Enfermedad periodontal y síndrome de Down / Periodontal disease and Down´s syndrome

El síndrome de Down es un factor de riesgo no modificable para la enfermedad periodontal; los individuos con síndrome de Down tienen una mayor prevalencia y severidad de enfermedad periodontal que no puede ser explicada únicamente por una higiene bucal deficiente, y diversos estudios sugieren que esto se debe a cambios en su respuesta inmune y en la composición microbiológica de su biofilm. En este trabajo se hará una revisión de las siguiente anormalidades del sistema inmune que fueron encontradas: - defectos en la quimiotaxis de los neutrófilos - fagocitosis parcial de los leucocitos contra los estafilococos - distribución alterada de subclases de IgG en saliva - aumentados niveles de prostaglandinas E2 - aumentada cantidad de metaloproteinasas de la matriz en el fluido gingival crevicular - reducida expresión de IL-10. Por estos motivos, la atención periodontal de los pacientes son síndrome de Down es ligeramente diferente...

Usefulness of exercise test and myocardial perfusion-gated single photon emission computed tomography to improve the prediction of major events.

BACKGROUND: The incremental prognostic value of myocardial perfusion-gated single photon emission computed tomography (MPGS) compared with exercise test has not yet been properly evaluated. METHODS AND RESULTS: Five thousand six hundred seventy-two consecutive patients with known or suspected coronary disease undergoing exercise MPGS between 1997 and 2007 were included. Three-year predictive models for total death and death from cardiovascular causes or acute myocardial infarction (ie, major cardiovascular events [MCE]) were built using Cox-regression modeling, including only the clinical information. Then the exercise and MPGS information was sequentially added. The added discriminative ability of exercise test information and MPGS was assessed by net reclassification improvement and integrated discrimination improvement. The increase in predictive ability of exercise information for death and MCE was high as assessed by net reclassification improvement (0.199 and 0.263) and integrated discrimination improvement (0.042 and 0.021). The only variable of MPGS associated with total death was ejection fraction (hazard ratio, 0.84; 95% confidence interval, 0.79-0.89; P<0.001). Global stress ischemic score emerged as an additional variable associated with MCE (hazard ratio, 1.07; 95% confidence interval, 1.02-1.12; P=0.007). Adding MPGS information barely improved the prognostic value for total death (net reclassification improvement, 0.017; integrated discrimination improvement, 0.013), but it increased for MCE (net reclassification improvement, 0.122; integrated discrimination improvement, 0.033). CONCLUSIONS: Adding MPGS information to exercise information does not improve prediction of total death, although it allows a more accurate prediction of MCE.