Analysis of the cytotoxicity and bioactivity of CeraSeal, BioRoot™ and AH Plus® sealers in pre-osteoblast lineage cells.

BACKGROUND: The objective of the present study was to evaluate in vitro the cytotoxicity and bioactivity of various endodontic sealers (CeraSeal, BioRoot™ and AH Plus®) in pre-osteoblast mouse cells (MC3T3 cells). METHODS: MC3T3 cells (ATCC CRL-2594) were plated in 1 × 104 cells/well in 96-well plates in contact with endodontic sealers at concentrations of 1:10 and 1:100. Cell viability was evaluated by MTT assay after 24 and 48 h. In addition, sealer bioactivity was measured by RT-PCR for mediator of inflammation (Tnf, Ptgs2) and mineralization (Runx2, Msx1, Ssp1 and Dmp1) after 24 h and by Alizarin Red S Assay of mineralization after 28 days. Data were analyzed using one-way ANOVA followed by the Tukey's post-test at a significance level of 5%. RESULTS: BioRoot™ presented 24-hour cytotoxicity (p < 0.05) at 1:10 concentration. In the period of 48 h, no endodontic cement was cytotoxic to the cells compared to the control (p > 0.05). TNF-α gene expression was induced by AH Plus® (p < 0.05), while Ptgs2 was induced by the CeraSeal and BioRoot™ (p < 0.05). The expression of Runx2 was stimulated by BioRoot™ and AH Plus® (p < 0.05). In contrast, the expression of Dmp-1 Dmp1 was higher for the CeraSeal and BioRoot™ (p < 0.05). Nonetheless, the sealers did not impact the formation of mineralization nodules (p > 0.05). CONCLUSION: CeraSeal, BioRoot™ and AH Plus® sealers were not cytotoxic to MC3T3 cells within 48 h, but differentially induced the expression of genes related to inflammation and mineralization without impacting biomineralization by the cells.

Dermatomyositis with Eosinophils.

Dermatomyositis is an idiopathic inflammatory myopathy that often presents with symmetric proximal skeletal muscle weakness and characteristic skin findings. Typical skin biopsy findings include vacuolar changes of the basal layer, increased dermal mucin, and a predominantly lymphocytic infiltrate. We report a case of dermatomyositis presenting as intensely pruritic papules and plaques, with initial histopathology being atypical of dermatomyositis due to the presence of eosinophils. The initial biopsy demonstrated a superficial dermatitis with eosinophils, initially thought to represent a drug eruption. A second biopsy of the same cutaneous manifestation was performed at a later time given high clinical suspicion for dermatomyositis and demonstrated a more classic vacuolar interface dermatitis with increased mucin and an absence of eosinophils. Notably, increased pruritus was specifically associated with the lesion that demonstrated tissue eosinophilia. The case illustrates the importance of considering tissue eosinophilia in the histologic presentation of dermatomyositis.

Crucial contribution of the universities to SARS-CoV-2 surveillance in Ecuador: Lessons for developing countries.

COVID-19 pandemic has challenged public health systems worldwide, particularly affecting developing countries in Latin America like Ecuador. In this report, we exposed the fundamental role of the Ecuadorian universities to improve COVID-19 surveillance in the country, with an overall contribution over 15% of the total SARS-CoV-2 RT-PCR tests done. We highlight the role of our university during the first semester of the COVID-19 pandemic, contributing to a massive free SARS-CoV-2 testing up to almost 10% of the total diagnosis completed in the country, mainly focus on underserved urban, rural and indigenous communities. Finally, we described our contribution to a high quality and low-cost SARS-CoV-2 RT-PCR diagnostic in Ecuador.

Microsatellite analysis reveals connectivity among geographically distant transmission zones of Plasmodium vivax in the Peruvian Amazon: A critical barrier to regional malaria elimination.

Despite efforts made over decades by the Peruvian government to eliminate malaria, Plasmodium vivax remains a challenge for public health decision-makers in the country. The uneven distribution of its incidence, plus its complex pattern of dispersion, has made ineffective control measures based on global information that lack the necessary detail to understand transmission fully. In this sense, population genetic tools can complement current surveillance. This study describes the genetic diversity and population structure from September 2012 to March 2015 in three geographically distant settlements, Cahuide (CAH), Lupuna (LUP) and Santa Emilia (STE), located in the Peruvian Amazon. A total 777 P. vivax mono-infections, out of 3264, were genotyped. Among study areas, LUP showed 19.7% of polyclonal infections, and its genetic diversity (Hexp) was 0.544. Temporal analysis showed a significant increment of polyclonal infections and Hexp, and the introduction and persistence of a new parasite population since March 2013. In STE, 40.1% of infections were polyclonal, with Hexp = 0.596. The presence of four genetic clusters without signals of clonal expansion and infections with lower parasite densities compared against the other two areas were also found. At least four parasite populations were present in CAH in 2012, where, after June 2014, malaria cases decreased from 213 to 61, concomitant with a decrease in polyclonal infections (from 0.286 to 0.18), and expectedly variable Hexp. Strong signals of gene flow were present in the study areas and wide geographic distribution of highly diverse parasite populations were found. This study suggests that movement of malaria parasites by human reservoirs connects geographically distant malaria transmission areas in the Peruvian Amazon. The maintenance of high levels of parasite genetic diversity through human mobility is a critical barrier to malaria elimination in this region.

Preventative care for patients with inflammatory bowel disease in the Veterans Health Administration.

Patients with inflammatory bowel disease (IBD) have underlying immune dysregulation. Immunosuppressive medications put them at risk of infection. This study assessed rates of recommended vaccinations and preventative screening in patients with IBD.Nationwide data on patients diagnosed with IBD in the Veterans Health Administration (VHA) October 2004 to September 2014 were extracted. Variation in vaccination, screenings, and risk of death by demographic factors (age group, gender) were estimated in bivariate and multivariable analyses.During the 10-year study period, 62,002 patients were treated for IBD. Nonmelanoma skin cancer was found in 2.6%, and these patients more commonly accessed dermatology clinic (22.5% vs 15.2%; chi-square = 66.6; df = 1; P < 0.0001). In total, 15% received DEXA scans, especially women (34.7% vs 13.2% men; chi-square = 1415.5; df = 1; P < 0.0001). Eye manifestations were noted in 38.3% yet only 31% were referred to ophthalmology. Abnormal Pap smears were found for 15% of women <65 (compared to 5% among normal patient populations); 34% had no record of Pap smear in VHA data. Vaccination rates were modest: pneumococcal 39%; TDAP 23%; hepatitis B 3%; varicella and PPD <0.5%. In an adjusted logistic regression model, 5-year mortality was lower among those using primary care prior to IBD diagnosis (odds ratio [OR] = 0.61; 95% CI 0.55-0.68).Despite the current IBD guidelines, vaccination and preventative screening rates were unacceptably low among patients diagnosed with IBD. Interventions such as education and increased awareness may be needed to improve these rates.

Pneumococcal vaccination rates in VHA patients with inflammatory bowel disease.

Inflammatory bowel disease (IBD) is an inflammatory condition of the digestive tract not caused by infectious agents. Symptoms of IBD, such as diarrhea and pain, diminish one's quality of life. Underlying immune dysregulation may put IBD patients at risk for severe infectious disease making preventative vaccination highly recommended. Therefore, this study sought to assess rates of pneumococcal vaccination in patients with IBD.A cross-sectional observational study was employed utilizing administrative data extracts from the Veterans Health Administration (VHA) to identify patients diagnosed with IBD per International Classification of Diseases, Version 9, Clinical Modification codes. Their pneumococcal vaccine histories were determined from Common Procedural Terminology codes. Data were aggregated to the patient level and subjected to multivariable logistic regression to assess factors associated with receipt of the vaccination and 1-year mortality; survival analyses extended follow-up to as much as 4 years following IBD diagnosis.From October 2004 to September 2009, 49,350 patients were diagnosed with IBD in the VHA. Incidence was approximately 6000 cases/y. Patients averaged 62 years (±15, range 19-98) with 45% aged 65 or older. Approximately 6% were women, 21% were highly disabled from a military service-connected condition, 46% had hypertension, 38% dyslipidemia, and 18% diabetes. Only 20% of the cohort received pneumococcal vaccination including 5% vaccinated prior to IBD diagnosis, 2% on the date of diagnosis, and 13% subsequently. Being married, living outside the Northeast, and having more comorbidities were associated with vaccination before IBD diagnosis; models of vaccination at or after diagnosis demonstrated poor fit: little better than chance. Vaccinations before, after, and at diagnosis were protective against 1-year mortality adjusting for clinical and demographic covariates. Living in the South was an independent risk factor for death among IBD patients.While vaccination for pneumococcus is a low-cost, low-risk recommendation for persons with IBD with an apparent survival benefit, vaccination rates were low.

Congenital eruption cyst: a case report.

Congenital pathologies are those existing at or dating from birth. Occurrence of congenital cystic lesions in the oral cavity is uncommon in neonates. Eruption cyst (EC) is listed among these unusual lesions. It occurs within the mucosa overlying teeth that are about to erupt and, according to the current World Health Organization (WHO) classification of epithelial cysts of the jaws, EC is a separate entity. This paper presents a case of congenital EC successfully managed by close monitoring of the lesion, without any surgical procedure or tooth extraction. Eruption of the teeth involved, primary central incisors, occurred at the fourth month of age. During this time neither the child nor mother had any complication such as pain on sucking, refusal to feed, airway obstruction, or aspiration of fluids or teeth.

Food Systems and Public Health: The Community Perspective.

This article addresses the intersection of the food system and public health from the community perspective, based on the work of the HOPE Collaborative in Oakland, California. The HOPE Collaborative initiated intensive community outreach and engagement as part of its planning process to address inequitable access to healthy food in Oakland's most vulnerable neighborhoods. This effort involved two levels of community assessment and an inquiry into the potential of addressing both healthy food access and poverty through the construction of local food enterprise networks. Many unanswered questions remain. However, it seems clear in that in order to reduce health disparities in Oakland's most vulnerable neighborhoods, the community must address inequities in both access to healthy food and access to economic opportunity.

Floor of the nose mucosa lysis and labial abscess caused by a bee sting.

Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.

Tissue damage after sodium hypochlorite extrusion during root canal treatment.

Sodium hypochlorite solution is toxic to vital tissues, causing severe effects if extruded during endodontic treatment. This paper presents a report on the tissue damage related to inadvertent extrusion of concentrated sodium hypochlorite solution during root canal treatment. A 65-year-old woman was referred with moderate pain, ecchymosis, and severe swelling of the right side of the face. These symptoms appeared immediately after a root canal treatment of the maxillary right canine, which had been started 21 hours earlier. It was diagnosed as air emphysema related to sodium hypochlorite solution extravasation during the endodontic treatment. To avoid this, an initial radiograph should be taken to determine the correct canal working length and confirm root canal integrity.

Intentional replantation of a mandibular molar: case report and 14-year follow-up.

This case report describes the nonsurgical endodontic treatment and intentional replantation of a mandibular molar and its nearly 14-year follow-up. A 56-year-old woman sought treatment with complaint of discomfort and sensitivity in the mandibular left area. The radiographic examination showed that the mandibular left first molar was endodontically treated, with over-instrumentation of the distal root and unsatisfactory obturation on the mesial root. A large periapical lesion was observed surrounding the roots. In view of the patient's limited interocclusal space and objection to undergo an apical surgery, intentional replantation was suggested as an alternative. The patient returned for clinical and radiographic follow-up at 15 days, 40 days, 6 months, 12 months, and once yearly thereafter. At the last visit, after 14 years, no painful symptomatology was reported, probing depth was no greater than 3 mm, the periradicular area had normal appearance and no evidence of root resorption or periapical lesion.

Treatment of external inflammatory root resorption after autogenous tooth transplantation: case report.

This paper describes a case of autogenous tooth transplantation. An external inflammatory root resorption developed in a 30-year-old female patient and was successfully treated with the placement of calcium hydroxide-based intracanal dressings. Autotransplantation of tooth 32 into the extraction socket of tooth 30 was carried out with no intraoperative complications and uneventful postoperative course. However, the patient did not appear on the 14th postoperative day to initiate endodontic therapy of the transplanted tooth. She did not return for 3 months, at which time the clinical and periapical radiographic examinations revealed the presence of external inflammatory root resorption. Endodontic treatment was initiated immediately. Root canals were prepared and filled with a calcium hydroxide-based intracanal dressing (Calen paste), changed every 21 days during a 6-month period, and were thereafter obturated with Sealapex calcium hydroxide-based sealer and gutta-percha points. After 2 years of follow-up, the transplanted tooth was symptom free with no exacerbated sensibility to percussion, normal mobility, occlusion, and masticatory function. Probing revealed no periodontal pockets or other pathological signs. Radiographic examination showed the periradicular area with normal appearance, completely healed resorption areas, and presence of an intact lamina dura.

Large apical periodontitis healing following root canal dressing with calcium hydroxide: a case report / Reparo de lesão periapical extensa após utilização de curativo de demora à base de hidróxido de cálcio: relato de caso

PURPOSE: The objective of this paper is to report the clinical case of a patient who presented a chronic apical periodontitis, arising from internal inflammatory resorption followed by pulp necrosis, and a long-term success of a root canal therapy using calcium hydroxide as root canal dressing. CASE DESCRIPTION: A 20-year-old male patient presented for routine dental treatment. By radiographic examination we noted an extensive radioluscent area, laterally to the permanent maxillary right lateral incisor, with possibility of communication with the lateral periodontium, suggestive of a chronic apical periodontitis. Due to external root resorption detection, we used a calcium hydroxide root canal dressing, changed every 15 days, for a period of 2 months. Root canal filling was performed using gutta-percha cones by lateral condensation technique Radiographic follow up held after 19 years of treatment indicated a periodontium in conditions of normality, with the presence of lamina dura. CONCLUSION: Calcium hydroxide is a suitable material to be used as root canal dressing in teeth with apical periodontitis. Long-term evaluation demonstrated the satisfactory clinical outcome following root canal treatment.

OBJETIVO: O objetivo deste trabalho é relatar o caso clínico de um paciente que apresentava lesão periapical crônica decorrente de necrose de pulpar e o sucesso a longo prazo de uma terapia endodôntica utilizando o hidróxido de cálcio como curativo de demora. DESCRIÇÃO DO CASO: O paciente, do gênero masculino, com 20 anos de idade, compareceu à Clínica Odontológica para tratamento de rotina. Por meio de exames radiográficos observamos uma área radioluscente extensa, lateralmente ao incisivo lateral superior direito, com possibilidade de comunicação com o periodonto lateral, sugestivo de lesão periapical. Devido à presença de reabsorção radicular externa, foi utilizado um curativo de demora à base de hidróxido de cálcio (Calen®), trocado a cada 15 dias, por um período de 2 meses. A obturação do canal radicular foi realizada com cones de guta-percha pela técnica de condensação lateral ativa. O acompanhamento radiográfico realizado após 19 anos do tratamento endodôntico indicou um periodonto em condições de normalidade, com integridade da lamina dura. CONCLUSÃO: O hidróxido de cálcio é um material adequado para ser usado como curativo de demora em dentes com lesão periapical, uma vez que a avaliação a longo prazo demonstrou resultados clínicos satisfatórios após o tratamento endodôntico.

Congenital eruption cyst: a case report

Congenital pathologies are those existing at or dating from birth. Occurrence of congenital cystic lesions in the oral cavity is uncommon in neonates. Eruption cyst (EC) is listed among these unusual lesions. It occurs within the mucosa overlying teeth that are about to erupt and, according to the current World Health Organization (WHO) classification of epithelial cysts of the jaws, EC is a separate entity. This paper presents a case of congenital EC successfully managed by close monitoring of the lesion, without any surgical procedure or tooth extraction. Eruption of the teeth involved, primary central incisors, occurred at the fourth month of age. During this time neither the child nor mother had any complication such as pain on sucking, refusal to feed, airway obstruction, or aspiration of fluids or teeth.

Patologias congênitas são aquelas que aparecem ao nascimento. A ocorrência de lesões císticas congênitas na cavidade bucal é rara em recém-nascidos. O cisto de erupção (CE) pode ser considerado como lesão rara que se localiza na mucosa que recobre um dente que está próximo do momento de sua erupção. De acordo com a classificação de cistos epiteliais dos maxilares, descrita pela Organização Mundial da Saúde (OMS), os CE são considerados uma entidade distinta. O presente relato descreve um caso clínico de um cisto congênito de erupção tratado com sucesso somente pelo acompanhamento da lesão, sem a necessidade de nenhuma intervenção cirúrgica ou extração dentária. A erupção dos dentes envolvidos (incisivos centrais decíduos) ocorreu aos 4 meses de idade e durante este período não houve reclamações da mãe e/ou da criança em relação a dor para sucção, recusa para se alimentar, obstrução das vias aéreas e aspiração de fluidos ou de dentes.

Floor of the nose mucosa lysis and labial abscess caused by a bee sting

Hymenoptera order includes bees, which have a stinging apparatus at the tail capable of delivering venom to the affected tissues. Myocardial infarction, acute renal failure, Necrotizing fasciitis, fatal infection and hemifacial asymmetry, are some of the unusual reactions reported following hymenoptera stings. This paper reports a case of bee sting in the right floor of the nose that mimicked an odontogenic infection affecting the upper lip, canine space and nasal cavity such as in cases of infection secondary to pulpal or periodontal pathology of the anterior teeth. After a thorough clinical and radiographic examination, odontogenic infection was discarded and the diagnosis of floor of the nose mucosal lysis and lip abscess secondary to a bee sting was made. This case was successfully managed with adequate incision, drainage and antibiotics without any further complication. There are several reports of unusual reactions following hymenoptera stings. However, just a few of them referred to infections of local reactions and none of them related to the anatomic location affected in the patient of the present case. Early diagnosis and treatment prevented infection dissemination and the likelihood of tissue necrosis as in previously reported cases of Necrotizing fasciitis.

A ordem das himenópteras inclui abelhas, que possuem um ferrão na cauda capaz de de injetar veneno nos tecidos afetados. Fasciite necrosante, infecção fatal e assimetria hemifacial são algumas das reações incomuns relatadas após picada de himenópteras. Este estudo relata um caso de picada de abelha no assoalho da narina direita que simulou uma infecção odontogênica atingindo o lábio superior, o espaço canino e a cavidade nasal, como observado nos casos de infecção secundária após patologia pulpar ou periodontal dos dentes anteriores. Após completo exame clínico e radiográfico, foi descartada a hipótese de infecção odontogênica e foi estabelecido o diagnóstico de lise da mucosa do assoalho da narina e abscesso do lábio, após picada de abelha. Este caso foi tratado com sucesso com adequada incisão, drenagem e administração de antibióticos, sem outras complicações. Há vários relatos de reações incomuns resultantes de picada de himenópteras, porém poucos são relativos a infecções locais e nenhum se refere à localização anatômica afetada no paciente do caso aqui relatado. Diagnóstico e tratamento precoces preveniram a disseminação da infecção e a possibilidade de necrose tecidual, como já relatado em casos de fasciite necrosante.