Efectividad de sustancias químicas en el clareamiento y biopelícula dental aplicado en el consultorio y ambulatorio / Effectiveness of chemical substances in bleaching and dental biofilm applied in the office and outpatient

El blanqueamiento dental está considerado como pieza fundamental en el embellecimiento de los seres humanos, ya que permite la restauración de la "sonrisa perfecta". Este proceso en sí, es poco invasivo y juega como un gran papel como aliado en la restauración satisfactoria de la sonrisa y autoestima del paciente. Es un procedimiento que debe ser aplicado cuidadosamente para lograr los efectos positivos del mismo. El fundamento de esta técnica es aclarar la tonalidad que han sufrido los dientes por diversos factores: extrinsecos, intrínsecos y decoloraciones internas. Durante el procedimiento, es usual el uso de peróxido de hidrógeno (H2O2) en concentraciones que van del 10 al 32 % en volumen o el peróxido de carbamida, un compuesto conformado por peróxido de hidrógeno y urea concentraciones del 10 al 22 %. El uso de peróxido de hidrógeno se lleva a cabo fundamentalmente en los consultorios, mientras que el uso del peróxido de carbamida es un procedimiento doméstico. A pesar de los excelentes resultados que se obtiene al usar ambos blanqueadores, su uso puede ocasionar erosiones dentales y sensibilidad dentaria. El primer caso, puede llevar a la adherencia de bacterias cariogénicas como el Strepctococus mutans responsable de caries. Los resultados obtenidos, demostraron que el peróxido de hidrógeno es un agente más agresivo que el peróxido de carbamida, lo cual origina mayor sensibilidad dentaria y un mayor control bacteriano; en cambio el peróxido de carbamida fue mejor blanqueador y originó menor sensibilidad dental(AU)

Tooth whitening is considered a fundamental piece in the beautification of human beings, since it allows the restoration of the "perfect smile". This process itself is minimally invasive and plays a great role as an ally in the satisfactory restoration of the patient's smile and self-esteem. It is a procedure that must be carefully applied to achieve its positive effects. The basis of this technique is to clarify the shade that the teeth have suffered due to various factors: extrinsic, intrinsic and internal discoloration. During the procedure, the use of hydrogen peroxide (H2O2) in concentrations ranging from 10 to 32% by volume or carbamide peroxide, a compound made up of hydrogen peroxide and urea concentrations of 10 to 22%, is usual. The use of hydrogen peroxide is mainly carried out in offices, while the use of carbamide peroxide is a home procedure. Despite the excellent results obtained by using both whiteners, their use can cause dental erosion and tooth sensitivity. The first case can lead to the adherence of cariogenic bacteria such as Streptococcus mutans responsible for caries. The results obtained showed that hydrogen peroxide is a more aggressive agent than carbamide peroxide, which causes greater dental sensitivity and greater bacterial control; On the other hand, carbamide peroxide was a better whitener and caused less dental sensitivity(AU)

Bleach-concentrated direct sputum smear microscopy procedure for diagnosis of pulmonary tuberculosis in poverty areas / Microscopia direta de amostra de escarro concentrado em água sanitária para diagnóstico de tuberculose pulmonar

ABSTRACT INTRODUCTION: Pulmonary tuberculosis caused by Mycobacterium tuberculosis is a serious public health problem affecting millions of people worldwide. The development of easy and low-cost diagnostic methods is crucial for disease control in rural remote and poverty areas and among vulnerable groups. OBJECTIVE: To evaluate the accuracy of laboratory methods for the diagnosis of Pulmonary tuberculosis. MATERIAL AND METHODS: Sputum samples from patients with clinical signs and symptoms were analyzed by microscopy after chemical treatment and spontaneous sedimentation and compared with methods employed routinely: direct sputum smear microscopy, culture, and GeneXpert®MTB/RIF. RESULTS: From the samples analyzed, 16% were positive by microscopy in the processed samples, 18% by both culture and Xpert®MTB/RIF, while 13% in the direct microscopy. The processed samples showed a 31% increase in positivity (57 samples) compared to conventional direct microscopy. In the analysis of the accuracy of the evaluated methods, all the results were statistically significant proving that they were not randomly positive or negative and confirming that there is a tendency for these results. CONCLUSION: Chemical treatment and spontaneous sedimentation of the sputum samples procedure represent an effective diagnostic tool in situations where more advanced technologies are not feasible. Besides the higher accuracy and greater detection of positive cases regarding the direct smear, the procedure strengthens biosafety by decreasing the risks of aerial contamination by Mycobacterium tuberculosis for laboratory professionals.

RESUMEN INTRODUCCIÓN: La tuberculosis pulmonar causada por Mycobacterium tuberculosis es un grave problema de salud pública que afecta millones de individuos en el mundo. El desarrollo de métodos de diagnóstico fáciles y de bajo costo es esencial para el control de la enfermedad en zonas rurales remotas y pobres y entre los grupos vulnerables. OBJETIVO: Evaluar la exactitud de métodos de laboratorio para el diagnóstico de tuberculosis pulmonar. MATERIAL Y MÉTODO: Las muestras del esputo de pacientes con signos y síntomas clínicos fueron analizadas por microscopía luego de tratamiento químico y sedimentación espontánea y comparados con métodos empleados ordinariamente: baciloscopía directa de esputo, cultivo y GeneXpert® MTB/RIF. RESULTADOS: Entre las muestras analizadas, 16% fueron positivas por microscopía en las muestras procesadas; 18% por cultivo y Xpert® MTB/RIF; y 13% por microscopía directa. Las muestras procesadas presentaran un aumento de 31% de positividad (57 muestras) con respecto a la microscopía directa convencional. En el análisis de los métodos, todos los resultados fueron estadísticamente significativos, comprobando que no eran aleatoriamente positivos o negativos y confirmando que hay una tendencia para esos resultados. CONCLUSIÓN: El tratamiento químico y la sedimentación espontánea de las muestras de esputo representan una herramienta diagnóstica eficaz en las situaciones en las cuales tecnologías más avanzadas no son viables. Además de la mayor precisión y mayor detección de casos positivos de lo que hace el frotis directo, el procedimiento fortalece la bioseguridad, disminuyendo los riesgos de contaminación del aire por Mycobacterium tuberculosis para el personal de laboratorio.

RESUMO INTRODUÇÃO: A tuberculose pulmonar causada por Mycobacterium tuberculosis é um grave problema de saúde pública que afeta mundialmente milhões de indivíduos. O desenvolvimento de métodos de diagnóstico fáceis e de baixo custo é essencial para o controle da doença nas áreas rurais remotas e de pobreza e entre os grupos vulneráveis. OBJETIVO: Avaliar a acurácia dos métodos laboratoriais para o diagnóstico de tuberculose pulmonar. MATERIAL E MÉTODOS: As amostras de escarro de pacientes com sinais e sintomas clínicos foram analisadas por microscopia após tratamento químico e sedimentação espontânea e comparadas com métodos empregados rotineiramente: baciloscopia direta do escarro, cultura e GeneXpert® MTB/RIF. RESULTADOS: Das amostras analisadas, 16% foram positivas por microscopia nas amostras processadas; 18%, por cultura e Xpert® MTB/RIF; e 13%, por microscopia direta. As amostras processadas apresentaram um aumento de 31% de positividade (57 amostras) em relação à microscopia direta convencional. Na análise dos métodos avaliados, todos os resultados foram estatisticamente significativos, comprovando que não eram positivos ou negativos aleatoriamente e confirmando que há uma tendência para esses resultados. CONCLUSÃO: O tratamento químico e a sedimentação espontânea das amostras de escarro representam uma ferramenta diagnóstica eficaz nas situações em que tecnologias mais avançadas não são viáveis. Além da maior precisão e maior detecção de casos positivos em relação ao esfregaço direto, o procedimento reforça a biossegurança, diminuindo os riscos de contaminação aérea por Mycobacterium tuberculosis para profissionais de laboratório

Improved sensitivity of direct microscopy for Mycobacterium tuberculosis in lymph nodes: comparison of fluorescent microscopy and modified bleach method ZN microscopy along with conventional ZN staining method

Background: Extra pulmonary tuberculosis arises as a result of lymphatic spread from a primary focus. Fine needle aspiration cytology has assumed an important role in the evaluation of peripheral lymphadenopathy as a possible minimally invasive alternative to excisional biopsy. In most low-income countries; the only practically available bacteriologic method for diagnosing EPTB is direct smear microscopy for acid fast bacilli from the sample of the lesion. There are various methods of staining and concentration for improving sensitivity of direct microscopy for detection of tubercle bacilli in specimen.Methods: This prospective study was carried out in the Department of Pathology, Subharti Medical College and associated Chattrapati Shivaji Subharti Hospital, Meerut for a period of 2 years from July 2016 - August 2018 in 151 patients with clinical suspicion of TB and significant lymphadenopathy.Results: AFB positivity increased from 40.39% on conventional ZN stain to 48.34% on modified bleach method ZN stain and to 56.29% on Auramine-O fluorescent stain. Taking fluorescent microscopy (Auramine-O) as reference method the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of conventional ZN stain and modified bleach method ZN stain were calculated as 71.8%, 100%, 100%, 73.33%, 84.10% and 85.33%,100%,100% ,84.61% ,92.05%, respectively.Conclusions: The addition of fluorescent microscopy (Auramine-O) and modified bleach method ZN microscopy along with conventional ZN staining method would be an important adjunct to improve the microscopic detection of Mycobacterium tuberculosis in fine-needle aspirates of lymph nodes.

Blanqueamiento interno: Reporte de caso / Non-vital bleaching: Case report

La discromia de un diente es una alteración que varía en etiología, localización y severidad. Esta puede estar relacionada a causas extrínsecas, intrínsecas o una combinación de ambos. Una manera de tratar estas piezas no vitales, es el blanqueamiento interno, el cual se presenta como una alternativa conservadora frente a otros procedimientos como restauraciones con resina, carillas o coronas cerámicas, ya que preserva al máximo la estructura dentaria. El objetivo de este trabajo es presentar un reporte de caso de una paciente con discromia de la pieza 21 y cómo fue tratada con blanqueamiento interno, además hacer una revisión de la literatura actual presentando la etiología de las alteraciones de color en dientes no vitales, las alternativas de tratamiento, así como los agentes disponibles para este fin. Las técnicas para realizar el blanqueamiento de una pieza no vital son: la técnica en consultorio o In-office bleaching, las técnicas ambulatorias (Walking bleach e inside/outside bleaching) y por último la técnica mixta. Asimismo existen agentes blanqueadores disponibles en diferentes concentraciones para realizar dichas técnicas, cuya efectividad será revisada en este trabajo. Existen diversos factores que afectarán la eficacia del blanqueamiento interno, como la edad del paciente, tiempo de oscurecimiento, el grado y origen de la discromia, que podrían afectar el resultado final y la longevidad del tratamiento.

Tooth discoloration varies in etiology, location and severity. It may be extrinsic, intrinsic or a combination of both. A treatment option in such cases is non-vital bleaching, which presents itself as a conservative alternative to other procedures like composite restorations, veneers or ceramic crowns, as it preserves the most of tooth structure. The aim of this paper is to report a clinical case of a patient with non vital tooth discoloration and how it was successfully treated with internal bleaching procedures; also to review the current literature discussing the etiology of discoloration in non-vital teeth, treatment options and agents available. Non-vital bleaching techniques include: In-office bleaching, walking bleach, inside/outside bleaching and finally, the combined technique. Bleaching agents are available in different concentrations for these techniques, whose effectiveness is discussed in this paper. There are several factors that could affect the effectiveness of non-vital bleaching, such as patient age, time, degree and etiology of discoloration. All of these can influence the final result and treatment longevity.

Improved diagnosis of tuberculosis in lymph node cytology by bleach method for detection of acid fast bacilli in comparison to conventional ziehl neelsen staining method.

Background: Extra pulmonary tuberculosis (TB) is prevalent in developing countries and its diagnosis is often delayed, thus increasing the morbidity and mortality. Bleach method is cost effective, sensitive and safe method for demonstration of Acid fast bacilli (AFB) and is very valuable in diagnosing a case of tuberculous lymphadenitis. This simple procedure would benefit the patients to receive an early and specific treatment. Aims & Objective: The aim of our study was early diagnosis of tuberculosis in lymph node Fine needle aspiration cytology (FNAC) by bleach method for detection of AFB in comparison to conventional Ziehl–Neelsen (ZN) method. Material and Methods: Total 115 cases clinically suspected as tuberculous lymphadenitis in one year duration were included in study. All the aspirates by FNAC were processed for routine cytology, ZN staining and bleach method. The significance of the bleach method over the ZN method was analyzed using the χ2 (chi-square) test. Results: Among the 115 aspirates, 59.13% (68/115) were indicative of TB on cytology, 27.83% (32/115) were positive for AFB on conventional ZN method and the smear positivity increased to 61.74% (71/115) on bleach method. Conclusion: The implementation of the bleach method clearly improves microscopic detection of AFB over ZN method. The bleach method can be easily performed and reduce chances of laboratory acquired infections.

Avaliacao da biotratabilidade do efluentede branqueamento de polpa celulosicapor processos aerobios e anaerobios / Evaluation of the biotreatability of bleachpulp mill effluent by aerobic and anaerobic process

Os efluentes da planta de branqueamento da produção de pasta celulósica apresentam, além de elevadas concentrações de matéria orgânica em termos de Demanda Química de Oxigênio (DQO) e Demanda Bioquímica de Oxigênio (DBO) e cor, compostos com elevada toxicidade, o que torna o tratamento destes efluentes problemático. O objetivo do presente artigo é avaliar a biotratabilidade dos efluentes de branqueamento ácido e alcalino de polpa celulósica kraft por processos aeróbios e anaeróbios por meio da caracterização, utilizando parâmetros convencionais e coletivos. Os resultados de DQO inerte, biodegradabilidade aeróbia e anaeróbia, distribuição de massas molares, produtos microbianos solúveis e substâncias poliméricas extracelulares indicaram a baixa biotratabilidade dos efluentes.

The bleaching pulp mill effluent presents, in addition to high concentrations of organic matter in terms of Chemical Oxygen Demand (COD) and Biochemical Oxygen Demand (BOD) and color, compounds with high toxicity, which makes the treatment of these effluents difficult. The aim of this article is to evaluate the biotreatability of acid and alkaline bleach effluents from kraft pulp by aerobic and anaerobic processes through characterization using conventional and collective parameters. The results of inert COD, aerobic and anaerobic biodegradability, molecular weight distribution, soluble microbial products and extracellular polymeric substances showed a low biotreatability of the effluents.

Bleach optimization of sputum smear microscopy for Pulmonary Tuberculosis.

The Revised National Tuberculosis Control Programme (RNTCP) aims to improve case detection rates of tuberculosis to facilitate prompt recognition and treatment. The low case detection rates in the programme can be directly attributed to failure to screen patients with suspected tuberculosis and the low sensitivity of the direct smear microscopy method to detect cases among the fraction of patients that are screened. Apart from low sensitivity, this method also has other disadvantages including the increased risk of infection transmission to technicians. There are several methods that can be used to improve sensitivity, but their applicability in a national programme and in resource limited settings are limited. Bleach processing of sputum smears prior to microscopy may be a cheap and effective way to improve on the sensitivity of the direct smear. Four distinctive techniques of sputum smear processing using bleach are described in the review, with the variations in each technique, along with the sensitivity. An analysis of reports published earlier on the bleach method is also presented including a discussion on when and why the bleach method works.

Improved microscopical detection of acid-fast bacilli by the modified bleach method in lymphnode aspirates.

Objectives: To improve the smear microscopy for detection of acid-fast bacilli (AFB) in fine needle aspiration cytology (FNAC) of lymph node using the bleach method and also to compare this with cytological diagnosis and the conventional Ziehl-Neelsen (ZN) method. Study Design: In 99 consecutive patients with clinical suspicion of tuberculosis (TB) presenting with lymphadenopathy, FNACs were performed. Smears from the aspirates were processed for routine cytology and the conventional ZN method. The remaining material in the needle hub and/or the syringe was used for the bleach method. The significance of the bleach method over the conventional ZN method and cytology was analyzed using the χ2 test. Results: Of 99 aspirates, 93 were studied and the remaining six were excluded from the study due to diagnosis of malignancy in 4.04% (4/6) and inadequate aspiration in 2.02% (2/6). Among the 93 aspirates, 33.33% (31/93) were positive for AFB on conventional ZN method, 41.94% (39/93) were indicative of TB on cytology and the smear positivity increased to 63.44% (59/93) on bleach method. Conclusion: The bleach method is simple, inexpensive and potent disinfectant, also limiting the risk of laboratory-acquired infections. The implementation of the bleach method clearly improves microscopic detection and can be a useful contribution to routine cytology.

Corrosive Injury of the Stomach and Esophagus by Sodium Hypochlorite Ingestion: A case report

Ingestion of sodium hypochlorite bleach is usually benign, leading most emergency departments to advocate conservative home management. We report a rare case of household bleach ingestion. A 54- year-old male ingested unintentionally an unknown quantity of household bleach (4% sodium hypochlorite, pH<12). He was transferred to our department for further evaluation and management from a local general hospital because of continuous vomiting and suspicious gastric malignant lesions on the endoscopic findings. The results of repeated gastrointestinal endoscopy were corrosive injury to the stomach and the esophagus. About 60 days following ingestion of the bleach, he underwent a hemigastrectomy due to pyloric stenosis. The literature regarding corrosive injury following bleach ingestion is reviewed.