Influence of bisphosphonates on alveolar bone density: a histomorphometric analysis

This study is a histomorphometrical analysis of the influence of the bisphosphonate alendronate on alveolar bone density. Eighteen male Wistar rats were randomly assigned to a control group (n = 9) that received no medication and an experimental group (n = 9) that received oral alendronate (1 mg/kg) from birth until euthanization at 3 months of age. Semi-serial 4-µm-thick transverse sections were obtained from the region between the roots of the left maxillary first molar, stained with hematoxylin and eosin, and examined with a Zeiss Axioskop II optical microscope for histomorphometric analysis. The images were captured with a digital camera coupled with the microscope and connected to a computer, and were analyzed using Image J 1.34s image-analysis software. A 1,200-point grid was positioned onto each digitized image. The number of intersection points of grid lines in the bone tissue was counted. The ratio between the number of points in the bone tissue and the total number of points of the grid (1,200) was used to determine the bone density of the analyzed tissue. Data from the control and experimental groups were compared and analyzed statistically by the Student's t-test (p = 0.05). There was no statistically significant difference (p = 0.3754) in the alveolar bone density between the control and alendronate-treated animals. It may be concluded that the bisphosphonate alendronate did not alter the morphology of the alveolar bone, maintaining its structural tissue characteristics in healthy animals.São Paulo State Research Foundation (FAPESP) and a research postgraduate scholarship granted by the Brazilian Government Research Funding Agency CAPES. The authors are indebted to the Department of Physiology of Ribeirão Preto Dental School, University of São Paulo, Brazil, and to the histotechnician MS. Fátima Aparecida Silveira from the Service Pathology of Bauru Dental School, University of São Paulo (USP), Brazi

Analysis of the dentin-pulp complex in teeth submitted to orthodontic movement in rats

In order to microscopically analyze the pulpal effects of orthodontic movement, 49 maxillary first molars of rats were submitted to orthodontic appliance composed of a closed coil spring anchored to the maxillary incisors, placed for the achievement of mesial movement. MATERIAL AND METHODS: Ten animals were used as the control group and were not submitted to orthodontic force; the other animals were divided into groups according to the study period of tooth movement, namely 1, 2, 3, 4, 5, 6 and 7 days. The investigation of pulp and periodontal changes included hyalinization, fibrosis, reactive dentin and vascular congestion. Statistical evaluation was performed between control and experimental groups and between periods of observation using non-parametric chi-square, Kruskal-Wallis and Dunn tests. RESULTS: There was no statistically significant difference concerning pulpal changes between control and experimental groups nor between periods of observation. The control group, at 3 and 5 days, revealed greater hyalinization of the periodontal ligament (p<0.05), whereas root resorption was significantly greater at 5 and 7 days (p<0.05). CONCLUSION: No morphological change from the effect of induced tooth movement could be found in the dentin-pulp complex. In addition, no inflammatory or pulp degeneration, detectable in optical microscopy, was found in experimental groups

Analysis of the dentin-pulp complex in teeth submitted to orthodontic movement in rats

In order to microscopically analyze the pulpal effects of orthodontic movement, 49 maxillary first molars of rats were submitted to orthodontic appliance composed of a closed coil spring anchored to the maxillary incisors, placed for the achievement of mesial movement. MATERIAL AND METHODS: Ten animals were used as the control group and were not submitted to orthodontic force; the other animals were divided into groups according to the study period of tooth movement, namely 1, 2, 3, 4, 5, 6 and 7 days. The investigation of pulp and periodontal changes included hyalinization, fibrosis, reactive dentin and vascular congestion. Statistical evaluation was performed between control and experimental groups and between periods of observation using non-parametric chi-square, Kruskal-Wallis and Dunn tests. RESULTS: There was no statistically significant difference concerning pulpal changes between control and experimental groups nor between periods of observation. The control group, at 3 and 5 days, revealed greater hyalinization of the periodontal ligament (

Analysis of predictors of root resorption in the orthodontic treatment (Part II)

This study aims to analyze the predictors of root resorption in orthodontic treatment. From 407 records, 377 pretreatment and posttreatment periapical radiographs of permanent maxillary central incisors of 199 patients treated with fixed appliances were divided according to the apical morphologies: pipetteshaped, dilacerated, pointed, rounded and rectangular; crown/root ratio; and presence or absence of partial hypodontia. Changes in root length between the onset and completion of orthodontic treatment were measured in digitized images and statistically compared using T student, one-way ANOVA and Tukey tests. The apical morphology influenced the occurrence of root resorption; teeth with rounded and rectangular apical morphologies were more resistant to root resorption (.001 and .0007, respectively). Short teeth and the presence of partial hypodontia or multiple partial hypodontia did not present greater tendency to root resorption (.1008 and .1544, respectively). The results indicated that abnormal apical morphology is a predictor of external apical root resorption after corrective orthodontic therapy. However, short teeth and partial hypodontia did not increase the prevalence of apical resorption. The susceptibility or individual predisposition to tooth resorptions during orthodontic treatment may be related to the apical morphology

Otimização e validação intralaboratorial de método analítico por CLAE/UV para identificação e quantificação de p-fenilenodiamina em tinturas de hena para cabelos e sobrancelhas

Introduction: p-Phenylenediamine (PPD), aromatic sensitizing amine, has been added to&nbsp; henna powder to modify its natural color to black, increasing its fixation time, a practice&nbsp; that is prohibited in eyelash and eyebrows dyes. Objective: The objective of this study was to optimize and validate, at an intra-laboratory level, an analytical method by HPLC/UV for identification and quantification of PPD in hen dyes for hair and eyebrows. Method: In the method, C8 reverse phase column, mobile phase 1% triethanolamine (pH 8.4) andacetonitrile (99: 1, v/v), detection 280nm, injection volume: 10uL, flow 1.0 mL/min, column temperature 32°C, run time 10 min, linearity 5-45 μg/mL (n = 5) with correlation coefficient 0.9982, were used. For Cochran test (homoscedasticity): 0.3350 and Critical (0.3934) with 99% confidence. Limits of detection 1.17 μg/mL and quantification 3.54 μg/mL. The coefficient of variation of repeatability was 0.12% and the intermediate precision by F-test yielded p value of 0.283 with 95% of confidence. Accuracy results comprised acceptance criteria of 90%-107%. Results: Of the 19 analyzed samples, 14 presented PPD content between 1.74 and 3.65% w/w, in disagreement with Legislation. Conclusions: The proposed method can contribute to monitoring of quality and safety of use of these products.Introdução: O p-fenilenodiamina (PPD), amina aromática sensibilizante, vem sendo adicionado ao pó de hena para modificar sua cor natural para preta, aumentando seu tempo de fixação, prática proibida em tinturas para cílios e sobrancelhas. Objetivo: O objetivo deste estudo foi otimizar e validar, em níveis intralaboratoriais, um método analítico por CLAE/UV para identificação e quantificação de PPD em tinturas de hena para cabelos e sobrancelhas. Método: Foi utilizada coluna em fase reversa C8, fase móvel trietanolamina 1% (pH 8,4) e acetonitrila (99:1, v/v), detecção a 280 nm, volume de injeção de 10 μL, fluxo 1,0 mL/min, temperatura da coluna32°C, tempo de corrida 10 min, linearidade 5-45 μg/mL (n = 5) com coeficiente de correlação de 0,9982. Para o teste de Cochran (homocedasticidade), 0,3350 e o Ccrítico (0,3934), com 99% de confiança. Limites de detecção, 1,17 μg/mL e quantificação, 3,54 μg/mL. O coeficiente de variação da repetibilidade 0,12% e na precisão intermediária pelo teste F obteve-se p-valor de 0,283 com 95% de confiança. Resultados: Os resultados da exatidão compreenderam os critérios de aceitação (90%-107%). Das 19 amostras analisadas, 14 apresentaram teor de PPD entre 1,74% a 3,65% p/p, em desacordo com a Legislação. Conclusões: O método proposto poderá contribuir com o monitoramento da qualidade e segurança de uso destes produtos

High anti-SARS-CoV-2 antibody seroconversion rates before the second wave in Manaus, Brazil, and the protective effect of social behaviour measures: results from the prospective DETECTCoV-19 cohort

Background: The city of Manaus, Brazil, has seen two collapses of the health system due to the COVID-19 pandemic. We report anti-SARS-CoV-2 nucleocapsid IgG antibody seroconversion rates and associated risk factors in Manaus residents before the second wave of the epidemic in Brazil. Methods: A convenience sample of adult (aged ≥18 years) residents of Manaus was recruited through online and university website advertising into the DETECTCoV-19 study cohort. The current analysis of seroconversion included a subgroup of DETECTCoV-19 participants who had at least two serum sample collections separated by at least 4 weeks between Aug 19 and Oct 2, 2020 (visit 1), and Oct 19 and Nov 27, 2020 (visit 2). Those who reported (or had no data on) having a COVID-19 diagnosis before visit 1, and who were positive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at visit 1 were excluded. Using an in-house ELISA, the reactivity index (RI; calculated as the optical density ratio of the sample to the negative control) for serum anti-SARS-CoV-2 nucleocapsid IgG antibodies was measured at both visits. We calculated the incidence of seroconversion (defined as RI values ≤1·5 at visit 1 and ≥1·5 at visit 2, and a ratio >2 between the visit 2 and visit 1 RI values) during the study period, as well as incidence rate ratios (IRRs) through cluster-corrected and adjusted Poisson regression models to analyse associations between seroconversion and variables related to sociodemographic characteristics, health access, comorbidities, COVID-19 exposure, protective behaviours, and symptoms. Findings: 2496 DETECTCoV-19 cohort participants returned for a follow-up visit between Oct 19 and Nov 27, 2020, of whom 204 reported having COVID-19 before the first visit and 24 had no data regarding previous disease status. 559 participants were seropositive for anti-SARS-CoV-2 nucleocapsid IgG antibodies at baseline. Of the remaining 1709 participants who were seronegative at baseline, 71 did not meet the criteria for seroconversion and were excluded from the analyses. Among the remaining 1638 participants who were seronegative at baseline, 214 showed seroconversion at visit 2. The seroconversion incidence was 13·06% (95% CI 11·52–14·79) overall and 6·78% (5·61–8·10) for symptomatic seroconversion, over a median follow-up period of 57 days (IQR 54–61). 48·1% of seroconversion events were estimated to be asymptomatic. The sample had higher proportions of affluent and higher-educated people than those reported for the Manaus city population. In the fully adjusted and corrected model, risk factors for seroconversion before visit 2 were having a COVID-19 case in the household (IRR 1·49 [95% CI 1·21–1·83]), not wearing a mask during contact with a person with COVID-19 (1·25 [1·09–1·45]), relaxation of physical distancing (1·31 [1·05–1·64]), and having flu-like symptoms (1·79 [1·23–2·59]) or a COVID-19 diagnosis (3·57 [2·27–5·63]) between the first and second visits, whereas working remotely was associated with lower incidence (0·74 [0·56–0·97]). Interpretation: An intense infection transmission period preceded the second wave of COVID-19 in Manaus. Several modifiable behaviours increased the risk of seroconversion, including non-compliance with non-pharmaceutical interventions measures such as not wearing a mask during contact, relaxation of protective measures, and non-remote working. Increased testing in high-transmission areas is needed to provide timely information about ongoing transmission and aid appropriate implementation of transmission mitigation measures. Funding: Ministry of Education, Brazil; Fundação de Amparo à Pesquisa do Estado do Amazonas; Pan American Health Organization (PAHO)/WHO.World Health OrganizationRevisión por pare

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030