ABSTRACT
ABSTRACT Objective: The objective of the present study was to evaluate, in vitro, fibroblastic proliferation on chemically conditioned root surfaces. Methods: Forty single-rooted human teeth, were cut into fragments and divided into four groups (n=20): GI (control) - scaling and root planing (SRP); GII - SRP + conditioning with 10% citric acid; GIII - SRP + conditioning with 24% EDTA gel and GIV - SRP + conditioning with 50 mg/ml of tetracycline hydrochloride. The fibroblasts were placed on these surfaces and cell proliferation evaluated using Trypan Blue stain. Smayer layer formation was analyzed using Scanning Electron Microscopy. Results: The results revealed that the chemical conditioners used were incapable of effectively removing the smear layer. However, when compared to the other groups, GIII showed the best results regarding removal of the smear layer (p<0.05). GI demonstrated the greatest cell proliferation at all studied time intervals compared to the chemically treated groups (p<0.05). Conclusion: The results of the present study reveal that all demineralizing agents evaluated presented lower cell proliferation levels when compared to the control group. In addition none of the chemical conditioners used removed the smear layer completely.
RESUMO Objetivo: Avaliar in vitro a proliferação de fibroblastos em superfícies radiculares, previamente condicionadas quimicamente. Métodos: Para este estudo, 40 dentes unirradiculares humanos hígidos, extraídos por acometimento periodontal irreversível, foram seccionados em fragmentos radiculares e divididos em 04 grupos (20 espécimes/grupo) de acordo com a aplicação do condicionamento ácido: GI (controle) - apenas submetidos à raspagem e alisamento radicular (RAR); GII - RAR + condicionamento com ácido cítrico a 10%; GIII- RAR + condicionamento com gel de EDTA a 24%, ph 7,0; e GIV- RAR + condicionamento com 50mg/ml de cloridrato de tetraciclina. Adicionalmente, as células foram plaqueadas sobre estas superfícies e foi avaliada a proliferação celular por meio do corante vital azul de Trypan. Para a análise da morfologia ultraestrutural foi utilizado Microscopia Eletrônica de Varredura (MEV). Resultados: Os resultados demonstraram que em relação à proliferação celular, os condicionadores químicos utilizados não foram capazes de remover efetivamente a smear layer. Entretanto, no grupo tratado com EDTA (GIII) foi observado uma maior remoção (P<0,05) na quantidade de smear layer quando comparado aos demais grupos. No grupo controle (GI) pode-se observar uma maior proliferação celular em todos os tempos (24h, 48h, 72h) quando comparado aos demais grupos que sofreram tratamento químico (P<0,05). Conclusão: Considerando os agentes desmineralizantes avaliados, a maior remoção de smear layer e proliferação celular foram alcançados com o gel de EDTA a 24%, quando comparado ao grupo condicionado com cloridrato de tetraciclina 50 mg/ml, após 72 horas de cultivo celular.
ABSTRACT
Necrotizing fasciitis (NF) is an infection that spreads along the fascial planes, causing subcutaneous tissue death characterized by rapid progression, systemic toxicity, and even death. NF often appears as a red, hot, painful, and swollen wound with an ill-defined border. As the infective process continues, local pain is replaced by numbness or analgesia. As the disease process continues, the skin initially becomes pale, then mottled and purple, and finally, gangrenous. The ability of NF to move rapidly along fascial planes and cause tissue necrosis is secondary to its polymicrobial composition and the synergistic effect of the enzymes produced by the bacteria. Treatment involves securing the airway, broad-spectrum antimicrobial therapy, intensive care support, and prompt surgical debridement, repeated as needed. Reducing mortality rests on early diagnosis and prompt aggressive treatment.
Subject(s)
Analgesia , Bacteria , Debridement , Early Diagnosis , Fasciitis, Necrotizing , Head , Hypesthesia , Critical Care , Mortality , Neck , Necrosis , Skin , Subcutaneous Tissue , Wounds and InjuriesABSTRACT
O objetivo do presente ensaio clínico controlado randomizado cego foi avaliar e comparar o efeito de duas modalidades de terapia periodontal inicial, raspagem e alisamento radicular por quadrante (RAR-Q) e one-stage full-mouth disinfection (FMD), nos parâmetros clínicos periodontais, qualidade de vida, medo, ansiedade e experiência de dor, em indivíduos com periodontite crônica. Foram aplicados os instrumentos Oral Impacts on Daily Performances (OIDP), Oral Health and Quality of Life (OHQoL) Dental Fear Survey (DFS), Dental Anxiety Scale (DAS) e Escala Visual Analógica (EVA), em 78 indivíduos divididos em 2 grupos de tratamento: RAR-Q (n=37) e FMD (n=41). Os parâmetros clínicos periodontais: profundidade de sondagem (PS), nível de inserção clínica (NIC), índice de placa (IPL), índice gengival (IG) e % sítios doentes (PS¿4mm e NIC¿3mm), foram coletados. As avaliações foram realizadas no exame inicial ou T0 (parâmetros clínicos periodontais, DAS e DFS), 30 dias após término do tratamento ou T1 (OIDP e OHQoL) e 180 dias após o tratamento ou T2 (parâmetros clínicos periodontais, OHQoL, OIDP, DAS e DFS). A aplicação da EVA foi realizada imediatamente após a finalização da terapia. Para a análise estatística foram utilizados o teste de Kruskal-Wallis, correlação de Pearson, teste de Wilcoxon e Análise de Conglomerados, com o objetivo de determinar perfis diferenciados dos indivíduos, baseado nos questionários OHQoL, OIDP, DAS e DFS. As análises foram realizadas através do software SPSS 17.0 e os resultados foram considerados significativos para p¿0,005. Observou uma correlação negativa significativa dos resultados do OHQOL com os parâmetros NIC (-0,35), IPL (-0,23) e IG (-0,27) e uma correlação positiva significativa do OIDP com os parâmetros NIC (0,41) e % de sítios doentes (0,23), no T0/T1. A mesma correlação significativa se manteve em T2, com exceção do parâmentro IPL. A análise de conglomerados identificou dois clusters: A (n=33) maior impacto/pior qualidade de vida, maior medo e ansiedade e, B (n=42) menor impacto/melhor qualidade de vida, com menor medo e ansiedade. Houve uma redução significativa em todos os parâmetros clínicos periodontais quando comparadas as avaliações antes e após o tratamento e uma associação negativa entre medo e ansiedade com os parâmetros NIC, IPL e IG. Ambos os grupos apresentaram queda no medo e ansiedade após o tratamento: FMD (p=0,019) e RAR-Q (p=0,043). Os grupos apresentaram média semelhante para a escala de dor: FMD (2,6 ±1,9) e RAR-Q (2,7 ±2,0) (p=0,930). Concluímos que os indivíduos tratados pela RAR-Q e pelo FMD apresentaram melhora nos parâmetros clínicos periodontais e qualidade de vida, sem diferenças significativas entre os grupos. Não houve diferenças significativas entre o tratamento pela RAR-Q e FMD nos níveis de dor, o mesmo ocorreu para ansiedade e medo, em T0/T1 e T2
The aim of this blinded randomized controlled clinical trial was to evaluate and compare the effect of two types of non-surgical periodontal therapy, scaling and root planing per quadrant (SRP) and one-stage full-mouth disinfection (FMD) in periodontal clinical parameters, quality of life, fear, anxiety and pain experience in patients with chronic periodontitis. The instruments Oral Impacts on Daily Performances (OIDP), Oral Health and Quality of Life (OHQoL) Dental Fear Survey (DFS), Dental Anxiety Scale (DAS) and Visual Analogue Scale (VAS) were applied in 78 subjects divided into 2 treatment groups: SRP (n=37) and FDM (n=41). The periodontal clinical parameters: probing depth (PD), clinical attachment level (CAL), plaque index (PI), gingival index (GI) and % of diseased sites (PD4mm and CAL3mm), were collected. Assessments were performed at baseline or T0 (periodontal clinical parameters, DAS and DFS), 30 days after periodontal therapy or T1 (OIDP and OHQoL) and 180 days after periodontal therapy or T2 (periodontal clinical parameters, OHQoL, OIDP, DAS and DFS). The application of VAS was performed immediately after completion of therapy. For statistical analysis, the Kruskal-Wallis test, Pearson correlation, Wilcoxon test were performed. Besides a Cluster Analysis were perormed in order to determine distinct profiles of individuals, based on questionnaires OHQoL, OIDP, DAS and DFS. Analyses were performed using SPSS 17.0 software and the results were considered significant for p0,005. It was observed a significant negative correlation between OHQOL scores and CAL (-0.35), PI (-0.23) and GI (-0.27) and a significant positive correlation between OIDP and CAL (0.41) and % of diseased sites (0.23), in T0/T1. The same significant correlation was maintained in T2, except for the periodontal clinical parameter PI. Cluster analysis identified two clusters: A (n = 33) greater impact/worse quality of life, greater fear and anxiety, and B (n = 42) lower impact/better quality of life, less fear and anxiety. There was a significant reduction in all periodontal clinical parameters comparing the results before and after treatment and a negative association between fear and anxiety, and CAL, PI and GI. Both groups showed a decline in fear and anxiety after treatment: FMD (p=0.019) and SRP (p=0.043). Both groups showed similar mean for pain scale: FMD (2.6 ± 1.9) and RAR-Q (2.7 ± 2.0) (p = 0.930). We conclude that individuals treated by SRP and the FMD showed an improvement in all periodontal clinical parameters and quality of life, with no significant differences between them. There were no significant differences between treatment by SRP and FMD in the scores of pain, the same occurred for anxiety and fear in T0/T1 and T2. Key words: periodontal debridment, quality of life, fear, anxiety, pain
Subject(s)
Humans , Male , Female , Chronic Periodontitis/therapy , Dental Anxiety/therapy , Dental Scaling/statistics & numerical data , Periodontal Debridement/trends , Cluster Analysis , Data Interpretation, Statistical , Quality of Life , Randomized Controlled TrialABSTRACT
Diabetic foot diseases which require surgical treatment consists of diabetic foot ulcer, infection and neuropathic arthropathy. Surgical procedures for diabetic foot ulcers and infections such as drainage, debridement, partial foot amputation and major limb amputation are most common procedures and arthodesis with or without deformity correction can be performed for specific diabetic neuropathic arthropathies. Underlying pathomechanism of diabetic foot disease includes diabetic peripheral neuropathy and vasculopathy. Treating physicians should be aware that concomitant complications of long-standing diabetic status such as cardiovascular and renal dysfunction should be addressed to treat intractable diabetic foot diseases successfully. However, with advent of adjuvant treatment which increases vascular supply on ischemic limb disease, proper surgical treatment on diabetic foot disease can prevent or delay major limb amputations, sustaining functional capability of diabetic patients.
Subject(s)
Humans , Amputation, Surgical , Congenital Abnormalities , Debridement , Diabetic Foot , Drainage , Extremities , Foot , Peripheral Nervous System Diseases , UlcerABSTRACT
A sepse após a injúria térmica é a maior causa de morbidade e mortalidade em pacientes queimados, uma vez que profundas alterações ocorrem na farmacocinética de agentes antimicrobianos. Investigaram-se trinta e um pacientes, portadores de sepse documentada e apresentando lesões ativas; utilizou-se o tratamento empírico conforme seguem os regimes de dose: 1 g, 12/12 h para a vancomicina, 1 g, 6/6 h para o imipenem e 2 g, 8/8 h para o cefepime. Sete coletas seriadas de sangue foram realizadas através de cateter venoso (2 mL/cada); o plasma foi obtido pela centrifugação e armazenado no congelador (-80o C) até o ensaio. A concentração plasmática dos antimicrobianos foi determinada simultaneamente pela aplicação do método bioanalítico desenvolvido no estudo. O método de cromatografia líquida de alta eficiência demonstrou boa linearidade, precisão e exatidão para a determinação simultânea da vancomicina, cefepime e imipenem plasmáticos; a plicação desse método bioanalítico permitiu o monitoramento plasmático terapêutico e o estudo farmacocinético. Com base nos resultados obtidos de concentração plasmática versus tempo, aplicou-se a modelagem para investigar a farmacocinética desses agentes antimicrobianos nos pacientes queimados. Os parâmetros cinéticos foram estimados com base no modelo aberto de um compartimento pela aplicação do programa PK Solutions v. 2.0; a estatística foi realizada pela utilização do programa GraphPad Prism v. 4.0. Com base na farmacocinética alterada, as concentrações obtidas para a vancomicina e imipenem se mostraram abaixo dos valores recomendados para atingir eficácia; por outro lado, as concentrações obtidas para o cefepime se mostraram dentro da faixa recomendada para atingir eficácia, uma vez que não se registrou alteração da farmacocinética deste antimicrobiano nos pacientes queimados. Desta forma, o monitoramento plasmático terapeutico se mostrou importante, permitindo o ajuste de dose para a vancomicina e para o imipenem, uma vez que...
Sepsis after thermal injury is the major cause of morbidity and mortality in burn patients, once deep changes on the pharmacokinetics of antimicrobials agents are expected. Thirty one burn patients were investigated, all of them had documented sepsis and presented active lesions; they were treated with empirical dose regimen as follows: 1 g, 12/12 h for vancomycin, 1 g, 6/6 h for imipenem and 2 g, 8/8 h for cefepime. A serial of seven blood samples were collected from the venous catheter (2 mL/each); plasma was obtained by centrifugation and storaged in an ultra-low freezer (-80o C) until assay. Drug plasma concentration was determined simultaneously by application of a bioanalytical method described previously. High performance liquid chromatographic method showed good linearity, precision and accuracy for vancomycin, cefepime and imipenem plasma measurements; its application permitted therapeutic drug monitoring and pharmacokinetic studies. Pharmacokinetic modeling was applied to data obtained based on drug plasma concentrations versus time, to investigate those antimicrobial agents in burn patients. Estimated kinetic parameters were based on the one compartment open model by application the software PK Solutions v. 2.0; statistics was performed by using the software GraphPad Prism v. 4.0. Based on altered pharmacokinetics, obtained plasma concentrations to reach drug efficacy were below the recommended values for vancomycin and imipenem; on the other hand, cefepime plasma concentrations to reach drug efficacy were in the recommended range, once its pharmacokinetics didnt change in burn patients. Then, therapeutic plasma monitoring was cost-effective permitting dose adjustment for vancomycin and imipenem, once the minimum effective concentration (MEC) wasnt reached for both antimicrobial agents by using the empirical dose regimen for burn patients. On the other hand, cefepime plasma monitoring was also cost-effective, since burn patients long term therapy can...