Prenatal depression outcomes in the next generation: A critical review of recent DOHaD studies and recommendations for future research.

Prenatal depression, a common pregnancy-related risk with a prevalence of 10-20 %, may affect in utero development and socioemotional and neurodevelopmental outcomes in the next generation. Although there is a growing body of work that suggests prenatal depression has an independent and long-lasting effect on offspring outcomes, important questions remain, and findings often do not converge. The present review examines work carried out in the last decade, with an emphasis on studies focusing on mechanisms and leveraging innovative technologies and study designs to fill in gaps in research. Overall, the past decade of research continues to suggest that prenatal depression increases risk for offspring socioemotional problems and may alter early brain development by affecting maternal-fetal physiology during pregnancy. However, important limitations remain; lack of diversity in study samples, inconsistent consideration of potential confounders (e.g., genetics, postnatal depression, parenting), and restriction of examination to narrow time windows and single exposures. On the other hand, exciting work has begun uncovering potential mechanisms underlying transmission, including alterations in mitochondria functioning, epigenetics, and the prenatal microbiome. We review the evidence to date, identify limitations, and suggest strategies for the next decade of research to detect mechanisms as well as sources of plasticity and resilience to ensure this work translates into meaningful, actionable science that improves the lives of families.

Comparison of insulin glargine and liraglutide added to oral agents in patients with poorly controlled type 2 diabetes.

AIM: To compare safety and efficacy of insulin glargine and liraglutide in patients with type 2 diabetes (T2DM). METHODS: This randomized, multinational, open-label trial included subjects treated for T2DM with metformin ± sulphonylurea, who had glycated haemoglobin (HbA1c) levels of 7.5-12%. Subjects were assigned to 24 weeks of insulin glargine, titrated to target fasting plasma glucose of 4.0-5.5 mmol/L or liraglutide, escalated to the highest approved clinical dose of 1.8 mg daily. The trial was powered to detect superiority of glargine over liraglutide in percentage of people reaching HbA1c <7%. RESULTS: The mean [standard deviation (s.d.)] age of the participants was 57 (9) years, the duration of diabetes was 9 (6) years, body mass index was 31.9 (4.2) kg/m(2) and HbA1c level was 9.0 (1.1)%. Equal numbers (n = 489) were allocated to glargine and liraglutide. Similar numbers of subjects in both groups attained an HbA1c level of <7% (48.4 vs. 45.9%); therefore, superiority of glargine over liraglutide was not observed (p = 0.44). Subjects treated with glargine had greater reductions of HbA1c [-1.94% (0.05) and -1.79% (0.05); p = 0.019] and fasting plasma glucose [6.2 (1.6) and 7.9 (2.2) mmol/L; p < 0.001] than those receiving liraglutide. The liraglutide group reported a greater number of gastrointestinal treatment-emergent adverse events (p < 0.001). The mean (s.d.) weight change was +2.0 (4.0) kg for glargine and -3.0 (3.6) kg for liraglutide (p < 0.001). Symptomatic hypoglycaemia was more common with glargine (p < 0.001). A greater number of subjects in the liraglutide arm withdrew as a result of adverse events (p < 0.001). CONCLUSION: Adding either insulin glargine or liraglutide to subjects with poorly controlled T2DM reduces HbA1c substantially, with nearly half of subjects reaching target levels of 7%.

Modulation of insulin dose titration using a hypoglycaemia-sensitive algorithm: insulin glargine versus neutral protamine Hagedorn insulin in insulin-naïve people with type 2 diabetes.

AIMS: To examine whether insulin glargine can lead to better control of glycated haemoglobin (HbA1c) than that achieved by neutral protamine Hagedorn (NPH) insulin, using a protocol designed to limit nocturnal hypoglycaemia. METHODS: The present study, the Least One Oral Antidiabetic Drug Treatment (LANCELOT) Study, was a 36-week, randomized, open-label, parallel-arm study conducted in Europe, Asia, the Middle East and South America. Participants were randomized (1:1) to begin glargine or NPH, on background of metformin with glimepiride. Weekly insulin titration aimed to achieve median prebreakfast and nocturnal plasma glucose levels ≤5.5 mmol/l, while limiting values ≤4.4 mmol/l. RESULTS: The efficacy population (n = 701) had a mean age of 57 years, a mean body mass index of 29.8 kg/m², a mean duration of diabetes of 9.2 years and a mean HbA1c level of 8.2% (66 mmol/mol). At treatment end, HbA1c values and the proportion of participants with HbA1c <7.0 % (<53 mmol/mol) were not significantly different for glargine [7.1 % (54 mmol/mol) and 50.3%] versus NPH [7.2 % (55 mmol/mol) and 44.3%]. The rate of symptomatic nocturnal hypoglycaemia, confirmed by plasma glucose ≤3.9 or ≤3.1 mmol/l, was 29 and 48% less with glargine than with NPH insulin. Other outcomes were similar between the groups. CONCLUSION: Insulin glargine was not superior to NPH insulin in improving glycaemic control. The insulin dosing algorithm was not sufficient to equalize nocturnal hypoglycaemia between the two insulins. This study confirms, in a globally heterogeneous population, the reduction achieved in nocturnal hypoglycaemia while attaining good glycaemic control with insulin glargine compared with NPH, even when titrating basal insulin to prevent nocturnal hypoglycaemia rather than treating according to normal fasting glucose levels.

Revisión de una fractura radicular con tratamiento atípico durante 23 años / Review of root fracture with atypical treatment for 23 years

Presentamos el caso de un incisivo central superior derecho, con fractura del tercio medio radicular, que fue tratado de forma atípica y se revisó durante 23 años de evolución. La fractura del tercio medio, conminuta en su área central, se produjo por un traumatismo contuso, acudiendo el paciente de urgencia por dolor agudo y movilidad del cliente. Con el diagnóstico de pulpitis aguda y fractura radicular media con subluxación, se decidió tratarlo en toda su longitud después de su ferulización. Practicado el tratamiento se dejó hidróxido de calcio en el conducto y a las dos semanas, con un diente asintomático desde el primer día, se selló definitivamente con hidróxido de calcio en suero fisiológico y gutapercha en condensación lateral. Tres meses después se retiró la ferulización y el diente esta asintomático, funcional y con una movilidad semejante a la de los incisivos vecinos. Radiológicamente, el área de fractura presento distintos aspectos diagnósticos a lo largo de 23 años de seguimiento. Actualmente, el incisivo sigue asintomático, firme, funcional y con un remodelado de su contorno bien definido (AU)

We are herewith presenting a case based on a maxillary right superior central incisor, which suffered a middle third fracture of the root. This fracture has been atypically treated and has been checked up throughout 23 years. The middle third fracture, which is comminuted in its central area, was caused by a contusion trauma. The patient came with urgency due to tooth mobility as well as an acute pain. After being diagnosed acute pulpitis and mid radicular fracture with subluxation, it was agreed to treat it throughout the whole process after its ferulization. Once treated, calcium hydroxide was left in the canal and two weeks after, with an asymptomatic tooth since the first day, it was sealed with calcium hydroxide with physiological saline solution and lateral condensation with gutta-percha. Three months after, ferulization was removed and the incisor was asymptomatic, functional and with mobility similar to the neighboring incisive. Radiograph examinations proved that the fracture presented different diagnosis throughout its 23 years. Nowadays, this incisor keeps being asymptomatic, firm and functional with a well done reshape (AU)

Incisivo central superior con necrosis y cese del desarrollo9, a 65 años vista / Incisive central tooth with necrosis and cessation of the development, in 65 years time

Presentamos el caso de un incisivo central superior derecho con necrosis y cese del desarrollo. L a paciente de 77 desconocía el estado del diente, que se mantenía funcional y asintomático, requiriendo nuestros servicios para rehabilitar el incisivo lateral vecino. Un traumatismo durante la niñez precisó tratamientos conservadores hasta coronarse. La pulpotomía cervical practicada (plombaje en su tiempo) no evitó la necrosis y cese del desarrollo, dejando un sistema amplio con ápice abierto. Quizás el intento de apexogénesis contribuyó de alguna forma a llegar hasta nuestros días. Año y medio después de su tratamiento, sigue una evolución favorable, asintomático, funcional y con mejora de su extensa lisis (AU)

We introduce the case of an incisive central right tooth with necrosis and cessation of the development. The 77 years old patient was unaware the state of the tooth, which remained functional and asymptomatic, requiring our services for rehabilitate the incisive neighboring side. A traumatism during the childhood required conservative treatments until reaching the top. The cervical pulpotomy practiced (plombage at the time), did not avoid the necrosis and the cassation of the development, leaving a wide system with an open apex. Perhaps the attempt of apexogénesis contributed in some way to arrive until nowadays. A year and half later to his treatment, he follows a favorable, improvement asymptomatic, functional and improvement of his extensive lisis (AU)

Maxilarización de un Segundo molar mandibular (3.7) / No disponible

Presentamos el caso de un segundo molar mandibular, que precisó un tratamiento de endodoncia por su pérdida de sustancia. Mostró un patrón maxilar tanto en su cámara pulpar como en la localización y disposición de sus conductos radiculares. En su raíz mesiovestibular (MV), distoventibular (DV) y lingual (L) supernumeraria, se localizó un conducto MV, un DV y un L respectivamente. En el L se detectó otro conducto, que surgiendo de este se proyecta hacia el ápice de la raíz MV. Variación del sistema poco frecuente y atípica también a nivel maxilar. Dos años después corroboramos el éxito de un tratamiento conservador, que exigió uno endodóncico complejo (AU)

We present the case of a second mandibular molar, which clarified treatment of endodontics for their loss of substance. He showed a pattern in his jaw while pulp chamber as in the location and disposition of their root canals. A its root mesiovestibular (MV) distovestibular (DV) and lingual (L) extra, was located a conduit MV a DV and L respectively. In the L we find another channel, which is emerging from this projected toward the apex of the root MV. Variation system also rare and unusual level jaw. Two years later we see the success of a conservative treatment, which demanded a endodóncio complex (AU)

Tratamiento de un primer molar inferior complejo / Treatment for first lower complex premolar teeth

Presentamos el caso de un primer premolar mandibular izquierdo de raíz única, con absceso periapical en fase aguda, que mostró un sistema complejo de tres conductos con tres foraminas independientes (mesiovestibular, distovestibular y lingual), cuyo diagnóstico preoperatorio no fue posible con la radiología preliminar. Durante la instrumentación sufrimos una seria complicación al bloquearse el acceso del conducto distovestibular y quedarse instrumentado solo conlimas K file 08 y 10. El tratamiento se practicó en cuatro citas. La limpieza mecánica, el tratamiento químico del sistema y la obturación practicada fue eficaz para cicatrizar la lesión periapical, manteniéndose el éxito del tratamiento dos años después

I would like to present following case a left mandibular first premolar with an only root which consisted or a chronic periapical abscess in its acute phase, it showed a complex system based on three canals with three independent foraminas called mesio-buccal, disto-buccal and lingual. Its preoperatory diagnosis was not possible to detect with previous X-ray. During instrumentation we experienced a serious complication as the access to the disto-buccal canal was blocked and was only left with 08 and #10 k-files. The treatment to follow was spaced along four appointments. Mechanical cleaning, chemical treatment system and sealing of the canal obturation were extremely effective for its periapical injury healing. Such treatment has been a total success until nowadays