Elaboration of a clinical and paraclinical score to estimate the probability of herpes simplex virus encephalitis in patients with febrile, acute neurologic impairment

Herpes simplex virus (HSV) encephalitis is associated with a high risk of mortality and sequelae, and early diagnosis and treatment in the emergency department are necessary. However, most patients present with non-specific febrile, acute neurologic impairment; this may lead clinicians to overlook the diagnosis of HSV encephalitis. We aimed to identify which data collected in the first hours in a medical setting were associated with the diagnosis of HSV encephalitis. We conducted a multicenter retrospective case-control study in four French public hospitals from 2007 to 2013. The cases were the adult patients who received a confirmed diagnosis of HSV encephalitis. The controls were all the patients who attended the emergency department of Grenoble hospital with a febrile acute neurologic impairment, without HSV detection by polymerase chain reaction (PCR) in the cerebrospinal fluid (CSF), in 2012 and 2013. A multivariable logistic model was elaborated to estimate factors significantly associated with HSV encephalitis. Finally, an HSV probability score was derived from the logistic model. We identified 36 cases and 103 controls. Factors independently associated with HSV encephalitis were the absence of past neurological history (odds ratio [OR] 6.25 [95 % confidence interval (CI): 2.22-16.7]), the occurrence of seizure (OR 8.09 [95 % CI: 2.73-23.94]), a systolic blood pressure ≥140 mmHg (OR 5.11 [95 % CI: 1.77-14.77]), and a C-reactive protein <10 mg/L (OR 9.27 [95 % CI: 2.98-28.88]). An HSV probability score was calculated summing the value attributed to each independent factor. HSV encephalitis diagnosis may benefit from the use of this score based upon some easily accessible data. However, diagnostic evocation and probabilistic treatment must remain the rule.

Implant overdentures: recommendations and analysis of the clinical benefits

Due to the progress made in implantology, in recent years the interest in prosthetic rehabilitation in edentulous mouths using overdentures has increased considerably. Indications to the treatment of implant supported overdenture could be classified in three groups: the first group consists of younger members of the elderly population who have an edentulous upper jaw rehabilitated with a conventional complete denture but experience discomfort with it and therefore desire a stable prosthesis and greater comfort in the mouth; the second group, for which the use of implant overdentures is recommended, consists of older patients who require greater stability from a complete mandibular denture; the third group consists of compromised patients and those with acquired or congenital maxillofacial conditions. Moreover, advantages of overdentures supported by implants are analyzed; in fact, they allow a lower bone reabsorption, a better retention and stability of the prosthesis than the traditional complete denture, an increased masticatory effectiveness, a reduction of pain during mastication tanks to the higher stability, a better sensory perception, a considerable patient satisfaction, and the option of making an immediate prosthetic rehabilitation with implants through immediate load.

The use of two species of crayfish as environmental quality sentinels: the relationship between heavy metal content, cell and tissue biomarkers and physico-chemical characteristics of the environment

In systems as heavily disturbed as rivers, the use of biological sentinels is a most interesting way of obtaining continuous assessment of environmental quality. This study seeks to establish the value of such sentinels of two species of crayfish: the native crayfish (Austropotamobius pallipes, Lereboullet 1858) and an introduced species, signal crayfish (Pacifastacus leniusculus, Dana 1852), by comparing the habitat quality (water and sediments) and heavy metal contents in crayfish with the degree of stress manifested by the animals, measured by cell and tissue biomarkers. For this purpose a histological study of the digestive gland was carried out together with measurements of heavy metal contents in samples from various points of the river network of Bizkaia (Spain), selected on the basis of their degree of disturbance. The results establish a positive correlation between these environmental conditions, the cell and tissue biomarkers of the digestive gland (thinning of the digestive epithelium, enlargement of digestive lysosomes) and the heavy metal contents of the animals (converted to an index of pollutant load).