Influência dos cimentos obturadores biocerâmicos versus o AH Plus® na dor pós-operatória, penetração em túbulos dentinários e atividade antimicrobiana: revisões sistemáticas e meta-análises / Influence of bioceramic root canal sealer versus AH Plus® on postoperative pain, penetration into dentinal tubules and antimicrobial activity: systematic reviews and meta-analyses

O objetivo desse estudo de revisões sistemáticas e meta-análises foi responder se os cimentos biocerâmicos resultam melhores efeitos para a dor pós operatória, capacidade em penetração em túbulos dentinários e atividade antimicrobiana em comparação ao cimento AH Plus®. Foram conduzidas duas revisões sistemáticas, orientadas pelas diretrizes PRISMA e foram registradas na PROSPERO (CRD4202125928) (Capítulo 1) e na Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Capítulo 2). Uma pergunta foi feita com base na população, intervenção, comparação e resultado (PICO), Capítulo 1: "O uso dos cimentos biocerâmicos resulta em menos dor pós operatória em comparação ao uso do cimento AH Plus® em pacientes tratados endodonticamente?"; Capítulo 2: "Os cimentos obturadores biocerâmicos apresentam superioridade na penetração em túbulos dentinários e atividade antimicrobiana ao cimento obturador AH Plus®?". Foram definidas as estratégias de buscas e realizadas buscas nas bases de dados: PubMed, Scopus, Web of Science, Embase, Cochrane Library, e OpenGrey. O Capítulo 1 utilizou a escala Cochrane para avaliar o risco de viés e a ferramenta GRADE para avaliar a qualidade das evidências. Enquanto, o Capítulo 2 utilizou a escala The Joanna Briggs para avaliar o risco de viés de estudos in vitro. As metaanálises foram conduzidas usando o "Meta" package, version 3.6.3, a diferença média (MD) medida de efeito foi calculada para variáveis quantitativas e odds ratio (OR) (Capítulo 1) e diferenças de médias padronizadas (SMD) (Capítulo 2), com um intervalo de confiança (IC) de 95%. Os resultados do Capítulo 1, foram incluídos 13 artigos na revisão sistemática, 11 foram incluídos na meta-análise. Para as variáveis quantitativas, o cimento biocerâmico apresentou menor ocorrência de dor pós-operatória do que o cimento AH Plus® em 24h (MD - 0,4101 [-0,80; -0,02], p = 0,0386) e 48h (MD -0,31 [-0,59; -0,03], p = 0,0295). Para as variáveis binárias, não houve diferença observada entre os cimentos avaliados: 24h (OR 1,12 [0,69; 1,80] p = 0,6476), 48h (OR 1,56 [0,76; 3,20] p = 0,2267), 72h (OR 1,38 [0,55; 3,45] p = 0,4893) e 7 dias (OR 2,10 [0,55; 8,01], p = 0,2790). Em relação à análise de risco de viés, observou-se baixo risco para a maioria dos domínios, exceto alocação que foi considerada pouco clara, enquanto a certeza da evidência variou de moderada a baixa. Os resultados do Capítulo 2, foram um total de 54 estudos foram incluídos, e 16 estudos foram incluídos na meta-análise. De modo geral, os estudos apresentaram baixo risco de viés. Não foi observado diferença estatística entre os cimentos avaliados para penetração em túbulos dentinários, independentemente dos terços: coronal SMD 0.58 [0.14; 1.31], p = 0.12; médio SMD 0.07 [0.54; 0.39], p = 0.75; e apical: SMD 0.08 [0.73; 0.56], p = 0.80. Os cimentos biocerâmicos e AH Plus® demonstraram similar ação antimicrobiana SMD [3.42; 5.32], p = 0.67 e SMD 0.67 [1.89; 0.55], p = 0.2825. Dessa forma, conclui-se que os cimentos biocerâmicos apresentam menor dor pós operatória nas primeiras 24 e 48 horas, e apresentam respostas similares para penetração em túbulos dentinários e atividade antimicrobiana quando comparado ao cimento AH Plus®(AU)

The aim of this study of systematic reviews and meta-analyses was to answer whether bioceramic sealers have better effects on postoperative pain, ability to penetrate dentinal tubules and antimicrobial activity compared to AH Plus® sealer. Two systematic reviews, guided by PRISMA guidelines, were conducted and registered in PROSPERO (CRD4202125928) (Chapter 1) and Open Science Framework (OSF) Registries (https://doi.org/10.17605/OSF.IO/BX7VQ) (Chapter 2). A question was asked based on population, intervention, comparison and outcome (PICO), Chapter 1: "Does the use of bioceramic sealers result in less postoperative pain compared to the use of AH Plus® sealer in endodontically treated patients?"; Chapter 2: "Do bioceramic filling sealers have superior penetration into dentinal tubules and antimicrobial activity compared to AH Plus® filling sealer?". Search strategies were defined and searches performed in the following databases: PubMed, Scopus, Web of Science, Embase, Cochrane Library, and OpenGrey. Chapter 1 used the Cochrane scale to assess the risk of bias and the GRADE tool to assess the quality of evidence. Meanwhile, Chapter 2 used The Joanna Briggs scale to assess the risk of bias from in vitro studies. Meta-analyses were conducted using the "Meta" package, version 3.6.3, the mean difference (MD) effect measure was calculated for quantitative variables and odds ratio (OR) (Chapter 1) and standardized mean differences (SMD) (Chapter 2), with a 95% confidence interval (CI). The results of Chapter 1 were included 13 articles in the systematic review, 11 were included in the meta-analysis. For quantitative variables, the bioceramic sealer had a lower occurrence of postoperative pain than the AH Plus® sealer in 24 hours (MD - 0.4101 [-0.80; - 0.02], p = 0.0386) and 48h (MD -0.31 [-0.59; -0.03], p = 0.0295). For the binary variables, there was no difference observed between the sealers evaluated: 24h (OR 1.12 [0.69; 1.80] p = 0.6476), 48h (OR 1.56 [0.76; 3.20] p = 0.2267), 72h (OR 1.38 [0.55; 3.45] p = 0.4893) and 7 days (OR 2.10 [0.55; 8.01], p = 0 .2790). Regarding the risk of bias analysis, a low risk was observed for most domains, except for allocation that was considered unclear, while the certainty of evidence ranged from moderate to low. The results of Chapter 2 were a total of 54 studies included, and 16 studies were included in the meta-analysis. Overall, the studies had a low risk of bias. There was no statistical difference between the sealers evaluated for penetration into dentinal tubules, regardless of the thirds: coronal SMD 0.58 [0.14; 1.31], p = 0.12; average SMD 0.07 [0.54; 0.39], p = 0.75; and apical: SMD 0.08 [0.73; 0.56], p = 0.80. Bioceramic sealers and AH Plus® demonstrated similar antimicrobial action to SMD [3.42; 5.32], p = 0.67 and SMD 0.67 [1.89; 0.55], p = 0.2825. Thus, it is concluded that bioceramic sealers have less postoperative pain in the first 24 and 48 hours, and have similar responses for penetration into dentinal tubules and antimicrobial activity when compared to AH Plus® sealer(AU)

Efetividade de soluções endodônticas na redução da viabilidade de Enterococcus faecalis cultivados em forma séssil e planctônica / Effectiveness of endodontic solutions to reduce the viability of sessile and planktonic Enterococcus faecalis

Este estudo teve como objetivo avaliar a sensibilidade dos biofilmes de E. faecalis a NaOCl, CHX e PAA após uma exposição de ácido cítrico 2,5%. O biofilme de E. faecalis foi formado em lamínulas de vidro circular de 13 mm Ø em placas de cultura de 24 poços. Os biofilmes foram tratados ou não durante 5 minutos com ácido cítrico, posteriormente, exposto a diferentes concentrações de NaOCl, CHX e PAA. A atividade antimicrobiana foi avaliada por meio da contagem de unidade formadora de colônias (UFCs). Ao analisar o percentual de redução bacteriana na forma planctônica em função do tempo e da solução/concentração, o teste de Anova demonstrou não haver diferença estatística entre CHX e NaOCl (p>0,05). Contudo a CHX, quando utilizada sozinha, apresentou menor efetividade que NaOCl (p<0,05) sobre o biofilme. O pré-tratamento do biofilme com ácido cítrico tornou as bactérias na forma séssil mais sensível ao NaOCl e ao PAA. Baseado nos resultados obtidos foi possível concluir que o tratamento com ácido cítrico aumentou a sensibilidade do biofilme de E. faecalis a irrigante utilizado em procedimento endodôntico e orienta o início do tratamento com irrigação prévia com o ácido cítrico.

The present study aimed to evaluate the sensitivity of E. faecalis biofilms to NaOCl, CHX and PAA after exposure to 2.5% citric acid. The E. faecalis biofilm was formed in 13-mm diameter circular glass microslides in 24-well culture plates. The biofilms were treated or not for 5 minutes with citric acid, and subsequently exposed to different concentrations of NaOCl, CHX and PAA. The antimicrobial activity was assessed by colony-forming unit (CFU) count. When analyzing the bacterial reduction percentage in planktonic form according to the time and solution/concentration, the Anova test demonstrated no statistical difference between CHX and NaOCl (p>0.05). However, CHX, when utilized alone, presented less effectiveness than NaOCl (p<0.05) on the biofilm. The citric acid pretreatment of the biofilm made the bacteria in the sessile form more sensitive to NaOCl and PAA. Based on the obtained results, it was possible to conclude that citric acid treatment increased the sensitivity of the E. faecalis biofilm to irrigants employed in endodontic procedures, guiding the beginning of treatment with prior citric acid irrigation.

Tratamiento anti-infeccioso de diarreas en pediatría: [revisión] / Anti-infective treatment of diarrhea in pediatrics: [review]

La diarrea es una de las causas más comunes de enfermedad en pediatría y la segunda causa de muerte infantil en el mundo. Cobra la vida de cerca de 4.000 niños cada día. La carga es mayor en el mundo en desarrollo donde el acceso al agua potable, saneamiento y atención médica son a menudo limitadas. Las características de las evacuaciones permiten orientar la terapia inicial. Las diarreas de etiología bacteriana se tratan según criterios muy bien especificados, la mayoría se autolimitan en más del 50 por ciento de los casos. Los virus constituyen la etiología más fecuente de las diarreas (más de 40 por ciento de los episodios agudos). Existen múltiples parásitos causales para los cuales existen también alternativas terapéuticas. La terapia anti-infecciosa cuando este indicado se debe iniciar precozmente, de esta manera, se reduce la duración y gravedad de la enfermedad, se previenen complicaciones, se disminuye la excreción del agente infeccioso y se evita la transmisión del patógeno.

Diarrhea disease is ona of the most commun causes of illness and the second leading cause of child dealth in the world. It claims the lives of nearly 4000 children each day. The burden is greatest in the developing world where access to safe water, sanitation, and medical care are often limited. Viruses are the most common cause of diarrhea (more than 40% of acute episodes). Episodes of bacterial diarrhea are self-limited in more than 50% of cases. There are multiple causative parasites for which there are also therapeutic alternatives. Anti-infective therapy should be initiated early, thus reducing the duration and severity of the disease, preventing complications, decreasing the excretion of the infectious agent and preventing the transmission of the pathogen.

Analysis of the Use and Reasonable Researching of Anti-infectious Medicine in Patients in ICU / 医学研究杂志

Objective Through an investigation and analysis of the using situation of anti-infectious medicine for the patients of ICU in hospital,to provide guidance for the rational antimicrobial use in clinic and strengthen the level of clinical doctors′reasonable use of the medicine. Methods The anti-infectious medicine used for the patient of ICU in hospital is analysed in respect to defined daily dose (DDD),drug utilization index(DUI). Results An overwhelming majority of anti-infectious medicine′s utilization is reasonable,but 52.4% of the anti-infectious medicine is over the demand of DUI≤1.The result of the DDDs:the Chemical Synthesis′s capacity(32.14%),the aminoglycosides(13.62%),the ?-Lactams and their?-Lactamase inhibitors(13.20%),the antifungal agents(12.66%),the cephalosporins(9.52%).The fuloroquinolones,the third and the forth cephalosporins and the carbapenems are used broadly.The medicine's unit-rate gets 92%,and six unit is the most of all.It can be seen from the category and distribution of the use of anti-infectious medicine that the cephalosprins is the first.The antimicrobial resistance is developed rapidly.The antimicrobial resistance of levofloxacin is 54.45%,then gentamicin is 51.78% and ampicillin,ciprofloxacin,cefazolin,ceftriaxone,SMZco are more than 40%. Conclusions In choosing the dose with the normal regulation(not the dose of indication),doctors consider less for the factors such as the age,medicine interacion,dose of indication,etc.Using the broad-spectrum usually led to many universal phenomenon such as antimicrobial resistance,bacteria migrated and antimycotic infection,etc.That makes double infection(32%) which can't be neglected.The theory of medicinal economics is less used in the clinic practices.

Analysis of prescriptions for anti-infectious agents for tumor patients / 中华医院管理杂志

Objective To find out about the use of anti-infectious agents by tumor outpatients of the hospital. Methods A survey was conducted on 1 011 prescriptions for anti-infectious agents written out in the hospital from October to December of 2003 and an analysis was made of the structure and rationality of their use by means of drug utilization studies. Results The utilization rate of anti-infectious agents was 8.35% , accounting for 1.09% of the total sum of money for the prescriptions. The kinds of anti-infectious agents used were mostly cephalosporins and quinolones. The utilization rate of agents of compatibility was 4.44%. The drug utilization index of some chemicals was close to 1.00, accounting for about 44.44% . Conclusion There is no widespread abuse of anti-infectious agents by the outpatients of the hospital and the utilization rates of anti-infectious agents and agents of compatibility are low. Still, there are some problems in the use and compatibility of certain agents and the rationality of their use is to be questioned. The use of anti-infectious agents should be planned in a scientific way and in line with the economic condition of the patients.

A study on the anti-inflammatory effects of nonsteroidal antiinflammatory ophthalmic solutions / 眼科

The topical effects of nonsteroidal anti-inflammatory agents, diclofenac, ketoprofen and naproxen, on reducing ocular inflammation were studied by aqueous paracentesis in rabbit eyes. In the aqueous humor, the inhibition rate of protein,the centration was 76.98% by diclofenac, 61.71% by ketoprofen and 20.83% by naproxen. The inhibition effect of ketoprofen on miosis is strongeer than that of placebo solution (vehicle) ; ketoprofen has significant difference at any examination time statistically (p