Normas de avaliação e tratamento do(a) paciente cirúrgico(a) diabético(a) / Evaluation rules and treatment of) surgical patient diabetic

A diabetes mellitus ou diabetes sacarina - doença descrita pela primeira vez por Aretaeus de Capadócia em 200 A.C.- é um termo que designa um grupo de anomalias do metabolismo cuja manifestação clínica comum é a hiperglicémia. A diabetes resulta de a) deficiência de insulina e/ou de b) resistência à acção de insulina. De acordo com a Associação Americana de Diabetes, consideram-se 4 categorias de diabetes mellitus: I - a Diabetes Mellitus de Tipo I (DM Tipo I) II - a Diabetes Mellitus de tipo II (DM Tipo II) III - a Diabetes Mellitus Secundária, com as seguintes sub-categorias: - Defeitos genéticos da função das células beta - Defeitos genéticos da acção da insulina - Doenças do pâncreas exócrino (em caso de pancreatite crónica, fibrose cística, hemocromatose, pós-pancreatectomia) - Endocrinopatias (síndrome de Cushing,acromegália, feocromocitoma, aldosteronoma, hipertiroidismo) - Acção de fármacos ou de outros produtos químicos (gluococorticóides, diuréticos tiazídicos, beta-bloqueadores, tiroxina) - Infecções (citomegalovírus, rubéola, coxsackie) - Formas raras de diabetes mediada por mecanismo auto-imune - Síndromes genéticos (S. de Down, S. de Turner, S. de Klinefelter, porfíria, Coreia de Huntington, e outros) IV - a Diabetes Gestacional ou Diabetes da Gravidez

Oral complaints related to menopause.

OBJECTIVES: The purpose of the present study was to correlate oral and systemic symptoms of menopause and the oral health and salivary composition and flow rate in a group of women in menopause prior to hormone replacement therapy. METHODS: One-hundred fifty-four women attending a menopause clinic were divided into two groups. Group A, 58 women, without any systemic disease or treatments, and Group B,96 women with diseases and on various medications. They answered a questionnaire on their general health and oral and systemic complaints related to menopause. Fifty-four of the women agreed to have an oral examination and saliva analysis. Whole resting and submandibular (SM-SL) stimulated saliva were analyzed. RESULTS: The oral discomfort complaint was found in 45% in Group A and in 60% in Group B. 74% complained of climacteric symptoms in Group A and 63% in Group B. The odds ratio (OR) between oral discomfort and climacterics complaints of menopause was 8.03 in Group A and 4.08 in Group B. The salivary composition and flow rates did not differ significantly between the groups of menopausal women. However the salivary total protein and IgA concentrations were significantly higher in comparison to healthy young controls. CONCLUSIONS: The present study reports a high prevalence of oral discomfort in the women attending a menopause clinic. A highly significant odds ratio between systemic and oral complaints of menopause was found. The significantly altered salivary composition in these women might point to sympathetic activation due to psychological stress.

Relationship of medical status, medications, and salivary flow rates in adults of different ages.

Multiple systemic disorders and medications have been reported to cause xerostomia or salivary gland hypofunction. The purpose of this study was to evaluate the relationship among systemic disorders, medications, and salivary flow rates. Sixty-three ambulatory dental patients aged 23 to 82 years were randomly selected. The nature, duration, and number of systemic disorders and medications were documented. Repeated measurements of unstimulated whole, chewing-stimulated whole, acid-stimulated parotid, and candy-stimulated parotid salivary flow rates were obtained. Data were analyzed with the Wilcoxon rank-sum test, nonparametric multivariate analysis of variance, and Fisher's exact test. For persons with systemic disorders who were taking medication, all salivary flow rates were significantly (p = 0.03 - 0.001) lower than the flow rates in healthy persons. Among persons with at least one systemic disorder who were taking medication, those who had been taking medication for longer than 2 years had significantly lower unstimulated whole saliva (p = 0.002), chewing-stimulated whole saliva (p = 0.0004), and candy-stimulated parotid saliva (p = 0.02) flow rates than those who had been taking medication for 1 to 2 years. The number of systemic disorders significantly (p = 0.02) and negatively affected the acid-stimulated parotid salivary rates. The prevalence of salivary hypofunction determined on the basis of unstimulated whole saliva and acid-stimulated parotid saliva was significantly higher (p = < 0.001, p = 0.007) in the those persons with systemic disorders and taking medications. The results suggest that salivary secretion is affected by the number of systemic disorders and duration of the potentially xerogenic medications.

Does variability in salivary protein concentrations influence oral microbial ecology and oral health?

Salivary protein interactions with oral microbes in vitro include aggregation, adherence, cell-killing, inhibition of metabolism, and nutrition. Such interactions might be expected to influence oral ecology. However, inconsistent results have been obtained from in vivo tests of the hypothesis that quantitative variation in salivary protein concentrations will affect oral disease prevalence. Results may have been influenced by choices made during study design, including saliva source, stimulation status, control for flow rate, and assay methods. Salivary protein concentrations also may be subject to circadian variation. Values for saliva collected at the same time of day tend to remain consistent within subjects, but events such as stress, inflammation, infection, menstruation, or pregnancy may induce short-term changes. Long-term factors such as aging, systemic disease, or medication likewise may influence salivary protein concentrations. Such sources of variation may increase the sample size needed to find statistically significant differences. Clinical studies also must consider factors such as human population variation, strain and species differences in protein-microbe interactions, protein polymorphism, and synergistic or antagonistic interaction between proteins. Salivary proteins may form heterotypic complexes with unique effects, and different proteins may exert redundant effects. Patterns of protein-microbe interaction also may differ between oral sites. Future clinical studies must take those factors into account. Promising approaches might involve meta-analysis or multi-center studies, retrospective and prospective longitudinal designs, short-term measurement of salivary protein effects, and consideration of individual variation in multiple protein effects such as aggregation, adherence, and cell-killing.