Catechin-based Dentin Pretreatment and the Clinical Performance of a Universal Adhesive: A Two-year Randomized Clinical Trial.

CLINICAL RELEVANCE: At 24 months, the dentin pretreatment with epigallocatechin-3-gallate did not impair the clinical performance of the adhesive Single Bond Universal regardless of the bonding strategy used. SUMMARY: Purpose: To evaluate the two-year effect of dentin pretreatment with epigallocatechin-3-gallate (EGCG) on the clinical performance of restorations of noncarious cervical lesions (NCCLs) with Single Bond Universal, applied in two different modes (self-etch and etch-and-rinse).Methods and Materials: In this randomized clinical trial, 33 volunteers were selected, and 156 NCCLs were assigned to four groups: ER, etch-and-rinse; ER-EGCG, 0.1% EGCG dentin pretreatment + etch-and-rinse; SE, self-etch; and SE-EGCG, 0.1% EGCG dentin pretreatment + self-etch. The NCCLs were restored with a nanofilled resin composite and evaluated at baseline and at six, 12, 18, and 24 months using FDI criteria for retention, marginal staining, marginal adaptation, caries, and postoperative sensitivity. Two evaluators were blinded to the treatments performed, and impressions were taken for resin replicas to allow indirect observations. Statistical analyses were performed with Kruskal-Wallis and McNemar tests with a significance level of 5%.Results: Six restorations (one from ER, two from SE, one from ER-EGCG, and two from SEEGCG) were lost at 24 months with no significant differences (p>0.05). The retention rates were 97.0% (ER and ER-EGCG), 94.1% (SE), and 94.2% (SE-EGCG). For marginal adaptation, a significant difference was detected between the baseline and 24 months for the SE group (p=0.0313). There were no statistical differences among all other evaluated criteria at 24 months, neither for each group at baseline nor for 24-month comparisons (p>0.05).Conclusions: The pretreatment with EGCG provided no benefit in the clinical performance of the adhesive regardless of the bonding strategy used. In addition, it adds an additional required step to the restorative procedure.

Effectiveness of Different Mechanical Methods on Dentin Caries Removal: Micro-CT and Digital Image Evaluation.

PURPOSE: To determine the caries removal effectiveness (CRE) and minimal invasive potential (MIP) of caries excavation methods using digital imaging and microtomography analyses. METHODS: Twelve human molars with occlusal caries lesions in dentin were randomly divided into three groups (carbide bur, exacavator, and polymer bur). They were sectioned mesiodistally, and standardized digital and computed microtomography x-ray (micro-CT) images were taken from each section before and after caries excavation. On each image, initial carious dentin (IC), prepared cavity (PC), and residual caries (RC) were defined according to visual criteria using ImageJ software. CRE was determined based on the RC/IC ratio, whereas MIP was determined by the PC/IC ratio. Data were analyzed using one-way analysis of variance and Student t-test or with Kruskal-Wallis and Student-Newman-Keuls test. The level of significance was set at 0.05. RESULTS: For both digital image and micro-CT analysis, the carbide bur showed higher CRE values than the excavator (p=0.0063 and p=0.0263, respectively) and the polymer bur (p=0.0028 and p=0.0005, respectively). The latter two presented similar results (p>0.05). Regarding MIP, for the digital image analysis, the polymer bur was different from the carbide bur (p=0.0030) but was not different from that of the excavator (p=0.1240). For micro-CT analysis, the MIP values of all the groups were significantly different, and the polymer bur was the most conservative method (p<0.05). CONCLUSIONS: The carbide bur was the most effective method for caries removal but was not completely conservative. The polymer bur and excavator presented low invasive potential but were not able to remove all of the carious dentin.

Biological restorations as an alternative to reconstructing posterior teeth: a case report.

This article reports on a three-year follow-up of two biological restorations performed on a 15-year-old female patient. After clinical evaluation, tooth fragments from extracted permanent molars were obtained from a Human Teeth Bank and were autoclaved, adjusted to the prepared cavity, and bonded to the remaining tooth structure with dual resin cement. The technical aspects are described and the benefits and disadvantages of biological restorations as an alternative treatment for rehabilitation of severely destroyed permanent molars are discussed.

Gatifloxacin in the treatment of community-acquired pneumonias: a comparative trial of ceftriaxone, with or without macrolides, in hospitalized adult patients with mild to moderately severe pneumonia.

Community-acquired pneumonia is very common, but some of the cases do require hospitalization for treatment, particularly when older patients and/or co-morbidities are involved; both "typical" and "atypical" respiratory pathogens take part etiologically, and there is increasing concern about the emergence of resistance. There is interest in therapeutic options that can: a) comprehend such a spectrum of bacteria and resistance; b) allow parenteral to oral sequential treatment. We made a multicenter, prospective and randomized trial to compare the "standard" treatment of ceftriaxone IV alone or in combination with erythromycin IV, followed by clarithromycin PO (ceftriaxone treatment arm), with gatifloxacin IV, followed by oral administration (gatifloxacin treatment arm). The need for hospitalization was based on clinical criteria as judged by the investigators. Standardized criteria for diagnosis and follow-up were employed. Fifty-six patients were enrolled, with 48% over 65 years old, and there were frequent co-morbidities. Of these, 51 were clinically evaluable, 26 in the gatifloxacin and 25 in the ceftriaxone arm, with comparable success rates, 92% and 88%, respectively, even when major prognostic factors were considered. There were no serious adverse events or significant laboratory value changes attributable to the study drugs. Gatifloxacin as monotherapy (initially IV then orally until completion of treatment) was shown to be effective and safe, comparable to ceftriaxone IV alone or in combination with a macrolide (initially IV then orally until completion of treatment), in empirical therapy for community-acquired pneumonias, for patients that, at the physician s discretion, require initial treatment as inpatients.

Gatifloxacin in the treatment of community-acquired pneumonias: a comparative trial of ceftriaxone, with or without macrolides, in hospitalized adult patients with mild to moderately severe pneumonia

Community-acquired pneumonia is very common, but some of the cases do require hospitalization for treatment, particularly when older patients and/or co-morbidities are involved; both "typical" and "atypical" respiratory pathogens take part etiologically, and there is increasing concern about the emergence of resistance. There is interest in therapeutic options that can: a) comprehend such a spectrum of bacteria and resistance; b) allow parenteral to oral sequential treatment. We made a multicenter, prospective and randomized trial to compare the "standard" treatment of ceftriaxone IV alone or in combination with erythromycin IV, followed by clarithromycin PO (ceftriaxone treatment arm), with gatifloxacin IV, followed by oral administration (gatifloxacin treatment arm). The need for hospitalization was based on clinical criteria as judged by the investigators. Standardized criteria for diagnosis and follow-up were employed. Fifty-six patients were enrolled, with 48 percent over 65 years old, and there were frequent co-morbidities. Of these, 51 were clinically evaluable, 26 in the gatifloxacin and 25 in the ceftriaxone arm, with comparable success rates, 92 percent and 88 percent, respectively, even when major prognostic factors were considered. There were no serious adverse events or significant laboratory value changes attributable to the study drugs. Gatifloxacin as monotherapy (initially IV then orally until completion of treatment) was shown to be effective and safe, comparable to ceftriaxone IV alone or in combination with a macrolide (initially IV then orally until completion of treatment), in empirical therapy for community-acquired pneumonias, for patients that, at the physician s discretion, require initial treatment as inpatients.

Effects of HEMA/solvent combinations on bond strength to dentin.

Re-expansion of dried demineralized dentin is required to optimize resin adhesion. This study tested the hypothesis that bond strengths to dentin depend upon the ability of experimental HEMA(2-hydroxy-ethyl-methacrylate)/solvent primers to re-expand the matrix. Dentin surfaces were acid-etched with 37% phosphoric acid for 20 sec, air-dried for 30 sec, primed with either 35/65% (v/v) HEMA/water, HEMA/methanol, HEMA/ethanol, or HEMA/propanol for 60 sec, and bonded with 4-META-TBBO(4-methacryloyloxyethyl trimellitate anhydride-tri-n-butyl borane) adhesive. After storage in water for 1 day at 37 degrees C, the samples were prepared for microtensile bond strength testing. We used transmission electron microscopy to measure the width of interfibrillar spaces in the hybrid layers. The HEMA/ethanol primer and the HEMA/propanol primer produced the highest and the lowest bond strengths, respectively (p < 0.05). Bond strengths were directly correlated with the width of the interfibrillar spaces (p < 0.05). Bond strengths are related to the ability of the primer to maintain the re-expansion of collapsed demineralized dentin matrix.

Effect of storage time on microtensile strength of polyacid-modified resin composites.

OBJECTIVE: The purpose of this study was to determine the cohesive microtensile strength of four polyacid-modified resin composites (PAMRC: Dyract, Dyract AP, Freedom and F2000) after 24h and 6 months of storage in water using the microtensile technique. METHODS: Blocks measuring 1.5 cm x 1.5 cm x 1.0 cm were constructed incrementally for each material using a silicone matrix. The blocks were stored in distilled water at 37 degrees C for 24 h and were then serially sectioned in both x and y directions to obtain several beams measuring 1.0 cm x 1.0 mm x 1.0 mm. Each beam was gently trimmed from two sides with ultra-fine diamond burs to reduce the cross-sectional area to a 'neck' of approximately 0.4mm(2) located in the middle of their length. The beams (18-22 per material) were randomly divided and tested in tension either after 24 h or after 6 months of storage in water at 37 degrees C in a Vitrodyne testing machine at 0.6 mm/min. RESULTS: Mean microtensile strengths (MPa) at 24 h were: 48.7+/-13.8 for Dyract AP; 36.5+/-14.1 for Dyract; 38.2+/-14.5 for Freedom and 48.6+/-7.2 for F2000. There was no statistically significant difference among the materials (p>0.05). At 6 months, only Dyract AP showed significant increase in microtensile strength (p<0.05) while the other materials showed no differences in microtensile strength with time (p>0.05). SIGNIFICANCE: The results indicate that storage in water for 6 months caused no reduction of the microtensile strength of PAMRC materials.

Trypanosoma cruzi meningoencephalitis in HIV-infected patients.

Five cases of Trypanosoma cruzi meningoencephalitis in HIV-infected patients are reported. All patients presented with mass lesions on head computed tomographic scan, trypanosomes in the cerebrospinal fluid and failure to respond to antitoxoplasmosis therapy. Benznidazole therapy was associated with clinical improvement in 1 patient. Another 4 patients had T cruzi identified in a peripheral smear. T cruzi needs to be considered in the differential diagnosis of HIV-infected patients with central nervous system mass lesions if they have a history of appropriate exposure.

[Treatment of american cutaneous leishmaniasis, with lesions in the mucosa, using pentamidine isethionate]. / Tratamento da leishmaniose tegumentar americana, com lesão em mucosa, por meio do isotionato de pentamidina.

Ten patients with mucosal lesions caused by American tegumental leishmaniasis were treated with pentamidine isethionate at the dose 4 mg/kg on alternate days by the intravenous route. The mean posology was 2,140 mg. Healing of the lesions occurred in 9 (90%) of the patients who completed treatment. There was no recurrence during a follow-up time of 1 to 24 months (mean, 7,7 months). One patient discontinued treatment before healing of the lesion because be developed diabetes mellitus. In 3 (30%) patients, blood exams showed increased urea and creatinine levels and leucopenia, which were corrected by increasing the interval between administrations of the drug. Pentamidine isethionate is efficient in bringing about cicatrization of the lesions but needs further evaluation in terms of its value in preventing recurrence.

[The treatment of cryptosporidiosis in AIDS patients using paromomycin]. / Tratamento da criptosporidíase em pacientes com AIDS, por meio da paromomicina.

The authors treated with paromomycin 25 patients, with AIDS and cryptosporidiosis. The drug was given orally in a doses of 500 mg qid, for a period of 14 days. Tolerance was good, with just two cases of mild side-effects. Clinical improvement was obtained in 19 (76%) patients. Parasitological cure, however, occurred only in a low percentage (25%). In some cases where initial success was observed, recrudescence occurred after some weeks or few months, but with retreatment again clinical improvement was obtained. Even if it does not lead to frequent parasite eradication, the good clinical results and tolerance permit us to consider paromomycin one of the few drugs effective for the treatment of cryptosporidial diarrhea in AIDS patients. Studies with maintainance therapy are indicated.

Immunogenicity and efficacy of a killed hepatitis A vaccine in day care center children.

The objective of this study was to characterize the immune response of children after the use of two different vaccine doses and to evaluate whether vaccination benefits children attending day care centers in areas with high anti-HAV seroprevalence. The study was conducted in a day care center with a stable population in São Paulo, Brazil. Two groups of 20 children, all seronegative for hepatitis A antibodies, were assigned randomly to receive three times 0.5 and 1.0 ml of the vaccine, the second and third dose 1 and 6 months after the first dose, respectively. There were 27 children in the control group. All children in both vaccinated groups had protective levels of antibodies in the serum after two inoculations, and serious adverse reactions were not observed. In the eighth month of follow-up, a hepatitis A outbreak occurred in the day care center. Five children in the control group had high titers of IgM class anti-HAV, four with clinical manifestations of acute hepatitis. None of the vaccinated children developed symptoms or signs of hepatitis (P = 0.0125), and the estimate of vaccine efficacy was 100%. Two nonstudy children from the center also had clinical and serological evidence of acute hepatitis A. It is concluded that vaccination represents an important method for prevention of hepatitis A transmission in day care centers. The results of this pilot study justify further testing in larger groups.

Infecçäo causada por Mycobacterium tuberculosis com resistência primária a múltiplas drogas: relato de caso em paciente com AIDS / Infection caused by Mycobacterium tuberculosis with primary resistance to multiple drugs: a case report of a patient with AIDS

Mycobacterium tuberculosis, primariamente resistente a múltiplas drogas, é problema de crescente importância nos Estados Unidos. No Brasil, näo existem relatos, pelo menos em literatura formal, de infecçäo por este patógeno. Relato de caso. Os autores relatam caso de paciente do sexo masculino que teve diagnóstico de tuberculose ganglionar cervical por meio de baciloscopia. Adicionalmente, anti-HIV feito por método ELISA resultou positivo. O paciente iniciou esquema terapêutico com isoniazida, rifampicina e pirazinamida. Segundo o paciente e seus familiares, os medicamentos foram administrados corretamente, mas näo foi observada melhora clínica. Após 75 dias de tratamento, o paciente foi internado no Hospital do Servidor Público Estadual de Säo Paulo com piora clínica caracterizada por aumento de gânglio submandibular, insuficiência respiratória e dor abdominal, vindo a falecer seis dias após a admissäo. Cultura do aspirado ganglionar, colhida no dia da internaçäo, mostrou crescimento de M. tuberculosis sensível ao etambutol e resistente à isoniazida, rifampicina, pirazinamida, etionamida e estreptomicina. Discussäo. O isolamento de M. tuberculosis multirresistente, mesmo que em paciente com forma extra-pulmonar da doença, traz à tona discussäo da necessidade da prevalência do patógeno em nosso meio mediante realizaçäo de cultura e antibiograma, e ressalta problemas inerentes à MTB-MDR, como a alta letalidade em pacientes com infecçäo clinicamente manifesta e a transmissäo intra-hospitalar, já demonstrada em outros países. É discutida a necessidade de cumprimento rigoroso das medidas de isolamento

[Infection caused by Mycobacterium tuberculosis with primary resistance to multiple drugs: a case report of a patient with AIDS]. / Infecção causada por Mycobacterium tuberculosis com resistência primária a múltiplas drogas: relato de um caso em paciente com AIDS.

Primary multidrug-resistant Mycobacterium tuberculosis is an important problem in the United States. There is no report in formal literature of this pathogen in Brazilian patients. CASE REPORT--We report a case of ganglionar tuberculosis diagnosed by acid-fast smears in a male, HIV positive patient. Mode of acquisition of HIV was not determined. Treatment was started, and isoniazid, rifampicin and pyrazinamide were prescribed. The patient and his family reported strict adherence to therapy, but no improvement was observed. After 75 days, the patient was admitted in our hospital because of clinical worsening. Clinical features were the presence of large submandibular and axillar lymph nodes, respiratory insufficiency and complains of abdominal pain. He died six days after admission. Culture obtained from the ganglionar aspirate disclosed M. tuberculosis susceptible to ethambutol, but resistant to isoniazid, rifampicin, pyrazinamide, ethionamide and streptomycin. DISCUSSION--Although this was a case of extrapulmonary tuberculosis, there is a concern about multidrug-resistant tuberculosis, that has been poorly evaluated in Brazil. Since high lethality and intrahospital transmission have been reported, we discuss the need of performing culture and antibiogram in suspected cases, and the prevention of the spread of M. tuberculosis to patients and health-care workers through the strict adherence to the isolation practices.

An outbreak of handscrubbing-related surgical site infections in vascular surgical procedures.

OBJECTIVE: To investigate an outbreak of surgical site infections (SSI) in a vascular surgery unit. SETTING: A 60-bed unit of vascular surgery, where surgeons performed an average of 30 operations per month at the Hospital do Servidor Público Estadual, a 1,000-bed tertiary care hospital in São Paulo, Brazil. DESIGN: We included in the case group nine patients who had limb amputations or arterial reconstructions, October 16 through 23, 1992. We included in the control group patients whose operations were performed within 30 days of the outbreak period. Control patients were matched for sex and type of operation. RESULTS: Six of 9 case patients experienced SSI, as compared with 3 of 18 control patients (P = .026) and 28 of 244 patients in the pre-epidemic period (P = .0002). Risk factors were identical for case and control groups. Factors assessed were American Society of Anesthesiology (ASA) status, duration of surgery, wound class, emergency status, remote site infections, preoperative length of stay, use of prophylactic antibiotics, and underlying diseases. Possible common sources also were analyzed. No differences were observed concerning hair removal, preoperative shower, wound dressing, and surgical team present in the operating room. During the outbreak period, the operating room was not provided with povidone-iodine, used in our hospital for skin cleansing and handscrubbing. Surgeons from all departments, including vascular surgery, used 2% iodine with 70% alcohol for skin cleansing. Surgeons from other departments used this iodine solution for handscrubbing, but the vascular surgeons used plain soap for handscrubbing. No increases in SSI rates were reported in other services. Comparison of case and control groups for handscrubbing was statistically significant (P < .00001). After reinstitution of povidone-iodine, only one SSI was diagnosed in 13 vascular procedures. CONCLUSIONS: Although we could not demonstrate definitely that scrubbing with plain soap was related to SSI, we found a strong suggestion of this association.

Microbiological studies of abscesses complicating Bothrops snakebite in humans: a prospective study.

Forty patients with abscesses at the site of Bothrops bite were evaluated. Ten brought the snake responsible for the bite, Bothrops jararaca in all cases. On admission a sample was collected from each case for aerobic and anaerobic culture, and no abscesses drained spontaneously. None of the patients had received antibacterial therapy at this time. The bacteria most frequently isolated were Morganella morganii (23 patients), Providencia rettgeri (7) Enterobacter sp. (4), Escherichia coli (3), group D streptococcus (11) and Bacteroides sp. (6). All enterobacteria tested were sensitive to chloramphenicol, aminoglycosides and cefotaxime. Group D streptococci were sensitive to chloramphenicol, ampicillin and penicillin G, whereas anaerobic bacteria were sensitive to chloramphenicol and tetracycline. These results suggest that in cases of abscess formation secondary to Bothrops bite, chloramphenicol alone is a good choice, being both safe and cheap.

Vesícula biliar hidrópica na síndrome linfonodomucocutânea (Sindrome de Kawasaki): relato de caso / Hydropic blister gallbladder in mucocutaneous lymph node syndrome (Kawasaki sindrome): a case report

Uma possível manifestaçao da síndrome linfonodomucocutânea (SLMC), ou síndrome de Kawasaki, é a hidropsia da vesícula biliar. Pode apresentar-se com sintomas abdominais previamente ao estabelecimento clínico da síndrome ou aparecer já no curso dela. Existem poucos relatos desta associaçao, com variaçao de incidência estimada entre 3 por cento e 13,7 por cento. Neste relato descrevemos um caso de SLMC numa criança de cinco anos de idade, que na evoluçao apresentou sintomas e sinais de envolvimento abdominal, com ultra-sonografia e tomografia computadorizada de abdome demonstrando a presença de vesícula biliar hidrópica. Tal patologia deve ser lembrada principalmente no diagnóstico diferencial de colangite acalculosa em crianças, devido ao crescente número de casos de SLMC identificados em nosso meio.

Oral ciprofloxacin for treatment of severe infections.

Twenty adult patients with severe infections were treated with oral ciprofloxacin, 500 or 750 mg twice daily. Treatment ranged from 8 to 25 days. Efficacy was good: 14 patients (70%) were cured, four (20%) improved and there were only two (10%) failures. Tolerance was very satisfactory, the most common side-effects being mild gastrointestinal symptoms (three patients). Only one adverse laboratory result was observed: a transient rise in blood urea nitrogen and creatinine levels. None of the adverse effects led to discontinuation of treatment. Thus, ciprofloxacin presents as a promising drug for treatment of severe infections caused by susceptible organisms when ambulatorial therapy, at least during a large part of the treatment, is possible and desirable.

Oral ciprofloxacin for treatment of chronic osteomyelitis.

Seventeen adult patients with chronic osteomyelitis were treated with oral ciprofloxacin, 750 mg twice daily. Treatment ranged from 28 to 254 days. Efficacy was considered to be good, based upon clinical resolution observed in 13 patients (76%). Clinical and microbiological failure was observed in 3 patients (18%), and there was one case of reinfection. Tolerance was very satisfactory, since the adverse reactions were mild and transitory; these occurred in 7 patients (41%), being cutaneous rash in 4 patients and diarrhoea in 3 patients. No patient had to discontinue treatment. Thus, oral ciprofloxacin may be useful option for the prolonged treatment of chronic osteomyelitis, provided that it is always associated with surgical debridement. Due to the probable development of ciprofloxacin resistance in the S. aureus multiresistant strain, already observed in two patients in the present investigation, it is suggested that for the treatment of such infections another drug with antistaphylococcal activity should be associated with the ciprofloxacin.