Impact of enterovirus and other enteric pathogens on oral polio and rotavirus vaccine performance in Bangladeshi infants

BackgroundOral polio vaccine (OPV) and rotavirus vaccine (RV) exhibit poorer performance in low-income settings compared to high-income settings. Prior studies have suggested an inhibitory effect of concurrent non-polio enterovirus (NPEV) infection, but the impact of other enteric infections has not been comprehensively evaluated.MethodsIn urban Bangladesh, we tested stools for a broad range of enteric viruses, bacteria, parasites, and fungi by quantitative PCR from infants at weeks 6 and 10 of life, coincident with the first OPV and RV administration respectively, and examined the association between enteropathogen quantity and subsequent OPV serum neutralizing titers, serum rotavirus IgA, and rotavirus diarrhea.ResultsCampylobacter and enterovirus (EV) quantity at the time of administration of the first dose of OPV was associated with lower OPV1-2 serum neutralizing titers, while enterovirus quantity was also associated with diminished rotavirus IgA (−0.08 change in log titer per tenfold increase in quantity; P = 0.037), failure to seroconvert (OR 0.78, 95% CI: 0.64–0.96; P = 0.022), and breakthrough rotavirus diarrhea (OR 1.34, 95% CI: 1.05–1.71; P = 0.020) after adjusting for potential confounders. These associations were not observed for Sabin strain poliovirus quantity.ConclusionIn this broad survey of enteropathogens and oral vaccine performance we find a particular association between EV carriage, particularly NPEV, and OPV immunogenicity and RV protection. Strategies to reduce EV infections may improve oral vaccine responses.ClinicalTrials.gov Identifier: NCT01375647.     

Molecular characterization of a clinical Haemophilus parainfluenzae isolate with cefotaxime resistance and decreased susceptibility to fluoroquinolones

We report an H. parainfluenzae clinical isolate resistant to cefotaxime and with decreased susceptibility to ciprofloxacin recovered from a patient with cystic fibrosis. The isolate had elevated MICs of ampicillin (256 mg/L), amoxicillin-clavulanate (8 mg/L), cefuroxime (8 mg/L) and cefotaxime (4 mg/L), and showed a β-lactamase-producing amoxicillin-clavulanic acid-resistant (BLPACR) phenotype. A bla_TEM-1 plus five amino acid substitutions in the PBP3 were found: Ser385Thr, Val511Ala, Ile519Val, Asn526Lys and Asp551Leu. MIC of ciprofloxacin was 0.5 mg/L, and substitutions in gyrA (Ser84Tyr) and parC (Ser84Phe) genes were detected.     

Stratification by demographic and clinical data of the antibiotic susceptibility of Escherichia coli from urinary tract infections of the community

AimTo determine the patterns of antibiotic susceptibility of Escherichia coli strains isolated from adult patients with urinary tract infection (UTI), and to stratify the results by age and type of UTI to verify if there are statistically significant differences that can help physicians to prescribe better empirical antibiotherapy.DesignCross-sectional prospective study.LocationCommunity of Getafe (Madrid). Primary care level.Participants100 E. coli strains, randomly chosen, isolated from the urine (10⁴–10⁵ cfu/ml) of different patients from primary care centers in the Getafe area.Main measurementsThe antibiotic susceptibility of the strains was evaluated and the results were stratified by age and type of UTI. The clinical and demographic data of the patients were analyzed, classifying each episode as complicated UTI or uncomplicated UTI.ResultsStrains isolated from patients with uncomplicated UTI showed significantly greater susceptibility than those of complicated UTI to amoxicillin (65.9% vs. 30.6%, p = 0.001), amoxicillin/clavulanic acid (95.5% vs. 77.6%, p = 0.013) and ciprofloxacin (81.8% vs. 63.3%, p = 0.047). In complicated UTI, susceptibility to ciprofloxacin was significantly greater in the ≤65 years age group compared to the older age group (78.3% vs. 50%, respectively, p = 0.041). In the rest of antibiotics, no statistically significant differences were obtained when comparing by age (≤65 years versus >65 years), both in uncomplicated and complicated UTI.ConclusionsClinical and demographic data of patients with UTI are of great importance in the results of the antibiotic susceptibility in E. coli. Antibiograms stratified by patient characteristics may better facilitate empirical antibiotic selection for UTI in primary care.     

Nutritional counseling improves quality of life and nutrient intake in hospitalized undernourished patients

ObjectiveUp to 60% of hospitalized patients are undernourished. We studied the impact of nutritional therapy on quality of life and food intake.MethodsUndernourished patients were randomized into two groups. The nutritional therapy group (NT group) received individual nutritional counseling and interventions, including oral nutritional supplements if appropriate, by a dietitian. The oral nutritional supplement group (ONS group) received oral nutritional supplements in addition to hospital meals without further instruction or counseling. Study duration was 10 to 15 d. At baseline and before discharge (time point 1) we measured energy and protein intakes and quality of life. Quality of life was measured again 2 mo after discharge (time point 2).ResultsEnergy and protein intakes increased between baseline and time point 1 in both groups (P = 0.001). The NT group (n = 18) met the energy requirements at time point 1 by 107% and of protein by 94%, the ONS group (n = 18) by 90% and 88%, respectively. Hospital meals alone did not cover the requirements. From baseline to time point 1, quality of life increased in both groups. Quality of life increased further in the NT group from time point 1 to time point 2 (P = 0.016), but not in the ONS group.ConclusionBoth interventions caused a significant increase in energy and protein intakes and quality of life. In the NT group every patient received an efficacious individualized intervention. In contrast, the 7 of 18 patients in the ONS group who did not consume ONS had no intervention at all. Therefore, undernourished patients should be counseled individually by a dietitian.     

Inercia terapéutica en pacientes hipertensos asistidos en atención primaria en España. Estudio Objetivo Kontrol

ObjectivesTo determine the level of therapeutic inertia (TI), and the factors associated to the patient, doctor and the health organisation, in hypertensive patients treated in Primary Care (PC).DesignCross-sectional, multicentre study.SettingA sample of PC Teams from all over Spain.ParticipantsThe study was conducted among PC doctors using a questionnaire and clinical records of 4 patients.Main measurementsThe TI was calculated for each patient (TIp) as the proportion of visits in which there was no change in medication when this was indicated.ResultsA total of 543 PC doctors provided data on 2,032 patients, who fulfilled the indication of a change in requirement. There was TI In 77.8% of cases. The TIp observed was non-existent or low for 17.1% of the patients, intermediate for 42% and high for 40.8%. For the patients, the factors most associated with TIp were, age (P < .001), diabetes (P < .001), stroke (P < .01), obesity (P < .01) and a low education level (P < .001). To be female, be less than 40 years or more than 55 years, to be a family doctor with a training program other than MIR and to work in the public sector increased the probability of TIp (P < .001 for all the assumptions).ConclusionsThe results of the study indicate that there is TI in 7 out every 10 visits made by hypertensive patients in Primary care. There are significant differences as regards the clinical characteristics of the patients and of the doctors.     

Vitamin B12 supplementation orally and intramuscularly in people with obesity undergoing gastric bypass

PurposeAlthough bariatric surgery can facilitate weight loss and improve many diseases, it impairs the absorption of many vitamins and micronutrients. Vitamin B12 is important for these patients and should be controlled and supplemented postoperatively. The aim of this paper is to compare serum vitamin B12 levels in two forms of supplementation (oral vs. intramuscular) for 6 months after gastric bypass.MethodsIn a prospective controlled cohort study, people with obesity patients undergoing gastric bypass received vitamin B12 supplementation either orally or intramuscularly. The patients were followed for 6 months, receiving serial doses of vitamin B12 and methylmalonic acid assessment at 6 months.ResultsA total of 53 patients were divided into two homogeneous groups: an oral group (n = 24) and an intramuscular group (n = 29). Serum vitamin B12 was measured preoperatively and postoperatively at 1, 2, 3, and 6 months. Serum methylmalonic acid was measured at 6 months. At each point, the serum vitamin B12 level remained within reference values in both groups, although it was higher in the oral group (p < 0.001). Methylmalonic acid also remained within reference values in both groups, with no significant differences.ConclusionDespite the anatomical and functional alterations that impair vitamin B12 absorption after gastric bypass, oral vitamin B12 supplementation was as effective as intramuscular in this population.     

Subcutaneous teicoplanin in staphylococcal bone and joint infections

ObjectiveWe aimed to describe the use of subcutaneous teicoplanin as an alternative for the treatment of staphylococcal bone and joint infections.MethodsA retrospective multicentric cohort (2002–2015) was conducted with patients receiving subcutaneous teicoplanin for a staphylococcal bone and joint infection.ResultsForty patients were assessed. A median loading dose of 9.4 mg/kg/12 h (IQR, 6.1–13.1) was administered to 35 patients, subcutaneously for 18 of them. Thirteen of these patients received three injections per week. No excess risk of failure was identified. The trough level was not significantly different between the various routes (p = 0.462), and was significantly higher if the loading dose was ≥ 9 mg/kg/injection (p < 10⁻³).ConclusionThe use of subcutaneous teicoplanin seems to be acceptable as an alternative to other routes of administration for antibiotics.     

The medication discrepancy detection service: A cost-effective multidisciplinary clinical approach

ObjectiveTo estimate the effectiveness of a Medication Discrepancy Detection Service (MDDS), a collaborative service between the community pharmacy and Primary Care.DesignNon-controlled before-and-after study.SettingBidasoa Integrated Healthcare Organisation, Gipuzkoa, Spain.ParticipantsThe service was provided by a multidisciplinary group of community pharmacists (CPs), general practitioners (GPs), and primary care pharmacists, to patients with discrepancies between their active medical charts and medicines that they were actually taking.OutcomesThe primary outcomes were the number of medicines, the type of discrepancy, and GPs’ decisions. Secondary outcomes were time spent by CPs, emergency department (ED) visits, hospital admissions, and costs.ResultsThe MDDS was provided to 143 patients, and GPs resolved discrepancies for 126 patients. CPs identified 259 discrepancies, among which the main one was patients not taking medicines listed on their active medical charts (66.7%, n = 152). The main GPs’ decision was to withdraw the treatment (54.8%, n = 125), which meant that the number of medicines per patient was reduced by 0.92 (9.12 ± 3.82 vs. 8.20 ± 3.81; p < .0001). The number of ED visits and hospital admissions per patient were reduced by 0.10 (0.61 ± .13 vs 0.52 ± 0.91; p = .405 and 0.17 (0.33 ± 0.66 vs. 0.16 ± 0.42; p = .007), respectively. The cost per patient was reduced by €444.9 (€1003.3 ± 2165.3 vs. €558.4 ± 1273.0; p = .018).ConclusionThe MDDS resulted in a reduction in the number of medicines per patients and number of hospital admissions, and the service was associated with affordable, cost-effective ratios.     

Varicella zoster virus infection of the central nervous system in a tertiary care center in Lebanon

ObjectiveTo describe the clinical manifestations and treatment outcomes of patients with VZV meningitis and encephalitis consulting at two medical centers in Lebanon.MethodsRetrospective study of patients with VZV meningitis and/or encephalitis confirmed by positive cerebrospinal fluid (CSF) VZV PCR.ResultsTwenty patients were identified (13 males). The average age was 49.7 ± 22.2 years. The most common complaint was headache (n = 17/20). Common comorbidities included hypertension (n = 7/20) and diabetes mellitus (n = 5/20). Immunosuppression was reported in two patients. Vesicles were only observed in eight patients. Altered mental status, focal neurological deficits, and fever were documented in six, two, and four patients respectively. All patients had CSF leukocytosis with lymphocytic predominance, normal CSF/serum glucose ratio, and high CSF protein. Eighteen patients had brain CT scans showing no relevant findings. Two of 12 patients with brain MRI had focal abnormalities. Unilateral temporal slow waves were observed in three of four patients who underwent electroencephalograms. Four patients had encephalitis and 16 had meningitis. Eighteen patients received an antiviral therapy. Treatment either included intravenous acyclovir or oral valacyclovir. The encephalitis and meningitis groups had comparable mean duration of treatment (13.5 ± 6.6 vs. 12.2 ± 5.4, respectively). All admitted patients showed clinical cure with no reported neurological sequelae.ConclusionVZV infection should be suspected in any patient with signs and symptoms of viral meningitis or encephalitis, irrespective of age, immune status, presence or absence of vesicles, fever, or neck stiffness.     

Mucoviscous characteristics of Klebsiella pneumoniae strains: A factor of clinical severity?

IntroductionHypermucoviscous Klebsiella pneumoniae (KP) strains are responsible for complicated bacteremia with multiple septic sites (liver, central nervous system, muscles). We aimed to compare the clinical severity of patients presenting with KP bacteremia based on the hypermucoviscous or non-hypermucoviscous characteristic of the strains.MethodsObservational retrospective study successively including all patients with KP bacteremia from May 2013 to March 2015 at the tertiary medical center of New Caledonia. The hypermucoviscous characteristic was defined by the string test results and molecular analysis to determine the capsular serotype.ResultsA total of 55 bacteremic patients were included in the study; 27% of isolated strains were hypermucoviscous. Hypermucoviscous strains accounted for two-thirds of community-acquired infections (72.5% vs. 33.4%, p = 0.01). The rate of intensive care hospitalization was high (hypermucoviscous 46.7%; standard 52.5%) without any difference between the two groups. No significant difference was observed in case fatality (hypermucoviscous 46.7% vs. standard 15%, p = 0.07) but patients with hypermucoviscous strains had longer hospital stays (73.5 days versus 50.7 days, p = 0.04) and longer persistence of positive blood cultures despite an appropriate treatment (OR 1.41, 95% CI: 1.0–1.96, p = 0.045).ConclusionHypermucoviscous KP bacteremia account for most community-acquired Klebsiella infections in New Caledonia and are associated with longer hospital stay and persistence of positive blood cultures despite the implementation of an appropriate treatment.     

Evaluation of pneumococcal urinary antigen testing for respiratory tract infection investigations

ObjectiveThe pneumococcal urinary antigen test enables rapid bacteriological diagnosis in respiratory tract infections. The objective was to identify factors associated with a positive pneumococcal urinary antigen test result.Patients and methodsThis seven-year retrospective monocentric study was performed on consecutive patients presenting with respiratory tract infections reported as pneumococcal-positive. Epidemiological, biological, and radiological factors were analyzed, and severity scores were calculated.ResultsA total of 223 patients were included. Significant associations were observed between positive test results and age over 65 years (P = 0.01), positive test results and immunosuppression factors (blood disease [25% Ag+ group vs. 4% Ag− group, P = 0.001], immunosuppressive therapy [10% Ag+ group vs. 0% Ag− group, P = 0.02]). Clinically, fever (64% Ag+ group vs. 42% Ag− group, P = 0.01) and cough (46% Ag+ group vs. 19% Ag− group, P < 0.01) were associated with a positive result, as were radiological alveolar opacities (67% Ag+ group vs. 44% Ag− group, P = 0.01). High PSI score was associated with the Ag+ group (79% vs. 56% Ag− group, P = 0.001).ConclusionAge, immunosuppressive factors, typical pneumococcal symptoms, and PSI scores were associated with a positive pneumococcal urinary antigen result.     

The effect of diarrheal disease on bivalent oral polio vaccine (bOPV) immune response in infants in Nepal

BackgroundA globally-coordinated phase out of all type 2 containing oral polio vaccine (OPV) is planned for April 2016 during which bivalent 1 + 3 OPV (bOPV) will replace trivalent OPV (tOPV) in routine immunization schedules and campaigns. Diarrhea impairs the immune response to tOPV, but the effect of diarrhea on bOPV is unknown.MethodsInfants aged 6 weeks to 11 months, who had received <3 doses of OPV and had mild-moderate diarrhea or no diarrhea, were recruited at five health facilities in Nepal. Neutralizing antibody titers to poliovirus types 1 and 3 were measured before and 28 days after bOPV administration. The effect of diarrhea and other factors on seroconversion or boosting in antibody titers to poliovirus was assessed by multivariable analysis.ResultsInfants with diarrhea, versus those without diarrhea, had reduced response for poliovirus types 1 (56% [87/156] vs 66% [109/164]) and 3 (34% [70/209] vs 52% [122/236]). After adjusting for other factors, infants with diarrhea had significantly reduced response for type 3 (odds ratio [OR] = 0.44, 95% CI 0.29–0.68), as did infants with >5 loose stools per day (OR = 0.36, 95% CI 0.21–0.62).ConclusionsDiarrhea reduced the immune response to bOPV. Provision of additional doses of polio vaccine is necessary to maintain high population immunity in areas with high prevalence of diarrheal disease.Clinical trial registryThis study is registered at clinicaltrials.gov as NCT01559636.     

Multiple and mixed Helicobacter pylori infections: Comparison of two epidemiological situations in Tunisia and France

Individuals can be infected by either a single or multiple strains of Helicobacter pylori. Multiple infection with genetically different isolates and particularly mixed infection with both antibiotic-susceptible and resistant isolates are difficult to detect and should impact the effectiveness of eradication treatment. It is largely assumed that multiple infections are more frequent in developing countries but an actual comparison developing/developed using a single methodology has never been reported. To compare the prevalence of multiple and mixed H. pylori infection in Tunisia and France, we conducted a prospective study including 42 H. pylori-culture positive infected patients (21 Tunisian and 21 French) never previously treated for H. pylori infection. One gastric biopsy was collected from antrum. Three to eleven (mean = 9) colonies were isolated from each biopsy. A total of 375 different isolates were genotyped using RAPD fingerprinting and antimicrobial susceptibility testing was performed on amoxicillin, clarithromycin, ciprofloxacin, rifampicin, tetracycline and metronidazole with E-tests. Multiple infection was defined by different RAPD fingerprintings among the different isolates from a single patient. Mixed infection was defined by different resistance profiles among the different isolates from a single patient. Multiple H. pylori infection is more prevalent in Tunisia than in France. It occurred in ten (48%) Tunisian patients and in one (5%) French patient (p < 0.001). Mixed infection is common (24%), it occurred in 4 (19%) Tunisian patients and in 6 (29%) French patients (p = 0.46) and was mainly (8/10) due to genetically related clones in single infection.     

The Pneumocell-study: Vaccination of IgG1- and IgG2-deficient patients with Prevnar13

BackgroundPatients with IgG-deficiency often suffer from repeated bacterial infections with S. pneumoniae. Since there is a lack of knowledge regarding whether IgG-deficient patients would benefit from conjugate pneumococcal vaccination, we set out to evaluate the effect of Prevnar13 vaccination in IgG₁- and/or IgG₂-deficient patients.MethodWe designed a small pilot-study including IgG₁- and/or IgG₂-deficient patients (n = 10) and age- and sex-matched healthy controls (n = 10). Serum, plasma and heparin-blood were collected prior to vaccination, as well as 1, 2 and 4 weeks post vaccination, and the levels of opsonophagocytic activity (Opa) titers and anti-pneumococcal IgG-antibodies were analyzed.ResultsPatients generally had lower Opa-titers than controls for most serotypes, but they exhibited an almost normal vaccine response to serotypes 6A and 6B. Notably, 5/10 patients showed vaccine-response to at least one serotype. Most patients reached the presumably protective levels of Opa-titers ≥8 and anti-pneumococcal IgG levels of 0.35 µg/ml by 4 weeks post-vaccination for a majority of the serotypes.ConclusionOur results show that vaccination of IgG-deficient patients with Prevnar13 is likely to have a clinical benefit. Our initial findings will provide a framework for future vaccine-trials in this vulnerable patient group.Registered at www.clinicaltrials.gov as NCT01847781.     

Evaluation of anorexia and analysis of related factors in patients with COVID-19

ObjectiveCOVID-19 may cause an anorexic situation. This in turn leads to underfeeding, puts the patient in an energy protein malnutrition state, develops the hyperinflammation, weakens the immunity, and makes COVID-19 conditions more dangerous. Meanwhile, the more severe inflammation conditions in the body, the more severe the anorexia, which in turn affect the disease severity. Studies evaluating appetite in COVID-19 patients are very rare; therefore, we evaluated anorexia and analyzed the related factors in patients with COVID-19.Material and methodsIn this cross sectional study, adult patients’ ≥18 years old with the positive real-time fluorescence polymerase chain reaction for COVID-19 were included. The patients were classified as mild, moderate, and severe based on the WHO classification. We measured the appetite score, weight, height, body mass index (BMI), depression and anxiety score, at admission for every patient.ResultsA total of 301 patients participated in the study. The prevalence of admission anorexia was 58%, and this rate was significantly more in the severe group compared to the mild and moderate groups (P < 0.001). Comorbidities, depression and anxiety were independently correlated with anorexia risk [(OR = 3.6, 95% CI 1.68–7.70, P = 0.001), (OR = 1.23, 95% CI 1.16–1.30, P < 0001), and (OR = 1.24, 95% CI 1.17–1.31, P < 0001)], respectively. This correlation was adherence to a U-shape association for BMI, which means BMI < 18.5 (OR = 3.35, 95% CI 1.8–10.42, P < 0001) and BMI ≥30 (OR = 2.45, 95% CI 1.02–6.53, P = 0.048) were related to higher risk of anorexia.ConclusionWe reported a high prevalence of anorexia (58%) in COVID-19 patients, which was positively correlated with disease severity. Furthermore, any factor worsening inflammatory state, including underweight, obesity, comorbidities, depression and anxiety can exacerbate anorexia in these patients.     

Cascade effects of laboratory testing are found to be rare in low disease probability situations: prospective cohort study

Objectives(1) To investigate the frequency of cascades of further diagnostic investigations and referrals after abnormal laboratory results in situations of low disease probability; (2) to investigate pretest and posttest determinants; and (3) to describe the cascades that occur.Study Design and SettingProspective cohort study in primary care in The Netherlands. Numbers of investigations/referrals were recorded during 6 months of follow-up for 256 patients with normal and abnormal laboratory results. The influences of the reason for ordering tests, interpretation of results, and pretest/posttest disease probability were examined.ResultsAfter receiving the laboratory results, the physicians ordered further investigations for 22 (17.3%) patients with abnormal results and for two (1.6%) patients with normal results (P < 0.001). They referred 12 (9.4%) patients with abnormal results and eight (6.2%) patients with normal results (P = 0.33). Six patients had two investigations and/or referrals, and one patient had three referrals. There were significantly more investigations/referrals for results interpreted as abnormal (P = 0.004) and for cases with a high posttest disease probability (P = 0.001).ConclusionThis study suggests that cascade processes after laboratory testing in situations of low disease probability are limited in magnitude and frequency. Improving interpretations may help improve the appropriateness of further investigations and referrals.     

Cryptosporidiosis and microsporidiosis as causes of diarrhea in kidney and/or pancreas transplant recipients

IntroductionGastrointestinal disorders in solid organ recipients may have various origins including cryptosporidiosis and microsporidiosis. The prevalence of these infections is poorly known in solid organ transplant (SOT) patients in industrialized countries.MethodsWe prospectively assessed the infectious causes of diarrhea in SOT patients. Secondary objectives were to gain further insight into the main characteristics of cryptosporidiosis, and to assess risk factors for this infection. All adult kidney and/or pancreas recipients presenting with diarrhea and admitted to our facility between May 1, 2014 and June 30, 2015 were enrolled. A stool sample was analyzed using a standardized protocol including bacteriological, virological, and parasitological investigations. Data related to clinical symptoms, immunosuppression, and environmental potential risk factors were collected through a self-administered questionnaire and computerized medical records.ResultsOut of 73 enrolled patients, 36 had infectious diarrhea (49.3%). Viruses ranked first (17/36), followed by parasites and fungi (11/17). Cryptosporidiosis was the most common parasitic disease (n = 6 patients). We observed four microsporidiosis cases. The estimated prevalence of cryptosporidiosis and microsporidiosis in this cohort was 3.7 and 2.4⁰/₀₀, respectively_. No significant risk factor for cryptosporidiosis or microsporidiosis, neither environmental nor immunological, could be evidenced.ConclusionBoth cryptosporidiosis and microsporidiosis represent a significant cause of diarrhea in kidney transplant recipients.     

Assessment of energy expenditure,physical activity and sleep pattern in patients with frequent symptomatic ventricular ectopic beats

BackgroundVentricular ectopic beats (VEBs) are considered as benign ventricular arrhythmias in patients without structural heart disease. However, symptomatic frequent VEBs can adversely affect energy metabolism. The present study aimed to determine the effect of symptomatic frequent VEBs on energy expenditure, physical activity and sleep pattern.MethodsThirty-seven patients with symptomatic frequent VEBs and no structural heart diseases were enrolled. Patients underwent simultaneous 24-hour-ambulatory Holter electrocardiogram monitoring and the BodyMedia armband device monitoring which measures energy expenditure. Data acquired from both devices were compared with the data acquired from healthy volunteers in the control group.ResultsTotal energy expenditure (TEE) was higher in the patient group than the control group (1470 ± 353 kcal vs 1125 ± 275 kcal, P < 0.001). Average metabolic equivalence (aMETs) (1.1 ± 0.2 vs. 1.3 ± 0.2, P = 0.028), physical activity duration (PAD) (0.35 vs. 0.48, P = 0.007) and sleep duration (SDN) (3.15 vs. 4.31, P = 0.004) were significantly lower in the patient group than control group. VEBs frequency was inversely correlated with only SDN (r = −0.374, P = 0.027).ConclusionTotal energy expenditure (TEE) is increased in patients with symptomatic frequent VEBs in comparison with healthy subjects while PAD, average metabolic equivalence (aMETs) and SDN are decreased. VEBs frequency was inversely correlated with SDN.     

Important oral care needs of older French people: A cross-sectional study

BackgroundOlder persons comprise a growing proportion of the European population and may have a distinct epidemiological oral profile requiring specific preventive and curative care poorly documented. The objectives of this study were to assess the oral health status of people ≥ 90 years of age in France, to compare their perceived and observed oral care needs and to investigate the oral problems associated with a low oral health-related quality-of-life (OHRQoL).MethodsAn oral cross-sectional study was performed during the 25th follow-up of a cohort of older persons being followed up prospectively for screening of dementia over a 15-year period in Gironde and Dordogne, France. Clinical oral indices were determined by oral examinations conducted at the participants’ place of living. Cohen's Kappa coefficient was used to assess the agreement between perceived and observed oral care needs. Oral problems associated with a low OHRQoL, measured with the Geriatric Oral Health Assessment Index (GOHAI < 50) were investigated with logistic regression. Odds ratios (OR) were estimated with their 95% confidence intervals (CI).ResultsData from 90 persons were analysed (76% female; median age = 93 years; 20% living in an institution). Plaque and calculus were present in 93% and 58% respectively, of the 74 dentate participants. The mean number of decayed, missing, and filled teeth was 26.5 (± 5.3); 66% of the participants had at least one untreated decayed tooth. Among the 85 participants with tooth loss not replaced by a fixed denture, two thirds had a removable dental prosthesis; 84% of these prostheses were considered to be maladapted. Among the 39 participants who felt unable to consult a dentist (43%), lack of transportation was the most frequently cited reason. Although 88% of the participants needed oral care, only 26% perceived that they had such a need (Kappa = 0.06). Oral problems associated with a GOHAI < 50 were the absence of posterior occluding teeth (OR = 7.15; 95%CI = 1.53–33.35; P = 0.012), feeling of dry mouth (OR = 11.94; 95%CI = 3.21–44.39; P = 0.0002) and oral pain (OR = 9.06; 95%CI = 1.91–69.00; P = 0.033).ConclusionsPersons ≥ 90 years of age have considerable preventive and curative dental care needs that impact their quality-of-life but they are rarely aware and lack transportation. NCT04065828.