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Introducción La encefalopatía hipóxico-isquémica es una de las principales causas de daño neurológico en el neonato. Actualmente, la hipotermia terapéutica es el tratamiento de elección para reducir la mortalidad y la discapacidad en los niños que presentan esta patología. Objetivo Identificar los cuidados enfermeros en recién nacidos con encefalopatía hipóxico-isquémica moderada a severa tratados con hipotermia terapéutica activa. Materiales y métodos Se realizó una revisión de la literatura científica en diferentes bases de datos (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase y Cochrane Plus) durante los últimos 5 años. La valoración documental se realizó por pares y la calidad se evaluó mediante las escalas CEBM y GRADE. Resultados De los 22 artículos seleccionados y revisados se evidencia que la hipotermia terapéutica es efectiva al reducir la morbimortalidad de los neonatos con encefalopatía hipóxico-isquémica. Los cuidados enfermeros durante el tratamiento de hipotermia se centran en 4 pilares básicos: los cuidados generales para la estabilización del recién nacido, la preparación del material, la administración del tratamiento médico en todas sus fases y el soporte emocional de la familia. Conclusiones La hipotermia terapéutica es efectiva al reducir las secuelas y la mortalidad de los neonatos con encefalopatía hipóxico-isquémica. Los cuidados enfermeros son esenciales y están presentes durante todo el tratamiento, detectan precozmente complicaciones en los niños y ofrecen apoyo psicológico a los padres. La formación del personal de enfermería en estos cuidados es fundamental. (AU)

Introduction Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. ObjectiveTo identify nursing care in new-borns with severe to moderate hypoxic-ischaemic encephalopathy, treated with active therapeutic hypothermia. Materials and methods A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. Results Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. Conclusions Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care. (AU)

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INTRODUCTION: Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. OBJECTIVE: To identify nursing care in new-borns with severe to moderate EHI, treated with active therapeutic hypothermia. MATERIALS AND METHODS: A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. RESULTS: Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. CONCLUSIONS: Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care.

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INTRODUCTION: Hypoxic-ischaemic encephalopathy is one of the main causes of neurological damage in the new-born. Therapeutic hypothermia is the current treatment to reduce mortality and disability in new-borns with this condition. OBJECTIVE: To identify nursing care in new-borns with severe to moderate hypoxic-ischaemic encephalopathy, treated with active therapeutic hypothermia. MATERIALS AND METHODS: A review of the scientific literature was carried out in different databases (PubMed, Lilacs, IBECS, Cinhal, OvidSP, Cuiden, Embase and Cochrane Plus) over the last five years. The documentary assessment was carried out by peers and the quality was evaluated using the CEBM and GRADE scales. RESULTS: Of the 22 articles selected and reviewed, it is evident that therapeutic hypothermia is effective in reducing the mobility and mortality of neo-nates with hypoxic-ischaemic encephalopathy. Nursing care during hypothermia treatment focuses on four basic pillars: general care for stabilisation of the new-born, preparation of the material, administration of medical treatment in all its phases and emotional support of the family. CONCLUSIONS: Therapeutic hypothermia is effective in reducing the sequelae and mortality of neonates with hypoxic-ischaemic encephalopathy. Nursing care is essential throughout the treatment, in the early detection of complications in the infant and psychological support for parents. It is essential for nurses to receive training in this care.

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BACKGROUND: Peripherally inserted central catheters have become a priority in infants who require long-term intravenous therapy, but their use involves certain risks. OBJECTIVE: The aim of the study was to describe the occurrence of adverse events in newborns with peripherally inserted central catheters and to determine the risk factors associated with them. METHODS: A descriptive cross-sectional study was designed and performed. All neonates with peripherally inserted central catheters from October 1st, 2014 to September 30th, 2015 were included. The adverse events and sociodemographic and clinical variables related to neonates and analyzed catheters were recorded. RESULTS: A total of 140 catheters were placed in 116 infants. All of them were analyzed. Adverse events occurred in 16.4%: catheter-associated bacteraemia (5.7%), obstruction (5.7%), extravasation (2.1%) and phlebitis (2.1%), <27weeks of pregnancy (OR=1.2, P=.02), birth weight <1000g (OR=6.7, P=.02), with catheters in situ for longer than one week (OR=9.8, P=.02) and with perfusion of antibiotics per catheter (OR=1.3, P<.01). Phlebitis is associated with the insertion of the catheter in LL and head (OR=1.1, P=.03). Factors associated with bacteraemia risk with adjusted prevalence odds ratio are extremely low birth weight neonates (OR=6.38; P=.03) and with a catheter in situ for longer than one week (OR=9.41; P=.04). CONCLUSIONS: The periodic evaluation of catheter-related adverse events is very useful to prepare improvement plans. This will maximize safety for the most vulnerable newborns, especially those of extremely low birth weight that require very long treatments.

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OBJECTIVES: The present randomized double-blind clinical trial aimed to compare the efficacy in reducing dentin hypersensitivity of a dentifrice formulation containing nano-hydroxyapatite with a fluoride dentifrice and a placebo. METHODS AND MATERIALS: One hundred and five subjects were recruited to participate in the study. A computer-generated random table with blocking to one of the three study treatments was used in order to have 35 subjects per group: (1) nano-hydroxyapatite 2% gel toothpaste fluoride free; (2) fluoride gel toothpaste; (3) placebo. Groups 1, 2, and 3 were instructed to treat their teeth for 10 min twice a day with the provided toothpaste gel. The participant's dentin hypersensitivity was evaluated at baseline and after 2 and 4 weeks using airblast and tactile tests. In addition, a subjective evaluation using a visual analogue scale was used. RESULTS: Significant lower values of cold air sensitivity and tactile sensitivity (p < 0.05) were found for the test group at 2 weeks and 4 weeks. In addition, statistically significant (p < 0.05) lower values of sensitivity were reported for group 1 compared to those for groups 2 and 3 at 2 and 4 weeks, respectively. The VAS scores were significantly lower (p < 0.05) in the test group at 2 and 4 weeks compared to those at baseline and in the control groups. CONCLUSION: The application of nano-hydroxyapatite in gel toothpaste fluoride free is an effective desensitizing agent providing relief from symptoms after 2 and 4 weeks.

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OBJECTIVES: The aim of this study was to compare the amount of tooth colour change, rebound rate and tooth sensitivity in patients submitted to a bleaching technique with 6% hydrogen peroxide (HP) with or without 2% nano-hydroxyapatite (n-HA). METHODS: Sixty subjects were included in this examiner-blinded, randomized clinical trial using a 6% HP gel with or without 2% n-HA. Tooth colour and tooth sensitivity were analysed before and after treatment. All data were analysed statistically. RESULTS: After bleaching, both treatments demonstrated significant improvements in tooth shade (P < 0.05 for both groups). At the 9-month recall, tooth shade remained significantly lighter than at baseline (P < 0.05 for both groups). However, a relapse of the tooth shade was observed compared with the immediate post-bleaching result (P < 0.05). 6% HP with 2% n-HA produced significantly lower sensitivity (P < 0.05) than the bleaching product without n-HA. Colour change evaluation resulted in no difference between the two groups. CONCLUSION: Both treatments demonstrated significant improvements in tooth shade. The bleaching effectiveness of the tested products was comparable. The use of 6% HP with 2% n-HA reduced the incidence of sensitivity during the bleaching treatment compared to a bleaching agent that did not contain n-HA.

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OBJECTIVES: To estimate the influence of educational level and oral hygiene behaviours on the prevalence and severity of dental caries and periodontal disease in an adult Italian population attending the Oral Hygiene department of a public Dental Clinic. METHODS: Dental caries was diagnosed according to the World Health Organization criteria. The DMFT index (decayed, missing, filled tooth) was used to record the dental caries' experience. The periodontal status was assessed using the community periodontal index of treatment needs (CPITN). Questionnaires on educational level and oral hygiene behaviours were also collected. RESULTS: A total of 350 patients were enrolled. The mean DMFT value reported was 4.37 ± 3.06, and higher values were observed for male patients (P < 0.05). Increased CPITN scores and DMFT values were significantly correlated with lower level of education (P < 0.05). Subjects of high educational status showed significantly better oral hygiene habits (P < 0.05). CONCLUSIONS: The oral health status, in terms of periodontal disease and dental caries, appears correlated with patients' educational level.

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Objetivo. Comparar la quimioembolización transarterial (TACE) convencional con la quimioembolización con partículas cargadas (DEB-TACE) para el tratamiento del hepatocarcinoma, valorando la respuesta tumoral, las complicaciones tras el tratamiento y la supervivencia. Material y métodos. Presentamos 72 pacientes diagnosticados de hepatocarcinoma. El estudio incluye 25 pacientes tratados con TACE (Grupo A) y 47 pacientes tratados con DED-TACE (Grupo B), empleando en ambos grupos adriamicina. Todos los pacientes se tratan consecutivamente desde enero de 2000 hasta diciembre de 2009. Todos presentaban una cirrosis en estadio Child-Pugh compensada. Los resultados se estudiaron conforme al criterio RECIST. El estudio estadístico consistió en ANOVA, Chi2, T-Test y estudio de Kaplan-Meier (test de Log-Rank). Resultados. La edad, el tamaño, el número de tumores y la reserva hepática en los dos grupos de pacientes fueron estadísticamente similares. El número de sesiones por paciente fue: Grupo A media 1,32±0,67 veces, Grupo B media 2,13±0,95 veces. La media de dosis de adriamicina por paciente fue: 50,60±29,95mg en grupo A y 231,91±110,2mg en grupo B. Se observó una respuesta completa del tumor en 5,6% en el grupo A y 13,9% en el grupo B. Conforme al sistema RECIST no se encontraron diferencias estadísticamente significativas. La DEB-TACE fue mejor tolerada con menos complicaciones inmediatas (p=0.001). No se encontraron diferencias significativas en la supervivencia entre los dos grupos. grupo A: media 686,24, mediana 709 días, y grupo B: media 765,32, mediana 672 días. Conclusión. En los pacientes con hepatocarcinoma irresecable, la quimioembolización con partículas cargadas de adriamicina es segura y mejor tolerada que la quimioembolización convencional y parece producir una mayor necrosis tumoral (AU)

Objective. To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. Material and methods We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. Results. Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32±0.67 in Group A versus 2.13±0.95 in Group B. The mean dose of adriamycin per patient was 50.60±29.95mg in Group A and 231.91±110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. Conclusion. In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors (AU)

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OBJECTIVE: To compare conventional transarterial chemoembolization (TACE) with doxorubicin-eluting bead transarterial chemoembolization (DEB-TACE) for the treatment of hepatocellular carcinoma, evaluating the tumor response, complications after treatment, and survival. MATERIAL AND METHODS: We present 72 patients diagnosed with hepatocellular carcinoma treated consecutively between January 2000 and December 2009. We studied 25 patients treated with TACE (Group A) and 47 patients treated with DEB-TACE (Group B); adriamycin (doxorubicin) was the chemotherapy agent used in both groups. All patients had compensated cirrhosis of the liver classified on the Child-Pugh score. The results were analyzed according to the RECIST criteria. Statistical analyses consisted of ANOVA, chi-square tests, Student's t-tests, and Kaplan-Meier log-rank tests. RESULTS: Patient's age, tumor size, number of tumors, and hepatic reserve were similar in the two groups. The mean number of sessions per patient was 1.32 ± 0.67 in Group A versus 2.13 ± 0.95 in Group B. The mean dose of adriamycin per patient was 50.60 ± 29.95 mg in Group A and 231.91 ± 110.2mg in Group B. A complete response of the tumor to treatment was observed in 5.6% of the patients in Group A and in 13.9% of those in Group B. According to the RECIST criteria, no significant differences were found. DEB-TACE was better tolerated and had fewer immediate complications (p=0.001). No significant differences were found in the survival of patients in the two groups (Group A: mean 686.24 days, median 709 days; Group B: mean 765.32 days, median 672 days. CONCLUSION: In patients with unresectable hepatocellular carcinoma, DEB-TACE is safe and better tolerated than conventional TACE; moreover, it seems to lead to greater necrosis of the tumors.

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PURPOSE OF THE STUDY Distal radioulnar joint (DRUJ) instability often develops after distal forearm fracture or severe dislocation of the wrist with damage to its stabilising structures. The instability is usually diagnosed as a chronic condition and only rarely at the time of injury. When the stabilising structures are not treated adequately soon after injury, instability develops and is accompanied with pain, restricted range of motion and reduced grip strength. This study presents the option of chronic instability treatment by tenodesis with use of the palmaris longus tendon. Its aim is to remind the broad medical community of this issue. MATERIAL Between July 1994 and November 2000, tenodesis was performed in 15 patients with chronic DRUJ instability. The right and left sides were affected in 10 and five patients, respectively; of them 12 were dominant extremities. All injuries were diagnosed as dorsal subluxation of the ulnar head, with side dislocation in three patients. METHODS The diagnosis was based on a thorough medical history, and clinical and radiographic examination, including projections in forced maximum radial and ulnar duction, as recommended by Geyer and Luzius as early as in 1964. Tenodesis was done by the Jäger and Wirth method using the palmaris longus tendon. The patients were scored according to the Modified Mayo Wrist System. RESULTS Of the 15 patients treated by this method, 14 were evaluated. Eight patients regarded the results as very good, with no pain at maximal physical activity, and five considered them good, experiencing pain only at maximal but not at everyday activities. One patient reported a poor outcome. The average score increased from pre-operative 40 to 60 points post-operatively. All patients had a slight restriction of rotation movements of the forearm. Residual instability was found in one patient. DISCUSSION It is a common view that this condition is caused by subluxation or dislocation of the ulnar head, while in fact it is subluxation or dislocation of the radius turning around the ulna. As reported in the literature, dorsal dislocation is three-times as frequent as volnar dislocation, and this is in agreement with our findings. There is a wide variety of the operative methods for tenodesis which differ in the distribution of tunnels in bone. Restriction of the range of motion in our patients also agreed with the literature data. No effect of a distal radius fracture on the results of surgery was recorded. CONCLUSIONS Our results show that tenodesis is a method suitable to treat chronic DRUJ instability if the indication criteria are observed, i. e., if no arthritic lesions are present in the joint.

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OBJECTIVES: To evaluate the effect of immediate versus delayed post space preparation and cementation on the retention of different types of fiber posts in canals obturated with an epoxy resin sealer. METHODS: Sixty-eight single-rooted human teeth were decoronated and the root canals were shaped with rotary instruments and obturated with gutta-percha and an epoxy resin sealer. The teeth were divided into four experimental groups according to the different times of post space preparation and cementation: immediate (group 1), 24h (group 2) and 1 week (group 3) after root canal filling. Control group (group 4) with no root canal obturation was included. Two teeth were randomly selected from each group for SEM examination. Each group was further divided into three subgroups of five teeth each (n=5), according to the type of post and the materials used for luting the posts. A push-out test was performed and differences among experimental groups were analyzed with two-way ANOVA and Tukey test (alpha=0.05). RESULTS: Interfacial strength values achieved in group 1, where an immediate cementation was performed, were significantly lower (p<0.05) than those in group 2 and group 3 in which post cementation was performed 24h or 1 week after the root canal filling. Post type affected post retention, FRC Postec and DT Light Post posts achieved higher interfacial strengths than ENA Post (p<0.05). SEM examination revealed a more conspicuous presence of sealer remnants on the walls of immediately prepared post spaces. CONCLUSIONS: Delayed cementation of fiber post resulted in higher retentive strengths irrespective of the post type.

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AIM: To evaluate the influence of various surface treatments to fibre posts on the microtensile bond strength with different composite resins. METHODOLOGY: A total of 110 fibre posts were randomly divided into five groups, according to the surface pre-treatment performed. Group 1: immersion in 24% H(2)O(2) for 10 min and silanization for 60 s; group 2: immersion in 10% H(2)O(2) for 20 min and silanization for 60 s; group 3: immersion in 4% hydrofluoric acid gel for 60 s and silanization for 60 s; group 4: silanization of the post surface for 60 s and application of the bonding agent G-Bond; group 5: silanization of the post surface for 60 s (control group). After treatment, two posts were randomly selected from each group to evaluate the morphological aspect of the post surface with scanning electron microscopy. The remaining posts in each group were divided into five subgroups of five posts each, which differed in the type of composite resin used for the core build-up. Post-core strength were calculated and the differences among experimental groups were analysed with two-way anova and the Tukey test (alpha = 0.05). RESULTS: The post-core strengths achieved in groups 1 and 2 were significantly higher (P < 0.05), than those of groups 3, 4 and 5. The post-core strength in the control group was significantly lower (P < 0.05) than all other groups. CONCLUSIONS: Hydrogen peroxide and hydrofluoric acid both modified the surface morphology of fibre posts and with silane, significantly enhanced the interfacial strength between them and core materials.

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AIM: Aim of the authors is to evaluate in vitro the histological alteration caused by hydrogen peroxide on a sample of radicular cysts. METHODS: Twelve radicular cysts were divided into 2 portions. The control group was histologically evaluated whereas the other portion, test, was treated with 3% hydrogen peroxide before histological analysis. Test and control portions were compared for integrity of the epithelium, inflammatory state of the cystic walls, presence of necrosis, stromal vacuolization and microvessel density (MVD). MVD was evaluated by immunohistochemistry using anti-CD34 monoclonal antibodies. RESULTS: Significantly lower epithelium integrity has been detected in the test group (p= or <0.007), (Wilcoxon test). Moreover, the test group presented a higher number of stromal vacuolization areas (p= or <0.004). However, necrosis and inflammation reported no significative differences. No significative differences were noticed for the MVD. CONCLUSION: Hydrogen peroxide showed a cytopathic and cytolytic activity in vitro. Those effects have been shown on both cysts tissues: epithelium and connective tissue. The present study did not reveal any statistically significant difference between the number of vessels in the control and in the test group. However, further in vitro and human studies are needed to validate this substance in the treatment of cysts.

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