[Argentinean registry on the management of Helicobacter pylori infection: effectiveness and safety of first line treatment]. / Registro argentino para el manejo de la infección por Helicobacter pylori: efectividad y seguridad de los esquemas de primera línea de tratamiento.

INTRODUCTION: The optimal management of Helicobacter pylori (H pylori) infection remains unclear. Updated information concerning local data is needed to design the best strategy to treat H. pylori infection to reach high eradication rates. The Argentinean Registry (Hp-ArgReg) on H. pylori management was launched to monitor the eradication practices of gastroenterologists. The objective was to assess the effectiveness and safety of firstline H. pylori treatment in Argentina. MATERIALS AND METHODS: A multicenter prospective registry of the clinical practice of the Argentinean gastroenterologists concerning H. pylori infection (Hp-ArgReg) was developed. Variables included: patient demographic information, previous eradication attempts, prescribed treatment, adverse events, compliance and outcome. RESULTS: Overall, 800 patients were included and 727 patients received first-line empirical treatment. The most frequent treatment indications were dyspepsia (78%) and gastroduodenal ulcer (12%). Among first-line treatments, quadruple therapies (with or without bismuth) achieved eradication rates of 94.9%, while triple therapies achieved eradication rates of 78.9%. Quadruple therapies were significantly more effective than triple therapies (P < 0.01, OR 5, CI 2.95-8.6). Sequential therapy with zinc showed an effectiveness of 95.6%. Adverse events were reported in 29% of the cases (mainly mild) and tolerance was quite similar among therapies. CONCLUSION: in Argentina, Quadruple therapies with or without bismuth and sequential therapy with zinc showed an H. pylori eradication effectiveness of over 90% in real clinical practice. Local Registries for H pylori management could help to control the spread of antibiotic resistance.

Introducción: El óptimo manejo de la infección por Helicobacter pylori (H. pylori) es objeto de debate. Contar con datos locales ayudaría a lograr altas tasas de erradicación. El Registro Argentino H. pylori (RegArg-Hp) se estableció con el objetivo de monitorear el manejo local de la infección. El objetivo fue describir la efectividad y seguridad de las terapias empíricas de primera línea para la erradicación del H. pylori utilizadas en Argentina. Materiales y métodos: Registro prospectivo, multicéntrico, de la práctica clínica de los gastroenterólogos argentinos. Se incluyeron datos demográficos de pacientes con infección por H. pylori, intentos previos de erradicación, tratamiento indicado, eventos adversos, cumplimiento y erradicación. Resultados: De 800 pacientes incluidos, 727 recibieron un tratamiento empírico de primera línea. Las indicaciones de tratamiento más frecuentes fueron dispepsia (78%) y úlcera gastroduodenal (12%). Entre los tratamientos de primera línea, las terapias cuádruples (con o sin bismuto) lograron tasas de erradicación del 94.9% mientras las terapias triples tasas de erradicación del 78.9%. Las terapias cuádruples fueron significativamente más efectivas que las triples (P < 0.01, OR 5, IC 2.95-8.6). La terapia secuencial con zinc mostró una efectividad del 95.6%. Se reportaron eventos adversos en el 29% de los pacientes, generalmente leves y con una tolerancia similar entre las diferentes terapias. Conclusiones: En Argentina, las terapias cuádruples con o sin bismuto y la secuencial con zinc presentaron una efectividad de erradicación de H. pylori superior al 90%. La implementación de registros locales podría contribuir al control de la resistencia a los antibióticos.

Transitional discharge interventions for people with schizophrenia.

BACKGROUND: Schizophrenia is a chronic mental illness characterized by delusions, hallucinations, and important functional and social disability. Interventions labeled as 'transitional' add to care plans made during the hospital stay in preparation for discharge. They also include interventions developed after discharge to support people with serious mental illness as they make the transition from the hospital to the community. Transitional discharge interventions may anticipate the future needs of the patient after discharge by co-ordinating the different levels of the health system that can effectively guarantee continuity of care in the community. This occurs through the provision of therapeutic relationships which give a safety net throughout the discharge and community reintegration processes to improve the general condition of users, level of functioning, use of health resources, and satisfaction with care. OBJECTIVES: To assess the effects of transitional discharge interventions for people with schizophrenia. SEARCH METHODS: On 7 December 2022, we searched the Cochrane Schizophrenia Group's Study-Based Register of Trials, which is based on CENTRAL, MEDLINE, Embase, PubMed, CINAHL, ClinicalTrials.gov, ISRCTN, PsycINFO, and WHO ICTRP. SELECTION CRITERIA: Randomized controlled trials (RCTs) evaluating the effects of transitional discharge interventions in people with schizophrenia and schizophrenia-related disorders. Eligible interventions included three key elements: predischarge planning, co-ordination of care and follow-up, and postdischarge support. DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Outcomes of this review included global state (relapse), service use (hospitalization), general functioning, satisfaction with care, adverse effects/events, quality of life, and direct costs. For binary outcomes, we calculated risk ratios (RRs) and their 95% confidence intervals (CIs). For continuous outcomes, we calculated the mean difference (MD) or standardized mean difference (SMD) and their 95% CIs. We used GRADE to assess certainty of evidence. MAIN RESULTS: We found 12 studies with 1748 participants comparing transitional discharge interventions to usual care. All were parallel-group RCTs. No studies assessed global state (relapse) or reported data about adverse events/effects. All studies had a high risk of bias, mainly due to serious concerns about allocation concealment, deviations from intended interventions, measurement of the outcomes, and missing outcome data. Transitional discharge interventions may make little to no difference in service use (hospitalization) at short- and long-term follow-ups, but the evidence is very uncertain (RR 1.18, 95% CI 0.55 to 2.50; I2 = 54%; 4 studies, 462 participants; very low-certainty evidence). Transitional discharge intervention may increase the levels of functioning after discharge (clinically important change in general functioning) (SMD 0.95, 95% CI -0.06 to 1.97; I² = 95%; 4 studies, 437 participants; very low-certainty evidence) and may increase the proportion of participants who are satisfied with the intervention (clinically important change in satisfaction) (RR 1.96, 95% CI 1.37 to 2.80; 1 study, 76 participants; very low-certainty evidence), but for both outcomes the evidence is very uncertain. Transitional discharge intervention may make little to no difference in quality of life compared to treatment as usual (SMD 0.24, 95% CI -0.30 to 0.78; I² = 90%; 4 studies, 748 participants; very low-certainty evidence), but we are very uncertain. For direct costs, one study with 124 participants did not report full details and thus the results were inconclusive. AUTHORS' CONCLUSIONS: There is currently no clear evidence for or against implementing transitional discharge interventions for people with schizophrenia. Transitional discharge interventions may improve patient satisfaction and functionality, but this evidence is also very uncertain. For future research, it is important to improve the quality of the conduct and reporting of these trials, including using validated tools for measuring their outcomes.

Prognosis recovery score of apical surgery Guided Bone Regeneration using cone beam computed tomography and digital bioinformatics.

Objective: Guided Bone Regeneration (GBR) is a dental surgical procedure that uses barrier membranes to prevent soft tissue invasion and conduct new bone growth. This study aimed to define a Prognosis Recovery score (PR score) to objectively classify post-surgery responders from non-responder patients who underwent GBR using Cone Beam Computed Tomography (CBCT). Methods: This prospective-observational-longitudinal-cohort study recruited 250 individuals who were assigned to: Conventional-Apical-Surgery (CAS, n = 39), Apical-Surgery using human fascia lata Membrane placement (ASM, n = 42), and Apical-Surgery using human fascia lata Membrane placement and lyophilized allograft Bone powder (ASMB, n = 39); and Apical-Surgery using collagen membrane Porcine origin and Bovine Bone-matrix (ASPBB, n = 130), an independent external validation cohort. Surgery was performed, and evolution was monitored by CBCTs at 0, 6-, 12-, 18-, and 24 months post-surgery. Results: Normalized lesion volumes were calculated, and non-linear time evolution morphology curves were characterized. The three-time evolution bone growth patterns were: a linear tendency (PR0), "S'' shaped log-logistic (PR1), and "C" cellular growth (PR2). The treatment success rates were PR2-46 %, PR2-88 %, and PR2-95 %/PR1-5% for CAS, ASM, and ASMB groups. The xenograft ASPBB counterpart achieved PR2-92 % and PR1-8%. The score PR had a sensitivity, specificity, and accuracy of 100 %. Conclusions: Patients' treatment success can be quantitatively, objectively, and precisely predicted with the Prognosis Recovery score (using only two CBCTs), according to their biological response to allograft or xenograft materials (time-evolution bone growth curves), reducing cost and radiation exposure. Clinical significance: Through digital imaging and bioinformatic analysis of bone regeneration observed in CBCTs, we defined a Prognosis Recovery (PR) score using only two CBCT volume assessments (0 and 6 months). The PR score allowed us to define three time-evolution curves depending on the biomaterials used and to classify patients in a quantitative, objective, and accurate way.

Micro-CT evaluation of the presence of voids in endodontic obturation.

Identifying the presence, size, type and location of voids in an endodontic obturation is of great clinical importance because it enables evaluation of the three-dimensionality of the sealing techniques, which can be related to the success of the endodontic treatment. AIM: To analyze by micro-CT the presence of voids in lower single-rooted premolar root canal obturations prepared using the single cone and ultrasound vibration technique. MATERIALS AND METHODS: Twenty extracted single-rooted lower premolars were selected, and the root canal prepared surgically and chemically. In GROUP 1 - Without Vibration, the canal was obturated with a single cone and bioceramic, without applying vibration. In GROUP 2 - With Vibration, the gutta-percha cone inside the root canal was held with a cotton plier to which ultrasound vibration was applied for 3 periods of 3 seconds each. A micro-CT scanner was used to acquire and reconstruct images for analysis. RESULTS: No significant difference was found between obturation techniques, though there were differences between thirds, with the cervical third having a higher percentage of voids than the middle and apical thirds. CONCLUSIONS: The results suggest that the volume of closed, open and total voids does not differ between treatments with and without ultrasound vibration. In the cervical third, the highest volume of voids was related to oval geometry in the teeth evaluated.

La presencia de vacíos en la obturación endodóntica, su tamaño y el tipo y localización tiene gran importancia clínica ya que permite evaluar la tridimensionalidad de las técnicas de sellado y relacionarlas con el éxito del tratamiento endodóntico. OBJETIVO: analizar mediante microtomografía la presencia de vacíos en la obturación del conducto radicular de premolares inferiores unirradiculares, utilizando la técnica de cono único y vibración con ultrasonido. MATERIALES Y MÉTODOS: se seleccionaron 20 premolares inferiores unirradiculares a los que se les realizó la preparación quirúrgica y química del conducto radicular. Se realizó la obturación con cono único y biocerámico GRUPO 1- sin vibración. En el GRUPO 2 - con vibración se aplicó vibración por ultrasonido, se tomó del cono de gutapercha colocado en el interior del conducto con pinza de algodón que fue vibrada durante 3 períodos de 3 segundos cada uno. Las mismas fueron adquiridas y reconstruidas en un microtomógrafo para posterior análisis de las imágenes obtenidas. RESULTADOS: No se evidenciaron diferencias significativas entre ambas técnicas de obturación comparadas, pero si entre los tercios analizados, siendo el cervical el que mayor porcentaje de vacíos presenta en comparación a los cortes correspondientes al tercio medio y apical. CONCLUSIONES: Los resultados sugieren que el volumen de vacíos cerrados, abiertos y total no varía en los tratamientos donde se aplica vibración por ultrasonido. En el tercio cervical, el mayor volumen de vacíos se relaciona con la geometría oval que presentaron las piezas dentarias evaluadas en este estudio.

Advances in the Production of Sustainable Bacterial Nanocellulose from Banana Leaves.

Interest in bacterial nanocellulose (BNC) has grown due to its purity, mechanical properties, and biological compatibility. To address the need for alternative carbon sources in the industrial production of BNC, this study focuses on banana leaves, discarded during harvesting, as a valuable source. Banana midrib juice, rich in nutrients and reducing sugars, is identified as a potential carbon source. An optimal culture medium was designed using a simplex-centroid mixing design and evaluated in a 10 L bioreactor. Techniques such as Fourier transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM), X-ray diffraction (XRD), and thermogravimetric analysis (TGA) were used to characterize the structural, thermal, and morphological properties of BNC. Banana midrib juice exhibited specific properties, such as pH (5.64), reducing sugars (15.97 g/L), Trolox (45.07 µM), °Brix (4.00), and antioxidant activity (71% DPPH). The model achieved a 99.97% R-adjusted yield of 6.82 g BNC/L. Physicochemical analyses revealed distinctive attributes associated with BNC. This approach optimizes BNC production and emphasizes the banana midrib as a circular solution for BNC production, promoting sustainability in banana farming and contributing to the sustainable development goals.

Micro-CT evaluation of the presence of voids in endodontic obturation / Evaluación microtomográfica de la presencia de vacíos en la obturación endodóntica

ABSTRACT Identifying the presence, size, type and location of voids in an endodontic obturation is of great clinical importance because it enables evaluation of the three-dimensionality of the sealing techniques, which can be related to the success of the endodontic treatment. Aim To analyze by micro-CT the presence of voids in lower single-rooted premolar root canal obturations prepared using the single cone and ultrasound vibration technique. Materials and methods Twenty extracted single-rooted lower premolars were selected, and the root canal prepared surgically and chemically. In GROUP 1 - Without Vibration, the canal was obturated with a single cone and bioceramic, without applying vibration. In GROUP 2 - With Vibration, the gutta-percha cone inside the root canal was held with a cotton plier to which ultrasound vibration was applied for 3 periods of 3 seconds each. A micro-CT scanner was used to acquire and reconstruct images for analysis. Results No significant difference was found between obturation techniques, though there were differences between thirds, with the cervical third having a higher percentage of voids than the middle and apical thirds. Conclusions The results suggest that the volume of closed, open and total voids does not differ between treatments with and without ultrasound vibration. In the cervical third, the highest volume of voids was related to oval geometry in the teeth evaluated.

RESUMEN La presencia de vacíos en la obturación endodóntica, su tamaño y el tipo y localización tiene gran importancia clínica ya que permite evaluar la tridimensionalidad de las técnicas de sellado y relacionarlas con el éxito del tratamiento endodóntico. Objetivo analizar mediante microtomografía la presencia de vacíos en la obturación del conducto radicular de premolares inferiores unirradiculares, utilizando la técnica de cono único y vibración con ultrasonido. Materiales y Método se seleccionaron 20 premolares inferiores unirradiculares a los que se les realizó la preparación quirúrgica y química del conducto radicular. Se realizó la obturación con cono único y biocerámico GRUPO 1- sin vibración. En el GRUPO 2 - con vibración se aplicó vibración por ultrasonido, se tomó del cono de gutapercha colocado en el interior del conducto con pinza de algodón que fue vibrada durante 3 períodos de 3 segundos cada uno. Las mismas fueron adquiridas y reconstruidas en un microtomógrafo para posterior análisis de las imágenes obtenidas. Resultados No se evidenciaron diferencias significativas entre ambas técnicas de obturación comparadas, pero si entre los tercios analizados, siendo el cervical el que mayor porcentaje de vacíos presenta en comparación a los cortes correspondientes al tercio medio y apical. Conclusiones Los resultados sugieren que el volumen de vacíos cerrados, abiertos y total no varía en los tratamientos donde se aplica vibración por ultrasonido. En el tercio cervical, el mayor volumen de vacíos se relaciona con la geometría oval que presentaron las piezas dentarias evaluadas en este estudio.

Frecuencia y tipología del segundo conducto mesiovestibular en primeros molares superiores / Frequency and typology of the second mesiobuccal canal in maxillary first molars

Objetivos: Evaluar mediante microscopia quirúrgica la presencia del segundo conducto mesiovestibular (MV2) en el piso de la cámara pulpar de los primeros molares superiores, determinar su abordabilidad, establecer el calibre de lima que llegó al tercio apical y tipificar radiovisiográficamente su morfología se-gún la clasificación de Weine. Materiales y métodos: Se utilizaron 48 primeros molares superiores huma-nos extraídos. Sé tomaron radiovisografías preope-ratorias (Carestream 5200) en sentido orto radial y mesio-distal. Se realizó apertura y se localizó entra-da del MV2 con microscopio quirúrgico (Newton MEC XXI, Argentina) a 16 x. Se cateterizó MV1 y MV2 con limas tipo K #10 y #15 (Dentsply Maillefer). Se cortó raíz distovestibular para mejorar visualización ra-diovisográfica. Se tomó conductometria en sentido mesio-distal para establecer la tipología. Se compa-raron frecuencias y porcentajes mediante test de Chi-cuadrado con corrección de Yates, prueba exac-ta de Fisher y test z para diferencia de proporcio-nes. Se calcularon intervalos de confianza 95% para porcentajes mediante método score de Wilson. Re-sultados: El 54% (26 casos) presentó MV2. De los 26 MV2, el 77% (20 casos) fueron abordables, porcen-taje significativamente mayor al 23% no abordable (z=3,62; P<0,05). Al hacer cateterismo, hubo asocia-ción significativa entre tipo de conducto (MV1 y MV2) y calibre de lima que llegó al tercio apical (Chi-cua-drado=29,12; gl=1; P<0,05). La tipología I (58%) fue significativamente mayor que las tipologías II (21%) y III (21%) (P<0,05 para ambas comparaciones). Con-clusión: El alto porcentaje de piezas que presentó MV2 evidencia la importancia clínica de detectarlo y tratarlo correctamente. Dado el alto porcentaje de piezas donde fue abordable, se concluye que el clíni-co debe tener conocimiento, destreza y la tecnología necesaria para poder abordarlo. Si bien la tipología I (58%) fue la más encontrada, cuando el MV2 termina en foramen independiente (tipo III), su omisión puede conducir al fracaso del tratamiento (AU))

Objectives: To evaluate by surgical microscopy the presence of second mesiobuccal canal (MB2) in the pulp chamber floor of the maxillary first molars, determine its approachability, establish the caliber of the file that reached the apical third, and radiographically typify its morphology according to Weine ́s classification. Materials and methods: 48 extracted human maxillary first molars were used. Preoperative radiovisographies (Carestream 5200) were taken in ortho-radial and mesio-distal direction. Coronal access was made and the entrance of MB2 was located with a surgical microscope (Newton MEC XXI, Argentina) at 16x. MB1 and MB2 were catheterized with K files #10 and #15 (Dentsply Maillefer). Distobuccal root was cut to improve radiovisographic visualization. Conductometry was taken in mesio-distal direction to establish the typology. Frequencies and percentages were compared using Chi-square test with Yates correction, Fisher's exact test and z test for difference in proportions. 95% confidence intervals were calculated for percentages using Wilson score method. Results: 54% (26 cases) presented MB2. Of the 26 MB2, 77% (20 cases) were approachable, a significantly higher percentage than those not approachable (z=3.62; P<0.05). When performing catheterization, there was a significant association between type of canal (MB1 and MB2) and file caliber that reached the apical third (Chi-square=29.12; df=1; P<0.05). Typology I (58%) was significantly higher than typologies II (21%) and III (21%) (P<0.05 for both comparisons). Conclusion: The high percentage of specimens that showed MB2 evidence the clinical importance of detecting and treating it correctly. Given the percentage of pieces where it was approachable (77%), it is concluded that the clinician must have the knowledge, skill and necessary technology to be able to approach it. Although typology I (58%) was the most found, when MB2 ends an independent foramen (type III), its omission can lead to treatment failure (AU)

Evaluación de la filtración apical al utilizar dos selladores biocerámicos / Evaluation of apical leakage when using two bioceramic sealers

Objetivo: Evaluar con técnica de diafanización el gra-do de filtración apical al utilizar dos selladores bio-cerámicos y la técnica de cono único con taper ex vivo. Materiales y métodos: Se utilizaron 60 premola-res inferiores humanos uniradiculares extraídos. La instrumentación se realizó con lima Primary 25/.07 (WaveOne Gold, Dentsply Maillefer), según protocolo del fabricante. Se irrigó con NaOCl 2,5% y EDTAC 17%. Para la obturación, la muestra se dividió aleatoria-mente en 4 grupos (n=15). Grupo 1: Cono único y Bio C Sealer. Grupo 2: Cono único y MTA Fillapex. Grupo control negativo: no se obturó. Grupo control positi-vo: Cono único y AH Plus. En todas las muestras se aplicaron dos capas de esmalte para uñas en toda la superficie dentaria con excepción del tercio apical y del grupo control positivo, que se esmaltó en su tota-lidad. Medio de filtración: tinta china negra por difu-sión pasiva. Se diafanizó con técnica de Robertson. Se usó programa AutoCad 2022, para medir filtración en milímetros lineales. Los datos se analizaron me-diante prueba de Kruskal-Wallis seguida por compa-raciones post hoc empleando el método de Conover (p<0,05, significativo). Resultados: La filtración con Bio C Sealer, MTA Fillapex, control negativo y control positivo tuvo una media (mínimo-máximo) de 0 (0-2), 1 (0-3), 6 (2-12) y 0 (0-0); sin diferencias significativas entre Bio C Sealer y MTA Fillapex (p>0,05), ni entre Bio C Sealer y control positivo (p>0,05); pero con di-ferencias significativas entre MTA Fillapex y control positivo (p<0,05), y entre control negativo y cual-quiera de los otros tres grupos (p<0,05). Conclusión: La obturación con Bio C Sealer lograría un nivel de sellado similar al que se obtiene con el control po-sitivo; mientras que la obturación con MTA Fillapex produciría un sellado ligeramente menos efectivo que el control positivo. Sin embargo, la filtración no variaría sustancialmente entre obturaciones con Bio C Sealer y MTA Fillapex (AU)

Objective: To evaluate the degree of apical filtration with diaphanization technique, using two bioceramic sealers and single cone technique with taper, ex vivo. Materials and methods: 60 extracted single-root human mandibular premolars were used. The instrumentation was carried out with primary file 25/.07 (WaveOne Gold, Dentsply Maillefer), according to the manufacturer's protocol. Irrigation was done with 2.5% NaOCl and 17% EDTAC. For obturation, the sample was randomly divided in 4 groups (n=15). Group 1: Single cone and Bio C Sealer. Group 2: Single cone and MTA Fillapex. Negative control group: it was not obturated. Positive control group: Single cone and AH Plus. In all samples, two layers of nail polish were applied to the entire tooth surface with exception of apical third and the positive control group, which was completely glazed. Filtration medium: black Chinese ink by passive diffusion. It was diaphanized with Robertson technique. AutoCad 2022 program was used to measure filtration in linear millimeters. Data were analyzed using Kruskal-Wallis test, followed by post hoc comparisons using Conover method (p < 0.05, significant). Results: Filtration with Bio C Sealer, MTA Fillapex, negative control and positive control had a mean (minimum-maximum) of 0 (0-2), 1 (0-3), 6 (2-12) and 0 (0-0); no significant differences between Bio C Sealer and MTA Fillapex (p > 0.05), nor between Bio C Sealer and positive control (p > 0.05); but with significant differences between MTA Fillapex and positive control (p < 0.05), and between negative control and any of the other three groups (p < 0.05). Conclusion: Obturation with Bio C Sealer would achieve a level of sealing similar to obtained with the positive control; while obturation with MTA Fillapex would produce a slightly less effective seal than the positive control. However, filtration would not vary substantially between fillings with Bio C Sealer and MTA Fillapex (AU)

Protocolo para la medición de espacios vacíos dentro de la obturación endodóntica con microtomografía / A protocol for the measurement of voids within the endodontic filling with microtomography

La microtomografía es un estudio que utiliza la ra-diación X para obtener imágenes de tamaños de mi-lésimas de milímetros y de alta resolución. Las imá-genes 2D son procesadas por diferentes softwares para lograr obtener volúmenes capaces de ser ana-lizados tridimensionalmente. La microtomografía es el estudio de elección a la hora de evaluar caracte-rísticas muy pequeñas con gran precisión. La obtu-ración endodóntica buscar lograr un sellado que no tenga espacios vacíos dentro de la masa de obtura-ción. Esto es importante debido a que los poros pue-den permitir, si están en contacto con la pared den-tinaria, la entrada de microorganismos al conducto radicular. El objetivo de este trabajo fue describir el procedimiento para el análisis y visualización de los espacios vacíos dentro de la obturación endodónti-ca, utilizando la microtomografía de rayos x, y esta-blecer un protocolo para ser utilizado por cualquier investigador(AU)

Microtomography is a study that uses X-radiation to obtain high-resolution images of sizes of thousandths of millimeters. The 2D images are processed by different software to obtain volumes capable of being analyzed three-dimensionally. Microtomography is the study of choice when evaluating very small features with great precision. Endodontic filling seeks to achieve a seal that does not have voids within the filling obturation. This is important because the voids can allow, if they are in contact with the dentin wall, the entry of microorganisms into the root canal. The objective of this work was to describe the procedure for the analysis and visualization of voids within the endodontic filling using microtomography and to establish the protocol to be used by any researcher (AU)

Avances en endodoncia regenerativa: reporte de caso con uso de la membrana amniótica humana / Advances in regenerative endodontics: report of a case using a human amniotic membrane

Los procedimientos endodónticos regenerativos (REPs) representan una evolución significativa en el campo de la endodoncia, buscando no sólo tratar la infección o lesión presente en el diente, sino tam-bién promover la regeneración de los tejidos denta-rios afectados. El presente caso clínico muestra un incisivo lateral superior izquierdo con apexogénesis incompleta y diagnóstico de absceso alveolar crónico reagudizado en una paciente de 22 años, en el que se aplicó un procedimiento de endodoncia regenerativa (REPs). La estrategia terapéutica elegida se basó en los principios de ingeniería tisular, incorporando la novedosa aplicación de la membrana amniótica hu-mana liofilizada esterilizada como andamio bioactivo intraconducto. Las evaluaciones clínicas, radiográ-ficas y tomográficas a corto, mediano y largo plazo revelaron el éxito de la terapia. La resolución exitosa mostró en los controles a la pieza dentaria asintomá-tica, con una notable remisión de la patología apical, aumento de la longitud radicular y disminución del calibre apical. Se ha podido destacar la eficacia de los REPs, con una exitosa aplicabilidad de la membra-na amniótica como andamio innovador (AU)

Regenerative endodontic procedures (REPs) represent a significant evolution in the field of endodontics, aiming not only to address the infection or injury within the tooth, but also to promote the regeneration of the affected dental tissues. In this clinical case, an upper left lateral incisor with incomplete apexogenesis and diagnosis of acute exacerbation of a chronic periapical lesion in a 22-year-old patient is presented. A regenerative endodontic procedure (REPs) was applied. The chosen therapeutic strategy was based on tissue engineering principles, incorporating the innovative use of sterilized lyophilized human amniotic membrane as an intraconduct bioactive scaffold. Clinical, radiographic, and tomographic assessments at short, medium, and long-term follow-up revealed the success of the therapy. Successful resolution demonstrated an asymptomatic tooth in the follow-up, with a notable resolution of apical pathology, increased root length, and decreased apical caliber. The effectiveness of REPs has been highlighted, demonstrating the successful applicability of amniotic membrane as an innovative scaffold (AU)

Aß Amyloid Fibers Drastically Alter the Topography and Mechanical Properties of Lipid Membranes.

Alzheimer's disease (AD) is related to the fibrillation of the Aß peptides at neuronal membranes, a process that depends on the lipid composition and may impart different physical states to the membrane. In the present work, we study the properties of the Aß peptide when mixed with a zwitterionic lipid (DMPC), using the Langmuir monolayer technique as an approach to control membrane physical conditions. First, we build on previous characterizations of pure Aß monolayers and observe that, in addition to high shear, these films present a pronounced compressional hysteresis. When Aß is assembled with DMPC in a binary film, the resulting membranes become heterogeneous, with a peptide-enriched phase distributed in a network-like pattern, and they exhibit a lateral transition that depends on the Aß content. At lower peptide proportions, the films segregate into two well-defined phases: one consisting of lipids and another enriched with peptides. The reflectivity of these phases differs from that obtained for pure Aß films. Thus, the formed fibers effectively cover most of the interface area and remain stable at higher pressures (from 20 to 30 mN m-1 depending on Aß content) compared to pure peptide films (17 mN m-1). Furthermore, such structures induce a compressional hysteresis in the film, similar to that of pure peptide films (which is nonexistent in the pure lipid monolayer), even at low peptide proportions. We claim that the mechanical properties at the interface are governed by the size of the fibril-like structures. Based on the low molar fractions and surface packing at which these phenomena were observed, we postulate that as a consequence of peptide intermolecular interactions, Aß may have drastic effects on the molecular arrangement and mechanical properties of a lipid membrane.

Reverse triggering during mechanical ventilation: Diagnosis and clinical implications.

This review addresses the phenomenon of "reverse triggering", an asynchrony that occurs in deeply sedated patients or patients in transition from deep to light sedation. Reverse triggering has been reported to occur in 30-90% of all ventilated patients. The underlying pathophysiological mechanisms remain unclear, but "entrainment" is proposed as one of them. Detecting this asynchrony is crucial, and methods such as visual inspection, esophageal pressure, diaphragmatic ultrasound and automated methods have been used. Reverse triggering may have effects on lung and diaphragm function, probably mediated by the level of breathing effort and eccentric activation of the diaphragm. The optimal management of reverse triggering has not been established, but may include the adjustment of ventilatory parameters as well as of sedation level, and in extreme cases, neuromuscular block. It is important to understand the significance of this condition and its detection, but also to conduct dedicated research to improve its clinical management and potential effects in critically ill patients.

Quantification of Dry Matter Content in Hass Avocado by Near-Infrared Spectroscopy (NIRS) Scanning Different Fruit Zones.

Accurate dry matter determination (DM) in Hass avocados is vital for optimal harvesting and ensuring fruit quality. Predictive models based on NIRS need to capture fruit DM gradient. This work aimed to determine the DM content in Hass avocado whole by NIRS scanning different fruit zones. Spectra were recorded for each zone of the fruit: peduncle (P), equator (E), and base (B). The calibration and validation included fruit from different orchards in two harvest cycles. The results show a DM gradient within the fruit: 24.47% (E), 24.68% (B), and 24.79% (P). The DM gradient was observed within the spectra using the RMSi (root mean square) criterion and PCA. The results show that at least one spectrum per fruit zone was needed to represent the variability within the fruit. The performances of the calibration using the whole set of data were R2: 0.74 and standard error of cross-validation (SECV) = 1.18%. In the validation stage using independent validation sets, the models showed similar performance (R2: 0.75, SECV 1.15%) with low values of the standard error of prediction (SEP): 1.62%. These results demonstrate the potential of near-infrared spectroscopy for high-throughput sorting of avocados based on their commercial quality.

Emergence of Raoultella ornithinolytica in human infections from different hospitals in Ecuador with OXA-48-producing resistance.

Purpose: The purpose of this study was to highlight the clinical and molecular features of 13 Raoultella ornithinolytica strains isolated from clinical environments in Ecuador, and to perform comparative genomics with previously published genomes of Raoultella spp. As Raoultella is primarily found in environmental, clinical settings, we focused our work on identifying mechanisms of resistance that can provide this bacterium an advantage to establish and persist in hospital environments. Methods: We analyzed 13 strains of Raoultella ornithinolytica isolated from patients with healthcare associated infections (HAI) in three hospitals in Quito and one in Santo Domingo de Los Tsáchilas, Ecuador, between November 2017 and April 2018. These isolates were subjected to phenotypic antimicrobial susceptibility testing, end-point polymerase chain reaction (PCR) to detect the presence of carbapenemases and whole-genome sequencing. Results: Polymerase chain reaction revealed that seven isolates were positive isolates for blaOXA-48 and one for blaKPC-2 gene. Of the seven strains that presented the blaOXA-48 gene, six harbored it on an IncFII plasmid, one was inserted into the bacterial chromosome. The blaKPC gene was detected in an IncM2/IncR plasmid. From the bioinformatics analysis, nine genomes had the gene blaOXA-48, originating from Ecuador. Moreover, all R. ornithinolytica strains contained the ORN-1 gene, which confers resistance for ß-lactams, such as penicillins and cephalosporins. Comparative genome analysis of the strains showed that the pangenome of R. ornithinolytica is considered an open pangenome, with 27.77% of core genes, which could be explained by the fact that the antibiotic resistance genes in the ancestral reconstruction are relatively new, suggesting that this genome is constantly incorporating new genes. Conclusion: These results reveal the genome plasticity of R. ornithinolytica, particularly in acquiring antibiotic-resistance genes. The genomic surveillance and infectious control of these uncommon species are important since they may contribute to the burden of antimicrobial resistance and human health.

The Pivotal Role of Angiotensin-Converting Enzyme Inhibitors and Angiotensin II Receptor Blockers in Hypertension Management and Cardiovascular and Renal Protection: A Critical Appraisal and Comparison of International Guidelines.

Arterial hypertension is the main preventable cause of premature mortality worldwide. Across Latin America, hypertension has an estimated prevalence of 25.5-52.5%, although many hypertensive patients remain untreated. Appropriate treatment, started early and continued for the remaining lifespan, significantly reduces the risk of complications and mortality. All international and most regional guidelines emphasize a central role for renin-angiotensin-aldosterone system inhibitors (RAASis) in antihypertensive treatment. The two main RAASi options are angiotensin-converting enzyme inhibitors (ACEis) and angiotensin II receptor blockers (ARBs). Although equivalent in terms of blood pressure reduction, ACEis are preferably recommended by some guidelines to manage other cardiovascular comorbidities, with ARBs considered as an alternative when ACEis are not tolerated. This review summarizes the differences between ACEis and ARBs and their place in the international guidelines. It provides a critical appraisal of the guidelines based on available evidence from randomized controlled trials (RCTs) and meta-analyses, especially considering that hypertensive patients in daily practice often have other comorbidities. The observed differences in cardiovascular and renal outcomes in RCTs may be attributed to the different mechanisms of action of ACEis and ARBs, including increased bradykinin levels, potentiated bradykinin response, and stimulated nitric oxide production with ACEis. It may therefore be appropriate to consider ACEis and ARBs as different antihypertensive drugs classes within the same RAASi group. Although guideline recommendations only differentiate between ACEis and ARBs in patients with cardiovascular comorbidities, clinical evidence suggests that ACEis provide benefits in many hypertensive patients, as well as those with other cardiovascular conditions.

Failure of First Transition to Pressure Support Ventilation After Spontaneous Awakening Trials in Hypoxemic Respiratory Failure: Influence of COVID-19.

OBJECTIVES: To describe the rate of failure of the first transition to pressure support ventilation (PSV) after systematic spontaneous awakening trials (SATs) in patients with acute hypoxemic respiratory failure (AHRF) and to assess whether the failure is higher in COVID-19 compared with AHRF of other etiologies. To determine predictors and potential association of failure with outcomes. DESIGN: Retrospective cohort study. SETTING: Twenty-eight-bedded medical-surgical ICU in a private hospital (Argentina). PATIENTS: Subjects with arterial pressure of oxygen (AHRF to Fio2 [Pao2/Fio2] < 300 mm Hg) of different etiologies under controlled mechanical ventilation (MV). INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We collected data during controlled ventilation within 24 hours before SAT followed by the first PSV transition. Failure was defined as the need to return to fully controlled MV within 3 calendar days of PSV start. A total of 274 patients with AHRF (189 COVID-19 and 85 non-COVID-19) were included. The failure occurred in 120 of 274 subjects (43.7%) and was higher in COVID-19 versus non-COVID-19 (49.7% and 30.5%; p = 0.003). COVID-19 diagnosis (odds ratio [OR]: 2.22; 95% CI [1.15-4.43]; p = 0.020), previous neuromuscular blockers (OR: 2.16; 95% CI [1.15-4.11]; p = 0.017) and higher fentanyl dose (OR: 1.29; 95% CI [1.05-1.60]; p = 0.018) increased the failure chances. Higher BMI (OR: 0.95; 95% CI [0.91-0.99]; p = 0.029), Pao2/Fio2 (OR: 0.87; 95% CI [0.78-0.97]; p = 0.017), and pH (OR: 0.61; 95% CI [0.38-0.96]; p = 0.035) were protective. Failure groups had higher 60-day ventilator dependence (p < 0.001), MV duration (p < 0.0001), and ICU stay (p = 0.001). Patients who failed had higher mortality in COVID-19 group (p < 0.001) but not in the non-COVID-19 (p = 0.083). CONCLUSIONS: In patients with AHRF of different etiologies, the failure of the first PSV attempt was 43.7%, and at a higher rate in COVID-19. Independent risk factors included COVID-19 diagnosis, fentanyl dose, previous neuromuscular blockers, acidosis and hypoxemia preceding SAT, whereas higher BMI was protective. Failure was associated with worse outcomes.

Flash vacuum expansion, a low-cost and energy-efficient alternative process to produce high-quality fruit puree: Application to Physalis peruviana.

Goldenberry has great potential for the development of high-quality products due to its attractive sensory attributes, bioactive compounds, and health benefits. However, postharvest losses are high due to the lack of processing technologies that can both be adapted to rural conditions in producing countries to generate high-quality products. Flash vacuum expansion coupled with vacuum pulping is a new process that can meet these requirements. In the process, the steam holding time (30, 40, and 50 s/130 kPa) and flash vacuum expansion (5 ± 1.2 kPa) were studied. The logarithmic reduction of microbial load and some quality indicators were analyzed during the process and during storage to assess the shelf life of fruit purées. The FVE process with 40 s steam blanching led to a microbial reduction of over 6 log colony forming units (CFU)/g, increased yield and ß-carotene content, and preserved most of the AA content (4-12%). Based on the half-lives of the quality indicators, the shelf life of the purées was between 16 d (20 °C) and 90 d (4 °C). The energy consumption was estimated at approximately 0.30 kWh/kg of product. These results demonstrate that the FVE process, although it includes heat treatment, allows a short exposure to heat of the whole fruits to obtain a high-quality puree with an adequate shelf life in a single step, with a relatively low equipment investment and moderate energy consumption.

Periodontal regeneration by minimally invasive procedures and its influence on pulp status.

Dental pulp and periodontium have different communication routes including, e.g., apical foramen, accessory canals and dentin tubules. Scaling, planing and root surface treatment with ethylenediaminetetraacetic acid (EDTA)-based conditioner are used in regenerative periodontal procedures. Such treatment may generate pathological communication between the two structures due to interruption of the vascular pedicle or migration of bacteria and/or inflammatory byproducts from deep periodontal pockets, which may generate pulp pathology. Aim: The aim of this study was to evaluate the influence of minimally invasive periodontal regenerative surgery on pulp vitality status in single-rooted and multi-rooted teeth associated to infraosseous defects extending to the middle and apical thirds. Materials and Method: This was a retrospective study on 30 teeth from 14 patients who received care between August 2018 and August 2019 at the postgraduate Department of Specialization in Periodontics of the Buenos Aires University School ofDentistry (FOUBA). Clinical and radiographic endodontic diagnosis was performed 6 months after the minimally invasive regenerative periodontal treatment. Results: Only two out of the 30 teeth presented changes in pulp status following regenerative periodontal procedure: irreversible pulpitis at 30 days and pulp necrosis at 180 days post-treatment. The rate for risk of change in pulp vitality status was 6.7%. Teeth with grade I and II furcation lesions (n=9) presented no change in pulp status. Conclusions: Regenerative periodontal surgery had no significant influence on pulp status in single-rooted and multi-rooted teeth with infraosseous defects extending to the level of the middle and apical third.

La pulpa dental y el periodonto presentan diferentes vías de comunicación. El foramen apical, los conductos accesorios y los túbulos dentinarios son ejemplos de ellos. Durante los procedimientos peri-odontales regenerativos se realiza el raspaje, alisado y tratamiento de la superficie radicular con un acondicionador a base de ácido etilendiaminotetraacético (EDTA). Este tratamiento podría generar una comunicación patológica entre ambas estructuras debido a la interrupción del pedículo vascular o a la migración de bacterias y/o subproductos inflamatorios provenientes de bolsas periodontales profundas que generen patología pulpar. Objetivo: El objetivo del presente estudio fue evaluar la influencia de la cirugía periodontal regenerativa mínimamente invasiva sobre el estado de vitalidad pulpar de piezas dentarias unirradiculares y multirradiculares con defectos infraóseos que se extendían hasta el tercio medio y apical. Materiales y Método: Se analizaron de forma retrospectiva 30 piezas dentarias de 14 pacientes atendidos entre el mes de agosto 2018 y agosto 2019 en el posgrado de la Especial-ización en Periodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). Se realizó el diagnóstico endodóntico de forma clínica y radiográfica a los 6 meses post-tratamiento periodontal regenerativo mínimamente invasivo. Resultados: De las 30 piezas solo 2 presentaron cambios en el estado pulpar luego del procedimiento periodontal regenerativo, pulpitis irreversibles a los 30 días y necrosis pulpar a los 180 días post-tratamiento. La tasa de riesgo de cambios en el estado de vitalidad pulpar fue del 6,7%. En relación a las piezas dentarias que presentaban lesiones de furcación grado I y II (n=9) ninguna presentó cambios en su estado pulpar. Conclusiones: La cirugía periodontal regenerativa no tuvo influencia significativa en el estado pulpar de piezas unirradiculares y multirra-diculares con defectos infraóseos que se extendían a nivel del tercio medio y apical.

Acute Phase Proteins in Dogs with Natural Infection by Trypanosoma cruzi.

Acute phase proteins have been used as tools for the diagnosis, monitoring, and prognosis of several diseases in domestic animals. However, the dynamics of these proteins in infection by Trypanosoma cruzi, the causative agent of Chagas disease in dogs, is still unknown. The aim of this study was to determine concentrations of acute phase proteins (C-reactive protein, haptoglobin, ferritin and paraoxonase-1) in dogs in a coastal town of Ecuador, with natural Trypanosoma cruzi infection with or without seroreactivity of Ehrlichia canis, Ehrlichia ewingii, Anaplasma phagocytophilum, Anaplasma platys, Borrelia burgdorferi and Dirofilaria immitis. For the detection of Trypanosoma cruzi serum antibodies, two different antigen-based enzyme-linked immunosorbent assay tests were implemented. For the detection of seroreactivity of Ehrlichia canis, Ehrlichia ewingii, Anaplasma phagocytophilum, Anaplasma platys, Borrelia burgdorferi and Dirofilaria immitis, an IDEXX SNAP® 4Dx® test was used. To determine the concentration of C-reactive protein and ferritin, an immunoturbidimetric assay was used; haptoglobin concentration was measured using a commercial colorimetric method validated in dogs; a spectrophotometric method was used to determine the serum concentration of paraoxonase-1. Results showed a reduction in the serum levels of paraoxonase-1 in Trypanosoma cruzi-seroreactive dogs, either with or without seroreactivity to other vector-borne diseases. A serum ferritin increment was observed in Trypanosoma cruzi-seroreactive dogs with seroreactivity to any other vector-borne diseases. Our findings suggest that paraoxonase-1 levels are reduced in Trypanosoma cruzi-seroreactive dogs without evident clinical signs of Chagas disease, despite their seroreactivity to the other vector-borne diseases studied. These findings could indicate an oxidative stress response in Trypanosoma cruzi-seroreactive dogs with no evident signs of inflammation.

Periodontal regeneration by minimally invasive procedures and its influence on pulp status / Regeneración periodontal a través de procedimientos mínimamente invasivos y su influencia en el estado pulpar

ABSTRACT Dental pulp and periodontium have different communication routes including, e.g., apical foramen, accessory canals and dentin tubules. Scaling, planing and root surface treatment with ethylenediaminetetraacetic acid (EDTA)-based conditioner are used in regenerative periodontal procedures. Such treatment may generate pathological communication between the two structures due to interruption of the vascular pedicle or migration of bacteria and/or inflammatory byproducts from deep periodontal pockets, which may generate pulp pathology. Aim: The aim of this study was to evaluate the influence of minimally invasive periodontal regenerative surgery on pulp vitality status in single-rooted and multi-rooted teeth associated to infraosseous defects extending to the middle and apical thirds. Materials and Method: This was a retrospective study on 30 teeth from 14 patients who received care between August 2018 and August 2019 at the postgraduate Department of Specialization in Periodontics of the Buenos Aires University School ofDentistry (FOUBA). Clinical and radiographic endodontic diagnosis was performed 6 months after the minimally invasive regenerative periodontal treatment. Results: Only two out of the 30 teeth presented changes in pulp status following regenerative periodontal procedure: irreversible pulpitis at 30 days and pulp necrosis at 180 days post-treatment. The rate for risk of change in pulp vitality status was 6.7%. Teeth with grade I and II furcation lesions (n=9) presented no change in pulp status. Conclusions: Regenerative periodontal surgery had no significant influence on pulp status in single-rooted and multi-rooted teeth with infraosseous defects extending to the level of the middle and apical third

RESUMEN La pulpa dental y el periodonto presentan diferentes vías de comunicación. El foramen apical, los conductos accesorios y los túbulos dentinarios son ejemplos de ellos. Durante los procedimientos peri-odontales regenerativos se realiza el raspaje, alisado y tratamiento de la superficie radicular con un acondicionador a base de ácido etilendiaminotetraacético (EDTA). Este tratamiento podría generar una comunicación patológica entre ambas estructuras debido a la interrupción del pedículo vascular o a la migración de bacterias y/o subproductos inflamatorios provenientes de bolsas periodontales profundas que generen patología pulpar. Objetivo: El objetivo del presente estudio fue evaluar la influencia de la cirugía periodontal regenerativa mínimamente invasiva sobre el estado de vitalidad pulpar de piezas dentarias unirradiculares y multirradiculares con defectos infraóseos que se extendían hasta el tercio medio y apical. Materiales y Método: Se analizaron de forma retrospectiva 30 piezas dentarias de 14 pacientes atendidos entre el mes de agosto 2018 y agosto 2019 en el posgrado de la Especial-ización en Periodoncia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). Se realizó el diagnóstico endodóntico de forma clínica y radiográfica a los 6 meses post-tratamiento periodontal regenerativo mínimamente invasivo. Resultados: De las 30 piezas solo 2 presentaron cambios en el estado pulpar luego del procedimiento periodontal regenerativo, pulpitis irreversibles a los 30 días y necrosis pulpar a los 180 días post-tratamiento. La tasa de riesgo de cambios en el estado de vitalidad pulpar fue del 6,7%. En relación a las piezas dentarias que presentaban lesiones de furcación grado I y II (n=9) ninguna presentó cambios en su estado pulpar. Conclusiones: La cirugía periodontal regenerativa no tuvo influencia significativa en el estado pulpar de piezas unirradiculares y multirra-diculares con defectos infraóseos que se extendían a nivel del tercio medio y apical.