Bloqueo retrolaminar ecoguiado como analgesia para el manejo de neuralgia por herpes zóster: a propósito de un caso / Retrolaminar ultrasound guided block as analgesic treatment for post herpetic neuralgia: case report

Los bloqueos interfasciales (BIF) son el resultado de inyectar un anestésico local en el espacio comprendido entre dos fascias con el objetivo de distribuir el volumen y bloquear la transmisión nerviosa correspondiente. La introducción de los BIF como técnica anestésico-analgésica es relativamente reciente. Su amplia difusión y estandarización en estos últimos años ha venido de la mano del uso de ultrasonidos; como resultado ha aumentado la eficacia de los bloqueos y la seguridad en la práctica de los mismos. El bloqueo retrolaminar (RL) y el bloqueo del plano del erector espinal (ESP) comparten características similares y pueden considerarse una alternativa analgésica para los dolores relacionados con afectación de la pared torácica, siendo el bloqueo RL de gran valor en pacientes con riesgo de neumotórax o en quienes no se obtenga adecuada visualización de la sonoanatomía para el bloqueo ESP. Se describe el caso de un paciente con neuralgia aguda por herpes zóster, a quien se le realizó un bloqueo RL exitoso.(AU)

Interfacial plane blocks (IPB) are the result of the injection of an anesthetic locally in the space created between two fasciae with the purpose of distributing the volume of the medication and block the transmission of the corresponding nerves. The introduction of IPB as an analgesic anesthetic technic is relatively resent, and its widespread and standardization this last few years has come by hand of the ultrasound, as a result the safety and efficiency of the IPB has increased. The retrolaminar block (RB) and the Spinal erector plane block (SPB) share characteristics and could be considered as an alternative to manage the thoracic wall pain pathologies, keeping in mind that the RB is of choice for patients in danger of suffering a pneumothorax or in those in which there is an inappropriate anatomic visualization though the echography for the SPB. In this article a case of a patient with acute neuralgia due to herpes zoster who received a successful RB is described.(AU)

Periodontal treatment and glycaemic control in patients with diabetes and periodontitis: an umbrella review.

BACKGROUND: Studies suggest that non-surgical periodontal treatment improves glycaemic control in patients with diabetes and periodontitis. The aim of this umbrella review is to summarize the effects of periodontal treatment on glycaemic control in patients with periodontitis and diabetes. METHODS: A systematic review of systematic reviews with or without meta-analysis published between 1995 and 2015 was performed. Three independent reviewers assessed for article selection, quality and data extraction. RESULTS: Thirteen (13) systematic reviews/meta-analysis were included for qualitative synthesis. A reduction (0.23 to 1.03 percentage points) in the levels of HbA1c at 3 months after periodontal intervention was found. This reduction was statistically significant in 10/12 meta-analysis. One review with sufficiently large samples found a non-significant reduction (-0.014 percentage points; 95% CI -0.18 to 0.16; p = 0.87). Only three studies separated the use of adjunctive antibiotics and found a reduction of 0.36 percentage points but the difference was not statistically significant. CONCLUSIONS: Highly heterogeneous short-term studies with small sample size suggest that periodontal treatment could help improve glycaemic control at 3 months in patients with type 2 diabetes and periodontitis. However, longer term studies having sufficient sample size do not provide evidence that periodontal therapy improves glycaemic control in these patients.

Effects of periodontal non-surgical therapy plus azithromycin on glycemic control in patients with diabetes: a randomized clinical trial.

BACKGROUND AND OBJECTIVE: Periodontitis may alter the systemic condition in patients with diabetes and hence interfere with glycemic control. The objective of this study was to determine the quantifiable changes in glycated hemoglobin (HbA1C) after periodontal non-surgical therapy plus azithromycin in a mixed population of patients with poorly controlled diabetes. MATERIALS AND METHODS: One hundred and five patients were randomized to receive non-surgical therapy plus azythromycin (AZ-Sca =33), non-surgical therapy plus placebo (PB-Sca = 37) and supragingival prophylaxis plus azithromycin (AZ-Pro = 35). Glycated hemoglobin, glycemia and periodontal parameters were measured at baseline, 3, 6 and 9 mo after treatment. RESULTS: Periodontal parameters were improved in the AZ-Sca and PB-Sca groups as compared to the AZ-Pro group. A greater reduction in probing depth was observed in the AZ-Sca as compared to the PB-Sca group. Improvement in clinical attachment level was similar between AZ-Sca and PB-Sca groups. A reduction from 8.0% to 7.2% (∆0.8%; p < 0.05) in HbA1C was observed in the AZ-Sca at 9 mo as compared to the PB-Sca group in which the reduction was from 7.9% to 7.6% (∆0.3%). There was no decrease in HbA1C in the AZ-Pro group over time. Mean glycemia values decreased from 195 mg/dL to 159.2 mg/dL (∆35.8 mg/dL; p < 0.05) in the AZ-Sca group whereas a decrease from 194 mg/dL to 174.8 mg/dL (∆19.2 mg/dL) in the PB-Sca group at 9 mo was observed. There were no differences between the AZ-Sca and PB-Sca groups for glycemic parameters. No improvement in glycemic values in the AZ-Pro group was observed. CONCLUSIONS: A modest improvement in glycemic control was detected with a trend towards the use of non-surgical therapy plus AZ as compared to the placebo.

Determinantes del diagnóstico periodontal / Determinants of periodontal diagnosis

Un correcto diagnóstico periodontal es necesario para la realización de una terapia periodontal exitosa en nuestro paciente. Entendiendo que la enfermedad periodontal es un proceso infeccioso-inflamatorio, diferentes variables se deben analizar clínicamente para determinar el diagnóstico. El diagnóstico entonces es un análisis concienzudo de la expresión clínica de la enfermedad, desde gingivitis hasta periodontitis. Este artículo analiza los determinantes más importantes del diagnóstico periodontal utilizados en la práctica clínica diaria.

The correct diagnosis of periodontal disease is a pre-requisite for an appropriate periodontal treatment. Periodontal disease is an infectious-inflammatory process that affects different clinical variables that must be analyzed before reaching the diagnosis. The diagnosis should be a carefully performed analysis of the clinical expression of the disease, from gingivitis to periodontitis. This article reviews the most important determinants of periodontal diagnosis.

Effects of cytomegalovirus infection on the mRNA expression of collagens and matrix metalloproteinases in gingival fibroblasts.

BACKGROUND AND OBJECTIVE: The purpose of this in vitro investigation was to study the effects of human cytomegalovirus infection on the mRNA expression for collagens I and III and for matrix metalloproteinases 1 and 2 in gingival fibroblasts. MATERIAL AND METHODS: Gingival fibroblasts were experimentally infected with the Towne strain of human cytomegalovirus and the kinetics of expression of mRNA for collagens I and III and for matrix metalloproteinases 1 and 2 was studied at different time-points. Total RNA was isolated at the indicated time, and the reverse transcription-polymerase chain reaction was used to analyze the level of mRNA expression. In addition, gingival specimens were obtained from 14 periodontitis and from three non-periodontitis subjects and mRNA analysis for collagens and metalloproteinases was carried out. Nested polymerase chain reaction was used to determine the presence or absence of human cytomegalovirus in subgingival samples from each subject. RESULTS: The infection of gingival fibroblasts with human cytomegalovirus during a 0-72-h period resulted in progressive reduction in the expression of mRNA for collagens I and III (p < 0.05). A higher concentration of human cytomegalovirus resulted in varying degrees of mRNA reduction, suggesting a virally mediated effect. Biopsies from human cytomegalovirus-positive individuals with periodontitis had a higher expression of mRNA for collagens I and III than biopsies from human cytomegalovirus-negative individuals. An up-regulation in the mRNA expression of matrix metalloproteinases 1 and 2 over time was observed (p < 0.05). Analysis of mRNA expression in gingival biopsies demonstrated higher expression of matrix metalloproteinase-1 in human cytomegalovirus-positive periodontitis specimens compared with human cytomegalovirus-negative periodontitis specimens. CONCLUSION: Altered expression of mRNA for collagens and metalloproteinases in human cytomegalovirus-infected gingival fibroblasts should be considered as possible modifying mechanisms in periodontitis-infected sites.

Profiling of inflammatory cytokines produced by gingival fibroblasts after human cytomegalovirus infection.

INTRODUCTION: The purpose of this study was to determine the profile of inflammatory cytokines that are produced after in vitro infection of gingival fibroblasts with human cytomegalovirus (HCMV). MATERIALS AND METHODS: Gingival fibroblasts were infected with the Towne strain of HCMV and the cytokine profile in the supernatant was studied using a human inflammation antibody array. Expression of messenger RNA (mRNA) using reverse transcription-polymerase chain reaction for interleukin-1beta (IL-1beta) and tumor necrosis factor-alpha (TNF-alpha) was also analyzed in infected gingival fibroblasts and gingival specimens from subjects with and without periodontitis according to HCMV detection. HCMV was determined in subgingival samples by nested polymerase chain reaction. RESULTS: Gingival fibroblasts produced mainly IL-1alpha, IL-12p40, IL-12p70, IL-6, TNF-alpha, and IL-1beta after HCMV infection. Expression of mRNA for IL-1beta and TNF-alpha was increased after HCMV infection. Production of IL-1beta and TNF-alpha was increased in HCMV-positive periodontitis specimens. In addition, infected gingival fibroblasts produced more IL-8, monocyte chemoattractant protein 1, macrophage inflammatory proteins 1alpha, and 1beta over time postinfection in comparison to baseline. The lowest production of all cytokines studied corresponded to IL-2, IL-4, IL-13, and interferon-gamma. A decreasing production pattern was observed for granulocyte-macrophage colony-stimulating factor, IL-7, and IL-17 while IL-11 and macrophage colony-stimulating factor were increased at 72 h postinfection. CONCLUSIONS: HCMV infection in gingival fibroblasts upregulated the production of proinflammatory-related cytokines and chemokines. The expression of IL-1beta and TNF-alpha was increased both in vitro and in specimens from HCMV-positive subjects with periodontitis. The overproduction of proinflammatory cytokines and chemokines as a result of viral infection should be considered an important pathogenic mechanism linking HCMV to periodontitis in vivo.

Comparison of nested polymerase chain reaction (PCR), real-time PCR and viral culture for the detection of cytomegalovirus in subgingival samples.

INTRODUCTION: The purpose of this study was to compare nested polymerase chain reaction (PCR), real-time PCR, and shell vial for the detection of human cytomegalovirus (HCMV) in subgingival samples in periodontitis patients. METHODS: A group of 44 patients and 24 individuals without periodontitis were included in the study. A full periodontal examination was conducted in each subject. Gingival crevicular fluid (GCF) was collected by pocket lavage and used for viral culture (shell vial). Additional subgingival samples were obtained with paper points and used for molecular analysis. Nested PCR and real-time PCR were used to detect and quantify HCMV. Student's t-test and chi-squared test were used to compare groups. The sensitivity and specificity for the tests were calculated on 2 x 2 tables considering the nested PCR as the gold standard. RESULTS: The detection of HCMV was greater using nested PCR than with either real-time PCR or shell vial (P < 0.0001). However, the frequency detection of both molecular techniques was higher than in viral culture (P < 0.0001). Only one case of chronic periodontitis was positive by viral culture. Agreement between nested PCR and real-time PCR was observed 47.7% and 4.1% of the time in the periodontitis and control groups, respectively. The sensitivity of real-time PCR was 60%, compared with 2.8% for the shell vial technique. CONCLUSIONS: In conclusion, this study confirmed that active HCMV infection occurs in human periodontitis; however, its frequency seems to be low. In contrast, latent periodontal HCMV infection seems to be a more frequent event.

Periodontitis is associated with preeclampsia in pregnant women.

BACKGROUND: Recent investigations have demonstrated a positive association between periodontitis and pregnancy complications. The purpose of this study was to determine the effect of periodontitis and the subgingival microbial composition on preeclampsia. METHODS: A case-control study was carried out in Cali, Colombia that included 130 preeclamptic and 243 non-preeclamptic women between 26 to 36 weeks of pregnancy. Sociodemographic data, obstetric risk factors, periodontal status, and subgingival microbial composition were determined in both groups. Preeclampsia was defined as blood pressure>or=140/90 mm Hg, and >or=2+ proteinuria, confirmed by 0.3 g proteinuria/24 hours of urine specimens. Controls were healthy pregnant women. Odds ratios (ORs) for periodontitis and subgingival microbiota compositions were calculated. RESULTS: A total of 83 out of 130 preeclamptic women (63.8%) and 89 out of 243 controls (36.6%) had chronic periodontitis (OR: 3.0; 95% confidence interval (CI): 1.91 to 4.87; P<0.001). Clinical attachment loss increased in the case group (4.0+/-0.10 mm) compared to the control group (3.0+/-0.08 mm) (P<0.001). The average newborn birth weight from preeclamptic mothers was 2.453 g, whereas in controls was 2.981 g (P<0.001). Two red complex microorganisms, Porphyromonas gingivalis and Tannerella forsythensis, and the green complex microorganism Eikenella corrodens were more prevalent in the preeclamptic group than in controls (P<0.01). CONCLUSIONS: Chronic periodontal disease and the presence of P. gingivalis, T. forsythensis, and E. corrodens were significantly associated with preeclampsia in pregnant women. Further research is needed to establish pathogenic mechanisms of active periodontal disease and subgingival periodontopathogens related to preeclampsia development.

Menopausia: actitudes y conocimientos en un grupo de medicos internos, de la facultad de medicina, de la Universidad de Antioquia / Menopause: attiude an knowledge in a group of final-year medical students of the school of medicine of the University of Antioquia

Se presentan los resultados de una encuesta realizada a los médicos de la Facultad de Medicina de la Universidad de Antioquia, en el segundo semestre de 1997. El proyecto se realizó con el doble propósito de construir conocimiento sobre el tema del climaterio femenino y, en segundo lugar, para aportar elementos pertinentes a la discusión de cambio curricular en que está empeñada la Facultad y la Universidad. Partimos de la hipótesis de que la historia personal del individuo limita las actitudes y condiciona el desarrollo de motivación y destrezas sobre un tema determinado. Se utilizó el censo y las técnicas de encuesta y escala Lickert para indagar sobre variables socioculturales, demográficas y de carácter científico/técnico. Se encontró que el nivel de conocimientos, medido por la nota, fue de 2.85 + 0.83; la actitud frente a la terapia fue baja en el 44 por ciento y alta en el 40 por ciento. Como se había previsto en la hipótesis, la relación entre actitudes y conocimientos fue directa, pero la asociación con variables sociodemográficas no pudo determinarse debido a la homogenidad de la población

Residues of organochlorines in mallards and blue-winged teal collected in Colombia and Wisconsin, 1984-1989.

We compared the seasonal concentrations of 12 organochlorine (OC) compounds in samples of breast muscle, associated skin, and subcutaneous fat of blue-winged teal (Anas discors) collected in Ciénaga Grande de Santa Marta, Colombia (1987-1988), and of mallards (Anas platyrhynchos) and blue-winged teal collected in Wisconsin (1984-1989). Although these species have similar feeding habits and overlapping breeding distributions, their winter ranges differ markedly. Most blue-winged teal winter in the Neotropics, whereas most mallards remain in the temperate regions of North America. A seasonal comparison of OC exposure in these species may help determine the geographic origins of contamination. All examined OCs were found to be below concentrations known to affect reproduction in waterfowl. DDE was most often detected in blue-winged teal and PCBs, in mallards. DDE exposure may have predominantly occurred outside of Wisconsin. The DDE concentration in blue-winged teal samples collected in Wisconsin in the spring (GM=0.406 microg/g) were greater (P<0.001) than in the fall (GM=0. 033 microg/g) and greater than the concentrations in mallard samples from the spring (GM=0.058 microg/g; P<0.001). Ciénaga Grande, however, was not a source of DDE contamination. The DDE concentrations in blue-winged teal samples from Ciénaga Grande did not differ between the spring (GM=0.037 microg/g) and the fall (GM=0. 039 microg/g) and were lower (P<0.001) than the concentration in blue-winged teal samples from Wisconsin in the spring. In contrast, PCB contamination seemed to have occurred in Wisconsin and affected mostly mallards. PCBs were not detected in the samples from Colombia and were detected in only five (8.3%) of the blue-winged teal samples from Wisconsin (GM=0.025 microg/g), however, those compounds were detected in 47% of the mallard samples collected in Wisconsin (GM=0.272 microg/g). DDE and PCB concentrations were greater (P=0.0) in mallard samples collected from wetlands adjacent to Lake Michigan than in samples from inland wetlands.