Vaginosis citolítica: actualización diagnóstica y terapéutica / Cytolytic vaginosis: diagnostic and therapeutic update

El objetivo es conocer el abordaje diagnóstico y terapéutico de la vaginosis citolítica. Para ello se hizo una búsqueda sistemática de la literatura médica mediante las bases de datos: PubMed, Central, etc. Se limitó a ensayos clínicos aleatorizados, metaanálisis y revisiones bibliográficas, con disponibilidad del texto completo para evaluarlos en su totalidad e incluirlos en la revisión; publicados entre 1980 y 2021. Se incluyeron 27 publicaciones. La vaginosis citolítica es un trastorno infradiagnosticado. En mujeres con síntomas y signos de candidiasis vulvovaginal, que no responden a la terapia, se debe considerar la probabilidad de estar en presencia de una vaginosis citolítica. El tratamiento obliga a elevar el pH vaginal a valores básicos y a disminuir el número excesivo de Lactobacillus, resultando de utilidad las duchas vaginales con bicarbonato de sodio y/o un tratamiento con antibióticos derivados de la penicilina junto a un inhibidor de ß-lactamasas o doxiciclina en las pacientes alérgicas a la penicilina. Finalmente, se concluye que la vaginosis citolítica es una afección común, frecuentemente se diagnostica de forma errónea porque se confunde con la candidiasis vulvovaginal; se caracteriza por producir un cuadro clínico similar. El tratamiento se enfoca en disminuir el número de Lactobacillus y la elevación del pH vaginal.

The objective is to know the diagnostic and therapeutic approach of cytolytic vaginosis. A systematic search of the medical literature was carried out using the following databases: Medline via PubMed, Central, and Cochrane Database of Systematic Reviews, among others. The search was limited to randomized clinical trials, meta-analyses, and literature reviews that had the full text available for full evaluation and inclusion in the review; published between 1980 and 2021. Twenty-seven publications were included. Cytolytic vaginosis is a frequently underdiagnosed disorder, which mimics Candida vaginitis. In women with symptoms and signs of vulvovaginal candidiasis who do not respond to antifungal therapy, the possibility of cytolytic vaginosis should be considered. The treatment of this condition requires raising the vaginal pH to basic values and reducing the excessive number of Lactobacillus, resulting in useful vaginal douches with sodium bicarbonate and/or treatment with antibiotics derived from penicillin together with a ß-lactamases inhibitor or doxycycline in patients allergic to penicillin. Finally, we conclude that cytolytic vaginosis is a common condition, frequently misdiagnosed because it is confused with vulvovaginal candidiasis, since it is characterized by producing a similar clinical picture. Treatment focuses on reducing the number of Lactobacillus and raising vaginal pH.

Effect of lime water processing of Pinelliae Rhizoma Praeparatum on toxic component lectin protein / 中国中药杂志

The present study investigated the effect of immersion in the excipient lime water on the toxic component lectin protein and explained the scientific connotation of lime water detoxication during the processing of Pinelliae Rhizoma Praeparatum. Western blot was used to investigate the effects of immersion in lime water with different pH(pH 10, 11, and 12.4), saturated sodium hydroxide, and sodium bicarbonate solution on the content of lectin protein. The protein compositions of the supernatant and the precipitate after immersing lectin protein in lime water of different pH were determined by the SDS-PAGE method combined with the silver staining technique. The MALDI-TOF-MS/MS technique was used to detect the molecular weight distribution of peptide fragments in the supernatant and precipitate after immersing lectin protein in lime water of different pH, and circular dichroism spectroscopy was used to detect the ratio changes in the secondary structure of lectin protein during the immersion. The results showed that immersion in lime water at pH>12 and saturated sodium hydroxide solution could significantly reduce the content of lectin protein, while immersion in lime water at pH<12 and sodium bicarbonate solution had no significant effect on lectin protein content. The corresponding lectin protein bands and molecular ion peaks were not detected at the 12 kDa position in the supernatant and precipitate after immersing the lectin protein in lime water at pH>12, which was attributed to the fact that lime water immersion at pH>12 could significantly change the ratio of the secondary structure of lectin protein, resulting in irreversible denaturation, while lime water immersion at pH<12 did not change the ratio of the secondary structure of lectin protein. Therefore, pH>12 was the key condition for the detoxication of lime water during the processing of Pinelliae Rhizoma Praeparatum. Lime water immersion at pH>12 could cause irreversible denaturation of lectin protein, resulting in a significant decrease in the inflammatory toxicity of Pinelliae Rhizoma Praeparatum, which played a key role in detoxification.

Treatment of intravesical instillation with fulguration-hydrodistention on female interstitial cystitis / 北京大学学报(医学版)

OBJECTIVE@#To investigate the efficacy and safety of intravesical instillation of heparin/alkalized lidocaine (lidocaine mixed with sodium bicarbonate) combined with hydrodistension and transurethral fulguration in the treatment of female interstitial cystitis (IC).@*METHODS@#Female patients who attended the Department of Urology at the First Hospital of China Medical University between January 2012 and December 2020 and met the diagnostic criteria proposed in the guidelines of the American Urological Association with a new diagnosis of IC were selected for retrospective analysis. Cystoscopy and biopsy of suspicious lesions were performed at the time of diagnosis. All the patients were treated with an intravesical instillation regimen of 2% lidocaine 10 mL + 5% sodium bicarbonate 5 mL + heparin 25 000 IU for a continuous period of 12 months, with or without water dilatation and transurethral electrocautery according to the patient's preference, categorized as hydrodistension and transurethral fulguration (HD/TF) group and non-HD/TF group. The patients were evaluated before and 1, 6, and 12 months after treatment for O'Leary-Sant interstitial cystitis patient symptom index scores (ICSI), interstitial cystitis patient problem index scores (ICPI), visual analog scale (VAS) of suprapubic pain, and functional bladder capacity (FBC) changes.@*RESULTS@#A total of 79 patients were collected in this study. Four (5.1%) of these patients underwent cystectomy due to pathological diagnosis of cancer or treatment failure. The remaining patients were followed up 1, 6 and 12 months after treatment. Repeated-measures ANOVA showed a significant decrease in ICPI, ICSI and VAS and an increase in FBC after treatment compared with before treatment (P < 0.05). FBC continued to decrease during the 1, 6 and 12 months' post-treatment follow-ups, with statistically significant differences; ICSI continued to decrease during the 1 and 6 months post-treatment follow-ups, with statistically significant differences, while the difference between ICSI at 6 months post-treatment and at 12 months' post-treatment was not statistically significant. In the HD/TF group, ICPI continued to decrease in the follow-up from 1 and 6 months after treatment, and the difference was statistically significant, while the difference between ICPI 6 months after treatment and 12 months after treatment was not statistically significant. There was no statistically significant difference between the remaining indicators 1, 6 and 12 months after treatment. ICPI, ICSI, VAS and FBC improved earlier and the changes in VAS and FBC were more significant in the HD/TF group compared with the non-HD/TF group (P < 0.05).@*CONCLUSION@#Heparin/alkalized lidocaine combination of intravesical instillation with hydrodistension and transurethral fulguration for IC is an effective treatment option. Heparin/alkalized lidocaine combination of intravesical instillation may be the first choice of treatment, which can significantly reduce the economic burden of patients and medical insurance system. If patients can accept it, transurethral fulguration with hydrodistension may be considered.

Comparación del efecto de omeprazol como monoterapia y su combinación con bicarbonato de sodio en el tratamiento de la pirosis moderada a severa: ensayo clínico controlado, aleatorizado y doble ciego / Comparison of the effect of omeprazole monotherapy and its combination with sodium bicarbonate in the treatment of moderate to severe heartburn: a double-blind, randomized controlled clinical trial

Heartburn occurs in 75% of patients with digestive discomfort of any origin and is one of the main symptoms of gastroesophageal reflux disease. Treatment focuses on lifestyle modification and symptomatology management with various drugs; when heartburn is moderate to severe, a proton pump inhibitor is more suitable. Omeprazole (OMZ) combined with sodium bicarbonate (BC) has demonstrated significant and sustained suppression of acid secretion. The objective was to compare the effect of sequential OMZ/BC therapy compared to OMZ monotherapy for the improvement of heartburn in Mexican individuals. The study was a double-blind, randomized, controlled, multicenter clinical study including 277 subjects with moderate to severe heartburn. Patients received 7 days of OMZ/BC and 7 days of OMZ (OMZ/BC7) or 14 days of OMZ (OMZ14). The primary endpoint was defined as the change in the number of days a week that the patient has heartburn, it was evaluated at 14 days. Both treatments reduced time (days) with heartburn by less than 4 days (OMZ14 3.9 vs. 4.2 days OMZ/BC7), as well as duration, number of events and intensity of heartburn. The treatments improved the quality of life, and the control of the symptoms. The proportion of adverse events was lower with OMZ/BC. The non-inferiority of OMZ/BC7 with respect to OMZ14 was verified.

La pirosis se presenta en el 75% de los pacientes con molestias digestivas de cualquier origen y es uno de los principales síntomas de la enfermedad por reflujo gastroesofágico. El tratamiento se enfoca en la modificación del estilo de vida y el manejo de la sintomatología con diversos fármacos; cuando la pirosis es moderada a severa, un inhibidor de la bomba de protones es más adecuado. El omeprazol (OMZ) combinado con bicarbonato de sodio (BC) ha demostrado supresión significativa y sostenida de la secreción ácida. El objetivo fue comparar el efecto de la terapia secuencial de OMZ/BC en comparación con el tratamiento continuo de OMZ para la mejoría de la pirosis en individuos mexicanos. Estudio clínico multicéntrico, doble ciego, controlado, aleatorizado que incluyó 277 sujetos con pirosis moderada a severa. Los pacientes recibieron 7 días de OMZ/BC y 7 días de OMZ (OMZ/BC7) o 14 días de OMZ (OMZ14). La variable primaria fue definida como el cambio del número de días a la semana que el paciente presenta pirosis, se evaluó a los 14 días. Ambos tratamientos redujeron los días con pirosis en menos 4 días (OMZ14 3,9 vs. 4,2 días OMZ/BC7), así como la duración, el número de eventos e intensidad de la pirosis. Los tratamientos mejoraron los indicadores de calidad de vida, y el control del padecimiento. La proporción de eventos adversos fue menor con OMZ/BC. Se comprobó la no-inferioridad de OMZ/BC7 respecto OMZ14.

Análise Bioquímica e Biomarcadores de Lesão e Fadiga em Atletas de Vôlei Suplementadas com Bicarbonato de Sódio / Biochemical Analysis and Injury and Fatigue Biomarkers in Volleyball Athletes Supplemented with Sodium Bicarbonate

Introdução: O objetivo do presente estudo foi analisar o potencial ergogênico e antifadiga da suplementação de bicarbonato em atletas de vôlei feminino durante sessão de treino de alta intensidade. Métodos: Realizou-se um ensaio clínico randomizado simples cego com 12 atletas profissionais de vôlei feminino, divididas em dois grupos experimentais: um controle e outro suplementado com 500ml de uma solução de bicarbonato de sódio 0,3-0,4mg/kg 90 minutos antes de um treinamento de alta intensidade, com duração de 60 minutos. Resultados: A análise estatística dos resultados mostra que houve diferença significativa entre o grupo suplementado e controle apenas na atividade da enzima creatina quinase (p=0,04) e na percepção subjetiva de esforço (p<0,001). Por outro lado, a atividade da enzima LDH e os níveis de glicose, lactato, proteína, albumina, triglicerídeos e TBARS não apresentaram diferenças significativas entre os dois grupos (p>0,05). A PSE medida pela escala de Borg adaptada não passou de cinco (de uma escala de 0 a 10) em nenhum dos grupos. Conclusão: Apesar de o bicarbonato ser um reconhecido agente de prevenção de fadiga, lesão e com efeitos ergogênicos para sessões de treinos extenuantes, sua suplementação nas condições propostas não mostrou benefícios, demonstrando que o tipo de protocolo de treino aplicado não justifica sua suplementação e que seu uso deve ser utilizado com cautela em razão de seus contraefeitos gastrintestinais.

Introduction: The aim of the present study was to analyze the ergogenic and antifatigue potential of bicarbonate supplementation in female volleyball athletes during a high intensity training session. Methods: A simple blind randomized clinical trial was conducted with 12 professional female volleyball athletes divided into two experimental groups: one control and the other supplemented with 500ml of 0.3-0.4mg / kg sodium bicarbonate solution 90 minutes before high-intensity training, lasting 60 minutes. Results: The statistical analysis of the results shows that there was a significant difference between the supplemented and the control group only in the activity of the enzyme creatine kinase (p = 0.04) and in the subjective perception of effort (p <0.001). On the other hand, the activity of the LDH enzyme and the levels of glucose, lactate, protein, albumin, triglycerides and TBARS did not present significant differences between the two groups (p> 0.05). The PSE measured by the adapted Borg scale did not exceed five (from a scale of 0 to 10) in any of the groups. Conclusion: Although bicarbonate is a recognized fatigue and injury prevention agent with ergogenic effects for strenuous training sessions, its supplementation under the proposed conditions did not show any benefits, demonstrating that the type of training protocol applied does not justify its supplementation and that its use should be used with caution because of its gastrointestinal counter-effects.

Bicarbonato de sodio intravenoso ¿Cuándo, cómo y por qué utilizarlo? / Intravenous sodium bicarbonate. When, how and why to use it?

Severe metabolic acidosis is defined by a pH < 7.2 with HCO3− < 8 mE- q/L in plasma. Its best treatment is to correct the underlying cause. However, acidemia produces multiple complications such as resistance to the action of catecholamines, pulmonary vasoconstriction, impaired cardiovascular function, hyperkalemia, immunological dysregulation, respiratory muscle fatigue, neurological impairment, cellular dysfunction, and finally, it contributes to multisystemic failure. Intravenous NaHCO3 buffers severe acidemia, preventing the associated damage and gains time while the causal disease is corrected. Its indication requires a risk-benefit assessment, considering its complications. These are hypernatremia, hypokalemia, ionic hypocalcemia, rebound alkalosis, and intracellular acidosis. For this reason, therapy must be "adapted" and administered judiciously. The patient will require monitoring with serial evaluation of the internal environment, especially arterial blood gases, plasma electrolytes, and ionized calcium. Isotonic solutions should be preferred instead of hypertonic bicarbonate. The development of hypernatremia must be prevented, calcium must be provided for hypocalcemia to improve cardiovascular function. Furthermore, in mechanically ventilated patients, a respiratory response similar to the one that would develop physiologically, must be established to be able to extract excess CO2 and thus avoid intracellular acidosis. It is possible to estimate the bicarbonate deficit, speed, and volume of its infusion. However, the calculations are only for reference. More important is to start intravenous NaHCO3 when needed, administer it judiciously, manage its side effects, and continue it to a safe goal. In this review we address all the necessary elements to consider in the administration of intravenous NaHCO3, highlighting why it is the best buffer for the management of severe metabolic acidosis.

Comparação do efeito de beta alanina, bicarbonato de sódio e limão como agentes tamponantes entre ciclistas em exercício de alta intensidade / Comparison of the effect of beta alanine, sodium bicarbonate and lemon as tamponant agents among high-intensity exercise cyclists

Alguns suplementos exercem atividade tamponante e têm sido reconhecidos por sua contribuição anaeróbica em exercícios de alta intensidade, retardando a fadiga muscular periférica e potencializando assim a performance esportiva. O objetivo deste estudo foi comparar o benefício ergogênico no tamponamento e dano muscular, dos suplementos beta alanina, bicarbonato de sódio e suco de limão por meio da dosagem de lactato sanguíneo e creatinofosfoquinase (CPK) e na performance de ciclistas submetidos a exercício anaeróbico de alta intensidade. Estudo transversal crossover, realizado em quatro etapas, com ciclistas do sexo masculino. A suplementação foi constituída de 6 g de beta alanina, 0,2 g/kg de bicarbonato de sódio e 30 mL de suco de limão. Lactato sanguíneo e enzima CPK foram dosados pelo método teste ultravioleta enzimático e cinético, respectivamente, em cada uma das etapas. A performance correspondeu à rotação máxima por minuto (RPM) da Air Bike. Participaram do estudo sete ciclistas, com média de idade de 31,14 ± 3,71 anos. O lactato e a CPK apresentaram significância entre os momentos em todas as etapas avaliadas, porém as suplementações comparadas entre si não apresentaram diferença estatística. Não houve melhora da performance (p>0,05) com as utilizações de bicarbonato de sódio, beta alanina e suco de limão em ciclistas. Para os parâmetros avaliados, nenhum dos suplementos apresentou superioridade nas variáveis de tamponamento, dano muscular e performance no treinamento.

Some supplements exert buffering activity and have been recognized for their anaerobic contribution to high-intensity exercise, delaying peripheral muscle fatigue and thus enhancing sports performance. The aim of this study was to compare the ergogenic benefit in muscle buffering and damage of beta alanine, sodium bicarbonate and lemon juice supplements through the measurement of blood lactate and creatine phosphokinase (CPK) and on the performance of cyclists submitted to high intensity anaerobic exercise. Cross-sectional study, carried out in 4 stages, with male cyclists. Supplementation was 6 g beta alanine, 0.2 g/kg of sodium bicarbonate and 30 mL of lemon juice. Blood lactate and creatine phosphokinase enzyme were measured by the enzymatic and kinetic ultraviolet test method, respectively, in each of the steps. Performance corresponded to the maximum rotation per minute (RPM) of the Air Bike. Seven cyclists participated in the study, with a mean age of 31.14 ± 3.71 years. Lactate and CPK presented significance between the moments in all the evaluated stages, however the supplements compared to each other showed no statistical difference. There was no performance improvement (p>0.05) with the use of sodium bicarbonate, beta alanine and lemon juice in cyclists. For the parameters evaluated, none of the supplements showed superiority in the variables of buffering, muscle damage and training performance.

Influence of NaHCO3 powder on color and roughness of the composite submitted to bleaching and euterpe oleracea / Influencia del polvo de NaHCO 3 en el color y rugosidad del composite sometido a blanqueo y euterpe oleracea

Aim: This study aims to evaluate the surface roughness and susceptibility to staining of bleached composite resin with 22% carbamide peroxide, as well as the effect of subsequent prophylaxis with NaHCO3 powder. Material and Methods: Forty disk-shaped (2 × 6 mm) specimens of composite resin (Z250 XT) were prepared. Half of the specimens were subjected to bleaching with 22% carbamide peroxide, and the other half were stored in artificial saliva. In sequence, all specimens were immersed in acai juice (Euterpe oleracea) for 4 h for 14 days, and subdivided into two groups. Group 1 samples were subjected to prophylaxis treatment, while group 2 samples were subjected to treatment with artificial saliva. Surface roughness (Ra) and color (ΔE*) were measured after polishing (T0), bleaching (T1), immersion in acai juice (T2), and application of NaHCO3 powder (T3) using a profilometer and a spectrophotometer. Results: Statistical analyses (analysis of variance and Tukey's test, p≤0.05) revealed that regarding color there was statistically significance for the factors in isolation, except for the factor bleaching. For both color and surface roughness there was statistically significant difference for the interaction, except for the interaction between NaHCO3 power and bleaching. Conclusion: The NaHCO3 air-powder polishing decreases the staining of the composite resin; however, it increases the surface roughness. With respect to the color variable, the whitening factor had no significant effect on the tested material; however, it increases surface roughness.

Objetivo: Este estudio tiene como objetivo evaluar la rugosidad de la superficie y la susceptibilidad a la tinción de la resina compuesta blanqueada con peróxido de carbamida al 22%, así como el efecto de la profilaxis posterior con polvo de NaHCO3. Material y Métodos: Se prepararon cuarenta especímenes en forma de disco (2 × 6 mm) de resina compuesta (Z250 XT). La mitad de los especímenes se sometieron a blanqueo con peróxido de carbamida al 22% y la otra mitad se almacenó en saliva artificial. En secuencia, todos los especímenes se sumergieron en jugo de acai (Euterpe oleracea) durante 4h durante 14 días, y se subdividieron en dos grupos. Las muestras del grupo 1 se sometieron a tratamiento profiláctico, mientras que las muestras del grupo 2 se sometieron a tratamiento con saliva artificial. La rugosidad de la superficie (Ra) y el color (ΔE*) se midieron después del pulido (T0), el blanqueo (T1), la inmersión en jugo de acai (T2) y la aplicación de polvo de NaHCO3 (T3) utilizando un perfilómetro y un espectrofotómetro. Resultados: Los análisis estadísticos (análisis de varianza y prueba de Tukey, p≤0.05) revelaron que en relación al color hubo significancia estadística para los factores en forma aislada, excepto para el factor blanqueamiento. Tanto para el color como para la rugosidad de la superficie hubo una diferencia estadísticamente significativa para la interacción, excepto para la interacción entre el poder de NaHCO3 y el blanqueo. Conclusión: El pulido al aire con polvo de NaHCO3 disminuye el manchado de la resina compuesta; sin embargo, aumenta la rugosidad de la superficie. Con respecto a la variable color, el factor de blanqueamiento no tuvo efecto significativo sobre el material ensayado; sin embargo, aumenta la rugosidad de la superficie.

The ion partition detected in homeopathically manufactured medicine cuprum metallicum and controls

Homeopathy is highly controversial. The main reason for this is its use of very highly dilute medicines (high homeopathic potencies, HHP), diluted beyond the Avogadro/Loschmidt limit. Research using Nano Tracking Analysis has demonstrated the presence of particles in HHPs. This study aims to verify the results of a previous publication that identified the ionic composition of these particles in all dilutions. We used Scanning Electron Microscopy & Energy Dispersive X-Ray Spectroscopy (SEM-EDX) to examine dilutions of a commonly used homeopathic medicine, an insoluble metal, Cuprum metallicum, for the presence of particles (NPs). The homeopathic medicines tested were specially prepared according to the European pharmacopoeia standards. We compared the homeopathic dilutions/dynamizations of copper with simple dilutions and dynamized lactose controls. We observed an ionic diversity common to all preparations including HHPs but also significant differences in the relative quantity of each ion between manufacturing lines of homeopathic copper and lactose controls. The probability that the observed differences could have occurred chance alone (especially above Avogadro limit) can be rejected at p < 0.001. The essential component of these homeopathic medicines is sodium hydrogen carbonate, modulated by some other elements and by its quantity, size and shape. Homeopathic medicines made of Cuprum metallicum do contain material with a specific ionic composition even in HHPs diluted beyond the Avogadro/Loschmidt limit. This specificity can be attributed to the manufacturing process. This material demonstrates that the step-by-step process (dynamized or not) does not match the theoretical expectations of a dilution process. The starting material and dilution/dynamization method influences the nature of these NPs. Further measurements are needed on other raw materials using the same controls (solvent and simply diluted manufacturing lines) to support these findings. The role of sodium bicarbonate must be carefully studied in the future.

The Materiality of Homeopathic Medicines. DynHom Research Program

Homeopathy is controversial because using highly dilute medicines (high homeopathic potencies, HHP) beyond the Avogadro/Loschmidt limit. Previous publications [1,2] using NMR relaxation revealed the involvement of nanobubbles and/or nanoparticles and/or nanometric superstructures in high potentizations. Nano Tracking Analyse (NTA) demonstrated the presence of particles in HHPs [3,4]. WithSEM-EDX [5] we observed an ionic diversity common to all preparations including HHPs and significant differences in the relative quantity of each ion between different homeopathic manufacturing lines and controls. FTIR spectroscopy [6] shows that the molecular composition is that of carbonates, primarily sodium bicarbonate.Methods:To observe the materiality of homeopathic medicines a multidisciplinary approach is necessary. In collaboration with several universities,we canobserve these medications with NMR, NTA, SEM-EDX, FTIR, pH,and EPA. Results:The essential component of all already studied homeopathic medicines is sodium hydrogen carbonate modulated by some other elements in a specific quantity, size,and shape. The probability that the observed results could have occurred just by random chance can be rejected(significantlyabove the Avogadro limit) p < 0,001.Conclusions:The homeopathic medicines do contain material with a specific ionic composition even in HHPs diluted beyond the Avogadro/Loschmidt limit. This specificity can be attributed to the manufacturing process. These results demonstrate that the step-by-step process (dynamized or not) does not match the theoretical expectations in a dilution process. The starting material and dilution/dynamization method influencethe nature of these NPs. The role of carbonates and sodium bicarbonate must be carefully studied in the future. Its aqueous solution is alkaline in nature but itis an amphoteric compound, which means that the compound has both acidic as well as alkaline character. The reaction with acids results in sodium salts and carbonic acid and the reaction with the basic solution producescarbonates and water. Specific electric fields are indeed detectable.

Aplicación de la técnica WALANT en las cirugías de mano / Use of WALANT Technique in Hand Surgeries

Introducción: En los últimos años la anestesia local sin torniquete y con el paciente despierto, técnica conocida por WALANT (por sus siglas en inglés), ha ganado mucha popularidad en las cirugías de la mano y la muñeca. Objetivo: Reportar nuestra experiencia con el uso de la técnica WALANT, a fin de prescindir del uso del torniquete en las cirugías de la mano. Métodos: En noviembre del 2020 fueron intervenidos 30 pacientes por diversas enfermedades ortopédicas, entre las que figuraron: dedos en resorte, síndrome del túnel carpiano, tenovaginitis estenosante del pulgar, gangliones del carpo y amputación del tercer radio por rigidez en extensión postraumática, entre otras. Para la evaluación de la técnica tuvimos en cuenta: tiempo quirúrgico, magnitud del sangrado, dolor durante la infiltración anestésica, la intervención, y en las primeras 24 horas del postoperatorio, la necesidad de refuerzo anestésico, uso de isquemia, complicaciones y nivel de satisfacción del paciente. Resultados: Los resultados obtenidos con esta técnica anestésica son semejantes a otras, con las ventajas que el sangrado es leve, no hay que utilizar isquemia, el tiempo quirúrgico es menor y el efecto anestésico duró entre 10 y 12 horas en todos los pacientes. En ninguno de los pacientes hubo necesidad de refuerzo anestésico. Conclusiones: Se demuestra la efectividad de la técnica WALANT en las cirugías de mano. Con ella se disminuye el gasto de materiales para el acto quirúrgico, así como de personal, es de fácil aplicación y disminuyen las sensaciones desagradables y los peligros del uso de isquemia en los pacientes(AU)

Introduction: Currently, the use of local anaesthetic with no tourniquet and wide awake patient (Wide Awake Local Anaesthetic No Tourniquet - WALANT) has gained popularity in surgeries of the hand and wrist. Objective: To report our experience in the use of WALANT technique in order to discard the use of tourniquet in hand surgeries. Method: In November 2020, thirty patients underwent surgery due to different orthopaedic conditions, among them trigger fingers, carpal tunnel syndrome, stenosing tenovaginitis of the thumb, carpal ganglion and amputation of the third radius due to post trauma stiffness, among others. In order to assess this technique, we considered surgical time, volume of bleeding, pain during anesthetic infiltration, intervention and the need for additional anesthetic during the first 24 hours after surgery; we considered also ischemia, complications and level patient´s satisfaction. Results: This technique had similar results to others; however, the bleeding is mild, there is no need for ischemia, the surgical time is lesser and the anesthetic effect lasted 10 to 12 hours in all patients. None of them required additional anesthetic. All subjects felt the initial infiltration but none complained of pain during the rest of the anesthetic injection or during the surgical act. There were no complications. Conclusions: The effectiveness of WALANT technique in hand surgeries is shown. The cost of materials for the surgical act is reduced with it, as well as the surgical staff, it is easy to use and unpleasant sensations and dangers of the use of ischemia in patients are reduced(AU)

Synergistic interaction of fluconazole/sodium bicarbonate on the inhibition of Candida glabrata phospholipase gene

Abstract Candida glabrata infections are responsible for deaths of people globally. Fluconazole is known to be less effective against C. glabrata, which developed many strategies to evade being destroyed by fluconazole. To achieve enhanced efficacy of fluconazole against C. glabrata, the interaction of fluconazole with sodium bicarbonate was investigated using the CLSI guidelines. The efficacy of fluconazole alone and in combination with sodium bicarbonate was evaluated using the time-kill and phospholipase production assays. Eventually, the expression of PLB was assessed using semi-quantitative RT-PCR to investigate the inhibitory properties of fluconazole alone and in combination with sodium bicarbonate against C. glabrata. The fluconazole/sodium bicarbonate combination displayed synergistic and antagonistic effects (FICI= 0.375-4.25). In C. glabrata ATCC, SN 152, and SN 164, the fluconazole/sodium bicarbonate combination exhibited a significant fungicidal activity (p< 0.05) but antagonistic effect in the case of SN 283. With exception of SN 283, a significant reduction was noted in phospholipase production in clinical isolates of C. glabrata treated with fluconazole/sodium bicarbonate combination. The PLB was down-regulated significantly by 0.168-0.515 fold in C. glabrata treated with fluconazole/sodium bicarbonate. The results suggested fluconazole/sodium bicarbonate to have a potential synergistic interaction in C. glabrata, and the underlying mechanism may be associated with phospholipase gene

Malignant hyperthermia: what we may need to have at hand / Hipertermia maligna: lo que tendríamos que tener a la mano

Malignant hyperthermia (MH) is often neglected in anesthesia because of its rare incidence (around 1:100,000 general anesthetics). However, when it occurs, it becomes the anesthesiologist's nightmare. In the United States, Canada, and in most European countries, it is mandatory to store dantrolene wherever halogenated agents and/or succinylcholine are used by anesthesia providers (including sites that use only succinylcholine and no volatiles for electroconvulsive therapies). Unfortunately, its availability in Colombia is not mandatory or universal

La hipertermia maligna (HM) es algo a menudo se descuida durante el acto anestésico debido a su muy baja incidencia (aproximadamente 1:100.000 anestesias generales). Sin embargo, cuando se presenta, se convierte en una pesadilla para el anestesiólogo. En los Estados Unidos, Canadá y la mayoría de los países de Europa es obligatorio contar con dantroleno siempre que los anestesiólogos administran agentes halogenados y/o succinilcolina (incluidos los centros que utilizan succinilcolina sola sin agentes volátiles para terapias electroconvulsivas). En Colombia, infortunadamente, su disponibilidad no es obligatoria ni universal

Uso de agentes antimicrobianos como solução refrigerante no ultrassom para tratamento das doenças periodontais: uma revisão de literatura / The use of antimicrobial agents as a cooling solution in ultrasound devices for periodontal diseases treatment: a literature review

Objetivo: revisar a literatura quanto ao uso de soluções no reservatório líquido do ultrassom (US) para o tratamento das doenças periodontais, avaliando as contribuições dessa associação e as soluções mais eficazes para essa terapêutica. Métodos: foi realizada pesquisa bibliográfica nas bases de dados Public Medline (PubMed), Lilacs, Science Direct e ISI web of knowledge. As palavras-chave utilizadas foram: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial" e "irrigation". Como critérios de inclusão, foram selecionados estudos prospectivos, retrospectivos, caso controle, transversal e relatos de casos, publicados em inglês. Resultados: após pesquisa e minuciosa revisão por título e resumo de cada estudo, 15 estudos foram selecionados para avaliação dos desfechos investigados. As principais soluções associadas ao US foram povidono-iodo (PVPI), clorexidina, óleos essenciais, bicarbonato de sódio. O irrigante mais utilizado foi o PVPI, seguido por clorexidina e óleos essenciais. Os agentes podem conferir discretas melhoras no nível clínico de inserção e profundidade de sondagem, porém os resultados são controversos, já que nem todos os ensaios demonstraram efeitos positivos. Uma importante evidência observada foi em relação à redução dos níveis de microrganismos derivados do aerossol do US quando essas substâncias foram utilizadas no reservatório de água, sendo esse um aspecto positivo de seu uso como solução refrigerante ao US. Considerações finais: de modo geral, não puderam ser confirmados benefícios adicionais dos irrigantes antimicrobianos nos principais parâmetros periodontais avaliados, porém não se pode descartar o potencial uso desses agentes para a redução da dispersão de microrganismos advindos do aerossol, promovendo assim maior proteção ao paciente e ao profissional.(AU)

Objective: to review the literature regarding the use of solutions in the liquid ultrasonic (US) reservoir devices for the treatment of periodontal diseases, evaluating the benefits of this association, and the most effective solution for this therapy. Methods: bibliographic research was carried out in the Public Medline (PubMed), Lilacs, Science Direct, and ISI web of knowledge databases. The keywords used were: "periodontal disease", "ultrasonic", "cooling solution", "antimicrobial", and "irrigation". Inclusion criteria were prospective, retrospective, case-control, cross-sectional studies, and case reports published in English. Results: after a meticulous analysis of each paper by title and summary, 15 studies were selected for further investigation of clinical outcomes. The main solutions associated with US devices as coolant were PVPI, Chlorhexidine, Essential Oils and Sodium Bicarbonate. The most used coolant agent was PVPI, followed by chlorhexidine and essential oils. It has been shown that irrigating solutions can provide improvements in the clinical attachment level and probing depth, but the results are controversial since not all trials showed positive effects. Important evidence observed was the reduction of the levels of microorganisms derived from the US aerosol when these substances were used as a cooling solution. Conclusions: in general, additional benefits of coolant solutions could not be confirmed in the main periodontal parameters evaluated, however, the potential use of these agents to reduce the dispersion of microorganisms derived from the aerosol cannot be ruled out, thus promoting additional protection to the patient and professional.(AU)

Acute effect of sodium bicarbonate supplementation by resistant training practices / Efeito agudo da suplementação de bicarbonato de sódio por práticas de treinamento de resistência

Currently, the use of sodium bicarbonate (SB) as an ergogenic supplement has been linked to improved performance in several high-intensity and short time interval modalities because it is a natural buffer of the body fluids of the human body. This study aimed to evaluate the acute effect of SB supplementation on muscle strength endurance of resistance training practitioners. Crossover clinical trial, placebo-controlled (PL), and single-masked, included 10 trained adult men. The maximum repetition (1RM) and exhaustion tests with 80% 1RM were performed in the extensor chair and direct thread. In all sessions, the volunteers were verbally stimulated, the total maximum repetitions in the exercises and the blood lactate concentration were measured. SB was supplemented at a dose of 0.3 g/kg body mass. Statistical analysis was performed using SPSS version 25.0. The Shapiro­Wilktest was used to evaluate the normality of the data, and the Student's t-test was used for independent and paired samples. The size of the Cohen's effect was calculated, and the significance level was set at p<0.05. Comparing the supplements, no significant differences were found in all variables tested. However, when comparing pretest and posttest periods, significant differences were found between lactate concentrations, with considerably large effect sizes (> 1.00).SB supplementation by endurance training practitioners induces blood alkalosis, which reduces fatigue and possibly improves muscle strength endurance

Atualmente, o uso de bicarbonato de sódio (SB) como suplemento ergogênico tem sido associado a um melhor desempenho em várias modalidades de alta intensidade e intervalos de tempo curtos, pois é um amortecedor natural dos fluidos corporais do corpo humano. Este estudo teve como objetivo avaliar o efeito agudo da suplementação de SB na resistência da força muscular de praticantes de treinamento de resistência. Ensaio clínico cruzado, controlado por placebo (PL) e com máscara única, incluiu 10 homens adultos treinados. Os testes de repetição máxima (1RM) e exaustão com 80% de 1RM foram realizados na cadeira extensora e na rosca direta. Em todas as sessões, os voluntários foram estimulados verbalmente, foram medidas as repetições máximas totais nos exercícios e a concentração de lactato sanguíneo. O SB foi suplementado na dose de 0,3 g / kg de massa corporal. A análise estatística foi realizada no SPSS versão 25.0. O teste Shapiro-Wilk foi usado para avaliar a normalidade dos dados, e o teste t de Student foi usado para amostras independentes e emparelhadas. O tamanho do efeito de Cohen foi calculado e o nível de significância foi estabelecido em p <0,05. Comparando os suplementos, não foram encontradas diferenças significativas em todas as variáveis testadas. No entanto, ao comparar os períodos pré e pós-teste, foram encontradas diferenças significativas entre as concentrações de lactato, com tamanhos de efeito consideravelmente grandes (> 1,00). A suplementação de SB por praticantes de treinamento de resistência induz alcalose no sangue, o que reduz a fadiga e possivelmente melhora a resistência da força muscular.

Effect of a calcium hydroxide-based intracanal medicament containing N-2-methyl pyrrolidone as a vehicle against Enterococcus faecalis biofilm

Abstract This study investigated the effect of a calcium hydroxide (CH) paste (CleaniCal®) containing N-2-methyl pyrrolidone (NMP) as a vehicle on Enterococcus faecalis (E. faecalis) biofilms compared with other products containing saline (Calasept Plus™) or propylene glycol (PG) (Calcipex II®). Methodology Standardized bovine root canal specimens were used. The antibacterial effects were measured by colony-forming unit counting. The thickness of bacterial microcolonies and exopolysaccharides was assessed using confocal laser scanning microscopy. Morphological features of the biofilms were observed using field-emission scanning electron microscopy (FE-SEM). Bovine tooth blocks covered with nail polish were immersed into the vehicles and dispelling was observed. The data were analyzed using one-way analysis of variance and Tukey tests (p<0.05). Results CleaniCal® showed the highest antibacterial activity, followed by Calcipex II® (p<0.05). Moreover, NMP showed a higher antibacterial effect compared with PG (p<0.05). The thickness of bacteria and EPS in the CleaniCal® group was significantly lower than that of other materials tested (p<0.05). FE-SEM images showed the specimens treated with Calasept Plus™ were covered with biofilms, whereas the specimens treated with other medicaments were not. Notably, the specimen treated with CleaniCal® was cleaner than the one treated with Calcipex II®. Furthermore, the nail polish on the bovine tooth block immersed in NMP was completely dispelled. Conclusions CleaniCal® performed better than Calasept Plus™ and Calcipex II® in the removal efficacy of E. faecalis biofilms. The results suggest the effect might be due to the potent dissolving effect of NMP on organic substances.

Sodium bicarbonate supplementation in resistance exercise performance, perceived exertion and blood lactate concentration

Aim: The aim was to evaluate the effect of sodium bicarbonate supplementation (NaHCO3) in repetition performance, perceived exertion and blood lactate concentration. Methods: Fourteen trained men (25.14 ± 3.5 years; 85.83 ± 10.18 kg; 1.78 ± 0.06 m; 26.88 ± 3.17 kg/m2) realized two upper-body resistance exercise sessions consisting of 15-RM load and 1 minute of the interval, combining bicarbonate supplementation (BS) or Placebo conditions. Results: After the ANOVA analysis, no difference was found on the total number of repetitions during the session on both BS and Placebo condition (p = 0.11). However, a greater number of total of repetitions on the machine chest fly exercise for BS vs. Placebo condition (p = 0.04) was observed. The perceived exertion increased regardless of the supplementation condition (p < 0.0001). Additionally, for the blood lactate was observed significant increases in BS vs. Placebo condition in the post verification (p = 0.013), corroborated for a bigger area under the curve (AUC) on the BS compared to Placebo (p = 0.026) condition. Conclusion: In conclusion, sodium bicarbonate supplementation was not able to improve performance during a resistance exercise session, except for the single-joint exercise performed with high values of perceived exertion, not altering the perceived exertion, and blood lactate between protocols.(AU)

Efeito da infusão da solução M& G na proteção do tecido renal de ratos Wistar submetidos a isquemia e reperfusão programada / Effect of infusion of M& G solution for protection of renal tissue in Wistar rats subjected to programmed ischemia-reperfusion

Resumo Contexto A isquemia e reperfusão (I/R) renal está envolvida diretamente com insuficiência renal aguda, ocorrendo em casos como infarto por embolização ou trombose, quadros de septicemia e transplante renal. Esse processo é complexo, envolvendo respostas imunes inatas e adaptativas, presença de infiltrado celular, produção e liberação de citocinas e quimiocinas. Também desencadeia respostas celulares e liberação de espécies reativas de oxigênio, além de resultar em apoptose e, em alguns casos, necrose celular. Nesse contexto, é imprescindível a avaliação dos mecanismos de proteção ao tecido renal. Objetivos O objetivo foi testar a solução desenvolvida M&G, avaliando sua capacidade protetora no rim por meio de análise morfométrica e presença e expressão de citocinas inflamatórias (TNF-alfa, VEGF, HIF e IL-8). Métodos Foram selecionados 18 ratos Wistar, divididos em três grupos: Sham (S), Controle (C) e Estudo (E). O grupo S foi submetido ao processo cirúrgico sem o clampeamento arterial. No grupo C, foi clampeada a aorta acima e abaixo da artéria renal esquerda, sem a infusão de solução preservadora. No grupo E, além do clampeamento, realizou-se a punção da aorta e a infusão contínua da solução M&G por 20 minutos a 15 °C. Realizou-se a avaliação morfológica e imuno-histoquímica com os marcadores. Resultados Identificaram-se diferenças morfológicas entre o grupo S comparado aos grupos C e E. Na análise dos marcadores, houve redução na intensidade de expressão do TNF e na expressão do VEGF no grupo E. Não houve diferenças com HIF e IL-8 entre os grupos. Conclusões A solução M&G apresentou redução da presença e expressão de TNF-alfa e tendência de redução do VEGF.

Abstract Background Renal ischemia-reperfusion (I/R) is directly associated with acute renal failure and can occur in conditions such as infarction caused by embolization or thrombosis, septicemia, and kidney transplantation. The process is complex, involving innate and adaptive immune responses, presence of cellular infiltrate, and production and release of cytokines and chemokines. It also triggers cell responses and release of reactive oxygen species, in addition to causing apoptosis and, in some cases, cell necrosis. Against this background, evaluation of renal tissue protection mechanisms is essential. Objectives The objective of this study was to test the M&G solution, developed in prior research, evaluating its capacity to protect the kidneys using morphometric analysis and by assaying the presence and expression of inflammatory cytokines (TNF-alpha, VEGF, HIF, and IL-8). Methods Eighteen Wistar rats were divided into three groups: Sham (S), Control (C), and Experimental (E). The S group underwent the surgical operation, but without arterial clamping. In group C, the aorta was clamped above and below the left renal artery, without infusion of the preservation solution. In group E, in addition to clamping, the aorta was punctured and M&G solution was infused continuously for 20 minutes at 15o C. Morphological analysis and immunohistochemical assessment of markers were then conducted. Results Morphological differences were identified in group S compared with groups C and E. Analysis of markers revealed reduced intensity of expression of TNF and of VEGF in group E. There were no differences in HIF or IL-8 between groups. Conclusions The M&G solution was associated with a reduction in presence and expression of TNF-alpha and a trend to reduced VEGF.

Acute effect of sodium bicarbonate supplementation on the performance during CrossFit® training

Abstract Aim: To verify the acute effect of sodium bicarbonate (NaHCO3) supplementation on performance during CrossFit® workout. Methods: Nine experienced males (30.8 ± 3.5 years; 84.4 ± 9.5 kg; 177.5 ± 4.03 cm; 2.2 ± 1.0 years) in CrossFit® participated in this study. They were allocated to two conditions: a) supplementation with 0.3 g.kg-1 of body weight of NaHCO3 and b) supplementation with 0.045 g.kg-1 of body weight of sodium chloride (NaCl). Blood lactate was analyzed at two different moments: before (lac-pre) and after the training protocol (lac-post). The heart rate (HR) and the rating of perceived exertion (RPE) were also collected every two minutes during the execution of the training protocol, and the RPE was also collected after it was finished. At the end of the training protocol, a questionnaire to measure gastrointestinal side effects (GSE) was answered by the participants. Repetitions performed in the training protocol was computed to evaluate the performance during the workout. Results: The results showed that there were no differences found when comparing the conditions for all parameters. HR and RPE were different in the first few minutes (< 4-6 minutes) when compared to the final minutes (> 14 minutes) of the workout. The area under the curve of HR and RPE was significantly lower in the NaHCO3 condition. Conclusion: Acute NaHCO3 supplementation did not improve performance during workout 'Cindy' in experienced men. Supplementation also did not alter hemodynamic and perceptual parameters, nor did it cause any GSE. However, responses as a function of time were reduced with NaHCO3 supplementation.