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1.
Eur J Clin Microbiol Infect Dis ; 38(3): 541-544, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30680561

RESUMO

The increasing prevalence of extensively drug-resistant (XDR) Pseudomonas aeruginosa infections is due to the global spread of defined high-risk clones (HRC). Among them, ST175 is particularly frequent in Spain and France. Here, we evaluated O-antigen serotyping and MALDI-TOF as typing methods for the early identification of ST175. O-antigen (O4) serotyping and MALDI-TOF biomarker peak-based recognition models were tested in several strain collections, including 206 non-duplicated P. aeruginosa clinical isolates collected in 2016. Resistance profiles were determined by broth microdilution and clonal epidemiology by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Up to 24.3% of the isolates were XDR and 28.2% non-susceptible to meropenem, while resistance to ceftolozane/tazobactam (2.9%) and colistin (0.5%) was infrequent. Half of all XDR isolates belonged to ST175 and most of them were only susceptible to ceftolozane/tazobactam and colistin. A model based on the detection of one MALDI-TOF biomarker peak yielded negative and positive predicted values (NPV/PPV) for the detection of ST175 of 100%/51.9%, whereas NPV/PPV for a model based on two biomarker peaks were 99.4%/87.1% and for O4 serotyping, 99.4%/84.1%. Both, O4 serotyping and MALDI-TOF biomarker peak analysis, proved to be sensitive and specific methods that could be easily incorporated in the routine workflow for the early detection of ST175 HCR. Since ST175 is associated with defined XDR profiles, with most isolates only being susceptible to colistin and ceftolozane/tazobactam, these simple techniques could be useful for optimizing semi-empiric antipseudomonal treatments in areas where this HRC is prevalent.


Assuntos
Técnicas de Tipagem Bacteriana , Farmacorresistência Bacteriana Múltipla , Antígenos O/sangue , Infecções por Pseudomonas/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Sorotipagem , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Antibacterianos/farmacologia , Biomarcadores/metabolismo , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , França , Humanos , Tipagem Molecular , Valor Preditivo dos Testes , Infecções por Pseudomonas/diagnóstico , Pseudomonas aeruginosa/classificação , Sensibilidade e Especificidade , Espanha , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz/normas
2.
Clin Oral Investig ; 22(9): 2981-2988, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29450738

RESUMO

OBJECTIVE: The objective of this randomized controlled clinical trial (RCT) was to compare the effect of bupivacaine and articaine at habitual doses on pain intensity and the need for analgesics after lower third molar extraction. MATERIALS AND METHODS: The final study sample comprised 50 Caucasian volunteers (26 males and 24 females; age range, 18-30 years) undergoing scheduled surgical extraction of impacted lower third molar. A computer-generated random sequence was used to allocate participants to the articaine (4%) or bupivacaine (0.5%) group. Surgeons and patients were blinded by labeling the articaine and bupivacaine carpules with numbers (1 and 2, respectively). Postoperative pain intensity (primary outcome) was evaluated with a visual analogue scale (VAS), while the requirement for and timing of rescue medication and the quality of intraoperative anesthesia were also measured (secondary outcomes). RESULTS: VAS-measured pain intensity was significantly higher (p < 0.05) in the articaine group than in the bupivacaine group at all time points except for 8 h post-surgery (p = 0.052). Rescue medication was required by 13 (52%) patients in the articaine group and 8 (32%) patients in the bupivacaine group, although the difference did not reach statistical significance (p = 0.252). The groups did not significantly differ (p = 0.391) in the quality of the intraoperative anesthesia. CONCLUSIONS: Bupivacaine is a valid alternative to articaine in third molar surgery and may offer residual anesthesia as a means of reducing postoperative pain. However, further well-designed RCTs are required in larger study populations to verify the effectiveness of bupivacaine to achieve residual analgesia after oral surgery. CLINICAL RELEVANCE: These findings suggest that bupivacaine may be useful as a coadjuvant to control acute postoperative pain. TRIAL REGISTRATION: ACTRN12617001138370.

3.
Clin Oral Investig ; 22(1): 119-129, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29101547

RESUMO

OBJECTIVE: The objectives of this systematic review were to unify criteria on the effectiveness of oral pregabalin to treat acute post-operative pain after cervicofacial surgery, to establish the most effective dose regimens, and to determine its effect on rescue medicine consumption and its association with adverse effects. MATERIALS AND METHODS: PubMed/Medline (National Library of Medicine, Washington, DC), Scopus, Web of Science, and Cochrane databases were searched for studies in any language published between January 2000 and September 2016. The following question was posed, in accordance with PRISMA guidelines: Is oral pregabalin effective and safe for the relief of acute pain after cervicofacial surgery? The critical reading of the literature utilized a list of questions prepared by the CASPe Network, applying the Jadad scale for evaluation of the methodological quality of trials. RESULTS: Eleven randomized controlled clinical trials were selected. The 11 trials obtained a score ≥ 3, considered as Ib evidence level and high quality. A single oral dose of 75-mg pregabalin before or after cervicofacial surgery alleviates pain and lessens the need for rescue analgesia consumption, while the statistical significance of these effects is higher with a single dose of 150-mg pregabalin, either before or after the surgery. CONCLUSION: Oral pregabalin appears to significantly alleviate post-operative pain and reduce rescue analgesia consumption, with no severe adverse effects. However, the ideal dose and most effective administration regimen remain controversial issues that need to be addressed in further high-quality clinical trials. CLINICAL RELEVANCE: These findings suggest that pregabalin may be useful for acute pain relief after cervicofacial surgery.


Assuntos
Analgésicos/administração & dosagem , Dor Facial/tratamento farmacológico , Manejo da Dor/métodos , Dor Pós-Operatória/tratamento farmacológico , Pregabalina/administração & dosagem , Dor Aguda , Administração Oral , Humanos , Medição da Dor
4.
J Prosthodont ; 26(2): 99-106, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26524480

RESUMO

PURPOSE: To compare survival rates among dental implants restored with immediate, early, and conventional loading protocols, also comparing between maxillary and mandibular implants, and to evaluate the influence of implant length and diameter and the type of prosthesis on treatment outcomes. MATERIALS AND METHODS: This retrospective cohort study initially included all 52 patients receiving dental implants between July 2006 and February 2008 at a private oral surgery clinic in Granada (Southern Spain). Clinical and radiographic examinations were performed, including periapical or panoramic radiographs, and incidences during completion of the restoration were recorded at 1 week, 3 months, 6 months, and at 1, 2, 3, 4, and 5 years. After a 5-year follow-up, 1 patient had died, 3 were lost to follow-up, and 6 required grafting before implant placement; therefore, the final study sample comprised 42 patients with 164 implants. RESULTS: Variables associated with the survival/failure of the restoration were: number of implants (higher failure rate with fewer implants), bone type (higher failure rate in type III or IV bone), and type of prosthesis (higher failure rate with single crowns). No significant association was found in univariate or multivariate analyses between survival rate and the loading protocol, implant length or diameter, or maxillary/mandibular location. CONCLUSIONS: Immediate occlusal loading, immediate provisionalization without occlusal loading, and early loading are viable treatment options with similar survival rates to those obtained with conventional loading. Bone quality and number of implants per patient were the most influential factors.


Assuntos
Implantação Dentária Endo-Óssea/métodos , Implantes Dentários , Falha de Restauração Dentária , Adulto , Idoso , Planejamento de Prótese Dentária , Prótese Dentária Fixada por Implante , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias , Radiografia Panorâmica , Estudos Retrospectivos , Fatores de Risco , Espanha , Fatores de Tempo , Resultado do Tratamento
5.
Clin Oral Investig ; 20(7): 1819-26, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26578119

RESUMO

OBJECTIVES: The aim of this randomized controlled clinical trial was to evaluate the efficacy and safety of pregabalin administered pre- and postoperatively in patients with pain and swelling due to the surgical removal of impacted lower third molars. MATERIALS AND METHODS: The final study sample comprised 60 volunteers (23 males and 37 females). Group 1 (n = 30) received 75 mg oral pregabalin 1 h before surgery and 1 h after surgery. Group 2 (n = 30) served as a control group and received no pregabalin. Both groups were administered with 650 mg paracetamol every 8 h for 2 days. Postoperative pain intensity and swelling were measured using a visual analog scale (VAS); pain relief experienced was reported using a four-point verbal rating scale (VRS); the rescue medication requirement, adverse effects, and global impression of the medication were also recorded. RESULTS: No significant difference in pain intensity (VAS) was observed between the groups. However, fewer rescue medication tablets were needed by pregabalin-treated patients than by controls (p = 0.021). The frequency and intensity of adverse effects were significantly higher in pregabalin-treated patients (p < 0.001), although no serious adverse events occurred. No significant difference in the degree of swelling was observed in any measurement except that from mandibular angle to lip junction, which showed lesser inflammation in the pregabalin group at 24 h post-surgery (p = 0.011). The global opinion on the medication received was more positive in the pregabalin group (p = 0.042). CONCLUSIONS: The administration of pregabalin reduces the requirement for rescue medication after third molar surgery and results in a more constant pain level, with fewer peaks of pain intensity. CLINICAL RELEVANCE: These findings suggest that pregabalin may be useful to control acute postoperative pain. Adverse effects are known to be reduced at the low pregabalin dose used in our study.


Assuntos
Analgésicos/uso terapêutico , Dente Serotino/cirurgia , Dor Pós-Operatória/tratamento farmacológico , Pregabalina/uso terapêutico , Dente Impactado/cirurgia , Administração Oral , Adolescente , Adulto , Analgésicos/administração & dosagem , Feminino , Humanos , Masculino , Medição da Dor , Pregabalina/administração & dosagem , Extração Dentária
6.
Rev. esp. cardiol. (Ed. impr.) ; 65(10): 879-894, oct. 2012. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-103672

RESUMO

Introducción y objetivos. La saturación de oxígeno mediante pulsioximetría se usa habitualmente en la monitorización de pacientes críticos, pero su utilidad como marcador diagnóstico de insuficiencia cardiaca aguda no ha sido evaluada. Este estudio analiza el papel diagnóstico de la saturación de oxígeno mediante pulsioximetría en una serie de pacientes con infarto agudo de miocardio. Métodos. En un estudio observacional prospectivo, se incluyó a 220 pacientes consecutivos con infarto agudo de miocardio. Se registraron la saturación de oxígeno mediante pulsioximetría basal (sin oxígeno), las constantes fisiológicas, la clase Killip y la puntuación radiológica a la misma hora, durante los primeros 3 días del ingreso. Se siguió a los pacientes durante 1 año. Resultados. Se obtuvieron 612 valoraciones. La saturación de oxígeno mediante pulsioximetría basal disminuyó de forma progresiva respecto a la presencia y la gravedad de la insuficiencia cardiaca, tanto valorada con la clasificación de Killip 1-3 (medias, 95, 92 y 85, respectivamente; p<0,001), como con la puntuación radiológica 0-4 (95, 94, 92, 89 y 83, respectivamente; p<0,001), con un cociente de correlación de 0,66 y 0,63 respectivamente. Las curvas receiver operating characteristic para la saturación de oxígeno mediante pulsioximetría mostraron que el punto de corte <93 tenía la mayor área, con sensibilidad del 65%, especificidad del 90% y precisión diagnóstica del 83%. Los pacientes agrupados según su saturación de oxígeno mediante pulsioximetría más baja, mostraron tasas significativamente distintas de mortalidad o rehospitalización con insuficiencia cardiaca. Conclusiones. La saturación de oxígeno mediante pulsioximetría es útil para establecer el diagnóstico y la gravedad de la insuficiencia cardiaca en situaciones agudas como el infarto de miocardio y puede tener implicaciones pronósticas. El diagnóstico debe sospecharse cuando la saturación de oxígeno mediante pulsioximetría basal es <93 (AU)


Introduction and objectives. Oxygen saturation by pulse oximetry is commonly used for monitoring critical patients, but its utility as a diagnostic marker of acute heart failure has not been assessed. This study analyzed the diagnostic role of oxygen saturation by pulse oximetry in a series of patients with acute myocardial infarction. Methods. In a prospective observational cohort study of 220 consecutive patients with acute myocardial infarction, data collection included baseline oxygen saturation by pulse oximetry (without oxygen), physiologic measurements, Killip class and data from portable chest radiography, recorded at the same hour on each of the first three days after admission. Patients were followed up for one year. Results. There were 612 assessments. Baseline oxygen saturation by pulse oximetry decreased progressively in relation to the presence and the severity of acute heart failure assessed by Killip classes 1 to 3 (mean: 95, 92 and 85, respectively; P<.001) or by radiology score 0 to 4 (95, 94, 92, 89 and 83, respectively; P<.001), with a correlation coefficient of 0.66 and 0.63, respectively. Receiver operating characteristic curves disclosed the cut-off of oxygen saturation by pulse oximetry<93 to have the greatest area, with a sensitivity of 65%, specificity 90%, and overall test accuracy 83%. Patients grouped according to lowest oxygen saturation by pulse oximetry showed significantly different rates of one-year mortality or rehospitalization for heart failure. Conclusions. Baseline oxygen saturation by pulse oximetry is useful in establishing the diagnosis and severity of heart failure in acute settings such as myocardial infarction and may have prognostic implications.The diagnosis may be suspected when baseline oxygen saturation by pulse oximetry is <93 (AU)


Assuntos
Humanos , Masculino , Feminino , Doenças Cardiovasculares/prevenção & controle , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Guias de Prática Clínica como Assunto , Monitoramento Epidemiológico/tendências , Monitoramento Epidemiológico , Biomarcadores , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde
7.
Rev Esp Cardiol (Engl Ed) ; 65(10): 879-84, 2012 Oct.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-22766468

RESUMO

INTRODUCTION AND OBJECTIVES: Oxygen saturation by pulse oximetry is commonly used for monitoring critical patients, but its utility as a diagnostic marker of acute heart failure has not been assessed. This study analyzed the diagnostic role of oxygen saturation by pulse oximetry in a series of patients with acute myocardial infarction. METHODS: In a prospective observational cohort study of 220 consecutive patients with acute myocardial infarction, data collection included baseline oxygen saturation by pulse oximetry (without oxygen), physiologic measurements, Killip class and data from portable chest radiography, recorded at the same hour on each of the first three days after admission. Patients were followed up for one year. RESULTS: There were 612 assessments. Baseline oxygen saturation by pulse oximetry decreased progressively in relation to the presence and the severity of acute heart failure assessed by Killip classes 1 to 3 (mean: 95, 92 and 85, respectively; P<.001) or by Radiology Score 0 to 4 (95, 94, 92, 89 and 83, respectively; P<.001), with a correlation coefficient of 0.66 and 0.63, respectively. Receiver operating characteristic curves disclosed the cut-off of oxygen saturation by pulse oximetry<93 to have the greatest area, with a sensitivity of 65%, specificity 90%, and overall test accuracy 83%. Patients grouped according to lowest oxygen saturation by pulse oximetry showed significantly different rates of one-year mortality or rehospitalization for heart failure. CONCLUSIONS: Baseline oxygen saturation by pulse oximetry is useful in establishing the diagnosis and severity of heart failure in acute settings such as myocardial infarction and may have prognostic implications.The diagnosis may be suspected when baseline oxygen saturation by pulse oximetry is <93. Full English text available from:www.revespcardiol.org.


Assuntos
Insuficiência Cardíaca/sangue , Insuficiência Cardíaca/diagnóstico , Oximetria/métodos , Doença Aguda , Idoso , Estudos de Coortes , Feminino , Insuficiência Cardíaca/terapia , Humanos , Estimativa de Kaplan-Meier , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Oxigênio/sangue , Estudos Prospectivos , Curva ROC , Reprodutibilidade dos Testes , Resultado do Tratamento
8.
Med Oral Patol Oral Cir Bucal ; 14(10): e538-46, 2009 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-19680211

RESUMO

Dental implant treatment is an excellent option for prosthetic restoration that is associated with high success rates. Implant stability is essential for a good outcome. The clinical assessment of osseointegration is based on mechanical stability rather than histological criteria, considering primary stability (absence of mobility in bone bed after implant insertion) and secondary stability (bone formation and remodelling at implant-bone interface). The aim of this study was to review the literature on Resonance Frequency Analysis (RFA) as a method for measuring dental implant stability. An online search of various databases was conducted on experimental and clinical research published between 1996 and 2008. The studies reviewed demonstrate the usefulness of RFA as a non-invasive method to assess implant stability. Further research is required to determine whether this system is also capable of measuring the degree of dental implant osseointegration.


Assuntos
Implantes Dentários , Humanos , Osseointegração
9.
Med Oral Patol Oral Cir Bucal ; 12(7): E518-23, 2007 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-17978776

RESUMO

INTRODUCTION: Approximately 3% of malignant tumors originate in the oral cavity. The majority are squamous cell carcinomas, and a small percentage, malignant tumors of the salivary glands, lymphoreticular diseases, bone tumors, melanomas, sarcomas, malignant odontogenic tumors and metastases of tumors from other locations. The prognosis of these pathologies depends on the size, infiltration, and site of the lesion, the presence or absence of metastatic spread, and to a certain degree the differentiation of the tumor. The prognosis of an oral cancer remains generally negative, with 5-year survival figures below 50%, producing high rates of mortality and morbidity. OBJECTIVES: To evaluate the influence of different variables on survival in an oral cancer population. PATIENTS AND METHODS: Two-hundred and sixteen patients with oral squamous cell carcinoma were studied over a period of five years, evaluating 42 variables grouped into five data sections: personal, lesion, site, stage, and risk factors. RESULTS AND CONCLUSIONS: Average survival was 2088 days, with a standard deviation of 98 days. The factors most associated with mortality were: location in the gingiva (p=0.0590), in the trigone (p=0.0104), size (T3-T4) (p=0.0004) and lymph node involvement (N2a-N2b) (p=0.0035). Tobacco and alcohol, nowadays considered to be highly significant in carcinogenesis, had no considerable influence on survival.


Assuntos
Carcinoma de Células Escamosas/mortalidade , Neoplasias Bucais/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha , Taxa de Sobrevida
10.
Med. oral patol. oral cir. bucal (Internet) ; 12(7): 518-523, nov. 2007. ilus, tab
Artigo em Inglês | IBECS | ID: ibc-65287

RESUMO

No disponible


Introduction: Approximately 3% of malignant tumors originate in the oral cavity. The majority are squamous cell carcinomas, and a small percentage, malignant tumors of the salivary glands, lymphoreticular diseases, bone tumors, melanomas, sarcomas, malignant odontogenic tumors and metastases of tumors from other locations. The prognosis of these pathologies depends on the size, infiltration, and site of the lesion, the presence or absence of metastatic spread, and to a certain degree the differentiation of the tumor. The prognosis of an oral cancer remains generally negative, with 5-year survival figures below 50%, producing high rates of mortality and morbidity.Objectives: To evaluate the influence of different variables on survival in an oral cancer population.Patients and methods: Two-hundred and sixteen patients with oral squamous cell carcinoma were studied over a period of five years, evaluating 42 variables grouped into five data sections: personal, lesion, site, stage, and risk factors.Results and conclusions: Average survival was 2088 days, with a standard deviation of 98 days. The factors most associated with mortality were: location in the gingiva (p=0.0590), in the trigone (p=0.0104), size (T3-T4) (p=0.0004) and lymph node involvement (N2a-N2b) (p=0.0035). Tobacco and alcohol, nowadays considered to be highly significant in carcinogenesis, had no considerable influence on survival (AU)


Assuntos
Humanos , Neoplasias Bucais/epidemiologia , Fatores de Risco , Intervalo Livre de Doença , Carcinoma de Células Escamosas/epidemiologia , Ameloblastoma/epidemiologia
11.
J Oral Implantol ; 33(2): 59-68, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17520948

RESUMO

Clinical follow-up was conducted on 127 cylindrical implants placed in 21 patients after 5 years of function: 75 implants were coated with titanium plasma spray (TPS) and 52 implants were coated with hydroxyapatite (HA). The aim of the study was to assess possible differences in clinical function and success rates for each implant type. Clinical and radiographic evaluations were conducted, and the periodontal indices of gingival bleeding, plaque, and calculus were measured. Cumulative data were analyzed for differences by implant type and jaw location. No significant differences were found between the 2 implant systems according to the periodontal parameters studied; however, 5-year success rates were 86.7% for TPS-coated implants and 94.3% for HA-coated implants. The periodontal probe index presented abnormal values in the patients with systemic disease and those who were provisionally restored with single-tooth restorations, complete screw-retained dentures, and fixed partial dentures. There were no differences regarding implant placement when mandibles and maxillae were compared. Long-term success rates were outstanding for HA-coated implants and acceptable for TPS-coated implants after 5 years of function. No significant differences were found between the 2 surfaces.


Assuntos
Materiais Revestidos Biocompatíveis/uso terapêutico , Implantes Dentários , Durapatita/uso terapêutico , Titânio/uso terapêutico , Adulto , Idoso , Implantação Dentária Endo-Óssea/métodos , Métodos Epidemiológicos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propriedades de Superfície
12.
Int J Periodontics Restorative Dent ; 25(3): 239-45, 2005 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-16001736

RESUMO

This case report describes the use of orthodontic traction to recover soft tissue lost around a maxillary right central incisor with major external root resorption associated with severe gingival recession. Traction of the residual root for 1 month produced a gingival appearance in harmony with the adjacent teeth. After the placement of an implant, a correct emergence profile was obtained, giving an optimal esthetic outcome. After a 3-year follow-up, complete regeneration of soft tissue persisted around the implant-supported crown.


Assuntos
Implantes Dentários para Um Único Dente , Prótese Dentária Fixada por Implante , Estética Dentária , Técnicas de Movimentação Dentária/métodos , Raiz Dentária/cirurgia , Adulto , Perda do Osso Alveolar/complicações , Implantação Dentária Endo-Óssea , Feminino , Retração Gengival/complicações , Humanos , Incisivo , Maxila , Extração Dentária , Raiz Dentária/patologia , Tração
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