Effects of an antimicrobial additive to toothbrushes on residual periodontal pathogens

OBJECTIVE: Previous studies have reported the link between residual microbial contamination of toothbrushes and periodontal diseases. The goal of this pilot study was to evaluate the effects of an antimicrobial additive (Microban) to toothbrushes on residual retention of periodontal pathogens. METHODOLOGY: Twenty patients had one side of their mouths brushed with a toothbrush containing the antimicrobial agent (experimental side), and the other side with a toothbrush containing no agent (control). Toothbrushes were air-dried (25 degrees C) for four or 24 hours. Toothbrush heads were vortexed and cultured for Prevotella species (Ps), Porphyromonas gingivalis (Pg), Actinobacillus actinomycetemcomitans (Aa), and non-specific colony-forming units (NS). The plates were incubated and counted. Means and standard deviations were calculated, and data were analyzed using a series of t-tests (paired and unpaired) and Wilcoxon matched-pairs signed-rank test. RESULTS: No significant inter- or intra-group differences in mean counts were found; however, when four-hour and 24-hour data for Aa, Pg, or NS were combined, experimental counts were lower than controls in 39/50 (78%) of the matched pairs (Wilcoxon signed-rank test p = 0.01). CONCLUSION: Toothbrushes containing the antimicrobial additive showed lower microbial counts than those without, but between-group means were not statistically significant.     

Ciprofloxacin- and hypocalcemia-induced torsade de pointes triggered by hemodialysis

Torsade de pointes is a polymorphic form of ventricular tachycardia associated with prolongation of the QT interval, which may be either congenital or acquired. Etiologies for the acquired forms include drug effects, hypokalemia, hypomagnesemia, hypocalcemia, starvation, sick sinus syndrome, and atrioventricular block. We present a 76-year-old man with acute on chronic renal failure, hypocalcemia, on ciprofloxacin, and a prolonged QT interval with torsade de pointes triggered by hemodialysis. The QT prolongation was corrected by treating the hypocalcemia. Hypocalcemia and ciprofloxacin are known to independently cause prolonged QT interval and torsade de pointes; our case illustrates that dialysis can trigger torsade on a background of this risk factor combination.     

Reinforcement as a means for quality improvement in management of coronary syndromes: adherence to evidence-based medicine

OBJECTIVE: To study the effect of reinforcement as a quality improvement intervention in the evidence-based management of the coronary syndromes. METHODS: In the pre-intervention phase, the charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed for measurement of total cholesterol on admission and fasting low density lipoprotein (LDL) cholesterol, implementation of aspirin therapy on admission, beta-blockers' use during hospitalization, and treatment with angiotensin converting enzyme (ACE) inhibitors in patients with left ventricular systolic dysfunction. Reinforcement was used as an intervention for quality improvement. All personnel of Division of Cardiology including nursing staff, medical residents, cardiology fellows, and attending physicians were reinforced to adhere to the evidence-based management. In the post-intervention phase, charts of 140 consecutive patients with ICD-9 codes 410-414 for coronary syndromes were reviewed to assess the improvement in the same quality of care parameters. RESULTS: By reinforcement, a significant improvement was noted in all quality of care parameters studied. Proportion of patients who had total cholesterol measured on admission increased from 78% to 92% (P<0.005), and those who had fasting LDL cholesterol measured increased from 22% to 70% (P<0.0001). Use of aspirin at admission (in 74% of patients pre- vs. 80% of patients post-intervention, P<0.05), beta-blockers during hospitalization (in 62% of patients pre- vs. 78% of patients post-intervention, P<0.001), and ACE inhibitors in patients with left ventricular systolic dysfunction (in 58% of patients pre- vs. 89% of patients post-intervention, P<0.001) improved significantly after reinforcement to the medical personal. CONCLUSION: Reinforcement to adhere to the evidence-based management results in a significant improvement in the quality of care provided to the patients with coronary syndromes.     

Technetium-99m-L,L-ethylenedicysteine renal scan as a single-modality investigation for the evaluation of renal morphology and function: a comparative study with technetium-99m-dimercaptosuccinic acid

AIM: To evaluate whether cortical scars can be detected using the summed images of technetium-99m-L,L-ethylenedicysteine (99mTc-L,L-EC) renal dynamic scan, and to compare the results with technetium-99m-dimercaptosuccinic acid (99mTc-DMSA) scan. To evaluate the inter-observer variability for 99mTc-L,L-EC and 99mTc-DMSA scan reporting. METHODS: One hundred and three patients were initially included in the study; 21 were excluded, five due to a single functioning kidney and 16 due to impaired renal function (serum creatinine>2.5 mg.dl(-1)). Eighty-two patients (39 females, 43 males), including 31 children, with a mean age of 33.4+/-11.3 years (range, 4 months to 74 years), underwent both 99mTc-DMSA and 99mTc-L,L-EC scintigraphy within a period of 14 days. 99mTc-L,L-EC images were regrouped into 2 min image sets, and the initial 2 min summed image (cortical phase) was used for the evaluation of scars. Three independent observers analysed both images separately on different days without being aware of the identity and clinical details of the patients. Their 99mTc-L,L-EC findings were compared with the consensus 99mTc-DMSA scan findings taken as reference. RESULTS: The overall sensitivity of 99mTc-L,L-EC scans was 93% and the specificity was 96%. The inter-observer variability was 0.91 for 99mTc-L,L-EC and 0.94 for 99mTc-DMSA scan reporting, using the weighted kappa analysis at P<0.05. CONCLUSIONS: 99mTc-L,L-EC is an excellent single-modality comprehensive investigational agent for renal morphology, function and outflow tract evaluation with the added advantages of lower cost, convenience and low radiation exposure to the patient.     

Anal canal cancer and chemoradiation treatment in two patients with systemic lupus erythematosus treated by chronic therapeutic immunosuppression

Two case reports of anal cancer developing during chronic therapeutic immunosuppression for systemic lupus erythematosus (SLE) and their cancer management are presented. The complex issues of delivery of curative chemoradiation treatment for anal cancer in the context of co-existing autoimmune connective tissue disease (AICD) are discussed. These two cases show that combined chemotherapy and radiation regimens are possible in patients with SLE. However, frequent, careful assessment with judicious and prompt management of haematological and other complications during treatment is important.     

Calcifications of the heart

Cardiac calcification usually represents the result of a pathologic process. Some forms of calcification represent chronic change in an ageing population, and must be differentiated from pathologic calcification. Still other forms of calcification are associated with ageing and chronic degeneration, but also reflect ongoing pathologic processes. Recognition of cardiac calcification may be an early sign or only sign of a pathologic process. Characterization of the calcification in terms of its distribution and appearance is a helpful means for determining which structures are calcified, differentiating pathologic from nonpathologic processes. This article provides an overview of the types of calcifications of the heart, pathogenesis, and utility of the various imaging modalities for their detection.     

Identification and quantification of antigens associated with HLA class I molecules on a bladder tumour cell line. Implications for vaccine design

The aim of this study was to isolate and identify antigenic peptides associated with HLA class I molecules on a bladder tumour cell line. HLA-A1 molecules were purified using an immunobead-purification technique and following elution of nonapeptides associated with the complex, their HPLC profile was determined by Tandem mass spectrometry (MS/MS). Three peptides were identified namely: (1) P991 (VTDPGNLLY); (2) P1041.5 (LTDLGFLVY), and (3) P1057.7 (LTDPHLLSY); these sequences matched elements of hepatitis B, MAGE1-A1 and herpes simplex viruses. These antigens had half-lives of approximately 120 min which is within the theoretical range of such short peptides. These results indicate that identification of MHC-associated peptides is possible without using an assay for cytotoxic T cells. Although this approach was applied on a relatively small scale, broader applications can be foreseen.     

Thoracic epidural infusions for post thoracotomy pain relief: a clinical study to compare the efficacy of fentanyl — bupivicaine mixtures versus fentanyl alone

Background: Optimum pain relief following thoracotomy is essential for patient comfort and to reduce the incidence of postoperative pulmonary complications. Methods: A randomized clinical trial was conducted on 90 patients scheduled for pulmonary resection. The patients were randomly divided into three groups. Group 1 received 0.125% bupivicaine with fentanyl 10μg.ml⁻¹, Group 2 received 0.25% bupivicaine with fentanyl 10μg.ml⁻¹ and Group 3 received only fentanyl 10μg.ml⁻¹ in a calculated dose as a continuous thoracic epidural infusion. Adequacy of anglesia was assessed at rest and during movement over 24 hours. Analgesic efficacy was assessed using a visual analogue score and an observer verbal ranking scale. Results: Pain scores were significantly higher in Group 3 during the assessment period. (p<0.01) as compared to the other groups. The use of intraoperative vasopressors was significantly higher (p<0.05) in Group 2 as compared to the other groups. No neurological complications were encountered in any of the study groups. Conclusion: We conclude that in the early postoperative period, the use of 0.125% bupivicaine improves fentanyl epidural analgesia in patients undergoing lung resection.