To evaluate the influence and effectiveness of the salivary decontamination protocol after polymerization of a universal adhesive on dentin adhesive strength, after 24 hours and 6 months of ageing. Methods: Fifty intact molars were sectioned in order to obtain two slices of dentin from each tooth. In all specimens except the control group (C-no contamination), after applying and light-curing the adhesive system (Scotchbond Universal), the adhesion surface was contaminated with human saliva, and was then subjected to a decontamination method that differed between groups (W-decontamination with water; W+A-decontamination with water and reapplication of adhesive; E-decontamination with ethanol; E+A-decontamination with ethanol and reapplication of adhesive). Shear bond strength was tested at 24 hours and 6 months of aging, until fracture, and the failure mode was observed. Data were statistically analyzed using non-parametric Mann-Whitney and Kruskal-Wallis tests (α=0.05). Results: At 24 hours of aging, the decontaminant (p=0.289) and the reapplication of the adhesive (p=0.072) did not influence the adhesive strength values, and all contaminated groups obtained significantly (p<0.05) lower adhesive strength values than the control group. At 6 months, the reapplication of the adhesive (W+A and E+A) provided increased adhesion values (p=0.001), but no differences were observed between the decontaminants (p=0.314). Only the W+A group yielded a statistically (p=0.376) similar value to the control group. Conclusion: When there is salivary contamination of the adhesion area after polymerization of the universal adhesive tested, water decontamination should be performed followed by a
Clinical case Female patient, 78 years-old, that complained of epigastric pain and intense fatigue for a week. While waiting in the urgency department, she became hypotensive, with refractory shock. Electrocardiogram showed sinus rhythm, 90 bpm, de novo right bundle block and infraST in the right precordial leads. The echocardiogram showed a dilated right ventricle (ratio RV/LV > 1), with depressed function and major tricuspid regurgitation, RV/RA gradient of at least 55 mmHg. Left ventricle presented “D-shape”, preserved function and no segmental kinetic changes. The pulmonary artery was dilated and a serpentiform mass was visible, protruding through the pulmonary valve; similar masses were also visible in its branches. The diagnosis of pulmonary embolism (PE) was assumed and fibrinolysis was started, given there were no contra-indications. One year before, she had an intermediate-risk PE in the context of COVID-19, with a similar echocardiographic presentation. She recovered RV function in the following months and stopped anticoagulation 3 months after that episode. Discussion PE can present with varying degrees of severity. Bedside echocardiography can be of major help in its diagnosis, especially in critical patients. The visualization of a thrombus in the pulmonary artery is rare, particularly in transthoracic echocardiogram. Echocardiogram is also useful for risk stratification and prognostic evaluation. This patient developed obstructive shock due to massive PE and the fibrinolytic treatment was paramount for her survival. A good echocardiogram helped in the differential diagnosis and enabled the Cardiologist to assist the patient in the best way.
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