Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T10:51:28Z No. of bitstreams: 2 Dissertação - Thainara Calixto da Paz - 2016.pdf: 1536674 bytes, checksum: 9a527593418c3d06cd5b9029999ee4b3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2017-01-26T10:52:00Z (GMT) No. of bitstreams: 2 Dissertação - Thainara Calixto da Paz - 2016.pdf: 1536674 bytes, checksum: 9a527593418c3d06cd5b9029999ee4b3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) / Made available in DSpace on 2017-01-26T10:52:00Z (GMT). No. of bitstreams: 2 Dissertação - Thainara Calixto da Paz - 2016.pdf: 1536674 bytes, checksum: 9a527593418c3d06cd5b9029999ee4b3 (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2016-12-05 / Human adenoviruses (HAdVs) may cause several clinical syndromes, and are a major cause of respiratory and acute gastroenteritis (AGE), especially among children. However, data on viral load, in more than one type clinical sample obtained from the same child, are still scarce. The aims of the present study were to evaluate the frequency of the HAdV, to determine the load viral in clinical samples, and to proceed molecular characterization of positive samples from children up to five years of age in association with symptomatology. For this, 200 children attended at Hospital Materno Infantil in Goiânia, Goiás; between March 2014 ad July 2015. One fecal and one nasopharyngeal swab sample was obtained from each child. The clinical samples (fecal and nasopharyngeal swabs) were submitted the DNA extraction by a commercial kit (Qiagen-Hilden, Alemanha), and screened by RT-qPCR (TaqMan) assay, with specific primers and probe targeting the hexon region of HAdV genome. The global frequency of HAdVs was 21% (42/200). Positivity in swabs was 9.5% (19/200), and in fecal samples 16% (32/200). Among the symptomatic children (n=129), 21% were positive in fecal samples (22/105) and 9.2% (10/108) in swab samples. Futhermore, 4.5% (9/200) were positive in both clinical samples. High viral loads were observed in both fecal and nasopharyngeal swab samples from symptomatic and asymptomatic children, and major positivity was found in symptomatic children with high load viral. High viral loads were observed in samples from symptomatic and asymptomatic children. Major positivity and load viral was found betwenn symptomatic children. HAdV types 3 of species B and 41 of HadV F species were detected. We hope that the data obtained can help in a better understanding of the pathogenesis of HAdV in children. / Os adenovírus humanos (HAdVs) são importantes agentes causadores de gastroenterite aguda e doença respiratória, principalmente entre as crianças menores de cinco anos de idade. Dados sobre a carga viral, em mais do que um tipo de amostra clínica obtida de um mesmo indivíduo durante a infecção, ainda são escassos. Os objetivos do presente estudo foram avaliar a frequência do HAdVs, determinar a carga viral em amostras clínicas, e proceder a caracterização molecular de amostras positivas de crianças até aos cinco anos de idade, em associação com a sintomatologia. Foram incluídas no estudo amostras de 200 crianças atendidas no Hospital Materno Infantil de Goiânia, Goiás; entre março de 2014 e julho de 2015. Uma amostra fecal e um swab nasofaringeano foram obtidos de cada criança. As amostras foram submetidas a extração, utilizando kit comercial (RNA mini-kit, Qiagen), e triadas por ensaio RT-qPCR (TaqMan, Life Technologies), com iniciadores e sonda específicos para a região codificadora do hexon. Foi observado índice global de positividade para HAdVs de 21% (42/200), o índice de positividade nas fezes foi 16% (32/200) e em swab foi de 9,5% (19/200). Entre as crianças sintomáticas (n=129), 21% foram positivas em amostras fecais (22/105) e 9,2% (10/108) em amostras de swabs. Ainda, 4,5% (9/200) foram positivas em ambas as amostras clínicas. Cargas virais elevadas foram observadas em amostras de crianças sintomáticas e assintomáticas, maior positividade foi encontrada em crianças sintomáticas com maiores cargas virais. Foram detectados HAdV tipos 3 da espécie B e 41 da espécie F de HadV. Esperamos que os dados obtidos possam auxiliar em um melhor entendimento da patogenia dos HAdV na população infantil.

Made available in DSpace on 2016-08-19T18:15:58Z (GMT). No. of bitstreams: 1 MARIA NEUSA SOUSA CAVALCANTE.pdf: 559402 bytes, checksum: 722392cbe89c47e945c68e6b760c003b (MD5) Previous issue date: 2009-09-25 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Visceral Leishmaniasis is a zoonosis that attacks man in an accidental way and in the present decade presents itself in a wide geographic expansion, attacking urban and peri-urban spaces of large Brazilian cities. The precarious social/economic and environmental conditions, as well as life habits are relevant to the epidemiology of the disease and seem to favor the maintaining of the transmission cycle. A Cohort study was accomplished during the period of August 2006 to January 2008, with the objective of investigating the occurrence of non-symptomatic infection by Leishmania chagas in humans in the villages of Maresia, Pantoja and Marisol in the municipal area of Raposa, MA. The study was delineated in three phases: in the first phase, a population census was taken; in the second phase, demographic, social/economic and epidemiologic data was collected using a questionnaire, as well as a physical examination and tests to detect the infection by Leishmania chagasi in 1371 individuals by the immune enzymatic test (ELISA), and in 1356 individuals by the Montenegro skin test (IDRM); and in the third phase, the physical exam as well as the ELISA test was performed on 958 individuals. In the statistical analysis of the risk factors, a logistic regression and Poisson test in the Stata 9.0 program was used, having a significant level p<0,05 (95%). The initial and final prevalence and the incidence of infection by Leishmania chagasi by means of the ELISA test was 19,8%, 16,6% and 8,4% respectively, and the prevalence by means of the IDRM test was 82%. The following variables were found to be associated with the incidence of infection by Leishmania chagasi by the ELISA test: over 15 years of age (p<0,001) and the presence of more than 4 dwellers in a residence (p=0,039); and association with the prevalence of infection by Leishmania chagasi by the IDRM test were: over 15 years of age (p=0,003), straw or adobe walls (p=0,0014), a poultry-gard present (p=0,004) and reference to mosquito-breeders in the peridomiciliar (p=0,026). The high prevalence detected by the IDRM in the localities studied indicates a large exposure of the dwellers to the vetor of LV, and the incidence detected by the ELISA demonstrates the vulnerability of the individuals to the risk of contracting the disease. / A leishmaniose visceral é uma zoonose que acomete o homem de forma acidental e apresenta-se em franca expansão geográfica com o acometimento de espaços urbanos e periurbanos de grandes cidades brasileiras. As precárias condições socioeconômicas, ambientais e hábitos de vida são relevantes na epidemiologia da doença e parecem favorecer a manutenção do ciclo de transmissão. Realizou-se um estudo de coorte, no período de agosto de 2006 a janeiro de 2008, com objetivo de investigar a ocorrência de infecção assintomática por Leishmania chagasi em humanos nas Vilas Maresia, Pantoja e Marisol no município de Raposa-MA. O estudo foi delineado em três fases: na primeira fase, realizado o censo populacional; na segunda fase, coleta dos dados demográficos, socioeconômicos, epidemiológicos utilizando um questionário, como também a realização do exame físico e de testes para detecção da infecção por Leishmania chagasi em 1371 indivíduos pelo método de Ensaio imunoenzimático (ELISA) e, em 1356 indivíduos pela Intradermorreação de Montenegro (IDRM); na terceira fase, realização em 958 indivíduos o exame físico bem como o teste de ELISA. Na análise estatística dos fatores de risco, utilizou-se a regressão logística e o teste Poisson no programa Stata 9.0, e, com nível de significância p<0,05 (95%). A prevalência inicial e final, e a incidência da infecção por L.chagasi por meio do teste ELISA foram de 19,8%, 16,6% e 8,4% respectivamente, e a prevalência por meio do teste IDRM de 82%. Encontrou-se associação com a incidência da infecção por L.chagasi pelo teste ELISA as seguintes variáveis: idade acima de 15 anos (p<0,001) e a presença de mais de 4 moradores na residência (p=0,039); e associação com a prevalência de infecção por L.chagasi pelo teste IDRM foram: idade maior que 15 anos (p=0,003), parede de palha/taipa ou adobe (p=0,0014), presença de galinheiro (p=0,004) e referência a criadouros do mosquito no peridomicílio (p=0,026). A alta prevalência detectada pelo IDRM nas localidades estudadas indica a grande exposição dos moradores ao vetor da LV, e a incidência detectada pelo ELISA demonstra a vulnerabilidade dos indivíduos ao risco de contrair a doença.

The intention of this analysis was to identify patients with treated Wilson disease (WD) and residual neurological symptoms in order to determine whether or not they were undergoing any treatment in addition to the common decoppering medication. Moreover, the effects of any symptomatic medication were analyzed. Two samples of WD patients were investigated either by a mailed questionnaire survey (n = 135) or by a retrospective analysis (n = 75). A considerable proportion of patients still suffered from neurological symptoms (n = 106, 50.5%), of whom a relatively small proportion was treated symptomatically (n = 33, 31.1%). The documented effects varied substantially, with anticholinergics and botulinum toxin (against dystonia) and primidone (against tremor) apparently being the most promising compounds. Further studies are required to analyze the symptomatic treatment of WD patients with residual neurological symptoms in more detail. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

FundaÃÃo de Amparo a Pesquisa do Estado do Piauà / Dengue is an infectious disease that is associated with high morbidity and mortality rates in tropical and subtropical countries. Infection can be asymptomatic or have warning signs leading to severity. The diversity of these episodes can be affected mainly by the ratio of serotypes/genotypes of the virus. Different interleukins are directly associated with dengue infection, and they are closely related to the immunopathogenesis of the disease. Genetic polymorphisms of these cytokines may be responsible for the imbalance of the inflammatory process and markers for dengue susceptibility and may be related to dengue symptoms. In this study, single nucleotide polymorphisms (SNPs) of the interleukins (IL) IL1&#946; -511C>T, IL1RN bp VNTR 86, IL6 -174G>C and IL10 -819C>T and TNF&#945; -308G>A were analyzed in a group of 198 individuals with suspected dengue infection, during August 2011 to August 2013. Dengue was confirmed in 118 patients, and the control group consisted of another 80 individuals without dengue. Clinical and epidemiological data were collected from medical records or personal interviews. The genotype frequencies of all SNPs analyzed were found to be in Hardy-Weinberg equilibrium (HWE), except for the TNF&#945; gene. The major finding was the association of the IL1&#946; (-511C>T) T allele with dengue susceptibility (p <0.05). Analysis of association showed that the presence of the IL6 (-174G>C) polymorphic allele showed an increase in dengue susceptibility combined with at least a polymorphic allele of TNF&#945; and with IL1&#946; (-511C>T) polymorphic allele. Also, the heterozygous genotype of IL10 (-819 C>T) was significantly associated with TNF&#945; (-308G>A) and IL1&#946; (-511C>T) with IL1RN homozygous polymorphic genotypes for both, respectively. Considering the clinical symptoms, only dizziness was found to be associated with the T allele IL1&#946; (-511C>T) (P = 0.01). Our data showed the importance of IL1&#946; (-511C>T) polymorphism for dengue susceptibility and highlighted the additive effect of some interleukins. Also shown was that this polymorphism can be a marker for dengue symptoms, which may be relevant for therapeutic approaches. / A dengue à uma doenÃa infecciosa que detÃm altas taxas de morbidade e mortalidade em paÃses tropicais e subtropicais do mundo. A infecÃÃo pode ser assintomÃtica, possuir sinais de alerta ou levar à gravidade. A diversidade destas manifestaÃÃes pode ser afetada, principalmente, pela relaÃÃo sorotipo/genÃtipo do vÃrus. Diferentes interleucinas estÃo diretamente associadas com a infecÃÃo de dengue, e estas estÃo estreitamente relacionadas com a imunopatogÃnese da doenÃa. Polimorfismos genÃticos de citocinas podem ser responsÃveis pelo desequilÃbrio do processo inflamatÃrio, sendo potenciais marcadores da susceptibilidade à dengue bem como responsÃveis pelos sintomas a ela associados. Neste estudo, polimorfismos de nucleotÃdeo Ãnico (SNP) das interleucinas (IL) 1&#946; -511C>T, IL1RN VNTR 86 bp, IL6 -174G>C, IL10 -819C>T e TNF&#945; -308G>A foram analisados em um grupo de 198 indivÃduos com suspeita de infecÃÃo por dengue, durante agosto de 2011 a agosto de 2013. A dengue foi confirmada em 118 pacientes e o grupo controle consistiu em 80 indivÃduos sem dengue. Os dados clÃnicos e epidemiolÃgicos foram coletados de prontuÃrio ou entrevista pessoal. As frequÃncias genotÃpicas de todos os SNPs analisados estavam em equilÃbrio de Hardy-Weinberg (HWE), exceto o gene TNF&#945;. A principal associaÃÃo encontrada foi o alelo T do IL1&#946; (-511C>T) para susceptibilidade a dengue (P<0,05). AnÃlises de associaÃÃo mostraram que a presenÃa do alelo polimÃrfico de IL6 (-174G>C) mostrou um aumento da susceptibilidade para dengue quando combinado com pelo menos um alelo polimÃrfico de TNF&#945; e com o alelo polimÃrfico do IL1&#946; (-511C>T). AlÃm disso, o genÃtipo heterozigoto de IL10 (-819 C>T) e IL1&#946; (-511C>T) foram significativamente associados com TNF&#945; (-308G>A) e com IL1RN com genÃtipos homozigotos polimÃrficos para ambos, respectivamente. Considerando os sintomas clÃnicos, apenas tontura foi encontrado associado com o alelo T do IL1&#946; -511C>T (P = 0,01). Nossos dados mostraram a importÃncia do polimorfismo do IL1&#946; (-511C>T) para a susceptibilidade de dengue e ressalta o efeito aditivo de algumas interleucinas. TambÃm demonstrou que este polimorfismo pode ser um marcador para sintomas de dengue, o que pode ser relevante para abordagens terapÃuticas.

Introdução: Os objetivos do tratamento do Transtorno Afetivo Bipolar (TB) foram além da recuperação sintomática, incluindo também a recuperação funcional, foco das abordagens psicossociais como a psicoeducação. Objetivo: Verificar o impacto da psicoeducação na recuperação sintomática e funcional dos pacientes bipolares. Métodos: Trata-se de um estudo randomizado controlado com 51 pacientes portadores de TB tipo I ou II, de acordo com os critérios do DSM-IV TR; em remissão, com pontuação 7 na escala HDRS 17 itens e 6 na escala YMRS; em acompanhamento ambulatorial no GRUDA do IPq HC FMUSP, ou em acompanhamento psiquiátrico particular ou ainda no CAPS Del Rei MG. A distribuição dos sujeitos nos grupos foi feita por meio de randomização estratificada, em que os sujeitos, primeiramente, foram divididos em blocos estratificados de acordo com gênero, faixa etária, número de episódios anteriores da doença, escolaridade e estado civil. Posteriormente, dentro de cada bloco, os sujeitos foram distribuídos nos grupos aleatoriamente, por meio do lançamento da moeda ao ar repetidas vezes, em que GE foi cara e GC coroa. Assim, foram formados dois grupos homogêneos, evitando-se tendências e favorecimentos. O grupo experimental foi composto de 29 pacientes que receberam, além do tratamento farmacológico, a intervenção psicoeducacional. O grupo controle foi composto de 22 pacientes que receberam, além do tratamento farmacológico, encontros placebo. Entende-se placebo por intervenção em relaxamento. Ambos os grupos tiveram 16 encontros, duas vezes por semana, com 90 minutos de duração. Os instrumentos de avaliação foram aplicados no início (TA), no meio (TB) e no fim do tratamento (TC), e no seguimento de seis (TD) e 12 meses (TE). As escalas utilizadas para avaliar a recuperação sintomática foram: HDRS para a depressão, e YMRS, para a mania. As escalas para avaliar a recuperação funcional foram: WHOQOL-Bref e Escala de Adequação Social- EAS. A melhora clínica global foi avaliada pela CGI. Resultados: HDRS aumentou de forma significativa ao longo do tempo (p=0,002), não houve diferença entre os grupos (p=0,890) e como a interação não foi significativa (p=0,373), o aumento foi equivalente entre os grupos; YMRS não alterou de forma significativa ao longo do tempo (p=0,359) e também não houve diferença significativa entre os grupos (p=0,294), as médias iniciaram baixas e mantiveram-se baixas; WHOQOL-Bref no domínio 4, houve uma tendência de diminuição das médias ao longo do tempo em ambos os grupos (p=0,059), apesar de não ter havido diferença significativa entre os grupos (p=0,175), parece haver uma tendência (p=0,084) do GE diminuir mais do que o GC; e EAS aumentou de forma significativa ao longo do tempo (p=0,044), não houve diferença entre os grupos (p=0,167) e, como a interação não foi significativa (p=0,410), o aumento foi equivalente nos dois grupos. CGI após o término do tratamento: 92,5% da PE e 78,2% do GC apresentaram melhora clínica global; após um ano, foram: 87,5% da PE e 75,1% do GC. Conclusão: Os resultados mostraram que a PE tendeu a impactar positivamente no bem estar do indivíduo em seu meio ambiente; promoveu uma melhora clínica global maior em todos os tempos avaliados com relação ao controle e essa melhora foi mantida em um ano; PE e controle mantiveram a recuperação sintomática maníaca. Apesar disso, a PE não protegeu de recaídas depressivas e de piora da adequação social. Portanto, a PE mostrou-se eficaz no bem-estar do paciente em seu meio ambiente, na melhora clínica global e na proteção de recaídas maníacas. / Introduction: The goals of treatment of bipolar affective disorder (BD) expanded beyond symptomatic recovery, also including functional recovery, the focus of psychosocial approaches as psychoeducation. Objective: To investigate the impact of psychoeducation (PE) in the symptomatic and functional recovery in bipolar patients. Methods: This is a randomized controlled trial with 51 patients with BD type I or II, according to the DSM-IV TR; in remission (score 7 on the HDRS - 17 items and 6 on the YMRS); in outpatient in the GRUDA IPq HC FMUSP, or in psychiatric care in private or CAPS Del Rei - MG. The distribution of subjects in the groups was made by stratified randomization, the subjects first were divided into blocks stratified by gender, age, number of previous episodes of illness, education and marital status. Subsequently, within each block, subjects were randomly divided into two groups, through the launch of the coin again and again, in which experimental group (EG) was expensive and control group (CG) crown. Thus were formed two homogeneous groups, avoiding trends and favors. The EG consisted of 29 patients who received, in addition to pharmacological treatment, the psychoeducational intervention. The CG consisted of 22 patients who received, in addition to pharmacological treatment, meetings \"placebo\". Both groups had 16 meetings, twice a week with 90 minutes. The assessment instruments were applied at the beginning (TA), in the middle (TB) and at the end of treatment (TC), and following six (TD) and 12 months (TE). The scales used to assess symptomatic recovery were: HDRS for depression, and YMRS for mania. Scales to assess functional recovery were WHOQOL-Bref and the Social Adjustment Scale- EAS. Clinical improvement was assessed by the CGI. Results: HDRS increased significantly over time (p = 0.002), no difference between groups (p = 0.890) and the interaction was not significant (p = 0.373), the increase was equivalent between groups; YMRS not change significantly over time (p = 0.359) and there was no significant difference between groups (p = 0.294), the averages started lower and remained low; WHOQOL-Bref in 4, there was a trend decrease in mean over time in both groups (p = 0.059), although there was no significant difference between groups (p = 0.175), there seems to be a trend (p = 0.084) lower in the EG than the CG , and EAS has increased significantly over time (p = 0.044), no difference between groups (p = 0.167), and the interaction was not significant (p = 0.410), the increase was equivalent in both groups. CGI after the end of treatment: 92.5% for PE and 78.2% of the control group showed clinical improvement overall, after one year were 87.5% for PE and 75.1% of GC. Conclusion: The results showed that the PE has tended to impact positively on the welfare of individuals in their environment, promoted a greater overall clinical improvement at all times evaluated than control and this improvement was maintained at one year. EG and CG maintained recovery symptomatic manic. Nevertheless, the PE did not protect depressive relapses and worsening of social adequacy. Therefore, the PE was effective in well-being of the patient in his environment, the global clinical improvement and protection of manic relapses.

Atrial fibrillation is a common arrhythmia encountered in the emergency department. In the United States, newly diagnosed cases of atrial fibrillation is projected to be 2.6 million cases in 2030 and the annual prevalence of atrial fibrillation is expected to be 12.1 million in 2030 (Colilla et al., 2013). Patients may present to the emergency department for treatment of atrial fibrillation with a variety of symptoms and therefore makes diagnosing atrial fibrillation based on symptomatology challenging for the clinician. The primary goal of this Doctor of Nursing Practice (DNP) project is to describe symptoms of atrial fibrillation in patients that seek medical treatment in the emergency department. Methods: This descriptive study contains secondary analysis of existing data derived from structured interviews that took place at two academic medical centers. This analysis included 74 patients that presented to the emergency department with symptoms suspected of acute coronary syndrome and were later diagnosed with atrial fibrillation. Descriptive statistics were used to synthesize data, while inferential statistics (bivariate tests) were used to compare symptoms between the age groups. Results: The mean age of subjects was 70 + 13 years, ranging 31 to 92 years. The majority of subjects were men (75.7%) and whites (90.5%). The most common symptoms reported by study subjects included chest discomfort (n = 50; 67.6%), followed by generalized weakness (n = 39; 52.7%) and shortness of breath (n = 39; 52.7%), and palpitations/ funny beating of the heart (n = 36; 48.6%) and unusual fatigue/ tiredness (n = 36; 48.6%). Sweating was the only symptom that was statistically significant in the younger adult group than in the older adult age group. Conclusion: The symptoms identified in this DNP project can be used to aid in identifying patients that present to the emergency with symptomatic atrial fibrillation. Further efforts for the assessment of atrial fibrillation should focus on the dissemination of common although nonspecific symptoms to facilitate the inclusion of atrial fibrillation as part of the differential diagnosis.

The intention of this analysis was to identify patients with treated Wilson disease (WD) and residual neurological symptoms in order to determine whether or not they were undergoing any treatment in addition to the common decoppering medication. Moreover, the effects of any symptomatic medication were analyzed. Two samples of WD patients were investigated either by a mailed questionnaire survey (n = 135) or by a retrospective analysis (n = 75). A considerable proportion of patients still suffered from neurological symptoms (n = 106, 50.5%), of whom a relatively small proportion was treated symptomatically (n = 33, 31.1%). The documented effects varied substantially, with anticholinergics and botulinum toxin (against dystonia) and primidone (against tremor) apparently being the most promising compounds. Further studies are required to analyze the symptomatic treatment of WD patients with residual neurological symptoms in more detail. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

The recent discovery that T cells recognize different sets of herpes simplex virus type 1 and type 2 epitopes from seropositive symptomatic and asymptomatic individuals might lead to a fundamental immunologic advance in vaccine development against herpes infection and diseases. The newly introduced needle-free mucosal (i.e., topical ocular and intravaginal) lipopeptide vaccines provide a novel strategy that might target ocular and genital herpes and possibly provide 'heterologous protection' from HIV-1. Indeed, mucosal self-adjuvanting lipopeptide vaccines are easy to manufacture, simple to characterize, extremely pure, cost-effective, highly immunogenic and safe. In this review, we bring together recent published and unpublished data that illuminates the status of epitope-based herpes vaccine development and present an overview of our recent approach to an 'asymptomatic epitope'-based lipopeptide vaccine.

Syftet med denna masterstudie var att jämföra den smärtlindrande effekten av fullständig utrensning och desinfektion av rotkanalsystemet med enbart utrymning av pulpakavum, utan instrumentering av rotkanalerna, som akutbehandling hos tänder med symtomatisk apikal parodontit. Materialet utgjordes av 16 patienter insamlade på Tandvårdshögskolans jourmottagning. Patienter med svullnad och allmänpåverkan exkluderades. Patienterna valdes slumpmässigt ut till att genomgå någon av behandlingarna. Den preoperativa smärtnivån och ev. analgetikaintag registrerades. Tre till fem dagar efter utförd behandling kontaktades patienterna per telefon och fick då gradera sin postoperativa smärtnivå samt analgetika- och/eller antibiotikaintag. Resultatet visade att 100% av patienterna som behandlades med fullständig utrensning erhöll tillfredställande smärtlindring jämfört med 71% av de patienter som behandlades med enbart utrymning av pulpakavum. Skillnaden var inte statistiskt signifikant. 44% av patienterna som behandlades med fullständig utrensning hade tagit smärtstillande postoperativt medan 29% av patienterna i utrymningsgruppen hade gjort det. Skillnaden var inte signifikant. Ingen av patienterna oavsett behandling hade tagit antibiotika efter behandlingen. Ingen skillnad förelåg i andelen patienter som blev tillräckligt smärtlindrade mellan fullständig utrensning och enbart utrymning av pulpakavum hos tänder med symtomatisk apikal parodontit. Det var inte heller någon skillnad i smärtsänkning mellan de två behandlingarna. / The aim was to compare the pain relieving effect of complete chemo mechanical disinfection of the root canal system with removal of necrotic tissue in the pulp chamber without instrumentation of the root canals as emergency treatment in teeth with symptomatic apical periodontitis. The material consisted of 16 patients collected at the emergency clinic at Malmö University. Patients with swelling and/or systemic involvement were excluded. The patients were randomized to either treatment. The preoperative pain level and intake of analgesics was registered. Three till 5 days postoperatively the patients were contacted and asked to grade the current pain level and intake of analgesics and/or antibiotics. The results showed that 100% of the patients treated with complete chemo mechanical disinfection of the root canal system obtained satisfying pain relief compared to 71% for patients treated with removal of necrotic tissue in the pulp chamber. 44% of the patients treated with chemo mechanical disinfection of the root canal system had some kind of analgesics postoperatively compared to 29% for those treated with removal of necrotic tissue in the pulp chamber. No patients in either group reported use of antibiotics postoperatively. The conclusion was that both complete chemo mechanical disinfection and removal of necrotic tissue implied a significant pain relief as emergency treatment in teeth with symptomatic apical periodontitis. There was no difference between the two treatments concerning the number of patients who obtained sufficient pain relief or in pain relieving effect.

Syftet med denna randomiserade kliniska studie var att jämföra anestesieffekten mellan 2 % lidocain med 1:200,000 adrenalin och 3 % prilocain med 0,03 i.u./ml felypressin vid en blockad av Nervus alveolaris inferior för behandling av patienter med symtomatisk pulpit i en underkäksmolar eller –premolar.Materialet utgjordes av 5 patienter som uppsökt Tandvårdshögskolans jourmottagning för akuta besvär. Patienterna fick upp till 3,6 ml av antingen 2% lidocain (n=4) eller 3% prilocain (n=1). Det valda medlet var okänt för både patient och behandlare under hela behandlingen. Behandling (pulpotomi) påbörjades först när patienten erhållit bedövad läpp. Information om smärta före och under behandling, intag av analgetika och oro inför behandling noterades. Lyckad anestesi ansågs vara ingen eller endast mild smärta under behandling (<54 mm av 170 mm på en visuell analog skala).Lyckandefrekvensen för lidocain var 50 % och för prilocain 100 %. Det insamlade materialet var för litet för möjliggöra statistisk analys.De patienter som inkluderades i denna pilotstudie var för få för att visa eventuella skillnader i anestesieffekt mellan lidocain och prilocain vid en blockad av Nervus alveolaris inferior för behandling av patienter med symtomatisk pulpit i en underkäksmolar eller –premolar. Ett större underlag krävs för att kunna dra slutsatser om något av de testade bedövningsmedlen är överlägset. Ett stickprov på 57 deltagare i varje grupp krävs för att upptäcka en skillnad i lyckandefrekvens på 25 % (power 80 %). Protokollet har nu testats och visat sig vara lämpligt att använda i en större studie. / The aim of this randomized clinical trial was to compare the anesthetic efficacy of 2% lidocaine with 1:200,000 epinephrine and 3% prilocaine with 0,03 i.u./ml felypressin used for the inferior alveolar nerve block (IANB) in endodontic treatment of adult patients with symptomatic pulpitis in posterior mandibular teeth.5 patients visiting the emergency clinic of the Faculty of Odontology, Malmö University participated in the study. They randomly received, in a double-blind manner, up to 3,6 ml of either 2% lidocaine (n=4) or 3% prilocaine (n=1) in a conventional IANB. Treatment (pulpotomy) was only initiated after profound lip numbness was obtained. Pre- and perioperative pain, intake of analgesics and anxiety was recorded. Anesthetic success was defined as no or only mild pain (a rating of <54mm on a 170mm Visual Analogue Scale) during treatment.The success rate for IANB using lidocaine was 50% and for prilocaine 100%. The material size was insufficient to enable statistical analysis.The few patients selected for this pilot study were insufficient to assess any difference in anesthetic efficacy between lidocaine and prilocaine for IANB in endodontic treatment of adult patients with symptomatic pulpitis in a posterior mandibular tooth. Further data collection is needed to make conclusions about possible superiority of any of the tested substances. A sample size of 57 test subjects in each group would give a power of 80% to detect a difference of 25% in success rate. The protocol appears to be suitable for use in a larger-scale study.