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Clinical judgement vs. evidence-based practice: two models to predict postoperative hematocrit following uncomplicated hysterectomyMayer, Sarah A. 13 July 2017 (has links)
BACKGROUND: Hysterectomies are one of the most frequently performed surgical procedures in the United States. There are a wide variety of diagnoses that require a patient to obtain this procedure, but the majority of hysterectomies are performed for benign indications. Currently, gynecologists do not follow a standardized protocol surrounding postoperative laboratory ordering, and healthcare professionals can order a wide range of tests as often as they choose. Extraneous laboratory orders are disruptive to the patients’ well-being and risk their health following surgery. These orders are costly for hospital systems, take up precious time of hospital employees, and influence the course of patient treatment only in extremely rare circumstances.
There are few studies that develop exclusion criteria for patients who may not require a laboratory test following surgery. Though systems to predict postoperative hematocrit have been created, they are complicated and difficult to use. The few studies that were performed are yet to be accepted by the medical community, in part because of their limited scope. This study will be the first to incorporate the results of robotic surgery in the analysis.
OBJECTIVE: The purpose of this study is to determine concrete parameters to indicate that a patient is in need of postoperative laboratory work and at risk for anemia or transfusion. We aim to develop two comprehensive models that guide surgical practitioners to identify the cases which do not require laboratory data.
METHODS: A total of 1027 gynecologic surgeries were performed at Saint Francis Hospital and Medical Center between April 1, 2014 and May 31, 2016. This retrospective study extracted data from EPIC EMR according to 42 variables preconceived to be the leading indicators of postoperative hematocrit and overall healing. Five healthcare professionals were surveyed to identify the variables that influence their postsurgical patient assessments and their decisions to order blood testing. This information was developed into score sheets with differing levels of stringency. Correlation highlighted 14 of the initial 42 variables as contributors to postoperative hematocrit and an equation model was built. Stepwise linear regression was used for univariate and multivariate analyses, from which we created our equation to predict all patients’ postoperative hematocrit.
RESULTS: Out of the 1027 initial cases, a total of 602 cases were identified as hysterectomies for benign indications. Survey data gave the highest value to urine output and heart rate as key indicators of postoperative anemia. From the survey data, two clinical scoring sheets with differing stringency were created to guide practitioner laboratory ordering. These sheets gave parameters of heart rate and urine output the largest correlative weight in determining postoperative hematocrit. However, based on regression analysis, parameters of age (AGE), body mass index (BMI), preoperative platelet count (PPC), estimated blood loss during surgery (IO EBL), preoperative hematocrit (PHCT) and postoperative fluid bolus orders (POSTOP FB) proved to be the key variables impacting postoperative hematocrit (POSTOP HCT). These items were translated into the equation: POSTOP HCT = 22.51 – 0.40*POSTOP FB – 0.01*IO EBL + 0.25 PHCT + 0.09*BMI + 0.06*AGE – 0.01*PPC (R-squared = 0.310).
CONCLUSIONS: This study aims to decrease superfluous laboratory testing, as well as to contribute to a larger conversation considering the potential merits of clinical judgement in a data-driven healthcare system. We have created a number of comparable strategies in order to reduce the number of unnecessary blood draws: two clinical scoring sheets and an equation. The score sheets indicate when to order additional testing. These sheets are representative of a range of surgical practitioners’ conventional clinical judgement. The equation serves as an evidence-based guide for determining postoperative hematocrit following benign gynecologic surgery. These predictive mechanisms will be validated and a superior method determined as our research continues with prospective application. We eventually expect to use the most accurate mechanism to reduce postoperative blood testing following all surgeries.
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Variedades completas com espectro positivo / Complete varieties with positive spectrumLima, Marcos César de Vasconcelos 17 June 2011 (has links)
LIMA, Marcos Cesar Vasconcelos. Variedades completas com espectro positivo. 2011. 53 f. Dissertação (Mestrado em Matemática) – Centro de Ciências, Universidade Federal do Ceará, Fortaleza, 2011. / Submitted by Andrea Dantas (pgmat@mat.ufc.br) on 2017-08-24T16:54:57Z
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Previous issue date: 2011-06-17 / In this dissertation we will present a theorem about the ends of complete manifold due to Peter Li and Jiaping Wang. This result can be interpreted as a generalization of Cheeger-Gromoll splitting theorem, which states that a complete Riemannian manifold M with nonnegative Ricci curvature then M has only one end or M is isometric to a product space R L, where L is a compact Riemannian manifold with nonnegative Ricci curvature. What Li-Wang did was expand this result for manifolds with Ricci curvature bounded from below by a nonnegative constant. / Nessa dissertação apresentaremos um teorema sobre os fins de um variedade completa devido a Peter Li e Jiaping Wang. Esse resultado pode ser interpretado como uma generalização do teorema splitting de Cheeger-Gromoll, que afirma que se uma variedade Riemanniana M completa tem curvatura de Ricci não-negativa então M tem somente um fim ou M é isomémetrica a um produto da forma R L, onde L é uma variedade Riemanniana compacta com curvatura de Ricci não-negativa. O que Li-Wang fizeram foi ampliar tal resultado para variedades de curvatura de Ricci limitada inferiormente por uma constante negativa.
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Task compatibility and feasibility maximization for whole-body control / Compatibilité des tâches et maximisation de la faisabilité pour le contrôle de l'ensemble du corpsLober, Ryan 20 November 2017 (has links)
Le développement de comportements utiles pour les robots complexes, tel que des humanoïdes, s'avère difficile. La commande corps-complet à base de modèle allège en partie ces difficultés, en permettant la composition des comportements corps-complets complexes à partir de plusieurs tâches atomiques effectuées simultanément sur le robot. Cependant, des hypothèses et erreurs de modélisation, faites pendant la planification des tâches, peuvent produire des combinaisons infaisables/incompatibles quand exécutées sur le robot, créant des mouvements corps-complet imprévisibles, et probablement dangereux. L'objectif de ce travail est de mieux comprendre ce qui rend les tâches infaisables ou incompatibles et de développer des méthodes automatiques pour améliorer ces problèmes pour que les mouvements corps-complets puissent être accomplis comme prévu. Nous commençons par construire un formalisme permettant d'analyser quand les tâches sont faisables et compatibles étant données les contraintes de commande. En utilisant les métriques de faisabilité et compatibilité à base de modèle, nous démontrons comment optimiser les tâches avec des outils de commande prédictive non-linéaire ainsi que les inconvénients de cette approche. Afin de surmonter ces faiblesses, une boucle d'optimisation est formulée, qui améliore automatiquement la faisabilité et compatibilité des tâches via la recherche de politique sans modèle en conjonction avec la commande corps-complets à base de modèle. À travers une série d'expériences simulées et réelles, nous montrons que la simple optimisation de faisabilité et compatibilité des tâches nous permet de réaliser des mouvements corps-complets utiles. / Producing useful behaviors on complex robots, such as humanoids, is a challenging undertaking. Model-based whole-body control alleviates some of this difficulty by allowing complex whole-body motions to be broken up into multiple atomic tasks, which are performed simultaneously on the robot. However, modeling errors and assumptions, made during task planning, often result in infeasible and/or incompatible task combinations when executed on the robot. Consequently, there is no guarantee that the prescribed tasks will be accomplished, resulting in unpredictable, and most likely, unsafe whole-body motions. The objective of this work is to better understand what makes tasks infeasible or incompatible, and develop automatic methods of improving on these two issues so that the overall whole-body motions may be accomplished as planned. We start by building a concrete analytical formalism of what it means for tasks to be feasible with the control constraints and compatible with one another. Using the model-based feasibility and compatibility metrics, we demonstrate how the tasks can be optimized using non-linear model predictive control, while also detailing the shortcomings of this model-based approach. In order to overcome these weaknesses, an optimization loop is designed, which automatically improves task feasibility and compatibility using model-free policy search in conjunction with model-based whole-body control. Through a series of simulated and real-world experiments, we demonstrate that by simply optimizing the tasks to improve both feasibility and compatibility, complex and useful whole-body motions can be realized.
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Comparative study of complete- mix and plug flow first-order kinetic models of constructed wetlands.Ackah, Louis Akainya 01 May 2013 (has links)
Constructed Wetlands are used in many parts of the world for the treatment of wastewater from diverse sources. They are effective, low cost and sustainable alternative to most conventional wastewater treatment processes. They are engineered to mimic many of the same processes that occur in natural wetlands but within a more controlled environment. The need for proper design of constructed wetlands for secondary and tertiary wastewater treatment is of utmost importance in meeting today's stringent water quality standards. Subsequently, numerous design tools have been proposed for the assessment of constructed wetland performance. Currently, applied modeling approaches include regression models, mass loading versus outflow concentration analysis, Monod type analytical models and first-order removal kinetic models. The principal objective of this research was to estimate the biochemical oxygen demand (BOD) removal using both the plug flow and complete-mix first order kinetic models. Results obtained by these models were then validated by comparing with published data from the Arcata constructed wetland. This study also investigated the sensitivity of effluent BOD quality to variation in influent concentration, temperature and hydraulic retention time. Analysis of the results revealed that variations in the field conditions influenced the removal rate of BOD in each zone of the wetland. The design reaction rate coefficient for each zone varied and was corrected for using the Arrhenius expression. The BOD removal performance of the Arcata wetland and any wetland operated under similar conditions was found to be better modeled by the plug flow model at zero background concentration. The study also found the BOD removal to be much influenced by the influent concentration and minimally influenced by temperature and hydraulic retention time.
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Energia laplaciana sem sinal de grafosPinheiro, Lucélia Kowalski January 2018 (has links)
Neste trabalho, estudamos o problema de encontrar grafos extremais com rela c~ao a energia laplaciana sem sinal. Mais especi camente, procuramos grafos com a maior energia laplaciana sem sinal em determinadas classes. Nesse sentido, conjecturamos que o grafo unic clico conexo com a maior energia laplaciana sem sinal e o grafo formado por um tri^angulo com v ertices pendentes distribu dos balanceadamente e provamos parcialmente essa conjectura. Tal resultado foi provado tamb em para a energia laplaciana. Al em disso, conjecturamos que o grafo com a maior energia laplaciana sem sinal dentre todos os grafos com n v ertices e o grafo split completo com uma clique de [n+1/ 3] v ertices e provamos tal conjectura para algumas classes de grafos, em particular, para arvores, grafos unic clicos e bic clicos. / In this work, we study the problem of nding extremal graphs with relation to the signless Laplacian energy. More speci cally, we look for graphs with the largest signless Laplacian energy inside certains classes. In this sense, we conjecture that the connected unicyclic graph with the largest signless Laplacian energy is the graph consisting of a triangle with balanced distributed pendent vertices and we partially prove this conjecture. This result was also proved for the Laplacian energy. Moreover we conjecture that the graph with the largest signless Laplacian energy among all graphs with n vertices is the complete split graph with a clique of [n+1/ 3] vertices and we prove this conjecture for some classes of graphs, in particular, for trees, for unicyclic and bicyclic graphs.
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Autopercepção da saúde bucal, força máxima de mordida e eficiência mastigatória de portadores de overdentures com diferentes sistemas de encaixe / Oral health self-perception, maximum bite force and masticatory efficiency in patients with overdentures with different attachments systemsLima, Amanda Laísa de Oliveira 05 June 2018 (has links)
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Previous issue date: 2018-06-05 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Grande parte dos pacientes reabilitados com próteses totais convencionais é insatisfeita devido a problemas com retenção e estabilidade, principalmente quando é usuária de próteses totais mandibulares. Uma opção de tratamento satisfatório é a utilização de próteses totais removíveis suportadas por implantes (overdentures), conectadas por meio de diferentes sistemas de encaixe. O objetivo neste estudo foi avaliar o efeito de dois diferentes sistemas de encaixes (O'ring e Locator) para overdenture mandibular retida por um implante sobre a autopercepção da saúde bucal, impacto da saúde bucal na qualidade de vida, força máxima de mordida e a eficiência mastigatória. Este estudo foi do tipo cross-over, composto por 28 participantes distribuídos igualmente em dois grupos de acordo com os critérios de inclusão e exclusão. Para avaliar o impacto da saúde bucal na qualidade de vida e a autopercepção da saúde bucal foram utilizados os questionários Ohip-Edent e GOHAI, respectivamente. Para a avaliação da força de mordida, utilizou-se um gnatodinamômetro, e em relação a eficiência mastigatória, utilizou-se cubos de silicone de condensação denso e amêndoas, mastigados por 30 ciclos, 40 ciclos e até o paciente se sentir “pronto para engolir”. A análise estatística dos dados foi realizada com os seguintes testes: Friedman e Wilcoxon (para os questionários utilizando uma média para as pontuações), t-student, análise de variância a dois fatores para medidas repetidas e Correlação de Pearson (força máxima de mordida e eficiência mastigatória). Nos questionários Ohip-Edent e GOHAI não foi observado diferença estatística com relação aos dois tipos de encaixes analisados. No teste de força máxima de mordida, o encaixe do tipo O’ring proporcionou uma força máxima de mordida superior quando comparado ao Locator (p=0,04), além disso, quanto maior esta força máxima de mordida, menor o número de ciclos mastigatórios realizados até o momento “pronto para engolir”, independente do alimento. No teste de eficiência mastigatória, observou-se que não houve diferença estatística em relação ao tipo de encaixe em ambos os alimentos (p>0,05), porém, pode-se afirmar que eficiência mastigatória foi diretamente proporcional a quantidade de ciclos mastigatórios somente para o alimento amêndoas (p<0,01). Assim, pode-se concluir que a força máxima de mordida foi influenciada positivamente pelo tipo de encaixe o’ring. / Most patients rehabilitated with conventional dentures feel dissatisfied due to problems with retention and stability, especially when they are user of mandibular conventional dentures. A satisfactory option of treatment is the use of removable total dentures supported by implants (overdentures), connected through different attachments systems. The aim this study was to evaluate with two different attachments systems (O-ring and Locator) for mandibular overdenture retained by a single implant on the self-perception of oral health, quality of life impact, maximum bite force, and masticatory efficiency. To evaluete impact of oral health on quality of life and self-perceived oral health were using the OHIP-Edent and GOHAI questionnaires, respectively. To avaluated bite force was using a gnathodynamometer, and with respect to masticatory efficiency, was using a dense condensation silicone cubes and almonds with 30 cycles, 40 cycles until the patient feel "ready to swallow". Statistical analysis of data was performed with tests subsequent: Friedman and Wilcoxon (to questionnaires using a mean to the scores), t-student, two-way ANOVA test for repeated measures and Pearson's Correlation (maximum bite force and masticatory efficiency). In the questionnaires OHIP-Edent and GOHAI. it was not observed statistical diference in relation to two types of attachments analyzed. In the maximum bite force test, the attachment of type O'ring provided a maximum bite force higher when compared the Locator attachment (p=0,04), in addition, the higher this maximum bite force, lower the number of masticatory cycle realized up to the moment "ready to swallow", independent of the food. In masticatory efficiency test, was observed wich not have statistical diference in relation the type of attachment in both the food (p>0.05) but can afirm that masticatory efficiency was directly proportional the quantity of masticatory cycles only to almonds (p<0.01). Therefore, can conclude that the choice of attachment of type O'ring to overdentures influenced on maximum bite force / 2016/17688-3
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Tratamento do linfoma canino com poliquimioterapia seguida ou não de transplante autólogo de medula ósseaCápua, Maria Luisa Buffo de [UNESP] 30 January 2009 (has links) (PDF)
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capua_mlb_dr_jabo.pdf: 641370 bytes, checksum: 71b19a28f172b3515a32ed7c27977d96 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Dezoito cães com diagnóstico citopatológico e/ou histopatológico de linfoma foram avaliados quanto às alterações clínicas e clinico-patológicas. Os animais foram submetidos ao protocolo quimioterápico de Madison-Wisconsin e avaliados clinicamente a cada sessão de quimioterapia quanto à sua resposta ao tratamento. Cinqüenta por cento dos cães apresentaram a forma multicêntrica da doença e 33% a forma cutânea. A manifestação clínica mais comum foi a linfadenomegalia superficial, acompanhada dos sinais sistêmicos de hiporexia, apatia e perda de peso. As principais alterações hematólogicas foram anemia normocítica normocrômica, trombocitopenia e leucocitose, associadas às síndromes paraneoplásicas. Elevações nas atividades séricas de lactato desidrogenase foram observadas em 58% dos cães e a hiperproteinemia ocorreu em 38% dos animais, sendo atribuída principalmente ao aumento de globulinas séricas. Vinte e sete por cento dos animais atingiram remissão completa da doença e 33% atingiram sobrevida de seis meses. Houve correlação positiva entre o valor do hematócrito e o tempo de sobrevida para os cães que morreram, entretanto, o mesmo não foi observado para o valor de lactato desidrogenase. Sugere-se a ocorrência da síndrome da lise tumoral aguda para sete animais dado o intervalo de tempo observado entre a quimioterapia e o óbito e o avançado estágio da doença. A ausência de resposta às tentativas de reindução da remissão, observada em quatro cães, pode estar relacionada com o fenômeno de resistência tumoral aos agentes quimioterápicos. / Clinical and laboratorial evaluation were performed in eighteen dogs with cytopathological and/or histopathological lymphoma diagnosis. Animals underwent the Madison-Wisconsin chemotherapy protocol and were evaluated clinically at each session performed weekly. The multicentric and cutaneous forms of the disease were observed in 50% and 33% of the dogs, respectively. The most common clinical sign was superficial lymphadenomegaly, combined to systemic signs of hyporexia, apathy and weight loss. The main hematological changes were anemia, thrombocytopenia and leukocytosis, associated with paraneoplastic syndromes. Elevated serum activity of lactate dehydrogenase was observed in 58% of the dogs and hyperproteinemia in 38%, attributed to serum globulin increase. Complete remission was achieved in 27% of the animals and the six-month survival rate was 33%. There was a positive correlation between the hematocrit and survival time in dogs that died, however, there was no correlation between lactate dehydrogenase and survival time. The time interval between chemotherapy and death and the advanced stage of the disease in seven animals suggest the occurrence of acute tumor lysis syndrome. The absence of response to attempts of remission reinduction in four animals may be related to the drug tumoral resistance effect.
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Estudo clínico e histopatológico da mucosa palatina em pacientes não usuários de prótese e em usuários de prótese com câmara de sucçãoCastro, Eni Vaz Franco Lima de [UNESP] 09 December 2005 (has links) (PDF)
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castro_evfl_dr_araca.pdf: 208031 bytes, checksum: 9315c888cbc65fc52c5d2cf626bd81c1 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Considerando-se a significativa importância do melhor conhecimento acerca das lesões de maior ocorrência no cotidiano do cirurgião-dentista, justifica-se o estudo das hiperplasias fibrosas inflamatórias em geral, especialmente aquelas de inter-relacionamento com a atuação direta do profissional, como as hiperplasias protéticas. No presente estudo, foram observados os aspectos clínicos e microscópicos da mucosa palatina em pacientes não usuários e usuários de prótese, com a finalidade de se identificar a possibilidade de direta relação entre lesão e suposto agente causal. No sentido de se tentar realizar um estudo mais abrangente e com resultados mais confiáveis, o presente trabalho foi desenvolvido em dois capítulos distintos, analisando-se inicialmente a mucosa palatina clinicamente normal de trinta pacientes usuários e não usuários de prótese total superior, observando-se que a presença de hiperplasia no epitélio de revestimento da mucosa palatina é um achado constante, tanto em usuários como em não usuários de prótese, sendo que a ausência de alterações clínicas nem sempre reflete a mesma normalidade ao exame histopatológico, sem uma relação de dependência entre inflamação e presença de hiperplasia epitelial e vice versa, em ambos os grupos. No segundo capítulo, foram estudados vinte e três pacientes com hiperplasia fibrosa palatina por câmara de sucção, antes e após tratamento compressivo, observando-se que lesões hiperplásicas podem não apresentar um quadro inflamatório crônico, sugerindo que o preenchimento gradativo da área de câmara de sucção é uma opção terapêutica de valor para esses casos. / Being considered the significant importance of the best knowledge concerning the lesions of larger occurrence in the routine of Surgeon Dentist, it is justified the study of the inflammatory fibrous hyperplasias in general, especially those of inter-relationship with the professional's direct performance, as the prosthetic hyperplasias. In the present study, the clinical and microscopic aspects of the palatine mucous membrane were observed in patients wearing or not total prosthesis, with the purpose of identifying the possibility of direct relationship between lesion and supposed causal agent. As an examining to try to accomplish a broader study with more reliable results, the present work was developed in two different chapters, being analyzed the clinically normal palatine mucous membrane of thirty patients initially wearing and not wearing of upper complete denture, being observed that the presence of hyperplasia in the epithelium coating of palatine mucous membrane is a constant discovery, as in wearing as in not prosthesis wearing individuals, and the absence of clinical alterations not always it reflects the same normality to the histopathologic exam, without a dependence relationship between inflammation and presence of epithelial hyperplasia and vice-versa, so much in wearing as in not prosthesis wearing. In the second chapter, twenty-three patients with palatine fibrous hyperplasia for suction chamber were studied, before and after treatment by use of tissue conditioning. It was observed that hyperplasic lesions cannot present a chronic inflammatory picture, suggesting that the gradual completion of the area of suction chamber is an important therapeutic option for those cases.
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Seleção do tamanho e da forma dos dentes anteriores superiores de próteses totais em quatro grupos raciais da população brasileiraVarjão, Fabiana Mansur [UNESP] 19 September 2005 (has links) (PDF)
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varjao_fm_dr_arafo.pdf: 1167104 bytes, checksum: 42b3246fa2f9731f0d52dbb897141d53 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O objetivo deste trabalho, composto por sete estudos clínicos, foi avaliar e discutir alguns parâmetros relacionados à seleção do tamanho e da forma dos dentes artificiais anteriores de próteses totais em quatro diferentes grupos raciais. A amostra constituiu-se de 160 indivíduos dentados naturais entre 18 e 33 anos, de ambos os sexos, sendo 40 brancos; 40 negros 40 pardos (descendentes de brancos e negros) e 40 amarelos (japoneses e chineses). Os resultados obtidos em todos os estudos demonstraram que: (1) indivíduos da raça negra apresentam dentes predominantemente maiores que indivíduos das demais raças; (2) não há evidência de correlação linear entre a LB e a largura dos seis dentes anteriores (em reta ou curva); (3) a relação entre a LB com a largura em reta e em curva dos dentes anteriores resultou em quocientes médios de 2,9 e 2,6, respectivamente. Esses quocientes poderiam ser utilizados como uma orientação inicial para a seleção da largura dos dentes anteriores, uma vez que eles levariam a erros de seleção clinicamente significantes na maioria (75%) das populações de cada raça estudada; (4) não há evidência de correlação linear entre a LB e largura do IC e entre a AF e a altura do IC; (5) as relações entre a LB e a largura do IC e entre a AF e a altura do IC resultaram em quocientes médios de 15,7 e 17,7, respectivamente. Esses quocientes poderiam ser utilizados como uma orientação inicial para a seleção do tamanho do IC; (6) existem poucos modelos de dentes artificiais cujas larguras são compatíveis com as larguras dos dentes naturais de indivíduos brasileiros, especialmente da raça negra; (7) há uma forte correlação linear entre a largura em reta e a largura em curva dos dentes anteriores, sendo possível prever individualmente uma medida a partir da outra; (8) não há relação consistente entre a forma do incisivo central e a forma da face ou do arco dentário. / This study evaluated some esthetic guidelines used for the selection of artificial teeth size and form in four racial groups. One hundred and sixty subjects aged from 18 to 33 years (40 Whites, 40 Blacks, 40 Mulattos and 40 Asians) were selected. From measurements made on dental casts, facial measurements and photographic records, the following data were obtained: individual width of each anterior tooth; right central incisor length (CIL); right central incisor width (CIW); combined width of the 6 anterior teeth (CAW); curve distance between the distal surfaces of the canines (CDC); bizygomatic width (BW); face length (FL); maxillary arch form; face form; right central incisor form. These quotients could be used as initial guides for the selection of the central incisors size; (6) there are few moulds of artificial teeth well matched with the teeth widths of Brazilian individuals, specially of the Black race; (7) there was a strong linear correlation between CAW and CDC, indicating that one measurement may be predict from the other; (8) there was no consistent correlation between the central incisor form and face form or arch form.
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Efetividade da desinfecção de próteses totais por energia de microondas no tratamento da estomatite protética associada à Candida sppNeppelenbroek, Karin Hermana [UNESP] 24 November 2005 (has links) (PDF)
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neppelenbroek_kh_dr_arafo.pdf: 741675 bytes, checksum: 00ef81add7daeb4f8b878ae9d4ac8577 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O presente estudo avaliou a efetividade da desinfecção de próteses totais no tratamento de estomatite protética associada à Candida spp. Sessenta pacientes com estomatite protética foram divididos em quatro grupos de acordo com o tratamento instituído: G0 (controle)- foram orientados a escovarem suas próteses com sabão de coco e dentifrício, deixando-as imersas em água durante a noite; G1- as próteses totais superiores dos pacientes foram irradiadas por microondas (650 W/ 6 minutos), três vezes por semana, durante 30 dias; G2- os pacientes receberam o mesmo tratamento do G1 associado à aplicação tópica de miconazol três vezes ao dia, por 30 dias; G3- apenas receberam terapia antifúngica tópica com miconazol de acordo com a prescrição indicada ao G2. Antes do início do tratamento, exames citológicos por esfregaço e culturas micológicas quantitativas foram obtidos da superfície interna das próteses totais superiores e da mucosa palatina de suporte de todos os pacientes. Os esfregaços e as culturas foram repetidos durante (15 dias), ao final do tratamento (30 dias) e após a sua suspensão (30 e 60 dias). Para a avaliação clínica, foram realizadas fotografias da mucosa palatina dos pacientes em cada consulta. Utilizou-se o teste de qui-quadrado (?2) para determinar diferenças entre os tratamentos dos grupos de estudo. A influência de fatores predisponentes na efetividade dos tratamentos também foi avaliada estatisticamente. Nos períodos durante (15 dias) e imediatamente após o tratamento (30 dias), os esfregaços citológicos e culturas quantitativas referentes à mucosa palatina e a superfície interna das próteses dos pacientes dos Grupos 1 e 2 não demonstraram formas miceliais e colônias viáveis de Candida spp. Em até 60 dias após a suspensão do tratamento, não foram observadas... / The present study evaluated the effectiveness of microwave disinfection of complete dentures on the treatment of Candida-related denture stomatitis. Sixty patients with denture stomatitis were divided into four treatment groups: G0 (control)- patients were instructed to scrub their dentures with coconut soap and toothpaste and soak them in water overnight; G1- patients had their maxillary denture microwaved (650 W/6 minutes) three times per week for 30 days; G2- patients received the treatment of G1 in conjunction with topical application of miconazole three times per day for 30 days; G3- patients received the same course of topical antifungal therapy with miconazole of G2. Before treatment, cytological smears and quantitative mycological cultures were taken from the tissue side of each maxillary denture and the corresponding palatal mucosa of all patients. Smears and cultures were repeated during (15 days), immediately after (30 days) and follow-up after the treatment (30 and 60 days). At each trial, palatal tissues of patients were photographed for clinical evaluation. Chi-squared statistical test (?2) was used to differentiate between the treatment groups. The influence of predisposing factors on treatment effectiveness was also analyzed statically. During (15 days) and immediately after the treatment (30 days), cytological smears and quantitative cultures of palatal mucosa and denture tissue surface of G1 and G2 patients did not exhibit mycelial forms and colonies of Candida spp. Following the treatment phase (30 and 60 days), no mycelial forms were found on smears of palatal mucosa of G1 and G2 patients. However, over the 60-day observation period following treatment, five patients in the G1 (33.33%) and six patients of G2 (40%) showed recurrence of mycelial forms of Candida spp. on the tissue surfaces of... (Complete abstract, access undermentioned electronic address)
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