Transtorno de humor unipolar, uma abordagem homeopática: relato de caso / Unipolar mood disorder, a homeopathic approach: case report

Introdução: O transtorno depressivo unipolar é, atualmente, uma das patologias mais frequentes do mundo. Sua prevalência em clínicas de saúde da família é alta. O médico clínico generalista deve estar preparado para atender tal demanda e atuar. Muito se conhece sobre as terapêuticas alopáticas existentes, mas de forma incansável, busca-se por práticas médicas alternativas e complementares as quais visam diminuir a poli farmácia com as suas consequentes interações medicamentosas, reduzindo, assim, efeitos colaterais importantes. A homeopatia vem de encontro a este objetivo. Tal prática herdou conceitos elementares de Hipócrates, considerado o pai da medicina e que, entre outros conceitos, advogava a terapêutica de cura pelos semelhantes. Em 1791, Samuel Hahnemann, fundador da Homeopatia, publica seu primeiro ensaio sobre o tratamento homeopático. Ele é instaurado a partir do princípio hipocrático da cura pelos semelhantes, uso de medicamento único e experimentação em homem são e doses infinitesimais. Esta monografia descreve o uso deste tipo de terapêutica em pacientes com diagnóstico de transtorno depressivo unipolar. Objetivo: Relatar um caso de tratamento homeopático em um paciente com sintomas depressivos atendido em consultório de Saúde da Família. Metodologia: Estudo de caso com delineamento observacional descritivo, apresentando caráter narrativo e reflexivo. A medicação homeopática utilizada é o Natrium muriaticum, após repertorização. Ademais, fez-se a revisão bibliográfica sobre o tema e sua correlação com a homeopatia. Resultado: O tratamento homeopático se demonstrou eficiente para controle da sintomatologia apresentada pela paciente, justificando o não uso de outros tratamentos adjuvantes. Conclusão: A homeopatia mostra-se uma aliada na complementariedade dos tratamentos em saúde mental, uma vez que pode tratar o ser em sua integralidade. Mais estudos são necessários para estudar a amplitude da potencialidade que a Homeopatia pode fornecer.

Morfología radicular y mediciones apicales en primeros molares en una población maya / Root morphology and apical measurements of first molars in a Mayan population

El conocimiento preciso de la morfología radicular dental son claves para el éxito en las terapias endodónticas. El objetivo de este estudio fue evaluar las distintas variaciones de la morfología radicular y apical en primeros molares superiores e inferiores de una población maya moderna. Se observaron microfotografías provenientes de 80 primeros molares superiores e inferiores, presentadas en cortes transversales a 1 y 2,5 mm del vértice apical, así como de las porciones 1/3, 1⁄2, 2/3 del largo radicular y en la unión amelocementaria. Se determinó el número de raíces, conductos y configuración de Vertucci, así como forma y medidas de diámetro mayor y menor a 1 mm del vértice apical. El 90 % de primeros molares superiores reportó la presencia de 3 raíces y el 10 % mostró 2. En tanto que el total de primeros molares inferiores (100 %) reportó 2 raíces. En general, en las raíces mesiales prevaleció el Tipo II de Vertucci mientras que en las distales y palatinas la Tipo I. En el corte a 1 mm del vértice apical la forma redonda fue la de mayor prevalencia en los conductos de primeros molares superiores (44,5 %), seguida de la irregular (34,1 %) y la oval (21,4 %); mientras que en los primeros molares inferiores la más prevalente fue la irregular (54, 5 %), seguida de la redonda (23,9 %) y oval (21,6 %). Los diámetros mayor y menor de los conductos mesiales a 1 mm apical midieron 0,46 y 0,23 mm y 0,64 y 0,25 mm en molares superiores e inferiores respectivamente. La frecuencia de MB2 en primeros molares superiores fue del 77,8 %. Los conductos con mayor variabilidad fueron los mesiales. Se observó baja frecuencia de conductos ovales. Los diámetros mayores de los conductos mesiales en general, fueron superiores a 0,45 mm.

Accurate knowledge of dental root morphology is a key to success in endodontic therapies. The aim of this study was to evaluate the different variations of the root and apical morphology in upper and lower first molars of a modern Mayan population. Photomicrographs were taken from 80 upper and lower first molars, presented in cross sections at 1 and 2.5 mm from the apical vertex, as well as from the 1/3, 1⁄2, 2/3 portions of the root length and at the cementoenamel junction. The number of roots, canal and Vertucci`s configuration was determined, as well as the shape and measurements of the major and minor diameters at 1 mm from the apex. In this study 90 % of upper first molars reported the presence of 3 roots and 10 % showed 2, while the total lower first molars (100 %) reported 2 roots. In general, Vertucci`s Type II prevailed in the mesial roots while Type I was prevalent in the distal and palatal ones. In the 1 mm cut of the apical vertex, the round shape was the most prevalent in the canal of the first upper molars (44.5 %), followed by irregular (34.1 %) and oval (21.4 %); while in the first lower molars the most prevalent one was irregular (54.5 %), followed by round (23.9 %) and oval (21.6 %). The major and minor diameters of the mesial canals at 1 mm apical recorded 0.46 and 0.23 mm and 0.64 and 0.25 mm in upper and lower molars respectively. The frequency of MB2 in upper first molars was 77.8 %. The canals with greater variability were the mesial ones. Low frequency of oval canals was observed. The largest diameters of the mesial canal in general were greater than 0.45 mm.

Serum levels of interleukin-6 are linked to the severity of the disease caused by Andes Virus.

Andes virus (ANDV) is the etiological agent of hantavirus cardiopulmonary syndrome in Chile. In this study, we evaluated the profile of the pro-inflammatory cytokines IL-1ß, IL-12p70, IL-21, TNF-α, IFN-γ, IL-10 and IL-6 in serum samples of ANDV-infected patients at the time of hospitalization. The mean levels of circulating cytokines were determined by a Bead-Based Multiplex assay coupled with Luminex detection technology, in order to compare 43 serum samples of healthy controls and 43 samples of ANDV-infected patients that had been categorized according to the severity of disease. When compared to the controls, no significant differences in IL-1ß concentration were observed in ANDV-infected patients (p = 0.9672), whereas levels of IL-12p70 and IL-21 were significantly lower in infected cases (p = <0.0001). Significantly elevated levels of TNF-α, IFN-γ, IL-10, and IL-6 were detected in ANDV-infected individuals (p = <0.0001, 0.0036, <0.0001, <0.0001, respectively). Notably, IL-6 levels were significantly higher (40-fold) in the 22 patients with severe symptoms compared to the 21 individuals with mild symptoms (p = <0.0001). Using multivariate regression models, we show that IL-6 levels has a crude OR of 14.4 (CI: 3.3-63.1). In conclusion, the serum level of IL-6 is a significant predictor of the severity of the clinical outcome of ANDV-induced disease.

Association of Single-Nucleotide Polymorphisms in IL28B, but Not TNF-α, With Severity of Disease Caused by Andes Virus.

BACKGROUND: Andes virus (ANDV) is the sole etiologic agent of hantavirus cardiopulmonary syndrome (HCPS) in Chile, with a fatality rate of about 35%. Individual host factors affecting ANDV infection outcome are poorly understood. In this case-control genetic association analysis, we explored the link between single-nucleotide polymorphisms (SNPs) rs12979860, rs8099917 and rs1800629 and the clinical outcome of ANDV-induced disease. The SNPs rs12979860 and rs8099917 are known to play a role in the differential expression of the interleukin 28B gene (IL28B), whereas SNP rs1800629 is implicated in the expression of tumor necrosis factor α gene (TNF-α). METHODS: A total of 238 samples from confirmed ANDV-infected patients collected between 2006 and 2014, and categorized according to the severity of the disease, were genotyped for SNPs rs12979860, rs8099917, and rs1800629. RESULTS: Analysis of IL28B SNPs rs12979860 and rs8099917 revealed a link between homozygosity of the minor alleles (TT and GG, respectively), displaying a mild disease progression, whereas heterozygosity or homozygosity for the major alleles (CT/CC and TG/TT, respectively) in both IL28B SNPs is associated with severe disease. No association with the clinical outcome of HCPS was observed for TNF-α SNP rs1800629 (TNF -308G>A). CONCLUSIONS: The IL28B SNPs rs12979860 and rs8099917, but not TNF-α SNP rs1800629, are associated with the clinical outcome of ANDV-induced disease, suggesting a possible link between IL28B expression and ANDV pathogenesis.

[Present situation of hepatitis B in Chile]. / Situación actual de la hepatitis B en Chile.

BACKGROUND: Hepatitis B virus infection generates carriers and 8% will evolve to a chronic phase. AIM: To perform a compilation of studies on hepatitis B in Chile and other sources of information to estimate the impact of this disease in our country. MATERIAL AND METHODS: Published and unpublished evidence about the infection, in the general population and risk groups in our country, was compiled and reviewed critically. Informal interviews with experts, revision of the mandatory notification book of the Ministry of Health and collection of data from laboratories that study hepatitis B virus, were also carried out. RESULTS: The seroprevalence of chronic carriers in blood donors is nearly O.3%. Among risk groups such as health care personnel, the figure is O.7%, among homosexuals 29%, among HIV positive patients 30%, among sexual workers 2% and among children with chronic hemodialysis, 9%. Prevalence rate according to notified cases in 2004 was 1.8 x 100,000 inhabitants. Detection of viral hepatitis B surface antigen in laboratories occurs in 0.2% of donors and 1.396 of non donors. CONCLUSIONS: The seroprevalence of hepatitis B virus, the lack of notification, and the introduction of hepatitis B vaccine to our Regular Program of Immunizations, are arguments to develop in Chile a hepatitis B and C surveillance system.

Situación actual de la hepatitis B en Chile / Present situation of hepatitis B in Chile

Background: Hepatitis B virus infection generates carriers and 8 percent will evolve to a chronic phase. Aim: To perform a compilation of studies on hepatitis B in Chile and other sources of information to estímate the impact of this disease in our country. Material and methods: Published and unpublished evidence about the infection, in the general population and risk groups in our country, was compiled and reviewed critically. Informal interviews to experts, revisión of the mandatory notification book of the Ministry of Health and collection of data from laboratories that study hepatitis B virus, were also carried out. Results: The seroprevalence of chronic carriers in blood donors is nearly O.3 percent. Among risk groups such as health care personnel, the figure is O.7 percent, among homosexuals 29 percent, among HIV positive patients 30 percent, among sexual workers 2 percent and among children with chronic hemodialysis, 9 percent. Prevalence rate according to notified cases in 2004 was 1.8 x 100,000 habitants. Detection of viral hepatitis B surface antigen in ¡aboratories occurs in 0.2 percent of donors and 1.396 of non donors. Conclusions: The seroprevalence of hepatitis B virus, the lack of notification, and the introduction of hepatitis B vaccine to our Regular Program of Immunizations, are arguments to develop in Chile a hepatitis B and C surveillance system.

Hepatopatía en dadores de sangre portadores asintomáticos del virus B de la hepatitis / Hepatopathy in blood donors who are asymptomatic carriers of hepatitis B virus

Los portadores crónicos de HBsAg tienen una alta probabilidad de infectar a quienes reciben su sangre y a sus contactos sexuales y evolucionar a daño hepático intenso. Se citaron a 56 dadores de sangre que resultaron (+) al ELISA para HBsAg para estudio de alteraciones hepáticas. El 57,1 por ciento concurrió a la citación. De ellos, 12,5 por ciento resultó negativo al repetírseles el ELISA. El 94 por ciento de los dadores repetidamente (+) al ELISA fueron confirmados por técnica de neutralización en el ISP. La prevalencia estimada de portadores asintomáticos de HBsAg en este grupo de personas es de 0,12 por cientom menor que lo señalado por otros autores, lo que puede atribuirse a un efectivo descenso por la práctica de medidas de control en los bancos de sangre. El 28 por ciento de los dadores HbsAg (+) refirió algún actor de riesgo de infección. Un alto porcentaje de dadores de sangre refirió un consumo exagerado de alcohol. Las alteraciones de las pruebas de laboratorio hepático fueron frecuentes, pero de muy baja intensidad. La excreción de bromosulfaleína fue la prueba de laboratorio mas frecuentemente alterada (36 por ciento). Sólo un paciente con indicación de biopsia aceptó relizársela, demostrándose hepatitis crónica persistente. Las pruebas de laboratorio pueden encontrarse levemente alteradas en dadores de sangre HBsAg (+), pero aún así es posible demostrar evidencias, a lo menos, de hapatitis crónica persistente