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Background: There are several invasive dental procedures that require local anesthetics. However, its infiltration is usually associated with anxiety and fear, increasing the perception of pain in pediatric patients. For this reason, it is important to evaluate different strategies for its application. We compared the anesthetic effect of the administration of 2% lidocaine with epinephrine 1:80000 non-alkalized at slow speed and alkalized at fast speed to block the inferior alveolar nerve in deciduous molars., Methods: A crossover clinical trial was carried out whose sample consisted of 38 patients between 6-10 years who required bilateral pulp treatment in their first mandibular primary molars. At the first appointment, they received 2% lidocaine with 1:80000 alkalinized epinephrine administered at a fast rate, and at the second appointment, 2% lidocaine with 1:80000 non-alkalized epinephrine administered at a low speed. We evaluated the onset of action, duration of the anesthetic effect, and intensity of pain during its infiltration., Results: We found that non-alkalized lidocaine at slow speed had a shorter onset time of action (57.21±22.21 seconds) and longer duration of effect (170.82±43.75 minutes) compared to administration of alkalinized lidocaine at fast speed (74.03±22.09 seconds, 148.24±36.24 minutes, respectively). There was no difference in the level of pain intensity., Conclusion: In this study, the slow administration of the non-alkalized local anesthetic showed a shorter onset time of action and a longer duration of the anesthetic effect in comparison with the alkalized local anesthetic administered at a rapid rate in the blockade of the inferior alveolar nerve in deciduous molars., Competing Interests: There is no conflict of interest among all authors., (©2023 The Author(s).)

This article summarizes the clinical practice guideline (CPG) for the management of acute pancreatitis in the Social Security of Peru (EsSalud), to provide evidence-based clinical recommendations for the management of acute pancreatitis in EsSalud. A guideline development group (GEG) was formed that included medical specialists and methodologists. The GEG formulated 7 clinical questions to be answered by this CPG. Systematic searches of systematic reviews and -when considered relevant- primary studies were carried out in PubMed during 2022. The evidence was selected to answer each of the clinical questions posed. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the GEG used the GRADE methodology to review the evidence and formulate the recommendations, the points of good clinical practice, and the corresponding flow charts. Finally, the CPG was approved with Resolution No. 105-IETSI-ESSALUD-2022. This CPG addressed 7 clinical questions on fluid therapy, start of enteral nutrition, analgesia, type of nutrition, antibiotic, and surgical treatment. Based on these questions, 8 recommendations (1 strong and 7 conditional), 13 BPCs, and 1 flowchart were formulated. This article summarizes the methodology and evidence-based conclusions of the CPG for the management of acute pancreatitis in EsSalud.

Aims and Objectives: The detection of SARS-COV-2 in the oral cavity has generated endless claims about the efficacy of using oral mouthwashes to reduce viral load. This review aims to assess the current evidence on the use of oral antiseptics against SARS-CoV-2 and to assess the certainty of the evidence according to the GRADE system. The question this study focussed on was what is the efficacy of oral antiseptics against SARS-CoV-2?, Materials and Methods: A bibliographic search was performed in Medline databases through PubMed, Science Direct, and Google Scholar (until February 2022), using search terms related to COVID-19 and oral antiseptics. Two independent researchers extracted the information from the articles included in an excel form. The identification and selection of the studies was carried out from August 2021 to February 2022., Results: It was found that oral antiseptics can have a potential beneficial effect on COVID-19, mainly in reducing viral load. However, these potential benefits are mainly based on in-vitro studies or clinical studies with various methodological limitations. At present, the certainty of the evidence is very low due to inconsistency (heterogeneity), moderate-to-high risk of bias, and imprecision of the results., Conclusion: The certainty of the current evidence on the efficacy of oral antiseptics against SARS-CoV-2 is very low, mainly due to the methodological limitations of the studies. Therefore, for evidence-based decision-making about this intervention, clinical studies with greater methodological rigor are required. Oral antiseptics could present potential benefits in patients with COVID-19 mainly by reducing viral load. However, a careful and conscious evaluation of the evidence is required for decision-making in clinical practice., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright: © 2022 Journal of International Society of Preventive and Community Dentistry.)

Background: Clinical practice guidelines (CPGs) are statements that should be rigorously developed to guide clinicians' decision-making. However, given the scarce evidence for certain vulnerable groups like children, CPGs' recommendations formulation could be challenging., Methods: We conducted a scoping review of CPGs for COVID-19 management in children. Documents were included if they claimed to be a "clinical practice guideline", published between January and October 2021, and described the process followed to issue their recommendations. We assessed the quality using the "Appraisal of Guidelines for Research and Evaluation II" (AGREE-II) and described how the recommendations were reached., Results: We found five CPGs that fulfilled our inclusion criteria. The median score on the overall AGREE-II evaluation was 61% (range: 49%-72%), and the score on the third domain referred to the rigor of methodological development was 52% (range: 25%-88%). Recommendations for remdesivir, tocilizumab, and intravenous immunoglobulin were heterogeneous across CPGs (in favor, against, no recommendation), as well as the methodologies used to present the evidence, perform the benefits/harms balance, and issue the recommendation., Conclusions: Heterogeneous recommendations and justifications across CPGs were found in the three assessed topics. Future CPGs should describe in detail their evidence-to-decision process to issue reliable and transparent recommendations., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Introduction: This article summarizes the evidence-based recommendations of the clinical practice guide (CPG) for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases., Methods: For the provision of these recommendations, a guideline development group (local GDG) was established, including medical specialists andmethodologists that formulated seven clinical questions. Systematic searches of systematic reviews and -when it was considered pertinent- primary studies were conducted in PubMed and CENTRAL during December 2017 and July 2019. The evidence to answer each of the posed clinical questions was selected. The quality of the evidence was evaluated using the Grading ofRecommendations Assessment, Development, and Evaluation (GRADE) methodology. In periodic work meetings, the local GDG used the GRADE methodology to review the evidence and formulate the recommendations, points of good clinical practice, and flowcharts. Finally, the CPG was approved with Resolution N° 104-IETSI-ESSALUD-2020., Results: This CPG addressed seven clinical questions, divided into four topics. Based on these questions, 12 recommendations (3 strong and 9 weak), 17 points of good clinical practice, and two flowcharts (one for diagnosis and another for management) were formulated., Conclusion: This article summarizes the methodology and evidence-based conclusions from the CPG for for the diagnosis and management of Helicobacter pylori infection in gastroduodenal diseases.

Introduction: Asthma is a chronic inflammatory disease that is highly prevalent among pediatric patients. The results about the effect of asthma on the rate of dental caries are contradictory. The objective of this study was to determine the prevalence of dental caries in asthma pediatric patients using inhaled drugs., Population and Methods: Case-control study in a sample made up of pediatric patients who attended Centro Médico Naval "Cirujano Mayor Santiago Távara" between December 2014 and March 2015. Patients were divided into two groups: group A (cases) included asthma patients using inhalers as part of their treatment; group B (controls), healthy subjects who attended the same facility. A medical examination was done to determine the type, time, and frequency of treatment and an oral exam, to establish the prevalence of dental caries and the decayed, missing, and filled teeth (DMFT) index., Results: The prevalence of dental caries was 34.2 % in the control group and 28.3 % in the case group (p = 0.094). In relation to the rate of dental caries, the DMFT index in the control group was 4.73 ± 0.32, and 3.98 ± 0.31 in the case group ( p = 0.08). However, it was evidenced that a longer duration of inhaler use led to a significantly higher DMFT index (p = 0.04)., Conclusions: Inhaled drugs do not increase the prevalence of dental caries in asthma pediatric patients. However, there is a direct relationship between treatment duration and the prevalence of dental caries., Competing Interests: The authors report no conflicts of interest in this work., (Sociedad Argentina de Pediatría.)

Introduction: Asthma is related to caries but the risk factors are not completely determined. Therefore, the objective of the study was to determine the risk of dental caries in pediatric asthmatic patients in inhalation treatment with salbutamol and budesonide who went to the National Hospital Arzobispo Loayza., Methods: Case-control study that consisted of 184 pediatric patients, between 5 and 12 years old, who attended the pneumology and pediatric dentistry service of the National Hospital Arzobispo Loayza during the years 2016-2017. The group of cases (n = 92) was composed of patients with moderate asthma medicated with inhaled salbutamol and budesonide, while the control group (n = 92) was composed of healthy patients. The risk of dental caries was evaluated with the dietary record, oral hygiene index and number of carious lesions., Results: The risk according to the type of cariogenic diet was moderate in both groups (p = 0.768). The oral hygiene index in the control group was regular in 63% (n = 58) and in the case group, bad in 60.9% (n = 56); p=0.001. The number of carious lesions in the control group was moderate in 50% (n = 46) and in the case group, high in 47.8% (n = 44); p = 0.001. Therefore, the risk of dental caries in the case group was high in 50% (n = 46) and in the control group it was moderate in 72.8% (n = 67); p = 0.001., Conclusion: The risk of dental caries in asthmatic patients on inhaled therapy with salbutamol and budesonide is significantly higher than that of healthy patients., (Universidad Nacional de Córdoba)