Evaluation of Microbial Reduction in Root Canals Instrumented with Reciprocating and Rotary Systems

Svrha: Ovim istraživanjem in vitro željela se procijeniti učinkovitost dezinfekcije korijenskih kanala nakon instrumentacije sistemom ReciprocTM i ProTaper UniversalTM, uz irigaciju 1-postotnim natrijevim hipokloritom (NaOCl). Materijali i metode: Četrdeset kanala jednokorijenskih mandibularnih premolara inficirano je bakterijama Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus i Candida albicans, a dvadeset kanala ostavljeno je bez infekcije. Uzorci su nasumično podijeljeni u šest grupa (n = 10): grupa 1: ProTaper UniversalTM + 1-postotni NaOCl; grupa 2 (pozitivna kontrola): ProTaper UniversalTM + fiziološka otopina; grupa 3 (negativna kontrola bez mikroorganizama): ProTaper UniversalTM + fiziološka otopina; grupa 4: ReciprocTM + 1-postotni NaOCl; grupa 5 (pozitivna kontrola): ReciprocTM + fiziološka otopina; grupa 6 (negativna kontrola bez mikroorganizama): ReciprocTM + fiziološka otopina. Rezultati: Kombinacija sistema ProTaper UniversalTM i 1-postotnog natrijeva hipoklorita potpuno je eliminirala sve mikroorganizme. Rast mikroorganizama uočen je pri korištenju sistema ReciprocTM i 1-postotnog natrijeva hipoklorita. Zaključak: Protokoli provedeni u ovom istraživanju pokazali su da sistem ReciprocTM uz 1-postotni NaOCl nije uspio u cijelosti eliminirati iz korijenskih kanala E. faecalis, P. aeruginosa, S. aureus i C. albicans.Objective: This in vitro study aimed to evaluate the efficacy of the disinfection of root canal systems carried out with ReciprocTM and ProTaper UniversalTM systems using 1% sodium hypochlorite (NaOCl). Methods: Forty human single-rooted mandibular premolars were infected with Enterococcus faecalis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida albicans, and twenty were not infected. The specimens were randomly divided into 6 groups (n = 10): Group 1: ProTaper UniversalTM + 1% NaOCl; Group 2 (positive control): ProTaper UniversalTM + saline; Group 3 (negative control without microorganisms): ProTaper UniversalTM + saline; Group 4: ReciprocTM + 1% NaOCl; Group 5 (positive control): ReciprocTM + saline; Group 6 (negative control without microorganisms): ReciprocTM + saline. Samples were collected before and after the completion of specific treatments, and plated in specific media cultures. The Fisher exact test was used for the statistical analysis of differences in terms of presence or absence of microbial growth among groups. For all tested pathogens, significant differences (p < 0.001) were verified between the instrumentation systems used. Results: ProTaper UniversalTM associated with 1% NaOCl completely eliminated all microorganisms. Microbial growth, however, was observed when ReciprocTM was used associated with 1% NaOCl. Conclusion: According to the protocol executed for this study, the ReciprocTM system associated with 1% NaOCl was not able to completely eliminate E. faecalis, P. aeruginosa, S. aureus and C. albicans from the root canal systems

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure &lt;= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Fungos produtores de micotoxinas em medicamentos fitoterápicos/ Ana Cristina Regis de Barros Correia

Os medicamentos fitoterápicos são considerados seguros e utilizados pela maioria da população por serem de origem natural. A presença de fungos nestes medicamentos deve ser cuidadosamente investigada ou monitorada, pois podem estar contaminados com espécies toxigênicas. Entre as drogas vegetais que tem maior número de pedidos de registro na Vigilância Sanitária estão a castanha-da-índia e a alcachofra nas formas farmacêuticas comprimido e cápsula. Este estudo teve como objetivos comparar a eficiência de diferentes meios de cultura para enumeração de fungos em medicamentos a base de castanha-da-índia e alcachofra; determinar a forma mais susceptível (comprimido, cápsula e solução oral) à presença de fungos; detectar espécies toxigênicas de Aspergillus e respectivos teleomorfos e Penicillium; e avaliar a capacidade de produzir micotoxinas in vitro. Os resultados mostram contaminação por fungos em três medicamentos de castanhada- índia, sendo um comprimido e duas cápsulas e um comprimido de alcachofra, sendo estas as formas mais susceptíveis à presença de fungos. Não houve diferença significativa entre os meios ágar Dicloran Rosa de Bengala Cloranfenicol, ágar Dicloran Glicerol 18% e ágar Sabouraud-dextrose. Os fungos mais frequentes foram Aspergillus, Emericella, Eurotium e Penicillium, destes 44,66% de Aspergillus e respectivos teleomorfos e 66,66% de Penicillium foram toxigênicos. A evidência da presença de fungos toxigênicos e patogênicos em medicamentos fitoterápicos reforça a importância do controle microbiológico na fabricação destes produtos, minimizando os riscos a saúde pública

Antimicrobial activity of chlorhexidine in root canals instrumented with the ProTaper Universal™ System

Aim: The purpose of the present study was to evaluate the antimicrobial activity of 0.2%, 1%, and 2% chlorhexidine in root canals instrumented with the ProTaper Universal™ system. Methods: Fifty human mandibular premolar teeth were infected with a mixture of Candida albicans, Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus. The specimens were randomly divided into 5 groups with 10 root canals according to the irrigant used. All root canals were instrumented with the ProTaper Universal™ system. Assessment of the antimicrobial action of the irrigant was performed before, during, and after instrumentation. Data were analyzed statistically by Chi-squared test and the Fisher exact test at 5% significance level. Results: The 0.2% chlorhexidine solution was ineffective against all test microorganisms. The 1% chlorhexidine solution was effective in eliminating P. aeruginosa and C. albicans after the use of the F1 and F3 instruments, respectively. The 2% chlorhexidine solution was effective at killing S. aureus, P. aeruginosa and C. albicans after the use of the S1 instrument. There were statistically significant differences (p<0.05) between the concentrations of chlorhexidine and the instruments used. Conclusions: The 0.2% chlorhexidine solution in combination with rotary instrumentation was ineffective against all test microorganisms. The 1% chlorhexidine solution was ineffective against S. aureus and E. faecalis. The 2% chlorhexidine solution was not sufficient to inactivate E. faecalis

Antimicrobial activity of chlorhexidine in root canals instrumented with the ProTaper Universal System

e purpose of the present study was to evaluate the antimicrobial activity of 0.2%, 1%, and 2% chlorhexidine in root canals instrumented with the ProTaper Universal system. Methods: Fifty human mandibular premolar teeth were infected with a mixture of Candida albicans, Pseudomonas aeruginosa, Enterococcus faecalis and Staphylococcus aureus. The specimens were randomly divided into 5 groups with 10 root canals according to the irrigant used. All root canals were instrumented with the ProTaper Universal system. Assessment of the antimicrobial action of the irrigant was performed before, during, and after instrumentation. Data were analyzed statistically by Chi-squared test and the Fisher exact test at 5% significance level. Results: The 0.2% chlorhexidine solution was ineffective against all test microorganisms. The 1% chlorhexidine solution was effective in eliminating P. aeruginosa and C. albicans after the use of the F1 and F3 instruments, respectively. The 2% chlorhexidine solution was effective at killing S. aureus, P. aeruginosa and C. albicans after the use of the S1 instrument. There were statistically significant differences (p<0.05) between the concentrations of chlorhexidine and the instruments used. Conclusions: The 0.2% chlorhexidine solution in combination with rotary instrumentation was ineffective against all test microorganisms. The 1% chlorhexidine solution was ineffective against S. aureus and E. faecalis. The 2% chlorhexidine solution was not sufficient to inactivate E. faecalis

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.13Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt