Impact of root canal preparation performed by ProTaper Next or Reciproc on the quality of life of patients: a randomized clinical trial.

AIM: To compare the impact of the two different root canal preparation systems on the quality of life of patients and correlate postoperative pain with the impact on quality of life. METHODOLOGY: A randomized clinical trial was conducted with 58 patients allocated into two groups based on the root canal preparation system employed: ProTaper Next (PN) or Reciproc (R). Data collection involved the administration of a questionnaire addressing demographic and clinical characteristics, the OHIP-14 (quality of life) and a visual analog scale (pain). The latter two were the outcomes of interest and were administered in the first 24 h after root canal treatment. The data were submitted to descriptive analysis, bivariate analysis, Poisson univariate and multiple regression, and Spearman's correlation test, with a 5% significance level. RESULTS: A greater frequency of impact after treatment was found for the items 'uncomfortable to eat food' and 'felt self-conscious'. No significant difference between groups was found regarding the severity of impact for total OHIP-14 score or any of the domain scores. CONCLUSIONS: The two root canal preparation systems exerted a similar impact on quality of life. Postoperative pain was correlated with impact on quality of life, affecting chewing function, self-consciousness and stress. Thus, it is important for dentists to provide care capable of preventing or treating the negative consequences of such therapy.

Avaliação fisiológica e comportamental de cães utilizados em terapia assistida por animais (TAA) / Phyisiological and behavioral assessment in dogs used in Animal-Assisted Therapy (AAT)

Realizou-se a observação comportamental de nove cães terapeutas (oito da raça Labrador Retriever e um Golden Retriever), dosaram-se cortisol sérico e salivar, aferiram-se a temperatura retal, a pressão arterial sistólica e as frequências cardíaca e respiratória nos seguintes momentos: M0 (média de três avaliações do cão em repouso) e em M1, M2 e M3 (imediatamente antes, imediatamente após e decorridas 24h das atividades de terapia assistida por animais - TAA), respectivamente. Não houve diferença significativa quanto às características estudadas (P>0,05), exceto pela temperatura, que foi mais elevada em M1 e M2 do que em M0 (P=0,009). A avaliação comportamental, realizada de maneira descritiva, não apresentou alteração negativa. Houve diferença significativa quanto à concentração de cortisol sérico entre os momentos M1 e M3 (P=0,071), e não ocorreu diferença da concentração do cortisol salivar entre os quatro momentos (P=0,746). As alterações observadas foram atribuídas à contenção e à manipulação dos animais e não desencadearam desconforto físico ou estresse dignos de nota em cães.

Behavioral observation of nine therapist dogs (eight Labrador Retrievers and one Golden Retriever) was performed and serum and salivar cortisol dosage, rectal temperature, systolic blood pressure and heart and respiratory rates were measured and evaluated at the following moments: M0 (average of three evaluations of the dog at rest) and M1, M2 e M3 (immediately before, at the end and 24 hours after the AAT activities, respectively). There was no significant difference in the parameters between the moments (P>0.05) except for temperature, which was higher in M1 and M2 than M0 (P=0.009). The behavioral assessment was conducted in a descriptive way and didn't present a negative effect. There was significant difference when comparing the serum cortisol levels between M1 and M3 (P=0.0712). There wasn't asignificant difference in salivary cortisol levels when comparing the values of the four moments (P=0.7458). The observed alterations are probably related to the containment and handling of animals, demonstrating that the therapy doesn't have a negative effect on dogs.

Differential diagnosis and treatment of hyponatremia following pituitary surgery.

Hyponatremia is a frequent occurrence after pituitary surgery, having been described in 9% to 35% of the patients. It is produced by the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) or, more frequently, by the cerebral salt-wasting syndrome (CSWS). The clinical presentation of both syndromes is identical and the differential diagnosis can be difficult. The determination of the volemic state is essential for the diagnosis, since the patients with the SIADH are euvolemic or hypervolemic, while those with CSWS are hypovolemic. Several methods can be used to detect the volemic state in these patients and, among them, the furosemide test can best discriminate between SIADH and CSWS. A furosemide infusion (20 mg) normalizes sodium serum levels in SIADH patients, but not in CSWS patients who remain hyponatremic. The differentiation between the 2 syndromes is clinically relevant since their treatment is antithetical. SIADH patients need liquid restriction of liquids and/or furosemide to reduce the volume of extracellular water, while CSWS patients need volume replacement with sodium supplementation (or fludrocortisone can be a good alternative). The diagnosis and treatment of these syndromes are discussed on the basis of the literature reports.

Dosagem do fator natriurético atrial em pacientes pediátricos submetidos à ventilaçäo pulmonar mecânica / Dosage of atrial natriuretic peptide in pediatric patients submitted to mechanical ventilation

OBJETIVOS: Os objetivos deste trabalho foram verificar se existe alteraçäo na secreçäo do fator natriurético atrial (FNA) em crianças submetidas à ventilaçäo pulmonar mecânica e se essas possíveis alterações levariam à modificações no débito urinário e na excreçäo urinária de sódio. METODOLOGIA: Estudo prospectivo, realizado em uma Unidade de Cuidados Intensivos Pediátricos Terciária, em nove crianças submetidas à ventilaçäo pulmonar mecânica para recuperaçäo anestésica, exceto em uma que sofreu traumatismo cranioencefálico näo-cirúrgico. O período de estudo foi de Setembro de 1995 a Março de 1996. Aguardava-se pelo menos três horas do início da ventilaçäo pulmonar mecânica e entäo colhia-se amostra de sangue para dosagem de fator natriurético atrial, gasometria arterial, glicemia, creatinina e eletrólitos. Coletava-se ainda urina durante 6 horas para a verificaçäo do débito urinário e da concentraçäo de sódio. Depois da extubaçäo, aguardava-se por um período de 15 a 30 minutos e colhia-se sangue e urina para as mesmas dosagens realizadas anteriormente. A comparaçäo estatística foi feita pelo teste näo-paramétrico de Wilcoxon Signed Rank, sendo o nível de significância de 0,05. RESULTADOS: O fator natriurético atrial mostrou uma tendência ao aumento quando a ventilaçäo pulmonar mecânica foi retirada (p= 0,0547). O débito urinário e a natriurese näo se alteraram com a ventilaçäo pulmonar mecânica. CONCLUSÕES: A tendência ao aumento do fator natriuretico atrial ocorreu provavelmente por diminuiçäo da pressäo intratorácica. A reposiçäo volêmica no trans-operatório pode ter influenciado no débito urinário e na natriurese. Em pacientes submetidos à ventilaçäo pulmonar mecânica por períodos prolongados, com altos parâmetros de pressäo inspiratória e pressäo expiratória final positiva, seria interessante a dosagem do fator natriurético atrial e se esse se encontrasse diminuído, seria uma indicaçäo para o seu uso

[Dosage of atrial natriuretic peptide in pediatric patients submitted to mechanical ventilation]. / Dosagem do fator natriurético atrial em pacientes pediátricos submetidos à ventilação pulmonar mecânica.

OBJECTIVE: The aims of this article are to verify if there is any alteration in the secretion of natriuretic atrial factor (NAF) in children submitted to mechanical pulmonary ventilation and if these possible alterations would lead to modification in the urinary volume and in the urinary sodium excretion. METHODOLOGY: A prospective study in a tertiary pediatric intensive care unit, nine children submitted to mechanical pulmonary ventilation for recuperation from anesthetics, except one who suffered a not surgical cranioencephalic trauma. The period of the study was from September 1995 to March 1996. Patients with renal pathology, pulmonary pathology, in use of diuretics until 24 hours before the collection of laboratory dosages, hemodynamic instability in need of vasoactive and inothropic agents, and patients with alterations of sodium blood levels were excluded from this work. In order to have an adequate alveolar recruitment at least 3 hours were taken. After this period a blood sample was collected for dosage of natriuretic atrial factor, arterial gas analysis, glucose analysis, creatinine and electrolytes dosage. Urine was collected in a 6 hours interval during the patient's period under mechanical pulmonary ventilation in order to verify the urinary volume and urinary sodium excretion. Fifteen to thirty minutes after extubation, blood an urine were collected for the same dosages done before. Urine was collected in a 6 hour period. A statistical comparison was done by the non parametric test of Wilcoxon signed rank, with a significance level of 0,05. RESULTS: The natriuretic atrial factor showed tendency to increase when mechanical pulmonary ventilation was taken away (p=0,0547). The urinary volume and natriuresis were not altered by mechanical pulmonary ventilation.