Periradicular repair after single- and two-visit root canal treatments using ultrasonic irrigant activation and calcium hydroxide dressing of teeth with apical periodontitis: study protocol for randomized controlled trials.

BACKGROUND: In certain clinical situations, root canal treatment in teeth with apical periodontitis is performed in multiple visits, with the use of intracanal dressing between visits, aiming to reduce microorganisms and their by-products of the root canal system prior to filling. However, in recent years, discussions have been growing about the real need for the use of intracanal dressing in these cases. The use of ultrasonic activation of the auxiliary chemical substance has increased the potential for decontamination promoted during the chemomechanical preparation of the root canal. Thus, this study is designed to explore whether the use of intracanal dressing between visits during endodontic treatment favors periradicular repair in teeth with apical periodontitis. METHODS: This is a randomized, prospective, double-blinded, controlled clinical trial designed to evaluate 3 distinct clinical approaches used during endodontic therapy: group 1-root canal treatment in a single visit (RCT-SV); group 2-root canal treatment in two visits with intracanal dressing (RCT-TVWD); and group 3-root canal treatment in two visits without intracanal dressing (RCT-TVWOD). A total of 150 adult patients aged 18 to 60, with at least one tooth diagnosed with asymptomatic apical periodontitis and periradicular lesion (confirmed with a cone beam computed tomography (CBCT)), will be randomized and will undergo one of the types of clinical approaches during endodontic therapy. Patients' postoperative pain levels will also be recorded in periods of 24, 48, and 72 h and 7 days. Subsequently, clinical findings and long-term follow-up evaluations, with periradicular repair, will be performed at 6 and 12 months by intraoral periapical radiograph (IOPAR) and CBCT at the 24-month follow-up. DISCUSSION: This study will evaluate the periradicular repair of mandibular molar teeth with apical periodontitis, providing information about the efficacy, benefits, and safety of performing the endodontic treatment in a single and two visits, with and without the use of calcium hydroxide dressing. All endodontic therapy procedures will be performed under a dental operating microscope and using ultrasonic activation of auxiliary chemical substances. These results may contribute to changes in the clinical approaches adopted during endodontic therapy of teeth with apical periodontitis and reveal the potential of complementary approaches that aim to enhance the decontamination of the root canal system during the preparation stage. TRIAL REGISTRATION: ClinicalTrials.gov NCT05256667. Registered on 24 February 2022.

Electronic Cigarette Use Promotes a Unique Periodontal Microbiome.

Electronic cigarettes (e-cigs) have become prevalent as an alternative to conventional cigarette smoking, particularly in youth. E-cig aerosols contain unique chemicals which alter the oral microbiome and promote dysbiosis in ways we are just beginning to investigate. We conducted a 6-month longitudinal study involving 84 subjects who were either e-cig users, conventional smokers, or nonsmokers. Periodontal condition, cytokine levels, and subgingival microbial community composition were assessed, with periodontal, clinical, and cytokine measures reflecting cohort habit and positively correlating with pathogenic taxa (e.g., Treponema, Saccharibacteria, and Porphyromonas). α-Diversity increased similarly across cohorts longitudinally, yet each cohort maintained a unique microbiome. The e-cig microbiome shared many characteristics with the microbiome of conventional smokers and some with nonsmokers, yet it maintained a unique subgingival microbial community enriched in Fusobacterium and Bacteroidales (G-2). Our data suggest that e-cig use promotes a unique periodontal microbiome, existing as a stable heterogeneous state between those of conventional smokers and nonsmokers and presenting unique oral health challenges. IMPORTANCE Electronic cigarette (e-cig) use is gaining in popularity and is often perceived as a healthier alternative to conventional smoking. Yet there is little evidence of the effects of long-term use of e-cigs on oral health. Conventional cigarette smoking is a prominent risk factor for the development of periodontitis, an oral disease affecting nearly half of adults over 30 years of age in the United States. Periodontitis is initiated through a disturbance in the microbial biofilm communities inhabiting the unique space between teeth and gingival tissues. This disturbance instigates host inflammatory and immune responses and, if left untreated, leads to tooth and bone loss and systemic diseases. We found that the e-cig user's periodontal microbiome is unique, eliciting unique host responses. Yet some similarities to the microbiomes of both conventional smokers and nonsmokers exist, with strikingly more in common with that of cigarette smokers, suggesting that there is a unique periodontal risk associated with e-cig use.

Hypertension is associated with a variant in the RARRES2 gene in populations of Ouro Preto, Minas Gerais, Brazil: a cross-sectional study.

BACKGROUND: Arterial hypertension (AH) is implicated in vascular health and contributes significantly to cardiovascular morbidity and mortality. In addition to the contribution of usual risk factors for AH, elucidating the influence of genetic factors is a promising area of investigation. Therefore, we evaluated the association between AH and cardiovascular risk factors (CVRFs) and genetic polymorphisms in communities in Southeast Brazil. METHODS: A total of 515 adults aged 18-91 years, who were cross-sectionally assessed between 2015-2016, were included. Demographic, clinical, behavioral, anthropometric characteristics, and laboratory parameters and 12 single nucleotide polymorphisms in seven candidate genes involved in cardiovascular risk (RARRES2, AGT, NOS3, GNB3, APOE, APOB, APOC3, LDLR, and PPARG) were evaluated, with AH as the outcome. Sex, age, and laboratory parameters were considered the main confounding factors. RESULTS: There was a significant association between age >60 years (odds ratio [OR] =6.74), alcohol dependence (OR=3.84), smoking (OR=1.74), overweight (OR=1.74), high plasma triglyceride (TG) levels (OR=1.98) and low high-density lipoprotein (HDL-c) (OR=6.22), diabetes (OR=3.68), and insulin resistance (OR=2.40) and AH. A significant association was observed between rs4721 in RARRES2 and AH. The T allele in homozygosis was a potent chance modifier for AH. The highest chance gradients for AH were characterized by the presence of the TT genotype and DMT2 (OR=9.70), high TG (OR=6.26), low HDL-c (OR=8.20), and age more than 60 years (OR=9.96). CONCLUSION: The interaction of the T allele of the rs4721 polymorphism in RARRES2 with CVRFs may predispose carriers to a higher cardiovascular risk.

Comparative Effects of E-Cigarette Aerosol on Periodontium of Periodontitis Patients.

Introduction: Tobacco use is one of the main causes of periodontitis. E-cigarette are gaining in popularity, and studies are needed to better understand the impact of e-cigarettes on oral health. Objective: To perform a longitudinal study to evaluate the adverse effects of e-cigarettes on periodontal health. Methods: Naïve E-cigarette users, cigarette smokers, and non-smokers were recruited using newspaper and social media. Age, gender, and ethnicity, were recorded. Participants were scheduled for two visits 6 months apart. At each visit, we collected data on the frequency and magnitude of e-cigarette and cigarette use, and alcohol consumption. Carbon monoxide (CO) levels, cotinine levels, salivary flow rate, periodontal probing depth (PD), bleeding on probing (BoP), and clinical attachment loss (CAL) were also determined at both baseline and follow-up visits and compared between groups with two-way repeated measures ANOVA. Periodontal diagnosis and other categorical variables were compared between groups with the chi-square statistic and logistic regression. Results: We screened 159 subjects and recruited 119 subjects. One-hundred-one subjects (31 cigarette smokers, 32 e-cigarette smokers, and 38 non-smokers) completed every assessment in both visits. The retention and compliance rate of subjects was 84.9%. The use of social media and craigslist was significant in recruiting e-cigarette subjects. Ethnicity and race differed between groups, as did average age in the male subjects. Carbon monoxide and salivary cotinine levels were highest among cigarette smokers. Bleeding on probing and average PDs similarly increased over time in all three groups, but CAL uniquely increased in e-cigarette smokers. Rates of severe periodontal disease were higher in cigarette smokers and e-cigarette users than non-smokers, but interpretation is confounded by the older age of the cigarette smokers. Conclusion: Among the recruited participants, CAL after 6 months was significantly worse only in the e-cigarette smokers. This study design and protocol will assist in future larger studies on e-cigarette and oral health.

Electronic Cigarette Aerosol Modulates the Oral Microbiome and Increases Risk of Infection.

The trend of e-cigarette use among teens is ever increasing. Here we show the dysbiotic oral microbial ecology in e-cigarette users influencing the local host immune environment compared with non-smoker controls and cigarette smokers. Using 16S rRNA high-throughput sequencing, we evaluated 119 human participants, 40 in each of the three cohorts, and found significantly altered beta-diversity in e-cigarette users (p = 0.006) when compared with never smokers or tobacco cigarette smokers. The abundance of Porphyromonas and Veillonella (p = 0.008) was higher among vapers. Interleukin (IL)-6 and IL-1ß were highly elevated in e-cigarette users when compared with non-users. Epithelial cell-exposed e-cigarette aerosols were more susceptible for infection. In vitro infection model of premalignant Leuk-1 and malignant cell lines exposed to e-cigarette aerosol and challenged by Porphyromonas gingivalis and Fusobacterium nucleatum resulted in elevated inflammatory response. Our findings for the first time demonstrate that e-cigarette users are more prone to infection.

Fatores de estresse associados à sintomatologia depressiva e qualidade do sono de acadêmicos de enfermagem / Stress factors associated with depressive symptoms and sleep quality in nursing students / Factores de estrés asociados a síntomas depresivos y calidad del sueño en estudiantes de enfermería

Objetivo: Analisar os fatores estressores associados à sintomatologia depressiva, qualidade de sono de acadêmicos de enfermagem. Método: Trata-se de uma pesquisa transversal, analítica e de abordagem quantitativa, realizada em março de 2016 junto a 159 discentes da área de saúde de uma instituição pública do estado de São Paulo por meio de instrumentos validados. Os dados foram analisados no Statistical Package for Social Sciences, versão 25.0, por meio de regressão linear. Valores de p<0,05 foram considerados significativos. Resultados: Observou-se, predomínio de alto estresse (50,9%), seguido por médio estresse (46,5%), bem como baixa qualidade do sono (99,4%) e presença de sintomas depressivos (100%) entre os discentes de enfermagem avaliados. Os fatores de estresse Gerenciamento do Tempo e ao Ambiente contribuíram significativamente para a redução na qualidade do sono. Já os fatores Gerenciamento do Tempo e a Realização de Atividades Práticas levaram ao aumento da sintomatologia depressiva entre os discentes. Conclusão: Os fatores de estresse estão significativamente associados à sintomatologia depressiva e à qualidade de sono de acadêmicos de enfermagem, que justifica a necessidade de uma revisão nas ações voltadas ao manejo de tais fatores durante a formação acadêmica.

Objective: To analyze the stressors associated with depressive symptoms, sleep quality of nursing students. Method: This is a cross-sectional, analytical and quantitative study, carried out in March 2016 with 159 students from the health area of a public institution in the state of São Paulo using validated instruments. The data were analyzed in the Statistical Package for Social Sciences, version 25.0, using linear regression. Values of p <0.05 were considered significant. Results: There was a predominance of high stress (50.9%), followed by medium stress (46.5%), as well as low quality of sleep (99.4%) and presence of depressive symptoms (100%) among the nursing students evaluated. The stress factors Time Management and the Environment contributed significantly to the reduction in sleep quality. The factors Time Management and Practical Activities led to an increase in depressive symptoms among students. Conclusion: Stress factors are associated with depressive symptoms and the quality of academic nursing sleep, which justifies the need for a review of actions aimed at treating these factors during academic training.

Objetivo: Analizar los factores estresantes asociados a síntomas depresivos, calidad del sueño de estudiantes de enfermería. Método: Se trata de un estudio transversal, analítico y cuantitativo, realizado en marzo de 2016 con 159 estudiantes del área de salud de una institución pública del estado de São Paulo utilizando instrumentos validados. Los datos se analizaron en el paquete estadístico de ciencias sociales, versión 25.0, mediante regresión lineal. Se consideraron significativos valores de p <0,05. Resultados: predominó el estrés alto (50,9%), seguido del estrés medio (46,5%), así como la baja calidad del sueño (99,4%) y la presencia de síntomas depresivos (100%) entre los estudiantes de enfermería evaluados. Los factores de estrés Gestión del tiempo y el medio ambiente contribuyeron significativamente a la reducción de la calidad del sueño. Los factores Gestión del tiempo y Actividades prácticas llevaron a un aumento de los síntomas depresivos entre los estudiantes. Conclusión: Los factores de estrés están asociados a los síntomas depresivos y la calidad del sueño de enfermería académica, lo que justifica la necesidad de una revisión de las acciones dirigidas a tratar estos factores durante la formación académica.

Changes in abundance of oral microbiota associated with oral cancer.

Individual bacteria and shifts in the composition of the microbiome have been associated with human diseases including cancer. To investigate changes in the microbiome associated with oral cancers, we profiled cancers and anatomically matched contralateral normal tissue from the same patient by sequencing 16S rDNA hypervariable region amplicons. In cancer samples from both a discovery and a subsequent confirmation cohort, abundance of Firmicutes (especially Streptococcus) and Actinobacteria (especially Rothia) was significantly decreased relative to contralateral normal samples from the same patient. Significant decreases in abundance of these phyla were observed for pre-cancers, but not when comparing samples from contralateral sites (tongue and floor of mouth) from healthy individuals. Weighted UniFrac principal coordinates analysis based on 12 taxa separated most cancers from other samples with greatest separation of node positive cases. These studies begin to develop a framework for exploiting the oral microbiome for monitoring oral cancer development, progression and recurrence.

Yeast two-hybrid liquid screening.

Yeast two-hybrid (YTH) method consists of a genetic trap that selects for "prey" cDNA products within a library that interact with a "bait" protein of interest. Here, we provide a protocol for YTH screening using a liquid medium screening method, which improves the sensitivity of this technique and streamlines the laborious classic screening in solid medium plates. The method uses a simple series of dilutions with established yeast strains transformed with diverse baits and complex cDNA libraries. This allows for prompt detection of positive clones revealed by liquid growth, due to activation of HIS3 reporter gene. Activation of a second reporter gene and reconstruction of the YTH interaction is highly reproducible using this system. This approach can either be performed using culture flasks or deep-well 96-well plates and the number of interactions obtained is similar, when compared to the classic method. In addition, the liquid screening method is faster and more economical for YTH screening and has the added benefit of automation if 96-well plates are used.

O processo de educação continuada na visão de enfermeiros de um hospital universitário / The process of continuing education from the perspective of nurses of a university hospital / El proceso de capacitación permanente en la visión de enfermeros de un hospital universitario

O objetivo deste estudo foi analisar a opinião dos enfermeiros sobre a educação continuada da equipe de enfermagem em um hospital universitário. Trata-se de pesquisa descritiva, exploratória, desenvolvida em um hospital universitário com a participação de cinquenta enfermeiros. A coleta deu-se por meio de um instrumento autoaplicável e os dados foram apresentados percentualmente. Os resultados evidenciaram que: os enfermeiros acreditam na educação continuada e a maioria desenvolve essa atividade anualmente; as estratégias de ensino-aprendizagem predominantes são exposição dialogada e problematização de casos; os programas englobam habilidades técnicas e comportamentais e a avaliação é feita por meio de auditoria. Foram sugeridas melhorias na estrutura física, recursos didáticos, planejamento e motivação para maior adesão da equipe. Uma cultura de compartilhamento entre a equipe de enfermagem e instituição seria significativa para o avanço do processo de educação continuada na prática de qualquer modelo assistencial e aquisição de competências profissional e pessoal...

The objective of this study was to analyze nurses' opinions regarding continuing education in a university hospital. This descriptive, exploratory study was developed at a university hospital with fifty nurses participating. Data were collected using a self-administered questionnaire and were presented in percentages. Results showed that: nurses believe in continuing education and most engage in this activity annually; the predominant teaching-learning strategies are exposure dialogue and problem-solving case studies; the programs are comprised of technical and behavioral skills; and evaluation is performed through audits. The suggestions made included improving the available facilities, increasing educational resources, and planning and motivation to encourage greater participation of the team. A sharing culture between the nursing team and the institution would significantly improve the process of continuing education and the acquisition of professional and personal skills...

Se objetivó analizar la opinión de los enfermeros sobre la capacitación permanente del equipo de enfermería de un hospital universitario. Investigación descriptiva, exploratoria, desarrollada en hospital universitario con participación de 50 enfermeros. Datos recolectados mediante instrumento autoaplicable, con información presentada en porcentajes. Los resultados demostraron que los enfermeros creen en la capacitación permanente, la mayoría desarrolla tal actividad en forma anual; las estrategias de enseñanza-aprendizaje predominantes son: exposición dialogada y problematización de casos; los programas engloban habilidades técnicas y comportamentales, y la evaluación se efectúa mediante auditoría. Fueron sugeridas mejoras de estructura física, recursos didácticos, planeamiento y motivación para mejorar la adhesión del equipo. Una cultura participativa entre el equipo de enfermería y la institución tendría valor significativo para el avance del proceso de capacitación permanente en la práctica de cualquier modelo asistencial y para la adquisición de competencias profesionales y personales...

Association between oral health and gastric precancerous lesions.

Although recent studies have suggested that tooth loss is positively related to the risk of gastric non-cardia cancer, the underlying oral health conditions potentially responsible for the association remain unknown. We investigated whether clinical and behavioral measures of oral health are associated with the risk of gastric precancerous lesions. We conducted a cross-sectional study of 131 patients undergoing upper gastrointestinal endoscopy. Cases were defined as those with gastric precancerous lesions including intestinal metaplasia or chronic atrophic gastritis on the basis of standard biopsy review. A validated structured questionnaire was administered to obtain information on oral health behaviors. A comprehensive clinical oral health examination was performed on a subset of 91 patients to evaluate for periodontal disease and dental caries experience. A total of 41 (31%) cases of gastric precancerous lesions were identified. Compared with non-cases, cases were significantly more likely to not floss their teeth [odds ratio (OR) = 2.89, 95% confidence interval (CI): 1.09-7.64], adjusting for age, sex, race, body mass index, smoking status, educational attainment and Helicobacter pylori status in serum. Among participants who completed the oral examination, cases (n = 28) were more likely to have a higher percentage of sites with gingival bleeding than non-cases [OR = 2.63, 95% CI: 1.37-5.05 for a standard deviation increase in bleeding sites (equivalent to 19.7%)], independent of potential confounders. Our findings demonstrate that specific oral health conditions and behaviors such as gingival bleeding and tooth flossing are associated with gastric precancerous lesions.

Uma forma alternativa de combate à escabiose

Trabalho apresentado pelo curso de medicina da Universidade Estadual de Santa Cruz no I Congresso Brasileiro de Extensão Universitária. Fala da elevada incidência de casos de escabiose e cita medidas de intervenção como: capacitação de agentes comunitários de saúde, práticas de educação em saúde incluindo visitas em domicílio e em ambiente escolar... Fala ainda sobre a realização de uma oficina pedagógica para a produção de um medicamento fitoterápico ("Sabão Escabicida"). Documento em PDF. Requer o Adobe Acrobat Reader