Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial.

Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Anesthetic Efficacy in Irreversible Pulpitis: A Randomized Clinical Trial

Abstract Inferior alveolar nerve block has a high failure rate in the treatment of mandibular posterior teeth with irreversible pulpitis. The aim of this study was to compare the anesthetic efficacy of 4% articaine, 2% lidocaine and 2% mepivacaine, all in combination with 1:100,000 epinephrine, in patients with irreversible pulpitis of permanent mandibular molars during a pulpectomy procedure. Sixty-six volunteers from the Emergency Center of the School of Dentistry, University of São Paulo, randomly received 3.6 mL of local anesthetic as a conventional inferior alveolar nerve block (IANB). The subjective signal of lip numbness, pulpal anesthesia and absence of pain during the pulpectomy procedure were evaluated respectively, by questioning the patient, stimulation using an electric pulp tester and a verbal analogue scale. All patients reported the subjective signal of lip numbness. Regarding pulpal anesthesia success as measured with the pulp tester, the success rate was respectively 68.2% for mepivacaine, 63.6% for articaine and 63.6% for lidocaine. Regarding patients who reported no pain or mild pain during the pulpectomy, the success rate was, respectively 72.7% for mepivacaine, 63.6% for articaine and 54.5% for lidocaine. These differences were not statistically significant. Neither of the solutions resulted in 100% anesthetic success in patients with irreversible pulpitis of mandibular molars.

Resumo O bloqueio do nervo alveolar inferior apresenta uma alta taxa de falha para o tratamento de dentes posteriores mandibulares com pulpite irreversível. O objetivo deste estudo foi comparar a eficácia anestésica da articaína 4%, lidocaína 2% e mepivacaína 2%, todas em combinação com epinefrina 1:100.000, em pacientes com pulpite irreversível de molares mandibulares durante um procedimento de pulpectomia. Sessenta e seis voluntários do Centro de Emergência da Faculdade de Odontologia da Universidade de São Paulo receberam aleatoriamente 3.6 mL de anestésico local no bloqueio convencional do nervo alveolar inferior (BNAI). O sinal subjetivo de dormência do lábio, anestesia pulpar e ausência de dor durante o procedimento de pulpectomia foram, respectivamente, avaliados pelo interrogatório do paciente, usando um estimulador pulpar elétrico e uma escala analógica verbal. Todos os pacientes relataram o sinal subjetivo de dormência do lábio. Em relação ao sucesso da anestesia pulpar medido com o Pulp Tester, a taxa de sucesso foi, respectivamente, 68.2% para mepivacaína, 63,6% para articaína e 63,6% para lidocaína. Relativamente aos pacientes que relataram nenhuma dor ou dor leve, durante a pulpectomia, a taxa de sucesso foi, respectivamente, 72.7% para mepivacaína, 63.6% para articaína e 54,5% para a lidocaína. Estas diferenças não foram estatisticamente significantes. Nenhuma das soluções resultou em 100% de sucesso anestésico em pacientes com pulpite irreversível de molares mandibulares.

How the fluctuations of water levels affect populations of invasive bivalve Corbicula fluminea (Müller, 1774) in a Neotropical reservoir?

Corbicula fluminea is an invasive bivalve responsible for several environmental and financial problems around the globe. Despite the invasive potential of this species, it suffers certain restrictions in lentic environments due to natural phenomena that significantly affect its population structure (e.g. water column fluctuation and sunlight exposure). The present study addresses how temporal decline of the water level in a Neotropical reservoir and exposure to sunlight affect the population structure of C. fluminea. Samplings were carried out twice in the reservoir of Furnas Hydroelectric Power Station (HPS) (Minas Gerais, Brazil), in 2011 and 2012. Population density, spatial distribution and mean shell length of C. fluminea were estimated for each year after sampling in 51 quadrats (0.0625m2) placed on three transects at different distances along the reservoir margins (0, 10 and 20 m from a fixed-point). We observed a predominance of C. fluminea in both years, with a simultaneous gradual decrease in density and richness of native species in the sampling area. Significant differences in density of C. fluminea were registered at different distances from the margin, and are related to the temporal variability of physical conditions of the sediment and water in these environments. We also registered a trend toward an increase in the density and aggregation of C. fluminea as we moved away from the margin, due to the greater stability of these areas (>10 m). The mean shell length of C. fluminea showed significant difference between the distinct distances from the margin and during the years, as well as the interaction of these factors (Distances vs.Years). These results were associated with the reproductive and invasive capacity of this species. This study reveals that these temporal events (especially water column fluctuation) may cause alterations in density, spatial distribution and mean shell length of C. fluminea and the composition of the native malacofauna in Neotropical lentic environments.

New multilocus sequence typing of MRSA in São Paulo, Brazil

An increased incidence of nosocomial and community-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has been observed worldwide. The molecular characterization of MRSA has played an important role in demonstrating the existence of internationally disseminated clones. The use of molecular biology methods in the surveillance programs has enabled the tracking of MRSA spread within and among hospitals. These data are useful to alert nosocomial infection control programs about the potential introduction of these epidemic clones in their areas. Four MRSA blood culture isolates from patients hospitalized at two hospitals in the city of São Paulo, Brazil, were analyzed; one of them was community acquired. The isolates were characterized as SCCmec, mecA and PVL by PCR, pulsed-field gel electrophoresis (PFGE) profile and molecular sequence typing (MLST) genotyping. The isolates presented type IV SCCmec, and none proved to be positive for PVL. The isolates showed a PFGE profile similar to the pediatric clone. MLST genotyping demonstrated that the isolates belonged to clonal complex 5 (CC5), showing a new yqiL allele gene, resulting in a new sequence typing (ST) (1176). Our results showed that strains of MRSA carrying a new ST are emerging in community and nosocomial infections, including bacteremia, in São Paulo, Brazil.

New multilocus sequence typing of MRSA in São Paulo, Brazil.

An increased incidence of nosocomial and community-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA) has been observed worldwide. The molecular characterization of MRSA has played an important role in demonstrating the existence of internationally disseminated clones. The use of molecular biology methods in the surveillance programs has enabled the tracking of MRSA spread within and among hospitals. These data are useful to alert nosocomial infection control programs about the potential introduction of these epidemic clones in their areas. Four MRSA blood culture isolates from patients hospitalized at two hospitals in the city of São Paulo, Brazil, were analyzed; one of them was community acquired. The isolates were characterized as SCCmec, mecA and PVL by PCR, pulsed-field gel electrophoresis (PFGE) profile and molecular sequence typing (MLST) genotyping. The isolates presented type IV SCCmec, and none proved to be positive for PVL. The isolates showed a PFGE profile similar to the pediatric clone. MLST genotyping demonstrated that the isolates belonged to clonal complex 5 (CC5), showing a new yqiL allele gene, resulting in a new sequence typing (ST) (1176). Our results showed that strains of MRSA carrying a new ST are emerging in community and nosocomial infections, including bacteremia, in São Paulo, Brazil.

Case Report. Bilateral sporotrichosis.

We describe a rare case of sporotrichosis, clinically exuberant, with bilateral distribution.

Simultaneous determination of benzocaine and cetylpiridinium chloride in tablets by first-derivative spectrophotometric method.

A new spectrophotometric method for the simultaneous determination of benzocaine and cetylpiridinium chloride in pharmaceutical tablets, which does not require any preliminary separation or treatment of the samples, is described. The quantitative determination of both drugs was carried out using the first derivative values measured at 231.40 and 310.00 nm for benzocaine and at 220.70 nm for cetylpiridinium chloride using the zero-crossing method. The calibration graphs were linear in the ranges from 10 to 25 mg/l of benzocaine and from 4 to 20 mg/l of cetylpiridinium chloride. The developed method was successfully applied for the assay of pharmaceutical tablets and proved to be simple, sensitive and selective. Thermogravimetric techniques, Karl Fischer and loss on drying were also used for a stoichiometric evaluation of the substances studied.

[Behavior of delayed-type hypersensitivity in parapsoriasis]. / Comportamento da hipersensibilidade de tipo tardio nas parapsoríases.

The authors present a study of behaviour of the late hypersensitivity in fourteen patients carrying parapsoriasis with age varying from 36 to 64 years being nine men and five women with time of the illness development from one to eleven years. There were thirteen white sick people and a yellow one. The parapsoriasis diagnosis was confirmed in all of them clinica and histopathologica. The patients were not getting any therapeutic with corticosteroids or immunosuppressive drugs at the time of study. They were studied immunological through methods in vivo. 1. Methods in vivo. a) Intradermoreactions with the infectious antigens: PPD, trichophytin, levedurin, E. coli. It was used as a control group of fourty normal fellows. b) Sensibility to DNCB. The results obtained allow the following thesis: 1. Low table of positivity to the intradermal reactions to the late reading only one of the antigens tested on the patients (E. coli) related to the others. According to these elements we cannot get at a conclusion for depression of the inespecific cellular immunity in our sick patients. 2. Significant statistics difference on the sensibility test to DNCB on the sick patients related to the controls, a fact which shows a certain degree of the depression of the inespecific cellular immunity. 3. The sick patients with parapsoriasis before taking some treatment should go through the study of a late hypersensitivity.

Ketoconazole no tratamento sistemico da onicomicose. / Ketoconazole in the systemic treatment of onychomycosis

Ketoconazole, uma nova droga antimicotica oral, foi administrada a 22 pacientes portadores de onicomicose das maos ou pes, na dose de 200mg diarios. O tempo de tratamento foi em media de 7,2 + ou - 2,1 meses. Foi obtida cura clinica e micologica em 95,4% dos pacientes. Reacoes adversas de intensidade leve (gastralgia e emagrecimento) foram observadas em apenas tres pacientes, nao incorrendo em interrupcao do tratamento

Lipodistrofia congenita generalizada. / Congenital total lipodystrophy

Os autores apresentam um caso de lipodistrofia congenita em mulher adulta, com ausencia de gordura no subcutaneo, diabetes resistente a insulina, aspecto acromegaloide, aparente hipertrofia muscular, hiperlipemia hipertricose, profusao abdominal e lesoes de acanthosis nigricans, com alteracoes laboratoriais de glicemia de jejum, triglicerides, lipidograma, insulina plasmatica em jejum, hormonio de crescimento, testosterona plasmatica e alteracoes radiologicas