Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we "gliflozin" patients with kidney stone disease? / Inibidores de cotransportadores sódio-glicose-2 (SGLT2) na nefrolitíase - devemos "gliflozinar" os litiásicos?

ABSTRACT The prevalence of nephrolithiasis is increasing worldwide. Despite advances in understanding the pathogenesis of lithiasis, few studies have demonstrated that specific clinical interventions reduce the recurrence of nephrolithiasis. The aim of this review is to analyze the current data and potential effects of iSGLT2 in lithogenesis and try to answer the question: Should we also "gliflozin" our patients with kidney stone disease?

RESUMO A prevalência da nefrolitíase está aumentando em todo o mundo. Apesar dos avanços na compreensão da patogênese da doença litiásica, poucos estudos demonstraram que intervenções clínicas específicas diminuem a recorrência da nefrolitíase. O objetivo desta revisão é analisar os dados atuais e efeitos potenciais dos iSGLT2 na doença litiásica e tentar responder à pergunta: devemos também "gliflozinar" os litiásicos?

Sodium intake according to NOVA food classification in Brazil: trends from 2002 to 2018 / Ingestão de sódio segundo a classificação NOVA no Brasil: tendências de 2002 a 2018 / Ingesta de sodio según la clasificación NOVA en Brasil: tendencias del 2002 al 2018

Abstract: Excessive sodium intake is a major global public health issue and the identification of dietary sources and temporal trends in its consumption are a key to effective sodium reduction policies. This study aims to update estimates of sodium intake and its dietary sources in Brazil according to the NOVA food classification system. Records of 7-day food purchases of households from the Brazilian Household Budgets Survey of 2002-2003, 2008-2009, and 2017-2018 were converted into nutrients using food composition tables and the mean availability was estimated per 2,000kcal/day. Mean daily sodium available for consumption in Brazilian households has increased from 3.9 to 4.7g per 2,000kcal, from 2002-2003 to 2017-2018, over twice the recommended levels of sodium intake. From 2002-2003 to 2017-2018, the processed culinary ingredients, including table salt, represented the largest dietary source of sodium, although their participation in dietary sodium was reduced by 17% (66.6% to 55%), while the percentage of dietary sodium from processed foods increased by 20.3% and from ultra-processed foods increased by 47.6% (11.3% to 13.6% and 17% to 25.1%, respectively). In conclusion, the total household sodium availability remains high and has increased over time in Brazil, yet the participation of different dietary sources of sodium have gradually changed.

Resumo: A ingestão excessiva de sódio é um dos principais problemas de saúde pública em todo o mundo e a identificação de fontes alimentares e tendências temporais no seu consumo são fundamentais para a elaboração de políticas eficazes de redução de sódio. Este estudo tem como objetivo atualizar as estimativas de ingestão de sódio e suas fontes alimentares no Brasil de acordo com o sistema de classificação NOVA. Os registros de compras de alimentos no período de 7 dias de famílias das Pesquisas de Orçamentos Familiares de 2002-2003, 2008-2009 e 2017-2018 foram convertidos em nutrientes utilizando tabelas de composição de alimentos. A disponibilidade média foi estimada em 2.000kcal/dia. A média diária de sódio disponível para consumo nos domicílios brasileiros aumentou de 3,9 para 4,7g por 2.000kcal, de 2002-2003 a 2017-2018, mais do que o dobro dos níveis recomendados de ingestão desse nutriente. De 2002-2003 a 2017-2018, os ingredientes culinários processados, incluindo o sal de cozinha, representaram a maior fonte de sódio, embora a sua participação no sódio dietético tenha sido reduzida em 17% (de 66,6% para 55%), enquanto a porcentagem de sódio dietético dos alimentos processados aumentou 20,3% e dos alimentos ultraprocessados aumentou 47,6% (11,3% para 13,6% e 17% para 25,1%, respectivamente). Concluindo, a disponibilidade total de sódio nos domicílios permanece alta e tem aumentado ao longo do tempo no Brasil, mas a participação de diferentes fontes dietéticas de sódio mudou gradualmente.

Resumen: La ingesta excesiva de sodio es uno de los principales problemas de salud pública en todo el mundo, y la identificación de las fuentes alimentarias y tendencias temporales en su consumo son esenciales para desarrollar políticas efectivas de reducción de sodio. Este estudio tiene como objetivo actualizar las estimaciones de la ingesta de sodio y sus fuentes alimentarias en Brasil según el sistema de clasificación NOVA. Los registros de compras de alimentos en el período de 7 días de familias de las Encuestas de Presupuestos Familiares de Brasil de 2002-2003, 2008-2009 y 2017-2018 se convirtieron en nutrientes utilizando tablas de composición de alimentos. La disponibilidad media se estimó en 2.000kcal/día. El promedio diario de sodio disponible para el consumo en los hogares brasileños aumentó de 3,9 a 4,7g por 2.000kcal, entre 2002-2003 y 2017-2018, más del doble de los niveles de ingesta recomendados de este nutriente. Entre 2002-2003 y 2017-2018, los ingredientes culinarios procesados, incluida la sal de mesa, representaron la mayor fuente de sodio, aunque su participación en el sodio dietético se redujo en un 17% (del 66,6% al 55%), mientras que el porcentaje de sodio dietético de los alimentos procesados aumentó un 20,3% y de los alimentos ultraprocesados aumentó un 47,6% (11,3% a 13,6% y 17% a 25,1%, respectivamente). En conclusión, la disponibilidad total de sodio en los hogares sigue siendo alta y ha aumentado a lo largo del tiempo en Brasil, pero la proporción de diferentes fuentes dietéticas de sodio ha cambiado gradualmente.

Role of apical sodium-dependent bile acid transporter in hepatobiliary diseases / 临床肝胆病杂志

Apical sodium-dependent bile acid transporter （ASBT） is a key transporter responsible for intestinal reabsorption of bile acid and plays an important role in maintaining bile acid and cholesterol homeostasis， and its expression is regulated by various factors including transcription factors， nuclear receptors， and intestinal microflora. The abnormal expression and function of ASBT can lead to disorders in the metabolism of bile acid and cholesterol， causing a variety of hepatobiliary diseases. At present， ASBT has attracted wide attention as a therapeutic target. This article elaborates on the biological characteristics and expression regulation mechanism of ASBT and reviews the role of ASBT in hepatobiliary diseases， in order to provide a new direction for the treatment of related diseases.

Experimental study of Lentinan antagonizes against hepatic lipid deposition induced by sodium arsenite in mice / 公共卫生与预防医学

Objective To investigate the ameliorative effect of Lentinan (LNT) on sodium arsenite (SA)-induced hepatic lipid deposition in mice. Methods C57BL/6 mice were used as the experimental subjects, which were divided into control group, SA-exposed group, LNT + SA-exposed group and LNT control group. Blood and liver tissue samples were collected at the end of the experiment, and serum glutathione transaminase (ALT) and glutathione aminotransferase (AST) levels were detected by enzyme-linked immunosorbent assay (ELISA). A part of liver tissues was stained with hematoxylin-eosin (HE) or oil red O to observe the characteristics of liver pathological damage and lipid deposition, and another part of liver tissues was used to detect triglyceride (TG) and Adiponectin (APN) levels by ELISA. Results Compared with control group or LNT control group, SA-exposed group showed the increased levels of AST and ALT, showing the characteristics of liver histopathological damage and lipid deposition, and the APN level decreased while the TG level increased (P<0.05). Compared with SA-exposed group, the levels of AST and ALT decreased in LNT + SA-exposed group, showing the reduced degree of liver tissue damage and lipid deposition, and APN level upregulated while TG level downregulated (P<0.05). Conclusion Chronic SA exposure induces liver function damage, APN downregulation and lipid deposition in C57BL/6 mice, while LNT intervention leads to the significantly improvement of hepatic damage and lipid deposition, which may be related to the elevated APN level in liver.

Melatonin inhibits arrhythmias induced by increased late sodium currents in ventricular myocytes / 药学学报

Melatonin (Mel) has been shown to have cardioprotective effects, but its action on ion channels is unclear. In this experiment, we investigated the inhibitory effect of Mel on late sodium currents (INa.L) in mouse ventricular myocytes and the anti-arrhythmic effect at the organ level as well as its mechanism. The whole-cell patch clamp technique was applied to record the ionic currents and action potential (AP) in mouse ventricular myocytes while the electrocardiogram (ECG) and monophasic action potential (MAP) were recorded simultaneously in mouse hearts using a multichannel acquisition and analysis system. The results demonstrated that the half maximal inhibitory concentration (IC50) values of Mel on transient sodium current (INa.T) and specific INa.L opener 2 nmol·L-1 sea anemone toxins II (ATX II) increased INa.L were 686.615 and 7.37 μmol·L-1, respectively. Mel did not affect L-type calcium current (ICa.L), transient outward current (Ito), and AP. In addition, 16 μmol·L-1 Mel shortened ATX II-prolonged action potential duration (APD), suppressed ATX II-induced early afterdepolarizations (EADs), and significantly reduced the incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in Langendorff-perfused mouse hearts. In conclusion, Mel exerted its antiarrhythmic effects principally by blocking INa.L, thus providing a significant theoretical basis for new clinical applications of Mel. Animal welfare and experimental process are in accordance with the regulations of the Experimental Animal Ethics Committee of Wuhan University of Science and Technology (2023130).

Effect of low concentration of sodium fluoride on osteogenic/odontogenic differentiation of human dental pulp cells / 口腔疾病防治

Objective@#To study the effect of low concentrations of sodium fluoride on the osteogenic/odontogenic differentiation of human dental pulp cells (hDPCs) in vitro.@*Methods@#This study was reviewed and approved by the Ethics Committee. hDPCs were cultured using a modified tissue explant technique in vitro. The effects of different concentrations of sodium fluoride on the proliferation of hDPCs were measured by methylthiazol tetrazolium (MTT) assay. Appropriate concentrations were added to the osteogenic/odontogenic differentiation induction medium, and the cells were induced in vitro. Alizarin red S staining was used to detect the osteoblastic/odontogenic differentiation ability of the cells, and the mRNA expression of the key differentiation factors was detected by RT-qPCR. Moreover, the expression of key molecules of endoplasmic reticulum stress (ERS) was detected by RT-qPCR and Western blot. The data were analyzed with the SPSS 18.0 software package.@*Results@#Low concentration of NaF (0.1 mmol/L) could stimulate cell proliferation in vitro, while a high concentration (5-10 mmol/L) could inhibit cell proliferation (P<0.05). According to the literature and the experimental data, 0.1 mmol/L NaF was selected as the following experimental concentration. The levels of alizarin red S staining were increased after NaF induction of mixed osteogenic/odontogenic differentiation in vitro. The mRNA expression levels of key molecules for osteogenic/odontogenic differentiation, dentin sialophosphoprotein (DSPP), bone sialoprotein (BSP) and osteocalcin (OCN), were increased (P<0.05). The mRNA levels of ERS markers (splicing x-box binding protein-1 (sXBP1), glucose-regulated protein 78 (GRP78) and activating transcription Factor 4 (ATF4) were increased in NaF-treated cells. The protein expression levels of key ER stress molecules (phosphorylated RNA-activated protein kinase-like ER-resident kinase (p-PERK), phosphorylated eukaryotic initiation factor-2α (p-eIF2α) and ATF4) were higher in NaF-treated cells.@*Conclusion@#A low concentration of NaF promotes the osteogenic/odontogenic differentiation of hDPCs and increases the level of ER stress.

Acidente de hipoclorito de sódio durante retratamento endodôntico / Sodium hypochlorite accident during endodontic retreatment / Accidente con hipoclorito de sodio durante retratamiento

O retratamento endodôntico é uma intervenção executada em um dente que já apresenta um tratamento realizado anteriormente que foi mal sucedido clínica e/ou radiograficamente. O objetivo deste trabalho foi o de relatar um caso de retratamento endodôntico na clínica de Atenção Básica III da Faculdade de Odontologia de Pernambuco devido ao desconforto estético do incisivo lateral superior que estava fraturado e necessitando de prótese fixa. Após anamnese, exames extra e intra-oral e exames radiográficos, constatou-se o canal do dente 12 havia sido tratado endodonticamente há aproximadamente quatro anos. A remoção da gutta percha contaminada foi realizada com as limas rotatórias EasyLogic RT® 25mm sequência 30.10 torque 4N e 900 RPM, 25.08 torque 4Ne 900 RPM. Após remoção da guta-percha, realizou-se o protocolo de irrigação com solução de hipoclorito de sódio a 2,5% (Biodinâmic). A odontometria foi realizada com localizador apical e confirmada por radiografia periapical e o repreparo do canal radicular confeccionado com a Lima EasyLogic 2® de número 35.06 e posterior irrigação com a solução de Labarraque. Nesse momento, o paciente relatou dor e após aspiração com sugador endodôntico, notou-se sangramento abundante, correspondendo ao extravasamento do hipoclorito de sódio (Enfizema por hipoclorito de sódio. O paciente foi medicado com Amoxacilina 875mg de 12 em 12 horas durante sete dias, Predisin 20mg ­ Corticóide - um comprimido pela manhã por 4 dias e Nimesulida 100mg de 12 em 12 horas durante 5 dias. Após 24 horas o paciente não relatou dor nem edema. Na segunda sessão, 10 dias após o acidente, a obturação foi realizada com cone único de guta-percha 35.06 HBassi (Easy, associado ao cimento Bio C Sealer Fillapex (Angelus®). Concluiu-se que a conduta terapêutica imediata instituída para este caso, foi efetiva para o controle da dor e prevenção de complicações adicionais após injeção acidental de hipoclorito de sódio.

Endodontic retreatment is an intervention performed on a tooth that already has a previously performed treatment that was clinically and/ or radiographically unsuccessful. The objective of this study was to report a case of endodontic retreatment at the Primary Care Clinic III of the Faculty of Dentistry of Pernambuco due to the aesthetic discomfort of the maxillary lateral incisor that was fractured and required a fixed prosthesis. After anamnesis, extra and intraoral exams and radiographic exams, it was found that the root canal of tooth 12 had been endodontically treated for approximately four years. Removal of contaminated gutta percha with those performed with EasyLogic RT® 25mm rotary files sequence 30.10 torque 4N and 900 RPM, 25.08 torque 4N and 900 RPM. After removing the gutta-percha, the irrigation protocol was performed with a 2.5% sodium hypochlorite solution (Biodynamic). Odontometry was performed with an apex locator and confirmed by periapical radiography and root canal re-preparation made with EasyLogic 2® File number 35.06 and subsequent irrigation with Labarraque's solution. At that moment, the patient reported pain and after aspiration with an endodontic sucker, there was profuse bleeding, corresponding to sodium hypochlorite extravasation (Sodium hypochlorite emphysema. The patient was medicated with Amoxicillin 875mg every 12 hours for seven days, Predisin 20mg - Corticosteroid - one tablet in the morning for 4 days and Nimesulide 100mg every 12 hours for 5 days. After 24 hours the patient did not report pain or swelling. In the second session, 10 days after the accident, the filling was performed with a single cone of gutta-percha 35.06 HBassi (Easy, associated with Bio C Sealer Fillapex cement (Angelus®). It was concluded that the immediate therapeutic approach instituted for this case was effective for pain control and prevention of complications. additional doses after accidental injection of sodium hypochlorite.

El retratamiento endodóntico es una intervención que se realiza sobre un diente que ya tiene un tratamiento realizado previamente que resultó clínica y/o radiográficamente fallido. El objetivo de este estudio fue relatar un caso de retratamiento endodóntico en la Clínica de Atención Básica III de la Facultad de Odontología de Pernambuco debido a la incomodidad estética del incisivo lateral maxilar que estaba fracturado y requirió prótesis fija. Después de anamnesis, exámenes extraorales, intraorales y exámenes radiográficos, se encontró que el conducto radicular del diente 12 había sido tratado endodónticamente durante aproximadamente cuatro años. Eliminación de gutapercha contaminada con las realizadas con limas rotatorias EasyLogic RT® 25mm secuencia 30.10 torque 4N y 900 RPM, 25.08 torque 4N y 900 RPM. Tras retirar la gutapercha, se realizó el protocolo de irrigación con una solución de hipoclorito de sodio al 2,5% (Biodynamic). Se realizó odontometría con localizador de ápices y se confirmó mediante radiografía periapical y repreparación del conducto radicular realizada con EasyLogic 2® File número 35.06 y posterior irrigación con solución de Labarraque. En ese momento el paciente refirió dolor y luego de aspiración con ventosa endodóntica presentó sangrado profuso, correspondiente a extravasación de hipoclorito de sodio (Enfisema por hipoclorito de sodio. El paciente fue medicado con Amoxicilina 875mg cada 12 horas por siete días. Predisin 20mg - Corticosteroide - una tableta por la mañana por 4 días y Nimesulida 100mg cada 12 horas por 5 días, luego de 24 horas el paciente no refirió dolor ni hinchazón, en la segunda sesión, 10 días después del accidente, se realizó el relleno con un solo cono de gutapercha 35.06 HBassi (Easy, asociado al cemento Bio C Sealer Fillapex (Angelus®). Se concluyó que el abordaje terapéutico inmediato instituido para este caso fue eficaz para el control del dolor y la prevención de complicaciones. dosis adicionales después de accidente inyección de hipoclorito de sodio.

Dapagliflozin in patients with critical illness: rationale and design of the DEFENDER study / Dapagliflozina em pacientes com doença crítica: justificativa e desenho do estudo DEFENDER

ABSTRACT Background: Critical illness is a major ongoing health care burden worldwide and is associated with high mortality rates. Sodium-glucose cotransporter-2 inhibitors have consistently shown benefits in cardiovascular and renal outcomes. The effects of sodium-glucose cotransporter-2 inhibitors in acute illness have not been properly investigated. Methods: DEFENDER is an investigator-initiated, multicenter, randomized, open-label trial designed to evaluate the efficacy and safety of dapagliflozin in 500 adult participants with acute organ dysfunction who are hospitalized in the intensive care unit. Eligible participants will be randomized 1:1 to receive dapagliflozin 10mg plus standard of care for up to 14 days or standard of care alone. The primary outcome is a hierarchical composite of hospital mortality, initiation of kidney replacement therapy, and intensive care unit length of stay, up to 28 days. Safety will be strictly monitored throughout the study. Conclusion: DEFENDER is the first study designed to investigate the use of a sodium-glucose cotransporter-2 inhibitor in general intensive care unit patients with acute organ dysfunction. It will provide relevant information on the use of drugs of this promising class in critically ill patients. ClinicalTrials.gov registry: NCT05558098

RESUMO Antecedentes: A doença crítica é um importante ônus permanente da assistência médica em todo o mundo e está associada a altas taxas de mortalidade. Os inibidores do cotransportador de sódio-glicose do tipo 2 têm demonstrado consistentemente benefícios nos desfechos cardiovasculares e renais. Os efeitos dos inibidores do cotransportador de sódio-glicose do tipo 2 em doenças agudas ainda não foram devidamente investigados. Métodos: O DEFENDER é um estudo de iniciativa do investigador, multicêntrico, randomizado, aberto, desenhado para avaliar a eficácia e a segurança da dapagliflozina em 500 participantes adultos com disfunção orgânica aguda hospitalizados na unidade de terapia intensiva. Os participantes aptos serão randomizados 1:1 para receber 10mg de dapagliflozina e o tratamento padrão por até 14 dias ou apenas o tratamento padrão. O desfecho primário é um composto hierárquico de mortalidade hospitalar, início de terapia renal substitutiva e tempo de internação na unidade de terapia intensiva, até 28 dias. O monitoramento da segurança será rigoroso durante todo o estudo. Conclusão: O DEFENDER é o primeiro estudo desenvolvido para investigar o uso de um inibidor do cotransportador de sódio-glicose do tipo 2 em pacientes de unidade de terapia intensiva geral com disfunção orgânica aguda. O estudo fornecerá informações relevantes sobre o uso de medicamentos dessa classe promissora em pacientes críticos. Registro ClincalTrials.gov: NCT05558098

Antimicrobial effect of phytosphingosine in acrylic resin

Abstract This study evaluated color stability (CS), anti-adherence effect (AAE), and cell viability of microorganisms on acrylic resin (AR) surface, treated associated or not with sodium percarbonate (SP). AR specimens were prepared, and color analysis was performed before and after the treatments and the CS was calculated. For analysis of AAE, the samples were sterilized by radiation in a microwave oven. Then samples were randomly distributed: phosphate-buffered saline (PBS - control), 0.5% sodium hypochlorite (SH), phytosphingosine (PHS), and phytosphingosine + SP (PHS+Na2CO3). The specimens remained in contact with solutions for 30 minutes and were later contaminated by Candida albicans. Aliquots were seeded in Petri dishes with Sabouraud Dextrose agar and incubated at 37°C for 24 hours. After the incubation, the number of colonies was counted. The cell viability of adhered microorganisms on the AR was evaluated and 20 fields were observed under an epifluorescence microscope, and the percentage of adhered viable cells was calculated. Data were compared (One-way ANOVA, Tukey, p<.05). As for CS, PHS+ Na2CO3 (0.4±0.1) resulted in less change than PBS (0.9±0.2), similar to the other groups (SH [1.0±0.3)]; PHS [0.9±0.2)]). There was no difference for all tested solutions regarding the ability to avoid microorganism adherence (p>0.05), but PHS (11.2±4.1) resulted in a smaller area of adhered viable cells, statistically different from SH (18.2±7.6) and PBS (26.4±10.8). It was concluded that PHS resulted in lower adhered viable cells and when associated with Na2CO3, also shows a lower effect on the CS of AR.

Resumo Este estudo avaliou estabilidade de cor (EC), efeito antiaderente (EAA) e viabilidade celular de microrganismos em superfície de resina acrílica (RA), tratada com solução de fitoesfingosina, associada ou não ao percarbonato de sódio (PS). Espécimes RA foram preparados e análise de cor foi realizada antes e após os tratamentos e EC foi calculada. Para análise de EAA, as amostras foram esterilizadas por radiação em forno de micro-ondas. Então foram distribuídas aleatoriamente: solução salina tamponada com fosfato (PBS - controle), hipoclorito de sódio 0,5% (SH), fitoesfingosina (PHS) e fitoesfingosina + SP (PHS+Na2CO3). Os espécimes permaneceram em contato com as soluções por 30 minutos e posteriormente foram contaminados por Candida albicans. Alíquotas foram semeadas em placas de Petri com ágar Sabouraud Dextrose e incubadas a 37°C por 24 horas. Após a incubação, o número de colônias foi contado. A viabilidade celular dos microorganismos aderidos na RA foi avaliada e 20 campos foram observados em microscópio de epifluorescência, e a porcentagem de células viáveis aderidas foi calculada. Os dados foram comparados (One-way ANOVA, Tukey, p<0,05). Quanto a EC, o PHS+ Na2CO3 [0,4 (0,1)] resultou em menor alteração que o PBS [0,9 (0,2)], semelhante aos demais grupos (SH [1,0 (0,3)]; PHS [0,9 (0,2)]). Não houve diferença para todas as soluções testadas quanto à capacidade de evitar a aderência de microorganismos (p>0,05), mas o PHS [11,2 (4,1)] resultou em uma área menor de células viáveis aderidas, estatisticamente diferente do SH [18,2 (7,6)] e PBS [26,4 (10,8)]. Concluiu-se que o PHS resultou em menor número de células viáveis aderidas e, quando associado ao Na2CO3, também apresenta menor efeito sobre o EC da RA.

Irrigants and irrigation activation systems in Endodontics

Abstract Root canal infections are typically polymicrobial and involve strong bacterial interactions. The goal of endodontic treatment is to remove infected content from the root canal system to allow the healing of a pre-existing periapical lesion or to prevent infection of the periradicular tissues. Instrumentation alone is not capable of touching all of the root canal walls. Therefore, the irrigation process is an essential step in the endodontic treatment. However, due to the complex anatomy of the root canal system, this cleaning is very challenging. Although syringe and needle irrigation associated with the use of chemical substances is still the most used method, it does not guarantee optimal cleaning of the root canals. As a result, not only alternative irrigating substances but also numerous activation systems - which are technologies that aim to optimize the action of irrigating substances, both chemically and physically - have been developed. This work aimed to review the characteristics of both classic and current alternatives of irrigating substances and irrigation activation systems.

Resumo As infecções dos canais radiculares são tipicamente polimicrobianas e envolvem fortes interações bacterianas. O objetivo do tratamento endodôntico é remover o conteúdo infeccioso do sistema de canais radiculares, a fim de permitir a cicatrização de uma lesão periapical pré-existente ou prevenir a infecção dos tecidos perirradiculares. A instrumentação por si só não é capaz de tocar todas as paredes dos canais radiculares, desta forma a irrigação é uma etapa essencial no tratamento endodôntico. No entanto, devido à complexa anatomia do sistema de canais radiculares, essa limpeza é muito desafiadora. Embora a irrigação convencional com seringa e agulha, fazendo o uso de substâncias auxiliares seja o método mais utilizado, ela não garante a limpeza ideal dos canais radiculares. Como resultado, foram desenvolvidos inúmeros sistemas de ativação que visam otimizar a ação das substâncias irrigadoras, tanto química quanto fisicamente. O objetivo deste artigo foi revisar as características das substâncias irrigadoras (clássicas e alternativas) e dos sistemas de ativação destas substâncias.

Sodio urinario como factor pronóstico para mortalidad en pacientes con falla cardiaca aguda descompensada

Introducción. En los pacientes con falla cardíaca, el sodio urinario se ha propuesto como marcador de gravedad y resistencia a los diuréticos, pero los resultados de los estudios reportados son heterogéneos. Objetivo. Evaluar el sodio en orina ocasional como factor pronóstico de mortalidad en pacientes con falla cardiaca descompensada. Materiales y métodos. Se realizó un análisis anidado de casos y controles de una cohorte prospectiva de falla cardíaca descompensada. El desenlace primario fue mortalidad a los 180 días. Se hizo un análisis bivariado para evaluar las variables que se asocian con la mortalidad. Se analizaron las diferencias de las variables clínicas entre los grupos con sodio urinario mayor o menor de 70 mEq/L. Resultados. Se incluyeron 79 pacientes de los cuales 15 fallecieron a los 180 días. La edad promedio fue de 68,9 años (DE: ±13,8), 30 eran mujeres (38 %). Quince pacientes (18,9 %) tuvieron un sodio en orina inferior a 70 mEq/L. En el análisis bivariado se encontró una asociación significativa de la mortalidad con las hospitalizaciones, la presión arterial sistólica inferior a 90 mm Hg, el uso de inotrópicos y el sodio urinario inferior a 70 mEq/L. Los pacientes con sodio urinario bajo habían estado hospitalizados con mayor frecuencia en el último año, tenían menores valores de sodio sérico y presión arterial al ingreso. Conclusión. Los pacientes con sodio urinario inferior a 70 mEq/L tienen características de mayor gravedad. En el análisis bivariado, el sodio urinario se asoció con mortalidad a los 180 días.

Introduction. Urinary sodium has been proposed as a prognostic marker and indicator of the diuretic response in patients with heart failure. However, study results are heterogeneous. Objective. To evaluate the spot urinary sodium level as a risk factor for mortality in patients with decompensated heart failure. Materials and methods. We conducted a case-control study nested in a prospective cohort of patients with decompensated heart failure. The primary outcome was mortality at 180 days. The risk factors associated with mortality were evaluated through a bivariate analysis. Differences in clinical variables between groups with urinary sodium greater than or lesser than 70 mEq/L were analyzed. Results. The study included 79 patients; 15 died at 180 days. Their mean age was 68.9 years (SD=± 13.8); 30 were women (38%), and 15 (18.9%) had urinary sodium <70 mEq/L. In the bivariate analysis, a significant association was found between mortality and past medical history of hospitalizations, SBP<90 mm Hg, the use of inotropes, and urinary sodium <70 mEq/L. Regarding clinical characteristics, patients with low urinary sodium level in the last year were hospitalized more frequently with hyponatremia and hypotension at admission. Conclusion. Patients with urinary sodium <70 mEq/L had more severe signs. In a bivariate analysis, urinary sodium was associated with mortality at 180 days.

Contenido de sodio en preparaciones de consumo frecuente fuera del hogar en tres zonas de Lima Metropolitana, Perú / Sodium content in commonly consumed away-from-home food in three areas of Metropolitan Lima, Peru

El objetivo fue caracterizar el contenido de sodio en preparaciones de consumo frecuente fuera del hogar en tres zonas de Lima Metropolitana. Se realizó un estudio transversal para el cual se identificaron veinte preparaciones de consumo frecuente según el lugar de expendio. La determinación del contenido de sodio se obtuvo mediante espectroscopía de absorción atómica en preparaciones recolectadas en el 2019. La mediana del contenido de sodio en productos de venta ambulatoria fue 492,36 mg/100 g (RIQ: 83,93 - 918,78); 471,37 mg/100 g, en preparaciones tradicionales y típicas (RIQ: 76,04 - 765,39); y 471,06 mg/100 g (RIQ: 115,31 - 695,18), en comidas rápidas. El 65% de las preparaciones fueron consideradas altas en sodio según los parámetros peruanos, mientras que el 30% de las preparaciones también presentaron un alto contenido, de acuerdo con los parámetros del Reino Unido. La mayoría de las preparaciones expendidas y consumidas fuera del hogar presentan un elevado contenido de sodio. Es esencial involucrar a todos los actores que participan en la preparación de alimentos para el consumo fuera del hogar, con el fin de sensibilizarlos e incluirlos en la promoción de políticas enfocadas en la reducción del consumo de sodio.

The aim of this study was to characterize the sodium content in commonly consumed away-from-home food in three areas of Metropolitan Lima. We conducted a cross-sectional study, in which twenty frequently consumed foods were identified according to the place of sale. Sodium content was determined through atomic absorption spectroscopy in preparations collected in 2019. The median sodium content in street food products was 492.36 mg/100g (IQR: 83.93 - 918.78), 471.37 mg/100 g in artisanal food (IQR: 76.04 - 765.39) and 471.06 mg/100 g in fast food (IQR: 115.31 - 695.18). Sixty-five percent of the foods were classified as having high sodium content according to Peruvian regulations, while 30% of the preparations had high sodium content, according to UK parameters. Most food sold and consumed away from home have high sodium content. It is essential to engage all stakeholders involved in food preparation for away-from-home consumption in order to raise awareness and involve them in the promotion of policies aimed at reducing sodium intake.

Main results and public health implications of the National School Health Survey (ENSE), Colombia 2017

Introduction: The school population represents a fundamental group for health promotion actions, given that the foundations of healthy behaviors in adult life are established in children and adolescents, who can be greatly influenced by the school. Objective: To describe the health-related behavioral factors of schoolchildren between 13 and 17 years of age in secondary and middle school in Colombia. Methods: A national cross-sectional study was conducted (i.e., School Health Survey -ENSE-) that recorded information on dietary practices, physical activity, alcohol and drug consumption, injuries and bullying, and oral, visual and hearing health. Sampling was probabilistic, cluster and multistage. Results: Schoolchildren have low consumption of fruits, vegetables (13.1%) and dairy (76.5 %), high consumption of ultra-processed foods (82.4 %), sugary drinks (74.0 %) and fast foods (14.8 %), frequent addition of salt at the table (43.3 %), low compliance with physical activity recommendations (15.0 %) and high sedentary lifestyle (46.3 %), frequent consumption of alcohol (44.7 %) and psychoactive substances (14.7 %), in addition to prevalent situations of bullying (15.4 %), rejection (8.2 %) and verbal aggression (42.7 %). Conclusions: The ENSE shows critical inequalities by gender, ethnicity and social class, throughout the country. The indicators observed in schoolchildren are precursors of various chronic and degenerative diseases and mental illness, which requires the urgent attention of the different social actors in the country.

Introducción: La población escolar es un grupo fundamental para las intervenciones de promoción de la salud, ya que en los niños y adolescentes se sientan las bases de un comportamiento saludable en la vida adulta, que puede ser muy influenciado por la escuela. Objetivo: Describir los factores comportamentales relacionados con la salud de los escolares de 13 a 17 años de edad que cursan educación básica secundaria y media en Colombia. Métodos: Se realizó una encuesta nacional transversal (Encuesta de Salud en Escolares -ENSE-) con los lineamientos de Global School-based Student Health Survey para recolectar información sobre prácticas alimentarias, actividad física, consumo de alcohol y drogas, lesiones e intimidación, y salud bucal, visual y auditiva. El muestreo fue probabilístico, por conglomerados y polietápico. Resultados: Se incluyeron 79.640 escolares de 298 municipios. Los escolares presentaron bajo consumo de frutas, verduras (13.1%) y productos lácteos (76.5 %), alto consumo de alimentos ultraprocesados (82.4 %), bebidas azucaradas (74.0 %) y comidas rápidas (14.8 %); alto uso de sal añadida en la mesa (43.3 %), actividad física inferior a la recomendada (15.0 %) y sedentarismo (46.3 %). Fue frecuente el consumo de alcohol (44.7 %) y sustancias psicoactivas (14.7 %) y reportaron situaciones de intimidación (15.4 %), rechazo (8.2 %) y agresiones verbales (42.7 %). Conclusiones: La ENSE muestra desigualdades por género, etnia y clase social en todo el país. Los hallazgos observados en los escolares son factores de riesgo de enfermedades crónico-degenerativas y mentales, y requieren la atención urgente de los actores sociales del país.

Role of Dietary Management and Physical Activity in Control of Hypertension in Rural Areas of Punjab-A Cross-sectional Study

Introduction: As reported by WHO, hypertension is the third ‘killer’ disease, accounting for one in every eight deaths worldwide. Many modifiable and non-modifiable risk factors are found to be associated with the disease. The present study aims to determine the role of dietary management and physical activity in the control of hypertension in a given population. Material and Methods: A cross-sectional study was conducted that. Study included all hypertensive patients (290) from the field practice area of a tertiary care institute. A self-constructed, pretested questionnaire was used to enquire about the socio- demographic factors and other risk factors associated with hypertension. The data was analyzed using SPSS 23 and valid conclusions were drawn by using the chi-square test. Results: Out of 290 patients, 204 (70.3%) were females and 86 (29.7%) were males. Univariate analysis identified decreased salt intake, decreased fatty food consumption, physical activity, stress management, and spiritual help as highly significant factors affecting hypertension. On multivariate analysis, physical activity, stress management and spiritual help were found to be significant. Conclusion: The study showed that physical activity, stress management and spiritual help were significantly associated with hypertension control among the elderly. Measures should be taken to create awareness about lifestyle modifications in the control of hypertension.

Effect of sodium/calcium hypochlorite on adhesion and adaptation of fiber posts luted with a dual resin cement

Abstract This study aimed to evaluate the effect of different concentrations of sodium hypochlorite (NaOCl) and calcium hypochlorite [Ca(OCl)2] on the bond strength and adaptation of glass fiber posts luted with a dual-curing resin cement. Fifty decoronated premolars were sectioned 14 mm from the apex and endodontically treated. The root canal filling was partially removed. The specimens were divided into 5 groups (n=10) according to the irrigant for post space irrigation: 0.9% sodium chloride (NaCl), (control); 2.5% NaOCl; 5.25% NaOCl; 2.5% Ca(OCl)2; and 5.25% Ca(OCl)2. For each group, irrigation was performed with 5 ml of solution. Afterward, the posts were luted with a dual-curing resin cement. One slice from each third was obtained and submitted to the push-out test and failure modes analysis. An additional slice from the middle third was submitted to confocal images for analysis of adaptation failures (gaps). Two-way ANOVA, Tukey's post-hoc, Kruskal-Wallis with Bonferroni adjusted, and chi-square tests, analyzed data. The group treated with 5.25% NaOCl showed lower bond strength values and generated more cohesive failures compared to the control (p < 0.05). Bond strength decreased from coronal to apical in the post space (p < 0.001). The groups treated with NaOCl had the highest percentages of gaps compared to the control (p < 0.05). Regardless of concentration, Ca(OCl)2 did not influence the bond strength and the occurrence of gaps (P > 0.05). Ca(OCl)2 is a good option for irrigating the post space before luting a fiber post with a dual-curing resin cement.

Resumo Este estudo teve como objetivo avaliar o efeito de diferentes concentrações de hipoclorito de sódio (NaOCl) e hipoclorito de cálcio [Ca(OCl)2] na resistência de união e adaptação de pinos de fibra de vidro cimentados com um cimento resinoso dual. Cinquenta pré-molares tiveram suas coroas removidas, foram seccionados a 14 mm do ápice e tratados endodonticamente. A obturação do canal radicular foi parcialmente removida. Os espécimes foram divididos em 5 grupos (n=10) de acordo com o irrigante para irrigação do espaço do pino: cloreto de sódio 0.9% (NaCl), (controle); NaOCl 2.5%; NaOCl 5.25%; Ca(OCl)2 2.5%; e Ca(OCl)2 5.25%. Para cada grupo, a irrigação foi realizada com 5 ml da solução. Posteriormente, os pinos foram cimentados com um cimento resinoso dual. Uma fatia de cada terço foi obtida e submetida ao teste push-out e análise dos modos de falha. Um corte adicional do terço médio foi submetido a imagens confocais para análise de falhas de adaptação (gaps). Os dados foram analisados pelos testes ANOVA de duas vias, post-hoc de Tukey, Kruskal-Wallis com ajuste de Bonferroni e qui-quadrado. O grupo tratado com NaOCl 5.25% apresentou menores valores de resistência de união e gerou mais falhas coesivas em relação ao controle (p < 0.05). A resistência de união diminuiu de coronal para apical no espaço do pino (p < 0.001). Os grupos tratados com NaOCl apresentaram os maiores percentuais de gaps em relação ao controle (p < 0.05). Independentemente da concentração, o Ca(OCl)2 não influenciou a resistência de união e a ocorrência de gaps (P > 0.05). O Ca(OCl)2 é uma boa opção para irrigar o espaço do pino antes de cimentar um pino de fibra com um cimento resinoso dual.

Analysis of antimicrobial efficacy of sodium hypochlorite and ozonated water against biofilm in oval canals

Abstract This in vitro study compared the antimicrobial efficacy of 2.5% sodium hypochlorite (NaOCl) and 8 µg/mL ozonated water agitated by passive ultrasonic irrigation (PUI) or PUI combined with EndoActivator (EA) against mature multispecies biofilm. One hundred and five oval-shaped mandibular premolars were instrumented, sterilized, and inoculated with Enterococcus faecalis, Candida albicans, and Staphylococcus aureus, divided into: control group - saline; O3 group - ozonated water; O3 PUI group - ozonated water with PUI agitation; O3 PUI+EA group - ozonated water with PUI+EA agitation; NaOCl group - NaOCl; NaOCl PUI group - NaOCl with PUI agitation; and NaOCl PUI+EA group - NaOCl with PUI+EA agitation. Microbiological samples were collected before (S1) and after (S2) the disinfection procedures and the data were statistically analyzed using the Kruskal-Wallis test. In the culture method, there was significant disinfection in the O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). The combination of NaOCl with PUI+EA reduced microbial counts to zero (p˂0.05). In the qPCR method, there was a significant reduction in the total count of viable microorganisms in the O3 PUI, O3 PUI+EA, NaOCl, NaOCl PUI, and NaOCl PUI+EA groups (p˂0.05). It can be concluded that 2.5% NaOCl with and without agitation, as well as 8 µg/mL ozonated water with its action enhanced by the agitation techniques, were effective in root canal disinfection, and their antimicrobial efficacy is related to the microorganisms present in the biofilm.

Resumo Este estudo in vitro comparou a desinfecção do hipoclorito de sódio 2,5% (NaOCl) e da água ozonizada 8 µg/mL agitados pela irrigação ultrassônica passiva (PUI) e por associação da PUI com EndoActivator (EA) na redução de biofilme misto maduro. Cento e cinco pré-molares inferiores ovalados foram instrumentados, esterilizados e inoculados com Enterococcus faecalis, Candida albicans e Staphylococcus aureus, divididos em: Grupo controle: soro; Grupo O3: água ozonizada; Grupo O3 PUI: água ozonizada agitada por PUI; Grupo O3 PUI + EA: água ozonizada agitada por PUI e EA: Grupo NaOCl: hipoclorito de sódio; Grupo NaOCl PUI: hipoclorito de sódio agitado por PUI; Grupo NaOCl PUI + EA: hipoclorito de sódio agitado por PUI e EA. Amostras microbiológicas foram coletadas antes (S1) e após (S2) os procedimentos de desinfecção e os dados foram analisados estatisticamente pelo teste de Kruskal-Wallis. No método de cultura, houve desinfecção significativa nos grupos O3 PUI + EA, NaOCl, NaOCl PUI e NaOCl PUI + EA (p˂0.05), sendo que no grupo NaOCl PUI + EA não houve crescimento de microrganismo (p˂0.05). No método de qPCR, nas contagens dos microrganismos antes e após os protocolos de desinfecção, houve redução microbiana nos grupos O3 PUI, O3 PUI + EA, NaOCl, NaOCl PUI, NaOCl PUI + EA (p˂0.05). Concluiu-se que o NaOCl 2,5% com e sem agitação foi eficiente, assim como a água ozonizada 8 µg/mL potencializada pelos métodos de agitação na desinfecção e que a mesma está relacionada com os microrganismos presentes no biofilme.

Comparación de la eficacia y toxicidad del estibogluconato de sodio y antimoniato de meglumina en el tratamiento de leishmaniasis cutánea en Perú / Efficacy and safety of sodium stibogluconate compared to meglumine antimoniate in the treatment of cutaneous leishmaniasis in Peru

Objetivos : Comparar la eficacia y toxicidad del antimoniato de meglumina (AM) y estibogluconato sódico (EGS) en el tratamiento de leishmaniasis cutánea (LC) en un hospital general. Material y métodos : Serie de casos comparativa de 193 pacientes con LC tratados en tres ensayos clínicos con AM (n=69) y EGS (n=124) durante 2001-2010. La administración de ambas drogas fue vía endovenosa lenta de 20 mg Sb5+/kg/día por 20 días consecutivos siguiendo las normativas de la OPS y OMS. La información clínica, toxicidad y eficacia fue obtenida de las historias clínicas almacenadas en el centro de investigación según la normativa local e internacional. Resultados : Las características demográficas fueron similares entre grupos, pero el tamaño y número de lesiones fueron mayores en el grupo AM. La eficacia del tratamiento con AM fue 76,0% versus 68,4% con EGS (p=0,340) y 55,1% versus 50,8% (p=0,570) en el análisis por protocolo y de intención de tratar, respectivamente. No se observaron efectos adversos inmediatos. Los síntomas más frecuentemente reportados fueron disgeusia (37,0%), mareos (32,0%), cefalea (36,0%), artralgias (31,0%) y linfangitis (21,0%). Los tres primeros síntomas, así como elevación de transaminasas, leucopenia, trombocitopenia y QTc prolongado fueron frecuentes en el grupo EGS, pero clínica y estadísticamente no significativos. El tratamiento fue suspendido definitivamente por toxicidad severa únicamente con EGS por emesis refractaria (2 participantes) y QTc prolongado con extrasístoles (1 participante). Conclusiones : La eficacia del tratamiento con AM y EGS fue comparable. La administración endovenosa de ambos no produjo efectos adversos inmediatos, aunque sí alteraciones clínicas y laboratoriales usuales.

SUMMARY Objectives : To compare the efficacy and safety of sodium stibogluconate (SS) and meglumine antimoniate (MA) in the treatment of cutaneous leishmaniasis (CL) in a general hospital. Methods: Case-series of 193 patients with CL treated in three clinical trials with MA (n=69) and SS (n=124) during 2001-2010. Both study drugs were administered intravenously at a slow speed at 20 mg Sb5+/kg/day for 20 consecutive days following WHO-PAHO recommendations. Clinical and safety data were gathered from clinical files. Results: Demographic characteristics were similar between the study groups, but the size and number of lesions were higher in the MA group. Efficacy was 76.0% in the MA vs. 68.4% in the SS group (p=0.340) and 55.1% vs. 50.8% (p=0.570) in the per protocol and intention to treat analysis. respectively. Side effects more frequently reported were dysgeusia (37.0%). dizziness (32.0%). headache (36.0%). arthralgia (31.0%) and lymphangitis (21.0%). These first three symptoms as well as elevation of transaminases, leukopenia, thrombocytopenia and prolonged QTc were numerically more frequent in the SS group but without reaching statistical significance. Treatment was stopped definitively for severe toxicity in the SS group due to refractory emesis (two patients) and prolonged QTc (one patient). Conclusions: The efficacy of MA and SS is comparable. The intravenous administration of these compounds did not produce immediate reactions, but it was associated with unusual clinical and laboratory abnormalities.

Irrigation protocols effects on radicular dentin: Cleaning, disinfection and remaining ultrastructure / Efecto del protocolo de irrigación en la dentina radicular: limpieza, desinfección y ultraestructura remanente

A successful endodontic treatment requires a combination of satisfactory mechanical instrumentation, adequate irrigation protocols, and three-dimensional obturation of the canal system. Irrigation is considered the most critical procedure to ensure cleaning and disinfection. To date, a large variety of irrigants has been proposed. However, sodium hypochlorite (NaOCl) remains the gold standard. In order to achieve complete cleaning and disinfection, final irrigation with EDTA and ultrasonic devices has been used as an ideal protocol. Most endodontic research focuses on the cleaning and antibacterial properties of the irrigant solutions. Recent evidence demonstrated that the irrigation protocols cause erosion, affecting the radicular dentin ultrastructure. This article aims to describe the clinical features of the present knowledge concerning the effect of irrigation protocols on radicular dentin.

Un tratamiento de endodoncia exitoso requiere de una satisfactoria instrumentación mecánica, protocolos de irrigación adecuados y obturación tridimensional del sistema de conductos radiculares. La irrigación se considera el procedimiento más crítico para garantizar la limpieza y desinfección. Hasta la fecha, se ha propuesto una gran variedad de irrigantes. Sin embargo, el hipoclorito de sodio (NaOCl) sigue siendo el estándar de oro. Para lograr una limpieza y desinfección completa, se ha utilizado como protocolo ideal la irrigación final con EDTA y dispositivos ultrasónicos. La mayor parte de la investigación en endodoncia se enfoca en las propiedades antibacterianas y de limpieza de las soluciones de irrigación. Reciente evidencia demostró que los protocolos de irrigación provocan erosión, afectando la ultraestructura de la dentina radicular. Este artículo tiene como objetivo describir algunas consideraciones clínicas del conocimiento actual sobre el efecto de los protocolos de irrigación en la dentina radicular.

Comparing the efficacy of sodium hyaluronate eye drops and carboxymethylcellulose eye drops in treating mild to moderate dry eye disease

Purpose: Aim of this study was to compare the efficacy of sodium hyaluronate (SH) and carboxymethyl cellulose (CMC) eye drops in treating mild to moderate dry eye disease in terms of relief of symptoms, mean change in tear film breakup time, Schirmer’s test, and impression cytology of conjunctiva from baseline. Methods: An observational study was carried out during a 2?year period in our tertiary referral hospital. The study consisted of 60 patients randomly allotted to two groups to receive SH and CMC eye drops for an 8?week period. Ocular surface disease index, tear film breakup time, and Schirmer’s test were performed at baseline visit and 4 and 8 weeks of treatment, and impression cytology of conjunctiva was performed at baseline and 8 weeks. Results: Significant improvement in patient symptoms, tear film breakup time, and Schirmer’s test from baseline was seen in both SH and CMC groups at 8 weeks posttreatment, whereas impression cytology of conjunctiva in both groups did not show significant improvement at 8 weeks of treatment. Data analysis using unpaired t?test showed comparable results. Conclusion: Both CMC and SH demonstrated equal efficacy in treating mild to moderate dry eye disease.