Idiopathic pericardial effusion in patients with hypertrophic cardiomyopathy

The International Journal of Cardiovascular Imaging - The aims of this study were to examine the prevalence of moderate to large (moderate–large) idiopathic pericardial effusion (i-PEF) in...     

Effects of toothbrush size and dentifrice type/brand on pea-sized and larger amounts of dentifrice

PURPOSE: To assess the effects of toothbrush size and dentifrice type/brand on amounts of dentifrice being placed when trying to replicate pictures with different amounts of dentifrice, including a pea-sized amount. METHODS: This laboratory trial used one researcher to repeatedly dispense five dentifrice products on three different child-sized toothbrushes using a standard procedure. Two sets of drawings, depicting the recommended pea-sized and larger amounts, were used as guides in an effort to place the same amount each time. Data were analysed using ANOVA. RESULTS: Amounts of dentifrice placed on the two larger toothbrushes were significantly greater than those placed on the smallest toothbrush (p < 0.0001). The amounts placed on the two larger toothbrushes with similar brushing areas but different shapes were not significantly different from each other. The effect of dentifrice type/brand varied in each analysis. For pea-sized amounts, one of 10 pairwise comparisons was significant. For amounts larger than pea-sized, another pair of the 10 pairwise comparisons was significant. However, there was no significant effect of dentifrice type/brand when considering both pea-sized and larger amounts together in the same analysis. CONCLUSIONS: Toothbrush size significantly affected the amount of dentifrice placed for both pea-sized and larger amounts. The amounts placed on larger size toothbrushes were greater than on the smaller size toothbrush. No consistent effects of selected dentifrices were found.     

Idiopathic chylous ascites in a patient with HIV infection: response to total parenteral nutrition and octreotide therapy

The authors describe a 47-year-old man infected with human immunodeficiency virus admitted for ascites and weight loss. Ascitic fluid analysis revealed chylous ascites (triglycerides 444 mg/dl) with negative microbiological tests. Neoplasia, cardiac disease and liver cirrhosis were excluded after an extensive diagnostic workout. Exploratory laparotomy with tissue sampling did not clarify ascites etiology. During hospital admission, patient status gradually deteriorated, severe malnutrition developed and ascites became refractory to diuretics. Total parenteral nutrition and octreotide therapy were started and maintained for 3 weeks with ascites resolution and no relapse after oral diet resumption. Chylous ascites is a rare entity with several causes that compromise intra-abdominal lymphatic drainage. This case illustrates the difficulty in establishing etiology in some patients and the effectiveness of total parenteral nutrition plus octreotide therapy in idiopathic chylous ascites in HIV-infected patients.     

Protein-Bound Uremic Toxins Lowering Effect of Sevelamer in Pre-Dialysis Chronic Kidney Disease Patients with Hyperphosphatemia: A Randomized Controlled Trial

P-cresyl sulfate and indoxyl sulfate are strongly associated with cardiovascular events and all-cause mortality in chronic kidney disease (CKD). This randomized controlled trial was conducted to compare the effects between sevelamer and calcium carbonate on protein-bound uremic toxins in pre-dialysis CKD patients with hyperphosphatemia. Forty pre-dialysis CKD patients with persistent hyperphosphatemia were randomly assigned to receive either 2400 mg of sevelamer daily or 1500 mg of calcium carbonate daily for 24 weeks. A significant decrease of total serum p-cresyl sulfate was observed in sevelamer therapy compared to calcium carbonate therapy (mean difference between two groups −5.61 mg/L; 95% CI −11.01 to −0.27 mg/L; p = 0.04). There was no significant difference in serum indoxyl sulfate levels (p = 0.36). Sevelamer had effects in terms of lowering fibroblast growth factor 23 (p = 0.01) and low-density lipoprotein cholesterol levels (p = 0.04). Sevelamer showed benefits in terms of retarding CKD progression. Changes in vascular stiffness were not found in this study.     

Natural history of treatment outcomes of permanent first molars: a study of sealant effectiveness

BACKGROUND: Few studies have used insurance claims data to retrospectively assess the natural history--a natural process or flow of events without any special interventions--and treatment outcomes of teeth with dental sealants. METHODS: The authors constructed treatment outcome trees (TOTs) from the Iowa Medicaid claims and eligibility data (1996-2000) of continuously enrolled 6-year-old children who routinely used Medicaid dental services. The authors used the TOTs to compare the restorative treatments of sealed permanent first molars with those of nonsealed permanent first molars. RESULTS: Forty percent of routine utilizers received a sealant during the four-year period. Overall, 25 percent of molars received at least one restoration. Sealed molars were less likely to receive further restorative treatment than were nonsealed molars (13 versus 29 percent). Sealed molars had fewer extensive restorative treatments (crowns, endodontic therapy and extractions) than did nonsealed molars. The median time to restorative treatment of the sealed molars also was greater than that of the nonsealed molars. All four first molars had comparatively similar patterns of subsequent care. CONCLUSIONS: Permanent first molars with sealants received less subsequent restorative treatment than did those without sealants. TOTs are useful tools for identifying necessary outcome information needed for program evaluations. CLINICAL IMPLICATIONS: Greater use of sealants could reduce the need for subsequent treatment and prolong the time until treatment may be necessary for permanent first molars.     

Pancreatoblastoma: an unusual diagnosis in an adult patient

The authors describe a 31-year-old man admitted due to progressive weight loss, diarrhea and massive hepatomegaly. Laboratory data showed anemia (haemoglobin 11.7 g/dl), abnormal liver tests (total bilirubin 1.4 g/dl, aspartate aminotransferase 70 U/l, alanine aminotransferase 37 U/l and alkaline phosphatase 520 U/l). Abdominal ultrasound (US) displayed a large heterogeneous liver with a segment IV 25 mm nodule. Magnetic resonance revealed a 4 cm pancreatic tail mass and several liver nodules consistent with metastasis. The patient underwent an endoscopic ultrasound (EUS) with fine needle aspiration (FNA) from the pancreatic mass and liver metastasis with cytological evaluation consistent with a pancreatoblastoma, later confirmed through a percutaneous US-guided liver biopsy. During the inpatient period, liver function deteriorated and acute kidney injury developed. Severe progressive cachexia was observed. The patient was discharged on renal replacement therapy and palliative care. Death occurred 3 months after diagnosis. Pancreatoblastoma is an uncommon pancreatic malignant epithelial cancer of the pancreas, typically occurring in the paediatric population. Adult pancreatoblastoma is extremely rare, with about 40 cases reported in the literature and generally presenting a more aggressive biologic and clinical behaviour. Surgical resection is the treatment of choice, but most cases are detected in advanced stages. This case underlines the ability to establish a pancreatoblastoma cytology-based diagnosis with EUS-FNA, and confirms the associated poor outcome.     

Four-year cost-utility analyses of sealed and nonsealed first permanent molars in Iowa Medicaid-enrolled children

OBJECTIVES: Dental sealants, by their ability to prevent caries and maintain teeth in better health, have some inherent utility to individuals, programs, or society. This study assessed the 4-year incremental cost utility of sealing first permanent molars of 6-year-old Iowa Medicaid enrollees from a societal perspective and identified the group of teeth or children in whom sealants are most cost effective. METHODS: Dental services for first permanent molars were assessed using claims and encounter data for a group of continuously enrolled Medicaid enrollees who turned 6 between 1996 and 1999. Previously published utilities were used to weight the different health states. The weighted sum of outcomes [Quality-Adjusted Tooth-Years (QATYs)] was the measure of effectiveness. Costs and QATYs were discounted to the time of the child's sixth birthday. RESULTS: For all first molars, the cost of treatment associated with sealed teeth was higher but the utility was also slightly higher over the 4-year period. The relative incremental cost per 0.19 QATY ratio [changing the health state from a restored tooth (utility= 0.81) to a nonrestored tooth (utility = 1)] by sealing the molar ranged from $36.7 to $83.5 per 0.19 QATY. The incremental cost/QATY ratio was lower for sealing lower utilizers and for mandibular versus maxillary molars. CONCLUSIONS: Sealants improved overall utility of first permanent molars after 4 years. The 4-year cost/QATY ratio of sealing the first permanent molar varied by arch and type of utilizers. Sealing first permanent molars in lower dental utilizers is the most cost-effective approach for prioritizing limited resources.     

Organochlorine Pesticide Residues in Plankton,Rangsit Agricultural Area,Central Thailand

Few studies have investigated organochlorine pesticide residue content in freshwater plankton communities in Thailand. As a result, this study looks to examine the concentration of organochlorine pesticide residues in plankton collected from Khlong 7 (canal) at Rangsit agricultural area, central Thailand from June 2006 to February 2007. The results from this study show that plankton communities were composed of microphytoplankton, microzooplankton, and mesozooplankton. The average method recoveries varied from 84% to 103% with a relative standard deviation between 0.20% and 3.72%. The concentrations of organochlorine pesticide residues during a one-year-period were in the range of 0.10–3.65 ng/g wet wt and contained DDT and derivatives > Σ endosulfan > Σ HCH > Σ heptachlor > aldrin and dieldrin > endrin and endrin aldehyde > methoxychlor, respectively. Moreover, the residues of Σ HCH, DDT and derivatives, and methoxychlor were higher during wet season than dry season (t-test, p ≤ 0.05).