección de patógenos perio dontales por medio de reacción en cadena de la polimerasa (PCR) se realizaron al inicio, 3, 6 y 9 meses después de la terapia pe -riodontal. La frecuencia de detección de Porphyromonas gingivalis, Treponema denticola y Aggregatibacter actinomycetemcomitans disminuyó a los 3 meses en todos los grupos. La frecuencia de detección de Tannerella forsythia se incrementó a los 3 meses en todos los grupos. Todos los patógenosperiodontales mostraron una frecuencia de detección similar a los 9 meses en todos los grupos. La terapia periodontal mas azitromicina no tuvo efectos adicionales sobre la frecuencia dedetección de los patógenos periodontales investigados en pacientes diabéticos...

Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial. / Microbiological effects of periodontal therapy plus azithromycin in patients with diabetes: results from a randomized clinical trial.

Current evidence suggests that periodontal infection may aggravate diabetes control. The aim of this study was to determine the changes in the frequency with which Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola and Aggregatibacter actinomycetemcomitans were detected in patients with diabetes with the use of non-surgical therapy plus azithromycin in a randomized clinical trial. One hundred and five (105) patients with diabetes and chronic periodontitis were randomly assigned to three treatment groups: subgingival mechanical therapy with azithromycin, subgingival mechanical therapy with placebo and supragingival prophylaxis with azithromycin. Complete periodontal clinical examinations and detection of periodontal pathogens using polymerase chain reaction were carried out at baseline, 3, 6 and 9 months after periodontal therapy. The frequency with which Porphyromonas gingivalis, Treponemadenticola and Aggregatibacter actinomycetemcomitans were detected decreased at 3 months in all groups. Tannerella forsythia increased after3 months in all groups. All organisms had similar frequencies at 9 months in all groups. Subgingival mechanical therapy with adjunctive azithromycin had no additional effect on the frequency with which the periodontal pathogens investigated were detected in patients with diabetes.

Tooth and periodontal clinical attachment loss are associated with hyperglycemia in patients with diabetes.

BACKGROUND: Periodontal disease has been associated with diabetes, but there is still controversy on the relationship between periodontal clinical parameters and glycemic control. The purpose of this study is to assess the relationship between blood glucose levels and clinical parameters of periodontal disease in individuals with diabetes. METHODS: A total of 65 individuals with diabetes and 81 individuals without diabetes were included in the study. A full-mouth periodontal examination and preprandial fasting glycemia values were recorded for each individual. Glycosylated hemoglobin was only measured in patients with diabetes. A comparative analysis between groups (Mann-Whitney U test) and a correlation analysis between glycemia and periodontal parameters were performed (Spearman test). RESULTS: Patients without diabetes presented more teeth than individuals with diabetes (P <0.05). Patients with diabetes with periodontitis displayed loss of periodontal clinical attachment compared to patients without diabetes, but the highest value was observed in patients with periodontitis that reported a smoking habit. Furthermore, patients with diabetes with periodontitis presented higher glycemia and glycated hemoglobin values in contrast to patients with gingivitis. Patients with diabetes with hyperglycemia had a higher risk to develop periodontitis (odds ratio = 2.24; 95% confidence interval = 1.02 to 4.93). A positive correlation was observed between glycemia and clinical attachment loss (AL), whereas a negative correlation between glycemia and the number of teeth present was found (P <0.05). CONCLUSIONS: Tooth and periodontal AL were increased by hyperglycemia in individuals with diabetes. This study contributes additional evidence that diabetes could aggravate periodontal disease and affect the systemic health of individuals.

Caracterización del uso de antieméticos en el postoperatorio en pacientes adultos sometidos a cirugía durante el periodo enero-mayo 2009, en el Hospital Clínica Bíblica de Costa Rica / Characterization of the use of antiemetics in the postoperative period in adult patients undergoing surgery during january to may 2009 in a private hospital Clínica Bíblica in Costa Rica

Evaluar y caracterizar el abordaje farmacoterapéutico antiemético en el periodo postoperatorio en pacientes adultos sometidos a cirugía en el Hospital Clínica Bíblica, hospital privado en Costa Rica. Métodos: Se seleccionaron pacientes, con edades entre 18 y 75 años, sometidos a cirugía, en quienes se había utilizado algún antiemético profiláctico al proceso quirúrgico, excluyéndose los pacientes que permanecieran hospitalizados menos de 24 horas tras la cirugía. Resultados: Dentro de la terapia profiláctica antiemética utilizada en este Hospital, se incluyó: granisetrón, metoclopramida, dexametasona, dimenhidrinato, entre otros; el granisetrón fue el antiemético más utilizado en un 81 por ciento de los casos, solo o en combinación. El uso de la dexametasona junto con el granisetrón fue la combinación más utilizada en un 57 por ciento. Sin hacer asociación al procedimiento quirúrgico, las náuseas y vómitos postoperatorios se presentaron en un 12 por ciento con el granisetrón, en un 25 por ciento con la metoclopramida, en un 9 por ciento con el dimenhidrinato, en un 13 por ciento con la dexametasona y en un 14 por ciento con otros antieméticos. Las cirugías que presentaron más incidencia de NVPO fueron las cirugías ortopédicas en un 30 por ciento, y las cirugías laparoscópicas en un 28 por ciento. En los casos en los que se utilizó fentanyl como anestésico, se presentaron vómitos en un 18 por ciento de los pacientes, mientras que en los casos en que no se utilizó fentanyl, el porcentaje de NVPO fue del 9 por ciento. Conclusión: A pesar del amplio uso de antieméticos profilácticamente, las náuseas y vómitos postoperatorios siguen presentándose en los pacientes de este Hospital. No se ha encontrado un algoritmo que permita prevenir totalmente las náuseas y vómitos postoperatorios, a pesar de la gran cantidad de conocimientos adquiridos en este campo. Se debe tomar en cuenta el riesgo individual de cada paciente y la satisfacción de este...

To evaluate and characterize the pharmaco-therapeutic approach with antiemetics during the postoperative, in adult patients undergoing surgery at a private hospital in Costa Rica(Hospital Clinica Biblica) Methods: This is an observational, prospective and cohort study. Those patients who had surgery and received antiemetic prophylaxis before the procedure were selected (ages between 18 and 75 years) excluding those who had hospitalization shorter than 24 hours.Results: Prophylactic antiemetic therapy in this private hospital utilizes granisetron, metoclopramide, dexamethasone, and dimenhydrinate, Granisetron, either alone or incombination, was the most used antiemetic in 81%. The combination most commonly used was dexamethasone and granisetron (57%). Without considering the surgical procedure, the incidence of postoperative nausea and vomiting (PONV) was 12% in patients taking granisetron, 25% with metoclopramide, 9% with dimenhydrinate, 13% with dexamethasone and 14% with otherantiemetics. On the other hand, looking at the procedure, the incidence of PONV in patients undergoing orthopedic surgery was by 30%, and 28% in those after laparoscopic surgery Finally,in cases in which fentanyl was used as an anesthetic 18% of the patients presented PONV, whereas in patients cases were fentanyl was not used, the rate of was 9%. Conclusion: Despite the widespread use of prophylactic antiemetics, PONV is still seen in thepatients at this private hospital. In spite of the wealth of knowledge in this field, physicians have not yet found an algorithm capable of the total prevention of PONV. Individual risks and patient`s satisfaction should be taken into account. Further research on this matter must continue in orderto unify and improve criteria of PONV treatment.

Índice de extensión y severidad (ESI) como parámetro para describir la respuesta a la terapia clínica en el manejo de la enfermedad periodontal / Use of the extension and severity index (ESI) as a parameter for describing clincial response to periodontal treatment

La respuesta al tratamiento periodontal ha sido evaluada tradicionalmente con promedios de parámetros clínicos periodontales como el sangrado al sondaje (BOP), profundidad clínica al sondaje y nivel clínico de inserción. El propósito de este estudio fue describir la respuesta al tratamiento periodontal por medio de un índice nuevo (ESI de bolsa). De una base de datos de1145 pacientes de la consulta particular, se selecciono una muestra de 169 pacientes con periodontitis crónica quienes tenían un examen inicial y un reexamen después de la terapia periodontal. Se hizo un estudio retrospectivo comparativo donde se evaluó la respuesta a la terapia periodontal por medio de algunos parámetros clínicos: (Índice de placa, sangrado al sondaje–BOP y ESI de bolsa). Adicionalmente se comparó la respuesta al tratamiento periodontal entre pacientes fumadores y no fumadores, y según la extensión y severidad inicial de la enfermedad periodontal. Todos los parámetros clínicos evaluados tuvieron una reducción estadísticamente significativa desde el examen inicial hasta el reexamen. No se observaron diferencias estadísticamente significativas en la reducción de los parámetros clínicos entre fumadores y no fumadores. Tampoco se encontraron diferencias estadísticamente significativas en la reducción promedio de los parámetros clínicos de acuerdo a la extensión y severidad inicial de la enfermedad periodontal (105 localizados moderados, 45 localizados severos, 7 generalizados moderados y 12 generalizados severos). En este estudio se pudo observar que el ESI de bolsa puede ser un parámetro útil, efectivo y confiable para evaluar la respuesta a la terapia periodontal...