Endodontic techniques with Nickel Titanium instruments: analysis of quality and efficiency of instrumentation in primary molars / Técnicas endodônticas com instrumentos de Níquel Titânio: análise da qualidade e eficiência da instrumentação em molares decíduos

ABSTRACT Objective: The purpose of the present in vitro study was to evaluate the efficiency of three different instruments in the root canals of artificial primary molars as well as the quality of the fillings. Methods: Sixty artificial primary molars were divided into three groups of 20 teeth. Each group was submitted to a different technique: Group 1 - conventional manual technique using Kerr files; Group 2 - manual technique with nickel-titanium files; Group 3 - NiTi rotary technique. The root canals were filled with calcium hydroxide paste. Aspects such as homogeneity of the fillings, taper and flowability of the preparations were considered comparatively to assess the quality of the instrumentations. The non-parametric Kruskal-Wallis and Mann-Whitney tests were used to compare the efficiency of the preparation of the root canal considering the preparation times of them. Results: All three techniques were equally effective at shaping the root canals of primary teeth. The working time was shorter with the rotary instrument (p=0.000). In the pairwise comparisons, working time was shorter with the rotary instrument compared to the manual techniques with steel files (p=0.000) and NiTi files (p=0.000). Comparing the manual techniques, the working time was shorter with NiTi files compared to steel files (p=0.011). Moreover, less variability in the preparation time was found when the rotary instrument was used. Conclusions: The mechanized rotary method led to a shorter operating time in comparison to the manual techniques and is therefore a preferable option for the preparation of the root canals of primary teeth.

RESUMO Objetivo: Avaliar a eficiência de três instrumentos diferentes nos canais radiculares de molares decíduos artificiais, bem como a qualidade das obturações. Métodos: Sessenta molares decíduos artificiais foram divididos em três grupos de 20 dentes. Cada grupo foi submetido a uma técnica diferente: Grupo 1 - técnica manual convencional com limas Kerr; Grupo 2 - técnica manual com limas de níquel-titânio; Grupo 3 - Técnica rotatória de níquel-titânio. Os canais radiculares foram preenchidos com pasta de hidróxido de cálcio. Aspectos como homogeneidade das obturações, conicidade e fluidez das preparações foram considerados comparativamente para avaliar a qualidade das instrumentações. Os testes não paramétricos de Kruskal-Wallis e Mann-Whitney foram utilizados para comparar a eficiência do preparo do canal radicular considerando os tempos de preparo dos mesmos. Resultados: Todas as três técnicas foram igualmente eficazes na modelagem dos canais radiculares. O tempo de trabalho foi menor com o instrumento rotatório (p=0,000). Nas comparações pareadas, o tempo de trabalho foi menor com o instrumento rotatório em comparação com as técnicas manuais com limas de aço (p=0,000) e limas de NiTi (p=0,000). Comparando as técnicas manuais, o tempo de trabalho foi menor com as limas de NiTi em comparação com as limas de aço (p=0,011). Além disso, foi encontrada menor variabilidade no tempo de preparo quando o instrumento rotatório foi utilizado. Conclusão: O método rotatório levou um menor tempo operatório em comparação com as técnicas manuais e, portanto, é uma opção preferível para o preparo dos canais radiculares de dentes decíduos.

Antimicrobial Photodynamic Therapy in the Endodontic Treatment of Deciduous Teeth: In Vivo Pilot Study

Abstract Objective: To evaluate the Antimicrobial Photodynamic Therapy (aPDT) in infected deciduous teeth by quantifying the viable bacteria in root canal treatment. Material and Methods: Radicular canal cultures were collected (n= 10). Four intra-canal samples were collected at four different times in each of the sampled teeth, as follows: Time 1 (T1), baseline: After opening the pulp-chamber; Time 2 (T2): After application of aPDT; Time 3 (T3): After mechanical, chemical manipulation; Time 4 (T4): After a second application of aPDT. The aPDT was performed with a 4J/cm energy low-intensity diode, together with 0.005% methylene blue as a photosensitizer. The clinical specimens were taken to the laboratory for a bacteria count (colony forming units) and the results were statistically analyzed using the Friedman and Wilcoxon tests, with a significance level of α=0.05. Results: Statistical differences were seen between the numbers of bacteria at times T1-T2, T1-T3 and T1-T4 on the cultivated plates. However, no significant statistical differences were observed between the number of bacteria in samples T2-T3, T2-T4 and T3-T4. Conclusion: Antimicrobial photodynamic therapy can be a good co-adjuvant in root canal decontamination of necrotic primary teeth.

Perceptions of the Use of the Diode Laser in Dental Surgery: A Qualitative Study

Abstract Objective: To discover the perceptions of pediatric patients, their parents and undergraduate Dentistry students of the use of the diode laser in frenectomy surgeries. Material and Methods: A qualitative study was conducted through semi-structured interviews, recorded and transcribed with subsequent content analysis. Twelve healthy children (5-8 years old) who needed a frenectomy were selected and invited, together with their parents, to undergo laser diode surgery. In addition, 28 undergraduate dentistry students were invited to attend the procedures. One week after performing the surgical procedures, the children (Group 1), their parents (Group 2) and the students who attended the procedures (Group 3) were individually interviewed for the thematic analysis. Results: The analysis of the conversations identified three emerging contents: positive thoughts on the use of diode laser; frustrations from the use of diode laser; and aspects related to professional training. Conclusion: The results pointed to the acceptance of surgical laser use in pediatric dentistry; however, the feelings of frustration indicate that its use requires guidance from the child and his/her parents, in addition to careful handling and specific training.

Agreement Between Working Length Measurements in Primary Teeth Obtained by Radiographs or Apical Locators

Abstract Objective: To perform an in vivo evaluation on the agreement between measurements of working length obtained by conventional radiographic examinations and an apex locator in deciduous teeth with or without root resorption. Material and Methods: Nine canals of teeth from children ranging from 3 to 5 years old were selected. Endodontic access was performed with a spherical diamond tip, the pulp was removed with Kerr-type steel files, and the canal was irrigated with 1% sodium hypochlorite. A file, compatible with the channel gauge, was then used to measure the length of the root canal with the apex locator. Conventional radiographs were also performed and, using a millimeter endodontic ruler, the length of the canal was determined. The differences between the measurements obtained between the two methods were analyzed using the Student's t-test. Results: The mean canal length for conventional radiography was 9.83 mm and 9.67 mm for the apex locator. The results of this study did not show significant differences (p=0.641), independent of the presence or absence of physiological root resorption. Conclusion: The similarity in measurements obtained with X-ray or an apex locator indicates that it is not necessary to use X-rays as a complement to obtain the working length. The use of the apex locator can provide a quicker treatment, reducing the clinical time and stress of the child.

Recobrimento radicular com enxerto de tecido conjuntivo e fibrina rica em plaquetas: uma revisão crítica / Root coverage with connective tissue graft and platelet-rich fibrin: a critical review

Objetivo:O objetivo desta revisão foi realizar uma análise crítica da literatura quanto à utilização do procedimento enxerto de tecido conjuntivo e da membrana de fibrina rica em plaquetas para recobrimento da raiz exposta, frisando os benefícios e previsibilidade de sucesso de cada uma. Métodos:Foi realizada uma busca nas bases PubMed, SciELO e BIREME em março de 2019, sendo incluídos estudos relevantes relacionados ao tema para síntese deste trabalho. Resultados: Foram selecionados 5 artigos para serem incluídos nessa revisão crítica, sendo 3 ensaios clínicos controlados randomizados, 1 ensaio clínico e 1 um relato de caso. Conclusão:O recobrimento radicular com uso de enxerto de tecido conjuntivo e fibrina rica em plaquetas apresentou resultados satisfatórios, devolvendo estética, saúde e regeneração dos tecidos gengivais e periodontais. Em relação à fibrina rica em plaquetas, há poucos casos na literatura quanto aos resultados clínicos a longo prazo.

Aim: This review sought to perform a critical analysis of the literature regarding the use of the graft procedure of connective tissue and Platelet-rich fibrin to cover the exposed root, emphasizing the benefits and predictability of success of each. Methods: This study performed a search on the PubMed, SciELO, and BIREME databases, and included relevant studies related to the topic for the synthesis of this work. Results:Five articles were selected to be included in this critical review, three randomized controlled clinical trials, one clinical trial, and one case report. Conclusion:The root covering using a subepithelial connective tissue graft and platelet-rich fibrin presents satisfactory results, restoring esthetics and health, and regenerating the gingival and periodontal tissues. Regarding platelet-rich fibrin, there are few cases in the literature regarding long-term clinical outcomes.

Oral health-related quality of life of children and teens with sickle cell disease

BACKGROUND: Children with sickle cell disease may have their quality of life affected by oral alterations. However, there is still little data on oral health-related quality of life in these children. The aim of this study was to investigate the influence of sickle cell disease, socioeconomic characteristics, and oral conditions on oral health-related quality of life of children and teens. METHOD: One hundred and six children and teens with sickle cell disease were compared to a similar sample of 385 healthy peers. Data were collected through oral examinations, interviews to assess quality of life (Child Perceptions Questionnaire for children aged 8-10 and 11-14) and questionnaires containing questions on socioeconomic status. RESULTS: There were no statistically significant differences in the total scores of the Child Perceptions Questionnaires or domain scores comparing sickle cell disease patients to control subjects. When sub-scales were compared, oral symptoms and functional limitations had a greater negative impact on the quality of life of adolescents with sickle cell disease (p-value <0.001 and p-value <0.01, respectively) when compared to healthy controls. The only statistically significant determinants of negative impact on oral health-related quality of life in the overall sample was home overcrowding (more than two people/room) in the younger children's group, and dental malocclusion among teens. CONCLUSION: There was no significant difference in the negative impact on the oral health-related quality of life between the group with sickle cell disease and the control group. Of the oral alterations, there was a significant difference in the oral health-related quality of life between adolescents with sickle cell disease and controls only in relation to malocclusion. Among the socioeconomic characteristics, only overcrowding was significantly associated with a negative impact on oral health-related quality of life.

The impact of the oral condition of children with sickle cell disease on family quality of life

Abstract The aim of this study was to assess the impact of oral conditions of children with sickle cell disease (SCD) on their parents' quality of life (QoL). A cross-sectional study was performed with parents of outpatients suffering from SCD at a hematology referral center in Belo Horizonte, MG. A qualified dentist performed an intraoral exam. The Family Impact Scale (FIS) was used to assess the parents' perception of QoL. The parents answered some questions regarding sociodemographic and medical information about their children. The dmft/DMFT score, DAI, gum bleeding and SCD severity were evaluated in terms of their impacts on the overall mean FIS scores and subscale scores. The chance of more frequent impacts was greater in parents of adolescents (OR = 2.04; 95%CI = 1.2, 3.4) than of younger children. Dental caries (dmft/DMFT ≥ 1) had a negative impact on the QoL of parents of younger children and adolescents (p < 0.05 and p < 0.01, respectively). Among the parents of younger children, dental caries and SCD severity significantly affected the subscales for parental activities (PA) and parental emotions (PE) (p < 0.01, p < 0.05, respectively). Among parents of adolescents, dental caries (DMFT) and severe malocclusion adversely affected the PE and PA subscales (p < 0.01, p < 0.05, respectively). SCD severity affected the overall FIS score among young children's parents (p < 0.05). In conclusion, dental caries, age and SCD severity were associated with a negative impact on the QoL of parents of children with SCD

Qualidade de vida relacionada à saúde bucal em crianças com anemia falciforme e suas famílias: há uma correlação entre o relato de pais e filhos? / Oral Health-related Quality of Life in children with Sickle Cell Disease and your Family: There is a correlation between the reports of parents and children?

O objetivo deste estudo foi determinar a correlação filho-pais na avaliação da qualidade de vida relacionada à saúde bucal de crianças e de suas famílias e determinar as características associadas a essa correlação em uma população pediátrica com anemia falciforme. Foi realizado um estudo transversal com 106 crianças, de 8 a 14 anos, com diagnóstico de anemia falciforme (AF), no estado de Minas Gerais, Brasil, e seus pais/cuidadores. Estas crianças estavam fazendo acompanhamento de saúde na Fundação Centro de Hematologia e Hemoterapia de Minas Gerais (Hemominas). A qualidade de vida relacionada à saúde bucal (QVRSB) foi mensurada, utilizando-se as versões brasileiras dos instrumentos Child Perception Questionnaire para crianças de 8 a 10 anos (CPQ8-10) e de 11 a 14 anos (versão curta do CPQ11-14), o Parental-Caregiver Perceptions Questionnaire (P-CPQ) e o Family Impact Scale (FIS). Um dentista calibrado realizou os exames clínicos bucais para avaliação da experiência de cárie dentária, má oclus¿o e sangramento gengival, segundo os critérios da Organização Mundial de Saúde (OMS). As informações sobre a AF, as características sócio-demográficas e econômicas foram obtidas por meio de entrevistas realizadas com os pais/responsáveis pelas crianças. Os dados foram analisados por meio do teste de correlação de Spearman e regressão linear. Houve uma forte correlação entre P-CPQ e FIS (rs=0,732). Foi observada correlação moderada entre as avaliações de QVRSB realizadas pela criança (CPQ) e pelo pai-proxy (P-CPQ) (rs=0,433). Ao se analisar a correlação entre a avaliação da QVRSB realizada pelas crianças (CPQ) e o impacto na família (FIS) relatado pelos pais, observou-se uma correlação fraca (rs=0,331). Maiores diferenças no z-escore entre P-CPQ e FIS foram associadas com a menor idade do filho (p<0,01), mais baixa espiritualidade/religiosidade (p<0,05), menor renda familiar (p<0,01) e severidade da má oclusão dentária (p<0,05)...

More recently, there has been increasing interest in the oral health-related quality of life (OHRQoL) of children, since pediatric oral disorders are likely to have a negative effect on the child quality of life (QoL). One issue that receives a great deal of attention is the comparison of the measurement of children OHRQoL reports with those of their parents. In this way, three systematic reviews were carried out to review the literature on valid and reliable informations from children and parents concerning child OHRQoL, and to identify the pattern of agreement/disagreement between their reports. The literature was searched using Medline, ISI, Lilacs and Scielo, from 1985-2007. Two researchers independently checked and then selected only articles that used well-validated instruments, provided quantitative measurements of child clinical oral health status, and presented children and parental perceptions of child OHRQoL. In the first systematic review, from 89 records found, thirteen fulfilled the criteria. All selected studies suggested good construct validity. However, child understanding of oral health and well-being are affected by age, age-related experiences, gender, race, education, culture, experiences related to oral conditions, opportunities for treatment, childhood period of changes, back-translating questionnaire and child self-perceived treatment need. Twelve of 402 articles originally identified were included in the second systematic review. The results showed that the relationships between clinical oral health status and QoL in children were not direct, but mediated by a variety of personal, social and environmental variables, as well as by the child development, which have influence on the comprehension about the relationship among health, illness and QoL. In the third one, out of 87 articles that were critically assessed, five studies were selected ...

Production and characterization of an extracellular lipase from Candida guilliermondii

Extracellular lipases from the endophytic yeast Candida guilliermondii isolated from castor leaves (Ricinus communis L.) were produced using low-cost raw materials such as agro-industrial residues and applying them in the esterification of oleic acid for evaluating their potential use in biodiesel production. After partial purification using ammonium sulfate, the enzyme was characterized and presented higher activity (26.8 ± 1.5 U mL-1) in the presence of 5 mmol L-1 NaCl at 30 ºC and pH 6.5. The production through submerged fermentation was formerly performed in 150 mL erlenmeyer flasks and, once the enzyme production was verified, assays in a 14 L bioreactor were conducted, obtaining 18 ± 1.4 U mL-1. The produced enzyme was applied in the oleic acid esterification under different solvents: hexane, cyclohexane or cyclohexanone) and different acid:alcohol molar ratios. Higher ester conversion rate (81%) was obtained using hexane and the molar ratio of 1:9 was the best conditions using methanol. The results suggest the potential for development of endophytic yeast in the production of biocatalyst through submerged fermentation using agroindustrial residues as culture medium.

Cárie dentária e necessidade de tratamento ortodôntico: impacto na qualidade de vida de escolares / Dental caries and need of orthodontic treatment: impact on the quality of life of schoolchildren

Objetivo: Avaliar o impacto da cárie e da maloclusão (necessidade etratamento ortodôntico) na qualidade de vida de escolares de oito a 14 anos de idade residentes em Belo Horizonte, Minas Gerais. Métodos: Realizou-se um estudo transversal com amostra deconveniência (n=75), dividida em dois grupos de acordo com a idade dos escolares: grupo 1 – oito a dez anos e grupo 2- 11 a 14 anos. Os dados foram coletados pelo exame clínico para diagnóstico da cárie dentária (CPOD) e avaliação da necessidade de tratamento ortodôntico (IED) e aplicação dos instrumentos CPQ8-10 e CPQ11-14, para avaliação do impacto na qualidade de vida. Realizou-se análise descritiva, teste qui-quadrado e Mann-Whitney.Resultados: No grupo de estudantes com idade entre oito e dez anos, observou-se associação estatisticamente significativa entre necessidade de tratamento ortodôntico (IED > 30) e impacto negativo na qualidade de vida (p = 0,004), principalmente nos domínios limitação funcional (p<0,001), bem-estar emocional (p=0,001) e bem-estar social (p=0,008). Não foi observada associação entre a cárie dentária e impacto negativo na qualidade de vida neste grupo (p=0,66). Entre as crianças com idade entre 11 e 14 anos, verificou-se associação estatisticamente significativa entre impacto na qualidade de vida, cárie (p=0,004) e necessidade de tratamento ortodôntico (p=0,001). Considerando-se a cárie, a associação foi observada com os domínios bem-estar emocional (p=0,006) e social (p=0,02). A necessidade de tratamento ortodôntico mostrou associação significativa com limitação funcional (p=0,02), bemestar emocional (p=0,05) e social (p=0,03). Conclusão: A maloclusão (necessidade de tratamento ortodôntico) mostrou associação com impacto negativo na qualidade e vida de estudantes na faixa etária entre oito e 14 anos. Impacto negativo também foi observado entre estudantes de 11 a 14 anos queapresentavam cárie dentária

Objective: To evaluate the impact of dental caries and malocclusion(need of orthodontic treatment) on the quality of life of schoolchildrenaged 8 to 14 years living in the city of Belo Horizonte, MG, Brazil.Method: This study was a cross-sectional investigation with aconvenience sample (n=75) divided into two groups, according to theage of schoolchildren: Group 1: 8 to 10 years and Group 2: 11 to 14years. Data were collected by clinical examination for diagnosis ofdental caries (DMFT index) and determination of orthodontic treatmentneed (DAI - dental aesthetic index), and through application of CPQ8-10and CPQ11-14 instruments to assess the influence on the quality of life.Descriptive analysis, Chi-square and Mann-Whitney tests wereperformed.Results: In the group of schoolchildren aged 8 to 10 years, there was astatistically significant association between the need of orthodontictreatment (DAI>30) and negative impact on the quality of life (p=0.004),especially for the domains “functional limitation” (p<0.001), “emotionalwell being” (p=0.001) and “social well being” (p=0.008).

No associationwas found between dental caries and negative impact on quality of lifein this group (p=0.66). In the group of schoolchildren aged 11 to 14years there was a statistically significant association between impact on the quality of life and dental caries (p=0.004) and need of orthodontictreatment (p<0.001). Regarding dental caries, there was significantassociation between the domains “emotional well being” (p=0.006) and“social well being” (p=0.02). The need of orthodontic treatmentshowed a significant association with “functional limitation” (p=0.02),“emotional well being” (p=0.05) and “social well being” (p=0.03).Conclusion: Malocclusion (need of orthodontic treatment) wasassociated with negative impact on the quality of life of schoolchildrenin the age range between 8 and 14 years. There was also negativeimpact on the quality of life of 11-14 children with dental caries

Displasia ectodérmica: relato de caso / Ectodermal dysplasia: case report

A displasia ectodérmica (DE) compreende um grupo grande e heterogêneo de doenças hereditáriasque se caracteriza por apresentar manifestações clínicas relacionadas às anomalias das estruturas de origemectodérmica, principalmente nos cabelos, unhas, dentes e pele. Este trabalho descreve o caso clínico de umpaciente do sexo masculino de 11 anos de idade, que compareceu à clínica odontológica de uma instituição deensino superior de Belo Horizonte MG. A criança apresentava-se com características da displasia ectodérmica,na forma hipoidrótica, e com história de diversos indivíduos afetados na família materna. Fez-se, ainda, revisãoda literatura e discussão da etiologia e tratamento para o caso descrito.

Efeito da L-tiroxina sódica na tolerância ao esforço em mulheres com hipotireoidismo subclínico / Effect of l-thyroxine sodium on exercise tolerance in women with subclinical hypothyroidism

Introdução. Vários estudos associam o hipotireoidismo subclínico a fatores de risco de doença aterosclerótica. Poucos deles correlacionam esse distúrbio à diminuição da tolerância ao esforço físico. Nesse contexto, a reposição hormonal com o emprego da L-tiroxina no tratamento desses doentes permanece controvertido. Objetivo. Analisar o efeito da L-tiroxina sódica na tolerância ao esforço físico em mulheres com hipotireoidismo subclínico. Método. Foram selecionadas sete mulheres com idade de 40 a 60 anos, TSH acima de 4,4 mU/L, T3 livre e T4 normais no plasma sem sinais clínicos de hipotireoidismo. Para avaliação da tolerância ao esforço foram submetidas a teste de esforço progressivo. Como parâmetro de esforço foi analisada a concentração de lactato sanguíneo nos períodos pré e pós-tratamento. Resultados. Houve melhora significativa na tolerância ao lactato e, consequentemente, na tolerância ao esforço após tratamento com L-tiroxina. Conclusão. A terapia de reposição hormonal com L-tiroxina sódica em portadoras de hipotireoidismo subclínico pode propiciar maior tolerância ao esforço físico progressivo.

Introduction. Several studies have associated subclinical hypothyroidism with risk factors for atherosclerotic disease, but its correlation with a decreased tolerance to the physical effort has been scarcely studied. In this context, the hormonal replacement with L-thyroxine for the treatment of these patients remains controversial. Objective. To analyze the effect of sodium L-thyroxine on the tolerance to the physical effort of patients with subclinical hypothyroidism. Method. Seven female volunteers aged from 40 to 60 years, without clinical signs of hypothyroidism, but with TSH above 4.4 mU/dL, and normal total T3 and free T4 in the plasma were selected. For the evaluation of tolerance to the physical effort, all patients were submitted to a progressive effort test. Levels of blood lactate before and after treatment were analyzed as parameters of effort.Results. There was a significant improvement in tolerance to the lactate and consequently, in tolerance to the effort after treatment with thyroxine.Conclusion. The hormone replacement therapy with L-thyroxine sodium in women with subclinical ?hypothyroidism may improve progressive exercise tolerance.

Efeito do chá verde (Camelia sinensis) em ratos com obesidade induzida por dieta hipercalórica / Antiobesity effects of green tea (Camelia sinensis) in high caloric diet-induced obese rats

INTRODUÇÃO: A obesidade é fator de risco para várias doenças. Estudos têm demonstrado que os polifenóis do chá verde auxiliam na perda de peso e interferem nos mecanismos de diversas doenças. A insulina, agindo por meio de seu receptor (IR), desencadeia uma série de respostas. A via IR/Shc é ligada ao crescimento celular e à mitogênese. OBJETIVOS: Estudar o efeito do chá verde no peso corporal e no teste de tolerância à glicose (GTT). No fígado, estudar a fosforilação do IR, a presença e a expressão de IR e Shc e suas alterações morfológicas. MATERIAL E MÉTODOS: Ratos Wistar, jovens e tratados com dieta hipercalórica ou dieta própria para ratos, foram submetidos a tratamento com chá verde. Para retirada do fígado, após anestesia, foi infundida insulina ou solução salina. Para avaliar o grau de fosforilação do IR, o fragmento foi homogeneizado e submetido a técnicas de imunoprecipitação e imunoblotting. Para análise morfológica, foi utilizada a técnica de coloração por hematoxilina e eosina e para localizar a presença de IR e Shc, técnica de imuno-histoquímica. RESULTADOS E CONCLUSÃO: Observamos diminuição do peso corporal e da esteatose no fígado e melhora no GTT. Houve aumento da fosforilação do IR no fígado dos animais obesos tratados com relação aos obesos não submetidos a tratamento. Verificaram-se lesões que poderiam ser associadas ao tratamento, como necrose focal. A análise imuno-histoquímica demonstrou presença de IR e Shc em todos os grupos estudados e sugeriu alterações na expressão de IR e Shc nos grupos obesos e obesos tratados.

INTRODUCTION: Obesity is a risk factor for several diseases. Studies have shown that polyphenols in green tea aid in weight loss and influence the mechanisms of several diseases. Insulin, acting through its receptor (IR), triggers a series of responses. IR/Shc pathway is linked to cell growth and mitogenesis. OBJECTIVES: To investigate the effect of green tea on body weight and on glucose tolerance test (GTT). To study IR phosphorylation, IR/Shc presence and expression and their morphological changes in the liver. MATERIAL AND METHODS: Young Wistar rats were fed with high-calorie diet or proper rat food diet and subsequently were treated with green tea. After anesthesia, insulin or saline solution was infused to remove the liver. A liver fragment was homogenized and underwent immunoprecipitation and immunoblotting in order to assess IR phosphorylation levels. Hematoxylin and eosin staining was applied for morphological analysis and immunohistochemistry was carried out to locate the presence of IR and Shc. RESULTS AND CONCLUSION: It was observed a reduction in body weight and in liver steatosis as well as an improvement in GTT. There was also an increase in IR phosphorylation in treated animals in comparison with non-treated ones. Lesions such as focal necrosis were observed and may be associated with the treatment. The immunohistochemical analysis demonstrated the presence of IR and Shc in all groups and suggested changes in IR and Shc expression in both treated and non-treated groups.

Spironolactone effects on myocardium changes induced by thyroid hormone in rats / Efeitos da espironolactona sobre as alterações miocárdicas induzidas pelo hormônio tireoideano em ratos

FUNDAMENTO: Estudar o papel do sistema renina-angiotensina-aldosterona na hipertrofia miocárdica induzida pelo hormônio tireoideano, utilizando-se a espironolactona. OBJETIVO: Analisar as alterações morfológicas no miocárdio induzidas pelo hormônio tireoideano e os efeitos da espironolactona nesse processo. MÉTODOS: Foram estudados 40 ratos Wistar, divididos em quatro grupos, que receberam: veículo utilizado para a diluição do hormônio tireoideano (C); levotiroxina sódica (50 µg/rato/dia) (H); espironolactona (0,3 mg/kg/dia) (E) e hormônio tireoideano + espironolactona (HE), nas mesmas doses citadas, durante 28 dias consecutivos. Todos os animais foram submetidos a pesagem, coleta de sangue para dosagens hormonais e realização de ECG no início e no final do experimento. Ao final do período de estudo, os animais foram sacrificados para determinação do peso do ventrículo esquerdo (VE) e obtenção de cortes de VE para análise morfológica. RESULTADOS: Houve aumento dos níveis de T3 no plasma, perda de peso corporal e aumento da freqüência cardíaca nos animais que receberam o hormônio. O peso do VE foi maior nos grupos H e HE. A análise histométrica mostrou maiores diâmetros dos miócitos no grupo H, com os valores decrescentes nos grupos HE, E e C, sendo as diferenças estatisticamente significantes entre todos os grupos. A espironolactona associada ao hormônio tireoideano (HT) diminuiu em 14,6 por cento a hipertrofia transversal dos miócitos. CONCLUSÃO: Em ratos tratados com hormônio tireoideano ocorre hipertrofia cardíaca com aumento do peso do VE e do diâmetro do miócito. A associação de espironolactona ao hormônio tireoideano previne parcialmente essa hipertrofia por mecanismos ainda desconhecidos.

BACKGROUND: To study the possible role of aldosterone on thyroid hormone-induced myocardium hypertrophy, using spironolactone. OBJECTIVE: To evaluate morphological changes in the myocardium induced by thyroid hormone and the possible effects of spironolactone use on these alterations. METHODS: Forty Wistar rats were studied. The animals were allocated to four groups and were given: the vehicle used for dilution of the thyroid hormone (C); sodium levothyroxin at 50 µg/rat/day (H); spironolactone, 0.3 mg/kg/day (S); or thyroid hormone plus spironolactone (HS), at the same doses mentioned above, for 28 consecutive days. All the animals were weighed, had blood drawn for hormonal measurements and underwent ECG at the start and the end of the experiment. At the end of experiment all animals were euthanized, the weight of the left ventricle (LV) was determined and LV slices were obtained for morphological analysis. RESULTS: There was an increase in T3 levels, decrease of body weight and higher heart rate in the animals from group H. The LV weight was significantly higher in the H e HS groups. The histometric analyses that measured the diameter of the myocytes showed higher values in group H and a progressive decrease in groups HS, S and C, with a significant difference among all the groups. The addition of spironolactone decreased the transversal myocyte hypertrophy by 14.6 percent. CONCLUSION: Rats treated with thyroid hormone present cardiac hypertrophy with increased LV weight and greater myocyte diameter. Spironolactone, when associated with thyroid hormone, can partially prevent this hypertrophy through mechanisms that are yet to be determined.

Discordância entre IGF-1 e GH pós-sobrecarga de glicose no rastreamento de acromegalia em paciente com macroprolactinoma: relato de caso e revisão sobre o tema / Discrepancy between IGF-1 and GH during 75 g oral glucose tolerance test measures to acromegaly screening in a patient with macroprolactinoma: case report and literature review

Neste artigo, descrevemos o caso de um paciente com diagnóstico de macroprolactinoma, que apresentava valores discordantes entre IGF-1 (elevado) e GH (hormônio de crescimento) pós-teste de tolerância oral à glicose (normal) realizados para pesquisa de co-secreção de GH pelo tumor. Houve normalização dos níveis de prolactina após uso de bromocriptina, porém, durante o acompanhamento, o paciente persistiu com níveis elevados de IGF-1 sem clínica aparente, sugerindo tratar-se de possível forma subclínica de acromegalia. Após o desenvolvimento de novos métodos laboratoriais, mais sensíveis, para a dosagem de GH, casos de discordância entre esses testes vêm sendo observados, levando alguns autores a sugerir que o nadir de GH pós-teste de tolerância à glicose oral (TTGO) para diagnóstico e tratamento da acromegalia pode ser bem menor do que o limite considerado atualmente (1,2). Assim, se isto for confirmado, casos subclínicos ou oligossintomáticos de acromegalia serão diagnosticados mais precocemente.

We describe a patient with macroprolactinoma and discrepant insulin-like growth factor (IGF-1) concentration (elevated) and growth hormone (GH) values during a 75 g oral glucose tolerance test (normal), that were measured to evaluate the co-secretion of GH by tumor. With the bromocriptin use, the patient achieved normalization of prolactin, but persisted with high levels of IGF1, suggesting to be subclinical acromegaly. After the development of new more sensitive GH assays, cases of discrepant GH and IGF-1 results have been observed and taken to some authors to suggest that GH nadir concentration during 75 g OGTT used to acromegaly diagnosis and treatment could be lower than values considered currently normal. Thus, if this is confirmed, subclinical and oligosymptomatic acromegaly cases could have earlier diagnoses.

Primary pigmented nodular adrenocortical disease associated with Carney complex: case report and literature review

CONTEXT: Carney complex (CNC), a familial multiple neoplasm syndrome with dominant autosomal transmission, is characterized by tumors of the heart, skin, endocrine and peripheral nervous system, and also cutaneous lentiginosis. This is a rare syndrome and its main endocrine manifestation, primary pigmented nodular adrenal disease (PPNAD), is an uncommon cause of adrenocorticotropic hormone-independent Cushing's syndrome. CASE REPORT: We report the case of a 20-year-old patient with a history of weight gain, hirsutism, acne, secondary amenorrhea and facial lentiginosis. Following the diagnosing of CNC and PPNAD, the patient underwent laparoscopic bilateral adrenalectomy, and she evolved with decreasing hypercortisolism. Screening was also performed for other tumors related to this syndrome. The diagnostic criteria, screening and follow-up for patients and affected family members are discussed.

CONTEXTO: O complexo de Carney (CNC), uma síndrome de neoplasia múltipla familiar com transmissão autossômica dominante, caracteriza-se por tumores cardíacos, cutâneos, endócrinos e do sistema nervoso periférico, além de lentiginose cutânea. RELATO DE CASO: Devido à raridade da síndrome, bem como de sua principal manifestação endócrina, a doença adrenal nodular pigmentada primária (PPNAD), causa incomum de síndrome de Cushing ACTH-independente, relatamos o caso de uma paciente de 20 anos com história de ganho de peso, hirsutismo, acne, amenorréia secundária e lentiginose em face. Após estabelecido o diagnóstico de CNC e PPNAD, a paciente foi submetida a adrenalectomia bilateral via laparoscópica, evoluindo com melhora do hipercortisolismo. Também foi realizado rastreamento para os demais tumores relacionados à síndrome. Serão discutidos os critérios diagnósticos, o rastreamento e o acompanhamento dos pacientes e familiares afetados.

Sinalizaçäo da insulina em sistema nervoso central de ratos / Insulin signalling in the central nervous system of mices

A insulina, agindo do seu receptor (IR) pertence á família dos receptores com atividade tirosina quinase, desencadeia uma série de respostas tecido-específicas mediadas por diferentes vias intracelulares. Uma destas vias, com atividade predominantemente ligada a crescimento celular e mitogênese envolve as proteínas SHC e GRB2. No presente estudo avaliou-se a sinalizaçäo da insulina através da vias SHC/GRB2 em sistema nervoso central (SNC) de ratos. Inicialmante determinou-se presença e quantidades de IR, SHC e GRB2 em córtex cerebral e cerebelar. As três proteínas foram encontradas em concentraçöes similares em ambos os tecidos. Entretanto, quando os animais experimentais foram submetidos a tratamento agudo com insulina detectou-se aumento significativo da fosforilaçäo de IR e SHC e da associaçäo SHC/GRB2 somente em cerebelo e näo em córtex cerebral.