Cost-Effectiveness of Tacrolimus Compared With Cyclosporine for Immunosuppression Therapy in Patients Who Underwent Heart Transplant in Colombia.

OBJECTIVES: To evaluate the cost-effectiveness of pharmacological treatment in maintenance therapy for adult heart transplant recipients from the Colombian health system perspective. METHODS: We constructed a decision tree model with a 1-year time horizon. A review of the clinical literature was performed to extract probabilities of health events and acute rejections avoided were used as the health outcome. Costs were calculated from the base-case approximation and were obtained from administrative databases in Colombia (Sistema de Información de Precios de Medicamentos 2020 and Suficiencia 2012-2019), and the prices were adjusted to US dollar 2021. RESULTS: Two evaluation results were presented. The first evaluates the tacrolimus + azathioprine + corticosteroid (TAC) scheme compared with cyclosporine + azathioprine + corticosteroid (CAC), in which the incremental cost-effectiveness ratio indicates that 1 additional rejection avoided has a cost of US dollar $5461.09 which, compared with the cost-effectiveness threshold in the base case, indicates that the TAC scheme is not a cost-effective (CE) strategy with respect to the CAC scheme. The second result shows the comparison of tacrolimus + mycophenolate mofetil + corticosteroid (TMC) with cyclosporine + mycophenolate mofetil + corticosteroid (CMC) in which TMC was found to be a dominant alternative to CMC. CONCLUSIONS: The tacrolimus-based immunosuppression scheme is not CE in its TAC scheme, versus CAC, and is dominant in its TMC scheme, versus CMC, sensitivity analyses show that tacrolimus could become a CE alternative in any scheme used against higher cost-effectiveness threshold.

Impact of N-acetylcysteine (NAC) and calcium hydroxide intracanal medications in primary endodontic infection: a randomized clinical trial.

OBJECTIVES: This RCT investigated the impact of N-acetylcysteine (NAC) and calcium hydroxide [Ca(OH)2] intracanal medications (ICMs) in primary endodontic infection with apical periodontitis (PEIAP). MATERIALS AND METHODS: Thirty-six teeth with PEIAP were randomly divided into groups according to the ICM: NAC, Ca(OH)2 + saline solution (SSL), and Ca(OH)2 + 2% chlorhexidine-gel (2% CHX-gel) (all, n = 12). Root canal samples (RCSs) were collected before (s1) and after instrumentation (s2) and after 14 days of ICM (s3). Chemomechanical preparation (CMP) was performed with a Reciproc file and 2.5% NaOCl. Checkerboard DNA-DNA hybridization was used to assess 40 target bacteria species. RESULTS: At s1, bacterial DNA was detected in 100% of RCSs (36/36). All 40 bacterial species were found in PEIAP. The mean number of species per RCS was 17.92 ± 13.18. The most frequent bacteria were S. mitis (65%), E. nodatum (63%), E. faecalis (63%), F. nucl sp vicentii (58%), T. forsythia (58%), and F. periodonticum (56%). CMP reduced the mean number of species per RCS to 6.8 ± 2.36 (p < 0.05). At s3, the intragroup analysis revealed a broader antimicrobial activity for Ca (OH)2 + 2% CHX-gel and NAC than Ca(OH)2 + SSL (p < 0.05). NAC eliminated 8/12 bacteria species resistant to both Ca (OH)2 ICMs, including P. micra, P. nigrescens, T. denticola, A. israelii, P. endodontalis, P. acnes, C. ochracea, and E. corrodens. CONCLUSIONS: Ca (OH)2 + 2% chlorhexidine gel (2% CHX gel) showed a greater bacterial elimination over the number of bacterial species; however, NAC eliminated 8/12 bacteria species resistant to both Ca (OH)2 ICMs (RBR-3xbnnn). CLINICAL RELEVANCE: The use of intracanal medication with a broad antimicrobial activity can optimize root canal disinfection. Ca(OH)2 + 2% CHX gel and NAC showed a broader antimicrobial activity than Ca(OH)2 + SSL against endodontic pathogens in primary root canal infection. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC), No. RBR-3xbnnn.

Effectiveness of 1-Visit and 2-Visit Endodontic Retreatment of Teeth with Persistent/Secondary Endodontic Infection: A Randomized Clinical Trial with 18 Months of Follow-up.

INTRODUCTION: This randomized clinical trial aimed to compare the effectiveness of endodontic retreatment of teeth with posttreatment apical periodontitis (PTAP) performed in 1 visit versus 2 visits on the reduction of cultivable bacteria (colony-forming units [CFUs]), lipopolysaccharides (LPSs), lipoteichoic acid (LTA), and the periapical lesion volume (mm3) after 18 months of follow-up. METHODS: Forty patients diagnosed with PTAP were selected and randomly divided into the following 2 groups: 1-visit retreatment and 2-visit retreatment with the placement of calcium hydroxide medication for 14 days. Cone-beam computed tomographic scans were performed at 2 stages: preoperatively and after 18 months of follow-up. Samples were collected before and after root canal procedures. A chromogenic limulus amebocyte lysate assay test was used to quantify endotoxins (EU/mL). LTA levels were measured using the enzyme-linked immunosorbent assay (pg/mL). Culture techniques were used to determine cultivable bacteria by counting the CFU (CFU/mL). The volume of the periapical lesions at the onset of the trial and at the 18-month posttreatment follow-up was obtained by the ITK-SNAP program (Cognitica, Philadelphia, PA). RESULTS: All samples showed baseline values greater than those collected after the retreatment protocol for all investigated parameters. A higher bacterial load and lower LTA level were found in the 2-visit group after the retreatment protocol (P < .05), with no statistical differences between the groups regarding endotoxin levels and periapical lesion volume (mm³) at the 18-month follow-up analyzed by cone-beam computed tomographic imaging (P > .05). CONCLUSIONS: Endodontic retreatment in 1 or 2 visits exhibited equally favorable periapical healing at 18 months, with no statistically significant differences between groups.

Guided endodontic access of severe calcified tooth without incisal edge ­ case report / Acesso endodôntico guiado de dente calcificado severamente sem borda incisal ­ relato de caso

Pulp tissue may suffer calcification because of trauma, operative procedures or carious lesions. This paper aimed to report and discuss the guided endodontic access as an alternative treatment. A 52 years old female patient had severe root canal calcification of tooth #11 associated with a radiolucent periapical lesion. Firstly, the crown and metal post and core were removed. A digital impression and cone-beam computed tomography "CBCT" scans were performed and imported to implant planning software (SimPlant Version 11; Materialise Dental, Leuven, Belgium).The guided endodontic access template was designed to allow the drill to reach a distance of 2 mm short of the apical foramen, once printed, it was tested in the mouth to evaluate its insertion and stability in the dental arch. The calcified root canal was penetrated using the access drill rotating by a low-speed hand-piece (10,000 rpm) under saline solution irrigation through advancing movements. Then, the apical foramen was negotiated with C-Pilot files #10 and #15. The working length was measured using the iPex-II apex locator. The instrumentation was carried out with Reciproc R50 and 2.5% sodium hypochlorite. One week later, a full-ceramic crown preparation was performed, and polyvinyl siloxane impression was carried out. A total of three follow-up sessions were performed after one week, one and twelve months. Bone neoformation was observed in the site of the periapical lesion and the patient had no signs or symptoms of any discomfort. Therefore, guided endodontics is indicated for severe calcified root canals.(AU)

O tecido pulpar pode sofrer calcificação por trauma, procedimentos cirúrgicos ou como resposta a lesões cariosas. Este trabalho teve como objetivo relatar e discutir o acesso endodôntico guiado como opção de tratamento. Paciente do sexo feminino, 52 anos, com calcificação severa do canal radicular do dente 11 associada a lesão periapical radiolucida. Na primeira intervenção clínica, a coroa e o pino de metal foram removidos. Uma impressão digital e imagens de CBCT foram realizadas e importadas para o software de planejamento de implante (SimPlant Versão 11; Materialize Dental, Leuven, Bélgica) tentando projetar um modelo de acesso endodôntico guiado para permitir que a broca alcance uma distância de 2 mm antes do forame apical, uma vez impresso, foi testado na boca para avaliar sua inserção e estabilidade na arcada dentária. O canal radicular calcificado foi penetrado com broca de acesso girando por peça de mão de baixa velocidade (10.000 rpm) sob irrigação com solução salina por meio de movimentos de avanço. Em seguida, o forame apical foi negociado com as limas C-Pilot nº 10 e nº 15. O comprimento de trabalho foi determinado usando o localizador de ápice iPex-II. A instrumentação foi realizada com Reciproc R50 e hipoclorito de sódio 2,5%. Uma semana depois, foi realizado o preparo da coroa total em cerâmica e a moldagem com polivinilsiloxano. Um total de três sessões de acompanhamento foram realizadas após uma semana, um e doze meses. A neoformação óssea foi observada no local da lesão periapical e a paciente não apresentava sinais ou sintomas de qualquer desconforto. Portanto, o acesso endodôntico guiado é indicado para canais radiculares calcificados severamente.(AU)

Influence of different post-endodontic restorations on the fatigue survival and biomechanical behavior of central incisors.

PURPOSE: To evaluate the influence of different post-endodontic techniques on the fatigue survival and biomechanical behavior of crowned restored central incisors. METHODS: The crowns of 69 bovine incisors were cut, and the roots were treated endodontically and assigned randomly into three groups (n=23): resin composite buildup (BUP), glass fiber post-retained resin composite buildup (GFP), and cast post-and-core (CPC). They received full crown preparation with 2 mm ferrule, and a leucite-reinforced ceramic crown was cemented adhesively. Three specimens from each group were tested monotonically. The remaining specimens were subjected to the stepwise stress fatigue test until fracture or suspension after 1.5 x 106 cycles in a chewing simulator. The load and step at which each specimen failed were analyzed by Kaplan-Meier and Mantel-Cox (log-rank test) statistics, followed by multiple pairwise comparisons, at 5% significance level. The three groups tested (BUP, GFP, and CPC) were 3D modeled (Rhinoceros 4.0) and the maximum principal stress (MPa) criteria were used to calculate the results using FEA. RESULTS: There was no statistical difference between the treatments regarding the load or the number of cycles (Mantel-Cox log-rank test for trend, X²= 0.015, df=1, P= 0.901, X²=3.171, df=1, P= 0.995). Crown cracks were the predominant failure mode, and oblique root fractures were only observed in groups GFP and CPC. In endodontically treated incisors with a 2-mm ferrule, the post-endodontic treatment had no significant effect on fatigue survival. Non-restorable fractures only occurred in teeth restored with posts. CLINICAL SIGNIFICANCE: Although the clinical significance of laboratory studies has some limitations, this study suggests that composite buildups without posts may be an option for restoring endodontically treated incisors with 2 mm ferrule height.

Primary versus post-treatment apical periodontitis: microbial composition, lipopolysaccharides and lipoteichoic acid levels, signs and symptoms.

OBJECTIVES: To compare the microbial load and composition and to determine the lipopolysaccharides (LPS) and lipoteichoic acid (LTA) concentrations found in primary apical periodontitis (PAP) and post-treatment apical periodontitis (PTAP), correlating these findings with clinical/tomographic features. MATERIAL AND METHODS: Sixty patients with PAP (31) and PTAP (29) were submitted to clinical and tomographic assessment. Samples were collected from each root canal using paper points for microbiological assessment (culture technique and Checkerboard DNA-DNA hybridization) and determination of LPS and LTA levels (limulus amebocyte lysate and enzyme-linked immunosorbent assays, respectively). Data were correlated with clinical/tomographic findings and statistically analyzed using the Mann-Whitney and Pearson correlation tests (α = 5%). RESULTS: A higher number of cultivable bacteria and LPS were found in PAP (p < 0.05). The median number of species per root canal found in PAP and PTAP was 9 and 22, respectively (p < 0.05). LPS was positively correlated with a larger periapical lesion volume (p < .05). LTA levels were similar in both infections and had no correlation with signs and symptoms. In PAP, gram-positive bacteria were correlated with spontaneous pain (p < .05) and exudate (p < .05). Tenderness to percussion and pain on palpation were correlated to the presence of both gram-positive and negative bacteria. In PTAP, a positive correlation was observed between both gram-positive and gram-negative bacteria with exudate and periapical lesion volume (p < .05). CONCLUSIONS: PAP had higher contents of microbial load and LPS compared with PTAP. However, PTAP presented a more diverse microbiota compared with PAP. Higher content of LPS was positively correlated with larger periapical bone destruction, whereas signs and symptoms with specific microorganisms. CLINICAL RELEVANCE: It was verified that PAP and PTAP are polymicrobial infections with predominance of gram-negative bacteria and a more diverse bacterial population found in PTAP. A wide interaction of specific microbial species resulted in different clinical features in both infections.

Effect of a Mandibular Advancement Device on the Upper Airway in a Patient With Obstructive Sleep Apnea.

The authors present a case of a 33-year-old male patient with obstructive sleep apnea syndrome who was treated with a mandibular advancement device with excellent results. The aim of this study is to underline the importance of new instruments that allow evaluating the upper airway with greater precision, such as cone beam tomography. Given the diagnosis and treatment, the upper airway was assessed using cone beam tomography; an increase in UA volume of 22% was observed (initial volume 22,962 mm), along with a 28% increase in area (initial area 971 mm). The evaluation of the UA using teleradiography also showed an increase in the points evaluated, with the midpoint of the soft palate presenting the greatest increase.

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial.

OBJECTIVE: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. METHODOLOGY: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. RESULTS: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). CONCLUSION: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Effect of passive ultrasonic activation on microorganisms in primary root canal infection: a randomized clinical trial

Abstract Objective: This clinical study sought to evaluate the effectiveness of passive ultrasonic activation (PUA) in eliminating microorganisms in primary endodontic infection (PEI) after instrumentation of root canals using microbiological culture and checkerboard DNA-DNA hybridization. Methodology: Twenty root canals with PEI and apical periodontitis were selected. The root canals were instrumented and then randomly divided into 2 groups, according to the irrigation method: PUA and conventional needle irrigation (CNI). Microbiological samples were collected before instrumentation (S1), after instrumentation (S2) and after irrigation with 17% EDTA (S3). The samples were subjected to anaerobic culture technique and checkerboard DNA-DNA hybridization analysis. Results: A statistically significant difference was found between CNI (23.56%) and PUA (98.37%) regarding the median percentage values for culturable bacteria reduction (p<0.05). In the initial samples, the most frequently detected species was S. constellatus (50%), and after root canal treatment was E. faecalis (50%). Conclusion: Both treatments significantly decreased the number of bacterial species compared with the initial sample. However, no statistical difference in the total microbial load between PUA and CNI groups was detected. The number of cultivable anaerobic bacteria reduced significantly using PUA, and the bacterial composition and number of bacterial species after using either CNI or PUA was similar.

Case Report: Interdisciplinary management of a complex odontoma with a periapical involvement of superior anterior teeth.

This case report aims to describe the management of a complex odontoma with endodontic involvement of surrounding teeth utilizing a new bioceramic cement consisting of five mineral oxides (5MO) as a retro-filling material. The patient presented for routine consultation with slight dental mobility in the antero-superior region. Upon clinical and computed tomography examination, bone rarefaction was observed in the apical region of teeth 11 and 12, external root resorption in the involved teeth and necrotic pulp of tooth 12. Root canal treatment was performed in teeth 11 and 12. Later, local surgical excision of the lesion was carried out, finding a mass with clinical features of complex odontoma, with histopathological examination of the mass confirming this diagnosis. Retro-filling of tooth 12 with 5MO was carried out. No signs and symptoms were observed over twelve-months of follow-up, with bone neoformation observed in the region. Therefore, 5MO appears to be an effective bioceramic cement that has reparative features.

Redução de bactérias cultiváveis, lipopolissacarídeos e colagenase/mmp-8 no tratamento endodôntico associado à ativação ultrassônica na infecção endodôntica primária: estudo clínico randomizado / Cultivable bacteria, lipopolysaccharides and neutrophil collagenase/mmp-8 reduction on the endodontic treatment associated to ultrasonic activation in primary endodontic infection: a randomized clinical trial

O objetivo desse estudo clínico randomizado foi avaliar em dentes com infecção endodôntica primária (IEP) os microrganismos anaeróbios cultiváveis (UFC/mL), níveis de endotoxinas (LPS) (EU/mL) e colagenase/MMP-8 da região periapical antes e durante o tratamento endodôntico utilizando diferentes protocolos de irrigação final: irrigação convencional (CNI), ativação ultrassônica passiva (PUA) e ativação ultrassônica continua (CUA). Quarenta e cinco dentes com IEP foram submetidos ao tratamento endodôntico utilizando NaOCl 2.5% como solução irrigadora seguido do uso de EDTA 17%. Os protocolos de limpeza final foram realizados com irrigação com agulha convencional (controle), PUA e CUA; na sequência os canais foram preenchidos com pasta de Ca(OH)2 + SS por 14 dias. Foram feitas coletas do conteúdo do canal radicular após abertura coronária (S1), após diferentes protocolos de irrigação final (S2) e após uso de medicação intracanal com pasta de hidróxido de cálcio [Ca(OH)2] (S3). O conteúdo coletado do canal foi submetido as análises por cultura microbiológica (UFC/mL) e níveis de endotoxinas (EU/mL) pelo Lisado de Amebócitos de Limulus (LAL). Após preparo dos canais e após medicação com Ca(OH)2 foram realizadas coletas do fluido periapical para análise da expressão de MMP-8 por ELISA. A análise estatística dos dados foi realizada pelo testes Kruskal-Wallis e Dunn para analise intergrupos de UFC/mL, LPS e MMP-8, todos eles com nível de significância de 5% (P<0.05). Microrganismos anaeróbios cultiváveis foram detectados em 100 % das amostras iniciais (S1) com valor médio de 1.18 x 105 CFU/mL (20 ­ 1.84 x 106 CFU/mL). CUA apresentou maior efetividade na redução de microrganismos anaeróbios cultiváveis em S3 (97.27%) seguido pela PUA (96.56%) e CNI (96.2%). Endotoxinas foram identificadas em 100% das amostras em S1 com valor médio de 538.10 EU/mL (0.017 x 6190 EU/mL), CUA mostrou uma maior redução nos níveis de LPS em S3 (97.75 %), seguido pela PUA (97.11%) e CNI (90.42%). O protocolo de irrigação final com ativação ultrassônica PUA e CUA favoreceu a redução de MMP-8 em comparação ao grupo CNI. Houve correlação estatística positiva entre os níveis de LPS e MMP-8. Conclui-se que o preparo biomecânico produz a maior redução no número de microrganismos anaeróbios e endotoxinas; O protocolo de irrigação final com PUA e CUA em associação ao preparo biomecânico produz maior redução nos níveis de Endotoxinas e MMP-8 em comparação com CNI. Existe correlação estatística positiva entre os níveis de LPS e MMP-8 presentes nas infecções endodônticas primárias, mostrando a associação do LPS com o processo de destruição tecidual(AU)

The aim of this randomized clinical trial was to evaluate in cultivated anaerobic microorganisms (CFU / mL), endotoxin levels (LPS) (EU / mL) and periapical collagenase / MMP-8 in teeth with primary endodontic infection (EPI) before and during Endodontic treatment using different final irrigation protocols: conventional irrigation (CNI), passive ultrasonic activation (PUA) and continuous ultrasonic activation (CUA). Forty-five teeth with IEP were submitted to endodontic treatment using 2.5% NaOCl as an irrigating solution followed by 17% EDTA. Final cleaning protocols were performed with conventional needle irrigation (control), PUA and CUA; The root canals were then filled with Ca (OH)2 paste for 14 days. Root canal contents were collected after coronary opening (S1), after root canal preparation (S2) and after intracanal calcium hydroxide paste [Ca (OH)2] (S3). Samples of the root canal content was performed to analysis by microbiological culture (CFU / mL) and endotoxin levels (EU / mL) by Limulus Amebocyte Lysate (LAL). After canal preparation and after Ca (OH)2 medication, periapical fluid samples were collected for analysis of MMP-8 expression by ELISA. Statistical analysis of the data was performed by Kruskal-Wallis and Dunn tests for intergroup analysis of CFU / mL, LPS and MMP-8, all with a significance level of 5% (P <0.05). Cultivable anaerobic microorganisms were detected in 100% of the initial samples (S1) with a mean value of 1.18 x 105 CFU / mL (20 - 1.84 x 106 CFU / mL). CUA showed greater effectiveness in reducing anaerobic microorganisms cultivable in S3 (97.27%) followed by PUA (96.56%) and CNI (96.2%). Endotoxins were identified in 100% of samples in S1 with a mean value of 538.10 EU / mL (0.017 x 6190 EU / mL), CUA showed a greater reduction in LPS levels in S3 (97.75%), followed by PUA (97.11%). and CNI (90.42%). The final irrigation protocol with ultrasonic activation PUA and CUA favored the reduction of MMP-8 compared to the CNI group. There was a positive statistical correlation between LPS and MMP-8 levels. It is concluded that the biomechanical preparation produces the greater reduction in the number of anaerobic microorganisms and endotoxins; The final irrigation protocol with PUA and CUA in combination with biomechanical preparation produces greater reduction in Endotoxin and MMP-8 levels compared to CNI. There is a positive statistical correlation between the levels of LPS and MMP-8 present in primary endodontic infections, showing the association of LPS with the tissue destruction process(AU)

Cost-Effectiveness Analysis of Diagnosis of Duchenne/Becker Muscular Dystrophy in Colombia.

OBJECTIVES: To determine the cost-effectiveness ratio of different courses of action for the diagnosis of Duchenne or Becker muscular dystrophy in Colombia. METHODS: The cost-effectiveness analysis was performed from the Colombian health system perspective. Decision trees were constructed, and different courses of action were compared considering the following tests: immunohistochemistry (IHC), Western blot (WB), multiplex polymerase chain reaction, multiplex ligation-dependent probe amplification (MLPA), and the complete sequencing of the dystrophin gene. The time horizon matched the duration of sample extraction and analysis. Transition probabilities were obtained from a systematic review. Costs were constructed with a type-case methodology using the consensus of experts and the valuation of resources from consulting laboratories and the 2001 Social Security Institute cost manual. Deterministic sensitivity and scenario analyses were performed with one or more unavailable alternatives. Costs were converted from Colombian pesos to US dollars using the 2014 exchange rate. RESULTS: In the base case, WB was the dominant strategy, with a cost of US $419.07 and a sensitivity of 100%. This approach remains the dominant strategy down to a 98.2% sensitivity and while costs do not exceed US $837.38. If WB was not available, IHC had the best cost-effectiveness ratio, followed by MLPA and sequencing. CONCLUSIONS: WB is a cost-effective alternative for the diagnosis of patients suspected of having Duchenne or Becker muscular dystrophy in the Colombian health system. The IHC test is rated as the second-best detection method. If these tests are not available, MLPA followed by sequencing would be the most cost-effective alternative.

In vitro and in vivo assessment of anti-hyperglycemic and antioxidant effects of Oak leaves (Quercus convallata and Quercus arizonica) infusions and fermented beverages.

The aim of this study was to evaluate the anti-hyperglycemic and antioxidant effects of oak leaves infusions and fermented beverages from Quercus convallata and Q. arizonica in vitro and in vivo. Female C57BL/6 mice fed with high saturated fat and fructose diet-induced obesity were treated with oak leaves beverages (200 µL/per day equivalent to 15mg of lyophilized sample/Kg of body weight for infusions and 31mg of lyophilized sample/Kg of body weight for fermented beverages) for 3months and an oral glucose tolerance test (OGTT) was performed. Blood plasma was obtained for determination of glucose, lipid profile, and oxidative stress markers (ABTS, nitric oxide, and ORAC assays). Insulin resistance was estimated using the product of triglycerides and glucose (TyG). Oak leaves infusions and fermented beverages exhibited exerted inhibition of α-amylase (8-15% and 5-9%, respectively) and α-glucosidase (98% and 99%, respectively) enzymes. After OGTT, the groups treated with either oak leaves infusions or fermented beverages showed lower glucose levels compared with the obesity control group (18%) and a similar glucose tolerance to healthy control group. On long-term evaluation, intervention groups showed a significant reduction in fasting glucose concentrations (41-50% for oak leaves infusions and 52-66% for fermented beverages) and TyG index (4.2-4.6% for oak leaves infusions and 5.9-7.5% for fermented beverages) compared with the obese control group. Oak leaves infusions and fermented beverages had antioxidant potential in vitro and scavenging activity for radicals such as peroxyl and peroxynitrite anions. Our results suggest anti-hyperglycemic and antioxidant effects of beverages prepared with leaves of Quercus species in vitro and in vivo.

Effectiveness in the Removal of Endotoxins and Microbiological Profile in Primary Endodontic Infections Using 3 Different Instrumentation Systems: A Randomized Clinical Study.

INTRODUCTION: This clinical study was conducted to correlate the microbiological profile and levels of endotoxins found in primary endodontic infection with the presence of clinical features and to evaluate the removal of microorganisms and endotoxins using rotary, reciprocating, and hybrid systems for biomechanical preparation. METHODS: Thirty single root canals with primary endodontic infection were evaluated with signs and symptoms and were randomly divided into 3 groups according to the instrumentation system used (n = 10) as follows: rotary Mtwo instruments (VDW, Munich, Germany) with 8 files, the reciprocating Reciproc system (VDW) with a single file, and Genius hybrid instruments with 3 files (1 rotary and 2 reciprocating files) with irrigation using 24 mL 2.5% sodium hypochlorite. Samples were collected before (S1) and after instrumentation (S2) before being submitted to microbiological culture (colony-forming units/mL) and the checkerboard DNA-DNA hybridization test. Endotoxins were quantified using the limulus amebocyte lysate assay. RESULTS: Microbiological culture showed statistical differences in the reduction of colony-forming units/mL with all systems tested (P < .05), but no statistical difference was found among the groups. The most frequently detected species were Capnocytophaga ochracea (53%) and Fusobacterium nucleatum (53%) at S1 and F. nucleatum (50%) and Leptotrichia buccalis (50%) at S2. As for the reduction of endotoxins at S2, Mtwo presented the best results (95.05%) followed by the Genius (91.85%) and Reciproc (64.68%) groups, but no statistical difference was found among the groups. Previous pain, tenderness to percussion, and presence of a sinus tract were associated with specific microorganisms (P < .05). CONCLUSIONS: Signs and symptoms were correlated with microorganisms. Endodontic treatment was effective in reducing bacteria and endotoxins but was not capable of completely removing them from the root canal.

Efeito do ultrassom na eliminação de micro-oganismos e endotoxinas em dentes com infecção endodôntica primária / Ultrasound effect in eliminating microorganisms and endotoxins in teeth with primary endodontic infection

Os objetivos do presente estudo foram: a) Verificar a carga microbiana e quantificar endotoxinas presentes nos canais radiculares de dentes com infecção endodôntica primária; b) Comparar a efetividade antibacteriana e sobre endotoxinas do preparo biomecânico com dois métodos de irrigação final: com ou sem irrigação ultrassônica passiva; c) Correlacionar sinais e sintomas com a microbiota presente e complexos bacterianos; d) Relacionar níveis de endotoxinas e carga microbiana com sinais e sintomas clinicos. Foram selecionados para o estudo 20 dentes uniradiculares, que apresentavam infecção endodôntica primária e lesão periapical, sendo estes submetidos a TCFC. Os canais foram preparados com sistema reciprocante e irrigação com NaOCl 2.5%, seguido de dois protocolos de irrigação final: com e sem uso de ultrassom. Todos os canais foram preenchidos com MIC com hidróxido de cálcio + soro fisiológico e após 14 dias foram obturados com cones de guta-percha e cimento AH Plus. Foram realizadas coletas do conteúdo do canal, logo após a abertura coronária (1ª Coleta); após PBM (2ª Coleta) e após limpeza final dos canais com NaOCl seguido de EDTA por 5 min (grupo sem PUI); ou irrigação com NaOCl + PUI e EDTA + PUI (3ª Coleta) (grupo com PUI) . Foram avaliados sinais/sintomas clínicos previo ao tratamento.O conteúdo das coletas foi analisado a partir de sondas de DNA pelo método de hibridização DNA-DNA checkerboard e foi realizado teste de avaliação da atividade antimicrobiana por cultura microbiológica. Alem disso foi realizado quantificação de endotoxinas pelo Lisado de Amebócitos de Limulus (LAL). E a volumetria dos canais foi feita através da TCFC utilizando o software Nemotec®. Os resultados foram submetidos a análise estatístico pelos testes Mann Whitney e teste ANOVA a dois fatores de medidas repetidas (5%). Valor de p < 0.05 foi considerado estatisticamente significante. Houve associação entre dor à percussão e complexos laranja principal e laranja periférico. Fístula foi associada ao complexo laranja principal e laranja periférico. Foi observada redução de bactérias após o tratamento endodôntico. Ao utilizar o método de hibridização DNA-DNA checkerboard, as bactérias mais prevalentes foram S. constellatus, E faecalis, F. nucleatum, P. gingivalis, P. melaninogenica e S. intermedius na primeira coleta. Os métodos de irrigação diminuíram número de espécies bacterianas comparado à coleta inicial. A irrigação ultrassônica passiva apresentou diferença estatística significativa sobre bactérias anaeróbias. PUI não apresento diferença significativa sobre bactérias aeróbias nem endotoxinas comparado com irrigação convencional. Concluiu-se que todos os canais apresentaram micro-organismos sendo que anaeróbios estiveram presentes em grande quantidade. Após preparo biomecânico do canal radicular e irrigação com PUI, houve redução significante da carga de micro-organismos anaeróbios. Os micro-organismos mais resistentes ao preparo biomecânico com e sem PUI foram S. constellatus , E. faecalis, S. intermedius e L.bucalis. Houve associação positiva entre sinais e sintomas clínicos com complexo laranja e com micro-organismos. Os níveis de endotoxinas diminuíram após o preparo biomecânico não foram inferenciados por PUI a irrigação convencional. (AU)

The objective of this study were: a) to check the microbial load and to quantify endotoxin present in the root canals of teeth with primary endodontic infection; b) to compare the effectiveness of bacteria and endotoxin reduction of the biomechanical preparation with final irrigation methods: with or without passive ultrasonic irrigation (PUI); c) to correlate signs and symptoms with the present microbiota and bacterial complexes; d) to relate endotoxin and microbial load levels with signs and symptoms before biomechanical preparation. Twenty single-root teeth were selected for the study, presenting primary endodontic infections and periapical lesion, which underwent CBCT. The canals were prepared with reciprocating system and irrigation with 2.5% NaOCl, followed by two final irrigation protocols: with and without ultrasound. All canals were filled with MIC with calcium hydroxide + saline and after 14 days were filled with gutta percha and AH Plus. Samples from the content of canal were harvested, after coronal opening (1st Sample); after PBM (2nd Sample) and after final cleaning of the canals with NaOCl followed by EDTA for 5 min (group without PUI); or irrigation with NaOCl + PUI and EDTA + PUI (3rd Sample) (group with PUI). The contents of the samples were analyzed from DNA probes by the DNA-DNA checkerboard hybridization method and a test was performed to evaluate the antimicrobial activity by microbiological culture. In addition, quantification of endotoxins by Limulus Amebocyte Lysate (LAL) was performed. The canal volumetry was assessed through the CBCT using Nemotec® software. The results were submitted to statistical analysis by Mann Whitney and repeated measures two-way ANOVA (5%). Value of p <0.05 was considered statistically significant. There was an association between pain at percussion and main orange and peripheral orange complexes. Fistula was associated with the main orange and peripheral orange complex. A reduction of bacteria was observed after endodontic treatment. When using the DNA-DNA checkerboard hybridization method, the most prevalent bacterias were S. constellatus, E faecalis, F. nucleatum, P. gingivalis, P. melaninogenica and S. intermedius in the first collection. Irrigation methods decreased number of bacterial species compared to initial collection. The passive ultrasonic irrigation presents statistically significant difference on anaerobic bacteria. PUI did not present significant difference on aerobic bacteria or endotoxins compared to conventional irrigation. In conclusion, all canals had microorganisms, and anaerobes were present in large quantities. The most frequent microorganisms were S. constellatus, E. faecalis, F. nucleatum SP, P. gingivalis e S. intermedius. After biomechanical preparation of root canal and irrigation with PUI, there was a significant reduction of the anaerobic microorganism load. The microorganisms most resistant to biomechanical preparation with and without PUI were S. constellatus , E. faecalis, S. intermedius e L. bucalis. There was a positive association between clinical signs and symtoms with orange complex and with microorganisms. Endotoxi levels decreased after biomechanical preparation, while not influenced by PUI in comparison to conventional irrigation(AU)

ß-hCG and prediction of therapeutic success in ectopic pregnancies treated with methotrexate, results from a prospective observational study.

OBJECTIVE: To evaluate the diagnostic accuracy of different beta-human chorionic gonadotrophin (ß-hCG) levels measurement, for predicting success of medical treatment in cases diagnosed as tubal ectopic pregnancy (TEP). DESIGN: Five-year prospective observational study. SETTING: Prenatal Diagnosis Unit, Vall d'Hebron University Hospital - Barcelona. PATIENTS: TEP cases fulfilling criteria for medical treatment with Methotrexate. INTERVENTIONS: ß-hCG levels were measured on d 0, 4 and 7 of treatment. Results were compared by non-parametrical tests. A ROC curve was plotted to define cut-off points. Diagnostic accuracy of the different measurements was evaluated. MAIN OUTCOME MEASURE: Failure of treatment defined as need for surgical treatment or persistence of high ß-HCG levels despite treatment. RESULTS: 126 women were diagnosed as TEP, eligible for medical treatment. There were no differences in parity, age, previous TEP, or adnexal mass size. Success rate was 88%. ß-HCG decreased significantly more, between days 0-7 and 4-7, in the successful cases. LR for success prediction was 6.2 and 7.8 for ß-HCG levels at days 4 and 7 respectively, 4.02 and 2.47 for decrement between days 0-7 (25%) and 4-7 (20%), respectively. CONCLUSION: ß-hCG cutoff values have a potential for predicting a successful medical treatment of TEP.