DNMT3B (rs2424913) polymorphism is associated with systemic lupus erythematosus alone and with co-existing periodontitis in a Brazilian population

The association between Periodontitis and Systemic Lupus Erythematosus (SLE) has been primarily based on their similar pathophysiology and both are associated with genetic polymorphisms. Objectives: To investigate an association between the methylation-related gene polymorphisms DNMT3B (rs2424913) and MTHFR (rs1801133) to Systemic Lupus Erythematosus (SLE) and Periodontitis. Methodology: In total, 196 individuals of all genders aged 24 to 60 years old were allocated into four groups based on their systemic and periodontal status, namely: Healthy control (n=60), periodontitis (n=51), SLE (n=47), and SLE + periodontitis (n=38). Individuals with SLE were stratified according to disease activity (SLEDAI) in inactive or active. We performed polymorphism analysis using PCR-RFLP with genomic DNA from mouthwash. We analyzed data using Fisher’s Exact, Chi-square test, and regression models. Results: Periodontal status were similar in subjects with periodontitis alone and combined with SLE. SLE patients with periodontitis had a longer SLE diagnosis than SLE only (p=0.001). For DNMT3 B polymorphism, the periodontitis, SLE, and Inactive SLE + periodontitis groups showed a higher frequency of T allele and TT genotypes compared to healthy controls (p<0.05). Regression analyses showed that the TT genotype is a strong risk factor for periodontitis (OR=4.53; CI95%=1.13–18.05) and also for SLE without periodontitis (OR=11.57; CI95%=3.12–42.84) and SLE with periodontitis (OR=5.27; CI95%=1.25–22.11) when compared to control. Conclusion: SLE patients with periodontitis had a longer length of SLE diagnosis. The DNMT3B (rs2424913) polymorphism was associated with periodontitis and SLE alone or combined with periodontitis. Our study contributes to understanding the genetic mechanisms involved in periodontitis and SLE susceptibility

Carcinoma adenóide cístico do pulmão : Adenoid cystic carcinoma of the lung

Introdução: O carcinoma adenóide cístico primário de pulmão é uma neoplasia torácica de crescimento lento e com malignidade de baixo grau. Representa 0,04 a 0,2% de todos os tumores pulmonares, sendo considerada uma neoplasia rara. Apresentação do caso: Paciente, sexo masculino, 49 anos de idade, foi admitido no Hospital Santa Casa de Misericórdia de Goiania, apresentando tosse persistente, dispneia, hemoptise e cerca de 4 episódios previos de pneumonia; negou comorbidades, etilismo e tabagismo, uso de medicamentos e alergias conhecidas. Discussão: O adenocarcinoma pulmonar possui como subtipo o carcinoma adenóide cístico. Anteriormente conhecido como cilindroma. Têm baixo grau de malignidade principalmente pelo seu lento crescimento e curso clínico estendido. Conclusão: Por se tratar de uma baixa malignidade, a sobrevida a longo prazo é satisfatoriamente prevista

Cisto cavum interpositum: Cavum interpositum cyst

Introdução: O velum interpositum (VI) é uma membrana no subaracnóideo formado por uma invaginação da pia-máter preenchido por líquido cefalorraquidiano (LCR). Sua formação ocorre durante o período embrionário e regridem posteriormente. A persistência dessa estrutura primitiva pode acarretar em sua dilatação, sendo denominado cavum veli interpositum (CVI) e, se maior que 10 mm em medida transversal axial, cisto cavum veli interpositum. Sua prevalência é maior em recém nascidos e prematuros. Apresentação do caso: paciente do sexo masculino, recém-nascido de 10 dias, foi admitido no Hospital Materno Infantil (HMI), por quadro de vômitos intermitentes, associado a febre de 39.5ºC. A mãe relata prematuridade de 31 semanas, trabalho de parto prolongado, cesariana e apresentação pélvica. RN teve um episódio convulsivo minutos antes da chegada à unidade. Nega outras queixas. A ressonância magnética destaca-se como exame padrão ouro, seguido da tomografia computadorizada de crânio. Discussão: Os cistos de CVI não apontam fisiopatologia e quadro clínico bem definidos, mas os conhecimentos acerca de sua localização são importantes para correlacionar sinais e sintomas neurológicos que condizem com efeito de massa, sendo um diagnóstico diferencial de lesões císticas intracranianas da linha média. A terapêutica ainda é restrita, mas há muitos relatos de casos em que a técnica de fenestração endoscópica minimamente invasiva foi preconizada para o tratamento dos cistos de CVI. Conclusão: Quanto ao prognóstico, em âmbito radiológico, estudos demonstram redução do cisto e do efeito de massa em imagem de ressonância magnética pós-operatória. E, apesar da resposta clínica ser dependente se os sintomas são decorrentes direta ou indiretamente do cisto, também demonstraram melhora nessa esfera

Second asymptomatic carotid surgery trial (ACST-2) : a randomised comparison of carotid artery stenting versus carotid endarterectomy

Background: Among asymptomatic patients with severe carotid artery stenosis but no recent stroke or transient cerebral ischaemia, either carotid artery stenting (CAS) or carotid endarterectomy (CEA) can restore patency and reduce long-term stroke risks. However, from recent national registry data, each option causes about 1% procedural risk of disabling stroke or death. Comparison of their long-term protective effects requires large-scale randomised evidence. Methods: ACST-2 is an international multicentre randomised trial of CAS versus CEA among asymptomatic patients with severe stenosis thought to require intervention, interpreted with all other relevant trials. Patients were eligible if they had severe unilateral or bilateral carotid artery stenosis and both doctor and patient agreed that a carotid procedure should be undertaken, but they were substantially uncertain which one to choose. Patients were randomly allocated to CAS or CEA and followed up at 1 month and then annually, for a mean 5 years. Procedural events were those within 30 days of the intervention. Intention-to-treat analyses are provided. Analyses including procedural hazards use tabular methods. Analyses and meta-analyses of non-procedural strokes use Kaplan-Meier and log-rank methods. The trial is registered with the ISRCTN registry, ISRCTN21144362. Findings: Between Jan 15, 2008, and Dec 31, 2020, 3625 patients in 130 centres were randomly allocated, 1811 to CAS and 1814 to CEA, with good compliance, good medical therapy and a mean 5 years of follow-up. Overall, 1% had disabling stroke or death procedurally (15 allocated to CAS and 18 to CEA) and 2% had non-disabling procedural stroke (48 allocated to CAS and 29 to CEA). Kaplan-Meier estimates of 5-year non-procedural stroke were 2·5% in each group for fatal or disabling stroke, and 5·3% with CAS versus 4·5% with CEA for any stroke (rate ratio [RR] 1·16, 95% CI 0·86-1·57; p=0·33). Combining RRs for any non-procedural stroke in all CAS versus CEA trials, the RR was similar in symptomatic and asymptomatic patients (overall RR 1·11, 95% CI 0·91-1·32; p=0·21). Interpretation: Serious complications are similarly uncommon after competent CAS and CEA, and the long-term effects of these two carotid artery procedures on fatal or disabling stroke are comparable

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London