Urinary incontinence in pregnant adolescents: A case series.

AIMS: Determine the severity of urinary incontinence (UI) and its effect on the quality of life (QoL) of pregnant adolescents, as well as explore the strategies used to manage UI and the reporting/investigation of this condition by healthcare professionals. METHODS: A case series was conducted in three Brazilian public hospitals that offer prenatal care. Inclusion criteria were: age between 10 and 19 years, gestational age of 27 weeks or more, and reported UI in the third trimester of pregnancy. All volunteers responded to the Incontinence Severity Index (to assess severity of UI) and the International Consultation on Incontinence Questionnaire for Urinary Incontinence-Short Form (to evaluate the effect of UI on QoL). A descriptive analysis of data were done. RESULTS: A total of 329 incontinent pregnant adolescents with mean age of 17.09 years (95%CI 16.92-17.26), who reported voiding urgency (72.0%), increased daytime urinary frequency (75.1%), nocturia (96.7%), and mixed UI (44.1%) were included in the study. UI was considered moderate to severe (79.3%) and had a moderate effect on QoL (mean 9.84; 95%CI 9.40-10.28). The volunteers used UI management strategies (66.6%), with bladder emptying prior to activities (56.8%) and the use of sanitary pads (29.5%) most frequently reported. UI is not disclosed voluntarily (89.1%) or explored by healthcare professionals (91.2%). CONCLUSION: UI can be moderate to severe and has a moderate effect on QoL in incontinent pregnant adolescents, who use strategies to manage this condition. Healthcare professionals do not identify this urinary symptom during prenatal care.

Use of polyphenols as a strategy to prevent bond degradation in the dentin-resin interface.

This study evaluated the effect of dentin pretreatment with the polyphenols quercetin and resveratrol on the resin-dentin microtensile bonding strength (µTBS) and collagen fibrils stability of the adhesive interface. Different concentrations (100, 250, 500, or 1,000 µg ml-1 ) of quercetin or resveratrol, or a mixture of quercetin and resveratrol (3:1, 1:1, 1:3; vol:vol), as well as distilled water or 2% chlorhexidine digluconate, were applied to etched dentin. Then, a two-step etch-and-rinse adhesive was applied followed by composite restoration. Measurements of resin-dentin µTBS were made after 1 and 120 d. The stability of collagen fibrils in the hybrid layer was evaluated using transmission electron microscopy. The Student's t-test and two-way factorial anova with Tukey's test were used to analyze the effects of dentin pretreatment and storage time on µTBS values. Comparisons between µTBS measurements made on 1 and 120 d showed that resveratrol had the best performance, with significantly higher µTBS values after 120 d for all concentrations of resveratrol tested. Quercetin pretreatment resulted in a significant rise of µTBS when used at concentrations of 100 and 500 µg ml-1 . Quercetin + resveratrol at the ratio of 1:1 performed better than when used at ratios of either 3:1 or 1:3. Resveratrol might represent a potential approach to achieve desirable bonding stability and reduce the frequent replacement of composite restorations.

Mechanical and aesthetics compatibility of Brazilian red propolis micellar nanocomposite as a cavity cleaning agent.

BACKGROUND: Propolis is a natural substance produced by bees and is known to have antimicrobial activity. Our aim was to evaluate the antimicrobial effect of micellar nanocomposites loaded with an ethyl acetate extract of Brazilian red propolis as a cavity cleaning agent and its influence on the color and microtensile bond strength (µTBS) of the dentin/resin interface. METHODS: An ultra-performance liquid chromatography coupled with a diode array detector (UPLC-DAD) assay was used to determine the flavonoids and isoflavones present in an ethyl acetate extract of Brazilian red propolis (EARP) and micellar nanocomposites loaded with EARP (MNRP). The antimicrobial activity of EARP and MNRP was tested against Streptococcus mutans, Lactobacillus acidophilus, and Candida albicans. One of the following experimental treatments was applied to etched dentin (phosphoric acid, 15 s): 5 µL of MNRP (RP3, 0.3%; RP6, 0.6%; or RP1, 1.0% w/v), placebo, and 2% chlorhexidine digluconate. Single Bond adhesive (3 M/ESPE) was applied and a 4-mm-thick resin crown (Z350XT, 3 M/ESPE) was built up. After 24 h, the teeth were sectioned into sticks for the µTBS test and scanning electron microscopy. Spectrophotometry according to the CIE L*a*b* chromatic space was used to evaluate the color. Data were analyzed using one-way ANOVA and the Tukey test or Kruskal-Wallis test and the same test for pairwise comparisons between the means (P < 0.05). RESULTS: The UPLC-DAD assay identified the flavonoids liquiritigenin, pinobanksin, pinocembrin, and isoliquiritigenin and the isoflavonoids daidzein, formononetin, and biochanin A in the EARP and micellar nanocomposites. EARP and MNRP presented antimicrobial activity against the cariogenic bacteria Streptococcus mutans and Lactobacillus acidophilus, and for Candida albicans. ΔE values varied from 2.31 to 3.67 (P = 0.457). The mean µTBS for RP1 was significantly lower than for the other groups (P < 0.001). Dentin treated with RP1 showed the shortest resin tags followed by RP6 and RP3. CONCLUSIONS: The EARP and (MNRP) showed antimicrobial activity for the main agents causing dental caries (Streptococcus mutans and Lactobacillus acidophilus) and for Candida albicans. MNRP at concentrations of 0.3 and 0.6% used as a cavity cleaner do not compromise the aesthetics or µTBS of the dentin/resin interface.

Brazilian red propolis: phytochemical screening, antioxidant activity and effect against cancer cells.

BACKGROUND: The implementation of new public healthcare models that stimulate the use of natural products from traditional medicine, as a so-called integrated medicine, refers to an approach that use best of both conventional medicine and traditional medicine. Propolis is a widely used natural product by different ancient cultures and known to exhibit biological activities beneficial for health. The large number of studies conducted with propolis had shown that its chemical composition differs as a function of the climate, plant diversity and bee species and plays an important role on its therapeutic properties. The aim of this study was to analyse the phytochemical profile of the ethanolic extract of red propolis (EEP) and its fractionation, antioxidant action of EEP and its fractions hexane, cloroform and ethyl acetate and cytotoxic activity of EEP on human tumour cell lines SF-295 (glioblastoma), OVCAR-8 (ovary) and HCT-116 (colon). METHODS: EEP was obtained by maceration with absolute ethanol, then it was concentrated in rotaevaporator up to complete evaporation of the solvent. The crude extract was fractionated with hexane, ethyl acetate, chloroform and methanol and they were subjected to phytochemical screening and total phenolic compounds. Antioxidant activity of EEP and fractions was done by means of the 2,2-diphenyl-1-picryhydrazyl (DPPH) method. Biomarkers of red propolis were identified by LC-Orbitrap-FTMS. To assess cytotoxic activity of the extract, cells were exposed to EEP over 72 h. Cell viability was assessed by means of MTT assay. The percentage of cell growth inhibition (IC50) was analysed by means of non-linear regression, and the absorbance values of the various investigated concentrations were subjected to one-factor analysis of variance (ANOVA) followed by Tukey's or Tamhane's tests (α = 0.05). RESULTS: The results obtained using phytochemical screening and LC-Orbitrap-FTMS indicated the presence of phlobaphene tannins, catechins, chalcones, aurones, flavonones, flavonols, xanthones, pentacyclic triterpenoids and guttiferones in Brazilian red propolis. EEP and its hexane, chloroform and ethyl acetate fractions obtained by liquid-liquid partitioning exhibited satisfactory antioxidant percentages. EEP (IC50 < 34.27 µg/mL) exhibited high levels of cytotoxicity on all human tumour cell lines tested when compared to negative control. CONCLUSIONS: C-Orbitrap-FTMS was useful to establish the chemical profile of the red propolis. Brazilian red propolis has antioxidant properties and decreases substantially the percentage of cell survival of human tumour cells; thus, it has potential to serve as an anticancer drug.

Recovery and identification of mature enamel proteins in ancient teeth.

Proteins in mineralized tissues provide a window to the past, and dental enamel is peculiar in being highly resistant to diagenesis and providing information on a very narrow window of time, such as the developing period; however, to date, complete proteins have not been extracted successfully from ancient teeth. In this work we tested the ability of a whole-crown micro-etch technique to obtain enamel protein samples from mature enamel of recently extracted (n = 2) and ancient (n = 2; ad 800 to 1100) third molars. Samples were analyzed using matrix-assisted laser desorption/ionization time-of-flight/time-of-flight (MALDI-TOF/TOF) mass spectrometry, and the resulting spectra were searched against the Swiss-Prot protein database using the Mascot software for protein identification. In our protocol, the separation of proteins in gel is not necessary. Successful identification of specific enamel proteins was obtained after whole-crown superficial enamel etching with 10% HCl. Most protein fragments recovered from dry teeth and mummy teeth contained amino-terminal amelogenin peptides. Only one peptide specific for the amelogenin X-isoform was identified. In conclusion, the reported techniques allowed the successful recovery of proteins specific to dental enamel from samples obtained in a very conservative manner, which may also be important in forensic and/or archeological science.

Layered double hydroxides for controlled fluoride release.

This study aims to develop a nano-sized fluoridated layered double hydroxide (LDH)-based release system via hydrothermal treatment for the controlled delivery of fluoride (F-) ions in the oral environment. The synthesis of conventional LDH-type (C-LDH) precursor nanomaterials was conducted using a co-precipitation method at constant pH, and the nanoparticulate-LDH (N-LDH) was synthesized by a hydrothermal procedure. Fluoride LDH (F-LDH) products were obtained through indirect synthesis using the precursor ion-exchange technique by varying the agitation time (2 and 24 h) and temperature (25 and 40 °C) to produce 12 material samples. The materials were characterized by energy dispersive x-ray, hexamethyldisilazane, digital radiography x-ray, Fourier-transform infrared, thermogravimetric analysis, and scanning electron microscopy. Additionally, the F-release kinetic profile was evaluated for 21 d in neutral and acid media with mathematical model analysis. Products with varying F-quantities were obtained, revealing specific release profiles. In general, there was a higher F-release in the acid medium, with emphasis on F-LDH-8. Fluoride-LDH and controlled fluoride delivery was successfully obtained, proving the potential of these nanomaterials as alternative anti-caries agents.

Propolis in Oral Healthcare: Antibacterial Activity of a Composite Resin Enriched With Brazilian Red Propolis.

The aim of this study was to obtain a Brazilian red propolis (BRP) enriched composite resin and to perform the characterization of its antibacterial activity, mechanical, and physical-chemical properties. Brazilian red propolis ethyl acetate extract (EABRP) was characterized by LC-ESI-Orbitrap-FTMS, UPLC-DAD, antibacterial activity, total flavonoids content, and radical scavenging capacity. BRP was incorporated to a commercial composite resin (RC) to obtain BRP enriched composite at 0.1, 0.15 and 0.25% (RP10, RP15 and RP25, respectively). The antibacterial activity RPs was evaluated against Streptococcus mutans by contact direct test and expressed by antibacterial ratio. The RPs were characterized as its cytotoxicity against 3T3 fibroblasts, flexural strength (FS), Knoop microhardness (KHN), post-cure depth (CD), degree of conversion (DC%), water sorption (Wsp), water solubility (Wsl), average roughness (Ra), and thermal analysis. Were identified 50 chemical compounds from BRP extract by LC-ESI-Orbitrap-FTMS. EABRP was bacteriostatic and bactericide at 125 and 500 µg/ml, respectively. The RP25 exhibited antibacterial ratio of 90.76% after 1 h of direct contact with S. mutans (p < 0.0001) while RC no showed significative antibacterial activity (p = 0.1865), both compared with cell control group. RPs and RC no showed cytotoxicity. RPs exhibited CD from 2.74 to 4.48 mm, DC% from 80.70 to 83.96%, Wsp from 17.15 to 21.67 µg/mm3, Wsl from 3.66 to 4.20 µg/mm3, Ra from 14.48 to 20.76 nm. RPs showed thermal resistance between 448-455°C. The results support that propolis can be used on development of modified composite resins that show antibacterial activity and that have compatible mechanical and physical-chemical properties to the indicate for composite resins.

Polyphenols and Brazilian red propolis incorporated into a total-etching adhesive system help in maintaining bonding durability.

OBJECTIVES: The aim of this study was to evaluate the degree of conversion and bond strength of a commercial dental adhesive modified by the incorporation of quercetin, resveratrol (RES), and Brazilian red propolis (BRP). METHODS: BRP markers were identified using ultra-performance liquid chromatography coupled with a diode array detector, and the antioxidant activity (AAO) of the three substances was analyzed. Single Bond 2 adhesive (3M ESPE) was modified by adding BRP, quercetin, and RES, separately, at 20 µg/mL, 250 µg/mL, and 500 µg/mL, respectively. The degree of conversion (DC) was measured using near-infrared spectroscopy 24 h after photopolymerization. Measurements of the resin-dentin microtensile bond strength (µTBS) were carried out after 1 day and 1 year. Student's t test and ANOVA with Tukey's test were used for data analysis (α = 0.05). RESULTS: The markers daidzein, liquiritigenin, pinobanksin, isoliquiritigenin, formononetin, pinocembrin, and biochanin A were found in the ethanolic extract of BRP. Quercetin, RES, and BRP showed high AAO. The DC of the tested adhesives remained adequate for this category of material, with a slight increase in the DC of adhesives with quercetin and BRP (P > 0.05). Comparisons between µTBS measurements made at 1 day and 1 year showed that, contrary to the control group, µTBS values for all modified adhesives were maintained after 1 year in distilled water (P > 0.05). CONCLUSIONS: These findings suggest that quercetin, RES, or BRP might be useful in adhesive dentistry to help improve hybrid layer resistance. CLINICAL SIGNIFICANCE: Dentin bonding agents with quercetin, RES, and BRP have potential to increase the longevity of composite restorations.

Effect of QMix irrigant in removal of smear layer in root canal system: a systematic review of in vitro studies.

OBJECTIVES: To evaluate the outcome of in vitro studies comparing the effectiveness of QMix irrigant in removing the smear layer in the root canal system compared with other irrigants. MATERIALS AND METHODS: The research question was developed by using Population, Intervention, Comparison, Outcome and Study design framework. Literature search was performed using 3 electronic databases PubMed, Scopus, and EBSCOhost until October 2019. Two reviewers were independently involved in the selection of the articles and data extraction process. Risk of bias of the studies was independently appraised using revised Cochrane Risk of Bias tool (RoB 2.0) based on 5 domains. RESULTS: Thirteen studies fulfilled the selection criteria. The overall risk of bias was moderate. QMix was found to have better smear layer removal ability than mixture of tetracycline isonomer, an acid and a detergent (MTAD), sodium hypochlorite (NaOCl), and phytic acid. The efficacy was less effective than 7% maleic acid and 10% citric acid. No conclusive results could be drawn between QMix and 17% ethylenediaminetetraacetic acid due to conflicting results. QMix was more effective when used for 3 minutes than 1 minute. CONCLUSIONS: QMix has better smear layer removal ability compared to MTAD, NaOCl, Tubulicid Plus, and Phytic acid. In order to remove the smear layer more effectively with QMix, it is recommended to use it for a longer duration.

Inhibition of matrix metalloproteinases: a troubleshooting for dentin adhesion.

Matrix metalloproteinases (MMPs) are enzymes that can degrade collagen in hybrid layer and reduce the longevity of adhesive restorations. As scientific understanding of the MMPs has advanced, useful strategies focusing on preventing these enzymes' actions by MMP inhibitors have quickly developed in many medical fields. However, in restorative dentistry, it is still not well established. This paper is an overview of the strategies to inhibit MMPs that can achieve a long-lasting material-tooth adhesion. Literature search was performed comprehensively using the electronic databases: PubMed, ScienceDirect and Scopus including articles from May 2007 to December 2019 and the main search terms were "matrix metalloproteinases", "collagen", and "dentin" and "hybrid layer". MMPs typical structure consists of several distinct domains. MMP inhibitors can be divided into 2 main groups: synthetic (synthetic-peptides, non-peptide molecules and compounds, tetracyclines, metallic ions, and others) and natural bioactive inhibitors mainly flavonoids. Selective inhibitors of MMPs promise to be the future for specific targeting of preventing dentin proteolysis. The knowledge about MMPs functionality should be considered to synthesize drugs capable to efficiently and selectively block MMPs chemical routes targeting their inactivation in order to overcome the current limitations of the therapeutic use of MMPs inhibitors, i.e., easy clinical application and long-lasting effect.

In situ zymography and immunolabeling in fixed and decalcified craniofacial tissues.

In situ zymography is a very important technique that shows the proteolytic activity in sections and allows researchers to observe the specific sites of proteolysis in tissues or cells. It is normally performed in non-fixed frozen sections and is not routinely performed in calcified tissues. In this study, we describe a technique that maintains proteolytic activity in fixed and decalcified sections obtained after routine paraffin sectioning in conventional microtome and cryostat sections. We used adult rat hemimandibles, which presented bone, enamel, and dentine matrices; the substrate used was dye-quenched-gelatin. Gelatinolytic activity was colocalized with MMP-2 using fluorescent antibodies. Specific proteolytic activity was observed in all sections, compatible with metalloproteinase activity, particularly in dentine and bone. Furthermore, matrix metalloproteinase-2 was colocalized to the sites of green fluorescence in dentine. In conclusion, the technique presented here will allow in situ zymography reactions in fixed, decalcified, and paraffin-embedded tissues, and we showed that paraformaldehyde-lysine-periodate-fixed cryostat sections are suitable for colocalization of gelatinolytic activity and protein labeling with antibodies.

Comprehensive multivariate correlations between climatic effect, metabolite-profile, antioxidant capacity and antibacterial activity of Brazilian red propolis metabolites during seasonal study.

The standardization of apiceutical products like as propolis extracts has been widely debated worldwide and variations in the propolis chemical composition are still very relevant topics for use-standardized of different propolis-type as medication by much of the world's population. The present manuscript discuss important issues related to the climate effect and variations in propolis metabolite-profiling changes, antioxidant capacity and variations of the antibacterial activity of the Brazilian red propolis metabolites using comprehensive multivariate correlations. It was observed the increasing of guttiferones concentrations during the intense drought period and drastic decreasing in rainy period. The climate variation induced the high concentration of flavonoids in rainy period with pronounced dropped in some rainy months. The Pearson´s analysis demonstrated correlation between IC50 from DPPH and guttiferones and flavonoids concentrations. The PCA-X and Hotelling T2 test showed outliers during the months with lowest concentrations of formononetin and isoliquiritigenin was observed in antibacterial tests. The PLS-DA, OPLS-DA and VIP analysis demonstrate guttiferone E, guttiferone B, liquiritigenin, naringenin are considered important substances responsible by anti-staphylococcal activity in red propolis composition during the rainy season and drought period, but a synergistic effect with other flavonoids and isoflavonoids are not ruled out.

Effect of dentin pretreatment with potassium oxalate: A 6-year follow-up.

Oxalate-based products are effective against dentine sensitivity and have been studied as an option to improve long-term adhesive bonding strength. Our aim was to evaluate the effect of potassium oxalate on the microtensile bond strength (µTBS) of the dentin/resin interface after 24 h, 1, and 6 years. Dentin on the occlusal surface of 16 human premolars was exposed and etched with 35% phosphoric acid. The teeth were divided into four groups. Two groups received 3% monohydrated potassium oxalate and the following adhesive systems and composites: Adper Scotchbond Multipurpose + FiltekZ350 (3M/ESPE) and Prime & Bond NT + Esthet-X (Dentsply). Two control groups did not receive potassium oxalate. Teeth were cut into sticks and kept in distilled water at 37°C for 24 h, 1, and 6 years. The sticks underwent µTBS testing after storage. ANOVA, Tukey's post hoc test, and paired t test were used to compare storage times (α = 0.05). The fracture mode of the specimens was classified under a stereomicroscope (40×). Morphology of the hybrid layer and the fracture pattern were observed with scanning electronic microscopy (SEM). Mean µTBS was high at 24 h and decreased after 1 and 6 years. After 6 years, the mean µTBS values were similar with no statistically significant difference between the groups (p = .121). SEM images showed proper dentin hybridization. Dentin pretreatment with potassium oxalate did not affect hybrid layer formation, but bond strength decreased over time after 24 h. Therefore, the clinical use of potassium oxalate to increase dentin bond durability is not indicated.

Polymeric Nanoparticles of Brazilian Red Propolis Extract: Preparation, Characterization, Antioxidant and Leishmanicidal Activity.

The ever-increasing demand for natural products and biotechnology derived from bees and ultra-modernization of various analytical devices has facilitated the rational and planned development of biotechnology products with a focus on human health to treat chronic and neglected diseases. The aim of the present study was to prepare and characterize polymeric nanoparticles loaded with Brazilian red propolis extract and evaluate the cytotoxic activity of "multiple-constituent extract in co-delivery system" for antileishmanial therapies. The polymeric nanoparticles loaded with red propolis extract were prepared with a combination of poly-ε-caprolactone and pluronic using nanoprecipitation method and characterized by different analytical techniques, antioxidant and leishmanicidal assay. The red propolis nanoparticles in aqueous medium presented particle size (200-280 nm) in nanometric scale and zeta analysis (-20 to -26 mV) revealed stability of the nanoparticles without aggregation phenomenon during 1 month. After freeze-drying method using cryoprotectant (sodium starch glycolate), it was possible to observe particles with smooth and spherical shape and apparent size of 200 to 400 nm. Attenuated total reflectance Fourier transform infrared spectroscopy (ATR-FTIR) and thermal analysis revealed the encapsulation of the flavonoids from the red propolis extract into the polymeric matrix. Ultra performance liquid chromatography coupled with diode array detector (UPLC-DAD) identified the flavonoids liquiritigenin, pinobanksin, isoliquiritigenin, formononetin and biochanin A in ethanolic extract of propolis (EEP) and nanoparticles of red propolis extract (NRPE). The efficiency of encapsulation was determinate, and median values (75.0 %) were calculated using UPLC-DAD. 2,2-Diphenyl-1-picryhydrazyl method showed antioxidant activity to EEP and red propolis nanoparticles. Compared to negative control, EEP and NRPE exhibited leishmanicidal activity with an IC50 value of ≅38.0 µg/mL and 31.3 µg/mL, 47.2 µg/mL, 154.2µg/mL and 193.2 µg/mL for NRPE A1, NRPE A2, NRPE A3 and NRPE A4, respectively. Nanoparticles loaded with red propolis extract in co-delivery system and EEP presented cytotoxic activity on Leishmania (V.) braziliensis. Red propolis extract loaded in nanoparticles has shown to be potential candidates as intermediate products for preparation of various pharmaceutical dosage forms containing red propolis extract in the therapy against negligible diseases such as leishmaniasis. Graphical Abstract Some biochemical mechanisms of cellular debridement of Leishmania (V.) braziliensis species by the flavonoids of red propolis extract (EEP) or NRPE loaded with red propolis extract.

Layered double hydroxides for controlled fluoride release

Abstract This study aims to develop a nano-sized fluoridated layered double hydroxide (LDH)-based release system via hydrothermal treatment for the controlled delivery of fluoride (F-) ions in the oral environment. The synthesis of conventional LDH-type (C-LDH) precursor nanomaterials was conducted using a co-precipitation method at constant pH, and the nanoparticulate-LDH (N-LDH) was synthesized by a hydrothermal procedure. Fluoride LDH (F-LDH) products were obtained through indirect synthesis using the precursor ion-exchange technique by varying the agitation time (2 and 24 h) and temperature (25 and 40 °C) to produce 12 material samples. The materials were characterized by energy dispersive x-ray, hexamethyldisilazane, digital radiography x-ray, Fourier-transform infrared, thermogravimetric analysis, and scanning electron microscopy. Additionally, the F-release kinetic profile was evaluated for 21 d in neutral and acid media with mathematical model analysis. Products with varying F-quantities were obtained, revealing specific release profiles. In general, there was a higher F-release in the acid medium, with emphasis on F-LDH-8. Fluoride-LDH and controlled fluoride delivery was successfully obtained, proving the potential of these nanomaterials as alternative anti-caries agents.

A comparative effect of various surface chemical treatments on the resin composite-composite repair bond strength.

AIM: The aim of this in vitro study was an attempt to investigate the effect of different surface treatments on the bond strength between pre-existing composite and repair composite resin. MATERIALS AND METHODS: Forty acrylic blocks were prepared in a cuboidal mould. In each block, a well of 5 mm diameter and 5 mm depth was prepared to retain the composite resin (Filtek™ Z350, 3M/ESPE). Aging of the composite discs was achieved by storing them in water at 37°C for 1 week, and after that were divided into 5 groups (n = 8) according to surface treatment: Group I- 37% phosphoric acid, Group II-10% hydrofluoric acid, Group III-30% citric acid, Group IV-7% maleic acid and Group V- Adhesive (no etchant). The etched surfaces were rinsed and dried followed by application of bonding agent (Adper™ Single Bond 2. 3M/ESPE). The repair composite was placed on aged composite, light-cured for 40 seconds and stored in water at 37°C for 1 week. Shear bond strength between the aged and the new composite resin was determined with a universal testing machine (crosshead speed of 0.5 mm/min). STATISTICAL ANALYSIS: The compressive shear strengths were compared for differences using ANOVA test followed by Tamhane's T2 post hoc analysis. RESULTS: The surface treatment with 10% hydrofluoric acid showed the maximum bond strength followed by 30% citric acid, 7% maleic acid and 37% phosphoric acid in decreasing order. CONCLUSION: The use of 10% hydrofluoric acid can be a good alternative for surface treatment in repair of composite resin restoration as compared to commonly used 37% orthophosphoric acid.

Morphine: An Effective Abortive Therapy for Pediatric Paroxysmal Sympathetic Hyperactivity After Hypoxic Brain Injury.

Paroxysmal sympathetic hyperactivity (PSH) is a life-threatening condition characterized by hyperadrenergic activity and autonomic dysfunction. Also termed autonomic storms, PSH can occur after a variety of cerebral insults, most commonly traumatic brain injury. Limited pediatric literature is available, especially in patients with brain injury from hypoxia. No consensus exists for the terminology, diagnostic criteria, or treatment algorithm for PSH. Thus, the optimal management, including medication selection and dosing, remains unclear. We present the detailed treatment of a 9-year-old, African American male with hypoxic brain injury after pulseless arrest following status asthmaticus, who subsequently developed PSH. The patient began to experience episodes of tachycardia, hypertension, tachypnea, diaphoresis, rigidity, and dystonic posturing on hospital day 5. After ruling out other potential causes, a diagnosis of PSH was made. Episodes of PSH failed to respond to lorazepam or labetalol but were aborted successfully with morphine. Management of PSH after hypoxic brain injury required medications for acute treatment as well as for prevention of PSH. Morphine was found to be highly effective and safe for aborting the autonomic crises. Other agents more commonly described in the literature did not result in an adequate response and were associated with significant adverse effects. A combination of clonazepam, baclofen, and either propranolol or clonidine aided in reducing the frequency of episodes of PSH. We suggest using morphine for aborting severe episodes of PSH that do not respond to antihypertensive agents or benzodiazepines.

Effect of in-office bleaching with 35% hydrogen peroxide with and without addition of calcium on the enamel surface.

This study aimed to evaluate effectiveness and effects of bleaching with 35% hydrogen peroxide with and without calcium on color, micromorphology, and the replacement of calcium and phosphate on the enamel surface. Thirty bovine enamel blocks (5.0 × 5.0 mm) were placed into the following groups: G1: artificial saliva (control); G2: 35% hydrogen peroxide gel without calcium (Whiteness HP Maxx-FGM); and G3: 35% hydrogen peroxide gel with calcium (Whiteness HP Blue-FGM). Three color measurements were performed with a spectrophotometer: untreated (baseline), after performing staining, and after application of bleaching agents. Calcium deposition on the enamel was evaluated before and after the application of bleaching agents using energy-dispersive X-ray spectrometry. The enamel surface micromorphology was observed under scanning electron microscopy. The pH of each product was measured. The data were subjected to one-factor analysis of variance (ANOVA), and any differences were analyzed using Tukey's test (P < 0.05). G3 showed greater variation in total color after the experiment than G2 and G1; there was no significant difference in calcium or phosphorus concentration before and after the experimental procedures; morphological changes were observed only in G2 and G3; and the pH values of the Whiteness HP Maxx and Whiteness HP Blue bleaching agents were 5.77 and 7.79, respectively. The 35% hydrogen peroxide with calcium showed greater bleaching potential, but the addition of calcium had no effect in terms of reducing morphological changes or increasing the calcium concentration on the enamel surface.

Antiparasitic drugs and lactation: focus on anthelmintics, scabicides, and pediculicides.

Infections involving helminths or parasitic worms affect more than 25% of the population worldwide. Because lactating women and their infants are often affected by the complications of these infections such as iron deficiency anemia and malnutrition, they benefit the most from drug therapy. However, scientific literature offers little information regarding transfer of anthelmintics in breast milk and its effects in lactating infants. Scabies and pediculosis, or lice, are common skin infections affecting school-aged children. Close contacts of infected children, which often include lactating mothers, need treatment with one of the several topical products available in the market. This article will review the physicochemical properties and use of anthelmintics, pediculicides, and scabicides while breastfeeding.