ABSTRACT
Postoperative pain and persisting fatigue represent critical concerns for patients receiving lung transplantation. The purpose of this study was to illustrate the trajectory of symptoms in a patient who presented with a posttransplant musculoskeletal syndrome after double redo-lung transplantation and attended therapeutic sessions of global postural re-education during the symptomatic phase. A 32-year-old woman with interstitial lung disease underwent double lung transplantation. At 23 months, functional parameters deteriorated, and the patient was placed on the active list for a second double-lung transplantation. Twenty months after re-transplantation, the patient reported continuous thoracic-lumbar musculoskeletal pain exacerbated by moving or performing the standard motor activities. Lower body flexibility improved during the observation period changed from -10 cm to 0 cm at the Chair Sitand- Reach Test. Leg strength improved as well, and the patient was able to perform more repetitions at the Squat Test, improving from 14 to 39. Pain intensity changed from 7 to 4 on a numerical rating scale. We observed that outcomes strictly related to treatment, with lower body flexibility, pain intensity, and physical function improving over time. As a result global postural re-education proved to be effective in this patient.
Subject(s)
Lung Diseases, Interstitial , Lung Transplantation , Adult , Female , Follow-Up Studies , Humans , Pain Measurement , SyndromeABSTRACT
The aim of this study was to compare the effects of manganese (Mn) on silver catfish exposed to different levels of dissolved oxygen. Silver catfish (Rhamdia quelen) were exposed to increasing concentrations of Mn (4.2, 8.4 or 16.2mgL(-1)) under either normoxia (100 percent saturation) or moderate hypoxia (51.87 percent saturation) for 15 days. Under normoxia, Mn exposure increased lipid peroxidation (LP) in brain and kidney; it increased gluthatione (GSH) levels in brain and decreased catalase (CAT) activity in both tissues. Moderate hypoxia was able to prevent Mn-induced LP in brain and to reduce this oxidative parameter in kidney; GSH level was increased in brain, while CAT activity was reduced in both tissues. Activity of isolated mitochondria of liver and gills was reduced by Mn exposure under both levels of dissolved oxygen, but this effect was more prominent in normoxia. As expected, liver, kidney and gills showed an increase of Mn accumulation according to waterborne levels, and these parameters presented positive relationship. The highest waterborne Mn (8.4 and 16.2mgL(-1)) resulted in greater accumulation under normoxia, indicating that moderate hypoxia can stimulate mechanisms capable of reducing Mn accumulation in tissues (though not in blood). Moderate hypoxia can be considered a stress factor and Mn an aquatic anthropogenic contaminant. Therefore we hypothesized that these two conditions together are able to invoke defense mechanisms in juvenile silver catfish, acting in a compensatory form, which may be related to adaptation and/or hormesis.
Subject(s)
Catfishes/physiology , Lipid Peroxidation/drug effects , Manganese/toxicity , Oxygen/pharmacology , Water Pollutants, Chemical/toxicity , Animals , Body Weight/drug effects , Brain/drug effects , Catfishes/metabolism , Gills/drug effects , Gills/metabolism , Kidney/drug effects , Liver/drug effects , Manganese/analysis , Manganese/metabolism , Mitochondria/drug effects , Water Pollutants, Chemical/analysisABSTRACT
BACKGROUND: The aim of our study was to test the aerostatic validity of a cyan-acrylic glue (Glubran 2), applied by means of a spray catheter, on an experimental pig model. MATERIALS AND METHODS: 15 young pigs were divided into three study groups of 5 based on surgical techniques: (1) atypical pulmonary resection with mechanical suturing and reinforcement with continuous suturing; (2) resection of the pulmonary parenchyma with a cold scalpel, followed by local application of Glubran 2; (3) atypical pulmonary resection with mechanical suturing followed by application of Glubran 2. RESULTS: The mean aerostasis time was calculated at 3.5 +/- 1.26 s. The histopathological analysis did not show any particular differences when comparing the effects of the treatments carried out with Glubran 2 spray glue and the standard treatments. No statistically significant differences were recorded in the short- and medium-term survival of pigs treated with Glubran 2 compared with the respective control groups. CONCLUSIONS: The application of Glubran 2 spray on wounds caused by pulmonary resections in pigs proved to have a rapid and effective influence for the purposes of aerostasis without significant differences in air losses and survivals.
Subject(s)
Adhesives/administration & dosage , Cyanoacrylates/administration & dosage , Lung/surgery , Animals , Female , Lung/pathology , Lung/physiopathology , Male , Models, Animal , Pulmonary Surgical Procedures/methods , Suture Techniques , Swine/surgeryABSTRACT
The present study describes the effect of a single dose of dexamethasone administered to mares at time of breeding. In an initial experiment, the authors investigated safety of treatment. In a second experiment the effect of treatment on the uterine environment, fetal development and pregnancy outcome was examined. In the final part of the study, mares susceptible to persistent mating induced endometritis were identified, by means of a risk factor score system and the effect of treatment evaluated. Results indicated that dexamethasone administered at breeding time did not negatively impact on mares medical and reproductive traits. A reduced inflammatory response was observed post-mating in treated versus control mares and mares with multiple risk factors for susceptibility to persistent mating induced endometritis showed improved pregnancy rates following treatment. The authors concluded that a single dose of dexamethasone administered at the time of breeding is safe and can be used to modulate the uterine inflammatory response to breeding in susceptible mares.
Subject(s)
Dexamethasone/administration & dosage , Dexamethasone/therapeutic use , Endometritis/veterinary , Horse Diseases/prevention & control , Animals , Anti-Inflammatory Agents/administration & dosage , Anti-Inflammatory Agents/therapeutic use , Breeding , Drug Administration Schedule , Endometritis/prevention & control , Female , Horses , Insemination, Artificial/veterinary , Risk FactorsABSTRACT
This study investigated if hypoxia acclimation modifies the hematological and oxidative profiles in tissues of Mn-exposed silver catfish (Rhamdia quelen), and if such modifications persist upon subsequent reoxygenation. Silver catfish acclimated to hypoxia (~3mgL-1) for 10days and subsequently exposed to Mn (~8.1mgL-1) for additional 10days exhibited lower Mn accumulation in plasma, liver and kidney, even after reoxygenation, as compared to normoxia-acclimated fish. Hypoxia acclimation increased per se red blood cells count and hematocrit, suggesting adaptations under hypoxia, while the reoxygenation process was also related to increased hematocrit and hemoglobin per se. Fish exposed to Mn under normoxia for 20days showed decreased red blood cells count and hematocrit, while reoxygenation subsequent to hypoxia increased red blood cells count. Hypoxia acclimation also prevented Mn-induced oxidative damage, observed by increased reactive species generation and higher protein carbonyl levels in both liver and kidney under normoxia. Mn-exposed fish under hypoxia and after reoxygenation showed decreased plasma transaminases in relation to the normoxia group. Moreover, acclimation to hypoxia increased reduced glutathione levels, catalase activity and Na+/K+-ATPase activity in liver and kidney during Mn exposure, remaining increased even after reoxygenation. These findings show that previous acclimation to hypoxia generates physiological adjustments, which drive coordinated responses that ameliorate the antioxidant status even after reoxygenation. Such responses represent a physiological regulation of this teleost fish against oxygen restriction and/or Mn toxicity in order to preserve the stability of a particular tissue or system.
Subject(s)
Acclimatization , Catfishes/metabolism , Hypoxia/metabolism , Sulfates/toxicity , Water Pollutants, Chemical/toxicity , Animals , Biomarkers/blood , Catalase/metabolism , Catfishes/blood , Cytoprotection , Erythrocytes/drug effects , Erythrocytes/metabolism , Fish Proteins/metabolism , Glutathione/metabolism , Hematocrit , Hemoglobins/metabolism , Kidney/drug effects , Kidney/metabolism , Liver/drug effects , Liver/metabolism , Manganese Compounds , Oxidative Stress/drug effects , Protein Carbonylation/drug effects , Sodium-Potassium-Exchanging ATPase/metabolism , Time FactorsABSTRACT
Exposure to hypoxia has shown beneficial adjustments in different species, including silver catfish (Rhamdia quelen), especially in situations of aquatic contamination with pollutants such as manganese (Mn). Considering that hypoxia is seasonal in the natural aquatic environment, we decided to assess whether these adaptive mechanisms could be maintained when reoxygenation is established. Silver catfish acclimated to moderate hypoxia (â¼3 mg L-1, 41% O2 saturation) for 10 days and subsequently exposed to Mn (â¼8.1 mg L-1) for additional 10 days displayed lower (47%) Mn accumulation in the gills, and it was maintained (62.6%) after reoxygenation, in comparison to normoxia. Oxidative status in the gills allowed us to observe increased reactive species (RS) generation and protein carbonyl (PC) level together with decreased mitochondrial viability induced by Mn under normoxia. Inversely, while hypoxia per se was beneficial on RS generation and PC level, this acclimation was able to minimize Mn toxicity, as observed by the minor increase of RS generation and the minor reduction of mitochondrial viability, together with decreased PC level. Interestingly, after reoxygenation, part of the protective influences observed during hypoxia against Mn toxicity were maintained, as observed through a lower level of PC and higher mitochondrial viability in relation to the group exposed to Mn under normoxia. Only groups exposed to Mn under hypoxia showed increased activity of both catalase (CAT) and Na+/K+-ATPase in the gills, but, while CAT activity remained increased after reoxygenation, Na+/K+-ATPase activity was decreased by Mn, regardless of the oxygen level. Based on these outcomes, it is possible to propose that environment events of moderate hypoxia are able to generate rearrangements in the gills of silver catfish exposed to Mn, whose influence persists after water reoxygenation. These responses may be related to the adaptive development, reducing Mn toxicity to silver catfish. Moderate hypoxia generates rearrangements in the gills of Silver catfish, exerting beneficial and persistent protection against Mn toxicity.
Subject(s)
Acclimatization/physiology , Catfishes/metabolism , Hypoxia/metabolism , Manganese/toxicity , Oxidative Stress/drug effects , Oxygen/metabolism , Water Pollutants, Chemical/toxicity , Animals , Catalase/metabolism , Gills/enzymology , Gills/metabolism , Gills/pathology , Hypoxia/physiopathology , Oxidation-Reduction , Thiobarbituric Acid Reactive Substances/metabolismABSTRACT
Platelet-endothelial cell adhesion molecule-1 protein (PECAM-1/CD31) is expressed in numerous physiological and pathological processes characterized by an increase of vascular permeability, and in normal and tumour tissues. CD31, member of the immunoglobulin super-family that mediates cell-to-cell adhesion, is a transmembrane glycoprotein, 130-140 kDa, also know as platelet-endothelium cell adhesion molecule (PECAM-1). CD31 is a ligand for CD38 and plays a role in thrombosis and angiogenesis. CD31 is strongly expressed in endothelial cells and weakly expressed in megakaryocytes, platelets, occasional plasma cells, lymphocytes (marginal zone B-cells, peripheral T-cells) and neutrophils. The present study evaluates the angiogenetic processes which are accompanied by an expansion of cystic radicular and keratocystic lesions of the jaw bone. Twelve subjects with maxillary cysts (8 males and 4 females) with an average age of 43 years were selected by the Chieti University Oral Surgery Department. The surgical samples taken were subjected to histological and immunohistochemical analysis. The histological evaluation confirmed the diagnosis of radicular cystisis and keratocystisis. The immunohistochemical analyses were positive for CD31 protein in all the lesions analysed, even though they had different intensities. Using a semiquantive analysis it was possible to highlight, in the radicular cyst samples, an intense expression of the vascular component both in the inflamed area and the adjacent stroma. The lesions with cheratin content showed newly-formed, rather modest, vascularity both in the area showing slight inflammation, where the cellular component is prevalent, and in the adjacent areas showing no sign of inflammation. Therefore, in our observations, angiogenesis could take on a primary role in the development of cystic lesions of the jaw bones. The differences of CD31 expression, in all samples, would advise for a wider monitoring able to evaluate the possible use of such a protein as a diagnostic marker.
Subject(s)
Keratinocytes/chemistry , Platelet Endothelial Cell Adhesion Molecule-1/analysis , Radicular Cyst/chemistry , Adult , Antigens, CD34/analysis , Female , Humans , Immunohistochemistry , Jaw , Male , Neovascularization, Physiologic , Vascular Endothelial Growth Factor A/analysisABSTRACT
This paper was designed as a review of the knowledge concerning bone adaptation around dental implants. Current literature concerning the biomechanics of bone and titanium dental implants as a main focus and pertinent to key aspects of the review was taken into consideration. Implant stiffness, design and surface were considered as factors affecting bone response to loaded dental implants. The emerging data allows the conclusion that implant design influences force transmission to periimplant bone, but seems to have poor power in preventing time-related marginal bone crest resorption. Mechanical stimulation such as prosthetic stress-dependent strains, affects bone tissue adaptation. Therefore, it is crucial to have high biomechanical control on implants to preserve implant ankilosis and to promote periimplant bone deposition.
ABSTRACT
The aim of the present study was to evaluate the efficacy of a between-patient disinfection procedures to maintain low bacterial counts in dental unit water line (DUWL) effluents, and control dental water line biofilms. Six dental units already in use, that had never been cleaned, were monitored for three weeks. During the first week only baseline contamination levels were assessed with no treatment of the system. In the second week lines were flushed with water for 30 s before treating each patient. During the third week, a disinfection procedure with 0.26% peracetic acid, followed by a water flush, was implemented before treating each patient. DUWL samples were collected both at the beginning and at the end of 216 dental procedures (72 during each period), plated on R2A agar and incubated at room temperature for seven days to obtain total bacterial counts in colony forming units per millilitre. To assess biofilm control, nine dental units (five never used and four old dental units with established biofilm) were used for 30 days in routine dental practice undergoing five between-patient DUWL disinfecting cycles every day. Water line samples were removed at baseline and at the end of the study and examined by scanning electron microscopy to determine the presence or absence of biofilms. A significant difference (P < 0.01) in mean DUWL bacterial counts was found between the three sets of observations. Biofilms were not present in any of the new dental units and a demonstrable reduction in the biofilms from the four dental units with previous presence of established biofilms was observed at the end of the study. In this study, a between-patient disinfection procedure consisting of flushing DUWL with peracetic acid with use of water was efficacious in the control of both microbial contamination of dental treatment water and dental water line biofilms.
Subject(s)
Biofilms , Dental Equipment/microbiology , Disinfectants/pharmacology , Disinfection/methods , Peracetic Acid/pharmacology , Water Microbiology , Colony Count, Microbial , Cross Infection/prevention & control , Humans , Water SupplyABSTRACT
The clinical course of 49 patients with the diagnosis of non-Hodgkin's lymphoma were studied in the Department of Otolaryngology of the Hospital General de Mexico between December 1986 and March 1997. The most frequent clinical symptoms in these patients were: nasal obstruction, rhinorrhea, fever, weight loss, cervical lymph adenopathy, rhinopharyngeal tumor, ulceration on the palate and periorbital cellulitis. In 73% of the patients in this series the primary presentation was nasal. Sixty-six percent of the patients were classified as intermediate grade lymphoma according to the New Working Formulation, and 33% were in a I B state according to the Ann Arbor predominant immunotype was B cell in 63% of the cases. An extensive review of the literature is also presented.
Subject(s)
Lymphoma, Non-Hodgkin , Nose Neoplasms , Paranasal Sinus Neoplasms , Adolescent , Adult , Aged , Female , Humans , Lymphoma, Non-Hodgkin/complications , Lymphoma, Non-Hodgkin/diagnosis , Lymphoma, Non-Hodgkin/pathology , Male , Middle Aged , Nose Neoplasms/complications , Nose Neoplasms/diagnosis , Nose Neoplasms/pathology , Paranasal Sinus Neoplasms/complications , Paranasal Sinus Neoplasms/diagnosis , Paranasal Sinus Neoplasms/pathology , Retrospective StudiesABSTRACT
Two hundred ninety-eight patients with post-operative pain after the surgical removal of an impacted third molar were randomly assigned, on a double-blind basis, to receive a single oral dose of piroxicam 20 mg, or piroxicam-beta-cyclodextrin equivalent to 20 mg piroxicam, or paracetamol 500 mg, or placebo. Using a semi-quantitative self-rating scale, patients rated their pain and its relief at 30-min intervals for the first 2 h, and then hourly for 4 h after treatment administration. All active medications were reported to be significantly superior to placebo. The three active drugs were comparable for the degree of analgesia up to the third hour, after which the effect of paracetamol decreased significantly as compared to piroxicam-beta-cyclodextrin and piroxicam. Piroxicam-beta-cyclodextrin and paracetamol were more rapid than piroxicam in inducing analgesia. The tolerability for the active drugs was comparable to that for placebo.
Subject(s)
Acetaminophen/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cyclodextrins/therapeutic use , Pain, Postoperative/drug therapy , Piroxicam/therapeutic use , beta-Cyclodextrins , Acetaminophen/administration & dosage , Acetaminophen/pharmacology , Adolescent , Adult , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Anti-Inflammatory Agents, Non-Steroidal/pharmacology , Cyclodextrins/administration & dosage , Cyclodextrins/pharmacology , Double-Blind Method , Drug Combinations , Female , Food Additives/administration & dosage , Food Additives/pharmacology , Food Additives/therapeutic use , Humans , Male , Middle Aged , Molar, Third/surgery , Pain, Postoperative/etiology , Piroxicam/administration & dosage , Piroxicam/pharmacology , Surgery, Oral , Surveys and Questionnaires , Tooth Extraction/adverse effectsABSTRACT
Direct person-to-person transmission of periodontal bacteria through saliva has recently been widely reported and dental units have been demonstrated to retract saliva from patients under treatment and to release it into the mouths of subjects undergoing the next operation. In this study the presence of a group of periodontal pathogenic bacteria inside waterlines in dental units was investigated using polymerase chain reaction (PCR) based methods. Briefly, 18 dental units of three different manufacturers were studied. Dental units were divided into two groups according to their prevalent use in routine practice. The first group consisted of nine dental units characterized by the frequent use of high-speed dental hand-pieces directly inside the mouth and in contact with patients' saliva. The second group, as a control, consisted of nine dental units where high-speed dental hand-pieces were not in use. A one cm section of the waterline tubing connected to the high-speed hand-piece was removed from each dental unit to evaluate the presence of DNA of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Treponema denticola. Two specimens were positive for Prevotella intermedia DNA. All the positive results were from samples obtained from dental units categorised in the first group. These findings clearly suggest that dental units have the potential to transmit periodontal pathogens. Manufacturers should be invited to design dental units that incorporate automated devices to disinfect DUWLs between patients with minimal effort by dental staff.
Subject(s)
Bacteria/isolation & purification , Biofilms/growth & development , DNA, Bacterial/analysis , Dental Equipment/microbiology , Equipment Contamination , Aggregatibacter actinomycetemcomitans/growth & development , Aggregatibacter actinomycetemcomitans/isolation & purification , Bacteroides/growth & development , Bacteroides/isolation & purification , Humans , Periodontal Diseases/microbiology , Polymerase Chain Reaction , Porphyromonas gingivalis/growth & development , Porphyromonas gingivalis/isolation & purification , Prevotella intermedia/growth & development , Prevotella intermedia/isolation & purification , Treponema denticola/growth & development , Treponema denticola/isolation & purificationSubject(s)
Cysts/pathology , Hamartoma/pathology , Lung Diseases/pathology , Pneumothorax/pathology , Cartilage/pathology , Cysts/complications , Cysts/diagnostic imaging , Cysts/surgery , Hamartoma/complications , Hamartoma/diagnostic imaging , Hamartoma/surgery , Humans , Lung Diseases/complications , Lung Diseases/diagnostic imaging , Lung Diseases/surgery , Male , Middle Aged , Pneumonectomy/methods , Pneumothorax/etiology , Radiography , Treatment OutcomeABSTRACT
The advantages of transmucosal healing implants with a bioactive zirconia collar as a support for partially fixed prosthodontic restorations are optimal peri-implant marginal tissue sealing, reduction in plaque accumulation and satisfactory aesthetic results. The zirconia used in this study evidenced not only optimal clinical performances, but also good biocompatibility. The results from this study demonstrated that zirconia coating enhances fibroblasts and osteoblast-like cell adhesion, spreading and proliferation, favoring microscopic tissue/cell in-growth and clinical implant fixation improvement. From clinical analysis, it emerged that the treatment group obtained better scores in every peri-implant parameter. This evidence attests faster stabilization of soft and hard tissues around both the transmucosal zirconia collar and at the crestal level of the implant. A reduced plaque accumulation around the implant with zirconia collar could provide a better peri-implant microbiological en-vironment by allowing the soft tissues expression of optimal sealing and good bone adaptation to loading. From these clinical and radiographic comparative analyzes, it emerged that in the treatment group the mean values were always similarly low. A rapid stabilization of both hard and soft peri-implant tissues was documented in the 1st yr. In the treatment group, there was the formation of stable tissue sealing the zirconia collar, which could preserve mucosal and bone levels. In conclusion, 2-yr clin-ical results demonstrated that implants supporting fixed restorations using transmucosal healing implants with a zirconia collar appeared a valid method, reporting 100% implant survival rates. Moreover, in vivo results obtained using strict parame-ters to assess the peri-implant status affirmed that a zirconia collar offers excellent biological acceptance. Our preliminary in vitro results statistically evidenced increased fibroblast and osteoblast adhesion and proliferation to zirconia compared to tita-nium, and an index of enhanced material integration with bone and soft tissue cells. (Journal of Applied Biomaterials & Biomechanics 2004; 2: 143-50).
ABSTRACT
AIMS: To verify the possible of identifying HCV-positive subjects by assaying hepatitis C immunological markers in the gingival crevicular fluid. METHODS: Ten HCV-EIA-positive subjects and ten HCV-EIA negative subjects were enrolled. One specimen each of blood, saliva and gingival crevicular fluid were collected from each subjects, and anti-HCV antibodies determined using a rapid test described elsewhere. RESULTS: The test was highly sensitive and specific (100%) on whole blood, but unable to detect anti-HCV antibodies in any specimen on whole saliva; anti-HCV antibodies were detected in about 80% of gingival crevicular fluid specimens from HCV-positive subjects, suggesting that the HCV virus and anti-HCV antibodies may enter the pounth in the gingival crevicular fluid and then spread outside the mouth via the saliva. CONCLUSIONS: The gingival crevicular fluid could be a valid alternative to blood for detection of HCV-positive subjects; in association with the HCV rapid test this may be a useful procedure for use in routine dental practice.
Subject(s)
Gingival Crevicular Fluid/immunology , Hepatitis C Antibodies/analysis , Hepatitis C/diagnosis , Enzyme-Linked Immunosorbent Assay , Hepacivirus/immunology , Humans , Immunoblotting , Saliva/immunology , Sensitivity and SpecificityABSTRACT
The cranial base of 60 adults affected by mandibular prognathism was studied with the aid of a computerized cephalometric analysis. The means and standard deviations of the values measured on the sample where compared with the cephalometric standards of the University of Michigan. The studied sample showed a significant reduction in length of the floor of the anterior cranial fossa, the cranial base angle showed no deviation from the control but the whole cranial base was backward and upward rotated in relation to the Frankfurt plane. The cranial base morphology was similar in patients with or without maxillary retrusion. The data in our possession may indicate that mid-facial sagittal growth in patients affected by mandibular prognathism is somehow impaired by altered cranial base growth. In any case the sagittal projection of the frontal and nasal bones appears to be reduced in our patients and this data must be kept in mind when studying these patients with the aid of cephalometry.
Subject(s)
Cephalometry , Prognathism/pathology , Skull/pathology , Adult , Cephalometry/methods , Female , Humans , Male , Malocclusion, Angle Class III/pathology , Prognathism/diagnostic imaging , Radiography , Skull/diagnostic imagingABSTRACT
The risk of infections via dental sprays has been confirmed once again by the detection, inside dental unit waterlines, of bacterial and viral contaminations, both from water supplies and from the oral cavity of patients. Conventional means of prevention, flushing of the ducts before any dental treatment and anti-retraction devices intended to avoid contamination originating from the patient, evaluated in laboratory and clinical conditions, have been shown to be ineffective in controlling the risk. Tests carried out in vitro, with circuit models, and with the dental unit in service, have confirmed the efficacy of a method to disinfect the waterlines with a disinfecting solution based on TAED and Peroxidant, which in aqueous solution develop peracetic ions (Autosteril method). Zero bacterial count, zero viral charge and a complete biofilm demolition were achieved both in lab conditions and in service units. After hygienic treatment, the same disinfection method, once installed on old units that had been in service for years and without any hygienic device, allowed us to restore and to maintain the microbiological quality of the irrigant also in dental units of old design, and significantly reduced biofilm formation inside the waterlines. Therefore, on the basis of scientific findings, a microbiologic monitoring protocol is proposed in order to verify the hygienic conditions of units which are in service.
Subject(s)
Dentistry/standards , Equipment Contamination , Infection Control/methods , Clinical Protocols , Disinfection/methods , Humans , Infections/epidemiologyABSTRACT
Severe Acute Respiratory Syndrome (SARS) is caused by a newly identified coronavirus, called SARS-associated coronavirus (SARS-CoV) that appears to be transmitted primarily through droplets of saliva. This is the reason why the most important international organizations recommend that the dentists adopt a unique preventive approach to the problem: SARS patients should not be treated in the dental office. This is possible only if a suspected case of SARS is correctly and promptly identified. But a correct identification is made difficult by several factors, such as the incubation period, a possibly asymptomatic onset of the illness, the still low specificity and sensitivity of laboratory and instrumental tests. A case or suspected case of SARS may thus unwillingly be treated at the dental office. It is therefore necessary to adopt protective measures for the dental personnel and to implement and enforce infection control measures in order to eliminate the risk of viral contamination. Nonetheless, these procedures do not ensure a complete elimination of SARS-CoV contamination risk since a major risk is represented by blood-borne infection, which is originated by the mouth of patients, and the contamination of dental units water lines (DUWLs) is most difficult to control. Blood-borne contamination may be achieved only by adopting a high level, between-patients disinfection protocol of the DUWLs based on the use of chemical agents with biocidal activity against spores, viruses, bacteria and fungi (Autosteril method). In conclusion a fully effective control of the cross-infection risk will be obtained only by adopting a correct, integrated use of different infection control procedures.
Subject(s)
Dentistry , Severe Acute Respiratory Syndrome/prevention & control , HumansABSTRACT
INTRODUCTION: Acute postoperative pain is a common experience in oral surgery practice. Non-steroidal anti-inflammatory drugs (NSAIDs) are quite effective against mild to moderate pain and they are generally better suited in ambulatory outpatients than narcotic analgesics. The analgesic activity of piroxicam, a well known NSAID has been documented in many pain states. Piroxicam can be administered once daily because of its long half-life, but its absorption in the gastrointestinal tract is slow as it is its onset of action. Piroxicam-beta-cyclodextrin (PBCD) is a new formulation of piroxicam which is the product of supermolecular encapsulation of piroxicam with the cyclic oligosaccharide beta-cyclodextrin. PBCD is absorbed much faster than standard piroxicam, and its action as an analgesic is consequently more rapid. The purpose of this study was to assess the efficacy and the rapidity of action of piroxicam-beta-cyclodextrin in comparison with standard piroxicam, paracetamol and placebo following surgical extraction of impacted third molars. MATERIALS AND METHODS: The study population was composed of 32 patients of both sexes and in good health. To be included into the study, patients must have had third molar removal resulting in acute post-surgical pain of at least moderate intensity. The patients were then randomly assigned to one of four treatment groups. PBCD 20 mg tablets; piroxicam 20 mg capsules; paracetamol 500 mg tablets, or placebo. The study was conducted according to a double-blind, double-dummy design. Pain intensity and pain relief were recorded at 0.5, 1, 1.5, 2, 3, 4 hours after a single dose of the study drugs, by means of a Keele-type rating scale. Rescue analgesics were not allowed before one and a half hour after taking the study drugs. A global evaluation of study drugs was expressed by patients at the end of the observation period. RESULTS: Treatment groups were homogeneous for demographic characteristics of the patients and for pain intensity at the time of medication with study drugs. All patients who received placebo requested supplemental analgesics, while none of the patients treated with the active drugs needed rescue analgesics. PBCD and paracetamol were comparable for their analgesic effect, while the time lag before a significant reduction of pain intensity with piroxicam was longer. Piroxicam and PBCD were superior to paracetamol because they showed a substantial analgesic effect through the 4-hour study duration, while paracetamol did not induce a complete relief from pain. DISCUSSION: One of the most commonly utilized model for the evaluation of analgesics is the third molar extraction pain. Our study clearly differentiated between active drugs and placebo. Furthermore, while PBCD and paracetamol showed a rapid effect, piroxicam was slow in inducing pain relief. The analgesic and anti-inflammatory activity of PBCD and piroxicam brought about the resolution of pain and inflammation consequent to the dental extraction. Paracetamol, a pure analgesic, was not equally active and pain persisted, even if at a low grade, throughout the observation period; probably this was due to local inflammation and edema. The results of our study appear to confirm the pharmacokinetic data on PBCD, which showed that therapeutic blood levels are reached faster with PBCD than with the standard piroxicam formulation. This results should be confirmed in studies with an adequate number of patients.
Subject(s)
Acetaminophen/therapeutic use , Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Cyclodextrins/therapeutic use , Pain, Postoperative/drug therapy , Piroxicam/therapeutic use , Tooth Extraction , beta-Cyclodextrins , Adolescent , Adult , Double-Blind Method , Drug Combinations , Drug Tolerance , Female , Humans , Male , Middle Aged , Molar, Third/surgery , Pain Measurement , PlacebosABSTRACT
BACKGROUND: The aim of this paper is to study the properties of innovative materials based on defective calcium phosphates produced by physical methods in the therapy of dentin hypersensitivity. METHODS: In particular, the effects of gels, aqueous solutions and toothpastes containing the above mentioned materials on dentinal permeability measured as dentin hydraulic conductance have been studied. The calcium phosphates have been characterized by X-ray powder diffraction (Rietveld analysis) and Fourier transform infra-red analysis. In addition, scanning electron microscopy has been performed to study the surface of dentin and enamel after treatment with the phosphates. In particular sound occlusal dentin, sound cervical dentin, carious occlusal dentin, sound buccal enamel and carious buccal enamel have been observed. RESULTS: The results have shown that these biocompatible materials can be produced with chemical and physical characteristics very similar to dentin and/or enamel. By forming a protective layer inside and outside the dentin tubuli, the calcium phosphates significantly reduce the dentinal hypersensitivity. CONCLUSIONS: These phosphates seem to be a promising material for clinical application.