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Some inflammatory mediators such as interleukin-10 (IL-10), the molecule of nitric oxide (NO) and the hormone estrogen can participate in the inflammatory periodontal disease (PD). This study aimed to: 1) review the relationship of IL 10, NO and estrogen as well as genetic polymorphisms linked to genes encoding IL 10, isoforms of NOS and estrogen receptors with the DP (Chapter 1); 2) to investigate the association of IL-10, NOS2A and ESR2 genes in chronic periodontitis (CP) and aggressive (AP) (Chapter 2); 3) assess the relationship between prior periodontal treatment (PPT) e oral hygiene habits in patients with generalized aggressive periodontitis (GAP) (chapter 3). In study 1 was carried out a literature review and included clinical studies in humans, with publications in the English language that investigated the role of IL 10, NO and estrogen and related genetic polymorphisms in PD. In study 2 were investigated SNPs (single nucleotide polymorphisms) -1087G> A (rs1800896), -819C> T (rs1800871) and -592C> A (rs1800872) in the IL10 gene, + 2087G> A (rs2297518) in NOS2A gene and + 1730G> A (rs4986938) in ESR2 gene in 50 AP patients, 61 CP patients and 61 control patients. In study 3, 55 patients with generalized aggressive periodontitis (GAP) were analyzed through clinical periodontal examination and collection of data of oral hygiene and prior periodontal treatment (PPT). Study 1 showed that levels of IL 10 and NO are correlated with the PC. Associations were found for SNPs -592 and -819 of the IL 10 gene with chronic periodontitis and haplotype ATA with chronic and aggressive periodontitis. There is positive evidence of the use of replacement therapy with estrogen on the periodontal tissues in postmenopausal women. In study 2 patients with genotype + 2087GG in NOS2A gene showed a trend toward a significant association with PD (p = 0.05; OR = 0.44; 95% CI = 0.20 to 0.95). There were no significant associations with PD in the genotype analysis of IL 10 and ESR2 genes or haplotypes of IL 10 gene. In study 3 patients who did not use dental floss had a reduced chance in 84% of undergoing TPP (p = 0.005; OR = 0.16; 95% CI = 0.04 to 0.59). It is concluded that high concentrations of IL-10 and NO can be found in inflamed periodontal tissues. Subjects with the GG genotype in the SPN +2087 NOS2A gene were protected against the development of PD. There was a significant relationship between the use of dental floss and the presence of previous periodontal treatment. Alguns mediadores inflamatórios como a interleucina-10 (IL-10), a molécula do óxido nítrico (NO) e o hormônio estrógeno parecem participar do processo inflamatório da doença periodontal (DP). Este trabalho teve por objetivo: 1) revisar a relação coma DP da IL-10, NO e estrógeno, assim como polimorfismos presentes nesses genes, respectivamente: IL10, isoformas das óxido nítrico sintases (NOS) e receptores de estrógeno (ESR) (capítulo 1); 2) investigar a associação dos genes IL10, NOS2A e ESR2 na periodontite crônica (PC) e agressiva (PAg) (capítulo 2); 3) avaliar o tratamento periodontal prévio (TPP) e hábitos de higiene oral em portadores de periodontite agressiva generalizada (PAgG) (capítulo3). No estudo 1, foi realizada uma revisão de literatura incluindo estudos clínicos em humanos, com publicações na língua inglesa, que investigaram o papel da IL-10, do NO e estrógeno e polimorfismos genéticos relacionados a esses mediadores na DP. No estudo 2, foram investigados os SNPs (Single Nucleotide Polymorphism ou polimorfismos de base única) -1087G>A (rs1800896), -819C>T (rs1800871) e -592C>A (rs1800872) no promotor do gene IL10, +2087G>A (rs2297518) no gene NOS2A e +1730G>A (rs4986938) no gene ESR2 em 50 pacientes com PAg, 61 pacientes com PC e 61 pacientes-controle. No estudo 3, foram avaliados 55 pacientes com PAgG mediante exame clínico periodontal, hábitos de higiene oral e tratamento periodontal prévio (TPP). Os resultados mostraram no estudo 1, que níveis elevados de IL-10 e NO estão correlacionados com a PC. Foram encontradas associações dos SNPs -592 e -819 do gene IL10 com a periodontite crônica e do haplótipo ATA com a periodontite crônica e agressiva. Existem evidências positivas do uso da terapia de reposição com estrógeno sobre os tecidos periodontais em mulheres na pós-menopausa. No estudo 2, o genótipo +2087GG no gene NOS2A mostrou tendência a uma associação significante com a DP (p= 0,05; OR= 0,44; 95% IC= 0,20-0,95). Não foram encontradas associações com DP na análise de genótipos dos genes IL10 e ESR2 ou haplótipos do gene IL10. No estudo 3 os pacientes que não utilizavam o fio dental apresentavam uma chance reduzida em 84% de terem realizado TPP (p= 0,005; OR= 0,16; 95% IC= 0,04-0,59). Conclui-se que concentrações elevadas de IL-10 e NO podem ser encontradas nos tecidos periodontais inflamados e existem associações dos polimorfismos genéticos no promotor do gene Interleucina-10 com a periodontite crônica e agressiva. Indivíduos que carregam o genótipo GG no SNP +2087 do gene NOS2A tendem a serem mais protegidos contra o desenvolvimento de DP. Nos pacientes com PAgG houve uma relação significativa entre o uso de fio dental e a presença de TPP.

Aggregatibacter actinomycetemcomitans is a pathogen strongly associated with the etiology of aggressive periodontitis. The purpose of this study was to evaluate by polymerase chain reaction (PCR) the presence of highly and minimally leukotoxic clones of A. actinomycetemcomitans in patients with aggressive periodontitis (AgP) and their family members (FM). Thirty five patients with AgP (33,9 ± 7,1 years), 33 FM (22,8 ± 11,4 years) and 41 patients with chronic periodontitis (CP) (44,1 ± 9,4 years) were clinical analyzed through plaque index (PI), gingival index (GI), probing depth (PD) and clinical attachment level (CAL). Subgingival biofilm samples were collected from the interproximal periodontal sites (> PD and > CAL) of each patient and their microbiological analysis were taken by PCR, concerning A. actinomycetemcomitans was observed and its leukotoxic clones. The PD and CAL average of this sites were: AgP – 9,8 mm e 10,7 mm, FM – 5,3 mm e 4,6 mm e CP – 8,2 mm e 9,4 mm. Statistically significant difference was observed among the groups. The presence of A. actinomycetemcomitans was observed in 23 (51,1%) patients with aggressive periodontitis and in others ones, 16 (30,1%) with chronic periodontitis. Among them 37 (94,8%) showed minimally leukotoxic clones and 2 (5,1%) highly leukotoxic clone, one was AgP group, the other was FM group, also with aggressive disease. Concerning to periodontal status of the FM group, 30,3% had aggressive periodontitis, 36,3% chronic periodontitis and 33,3% were periodontally normal or had gingivitis. Among them 12,2% were A. actinomycetemcomitans positive. The higher values of PD and CAL were observed in aggressive periodontitis patients that were A. actinomycetemcomitans positive when compared with A. actinomycetemcomitans negative patients (p

Descrita pela primeira vez pelo médico inglês Richard Asher, em 1951, a síndrome de Munchausen (SM) é um transtorno factício em que o paciente se mostra aguda e dramaticamente doente, com a habilidade de mimetizar sinais e sintomas de forma a necessitar de internações prolongadas, procedimentos de diagnósticos invasivos, longo tempo de terapia com as mais variadas classes de drogas e cirurgias. Descreve-se um caso de SM do Hospital Universitário Walter Cantídio, da Universidade Federal do Ceará, em que a paciente apresentava artrite e enfisema subcutâneo. Na ocasião, ela tinha 26 anos, era agente de saúde e tinha sérios problemas familiares. Este estudo também aborda uma revisão de literatura. First described in 1951 by Richard Asher, the Munchausen's Syndrome (MS) is a factitious disorder where the patient is acutely and severely ill and he/she is able to mimic sings and symptoms s resulting in long hospitalizations, invasive diagnostic procedures and prolonged therapies with a variety of drugs and surgeries. The case of a 26-year-old woman with arthritis and subcutaneous enphysema hospitalized at the university hospital in the state of Ceará is described. At that time, the patient was a health professional and had serious family problems. A literature review is also carried out.