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BACKGROUND: The aim of this study was to investigate the effect of CYB2B6 (c.516G>T, rs3745274), CYP2C9 (c.1075A>C, rs1057910) and UGT1A9 (c.98T>C, rs72551330) polymorphisms on the pharmacokinetics of single-drug propofol in adult patients undergoing intravenous sedation. METHODS: In this prospective clinical study, a total of 124 patients undergoing anaesthesia with propofol, as a single drug, were evaluated when undergoing colonoscopy procedure. Clinical variables were obtained from the patient's anamnesis prior to performing the anaesthetic procedure, in the moment of the patient's loss of consciousness, during the colonoscopy exam (recorded every 5 min) and in the awakening time. RESULTS: Polymorphic genotypes for the rs3745274 and rs1057910 polymorphisms were associated with bispectral index, target-controlled infusion (TCI)/effector concentration of propofol and TCI/plasma concentration of propofol values. Based on multivariate analysis, it was observed that weight, age, surgery time, systolic blood pressure and the rs1057910 polymorphism corresponded to predictive values for the dose of propofol used. Weight (B = 4.807±0.897), age (B = 1.834±0.834) and duration of surgery (B = 8.164±1.624) corresponded to factors associated with increased propofol dose, while systolic blood pressure (B = -1.892±0.679) and the genotypes (AA vs CA) of the single nucleotide polymorphism (SNP) rs1057910 CYPP2C9 gene (B = -74.161±26.820) decreased the total dose of propofol used. CONCLUSION: We concluded that the rs1057910 and rs3745274 polymorphisms affect the metabolism of propofol in patients exclusively submitted to this drug. Thus, the knowledge of the polymorphic genotypes of the CYPP2C9 and CYB2B6 genes may be predictive of different metabolising phenotypes, suggesting expected behaviours of BIS parameter in the anaesthetic procedure, which contributes to safer monitoring by anaesthesiologists during the clinical intervention.
Subject(s)
Propofol , Humans , Cohort Studies , Cytochrome P-450 CYP2C9/genetics , Electroencephalography , Polymorphism, Single Nucleotide , Propofol/pharmacokinetics , Propofol/therapeutic use , Prospective Studies , Cytochrome P-450 CYP2B6/genetics , UDP-Glucuronosyltransferase 1A9/geneticsABSTRACT
BACKGROUND: The aim of this study was to investigate the effect of CYB2B6 (c.516G>T, rs3745274), CYP2C9 (c.1075A>C, rs1057910) and UGT1A9 (c.98T>C, rs72551330) polymorphisms on the pharmacokinetics of single-drug propofol in adult patients undergoing intravenous sedation. METHODS: In this prospective clinical study, a total of 124 patients undergoing anaesthesia with propofol, as a single drug, were evaluated when undergoing colonoscopy procedure. Clinical variables were obtained from the patient's anamnesis prior to performing the anaesthetic procedure, in the moment of the patient's loss of consciousness, during the colonoscopy exam (recorded every 5 min) and in the awakening time. RESULTS: Polymorphic genotypes for the rs3745274 and rs1057910 polymorphisms were associated with bispectral index, target-controlled infusion (TCI)/effector concentration of propofol and TCI/plasma concentration of propofol values. Based on multivariate analysis, it was observed that weight, age, surgery time, systolic blood pressure and the rs1057910 polymorphism corresponded to predictive values for the dose of propofol used. Weight (B = 4.807±0.897), age (B = 1.834±0.834) and duration of surgery (B = 8.164±1.624) corresponded to factors associated with increased propofol dose, while systolic blood pressure (B = -1.892±0.679) and the genotypes (AA vs CA) of the single nucleotide polymorphism (SNP) rs1057910 CYPP2C9 gene (B = -74.161±26.820) decreased the total dose of propofol used. CONCLUSION: We concluded that the rs1057910 and rs3745274 polymorphisms affect the metabolism of propofol in patients exclusively submitted to this drug. Thus, the knowledge of the polymorphic genotypes of the CYPP2C9 and CYB2B6 genes may be predictive of different metabolising phenotypes, suggesting expected behaviours of BIS parameter in the anaesthetic procedure, which contributes to safer monitoring by anaesthesiologists during the clinical intervention.
ABSTRACT
Objetivo:Fazer uma revisão integrativa a respeito do atendimento de pacientes com necessidades especiais (PNE) em Centros de Especialidades Odontológicas (CEO) no Brasil. Métodos: Para as buscas nas bases eletrônicas PubMed, BBO e LILACS, e Google Scholar, foram utilizados em português, espanhol e inglês, os descritores e termos livres: "pessoas com deficiência", "pessoa com necessidade especial", "pessoa com incapacidade", odontologia, "atenção secundária à saúde", "atenção secundária", "centro de especialidades odontológicas", CEO, "disabled persons", handicapped, "people with disabilities", dentistry, "secondary care", "dental specialty center" ,"secondary care centers", "personas con discapacidad", "atención secundaria de salud" e "centro de especialidad dental". Não foi feita restrição quanto ao idioma, mas o período consultado foi de 2016 a 2021. Incialmente foram excluídas as duplicatas, em seguida os textos cujos títulos e resumos não estivessem de acordo com os critéios de inclusão. Uma vez eleitos os textos a serem incluídos após leitura na íntegra, foi feita a extração dos dados de interesse: autor (ano), tipo de estudo, caracterização da amostra, local, objetivo, resultados principais e conclusão. A análise da qualidade metodológica e do risco de viés dos estudos foi feita por meio da ferramenta Quality Assessment Tool for Quantitative Studies do Effective Public Health Practice Project. Resultados: De 383 estudos, cinco foram incluídos. As barreiras mencionadas que dificultam o acesso dos PNE aos CEO se referiram a questões socioeconômicas e demográficas, localização dos CEO, escassez de recursos financeiros, limitações para acessibilidade e qualificaçao profissional deficitária para a prestação dos atendimentos. A qualidade metodológica foi considerada fraca em todos os estudos, o que indica alto risco de viés. Conclusão: Mesmo com a evolução gradativa do atendimento dos PNE nos CEO, ainda há aprimoramentos necessários, tanto em relação à qualificação dos profissionais para que tenham conhecimento e manejo para realizar os atendimentos seguindo os protocolos necessários, quanto à melhoria do acesso para esses pacientes.
Aim: To conduct an integrative review regarding the care provided to patients with special needs (PSN) in Dental Specialty Centers (DSCs) in Brazil. Methods: To perform searches in the PubMed, BBO and LILACS, and Google Scholar electronic databases, the following descriptors and free terms were used, in three languages of Portuguese, Spanish, and English: "pessoas com deficiência", "pessoa com necessidade especial", "pessoa com incapacidade", odontologia, "atenção secundária à saúde", "atenção secundária", "centro de especialidades odontológicas", CEO, "disabled persons", handicapped, "people with disabilities", dentistry, "secondary care", "dental specialty center" ,"secondary care centers", "personas con discapacidad", "atención secundaria de salud" e "centro de especialidad dental". No language restriction was made, but the period consulted was from 2016 to 2021. First, duplicates were excluded. After, texts whose titles and abstracts did not comply with the inclusion criteria were also excluded. Once the included texts had been chosen, and after reading them in full, the data of interest was extracted: author (year), type of study, sample characterization, location, objective, main results, and conclusion. The Quality Assessment Tool for Quantitative Studies of the Effective Public Health Practice Project was used to analyze the methodological quality and risk of bias found in the studies. Results: Of the 383 studies, five were included. The barriers that make it difficult for PSNs to access DSCs are related to socioeconomic and demographic issues, the location of DSCs, the scarcity of financial resources, limitations in accessibility, and deficient professional qualification to provide proper care. Methodological quality was considered weak in all studies (100%), with a high risk of bias. Conclusion: Even with the gradual evolution of the care provided to PSNs in DSCs, improvements are still necessary, both in relation to the qualification of professionals so that they have the knowledge and handling necessary to perform the care following the necessary protocols, as well as the improvement of access for these patients.
Subject(s)
Secondary Care , Oral Health , Dental Care for DisabledABSTRACT
AIMS: The present study investigated if recurrent manifestation of oral herpes lesions is associated with other factors and impacts the oral health-related quality of life in para-athletes. METHODS AND RESULTS: The studied population was composed of a convenience sample of 370 Brazilian para-athletes. All included individuals answered questionnaires and were submitted to an oral examination. A self-reported questionnaire addressed demographic and oral health data, including the recurrent manifestation of oral herpes lesions. The Oral Health Impact Profile was also applied in its reduced version with 14 questions (OHIP-14). The population was categorized according to results from previous competitions into a high-performance level, medium-performance level, and regional-performance level. Chi-square or Fisher's exact tests, odds ratio calculation, logistic regression analysis, and t-tests were performed (α = 5%). Sixty (16.2%) para-athletes reported recurrent manifestations of oral herpes lesions. Para-athletes with sleep bruxism (p = .007) and awake bruxism (p = .048) had a higher chance of reporting oral herpes lesions. Type of breathing was also associated with oral herpes lesions (p = .031). The OHIP-14 mean distribution among the groups was not statistically significant (p > .05). CONCLUSION: Bruxism and type of breathing were associated with self-reported oral herpes lesions in Brazilian para-athletes.
Subject(s)
Bruxism , Para-Athletes , Sleep Bruxism , Brazil/epidemiology , Humans , Oral Health , Quality of Life , Surveys and QuestionnairesABSTRACT
Desquamative gingivitis is an oral sign of systemic changes that may be symptomatic or asymptomatic. It is generally related to immunological changes. This report is aimed at describing the case of a 51-year-old female patient, who presented with clinical desquamative gingivitis and was initially diagnosed and treated as necrotizing periodontal disease, but no improvement. The cause was hypothesized to be an autoimmune disease. Drug therapy was initiated as a combination of prednisone and topical clobetasol propionate 0.5% cream twice a day. After this treatment, there was an improvement in pain and the blistering of the gingiva. However, the gingiva remained erythematous. A biopsy led to the diagnosis of benign mucous membrane pemphigoid (BMMP). The BMMP case reported in this article has been successfully treated with systemic and topical immunosuppressive therapy. The efficacy of systemic corticosteroids with dapsone and multidisciplinary follow-up has been highlighted and can lead to the stabilization and adequate control of the disease.
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Objective: To describe the appropriateness of referrals of high-risk pregnancies in the basic healthcare network of Sobral, in Ceará, Brazil. Methods: A descriptive quantitative study. The medical files of 173 pregnant patients referred to the high-risk outpatient clinic of Centro de Especialidades Médicas of Sobral, during the period from July 2006 to April 2007, were analyzed. Variables analyzed were correctness of the referrals, professionals who made them, causes and origins of the referrals, and age bracket of the patients referred. The referrals were divided into ?appropriate? and ?inappropriate?, according to the classification of risk established by the technical manual of the Ministry of Health. Results: Of the 173 cases, 102 (59%) were considered appropriate/correct, and 71 (41%) referrals were considered inappropriate/incorrect. The referrals were divided according to the professional class of the referring individuals: physicians or nurses. Of the 173 referrals, 49 (28.3%) were made by physicians, and 124 (71.7%) by nurses. Of the 49 patients referred by physicians, 39 (79.6%) were considered correct. Of the 124 referrals made by nurses, 63 (50.8%) were considered incorrect, revealing a significant difference between the groups (p < 0.00001). The most common causes of referrals of pregnant patients were hypertensive syndromes (23.6%), physiological modifications of pregnancy (22.6%), prolonged pregnancy (15.1%), and diabetes (12.3%). Conclusions: There was a low rate of appropriate/correct referrals. There is a need for training in the basic healthcare network for quality prenatal care, with special emphasis on referring nurses.
Objetivo: Descrever a adequação dos encaminhamentos de gestações de alto risco na rede básica de atenção à saúde de Sobral, no Ceará, Brasil. Métodos: Estudo descritivo, de natureza quantitativa. Foram revisados 173 prontuários de gestantes referenciadas ao ambulatório de alto risco do Centro de Especialidades Médicas de Sobral, no período de Julho de 2006 a Abril de 2007. As variáveis analisadas foram: adequação dos encaminhamentos, profissional que encaminhou, causas e origem dos encaminhamentos e faixa etária das gestantes referenciadas. Os encaminhamentos foram divididos em adequados e inadequados, segundo a classificação de risco estabelecido pelo manual técnico do Ministério da Saúde. Resultados: Dos 173, 102 (59%) foram considerados adequados e 71 (41%) encaminhamentos inadequados. Os encaminhamentos foram divididos conforme a classe profissional que referenciou: médicos ou enfermeiros. Dos 173 encaminhamentos, 49 (28,3%) foram por médicos e 124 (71,7%) por enfermeiros. Dos 49 encaminhados por médicos, 39 (79,6%) foram adequados. Dos 124 encaminhamentos por enfermeiros, 63 (50,8%) foram adequados, sendo observada diferença significante entre os grupos (p < 0,00001). As causas mais frequentes de encaminhamentos das gestantes foram: síndromes hipertensivas (23,6%), alterações fisiológicas da gestação (22,6%), gravidez prolongada (15,1%) e diabetes (12,3%). Conclusões: Houve baixa adequação de encaminhamentos. Há necessidade de capacitação dos serviços da rede básica para realização de pré-natal com qualidade, com ênfase especial aos referenciadores enfermeiros.
ABSTRACT
Os autores apresentam um caso clínico de um paciente portador de mieloma múltiplo, com anemia, proteinúria, dores ósseas, velocidade de hemossedimentação elevada, em que faltou a positividade da proteinúria de Bence Jones, e a eletroforese das proteínas plasmáticas não apresentava o pico monocional da doença
