Intoxicación por fosfuro de aluminio / Aluminum phosphide poisoning

Resumen En la industria agrícola se ha implementado el uso de plaguicidas lo que ha aumentado la cantidad y calidad de los productos agrícolas en varios países en desarrollo, su objetivo es mejorar la calidad de vida y sustento de los consumidores, sin embargo, el uso inadecuado puede causar graves intoxicaciones tanto por ingestión accidental, ocupacional o ingestión con fines suicidas u homicidas, lo cual los hace un tema de relevancia médico legal. El fosfuro de aluminio es un rodenticida, insecticida y fumigante sólido usado como una sustancia ideal para la conservación de los granos, ya que es altamente tóxico contra los insectos que invaden los granos en todos sus estadios sin afectar como tal las semillas y su germinación, es un compuesto accesible y económico lo que hace que su uso con fines suicidas y homicidas sea elevado, ante la intoxicación con fosfuro de aluminio se han descritos síntomas bastante inespecíficos como lo son dolor en el epigastrio, vómitos, diarrea, mareos, disnea y en algunos casos acompañado de un olor a ajo que es característico de ésta intoxicación lo que aumenta la sospecha clínica. Se realizó una revisión bibliográfica en diferentes bases de datos, de los artículos publicados referentes al tema de los últimos doce años, con el objetivo de profundizar en las características del fosfuro de aluminio, su mecanismo de acción y toxicidad. Se concluye que es fundamental conocer los diferentes plaguicidas y sus efectos en la salud, principalmente de aquellos con una alta letalidad, que se podrían estar utilizando clandestinamente y que al ser sumamente económicos son de fácil acceso para emplearse con fines delictivos.

Abstract The agricultural industry has implemented the use of pesticides, which has increased the quantity and quality of agricultural products in several developing countries, its objective is to improve the quality of life and livelihood of consumers, however, improper use can cause serious intoxications both by accidental ingestion, occupational or ingestion for suicidal or homicidal purposes, which makes them an issue of medico-legal relevance. Aluminum phosphide is a rodenticide, insecticide and solid fumigant used as an ideal substance for the preservation of grains, since it is highly toxic against insects that invade the grains in all their stages without affecting the seeds and their germination, it is an accessible and economic compound which makes its use for suicidal and homicidal purposes high, In the face of aluminum phosphide poisoning, quite unspecific symptoms have been described, such as pain in the epigastrium, vomiting, diarrhea, dizziness, dyspnea and in some cases accompanied by a garlic odor which is characteristic of this poisoning, which increases clinical suspicion. A bibliographic review was conducted in different databases, of the articles published on the subject in the last twelve years, with the aim of deepening in the characteristics of aluminum phosphide, its mechanism of action and toxicity. It is concluded that it is essential to know the different pesticides and their effects on health, those with a high lethality, which could be used clandestinely and which, being extremely cheap, are easily accessible to be used for criminal purposes

Investigation of a modified hydraulic calcium silicate-based material - Bio-C Pulpo

Abstract This study evaluated the physicochemical, biological, and antimicrobial properties of a new hydraulic calcium silicate-based modified material, and compared it with MTA Repair HP and MTA Angelus. The materials were assessed regarding color luminosity (L), color change, radiopacity, setting time, and ISO 6876:2012 linear flow. Volumetric filling and volume change were evaluated using microcomputed-tomography (µCT). Chemical characterization after 28 days in Hank's Balanced Salt Solution (HBSS) and pH analysis were also assessed. Biological characterization of cytotoxicity and microbiological assessment were also undertaken. Shapiro-Wilk, ANOVA, Levene and post hoc analyses with Bonferroni correction were performed, adopting a 5% significance level (p <0.05). Bio-C Pulpo exhibited the highest L values after 90 days. All tested materials demonstrated color change during the analyses, and had radiopacity above 5 mm Al. MTA Repair HP set faster than Bio-C Pulpo, whereas the latter had the highest linear flow. MTA Repair HP had the highest volumetric filling in µCT analysis. Bio-C Pulpo showed the highest alkalinity during all tested periods, and the highest volumetric loss (above 9%), in comparison with MTA Repair HP and MTA Angelus. Bio-C Pulpo did not form calcium hydroxide after hydration. MTA Repair HP demonstrated the highest cytocompatibility, and Bio-C Pulpo, the highest cytotoxicity. No inhibition halos were observed for any material, and similar higher turbidity values were seen after direct contact. Composition additives used in Bio-C Pulpo modified its properties, and both the absence of calcium hydroxide deposition after hydration, and the related cytotoxicity of this material are of particular concern.

Cytotoxicity of New Calcium Aluminate Cement (EndoBinder) Containing Different Radiopacifiers

Abstract This study aimed to evaluate the cytotoxicity of a calcium aluminate cement (EndoBinder) containing different radiopacifiers, Bi2O3, ZnO or ZrO2, compared with Mineral Trioxide Aggregate (MTA). According to ISO 10993-12:2012 (E) recommendations, 0.2 g of each cement were applied in transwell inserts and placed in 24-well culture plates containing 1 mL of culture medium (DMEM). After 24 h of incubation, the extracts (DMEM containing components released from the cements) were applied to immortalized odontoblast-like MDPC-23 cells. Cell viability (MTT test), alkaline phosphatase activity (ALP), total protein production and cell morphology (Scanning Electron Microscopy - SEM) were evaluated. The volume of 50 µL of extract was used to determine the chemical elements released by the cements using Energy Dispersive Spectroscopy (EDS). The following groups were established (n=6): NC - negative control (without treatment); EB - EndoBinder without radiopacifier; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 and WMTA - White MTA. Data were subjected to statistical analysis (Kruskal-Wallis test, level of significance=5%). Cells exposed to the different versions of EndoBinder presented small reduction in viability, total protein production and ALP activity, with values similar to the NC and WMTA groups (p>0.05). Different elements (C, O, Na, Al, P, Si, Cl, Bi, K) released by the cements were detected in the extracts. However, the cells had no significant changes in their morphology. EndoBinder and MTA did not affect negatively the metabolism of the odontoblastic-like cells, showing it to be cytocompatible, irrespective of the used radiopacifier.

Resumo Este estudo avaliou a citotoxicidade de um cimento de aluminato de cálcio (EndoBinder) contendo diferentes radiopacificadores, Bi2O3, ZnO ou ZrO2, comparativamente ao trióxido mineral agregado (MTA). Seguindo a norma ISO 10993-12:2012 (E), 0,2 g de cada cimento foi aplicada em insertos transwell, que foram colocados em placas de cultura de 24 wells contendo 1 mL de meio de cultura (DMEM). Após 24 h de incubação, os extratos (DMEM contendo componentes liberados dos cimentos) foram aplicados sobre células pulpares imortalizadas MDPC-23. Viabilidade celular (teste de MTT), atividade da fosfatase alcalina (ALP), produção de proteína total e a morfologia das células (Microscópio Eletrônico de Varredura - MEV) foram avaliadas. Um volume de 50 µL do extrato foi utilizado para determinar, através de Espectroscopia de Energia Dispersiva (EDS), os elementos químicos liberados pelos cimentos. Os seguintes grupos foram estabelecidos (n=6): NC - controle negativo (sem tratamento); EB - EndoBinder sem radiopacificador; EBBO - EndoBinder+Bi2O3; EBZnO - EndoBinder+ZnO; EBZrO - EndoBinder+ZrO2 e WMTA - MTA branco. Os dados foram submetidos à análise estatística (teste de Kruskal-Wallis, nível de significância=5%). Células expostas às diferentes versões de EndoBinder apresentaram pequena redução na viabilidade, produção de proteína total e atividade da ALP, com valores semelhantes aos grupos NC e WMTA (p>0,05). Diversos elementos (C, O, Na, Al, P, Si, Cl, Bi, K) liberados pelos cimentos foram detectados nos extratos. Entretanto, as células não apresentaram alterações significativas em sua morfologia. EndoBinder e MTA, não afetaram negativamente o metabolismo das células odontoblastóides, mostrando-se citocompatíveis, independente do radiopacificador utilizado.

Physical-chemical properties and cytotoxicity analysis of 5 different endodontic sealers / Propriedades físico-químicas e análise da citotoxicidade de 5 diferentes cimentos endodônticos

The aim of this study was to analyze the radiopacity, setting time, flowability, pH, calcium ion release, solubility and cytotoxicity of bioceramic cements Totalfill BC Sealer and Totalfill BC RRM, and compare them with AH Plus, MTA Fillapex and MTA Angelus. The groups were divided and compared among them according to the filling and retro-filling cement functions. Totalfill BC Sealer was compared with AH Plus and MTA Fillapex; and Totalfill BC RRM retrofilling cement with MTA Angelus. For radiopacity analysis, specimens were placed in metal rings measuring 10x1 mm placed on occlusal film together with the aluminum scale. Digora 1.51 software was used to evaluate the digitized images and determine radiographic density. Setting time was tested in accordance with the American Society for Testing and Materials C266-08 standard specifications, but specimens were fabricated in accordance with the International Organization for Standardization 6876: 2001. Flow was tested in accordance with ANSI/ADA No.57/200 specifications. In total 30 acrylic teeth were filled with filling-cements and 20, with (retrograde cavity) retro-filling cements. All teeth were immersed in ultrapure water for pH and calcium ion release measurement (atomic absorption spectrophotometer) for time intervals of 1, 3, 24, 72, 168 and 360 hours. Solubility was tested by scanning and digitizing 50 acrylic teeth twice by Micro- CT, before and after immersion in ultrapure water for time intervals of 168, 360 and 720 hours. The images were reconstructed and volume (mm3) values of samples obtained by means of CTan software (CTan v1.11.10.0, SkyScan). The in vitro effects on cells were analyzed at concentrations of 100, 50, 10, 5, 1 mg/mL, and 0 mg / mLnegative control group and recorded in time intervals of 24, 48 and 72 hours by MTT reduction assay. The results were statistically analyzed by the ANOVA, Tukey, Kruskal-Wallis and Dunn tests (P<0.05). All radiopacity values according to ISO 6876/2001, AH Plus (7.86 mm Al) being the most radiopaque followed by Totalfill BC Sealer (4.84 mm Al), MTA Fillapex (3.41 mm Al), Totalfill BC RRM (6.8 mm Al), and MTA Angelus (6.7 mm Al). The following values were the initial and final setting time (in hours), respectively: AH Plus (8 and 15); Totalfill BC Sealer (11 and 24); MTA Fillapex (13 and 26); MTA Angelus (10 and 120 minutes) and Totalfill BC RRM (3 hours and 22 hours). In flow analysis, the cements behaved as follows: MTA Fillapex (47 mm), Totalfill BC Sealer (41.5 mm), Totalfill BC RRM (33.5 mm), AH Plus (33 mm) e MTA Angelus (17.5 mm) (p < 0.05). pH analysis showed in general the lowest values for AH Plus cement, followed by Totalfill BC RRM, MTA Angelus, MTA Fillapex and Totalfill BC Sealer. AH Plus showed the highest Ca2+ release in time interval 1 hour (1.38 mg/L); MTA Fillapex, in 360 hours (3.81 mg/L); MTA Angelus, 1 hour (1.38 mg/L); Totalfill BC Sealer, 360 hours (6.77 mg/L) and Totalfill BC RRM, 360 hours (3.81 mg/L). Almost all the sealers presented solubility lower than 3% in all periods, as recommended by ISO 6876/2001. Whereas, the MTA Fillapex solubility value was higher than 5% in all periods. Relative to cytotoxicity, all the cements were shown to be toxic at the concentration of 100 mg/mL, however, Totalfill BC Sealer and Totalfill BC RRM showed the best cell viability result compared with the other cements tested. We concluded that all root canal filling and root retro-filling complied with the requisites of radiopacity, setting time, flow, pH, calcium ion release, solubility and cytotoxicity. With the exception of the MTA Fillapex that not only fulfilled the requirement of solubility. Of the sealers, Totalfill BC Sealer was outstanding: it showed the highest pH and Ca2+ release, and lowest cytotoxicity. Among the retrofilling cements, Totalfill BC RRM maintained its high pH, higher Ca2+ release, and lower cytotoxicity. (AU)

O objetivo do presente estudo foi analisar a radiopacidade, tempo de presa, escoamento, pH, liberação de íons cálcio, solubilidade e citotoxicidade dos cimentos biocerâmicos Totalfill BC Sealer e Totalfill BC RRM e compará-los ao AH Plus, MTA Fillapex e MTA Angelus. Os grupos foram divididos e comparados entre si de acordo com as funções dos cimentos de obturação e retro-obturação. Comparamos o cimento obturador Totalfill BC Sealer com os cimentos AH Plus e MTA Filapex, e o cimento retrobturador Totalfill BC RRM com o cimento retrobturador MTA Angelus. Para análise da radiopacidade, os espécimes foram colocados em anéis metálicos medindo 10x1 mm, dispostos sobre um filme oclusal com uma escala de alumínio. O software Digora 1.51 foi utilizado para avaliar as imagens digitalizadas e determinar a densidade radiográfica. O tempo de presa foi realizado de acordo com as especificações da American Society for Testing and Materials C266-08 standard specifications, mas os espécimes foram feitos de acordo com a International Organization for Standardization 6876: 2001. O escoamento foi realizado de acordo com as especificações ANSI/ADA N0 57/2000. Trinta dentes acrílicos foram preenchidos com cimentos obturadores e vinte dentes de acrílico (com cavidade retrógrada) foram preenchidos com cimentos retro-obturadores e imersos em água ultrapura para mensuração do pH e liberação de íons cálcio (espectrofotômetro de absorção atômica) no período de 1, 3, 24, 72, 168 e 360 horas. Para o teste de solubilidade, foram escaneados 50 dentes acrílicos e digitalizados duas vezes pelo Micro-CT, antes e após a imersão em água ultrapura nos períodos de 168, 360 e 720 horas. As imagens foram reconstruídas e o volume (mm3) das amostras foi obtido usando o software CTan (CTan v1.11.10.0, SkyScan). Os efeitos celulares in vitro foram analisados nas concentrações de 100, 50, 10, 5, 1 mg/mL e 0 mg / mLgrupo controle negativo e registados nos períodos de 24, 48 e 72 horas através do ensaio de redução de MTT. Os resultados foram analisados estatisticamente pelos testes ANOVA, Tukey, Kruskal-Wallis e Dunn (p < 0.05). Todos os valores de radiopacidade estavam de acordo com a norma ISO 6876/2001, sendo o AH Plus (7.86 mm Al) o mais radiopaco seguido dos demais cimentos; Totalfill BC Sealer (4.84 mm Al), MTA Filapex (3.41 mm Al), Totalfill BC RRM (6,8 mm Al), MTA Angelus (6,7 mm Al). Os valores obtidos para o tempo de presa inicial e final foram respectivamente, AH Plus (8 e 15 horas), Totalfill BC Sealer (11 e 24 horas), MTA Filapex (13 e 26 horas), Totalfill BC RRM (3 horas e 22 horas) e MTA Angelus (10 e 120 minutos). Na análise de escoamento os cimentos se comportaram da seguinte forma: AH Plus (33 mm), MTA Filapex (47 mm), Totalfill BC Sealer (41,5 mm), Totalfill BC RRM (33,5 mm), e MTA Angelus (17,5 mm) (p < 0.05). A análise do pH mostrou que o cimento AH Plus de um modo geral, foi o que apresentou os menores valores, seguido do Totalfill BC RRM, MTA Angelus, MTA Filapex e Totalfill BC Sealer. A maior liberação de Ca2+ do AH Plus foi no período de 1 hora (1.38 mg/L), MTA Filapex foi em 360 horas (3.81 mg/L), Totalfill BC Sealer 360 horas (6.77 mg/L), Totalfill BC RRM 360 horas (3.81 mg/L) e MTA Angelus em 1 hora (1.38 mg/L). Todos os cimentos apresentaram solubilidade menor que 3% em todos os períodos, como recomendado pela ISO 6876/2001. Entretanto, os valores de solubilidade do MTA Fillapex excedeu mais que 5% em todos os períodos. Com relação à citotoxicidade, todos os cimentos mostraram-se tóxicos na concentração de 100 mg/mL, porém o Totalfill BC Sealer e Totalfill BC RRM apresentaram melhor resultado de viabilidade celular comparado aos demais cimentos testados. Concluiu-se que os cimentos de obturação e retro-obturação cumpriram os requisitos de radiopacidade, tempo de presa, escomento, pH, liberação de íons cálcio, solubilidade e citotoxicidade. Com exceção do MTA Fillapex que não cumpriu somente o requisito de solubilidade. Dos cimentos obturadores, o que melhor se portou foi o Totalfill BC Sealer, apresentando maior pH e liberação de íons cálcio e menor citotoxicidade. Dentre os cimentos retro-obturadores, Totalfill BC RRM foi o que melhor se destacou, mantendo seu pH elevado, possuindo maior liberação de Ca2+ e menor citotoxicidade. (AU)

Interaction of dental pulp stem cells with Biodentine and MTA after exposure to different environments

ABSTRACT Objective: The aim of the present study was to evaluate and compare the cytotoxic effects of Biodentine and MTA on dental pulp stem cells (DPSCs) and to assess cell viability and adherence after material exposure to an acidic environment. Material and Methods: DPSCs were cultured either alone or in contact with either: Biodentine; MTA set for 1 hour; or MTA set for 24 hours. After 4 and 7 days, cell viability was measured using the MTT assay. Biodentine and MTA were also prepared and packed into standardized bovine dentin disks and divided into three groups according to the storage media (n=6/group): freshly mixed materials without storage medium (Group A); materials stored in saline (Group B); materials stored in citric acid buffered at pH 5.4 (Group C). After 24 hours, DPSCs were introduced in the wells and cell adherence, viability, and cellular morphology were observed via confocal microscopy after three days of culture. Cell viability was analyzed using repeated-measures analysis of variance test with Tukey's post hoc tests (α=0.05). Results: Biodentine expressed significantly higher cell viability compared with all other groups after 4 days, with no differences after 7 days. Notably, cell viability was significantly greater in 24-hour set MTA compared with 1-hour set MTA and control groups after 7 days. Material exposure to an acidic environment showed an increase in cell adherence and viability in both groups. Conclusions: Biodentine induced a significantly accelerated cell proliferation compared with MTA. Setting of these materials in the presence of citric acid enhanced DPSC viability and adherence.

Cytotoxicity and genotoxicity of calcium silicate-based cements on an osteoblast lineage

Abstract Several calcium silicate-based biomaterials have been developed in recent years, in addition to Mineral Trioxide Aggregate (MTA). The aim of this study was to evaluate the cytotoxicity, genotoxicity and apoptosis/necrosis in human osteoblast cells (SAOS-2) of pure calcium silicate-based cements (CSC) and modified formulations: modified calcium silicate-based cements (CSCM) and three resin-based calcium silicate cements (CSCR1) (CSCR 2) (CSCR3). The following tests were performed after 24 hours of cement extract exposure: methyl-thiazolyl tetrazolium (MTT), apoptosis/necrosis assay and comet assay. The negative control (CT-) was performed with untreated cells, and the positive control (CT+) used hydrogen peroxide. The data for MTT and apoptosis were submitted to analysis of variance and Bonferroni's posttest (p < 0.05), and the data for the comet assay analysis, to the Kruskal-Wallis and Dunn tests (p < 0.05). The MTT test showed no significant difference among the materials in 2 mg/mL and 10 mg/mL concentrations. CSCR3 showed lower cell viability at 10 mg/mL. Only CSC showed lower cell viability at 50 mg/mL. CSCR1, CSCR2 and CSCR3 showed a higher percentage of initial apoptosis than the control in the apoptosis test, after 24 hours exposure. The same cements showed no genotoxicity in the concentration of 2 mg/mL, with the comet assay. CSC and CSCR2 were also not genotoxic at 10 mg/mL. All experimental materials showed viability with MTT. CSC and CSCR2 presented a better response to apoptosis and genotoxicity evaluation in the 10 mg/mL concentration, and demonstrated a considerable potential for use as reparative materials.

Cytotoxic effects of new MTA-based cement formulations on fibroblast-like MDPL-20 cells

Abstract The present study aimed at evaluating the cytotoxic effects of a novel cement called CER on periodontal fibroblast-like cells of mice (MDPL-20), in comparison with different formulations of Mineral Trioxide Aggregate (MTA), by means of the cell viability test (MTT) and cell morphology analysis. Thirty-two round-shaped samples were fabricated with the following cements: white MTA, white and gray CER and experimental white MTA. The samples were immersed in serum-free culture medium for 24 hours or 7 days (n = 16). The extracts (culture medium + components released from the cements) were applied for 24 hours to previously cultured cells (40.000 cells/cm2) in the wells of 24-well plates. Cells seeded in complete culture medium were used as a negative control. Cell viability was assessed using the MTT assay. Two samples of each cement were used for cell morphology analysis by Scanning Electron Microscopy (SEM). The extracts obtained at the 7-day period presented higher cytotoxicity compared with the 24-hour period (p < 0.05). The gray CER obtained at 24 hours presented the highest cytotoxic effect, whereas the experimental white MTA presented the lowest, similar to the control (p > 0.05). However, at the 7-day period, the experimental white MTA presented no significant difference in comparison with the other cements (p > 0.05). At the 7-day period, CER cement presented cytotoxic effects on fibroblast-like cells, similar to different MTA formulations. However, the immersion period in the culture medium influenced the cytotoxicity of the cements, which was greater for CER cement at 24 hours.

Analysis of radiopacity, pH and cytotoxicity of a new bioceramic material

AbstractObjective RetroMTA® is a new hydraulic bioceramic indicated for pulp capping, perforations or root resorption repair, apexification and apical surgery. The aim of this study was to compare the radiopacity, pH variation and cytotoxicity of this material to ProRoot® MTA.Material and Methods Mixed cements were exposed to a digital x-ray along with an aluminum stepwedge for the radiopacity assay. pH values were verified after incubation period of 3, 24, 48, 72 and 168 hours. The cytotoxicity of each cement was tested on human periodontal ligament fibroblasts using a multiparametric assay. Data analysis was performed using ANOVA and Tukey’spost hoc in GraphPad Prism.Results ProRoot® MTA had higher radiopacity than RetroMTA®(p<0.001). No significant differences were observed for the pH of the materials throughout experimental periods (p>0.05) although pH levels of both materials reduced over time. Both ProRoot® MTA and RetroMTA® allowed for significantly higher cell viability when compared with the positive control (p<0.001). No statistical difference was observed between ProRoot® MTA and RetroMTA® cytotoxicity level in all test parameters, except for the ProRoot® MTA 48-hour extract media in the NR assay (p<0.05).Conclusion The current study provides new data about the physicochemical and biological properties of Retro® MTA concerning radiopacity, pH and cytotoxic effects on human periodontal ligaments cells. Based on our findings, RetroMTA® meets the radiopacity requirements standardized by ANSI/ADA number 572, and similar pH values and biocompatibility to ProRoot® MTA. Further studies should be performed to evaluate additional properties of this new material.

Radiopacity and cytotoxicity of Portland cement associated with niobium oxide micro and nanoparticles

Objective Mineral Trioxide Aggregate (MTA) is composed of Portland Cement (PC) and bismuth oxide (BO). Replacing BO for niobium oxide (NbO) microparticles (Nbµ) or nanoparticles (Nbη) may improve radiopacity and bioactivity. The aim of this study was to evaluate the radiopacity and cytotoxicity of the materials: 1) PC; 2) White MTA; 3) PC+30% Nbµ; 4) PC+30% Nbη. Material and Methods For the radiopacity test, specimens of the different materials were radiographed along an aluminum step-wedge. For cell culture assays, Saos-2 osteoblastic-cells (ATCC HTB-85) were used. Cell viability was evaluated through MTT assay, and bioactivity was assessed by alkaline phosphatase activity assay. Results The results demonstrated higher radiopacity for MTA, followed by Nbµ and Nbη, which had similar values. Cell culture analysis showed that PC and PC+NbO associations promoted greater cell viability than MTA. Conclusions It was concluded that the combination of PC+NbO is a potential alternative for composition of MTA. .

Aluminium Phosphide Poisoning.

Aluminium phosphide poisoning is a major cause of morbidity and mortality in northwest and central India. It liberates lethal phosphine gas when it comes in contact either with atmospheric moisture or with hydrochloric acid in the stomach. The mechanism of toxicity includes cellular hypoxia due to the effect on mitochondria, inhibition of cytochrome C oxidase and formation of highly reactive hydroxyl radicals. In India, most of the patients who come with Celphos poisoning succumb to its toxicity because of the considerable time gap between the ingestion of the poison and the initiation of proper treatment. This has led to widely prevalent scepticism among physicians while managing cases of Celphos poisoning. Due to no known specific antidote, management remains primarily supportive care. In most of the studies, poor prognostic factors were presence of acidosis and shock. The overall outcome improved in the last decade due to better and advanced intensive care management.

Evaluation of cytotoxicity, antimicrobial activity and physicochemical properties of a calcium aluminate-based endodontic material

A calcium aluminate-based endodontic material, EndoBinder, has been developed in order to reduce MTA negative characteristics, preserving its biological properties and clinical applications. Objectives: The aim of this study was to evaluate the cytotoxicity, antimicrobial activity, pH, solubility and water sorption of EndoBinder and to compare them with those of white MTA (WMTA). Material and Methods: Cytotoxicity was assessed through a multiparametric analysis employing 3T3 cells. Antimicrobial activity against Enterococcus faecalis (ATCC 29212), Staphylococcus aureus. (ATCC 25923) and Candida albicans (ATCC 10556) was determined by the agar diffusion method. pH was measured at periods of 3, 24, 72 and 168 hours. Solubility and water sorption evaluation were performed following ISO requirements. Data were statistically analyzed by ANOVA and Tukey`s test with a significance level of 5%. Results: EndoBinder and WMTA were non-cytotoxic in all tested periods and with the different cell viability parameters. There was no statistical differences between both materials (P>.05). All tested materials were inhibitory by direct contact against all microbial strains tested. EndoBinder and WMTA presented alkaline pH in all tested times with higher values of pH for WMTA (P<.05). Both materials showed values complying with the solubility minimum requirements. However, EndoBinder showed lower solubility than WMTA (P<.05). No statistical differences were observed regarding water sorption (P>.05). Conclusion: Under these experimental conditions, we concluded that the calcium aluminate-based endodontic material EndoBinder demonstrated suitable biological and physicochemical properties, so it can be suggested as a material of choice in root resorption, perforations and root-end filling. .

Human tooth germ stem cell response to calcium-silicate based endodontic cements

OBJECTIVE: The aim of this study was to compare the cytotoxic effects of endodontic cements on human tooth germ stem cells (hTGSCs). MTA Fillapex, a mineral trioxide aggregate (MTA)-based, salicylate resin containing root canal sealer, was compared with iRoot SP, a bioceramic sealer, and AH Plus Jet, an epoxy resin-based root canal sealer. MATERIAL AND METHODS: To evaluate cytotoxicity, all materials were packed into Teflon rings (4 mmµ3 mm) and co-cultured with hTGSCs with the aid of 24-well Transwell permeable supports, which had a pore size of 0.4 µm. Coverslips were coated with MTA Fillapex, iRoot SP and AH Plus Jet and each coverslip was placed onto the bottom of one well of a six-well plate for scanning electron microscopy (SEM) analysis. Before the cytotoxicity and SEM analysis, all samples were stored at 37ºC and at 95% humidity and 5% CO2 for 24 hours to set. The cellular viability was analyzed using MTS test (3-(4,5-dimethyl-thiazol-2-yl)-5-(3-carboxy-methoxy-phenyl)-2-(4-sulfo-phenyl)-2H-tetrazolium). The cytotoxic effects and SEM visualization of the tested materials were analyzed at 24-hour, 72-hour, one-week and two-week periods. RESULTS: On the 1st day, only MTA Fillapex caused cytotoxicity compared to negative control (NC) group (p<0.008). No significant difference was observed between the other tested materials at this period (p>0.05). After 14 days of incubation with the test materials, MTA Fillapex exhibited significantly higher cytotoxicity compared with iRoot SP, AH Plus Jet and the NC group (P<0.008). In the SEM analysis, the highest levels of cell attachment were observed for iRoot SP and the control group. After 24 hours, MTA Fillapex reduced the number of cells attached to the surface. CONCLUSIONS: Within the limitations of this study, sealers exerted different cytotoxic effects on hTGSCs. Although all materials ...

In Vitro Cytotoxicity of White MTA, MTA Fillapex® and Portland Cement on Human Periodontal Ligament Fibroblasts

The aim of this study was to compare the in vitro cytotoxicity of white mineral trioxide aggregate (MTA), MTA Fillapex® and Portland cement (PC) on human cultured periodontal ligament fibroblasts. Periodontal ligament fibroblast culture was established and the cells were used for cytotoxic tests after the fourth passage. Cell density was set at 1.25 X10 4 cells/well in 96-well plates. Endodontic material extracts were prepared by placing sealer/cement specimens (5X3mm) in 1mL of culture medium for 72 h. The extracts were then serially two-fold diluted and inserted into the cell-seeded wells for 24, 48 and 72 h. MTT assay was employed for analysis of cell viability. Cell supernatants were tested for nitric oxide using the Griess reagent system. MTA presented cytotoxic effect in undiluted extracts at 24 and 72 h. MTA Fillapex® presented the highest cytotoxic levels with important cell viability reduction for pure extracts and at ½ and » dilutions. In this study, PC did not induce alterations in fibroblast viability. Nitric oxide was detected in extract-treated cell supernatants and also in the extracts only, suggesting presence of nitrite in the soluble content of the tested materials. In the present study, MTA Fillapex displayed the highest cytotoxic effect on periodontal ligament fibroblasts followed by white MTA and PC.

Resumo O objetivo deste estudo foi comparar a citotoxicidade in vitro de agregado trióxido mineral (MTA) branco, MTA Fillapex® e cimento Portland (PC) em cultura de fibroblastos de ligamento periodontal humano. A cultura de fibroblastos de ligamento periodontal foi estabelecida e as células foram utilizadas para os testes citotóxicos após a quarta passagem. A densidade celular foi ajustada em 1,25X10 4 células/poço em placas de 96 poços. Extratos dos materiais endodônticos foram preparados por meio da inserção de corpos de prova dos cimentos (5 X 3 mm) em 1 mL de meio de cultura durante 72 h. Os extratos foram diluídos serialmente na razão de ½ e inseridos aos poços contendo as células por 24, 48 e 72 h. Ensaio de MTT foi realizado para a avaliação da viabilidade celular. O sobrenadante das células foi testado em relação à presença de óxido nítrico utilizando o sistema de reagentes de Griess. O MTA apresentou efeito citotóxico quando o extrato era aplicado sem diluição durante 24 e 72 h. O MTA Fillapex apresentou os maiores níveis de citotoxicidade com importante redução da viabilidade celular quando o extrato foi aplicado puro e em diluições de ½ e ». Neste estudo, PC não induziu alterações na viabilidade de fibroblastos. Óxido nítrico foi detectado no sobrenadante de células tratadas com os extratos e ainda nos extratos somente, o que sugere a presença de nitrito no conteúdo solúvel dos materiais testados. No presente estudo, MTA Fillapex foi o material que demonstrou o maior efeito citotóxico sobre fibroblastos de ligamento periodontal seguido do MTA branco e do PC. .

Rat subcutaneous tissue response to MTA Fillapex® and Portland cement

The aim of this study was to evaluate the response of rat subcutaneous tissue to MTA Fillapex® (Angelus), an experimental root canal filling material based on Portland cement and propylene glycol (PCPG), and a zinc oxide, eugenol and iodoform (ZOEI) paste. These materials were placed in polyethylene tubes and implanted into the dorsal connective tissue of Wistar rats for 7 and 15 days. The specimens were stained with hematoxylin and eosin, and evaluated regarding inflammatory reaction parameters by optical microscopy. The intensity of inflammatory response against the sealers was analyzed by two blinded and previously calibrated examiners for all experimental periods (kappa=0.96). The histological evaluation showed that all materials caused a moderate inflammatory reaction at 7 days, which subsided with time. A greater inflammatory reaction was observed at 7 days in the tubes filled with ZOEI paste. Tubes filled with MTA Fillapex presented some giant cells, macrophages and lymphocytes after 7 days. At 15 days, the presence of fibroblasts and collagen fibers was observed indicating normal tissue healing. The tubes filled with PCPG showed similar results to those observed in MTA Fillapex. At 15 days, the inflammatory reaction was almost absent at the tissue, with several collagen fibers indicating normal tissue healing. Data were analyzed by the nonparametric Kruskal-Wallis test (α=0.05). Statistically significant difference (p<0.05) was found only between PCPG at 15 days and ZOEI at 7 days groups. No significant differences were observed among the other groups/periods (p>0.05). MTA Fillapex and Portland cement added with propylene glycol had greater tissue compatibility than the PCPG paste.

O objetivo deste estudo foi avaliar a resposta do tecido subcutâneo de rato ao MTA Fillapex® (Angelus), a um cimento endodôntico experimental à base de cimento Portland e propilenoglicol, e à pasta de óxido de zinco e eugenol com iodofórmio. Estes materiais foram colocados em tubos de polietileno e implantados no tecido conjuntivo do dorso de ratos Wistar, por 7 e 15 dias. Os espécimes foram corados com hematoxilina e eosina e os parâmetros de reação inflamatória foram avaliados em microscópio óptico. A intensidade da resposta inflamatória provocada pelos cimentos foi analisada em todos os períodos por dois observadores previamente calibrados (kappa 0,96) e sem conhecimento dos grupos experimentais. O exame histológico mostrou que todos os materiais provocaram reação inflamatória moderada aos 7 dias que regrediu com o tempo. A maior resposta inflamatória do tecido foi observada aos 7 dias, nos tubos preenchidos com pasta de Óxido de Zinco e Eugenol com Iodofórmio. Os tubos com MTA Fillapex apresentaram algumas células gigantes, macrófagos e linfócitos após 7 dias. Aos 15 dias, a presença de fibroblastos e fibras de colágenas foi observada, indicando processo de cicatrização do tecido. Os tubos com o cimento Portland mostraram resultados semelhantes aos observados no grupo MTA Fillapex. Aos 15 dias, a reação inflamatória apresentada foi praticamente ausente, com muitas fibras colágenas, indicando cicatrização normal do tecido. A análise estatística mostrou diferença estatisticamente significante entre o grupo de cimento Portland (15 dias) e óxido de zinco eugenol com Iodofórmio (7 dias) (p<0,05). Nos outros grupos não houve diferença estatística significante. MTA Fillapex e cimento Portland são mais biocompatíveis do que os outros cimentos testados.

Novel experimental cements for use on the dentin-pulp complex

This aim of this study was to evaluate the physicochemical and biological properties of novel experimental cements (Hybrid, Paste and Resin) based on synergistic combinations of existing materials, including pH, diametral tensile strength (DTS) and cytotoxicity comparing them with mineral trioxide aggregate (MTA - Angelus®) and a glass ionomer cement (GIC) developed at our laboratory. For the physicochemical and biological tests, specimens with standard dimensions were produced. pH measurements were performed with digital pH meter at the following time intervals: 3, 24, 48 and 72 h. For the DTS test, cylindrical specimens were subjected to compressive load until fracture. The MTT assay was performed for cytotoxicity evaluation. Data were analyzed by ANOVA and Tukey's test (α=0.05). Paste group showed pH values similar to MTA, and Hybrid group presented pH values similar to GIC (p>0.05). The tested materials showed pH values ranging from alkaline to near neutrality at the evaluated times. MTA and GIC showed similar DTS values. The lowest and highest DTS values were seen in the Paste and Resin groups, respectively (p<0.05). Cell viability for MTA and experimental Hybrid, Paste and Resin groups was 49%, 93%, 90% and 86%, respectively, when compared with the control group. The photo-cured experimental resin cement showed similar or superior performance compared with the current commercial or other tested experimental materials.

O objetivo deste estudo foi avaliar propriedades físico-químicas e biológicas de novos cimentos experimentais (Híbrido, Pasta e Resinoso) baseado na combinação sinérgica de materiais existentes, incluindo pH, resistência à tração diametral (RTD) e citotoxidade, comparando-os ao MTA (Angelus®) e a um cimento de ionômero de vidro (CIV) desenvolvido em nosso laboratório. Para a realização dos testes físico-mecânico e biológico, foram confeccionados espécimes com dimensões padrão. O teste de pH foi realizado por meio de pH-metro digital nos tempos: 3, 24, 48 e 72 h. Para o teste de RTD, espécimes cilíndricos foram submetidos a carga compressiva até sua fratura. Para avaliação da citotoxidade, utilizou-se o teste MTT. Os dados foram analisados utilizando ANOVA e teste de Tukey (α=0,05). O grupo Pasta apresentou valores de pH semelhantes ao MTA, assim como o grupo Híbrido seguiu os parâmetros do CIV (p>0,05). Todos os materiais apresentaram valores de pH alcalinos ou próximosà neutralidade nos tempos avaliados. MTA e CIV apresentaram valores de RTD similares. Os menores e maiores valores observados foram do grupo Pasta e Resinoso, respectivamente (p<0,05). A viabilidade celular para os grupos MTA, Híbrido, Pasta, Resinoso, quando comparados ao grupo controle foi de: 49, 93, 90 e 86%, respectivamente. O cimento experimental Resinoso apresentou desempenho similar ou superior aos materiais comerciais e experimentais avaliados.

Aluminum phosphide poisoning known as rice tablet: A common toxicity in North Iran.

Background: Aluminum phosphide (ALP) is a highly effective insecticide and rodenticide used frequently to protect stored grain. Acute poisoning with this compound is common in some countries including India and Iran, and is a serious health problem. Aim: The objective of this study was to survey ALP poisoning locally known as "Rice Tablet" and the outcome in a referral poisoning hospital in Mazandaran province, northern part of Iran. Materials and Methods: The study was a cross-sectional study from March 2007 to February 2008. Records of all patients admitted and hospitalized to a referral teaching hospital during the 2 year period were collected. Information including gender, age, cause of toxicity, amount of AIP consumed, route of exposure, time between exposure and hospital admission, signs and symptoms of toxicity at admission, therapeutic intervention, laboratory tests, and outcome were extracted from the patients' notes. Patients who died and survived were compared using appropriate statistical tests. Results: During the two-year period, 102 patients, 46 men and 56 women with mean (±SD) age 28.5 ± 12.4 year were admitted with ALP poisoning. The most common signs and symptoms at admission were nausea (79.4%), vomiting (76.5%), and abdominal pain (31.4%). 41.1% of the patients showed metabolic acidosis. Suicidal intention was the most common cause of poisoning (97%) leading to 19 (18.6%) deaths. Compared with the patients who survived, those who died had taken higher amount of ALP tablet (2.2 ± 2.4 vs. 1.4 ± 1.0, P < 0.05), had poor liver function test (P < 0.0001) and severe metabolic acidosis (pH: 7.17 ± 0.19 vs. 7.33 ± 0.08, P < 0.0001). Conclusion: ALP poisoning is a common toxicity in Iran causing high morality. This is a serious health problem in agricultural region where ALP is readily available. Withdrawal of ALP tablet from the market and introduction of safer products as rodenticides and insecticides is recommended.

Cytotoxic effects of White-MTA and MTA-Bio cements on odontoblast-like cells (MDPC-23)

This study evaluated the cytotoxic effects of 2 mineral trioxide aggregate (MTA) cements - White-MTA-Angelus and a new formulation, MTA-Bio - on odontoblast-like cell (MDPC-23) cultures. Twenty-four disc-shaped (2 mm diameter x 2 mm thick) specimens were fabricated from each material and immersed individually in wells containing 1 mL of DMEM culture medium for either 24 h or 7 days to obtain extracts, giving rise to 4 groups of 12 specimens each: G1 - White-MTA/24 h; G2 - White-MTA/7 days; G3 - MTA-Bio/24 h; and G4 - MTA-Bio/7 days. Plain culture medium (DMEM) was used as a negative control (G5). Cells at 30,000 cells/cm² concentration were seeded in the wells of 24-well plates and incubated in a humidified incubator with 5 percent CO2 and 95 percent air at 37ºC for 72 h. After this period, the culture medium of each well was replaced by 1 mL of extract (or plain DMEM in the control group) and the cells were incubated for additional 2 h. Cell metabolism was evaluated by the MTT assay and the data were analyzed statistically by ANOVA and Tukey's test (α=0.05). Cell morphology and the surface of representative MTA specimens of each group were examined by scanning electron microscopy. There was no statistically significant difference (p>0.05) between G1 and G2 or between G3 and G4. No significant difference (p>0.05) was found between the experimental and control groups either. Similar cell organization and morphology were observed in all groups, regardless of the storage periods. However, the number of cells observed in the experimental groups decreased compared to the control group. MTA-Bio presented irregular surface with more porosities than White-MTA. In conclusion, White-MTA and MTA-Bio presented low cytotoxic effects on odontoblast-like cell (MDPC-23) cultures.

Este estudo avaliou o efeito citotóxico de dois cimentos MTA - MTA Branco-Angelus e uma nova formulação, MTA-Bio - sobre células odontoblastóides (MDPC-23) mantidas em cultura. Vinte e quatro espécimes padronizados (2 mm diâmetro x 2 mm largura) foram confeccionados de cada material e imersos individualmente em compartimentos contendo 1 mL de meio de cultura DMEM por 24 h ou 7 dias para obtenção dos extratos, formando 4 grupos de 12 espécimes cada: G1 - MTA-Branco/24 h; G2 - MTA-Branco/7 dias; G3 - MTA-Bio/24 h; e G4 - MTA-Bio/7 dias. Meio de cultura puro (DMEM) foi utilizado como controle negativo (G5). Células na concentração de 30.000 células/cm² foram semeadas nas placas de 24 compartimentos e incubadas em incubadora com 5 por cento CO2 e 95 por cento ar a 37ºC por 72 h. Após esse período, o meio de cultura de cada compartimento foi substituído por 1 mL do extrato (ou DMEM puro no grupo controle) e as células foram incubadas pelo período adicional de 2 h. O metabolismo celular foi avaliado pelo teste do MTT e os dados foram analisados estatisticamente pelo teste de ANOVA e Tukey (α=0,05). A morfologia celular e da superfície dos espécimes de MTA representativos de cada grupo foram avaliados em microscopia eletrônica de varredura. Não houve diferença estatisticamente significante (p>0,05) entre os gurpos G1 e G2 ou entre G3 e G4. Não foi encontrada diferença estatística (p>0,05) entre os grupos experimentais e controle. Morfologia e organização celular semelhante foram observadas em todos os grupos, independente do período de extração. Entretanto, o número de células observado nos grupos experimentais diminui quando comparado ao grupo controle. MTA-Bio apresentou uma superfície irregular com mais porosidades que o MTA-Branco. Pode-se concluir que os cimentos MTA-Branco e MTA-Bio apresentaram reduzido efeito citotóxico sobre células odontoblastóides (MDPC-23) mantidas em cultura.

Aluminium phosphide poisoning: a case report

This paper reports the case of a family in which three children were presented at Emergency Room [ER] with poisoning after the use of a pesticide at home. Initially, the cases were managed as routine cases of organophosphorus poisoning; however, the death of two children made the health team members realise that the poison's effects were delayed and devastating. Later, the compound was identified as Aluminium Phosphide [ALP], and the life of the last surviving child in the family was saved

The effects of ingested aluminium on brain cytochrome oxidase activity / Efectos de la ingestión de aluminio sobre la actividad de la oxidasa citocrómica del cerebro

Aluminium has a unique combination of physical and chemical properties which has enabled man to put this metal to very wide and varied use. However, prolonged exposure to aluminium ions may lead to adverse health effects. In this study, we evaluated the effects of dietary aluminium on the protein composition and the intrinsic activity of cytochrome oxidase (COX) for brain mitochondria. New Zealand white rabbits were maintained on a diet of commercial rabbit pellets and distilled water for a period of 12 weeks. For the experimental group, AlCl3, 330mg/kg/L was added to the drinking water. When compared to the control, mitochondria isolated from the brains of the AlCl3 fed rabbits showed no change in Km but an approximate 35% decrease in both the low and high affinity Vmax values. Also, whereas the protein composition of the mitochondria from both sources appeared to be normal, isolation of highly purified COX proved to be difficult and for the AICI3 fed rabbits, a number of the enzyme's low molecular weight subunits were absent. These results appear to confirm a relationship between long term aluminium consumption and low brain COX activity; they further suggest that an altered COX structure may be the cause of the low enzymic activity.

El aluminio posee una combinación única de las propiedades físicas y químicas que ha permitido al ser humano hacer un uso amplio y variado de este metal. Sin embargo, un número de estudios recientes, sugiere que la exposición prolongada a los iones de aluminio puede tener efectos nocivos sobre la salud. En el presente estudio, evaluamos los efectos del aluminio dietético sobre la composición proteínica y la actividad intrínseca de la oxidasa citocrómica (COX) para la mitocondria cerebral. Conejos blancos de Nueva Zelanda, fueron mantenidos con una dieta de alimento para conejos y agua destilada por un período de 12 semanas. Para el grupo experimental AlCl3, 330mg/kg/L fueron añadidos al agua potable. En comparación con el grupo de control, las mitocondrias aisladas de los cerebros de los conejos alimentados con AlCl3 no mostraron cambios en Km pero hubo una disminución de aproximadamente 35% tanto en los valores Vmax de baja y alta afinidad. Por otro lado, mientras que la composición proteica de las mitocondrias de ambas fuentes parecía ser normal, resultó difícil aislar el COX altamente purificado y un número de enzimas de subunidades de bajo peso molecular MMMM estuvieron ausentes. Estos resultados parecen confirmar una relación entre el consumo de aluminio a largo plazo y la baja actividad del COX del cerebro. Asimismo, sugieren que una alteración de la estructura del COX puede ser la causa de una baja actividad enzimática.