Apical periodontitis, atherosclerosis, and hypertension: correlation between inflammatory mechanisms and systemic repercussions - integrative review

Apical periodontitis (AP) is a condition characterized by inflammatory and infectious components in the tooth canal. AP affects periradicular tissues and has systemic repercussions. Physical exercise is a structured activity that requires cardiorespiratory function, and can modulate the inflammatory profile in pathological conditions. As a result, this study aimed to determine the effects of aerobic physical training (PT) on the alveolar bone with and without AP, and its systemic inflammatory repercussions. AP was induced in the mandibular first molars, and PT was performed on a treadmill for five consecutive days over four weeks, with progressive increases in speed and activity time. Blood samples were collected to determine serum cytokine levels using immunoassays, and alveolar bone samples were collected for histopathological evaluation, lesion volume and microarchitecture assessment using computed microtomography. Animals with AP had increased pro-inflammatory cytokines levels compared to those without AP; however, these levels were attenuated or restored by PT. Compared to the AP group, the AP + PT group had a smaller lesion volume and greater preservation of the bone trabeculae in the remaining alveolar bone surrounding the lesion. In overall, PT minimized the severity of AP proving to be a valid strategy for individuals undergoing endodontic treatment.

Objective: To identify in the literature factors that influence the mortality of critically ill burn patients. Method: This is an integrative literature review. To create the guiding question, the PICo strategy was used, in which the population was established as "burn patient", interest in "factors associated with mortality" and as context "critical condition", formulating the following research question: What are the factors that influence the mortality of critically ill burn victims? The search was conducted in two selected databases: Virtual Health Library and PubMed, from August to October 2023. As this is an integrative review, the study does not require approval by the research ethics committee. Results: A total of 3077 scientific studies were identified in the initial search of the selected databases. After applying the selection criteria, 17 studies remained to compose the final sample. Among the findings, the main factors that influenced mortality were advanced age, greater burned surface area and body depth, presence of smoke inhalation, thermal burn due to direct flames, comorbidities, especially cardiovascular and renal diseases, and hypoalbuminemia. Conclusion: it was possible to identify that the main factors that influence the mortality of burn patients who are in serious condition, described in the literature are: advanced age, extent of the burned area, smoke inhalation, comorbidities and low amount of albumin in the body. It is important to know these factors in order to be able to offer comprehensive care and minimize risks in order to reduce deaths caused by the event.

The postpartum period is considered a phase of many physiological and hormonal changes that affect the individual. Fatigue is something present and can influence the postpartum woman in a negative way. In this way, the nurse has an essential role, and the nursing process can be used to establish an efficient care plan. To present the main nursing interventions and activities of the nursing diagnosis (ND) fatigue (00093) in individuals/people in the immediate postpartum period obtained through an integrative literature review and correlate with the proposed ND puerperal fatigue/excessive burden of fatigue in the postpartum period. Integrative literature review, carried out in the databases Cochrane, Scopus and Medical Literature Analysis and Retrieval System Online (MEDLINE), Web of Science (WoS), Virtual Health Library (VHL), and Cumulative Index to Nursing and Allied Health Literature (CINAHL), following rigorous methodological standards. Six articles were included that identified the main nursing interventions related to the proposed ND puerperal fatigue. The integrative review highlighted the main nursing interventions and activities, and this study will be the basis for the next stages of the validation process for the ND puerperal fatigue/excessive fatigue in the postpartum period. This work can help nurses in clinical practice establish an efficient care plan through the most accurate nursing interventions and thus improve the quality of nursing services.

Objective: To verify the relationship between obesity and the occurrence of negative outcomes in hospitalized patients. Methodology: An integrative review was carried out using the National Library of Medicine of the National Institutes of Health (PubMed) and the Virtual Health Library (VLH/BVS) database. Results: It was observed that obese patients are 2 to 5 times more likely to need Invasive Mechanical Ventilation (IMV) when admitted to the Intensive Care Unit. Patients with high BMI (obese) and who needed mechanical ventilation had a mortality rate above 60%. The risk increases as the patient has other pathologies, this fact is shown that mortality by COVID-19 has multifactorial causes. Conclusion: The study showed that obesity is a risk factor associated with the increased development of the severe form of the disease, usually associated with other pathologies (hypertension, diabetes and cardiovascular diseases). That is, obesity increases the likelihood of unfavorable outcomes.

Background: Rural and remote nursing has unique practice requirements that create a need for distinct education and practice preparation. Preparing registered nurses (RNs) to work in rural and remote communities is essential for the support and advancement of rural and remote health, as there is a shortage of rural and remote health care providers. Purpose: An integrative literature review was conducted to identify the current continuing education needs of rural and remote RNs internationally. Sample: Eight studies were included in the integrative review of the literature. Countries reported in the literature included Canada (n = 2), Australia (n = 2), Sweden (n = 1) and the United States (n = 3). Method: An integrative literature review on rural and remote nursing practice continuing education was conducted using Torraco’s (2005) guidelines, in addition to Whittemore and Knafl’s (2005) methodological strategies. A search strategy was created, tested, and approved by the research team.Themes were extracted, collated, analyzed, and knowledge synthesized. Findings: Rural and remote RNs identified areas requiring enhanced ongoing training. The identified training areas were summarized into the following four themes: 1) Comprehensive specialized nursing practice for direct patient care, 2) Unanticipated events, 3) Non-direct patient care, and 4) Advanced specialty courses. Conclusion: The autonomy, competency, and expertise that is expected of RNs working in rural and remote locations requires educational supports. Rural and remote nursing continuing education is required in the areas of: comprehensive specialized nursing practice for direct patient care, unanticipated events, non-direct patient care, and advanced specialty courses. Keywords: continuing education, integrative review, registered nurse(s), remote, rural Acknowledgements: The authors thank Saskatchewan Polytechnic for partial funding of this review through the Seed Applied Research Program. The authors also thank their research team member Chau Ha and research assistant Devendrakumar Kanani for their contributions to this integrative review.

Objective To investigate the effect of root canal filling calcium hydroxide paste combined with root canal on serum levels of inflammatory factors in treatment of dental pulp diseases and periapical periodontitis. Methods Eighty-two patients with pulpitis and periapical periodontitis from February 2015 to January 2016 were divided into control group (n=41) and study group (n=41) according to different dosage regimen. Both groups were treated with root canal therapy, the control group was treated with zinc oxide iodoform clove oil cement, the study group was given calcium hydroxide paste. The clinical curative effects, pain during root canal therapy (IAE) was observed. Before and after treatment between the two groups, periodontal index [gingival index (GI), periodontal probing depth (PD), bleeding on probing index (BI), plaque index (PLI)] [white blood cells and inflammatory factors interleukin -4 (IL-4), IL-6, high sensitive C reactive protein (hs-CRP), tumor necrosis factor alpha (TNF-alpha)] level changes were compared. Results The total effective rate of the study group (95.12%) was higher than that of the control group (78.05%), and the incidence of Ⅲ IAE (7.32%) was lower than that of the control group (34.39%), and the difference was significant (P 0.05), after treatment, the each indexes in study group were better than those in the control group, the difference was significant (P<0.05). Conclusions Root canal filling calcium hydroxide paste combined with root canal can effectively improve the serum levels of inflammatory factors and periodontal status in the patients with pulpitis and periapical periodontitis, root canal therapy can relieve period pain, improve the therapeutic effect, has the value of popularization. Key words: Calcium hydroxide paste; Root canal filling; Root canal treatment; Pulp disease; Periapical periodontitis

Association of Radiographically Diagnosed Apical Periodontitis and Cardiovascular Disease: A Hospital Records–based Study

Controversial findings exist in the literature regarding the association between tobacco smoking and development of apical periodontitis or need for root canal treatment, with some studies reporting an increase in the prevalence of these outcomes in smokers, whilst others reporting no association. To evaluate if there is scientific evidence to support an association between tobacco smoking and a greater prevalence of apical periodontitis and/or root canal treatments. A systematic search was performed using MeSH terms and free terms in the PubMed, Scopus, Virtual Health Library (VHL), Cochrane library and Open Gray databases. Observational studies that evaluated the association between smoking and the development or healing of periapical lesion and/or the prevalence of root canal treatment in humans were included. A quality assessment of included studies was performed, and the relevant information and findings were evaluated. A meta-analysis using nine included studies was performed through RevMan software, and the certainty of evidence was evaluated through GRADE. Fifteen studies were included, of which 10 were classified as low risk of bias, 4 were considered as moderate risk of bias and 1 as high risk of bias. Ten studies reported that smoking was associated with a greater prevalence of periapical periodontitis and/or root canal treatment. Five studies reported no association. Nine studies were included in the pooledmeta-analysis, comprising two subgroups: apical periodontitis and root canal treatment. From these nine studies, eight studies were included in the apical periodontitis subgroup meta-analysis and demonstrated that this condition was significantly more prevalent in smokers when compared to the nonsmokers (odds ratio=2.78[CI: 1.60, 4.85], P<0.001; I2 =79%; no adjusted odds ratio). Three studies were included in the root canal treatment subgroup meta-analysis and demonstrated an increased prevalence in smokers when compared to the nonsmokers (odds ratio=2.73 [CI: 1.06, 2.83], P<0.001; I2 =72%; no adjusted odds ratio). The pooled meta-analysis demonstrated that smokers had twice the chance of having apical periodontitis and/or root canal treatment when compared to nonsmokers (odds ratio of 2.42 [CI: 1.59, 3.68], P<0.01; I2 =85%). The GRADE analysis demonstrated moderate certainty of evidence. Several confounding factors were identified such as misinformation regarding the period of time subjects had smoked, as well as the frequency of smoking and the number of cigarettes consumed. No adjustment in odds ratio data for confounding was performed. This systematic review and meta-analysis indicate that tobacco smokers have an increased prevalence of periapical periodontitis and root canal treatments with moderate certainty of evidence.

Motorcycle-related traffic accidents represent a significant public health issue in Brazil. Motorcyclists are particularly vulnerable due to the lack of protective physical structures, leaving the human body exposed to direct impacts during collisions. This study aimed to analyze the most prevalent injuries among victims of motorcycle traffic accidents. An integrative literature review was conducted using the PubMed, BVS (Virtual Health Library), SciELO (Scientific Electronic Library Online), and Cochrane Library databases. The search employed the following Health Science Descriptors (DeCS): “Traffic Accidents,” “Motorcycles,” and “Wounds and Injuries,” combined with the Boolean operator AND. Articles written in Portuguese, English, or Spanish, freely available in full text, published between 2019 and 2024, and aligned with the study’s objective were included. Exclusions included incomplete texts, integrative reviews, monographs, dissertations, theses, conference proceedings, and editorials. The final sample comprised 7 articles. Results indicate that skull/facial injuries are the most prevalent among motorcycle accident victims and are associated with high severity. Identifying these injuries can aid in planning and developing strategies to reduce the high incidence of such accidents.

Objetivou-se verificar evidências na literatura acerca da eficácia da terapia a laser de baixa intensidade na reparação tecidual de úlceras diabéticas dos pés. Realizou-se uma revisão integrativa de literatura, por meio das plataformas online de pesquisa Us national Library of Medicine (PUBMED) e Biblioteca Virtual em Saúde (BVS) nas bases de dados LILACS, MEDLINE E BDENF. Para a elaboração da questão de pesquisa da revisão integrativa, utilizou-se a estratégia PICO, fundamental para a melhora da especificidade e clareza conceitual da situação clínica a ser estudada retornando resultados de maior qualidade e precisão. Foram selecionados artigos indexados em periódicos nacionais e internacionais, disponibilizados na íntegra, pesquisas envolvendo seres humanos sem distinção de gênero, e estudos compreendidos nos últimos 5 anos em todos os idiomas encontrados. Os resultados obtidos demonstram eficácia comprovada no tratamento de ulcerações diabéticas através da estimulação celular proporcionada pelo laser, que resulta em uma maior proliferação celular, neovascularização, e síntese de colágeno. Portanto, o Laser faz-se importante por ser uma terapia de baixo-custo alternativa ao tratamento convencional das úlceras diabéticas, que oferece evidência científica no processo de reparação tecidual e redução da área lesionada.

Objective: To analyze whether there is strong scientific evidence on the relationship between diabetes mellitus and the behavior of children and adolescents. Method: Integrative literature review considering the virtual portals PubMed and BVS - Virtual Health Library. In this review were adopted the descriptors or MeSH Terms "Diabetes Mellitus", "Complications of Diabetes Mellitus", "Child Behavior" and "Adolescent Behavior", with the Boolean operators AND an NOT, respecting the PRISMA methodology: Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The guiding question was directly related to the general objective of this review. We included scientific articles, published without time limit, in English, Spanish, and Portuguese. The exclusion criteria were: opinions, letters to the reader, essays, monographs, dissertations or theses, and studies without abstracts, focused exclusively on eating behavior, involving other dysfunctions that may affect the nervous system or behavior, or that were not related to the guiding question. The selection of the records was made independently by two researchers. From the reading of the title and abstract there was the selection of the papers for reading in full. Results: From 5,355 records, five articles were included and synthesized. Conclusion: Sleep difficulties, difficulties in the performance of executive functions, cognitive or daily routine were related to behavioral problems of this target population, as well as greater symptoms of depression, anxiety, and emotional instability, with the need for specialized monitoring.

Apical periodontitis: a very prevalent problem.

Root Canal Treatment and Apical Periodontitis in a Brazilian Population with Type 1 Diabetes Mellitus: A Cross-sectional Paired Study

Adolescence is a stage of life where there are major physical and biological transformations concomitant with psychological and social ones, which occur with the development of sexuality and which influence the human being's personality and other aspects of life. Health literacy (HL) can be understood as an individual's ability to access, understand, evaluate and put into practice basic health information. Adolescent oral health literacy (OHL) is an area that is little explored, despite the importance of this formative stage in the individual approach to healthy lifestyles and behaviors. The objective of this study was to carry out an integrative literature review on research instruments validated in Brazil for OHL among adolescents. The search strategy was carried out in August 2023, with a broad search for studies that assessed OHL in adolescents, in the Virtual Health Library (VHL), US National Library of Medicine (PubMed) and Scientific Electronic databases. Library Online (Scielo). The keywords used were “health literacy” and “oral health” and “adolescents”. Inclusion criteria: free full texts; only: articles, books and documents, clinical trials, meta-analyses, controlled and randomized trials, analyzes and systematic reviews; without limitations of date or language. Exclusion criteria: studies without the three descriptors present in the text simultaneously, theses and monographs, abstracts, letters to the editor. 47 articles were found in VHL, 118 in PubMed and 13 in Scielo. Nineteen articles were analyzed and presented according to: author, title, year of publication, type of study, objectives, sample size and age group, sample recruitment, data collection tool, limitations and health outcomes. The only research instrument on adolescent OHL validated in Brazil was the BREALD-30 questionnaire, a Brazilian version of the Rapid Estimate of Adult Literacy in Dentistry, which measures literacy through word recognition. An important research gap in this field was revealed.

Ozone is a colorless gas with a characteristic odor present in nature in the form of trivalent oxygen. In 2015, the Federal Council of Dentistry (CFO/Brazil) approved the use of ozone therapy and in 2018 the Ministry of Health (MS/Brazil) approved the application of Ozone Therapy as a Complementary Integrative Practice in the Unified Health System. Therefore, the objective of this study was to verify the applicability of ozone therapy in dental practice. This is an integrative literature review whose search was performed in the Medline/Pubmed, LILACS, SciElo, and Google Scholar databases. Studies published in the last 5 years in English, Portuguese or Spanish were eligible. After the search, 312 titles were found and after exclusion of duplicates and analysis of abstracts and full text, 13 articles were included in this review. The literature reports the application of ozone therapy in several areas in the treatment of acute and chronic diseases. As a mechanism of action, ozone has a direct antimicrobial effect, immunoregulation, antioxidant defenses, analgesic, and vasodilator effects. In dentistry, its applicability is mainly in preventive dentistry and as a complement in surgical procedur es, endodontic, and periodontal treatments.