Potential for Person-to-Person Transmission of Henipaviruses: A Systematic Review of the Literature.

Nipah virus Bangladesh (NiVB) is a bat-borne zoonosis transmitted between people through the respiratory route. The risk posed by related henipaviruses, including Hendra virus (HeV) and Nipah virus Malaysia (NiVM), is less clear. We conducted a broad search of the literature encompassing both human infections and animal models to synthesize evidence about potential for person-to-person spread. More than 600 human infections have been reported in the literature, but information on viral shedding was only available for 40 case-patients. There is substantial evidence demonstrating person-to-person transmission of NiVB, and some evidence for NiVM. Less direct evidence is available about the risk for person-to-person transmission of HeV, but animals infected with HeV shed more virus in the respiratory tract than those infected with NiVM, suggesting potential for transmission. As the group of known henipaviruses continues to grow, shared protocols for conducting and reporting from human investigations and animal experiments are urgently needed.

Model-based Cost-effectiveness of State-level Latent Tuberculosis Interventions in California, Florida, New York, and Texas.

BACKGROUND: Targeted testing and treatment (TTT) for latent tuberculosis (TB) infection (LTBI) is a recommended strategy to accelerate TB reductions and further TB elimination in the United States. Evidence on cost-effectiveness of TTT for key populations can help advance this goal. METHODS: We used a model of TB transmission to estimate the numbers of individuals who could be tested by interferon-γ release assay and treated for LTBI with 3 months of self-administered rifapentine and isoniazid (3HP) under various TTT scenarios. Specifically, we considered rapidly scaling up TTT among people who are non-US-born, diabetic, living with human immunodeficiency virus (HIV), homeless or incarcerated in California, Florida, New York, and Texas-states where more than half of US TB cases occur. We projected costs (from the healthcare system perspective, in 2018 dollars), 30-year reductions in TB incidence, and incremental cost-effectiveness (cost per quality-adjusted life-year [QALY] gained) for TTT in each modeled population. RESULTS: The projected cost-effectiveness of TTT differed substantially by state and population, while the health impact (number of TB cases averted) was consistently greatest among non-US-born individuals. TTT was most cost-effective among persons with HIV (from $2828/QALY gained in Florida to $11 265/QALY gained in New York) and least cost-effective among people with diabetes (from $223 041/QALY gained in California to $817 753/QALY in New York). CONCLUSIONS: The modeled cost-effectiveness of TTT for LTBI varies across states but was consistently greatest among people with HIV; moderate among people who are non-US-born, incarcerated, or homeless; and least cost-effective among people with diabetes.

Low MGMT digital expression is associated with a better outcome of IDH1 wildtype glioblastomas treated with temozolomide.

INTRODUCTION: Glioblastoma (GBM) is the deadliest primary brain tumor. The standard treatment consists of surgery, radiotherapy, and temozolomide (TMZ). TMZ response is heterogeneous, and MGMT promoter (MGMTp) methylation has been the major predictive biomarker. We aimed to describe the clinical and molecular data of GBMs treated with TMZ, compare MGMT methylation with MGMT expression, and further associate with patient's outcome. METHODS: We evaluate 112 FFPE adult GBM cases. IDH1 and ATRX expression was analyzed by immunohistochemistry, hotspot TERT promoter (TERTp) mutations were evaluated by Sanger or pyrosequencing, and MGMTp methylation was assessed by pyrosequencing and MGMT mRNA expression using the nCounter® Vantage 3D™ DNA damage and repair panel. RESULTS: Of the 112 GBMs, 96 were IDH1WT, and 16 were IDH1MUT. Positive ATRX expression was found in 91.6% (88/96) of IDHWT and 43.7% (7/16) of IDHMUT. TERTp mutations were detected in 70.4% (50/71) of IDHWT. MGMTp methylation was found in 55.5% (35/63) of IDHWT and 84.6% (11/13) of IDHMUT, and as expected, MGMTp methylation was significantly associated with a better response to TMZ. MGMT expression was inversely correlated with MGMTp methylation levels (- 0.506, p < 0.0001), and MGMT low expression were significantly associated with better patient survival. It was also observed that integrating MGMTp methylation and expression, significantly improved the prognostication value. CONCLUSIONS: MGMT mRNA levels evaluated by digital expression were associated with the outcome of TMZ-treated GBM patients. The combination of MGMT methylation and mRNA expression may provide a more accurate prediction of TMZ response in GBM patients.

Sub-district level correlation between tuberculosis notifications and socio-demographic factors in Dhaka City corporation, Bangladesh.

We developed a novel method to align two data sources (TB notifications and the Demographic Health Survey, DHS) captured at different geographic scales. We used this method to identify sociodemographic indicators - specifically population density - that were ecologically correlated with elevated TB notification rates across wards (~100 000 people) in Dhaka, Bangladesh. We found population density was the variable most closely correlated with ward-level TB notification rates (Spearman's rank correlation 0.45). Our approach can be useful, as publicly available data (e.g. DHS data) could help identify factors that are ecologically associated with disease burden when more granular data (e.g. ward-level TB notifications) are not available. Use of this approach might help in designing spatially targeted interventions for TB and other diseases in settings of weak existing data on disease burden at the subdistrict level.

Quantifying geographic heterogeneity in TB incidence and the potential impact of geographically targeted interventions in South and North City Corporations of Dhaka, Bangladesh: a model-based study.

In rapidly growing and high-burden urban centres, identifying tuberculosis (TB) transmission hotspots and understanding the potential impact of interventions can inform future control and prevention strategies. Using data on local demography, TB reports and patient reporting patterns in Dhaka South City Corporation (DSCC) and Dhaka North City Corporation (DNCC), Bangladesh, between 2010 and 2017, we developed maps of TB reporting rates across wards in DSCC and DNCC and identified wards with high rates of reported TB (i.e. 'hotspots') in DSCC and DNCC. We developed ward-level transmission models and estimated the potential epidemiological impact of three TB interventions: active case finding (ACF), mass preventive therapy (PT) and a combination of ACF and PT, implemented either citywide or targeted to high-incidence hotspots. There was substantial geographic heterogeneity in the estimated TB incidence in both DSCC and DNCC: incidence in the highest-incidence wards was over ten times higher than in the lowest-incidence wards in each city corporation. ACF, PT and combined ACF plus PT delivered to 10% of the population reduced TB incidence by a projected 7%-9%, 13%-15% and 19%-23% over five years, respectively. Targeting TB hotspots increased the projected reduction in TB incidence achieved by each intervention 1.4- to 1.8-fold. The geographical pattern of TB notifications suggests high levels of ongoing TB transmission in DSCC and DNCC, with substantial heterogeneity at the ward level. Interventions that reduce transmission are likely to be highly effective and incorporating notification data at the local level can further improve intervention efficiency.

In Vitro Effect of Simulated Tooth Brushing and Children's Mouth Rinses on Physical Properties of Glass Ionomer Cement.

OBJECTIVE: The present study investigated the erosive potential of children's mouthrinses on glass ionomer cement (GIC) samples after simulated toothbrushing. STUDY DESIGN: Forty round-shaped samples of GIC were divided into 3 groups: G1- cetylpyridinium chloride, G2- xylitol and triclosan and G3-Malva sylvestris and xylitol and G4-distilled water as a control group. Prior to the main tests, the samples were submitted to the surface roughness measurement (Ra) and weight analysis (W). Afterward, they were brushed twice day (2× / day) for 15 days and immersed in mouthrinses after the last daily brushing. The final surface roughness (R2) and weight (W2) were determined after completing the tooth brushing-mouth rinsing cycles and the real increase in roughness (ΔRa) and real weight loss (ΔW) were calculated. In addition, stereoscopic images taken at 30× magnification. The data was analyzed by one-way ANOVA and Tukey-test post hoc tests for intergroup comparison and the T-test for dependent samples (α = 0.05). RESULTS: Only group G2 showed increased in roughness ΔRa (1.53 ± 0.94) whereas ΔW values were not significant. However, evident cracks and voids were verified for all tested children's rinses. CONCLUSION: Thus, children's mouthrinse containing xylitol / triclosan increased the GIC roughness, especially when associated with brushing.

Effect of Dental Prophylaxis Techniques on the Surface Roughness of Resin Composites.

AIM: The aim of this study is to evaluate the effect of dental prophylaxis techniques on surface roughness of composite resins. MATERIALS AND METHODS: A total of 36 nanohybrid resin composite test specimens were fabricated and divided into three groups (n = 12). They were kept in distilled water at 37°C for 24 hours and submitted to the finishing and polishing technique. For the prophylactic techniques, in group G1, a mixture of pumice stone and distilled water was used with the aid of a rubber cup; in group G2, Herjos-F prophy paste was used with a rubber cup; and in group G3, a bicarbonate jet spray was used. Afterward, all the samples were repolished using the Soflex pop-on disks. A roughness meter was used to measure surface roughness at three points in time: Before the prophylactic techniques (1st evaluation), afterward (2nd evaluation), and following repeat polishing (3rd evaluation). RESULTS: It was found that roughness values changed significantly between the 1st and 2nd evaluations (p < 0.05) and between the 2nd and 3rd evaluations (p < 0.05), showing that the change in roughness depended on the type of prophylactic treatment. Roughness was significantly higher after the bicarbonate jet (p < 0.05). CONCLUSION: Prophylaxis using the sodium bicarbonate jet significantly altered the roughness of nanoparticle-reinforced resin. CLINICAL SIGNIFICANCE: Dental prophylaxis is the most common practice employed to remove bacterial plaque and other coatings. However, one side effect of the cleaning may be a rougher surface subject to degradation and staining. The correct use of prophylactic devices and avoiding prolonged use on resin restorations reduce surface roughness.

In vivo Evaluation of Proximal Resin Composite Restorations performed using Three Different Matrix Systems.

OBJECTIVE: The aim of this in vivo study was to radiographically evaluate the proximal contour of composite resin restorations performed using different matrix systems. MATERIALS AND METHODS: Patients with premolars needing class II type resin composite restorations involving the marginal ridge were selected. Thirty premolars were selected and randomly divided into three groups (n = 10 each) to receive restorations using different matrix systems: group 1: metal matrix coupled to a carrier matrix and wood wedge (G1-MMW); group 2: sectioned and precontoured metal matrix and elastic wedge (G2-SME); and group 3: a polyester strip and reflective wedge (G3-PMR). After the restorative procedure, bitewing radiographs were performed and analyzed by three calibrated professionals. The quality of the proximal contact and marginal adaptation of the proximal surfaces was classified as either correct or incorrect (undercontour/overcontour). RESULTS: The Pearson Chi-square statistical test (α = 5%) revealed a statistically difference between frequencies of correct and incorrect restorations (α(2) = 6.787, p < 0.05). The group G2 SME produced a higher frequency of correct proximal contours (90%), while G1-MMW and G3-PMR had a ratio of 40% correct and 60% incorrect contours respectively. CONCLUSION: None of the matrix systems was able to prevent the formation of incorrect proximal contours; however, the sectioned and precontoured metal matrix/elastic wedge configuration provided better results as compared to the other groups.

Comparative assessment of the cost-effectiveness of Tuberculosis (TB) active case-finding interventions: A systematic analysis of TB REACH wave 5 projects.

PURPOSE: Interventions that can help streamline and reduce gaps in the tuberculosis (TB) care cascade can play crucial roles in TB prevention and care, but are often operationally complex and resource intensive, given the heterogenous settings in which they are implemented. In this study, we present a comparative analysis on cost-effectiveness of TB REACH Wave 5 projects with diverse programmatic objectives to inform future decisions regarding funding, strategic adoption, and scale-up. METHODS: We comprehensively reviewed project reports and financial statements from TB REACH Wave 5, a funding mechanism for interventions that aimed to strengthen the TB care cascade in diverse settings. Two independent reviewers abstracted cost (in 2017 US dollars) and key programmatic data, including project type (case-finding only; case-finding and linkage-to-care; or case-finding, linkage-to-care and patient support), operational setting (urban or rural), and project outputs (numbers of people with TB diagnosed, started on treatment, and successfully completing treatment). Cost-effectiveness ratios for each project were calculated as ratios of apportioned programmatic expenditures to corresponding project outputs. RESULTS: Of 32 case finding and patient support projects funded through TB REACH Wave 5, 29 were included for analysis (11 case-finding only; 9 case-finding and linkage-to-care; and 9 case-finding, linkage-to-care and patient support). 21 projects (72%) were implemented in either Africa or Southeast Asia, and 19 (66%) focused on serving urban areas. Average cost-effectiveness was $184 per case diagnosed (range: $30-$10,497), $332 per diagnosis and treatment initiation ($123-$10,608), and $40 per patient treatment supported ($8-$160). Cost per case diagnosed was lower for case-finding-only projects ($132) than projects including linkage-to-care ($342) or linkage-to-care and patient support ($254), and generally increased with the corresponding country's per-capita GDP ($543 per $1000 increase, 95% confidence interval: -$53, $1138). CONCLUSION: The costs and cost-effectiveness of interventions to strengthen the TB care cascade were heterogenous, reflecting differences in context and programmatic objective. Nevertheless, many such interventions are likely to offer good value for money. Systematic collection and analysis of cost-effectiveness data can help improve comparability, monitoring, and evaluation.

Orofacial Manifestations of Fetal Alcohol Syndrome: Two Case Reports and a Scoping Review.

Purpose: Fetal alcohol syndrome (FAS) results from the teratogenic effects of alcohol on the fetus. Oral manifestations are commonly found in FAS and contribute to the diagnosis. The purpose of this study was to provide a review of the literature and describe two cases of FAS.
Methods: Electronic searches were conducted in August 2021 in multiple databases. The cases of two children with FAS are reported.
Results: One hundred sixty-six articles were included. The oral features frequently reported were micrognathia, cleft palate, high arched palate, maxillary hypoplasia, prognathia and crowding. The first patient had systemic and orofacial changes, such as delayed physical and cognitive development, micrognathia, tooth impaction, malocclusion and enamel hypoplasia. The second child had cognitive, and speech and behavioral deficits, but no oral and dental abnormalities.
Conclusion: Dentists should be aware of clinical findings since they may take part in the diagnosis and management of FAS.

Cancer immune profiling unveils biomarkers, immunological pathways, and cell type score associated with glioblastoma patients' survival.

Introduction: Glioblastoma (GBM), isocitrate dehydrogenase (IDH) wild-type (IDH wt), and grade 4 astrocytomas, IDH mutant (IDH mut), are the most common and aggressive primary malignant brain tumors in adults. A better understanding of the tumor immune microenvironment may provide new biomarkers and therapeutic opportunities. Objectives: We aimed to evaluate the expression profile of 730 immuno-oncology-related genes in patients with IDH wt GBM and IDH mut tumors and identify prognostic biomarkers and a gene signature associated with patient survival. Methods: RNA was isolated from formalin-fixed, paraffin-embedded sections of 99 tumor specimens from patients treated with standard therapy. Gene expression profile was assessed using the Pan-Cancer Immune Profiling Panel (Nanostring Technologies, Inc., Seattle, WA, USA). Data analysis was performed using nSolverSoftware and validated in The Cancer Genome Atlas. In addition, we developed a prognostic signature using the cox regression algorithm (Least Absolute Shrinkage and Selection Operator). Results: We found 88 upregulated genes, high immunological functions, and a high macrophage score in IDH wt GBM compared to IDH mut tumors. Regarding IDH wt GBM, we found 24 upregulated genes in short-term survivors (STS) and overexpression of CD274 (programmed death-ligand 1, PD-L1). Immune pathways, CD45, cytotoxic, and macrophage scores were upregulated in STS. Two different prognostic groups were found based on the 12-gene signature (CXCL14, PSEN2, TNFRSF13C, IL13RA1, MAP2K1, TNFSF14, THY1, CTSL, ITGAE, CHUK, CD207, and IFITM1). Conclusion: The elevated expression of immune-oncology-related genes was associated with worse outcome in IDH wt GBM patients. Increased immune functions, CD45, cytotoxic cells, and macrophage scores were associated with a more aggressive phenotype and may provide promising possibilities for therapy. Moreover, a 12 gene-based signature could predict patients' prognosis.

Acute Limb Ischemia After Self-Injection of Crushed Morphine Tablets into the Radial Artery: Role of Infrared Thermography in the Assessment of Tissue Perfusion.

BACKGROUND This article presents a case involving complications after intentional injection of crushed tablets into the arterial circulation, its diagnosis, and the treatment adopted. The diagnosis process illustrates the potential of techniques based on thermal imaging as tools to assess tissue perfusion. Inadvertent intravenous injection of crushed tablets is more common, but there are few reports on arterial circulation, and no studies were found on the self-injection of crushed morphine tablets, particularly into the radial artery. CASE REPORT A 51-year-old man with alcoholism and a history of illegal drug usage intentionally self-injected 3 crushed morphine tablets into his right radial artery. The patient progressed with compartment syndrome, requiring decompressive fasciotomy of the right forearm and ischemia of the right fingers, which were amputated. He presented with rhabdomyolysis and required dialysis. The patient agreed to full heparinization, corticotherapy, and the use of nitroglycerin and prostaglandin E1. Due to the progression of the necrotic area, the patient underwent proximal phalanx excision and surgical reconstruction of the right-hand remnant. CONCLUSIONS The injection of morphine tablets into circulation caused severe complications, which led to the excision of the proximal phalanx and the surgical reconstruction of the remnant of the right hand. In the present case, infrared thermography proved to be an effective method in assessing tissue perfusion.

Blockade of interleukin seventeen (IL-17A) with secukinumab in hospitalized COVID-19 patients - the BISHOP study.

BACKGROUND: Patients with severe COVID-19 seem to evolve with a compromised antiviral response and hyperinflammation. Neutrophils are critical players in COVID-19. IL-17A plays a major role in protection against extracellular pathogens and neutrophil attraction/activation. We hypothesized that secukinumab, an anti-IL17A monoclonal antibody, could prevent the deleterious hyperinflammation in COVID-19. METHODS: BISHOP was a randomized, open-label, single-centre, phase-II controlled trial. Fifty adult patients hospitalized with PCR-positive Covid-19, were randomized 1:1 to receive 300 mg of secukinumab subcutaneously at day-0 plus standard of care (group A) or standard of care alone (group B). A second dose of 300 mg of secukinumab could be administered on day-7, according to staff judgement. The primary endpoint was ventilator-free days at day-28 (VFD-28). Secondary efficacy and safety outcomes were also explored. RESULTS: An intention-to-treat analysis showed no difference in VFD-28: 23.7 (95%CI 19.6-27.8) in group A vs. 23.8 (19.9-27.6) in group B, p = .62; There was also no difference in hospitalization time, intensive care unit demand and the incidence of circulatory shock, acute kidney injury, fungal or bacterial co-infections. There was no difference in the incidence of severe adverse events. Pulmonary thromboembolism occurred only in males and was less frequent in secukinumab-treated patients (4.2% vs. 26.2% p = .04). There was one death in each group. Upper airway viral clearance was also similar in both groups. CONCLUSION: The efficacy of secukinumab in the treatment of Covid19 was not demonstrated. Secukinumab decreased pulmonary embolism in male patients. There was no difference between groups in adverse events and no unexpected events were observed.

Cost-effectiveness of scaling up short course preventive therapy for tuberculosis among children across 12 countries.

BACKGROUND: While household contact investigation is widely recommended as a means to reduce the burden of tuberculosis (TB) among children, only 27% of eligible pediatric household contacts globally received preventive treatment in 2018. We assessed the cost-effectiveness of household contact investigation for TB treatment and short-course preventive therapy provision for children under 15 years old across 12 high TB burden countries. METHODS: We used decision analysis to compare the costs and estimated effectiveness of three intervention scenarios: (a) status quo (existing levels of coverage with isoniazid preventive therapy), (b) contact investigation with treatment of active TB but no additional preventive therapy, and (c) contact investigation with TB treatment and provision of short-course preventive therapy. Using country-specific demographic, epidemiological and cost data from the literature, we estimated annual costs (in 2018 USD) and the number of TB cases and deaths averted across 12 countries. Incremental cost effectiveness ratios were assessed as cost per death and per disability-adjusted life year [DALY] averted. FINDINGS: Our model estimates that contact investigation with treatment of active TB and provision of preventive therapy could be highly cost-effective compared to the status quo (ranging from $100 per DALY averted in Malawi to $1,600 in Brazil; weighted average $383 per DALY averted [uncertainty range: $248 - $1,130]) and preferred to contact investigation without preventive therapy (weighted average $751 per DALY averted [uncertainty range: $250 - $1,306]). Key drivers of cost-effectiveness were TB prevalence, sensitivity of TB diagnosis, case fatality for untreated TB, and cost of household screening. INTERPRETATION: Based on this modeling analysis of available published data, household contact investigation with provision of short-course preventive therapy for TB has a value-for-money profile that compares favorably with other interventions. FUNDING: Unitaid (2017-20-IMPAACT4TB).

Incorporating patient reporting patterns to evaluate spatially targeted TB interventions.

PURPOSE: Tuberculosis (TB) is geographically heterogeneous, and geographic targeting can improve the impact of TB interventions. However, standard TB notification data may not sufficiently capture this heterogeneity. Better understanding of patient reporting patterns (discrepancies between residence and place of presentation) may improve our ability to use notifications to appropriately target interventions. METHODS: Using demographic data and TB reports from Dhaka North City Corporation and Dhaka South City Corporation, we identified wards of high TB incidence and developed a TB transmission model. We calibrated the model to patient-level data from selected wards under four different reporting pattern assumptions and estimated the relative impact of targeted versus untargeted active case finding. RESULTS: The impact of geographically targeted interventions varied substantially depending on reporting pattern assumptions. The relative reduction in TB incidence, comparing targeted with untargeted active case finding in Dhaka North City Corporation, was 1.20, assuming weak correlation between reporting and residence, versus 2.45, assuming perfect correlation. Similar patterns were observed in Dhaka South City Corporation (1.03 vs. 2.08). CONCLUSIONS: Movement of individuals seeking TB diagnoses may substantially affect ward-level TB transmission. Better understanding of patient reporting patterns can improve estimates of the impact of targeted interventions in reducing TB incidence. Incorporating high-quality patient-level data is critical to optimizing TB interventions.

Costing the implementation of public health interventions in resource-limited settings: a conceptual framework.

BACKGROUND: Failing to account for the resources required to successfully implement public health interventions can lead to an underestimation of costs and budget impact, optimistic cost-effectiveness estimates, and ultimately a disconnect between published evidence and public health decision-making. METHODS: We developed a conceptual framework for assessing implementation costs. We illustrate the use of this framework with case studies involving interventions for tuberculosis and HIV/AIDS in resource-limited settings. RESULTS: Costs of implementing public health interventions may be conceptualized as occurring across three phases: design, initiation, and maintenance. In the design phase, activities include developing intervention components and establishing necessary infrastructure (e.g., technology, standard operating procedures). Initiation phase activities include training, initiation of supply chains and quality assurance procedures, and installation of equipment. Implementation costs in the maintenance phase include ongoing technical support, monitoring and evaluation, and troubleshooting unexpected obstacles. Within each phase, implementation costs can be incurred at the site of delivery ("site-specific" costs) or more centrally ("above-service" or "central" costs). For interventions evaluated in the context of research studies, implementation costs should be classified as programmatic, research-related, or shared research/program costs. Purely research-related costs are often excluded from analysis of programmatic implementation. CONCLUSIONS: In evaluating public health interventions in resource-limited settings, accounting for implementation costs enables more realistic estimates of budget impact and cost-effectiveness and provides important insights into program feasibility, scale-up, and sustainability. Assessment of implementation costs should be planned prospectively and performed in a standardized manner to ensure generalizability.

Whitening toothpastes effect on nanoparticle resin composite roughness after a brushing challenge: An in vitro study.

BACKGROUND: Nowadays, the use of whitening toothpastes is a common habit, especially among young adults, due to aesthetic appeal. On the other hand, little is known regarding the effects of brushing with those newly dentifrices on wear properties of resin composites. MATERIAL AND METHODS: Thirty specimens of nanoparticle composite resin were fabricated and stored in distilled water for 24 h at 370C. After this, the roughness analysis was performed and submitted to the simulated brushing technique using three types of toothpastes: conventional (GI), and two with whitening effect (GII and GIII) for a period of 15 days, with 2 brushing sessions per day for 2 minutes each. The final surface roughness was analyzed after completing all the brushing cycles and stereoscopic images were taken for each group. The data was analyzed by one-way ANOVA and Tukey-test post hoc for intergroup comparison and the T-test for dependent samples as well (α = 0.05). RESULTS: However showing an increase of roughness for all groups after the brushing cycles (p = 0.01), no statistically significant differences among the groups after simulated brushing was verified (p = 0.17). Yet, just some cracks of the stereoscopic images were shown, demonstrating no distinct visual effects among the studied groups. CONCLUSIONS: After simulated brushing with the whitening toothpastes, similar degree of roughness was verified on the composite resin tested. Key words:Composite resin, toothpastes, whitening.

In vitro quantitative comparison of erosive potential of infant mouthwashes on glass ionomer cement.

BACKGROUND: The widespread use of mouthwashes, specially in children, is a concern, since the long-term use may modify the topography of dental materials. However, this process still unclear regarding the wear related to infant mouthwashes on glass ionomer cement. Thus, the purpose of this investigation was evaluate the erosive potential of infant mouthwashes on glass ionomer cement specimens. MATERIAL AND METHODS: Forty round-shaped specimens were divided into 4 groups (N=10) and submitted to erosive cycling for 15 days, being exposed 2X/day in the following children's active agents mouthwash solutions: G1- cetylpyridinium chloride, G2- xylitol and triclosan and G3 - Malva sylvestris and xylitol. Prior to cycling, the specimens were submitted to the surface roughness measurement. After erosive cycling, the specimens were reanalyzed, and calculated the increase of roughness (∆Ra). Additionally, it was adopted distilled water as a negative control (G4). As an extra analysis, the mouthwashes had their pH values measured. The results were submitted to T-test and ANOVA followed by Tukey test at 5%. RESULTS: In relation to pH values, G2 presented the most acidic pH value (pH = 6.83) in comparison to other substances. Regarding the comparison of the final roughness values (R) among the groups, it was verified that the mouthwashes showed significant roughness increase in comparison to control group, especially to G3 group (Rf = 1.67 ± 0.14) as well the ΔRa values with statistical difference in comparison to distilled water. Still, with exception of control group outcome, an increase of roughness of each mouthwash was verified after the studied period. CONCLUSIONS: Active agents present in infant mouthwashes were capable of roughness increased of glass ionomer cement surface, demonstrating an erosive potential of this material largely used in pediatric dentistry. Key words:Dental erosion, dental cements, mouthwash.

O método de fotopolimerização é capaz de influenciar nos valores de microdureza das resinas compostas? Um estudo in vitro / Is the photopolimerization method able to influence on the microhardness values of composite resins? An in vitro study

Introdução: a inovação dos métodos de fotopolimerização foi proposta na tentativa de diminuir o estresse de contração de polimerização das resinas compostas e proporcionar maior conforto ao paciente, reduzindo o tempo de atendimento odontológico. Objetivo: avaliar a microdureza de duas resinas compostas nanoparticuladas submetidas a diferentes técnicas de polimerização. Material e método: quarenta espécimes foram divididos em quatro grupos (n=10) da seguinte forma: Filtek Z350 XT® + técnica imediata (GI); Filtek One Bulkfill® + técnica imediata (GII); Filtek Z350 XT® + técnica de pulso tardio (GIII); Filtek One Bulkfill® + técnica de pulso tardio (GIV). Após o armazenamento em água destilada à temperatura ambiente, os corpos de prova foram direcionados para a medição de microdureza. Utilizou-se teste T para comparação de técnicas e teste Two-Way ANOVA para calcular os efeitos das resinas compostas, técnicas de polimerização e interações referentes à variável dependente (p ≤0,05). Resultado: a resina Filtek Z350 XT® apresentou maior dureza na técnica imediata (GI - 312,45 ± 64,37) e pulso tardio (GIII - 244,50 ± 75,63) comparado à resina Filtek One Bulkfill®, em ambas as técnicas. Observaram-se maiores valores de dureza referentes à técnica imediata, com diferença estatística significativa em relação à resina testada (p = 0,04 - Filtek Z350 XT®; p = 0,03 - Filtek One Bulkfill®). Ambos os fatores isolados (resina e técnicas) apresentaram efeito nos valores de microdureza (p = 0,02 e p < 0,01, respectivamente). Conclusão: a técnica convencional demonstrou atingir maiores valores de dureza quando comparada à técnica de polimerização alternativa.

Introduction: the innovation of photopolymerization methods was proposed in an attempt to reduce the polymerization shrinkage stress of composite resins and also provide more comfort to patient reducing the chair time. The aim of this in vitro study was to assess the microhardness of two nanofilled composite resins subject to different curing techniques. Objective: assess the microhardness of two nanofilled composite resins subject to different curing techniques. Material and method: forty specimens were divided into four groups (N=10) as follows: Filtek Z350 XT® + immediate technique (GI); Filtek One Bulkfill® + immediate technique (GII); Filtek Z350 XT® + delayed pulse technique (GIII); Filtek One Bulkfill® + delayed pulse technique (GIV). After storage in distilled water at room temperature the specimens were assessed for microhardness measurement. T-test was used for comparison of techniques and two-way ANOVA used to calculate the effects of composite resins, curing techniques and their interactions on dependent variable (p set at 0.05). Result: Filtek Z350 XT® resin presented greater hardness on immediate technique (GI - 312,45 ± 64.37) and delayed pulse (GIII - 244,50 ± 75.63) compared to Filtek One Bulkfill® under both techniques. Overall, it was observed greater hardness values under immediate technique with a significant statistical difference apart of tested resin (p = 0.04 - Filtek Z350 XT®; p = 0.03 - Filtek One Bulkfill®). Both isolated factors (resin and techniques) presented effect on microhardness values (p = 0.02 and p < 0.01, respectively). Conclusion: the conventional technique demonstrated to reach higher hardness values when compared to the alternative polymerization technique

Piora da fragilidade em pessoas idosas comunitárias com hipertensão e fatores associados / Worsening frailty in community-dwelling older people with hypertension and associated factors

Resumo Objetivo Estimar a prevalência e fatores associados à piora da fragilidade em idosos com hipertensão arterial. Métodos Estudo quantitativo, longitudinal prospectivo e analítico. Realizado em idosos hipertensos comunitários mineiros. A amostragem foi probabilística, por conglomerados em duas etapas. A coleta de dados ocorreu no domicílio dos idosos em dois momentos. Foram analisadas variáveis demográficas, socioeconômicas e clínico-assistenciais. A fragilidade foi mensurada pela Escala de Fragilidade de Edmonton. Utilizou-se a regressão de Poisson com variância robusta para obter as razões de prevalência brutas e ajustadas Resultados Participaram do estudo 281 idosos, 23,1% apresentaram piora do seu estado de fragilidade. A prevalência de fragilidade passou de 38,0%, no ano base, para 31,2% na primeira onda. A piora da fragilidade foi associada a autopercepção negativa da saúde, à polifarmácia e à internação nos últimos 12 mese Conclusão Houve transição entre os estados de fragilidade. Um contingente importante dos idosos apresentou piora da fragilidade.

Abstract Objective To estimate the prevalence and factors associated with the worsening of frailty in older people with arterial hypertension. Methods Quantitative, longitudinal, prospective and analytical study. Carried out in community-dwelling hypertensive older people from Minas Gerais. Sampling was probabilistic, by clusters in two stages. Data collection took place at the older people's homes in two moments. Demographic, socioeconomic and clinical-assistance variables were analyzed. Frailty was measured by the Edmonton Frailty Scale. Poisson regression with robust variance was used to obtain crude and adjusted prevalence ratios. Results 281 older people participated in the study, 23.1% showed a worsening of their state of frailty. The prevalence of frailty increased from 38.0% in the base year to 31.2% in the first wave. The worsening of frailty was associated with negative self-perception of health, polypharmacy and hospitalization in the last 12 months. Conclusion There was a transition between states of frailty. An important contingent of the older people showed worsening frailty.