Analysis of oral risk factors for ventilator-associated pneumonia in critically ill patients

Clinical Oral Investigations - This a cross-sectional study to evaluate the association between oral health findings and ventilator-associated pneumonia (VAP) among critically ill patients in...     

Chloride deficiency as a presentation or complication of cystic fibrosis

Thirteen children with cystic fibrosis (CF), aged 1.5 months–15 years, had 18 episodes of hypochloraemia and metabolic alkalosis over the period 1983–1991. Five patients were not known to have CF prior to developing these electrolyte disturbances. There were two distinct clinical presentations: 5 patients had an acute isolated picture of heat exhaustion while 8 patients (all infants) had a more chronic course associated with failure to thrive. Many episodes were not associated with particularly high environmental temperatures, although most occurred during the summer and early autumn months. Serum electrolytes should be assessed regularly in children with CF, and this diagnosis should be considered in any infant presenting with unexplained hypochloraemic metabolic alkalosis.     

No association of CTLA4 gene with celiac disease in the Basque population

BACKGROUND: Celiac disease (CD) is an autoimmune disorder caused by intolerance to ingested gluten that develops in genetically susceptible individuals. The contribution of human leukocyte antigen (HLA) genes to the genetic risk to CD has been known for a long time; however, non-HLA genetic factors are likely to be required for the development of the disease. Several studies have associated the CD28/CTLA4 region on chromosome 2q33 with the disease in different populations. The CTLA4 gene encodes a receptor involved in the control of T-cell proliferation and mediates T-cell apoptosis.AIM To determine the contribution of two polymorphisms of the CTLA4 to the disease: the A/G dimorphism at position +49 in exon 1 and the (AT)(n) microsatellite in the 3' untranslated region. PATIENTS: Forty-one celiac families of Basque origin (43 patients with CD and 80 first-degree relatives). METHODS: Restriction enzyme digestion of polymerase chain reaction amplified genomic DNA for the A/G dimorphism and polymerase chain reaction followed by high-resolution electrophoresis for the (AT)(n) microsatellite. For disease association studies, the Affected Family Based Controls approach was used. RESULTS: The frequency of the A allele of 49 A/G polymorphism was 67.47% in the celiac allele group compared with 70.13% in the Affected Family Based Controls group. These differences were not significant. Analysis of the (AT)(n) polymorphism identified 17 different alleles, ranging from 262 to 312 bp in length, but no allele was significantly associated with the disease. CONCLUSIONS: Our results did not show any evidence of association of any of the CTLA4 gene polymorphisms with the disease. This may result from population-specific differences in genetics and environmental susceptibility to CD.     

Healing of alveolar bone in resorbable and non-resorbable membrane-protected defects. A histologic pilot study in dogs

Two main types of membrane barriers are used for bone regeneration, non-resorbable and resorbable. Polytetrafluorethilene non-resorbable membranes have been extensively studied but they require a second surgical step for removal. Although polylactic acid (PLA) resorbable membranes avoid this problem, they have not been sufficiently evaluated on bone defects. The purpose of this pilot study was to compare the healing events of bone regeneration after placement of non-resorbable or resorbable membranes and to evaluate the amount of newly formed bone 2 and 4 months after membrane placement. Mandibular second, third and fourth premolars of four adult mongrel dogs were extracted bilaterally. Two rectangular bone defects (8 mm corono-apical and 12 mm mesial-distal) were created bilaterally 3 months after tooth extractions. Each dog received two resorbable membranes and one non-resorbable membrane; one defect was left untreated. Two dogs were killed at 2 months and the remaining two at 4 months following surgery. Undecalcified sections were obtained and stained with toluidine blue and pyronin G. Histomorphometric analysis was performed using the NIH Image software. Newly formed bone was observed under both resorbable and non-resorbable membranes. The amount of regenerated bone was similar between both treatments at 2 and 4 months after surgery. At 2 months, the newly formed bone was still immature whereas at 4 months some areas of woven bone were observed. The bone formation observed in the untreated defects was significantly lower than that observed in both resorbable and non-resorbable membrane-protected defects. In summary, the present study suggests that PLA membranes can yield good results when used on bone defects while avoid a second surgical procedure.     

Cow's milk protein-sensitive enteropathy. Clinical and histological results of the cow's milk provocation test

Nineteen infants suspected of having cow's milk protein-sensitive enteropathy were studied. They all showed failure to thrive, diarrhoea and/or vomiting when fed a diet of cow's milk, and improved when their diet was changed to casein hydrolysate. Jejunal biopsy was done before and 18--23 hours after a milk challenge. Of the 19 infants, 12 presented histological evidence of cow's milk protein intolerance. Eight suffered from vomiting and diarrhoea within 9 days of the milk challenge, but in 4 cases the histological abnormalities were not accompanied by clinical symptoms. In one case a chicken meat intolerance was documented. The histological appearance of the intestinal mucosa after chicken challenge was identical to that observed after milk challenge. In our opinion, repeated intestinal biopsies before and after an acute challenge is the best method to establish the diagnosis not only of cow's milk protein intolerance but also of intolerance to other alimentary proteins.     

Occupational exposures to bloodborne pathogens among healthcare workers in Rio de Janeiro, Brazil

Healthcare workers (HCWs) frequently face the risk of occupational infection from bloodborne pathogens following exposure to blood and body fluids. This study describes the results of a surveillance system of occupational exposure to bloodborne pathogens among HCWs in Rio de Janeiro, Brazil, during an eight-year period. A total of 15 035 exposures reported from 537 health units were reviewed. Six circumstances comprised nearly 70% of the reported exposures: recapping needles (14%), performing surgical procedures or handling surgical equipment (14%), handling trash (13%), during disposal into sharps containers (13%), performing percutaneous venepuncture (10%) and during blood drawing (5%). Easily preventable exposures, such as incidents related to recapping needles, handling trash, and sharps left in an inappropriate place, represented 30% of the exposures reported. Post-exposure prophylaxis (PEP) for human immunodeficiency virus (HIV) was initiated for 46% of exposed HCWs. Although Brazilian guidelines indicate that PEP is usually not recommended for exposures with insignificant or very low risk of HIV infection, PEP was prescribed to a large proportion of exposed HCWs under these circumstances. The prevention of occupational exposure to bloodborne pathogens among HCWs and their safety must be considered as a public health issue. Although infection-preventative measures such as antiretroviral drugs and rapid tests are available, this study shows that there are still a high number of easily preventable exposures. The implementation of more effective prevention strategies is urgently required in this country.