A clinical and epidemiologic study morsicatio buccarum/labiorum

abstract – A study of habitual self mutilation of the buccal and/or labial mucosa by biting was conducted on 8,589 persons attending the Royal Dental College, Copenhagen. Forty-two cases were found. The youngest patient was 5 years old and the oldest was 47. The condition occurred most frequently (1.77%) among persons aged 15–19 years. There was no difference in prevalence between males and females. Combined mutilation of cheek(s) and lip(s) was more frequent (62%) than isolated mutilation of the cheek(s) (24%) or isolated mutilation of the lip(s) (14%). Bilateral biting of the cheeks was more frequent than unilateral biting, and biting of the lower lip was more frequent than biting of the upper lip. Ninety-three per cent of the patients were aware of their habit, and most of them stated that they had been biting for years. Twenty patients were re-examined; in all but one patients the biting persisted but in 7 patients the location of the lesions had changed. In several cases a link could be traced to personal problems and mental stress. It was further noticed that many patients were students and white-collar workers, suggesting that "intellectual" work may predispose for the habit.     

Tracheal mucormycosis presented as an intraluminal soft tissue mass

BACKGROUND: Mucormycosis is a potentially lethal disease caused by an opportunistic fungal infection. It occurs mostly in diabetic or immunosuppressed patients and usually involves the lungs or paranasal sinuses. METHODS: We report a rare case of a patient with diabetic ketoacidosis who presented with progressive cough and dyspnea. CT of the neck and chest showed an intraluminal soft-tissue mass extending from the first tracheal ring to the thoracic inlet, causing severe destruction of the trachea. Direct laryngoscopy and biopsy demonstrated hyphal invasion with architecture typical of invasive mucormycosis. RESULTS: The patient underwent resection of the upper trachea and prolonged amphotericin B therapy and is disease free at 24 months after surgery. CONCLUSIONS: In patients with diabetes presenting with progressive hoarseness, dyspnea, and endobronchial mass, a fungal infection should be considered. In case of invasive tracheal mucormycosis, prompt diagnosis and early surgical resection may help improve survival.     

A randomized, double-blind, multicenter, controlled clinical trial of cyclosporine plus chloroquine vs. cyclosporine plus placebo in early-onset rheumatoid arthritis

BACKGROUND: Our objective was to assess the efficacy and safety of cyclosporine-A (CsA) plus chloroquine (Clq) in early-onset rheumatoid arthritis (RA) compared to CsA plus placebo. METHODS: We conducted a prospective, 12-month follow-up, multicenter, double-blind, placebo-controlled study of CsA (2.5-5 mg/kg/day[d]) plus Clq (150 mg/d) vs. CsA plus placebo in active RA of <2 years of evolution. RESULTS: A total of 149 patients were included; 111 patients (74.4%) completed the 12-month follow-up period. Evaluation at 6 and 12 months showed improvement for all clinical disease parameters. In both groups there was a decrease in tender joint count, swollen joint count, pain, assessment of efficacy by both investigator and patient, functional assessment, and morning stiffness, all differences statistically significant. With an intention-to-treat analysis, there was 64% in the CsA plus Clq group (CsA/Clq) and 63% in the CsA plus placebo group (CsA/Plac) at 12 months in the American College of Rheumatology (ACR)-20 criteria of improvement. Response rate for ACR-50 was 48 and 47%, and for ACR-70 it was 29% in both groups; the difference was not statistically significant between study groups. Gastrointestinal complaints were common in both groups. Four patients in CsA/Clq group and five patients in CsA/placebo group increased creatinine levels; two patients in each group discontinued treatment due to this reason. CONCLUSIONS: There was no advantage to adding chloroquine to cyclosporine in patients with RA.     

Arsenic exposure and human papillomavirus response in non-melanoma skin cancer Mexican patients: a pilot study

We assessed the relationships between chronic arsenic (As) exposure, human papilloma virus (HPV) contact and non-melanoma skin cancer (NMSC) by means of a dermatology clinic-based case–control study (42 cases and 48 controls) in Region Lagunera, Mexico, where chronic As poisoning is endemic. Exposure was determined through detailed history of residence in the As-contaminated area and measurement of As levels in drinking water and urine. We used a consensus epitope from the central region of L1 protein of the HPV family to determine antibodies against HPV. A history of As exposure and HPV seropositivity were associated with increased NMSC risks. A history of exposure to high levels of As increased the risk for NMSC (OR=4.53; P=0.11) in the group of seronegative HPV patients. A positive response to HPV significantly increased the OR for NMSC to 9.04 (P=0.01) when history showed exposure to low levels of As. Interestingly, the OR was significantly increased to 16.5 (P=0.001) when both exposure to high levels of As and HPV seropositivity were present. In addition, the presence of NMSC increased the OR (5.45; P=0.03) for a positive response to HPV when history showed exposure to low levels of As, but the OR was increased to 8.0 (P=0.005) in the cases with high exposure levels. Thus, HPV infection could constitute an additional risk factor for NMSC development in humans chronically exposed to As. However, further studies with additional populations are needed to determine the interaction between HPV and As exposure in NMSC.     

Nebulized amphotericin B concentration and distribution in the respiratory tract of lung-transplanted patients

BACKGROUND: A criticism of using nebulized amphotericin B (nAB) as prophylaxis against Aspergillus infection after lung transplantation is the lack of knowledge of its pharmacokinetics and distribution in the lung. The aim of this study was to ascertain the concentrations and distribution of nAB in the respiratory tract of patients receiving lung transplantations. METHODS: In the drug-concentration study, 120 bronchoscopies were performed in 39 patients receiving lung transplantions after administration of 6 mg of nAB once daily for a minimum of 7 days. Mean nAB concentration in bronchial aspirated secretions (BAS) and bronchoalveolar lavage (BAL) was determined at 4, 12, 24, and 48 hours postnebulization. In the distribution study, 17 patients inhaled 6 mg of 99m technetium-labeled AB, and pulmonary distribution was measured using a gamma camera. Pulmonary perfusion was also measured. Both tests were quantitatively evaluated. RESULTS: In the drug-concentration study, mean concentrations of 1.46 microg/mL in BAS and 15.75 microg/mL in BAL were reached at 4 hours. At 24 hours, concentrations were 0.37 microg/m and 11.02 microg/mL in BAS and BAL, respectively. In the distribution study, 99m technetium-labeled AB distribution was uniform in 12 of 13 allografts without bronchiolitis obliterans syndrome (BOS) and in 1 of 4 allografts with BOS. A close correlation was observed between regional drug distribution and regional perfusion (r=0.82, P<0.01). CONCLUSIONS: nAB concentrations remained high for the first 24 hours in BAL and for less time in BAS, with distribution of the drug being uniform in patients without BOS. Furthermore, lung-perfusion studies appear to be useful to ascertain nAB distribution in patients receiving lung transplantions.     

Production of retroviral vectors: review

Retroviral vectors are presently amongst the most widely used vectors in gene therapy clinical trials to target pathologies of different origins, such as cancers, genetic diseases or neurological disorders. This review provides an overview on the evolution of retroviral vector design and production for gene therapy applications, including state of the art developments in flexible producer cells and safe vectors. In addition, production and purification processes will be addressed, with a particular focus on the improvements undertaken to increase vector productivity and to reduce the rapid loss of infectivity, which presently represent the main challenges in retroviral vectors production for gene therapy.     

Risk factors for developing nosocomial infections among pediatric patients

BACKGROUND: Nosocomial infections (NIs) are important causes of morbidity and mortality in pediatric hospitals. Multiple factors contribute towards exposing children to the risk of infection when hospitalized, and some of them differ from those in adults. METHODS: This was a prospective study in a tertiary-level teaching pediatric hospital in Salvador, Bahia, Brazil, conducted from January to July, 2003, to describe the epidemiologic characteristics of NIs. Centers for Disease Control's standard definitions were used and the data recorded included intrinsic and extrinsic risk factors. RESULTS: We evaluated 808 patients. There were 143 episodes of NI in 124 patients (15.4%). The overall incidence of NI cases was 9.2 per 1,000 patient-days, with higher rates among children aged less than 1 year (P < 0.001) and those with nonsurgical clinical diseases (P < 0.001). Gastrointestinal infections (39.2%) and eye, ear, nose, throat or mouth infections (29.4%) were most common. The factors most closely associated with higher incidence of NI were respiratory disease on admission (incidence density ratio [IDR], 4.0; 95% confidence interval [CI], 2.83-5.72), another disease associated with admission diagnosis (IDR, 3.5; 95% CI, 2.41-5.02), nonsurgical clinical disease (IDR, 5.9; 95% CI, 3.92-8.85) and pediatric intensive care unit residence (IDR, 3.5; 95% CI, 1.91-6.28). The lengths of hospital stay for patients with and without nosocomial infection were, respectively, 14.1 days (SD, 20.5 days) and 5.1 days (SD, 6.6 days) (t = 121.76; P < 0.001). CONCLUSIONS: Nosocomial infections are a frequent complication in pediatrics. They are not necessarily related to invasive procedures but certainly are related to a group of factors that have particular characteristics in the pediatric age group.