Redox biomarkers in saliva and nuclear abnormalities in jugal epithelial cells of individuals with type 2 diabetes mellitus and periodontitis.

OBJECTIVE: To evaluate salivary redox biomarkers levels in individuals with periodontitis and type 2 diabetes mellitus (T2DM) and correlate with periodontal parameters and nuclear alterations in epithelial cells from jugal mucosa. DESIGN: Sixty individuals were categorized into three groups: T2DM with periodontitis (DM, n = 20), non-T2DM with periodontitis (PE, n = 20), and non-T2DM with periodontal health (HC, n = 20). All participants underwent fasting blood glucose and glycated hemoglobin measurements. After a periodontal examination, samples of epithelial cells from the jugal mucosa and saliva were collected. DNA damage was assessed by counting nuclear abnormalities using cytological analysis. Biomarkers of oxidative stress were determined through biochemical methods. Significant differences among groups were assessed using Kruskal-Wallis, Mann-Whitney, and Chi-square tests at a 5% significance level. Data were analyzed using Spearman's correlation coefficient, linear regression, and logistic regression. RESULTS: Frequencies of nuclear abnormalities, as well as levels of reduced glutathione and uric acid, were significantly higher in the DM group compared to the PE and HC groups (p < 0.05). Fasting glucose, glycated hemoglobin, nuclear abnormalities, reduced glutathione, and uric acid exhibited positive correlations with periodontal parameters (p < 0.05). Furthermore, reduced glutathione was associated with dental biofilm (OR = 1.027 [95% CI, 1.004-1.049]) and condensed chromatin (OR = 0.415 [95% CI, 0.196-0.878]). CONCLUSIONS: Periodontitis and T2DM are correlated with nuclear abnormalities, as well as salivary reduced glutathione and uric acid levels. Moreover, a higher prevalence of teeth with dental biofilm increases the likelihood of elevated levels of reduced glutathione in saliva, while the presence of condensed chromatin decreases that likelihood.

Biomarcadores da homeostase redox em saliva e alterações nucleares no epitélio da mucosa jugal de indivíduos com diabetes mellitus tipo 2 e periodontite / Oxidative stress biomarkers in saliva and nucear changes in epithelial cells of indivudals with type e Diabetes Mellitus and periodontitis

O presente estudo é composto por dois capítulos, sendo o primeiro um artigo de revisão sistemática que abordou as evidências científicas para a diferença de biomarcadores do estresse oxidativo em indivíduos com diabetes mellitus tipo 2 com e sem periodontite. Foram incluídos 9 estudos na análise final, pesquisados através das seguintes bases de dados: PubMed, Scopus, Embase, Web of Science, Cochrane Library, Biblioteca Virtual da Saúde e por outras fontes. Os estudos relataram elevadas concentrações de agentes oxidantes e baixos níveis de antioxidantes em indivíduos com diabetes mellitus tipo 2 e periodontite quando comparados aos indivíduos sem periodontite. Considerando os poucos estudos encontrados, as falhas metodológicas, poucos marcadores estudados e ausência de homogeneidade na avaliação dos marcadores do balanço redox, bem como, a baixíssima certeza da evidência entre os estudos incluídos nesta revisão sistemática, não foi possível determinar se há ou não diferenças nos níveis de estresse oxidativo em indivíduos com diabetes mellitus tipo 2 associado ou não à periodontite e, portanto, estudos observacionais prospectivos e de intervenção são recomendados. O segundo capítulo é um artigo de pesquisa que retrata a periodontite e o diabetes mellitus tipo 2 como doenças com características de inflamação crônica e com estresse oxidativo permanentemente elevado, o que afeta o padrão de funcionamento do sistema imunológico e resulta em danos a importantes macromoléculas biológicas. Trata-se de um estudo observacional, que objetivou avaliar biomarcadores da homeostase redox em saliva e a presença de alterações nucleares em pacientes com periodontite com ou sem diabetes tipo 2 e em indivíduos periodontalmente e sistemicamente saudáveis. Um total de 60 participantes foram divididos igualmente em três grupos: diabetes tipo 2 com periodontite (DPE); sem diabetes com periodontite (PE); saudáveis sem doença periodontal (HC). Após as medições clínicas periodontais, as células epiteliais da mucosa jugal e a amostra de saliva foram coletadas. O dano ao DNA foi determinado pela contagem de micronúcleos e anormalidades nucleares em células epiteliais. Os níveis de estresse oxidativo foram determinados por glutationa reduzida (GSH), ácido úrico (UA), capacidade antioxidante total (TAC), substâncias reativas ao ácido tiobarbitúrico (TBARs) e proteínas totais. Os dados numéricos foram testados pelos testes de Mann-Whitney e Kruskal-Wallis, as variáveis numéricas pelo teste do qui-quadrado e as correlações pelo coeficiente de Spearman, regressões linear e logística foram realizadas, adotando o nível de significância de 5%. As frequências de micronúcleos, cariorrexia, cromatina condensada e células picnóticas, e dos biomarcadores GSH e UA foram significativamente maiores no grupo DPE seguido dos grupos PE e HC (p<0,05). Glicemia em jejum, hemoglobina glicada, frequência de micronúcleos (MN), anormalidades nucleares (NA - cariorrexia, cromatina condensada e células picnóticas), GSH e UA apresentaram de leve a moderada correlação positiva com os parâmetros de progressão da periodontite (p<0,05). A análise de regressão linear mostrou que GSH categorizada teve correlação com sangramento gengival (p = 0,002) e TBARs (p = 0,020) e UA com sangramento à sondagem (p = 0,001) e TAC (p = 0,001). A análise de regressão logística mostrou que os níveis categorizados de GSH tiveram correlação com sangramento à sondagem (OR = 1,121 [95% CI, 1,025-1,225]) e supuração (OR = 0,155 [95% CI, 0,029-0,838]). Portanto, as correlações positivas entre os parâmetros periodontais, MN, NA (cromatina condensada, células cariorréticas e picnóticas), e os parâmetros redox na saliva (GSH e UA) refletem piores condições periodontais e dos parâmetros do diabetes mellitus tipo 2. Os biomarcadores na saliva (GSH e UA) apresentaram um importante papel na detecção de alteração no funcionamento do balanço redox e dos danos nucleares em células epiteliais da mucosa jugal. (AU)

This study consists of two chapters, the first is a systematic review article which addressed the scientific evidence for the difference of oxidative stress biomarkers in individuals with type 2 diabetes mellitus with and without periodontitis. Nine studies were included in the final analysis, searched through the following databases: PubMed, Scopus, Embase, Web of Science, Cochrane Library, Virtual Health Library and other sources. The studies reported high concentrations of oxidizing agents and low antioxidants levels in individuals with type 2 diabetes mellitus and periodontitis when compared to with no periodontitis. Considering the few studies found, the methodological flaws, few markers studied and absence homogeneity in the evaluation of redox balance markers, as well as, the very low certainty of the evidence among included studies in this systematic review, it was not possible to determine whether there are or not differences in the oxidative stress levels in individuals with type 2 diabetes mellitus associated or no with periodontitis and further prospective observational and interventional studies are recommended. The second chapter is a research article that describe the periodontitis and type 2 diabetes mellitus as diseases with features of chronic inflammation and with oxidative stress permanently elevated which affects the pattern of functioning of the immune system and results in damage to important biological macromolecules. This is an observational study, which aimed to evaluate redox homeostasis biomarkers in saliva and the presence of nuclear changes in patients with periodontitis with and without type 2 diabetes and periodontally and systemically healthy individuals. A total of 60 participants were allotted into three groups equally: type 2 diabetes with periodontitis (DPE); non-diabetes with periodontitis (PE); healthy without periodontal disease (HC). After periodontal measurements, cheek epithelial cells and saliva samples were collected. DNA damage was determined by counting micronucleus and nuclear abnormalities in epithelial cells. Oxidative stress levels were determined by reduced glutathione (GSH), uric acid (UA), total antioxidant capacity, thiobarbituric acid reactive substances, and total proteins. Numeric data were tested by Mann-Whitney and Kruskal-Whallis tests, qualitative variables by chi-square test and correlations by the spearman coeficiente, and linear and logistic regression were performed, adopting the significance level of 5%. The frequencies of micronucleus (MN), karyorrhectic, condensed chromatin, pyknotic cells, GSH and UA were significantly higher in DPE group followed PE and HC groups (p<0.05). Fasting blood glucose, glycated hemoglobin, MN and nuclear abnormalities (NA) frequencies (karyorrhectic, condensed chromatin and pyknotic cells), GSH and UA showed a positive mild to moderate correlation with periodontitis progression parameters (p<0.05). Linear regression analysis showed that categorized GSH had correlation with gingival bleeding (p = 0.002) and TBARs (p = 0.020) and UA with bleeding on probing (p = 0.001) and TAC (p = 0.001). Logistic regression analysis showed that categorized GSH levels had correlation with bleeding on probing (OR = 1.121 [95% CI, 1.025-1.225]) and supuration (OR = 0.155 [95% CI, 0.029-0.838]). Therefore, positive correlations among periodontal parameters, MN, NA, and salivary oxidative stress biomarkers (GSH and UA) reflects worse periodontal conditions and of the type 2 diabetes mellitus parameters. Salivary biomarkers (GSH and UA) played an important role in the detection the functioning of the redox balance and nuclear damage in cheek epithelial cells. (AU)

Fatores associados à presença de Candida spp. em amostras de fluido vaginal de mulheres residentes em comunidades quilombolas / Factors associated with the presence of Candida spp. in vaginal fluid samples from women living in quilombola settlements

RESUMO: Objetivo: Investigar a frequência e fatores associados à detecção de Candida spp. em fluido vaginal de mulheres residentes em uma comunidade quilombola. Materiais e Método: Um estudo transversal foi conduzido com 177 mulheres residentes em uma comunidade quilombola no Nordeste do Brasil. Foram coletados dados sociodemográficos, hábitos de vida, saúde geral e saúde reprodutiva. O material coletado na região do colo do útero foi submetido a exame citopatológico. Amostras de fluido vaginal foram coletadas para a análise microbiológica. Os testes Qui-quadrado, exato de Fisher e modelos de Re-gressão Logística foram utilizados na análise estatística. Resultados: Foi detectado Candida spp. em 28,9% das amostras. A espécie mais frequente nos casos positivos foi a Candida albicans (49%), seguida da Candida krusei (39,2%). Após o ajustamento, observou-se que mulheres com idade igual ou maior que 50 anos apresentaram maior chance da detecção de Candida spp. no fluido vaginal (OR ajustada = 3,46; IC95% = 1,68-7,12), enquanto as mulheres com queixa de corrimento vaginal apresentaram uma chance menor de detecção de Candida spp. (OR ajustada = 0,29; IC95% = 0,11-0,78). Conclusão: Os achados sugerem uma elevada detecção de Candida spp. no fluido vaginal entre mulheres residentes em comunidades quilombolas, o que sinaliza a necessidade do planejamento de medidas para prevenção e rastreamento de caso de candidíase vulvovaginal neste grupo populacional. Além disso, a presença de Candida spp. foi mais elevada em mulheres a partir da quinta década de vida, menor nas mulheres com queixas de corrimento vaginal. (AU)

ABSTRACT: Objective: Investigate the frequency and factors associated with the detection of Candida spp. in vaginal fluid from women living in a quilombola settlement. Materials and Method: A cross-sectional study was conducted with 177 women living in a quilombola settlement in Northeast, Brazil. Socio-demographic data, living habits, general health, and reproductive health were collected. The material collected in the region of the cervix was submitted to cytopathological examination. Vaginal fluid samples were collected for microbiological analysis. Chi-square test, exact Fisher's test, and logistic regression models were used for the statistical analysis. Results: Candida spp. was detected in 28.9% of the samples. The most frequent species in positive cases were Candida albicans (49%), followed by Candida krusei (39.2%). After adjustment, it was observed that women aged over 50 years had a higher chance of detecting Candida spp. in vaginal fluid (OR adjusted = 3.46; 95% CI = 1.68-7.12), while women complaining of vaginal discharge had a lower chance of detecting Candida spp. (OR adjust-ed = 0.29; 95% 95% CI= 0.11-0.78). Conclusion: The findings suggest a high detection of Candida spp. in vaginal fluid among women living in quilombola settlements, which indicates the need for planning measures for prevention and track the cases of vulvovaginal candidiasis in this population group. Besides, the presence of Candida spp. was higher in women from the fifth decade of life, lower in women with complaints of vaginal discharge. (AU)

Relationship between microcephaly and Zika virus during pregnancy: a review.

AIM: the present study analysed the association between Zika-virus and microcephaly during the gestational period of women in Brazil. METHODOLOGY: Systematic reviews of intervention research, current publications of clinical investigations were used systematic search strategies in three electronic databases PubMed, SciELO and Google academic. The following keywords were used: Microcephaly, gestation, Zika-virus to perform the search, and 1020 articles were obtained after exclusion, 45 were left and 35 were eligible. The collection period was from 2004 to 2017. RESULTS: Epidemiological data suggest a temporal association between the quantitative increase and the Zika-virus epidemic, especially in Northeast Brazil. It is not consensual to measure the cephalic perimeter curve to be considered. CONCLUSION: Given this, the application of techniques to accurately diagnose the relationship between causes and effects in the pathogenesis of Zika virus infection in the central nervous system should be prioritized.

Relationship between microcephaly and Zika virus during pregnancy: a review

SUMMARY AIM: the present study analysed the association between Zika-virus and microcephaly during the gestational period of women in Brazil. Methodology: Systematic reviews of intervention research, current publications of clinical investigations were used systematic search strategies in three electronic databases PubMed, SciELO and Google academic. The following keywords were used: Microcephaly, gestation, Zika-virus to perform the search, and 1020 articles were obtained after exclusion, 45 were left and 35 were eligible. The collection period was from 2004 to 2017. Results: Epidemiological data suggest a temporal association between the quantitative increase and the Zika-virus epidemic, especially in Northeast Brazil. It is not consensual to measure the cephalic perimeter curve to be considered. Conclusion: Given this, the application of techniques to accurately diagnose the relationship between causes and effects in the pathogenesis of Zika virus infection in the central nervous system should be prioritized.

RESUMO OBJETIVO: O presente estudo analisou a associação entre Zika vírus e microcefalia durante o período gestacional de mulheres no Brasil. METODOLOGIA: Revisões sistemáticas de pesquisas de intervenção, publicações atuais de investigações clínicas. Foram utilizadas estratégias de buscas sistemáticas em três bases de dados eletrônicos: PubMed, SciELO e Google acadêmico. Utilizaram-se as palavras-chave microcefalia, gestação e Zika vírus para realizar a busca, sendo obtidos 1.020 artigos. Após a exclusão, restaram 45 e na elegibilidade, 35. O período da coleta foi de 2004 a 2017. Resultados: Os dados epidemiológicos preconizam uma associação temporal entre a ampliação do quantitativo e epidemia de Zika vírus, especialmente no Nordeste do Brasil. Não é consensual a mensuração da curva de perímetro cefálico a ser considerada. CONCLUSÃO: Visto isso, deve ser priorizada a aplicação de técnicas para diagnosticar com precisão as relações entre causas e efeitos na patogênese da infecção pelo Zika vírus no sistema nervoso central.