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1.
Int J Mol Sci ; 23(21)2022 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-36361571

RESUMO

Biological mediators secreted during peripheral chronic inflammation reach the bloodstream and may damage the blood-brain barrier (BBB), triggering central nervous system (CNS) disorders. Full-fledged human BBB models are efficient tools to investigate pharmacological pathways and mechanisms of injury at the BBB. We here employed a human in vitro BBB model to investigate the effects of either plasma from inflammatory bowel disease (IBD) patients or tumor necrosis factor α (TNFα), a cytokine commonly released in periphery during IBD, and the anti-inflammatory role of pioglitazone, a peroxisome proliferator-activated receptor γ agonist (PPARγ). The BBB model was treated with either 10% plasma from healthy and IBD donors or 5 ng/mL TNFα, following treatment with 10 µM pioglitazone. Patient plasma did not alter BBB parameters, but TNFα levels in plasma from all donors were associated with varying expression of claudin-5, claudin-3 and ICAM-1. TNFα treatment increased BBB permeability, claudin-5 disarrangement, VCAM-1 and ICAM-1 expression, MCP1 secretion and monocyte transmigration. These effects were attenuated by pioglitazone. Plasma from IBD patients, which evoked higher BBB permeability, also increased ICAM-1 expression, this effect being reversed by pioglitazone. Our findings evidence how pioglitazone controls periphery-elicited BBB inflammation and supports its repurposing for prevention/treating of such inflammatory conditions.


Assuntos
Barreira Hematoencefálica , Doenças Inflamatórias Intestinais , Humanos , Barreira Hematoencefálica/metabolismo , Claudina-5/metabolismo , Inflamação/tratamento farmacológico , Inflamação/metabolismo , Doenças Inflamatórias Intestinais/metabolismo , Molécula 1 de Adesão Intercelular/metabolismo , Pioglitazona/farmacologia , Fator de Necrose Tumoral alfa/metabolismo
2.
Scand J Gastroenterol ; 49(8): 986-92, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24742130

RESUMO

OBJECTIVE: Liver biopsy (LB) remains the gold standard for the assessment of liver fibrosis, although it is invasive and can have complications. The present study compares several noninvasive methods of fibrosis assessment in chronic hepatitis C (CHC), including acoustic radiation force impulse (ARFI) elastography, aspartate aminotransferase:platelet ratio index (APRI), Forns, FIB-4, and King scores versus percutaneous LB. MATERIAL AND METHODS: This prospective study enrolled 51 untreated CHC patients. Biological tests necessary for the calculation of the scores (according to the classic formulas) were performed within a week of LB. The time interval between LB and tissue stiffness, assessed according to the Metavir score, was <6 months. Cutoff values were determined using area under receiver-operating characteristic curves (AUROC). RESULTS: The best test for predicting significant fibrosis (F ≥2 Metavir) was ARFI elastography with an AUROC of 0.90, followed by FIB-4 (AUROC = 0.86), King (AUROC = 0.85), Forns (AUROC = 0.84), and APRI (AUROC = 0.82). For a cutoff of 1.31 m/s, ARFI had 89.3% sensitivity (Se) and 87% specificity (Sp). The best test for predicting cirrhosis was ARFI elastography with an AUROC of 0.98, followed by FIB-4 (AUROC = 0.94), King (AUROC = 0.90), APRI (AUROC = 0.82), and Forns (AUROC = 0.81). For a cutoff of 1.95 m/s, ARFI had 100% Se and 95.2% Sp. CONCLUSION: ARFI elastography had very good accuracy for the assessment of liver fibrosis. It was more effective than APRI, Forns, King, and FIB-4 scores for the prediction of significant fibrosis and cirrhosis in CHC patients.


Assuntos
Aspartato Aminotransferases/sangue , Técnicas de Imagem por Elasticidade , Hepatite C Crônica/diagnóstico , Cirrose Hepática/diagnóstico , Contagem de Plaquetas , Adulto , Idoso , Biomarcadores/sangue , Biópsia , Índice de Massa Corporal , Técnicas de Imagem por Elasticidade/métodos , Feminino , Hepatite C Crônica/sangue , Hepatite C Crônica/complicações , Hepatite C Crônica/patologia , Humanos , Cirrose Hepática/sangue , Cirrose Hepática/patologia , Cirrose Hepática/virologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença
3.
Cochrane Database Syst Rev ; (3): CD010042, 2013 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-23543584

RESUMO

BACKGROUND: During controlled ovarian hyperstimulation (COH) follicle-stimulating hormone (FSH) is frequently used for several days to achieve follicular development. FSH is a relatively expensive drug, substantially contributing to the total expenses of assisted reproductive techniques (ART). When follicles achieve a diameter greater than 10 mm they start expressing luteinising hormone (LH) receptors. At this point, FSH might be replaced by low-dose human chorionic gonadotropin (hCG), which is less expensive. In addition to cost reduction, replacing FSH by low-dose hCG has a theoretical potential to reduce the incidence of ovarian hyperstimulation syndrome (OHSS). OBJECTIVES: To evaluate the effectiveness and safety of using low-dose hCG to replace FSH during the late follicular phase in women undergoing COH for assisted reproduction, compared to the use of a conventional COH protocol. SEARCH METHODS: We searched for randomised controlled trials (RCT) in electronic databases (Menstrual Disorders and Subfertility Group Specialized Register, CENTRAL, MEDLINE, EMBASE, PsycINFO, CINAHL, LILACS), trials registers (ClinicalTrials.gov, Current Controlled Trials, World Health Organization International Clinical Trials Registry Platform), conference abstracts (ISI Web of knowledge), and grey literature (OpenGrey); additionally we handsearched the reference list of included studies and similar reviews. The last electronic search was performed in February 2013.. SELECTION CRITERIA: Only true RCTs comparing the replacement of FSH by low-dose hCG during late follicular phase of COH were considered eligible; quasi or pseudo-randomised trials were not included. Cross-over trials would be included only if data regarding the first treatment of each participant were available; trials that included the same participant more than once would be included only if each participant was always allocated to the same intervention and follow-up periods were the same in both/all arms, or if data regarding the first treatment of each participant were available. We excluded trials that sustained FSH after starting low-dose hCG and those that started FSH and low-dose hCG at the same time. DATA COLLECTION AND ANALYSIS: Study eligibility, data extraction, and assessment of the risk of bias were performed independently by two review authors, and disagreements were solved by consulting a third review author. We corresponded with study investigators in order to solve any query, as required. The overall quality of the evidence was assessed in a GRADE summary of findings table. MAIN RESULTS: The search retrieved 1585 records; from those five studies were eligible, including 351 women (intervention = 166; control = 185). All studies were judged to be at high risk of bias. All reported per-woman rather than per-cycle data.When use of low-dose hCG to replace FSH was compared with conventional COH for the outcome of live birth, confidence intervals were very wide and findings were compatible with appreciable benefit, no effect or appreciable harm for the intervention (RR 1.56, 95% CI 0.75 to 3.25, 2 studies, 130 women, I² = 0%, very-low-quality evidence). This suggests that for women with a 14% chance of achieving live birth using conventional COH, the chance of achieving live birth using low-dose hCG would be between 10% and 45%.Similarly confidence intervals were very wide for the outcome of OHSS and findings were compatible with benefit, no effect or harm for the intervention (OR 0.30, 95% CI 0.06 to 1.59, 5 studies, 351 women, I² = 59%, very-low-quality evidence). This suggests that for women with a 3% risk of OHSS using conventional COH, the risk using low-dose hCG would be between 0% and 4%.The confidence intervals were wide for the outcome of ongoing pregnancy and findings were compatible with benefit or no effect for the intervention (RR 1.14, 95% CI 0.81 to 1.60, 3 studies, 252 women, I² = 0%, low-quality evidence). This suggests that for women with a 32% chance of achieving ongoing pregnancy using conventional COH, the chance using low-dose hCG would be between 27% and 53%.The confidence intervals were wide for the outcome of clinical pregnancy and findings were compatible with benefit or no effect for the intervention (RR 1.19, 95% CI 0.92 to 1.55, 5 studies, 351 women, I² = 0%, low-quality evidence). This suggests that for women with a 35% chance of achieving clinical pregnancy using conventional COH, the chance using low-dose hCG would be between 32% and 54%.The confidence intervals were very wide for the outcome of miscarriage and findings were compatible with benefit, no effect or harm for the intervention (RR 1.08, 95% CI 0.50 to 2.31, 3 studies, 127 pregnant women, I² = 0%, very-low-quality evidence). This suggests that for pregnant women with a 16% risk of miscarriage using conventional COH, the risk using low-dose hCG would be between 8% and 36%.The findings for the outcome of FSH consumption were compatible with benefit for the intervention (MD -639 IU, 95% CI -893 to -385, 5 studies, 333 women, I² = 88%, moderate-quality evidence).The findings for the outcome of number of oocytes retrieved were compatible with no effect for the intervention (MD -0.12 oocytes, 95% CI -1.0 to 0.8 oocytes, 5 studies, 351 women, I² = 0%, moderate-quality evidence). AUTHORS' CONCLUSIONS: We are very uncertain of the effect on live birth, OHSS and miscarriage of using low-dose hCG to replace FSH during the late follicular phase of COH in women undergoing ART, compared to the use of conventional COH. The current evidence suggests that this intervention does not reduce the chance of ongoing and clinical pregnancy; and that it is likely to result in an equivalent number of oocytes retrieved expending less FSH. More studies are needed to strengthen the evidence regarding the effect of this intervention on important reproductive outcomes.


Assuntos
Gonadotropina Coriônica/administração & dosagem , Substituição de Medicamentos , Fármacos para a Fertilidade Feminina/administração & dosagem , Hormônio Foliculoestimulante/administração & dosagem , Fase Folicular/efeitos dos fármacos , Técnicas de Reprodução Assistida , Aborto Espontâneo/epidemiologia , Gonadotropina Coriônica/efeitos adversos , Intervalos de Confiança , Feminino , Fármacos para a Fertilidade Feminina/efeitos adversos , Fase Folicular/fisiologia , Humanos , Nascido Vivo , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto
4.
Biomedicines ; 11(6)2023 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-37371853

RESUMO

Therapeutic drug monitoring (TDM) during induction therapy with anti-tumor necrosis factor drugs has emerged as a strategy to optimize response to these biologics and avoid undesired outcomes related to inadequate drug exposure. This study aimed to describe clinical, biological, and endoscopic remission rates at six months in Brazilian inflammatory bowel disease (IBD) patients following a proactive TDM algorithm guided by IFX trough levels (ITL) and antibodies to IFX (ATI) levels during induction, at week six. A total of 111 IBD patients were prospectively enrolled, excluding those previously exposed to the drug. ITL ≥ 10 µg/mL was considered optimal. Patients with suboptimal ITL (<10 µg/mL) were guided according to ATI levels. Those who presented ATI ≤ 200 ng/mL underwent dose intensification in the maintenance phase, and patients with ATI > 200 ng/mL discontinued IFX. In our study, proactive TDM was associated with persistence in the IFX rate at six months of 82.9%. At that time, rates of clinical, biological, and endoscopic remission in patients under IFX treatment were 80.2%, 73.9%, and 48.1%, respectively. Applying a simplified TDM-guided algorithm during induction seems feasible and can help improve patients' outcomes in clinical practice.

5.
Arq Gastroenterol ; 59(suppl 1): 51-84, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36995889

RESUMO

BACKGROUND: Inflammatory bowel diseases are immune-mediated disorders that include Crohn's disease (CD) and ulcerative colitis (UC). UC is a progressive disease that affects the colorectal mucosa causing debilitating symptoms leading to high morbidity and work disability. As a consequence of chronic colonic inflammation, UC is also associated with an increased risk of colorectal cancer. OBJECTIVE: This consensus aims to provide guidance on the most effective medical management of adult patients with UC. METHODS: A consensus statement was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's Disease and Colitis [GEDIIB]). A systematic review including the most recent evidence was conducted to support the recommendations and statements. All recommendations/statements were endorsed using a modified Delphi Panel by the stakeholders/experts in inflammatory bowel disease with at least 80% or greater consensus. RESULTS AND CONCLUSION: The medical recommendations (pharmacological and non-pharmacological) were mapped according to the stage of treatment and severity of the disease onto three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus targeted general practitioners, gastroenterologists and surgeons who manage patients with UC, and supports decision-making processes by health insurance companies, regulatory agencies, health institutional leaders, and administrators.


Assuntos
Colite Ulcerativa , Neoplasias Colorretais , Doença de Crohn , Doenças Inflamatórias Intestinais , Humanos , Adulto , Colite Ulcerativa/tratamento farmacológico , Doença de Crohn/complicações , Doença de Crohn/terapia , Doença de Crohn/diagnóstico , Brasil , Doenças Inflamatórias Intestinais/complicações , Inflamação , Neoplasias Colorretais/complicações
6.
Arq Gastroenterol ; 59(suppl 1): 20-50, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36995888

RESUMO

BACKGROUND: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn's disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. OBJECTIVE: To guide the safest and effective medical treatments of adults with CD. METHODS: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. RESULTS AND CONCLUSION: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Adulto , Humanos , Doença de Crohn/terapia , Doença de Crohn/tratamento farmacológico , Consenso , Brasil , Colite Ulcerativa/tratamento farmacológico
7.
J Dent Child (Chic) ; 89(2): 75-82, 2022 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-35986474

RESUMO

Purpose: To assess the levels of empathy and self-confidence of pre- and post-doctoral dental students during the dental care of children of different facial types, sex and skin color.
Methods: A cross-sectional survey was conducted with 170 Brazilian dental students. Photos of four mesofacial pediatric patients of different sex (male, female) and skin color (white, black) were digitally altered to dolichofacial and brachyfacial facial types. The 12 photos obtained (four originals and eight digitally altered) were projected during lectures and students reported their level of empathy (scores from zero to 10) and self-confidence (not confident/confident) using a structured questionnaire, based exclusively on children's appearance. Bivariate analysis and Poisson robust regression were performed (P <0.05).
Results: Students' lower empathy was observed among brachyfacial children (preva- lence ratio [PR] = 0.940; 95 percent confidence interval [95 percent CI] = 0.904 to 0.978). Female (PR=1.202; 95 percent CI=1.162 to 1.243) and black children (PR=1.068; 95 percent CI=1.035 to 1.103) received students' higher empathy scores. Higher percentages of self-confidence were associated with mesofacial (P =0.049), female (P <0.001), and black (P =0.001) children. Students' lower self-confidence was associated with brachyfacial (PR=1.106; 95 percent CI=1.066 to 1.147), male (PR=1.202; 95 percent CI=1.165 to 1.239) and white (PR=1.056; 95 percent CI =1.025 to 1.088) pediatric patients.
Conclusions: Brachyfacial children were associated with dental students' lower levels of empathy and self-confidence while female and black children received higher levels of empathy and self-confidence. However, dental students felt less confident regarding the dental care of white children.


Assuntos
Empatia , Estudantes de Odontologia , Criança , Estudos Transversais , Assistência Odontológica , Feminino , Humanos , Masculino , Pigmentação da Pele
8.
J Periodontol ; 93(2): 308-319, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34050677

RESUMO

BACKGROUND: This study evaluated the effects of infrared light laser therapy (ILLT) on ligature-induced periodontitis in rats using micro-computed tomography (micro-CT), histology, fibroblast migration, and viability analysis. METHODS: Forty-eight rats were randomly distributed into three groups: control (no periodontitis), PDC (periodontitis without laser therapy), and PD+L (periodontitis with laser therapy). Periodontitis was induced by ligature placement for 4 weeks. The 12-week-old rats (baseline) were subjected to laser treatment and euthanized 30 days after. After treatment, the mandibular first molars were prepared for micro-CT scanning, and histological sections were assessed as to the cementoenamel junction, alveolar bone crest, and polymorphonuclear (PMN) cell infiltration. In vitro assays were carried out to examine NIH/3T3 fibroblast viability after laser therapy. RESULTS: Migration and cell viability assays revealed that the ILLT maintained fibroblast cell viability with 4 J/cm2 , reaching 100% healing. The control group (at baseline and 30 days) presented a statistically significant difference from the PDC group at 30 days in terms of distance from the cementoenamel junction to the alveolar bone crest (CEJ-ABC). The PD+L group showed a statistically substantial difference from the PDC group at 30 days in terms of trabecular thickness (Tb.Th), degree of anisotropy (DA), and closed porosity percentage (Po%). CONCLUSION: ILLT seemed to preserve the bone structure in the in vivo periodontitis induction model at 30 days and did not reduce cell viability or increase fibroblast migration in vitro. The ILLT provides positive effects on mandibular bone microstructure.


Assuntos
Perda do Osso Alveolar , Terapia com Luz de Baixa Intensidade , Periodontite , Perda do Osso Alveolar/diagnóstico por imagem , Perda do Osso Alveolar/patologia , Animais , Lasers , Periodontite/patologia , Periodontite/radioterapia , Ratos , Microtomografia por Raio-X
9.
Arch Endocrinol Metab ; 65(6): 730-738, 2021 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-34762779

RESUMO

OBJECTIVE: Identifying significant fibrosis is crucial to evaluate the prognosis and therapeutic interventions in patients with nonalcoholic fatty liver disease (NAFLD). We assessed the performance of acoustic radiation force impulse (ARFI) elastography, APRI, FIB-4, Forns, NFS and BARD scores in determining liver fibrosis in severe obesity. METHODS: A prospective study included 108 patients undergoing bariatric surgery. Liver biopsy specimens were obtained intraoperatively and classified according to the NAFLD Activity Score. Patients were assessed with serological markers and shear wave velocity of the liver was measured with the Siemens S2000 ultrasound system preoperatively. Optimal cut-off values were determined using the area under the receiver operating characteristic curves (AUROC). RESULTS: In the entire cohort prevalence of NAFLD was 80.6%, steatohepatitis 25.9% and significant fibrosis 19.4%. The best tests for predicting significant fibrosis were FIB-4 and Forns scores (both AUROC 0.78), followed by APRI (AUROC 0.74), NFS (AUROC 0.68), BARD (AUROC 0.64) and ARFI (AUROC 0.62). ARFI elastography was successful in 73% of the patients. Higher body mass index (BMI) correlated with invalid ARFI measurements. In patients with BMI < 42 kg/m2, ARFI showed 92.3% sensitivity and 82,6% specificity for the presence of significant fibrosis, with AUROC 0.86 and cut-off 1.32 m/s. CONCLUSION: FIB-4 and Forns scores were the most accurate for the prediction of significant fibrosis in bariatric patients. Applicability and accuracy of ARFI was limited in individuals with severe obesity. In patients with BMI < 42 kg/m2, ARFI elastography was capable for predicting significant fibrosis with relevant accuracy.


Assuntos
Técnicas de Imagem por Elasticidade , Hepatopatia Gordurosa não Alcoólica , Obesidade Mórbida , Acústica , Biópsia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico por imagem , Hepatopatia Gordurosa não Alcoólica/patologia , Obesidade Mórbida/complicações , Obesidade Mórbida/diagnóstico por imagem , Estudos Prospectivos , Curva ROC , Fatores de Risco
10.
Front Immunol ; 12: 714138, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34603288

RESUMO

Non-responsiveness to anti-TNF-α therapies presents relevant rates in inflammatory bowel disease patients, presenting the need to find biomarkers involved in therapeutic efficacy. Herein, we demonstrate that higher levels of colonic formyl peptide receptor 1 and annexin A1 correlate with histological recovery in Crohn's disease patients under remission. Using the dextran sulfate sodium colitis model in mice, we suggest that infliximab induces annexin A1 expression and secretion in activated intestinal leukocytes. Conversely, this mechanism might stimulate epithelial formyl peptide receptors, inducing wound healing and consequent histological remission. Our data indicate that assessing intestinal expressions of formyl peptide receptors and annexin A1 might provide precious information on the disease activity and responsiveness to infliximab in inflammatory bowel disease patients.


Assuntos
Anexina A1/metabolismo , Colite/etiologia , Colite/metabolismo , Doença de Crohn/etiologia , Doença de Crohn/metabolismo , Receptores de Formil Peptídeo/metabolismo , Adulto , Animais , Anexina A1/genética , Antirreumáticos/farmacologia , Biópsia , Colite/tratamento farmacológico , Colite/patologia , Doença de Crohn/tratamento farmacológico , Doença de Crohn/patologia , Modelos Animais de Doenças , Suscetibilidade a Doenças , Feminino , Humanos , Infliximab/farmacologia , Leucócitos/imunologia , Leucócitos/metabolismo , Masculino , Camundongos , Camundongos Knockout , Modelos Biológicos , Especificidade de Órgãos , Receptores de Formil Peptídeo/genética , Inibidores do Fator de Necrose Tumoral/farmacologia , Adulto Jovem
11.
Probiotics Antimicrob Proteins ; 12(4): 1398-1408, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-31970649

RESUMO

Probiotics form a promising strategy to maintain intestinal health. Milks fermented with probiotic strains, such as the Lactobacillus paracasei ST11, are largely commercialized in Brazil and form a low-cost alternative to probiotic pharmaceutical formulations. In this study, we assessed the probiotic effects of milk fermented by L. paracasei ST11 (administered through fermented milk) in a Salmonella typhimurium infection model in BALB/c mice. We observed in this murine model that the applied probiotic conferred protective effects against S. typhimurium infection, since its administration reduced mortality, weight loss, translocation to target organs (liver and spleen) and ileum injury. Moreover, a reduction in the mRNA expression of pro-inflammatory cytokines such as IFN-γ, IL-6, TNF-α and IL-17 in animals that received the probiotic before challenge was observed. Additionally, the ileum microbiota was better preserved in these animals. The present study highlights a multifactorial protective aspect of this commercial probiotic strain against a common gastrointestinal pathogen.


Assuntos
Produtos Fermentados do Leite , Resistência à Doença/efeitos dos fármacos , Regulação da Expressão Gênica/efeitos dos fármacos , Lacticaseibacillus paracasei/fisiologia , Probióticos/farmacologia , Infecções por Salmonella/prevenção & controle , Animais , Peso Corporal/efeitos dos fármacos , Dieta , Resistência à Doença/genética , Resistência à Doença/imunologia , Regulação da Expressão Gênica/imunologia , Íleo/efeitos dos fármacos , Íleo/imunologia , Íleo/microbiologia , Interferon gama/genética , Interferon gama/imunologia , Interleucina-17/genética , Interleucina-17/imunologia , Interleucina-6/genética , Interleucina-6/imunologia , Fígado/efeitos dos fármacos , Fígado/imunologia , Fígado/microbiologia , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Infecções por Salmonella/imunologia , Infecções por Salmonella/microbiologia , Infecções por Salmonella/mortalidade , Salmonella typhimurium/efeitos dos fármacos , Salmonella typhimurium/crescimento & desenvolvimento , Salmonella typhimurium/patogenicidade , Baço/efeitos dos fármacos , Baço/imunologia , Baço/microbiologia , Análise de Sobrevida , Fator de Necrose Tumoral alfa/genética , Fator de Necrose Tumoral alfa/imunologia
12.
Dentomaxillofac Radiol ; 49(2): 20190155, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31670576

RESUMO

OBJECTIVES: To verify quantitative differences of the mandibular cortical and trabecular bone between patients with multiple myeloma (MM) under bisphosphonate (BP) therapy and a control group never exposed to BP. METHODS: Clinical and demographic characteristics were collected through medical records and interviews. Mandibular cortical thickness (MCT) and fractal dimension (FD) were measured on cone beam computed tomography (CBCT) images, on the molar region, in both groups. Additionally, FD was measured on periapical digital intraoral radiography and results were compared to CBCT measurements. RESULTS: There were 33 patients with MM under BP therapy and 28 controls, with no significant differences in gender and age between groups. Pamidronate was used by all MM patients, either associated or not to other types of BP. The median MCT was higher in MM group exposed to BP (5.20 mm) than in controls (3.50 mm, p < 0.001). There were no significant differences in the median FD between patients in the MM group and controls, on CBCT (0.95 vs 0.90, p = 0.814) and periapical digital intraoral radiography (0.98 vs 0.96, p = 0.963), respectively, even when more than one type of BP was used. CONCLUSIONS: The MCT represents an useful tool in the detection of bone dimensional changes caused by BP, in patients with MM. Additional studies are necessary to improve the knowledge on the quantitative evaluation of trabecular jaw bone, in individuals with MM, under BP therapy.


Assuntos
Conservadores da Densidade Óssea , Difosfonatos , Mandíbula , Mieloma Múltiplo , Conservadores da Densidade Óssea/uso terapêutico , Tomografia Computadorizada de Feixe Cônico , Difosfonatos/uso terapêutico , Humanos , Arcada Osseodentária/diagnóstico por imagem , Arcada Osseodentária/efeitos dos fármacos , Mandíbula/diagnóstico por imagem , Mandíbula/efeitos dos fármacos , Mieloma Múltiplo/complicações , Radiografia Dentária Digital
13.
World J Gastroenterol ; 26(25): 3611-3624, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32742130

RESUMO

BACKGROUND: The etiology of inflammatory bowel disease (IBD) is unknown, but it is believed to be multifactorial. The hygiene hypothesis proposes that better hygiene conditions would lead to less infectious disease during childhood and favor the development of immune-mediated diseases. AIM: To test the hygiene hypothesis in IBD by assessing the environmental risk factors associated with IBD development in different regions of Brazil with diverse socioeconomic development indices. METHODS: A multicenter case-control study was carried out with 548 Crohn's disease (CD) and 492 ulcerative colitis (UC) outpatients and 416 healthy controls, from six IBD centers within different Brazilian states at diverse socioeconomic development stages. A semi-structured questionnaire with 87 socioeconomic and environmental questions was applied. Logistic regression model was created to assess the odds ratio (OR) with P value and 95% confidence intervals (CI). RESULTS: Predictive variables for both diseases (CD and UC) were women [odd ratios (OR) = 1.31; OR = 1.69], low monthly family income (OR = 1.78; OR = 1.57), lower number of cohabitants (OR = 1.70; OR = 1.60), absence of vaccination (OR = 3.11; OR = 2.51), previous history of bowel infections (OR = 1.78; OR = 1.49), and family history of IBD (OR = 5.26; OR = 3.33). Associated risk factors for CD were age (18-39 years) (OR = 1.73), higher educational level (OR = 2.22), absence of infectious childhood diseases (OR = 1.99). The UC predictive variables were living in an urban area (OR = 1.62), inadequate living conditions (OR = 1.48) and former smokers (OR = 3.36). Appendectomy was a risk factor for CD (OR = 1.58) with inverse association with UC (OR = 4.79). Consumption of treated and untreated water was associated with risk of CD (OR = 1.38) and UC (OR = 1.53), respectively. CONCLUSION: This is the first examining environmental exposures as risk factors for inflammatory bowel disease in Brazil. Most of the variables associated with disease risk support the role of the hygiene hypothesis in IBD development.


Assuntos
Colite Ulcerativa , Doenças Inflamatórias Intestinais , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/epidemiologia , Feminino , Humanos , Masculino , Fatores de Risco , Adulto Jovem
14.
Dentomaxillofac Radiol ; 48(7): 20190053, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31322923

RESUMO

OBJECTIVES: To develop and validate formulas for age and sex estimation based on the pulp cavity volume of teeth using cone beam CT. METHODS: The sample was composed of 116 cone beam CT scans from Brazilian individuals of both sexes, ranging in age from 13 to 70 years. A total of 232 teeth (upper central incisors and canines) were evaluated. Two calibrated examiners determined pulp cavity volumes using the ITK-SNAP software. Pearson's correlation test was used to assess the correlation between chronological age and pulp volume. Linear and logistic regression models were developed for age and sex estimation, respectively, and were validated in another sample of 72 teeth. RESULTS: Pearson's correlation coefficients between age and pulp volume were negative and significant (p < 0.0001) for both teeth (r = -0.8782 for central incisors and r = -0.8738 for canines). The age estimation formulas showed good determination coefficients (adjusted R² = 0.7614 to 0.8367). For sex estimation, when the age was known, the coefficients were also good (adjusted R² = 0.649 to 0.812). However, when the age was unknown, the coefficients of the sex estimation formulas were low (adjusted R² = 0.047 to 0.393). Validation showed high accuracy of age estimation in individuals older than 35 years, as well as high accuracy of sex estimation when the age was known. CONCLUSIONS: Our formulas provided excellent results and can be applied to the Brazilian population. The best results were observed for age estimation in females and for sex estimation when the age was known.


Assuntos
Determinação da Idade pelos Dentes , Tomografia Computadorizada de Feixe Cônico , Cavidade Pulpar , Imageamento Tridimensional , Adolescente , Adulto , Determinação da Idade pelos Dentes/métodos , Idoso , Brasil , Polpa Dentária , Cavidade Pulpar/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Rev Assoc Med Bras (1992) ; 65(4): 547-553, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31066808

RESUMO

The Guidelines Project, an initiative of the Brazilian Medical Association, aims to combine information from the medical field in order to standardize producers to assist the reasoning and decision-making of doctors. The information provided through this project must be assessed and criticized by the physician responsible for the conduct that will be adopted, depending on the conditions and the clinical status of each patient.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Adalimumab/uso terapêutico , Anticorpos Monoclonais Humanizados/uso terapêutico , Brasil , Tomada de Decisão Clínica , Ciclosporina/uso terapêutico , Humanos , Infliximab/uso terapêutico , Indução de Remissão , Resultado do Tratamento
17.
Parasitol Res ; 102(1): 145-9, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-17906962

RESUMO

We comparatively evaluate the effect of metronidazole (MTZ) and its five analogues on trophozoites of Giardia lamblia axenically growing. The compounds MTZ-Ms, MTZ-I, MTZ-Br, MTZ-N(3), and MTZ-NH(3)Cl were obtained by molecular modification of the side chain of MTZ. Four of them presented higher giardicidal activity when compared with MTZ. Among them, MTZ-Br and MTZ-I were the most active, without cytotoxic effects against mitogen-activated human peripheral blood mononuclear cells (PBMC). The alteration of MTZ side chain constitutes a fruitful field to develop new drugs for the treatment not only of giardiasis but also of other diseases and signalize that metronidazole analogues are promising candidates as giardicidal and should be further evaluated.


Assuntos
Antiprotozoários/farmacologia , Giardia lamblia/efeitos dos fármacos , Metronidazol/análogos & derivados , Metronidazol/farmacologia , Animais , Células Cultivadas , Relação Dose-Resposta a Droga , Giardia lamblia/citologia , Humanos , Concentração Inibidora 50 , Leucócitos Mononucleares/efeitos dos fármacos , Metronidazol/química , Estereoisomerismo , Relação Estrutura-Atividade
18.
Arq Gastroenterol ; 44(3): 205-9, 2007.
Artigo em Português | MEDLINE | ID: mdl-18060272

RESUMO

BACKGROUND: Alcohol relapse after transplantation is a serious concern in transplant centers and is a subject of controversy and debate. AIM: To evaluate the relapse of alcohol ingestion and the eventual associated factors in cirrhotic patients referred for liver transplantation. METHODS: A retrospective study comprised of 90 adult patients with liver cirrhosis, listed for transplant. The exclusion criteria were: not having at least 6 months of abstinence and release not approved by the psychology team. The diagnosis of relapse (ingestion of any quantity of alcohol) was done based on the information in the patients histories and those provided by telephone contact. RESULTS: The rate of relapse was of 18.9%. This corresponded to 14.6% of the total number of men and 62.5% of the total number of women. Race, mean age, classification of hepatic dysfunction, time of alcoholism, quantity of alcohol ingested and the execution of transplant did not show significant correlation to alcohol relapse. The comparison between time of abstinence and relapse had an inversely proportional correlation. CONCLUSION: Relapse of alcohol consumption was low. Being of the female gender and having less than 1 year of abstinence has an influence upon alcohol relapse.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Cirrose Hepática Alcoólica/cirurgia , Transplante de Fígado/estatística & dados numéricos , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Seleção de Pacientes , Recidiva , Estudos Retrospectivos , Fatores de Risco , Temperança/estatística & dados numéricos , Listas de Espera
19.
J Forensic Sci ; 62(5): 1374-1378, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28597948

RESUMO

In addition to clinical examination, forensic odontologists can use diagnostic imaging as an auxiliary method for identification. This paper reports a case where forensic odontologists from the Afrânio Peixoto Legal Medicine Institute in Rio de Janeiro (Brazil) positively identified a carbonized and partially calcined body using oral and maxillofacial imaging. The cadaver showed several metallic plates fixed with metallic screws on bones of the neurocranium and viscerocranium. Family members provided spiral computed tomography scans of the skull and a panoramic radiograph that were acquired after an accident that required surgical procedures. Comparative analysis between the clinical exam and the maxillofacial images demonstrated complete coincidence, confirming the victim's identity. Dactyloscopy, which is the most commonly used method of identification, was not possible because of the body carbonization. Thus, diagnostic imaging, especially computed tomography, was essential for elucidation of this case.


Assuntos
Placas Ósseas , Parafusos Ósseos , Aparelhos Ortodônticos , Crânio/diagnóstico por imagem , Restauração Dentária Permanente , Incêndios , Odontologia Legal/métodos , Humanos , Radiografia Panorâmica , Tomografia Computadorizada Espiral
20.
Arq. gastroenterol ; 59(supl.1): 20-50, 2022. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1429854

RESUMO

ABSTRACT Background: Inflammatory bowel disease (IBD) is an immune-mediated disorder that includes Crohn's disease (CD) and ulcerative colitis. CD is characterized by a transmural intestinal involvement from the mouth to the anus with recurrent and remitting symptoms that can lead to progressive bowel damage and disability over time. Objective: To guide the safest and effective medical treatments of adults with CD. Methods: This consensus was developed by stakeholders representing Brazilian gastroenterologists and colorectal surgeons (Brazilian Organization for Crohn's disease and Colitis (GEDIIB)). A systematic review of the most recent evidence was conducted to support the recommendations/statements. All included recommendations and statements were endorsed in a modified Delphi panel by the stakeholders and experts in IBD with an agreement of at least 80% or greater consensus rate. Results and conclusion: The medical recommendations (pharmacological and non-pharmacological interventions) were mapped according to the stage of treatment and severity of the disease in three domains: management and treatment (drug and surgical interventions), criteria for evaluating the effectiveness of medical treatment, and follow-up/patient monitoring after initial treatment. The consensus is targeted towards general practitioners, gastroenterologists, and surgeons interested in treating and managing adults with CD and supports the decision-making of health insurance companies, regulatory agencies, and health institutional leaders or administrators.


RESUMO Contexto: A doença inflamatória intestinal (DII) é uma doença imunomediada que inclui a doença de Crohn (DC) e a retocolite ulcerativa. A DC é caracterizada por um envolvimento intestinal transmural da boca ao ânus com sintomas recorrentes e remitentes que podem levar a danos intestinais progressivos e incapacidade ao longo do tempo. Objetivo: Orientar os tratamentos médicos mais seguros e eficazes de adultos com DC. Métodos: Este consenso foi desenvolvido por autores que representam gastroenterologistas e cirurgiões brasileiros especialistas em doenças colorretais (GEDIIB, Organização Brasileira de Doença de Crohn e Colite). Uma revisão sistemática das evidências mais recentes foi realizada para apoiar as recomendações/declarações. Todas as recomendações e declarações incluídas foram endossadas em um painel Delphi modificado pelas partes interessadas e especialistas em DII com uma concordância de pelo menos 80% ou mais. Resultados e conclusão: As recomendações médicas (intervenções farmacológicas e não farmacológicas) foram mapeadas de acordo com o estágio de tratamento e gravidade da doença em três domínios: manejo e tratamento (intervenções medicamentosas e cirúrgicas), critérios para avaliar a eficácia do tratamento médico, e acompanhamento/monitoramento do paciente após o tratamento inicial. O consenso é direcionado a clínicos gerais, gastroenterologistas e cirurgiões interessados em tratar e gerenciar adultos com DC e apoia a tomada de decisões de companhias de seguro de saúde, agências reguladoras e líderes ou administradores de instituições de saúde.

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