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1521. Prognosis of MTA Apexification Versus Calcium Hydroxide Apexification

and open apex permanent dentition. Case Study Key results Both MTA apexification and long-term calcium hydroxide techniques had good outcome in a 5-year follow up for treating dens in dente (dens invaginatus) cases. Both cases were cleaned with antimicrobial irrigants during preparation. For MTA apexification, calcium hydroxide was placed inter-appointment for 2 weeks. For long-term calcium hydroxide treatment, the paste was replaced at 2 weeks, then monthly for 14 months, at which time the root had

2011 UTHSCSA Dental School CAT Library

1522. Treatment of a Root Fragment in the Maxillary Sinus

Treatment of a Root Fragment in the Maxillary Sinus UTCAT832, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Treatment Of A Root Fragment In The Maxillary Sinus Clinical Question In surgical extraction patients with a root tip inadvertently pushed into their maxillary sinus, will immediate surgical therapy be a more effective way in leading to a smooth recovery as compared to a delayed operation date with antibiotic

2011 UTHSCSA Dental School CAT Library

1523. How Safe Is That Tattoo?

also cause systemic infections such as staphylococcal toxic shock syndrome, pseudomonal abscesses, and infective endocarditis. The British Cardiac Society/Royal College of Physicians and 60% of physician members of the International Society of Adult Congenital Cardiac Disease (IASCCD) surveyed in 1999 recommend prophylactic antibiotics before obtaining a tattoo for patients with congenital heart disease, as a preventive measure against infective endocarditis. Importantly, 75% of the same group (...) . In addition to changing needles and inkwells, it is also a good idea for patients to ensure that the tattoo artist washes his hands and changes gloves between each client, disinfects all equipment, shaves and cleans the body site with an antimicrobial wash before administering the tattoo, and provides appropriate aftercare instructions. The tattoo artist should also be educated about potential health risks and adverse events associated with tattoos, as clients might return to the tattoo artist before

2011 Clinical Correlations

1524. Packing Abscesses for Recurrent Infection

of egress for pus. Surprisingly, there is only one randomized, controlled trial evaluating the utility of packing in simple cutaneous abscesses managed in the ED setting . The sample size is small (n = 48), the methods are good, and outcome assessments were blinded. Of note, all subjects were prescribed antibiotics. At 48 hours, 17% in the packing group and 20% in the nonpacking group received a secondary intervention (p = 0.72), although use of these interventions was left to judgment and most were (...) =1943) evaluating a ‘closed’ versus ‘open’ technique for abscess treatment found the closed approach yielded faster healing and no difference in recurrence. In the closed approach, incision and drainage is performed and sutures placed to close the wound. The open technique included packing. While all types of abscesses were included in this review, they were drained under general anesthesia and all patients received one dose of intravenous antibiotics during the procedure, suggesting

2011 theNNT

1525. Case of the Month: Vertebral Osteomyelitis and Psoas Abscess with Acinetobacter Baumanii: Report of an Unusual Case

vertebral bodies and L2-3 interspace were involved with a destructive process producing exuberant pus. Culture of vertebral bone obtained at surgery yielded Acinetobacter baumannii , resistant to all antibiotics except for ampicillin/sulbactam. (Sensitivity testing to polymixin and tigecycline was not performed.) Empiric antibiotic therapy was discontinued, and ampicillin/sulbactam was begun. Discussion Vertebral osteomyelitis, psoas abscess, and spinal epidural abscess, are inter-related infections (...) colonized or infected with the organism. [8] Risk factors for developing Acinetobacter infections include central vascular lines, tracheostomy, mechanical ventilation, enteral feedings, debilitated state, and recent surgery. Another documented risk factor is recent use of fluoroquinolones, third generation cephalosporins, and carbapenem antibiotics. 9 Acinetobacter is only occasionally a cause of infection outside of a health care setting, especially in temperate climates. As a community acquired

2011 Clinical Correlations

1526. Dental Procedures Do Not Raise The Risk of Infection of Prosthetic Hip or Knee Joints

Dental Procedures Do Not Raise The Risk of Infection of Prosthetic Hip or Knee Joints UTCAT2066, Found CAT view, CRITICALLY APPRAISED TOPICs University: | | ORAL HEALTH EVIDENCE-BASED PRACTICE PROGRAM View the CAT / Title Dental Procedures Do Not Raise The Risk Of Infection Of Prosthetic Hip Or Knee Joints Clinical Question In a patient who has had prosthetic replacement of the hip or knee joint, does dental treatment increase the likelihood of prosthesis infection? Does antibiotic prophylaxis (...) at dental treatment lower the likelihood of prosthesis infection? Clinical Bottom Line Dental procedures do not raise the risk of infection of prosthetic hip or knee joints, nor does antibiotic prophylaxis for dental procedures lower the likelihood of joint infection. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Berbari / 2010 339 cases, 339 controls, all underwent prosthetic hip or knee replacement Case

2011 UTHSCSA Dental School CAT Library

1527. Probiotics for Acute Infectious Diarrhea

of diarrhea Harm Endpoints: None reported Narrative: Diarrhea is a major cause of mortality and morbidity worldwide, and treatment regimens often include a oral and/or intravenous rehydration, antibiotics, and anti-motility agents. The administration of probiotics have been proposed as an add-on intervention that may be able to decrease the duration and severity of diarrhea. The Cochrane Review included 63 randomized controlled trials (56/63 in infants and children) of 8014 subjects with proven

2011 theNNT

1528. Cholera in Haiti

secretion of sodium and chloride [6]. This leads to a massive osmotic outpouring of sodium, chloride, potassium and bicarbonate that overwhelms the absorptive capacity of the bowel and results in severe watery diarrhea [2]. The typical “rice water stool” of cholera patients is loaded with V. cholerae and is highly infectious [2]. The treatment of cholera’s deadly desiccating diarrhea involves prompt rehydration with electrolyte-rich oral or intravenous rehydration solutions. Antibiotics, most frequently (...) cholera strains [4]. It can survive longer in the human host and induce more diarrhea, thus it is able to disseminate faster and more broadly than other strains [4]. This new strain is not only more fit, it also appears to have developed more antibiotic resistance than other strains [4]. There is great concern that this hardier and deadlier strain will not only continue to batter Haiti, but it may also establish itself throughout the Americas. So where did this cholera strain come from? Is it domestic

2011 Clinical Correlations

1529. Intercessory Prayer: What Do Sneezes and Prayers Have in Common?

. The antibiotics worked, but the prayer worked better.”[2] In this story, we find an example of how a patient can perceive prayer to be as efficacious, if not more so, than medical intervention. Many prospective studies have examined the use of prayer as a coping mechanism and its relationship with the healing process. One randomized, double-blinded, prospective study of coronary care unit (CCU) patients found that intercessory prayer was associated with .[3] The 2006 Study of the Therapeutic Effects

2011 Clinical Correlations

1530. Tooth Discoloration Is A Risk Associated With Regenerative Endodontics

, (Mandras, 2013; PMID 23755774) provides two alternative antibiotic combinations: 3-MIX C (clarithromycin) and 3-MIX F (fosfomycin). Both were shown to exhibit great antimicrobial activity without the permanent staining side effect. This evidence does not change the previously published answer to the clinical question, but it does provide alternative options for antimicrobials during regenerative endodontic treatment(s) | | | | | | | | Links from web sites affiliated with The University of Texas Health (...) treatment. A controlled laboratory study has validated this finding by showing that the Minocycline, contained within the triple antibiotic paste, discolors the teeth similarly to the paste. Best Evidence (you may view more info by clicking on the PubMed ID link) PubMed ID Author / Year Patient Group Study type (level of evidence) #1) Kim/2010 20 extracted maxillary & mandibular incisors Random controlled bench top study Key results Only the teeth exposed to Minocycline showed the same discoloration

2011 UTHSCSA Dental School CAT Library

1531. Chlorhexidine Is Not Superior To Sodium Hypochlorite As A Root Canal Disinfectant During Root Canal Therapy For Apical Periodontitis

and/or STUDENTS COMMENTS ON PUBLISHED CATs) by Sara Fayazi (San Antonio, TX) on 09/13/2013 I conducted the search in PubMed and found one review article relevant by Luddin & Ahmed, 2013, PMID: . Enterococcus faecalis is one of the most resistant microorganisms that dominants the microbial ecosystem of persistent periradicular lesions. For that reason, many in vitro and in vivo studies evaluated and compared the antibacterial activity of sodium hypochlorite and chlorhexidine at varying concentrations using (...) different experimental models against this microorganism. This study analyzed the related laboratory investigations of both irrigants against E.faecalis by agar diffusion model. By using the same method, some studies demonstrated that NaOCl at the concentrations of 2.5% and below has lower antibacterial activity than 2% CHX against E. faecalis. However, few authors claimed that the efficacy of 2.5% NaOCl was equivalent to that of 0.2% CHX. It seems that using both irrigants has synergistic effect, so

2011 UTHSCSA Dental School CAT Library

1534. Can inflammatory markers distinguish streptococcal from viral tonsillitis?

and ineffective use of antibiotic therapy in many situations. Microbiological culture is the best way to establish an aetiological diagnosis, but is time consuming. The question therefore arises whether inflammatory markers such as C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), white cell count (WCC) and procalcitonin (PCT) can differentiate streptococcal from viral tonsillitis. Search Strategy Medline (PubMed), EMBASE and the Cochrane Controlled Trials Register (CCTR) were searched (...) and local inflammatory changes in palatine tonsils. Excluded were patients who received antibiotics in preceding 2 weeks. Case control study (level 3b) CRP Mean (SD): 70 (35) mg/L (Group A strep), 59 (7) mg/L (virus) P-values, confidence intervals and sensitivities and specificities were not calculated. Population group not representative of general population. WCC Mean (SD): 13.3 (4.3) x 109/L (Group A strep), 7.9 (2.4) x109/L (virus) WCC Suggested cut-off level of >12 x109/L for group A strep ESR

2011 BestBETS

1535. How common is co-existing meningitis in infants with urinary tract infection?

and aseptic meningitis Bacterial meningitis: 0 Aseptic meningitis: 12 The study only included infants who had urine and CSF cultures obtained on the same day. The number of infants with UTI who did not undergo LP is not provided None of the patients had received antibiotics prior to urine and CSF specimens being obtained (based on history and testing of urine antimicrobial activity) Bonsu et al, 2007 258 infants aged 0–3 months with UTI who underwent LP (UTI definition: positive urine culture with ≥1000 (...) with aseptic meningitis had received antibiotics prior to LP (ie, cultures potentially false-negative); however, one of these cases was positive for enterovirus on PCR Dayan et al, 2004 125 infants aged 0–2 months with UTI who underwent LP (UTI definition: any pure growth on SPA specimen; positive urine culture with ≥10 000 CFU/ml for catheter specimen) Retrospective cohort study (level 2b) Culture-proven meningitis Bacterial meningitis: 1 (0.8%) (E coli) Part of a larger study population of infants

2011 BestBETS

1536. The Treatment For Clostridium Difficile? Transplant!

hospital wards, we know that Clostridium difficile colitis is an extremely serious infection that is becoming more [ , ] It has been reported that about 15-30% of patients treated for Clostridium difficile colitis experience recurrent episodes, resulting in an increase in mortality and morbidity, [ , , ] Prior treatment guidelines have recommended antimicrobial therapies. This may seem paradoxical, given that this infection is intrinsically antibiotic-related. Other non-pharmacological methods have (...) randomized trials are still underway, preliminary results anticipate a cure rate of about 90%. But, there is one downside: it is a fecal transplant. Yes, you read it correctly: fecal. I am referring to stools being transplanted from a healthy donor to a patient with Clostridium difficile colitis that is refractory to conventional medical therapy. Scientists call this procedure fecal bacteriotherapy. The transplantation of feces for the treatment of antibiotic-associated colitis was first described

2011 Clinical Correlations

1537. Low Dose Vitamin K Supplementation and Anticoagulation Control

be divided into 2 categories: (1) those that interact with cytochrome P450, which metabolizes warfarin and (2) those that alter phytonadione (vitamin K) levels. The majority of inter- and intra-individual warfarin dose variability is attributable to the agents in category 1 above, which include everything from antibiotics, antihistamines, and barbiturates to alcohol and antacids. However, once one controls for these variables, oral intake of vitamin K persists as an integral factor in anticoagulation

2011 Clinical Correlations

1538. Tales of Survival: Physical Exam

of patients like these at first—patients who were memorable because my experiences with them seemed to represent a step forward in my professional development in a very tangible and recognizable way. Instead I now find myself writing about Mr. L, described above, who at first glance did not seem an ideal patient to write about at all. His diagnosis was simple enough and management was relatively straightforward: antibiotics, debridement, supportive therapy. Without the ability to converse

2011 Clinical Correlations

1539. Topical chlorhexidine may be useful in preventing dry socket.

and delivery systems? Review Methods: In December 2008, the authors searched three electronic databases for randomized and nonrandomized clinical trials that evaluated CHX at any concentration or delivery system. The authors excluded studies in which the same patient received both CHX and antibiotic interventions. For trials that lacked a placebo control, the authors used data from another that evaluated patients with similar characteristics. Main Results: The search produced 12 clinical trials

2011 ADA Center for Evidence-Based Dentistry

1540. Adenoidectomies decrease the pathogenic nasopharyngeal bacterial

to decrease after adenoidectomy but the carriage of nonpathogens increases. The methodological quality of the design was poor. Other factors may have biased the effect of adenoidectomy on the colonization of bacteria in the nasopharynx. For instance, the use of antibiotics was only reported in three publications. Also, the postoperative swabs were taken after a short period of time varying from 10 days to three months. There should be more long term data. Source of Funding: None Commentary Importance (...) and Context: It is important to know if a patient has a respiratory infection and/or is taking any antibiotics before starting dental treatment on a patient in order to determine the methods used for dental treatment. Strengths and Weaknesses of the Systematic Review: This low quality included a comprehensive literature search strategy, well defined inclusion/exclusion criteria . It also included a list of studies with its characteristics provided in a clear table format. The weakness

2011 ADA Center for Evidence-Based Dentistry

Evidence-based Synopses

Synopses are typically easily digested, critical commentaries of articles e.g. critically appraised topics.