Tasas de suicidio y concentración de litio en agua corriente en Rocha y Montevideo. Primer estudio en Uruguay, período 2019-2020

El suicidio es un fenómeno que además de las pérdidas humanas que involucra, repercute negativamente en familiares y allegados, produciendo a su vez enormes gastos en el sistema sanitario. En Uruguay, la tasa de suicidio no solo ha experimentado un aumento sostenido, representando una preocupación constante para las autoridades, sino que suele ser una de la más altas de Latinoamérica, en 2022 fue de 23,08 cada 100.000 habitantes. Reconociendo que el suicidio es un fenómeno multifactorial grave, diversos estudios han indagado sobre la posible correlación entre la presencia de litio en agua corriente y tasas de suicidio, habiéndose observado una relación inversa, lo que permitiría considerar el litio como eventualmente protector de la conducta suicida. El presente estudio pretende abordar dicha correlación en los departamentos de Rocha y Montevideo, de Uruguay. Los resultados obtenidos no son concluyentes. En cuanto a las concentraciones de litio presentes en agua corriente, en general son menores a las señaladas en otros estudios como protectoras (30 µ/L). Es necesario profundizar en este eje de discusión, como en otros, para obtener un diagnóstico más detallado de este complejo y sentido fenómeno.

Suicide is a phenomenon that, in addition to the human losses it involves, has a negative impact on family members and acquaintances, leading to enormous costs in the healthcare system. In Uruguay, the suicide rate has not only experienced a sustained increase, representing a constant concern for authorities, but it also tends to be one of the highest in Latin America, reaching 23.08 per 100,000 inhabitants in 2022. Recognizing that suicide is a serious multifactorial phenomenon, several studies have investigated the possible correlation between the presence of lithium in tap water and suicide rates, noting an inverse relationship. This suggests that lithium could potentially be considered protective against suicidal behavior. This study aims to address this correlation in the departments of Rocha and Montevideo, Uruguay. The results obtained are inconclusive. Regarding the concentrations of lithium present in tap water, they are generally lower than those indicated in other studies as protective (30 µg/L). It is necessary to delve deeper into this axis of discussion, as in others, to obtain a more detailed diagnosis of this complex and profound phenomenon.

O suicídio é um fenómeno que, além das perdas humanas que envolve, tem um impacto negativo nos familiares e amigos, produzindo enormes gastos no sistema de saúde. No Uruguai, a taxa de suicídio não só tem registado um aumento sustentado, representando uma preocupação constante para as autoridades, mas geralmente é uma das mais altas da América Latina, sendo de 23,08 por 100.000 habitantes em 2022. Reconhecendo que o suicídio é um fenómeno multifatorial grave, vários estudos têm investigado a possível correlação entre a presença de lítio na água encanada e as taxas de suicídio; observa-se uma relação inversa, o que permitiria considerá-lo como um possível protetor do comportamento suicida. O presente estudo visa abordar esta correlação nos departamentos de Rocha e Montevidéu no Uruguai. Os resultados obtidos não são conclusivos. Quanto às concentrações de litio presentes na água corrente, são geralmente inferiores às indicadas em outros estudos como protetoras (30 µ/L). É necessário aprofundar esta área de discussão como em outras linhas de pesquisa, e obter um diagnóstico mais detalhado deste fenômeno complexo e significativo.

Dress por litio: reporte de un caso pediátrico / Lithium dress: a pediatric case report / Dress por Lítio: relato de caso pediátrico

La reacción a medicamentos con eosinofilia y síntomas sistémicos denominada DRESS(por sus siglas en inglés, Drug Reaction with Eosinophilia and Systemic Symptoms) hace parte de un amplio espectro denominado toxicodermias. La incidencia exacta no es conocida en niños; sin embargo, en la literatura se ha estimado una tasa de mortalidad que puede llegar a ser tan alta como el 10 %. Presentamos el caso de una paciente adolescente con antecedente personal de trastorno afectivo bipolar (TAB), quien recibía de forma ambulatoria sertralina, quetiapina y trazodona. Por presencia de alucinaciones se adicionó litio al manejo. Diez días después acude al servicio de urgencias por aparición de erupción cutánea y síntomas sistémicos, por lo que se sospechó un cuadro clínico secundario a hipersensibilidad a los medicamentos.

The reaction to drugs with eosinophilia and systemic symptoms called DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) is part of a broad spectrum called toxicodermias. The exact incidence is not known in children; However, a mortality rate that can be as high as 10% has been estimated in the literature. We present the case of a teenage patient with a personal history of bipolar affective disorder (BD), who received sertraline, quetiapine and trazodone on an outpatient basis. Due to the presence of hallucinations, lithium was added to the management. Ten days later she went to the emergency department due to the appearance of a skin rash and systemic symptoms, for which a clinical condition secondary to hypersensitivity to medications was suspected.

A reação a medicamentos com eosinofilia e sintomas sistêmicos denominada DRESS (Por suas siglas em inglês Drug Reaction with Eosinophilia and Systemic Symptoms) faz parte de um amplo espectro denominado toxicodermias. A incidência exata não é conhecida em crianças; No entanto, uma taxa de mortalidade que pode chegar a 10% foi estimada na literatura. Apresentamos o caso de um paciente adolescente com história pessoal de transtorno afetivo bipolar (TAB), que recebeu sertralina, quetiapina e trazodona em regime ambulatorial. Devido à presença de alucinações, foi adicionado lítio ao manejo. Dez dias depois, recorreu ao pronto-socorro devido ao aparecimento de erupção cutânea e sintomas sistêmicos, suspeitando-se de quadro clínico secundário a hipersensibilidade a medicamentos.

Marginal gap of zirconia and lithium disilicate frameworks produced by the CAD-CAM technique through a comparator microscope ­ in vitro analysis / Fenda marginal de estruturas de zircônia e dissilicato de lítio produzidas pela técnica CAD-CAM através de um microscópio comparador ­ análise in vitro

Objective: The aim of this study was to evaluate the marginal gap of frameworks produced using the CAD-CAM system, from zirconia and lithium disilicate blocks, adapted to a tooth preparation and a gypsum die. Material and Methods: For this study, a human first molar tooth was used as a master model with a full crown preparation. It was molded 20 times to obtain the gypsum die and randomly divided into 2 groups (n=10) for the fabrication of zirconia and lithium disilicate frameworks. The frameworks were made using pre-sintered zirconia blocks and lithium disilicate blocks, both CAD-CAM systems. The marginal gap was measured in µm at four points (buccal, palatal, mesial, and distal) using a comparator microscope with 30x magnification, with the framework seated on the master model (tooth), and on the gypsum die. Marginal gap data (µm) were evaluated using two-way analysis of variance and Tukey's test with a significance level of 5%. Results: The results showed that there was no statistically significant interaction between the factors studied (p=0.223) or isolated factors (ceramic factor p=0.886 and die factor p=0.786). Conclusion: Both ceramics produced using the CAD-CAM technique did not exhibit statistical differences in marginal adaptation on the two types of substrates, both on tooth preparation and on the gypsum die (AU)

Objetivo: O objetivo deste estudo foi avaliar o espaço marginal de estruturas produzidas usando o sistema CAD-CAM, a partir de blocos de zircônia e dissilicato de lítio, adaptadas a um preparo sobre dente e a um troquel de gesso. Material e Métodos: Para este estudo, um dente molar humano foi utilizado como modelo mestre com preparo para coroa total. Este foi moldado 20 vezes para obter o troquel de gesso e dividido aleatoriamente em 2 grupos (n=10) para a fabricação de estruturas de zircônia e dissilicato de lítio. As estruturas foram feitas usando blocos de zircônia pré-sinterizados e blocos de dissilicato de lítio, ambos sistemas para CAD-CAM. O espaço marginal foi medido em µm, em quatro pontos (bucal, palatal, mesial e distal), utilizando um microscópio comparador com ×30 de ampliação e com a estrutura assentada no modelo mestre (dente) e no troquel de gesso. Os dados de espaço marginal (µm) foram avaliados usando análise de variância bidirecional e teste de Tukey com um nível de significância de 5%. Resultados: Os resultados mostraram que não houve interação estatisticamente significativa entre os fatores estudados (p=0,223) ou isoladamente (fator cerâmica p=0,886 e fator troquel p=0,786). Conclusão: Ambas as cerâmicas produzidas usando a técnica CAD-CAM não apresentaram diferenças estatísticas em relação à adaptação marginal nos dois tipos de substratos, tanto na preparação dentária quanto no troquel de gesso(AU)

Clinical application of lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture in the restoration of single anterior tooth loss / 口腔疾病防治

Objective@#To investigate the clinical effect of lithium disilicate glass ceramic cantilever resin-bonded fixed partial dentures (CRBFPDs) on single anterior tooth loss to provide a reference for the selection of restoration methods for single anterior tooth loss.@*Methods@#This study was reviewed and approved by the Ethics Committee, and informed consent was obtained from the patients. Forty-two patients with less than two anterior teeth with monomaxillary loss were included in this study. After 6 months, 1 year, 2 years, and 3 years, the aesthetic and functional effects of the restorations and the periodontal health status were evaluated, and the visual analog scale (VAS) was used to assess patient satisfaction.@*Results@#During the observation period, the connector fractured in one case within 3 months. One case had debonded within 2 years. The aesthetic restoration effect of all lithium disilicate glass ceramic CRBFPDs was categorized as Class A. The periodontal health was good, there was no clinical absorption in the soft and hard tissues of the abutment or subbridge, periodontal status according to the evaluation indices was classified as class A, and the total satisfaction rate of the patient was 100%.@*Conclusion@#For single anterior tooth loss patients, lithium disilicate glass ceramic cantilever resin-bonded fixed partial denture can achieve the restoration effect of less invasion, better adhesion, aesthetics, comfort and good biocompatibility. With high patient satisfaction, it can be considered an ideal restoration method for replacing a single anterior tooth.

Kidney function among male workers of a lithium-ion battery-related enterprise in Shanghai / 环境与职业医学

Background Under the guidance of achieving carbon peaking and carbon neutrality goals, the demand for lithium-ion batteries has increased significantly. However, during the production, use, and maintenance of lithium-ion batteries, workers are inevitably exposed to various occupational hazards, and some chemicals are nephrotoxic. Objective To evaluate the kidney function and potential determinants among male workers in a lithium-ion battery-related enterprise in Shanghai. Methods The data of occupational health examination carried out by an occupational disease prevention and control institution for workers in a lithium-ion battery-related enterprise in Shanghai were collected. The workers participating pre-employment occupational health examination were treated as a control group, and the other group was recruited from those participating periodic health examination. Serum creatinine, urea nitrogen, uric acid, and renal ultrasound were used to assess the kidney function of workers. Kidney function was classified according to the reference range of kidney function indicators in Diagnostics (9th Edition, national planning textbook for high education in medicine). Binary logistic regression and generalized linear regression were used to identify potential determinants of abnormal values in kidney function indicators in workers. Results There were 6184 workers in the control group (pre-employment) with a mean age of (27.40±4.50) years. There were 3526 workers on the job with a mean age of (29.40±4.99) years and the median time of service was 2.00 (1.00, 3.42) years. The prevalence rates of high serum creatinine, high urea nitrogen, and high uric acid, and abnormal kidney ultrasound among the control group were 0.66%, 2.47%, 30.32%, and 10.12%, respectively; the indicators in the on-the-job workers were 0.96%, 3.35%, 38.25%, and 12.68%, respectively, significantly higher than those in the control group (P<0.05). After adjusting for worker age, length of service, smoking status, drinking status, hypertension, and hyperglycemia, the binary logistic regression models showed that regular smokers had a higher risk of high urea nitrogen than nonsmokers (OR=1.411, 95%CI: 1.011, 1.969). The risk of high uric acid was lower in older workers (OR=0.966, 95%CI: 0.953, 0.979), and higher in workers with more years of service (≤1 year, OR=1.295, 95%CI: 1.093, 1.534; >1-3 years, OR=1.747, 95%CI: 1.494, 2.042; >3 years, OR=1.866, 95%CI: 1.511, 2.304), hypertension (OR=1.400, 95%CI: 1.055, 1.859), and hyperglycemia (OR=1.565, 95%CI: 1.221, 2.006). Workers who were older (OR=1.038, 95%CI: 1.022, 1.054) and had longer working years (>1-3 years, OR=1.518, 95%CI: 1.201, 1.920), occasional smoking habits (OR=1.239, 95%CI: 1.039, 1.478), regular drinking habits (OR=1.875, 95%CI: 1.139, 3.087), and hypertension (OR=1.465, 95%CI: 1.075, 1.998) were at a higher risk of renal ultrasound abnormalities. The generalized linear models showed that length of service (>1-3 years, β=1.120, 95%CI: 0.360, 1.880; >3 years, β=1.451, 95%CI: 0.543, 2.358), smoking status (occasional, β=0.818, 95%CI: 0.156, 1.479; regular, β=0.841, 95%CI: 0.066, 1.616), and hypertension (β=2.742, 95%CI: 1.390, 4.094) were the influencing factors of serum creatinine concentration in the workers. Age (β=0.014, 95%CI: 0.009, 0.019) and length of service (>1-3 years, β=0.079, 95%CI: 0.012, 0.146) were the influencing factors of urea nitrogen. Age (β=−1.759, 95%CI: −2.288, −1.231), length of service (≤1 year, β=10.676, 95%CI: 4.035, 17.316; >1-3 years, β=26.117, 95%CI: 19.962, 32.272; >3 years, β=34.558, 95%CI: 26.116, 43.001), hypertension (β=23.162, 95%CI: 11.617, 34.707), and hyperglycemia (β=15.017, 95%CI: 4.853, 25.180) were the influencing factors of uric acid. Conclusion The prevalence of abnormal kidney function of workers in selected lithium-ion battery-related enterprise is varied by age, length of service, smoking status, drinking status, hypertension, and hyperglycemia. There may be a trend that the longer the time working in a lithium-ion battery-related enterprise, the worse the workers' kidney function. Therefore, the enterprise should pay attention to the possible reasons for their changes and take targeted interventions.

Hemodynamics and arrhythmia disorder caused by lithium poisoning:A case report / 中南大学学报(医学版)

Bipolar affective disorder refers to a category of mood disorders characterized clinically by the presence of both manic or hypomanic episodes and depressive episodes.Lithium stands out as the primary pharmacological intervention for managing bipolar affective disorder.However,its therapeutic dosage closely approaches toxic levels.Toxic symptoms appear when the blood lithium concentration surpasses 1.4 mmol/L,typically giving rise to gastrointestinal and central nervous system reactions.Cardiac toxicity is rare but serious in cases of lithium poisoning.The study reports a case of a patient with bipolar affective disorder who reached a blood lithium concentration of 6.08 mmol/L after the patient took lithium carbonate sustained-release tablets beyond the prescribed dosage daily and concurrently using other mood stabilizers.This resulted in symptoms such as arrhythmia,shock,impaired consciousness,and coarse tremors.Following symptomatic supportive treatment,including blood dialysis,the patient's physical symptoms gradually improved.It is necessary for clinicians to strengthen the prevention and recognition of lithium poisoning.

Three-dimensional finite element analysis of distal proximal occlusal defect of short crown molar restored with endocrown / 中国组织工程研究

BACKGROUND:For teeth with normal dental crown height,pulp cavity retention crown restoration with different depths of the pulp cavity and different repair materials affects the stress and flexural strength of tooth tissue.For short crown molar defects,the research on pulp cavity repair mainly focuses on clinical observation and in vitro flexural strength experiments. OBJECTIVE:To establish a three-dimensional finite element model for short crown molar restored by the endocrown after root canal treatment to analyze the effects of different pulp cavity retention depths and different repair materials on the distribution and size of dentin equivalent stress. METHODS:Based on establishing the complete model of the short crown mandible first molar,a three-dimensional finite element model was established for repairing the distal adjacent defect of the short crown molar with different pulp cavity retention depths(h=2,3,4 mm)and different repair materials(zirconia,lithium disilicate).Under the oblique loading,the equivalent stress distribution was observed.The peak value of dentin equivalent stress and the mean value of equivalent stress near the bottom of the mesial pulp cavity wall were calculated. RESULTS AND CONCLUSION:(1)Equivalent stress concentration areas:The stress of complete short crown molar and restored models mainly concentrated in the mesial root mesial neck and mesial root lingual neck.The stress concentration area was found in the mesial pulp cavity wall corresponding to the bottom layer of restored models,and the stress concentration was obvious in the 4 mm retention depth group.(2)Under the same repair material,the peak value of dentin equivalent stress was the lowest at 3 mm for all models after repair.The average value of equivalent stress near the bottom of the mesial pulp cavity wall was lowest at 3 mm.(3)Under the same retention depth,there was no significant difference between the two materials in the dentin equivalent stress peak and the mean value near the bottom of the mesial pulp cavity.(4)The results showed that under the conditions of this experiment,the endocrown was used to repair the defect of the short crown molar and the retention depth was 3 mm,which was more beneficial to protect the remaining dental tissue.The selection of zirconia or lithium disilicate as the repair material had little effect on the dentin stress.

Research progress on occupational hazards in lithium battery industry and their health risks / 环境与职业医学

Lithium batteries are widely used in energy storage, power, and other fields due to their advantages such as high performance and low cost. With the rapid development of the lithium battery industry, its production is constantly growing. However, the identification of occupational hazards and assessment of their health risks in lithium battery industry has rarely been reported. The composition of lithium batteries is complex and involves large numbers of compounds. Besides the traditional occupational hazards, workers may be exposed to many emerging chemicals throughout the production of raw materials, assembly and disassembly of lithium batteries. Therefore, this paper introduced the process chain of lithium battery production, analyzed the underlying occupational hazards in the industry, reviewed the health impacts of typical occupational hazards, and proposed the future research needs according to the current status of research on occupational exposure and health hazards in the lithium battery industry.

Long-term effect of firing protocols on surface roughness and flexural strength of lithium disilicate glass-ceramic

Abstract This study evaluated the effect of different firing protocols on the surface roughness and flexural strength of CAD/CAM lithium disilicate glass-ceramic (LD) after aging methods. Forty-two LD bars of 16 x 4 x 2 mm (IPS e-max CAD, Ivoclar) were randomly separated into two groups according to firing protocols: Single firing-Staining, glazing, and crystallization in a single step; Multiple firings-Crystallization+First staining+Firing+Second staining+Firing+Glazing+Firing. After protocols, initial surface roughness readings were taken (Surfcorder SE1700, Kosakalab). Samples were then randomly separated into three groups (n=7) according to the aging methods they were submitted: Thermomechanical cycling (TMC, ER System, Erios, 1,200,000 cycles, 0.3 MPa, 2 Hz and 5°C/37°C/55°C, 30 s swell time); Simulated toothbrushing (STB, Pepsodent, MAVTEC, 73,000 cycles), and Control (no aging). Final surface roughness readings were done, and samples were submitted to a three-point bending test (OM100, Odeme Dental Research) and fractographic analysis by scanning electron microscopy (EVO-MA10, ZEISS). Data were analyzed (2-way ANOVA, (α=.05). There was no difference (p>.05) in the flexural strength between the firing protocols, regardless of the aging method. STB decreased the flexural strength of samples submitted to multiple firings, different from control (p<.05). Without aging (Control), before TMC, and after STB, LD had lower surface roughness when submitted to multiple firings than to single firing (p<.05). The firing protocols did not affect the flexural strength or the surface roughness of the lithium disilicate glass-ceramic, even after aging. However, toothbrushing negatively affected the flexural strength and smoothed the surface of the ceramic submitted to multiple firings.

Resumo Este estudo avaliou o efeito de diferentes protocolos de queima na rugosidade de superfície e resistência à flexão de uma cerâmica vítrea de dissilicato de lítio (DL) para CAD/CAM, após métodos de envelhecimento. Quarenta e dois barras de DL (IPS e-max CAD, Ivoclar) de 16 x 4 x 2 mm foram separadas aleatoriamente em dois grupos de acordo com os protocolos de queima: Single firing-Pigmentação, glazeamento e cristalização em única etapa. Multiple firings-Cristalização+Primeira camada do pigmento+Queima+Segunda camada do pigmento+Queima+Glazeamento+Queima. Após os protocolos, foram realizadas leituras iniciais de rugosidade de superfície (Surfcorder SE1700, Kosakalab). As amostras foram então separadas aleatoriamente em três grupos (n=7) segundo o método de envelhecimento a que foram submetidas: Ciclagem termomecânica (CTM, Sistema ER, Erios, 1.200.000 ciclos, 0.3 MPa, 2 Hz e 5°C/37°C/55°C, 30 s de imersão), Escovação simulada (ES, Pepsodent, MAVTEC, 73.000 ciclos) e Controle (sem envelhecimento). Leituras finais de rugosidade foram realizadas, e as amostras foram submetidas ao ensaio de resistência à flexão em três pontos (OM100, Odeme Dental Research) e à análise fractográfica por microscopia eletrônica de varredura (EVO-MA10, ZEISS). Os dados foram analisados (ANOVA de dois fatores, (α=.05). Não houve diferença (p>.05) na resistência à flexão entre os protocolos de queima, independente do envelhecimento. ES diminuiu a resistência à flexão das amostras submetidas a multiple firings, diferente do controle (p<.05). Sem envelhecimento (Controle), antes da CTM e após ES, LD apresentou menor rugosidade de superfície quando submetido a multiple firings do que a single firing (p<.05). Os protocolos de queima não afetaram a resistência à flexão nem a rugosidade de superfície da cerâmica vítrea de dissilicato de lítio, mesmo após envelhecimento. No entanto, a escovação afetou negativamente a resistência à flexão e poliu a superfície da cerâmica submetida a multiple firings.

Rehabilitación del sector anterior con disilicato de litio. Relato de un caso / Rehabilitation of the previous sector with lithium disilicate. Case report

Mediante este caso se describen los criterios de selección del color en restauraciones indirectas con disilicato de litio en el sector anterior. Mujer de 34 años, atendida en la Facultad de Odontología de la Universidad Nacional de Concepción (FOUNC), Paraguay, por una preocupación estética del sector anterior, en especial la diferencia de color de las piezas dentarias. La rehabilitación consistió en la confección de coronas de disilicato de litio de las piezas 11, 12, 13, 14, 21, 22, 24, 25 y laminado para carillas de la pieza 23. Fueron aplicadas técnicas de selección de color individualizadas, pruebas de color y cementación antes del cementado final para obtener resultados altamente estéticos. Gracias a los resultados fue posible observar la conjunción de factores como la correcta selección del color del sustrato dentario, el cemento resinoso, el material de restauración y la comunicación eficiente con el laboratorio, fundamental para el éxito del tratamiento.

This case describes the color selection criteria for indirect lithium disilicate restorations in the anterior sector. A 34-year-old woman treated at the Faculty of Dentistry of the National University of Concepción (FOUNC), Paraguay, due to an aesthetic concern in the anterior sector, especially the difference in color of the teeth. The rehabilitation consisted of making lithium disilicate crowns for teeth 11, 12, 13, 14, 21, 22, 24, 25 and laminate for veneers for tooth 23. Individualized color selection techniques, color and cementation prior to final cementation for highly esthetic results. Thanks to the results, it was possible to observe the conjunction of factors such as the correct selection of the color of the dental substrate, the resinous cement, the restorative material, and efficient communication with the laboratory, essential for the success of the treatment.

Revisiting global cognitive and functional state 13 years after a clinical trial of lithium for mild cognitive impairment

Objectives: To re-evaluate a sample of older adults enrolled in a randomized controlled trial of lithium for amnestic mild cognitive impairment (MCI) after 11 to 15 years, re-assessing their current (or last available) global cognitive and functional state. Methods: We recalled all former participants of the Lithium-MCI trial conducted by our group between 2009 and 2012 to perform a single-blinded, cross-sectional evaluation of their global clinical state to compare the long-term outcome of those who received lithium vs. those who received placebo. Results: Of the original sample (n=61), we were able to reach 36 participants (59% of retention), of whom 22 had previously received lithium (61% of the recall sample) and 14 (39%) had received placebo. Since 30.5% of the recalled sample was deceased, psychometric data were collected only for 69.5% of the participants. We found statistically significant differences in current mean Mini Mental State Examination score according to previous treatment group (25.5 [SD, 5.3] vs. 18.3 [SD, 10.9], p = 0.04). The lithium group also had better performance in the phonemic Verbal Fluency Test than the control group (34.4 [SD, 14.4] vs. 11.6 [SD, 10.10], p < 0.001). Differences in these measures also had large effect sizes, as shown by Cohen's d values of 0.92 and 1.78, respectively. Conclusion: This data set suggests that older adults with amnestic MCI who had been treated with lithium during a previous randomized controlled trial had a better long-term global cognitive outcome than those from a matched sample who did not receive the intervention.

Research on friction and wear behaviors of silicon-lithium spray coating on zirconia ceramics / 北京大学学报(医学版)

OBJECTIVE@#To study microstructure, friction and wear behaviors of silicon-lithium spray coating on the surface of zirconia ceramics and to preliminarily evaluate its esthetic so as to provide support and guidance for the clinical application.@*METHODS@#Zirconia ceramic specimens were randomly divided into three groups: coating group (two subgroups), polishing group (two subgroups), and glazing group (four subgroups), with 10 samples in each subgroup. The two subgroups of coating group were the zirconia ceramics with the untreated and preliminary polishing surfaces sprayed with silicon-lithium coating, respectively. The two subgroups of polishing group were preliminary polishing and fine polishing of zirconia ceramics, respectively. The four subgroups of glazing group were preliminarily polished zirconia ceramics glazed with Biomic and Stain/Glaze products, respectively; and untreated zirconia ceramics glazed with Biomic and Stain/Glaze products, respectively. The above 8 subgroups of zirconia ceramic specimens were used as friction pairs with 80 steatite ceramics for 50 000 chewing cycles under 50 N vertical load and artificial saliva lubrication using chewing simulation. Scanning electron microscope was used to observe the microstructure of the surface and section of the coating group, and the thickness of the coating and glazing were measured. The linear roughness of the coating and polishing groups was mea-sured using a laser confocal scanning microscope. Vickers hardness was measured using a microhardness tester and the esthetic of zirconia ceramic full crown sprayed with silicon-lithium coating was preliminarily evaluated. White light interferometer was used to measure the width, the maximum depth and the volume of the wear scars of each group, and the wear depth of steatite ceramics and wear rate of zirconia ceramic specimens were calculated. Kruskal-Wallis nonparametric test and Dunn's multiple comparisons test were used to analyze the wear depth of each group (α=0.05).@*RESULTS@#The microstructures of the silica-lithium spray coatings on the untreated and preliminarily polished zirconia ceramic surfaces showed the protruding defects, and the line roughness of coating group was larger than that of the polishing group. The median thickness of the silica-lithium spray coating on the preliminarily polished zirconia ceramic was 13.0 μm (interquartile range, IQR: 11.6, 17.9), while that of the silica-lithium spray coating on the untreated zirconia ceramic was 4.4 μm (IQR: 4.1, 4.7). The Vickers hardness and wear rate of the coating group were between the polishing group and the glazing group. The wear depths of the wear scars of steatite ceramics were the glazing group, coating group, and polishing group in descending order, and there was statistically significant difference between glazing and polishing groups (P < 0.05). With the increase of polishing procedure, the wear depth of steatite ceramics decreased in each subgroups. The orders of maximum depth and volume of wear scars of zirconia ceramic were the glazing group, coating group, and polishing group in descending order, and there was statistically significant difference in the maximum depth of wear scars between glazing and polishing groups (P < 0.05).@*CONCLUSION@#The silica-lithium spray coating on the zirconia ceramic, can be used as a new method for zirconia ceramic surface treatment, because it can increase the esthetic of zirconia ceramics compared with polishing and reduce the wear of steatite ceramics compared with glazing.

Mechanical behavior of different machinable ceramic crowns using vertical and horizontal preparations: an in-vitro study / Comportamento mecânico de diferentes coroas cerâmicas usináveis usando preparos verticais e horizontais: um estudo in vitro

Objective: the aim of this study was to compare the mechanical behavior of different ceramics when used in thin vertical preparations versus traditional horizontal preparation. Material and Methods: two stainless-steel dies were milled to simulate a minimally invasive vertical preparation (VP) and a traditional horizontal preparation (HP) for an all-ceramic crown of a maxillary first premolar. The stainless-steel dies were duplicated using epoxy resin. Eighty monolithic crowns were milled and divided into 2 groups according to preparation design. Each design group was subdivided into 4 sub-groups according to material (n=10): IPS e.max CAD (lithium disilicate), Bruxzir shaded zirconia (full contour zirconia), CeraSmart (resin nanoceramic) and CEREC Tessera (advanced lithium disilicate). The crowns were cemented on their relevant epoxy resin dies using self-adhesive resin cement. All specimens were subjected to 15,000 thermocycles and then loaded to fracture in a universal testing machine. Data were analyzed using two-way ANOVA and Tukey pair wise comparison test. Results: the fracture resistance mean values of the VP (1344 + 118 N) was significantly lower than the HP design (1646 + 191 N). Ceramic crowns made of full contour zirconia had higher fracture resistance mean values (2842 + 380 N) than advanced lithium disilicate (1272 + 125 N) followed by lithium disilicate crowns (983 + 52 N) and resin nanoceramic (882 + 61 N). Conclusion: both vertical and horizontal preparations, regardless the different ceramic materials, showed clinically acceptable fracture resistance values. (AU)

Objetivo: o objetivo deste estudo foi comparar o comportamento mecânico de diferentes cerâmicas quando utilizadas em preparos verticais finos ou preparos horizontais tradicionais. Material e Métodos: dois modelos de aço inoxidável foram fresados para simular um preparo vertical minimamente invasivo (PV) e um preparo horizontal tradicional (PH) para uma coroa totalmente em cerâmica de um primeiro pré-molar superior. As matrizes de aço inoxidável foram duplicadas usando resina epóxi. Oitenta coroas monolíticas foram fresadas e divididas em 2 grupos de acordo com o desenho do preparo. Cada grupo foi subdividido em 4 subgrupos de acordo com o material (n=10): IPS e.max CAD (dissilicato de lítio), zircônia Bruxzir (zircônia de contorno total), CeraSmart (resina nanocerâmica) e CEREC Tessera (dissilicato de lítio avançado). As coroas foram cimentadas em suas respectivas matrizes de resina epóxi usando cimento resinoso autoadesivo. Todos os espécimes foram submetidos a 15.000 ciclos térmicos e então carregados até a fratura em uma máquina de teste universal. Os dados foram analisados usando ANOVA com dois fatores e teste de comparação por pares de Tukey. Resultados: os valores médios de resistência à fratura do PV (1344 + 118 N) foram significativamente menores do que PH (1646 + 191 N). As coroas de cerâmica feitas de zircônia de contorno total apresentaram maiores valores médios de resistência à fratura (2842 + 380 N) do que dissilicato de lítio avançado (1272 + 125 N), seguido por coroas de dissilicato de lítio (983 + 52 N) e resina nanocerâmica (882 + 61 N). Conclusão: preparos verticais e horizontais, independentemente dos diferentes materiais cerâmicos, apresentaram valores de resistência à fratura clinicamente aceitáveis. (AU)

Color stability and degree of conversion of amine-free dual cured resin cement used with two different translucencies of lithium disilicate ceramics / Estabilidade de cor e grau de conversão de cimento resinoso dual sem amina usado com duas translucidezes diferentes de cerâmica de dissilicato de lítio

Objective: The present study aims to evaluate the color stability and degree of conversion of amine-free dual cured resin cement compared to light cured and amine-containing dual cured resin cements used with two different translucencies of thin esthetic restorations. Material and Methods: A total of 120 specimens were prepared for color stability testing (n=60). The specimens were divided into three main groups according to the resin cement type. Group 1: amine-free dual cured, Group 2: light cured, Group 3: amine-containing dual cured. Each group was further subdivided according to the ceramic translucency into two subgroups: high and low translucency. Color stability was assessed by a spectrophotometer before and after thermal aging. For the degree of conversion assessment (n=60), Fourier transform infrared spectroscopy was used at three different time intervals. Statistical analysis was performed using multi-factorial ANOVA, followed by one-way ANOVA with Bonferroni correction. Results: Amine-containing resin cement showed significantly higher ΔEab and ΔE00in both translucencies (4.5±0.3, 3.5±0.3 respectively for high translucency ceramic and 3.8±0.4, 3.0±0.3 respectively for low translucency) than the other tested cements (p<0.001). The highest degree of conversion (DC) was shown after 2 weeks by the amine-free dual cured resin cement (86.27±0.74). Conclusion: Amine-free dual cured resin cement can be an alternative to light cured one for cementation of thin veneers since it showed comparable color stability and high degree of conversion (AU)

Objetivo: O presente estudo tem como objetivo avaliar a estabilidade de cor e o grau de conversão do cimento resinoso dual sem amina em comparação com cimentos resinosos fotopolimerizáveis contendo amina usados com duas translucidezes diferentes em restaurações estéticas definitivas. Material e Métodos: Um total de 120 espécimes foram preparados para teste de estabilidade de cor (n=60). Os espécimes foram divididos em três grupos principais de acordo com o tipo de cimento resinoso. Grupo 1: polimerização dupla sem amina, Grupo 2: fotopolimerização, Grupo 3: polimerização dupla contendo amina. Cada grupo foi ainda subdividido de acordo com a translucidez da cerâmica em dois subgrupos: alta e baixa translucidez. A estabilidade da cor foi avaliada por um espectrofotômetro antes e após o envelhecimento térmico. Para a avaliação do grau de conversão (n=60), a espectroscopia de infravermelho com transformada de Fourier foi usada em três intervalos de tempo diferentes. A análise estatística foi realizada usando ANOVA multifatorial, seguida de ANOVA um faot com correção de Bonferroni. Resultados: O cimento resinoso contendo amina apresentou ΔEab e ΔE00 significativamente maiores em ambas as translucidezes (4,5±0,3, 3,5±0,3 respectivamente para cerâmica de alta translucidez e 3,8±0,4, 3,0±0,3 respectivamente para baixa translucidez) do que os outros cimentos testados (p< 0,001). O maior grau de conversão (DC) foi mostrado após 2 semanas pelo cimento resinoso dual sem amina (86,27±0,74). Conclusão: O cimento resinoso dual sem amina pode ser uma alternativa ao cimento polimerizável na restauração de facetas finas, uma vez que apresentou estabilidade de cor comparável e alto grau de conversão. (AU).

Practical considerations in the pharmacological treatment of bipolar disorder / 四川精神卫生

Bipolar disorder is one of the most common mood disorders characterized by an early age of onset and high prevalence rate， and patients tent to have poor prognosis due to high misdiagnosis rate and incomplete diagnosis rate. At present， existing pharmacological treatment for bipolar disorder remains highly variable. Therefore， this paper presents a review of indications of the medications， clinical therapeutic effect and adverse drug reactions， thus providing references for the pharmaceutical treatment of bipolar disorder.

Influence of substrate, cement and aging on the biaxial flexural strength of lithium disilicate / Influência do substrato, cimento e envelhecimento na resistência a flexão biaxial do dissilicato de lítio

Objective: To evaluate the biaxial flexural strength (BFS) of lithium disilicate (L), cemented on different substrates (epoxy resin - E and metal - M) with dual-cure resin cement (Rc) and zinc phosphate cement (Zc), not aged, thermally aged (TC) or thermo-mechanical aged (TC/MC). Material and Methods: Disks of L, E, and M were fabricated, and the cementation was performed according to the following groups: ERc (L+E+Rc); MRc (L+M+Rc); MZc (L+M+Zc); EZc (L+E+Zc). Ten samples from each described group were tested in BFS, ten more samples were subjected to TC (1×104 cycles between 5 ºC and 55 ºC water), and the last 10 samples were subjected to TC/MC (MC: 1.2×106 cycles, 50 N, 3.8 Hz). The BFS test was performed and scanning electron microscopy (SEM) was performed to evaluate the failure mode. The effect of the cementation strategy (cement/substrate) was compared in each aging method and the effect of the aging method was evaluated for each cementation strategy by one-way ANOVA and Tukey post-hoc test (α=0.05). Results: The strength values were highest to M (237.8 ~ 463.9 MPa), in comparison to the E (41.03 ~ 66.76 MPa), despite aging and luting agent. Flexural strength data decreased after TC and TC/MC in groups cemented with Zc, but was stable when cemented with Rc. SEM analysis indicated that failure origins were located at the tensile surface of the L. Conclusion: Lithium disilicate discs cemented to the metallic substrate presented the highest biaxial flexural strength. The cementation with dual-cure resin cement did not decrease BFS after aging (AU)

Objetivo: Avaliar a resistência à flexão biaxial (BFS) do dissilicato de lítio (L), cimentado sobre diferentes substratos (resina epóxi - E e metal - M) com cimento resinoso dual (Rc) e cimento de fosfato de zinco (Zc), não envelhecido, submetido ao envelhecido térmico (TC) ou ao envelhecido térmico-mecânico (TC/MC). Material e Métodos: Foram confeccionados discos de L, E e M, e a cimentação foi realizada de acordo com os seguintes grupos: ERc (L+E+Rc); MRc (L+M+Rc); MZc (L+M+Zc); EZc (L+E+Zc). Dez amostras de cada grupo descrito foram testadas em BFS, mais dez amostras foram submetidas à TC (1×104 ciclos de imersão em água entre 5 ºC e 55 ºC), e as últimas 10 amostras foram submetidas à TC/MC (MC: 1.2 ×106 ciclos, 50 N, 3.8 Hz). Foram realizados os testes de BFS e a microscopia eletrônica de varredura (MEV) para avaliar o modo de falha. O efeito da estratégia de cimentação (cimento/substrato) foi comparado em cada método de envelhecimento e o efeito do método de envelhecimento foi avaliado para cada estratégia de cimentação por ANOVA a um fator e teste post-hoc de Tukey (α=0,05). Resultados: Os valores de resistência foram maiores para M (237.8 ~ 463.9 MPa), em comparação com E (41.03 ~ 66.76 MPa), independentemente do envelhecimento e do agente cimentante utilizado. Os dados de resistência à flexão diminuíram após TC e TC/MC nos grupos cimentados com Zc, mas se mantiveram estáveis quando cimentados com Rc. A análise MEV indicou que a origem das falhas estava localizada na superfície de tração do L. Conclusão: Os discos de dissilicato de lítio cimentados ao substrato metálico apresentaram maior resistência à flexão biaxial. A cimentação com cimento resinoso dual não diminuiu o BFS após o envelhecimento (AU)

Stress distribution in occlusal veneers with different finish lines when applying vertical and tangential forces / Distribución de estrés en carillas con diferentes líneas de terminación aplicando fuerzas verticales y tangenciales

Abstract To evaluate stress distribution when applying vertical and tangential forces to 1mm thick occlusal veneers with different finish lines preparations, using the finite element method. One extracted third molar was prepared for occlusal veneers, firstly without any bevel. It was scanned in order to design two groups of lithium disilicate (G1A, G2A) and composite resin (G1B, G2B) occlusal veneers. Then, the third molar preparation was modified, beveling the finish line and it was subsequently scanned again to design the occlusal veneer groups with bevel (LD: G3A, G4A and CR: G3B, G4B). The four groups were subjected to different forces (400 N vertical and 900 N tangential). At 400 N, the non-beveled veneers showed slightly higher Von Mises stress values (G1A: 783 MPa and G1B 736.5 MPa) than the beveled veneers (G3A: 685.7 MPa and G3B: 675.8 MPa). However, when 900 N tangential forces were applied, the beveled occlusal veneers showed higher Von Mises stress values (G4A: 4297 MPa and G4B: 4133 MPa) than the non-beveled occlusal veneers (G2A: 2581.1 MPa and G2B: 3519.1 MPa). Furthermore, it was observed that the tissue under the occlusal veneers with bevel showed higher Von Mises stress values than the models without any bevel. Beveled and non-beveled occlusal veneers of lithium disilicate and composite resin presented similar stress distribution values when vertical forces of 400 N were applied; whereas with tangential forces of 900 N applied near to the finish line, the beveled groups presented notably higher stress values than the non-beveled groups. However, both finish line preparations presented adequate values for possible clinical performance.

Resumen Evaluar la distribución de estrés al aplicar fuerzas verticales y tangenciales en carillas oclusales de 1mm de espesor con diferentes líneas de terminación marginal por el método de elementos finitos. Se preparó un tercer molar extraído para carilla oclusal, primero sin bisel. Se escaneó para diseñar dos grupos de carillas oclusales de disilicato de litio (G1A, G2A) y resina compuesta (G1B, G2B). Después, esta preparación molar fue modificada, biselando la línea de terminación y escaneándola nuevamente para diseñar los grupos de carillas oclusales con bisel (DL: G3A, G4A and RC: G3B, G4B). Los 4 grupos fueron sometidos a fuerzas diferentes (400 N vertical y 900 N tangencial). Con 400 N, las carillas sin bisel presentaron ligera mayor tensión de Von Mises (G1A: 783 MPa y G1B 736.5 MPa) que las carillas con bisel (G3A: 685.7 MPa y G3B: 675.8 MPa). De distinta forma, al aplicar fuerzas tangenciales de 900 N, las carillas oclusales con bisel presentaron mayor tensión de Von Mises (G4A: 4297 MPa y G4B: 4133 MPa) que las carillas oclusales sin bisel (G2A: 2581.1 MPa y G2B: 3519.1 MPa). Además, se observó que los tejidos subyacentes a las carillas oclusales con bisel, presentaron mayor tensión de Von Mises, frente a los modelos sin bisel. Las carillas oclusales con y sin bisel de disilicato de litio y resina compuesta presentaron una distribución de estrés similar con fuerzas verticales de 400 N, por otro lado, con fuerzas tangenciales de 900 N, los grupos con bisel presentaron notablemente mayor tensión que los grupos sin bisel. Sin embargo, ambos diseños de terminación marginal presentaron valores adecuados para un posible desempeño clínico.

Fracture resistance of pressed ZLS crowns versus pressed LD crowns under thermo-mechanical cycling

Resumo Este estudo teve como objetivo avaliar a resistência à fractura do silicato de lítio reforçado com zircônio todo o material cerâmico "Celtra Press" em comparação com um "IPS e-max Press" em condições orais simuladas. Quatorze coroas cerâmicas foram fabricadas em moldes epóxi que foram duplicados a partir de moldes principais de aço inoxidável e divididos em dois grupos iguais (n=7) de acordo com o material de construção; Grupo A: Coroas fabricadas com material IPS e-max Press e Grupo B: Coroas fabricadas com material Celtra Press. As coroas foram então cimentadas nos seus moldes correspondentes com um cimento de resina auto-adesivo e submetidas a ciclos térmicos e cargas cíclicas. Em seguida, foram carregadas para fraturar numa máquina universal de ensaios. Os resultados foram tabulados e analisados estatisticamente utilizando os testes Kolmogorov-Smirnov e Shapiro-Wilk. O teste t de Student usado para comparar os valores médios. O nível de significância foi fixado em P ≤ 0,05 e intervalo de confiança de 95%. A análise estatística foi realizada utilizando o software Graph Pad Instat (Graph Pad, Inc.) para Windows. Os valores médios ± SD da resistência à fractura foram registados para o grupo Disilicate de lítio (1706,01 ±154,32 N) enquanto que os valores médios ± SD registados com o grupo celtra foram (1550,67±196,71 N). As coroas cerâmicas de silicato de lítio reforçado com zircónio produziram valores de resistência à fractura comparáveis aos das coroas cerâmicas de dissilicato de lítio e ambos os materiais testados estão dentro dos valores clinicamente aceitáveis na área posterior.

Abstract The aim of this study was conducted to assess the fracture resistance of zirconia reinforced lithium silicate all ceramic material "Celtra Press" compared to lithium disilicate one "IPS e-max Press" under simulated oral conditions. Fourteen ceramic crowns were fabricated on epoxy dies which were duplicated from stainless steel master die and divided into two equal groups (n=7) according to the material of construction; Group A: Crowns fabricated with IPS e-max Press material and Group B: Crowns fabricated with Celtra Press material. The crowns were then cemented onto their corresponding dies with a self-adhesive resin cement and subjected to thermocycling and cyclic loading. Then they were loaded to fractur in a universal testing machine. The results were tabulated and statistically analyzed using Kolmogorov-Smirnov and Shapiro-Wilk tests. Student t-test used to compare mean values. The significance level was set at P ≤ 0.05 and 95% Confidence interval. Statistical analysis was performed using Graph Pad Instat (Graph Pad, Inc.) software for windows. The mean ± SD values of fracture resistance were recorded for lithium Disilicate group (1706.01 ±154.32 N) meanwhile the mean ± SD value recorded with celtra group were (1550.67±196.71 N). Zirconia reinforced lithium silicate ceramic crowns produced comparable fracture resistance values to lithium disilicate ceramic crowns and both tested materials are within the clinically acceptable values in the posterior area.

Efectos adversos severos de los estabilizadores del ánimo: revisión de la literatura

Introducción: El trastorno bipolar TB es una enfermedad crónica y recurrente, según el DSM 5 se clasifica en los subtipos: trastorno bipolar I, trastorno bipolar II, ciclotimia y categorías residuales de formas atípicas que no encajan en los subtipos antes mencionados. La prevalencia del TB tipo I es similar entre hombres y mujeres, mientras que el TB tipo II ocurre con mayor frecuencia en mujeres. Según la Encuesta nacional de salud mental la prevalencia estimada del trastorno bipolar tipo I en Colombia es del 1,9% en los hombres y del 0,6% en las mujeres, para un porcentaje total de 1,3%. La etiología de TB incluye factores genéticos, neuro bioquímicos, neuro anatómicos, así como médicos y ambientales. El tratamiento del trastorno bipolar se puede dividir en dos fases distintas: manejo de un episodio inicial y tratamiento a largo plazo para prevenir recaídas, los fármacos utilizados comúnmente son: litio, antipsicóticos y anticonvulsivantes. Los estabilizadores del estado del ánimo aceptados por la FDA son: litio, carbamazepina, divalproato, y lamotrigina. Una reacción adversa a medicamentos (RAM) se define como cualquier respuesta nociva y no intencionada a un medicamento, constituye una importante causa de morbimortalidad y de aumento de los costes sanitarios. Los sistemas de farmaco-vigilancia permiten la identificación y prevención de los riesgos asociados al uso de medicamentos. Metodología: Se realizó una búsqueda bibliográfica mediante la base de datos PubMed, utilizando términos MeSH. Los criterios de inclusión utilizados fueron: a) Artículos publicados entre el año 2016 y 2021, b) Idioma inglés o español, c) Población a estudio: pacientes con diagnóstico de trastorno bipolar según criterios del DSM. Resultados: Se encontró que los efectos adversos severos de los estabilizadores del estado del ánimo como la carbamazepina y el ácido valproico son variados, se pueden presentar manifestaciones cutáneas como el síndrome de Stevens-Johnson, necrólisis epidérmica tóxica; manifestaciones hematológicas como anemia aplásica y manifestaciones hepáticas como lo son la hepatotoxicidad e hiperamonemia.

SUMMARY Introduction: Bipolar disorder TB is a chronic and recurrent disease, according to DSM 5 it is classified into subtypes: bipolar I disorder, bipolar II disorder, cyclothymia and residual categories of atypical forms that do not fit into aforementioned subtypes. Prevalence of type I TB is similar between men and women, while type II TB occurs more frequently in women. According to the National Mental Health Survey, estimated prevalence of type I bipolar disorder in Colombia is 1.9% in men and 0.6% in women, for a total percentage of 1.3%. Etiology of TB includes genetic, neuro biochemical, neuro anatomical, as well as medical and environmental factors. Treatment of bipolar disorder can be divided into two phases: management of an initial episode and long-term treatment to prevent relapses, drugs normally used are: Lithium, antipsychotics and anticonvulsants. Mood stabilizers accepted by FDA are: Lithium, carbamazepine, divalproex, and lamotrigine. An adverse drug reaction (ADR) is defined as any harmful and unintended response to a drug, it constitutes a major cause of morbidity and mortality and increased healthcare costs. Pharma-covigilance systems allow identification and prevention of risks associated with use of drugs. Methodology: A graphic search was performed using PubMed database, using MeSH terms. Inclusion criteria used were: a) Articles published between 2016 and 2021, b) English or Spanish language, c) Study population: Patients with a diagnosis of Bipolar Disorder according to DSM criteria. Results: It was found that severe adverse effects of mood stabilizers such as carbamazepine and valproic acid are varied, skin manifestations such as Stevens-Johnson's syndrome, toxic epidermal necrolysis can occur; Hematological manifestations such as aplastic anemia and hepatic manifestations such as hepatotoxicity and hyperammonemia.

Introdução: O transtorno bipolar TB é uma doença crônica e recorrente, segundo o DSM 5 é classificada em subtipos: transtorno bipolar I, transtorno bipolar II, ciclo-timia e categorias residuais de formas atípicas que não se enquadram nos subtipos mencionados. A prevalência de TB tipo I é semelhante entre homens e mulheres, enquanto a TB tipo II ocorre com mais frequência em mulheres. De acordo com a Pesquisa Nacional de Saúde Mental, a prevalência estimada de transtorno bipolar tipo I na Colômbia é de 1,9% nos homens e 0,6% nas mulheres, para um percentual total de 1,3%. A etiologia da TB inclui fatores genéticos, neuro-bioquímicos, neuro-anatômicos, médicos e ambientais. O tratamento do transtorno bipolar pode ser dividido em duas fases distintas: manejo de um episódio inicial e tratamento de longo prazo para prevenção de recidivas, os medicamentos comumente utilizados são: lítio, antipsicóticos e anticonvulsivantes. Os estabilizadores de humor aceitos pela FDA são: lítio, carbamazepina, divalproex e lamotrigina. Uma reação adversa a medicamento (ADR) é definida como qualquer resposta prejudicial e não intencional a um medicamento, é uma das principais causas de morbidade e mortalidade e aumento dos custos de saúde. Os sistemas de farmacovigilância permitem a identificação e prevenção dos riscos associados ao uso de medicamentos. Metodologia: Foi realizada pesquisa bibliográfica na base de dados PubMed, utilizando termos MeSH. Os critérios de inclusão utilizados foram: a) Artigos publicados entre 2016 e 2021, b) Língua inglesa ou espanhola, c) População do estudo: Pacientes com diagnóstico de Bipolar Desordem de acordo com os critérios do DSM. Resultados: Verificou-se que os efeitos adversos graves dos estabilizadores do humor como a carbamazepina e o ácido valpróico são variados, podendo ocorrer manifestações cutâneas como a síndrome de Stevens-Johnson, podendo ocorrer necrólise epidérmica tóxica; Manifestações hematológicas como anemia aplástica e manifestações hepáticas como hepatotoxicidade e hiperamonemia.

Correlación entre el desempeño cognitivo y la neuroanatomía estructural en pacientes con trastorno afectivo bipolar tipo I tratados con y sin litio / Correlation Between Cognitive Performance and Structural Neuroanatomy in Patients with Type I Bipolar Affective Disorder Treated with and Without Lithium

RESUMEN Introducción: El tratamiento del trastorno afectivo bipolar (TAB) con litio se ha relacionado con menos deterioro cognitivo y menores cambios en la anatomía estructural cerebral comparado con otros tratamientos. Sin embargo, los estudios son heterogéneos y son pocos los que evalúan si estos efectos están relacionados. El objetivo de este estudio es evaluar y relacionar el desempeno cognitivo y la neuroanatomía estructural en pacientes tratados con y sin litio. Métodos: Estudio de corte trasversal que incluyó a 48 sujetos con TAB I: 22 tratados con litio y 26 sin litio. Se evaluó el desempeno en las pruebas neuropsicológicas Wechsler III (WAIS III), TMTAyB (Trial Making Test), prueba de aprendizaje verbal de California (TAVEC), prueba de Figura compleja de Rey y prueba de clasificación de tarjetas de Wisconsin. Se evaluaron estructuras cerebrales obtenidas por resonancia magnétiva (RM) cerebral. Se calculó la diferencia de medias estandarizada (DME) entre ambos grupos, con ajuste por variables de confusión mediante puntuación de propensión, y se empleó el coeficiente de correlación de Spearman (p) para evaluar la relación existente entre el desempeno cognitivo y las regiones neuroanatómicas. Resultados: Respecto al grupo sin litio, el grupo con litio tuvo menos errores perseverativos en el Wisconsin (DME = -0,69) y mayores áreas corticales derecha e izquierda (DME = 0,85 y DME = 0,92); mayor superficie en el cíngulo anterior izquierdo (DME = 1,32), la corteza orbi-tofrontal medial derecha (DME = 1,17), el giro frontal superior derecho (DME = 0,82), los giros precentrales derecho e izquierdo (DME = 1,33 y DME = 0,98); mayor volumen de la amígdala derecha (DME = 0,57), el hipocampo derecho (DME = 0,66), el putamen derecho (DME = 0,87) y el tálamo derecho (DME = 0,67). En el grupo con litio, se encontró una correlación con dichos errores y el espesor del giro precentral izquierdo (p = -0,78), el volumen del tálamo derecho (p = -0,44) y la amígdala derecha (p = 0,6). Conclusiones: El grupo con litio tuvo mejor flexibilidad cognitiva y mayor dimensión en algunas regiones corticales frontales y subcorticales. Además, hubo correlación moderada a alta entre el desempeno en esta función ejecutiva y el espesor del giro precentral derecho, y los volúmenes del tálamo y la amígdala derecha. Estos hallazgos podrían indicar un efecto neuroprotector del litio

ABSTRACT Introduction: Lithium treatment of bipolar disorder (BD) has been associated with less impairment and fewer changes in structural brain anatomy compared to other treatments. However, the studies are heterogeneous and few assess whether these effects are related. The objective of this study was to evaluate and relate cognitive performance and structural neuroanatomy in patients treated with and without lithium. Methods: Cross-sectional study that included 48 subjects with BD-I, of which 22 were treated with lithium and 26 without lithium. Performance was assessed on Wechsler III (WAIS III), TMT A and B (Trial Making Test) neuropsychological tests, California verbal learning test (CVLT), Rey complex figure test and Wisconsin card sorting test. Brain structures obtained by magnetic resonance imaging (MRI) were evaluated. The standardised mean difference (SMD) between both groups was calculated, adjusted for confounding variables using a propen-sity score, and the Spearman correlation coefficient (p) was used to assess the relationship between cognitive performance and neuroanatomical regions. Results: Compared to the group without lithium, the group with lithium had fewer perse-verative errors in the Wisconsin test (SMD = -0.69) and greater left and right cortical areas (SMD = 0.85; SMD = 0.92); greater surface area in the left anterior cingulate (SMD = 1.32), right medial orbitofrontal cortex (SMD = 1.17), right superior frontal gyrus (SMD = 0.82), and right and left precentral gyrus (SMD = 1.33; SMD = 0.98); greater volume of the right amyg-dala (SMD = 0.57), right hippocampus (SMD = 0.66), right putamen (SMD = 0.87) and right thalamus (SMD=.67). In the lithium group, a correlation was found with these errors and the thickness of the left precentral gyrus (p = -0.78), the volume of the right thalamus (p =-0.44), and the right amygdala (p = 0.6). Conclusions: Thelithium group had better cognitive flexibility and greater dimension in some frontal and subcortical cortical regions. Furthermore, there was a moderate to high correlation between performance in this executive function and the thickness of the right precentral gyrus, and the volumes of the thalamus and the right amygdala. These findings could suggest a neuroprotective effect of lithium.