Effect of treatment with phosphate, casein phosphopeptide and fluoride on the remineralization: in vitro study

Abstract This study aimed to evaluate in vitro the effect protocols and anticaries agents containing casein amorphous calcium fluoride phosphopeptide-phosphate (CPP-ACPF, MI Paste Plus), sodium trimetaphosphate (TMP) and fluoride (F), in remineralization of caries lesions. Bovine enamel blocks with initial caries lesions were divided into groups (n = 12): 1) Toothpaste without F-TMP-MI Plus (Placebo); 2) Toothpaste 1100 ppm F (1100F), 3) 1100F + MI Paste Plus (1100F-MI Paste Plus), 4) Toothpaste with 1100F + Neutral gel with 4,500 ppm F + 5%TMP (1100F + Gel TMP) and 5) Toothpaste with 1100F + Neutral gel with 9,000 ppm F (1100F + Gel F). For the 4 and 5 groups the gel was applied only once for 1 minute, initially to the study. For the 3 group, after treatment with 1100F, MI Paste Plus was applied 2x/day for 3 minute. After pH cycling, the percentage of surface hardness recovery (%SHR); integrated loss of subsurface hardness (ΔKHN); profile and depth of the subsuperficial lesion (PLM); concentrations of F, calcium (Ca) and phosphorus (P) in enamel was determined. The data were analyzed by ANOVA (1-criterion) and Student-Newman-Keuls test (p < 0.001). Treatment with 1100F alone led to ~ 28% higher remineralization when compared to treatment with 1100F associated with MI Paste Plus (p < 0.001). The 1100F and 1100F + Gel F groups showed similar values for %SHR (p = 0.150). 1100F + Gel TMP treatment also remineralized the enamel surface by ~ 30% and 20% when compared to the 1100F + Gel F and 1100F groups (p < 0.001). The lower lesion depth (ΔKHN) was observed for the 1100F + Gel TMP group (p < 0.001), where it was 54% and 44% lower in comparison to the 1100F and 1100F + Gel F groups (p < 0.001). Polarized light microscopy photomicrographs showed subsurface lesions in all groups, but these lesions were present to a lower extent in the 1100F + Gel TMP group (p < 0.001). Treatment with 1100F + Gel TMP promoted an increase in the concentration of Ca in the enamel by ~ 57% and ~ 26% when compared to the 1100F and 1100F + MI Paste Plus groups (p < 0.001), respectively. There were no significant differences between the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001). Similar values of P in the enamel were observed in the 1100F, 1100F + MI Paste Plus and 1100F + Gel F groups (p > 0.001), except for the 1100F + Gel TMP group, which presented a high concentration (p < 0.001). We conclude that the 1100F+TMP gel treatment/protocol led to a significant increased remineralization when compared to the other treatments/protocols and may be a promising strategy for patients with early caries lesions.

Effect of fluoride gels with nano-sized sodium trimetaphosphate on the in vitro remineralization of caries lesions

Abstract Objective To evaluate the effects of fluoride (F) gels supplemented with micrometric or nano-sized sodium trimetaphosphate (TMPmicro and TMPnano, respectively) on the in vitro remineralization of caries-like lesions. Methodology Bovine enamel subsurface lesions (n=168) were selected according to their surface hardness (SH) and randomly divided into seven groups (n=24/group): Placebo (without F/TMP), 4,500 ppm F (4500F), 4500F + 2.5% TMPnano (2.5% Nano), 4500F + 5% TMPnano (5% Nano), 4500F + 5% TMPmicro (5% Micro), 9,000 ppm F (9000F), and 12,300 ppm F (Acid gel). The gels were applied in a thin layer for one minute. Half of the blocks were subjected to pH cycling for six days, whereas the remaining specimens were used for loosely- (calcium fluoride; CaF2) and firmly-bound (fluorapatite; FA) fluoride analysis. The percentage of surface hardness recovery (%SHR), area of subsurface lesion (ΔKHN), CaF2, FA, calcium (Ca), and phosphorus (P) on/in enamel were determined. Data (log10-transformed) were subjected to ANOVA and the Student-Newman-Keuls' test (p<0.05). Results We observed a dose-response relation between F concentrations in the gels without TMP for %SHR and ΔKHN. The 2.5% Nano and 5% Micro reached similar %SHR when compared with 9000F and Acid gels. For ΔKHN, Placebo and 5% Nano gels had the highest values, and 5% Micro, 2.5% Nano, 9000F, and Acid gels, the lowest. All groups had similar retained CaF2 values, except for Placebo and Acid gel. We verified observed an increase in Ca concentrations in nano-sized TMP groups. Regarding P, TMP groups showed similar formation and retention to 9000F and Acid. Conclusion Adding 2.5% nano-sized or 5% micrometric TMP to low-fluoride gels lead to enhanced in vitro remineralization of artificial caries lesions.

In vitro effect of low-fluoride toothpaste supplemented with sodium trimetaphosphate, xylitol, and erythritol on enamel demineralization

Abstract Regular use of toothpaste with fluoride (F) concentrations of ≥ 1000 ppm has been shown to contribute to reducing caries increment. However, when used by children during the period of dental development, it can lead to dental fluorosis. Objective: In this study, we aimed to evaluate the in vitro effect of a toothpaste formulation with reduced fluoride (F) concentration (200 ppm) supplemented with sodium trimetaphosphate (TMP: 0.2%), Xylitol (X:16%), and Erythritol (E: 4%) on dental enamel demineralization. Methodology: Bovine enamel blocks were selected according to initial surface hardness (SHi) and then divided into seven experimental toothpaste groups (n=12). These groups included 1) no F-TMP-X-E (Placebo); 2) 16% Xylitol and 4% Erythritol (X-E); 3) 16% Xylitol, 4% Erythritol and 0.2%TMP (X-E-TMP); 4) 200 ppm F (no X-E-TMP: (200F)); 5) 200 ppm F and 0.2% TMP (200F-TMP); 200 ppm F, 16% Xylitol, 4% Erythritol, and 0.2% TMP (200F-X-E-TMP); and 7) 1,100 ppm F (1100F). Blocks were individually treated 2×/day with slurries of toothpastes and subjected to a pH cycling regimen for five days (DES: 6 hours and RE: 18 hours). Then, the percentage of surface hardness loss (%SH), integrated loss of subsurface hardness (ΔKHN), fluoride (F), calcium (Ca), and phosphorus (P) in enamel were determined. The data were analyzed by ANOVA (1-criterion) and the Student-Newman-Keuls test (p<0.001). Results: We found that the 200F-X-E-TMP treatment reduced %SH by 43% compared to the 1100F treatments (p<0.001). The ΔKHN was ~ 65% higher with 200F-X-E-TMP compared to 1100F (p<0.001). The highest concentration of F in enamel was observed on the 1100F treatment (p<0.001). The 200F-X-E-TMP treatment promote higher increase of Ca and P concentration in the enamel (p<0.001). Conclusion: The association of 200F-X-E-TMP led to a significant increase of the protective effect on enamel demineralization compared to the 1100F toothpaste.

Unplanned pregnancy in Brazil: national study in eight university hospitals / Gravidez não planejada no Brasil: estudo nacional em oito hospitais universitários

ABSTRACT OBJECTIVE To estimate the prevalence of unplanned pregnancy in eight public university hospitals, distributed in the five regions that make up Brazil. METHODS A secondary analysis of a national multicenter cross-sectional study, carried out in eight public university hospitals between June 1 and August 31, 2020, in Brazil. Convenience sample including women who gave birth within sixty consecutive days and met the following criteria: over 18 years old; gestational age over 36 weeks at delivery; with a single and live newborn, without malformations. RESULTS Sample composed of 1,120 postpartum women, of whom 756 (67.5%) declared that the pregnancy had not been planned. The median prevalence of unplanned pregnancy was 59.7%. The prevalence of unplanned pregnancy across hospitals differed significantly: Campinas (54.8%), Porto Alegre (58.2%), Florianópolis (59%), Teresina (61.2%), Brasília (64.3%), São Paulo (64.6%), Campo Grande (73.9%) and Manaus (95.3%) (p < 0.001). Factors significantly associated with unplanned pregnancy were maternal age, black color, lower family income, greater number of children, greater number of people living in household, and not having a partner. CONCLUSION In the studied sample, about two thirds of the pregnancies were declared as unplanned. The prevalence of unplanned pregnancies was related to social and demographic factors and varied significantly across the university hospitals evaluated.

RESUMO OBJETIVO Estimar a prevalência de gestação não planejada (GNP) em oito hospitais públicos universitários, distribuídos nas cinco regiões que compõem o Brasil. MÉTODOS Análise secundária de um estudo transversal multicêntrico nacional, realizado em oito hospitais universitários públicos, entre 1º de junho e 31 de agosto de 2020, no Brasil. Amostra por conveniência incluindo mulheres que deram à luz em período de sessenta dias consecutivos e atenderam aos seguintes critérios: maiores de 18 anos; idade gestacional acima de 36 semanas no parto; com recém-nascido único e vivo, sem malformações. RESULTADOS Amostra composta por 1.120 puérperas, das quais 756 (67,5%) declararam que a gravidez não tinha sido programada. A mediana da prevalência de GNP foi de 59,7%. Observou-se diferença significativa na prevalência de GNP entre os hospitais: Campinas (54,8%), Porto Alegre (58,2%), Florianópolis (59%), Teresina (61,2%), Brasília (64,3%), São Paulo (64,6%), Campo Grande (73,9%) e Manaus (95,3%) (p < 0,001). Foram fatores significativamente associados a GNP a idade materna, cor negra, menor renda familiar, maior número de filhos, maior número de pessoas convivendo em casa e não ter parceiro. CONCLUSÃO Na amostra estudada, cerca de dois terços das gestações foram declaradas como não programadas. A prevalência de gestação não planejada teve relação com fatores sociais e demográficos e variou significativamente entre os hospitais universitários avaliados.

Screening, diagnosis and management of hypothyroidism in pregnancy: Number 10 - October 2022

Key points Pregnancy places a metabolic overload on the maternal thyroid, especially in the first trimester, mainly because of the demand imposed by the conceptus. The fetal thyroid becomes functionally mature only around pregnancy week 20. Until then, the fetus depends on the transfer of maternal thyroid hormones (THs). Thyroid hormones are essential for the adequate fetal neurofunctional and cognitive development. Hypothyroidism brings higher risks of obstetric and fetal complications, namely, first-trimester miscarriage, preeclampsia and gestational hypertension, placental abruption, prematurity, low birth weight, and higher perinatal morbidity and mortality. Primary hypothyroidism (involvement of the gland with difficulty in producing and/or releasing TH) is the most common form of disease presentation, with the main etiology of Hashimoto's thyroiditis of autoimmune origin. In about 85%-90% of cases of Hashimoto's thyroiditis, antithyroid antibodies are present; the antithyroperoxidase (ATPO) is the most frequent. Positivity for ATPO is determined when circulating values exceed the upper limit of the laboratory reference. It implies greater risks of adverse maternal-fetal outcomes. Such a correlation occurs even in ranges of maternal euthyroidism. The critical point for the diagnosis of hypothyroidism during pregnancy is an elevation of thyroid-stimulating hormone (TSH). The measurement of free thyroxine (FT4) differentiates between subclinical and overt hypothyroidism. In subclinical hypothyroidism, FT4 is within the normal range, whereas in overt hypothyroidism, FT4 values are below the lower limit of the laboratory reference. Treatment of hypothyroidism is performed with levothyroxine (LT4) replacement with the aim of achieving adequate TSH levels for pregnancy. Some women have a previous diagnosis of hypothyroidism, and may or may not be compensated at the beginning of pregnancy. Even in compensated cases, the increase in LT4 dose is necessary as soon as possible. In the postpartum period, adjustment of the LT4 dose depends on the condition of previous disease, on the positivity for ATPO, and also on the value of LT4 in use at the end of pregnancy. Recommendations In places with full technical and financial conditions, TSH testing should be performed for all pregnant women (universal screening) as early as possible, ideally at the beginning of the first trimester or even in preconception planning. In places with less access to laboratory tests, screening is reserved for cases with greater risk factors for decompensation, namely: previous thyroidectomy or radioiodine therapy, type 1 diabetes mellitus or other autoimmune diseases, presence of goiter, previous history of hypo or hyperthyroidism or previous ATPO positivity. The TSH dosage should be repeated throughout pregnancy only in these cases. The diagnosis of hypothyroidism is made from the TSH value > 4.0 mIU/L. Pregnant women with previous hypothyroidism, overt hypothyroidism diagnosed during pregnancy or those with the above-mentioned higher risk factors for decompensation should be referred for risk antenatal care, preferably in conjunction with the endocrinologist. Overt hypothyroidism in pregnancy is identified when TSH > 10 mIU/L, and treatment with LT4 is readily recommended at an initial dose of 2 mcg/kg/day. TSH values > 4.0 mUI/L and ≤ 10.0 mUI/L require FT4 measurement with two diagnostic possibilities: overt hypothyroidism when FT4 levels are below the lower limit of the laboratory reference, or subclinical hypothyroidism when FT4 levels are normal. The treatment for subclinical hypothyroidism is LT4 at an initial dose of 1 mcg/kg/day, and the dose should be doubled upon diagnosis of overt hypothyroidism. In cases of TSH > 2.5 and ≤ 4.0 mIU/L, if there are complete conditions, ATPO should be measured. If positive (above the upper limit of normal), treatment with LT4 at a dose of 50 mcg/day is indicated. If conditions are not complete, the repetition of the TSH dosage should be done only for cases at higher risk. In these cases, treatment with LT4 will be established when TSH > 4.0 mIU/L at a dose of 1 mcg/kg/day; if needed, the dose can be adjusted after FT4 evaluation. Women with previous hypothyroidism should have their LT4 dose adjusted to achieve TSH < 2.5 mIU/L at preconception. As soon as they become pregnant, they need a 30% increase in LT4 as early as possible. In practice, they should double the usual dose on two days a week. Levothyroxine should be given 30-60 minutes before breakfast or three hours or more after the last meal. Concomitant intake with ferrous sulfate, calcium carbonate, aluminum hydroxide and sucralfate should be avoided. The target of LT4 therapy during pregnancy is to achieve a TSH value < 2.5 mIU/L. Once the therapy is started, monthly control must be performed until the mentioned goal is reached. In the postpartum period, women with previous disease should resume the preconception dose. Cases diagnosed during pregnancy in use of LT4 ≤ 50 mcg/day may have the medication suspended. The others should reduce the current dose by 25% to 50% and repeat the TSH measurement in six weeks. Cases of ATPO positivity are at higher risk of developing postpartum thyroiditis and de-escalation of LT4 should be performed as explained.

Low-cost 3D modeling software for generating patient-specific drill guide templates for cervical pedicle screw insertion: An in vitro study

BACKGROUND@#Instrumented posterior cervical spine surgery (IPCSS) can be conducted using screws inserted through the pedicles of the vertebra. A safe IPCSS method uses 3D-printing to produce templates that will serve as drill guides for screw placement.@*OBJECTIVES@#This study describes the generation of 3D-printed drill guides using low-cost general purpose 3D modeling software and the comparison of screw insertion accuracy scores against the traditional landmark method and guides created using commercial grade software.@*METHODS@#Twenty-five (25) subaxial pedicles of five cadaveric spines were selected and scanned using computed tomography (CT). A digital reconstruction of the five cadaveric spines were created based on the CT DICOM data. A low-cost 3D modeling software, Rhinoceros 3D, was utilized for trajectory planning and generation of a patientspecific drill template using the digital reconstruction. The templates were then fabricated in ABS plastic using a fused deposition modeling (FDM) 3D printer. Insertion of cervical pedicle screws on the cadaveric spines was done by an orthopedic resident using the 3D printed guides. Postoperative CT scans were obtained, and placement accuracy of the screws were scored by two assessors utilizing a four-point rating system. Screws in correct placement were scored Grade 0 while misplaced screws with neurovascular damage were given a score of Grade 3.@*RESULTS@#Accuracy scores for the 3D-printed drill guides were 52% for assessor 1 and 44% for assessor 2. For assessor 1, screw placement in C3, C6, and C7 received the highest scores. For assessor 2, the highest scores were achieved in C3 and C7. The hybrid method of Bundoc et al. achieved scores of 94% while 3D printed guides utilizing commercial software like Materialise Mimics, Geomagic Freeform, or UG Imageware achieved scores of 80-100%. The traditional landmark method had scores ranging from 12% to 94% depending on the skill of the surgeon.@*CONCLUSION@#Commercial medical 3D image-based engineering software has high acquisition costs that might be beyond the reach of most institutions. A sub-$1000 general purpose 3D modeling software can be used to create drill templates. Several factors were identified in the design and fabrication of the template that can be addressed to increase accuracy. Trajectory planning can also be improved by automating the process. The researchers recommend further studies in these areas specially in the context of developing 3D printing as a support service for surgical operations in the Philippines.

New insights into the anti-erosive property of a sugarcane-derived cystatin: different vehicle of application and potential mechanism of action

Abstract A new sugarcane-derived cystatin (CaneCPI-5) showed anti-erosive properties when included in solutions and strong binding force to enamel, but the performance of this protein when added to gel formulations and its effect on surface free energy (SFE) requires further studies. Objective 1) to evaluate the protective effect of gels containing different concentrations of CaneCPI-5 against initial enamel erosion (Experiment 1); and 2) to analyze the SFE (γS) after treating the enamel surface with CaneCPI-5 solution (Experiment 2). Methodology In Experiment 1, 75 bovine enamel specimens were divided into five groups according to the gel treatments: placebo (negative control); 0.27%mucin+0.5%casein (positive control); 0.1 mg/mL CaneCPI-5; 1.0 mg/mL CaneCPI-5; or 2.0 mg/mL CaneCPI-5. Specimens were treated with the gels for 1 min, the AP was formed (human saliva) for 2 h and the specimens were incubated in 0.65% citric acid (pH=3.4) for 1 min. The percentage of surface hardness change (%SHC) was estimated. In Experiment 2, measurements were performed by an automatic goniometer using three probing liquids: diiodomethane, water and ethylene glycol. Specimens (n=10/group) remained untreated (control) or were treated with solution containing 0.1 mg/mL CaneCPI-5, air-dried for 45 min, and 0.5 µL of each liquid was dispensed on the surface to measure contact angles. Results Gels containing 0.1 and 1.0 mg/mL CaneCPI-5 significantly reduced %SHC compared to the other treatments (p<0.05). Treated enamel showed significantly lower γS than control, without changes in the apolar component (γSLW), but the polar component (γSAB=Lewis acid-base) became more negative (p<0.01). Moreover, CaneCPI-5 treatment showed higher γS - (electron-donor) values compared to control (p<0.01). Conclusions Gels containing 0.1 mg/mL or 1.0 mg/mL CaneCPI-5 protected enamel against initial dental erosion. CaneCPI-5 increased the number of electron donor sites on the enamel surface, which may affect AP formation and could be a potential mechanism of action to protect from erosion.

Novel pulp capping material based on sodium trimetaphosphate: synthesis, characterization, and antimicrobial properties

Abstract Objectives: To evaluate the mechanical, physicochemical, and antimicrobial properties of four different formulations containing micro- or nanoparticles of sodium trimetaphosphate (mTMP and nTMP, respectively). Methodology: Four experimental groups were used in this investigation: two mTMP groups and two nTMP groups, each containing zirconium oxide (ZrO2), and solution containing either chitosan or titanium oxide (TiO2) nanoparticles (NPs). Setting time, compression resistance, and radiopacity were estimated. The agar diffusion test was used to assess the antimicrobial activity of the formulations against five different microbial strains: Streptococcus mutans, Lactobacillus casei, Actinomyces israelii, Candida albicans, and Enterococcus faecalis. Parametric and nonparametric tests were performed after evaluating homoscedasticity data (p<0.05). Results: From the properties evaluated, nTMP cements required less setting time and showed greater resistance to compression. Cements containing TiO2 showed greater radiopacity for both nTMP and mTMP. All four cement formulations showed antimicrobial activity against S. mutans and L. casei Conclusion: Formulations containing nTMP have shorter setting times and higher compressive strength, and those with TiO2 nanoparticles showed antimicrobial activities. Clinical relevance: The cement containing nTMP, ZrO2, and TiO2 could be an alternative material for protecting the pulp complex.

Increased Risk for Maternal Anxiety during the COVID-19 Outbreak in Brazil among Pregnant Women without Comorbidities / Aumento do risco de ansiedade materna durante o surto de COVID-19 no Brasil entre gestantes sem comorbidades

Abstract Objective To study maternal anxiety in pregnant women without comorbidities in the context of the COVID-19 outbreak in Brazil and to study maternal knowledge and concerns about the pandemic. Methods This is a secondary analysis from a national multicenter cross-sectional study performed in 10 cities, from June to August, 2020, in Brazil. Interviewed postpartum women, without medical or obstetrical comorbidities, were included in the present subanalysis. A structured questionnaire and the Beck Anxiety Inventory (BAI) were applied. Results Out of the 1,662 women, 763 (45.9%) met the criteria for the current analysis and 16.1% presented with moderate and 11.5% with severe maternal anxiety. Moderate or severe maternal anxiety was associated with high school education (odds ratio [OR]:1.58; 95% confidence interval [CI]:1.04-2.40). The protective factor was cohabiting with a partner (OR: 0.46; 95%CI: 0.29-0.73). There was a positive correlation between the total BAI score and receiving information about care in the pandemic (rpartial 0.15; p < 0.001); concern about vertical transmission of COVID-19 (rpartial 0.10; p = 0.01); receiving information about breastfeeding (rpartial 0.08; p = 0.03); concerns about prenatal care (rpartial 0.10; p = 0.01), and concerns about the baby contracting COVID-19 (rpartial 0.11; p = 0.004). The correlation was negative in the following aspects: self-confidence in protecting from COVID-19 (rpartial 0.08; p = 0.04), having learned (rpartial 0.09; p = 0.01) and self-confidence in breastfeeding (rpartial 0.22; p < 0.001) in the context of the pandemic. Conclusion The anxiety of pregnant women without medical or obstetrical comorbidities was associated to high school educational level and not living with a partner during the COVID-19 pandemic. Self-confidence in protecting against COVID-19 and knowledge about breastfeeding care during the pandemic reduced maternal anxiety.

Resumo Objetivo Estudar a ansiedade materna em gestantes sem comorbidades no contexto do surto de COVID-19 no Brasil e estudar o conhecimento e as preocupações maternas sobre a pandemia. Métodos Trata-se de análise secundária de um estudo transversal multicêntrico nacional realizado em 10 cidades, de junho a agosto de 2020, no Brasil. Mulheres no pós-parto entrevistadas, sem comorbidades médicas ou obstétricas, foram incluídas nesta subanálise. Foram aplicados um questionário estruturado e o Inventário de Ansiedade de Beck (BAI, na sigla em inglês). Resultados Das 1.662 mulheres, 763 (45,9%) atenderam aos critérios da análise atual e 16,1% apresentaram ansiedade materna moderada e 11,5% ansiedade materna grave. A ansiedade materna moderada ou grave foi associada à escolaridade no ensino médio (odds ratio [OR]: 1,58; intervalo de confiança [IC] 95%: 1,04-2,40). O fator protetor foi coabitar com companheiro (OR: 0,46; IC95%: 0,29-0,73). Houve correlação positiva entre a pontuação total do BAI e o recebimento de informações sobre cuidados na pandemia (rparcial 0,15; p < 0,001); preocupação com a transmissão vertical de COVID-19 (rparcial 0,10; p = 0,01); receber informações sobre amamentação (rparcial 0,08; p = 0,03); preocupações sobre cuidados pré-natais (rparcial 0,10; p = 0,01) e preocupações sobre o bebê contrair COVID-19 (rparcial 0,11; p = 0,004). A correlação foi negativa com os seguintes aspectos: ter autoconfiança para se proteger (rparcial 0,08; p = 0,04), aprender (rparcial 0,09; p = 0,01) e ter autoconfiança para amamentar (rparcial 0,22; p < 0,001) no contexto da pandemia. Conclusão A ansiedade de gestantes sem comorbidades médicas ou obstétricas esteve associada à escolaridade no ensino médio e não morar com companheiro durante a pandemia de COVID-19. A autoconfiança na proteção contra COVID-19 e o conhecimento sobre os cuidados com a amamentação durante a pandemia reduziram a ansiedade materna.

Resistencia al impacto de dos acrílicos convencionales y dos de alto impacto para prótesis total / Impact resistance of two conventional and two high impact acrylics for dentures / Resistência ao impacto de dois acrílicos convencionais e dois acrílicos de alto impacto para próteses totais

Resumen Introducción y objetivo: las resinas acrílicas son los materiales idóneos para la elaboración prótesis totales, sin embargo, las caídas o golpes los hace susceptibles de fracturas. Conocer las propiedades y limitaciones de los acrílicos en nuestro entorno, nos permite realizar tratamientos con los mejores materiales. El objetivo de este estudio fue comparar la resistencia al impacto de dos acrílicos convencionales y dos de alto impacto para bases protésicas. Materiales y métodos: se realizaron 40 barras en cera para base para ser enmufladas de acuerdo con especificaciones de cuatro marcas de acrílicos (n=10), Lucitone199®, Masterdent acrylic resin, Veracril alto impacto® y convencional. La resistencia impacto se evaluó mediante la prueba de Charpy (Máquina ITC-XJU-22), con masa de péndulo de 0.237 Kg y fuerza de impacto de 1J. se realizó análisis estadístico por ANOVA a una vía y prueba de tukey. Resultados: los valores de resistencia al impacto fueron 16.5, 10.8, 9.3 y 5.9 KJ/m2 para Lucitone199®, Veracril alto impacto®, Veracril convencional® y Masterdent acrylic resin. Conclusiones: con las limitaciones de esta investigación, los acrílicos de alto impacto se pueden considerar como una alternativa más viable para la elaboración de prótesis totales ante los acrílicos convencionales, en busca de disminuir el riesgo de fracturas por accidentes o cargas repentinas de impacto.

Abstract Introduction and objective: acrylic resins are the ideal materials for the elaboration of dentures and removable prostheses, although the falls or blows make them susceptible to fractures. Knowing the properties and limitations of acrylics in our environment, allows us to carry out treatments with the best materials. The objective of this study was to compare the impact resistance of two conventional and two high impact acrylics for prosthetic bases. Materials and methods: 40 bars were made in base-wax and processed in muffles according to specifications of four trademarks of acrylics (n=10), Lucitone199®, Masterdent acrylic resin®, Veracril alto impacto® and convencional®. The impact resistance was evaluated by the Charpy test (Machine ITC-XJU-22), with a pendulum mass of 0.237 Kg and an impact force of 1J. One-way ANOVA and tukey test were performed for statistical analysis was performed. Results: the impact resistance values were 16.5, 10.8, 9.3 and 5.9 KJ / m2 for Lucitone199®, Veracril alto impacto®, Veracril convencional® and Masterdent acrylic resin®. Conclusions: with the limitations of this investigation, high impact acrylics can be considered as a more viable alternative for the elaboration of dentures compared to conventional acrylics, in order to reduce the risk of fractures due to accidents or sudden impact loads.

Resumo Introdução y objetivo: as resinas acrílicas são os materiais ideais para a elaboração de próteses totais, porém as quedas ou golpes os tornam suscetíveis a fraturas. Conhecer as propriedades e limitações dos acrílicos em nosso ambiente, permite realizar tratamentos com os melhores materiais.. O objetivo deste estudo foi comparar a resistência ao impacto de d ois acrílicos convencionais e dois de alto impacto para bases protéticas. Materiais e métodos: foram feitas 40 barras de cera para que a base seja silenciada de acordo com as especificações de quatro marcas de acrílicos (n=10), Lucitone199®, resina acrílica Masterdent, Veracril high impact® e convencional. A resistência ao impacto foi avaliada pelo teste de Charpy (Máquina ITC-XJU-22), com uma massa pendular de 0.237 kg e uma força de impacto de 1J. Foi realizada análise estatística ANOVA unidirecional e teste de tukey. Resultados: os valores de resistência ao impacto foram de 16.5, 10.8, 9.3 e 5.9 KJ/m2 para a resina acrílica Lucitone199®, Veracril high impact®, Veracril convencional® e Masterdent. Conclusões: com as limitações desta investigação, os acrílicos de alto impacto podem ser considerados uma alternativa mais viável para a elaboração de próteses totais em comparação aos acrílicos convencionais, a fim de reduzir o risco de fraturas devido a acidentes ou cargas de impacto repentinas.

Supervisors' perceptions on errors of nursing students in clinical clerkship: a qualitative research / Percepciones de los supervisores sobre los errores de los estudiantes de enfermería en prácticas clínicas: una investigación cualitativa / Percepções dos supervisores sobre erros dos estudantes de enfermagem em estágio clínico: uma pesquisa qualitativa

ABSTRACT Objectives: to compare pedagogical supervisors' and clinical supervisors' perceptions about the errors made by nursing students in clinical clerkship. Methods: a qualitative exploratory-descriptive study developed with 105 participants. Data collection was performed with a questionnaire with open-ended questions. Content analysis performed according to the conceptual model of student errors in clinical teaching. Results: pedagogical supervisors perceive, in descending order, errors in transversal competencies, in the execution of care and medication. Clinical supervisors perceive, in descending order, the execution of care, medication, and transversal competencies. Final Considerations: there was coincidence and complementarity in clinical supervisors' and pedagogical supervisors' perceptions, although not in the same order, regarding the errors made. This study presents contributions related to the existing knowledge in relation to medication errors, which are not the most perceived, and those of transversal competencies, which take on a prominent position.

RESUMEN Objetivos: comparar la percepción de los supervisores pedagógicos y supervisores clínicos sobre los errores cometidos por los estudiantes de enfermería en práctica clínica. Métodos: estudio cualitativo exploratorio-descriptivo, desarrollado con 105 participantes. Recolección de datos realizada con un cuestionario con preguntas abiertas. Análisis de contenido realizado según el modelo conceptual de errores del alumno en educación clínica. Resultados: los supervisores pedagógicos perciben, en orden decreciente, los errores en las competencias transversales, en la ejecución de los cuidados y la medicación. Los supervisores clínicos perciben, en orden decreciente, la ejecución de cuidados, medicación y habilidades transversales. Consideraciones Finales: hubo coincidencia y complementariedad en las percepciones de los supervisores clínicos y los supervisores pedagógicos, aunque no en el mismo orden, sobre los errores cometidos. El estudio presenta aportes relacionados con el conocimiento existente en relación a los errores de medicación, que no son los más percibidos, y los de habilidades transversales, que asumen un lugar destacado.

RESUMO Objetivos: comparar a percepção de supervisores pedagógicos e de supervisores clínicos sobre os erros cometidos por estudantes de enfermagem em estágio clínico. Métodos: estudo qualitativo exploratório-descritivo, desenvolvido com 105 participantes. Coleta de dados realizada com questionário com perguntas abertas. Análise de conteúdo realizada segundo modelo conceptual de erros de estudantes em ensino clínico. Resultados: os supervisores pedagógicos percebem, em ordem decrescente, os erros nas competências transversais, na execução de cuidados e de medicação. Os supervisores clínicos percebem, por ordem decrescente, a execução de cuidados, de medicação e as competências transversais. Considerações Finais: verificou-se coincidência e complementaridade nas percepções de supervisores clínicos e de supervisores pedagógicos, embora não na mesma ordem, em relação aos erros cometidos. O estudo apresenta contribuições relativas ao conhecimento existente em relação aos erros de medicação, que não são os mais percebidos, e os de competências transversais, que assumem posição de destaque.

Effect of S. mutans combinations with bifidobacteria/lactobacilli on biofilm and enamel demineralization

Abstract The present study evaluated the ability of Bifidobacterium and Lactobacillus species associated with streptococci to increase insoluble extracellular polysaccharide (EPS) production and initial caries lesion progression. Bovine enamel blocks (n = 190; 4 mm x 4 mm) were prepared, selected according to initial surface hardness (SH), and divided into two groups: a) double combinations: S. mutans with Bifidobacterium or Lactobacillus, and b) triple combinations: S. mutans and S. sobrinus with Bifidobacterium or Lactobacillus species. The blocks were exposed to the bacterial associations for 7 days. Subsequently, quantity of EPS from biofilms and caries lesion depth were determined by means of colorimetric and cross-sectional enamel hardness (ΔKHN) analysis. The data were submitted to one-way analysis of variance, followed by the Bonferroni test (p < 0.05). S. mutans with B. animalis or B. dentium produced a higher quantity of EPS; S. mutans + B. animalis led to the highest ∆KHN. S. mutans + S. sobrinus + B. longum induced greater EPS and ∆KHN values. In conclusion, associations of B. animalis and B. longum with streptococci promoted EPS production and caries lesion progression.

Influence of diabetic neuropathy on gait complexity / Influência da neuropatia diabética na complexidade da marcha / Influencia de la neuropatía diabética en la complejidad de la marcha

ABSTRACT Introduction: Human gait is a complex movement dependent on multilevel neural control, which allows a consistent, regular and complex periodic pattern, properties that characterize it as a nonlinear system. Sensory and motor deficits, with diminished proprioceptive responses, may reduce the adaptive capacity of the system, as demonstrated in Parkinson's, Alzheimer's and Huntington's diseases. However, little is known about the effect of peripheral diabetic neuropathy on these responses. Objectives: To analyze the influence of peripheral diabetic neuropathy on entropy in different gait environments. Methods: Ten elderly patients, with and without a diagnosis of peripheral diabetic neuropathy, walked on a treadmill (initial speed of 3 km/h, with 0.5 km/h increments every 5 minutes up to the speed of 5 km/h) to record center of mass acceleration in the vertical, mediolateral and anteroposterior components throughout the test. The sample entropy of the three vectors was calculated for each test speed. Results: The vertical component did not show any statistically significant differences. The mediolateral component showed statistically significant difference for the factors group, speed, and interaction between factors (group and speed). The anteroposterior component showed statistically significant differences for the group factor, but not for speed and interaction between factors (group and speed). Effect sizes classified as large were found in all the comparisons. Conclusions: Peripheral diabetic neuropathy produced changes in the ability to adapt to changes in the environment during gait, probably due to changes in the complexity of the multilevel neural control system, which depends on motor and sensory feedback, known to be affected by peripheral diabetic neuropathy. Level of Evidence II; Diagnostic studies - Investigating a diagnostic test.

RESUMO Introdução: A marcha humana é um movimento complexo dependente de controle neural multinível, que permite um padrão periódico uniforme, regular e complexo, que a caracterizam como um sistema não linear. O déficit sensitivo e motor com diminuição das respostas proprioceptivas pode diminuir a capacidade de adaptação do sistema, como já demonstrado nas doenças de Parkinson, Alzheimer e Huntington. Contudo, pouco se conhece sobre o efeito da neuropatia diabética periférica nessas respostas. Objetivos: Analisar a influência da neuropatia diabética periférica na entropia em diferentes ambientes de marcha. Métodos: Dez idosos, sem e com diagnóstico de neuropatia diabética periférica, caminharam em esteira rolante (velocidade inicial 3 km/h e incremento de 0,5 km/h a cada 5 minutos até a velocidade 5 km/h) para o registro da aceleração do centro de massa nos componentes vertical, médio-lateral, e anteroposterior ao longo de todo teste. A entropia amostral dos três vetores foi calculada para cada velocidade de teste. Resultados: O componente vertical não apresentou nenhuma diferença com significância estatística. O componente médio-lateral mostrou diferenças com significância estatística para os fatores grupo, velocidade e interação entre os fatores (grupo e velocidade). O componente anteroposterior apresentou diferenças com significância estatística para o fator grupo, mas não para o fator velocidade e interação entre os fatores (grupo e velocidade). Em todas as comparações, foram encontrados tamanhos de efeito classificados como grandes. Conclusões: A neuropatia diabética periférica produziu alterações na capacidade de adaptação sobre as variações do ambiente durante a marcha, provavelmente, em decorrência de alterações da complexidade do sistema de controle neural multinível, que depende da retroalimentação sensitiva e motora, sabidamente afetadas pela neuropatia diabética periférica. Nível de Evidência II; Estudos diagnósticos - Investigação de um exame para diagnóstico.

RESUMEN Introducción: La marcha humana es un movimiento complejo dependiente de control neural multinivel, que permite un patrón periódico uniforme, regular y complejo, que la caracterizan como un sistema no lineal. El déficit sensitivo y motor con disminución de las respuestas propioceptivas puede disminuir la capacidad de adaptación del sistema, como ya fuera demostrado en las enfermedades de Parkinson, Alzheimer y Huntington. No obstante, poco se conoce sobre el efecto de la neuropatía diabética periférica en esas respuestas. Objetivos: Analizar la influencia de la neuropatía diabética periférica en la entropía en diferentes ambientes de marcha. Métodos: Diez ancianos, sin y con diagnóstico de neuropatía diabética periférica, caminaron en cinta rodante (velocidad inicial 3 km/h e incremento de 0,5 km/h a cada 5 minutos hasta la velocidad de 5 km/h) para el registro de la aceleración del centro de masa en los componentes vertical, medio-lateral, e anteroposterior a lo largo de todo el test. La entropía de muestreo de los tres vectores fue calculada para cada velocidad de test. Resultados: El componente vertical no presentó ninguna diferencia con significancia estadística. El componente medio-lateral mostró diferencias con significancia estadística para los factores grupo, velocidad e interacción entre los factores (grupo y velocidad). El componente anteroposterior presentó diferencias con significancia estadística para el factor grupo, pero no para el factor velocidad e interacción entre los factores (grupo y velocidad). En todas las comparaciones, se encontraron tamaños de efecto clasificados como grandes. Conclusiones: La neuropatía diabética periférica produjo alteraciones en la capacidad de adaptación sobre las variaciones del ambiente durante la marcha, probablemente como consecuencia de alteraciones de la complejidad del sistema de control neural multinivel, que depende de la retroalimentación sensitiva y motora, sabidamente afectadas por la neuropatía diabética periférica. Nivel de Evidencia II; Estudios de diagnósticos - Investigación de un examen para diagnóstico.

Síndrome de burnout durante a residência médica / Burnout syndrome during medical residency

No presente artigo, a Comissão Nacional Especializada em Residência Médica da Febrasgo traz à tona elementos essenciais para conhecer, reconhecer e prevenir a síndrome de burnout em médicos-residentes de ginecologia-obstetrícia. (AU)

Atenolol increases dental mineralization in male offspring of treated hypertensive rats and normotensive rats

Abstract This study evaluates how atenolol affects dental mineralization in offspring of female spontaneously hypertensive rats (fSHR) and normotensive Wistar rats (fW). fSHR and fW were treated with atenolol (100 mg/Kg/day, orally) during pregnancy and lactation. Non-treated fSHR and fW were the control groups. Enamel and dentin hardness were analyzed (Knoop, 15 g load, 10s) in mandibular incisor teeth (IT) and molar teeth (MT) obtained from the male offspring of atenolol-treated and non-treated fWistar and fSHR. Data were analyzed by ANOVA, followed by Tukey post hoc test (p < 0.05). Atenolol reduced the arterial blood pressure (SBP) in fSHR, but it did not change the SBP in fW. The offspring of non-treated fSHR had lower enamel (IT and MT) and dentin (IT) hardness than the offspring of non-treated fW (p < 0.05). Atenolol increased enamel and dentin hardness in the IT obtained from the offspring of fSHR and fW (p<0.05), but the offspring of fSHR presented higher values (p < 0.05). Atenolol did not alter enamel width in the IT obtained from any of the groups, but it increased enamel and dentin hardness in the IT obtained from the offspring of fSHR and fW. Atenolol affected the IT obtained from the offspring of fSHR. Atenolol increased only enamel hardness in the MT obtained from the offspring of fW. In conclusion, maternal hypertension reduces tooth hard tissues, and treatment with atenolol increases tooth hardness in male offspring of hypertensive and normotensive female rats.