Wernicke-Korsakoff Syndrome associated with hyperemesis gravidarum and fetal death: Case report and literature review / Síndrome de Wernicke-Korsakoff associado a hiperêmese gravídica e morte fetal: Relato de caso e revisão de literatura

We describe a clinical case of a pregnant patient with hyperemesis gravidarum who progressed to abortion, Wernicke's encephalopathy, and Korsakoff's psychosis, all related to thiamine deficiency. The patient presented symptoms of disorientation, nonspecific limb movements, and fever, initially treated with metronidazole and ceftriaxone for suspected infected abortion. Subsequently, the patient was diagnosed with retained and infected abortion, and thiamine replacement therapy was initiated with an intravenous loading dose of 900 mg/day. During hospitalization, the patient presented with tetraparesis, nystagmus, decreased level of consciousness, anterograde and retrograde amnesia, confabulation, and aphasia. Magnetic resonance imaging showed lesions in the pons, typical of Wernicke's encephalopathy. The patient was empirically treated with acyclovir and ampicillin and showed clinical improvement. The text also provides a brief narrative review of the literature on the topic.

Descrevemos um caso clínico de uma paciente grávida com hiperêmese gravídica que evoluiu para aborto, Encefalopatia de Wernicke e Psicose de Korsakoff, ambas relacionadas à deficiência de tiamina. A paciente apresentou sintomas de desorientação, movimentos inespecíficos dos membros e febre, sendo, inicialmente, tratada com metronidazol e ceftriaxona por suspeita de aborto infectado. Posteriormente, a paciente foi diagnosticada com aborto retido e infectado e iniciou-se a reposição de tiamina com dose endovenosa de ataque de 900 mg/dia. Durante o internamento, a paciente apresentou tetraparesia, nistagmo, rebaixamento do nível de consciência, amnésia anterógrada e retrógrada, confabulação e afasia. A ressonância magnética mostrou lesões na ponte, típicas da Encefalopatia de Wernicke. A paciente foi tratada com aciclovir e ampicilina empiricamente e apresentou melhoras no quadro clínico. O texto também faz uma breve revisão narrativa da literatura sobre o tema.

Retrospective cohort study to evaluate the continuous use of anticholesterolemics and diuretics in patients with COVID-19.

Purpose: The purpose of this study is to evaluate the interference of the continuous use of drug classes in the expression of biomarkers during the first week of hospitalization and in the prognosis of patients with COVID-19. Methods: The patients diagnosed with COVID-19 and confirmed with SARS-CoV-2 by RT-qPCR assay underwent the collection of fasting whole blood samples for further analysis. Other data also extracted for this study included age, sex, clinical symptoms, related comorbidities, smoking status, and classes of continuous use. Routine serum biochemical parameters, including alanine aminotransferase, aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, N-terminal fragment of B-type natriuretic peptide, and cardiac troponin, were measured. Results: In this cross-sectional study, a total of 176 patients with COVID-19 hospitalizations were included. Among them, 155 patients were discharged (88.5%), and 21 patients died (12%). Among the drug classes evaluated, we verified that the continuous use of diuretic 4.800 (1.853-11.67) (p = 0.0007) and antihypercholesterolemic 3.188 (1.215-7.997) (p = 0.0171) drug classes presented a significant relative risk of death as an outcome when compared to the group of patients who were discharged. We evaluated biomarkers in patients who used continuous antihypercholesterolemic and diuretic drug classes in the first week of hospitalization. We observed significant positive correlations between the levels of CRP with cardiac troponin (r = 0.714), IL-6 (r = 0.600), and IL-10 (r = 0.900) in patients who used continuous anticholesterolemic and diuretic drug classes and were deceased. In these patients, we also evaluated the possible correlations between the biomarkers AST, NT-ProBNP, cardiac troponin, IL-6, IL-8, and IL-10. We observed a significantly negative correlations in AST levels with NT-ProBNP (r = -0.500), cardiac troponin (r = -1.00), IL-6 (r = -1.00), and IL-10 (r = -1.00) and a positive correlation with IL-8 (r = 0.500). We also observed significant negative correlation in the levels of NT-ProBNP with IL-10 (r = -0.800) and a positive correlation with cardiac troponin (r = 0.800). IL-6 levels exhibited positive correlations with cardiac troponin (r = 0.800) and IL-10 (r = 0.700). Conclusion: In this study, we observed that hospitalized COVID-19 patients who continued using anticholesterolemic and diuretic medications showed a higher number of correlations between biomarkers, indicating a poorer clinical prognosis. These correlations suggest an imbalanced immune response to injuries caused by SARS-CoV-2.

Continued Emergence and Evolution of Omicron in South Africa: New BA.4 and BA.5 lineages

South Africas fourth COVID-19 wave was driven predominantly by three lineages (BA.1, BA.2 and BA.3) of the SARS-CoV-2 Omicron variant of concern. We have now identified two new lineages, BA.4 and BA.5. The spike proteins of BA.4 and BA.5 are identical, and comparable to BA.2 except for the addition of 69-70del, L452R, F486V and the wild type amino acid at Q493. The 69-70 deletion in spike allows these lineages to be identified by the proxy marker of S-gene target failure with the TaqPath COVID-19 qPCR assay. BA.4 and BA.5 have rapidly replaced BA.2, reaching more than 50% of sequenced cases in South Africa from the first week of April 2022 onwards. Using a multinomial logistic regression model, we estimate growth advantages for BA.4 and BA.5 of 0.08 (95% CI: 0.07 - 0.09) and 0.12 (95% CI: 0.09 - 0.15) per day respectively over BA.2 in South Africa.

Rapid epidemic expansion of the SARS-CoV-2 Omicron variant in southern Africa

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic in southern Africa has been characterised by three distinct waves. The first was associated with a mix of SARS-CoV-2 lineages, whilst the second and third waves were driven by the Beta and Delta variants respectively1-3. In November 2021, genomic surveillance teams in South Africa and Botswana detected a new SARS-CoV-2 variant associated with a rapid resurgence of infections in Gauteng Province, South Africa. Within three days of the first genome being uploaded, it was designated a variant of concern (Omicron) by the World Health Organization and, within three weeks, had been identified in 87 countries. The Omicron variant is exceptional for carrying over 30 mutations in the spike glycoprotein, predicted to influence antibody neutralization and spike function4. Here, we describe the genomic profile and early transmission dynamics of Omicron, highlighting the rapid spread in regions with high levels of population immunity.

Analysis of enamel/restoration interface submitted cariogenic challenge and fluoride release.

The treatment of high-risk patients still is a challenge. The understanding and development non-invasive, non-destructive, and non-ionizing techniques, can help to guide the treatment and the diagnosis of primary and recurrent caries. The present study evaluated the behavior of enamel/restoration interface after a cariogenic challenge by Fourier domain optical coherence tomography (FD-OCT), scanning electron microscopy (SEM) examination, and the fluoride release of the different restorative materials. Cavities (1.5 × 0.5 mm) were performed in enamel surface and divided into groups (n = 8): glass ionomer cement (GIC), resin-modified glass ionomer cement (RMGIC), and resin composite (RC). The samples were submitted to pH-cycling, and the solutions analyzed for cumulative fluoride by ion-analyzer. The morphology was analyzed by SEM through replicas. The optical attenuation coefficient (OAC) was calculated through exponential decay from the images generated by FD-OCT. Data were analyzed considering α = 0.05. OAC values increased for all groups after pH-cycling indicating demineralization (p < .05). Considering the remineralizing solution, RMGIC presented higher fluoride release rate, followed by GIC, while RC did not release any fluoride. Yet for the demineralizing solution, RMGIC and GIC released similar fluoride rates, overcoming RC (p < .05). Micrographs revealed no changes on the restorations margins, although enamel detachment was observed for RC and GIC after pH-cycling.

Multivariate optimization of an ultrasound-assisted extraction procedure for the determination of Cu, Fe, Mn, and Zn in plant samples by flame atomic absorption spectrometry.

In this work, a simple, easy, and fast ultrasound-assisted extraction procedure for the determination of Cu, Fe, Mn, and Zn in plant samples was developed. Sample preparation conditions were optimized in a multivariate manner using mixture design and Box-Behnken. The extraction conditions adequate to obtain the maximum response were 90% power, 10 minutes, 40 °C temperature, and using an extraction solution composed of HNO3 and HCl at a concentration of 0.5 and 1.1 mol L-1, respectively, for a volume of 10 mL and 250 mg of samples. Accuracy was verified from the analysis of a certified reference material (Apple leaves, NIST 1515) yielding recoveries between 89 and 98% for the procedure. Precision was evaluated in a repeatability study (n = 10), yielding RSDs less than 6.7%, and the limits of quantification (mg kg-1) were 0.95, 2.42, 1.31, and 1.18 for Cu, Fe, Mn, and Zn, respectively. The concentrations determined in the stem and leaf of the mangrove species varied according to the collection point and the tissue, being consistent with other studies. The proposed procedure was efficient and reliable for elemental determination in plant samples, with the advantages of low cost and reagent consumption besides short analysis time as a valid alternative to the conventional sample preparation procedure.

Effect of conditioning solutions containing ferric chloride on dentin bond strength and collagen degradation.

OBJECTIVE: To investigate the effects of conditioning solutions containing ferric chloride (FeCl3) on resin-dentin bond strength; on protection of dentin collagen against enzymatic degradation and on cathepsin-K (CT-K) activity. METHODS: Conditioning solutions were prepared combining citric acid (CA) and anhydrous ferric chloride (FeCl3) in different concentrations. The solutions were applied to etch flat dentin surfaces followed by bonding with adhesive resin. Phosphoric acid (PA) gel etchant was used as control. The microtensile bond strength (µTBS) was tested after 24h of storage in water and after 9 months of storage in phosphate buffer saline. Dentin slabs were demineralized in 0.5M EDTA, pre-treated or not with FeCl3 and incubated with CT-K. The collagenase activity on dentin collagen matrix was examined and characterized by SEM. Additional demineralized dentin slabs were treated with the conditioning solutions, and the amount of Fe bound to collagen was determined by EDX. The activity of CT-K in the presence of FeCl3 was monitored fluorimetrically. Data were analyzed by ANOVA followed by post-hoc tests as required (α=5%). RESULTS: Slightly higher bond strengths were obtained when dentin was conditioned with 5% CA/0.6% FeCl3 and 5% CA-1.8%FeCl3 regardless of storage time. Bond strengths reduced significantly for all tested conditioners after 9 months of storage. Treating dentin with 1.8% FeCl3 was effective to preserve the structure of collagen against CT-K. EDX analysis revealed binding of Fe-ions to dentin collagen after 15s immersion of demineralized dentin slabs into FeCl3 solutions. FeCl3 at concentration of 0.08% was able to suppress CT-K activity. SIGNIFICANCE: This study shows that FeCl3 binds to collagen and offers protection against Cat-K degradation. Mixed solutions of CA and FeCl3 may be used as alternative to PA to etch dentin in resin-dentin bonding with the benefits of preventing collagen degradation.

Influence of adhesive cementation systems on the bond strength of relined fiber posts to root dentin.

STATEMENT OF PROBLEM: Glass fiber post cementation procedures have undergone significant development. Relining the post with composite resin is a technique that aims to reduce resin cement thickness and consequently problems inherent to polymerization. Evidence is sparse regarding the efficacy of bonding procedures at increasing depths (from cervical to apical) using different adhesive cementation techniques. PURPOSE: The purpose of this in vitro study was to evaluate the push-out bond strength (PBS) of composite resin relined glass fiber posts cemented to bovine root dentin using different adhesive cementation protocols. MATERIAL AND METHODS: Eighteen bovine teeth (n=6) were embedded in polystyrene resin blocks, and the crowns were sectioned leaving a root portion of 20 mm in length. Root canals were prepared using rotary instruments provided by the post manufacturer (Whitepost DC #1), resulting in a uniform root canal preparation. The root canals were lubricated with a water-soluble glycerin gel. Silane (Prosil) was applied and the posts relined with a microhybrid composite resin (Filtek Z100) to conform to the root canal anatomy. Three adhesive cementation protocols were evaluated: a 3-step etch-and-rinse adhesive system (Adper Scotchbond Multi Purpose) in combination with a dual polymerizing resin cement (RelyX ARC); a universal adhesive system (Scotchbond Universal) associated with a dual polymerizing resin cement (RelyX Ultimate); and a self-adhesive dual polymerizing resin cement (RelyX Unicem 2). The roots were sectioned, resulting in four 2-mm segments at 4 different depths (cervical to apical) and evaluated by the PBS test, using a universal testing machine (Instron 4411) at 0.5 mm/min, until failure. Interfaces were evaluated by scanning electron microscopy, and failures were classified as cohesive failure in composite resin, cohesive failure in cement, cohesive failure in root dentin, adhesive failure, or mixed. Data were analyzed by 2-way split-plot ANOVA and the Tukey post hoc test (α=.05). RESULTS: No statistical differences were found for PBS when different cementation systems were compared (P=.253). Increased depths resulted in reduced PBS values for all cementation protocols evaluated (P<.001). CONCLUSIONS: Regardless the cementation system used, the lowest PBS values were at the apical region of resin relined glass fiber posts bonded to root dentin. Furthermore, the highest PBS is observed at the cervical portion of root dentin.

In vitro effects of caffeine in growth cartilage of rats.

OBJECTIVE: To evaluate the in vitro effetcs of caffeine on proliferation, apoptosis a nd gene transcripts expression of chondrogenic differentiation in growth cartilage. METHODS: THE CARTILAGINOUS EPIPHYSES OF FEMURS OF NEWBORN RATS, WHICH WERE DIVIDED INTO TWO SUBGROUPS: treated with caffeine and control group, both observed over the time periods of 0, 7, 14 and 21 days. The cartilaginous epiphyses of femurs of each subgroup and each time span were subjected to histomorphometric, immunohistochemical analysis, Tunel technique and RT-PCR in real time. RESULTS: The decrease in proliferative activity and the increase of apoptotic chondroblasts at 21 days were found regardless of the subgroup. However, the decrease in cell proliferation caused by caffeine was lower than in the control group and significantly increased the expression of gene transcripts for chondrogenic differentiation, represented by Sox-9 and Runx-2. However, the in vitro culture with caffeine revealed antagonistic effects: despite the positive effect on chondroblasts proliferation and differentiation, caffeine increased apoptosis, characterized by increased expression of caspase 3 and of the number of cells undergoing apoptosis (p<0.05). CONCLUSION: Caffeine presents antagonistic effects in vitro on growth cartilage, increasing the proliferation, differentiation and cell apoptosis. Experimental Study .

In vitro effects of caffeine in growth cartilage of rats / Efeitos in vitro da cafeína na cartilagem de crescimento de ratos

OBJETIVO: Avaliar os efeitos in vitro da cafeína na proliferação, apoptose e expressão de transcriptos gênicos de diferenciação condrogênica na cartilagem de crescimento.MÉTODO: As epífises cartilaginosas de fêmures de ratos neonatos foram divididas em dois subgrupos: os tratados com cafeína e o grupo controle, ambos observados nos tempos de 0, 7, 14 e 21 dias. As epífises cartilaginosas de fêmures de cada subgrupo e de cada tempo foram submetidas à histomorfometria, análise imunoistoquímica, técnica de túnel e RT-PCR em tempo real.RESULTADO: A diminuição da atividade proliferativa e o aumento de condroblastos em apoptose aos 21 dias foram encontrados em ambos os subgrupos. Entretanto a diminuição da proliferação celular causada pela cafeína foi menor quando comparada ao grupo controle e aumentou significativamente a expressão de transcriptos gênicos para diferenciação condrogênica, representada pelo SOX-9 e pelo RUNX-2. Entretanto o cultivo in vitro com cafeína demostrou efeitos antagônicos: apesar dos efeitos positivos na proliferação e diferenciação de condroblatos, cafeína aumentou a apoptose, caracterizada pelo aumento da expressão de caspase-3 e do numero de células em apoptose (p< 0.05).CONCLUSÃO: A cafeína apresenta efeitos antagônicos in vitro na cartilagem em crescimento, aumentando a proliferação, diferenciação e apoptose celular. Estudo experimental.

OBJECTIVE: To evaluate the in vitro effetcs of caffeine on proliferation, apoptosis and gene transcripts expression of chondrogenic differentiation in growth cartilage.METHODS: The cartilaginous epiphyses of femurs of newborn rats, which were divided into two subgroups: treated with caffeine and control group, both observed over the time periods of 0, 7, 14 and 21 days. The cartilaginous epiphyses of femurs of each subgroup and each time span were subjected to histomorphometric, immunohistochemical analysis, Tunel technique and RT-PCR in real time.RESULTS: The decrease in proliferative activity and the increase of apoptotic chondroblasts at 21 days were found regardless of the subgroup. However, the decrease in cell proliferation caused by caffeine was lower than in the control group and significantly increased the expression of gene transcripts for chondrogenic differentiation, represented by SOX-9 and RUNX-2. However, the in vitro culture with caffeine revealed antagonistic effects: despite the positive effect on chondroblasts proliferation and differentiation, caffeine increased apoptosis, characterized by increased expression of caspase 3 and of the number of cells undergoing apoptosis (p<0.05).CONCLUSION: Caffeine presents antagonistic effects in vitro on growth cartilage, increasing the proliferation, differentiation and cell apoptosis. Experimental Study.

Efeito dos materiais restauradores fluoretados na cárie secundária: revisão de literatura / Effect of fluoride-containing restorative materials on secondary caries: review of literature

Entre os principais fatores que levam a substituição de reparações, a presença de cárie secndária é um dos mais polêmicos. Na tentativa de reduzir esse tipo de lesão, muitos estudos têm sido realizados a respeito dos materiais restauradores fluoretados. Atualmente, existem vários produtos no mercado odontológico, entretanto, o cimento de ionômero de vidro é o que tem apresentado maior liberação de flúor e conseqüente efeito cariostático e anti-cariogênico. Do mesmo modo, as restaurações de amálgama com a utilização de agentes intermediários e soluções fluoretadas antes da restauração favorecem a prevenção de cárie secundária. Essa prevenção também pode ocorrer com a utilização de resinas compostas e sistemas adesivos contendo flúor. Assim, mediante a discussão existente sobre este assunto, buscaremos na literatura informações complementares a respeito dos materais restauradores que contém flúor e o efeito de sua liberação na inibição da cárie secundária, auxiliando o Cirurgião-dentista na eleição do material quanto a esse aspecto

Terapia multidisciplinar para tratamento de cárie subgengival / Multidisciplinary therapy for treatment of subgingival caries

A presença de cárie subgengival é frequente na clínica odontológica. Para um tratamento adequado, a associação entre procedimentos periodontais e restauradores é fundamental. O presente relato de caso descreveu a utilização de procedimentos cirúrgicos periodontais (gengivectomia) e restauradores para a reabilitação estética de um paciente que apresentava comprometimento pela presença de lesões de cárie