The Assessment of Resin-Based Composite Sealants' Effectiveness in Arresting Non-Cavitated Dentin Carious Lesions (ICDAS 3)-A 12 Month Follow-Up Preliminary Study.

Background and Objectives: The therapeutic management of carious lesions remains a significant focus for researchers, given their persistently high prevalence despite being largely preventable. This study aimed to compare the effectiveness of a composite resin-based sealant material in halting extended non-cavitated dentin carious lesions when used therapeutically versus preventively on caries-free teeth over a period of twelve months. Materials and Methods: out of the 236 children examined, 45 were excluded from the study due to non-compliance with the inclusion criteria. Thus, the study included 191 children aged 10-12 years, and 764 molars in total. Results: among these molars, 171 were caries-free (ICDAS II code 0), forming the Control group, while 180 molars were classified with an ICDAS II score of 3, forming the Study group. All molars were sealed and evaluated at 6- and 12-month follow-up intervals. Both intervals revealed statistically significant differences (p < 0.05) in sealant retention and carious lesion development between sound (ICDAS code 0) and decayed (ICDAS code 3) teeth. Conclusions: the findings did not support the effectiveness of sealants in halting non-cavitated dentin carious lesions classified as ICDAS II with code 3 compared to their preventive application in sound teeth classified as ICDAS II with code 0.

Electrocardiogram Features in Non-Cardiac Diseases: From Mechanisms to Practical Aspects.

Despite the noteworthy advancements and the introduction of new technologies in diagnostic tools for cardiovascular disorders, the electrocardiogram (ECG) remains a reliable, easily accessible, and affordable tool to use. In addition to its crucial role in cardiac emergencies, ECG can be considered a very useful ancillary tool for the diagnosis of many non-cardiac diseases as well. In this narrative review, we aimed to explore the potential contributions of ECG for the diagnosis of non-cardiac diseases such as stroke, migraine, pancreatitis, Kounis syndrome, hypothermia, esophageal disorders, pulmonary embolism, pulmonary diseases, electrolyte disturbances, anemia, coronavirus disease 2019, different intoxications and pregnancy.

Distinct Features of Vascular Diseases in COVID-19.

The Coronavirus Disease 2019 (COVID-19) pandemic was declared in early 2020 after several unexplained pneumonia cases were first reported in Wuhan, China, and subsequently in other parts of the world. Commonly, the disease comprises several clinical features, including high temperature, dry cough, shortness of breath, and hypoxia, associated with findings of interstitial pneumonia on chest X-ray and computer tomography. Nevertheless, severe forms of acute respiratory syndrome-related coronavirus 2 (SARS-CoV-2) are not limited to the respiratory tract but also may be extended to other systems, including the cardiovascular system. The bi-directional relationship between atherosclerosis and COVID-19 is accompanied by poor prognosis. The immune response hyperactivation due to SARS-CoV-2 infection causes an increased secretion of cytokines, endothelial dysfunction, and arterial stiffness, which promotes the development of atherosclerosis. Also, due to the COVID-19 pandemic, access to healthcare amenities was reduced, resulting in increased morbidity and mortality in patients at risk. Furthermore, as lockdown measures were largely adopted worldwide, the sedentary lifestyle and the increased consumption of processed nutrients or unhealthy food increased, and in the consequence, we might observe even 70% of overweight and obese population. Altogether, with the relatively low ratio of vaccinated people in many countries, and important health debt appeared, which is now and will be for next decade a large healthcare challenge. However, the experience gained in the COVID-19 pandemic and the new methods of patients' approaching have helped the medical system to overcome this crisis and will hopefully help in the case of new possible epidemics.

Severe Intentional Corrosive (Nitric Acid) Acute Poisoning: A Case Report and Literature Review.

Despite being one of the most debilitating conditions encountered in the field of toxicology, there is a lack of neutralization measures for the toxins involved in acute corrosive poisoning, and this promotes progressive contact injury of deep tissues after poisoning has occurred. Multiple controversies still surround management strategies during the acute phase of poisoning and the long-term follow-up of the patient. Here, we report a severe case of intentional poisoning with nitric acid complicated by extensive injury of the upper digestive tract, multiple stricture formation, and complete dysphagia. Serial endoscopic dilation and insertion of a jejunostomy feeding tube were necessary, and underlying psychiatric illness negatively affected the outcome of the patient. We conclude that an interdisciplinary approach is necessary to properly reduce the extent of lesions and sequelae induced by corrosion. Early endoscopic mapping of injuries is of major importance to better predict the evolution and possible complications of poisoning. Interventional and reconstructive surgical procedures may significantly improve the life expectancy and quality of life of patients following intoxication with corrosive substances.

The "Viral" Form of Polyarteritis Nodosa (PAN)-A Distinct Entity: A Case Based Review.

Classic polyarteritis nodosa (PAN) is a vasculitis with systemic manifestations that is characterized by inflammatory and necrotizing lesions affecting medium and small muscular arteries, most frequently at the bifurcation of the vessels. These lesions lead to the formation of microaneurysms, hemorrhaging ruptured aneurysms, thrombosis, and, consequently, ischemia or organ infarction. Background and Objectives: We present a complex clinical case of a patient with a late diagnosis of polyarteritis nodosa with multiorgan involvement. Materials and Methods: The 44-year-old patient, in an urban environment, presented on her own in the emergency room for acute ischemia phenomena and forearm and right-hand compartment syndrome, requiring surgical decompression in the Plastic Surgery Clinic. Results: Significant inflammatory syndrome is noted, alongside severe normocytic hypochromic iron deficiency anemia, nitrogen retention syndrome, hyperkalemia, hepatic syndrome, and immunological disturbances: absence of cANCA, pANCA, anti Scl 70 Ac, antinuclear Ac, and anti dDNA Ac, as well as a low C3 fraction of the plasmatic complement system. The morphological aspect described in the right-hand skin biopsy correlated with the clinical data supports the diagnosis of PAN. Conclusions: The viral form of PAN seems to be individualized as a distinct entity, requiring early, aggressive medication.

Native and Prosthetic Simultaneously Double Valve Infective Endocarditis with Enterococcus faecalis-Case-Based Review.

Infective endocarditis is a severe infective heart disease, commonly involving native or prosthetic valves. It frequently presents with univalvular involvement and simultaneous double valve or multivalvular involvement is rarely described. The third leading cause of infective endocarditis worldwide is Enterococcus faecalis, which is associated with high mortality rates despite important advances in antimicrobial therapy. It develops secondary to enterococcal bacteremia, with its origin from the gastrointestinal or genitourinary tract and predominantly affecting the elderly population with multiple comorbidities. Clinical presentation is usually less typical, and the treatment is challenging. It can be marked by antibiotic resistance, side effects, and subsequent complications. Surgical treatment can be considered if deemed appropriate. To the best of our knowledge, we present the first case-based narrative review of Enterococcus faecalis double valve endocarditis involving both the aortic native and prosthetic mitral valve, highlighting the clinical characteristics, treatment, and complications of this condition.

Management of Hyponatremia in Heart Failure: Practical Considerations.

Hyponatremia is commonly encountered in the setting of heart failure, especially in decompensated, fluid-overloaded patients. The pathophysiology of hyponatremia in patients with heart failure is complex, including numerous mechanisms: increased activity of the sympathetic nervous system and the renin-angiotensin-aldosterone system, high levels of arginine vasopressin and diuretic use. Symptoms are usually mild but hyponatremic encephalopathy can occur if there is an acute decrease in serum sodium levels. It is crucial to differentiate between dilutional hyponatremia, where free water excretion should be promoted, and depletional hyponatremia, where administration of saline is needed. An inappropriate correction of hyponatremia may lead to osmotic demyelination syndrome which can cause severe neurological symptoms. Treatment options for hyponatremia in heart failure, such as water restriction or the use of hypertonic saline with loop diuretics, have limited efficacy. The aim of this review is to summarize the principal mechanisms involved in the occurrence of hyponatremia, to present the main guidelines for the treatment of hyponatremia, and to collect and analyze data from studies which target new treatment options, such as vaptans.

Clinical and Pathological Manifestation of the Oral Mucosa in Institutionalized Children from Romania.

Institutionalized children, regardless of their age, are prone to psychiatric disorders, compared to those who live in two-parent families, due to the unfavorable physical and psychological conditions in which they develop. Unpropitious psychological conditions affect the child's general health and induce local manifestations that can be found in the oral cavity, affecting both soft tissues and teeth. Therefore, the purpose of our study was to assess and diagnose a series of pathological manifestations of the oral mucosa associated with poor living conditions or closely related to psychological stress. The clinical examination was performed by 4 specialist dentists, who consulted 150 children representing the study group and 52 children representing the control group, all having ages between 14 and 18 years old and meeting the same inclusion criteria. From the control group, 62.5% presented plaque-induced gingivitis (26.6% girls, 35.8% boys), 26.6% presented mucosal lesions produced by lip and cheek biting (23.3% girls, 35.8% boys), and 11.7% presented geographic tongue (6.6% girls, 5% boys), herpes simplex eruptions (3.3% girls, 4.2% boys) and oral ulcerations (12.5% girls, 10.8% boys). Morsicatio buccarul is a chronic, self-mutilating habit, currently becoming one of the most common tics encountered among institutionalized children. Furthermore, these children do not benefit from constant support and guidance to perform their dental hygiene, so the incidence of gingivitis induced by bacterial plaque and calculus is very high.

The Value of Early and Follow-Up Elevated Scores Based on Peripheral Complete Blood Cell Count for Predicting Adverse Outcomes in COVID-19 Patients.

Background: The ongoing COVID-19 pandemic has put a constant strain on hospital resources, so there is a dire need for investigation methods that are widely available and that can predict mortality and the need for critical care. Hematological indices, which can be easily calculated from a complete blood count (CBC), are useful in determining a patient's inflammatory response to infectious diseases. Aim: This was a prospective cohort study that aimed to assess the prognostic value of scores based on CBCs in hospitalized patients with mild or moderate COVID-19 and medical comorbidities regarding the need for intensive care unit (ICU) therapy and short-term mortality. Methods: We included 607 patients with confirmed COVID-19, followed up for the need for ICU admission (15.5%) and 30 day mortality post-discharge (21.7%). CBC-derived scores were tested upon emergency department (ED) admission and after a median of 8 days. Results: In a multivariate model, elevated followed-up neutrophil-to-lymphocyte ratio (NLR) predicted increased odds for ICU admission (OR: 1.14 [95%CI: 1.06−1.22], p < 0.001) and short-term mortality (OR: 1.30 [95%CI: 1.09−1.57], p = 0.005). Monocyte-to-lymphocyte ratio (MLR) predicted 2.5-fold increased odds for ICU admission and 2.2-fold increased odds for mortality. Conclusion: NLR and MLR followed up 8 days post-admission are predictive for adverse outcomes in mild or moderate COVID-19 patients.

Recognition and Management of Serotonin Toxidrome in the Emergency Department-Case Based Review.

Serotonin syndrome (SS) is a clinical toxidrome with high variability in clinical practice. It develops due to increased serotonin levels in the central nervous system. With an underestimated frequency, SS can develop following an overdose, a therapeutic dose increase, or drug to drug interaction of at least one serotonergic agent. It can present with autonomic signs, neuromuscular changes and an altered mental status. However, history and clinical examination are key features to formulate the diagnosis. Treatment options consist of supportive measures, discontinuation of the offending agent and certain therapeutic agents previously reported to improve outcomes. Physicians have limited experience with SS, partially due to the lack of its identification in clinical practice. Therefore, we have integrated, in a narrative review, the case of a young male with SS following an atypical antipsychotic overdose superimposed on chronic treatment with agents previously known to produce SS.

Cardiac Biomarkers and Risk Scores in Relation with History of Atherosclerotic Cardiovascular Disease in Patients Admitted with COVID-19: The Experience of an Eastern European Center.

BACKGROUND: Data regarding the combined prognostic role of biomarkers and risk scores in relation with the history of atherosclerotic cardiovascular disease (ASCVD) in COVID-19 patients are lacking. METHODS: The aim of this observational cohort study was to evaluate the combined prognostic value of N-terminal pro B-type natriuretic peptide (NT-pro BNP), troponin and risk scores in relation with ASCVD history in hospitalized COVID-19 patients. The primary composite endpoint was Intensive Care Unit (ICU) admission and death. RESULTS: From April 2020 to June 2022, 1066 consecutive COVID-19 patients with available biomarkers upon admission were included. During a median follow-up period of 12 days, 176 patients (16.5%) died. Independent predictors of ICU admission and death in patients with ASCVD were NT-pro BNP (HR 2.63; 95% CI, 1.65-4.18) and troponin (HR 1.51; 95% CI, 1.13-2.03). In patients without ASCVD, only NT-pro BNP was predictive for the primary endpoint (HR 1.66; 95% CI, 1.10-2.53). This remained significant after adjustment for other relevant covariates (HR 3.54; 95% CI, 1.98-6.33) in patients with ASCVD and in patients without ASCVD (HR 1.82; 95% CI, 1.02-3.26). CONCLUSIONS: These data showed the combined prognostic accuracy of NT-pro BNP and troponin in relation with ASCVD history for ICU admission and death in COVID-19 patients.

Rare Causes of Acute Coronary Syndrome: Carbon Monoxide Poisoning.

Acute coronary syndrome (ACS) is a spectrum of clinical and paraclinical disorders arising from an imbalance of oxygen demand and supply to the myocardium. The most common cause is atherosclerosis; however, other rare causes such as carbon monoxide (CO) poisoning should be considered. Through tissue hypoxia and direct cell injury, CO poisoning can lead to a broad spectrum of cardiac disorders, especially ACS. Materials and Methods. We have conducted a retrospective study in the Toxicology Department of Saint Spiridon Emergency University Hospital, including all patients admitted through the emergency department with CO poisoning. We divided the cohort into event group (myocardial injury) and non-event group (patients without myocardial injury) and performed a subset analysis of the former. Results. A total of 65 patients were included, 22 in the event and 43 in the non-event group. The severity of poisoning did not correlate with myocardial injury; however, 50% of the event group had severe poisoning with carboxyhaemoglobin ≥ 20%. Cardiac enzyme markers (troponin and creatin-kinase MB) had a statistically significant increase in the event group compared to the non-event group (p < 0.05). Most of the patients in the STEMI (50%) and NSTEMI (66.7%) groups had severe CO intoxication. The STEMI group had a mean age of 27.7 years old and no comorbidities. Conclusions. Myocardial injury can develop in CO poisoning irrespective of the severity of poisoning, and it can be transient, reversible, or permanent. Our study introduces new information on adverse cardiac events in patients with CO poisoning, focusing on the ACS. We found that the severity of CO poisoning plays an important role in developing myocardial injury, as 50% of patients in the event group were severely intoxicated. While in-hospital mortality in our study was low, further prospective studies should investigate the long-term mortality in these patients.

The Value of Troponin as a Biomarker of Chemotherapy-Induced Cardiotoxicity.

In cancer survivors, cardiac dysfunction is the main cause of mortality. Cardiotoxicity represents a decline in cardiac function associated with cancer therapy, and the risk factors include smoking, dyslipidemia, an age of over 60 years, obesity, and a history of coronary artery disease, diabetes, atrial fibrillation, or heart failure. Troponin is a biomarker that is widely used in the detection of acute coronary syndromes. It has a high specificity, although it is not exclusively associated with myocardial ischemia. The aim of this paper is to summarize published studies and to establish the role of troponin assays in the diagnosis of cardiotoxicity associated with various chemotherapeutic agents. Troponin has been shown to be a significant biomarker in the diagnosis of the cardiac dysfunction associated with several types of chemotherapeutic drugs: anthracyclines, anti-human epidermal growth factor receptor 2 treatment, and anti-vascular endothelial growth factor therapy. Based on the data available at this moment, troponin is useful for baseline risk assessment, the diagnosis of cardiotoxicity, and as a guide for the initiation of cardioprotective treatment. There are currently clear regulations regarding the timing of troponin surveillance depending on the patient's risk of cardiotoxicity and the type of medication administered, but data on the cut-off values of this biomarker are still under investigation.

A Rare Case of Undifferentiated Pleomorphic Cardiac Sarcoma with Inflammatory Pattern.

Cardiac undifferentiated pleomorphic sarcoma (UPS) associated with fever and inflammatory response is an extremely rare condition. Herein, we report a rare case of cardiac UPS with unusual clinical presentation and inflammatory response. A 67-year-old male complaining of progressive dyspnea and intermittent fever of unknown cause was referred to our hospital for surgical resection of a left atrial mass. Laboratory analysis showed leukocytosis (26 × 103/µL) and high C-reactive protein (CRP) levels (155.4 mg/L). Hemoculture tests and urine analysis were negative for infection. A contrast chest computed tomography revealed a mass measuring 5.5 × 4.5 cm, occupying the left atrium cavity. The patient underwent surgical excision of the mass, however, surgical margin of the resected tumor could not be evaluated, due to the multifragmented nature of the resection specimen. Postoperative CRP and leukocyte levels normalized, highlighting the relationship between the tumor and the inflammatory status. Early diagnosis is crucial for a proper management and favorable outcome, enabling patients to undergo chemotherapy and achieve complete surgical resection.

Severe Coronary Artery Vasospasm after Mitral Valve Replacement in a Diabetic Patient with Previous Stent Implantation: A Case Report.

Postoperative coronary vasospasm is a well-known cause of angina that may lead to myocardial infarction if not treated promptly. We report a case of a 70-year-old female with severe mitral regurgitation submitted to mitral valve replacement, and a history of diabetes mellitus type II, stroke, idiopathic thrombocytopenic purpura on steroid therapy, and previous percutaneous coronary intervention (PCI) for severe obstruction of the circumflex coronary artery, 4 months prior to surgery. Immediately after intensive care unit admission, the patient developed pulseless electrical activity which required extracorporeal membrane oxygenation for hemodynamic support. The coronary angiography showed diffuse occlusive coronary artery vasospasm, ameliorated after intra-coronary administration of nitroglycerin. The following postoperative evolution was marked by cardiogenic shock and multiple organ dysfunction syndrome. Subsequent echocardiographic findings showed an increase in left ventricular function with an EF of 40%, and extracorporeal membrane oxygenation (ECMO) support was weaned after seven days. However, after a few hours, the patient progressively deteriorated, with cardiac arrest and no response to resuscitation maneuvers. Hemodynamic instability following the surgical procedure in a patient with previous PCI associated with an autoimmune disease and diabetes mellitus should raise the suspicion of a coronary artery vasospasm.

The Assessment of Early Server Childhood Caries Status in Abandoned Institutionalized Children.

Oral health is a critical indicator of children's quality of life, which at this early age, depends exclusively on the attention, involvement, and guidance of parents or caregivers. Assessing carious damage and measuring the prevalence of early severe tooth decay in temporary teeth in children is obtained by calculating the dmft index, giving the sum of an individual's decayed, missing, and filled teeth. The aim of our study was to conduct a clinical examination of the oral status of institutionalized children from Romania. We selected and included in the study 144 children, both boys and girls in equal number, with ages of five or six years old, from which 110 were eligible for the study and met the inclusion criteria. Of all children, 20.90% were five years old girls, 27.27% five years old boys, 26.36% six years old girls, and 25.46% six years old boys. Of all, 10,45% had more than three incisors presenting decays, equally affected by gender. Of the boys' group, 20% of age six had more de two canines affected, and 26.7% of five years old girls had more than three affected canines. Of the five years boys' group, 24.3% had more than three affected temporary molars, 44.9% of six years boys had more than five. Of the five years old girls, 33.3% had more than four temporary molars affected and, 56.6% of the six years old girls' group had more than five molars presenting carious lesions. The dental status and dmft values were similar for five years old and six years old children and similar boys and girls. Due to the vulnerability of young children that consists not only in their inability to identify, express, and address their own needs but also the lack of parental support, lack of an optimal diet for age, and proper hygiene, they reach adolescence with an impaired dental status, inappropriate for their age.

Inflammatory and Cardiac Biomarkers in Relation with Post-Acute COVID-19 and Mortality: What We Know after Successive Pandemic Waves.

BACKGROUND: Biomarkers were correlated with mortality in critically ill COVID-19 patients. No prediction tools exist for noncritically ill COVID-19 patients. We aimed to compare the independent prognostic value of inflammation and cardiac biomarkers for post-acute COVID-19 patients and the 30-day mortality rate in noncritically ill COVID-19 patients, as well as the relation with the virus variant involved. METHODS: This observational cohort study was conducted at an emergency clinical hospital between 1 October 2020 and 31 December 2021. We included consecutive patients with biomarkers determined within 24 h of presentation, followed up at least 30 days postdischarge. RESULTS: Post-acute COVID-19 was diagnosed in 20.3% of the cases and the all-cause 30-day mortality rate was 35.1% among 978 patients infected with variants of concern. Neutrophil-to-lymphocyte ratio (1.06 [95%CI, 1.01-1.11], p = 0.015) and NT-pro BNP were correlated with 30-daymortality, while the monocyte-to-lymphocyte ratio (2.77 [95%CI, 1.10-6.94], p = 0.03) and NT-pro BNP (1.68 [95%CI, 1.00-2.84], p = 0.05) were correlated with post-acute COVID-19. High-sensitivity to troponin was associated with 30-day mortality (1.55 [95%CI, 1.00-2.42], p = 0.05). A Cox proportional-hazards model confirmed that NT-pro BNP was independently associated with mortality. NT-pro BNP remained independently associated with 30-day mortality during follow-up (1.29 [95%CI, 1.07-1.56], p = 0.007) after adjustment for confounders. CONCLUSION: Inflammation and cardiac biomarkers, determined upon admission and predischarge, in a cohort of hospitalized noncritically ill COVID-19 patients throughout successive pandemic waves, showed a predictive value for post-acute COVID-19 and 30-day mortality.

Theoretical and Practical Aspects in the Use of Bretschneider Cardioplegia.

The race for an ideal cardioplegic solution has remained enthusiastic since the beginning of the modern cardiac surgery era. The Bretschneider solution, belonging to the "intracellular cardioplegic" group, is safe and practical in myocardial protection during ischemic time. Over time, some particular concerns have arisen regarding the effects on cardiac metabolism and postoperative myocardial functioning. This paper reviews the most important standpoints in terms of theoretical and practical analyses.

Comparative Assessment of Retention and Caries Protective Effectiveness of a Hydrophilic and a Conventional Sealant-A Clinical Trial.

Sealants are highly efficient and the most secure method for the prevention of caries lesions from pits and fissures in recently erupted permanent teeth. The aim of this study is to clinically assess and compare the retention and evolution of caries of a moisture-tolerant resin-based sealant with a conventional hydrophobic resin-based sealant. Material and method: We have included in the study 28 children with between 6 and 8 years old. For each child we sealed 4 permanent molars (a total of 112 teeth). The study group was divided into two subgroups: the Embrace Group­consisting of 56 first permanent molars that underwent dental sealing with moisture-tolerant resin-based fissure sealant (Embrace™ WetBond™ Pulpdent, Watertown, MA, USA) and the Helioseal Group­represented by the same number of 56 first permanent molars that were sealed with conventional hydrophobic resin-based sealant (Helioseal F™, Ivoclar Vivadent Schaan, Liechtenstein). The retention and the incidence of new carious lesions of each sealant were assessed clinically at 6, 12, 18, and 24 months. Results: The 12-month follow-up assessment showed perfect integrity in 50 molars (89.28%) sealed with moisture-tolerant resin-based material (Embrace Group), and in 51 molars (91.07%) with conventional resin-based sealant (Helioseal Group). At the 24-month recall, the retention was maintained in 44 molars (78.57%) in the Embrace Group and in 45 molars (80.35%) in the Helioseal Group, respectively. The follow-up assessments showed no statistically significant differences (p > 0.5) between the two materials regarding sealant retention. First evidence of new carious lesions was present at 12 months on two molars sealed with Embrace WetBond and on one molar sealed with Helioseal. At the 24-month evaluation, the prevalence of caries in the Embrace Group was 7.14% (four caries) and 3.56% (two caries) in the Helioseal Group. Moreover, there were no statistically significant differences (p > 0.05) between the two materials regarding new caries development at any of the follow-up assessments. Conclusions: Moisture-tolerant resin-based sealant was effective in terms of retention and caries prevention.

Fly-Ash Evaluation as Potential EOL Material Replacement of Cement in Pastes: Morpho-Structural and Physico-Chemical Properties Assessment.

The main objective of the study was to produce alternative binder materials, obtained with low cost, low energy consumption, and low CO2 production, by regenerating end-of-life (EOL) materials from mineral deposits, to replace ordinary Portland cement (OPC). The materials analyzed were ash and slag from the Turceni thermal power plant deposit, Romania. These were initially examined for morphology, mineralogical composition, elemental composition, degree of crystallinity, and heating behavior, to determine their ability to be used as a potential source of supplementary cementitious materials (SCM) and to establish the activation and transformation temperature in the SCM. The in-situ pozzolanic behavior of commercial cement, as well as cement mixtures with different percentages of ash addition, were further observed. The mechanical resistance, water absorption, sorptivity capacity, resistance to alkali reactions (ASR), corrosion resistance, and resistance to reaction with sulfates were evaluated in this study using low-vacuum scanning electron microscopy.