Efficacy evaluation of different digital radiography systems and cone beam computed tomography in detection of fractured endodontic instruments in root canals with and without filling

Orientadores: Christiano de Oliveira Santos, Deborah Queiroz de Freitas FrançaTese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de PiracicabaResumo: A presença de instrumentos fraturados no interior de canais radiculares constitui um dos acidentes mais indesejáveis nos procedimentos endodônticos, podendo dificultar uma obturação satisfatória e constituir um nicho para a propagação de micro-organismos, comprometendo o prognóstico do caso. A detecção de instrumentos fraturados no interior dos canais deve ser realizada por meio de exames por imagem, porém a literatura é contraditória quanto aos exames mais indicados nesses casos. O objetivo no presente estudo foi avaliar a eficácia de diferentes métodos radiográficos na detecção de instrumentos endodônticos fraturados, em canais com e sem material obturador. Utilizou-se 31 dentes molares inferiores humanos (80 canais). Foram realizadas radiografias periapicais em diferentes sistemas digitais, sendo dois sistemas semidiretos com placas de armazenamento de fósforo: VistaScan® e Express® e um sistema direto com a utilização de sensor CMOS: SnapShot® (incidências radiográficas orto, disto e mesiorradiais); e imagens de tomografia computadorizada de feixe cônico (TCFC) com campo de visão (FOV) de 6x4 cm, variando-se o voxel (0,085 mm3 e 0,2 mm3). Os canais radiculares foram divididos em quatro grupos: G1 - sem material obturador (n=10); G2 - sem material obturador e com limas fraturadas (n=30); G3 - com material obturador (n=10); G4 - com material obturador e com limas fraturadas (n=30). Primeiramente, foram avaliadas apenas as imagens periapicais em incidência ortorradial de todos os sistemas digitais; em seguida, a associação das três imagens, orto, disto e mesiorradial, dos três sistemas; por fim, as imagens de TCFC nos dois voxels. Todas as imagens foram avaliadas e reavaliadas por três especialistas em Radiologia Odontológica e um Endodontista, que classificaram as imagens quanto à presença ou ausência de limas fraturadas nos canais radiculares, em uma escala de 5 pontos. As reprodutibilidades inter e intra-avaliador foram calculadas por meio do teste Kappa ponderado. Foram calculados os valores de sensibilidade, especificidade e acurácia (a área sob a curva ROC). As modalidades de imagens foram comparadas por meio da análise de variância, um fator com teste post-hoc de Tukey e com nível de significância de 5%. Na ausência de material obturador, os valores de acurácia foram elevados e não houve diferença estatística significante entre as técnicas radiográficas estudadas, entre os diferentes sistemas digitais (p>0,05) e entre os diferentes voxels da TCFC (p=0,713). Na presença de material obturador, a acurácia das imagens periapicais apresentaram diferença significante das imagens de TCFC; em única incidência os sistemas digitais em estudo, Express®, VistaScan® e SnapShot®, apresentaram valores de acurácia de 0,773, 0,747 e 0,817, respectivamente; e observou-se diferença significante (p=0,021) entre os sistemas SnapShot® e VistaScan®. Para as três incidências, a acurácia do Express®, VistaScan® e SnapShot® foi 0,707, 0,740 e 0,784, respectivamente, sendo observada diferença significante entre SnapShot® e Express® (p=0,035). Não houve diferença significante entre os diferentes voxels da TCFC (p=0,306). Assim, concluiu-se que para a detecção de instrumentos endodônticos fraturados no interior de canais radiculares, na ausência ou presença de material obturador, radiografias periapicais em uma incidência mostraram-se acurada sugerindo que essa seja a técnica de primeira escolha. Sistemas radiográficos digitais diretos, com maior resolução espacial, devem ser preferidos, especialmente em casos de canais com material obturador. Nessa mesma situação, a realização de TCFC deve ser evitada, para detecção de instrumental fraturado, devido à sua baixa acuráciaAbstract: The presence of fractured instruments inside the root canal is one of the most undesirable accidents, which may disfavor satisfactory obturation and provide a niche for the dissemination of micro-organisms, affecting the prognosis. Detection of fractured instruments in the root canals must be performed by imaging methods, but the literature is contradictory on which tests are most suitable in these cases. The aim in this study was to evaluate the efficacy of different radiographic methods in detecting fractured endodontic instruments in canals with e without filling. Thirty-one human molars were used (80 canals). Periapical radiographs were made in different digital systems, two semidirect systems with storage phosphor plates: VistaScan® and Express®; and a direct system using CMOS sensor: SnapShot® (radiographic views ortho, disto and mesiorradial). CBCT images were obtained with a 6x4 cm field of view (FOV) and 0.085 mm3 and 0.2 mm3 voxels. Root canals were divided into four groups: G1 - without fillings (n = 10); G2 - with fractured files (n = 30); G3 - filled (n = 10); G4 - filled and with fractured files (n = 30). Frist, were evaluated only the periapical images in ortorradial incidence of all digital systems; then the combination of the three images, ortho, disto and mesiorradial, the three systems; finally, the CBCT images in the two voxels. All images were assessed and reassessed by three Oral and Maxillofacial Radiologists and an Endodontist, who rated the images for the presence or absence of fractured files in root canals, on a 5-point scale. The interrater and intrarater reliability were calculated using the weighted Kappa test. The sensitivity, specificity and accuracy (area under the ROC curve) were calculated. Imaging modalities were compared by one-way analysis of variance with post-hoc Tukey and 5% significance level. In the absence of filling materials, the accuracy was higher and there is not significant difference between the radiographic modalities, different digital systems (p>0.05) and different CBCT voxels (p=0.713). In the presence of filling materials, the accuracy of periapical images showed significant difference in CBCT images; in single incidence the digital systems studied Express®, VistaScan® and SnapShot® showed accuracy values of 0.773, 0.747 and 0.817, respectively; and there was a significant difference (p=0.021) between the SnapShot® and VistaScan®. For the three incidences, the accuracy of Express®, VistaScan® and SnapShot® was 0.707, 0.740 and 0.784, respectively; and there was a significant difference (p=0.035) between SnapShot® and Express®. There was no significant difference between the different voxels of CBCT (p=0.306). Thus, it was concluded that for the diagnosis of fractured endodontic instruments inside the root canal in the absence or presence of filling, periapical radiographs in one incidence were accurate, suggesting that this technique is the first choice. Direct digital radiographic systems with higher spatial resolution should be preferred, especially in the cases of canals with filling material. In this same situation, performing CBCT should be avoided, for the detection of fractured instrument, due to its low accuracyDoutoradoRadiologia OdontologicaDoutora em Radiologia Odontológic

Prevalence Of Suggestive Images Of Carotid Artery Calcifications On Panoramic Radiographs And Its Relationship With Predisposing Factors

Panoramic radiographs (PR) can display radiopaque images suggestive of calcified atheroma in the carotid artery in asymptomatic patients. The aim of this study was to evaluate the prevalence of these images on PR and their linkage with hypertension, obesity, age, gender and smoking habits. PR of 505 patients were evaluated. They were older than 30 years old and their PR had been taken for different clinical reasons. Their body mass index was calculated; their waist circumference was also taken into consideration. Information about smoking habits and hypertension was obtained. The observers analyzed the presence of radiopaque mass in the region of the cervical vertebrae C3-C4 through the PR, confirmed by an antero-posterior (AP) radiograph. The results showed a 7.92% prevalence of suggestive images of calcifications on PR and on AP radiograph. The adjusted Odds Ratio showed association with age and smoking habits. The calcification process is almost nine times higher for the elderly when compared to the young. As far as smokers are concerned, this process is twice worse when compared to no smokers. In conclusion, 7.92% of the group studied presented suggestive images of carotid atherosclerosis on PR, which is directly associated with the age and smoking habits.2172201220

Bisphosphonate-related osteonecrosis of the jaw: a review of the literature

Bisphosphonates (BPs) are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defines BRONJ as an area of exposed bone in the maxillofacial region that has not healed within 8 weeks after identification by a healthcare provider in a patient who is receiving or has been exposed to a bisphosphonate and has not had radiation therapy to the craniofacial region. Bisphosphonate-related osteonecrosis of the jaw (BRONJ) can adversely affect quality of life, as it may produce significant morbidity. The American Association of Oral and Maxillofacial Surgeons (AAOMS) considers as vitally important that information on BRONJ be disseminated to other dental and medical specialties. The purpose of this work is to offer a perspective on how dentists should manage patients on BPs, to show the benefits of accurately diagnosing BRONJ, and to present diagnostic aids and treatments strategies for the condition.Bisphosphonates (BPs) are a class of drugs used to treat osteoporosis and malignant bone metastasis. BPs show high binding capacity to the bone matrix, especially in sites of active bone metabolism. The American Society for Bone and Mineral Research defin2014sem informaçãosem informaçã

Soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares no município de São Paulo, 2020

OBJECTIVE: To estimate seroprevalence of SARS-CoV-2 antibodies in schoolchildren aged 4 to 14 years living in the city of São Paulo, according to clinical, demographic, epidemiological, and social variables, during the school closure period as a measure against covid-19 spread. METHODS: A serological survey was made in September 2020 with a random sample stratified by school system (municipal public, state public and private) type. A venous blood sample was collected using the Wondfo SARS-CoV-2 Antibody Test (lateral flow method) for detection of total SARS-CoV-2 virus antibodies. Semi-structured questionnaires were applied to collect clinical, demographic, social, and epidemiological data. RESULTS: Seroprevalence of SARS-CoV-2 antibodies in schoolchildren was of 16.6% (95%CI 15.4–17.8). The study found higher seroprevalence in the municipal (18.5%; 95%CI 16.6–20.6) and state (16.2%; 95%CI 14.4–18.2) public school systems compared to the private school system (11.7; 95%CI 10.0–13.7), among black and brown students (18.4%; 95%CI 16.8–20.2) and in the most vulnerable social stratum (18.5 %;95%CI 16.9–20.2). Lower seroprevalence was identified in schoolchildren who reported following the recommended protective measures against covid-19. CONCLUSION: Seroprevalence of SARS-CoV-2 antibodies is found mainly in the most socially vulnerable schoolchildren. This study can contribute to support public policies that reinforce the importance of suspending face-to-face classes and developing strategies aimed at protective measures and monitoring of the serological status of those who have not yet been included in the vaccination schedule.OBJETIVO: Estimar a soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares de quatro a 14 anos de idade residentes no município de São Paulo, segundo variáveis clínicas, demográficas, epidemiológicas e sociais, durante o período de fechamento das escolas como medida de controle da covid-19. MÉTODOS: Realizou-se um inquérito sorológico em setembro de 2020 com amostra aleatória estratificada por tipo de rede de ensino (pública municipal, pública estadual e privada). Foi coletada amostra de sangue venoso utilizando-se o teste de imunoensaio de fluxo lateral da fabricante Wondfo para detecção de anticorpos totais contra o vírus SARS-CoV-2. Aplicaram-se questionários semiestruturados para o levantamento de dados clínicos, demográficos, sociais e epidemiológicos. RESULTADOS: A soroprevalência de anticorpos do vírus SARS-CoV-2 em escolares foi de 16,6% (IC95% 15,4–17,8). O estudo encontrou soroprevalências mais elevadas na rede pública municipal (18,5%; IC95% 16,6–20,6) e estadual (16,2%; IC95% 14,4–18,2) em relação à rede privada (11,7; IC95% 10,0–13,7) e entre escolares da raça/cor preta e parda (18,4%; IC95% 16,8–20,2) e no estrato social mais vulnerável (18,5%; IC95% 16,9–20,2). A pesquisa identificou menores soroprevalências nos escolares que relataram seguir as medidas recomendadas de proteção contra a covid-19. CONCLUSÃO: A soroprevalência de anticorpos contra o vírus SARS-CoV-2 atinge principalmente os escolares socialmente mais vulneráveis. Este estudo pode contribuir para embasar políticas públicas que reforcem a importância da suspensão das aulas presenciais e da necessidade de estratégias de medidas de proteção e acompanhamento do status sorológico daqueles que ainda não foram contemplados no calendário vacinal

Pervasive gaps in Amazonian ecological research

Biodiversity loss is one of the main challenges of our time,1,2 and attempts to address it require a clear un derstanding of how ecological communities respond to environmental change across time and space.3,4 While the increasing availability of global databases on ecological communities has advanced our knowledge of biodiversity sensitivity to environmental changes,5–7 vast areas of the tropics remain understudied.8–11 In the American tropics, Amazonia stands out as the world’s most diverse rainforest and the primary source of Neotropical biodiversity,12 but it remains among the least known forests in America and is often underrepre sented in biodiversity databases.13–15 To worsen this situation, human-induced modifications16,17 may elim inate pieces of the Amazon’s biodiversity puzzle before we can use them to understand how ecological com munities are responding. To increase generalization and applicability of biodiversity knowledge,18,19 it is thus crucial to reduce biases in ecological research, particularly in regions projected to face the most pronounced environmental changes. We integrate ecological community metadata of 7,694 sampling sites for multiple or ganism groups in a machine learning model framework to map the research probability across the Brazilian Amazonia, while identifying the region’s vulnerability to environmental change. 15%–18% of the most ne glected areas in ecological research are expected to experience severe climate or land use changes by 2050. This means that unless we take immediate action, we will not be able to establish their current status, much less monitor how it is changing and what is being lostinfo:eu-repo/semantics/publishedVersio

Qualidade de vida de indivíduos com HIV: revisão integrativa / Quality of living of individuals with HIV integration review

 A qualidade de  vida de pacientes vivendo com HIV/AIDS é essencial, tendo em vista o caso específico dos adolescentes é ainda mais importante porque o jovem além de lidar com a resistência e a aceitação da doença, deve também enfrentar os conflitos da puberdade.O presente trabalho tem como objetivo realizar uma revisão integrativa em relação a qualidade de vida dos pacientes com HIV. Trata-se de um estudo de revisão integrativa realizado no período de 2016 a 2017, utilizando-se o banco de dados Medline e Lilacs. Apesar do impacto da infecção pelo HIV/AIDS na saúde psicológica e nas relações sociais dos indivíduos infectados, assim como no domínio físico, o uso da TARV provocou consequências positivas na saúde psicológica, proporcionando a desconstrução da ideia de morte advinda ao diagnóstico de portador do HIV/AIDS e a construção de melhores perspectivas de vida. A adesão ao tratamento em HIV/AIDS está relacionada a um aumento da sobrevida e de sua qualidade. Porém deve-se respeitar a posição pessoal do portador para fazer ou não o tratamento

Worldwide trends in underweight and obesity from 1990 to 2022: a pooled analysis of 3663 population-representative studies with 222 million children, adolescents, and adults

Background Underweight and obesity are associated with adverse health outcomes throughout the life course. We estimated the individual and combined prevalence of underweight or thinness and obesity, and their changes, from 1990 to 2022 for adults and school-aged children and adolescents in 200 countries and territories. Methods We used data from 3663 population-based studies with 222 million participants that measured height and weight in representative samples of the general population. We used a Bayesian hierarchical model to estimate trends in the prevalence of different BMI categories, separately for adults (age ≥20 years) and school-aged children and adolescents (age 5–19 years), from 1990 to 2022 for 200 countries and territories. For adults, we report the individual and combined prevalence of underweight (BMI <18·5 kg/m2) and obesity (BMI ≥30 kg/m2). For schoolaged children and adolescents, we report thinness (BMI <2 SD below the median of the WHO growth reference) and obesity (BMI >2 SD above the median). Findings From 1990 to 2022, the combined prevalence of underweight and obesity in adults decreased in 11 countries (6%) for women and 17 (9%) for men with a posterior probability of at least 0·80 that the observed changes were true decreases. The combined prevalence increased in 162 countries (81%) for women and 140 countries (70%) for men with a posterior probability of at least 0·80. In 2022, the combined prevalence of underweight and obesity was highest in island nations in the Caribbean and Polynesia and Micronesia, and countries in the Middle East and north Africa. Obesity prevalence was higher than underweight with posterior probability of at least 0·80 in 177 countries (89%) for women and 145 (73%) for men in 2022, whereas the converse was true in 16 countries (8%) for women, and 39 (20%) for men. From 1990 to 2022, the combined prevalence of thinness and obesity decreased among girls in five countries (3%) and among boys in 15 countries (8%) with a posterior probability of at least 0·80, and increased among girls in 140 countries (70%) and boys in 137 countries (69%) with a posterior probability of at least 0·80. The countries with highest combined prevalence of thinness and obesity in school-aged children and adolescents in 2022 were in Polynesia and Micronesia and the Caribbean for both sexes, and Chile and Qatar for boys. Combined prevalence was also high in some countries in south Asia, such as India and Pakistan, where thinness remained prevalent despite having declined. In 2022, obesity in school-aged children and adolescents was more prevalent than thinness with a posterior probability of at least 0·80 among girls in 133 countries (67%) and boys in 125 countries (63%), whereas the converse was true in 35 countries (18%) and 42 countries (21%), respectively. In almost all countries for both adults and school-aged children and adolescents, the increases in double burden were driven by increases in obesity, and decreases in double burden by declining underweight or thinness. Interpretation The combined burden of underweight and obesity has increased in most countries, driven by an increase in obesity, while underweight and thinness remain prevalent in south Asia and parts of Africa. A healthy nutrition transition that enhances access to nutritious foods is needed to address the remaining burden of underweight while curbing and reversing the increase in obesit

Global variation in diabetes diagnosis and prevalence based on fasting glucose and hemoglobin A1c

Fasting plasma glucose (FPG) and hemoglobin A1c (HbA1c) are both used to diagnose diabetes, but these measurements can identify different people as having diabetes. We used data from 117 population-based studies and quantified, in different world regions, the prevalence of diagnosed diabetes, and whether those who were previously undiagnosed and detected as having diabetes in survey screening, had elevated FPG, HbA1c or both. We developed prediction equations for estimating the probability that a person without previously diagnosed diabetes, and at a specific level of FPG, had elevated HbA1c, and vice versa. The age-standardized proportion of diabetes that was previously undiagnosed and detected in survey screening ranged from 30% in the high-income western region to 66% in south Asia. Among those with screen-detected diabetes with either test, the age-standardized proportion who had elevated levels of both FPG and HbA1c was 29-39% across regions; the remainder had discordant elevation of FPG or HbA1c. In most low- and middle-income regions, isolated elevated HbA1c was more common than isolated elevated FPG. In these regions, the use of FPG alone may delay diabetes diagnosis and underestimate diabetes prevalence. Our prediction equations help allocate finite resources for measuring HbA1c to reduce the global shortfall in diabetes diagnosis and surveillance

Design and baseline characteristics of the finerenone in reducing cardiovascular mortality and morbidity in diabetic kidney disease trial

Background: Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. Patients and Methods: The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate >= 25 mL/min/1.73 m(2) and albuminuria (urinary albumin-to-creatinine ratio >= 30 to <= 5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level alpha = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. Conclusions: FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049