RESUMO

Introdução: A fitoterapia se baseia na utilização de plantas medicinais, através de diferentes formulações farmacêuticas com fins terapêuticos. Na Odontologia, os fitoterápicos têm sido alvo de estudos, devido suas propriedades benéficas, além de apresentarem biocompatibilidade, baixo custo e fácil acesso. Objetivo: Realizar um levantamento na literatura científica sobre a utilização da fitoterapia na Odontologia, com vistas aos efeitos antimicrobiano, anti-inflamatório e reparador. Material e Métodos: A busca ocorreu entre fevereiro a julho/2023, nas bases PubMed e LILACS, além de livre busca, cruzando-se os descritores "Phytotherapy", "Dentistry", "Anti-inflamatory Agents", "Anti-Infective Agents", "Wound Healing", "Fitoterapia", "Odontologia", "Anti-inflamatório", "Antimicrobiano" e "Cicatrização". Após leitura inicial, seguida da análise crítica com aplicação dos critérios estabelecidos, foram selecionadas 50 referências. Desenvolvimento: Diversas plantas são empregadas sob a forma de fitoterapia, como Aloe vera (babosa), Matricaria recutita (camomila), Copaifera (copaíba), Punica granatum (romã), Uncaria tomentosa (unha-de-gato), Malva sylvestris (malva), Althaea officinalis (malvaísco), Myracrodruon urundeuva (Aroeira), Lippia sidoides (Alecrim pimenta) e Glycyrrhiza glabra (Alcaçuz). Na Odontologia, pesquisas evidenciaram resultados satisfatórios para o tratamento de afecções da cavidade oral, especialmente com caráter inflamatório e infeccioso, além de aclerar a cicatrização. Esses achados apontam que a fitoterapia é um tratamento eficaz, acessível e com mínimos efeitos colaterais. Considerações finais: Com base na literatura revisada, a fitoterapia parece ser uma alternativa promissora no tratamento de afecções orais, devido aos seus notáveis efeitos cicatrizantes, antimicrobianos e anti-inflamatórios. Contudo, mais pesquisas com metodologias adequadas são necessárias para que se estabeleçam protocolos clínicos seguros e eficazes.

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Introduction: Phytotherapy is based on the use of medicinal plants through different pharmaceutical formulations for therapeutic purposes. In Dentistry, phytotherapeutics have been the subject of studies due to their beneficial properties, as well as their biocompatibility, low cost, and easy accessibility. Objective: To conduct a literature review on the use of phytotherapy in Dentistry, focusing on antimicrobial, anti-inflammatory, and reparative effects. Materials and Methods: The search took place between February and July 2023, using PubMed and LILACS databases, in addition to a free search, crossing the descriptors "Phytotherapy," "Dentistry," "Anti-inflammatory Agents," "Anti-Infective Agents," "Wound Healing," "Fitoterapia," "Odontologia," "Anti-inflammatory," "Antimicrobial," and "Cicatrização." After an initial reading, followed by critical analysis with the application of established criteria, 50 references were selected. Development: Various plants are employed in phytotherapy, such as Aloe vera (aloe), Matricaria recutita (chamomile), Copaifera (copaiba), Punica granatum (pomegranate), Uncaria tomentosa (cat's claw), Malva sylvestris (mallow), Althaea officinalis (marshmallow), Myracrodruon urundeuva (Brazilian copaiba), Lippia sidoides (rosemary pepper), and Glycyrrhiza glabra (licorice). In Dentistry, research has shown satisfactory results for the treatment of oral cavity conditions, especially those with inflammatory and infectious characteristics, as well as accelerating healing. These findings suggest that phytotherapy is an effective, accessible treatment with minimal side effects. Final considerations: Based on the reviewed literature, phytotherapy appears to be a promising alternative in the treatment of oral conditions due to its notable healing, antimicrobial, and anti-inflammatory effects. However, more research with appropriate methodologies is necessary to establish safe and effective clinical protocols.

Assuntos

Terapêutica , Cicatrização , Odontologia , Fitoterapia , Anti-Inflamatórios , Boca

RESUMO

Introdução: A segurança e eficácia do uso de medicamentos durante a lactação são preocupações para mães e profissionais de saúde. Esta pesquisa analisa as orientações das bulas de medicamentos comumente prescritos para dispepsia e constipação, que visa fornecer informações essenciais para orientar as decisões terapêuticas durante esse período crucial da maternidade. Objetivos: Analisar as informações das bulas sobre contraindicações de medicamentos para dispepsia e constipação durante a amamentação, verificando se estão de acordo com as evidências científicas. Métodos: Medicamentos para dispepsia e constipação foram selecionados de acordo com a classificação da Anatomical Therapeutic Chemical (ATC) e o registro ativo no Brasil. A presença de contraindicações para o uso de medicamentos nas bulas do profissional de saúde e do paciente foi comparada com as informações contidas no manual técnico do Ministério da Saúde, Medicamentos e Leite Materno, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria e Reprotox. Resultados: Nenhuma informação sobre o uso durante a amamentação foi encontrada em 20,0 e 24,3% das bulas para dispepsia e constipação, respectivamente. A concordância entre as bulas dos medicamentos para dispepsia e as fontes consultadas foi baixa (27,2% das bulas contraindicavam o medicamento na lactação, enquanto nas fontes o percentual de contraindicação variou de 0 a 8,3%). Com relação a medicamentos para constipação, 26,3% das bulas os contraindicavam, enquanto nas fontes o percentual variou de 0 a 4,8%. Conclusões: O estudo mostrou que pelo menos duas em cada dez bulas para dispepsia e constipação não fornecem informações adequadas sobre o uso desses medicamentos em lactentes, e também que houve baixa concordância entre o texto das bulas e as fontes de referência quanto à compatibilidade do medicamento com a amamentação.

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Introduction: The safety and effectiveness of medication use during lactation are concerns for mothers and healthcare professionals. This research analyzes the instructions on the leaflets of medications commonly prescribed for dyspepsia and constipation, which aims to provide essential information to guide therapeutic decisions during this crucial period of motherhood. Objectives: To analyze the information in package inserts about contraindications of drugs for dyspepsia and constipation during breastfeeding, verifying whether these are consistent with scientific evidence. Methods: Drugs for dyspepsia and constipation were selected according to the Anatomical Therapeutic Chemical (ATC) classification and active registry in Brazil. The presence of contraindications for the use of medications in the health professional's and patient's package inserts was compared with the information in the technical manual of the Ministry of Health, Medications and Mothers' Milk, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria and Reprotox. Results: No information about use during breastfeeding was found in 20.0 and 24.3% of leaflets for dyspepsia and constipation, respectively. The agreement between the leaflets of medications for dyspepsia and the sources consulted was low (27.2% of the leaflets contraindicated the medication during lactation, while in the sources the percentage of contraindication varied from 0 to 8.3%). In relation to medicines for constipation, 26.3% of the leaflets contraindicated them, while in the sources the percentage ranged from 0 to 4.8%. Conclusions: The study pointed out that at least two out of every ten package inserts for dyspepsia and constipation do not provide adequate information on the use of these drugs in infants, and also shows low concordance between the text of the package inserts and the reference sources regarding compatibility of the drug with breastfeeding.

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Introducción: La seguridad y eficacia del uso de medicamentos durante la lactancia son preocupaciones para las madres y los profesionales de la salud. Esta investigación analiza las instrucciones contenidas en los prospectos de medicamentos comúnmente recetados para la dispepsia y el estreñimiento, con el objetivo de proporcionar información esencial para guiar las decisiones terapéuticas durante este período crucial de la maternidad. Objetivos: Analizar la información contenida en los prospectos sobre las contraindicaciones de los medicamentos para la dispepsia y el estreñimiento durante la lactancia, verificando si estas son consistentes con la evidencia científica. Métodos: Se seleccionaron medicamentos para la dispepsia y el estreñimiento de acuerdo con la clasificación ATC y el registro activo en Brasil. Se comparó la presencia de contraindicaciones para el uso de medicamentos en los prospectos del profesional de la salud y del paciente con la información del manual técnico del Ministerio de Salud, Medicamentos y Leche Materna, LactMed, UptoDate, Micromedex, Documento Científico da Sociedade Brasileira de Pediatria y Reprotox. Resultados: No se encontró información sobre su uso durante la lactancia en el 20% y el 24,3% de los prospectos para dispepsia y estreñimiento, respectivamente. La concordancia entre los prospectos de los medicamentos para la dispepsia y las fuentes consultadas fue baja (el 27,2% de los prospectos contraindicaba el medicamento durante la lactancia, mientras que en las fuentes el porcentaje de contraindicación variaba del 0% al 8,3%). Con relación a los medicamentos para el estreñimiento, el 26,3% de los prospectos los contraindicaba, mientras que en las fuentes el porcentaje osciló entre el 0% y el 4,8%. Conclusiones: El estudio señaló que al menos dos de cada diez prospectos para dispepsia y estreñimiento no brindan información adecuada sobre el uso de estos medicamentos en lactantes, y también muestra la baja concordancia entre el texto de los prospectos y la referencia. fuentes sobre la compatibilidad del fármaco con la lactancia.

Assuntos

Humanos , Fármacos Gastrointestinais , Aleitamento Materno , Constipação Intestinal , Dispepsia , Bulas de Medicamentos

RESUMO

With the increasing rate of infections caused by multidrug-resistant organisms (MDRO), selecting appropriate empiric antibiotics has become challenging. We aimed to develop and externally validate a model for predicting the risk of MDRO infections in patients with cirrhosis. METHODS: We included patients with cirrhosis and bacterial infections from two prospective studies: a transcontinental study was used for model development and internal validation (n = 1302), and a study from Argentina and Uruguay was used for external validation (n = 472). All predictors were measured at the time of infection. Both culture-positive and culture-negative infections were included. The model was developed using logistic regression with backward stepwise predictor selection. We externally validated the optimism-adjusted model using calibration and discrimination statistics and evaluated its clinical utility. RESULTS: The prevalence of MDRO infections was 19% and 22% in the development and external validation datasets, respectively. The model's predictors were sex, prior antibiotic use, type and site of infection, MELD-Na, use of vasopressors, acute-on-chronic liver failure, and interaction terms. Upon external validation, the calibration slope was 77 (95% CI .48-1.05), and the area under the ROC curve was .68 (95% CI .61-.73). The application of the model significantly changed the post-test probability of having an MDRO infection, identifying patients with nosocomial infection at very low risk (8%) and patients with community-acquired infections at significant risk (36%). CONCLUSION: This model achieved adequate performance and could be used to improve the selection of empiric antibiotics, aligning with other antibiotic stewardship program strategies.

RESUMO

OBJECTIVE: To compare the color change, the risk and intensity of tooth sensitivity (TS), and gingival irritation (GI) of at-home bleaching applied on the buccal surface only or the buccal and lingual surfaces. MATERIALS AND METHODS: Sixty patients with canines A2 or darker were selected and their superior arches were randomized in two groups: at-home bleaching on the buccal-only or on the buccal and lingual surfaces, with 7.5% hydrogen peroxide, for 1 h daily/2 weeks. The color change was evaluated at baseline, 7, 14 days, and 1 month after bleaching using shade guides scales (ΔSGU) and a spectrophotometer (ΔEAB, ΔE00, and ΔWID). Risk and intensity of TS and GI were recorded daily using visual analogic scale (0-10). Patient satisfaction was evaluated with the orofacial esthetics. Paired t-test, McNemar's, and Wilcoxon signed-rank test were used for data analysis (α = 5%). RESULTS: Neither the color change nor the risk/intensity of TS was statistically different between groups (p > 0.05). Patient satisfaction increased after bleaching for both groups (p < 0.05). CONCLUSION: The addition of one contact surface does not result in an increased whitening degree compared to bleaching applied solely on the buccal surface. CLINICAL SIGNIFICANCE: Understanding the influence of surfaces interacting with the bleaching agent is crucial for comprehending the bleaching mechanism and avoiding unnecessary material expenses. Notably, employing the buccal-only technique is sufficient to achieve the desired efficacy.

Assuntos

Clareamento Dental , Humanos , Clareamento Dental/métodos , Método Simples-Cego , Feminino , Masculino , Adulto , Peróxido de Hidrogênio/administração & dosagem , Adulto Jovem

RESUMO

INTRODUCTION: Veterinary oncology is constituted mainly by human-use drugs with hazardous agents. Occupational risks are present in all stages of handling. Many studies highlighted that veterinarians and pharmacists staff present a lack of knowledge and insufficient structure for promoting safety practices. This study investigated the professional profile and structure of veterinary antineoplastic chemotherapy in Brazilian services. METHODS: A nationwide survey was carried out through digital platforms by a self-applicable from 2020 to 2021. The characteristics of the structure, facilities, professional profiles, practices related to antineoplastic chemotherapy services, and inspections provided by regulatory companies were investigated. Frequency and ranges were used to examine and describe data. RESULTS: This study analyzed 108 respondents from all Brazilian regions where 36 participants worked in veterinary oncology. Dogs and cats comprised more than 90% of animals assisted. Vincristine, doxorubicin, carboplatin, vinblastine, and cyclophosphamide were the most commonly used drugs. Considering pharmacists-led (n = 4) vs veterinarians-led (n = 18) services, structure with safety for handling hazardous drugs (4 vs 9), correct PPE usage (3 vs 0), and occurrence of occupational accident (0 vs 5) were registered. Almost 60% were dissatisfied with the structure and the managerial unwillingness to promote facility improvements. The majority of participants reported an absence of service inspection. CONCLUSION: The results demonstrated worrying concerning the inadequacy of the physical structure of the facilities, human resources, and handling hazardous drugs increased occupational health risk. The lack of competent authority standards and supervision corroborates practices that expose professionals, the population, and the environment to hazardous agents.

RESUMO

Children and adolescents suffering from moderate-to-severe atopic dermatitis (AD) face a significant disease burden that greatly impacts their quality of life. Treatment options for AD are currently limited. To assess the safety and efficacy of biologic drugs, dupilumab, lebrikizumab, or tralokinumab, in improving outcomes in patients with moderate to severe inadequately controlled AD. We searched PubMed, Embase and Cochrane databases for randomized controlled trials (RCTs) comparing dupilumab, lebrikizumab or tralokinumab to placebo in patients with AD. We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs), random effects model was used and a p-value <0.05 was considered as statistically significant. We analysed data into Review Manager 5.4. A total of five RCTs and 973 patients were included, of whom 592 were prescribed a biologic drug. Compared with placebo, patients receiving a biologic drug had a greater improvement, achieved an Investigator Global Assessment (IGA) score of 0 or 1 (OR 5.05; 95% CI 3.08-8.29), Eczema Area and Severity Index (EASI) 75 (OR 6.87; 95% CI 4.71-10.02), EASI 50 (OR 8.89; 95% CI 6.18-12.78) and EASI 90 (8.30; 95% CI 4.81-14.31). The proportion of patients with 3 points or more (OR 6.56; 95% CI 4.34-9.90) or 4 points or more (OR 8.09; 95% CI 5.19-12.59) improvement from baseline in peak pruritus NRS was significantly higher with biologic drugs than placebo. There were no significant differences between groups regarding adverse events (OR 0.79; 95% CI 0.58-1.07), and conjunctivitis (OR 2.08; 95% CI 1.00-4.33). In this meta-analysis, dupilumab, lebrikizumab, and tralokinumab have shown significant improvements in signs, symptoms and quality of life in children or adolescents with moderate to severe AD. Larger studies may be needed to continue evaluating the safety and efficacy of these biologic drugs in this patient population.

RESUMO

Objective: Throughout microsurgical anastomosis, many surgeons use topical vasodilators in order to reduce pathological vasospasm. It was carried out an experimental study comparing the effectiveness of topical use of Nitroglycerin, Papaverine, Magnesium sulfate over a control group in the femoral artery and vein of rats, in reducing prolonged vasospasm. Methods: Randomized comparative experimental study in 15 rats, divided into four groups. The external diameter of the vases soaked in the randomized solution was measured. For statistical analysis, it was calculated the percentual increase in the external diameter of the vessels. Results: A statistically significant increase in arterial dilation was observed after 10 minutes of topical application of 10% magnesium sulfate compared to the control group, with p = 0.044 . No other drug showed a vasodilator effect superior to the control group. Magnesium sulfate at 10% is still not used in microsurgery and costs 15 times less than papaverine, the standard drug for topical vasodilation in clinical cases at our service. Conclusion: Magnesium sulfate had better vasodilating effects over the control group after 10 minutes of arterial microanastomosis. None of the tested drugs have presented superior vasodilating effects over each other nor the control group after venous microanastomosis. Level of evidence II, Experimental study, Randomized Trial.

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Objetivo: Durante a anastomose microcirúrgica, muitos cirurgiões utilizam vasodilatadores tópicos para reduzir o vasoespasmo prolongado patológico, assim reduzindo o risco de complicações vasculares. Entretanto, ainda faltam dados experimentais para identificação da droga padrão-ouro para vasodilatadores tópicos em microcirurgia e sua avaliação de análise de custo, já que a droga geralmente utilizada para este objetivo é baseada, na maior parte dos casos, na experiência do cirurgião. Métodos: Foi realizado um estudo experimental comparativo randomizado, avaliando a eficácia do uso tópico de Nitroglicerina, Papaverina e Sulfato de Magnésio em relação a um grupo controle, na redução do vasoespasmo na artéria e veia femoral de ratos. Foram avaliados o diâmetro externo dos vasos embebidos em solução randomizada dos fármacos para vasodilatação. Após cálculo do aumento percentual no diâmetro externo dos vasos, foi realizada análise estatística. Resultados: Observou-se aumento estatisticamente significativo da dilatação arterial após 10 minutos de aplicação tópica de sulfato de magnésio a 10% em relação ao grupo controle, com p = 0,044. Nenhuma outra droga apresentou efeito vasodilatador superior ao grupo controle. O sulfato de magnésio a 10% ainda não é utilizado em microcirurgia e apresenta custo até 15 vezes menor quando comparado com a papaverina, droga padrão para vasodilatação tópica em casos clínicos em nosso serviço. Conclusão: O sulfato de magnésio apresentou melhor efeito vasodilatador quando comparado ao grupo controle, após 10 minutos da microanastomose arterial. Nenhum dos fármacos testados apresentou efeito vasodilatador superior após a microanastomose venosa. Nível de Evidência II, Estudo experimental, Ensaio Randomizado.

RESUMO

BACKGROUND: It has been documented that NSAIDs (nonsteroidal anti-inflammatory and antirheumatic drugs) reduce the effectiveness of some antihypertensive drugs. OBJECTIVE: Analyze the prescription of NSAID and the variables associated in outpatients with hypertension and explore some characteristics of the physicians. MATERIAL AND METHODS: Cross-sectional study, included patients with hypertension from the Family Medicine Unit No. 24 in Mante, Tamaulipas. From the patients, sociodemographic data, clinical history and pharmacological treatments were obtained. From the physicians, sociodemographic and academic information were collected. RESULTS: Mean age of the patients was 63 ± 11 years and 31.7% were prescribed NSAIDs. When compare exposed versus non-exposed to NSAIDs, being in uncontrolled high blood pressure, uncontrolled hypertension, multimorbidity and polypharmacy. The variables associated to the prescription of NSAIDs were: uncontrolled hypertension, multimorbidity and polypharmacy. The 56.7% of the physicians were women, 83.3% with experience >10 years and 33.3% with current certification by the Council in Family Medicine. CONCLUSIONS: The inappropriate prescription of NSAIDs revealed the need to implement actions to mitigate the potential risk for the hypertension patients to present a complication.

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ANTECEDENTES: Los antiinflamatorios y los antirreumáticos no esteroideos (AINE) disminuyen la eficacia de algunos antihipertensivos. OBJETIVO: Analizar el patrón de prescripción de AINE y las variables asociadas en pacientes ambulatorios con diagnóstico de hipertensión arterial, así como explorar algunas características de los médicos prescriptores. MATERIAL Y MÉTODOS: Estudio transversal de pacientes con hipertensión de la Unidad de Medicina Familiar 24 en Ciudad Mante, Tamaulipas. De los pacientes se registraron datos sociodemográficos, antecedentes patológicos y tratamientos farmacológicos; y de los médicos, información sociodemográfica y académica. RESULTADOS: La edad promedio de los pacientes fue de 63 ± 11 años, 31.7 % recibía AINE y al contrastarlos con quienes no los recibían, se identificó mayor proporción de obesidad, presión arterial más elevada, más casos en descontrol de la hipertensión arterial, multimorbilidad y polimedicación. Las variables asociadas a la prescripción de AINE fueron estar en descontrol de la hipertensión arterial, multimorbilidad y polimedicación; 56.7 % de los médicos prescriptores fue del sexo femenino, 83.3 % con antigüedad superior a 10 años y 33.3 % con certificación vigente. CONCLUSIONES: La prescripción inapropiada de AINE reveló la necesidad de implementar acciones para mitigar el riesgo potencial de los pacientes hipertensos de presentar una complicación.

Assuntos

Anti-Inflamatórios não Esteroides , Antirreumáticos , Hipertensão , Pacientes Ambulatoriais , Polimedicação , Humanos , Feminino , Estudos Transversais , Masculino , Pessoa de Meia-Idade , Anti-Inflamatórios não Esteroides/uso terapêutico , Hipertensão/tratamento farmacológico , Idoso , Antirreumáticos/uso terapêutico , Anti-Hipertensivos/uso terapêutico , Padrões de Prática Médica/estatística & dados numéricos , Prescrição Inadequada/estatística & dados numéricos , Prescrição Inadequada/prevenção & controle

RESUMO

AIM: Natural bioactive products have been tested as alternative antimicrobial agents. This study evaluated the effect of Punica granatum extract (PGE) on oral multispecies biofilms. METHODOLOGY: Lyophilized extracts from pomegranate peel were prepared, and the punicalagin content was assessed by ultra-performance liquid chromatography (UPLC). Oral multispecies biofilms from 2 donors were grown on four collagen-coated hydroxyapatite discs. After incubation for 7 days or 3 weeks, the biofilms were exposed to water (control), 2% CHX, 10% PGE, 20% PGE or 30% PGE for 3 min. The proportions of dead bacteria were assessed by the live/dead staining and confocal microscopy. After the analysis, the best PGE concentration (30%) was combined with CHX. The experimental phases were repeated using water, 2% CHX, 30% PGE and 30% PGE + 2% CHX. Five random areas of the biofilm on each disc were scanned, resulting in 20 scanned areas for each group. RESULTS: Regarding the biofilm volume, no differences were found amongst solutions (p = .111). The PGE solution killed bacteria effectively in 1-week, 2-week and 3-week-old-plaque biofilms, ranging from 37 to 55.3%, depending on the PGE concentration. The 30% PGE (a) (p = .0009) had greater antibiofilm effectiveness than 2% CHX (b), which killed bacteria in the 25.2 to 48.7% range. The 10% and 20% PGE had intermediate values (ab), without significant differences from 30% PGE (p = 1.002). Water (c) had the lowest proportion of dead bacteria (p < .00001) in a range of 5 to 6.7% and lower effectiveness in killing bacteria (p < .05). The PGE alone or mixed with 2% CHX had greater anti-biofilm effectiveness than CHX (p < .05). The old plaque biofilms were more resistant than the 7-day-old plaque (p < .05). CONCLUSIONS: The 30% PGE (alone or combined with CHX) exhibited a greater antibiofilm effect on oral multispecies biofilms grown on hydroxyapatite discs than 2% CHX.

RESUMO

BACKGROUND: Invasive fungal diseases (IFD) are high morbidity and mortality infections in children with cancer suffering episodes of high-risk febrile neutropenia (HRFN). IFD epidemiology has changed in the last two decades, with an increasing incidence in recent years due to the growing number of immunocompromised children at risk for IFD. The aim of this study was to evaluate the incidence of IFD in children with cancer in the period 2016-2020 compared to 2004-2006 in six hospitals in Chile. METHODS: Prospective, multicentre study, carried out between 2016 and 2020 in six hospitals in Chile. The defined cohort corresponds to a dynamic group of HRFN episodes in patients <18 years old with cancer, who at the fourth day of evolution still presented fever and neutropenia (persistent HRFN). Each episode was followed until resolution of FN. The incidence of IFD was calculated between 2016 and 2020 and compared with data obtained in the period 2004-2006. The incidence rate was estimated. RESULTS: A total of 777 episodes of HRFN were analysed; 257 (33.1%) were considered as persistent-HRFN occurring in 174 patients. The median age was 7 years (IQR: 3-12 years) and 52.3% (N = 91) were male. Fifty-three episodes of IFD were detected: 21 proven, 14 probable and 18 possible. Possible IFD were excluded, leaving 239 episodes of persistent-HRFN with an IFD incidence of 14.6% (95% CI 10.5-19.9) and an incidence rate of 13.6 IFD cases per 1000 days of neutropenia (95% CI 9.5-20.0). Compared to 2004-2006 cohort (incidence: 8.5% (95% CI 5.2-13.5)), a significant increase in incidence of 6.1% (95% CI 0.2-12.1, p = .047) was detected in cohorts between 2016 and 2020. CONCLUSION: We observed a significant increase in IFD in 2016-2020, compared to 2004-2006 period.

Assuntos

Infecções Fúngicas Invasivas , Neoplasias , Humanos , Chile/epidemiologia , Masculino , Estudos Prospectivos , Criança , Feminino , Pré-Escolar , Infecções Fúngicas Invasivas/epidemiologia , Infecções Fúngicas Invasivas/tratamento farmacológico , Neoplasias/epidemiologia , Neoplasias/complicações , Incidência , Hospedeiro Imunocomprometido , Adolescente , Lactente , Antineoplásicos/uso terapêutico

RESUMO

This study reports on the modification of bacterial cellulose (BC) membranes produced by static fermentation of Komagataeibacter xylinus bacterial strains with graphene oxide-silver nanoparticles (GO-Ag) to yield skin wound dressings with improved antibacterial properties. The GO-Ag sheets were synthesized through chemical reduction with sodium citrate and were utilized to functionalize the BC membranes (BC/GO-Ag). The BC/GO-Ag composites were characterized to determine their surface charge, morphology, exudate absorption, antimicrobial activity, and cytotoxicity by using fibroblast cells. The antimicrobial activity of the wound dressings was assessed against Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa. The results indicate that the BC/GO-Ag dressings can inhibit ∼70% of E. coli cells. Our findings also revealed that the porous BC/GO-Ag antimicrobial dressings can efficiently retain 94% of exudate absorption after exposure to simulated body fluid (SBF) for 24 h. These results suggest that the dressings could absorb excess exudate from the wound during clinical application, maintaining adequate moisture, and promoting the proliferation of epithelial cells. The BC/GO-Ag hybrid materials exhibited excellent mechanical flexibility and low cytotoxicity to fibroblast cells, making excellent wound dressings able to control bacterial infectious processes and promote the fast healing of dermal lesions.

Assuntos

Antibacterianos , Materiais Biocompatíveis , Celulose , Escherichia coli , Grafite , Teste de Materiais , Nanopartículas Metálicas , Testes de Sensibilidade Microbiana , Prata , Staphylococcus aureus , Cicatrização , Grafite/química , Grafite/farmacologia , Prata/química , Prata/farmacologia , Cicatrização/efeitos dos fármacos , Celulose/química , Celulose/farmacologia , Nanopartículas Metálicas/química , Antibacterianos/química , Antibacterianos/farmacologia , Staphylococcus aureus/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Materiais Biocompatíveis/química , Materiais Biocompatíveis/farmacologia , Tamanho da Partícula , Pseudomonas aeruginosa/efeitos dos fármacos , Gluconacetobacter xylinus/química , Humanos , Camundongos , Bandagens , Animais

RESUMO

OBJECTIVE: To assess whether beta-lactam extended or continuous beta-lactam infusions (EI/CI) improve clinical outcomes in children with proven or suspected bacterial infections. STUDY DESIGN: We included observational and interventional studies that compared beta-lactam EI or CI with standard infusions in children less than 18 years old, and reported on mortality, hospital or intensive care unit length of stay, microbiological cure, and/or clinical cure. Data sources included PubMed, Medline, EBM Reviews, EMBASE, and CINAHL and were searched from January 1, 1980, to November 3, 2023. Thirteen studies (2945 patients) were included: 5 randomized control trials and 8 observational studies. Indications for antimicrobial therapies and clinical severity varied, ranging from cystic fibrosis exacerbation to critically ill children with bacteriemia. RESULTS: EI and CI were not associated with a reduction in mortality in randomized control trials (n = 1464; RR 0.93, 95% CI 0.71, 1.21), but were in observational studies (n = 833; RR 0.43, 95% CI 0.19, 0.96). We found no difference in hospital length of stay. Results for clinical and microbiological cures were heterogeneous and reported as narrative review. The included studies were highly heterogeneous, limiting the strength of our findings. The lack of shared definitions for clinical and microbiological cure outcomes precluded analysis. CONCLUSIONS: EI and CI were not consistently associated with reduced mortality or length of stay in children. Results were conflicting regarding clinical and microbiological cures. More well-designed studies targeting high-risk populations are necessary to determine the efficacy of these alternative dosing strategies.

RESUMO

Introduction: Despite the rising concern with fungal resistance, a myriad of molecules has yet to be explored. Geraniol, linalool, and citronellal are monoterpenes with the same molecular formula (C10H18O), however, neither the effect of these compounds on inflammatory axis induced by Candida spp. nor the antibiofilm Structure-Activity Relationship (SAR) have been well-investigated. Herein we analyzed geraniol, linalool and citronellal antifungal activity, cytotoxicity, and distinctive antibiofilm SAR, also the influence of geraniol on Candida spp induced dysregulated inflammatory axis, and in vivo toxicity. Methods: Minimal inhibitory (MIC) and fungicidal (MFC) concentrations against Candida spp were defined, followed by antibiofilm activity (CFU-colony forming unit/mL/g of dry weight). Cytotoxic activity was assessed using human monocytes (THP-1) and oral squamous cell (TR146). Geraniol was selected for further analysis based on antifungal, antibiofilm and cytotoxic results. Geraniol was tested using a dual-chamber co-culture model with TR146 cells infected with C. albicans, and THP-1 cells, used to mimic oral epithelium upon fungal infection. Expression of Candida enzymes (phospholipase-PLB and aspartyl proteases-SAP) and host inflammatory cytokines (interleukins: IL-1ß, IL-6, IL-17, IL-18, IL-10, and Tumor necrosis factor-TNF) were analyzed. Lastly, geraniol in vivo toxicity was assessed using Galleria mellonella. Results: MIC values obtained were 1.25-5 mM/mL for geraniol, 25-100 mM/mL for linalool, and 100-200 mM/mL for citronellal. Geraniol 5 and 50 mM/mL reduced yeast viability during biofilm analysis, only 500 mM/mL of linalool was effective against a 72 h biofilm and no biofilm activity was seen for citronellal. LD50 for TR146 and THP-1 were, respectively: geraniol 5.883 and 8.027 mM/mL; linalool 1.432 and 1.709 mM/mL; and citronellal 0.3006 and 0.1825 mM/mL. Geraniol was able to downregulate expression of fungal enzymes and host pro-inflammatory cytokines IL-1ß, IL-6, and IL-18. Finally, safety in vivo parameters were observed up to 20 mM/Kg. Discussion: Despite chemical similarities, geraniol presented better antifungal, antibiofilm activity, and lower cytotoxicity when compared to the other monoterpenes. It also showed low in vivo toxicity and capacity to downregulate the expression of fungal enzymes and host pro-inflammatory cytokines. Thus, it can be highlighted as a viable option for oral candidiasis treatment.

RESUMO

OBJECTIVE: This study analyzed, using an umbrella review, existing systematic reviews on medications to prevent and control postoperative endodontic pain to guide professionals in choosing the most effective drug. MATERIALS AND METHODS: An electronic search in the PubMed (MEDLINE), LILACS, SciELO, EMBASE, Scopus, Web of Science, Cochrane Reviews, and Data Archiving and Networked Services (DANS) databases retrieved 17 systematic reviews. The study included only systematic reviews of clinical trials with or without meta-analyses evaluating effectiveness of medications in reducing pain after non-surgical endodontic treatment. RESULTS: The evidence showed that steroidal and non-steroidal anti-inflammatory drugs and opioids effectively controlled pain within six to 24 h. CONCLUSIONS: Dexamethasone, prednisolone, paracetamol, and mainly ibuprofen provided higher postoperative pain relief. The quality of evidence of the reviews ranged from very low to high, and the risk of bias from low to high, suggesting the need for well-designed clinical trials to provide confirmatory evidence. CLINICAL RELEVANCE: This review emphasizes the efficacy of developing protocols for pain control after endodontic therapy.

Assuntos

Dor Pós-Operatória , Tratamento do Canal Radicular , Humanos , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Tratamento do Canal Radicular/métodos , Anti-Inflamatórios não Esteroides/uso terapêutico , Medição da Dor , Analgésicos/uso terapêutico , Analgésicos Opioides/uso terapêutico

RESUMO

Nerve agents are organophosphates (OPs) that act as potent inhibitors of acetylcholinesterase (AChE), the enzyme responsible for the hydrolysis of acetylcholine. After inhibition, a dealkylation reaction of the phosphorylated serine, known as the aging of AChE, can occur. When aged, reactivators of OP-inhibited AChE are no longer effective. Therefore, the realkylation of aged AChE may offer a pathway to reverse AChE aging. In this study, molecular modeling was conducted to propose new ligands as realkylators of aged AChE. We applied a methodology involving docking and quantum mechanics/molecular mechanics (QM/MM) calculations to evaluate the resurrection kinetic constants and ligand interactions with OP-aged AChE, comparing them to data found in the literature. The results obtained confirm that this method is suitable for predicting kinetic and thermodynamic parameters of ligands, which can be useful in the design and selection of new and more effective ligands for AChE realkylation.

Assuntos

Acetilcolinesterase , Inibidores da Colinesterase , Indolquinonas , Acetilcolinesterase/química , Acetilcolinesterase/metabolismo , Inibidores da Colinesterase/química , Inibidores da Colinesterase/farmacologia , Cinética , Indolquinonas/química , Simulação de Acoplamento Molecular , Ligantes , Termodinâmica , Modelos Moleculares , Humanos , Simulação de Dinâmica Molecular

RESUMO

Chalcone (E)-1,3-diphenyl-prop-2-en-1-one and a series of 14 methoxylated derivatives have been synthesized via Claisen-Schmidt aldol condensation and characterized by FTIR, CG/MS/DIC, 1D (1H and 13C), 2D (COSY, HSQC, and HMBC) NMR, and EMAR techniques. All molecules were tested at 1 mM concentration for antifungal (Sclerotium sp., Macrophomina phaesolina and Colletotrichum gloeosporioides), antibacterial (Acidovorax citrulli two strains), and antiprotozoal (Phytomonas serpens) activities. Unmodified chalcone (CH0) and derivatives CH1, CH2, CH8 stood out in terms of antifungal activity. CH0 presented IC50 values of 47.3 µM (9.8 µg/mL) for the fungus C. gloeosporioides. In addition, fluorescence microscopy indicated that CH0 promoted loss of hyphal cell membrane integrity. The CH1 and CH2 derivatives promoted the inhibition of Sclerotium sp. with IC50 of 127.5 µM (32.9 µg/mL) and 110.4 µM (29.6 µg/mL), respectively. All molecules showed high activity against the phytoparasite P. serpens with IC50 values of 0.98, 2.40, 10.25, and 3.11 µM for the derivatives CH2, CH3, CH5 and CH14 respectively. The results demonstrated that derivatives methoxylated in both rings (CH2) as well as derivatives with a furan ring associated with the methoxy group in ring A, as well as unmodified chalcone can be promising agricultural fungicides for controlling the fungi studied.

RESUMO

Efforts are intensifying to identify bioactive microbial metabolites from biocontrol agents to manage plant pathogens in critical crops. This study examined both volatile organic compounds (VOCs) and non-volatile compounds from Metarhizium carneum and Lecanicillium uredinophilum strains for their antimicrobial effects against various phytopathogens and analyzed their exo-metabolomes. M. carneum VOCs inhibited four bacterial and eight fungal species by up to 45.45 %, while L. uredinophilum VOCs inhibited five bacterial and eight fungal species by up to 50.91 %. Additionally, n-BuOH extracts from both biocontrol agents effectively targeted three fungi and five bacteria. The exo-metabolomes of M. carneum and L. uredinophilum included 125 and 102 spectrometric features, respectively, primarily consisting of polyketides, alkaloids, lipids, organic aromatic compounds, terpenoids, and peptides. Our findings revealed a correlation between the phylogenetic relationships of M. carneum strains, their bioactivity patterns against phytopathogens, and their metabolomic profiles. Notably, some compounds detected in both fungi previously demonstrated biological activity against plant pathogens, enhancing their biocontrol potential. This study not only evidences the antimicrobial properties of diffusible compounds from M. carneum and L. uredinophilum, but also documents the antimicrobial potential of their VOCs for the first time, supporting their use in sustainable agricultural practices, reducing reliance on chemical inputs.

RESUMO

Introdução:A sensibilidade dentária é o efeito adverso mais comum relacionado ao clareamento dentário. Na técnica de consultório, o peróxido de carbamida a 37%, surgiu como possibilidade de clarear e não causar sensibilidade.Objetivo:trata-se deum relato de caso, que avaliou a eficácia (mudança de cor) e a presença ou não de sensibilidade dentária quando se fezo uso de um produto àbase de peróxido de hidrogênio a35% e outro de peróxido de carbamida a 37%, na técnica de clareamento dentário de consultório.Relato de caso:Paciente de25 anos, sexo masculino, submetido a estudo de boca dividida, onde no hemiarco esquerdo foi aplicado peróxido de hidrogênio a 35% e no hemiarco direito, peróxido de carbamida a 37%. Foram feitas 3 sessões, sendo Peróxido de Carbamidacom aplicação única de 45 minutos, e Peróxido de Hidrogêniocom 3 aplicações de 15 minutos, em seu respectivo lado de aplicação e intervalo de sete dias entre cada sessão. Os valores de sensibilidade foram analisados antes e depois de cada sessão por meio da escala visual analógica de dor, e a alteração de cor foi avaliada através da Escala Vita, analisando incisivos e caninos superiores, antes de cada sessão.Conclusões:O clareamento dental com o Peróxido de Hidrogênio apresentou melhor eficácia clareadora e o Peróxido de Carbamida apresentou ausência de sensibilidade durante o procedimento clareador. Sugerem-se mais estudos do tipo ensaio clínico, com o Peróxido de Carbamida, para que se possa, com uma amostra maior de pacientes, verificar suas vantagens no quesito sensibilidade, bem como sua efetividade clareadora (AU).

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Introduction:Tooth sensitivity is the most common adverse effect related to tooth bleaching. In the in-office technique, 37% carbamide peroxide has emerged as a way of tooth bleaching which does not cause sensitivity.Objective:This paper consists of a case report that evaluated the efficacy (color change) and the presence or absence of tooth sensitivity when using a product based on 35% hydrogen peroxide and another product based on 37% carbamide peroxide in the in-office tooth bleaching technique.Case report:A 25-year-old male patient underwent a split-mouth study in which 35% hydrogen peroxide was applied to the left hemi-arch and 37% carbamide peroxide to the right hemi-arch. Three sessions were carried out, carbamide peroxide with a single 45-minute application, and hydrogen peroxide with three 15-minute applications, on their respective application side and with a seven-day interval between each session. Sensitivity values were analyzed before and after each session using the visual analogue pain scale, and color change was assessed using the Vita Scale, analyzing upper incisors andcanines before each session. Conclusions:Teeth bleaching with hydrogen peroxide showed better bleaching efficacy and carbamide peroxide showed no sensitivity during the bleaching procedure. Further clinical trials with carbamide peroxide are suggested inorder to verify, with a larger sample of patients, its advantages in terms of sensitivity, as well asits bleaching effectiveness (AU).

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Introducción: La sensibilidad de la dentina es el efecto adverso más común relacionado con el blanqueamiento dental. En la técnica en clínica, el peróxido de carbamida al 37% ha surgido como una posibilidad de blanqueamiento sin causar sensibilidad.Objetivo: Se tratade un informe de caso que evaluó la eficacia (cambio de color) y la presencia o ausencia de sensibilidad de la denina al utilizar un producto a base de peróxido de hidrógeno al 35% y otro a base de peróxido de carbamida al 37% en la técnica de blanqueamiento dental en clínica.Informe de caso:Un paciente del sexo maculino de 25 años fue sometido a un estudio de boca dividida en el que se aplicó peróxido de hidrógeno al 35% en la hemiarcada izquierda y peróxido de carbamida al 37% en la hemiarcada derecha.Se realizaron tres sesiones, la peróxido de carbamida con una única aplicación de 45 minutos, y la peróxido de hidrógeno con tres aplicaciones de 15 minutos, en sus respectivos lados de aplicación y con un intervalo de siete días entre cada sesión. Se analizaron los valores de sensibilidad antes y después de cada sesión mediante la escala analógica visual del dolor, y se evaluó el cambio de color mediante la Escala Vita, analizando los incisivos superiores y los caninos antes de cada sesión. Conclusiones: El blanqueamiento dental con peróxido de hidrógeno demostró una mayor eficacia blanqueadora y el peróxido de carbamida no manifestó sensibilidad durante el procedimiento de blanqueamiento. Se sugiere realizar más ensayos clínicos con peróxido de carbamidaparapoder utilizar una muestra mayor de pacientes y verificar sus ventajas en términos de sensibilidad, así como su eficacia blanqueadora (AU).

Assuntos

Humanos , Masculino , Adulto , Clareamento Dental/efeitos adversos , Sensibilidade da Dentina/terapia , Peróxido de Carbamida/administração & dosagem , Peróxido de Hidrogênio/administração & dosagem , Resultado do Tratamento , Clareadores

RESUMO

This review article explores the fundamental principles of modern endodontics with a focus on root canal cleaning and shaping. It reviews commonly used endodontic irrigant, namely sodium hypochlorite (NaOCl), herbal extracts, chlorhexidine (CHX), and chelating agents, highlighting their properties, applications, and potential drawbacks. NaOCl, a key antimicrobial agent, demonstrates effectiveness against various microorganisms but poses challenges such as high cytotoxicity. Herbal extracts, gaining recognition in endodontics, present an alternative with potential advantages in preserving dentin integrity. CHX, known for its broad-spectrum antimicrobial activity, is discussed in both liquid and gel formulations, emphasizing its role in reducing smear layer formation and preserving hybrid layer durability. Chelating agents, specifically ethylenediaminetetraacetic acid and citric acid, play a vital role in removing the smear layer, enhancing dentin permeability, and facilitating the penetration of antimicrobial agents. The review article underscores the importance of careful application and consideration of each irrigant's properties to ensure safe and effective endodontic procedures. It serves as a valuable guide for clinicians in selecting appropriate irrigants based on specific treatment requirements.

RESUMO

Patient response to antipsychotic drugs varies and may be related to clinical and genetic heterogeneity. This study aimed to determine the performance of clinical, genetic, and hybrid models to predict the response of first episode of psychosis (FEP). patients to the antipsychotic risperidone. We evaluated 141 antipsychotic-naïve FEP patients before and after 10 weeks of risperidone treatment. Patients who had a response rate equal to or higher than 50% on the Positive and Negative Syndrome Scale were considered responders (n = 72; 51%). Analyses were performed using a support vector machine (SVM), k-nearest neighbors (kNN), and random forests (RF). Clinical and genetic (with single-nucleotide variants [SNVs]) models were created separately. Hybrid models (clinical+genetic factors) with and without feature selection were created. Clinical models presented greater balanced accuracy 63.3% (confidence interval [CI] 0.46-0.69) with the SVM algorithm than the genetic models (balanced accuracy: 58.5% [CI 0.41-0.76] - kNN algorithm). The hybrid model, which included duration of untreated psychosis, Clinical Global Impression-Severity scale scores, age, cannabis use, and 406 SNVs, showed the best performance (balanced accuracy: 72.9% [CI 0.62-0.84] - RF algorithm). A hybrid model, including clinical and genetic predictors, can provide enhanced predictions of response to antipsychotic treatment.