SARS-CoV-2 and finding of vein thrombosis: can IMPROVE and IMPROVEDD scores predict COVID-19 outcomes?

OBJECTIVE: Diffuse thrombosis represents one of the most predominant causes of death by COVID-19 and SARS-CoV-2 infection seems to increase the risk of developing venous thromboembolic diseases (VTE). Aim of this study is to analyze the relationship between validated predictive scores for VTE such as IMPROVE and IMPROVEDD and: (1) Intensification of Care (IoC, admission to Pulmonology Department or Intensive Care Unit) (2) in-hospital mortality rate 3) 30-days mortality rate. PATIENTS AND METHODS: We retrospectively evaluated 51 adult patients with laboratory diagnosis of SARS-CoV-2 infection and calculated IMPROVE and IMPROVEDD scores. All patients underwent venous color-Doppler ultrasound of the lower limbs to assess the presence of superficial vein thrombosis (SVT) and/or deep vein thrombosis (DVT). Patients with normal values of D-dimer did not receive heparin therapy (LMWH); patients with ≥ 4 ULN values of D-dimer or with a diagnosis of DVT were treated with therapeutic LMWH dosage, while the remaining patients were treated with prophylactic LMWH dosages. RESULTS: We found strong relations between IMPROVE score and the need for IoC and with the in-hospital mortality rate and between the IMPROVEDD score and the need for IoC. We defined that an IMPROVE score greater than 4 points was significantly associated to in-hospital mortality rate (p = 0.05), while an IMPROVEDD score greater than 3 points was associated with the need for IoC (p = 0.04). Multivariate logistic analysis showed how IMPROVE score was significantly associated to in-hospital and 30-days mortality rates. CONCLUSIONS: IMPROVE score can be considered an independent predictor of in-hospital and 30-days mortality.

Noncarious cervical lesions and their association with toothbrushing practices: in vivo evaluation.

OBJECTIVES: This pilot study aims to investigate the prevalence of noncarious cervical lesions (NCCLs) in a student population at the Faculty of Dentistry of Araçatuba­UNESP and to assess the potential relation between buccal hygiene habits and the presence and number of NCCLs. METHODS: This study was conducted with a sample of 58 young volunteers (15 men and 43 women; mean age, 23.6 ± 1.8 years and 22.3 ± 2.4 years, respectively). The research was divided into three steps: 1) clinical assessment; 2) oral-hygiene practices self-report questionnaire; and 3) analysis of toothbrush filament deformations. After the clinical exam the participants were divided into two groups, a control group (without NCCLs) and a test group (NCCLs), according to NCCL presence. The data were statistically analyzed with SPSS 16.0 software, using t-test, χ2, Fisher exact test, and Spearman correlation. RESULTS: NCCLs were present in 53% of the subjects. The presence of NCCLs was marginally statistically associated with age (p=0.15) and proportionally more prevalent in male (80%) subjects (p=0.01). NCCLs were more concentrated in the posterior-superior quadrant (93%) in both the right (90%) and left (55%) sides of the mouth. The direct rank correlation was presented between presence of NCCLs and toothbrush firmness; and between number of NCCLs and age and force applied during toothbrushing. CONCLUSION: Within the limitations of this pilot study, the use of medium and hard toothbrushes and greater force applied during toothbrushing might contribute to the development and/or aggravation of NCCLs.

[State of the art and scientific evidence on the role of unidirectional airflow ventilation systems in reducing surgical site infections]. / Stato dell'arte ed evidenze scientifiche sul ruolo dei sistemi di ventilazione a flusso unidirezionale nella riduzione delle infezioni del sito chirurgico.

The use of unidirectional airflow ventilation systems in operating rooms is frequently recommended for the prevention of Surgical Site Infections (SSI). However, scientific evidence is lacking to clearly support this technology which entails high investment costs and operating expenses, as compared with traditional ventilation systems. This sparse evidence is mainly related to the small number of interventions analyzed in each study and the difficulty to distinguish the effects of ventilation and other important confounding factors, such as antibiotic prophylaxis, special operating staff clothing and adoption of educational and training programs against SSI for the surgical personnel. The different behavior of the industrialized countries towards this issue, as it comes out analyzing the existing Rules and Guidelines concerning operating rooms ventilation, reflects a precautionary approach towards a technology which, until recently, has clearly demonstrated neither benefits nor limitations. In 2008, a relevant scientific study was published, reporting results from 63 departments of 55 German hospitals for a total of 99.230 surgical interventions, in which a standardized SSI surveillance was performed. Unexpectedly, the study concluded that unidirectional airflow ventilation showed no benefit and was even associated with a significantly higher risk for severe SSI, as compared with turbulent clean air. The present review collects updates from the scientific literature and national and international Rules and Guidelines concerning the use of unidirectional airflow ventilation systems in operating rooms, analyzing all aspects involved in this issue, from the debated efficacy of these systems in reducing the incidence of SSI to the "side effects" associated to their use, as the relevant costs and the reduction of the environmental comfort for the operators.

Root surface treatment with vitamin C in tooth replantation: microscopic study in rats.

AIM: Late tooth replantation is a worthy procedure, especially in growing patients, being the best option for tooth avulsion. This study evaluated the effects of root surface treatment with 2% acidulated phosphate sodium fluoride and effervescent vitamin C (Redoxon) in late replantation. METHODS: Twenty rat teeth (Rattus norvegicus, albinus, Wistar) were extracted and left on a table for 6 h. Then, the dental papilla and enamel organ were sectioned and the pulp was removed through the apex. After removal of the periodontal ligament with a blade, the animals were divided into 2 groups: Group I teeth were immersed in 2% acidulated phosphate sodium fluoride solution for 10 min and obturated with Ca(OH)(2) paste. Group II teeth were immersed in effervescent vitamin C solution (Redoxon 2 g) for 10 min and obturated as for Group I. After these procedures, teeth were replanted and animals were killed after 60 days. RESULTS: The study revealed a larger amount of replacement resorption in Group I and larger amount of ankylosis in Group II, with statistically significant difference and absence of inflammatory resorption. CONCLUSION: The substances used for root surface treatment were unable to prevent replacement resorption and ankylosis, which are expected when the periodontal ligament has been lost.

Analysis of surface roughness of glass-ionomer cements and compomer.

The purpose of this study was to evaluate the surface roughness of two glass-ionomer cements (Vitremer and Chelon-Fil), and one compomer (Dyract) when submitted to different finishing/polishing procedures at different times. A hundred 80-sample discs were made of each material and randomly divided into six finishing/polishing groups: mylar strip (control); Sof-Lex discs; diamond burs; diamond burs/Sof-Lex discs; 30-fluted carbide bur; 30-fluted carbide bur/Sof-Lex discs. These procedures were carried out immediately after preparation of the samples, after 24 and 168 h. Average surface roughness (Ra) was measured with a profilometer and the values were compared using anova (P < 0.05). The smoothest surface for all materials was obtained when cured in contact with the mylar strip. All other tested products increased surface roughness of restorative materials, but Sof-lex discs lead to better results. The worst results were verified with diamond burs. The finishing/polishing procedures, when performed immediately, can improve the roughness of glass-ionomer cements but not of the compomer tested.

Retention of oral microorganisms on conventional and resin-modified glass-ionomer cements.

Secondary caries are a worldwide public and socioeconomic problem. The placement of restorations can lead to the development of environmental conditions favorable to microbial colonization, especially on the tooth/restoration interface, which is a predisposing factor for secondary caries. The aim of this study was to evaluate microbial retention on conventional (Chelon-Fil and Vidrion R) and resin-modified (Vitremer and Fuji II LC) glass-ionomer cements, in situ, using a hybrid composite resin (Z100) as a control. Twelve volunteers wore Hawley appliances with specimens made of all tested filling materials for 7 days. The specimens were then removed from the appliances and transferred to tubes containing 2.0 ml of Ringer-PRAS. Microorganisms from the samples were inoculated onto blood agar and Mitis Salivarius Bacitracin agar and incubated under anaerobiosis (90% N2, 10% CO2), at 37 degrees C, for 10 and 2 days, respectively. The resin-modified glass-ionomer cements and the composite resin retained the same levels of microorganisms on their surfaces. The resin-modified glass-ionomers retained less mutans streptococci than the composite resin and conventional glass-ionomer cements. The conventional glass-ionomer cements retained less mutans streptococci than the composite resin, but that difference was not statistically significant.

[Effect of the application of fluoride on the superficial roughness of vitremer glass ionomer cement and microbial adhesion to this material]. / Influência da aplicação de flúor sobre a rugosidade superficial do ionômero de vidro Vitremer e adesão microbiana a este material.

Glass ionomer cements are important options in restorative and preventive dentistry due to their adhesion to the tooth surface and to fluoride release, which can decrease the risk of recurrent caries. The topical use of acidulated and neutral fluoride gels has been frequent in dentistry. However, this procedure can adversely affect the surface of restorative materials, increasing their roughness and the retention of dental plaque. Thus, this study evaluated the period in which Vitremer glass ionomer cement maintains its antimicrobial activity over Streptococcus mutans ATCC 25175, as well as the effects of topical application of acidulated and neutral fluoride gels on these microbiological parameters and on the superficial characteristics of the restorative material. It was verified that the antimicrobial activity of Vitremer is very transient, decreasing to an undetectable level after four days, and the topical application of fluoride gel did not restore this activity. It was observed that S. mutans ATCC 25175 adheres to this restorative material, and the topical fluorides did not affect this event. The surface of Vitremer was not altered by the application of fluoride gels.