Antifungal susceptibility of oral isolates of Candida species from chronic kidney disease patients on chronic dialysis.

Chronic renal disease patients under chronic dialysis (CRDD) have a multifactorial immunological deterioration with an increased risk of Candida infections. Incidence of Candida infections is increasing. Choice of suitable antifungal agents is limited due to the resistance of some species to several antifungals. Aim of the present study was to identify the distribution and antifungal susceptibility patterns of oral isolated Candida species from infected and colonized patients, as well as to investigate the risk factors for oral infection in patients on dialysis. Cross-sectional study, approved by the institutional bioethics committees was performed in CRDD patients. Demographic, clinic data, and oral mucosa samples were obtained. Infection diagnosis was established clinically and confirmed with exfoliative cytology, each sample was plated on CHROMagar Candida and incubated at 36°C for 2 days. Yeast species were identified by carbohydrate assimilation ID 32C AUX system and the apiweb database. For the antifungal susceptibility test, the M44 A-3 method (CLSI) using fluconazole (FCZ), miconazole (MCZ), nystatin (NYS), and voriconazole (VCZ). Study included 119 participants, the main cause of CRD was nephropathy due to DM2 (58%), and three-fourths of the patients were under hemodialysis. Candida prevalence was 56.3% of 67 colonized or infected patients, 88 isolates were obtained. Principal identified species were C. albicans (51.1%), C. glabrata (25%), and C. tropicalis (14.8%). C. glabrata showed a reduced response to FCZ in 50% of isolates and C. albicans had a reduced response in 16% of the isolates. Antifungal agent with the least efficacious response or with the lowest susceptibility in the isolates of these patients was MCZ, followed by VCZ and FCZ, whereas NYS induced the best antifungal response.

[The effect of mycophenolate mofetil and azathioprine on gingival enlargement associated with cyclosporin A use in kidney transplant patients]. / Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso de Ciclosporina A en pacientes con trasplante renal.

AIM: To assess gingival overgrowth prevalence and severity in a group of kidney transplant (KT) patients, and analyze the effect of immunosuppressor drugs Cyclosporin A (CsA), Tacrolimus (Tac), Sirolimus (Siro), Azathioprine (Aza) and Mofetil Mycophenolate on this complication. METHODS: Gingival overgrowth presence and severity was classified, and the impact of immunosuppressor drugs, age, oral hygiene, verapamil and nifedipine on this condition was analyzed by multiple logistic regression. RESULTS: 172 KT pts. were examined; 137 used CsA, 25 Tac, 6 Sirolimus, 107 Aza and 56 MMF. Gingival overgrowth prevalence was 59.1% on CsA, 12.0% on Tac, and 16.7% on Sirolimus. CsA odds ratio (OR) 15.2, age <45 OR 5.6, and poor oral hygiene OR 3.2, increased, and Aza OR 0.05 and MMF OR 0.03, decreased GO prevalence. CONCLUSIONS: Aza and MMF effect was a significant protection against GO prevalence in this group of KT patients.

Efecto del micofenolato de mofetilo y azatioprina sobre la hiperplasia gingival asociada al uso deciclosporina A en pacientes con trasplante renal / No disponible

Objetivos: determinar la prevalencia y gravedad de hiperplasia gingival en un grupo de pacientes con trasplante renal (TR) y analizar el efecto del uso de los inmunosupresores ciclosporina A (CsA), tacrolimus (Tac), sirolimus (Siro) yazatioprina (Aza) o micofenolato de mofetilo (MMF) sobre esta complicación. Métodos: se clasificó la presencia y gravedad de la hiperplasia gingival. Se analizó el impacto de los medicamentos inmunosupresores, edad, higiene bucal, verapamilo y nifedipina sobre esta complicación mediante regresión logística múltiple. Resultados: fueron 172 pacientes. Usaban CsA 137, Tac 25, Siro 6, Aza 107 y MMF 56.Tuvieron hiperplasia gingival el 59,1% con CsA, 12,0% conTac, y 16,7% con Siro. Aumentaron la frecuencia de hiperplasia gingival CsA con razón de momios (RM) 15,2, edad<45 años con RM 5,6 y mala higiene bucal con RM 3,2, y la disminuyeron Aza con RM 0,05 y MMF con RM 0,03. Conclusiones: Aza y MMF ofrecieron protección significativa ontra el desarrollo de hiperplasia gingival en este grupo de pacientes con TR (AU)

Aim: To assess gingival overgrowth prevalence and severity in a group of kidney transplant (KT) patients, and analyze the effect of immunosuppressor drugs Cyclosporin A (CyA), Tacrolimus (Tac), Sirolimus (Siro), Azathioprine (Aza) and Mofetil Mycophenolate on this complication. Methods: Gingival overgrowth presence and severity was classified, and the impact of immunosuppressor drugs, age, oral hygiene, verapamil and nifedipine on this condition was analyzed by multiple logistic regression. Results: 172 KT pts. were examined; 137 used CyA, 25 Tac, 6 Sirolimus, 107 Aza and 56 MMF. Gingival overgrowth prevalence was 59.1% on CyA, 12.0% on Tac, and 16.7% on Sirolimus. CyA odds ratio (OR) 15.2, age <45 or 5 6 and poor oral hygiene 3 2 increased aza 0 05 mmf 03 decreased go prevalence conclusions: effect was a significant protection against in this group of kt patients (AU)

Pérdida de dientes en pacientes diabéticos con y sin insuficiencia renal crónica y diálisis / No disponible

Objetivos: Comparar la pérdida de dientes (PD) en diabéticos tipo 2 con (DM IRC) y sin (DM) insuficiencia renal crónica. Métodos: Se cuantificó la pérdida de dientes (PD) y se clasificó en: dentadura no comprometida (DNC) ≥ 25 dientes, parcialmente comprometida (DPC) 9 a 24, comprometida(DC) 0 a 8.Resultados: DM IRC y DM: n = 103 y 130, edad promedio57,9 y 58,5 años (p = 0,716), y al diagnóstico de diabetes38,5 y 47,8 años (p < 0,001), edéntulos 23,5% y 13,8% (p =0,057), DNC 24,5% y 35,4% (p = 0,074). La PD se asoció fundamentalmente a EP (p < 0,001). En DM IRC, albúmina baja (< 3,5 g/dl) fue más frecuente en diálisis peritoneal(p = 0,0014), mujeres (p = 0,0100), personas que sufrían mal sabor de boca (MSB) (p = 0,0174) y DC (p = 0,0242).Conclusiones: Existe una tendencia clara, pero no se confirma mayor PD en DM IRC vs DM. La asociación de albúmina baja con MSB y DC sugiere manejo de estas condiciones como parte del manejo nutricional del paciente diabético con IRC (AU)

Aim: To compare tooth loss (TL) in ESRD (ESRD DM) and non-ESRD (DM) type 2 diabetic patients. Methods: Teeth loss was quantified, and dentition classified as: Non-Compromised (NCD) with ≥ 25 teeth, partially compromised(PCD) with 9 to 24, and compromised (CD) with 0 to 8 teeth. Results: ESRD DM and DM: n = 103 and 130, mean age 57.9and 58.5 yr (p = 0.716), and at diabetes diagnosis 38.5 and 47.8yr (p < 0.001). Edentulous 23.5% and 13.8% (p = 0.057), NCD24.5% and 35.4% (p = 0.074). TL was strongly associated mainly to periodontal disease (p < 0.001). For ESRD DM, a low serum albumin (< 3.5 g/dl) was more prevalent in peritoneal dialysis cases (p = 0.0014), women (p = 0.0100), people reporting unpleasant taste (UT) (p = 0.0174), and those with a CD(p = 0.0242).Conclusions: There was a clear trend for more severe TL in ESRDDM cases, but no statistical difference was found. The association between low serum albumin, UT and CD imply a need for treatment of these conditions as a part of nutritional intervention in ESRD DM cases (AU)