Comparison between types of dressing following catheter insertion and early exit-site infection in peritoneal dialysis.

AIMS AND OBJECTIVES: To investigate whether the type of dressing used (occlusive vs. semi-occlusive) impacts on exit-site infection. BACKGROUND: The exit-site infections are a major predisposing factor for peritoneal dialysis-related peritonitis, the main cause of technique failure and an important cause of mortality. The care taken in exit-site dressing is considered an important procedure for the prevention of trauma and contamination of this area. Nevertheless, to our knowledge, no study has yet analysed the impact of different dressing types on early exit-site infection (up to two months after catheter insertion). DESIGN: A prospective observational study involving the BRAZPD II (Brazilian Peritoneal Dialysis Multicenter Study) cohort. METHODS: All incident patients with data available for dressing type applied following peritoneal dialysis catheter insertion were included in the study. A multilevel logistic regression model was used to compare the log-odds of exit-site infections between groups. RESULTS: A total of 2460 incident patients were included. Occlusive and semi-occlusive dressings were applied in 82·6% (n = 2031) and 17·4% (n = 427) of patients, respectively. Exit-site infection incidence was not affected by the type of dressing used, with a logit for occlusive dressing of 2·15 (95% CI 0·81-5·70). The combined outcome of exit-site infection and tunnel infection also showed no significance between the groups (logit 1·46, 95% CI 0·72-2·97). CONCLUSION: Our results indicate that the type of exit-site dressing used during the healing phase following peritoneal dialysis catheter insertion has no impact on early exit-site infection rates. RELEVANCE TO CLINICAL PRACTICE: Provides evidence to support the similarity between occlusive and semi-occlusive dressing regarding infection rates in exit site of peritoneal dialysis catheter, therefore allowing the choice to be made accordingly to routine or availability.

Efficacy of vascularized periosteal membranes in providing soft tissue closure at grafted human maxillary extraction sites.

PURPOSE: Soft tissue closure is mandatory for optimal healing of extraction sites treated via guided bone regeneration. The objective of this study was to evaluate the efficacy of a flap design based on the extension of palatal tissues to obtain and maintain soft tissue coverage over grafted extraction sockets. MATERIALS AND METHODS: Adult patients (n = 22) with at least two teeth indicated for extraction were treated. After atraumatic extraction, control sockets were filled with a composite graft (1:1) containing demineralized freeze-dried bone allografts and Bio-Oss. Experimental sockets were treated identically, except that an Atrisorb absorbable barrier membrane was also placed over the graft material before flap closure, which was obtained, in all sockets, by the coronal extension of a vascularized pedicle dissected from the periosteal aspect of the palate. RESULTS: Primary tension-free wound closure was achieved at all treated sites. Exfoliation of the graft material during healing was not observed in either treatment group. High levels of soft tissue closure were maintained throughout the study period for both treatment groups, and membrane exposure was observed in only 7% of treated sites. CONCLUSION: On the basis of this study it appears that the reported technique was an adequate method of achieving and maintaining complete soft tissue coverage and promoting healing by primary intention in grafted extraction sockets in humans.

Prevalência de lesões precursoras do câncer uterino em mulheres de uma cidade do litoral norte do Rio Grande do Sul / Prevalence of cervical cancer precursor lesions in women from a city of the Rio Grande do Sul northern coast

Objetivo: Analisar a prevalência e análise descritiva do perfil das mulheres que realizaram o exame citopatológico em uma cidade do litoral norte do Rio Grande do Sul. Métodos: Foram analisadas as variáveis sociodemográficas e clínicas, e análise microbiológica de pacientes de janeiro de 2018 a janeiro de 2019. Resultados: O estudo foi composto por 4.988 laudos de exames citopatológicos. A partir da análise citopatológica cervical, as pacientes que apresentaram lesão intraepitelial de baixo grau (LSIL) corresponderam a 62 amostras e a lesão intraepitelial de alto grau (HSIL), a oito pacientes. Em relação à análise microbiológica, o microrganismo patogênico mais prevalente foi a bactéria anaeróbica Gardnerella vaginalis. Conclusão: Estes resultados podem servir de apoio fundamental para a criação de programas de rastreamento de base populacional, visando reduzir a incidência e mortalidade por câncer do colo uterino.

Objective: To analyze the prevalence and analysis descriptive of the profile of women who underwent examination cytopathological in a city of the north coast of Rio Grande do Sul. Methods: Were analyzed as variables sociodemographic and clinical, and analyzes microbiological of patients from January 2018 to January 2019. Results: The study consisted of 4.988 examinations cytopathological. From the analysis cytopathologicalof the cervix, patients with low grade intraepithelial lesion (LSIL) corresponded to 62 samples and high grade intraepithelial lesion (HSIL) to eight patients. Regarding analysis microbiological, the most prevalent microorganism pathogenic was the bacterium anaerobic Gardnerella vaginalis. Conclusion: These results can serve as a fundamental support for the creation of tracking programs population-based, reducing the incidence of mortality and cervical cancer.

Superficial topography and porosity of an absorbable barrier membrane impacts soft tissue response in guided bone regeneration.

BACKGROUND: Surface topography and porosity of barrier membranes is suggested to impact the soft and hard tissue response. In this study, the specific soft and hard tissue response characteristics of a synthetic polylactide membrane are evaluated including soft tissue inflammation, osteogenesis, and osteopromotion. METHODS: Analysis of porosity and surface topography of the test material was performed by scanning electron microscopy. Transosseous parietal defects were surgically created bilaterally in 32 BalbC/ByJ mice and treated either with the barrier (test) or sham-operated (control). Healing was assessed histologically and histomorphometrically with quantification of bone bridging. RESULTS: Scanning electron microscopy analyses of the barrier revealed a microstructure resembling cancellous bone. Interconnecting pores and channels, measuring between 6 and 60 microm in diameter, formed by smooth internal walls were observed throughout the device. Two distinct patterns of porosity were observed. The external surface of the membrane was characterized by a highly porous structure, with minimal interporous nodes and average pore sizes ranging between 6 and 20 microm in diameter. The internal surface was characterized by a minimal porous structure, with significant interporous nodes and average pore sizes ranging between 18 and 60 mum in diameter. Histomorphometric analyses demonstrated increased bone bridging by 60% and 300% in membrane-treated sites after 14 and 28 days of healing, respectively. The rough surface of the barrier contained significantly more giant cells, whereas the smooth surface contained significantly more inflammatory cells. CONCLUSION: The surface topographies engineered on different sides of the barrier promote differential soft tissue responses leading, however, to similar amounts of enhanced bone formation.

Efficacy of combined regenerative treatments in human mandibular class II furcation defects.

BACKGROUND: The treatment of molar furcation defects remains a considerable challenge in clinical practice. The degree of success in the management of furcation involvement is highly variable and inversely related to initial probing depth (PD) measurements in these lesions. The identification of clinical measurements influential to the treatment outcomes is critical to optimize the results of surgical periodontal therapy. Therefore, the objective of this study was to evaluate the clinical response of mandibular buccal Class II furcation lesions to a combined regenerative treatment modality. METHODS: Sixty patients were divided into two (n = 30) treatment groups. An experimental combined regenerative therapy (ET) was compared to open flap debridement (OFD). The ET was a combination of a composite graft consisting of bioabsorbable hydroxyapatite and tetracycline (3:1), a guided tissue regeneration barrier, and a coronally advanced flap. The clinical variables evaluated were plaque, bleeding on probing, gingival recession, PD, vertical attachment level (VAL), horizontal attachment level (HAL), furcation vertical height, furcation horizontal depth, and the amount of tissue under the barrier membrane at uncovering. Reevaluation was performed 12 months after the surgical procedure. RESULTS: Both treatments resulted in improvements in all clinical variables evaluated. Postoperative measurements revealed a reduction in PD of 3.65 +/- 0.6 mm and 0.60 +/- 1.0 mm; VAL gains of 3.05 +/- 0.6 mm and 0.65 +/- 0.6 mm and HAL gains of 3.45 +/- 1.3 mm and 0.55 +/- 0.7 mm in the ET and OFD groups, respectively. In the ET group, significant positive correlations were found between baseline PD and PD reduction at 12 months, and the initial VAL correlated positively with PD reduction and HAL gain. The horizontal furcation depth and amount of tissue formed under the membrane at uncovering correlated positively with PD reduction and HAL and VAL gains. For the OFD group, the initial PD correlated positively with PD reduction and VAL and HAL gains and correlated negatively with recession. Initial VAL correlated positively with PD reductions and VAL and HAL gains. The initial HAL correlated negatively with recession at 12 months. CONCLUSIONS: ET exhibited significantly better clinical results, with more PD reduction, HAL and VAL gains, and a higher frequency of furcation closure compared to OFD and showed promise as a regenerative treatment technique. The ability to predict a response to treatment based upon pretreatment parameters was not consistent between groups; thus, prediction of treatment outcomes based on pretreatment measurements should be carefully evaluated for each treatment modality.