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1.
Br J Clin Pharmacol ; 2020 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-32022291

RESUMO

AIMS: Therapeutic drug monitoring (TDM) of trough serum infliximab concentrations has been mainly used in case of loss of response in patients with inflammatory bowel disease (IBD). The aim of this study was to evaluate the effectiveness and safety of a multidisciplinary early proactive TDM (mep-TDM) programme for dose adjustment. METHODS: A 3-year prospective study was conducted based on a sample of 81 patients who started treatment and were subsequently subjected to mep-TDM with the first control at week 14. Data of a historical control group of 72 patients treated with infliximab and managed with empirical dosing were included. Effectiveness variables were treatment failure, IBD-related surgery and IBD-related hospitalization. Safety variables were serious infusion reactions (SIRs) and adverse reactions. Cox regression was used for survival analysis. RESULTS: In the mep-TDM study group, compared to the control group, there was a significant reduction in the risk of treatment failure (hazard ratio [HR]: 0.51; 95% confidence interval [CI]: 0.27-0.92; P = .037), IBD-related surgery (HR: 0.14; 95% CI: 0.03-0.65; P = .012) and hospitalization (HR: 0.38; 95% CI: 0.17-0.87; P = .022). SIRs were lower in the mep-TDM group (2.5% vs 10.4%; P < .050); the incidence of adverse reactions was similar (3.7% vs 3.9%; p > .999). CONCLUSION: This study found that compared to empirical dosing, mep-TDM is associated with improved efficacy and safety of infliximab therapy, reduced IBD-related hospitalization and surgery and incidence of SIRs, and increasing long-term durability of treatment effects.

2.
Strahlenther Onkol ; 196(1): 1-14, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31586232

RESUMO

PURPOSE: Abdominal recurrences of gastrointestinal malignancies are common. Evidence in clinical studies has shown that re-irradiation (Re-I) is tolerable and efficient in different tumor locations. In contrast, little clinical data are available on normal long-term Re­I tolerance doses. A systematic review of upper abdominal Re­I was performed with the aim of exploring the cumulative dose, toxicity, and outcomes. METHODS: A computerized search was undertaken in MEDLINE, EMBASE, OVID, and the Cochrane database. Only studies reporting toxicity and/or outcomes were taken into consideration. To improve the comparability of the different Re­I regimens and assess the relationship between Radiotherapy (RT) dose and toxicity, the equivalent dose in 2­Gy fractions was calculated according to the linear quadratic model. RESULTS: Sixteen studies met the inclusion criteria, with the total patients numbering 408. Median follow-up Re­I ranged from 5.9 to 45 months. The median time elapsed since previous RT treatment was 15 months (2-162 months). Re­I prescription doses were variable (22.5 Gy in 3 fractions to 126.5 Gy with 125I). Cumulative doses calculated for acute- and late-responding tissues ranged from 67.25 to 136 Gy and 30.3 to 188.38 Gy, respectively. Comprehensively, the pooled ≥G3 toxicity was 12% (95%CI: 7.6-19%). The overall 1­year survival and local recurrence-free survival rates were 53.7% (95%CI: 45.6-63.2%) and 66.5% (95% CI: 58.7-75.4%), respectively. Pain improvement was reported in 66.9% of patients. CONCLUSION: Due to limited evidence as a result of the retrospective design of the majority of the studies, our review suggests that upper abdominal Re­I is effective in terms of local control and palliation, with a moderate rate of severe toxicities.

3.
Int J Oral Maxillofac Implants ; 34(6): 1328­1336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31532826

RESUMO

PURPOSE: There is a lack of knowledge concerning the critical buccal bone thickness required for securing favorable functional and esthetic outcomes, conditioned to the dimensional changes after implant placement. A preclinical study was therefore carried out to identify the critical buccal bone wall thickness for minimizing bone resorption during physiologic and pathologic bone remodeling. MATERIALS AND METHODS: A randomized, two-arm in vivo study in healthy beagle dogs was carried out. The first group of dogs was sacrificed 8 weeks after implant placement for histomorphometric examination of postsurgical resorption of the buccal bone wall. The second group of dogs was monitored during three ligature-induced peri-implantitis episodes and a spontaneous progression episode. Morphometric and clinical variables were defined for the study of physiologic and pathologic buccal and lingual bone loss. RESULTS: Seventy-two implants were placed in healed mandibular ridges of 12 beagle dogs. Two groups were defined: 36 implants were placed in sites with a thin buccal bone wall (< 1.5 mm), and 36 were placed in sites with a thick buccal bone wall (≥ 1.5 mm). No implants failed during the study period. For the great majority of the histomorphometric parameters, a critical buccal bone wall thickness of at least 1.5 mm seemed to be essential for maintaining the buccal bone wall during physiologic and pathologic bone resorption. Suppuration (+) and mucosal recession (-) were more often associated with implants placed in sites with a thin buccal bone wall. CONCLUSION: A critical buccal bone wall thickness of 1.5 mm at implant placement is advised, since a thicker peri-implant buccal bone wall (> 1.5 mm) is exposed to significantly less physiologic and pathologic bone loss compared with a thinner buccal bone wall (< 1.5 mm).


Assuntos
Remodelação Óssea , Implantes Dentários , Estética Dentária , Animais , Implantação Dentária Endo-Óssea , Cães , Mandíbula , Distribuição Aleatória , Zigoma
4.
Clin Oral Implants Res ; 30(12): 1209-1219, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31514229

RESUMO

OBJECTIVES: The aim was to evaluate the degree of bone regeneration and re-osseointegration attained when combining a xenogeneic bone replacement graft plus rhBMP-2 and a collagen membrane in ligature-induced peri-implantitis osseous defects in dogs. MATERIAL AND METHODS: Thirty-six implants were placed in a total of 6 Beagle dogs, 3 months after tooth extraction. Once experimental peri-implantitis was induced, defects were randomly allocated into two treatment groups: in the test group guided bone regeneration was applied using de-proteinized bovine bone mineral with 10% collagen soak loaded with rhBMP2 covered with a natural collagen membrane. In the control group, the same scaffold and membrane were used but saline was used to soak the grafting material. After a period of 8 weeks of healing, a submerged environment clinical measurements were taken and histological outcomes were evaluated once the animals were euthanized. Histological bone defect regeneration (BR) was considered as the primary outcome variable, and dog was selected as the unit of analysis. RESULTS: Partial defect resolution was observed in both treatment groups. The histometric analysis showed a higher degree of bone regeneration for the test group, although differences were not statistically significant, both in terms of histological bone gain and percentage of re-osseointegration. CONCLUSIONS: (a) The addition of rhBMP2 to a bovine xenograft/collagen vehicle carrier failed to provide a significant added value in terms of bone regeneration or re-osseointegration, (b) partial re-osseointegration of a previously contaminated surface was achieved, although (c) a complete defect resolution and re-osseointegration to the level previous to the induction of the disease failed to occur in any of the treatment groups.


Assuntos
Implantes Dentários , Peri-Implantite , Animais , Regeneração Óssea , Osso e Ossos , Bovinos , Cães , Regeneração Tecidual Guiada Periodontal , Osseointegração
5.
Clin Oral Investig ; 2019 Jul 26.
Artigo em Inglês | MEDLINE | ID: mdl-31346723

RESUMO

OBJECTIVE: The aim of the present study was to assess the effects of alendronate (ALN) on bone remodeling following tooth extraction in a dog model. MATERIAL AND METHODS: For the study, fifteen male Beagles dogs of approximately 12 months of age were used. Mesial roots of four mandibular premolars were endodontically treated, and the distal roots were removed. ALN concentrations of 0.5, 1, and 2 mg/mL were topically applied for 15 min, while a sterile saline was used as a negative control. After the healing period of 1, 2, and 8 weeks, the samples were analyzed by micro-CT and histology. RESULTS: Treatment with ALN increased vertical distance between the lingual and the buccal crestal bones. While the ALN-treated sockets had preserved more lingual bone areas, control sockets showed better preservation of the buccal bone areas. ALN treatment resulted in more osteoid formation within the extraction sockets compared with the control. Higher bone volume was found in ALN groups than in the control at 2-week and 8-week healing periods, reaching the significant difference only for the extraction sockets pooled for the ALN treatment. CONCLUSIONS: Although ALN treatment could not prevent buccal bone resorption following tooth extraction in dogs, it proved beneficial for the preservation of the lingual bone and formation of new bone within the socket. There was no clear relation between the ALN dosages and the alterations within the extraction sockets. CLINICAL RELEVANCE: ALN affects bone remodeling of the extraction socket. The optimal concentration remains to be determined in future studies.

6.
Endosc Int Open ; 7(6): E743-E750, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31157291

RESUMO

Background and study aims Chromoendoscopy with targeted biopsy is the technique of choice for colorectal cancer screening in longstanding inflammatory bowel disease. We aimed to analyze results of a chromoendoscopy screening program and to assess the possibility of identifying low-risk dysplastic lesions by their endoscopic appearance in order to avoid histological analysis. Materials and methods We retrospectively reviewed chromoendoscopies performed between February 2011 and June 2017 in seven Spanish hospitals in a standardized fashion. We analyzed the findings and the diagnostic yield of the Kudo pit pattern for predicting dysplasia. Results A total of 709 chromoendoscopies (569 patients) were reviewed. Median duration of disease was 16.7 years (SD 8.1); 80.4 % had ulcerative colitis. A total of 2025 lesions (3.56 lesions per patient) were found; two hundred and thirty-two lesions were neoplastic (11.5 %) (223 were LGD (96.1 %), eight were HGD (3.4 %), and one was colorectal cancer (0.5 %). The correlation between dysplasia and Kudo pit patterns predictors of dysplasia (≥ III) was low, with an area under the curve of 0.649. Kudo I and II lesions were correctly identified with a high negative predictive value (92 %), even by non-experts. Endoscopic activity, Paris 0-Is classification, and right colon localization were risk factors for dysplasia detection, while rectum or sigmoid localization were protective against dysplasia. Conclusions Chromoendoscopy in the real-life setting detected 11 % of dysplastic lesions with a low correlation with Kudo pit pattern. A high negative predictive value would prevent Kudo I and, probably, Kudo II biopsies in the left colon, reducing procedure time and avoiding complications.

7.
Pharmacogenomics J ; 19(6): 547-555, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31043678

RESUMO

The production of antibodies to anti-tumor necrosis factor alpha (TNF) agents is one of the main causes of treatment failure in Crohn's disease (CD). To date, however, the contribution of genetics to anti-TNF immunogenicity in CD is still unknown. The objective of the present study was to identify genetic variation associated with anti-TNF immunogenicity in CD. We performed a two-stage genome-wide association study in a cohort of 96 and 123 adalimumab-treated patients, respectively. In the discovery stage, we identified a genome-wide significant association between the CD96 locus and the production of antibodies to anti-TNF treatment (P = 1.88e-09). This association was validated in the replication stage (P < 0.05). The risk allele for anti-TNF immunogenicity was found to be also associated with a lack of response to anti-TNF therapy (P = 0.019). These findings represent an important step toward the understanding of the immunogenicity-based mechanisms that underlie anti-TNF response in CD.

8.
Dig Dis ; 37(6): 444-450, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31039560

RESUMO

BACKGROUND: Adalimumab (ADA) is an anti-tumor necrosis factor agent that has been shown to be effective in inducing and maintaining remission in adult patients with inflammatory bowel disease. The relationship between the ADA trough levels and clinical efficacy has been demonstrated, but there is variability in the definition of the most suitable range for its clinical applicability. SUMMARY: A review of published studies during the last 5 years on ADA serum levels and its relationship with the clinical outcome was performed. The studies selected included 7 observational studies, a systematic review, a meta-analysis and a post hoc analysis of a clinical trial. The reported ADA levels that discriminate patients in clinical remission from those with active disease range from 4.5 to 8 µg/mL. This therapeutic range varies when considering endoscopic remission (7.5 to >13.9 µg/mL). Although the sample of patients with ulcerative colitis is small, a tendency to reach higher levels of ADA is observed in both clinical and endoscopic remission. Key Messages: The optimal therapeutic cut-off point of serum ADA levels ranges from 4.5-5 to 12 µg/mL, where ADA levels are associated with an adequate clinical monitoring of the disease during maintenance therapy. These ranges vary according to the target, suggesting levels of 4.8 µg/mL as the cut-off for clinical remission and levels ≥7.5 µg/mL for mucosal healing/endoscopic response. Controlled prospective studies are required to determine the optimal therapeutic interval of ADA serum levels both as induction and as maintenance therapy.


Assuntos
Adalimumab/sangue , Adalimumab/uso terapêutico , Doenças Inflamatórias Intestinais/sangue , Doenças Inflamatórias Intestinais/tratamento farmacológico , Anti-Inflamatórios/uso terapêutico , Endoscopia , Humanos , Publicações , Resultado do Tratamento
9.
J Urol ; 202(4): 725-731, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31075058

RESUMO

PURPOSE: Salvage radical prostatectomy has historically yielded a poor functional outcome and a high complication rate. However, recent reports of robotic salvage radical prostatectomy have demonstrated improved results. In this study we assessed salvage radical prostatectomy functional outcomes and complications when comparing robotic and open approaches. MATERIALS AND METHODS: We retrospectively collected data on salvage radical prostatectomy for recurrent prostate cancer after local nonsurgical treatment at 18 tertiary referral centers from 2000 to 2016. The Clavien-Dindo classification was applied to classify complications. Complications and functional outcomes were evaluated by univariable and multivariable analysis. RESULTS: We included 395 salvage radical prostatectomies, of which 186 were open and 209 were robotic. Robotic salvage radical prostatectomy yielded lower blood loss and a shorter hospital stay (each p <0.0001). No significant difference emerged in the incidence of major and overall complications (10.1%, p=0.16, and 34.9%, p=0.67), including an overall low risk of rectal injury and fistula (1.58% and 2.02%, respectively). However, anastomotic stricture was more frequent for open salvage radical prostatectomy (16.57% vs 7.66%, p <0.01). Overall 24.6% of patients had had severe incontinence, defined as 3 or more pads per day, for 12 or 6 months. On multivariable analysis robotic salvage radical prostatectomy was an independent predictor of continence preservation (OR 0.411, 95% CI 0.232-0.727, p=0.022). Limitations include the retrospective nature of the study and the absence of a standardized surgical technique. CONCLUSIONS: In this contemporary series to our knowledge salvage radical prostatectomy showed a low risk of major complications and better functional outcomes than previously reported. Robotic salvage radical prostatectomy may reduce anastomotic stricture, blood loss and hospital stay, and improve continence outcomes.


Assuntos
Recidiva Local de Neoplasia/cirurgia , Prostatectomia/efeitos adversos , Neoplasias da Próstata/cirurgia , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Terapia de Salvação/efeitos adversos , Idoso , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Constrição Patológica/epidemiologia , Constrição Patológica/etiologia , Seguimentos , Humanos , Incidência , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Próstata/patologia , Próstata/cirurgia , Antígeno Prostático Específico/sangue , Prostatectomia/métodos , Neoplasias da Próstata/sangue , Neoplasias da Próstata/patologia , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/métodos , Terapia de Salvação/métodos , Resultado do Tratamento , Incontinência Urinária/epidemiologia , Incontinência Urinária/etiologia
10.
J Bone Miner Metab ; 37(4): 573-583, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31087186

RESUMO

Osteoporosis is a major public health problem affecting more than 200 million people worldwide. The use of different animal models, for the study of its pathophysiology and treatments, is important being actually the ovariectomized rat the most widely used; although this model has several problems due its small size, lack of true closure of epiphyseal plate and bone differences with humans. This review is aimed at summarizing the most common methods published for osteoporosis induction in rabbits as model for human disease with their advantages and disadvantages. The paper shows the advantages of the use of this specie compared with the rat. All the techniques seemed to achieve the osteoporotic condition, but the one which obtained the most consistent bone mineral reduction in less time was the combination of surgery and corticoid treatment. The conclusion of the review was that rabbits are promising as a model of osteoporosis research because of their size, haversian remodelling and closure of epiphyseal plate, which solve some of the problems of the rat model. There are different techniques in the literature used to achieve the osteoporotic condition with diverse results, but there is a lack of consensus as to the best one.


Assuntos
Modelos Animais de Doenças , Osteoporose/patologia , Animais , Cálcio na Dieta , Feminino , Glucocorticoides/administração & dosagem , Osteoporose/fisiopatologia , Ovariectomia/efeitos adversos , Coelhos
11.
Rev. cuba. salud pública ; 45(1): e1189, ene.-mar. 2019. graf
Artigo em Espanhol | LILACS | ID: biblio-991124

RESUMO

RESUMEN Introducción: La automedicación es un problema de salud, especialmente, en estudiantes que viven en residencias universitarias. Objetivo: Caracterizar la automedicación en estudiantes que viven en una residencia universitaria de la ciudad de Chillán. Métodos: Estudio descriptivo transversal. La muestra fue no probabilística y quedó conformada por 102 estudiantes que representaron el 68 % del universo. Para caracterizar la práctica de automedicación se creó un instrumento basado en la literatura, el cual se validó por expertos y prueba piloto. Resultados: Se obtuvo una prevalencia de automedicación del 81,2 %. Las principales razones refieren no considerar necesario consultar al médico (46 %). Si la sintomatología persiste, un 56 % concurre al médico. La adquisición de medicamentos es principalmente en farmacias (63 %) y las fuentes de promoción de la conducta son lideradas por familiares (51 %) y amigos (47,6 %). Los síntomas más frecuentes que fueron causa de la automedicación fueron: dolor de cabeza, gripe e inflamaciones, las cuales fueron tratadas preferentemente por el grupo de fármacos antiinflamatorios no esteroideos. El 80 % considera que automedicarse es una práctica riesgosa, el 64 % ha recomendado algún medicamento y un 46 % tienen un stock de ellos en su lugar de residencia. Conclusiones: La automedicación constituye una forma de autocuidado que debe ser enfocada en forma conjunta por todos los entes participantes a fin de minimizar los potenciales riesgos asociados.


ABSTRACT Introduction: Self-medication is a health problem, especially in students who live in university residences. Objective: To characterize self- medication in students from a university dorm in the city of Chillán, Chile. Methods: Cross-sectional, descriptive study. The sample was non- probabilistic and it was formed by 102 students that represented the 68 % of the sample group. In order to evaluate self- medication and its characteristics, a tool was created based on the literature, which was validated by experts and a pilot test. Results: There was a self-medication's prevalence of 81,2 %. The main causes for doing it have to do with that they do not consider necessary to consult a doctor (46 %); if the symptomatology persists, 56 % of them go to the doctor. The acquisition of medicines comes mainly from pharmacies (63 %) and the sources of behavior's promotion are led by relatives (51%) and friends (47,6 %). The more frequent symptoms reported were: headaches, flu and inflammation, which were preferably treated by non-steroidal anti-inflammatory drugs. The 80 % considered that self- medication is a risky practice; nevertheless, 64 % have sometimes recommended a medicine and 46 % of them have a medicine's stock at home. Conclusions: Self- medication establishes a way of self-care that should be focused jointly by all participating entities to minimize the potential associated risks.


Assuntos
Humanos , Masculino , Feminino , Adolescente , Automedicação/efeitos adversos , Automedicação/psicologia , Chile , Epidemiologia Descritiva , Estudos Transversais
12.
Rev. cuba. salud pública ; 45(1)ene.-mar. 2019. graf
Artigo em Espanhol | CUMED | ID: cum-73451

RESUMO

Introducción: La automedicación es un problema de salud, especialmente, en estudiantes que viven en residencias universitarias. Objetivo: Caracterizar la automedicación en estudiantes que viven en una residencia universitaria de la ciudad de Chillán. Métodos: Estudio descriptivo transversal. La muestra fue no probabilística y quedó conformada por 102 estudiantes que representaron el 68 por ciento del universo. Para caracterizar la práctica de automedicación se creó un instrumento basado en la literatura, el cual se validó por expertos y prueba piloto. Resultados: Se obtuvo una prevalencia de automedicación del 81,2 por ciento. Las principales razones refieren no considerar necesario consultar al médico (46 por ciento). Si la sintomatología persiste, un 56 por ciento concurre al médico. La adquisición de medicamentos es principalmente en farmacias (63 por ciento) y las fuentes de promoción de la conducta son lideradas por familiares (51 por ciento) y amigos (47,6 por ciento). Los síntomas más frecuentes que fueron causa de la automedicación fueron: dolor de cabeza, gripe e inflamaciones, las cuales fueron tratadas preferentemente por el grupo de fármacos antiinflamatorios no esteroideos. El 80 por ciento considera que automedicarse es una práctica riesgosa, el 64 por ciento ha recomendado algún medicamento y un 46 por ciento tienen un stock de ellos en su lugar de residencia. Conclusiones: La automedicación constituye una forma de autocuidado que debe ser enfocada en forma conjunta por todos los entes participantes a fin de minimizar los potenciales riesgos asociados(AU)


Introduction: Self-medication is a health problem, especially in students who live in university residences. Objective: To characterize self- medication in students from a university dorm in the city of Chillán, Chile. Methods: Cross-sectional, descriptive study. The sample was non- probabilistic and it was formed by 102 students that represented the 68 percent of the sample group. In order to evaluate self- medication and its characteristics, a tool was created based on the literature, which was validated by experts and a pilot test. Results: There was a self-medication's prevalence of 81,2 percent. The main causes for doing it have to do with that they do not consider necessary to consult a doctor (46 percent); if the symptomatology persists, 56 percent of them go to the doctor. The acquisition of medicines comes mainly from pharmacies (63 percent) and the sources of behavior's promotion are led by relatives (51 percent) and friends (47,6 percent). The more frequent symptoms reported were: headaches, flu and inflammation, which were preferably treated by non-steroidal anti-inflammatory drugs. The 80 percent considered that self- medication is a risky practice; nevertheless, 64 percent have sometimes recommended a medicine and 46 percent of them have a medicine's stock at home. Conclusions: Self- medication establishes a way of self-care that should be focused jointly by all participating entities to minimize the potential associated risks(AU)


Assuntos
Humanos , Masculino , Feminino , Adolescente , Automedicação/efeitos adversos , Automedicação/psicologia , Chile , Epidemiologia Descritiva , Estudos Transversais
13.
JMIR Res Protoc ; 8(1): e10914, 2019 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-30681969

RESUMO

BACKGROUND: Pesticide use is increasing in low- and middle-income countries (LMICs) including Costa Rica. This increase poses health risks to farm owners, farm workers, and communities living near agricultural farms. OBJECTIVE: We aimed to examine the health effects associated with occupational pesticide exposure in farm owners and workers from conventional and organic smallholder farms in Costa Rica. METHODS: We conducted a cross-sectional study involving 300 owners and workers from organic and conventional horticultural smallholder farms in Zarcero County, Costa Rica. During the baseline study visit, we administered a structured, tablet-based questionnaire to collect data on sociodemographic characteristics, pesticide exposure, and health conditions (eg, respiratory and allergic outcomes and acute pesticide intoxication symptoms) and administered a neurobehavioral test battery (eg, Finger Tapping Test and Purdue Pegboard); we measured blood pressure, anthropometry (height, weight, and waist circumference), and erythrocytic acetylcholinesterase activity and also collected urine samples. In addition, a functional neuroimaging assessment using near-infrared spectroscopy was conducted with a subset of 50 study participants. During the follow-up study visit (~2-4 weeks after the baseline), we administered participants a short questionnaire on recent pesticide exposure and farming practices and collected hair, toenail, and urine samples. Urine samples will be analyzed for various pesticide metabolites, whereas toenails and hair will be analyzed for manganese (Mn), a biomarker of exposure to Mn-containing fungicides. Self-reported pesticide exposure data will be used to develop exposure intensity scores using an exposure algorithm. Furthermore, exposure-outcome associations will be examined using linear and logistic mixed-effects regression models. RESULTS: Fieldwork for our study was conducted between May 2016 and August 2016. In total, 113 farm owners and 187 workers from 9 organic and 83 conventional horticultural smallholder farms were enrolled. Data analyses are ongoing and expected to be published between 2019 and 2020. CONCLUSIONS: This study is one of the first to examine differences in health effects due to pesticide exposure between farm owners and workers from organic and conventional smallholder farms in an LMIC. We expect that this study will provide critical data on farming practices, exposure pathways, and how occupational exposure to pesticides may affect farm owners and workers' health. Finally, we hope that this study will allow us to identify strategies to reduce pesticide exposure in farm owners and workers and will potentially lay the groundwork for a future longitudinal study of health outcomes in farm owners and workers exposed to pesticides. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/10914.

15.
Clin Oral Implants Res ; 29(10): 1050-1059, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30281171

RESUMO

OBJECTIVES: The purpose of this study was to compare the effects of rhBMP2 with rhBMP9 on ridge augmentation following healing of extraction sockets in dogs. MATERIAL AND METHODS: Five male Beagle dogs, approximately 12 months of age, were used. The mesial roots of the four maxillary premolars were endodontically treated. The distal roots were extracted, and the buccal bony walls removed. All extraction sockets were filled with deproteinized bovine bone mineral (DBBM). A collagen membrane was soaked with 4 µg or 20 µg of rhBMP9, 20 µg of rhBMP2 or sterile saline and placed over the augmented sites. All animals were euthanized after 8 weeks of healing and investigated by micro-CT and histologic analysis. A one-way ANOVA with Tukey's HSD post hoc test was used to compare the differences between the four groups. RESULTS: New bone apposition in all defects was observed from the original bone. RhBMP samples showed an increase in bone formation in the buccal area and better integration of DBBM particles when compared to control sites. Both rhBMP9 defects showed higher values of bone (p = 0.024), bone marrow (p = 0.044), and total augmentation volume (p = 0.033) than the rhBMP2 (20 µg) or control sites. Highest bone area was found in rhBMP9 defects (p = 0.895). CONCLUSIONS: Within the limitations of the present study, rhBMP9 sites demonstrated higher bone-inducing potential in combination with DBBM than rhBMP2. While rhBMP9s failed to demonstrate a clear dose-response relationship to the outcomes, future studies are necessary to evaluate the appropriate dose and carrier systems.


Assuntos
Aumento do Rebordo Alveolar/métodos , Proteína Morfogenética Óssea 2/uso terapêutico , Fatores de Diferenciação de Crescimento/uso terapêutico , Animais , Regeneração Óssea/efeitos dos fármacos , Substitutos Ósseos/uso terapêutico , Cães , Humanos , Masculino , Proteínas Recombinantes , Extração Dentária
16.
Aliment Pharmacol Ther ; 48(8): 839-851, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30281832

RESUMO

BACKGROUND: Effectiveness of vedolizumab in real world clinical practice is unknown. AIM: To evaluate the short and long-term effectiveness of vedolizumab in patients with inflammatory bowel disease (IBD). METHODS: Patients who received at least 1 induction dose of vedolizumab were included. Effectiveness was defined based on Harvey-Bradshaw index (HBI) in Crohn's disease (CD) and Partial Mayo Score (PMS) in ulcerative colitis (UC). Short-term response was assessed at week 14. Variables associated with short-term remission were identified by logistic regression analysis. The Kaplan-Meier method was used to evaluate the long-term durability of vedolizumab treatment. Cox model was used to identify factors associated with discontinuation of treatment and loss of response. RESULTS: 521 patients were included (median follow-up 10 months [interquartile range 5-18 months]). At week 14, 46.8% had remission and 15.7% clinical response. CD (vs UC), previous surgery, higher CRP concentration and disease severity at baseline were significantly associated with impaired response. The rate of vedolizumab discontinuation was 37% per patient-year of follow-up (27.6% in UC and 45.3% in CD, P < 0.01). CD (vs UC), anaemia at baseline, steroids during induction and CRP concentration were associated with lower durability of treatment. Seven per cent of patients developed adverse events, infections being the most frequent. CONCLUSIONS: Over 60% of IBD patients respond to vedolizumab. Many patients discontinue treatment over time. CD and disease burden impair both short- and long-term response. Vedolizumab seems to be safe in clinical practice.


Assuntos
Anticorpos Monoclonais Humanizados/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Sistema de Registros , Adulto , Anticorpos Monoclonais Humanizados/efeitos adversos , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/tratamento farmacológico , Colite Ulcerativa/epidemiologia , Doenças Transmissíveis/induzido quimicamente , Doenças Transmissíveis/diagnóstico , Doenças Transmissíveis/epidemiologia , Doença de Crohn/diagnóstico , Doença de Crohn/tratamento farmacológico , Doença de Crohn/epidemiologia , Feminino , Seguimentos , Fármacos Gastrointestinais/efeitos adversos , Humanos , Doenças Inflamatórias Intestinais/epidemiologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão , Espanha/epidemiologia , Resultado do Tratamento
17.
Clin Oral Implants Res ; 29(10): 1016-1024, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30267449

RESUMO

OBJECTIVES: To investigate the impact of progressive bone loss in an experimental peri-implantitis model in the dog upon the implant stability quotient (ISQ) measured in the course of induced and spontaneous conditions of disease, and to evaluate the association between the clinical parameters and ISQ. MATERIALS AND METHODS: Seventy-two implants were placed in 12 Beagle dogs. Of these, 36 implants in six dogs were assessed during ligature-induced peri-implantitis (three timepoints) and at one timepoint following a period of spontaneous progression. The ISQ was recorded using resonance frequency analysis (RFA). Furthermore, the clinical peri-implant parameters were registered at four sites per implant at each timepoint. Marginal bone loss (MBL) was determined using computed tomography at four sites per implant and bone-to-implant contact (BIC) was assessed from histological samples. A linear regression model was estimated by generalized estimation equations (GEEs) in order to study the MBL-ISQ values at each measurement timepoint. Pearson's correlation test was applied. RESULTS: None of the implants failed during the study period. At implant level, a strong negative correlation was found for all timepoints between ISQ and MBL (r = -0.58; p < 0.001). Accordingly, as follow-up progressed, lower ISQ and higher MBL values were observed. A prediction of MBL depending on the ISQ values and timepoints showed a decrease in one ISQ unit to be related to ~1 mm of MBL. Likewise, a statistically significant correlation was found between BIC and ISQ evaluated after spontaneous chronification of peri-implantitis (r = 0.34; p = 0.04). Nevertheless, the ISQ values failed to correlate to any of the clinical parameters recorded. CONCLUSION: Resonance frequency analysis seems accurate in diagnosing progressive bone loss, as a statistically significant decrease in ISQ was recorded in the course of peri-implant disease. Nevertheless, the clinical relevance of this observation as a diagnostic tool is debatable, since implant stability remains high.


Assuntos
Perda do Osso Alveolar/diagnóstico , Implantação Dentária Endo-Óssea/efeitos adversos , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/patologia , Animais , Dente Suporte/efeitos adversos , Projeto do Implante Dentário-Pivô/efeitos adversos , Implantes Dentários/efeitos adversos , Cães , Peri-Implantite/diagnóstico , Peri-Implantite/etiologia , Peri-Implantite/patologia , Reprodutibilidade dos Testes , Tomografia Computadorizada por Raios X
18.
Clin Oral Implants Res ; 29(10): 986-995, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30246362

RESUMO

OBJECTIVES: To study the hard and soft tissue volume after placing immediate (IMI) or delayed implants (DLI) with a triangular coronal macro-design (Test/T) or a conventional cylindrical design (Control/C). MATERIAL AND METHODS: T/C implants were inserted in healed ridges or in fresh extraction sockets of eight beagle dogs. Biopsies were processed for Micro-CT analysis and dental stone casts were optically scanned to obtain STL files revealing the soft tissue contours at 12 weeks. Image analysis software was utilized to match common landmarks superimposing the two sets of data. Three distinct volumes were calculated; buccal bone volume (B-BV), soft tissue volume below the implant shoulder (EC-STV), and the soft tissue volume above the implant shoulder (SC-STV). Using linear measurements, the soft tissue height (STH), the mucosal thickness (MT-IS), and the distance from the implant shoulder to the bone crest (I-BC) were assessed in the digital images and in conventional histology to assess the concordance, reproducibility, and reliability. RESULTS: There were no significant differences between test and control implants regarding the buccal bone volume, although test implants had greater B-BV in all locations except for PM2. The soft tissue volume was similar at T/C implants. The surgical approach influenced the distribution of the total tissue volume. In the IMI, a low position of the bone crest was correlated with low values of B-BV, SC-STV, MT-IS, and STH. Linear measurements showed a high correlation between the histology and digital measurements and high inter and intra examiner agreement. CONCLUSION: The superimposition of Micro-CT/STL allowed the analysis of soft and hard tissue volumes. Reduction of the implant buccal aspect resulted in nonsignificant higher bone volume although similar soft tissue volume while the surgical approach influenced soft tissue response.


Assuntos
Processo Alveolar/diagnóstico por imagem , Implantação Dentária Endo-Óssea , Implantes Dentários , Carga Imediata em Implante Dentário , Periodonto/diagnóstico por imagem , Animais , Cães , Distribuição Aleatória , Resultado do Tratamento , Microtomografia por Raio-X
19.
Cardiol Res ; 9(2): 94-98, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29755626

RESUMO

Background: Impaired renal function has been shown in previous studies to be an independent predictor of cardiovascular adverse events amongst patients admitted for percutaneous coronary intervention (PCI) following ST-segment elevation myocardial infarction (STEMI). This study investigates the impact of admission serum creatinine (SCr) on major cardiovascular outcomes among STEMI patients undergoing PCI. Methods: A retrospective study of patients admitted for PCI following STEMI was conducted using the National Cardiovascular Database Action Registry (NCDR) at Cleveland Clinic Akron General (CCAG) Hospital. The primary outcome was a composite of major clinical events: cardiogenic shock, atrial fibrillation, ventricular tachycardia/fibrillation, heart failure, bleeding and mechanical ventilation. SCr was an independent and continuous variable. Results: A total of 656 patients included in the study with the diagnosis of STEMI who subsequently underwent primary PCI. Patients with eGFR < 60 mL/min/1.73 m2 on admission had an increased incidence of cardiogenic shock (P = 0.001), bleeding (P < 0.001), heart failure (P < 0.0005) and higher mortality rates (P = 0.0005). Furthermore, in the setting of STEMI, elevated SCr was also associated with an increased risk of developing major adverse events like cardiogenic shock (P = 0.05), bleeding (P = 0.05), and heart failure (P = 0.005). Conclusions: In the setting of STEMI, elevated SCr and eGFR < 60 mL/min/1.73 m2 was associated with an increased risk of developing major adverse events including cardiogenic shock, bleeding and heart failure.

20.
J Clin Periodontol ; 45(7): 869-883, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29505132

RESUMO

OBJECTIVES: To analyse bone remodelling and peri-implant soft tissues around platform-switching implants with and without a machined collar placed at different levels in relation to bone crest. MATERIAL AND METHODS: All mandibular premolars and the first molars were extracted in five dogs. At 6 months, six implants with and without a machined neck (MACH and GBAE implants, respectively) were randomly inserted in each hemimandible positioning the implant-abutment interface in either a supracrestal (+1.5 mm), equicrestal, or subcrestal (-1.5 mm) position. After 6 months, animals were killed for histomorphometric analysis. RESULTS: When net bone loss (primary outcome variable) was compared between MACH and GBAE groups, the multivariable regression analysis revealed no significant differences between implants inserted at the same vertical position. The dimensions of the peri-implant mucosa were greater in MACH implants compared with GBAE implants; however, these differences failed to reach statistical significance. Regarding the number of inflammatory cells and collagen fibre orientation, no statistically significant differences were found between MACH and GBAE groups. CONCLUSIONS: The surface treatment of the implant neck does not seem to have an influence on net bone loss, and there were no statistically significant differences in the peri-implant soft tissues between platform-switching implants with and without a machined neck.


Assuntos
Perda do Osso Alveolar , Implantes Dentários , Animais , Remodelação Óssea , Projeto do Implante Dentário-Pivô , Implantação Dentária Endo-Óssea , Planejamento de Prótese Dentária , Cães
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