Temporal Series Analysis of Population Cycle Threshold Counts as a Predictor of Surge in Cases and Hospitalizations during the SARS-CoV-2 Pandemic.

Tools to predict surges in cases and hospitalizations during the COVID-19 pandemic may help guide public health decisions. Low cycle threshold (CT) counts may indicate greater SARS-CoV-2 concentrations in the respiratory tract, and thereby may be used as a surrogate marker of enhanced viral transmission. Several population studies have found an association between the oscillations in the mean CT over time and the evolution of the pandemic. For the first time, we applied temporal series analysis (Granger-type causality) to validate the CT counts as an epidemiological marker of forthcoming pandemic waves using samples and analyzing cases and hospital admissions during the third pandemic wave (October 2020 to May 2021) in Madrid. A total of 22,906 SARS-CoV-2 RT-PCR-positive nasopharyngeal swabs were evaluated; the mean CT value was 27.4 (SD: 2.1) (22.2% below 20 cycles). During this period, 422,110 cases and 36,727 hospital admissions were also recorded. A temporal association was found between the CT counts and the cases of COVID-19 with a lag of 9-10 days (p ≤ 0.01) and hospital admissions by COVID-19 (p < 0.04) with a lag of 2-6 days. According to a validated method to prove associations between variables that change over time, the short-term evolution of average CT counts in the population may forecast the evolution of the COVID-19 pandemic.

Confocal laser scanning microscopic analysis of the penetration of an epoxy resin-based sealer into dentinal tubules after calcium hydroxide dressing.

This study assessed the penetration of an epoxy resin-based sealer into dentinal tubules of root canals previously medicated with calcium hydroxide. Sixteen palatal root canals of upper molars were instrumented and distributed into two groups: (G1) root canals medicated with calcium hydroxide and obturated after its removal; (G2) root canals obturated without the use of dressing. Sealer mixed with rhodamine B provided fluorescence for confocal laser scanning microscopy. Measurements of area and linear penetration of the sealer were assessed in three thirds by ImageJ software. The data were statistically compared by Kruskal-Wallis, Dunn's and Mann-Whitney U tests (P < 0.01). The calcium hydroxide decreased the penetration of the sealer. The coronal and middle thirds had similar areas and linear penetrations in both groups, whereas the apical third had less penetration. In conclusion, the penetration of the epoxy resin-based sealer is influenced by the calcium hydroxide dressing used between appointments.

Análisis comparativo de la contaminación en barras de gutapercha / Comparative analysis of gutta-percha bar contamination

Se realizó una investigación analítica realizada in vitro en el laboratorio general del Hospital "Carlos Andrade Marín". La población estuvo compuesta por 20 barras de gutapercha marca Meta®Biomed (Korea), distribuidas en cuatro grupos compuestos por 5 barras atendiendo a características preestablecidas en cuanto a realización de termoplastificación y manipulación. Solo el 15% de las muestras se registró indicios de crecimiento bacteriano, de las que el 66,67% pertenecieron al grupo de barras sólidas de gutapercha que fueron manipuladas, estableciéndose diferencias significativas con respecto al resto de los grupos (p≤0.01), según la prueba de T-stu-dents. La mayoría de las muestras no mostró indicios de crecimiento bacteriano. Sin embargo, dos de las tres muestras que manifestaron esa actividad microbiológica pertenecieron al grupo de las barras sólidas de gutapercha que fueron manipuladas.

An in vitro analytical research was carried out in the general laboratory of the "Carlos Andrade Marín" Hospital. The population consisted of 20 bars of Meta®Biomed brand gutta-percha (Korea) distributed in four groups made up of 5 bars according to the pre-established characteristics in terms of thermoplasticization and handling. Only 15% of the selected samples showed signs of bacterial growth, of which 66.67% belonged to the group of solid gutta-percha bars that were manipulated, establishing specific differences with respect to the rest of the groups (p≤0.01), according to the T-students test. Most of the samples have no evidence of bacterial growth. However, two of the three samples that showed this microbiological activity belonged to the group of solid gutta-percha bars that were manipulated

Microfiltración apical entre dos cementos de obturación: biocerámico y resinoso en premolares unirradiculares preparadas con protaper, y obturadas con condensación lateral / Apical microfiltration between two filling cements: bioceramic and resinous in unirradicular premolars prepared with protaper and sealed with lateral condensation

Resumen Objetivo: Comparar in vitro la microfiltración apical en premolares unirradiculares obturados con cemento a base de resina epóxica y cemento biocerámico. Método: 40 piezas dentales unirradiculares fueron seleccionadas y divididas en dos grupos para ser obturadas esperando el tiempo de fraguado de acuerdo con las instrucciones del fabricante. El grupo A se obturó con cemento biocerámico Endosequence y, el grupo B, con cemento a base de resina epóxica AH-Plus: posteriormente los dos grupos fueron sellados con barniz de uñas hasta 3mm de la parte apical, luego se colocaron las muestras en la incubadora a 37ºC. Ambos fueron sometidos a 750 ciclos de termociclado, para reproducir el ambiente parecido a la cavidad oral. Para análisis de microfiltración se utilizó el método de difusión del colorante, se sumergieron en azul de metileno al 2 % por 6 días, posteriormente los especímenes fueron sometidos en una bomba de vacío. Los dientes fueron cortados longitudinalmente para ser evaluadas mediante el estereomicroscopio. El análisis estadístico fue hecho mediante T-Student y Chi-Cuadrado. Resultados: El grupo A corresponde a Endosequence obtuvo una medida de 0,55mm y el grupo B corresponde a AH-Plus 1,20mm con un estimado de significancia de p=0,013. Conclusión: El análisis de ambos cementos de obturación demostró que Endosequence posee menor microfiltración apical que AH-Plus.

Abstract Aim: To compare in vitro by the stereomiscroscope the lesser apical microfiltration in uniradicular premolars, between the cement based on Epoxy Resin and Bioceramic cement. Method: The study was performed on 40 uniradicular dental pieces divided into two groups, the samples were prepared using the protaper system and the obturation was performed using the lateral condensation technique, the first group was sealed withEndosequence bioceramic cement and the second group with Cement based on AH-Plus epoxy resin, then sealed with nail varnish up to 3mm from the apical part, then the samples were placed in the incubator at 37ºC, waiting for the set time corresponding to each group according to the manufacturer's instructions . The two groups of the present study were submitted to 750 cycles of thermocycling, to provide an environment similar to the oral cavity, then longitudinal cuts were made to the samples. The microfiltration was evaluated using the dye diffusion method, immersed in 2% methylene blue for 6 days, then the specimens were subjected to a vacuum pump. The teeth were cut longitudinally to be evaluated by the stereomicroscope. The statistical analysis was through T-Student and Chi-Square. Results: Group A corresponds to Endosequence obtained a mean of 0,55mm and Group B corresponds to AH-Plus 1,20mm with an estimated significance of p = 0,013. Conclusion: Both obturation cements have significant differences, therefore Endosequence has less apical microfiltration than AHPlus.

Influencia de la medicación intracanal con pasta de hidróxido de calcio en la penetración del cemento obturador / obturadorInfluence of intracanal medication with calcium hydroxide paste in the penetration of the shutter cement / Influência da medicação intracanal com pasta de hidróxido de cálcio na infiltração do cimento obturador

La eliminación del hidróxido de calcio en el conducto radicular es determinante para el éxito del tratamiento endodóntico, los remanentes pueden interaccionar negativamente con los selladores endodónticos aumen-tando las filtraciones y disminuyendo la calidad de la obturación. Objetivo: Evaluar el efecto de la medicación intraconducto con pasta de hidróxido de calcio en la penetración del cemento obturador en el interior de los túbulos dentinarios. Materiales y métodos: 20 raíces distales de molares superiores se instrumentaron uti-lizando el Sistema Wave One Large 40/.08. Se dividieron aleatoriamente en dos grupos: uno obturado con técnica de cono único y cemento Ah plus con rodamina-B y otro obturado con la misma técnica y cemento Ah plus con rodamina B, previa colocación por 15 días y remoción mediante recapitulación de la pasta de hidróxido de calcio. Posteriormente los dientes fueron cortados transversalmente y se realizaron fotomicro-grafías del tercio cervical, medio y apical a través de la técnica de microscopia confocal de barrido por láser. La profundidad máxima de penetración fue determinada a través del programa Image J. Resultados: El ce-mento sellador Ah plus presentó menores valores de penetración cuando fue empleada previamente la pasta de hidróxido de calcio como medicación intracanal (p<0,01). El tercio del conducto con mayor penetración fue el tercio cervical seguido por el tercio medio y por último el apical (p<0,01). Conclusión: Los remanentes de hidróxido de calcio disminuyen la penetración del cemento sellador Ah plus en los túbulos dentinarios en todos los tercios del conducto radicular.

The elimination of calcium hydroxide in the root canal is decisive for the success of endodontic treatment, the remnants can interact negatively with endodontic sealants increasing filtrations and decreasing the quality of the seal. Objective: To evaluate the effect of intra-duct medication with calcium hydroxide paste on the pen-etration of the sealing cement inside the dentinal tubules. Materials and methods: 20 distal roots of upper molars were instrumented using the Wave One Large 40 / .08 System. They were randomly divided into two groups: one sealed with a single cone technique and Ah plus cement with rhodamine-B and another sealed with the same technique and Ah plus cement with rhodamine B, previous placement for 15 days and removal by recapping the paste calcium hydroxide. Subsequently, the teeth were cut transversely and photomicro-graphs of the cervical, middle and apical third were performed using the laser scanning confocal microscopy technique. The maximum depth of penetration was determined through the Image J program. Results: The Ah plus sealing cement had lower penetration values when the calcium hydroxide paste was previously used as an intra-channel medication (p <0.01). The third of the duct with the highest penetration was the cervical third followed by the middle third and finally the apical (p <0.01). Conclusion: Remaining calcium hydroxide decreases the penetration of the sealing cement Ah plus in the dentinal tubules in all thirds of the root canal.

A eliminação do hidróxido de cálcio do canal radicular é determinante para o sucesso do tratamento endo-dôntico; os remanescentes podem interagir negativamente com os cimentos endodônticos, aumentando as filtrações e diminuindo a qualidade do selamento. Objetivo: Avaliar o efeito da medicação intracanal com pasta de hidróxido de cálcio na penetração do cimento de selamento no interior dos túbulos dentinários. Materiais e métodos: 20 raízes distais de molares superiores foram instrumentadas usando o sistema Wave One Large 40 /.08. Eles foram divididos aleatoriamente em dois grupos: um selado com técnica de cone único mais cimento Ah plus com rodamina-B e outro selado com a mesma técnica e cimento Ah plus com rodami-na-B, prévia colocação por 15 dias e remoção recolocação da pasta hidróxido de cálcio. Posteriormente, os dentes foram cortados transversalmente e fotomicrografias do terço cervical, médio e apical foram realizadas pela técnica de microscopia confocal de varredura a laser. A profundidade máxima de penetração foi de-terminada pelo programa Image J. Resultados: O cimento selante Ah plus apresentou menores valores de infiltração quando a pasta de hidróxido de cálcio foi utilizada anteriormente como medicamento intracanal (p <0,01). O terço do conduto com maior penetração foi o terço cervical, seguido pelo terço médio e finalmente o apical (p <0,01). Conclusão: O hidróxido de cálcio restante diminui a penetração do cimento selante Ah plus nos túbulos dentinários em todos os terços do canal radicular.

Comparación in vitro del sellado apical entre dos sistemas de obturación termoplastificada: Guttacore y E&Q Master / In vitro comparison of the apical seal between two thermoplastic filling systems: Guttacore and E&Q Master

Objetivo: Comparar el sellado apical in vitro de los sistemas de obturación termoplastificada, GuttaCore® y E&Q Master®, desde la perspectiva de microfiltración. Métodos: Cuarenta piezas unirradiculares se instrumentaron con sistema rotatorio e irrigaron con hipoclorito de sodio al 2,5% y EDTA al 17%. Las muestras se dividieron en dos grupos (n=20); se obturaron y colocaron en estufa incubadora a 37°C y 100% de humedad durante 3 días. Cada muestra se cubrió con barniz de colores excepto 3 mm apicales para ser sumergidas en azul de metileno al 2% por 3 días, y centrifugados por 20 min a 3000 rpm. Las muestras se lavaron y fracturaron axialmente para su análisis, mediante fotografías, en el estereomicroscopio. Para el análisis de datos se utilizó la prueba t de Student con un nivel de significancia del 5%. Resultados: Los valores medios de microfiltración fueron 0,660 mm y 0,825 mm para GuttaCore® y E&Q Master®, respectivamente, no encontrándose diferencias estadísticamente significativas entre ellas (p=0,525). Conclusión: GuttaCore® y E&Q Master® son sistemas de obturación que ofrecen un buen sellado apical no existiendo diferencia entre ellos. Palabras clave: EDTA; Gutapercha; Hipoclorito de Sodio; Microfiltración.

Objective: Compare in vitro the apical seal of thermoplastic filling systems, GuttaCore®and E&Q Master®, from the perspective of microfiltration. Methods: Forty single-rooted teeth were instrumented with rotary system and irrigated with 2.5% sodium hypochlorite and 17% EDTA. The samples were divided into two groups (20 for each system); sealed and placed in the incubator at 37°C and 100% humidity for 3 days. Each sample was covered with colored varnish except the last 3 apical millimiters to be immersed in 2% methylene blue for 3 days and centrifuged for 20 min at 3000 rpm. The samples were washed and fractured axially for their analysis in the stereomicroscope by means of photographs. For the data analysis we used the t Studenttest with a level of significance of 5%.Results: The mean microfiltration values were 0.660 mm and 0.825 mm for GuttaCore and E&Q Master respectively, no statistically significant differences were found between them (p=0.525). Conclusion: GuttaCore and E&Q Master are seal systems that offer good apical sealing, there is no difference between them. Keywords: EDTA; Gutta-Percha; Microfiltration; Sodium Hypochlorite.

Evaluation of the WaveOne Gold and One Shape New Generation in Reducing Enterococcus faecalis from Root Canal.

The aim of this study was to evaluate the WaveOne Gold and One Shape New Generation systems regarding the bacterial removal from root canals infected with Enterococcus faecalis by comparing them to the conventional WaveOne and One Shape systems. Forty-eight distobuccal root canals of maxillary molars sterilized with ethylene oxide were infected with E. faecalis for 21 days, and then root canal initial bacterial sample was collected with paper cones and plated on M-enterococcus agar. The specimens were randomly divided into 4 groups according to the instrumentation: WaveOne Gold, One Shape New Generation, WaveOne and One Shape. After instrumentation, samples were collected with use of scraping and paper cones at immediate and 7 days after instrumentation. The bacterial reduction was calculated and then made intragroup analysis by Friedman test and intergroup analysis by Kruskal-Wallis with Dunn's post-hoc test, all at 5% significance. All techniques significantly reduced the number of bacteria in the root canal (p<0.05). WaveOne Gold and One Shape New Generation promoted higher bacterial reduction than WaveOne and One Shape systems (p<0.05), but no significant difference was found between WaveOne Gold and One Shape New Generation or between WaveOne and One Shape (p>0.05). Novel single-file systems promote better bacterial removal than the conventional single-file systems.

Evaluation of the waveone gold and one shape new generation in reducing enterococcus faecalis from root canal

Abstract The aim of this study was to evaluate the WaveOne Gold and One Shape New Generation systems regarding the bacterial removal from root canals infected with Enterococcus faecalis by comparing them to the conventional WaveOne and One Shape systems. Forty-eight distobuccal root canals of maxillary molars sterilized with ethylene oxide were infected with E. faecalis for 21 days, and then root canal initial bacterial sample was collected with paper cones and plated on M-enterococcus agar. The specimens were randomly divided into 4 groups according to the instrumentation: WaveOne Gold, One Shape New Generation, WaveOne and One Shape. After instrumentation, samples were collected with use of scraping and paper cones at immediate and 7 days after instrumentation. The bacterial reduction was calculated and then made intragroup analysis by Friedman test and intergroup analysis by Kruskal-Wallis with Dunn's post-hoc test, all at 5% significance. All techniques significantly reduced the number of bacteria in the root canal (p<0.05). WaveOne Gold and One Shape New Generation promoted higher bacterial reduction than WaveOne and One Shape systems (p<0.05), but no significant difference was found between WaveOne Gold and One Shape New Generation or between WaveOne and One Shape (p>0.05). Novel single-file systems promote better bacterial removal than the conventional single-file systems.

Resumo A proposta deste estudo foi avaliar os sistemas WaveOne Gold e One Shape New Generation em relação à remoção bacteriana de canais infectados com Enterococcus faecalis, comparando-os com seus sistemas convencionais WaveOne e One Shape. Quarenta e oito canais disto vestibulares de molares superiores esterilizados em óxido de etileno foram contaminados com E. faecalis por 21 dias, e então acoleta bacteriana inicial foi feita com cone de papel e plaqueadas em M-enterococcus agar. Os espécimes foram aleatoriamente divididos em quarto grupos de acordo com a instrumentação: WaveOne Gold, One Shape New Generation, WaveOne e One Shape. Após instrumentação, amostras foram coletadas utilizando limagem e cones de papel imediatamente e 7 dias após o preparo. A redução bacteriana foi calculada e então feita análise intra grupos com teste de Friedman, e entre grupos utilizando Kruskal-Wallis e teste de Dunn, todos a 5% de significância. Todas as técnicas reduziram significantemente o número de bactérias do canal radicular (p<0.05). WaveOne Gold e One Shape New Generation promoveram maior redução bacteriana que WaveOne e One Shape (p<0.05), mas nenhuma diferença significante foi encontrada entre WaveOne Gold e One Shape New Generation ou entre WaveOne e One Shape (p>0.05). Novos sistemas de lima-única promovem melhor remoção bacteriana que seus sistemas convencionais.

δß-Thalassemia trait: how can we discriminate it from ß-thalassemia trait and iron deficiency anemia?

OBJECTIVES: To analyze the differences not only in classic hematologic parameters but also in RBC subpopulations among δß-thalassemia trait (δß-TT), ß-thalassemia trait (ß-TT), and iron deficiency anemia (IDA) and to evaluate the role of fetal hemoglobin (HbF) in elevated RBC distribution width (RDW). METHODS: Samples from 553 patients with microcytosis (74 δß-TT, 272 ß-TT, and 207 IDA) were run on an Advia 2120i analyzer (Siemens Medical Solutions Diagnostics, Tarrytown, NY). Classic hematologic parameters and RBC subpopulations were assessed. The correlation between HbF and RDW in patients with thalassemia (both ß and δß) was evaluated. An independent sample t test was used to compare classic hematologic parameters and RBC subpopulations among ß-TT, IDA, and δß-TT and receiver operating characteristic curves performed in the significant comparisons. RESULTS: RDW was significantly higher in δß-TT compared with ß-TT (18.79% vs 16.04%, P < .001), as was mean corpuscular volume (66.39 vs 64.82 fL, P < .001), mean corpuscular hemoglobin (20.73 vs 20.04 pg, P < .001), and mean corpuscular hemoglobin concentration (31.16 vs 30.66 g/dL, P = .03). Pearson coefficient showed a good correlation between HbF and RDW. The values obtained for all the parameters were significantly different (P < .001) between patients with thalassemia (ß and δß) and IDA. CONCLUSIONS: RDW is the best parameter to discriminate δß-TT from ß-TT. The degree of anisocytosis in patients with ß-TT and δß-TT is strongly correlated with HbF.

¿Cuál es la rentabilidad diagnóstica del frotis de sangre periférica? / What is the diagnostic yield of the peripheral blood smear?

Fundamento y objetivo. A pesar de que el frotis de sangre periférica es una herramienta muy útil en el diagnóstico de diversas enfermedades, para que aporte beneficio es crucial que el encargado de examinarlo conozca datos clínicos del paciente y sepa qué tiene que buscar o descartar. El objetivo de nuestro trabajo fue evaluar el beneficio real que aporta el frotis y los factores que predicen su impacto en la práctica clínica. Pacientes y métodos. Se analizaron de forma prospectiva todos los frotis consecutivos (n = 618) solicitados en un mes por 6 hospitales de la comunidad de Madrid y revisados en nuestro laboratorio. En cada frotis se evaluó la información previa aportada por el médico peticionario y la serie hematológica alterada. Clasificamos cada frotis, según lo que aportó al clínico, en: a) sin información relevante; b) confirma diagnóstico ya conocido, y c) aporta información relevante para el diagnóstico o pronóstico. Resultados. No se obtuvo ninguna información relevante en 402 frotis (65,04%). En los frotis útiles se observó mayor proporción de sospechas diagnósticas previas (20%) en comparación con los no diagnósticos (5,1%) (p < 0,001) y menos peticiones con hemograma normal (3,8 vs 42,7%, p < 0,001). Conclusiones. En nuestra experiencia, 2 de cada 3 frotis solicitados no aportan ninguna información relevante. Conocer la sospecha diagnóstica y tener al menos una de las 3 series alteradas tiene impacto significativo en la rentabilidad del frotis(AU)

Background and objetive. Although examination of peripheral blood smear is a very helpful tool in the diagnosis of several pathologies, it is essential that the person who performs it knows the patient clinical data and what to look for in order to obtain the highest benefit. The aim of this study is to determine the proportion of useful blood smears in clinical practice and to identify possible predictive factors. Patients and methods. We prospectively analysed 618 consecutive peripheral blood smears performed in our laboratory, requested by 6 hospitals in Madrid. Clinical features provided by the physician and abnormalities in complete blood count (none / white cells / red cells / platelets / all of them) were evaluated in each case. According to the information obtained from them, blood smears were classified into: a) non-diagnostic; b) a previously-known diagnosis is confirmed, and c) new relevant information provided. Results. No useful information was obtained by 402 (65.04%) blood smears. A higher proportion of previous clinical suspicions was observed in helpful blood smears compared to non-diagnostic ones (20% vs 5.1%, P<.001), and also less for completely normal blood counts (3.8% vs 42.7%, P <.001). Conclusions. In our experience, two thirds of requested peripheral blood smears provide no useful information at all. Clinical suspicion and the presence of at least one abnormality in complete blood count showed a significant impact in blood smear yield(AU)