Randomized clinical trial of four adhesion strategies: 18-month results.

STATEMENT OF THE PROBLEM: With Institutional Review Board approval, 39 patients who needed restoration of noncarious cervical lesions (NCCLs) were enrolled in this study. A total of 125 NCCLs were selected and randomly assigned to four groups: 1) a three-step etch-and-rinse adhesive, Adper Scotchbond Multi-Purpose (MP, 3M ESPE, St Paul, MN, USA); 2) a two-step etch-and-rinse adhesive, Adper Single Bond Plus (SB, 3M ESPE); 3) a two-step self-etch adhesive, Adper Scotchbond SE (SE, 3M ESPE); and 4) a one-step self-etch adhesive, Adper Easy Bond (EB, 3M ESPE). A nanofilled composite resin was used for all restorations. Restorations were evaluated at six months and 18 months using modified U.S. Public Health Service (USPHS) parameters. RESULTS: At six months after initial placement, 107 restorations (85.6% recall rate) were evaluated. At 18 months, 94 restorations (75.2% recall rate) were available for evaluation. The 6 mo/18 mo overall retention rates (%) were 100/90.9 for MP; 100/91.7 for SB; 100/90.9 for SE; and 96.4/92.3 for EB with no statistical difference between any pair of groups at each recall. Sensitivity to air decreased significantly for all adhesives from the preoperative to the postoperative stage and was stable thereafter. Interfacial staining did not change statistically from baseline to six months; however, interfacial staining at the enamel margins was statistically worse at 18 months than at baseline for the two self-etch adhesives EB and SE. Marginal adaptation was statistically worse at 18 months compared with baseline only for EB. This tendency was already significant at the six-month recall. CONCLUSION: Although 18-month retention was similar for the different adhesion strategies, enamel marginal deficiencies were more prevalent for the self-etch adhesives.

Preoperative psychological factors predicting graft rejection in patients undergoing kidney transplant: a pilot study.

BACKGROUND: The aim of this study was to investigate whether pretransplant psychological variables included in the CBA 2.0 Primary Scale-fear, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression-could predict graft rejection among patients undergoing kidney transplantation. METHODS: After ethical committee approval we enrolled 33 consecutive adult patients undergoing kidney transplantation. The inclusion criteria were a stable clinical situation in an out-of-hospital setting; Italian language literacy; a minimum of secondary school-level education, and written informed consent. We excluded patients with a psychotic disturbance, neurocognitive deficit, dementia, serious mental delay (IQ <50), current alcohol or drug abuse, recent ideation or attempted suicide or nonadherence to the therapeutic protocol. Acute and/or chronic graft rejection was diagnosed according to clinical and histopathologic criteria. CBA-2,0 "Primary Scale" series of questionnaires were handed out to patients at the time of the examinations to discrem eligibility for transplantation. Analyses of variance were performed to compare psychological scores among patients with versus without graft rejection. Logistic regression analyses of psychological variables were performed to detect possible predictors for graft rejection. The results of the analysis showed that higher psychoticism scores were able to predict graft rejection (P<.05). RESULTS: The findings of this study suggest that it is mandatory to preoperatively plan an holistic treatment including psychological intervention mainly focused on psychoticism.

Psychological risk factors for graft rejection among liver transplant recipients.

The purpose of this prospective study was to find psychological risk factors predicting acute, chronic, and psychological rejection in patients undergoing liver transplantation using Cognitive Behavioural Assessment (CBA-2.0). The primary scale included an assessment of fears, personality, obsessive-compulsive symptoms, state and trait anxiety, psychological reactions, and depression. We prospectively recruited 44 patients undergoing orthotopic liver transplantation (OLT). Exclusion criteria were: education level below secondary school, unstable clinical situation in an out-patient setting, fulminant hepatitis, psychotic disorders, neurocognitive deficits, dementia, serious mental retardation, current alcohol or drug abuse, recent ideation of or attempted suicide, and non-adherence to therapy. CBA-2.0 primary scale series of questionnaires were handed out to patients immediately after the medical examination, which had been performed to ascertain eligibility for OLT. Rejection (acute and/or chronic) was diagnosed according to clinical and histopathological criteria. Psychological rejection was diagnosed when patients declared, after transplantation, a refusal of the new organ which caused psychiatric symptoms requiring medical treatment and/or psychotherapy. Analysis of variance and logistic regression of psychological variables was performed to detect possible risk factors for each type of rejection. A greater fear of repulsive animals was able a predictor for an acute rejection episode (odds ratio=1.1; P<.05). No other psychological pretransplant predictor was noted for chronic or psychological rejection. In patients undergoing OLT, preoperative emotions of fear could predict an acute graft rejection episode. These findings imply that pre-OLT screening should include psychological factors in addition to traditional medical criteria with intervention in selected cases.

Prevalence of serological markers of hepatitis B virus in pregnant women from Paraná State, Brazil.

The prevalence of hepatitis B virus (HBV) in Brazil increases from South to North but moderate to elevated prevalence has been detected in the Southwest of Paraná State. The prevalence of serological markers of HBV was evaluated in 3188 pregnant women from different counties in Paraná State and relevant epidemiological features were described. The prevalence of HBV markers in pregnant women for the state as a whole was 18.5% (95% CI = 17.2-19.9), ranging from 7.2% in Curitiba to 38.5% in Francisco Beltrão. The endemicity of HBV marker prevalence in pregnant women was intermediate in Cascavel, Foz do Iguaçu, and Francisco Beltrão, and low in Curitiba, Londrina, Maringá, and Paranaguá. Multiple logistic regression showed that HBV marker prevalence increased with age, was higher among black women, among women of Italian and German descent, and among women who had family members in neighboring Rio Grande do Sul State. Univariate analysis showed that HBV marker prevalence was also higher among women with no education or only primary education, with a lower family income and whose families originated from the South Region of Brazil. Pregnant women not having positive HBV markers (anti-HBc, HBsAg or anti-HBs detected by ELISA) corresponded to 73.7% of the population studied, implying that HBV vaccination needs to be reinforced in Paraná State. The highest prevalence was found in three counties that received the largest number of families from Santa Catarina and Rio Grande do Sul, where most immigrants were of German or Italian ascendance. This finding probably indicates that immigrants that came to this area brought HBV infection to Southwestern Paraná State.

Prevalence of serological markers of hepatitis B virus in pregnant women from Paraná State, Brazil

The prevalence of hepatitis B virus (HBV) in Brazil increases from South to North but moderate to elevated prevalence has been detected in the Southwest of Paraná State. The prevalence of serological markers of HBV was evaluated in 3188 pregnant women from different counties in Paraná State and relevant epidemiological features were described. The prevalence of HBV markers in pregnant women for the state as a whole was 18.5 percent (95 percent CI = 17.2-19.9), ranging from 7.2 percent in Curitiba to 38.5 percent in Francisco Beltrão. The endemicity of HBV marker prevalence in pregnant women was intermediate in Cascavel, Foz do Iguaçu, and Francisco Beltrão, and low in Curitiba, Londrina, Maringá, and Paranaguá. Multiple logistic regression showed that HBV marker prevalence increased with age, was higher among black women, among women of Italian and German descent, and among women who had family members in neighboring Rio Grande do Sul State. Univariate analysis showed that HBV marker prevalence was also higher among women with no education or only primary education, with a lower family income and whose families originated from the South Region of Brazil. Pregnant women not having positive HBV markers (anti-HBc, HBsAg or anti-HBs detected by ELISA) corresponded to 73.7 percent of the population studied, implying that HBV vaccination needs to be reinforced in Paraná State. The highest prevalence was found in three counties that received the largest number of families from Santa Catarina and Rio Grande do Sul, where most immigrants were of German or Italian ascendance. This finding probably indicates that immigrants that came to this area brought HBV infection to Southwestern Paraná State.

HEV, TTV and GBV-C/HGV markers in patients with acute viral hepatitis.

The aim of the present study was to evaluate the prevalence of HEV, TTV and GBV-C/GBV-C/HGV in patients with acute viral hepatitis A, B and non-A-C. We evaluated sera of 94 patients from a sentinel program who had acute hepatitis A (N = 40), B (N = 42) and non-A-C (N = 12); 71 blood donors served as controls. IgM and anti-HEV IgG antibodies were detected by enzyme immunoassay using commercial kits. TTV and GBV-C/HGV were detected by nested PCR; genotyping was done by sequencing and phylogenetic analysis. Anti-HEV IgG was present in 38, 10 and 17% of patients with hepatitis A, B and non-A-C. Four patients with hepatitis A and 1 with non-A-C hepatitis also had anti-HEV IgM detected in serum. TTV was detected in 21% of patients with acute hepatitis and in 31% of donors. GBV-C/HGV was detected in 9% of patients with hepatitis, and in 10% of donors. We found TTV isolates of genotypes 1, 2, 3, and 4 and GBV-C/HGV isolates of genotypes 1 and 2. Mean aminotransferase levels were lower in patients who were TTV or GBV-C/HGV positive. In conclusion, the detection of anti-HEV IgM in some acute hepatitis A cases suggests co-infection with HEV and hepatitis E could be the etiology of a few cases of sporadic non-A-C hepatitis in Salvador, Brazil. TTV genotype 1, 2, 3 and 4 isolates and GBV-C/HGV genotype 1 and 2 strains are frequent in the studied population. TTV and GBV-C/HGV infection does not appear to have a role in the etiology of acute hepatitis.

HEV, TTV and GBV-C/HGV markers in patients with acute viral hepatitis

The aim of the present study was to evaluate the prevalence of HEV, TTV and GBV-C/GBV-C/HGV in patients with acute viral hepatitis A, B and non-A-C. We evaluated sera of 94 patients from a sentinel program who had acute hepatitis A (N = 40), B (N = 42) and non-A-C (N = 12); 71 blood donors served as controls. IgM and anti-HEV IgG antibodies were detected by enzyme immunoassay using commercial kits. TTV and GBV-C/HGV were detected by nested PCR; genotyping was done by sequencing and phylogenetic analysis. Anti-HEV IgG was present in 38, 10 and 17 percent of patients with hepatitis A, B and non-A-C. Four patients with hepatitis A and 1 with non-A-C hepatitis also had anti-HEV IgM detected in serum. TTV was detected in 21 percent of patients with acute hepatitis and in 31 percent of donors. GBV-C/HGV was detected in 9 percent of patients with hepatitis, and in 10 percent of donors. We found TTV isolates of genotypes 1, 2, 3, and 4 and GBV-C/HGV isolates of genotypes 1 and 2. Mean aminotransferase levels were lower in patients who were TTV or GBV-C/HGV positive. In conclusion, the detection of anti-HEV IgM in some acute hepatitis A cases suggests co-infection with HEV and hepatitis E could be the etiology of a few cases of sporadic non-A-C hepatitis in Salvador, Brazil. TTV genotype 1, 2, 3 and 4 isolates and GBV-C/HGV genotype 1 and 2 strains are frequent in the studied population. TTV and GBV-C/HGV infection does not appear to have a role in the etiology of acute hepatitis.

Valuation of the psychiatric damage. Considerations about two clinical cases.

We report a description of two mothers who scrupulously followed clinical controls and tests advised during pregnancy within a hospital environment, and who then gave birth to babies with serious deformation pathologies. In both cases, the seriousness of the psychiatric damage, is obviously useful for the medico-legal assessments. We have studied in both cases their mental make-up, understood as stable relationships between parts of the mind (thought, language, perception...). We have observed that in a fragile make-up a non significant event in many ways can cause an extremely violent reaction, whilst on the contrary, a serious event in "solid" people may not cause damaging consequences. The assessment of the mental make-up, conditions the degree of psychiatric damage, which is useful to the medical examiner, and is of fundamental importance for the individual choice of a therapeutic process.

[Study of tensile bond strength of 3 different adhesive systems associated with composites on dentinal surfaces]. / Estudo de resistência à tração de três sistemas adesivos associados a resina composta em superfícies dentinárias.

The aim of this in vitro study was to compare the tensile bond strength of 3 different bonding systems, associated to composite resins, bonded to dentinal surfaces. Forty-four dentinal surfaces were obtained from recently extracted human molars. A standardized smear layer was obtained and the surfaces were divided in 3 groups: G1) self etch + microhybrid composite; G2) single-component adhesive + phosphoric acid + microhybrid composite and G3) conventional system (acid + primer + bond) + microhybrid composite. Specimens made of composite resin were constructed in the shape of an inverted truncated cone with 3 mm of diameter. Tensile bond strength test was performed at the speed of 0.5 mm/min, and the results were expressed in MPa. The analysis of variance ANOVA (p < 0.05) determined that the type of bonding system used influenced tensile bond strength. Tukey's test, however, showed that the results of the comparison between G2 and G3 were the only statistically significant ones, with G2 showing greater values of tensile bond strength.

Hepatitis E virus immunoglobulin G antibodies in different populations in Campinas, Brazil.

The seroprevalence of anti-hepatitis E virus (HEV) antibodies was investigated by enzyme immunoassay in 205 volunteer blood donors, 214 women who attended a center for anonymous testing for human immunodeficiency virus (HIV) infection, and 170 hospital employees in Campinas, a city in southeastern Brazil. The prevalence of anti-HEV antibodies ranged from 2.6% (3 of 117) in health care professionals to 17.7% (38 of 214) in women who considered themselves at risk for HIV. The prevalence of anti-HEV antibodies in health care professionals was not significantly different from that in healthy blood donors (3.0%, 5 of 165) and blood donors with raised alanine aminotransferase levels (7.5%, 3 of 40). The prevalence of anti-HEV antibodies (13.2%, 7 of 53) in cleaning service workers at a University hospital was similar to that among women at risk for HIV infection. These results suggest that HEV is circulating in southeastern Brazil and that low socioeconomic status is an important risk factor for HEV infection in this region.

Detection of hepatitis A antibodies by ELISA using saliva as clinical samples.

The possibility of detecting acute infection and immunity using body fluids that are easier to collect than blood, mainly in children, would facilitate the investigation and follow-up of outbreaks of hepatitis A (HAV). Our study was carried out to evaluate the detection of anti-HAV IgM, IgA and total antibodies in saliva using serum samples as reference. Forty three paired serum and saliva samples were analyzed. From this total, 24 samples were obtained from children and 1 from one adult during the course of acute hepatitis A; an additional 18 samples were obtained from health professionals from Adolfo Lutz Institute. The sensitivity to detect anti-HAV IgM was 100% (95%CI: 79.1 to 100.0%), employing saliva as clinical samples. In detecting anti-HAV IgA, the sensitivity was 80. 8% (95%CI: 60.0 to 92.7%) and for the total antibodies was 82.1% (95%CI: 62.4 to 93.2%). The specificity was 100% for each. The rate of agreement was high comparing the results of serum and saliva samples for detecting HAV antibodies. We conclude that saliva is an acceptable alternative specimen for diagnosing acute hepatitis A infection, and for screening individuals to receive hepatitis A vaccine or immunoglobulin.

Duality of patterns in hepatitis A epidemiology: a study involving two socioeconomically distinct populations in Campinas, São Paulo State, Brazil.

To evaluate the prevalence of antibodies against hepatitis A in two socioeconomically distinct populations, 101 and 82 serum samples from high and low socioeconomic groups, respectively, were analysed for the presence of IgG anti-HAV using a commercial ELISA. The prevalence in low socioeconomic level subjects was 95.0%, whereas in high socioeconomic subjects was only 19.6% (p < 0.001). These data show a duality in Brazil: anti-HAV prevalence in low socioeconomic subjects is similar to that of developing countries, while in high socioeconomic subjects, a pattern typical of developed countries is found. The control of this infection in our country is primarily related to the improvement of sanitation, but especially for high socioeconomic level populations, the use of vaccination against hepatitis A is strongly advisable to avoid the occasional appearance of this disease in adults.

Effects of acid etching on dentin surface: SEM morphological study.

The aim of this in vitro study was to evaluate, using scanning electron microscopy (SEM), the effects of acid solutions on dentin surface, and to analyze the depth of demineralization that the acid solutions cause on dentin, using different acids. Fifteen 3-mm thick dentin discs were prepared from the middle third of human molars. Standard smear layer was prepared on the dentin surface using 600 grit sandpaper, for 1 minute. The acids used were 10%, 35% and 37.5% phosphoric acid and 10% maleic acid, for 15 seconds, washed and dried. The control group received no treatment. Dentin discs were fractured, observed on the horizontal surface and also on the fractured surface to evaluate the depth of demineralization. Specimens were immersed in 4% glutaraldehyde in phosphonate buffer, and prepared for SEM examination at 2000X and 4000X magnification. Acid etching of dentin, regardless of the concentration of phosphoric acid, caused removal of the smear layer, exposing the apertures of dentinal tubules. This was not observed when 10% maleic acid was used. At the fractured surface, one could observe an increase in demineralization of the width of dentinal tubules, to a specific depth of about 8.19 to 11 mm, except for 10% maleic acid.

Multiple drug intolerance: allergological and psychological findings.

In order to evaluate pseudoallergic reactions to drugs, we studied a particular group of patients intolerant towards many drugs, pharmacologically dissimilar and administered during different periods of time. These patients consider themselves as "allergic" to "all" drugs. Twenty female patients, all with a history of intolerance to at least three drugs, chemically and antigenically dissimilar and not belonging to the same category of drugs, were studied. These patients underwent an allergological testing (negative in all cases) and a psychodiagnostic test (Rorschach's test); the latter was also performed in 20 normal control subjects. The psychodiagnostic findings demonstrated the negative psychological constitution of the experimental group in which the presence of a smaller quantity of energy leads to a minor capability of expressing emotions and to a major expression of depressive feelings. These patients suppress emotions to a greater extent, probably because of an expressive inhibition, while in the control group there is a possibility of mental elaboration. This implies that during the early period of emotional development with their parents, attempts to express affection received negative and frustrating replies. Therefore in later development, the expression of affection was suppressed. This last dynamic consideration, together with the former energetic and structural findings, demonstrates the pathogenic complexity of multiple drug intolerance, including, together with dysmetabolic, hormonal (clear prevalence of female subjects), autonomic and dysreactive factors, an important psychosomatic component. The diagnosis therefore also includes a careful psychodiagnostic test.