AVALIAÇÃO DA MICROINFILTRAÇÃO DE MATERIAIS RESTAURADORES PROVISÓRIOS UTILIZADOS EM ENDODONTIA

O uso adequado dos materiais restauradores provisórios é de grande valia para o tratamento endodôntico, uma vez que ele é capaz de evitar a microinfiltração coronária e, com isso, prevenir uma possível recontaminação dos canais radiculares. Por esse motivo, o objetivo do presente estudo foi investigar a microinfiltração coronal marginal de cinco grupos de materiais restauradores provisórios utilizados em dentes tratados endodonticamente. Foram avaliados sessenta e um dentes, do grupo dos caninos, com tratamento endodôntico realizado previamente, e um hígido (sem ter sido realizado o acesso coronário), armazenados no Banco de Dentes Humanos da Unoesc, a partir de uma amostra intencional dividida em cinco grupos com 12 dentes: Grupo I- Cimpat Branco® (Septodont), Grupo II- Coltosol® (Vigodent), Grupo III- Cavitec® (Caithec), Grupo IV- Villevie® (Dentalville do Brasil Ltda.), Grupo V- Selamento duplo com Villevie® (Dentalville do Brasil Ltda.) + Cimento de Ionômero de Vidro (Maxxion R® - FGM) e dois grupos controle com um dente cada. Os dentes foram imersos em uma solução de azul de metileno a 0,5%, armazenados em estufa a 37 °C por 72 horas e, em seguida, seccionados longitudinalmente no sentido vestíbulo-lingual. Obtiveram-se as médias de infiltração, as quais foram submetidas ao teste estatístico de Tukey e ANOVA. Nos resultados constatou-se que o Grupo I (Cimpat Branco®, Septodont) apresentou menores médias de índices de infiltração (0,75 ± 0,26), seguido do Grupo II (1 ± 0,31), Grupo IV (3 ± 0,58), Grupo V (3 ± 0,49) e Grupo III (4 ± 0,49) com o pior índice. Conclui-se que os Grupos I e II mostraram os menores índices, contudo, todos os materiais testados apresentaram alguma infiltração. Por esse motivo, o cuidado na escolha do selador coronário é muito importante no controle e prevenção de contaminações, o que está diretamente ligado ao sucesso do tratamento.Palavras-chave: Restauração dentária provisória. Infiltração dentária. Endodontia

AVALIAÇÃO DA EFETIVIDADE DO CLAREAMENTO CASEIRO EM DENTES COM APARATOLOGIA ORTODÔNTICA

A busca por um sorriso harmonioso inclui diversos aspectos e o clareamento dentário está entre os principais deles. A maioria dos pacientes almeja dentes claros e essa procura inclui aqueles que estão sob tratamento ortodôntico, os quais apesar do aparato em boca, também se sentem mais satisfeitos com dentes brancos antes do término do tratamento. Assim, o objetivo deste estudo foi realizar uma avaliação in vitro da efetividade da técnica do clareamento caseiro em dentes que possuem aparatologia ortodôntica instalada. Para isso, foram utilizados 64 dentes divididos em quatro grupos: Grupo A (Controle) – sem aparatologia ortodôntica e clareado com Power Bleaching®; Grupo B – com aparatologia ortodôntica e clareado com Power Bleaching®; Grupo C (Controle) – sem aparatologia ortodôntica e clareado com Opalescence® TresWhiteSupreme; Grupo D – com aparatologia ortodôntica e clareado com Opalescence® TresWhiteSupreme. Antes e após o término do clareamento a cor dos dentes foi aferida com o auxílio de uma matriz individualizada, com os dentes montados em acrílico. A aferição da cor das amostras de dente foi feita com o espectrofotômetro EasyShade®. Todos os grupos receberam a aplicação diária do gel clareador, por um período de 21 dias, sendo o gel Power Bleaching® por seis horas, e as tiras Opalescence® TreswhiteSupreme por uma hora. Por meio do teste de Friedman foi demonstrado que após a aplicação das duas técnicas clareadoras, independentemente da ausência ou presença da aparatologia ortodôntica, o elemento dental apresentou-se significativamente mais claro. Conclui-se que ambos os agentes clareadores utilizados na técnica de clareamento caseiro têm efeito significativo no clareamento em dentes com aparatologia ortodôntica. Palavras-chave: Clareamento dental. Ortodontia. Agente clareador.

SUCÇÃO NUTRITIVA DO BEBÊ

A primeira fonte de alimentação do bebê é o leite materno oferecido para a criança logo após o nascimento. Segundo a Organização Mundial da Saúde, até os seis meses de vida o aleitamento materno exclusivo oferece os nutrientes necessários para o desenvolvimento da criança, além de protegê-la contra doenças, preparar o trato gastrointestinal e criar um vínculo afetivo entre mãe e bebê. O objetivo deste trabalho foi orientar e repassar informações relevantes para as gestantes sobre a importância da amamentação no peito, assim como os cuidados que devem ser tomados quando a amamentação artificial for necessária. Nesse contexto, enfatizou as implicações que a alimentação natural, quando não levada a termo, tem na prática odontológica, como o surgimento de problemas nos músculos mastigatórios, nos dentes e na deglutição pela ausência de força muscular e de movimentos durante a mamada no peito. Dessa forma, o trabalho proposto foi desenvolvido pelos acadêmicos da oitava fase do Curso de Odontologia da Universidade do Oeste de Santa Catarina de Joaçaba, no componente curricular OSC IV, abordando de forma lúdica um teatro baseado no programa “Bem Estar” da Rede Globo, que trouxe ensinamentos sobre amamentação natural e sua importância para o bebê. A apresentação contou com a participação das gestantes do município de Luzerna, SC e a estratégia adotada, por meio da formulação de questões e respostas destas, possibilitou uma excelente oportunidade aos acadêmicos de interagirem de forma interativa, dinâmica, informativa e divertida. O encontro proporcionou momentos de aprendizado, integração e alegria com as gestantes, que de uma forma diferenciada obtiveram informações muito importantes, as quais são úteis no período gestacional e também no período pós-parto.Palavras-chave: Aleitamento materno. Sucção nutritiva. Amamentação natural

FALHAS CLÍNICAS QUE COMPROMETEM A LONGEVIDADE DAS RESTAURAÇÕES DIRETAS EM DENTES ANTERIORES E POSTERIORES

A procura por materiais estéticos tornou a resina composta um material muito procurado e almejado pelos pacientes, apesar do amálgama ainda ser um material de ótima escolha, com propriedades que beneficiam a estabilidade mecânica da restauração. Embora os materiais tenham evoluído muito, existem falhas inerentes a eles, que muitas vezes não conseguem ser evitadas, mas podem ser controladas pelos dentistas. O objetivo do trabalho foi relatar um caso clínico em que foi observada grande quantidade de falhas clínicas presentes em restaurações de resina composta na cavidade oral da paciente, tanto em dentes anteriores quanto em posteriores, indicando redução na longevidade desses materiais. O trabalho foi realizado na Clínica Integrada I do Curso de Odontologia da Unoesc Joaçaba. Contou com a participação da paciente VTVS, sexo feminino, 40 anos, que apresentava múltiplas restaurações em resina composta com falhas clínicas, como: infiltração marginal, descoloração das margens, aparecimento de cárie secundária, desadaptação e fratura marginal. Após diagnóstico clínico e radiográfico das necessidades, o tratamento proposto foi a substituição das restaurações danificadas por materiais adequados, os quais foram escolhidos baseados no anseio estético da paciente. Dessa forma, a indicação foi substituir as restaurações de resina composta pelo mesmo material, com exceção do elemento 26, que em razão da pequena quantidade de estrutura dental remanescente preconizou-se pela utilização de amálgama. Foi percebido com o caso clínico que o maior número de falhas é encontrado na resina composta, indicando sua menor longevidade em relação ao amálgama, por exemplo. E que mesmo com a evolução dos materiais, a substituição de restaurações continua sendo um dos procedimentos mais frequentes na clínica odontológica e isso poderia ser minimizado com a utilização correta das técnicas e/ou seleção correta do caso.Palavras-chave: Resina Composta. Longevidade. Infiltração marginal. 

Position statement of the EADV Artificial Intelligence (AI) Task Force on AI‐assisted smartphone apps and web‐based services for skin disease

Background: As the use of smartphones continues to surge globally, mobile applications (apps) have become a powerful tool for healthcare engagement. Prominent among these are dermatology apps powered by Artificial Intelligence (AI), which provide immediate diagnostic guidance and educational resources for skin diseases, including skin cancer. Objective: This article, authored by the EADV AI Task Force, seeks to offer insights and recommendations for the present and future deployment of AI‐assisted smartphone applications (apps) and web‐based services for skin diseases with emphasis on skin cancer detection.MethodsAn initial position statement was drafted on a comprehensive literature review, which was subsequently refined through two rounds of digital discussions and meticulous feedback by the EADV AI Task Force, ensuring its accuracy, clarity and relevance. Results: Eight key considerations were identified, including risks associated with inaccuracy and improper user education, a decline in professional skills, the influence of non‐medical commercial interests, data security, direct and indirect costs, regulatory approval and the necessity of multidisciplinary implementation. Following these considerations, three main recommendations were formulated: (1) to ensure user trust, app developers should prioritize transparency in data quality, accuracy, intended use, privacy and costs; (2) Apps and web‐based services should ensure a uniform user experience for diverse groups of patients; (3) European authorities should adopt a rigorous and consistent regulatory framework for dermatology apps to ensure their safety and accuracy for users. Conclusions: The utilisation of AI‐assisted smartphone apps and web‐based services in diagnosing and treating skin diseases has the potential to greatly benefit patients in their dermatology journeys. By prioritising innovation, fostering collaboration and implementing effective regulations, we can ensure the successful integration of these apps into clinical practice

Development and Implementation of the AIDA International Registry for Patients With Still's Disease

Objective: Aim of this paper is to present the design, construction, and modalities of dissemination of the AutoInflammatory Disease Alliance (AIDA) International Registry for patients with systemic juvenile idiopathic arthritis (sJIA) and adult-onset Still's disease (AOSD), which are the pediatric and adult forms of the same autoinflammatory disorder. Methods: This Registry is a clinical, physician-driven, population- and electronic-based instrument implemented for the retrospective and prospective collection of real-world data. The collection of data is based on the Research Electronic Data Capture (REDCap) tool and is intended to obtain evidence drawn from routine patients' management. The collection of standardized data is thought to bring knowledge about real-life clinical research and potentially communicate with other existing and future Registries dedicated to Still's disease. Moreover, it has been conceived to be flexible enough to easily change according to future scientific acquisitions. Results: Starting from June 30th to February 7th, 2022, 110 Centers from 23 Countries in 4 continents have been involved. Fifty-four of these have already obtained the approval from their local Ethics Committees. Currently, the platform counts 290 users (111 Principal Investigators, 175 Site Investigators, 2 Lead Investigators, and 2 data managers). The Registry collects baseline and follow-up data using 4449 fields organized into 14 instruments, including patient's demographics, history, clinical manifestations and symptoms, trigger/risk factors, therapies and healthcare access. Conclusions: This international Registry for patients with Still's disease will allow a robust clinical research through collection of standardized data, international consultation, dissemination of knowledge, and implementation of observational studies based on wide cohorts of patients followed-up for very long periods. Solid evidence drawn from "real-life " data represents the ultimate goal of this Registry, which has been implemented to significantly improve the overall management of patients with Still's disease. NCT 05200715 available at

Health Economic Consequences Associated With COVID-19–Related Delay in Melanoma Diagnosis in Europe

Importance: The COVID-19 pandemic resulted in delayed access to medical care. Restrictions to health care specialists, staff shortages, and fear of SARS-CoV-2 infection led to interruptions in routine care, such as early melanoma detection; however, premature mortality and economic burden associated with this postponement have not been studied yet. Objective: To determine the premature mortality and economic costs associated with suspended melanoma screenings during COVID-19 pandemic lockdowns by estimating the total burden of delayed melanoma diagnoses for Europe. Design, Setting, and Participants: This multicenter economic evaluation used population-based data from patients aged at least 18 years with invasive primary cutaneous melanomas stages I to IV according to the American Joint Committee on Cancer (AJCC) seventh and eighth editions, including melanomas of unknown primary (T0). Data were collected from January 2017 to December 2021 in Switzerland and from January 2019 to December 2021 in Hungary. Data were used to develop an estimation of melanoma upstaging rates in AJCC stages, which was verified with peripandemic data. Years of life lost (YLL) were calculated and were, together with cost data, used for financial estimations. The total financial burden was assessed through direct and indirect treatment costs. Models were building using data from 50 072 patients aged 18 years and older with invasive primary cutaneous melanomas stages I to IV according to the AJCC seventh and eighth edition, including melanomas of unknown primary (T0) from 2 European tertiary centers. Data from European cancer registries included patient-based direct and indirect cost data, country-level economic indicators, melanoma incidence, and population rates per country. Data were analyzed from July 2021 to September 2022. Exposure: COVID-19 lockdown-related delay of melanoma detection and consecutive public health and economic burden. As lockdown restrictions varied by country, lockdown scenario was defined as elimination of routine medical examinations and severely restricted access to follow-up examinations for at least 4 weeks. Main Outcomes and Measures: Primary outcomes were the total burden of a delay in melanoma diagnosis during COVID-19 lockdown periods, measured using the direct (in US$) and indirect (calculated as YLL plus years lost due to disability [YLD] and disability-adjusted life-years [DALYs]) costs for Europe. Secondary outcomes included estimation of upstaging rate, estimated YLD, YLL, and DALY for each European country, absolute direct and indirect treatment costs per European country, proportion of the relative direct and indirect treatment costs for the countries, and European health expenditure. Results: There were an estimated 111 464 (range, 52 454-295 051) YLL due to pandemic-associated delay in melanoma diagnosis in Europe, and estimated total additional costs were$7.65 (range, $3.60 to$20.25) billion. Indirect treatment costs were the main cost driver, accounting for 94.5% of total costs. Estimates for YLD in Europe resulted in 15 360 years for the 17% upstaging model, ranging from 7228 years (8% upstaging model) to 40 660 years (45% upstaging model). Together, YLL and YLD constitute the overall disease burden, ranging from 59 682 DALYs (8% upstaging model) to 335 711 DALYs (45% upstaging model), with 126 824 DALYs for the real-world 17% scenario. Conclusions and Relevance: This economic analysis emphasizes the importance of continuing secondary skin cancer prevention measures during pandemics. Beyond the personal outcomes of a delayed melanoma diagnosis, the additional economic and public health consequences are underscored, emphasizing the need to include indirect economic costs in future decision-making processes. These estimates on DALYs and the associated financial losses complement previous studies highlighting the cost-effectiveness of screening for melanoma

Clinical and laboratory features associated with macrophage activation syndrome in Still's disease: data from the international AIDA Network Still's Disease Registry

: To characterize clinical and laboratory signs of patients with still's disease experiencing macrophage activation syndrome (MAS) and identify factors associated with MAS development. patients with still's disease classified according to internationally accepted criteria were enrolled in the autoInflammatory disease alliance (AIDA) still's disease registry. clinical and laboratory features observed during the inflammatory attack complicated by MAS were included in univariate and multivariate logistic regression analysis to identify factors associated to MAS development. A total of 414 patients with Still's disease were included; 39 (9.4%) of them developed MAS during clinical history. At univariate analyses, the following variables were significantly associated with MAS: classification of arthritis based on the number of joints involved (p = 0.003), liver involvement (p = 0.04), hepatomegaly (p = 0.02), hepatic failure (p = 0.01), axillary lymphadenopathy (p = 0.04), pneumonia (p = 0.03), acute respiratory distress syndrome (p < 0.001), platelet abnormalities (p < 0.001), high serum ferritin levels (p = 0.009), abnormal liver function tests (p = 0.009), hypoalbuminemia (p = 0.002), increased LDH (p = 0.001), and LDH serum levels (p < 0.001). at multivariate analysis, hepatomegaly (OR 8.7, 95% CI 1.9-52.6, p = 0.007) and monoarthritis (OR 15.8, 95% CI 2.9-97.1, p = 0.001), were directly associated with MAS, while the decade of life at Still's disease onset (OR 0.6, 95% CI 0.4-0.9, p = 0.045), a normal platelet count (OR 0.1, 95% CI 0.01-0.8, p = 0.034) or thrombocytosis (OR 0.01, 95% CI 0.0-0.2, p = 0.008) resulted to be protective. clinical and laboratory factors associated with MAS development have been identified in a large cohort of patients based on real-life data

Interaction of the Coffee Diterpenes Cafestol and 16-O-Methyl-Cafestol Palmitates with Serum Albumins

The main coffee diterpenes cafestol, kahweol, and 16-O-methylcafestol, present in the bean lipid fraction, are mostly esterified with fatty acids. They are believed to induce dyslipidaemia and hypercholesterolemia when taken with certain types of coffee brews. The study of their binding to serum albumins could help explain their interactions with biologically active xenobiotics. We investigated the interactions occurring between cafestol and 16-O-methylcafestol palmitates with Bovine Serum Albumin (BSA), Human Serum Albumin (HSA), and Fatty Free Human Serum Albumin (ffHSA) by means of circular dichroism and fluorimetry. Circular Dichroism (CD) revealed a slight change (up to 3%) in the secondary structure of fatty-free human albumin in the presence of the diterpene esters, suggesting that the aliphatic chain of the palmitate partly occupies one of the fatty acid sites of the protein. A warfarin displacement experiment was performed to identify the binding site, which is probably close but not coincident with Sudlow site I, as the affinity for warfarin is enhanced. Fluorescence quenching titrations revealed a complex behaviour, with Stern-Volmer constants in the order of 103-104 Lmol-1. A model of the HSA-warfarin-cafestol palmitate complex was obtained by docking, and the most favourable solution was found with the terpene palmitate chain inside the FA4 fatty acid site and the cafestol moiety fronting warfarin at the interface with site I

Coffee silverskin as a renewable resource to produce butanol and isopropanol

Coffee is the second largest traded commodity after oil and large amounts of by-products are generated in the coffee industry every year. In particular, coffee silverskin (CS) and spent coffee grounds (SCG) are the main coffee industry residues. CS is about 4.2% (w/w) of coffee beans and the valorisation of this waste through the biorefinery approach may boost the circular economy development. In the present contribution, CS was pretreated with one of the mainly investigated biomass pretreatment reported in literature: alkaline hydrolysis in NaOH solutions. After enzymatic hydrolysis of the pretreated CS, the obtained sugars were used as carbon source to produce butanol and isopropanol by Clostridium beijerinckii DSM 6423. Moreover, fermentation tests were also carried out with synthetic media to investigate the effects of the alkaline pretreatment on the fermentation process. When pretreated CS was used as feedstock, the largest yields were 0.16 and 0.31 gsolvent/gsugars isopropanol and butanol, respectively. The reported results foster further studies regarding the reuse of CS for solvents production through fermentation processes.</p