RESUMEN
Studies investigating Xpert MTB/RIF diagnostic performance on cerebrospinal fluid (CSF) samples are lacking in resource-rich settings. Xpert MTB/RIF results for 740 CSF samples from 698 patients across England were retrospectively compared with the results of culture of the same and contemporary samples. The overall sensitivity was calculated at 55%.
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Líquido Cefalorraquídeo/microbiología , Farmacorresistencia Bacteriana , Técnicas de Diagnóstico Molecular , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/genética , Rifampin/farmacología , Tuberculosis del Sistema Nervioso Central/diagnóstico , Tuberculosis del Sistema Nervioso Central/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Juego de Reactivos para Diagnóstico , Sensibilidad y Especificidad , Adulto JovenRESUMEN
Increasing antibiotic resistance makes choosing antibiotics for suspected Gram-negative infection challenging. This study set out to identify key determinants of mortality among patients with Gram-negative bacteraemia, focusing particularly on the importance of appropriate empiric antibiotic treatment. We conducted a prospective observational study of 679 unselected adults with Gram-negative bacteraemia at ten acute english hospitals between October 2013 and March 2014. Appropriate empiric antibiotic treatment was defined as intravenous treatment on the day of blood culture collection with an antibiotic to which the cultured organism was sensitive in vitro. Mortality analyses were adjusted for patient demographics, co-morbidities and illness severity. The majority of bacteraemias were community-onset (70%); most were caused by Escherichia coli (65%), Klebsiella spp. (15%) or Pseudomonas spp. (7%). Main foci of infection were urinary tract (51%), abdomen/biliary tract (20%) and lower respiratory tract (14%). The main antibiotics used were co-amoxiclav (32%) and piperacillin-tazobactam (30%) with 34% receiving combination therapy (predominantly aminoglycosides). Empiric treatment was inappropriate in 34%. All-cause mortality was 8% at 7 days and 15% at 30 days. Independent predictors of mortality (p <0.05) included older age, greater burden of co-morbid disease, severity of illness at presentation and inflammatory response. Inappropriate empiric antibiotic therapy was not associated with mortality at either time-point (adjusted OR 0.82; 95% CI 0.35-1.94 and adjusted OR 0.92; 95% CI 0.50-1.66, respectively). Although our study does not exclude an impact of empiric antibiotic choice on survival in Gram-negative bacteraemia, outcome is determined primarily by patient and disease factors.
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Antibacterianos/uso terapéutico , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Infecciones por Bacterias Gramnegativas/tratamiento farmacológico , Infecciones por Bacterias Gramnegativas/microbiología , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Bacteriemia/diagnóstico , Bacteriemia/mortalidad , Causas de Muerte , Comorbilidad , Inglaterra/epidemiología , Femenino , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/mortalidad , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
National Blood Service (NBS) Tissue Services (TS) operates living donor and deceased donor tissue banking programmes. The living bone donor programme operates in collaboration with 91 orthopaedic departments across the country and collects bone donations, in the form of surgically removed femoral heads (FHs), from over 5,000 patients per annum undergoing total hip replacement. Bone donated via the living programme constitutes approximately 55% of the total bone donated to NBS. Non-NBS tissue banks, primarily in hospital orthopaedic departments, also bank donated bone for the UK. A survey of information received from 16 collaborating orthopaedic centres, between April 2003 and August 2004, identified 709 excluded donors. The total number of donations banked from these sites was 1,538. Donations can be excluded before collection if there are contraindications noted in a potential donor's medical history before their operation. Donors may also be excluded after collection of the FH, for instance because of reactive microbiology tests for blood borne viruses, or if the donation storage conditions or related documentation have not met stringent quality requirements. In this survey, bone or joint conditions were the major reasons for excluding potential donors before donation (154 of 709 exclusions, 22%), followed by a current or a past history of malignancy (139 of 709 exclusions, 20%). Local staffing and operational difficulties sometimes resulted in potential donors being missed, or specific reasons for exclusion not being reported (117 exclusions). These out numbered exclusions due to patient refusal (80 exclusions). A small number (< 5) appear to have been excluded erroneously. There was considerable local variation in the reasons given for exclusion and certainly under-reporting. A survey of donations discarded after collection in the same period highlighted that 43% were donor related; 110 of 370 did not provide a follow-up blood sample. More than 30% were due to delays in forwarding blood samples to the microbiological laboratory for testing, resulting in deterioration of the sample quality. Training to ensure that standards are complied with and a firm evidence base for exclusion criteria, applied uniformly, will help focus donor identification efforts on individuals meeting rational criteria so that fewer potential donations are lost.
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Bancos de Huesos , Selección de Donante/estadística & datos numéricos , Donadores Vivos/estadística & datos numéricos , Recolección de Datos , Humanos , Consentimiento Informado , Sistema de Registros , Estudios RetrospectivosRESUMEN
OBJECTIVE: The purpose of this study was to compare E-speed Plus film and digital imaging with a charge-coupled device (CCD) sensor and a complementary metal-oxide semiconductor active pixel sensor (CMOS-APS) in the detection of periapical bone lesions. STUDY DESIGN: Periapical lesions were created in the cortical and trabecular bone of 10 dried human mandibles. Seventy radio-graphic images and 140 digital images were evaluated by 6 endodontists and 2 radiologists. Receiver operating characteristics curves and analysis of variance were used for statistical analysis.Results. No statistically significant differences were found between film, CCD, and CMOS-APS systems. Lesion detection occurred with significantly greater accuracy in cortical bone than in trabecular bone, as well as when the cortical plate was involved. CONCLUSIONS: That no differences were found between the two sensors lends support for the use of CMOS-APS sensors, which require less system power and may have longer life spans than CCD sensors. Digital imaging required 50% less radiation than film to obtain the same diagnostic information.
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Proceso Alveolar/diagnóstico por imagen , Procesamiento de Imagen Asistido por Computador/métodos , Enfermedades Mandibulares/diagnóstico por imagen , Enfermedades Periapicales/diagnóstico por imagen , Radiografía Dental Digital/métodos , Película para Rayos X , Pérdida de Hueso Alveolar/diagnóstico por imagen , Análisis de Varianza , Endodoncia , Diseño de Equipo , Humanos , Procesamiento de Imagen Asistido por Computador/instrumentación , Curva ROC , Dosis de Radiación , Radiografía Dental Digital/instrumentación , Radiología , Raíz del Diente/diagnóstico por imagenRESUMEN
PURPOSE: To evaluate the effect of direction of first cure and the presence or absence of a facial margin bevel on the adaptation of facial margins of Class III resin-based composite (RBC) restorations. MATERIALS AND METHODS: Custom polyvinyl siloxane (PVS) light shields were fabricated for both the mesial and distal surfaces of 20 extracted incisors. Class III cavities were prepared in the mesial and distal surfaces of the incisors. On the facial, lingual, and gingival margins of 20 of the preparations a 0.5 mm wide enamel bevel was placed. The lingual and gingival, but not the facial, margins were beveled on the other 20 preparations. The PVS light shield was adapted to the tooth and trimmed to allow 1-2 mm of the facial margin to be exposed on 10 of the beveled and 10 of the non-beveled preparations. For the remaining 20 preparations the PVS light shield was trimmed to allow access of the curing light only from the lingual. Teeth were restored with Prisma TPH RBC. Using the appropriate shield, restorations in the facial first cure group were cured first from the facial and then from the lingual. Restorations in the lingual first cure group were cured only from the lingual. Restorations were finished flush with enamel margins and thermocycled following storage. Samples were exposed to a 50% solution of silver nitrate followed by light exposure. Teeth were sectioned and microleakage was evaluated at three levels (incisal, middle, and cervical). Four evaluators (blinded to direction of cure) independently scored microleakage using a categorical evaluation scale. Statistical analysis included non-parametric descriptive statistics, Cohen's kappa, chi-square analysis, and Kruskal-Wallis ANOVA. RESULTS: Samples prepared without a facial bevel revealed significantly more (P = 0.01) microleakage than preparations with a facial bevel. At the most incisal level, restorations cured first from the facial revealed significantly more (P < 0.001) microleakage than restorations cured first from the lingual. At the middle and cervical levels, restorations cured first from the facial revealed significantly less (P < 0.001) microleakage than restorations cured first from the lingual. When a facial bevel was present, samples cured first from the facial showed significantly less (P < 0.001) microleakage than those cured only from the lingual.
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Resinas Compuestas/efectos de la radiación , Adaptación Marginal Dental , Restauración Dental Permanente/métodos , Análisis de Varianza , Distribución de Chi-Cuadrado , Resinas Compuestas/química , Preparación de la Cavidad Dental/clasificación , Esmalte Dental/ultraestructura , Filtración Dental/clasificación , Filtración Dental/patología , Materiales Dentales/química , Pulido Dental , Restauración Dental Permanente/clasificación , Restauración Dental Permanente/instrumentación , Humanos , Incisivo , Luz , Variaciones Dependientes del Observador , Fotoquímica/instrumentación , Polivinilos/química , Reproducibilidad de los Resultados , Siloxanos/química , Tinción con Nitrato de Plata , Método Simple Ciego , Estadística como Asunto , Estadísticas no Paramétricas , Propiedades de Superficie , TermodinámicaRESUMEN
Separation of instruments while performing root canals is something that has plagued all practitioners. The purpose of this study was to evaluate the effect of rotational speed on nickel-titanium file distortion and separation. Forty extracted human molars were instrumented with Profile (Dentsply Tulsa Dental Products, Tulsa, OK) ISO .04 rotary nickel-titanium instruments at 166.67 or 333.33 rpm. The instruments were evaluated after instrumentation for separation and/or distortion. The results of this study were statistically significant and indicate that file distortion and/or separation is four times as likely to occur at 333.33 rpm vs. 166.67 rpm.
Asunto(s)
Técnica Odontológica de Alta Velocidad , Instrumentos Dentales , Preparación del Conducto Radicular/instrumentación , Análisis del Estrés Dental , Humanos , Diente Molar , Níquel , Rotación , TitanioRESUMEN
Previous studies have investigated the finishing and smoothness of composite and traditional glass-ionomer restorations, but few have included resin-modified glass-ionomer cements or more recent finishing systems. The results of using three different finishing systems (Sof-Lex, Enhance, finishing burs) on two composites (Silux, Prisma TPH), a traditional glass ionomer (Ketac-Fil), and a resin-modified glass ionomer (Fuji II LC) were studied. Sixty samples were condensed into sectioned acrylic tubes, covered with a Mylar matrix plus a glass slide at each surface, then cured as per the manufacturers' instructions. Samples were randomized to three groups of five for each material and testing with a Surfanalyzer 4000 of unfinished samples (cured with Mylar matrix) was done to obtain baseline average surface roughness (Ra). Samples were then finished as per the manufacturers' instructions using polishing disks, abrasive impregnated disks, and finishing burs before further surface testing. Samples finished with burs and with abrasive impregnated disks were further polished using polishing paste (Prisma Gloss) and again tested. Data were analyzed with ANOVA testing and Tukey's HSD pairwise comparison. Initial testing after randomization to groups showed no significant difference in surface roughness (P = 0.24). Two-factor analysis revealed no significant difference between materials (P = 0.34), a significant difference in method of finish (P < or = 0.00), with no significant interaction between type of material and method of finish (P = 0.11). Aluminum oxide disk and impregnated disk systems provided the best finish for microfilled composite and both glass-ionomer materials (P < or = 0.00). No significant difference in method of finish existed with the hybrid composite (P = 0.07). Overall, esthetic restorative material finishing is best accomplished using abrasive impregnated disks or aluminum oxide disks. Finishing burs gave a significantly rougher surface than the former methods.
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Resinas Compuestas , Pulido Dental/métodos , Restauración Dental Permanente , Cementos de Ionómero Vítreo , Óxido de Aluminio , Análisis de Varianza , Pulido Dental/instrumentación , Análisis Factorial , Cementos de Ionómero Vítreo/química , Maleatos , Microscopía Electrónica de Rastreo , Resinas Sintéticas , Propiedades de SuperficieRESUMEN
The purpose of this study was to assess patient preference and product efficacy of three non-prescription products for the symptomatic relief of xerostomia. The study group consisted of 80 individuals with a complaint of chronic (> six months) xerostomia and an unstimulated salivary flow rate of < 0.1 mL/min. The three products--a sorbitol/xylitol-sweetened chewing gum, a sorbitol-sweetened sour lemon lozenge, and a sorbitol/xylitol-sweetened artificial saliva substitute spray--were assigned in a permuted block randomization scheme. Each product was used for two weeks with an interval of one week between trials. The study did not identify any product to be statistically significant in terms of patient preference. Kruskal-Wallis testing revealed no statistical significance (P > 0.589) among the products. No product demonstrated marked efficacy in stimulating salivary output. ANOVA analysis followed by Tukey HSD testing revealed no significant difference between the baseline paraffin-stimulated mean flow rate and the gum- and lozenge-stimulated flow rates.
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Goma de Mascar , Saliva Artificial , Alcoholes del Azúcar/uso terapéutico , Xerostomía/terapia , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Dulces , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Satisfacción del Paciente , Salivación/efectos de los fármacos , Tasa de Secreción/efectos de los fármacos , Método Simple Ciego , Sorbitol , Estadísticas no Paramétricas , Estimulación Química , Encuestas y Cuestionarios , Edulcorantes/uso terapéutico , Xerostomía/fisiopatología , XilitolRESUMEN
Signs and symptoms of the breakdown of the various components of the stomatognathic system, in particular the TMJ structures, masticatory muscles, dental structures, and periodontium, can have a variety of causes. Occlusal interferences have been implicated as one contributing factor in these areas of breakdown. If this is indeed the case, then elimination of these interferences should improve these signs and symptoms. A retrospective study involving 30 practicing dentists who make up part of the visiting faculty of the Pankey Institute analyzed a variety of signs and symptoms both prior to equilibration and after equilibration to elucidate signs and symptom dynamics following treatment.
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Oclusión Dental Traumática/terapia , Ajuste Oclusal , Sistema Estomatognático/fisiopatología , Trastornos de la Articulación Temporomandibular/terapia , Factores de Edad , Oclusión Dental Traumática/complicaciones , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ferulas Oclusales , Evaluación de Resultado en la Atención de Salud , Pautas de la Práctica en Odontología , Análisis de Regresión , Estudios Retrospectivos , Factores Sexuales , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Trastornos de la Articulación Temporomandibular/etiologíaRESUMEN
There have been long-term problems in establishing agreement among clinical and preclinical examiners in dentistry. The purpose of this study was to develop a training program and study its effect on examiner agreement when judging the clinical service ability of amalgam restorations. Ten examiners with varying backgrounds, levels of experience, and no previous training with methods to standardize clinical evaluation evaluated 44 amalgam restorations in 17 patients before and after a brief training session. The restorations were judged as either acceptable (leave alone), or unacceptable (replacement or alteration required). The training program was brief and consisted of the introduction of a rating scale with descriptive criteria, followed by a clinical session where the examiners practiced using the rating scale and criteria to arrive at operational decisions. Intraexaminer and intraexaminer agreement were calculated for both evaluation sessions. The training program improved the reliability of the examiners evaluating the clinical service ability of the amalgam restorations. Although the gain was not to the level commonly accepted in the literature, it clearly demonstrates a step in the right direction.
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Amalgama Dental , Restauración Dental Permanente/normas , Operatoria Dental/normas , Educación Continua en Odontología , Evaluación de Resultado en la Atención de Salud/normas , Adolescente , Adulto , Estudios de Evaluación como Asunto , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Estadísticas no ParamétricasRESUMEN
This study compares and analyzes the clinical performance of recent dental graduates over a 15-year period. A majority of the 981 board examiners, cumulatively surveyed, observed an increase in diagnosis/treatment planning and periodontal skills, and a decrease in operative and prosthodontic skills, while many other skills were performed at approximately the same level.
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Competencia Clínica , Educación en Odontología/tendencias , Análisis de Varianza , Certificación , Evaluación Educacional , Humanos , Consejos de Especialidades , Estadísticas no Paramétricas , Encuestas y Cuestionarios , Estados UnidosRESUMEN
A quantitative assessment of dentin bridges was conducted on sections prepared from teeth capped with four pulp-capping agents (Bioglass, Life, Demineralized Dentin Matrix, and Teflon) in a micro-swine model. The degree of mineralization of the dentin bridges relative to the adjacent primary dentin was measured using a computer-based image analysis of microradiographs prepared from the sections. The rate of formation of the dentin bridge was measured from fluorescent bands formed in the same sections by a Demeclocycline dentin marker. There were no statistically significant differences in the relative mineral densities of the dentin bridges and the rate of dentin bridge formation under the four pulp-capping agents. These findings support the suggestion that components of the extracellular matrix rather than pulp-capping agents may be important in the formation and mineralization of dentin bridges in repairing dental pulps.
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Recubrimiento de la Pulpa Dental/métodos , Dentina Secundaria/crecimiento & desarrollo , Dentinogénesis/efectos de los fármacos , Análisis de Varianza , Animales , Hidróxido de Calcio/farmacología , Cerámica/farmacología , Demeclociclina , Materiales Dentales/farmacología , Pulpa Dental/citología , Pulpa Dental/efectos de los fármacos , Dentina , Dentina Secundaria/química , Procesamiento de Imagen Asistido por Computador , Técnicas In Vitro , Politetrafluoroetileno/farmacología , Porcinos , Porcinos EnanosAsunto(s)
Cavidad Pulpar/anatomía & histología , Odontometría/métodos , Tratamiento del Conducto Radicular/métodos , Raíz del Diente/anatomía & histología , Cavidad Pulpar/diagnóstico por imagen , Estudios de Evaluación como Asunto , Humanos , Modelos Lineales , Matemática , Proyectos Piloto , Radiografía Dental , Reproducibilidad de los Resultados , Raíz del Diente/diagnóstico por imagenRESUMEN
This study was undertaken to analyze the current reasons practitioners in general practice settings choose to place amalgam and composite restorations. Data were gathered on individual restorations in the clinical setting to provide information on reasons practitioners state that restorations are placed, the type of material most often placed in different restoration classifications, and the age of restorations at the time of replacement. The results of this study indicate that approximately one-half of all restorations, both amalgam and composite, were placed to treat primary caries. One-half of the remaining restorations placed, i.e., not including those with primary caries, were placed to treat recurrent caries. With respect to restorative materials, amalgam was most often placed in class 1 and class 2 situations (88.9% of the amalgam restorations reported), while composite was most often placed in class 3, 4, or 5 situations (77.4% of the composite restorations reported). From the total data set returned for replaced restorations, only 20% of the data forms reported on verified longevity of the restoration being replaced. Analysis of these data gave a calculated median longevity for amalgam and composite restorations of 10 years and 5 years respectively.
Asunto(s)
Resinas Compuestas , Amalgama Dental , Restauración Dental Permanente/estadística & datos numéricos , Pautas de la Práctica en Odontología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Análisis de Varianza , Toma de Decisiones , Caries Dental/patología , Caries Dental/terapia , Restauración Dental Permanente/métodos , Femenino , Odontología General , Humanos , Masculino , Persona de Mediana Edad , Retratamiento , Encuestas y Cuestionarios , Resultado del TratamientoRESUMEN
The Cytobrush Plus cell collector (cytobrush) was compared with the wooden tongue depressor during oral exfoliative cytology. The degree of patient discomfort, the convenience to the clinician, and the quantity and distribution of epithelial cells collected were evaluated. Two-factor analysis of variance and parametric and nonparametric analyses were performed. Because of the favorable findings revealed in this study, we recommend that the cytobrush be considered for use when obtaining diagnostic cytologic smears from the oral mucosa.
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Técnicas Citológicas/instrumentación , Diagnóstico Bucal/instrumentación , Mucosa Bucal/citología , Análisis de Varianza , Candidiasis Bucal/diagnóstico , Carcinoma de Células Escamosas/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedades de la Boca/diagnóstico , Neoplasias de la Boca/diagnóstico , Satisfacción del Paciente , Manejo de Especímenes/instrumentaciónRESUMEN
In this study a random sample of 357 members of dental examiner boards in the United States was surveyed to determine the perceptions of candidate ability on examinations for dental licensure. A response rate of 82% was achieved. Data from this survey were compared to a similar survey conducted 10 years ago. Analysis and comparison of these two surveys indicate that candidate ability in operative dentistry has continued to decline as perceived by dental examiners in the United States over the past decade.
Asunto(s)
Competencia Clínica/normas , Operatoria Dental/normas , Adulto , Anciano , Análisis de Varianza , Operatoria Dental/educación , Conocimientos, Actitudes y Práctica en Salud , Humanos , Licencia en Odontología , Persona de Mediana Edad , Encuestas y Cuestionarios , Estados UnidosRESUMEN
Some endodontic emergencies occur as a result of attempts to relieve symptoms of pulpitis. The aim of this study was to identify any predictor of postoperative pain in a patient population treated by dental students. Patients who reported for treatment of symptomatic pulpitis were subjected to three different emergency treatment regimens. Clinical data was collected on those patients who reported in the emergency service with severe postoperative pain within 24 hours of emergency endodontic treatment. Statistical analysis of these data suggested that the type of endodontic emergency procedure carried out was a significant predictor of severe postoperative pain.
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Dolor Postoperatorio/epidemiología , Pulpectomía/efectos adversos , Pulpitis/terapia , Pulpotomía/efectos adversos , Adolescente , Adulto , Factores de Edad , Anciano , Niño , Urgencias Médicas , Femenino , Florida/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Periodontitis Periapical/complicaciones , Pulpectomía/métodos , Pulpectomía/estadística & datos numéricos , Pulpitis/complicaciones , Pulpotomía/estadística & datos numéricos , Materiales de Obturación del Conducto Radicular/uso terapéutico , Irrigantes del Conducto Radicular/uso terapéutico , Factores Sexuales , Hipoclorito de Sodio/uso terapéutico , Diente/patología , Cemento de Óxido de Zinc-Eugenol/uso terapéuticoRESUMEN
To date, effective caries prevention largely relies on the regular use of fluoride and oral hygiene. The potential efficacy of basing caries prevention on nutritional modifications has been suggested a long time ago. Subsequently, a great number of laboratory, animal and clinical investigations have convincingly demonstrated that partial substitution of sugar by noncariogenic sweeteners offers considerable benefits for dental health. This article reviews scientific information on sorbitol and xylitol, two caloric sugar substitutes that have been extensively studied with regard to their noncariogenic properties.
Asunto(s)
Caries Dental/prevención & control , Sorbitol , Edulcorantes , Xilitol , HumanosRESUMEN
This investigation quantitatively analyzed apical leakage in teeth in which one of two new thermoplasticized gutta-percha obturating techniques were used. Apical leakage observed after use of the thermoplasticized techniques was compared to leakage found in teeth that had been obturated with conventional lateral condensation. Statistically significant differences (P less than 0.05) were found among the three groups. The lateral condensation group exhibited the least leakage, followed by the thermoplasticized group, and the thermoplasticized twist-off group exhibited the most apical leakage.