Evaluation of biomarkers for treatment selection using individual participant data from multiple clinical trials

Biomarkers that predict treatment effects may be used to guide treatment decisions, thus improving patient outcomes. A meta‐analysis of individual participant data (IPD) is potentially more powerful than a single‐study data analysis in evaluating markers for treatment selection. Our study was motivated by the IPD that were collected from 2 randomized controlled trials of hypertension and preeclampsia among pregnant women to evaluate the effect of labor induction over expectant management of the pregnancy in preventing progression to severe maternal disease. The existing literature on statistical methods for biomarker evaluation in IPD meta‐analysis have evaluated a marker's performance in terms of its ability to predict risk of disease outcome, which do not directly apply to the treatment selection problem. In this study, we propose a statistical framework for evaluating a marker for treatment selection given IPD from a small number of individual clinical trials. We derive marker‐based treatment rules by minimizing the average expected outcome across studies. The application of the proposed methods to the IPD from 2 studies in women with hypertension in pregnancy is presented.     

Validation of the Sexual Inhibition and Sexual Excitation Scales (SIS/SES) in Portugal: Assessing Gender Differences and Predictors of Sexual Functioning

The Sexual Inhibition and Sexual Excitation Scales (SIS/SES) were developed to assess individual propensities for sexual excitation and sexual inhibition in men and women. The objective of the present study was to validate the Portuguese version of the SIS/SES and to investigate the degree to which SIS/SES scores predict different dimensions of Portuguese men’s and women’s sexual functioning. Gender differences were also examined. A community sample of 370 Portuguese men and 373 women completed self-report measures of sexual function (IIEF, Rosen et al., 1997; FSFI, Rosen et al., 2000) and of the propensity for sexual inhibition and sexual excitation (SIS/SES, Janssen et al., 2002a). Exploratory factor analysis revealed a three-factor solution further supported by confirmatory factor analysis. The three factors identified resemble the original ones, and reliability analyses indicated they have both satisfactory internal consistency and stability over time. Age and Sexual Inhibition Due to the Threat of Performance Failure (SIS1) were both significant negative predictors of men’s sexual desire, erectile function, and orgasm. Sexual Excitation (SES) was a positive predictor of sexual desire in both men and women and of men’s erectile function and of women’s lubrication and orgasm. Age was also a significant and negative predictor of women’s sexual desire. Significant gender differences were found for all three SIS/SES scales with men having significantly higher excitation and lower inhibition scores as compared to women. The Portuguese version of the SIS/SES was shown to be suitable for use within the Portuguese population in both clinical and basic research. Our findings provide further cross-cultural validation of the Dual Control Model of Sexual Response and underscore the importance of the role of excitatory and inhibitory processes in women’s and men’s sexual functioning and response.     

Acute Toxicity of Ammonia,Nitrite and Nitrate to Shrimp <Emphasis Type="Italic">Litopenaeus vannamei</Emphasis> Postlarvae in Low-Salinity Water

Shrimp farming in low salinities waters is an alternative to increasing production, and counteracting disease problems in brackish and marine waters. However, in low-salinity waters, toxicity of nitrogen compounds increases, and there is no available data of its acute toxicity in shrimp postlarvae. This study determined the acute toxicity of ammonia, nitrite and nitrate in Litopenaeus vannamei postlarvae in 1 and 3 g/L salinity, as well as the safety levels. The LC₅₀ confirms that nitrite is more toxic than ammonia and nitrate in low salinity waters, and that its toxicity increases with a decrease in salinity. The safe levels estimated for salinities of 1 and 3 g/L were 0.54 and 0.81 mg/L for total ammonia–N, 0.17 and 0.25 mg/L for NO₂–N, and 5.6 and 21.5 mg/L for NO₃–N, respectively.     

Prediction of caries activity in children with today''s low caries incidence

One hundred 14-yr-old children were observed over 1 yr to find out if caries incidence and caries progression could be predicted in a low prevalence child population by means of well-known caries related factors. The mean caries incidence was low (0.45, SD 0.70) but, on the other hand, 32% of the children developed at least one new lesion during the test period. In only eight out of 35 children progressing lesions were demonstrated. Independent variables at baseline examination were caries prevalence, sucrose intake, fluoride exposure, oral hygiene, saliva secretion rate, and salivary concentrations of mutans streptococci and lactobacilli. A weak but statistically significant correlation was demonstrated between caries incidence and caries prevalence. No other significant correlations were shown. It was concluded that caries activity could not be predicted in this population. Low disease prevalence was a major reason for the weak correlations.     

Caries reductions related to the use of fluorides: a retrospective cohort study

AIM: To test whether topical fluoride regimes provided additional caries protection to the first molar teeth of children exposed to fluoridated toothpaste and optimally fluoridated water supplies. PARTICIPANTS AND METHODS: This two-year retrospective cohort study included 660, 8-year-old-children. A cluster sampling technique was used to select three groups of 220 children. Group 1 was selected from schools using fluoride mouthrinses (Programme 1). Group 2 was selected from schools applying fluoride gel (APF 1.23%) in addition to the weekly fluoride mouthrinse (Programme 2). Oral health education and oral hygiene instruction were provided to both groups. The control group was selected from schools in the same area that had not adopted any oral health preventive programme. All children were exposed to optimally fluoridated water and fluoridated toothpaste for the last two years or more. Participants were examined for DMFS scores of their first molars using WHO criteria by one examiner (MLRS). RESULTS: The percentage caries free children in Control, Programme 1 and Programme 2 were 55%, 65% and 65.5%, respectively. The differences between Programme 1 and 2 in relation to the Control Group were statistically significant (P < 0.05). There was no difference between Programme 1 and 2 (P = 0.92). CONCLUSIONS: Weekly fluoride rinsing combined whether or not with fluoride gel applications once every three months, provided additional caries-preventive benefits to children with high levels of caries and exposed to optimally fluoridated drinking water and toothpaste. There was no difference in caries levels between children having fluoride rinses and those having fluoride rinses and fluoride gel.     

Periodontal and oral microbiological status of an adult population undergoing haemodialysis: a cross-sectional study

OBJECTIVES: The aim of this cross-sectional study was to evaluate the periodontal status and oral microbiological patterns of a population with end-stage renal disease (ESRD), undergoing haemodialysis (HD). DESIGN: This was a cross-sectional study, involving 52 patients from the Nephrology Department and 52 matched control subjects. MATERIALS AND METHODS: The subjects had a periodontal clinical examination; subgingival plaque samples were taken and analysed using a semiquantitative polymerase chain reaction (PCR) test to detect Porphyromas gingivalis, Tannerella forsythia, Prevotella intermedia, Prevotella nigrescens and Actinobacillus actinomycetemcomitans. Subgingival plaque and saliva samples were studied for Candida and Enterobacteriaceae. MAIN OUTCOME MEASURES: Most of the 104 subjects had some degree of loss of periodontal attachment (LPA) > or =3 mm [11 (10.5%) had severe LPA; 16 (15.4%) moderate LPA; and 64 (61.5%) mild LPA]. Only 13 subjects (12.5%) presented good periodontal health. Results: No statistically significant differences were found between the HD patients and the control group regarding bleeding index, number of teeth, or percentage of LPA > or =3 mm. However, a statistically significant difference was seen in the degree of oral hygiene. CONCLUSIONS: On the basis of the findings presented here, we cannot associate ESRD with more severe periodontal destruction. Although HD patients presented a higher number of periodontopathic microorganisms than the matched controls, a prolonged duration of HD did not bear a statistically significant relationship with the percentage of sites with LPA > or =3 mm, specific microbiota or composition of biofilm.     

Descriptive epidemiological study of personal factors in relation to chronology of tooth eruption

We are made 730 inquirys about mothers to study the age in the teething begin to relationship with personal details. The issue shows a light relation in the advance teething with tall, weight, beginning the walking and female sex, and we have not shown relation with the nursing.     

Diagnostic & therapeutic strategies for the management of the diabetic patient

The bridge between oral and systemic health exists and becomes more concrete as data continue to emerge in support of this relationship. The medical management of diabetes is affected by the presence of chronic infections, such as periodontitis. This article reviews the pathogenesis of periodontal disease as it relates to diabetes. The author discusses patient susceptibility in terms of risk and recommends risk assessment to determine optimal treatment strategies. Patients with poorly controlled diabetes are at greater risk for developing periodontitis. The opportunity for systemic exposure to periodontal pathogens and proinflammatory mediators associated with periodontitis is discussed relative to their specific effects on patients with diabetes. The importance of good metabolic control in terms of risk for developing long-term complications of diabetes is presented and the impact of periodontitis on achieving adequate metabolic control is described. Special considerations for the management of patients with diabetes in the dental office are reviewed, including the signs and symptoms of diabetes, risk assessment for diabetes, and the challenges of "tight control" with insulin and oral agents with regards to hypoglycemia. It is recommended by the author that a thorough medical history of the patient be obtained, that the patient's medications are known, that the dentist consults with the patient's physician to assess the patient's glycemic control, and that the patient's blood glucose levels and dietary intake be monitored before treatment. Finally, the author reviews the long-term complications of diabetes, particularly the oral complications that can affect overall health. The author concludes with the belief that the treatment of periodontal diseases should not be considered optional or elective but, instead, should be a necessary and integral part of a patient's overall healthcare program.