Aerosol-generating procedures and associated control/mitigation measures: Position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association.

Background: Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosolgenerating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the evidence of the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods: The authors searched 6 databases-MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar-for relevant scientific evidence published between January 2012 and December 2022 to answer 6 research questions about the risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results: A total of 78 studies fulfilled the eligibility criteria. The literature on the risk of infection transmission including SARS-CoV-2 between dental hygienists and their patients is limited. Although several mouthrinses are effective in reducing bacterial contaminations in aerosols, their effectiveness against SARS-CoV-2 is also limited. The combined use of eyewear, masks, and face shields is effective in preventing contamination of the facial and nasal region while performing AGPs. High-volume evacuation with or without an intraoral suction, low-volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories is effective in limiting the spread of aerosols. Discussion and Conclusion: Aerosols produced during clinical procedures can pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence will ensure greater patient and provider safety in oral health settings. More studies in oral health clinical environments would shape future practices and protocols, ultimately to ensure the delivery of safe clinical care.

Contexte: Depuis l'éclosion de la COVID-19, la façon de réduire le risque de propagation de virus et d'autres microorganismes tout en effectuant des interventions générant des aérosols (IGA) est devenue un enjeu complexe au sein des communautés de la médecine dentaire et de l'hygiène dentaire. L'objectif de cet exposé de position est de résumer les données probantes de l'efficacité des diverses méthodes d'atténuation utilisées pour réduire le risque de transmission des infections pendant les IGA en médecine dentaire. Méthodes: Les auteurs ont effectué des recherches dans MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library et Google Scholar pour trouver des preuves scientifiques pertinentes publiées entre janvier 2012 et décembre 2022 afin de répondre à 6 questions de recherche sur le risque de transmission, les méthodes, les dispositifs et l'équipement de protection individuelle (EPI) utilisés pour réduire le contact avec les agents pathogènes microbiens et limiter la propagation des aérosols. Résultats: Au total, 78 études ont satisfait aux critères d'admissibilité. La documentation est limitée en ce qui concerne le risque de transmission des infections, y compris le SRAS-CoV-2, entre les hygiénistes dentaires et leurs patients. Bien que plusieurs rince-bouches soient efficaces pour réduire la contamination bactérienne dans les aérosols, leur efficacité contre le SRAS-CoV-2 est limitée. L'utilisation combinée de lunettes, de masques et d'écrans faciaux est efficace pour prévenir la contamination de la région faciale et nasale lors de l'exécution d'IGA. L'évacuation à volume élevé avec ou sans aspiration intraorale, l'évacuation à faible volume, l'aspirateur de salive et la digue dentaire en caoutchouc (le cas échéant) ont démontré une efficacité à réduire la transmission des aérosols au-delà du site de production. Enfin, la combinaison appropriée de ventilation et de filtration dans les salles de traitement dentaire permet de limiter efficacement la propagation des aérosols. Discussion et conclusion: Les aérosols produits lors des interventions cliniques peuvent présenter un risque de transmission des infections entre les hygiénistes dentaires et leurs patients. La mise en oeuvre de pratiques appuyées par les données probantes disponibles assurera une plus grande sécurité des patients et des prestataires dans les milieux de santé buccodentaire. Un plus grand nombre d'études dans les environnements cliniques de santé buccodentaire permettrait de façonner les pratiques et les protocoles futurs dans le but d'assurer la prestation sécuritaire des soins cliniques.

Aerosol Generating Procedures and Associated Control/Mitigation Measures: A position paper from the Canadian Dental Hygienists Association and the American Dental Hygienists' Association.

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry.Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols.Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols.Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery.

Takotsubo syndrome as an acute cardiac complication following combined chemotherapy.

Background: Acute cardiac complications post-chemotherapy is rare. Stress cardiomyopathy, one of these complications, should be considered in differential diagnoses as its symptoms closely resemble those of acute myocardial infarction and can lead to mortality. Objective: The objective of this paper is to describe Takotsubo syndrome (TTS) as an acute complication following combined chemotherapy in a patient with significant thromboembolic burden and metastatic cervical cancer. Case: A 61-year-old female patient with a diagnosis of metastatic cervical cancer experienced acute chest pain. Elevated troponin levels and abnormalities in the electrocardiogram initially suggested an acute myocardial infarction, occurring after a chemotherapy session involving Carboplatin and Paclitaxel infusion. Although initial treatment targeted myocardial infarction, further diagnostic evaluations including coronary angiography and cardiac magnetic resonance imaging revealed no coronary artery disease but identified features consistent with stress cardiomyopathy, indicative of Takotsubo syndrome (TTS). This diagnosis led to an improvement in symptoms and a resolution of the acute changes observed. Conclusion: Stress cardiomyopathy, particularly TTS, is being increasingly recognized as an acute complication associated with combined chemotherapy regimens. The potential cardiotoxic effects of these chemotherapy agents demand careful monitoring and evaluation in patients undergoing oncological treatment, underscoring the importance of integrating cardioprotective strategies into the management of these patients.

The Latin America and the Caribbean search strategy proposal.

Latin America and the Caribbean's public health literature is not widely recognized. Science in this region has even been compared to a night sky with just a few specks of light. To make those lights as reachable as possible, we developed the Latin America and the Caribbean Search Strategy (LACSS). This is a new method to utilize our region's health promotion results within MEDLINE/PubMed. In contrast to a typical MeSH query, LACSS retrieves up to six times more publication results regarding non-communicable diseases, neglected tropical diseases, injuries and other important public health relevant topics in the region. We believe that global health promotion will be improved in this region by improving its visibility, and this search strategy will contribute to this.

La implementación de procedimientos estandarizados en la prevención de enfermedades transmitidas por los alimentos. Conteo microbiológico del Staphylococcus aureus en quesos frescos / Implementation of standardized procedures to prevent diseases transmitted by foodstuffs. Microbiological count of Staphylococcus aureus in freshcheese

Introducción: las enfermedades transmitidas por alimentos son una problemática mundial a la que la Organización Mundial de la Salud y los países brindan una atención especial. Dentro de los grupos de alto riesgo se encuentran los productos de origen animal, como la leche y sus derivados. Staphylococcus aureus es un microorganismo causante de brotes de las enfermedades transmitidas por alimentos, lo que genera la necesidad de estudiar la carga microbiana y establecer los controles adecuados. Objetivo: evaluar la calidad microbiológica en el proceso manufacturero en el área de producción de la Cooperativa de Producción Agropecuaria Chone LTDA, con el fin de asegurar la ausencia del Staphylococcus aureus en el queso fresco 100% chonero. Materiales y métodos: Se realizó un estudio de evaluación de la calidad en cuatro fases. Se realizaron exámenes microbiológicos iniciales, se identificaron las causas esenciales de contaminación identificadas por observación directa, revisión de documentos y entrevistas, como base para la elaboración e implementación de POE (Procedimientos Operativos Estandarizados) y POES (Procedimientos Operativos Estandarizados de Saneamiento). Se cumplieron los requerimientos éticos y se realizaron los análisis estadísticos utilizando porcentaje e índices como medida resumen y con el uso de IBM SPSS, versión libre, realizándose regresión logística binaria para determinar la probabilidad de éxito al aplicar dichos procedimientos. Resultados: los análisis microbiológicos iniciales (antes de implementación de POE y POES), dieron como resultado: 98, 116, 79, 120 y 13 UFC/g para las muestras: DiQ1, DiQ2, DiQ3, DiQ4 y DiQ5, respectivamente. Las causas esenciales de contaminación fueron falta de control microbiológico, falta de control del aspecto del personal y falta de control del agua) Una vez implementados los POE y POES, el análisis mostró ausencia en todas las muestras analizadas. Conclusiones: se concluye que la aplicación de POE y POES tiene un efecto significativo sobre la ausencia del Staphylococcus aureus, con probabilidad de éxito del 100% (AU).

Introduction: Diseases transmitted by foodstuffs (DTF) are a worldwide problem that receives special attention by WHO and different countries. High risk groups include foodstuff of animal origin, like milk and its by-products. Staphylococcus aureus is a microorganism responsible for DTF outbreaks which generates the necessity of studying its microbial burden and establishing the adequate controls. Objective: to evaluate the microbiological quality of the manufacturing process in the production area of the Farming and Stockbreeding Cooperative Chone LTDA, to assure the absence of Staphylococcus aureus in the manufacturing process of fresh cheese. Materials and methods: A study to assess the quality in four stages was carried out: initial microbiological tests, identification of the essential contamination causes by direct observation, documental review and inquires. They were used to elaborate and implement the Standardized Operational Procedures (SOP) and the Standardized Operational Procedures of Sanitation (SOPS). The ethical requirements were fulfilled and the statistical tests were performed using percentages and indexes as summary measures through IBM SPSS, free version; binary logistic regression was made to determine the success when applying those procedures. Results: initial microbiological controls (before implementing SOP and SOPS) gave these results 98, 116, 79, 120, and 13 UFC/g for samples DiQ1, DiQ2, DiQ3, DiQ4 and DiQ5 respectively. The main contamination causes were lack of microbiological control, lack of control on the staff's cleanliness and lack of control on the water. After implementing SOP and SOPS microbiological control found particularly clean samples. Conclusions: SOP and SOPS have a significant effect on the amount of Staphylococcus aureus, with 100% success probability (AU).

Video Caso Clínico: Estimulación Vagal Directa Como Maniobra Electrofisiológica Alternativa en el Diagnóstico de Taquicardia Durante Estudio Electrofisiológico / Case Report: Direct Vagal Stimulation as Alternative Electrophysiological Procedure in the Diagnosis of Tachycardias During Electrophysiological Study

INTRODUCCIÓN: El síndrome de Wolff Parkinson White se caracteriza por la conexión anómala entre la aurícula y el ventrículo durante el paso del estímulo sinusal, generalmente causada por una vía accesoria que conecta el músculo auricular con el músculo ventricular llamado haz de Kent, caracterizándose por la presencia de síntomas como: palpitaciones, sincope o muerte súbita y sumado a la presencia de onda delta, intervalo PR corto, QRS ancho y alteraciones de la repolarización ventricular en el electrocardiograma. El estudio electrofisiológico tiene como objetivo confirmar la presencia, localización y características de este haz anómalo y posteriormente, con seguridad, proceder a la ablación por radiofrecuencia eliminando esta vía accesoria, siendo considerado un procedimiento curativo en el caso del síndrome de Wolff Parkinson White. Durante el estudio se realiza estimulaciones eléctricas en los sitios específicos, tanto de la aurícula como del ventrículo, además se utiliza medicación intravenosa como la adenosina que actúa bloqueando al nódulo aurículoventricular y así observar el paso residual de la estimulación sinusal normal y/o el paso retrogrado del estímulo ventricular hacia la aurícula a través del haz de Kent, permitiendo de esta forma analizar las características de las conexiones aurículoventriculares previo a la ablación. La posibilidad de realizar una estimulación vagal selectiva de alta frecuencia y baja amplitud a nivel infraorbitario, descrita por Pachón et al [1], a través de la vena yugular interna y el consecuente bloqueo aurículoventricular transitorio que esta ocasiona, permite realizar el estudio sin necesidad de utilizar otras maniobras electrofisiológicas o medicación endovenosa

BACKGROUND: Wolff Parkinson White Syndrome is characterized by the bypass of the electrical signal through an abnormal pathway, different from the atrioventricular node that connects the atrial and ventricular muscles (Bundle of Kent). It presents with palpitations, syncope or can even cause sudden death. Electrocardiogram findings consist on Delta waves, shortened PR interval, widened QRS complex and altering of the ventricular repolarization. In the presence of Ventricular pre-excitation (Wolff Parkinson White Syndrome), the electrophysiological testing is key to confirm the presence, site and features of this accessory pathway. Later, with the certainty of the diagnosis proceed to perform the Radiofrequency Ablation, the definitive treatment to eliminate this abnormal pathway. This test is usually done with the use of electrophysiological maneuvers, stimulating key sites in the atria and the ventricle, with the help of intravenous drugs like Adenosine. The objective is to block the AV node to look how the remnants of the normal electrical signal move through the abnormal pathway, thus letting the physician analyze the characteristics previously mentioned of this pathway. After the ablation, these maneuvers are repeated to confirm the complete elimination of the accessory pathway that has direct relation with the prognostic. Based on the possibility of high frequency and low amplitude selective vagal stimulation described by Pachón et al [1], at infraorbital level through the internal jugular vein and the resulting transitory atrioventricular block. It is possible to study the abnormal pathway without the need of electrophysiological maneuvers or the use of IV drugs, either pre or post ablation.

MEBO: una nueva alternativa en el tratamiento de las quemaduras / MEBO: a new alternative in the treatment of the burns

Recientemente, estudios experimentales, así como experiencias clínicas soportan la creencia que las lesiones cicatrizan mejor en el medio húmedo creado por los vendajes oclusivos. En virtud de sus ingredientes activos y fórmula especial, MEBO aisla el lecho de la lesión de los factores invasivos medioambientales y reduce la pérdida de líquidos corporales, produce un efecto anti-inflamatorio y anti-edema, reduce el dolor tremendamente, controla la invasión por bacterias y hongos, mejora la cicrocirculación y así recupera a la células semi-viables y promueve cicatrización con mínimas ecaras y aceptables resultados estéticos. El objetivo del presente estudio fue explorar la efectividad terapéutica de MEBO en el manejo de las quemaduras...