The effect of photobiomodulation therapy associated with casein phosphopeptide-amorphous calcium phosphate fluoride paste on the treatment of posthome whitening tooth sensitivity and color change: A randomized clinical trial.

OBJECTIVE: This study assessed whether combining photobiomodulation therapy (PBMT) with casein phosphopeptide-amorphous calcium phosphate fluoride (CPP-ACPF) paste can effectively reduce post-home whitening tooth sensitivity (TS) without compromising shade change. METHODS: Fifty participants were selected and assigned to one of four groups: (1) PLACEBO group-received a placebo paste and PBMT simulation; (2) PBMT group-received a placebo paste + PBMT; (3) CPP-ACPF group-received CPP-ACPF paste and PBMT simulation; (4) CPP-ACPF + PBMT group-received both CPP-ACPF paste and PBMT. The participants used whitening trays containing 22% carbamide peroxide for 2 h a day for 21 days. TS was measured daily using a visual analog scale, while shade change was assessed using a spectrophotometer: before bleaching treatment (T0), after the first (T1), second (T2), and third (T3) weeks of treatment, and 30 days (T4) after completing the whitening treatment. RESULTS: Intragroup analysis revealed that the PLACEBO group had the highest increase in sensitivity during the whitening treatment. The CPP-ACPF and PBMT groups showed no significant difference tooth whitening (TW) between weeks regarding aesthetic change. The CPP-ACPF and PBMT group exhibited a significant reduction in TS between the first and third and between the second and third weeks TW, but not between the first and second. Conversely, the PLACEBO group showed a higher sensitivity than the other groups (p < .05). The CPP-ACPF and PBMT groups did not differ from each other. Furthermore, the CPP-ACPF and PBMT group showed a greater decrease in sensitivity than the PLACEBO group at T1, T2, and T3 (p < .01), and was significantly differed from CPP-ACPF and PBMT groups only at T2 and T3. All groups confirmed TW effectiveness. Student's and paired t-test did not reveal any significant difference between groups (p > .05). CONCLUSION: Therefore, PBMT associated with CPP-ACPF paste can reduce TS without compromising the efficacy of TW.

Inflammatory Profile Associated with Secondary Infection from Bothrops atrox Snakebites in the Brazilian Amazon.

Bothrops snakebite envenomation (SBE) is consider an important health problem in Brazil, where Bothrops atrox is mainly responsible in the Brazilian Amazon. Local effects represent a relevant clinical issue, in which inflammatory signs and symptoms in the bite site represent a potential risk for short and long-term disabilities. Among local complications, secondary infections (SIs) are a common clinical finding during Bothrops atrox SBE and are described by the appearance of signs such as abscess, cellulitis or necrotizing fasciitis in the affected site. However, the influence of SI in the local events is still poorly understood. Therefore, the present study describes for the first time the impact of SBE wound infection on local manifestations and inflammatory response from patients of Bothrops atrox SBE in the Brazilian Amazon. This was an observational study carried out at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus (Brazil), involving victims of Bothrops SBE. Clinical and laboratorial data were collected along with blood samples for the quantification of circulating cytokines and chemokines before antivenom administrations (T0) and 24 h (T1), 48 h (T2), 72 h (T3) and 7 days after (T4). From the 94 patients included in this study, 42 presented SI (44.7%) and 52 were without SI (NSI, 55.3%). Patients classified as moderate envenoming presented an increased risk of developing SI (OR = 2.69; CI 95% = 1.08-6.66, p = 0.033), while patients with bites in hands showed a lower risk (OR = 0.20; CI 95% = 0.04-0.96, p = 0.045). During follow-up, SI patients presented a worsening of local temperature along with a sustained profile of edema and pain, while NSI patients showed a tendency to restore and were highlighted in patients where SI was diagnosed at T2. As for laboratorial parameters, leukocytes, erythrocyte sedimentation ratio, fibrinogen and C-reactive protein were found increased in patients with SI and more frequently in patients diagnosed with SI at T3. Higher levels of circulating IL-2, IL-10, IL-6, TNF, INF-γ and CXCL-10 were observed in SI patients along with marked correlations between these mediators and IL-4 and IL-17, showing a plurality in the profile with a mix of Th1/Th2/Th17 response. The present study reports for the first time the synergistic effects of local infection and envenoming on the inflammatory response represented by local manifestations, which reflected on laboratorial parameters and inflammatory mediators and thus help improve the clinical management of SI associated to Bothrops SBE.

Addressing a century-old hypothesis - do pioneer beetles of Ips typographus use volatile cues to find suitable host trees?

Global warming and more frequent climate extremes have caused bark beetle outbreaks of unprecedented scale of these insects in many conifer forests world-wide. Conifers that have been weakened by drought and heat or damaged by storms are highly susceptible to bark beetle infestation. A large proportion of trees with impaired defences provides good conditions for beetle population build-up of beetles, but mechanisms driving host search of pioneer beetles are still uncertain in several species, including the Eurasian spruce bark beetle Ips typographus. Despite a two-century-long history of bark beetle research, we still lack a sufficient understanding of interactions between I. typographus and its host Norway spruce (Picea abies) to forecast future disturbance regimes and forest dynamics. Depending on the scale (habitat or patch) and beetle population state (endemic or epidemic), host selection is likely driven by a combination of pre and postlanding cues, including visual selection or olfactory detection (kairomones). Here, we discuss primary attraction mechanisms and how volatile emission profiles of Norway spruce may provide cues on tree vitality and suitability for attacks by I. typographus, in particular during the endemic phase. We identify several crucial knowledge gaps and provide a research agenda addressing the experimental challenges of such investigations.

A randomized clinical study of the performance of self-etching adhesives containing HEMA and 10-MDP on non-carious cervical lesions: A 2-year follow-up study.

OBJECTIVE: To evaluate the association of HEMA and 10-MDP in the clinical performance of self-etching adhesives in the restoration of NCCLs during 2-years. MATERIALS AND METHODS: 60 restorations were performed in 17 volunteers and randomized into three groups: G1 (n = 20) - Prime and Bond Universal (10-MDP); G2 (n = 20) - Optibond All-in-One (HEMA); and G3 (n = 20) - Clearfil SE (10-MDP and HEMA). No cavity preparation was performed. After 2 years, the restorations were evaluated using the modified USPHS criteria for retention, marginal adaptation/ staining, postoperative sensitivity and secondary caries. The results were analyzed using Fisher's exact test and Kruskal-Wallis test. RESULTS: All groups showed 100% retention rate, except G1, who lost two restorations (p > 0.05). Regarding marginal adaptation, G1 showed greater deficiency, as only eight restorations (40%) remained intact (p < 0.05). Regarding marginal staining, G1 and G2 showed higher rate, as only 12 restorations (65%) in each one were free of staining (p < 0.05). All groups showed similar results for postoperative sensitivity and secondary caries (p > 0.05). CONCLUSION: The association of HEMA and 10-MDP monomers in the self-etching adhesives did not influence the clinical performance of the NCCL restorations with respect to retention, postoperative sensitivity, and incidence of secondary caries. However, positively influenced the marginal adaptation and marginal staining at the 2-year follow-up. CLINICAL SIGNIFICANCE: The association of HEMA and 10-MDP monomers in the self-etching adhesives positively influence the clinical performance of the NCCL restorations with respect to marginal adaptation and marginal staining.

FungalTraits vs. FUNGuild: Comparison of Ecological Functional Assignments of Leaf- and Needle-Associated Fungi Across 12 Temperate Tree Species.

Recently, a new annotation tool "FungalTraits" was created based on the previous FUNGuild and FunFun databases, which has attracted high attention in the scientific community. These databases were widely used to gain more information from fungal sequencing datasets by assigning fungal functional traits. More than 1500 publications so far employed FUNGuild and the aim of this study is to compare this successful database with the recent FungalTraits database. Quality and quantity of the assignment by FUNGuild and FungalTraits to a fungal internal transcribed spacer (ITS)-based amplicon sequencing dataset on amplicon sequence variants (ASVs) were addressed. Sequencing dataset was derived from leaves and needles of 12 temperate broadleaved and coniferous tree species. We found that FungalTraits assigned more functional traits than FUNGuild, and especially the coverage of saprotrophs, plant pathogens, and endophytes was higher while lichenized fungi revealed similar findings. Moreover, ASVs derived from leaves and needles of each tree species were better assigned to all available fungal traits as well as to saprotrophs by FungalTraits compared to FUNGuild in particular for broadleaved tree species. Assigned ASV richness as well as fungal functional community composition was higher and more diverse after analyses with FungalTraits compared to FUNGuild. Moreover, datasets of both databases showed similar effect of environmental factors for saprotrophs but for endophytes, unidentical patterns of significant corresponding factors were obtained. As a conclusion, FungalTraits is superior to FUNGuild in assigning a higher quantity and quality of ASVs as well as a higher frequency of significant correlations with environmental factors.

Prevalência de experiências traumáticas na infância entre usuários na atenção primária no centro-oeste do Brasil / Prevalence of traumatic childhood experiences in users of primary care in the midwest region of Brazil / Prevalencia de experiencias infantiles traumáticas entre usuarios en la atención primaria en centro-oeste de Brasil

Objetivo: analisar as experiências traumáticas na infância e sua associação com características sociodemográficas, da infância e da família de usuários da Atenção Primária de Saúde. Método: Estudo transversal com adultos atendidos nas unidades básicas de saúde de Cuiabá, MT. Utilizou-se um questionário autoaplicável e as experiências traumáticas foram avaliadas por meio do Questionário sobre Traumas na Infância (QUESI). Os testes Qui-quadrado e Exato de Fisher avaliaram a associação entre as variáveis. Resultados: Dos 463 entrevistados, 78,8% vivenciaram pelo menos um tipo de trauma na infância. Os abusos (físico, sexual e emocional) e negligência emocional estiveram associados a grande parte dos fatores relacionados à família e à infância. Conclusão: Evidenciou-se elevadas prevalências de abusos e negligências, mostrando-se associados a grande parte dos fatores relacionados à família e à infância em usuários da atenção primária da capital matogrossense e pouca distinção segundo características sociodemográficas (AU).

Objective: to analyze traumatic experiences in childhood and their association with sociodemographic, childhood and family characteristics of users of Primary Health Care. Method: Cross-sectional study with adults assisted at basic health units in Cuiabá, MT. A self-administered questionnaire was used, and traumatic experiences were assessed using the Childhood Trauma Questionnaire (QUESI). Chi-square and Fisher's exact tests assessed the association between variables. Results: Of the 463 respondents, 78.8% experienced at least one type of trauma in childhood. Abuse (physical, sexual and emotional) and emotional neglect were associated with most factors related to family and childhood. Conclusion: There was a high prevalence of abuse and neglect, being associated with most of the factors related to family and childhood in users of primary care in the capital of Mato Grosso and little distinction according to sociodemographic characteristics (AU).

Objetivo: analizar las experiencias traumáticas en la infancia y su asociación con las características sociodemográficas, infantiles y familiares de los usuarios de la Atención Primaria de Salud. Método: Estudio transversal con adultos en la unidades basicas de salud de Cuiabá, MT. Se utilizó un cuestionario autoadministrado y las experiencias traumáticas se evaluaron mediante el Cuestionario de Trauma Infantil. Las pruebas de chi-cuadrado y exacta de Fisher evaluaron la asociación entre variables. Resultados: De los 463 encuestados, el 78,8% experimentó al menos un tipo de trauma en la infancia. El maltrato (físico, sexual y emocional) y el abandono emocional se asociaron con la mayoría de los factores relacionados con la familia y la infancia. Conclusión: Hubo una alta prevalencia de maltrato y abandono, siendo asociado a factores relacionados con la familia y la infancia en los usuarios de la atención primaria de Cuiabá y poca distinción según las características sociodemográficas (AU).

Effect of 1.5% potassium oxalate on sensitivity control, color change, and quality of life after at-home tooth whitening: A randomized, placebo-controlled clinical trial.

OBJECTIVE: This clinical trial evaluated the effect of 1.5% potassium oxalate (PO) in controlling sensitivity and color change after at-home tooth whitening. It also evaluated the influence of PO on health-related quality of life (HRQoL) and the degree of patient satisfaction after bleaching treatment. MATERIALS AND METHODS: Fifty volunteers were randomized into two groups (n = 25): At-home bleaching gel with 22% carbamide peroxide for 45 min + placebo gel (GP) or 1.5% PO (GPO) for 10 min. The intensity of tooth sensitivity was assessed daily through the visual analog scale. The color analysis was performed three times: baseline, 21 days, and 1 month after the last application of the whitening gel. The impact of the oral condition on the patient's quality of life (OIDP) was used to measure the impact caused by the whitening treatment in relation to the individuals' ability to carry out their daily activities and its influence on HRQOL. RESULTS: No difference in tooth sensitivity was observed (p > 0.05). In addition, there was no difference in color change between groups (p > 0.05). However, there was an intragroup statistical difference throughout the evaluation period (p <0.05). The OIDP analysis showed a statistical difference between the groups (p > 0.05) and there was no difference between the groups regarding the degree of satisfaction with the bleaching (p > 0.05). CONCLUSIONS: The 1.5% PO was effective in preventing sensitivity and did not interfere with tooth whitening. Desensitizing therapy had a positive impact on quality of life and patient satisfaction.

A poisoned apple: First insights into community assembly and networks of the fungal pathobiome of healthy-looking senescing leaves of temperate trees in mixed forest ecosystem.

Despite the abundance of observations of foliar pathogens, our knowledge is severely lacking regarding how the potential fungal pathobiome is structured and which processes determine community assembly. In this study, we addressed these questions by analysing the potential fungal pathobiome associated with the senescing leaves and needles of 12 temperate tree species. We compared fungal plant pathogen load in the senescing leaves/needles and demonstrated that healthy-looking leaves/needles are inhabited by diverse and distinct fungal plant pathogens. We detected 400 fungal plant pathogenic ASVs belonging to 130 genera. The fungal plant pathogenic generalist, Mycosphaerella, was found to be the potential most significant contributor to foliar disease in seedlings. The analyses of assembly process and co-occurrence network showed that the fungal plant pathogenic communities in different tree types are mainly determined by stochastic processes. However, the homogenising dispersal highly contributes in broadleaf trees, whereas ecological drift plays an important role in coniferious trees. The deterministic assembly processes (dominated by variable selection) contributed more in broadleaf trees as compared to coniferous trees. We found that pH and P level significantly corresponded with fungal plant pathogenic community compositions in both tree types. Our study provides the first insight and mechanistic understanding into the community assembly, networks, and complete taxonomy of the foliar fungal pathobiome in senescing leaves and needles.

The Latin America Early Career Earth System Scientist Network (LAECESS): addressing present and future challenges of the upcoming generations of scientists in the region.

Early career (EC) Earth system scientists in the Latin America and the Caribbean region (LAC) have been facing several issues, such as limited funding opportunities, substandard scientific facilities, lack of security of tenure, and unrepresented groups equality issues. On top of this, the worsening regional environmental and climatic crises call for the need for this new generation of scientists to help to tackle these crises by increasing public awareness and research. Realizing the need to converge and step up in making a collective action to be a part of the solution, the Latin America Early Career Earth System Scientist Network (LAECESS) was created in 2016. LAECESS's primary goals are to promote regional networking, foster integrated and interdisciplinary science, organize soft skills courses and workshops, and empower Latin American EC researchers. This article is an initial step towards letting the global science community grasp the current situation and hear the early career LAC science community's perspectives. The paper also presents a series of future steps needed for better scientific and social development in the LAC region.

CCL-2 and CXCL-8: Potential Prognostic Biomarkers of Acute Kidney Injury after a Bothrops atrox Snakebite.

In the Brazilian Amazon, the snake Bothrops atrox is the primary cause of snakebites. B. atrox (BaV) venom can cause systemic pathophysiological changes such as acute kidney injury (AKI), which leads to the production of chemokines and cytokines in response to the envenomation. These soluble immunological molecules act by modulating the inflammatory response; however, the mechanisms associated with the development of AKI are still poorly understood. Here, we characterize the profile of these soluble immunological molecules as possible predictive biomarkers of the development of AKI. The study involved 34 patients who had been victims of snakebites by Bothrops sp. These were categorized into two groups according to the development of AKI (AKI(-)/AKI(+)), using healthy donors as the control (HD). Peripheral blood samples were collected at three-time points: before antivenom administration (T0) and at 24 and 48 hours after antivenom (T1 and T2, respectively). The soluble immunological molecules (CXCL-8, CCL-5, CXCL-9, CCL-2, CXCL-10, IL-6, TNF, IL-2, IL-10, IFN-γ, IL-4, and IL-17A) were quantified using cytometric bead array. Our results demonstrated an increase in CXCL-9, CXCL-10, IL-6, IL-2, IL-10, and IL-17A molecules in the groups of patients who suffered Bothrops snakebites (AKI(-) and AKI(+)) before antivenom administration, when compared to HD. In the AKI(+) group, levels of CXCL-8 and CCL-2 molecules were elevated on admission and progressively decreased during the clinical evolution of patients after antivenom administration. In addition, in the signature analysis, these were produced exclusively by the group AKI(+) at T0. Thus, these chemokines may be related to the initiation and extension of AKI after envenomation by Bothrops and present themselves as two potential biomarkers of AKI at T0.

Evaluation of the Bond Strength of Self-Etching Adhesive Systems Containing HEMA and 10-MDP Monomers: Bond Strength of Adhesives Containing HEMA and 10-MDP.

The aim of this in vitro study was to assess the bond strength of self-etching adhesives containing HEMA and 10-MDP monomers. Twenty-four bovine teeth were divided into three groups. Two cylinders of composite resin were made in each tooth (n = 16): G1-Prime and Bond Universal (control); G2-OptiBond All-in-One (HEMA); and G3-Clearfil SE (10-MDP and HEMA). After 24-hour storage in distilled water, the specimens were fixed to a universal testing machine (Kratos Equipamentos Ltda.) for the microshear test at a speed of 0.5 mm/min. A qualitative analysis of the fracture pattern was also performed using scanning electron microscopy (500× magnification). The normality of sample data distribution was determined using the Shapiro-Wilk test. The results were assessed using the Kruskal-Wallis test, and α level of 5% was used for the analysis. The results indicated a statistical difference (p > 0.05) between G3 (15.6080 MPa) and G2 (11.2180 MPa). No statistical difference was observed when G1 (14,6325 MPa) was compared with the other two groups. It was also observed that a mixed fracture pattern was predominant in all groups. The self-etching adhesive containing HEMA and 10-MDP monomers showed to be promising in increasing the bond strength between the dental substrate and the composite resin, whereas the adhesive containing only HEMA exhibited lower bond strength to dentin.

The CO2 record at the Amazon Tall Tower Observatory: A new opportunity to study processes on seasonal and inter-annual scales.

High-quality atmospheric CO2  measurements are sparse in Amazonia, but can provide critical insights into the spatial and temporal variability of sources and sinks of CO2 . In this study, we present the first 6 years (2014-2019) of continuous, high-precision measurements of atmospheric CO2 at the Amazon Tall Tower Observatory (ATTO, 2.1°S, 58.9°W). After subtracting the simulated background concentrations from our observational record, we define a CO2 regional signal ( ΔCO2obs ) that has a marked seasonal cycle with an amplitude of about 4 ppm. At both seasonal and inter-annual scales, we find differences in phase between ΔCO2obs and the local eddy covariance net ecosystem exchange (EC-NEE), which is interpreted as an indicator of a decoupling between local and non-local drivers of ΔCO2obs . In addition, we present how the 2015-2016 El Niño-induced drought was captured by our atmospheric record as a positive 2σ anomaly in both the wet and dry season of 2016. Furthermore, we analyzed the observed seasonal cycle and inter-annual variability of ΔCO2obs together with net ecosystem exchange (NEE) using a suite of modeled flux products representing biospheric and aquatic CO2 exchange. We use both non-optimized and optimized (i.e., resulting from atmospheric inverse modeling) NEE fluxes as input in an atmospheric transport model (STILT). The observed shape and amplitude of the seasonal cycle was captured neither by the simulations using the optimized fluxes nor by those using the diagnostic Vegetation and Photosynthesis Respiration Model (VPRM). We show that including the contribution of CO2 from river evasion improves the simulated shape (not the magnitude) of the seasonal cycle when using a data-driven non-optimized NEE product (FLUXCOM). The simulated contribution from river evasion was found to be 25% of the seasonal cycle amplitude. Our study demonstrates the importance of the ATTO record to better understand the Amazon carbon cycle at various spatial and temporal scales.

Serum From Preeclamptic Women Triggers Endoplasmic Reticulum Stress Pathway and Expression of Angiogenic Factors in Trophoblast Cells.

Preeclampsia (PE) is a hypertensive disease of pregnancy-associated with placental cell death and endoplasmic reticulum (ER) stress. It is unknown whether systemic factors aggravate placental dysfunction. We investigated whether serum factors in pregnant women with PE activate ER stress and unfolded protein responses (UPRs) in placental explants and trophoblast cells lineage. We cultured placental explants from third-trimester term placentas from control non-preeclamptic (NPE) pregnant women with serum from women with PE or controls (NPE). In PE-treated explants, there was a significant increase in gene expression of GADD34, CHOP, and SDF2. At the protein level, GRP78, SDF2, p-eIF2α, and p-eIF2α/eIF2α ratio were also augmented in treated explants. Assays were also performed in HTR8/SV-neo trophoblast cell line to characterize the putative participation of trophoblast cells. In PE serum-treated protein levels of p-eIF2a and the ratio p-elF2 α/elF2α increased after 12 h of treatment, while the gene expression of GADD34, ATF4, and CHOP was greater than control. Increased expression of SDF2 was also detected after 24 h-cultured HTR8/SV-neo cells. PE serum increased sFLT1 gene expression and decreased PlGF gene expression in placental explants. Morphologically, PE serum increased the number of syncytial knots and reduced placental cell metabolism and viability. Analysis of the serum of pregnant women with PE through Raman spectroscopy showed changes in amino acids, carotenoids, lipids, and DNA/RNA, which may be associated with the induction of ER stress found in chorionic villi treated with this serum. In conclusion, this study provides evidence that the serum of pregnant women with PE may impact placental villi changing its morphology, viability, and secreted functional factors while triggers ER stress and an UPR. The differences between PE and control sera include molecules acting as inducing factors in these processes. In summary, the results obtained in our assays suggest that after the development of PE, the serum profile of pregnant women may be an additional factor that feeds a continuous imbalance of placental homeostasis. In addition, this study may expand the possibilities for understanding the pathogenesis of this disorder.

Bleeding Disorders in Bothrops atrox Envenomations in the Brazilian Amazon: Participation of Hemostatic Factors and the Impact of Tissue Factor.

Bleeding is a common hemostatic disorder that occurs in Bothrops envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in Bothrops atrox envenomations with bleeding. This is an observational study with B. atrox snakebite patients (n = 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (n = 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (n = 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of B. atrox envenomations with systemic bleeding due to tissue factor release.

Amazonian biogenic volatile organic compounds under global change.

Biogenic volatile organic compounds (BVOCs) play important roles at cellular, foliar, ecosystem and atmospheric levels. The Amazonian rainforest represents one of the major global sources of BVOCs, so its study is essential for understanding BVOC dynamics. It also provides insights into the role of such large and biodiverse forest ecosystem in regional and global atmospheric chemistry and climate. We review the current information on Amazonian BVOCs and identify future research priorities exploring biogenic emissions and drivers, ecological interactions, atmospheric impacts, depositional processes and modifications to BVOC dynamics due to changes in climate and land cover. A feedback loop between Amazonian BVOCs and the trends of climate and land-use changes in Amazonia is then constructed. Satellite observations and model simulation time series demonstrate the validity of the proposed loop showing a combined effect of climate change and deforestation on BVOC emission in Amazonia. A decreasing trend of isoprene during the wet season, most likely due to forest biomass loss, and an increasing trend of the sesquiterpene to isoprene ratio during the dry season suggest increasing temperature stress-induced emissions due to climate change.

Effect of nanohydroxyapatite associated with photobiomodulation in the control of dentin hypersensitivity: A randomized, double-blind, placebo-controlled clinical trial.

PURPOSE: To evaluate the effect of nanohydroxyapatite ( nHAP) associated with photobiomodulation (PBM) in the control of dentin hypersensitivity (DH). (C-Shape It). METHODS: 32 subjects with 83 hypersensitive teeth were randomized into four groups (N =8) : GPlacebo - simulated PBM (without light emission) followed by the application of nHAP-free toothpaste; GLaser - PBM followed by the application of nHAP-free toothpaste; GnHAP - simulated PBM followed by the application of nHAP; GLasernHAP - PBM followed by the application of nHAP. A visual analogue scale (VAS) was used to measure DH after a tactile and evaporative stimulus. DH evaluations were performed at four times: baseline, 1st, and 2nd treatment sessions, and 1 month. A questionnaire was used to evaluate the risk factors associated with DH intensity. Mixed-design ANOVA followed by Tukey test and logistic regression were used. RESULTS: The mechanical stimulus showed a significant reduction in DH in all experimental groups (P< 0.05) at the 2nd treatment session. For the evaporative stimulus, the GLasernHAP group presented a significant reduction in DH at the 1st treatment session (P< 0.05). Intragroup analysis showed that only the GnHAP group showed regression of DH at 1 month for the two applied stimuli. The variables of parafunctional habits, diets rich in acidic drinks and anxiety had significant relationships with the intensity of DH (P< 0.05). CLINICAL SIGNIFICANCE: The use of nHAP and application of PBM to laser are effective in the control of dentin hypersensitivity. However, their association did not enhance the desensitizing effect.

Snakebite envenomation in the Brazilian Amazon: a cost-of-illness study.

BACKGROUND: Snakebites account for significant morbidity and mortality. Their occurrence in the Brazilian Amazon warrants an analysis that will enable better understanding of their economic impact and thus contribute to their management and prevention. This study aimed to estimate the cost of snakebite envenomation in the Brazilian Amazon in 2015. METHODS: We conducted a cost-of-illness study of snakebite in the Brazilian Amazon in 2015 based on official surveillance data to estimate burden from a societal, patient and public health system perspective. Direct medical costs were estimated via a top-down approach. Loss of productivity was estimated by a human capital approach. RESULTS: The study included 11 503 cases and 56 deaths. The estimated cost to the health system was US$3.115.861,28. The estimated cost due to premature death caused by snakebite was US$3031 300.38. The cost attributed to the loss of productivity due to absence from work was US$1539 518.62. The estimated cost from the patient's perspective was US$268 914.18. Therefore the total cost of snakebite in the Brazilian Amazon was estimated to be almost than US$8 million in 2015. CONCLUSIONS: The economic burden of snakebite in Brazilian Amazon is notably high. Snakebites cause loss of productivity through inpatient treatment or deaths.

Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy.

Introduction:Bothrops atrox snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in Bothrops snakebite patients after being given antivenom therapy.Methods: This is a prospective study of Bothrops snakebite patients (n = 100) treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48 h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up.Results: On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12 h after the antivenom therapy. Three patients developed systemic bleeding 48 h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48 h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24 h after antivenom therapy, and decreased on discharge. Bothrops venom levels in patients decreased 12 h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths.Conclusion: Laboratorial parameters of coagulopathy returned to normal values within 48 h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48 h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.

Bleeding disorders in bothrops atrox envenomations in the Brazilian Amazon: participation of hemostatic factors and the impact of tissue factor

Bleeding is a common hemostatic disorder that occurs in Bothrops envenomations. We evaluated the changes in coagulation, fibrinolysis components, and platelets in Bothrops atrox envenomations with bleeding. This is an observational study with B. atrox snakebite patients (n = 100) treated in Manaus, Brazilian Amazon. Bleeding was recorded on admission and during hospitalization. We found that the platelet count in our patients presented a weak correlation to tissue factor, factor II, and plasminogen. Tissue factor presented weak correlation to factor V, II, D-dimer, plasminogen, alpha 2-antiplasmin, and moderate correlation to fibrinogen and fibrin/fibrinogen degradation product (FDP). Patients with systemic bleeding (n = 20) presented low levels of factor V, II, fibrinogen, plasminogen, and alpha 2-antiplasmin, and high levels of tissue factor and FDP compared to those without bleeding. Patients with only local bleeding (n = 41) and without bleeding showed similar levels of hemostatic factors. Thrombocytopenia was observed mainly in patients with systemic bleeding and increased levels of serum venom. No association was found between venom levels and systemic bleeding, or between venom levels and clinical severity of envenomation. This is the first report that shows the participation of the extrinsic coagulation pathway in the consumption coagulopathy of B. atrox envenomations with systemic bleeding due to tissue factor release.

Bothrops snakebites in the Amazon: recovery from hemostatic disorders after Brazilian antivenom therapy

Introduction: Bothrops atrox snakebites are a major public health problem in the Amazon region and also cause hemostatic disorders. In this study, we assessed the recovery from hemostatic disorders in Bothrops snakebite patients after being given antivenom therapy. Methods: This is a prospective study of Bothrops snakebite patients (n=100) treated at the Fundação de Medicina Tropical Dr. Heitor Vieira Dourado, Manaus, Brazilian Amazon, between January 2016 and December 2017. Blood samples were taken for the measurement of venom concentrations, platelets, clotting time and factors of patients on admission, 12, 24 and 48h after antivenom therapy, and taken again on discharge. The presence of systemic bleeding was recorded during the follow-up. Results: On admission, systemic bleeding was observed in 14% of the patients. Thrombocytopenia was noted in 10% of the patients. A total of 54% of the patients presented unclottable blood with low levels of fibrinogen and alpha 2-antiplasmin, and high levels of fibrin/fibrinogen degradation product (FDP) and D-dimers. Unclottable blood and systemic bleeding were overcome in most patients 12h after the antivenom therapy. Three patients developed systemic bleeding 48h after antivenom therapy. Levels of fibrinogen and alpha 2-antiplasmin, FDP and D-dimer returned to normal around 48h after the treatment or on discharge. The frequency of thrombocytopenia with high mean platelet volume increased in the first 24h after antivenom therapy, and decreased on discharge. Bothrops venom levels in patients decreased 12h after antivenom therapy and were not correlated with coagulation and fibrinolytic parameters. There were no deaths. Conclusion: Laboratorial parameters of coagulopathy returned to normal values within 48h after the antivenom therapy until discharge. A few patients still presented bleeding signs within 48h after beginning antivenom therapy. However, the Brazilian antivenom was able to overcome the hemostatic disorders in these cases of envenomation.