Riesgo de transmisión de enfermedades infecciosas en la clínica dental

Se presenta en este artículo una revisión del riesgo de transmisión de enfermedades infecciosas en la clínica dental. Las hepatitis víricas, en especial la hepatitis B y la C, la infección por el virus de la inmunodeficiencia humana, la tuberculosis, y otras enfermedades infecciosas pueden ser potencialmente transmitidas en el ejercicio de la profesión, tanto a los pacientes como a los profesionales. El conocimiento de la probabilidad de transmisión y sus características son la base sobre la que desarrollarán las medidas preventivas de control de infección que intentan evitar o por lo menos minimizar la probabilidad de adquirir estas enfermedades en el ámbito laboral.

Allergic reactions following contrast material administration: nomenclature, classification, and mechanisms

In forensic pathology routine, fatal cases of contrast agent exposure can be occasionally encountered. In such situations, beyond the difficulties inherent in establishing the cause of death due to nonspecific or absent autopsy and histology findings as well as limited laboratory investigations, pathologists may face other problems in formulating exhaustive, complete reports, and conclusions that are scientifically accurate. Indeed, terminology concerning adverse drug reactions and allergy nomenclature is confusing. Some terms, still utilized in forensic and radiological reports, are outdated and should be avoided. Additionally, not all forensic pathologists master contrast material classification and pathogenesis of contrast agent reactions. We present a review of the literature covering allergic reactions to contrast material exposure in order to update used terminology, explain the pathophysiology, and list currently available laboratory investigations for diagnosis in the forensic setting.

What influence do anticoagulants have on oral implant therapy? A systematic review.

OBJECTIVES: This systematic review aims to assess the risks (both thromboembolic and bleeding) of an oral anticoagulation therapy (OAT) patient undergoing implant therapy and to provide a management protocol to patients under OAT undergoing implant therapy. MATERIAL AND METHODS: Medline, Cochrane Data Base of Systematic Reviews, the Cochrane Central Register of Controlled Trials and EMBASE (from 1980 to December 2008) were searched for English-language articles published between 1966 and 2008. This search was completed by a hand research accessing the references cited in all identified publications. RESULTS: Nineteen studies were identified reporting outcomes after oral surgery procedures (mostly dental extractions in patients on OAT following different management protocols and haemostatic therapies). Five studies were randomized-controlled trials (RCTs), 11 were controlled clinical trials (CCTs) and three were prospective case series. The OAT management strategies as well as the protocols during and after surgery were different. This heterogeneity prevented any possible data aggregation and synthesis. The results from these studies are very homogeneous, reporting minor bleeding in very few patients, without a significant difference between the OAT patients who continue with the vitamin K antagonists vs. the patients who stopped this medication before surgery. These post-operative bleeding events were controlled only with local haemostatic measures: tranexamic acid mouthwashes, gelatine sponges and cellulose gauzes's application were effective. Post-operative bleeding did not correlate with the international normalised ratio (INR) status. In none of the studies was a thromboembolic event reported. CONCLUSIONS: OAT patients (INR 2-4) who do not discontinue the AC medication do not have a significantly higher risk of post-operative bleeding than non-OAT patients and they also do not have a higher risk of post-operative bleeding than OAT patients who discontinue the medication. In patients with OAT (INR 2-4) without discontinuation, topical haemostatic agents were effective in preventing post-operative bleeding. OAT discontinuation is not recommended for minor oral surgery, such as single tooth extraction or implant placement, provided that this does not involve autogenous bone grafts, extensive flaps or osteotomy preparations extending outside the bony envelope. Evidence does not support that dental implant placement in patients on OAT is contraindicated.

Utilité de la prophylaxie antibiotique avant un geste dentaire pour tes porteurs de prothèses totales du genou ou de la hanche [Antibiotic prophylaxis before dental procedures in arthroplasty patients]

Antibiotic prophylaxis is commonly prescribed to patients with total arthroplasties before a dental intervention. This attitude is not evidence-based for several reasons: 1) the usual pathogens of prosthetic joint infections are not of oral origin; 2) even if given, systemic antibiotic do not completely suppress the occult bacteraemia occurring during dental intervention and 3) humans may have up to twelve episodes of occult bacteraemia of dental origin per day. Routine antibiotic prophylaxis should be clearly distinguished from the antibiotic treatment required in case of established oral cavity infection. A constant optimal oral and dental hygiene is more important in terms of prevention and should be routinely recommended to every patient carrying a joint arthroplasty.

Protocolo para produção de material propagativo de batata em meio líquido

Os meios semi-sólidos são os mais utilizados em trabalhos de micropropagação, mas há indícios de que o estado físico dos meios de cultura influencia a multiplicação dos cultivos. O objetivo deste trabalho foi estabelecer um protocolo para a multiplicação de material propagativo de batata em meio de cultura líquido. Explantes de batata da cultivar Eliza, com uma gema axilar, foram cultivados em seis diferentes meios de cultura, com (semi-sólido) ou sem (líquido) a adição do solidificante ágar. Após 21 dias de cultivo, o meio de cultura que proporcionou os melhores resultados para crescimento e taxa de multiplicação teve sua composição modificada com o objetivo de melhorar a eficiência de multiplicação de cinco cultivares em meio líquido. Foi também avaliada a necessidade de agitação dos cultivos em meio líquido. Houve ganho na eficiência de multiplicação in vitro da batata, quando se utiliza meio de cultura líquido. Os melhores resultados são obtidos quando o material é cultivado em meio constituído pelos sais de MS na concentração plena, acrescido de ácido pantotênico (5,0 mg L-1), tiamina (1,0 mg L-1), ácido giberélico (0,25 mg L-1) e sacarose (20 g L-1), sob agitação constante.

Rehabilitation of orbital cavity after total orbital exenteration using oculofacial prostheses anchored by osseointegrated dental implants posed as a one-step surgical procedure

BACKGROUND: Total orbital exenteration is a radical surgical procedure, which typically involves the removal of the entire contents of the orbit including the periorbita, leaving the patient with a deep orbital deformity and results in devastating cosmetic, functional, and psychological consequences requiring difficult and challenging procedures for oculoplastic surgeons. Oculofacial prostheses retained by endosseous dental implants present an attractive and viable alternative when aesthetic and functional demands are beyond the capacity of local reconstructive efforts. PATIENTS AND METHODS: A 72-year-old woman presenting a malignant melanoma of the right eyelids and a 77-year-old man presenting a sebaceous carcinoma of the left upper eyelid underwent a total exenteration followed by positioning of endosseous implants (Straumann system Dental implants) as an integrated one-step combined surgical procedure. The oculofacial prosthesis was placed after epithelialization of the orbital cavity. RESULTS: The implants were perfectly osseointegrated without any complications, providing sufficient retention of the prostheses. A satisfactory aesthetic outcome has been achieved for both patients. CONCLUSIONS: Oculofacial prostheses anchored by osseointegrated dental implants placed as one-step surgical procedure ensure an adequate aesthetic result as well as a considerably decreased rehabilitation time and present a satisfactory solution when reconstruction is not a suitable option.

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Report on a review of certain expenditures made by the Iowa Department of Public Health, including the Iowa Board of Pharmacy, the Iowa Dental Board, the Iowa Board of Medicine, and the Iowa Board of Nursing, from July 1, 2011 through August 31, 2014

Wear of two denture teeth materials in vivo-2-year results.

OBJECTIVE: (1) To quantify wear of two different denture tooth materials in vivo with two study designs, (2) to relate tooth variables to vertical loss. METHODS: Two different denture tooth materials had been used (experimental material=test; DCL=control). In study 1 (split-mouth, 6 test centers) 60 subjects received complete dentures, in study 2 (two-arm, 1 test center) 29 subjects. In study 1 the mandibular dentures were supported by implants in 33% of the subjects, in study 2 only in 3% of the subjects. Impressions of the dentures were taken and poured with improved stone at baseline and after 6, 12, 18 and 24 months. Each operator evaluated the wear subjectively. Wear analysis was carried out with a laser scanning device. Maximal vertical loss of the attrition zones was calculated for each tooth cusp and tooth. A mixed linear model was used to statistically analyse the logarithmically transformed wear data. RESULTS: Due to drop-outs and unmatchable casts, only 47 subjects of study 1 and 14 of study 2 completed the 2-year recall. Overall, 75% of all teeth present could be analysed. There was no statistically difference in the overall wear between the test and control material for either study 1 or study 2. The relative increase in wear over time was similar in both study designs. However, a strong subject effect and center effect were observed. The fixed factors included in the model (time, tooth, center, etc.) accounted for 43% of the variability, whereas the random subject effect accounted for another 30% of the variability, leaving about 28% of unexplained variability. More wear was consistently recorded in the maxillary teeth compared to the mandibular teeth and in the first molar teeth compared to the premolar teeth and the second molars. Likewise, the supporting cusps showed more wear than the non-supporting cusps. The amount of wear did not depend on whether or not the lower dentures were supported by implants. The subjective wear was correct in about 67% of the cases if it is postulated that a wear difference of 100μm should be subjectively detectable. SIGNIFICANCE: The clinical wear of denture teeth is highly variable with a strong patient effect. More wear can be expected in maxillary denture teeth compared to mandibular teeth, first molars compared to premolars and supported cusps compared to non-supported cusps. Laboratory data on the wear of denture tooth materials may not be confirmed in well-structured clinical trials probably due to the large inter-individual variability.

Estudi de la capacitat del suro com a material adsorbent de pesticides

La presència de pesticides en el medi ambient pot comportar efectes nocius pel propi medi i la salut humana, fet que, en alguns casos, converteix en necessària la seva eliminació. Un dels mètodes utilitzats per dur a terme aquesta eliminació és la sorció de contaminats sobre materials adsorbents. Per tal de fer d’aquest mètode un procés sostenible cal investigar nous materials capaços de retenir els contaminants. El suro és la part més externa de l’escorça de l’alzina surera: Quercus Suber L. S’extreu cada 5- 10 anys depenent de la regió i es caracteritza per ser una font natural, renovable i biodegradable amb una heterogènia composició química que el converteix en un material potencialment apte com a adsorbent d’un ampli rang de contaminants. En aquest context, l’objectiu principal d’aquest treball és investigar l’afinitat d’adsorció del suro amb quatre pesticides de diferent hidrofobicitat i estructura química i estudiar el paper que hi juguen els seus compostos químics (extractius, suberina, lignina i polisacàrids) en aquest procés de sorció. Els pesticides investigats han estat: Metamitron: poc hidrofòbic (logKow = 0.83) i de caràcter molecular, Alaclor: moderadament hidrofòbic (logKow = 2.80) i de caràcter iònic (pKa = 0.62), 2,4-D: moderadament hidrofòbic (logKow = 2.81) i de caràcter iònic (pKa = 2.64) i Clorpirifos: molt hidrofòbic (logKow = 4.92) i de caràcter molecular

La cultura material de Tarraco - Tarracona (Hispania Tarraconensis - Regnum Visigothorum): cerámica común y ánforas

Síntesis actualizada de los estudios monográficos realizados sobre las cerámicas comunes y ánforas de la ciudad de Tarraco desde finales del s. IV hasta inicios del s. VIII. Se hace especial hincapié en los últimos hallazgos del siglo VII que reflejan una intensificación de la presencia de materiales orientales en la ciudad.

Systemic exposure to tobramycin after local antibiotic treatment with calcium sulphate as carrier material.

INTRODUCTION: Osteoset(®) T is a calcium sulphate void filler containing 4% tobramycin sulphate, used to treat bone and soft tissue infections. Despite systemic exposure to the antibiotic, there are no pharmacokinetic studies in humans published so far. Based on the observations made in our patients, a model predicting tobramycin serum levels and evaluating their toxicity potential is presented. METHODS: Following implantation of Osteoset(®) T, tobramycin serum concentrations were monitored systematically. A pharmacokinetic analysis was performed using a non-linear mixed effects model based on a one compartment model with first-degree absorption. RESULTS: Data from 12 patients treated between October 2006 and March 2008 were analysed. Concentration profiles were consistent with the first-order slow release and single-compartment kinetics, whilst showing important variability. Predicted tobramycin serum concentrations depended clearly on both implanted drug amount and renal function. DISCUSSION AND CONCLUSION: Despite the popularity of aminoglycosides for local antibiotic therapy, pharmacokinetic data for this indication are scarce, and not available for calcium sulphate as carrier material. Systemic exposure to tobramycin after implantation of Osteoset(®) T appears reassuring regarding toxicity potential, except in case of markedly impaired renal function. We recommend in adapting the dosage to the estimated creatinine clearance rather than solely to the patient's weight.

Epoxy Thermoplastic Traffic Marking Material, HR-1033, 1982

This Implementation Package summarizes the result of an effort to develop a more durable traffic marking material-Epoxy Thermoplastic (ETP). The report includes background information on the development of ETP, a discussion of the field tests and evaluations, the material composition and equipment modifications for applying ETP. The package also includes material specifications for purchasing ETP and specifications for the application of ETP by contract.

Laboratory Study of the Leachate from Crushed Portland Cement Concrete Base Material, MLR-96-04, 1999

Since the 1980s, the Iowa Department of Transportation has increased its use of recycled Portland Cement Concrete (PCC) as drainable base material below some new pavements. Water flowing out of the longitudinal drains on projects having recycled PCC drainable bases was found to have a high pH value. The high pH water impedes vegetation growth and becomes a contributing factor to soil erosion at the drain outlet. In addition, the high pH water contributes to the growth of crystalline deposits on the drain outlet wire mesh rodent guard and in some cases caused it to become completely blocked. This research determined which of three choices of recycled PCC drainable base material, gradation, and design would give the lowest pH value in the drain discharge water. The drainable base material having its fines separated out and placed as a 2-in. (5.1-mm) bottom layer, below the remaining coarse material, generally gave pH values around 11.2 while other designs tested gave pH values around 11.5.