ABSTRACT
BACKGROUND: Cytomegalovirus (CMV) infections are an important cause of morbidity and mortality in transplant recipient. To date, the antigenemia assay is the most used technique for diagnostic and management of CM V infections. However, quantification of CMV viral load by real time polymerase chain reaction (RT-PCR) has becoming the method of choice to detect CMV in a rapid, sensitive and specific manner. OBJECTIVE: To compare antigenemia and RT-PCR assays in the detection of CMV in blood sample from solid organ and bone marrow transplant (BMT) in children attended at the Dr. Luis Calvo Mackenna Hospital. METHODS: In a prospective study, we detect the presence of CMV in blood sample by RT-PCR and antigenemia assays. RESULTS: We analyzed 219 blood samples from 68 children subjected to kidney, liver and BMT. Out of 219 samples analyzed, 147 were negative and 33 were positive for CMV by both techniques. Thirty-seven samples were positive only by RT-PCR and 2 by antigenemia. Considering the antigenemia as a reference, RT-PCR shows 94%, 80%, 34% and 99% sensitivity, specificity, positive and negative predictive values, respectively. The kappa coefficient between both techniques was 0.528. CONCLUSION: Quantitative determination of CMV viral load by RT-PCR is a sensitive technique with excellent negative predictive valué compared to antigenemia. Our results support the use of RT-PCR as a technique that might facilítate the diagnostic and treatment of active CMV infection in pediatric transplants.
Subject(s)
Antigens, Viral/blood , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/isolation & purification , Hematopoietic Stem Cell Transplantation , Organ Transplantation , Polymerase Chain Reaction/methods , Child , Child, Preschool , Cytomegalovirus/genetics , Cytomegalovirus/immunology , Cytomegalovirus Infections/etiology , Cytomegalovirus Infections/immunology , DNA, Viral/blood , Female , Humans , Male , Postoperative Complications , Prospective Studies , Sensitivity and SpecificityABSTRACT
Background: Cytomegalovirus (CMV) infections are an important cause of morbidity and mortality in transplant recipient. To date, the antigenemia assay is the most used technique for diagnostic and management of CM V infections. However, quantification of CMV viral load by real time polymerase chain reaction (RT-PCR) has becoming the method of choice to detect CMV in a rapid, sensitive and specific manner. Objective: To compare antigenemia and RT-PCR assays in the detection of CMV in blood sample from solid organ and bone marrow transplant (BMT) in children attended at the Dr. Luis Calvo Mackenna Hospital. Methods: In a prospective study, we detect the presence of CMV in blood sample by RT-PCR and antigenemia assays. Results: We analyzed 219 blood samples from 68 children subjected to kidney, liver and BMT. Out of 219 samples analyzed, 147 were negative and 33 were positive for CMV by both techniques. Thirty-seven samples were positive only by RT-PCR and 2 by antigenemia. Considering the antigenemia as a reference, RT-PCR shows 94 percent, 80 percent, 34 percent and 99 percent sensitivity, specificity, positive and negative predictive values, respectively. The kappa coefficient between both techniques was 0.528. Conclusion: Quantitative determination of CMV viral load by RT-PCR is a sensitive technique with excellent negative predictive valué compared to antigenemia. Our results support the use of RT-PCR as a technique that might facilítate the diagnostic and treatment of active CMV infection in pediatric transplants.
Antecedentes: Las infecciones por citomegalovirus (CMV) corresponden a una importante causa de morbilidad y mortalidad en pacientes sometidos a trasplantes. Hasta la fecha, la detección de CMV en células infectadas en sangre periférica mediante la técnica de inmunofluorescencia (antigenemia) es la más utilizada para el diagnóstico y monitorización de la infección por este agente. Sin embargo, en el último tiempo la cuantificación de la carga de ácido nucleico (ADN) de CMV en sangre mediante la técnica de reacción de polimerasa en cadena en tiempo real (RPC-TR) ha permitido la detección de CMV de forma más rápida, sensible y específica. Objetivos: Comparar las técnicas de antigenemia y RPC-TR para la detección de CMV en sangre en niños sometidos a trasplante de órganos sólidos y trasplante de precursores hematopoyéticos (TPH) en el Hospital Dr. Luis Calvo Mackenna. Metodología: En un estudio prospectivo de seguimiento preventivo de reactivación se detectó la presencia de CMV en muestras de sangre utilizando las técnicas de RPC-TR y antigenemia. Resultados: Se analizaron 219 muestras de sangre, correspondiente a 68 niños sometidos a trasplante de hígado, riñon y TPH. De las muestras analizadas, 147 fueron negativas y 33 positivas para CMV utilizando ambas técnicas. Treinta y siete muestras resultaron ser positivas sólo por RPC-TR y dos sólo por antigenemia. Tomando en cuenta la antigenemia como referencia, la RPC-TR mostró una sensibilidad, especificidad, valor predictor positivo y negativo de 94 por ciento, 80 por ciento, 34 por ciento y 99 por ciento, respectivamente. El índice de concordancia entre ambas técnicas tuvo un valor de kappa = 0,528. Conclusión: La determinación cuantitativa de ADN de CMV por RPC-TR es una técnica sensible, con un gran valor predictor negativo comparada con la antigenemia. Los resultados obtenidos en este trabajo apoyan el uso de RPC-TR para el diagnóstico y tratamiento oportuno de las infecciones activas por CMV en niños sometidos a trasplantes.
Subject(s)
Child , Child, Preschool , Female , Humans , Male , Antigens, Viral/blood , Cytomegalovirus Infections/diagnosis , Cytomegalovirus/isolation & purification , Hematopoietic Stem Cell Transplantation , Organ Transplantation , Polymerase Chain Reaction/methods , Cytomegalovirus Infections/etiology , Cytomegalovirus Infections/immunology , Cytomegalovirus/genetics , Cytomegalovirus/immunology , DNA, Viral/blood , Postoperative Complications , Prospective Studies , Sensitivity and SpecificityABSTRACT
In-Ceram is a sintered, high-alumina-content, glass-infiltrated ceramic core material reported to have sufficient strength for all-ceramic fixed partial dentures. While Vita/Vident recommends that In-Ceram should be used only for anterior FPDs, the purpose of this study was to push the sintered alumina material to its limits by testing posterior FPDs with premolar and molar pontics. This prospective clinical trial tested the longevity of 61 three-unit In-Ceram alumina FPDs. The failed specimens were analyzed to determine factors contributing to failure. The abutment teeth were prepared for full crown retainers with shoulder margins and 1.3 mm of axial reduction. All FPDs were cemented with an encapsulated glass ionomer. None of the patients reported postcementation sensitivity. During the three-year period, seven FPDs fractured through the connector area. By location of the pontic, failure rates were 0 percent for anteriors, 11 percent for premolars and 24 percent for molars. Based on the results of this clinical study at the three-year point, In-Ceram alumina can be reliably utilized for anterior FPDs as indicated by a 100 percent success rate. The findings do not support the use of In-Ceram alumina for posterior FPDs as was advised by the porcelain manufacturer. Glass ionomer cement can be predictably used to cement In-Ceram FPDs with few clinical side effects. Because of a technological malfunction, this article could not be presented with the others on ceramic restorations that appeared in the February issue.
Subject(s)
Aluminum Oxide/therapeutic use , Dental Porcelain/therapeutic use , Denture Design , Denture, Partial, Fixed , Dental Restoration Failure , Esthetics, Dental , Glass Ionomer Cements , Humans , Tooth Preparation , Treatment OutcomeABSTRACT
This study evaluated the effect of porcelain surface treatment on the shear bond strength of composite resin to various porcelains and porcelain combinations. A variety of feldspathic porcelains with low and medium alumina content were tested. Porcelain/composite resin samples were stored in 37 degrees C water, thermocycled 1,000 times, and tested in shear. A 3-minute etching using hydrofluoric acid significantly increased the bond strength of most of the feldspathic porcelains with low and medium alumina content. Silane application to all types of etched porcelain had no significant effect on bond strength.
Subject(s)
Composite Resins , Dental Bonding , Dental Porcelain , Acid Etching, Dental , Analysis of Variance , Dental Stress Analysis , Materials Testing , Silanes , Tensile StrengthSubject(s)
Color , Crowns , Dental Porcelain , Dental Veneers , Denture, Partial , Denture Design , Humans , Light , Optics and Photonics , Tooth/anatomy & histologyABSTRACT
Most ceramic restorations are fabricated in a location remote from the dental office. Successful fabrication of matching life-like ceramic restorations necessitates a collaborative effort between the dentist and the ceramist. To meet the demands for visual communication of shade and surface texture, the following steps are recommended. 1. A means of communicating and recording surface texture that facilitates blending the restorations with the natural dentition should be used. 2. The system should use an esthetics prescription form that functions with the Shade Indicator Chart system to relate the shade of opaque, body, and incisal porcelains and their arrangement to the ceramist. 3. An easily made identification mold to form shade tabs is needed. 4. Identification shade tabs should be made to verify and document shade formulations selected with the Shade Indicator Chart system. 5. Methods for precisely mapping and reproducing individual characterization patterns are needed. This information permits the visualization of the end result, allowing the artistic expression of the ceramist to create vital-appearing restorations intrinsically and in harmony with the natural dentition.
Subject(s)
Audiovisual Aids , Color , Communication , Dental Porcelain , Denture Design/instrumentation , Crowns , Denture, Partial , Esthetics, Dental , Humans , Interprofessional Relations , PrescriptionsABSTRACT
The inherent problems in present shade matching procedures and communication between dentist and ceramist have been discussed. These five areas of weakness include the observer, variable viewing conditions, commercially available shade guides, inadequate technology, and poor communication. A systematic procedure that breaks down shade selection to the elements of opaque, body, and incisal porcelain shades was presented. This method simplifies and adds clarity in the registration of shades, improving the communication chain between dentist and ceramist. The system is suggested as a means to overcome many of the inherent problems in shade selection and communication. This approach enhances the dentist-ceramist team's ability to esthetically match metal-ceramic restorations to the natural dentition. Future parts of this series will present procedures for improved communication and a system for porcelain application.
