Exposure to animals and risk of oligoarticular juvenile idiopathic arthritis: a multicenter case-control study

Background  

An inverse association between early contact with microbial compounds and respiratory allergies is well established. The protective effect of infant contact with animals was also shown for inflammatory bowel disease (IBD) and systemic lupus erythematosus (SLE). We aimed to test the association between animal contact in infancy and oligoarticular juvenile idiopathic arthritis (OA JIA).     

Impact of oral health status on oral health-related quality of life in Chinese hospitalised geriatric patients

Objectives To examine the oral health status of Chinese hospitalised geriatric patients and identify its impacts on their oral health-related quality of life (OHRQoL). Design Cross-sectional correlational study. Setting Geriatric wards of a regional hospital in Hong Kong. Subjects A consecutive sample of Chinese hospitalised geriatric patients (N = 155) aged ≥ 65 years who were communicable. Measurements The Brief Oral Health Status Examination (BOHSE) was used to evaluate oral status. The General Oral Health Assessment Index (GOHAI) was used to assess OHRQoL. Results The oral health status of the Chinese hospitalised geriatric patients was fair, with the more prominent problems being decayed teeth, lack of occluded teeth, coated tongue, excessive tartar, dry and rough red oral tissue and diseased gum. The GOHAI score indicated their compromised OHRQoL. By using hierarchical regression analysis, fewer than eight pairs of occluding teeth (β = −0.33, P < 0.001), unhealthy gum (β = −0.26, P = 0.03) and perceived oral dryness (β = −0.18, P = 0.04) significantly accounted for 17% of variance in the OHRQoL of Chinese hospitalised geriatric patients. Conclusion This study suggests that routine screening for dental and gum problems, providing adequate adaptation of denture prosthesis and reducing oral dryness of geriatric patients may be important care to optimise the OHRQoL of Chinese hospitalised geriatric patients. The study needs to be replicated in larger-scale multicentre settings and incorporate the use of more-comprehensive oral assessment indices.     

Identifying depression in epilepsy in a busy clinical setting is enhanced with systematic screening

PurposeDepression is a highly prevalent, relatively underdiagnosed and undertreated comorbid condition in epilepsy. The purpose of this study was to determine the effect of using a validated self-reporting depression scale on the ability to detect depression in people with epilepsy receiving care in a busy clinical setting.MethodsThe Neurological Disorders Depression Inventory for Epilepsy (NDDI-E) is a 6-item questionnaire validated to screen for depression in people with epilepsy. We performed a retrospective chart review of 192 consecutive patients who had completed the NDDI-E while receiving care at a seizure clinic in the largest public hospital in Houston, Texas. For comparison, charts of 192 consecutive patients receiving care immediately prior to the implementation of the NDDI-E in the same clinic were assessed.ResultsFifty-five (28.6%) of patients screened positive for depression with the NDDI-E. They subsequently received a semi-structured psychiatric interview based on the DSM-IV model and 89% (n = 49) were confirmed to have major depression. Use of the NDDI-E thus resulted in the detection of active depression in 25.5% (n = 49) of the patients, whereas only 2.6% (n = 5) of patients in the group not systematically screened were found to have active depression (p < 0.0001). Thirty-two of the 49 (65%) patients with depression detected by screening were not previously diagnosed or treated. Multivariate analysis revealed that a history of depression, seizure frequency, and topiramate use were independent predictors of depression. Lamotrigine use was protective against depression.DiscussionUse of the NDDI-E significantly improved the ability to detect depression in epilepsy patients in a busy clinical practice.     

Auditory ganglion source of Sonic hedgehog regulates timing of cell cycle exit and differentiation of mammalian cochlear hair cells

Neural precursor cells of the central nervous system undergo successive temporal waves of terminal division, each of which is soon followed by the onset of cell differentiation. The organ of Corti in the mammalian cochlea develops differently, such that precursors at the apex are the first to exit from the cell cycle but the last to begin differentiating as mechanosensory hair cells. Using a tissue-specific knockout approach in mice, we show that this unique temporal pattern of sensory cell development requires that the adjacent auditory (spiral) ganglion serve as a source of the signaling molecule Sonic hedgehog (Shh). In the absence of this signaling, the cochlear duct is shortened, sensory hair cell precursors exit from the cell cycle prematurely, and hair cell differentiation closely follows cell cycle exit in a similar apical-to-basal direction. The dynamic relationship between the restriction of Shh expression in the developing spiral ganglion and its proximity to regions of the growing cochlear duct dictates the timing of terminal mitosis of hair cell precursors and their subsequent differentiation.     

Elevated asymmetric dimethylarginine (ADMA) and inverse correlation between circulating ADMA and glomerular filtration rate in children with sporadic focal segmental glomerulosclerosis (FSGS)

Background. Steroid-resistant nephrotic syndromes (NS) withfocal and segmental glomerulosclerosis (FSGS) can be differentiatedinto sporadic and syndromic forms. In sporadic NS, a circulatingFSGS-factor is discussed in the pathogenesis and is thoughtto inhibit the synthesis of nitric oxide (NO) from L-arginineby blocking the NO synthase (NOS). Asymmetric dimethylarginine(ADMA) is an endogenous inhibitor of all types of NOS. In aprevious study we did not find an elevation of ADMA in a syndromicform of FSGS, the Schimke-immuno-osseous dysplasia. Here wereport for the first time data on the L-arginine/NO pathwayin sporadic FSGS of childhood. Methods. Nine children (5 to 18 years of age) suffering fromsporadic FSGS and age-matched healthy controls were investigated.ADMA in plasma and urine as well as L-arginine in plasma weredetermined by gas chromatography–tandem mass spectrometry.The NO metabolites nitrate and nitrite were measured in plasmaand urine by gas chromatography–mass spectrometry (GC-MS).The ADMA metabolite dimethylamine (DMA) was measured in urineby GC-MS. Results. We found elevated plasma levels of ADMA in childrensuffering from sporadic FSGS compared to healthy controls (851nmol/L versus 684 nmol/L, P = 0.008). An inverse correlationbetween ADMA and glomerular filtration rate (GFR) was foundin sporadic FSGS (Pearson's correlation coefficient –0.784,P = 0.012). Conclusion. Our study suggests that ADMA synthesis is elevatedin sporadic FSGS. This finding argues for the involvement ofADMA in the pathogenesis of this disease in childhood.     

Postoperative analgesia is not different after local vs systemic administration of meloxicam in patients undergoing inguinal hernia repair

PURPOSE: To distinguish between local and systemic drug effects, we compared pain scores, analgesic consumption and plasma concentrations after local vs i.v. administration of meloxicam 7.5 mg in patients with inguinal hernia repair. METHODS: In a double-blind, randomized study 56 patients received either local or i.v. meloxicam 7.5 mg. Postoperative pain was assessed with a visual analogue scale (VAS) at rest, on mobilization, and on coughing, the need for supplementary analgesics (fentanyl i.v. and/or acetaminophen-codeine tablets) was recorded, and blood samples were drawn during 24 hr after meloxicam administration. RESULTS: No significant differences were found between groups with respect to pain scores, or in the consumption of supplementary analgesics. Following local application of meloxicam, the peak plasma concentration (C(max)) of 0.5 +/- 0.2 mg*L(-1) achieved after 1.8 +/- 0.5 hr was much lower than the C(max) of 2.5 +/- 0.9 mg*L(-1) achieved immediately after i.v. administration (P <0.05). Mean meloxicam plasma concentration after infiltration was significantly lower than after i.v. doses for the first three hours after administration (P <0.05). CONCLUSION: We showed no differences in pain scores and analgesic consumption between local and i.v. administration of meloxicam 7.5 mg during the first 24 hr after herniorrhaphy, while plasma concentration of meloxicam was lower after local administration. These results indicate a lack of difference in pain relief after concentrating meloxicam at the hernia wound or after achieving high blood levels rapidly (i.v.). Local administration of meloxicam may confer an advantage over systemic administration by eliciting lower incidences of systemic adverse effects.