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A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Dentistry Johannesburg, 2013 / The aim of this study was to test various alternating sequences of sodium hypochlorite (NaOCl), anolyte solution, and EDTA for their ability to remove the mineralised portion of the smear layer, and to destroy bacteria. Forty-eight single canal teeth were collected and randomly divided into six groups, prepared to working length, sterilized and inoculated with Enterococcus faecalis. The irrigation protocols were as follows: Group 1 (four roots) 3ml sterile distilled water, Group 2 (four roots) 3ml 6% sodium hypochlorite, Group 3 (ten roots) 3ml 6% sodium hypochlorite followed by 3ml 18% EDTA, Group 4 (ten roots) 3ml 6% sodium hypochlorite followed by 5ml anolyte solution, Group 5 (ten roots) 0.5ml 6% sodium hypochlorite followed by 5ml anolyte solution followed by 3ml 18% EDTA and Group 6 (ten roots) 5ml anolyte solution followed by 3ml 18% EDTA. Sterile paper points were inserted into the canals after sterilization, inoculation and irrigation. Standard cultivation techniques were used to count the colony forming units of viable bacteria at each phase. The roots were split longitudinally and prepared for SEM evaluation. Two photomicrographs were randomly taken in the coronal, middle and iv apical thirds of each root and the number of patent dentinal tubules counted. The One-way ANOVA was used for statistical evaluation. The small sample size limited definitive conclusions but the results indicated that the coronal thirds of the roots showed better smear layer removal than the apical thirds, Sodium hypochlorite followed by EDTA showed the best smear layer removal. The various sequences of NaOCl, anolyte solution, and EDTA all had similar antibacterial results.

Lost circulation and wellbore failure are common problems in the petroleum industry and they increase drilling costs dramatically. Casing drilling in depleted zones helps reduce drilling costs and problems related to lost circulation and wellbore failure. Thus, casing drilling is an important technology to minimize or eliminate conventional drilling problems in depleted zones. This thesis is focused on a study of smear effect in casing drilling in depleted formations. It is based on information about casing drilling and a commercial computer software ABAQUS. The smearing mechanism of drilling solids into the wellbore wall and the effects of parameters that affect the stress distribution around the wellbore wall are studied. Moreover, multiple wellbore cracks are studied to determine their effects on hoop stress distribution and all the results are given at the results chapter of this study. All the discussions about the changing parameters are given in results section. In conclusion, the smear effect in casing drilling can significantly improve hoop stresses around the wellbore and lost circulation problems can be minimized by using casing as a drilling string. These models can be used as a basic tool to understand smear effects in casing drilling in depleted formations. / text

O presente estudo avaliou, por meio de microscopia eletrônica de varredura (MEV) e análise Fourier Transform Infrared Spectroscopy (FT-IR), a capacidade de limpeza e as alterações da superfície dentinária após diferentes tratamentos. Foram utilizados 32 incisivos bovinos, dos quais obteve-se uma amostra de dentina do terço médio radicular de cada espécime. Inicialmente as 32 amostras foram analisadas em FT-IR após os seguintes tratamentos: dentina normal, sem tratamento (T1); NaOCl 2,5% por 5´ (T2). Os espécimes foram, então, distribuídos em quatro agrupamentos conforme tratamento com soluções (n=8): T3- EDTA 15%; T4- quitosana 1% diluída em ácido acético 1% + genipina 0,06%; T5- quitosana 1% diluída em ácido acético 1% + EDTA 15% + genipina 0,06%; T6- quitosana 1% diluído em EDTA 5% + genipina 0,06%. Os dados referentes a relação amidaIII/fosfato de cada tratamento foi submetida ao teste ANOVA, com dados vinculados seguido do teste de Tukey (p<0,001). Para a avaliação em MEV, após biomecânica de 8 raízes bovinas com limas rotatórias e NaOCl 2,5%, as mesmas foram distribuídas em 4 grupos (n=2), conforme irrigação final. As soluções utilizadas em G1, G2 G3 e G4 foram, respectivamente, as mesmas empregadas em T3, T4, T5 e T6, com volume de 1mL por 5´. Foram obtidas 6 fotomicrografias do terço médio radicular de cada espécime para análise da capacidade de limpeza e da deposição de quitosana/genipina sobre a superfície dentinária. Os resultados mostraram não haver diferença na porcentagem da razão amidaIII/fosfato entre T1 e T2. Houve diferença significante entre a porcentagem da razão amidaIII/fosfato de T3, T4, T5 e T6 em relação à T1. A porcentagem da razão amidaIII/fosfato foi significantemente menor para T4 em relação a T3, T5 e T6. Todos os grupos, com exceção de G2, removeram a camada de smear. Observou-se deposição de quitosana/genipina sobre a dentina do G3 e G4. Dentre os tratamentos propostos, o uso de quitosana solubilizada em EDTA associada à genipina removeu a camada de smear sem erudir o tecido, além de evidenciar a presença de aglomerado de quitosana/genipina sobre a superfície dentinária. / The present study evaluated, by scanning electron microscopy (SEM) and Fourier Transform Infrared Spectroscopy (FT-IR) analysis, the cleaning ability and the changes of the dentin surface after different treatments. Thirty-two bovine incisors were used, from which a dentin sample was obtained from the middle third of each specimen. Initially the 32 samples were analyzed in FT-IR after the following treatments: normal dentin, without treatment (T1); NaOCl 2.5% by 5\' (T2). The specimens were then distributed into four groups according to treatment with solutions (n = 8): T3- EDTA 15%; T4- chitosan 1% diluted in acetic acid 1% + genipine 0.06%; T5- chitosan 1% diluted in acetic acid 1% + EDTA 15% + genipine 0.06%; T6 chitosan 1% diluted in 5% EDTA + 0.06% genipine. The data concerning the amideIII / phosphate ratio of each treatment was submitted to the ANOVA test, with bound data followed by the Tukey test (p <0.001). For evaluation in SEM, after biomechanics of 8 bovine roots with rotating files and 2.5% NaOCl, they were distributed in 4 groups (n = 2), according to final irrigation. The solutions used in G1, G2, G3 and G4 were, respectively, the same as those employed in T3, T4, T5 and T6, with a volume of 1mL per 5\'. Six photomicrographs of the root mean third of each specimen were obtained for analysis of the cleaning capacity and chitosan/genipine deposition on the dentin surface. The results showed no difference in the percentage of the amide III/phosphate ratio between T1 and T2. There was a significant difference between the percentage of amide III/phosphate ratio of T3, T4, T5 and T6 in relation to T1. The percentage of the amide III/phosphate ratio was significantly lower for T4 compared to T3, T5 and T6. All groups, except for G2, removed the smear layer. Chitosan/genipine deposition was observed on G3 and G4 dentin. Among the proposed treatments, the use of chitosan solubilized in EDTA associated to genipine removed the smear layer without erode the tissue, besides evidencing the presence of agglomerate of chitosan/genipine on the dentin surface.

O presente estudo avaliou, por meio de microscopia eletrônica de varredura (MEV) e análise Fourier Transform Infrared Spectroscopy (FT-IR), a capacidade de limpeza e as alterações da superfície dentinária após diferentes tratamentos. Foram utilizados 32 incisivos bovinos, dos quais obteve-se uma amostra de dentina do terço médio radicular de cada espécime. Inicialmente as 32 amostras foram analisadas em FT-IR após os seguintes tratamentos: dentina normal, sem tratamento (T1); NaOCl 2,5% por 5´ (T2). Os espécimes foram, então, distribuídos em quatro agrupamentos conforme tratamento com soluções (n=8): T3- EDTA 15%; T4- quitosana 1% diluída em ácido acético 1% + genipina 0,06%; T5- quitosana 1% diluída em ácido acético 1% + EDTA 15% + genipina 0,06%; T6- quitosana 1% diluído em EDTA 5% + genipina 0,06%. Os dados referentes a relação amidaIII/fosfato de cada tratamento foi submetida ao teste ANOVA, com dados vinculados seguido do teste de Tukey (p<0,001). Para a avaliação em MEV, após biomecânica de 8 raízes bovinas com limas rotatórias e NaOCl 2,5%, as mesmas foram distribuídas em 4 grupos (n=2), conforme irrigação final. As soluções utilizadas em G1, G2 G3 e G4 foram, respectivamente, as mesmas empregadas em T3, T4, T5 e T6, com volume de 1mL por 5´. Foram obtidas 6 fotomicrografias do terço médio radicular de cada espécime para análise da capacidade de limpeza e da deposição de quitosana/genipina sobre a superfície dentinária. Os resultados mostraram não haver diferença na porcentagem da razão amidaIII/fosfato entre T1 e T2. Houve diferença significante entre a porcentagem da razão amidaIII/fosfato de T3, T4, T5 e T6 em relação à T1. A porcentagem da razão amidaIII/fosfato foi significantemente menor para T4 em relação a T3, T5 e T6. Todos os grupos, com exceção de G2, removeram a camada de smear. Observou-se deposição de quitosana/genipina sobre a dentina do G3 e G4. Dentre os tratamentos propostos, o uso de quitosana solubilizada em EDTA associada à genipina removeu a camada de smear sem erudir o tecido, além de evidenciar a presença de aglomerado de quitosana/genipina sobre a superfície dentinária. / The present study evaluated, by scanning electron microscopy (SEM) and Fourier Transform Infrared Spectroscopy (FT-IR) analysis, the cleaning ability and the changes of the dentin surface after different treatments. Thirty-two bovine incisors were used, from which a dentin sample was obtained from the middle third of each specimen. Initially the 32 samples were analyzed in FT-IR after the following treatments: normal dentin, without treatment (T1); NaOCl 2.5% by 5\' (T2). The specimens were then distributed into four groups according to treatment with solutions (n = 8): T3- EDTA 15%; T4- chitosan 1% diluted in acetic acid 1% + genipine 0.06%; T5- chitosan 1% diluted in acetic acid 1% + EDTA 15% + genipine 0.06%; T6 chitosan 1% diluted in 5% EDTA + 0.06% genipine. The data concerning the amideIII / phosphate ratio of each treatment was submitted to the ANOVA test, with bound data followed by the Tukey test (p <0.001). For evaluation in SEM, after biomechanics of 8 bovine roots with rotating files and 2.5% NaOCl, they were distributed in 4 groups (n = 2), according to final irrigation. The solutions used in G1, G2, G3 and G4 were, respectively, the same as those employed in T3, T4, T5 and T6, with a volume of 1mL per 5\'. Six photomicrographs of the root mean third of each specimen were obtained for analysis of the cleaning capacity and chitosan/genipine deposition on the dentin surface. The results showed no difference in the percentage of the amide III/phosphate ratio between T1 and T2. There was a significant difference between the percentage of amide III/phosphate ratio of T3, T4, T5 and T6 in relation to T1. The percentage of the amide III/phosphate ratio was significantly lower for T4 compared to T3, T5 and T6. All groups, except for G2, removed the smear layer. Chitosan/genipine deposition was observed on G3 and G4 dentin. Among the proposed treatments, the use of chitosan solubilized in EDTA associated to genipine removed the smear layer without erode the tissue, besides evidencing the presence of agglomerate of chitosan/genipine on the dentin surface.

No description available.

Abstract Introduction: "Pap smear" was first proposed in 1928 by Dr. Papanicolaou in USA as a screening test for cervical cancer. In most developed, higher-educated country,the majority of the female population receive regular Pap smear, and hence the incidence of invasive or late stage cervical cancer is relative low. In contrast, in those developing,or under-developed country ,the percentage of women receiving regular Pap smear is lower, and cervical neoplasm is more often diagnosed in the invasive or even later stage.General speaking,the incidence of invasive cervical cancer in a country may be recognized as a relative indicator for the quality of public health care. The higher the percentage of women receiving regular Pap smear is ,the lower the incidence of invasive cervical cancer. In Taiwan, the annual incidence of newly-diagnosed invasive cervical cancer remains high, and cervical cancer stand as the top one of the most lethal female cancer. In theory,since the incubation period from the pre-cancer stage(cervical intraepithelial neoplasm) to frank malignancy in cervix is rather long, allowing adequate opportunity and timing for Pap smear screening, more cervical neoplasm may be diagnosed and treated in the pre-cancer stage, and hence lower the incidence of cancer death from treatment failure. Disappointingly, even being a major program of public health care, and being supported by national institute, the Pap smear rate in Taiwan is far from ideal. We try to find out the causes of low Pap smear rate via analyzing the pattern and availability of health care, medical knowledge, and attitude of those cervical cancer patients. These factors may be of benefit to promote modifying public health program, and thus increase the receptivity and popularity of regular Pap smear in general population. Material and method: This is a retrospective study, focusing on the cervical cancer patients (including carcinoma in situ and invasive cancer of cervix), which were confirmed pathologically and treated successfully in a single hospital in the recent 3 years. Totally, 155 cases were enrolled. All these patients were interviewed face to face, and data were collected (focusing on basic data and the possible factors influencing Pap smear rate) according to a fixed form. SPSS for Windows Ver. 10.0 was used for data analysis. Percentage, distribution was used for descriptive statistics. Cross table analysis, chi-square test, and logistic regression analysis were used for comparing group difference. Results: The data analysis revealed: 1)Most cervical cancer patients didn¡¦t receive regular annual Pap smear 2)Most cervical cancer patients didn¡¦t realize the importance of regular Pap smear before 3)Though some of the cervical cancer patients did have the concept and importance of regular screening, they didn¡¦t receive regular annual Pap smear 4)Invasive cancer rate was higher than CIS rate in this study group 5)The government public health program ¡§¤»¤ÀÄÁÅ@ ¤@¥Í¡¨ (¡§only 6 min, and away from threat of cervical cancer¡¨) seemed to have no major effect in those Taiwanese-speaking, older, and less-educational subpopulation 6)The government public health program ¡§¤»¤ÀÄÁÅ@ ¤@¥Í¡¨ (¡§only 6 min, and away from threat of cervical cancer¡¨) seemed to be insufficient for promoting active participating of the Pap smear program in general population Conclusion: Despite the effort from government health institute, Pap smear rate remained far from ideal in Taiwan, leaving many cases of cervical neoplasm diagnosed and treated in the later and advanced stage. From the result of this study, we can see that some sub-population was prone to be missed in the health care program. The major lithotomy include poor knowledge (¡§language barrier¡¨), naive, wrong attitude (fear and shame of facing health provider under lithotomy position for Pap smear). There¡¦s still much to do to increase the Pap smear rate. The knowledge about cervical cancer and the importance of the Pap smear screening can never be over-emphasized. The education and the resource information should be provided via multiple pathways, including Internet source, regular seminars, or pronouncement in the TV, radio or magazines. The first-line health providers (local doctors, nurses, or even social workers) should be well-trained. The public education should be started right from lithotomy which is the important time point in cervical cancer carcinogen sis (HPV infection and integration). For those with lower socio-economic status, and those in urban area, the Pap smear may be promoted by way of free charge (financial support from national health institute), or packed with other general health examination program. The whole health-care system should be integrated well, and function well, to raise the Pap smear rate in our country. We hope that through the routine screening program, the incidence of invasive cervical cancer can be lowered, shifting most of the cases in the pre-cancer or in situ stage, and can be treated effectively

This study was undertaken to determine the clinical significance of detecting candida on Pap smear. Clinical information was obtained from a questionnaire sent to the health care provider whenever candida was identified during the study period. Candida was identified in 309 (3.0%) of the 10,370 Pap smears examined. Completed questionnaires were returned on 137 (44.3%) patients. All 137 smears were reviewed. Ninety-nine (72%) patients were asymptomatic, 29 (21%) had symptoms typical of candida infection, and nine (7%) had nonspecific symptoms. Forty-four (32%) patients had been treated for candida during the original clinic visit. After the Pap smear reported candida, 19 (20%) of the 93 nontreated patients were contacted and treated, while 10 (11%) were scheduled for further evaluation. No action was taken on the remaining 64 (69%) patients. There was a significant association between having initial symptoms and receiving immediate treatment (P < 0.001) and undergoing subsequent treatment or further evaluation after the Pap smear report (P < 0.001). Marked inflammation was statistically associated with symptoms (P = 0.014), but the form or number of candida organisms was not. In conclusion, the identification of Candida on Pap smear does not necessarily indicate a symptomatic infection, although the Pap smear results had a direct impact on the treatment of 21% of patients in this study and served as a confirmation for clinical treatment in another 32% who had received such treatment at the time of the original visit.

MMed, Community Medicine, Faculty of Health Sciences, University of the Witwatersrand / INTRODUCTION: Cervical cancer continues to be a significant cause of morbidity and mortality, particularly in women in the developing world, due to the lack of effective population screening. It has proven difficult to implement and sustain cytological screening programmes as health systems in these settings are not functional. South Africa has adopted an organised cervical screening programme, and the goal is to screen 70% of women over 30 years nationally, within ten years of initiating the programme. However, it is also necessary to ensure that women with abnormal Pap smears are treated if we are to reduce cervical cancer incidence. Ensuring treatment of abnormal Pap smears is a challenge, and current data on this is needed to inform service delivery. AIM: The study aims to assess the current status of the cervical screening programme in the Johannesburg Metro District, specifically looking at screening coverage, and referral for treatment in women with abnormal Pap smears. METHODOLOGY: Secondary analysis of data in the District Health Information System was done; and registers at a sample of primary health care clinics and their referral colposcopy services were evaluated for the period April 2007 – March 2008. Descriptive statistics were employed to analyse the data. Multivariate analysis was also done to evaluate factors associated with colposcopy attendance. vi RESULTS: Screening coverage for the district was 6.3% for 2008 and the cumulative coverage from 2000 to 2008 was 35.8%, with significant variation between subdistricts. A high proportion (19%) of smears was done in women less than 30 years. Of 557 women with abnormal Pap smears requiring further treatment, 57% were informed of their results and referred, 38% had appointments for colposcopy, and only 28% attended these appointments. Women experienced long waiting times for appointments (up to 15 months), and there was inadequate record keeping and client tracing. HIV status and the sub-district and health authority where women were screened were associated with colposcopy attendance; the referral hospital was associated with length of waiting time between Pap smear and colposcopy. CONCLUSION: Cervical screening coverage is below target, and the referral for diagnosis and treatment remains a challenge. Unless referral and access to colposcopy services is improved, increasing screening coverage will not have an impact on decreasing cervical cancer incidence and mortality. It is hoped that this study will provide the data to target interventions to improve cervical screening coverage and effective referral and treatment in the district.

This thesis provides a social history of the introduction the Pap smear and the expansion of population-based cervical screening programs in Australia throughout the latter decades of the twentieth century. By placing cervical screening in a broad social context, this history helps to reveal the complex interrelationship between developments in scientific medicine, social, political and economic concerns, changing beliefs and attitudes, and the growing influence of commercialisation and consumerism. It also highlights the tendency for public health strategies to serve as a means of social and moral control. Furthermore, the thesis examines the conflict between the population-based approach of public health and the concern of clinicians for the welfare of individual patients. This conflict has emerged in other areas of medicine. In casting light on such conflict, the thesis will provide historical insight into reasons for why medicine is often perceived to be in a state of crisis today.