Influence of the combined effect of desensitizing dentifrices and universal adhesives on dentin bond strength under erosive conditions.

OBJECTIVE: This study aimed to evaluate whether the use of desensitizing dentifrices containing obliterating agents can affect bond strength of eroded/abraded dentin. METHODOLOGY: A total of 100 dentin samples were obtained from human molars. The teeth were cut into 3 mm-thickness discs and allocated in five groups (n=20), according to the toothpaste used: WoF - abrasion with fluoride-free toothpaste (Cocoricó); Arg - toothpaste containing arginine (Colgate Sensitive Pro-Relief); Nov - calcium sodium phosphosilicate toothpaste (Sensodyne Repair and Protect); SnF - fluoride-containing toothpaste (AmF/SnCl2/SnF2 - Elmex Erosion); and Control (no erosive/abrasive process). The erosive/abrasive cycle consisted of immersion in citric acid (1%, pH 2.6, 5 min, 4×/day) and abrasion (2×/day, 120-20 sec abrasion, 100 sec immersion) with each toothpaste. During intervals, samples were immersed in artificial saliva. This cycle was performed for five days. Two resin cylinders (2 mm in diameter) were constructed on each sample for the shear bond strength test using a universal adhesive system. The self-etch and etch-and-rinse (Scotchbond Universal) strategies were employed, each in half of the total sample (n=10). Bond strength (MPa) was measured in a shear test and failure modes were assessed with a stereomicroscope. Statistical analysis was performed using the two-way analysis of variance (ANOVA) and Tukey tests (p<0.05). RESULTS: A statistically significant difference was found between the adhesive strategies tested (p<0.001), with the self-etching form showing higher values than the etch-and-rinse. Moreover, no significant differences were observed between the tested toothpastes (p=0.750) and interactions (p=0.438). CONCLUSION: The use of toothpaste containing obliterating agents does not affect bond strength to dentin subjected to erosive/abrasive conditions when a universal adhesive is used. However, the self-etch strategy might be preferred for eroded/abraded dentin.

PATELLAR FRACTURE IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: IN VITRO ANALYSIS.

Objective: To determine, by biomechanical analysis, safe patellar cut limits in anterior cruciate ligament (ACL) reconstruction that minimize fracture risks. Methods: From three-dimensional reconstruction, triangular cuts were made in the patella, with a depth of 6.5 mm and variable width and length (10 to 20 mm and 8 to 12 mm, respectively, both with an interval of 1 mm). The combinations of cuts constituted 55 models for tests, with five variations in width and 11 variations in length, tested with the finite element method (FEM). Results: The mean of the localized principal maximum (traction force) values was 4.36 Pa (SD 0.87 ± 0.76) and the localized principal minimum (compression force) was -4.33 Pa (SD 1.05 ± 1.11). Comparing width and length to the tension force of the values of the main maximum, we found statistical significance from 11 mm for width and 13 mm for length. Conclusion: In ACL reconstruction, the removal of the patellar bone fragment is safe for fragments smaller than 11 mm in width and 13 mm in length, which corresponds to 24% of the width and 28% of the length of the patella used. Level of Evidence II, Comparative Prospective Study.

Objetivo: Determinar, por meio de análise biomecânica, os limites de corte patelar seguros para a reconstrução do ligamento cruzado anterior (LCA) e que minimizem riscos de fratura. Métodos: A partir de reconstrução tridimensional, foram feitos cortes triangulares na patela, com profundidade de 6,5 mm e largura e comprimento variáveis (8 a 12 mm e 10 a 20 mm), respectivamente, com intervalo de 1 mm). As combinações dos cortes constituíram 55 modelos para ensaios, com 5 variações de largura e 11 variações de comprimento, ensaiados por meio do método dos elementos finitos (MEF). Resultados: A média dos valores da máxima principal localizada (força de tração) foi de 4,36 Pa (DP 0,87 ± 0,76), e a mínima principal localizada (força de compressão) foi de −4,33 Pa (DP 1,05 ± 1,11). Comparando largura e comprimento à força de tensões dos valores da máxima principal, houve significância estatística a partir de 11 mm para largura e 13 mm para comprimento. Conclusão: Na reconstrução do LCA, a retirada do fragmento ósseo patelar mostrou-se segura para fragmentos menores que 11 mm de largura e 13 mm de comprimento, o que corresponde a 24% da largura e 28% do comprimento da patela utilizada. Nível de Evidência II, Estudo Prospectivo Comparativo.

Patellar fracture in anterior cruciate ligament reconstruction: in vitro analysis / Fratura patelar na reconstrução do ligamento cruzado anterior: análise in vitro

ABSTRACT Objective: To determine, by biomechanical analysis, safe patellar cut limits in anterior cruciate ligament (ACL) reconstruction that minimize fracture risks. Methods: From three-dimensional reconstruction, triangular cuts were made in the patella, with a depth of 6.5 mm and variable width and length (10 to 20 mm and 8 to 12 mm, respectively, both with an interval of 1 mm). The combinations of cuts constituted 55 models for tests, with five variations in width and 11 variations in length, tested with the finite element method (FEM). Results: The mean of the localized principal maximum (traction force) values was 4.36 Pa (SD 0.87 ± 0.76) and the localized principal minimum (compression force) was −4.33 Pa (SD 1.05 ± 1.11). Comparing width and length to the tension force of the values of the main maximum, we found statistical significance from 11 mm for width and 13 mm for length. Conclusion: In ACL reconstruction, the removal of the patellar bone fragment is safe for fragments smaller than 11 mm in width and 13 mm in length, which corresponds to 24% of the width and 28% of the length of the patella used. Level of Evidence II, Comparative Prospective Study.

RESUMO Objetivo: Determinar, por meio de análise biomecânica, os limites de corte patelar seguros para a reconstrução do ligamento cruzado anterior (LCA) e que minimizem riscos de fratura. Métodos: A partir de reconstrução tridimensional, foram feitos cortes triangulares na patela, com profundidade de 6,5 mm e largura e comprimento variáveis (8 a 12 mm e 10 a 20 mm), respectivamente, com intervalo de 1 mm). As combinações dos cortes constituíram 55 modelos para ensaios, com 5 variações de largura e 11 variações de comprimento, ensaiados por meio do método dos elementos finitos (MEF). Resultados: A média dos valores da máxima principal localizada (força de tração) foi de 4,36 Pa (DP 0,87 ± 0,76), e a mínima principal localizada (força de compressão) foi de −4,33 Pa (DP 1,05 ± 1,11). Comparando largura e comprimento à força de tensões dos valores da máxima principal, houve significância estatística a partir de 11 mm para largura e 13 mm para comprimento. Conclusão: Na reconstrução do LCA, a retirada do fragmento ósseo patelar mostrou-se segura para fragmentos menores que 11 mm de largura e 13 mm de comprimento, o que corresponde a 24% da largura e 28% do comprimento da patela utilizada. Nível de Evidência II, Estudo Prospectivo Comparativo.

Influence of the combined effect of desensitizing dentifrices and universal adhesives on dentin bond strength under erosive conditions

Abstract Objective This study aimed to evaluate whether the use of desensitizing dentifrices containing obliterating agents can affect bond strength of eroded/abraded dentin. Methodology A total of 100 dentin samples were obtained from human molars. The teeth were cut into 3 mm-thickness discs and allocated in five groups (n=20), according to the toothpaste used: WoF - abrasion with fluoride-free toothpaste (Cocoricó); Arg - toothpaste containing arginine (Colgate Sensitive Pro-Relief); Nov - calcium sodium phosphosilicate toothpaste (Sensodyne Repair and Protect); SnF - fluoride-containing toothpaste (AmF/SnCl2/SnF2 - Elmex Erosion); and Control (no erosive/abrasive process). The erosive/abrasive cycle consisted of immersion in citric acid (1%, pH 2.6, 5 min, 4×/day) and abrasion (2×/day, 120-20 sec abrasion, 100 sec immersion) with each toothpaste. During intervals, samples were immersed in artificial saliva. This cycle was performed for five days. Two resin cylinders (2 mm in diameter) were constructed on each sample for the shear bond strength test using a universal adhesive system. The self-etch and etch-and-rinse (Scotchbond Universal) strategies were employed, each in half of the total sample (n=10). Bond strength (MPa) was measured in a shear test and failure modes were assessed with a stereomicroscope. Statistical analysis was performed using the two-way analysis of variance (ANOVA) and Tukey tests (p<0.05). Results A statistically significant difference was found between the adhesive strategies tested (p<0.001), with the self-etching form showing higher values than the etch-and-rinse. Moreover, no significant differences were observed between the tested toothpastes (p=0.750) and interactions (p=0.438). Conclusion The use of toothpaste containing obliterating agents does not affect bond strength to dentin subjected to erosive/abrasive conditions when a universal adhesive is used. However, the self-etch strategy might be preferred for eroded/abraded dentin.

Diffuse Large B-Cell Lymphoma in Bilateral Basal Ganglia: A Rare Case Report.

Primary central nervous system lymphoma (PCNSL) may affect the basal nuclei of the brain. The most common type is diffuse large B-cell lymphoma. This is a case report of an adolescent with rare bilateral lymphoma in the basal ganglia. A male patient aged 16 years had a clinical picture of rapid progression to motor aphasia, dysphagia, and right hemiplegia. Magnetic resonance imaging (MRI) of the skull, along with spectroscopy, indicated lymphoproliferative or neoplastic disease. A biopsy confirmed diffuse large B-cell lymphoma. However, the patient died before starting the definitive treatment. PCNSL is infrequent in the pediatric population, but it has a better prognosis in this age group, especially when diagnosed early. It affects immunodeficient patients more often. In addition to MRI, spectroscopy and positron-emission tomography help clarify the diagnosis. Biopsy is a gold standard for diagnosis, leading to the appropriate initiation of chemotherapy and radiotherapy treatment. PCNSL is rare in young patients. With an early diagnosis, better therapeutic planning is possible. Unfortunately, in the present case, the diagnosis was late, and the patient had an unfavorable outcome.

Multidisciplinary approach for the closure of multiple diastemata with composite resin.

Morphologic anterior tooth alterations and diastemata between the anterior teeth are often considered a major esthetic problem. In most cases, the treatment of these conditions involves a multidisciplinary approach. Orthodontic treatment together with direct composite resin veneers are a viable option to close diastemata and alter tooth shape. The extent and etiology of the diastemata must be considered and properly evaluated for the treatment. The present article is a case report of a patient with multiple diastemata in the maxillary anterior teeth, dental crowding, and peg-shaped lateral incisors corrected with orthodontic treatment and direct composite resin veneers. Digital planning was the tool used to decide the tooth proportions before orthodontic treatment and to guide the diagnostic wax-up. An etch-and-rinse adhesive system was applied after etching. A polychromatic layering technique under rubber dam isolation was used for the composite resin veneer construction. Finishing and polishing procedures were achieved using polishing discs and abrasive materials. Direct composite resin is an alternative that allows predictability, esthetics, and the possibility of adjustments, resulting in patient satisfaction.

The Serum Concentration of Vancomycin as a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Critically Ill Patients.

The impact of serum concentrations of vancomycin is a controversial topic. RESULTS: 182 critically ill patients were evaluated using vancomycin and 63 patients were included in the study. AKI occurred in 44.4% of patients on the sixth day of vancomycin use. Vancomycin higher than 17.53 mg/L between the second and the fourth days of use was a predictor of AKI, preceding AKI diagnosis for at least two days, with an area under the curve of 0.806 (IC 95% 0.624-0.987, p = 0.011). Altogether, 46.03% of patients died, and in the Cox analysis, the associated factors were age, estimated GFR, CPR, and vancomycin between the second and the fourth days. DISCUSSION: The current 2020 guidelines recommend using Bayesian-derived AUC monitoring rather than trough concentrations. However, due to the higher number of laboratory analyses and the need for an application to calculate the AUC, many centers still use therapeutic trough levels between 15 and 20 mg/L. CONCLUSION: The results of this study suggest that a narrower range of serum concentration of vancomycin was a predictor of AKI in critically ill septic patients, preceding the diagnosis of AKI by at least 48 h, and it can be a useful monitoring tool when AUC cannot be used.

Obstetric nurse and the factors that influence care in the delivery process.

OBJECTIVE: To identify the factors that influence the improvement of obstetric nurse care in the delivery process. METHODS: Descriptive exploratory study with a qualitative approach conducted at a teaching maternity hospital located in the city of Salvador, Bahia, Brazil with 20 obstetric nurses from the Obstetric Center. Data was collected through semi-structured interviews between June and September 2017 and was then subjected to the Thematic-Categorical Content Analysis proposed by Franco. RESULTS: Six categories emerged from the analysis, which presented factors that favor the improvement of obstetric care in the delivery process and factors unfavorable to this care. These factors address power and gender relations among health professionals; recognition of obstetric nurses; physical space and bed occupation; interaction between woman/ companion, among others. FINAL CONSIDERATIONS: The factors indicated by obstetric nurses reveal the need for improvements in the working conditions by managers and changes of behavior and codes of conduct of health professionals.

Obstetric nurse and the factors that influence care in the delivery process / Enfermera obstetra y los factores que influyen en la atención del proceso de parto / Enfermeira obstetra e os fatores que influenciam o cuidado no processo de parto

Objetivo: To know the factors that influence the improvement of obstetric nurse care in the delivery process. Methods: Qualitative, descriptive exploratory study conducted at a maternity school located in the city of Salvador, Bahia, Brazil with 20 obstetric nurses from the Obstetric Center. Data collection took place through interviews, guided by a semi-structured form between the months of June and September 2017. The data were subjected to the Categorical Thematic Content Analysis proposed by Franco. Results: Six categories emerged, which presented factors that collaborate and hinder the care of the obstetric nurse in the delivery process. These address the power and gender relations between health professionals; recognition of the obstetric nurse; physical space and bed occupation; interaction between woman / companion, among others. Final considerations: The factors indicated by obstetric nurses reveal the need for improvements in working conditions by managers and changes in the conduct / behavior of professionals.

Objetivo: Conocer los factores que influyen en la mejora de la atención de la enfermera obstetra en el proceso de parto. Métodos: Estudio exploratorio cualitativo y descriptivo realizado en una escuela de maternidad ubicada en la ciudad de Salvador, Bahía, Brasil, con 20 enfermeras obstetras del Centro de Obstetricia. La recopilación de datos se realizó a través de entrevistas, guiadas por una forma semiestructurada entre los meses de junio y septiembre de 2017. Los datos se presentaron al análisis de contenido temático categórico propuesto por Franco. Resultados: Surgieron seis categorías, que presentaban factores que colaboran y dificultan el cuidado de la enfermera obstétrica en el proceso de parto. Estos abordan el poder y las relaciones de género entre los profesionales de la salud; reconocimiento de la enfermera obstétrica; espacio físico y ocupación de la cama; interacción entre mujer / acompañante, entre otros. Consideraciones finales: Los factores indicados por las enfermeras obstétricas revelan la necesidad de mejoras en las condiciones laborales por parte de los gerentes y los cambios en la conducta / comportamiento de los profesionales.

Objetivo: Conhecer os fatores que influenciam a melhoria do cuidado da enfermeira obstetra no processo de parto. Métodos: Estudo qualitativo, descritivo exploratório realizado em uma maternidade escola localizada no município de Salvador, Bahia, Brasil com 20 enfermeiras obstetras do Centro Obstétrico. A coleta de dados ocorreu por meio de entrevistas, guiadas por formulário semiestruturado entre os meses de junho e setembro de 2017. Os dados foram submetidos à Análise de Conteúdo Temático-Categorial proposta por Franco. Resultados: Emergiram seis categorias, as quais apresentaram fatores que colaboram e dificultam o cuidado da enfermeira obstetra no processo de parto. Estes abordam as relações de poder e gênero entre profissionais de saúde; reconhecimento da enfermeira obstetra; espaço físico e ocupação de leitos; interação entre mulher/acompanhante, dentre outros. Considerações finais: Os fatores sinalizados pelas enfermeiras obstetras revelam a necessidade de melhorias nas condições de trabalho por gestores e mudanças de condutas/comportamentos de profissionais.

Influence on Secondary Metabolism of Piper nigrum L. by Co-Inoculation with Arbuscular Mycorrhizal Fungi and Fusarium solani f. sp. piperis.

To elucidate defense mechanisms of Piper nigrum against fusariosis, an experiment based on co-inoculation of arbuscular mycorrhizal fungi (AMF) and Fusarium solani f. sp. piperis was performed. Variations in secondary metabolism in plants infected with F. solani f. sp. piperis (FUS) and co-inoculated with AMFs and F. solani (AMF + FUS) were monitored at 7- and 21-days post inoculations (dpi). The pathogen induced a decrease in oxygenated sesquiterpenes (82.0-77.4%), and changes in the concentrations of the main compounds, α-muurolene, α-muurolol, and 2E-hexenal in the leaves. It was observed that the concentration of 2E-hexenal decreased at 7 dpi, α-muurolene decreased at 21 dpi, and α-muurolol increased at 21 dpi. There was a prevalence of sesquiterpene and monoterpene hydrocarbons in the roots, such as ß-caryophyllene, δ-elemene, and limonene. The infection and co-inoculation induced greater production of phenolics in the roots at 7 dpi. The enzymatic activity of phenylalanine ammonia-lyase decreased in the leaves at 21 dpi and in the roots on both days, while the lipoxygenase activity decreased only in the roots at 21 dpi. The results demonstrated that co-inoculation with AMFs and F. solani induces changes in the defense metabolism of P. nigrum, but it is not efficient in the biocontrol of fusariosis during the evaluated period.

Hydroxy acids for adhesion to enamel and dentin: Long-term bonding performance and effect on dentin biostability.

OBJECTIVES: To test the demineralization potential, bonding performance, and dentin biostability when using hydroxy acids for etching enamel and dentin. METHODS: Surface microhardness, roughness and depth of demineralization were investigated after etching enamel and dentin with 35 % glycolic acid (Gly), tartaric acid (Ta), gluconic acid (Glu), gluconolactone (Gln), or phosphoric acid (Pa) (n = 5/group). Dentin microtensile bond strength (µTBS) after 24 h or 1 year of bonding (n = 8 teeth/group) and enamel shear bond strength (SBS) after 24 h (n = 10 teeth/group) were obtained. In dentin, failure mode was classified as adhesive, cohesive in dentin/resin, or mixed. Dentin biostability was assessed by loss of dry weight and collagen degradation after 30-day incubation (n = 10 beams/group). Statistical analysis consisted of ANOVA with post-hoc Tukey's HSD, Tukey-Kramer test, Bonferroni correction, and Fisher's exact tests (α = 0.05). RESULTS: Gly showed better or similar results than Pa for enamel microhardness and dentin roughness, while no significant differences were observed among Ta, Glu, and Gln (p > .05). Hydroxy acids produced significantly shallower demineralization than Pa (p < .05). Gln resulted in the lowest SBS and µTBS, while Gly, Glu, Ta, and Pa showed no significant difference. There was no significant difference in µTBS between 24 h and 1 year of storage. The association between failure mode and etchant was statistically significant after 24 h only (p < .001). Hydroxy acids resulted in higher dentin biostability than Pa (p < .05). CONCLUSIONS: Gly, Glu and Ta resulted in adequate bonding performance and reduced dentin degradation and are potential alternative etchants to improve long-term stability of adhesive restorations. CLINICAL SIGNIFICANCE: This study supports the potential use of hydroxy acids as alternative etchants when bonding to enamel and dentin and demonstrates that specific acids are more suitable to be used in adhesion since they result in appropriate bond strength and less dentin degradation.

Enunciações avaliativas de acompanhantes sobre o cuidado prestado à mulher / Declaraciones evaluativas de escorts acerca de la atención prestada a las mujeres / Evaluative statements of escorts about the care provided to women

Objetivo descrever as enunciações avaliativas de acompanhantes sobre o cuidado prestado às mulheres em processo de parto. Método pesquisa descritiva com abordagem qualitativa realizada com dez acompanhantes em uma maternidade escola. Utilizou-se a entrevista semiestruturada como técnica de coleta de dados. Para o tratamento das falas, empregou-se a Análise de Conteúdo Temática Categorial. Resultados o conteúdo obtido foi sistematizado em duas categorias: enunciações avaliativas relacionadas aos serviços de saúde e enunciações avaliativas relacionadas ao cuidado prestado às mulheres em processo de parto. Considerações Finais as(os) acompanhantes enunciaram e vivenciaram o cuidado prestado muitas vezes como limitado e associado à sobrecarga de trabalho dos profissionais, entretanto reforçaram o acolhimento e a comunicação como importantes.

Objetivo describir las declaraciones evaluativas de los acompañantes acerca la atención prestada a las mujeres en el proceso de parto. Método se trata de una investigación descriptiva con enfoque cualitativo realizada con diez acompañantes en una escuela de maternidad. La entrevista semiestructurada se utilizó como técnica de recopilación de datos. Para el tratamiento de las declaraciones, se utilizó el Categorial de Análisis Temático de Contenido. Resultados el contenido obtenido se sistematizó en dos categorías: declaraciones evaluativas relacionadas con los servicios de salud y declaraciones evaluativas relacionadas con la atención prestada a las mujeres en el proceso de parto. Consideraciones finales los acompañantes enunciaron y experimentaron la atención prestada muchas veces tan limitada y asociada con la sobrecarga de trabajo de los profesionales, sin embargo, reforzaron la recepción y la comunicación como importante.

Objective describing the evaluative statements of escorts about the care provided to women in the process of birth. Method a descriptive research with qualitative approach performed with ten escorts in a maternity school. The semi-structured interview was used as a data collection technique. For the treatment of the statements, the Thematic Content Analysis Categorial was used. Results the content obtained was systematized into two categories: evaluative statements related to health services and evaluative statements related to the care provided to women in the process of birth. Final thoughts the escorts enunciated and experienced the care provided many times as limited and associated with the workload of the professionals; however, they reinforced the reception and communication as important.

Percepções de mulheres sobre a assistência de enfermagem durante o parto normal / Percepciones de las mujeres sobre la atención de enfermería durante el parto normal / Women's perceptions about nursing care during normal delivery

Objetivo conhecer a percepção de mulheres sobre a assistência de Enfermagem recebida durante o processo de parto normal. Método pesquisa descritiva com abordagem qualitativa, efetuada em duas maternidades públicas de Salvador, Bahia, Brasil. A coleta de dados foi efetuada por entrevista, entre os meses de novembro de 2017 e abril de 2018. Participaram da pesquisa 13 mulheres. A sistematização dos dados foi realizada pelo referencial teórico de Bardin. Resultados emergiram duas categorias científicas: assistência de Enfermagem permeada por satisfação; e assistência permeada por relações verticais e sentimentos de abandono. As mulheres verbalizaram satisfação com a assistência de Enfermagem relacionadas à aplicação dos métodos não farmacológicos para alívio da dor, apoio e promoção do bem-estar, embora também se fez presente a verticalização das relações e a ausência de acompanhamento profissional. Conclusão a percepção das mulheres sobre a assistência de Enfermagem recebida durante o processo de parto normal foi dicotômica.

Objetivo conocer la percepción de las mujeres sobre la atención de enfermería recibida durante el proceso normal de parto. Método investigación descriptiva con enfoque cualitativo, realizada en dos hospitales públicos de maternidad en Salvador, Bahía, Brasil. Los datos fueron recogidos por entrevista entre noviembre de 2017 y abril de 2018. Participaron en el estudio 13 mujeres. La sistematización de datos fue realizada por el marco teórico de Bardin. Resultados surgieron dos categorías científicas: cuidados de enfermería impregnados de satisfacción; y la asistencia impregnada de relaciones verticales y sentimientos de abandono. Las mujeres verbalizaron la satisfacción con la atención de enfermería, relacionada con la aplicación de métodos no farmacológicos para el alivio del dolor, el apoyo y la promoción del bienestar, aunque también estuvieron presentes la verticalización de las relaciones y la ausencia de seguimiento profesional. Conclusión la percepción de las mujeres sobre la atención de enfermería recibida durante el proceso normal de parto fue dicotómica.

Objective to know women's perception about the nursing care received during the normal delivery process. Method descriptive research with qualitative approach, carried out in two public maternity hospitals in Salvador, Bahia, Brazil. Data were collected by interview between November 2017 and April 2018. The participants were 13 women. Data systematization was performed by Bardin's theoretical framework. Results two scientific categories emerged: Nursing care permeated by satisfaction; and care permeated by vertical relationships and feelings of abandonment. The women verbalized satisfaction with Nursing care, related to the application of non-pharmacological methods for pain relief, support and promotion of well-being, despite the vertical-oriented process of relationships and the absence of professional follow-up. Conclusion women's perception about Nursing care received during the normal delivery process was dichotomous.

Serum Concentration of Vancomycin Is a Diagnostic Predictor of Nephrotoxic Acute Kidney Injury in Septic Patients in Clinical and Surgical Wards.

INTRODUCTION AND AIM: There have been few studies to evaluate the monitoring of plasmatic concentrations of vancomycin in septic patients and their association with acute kidney injury (AKI) and death. This study aimed to evaluate the prevalence of adequate, subtherapeutic, and toxic serum concentrations of vancomycin in hospitalized septic patients and to associate the adequacy of therapeutic monitoring with clinical outcomes. METHODOLOGY: This was a cohort-unicentric study that evaluated septic patients aged >18 years using vancomycin admitted to clinical and surgical wards of a Brazilian university center from August 2016 to July 2017 in a daily and uninterrupted way. We excluded patients with AKI prior to the introduction of vancomycin or with AKI development <48 hours after use, patients with AKI of other etiologies, stage V chronic kidney disease, and pregnant women. RESULTS: We evaluated 225 patients, and 135 were included. Evaluation of serum concentration of vancomycin was realized in 94.1%, and of those, 59.3% presented toxic concentrations. The prevalence of AKI was 27.4% and happened on average on the ninth day of vancomycin usage. Between the fourth and sixth days, vancomycin serum concentration of >21.5 mg/L was a predictor of AKI, with area under the curve of 0.803 (95% CI 0.62-0.98, p=0.005), preceding the diagnosis of AKI by at least 3 days. Of these patients, 20.7% died, and serum concentrations of vancomycin between the fourth and sixth days were identified as risk factors associated with negative outcomes. CONCLUSION: Serum concentration of vancomycin is an excellent predictor of AKI in patients admitted to wards, preceding the diagnosis of AKI by at least 72 hours. Toxic concentrations of vancomycin are associated with AKI, and AKI was a risk factor for death. Also, serum concentration of vancomycin >21.5 mg/L was the only variable associated with death in the Cox model.

Otimismo, autoeficácia e lócus de controle na adesão ao tratamento de pessoas hipertensas / Optimism, self-efficacy and locus of control on hypertension treatment adherence / Optimismo, autoeficacia y locus de control en la adherencia al tratamiento em hipertensos

Este estudo analisou a relação do otimismo, da autoeficácia e do lócus de controle na adesão ao tratamento de pessoas hipertensas, bem como os principais preditores da adesão na amostra selecionada, considerando-se as variáveis sociodemográficas e os construtos psicológicos avaliados. A amostra foi composta de 100 hipertensos, e foram utilizados cinco instrumentos: questionário sociodemográfico e clínico, a Escala de Adesão Terapêutica de Morisky, o Teste de Orientação na Vida, a Escala de Autoeficácia Geral Percebida e a Escala de Lócus de Controle da Saúde. Por meio da técnica de regressão logística, verificou-se que praticar atividade física, não consumir álcool, ter maiores pontuação no lócus de controle acaso e na autoeficácia foram preditores de média e alta adesão ao tratamento. Finalmente, os resultados demonstraram a necessidade de mais investigações acerca da relação entre variáveis psicológicas e aderência ao tratamento hipertensivo, especialmente no que se refere ao lócus de controle acaso e sua influência sobre os comportamentos de saúde.

This study analyzed the association between optimism, self-efficacy and locus of control on treatment adherence of hypertensive adults, as well as the main predictors of adherence from sociodemographic variables and the psychological constructs. The sample consisted of 100 hypertensive patients. Five instruments were applied: sociodemographic and clinical questionnaire, Morisky Medication Adherence Scale, Life Orientation Test, General Self-Efficacy Scale, and Multidimensional Health Locus of Control Scale. The logistic regression technique showed that physical activity, not consuming alcohol, and having greater scores in luck locus of control and in the self-efficacy were predictors of medium and high adherence. Finally, results demonstrated the need for further investigations on the relationship between psychological variables and adherence to hypertensive treatment, especially about the influence of the locus of control related to the luck on the health behavior.

Esta investigación examinó la relación entre optimismo, autoeficacia y locus de control en la adherencia de las personas hipertensas, así como sus principales predictores, teniendo en cuenta aspectos sociodemográficos y psicológicos evaluados. La muestra fue compuesta de 100 hipertensos. Se utilizaron cinco instrumentos: cuestionario socio demográfico y clínico, Escala de Adherencia al Tratamiento de Morisky, Test de Optimismo, Escala de Autoeficacia Generalizada y Escala Multidimensional de Locus de Control de la Salud. A través de la técnica de regresión logística se verifico que practicar actividad física, no consumir alcohol y tener mayores puntuaciones en locus de control acaso y la autoeficacia fueron predictores de media y alta adhesión. Finalmente, los resultados demostraron la necesidad de mayores investigaciones acerca de la relación entre variables psicológicas y adherencia al tratamiento, especialmente en lo que se refiere al locus acaso y su influencia sobre los comportamientos de salud.

Arbuscular Mycorrhizal Fungi Colonization Promotes Changes in the Volatile Compounds and Enzymatic Activity of Lipoxygenase and Phenylalanine Ammonia Lyase in Piper nigrum L. 'Bragantina'.

Arbuscular mycorrhizal fungi (AMF) have been used to promote numerous benefits to plants. In this study, we evaluated the symbiosis between AMF species (Rhizophagus clarus, Claroideoglomus etunicatum) and Piper nigrum L. 'Bragantina'. Volatile compounds, lipoxygenase (LOX) and phenylalanine ammonia-lyase (PAL) activities, and total phenolic content were monitored from 1 to 60 days post-inoculation (dpi). Hyphae, arbuscles, and vesicles were observed during the root colonization. In the leaves, AMF induced an increase of sesquiterpene hydrocarbons (54.0%-79.0%) and a decrease of oxygenated sesquiterpenes (41.3%-14.5%) at 7 dpi and 60 dpi (41.8%-21.5%), respectively. Cubenol, the main volatile compound of leaves, showed a significant decrease at 7 dpi (21.5%-0.28%) and 45 dpi (20.4%-18.42%). ß-caryophyllene, the major volatile compound of the roots, displayed a significant reduction at 45 dpi (30.0%-20.0%). LOX increased in the roots at 21, 30, and 60 dpi. PAL was higher in leaves during all periods, except at 60 dpi, and increased at 21 and 45 dpi in the roots. The total phenolic content showed a significant increase only in the roots at 30 dpi. The results suggested that AMF provided changes in the secondary metabolism of P. nigrum, inducing its resistance.

Comparação entre métodos de diagnósticos para a quantificação da lipoproteína de baixa densidade em pacientes atendidos em um Hospital Universitário / Comparison between diagnostic methods for the quantification of low-density lipoprotein in patients attended at a University Hospital

Introdução: Estudos relatam uma forte ligação entre as dislipidemias e as ateroscleroses. Por esta razão, exames como o perfil lipídico são realizados rotineiramente com o intuito de prevenção e monitoramento dessas doenças. A lipoproteína de baixa densidade possui grande destaque por apresentar maior relação com fatores de risco para o desenvolvimento de doenças ateroscleróticas. Métodos diretos de obtenção dos valores dessa lipoproteína são confrontados com resultados obtidos usualmente na rotina, através de equações que fornecem valores estimados. Objetivo: Comparar os métodos de diagnósticos utilizados para a obtenção da lipoproteína de baixa densidade através das Fórmulas de Friedewald e Martin com os resultados obtidos por metodologia automatizada, em pacientes atendidos em um Hospital Universitário de Juiz de Fora - MG. Material e Métodos: Foram coletadas amostras de sangue venoso para a obtenção do soro de 208 pacientes. Quantificaram-se os níveis de colesterol total, triglicerídeos e da lipoproteína de alta densidade para a obtenção da lipoproteína de baixa densidade através das equações de Friedewald e Martin. Resultados: Há uma correlação positiva entre os resultados de lipoproteína de baixa densidade calculados pelos métodos de Martin e direto (ρ=0,916), e uma correlação positiva entre os resultados pelos métodos de Friedewald e direto (ρ=0,915). Discussão: Foi observada uma correlação positiva entre os valores de colesterol e de lipoproteína de baixa densidade pelas três metodologias. O método de Bland-Altman foi utilizado para comparação dos resultados obtidos pelas equações e pela metodologia direta. Conclusão: Ainda que as equações de Friedewald e Martin tenham apresentado boa correlação com a lipoproteína de baixa densidade medida por metodologia direta, estudos que relacionam doenças arteriais ateroscleróticas à lipoproteína de baixa densidade devem considerar a quantificação direta desta a fim de abranger os indivíduos com suas diversas especificidades.

Introduction: Studies have reported a strong link between dyslipidemia and atherosclerosis. For this reason, exams such as the lipid profile are routinely performed for the prevention and monitoring of these diseases. Among the lipid indices, low density lipoproteins should be highlighted because due to their greater relation with risk factors for the development of atherosclerotic diseases. Therefore, direct methods of obtaining low density lipoproteins values, considered more accurate, are confronted with results usually obtained in the routine, through equations that provide estimated values. Objective:We compared the diagnostic methods used to obtain low density lipoproteins through the Friedewald and Martin formulas with the results obtained by automated methodology in patients attended at a University Hospital of Juiz de Fora ­ MG. MaterialandMethods: A total of 208 patients were recruited and venous blood samples were collected to obtain serum. The levels of total cholesterol, triglycerides and high density lipoprotein were quantified to obtain low density lipoproteins through the Friedewald and Martin equations. Results:A positive correlation between low density lipoproteins results has calculated by Martin and direct methods (ρ = 0.916), and positive correlation between Friedewald results and direct (ρ = 0.915). Discussion: We observed a positive correlation between the values of cholesterol and low density lipoproteins by the three methodologies. The Bland-Altman method has been used to compare the results obtained in search and methodology. Conclusion:Although the Friedewald and Martin equations have a good correlation with low density lipoproteins as measured by direct methodology, studies that relate atherosclerotic arterial diseases to low density lipoproteins should consider the direct quantification of this lipoprotein in order to cover individuals with their different specificities.

The influence of disinfection on dimensional stability of temporary crowns / A influência da desinfecção na estabilidade dimensional de coroas temporárias

Objective: Evaluate the influence of different disinfection methods on the dimensional stability of temporary acrylic resin crowns. Material and Methods: A metallic die with two different marks at the margin was used to prepare the specimens with two different resins (bis-acrylic resin-Structur, acrylic resin-Dencrilay). They were divided into eight groups (n=8), determined according to the disinfection methods (microwave, acetic acid, 1% hypochlorite) and control. The marginal adaptation was recorded using an optical microscope (50X) comparing two different marks on the margin of the crowns with 2 points along the entire circumferential margin before and after disinfection methods. Results: Results were compared statistically by ANOVA and Tukey's test (p≤0.05). The two-way ANOVA showed statistical difference between types of materials. No significant differences were found between disinfection methods and interaction of factors. Conclusion: All procedures affected the marginal adaptation however temporary crowns made by bis-acrylic resin demonstrate higher dimensional stability. (AU)

Objetivo: Avaliar a influência de diferentes métodos de desinfecção na estabilidade dimensional de coroas temporárias de resina acrílica. Material e Métodos: um molde metálico com duas marcas diferentes na margem foi utilizado para preparar os espécimes com duas resinas diferentes (resina bis-acrílica - estrutura, resina acrílica-Dencrilay). Eles foram divididos em oito grupos (n = 8), determinados de acordo com os métodos de desinfecção (microondas, ácido acético, 1% de hipoclorito) e controle. A adaptação marginal foi registrada usando um microscópio óptico (50X) comparando duas marcas diferentes na margem das coroas com 2 pontos ao longo de toda a margem circunferencial antes e após os métodos de desinfecção. Resultados: os resultados foram comparados estatisticamente por ANOVA e teste de Tukey (p≤0,05). A ANOVA de dois fatores mostrou diferença estatística entre os materiais utilizados. Não foram encontradas diferenças significativas entre os métodos de desinfecção e a interação dos fatores. Conclusão: Todos os procedimentos afetaram a adaptação marginal, porém as coroas temporárias feitas em resina bis-acrílica demonstram maior estabilidade dimensional. (AU)