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- Associação dos polimorfismos dos genes da IL-1 e do IL-1RA com a peri-implantitePublication . Cardoso, José Maria Correia Gonçalves Neves; Alves, Ricardo Castro; Ribeiro, Ana Clara; Noronha, Susana do CantoDental implants are currently an increasingly predictable and effective modality for the rehabilitation of partially or totally edentulous patients, contributing to the patient's quality of life. This type of rehabilitation has high success and survival rates, however biological complications may arise. Such complications mainly refer to inflammatory conditions associated with bacterial challenge, and two clinical variants can be distinguished: peri-implant mucositis and peri-implantitis. While the presence of an inflammatory lesion is a common feature of both conditions, only the latter is associated with loss of supporting bone. Mucositis is thought to precede peri-implantitis. With the massive increase in the number of patients with dental implants, the prevalence of inflammatory conditions around implants is also intensifying. Peri-implantitis is becoming a scourge and a serious public health problem, being their management challenging, and being associated with significant morbidity. The treatment of peri-implantitis involves high costs for the community and often fails to control the progression of the disease, leading to loss of the implant. This situation of implant loss is associated with bone loss, which in some cases may require complex bone grafting procedures for a new implant placement or, as a last resort, may make a new implant placement impossible. The impossibility of replacing an implant has consequences for the patient in terms of health, function and esthetics. There is currently no test that can determine the susceptibility of a patient to peri-implantitis who will receive a dental implant. At the end of the last century, the hypothesis was generated that the genetic background of an individual may modulate the severity and progressive character of oral inflammations through expression of cytokines and their modulators. Interleukin-1 (IL-1) is a multifunctional cytokine playing a key role in the pathogenesis of inflammatory diseases with a large number of diverse activities and functions in immune response, inflammation, tissue breakdown, and tissue homeostasis. The IL-1 family includes 11 cytokines, whose coding genes are located on the long arm of chromosome 2q. The two most extensively studied members are the IL-1A, IL-1B genes, which encode IL-1α and IL-1β, respectively. Within the IL-1 family of proteins, there is also the IL-1 receptor antagonist (IL-1Ra), which is encoded by the IL-1RN gene. IL-1Ra plays an anti inflammatory role by preventing the transmission of proinflammatory signals and preventing the immune response by using the same receptor as proinflammatory IL-1. Scientific evidence indicates that biological complications in dental implants tend to be concentrated in a subset of individuals, which seems to imply that the host response may play a determining role in implant success. Even when exposed to similar risk factors, not all patients develop peri-implantitis, a situation that highlights the importance of genetic predisposition and differences between populations. Given the crucial role of IL-1 and IL-1Ra in inflammation, the genes IL-1A, IL-1B and IL1RN are potential candidates for genetic markers in peri-implantitis. However, studies that analyzed the relationship between these polymorphisms and peri-implantitis have shown conflicting results. Therefore, a systematic review and meta-analysis was performed, before the experimental work, to quantitatively synthesize existing studies to evaluate the association of common functional polymorphisms in the IL-1 and IL-1RN genes with susceptibility to periimplantitis (Chapter 2). This review attempted to overcome the existing limitations of published systematic reviews and meta-analyses. No robust conclusions could be drawn from the current literature about the possible link between genetic variations and the occurrence of peri-implantitis. The inequality of the design of the studies requires more studies to be carried out using larger population samples and from different ethnic groups. Studies have reported that the frequency of gene polymorphisms associated with genetic susceptibility to a particular disease can be influenced by ethnic and racial variations. There are few studies that try to evaluate this possible relationship in southern Europe. In this sense our main purpose was to investigate whether the three genetic variants (IL-1A - 889C/T, IL-1B + 3954C/T and IL-1RN (Variable Number of Tandem Repeats (VNTR)) were associated with the occurrence of peri-implantitis in a Portuguese Caucasian population. Prior to the main study, a pilot study was conducted with twenty participants (Chapter 4) to test the feasibility of the study and to calculate the sample size. Subsequently, a cross-sectional analytical study was carried out (Chapter 5), involving a total of 102 Portuguese Caucasian individuals. Participants were categorized into two groups: 59 with healthy implants and 43 individuals with periimplantitis. Buccal mucosa samples were swabbed and genetic analysis was performed at the Molecular Biology Laboratory of the Egas Moniz School of Health and Science, using the real-time polymerase chain reaction (PCR) technique for IL-1A and IL-1B and using PCR for IL-1RN. The IL-1A -889 C/T polymorphism showed a higher prevalence of the altered allele (T allele) in cases of peri-implantitis than in healthy cases (27.9% vs 16.9% respectively), although without statistically significant differences (p = 0.060). For the IL-1B +3954 C/T and IL-1RN (VNTR) polymorphisms, the analysis revealed that the frequencies of the different alleles and different genotypes did not differ significantly between the groups. Although there are studies that attempt to link the existence of certain genetic polymorphisms and the presence of peri-implantitis, with contradictory results, the scientific evidence on the possible relationship between genetic alterations and biochemical alterations in the peri-implant crevicular fluid (PICF) is very scarce. The possible association between genetic polymorphisms and periimplantitis must be based on a change in the individual's immune-inflammatory. In this way the aim of our investigation was also to evaluate the levels of the inflammatory response markers IL-1β, PGE2 and TNF-α in the PICF of patients with healthy dental implants and individuals with peri-implantitis, under consideration of the patients´ individual IL-1 and IL-1RN genotypes. Biochemical analysis was performed on 51 of the 102 patients who underwent genetic analysis (Chapter 6). For the biochemical analysis, the concentrations of PICF inflammatory mediators IL-1b and TNF-a were analyzed using multiplexed fluorescent sphere immunoassays and PGE2 by enzyme-linked immunosorbent assay (ELISA). In patients where the presence of the polymorphism in the IL-1RN was detected, there was an increase in the concentration of the three inflammatory mediators with statistically significant differences for TNF-a and PGE2 mean values, regardless of peri-implant health status (p = 0.002 and p = 0.049, respectively). Based on the results obtained in this work, it could be concluded that there was no correlation between IL-1A -889, IL-1B +3954 and IL-1RN polymorphisms and peri-implantitis, on the studied population. On the other hand, it was observed that the prevalence of these polymorphisms in the population evaluated was lower than in other European countries. This situation may hypothetically explain the absence of differences between groups regarding the role of these polymorphisms in the occurrence of peri-implantitis. This situation emphasizes how important it is to develop this type of studies in different ethnic groups. It was observed that individuals with the IL-1RN gene polymorphism, regardless of their peri-implant health status, have higher levels of TNF-α and PGE2 in the PICF compared to patients without the polymorphism, which could put them at greater risk of peri-implant inflammatory complications. These results should be confirmed in studies with larger samples and ideally with a longitudinal character, as this will allow better control of the various factors that may influence the onset and progression of a disease with a multifactorial etiology such as periimplantitis. Among the patients with the positive composite genotype (at least one allele with nucleotide sequence changed in IL-1A and IL-1B genes), it was observed that those with peri-implantitis had a greater volume of PICF and a higher concentration of PGE2.
- Qualidade de vida no idoso com dependência funcional: influência de um programa de reabilitação durante o internamentoPublication . Cachola, Helena Sofia Mira; Moreira, JoséEnquadramento: Ao longo do ciclo de vida ocorrem alterações fisiológicas que condicionam o grau de funcionalidade da pessoa, com consequente aumento da dependência no autocuidado. O enfermeiro especialista em enfermagem de reabilitação assume um papel fundamental como facilitador nas transições identificadas ao longo do processo de saúde-doença, prevenção de incapacidades, minimização do impacto do internamento na funcionalidade e otimização da qualidade de vida dos idosos. Objetivo: Desenvolver competências em enfermagem de reabilitação, identificando ganhos sensíveis aos cuidados de Enfermagem de Reabilitação ao utente idoso em contexto de internamento, minimizando o respetivo impacto na sua qualidade de vida. Metodologia: O projeto de intervenção foi suportado pela metodologia de estudo de casos múltiplos, com base numa amostra de conveniência. Os cuidados foram contextualizados através do referencial teórico de Afaf Meleis e do modelo teórico de Nancy Roper, seguindo as etapas do processo de enfermagem. Resultados: Todos os seis utentes incluídos no programa de enfermagem de reabilitação apresentaram ganhos no aumento da funcionalidade, evoluindo de um score médio de 51.1 pontos na avaliação da Medida de Independência Funcional, para um score médio de 92 pontos. No que se refere à perceção da Qualidade de Vida, todos os participantes evoluíram de forma positiva nos vários domínios que constituem o instrumento EQ-5D-3L. Conclusão: As intervenções realizadas no âmbito do projeto implementado demonstraram ser eficazes na maximização da funcionalidade e da qualidade de vida dos idosos hospitalizados, alicerçadas nas competências adquiridas e desenvolvidas de enfermeiro especialista, enfermeiro especialista em enfermagem de reabilitação e de mestre.