Innovative perspectives on the value of diagnostic tests in clinical practice / Perspectivas innovadoras sobre el valor de las pruebas diagnósticas en la práctica clínica

Abstract Diagnostic tests have intrinsic characteristics such as sensitivity, specificity, overall accuracy and likelihood ratios which define their operational performance. It is not uncommon to find in the literature that test value and clinical utility are defined based exclusively on those characteristics. This paper introduces several arguments aimed at prompting a reflection regarding the characteristics that define the true value of diagnostic tests in clinical practice. It concludes with the view that the value of each diagnostic test needs to be established in accordance with the circumstances in which it is used, taking into account extrinsic characteristics such as in whom it is used, when, where and by who.

Resumen Las pruebas diagnósticas tienen características intrínsecas, como la sensibilidad, especificidad, exactitud global y las razones de verosimilitud, que definen su desempeño operacional. No es infrecuente encontrar en la literatura que se valore la prueba y se defina su utilidad clínica exclusivamente de acuerdo con estas características. En este documento se presentan varios argumentos que permiten reflexionar sobre las características que verdaderamente definen el valor de las pruebas diagnósticas en la práctica clínica. Se concluye con una perspectiva en la que el valor de cada prueba diagnóstica se establece de acuerdo con las circunstancias de uso de la misma: de quién, cuándo, dónde y en quién se use la prueba, y todas estas son características extrínsecas de una prueba diagnóstica.

Rendimiento diagnóstico de los antígenos de Leishmania braziliensis y Leishmania peruviana en el método de inmunoblot para la detección de la leishmaniasis tegumentaria americana / Diagnostic performance of Leishmania braziliensis and Leishmania peruviana antigens in the immunoblot method for the detection of american tegumentary leishmaniasis

RESUMEN El presente estudio se planteó determinar el rendimiento de antígenos de Leishmania braziliensis y Leishmania peruviana en la detección de LTA, fue desarrollado a partir de muestras de suero obtenidas entre 2013 - 2016. Los antígenos solubles y de excreción/secreción obtenidos fueron transferidos a membrana de nitrocelulosa mediante un ensayo de inmunotransferencia. Se realizó la evaluación frente a sueros confirmados para LTA, a un nivel de confianza al 95%, logrando determinar que, el antígeno soluble de Leishmania braziliensis presenta una sensibilidad del 87,7%, especificidad del 100% y área bajo la curva de 0,95; mientras que, Leishmania peruviana se encontró valores de 92,3%, 95,7% y 0,94 respectivamente. De acuerdo a los resultados, recomendamos realizar la caracterización y análisis de las regiones inmunogénicas reportadas a fin de continuar con el desarrollo de proteínas recombinantes y sintéticas, orientadas a mejorar la eficiencia del diagnóstico serológico de la enfermedad.

ABSTRACT This study aimed to determine the performance of Leishmania braziliensis and Leishmania peruviana antigens in the detection of ATL by using serum samples obtained between 2013 - 2016. The obtained soluble and excretion/secretion antigens were transferred to membrane nitrocellulose by immunoblot assay. The evaluation was carried out against sera confirmed for ATL, at a confidence level of 95%, determining that the soluble antigen of Leishmania braziliensis had a sensitivity of 87.7%, specificity of 100% and area under the curve of 0.95; on the other hand, Leishmania peruviana showed values of 92.3%, 95.7% and 0.94, respectively. According to the results, we recommend that the reported immunogenic regions should be characterized and analyzed in order to continue with the development of recombinant and synthetic proteins, aimed at improving the efficiency of the serological diagnosis of the disease.

Sensibilidade dentinária associada ao clareamento dental em dentes vitais - uma revisão de literatura / Tooth sensitivity related to vital teeth dental bleaching ­ a literature review

O clareamento dental pode ser realizado através da técnica caseira ou de consultório, utilizando agentes como o peróxido de carbamida (PC) e peróxido de hidrogênio (PH). Apesar de seguro, existem alguns efeitos adversos relacionados ao clareamento dental, como a sensibilidade dentinária (SD), que pode estar presente em diferentes graus dependendo da técnica utilizada. A aplicação de agentes dessensibilizantes antes, durante ou depois do clareamento dental vem sido estudada para evitar ou reduzir a sensibilidade associada ao clareamento. O estudo visa revisar a literatura em relação a aspectos e conceitos importantes do clareamento dental, discutindo seus possíveis efeitos adversos com foco na sensibilidade dentinária. Foi realizada uma pesquisa digital da base de dados Medline, via PubMed, utilizando palavras-chave relacionadas ao tema, priorizando artigos publicados há menos de 20 anos e escritos em inglês ou português. Artigos também foram buscados manualmente e foram utilizados livros de odontologias relacionados ao tema. De um total de 48 artigos, 28 foram escolhidos para a composição do trabalho, além de 2 livros de dentística que abordam o clareamento dental. Constata-se que a sensibilidade dentinária é um efeito adverso comum relacionado ao clareamento dental, que possui causa exata desconhecida, porém sabe-se que está relacionada à difusão do peróxido de hidrogênio pelos tecidos dentários. A sensibilidade dentinária é mais frequente na técnica de clareamento de consultório do que na técnica caseira, e pode ser agravada por fatores relacionados ao indivíduo e/ou ao dente. Alguns agentes como o nitrato de potássio, fosfopeptídeos de caseína-fosfato de cálcio amorfo (CPP-ACP), vidros bioativos e partículas de hidroxiapatita, se mostraram efetivos no controle da sensibilidade dentinária.

Dental bleaching can be performed in at-home or in-office techniques, using agents such as carbamide peroxide or hydrogen peroxide. Although it's safe, there are some side effects related to dental bleaching, such as tooth sensitivity, which may be present in different degrees, depending on the chosen technique. The application of desensitizing agents before, during or after dental bleaching is being studied to avoid or reduce the bleaching related sensitivity. The study aims to review the literature over important aspects and concepts of dental bleaching, discussing its possible side effects, focusing on tooth sensitivity. Methods: an online search was done on Medline's database, through PubMed, using keywords related to the theme, prioritizing articles published less than 20 years ago, written in English or Portuguese. Articles were also researched manually, and dentistry books related to the theme were used as well. Out of 48 articles, 28 were chosen to this study's composition, in addition to 2 books that approach dental bleaching. Tooth sensitivity is a common side effect related to dental bleaching, with an unknown cause, however, it is known that it's related to hydrogen peroxide's diffusion through dental tissues. Tooth sensitivity is more frequent within in-office technique than within at-home technique, and may be worsen by individual and/or dental related factors. Agents such as potassium nitrate, CPP-ACP, bioactive glasses and hydroxyapatite particles, showed up to be effective in dental sensitivity control.

Antimicrobial sensitivity pattern of bacterial pathogens for uncomplicated urinary tract infection in female patients at a tertiary level hospital

Background: Urinary tract infections (UTIs) remain the common infections in outpatients as well as hospitalized patients. Antimicrobials are frequently used drugs for the treatment of UTIs. Periodic evaluation of antimicrobial activity of different antimicrobial agents is essential as the pattern of antimicrobial sensitivity may vary over period. The aim of this study was to identify the antimicrobial sensitivity pattern of the isolated uropathogens in female patients in urinary tract infection at a tertiary care hospital in Bangladesh. Methods: This observational cross-sectional type of study was conducted in the department of pharmacology and therapeutics in collaboration with department of microbiology SBMC, outpatient department of medicine, and gynaecology and obstetrics, SBMCH, Barishal, from January 2017 to December 2017. Results: In this study, age of the subjects ranging from 18 to 65 years, majority subjects (57.0%) belonged to age group of 31-44 years. The mean age was found 44.5±9.1 years. Out of 200 cases, 83% cases hailing from rural area and 17% from urban site. In this study microbial culture result of uncomplicated UTI revealed that 103 (51.5%) of urine samples had significant bacteriuria. E. coli was found to be the most prevalent 47 (45.6%), followed by Klebsiella pneumoniae 18 (17.4%), Proteus spp. 11 (10.6%) and Enterobacter spp. 9 (8.7%). Conclusions: The pattern of resistance to commonly used antimicrobials for treating UTI alerts us against indiscriminate usage of antimicrobials.

Peróxido de carbamida 37% no clareamento dentário e sua atuação na efetividade clareadora e eliminação de sensibilidade: relato de caso / The usage of 37% carbamide peroxide in tooth bleaching and its effect on bleaching effectiveness and elimination of sensitivity: a case report / Peróxido de carbamida al 37% en el blanqueamiento dental y su efecto sobre la eficacia del blanqueamiento y la eliminación de la sensibilidad: informe de un caso

Introdução:A sensibilidade dentária é o efeito adverso mais comum relacionado ao clareamento dentário. Na técnica de consultório, o peróxido de carbamida a 37%, surgiu como possibilidade de clarear e não causar sensibilidade.Objetivo:trata-se deum relato de caso, que avaliou a eficácia (mudança de cor) e a presença ou não de sensibilidade dentária quando se fezo uso de um produto àbase de peróxido de hidrogênio a35% e outro de peróxido de carbamida a 37%, na técnica de clareamento dentário de consultório.Relato de caso:Paciente de25 anos, sexo masculino, submetido a estudo de boca dividida, onde no hemiarco esquerdo foi aplicado peróxido de hidrogênio a 35% e no hemiarco direito, peróxido de carbamida a 37%. Foram feitas 3 sessões, sendo Peróxido de Carbamidacom aplicação única de 45 minutos, e Peróxido de Hidrogêniocom 3 aplicações de 15 minutos, em seu respectivo lado de aplicação e intervalo de sete dias entre cada sessão. Os valores de sensibilidade foram analisados antes e depois de cada sessão por meio da escala visual analógica de dor, e a alteração de cor foi avaliada através da Escala Vita, analisando incisivos e caninos superiores, antes de cada sessão.Conclusões:O clareamento dental com o Peróxido de Hidrogênio apresentou melhor eficácia clareadora e o Peróxido de Carbamida apresentou ausência de sensibilidade durante o procedimento clareador. Sugerem-se mais estudos do tipo ensaio clínico, com o Peróxido de Carbamida, para que se possa, com uma amostra maior de pacientes, verificar suas vantagens no quesito sensibilidade, bem como sua efetividade clareadora (AU).

Introduction:Tooth sensitivity is the most common adverse effect related to tooth bleaching. In the in-office technique, 37% carbamide peroxide has emerged as a way of tooth bleaching which does not cause sensitivity.Objective:This paper consists of a case report that evaluated the efficacy (color change) and the presence or absence of tooth sensitivity when using a product based on 35% hydrogen peroxide and another product based on 37% carbamide peroxide in the in-office tooth bleaching technique.Case report:A 25-year-old male patient underwent a split-mouth study in which 35% hydrogen peroxide was applied to the left hemi-arch and 37% carbamide peroxide to the right hemi-arch. Three sessions were carried out, carbamide peroxide with a single 45-minute application, and hydrogen peroxide with three 15-minute applications, on their respective application side and with a seven-day interval between each session. Sensitivity values were analyzed before and after each session using the visual analogue pain scale, and color change was assessed using the Vita Scale, analyzing upper incisors andcanines before each session. Conclusions:Teeth bleaching with hydrogen peroxide showed better bleaching efficacy and carbamide peroxide showed no sensitivity during the bleaching procedure. Further clinical trials with carbamide peroxide are suggested inorder to verify, with a larger sample of patients, its advantages in terms of sensitivity, as well asits bleaching effectiveness (AU).

Introducción: La sensibilidad de la dentina es el efecto adverso más común relacionado con el blanqueamiento dental. En la técnica en clínica, el peróxido de carbamida al 37% ha surgido como una posibilidad de blanqueamiento sin causar sensibilidad.Objetivo: Se tratade un informe de caso que evaluó la eficacia (cambio de color) y la presencia o ausencia de sensibilidad de la denina al utilizar un producto a base de peróxido de hidrógeno al 35% y otro a base de peróxido de carbamida al 37% en la técnica de blanqueamiento dental en clínica.Informe de caso:Un paciente del sexo maculino de 25 años fue sometido a un estudio de boca dividida en el que se aplicó peróxido de hidrógeno al 35% en la hemiarcada izquierda y peróxido de carbamida al 37% en la hemiarcada derecha.Se realizaron tres sesiones, la peróxido de carbamida con una única aplicación de 45 minutos, y la peróxido de hidrógeno con tres aplicaciones de 15 minutos, en sus respectivos lados de aplicación y con un intervalo de siete días entre cada sesión. Se analizaron los valores de sensibilidad antes y después de cada sesión mediante la escala analógica visual del dolor, y se evaluó el cambio de color mediante la Escala Vita, analizando los incisivos superiores y los caninos antes de cada sesión. Conclusiones: El blanqueamiento dental con peróxido de hidrógeno demostró una mayor eficacia blanqueadora y el peróxido de carbamida no manifestó sensibilidad durante el procedimiento de blanqueamiento. Se sugiere realizar más ensayos clínicos con peróxido de carbamidaparapoder utilizar una muestra mayor de pacientes y verificar sus ventajas en términos de sensibilidad, así como su eficacia blanqueadora (AU).

Bacterial profiling, sensitivity and resistance pattern of neonatal sepsis in neonatal intensive care unit of tertiary care hospital

Background: This study aimed to identify the distribution of pathogens and their antimicrobial resistance patterns in the neonates admitted to the NICU of a tertiary care hospital in northern India.Methods: After obtaining written informed consent, neonates with confirmed or suspected cases of neonatal sepsis (n=167) aged 0-28 days were included. As soon as the baby arrived, all the clothes were removed and kept in a pre-heated warmer. Before administering I/V antibiotics, all the routine and culture samples were taken. The clinical data were collected and analysed using SPSS.Results: Most of the neonates were from lower middle class, out-born, LSCS, early preterm, and low birth weight (LBW). 167 neonates had culture-confirmed infections [blood culture positive (13.8%) and sepsis screen positive (86.2%)]. Gastric aspirate cytology was positive in 61.7% of patients. Maximum cytology-positive cases were seen in neonates with EOS. The most common risk factors were birth asphyxia. 142 individuals were discharged, with 72.5% diagnosed with EOS and 89% with LOS. There was a significant difference in gastric aspirate cytology when associated with expiry and discharge. Out of 167 neonates, 13.77% were culture-positive for neonatal sepsis. Out of 23 organisms, 82.6% were resistant, while, 17.4% were not. Staph aureus was the major causative organisms. Among the Gram Positive and Negative bacteria, the highest sensitivity was observed for imipenum. All gram-positive bacteria were resistant to cotrimazole, tobramycin, and erythromycin.Conclusions: Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

Evaluación del desempeño de tres puntajes no invasivos para el diagnóstico de fibrosis avanzada en una población con hígado graso no alcohólico / Evaluation of the performance of three non-invasive scores for the diagnosis of advanced fibrosis in a population with non-alcoholic fatty liver disease

Introducción. La enfermedad hepática grasa no alcohólica (EHGNA) es la hepatopatía crónica más común en el mundo, y en aproximadamente el 10 % de los casos progresará a cirrosis o a carcinoma hepatocelular. La presencia de fibrosis hepática es el mejor predictor de esta progresión, pero su diagnóstico mediante biopsia hepática es invasivo y con riesgo de complicaciones (alrededor del 2,5 %). Existen puntajes no invasivos que se han desarrollado y validado para estadificar la fibrosis, pero no conocemos su rendimiento en la población colombiana. El objetivo de este estudio fue evaluar el desempeño de los puntajes fibrosis-4 (FIB-4), la relación AST/ALT y el índice AST/plaquetas (APRI) para la detección de fibrosis avanzada en pacientes colombianos con EHGNA. Metodología. Estudio observacional tipo transversal de pacientes con EHGNA, que entre 2008 y 2022 tuvieran disponible el resultado de una biopsia hepática. Se hizo una descripción demográfica básica y se calculó el FIB-4, la relación AST/ALT y el APRI con los laboratorios más recientes previos al procedimiento. Posteriormente se calcularon valores de sensibilidad, especificidad, valores predictivos, razones de verosimilitud y área bajo la curva-característica operativa del receptor (AUC-ROC) para los puntos de corte evaluados previamente en la literatura. Resultados. Se incluyeron 176 pacientes, de los cuales el 14,3 % tenían fibrosis avanzada. El FIB-4 presentó el mejor rendimiento con un valor AUC-ROC de 0,74 para el punto de corte de 1,30 y 2,67. En segundo lugar, estuvo la relación AST/ALT con un valor AUC-ROC de 0,68 con el punto de corte de 0,8, y finalmente el APRI con valor AUC-ROC 0,62 con el punto de corte de 1. Conclusión. En la población analizada los tres puntajes tienen menor rendimiento diagnóstico comparado a los resultados reportados en Europa y Japón. El FIB-4 es el único que alcanza una AUC-ROC con rendimiento razonable, con la limitación que 27,4 % obtuvieron un resultado indeterminado.

Introduction. Non-alcoholic fatty liver disease (NAFLD) is the most prevalent chronic liver disease worldwide, with approximately 10% of cases progressing to cirrhosis or hepatocellular carcinoma. Liver fibrosis presence is the best predictor of this progression, yet its diagnosis through liver biopsy is invasive and poses risk of complications. Although non-invasive scoring systems have been developed and validated for fibrosis staging, their performance remains unexplored in the Colombian population. This study aims to assess the efficacy of the fibrosis-4 (FIB-4) score, AST/ALT ratio, and AST to platelet ratio index (APRI) in detecting advanced fibrosis among Colombian NAFLD patients. Methods. This cross-sectional observational study included NAFLD patients with available liver biopsy results from 2008 to 2022. Basic demographic characteristics were described, and FIB-4, APRI, and AST/ALT ratio were calculated using the latest laboratory data before the procedure. Subsequently, sensitivity, specificity, predictive values, likelihood ratios, and the area under the receiver operating characteristic curve (AUC-ROC) were computed for previously assessed cutoff points. Results. A total of 176 patients were included, among whom 14.3% had advanced fibrosis. FIB-4 demonstrated superior performance with an AUC-ROC value of 0.74 for cutoff points of 1.30 and 2.67. Following was the AST/ALT ratio with an AUC-ROC value of 0.68 for cutoff point of 0.8, and finally, APRI with an AUC-ROC of 0.62 for the cutoff point of 1. Conclusion. All three scores have lower diagnostic efficacy compared to results reported in Europe and Japan. FIB-4 is the only one that achieves an acceptable AUC-ROC performance with the limitation that an indeterminate result was obtained in 27,4% of the sample.

A prospective study on evaluation of antibiotics usage in patients with sepsis at a tertiary care hospital

Background: Most developing countries are adopting antibiotic usage in sepsis. This study was conducted to evaluate the antibiotic usage in patients and to study medical adherence in high-risk patients. The study in particular aims to evaluate antibiotic usage in sepsis patients along with their related ADR’s. The study also aims to optimize the usage of antibiotics in high-risk patients at a tertiary care hospital. Methods: Study was prospective and observational review of patients record in the hospital. Clinical notes, medication chart and electronic data management system at the hospital were used to analyse usage of antibiotics. Culture and sensitivity reports were obtained from relevant departments. Observations were then compiled and documented. Results: Out of 40 cases collected 22 (55%) patients were male and 18 (45%) were female. Majority of the study population belongs to 71 years and above with 15 (37.5%) followed by age group of 41-60 years with 14 (35%). Most frequently prescribed antibiotics were found to be meropenem 16 (21.33%) and piperacillin tazobactam 14 (18.67%). The most resistant antibiotic was found to be cotrimazole in 35 (87.5%). ADRs were found in 35% of all cases. Conclusions: Prescribing patterns for antibiotics need to be optimized. Adherence to and update of the policy is also recommended. It was found that the adherence to hospital antibiotic policy is low.

Adição da Troponina Ultrassensível à Avaliação de Risco Perioperatório Melhora a Capacidade Preditiva de Morte em Pacientes Submetidos à Cirurgia Não Cardíaca / Addition of High-Sensitivity Troponin to Perioperative Risk Assessment Improves the Predictive Ability of Death in Non-Cardiac Surgery Patients

Resumo Fundamento A estratificação ode risco é uma importante etapa na avaliação perioperatória. No entanto, os principais escores de risco não incorporam biomarcadores em seus conjuntos de variáveis. Objetivo Avaliar o poder incremental da troponina à estratificação de risco tradicional. Métodos Um total de 2230 pacientes admitidos na unidade de terapia intensiva após cirurgia não cardíaca foram classificados de acordo com três tipos de risco: Risco Cardiovascular (RCV), Índice de Risco Cardíaco Revisado (IRCR), e Risco Inerente da Cirurgia (RIC). O principal desfecho foi mortalidade por todas as causas. A regressão de Cox foi usada, assim como a estatística C antes e após a adição de troponina ultrassensível (pelo menos uma medida até três dias após a cirurgia). Finalmente, o índice de reclassificação líquida e a melhoria de discriminação integrada foram usadas para avaliar o poder incremental da troponina para a estratificação de risco. O nível de significância usado foi de 0,05. Resultados A idade média dos pacientes foi 63,8 anos e 55,6% eram do sexo feminino. A prevalência de lesão miocárdica após cirurgia não cardíaca (MINS) foi 9,4%. Pacientes com um RCV elevado apresentaram uma maior ocorrência de MINS (40,1% x 24,8%, p<0,001), bem como pacientes com alto RIC (21,3 x 13,9%, p=0,004) e aqueles com IRCR≥3 (3,0 x 0,7%, p=0,009). Pacientes sem MINS, independentemente do risco avaliado, apresentaram taxa de mortalidade similar. A adição de troponina à avaliação de risco melhorou a capacidade preditiva de mortalidade em 30 dias e de mortalidade em um ano em todas as avaliações de risco. Conclusão A prevalência de MINS é mais alta na população de alto risco. No entanto, sua prevalência na população de risco mais baixo não é desprezível e causa um maior risco de morte. A adição da troponina ultrassensível melhorou a capacidade preditiva da avaliação de risco em todos os grupos.

Abstract Background Risk stratification is an important step in perioperative evaluation. However, the main risk scores do not incorporate biomarkers in their set of variables. Objective Evaluate the incremental power of troponin to the usual risk stratification Methods A total of 2,230 patients admitted to the intensive care unit after non-cardiac surgery were classified according to three types of risk: cardiovascular risk (CVR), Revised Cardiac Risk Index (RCRI); and inherent risk of surgery (IRS). The main outcome was all-cause mortality. Cox regression was used as well as c-statistics before and after addition of high-sensitivity troponin (at least one measurement up to three days after surgery). Finally, net reclassification index and integrated discrimination improvement were used to assess the incremental power of troponin for risk stratification. Significance level was set at 0.05. Results Mean age of patients was 63.8 years and 55.6% were women. The prevalence of myocardial injury after non-cardiac surgery (MINS) was 9.4%. High CVR-patients had a higher occurrence of MINS (40.1 x 24.8%, p<0.001), as well as high IRS-patients (21.3 x 13.9%, p=0.004) and those with a RCRI≥3 (3.0 x 0.7%, p=0.009). Patients without MINS, regardless of the assessed risk, had similar mortality rate. The addition of troponin to the risk assessment improved the predictive ability of death at 30 days and at 1 year in all risk assessments. Conclusion The prevalence of MINS is higher in the high-risk population. However, its prevalence in lower-risk population is not negligible and causes a higher risk of death. The addition of high-sensitivity troponin increased the predictive ability of risk assessment in all groups.

Clinical assessment and patient education of chemical intolerance

Chemical intolerance (CI) is characterized by multi-system symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxicants. Symptoms of this “medically unexplained illness” often include fatigue, headache, weakness, rash, mood changes, musculoskeletal pain, gastrointestinal, difficulties with memory, concentration, and respiratory problems. A general disease mechanism called toxicant-induced loss of tolerance (TILT) explains the initiation, symptoms, and intolerances to chemicals, foods, and medicines reported worldwide by individuals with this condition. TILT is a 2-stage disease process initiated by a major chemical exposure, or a series of low-level exposures, followed by multisystem symptoms and onset of new intolerances. Despite its prevalence of up to 20%, most primary care physicians are not aware of this disease process and thus have been unable to recognize patients with CI. This case series describes three family medicine clinic patients who had multisystem symptoms that were triggered by chemical exposures, saw multiple specialists with no improvement, who were eventually diagnosed with CI and went through a behaviorally based avoidance education program. This report describes the impact of a coordinated educational intervention for patients with CI. We offer several educational tools for health practitioners to discuss with their patients. These patient stories highlight the importance for physicians to be knowledgeable about CI in order to facilitate symptom reduction and improve the quality of life for these patients.

O uso do laser de alta e baixa intensidade para o tratamento de hipersensibilidade dentinária: uma revisão integrativa

Objetivo: Determinar as evidências científicas sobre a influência do uso de lasers de baixa e alta intensidade no tratamento da hipersensibilidade da dentina. Revisão de literatura: Foram realizadas buscas na Biblioteca Virtual em Saúde (BVS), incluindo as bases de dados: Literatura Latino Americana e do Caribe em Ciências da Saúde (LILACS); Bibliografia Brasileira de Odontologia (BBO); e National Library of Medicine (MEDLINE). A maioria dos estudos destacam a eficácia dos lasers na redução da HD, com o laser Nd:YAG mostrando-se eficaz na obliteração dos túbulos dentinários e proporcionando alívio a longo prazo. Apesar dos benefícios, alguns estudos alertam para possíveis danos à polpa dentária, especialmente com lasers de alta potência. Considerações finais: Embora os lasers tenham se mostrado eficazes na redução da HD, a escolha do laser deve ser personalizada para cada paciente, destacando a necessidade de aprimorar os protocolos clínicos e adquirir experiência relevante por parte dos profissionais especialistas.

Objective: To determine the scientific evidence on the influence of the use of low and high intensity lasers in the treatment of dentin hypersensitivity. Literature review: Searches were carried out in the Virtual Health Library (VHL), including the databases: Latin American and Caribbean Literature in Health Sciences (LILACS); Brazilian Bibliography of Dentistry (BBO); and National Library of Medicine (MEDLINE). Most studies highlight the effectiveness of lasers in reducing HD, with the Nd:YAG laser proving effective in obliterating dentinal tubules and providing long-term relief. Despite the benefits, some studies warn of possible damage to the dental pulp, especially with high-power lasers. Final considerations: Although lasers have been shown to be effective in reducing HD, the choice of laser must be personalized for each patient, highlighting the need to improve clinical protocols and acquire relevant experience on the part of specialist professionals.

Comparación In vitro de la eficacia antibacteriana de dos medicaciones intraconducto hidróxido de calcio y quitosano / In Vitro comparison of the antibacterial efficacy of two intracanal medications calcium hydroxide and chitosan

Resumen Objetivo: Determinar cuál de estas medicaciones intraconductos (hidróxido de calcio, quitosano e hidróxido de calcio+quitosano), muestra más efecto antibacteriano en la sensibilidad de la bacteria Enterococcus faecalis. Metodología: Se realizó un estudio in vitro por la técnica de susceptibilidad antimicrobiana aplicando el método macrodilución con el objeto de establecer si una concentración de los compuestos tres grupos: Grupo 1: hidróxido de calcio. Grupo 2: quitosano. Grupo 3: hidróxido de calcio+quitosano posee actividad antibacteriana ante la bacteria Enterococcus faecalis y para apoyar esta prueba se realizó la técnica antibiograma por medición de halos de inhibición con el objetivo de determinar la sensibilidad de Enterococcus faecalis a las medicaciones intraconducto hidróxido de calcio y quitosano. Resultados: Existen diferencias estadísticamente significativas en las medicaciones intraconducto de hidróxido de calcio, quitosano e hidróxido de calcio+quitosano frente a la bacteria E. faecalis, mostrando mejor resultado cuando se utiliza el quitosano solo, en la unidad formadora de colonias y en la técnica de antibiograma por halos de inhibición mostro mejores resultados. Limitaciones: No se presentó alguna limitación durante el presente estudio. Valor: No se ha realizado un estudio similar en la Escuela Militar de Graduados de Sanidad. Conclusiones: El quitosano es efectivo contra Enterococcus faecalis, puede reducir significativamente la cantidad de bacterias en una dilución baja de 100 mg/ml, por lo tanto podemos concluir que el quitosano es un candidato prometedor como agente antibacteriano biocompatible alternativo y puede utilizarse como medicación intraconducto a futuro en tratamientos de conductos.

Abstract Objective: Determine which of these intracanal medications (calcium hydroxide, chitosan, and calcium hydroxide+chitosan), shows more antibacterial effect on the sensitivity of Enterococcus faecalis bacterium. Methodology: An in vitro study was carried out using the antimicrobial susceptibility technique applying the microdilution method in order to establish whether a concentration of the compounds was in three groups: Cluster 1: calcium hydroxide. Cluster 2: Chitosan. Cluster 3: calcium hydroxide + chitosan has antibacterial activity against the Enterococcus faecalis bacterium and to support this test, the antibiogram technique was performed by measuring inhibition halos to determine the sensitivity of E. faecalis to intracanal medications calcium hydroxide and chitosan. Results: There are statistically significant differences in the intracanal medications of calcium hydroxide, chitosan, and calcium hydroxide+chitosan against the bacterium Enterococcus faecalis, showing better results when chitosan is used alone, in the colony-forming unit and in the antibiogram technique for inhibition halos showed better results. Limitations: Due to the shortage of Ketamine in hospital units, it is difficult to replicate the study in larger samples. Value: A similar study has not been carried out at the Escuela Militar de Graduados de Sanidad. Conclusions: Chitosan is effective against E. faecalis, it can significantly reduce the number of bacteria at a low dilution of 100 mg/ml, therefore we can conclude that chitosan is a promising candidate for an alternative biocompatible antibacterial agent and can be used as a intracanal medication in root canal treatments.

Assessment of the emotional intelligence and its dimensions of medical interns

Background: Emotional intelligence (EI) is multidimensional and includes maturity, sensitivity and competency. It is the skill to identify and understand own and others� emotions to respond appropriately. Medical interns are expected to have a high degree of EI to face their professional career challenges. During the medical professional training cognitive and clinical skills are evaluated but their EI and its dimensions are nor assessed; hence this study was planned to assess the EI and its dimensions in medical interns.Methods: Objectives were to assess the EI and its dimensions of 140 medical interns. Study design was a descriptive and cross-sectional study. Ethical approval from institutional ethics committee and informed written consent from participants was obtained; administered a questionnaire-based EI test. Data obtained was analysed by ANOVA.Results: Eighty (62.0%) participants were females and 49 (38.0%) males. The mean age of them was 23 years. The mean total EI score was 343.72. It was slightly higher (344.00) in the female interns than in males (343.27). Among the emotional dimensions majority (79.1%) of interns had significantly high (p=0.0001) percentile scores in competency. 67.4% were having significantly lower (p=0.0001) percentile scores in maturity dimension of EI. Sensitivity percentile score was high in 54.3% and low in 45.7% (p=0.7724).Conclusions: This study provides insight about the EI and its dimensions in the medical interns. The maturity and sensitivity are the weaker dimensions of EQ requiring improvement or further development.

Comparison of rapid dengue NS1, qualitative ELISA, and quantitative ELISA result

Background: Non-structural glycoprotein-1 (NS1) is a useful biomarker for early diagnosis of dengue fever. NS-1 antigen ELISA can be used for the early diagnosis of dengue fever in the acute stage. Quantitative methods are better for epidemic settings due to high false negative rates in qualitative ELISA. Methods: The study was initiated after approval from the institutional ethics council (IEC/DISS/17118). Study examined 280 patients with dengue symptoms who presented to the hospital's OPDs and IPDs. Patients were tested using qualitative ELISA, and those with Leptospira antibody, malaria, or Chikungunya IgM antibody were excluded. Age, gender, symptoms, comorbidities, total leucocyte count, platelet count, and risk category were all patient-related parameters. Patient-related parameters were recorded, and data was collected using Microsoft excel and analysed statistically. Results: Most patients aged 2-40 with male predominance had fever, chills, and body aches, 243 (86.8%) tested positive for ELISA NS1. Quantitative ELISA test showed a statistically significant correlation with rapid antigen NS1 result (p=0.015). Its AUC was 0.883 (p=0.0001), and its cut-off was (>109.1) with 96.9% sensitivity and 13.64% specificity. The AUC of quantitative ELISA NS1 against qualitative ELISA NS1 was 0.853 which was statistically significant (p<0.0001). At the cut-off >74.34, the test's sensitivity was 92.59% and specificity was 75.68%. Conclusions: Qualitative ELISA NS1 test is better than rapid antigen test for screening due to its higher specificity and similar sensitivity.

Perfil da microbiota e padrões de resistência aos antimicrobianos em uroculturas de pacientes transplantados renais / Profile of the microbiot and anti-microbain resistance patterns in urocultures of reneal transplant patients

Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.

Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.

Pathogenesis, diagnosis, and management of dentin hypersensitivity

Dentin sensitivity is a problem characterized by brief sharp pain that occurs in response to things like changes in temperature, sweet or sour substances and mechanical factors. This condition significantly affects the lives of patients leading to restrictions and changes in oral hygiene routines. It is crucial for care to understand the causes, symptoms, diagnosis and management of dentin sensitivity. The development of dentin sensitivity is closely related to the structure of teeth which involves the exposure of tubes in the dentin that contain nerve endings sensitive to stimuli. Different theories, such as the theory and direct innervation theory provide insights into how this pain occurs. Diagnosis involves an evaluation of signs and symptoms along with patient history and specific tests to confirm sensitivity. Management options include adjusting behaviors using desensitizing toothpaste or fluoride applications utilizing bonding agents or even undergoing procedures like gingival grafts. These approaches aim to reduce pain and improve the quality of life for individuals affected by dentin sensitivity. Dental professionals play a role, in diagnosing, treating and educating patients about this condition to ensure results and better oral health.

Evaluación de la prueba G8 como tamizaje para valoración geriátrica integral en pacientes adultos mayores con cáncer / Evaluation of the G-8 test as a screening tool for comprehensive geriatric assessment in elderly patients with cancer

RESUMEN Objetivo: evaluar la sensibilidad y especificidad del test G8 en el tamizaje de adultos mayores con cáncer para la realización de la valoración geriátrica integral (VGI). Materiales y métodos: el presente estudio observacional y retrospectivo se realizó en el Servicio de Geriatría del Hospital Almenara de Lima, Perú. Se revisaron los informes de VGI en las historias clínicas electrónicos de adultos mayores (> 60 años) con cáncer, ambulatorios y hospitalizados, durante noviembre de 2022 y julio de 2023. Los pacientes se clasificaron según los criterios SIOG-1 (Sociedad Internacional de Oncología Geriátrica), formando dos grupos: pacientes aptos y pacientes no aptos o unfit (vulnerables + frágiles + muy enfermos). Del test G8 se estimó la sensibilidad, especificidad y valor predictivo positivo, área bajo la curva característica operativa del receptor (AUC). Resultados: ingresaron al estudio 201 pacientes, 91 mujeres (45,3%) y 110 (54,7%) varones, la media de la edad fue de 76,2 ± 7,4 años. Las neoplasias más frecuentes fueron colorrectal, estómago, próstata y vías biliares. La prevalencia de pacientes aptos y no aptos (unfit) fue del 23,4 y 76,6%, respectivamente. Cuando el puntaje de la prueba G8 fue ≤11, la sensibilidad, especificidad, valor predictivo positivo y AUC fueron 73,4% (intervalo de confianza al 95%: 65,7-80,2%), 91,5% (79,6%-97,6%), 96,6% (91,7-98,6%) y 89% (84-93%), respectivamente. Conclusiones: el test G8 con puntaje ≤11 tendría una alta sensibilidad y especificidad, para identificar adultos con cáncer vulnerables o frágiles, que podrían beneficiarse de la VGI.

ABSTRACT Objective: To evaluate sensitivity and specificity of the G8 test in screening older adults with cancer who may benefit from a Comprehensive Geriatric Assessment (CGA). Material and methods: This observational retrospective study was carried out in the Geriatrics Service of the Guillermo Almenara Hospital in Lima, Peru. CGA reports were reviewed in the electronic medical records of older adults (> 60 years) with cancer, both outpatients and inpatients, between November 2022 and July 2023. Patients were classified according to the SIOG-1 (International Society of Geriatric Oncology) criteria into two groups: fit and non-fit patients (vulnerable + frail + too sick). Sensitivity, specificity, and positive predictive value, area under the receiver operating characteristic curve (AUC), were estimated for the G8 test. Results: 201 patients entered the study, 91 women (45.3%) and 110 (54.7%) men; their mean age was 76.2 ± 7.4 years. The most frequent neoplasms were colorectal, stomach, prostate, and bile ducts. The prevalence of eligible and unfit patients was 23.4% and 76.6%, respectively. When the G8 test score was ≤11, sensitivity, specificity, positive predictive value, and AUC were 73.4% (95% Confidence Interval: 65.7- 80.2%), 91.5% (79.6%-97.6%), 96.6% (91.7-98.6%), and 89% (84-93%), respectively. Conclusions: The G8 test with a score ≤11 would have high sensitivity and specificity for identifying vulnerable or frail patients with cancer who could benefit from the CGA.

Perception of first-order grating acuity and second-order spatial contrast sensitivity in anisometropia amblyopia / 国际眼科杂志(Guoji Yanke Zazhi)

AIM: To study the perception of first-order grating acuity and second-order spatial contrast sensitivity in patients with monocular anisometropia amblyopia.METHODS:A total of 715 children(715 eyes)diagnosed as monocular anisometropia amblyopia in our hospital from January 2018 to December 2022 were collected as amblyopia group, and 745 children(745 eyes)with normal corrected visual acuity were collected. The best corrected visual acuity(BCVA), first-order grating acuity and/or second-order spatial contrast sensitivity were measured, repectively. The perception ability of amblyopia patients to first-order grating acuity and second-order spatial contrast sensitivity were analyzed.RESULTS:There were significant differences between amblyopia group and normal control group in the perception of first-order grating acuity(11.58±6.10 vs. 20.27±3.47, P&#x0026;#x003C;0.001)and second-order spatial contrast sensitivity(0.33±0.16 vs 0.12±0.04, P&#x0026;#x003C;0.001). And there were significant differences between mild-to-moderate amblyopia and severe amblyopia patients in first-order grating acuity(12.10±6.23 vs. 8.13±3.70, P&#x0026;#x003C;0.001)and second-order spatial contrast sensitivity(0.32±0.16 vs. 0.37±0.17, P&#x0026;#x003C;0.05).CONCLUSION: The first-order and second-order visual pathway of the cerebral cortex in children with monocular anisometropia amblyopia have different degrees of damage. The injury of severe amblyopia is more serious than that of mild-to-moderate amblyopia.

Detection of molecular affecting sensitivity to local glucocorticoid therapy in oral lichen planus through transcriptome sequencing / 北京大学学报(医学版)

Objective:To detect key genes of local glucocorticoid therapy in oral lichen planus(OLP)through transcriptome sequencing.Methods:The study prospectively enrolled 28 symptomatic patients who visitied Department of Oral Mucosa,Peking University Hospital of Stomatology from November 2019 to March 2023.Topical inunction of 0.1 g/L of dexamethasone was applied for 1 min,3 times daily for 4 weeks.The patients'signs and pain symptoms were recorded and they were classified as effective group and ineffective group according to the treatment outcome.Their mucosa samples were collected before treatment.After isolating total RNA,transcriptome sequencing was performed.The gene expression data obtained by sequencing were analyzed differently using the DESeq2 package in R software,and the Kyoto encyclopedia of genes and genomes(KEGG)pathway enrichment analysis was performed on the basis of the hypergeometric distribution algorithm to describe the biological function of differentially expressed genes(DEGs),accordingly detecting sensitivity related molecular affecting therapeutic effect of dexamethasone.Results:After 4 weeks treatment by topical dexamethasone,13 cases of the 28 OLP pa-tients responding well with the sign score reducing from 7.0(4.5,9.0)to 5.0(3.0,6.3),pain score decreasing from 5.0(2.0,5.5)to 2.0(0.0,3.5),oral health impact profile lessening from 5.0(3.5,9.0)to 1.0(0.0,5.0)significantly(P＜0.01)were classified as effective group and 15 cases with poor response to the drug were sorted as ineffective group.There were no significant differences of demographic and baseline levels of clinical features,especially disease severity between these two groups.A total of 499 DEGs including 274 upregulated and 225 downregulated genes were identified between ef-fective group and ineffective group.KEGG enrichment analysis showed that upregulated genes in effective group compared with ineffective group including CLDN8,CTNNA3,MYL2 and MYLPF were associated with leukocyte transendothelial migration,while downregulated genes were significantly enriched in tumor necrosis factor(TNF),interleukin-17(IL-17),nuclear factor kappa B(NF-κB)signaling pathways,and cortisol synthesis and secretory.Conclusion:High expressions of CLDN8,CTNNA3,MYL2 and MYLPF genes in patients with oral lichen planus have a good clinical response to topical dexamethasone,while patients with high expression genes of inflammation pathway such as TNF,IL-17,NF-κB and corti-sol synthesis and secretion received poor effect.