Technique for Darkening of Extracted Teeth Simulating Pulpal Necrosis Discoloration.

Background: The use of discolored teeth is required to test whitening products, and it is difficult to obtain them, given their scarcity. Objective: To present a technique for in vitro darkening of extracted teeth simulating pulpal necrosis discoloration. Materials and Methods: Hemolysates I and II from human blood were subjected or not to laser irradiation (442 nm) for 1 h. The concentration of oxyhemoglobin (O2Hb) was analyzed by ultraviolet/visible spectroscopy, and the conversion of O2Hb to methemoglobin (MetHb) by transmission spectroscopy was assessed immediately and after 3 and 40 days. For darkening evaluation, bovine incisors were divided into two groups (n = 25), and their pulp chambers were filled with hemolysate solution II (HSII) and hemolysate II solution + laser (HSII+L). After storage in artificial saliva for 40 days at 37°C, color changes were measured by a colorimeter and ΔE was compared with the NBS parameters. Data were analyzed using a mixed linear model (α=5%). Results: HSII+L presented the lowest O2Hb and higher MetHb. The conversion of O2Hb to MetHb in HSII+L was 42% higher than in HSII. Both groups were effective in darkening the teeth, according to the NBS. Darkening stabilized from day 35. HSII promoted a marked color difference. Conclusion: The proposed technique was effective in darkening the extracted teeth simulating necrosis discoloration for in vitro models.

Limitação do suporte de vida em unidade de terapia intensiva pediátrica / Limitation of life support in the pediatric intensive care unit

O presente estudo resulta de revisão de prontuários de pacientes falecidos no período de quatro anos em UTI pediátrica de hospital universitário, tendo analisado variáveis como tempo de internação, diagnóstico da principal falência orgânica da criança, ocorrência de doenças crônicas prévias, tomada de decisões dos médicos referentes à introdução de medidas de suporte vital de vida, ordens de não reanimação e qualidade da relação dos profissionais com familiares dos pacientes. Os resultados sugerem que as condutas adotadas pelos médicos refletem majoritariamente a preocupação de se protegerem contra eventuais processos judiciais decorrentes da acusação de omissão de socorro. Embora os casos clínicos estudados refiram-se a pacientes portadores de enfermidades terminais, o que por si só envolve complexos conflitos morais, em nenhum momento foi oferecido aos familiares dos pacientes a possibilidade de participarem dos processos de decisões médicas e, tampouco, existem registros de consultas ao comitê de ética do hospital.

The present study has been made through a revision of medical reports during the period of three years at thePediatric Intensive Care Unit of a University Hospital, having analyzed the variables as, hospitalization time,diagnosis of the child’s principle organ failure, presence of chronic disease, the doctor’s decision concerningthe introduction of life support measure, the do-not-resuscitate (DNR) orders additionally the relationshipquality towards doctors and relatives. Most of the obtained results revealed that the procedures adopted bydoctors reflect majorly the professional concerns to protect themselves from lawsuits about neglecting help.Although, the clinic cases studied refers to patients carriers of terminal illness, which only by itself, involves anenormous quantity of moral conflicts, at none of these situations were offered to the patient’s relatives thepossibility to participate at the deliberately procedures about the medical decision therefore there were no consultations with the Ethics Committee from the Hospital.

Serological, clinical and epidemiological evaluation of toxocariasis in urban areas of south Brazil.

Toxocariasis is a worldwide public-health problem that poses major risks to children who may accidentally ingest embryonated eggs of Toxocara. The objectives of this study were to investigate the occurrence of anti-Toxocara spp. antibodies in children and adolescents and the variables that may be involved, as well as environmental contamination by Toxocara spp. eggs, in urban recreation areas of north central mesoregion, Paraná State, Brazil. From June 2005 to March 2007. a total of 376 blood samples were collected by the Public Health Service from children and adolescents one to 12 years old, of both genders. Samples were analyzed by the indirect ELISA method for detection of anti-Toxocara antibodies. Serum samples were previously absorbed with Ascaris suum antigens, and considered positive with a reagent reactivity index >1. Soil samples from all of the public squares and schools located in the four evaluated municipalities that had sand surfaces (n = 19) or lawns (n = 15) were analyzed. Of the 376 serum samples, 194 (51.6%) were positive. The seroprevalence rate was substantially higher among children aging one to five years (p = 0.001) and six to eight years (p = 0.022). The clinical signs and symptoms investigated did not show a statistical difference between seropositive and seronegative individuals (p > 0.05). In 76.5% of the investigated recreation places, eggs of Toxocara were detected in at least one of the five collected samples. Recreation areas from public schools were 2.8 times more contaminated than from public squares. It is important to institute educational programs to inform families and educators, as well as to improve sanitary control of animals and cleaning of the areas intended for recreation in order to prevent toxocariasis.

Serological, clinical and epidemiological evaluation of toxocariasis in urban areas of south Brazil / Avaliação sorológica, clínica e epidemiológica da toxocaríase em áreas urbanas do sul do Brasil

Toxocariasis is a worldwide public-health problem that poses major risks to children who may accidentally ingest embryonated eggs of Toxocara. The objectives of this study were to investigate the occurrence of anti-Toxocara spp. antibodies in children and adolescents and the variables that may be involved, as well as environmental contamination by Toxocara spp. eggs, in urban recreation areas of north central mesoregion, Paraná State, Brazil. From June 2005 to March 2007. a total of 376 blood samples were collected by the Public Health Service from children and adolescents one to 12 years old, of both genders. Samples were analyzed by the indirect ELISA method for detection of anti-Toxocara antibodies. Serum samples were previously absorbed with Ascaris suum antigens, and considered positive with a reagent reactivity index >1. Soil samples from all of the public squares and schools located in the four evaluated municipalities that had sand surfaces (n = 19) or lawns (n = 15) were analyzed. Of the 376 serum samples, 194 (51.6 percent) were positive. The seroprevalence rate was substantially higher among children aging one to five years (p = 0.001) and six to eight years (p = 0.022). The clinical signs and symptoms investigated did not show a statistical difference between seropositive and seronegative individuals (p > 0.05). In 76.5 percent of the investigated recreation places, eggs of Toxocara were detected in at least one of the five collected samples. Recreation areas from public schools were 2.8 times more contaminated than from public squares. It is important to institute educational programs to inform families and educators, as well as to improve sanitary control of animals and cleaning of the areas intended for recreation in order to prevent toxocariasis.

A toxocaríase é um problema de saúde pública mundial, com maior risco para crianças que podem, acidentalmente, ingerir ovos embrionados de Toxocara spp.. Os objetivos deste estudo foram avaliar a ocorrência de anticorpos anti-Toxocara spp. em crianças e adolecentes e as variáveis que podem estar envolvidas, bem como a contaminação ambiental por ovos de Toxocara spp., em locais de recreação, em áreas urbanas da mesorregião norte central, Paraná, Brasil. De junho de 2005 a março de 2007 foram coletadas 376 amostras de sangue de crianças e adolescentes de um a doze anos, de ambos os sexos, atendidas pelo Sistema Único de Saúde. As amostras foram analisadas pelo método de ELISA indireto para detecção de IgG anti-Toxocara e previamente absorvidas com antígeno de Ascaris suum. Foram consideradas reagentes as amostras com índice de reatividade > 1. A análise das amostras de areias (n = 19) e gramados (n = 15) de cada município foi realizada em todas as praças e escolas públicas. Das 376 amostras de soro, 194 (51,6 por cento) foram positivas. A taxa de soroprevalência foi substancialmente mais elevada entre as crianças na faixa etária de até um a cinco (p = 0.001) e de seis a oito anos de idade (p = 0,022). Os sinais e sintomas clínicos investigados não mostraram diferenças estatísticas entre soropositivos e soronegativos (p > 0,05). Em 76,5 por cento dos locais de recreação investigados, ovos de Toxocara foram detectados em pelo menos uma das cinco amostras. Os locais de recreação das escolas públicas estavam 2,8 vezes mais contaminados do que as praças. É importante a realização de programas educativos junto às famílias e educadores, o controle sanitário de animais e a higienização dos locais destinados à recreação para prevenção da toxocaríase.

Induced hypotension in orthognathic surgery: a comparative study of 2 pharmacological protocols.

PURPOSE: The objective of this comparative study was to report on the use of 2 different pharmaceutical protocols involving 2 different anesthetic techniques (IV and balanced) to induce hypotension in patients submitted to orthognathic surgery by assessing the patients' intra- and postoperative physiologic response and hemodynamic stability. PATIENTS AND METHODS: Twenty ASA I patients, between 17 and 44 years of age who had dental and skeletal deformities were subdivided into 2 groups: group I (clonidine associated to remifentanil), and group II (dexmedetomidine associated to isoflurane), in addition, other drugs were common to both groups. The following responses were assessed: arterial blood pressure, heart rate, temperature during intra- and postoperative periods, incidence of nausea and vomiting, postoperative pain, awakening time, extubation time, and postanesthetic recovery time. RESULTS: The results of the study using Repeated Measures Test statistical analysis showed that there were no significant differences between the 2 groups in respect to physiologic responses or surgery time. CONCLUSION: Both protocols tried in this study proved to be effective and safe, and they seem to be interesting alternatives in longer orthognathic surgeries with the expectation of an important blood loss. The choice for either protocol should be based on the inherent risks involved in their use and their cost-benefit ratio.