Diagnóstico y tratamiento integral en pacientes con Amelogénesis Imperfecta: reporte de un caso / Diagnóstico e tratamento integral em pacientes com Amelogênese Imperfeita: relato de um caso / Diagnosis and comprehensive treatment for patients with Amelogenesis Imperfecta. Case report

Objetivo: La Amelogénesis Imperfecta comprende un grupo heterogéneo de defectos del esmalte de origen genético, debidos a alteraciones en la formación del esmalte dentario, en calidad y/o cantidad. El diagnóstico se basa en la observación clínica, exámenes radiográficos, la historia familiar, el árbol genealógico y cuando es posible el diagnóstico genético. Se caracteriza por tener un amplio rango de presentaciones clínicas en ambas denticiones. Esta afección tiene un alto impacto en niños y adolescentes debido a que la carencia estética y la disfunción limitan su calidad de vida. La atención integral se convierte en un aspecto esencial y demanda una inteligente y necesaria interacción profesional, paciente y familia, la cual debe establecerse en forma temprana y de manera interdisciplinaria. Objetivo: Presentar un reporte de casocaso de un paciente de 11 años con Amelogénesis Imperfecta y diagnóstico clínico y radiográfico de tipo hipoplásico, apoyado en su historia familiar. El tratamiento integró varias etapas: uso de agentes remineralizantes a fin de restaurar los tejidos dentarios; ortodoncia para crear espacio para la erupción del canino retenido (13) y alineación de la arcada dentaria superior y rehabilitación dentaria con resinas compuestas y coronas metálicas fenestradas en oclusal. Conclusiones: El seguimiento por cinco años con una actitud muy positiva de la paciente hacia el mantenimiento de su salud, confirma que en el adolescente, una sonrisa saludable es importante en el desarrollo de la autoestima y las relaciones interpersonales.

A Amelogênese Imperfeita compreende um grupo heterogêneo de defeitos de esmalte de origem genética, que ocorre devido a alterações na formação de esmalte dentário, e podendo comprometer em qualidade e/ou quantidade do mesmo. O diagnóstico é baseado em observação clínica e radiográfica, história familiar, padrão genético familiar e quando possível, realização de uma investigação genética. Ela caracteriza-se por ter uma ampla gama de manifestações clínicas em ambas as dentições. Esta condição tem um alto impacto em crianças e em adolescentes, gerando um comprometimento social, a funçáo e consequentemente, limitando a qualidade de vida dos pacientes. O cuidado integral torna-se um aspecto essencial do tratamento, exigindo uma interação do profissional com o paciente e seus familiares, que deve ser estabelecida de forma precoce e interdisciplinar. Os objetivos do plano de tratamento devem abranger três aspectos: prevenção, restauração da estrutura dental e reabilitação estética. Objetivo: Paciente de 11 anos de idade, com amelogênese Imperfeita de tipo hipoplásico, segundo o diagnostico clínico e radiográfico e com base na história familiar. O tratamento foi realizado em diversas etapas: uso de agentes remineralizantes na remineralizacão de tecidos dentais, tratamento ortodóntico para criar espaço para a erupção do canino retido e o alinhamento da arcada dentária superior, e por último, a reabilitação com resinas compostas e coroas metálicas fenestradas na superfície oclusal. Conclusão: Durante cinco anos de acompanhamento, o paciente tem demonstrado uma atitude muito positiva em relação à manutenção de sua saúde, confirmando-se que na adolescência, um sorriso saudável é importante no desenvolvimento da autoestima e das relações interpessoais.

Amelogenesis Imperfecta is a diverse group of hereditary and heterogeneous enamel defects, due to alterations in the formation of dental enamel in quality and/or quantity. Diagnosis is based on clinical and radiological findings, family history, family tree, and genetic diagnosis when it is possible. It is characterized by a wide range of clinical presentations in both dentitions. This condition has a high impact on children and adolescents, generates a very disadvantageous social performance since aesthetic problems and dysfunction limit their quality of life. Comprehensive care becomes an essential aspect and it demands a close and necessary professional, patient and family interaction, which must be established early and in an interdisciplinary way. Objective: We present a patient with Amelogenesis Imperfecta, 11 years old, with a clinical and radiographic diagnosis of hypoplastic type, based on her family history. The treatment integrated several stages: use of remineralizing agents in order to restore Latinoamericanadental tissues, orthodontics to create space for the eruption of the retained canine (13), and the alignment of upper dental arch, and rehabilitation with composite resins and metal crowns fenestrated in occlusal. Conclusion: The five year follow- up, with a very positive attitude of the patient toward the maintenance of her health, suggests that in adolescence, a healthy smile is important in the development of self-esteem and interpersonal relationships.

Ethanol increases the distribution of MDMA to the rat brain: possible implications in the ethanol-induced potentiation of the psychostimulant effects of MDMA.

Ecstasy (3,4-methylenedioxymethylamphetamine; MDMA) is a popular club drug often taken with ethanol (EtOH). We recently found EtOH potentiated the psychomotor effects of MDMA in rats. This potentiation could reflect pharmacodynamic or/and pharmacokinetic processes. To test the latter hypothesis, rats were injected i.p. with 6.6 or 10 mg/kg MDMA with or without 1.5 g/kg EtOH, and were killed at 5, 15 or 60 min after injection. MDMA, its primary metabolite, 3,4-methylenedioxyamphetamine (MDA), and EtOH concentrations were determined in the plasma and the hippocampus, frontal cortex and striatum at each time-point. EtOH potentiated MDMA-induced hyperactivity mainly during the first 60 min post-administration. Fifteen and 60 min after treatment with MDMA and EtOH, MDMA concentrations were greater than after MDMA alone in the blood and the three brain regions examined. EtOH, however, did not increase the fraction of MDMA converted to MDA, as shown by unaltered MDA/MDMA ratios at either MDMA dose. Interestingly, when combined with EtOH, the distribution of MDMA and MDA in the brain was not homogeneous. Concentrations of both were much higher in the striatum and cortex, than in the hippocampus. Thus, at least part of the potentiation of the MDMA-induced hyperlocomotion by EtOH might be the result of a higher concentration of MDMA and metabolites in the blood and brain. Our results present clear evidence that EtOH increases brain and blood concentrations of MDMA and leads to the possibility of both enhanced MDMA-based neurotoxicity and increased liability for abuse.

Determination of cannabinoids in whole blood by UPLC-MS-MS.

An ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS-MS) method was developed and validated for the simultaneous determination of Delta(9)-tetrahydrocannabinol (THC), 11-hydroxy-Delta(9)-tetrahydrocannabinol (11-OH-THC), and 11-nor-9-carboxy-Delta(9)-tetrahydrocannabinol (THC-COOH) in whole blood. Samples were prepared by protein precipitation followed by solid-phase extraction. Data were acquired using positive electrospray ionization and multiple reaction monitoring. Two transitions were selected for THC (m/z 315.0 > 193.0 and m/z 315.0 > 122.7) and THC-COOH (m/z 345.0 > 299.0 and m/z 345.0 > 327.0), and one transition was chosen for 11-OH-THC (m/z 331.0 > 313.0). Deuterated analogues of each analyte were used as internal standards for quantification. Run time was 10 min. Limits of quantification (LOQ) were 0.05 ng/mL for THC, 0.1 ng/mL for 11-OH-THC, and 0.2 ng/mL for THC-COOH. Linearity was established from LOQ to 50 ng/mL for each substance (r(2) always > 0.999). Accuracy ranged from 96 to 106%, and imprecision was less than 10% for all analytes. The UPLC-MS-MS method was found to be sensitive, specific, and rapid because it requires no derivatization step. It can be an alternative to gas chromatography-mass spectrometry for the determination of cannabinoids in whole blood.