Recomendaciones de la Asociación Colombiana de Neurología para el uso de anticuerpos monoclonales antiCGRP en la profilaxis de migraña / Recommendations on the use of the antiCGRP monoclonal antibodies for migraine prophylaxis on behalf of the Colombian Association of Neurology

RESUMEN INTRODUCCIÓN: El desarrollo de anticuerpos monoclonales (mAbs) contra el péptido relacionado con el gen de la calcitonina (CGRP) ha determinado una nueva era terapéutica en la profilaxis de migraña, demostrando su efectividad en pacientes con migraña episódica (ME) y migraña crónica (MC), con respuesta desde pacientes naïve hasta refractarios a múltiples medicamentos. La disminución del 50% de los ataques de migraña al mes (DMM) durante los primeros 3 meses de uso es el desenlace aproximado en el 50% de los pacientes que reciben esta terapia. OBJETIVO: Este consenso de la Asociación Colombiana de Neurología (ACN) tiene el objetivo de guiar la selección y uso racional de los mAbs antiCGRP en pacientes con ME y MC. MATERIALES Y MÉTODOS: El comité de cefalea de la ACN mediante la aplicación de la metodología Delphi y discusiones en reuniones posteriores desarrolló un documento en formato de consenso soportado en literatura y recomendaciones de expertos. RESULTADOS: Se obtuvieron respuestas de 14 expertos en cefalea sobre moléculas utilizadas en profilaxis de migraña, analizando su aplicabilidad en situaciones clínicas frecuentes. DISCUSIÓN: Los mAbs antiCGRP han demostrado efectividad con adecuado soporte fisiopatológico, considerando que son moléculas de alto precio en una enfermedad de alta prevalencia, existe la necesidad de guíar la selección del paciente que mejor puede beneficiarse de su administración CONCLUSIONES: Los mAbs antiCGRP están recomendados en pacientes con ME y MC que presentan falla terapéutica a otras moléculas profilácticas.

ABSTRACT INTRODUCTION: The development of monoclonal antibodies (mAbs) against Calcitonin Gene Related Peptide (CGRP) has determined a new therapeutic era in migraine prophylaxis, demonstrating its effectiveness in patients with episodic migraine (EM) and chronic migraine (CM), obtaining a response in naive patients and in those who are refractory to multiple medications. A 50% decrease in migraine attacks per month during the first 3 months of use is the approximate outcome in 50% of patients receiving this therapy. OBJECTIVE: This consensus from the Colombian Association of Neurology (ACN) has the objective of serving as a guide for the rational use of antiCGRP mAbs in patients with EM and CM. METHODS AND MATERIALS: The headache committee through the application of the Delphi methodology and discussions in subsequent meetings, develops this consensus, supported in the published literature and expert recommendations. RESULTS: Fourteen answers from headache experts were received regarding the use of drugs for migraine prophylaxis, analyzing their applicability in frequent clinical situations. DISCUSSION: AntiCGRP mAbs have proved their effectiveness with adequate pathophysiological support, but with a high price in a highly prevalent disease, there is then a need to select the patient who best benefits from this therapy. CONCLUSIONS: AntiCGRP mAbs are recommended in patients with EM and CM that have previously failed to other prophylactic drugs.

El paciente con cefalea durante el ejercicio en urgencias / The patient with headache during exercise in emergency department

RESUMEN La cefalea relacionada con la actividad física no es infrecuente. En pacientes jóvenes suele corresponder a cefalea por esfuerzo físico primaria. Sin embargo, aun en la presencia de características típicas, el diagnóstico de cefalea primaria relacionada con el ejercicio debe hacerse luego de una investigación exhaustiva. Las causas secundarias típicas incluyen hemorragia subaracnoidea, síndrome de vasoconstricción cerebral reversible y disección arterial. Una etiología menos común es la trombosis de senos venosos durales. En esta revisión presentamos el caso de una mujer joven que experimentó cefalea durante una prueba física, en quien se documenta una trombosis de senos venosos extensa.

SUMMARY Headache related to physical activity is not uncommon. In young patients it usually corresponds to headache due to primary physical exertion. However, even in the presence of typical features, the diagnosis of primary exercise-related headache should be made after extensive investigation. Secondary causes include subarachnoid hemorrhage, reversible cerebral vasoconstriction syndrome, and arterial dissection. A less common etiology is thrombosis of the dural venous sinuses. In this review we present the case of a young woman who presented with headache during a physical test in which extensive venous sinus thrombosis was documented.

Guideline on the preventive treatment of chronic migraine, chronic tension type headache, hemicrania continua and new daily persistent headache on behalf of the Colombian Association of Neurology / Guía de la Asociación Colombiana de Neurología para el tratamiento preventivo de la migraña crónica, cefalea tipo tensión crónica, hemicránea continua y cefalea diaria persistente de novo

SUMMARY INTRODUCTION: Chronic daily headache is a high impact entity in the general population. Although chronic migraine and tension-type headache are the most frequent conditions, it is necessary to consider hemicrania continua and new daily persistent headache as part of the differential diagnoses to perform a correct therapeutic approach. OBJECTIVE: To make recommendations for the treatment of chronic daily headache of primary origin METHODOLOGY: The Colombian Association of Neurology, by consensus and Grade methodology (Grading of recommendations, assessment, development and evaluation), presents the recommendations for the preventive treatment of each of the entities of the daily chronic headache of primary origin group. RESULTS: For the treatment of chronic migraine, the Colombian Association of Neurology recommends onabotulinum toxin A, erenumab, topiramate, flunarizine, amitriptyline, and naratriptan. In chronic tension-type headache the recommended therapeutic options are amitriptyline, imipramine, venlafaxine and mirtazapine. Topiramate, melatonin, and celecoxib for the treatment of hemicrania continua. Options for new daily persistent headache include gabapentin and doxycycline. The recommendations for inpatient treatment of patients with chronic daily headache and the justifications for performing neural blockades as a therapeutic complement are also presented. CONCLUSION: The therapeutic recommendations for the treatment of chronic daily headache based on consensus methodology and Grade System are presented.

RESUMEN INTRODUCCIÓN: La cefalea crónica diaria es una entidad de alto impacto en la población general. Aunque la migraña crónica y la cefalea tipo tensión son las condiciones más frecuentes, es necesario considerar la hemicránea continua y la cefalea diaria persistente de novo como parte de los diagnósticos diferenciales para realizar un enfoque terapéutico correcto. OBJETIVO: Hacer recomendaciones para el tratamiento de la cefalea crónica diaria de origen primario METODOLOGÍA: La Asociación Colombiana de Neurología, mediante consenso y metodología GRADE (Grading of Reccomendations, Assesment, Development and Evaluation), presenta las recomendaciones para el tratamiento preventivo de cada una de las entidades del grupo de la cefalea crónica diaria de origen primario. RESULTADOS: Para el tratamiento de la migraña crónica, la Asociación Colombiana de Neurología recomienda onabotulinum toxina A, erenumab, galcanezumab, fremanezumab, topiramato, flunarizina, amitriptilina y naratriptan. En cefalea tipo tensional crónica las opciones terapéuticas recomendadas son amitriptilina, imipramina, venlafaxina y mirtazapina. Para el tratamiento de la hemicránea continua topiramato, melatonina y celecoxib. Las opciones para cefalea diaria persistente de novo incluyen gabapentin y doxiciclina. Se presentan adicionalmente las recomendaciones para el tratamiento intrahospitalario de los pacientes con cefalea crónica diaria y las justificaciones para la realización de bloqueos neurales como complemento terapéutico. CONCLUSIÓN: se presentan las recomendaciones terapéuticas para el tratamiento de la cefalea crónica diaria basado en metodología de consenso y sistema GRADE.

Light chain cardiac amyloidosis - a rare cause of heart failure in a young adult

SUMMARY Cardiac amyloidosis is an infiltrative cardiomyopathy, resulting from amyloid deposition within the myocardium. In primary systemic (AL-type) amyloidosis, the amyloid protein is composed of light chains resulting from plasma-cell dyscrasia, and cardiac involvement occurs in up to 50% of the patients We present a case of a 43-year-old man, with complaints of periodical swollen tongue and xerostomia, bleeding gums and haematuria for two months. His blood results showed normocytic anaemia, thrombocytopenia and a high spontaneous INR, therefore he was referred to the Internal Medicine clinic. In the first visit, he showed signs and symptoms of overt congestive heart failure and was referred to the emergency department. The electrocardiogram showed sinus tachycardia and low voltage criteria. Echocardiography showed biventricular hypertrophy with preserved ejection fraction, restrictive physiology with elevated filling pressures, thickened interatrial septum and atrioventricular valves, small pericardial effusion and relative "apical sparing" on 2D longitudinal strain. Cardiac MRI showed diffuse subendocardial late enhancement. Serum protein electrophoresis was inconclusive, however urine analysis revealed nephrotic range proteinuria, positive Bence Jones protein and an immunofixation test with a monoclonal lambda protein band. Abdominal fat biopsy was negative for Congo red stain, nevertheless a bone marrow biopsy was performed, revealing lambda protein monoclonal plasmocytosis, confirming the diagnosis of primary systemic amyloidosis. This case represents a rare cause of heart failure in a young adult. Low-voltage QRS complexes and typical echocardiography features should raise the suspicion for cardiac amyloidosis. Prognosis is dictated by the level of cardiac involvement; therefore, early diagnosis and treatment are crucial.

RESUMO A amiloidose cardíaca corresponde a uma miocardiopatia infiltrativa, resultante do depósito da proteína amiloide no miocárdio. Na amiloidose sistêmica primária (tipo AL), a proteína amiloide é composta por cadeias leves que resultam de discrasia dos plasmócitos, havendo envolvimento cardíaco em até 50% dos doentes. Apresentamos o caso de um homem de 43 anos, com queixas de edema periódico da língua e xerostomia, hemorragia gengival e hematúria há dois meses. Analiticamente havia a destacar anemia normocítica, trombocitopenia e um INR alto espontâneo, pelo que foi referenciado à consulta de Medicina Interna. Na primeira consulta, apresentou-se com sinais de insuficiência cardíaca congestiva franca, pelo que foi referenciado ao Serviço de Urgência. O eletrocardiograma demonstrou taquicardia sinusal e critérios de baixa voltagem. O ecocardiograma revelou hipertrofia biventricular com fração de ejeção preservada, fisiologia restritiva com elevação das pressões de enchimento, espessamento do septo interauricular e das válvulas auriculoventriculares, derrame pericárdico ligeiro e padrão de apical sparing no strain longitudinal 2D. Realizou ainda ressonância magnética cardíaca, que mostrou realce tardio subendocárdico difuso. A eletroforese das proteínas foi inconclusiva, contudo a análise da urina revelou proteinúria no espectro nefrótico, presença de proteína de Bence Jones e um teste de imunofixação com uma banda monoclonal de cadeias lambda. A biópsia da gordura abdominal foi negativa. Não obstante, foi realizada uma biópsia da medula óssea, verificando-se plasmocitose monoclonal lambda, o que confirmou o diagnóstico de amiloidose primária sistêmica. Este caso representa uma causa rara de insuficiência cardíaca no jovem adulto. A baixa voltagem no eletrocardiograma e os achados ecocardiográficos típicos devem fazer suspeitar de amiloidose cardíaca. O prognóstico é ditado pelo nível de envolvimento cardíaco, motivo pelo qual o diagnóstico e o tratamento precoces são essenciais.

Oral health related quality of life among pregnant women: a randomized controlled trial

Abstract: The aim of the present study was to compare negative impacts of oral conditions in Oral Heath Related Quality of Life (OHRQoL) assessed by the Oral Health Impact Profile-14 (OHIP-14) scores in pregnant women receiving or not comprehensive periodontal treatment. This randomized controlled clinical trial included pregnant women aged between 18 and 35 years old. Participants were randomized in a test group with 96 and a control group with 114 women. Patients in the test group received comprehensive periodontal treatment, supra and subgingival scaling and root-planning and periodontal maintenance appointments. The OHIP-14 was applied before and after treatment. The primary outcome was changes in OHIP-14 scores after follow-up period. The impact of having received or not comprehensive periodontal treatment on the change of the OHIP-14 scores was also investigated. Both groups showed significant reduction in OHIP-14 scores and effect size for the test group was 0.60 and 0.36 for the control group. Multinomial logistic regression analysis showed that participants of the control group had 5.9-fold odds (CI 95% 1.88-18.52) of worsening in OHIP-14 scores and their perception of oral conditions in relation to test group. Comprehensive periodontal treatment during pregnancy can reduce the negative impacts in OHRQoL.

Association between metabolic syndrome and periodontitis: a systematic review and meta-analysis

Abstract The aim of the present study was to evaluate the association between metabolic syndrome (MS) and periodontitis (PD), through a systematic review and meta-analysis. Original observational studies assessing the association between MS and PD in adults, published before May 11th (2017), were identified through electronic searches of MEDLINE, EMBASE and Cochrane Library databases. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was used. For studies to be included, they had to mention the criteria used to diagnose MS and to have used at least one clinical measure to diagnose PD. There was no language restriction. Three reviewers independently identified eligible studies for possible inclusion in the systematic review and meta-analysis. The quality of the studies was evaluated by the Newcastle-Ottawa scale for observational studies. A random model meta-analysis was conducted. The strategies used to investigate heterogeneity were sequential analysis, subgroup analysis, univariate meta-regression and sensitivity analysis. Thirty-three studies met the inclusion criteria for the systematic review, and 26 had enough information to be included in the meta-analysis, totaling 52,504 patients. MS and PD were associated with an odds ratio of 1.38 (95%CI 1.26-1.51; I2 = 92.7%; p < 0.001). Subgroup analysis showed that complete periodontal examination (I2 = 70.6%; p < 0.001) partially explained the variability between studies. The present findings suggest an association between MS and PD. Individuals with MS are 38% more likely to present PD than individuals without this condition. Prospective studies should be conducted to establish cause and effect relations between MS and PD.

Absence of interdental papilla ­ Systematic review of available therapeutic modalities / Ausência de papila interdental ­ revisão sistemática sobre as modalidades terapêuticas disponíveis

The objective of the present study was to conduct a systematic review of the treatment alternatives for the absence of interdental papilla (AIP), a clinical situation that can have aesthetic and phonetic impacts. A search for original articles, in humans, reporting more than one case, without language restrictions, dealing with therapeutic alternatives for AIP, was conducted in the databases of MEDLINE and EMBASE. The strategy included [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] up to the year of 2010, resulting in seven studies being included. One study was found upon checking the reference lists and was added, bringing the total to 8 studies. The sample size ranged from two to 19 participants. Six of the eight studies used periodontal surgical techniques and fi ve associated the subepithelial connective tissue graft. Two studies treated AIP with reticulated hyaluronic acid gel. The follow-up time ranged from four to 24 months. The results, in relation to the interdental space area, ranged from 43% to 100% of fi lling and the reduction of the distance between the contact point and the tip of the papilla ranged from 0.73 to 2.8 mm. Two studies did not describe the results numerically. It was concluded that the therapeutic results presented by the authors were positive. However, it is necessary to take into consideration that the designs of the studies included here have a weak capacity for generating scientifi c evidence. As studies with a randomized clinical trial design are not conducted to respond to this clinical question, the results of the present study should be used with caution.

O objetivo deste estudo foi realizar uma revisão sistemática sobre as alternativas de tratamento da ausência da papila interdental (API), situação clínica que pode trazer impactos estéticos e fonéticos. Uma busca por artigos originais, em humanos, apresentando mais de 1 caso, sem restrição de idiomas, que tratassem sobre alternativas terapêuticas para a API foi realizada nas bases de dados Pubmed e Embase. A estratégia incluiu: [("interdental papilla" OR "black triangles" OR "open gingival embrasure") AND ("treatment" OR "therapy" OR "reconstruction")] a partir do ano de 2010, resultando em sete estudos incluídos. Um estudo foi encontrado na verifi cação das listas de referências e adicionado, totalizando 8 estudos. O tamanho amostral variou de dois a 19 participantes. Seis dos oito estudos utilizaram técnicas cirúrgicas periodontais e cinco associaram o enxerto conjuntivo subepitelial. Dois estudos trataram a API com gel de ácido hialurônico reticulado. O tempo de acompanhamento variou de quatro a 24 meses. Os resultados em relação ao espaço/área interdental variaram de 43 a 100% de preenchimento e a redução da distância entre o ponto de contato e a ponta da papila variou de 0,73 a 2,8 mm. Dois estudos não descreveram numericamente os resultados. Conclui-se que os resultados terapêuticos apresentados pelos autores foram positivos. Entretanto, é preciso levar em consideração que o delineamento dos estudos incluídos tem fraca capacidade de gerar evidência científi ca. Enquanto estudos com delineamento do tipo ensaio clínico randomizado não sejam realizados para responder essa pergunta clínica, os resultados do presente estudo devem ser utilizados com cautela.

Endocardite pneumocócica em válvula aórtica nativa - apresentação fulminante / Native aortic valve pneumococcal endocarditis - fulminant presentation

RESUMO A endocardite pneumocócica é uma entidade rara, cuja incidência se situa entre 1% e 3% dos casos de endocardite de válvula nativa. Esta patologia tem um prognóstico naturalmente adverso, com elevada mortalidade. Relata-se predileção pela válvula aórtica, de forma que é frequente que se apresente com insuficiência cardíaca. Apresentamos o caso de uma paciente do sexo feminino com 60 anos de idade e história pregressa de sinusite, admitida com diagnóstico de pneumonia. Após rápida deterioração, com sinais de choque séptico, ela foi transferida para a unidade de terapia intensiva. O ecocardiograma transesofágico revelou grave refluxo aórtico, devido à presença de vegetações valvares. As hemoculturas foram positivas para Streptococcus pneumoniae. A paciente foi submetida à cirurgia cardíaca e apresentou múltiplas complicações pós-operatórias. Apesar disso, apresentou lenta, porém completa recuperação. A endocardite infecciosa deve ser afastada em caso do surgimento de qualquer suspeita, e a ecocardiografia deve ser realizada precocemente nos pacientes com resposta insuficiente aos vasopressores e inotrópicos. Pacientes com endocardite pneumocócica se beneficiam de uma abordagem agressiva, com realização precoce da intervenção cirúrgica.

ABSTRACT Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.

Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

O objetivo do estudo foi comparar a percepção estética do sorriso de pacientes, estudantes de odontologia e dentistas, em relação a diferentes situações de posição da margem gengival. Cento e vinte e três indivíduos (41 pacientes, 41 estudantes de odontologia e 41 dentistas) responderam um questionário estruturado e avaliaram 6 fotografias de um mesmo sorriso modificadas no Photoshop representando: periodonto inalterado (sem recessão gengival), recessão de 2 mm em um incisivo lateral superior, recessão de 2 mm em ambos incisivos laterais superiores, recessão de 2 mm em um canino superior, recessão de 2 mm em ambos caninos superiores e recessão generalizada de 2 mm. Uma escala visual analógica (EVA) foi usada para graduar a percepção estética. Médias da EVA foram calculadas e comparadas entre as situações gengivais, bem como entre os grupos de respondentes pela ANOVA de um critério com nível de significância de 0,05. A análise da EVA revelou que os valores médios variaram entre de 4,2 (±1,8) a 6,8 (±1,7). Periodonto inalterado foi avaliado com o maior escore por todos os grupos (com diferença estatisticamente significativa entre dentistas e estudantes de odontologia). Entretanto, pacientes avaliaram periodonto inalterado com valores menores quando comparados a dentistas e estudantes de odontologia. Entre pacientes nenhuma diferença significativa foi observada para nenhuma das situações apresentadas. Quando dentistas e estudantes de odontologia foram considerados, a pior situação foi observada para recessão gengival generalizada (4,2±1,8 e 4,9±1,8, respectivamente). Pacientes e profissionais da odontologia demonstraram diferentes percepções sobre as situações de estética relacionadas à posição da margem gengival.

Avances en la comprensión de la transición nutricional colombiana / Avanços na compreensão da transição nutricional colombiana / Advances in understanding Colombia´s nutrition transition

Objetivo: describir la presencia y las características relacionadas con la transición nutricional colombiana, a partir de datos antropométricos y sociodemográficos. Métodos: se estimó el estado nutricional de mujeres en edad fértil y niños menores de cinco años, con base en la información registrada en las bases de datos de la Encuesta Nacional de Demografía y Salud de Colombia delos años 1995, 2000, 2005 y 2010. Se evaluó la asociación entre el estado nutricional de los dos subgrupos y las características sociodemográficas, como también con marcadores potencialesde actividad física sedentaria. Resultados y conclusiones: se encontraron distintas expresionesde la transición nutricional en Colombia: mayor prevalencia de sobrepeso y obesidad en ambos subgrupos respecto a desnutrición, una prevalencia creciente y acelerada de obesidad en el grupo de mujeres en edad fértil, asociación del estado nutricional con marcadores potenciales de actividadfísica sedentaria y estado nutricional relacionado con algunas variables sociodemográficas...

Objective: to describe the presence and characteristics related to the Colombian nutrition transition by analyzing anthropometric and sociodemographic data. Methods: the nutritional conditionof women in childbearing age and of children under 5 years was estimated based on information from the Colombian 1995, 2000, 2005 and 2010 Demographic Health Surveys. Association between the nutritional condition of the two subgroups with sociodemographic characteristicsand potential markers of sedentary physical activity was evaluated. Results and Conclusions: different expressions of the nutritional transition in Colombia were observed: Higher prevalenceof overweight and obesity in both population subgroups as compared to undernutrition, an increasing and accelerated prevalence of obesity of women in childbearing age, associationof the nutritional condition with potential markers of sedentary physical activity in households and nutritional condition related to some sociodemographic variables...

Objetivo: Descrever a presencia e características relacionadas com a transição nutricional colombianaa partir de dados antropométricos e sociodemográficos. Métodos: Estimou-se o estado nutricional de mulheres em idade fértil e crianças menores de 5 anos com base na informação registrada nas bases de dados do Inquérito Nacional de Demografia e Saúde de Colômbia dos anos 1995, 2000, 2005 e 2010. Avaliou-se a associação entre estado nutricional dos dois subgrupos e características sociodemográficas mesmo com marcadores potenciais de atividade física sedentária. Resultados e conclusões: Encontraram-se diferentes expressões da transição nutricional na Colômbia: Maior prevalência de sobrepeso e obesidade em ambos os subgrupos respeito à desnutrição, prevalência crescente e acelerada de obesidade no grupo de mulheresem idade fértil, associação do estado nutricional com marcadores potenciais de atividade física sedentária e estado nutricional relacionado com variáveis sociodemográficas...

Periodontal disease and systemic complications

Periodontal diseases comprise a number of infectious and inflammatory conditions brought about by the interaction between supragingival and subgingival biofilms and the host inflammatory response. Periodontal diseases should be considered systemic conditions. This means that they are both modulated by the body's systems and play a role as a risk factor for systemic derangements. The current evidence supports some of these interactions, such as smoking as a risk factor for periodontal disease and diabetes mellitus, as both influenced by and influencing inflammatory changes in the periodontal tissue. Other potential associations are still being researched, such as obesity, hormonal changes, cardiovascular disease, and adverse outcomes in pregnancy. These, and others, still require further investigation before the repercussions of periodontal disease can be fully elucidated. Nevertheless, at the present time, the treatment of periodontal diseases-and, most importantly, their prevention-enables adequate intervention as a means of ensuring periodontal health.

Revisão por décadas da evolução dos experimentos com o uso de condicionamento ácido sobre o complexo dentino-pulpar / Review of the acid etch technique upon the pulpo-dentinal complex

O objetivo deste trabalho foi reunir estudos a respeito da evolução do uso do condicionamento ácido sobre o complexo dentino-pulpar levando em consideração principalmente aspectos referentes à biocompatibilidade e permeabilidade dentinária ao longo das décadas de 70, 80 e 90. Verificou-se as vantagens do condicionamento ácido no que se refere à retenção e preservação da estrutura dentária. Apesar desse significativo avanço, ressalta-se a relevância da proteção pulpar, para diminuir os efeitos deletérios do ácido