Side effects of different head and neck radiotherapy doses on wistar rat's behavior.

Radiotherapy (RT) is a common treatment for head and neck tumors. However, it causes several physical and behavioral side effects, and no study has assessed the emotional effects in rats. Therefore, the present study evaluated the influence of head and neck RT on the behavior and body weight gain in Wistar rats. Fifty-four male Wistar rats were allocated into six groups (n = 9) according to the irradiation dose, which was applied at the first day of the experiment: RT-7.5 (single dose of 7.5 Gy); RT-10 (single dose of 10 Gy); RT-15 (single dose of 15 Gy); RT-30 (single dose of 30 Gy); Control (without RT). The animals were irradiated in the region of the right face, and behavioral tests and weighing were performed on days one, seven, and 28. The open field and Y-maze tests were undertaken to analyze the animal's behavior. The dose of 30 Gy was lethal when applied to the head and neck region. The irradiated animals had less weight gain when compared to the control ones, but there was no statistical difference. In the open field and Y-maze tests, lower mobility of animals in the RT groups was observed both on day seven and at the end of the experiment (day 28) when compared to the control rats (p < 0.05). It was possible to conclude that the different doses of radiation induced depressive behavior in the animals, and that the weight gain tended to be lower in the irradiated groups, however, without statistical difference.

Prevalence of apical periodontitis in people living with HIV in Southern Brazil / Prevalência de periodontite apical em pessoas vivendo com HIV no Sul do Brasil

Objective: This cross-sectional study aimed to describe the prevalence of apical periodontitis (AP) in people living with HIV (PLHIV) over 50 years old and explore its association with sociodemographic, medical, and oral characteristics. Methods: Data from 59 PLHIV were collected, and the periapical area of 1018 teeth was evaluated through periapical radiographs (Rx) using the periapical index (PAI). The presence and quality of root fillings and restorations (coronal fillings and crowns) were assessed with Rx, and caries presence was based on Rx and clinical data. Viral load (VL) and T CD4 counts were also analyzed. Results: AP prevailed in 71% of individuals and 8% of teeth. Family income of >5 Brazilian minimum wages (OR=0.06, 95% CI=0.005-0.62) and having at least one root-filled tooth (OR=14.55, 95% CI=1.45-145.72) were associated with AP prevalence, whereas VL and T CD4 were not. Caries, root filling, and restorations were associated with AP occurrence. Conclusion: PLHIV presented a high AP prevalence, but intrinsic factors related to HIV infection were not associated with AP in the studied subjects. PLHIV would benefit from oral health policies to prevent AP, as the results indicate that the endodontic disease in the present sub-population might be related to social problems.(AU)

Objetivo: este estudo transversal teve como objetivo descrever a prevalência de periodontite apical (PA) em pessoas vivendo com HIV (PVHIV) acima de 50 anos de idade, e explorar sua associação com características sociodemográficas, médicas e bucais. Métodos: os dados de 59 PVHIV foram coletados e a região periapical de 1018 dentes foi avaliada através de radiografias periapicais (Rx) usando o Índice Periapical (PAI). A presença e qualidade das obturações radiculares e restaurações (restaurações diretas e coroas) também foram avaliadas no Rx; a presença de cárie foi baseada em dados clínicos e radiográficos. Carga Viral (CV) e contagem de linfócitos T CD4 também foram avaliados. Resultados: a prevalência de PA nos indivíduos foi de 71%, e 8% dos dentes apresentaram PA. Renda familiar >5 salários mínimos (OR=0.06, 95% CI=0.005-0.62) e ter pelo menos um dente com obturação endodôntica (OR=14.55, 95% CI=1.45-145.72) foram associados com a prevalência de PA, enquanto que CV e T-CD4 não foram. A presença de cárie, obturação endodôntica e restaurações foram associadas com a presença de PA no dente. Conclusão: PVHIV apresentaram uma alta prevalência de PA, mas fatores intrínsecos relacionados à infecção pelo HIV não foram associados com PA nos sujeitos avaliados. PVHIV se beneficiariam de políticas públicas de saúde para prevenir a PA, uma vez que os resultados indicam que a doença endodôntica na presente subpopulação pode ser relacionada a problemas sociais.(AU)

Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis.

BACKGROUND: Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). METHODS: FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1ß. RESULTS: RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well-developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1ß by CIA-FLSs than by RA-FLSs. CONCLUSION: This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

Morphofunctional analysis of fibroblast-like synoviocytes in human rheumatoid arthritis and mouse collagen-induced arthritis

Abstract Background Fibroblast-like synoviocytes (FLS) play a prominent role in rheumatoid synovitis and degradation of the extracellular matrix through the production of inflammatory cytokines and metalloproteinases (MMPs). Since animal models are frequently used for elucidating the disease mechanism and therapeutic development, it is relevant to study the ultrastructural characteristics and functional responses in human and mouse FLS. The objective of the study was to analyze ultrastructural characteristics, Interleukin-6 (IL-6) and Metalloproteinase-3 (MMP-3) production and the activation of intracellular pathways in Fibroblast like synoviocytes (FLS) cultures obtained from patients with rheumatoid arthritis (RA) and from mice with collagen-induced arthritis (CIA). Methods FLSs were obtained from RA patients (RA-FLSs) (n = 8) and mice with CIA (CIA-FLSs) (n = 4). Morphology was assessed by transmission and scanning electron microscopy. IL-6 and MMP-3 production was measured by ELISA, and activation of intracellular signaling pathways (NF-κB and MAPK: p-ERK1/2, p-P38 and p-JNK) was measured by Western blotting in cultures of RA-FLSs and CIA-FLSs stimulated with tumor necrosis factor-alpha (TNF-α) and IL-1β. Results RA-FLS and CIA-FLS cultures exhibited rich cytoplasm, rough endoplasmic reticula and prominent and well- developed Golgi complexes. Transmission electron microscopy demonstrated the presence of lamellar bodies, which are cytoplasmic structures related to surfactant production, in FLSs from both sources. Increased levels of pinocytosis and numbers of pinocytotic vesicles were observed in RA-FLSs (p < 0.05). Basal production of MMP-3 and IL-6 was present in RA-FLSs and CIA-FLSs. Regarding the production of MMP-3 and IL-6 and the activation of signaling pathways, the present study demonstrated a lower response to IL-1β by CIA-FLSs than by RA-FLSs. Conclusion This study provides a comprehensive understanding of the biology of RA-FLS and CIA-FLS. The differences and similarities in ultrastructural morphology and important inflammatory cytokines shown, contribute to future in vitro studies using RA-FLS and CIA-FLS, in addition, they indicate that the adoption of CIA-FLS for studies should take careful and be well designed, since they do not completely resemble human diseases.

Performance of High Mobility Protein Group 1 and Interleukin-6 as Predictors of Outcomes Resulting from Variceal Bleeding in Patients with Advanced Chronic Liver Disease.

Variceal bleeding is a serious complication in cirrhotic patients and is related to increased expression of inflammatory mediators that accentuate circulatory dysfunction. The study aims to evaluate the performance of high mobility protein group 1 (HMG1) and interleukin-6 (IL-6) as predictors of acute kidney injury (AKI), infection and death in these patients. Fifty patients who were diagnosed with advanced chronic liver disease with variceal bleeding were included. The mean age was 52.8 ± 10.8 years, and 33 (66%) were male. Twenty-one (42%) patients were classified as Child-Pugh C, 21 (42%) Child-Pugh B and 8 (16%) Child-Pugh A. The mean HMG1 serum level was 2872.36 pg/mL ± 2491.94, and the median IL-6 serum level was 47.26 pg/mL (0-1102.4). In AKI, the serum level of HMG1 that performed best on the ROC curve was 3317.9 pg/mL. The IL-6 serum level was not associated with AKI. HMG1 and IL-6 cut-off values that better predicted infection were 3317.9 pg/mL and 72.9 pg/mL, and for mortality, the values were 2668 pg/mL and 84.5 pg/mL, respectively. In multivariate analysis, the variables that were associated with AKI and infection outcomes were model for end-stage liver disease and HMG1. Infections were related to the risk of death. Clinical and laboratory variables related to the outcomes were identified. Serum levels of HMG1 were associated with AKI and infection and had good performance in the ROC curve. IL-6 levels were not maintained in logistic regression outcomes but had good performance in infection and death outcomes. Such data will be useful for comparisons and possible future validations.

Detectability of Middle Mesial Canal in Mandibular Molar After Troughing Using Ultrasonics and Magnification: An Ex Vivo Study.

The aim of this study was to evaluate the frequency of the identification of middle mesial (MM) canals in extracted permanent first and second mandibular molars before and after executing a troughing technique with high magnification. Sample consisted of 105 mandibular molars. After gaining access to the pulp chamber and cleaning the chamber floor, root canals were detected in three different stages. The initial location was performed under direct viewing without magnification. In the second stage, a dental operating microscope was employed at 12 magnification. If the MM canal was not observed, a standardized troughing technique was executed with the use of an ultrasonic tip between the mesiobuccal and mesiolingual canals under magnification. Statistical differences in the frequency of MM canals before and after troughing were determined using McNemar's test, with the significance level set at 5%. No significant increase in the identification of the MM canal was found when comparing observations before (9.52%) and after (12.38%) the troughing technique under high magnification. However, viewing under magnification and the execution of troughing significantly increased the location of the MM canal (12.38%) when compared to viewing without magnification (3.81%) (p<0.01). The troughing technique with the aid of a dental operating microscope significantly improved the identification of MM canals compared to viewing without magnification. Troughing is a safe, minimally invasive procedure that benefits the treatment of mandibular molars.

Detectability of middle mesial canal in mandibular molar after troughing using ultrasonics and magnification: an ex vivo study

Abstract The aim of this study was to evaluate the frequency of the identification of middle mesial (MM) canals in extracted permanent first and second mandibular molars before and after executing a troughing technique with high magnification. Sample consisted of 105 mandibular molars. After gaining access to the pulp chamber and cleaning the chamber floor, root canals were detected in three different stages. The initial location was performed under direct viewing without magnification. In the second stage, a dental operating microscope was employed at 12 magnification. If the MM canal was not observed, a standardized troughing technique was executed with the use of an ultrasonic tip between the mesiobuccal and mesiolingual canals under magnification. Statistical differences in the frequency of MM canals before and after troughing were determined using McNemar's test, with the significance level set at 5%. No significant increase in the identification of the MM canal was found when comparing observations before (9.52%) and after (12.38%) the troughing technique under high magnification. However, viewing under magnification and the execution of troughing significantly increased the location of the MM canal (12.38%) when compared to viewing without magnification (3.81%) (p<0.01). The troughing technique with the aid of a dental operating microscope significantly improved the identification of MM canals compared to viewing without magnification. Troughing is a safe, minimally invasive procedure that benefits the treatment of mandibular molars.

Resumo O objetivo deste estudo foi avaliar a frequência de identificação do canal médio-mesial (MM) antes e após a execução da técnica de troughing sob ampliação microscópica em primeiros e segundos molares inferiores permanentes extraídos. A amostra foi composta por 105 molares inferiores. Após abertura coronária e limpeza do assoalho pulpar, os canais radiculares foram detectados em três etapas diferentes. A localização inicial foi realizada sob visão direta, sem ampliação microscópica. Na segunda visualização, foi empregado um microscópio óptico com um aumento de ´12. Se o canal MM não foi observado, uma técnica padronizada de troughing foi realizada com o uso de pontas ultrassônicas entre os canais mésio-vestibular e mésio-lingual sob ampliação microscópica. Diferenças estatísticas na frequência dos canais MM antes e após o troughing foram determinadas usando o teste de McNemar, com um nível de significância de 5%. Não houve um aumento estatisticamente significativo na identificação do canal MM quando comparadas as visualizações antes (9,52%) e depois (12,38%) da técnica do troughing utilizando o microscópio óptico. Porém, a visualização com microscópio e a execução do troughing aumentaram significativamente a localização do canal MM (12,38%) quando comparada à visão prévia sem aumento (3,81%) (p<0,01). A técnica do troughing com o auxílio do microscópio óptico aumentou significativamente a identificação do canal MM quando comparada à visualização sem magnificação. Troughing é um técnica segura, minimamente invasiva e traz benefícios ao tratamento de molares inferiores.

The use of smartphones in radiographic diagnosis: accuracy on the detection of marginal gaps.

OBJECTIVE: To compare the accuracy of computer monitor and smartphone screen for radiographic diagnosis of marginal gap. MATERIALS AND METHODS: Forty teeth with mesial-occlusal-distal inlays (each tooth with a perfect fit and a 0.4-mm marginal gap restoration) were imaged with a phosphor plate system. Original digital radiographs were exported and analyzed with two different methods: computer monitor and smartphone screen; for the last method, images were shared with WhatsApp. Three examiners assessed all radiographs (n = 160) for the presence of marginal gap by using a dichotomous scale (yes/no). Diagnostic performance of each examiner and viewing method was evaluated by means of sensitivity (Se), specificity (Sp), and overall accuracy (Ac). Difference between the frequencies of gap detection of each method was analyzed using the McNemar test. Intra- and inter-examiner agreements were calculated using kappa statistics. RESULTS: Intra- and inter-examiner agreements were ≥ 0.80 for both methods. Similar diagnostic performance was found for computer monitor (Se = 0.87-1; Sp = 0.8-0.97; Ac = 0.84-0.99) and smartphone (Se = 0.77-1; Sp = 0.87-1; Ac = 0.88-0.95) viewing methods. No statistically significant differences in the frequency of gap detection were observed between the methods (P > 0.05). CONCLUSION: Diagnostic accuracy of smartphone screens was similar to that of computer monitor for marginal gap detection. CLINICAL RELEVANCE: Smartphones are becoming a common daily tool. In this sense, it might be an important new aid in Dentistry, including radiographic evaluation, which could benefit patients and dentists.

Fibroblast-like synoviocytes from fluid and synovial membrane from primary osteoarthritis demonstrate similar production of interleukin 6, and metalloproteinases 1 and 3.

OBJECTIVES: The objective of the study was to compare the production of metalloproteinases (MMP)-1, -3 and interleukin (IL)-6 by fibroblast-like synoviocytes (FLS) derived from synovial fluid (FD-FLS), and FLS derived from synovial tissue (TD-FLS) of patients with primary osteoarthritis (OA). The more accessible FD-FLS could facilitate the study of the role of these cells in OA pathophysiology. METHODS: MMP-1, MMP-3, and IL-6 levels were measured in the supernatant culture at baseline and 22 hours after stimulation with TNF-α and IL-1 ß. RESULTS: There was no difference at baseline between MMP-1, MMP-3 and IL-6 production by FD-FLS and TDFLS. Analogous to baseline, stimulation of FD-FLS and TD-FLS with IL-1ß and TNF-α did not result in difference on MMP-3 and IL-6 production. However, TD-FLS produced more MMP-1 than FD-FLS after stimulation with IL-1ß (p=0.01). Additionally, there was a positive correlation for production of MMP-1, MMP-3 and IL-6 between FD-FLS and TD-FLS (r=0.40 and p<0.0008; r=0.66 and p<0.0001; r=0.76 and p<0.0001, respectively). Supporting this statistical significant positive correlation, the Bland-Altman plotting, showed a homogeneous distribution of the values and low mean disagreement rates between all results of FD-FLS and TD-FLS (23.1%, 56.8% and 48.1%, respectively). CONCLUSIONS: Our data demonstrated functional similarity between FD-FLS and TD-FLS and support the use of a more accessible source of FLS for the study of the pathogenesis of joint destruction and therapeutic targets in primary OA.

Diagnostic Efficacy of Four Methods for Locating the Second Mesiobuccal Canal in Maxillary Molars.

INTRODUCTION: The major cause for failure of root canal therapy is the inability to recognize the presence of all canals of the root canal system. Auxiliary tools, such as magnifying loupe, operative microscope and computed tomography (CT) images are used to facilitate the location of canals. The objective of the present survey was to evaluate the diagnostic efficacy of four methods for detecting the second canal of mesiobuccal roots (MB2) of permanent maxillary molars. METHODS AND MATERIAL: A total of 147 extracted human maxillary molars were assessed. The floor of the pulp chamber was inspected by an endodontist to find MB2 canals. Analyses were performed without magnification (direct visual method), using a loupe (with 3.5× magnification), and using a microscope (with 16× magnification). A fourth analysis was conducted using cone-beam computed tomography (CBCT) images. Teeth were sectioned horizontally into three parts (cervical, medial and apical thirds) to confirm the presence of MB2 canals (reference standard method). Sensitivity, specificity, and positive/negative predictive values were calculated for each method. RESULTS: No statistically significant differences were observed in the frequency of MB2 found between the microscope and the reference standard or between CBCT and the reference standard. CBCT had higher sensitivity (0.88), specificity (0.88), positive (0.84) and negative (0.91) predictive value than the other three methods. CONCLUSION: CBCT was the most accurate method for detecting the MB2 and it had a diagnostic efficacy similar to that of the reference standard method.

Perfil de citocinas em recém-nascidos prematuros utilizando amostras de sangue coletadas em papel filtro: correlação com desfechos clínicos desfavoráveis / Cytokines in preterm newborns using blood samples collected on filter paper: correlation with unfavorable clinical outcomes

INTRODUÇÃO: A identificação precoce de citocinas pode favorecer a condução clínica e adoção de medidas preventivas na população neonatal. OBJETIVO: Avaliar os níveis séricos de Interleucinas (IL) 2, IL-4, IL-6, IL-8, IL-10, Interferon gama (IFN-γ), Fator de Necrose Tumoral alfa (TNF-α) e Fator Estimulador de Colônias de Granulócitos e Mastócitos (GM-CSF) nas primeiras três horas de vida de recém-nascidos prematuros através de coleta de sangue em papel filtro. MÉTODOS: Estudo analítico observacional prospectivo desenvolvido com 34 recém-nascidos prematuros com idade gestacional entre 28 e 32 semanas. As dosagens foram feitas com 10, 60 e 180 minutos de vida em papel filtro. Utilizado o reagente Bio-Plex ProT Human Cytokine Standard 8 plex, Group I BIO-RAD e as leituras realizadas com Luminex 100. RESULTADOS: Houve associação entre sepse e a presença de IFN-γ e TNF-α com 10, 60 e 180 minutos de vida. A associação entre sepse e a presença de IL-6 foi observada com 180 minutos de vida. Níveis reduzidos de GM-CSF na primeira hora de vida foram relacionados à hipotermia (p=0,005) à admissão na unidade neonatal. CONCLUSÃO: A detecção dos níveis de citocinas em papel filtro é viável nas primeiras horas de vida de recém-nascidos prematuros. As vantagens são a facilidade de coleta, armazenamento, transporte e utilização de pequenos volumes. O IFN-γ e TNF-α e IL-6 podem ser considerados marcadores para o desenvolvimento de sepse nessa população. A redução dos níveis de GM-CSF em pacientes hipotérmicos favorecendo quadros de neutropenia aponta para a importância da prevenção da hipotermia. (AU)

Introduction: Early identification of cytokines may favor clinical management and the adoption of preventive measures. Objective: This study aims to evaluate the serum levels of IL-2, IL-6, IL-8, IL- 10, Interferon gamma (IFN-γ), Tumor Necrosis Factor alpha (TNF-α) and Stimulating Factor of Granulocyte and Mast Cell Colonies (GMCSF) in the first three hours of life of preterm newborns through blood collection on filter paper. Methods: Prospective observational analytical study developed with 34 preterm infants with gestational age between 28 and 32 weeks. Measurements were made at 10, 60 and 180 minutes of life on filter paper. Used Bio-Plex Pro T Human Cytokine Standard 8 plex reagent, Group I BIO-RAD and readings performed through the Luminex 100. Results: There was an association between sepsis and the presence of IFN-γ and TNF-α at 10, 60 and 180 minutes of life. Association between sepsis and the presence of IL-6 was observed with 180 minutes. Reduced levels of GM-CSF in the first hour of life were related to hypothermia on admission to the neonatal unit (p=0.005). Conclusion: The detection of levels of cytokines in samples collected on filter paper showed to be viable in the first few hours of life with the following advantages: ease of collection, storage / transport and the use of small volumes. IFN-γ and TNF-α and IL-6 may be considered promising markers for the development of sepsis in this population. The reduction of levels of GM-CSF in hypothermic patients favoring neutropenia alerts the need for preventive care of this condition. (AU)

Uniparental ancestry markers in Chilean populations.

The presence of Native Americans, Europeans, and Africans has led to the development of a multi-ethnic, admixed population in Chile. This study aimed to contribute to the characterization of the uniparental genetic structure of three Chilean regions. Newborns from seven hospitals in Independencia, Providencia, Santiago, Curicó, Cauquenes, Valdívia, and Puerto Montt communes, belonging to the Chilean regions of Santiago, Maule, and Los Lagos, were studied. The presence of Native American mitochondrial DNA (mtDNA) haplogroups and two markers present in the non-recombinant region of the Y chromosome, DYS199 and DYS287, indicative of Native American and African ancestry, respectively, was determined. A high Native American matrilineal contribution and a low Native American and African patrilineal contributions were found in all three studied regions. As previously found in Chilean admixed populations, the Native American matrilineal contribution was lower in Santiago than in the other studied regions. However, there was an unexpectedly higher contribution of Native American ancestry in one of the studied communes in Santiago, probably due to the high rate of immigration from other regions of the country. The population genetic sub-structure we detected in Santiago using few uniparental markers requires further confirmation, owing to possible stratification for autosomal and X-chromosome markers.

Analysis of the genetic ancestry of patients with oral clefts from South American admixed populations.

Increased susceptibility to cleft lip, with or without cleft palate (CL±P) has been observed in South America, as related to Amerindian ancestry, using epidemiological data, uniparental markers, and blood groups. In this study, it was evaluated whether this increased risk remains when Amerindian ancestry is estimated using autosomal markers and considered in the predictive model. Ancestry was estimated through genotyping 62 insertion and deletion (INDEL) markers in sample sets of patients with CL±P, patients with cleft palate (CP), and controls, from Patagonia in southern Argentina and Belém in northern Brazil. The Amerindian ancestry in patients from Patagonia with CL±P was greater than in controls although it did not reach statistical significance. The European ancestry in patients with CL±P from Belém and in patients with CP from Belém and Patagonia was higher than in controls and statistically significant for patients with CP who were from Belém. This high contribution of European genetic ancestry among patients with CP who were from Belém has not been previously observed in American populations. Our results do not corroborate the currently accepted risks for CL±P and CP estimated by epidemiological studies in the North American populations and probably reflect the higher admixture found in South American ethnic groups when compared with the same ethnic groups from the North American populations.

Status Asmaticus: lenda ou realidade? Como tratar melhor? / Status Asmathicus: legend or reality? How to treat better?

A história natural do status asmaticus é na maioria das vezes de resolução com mortalidade geral menor que 1%. Cerca de 80% dos pacientes com exacerbação de asma brônquica são liberados da emergência nas primeiras duas horas de tratamento. No entanto, nos pacientes com necessidade de ventilação mecânica a mortalidade pode chegar a 8%. O tratamento rápido e eficaz é essencial para o sucesso do tratamento e a prevenção de complicações. Neste artigo são abordadas as recomendações atuais do tratamento das exacerbações graves de asma brônquica nos setores de emergência e terapia intensiva...

The natural history of status asthmaticus is, most of the time, sorted out with overall mortality less than 1%. About 80% of patients with exacerbation of asthma emergency are released within the first two hours of treatment. However, in patients requiring mechanical ventilation mortality can reach 8%. The rapid and effective treatment is essential for the success of the treatment and the prevention of complications. This paper addresses the current recommendations the treatment of severe exacerbations of asthma in the emergency department and intensive care...