3,216 research outputs found

    Doença de addison de etiologia auto-imune

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    Autoimmune Addison's disease is a rare and potentially, fatal endocrinopathy, that can occur either isolated or as part of the types I and II polyglandular autoimmune syndromes (PAS). Adrenocortical autoantibodies are considered sensitive immunological markers of the destructive autoimmune process, and can identify individuals in the pre-clinical stage of the disease. The steroidogenic enzyme 21-hydroxylase (P450c21) represents the major adrenal autoantigen, although other P450 cytochromes (17a-hydroxylase and side chain cleavage) can also trigger an autoimmune response, mainly in the PAS type I and in Addison's disease with associated premature ovarian failure. The role of P45021 autoantibodies in the pathogenesis of the adrenal failure is not yet well established, and the same happens with the anti-ACTH receptor antibodies.A doença de Addison de etiologia auto-imune é uma endocrinopatia rara e potencialmente fatal, que pode ocorrer de forma isolada ou como parte das síndromes poliglandulares auto-imunes (SPA) dos tipo I e II. Auto-anticorpos anti-cortex adrenal são considerados marcadores imunológicos sensíveis do processo auto-imune destrutivo, podendo identificar indivíduos na fase pré-clínica da doença. A enzima 21-hidroxilase (citocromo P450c21) representa o principal antígeno adrenocortical, embora outros citocromos P450 (17a-hidroxílase e colesterol desmolase) possam, também, desencadear a resposta auto-imune, principalmente na SPA do tipo I e na doença de Addison associada à falência ovariana precoce. O papel dos auto-anticorpos anti-P450c21 na patogênse da falência adrenal ainda não está bem estabelecido, assim como aquele dos anticorpos anti-receptor do ACTH.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de MedicinaUNIFESP, EPM, Depto. de MedicinaSciEL

    Bone regeneration processes with the use of biomaterials and molecular and cellular constituents for dental implants

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    Introduction: When a dental element is lost in the posterior region of the maxilla, there is a natural reabsorption of the alveolar process and, at the same time, pneumatization of the maxillary sinus will occur. For this reason, the maxillary sinus floor elevation procedure should be performed, or short implants when possible. Often the focus is on the type of biomaterial to be used and the success and predictability of our results does not depend only on the biomaterial. It is also necessary to consider the type of defect to be treated, its morphology. The characteristics of the biomaterials to be used must be considered, as well as the characteristics of the bed and the bone defect for treatment. Objective: It was to carry out a concise systematic review of bone regeneration processes using biomaterials and the main molecular and cellular constituents for subsequent dental implantation. Methods: The present study followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results and Conclusion: 152 articles involving implantology and biomaterials were found. A total of 64 articles were fully evaluated and 28 were included in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 5 studies with high risk of bias (studies with small sample size) and 3 studies with uncertain risk (studies with results without statistical significance). The search for a solution for large bone defects directed studies to tissue regeneration therapy or bone regeneration. These studies can promote the use of fillers and epithelial barriers that help in the treatment as an adjuvant to bone graft techniques, favoring greater predictability in alveolar and peri-implant reconstructions and with a good prognosis. The main filler biomaterials can be fibrin-rich plasma, Bio-Oss®. However, it is necessary to understand the chemical, physical and biological processes of both the biological material and the biological niche of the host. Crossing compatible information between microenvironments allows cell recognition and signaling cascades for neovascularization and regeneration and bone filling for successful posterior dental implant

    Major considerations of minimally invasive surgery in bucomaxillofacial procedures: quality of life and aesthetics

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    Introduction: In minimally invasive or atraumatic surgery or dental procedures, there are several clinical studies with increasing expectations to establish treatment guidelines. It is estimated that in minimally invasive dental surgery in general, synthesis studies with meta-analysis and decision analysis represent almost 29% of all studies. Objective: Demonstrate, through a systematic review of the literature, the evolution and consequent importance of improving surgical techniques and/or minimally invasive treatments in dentistry. It was hypothesized that there were statistically significant results on advances in the attempt to minimize trauma, providing quality of life and better aesthetics to patients. Methods: The present study was followed by a systematic review model (PRISMA). The search strategy was performed in the PubMed, Cochrane Library, Web of Science and Scopus, and Google Scholar databases. The Cochrane Instrument was used to assess the risk of bias of the included studies. Results: The total of 92 articles involving minimally invasive surgery and dentistry were found. A total of 54 articles were fully evaluated and 23 were included in the present study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 3 studies with a high risk of bias (studies with small sample size) and 2 studies with uncertain risk (studies with results without statistical significance). Since the most primordial extraction techniques were created and developed, several attempts have been made to minimize the professional's effort, reduce surgical time and alleviate bleeding and the inflammatory processes, edema, pain, and ecchymosis that can affect patients, in trans and postoperative periods. Thus, the maximum preservation of the integrity of the soft tissues (papillae and free and inserted gingival band) adjacent to the prosthetic spaces should be sought; preservation of the alveolar bone ridge level. Based on the histological concept in which living tissues are formed by cells joined by thin elastic tissue and with nerve fibrils, capillaries, lymphatic and blood vessels. The disruption of these cells by surgical trauma provides the release of enzymes that delay healing. For this reason, surgical trauma should be minimized. Conclusion: There are many attempts to minimize the professional effort, reduce surgical time and alleviate bleeding and inflammatory processes, edema, pain, and ecchymosis that can affect patients. Thus, the maximum preservation of the integrity of the soft tissues adjacent to the prosthetic spaces and the preservation of the level of the ridge of the alveolar bone to achieve a minimization of surgical trauma must be sought

    Proposta para construção de material didático-pedagógico para o ensino de geografia: calendário do tempo

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    Anais do II Seminário Seminário Estadual PIBID do Paraná: tecendo saberes / organizado por Dulcyene Maria Ribeiro e Catarina Costa Fernandes — Foz do Iguaçu: Unioeste; Unila, 2014Atualmente, há necessidade de reinventar materiais didático­pedagógicos que facilitem a compreensão de conteúdos em geografia. O presente trabalho tem como objetivo demonstrar a importância da elaboração de materiais didáticos para alunos do ensino fundamental, bem como explicar um pouco sobre o subprojeto Interdisciplinar Geografia no âmbito do Programa Institucional de Bolsas à Iniciação à Docência da Universidade Estadual do Centro ­ PIBID e sua atuação na escola. Foi elaborado uma estratégia de ensino para explicar melhor o conteúdo de clima e tempo, uma vez que é de necessidade básica do aluno para compreender melhor os fenômenos naturais do seu cotidian

    Polycystic ovary syndrome, metabolic syndrome, cardiovascular risk and the role of insulin sensitizing agents

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    The Polycystic Ovary Syndrome (PCOS) affects 6 to 10% of women of childbearing age. Insulin resistance and hyperinsulinemia are present in nearly all PCOS patients and play a central role in the development of both hyperandrogenism and metabolic syndrome (MS). MS occurs in approximately 43% of PCOS patients, raising the cardiovascular risk to up seven fold in these patients. Several serum, functional and structural markers of endothelial dysfunction and subclinical atherosclerosis were described in PCOS patients, even those young and non-obese. However, despite the fact that PCOS adversely affects the cardiovascular profile, long-term studies did not demonstrate a consistent raise in cardiovascular mortality, which seems to be more observed in the post-menopausal period. Recently, oral contraceptives are being substituted for insulin sensitizing agents (metformin and glitazones) in the PCOS treatment, due to their effects on insulin resistance and cardiovascular risk.A Síndrome dos Ovários Policísticos (SOP) afeta de 6 a 10% das mulheres em idade reprodutiva. Resistência à insulina e hiperinsulinemia estão presentes em praticamente todas as pacientes com SOP e desempenham papel central no desenvolvimento tanto do hiperandrogenismo como da síndrome metabólica (SM). SM ocorre em aproximadamente 43% das pacientes com SOP, elevando em até sete vezes o risco de doença cardiovascular nestas pacientes. Vários marcadores séricos, funcionais e estruturais de disfunção endotelial e de aterosclerose subclínica foram descritos em pacientes com SOP, mesmo nas jovens e não-obesas. Entretanto, embora a SOP afete adversamente o perfil cardiovascular, estudos a longo prazo não demonstraram consistentemente aumento da mortalidade cardiovascular, a qual parece ser mais observada no período da pós-menopausa. Recentemente, os anticoncepcionais orais estão sendo substituídos pelos agentes sensibilizadores de insulina (metformina e glitazonas) no tratamento da SOP, devido aos seus efeitos sobre a resistência à insulina e o risco cardiovascular.UNIFESP-EPMUNIFESP, EPMSciEL

    Threshold and latency of acoustic reflex under effect of contralateral noise

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    OBJETIVO: Investigar o efeito inibitório da via eferente auditiva na variação do limiar e da latência do reflexo acústico ipsilateral com estimulação contralateral. MÉTODOS: Foram avaliados 17 pacientes entre 18 e 30 anos, com audição dentro dos padrões de normalidade submetidos à pesquisa de limiar e de latência do reflexo acústico, com e sem estimulação contralateral. RESULTADOS: Foram observadas médias de latência sem ruído contralateral para as freqüências de 500, 1000 e 2000 Hz respectivamente em 234,48, 214,96 e 236,71 milissegundos. Os valores de latência com ruído nas mesmas freqüências foram 230,74, 214,00 e 232,15 milissegundos. CONCLUSÃO: Houve diminuição da latência e aumento dos limiares do reflexo acústico quando apresentado estímulo supressor na orelha contralateral.PURPOSE: To investigate the inhibitory effect of the efferent auditory path in the variation of the threshold and the latency of ipsilateral acoustic reflex with contralateral stimulation. METHODS: Seventeen male and female patients, with ages between 18 and 30 years and with average normal hearing, were evaluated. After verification of inclusion criteria, the subjects were submitted to acoustic reflex threshold and latency testings, with and without contralateral masking. RESULTS: The latency average rates without contralateral noise at the frequencies 500 Hz, 1000 Hz and 2000 Hz were, respectively, 234,48, 214,96 and 236,71 milliseconds. The latency rates with noise at the same frequencies were 230,74, 214,00 and 232,15 milliseconds. CONCLUSION: The results showed latency decrease and increase on the acoustic reflex thresholds with contralateral white noise suppressor stimulus

    Aumento da probabilidade diagnóstica de síndrome de cushing subclínica em uma amostra populacional de pacientes adultos obesos com diabetes mellitus tipo 2

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    Endogenous Cushing s Syndrome (CS) is unusual. Patients with subclinical CS (SCS) present altered cortisol dynamics without obvious manifestations. CS occurs in 2-3% of obese poorly controlled diabetics. We studied 103 overweight adult outpatients with type 2 diabetes to examine for cortisol abnormalities and SCS. All collected salivary cortisol at 23:00 h and salivary and serum cortisol after a 1 mg dexamethasone suppression test (DST). Patients whose results were in the upper quintile for each test (253 ng/dL, 47 ng/dL, and 1.8 mg/dL, respectively for the 23:00 h and post-DST saliva and serum cortisol) were re-investigated. Average values from the upper quintile group were 2.5-fold higher than in the remaining patients. After a confirmatory 2 mg x 2 day DST the investigation for CS was ended for 61 patients with all normal tests and 33 with only one (false) positive test. All 8 patients who had two abnormal tests had subsequent normal 24h-urinary cortisol, and 3 of them were likely to have SCS (abnormal cortisol tests and positive imaging). However, a final diagnosis could not to be confirmed by surgery or pathology. Although not confirmatory, the results of this study suggest that the prevalence of SCS is considerably higher in populations at risk than in the general population.A síndrome de Cushing (SC) endógena é rara. Pacientes com SC subclínica (SCS) apresentam hipercortisolismo sem manifestações clínicas. SC ocorre em 2-3% de diabéticos mal controlados. Estudamos 103 pacientes adultos obesos ambulatoriais com diabetes mellitus tipo 2 para avaliar alterações do cortisol e SCS. Todos coletaram cortisol salivar às 23:00 h e cortisol salivar e sérico após teste de supressão com 1 mg de dexametasona (DST). Pacientes cujos resultados de qualquer teste estavam no quintil superior (253 ng/dL, 47 ng/dL e 1,8 mg/dL, respectivamente para cortisol salivar 23:00 h e salivar e sérico pós-DST) foram reavaliados. Os valores médios desse grupo encontravam-se 2,5 vezes acima dos valores dos demais pacientes. Após um teste confirmatório com 2 mg x 2 dias DST, a investigação da SC foi encerrada para 61 pacientes com todos os testes normais e 33 com apenas um teste (falso) positivo. Todos os 8 pacientes com dois testes alterados apresentaram cortisol urinário normal, mas 3 deles mostraram maior probabilidade diagnóstica de SCS (hipercortisolismo e alterações em exames de imagem). Contudo, o diagnóstico final não pode ser confirmado por cirurgia ou patologia em nenhum deles. Embora não confirmatórios, os resultados deste estudo sugerem que a prevalência de SCS seja maior em populações de risco do que na população geral.Federal University of São Paulo Department of Medicine Division of EndocrinologyUNIFESP, Department of Medicine Division of EndocrinologySciEL
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