Avaliação do padrão de expressão das proteínas salivares lactoferrina e lisozima e sua associação com experiência e atividade de cárie

PURPOSE: Saliva contains both specific and non-specific protective factors of the immune system, such as antimicrobial proteins, which can inhibit the adhesion and viability of cariogenic microorganisms. The association between caries experience/activity and the electrophoretic profiles of salivary proteins lactoferrin and lysozyme was evaluated. METHODS: Eighty 12-year-old students from public schools in Londrina, PR, Brazil, were selected and divided into two groups: Group A - with decayed teeth and Group B - with caries-free teeth. The parent/guardian of each child signed a consent form and filled out a questionnaire regarding the oral and systemic health of his/her child. A clinical examination to diagnose the presence or absence of dental caries, by means of the DMFT index, was conducted. A total of 1 mL of saliva was collected for protein analysis using a polyacrylamide gel electrophoresis (SDS-PAGE). RESULTS: A total of 58.8% of the children were caries-inactive; in contrast, 63.3% showed caries experience. There was a slight association between lysozyme concentrations and DMFT. Lactoferrin was positively correlated with both DMFT and restored teeth. CONCLUSION: The quantification of lactoferrin and lysozyme enabled an assessment of possible associations with caries status, thus improving the understanding of the biological and etiological aspects of caries.OBJETIVO: A saliva contém fatores de defesa adquiridos e não adquiridos, como proteínas antimicrobianas capazes de inibir a aderência e a viabilidade dos microrganismos cariogênicos. Avaliou-se a associação entre a experiência/atividade de cárie e o perfil eletroforético das proteínas salivares lactoferrina e lisozima. METODOLOGIA: Oitenta escolares aos 12 anos de idade da Rede Estadual de Ensino de Londrina, PR, Brasil, foram divididos em dois grupos: Grupo A - com cárie e Grupo B - sem cárie. Os responsáveis legais assinaram um termo de consentimento informado, e responderam um questionário sobre a saúde bucal e sistêmica das crianças. Foi realizado exame clínico, para diagnosticar a presença ou ausência de cárie através do Índice CPO-D e coletado 1 mL de saliva para análise das proteínas por meio da eletroforese em gel de poliacrilamida (SDS-PAGE). RESULTADOS: Observou-se que 58,8% das crianças eram cárie-inativas, apesar de 63,3% possuírem experiência de cárie. Houve uma tendência de associação entre a concentração de lisozima com o CPO-D. A proteína lactoferrina correlacionou-se positivamente com CPO-D e dentes restaurados. CONCLUSÃO: A quantificação destas proteínas permitiu observar possível associação com a cárie, favorecendo uma melhor compreensão do aspecto biológico e etiológico da doença.North of Paraná UniversityNational Foundation for the Development of Privately-held Institutions of Higher Educatio

Patient-Controlled Analgesia (PCA) in Acute Pain: Pharmacological and Clinical Aspects

Moderate or severe pain are important sources of complications as well as morbidity and mortality in the postoperative period after surgical procedures. Patient‐controlled analgesia (PCA) is an effective strategy for postoperative analgesia, since it may provide suitable analgesic dose just after system activation, with reduced periods of pain and an increase in patients’ satisfaction. Although intravenous and epidural routes are the typical approaches used for PCA, regional patient‐controlled analgesia has been shown to be an effective alternative providing a higher standard of analgesia with lower incidence of adverse effects. New devices and routes of PCA administration (transdermal, sublingual, inhalation, and oral routes) have shown to be promising alternatives in clinical studies. Nowadays, there is still no consensus regarding which is the best route or drug used since clinical efficacy/safety depends on the complex comprehension of the drugs pharmacokinetic profile through different routes of administration. Additionally, pharmacoeconomic studies are needed to evaluate the cost‐effectiveness of these approaches

Vitamin D deficiency, functional status, and balance in older adults with osteoarthritis

ACKGROUND Low vitamin D levels are associated with a more severe case of knee osteoarthritis (OA). However, there are few published reports concerning an association between vitamin D deficiency and functional status of individuals with OA and no reports about postural balance in this population. AIM To analyze the relationship between vitamin D deficiency and severity, functional status, and balance in elderly patients with OA. METHODS In this cross-sectional study, 105 elderly patients with hip and knee OA were included. The severity was assessed by the Kellgren-Lawrence criteria. The functional status was assessed with the Lequesne index. Postural balance was assessed using a force platform, and center-of-pressure parameters (velocity at anteroposterior and mediolateral axis) were used as the balance outcomes. Serum 25(OH) vitamin D levels were measured using a chemiluminescence method. RESULTS Most of the patients (mean age: 70.6 ± 6.5 years) were female (n = 78, 74.3%). In the group with vitamin D deficiency, 43 patients (56.6%) had severe OA, while 33 patients (43.4%) had mild or moderate OA (χ2 test, P = 0.04). Patients with vitamin D deficiency showed a higher Lequesne index score (Mann-Whitney test, P = 0.04), indicating a worse functional impairment when compared to individuals with normal vitamin D levels. Additionally, patients with vitamin D deficiency had worse postural balance according to the Mann-Whitney test (P = 0.03). CONCLUSION Vitamin D deficiency is associated with worse severity, functional status, and postural balance in patients with OA

Efeito da terapia ultrassônica de baixa intensidade em cultura celular de fibroblastos

Within the physiotherapy practice there is a wide use of therapeutic ultrasound for the treatment of various musculoskeletal disorders. The aim of this study was to evaluate the effect of Low Intensity Ultrasonic irradiation with differents forms of pulse and intensity in cell culture of L929 fibroblasts (ATCC CCL-1 NCTC), in order to check cell viability and define parameters of dosimetry. For this purpose, it was used the application of pulsed ultrasound with a frequency of 1MHz in cultured fibroblast cells divided into five groups (control and instantaneous intensity of 0.3W/cm2-10%, 0.3W/cm2 -20%, 0.5W/cm2-10% and US 0.5W/cm2-20% - 100Hz). Irradiation occurred at intervals of 24, 48 and 72 hours for two minutes and 24 hours after each irradiation test MTT [3-(4,5-dimethylthiazol)-2,5-diphenyltetrazolium bromide] was performed. Results showed that when comparing the values of viable cells by MTT method in the five groups, we could not find statistically significant difference in any of them, in these three conditions (24, 48 and 72 hours); while. Whereas, when performing the analysis of repeated measures in the different groups, it was found a statistically significant difference only in the group irradiated with ultrasound at 0.5W/cm2 with pulse regime of 10% (p=0.003). Based on these results, it is concluded that the Low Intensity Ultrasonic irradiation in L929 fibroblast cell culture, only in the group with an intensity of 0.5W/cm2 -10% obtained numerical growth, with statistical significance in all periods evaluation.En la práctica fisioterápica se utiliza bastante el ultrasonido como terapia para el tratamiento de diversos trastornos muscoloesqueléticos. Este artículo tiene por objetivo evaluar el efecto de la irradiación ultrasónica de baja intensidad, con diferentes regímenes de pulsos y de intensidades, en cultivo celular de fibroblastos L929 (ATCC CCL-1 NCTC), para verificar la viabilidad celular y establecer los parámetros de dosimetría. Se utilizó el ultrasonido pulsado, con frecuencia de 1Mhz, en un cultivo de células fibroblásticas, divididas en cinco grupos (con control y con la intensidad instantánea del 0,3W/cm2-10%; 0,3W/cm2 -20%; 0,5W/cm2 -10% y US 0,5W/cm2-20 % - 100Hz). La irradiación se llevó a cabo en intervalos de 24, 48 y 72 horas, durante dos minutos y después de las 24 horas de cada irradiación se realizó la prueba de MTT {Bromuro de [3-(4,5-dimetiltiazol)-2,5-difeniltetrazólio]}. Los resultados mostraron que en la comparación entre los valores de células viables por el método MTT en los cinco grupos evaluados no ha sido posible encontrar ninguna diferencia estadísticamente significativa en los tres momentos evaluados (24, 48 y 72 horas). En cambio, al llevar a cabo el análisis de medida repetida en los diferentes grupos, se obtuvo una diferencia estadísticamente significativa solamente en el grupo irradiado con ultrasonido a 0,5W/cm2 con el régimen de pulso del 10% (p=0,003). Basándose en estos resultados se concluyó que la irradiación ultrasónica de baja intensidad en cultivo celular de fibroblastos L929 obtuvo el aumento sólo en el grupo con intensidad de 0,5W/cm2-10%, con significancia en todos los periodos de evaluación.Dentro da prática fisioterápica verifica-se a ampla utilização do ultrassom terapêutico para tratamento das diversas afecções musculoesqueléticas. O objetivo deste estudo foi avaliar o efeito da irradiação Ultrassônica de Baixa Intensidade, com diferentes regimes de pulsos e intensidade, em cultura celular de fibroblastos L929 (ATCC CCL-1 NCTC), de modo a verificar a viabilidade celular e definir parâmetros de dosimetria. Para isso, utilizou-se a aplicação de ultrassom pulsado, com frequência de 1Mhz, em cultura de células fibroblásticas, divididas em cinco grupos (controle e com intensidade instantâneas de 0,3W/cm2-10%; 0,3W/cm2 -20 %; 0,5W/cm2 -10% e US 0,5W/cm2 -20 % - 100Hz). A irradiação ocorreu com intervalos de 24, 48 e 72 horas, por dois minutos, e após 24 horas de cada irradiação foi realizado teste de MTT Brometo de [3-(4,5-dimetiltiazol)-2,5-difeniltetrazólio]. Os resultados revelaram que ao compararem-se os valores de células viáveis pelo método MTT nos cinco grupos, não foi possível encontrar diferença estatisticamente significativa em nenhum deles, nos três momentos avaliados (24, 48 e 72 horas); enquanto que, ao se realizar a análise de medida repetida nos diferentes grupos, encontrou-se diferença estatisticamente significativa apenas no grupo irradiado com ultrassom a 0,5W/ cm2com regime de pulso de 10% (p=0,003). Com base nesses resultados, conclui-se que a irradiação Ultrassônica de Baixa Intensidade em cultura celular de fibroblastos L929, somente no grupo com intensidade de 0,5W/cm2-10% obteve o crescimento numérico, com significância estatística em todos os períodos de avaliação

The importance of optimal 25-hydroxyvitamin D levels in the glycemic control of older adults with type 2 Diabetes Mellitus: Data from the study on aging and longevity EELO

Introduction: Optimal serum levels of vitamin D are of great importance, especially in populations with comorbidities such as Diabetes Mellitus (DM). Objective: The study evaluated the relationship between hypovitaminosis D and glycemic control in older adults with type 2 DM. Methods: Cross-sectional and prospective study, part of the EELO project (Study on Aging and Longevity), conducted in Southern Brazil. Glycated hemoglobin (diabetes ≥6.5%) and serum levels of vitamin D (25(OH)D) were evaluated. Hypovitaminosis D was determined using cutoff points <20 and <30 ng/mL). Multivariate logistic regression was used to assess the risk of having uncontrolled DM. Results: Of the 120 older adults included in the study, aged between 60 and 87 years, 74.2% were women, 66.7% used hypoglycemic medications and 75.8% exhibited uncontrolled diabetes. An inverse correlation was observed between the levels of 25(OH)D and glycated hemoglobin (rS=-0.19, p=0.037), suggesting that low levels of vitamin D are associated with poor glycemic control in diabetic individuals. The prevalence of hypovitaminosis D when using the cutoff points of <20 and <30 ng/mL were 34.2% and 75.0%, respectively. The odds ratio (OR) analysis showed that individuals with 25(OH)D<20ng/mL have almost 4 times more risk of having uncontrolled DM (OR:3.94; CI95%:1.25-12.46, p=0.02) when compared to the older adults with sufficient levels of vitamin D. Conclusion: The results indicate that the optimal serum levels currently recommended for 25(OH)D should preferably be 30 ng/mL or higher to contribute to better glycemic control in older adults with type 2 DM.

Analysis of functional status of elderly with osteoarthritis

En este estudio se analiza la influencia del género, de la edad y del tratamiento farmacológico para la osteoartritis (OA) en la funcionalidad de las personas mayores. Se trata de un estudio transversal, lo cual 105 personas mayores han participado de ambos géneros (Edad: 70,73±6,0 años) con OA de cadera y/o rodilla confirmado por el análisis radiográfico. Se valoró la funcionalidad bajo dos instrumentos: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e Índice Algofuncional de Lequesne. En el análisis de datos se mostró peor funcionalidad tanto en el cuestionario Lequesne (p=0,007) como en el WOMAC (p=0,013) y en sus dominios intensidad de dolor (p=0,013), rigidez (p=0,032) y funcionalidad (p=0,018). No obstante, no se comprobaron diferencias en estos instrumentos en relación a las distintas franjas etarias o a la alteración de la articulación, de acuerdo a los indicios en la radiografía (p>;0,05). Se observó que los que fueron tratados con medicamentos para la OA presentaban funcionalidad peor que los que no lo utilizaban (Lequesne, p=0,005; WOMAC, p=0,008; y dominios: intensidad de dolor, p=0,004; rigidez, p=0,007 y funcionalidad p=0,023). En el modelo multivariante, se observó que el género y el tratamiento farmacológico influyeron en la funcionalidad de las personas mayores con OA (pThe objective of this study was to analyze the influence of gender, age and pharmacological treatment for osteoarthritis (OA) on the functional status of physically independent elderly. This cross-sectional study involved 105 elder individuals from both genders (age: 68.80±6.3 years) with OA of the hip and / or knee, which was confirmed by radiographic analysis. Two specific instruments assessed functional status: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne Index. It was observed worse condition in females in Lequesne (p=0.007), global WOMAC (p=0.013), as well as in its fields: pain intensity (p=0.023), stiffness (p=0.032) and functional status (p=0.018). However, considering age and radiological status, no differences were observed between groups in all variables (p>;0.05). It was observed that the individuals with pharmacological treatment for OA have poor functional status in all functional questionnaires (Lequesne, p=0.005; global WOMAC, p=0.008 as well as in specific WOMAC fields, such as Pain intensity, p=0.004; Stifness, p=0.007; and Functional status p=0.023). At multivariate modelo (multiple linear regression), it was observed that gender and pharmacological treatment may influence the functional status of elderly with OA, whereas women and medicated individuals are those showing the worse condition both in Lequesne and WOMAC indexes. It was observed worse functional status in women with osteoarthritis and pharmacological treatment evoked no improvement in functional status of these individuals.O objetivo deste estudo foi analisar a influência do gênero, idade e farmacoterapia da osteoartrite (OA) sobre a funcionalidade de idosos. Trata-se de um estudo transversal com 105 idosos de ambos os gêneros (Idade: 70,73±6,0 anos) e portadores de OA de quadril e/ou joelho, confirmado por análise radiográfica. A funcionalidade foi avaliada por dois instrumentos: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) e Índice Algofuncional de Lequesne. As análises dos dados apresentaram pior funcionalidade tanto no questionário Lequesne (p=0,007) como no WOMAC (p=0,013) e em seus domínios Intensidade da Dor (p=0,013), Rigidez (p=0,032) e Funcionalidade (p=0,018). Contudo, não foram verificadas diferenças nos instrumentos avaliados quanto a diferentes faixas etárias ou comprometimento da articulação segundo alterações radiográficas (p>;0,05). Foi observado que os medicados apresentavam pior funcionalidade em comparação aos que não utilizavam medicamentos para OA (Lequesne: p=0,005; WOMAC: p=0,008 e domínios: Intensidade da Dor: p=0,004; Rigidez: p=0,007 e Funcionalidade: p=0,023). No modelo multivariado, foi observado que o gênero e o tratamento farmacológico influenciam a funcionalidade de idosos portadores de OA (