Diffusion of hydroxyl ion on external root surface using different irrigating solutions: An In vitro study

Aims: The aim of this study was to evaluate the diffusion of hydroxyl ion to the external root surface using different irrigating solutions and intracanal medication with calcium hydroxide. Materials and Methods: Sixty bovine tooth roots were randomly divided into six experimental groups (n = 10), according to the irrigating substance used during biomechanical preparation: 12% glycolic propolis extract (PROP); 20% glycolic ginger extract (GENG); 2% sodium hypochlorite with surfactant (NaOClS); 2% chlorhexidine gel (CLX); 2.5% sodium hypochlorite (NaOCl); and physiological saline solution. After filling the root canals with calcium hydroxide paste, pH measurements were taken directly at the external cavities over time intervals of up to 30 days. Statistical Analysis Used: Data were submitted to two-way ANOVA and Tukey's test (P < 0.05). Results: The pH of the external root surface was increased when the surfactant associated with NaOCl was used. However, the pH values were very close for the different groups. Hydroxyl ion diffusion up to the external root surface did not exceed the pH value of 8.5, and in the hollow passage of the canal, the pH was higher than 12. Conclusions: Hydroxyl ion diffusion of calcium hydroxide paste through the dentinal tubules up to the external root surface allows minimal alkalinization of this surface, and it is greater when using NaOCl with surfactant during biomechanical preparation.

Influência do ressecamento da superfície radicular, do tratamento com EDTA e ácido Hialurônico na viabilidade e expressão de citocinas inflamatórias de fibroblastos do ligamento periodontal / Influence of root surface dryness and treatment with EDTA and Hyaluronic acid on the viability and expression of inflammatory cytokines of periodontal ligament fibroblasts

O momento ideal para o reimplante de um dente avulsionado é imediatamente após a avulsão, no entanto, isso nem sempre é possível. Uma série de fatores influenciam na viabilidade das células do ligamento periodontal (PDL) contribuindo para acelerar ou minimizar a ocorrência da reabsorção radicular ou anquilose, consequências mais frequentes dos reimplantes. Um destes fatores é o período extra-oral e o tratamento da superfície radicular. O EDTA (ácido etilenodiamino tetracético) a 17% e o ácido hialurônico (AH) são utilizados para tratar a superfície radicular, visando menor ocorrência de reabsorção inflamatória e por substituição. Sendo assim, os objetivos deste estudo foram: a) avaliar a viabilidade de fibroblastos do ligamento periodontal (PDLF) em contato com discos radiculares submetidos ou não ao ressecamento de superfície por diferentes tempos e tratados com EDTA e/ou AH; b) quantificar as citocinas inflamatórias IL-6, IL-8, IL-1ß e TNF-α expressas por PDLF; c) observar a adesão de PDLF na superfície do discos radiculares tratados. Foram obtidos 108 discos de dentina e cemento da superfície radicular de dentes bovinos, com 4,5 mm de diâmetro, que foram previamente submetidos a dissolução do ligamento periodontal em solução de hipoclorito de sódio 1% por 15 min. Em seguida os discos foram esterilizados em concentrações decrescentes de álcool (100%,90%,80% e 70%). Os espécimes foram submetidos ou não ao ressecamento radicular por 1h ou 24h e tratados com EDTA associado ou não ao ácido hialurônico, colocados em placas de 96 poços onde foram semeadas células de culturas primárias de PDLF, que ficaram em contato com os discos por 48 h. A viabilidade celular na superfície dos discos foi avaliada através do ensaio de XTT. A microscopia eletrônica de varredura foi utilizada para verificar a adesão de PDLF à superfície dos discos. A detecção e quantificação das citocinas foi realizada pelo teste ELISA. Os dados foram submetidos à análise estatística pelo teste ANOVA e Tukey (p < 0,05). A maior média foi apresentada no grupo sem ressecamento para o tratamento EDTA+AH (148,39), que diferiu significativamente dos grupos controle e EDTA. No grupo ressecamento 1 h EDTA+AH (144,91) foi diferente dos demais. Para ressecamento 24h, verificou-se que o grupo EDTA+AH diferiu do grupo controle. Não houve modificações na expressão das citocinas IL-6, IL-8, IL-1ß e TNF-α quando foi acrescentado os tratamentos propostos. A IL-6 mostrou uma diminuição quando em contato com AH no periodo de 24h. Foi observada pelo MEV adesão de PDLF na superfície de todos os discos tratados e em todos os períodos analisados. Conclui-se que o ácido hialurônico é uma alternativa de tratamento para casos de dentes avulsionados já que mostrou seu papel promovendo adesão e aumento da viabilidade(AU)

The ideal time for reimplantation of an avulsed tooth is immediately after avulsion, however, this is not always possible. A number of factors influence the viability of the cells of the periodontal ligament (PDL) contributing to accelerate or minimize the occurrence of root resorption or ankylosis, more frequent consequences of reimplantation. One of these factors is the extra-oral period and root surface treatment. EDTA (17% ethylenediaminetetraacetic acid) and hyaluronic acid (HA) are used to treat the root surface, aiming for a lower occurrence of inflammatory resorption and replacement. Thus, the objectives of this study were: a) to evaluate the viability of periodontal ligament fibroblasts (PDLF) in contact with root disks submitted to surface dryness at different times and treated with EDTA and / or AH; b) quantify the inflammatory cytokines IL-6, IL-8, IL-1ß and TNF-α expressed by PDLF; c) observe the adhesion of PDLF on the surface of the treated root discs. 108 dentin and cementum disks were obtained from the root surface of bovine teeth, 4.5 mm in diameter, which were previously submitted to dissolution of the periodontal ligament in 1% sodium hypochlorite solution for 15 min. Then the disks were sterilized in decreasing concentrations of alcohol (100%, 90%, 80% and 70%). The specimens were submitted to root resection for 1 h or 24 h and treated with EDTA, whether or not associated with hyaluronic acid, placed in 96-well plates where cells from PDLF primary cultures were seeded and left in contact with the discs for 48 h. Cell viability at disc surfaces was assessed by the XTT assay. Scanning electron microscopy was used to verify the adhesion of PDLF to the disc surface. Detection and quantification of cytokines was performed by ELISA. Data were submitted to statistical analysis by the ANOVA and Tukey test (p <0.05). The highest mean was presented in the non-dry group for EDTA + AH treatment (148,39), which differed significantly from the control and EDTA groups. In the dryness group 1 h EDTA + AH (144.91) was different from the others. For dryness 24 h, it was found that the EDTA + AH group differed from the control group. There were no changes in the expression of cytokines IL-6, IL-8, IL-1ß and TNFα when the proposed treatments were added. IL-6 showed a decrease when in contact with HA in the 24-hour period. It was observed by the MEV adhesion of PDLF on the surface of all treated discs and in all periods analyzed. It is concluded that hyaluronic acid is an alternative treatment for cases of avulsed teeth since it showed its role promoting adhesion and increased viability(AU)

Higher overall survival in metastatic pancreatic cancer: the impact of where and how treatment is delivered / Maior sobrevida global em pacientes com câncer pancreático metastático: o impacto de onde e como o tratamento é realizado

Objective To determine the overall survival of patients with advanced pancreatic cancer and evaluate factors that impact prognosis in a private cancer center.Methods Data from the Hospital Cancer Registry at Hospital Israelita Albert Einstein were retrospectively collected. The patients enrolled had metastatic cancer at diagnosis or earlier staging and subsequent recurrence. Cases of neuroendocrine tumors were excluded.Results A total of 65 patients were evaluated, including 63 with adenocarcinoma. The median overall survival for patients in all stages was 20.7 months (95%CI: 15.6-25.7), while the overall survival of metastatic disease was 13.3 months. Among the 33 cases with stage IV cancer, there was no evidence of a statistically significant association between median survival and CA19-9 dosage (p=0.212), tumor location (p=0.482), first treatment performed (p=0.337), lymphovascular invasion (p=0.286), and age (p=0.152). However, the number of lines of chemotherapy was significantly associated with survival (log-rank p=0.013), with an estimated median survival of 10.2 months for patients who received up to two lines of treatment and 23.5 months for those receiving more than two lines of chemotherapy.Conclusion The survival of patients treated was longer than that reported in the literature. The only statistically significant factor related to increased survival was higher number of lines of chemotherapy received. We believe that the higher socioeconomic status of patients surveyed in this study, as well as their greater access to treatment options, may have influenced their overall survival.

Objetivo Determinar a sobrevida global dos pacientes com câncer pancreático avançado e avaliar fatores com impacto prognóstico em um centro de câncer privado.Métodos Foram coletados retrospectivamente os dados do Registro de Câncer do Hospital Israelita Albert Einstein. Os pacientes incluídos apresentaram câncer metastático ao diagnóstico ou em estádio mais precoce com recorrência subsequente. Os casos de tumores neuroendócrinos foram excluídos.Resultados Foram avaliados 65 pacientes, incluindo 63 com adenocarcinoma. A sobrevida global mediana dos pacientes em todos os estádios foi 20,7 meses (IC95%: 15,6-25,7), enquanto a sobrevida global de doença metastática foi de 13,3 meses. Entre os 33 casos com câncer em estádio IV, não houve evidência de associação estatisticamente significativa entre a sobrevida mediana e CA19-9 ao diagnóstico (p=0,212), localização do tumor (p=0,482), primeiro tratamento realizado (p=0,337), invasão vasculo-linfática (p=0,286) e idade (p=0,152). No entanto, o número de linhas de quimioterapia foi significativamente associado com a sobrevida (log-rankp=0,013), com uma sobrevida mediana estimada de 10,2 meses para os pacientes que receberam até duas linhas de tratamento e de 23,5 meses para os que receberam mais de duas linhas.Conclusão A sobrevida dos pacientes tratados foi maior do que o relatado na literatura. O único fator estatisticamente significativo relacionado à maior sobrevida foi maior número de linhas de quimioterapia recebidas. Acreditamos que o nível socioeconômico dos pacientes pesquisados neste estudo, assim como seu maior acesso a opções de tratamento, pode ter influenciado em sua sobrevivência global.

Assessment of adherence to the guidelines for the management of nausea and vomiting induced by chemotherapy / Avaliação da aderência à diretriz de cuidados para náuseas e vômitos induzidos por quimioterapia

ABSTRACT Objective: To assess adherence of the prescribing physicians in a private cancer care center to the American Society of Clinical Oncology guideline for antiemetic prophylaxis, in the first cycle of antineoplastic chemotherapy. Methods: A total of 139 chemotherapy regimens, of 105 patients, were evaluated retrospectively from 2011 to 2013. Results: We observed 78% of non-adherence to the guideline rate. The main disagreements with the directive were the prescription of higher doses of dexamethasone and excessive use of 5-HT3 antagonist for low risk emetogenic chemotherapy regimens. On univariate analysis, hematological malignancies (p=0.005), the use of two or more chemotherapy (p=0.05) and high emetogenic risk regimes (p=0.012) were factors statistically associated with greater adherence to guidelines. Treatment based on paclitaxel was the only significant risk factor for non-adherence (p=0.02). By multivariate analysis, the chemotherapy of high emetogenic risk most correlated with adherence to guideline (p=0.05). Conclusion: We concluded that the adherence to guidelines is greater if the chemotherapy regime has high emetogenic risk. Educational efforts should focus more intensely on the management of chemotherapy regimens with low and moderate emetogenic potential. Perhaps the development of a computer generated reminder may improve the adherence to guidelines. .

RESUMO Objetivo: Avaliar a adesão dos médicos prescritores, de um centro privado especializado em oncologia, à diretriz de antiêmese profilática da American Society of Clinical Oncology, no primeiro ciclo de quimioterapia antineoplásica. Métodos: Foram avaliados retrospectivamente 139 esquemas de quimioterapia, de 105 pacientes, tratados no período de 2011 a 2013. Resultados: Foram observados 78% de taxa de não adesão à diretriz. As principais discordâncias com a diretriz foram prescrição de doses mais elevadas de dexametasona e uso excessivo de antagonista 5-HT3 para regimes de quimioterapia de risco emetogênico baixo. Pela análise univariada, malignidades hematológicas (p=0,005), uso de dois ou mais quimioterápicos (p=0,05) e regimes de alto risco emetogênico (p=0,012) foram fatores estatisticamente associados a maior adesão à diretriz. O tratamento baseado em paclitaxel foi o único fator estatisticamente significativo para a não adesão (p=0,02). Pela análise multivariada, a quimioterapia de alto risco emetogênico apresentou maior correlação com a adesão à diretriz (p=0,05). Conclusão: Houve maior aderência para a quimioterapia de alto risco emetogênico. Esforços educacionais devem se concentrar mais intensamente na gestão de regimes de quimioterapia com potencial emetogênico baixo e moderado. Talvez o desenvolvimento de lembretes gerados por sistemas informatizados possa melhorar a aderência à diretriz. .

Neutropenic patients and their infectious complications at a University Hospital

OBJECTIVE: The aim of this study was to analyze the characteristics and infectious complications of neutropenic patients in a referral hospital. METHODS: A cross-sectional study was carried out between April and September 2008, which enrolled all neutropenic patients identified by daily blood counts in the Universidade Federal de Minas Gerais. Demographic data and information on infections were obtained from the Hospital Infection Control Committee. Statistical analysis was performed using the Statistical Package for Social Sciences. RESULTS: One hundred and sixteen patients were followed up during 129 hospitalizations. The patients had a mean age of 48.7 years old. Sixty-four (55.2%) patients were male and 25 (21.6%) died during the follow-up. In 97 (75.2%) of the hospitalizations, patients had episodes of febrile neutropenia. Patients classified as low-riskhad a mortality rate of 16.2% (n = 12) vs. 39.1% (n = 9) among high-risk patients (p-value = 0.02). The death rate of the patients who had been submitted to hematopoietic stem cell transplantation was 13.5% (n = 5)vs. 26.7% (n = 16) among patients not submitted to transplantation (p-value = 0.13). Of the 155 infections diagnosed, 45.5% were defined as clinically documented. The etiological agent most frequently isolated was Escherichia coli and the main topography reported was bloodstream infections. The most used antimicrobial agents were cefepime, vancomycin and fluconazole. Approximately 24% of patients evolved with impaired renal function during hospitalization. CONCLUSION: Most reported infections in neutropenic patients were defined as clinically documented, which shows the importance of suspicion in patients without specific signs and symptoms for early diagnosis and the need for the classification of risk for timely interventions.