Influência da Cinemática de Instrumentação no Preparo do Sistema de Canais Radiculares: uma Revisão Sistemática de Estudos por Microtomografia Computadorizada / Influence of Instrumentation Kinematics on Root Canal System Preparation: a Sytematics Review of Studies by Microcomputed Tomography

The objective of this study was to conduct a systematic review focused on studies that used micro-computed tomography (micro-CT) analysis to evaluate untouched canal areas after root canal preparation with continuous rotary and reciprocating kinematics. Electronic search strategies were used in LILACS, PubMed (MedLine), Science Direct, Cochrane, Scopus and Web of Science databases. An additional search for gray literature was performed on Google Scholar, OpenGrey and ProQuest. In addition, manual searches were performed on the reference list of included articles. It covered studies in English, Portuguese and Spanish, without restriction regarding the publication time. The articles selected for inclusion in this review meet all the following criteria: in vitro studies that evaluated, with the use of micro-CT, the percentage of untouched areas after root canal preparation comparing rotary and reciprocating kinematics. A total of 11 studies were selected for qualitative and quantitative analysis. One study showed that the Reciproc system has a smaller percentage of untouched channel walls in lower incisors when compared to BioRace system. Another study showed no significant differences between reciprocating systems Reciproc and WaveOne with BioRace in mesial root canals of lower molars. Similarly, they did not observe any difference between ProTaper Next and ProTaper Universal with WaveOne. A single study showed differences between XP-Endo Shaper system (rotary) compared with WaveOne Gold. The studies evaluated in the present review showed by micro-CT that none of the instrumentation systems, regardless of the kinematics used or NiTi heat treatment, was able to completely touch the root canal walls.

O objetivo deste estudo foi realizar uma revisão sistemática dos estudos que avaliaram por microtomografia computadorizada (micro - CT) as áreas não tocadas do canal radicular após o preparo com cinemática rotatória continua e reciprocante. Foram utilizadas estratégias eletrônicas de busca nas bases LILACS, PubMed (MedLine), Science Direct, Cochrane, Scopus e Web of Science. Uma busca adicional por literatura cinzenta foi realizada no Google Scholar, OpenGrey e ProQuest. A busca abrangeu estudos em inglês, português e espanhol, sem restrição em relação ao tempo de publicação. Adicionalmente, pesquisas manuais foram realizadas na lista de referências dos artigos incluídos. Os artigos selecionados foram estudos in vitro que avaliaram por micro - CT a porcentagem de áreas não tocadas após o preparo do canal radicular, comparando as cinemáticas rotatórias e reciprocante. No total 11 estudos foram selecionados para análise qualitativa e quantitativa. Um estudo mostrou que o sistema Reciproc (reciprocante) tem uma porcentagem menor de paredes não tocadas do canal em incisivos inferiores, quando comparado com o sistema BioRace (rotatório). Outro estudo não mostrou diferenças significativas entre os sistemas reciprocantes Reciproc e WaveOne e o sistema BioRace em canais radiculares mesiais de molares inferiores. Da mesma forma, não foram observadas diferenças entre ProTaper Next, ProTaper Universal (rotat órios) e WaveOne. Um único estudo apresentou diferenças entre as cinemáticas, XP - Endo Shaper (rotatório) mostrou maior porcentagem de áreas tocadas quando comparado com TRUShape e WaveOne Gold. Os estudos avaliados mostraram que nenhum dos sistemas de instrumentação, independente da cinemática, foi capaz de tocar completamente as paredes dos canais radiculares.

Manejo inicial del paciente con afectación psiquiátrica en urgencias hospitalarias: revisión sistemática / Initial management of the patients with psychiatric involvement in hospital emergency departments: a systematic review

Se revisaron los estudios que han investigado el manejo inicial del paciente con afectación psiquiátrica en urgencias hospitalarias a fin de establecer recomendaciones prácticas. Se realizó una revisión sistemática de artículos publicados entre 2010 y 2020, en cualquier idioma, mediante consulta en Biblioteca Cochrane Plus, Pubmed, IBECS, LILACS y MEDLINE. La calidad de los artículos revisados se evaluó mediante la herramienta AMSTAR2 y la plataforma FCL 3.0, junto con la declaración PRISMA. Los resultados de los once artículos seleccionados mostraron que mejorar la formación del personal, los recursos disponibles, el uso adecuado de la contención y la elección adecuada de la medicación puede ayudar a mejorar la atención del paciente con patología mental en el servicio de urgencias hospitalarias. Se recomienda el mismo manejo que en cualquier otro paciente, pero si está agitado o no colaborativo será necesario aplicar contención verbal, farmacológica y/ o mecánica, en ese orden

This article is a systematic review of studies that have investigated the initial management of patients with psychiatric conditions in hospital emergencies services in order to establish practical recommendations. A systematic review of the literature was carried out, consisting of studies published from 2010 to 2020, available in any language, consulting Cochrane Library Plus, PubMed, IBECS, LILACS and MEDLINE. The quality of the studies included in this review was assessed by the AMSTAR2 tool and the FCL 3.0 platform, together with the PRISMA statement.Results from the eleven papers selected showed that improvements in staff training, available resources, appropriate use of restraint and appropriate choice of medication can help to improve the care of patients with mental pathology in hospital emergency services. The same management for any other patient is recommended. However, if the patient is agitated or uncooperative, verbal, pharmacological and/or mechanical restraint (in this order) may be necessary

Somnolencia diurna excesiva e higiene del sueño en adultos trabajadores de España / Excessive daytime sleepiness and sleep higiene of working adults in Spain

Fundamento: Determinar la prevalencia de somnolencia diurna excesiva (SDE) mediante la escala de somnolencia de Epworth (ESE), e identificar qué variables personales o del puesto de trabajo predicen el riesgo de sufrir SDE. Materiales y métodos: Estudio transversal realizado en 476 funcionarios de la Región de Murcia (octubre 2013-febrero 2016). La prevalencia de SDE y de mala higiene del sueño (MHS) se obtuvo de las puntuaciones de la ESE y del cuestionario de higiene del sueño (EHS), y se relacionaron con distintas variables recogidas mediante un cuestionario auto-administrado. Las variables predictoras de SDE se identificaron mediante regresión logística multivariante. Resultados: La prevalencia de SDE (16,7%) fue inferior a la de MHS (23,4%). Las mujeres obtuvieron mayores puntuaciones en la ESE (7,5 vs 6,3; p=0,001) y sufrían el doble de SDE (23,0 vs 10,7%, p<0,001). Los funcionarios con SDE obtuvieron puntuaciones más altas en la ESE (34,3 vs 32,7; p=0,044) y mostraban más MHS (38,7 vs 24,9%, p=0,014). Entre los fumadores predominaron las mujeres (57%; p=0,087) y la MHS (50,0% vs 25,8 en exfumadores y 18,9 en nunca fumadores, p<0,001). Ser mujer (OR=2,5, IC95%: 1,4-4,3; p<0,001) y tener mala higiene del sueño (OR=1,8, IC95%: 1,0-3,2; p=0,032) fueron factores predictores independientes de padecer SDE. Conclusiones: La SDE está presente en los funcionarios de la comunidad autónoma de Murcia y es más frecuente en mujeres. Ser mujer y tener mala higiene del sueño son predictores de padecer SDE

Background: To calculate the prevalence of excessive daytime sleepiness (EDS) (through the Epworth Sleepiness Scale, ESE) and to identify the personal and working variables predicting the risk of EDS. Methods: Cross-sectional study performed on 476 civil servants from Murcia (October 2013 - February 2016). Prevalence of EDS and bad sleep hygiene (LSH) were determined from scores on the Epworth Sleepiness Scale and Sleep Hygiene Scale (SHS), respectively, and their association with different variables was obtained from a self-administered questionnaire. Independent predictors of EDS were identified by multivariate logistic regression. Results: EDS was less prevalent (16.7%) than LSH (23.4%). Women scored higher in ESE (7.5 vs 6.3; p=0,001) and suffered twice the EDS of men (23.0 vs 10.7%, p<0.001). Workers with EDS scored higher on SHS (34.3 vs 32.7; p=0.044) and had LSH more frequently (38.7 vs 24.9%, p=0.014). Smokers were predominantly women (57.0%; p=0.087) with LSH (50.0 vs 25.8 and 18.9% amongst ex-smokers and non-smokers, p<0.001). Being a woman OR=2.5, 95%IC: 1.4-4.3; p<0.001) and having bad sleep hygiene (OR=1.8 95%IC: 1.0-3.2, p=0.032) were predictive factors irrespective of suffering from EDS. Conclusions: EDS was present in civil servants in the region of Murcia, and was higher in women than men. Excessive daytime sleepiness is strongly associated with bad sleep hygiene and became a woman

Síndrome de la costilla deslizante. Serie de 4 casos clínicos / No disponible

Introducción: El síndrome de costilla deslizante (SCD) es una entidad poco frecuente en niños. Se cree que su causa es una debilidad en los ligamentos costales que permite una hipermovilidad de las costillas. Genera un dolor intermitente en la región baja del tórax o alta del abdomen que puede afectar a las actividades de la vida diaria o generar un dolor crónico. Material y métodos: Revisión retrospectiva de SCD entre octubre de 2012 y diciembre de 2017. Se recogió información acerca de los datos demográficos, síntomas, estudios de imagen, hallazgos intraoperatorios, material fotográfico y seguimiento a largo plazo. Resultados: Durante este periodo, 4 pacientes fueron diagnosticados de SCD. La mediana de edad al diagnóstico fue de 13 años (12-15 años) con una duración previa de los síntomas de 13 meses (12-36 meses). En 2 pacientes se asoció una dismorfia costal (DC). El diagnóstico fue clínico con confirmación ecográfica. Se realizó resección de los cartílagos afectos en 3 pacientes con un seguimiento posterior de 6 meses (3-30 meses). Actualmente se encuentran sin dolor y con un resultado estético satisfactorio. Un paciente rechazó la intervención. Conclusiones: El SCD aparece en pacientes preadolescentes que en algunos casos asocian DC. Una exploración física y ecografía enfocada son las claves para un diagnóstico certero. La resección de cartílagos es efectiva a largo plazo

Aim of the study: The slipping rib syndrome (SRS) is an unknown pathology for the pediatric surgeon due to its low incidence in children. The weakness of the costal ligaments allowing an area of rib hypermobility has been postulated recently as the main etiology. It produces an intermittent pain in the lower thorax or upper abdomen that can affect to the daily activities and can be the origin of unspecific chronic pain. Methods: A retrospective review of patients diagnosed with SRS between october 2012 and march 2017 was performed. Data of demographics, symptoms, imaging studies, surgical findings and long-term follow-up were collected. Results: During this period, 4 patients were diagnosed with SRS. Median age at diagnosis was 13 years (12-15 years) with a mean duration of symptoms of 13 months (12-36 months). In 2 patients the SRS was associated with Costal Dysmorphia (CD). The initial diagnosis was clinical with posterior ultrasound confirmation. Resection of the affected cartilages was performed in 3 patients and after a follow-up of 6 months (3-30 months), they all are painless and refer a good cosmetic result. One patient refused the intervention. Conclusions: The SRS is an infrequent cause of thoracic pain with an etiology not well understood. The awareness of this disease and its typical presentation can avoid unnecessary studies. The resection of the affected cartilages is a safe and effective treatment

Antifungal agents: Mode of action in yeast cells

Different kinds of mycoses, especially invasive, have become an important public health problem as their incidence has increased dramaticallyin the last decades in relation to AIDS, hematological malignancies, transplant recipients and other immunosuppressed individuals.Management of fungal infections is markedly limited by problems of drug safety, resistance and effectiveness profile. Current therapy forinvasive mycoses uses a relatively reduced number of antifungal drugs, such as amphotericin B, fluconazole and itraconazole. Other newantifungal agents from old and new chemical families, like voriconazole, posaconazole, ravuconazole, caspofungin and micafungin, havebeen introduced into the armamentarium for fungal infections management. This review is focused on the mode of action of those antifungaldrugs used against pathogenic yeasts. The interaction of amphotericin B with ergosterol and other membrane sterols results in theproduction of aqueous pores of drug and the ergosterol biosynthetic pathway is the target of the allylamines, phenylmorpholines and azoleantifungal agents. The main molecular target of azole antifungals is the cytochrome P-450 protein Erg11p/Cyp51p. Echinocandins, a newclass of antifungal drugs, are fungal secondary metabolites that act against beta-1-3-D-glucan synthesis. The phenylmorpholines, of whichamorolfine is the sole representative in human therapy, affect two targets in the ergosterol pathway: Erg24p (delta 14 reductase) and Erg2p(delta 8–delta 7 isomerase). The sordarins group are protein synthesis inhibitors that work by blocking the function of fungal translationelongation factor 2. Other protein inhibitors are zofimarin, BE31045, SCH57504, xylarin, hypoxysordarin and GR135402. In order to overcomethe problems derived from the exploitation of azole drugs, macrolides and echinocandins, novel targets were explored. Proposed antifungaldrugs have been developed against potential targets like the N-myristylation of fungal proteins, with inhibitors like myristate and histidineanalogues or myristoylpeptide derivatives, aminobenzothiazoles, quinolines and benzofurans. Polymerization of cell wall carbohydratesfrom uridine di-phospho sugars is another potential target

Las micosis, especialmente las invasoras, se han convertido en un importante problema de salud al aumentar espectacularmente su incidenciadurante las últimas décadas en pacientes con sida, neoplasias hematológicas, trasplantes y otros tipos de inmunosupresión. Su tratamientoestá muy limitado por problemas de eficacia, resistencia y seguridad farmacológicas, y actualmente se utiliza un número relativamente reducidode antifúngicos, como amfotericina B, fluconazol e itraconazol. Otros nuevos antifúngicos, procedentes tanto de recientes familias químicascomo de las clásicas, se han introducido en los protocolos de las infecciones fúngicas. Esta revisión se centra en el mecanismo de acciónde los antifúngicos utilizados frente a levaduras patógenas. La interacción de amfotericina B con ergosterol y otros esteroles de membrana dacomo resultado la producción de poros acuosos y la vía biosintética del ergosterol es la diana sobre la que actúan las alilaminas, las fenilmorfolinasy los azoles. La principal diana molecular de los azoles es la proteína Erg11p/Cyp51p del citocromo P-450. Las equinocandinas son metabolitossecundarios fúngicos que inhiben la síntesis de beta-1-3-D-glucano. Las fenilmorfolinas, de las que amorolfina es la única utilizadaen humanos, afecta a dos dianas en la vía del ergosterol: Erg24p (delta 14 reductasa) y Erg2p (delta 8-delta 7 isomerasa). Las sordarinas soninhibidores de la síntesis proteica que bloquean la función del factor de elongación 2. Otros inhibidores proteicos son zofimarina, BE31045,SCH57504, xilarina, hipoxisordarina y GR135402. Con objeto de superar los problemas derivados del abuso de azoles, macrólidos y equinocandinas,se han explorado nuevas dianas y posibles antifúngicos frente a ellas,como los inhibidores de la N-miristilación de las proteínas fúngicas,por ejemplo miristato y análogos de la histidina o derivados miristoil peptidicos, aminobenzotiazoles, quinolinas y benzofuranos. La polimerizaciónde los hidratos de carbono de la pared celular procedentes de azúcares uridina difosfato es otra posible diana

Tumores del nervio facial / Facial Nerve Tumours

Introducción. Los tumores originados a partir del nervio facial son sumamente raros y su enfoque terapéutico afecta a especialistas en diversas disciplinas. Objetivo. Analizar los casos tratados en un período de cinco años en nuestra institución. Pacientes y métodos. Se evaluaron retrospectivamente todos los sujetos operados de tumores del nervio facial entre enero de 1992 y diciembre de 1996. A todos ellos se les registró la edad, el sexo, el lado, el tiempo hasta el diagnóstico, el síntoma de inicio y los síntomas presentes en el momento del diagnóstico, la historia previa de alteraciones del nervio facial y la clínica neurológica asociada. Igualmente se anotaron localización de la lesión, la técnica quirúrgica, la anatomía patológica, las complicaciones posoperatorias, la estancia posquirúrgica, las secuelas faciales y los procedimientos quirúrgicos reparadores sobre los nervios faciales operados. Resultados. Se trataron seis casos, con una media de edad de 29 años (rango: 16-46 años). Tres pacientes eran varones (50%). El síntoma inicial de la enfermedad fue parálisis facial (4), hipoacusia neurosensorial (1) y acúfeno (1). Los seis individuos (100%) presentaron alteraciones de la función facial en el curso de la enfermedad. El diagnóstico anatomopatológico fue schwannoma en cuatro casos y hemangioma en los dos restantes. Se realizaron injertos neurales en tres pacientes y se objetivó algún tipo de déficit al final del seguimiento en todos los casos. Conclusiones. Los tumores del nervio facial son muy raros. Se necesita un diagnóstico precoz con el objetivo de disminuir las secuelas faciales tras la cirugía en esta entidad (AU)

Introduction. Tumours originating in the facial nerve are extremely rare and their therapeutic approach requires the aid of specialists from a number of disciplines. Aims. Our aim was to analyse the cases treated in our centre over a fiveyear period. Patients and methods. All the subjects submitted to surgical interventions to treat facial nerve tumours between January 1992 and December 1996 were evaluated retrospectively. Data recorded from all patients included age, sex, side affected, time prior to diagnosis, presenting symptom and symptoms observed at the time of diagnosis, previous history of disorders affecting the facial nerve and associated neurological symptoms. We also noted the location of the lesion, the surgical technique used, pathology findings, post-operative complications, length of post-operative stay in hospital, facial sequelae and surgical repair procedures used on the facial nerves involved in the intervention. Results. Six cases, with a mean age of 29 years (range: 16-46 years), were treated. Three of the patients were males (50%). Symptoms of the disease included facial palsy (4), neurosensory hypoacusis (1) and tinnitus (1). All six individuals (100%) had alterations affecting facial functioning in the course of the disease. The pathological diagnosis was schwannoma in four cases and hemangioma in the other two. Neural grafts were carried out in three patients and some kind of deficit was observed at the end of the follow-up in all the cases. Conclusions. Facial nerve tumours are very infrequent. An early diagnosis is needed to diminish the facial sequelae following surgery performed to treat this clinical entity (AU)

Ciclopiroxolamine: in vitro antifungal activity against clinical yeast isolates.

The in vitro susceptibility of 225 clinical isolates of yeasts to ciclopiroxolamine (CPO) was compared with that of clotrimazole, econazole, ketoconazole, miconazole, tioconazole, fluconazole, itraconazole and nystatin using a standardized agar diffusion method (NeoSensitabs). Two hundred and eight strains of yeasts comprising 16 species of Candida and 22 strains belonging to other yeast genera were tested. One strain (0.4%) was resistant, four strains (1.8%) of intermediate susceptibility and 220 strains (97.3%) susceptible to CPO. More strains were susceptible to CPO than to the other antifungals studied. Susceptibility patterns of antifungal agents were not linked to species. The in vitro antifungal susceptibility profile of CPO was better than topical azole derivatives or fluconazole and itraconazole against a wide variety of clinically important yeasts.

Actividad del itraconazol frente a aislamientos clínicos de Aspergillus spp. y Fusarium spp. determinada por el método M38-P del NCCLS / Activity of itraconazole against clinical isolates of Aspergillus spp. and Fusarium spp. determined by the M38-P NCCLS method

Se ha estudiado la actividad antifúngica del itraconazol en 101 aislamientos clínicos de Aspergillus fumigatus, A. flavus, A. niger, A. terreus, A. nidulans, A. candidus, A. glaucus, A. clavatus, Fusarium solani, F. oxysporum y F. semitectum. Las concentraciones mínimas inhibitorias (CMI) se determinaron siguiendo el protocolo del documento M38-P del NCCLS por medio de un método de microdilución en medio líquido RPMI 1640 (lectura visual a las 48 y 72 horas de incubación). En general, la CMI no varió con el tiempo de incubación, excepto en una cepa de A. fumigatus en la cual la CMI pasó de 2 a 16 mg/l. La media geométrica de las CMI y la CMI90 de itraconazol para Aspergillus spp. fueron 0,44 mg/l y 0,5 mg/l, respectivamente, y para Fusarium spp. 14,1 mg/l y 16 mg/l, respectivamente. Con 0,5 mg/l se inhibió el 75 por ciento de las cepas de Aspergillus spp., y con 2 mg/l el 100 por ciento de ellas. A. niger y A. fumigatus fueron las especies más resistentes (CMI90 2 mg/l). Las CMI de todas las cepas de Fusarium ensayadas estuvieron comprendidas entre 4 y 16 mg/l (AU)