Intervención interdisciplinaria para la prevención primaria de la caries en lactantes de 0 a 18 meses / Interdisciplinary intervention for the primary prevention of dental caries in children under 18 months

Introducción: la caries es la enfermedad crónica más frecuente en la infancia. La presencia de caries en la dentición temporal es el principal factor de riesgo para desarrollar caries en la dentición definitiva. La mayoría de los factores de riesgo de la caries son modificables y pueden convertirse en elementos para la prevención y control de la enfermedad. Con el objetivo de reducir la incidencia de caries a la edad de 18 meses se diseña una intervención interdisciplinaria de prevención primaria dirigida a familias con niños que se visitan siguiendo el Protocol d’activitats preventives i de promoció de la salut a l’edat pediátrica (PAPPS). Material y métodos: ensayo clínico no aleatorizado, realizado en dos centros de asistencia primaria de Catalunya desde enero de 2019 hasta junio de 2022. En uno de los centros se diseñó e implementó una intervención educativa de prevención primaria de la caries con consejos y habilidades para las familias. En el otro centro se mantuvo el protocolo habitual de recomendaciones. Se evaluó y comparó la incidencia de caries en ambos grupos a la edad de 18 meses con un modelo de regresión logística estimado con el programa R. Resultados: la incidencia de caries a los 18 meses fue superior en los niños del grupo control (OR = 6,0; IC 95% 1,8-20,2), a pesar de que la valoración del riesgo de caries basada en el sistema llamado Caries Management by Risk Assessment (CAMBRA) indicó mayor riesgo de desarrollo de caries en los lactantes del grupo intervención. Conclusión: la intervención interdisciplinaria de prevención primaria de la caries incorporada en los programas de salud infantil reduce la incidencia de caries en los primeros años de vida. (AU)

Introduction: caries is the most common chronic disease in childhood. The presence of caries in the primary dentition is the main risk factor for developing caries in the permanent dentition. Most of the risk factors for caries are modifiable and can become elements for the prevention and control of the disease. With the goal of reducing the incidence of caries in children at age 18 months, we designed an interdisciplinary primary prevention intervention aimed at families with children who attended routine preventive visits within the PAPPS (“Protocol d’activitats preventives i de promoció de la salut a l’edat pediàtrica”) child health programme. Methodology: non-randomized clinical trial carried out in two primary care centres in Catalonia between January 2019 and June 2022. In one of the centres, an educational intervention for the primary prevention of caries was designed and implemented to provide families with guidance and skills. In the other centre, patients received standard care. The incidence of caries was assessed and compared in both groups at age 18 months by means of a logistic regression model fitted with the R software. Results: the incidence of caries at 18 months was higher in children in the control group (OR=6.0; 95% CI: 1.8-20.2), despite the fact that the caries risk assessment by means of the “Caries Management by Risk Assessment” (CAMBRA) protocol indicated a higher risk of caries in infants in the intervention group. Conclusion: the interdisciplinary primary caries prevention intervention integrated into the child health prevention and promotion programme achieved a reduction in the incidence of caries in early childhood. (AU)

Biomarkers of Periodontitis and Its Differential DNA Methylation and Gene Expression in Immune Cells: A Systematic Review.

The characteristic epigenetic profile of periodontitis found in peripheral leukocytes denotes its impact on systemic immunity. In fact, this profile not only stands for periodontitis as a low-grade inflammatory disease with systemic effects but also as an important source of potentially valuable clinical biomarkers of its systemic effects and susceptibility to other inflammatory conditions. Thus, we aimed to identify relevant genes tested as epigenetic systemic biomarkers in patients with periodontitis, based on the DNA methylation patterns and RNA expression profiles in peripheral immune cells. A detailed protocol was designed following the Preferred Reporting Items for Systematic Review and Meta-analysis -PRISMA guideline. Only cross-sectional and case-control studies that reported potential systemic biomarkers of periodontitis in peripheral immune cell types were included. DNA methylation was analyzed in leukocytes, and gene expression was in polymorphonuclear and mononuclear cells. Hypermethylation was found in TLR regulators genes: MAP3K7, MYD88, IL6R, RIPK2, FADD, IRAK1BP1, and PPARA in early stages of periodontitis, while advanced stages presented hypomethylation of these genes. TGFB1I1, VNN1, HLADRB4, and CXCL8 genes were differentially expressed in lymphocytes and monocytes of subjects with poorly controlled diabetes mellitus, dyslipidemia, and periodontitis in comparison with controls. The DAB2 gene was differentially overexpressed in periodontitis and dyslipidemia. Peripheral blood neutrophils in periodontitis showed differential expression in 163 genes. Periodontitis showed an increase in ceruloplasmin gene expression in polymorphonuclears in comparison with controls. Several genes highlight the role of the epigenetics of peripheral inflammatory cells in periodontitis that could be explored in blood as a source of biomarkers for routine testing.

Capacidad discriminatoria y concordancia entre el ELISA-F29 y la PCR en individuos con infección por T. cruzi / Capacidade discriminatória e acordo entre o ELISA-F29 e a PCR em indivíduos infectados com T. cruzi / Discriminatory Power and Concordance between ELISA-F29 and PCR in individuals with infection due to T cruzi

El diagnóstico de la infección por Trypanosoma cruzi (T. cruzi) se realiza rutinariamente mediante pruebas serológicas mientras que el empleo de mÚtodos moleculares se encuentra aún en proceso de estandarización. Objetivo: Evaluar la capacidad discriminatoria y concordancia entre una prueba serológica y una molecular para determinar la infección por T. cruzi. MÚtodos: Se realizo Reaccion en Cadena de la Polimerasa (PCR) y la prueba de ELISA-F29 en 95 muestras de participantes de la cohorte ô Cardiovascular health investigation and collaboration countries of America to assess the markers and outcomes of Chagas diseaseõ CHICAMOCHA. Se evaluó la capacidad discriminatoria del ELISA-F29 respecto al resultado de PCR mediante la estimación del área bajo la curva ROC. Se estimó la tasa de falsos positivos al 25% y sensibilidad al 75%. Se determinó la concordancia mediante kappa de Cohen. Resultados: Se realizaron pruebas de PCR en dos momentos diferentes en 95 individuos (edad media: 38 años; 64% hombres), con tasas de positividad entre 1.1% û 2.2% para los primers S35-S36 y entre 18.3% û 34.7% para los primers 121-122, respectivamente. La capacidad discriminatoria del ELISA- F29 respecto a PCR fue 0.62 (IC95%: 0.53; 0.70) y tasa de falsos positivos del 56% (IC95%: 42; 70). El punto de corte óptimo para el cociente de absorbancia fue 2.53 (sensibilidad 59% y especificidad 60%). Para el primer 121-122 los niveles de acuerdo observado y kappas estimados fueron: 52.6% y 0.10 (IC95%: -0.08, 0.28) para la primera medición, 62.4% y 0.09 (IC95%: -0.09, 0.28) para la segunda medición y 57.5% y 0.13 (IC95%: 0.01, 0.26) al evaluar simultáneamente las dos mediciones. Conclusiones: Los resultados demuestran una baja concordancia evidenciada por los valores de kappa determinados en el estudio. Es necesario afinar los estudios para evaluar la utilidad de las pruebas moleculares en el diagnóstico de la Enfermedad de Chagas.

The diagnosis of infection with Trypanosoma cruzi (T. cruzi) is routinely performed by serological tests while the use of molecular methods is still in process of standardization. Objective: To evaluate the discriminatory capacity and agreement between a serological test and a polymerase chain reaction (PCR) to determine T. cruzi infection. Methodology: PCR and ELISA test-F29 were performed to 95 participants of ôCardiovascular health investigation and collaboration countries of America to assess the markers and outcomes of Chagas diseaseõ (CHICAMOCHA). Discriminatory capacity of ELISA ûF29 with respect to PCR results were evaluated by estimating the area of ROC curve. The false positive rate was estimated to 25% and sensitivity to 75%. The agreement was determined using Cohen's kappa. Results: PCR tests were performed at two different times in 95 individuals (mean age: 38; 64% male), with positivity rates between 1.1 to 2.2% for S35-S36 primers and from 18.3% to 34, 7% for primers 121-122, respectively. ELISA-F29 discriminatory capacity regarding PCR was 0.62 (95% CI: 0.53, 0.70). The false positive rate was 56% (95% CI: 42; 70). The optimal cutoff for absorbance ratio of ELISA-F29 was 2.53 (sensitivity 59%, specificity 60%). For the primers 121-122, levels of observed agreement and kappa estimates were 52.6% and 0.10 (95% CI: -0.08, 0.28) for the first measurement, 62.4% and 0.09 (95% CI: -0.09, 0.28) for the second measurement, and 57.5% and 0.13 (95% CI: 0.01, 0.26) for the two measurements simultaneously evaluated. Conclusions: The results show poor agreement evidenced by kappa values determined in the study. It is necessary to refine the studies to evaluate the utility of molecular testing in the diagnosis of Chagas disease.

O diagnostico de infecção por Trypanosoma cruzi (T. cruzi) Ú rotineiramente realizado por sorologia, enquanto o uso de muitodos moleculares ainda estß sendo padronizado. Objetivo: Avaliar a capacidade discriminat¾ria e a concordÔncia entre um teste sorol¾gico e o molecular para determinar a infecþÒo pelo T. cruzi. Metodologia: Foi realizada a ReaþÒo em Cadeia da Polimerase (PCR) e a prova de ELISA-F29 em 95 amostras de participantes da coorte "Investigação em Saúde Cardiovascular e colaboração com os países da América para avaliar os marcadores e resultados de doença de Chagas" CHICAMOCHA. Foi avaliada a capacidade discriminatória do ELISA-F29 com relação aos resultados de PCR por meio da avaliação da área com a curva de ROC. A taxa de falsos positivos é estimada em 25% e a de sensibilidade em 75%. A correlação é determinada por Cohen kappa. Resultados: Foram realizados testes de PCR em dois momentos diferentes, em 95 indivíduos (idade média: 38 anos; 64% do sexo masculino), com taxas de positividade entre 1,1% - 2,2% para os primeiros S35-S36 e entre 18,3% - 34,7% para os primeiros 121-122, respectivamente. O poder discriminatório ELISA-F29 sobre PCR foi 0,62 (IC 95%: 0,53; 0,70) e taxa de falsos positivos de 56% (IC 95%: 42; 70). O ponto de corte otimo para a relação de absorvãncia foi de 2,53 (59% de sensibilidade, especificidade de 60%). Para os primeiros 121-122, de acordo com os níveis observados e kappas estimadas foram 52.6% e 0.10 (IC95%: -0.08, 0.28) para a primeira medição, 62.4% e 0.09 (IC 95%: -0.09, 0 .28) para a segunda medição, 57.5% e 0,13 (IC95%: 0.01, 0.26) ao avaliar simultaneamente as duas medições. Conclussões: Os resultados mostram pouca concordância evidenciada pelos valores de kappa determinados no estudo. É necessário precisar e ajustar os estudos para avaliar a utilidade do teste molecular no diagnóstico da doença de Chagas.