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Decontamination in Children

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141. Effectiveness of Photodynamic Therapy for Endodontic Treatment of Deciduous Teeth

of primary teeth when combined with photodynamic therapy. Will be selected 30 primary teeth of children aged between 3 and 6 years. The teeth will be divided into two groups: group I control, which will be applied the conventional endodontic treatment and group II to be held endodontic treatment with application of photodynamic therapy. In both groups will be made microbiological evaluations before and after endodontic treatment and clinical and radiographic evaluations will be conducted in the day, 1 (...) hypochlorite (Milton's solution) and endo PTC (Fórmula & Ação) with each change of file. Filling of root canals with calcium hydroxide (Ultra-cal, Ultradent, Brazil); base of thin gutta-percha and filling with glass ionomer cement; restorative treatment performed in subsequent session. Procedure: Endodontic treatment It will be done the endodontic treatment using the photosynamic therapy for decontamination of the root chanel. Experimental: Photodynamic therapy Endodontic Treatment with photodynamic terapy

2015 Clinical Trials

142. Evaluation of Free Air Portable Air Powered Respirator

Influenza Other: Free Air Portable Air Powered Respirator Other: N95 Respirator Not Applicable Detailed Description: Airborne transmission represents one of the most rapidly spreading and least understood dissemination mechanisms for pathogens. Public health strategies to prevent and control the often explosive outbreaks associated with such pathogens are: 1) vaccination and treatment, if available, 2) decontamination of the exposed areas and surfaces, and 3) isolation and barrier precautions (...) : 18 Years to 49 Years (Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria: Age 18-49 years of age Employee or student at Wake Forest University School of Medicine and Wake Forest University Exclusion Criteria: Respiratory tract disorders and other chronic diseases, and medical conditions and treatments which are contraindications to mask usage Severe claustrophobia or inability to tolerate masks Contraindications to FluMist: Children younger than 18

2015 Clinical Trials

143. Management of calcium channel blocker overdose in the emergency department

of this. The St-Onge paper below concludes: “The evidence for treatment of CCB poisoning derives from a highly biased and heterogeneous literature… Based on the published literature, few valid inferences can be drawn about the relative merits of one intervention over another.” Considering the frustration this has caused me, this will probably have to be the subject of a long rant on the section of this blog sometime soon. I did not mention GI decontamination anywhere above. It is certainly a controversial (...) subject, but neither side of the argument has great evidence to support them. This is a potentially deadly overdose without a great antidote, which should make it an ideal candidate for GI decontamination. However, there is no evidence that GI decontamination is beneficial, but there is plenty of evidence of harm. In a patient who is intubated and presented early, I would consider activated charcoal. With regards to whole bowel irrigation, I tend to agree with Leon Gussow ( ), who says

2015 First10EM

144. A novel culture medium for isolation of rapidly-growing mycobacteria from the sputum of patients with cystic fibrosis. (PubMed)

culture medium (RGM medium) was evaluated for the isolation of rapidly-growing NTM from the sputum of children and adults with CF.A total of 118 isolates of rapidly-growing mycobacteria and 98 other bacteria and fungi were inoculated onto RGM medium. These were assessed for growth at 30°C over a seven day period. A total of 502 consecutive sputum samples were collected from 210 patients with CF. Each sample was homogenized and cultured onto RGM medium and also onto BCSA. Cultures were incubated (...) with 46 on RGM medium.RGM medium offers a simple and effective culture method for the isolation of rapidly-growing mycobacteria from sputum samples from patients with CF without decontamination of samples. RGM medium allows for the systematic screening of all sputum samples routinely referred for culture from patients with CF.Copyright © 2015 European Cystic Fibrosis Society. Published by Elsevier B.V. All rights reserved.

2015 Journal of Cystic Fibrosis

145. Staphylococcus aureus Skin Infection Recurrences among Household Members: An Examination of Host, Behavioral, and Pathogen Level Predictors. (PubMed)

Staphylococcus aureus Skin Infection Recurrences among Household Members: An Examination of Host, Behavioral, and Pathogen Level Predictors. Many patients suffer from recurrent Staphylococcus aureus infections, but there are few data examining recurrence predictors.We followed adults and children after treatment for S. aureus skin infections and their household contacts in Los Angeles and Chicago. We surveyed subjects for S. aureus body colonization, household fomite contamination (...) predictors of subsequent skin infection were Chicago site, antibiotic use in the prior year, and skin infection in the prior 3 months.In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites.© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights

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2014 Clinical Infectious Diseases

146. Dental Implant Maintenance

: results from a 2-year prospective clinical study in humans. Clin Oral Implants Res. 2011 Feb 11. doi: 10.1111/j.1600-0501.2010.02098.x. [Epub ahead of print] 77. Schwarz F, Sahm N, Iglhaut G, Becker J. .Impact of the method of surface debridement and decontamination on the clinical outcome following combined surgical therapy of peri-implantitis: a randomized controlled clinical study. J Clin Periodontol. 2011 Mar;38(3):276-84. 78. Kotsovilis S, Karoussis IK, Trianti M, Fourmousis I. Therapy of peri (...) Dec;15(5):431-9. 101. Michel J, Michel M, Nadan J, Nowzari H. The Street Children of Manila are affected by Early-in-life Periodontal Infection: Description of a Treatment Modality: Sea Salt. Journal de Parodontologie et d'Implantologie Orale. 2011 – in press. 102. Felo A, Shibly O, Ciancio SG, Lauciello FR, Ho A. Effects of subgingival chlorhexidine irrigation on peri-implant maintenance. Am J Dent. 1997 Apr;10(2):107-10. 103. Slots J. Selection of antimicrobial agents in periodontal therapy. J

2014 The Endo Blog

147. Safety of Probiotics to Reduce Risk and Prevent or Treat Disease

use RCTs 76 Figure 22. RR Number of Children With Adverse Events 82 Figure 23. RR Number of Adults With Adverse Events 83 Figure 24. RR Number of Elderly Participants With Adverse Events 85 Figure 25. RR Number of Critically Ill or High-Risk Participants With Adverse Events 88 Figure 26. Number of Participants With Serious Adverse Events 94 Appendixes Appendix A. Exact Search Strings and List of Manufacturers Appendix B. Sample Data Abstraction Forms Appendix C. Evidence Tables Appendix D (...) no evidence that a particular mechanism or route of administration of probiotic organisms was associated with an increased risk of an adverse event in intervention participants relative to control group participants. Stratified analyses and meta-regressions showed no increased risk of adverse events for children (RR 0.96; 95% CI: 0.88, 1.04; p=0.296, 35 RCTs), adults (RR 0.97; 95% CI: 0.79, 1.19; p=0.745, 40 RCTs), or elderly (RR 0.94; 95% CI: 0.82, 1.08; p=0.367, 4 RCTs) participants compared

2011 EvidenceUpdates

148. Pediculosis (Overview)

over things with a fine-tooth comb" are part of everyday vocabulary. Louse infestation remains a major problem throughout the world, making the diagnosis and treatment of louse infestation a common task in general medical practice. [ ] Pediculosis capitis results in significant psychological stress in children and adults and missed schooldays in children, particularly in areas with a no-nit policy. [ ] Lice are ectoparasites that live on the body. Lice feed on human blood after piercing the skin (...) are spread by sitting on a toilet seat; pubic lice’s feet are not designed to walk on smooth surfaces such a toilet seats, and the lice cannot live for long away from a warm human body. [ ] Because these organisms are most often spread through close or intimate contact, P pubis infestation is classified as an STD. Condom use does not prevent transmission of P pubis . Upon diagnosis of pubic lice, concern should be raised about the possibility of concomitant STDs. In children, infestation of pubic lice


149. Nosocomial Pneumonia (Overview)

nutritional deficiencies. Early (within 48 hours) enteral nutrition appears to decrease infectious complications. Parenteral nutrition does not seem to have this effect and should be considered only in patients with a contraindication to enteral replacement. [ , ] Beds that permit some degree of patient turning may decrease the likelihood of hospital-acquired pneumonia (HAP)/ventilator-associated pneumonia (VAP) in at-risk patients. Decontamination of the mouth and gut may affect the risk of producing MDR (...) -associated tracheitis in children: does antibiotic duration matter?. Clin Infect Dis . 2011 Jun. 52(11):1324-31. . . Siempos II, Vardakas KZ, Manta KG, Falagas ME. Carbapenems for the treatment of immunocompetent adult patients with nosocomial pneumonia. Eur Respir J . 2007 Mar. 29(3):548-60. . Kullar R, Davis SL, Levine DP, Rybak MJ. Impact of vancomycin exposure on outcomes in patients with methicillin-resistant Staphylococcus aureus bacteremia: support for consensus guidelines suggested targets. Clin


150. Anthrax (Follow-up)

IgG1 kappa monoclonal antibody. [ ] Human anthrax immune globulin (Anthrasil) is indicated for treatment of inhalational anthrax in adults and children in combination with antibiotic therapy. [ ] The indication for anthrax vaccine adsorbed (BioThrax) was expanded in November 2015 to include postexposure use following suspected or confirmed B anthracis exposure in combination with antimicrobial therapy. It was originally approved for pre-exposure prophylaxis in high-risk individuals (...) outlined as recommended by the CDC, IDSA, and AAP (see table below). Table 3. CDC Expert Panel Recommendations for Treatment of Cutaneous Anthrax Nonpregnant adults Pregnant/lactating women Children Recommended therapy [ ] : Treatment duration, 7-10 days Ciprofloxacin 500 mg every 12 hours Ciprofloxacin 500 mg every 12 hours Ciprofloxacin 30 mg/kg/day divided every 12 hours (max dose, 500 mg/dose) Doxycycline 100 mg every 12 hours Amoxicillin 75 mg/kg/day divided every 8 hours (max dose, 1 g/dose

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151. Wound Closure Technique

a strong flexible bond. In some forms, it can induce a substantial inflammatory reaction if implanted subcutaneously. If used superficially on the epidermal surface, few problems with inflammation occur. In a study on the use of adhesives in the emergency department, adhesives were more likely to be used in facial lacerations and in children and less likely to be used in longer wounds. [ ] The concomitant use of either a topical anesthetic or no anesthetic, as opposed to an injectable, was cited (...) , and meticulous hemostasis prior to closure. Human bites and some animal bites (especially feline) are at significant risk for early infection. In these cases, antibiotics are imperative with or without primary closure. If closure is considered, wound decontamination must be as thorough as possible. Late complications include scar formation, which may be due to either improper suturing with excess tension or lack of eversion of the edges. Additionally, are unfortunate later complications of wound closure

2014 eMedicine Surgery

152. Toxicity, Organophosphate (Overview)

. Treatment begins with decontamination. Airway control and oxygenation are paramount. The mainstays of pharmacological therapy include atropine, pralidoxime (2-PAM), and benzodiazepines (eg, diazepam). Initial management must focus on adequate use of atropine. Optimizing oxygenation prior to the use of atropine is recommended to minimize the potential for dysrhythmias. See Treatment and Medication. Next: Background Organophosphate compounds were first synthesized in the early 1800s when Lassaigne reacted (...) . Respiratory failure is the most common cause of death. Age Organophosphates (OPs) may affect children or other at-risk populations differently. The increased susceptibility has not been elucidated but may involve delayed or persistent effects. More work in this area is in progress and should help identify the true risk potential. [ ] Previous References Bouvier G, Seta N, Vigouroux-Villard A, Blanchard O, Momas I. Insecticide urinary metabolites in nonoccupationally exposed populations. J Toxicol Environ


153. Toxicity, Mustard Agent (Overview)

. Mustard agents constitute both a vapor and a liquid threat. Mustard agents cause tissue damage within several minutes of contact. [ ] No immediate symptomatic or local reaction occurs to mustard vapor or liquid. Decontamination must be performed immediately after contact to prevent injury. A latent period occurs, ranging from 4-12 hours after mild exposure and 1-3 hours after severe exposure, prior to the onset of symptoms. More than 80% of mustard casualties are from vapor exposure, but more severe (...) , Uniformed Services University of the Health Sciences, F Edward Hebert School of Medicine Zygmunt F Dembek, PhD, MPH, MS, LHD is a member of the following medical societies: , Disclosure: Nothing to disclose. Additional Contributors Fred Henretig, MD Director, Section of Clinical Toxicology, Professor, Medical Director, Delaware Valley Regional Poison Control Center, Departments of Emergency Medicine and Pediatrics, University of Pennsylvania School of Medicine, Children's Hospital Disclosure: Nothing


154. Toxicity, Mushroom (Overview)

, children are often exposed to nontoxic mushrooms, while older persons are at greater risk for the development of serious complications with mushroom poisoning than are healthy young adults. Mushroom exposure in children is an infrequent but perennial problem for parents and clinicians. Parental anxiety is generally high because of fears of unknown or untoward effects. The challenges for clinicians are to identify such poisonings, to discern whether poisoning has taken place, to order appropriate (...) figures regarding the frequency of mushroom poisoning are difficult to obtain. Cases usually are sporadic, and a few outbreaks have been reported. During the 10-year period from 2001 to 2011, 83,140 mushroom ingestions were reported to US Poison Control Centers; of these, 64,534 (77.6%) were pediatric ingestions and 48,437 (58.3%) occurred in children younger than 6 years. A total of 48,423 (58.2%) patients were male. The majority of ingestions, 65,255 (78.5%), were unintentional. Identification


155. Toxicity, Iron (Overview)

Author: Clifford S Spanierman, MD; Chief Editor: Michael A Miller, MD Share Email Print Feedback Close Sections Sections Iron Toxicity Overview Practice Essentials Iron overdose has been one of the leading causes of poisoning deaths in children younger than 6 years. Iron is used in pediatric or prenatal vitamin and mineral supplements and for treatment of anemia. Iron tablets are particularly tempting to young children because they look like candy. Iron overdose in adults is typically a suicide (...) attempt. [ ] Iron overload may develop chronically as well, especially in patients requiring multiple transfusions of red blood cells. This condition develops in patients with , , and hematologic malignancies such as . [ , , ] For full discussion of iron toxicity in children, see . Next: Pathophysiology Iron toxicity can be classified as corrosive or cellular. Ingested iron can have an extremely corrosive effect on the gastrointestinal (GI) mucosa, which can manifest as nausea, vomiting, abdominal


156. Toxicity, Salicylate (Overview)

, and liquids. Salicylate is also available for topical application, in creams or lotions. Salicylate ingestion continues to be a common cause of poisoning in children and adolescents. The prevalence of aspirin-containing analgesic products makes these agents, found in virtually every household, common sources of unintentional and suicidal ingestion. However, the incidence of salicylate poisoning in children has declined because of reliance on alternative analgesics and the use of child-resistant containers (...) . Repackaging has decreased children's accessibility to lethal amounts, and salicylate's association with Reye syndrome has significantly decreased its use. Still, more than 10,000 tons of aspirin are consumed in the United States each year. Aspirin or aspirin-equivalent preparations (in milligrams) include children's aspirin (80-mg tablets with 36 tablets per bottle), adult aspirin (325-mg tablets), methyl salicylate (eg, oil of wintergreen; 98% salicylate), and Pepto-Bismol (236 mg of non-aspirin


157. Q Fever (Follow-up)

) did not affect resolution of acute disease or severity of neurologic sequelae. [ ] Macrolides, especially azithromycin and clarithromycin, can also be used as alternative agents, but some strains of C burnetii show resistance. [ ] Trimethoprim-sulfamethoxazole (TMP-SMZ) has also been used. [ , ] No reliable regimen is available for children (< 8 y) or pregnant women. Macrolides or TMP-SMZ may be options in these populations. [ , ] Adjuvant corticosteroid treatment has been used in antimicrobial (...) populations should be screened for glucose-6-phosphate dehydrogenase deficiency before receiving hydroxychloroquine. If hydroxychloroquine is used, a yearly ophthalmologic evaluation is required to rule out retinal toxicity. Patients should be reminded of photosensitivity risk while on doxycycline therapy. Previous Next: Prevention C burnetii must be cultured in biosafety level 3 laboratories. Use only seronegative sheep in research facilities. Isolation and decontamination with standard precautions

2014 eMedicine Pediatrics

158. Hematopoietic Stem Cell Transplantation (Diagnosis)

patients) Ganciclovir, IV immunoglobulin (IVIg), and CMV-negative blood products (CMV-seronegative patients) Pneumocystis prophylaxis with trimethoprim-sulfamethoxazole or pentamidine Prophylaxis of pneumococcal bacteremia with penicillin, erythromycin, or extended-spectrum fluoroquinolones (immunosuppressed GVHD patients) IVIg (patients with documented hypogammaglobulinemia) Gut decontamination with metronidazole or fluoroquinolones (acute GVHD) Hepatitis B virus (HBV) vaccine (all HBsAg-negative (...) Leukocyte adhesion deficiency Indications for HSCT in specific diseases Acute myeloid leukemia Allogeneic HSCT is the treatment of choice for all children with acute myeloid leukemia (AML) with a human leukocyte antigen (HLA) ̶ matched sibling in their first complete remission (CR1). In adults, this is reserved for those with high-risk features in their CR1. In adults with standard or good risk features, stem cell transplantation is reserved for their second complete remission (CR2). HSCT is the only

2014 eMedicine Pediatrics

159. Enterococcal Infection (Diagnosis)

are infected more commonly than children (excepting the neonatal period). Most of the literature regarding invasive enterococcal infections in children focuses on the neonatal period and indicates that approximately 50% of newborn infants are colonized with E faecalis by age 1 week. Older children who develop bacteremia have underlying risk factors. Previous References van Vliet MJ, Tissing WJ, Dun CA, et al. Chemotherapy treatment in pediatric patients with acute myeloid leukemia receiving antimicrobial (...) with cancer. Clin Infect Dis . 2006 May 15. 42(10):1506-7. . . Bonadio WA. Group D streptococcal bacteremia in children. A review of 72 cases in 12 years. Clin Pediatr (Phila) . 1993 Jan. 32(1):20-4. . Tebruegge M, Pantazidou A, Clifford V, Gonis G, Ritz N, Connell T, et al. The age-related risk of co-existing meningitis in children with urinary tract infection. PLoS One . 2011. 6(11):e26576. . . Lubell TR, Schnadower D, Freedman SB, Macias CG, Agrawal D, Kuppermann N, et al. Comparison of Febrile Infants

2014 eMedicine Pediatrics

160. Toxicity, Organophosphate (Follow-up)

exposure is recommended. [ ] Next: Deterrence/Prevention Health care providers must avoid contaminating themselves while handling patients poisoned by organophosphates. The potential for cross-contamination is highest in treating patients after massive dermal exposure. Use personal protective equipment, such as neoprene or nitrile gloves and gowns, when decontaminating patients because hydrocarbons can penetrate nonpolar substances such as latex and vinyl. Use charcoal cartridge masks for respiratory (...) , Abou Salem ME, Mechael AA, Hendy OM, Rohlman DS, Ismail AA. Effects of occupational pesticide exposure on children applying pesticides. Neurotoxicology . 2008 Sep. 29(5):833-8. . Levy-Khademi F, Tenenbaum AN, Wexler ID, Amitai Y. Unintentional organophosphate intoxication in children. Pediatr Emerg Care . 2007 Oct. 23(10):716-8. . Jayawardane P, Dawson AH, Weerasinghe V, Karalliedde L, Buckley NA, Senanayake N. The spectrum of intermediate syndrome following acute organophosphate poisoning


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