Asociación entre la periodontitis crónica y la respuesta inmunológica TH2

The periodontal disease affects a great part of the world’s population. This disease is a result of the interaction of the host with the microorganisms in the biofilm; therefore the type of immunological reaction will determine the grade of the disease. The Th1/ Th2 balance, was determined by immunohistochemistry (using interferon gamma and interleukin-13) in histological sections of biopsies of the gum of patients previously diagnosed clinical and histologically. The result was a prevalence of Th1 in health and a balance Th1/Th2 in gingivitis with a trend toward Th2 in periodontitis.La enfermedad periodontal afecta una gran parte de la población mundial. Dicha enfermedad es resultado de la interacción del hospedero con los microorganismos de la biopelícula, por lo cual, el tipo de respuesta inmunológica que prevalezca determinará el grado de la enfermedad. Se determinó el balance TH1/ TH2 por la determinación inmunohistoquímica de interferón gamma e interleucina-13 en cortes histológicos de biopsias de encía de sujetos diagnosticados clínicamente e histológicamente, encontrando un predominio de la respuesta Th1 en salud, que se va perdiendo, con equilibrio Th1/Th2 en gingivitis y finalmente, un predominio Th2 en la periodontitis

Evaluation of a quality improvement intervention to reduce anastomotic leak following right colectomy (EAGLE): pragmatic, batched stepped-wedge, cluster-randomized trial in 64 countries

Background Anastomotic leak affects 8 per cent of patients after right colectomy with a 10-fold increased risk of postoperative death. The EAGLE study aimed to develop and test whether an international, standardized quality improvement intervention could reduce anastomotic leaks. Methods The internationally intended protocol, iteratively co-developed by a multistage Delphi process, comprised an online educational module introducing risk stratification, an intraoperative checklist, and harmonized surgical techniques. Clusters (hospital teams) were randomized to one of three arms with varied sequences of intervention/data collection by a derived stepped-wedge batch design (at least 18 hospital teams per batch). Patients were blinded to the study allocation. Low- and middle-income country enrolment was encouraged. The primary outcome (assessed by intention to treat) was anastomotic leak rate, and subgroup analyses by module completion (at least 80 per cent of surgeons, high engagement; less than 50 per cent, low engagement) were preplanned. Results A total 355 hospital teams registered, with 332 from 64 countries (39.2 per cent low and middle income) included in the final analysis. The online modules were completed by half of the surgeons (2143 of 4411). The primary analysis included 3039 of the 3268 patients recruited (206 patients had no anastomosis and 23 were lost to follow-up), with anastomotic leaks arising before and after the intervention in 10.1 and 9.6 per cent respectively (adjusted OR 0.87, 95 per cent c.i. 0.59 to 1.30; P = 0.498). The proportion of surgeons completing the educational modules was an influence: the leak rate decreased from 12.2 per cent (61 of 500) before intervention to 5.1 per cent (24 of 473) after intervention in high-engagement centres (adjusted OR 0.36, 0.20 to 0.64; P < 0.001), but this was not observed in low-engagement hospitals (8.3 per cent (59 of 714) and 13.8 per cent (61 of 443) respectively; adjusted OR 2.09, 1.31 to 3.31). Conclusion Completion of globally available digital training by engaged teams can alter anastomotic leak rates. Registration number: NCT04270721 (http://www.clinicaltrials.gov)