[Efectividad de la suspensión bacteriana sublingual en la prevención de infecciones de vías aéreas de repetición en pediatría].

Background: Upper respiratory tract infections (URIs) are very common in the pediatric population. Most of these infections are mild, but due to their chronicity they affect quality of life (QoL), in addition to high costs for medical care. The use of bacterial extracts (BE) that stimulate general immunity can reduce its frequency and improve the QoL of the patient. Objective: Evaluate the effectiveness of a BE in the prevention of ARVI in children from 1 to 6 years of age. Methods: Children between the ages of 1 and 6 years, with a diagnosis of RAVI, were randomized into 3 different groups, with medical follow-up at 6 and 12 weeks after the start. The EB was administered with different doses to each group. An ANOVA test with a Tukey post hoc is used for multiple comparisons (maximum type I error of 0.05). Results: 33 children (12 girls) with a mean age of 3.11 years were included. The average frequency of RAVI prior to treatment was 2.2 events/month and 0.9 and 0.4 events/month at 6 and 12 weeks, respectively. The IVARS were reduced by 76.9% at 3 months of treatment. (Graph). No adverse effects were reported. Conclusions: BE is safe and effective in reducing the frequency of RAVI in children, in agreement with the literature. There is not enough published scientific evidence, but the BE seems to have an application in the prevention and treatment of RAVI. Sublingual administration is comfortable in this age group.

Antecedentes: Las infecciones de vías aéreas superiores (IVASR) son muy frecuentes en la población pediátrica. La mayoría de estas infecciones son leves, pero por la cronicidad afectan la calidad de vida (CdV), además de elevados costos por la atención médica. El uso de extractos bacterianos (EB) que estimulen la inmunidad general pueden reducir su frecuencia y mejorar la CdV del paciente. Objetivo: Evaluar la efectividad de un EB en la prevención de IVASR en niños de 1 a 6 años. Métodos: Se aleatorizaron niños entre 1 y 6 años, con diagnóstico IVASR en 3 grupos distintos, seguimiento médico a las 6 y 12 semanas tras el inicio. El EB se administró con dosis distintas a cada grupo. Se utiliza una prueba de ANOVA con un post hoc Tukey para comparaciones múltiples (error tipo I máximo de 0.05). Resultados: Se incluyeron 33 niños (12 niñas) con una media de edad de 3.11 años. La frecuencia de IVASR previo al tratamiento en promedio fue de 2.2 eventos/mes y de 0.9 y de 0.4 eventos/mes a las 6 y 12 semanas respectivamente. La IVARS se redujeron un 76.9% a los 3 meses de tratamiento. (Gráfica). No se reportaron efectos adversos. Conclusiones: El EB es seguro y efectivo en disminuir la frecuencia de IVASR en niños en concordancia con la literatura. No hay suficiente evidencia científica publicada pero el EB parece tener aplicación en la prevención y tratamiento de las IVASR. La administración sublingual es cómoda en este grupo etario.

Efficacy of methenamine with methylthioninium in the treatment of dysuria: a randomized clinical study.

INTRODUCTION AND HYPOTHESIS: Dysuria is a common symptom present in several urological and gynecological conditions. Management relies on the underlying disease but may require additional symptomatic treatment. This study evaluated the combination of methenamine 250 mg and methylthioninium chloride 20 mg in the treatment of dysuria versus phenazopyridine. METHODS: This was a multicenter, single-blind, randomized, superiority clinical trial, including individuals over 18 with dysuria and a score ≥ 5 points on the pre-treatment categorical scale for pain. The primary outcome was the proportion of participants presenting excellent clinical response within 24 h after treatment. Improvement up to 72 h, time to reach improvement, sustained healing, investigators' opinion, and safety were also evaluated. RESULTS: Three hundred and fifteen participants were evaluated. Demographic characteristics and symptoms of dysuria were comparable between groups at baseline. The difference in the excellent response rate between treatments within 24 h was 12.7% (95% CI 6.16, 19.21) for pain, 9.4% (95% CI 3.32, 15.39) for burning, and 12.7% (95% CI 6.37, 18.99) for burning on urination, all in favor of the test drug, which was also superior from 36 to 48 h. Treatments were similar concerning time to reach the absence of symptoms and in the percentage of participants with sustained healing after 72 h. CONCLUSIONS: The association of methenamine with methylthioninium is superior to phenazopyridine in the treatment of dysuria.

Leishmania (L.) infantum BH401 strain induces classic renal lesions in dogs: Histological and confocal microscopy study.

Extracellular matrix (ECM) alterations in visceral leishmaniasis are related mainly to collagen deposition (fibropoiesis). In canine visceral leishmaniasis (CVL), an intense fibrosis associated to chronic inflammation in organs such as kidneys is described. However, renal fibropoiesis has not been described in natural or experimental infections with L. (L.) infantum. We aimed to characterize renal nephropathies by histology and confocal microscopy comparing renal lesions in dogs naturally and experimentally infected with L. (L.) infantum. Sixty-two mixed-breed symptomatic dogs naturally infected with L. (L.) infantum, sixteen beagles experimentally infected with two strains of L. infantum (eleven dogs with the BH400 strain and five dogs with the BH401 strain), and five uninfected beagles (controls) were used. Samples were stained with hematoxylin & eosin for routine histology. Congo red was used to visualize amyloid protein deposits, periodic acid-Schiff to identify glomerular basal membrane anomalies, Masson's trichrome for collagen deposits, and Jones' methenamine silver to reveal membranous glomerulonephropathy. Immunohistochemistry was used to identify Leishmania amastigotes, and confocal microscopy was used for macrophage characterization (L1/calprotectin and CD163 antigen receptors). The most common lesions were chronic glomerular and interstitial nephritis, which was found in all naturally infected dogs and dogs experimentally infected with L. infantum strain BH401 but not with the BH400 strain. Glomeruloesclerosis was the main lesion presented in all BH401 group. Morphometric analysis revealed positive correlation of renal glomeruli tufts with cellular expression of L1/calprotectin and CD163 antigens. Leishmania infantum strain BH401 shows pathogenicity that may be sufficient to induce classic chronic visceral renal leishmaniasis.

Undecilenamidopropil betaína (Prontosan solución/gel). Apósito de plata nanocristalina (Acticoat). Apósito de cadexómero de yodo (Iodosorb) / Undecilenamidopropyl betaine (Prontosan solution / gel). Nanocrystalline silver dressing (Acticoat). Iodine cadexomer dressing (Iodosorb)

CONTEXTO: En el año 2013, la tercera ENFR mostró que tanto los resultados de prevalencia de realización de mediciones de la glucemia (76,8 %) como el autorreporte de diabetes o glucemia elevada (9,8 %) se incrementaron levemente respecto del 2009. La afectación macrovascular (aterosclerosis) determina aproximadamente el 13% de los infartos de miocardio. Una de las complicaciones crónicas más graves de la DM2, es la que se produce en torno al pie de la persona con diabetes. Las úlceras y amputaciones son un gran problema de salud que genera un alto costo social y económico a la persona, sus familiares y a los sistemas de salud. Según las guías de Nación de Prevención del pie diabético de la secretaria de Salud: "los sistemas de salud deberán crear programas de amplia cobertura de masas para reforzar los aspectos de la prevención, el acceso y elevación de la calidad de la atención médica, particularmente la especializada e integrada en equipos multidisciplinarios, con el objetivo de prevenir, identificar y tratar oportunamente los problemas y las complicaciones del pie diabético". Aproximadamente el 1% de las personas con diabetes sufren una amputación de miembros inferiores. En los datos reportados por Argentina, Barbados, Brasil, Cuba y Chile, el rango de amputaciones del pie diabético es del 45-75% de todas las amputaciones; encontrándose hasta un 10% de personas con pie de riesgo en la población atendida en el primer nivel de atención. El 25% de los individuos con diabetes desarrollarán una úlcera en el pie durante su vida. La mayoría de las úlceras de pie son consecuencia de la combinación de neuropatía e isquemia. BÚSQUEDA Y ANÁLISIS DE LA EVIDENCIA CIENTÍFICA: Se realizó una búsqueda no sistemática de bibliografía científica priorizando la inclusión de revisiones sistemáticas y metaanálisis, evaluaciones de tecnologías sanitarias e informes de seguridad, guías de Práctica Clínica basadas en la evidencia. DESCRIPCIÓN DE LA TECNOLOGÍA: Prontosan® (B. Braun, Melsungen AG, Alemania) es una solución de para irrigar las heridas, transparente, incolora, que contiene undecilenamidopropil betaína, poliaminopropilbiguanida, hidróxido de sodio y agua purificada. La solución se utiliza para la limpieza de heridas. y para humedecer y lubricar apósitos absorbentes úlceras, quemaduras, heridas postquirúrgicas y abrasiones. Se utiliza en general en heridas contaminadas y crónicas. Prontosan se lanzó por primera vez en Holanda y ha sido definido como un dispositivo médico, clase IIb. ESTRATEGIA DE BÚSQUEDA: Se realizó una búsqueda en las bases de datos bibliográficas, en buscadores genéricos de Internet como google, Agencias de Evaluación de Tecnología Sanitarias y Agencias nacionales e internacionales reguladoras de alimentos y medicamentos. CONCLUSIONES: Polihexamida betaina: La evidencia existente es escasa y de baja calidad metodológica. Muchos de los estúdios realizados y que han sido incorporados a las revisiones citadas están avalados y financiados por la industria farmacéutica. Basándose ene estos ensayos este dispositivos podría promover la cicatrización de las heridas estancadas crónicas, reducir la carga bacteriana, eliminar el estafilococo aureus resistente a la meticilina (SARM) y aliviar el dolor relacionado con la herida. (Recomendación débil a favor). Apósito de plata nanocristalina (Acticoat) y apósito de cadexómero de yodo (Iodosorb): No hay evidencia sólida de diferencias entre apósitos para heridas para cualquier resultado em úlceras del pie en personas con Diabetes (tratada en cualquier contexto). Al elegir los apósitos, considerar el costo unitario de los apósitos, junto con sus propiedades de gestión y preferencia del paciente. (Recomendación débil a favor). Teniendo en cuenta la escasa evidencia disponible y la calidad de la misma, la falta de concordancia dentro de las guías de práctica clínica en relación a los tipos de cuidados estándares para la curación del pie diabético resulta dificultoso realizar una recomendación contundente en relación al tipo de dispositivos a utilizar. Es importante tener en cuenta la experiencia del Consultorio del Pie Diabético del Hospital provincial Neuquén refieren tres años de experiencia en el manejo de los mismos, y que el personal del mismo está capacitado en la utilización de los insumos solicitados nos parece relevante incluir en este informe el contexto local y por lo tanto recomendar la incorporación de los insumos solicitados. Es de fundamental importancia evaluar la posibilidad de realizar estudios que permitan visualizar los resultados de eficacia en la curación del pie diabético y realizar seguimiento de la utilización óptimo de los mismos. En relación a la equidad consideramos crítico realizar un programa de capacitación a al interior de la provincia y en otros hospitales de centro de salud de la zona metropolitana para garantizar el acceso a la citada tecnología.

The mechanism of Tröger's base formation probed by electrospray ionization mass spectrometry.

Using direct infusion electrospray ionization mass and tandem mass spectrometric experiments [ESI-MS(/MS)], we have performed on-line monitoring of some reactions used to form Tröger's bases. Key intermediates, either as cationic species or as protonated forms of neutral species, have been intercepted and characterized. The role of urotropine as the methylene source in these reactions has also been accessed. Reaction pathways shown by ESI-MS(/MS) have been probed by gas-phase ion/molecule reactions, and an expanded mechanism for Tröger's base formation based on the mass spectrometric data has been elaborated.

Three-dimensional high-inductance birdcage coil for NQR applications.

A birdcage coil capable of operating simultaneously and independently in three orthogonal dimensions has been developed. A co-rotational end-ring mode producing an RF field in the longitudinal direction was utilized in addition to the two common transverse orthogonal modes. Two conductor turns were used for each of the coil's windows, increasing its inductance by a factor of four, thereby, making the coil suitable for low-frequency applications. Two or three-frequency detection can be easily carried out with this device. Orthogonality of the coil's channels allows arbitrarily close frequency positioning of each resonant mode, potentially useful in wide-line NQR studies, in which simultaneous excitation/detection of signals from three adjacent regions of a single wide line can be performed. The coil's performance was evaluated using a three-dimensional scheme, in which a circularly polarized experiment was combined with a linearly polarized measurement at another frequency, resulting in SNR improvement by 55%.

RF probe recovery time reduction with a novel active ringing suppression circuit.

A simple Q-damper device for active probe recovery time reduction is introduced along with a straightforward technique for the circuit's component value optimization. The device is inductively coupled to a probe through a coupling transformer positioned away from the main coil, which makes the design independent of the coil type being used. The Q-damper is a tuned circuit, which is resonant at the same frequency as the probe and can be actively interrupted. When the circuit is interrupted, it is detuned and, thereby, is uncoupled from the probe, which operates normally. Turning the device on leads to re-coupling of the circuits and causes splitting of the probe's resonance line, which can be observed through its drive port. A resistance of an appropriate value is introduced into the Q-damper circuit, resulting in smoothing of the resonance splitting into one broad line, representing the coupled system's low-Q state, in which the energy stored in the main coil is efficiently dissipated. The circuit's component values are optimized by monitoring the shape of this low-Q state. Probe recovery time reduction by, approximately, an order of magnitude has been obtained with this device. Application of the device during an NQR experiment led to an increase in the signal-to-noise ratio by a factor of 4.9.

Prevalence of varicose veins and venous anatomy in patients without truncal saphenous reflux.

OBJECTIVES: To determine the prevalence and distribution of primary venous reflux in the lower limbs in patients without truncal saphenous reflux. DESIGN: Prospective cohort study. PATIENTS AND METHODS: One thousand and seven hundred and twelve patients with suspected venous disease were examined by duplex ultrasonography. Seven hundred and thirty-five patients had primary varicose veins with competent saphenous trunks. Limbs with truncal saphenous reflux, deep vein reflux or obstruction, previous injection sclerotherapy or vein surgery, arterial disease and inflammation of non-venous origin were excluded from further consideration. The CEAP classification system was used for clinical staging. Systematic duplex ultrasound examination was undertaken to assess the distribution of incompetent saphenous tributaries. RESULTS: The prevalence of primary reflux with competent saphenous trunks was 43%. Reflux of GSV calf tributaries was the most common. The majority of the limbs (96%) belonged to chronic venous disease classes C1 and C2 of the CEAP classification. CONCLUSIONS: Superficial venous reflux causing varicose veins in the presence competent saphenous trunks is very prevalent in this series in contrast to other studies, presumably reflecting differing patient populations. Our data clearly show that varicose veins may occur in any vein and do not depend on truncal saphenous incompetence. Careful duplex ultrasound evaluation allows the pattern of venous reflux to be established in this group of patient ensuring appropriate management of varices.

Evaluación dermotoxicológica de la hexamina / Dermatoxicologic evaluation of methenamine

Se realizó la evaluación del posible efecto irritante de un formulado que se empleará como desodorante y que contiene como principio activo la hexamina, la cual es empleada como antiséptico urinario. Este formulado se aplicó por vía oftálmica en 6 conejos de la raza Nueva Zelandia durante 7 d. Las valoraciones se basan en las observaciones macroscópicas de los posibles efectos adversos que se presentan en las estructuras de la piel

Influence of calcium hydroxide dressing on the obturation of simulated lateral canals.

The purpose of this in vitro study was to evaluate what influence an interappointment dressing with calcium hydroxide might have on the ability to subsequently obturate simulated lateral canals. Twenty extracted single-rooted human teeth were instrumented at the working length to a #35 file before creating three simulated lateral canals on the mesial and distal surfaces of the root, one in each third, using a #15 engine reamer. After enlarging the root canals to a #45 file, the teeth were randomly divided into two groups of 10. In both groups AH26 was used as the sealer. In group A, the obturation was performed immediately using Ultrafil. In group B, root canals were filled with calcium hydroxide and incubated for 7 days. The teeth were then reinstrumented, irrigated with 2.5% sodium hypochlorite solution, dried with paper points, and obturated as in group A. Teeth in group A showed a larger number of filled lateral canals compared with those in group B. Statistical significant differences were observed when comparing the same third in the two groups (apical third p < 0.05, middle third p < 0.01, and coronal third p < 0.01). No differences were found among the different thirds in the same group (p > 0.05).

Evaluation of Er:YAG laser and EDTAC on dentin adhesion of six endodontic sealers.

The effect of Er:YAG laser application and EDTAC on the adhesion of epoxy resin-based endodontic sealers to human dentin was evaluated in vitro. A total of 99 extracted human maxillary molars with their crowns worn flat were used. The teeth were divided into 3 groups: group 1, the dentin surface received no treatment; group 2, EDTAC was applied to the dentin surface for 5 min; group 3, the dentin surface received Er:YAG laser application (2.25 W potency; 11 mm focal distance; 4 Hz frequency; 200 mJ energy; 62 J total energy; 313 mean impulse). Three teeth from each group were analyzed by scanning electron microscopy for changes in dentin surface. The epoxy resin root canal sealers used were: AH Plus, Topseal, Sealer 26, AH 26, and Sealer Plus. The zinc oxide eugenol-based sealer Fillcanal was used as control. Adhesion was measured with a Universal testing machine. The results showed a statistically significant difference at the level of 1% among the dentin treatments. The dentin treated with Er:YAG laser showed greater adhesion with the sealers than dentin treated with EDTAC which was greater than dentin that received no treatment. The Tukey test showed the formation of 5 groups in decreasing order of adhesion: AH Plus, Topseal and Sealer 26, AH 26, Sealer Plus, and Fillcanal (Grossman cement).

Release of formaldehyde by 4 endodontic sealers.

OBJECTIVE: The purpose of this study was to evaluate the release of formaldehyde by some root canal filling materials. STUDY DESIGN: Two older endodontic sealers, AH 26 and Endomethasone, and 2 recently available sealers, AH Plus and Top Seal, were analyzed. Infrared and electronic spectroscopy were used to determine formaldehyde content after set of the materials. RESULTS: Analysis showed that the AH 26 and Endomethasone sealers released formaldehyde. Although the AH Plus and Top Seal sealers have similar chemical composition, they released formaldehyde in a minimal concentration. CONCLUSIONS: The AH 26 and Endomethasone sealers released formaldehyde after setting; however, a minimum release was observed for the AH Plus and Top Seal sealers.

Antimicrobial effect of six endodontic sealers: an in vitro evaluation.

The aim of this study was to determine the in vitro antimicrobial effect of six endodontic sealers after 2, 20 and 40 days. The sealers studied were Apexit, Endion, AH26, AH-Plus. Procosol and Ketac Endo. The microorganisms used were Candida albicans, Staphylococcus aureus, Streptococcus mutans and Actinomyces israelii. Petri dishes were filled with sterile agar and 0.1-ml wells were prepared and filled with the sealers. The agar plates were stored for 24 h at 37 degrees C. The samples were then removed, immersed in 4.5 ml of culture medium and divided into three groups. The samples in group 1 were stored for 2 days at 37 degrees C whereas the samples of groups 2 and 3 were stored at 4 degrees C for 20 and 40 days respectively. The samples were then removed and discarded, and 0.1 ml of the culture medium was seeded on the agar plates in order to perform colony forming unit counts. Apexit, Endion and AH-Plus produced slight inhibition on Streptococcus mutans at 20 days and on Actinomyces israelii at every time interval. No effect was found on Candida albicans and Staphylococcus aureus. Ketac Endo only produced an antimicrobial effect on Actinomyces israelii at 2 and 40 days. AH26 and Procosol showed antimicrobial effect at 40 days on Candida albicans, at 20 and 40 days on Streptococcus mutans and Staphylococcus aureus, and an effective inhibition on Actinomyces israelii at every time interval. Statistical analysis revealed both sealers and microorganisms to be significant factors affecting results in groups 2 and 3. In conclusion, the sealers evaluated in this study showed different inhibitory effects depending on time span. Overall, sealers containing cugenol and formaldehyde proved to be most effective against the microorganisms at the time intervals studied.

Cytotoxicity of endodontic materials.

An in vitro cell culture model of human gingival fibroblasts and L-929 cells was used to measure the cytotoxicity of currently used root canal sealers Endomet, CRCS, and AH26 and root-end filling materials Amalgam, Gallium GF2, Ketac Silver, mineral trioxide aggregate (MTA), and Super-EBA. Cytotoxic effects were assessed using the MTT assay for mitochondrial enzyme activity and the CV assay for cell numbers. Using inserts culture and L-929 fibroblasts. All-Bond-2 was also evaluated. The statistical analysis of results showed that CRCS was the least cytotoxic sealer followed by Endomet and AH26. Among root-end filling materials, MTA was not cytotoxic; Gallium GF2 displayed little cytotoxicity; and Ketac Silver, Super-EBA, and Amalgam showed higher levels of cytotoxicity. All Bond-2 also displayed a high degree of cytotoxicity. CRCS was the best root canal sealer and MTA the best root-end filling material. The outcome was favorable also for Gallium GF2 as a retrofilling material.

Disintegration of endodontic cements in water.

The disintegration of three endodontic cements in water was determined quantitatively and qualitatively. The materials studied were Ketac-Endo (KE), Tubli Seal (TS), and AH26 (AH). Specimens were immersed in water for 48 h (GI), 7 (GII) and 45 days (GIII). The solid residue was then determined. For the qualitative analysis three groups of tubes were filled with the materials and stored in water for the same periods. The exposed surface was photographed. Results expressed as percentage of original mass in the quantitative analysis for loss of mass due to dissolution were: GI = KE 2.39 (0.70); TS 3.56 (0.37); AH 4.94 (2.83); GII = KE 2.84 (0.30); TS 2.50 (0.50); AH 0.66 (0.26); GIII = KE 1.60 (0.84); TS 1.03 (0.42); AH 1.22 (0.54). Tukey's least significant difference (0.05) was 2.94. In the qualitative experiment KE disintegration was far more evident than that suffered by other materials. The quantitative results had no correlation with the qualitative observations probably due to the difference in the moment when the materials were immersed.

Endodontic retreatment of thermafil or lateral condensation obturations in post space prepared teeth.

The purpose of this study was to quantify the amount of remaining gutta-percha/sealer after retreatment of post space prepared teeth obturated with a lateral condensation technique or with Thermafil with plastic and metallic carrier. The time required for retreatment was also recorded. Forty-five extracted mandibular premolars were prepared using a step-back flared technique and obturated. The post space was prepared and a 5-mm obturation was left in the canal. Retreatment of all groups was done using a solvent technique. The teeth were split longitudinally and photographed. The total area of the canal and the area of gutta-percha/sealer were traced on white paper. Both areas were quantified using a computerized image analysis system and the ratio of remaining obturation material to root canal periphery was derived and statistically analyzed. Statistical analysis (analysis of variance, p = 0.01) showed no differences among the techniques when the average percentage of remaining gutta-percha/sealer was compared. Results revealed that the Thermafil metallic retreatment group consumed significantly more time than the others (analysis of variance, Scheffe p = 0.01). The metallic carriers were not easily removed from the canals, six metal carriers could not be retrieved during the retreatment routine.