Clinical and microbial evaluation of dental scaling associated with subgingival minocycline in chronic periodontitis subjects

The aims of this double-blind randomized clinical trial were to evaluate the presence of periodontal pathogens and the clinical response of periodontal pockets treatment to scaling and root planing (SRP) associated with subgingival minocycline (SM). A total of 36 subjects, 26 to 60 years old (40.7 +/- 9.1), who had been previously diagnosed with chronic periodontitis, were included in the present study. Eighteen subjects were selected for the test group (TG), who were treated with SRP plus SM (new treatment), and 18 subjects for the control group (CG) who received SRP plus vehicle (current treatment). Two homologous sites in each subject with a probing depth (PD) > or = 6 mm were chosen. To evaluate the clinical response after treatment, PD was measured at baseline and at 90 days. Microbiological evaluation was performed to detect 7 periodontal pathogens using polymerase chain reaction at baseline, 30, and 120 days. A mean reduction in PD of 2.8 and 2.1 mm was observed in the TG and CG, respectively. At baseline, P. gingivalis was the most prevalent organism in both test (65.8%) and control (48.6%) groups. After 120 days it fell to 30.8% in TG and to 23.1% in CG. There were no statistically significant differences between the test and control groups concerning PD (p > 0.05 by Wilcoxon test) or presence of periodontal pathogens (p > 0.05 by Wilcoxon and chi-square; p > 0.01 by Signal test). The results observed showed that the new treatment was as effective as the current treatment in reducing periodontal pathogens and PD among chronic periodontitis subjects.     

Mother-to-Infant transmission of hepatitis C virus (HCV) in Brazil

Sixty-one women with anti-HCV antibodies, detected by a third-generation enzyme immunoassay (EIA3), were prospectively recruited for investigation of vertical HCV transmission during child-birth, at the University Hospital of the Catholic University of Campinas, Brazil, between January 1994 and July 1998. Six of the women presented coinfection with the human immunodeficiency virus type 1 (HIV-1). All of the 72 children born in this period were followed at least until they were 18 months of age. Analyses of anti-HCV, HCV RNA, and alanine aminotransferase were performed in a minimum of two blood samples during follow-up. One (2.4 per cent; 95 per cent CI, 2.2-7) of the 42 children born to HCV viremic mothers was both anti-HCV and HCV RNA-positive, with altered ALT levels. Passively transferred maternal anti-HCV antibodies became undetectable within 9-12 months. None of the nine infants born to HIV-1 infected mothers were infected either by HIV or HCV. Thus, the mother-infant HCV transmission rate is low and seems to be associated with maternal HCV RNA positivity.     

Herpes simplex virus esophagitis in immunocompetent children

OBJECTIVES: To review clinical, laboratory, endoscopic and histologic features, treatment and outcome of immunocompetent children with Herpes simplex virus esophagitis. METHODS: Retrospective analysis of the medical records of six children (five males) referred to our unit between 1997-2001. RESULTS: The median age at presentation was 4 years. Fever was present in all, odynophagia/dysphagia in five, retrosternal pain in four, vomiting in three, drooling in two and irritability and drowsiness in one. The median time between the onset of symptoms and the diagnosis was 6.5 days. Endoscopy, performed in all, showed friable mucosa and erosive-ulcerative involvement, with histology showing inflammation and ulcerated esophagitis. Tissue viral culture was performed in five patients and was positive in three, and polymerase chain reaction was positive in two of four tested. Serology was consistent with primary Herpes simplex virus infection in all. All received nasogastric feeding and acyclovir. The outcome was very good. CONCLUSIONS: This is an uncommon and under-recognized condition in the immunocompetent child. The most common symptoms are sometimes not diagnostic, particularly in very young children. The presence of unusual clinical signs may lead to a difficult and delayed diagnosis. Treatment with acyclovir may have hastened the resolution of symptoms, but a controlled clinical study was not performed.     

Low birth weight infants and Calmette-Guérin bacillus vaccination at birth: community study from Guinea-Bissau

BACKGROUND: In developing countries, low birth weight (LBW) children are often not vaccinated with Calmette-Guérin bacillus (BCG) at birth. Recent studies have suggested that BCG may have a nonspecific beneficial effect on infant mortality. We evaluated the consequences of not vaccinating LBW children at birth in Guinea-Bissau. METHODS: Between 1989 and 1999, 7138 children born at the central hospital had a birth weight registered. We assessed BCG coverage until 3 years of age. Data on tuberculin skin test (TST) for 297 children and BCG scar for 1319 children in the study population were reanalyzed for differences between normal birth weight (NBW) children and LBW children. We assessed the effect of early BCG vaccination on mortality to 12 months of age. RESULTS: Among LBW children there were 1.5- to 3-fold more unvaccinated individuals than among NBW children up to 4 months of age. There was no overall difference between LBW and NBW children in TST or BCG scarring; LBW children vaccinated early may have had slightly reduced reactions to tuberculin. Among 845 LBW children, 182 had received BCG within the first week of life. Controlling for background factors and censoring at first diphtheria-tetanuspertussis vaccination, measles vaccination or at 6 months of age (whichever came first), the mortality rate ratio for BCG-vaccinated versus -unvaccinated LBW children was 0.17 (95% confidence interval, 0.06-0.49), with an even stronger effect for LBW children vaccinated in the first week of life (mortality rate ratio, 0.07; 95% confidence interval, 0.01-0.62). CONCLUSIONS: The policy of not vaccinating with BCG at birth had a negative impact on vaccination coverage for LBW children. Early BCG vaccination had no large negative impact on TST and BCG scarring. Mortality was lower for BCG-vaccinated than for unvaccinated LBW children controlling for available background factors. BCG vaccination of LBW children may have a beneficial effect on survival that cannot be explained by protection against tuberculosis. Future studies should examine possible adverse effects from equalizing BCG policy for LBW and NBW children.     

A comparative study of MMP-2 in vulvar neoplasms

OBJECTIVE: To investigate differences in MMP-2 protein expression in VIN, vulvar invasive carcinoma, and lichen sclerosus, we performed an immunohistochemical study in which tissue samples from individuals affected by these conditions were compared with normal vulvar tissue. METHODS: A total of 57 cases were selected, as follows: 14 cases of vulvar invasive carcinoma, 22 of vulvar intraepithelial neoplasia (6 of VIN I, 5 of VIN II, and 11 of VIN III), 9 of vulvar lichen sclerosus, and 12 samples of normal vulvar tissue. Immunohistochemistry was done with primary monoclonal antibodies against MMP-2 and quantification of the immunostaining was done by counting the number of antigen-positive stromal cells per 1000 stromal cells. RESULTS: Normal vulvar tissue had a median score of 37.99 stromal cells positive for MMP-2. The median scores for VIN I/II and lichen sclerosus were 41.98 and 46.51, respectively, with no statistical differences when compared to the normal group. Invasive cancer had a score statistically higher (160.36) than any of the other groups. CONCLUSION: Invasive vulvar carcinoma had a score statistically higher of MMP-2 than normal tissue, VIN, and lichen sclerosus.     

Neurocryptococcosis: diagnosis by PCR method

Cryptococcus neoformans detection was optimized using PCR technique with the objective of application in the clinical laboratory diagnosis. The amplification area was ITS and 5,6S which encodes the ribosomal RNA (rRNA). A total of 72 cerebrospinal fluid (CSF) samples were used, obtained from cases with and without AIDS. The patients had cryptococcal meningitis (n = 56) and meningitis caused by other agents (n = 16). The results demonstrated that PCR test had the highest sensitivity rates, superior to culture (85.7%) and to India ink test (76.8%). PCR was found to be sensitive in detecting 1 cell/mL and highly specific since it did not amplify other fungal DNA. The comparative analysis of the methods showed that PCR is more sensitive and specific and is applicable as an important laboratorial resource for neurocryptococcosis diagnosis.