RESUMEN
ABSTRACT Studies linking type of diet and juvenile idiopathic arthritis (JIA) have variable results and are inconsistent. This case shows an evolution which fulfilled the criteria of JIA, but was diagnosed as food allergy. Case: A seven-year old boy had fever, arthralgia, general malaise, headaches, abdominal pain and rashes. These symptoms were diagnosed as fever of unknown origin (FUO) and probable JIA. There was a stabbing pain in the right iliac fossa. An upper and lower endoscopy were performed and nodular ileocolitis was detected. A hypoallergenic diet was prescribed, in addition to mesalazine and oral corticosteroids. The patient was asymptomatic for 2.5 months and then relapsed with all symptoms after consuming dairy. This JIA case shows the diagnostic phases of food allergy: improvement and recurrence of symptoms with the reintroduction of the allergen (oral challenge=gold standard of food allergy). There is evidence that supports the existence of a gut-joint axis, where the luminal content triggers a series of immunologically mediated reactions that can cause systemic diseases such as JIA and other connective tissue diseases. This case report adds reasonable evidence in support of food allergy as a cause of JIA.
RESUMEN Los estudios que relacionan el tipo de dieta y la artritis idiopática juvenil (AIJ) tienen resultados variables y son inconsistentes. Este caso muestra una evolución que cumplió con los criterios de AIJ, pero fue diagnosticada como alergia alimentaria. Caso: Un niño de siete años tenía fiebre, artralgia, malestar general, dolores de cabeza, dolor abdominal y erupciones cutáneas. Estos síntomas fueron diagnosticados como fiebre de origen desconocido (FUO) y probable AIJ. Hubo un dolor punzante en la fosa ilíaca derecha. Se realizó una endoscopia superior e inferior y se detectó ileocolitis nodular. Se prescribió una dieta hipoalergénica, además de mesalazina y corticosteroides orales. El paciente estuvo asintomático durante 2,5 meses y luego recayó con todos los síntomas después de consumir lácteos. Este caso de AIJ muestra las fases diagnósticas de la alergia alimentaria: mejora y recurrencia de los síntomas con la reintroducción del alergeno (desafío oral = estándar de oro de alergia alimentaria). Existe evidencia que respalda la existencia de un eje de la articulación intestinal, donde el contenido luminal desencadena una serie de reacciones inmunológicamente mediadas que pueden causar enfermedades sistémicas como la AIJ y otras enfermedades del tejido conectivo. Este informe del caso agrega evidencia razonable en apoyo de la alergia a los alimentos como causa de AIJ.
Asunto(s)
Niño , Humanos , Masculino , Artritis Juvenil/etiología , Hipersensibilidad a los Alimentos/complicaciones , Hipersensibilidad a los Alimentos/diagnósticoRESUMEN
Objetivos: Evaluar el efecto del tratamiento periodontal sobre la artritis reumatoide. Material y Métodos: Se realizó una búsqueda electrónica de ensayos clínicos publicados desde junio de 2009 hasta junio de 2014 en PUBMED, Cochrane y manual en las revistas de Periodoncia con más alto factor de impacto según el ISI web of science: Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research y The international Journal of Periodontics and Restorative Dentistry. La búsqueda fue realizada por dos operadores calibrados de manera independiente. Resultados: Se encontraron cuatro artículos del tipo ensayos clínicos, tres randomizados y uno controlado. El tratamiento periodontal redujo los signos y síntomas de la artritis reumatoidea mediante la valoración de marcadores séricos. La evaluación del riesgo de sesgo de los artículos incluídos fue alto. Conclusiones: Aparentemente la terapia periodontal aunada a la terapia sistémica de la artritis reumatoidea mejora el estado sistémico del paciente.
Objectives: To evaluate the effect of periodontal treatment on rheumatoid arthritis. Material and Methods: An electronic search was realized in PubMed, The Cochrane Library and manual search of the most important journals of Periodontology with the highest impact factor according to the ISI web of science: Journal of Clinical Periodontology, Journal of Periodontology, Journal of Periodontal Research and The International Journal of Periodontics and Restorative Dentistry. The search was performed by two operators independently calibrated. Results: We found four clinical trials, three of them were randomized and one was controlled. The periodontal treatment reduced the signs and symptoms of rheumatoid arthritis by assessing serum markers. Assessment of risk of bias of included articles was high. Conclusions: Apparently periodontal therapy combined with systemic therapy of rheumatoid arthritis improve patient status.
RESUMEN
O presente trabalho teve como objetivo o estudo do estado sólido do ganciclovir (GCV) e suas diferentes formas polimórficas. O GCV é um fármaco antiviral útil no tratamento de infecções por citomegalovírus (CMV). Embora seja um fármaco amplamente usado, poucos estudos têm sido realizados sobre seu estado sólido. Atualmente, o GCV é conhecido por apresentar quatro formas cristalinas, duas anidras (Forma I e II) e duas hidratas (III e IV). Neste trabalho, nós reportamos a solução da estrutura cristalográfica da Forma I do GCV, que foi encontrado durante o screening de cristalização do fármaco, em que nove ensaios de cristalização (GCV-1, GCV-A, GCV-B, GCV-C, GCV-D, GCV-E, GCV-F, GCV-G e GCV-H) foram realizados e os materiais resultantes foram caracterizados por Difratometria de raios X (DRX), análise térmica (DTA/TG) e Hot Stage Microscopy. De todas as cristalizações realizadas foram obtidas quatro formas sólidas, denominadas como Forma I (GCV-1, GCV-B e GCV-H), Forma III (GCV-C, GCV-D, GCV-F e GCV-G), Forma IV (GCV-A) e Forma V (GCV-E). Esta última está sendo descrita pela primeira vez na literatura e indica a presença de outra forma hidratada de GCV. As Formas I, III e IV corresponderam a forma anidra e as duas formas hidratadas do fármaco, respectivamente. Além disso, foi evidenciado por experimentos de conversão de slurry e análise térmica que o cristalizado de GCV-1 (Forma I) foi o mais estável entre os materiais obtidos, e este deu origem ao monocristal da Forma I de GCV, estrutura cristalina anidra do fármaco. Neste trabalho, pela primeira vez, a estrutura cristalina deste composto foi definida por cristalografia de raios X de monocristal. A análise estrutural mostrou que a Forma I do fármaco cristaliza no grupo espacial monoclínico P21/c e está composta por quatro moléculas de GCV na sua unidade assimétrica. Cada molécula está unida intermolecularmente por ligações de hidrogênio, que dão lugar à formação de cadeias infinitas e estas por sua vez se arranjam de maneira a formar uma estrutura tridimensional.
This presented work aims to study the solid state of ganciclovir (GCV) and its different polymorphic forms. GCV is an antiviral drug useful in the treatment of cytomegalovirus (CMV) infections. Although it is a widely-used drug, few studies have been conducted on its solid state. Currently, GCV is known to have four crystalline forms, two anhydrous (Form I and II) and two hydrates (III and IV). In this investigation, we report a successful preparation of GCV Form I and its crystallographic structure, which was found during the crystallization of the drug, in which nine crystallization tests (GCV-1, GCV-A, GCV-B, GCV- D, GCV-E, GCV-F, GCV-G and GCV-H) were performed and the resulting materials were characterized by X-ray diffractometry (XRD), thermal analysis (DTA/TG) and Hot Stage Microscopy. Of all the crystallizations performed, four solid forms were obtained, denoted as Form I (GCV-1, GCV-B and GCV- H), Form III (GCV-C, GCV-D, GCV-F and GCV-G), Form IV (GCV-A) and Form V (GCV-E). The latter is being described for the first time in the literature and indicates the presence of another hydrated form of GCV. Forms I, III and IV corresponded to the anhydrous form and the two hydrated forms of the drug, respectively. In addition, it was evident by both the slurry conversion and the thermal analysis methods that the GCV-1 crystallized (Form I) was indeed the most stable amongst the materials obtained. This gave rise to GCV Form I monocrystal, anhydrous crystalline structure of the drug. The compound was characterized by monocrystal X-ray crystallography. The structural analysis showed that Form I of the drug crystallized in the monoclinic system space group P21/c is composed of four molecules of GCV in its asymmetric unit. Each molecule is linked intermolecularly by hydrogen bonds, which give rise to the formation of infinite chains arranged in a way that form a three-dimensional structure.