Evidence-based clinical practice guideline for the use of pit-and-fissure sealants: a report of the American Dental Association and the American Academy of Pediatric Dentistry

BACKGROUND: This article presents evidence-based clinical recommendations for the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars in children and adolescents. A guideline panel convened by the American Dental Association (ADA) Council on Scientific Affairs and the American Academy of Pediatric Dentistry conducted a systematic review and formulated recommendations to address clinical questions in relation to the efficacy, retention, and potential side effects of sealants to prevent dental caries; their efficacy compared with fluoride varnishes; and a head-to-head comparison of the different types of sealant material used to prevent caries on pits and fissures of occlusal surfaces. TYPES OF STUDIES REVIEWED: This is an update of the ADA 2008 recommendations on the use of pit-and-fissure sealants on the occlusal surfaces of primary and permanent molars. The authors conducted a systematic search in MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and other sources to identify randomized controlled trials reporting on the effect of sealants (available on the US market) when applied to the occlusal surfaces of primary and permanent molars. The authors used the Grading of Recommendations Assessment, Development, and Evaluation approach to assess the quality of the evidence and to move from the evidence to the decisions. RESULTS: The guideline panel formulated 3 main recommendations. They concluded that sealants are effective in preventing and arresting pit-and-fissure occlusal carious lesions of primary and permanent molars in children and adolescents compared with the nonuse of sealants or use of fluoride varnishes. They also concluded that sealants could minimize the progression of noncavitated occlusal carious lesions (also referred to as initial lesions) that receive a sealant. Finally, based on the available limited evidence, the panel was unable to provide specific recommendations on the relative merits of 1 type of sealant material over the others. CONCLUSIONS AND PRACTICAL IMPLICATIONS: These recommendations are designed to inform practitioners during the clinical decision-making process in relation to the prevention of occlusal carious lesions in children and adolescents. Clinicians are encouraged to discuss the information in this guideline with patients or the parents of patients. The authors recommend that clinicians reorient their efforts toward increasing the use of sealants on the occlusal surfaces of primary and permanent molars in children and adolescents.(AU)

Anafilaxia poco frecuente y adenoma suprarrenal funcionante / Rare anaphylaxis and functioning adrenal adenoma

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Solid-phase extraction method for the determination of free and conjugated phenol compounds in human urine.

A rapid flow system for automatic sample conditioning for the determination of phenol compounds in human urine has been developed and optimised. Free phenols are detected directly in urine samples while total phenols require acid hydrolysis to convert their conjugate fraction into free phenols, all compounds then being cleaned up and preconcentrated by solid-phase extraction. Separation and determination are done by gas chromatography, using mass spectrometry operating in the selective ion monitoring mode for quantitation. The linear range was 1-160 ng/ml of urine for most of the phenols. Limits of detection for phenol compounds (phenol, alkylphenols and chlorophenols) in the nanogram-per-millilitre range (0.3-0.6 ng/ml) are thus achieved by using 1 ml of urine; also, the repeatability, as RSD, is less than 6.5%. Based on the results for urine samples from unexposed individuals, 2-methylphenol, 2-chlorophenol and 2,4-dichlorophenol are largely detected in hydrolysed urine samples, whereas phenol and 4-methylphenol are detected in hydrolysed and unhydrolysed urine. Other chlorophenols such as trichlorophenols and pentachlorophenol are not detected. The results obtained in the analysis of urine from an individual before and after dietary intake reveal that the levels of phenol compounds in urine look related to food intake.

Study of the degradation of the herbicides 2,4-D and MCPA at different depths in contaminated agricultural soil.

Two phenoxyacid herbicides (2,4-D and MCPA) and their six corresponding phenols were determined in soil by using gas chomatography with electron impact mass spectrometry (GC/MS) for confirmation/quantitation. An automatic extraction (leaching), preconcentration, and cleanup (sorption) module was developed to extract the eight compounds from soil. The average recovery of all species, spiked to soil at microg/kg-mg/kg levels, was 95% (average standard deviation +/- 5%). A plot of agricultural clayey soil (approximately 12 m2) was contaminated with both herbicides (approximately 96 g/m3, depth 10 cm, density 1.23 g/cm3) and irrigated with (17 mm) at variable time intervals. Both herbicides and their corresponding phenol compounds were monitored at different soil depths over a 50 day period. The degradation of both herbicides in the surface layer (t(1/2) approximately 5 days) is a result of photodecomposition and microbial action; in the deeper layers, the degradation products occur in lower proportions by effect of leaching and are also the result of microbial action. The six phenol metabolites are only detected in the surface layer as they form preferentially by photodecomposition. The main metabolites (viz. 2,4-DCP for 2,4-D and 4-C-2-MP for MCPA) are formed within 24 h after the soil is contaminated; their concentration peaks are at day 8 in the absence of irrigation.

Adsorption and Interactions of Methyl Green with Montmorillonite and Sepiolite.

The divalent organic cation, methyl green (MG), undergoes a slow transformation (6 h) to a monovalent cation, carbinol (MGOH(+)) upon dilution of its solution (10 mM), or in a buffer at neutral pH. Adsorption isotherms of MG on montmorillonite were determined by two procedures, both of which yield a final pH of suspensions between 7 to 7.4. When the amounts of MG in suspension were lower than the cation-exchange capacity (CEC) of the clay (0.8 mol(c)/kg clay), no measurable amount of MG remained in solution. The maximal amounts of MGOH(+) adsorbed were larger than those of MG(2+), being 1.15 and 0.75 mol MG/kg clay, respectively, corresponding to 140% of the CEC in the first case. On a charge basis the adsorption of added MG(2+) amounts to 185% of the CEC, which raises the possibility that a certain fraction of MG(2+) transformed into the monovalent form during the incubation period, since other divalent organic cations previously studied only adsorbed up to the CEC (paraquat), or slightly above it (diquat). Adsorption of MG on sepiolite (CEC=0.15 mol(c)/kg) further emphasizes the two patterns of its adsorption. The maximal adsorbed amounts of MG(2+) and MGOH(+) were 0.09 and 0.30 mol/kg clay, respectively. X-ray diffraction measurements gave lower values for the basal spacings for montmorillonite-MG(+) than for MGOH(+), suggesting that MG(2+) binds two clay platelets together, as in the case of other divalent cations. A competition for adsorption between MG and the monovalent organic cation, acriflavin (AF), gave lower adsorbed amounts of AF when competing with MG(+), which is interpreted to be due to the smaller basal spacing in this case, which partially inhibits the entry of AF molecules into the interlammelar space. Spectra of montmorillonite-MG particles in the visible range exhibited significant differences between clay-MG and clay-carbinol. Copyright 2000 Academic Press.

Discrimination of structural isomers of chlorinated phenols in waters using gas chromatography-mass spectrometry in the negative chemical ionization mode.

The analysis and identification of structural isomers of mono-, di- and trichlorophenols is reported. The fragmentation of the phenols was examined by GC-MS in both electron impact (EI) and negative chemical ionization (NCI) modes, using methane as reagent gas. The ability of NCI to discriminate these isomeric compounds from differences in relative intensities for selected peaks is demonstrated. 3- and 4-chlorophenols have similar retention times; however, they can still be discriminated because their negative mass spectra and rather different. In dichlorophenols, the presence of one chlorine atom in the ortho position decreases their retention time and the relative intensity of the fragment ion at m/z 140. The NCI mass spectra for trichlorophenols are different from the rest, particularly for the m/z value corresponding to the chlorine atom. Tetra- and pentachlorophenols were also studied and sequential losses of Cl observed. An automatic solid-phase extraction system can optionally be used to preconcentrate chlorophenols in waters prior to determination at legally established toxic levels.

Interactions of Monovalent Organic Cations with Pillared Clays.

Interactions between an acid-activated pillared clay and several organic cations including dyes (methylene blue, MB; crystal violet, CV; acriflavin, AF) and benzyl derivatives (benzyltrimethylammonium, BTMA; benzyltriethylammonium, BTEA) were studied by adsorption measurements and X-ray diffraction. When the dyes were adsorbed from low ionic strength solutions, adsorption was irreversible but saturated at levels below the cation exchange capacity (CEC) of the clay (0.6 meq/g). The difference with CEC value was largest for CV. This mode of adsorption was interpreted in terms of interlayer adsorption with steric hindrance in the pillared galleries. On the other hand, when the dyes were adsorbed from high ionic strength solutions, adsorption levels well beyond the CEC of the clay could be reached, in particular for MB and CV. This was interpreted in terms of a second adsorption mode, involving formation of molecular aggregates on the outer surface of the clay, as evidenced by X-ray diffraction. The behavior of the cationic benzyl derivatives was markedly different, with an adsorption level always below the CEC and a decrease of adsorption as the ionic strength was increased, as expected for non-complex-forming cations. Copyright 1999 Academic Press.

Procedimiento excisional electroquirúrgico con asa diatérmica para el tratamiento de la neoplasia intraepitelial cervical / Electrosurgical excisional procedure with diatermic asa for the treatment of intraepithelial cervical neoplasia

Objetivo: evaluar la excisión de la zona dr transformación con ASA (EZTA), en nuestras manos. Población y método: un total de 407 pacientes con citología anormal, a las que se les practicó EZTA después de colposcopía con o sin biopsia dirigida, sugestivas de lesión intraepitelial escamosa (LIE) o glandular, del 26 de abril de 1993 al 20 de febrero de 1995. Resultados: el porcentaje de curación fue de 95.09 por ciento el 84.03 por ciento de las pacientes en las que el procedimiento de consideró suficiente como tratamiento, acudieron a control citológico posterior; un 15.74 por ciento con complicaciones graves. CONCLUSION: la excisión de la ZT con ASA, por ser efectiva, barata y relativamente fácil de practicar, parece ser un procedimiento terapéutico con el que se puede disminuir la mortalidad por Cáncer del Cuello Uterino en nuestro país, implementandolo a la par de detección masiva.