Major clinical findings of endodontic retreatment: a concise systematic review

Introduction: In the endodontic treatment and retreatment scenario, the primary objective is to eliminate necrotic tissue and infectious bacteria, especially cleaning and shaping. Endodontic retraction is a procedure performed on a tooth that has received a previous attempt at a definitive treatment that has resulted in a condition that requires further endodontic treatment to achieve a successful outcome. The main cause of treatment failure is insufficient cleaning and inadequate filling. Objective: The present study carried out a concise systematic review to evaluate the main findings of clinical studies on endodontic retreatments, showing the main techniques, efficacy, and safety. Methods: The rules of the Systematic Review-PRISMA Platform. The research was carried out from December 2021 to March 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results: A total of 124 articles were found. A total of 74 articles were evaluated in full and 17 were included and evaluated in the present study. Studies have demonstrated the effectiveness of rotational systems in endodontic retreatment but never producing completely obturator-free root canals. Reciproc instruments were associated with significantly higher cyclic fatigue strength than WaveOne instruments. The persistent infection microbiota is polymicrobial with a predominance of E. faecalis and P. gingivalis in all stages of endodontic retreatment, regardless of the method used for microbial identification. A higher bacterial load and lower lipoteichoic acid level were found in the 2-visit group after the retreatment protocol. Postoperative pain was significantly reduced at 48 and 72 hours after the application of nano-silver and nano-calcium hydroxide alone. Conclusion: The results of clinical trials showed that the root canal instrumentation system with rotary files maintains the quality of the root preparation and reduces the number of files needed to obtain a canal, which would consequently reduce the operative time and also considerably reduce the risk of torsion fracture within the root canal, allowing successful endodontic retreatment. Also, a condition for successful endodontic retreatment is the adequate cleaning of the root canals, therefore, special attention must be given to the technique used to remove the filling material

Internações por intoxicações medicamentosas em crianças menores de cinco anos no estado de Minas Gerais/Brasil, 2009 – 2018

Objetivo: descrever as internações hospitalares no estado de Minas Gerais devido às intoxicações medicamentosas, em crianças menores de cinco anos de idade, entre os anos de 2009 e 2018. Métodos: estudo descritivo-analítico de levantamento, com dados do Sistema de Internações Hospitalares do Sistema Único de Saúde (SIH/SUS); os diagnósticos foram extraídos conforme a 10ª Revisão da Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde (CID-10); os medicamentos envolvidos foram categorizados em classes terapêuticas segundo a Anatomical Therapeutic Chemical (ATC) e os dados obtidos foram analisados por estatística descritiva. Resultados: foram identificadas 1.888 internações com 2358 diagnósticos de intoxicações e três óbitos; as classes terapêuticas mais frequentes foram fármacos não especificados (47,54%), antiepilépticos/sedativo-hipnóticos/antiparkinsonianos (14,72%); fármacos psicotrópicos (6,62%); antibióticos sistêmicos (4,88%); e analgésicos/antitérmicos não opiáceos (4,75%). Conclusão: dentre as classes terapêuticas identificadas, os medicamentos que atuam no Sistema Nervoso Central foram os principais agentes causadores de intoxicação medicamentosa. No entanto, mais estudos são necessários para a análise das internações de todo o estado, uma vez que o SIH/SUS apenas contempla as internações subsidiadas pelo SUS.Objective: Describe hospital admissions in the state of Minas Gerais due to drug intoxications in children under five years old between 2009 and 2018. Methods: descriptive-analytical survey study, with data from the National Hospital Information System (SIH/SUS); the drugs involved were categorized into therapeutic classes (ATC), and the data obtained were analyzed by descriptive statistics. Results: 1,888 hospitalizations were identified with 2,358 diagnoses of poisoning and three deaths; the most common therapeutic classes were unspecified drugs (47.54%); antiepileptic/sedative-hypnotics/antiparkinson drugs (14.72%); psychotropic drugs (6.62%); systemic antibiotics (4.88%); and non-opioid analgesics/antipyretics (4.75%). Conclusion: among the defined therapeutic classes, drugs that act in the Central Nervous System were the main agents causing drug intoxication. However, more studies are needed to analyze hospitalizations across the state since SIH/SUS only contemplates hospitalizations subsidized by SUS

Evidence of the association between endodontic infections and heart diseases: a systematic review

Introduction: In the scenario of heart diseases, especially cardiovascular diseases (CVD), there are several predictors of these diseases, including diseases related to oral health. Objective: It was to analyze through clinical studies the association of diseases of the oral cavity with cardiovascular diseases, to point out the main causes and treatments for future clinical studies. Methods: The rules of the Systematic Review-PRISMA Platform were followed. The research was carried out from January 2022 to April 2022 and developed based on Scopus, PubMed, Science Direct, Scielo, and Google Scholar. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: In line with the objective proposed in the present study, the results concluded that the association between chronic endodontic infection and CVD cannot be disregarded, although it is of limited quality evidence at the moment. Thus, clinical studies observed that the risk of diagnosing CVD in patients with chronic endodontic infection was 1.38 times those without infection. Furthermore, early childhood caries showed that the microbiome profile composed of Fusobacterium, Prevotella, Capnocytophaga, and Oribacterium were more abundant in the group with congenital heart disease than in the group without congenital heart disease. Also, the greater number of missing teeth was associated with an increased risk of a first acute myocardial infarction, and endodontic inflammatory disease may contribute as an independent risk factor for cardiovascular diseases

Identification of inappropriate prescribing in a Brazilian nursing home using STOPP/START screening tools and the Beers' Criteria

The objective of this study was to determine the prevalence of Potentially Inappropriate Medication (PIM) use and associated factors, as well as the prevalence of Prescribing Omissions (PO). A cross-sectional study was conducted in a philanthropic Brazilian nursing home involving 46 individuals aged 60 years or older. The following information was collected from medical records and drug prescriptions: gender, age, health conditions and drugs used in the past thirty days. PIM and PO were identified according to the Beers' Criteria and the STOPP/START screening tools. Over one third (37%) of the population used at least one PIM according to the Beers' Criteria (n=17) and 60.9% according to the STOPP tool. A significant association was found between polypharmacy (use of five or more drugs) and use of PIM according to the Beers' Criteria, but not according to the STOPP. Eight residents (17.4%) were exposed to eight PO. This study allowed the diagnosis of a concerning drug utilization profile with use of a high number of PIMs. Thus, there is an evident need to implement strategies for improving geriatric prescription.O objetivo deste estudo foi determinar a prevalência de uso de medicamentos potencialmente inadequados (MPI) e fatores associados, bem como a prevalência de omissões farmacoterapêuticas (OF). Trata-se de um estudo transversal realizado em uma instituição filantrópica brasileira de longa permanência com 46 indivíduos com 60 anos ou mais. As seguintes informações foram coletadas a partir de prontuários e prescrições: sexo, idade, condições de saúde e medicamentos utilizados nos últimos trinta dias. MPI e OF foram identificados pelo Critério de Beers e as ferramentas de triagem STOPP/START. Mais de um terço (37%) da população utilizou pelo menos, um MPI de acordo com os critérios de Beers (n=17) e 60.9% de acordo com a ferramenta STOPP. Associação estatisticamente significante foi detectada entre a polifarmácia (consumo de cinco ou mais medicamentos) e uso de MPI de acordo com os critérios de Beers, mas não de acordo com o STOPP. Oito residentes (17,4%) foram expostos a oito OF. Este estudo permitiu o diagnóstico de um perfil de utilização de medicamentos preocupante com número elevado de utilização de MPI. Isso indica a necessidade de implementar estratégias para melhorar a qualidade da prescrição geriátrica

Post-marketing Study of Linagliptin: A Pilot Study

IntroductionLinagliptin is a high-cost oral antidiabetic that has been widely used, and studies on its effectiveness and safety for the treatment of type 2 diabetes mellitus (DM2) in the real world is rare and necessary.ObjectiveTo analyze the values of glycated hemoglobin (HbA1c) and adverse events before and after the use of linagliptin in the post-marketing context of a pilot study.MethodsThis is a descriptive observational and exploratory study with a retrospective longitudinal approach, conducted between January 2014 and December 2016. All patients who participated in the study were over 18 years of age, with DM2, assisted by the Brazilian Public Health System (Sistema Único de Saúde – SUS) and had been indicated for use of linagliptin. The users were followed up and the variables of interest were collected from a computerized health information system (sistema informatizado de saúde – SIS) and patient records. For effectiveness analysis, HbA1c before (T0) and after (T1) the use of linagliptin was considered in patients registered as having collected linagliptin at the pharmacy for at least three consecutive months. For safety analysis, registered adverse events (AE) were verified in patients’ records. The sample was stratified according to the pharmacotherapeutic scheme of the users. To compare the means before (T0) and after (T1), a paired t-test (data with normal distribution) and Wilcoxon Signed Rank Sum test (non-normal distribution data) were performed.ResultsConsidering the total population of the study, in a different pharmacotherapeutic regimen, a median reduction in HbA1c of -0.86% (p < 0.05) was observed. After stratification by pharmacotherapeutic regimen, the most significant reduction of HbA1c was -1.07% (p = 0.014) for the linagliptin group associated with insulins and oral antidiabetic agents (n = 13). On the other hand, patients taking linagliptin in monotherapy had the lowest HbA1c reduction, -0.48% (p > 0.05). AE occurred in 12 (36.4%) patients, and 16.7% were in monotherapy.ConclusionLinagliptin did not presented, in real world, the desired performance as showed in randomized premarketing clinical trials and it should be carefully evaluated in public health services

Abordagem endovascular na terapêutica da coarctação de aorta / Endovascular approach in aortic coarctation therapy

INTRODUÇÃO: A coarctação de aorta (CoA) é uma cardiopatia congênita que se define por um estreitamento da aorta, com altas taxas de morbidade e mortalidade. Os procedimentos de tratamento disponíveis incluem cirurgia e dilatação de balão endovascular com ou sem colocação de stent. O atual manejo endovascular da doença da aorta torácica conseguiu diminuir a mortalidade de 40% para 14%.METODOLOGIA: Foi realizada a busca por literaturas nas bases de dados MEDLINE/PubMed, LILACS e SciELO. Utilizou-se o recorte temporal entre os anos de 2011 e 2021 e os descritores “Coarctação Aórtica”, “Procedimentos Endovasculares” e “Terapêutica”. Foram selecionados artigos que melhor se encaixavam na busca.RESULTADOS: O tratamento endovascular reduziu significativamente a morbidade intra-hospitalar e pós-operatória quando comparado a outras técnicas de tratamento.DISCUSSÃO: O tratamento cirúrgico de coarctação da aorta está associado a complicações potenciais, como aneurisma, hipertensão e doença cerebral crônica durante o período de acompanhamento. Diante disso, o desejo de reduzir a morbimortalidade associada ao procedimento cirúrgico motivou a terapia endovascular para a doença. Ambas as opções de tratamento da CoA possuem particularidades que devem ser levadas em consideração no tratamento dessa patologia.CONCLUSÃO: O tratamento endovascular apresentou benefícios em relação ao tratamento cirúrgico, visto que houve a redução das complicações, morbidade intra-hospitalar e pós-operatória