Infiltração apical em obturações de canais realizadas após aplicação do laser Nd: YAG ou solução de EDTA nas paredes do canal radicular

Marginal apical leakage was evaluated in root canal filling performed with two sorts of cements after applying Nd:YAG laser or an EDTA solution in the root canal walls. Sixty-two human lower premolars had their canals instrumented through mechanical technique. Afterwards the external root surfaces were impermeabilized, except for the foramen. The roots were then divided into 4 groups of 15, according to the type of treatment performed on the root canal walls and the type of cement utilized in the filling. Group I - application of Nd:YAG laser and filling with AH Plus cement; Group II - application of Nd:YAG laser and filling with Endofill cement; Group III - application of EDTA for 5 minutes and filling with AH Plus cement; Group IV - application of EDTA for 5 minutes and filling with Endofill cement. Two teeth served as negative and positive controls. Afterwards, the roots were immersed in a 2%-methylene blue dye, for 48 hours. Wearing of the roots took place following the removal of impermeabilization for the reading of leakage magnitude, by means of a light microscope through planimetry technique The results indicated AH Plus cement as the one to allow the least apical leakage, as well as Nd:YAG laser application, when utilized in the treatment of root canal walls, prior to filling.Avaliou-se a infiltração marginal apical em obturações endodônticas utilizando dois tipos de cimentos após a aplicação do laser Nd:YAG ou solução de EDTA nas paredes do canal radicular. Utilizou-se sessenta e dois dentes pré-molares inferiores humanos que tiveram seus canais radiculares instrumentados por técnica mecanizada. Em seguida, as superfícies externas radiculares foram impermeabilizadas, exceto o forame apical. As raízes foram, então, divididas em 4 grupos de 15, de acordo com o tipo de tratamento realizado nas paredes dos canais radiculares e o tipo de cimento utilizado para a obturação. Grupo I - aplicação do laser Nd:YAG e obturação com cimento AH Plus; Grupo II - aplicação do laser Nd:YAG e obturação com cimento Endofill; Grupo III - aplicação de EDTA por 5 minutos e obturação com cimento AH Plus; Grupo IV - aplicação de EDTA por 5 minutos e obturação com cimento Endofill. Dois dentes serviram como controles positivo e negativo. Em seguida, as raízes foram imersas em solução de azul-de-metileno a 2%, durante 48 horas. Após remoção da impermeabilização foi realizado o desgaste das raízes para leitura da magnitude das infiltrações, por meio de um microscópio óptico pela técnica da planimetria. Os resultados indicaram que o cimento AH Plus foi o que permitiu menor infiltração apical, assim como a aplicação do laser Nd:YAG, quando utilizado no tratamento das paredes dos canais radiculares, anteriormente à obturação

Effectiveness of 980-mm Diode and 1064-nm Extra-Long-Pulse Neodymium-Doped Yttrium Aluminum Garnet Lasers in Implant Disinfection

Objective: To evaluate the potential of 980-nm gallium aluminum arsenide (GaAlAs) and 1064-nm neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers to reduce bacteria after irradiation of implant surfaces contaminated with Enterococcus faecalis and Porphyromonas gingivalis and on irradiated implant surface morphology. Background: Despite the frequency of implant success, some implant loss is related to peri-implantitis because of difficulty in eliminating the biofilm. Methods: Implants (3.75 x 13 mm) with machined surfaces, surfaces sand blasted with titanium oxide (TiO(2)), and sand-blasted and acid-etched surfaces were exposed to P. gingivalis and E. faecalis cultures and irradiated with 980-nm GaAlAs or 1064-nm Nd: YAG lasers. After laser treatments, the number of remaining colony-forming units and implant surface morphology were analyzed using scanning electron microscopy (SEM). Results: The Nd: YAG laser was able to promote a total contamination reduction on all implants irradiated. The results with the GaAlAs laser showed 100% bacteria reduction on the implants irradiated with 3 W. Irradiation with 2.5 W and 3 W achieved 100% of bacteria reduction on P. gingivalis-contaminated implants. Decontamination was not complete for the sand-blasted TiO(2) (78.6%) and acid-etched surfaces (49.4%) contaminated with E. faecalis and irradiated with 2.5 W. SEM showed no implant surface changes. Conclusion: The wavelengths used in this research provided bacteria reduction without damaging implant surfaces. New clinical research should be encouraged for the use of this technology in the treatment of peri-implantitis

Antibiotic use and associated factors in a large sample of hospitalised older people.

OBJECTIVES: The aims of this study were to assess (i) the prevalence of antibiotic use, (ii) factors associated with their use and (iii) the association with in-hospital mortality in a large sample of hospitalised older people in Italy. METHODS: Data were obtained from the 2010-2017 REPOSI register held in more than 100 internal medicine and geriatric wards in Italy. Patients aged ≥65 years with at least one antibiotic prescription during their hospitalisation were selected. Multivariable logistic regression models were used to determine factors associated with antibiotic use. RESULTS: A total of 5442 older patients were included in the analysis, of whom 2786 (51.2%) were prescribed antibiotics during their hospitalisation. The most frequently prescribed antibiotic class was β- lactams, accounting for 50% of the total prescriptions. Poor physical independence, corticosteroid use and being hospitalised in Northern Italy were factors associated with a higher likelihood of being prescribed antibiotics. Antibiotic use was associated with an increased risk of in-hospital mortality (odds ratio=2.52, 95% confidence interval 1.82-3.48) also when accounting for factors associated with their use. CONCLUSION: Hospitalised older people are often prescribed antibiotics. Factors related to poor physical independence and corticosteroid use are associated with increased antibiotic use. Being prescribed antibiotics is also associated with an increased risk of in-hospital death. These results demand the implementation of specific stewardship programmes to improve the correct use of antibiotics in hospital settings and to reduce the risk of antimicrobial resistance

Prognostic relevance of glomerular filtration rate estimation obtained through different equations in hospitalized elderly patients

The estimated glomerular filtration rate (eGFR) is a predictor of important outcomes and its reduction has been associated with the risk of all-cause mortality in both general population and elderly patients. However while reduced renal function is common in older people, the best method for estimating GFR remains unclear, especially in an acute care setting. Most studies analyzing the accuracy of eGFR in the elderly were carried out in different heterogeneous settings. In this study, we compare the prognostic value of different formulas estimating GFR in predicting the risk of in-hospital morbidity and mortality within 3 months from discharge in elderly hospitalized patients. Data were extracted from \u201cRegistro Politerapia Societ\ue0 Italiana di Medicina Interna (REPOSI)\u201d. Patients with available creatinine values at hospital admission were selected and eGFR was calculated according to the different formulas: Cockcroft-Gault, Modification of Diet in Renal Disease equation, Chronic Kidney Disease Epidemiology Collaboration, Berlin Initiative Study and Full Age Spectrum. 4621 patients were included in the analysis. Among these, 4.2% and 14.2% died during hospitalization and within 3 months from discharge, respectively. eGFR > 60 ml/min/1.73 m2 at admission was associated with a very low risk of mortality during the hospital stay and within 90 days from discharge, while an eGFR < 60 ml/min/1.73 m2 was associated with unfavorable outcomes, although with a poor level of accuracy (AUC 0.60\u20130.66). No difference in predictive power between different equations was found. Physicians should be aware of the prognostic role of eGFR in a comprehensive assessment of elderly in-patients

Prevalence, characteristics and treatment of chronic pain in elderly patients hospitalized in internal medicine wards

Background: Chronic pain is a frequent characteristic of elderly people and represents an actual and still poorly debated topic. Objective: We investigated pain prevalence and intensity, and its pharmacological therapy in elderly patients hospitalized in 101 internal medicine wards. Methods: Taking advantage of the “REgistro POliterapie Società Italiana Medicina Interna” (REPOSI), we collected 2535 patients of whom almost a quarter was older than 85 years old. Among them, 582 patients were affected by pain (either chronic or acute) and 296 were diagnosed with chronic pain. Results: Patients with pain showed worse cognitive status, higher depression and comorbidities, and a longer duration of hospital stay compared to those without pain (all p <.0366). Patients with chronic pain revealed lower level of independency in their daily life, worse cognitive status and higher level of depression compared to acute pain patients (all p <.0156). Moreover, most of them were not treated for pain at admission (73.4%) and half of them was not treated with any analgesic drug at discharge (50.5%). This difference affected also the reported levels of pain intensity. Patients who received analgesics at both admission and discharge remained stable (p =.172). Conversely, those not treated at admission who received an analgesic treatment during the hospital stay decreased their perceived pain (p <.0001). Conclusions: Our results show the need to focus more attention on the pharmacological treatment of chronic pain, especially in hospitalized elderly patients, in order to support them and facilitate their daily life after hospital discharge