Norovirus, Hepatitis A and SARS-CoV-2 surveillance within Chilean rural wastewater treatment plants based on different biological treatment typologies.

During the COVID-19 pandemic, wastewater from WWTPs became an interesting source of epidemiological surveillance. However, there is uncertainty about the influence of treatment type on virus removal. The aim of this study was to assess viral surveillance within wastewater treatment plants (WWTPs) based on different biological treatments. Seasonal monitoring (autumn-winter and spring-summer) was conducted in 10 Chilean rural WWTPs, which were based on activated sludge, aerated lagoons, bio-discs, constructed wetlands, vermifilters and mixed systems. Viruses were measured (influent/effluent) by the RT-qPCR technique, using a commercial kit for SARS-CoV-2, NoV GI, NoV GII, and HAV. The detection of SARS-CoV-2 viral variants by genotyping was performed using SARS-CoV-2 Mutation Assays (ThermoFisher Scientific, USA). JC polyomavirus detection (control), as well as a qPCR technique. Results showed that SARS-CoV-2, NoV GI and GII were detected in influents at values between <5 and 462, 0 to 28, and 0 to 75 GC/mL, respectively. HAV was not detected among the studied WWTPs. The monitored WWTPs removed these viruses at percentages between 0 and 100 %. WWTPs based on activated sludge with bio-discs demonstrated to be the most efficient at removing SARS-CoV-2 (up to 98 %) and NoV GI and GII (100 %). Meanwhile, bio-discs technologies were the least efficient for viral removal, due to biofilm detachment, which could also adsorb viral aggregates. A correlation analysis established that solids, pH, and temperature are the most influential parameters in viral removal. Wastewater-based surveillance at WWTP allowed for the detection of Omicron before the Chilean health authorities notified its presence in the population. In addition, surveillance of viruses and other microorganisms could help assess the potential public health risk of wastewater recycling.

Tiroiditis subaguda posterior a la administración de la vacuna COVID-19. Presentación de tres casos clínicos / Subacute thyroiditis following COVID-19 vaccine administration. Presentation of three clinical cases

La tiroiditis subaguda (TSA) es un trastorno inflamatorio autolimitado de la glándula tiroides. Es más común en mujeres y se caracteriza por dolor cervical, síntomas inflamatorios sistémicos y disfunción tiroidea. La TSA se ha asociado a una infección viral previa, generalmente respiratoria o enteral. Múltiples virus se han relacionado con TSA. Desde mayo de 2020 se reportaron casos de TSA relacionados con la infección por SARS-CoV-2. Describimos 3 casos de SAT después de la vacuna COVID-19. Dos casos fueron inoculados con vacuna SARS-CoV-2 inactivada (CoronaVac) y uno con vacuna de ARNm Pfizer-BioNTech. Los síntomas clínicos comenzaron pocas semanas después de la inoculación. Presentaron dolor cervical anterior, fiebre, astenia y tirotoxicosis transitoria. En todos los casos la evolución fue favorable. Hasta donde sabemos, estos son los primeros casos de SAT posteriores a la vacuna COVID-19 descritos en Chile.

Subacute thyroiditis (SAT) is a self-limited inflammatory disorder of the thyroid gland. The disease is more common in women and is characterized by neck pain, systemic symptoms, and thyroid dysfunction. SAT It has been associated with viral, respiratory or enteral infection. Multiple viruses had been related to SAT. Since May 2020, cases of SAT related to SARS-CoV-2 infection were reported. We describe 3 cases of SAT following COVID-19 vaccine. Two cases were inoculated with inactivated SARS-CoV-2 vaccine (CoronaVac) and one with mRNA vaccine Pfizer­BioNTech. The clinical symptoms began few weeks after inoculation. They presented with neck pain, fever, general malaise and transient thyrotoxicosis. All cases revered spontaneously. To our knowledge, these are the first cases of SAT following COVID-19 vaccine described in Chile.

Primary myxoid liposarcoma of the pelvis: An unusual location.

Myxoid liposarcoma is the second most common type of liposarcoma, normally located in deep tissues of the lower extremities and rarely in the mesenchyma of abdomen and pelvis We present a patient who, incidentally, showed a large pelvis mass. CT and MR revealed a loculated lesión with hypodense areas and very high signal in T2 respectively as well as heterogeneous contrast enhancement. The imaging findings of pelvic myxoid liposarcoma are nonspecific, but nevertheless a painless mesenchymal mass should be considered when we see lesions of myxoid aspect in the pelvic area without a clear relationship with defined anatomic structures.

Cytotoxicity evaluation of a copaiba oil-based root canal sealer compared to three commonly used sealers in endodontics.

BACKGROUND: The constant development of new root canal sealers has allowed the solution of a large number of clinical cases in endodontics, however, cytotoxicity of such sealers must be tested before their validation as filling materials. The aim of this study was to evaluate the cytotoxic effect of a new Copaiba oil-based root canal sealer (Biosealer [BS]) on osteoblast-like Osteo-1 cells. MATERIALS AND METHODS: The experimental groups were formed according to the culture medium conditioned with the tested sealers, as follows: Control group (CG) (culture medium without conditioning); Sealer 26 (S26) - culture medium + S26; Endofill (EF) - culture medium + EF; AH Plus (AHP) - culture medium + AHP; and BS - culture medium + BS (Copaiba oil-based sealer). The conditioned culture medium was placed in contact with 2 × 10(4) cells cultivated on 60 mm diameter Petri dishes for 24 h. Then, hemocytometer count was performed to evaluate cellular viability, using Trypan Blue assay. The normal distribution of data was tested by the Kolmogorov-Smirnov test and the values obtained for cellular viability were statistically analyzed (1-way ANOVA, Tukey's test - P < 0.05), with a significance level of 5%. RESULTS: S26, EF and AHP presented decreased cellular viability considerably, with statistical significance compared with CG (P < 0.05). BS maintained cellular viability similar to CG (P > 0.05). CONCLUSION: The Copaiba oil-based root canal sealer presented promising results in terms of cytotoxicity which indicated its usefulness as a root canal sealer.

Rendimiento de índices pronósticos en infección asociada a Clostridium difficile grave: Análisis retrospectivo en un hospital universitario / Performance of prognostic index in severe Clostridium difficile-associated infection: Retrospective analysis in a university hospital

Introduction: By consensus severe, Clostridium difficile-associated infection (CDAI) is one that results in hospitalization in ICU, colectomy or death within 30 days. Multiple prognostic indices (IP) attempt to predict these adverse events. Objective: To evaluate the performance of 4 PI in predicting severe CDI. Methods: Hospitalized patients ≥ 18 years old with ICD were retrospectively evaluated. Patients with recurrent infection or hematological cancer were excluded. Four PI were evaluated: UPMC version 1, Calgary version 1, Hines VA and Calgary version 2. Results: Seven of 81 patients (8.1%) met the definition of severe CDI. Positive predicted value (PPV) and negative predicted value (NPV) of PI ranged from 20-75% and 91.3-95.7%, respectively. Only Hines VA index had a satisfactory Kappa index (0.74; 95% CI 0.41-1) with a PPV of 75% and NPV of 95,7%. However, because of the variables included, this PI could be calculated only in 32.6% of patients. Conclusion: Hines VA index has the best predicted value and agreement to rule out a severe CDI. Like others PI it has the limitation of including difficult variables to assess in all patients and tends to overestimate an unfavorable course.

Introducción: Por consenso, la infección asociada a Clostridium difficile (IACD) grave es aquella que resulta en hospitalización en unidad de cuidados intensivos, colectomía o muerte dentro de 30 días. Múltiples índices pronósticos (IP) intentan predecir estos eventos adversos. Objetivo: evaluar el rendimiento de cuatro IP en la predicción de IACD grave. Metodología: pacientes hospitalizados ≥ 18 años con IACD fueron evaluados retrospectivamente. Se excluyeron pacientes con infección recurrente o cáncer hematológico. Se evaluaron cuatro IP: UPMC versión 1, Calgary versión 1, Hines VA y Calgary versión 2. Resultados: Siete de 81 pacientes (8,1%) presentaron una IACD grave. El valor predictor positivo (VPP) y valor predictor negativo (VPN) de los IP varió entre 20-75% y 91,3-95,7%, respectivamente. Sólo el índice de Hines VA tuvo un índice Kappa satisfactorio (0,74;IC 95% 0,46-1) con un VPP de 75% y un VPN de 95,7%. Sin embargo, por las variables incluidas en este IP, sólo pudo ser calculado en 32,6% de los pacientes. Conclusión: El índice de Hines VA presenta el mejor valor predictor y concordancia para descartar una IACD grave. Como otros IP, tiene la limitación de incluir variables difícilmente evaluables en todos los pacientes y tiende a sobreestimar un curso desfavorable.

[Performance of prognostic index in severe Clostridium difficile-associated infection: retrospective analysis in a university hospital]. / Rendimiento de índices pronósticos en infección asociada a Clostridium difficile grave: Análisis retrospectivo en un hospital universitario.

INTRODUCTION: By consensus severe, Clostridium difficile-associated infection (CDAI) is one that results in hospitalization in ICU, colectomy or death within 30 days. Multiple prognostic indices (IP) attempt to predict these adverse events. OBJECTIVE: To evaluate the performance of 4 PI in predicting severe CDI. METHODS: Hospitalized patients ≥ 18 years old with ICD were retrospectively evaluated. Patients with recurrent infection or hematological cancer were excluded. Four PI were evaluated: UPMC version 1, Calgary version 1, Hines VA and Calgary version 2. RESULTS: Seven of 81 patients (8.1%) met the definition of severe CDI. Positive predicted value (PPV) and negative predicted value (NPV) of PI ranged from 20-75% and 91.3-95.7%, respectively. Only Hines VA index had a satisfactory Kappa index (0.74; 95% CI 0.41-1) with a PPV of 75% and NPV of 95,7%. However, because of the variables included, this PI could be calculated only in 32.6% of patients. CONCLUSION: Hines VA index has the best predicted value and agreement to rule out a severe CDI. Like others PI it has the limitation of including difficult variables to assess in all patients and tends to overestimate an unfavorable course.

The Clostridium difficile exosporium cysteine (CdeC)-rich protein is required for exosporium morphogenesis and coat assembly.

Clostridium difficile is an important nosocomial pathogen that has become a major cause of antibiotic-associated diarrhea. There is a general consensus that C. difficile spores play an important role in C. difficile pathogenesis, contributing to infection, persistence, and transmission. Evidence has demonstrated that C. difficile spores have an outermost layer, termed the exosporium, that plays some role in adherence to intestinal epithelial cells. Recently, the protein encoded by CD1067 was shown to be present in trypsin-exosporium extracts of C. difficile 630 spores. In this study, we renamed the CD1067 protein Clostridium difficile exosporium cysteine-rich protein (CdeC) and characterized its role in the structure and properties of C. difficile spores. CdeC is expressed under sporulation conditions and localizes to the C. difficile spore. Through the construction of an ΔcdeC isogenic knockout mutant derivative of C. difficile strain R20291, we demonstrated that (i) the distinctive nap layer is largely missing in ΔcdeC spores; (ii) CdeC is localized in the exosporium-like layer and is accessible to IgGs; (iii) ΔcdeC spores were more sensitive to lysozyme, ethanol, and heat treatment than wild-type spores; and (iv) despite the almost complete absence of the exosporium layer, ΔcdeC spores adhered at higher levels than wild-type spores to intestinal epithelium cell lines (i.e., HT-29 and Caco-2 cells). Collectively, these results indicate that CdeC is essential for exosporium morphogenesis and the correct assembly of the spore coat of C. difficile.

Avaliação in vitro da atividade antimicrobiana de pastas endodônticas à base de extrato glicólico de Musa paradisiaca frente a Enterococcus faecalis / In vitro evaluation of the antimicrobial activity of endodontic pastes made of Musa paradisiaca glycolic extract over Enterococcus faecalis

Os produtos de Musa paradisiaca (bananeira) são usados como sedativo para odontalgia, cicatrizante de feridas cirúrgicas de exodontia, úlcera gástrica, entre outras indicações em comunidades que têm por tradição o uso das plantas como Medicina alternativa. Na Endodontia, almeja-se uma medicação intracanal ideal contra cepas resistentes em infecções endodônticas refratárias. Por esse motivo, o objetivo desse trabalho foi testar a atividade antimicrobiana do extrato glicólico de Musa paradisiaca (Mp) sobre Enterococcus faecalis (Ef). Para realizar o experimento, o extrato glicólico de Musa paradisiaca (EGB) substituiu o Polietilenoglicol 400 (PEG), que é um veículo que compõe algumas medicações intracanal. Foi utilizado o teste de difusão em ágar, pelo método do poço, para a avaliação da atividade antimicrobiana contra a cepa de Ef, normalmente relacionada a infecções refratárias endodônticas. Experimento “A”: G1, PEG (controle negativo); G2, PEG e Ca(OH) 2 ; G3, EGB; G4, EGB e Ca(OH) 2 e G5, gel de clorexidina 2% (CHX – controle positivo). Experimento “B”: G1, PEG (controle negativo); G2, PEG e ZnO; G3, PEG, Ca(OH) 2 e ZnO; G4, EGB e ZnO; G5, EGB, Ca(OH) 2 e ZnO e G6, CHX (controle positivo). Apenas a pasta de EGB e ZnO obteve atividade antimicrobiana estatisticamente significante, podendo ser uma propriedade importante para a composição de medicação intracanal. Todo novo biomaterial baseado na etnobotânica deve ser testado criteriosamente para viabilizar sua aplicabilidade clínica, o que justificou a pertinência deste estudo preliminar. No entanto, testes físico-químicos e de biocompatibilidade são imprescindíveis para futuro emprego de fitoterápicos na Endodontia

The products of Musa paradisiaca (banana plantain) are used as a sedative for dental pain, healing of tooth extraction surgical wounds, gastric ulcer, among other indications in communities that have the tradition of using plants as alternative Medicine. Endodontics searchs for an ideal intracanal medication for resistant strains on refractory endodontic infections. Therefore, the objective of this study was to test the antimicrobial activity of Musa paradisiaca (Mp) glycolic extract over Enterococcus faecalis (Ef). To perform the experiment, the Polyethyleneglycol 400 (PEG), used to make some intracanal medication, was replaced by Musa paradisiaca glycolic extract. Agar well diffusion test was used to evaluate antimicrobial activity over Ef. Strains normally related to refractory endodontic infections. Experiment “A”: G1, PEG (negative control); G2, PEG and Ca(OH)2; G3, EGB; G4, EGB and Ca(OH)2; and G5, 2% chlorhexidine gel (CHX - positive control). Experiment “B”: G1, PEG (negative control); G2, PEG and ZnO; G3, PEG, Ca(OH)2 and ZnO; G4, ZnO and EGB; G5, EGB, Ca(OH)2 and ZnO; and G6, CHX (positive control). Only the EGB and ZnO paste has obtained statistically significant antimicrobial activity, indicating that it can be an important property for a new intracanal medication. Every new biomaterial based on ethnobotanic should be carefully tested to allow its clinical applicability reinforcing the relevance of this preliminary study. However, physicochemical and biocompatibility tests are essential to future utilization of herbal medicines in Endodontics

Management of dens invaginatus type III with large periradicular lesion.

AIM: This study describes a clinical case of type III dens invaginatus with an extensive periradicular lesion treated successfully. BACKGROUND: Dens invaginatus is a maldevelopment of the dental germ which occurs as a result of the invagination of the enamel organ. These cases may present difficulties with respect to its diagnosis and treatment because of canal morphology. The success of endodontic therapy requires a knowledge of dental anatomy and its anomalies. CASE REPORT: A 17-year-old female patient is reported presenting right maxillary lateral incisor (tooth no. 7) classified as type III dens invaginatus with necrotic pulp and presence of an extensive radiolucid lesion. Endodontic treatment was recommended for tooth. However, intracanal exudate was present, suggesting a resistant infection. Enucleation of the lesion was performed as a complementary approach. The root canal obturation was carried out by the gutta-percha thermoplastification technique with root canal sealer, followed by restoration of the tooth. Healing of the lesion with hard tissue formation was confirmed at follow-up. CONCLUSION: A combination of endodontic and surgical treatments were fundamental to the maintenance of the tooth. The treatment was considered successful. CLINICAL SIGNIFICANCE: Root canal therapy of dens invaginatus should be based on a thorough clinical and radiographic evaluation. The knowledge of classification and anatomical variations of teeth with dens invaginatus are of great importance for correct treatment.

Tip diameter of 0.04 and 0.06 tapered gutta-percha points from different commercial brands / Diâmetro da ponta (d0) de cones de guta-percha de conicidades 0, 04 e 0, 06 de diferentes marcas comerciais

Objective: The aim of this study was to determine the correlation between the diameter D0 of guttapercha points from three different commercial brands (Tanari Man, Cone Tech and Dentsply) and their original respective values. Materials and methods: A high precision micrometer was used by a single calibrated operator to evaluate if the gutta-percha points are in aggrement with the n. 57 ANSI/ADA specification. Results: For the 0.04 tapered points, Cone Tech showed lower percentage of inadequate points (52%), followed by Dentsply (56%) and Tanari (80%). For the 0.06 tapered points, Cone Tech showed lower percentage of inadequate points (50%), followed by manufacturers Dentsply (53%) and Tanari (81%). Conclusions: It can be concluded that there is no standardization in the diameter D0 of the gutta-percha points of different commercial brands.

Objetivo: O objetivo deste estudo foi determinar a correlação entre o diâmetro D0 dos cones de guta-percha detrês diferentes marcas comerciais (Tanari Man, Cone Tech e Dentsply) com seus respectivos valores originais. Materiais e métodos: Um micrômetro de alta precisão foi utilizado por um único operador devidamente calibradopara avaliar se os cones de guta-percha estavam de acordo com a norma n. 57 da ANSI/ADA. Resultados:Para a conicidade 0.04, Cone Tech apresentou menor percentual de cones inadequados (52%), seguido deDentsply (56%) e Tanari (80%). Para a conicidade 0.06, Cone Tech apresentou menor percentual de conesinadequados (50%), seguido de Dentsply (53%) e Tanari (81%). Conclusões: Pôde-se concluir que não há padronizaçãono diâmetro D0 dos cones de guta-percha das diferentes marcas comerciais.

Dimensional alterations and solubility of new endodontic sealers

This study evaluated the dimensional alterations and the solubility of two experimental endodontic sealers based on Copaifera multijuga oil-resin (Biosealer) and castor oil bean cement (Poliquil), maintained in different storage solutions. Twenty specimens (3 mm diameter and 2 mm height) of each sealer were assigned to 2 groups (n=10) according to the storage solution: simulated tissue fluid (STF) or distilled water (DW). The specimens were stored in these solutions during 90 days, being removed every 30 days for weighting. The solutions were renewed every 15 days. The results were subjected to statistical analysis by Dunn's and Mann-Whitney tests (a=0.05). The solubility of Poliquil was higher in STF (38.4 ± 36.0) than in DW (28.4 ± 15.0), while Biosealer showed higher solubility in DW (34.61 ± 6.0) than in STF (18.59 ± 8.0). The storage solution influenced the behavior of sealers in relation to the weight variation (p=0.0001). Poliquil presented higher variation of weight independent of the solution (p=0.239). Biosealer also presented higher variation of weight regardless of the solution (p=0.0001). The solubility of Biosealer was different from that of Poliquil, but both sealers showed low solubility in STF. Under the tested conditions, neither of the materials were according to the ADA'S specification.

O presente estudo avaliou a alteração dimensional e solubilidade de 2 cimentos experimentais (à base de resina do óleo de Copaíba - Biosealer e cimento do polímero da mamona - Poliquil), mantidos em diferentes meios de armazenamento. Foram confeccionados 20 espécimes de cada cimento com 3 mm de diâmetro e 2 mm de altura os quais foram divididos em 2 grupos (n=10) de acordo com o meio de armazenamento (fluido tissular simulado ou água destilada). Os espécimes foram atidos nas soluções durante 90 dias, sendo removidos a cada 30 dias para pesagem das amostras, no entanto as soluções foram trocadas a cada 15 dias. Os resultados foram submetidos aos testes de Dunn (5 por cento) e Mann-Whitney. Os meios de armazenamento causaram influência no comportamento dos cimentos em relação ao peso (p=0,0001). Poliquil apresentou alta variação de peso independente da solução (p=0,239). Biosealer também apresentou alta variação de peso independente da solução (p=0,0001). A solubilidade do Biosealer foi diferente do Poliquil, entretanto, ambos cimentos mostraram baixa solubilidade no fluido tissular simulado. Nas condições do experimento, nenhum cimento está de acordo com a especificação da ADA.

Tuberculosis pulmonar: su tratamiento y cobertura en el Cantón Pedro Moncayo

La Tb. pulmonar es una enfermedad infecciosa crónica; aunque la tuberculosis tiene tratamiento desde la década de los setenta, sigue representando una alta tasa de morbimortalidad a nivel mundial. Se realizó un estudio de los casosm de tuberculosis en el Cantón Pedro Moncayo que cuenta con una población estimada de 18043 habitantes para 1998, la zona rural marginal cuenta con altos índices de pobreza, malnutrición, hacinamiento y falta de atención sanitaria. Se encontró 19 casos de tuberculosis pulmonar desde 1991 a 1998, de los cuales el 52,6 por ciento fueron mujeres con una media edad de 42,3 años, y un 47,4 por ciento de hombres con una media edad de 33 años; el síntoma más frecuente fue la tos de larga evolución...