Topical Vitamin D Prevents Bone Loss and Inflammation in a Mouse Model.

There is a strong association between vitamin D levels and periodontal disease based on numerous epidemiological studies. We have previously shown that experimental deficiency of serum vitamin D in mice leads to gingival inflammation and alveolar bone loss. Treatment of cultured oral epithelial cells with the active form of vitamin D, 1,25(OH)2 vitamin D3 (1,25(OH)2D3), inhibits the extracellular growth and intracellular invasion of bacteria associated with periodontal disease. Maintenance of periodontal health may be due in part to the anti-inflammatory activities of vitamin D. Furthermore, this hormone can induce the expression of an antimicrobial peptide in cultured oral epithelial cells. We have shown that oral epithelial cells are capable of converting inactive vitamin D to the active form, suggesting that topical treatment of the oral epithelium with inactive vitamin D could prevent the development of periodontitis. We subjected mice to ligature-induced periodontitis (LIP), followed by daily treatment with inactive vitamin D or 1,25(OH)2D3. Treatment with both forms led to a reduction in ligature-induced bone loss and inflammation. Gingival tissues obtained from vitamin D-treated LIP showed production of specialized proresolving mediators (SPM) of inflammation. To examine the mechanism, we demonstrated that apical treatment of 3-dimensional cultures of primary gingival epithelial cells with vitamin D prevented lipopolysaccharide-induced secretion of proinflammatory cytokines and led to a similar production of SPM. Analysis of the oral microbiome of the mice treated with vitamin D showed significant changes in resident bacteria, which reflects a shift toward health-associated species. Together, our results show that topical treatment of oral tissues with inactive vitamin D can lead to the maintenance of periodontal health through the regulation of a healthy microbiome and the stimulation of resolution of inflammation. This strongly supports the development of a safe and effective vitamin D-based topical treatment or preventive agent for periodontal inflammation and disease.

Bilateral macular edema in sistemic sclerosis.

Systemic sclerosis is a chronic, autoimmune, multisystem disease characterized by vascular dysfunction, chronic inflammation and widespread fibrosis. Although vascular involvement commonly manifests in the skin, it can also affect other organs, including the eyes. The characteristic vascular alteration is an obliterative fibroproliferative vasculopathy leading to hypoxia and tissue ischemia. We present a case of bilateral macular edema in a patient diagnosed with systemic sclerosis, as a consequence of retinal and choroidal vascular changes.

Gyrate atrophy of the choroid and retina: Update on diagnosis and treatment.

Gyrate atrophy of the choroid and retina (GACR) is a rare autosomal recessive disease characterised by elevated plasma ornithine levels due to deficiency of the enzyme ornithine aminotransferase (OAT). The accumulation of this amino acid in plasma leads to the development of patches of chorioretinal atrophy in the peripheral retina extending into the macular area. Patients usually present with night blindness followed by constriction of the visual field and, finally, decreased central vision and blindness. The disease is diagnosed by the presence of the characteristic clinical picture, the presence of hyperornithinaemia in plasma and the detection of mutations in the OAT enzyme gene. There is currently no effective gene therapy and the most common therapeutic intervention mainly involves dietary modifications with arginine restriction. This article aims to summarise the pathogenesis, clinical and diagnostic findings and treatment options in patients with GACR.

Asociación del colesterol remanente con el grado de control glucémico y la presencia de complicaciones microvasculares en personas con diabetes mellitus tipo 1 / Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus

Introducción Este trabajo investiga la relación entre el colesterol remanente, las métricas de glucosa y las complicaciones crónicas de la diabetes tipo 1 en individuos con sistemas flash de glucosa. Material y métodos Se recopilaron variables clínicas y métricas de glucosa de personas usuarias de sensores de glucosa. Se llevaron a cabo modelos estadísticos para estudiar la asociación del colesterol remanente con las métricas de glucosa, así como con la retinopatía y la nefropatía diabética. Resultados Se incluyeron 383 personas con una edad de 48,3±16,2 años, siendo un 54,1% mujeres, con un colesterol remanente de 16±10mg/dl. Los resultados mostraron que el colesterol remanente se asocia a un menor tiempo en rango (p=0,015) y a un mayor tiempo por encima del rango (p=0,003). La nefropatía diabética fue la única complicación que se asoció con un colesterol remanente mayor a 30mg/dl, OR: 8,93: IC 95%: 2,99-26,62; p<0,001. Conclusión El colesterol remanente se asocia de forma independiente con la hiperglucemia y la nefropatía diabética en personas con diabetes tipo 1. (AU)

Introduction This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. Material and methods Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. Results A total of 383 individuals, aged 48.3±16.2 years, with 54.1% women, and a remnant cholesterol level of 16±10mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (P=.015) and more time above the target range (P=.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30mg/dL; OR: 8.93; 95% CI: 2.99-26.62, P<.001. Conclusion Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes. (AU)

Asociación del colesterol remanente con el grado de control glucémico y la presencia de complicaciones microvasculares en personas con diabetes mellitus tipo 1 / Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus

Introducción Este trabajo investiga la relación entre el colesterol remanente, las métricas de glucosa y las complicaciones crónicas de la diabetes tipo 1 en individuos con sistemas flash de glucosa. Material y métodos Se recopilaron variables clínicas y métricas de glucosa de personas usuarias de sensores de glucosa. Se llevaron a cabo modelos estadísticos para estudiar la asociación del colesterol remanente con las métricas de glucosa, así como con la retinopatía y la nefropatía diabética. Resultados Se incluyeron 383 personas con una edad de 48,3±16,2 años, siendo un 54,1% mujeres, con un colesterol remanente de 16±10mg/dl. Los resultados mostraron que el colesterol remanente se asocia a un menor tiempo en rango (p=0,015) y a un mayor tiempo por encima del rango (p=0,003). La nefropatía diabética fue la única complicación que se asoció con un colesterol remanente mayor a 30mg/dl, OR: 8,93: IC 95%: 2,99-26,62; p<0,001. Conclusión El colesterol remanente se asocia de forma independiente con la hiperglucemia y la nefropatía diabética en personas con diabetes tipo 1. (AU)

Introduction This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. Material and methods Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. Results A total of 383 individuals, aged 48.3±16.2 years, with 54.1% women, and a remnant cholesterol level of 16±10mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (P=.015) and more time above the target range (P=.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30mg/dL; OR: 8.93; 95% CI: 2.99-26.62, P<.001. Conclusion Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes. (AU)

Association of remnant cholesterol with glycemic control and presence of microvascular complications in individuals with type 1 diabetes mellitus.

INTRODUCTION: This study examines the relationship between remnant cholesterol, glucose metrics, and chronic complications of type 1 diabetes in users of glucose monitoring systems. MATERIAL AND METHODS: Clinical variables and glucose metrics were collected from individuals using glucose sensors. Statistical models were employed to investigate the association of remnant cholesterol with glucose metrics, diabetic retinopathy, and diabetic nephropathy. RESULTS: A total of 383 individuals, aged 48.3 ±â€¯16.2 years, with 54.1% women, and a remnant cholesterol level of 16 ±â€¯10 mg/dL, were included. The results demonstrated that remnant cholesterol was associated with less time within the target range (p = 0.015) and more time above the target range (p = 0.003). Diabetic nephropathy was the only complication associated with remnant cholesterol levels exceeding 30 mg/dL, OR 8.93, 95% CI (2.99-26.62), p < 0.001. CONCLUSION: Remnant cholesterol is independently associated with hyperglycemia and diabetic nephropathy in individuals with type 1 diabetes.

Veno-venal extracorporeal membrane oxygenation to support whole-lung lavage in a severe case of pulmonary alveolar proteinosis.

We present the case of a 71-year-old woman with severe bilateral primary alveolar proteinosis admitted for bilateral whole lung lavage (WLL) with a double-lumen endotracheal tube. She had a cardiac arrest of respiratory origin during the procedure and recovered after one minute of advanced resuscitation. A second LLP was scheduled under respiratory support with veno-venous extracorporeal membrane oxygenation (VV-ECMO). During this second WLL the patient was completely VV-ECMO-dependent, and the procedure was successfully completed. She was gradually weaned over the next 48 h. The patient was finally discharged after clinical improvement and home oxygen therapy was discontinued. WLL is the treatment of choice for severe cases of alveolar proteinosis. In rare cases the intervention may be poorly tolerated due to the degree of lung involvement. This case illustrates how VV-ECMO support is an option that may benefit this subgroup of at-risk patients.

Ventilación controlada por flujo y gafas nasales de alto flujo en cirugía láser de estenosis subglótica grado III / Flow-controlled ventilation and hi-flow nasal oxygen in laser surgery for a grade III subglottic stenosis patient

Paciente de 49 años (IMC 29,4 kg/m2 y ASA III) con estenosis subglótica (ES) de más de 70% (grado III) intervenida mediante resección láser y posterior dilatación. Durante la resección láser se empleó ventilación controlada por flujo utilizando el respirador Evone®, que permite controlar todo el ciclo respiratorio regulando tanto el flujo inspiratorio como el espiratorio sin comprometer el intercambio gaseoso a pesar de administrar FIO2 máxima de 0,3 por riesgo de ignición. Antes de proceder a la dilatación endoscópica, se retiró el tubo endotraqueal láser de 4,5 mm de diámetro interno y se inició terapia con gafas nasales de alto flujo (GNAF) para prolongar la oxigenación apneica. El tiempo total de apnea fue de 11 minutos, manteniendo en todo momento SpO2 > 98% y End Tidal de CO2 máximo de 60 mmHg.(AU)

A 49-year old patient (BMI 29.4 kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5 mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11 minutes, maintaining SpO2 > 70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone > ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60 mmHg throughout the procedure.(AU)

Flow-controlled ventilation and hi-flow nasal oxygen in laser surgery for a grade III subglottic stenosis patient.

A 49-year old patient (BMI 29.4kg/m2 and ASA III) with grade III subglottic stenosis (> ventilator in flow controlled ventilation mode, which allowed us to regulate both inspiratory and expiratory flow without compromising gas exchange despite maintaining peak FIO2 at 0.3 due to the risk of ignition. Before proceeding with endoscopic dilation, the 4.5mm laser endotracheal tube was withdrawn and high flow nasal cannula oxygenation was started in order to prolong apnoeic oxygenation. Total apnoea time was 11min, maintaining SpO2>70%) underwent laser resection followed by dilation. During resection he was ventilated by the Evone>ventilator; high flow nasal cannula therapy; apnoeic oxygenation-98% and peak EtCO2 60mmHg throughout the procedure.

Estudio en vida real para evaluar la adherencia y el sabor de un suplemento oral Nutricional hipercalórico e hiperproteico en pacientes con desnutrición en un hospital / A real-world study to evaluate adherence and flavor of a high-protein hypercaloric oral nutritional supplement in patients with malnutrition in a hospital

Objetivo: el objetivo de nuestro estudio en vida real fue evaluar en pacientes ingresados desnutridos la adherencia y las preferencias de sabor de un suplemento oral Nutricional (SON) hipercalórico e hiperproteico. Métodos: se incluyeron en este estudio en vida real un total de 34 pacientes ingresados con pérdida de peso reciente. Se administró un sabor (café, vainilla o fresa) cada día de forma aleatoria a cada paciente durante tres días consecutivos. En los primeros tres días se pidió a los pacientes que completaran dos cuestionarios destinados a reflejar la tolerancia y aceptación del SON (Renutryl®). La adherencia del SON fue evaluada durante el ingreso hospitalario. Resultados: el sabor dulce fue más elevado para el sabor fresa (4,54 ± 0,2 puntos) que para el sabor vainilla (3,13 ± 0,1 puntos; p < 0,03) y el sabor café (3,03 ± 0,1 puntos; p < 0,02). Al analizar a los pacientes que tomaron suplementos después de elegir el sabor, los pacientes que eligieron café tomaron un total de 13,3 ± 1,1 envases de promedio durante la hospitalización (0,91 ± 0,2 por día), los pacientes que eligieron fresa tomaron 13,4 ± 1,3 envases (0,92 ± 0,1 por día) y, finalmente, los pacientes que eligieron envases de vainilla tomaron 8,3 ± 0,9 envases durante el ingreso (0,61 ± 0,1 por día), con diferencias significativas a favor de los sabores de fresa y café frente al sabor de vainilla. Por otra parte, el SON elegido mayoritariamente por los pacientes al alta hospitalaria fue el pack multisabor (n = 20; 50 %).Conclusiones: las preferencias de sabor de los SON de tres sabores son similares, aunque la adherencia fue más elevada durante el ingreso con respecto a los SON con sabor a café y fresa. La dulzura puede haber influido en este hallazgo, sobre todo con el sabor fresa, con una buena tolerancia de los 3 sabores (AU)

Aim: the objective of our real-life study was to evaluate adherence and taste preferences of a hypercaloric and hyperprotein oral nutritional supplement (ONS) in malnourished hospitalized patients. Methods: a total of 34 in patients with recent weight loss were included in this study. One flavor (coffe, vanilla or strawberry) was administered each day in a random way to each patient during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires intended to reflect ONS (Renutryl®) tolerance and acceptance. Adherence to the ONS was measured during hospital stay. Results: the sweet flavor was higher for strawberry (4.54 ± 0.2 points) than for the vanilla flavor (3.13 ± 0.1 points; p < 0.03) and coffee flavor (3.03 ± 0.1 points; p <0.02). When analyzing the total number of patients who took supplements after choosing the flavor, the patients who chose coffee took a total of 13.3 ± 1.1 packages on average during hospitalization (0.91 ± 0.2 per day), the patients who chose strawberry took 13.4 ± 1.3 packages (0.92 ± 0.1 per day), and finally the patients who chose vanilla packages took 8.3 ± 0, 9 packages during admission (0.61 ± 0.1 per day), with significant differences in favor of the strawberry and coffee flavors versus vanilla. The ONS chosen mostly by the patients at hospital discharge was the multiflavor pack (n = 20; 50 %). Conclusions: taste preferences for the three flavored ONSs are similar, although adherence was higher during admission to the coffee- and strawberry-flavored ONS. Sweetness may have influenced this finding, especially with the strawberry flavor, with a good tolerance of all three flavors (AU)