Hipersensibilidade dentinária (HSD) é caracterizada como uma dor dentária curta e aguda, causada em resposta a estímulos térmicos, evaporativos, táteis ou osmóticos, e que não pode ser atribuída a qualquer outro tipo de patologia. A epidemiologia da HSD ainda é pouco estuda em nível populacional. O objetivo desta dissertação foi abordar a epidemiologia da HSD através da revisão crítica da literatura e da apresentação de um estudo de base populacional sobre prevalência, extensão e indicadores de risco para essa condição.Uma amostra representativa de 1023 habitantes adultos, com mais de 35 anos de idade, residentes em Porto Alegre foi obtida através de uma amostragem probabilística proporcional estratificada de múltiplo-estágio. Os participantes do estudo responderam a um questionário estruturado a respeito de dados sociodemográficos e comportamentais e receberam um exame clínico para diagnóstico de HSD térmico (jato de ar) e tátil (sonda) aplicados na superfície vestibular de todos os dentes presentes. Comandos analíticos que consideram a amostra complexa foram utilizados para gerar estimativas em modelos de risco multivariados. Aproximadamente um terço da população foi diagnosticada com HSD (jato de ar = 33,4% / sonda = 34,2%). Dentre os indivíduos que apresentaram HSD, em média 2 a 3 dentes apresentaram HSD. Os dentes mais afetados com HSD foram pré-molares superiores, molares superiores e pré-molares inferiores. Recessão gengival foi fator determinante para a ocorrência de HSD e foi modelada separadamente das demais variáveis. Mulheres, indivíduos mais jovens, fumantes, de melhor nível educacional e aqueles que relatam tratamento periodontal tiveram significativamente mais chance de HSD. Conclui-se que a prevalência e de HSD encontrada na população estudada é alta, porém com um número pequeno de dentes afetados. A ocorrência de HSD está associada a fatores comportamentais e sociodemográficos importantes, para os quais se podem estabelecer estratégias preventivas em nível individual e populacional. / Dentine hypersensitivity (DH) is characterized by an acute and short dental pain in response to thermal, evaporative, tactile and osmotic stimuli, which cannot be attributed to any other type of pathology. The epidemiology of DH is still little studied on the population level. The aim of this thesis was to assess the epidemiology of DH by conducting a critical appraisal of the literature and presenting the findings of a population-based study about the prevalence, extent and risk indicators of this condition. A representative sample of 1,023 adult 35 years and older inhabitants of Porto Alegre was obtained using a multistage, stratified, proportional to size, probability sampling strategy. Participants answered a structured questionnaire about sociodemographic and behavioral variables and were submitted to a clinical examination to diagnose DH using a blast of air and a manual probe on the buccal surfaceof all present teeth. Analytical commands that take into consideration the complex sampling design were used to generate estimates and multivariable risk models. Approximately one third of the population was diagnosed with DH (air blast= 33.4% and probe= 34.2%). Among individuals with DH, in average 2 to 3 teeth were affected by DH. The teeth most affected by DH were maxillary premolars and molars, followed by mandibular premolars. Gingival recession was a determinant factor for the occurrence of DH and was modeled separately from the other variables. Females, younger individuals, smokers, individuals of higher education and those reporting positive history of periodontal treatment had significantly higher chances of DH. It can be concluded that the prevalence of DH found in the studied population is high, although with few teeth affected. The occurrence of DH is associated with important sociodemographic and behavioral factors for which preventive strategies may be established on individual and population levels.

Introdução: O saco endolinfático tem sido apontado como o alvo das reações imuno-alérgicas da orelha interna. A prevalência de alergia em pacientes com Doença de Ménière foi estabelecida em torno de 41,6% para inalantes e 26,6% para alimentos, por Derebery em 2000, dados aumentados em relação à prevalência de alergia na população em geral, que, no Brasil, varia de 9% a 30% para inalantes e de 1% a 3% para alimentos. Objetivos: Avaliar a prevalência de reações de hipersensibilidade tipo I a inalantes e alimentos na população do setor de Otoneurologia do Hospital das Clínicas da Faculdade de Medicina de São Paulo e descrever os sintomas vestibulares dos pacientes. Casuística e método: Setenta e cinco pacientes com distúrbios do equilíbrio de origem periférica foram submetidos a questionário de caracterização clínica de sintomas cócleo-vestibulares e teste cutâneo (prick test) para 13 inalantes e 5 alimentos. Resultados: Vinte e cinco (33,3%) pacientes apresentaram prick test positivo a pelo menos um alérgeno inalante e 6 (8%) a pelo menos um alérgeno alimentar. Quatro pacientes apresentaram prick test positivo na ausência de sintomas alérgicos. Prevaleceu a queixa de tontura de caráter rotatório em proporções semelhantes entre os pacientes com prick test positivo e negativo. Conclusão: A prevalência de reações de hipersensibilidade tipo I a inalantes e a alimentos na população avaliada foi maior do que na população em geral. Os sintomas vestibulares não diferiram entre os pacientes da amostra, com prick test positivo ou negativo. No entanto, deve-se obter maior número de amostra para que os dados sejam confiáveis. / Introduction: The endolymphatic sac has been pointed out as the target of immuno-allergic reactions in the inner ear. The prevalence of allergy in patients with Ménières disease was established as approximately 41,6% for inhalants and 26,6% for food by Derebery in 2000, an increase in the data in relation to that of the prevalence of allergy in the general population, which in Brazil varies from 9% to 30% for inhalants and from 1% to 3% for food. Objectives: To evaluate the prevalence of reactions to type I hypersensitivity to inhalants and food in the population of the Otoneurological Section of the Clinics Hospital of the University of São Paulo Medicine School and to describe the vestibular symptoms of the patients. Method: Seventy-five patients with peripheral equilibrium disturbances who had answered a questionnaire of clinical characterization regarding cochlear-vestibular symptoms and undergone prick test for 13 inhalants and 5 types of food. Results: Twenty-five (33,3%) of the patients were positive for the prick test and for at least one allergen inhalant and 6 (8%) for at least one food allergen. Four patients were positive for the prick test in the absence of allergy symptoms. There was a prevalence of the complaint of rotatory dizziness in similar proportions among the patients with positive and negative prick test. Conclusion: The presence of type I hypersensitivity reactions to inhalants and food in the population evaluated was greater than in the general population. The vestibular symptoms did not differ among the patients in the sample, neither with positive or negative prick test results. However, a sample of greater number should be obtained for a higher confidence level of data results.

Existem fortes evidências de que a supressão da hipersensibilidade nos recém nascidos pode ser mediada pela transferência de anticorpos maternos, dependendo de sua concentração e especificidade, no entanto carece estudos sobre a eficácia em humanos. Realizamos este estudo a fim de caracterizar qualitativa e quantitativamente a transmissão de anticorpos direcionados ao principal alérgeno da poeira domiciliar (Der p) via placenta e colostro materno, assim como investigar o efeito da sensibilização materna ao Der p na transferência passiva destes anticorpos. Para tais objetivos, analisamos amostras de sangue materno, cordão umbilical e colostro de puérperas sensibilizadas. Demonstramos pela primeira vez que S-IgA anti-Der p pode ser transferida ao lactente em concentrações bastante variáveis e com alto índice de avidez, independente da sensibilização materna ao mesmo ácaro. Demonstramos também que o nível de IgG específica ao Der p é mais elevado em recém nascidos de mães sensibilizadas quando comparado aos de mães controle não sensibilizadas. Já a avidez específica da IgG anti-Der p foi muito semelhante entre as amostras pareadas de cordão umbilical e soro materno, assim como em amostras do grupo estudo e grupo controle. / It is known that the incidence of allergic disease has been rising very fast in the last decade and nowadays affects thousands of children worldwide. For this reason, it is of great interest that efficient strategies of prevention of atopy should be applied in the first years of life or even before birth. The are strong evidences that the suppression of hypersensitivity in newborn can be mediated by the transference of maternal antibodies, depending on their concentration and specificity, however still little is known about the mechanisms involving, in special in humans. We made this study aiming to characterize qualitatively and quantitatively the antibodies transmission directed to the main home dust allergen (Dermatophagoides pteronyssinus; Der p) through placental transference and maternal breastfeeding as well as to investigate the maternal sensitizing effect against to Der p in passive transference of these antibodies. For those objectives, we quantified by ELISA, IgG anti-Der p in paired samples of maternal blood and umbilical cord and anti-Der p S-IgA in colostrums of sensitized mother (n=13) and not sensitized (n=26); and we analyzed the functional activity of the same antibodies by avidity assays. The sensibility was determined in maternal sera by specific RAST (Cap System® Pharmacia). We show by the first time that anti-Der p S-IgA is transferred to the infant in very variable concentrations and with high levels of avidity, but is not dependent of maternal sensitization. We believe that breastfeeding is important, because it supplies S-IgA with the capacity to neutralize in a specific manner and block the entrance of Der p through mucosa, in infant of RAST+ mothers as well as of RAST-. We also demonstrate that total and specific to Der p IgG levels are more elevated in newborns of sensitized mothers when compared to of those of control mothers and non-sensitized indicating that the maternal sensitizing can influence the fetal immune response. In the other hand, the specific avidity of anti-Der p IgG was very similar between paired samples of umbilical cord and maternal sera, as well as in samples of study group and control group, suggesting thar the avidity index of IgG does not influence on placental transfer of specific antibodies. Once that the maternal antibody transference represent a important mechanism for immunomodulation of allergic response, we expect that a better understanding of the influence of maternal sensitivity on passive transfer of specific antibodies to babies will contribute with advances in the elaboration of adequate strategies of prevention of allergic sensitivity with more efficient therapeutic results.

Hipersensibilidade dentinária (HSD) é caracterizada como uma dor dentária curta e aguda, causada em resposta a estímulos térmicos, evaporativos, táteis ou osmóticos, e que não pode ser atribuída a qualquer outro tipo de patologia. A epidemiologia da HSD ainda é pouco estuda em nível populacional. O objetivo desta dissertação foi abordar a epidemiologia da HSD através da revisão crítica da literatura e da apresentação de um estudo de base populacional sobre prevalência, extensão e indicadores de risco para essa condição.Uma amostra representativa de 1023 habitantes adultos, com mais de 35 anos de idade, residentes em Porto Alegre foi obtida através de uma amostragem probabilística proporcional estratificada de múltiplo-estágio. Os participantes do estudo responderam a um questionário estruturado a respeito de dados sociodemográficos e comportamentais e receberam um exame clínico para diagnóstico de HSD térmico (jato de ar) e tátil (sonda) aplicados na superfície vestibular de todos os dentes presentes. Comandos analíticos que consideram a amostra complexa foram utilizados para gerar estimativas em modelos de risco multivariados. Aproximadamente um terço da população foi diagnosticada com HSD (jato de ar = 33,4% / sonda = 34,2%). Dentre os indivíduos que apresentaram HSD, em média 2 a 3 dentes apresentaram HSD. Os dentes mais afetados com HSD foram pré-molares superiores, molares superiores e pré-molares inferiores. Recessão gengival foi fator determinante para a ocorrência de HSD e foi modelada separadamente das demais variáveis. Mulheres, indivíduos mais jovens, fumantes, de melhor nível educacional e aqueles que relatam tratamento periodontal tiveram significativamente mais chance de HSD. Conclui-se que a prevalência e de HSD encontrada na população estudada é alta, porém com um número pequeno de dentes afetados. A ocorrência de HSD está associada a fatores comportamentais e sociodemográficos importantes, para os quais se podem estabelecer estratégias preventivas em nível individual e populacional. / Dentine hypersensitivity (DH) is characterized by an acute and short dental pain in response to thermal, evaporative, tactile and osmotic stimuli, which cannot be attributed to any other type of pathology. The epidemiology of DH is still little studied on the population level. The aim of this thesis was to assess the epidemiology of DH by conducting a critical appraisal of the literature and presenting the findings of a population-based study about the prevalence, extent and risk indicators of this condition. A representative sample of 1,023 adult 35 years and older inhabitants of Porto Alegre was obtained using a multistage, stratified, proportional to size, probability sampling strategy. Participants answered a structured questionnaire about sociodemographic and behavioral variables and were submitted to a clinical examination to diagnose DH using a blast of air and a manual probe on the buccal surfaceof all present teeth. Analytical commands that take into consideration the complex sampling design were used to generate estimates and multivariable risk models. Approximately one third of the population was diagnosed with DH (air blast= 33.4% and probe= 34.2%). Among individuals with DH, in average 2 to 3 teeth were affected by DH. The teeth most affected by DH were maxillary premolars and molars, followed by mandibular premolars. Gingival recession was a determinant factor for the occurrence of DH and was modeled separately from the other variables. Females, younger individuals, smokers, individuals of higher education and those reporting positive history of periodontal treatment had significantly higher chances of DH. It can be concluded that the prevalence of DH found in the studied population is high, although with few teeth affected. The occurrence of DH is associated with important sociodemographic and behavioral factors for which preventive strategies may be established on individual and population levels.

Class of 2017 Abstract / Objectives: The specific aims of this project were to evaluate the incidence of carboplatin HSR in patients with the BRCA1 or BRCA2 mutations compared to those without these mutations. Secondary objectives were to identify carboplatin cycles where reactions occurred, grade of reaction, and treatment outcomes. Methods: This retrospective chart review included 167 ovarian, fallopian tube, and primary peritoneal cancer patients at the University of Arizona Cancer Center who underwent a regimen with carboplatin from 2013-2015. Results: 126 out of 167 patients were analyzed. HSR occurred in 4 patients with BRCA mutations, and in 9 patients without mutations, though incidence was not significant with respect to the groups (3.1% versus 17.4%, P=0.5291). Overall, there were 11 grade 1 reactions, 14 grade 2 reactions, and 16 grade 3 reactions to carboplatin. Conclusions: Presence of a BRCA1/2 mutation was not associated with a higher incidence of HSR in carboplatin. More studies are needed to clarify the impact of BRCA mutations on developing carboplatin HSR.

While food hypersensitivity can be a life-threatening problem, its scope is yet to be fully developed. More work is needed to further define its parameters but basic food hypersensitivity has been significantly clarified in the decade of the 80's to become standard practice for most updated allergists. Studies related to inhalation of food antigens remains within the purview of research centers as does other immunologic processes. The diagnosis of food hypersensitivity remains dependent on the medical history with test like elimination diets, skin testing, and RAST. Double-blind, placebo-controlled, food challenges (DBPCFC) provide the most definitive support for the association between certain symptoms and a specific food.

京都大学 / 0048 / 新制・課程博士 / 博士(医学) / 甲第18892号 / 医博第4003号 / 新制||医||1009(附属図書館) / 31843 / 京都大学大学院医学研究科医学専攻 / (主査)教授 竹内 理, 教授 鈴木 茂彦, 教授 長澤 丘司 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

Dabbing has been gaining popularity among young people in recent years due to its ability to deliver a high concentration of tetrahydrocannabinol. When produced illegally, it is usually contaminated by toxic substances and associated with multiple health hazards. We present the case of a 66-year-old woman who developed hypersensitivity pneumonitis after dabbing butane hash oil for the first time and was successfully treated with corticosteroids with complete resolution of her symptoms. This case report emphasizes the respiratory complications associated with using a noxious substance like butane hash oil and gives physicians an insight into the diagnosis and management of dabbing-induced hypersensitivity pneumonitis.

Introdução: Estudos demonstram que as alergias alimentares influenciam negativamente a qualidade de vida dos pacientes e familiares. Embora este tema seja importante, ainda há poucos estudos na literatura internacional e não existe estudos nacionais qualitativos em alergia alimentar. Objetivos: Compreender as percepções de familiares de crianças e adolescentes com alergia às proteínas do leite de vaca em relação à doença e seu tratamento. Trajetória Metodológica: Trata-se de um estudo qualitativo, em que foram entrevistados os familiares diretamente responsáveis pelos cuidados de crianças e adolescentes com alergia à proteína do leite de vaca confirmada, acompanhados no ambulatório de alergia alimentar da Unidade de Alergia e Imunologia do Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo há, pelo menos, um ano. As entrevistas foram realizadas em condições de privacidade e foram propostas duas questões: \"Fale sobre a sua experiência com o tratamento da alergia à proteína do leite de vaca\" e \"O que o(a) Sr(a) espera do tratamento da doença do seu(sua) filho(a)?\". Os dados foram gravados, transcritos, avaliados utilizando-se o método de análise de conteúdo, sendo constituídas categorias e subcategorias a partir dos discursos. Resultados: Foram realizadas nove entrevistas, a maioria com mães dos pacientes. Surgiram três categorias com subcategorias: A. Tratamento e educação do paciente e familiares (experiências vividas, base do tratamento e como lidar com a doença), B. Resolução da doença (expectativa e melhora gradativa), C. Qualidade de vida (inclusão social, cotidiano familiar e custo dos alimentos). Os familiares vivenciaram dificuldades durante o início do tratamento, mas revelaram que as orientações fornecidas no seguimento tornaram as adaptações à doença mais fáceis. Eles também compararam a alergia à proteína do leite de vaca com outras doenças crônicas e destacaram a importância do acompanhamento de seus filhos na instituição para realizar um controle adequado. Além disso, enfatizaram que o seguimento também é importante para os profissionais de saúde, que aprimoram os conhecimentos sobre a doença. Os familiares comentaram sobre as dificuldades em obter a colaboração de outros membros da família em relação à dieta de exclusão, suas experiências frente a uma reação alérgica, dúvidas quanto ao tratamento e lacunas do conhecimento sobre a doença entre outros médicos e na população em geral. Alguns deles acreditavam que não havia tratamento para a alergia à proteína do leite de vaca, porque não existiam medicamentos ou vacinas, mas mantinham a esperança da descoberta de uma cura. A maioria dos familiares estava satisfeita com a melhora gradativa dos seus filhos, a qual era percebida pela redução da gravidade dos sintomas e tolerância a traços de leite. Além disso, eles comentaram sobre os esforços em proporcionar uma vida normal para seus filhos, as mudanças em suas vidas e a dificuldade em comprar alimentos especiais. Conclusão: O estudo qualitativo permitiu entender como os familiares enfrentam a doença, suas histórias e as expectativas quanto ao tratamento. Os familiares de crianças e adolescentes com alergia à proteína do leite de vaca sentem um grande impacto da doença e necessitam de apoio e orientação dos profissionais de saúde / Introduction: Some studies have shown that food allergies negatively influence on patient\'s and caregivers\' quality of life. Although this theme is important, there aren\'t many studies in the international literature and there is no national qualitative study in food allergy. Objectives: To understand the perceptions of caregivers of patients with cow\'s milk allergy regarding the disease and its treatment. Methods: Qualitative study in which caregivers of children and adolescents with confirmed cow\'s milk allergy followed, at least, for one year, were interviewed. They were recruited from the outpatient clinic of the Allergy and Immunology Division from Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The interviews were conducted under conditions of privacy and two opened questions were proposed: \"Tell me about your experience with cow\'s milk allergy treatment\" and \"What do you expect from your child\'s disease treatment?\". Data were audio-recorded, transcribed, analyzed using the content analysis method and categories and subcategories were generated based on their speeches. Results: Nine interviews were done, mostly with mothers of the patients. Three categories with subcategories emerged: A. Treatment and education of the patient and their caregivers (life experiences, bases of treatment, coping with the disease), B. Resolution of the disease (hope, gradual improvement), C. Quality of life (social inclusion, family daily activities, costs of dietary treatment). Caregivers experienced difficulties during the initial treatment but pointed out that the guidance given during follow-up made the adjustments easier. They also compared the cow\'s milk allergy with other chronic diseases and highlighted the importance of their children follow-up in this institution for adequate control of them. Moreover, they emphasized that the follow-up is also important for medical staff, for knowledge improvement about the disease. Family members commented on the difficulties about lack of cooperation from other family members regarding the restrictive diet, their experience coping with the allergic reaction, doubts about the treatment and gaps on knowledge about the disease by other physicians and people. Some of them believed that there is no treatment for the disease, because there are no drugs or vaccines, but they were waiting for cure. The majority of relatives were satisfied with the gradual improvement of patients observed by reduction on the severity of symptoms and tolerance of milk traces within foods. In addition, they commented on the efforts to give a normal life for their children, the changes in their daily lives and the difficulty to buy special products. Conclusion: This qualitative study allowed us to understand how families cope with the disease, their histories and expectations about the treatment. The relatives of children and adolescents with cow\'s milk allergy feel a great burden of the disease and need support and orientation from health professionals

Background: Altered autonomic nervous system (ANS) function has been proposed as a mechanism in the development of central sensitisation (CS) and visceral pain hypersensitivity (VPH). The contribution of the parasympathetic nervous system (PNS) and the factors that mediate differences in sensitisation to acid are unclear and their study will clarify risk factors for oesophageal pain hypersensitivity (OPH) in gastrooesophageal reflux disease. Aims: To investigate psychophysiological and pharmacological manipulation of PNS tone in the development of OPH, and to determine factors which predict the development of OPH to acid infusion in healthy volunteers in a validated model of acid induced OPH. Methods: Pain thresholds to electrical stimulation in the proximal oesophagus were determined before and after a 30-minute distal oesophageal infusion of 0.15 mol/L hydrochloric acid in subjects. Sympathetic (SNS) and PNS parameters were measured at baseline and continuously thereafter. Subjects underwent psychological profiling for anxiety, depression, attachment vulnerability and personality type. Using this model, five studies were undertaken: Study 1 a pilot study to trail modulation suitability for further study used. In Study 2, subjects who demonstrated secondary hyperalgesia in the proximal non-acid-exposed oesophagus performed deep or sham breathing. Study 3 subjects, who did not sensitise to acid, underwent a validated stress test to induce OPH. With Study 4, deep breathing with IV saline (placebo) or atropine (PNS antagonist) was used to evaluate deep breathing’s induced PNS tone in OPH reduction. Study 5, a genetic pilot study, exploring the role of the GCH-1 haplotype in VPH. Results: ANS control’s key role in CS was clarified. Deep breathing increased PNS tone and prevented acid-induced OPH in comparison to sham breathing and confirmed increased PNS tone’s reversal of OPH. Psychological factors of anxiety, alexithymia and attachment status influence ANS modulation of CS. Individuals’ predisposition to VPH due to psychogenetic profiles were clarified and their biopsychosocial role illustrated. Conclusions and Inferences: A mechanistic explanation for the analgesic effect of deep breathing is provided with potential therapeutic implications in the treatment of VPH syndromes. Further clinical study is warranted to develop cost-effective treatments for chronic VPH syndromes.