Análise comparativa das características composicionais, técnicas e comerciais dos cimentos endodônticos obturadores à base de silicato de cálcio / Comparative analysis of compositional, technical and commercial characteristics of calcium silicate-based endodontic root canal sealers

Introdução: os cimentos endodônticos obturadores à base de silicato de cálcio têm sido amplamente utilizados na endodontia, principalmente em razão de suas reconhecidas propriedades bioativas. Como consequência, uma quantidade expressiva de marcas comerciais foi lançada no mercado, dificultando a compreensão do profissional, principalmente no que diz respeito às diferentes composições químicas, apresentações, formas de uso e custo-benefício. Objetivos: o Objetivo deste trabalho foi analisar as diferenças composicionais, técnicas (indicações e apresentação comercial) e comerciais (custo e disponibilidade de venda) dos cimentos endodônticos obturadores à base de silicato de cálcio, disponíveis para uso e comercialização no Brasil. Metodologia: foi realizada uma busca sistemática no site da Anvisa, sendo identificados sete cimentos endodônticos obturadores biocerâmicos para uso no Brasil. As bulas dos produtos foram analisadas para verificação de composição, apresentação e indicação de uso. Sites especializados foram consultados para verificação de preço dos produtos. Resultados: observou-se que a composição química varia bastante, a depender do fabricante, sendo os silicatos tricálcico e dicálcico os componentes mais frequentes. A maioria dos cimentos é apresentada comercialmente pronta para uso, e possui óxido de zircônio como agente radiopacificador. A venda através de sites especializados ainda é restrita a alguns produtos, e o custo varia de acordo com a quantidade de material por embalagem. Conclusão: este trabalho apresentou as características composicionais, técnicas e comerciais de sete cimentos endodônticos obturadores à base de silicato de cálcio registrados na ANVISA e autorizados para uso no Brasil.

Introduction: calcium silicate-based endodontic sealers have been widely used in endodontics, mainly because of their recognized bioactive properties. As a result, a significant number of commercial brands were launched on the market, making it difficult for professionals their comprehension, especially with regard to different chemical compositions, presentations, forms of use and cost-effectiveness. Objective: the Objective of this work was to analyze the compositional, technical (indications and commercial presentation) and commercial (cost and availability) differences of calcium silicate-based endodontic sealers, available for use and commercialization in Brazil. Methodology: a systematic search was carried out on the Anvisa website, and seven bioceramic endodontic sealers for use in Brazil were identified. Product leaflets were analyzed to verify composition, presentation and indication of use. Specialized websites were consulted to verify the price of the products. Results: it was observed that the chemical composition varies a lot, depending on the manufacturer, with tricalcium and dicalcium silicates being the most frequent components. Most sealers are commercially available ready-to-use, and have zirconium oxide as a radiopacifying agent. The sale through specialized websites is still restricted to some products, and the cost varies according to the amount of material per package. Conclusion: this work presented the compositional, technical and commercial characteristics of seven calcium silicate-based endodontic sealers registered at ANVISA and authorized for use in Brazil.

Comparative effects of dexmedetomidine and propofol on brain and lung damage in experimental acute ischemic stroke.

Acute ischemic stroke is associated with pulmonary complications, and often dexmedetomidine and propofol are used to decrease cerebral metabolic rate. However, it is unknown the immunomodulatory actions of dexmedetomidine and propofol on brain and lungs during acute ischemic stroke. The effects of dexmedetomidine and propofol were compared on perilesional brain tissue and lung damage after acute ischemic stroke in rats. Further, the mean amount of both sedatives was directly evaluated on alveolar macrophages and lung endothelial cells primarily extracted 24-h after acute ischemic stroke. In twenty-five Wistar rats, ischemic stroke was induced and after 24-h treated with sodium thiopental (STROKE), dexmedetomidine and propofol. Dexmedetomidine, compared to STROKE, reduced diffuse alveolar damage score [median(interquartile range); 12(7.8-15.3) vs. 19.5(18-24), p = 0.007)], bronchoconstriction index [2.28(2.08-2.36) vs. 2.64(2.53-2.77), p = 0.006], and TNF-α expression (p = 0.0003), while propofol increased VCAM-1 expression compared to STROKE (p = 0.0004). In perilesional brain tissue, dexmedetomidine, compared to STROKE, decreased TNF-α (p = 0.010), while propofol increased VCAM-1 compared to STROKE (p = 0.024). In alveolar macrophages and endothelial cells, dexmedetomidine decreased IL-6 and IL-1ß compared to STROKE (p = 0.002, and p = 0.040, respectively), and reduced IL-1ß compared to propofol (p = 0.014). Dexmedetomidine, but not propofol, induced brain and lung protection in experimental acute ischemic stroke.

Intracranial Pressure During the Development of Renovascular Hypertension.

[Figure: see text].

Tecnologia educativa na prevenção e cuidado de infecções respiratórias na creche / Educational technology for prevention and care of respiratory infections in daycare centers

Objective:to describe the validation process of an educational technology in the form of a booklet on the prevention and care of respiratory infections in children at day care centers. Method:methodological study that used the theoretical step of Pasquali's model. Data were collected from November 2013 to March 2014 and validated using the Delphi technique, in two moments: content analysis by 11 expert judges, and face analysis by 9 day care center instructors in the municipality of Coari/Amazonas. Questionnaires were organized on a Likert scale and analyzed quantitatively. Results:the material proved to be statistically validated, as it presented an excellent level of agreement between expert judges (90.91%) and the target audience (99.15%), with no disagreement in the evaluations. Conclusion:the educational technology was considered a facilitator in the care and education process in health actions, serving as a tool to promote effective communication and helping in the proper management of children with respiratory infections.

Objetivo: descrever o processo de validação de tecnologia educativa tipo cartilha sobre prevenção e cuidados de infecções respiratórias de crianças na creche. Método: estudo metodológico que utilizou a etapa teórica do modelo de Pasquali. Dados coletados de novembro de 2013 a março de 2014 e validados com uso da técnica de Delphi, em dois momentos: análise do conteúdo por 11 juízes especialistas e análise da aparência por 9 educadoras infantis de creche no município de Coari/Amazonas. Os questionários foram organizados em escala de Likert e analisados quantitativamente. Resultados: o material mostrou-se validado estatisticamente, ao apresentar um nível de concordância excelente entre os juízes expertises(90,91%) e o público-alvo (99,15%), não apresentando discordância nas avaliações. Conclusão: a tecnologia educacional tem sido considerada facilitadora no processo de cuidar e educar nas ações de saúde, servindo como ferramenta para promover a comunicação eficaz auxiliando no manejo adequado de crianças com infecções respiratórias.

Effects of Obesity on Pulmonary Inflammation and Remodeling in Experimental Moderate Acute Lung Injury.

Obese patients are at higher risk of developing acute respiratory distress syndrome (ARDS); however, their survival rates are also higher compared to those of similarly ill non-obese patients. We hypothesized that obesity would not only prevent lung inflammation, but also reduce remodeling in moderate endotoxin-induced acute lung injury (ALI). Obesity was induced by early postnatal overfeeding in Wistar rats in which the litter size was reduced to 3 pups/litter (Obese, n = 18); Control animals (n = 18) were obtained from unculled litters. On postnatal day 150, Control, and Obese animals randomly received E. coli lipopolysaccharide (ALI) or saline (SAL) intratracheally. After 24 h, echocardiography, lung function and morphometry, and biological markers in lung tissue were evaluated. Additionally, mediator expression in neutrophils and macrophages obtained from blood and bronchoalveolar lavage fluid (BALF) was analyzed. Compared to Control-SAL animals, Control-ALI rats showed no changes in echocardiographic parameters, increased lung elastance and resistance, higher monocyte phagocytic capacity, collagen fiber content, myeloperoxidase (MPO) activity, and levels of interleukin (IL-6), tumor necrosis factor (TNF)-α, transforming growth factor (TGF)-ß, and type III (PCIII), and I (PCI) procollagen in lung tissue, as well as increased expressions of TNF-α and monocyte chemoattractant protein (MCP)-1 in blood and BALF neutrophils. Monocyte (blood) and macrophage (adipose tissue) phagocytic capacities were lower in Obese-ALI compared to Control-ALI animals, and Obese animals exhibited reduced neutrophil migration compared to Control. Obese-ALI animals, compared to Obese-SAL, exhibited increased interventricular septum thickness (p = 0.003) and posterior wall thickness (p = 0.003) and decreased pulmonary acceleration time to pulmonary ejection time ratio (p = 0.005); no changes in lung mechanics, IL-6, TNF-α, TGF-ß, PCIII, and PCI in lung tissue; increased IL-10 levels in lung homogenate (p = 0.007); reduced MCP-1 expression in blood neutrophils (p = 0.009); decreased TNF-α expression in blood (p = 0.02) and BALF (p = 0.008) neutrophils; and increased IL-10 expression in monocytes (p = 0.004). In conclusion, after endotoxin challenge, obese rats showed less deterioration of lung function, secondary to anti-inflammatory and anti-fibrotic effects, as well as changes in neutrophil and monocyte/macrophage phenotype in blood and BALF compared to Control rats.

Biologic Impact of Mechanical Power at High and Low Tidal Volumes in Experimental Mild Acute Respiratory Distress Syndrome.

BACKGROUND: The authors hypothesized that low tidal volume (VT) would minimize ventilator-induced lung injury regardless of the degree of mechanical power. The authors investigated the impact of power, obtained by different combinations of VT and respiratory rate (RR), on ventilator-induced lung injury in experimental mild acute respiratory distress syndrome (ARDS). METHODS: Forty Wistar rats received Escherichia coli lipopolysaccharide intratracheally. After 24 h, 32 rats were randomly assigned to be mechanically ventilated (2 h) with a combination of different VT (6 ml/kg and 11 ml/kg) and RR that resulted in low and high power. Power was calculated as energy (ΔP,L/E,L) × RR (ΔP,L = transpulmonary driving pressure; E,L = lung elastance), and was threefold higher in high than in low power groups. Eight rats were not mechanically ventilated and used for molecular biology analysis. RESULTS: Diffuse alveolar damage score, which represents the severity of edema, atelectasis, and overdistension, was increased in high VT compared to low VT, in both low (low VT: 11 [9 to 14], high VT: 18 [15 to 20]) and high (low VT: 19 [16 to 25], high VT: 29 [27 to 30]) power groups. At high VT, interleukin-6 and amphiregulin expressions were higher in high-power than in low-power groups. At high power, amphiregulin and club cell protein 16 expressions were higher in high VT than in low VT. Mechanical energy and power correlated well with diffuse alveolar damage score and interleukin-6, amphiregulin, and club cell protein 16 expression. CONCLUSIONS: In experimental mild ARDS, even at low VT, high mechanical power promoted ventilator-induced lung injury. To minimize ventilator-induced lung injury, low VT should be combined with low power.

DRAIN AMYLASE ON THE FIRST POSTOPERATIVE DAY OF WHIPPLE SURGERY: WHAT VALUE IS THE BEST PREDICTOR FOR EARLY DRAIN REMOVAL?

BACKGROUND: The value of drain amylase on the first postoperative day after pancreatic resections has been described as an efficient predictor of pancreatic fistula. In spite of this, the cut-off point below which the drains can be removed early remains controversial. AIM: Validate the use of the amylase on the 1st postoperative day in the correlation with pancreatic fistula and define the value at which early drain removal is safe. METHOD: Were included patients undergoing Whipple surgery in the period of 2007 to 2016. Group 1 enrolled the ones who did not develop fistula and those who developed biochemical fistula for less than seven days postoperatively and group 2 included patients who developed persistent biochemical fistula between seven and 21 days and those with grade B and C fistula. RESULTS: Sixty-one patients were included, 41 comprised group 1 and 20 group 2. The incidence of abdominal collections, need for reoperation and time of hospitalization were for group 1 and 2, respectively: 17.1%, 17.1% and 9.5 days, and 65%, 40% and 21.1 days. The median of the amylase from the drain at 1st postoperative day was in group 1 and 2, respectively: 175 U/l and 3172.5 U/l (p=0.001). Using a cut-off of 180 to predict the group to which the patient would belong there was obtained sensitivity, specificity, positive predictive value and negative predictive value of 100%, 48.8%, 50% and 100% respectively. CONCLUSION: It was validated the cut-off value of 180 U/l as appropriate to early drain removal.

Biological Response to Time-Controlled Adaptive Ventilation Depends on Acute Respiratory Distress Syndrome Etiology.

OBJECTIVES: To compare a time-controlled adaptive ventilation strategy, set in airway pressure release ventilation mode, versus a protective mechanical ventilation strategy in pulmonary and extrapulmonary acute respiratory distress syndrome with similar mechanical impairment. DESIGN: Animal study. SETTING: Laboratory investigation. SUBJECTS: Forty-two Wistar rats. INTERVENTIONS: Pulmonary acute respiratory distress syndrome and extrapulmonary acute respiratory distress syndrome were induced by instillation of Escherichia coli lipopolysaccharide intratracheally or intraperitoneally, respectively. After 24 hours, animals were randomly assigned to receive 1 hour of volume-controlled ventilation (n = 7/etiology) or time-controlled adaptive ventilation (n = 7/etiology) (tidal volume = 8 mL/kg). Time-controlled adaptive ventilation consisted of the application of continuous positive airway pressure 2 cm H2O higher than baseline respiratory system peak pressure for a time (Thigh) of 0.75-0.85 seconds. The release pressure (Plow = 0 cm H2O) was applied for a time (Tlow) of 0.11-0.18 seconds. Tlow was set to target an end-expiratory flow to peak expiratory flow ratio of 75%. Nonventilated animals (n = 7/etiology) were used for Diffuse Alveolar Damage and molecular biology markers analyses. MEASUREMENT AND MAIN RESULTS: Time-controlled adaptive ventilation increased mean respiratory system pressure regardless of acute respiratory distress syndrome etiology. The Diffuse Alveolar Damage score was lower in time-controlled adaptive ventilation compared with volume-controlled ventilation in pulmonary acute respiratory distress syndrome and lower in time-controlled adaptive ventilation than nonventilated in extrapulmonary acute respiratory distress syndrome. In pulmonary acute respiratory distress syndrome, volume-controlled ventilation, but not time-controlled adaptive ventilation, increased the expression of amphiregulin, vascular cell adhesion molecule-1, and metalloproteinase-9. Collagen density was higher, whereas expression of decorin was lower in time-controlled adaptive ventilation than nonventilated, independent of acute respiratory distress syndrome etiology. In pulmonary acute respiratory distress syndrome, but not in extrapulmonary acute respiratory distress syndrome, time-controlled adaptive ventilation increased syndecan expression. CONCLUSION: In pulmonary acute respiratory distress syndrome, time-controlled adaptive ventilation led to more pronounced beneficial effects on expression of biomarkers related to overdistension and extracellular matrix homeostasis.

Drain amylase on the first postoperative day of whipple surgery: what value is the best predictor for early drain removal? / Amilase do dreno no primeiro dia de pós-operatório de operaçao de whipple: qual valor é melhor preditor para a retirada precoce do dreno?

ABSTRACT Background: The value of drain amylase on the first postoperative day after pancreatic resections has been described as an efficient predictor of pancreatic fistula. In spite of this, the cut-off point below which the drains can be removed early remains controversial. Aim: Validate the use of the amylase on the 1st postoperative day in the correlation with pancreatic fistula and define the value at which early drain removal is safe. Method: Were included patients undergoing Whipple surgery in the period of 2007 to 2016. Group 1 enrolled the ones who did not develop fistula and those who developed biochemical fistula for less than seven days postoperatively and group 2 included patients who developed persistent biochemical fistula between seven and 21 days and those with grade B and C fistula. Results: Sixty-one patients were included, 41 comprised group 1 and 20 group 2. The incidence of abdominal collections, need for reoperation and time of hospitalization were for group 1 and 2, respectively: 17.1%, 17.1% and 9.5 days, and 65%, 40% and 21.1 days. The median of the amylase from the drain at 1st postoperative day was in group 1 and 2, respectively: 175 U/l and 3172.5 U/l (p=0.001). Using a cut-off of 180 to predict the group to which the patient would belong there was obtained sensitivity, specificity, positive predictive value and negative predictive value of 100%, 48.8%, 50% and 100% respectively. Conclusion: It was validated the cut-off value of 180 U/l as appropriate to early drain removal.

RESUMO Racional: O valor da amilase do dreno no primeiro dia pós-operatório após ressecções pancreáticas é descrito como eficiente preditor de fístula pancreática. Entretanto, o valor abaixo do qual os drenos podem ser removidos precocemente permanece controverso. Objetivo: Validar o uso da amilase do primeiro dia pós-operatório na correlação com a fístula pancreática e definir o valor em que seja segura a retirada precoce do dreno. Método: Foram incluídos pacientes submetidos à operação de Whipple no período de 2007 a 2016. No grupo 1 entraram os que não desenvolveram fístula e os que desenvolveram fístula bioquímica por menos de sete dias de pós-operatório e no grupo 2 os que desenvolveram fístula bioquímica persistente entre 7 e 21 dias e aqueles com fístula grau B e C. Resultados: Sessenta e um pacientes foram incluídos, sendo 41 do grupo 1 e 20 do grupo 2. A incidência de coleções abdominais, necessidade de reoperação e tempo de internação foram para o grupo 1 e 2, respectivamente 17,1%, 17,1% e 9,5 dias, e 65%, 40% e 21,1 dias. A mediana da amilase no grupo 1 e 2, respectivamente foi de 175 U/l e 3172,5 U/l (p=0,001). Utilizando o ponto de corte de 180 para predizer o grupo a que o paciente pertenceria, obteve-se sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo de: 100%, 48,8%, 50% e 100% respectivamente. Conclusão: Esta amostra pôde validar o ponto de corte de 180 U/l como adequado para a retirada precoce do dreno.

O conhecimento dos familiares sobre cuidados à criança com leucemia linfocítica aguda no isolamento protetor / Family knowledge on child care with acute lymphocytic leukemia in protective isolation / El conocimiento de la familia sobre los cuidados a los niños con leucemia linfoblástica aguda en aislamiento protector

Objetivo: descrever o conhecimento dos familiares sobre os cuidados à criança com leucemia linfocítica aguda em isolamento protetor. Método: estudo de natureza qualitativa e descritiva, realizado no isolamento do centro de Referência para doenças onco-hematológicas da Região Norte, em Manaus, por meio de entrevista semiestruturada com 11 familiares, entre janeiro e março de 2016. Os dados foram analisados através da Análise Temática. Resultados: nas categorias: "Isolamento Protetor como prevenção de infecção: ainda um bicho de sete cabeças?" e "Cuidados no Isolamento Protetor: é preciso que todos tenham informações"; observou-se que o isolamento possui várias facetas: de proteção, prevenção, separação, que foram vivenciados pelos familiares nesse ambiente cuja rotina é diferenciada para cuidar da criança leucêmica. Conclusão: permeados de dúvidas e ansiedade, os familiares conhecem pouco sobre os cuidados a criança no isolamento; mostraram-se dispostos a aprender e sugerem a construção de um material educativo para facilitar o empoderamento do conteúdo.

Aim: to describe family members' knowledge about child care with acute lymphocytic leukemia in protective isolation. Method: this was a qualitative and descriptive study, carried out in the isolation of the Reference center for oncohematological diseases of the Northern Region, in Manaus, through a semi-structured interview with 11 relatives, from January to March 2016. Data were analyzed through Thematic Analysis. Results: from the categories: "Protective Isolation as infection prevention: is it still a seven-headed animal?" and "Protective Isolation Care: everyone needs information" it was possible to observe that the isolation has several facets. For instance, protection, prevention and the separation experienced by the family in this environment (whose routine is differentiated in order to care for the leukemic child). Conclusion: family members know little about child care in isolation and are permeated with doubts and anxiety. They have been willing to learn and suggest the construction of an educational material to facilitate the empowerment of content.

Objetivo: describir el conocimiento familiar sobre el cuidado a los niños con leucemia linfoblástica aguda en aislamiento protector. Método: estudio descriptivo cualitativo, en un centro de referencia de aislamiento para enfermedades oncohematológicas de la Región Norte, en Manaus, por medio entrevistas semiestructuradas con 11 familiares, entre enero y marzo de 2016. Los datos fueron analizados a través de análisis temático. Resultados: en las categorías: "Aislamiento con blindaje como prevención a la infección: un trabajo complejo" y "Cuidado en el blindaje de aislamiento: todos deben tener información"; se observó que el aislamiento tiene múltiples facetas: protección, prevención, separación que fueron vividas por la familia en un espacio en el cual la rutina es diferenciada para cuidar del niño con leucemia. Conclusión: con muchas dudas y ansiedad, la familia sabe poco sobre la atención de aislamiento, pero quiere aprender y sugiere el desarrollo de un material educativo para facilitar el empoderamiento del contenido.