Influência do pré-alargamento coronário na resistência à fadiga cíclica de instrumentos reciprocantes tratados termicamente / Influence of coronal pre-enlargement on cyclic fatigue resistance of heat-treated reciprocating instruments

Objetivo: O objetivo do presente estudo foi avaliar a influência do pré-alargamento coronário na resistência à fadiga cíclica de dois instrumentos reciprocantes tratados termicamente. Métodos: 20 instrumentos Reciproc Blue (R25 Blue) e 20 instrumentos X1 Blue (X1) foram utilizados para instrumentar blocos de resina simulando um molar superior com três canais radiculares. Os dentes foram divididos em quatro grupos (n=10), de acordo com o instrumento e com a técnica de instrumentação utilizada: grupos R25 e X1 - instrumentação com R25 Blue (25/0.08) ou X1 Blue (25/0.06), respectivamente, sem alargamento prévio; e grupos R25 ou X1 + pré-alargamento cervical - pré-alargamento com os instrumentos ProTaper Universal SX e S1 antes da instrumentação com R25 Blue ou X1. Os instrumentos foram testados com relação à fadiga cíclica utilizando-se um canal simulado de aço inoxidável com ângulo de curvatura de 86 graus e raio de curvatura de 6 mm. Os instrumentos foram acionados utilizando-se o movimento "RECIPROC ALL" do motor endodôntico (VDW) e o tempo de instrumentação até a fratura do instrumento foi contabilizado. Os resultados foram analisados pelo teste t de Student (p<0,05). Resultados: Os instrumentos X1 apresentaram maior resistência à fadiga cíclica do que R25 Blue em ambas as condições testadas (p<0,05). Não houve diferença entre os grupos com e sem pré-alargamento coronário para os instrumentos R25 Blue e X1 (p>0,05). Conclusão: O instrumento X1 Blue apresentou maior resistência à fadiga cíclica do que o Reciproc Blue. O pré-alargamento coronário não foi capaz de aumentar a resistência à fratura por fadiga cíclica dos instrumentos testados (AU).

Objective: The aim of this study was to evaluate the influence of cervical pre-flaring on the cyclic fatigue resistance of two heat-treated reciprocating instruments. Methods: 20 Reciproc Blue (R25 Blue) instruments e 20 X1 Blue File (X1) were used to instrument resin blocks simulating an upper molar with 3 root canals. The specimens were divided into four groups (n=10) according the instrument and type of instrumentation used: R25 and X1 groups: root canal preparation with R25 Blue (25/0.08) ou X1 Blue (25/0.06), without cervical pre-flaring; R25 or X1 + cervical pre-flaring- pre-flaring with ProTaper Universal SX e S1 before instrumentation with R25 Blue or X1 blue. After instrumentation the instruments were tested for cyclic fatigue using a simulated stainless steel root canal with 86 degree bending angle and 6 mm bending radius. The instruments were triggered using the "RECIPROC ALL" motion of a reciprocating endodontic motor (VDW) and the instrumentation time until instrument fracture was accounted. Results were analyzed by Students t-test (p<0.05). Results: Statistical analysis showed that the X1 Blue showed higher resistance to cyclic fatigue than the R25 Blue under both conditions tested (p<0.05). There were no differences between the groups with and without coronary pre-flaring for the R25 Blue and X1 Blue (p<0.05). Conclusion: X1 Blue showed higher resistance to cyclic fatigue than the R25 Blue. The cervical pre-flaring did not increased the resistance to cyclic fatigue fracture of the tested instruments (AU)

Study on the interaction of three classical drugs used in psychiatry in albumin through spectrofluorimetric modeling.

Comparative study of haloperidol (HPD), biperiden (BPD) and clonazepam (CNZ) interactions with human and bovine serum albumin was performed based on fluorescence quenching analysis. We used mathematical modeling comparing spectrofluorimetric data to obtain information on the possibility of competition among three drugs by sites binding. Results showed that the three drugs studied have high affinity for albumin and suggest the existence of two site classes in HSA for HPD and only one class for BPD and CNZ, in the range of concentrations tested for each drug. Among them, only HPD forms complex with HSA. Comparing normalized quenching plots suggested that the primary sites in HSA and BSA for HPD and CNZ are located at subdomain IB, whereas BPD would bind in the subdomain IIA. Considering the competition for binding sites in HSA, titrations of HPD-HSA complex by BPD and CNZ, as well as the titration of HSA solution containing CNZ titrated by BPD, show that although the three drugs do not compete with each other for binding sites, their interaction with HSA can cause conformational change in the protein, and to increase or decrease the accessibility to binding sites for other drug. This may mean alteration in the free plasma drug concentrations.

Budgetarry impact of the incorporation of claritromycin in the treatment of infection by new coronavirus / Impacto presupuestario de la incorporación de claritromicina en el tratamiento de la infección por nuevos coronavirus / Impacto orçamentário da incorporação da claritromicina no tratamento da infecção pelo novo coronavírus

Introduction: In Brazil, the use of third generation cephalosporins associated with a macrolide (azithromycin or clarithromycin), has been recommended at admission. Objective: To estimate the budgetary impact of the use of clarithromycin as a supporting macrolide in the empirical treatment scheme for patients with Severe Acute Respiratory Syndrome. Method: Budgetary Impact Analysis. Unified Health System perspective, local level. 5-year time horizon. Used the Brazilian Budget Impact Analysis Worksheet. Three alternative scenarios and one reference were analyzed. Results: The five-year cost in the reference scenario was R$ 2,504,887.92. Conclusion: The incorporation of clarithromycin in alternative scenarios may represent an average incremental cost of more than 22% of the budget available for the acquisition of azithromycin in 5 years, which may be economically unfeasible to offer to all patients in hospitals, without having loss in meeting other demands.

Introducción: en Brasil, se recomienda el uso de cefalosporinas de tercera generación asociadas con un macrólido (azitromicina o claritromicina) al ingreso. Objetivo: estimar el impacto presupuestario del uso de claritromicina como un macrólido de apoyo en el esquema de tratamiento empírico para pacientes con síndrome respiratorio agudo severo. Método: Análisis de impacto presupuestario. Perspectiva del Sistema Único de Salud, nivel local. Horizonte temporal de 5 años. Se utilizó la hoja de trabajo de análisis de impacto presupuestario brasileño Se analizaron tres escenarios alternativos y una referencia. Resultados: El costo a cinco años en el escenario de referencia fue de R $ 2.504.887,92. Conclusión: La incorporación de claritromicina en escenarios alternativos puede representar un costo incremental promedio de más del 22% del presupuesto disponible para la adquisición de azitromicina en 5 años, lo que puede ser económicamente inviable para ofrecer a todos los pacientes en hospitales, sin tener pérdida en el cumplimiento de otras demandas.

Introdução: No Brasil, o uso de cefalosporinas de terceira geração associadas a um macrolídeo (azitromicina ou claritromicina), tem sido recomendada na internação. Objetivo: Estimar o impacto orçamentário do uso da claritromicina como macrolídeo coadjuvante no esquema de tratamento empírico de pacientes com Síndrome Respiratória Aguda Grave. Método: Análise de Impacto Orçamentário. Perspectiva do Sistema Único de Saúde, nível local. Horizonte temporal de 5 anos.  Utilizou a Planilha Brasileira de Análise de Impacto Orçamentário. Analisados três cenários alternativos e um de referência. Resultados: O custo em cinco anos no cenário de referência foi de R$2.504.887,92. Conclusão: A incorporação da claritromicina nos cenários alternativos pode representar um custo incremental médio superior a 22% do orçamento disponível para a aquisição de azitromicina em  5 anos, o que podendo ser economicamente inviável a sua oferta para todos os pacientes nos hospital, sem que houvesse prejuízo no atendimento de outras demandas.

Rivaroxaban Used in the Treatment Patients With Gynecologic Cancer and Venous Thromboembolism: The Experience of Instituto Nacional de Câncer-Rio de Janeiro, Brazil.

INTRODUCTION: Venous thromboembolism (VTE) is a major complication of malignant diseases and is a frequent cause of death in patients with cancer. Managing anticoagulation in these patients is challenging because of the high risk of recurrent VTE and bleeding events. Rivaroxaban is an oral anticoagulant that provides rapid onset of anticoagulation. OBJECTIVE: The aim of this study was to describe the complications of rivaroxaban and potentially associated factors in patients with gynecologic cancer and VTE. METHODS: This was an observational study in women with gynecological cancer who developed VTE and were treated with 15 and 20 mg rivaroxaban at Instituto Nacional de Câncer from July 2014 to July 2015. RESULTS: Forty-one patients were treated with rivaroxaban. Most patients were younger than 60 years and presented cervical cancer; 58.5% of women did not have complications, thus remaining at a dose of 20 mg/d. Because of complications, 12.2% had the dose reduced to 15 mg/d, 12.2% had the drug suspended, 7.3% had progressive worsening of the disease with suspension of anticoagulation, and 9.8% progressed to death because of progression of the disease. CONCLUSIONS: Rivaroxaban has been documented as a low-cost, easily controlled option compared with standard therapy. Most participants in this study had no complications. However, it was not possible to assess associations with statistical significance. Further analytical studies with larger samples are required to evaluate the safety and efficacy of this treatment in patients with gynecologic cancer.

Avaliação da qualidade de vida de mulheres com carcinoma do colo do útero em quimioterapia paliativa / Evaluation of quality of life in women with cervical cancer undergoing palliative chemotherapy / Calidad de la vida de las mujeres en evaluación útero con carcinoma de cuello uterino en quimioterapia paliativa

Introdução: No câncer do colo do útero, a avaliação da qualidade de vida é de suma importância, pois identifica aspectos relacionados ao bem-estar físico, mental e social que são afetados pela doença. Objetivo: Avaliar o impacto do tratamento quimioterápico paliativo com carboplatina e paclitaxel na qualidade de vida relacionada à saúde de mulheres com câncer do colo uterino. Método: Trata-se de um estudo descritivo, não comparativo, sobre qualidade de vida de pacientes com câncer do colo do útero submetidas ao primeiro tratamento quimioterápico paliativo no período de 1 de abril a 30 de julho de 2015. Foram coletados dos prontuários dados sociodemográficos, e a qualidade de vida foi mensurada por meio da aplicação de questionário validado antes da realização do primeiro, segundo, quarto e sexto ciclos da quimioterapia. Para analisar a magnitude das alterações das variáveis, foram empregados os critérios estabelecidos por Osoba; e, para a análise de diferenças significativas entre as medidas, foi utilizado o teste de Wilcoxon. Resultados: Foi observado um impacto negativo nos sintomas da diarreia e neuropatia periférica, bem como melhora da capacidade emocional, física, funcional e social, além da minimização de sintomas como fadiga, dor, falta de apetite, náuseas e vômito e constipação. Contudo, não foi possível observar diferença estatística na alteração do estado geral de saúde ao longo do tratamento. Conclusão: Apesar do impacto positivo observado em diversos sintomas e funções, não foi possível observar melhora da qualidade de vida das pacientes avaliadas.

Introduction: In cervical cancer, evaluating quality of life, is very important because it identifies aspects related to physical, mental and social well-being that are affected by the disease. Objective: To evaluate the impact of palliative chemotherapy with carboplatin and paclitaxel on quality of life related to health in women with cervical cancer. Method: This is an observational prospective study of quality of life in patients with cervical cancer undergoing the first palliative chemotherapy in the period from 1 April to 30 July 2015. Sociodemographic data were collected from medical records and quality of life was measured by a validated questionnaire prior to undergoing the first, second, fourth and sixth chemotherapy cycles. To analyze the magnitude of the change of variables, the criteria established by Osoba were used and statistical significance analysis was performed using the Wilcoxon test. Results: A negative impact was observed in the symptoms of diarrhea, and peripheral neuropathy, as well as improvement in emotional, physical, functional and social capacity and minimizing of symptoms such as fatigue, pain, loss of appetite, nausea and vomiting and constipation. However, it was not possible to observe statistically significant differences in change in general health during the treatment. Conclusion: Despite the positive impact observed on various symptoms and functions, it was not possible to observe improvement in the quality of life of the patients evaluated.

Introducción: En el cáncer de cuello uterino, la evaluación de la calidad de vida, es muy importante, ya que identifica los aspectos relacionados con el bienestar físico, mental y social que se ven afectados por la enfermedad. Objetivo: Evaluar el impacto de la quimioterapia paliativa con carboplatino y paclitaxel en la calidad de vida relacionada con la salud de las mujeres con cáncer de cuello uterino. Método: Se realizó un estudio descriptivo no comparativo sobre la calidad de vida de pacientes con cáncer de cuello uterino, sometidas al tratamiento de quimioterapia paliativa en el período del 1 de abril al 30 de julio del año 2015 se obtuvieron de los registros médicos de datos sociodemográficos y de calidad de vida se midió mediante un cuestionario validado antes de el primer, segundo, cuarto y sexto ciclo de quimioterapia. Para analizar la magnitud del cambio de variables, se utilizaron los criterios establecidos por Osoba y para el análisis de diferencias significativas entre las medidas se realizó mediante el test de Wilcoxon. Resultados: Se observó un impacto negativo en los síntomas de diarrea, y la neuropatía periférica, así como la mejora de la capacidad emocional, problemas físicos, funcionales y sociales y la minimización de los síntomas tales como fatiga, dolor, pérdida de apetito, náuseas y vómitos y estreñimiento. Sin embargo, no fue posible observar diferencias estadísticamente significativas en el cambio en la salud general durante el tratamiento. Conclusión: A pesar del impacto positivo observado en diversos síntomas y funciones, no fue posible observar mejoría en la calidad de vida de las pacientes evaluadas.

Binding of Sulpiride to Seric Albumins.

The aim of this work was to study the interaction of sulpiride with human serum albumin (HSA) and bovine serum albumin (BSA) through the fluorescence quenching technique. As sulpiride molecules emit fluorescence, we have developed a simple mathematical model to discriminate the quencher fluorescence from the albumin fluorescence in the solution where they interact. Sulpiride is an antipsychotic used in the treatment of several psychiatric disorders. We selectively excited the fluorescence of tryptophan residues with 290 nm wavelength and observed the quenching by titrating HSA and BSA solutions with sulpiride. Stern-Volmer graphs were plotted and quenching constants were estimated. Results showed that sulpiride form complexes with both albumins. Estimated association constants for the interaction sulpiride-HSA were 2.20 (±0.08) × 104 M(-1), at 37 °C, and 5.46 (±0.20) × 104 M(-1), at 25 °C. Those for the interaction sulpiride-BSA are 0.44 (±0.01) × 104 M(-1), at 37 °C and 2.17 (±0.04) × 104 M(-1), at 25 °C. The quenching intensity of BSA, which contains two tryptophan residues in the peptide chain, was found to be higher than that of HSA, what suggests that the primary binding site for sulpiride in albumin should be located next to the sub domain IB of the protein structure.