Behavioral or neuropsychiatric symptoms of Alzheimer's disease: from psychopathology to pharmacological management / Sintomas comportamentais ou neuropsiquiátricos da doença de Alzheimer: psicopatologia e abordagem terapêutica

Abstract Neuropsychiatric or behavioral symptoms of dementia encompass a series of disorders, such as anxiety, depression, apathy, psychosis, and agitation, all commonly present in individuals living with dementia. While they are not required for the diagnosis of Alzheimer's disease (AD), they are ubiquitously present in all stages of the disease, contributing to negative clinical outcomes, including cognitive decline, functional disability, and caregiver burden. Neuropsychiatric symptoms have been conceptualized not only as risk factors but as clinical markers of decline along the AD spectrum. The concept of "mild behavioral impairment", the behavioral correlate of mild cognitive impairment, has been proposed within this framework. The first steps in the management of behavioral symptoms in AD involve defining the target and investigating potential causes and/or aggravating factors. Once these factors are addressed, non-pharmacological approaches are preferred as first-line interventions. Following the optimization of anticholinesterase treatments, specific pharmacological approaches (e.g., antidepressants, antipsychotics) can be considered weighing potential side effects.

Resumo Sintomas neuropsiquiátricos ou comportamentais de demência envolvem uma série de condições, como ansiedade, depressão, apatia, psicose e agitação, frequentemente observadas em indivíduos com demência. Embora esses sintomas não sejam necessários para o diagnóstico da doença de Alzheimer, estão presentes em todas as fases ou estágios da doença, contribuindo negativamente para o declínio cognitivo, comprometimento funcional e sobrecarga do cuidador. Os sintomas neuropsiquiátricos têm sido conceituados não apenas como fatores de risco, mas também como marcadores clínicos de progressão da doença de Alzheimer. O construto "comprometimento comportamental leve", correlato comportamental do comprometimento cognitive leve, tem sido proposto nesse contexto. Os primeiros passos na abordagem dos sintomas comportamentais da doença de Alzheimer envolvem definir os alvos-terapêuticos e investigar potenciais causas ou fatores agravantes. Após intervir nesses fatores, abordagens não farmacológicas constituem a primeira linha de intervenção. Depois da otimização do tratamento anticolinesterásico, terapias farmacológicas específicas (por exemplo, antidepressivos, antipsicóticos) podem ser consideradas, levando-se em conta potencias efeitos colaterais.

Avaliação da influência da agitação ultrassônica na resistência de união de dois materiais reparadores utilizados para selar perfurações na furca / Assessment of the influence of ultrasonic agitation on the joint resistance of two repairing materials used to seal perforations in the burning / Evaluación de la influencia de la agitación ultrasónica en la resistencia de la unión de dos materiales de reparación utilizados para sellar otras perforaciones

Avaliou-se a influência da utilização da agitação ultrassônica na resistência de união à dentina, por meio de push-out, proporcionada pelos cimentos MTA-Angelus branco (MTA) e Biodentine (BD), empregados no selamento de perfurações de furca. Foram utilizados 48 primeiros ou segundos molares inferiores, com raízes não fusionadas, distantes cerca de 2 mm entre si na porção cervical das mesmas. Os dentes foram acessados e, em seguida, as raízes foram seccionadas transversalmente abaixo da junção cemento-esmalte. Os dentes foram montados em blocos de silicona de adição e perfurações de furca realizadas em seus assoalhos paralelamente ao longo eixo dos dentes e perpendiculares aos assoalhos dentais. A amostra foi dividida em quatro grupos (n = 12) em função do material reparador e da utilização ou não da agitação ultrassônica (AU). Quando empregada, a AU foi aplicada em 2 ciclos de 20 segundos por meio de inserto cônico liso acionado por ultrassom piezoelétrico. Concluídos os selamentos eles foram protegidos com cimento de ionômero de vidro e os dentes imersos em PBS. Decorridos 7 dias discos com 1 mm de altura foram retirados dos assoalhos dentais com auxílio de cortadora metalográfica e levados à máquina de ensaio universal. Os resultados expressos em MPa foram submetidos aos testes ANOVA dois fatores e de Bonferroni. Os maiores valores de resistência obtidos foram no grupo Biodentine com ultrassom (29,41 MPa), seguidos em ordem decrescente pelos grupos Biodentine sem ultrassom; MTA com ultrassom e MTA sem ultrassom (3,72 MPa). Nas condições do estudo concluiu-se que o BD apresentou maior resistência de união à dentina radicular; ainda, que a agitação ultrassônica influenciou positivamente na resistência de união do material à dentina.

We evaluated the influence of the use of ultrasonic agitation on the resistance to the dentin, by means of push-out, provided by the white MTA-Angelus (MTA) and Biodentine (BD) cements, used in the sealing of drilling holes. 48 first or second lower molars were used, with unfused roots, about 2 mm apart in the cervical portion of them. The teeth were accessed and then the roots were sectioned transversely below the cementenamel junction. The teeth were mounted in addition silicon blocks and hole drills performed on their floors parallel along the axis of the teeth and perpendicular to the dental floorings. The sample was divided into four groups (n = 12) depending on the repair material and whether ultrasonic agitation (AU) was used. When employed, the AU was applied in 2 20-second cycles by means of a smooth conical insert activated by piezoelectric ultrasound. Once the seals were completed, they were protected with glass ionomer cement and the teeth immersed in PBS. After 7 days, 1 mm high disks were removed from the dental floorboards with the aid of a metallographic cutter and taken to the universal test machine. Results expressed in MPa were submitted to two-factor and Bonferroni ANOVA tests. The highest resistance values obtained were in the group Biodentine with ultrasound (29.41 MPa), followed in descending order by the groups Biodentine without ultrasound; MTA with ultrasound and MTA without ultrasound (3.72 MPa). Under the conditions of the study, it was concluded that BD showed greater resistance to root dentin binding; also, that ultrasonic agitation positively influenced the resistance of the material to dentin binding.

influencia del uso de la agitación ultrasónica sobre la resistencia de la unión a la dentina se evaluó mediante un estiramiento, proporcionado por los cementos blancos (MTA) y biodentinos (BD) MTA-Angelus, empleados en el sello de los taladros. Se utilizaron los primeros o segundos molares inferiores, con raíces sin fundir, a unos 2 mm de distancia en la porción cervical de las raíces. Se accedió a los dientes y luego las raíces se seccionaron transversalmente por debajo de la unión cemento-enamel. Los dientes se ensamblaron además bloques de silicona y agujeros de perforación en sus pisos a lo largo del eje de los dientes y perpendiculares al suelo dental. La muestra se dividió en cuatro grupos (n = 12) según el material de reparación y si se utilizó o no la agitación ultrasónica (AU). Cuando se empleó, la UA se aplicó en 2 ciclos de 20 segundos mediante una inserción cónica suave activada por ultrasonido piezoeléctrico. Una vez concluidos los sellos, se protegieron con cemento ionómero de vidrio y los dientes se sumergieron en PBS. Al cabo de 7 días, los discos de 1 mm de altura se retiraron del suelo de corte metálico y se llevaron a la máquina de ensayo universal. Los resultados expresados como MPa se presentaron a las pruebas de dos factores ANOVA y Bonferroni. Los valores de resistencia más altos obtenidos fueron en el grupo de Biodentina con ultrasonido (29,41 MPa), seguidos en orden descendente por los grupos de Biodentina sin ultrasonido; MTA de ultrasonido y MTA libre de ultrasonido (3,72 MPa). En las condiciones del estudio se concluyó que la DB mostró mayor resistencia de la unión a la dentina raíz; y que la agitación ultrasónica tuvo una influencia positiva en la resistencia del material a la dentina.

Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population

Abstract Introduction Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale's psychometric properties. Method An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital's psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. Results In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). Conclusion The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.

The Influence of Agitation Rates, pH and Calcium Carbonate on L-lysine Production by Bacillus subtilis using Agricultural Products as Carbon and Nitrogen Sources

L-Lysine is an essential amino acid that is required in the diet of humans and animals. It is utilized in human medicine, cosmetics and pharmaceutical industry. ’The influence of agitation rates, pH and calcium carbonate on L-lysine production by Bacillus subtilis using agricultural products as carbon and nitrogen sources was studied. The L-lysine-producing bacteria had already been isolated from Nigerian soil. They were purified and Identified as B. subtilis PR13 and B. subtilis PR9, using cultural, biochemical and molecular characteristics. Optimization of some parameters which included agitation rates, pH values and CaCO3 concentrations, on L-lysine production by the Bacillus species was carried out. The L-lysine was produced in 250 ml flasks containing fermentation media (FM1 and FM2). The findings revealed that, enhanced L-lysine yield of 2.10 and 1.33 mg/ml was observed at agitation rate of 180 rpm for B. subtilis PR13 and PR9 respectively. There was a positive correlation between agitation rates and L- lysine production by B. subtilis PR13 and PR9 (r = 0.96 and 0.83 respectively). The pH of 7.5, stimulated optimum L- lysine yield of 2.27 mg/ml for PR13 and 1.38 mg/ml for PR9. There was a positive correlation between pH values and L-lysine production by B. subtilis PR13 and PR 9 (r = 0.63 and 0.50 respectively). The supplementation of 40g/l of CaCO3, enhanced optimum L-lysine yield of 2.18 mg/ml for B. subtilis PR 13 and 1.30 mg/ml for B. subtilis PR9. There was a positive correlation between varying concentrations of calcium carbonate and L-lysine production by the B. subtilis PR13 (r =0.35), while negative correlation was observed for B. subtilis PR 9 (r = -0.10). The results obtained in the study illustrated that the optimization of process parameters could increase the L-lysine yield from agricultural products by B. subtilis PR13 and B. subtilis PR9.

Cultivo in vitro de raíces pilosas del arbusto Phyllanthus acuminatus (Phyllanthaceae) / In vitro culture of hairy roots of the shrub, Phyllanthus acuminatus (Phyllanthaceae)

Introducción: En condiciones naturales, las raíces del arbusto, Phyllanthus acuminatus, producen bajas concentraciones de metabolitos secundarios de interés medicinal. Esto abre una oportunidad para el cultivo in vitro, para aumentar la concentración de metabolitos. Objetivo: Determinar las condiciones óptimas de cultivo líquido para raíces pilosas de P. acuminatus. Métodos: Se utilizó la evaluación del crecimiento de la biomasa según porcentaje de inóculo inicial (0.50 y 0.10 %), porcentaje de nutrientes de los medios (100, 50 y 25 %) y tasa de agitación (90, 100 y 110 min-1) (N= 15 repeticiones). Resultados: Las mejores condiciones de cultivo líquido fueron: 0.10 % de inóculo inicial, nutrientes al 25 % y 90 min-1 para la tasa de agitación. Hay diferencias entre las raíces pilosas y las raíces no transformadas. Conclusiones: es factible producir raíces pilosas de P. acuminatus a gran escala, aplicando e implementando las condiciones evaluadas de porcentaje de inóculo, nutrientes en el medio y tasas de agitación utilizadas en este estudio.

Introduction: Under natural conditions, the roots of the shrub, Phyllanthus acuminatus, produce low concentrations of secondary metabolites of medicinal interest. This opens an opportunity for in vitro culture, to increase metabolite concentration. Objective: To determine the optimal liquid culture conditions for hairy roots of P. acuminatus. Methods: We used biomass growth evaluation according to initial inoculum percentage (0.50 and 0.10 %), percentage of medium nutrients (100, 50 and 25 %) and agitation rate (90, 100 and 110 min-1) (N=15 replications). Results: The best liquid culture conditions were: 0.10 % of initial inoculum, nutrients at 25 % and 90 min-1 for the agitation rate. There are differences among hairy roots and non-transformed roots. Conclusions: It is feasible to produce P. acuminatus hairy roots at a large scale, applying and implementing the evaluated conditions of inoculum percentage, nutrients in the medium and agitation rates.

A study of clinical and etiological profile in elderly individuals presenting to a tertiary care center of South India with altered mental status

Background and Objectives: Altered mental status (AMS) is a challenging diagnosis in elderly patients and has a wide range of etiologies. The aim of this study was to know the clinical and etiological profile in the elderly, so that physicians will be better aware of AMS backgrounds and reducing morbidity and mortality rates among the patients. Materials and Methods: This was a prospective observational study conducted at the emergency department (ED) and medical intensive care unit (MICU) of a tertiary care hospital in South India from November 1, 2019, to October 31, 2020. Patients aged 65 years and older who presented to the ED and MICU with AMS were included in this study. They were evaluated clinically and necessary investigations were done to know the etiologies. Results: Among 100 elderly patients, 64% belonged to young old (age group of 65–74 years), 30% belonged to old (age group of 75–84 years), and 6% belonged to oldest old (>85 years). Sixty?one percent were male and 39% were female. The most common cause for AMS in elderly was primary neurological cause (40%, cerebrovascular accident was most common cause). The other causes were metabolic encephalopathy (29%, hyponatremia being most common) followed by multifactorial causes (24%). Infections and hypertensive encephalopathy were noted in 6% and 1% respectively. The common comorbidities found were hypertension (71%) and type 2 diabetes mellitus (50%), and 28% had diabetes mellitus and hypertension, whereas 25% had multiple comorbidities. Conclusion: The elderly patients who present with AMS must be screened for the above etiologies. This study helps the physicians to have an idea regarding common causes of AMS in elderly patients at presentation, hence appropriate management approach thus helps in reducing morbidity and mortality.

Environmental parameters modulate lead chloride toxicity on Artemia salina

Different environmental conditions can influence the effects of toxic agents on living beings. Recently, a series of experiments performed in Artemia salina submitted to different kinds of intoxication have shown that both, isotherapic and succussed watercan change Artemia salina ́s bio resilience at different levels. Moreover, it seems to vary according to the circalunar cycle. Objective:To verify if circalunar phases and water agitation can modify the toxicity of lead chloride on Artemia salina in vitro. Methodology:Artemia salina cysts were exposed to seawater containing 0.04% of lead chloride (equal to EC10 or 10% effective concentration, previously determined in a pilot study) in 96-well culture plates. Thirty-six experimental repetitions were performed in four series to observe the possible effects of adding stirred water, the so-called succussed water, and the moon phases. The hatched cysts were recorded after 48 hours using a digital microscope (1000x magnification) to identify the hatching percentage and the viability and mobility of the born nauplii. Results:The exposition of cysts to PbCl2 led to an increase in the hatching rate, and it was more evident during the full moon (p = 0.00014) The addition of succussed water into the seawater medium reduced this effect to the baseline levels. An increase in mobility was seen in nauplii born from exposed cysts during the full moon (p = 0.00077), but this effect was not affected by the treatment with succussed water. Discussion:Although the effects of lead chloride EC10 on the increase of nauplii hatching were expected, two environmental variables changed the sensitivity of cysts to this harmful stimulus. The circalunar cycle varied the hatching rate according to the moon phase, even in laboratory conditions, and the addition of succussed water into the medium reduced the hatching rate, even with different intensities according to the moon phase. The organization of nano and microbubbles generated after the succussion of water could be related to this protective effect and can explain, at least partially the effects of high diluted preparations on this biological context. Conclusion:Environmental factors, such as the circalunar cycle and products of water agitation, can modulate the adaptative control of hatching in Artemia salina exposed to lead chloride at EC10.

Delirium, catatonía y síndrome de abstinencia manifestados como agitación psicomotora en COVID-19: una propuesta de manejo farmacológico en el hospital general

Background: Neuropsychiatric symptoms can be part of the clinical spectrum of COVID-19 infections. Aim: To devise an evidence based clinical algorithm as a guide for clinicians, to identify and treat underlying clinical syndromes of psychomotor agitation, such as delirium, catatonia or substance withdrawal in patients who are hospitalized and infected with SARS-CoV-2. Material and Methods: A review of the literature about the pharmacological management of neuropsychiatric manifestations of COVID-19 at the general hospital, to develop a clinical protocol based on a consensus from an interdisciplinary expert panel at a Clinical Hospital. Results: A consensual clinical algorithm for the management of delirium, catatonia, and substance withdrawal, manifested as psychomotor agitation in patients hospitalized with COVID-19, was developed as a clinical proposal for physicians at different levels of complexity in health services. Conclusions: Cooperation among different clinical units in the general hospital facilitated the implementation of a clinical algorithm for clinicians for the management of psychomotor agitation in COVID-19 patients.

The observation on the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits / 中国医师进修杂志

Objective:To investigate the effect of prospective intervention on emergence agitation and postoperative recovery in patients with chronic sinusitis during preoperative visits.Methods:A total of 80 patients with chronic sinusitis who underwent general anesthesia in Dayi County People′s Hospital of Chengdu City from December 2019 to October 2020 were selected and randomly divided into group D and group G, with 40 patients in each group. Group D received preoperative visit with conventional methods and group G received preoperative visit with prospective intervention methods. The hemodynamic changes of patients in the two groups at 30 min before the operation (T 1) and 1 (T 2), 5 (T 3), 10 (T 4) and 30 min (T 5) after tracheal tube extraction were recorded. The anxiety and depression scores of patients before the intervention and 1 d after the operation were compared between the two groups. The incidence of emergence agitation after the operation and complications during anesthesia awakening period were observed in the two groups, sino-nasal outcome test-20 (SNOT-20) was used to assess the postoperative recovery. Results:The incidence of emergence agitation in group G was lower than that in group D: 7.5%(3/40) vs. 25.0%(10/40), the difference was statistically significant ( χ2 = 4.50, P<0.05). There was no significant difference in systolic blood pressure, diastolic blood pressure and heart rate between the two groups at T 1 and T 5 ( P>0.05), but the level of above indicators in group G at T 2, T 3 and T 4 were significantly higher than those in group D ( P<0.05). The scores of State-Trait Anxiety Inventory(S-AI) and Self-Rating Depression Scale (SDS) in group G at the first day after the operation were significantly lower than those in group D: (35.45 ± 5.32) scores vs. (39.35 ± 4.91) scores, (35.42 ± 7.82) scores vs. (38.76 ± 5.21) scores, the differences were statistically significant ( P<0.05). The incidence of complications during anesthesia awakening period in group G was slightly lower than that in group D ( P>0.05). After the operation, the scores of sinusitis symptoms and nasal symptoms in the two groups were significantly decreased compared with those before the operation, and the scores of group G were significantly lower than those in group D ( P<0.05). Conclusions:Prospective intervention before anesthesia in patients with chronic sinusitis surgery can reduce stress response, improve bad mood, reduce the incidence of emergence agitation, and promote the postoperative recovery.

Application and evaluation of multi-sensory stimulation therapy in agitation behavior of patients with Alzheimer′s disease / 中国实用护理杂志

Objective:To investigate the effect of multi-sensory stimulation therapy on agitation behavior in patients with Alzheimer's disease(AD).Methods:A total of 45 patients with AD hospitalized in the Department of Neurology of Xuanwu Hospital, Capital Medical University, from June 2021 to January 2022 were selected, including 23 cases in the control group and 22 cases in the experimental group. The control group was treated with routine nursing methods, and the experimental group was treated with multi-sensory stimulation. The scores of Cohen-Mansfield Agitation Inventory (CMAI) and Behavioral Pathology in Alzheimer′s Disease Rating Scale (BEHAVE-AD) were compared between the two groups before and after treatment.Results:CMAI comparison showed that after the intervention, the CMAI scores of the experimental group and the control group was 33.14 ± 3.72 and 37.13 ± 7.23 respectively. The difference was statistically significant ( t=-2.34, P<0.05). The total score of "physical non aggressive behavior" and "language non aggressive behavior" in the experimental group were (11.09±2.91), (5.73±2.16), which were lower than those in the control group (13.57±4.33), (8.22±2.71). The differences were statistically significant ( t=-2.26,-3.39, P<0.05). The BEHAVE-AD scores of the experimental group before and after the intervention were (13.14 ± 9.54), (9.50 ± 4.81), in the control group were (11.04 ± 8.34), (10.70 ± 9.81). There was significant difference in BEHAVE-AD score before and after the intervention in the experimental group ( t=2.21, P<0.05), but there was no significant difference compared with the control group ( t=-0.73, P>0.05). "Behavior disorder" of the experimental group improved significantly after the intervention, and the score was (2.41 ± 1.26) compared with the control group (4.48 ± 2.87), the difference was statistically significant ( t=-3.10, P<0.05). Conclusions:Compared with routine nursing, visual + auditory + tactile multi-sensory stimulation can improve the agitation behavior of AD patients, especially non aggressive agitation behavior, which has certain clinical significance and can provide reference for future related research.

The effect of visual preconditioning on emergence agitation of preschool children during ophthalmologic anesthesia / 中国实用护理杂志

Objective:To investigate the effect of visual preconditioning on emergence agitation in ophthalmic surgery among preschool children.Methods:A total of 156 preschool children who underwent elective ophthalmic surgery in Qilu Hospital of Shandong University from February to September 2021 were selected as the research subjects, and they were divided into the control group and the intervention group by random number table method, there were 78 cases in each group. The control group was given normal nursing 1 hour before surgery while the intervention group accepted visual preconditioning by covering the affected eye. Chinese Version of the Modified Yale Preoperative Anxiety Scale (Cm-YPAS) was used to evaluate the grade of anxiety for the patients during the process of anesthesia induction. Pediatric Anesthesia Emergence Delirium (PAED) was used to compare the score of emergence agitation and the incidence rate of emergence agitation of the two groups.Results:Finally, 75 cases were included in the intervention group and 75 cases in the control group. During anesthesia induction, the intervention group scored (39.78±4.84) and the control group scored (41.07±5.09) with Cm-YPAS, and there was no statistical difference between the two groups ( P>0.05). Furthermore, compared the PAED score of the intervention group 5(4,8) with the control group 8(5, 11), there were statistically significant differences between the two groups ( Z=-3.07, P<0.01). Emergence agitation incidence in the intervention group was 14.67%(11/75), which was lower than that in the control group 38.67%(29/75), the difference was significant ( χ2=11.05, P<0.01). Conclusions:Visual preconditioning can effectively improve recovery quality after general anesthesia and decrease the incidence rate of emergence agitation in ophthalmic surgery among preschool pediatric patients. It′s well worthy of application and dissemination of visual preconditioning clinically.

Effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia / 中国医师进修杂志

Objective:To investigate the effect of dexmedetomidine on agitation and hemodynamics during the recovery period in children after sevoflurane anesthesia.Methods:A total of 120 pediatric patients with selective tonsillectomy and adenoidectomy admitted to Shaoxing Central Hospital from January 2019 to December 2020 were randomly divided into the control group and the observation group, with 60 cases in each group. Both groups were induced by sevoflurane inhalation, followed by endotracheal intubation with 0.6 mg rocuronium and 2 μg/kg fentanyl intravenous injection. The observation group received dexmedetomidine combined with sevoflurane to maintain anesthesia, while the control group received normal saline combined with sevoflurane to maintain anesthesia. Heart rate (HR) and mean arterial pressure (MAP) were recorded at four times: before anesthesia (T 0), endotracheal intubation (T 1), the beginning of surgery (T 2) and the end of surgery (T 3). The time of anesthesia, surgery, recovery and extubation were recorded. Pediatric anesthesia emergence delirium (PAED) score, faces pain scale (FPS) score, the incidence of agitation and postoperative special events were compared between the two groups. Results:There were no significant differences in operation time, anesthesia time, extubation time and recovery time between the two groups ( P>0.05). The levels of HR and MAP in the control group were increased at T 1, T 2, T 3, and were higher than those in the observation group, the differences were statistically significant ( P<0.05). The scores of FPS, PAED and the incidence of agitation in the observation group were lower than those in the control group: (2.32 ± 0.61) scores vs. (3.66 ± 0.85) scores, (6.88 ± 1.85) scores vs. (11.75 ± 3.03) scores, 13.33% (8/60) vs. 3.33% (2/60), the differences were statistically significant ( t = 9.92, 10.63, χ2 = 3.93, P<0.05). The incidences of postoperative treatment with propofol, analgesics and respiratory tract adverse events in the observation group were lower than those in the control group: 3.33%(2/60) vs. 13.33%(8/60), 5.00%(3/60) vs. 16.67% (10/60), 3.33%(2/60) vs. 15.00%(9/60), the differences were statistically significant ( χ2 = 3.93, 4.23, 4.90, P<0.05). Conclusions:Dexmedetomidine maintenance induction of anesthesia for sevoflurane anesthesia in children can effectively reduce the incidence of agitation in the period of recovery, and has little effect on hemodynamics, with high safety.

Avaliação do escurecimento dentinário causado por cimentos obturadores endodônticos em função do uso de agitação ultrassônica / Evaluation of dentin discoloration caused by endodontic root canal sealers due to ultrasonic agitation

Introdução: A descoloração da estrutura dentária representa um grande problema estético e uma das razões mais comuns pelas quais os pacientes vão ao cirurgião-dentista. Objetivo: O objetivo do presente estudo foi avaliar a descoloração dentinária causada pelo emprego dos cimentos obturadores endodônticos AH Plus, MTA Fillapex, Pulp Ca- nal Sealer EWT e Sealer Plus; além de avaliar a influência do uso da agitação ultrassônica (AUS). Métodos: Oitenta blocos de dentes bovinos foram confeccionados e tiveram cavidades circulares preparadas em suas faces palatinas, deixando remanescente de 2,0mm de espessura. Em seguida, os blocos foram randomicamente divididos em função do cimento utilizado e do uso ou não da AUS (n=10). A cor foi mensurada por meio de um espectrofotômetro após a inserção dos cimentos e restauração das cavidades, nos tempos: imediatamente após a inserção dos cimentos (T0 ), após 7 dias (T1 ) e após 180 dias (T2 ). Resultados: Observou-se alteração de cor clinicamente perceptível (ΔE>3,7) causada pelos quatro cimentos obturadores, tanto após 7 dias quanto após 180 dias. Não foram encontradas diferenças significativas entre os grupos nos dois tempos (p>0,05). Conclusões: Pôde-se concluir que os cimentos analisados causaram escurecimento dentinário clinicamente perceptível já após 7 dias, o qual perdurou por todo o período da análise; ainda, que a agitação ultrassônica não interferiu significativamente na ΔE, não influenciando na descoloração dentinária causada pelos cimentos testados (AU).

Introduction: Tooth discoloration is an aesthetic problem commonly reported by patients as one of the main reasons to seek a dentist. Thus, this study aimed to evaluate the dentin discoloration caused by AH Plus, MTA Fillapex, Sealer Plus and Pulp Canal Sealer EWT endodontic sealers, associated or not with ultrasonic agitation during the obturation. Methods: Round cavities were prepared on the palatal faces of eighty bovine teeth slabs, preserving a 2 mm of dentin thickness. The slabs were randomly separated in groups by type of sealer employed and based on the use or not of ultrasonic agitation (n = 10). The color was measured by a spectrophotometer after sealer insertion into the cavities (T0), after 7 (T1) and 180 days (T2). Results: Clinically detectable discoloration (∆E > 3,7) was present in all groups at T1 and T2. Statistically significant differences were not found between T1 and T2 (P > .05). Conclusion: All endodontic sealers tested caused dentin discoloration after 7 days. The color-changing persisted thought the entire experimental period. Moreover, the ultrasonic agitation did not influence on the dentin discoloration caused by the endodontic sealers tested (AU).

Guía práctica para el manejo de la agitación psicomotora en pediatría / Clinical Guide for the management of psychomotor agitation in pediatrics

La agitación psicomotora es un estado de hiperactividad impulsiva aguda en grados variables, que requiere intervención. Sus manifestaciones abarcan un amplio espectro desde mínima inquietud hasta perturbaciones intensas con grandes movimientos no propositivos o violentos. Datos recientes muestran que aproximadamente 10-20% de los niños, niñas y adolescentes (NNA) presenta una patología de la esfera psiquiátrica y/o abuso de sustancias y, en consecuencia, han aumentado las consultas por estos motivos en servicios de urgencia pediátrica. Hasta 1 de cada 15 NNA requiere contención de algún tipo. Las causas de agitación son múltiples y se deben investigar en cada paciente. El objetivo de este trabajo es concientizar al equipo de salud sobre el problema y contribuir a la estandarización del manejo clínico en pediatría. Se describen intervenciones no farmacológicas, contención farmacológica y física, con sus respectivas indicaciones.

Psychomotor agitation is a state of acute impulsive hyperactivity with varying degrees of magnitude that requires intervention. Its manifestations cover a broad spectrum from minimal unrest to intense disturbances with large non-purposeful or violent movements. Recent data show that approximately 10-20% of children and adolescents have a psychiatric disease and/or substance abuse disorder and, consequently, consultations for these reasons have increased in pediatric emergency services. Up to 1 in 15 children require some form of restraint. Causes of agitation are multiple and must be investigated in each patient. The objectives of this review are to improve awareness of the issue to health work-teams and aims at the standardization of its medical management in pediatrics. Non-pharmacological interventions, chemical and physical restraint methods are described, with their respective indications.

Effect of Agitation on Anaerobic Co-Digestion of Swine Manure and Food Waste

Abstract The synergism of food waste associated with swine manure can provide an increase in biogas production, besides promoting greater stability in the anaerobic co-digestion process. To verify this effect, co-digestion tests were performed in two reactors, one with agitation, and the other without agitation. In both systems, gasometers were used to measure biogas production in an experiment lasting two hydraulic retention times (HRT). On each feeding day, the temperatures of the ambient and of the effluent taken from the reactors were measured, and samples of the food waste and effluent were collected to perform analysis of pH, total solids (TS), volatile solids (VS), fixed solids (FS), volatile acidity (AV), and total alkalinity (TA). In addition, the chemical oxygen demand (COD) was determined every five days, and gas composition was determined at the beginning of the second HRT. As important results, in both reactors a decrease in pH was verified due to the weakening of the buffer effect of the medium. This was due to the low alkalinity found in the food waste, causing an increase in acidity in the contents of the reactors. The volume of biogas produced was higher in the reactor with agitation, which meant an increased efficiency of the process. Finally, a low methane content was verified through chromatographic analyses, indicating a reduction in the activity of the microorganisms present in the medium. Thus, it is concluded that agitation linked to anaerobic co-digestion of swine manure with food waste exerted a positive effect on biogas production.

Biosynthesis of lipase by Burkholderia cenocepacia ST8 using waste cooking oil as feedstock

Aims@#Every year, an estimated 25 million tons of waste oil are produced worldwide, and the generation of waste oil is one of the biggest global environmental problems. The incorporation of oil as a substrate for lipase production has been studied and shown to have a positive impact on its production. Burkholderia sp. is one of the major lipase-producing bacteria with their ability in bioremediation of oil-contaminated soil. This study aims to compare the production of lipase by Burkholderia cenocepacia ST8 using waste cooking oil and unused cooking oil as feedstock.@*Methodology and results@#The effect of different types of waste cooking oil (sunflower oil and palm oil) and concentration (1-3%) of waste cooking oil, agitation speed (100-400 rpm) and initial dissolved oxygen concentration (10-50%) on lipase production by B. cenocepacia ST8 under batch fermentation mode were investigated. The major fatty acids of which had been consumed were determined using gas chromatography. Results showed that 2% (v/v) of single used sunflower cooking oil produced the highest lipase activity of 138.86 U/mL with a productivity of 2.10 U/mL/h; agitation speed of 300 rpm produced the highest lipase activity of 183.56 U/mL with a productivity of 3.06 U/mL/h while 30% initial concentration of dissolved oxygen produced a lipase activity of 176.45 U/mL with a productivity of 2.94 U/mL/h. Oleic acid and linoleic acid were found to be the most consumed by B. cenocepacia ST8 among other fatty acids. @*Conclusion, significance and impact of study@#This study shows that 2% (v/v) single used sunflower cooking oil was the better type and optimum concentration of carbon source for the production of lipase by the fermentation of B. cenocepacia under 300 rpm and 30% initial concentration dissolved oxygen. The incorporation of 2% (v/v) single used sunflower cooking oil may be a great alternative to reduce the cost for the production of lipase as well as reducing the amount of waste oil generation.

La musicoterapia como alternativa para el control de la agitación y sedación de pacientes con ventilación mecánica invasiva / Music therapy as an alternative to control psychomotor agitation and sedation of the patients with invasive mechanical ventilation

RESUMEN * Introducción: Se promueve la utilización de la musicoterapia para el manejo de determinados problemas de salud. Objetivo: Precisar el efecto de la musicoterapia sobre la sedación de pacientes con ventilación mecánica invasiva en la Unidad de Cuidados Intensivos del Hospital General Docente "Dr. Agostinho Neto" de Guantánamo en 2018. Método: Durante enero-diciembre de 2018, se realizó un preexperimento con la aplicación de musicoterapia. Participaron 40 pacientes durante el proceso de destete de la ventilación mecánica invasiva. Aleatoriamente, se asignaron a un grupo estudio (n=20) que se les ofreció musicoterapia y a un grupo control (n=20) que no se les ofreció esta terapéutica. Se estudiaron las modificaciones de la frecuencia cardiaca, frecuencia respiratoria, presión arterial media, dosis de sedantes y el nivel de agitación, criterios de profesionales y pacientes respecto a esta técnica. Los datos se resumieron mediante frecuencias absolutas, porcentajes, media y la desviación típica y las diferencias se evaluaron con la técnica t de Students. Resultados: La musicoterapia mejoró la presión arterial media, frecuencia cardiaca y respiratoria, disminuyó las dosis utilizadas de sedantes y mejoró la agitación en el grupo estudio (p<0,05). Los profesionales y pacientes ofrecieron criterios favorables respecto a sus bondades para el control de la agitación (p<0,05). Conclusiones: La musicoterapia es una terapia no farmacológica útil para el control de la agitación del paciente durante el proceso de destete de la ventilación mecánica invasiva.

ABSTRACT * Introduction: Music therapy is promoted as a tool to handle certain health issues. Objective: To specify the effect of music therapy in sedated patients with invasive mechanical ventilation in the intensive care unit at the General Teaching Hospital ¨Dr. Agostinho Neto¨ in Guantanamo during the year 2018. Method: From January to December, 2018, a pre-experimental application of music therapy was undertaken. 40 patients were part of the experiment, during the process of weaning from invasive mechanical ventilation. Patients were randomly selected to the studied group (n=20) or to a control group (n=20), the first being treated with music therapy while the last was not. Modifications in heart rate, respiratory rate, mean arterial pressure, sedative dose and levels of psychomotor agitation were taken into account; also listening to professionals´ and patients´ opinions on the treatment. The information gathered was sorted in absolute frequencies, percentages, mean and standard deviation, and the differences were evaluated with Student´s t-distribution. Results: Music therapy improved heart and respiratory rate, mean arterial pressure and helped to decrease the use of sedative doses; besides, it improved the agitation in the group studied (p<0.05). Patients and professionals both gave favorable opinions about the treatment and its ability to control the agitation (p<0.05). Conclusions: Music therapy constitutes a non-pharmacological form of therapy that proves effective to control agitation in patients during the process of weaning from invasive mechanical ventilation.

Canal Cleanliness and Smear Layer Removal Using Different Irrigant Activation Methods - A Scanning Electron Microscopy Study

rrigation is one the most important aspects during root canal treatment of the teeth which can be achieved by mechanical cleaning and shaping with the aid of irrigants. However, the irrigant does not travel to all the places of the root canal especially the apical third. Hence, to make this irrigant reach the apical third, we need irrigant activation methods which will agitate the irrigant and help in accessing the places which are difficult to reach in the root canal system. The objective of this research was to check the canal cleanliness and the removal of the debris after irrigant activation using manual dynamic agitation (MDA), plastic F file, sonic irrigation (SI) and conventional syringe irrigation (CSI). METHODSSixty single rooted teeth were chosen for this study which were biomechanically prepared using ProTaper system (Dentsply Maillefer, USA) up to a preparation of F2 and 3 % NaOCl and 17 % EDTA were used as irrigants. All the samples were equally divided into groups of fifteen each depending on the mode of irrigant activation method used - Group 1, Manual Dynamic Agitation (MDA); Group 2, plastic F file; Group 3, EndoActivator (SI); and Group 4, control group (C). These teeth were then split along the long axis and were observed under the SEM for any debris and to determine the degree of canal cleanliness. RESULTSGroup 4 (control group) showed the maximum debris under SEM with a statistically significant difference with a P value less than 0.05; next was the manual dynamic agitation group. Plastic F file group and sonic irrigation groups showed almost similar results in terms of debris. CONCLUSIONSIrrigant activated using sonic mode and plastic F file efficiently removed the debris in comparison to the other two groups of syringe irrigation and manual dynamic agitation.

Assessment of delirium in children admitted into the Intensive Care Unit: psCAM-ICU Tool

Abstract Background: Delirium has been identified as a risk factor for the mortality of critically ill patients, generating great social and economic impacts, since patients require more days of mechanical ventilation and a prolonged hospital stay in the intensive care unit (ICU), thus increasing medical costs. Objective: To describe the prevalence and characteristics of delirium episodes in a sample of 6-month to 5-year-old children who are critically ill. Methods: Cohort study at a Pediatric Intensive Care Unit (PICU) in Bogotá (Colombia). Participants were assessed by the Preschool Confusion Assessment Method for the ICU (psCAM-lCU) within the first twenty-four hours of hospitalization. Results: One quarter of the participants (25.8%) presented some type of delirium. Among them, two sub-types of delirium were observed: 62.5% of the cases were hypoactive and 37.5% hyperactive. Moreover, from them, six were male (75%) and 2 female (25%). Primary diagnosis was respiratory tract infection in 62.55% of the patients, while respiratory failure was diagnosed in the remaining 37.5%. Conclusions: The implementation of delirium monitoring tools in critically ill children provides a better understanding of the clinical manifestation of this phenomenon and associated risk factors in order to contribute to the design of efficient intervention strategies.

Resumen Introducción: el delirium se ha identificado como un factor de riesgo para la mortalidad de pacientes en estado crítico, lo que genera un mayor impacto social y económico, teniendo en cuenta que los pacientes requieren más días de ventilación mecánica y una estancia hospitalaria prolongada en la unidad de cuidados intensivos (UCI), lo que incrementa los costos médicos de su estadía. Objetivo: describir la prevalencia y las características de los episodios de delirium en una muestra de niños de seis meses a cinco años en estado crítico. Métodos: estudio de cohorte en una Unidad de Cuidados Intensivos Pediátricos (UCIP) en Bogotá (Colombia). Los participantes fueron evaluados por el método de evaluación de confusión preescolar para la UCI (psCAM-UCI) dentro de las 24 horas iniciales del período de hospitalización. Resultados: una cuarta parte de los participantes (25,8 %) presentó algún tipo de delirium. Entre ellos, se observaron dos subtipos de delirium: el 62,5 % de los casos era hipoactivo y el 37,5 % hiperactivo. Además, el 75% (6) de los participantes delirantes eran hombres y el 25 % (2) mujeres. En 62,5 % de los pacientes el diagnóstico primario fue infección de las vías respiratorias, mientras que la insuficiencia respiratoria fue diagnosticada en el 37,5 % restante. Conclusiones: la implementación de herramientas de monitoreo del delirium con niños en estado crítico proporciona una mejor comprensión de la presentación clínica de este fenómeno y los factores de riesgo asociados, con lo cual es posible contribuir al diseño de estrategias de intervención eficientes.

Resumo Introdução: o delirium foi identificado como um fator de risco para a mortalidade de pacientes graves, o que gera maior impacto social e econômico, visto que os pacientes necessitam de mais dias de ventilação mecânica e internação prolongada na unidade de terapia intensiva (UTI), o que aumenta os custos médicos para a sua estadia. Objetivo: descrever a prevalência e as características dos episódios de delirium em uma amostra de crianças de 6 meses a 5 anos, gravemente doentes. Métodos: estudo de coorte em uma Unidade de Terapia Intensiva Pediátrica (UTIP) em Bogotá (Colômbia). Os participantes foram avaliados pelo método de avaliação de confusão pré-escolar para a UTI (psCAM-UTl) dentro das primeiras 24 horas do período de internação. Resultados: um quarto dos participantes (25,8%) apresentou algum tipo de delirium. Entre eles, dois subtipos de delirium foram observados: 62,5% dos casos eram hipoativos e 37,5% hiperativos. Além disso, 75% (6) dos participantes delirantes eram do sexo masculino e 25% (2) feminino. Em 62,5 % dos pacientes, o diagnóstico primário foi infecção das vias respiratórias, enquanto a insuficiência respiratória foi diagnosticada em 37,5 % restante. Conclusões: a implementação de instrumentos de monitorização do delirium com crianças gravemente doentes permite uma melhor compreensão da apresentação clínica do fenômeno e dos fatores de risco associados, de forma a contribuir para o desenho de estratégias de intervenção eficazes.

Efficacy of diode laser and sonic agitation of Chlorhexidine and Silver-nanoparticles in infected root canals / Eficácia do laser de diodo e agitação sônica de clorexidina e nanopartículas de prata em canais radiculares infectados

Objective: To assess the efficacy of agitation of chlorohexidine (CHX) and Silver nanoparticles "AgNps" with 810nm diode laser or sonic endoactivator compared to side ­vented needle on infected root canals with Enterococcus "E" Faecalis biofilms. Material and Methods: Sixty-five extracted human premolars with single oval canals were instrumented by protaper system up to F3. Biofilms of E. faecalis were generated based on a previously established protocol. Two teeth were used to check the biofilm formation, then the remaining Teeth were randomly divided into three equal experimental groups according to agitation techniques used: group 1 (810 nm diode laser with 1 watt) , group 2 (sonic endoactivator) and group 3 (Side vented needle). Each group was further divided into three equal subgroups according to the irrigant solution into; subgroup A: chlorohexidine, subgroup B: silver nanoparticles and subgroup C: distilled water: Confocal laser scanning microscopy "CLSM" was used to assess bacterial viability. Data were analyzed by appropriate statistical analyses with P = 0.05. Results: Regarding the activation method, all groups had a significantly high percentage of dead bacteria (P < 0.05). However, Laser was significantly the highest and Endoactivator the least (P < = 0.001). Diode laser agitation of AgNps irrigant showed the highest reduction percentage of bacteria (78.1%) with a significant difference with both CHX and water irrigation, Conclusion: Under the condition of the present study; results reinforced that laser activation is a useful adjunct, 810 nm diode laser agitation of AgNps or chlorhexidine was more effective in disinfection of oval root canals than endoactivator and side vented needle techniques. (AU)

Objetivo: Avaliar a eficácia da agitação de clorohexidina (CHX) e nanopartículas de prata (AgNps) , com laser de diodo de 810 nm ou endoativador sônico, em comparação à agulha de ventilação lateral, em canais radiculares infectados com biofilmes de Enterococcus "E"; Faecalis. Material e Métodos: Sessenta e cinco pré-molares humanos com um único canal oval, extraídos, foram instrumentados pelo sistema protaper até F3. Os biofilmes de E. faecalis foram gerados com base em um protocolo previamente estabelecido. Foram utilizados dois dentes para verificar a formação do biofilme, e os dentes restantes foram divididos aleatoriamente em três grupos experimentais iguais, de acordo com as técnicas de agitação utilizadas: grupo 1 (laser de diodo 810 nm com 1 watt), grupo 2 (endoativador sônico) e grupo 3 (Agulha com ventilação lateral). Cada grupo foi dividido em três subgrupos iguais, de acordo com a solução irrigante; subgrupo A: clorohexidina, subgrupo B: nanopartículas de prata e subgrupo C: água destilada: A microscopia confocal de varredura a laser foi usada para avaliar a viabilidade bacteriana. Os dados foram analisados por análises estatísticas apropriadas com P = 0,05. Resultados: Em relação ao método de ativação, todos osgrupos apresentaram percentual significativamente alto de bactérias mortas (P < 0.05). No entanto, para o laser foi significativamente o mais alto e, para oendoativador, o menos alto (P < = 0.001). A agitação com laser de diodo doirrigante AgNps apresentou a maior porcentagem de redução de bactérias (78,1%), com diferença significativa tanto para irrigação com CHX quanto comágua. Conclusão: Sob as condições do presente estudo; os resultadosreforçaram que a ativação a laser é um complemento útil, a agitação por laserde diodo de 810 nm de AgNps ou clorexidina foi mais eficaz na desinfecção dos canais radiculares ovais do que as técnicas de endoativador e agulha com ventilação lateral. (AU)