Reparação pós-exodôntica em pacientes com diabetes tipo 2 / Post-extraction wound healing in patients with type 2 diabetes

A hiperglicemia, bem como o diabetes, é reconhecida como fator de risco para infecções pós-cirúrgicas, assim manter o controle glicêmico perioperatório tem sido padrão de cuidado em saúde. Entretanto há poucos estudos sobre o impacto do controle glicêmico no processo de reparação de cirurgias de extração dentária. Apesar da escassez de estudos e de evidências clínicas e científicas que investiguem o risco de infecções pós-exodônticas em pessoas com diabetes, existem livros, artigos e guias que recomendam aos dentistas o uso de antibióticos profiláticos nesses indivíduos, especialmente para aqueles descompensados. O objetivo deste estudo foi avaliar clinicamente a cicatrização pós-exodôntica, em relação à cronologia dos eventos reparacionais e em relação à ocorrência de complicações pós-operatórias, em indivíduos com diabetes tipo 2 comparados a um grupo controle. Além disso, procuramos relacionar os eventos pós-cirúrgicos com o controle metabólico e com o perfil imunológico dos pacientes. Este estudo prospectivo longitudinal caso controle incluiu 53 indivíduos com diabetes tipo 2 (grupo de estudo=GE) e 29 indivíduos sem diabetes (grupo controle=GC). Foi aplicado questionário sobre a história médica, realizados exames clínicos intraoral e extraoral e exames laboratoriais para conhecimento do controle glicêmico e do perfil imunológico do indivíduo, tais como, hemograma completo, hemoglobina glicada (A1C), glicemia de jejum, IgA, IgG, IgM, C3, C4, linfócitos T CD3+, CD4+, CD8+, quimiotaxia de neutrófilos, oxidação de neutrófilos, fagocitose de neutrófilos e monócitos. Todos os participantes foram submetidos a extrações padronizadas de dentes erupcionados...

Hyperglycemia and diabetes are recognized as a risk factor for postoperative infections. Thus, maintaining perioperative glucose control has become the standard of care. However, there are scarce data on the appropriate glucose control during minor dental surgery. Despite the paucity of studies investigating the risk of postsurgical oral infections in persons with diabetes, there are text books, papers and guidelines recommending to dentists the use of prophylactic antibiotics for patients with poorly controlled diabetes undergoing invasive oral procedures. The aim of this study was to clinically evaluate the post extraction healing regarding to the chronology and to the occurrence of postoperative complications in patients with type 2 diabetes compared to a control group. Additionally, we associated the postoperative events with metabolic control and the immunological profile of the participants. This prospective case-control study included 53 subjects with type 2 diabetes (SG) and 29 controls without diabetes (CG). A questionnaire on medical history was applied, intraoral and extraoral clinical examinations were conducted and laboratory tests for glycemic control and immunological profile of the individual, such as complete blood count, glycated hemoglobin (A1C), fasting glucose, IgA, IgG, IgM, C3, C4, lymphocytes T CD3+, CD4+, CD8+, neutrophil chemotaxis, oxidation of neutrophil phagocytosis by neutrophils and monocytes, were obtained at the time of the extraction. All participants underwent standardized extractions of erupted teeth and clinical assessments were performed 3, 7, 21 and 60 days after surgery...

Correlation of antinuclear antibody immunofluorescence patterns with immune profile using line immunoassay in the Indian scenario.

Background: Immunity status, individual response to disease and types of antibodies produced are well known to vary from person to person, place to place and probably from population to population. A broad spectrum of specific auto antibodies that have so far been associated with specific rheumatic diseases, as noted in Western literature, has been well taken as a reference standard all over the world. There is neither research work nor any data correlating the auto antibodies and their antinuclear antibody (ANA) patterns with the immunoprofile in the Indian population to date. Aims: To understand a definite association between ANA patterns and specific antibodies in the serum in the Indian study population and to document similarities / differences with the West. Settings and Design: This prospective and retrospective double blind study was undertaken on the South Indian population referred for ANA testing by Indirect Immunofluorescence method and by immunoline methods. Materials and Methods: Serum samples of patients from a random South Indian population who sought medical help for rheumatic disease were subjected for ANA testing by indirect immunofluorescence (IIF) method and line immunoassay during the study period of 27 months. Serum samples were processed in dilution of 1:100 using HEp - 2010 / liver biochip (Monkey) (EUROIMMUN AG). The serum samples which were further processed for line immunoassay were treated in 1:100 dilution on nylon strips coated with recombinant and purified antigens as discrete lines with plastic backing (EUROIMMUN AG) coated with antigens nRNP / Sm, Sm, SSA, Ro-52, SSB, Scl-70, PM-Scl, PCNA, Jo-1, CENP-B, dsDNA, nucleosomes, histones, ribosomal protein-P, anti-mitochondrial antibodies (AMA-M2) along with a control band. The analysis was done by comparing the intensity of the reaction with positive control line by image analysis. Results: The antinuclear antibody indirect immunofluorescence (ANA - IIF) patterns obtained were projectable to visualize a certain spectrum of specific antibodies such as homogenous (45.5%) with dsDNA, nucleosomes, histones, SSA / Ro-52, RIB and RNP / Sm, speckled pattern (35.6%) with Sm, RNP, SSA/Ro-52, SSB, Sm and RIB; nucleolar pattern with Scl-70, Sm, RNP and centromere pattern with CENP-B. The methodology indicated that, cytoplasmic pattern noted in ANA also needs to be correlated with primate liver in a biochip, which should prompt further decision for a request for line immunoassay and it is preferable for two pathologists to report independently and sign out a consensus ANA report for better predictive value. Conclusions: As a definite correlation between the ANA patterns and the group of antibodies was detected by line immunoassay, one could predict presence of certain specific auto antibodies for a particular ANA pattern identified. This may restrict one from requesting for line immunoassay, which is expensive and economizes on the cost of laboratory investigations in a developing country like India. Thus, screening of sera by ANA-IIF method alone may suffice and probably reduce the expense of detailed immunological work-up with minimal loss in diagnostic accuracy. This study, the first of its kind in India, provides database and reference for the Indian subpopulation.