Anti-bacterial activity of essential oils against multidrug-resistant foodborne pathogens isolated from raw milk

The presence of pathogenic bacteria in food is considered as a primary cause of food-borne illness and food quality deterioration worldwide. The present study aimed to determine the effectiveness of five essential oils (EOs) against multidrug-resistant foodborne pathogens. In the current study Gram-negative bacteria (Escherichia, Enterobacter, Citrobacter, Proteus, Pseudomonas, and Klebsiella) and the Gram-positive bacteria Staphylococcus were isolated from raw milk and biochemically characterized. The anti-bacterial effect of different antibiotics and EOs (thyme, oregano, lemongrass, mint, and rosemary) was determined using the standard disc diffusion method. The antibiogram study revealed that Gram-negative bacteria were highly resistant to penicillin while Staphylococcus was resistant to streptomycin, amoxicillin, and lincomycin. Moderate resistance was observed to doxycycline, amikacin, enrofloxacin, kanamycin and cefixime. Isolates were found less resistant to gentamycin, chloramphenicol, and ciprofloxacin. EOs showed a broad range of antimicrobial activity against all bacteria except P. aeruginosa. Of these, thyme was more effective against most of the multi-drug resistant bacterial strains and formed the largest zone of inhibition (26 mm) against Escherichia followed by oregano oil (18 mm) against Staphylococcus (p<0.05). Klebsiella spp and Citrobacter spp showed resistance to mint and lemongrass oil respectively. The EOs such as lemongrass, mint and rosemary were less active against all the bacteria. The findings of the recent study suggest the use of EOs as natural antibacterial agents for food preservation.

HISTOPATHOLOGICAL PROFILE OF GASTROINTESTINAL NEUROENDOCRINE TUMORS IN A TERTIARY CARE HOSPITAL

Background. Recently there has been a lot of discussion about the terminology and classification of neuroendocrine tumours of the gastrointestinal tract. The WHO has recommended a change of terminology and classification of these tumours. In 2019 a significant update was done in the WHO classification of neuroendocrine tumours of GIT in which neuroendocrine carcinomas (NECs) are all considered high-grade tumours. Previously, grade 1 and 2 tumours were regarded as neuroendocrine tumours (NETs) and grade 3 neoplasms as NECs. The new classification avoids confusion between these two clinically and molecularly distinct notions. Objective. The aim of the research was to study GI neuroendocrine neoplasms and classify them as per location and Histopathological classification of GI neuroendocrine neoplasms according to the recent WHO classification. To use IHC whenever and wherever required for categorization of GI NET’s. Methods. Over a period of 15 years, a total of 85 cases of neuroendocrine neoplasms of GIT were studied. The histopathological material of patients was reviewed and histopathological diagnosis confirmed. Paraffin embedded tissue blocks were used to study and review the material. Sections from tissue blocks were stained. Five-micron sections were cut and stained. The sections were stained using DAKO LSAB-2® system HRP glass slides coated with 0.5% poly-lysine. Results. Out of 85 cases 40 involved male and 45 female patients. The mean age was 46.4 years; age range 9-85 years. In our study, appendix 24 (28.23%) and stomach 11 (12.95%) were the commonest sites of primary involvement followed by colon (10), ileum (10), duodenum (5), GE junction (5), jejunum (3), oesophagus (2), rectum (2) and gall bladder (1). Metastasis to the liver were observed in 12 patients with known and unknown primary diagnosis. Based on the latest WHO classification 5 patients were classified under NECs and the rest under NETs. Conclusions. Neuroendocrine tumours (NETs) are uncommon malignancies of GIT. Appendix followed by stomach was the most common anatomical site. NET Grade 1 was the most common histological type. IHC markers NSE, Synaptophysin and Chromogranin can be used in diagnosis of NETs.

Lernaeid parasites prevalence in commercial freshwater fish species at various fish farms in Pakistan

Reports abound on Lernaea parasitizing the brood stock, fingerlings, and marketable-sized culturable freshwater fish species in various parts of the world. We investigated seven small-scale aquaculture farms and how the prevailing Lernaea is impacting them. Randomly seven fish farms were selected to determine the prevalence percentage of lernaeid ectoparasites. Relevant information of the fishponds to estimate the various aspects such as effects of water source and quality, feed, stocking density, treatment used, and weight and length of fish, concerned with Lernaea infestation and prevalence was gathered. The results indicated that Catla catla (F. Hamilton, 1822) showed highest prevalence (41.7%) among the seven fish species, whereas Oreochromis niloticus showed zero. Other five fish species Ctenopharyngodon idella, Cirrhinus cirrhosis, Cyprinus carpio, Labeo rohita and Hypophthalmichthys molitrix showed 13.2%, 8.1%, 7.7%, 7.4%, 0.9% prevalence, respectively. In Royal Fish Farm 84.3% lernaeid infestation was observed, while no parasite was observed in the Vicent's Chunnian fish farm. The water source, quality, feed, fertilizers, stocking density, water temperature, and potential treatment options displayed varying tendencies among fish farms and prevalence. Depending on the weight and length, the highest prevalence (56.7%, and 66.7%) was observed in 3501-4000 g and 81-90 cm groups. The infestation rate varied in various fish body parts with the dorsal fin the most vulnerable organ and showed 2.3% overall prevalence (while 18.4% contribution within total 12.6% infestation). Out of 147 infected fish samples, 45 were extensively contaminated by Lernaea spread. In conclusion, our findings confirm that Lernaea could pose a considerable threat to marketable fish, and various treatment options should be educated to the farmers to help mitigate the spread and potential losses. Furthermore, Catla catla is more vulnerable to Lernaea infestation (41.7%), so are the fish species being cultured at higher stocking densities.

Development of chitosan based microencapsulated spray dried powder of tuna fish oil: oil load impact and oxidative stability

The impact of fish oil concentration on the oxidative stability of microcapsules through the spray drying process using chitosan and maltodextrin as wall material was studied. Emulsions were prepared with different Tuna fish oil (TFO) content (TFO-10%, TFO20%, TF030% TF0-40%) while wall material concentration was kept constant. Microencapsulated powder resulting from emulsion prepared with high fish oil load have high moisture content, wettability, total oil and low encapsulation efficiency, hygroscopicity and bulk tapped density. Oxidative stability was evaluated periodically by placing microcapsules at room temperature. Microcapsules prepared with TFO-10% presented high oxidative stability in terms of peroxide value (2.94±0.04) and anisidine value (1.54±0.02) after 30 days of storage. It was concluded that optimal amounts of fish oil for microencapsulation are 10% and 20% using chitosan and maltodextrin that extended its shelf life during study period.

Evaluation of three alum-precipitated Aeromonas hydrophila vaccines administered to Labeo rohita, Cirrhinus mrigala and Ctenopharyngodon idella: immunokinetics, immersion challenge and histopathology

Aeromonas hydrophila is a cause of infectious disease outbreaks in carp species cultured in South Asian countries including Pakistan. This bacterium has gained resistance to a wide range of antibiotics and robust preventive measures are necessary to control its spread. No prior use of fish vaccines has been reported in Pakistan. The present study aims to develop and evaluate inactivated vaccines against local strain of A. hydrophila in Pakistan with alum-precipitate as adjuvant. The immunogenic potential of vaccine was evaluated in two Indian major carps (Rohu: Labeo rohita, Mori: Cirrhinus mrigala) and a Chinese carp (Grass carp: Ctenopharyngodon idella). Fish were vaccinated intraperitoneally followed by a challenge through immersion. Fish with an average age of 4-5 months were randomly distributed in three vaccinated groups with three vaccine concentrations of 108, 109 and 1010 colony forming unit (CFU)/ml and a control group. Fixed dose of 0.1ml was applied to each fish on 1st day and a booster dose at 15 days post-vaccination (DPV). Blood samples were collected on 14, 28, 35, 48 and 60 DPV to determine antibody titers in blood serum using compliment fixation test (CFT). Fish were challenged at 60 DPV with infectious A. hydrophila with 108 CFU/ml through immersion. Significantly higher levels of antibody titers were observed from 28 DPV in all vaccinated groups as compared to those in the control group. In challenge experiment the average RPS (relative percent survivability) was 71% for groups vaccinated with 109 and 1010 CFU/ml and 86% for 108 CFU/ml. Vaccine with 108 CFU/ml induced highest immune response followed by 109 and 1010 CFU/ml. The immune response of L. rohita and C. idella was better than that of C. mrigala. In general, normal histopathology was observed in different organs of vaccinated fish whereas minor deteriorative changes were found in fish vaccinated with higher concentrations of the vaccine.

FAVIPIRAVIR AND DEXAMETHASONE IN MANAGEMENT OF SARS-COV2 INFECTION

Background. The clinical presentation of Coronavirus disease 19 (COVID-19) varies from mild symptoms to severe illness including multiorgan dysfunction. Favipiravir is an antiviral agent which has been previously used for treatment of influenza and was recently approved for treatment of mild to moderate COVID-19 in India. Objective. The Objective of this study was to assess the role of Favipiravir and Dexamethasone in patients with COVID-19. Methods. A total of 17 patients were included in this observational study. The included patients were RT-PCR for SARS-Cov-2 positive with increased inflammatory markers. All patients received Antiviral therapy, Anticoagulation (Enoxaparin 0.4mg subcutaneous twice daily), Steroids (Dexamethasone 8mg daily for 5days and 4mg daily for 5 days). Viral clearance (time to RT-PCR negative), time to defervescence after antiviral therapy, time to become independent of Oxygen support was studied. Results. Fever, myalgias, dry cough and dyspnea were the commonest presentation of COVID-19. All of our patients had lymphopenia. In our study 11 (64.7%) patients had bilateral ground glass opacities on CT chest while 6 had consolidation in addition to ground glass opacities. In two patients, who required non-invasive ventilation, Favipiravir was stopped and these patients received Remdesivir for a total of 5 days. In patients who received Favipiravir only, the Median time to RT-PCR negative, defervescence and oxygen independence was 8,3 and 6 days respectively. Conclusion. Our observational study demonstrated improvement in the majority of patients with COVID-19 with use of Favipiravir. Additional studies are needed to compare the efficiency of Favipiravir with Remdesivir.

[Medicaments and oral care: Is there still a rationale for clinical periodontal microbiology?]

Clinical microbiology now occupies an important place in periodontics and oral implant dentistry as a supplementary diagnostic tool and in planning treatment, particularly with respect to the rational use of antibiotics. This view is in line with the emphatic call by the World Health Organization and the European Union for the prudent use of antibiotics due to the global increase in resistance to antibiotics. Furthermore side effects may occur, such as the disturbance of the microbial intestinal and oral microflora, sometimes leading to serious pathological conditions. Hyposalivation following the use of antibiotics may lead to an oral environmental condition in which caries may develop faster than usual.

[A renewed focus on extra-oral manifestations of oral infections]

Dental focal infections are extraoral manifestations caused by oral pathogens. Pathological oral conditions, such as periapical inflammation and periodontitis, can cause bacteremia. Dissemination of oral pathogens to nonoral sites can subsequently cause infections in extraoral tissues and organs. Cardiovascular infections and brain abscesses are the most common of these. The course of such infections can be lethal. In order to improve patient care, a closer collaboration between dental and medical caregivers is necessary.

What is causing high polio vaccine dropout among Pakistani children?

OBJECTIVES

Although the antipolio drive is undertaken across Pakistan, there are still children who have not received any oral polio vaccine or are unable to complete recommended doses of polio vaccine. This study aims at empirically analyzing the associated factors with the no oral polio vaccination (OPV) and OPV dropout groups of children in Pakistan.

STUDY DESIGN

This is a cross-sectional study.

METHODS

Data were obtained from the three waves of Pakistan Demographic and Health Survey of children aged between 12 and 23 months (1990-1991: n = 1214; 2006-2007: n = 1522; 2012-2013: n = 2074). Children who received no OPV and those who drop out of polio vaccination (OPV1-OPV3) were considered as outcome variables. The bivariate relationship of outcome variable with each socio-economic, demographic, and spatial variable is estimated with a P-value of <0.01. For both no OPV and OPV dropout children, we used logistic regression analysis separately.

RESULTS

The percentage of children aged 12-23 months who dropped out of OPV1-OPV3 vaccination was about 76% in the year 1990-1991; 21% in 2006-2007, and 17.5% in 2012-2013 at the national level. Among all indicators, provinces, rural versus urban residence, the mother's age at marriage, the child's birth place (home versus hospital), parental education, and household wealth status are significant predictors of no OPV and/or OPV dropout in Pakistan. Among provinces, Balochistan, Khyber Pakhtunkhwa (KPK), and Sindh are the lagging provinces.

CONCLUSION

Improving the socio-economic status of women helps decrease the chance of polio dropout and thus improves service delivery and program implementation.

Health Issues in Ethnic Minorities: Awareness and Action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.

[Periodontitis and systemic diseases: from science to clinical practice]

The evidence for an association between systemic diseases and periodontitis is strongest with diabetes mellitus type 2 and cardiovascular disease. There is a moderate association of periodontitis with adverse pregnancy outcomes and rheumatoid arthritis. Periodontal treatment has, on average, a positive effect on reducing systemic infection and improving the condition of the vascular system. For diabetes patients, periodontal treatment can also have a positive effect on metabolic regulation. There is insufficient evidence that periodontal treatment prevents adverse pregnancy outcomes and rheumatoid arthritis.

[Treatment of periodontitis in cases of diabetes mellitus is always worthwhile!]

In the May edition of The Nederlands Tijdschrift voor Tandheelkunde the editorial commentary was devoted to the question to what extent the treatment of periodontitis in patients with diabetes mellitus is worthwhile. B.G. Loos, W.J. Teeuw, V. Gerdes and F. Abbas offer a response to this commentary and argue that the treatment of periodontitis in patients with diabetes mellitus is always worthwhile.

Association of run-in periods with weight loss in obesity randomized controlled trials

Study-level design characteristics that inform the optimal design of obesity randomized controlled trials (RCTs) have been examined in few studies. A pre-randomization run-in period is one such design element that may influence weight loss. We examined 311 obesity RCTs published between 1 January 2007 and 1 July 2009 that examine d weight loss or weight gain prevention as a primary or secondary end-point. Variables included run-in period, pre-post intervention weight loss, study duration (time), intervention type, percent female and degree of obesity. Linear regression was used to estimate weight loss as a function of (i) run-in (yes/no) and (ii) run-in, time, percent female, body mass index and intervention type. Interaction terms were also examined. Approximately 19% (18.6%) of the studies included a run-in period, with pharmaceutical studies having the highest frequency. Although all intervention types were associated with weight loss (Mean = 2.80 kg, SD = 3.52), the inclusion of a pre-randomization run-in was associated with less weight loss (P = 0.0017) compared with studies that did not include a run-in period. However, this association was not consistent across intervention types. Our results imply that in trials primarily targeting weight loss in adults, run-in periods may not be beneficial for improving weight loss outcomes in interventions.

The effect of Porphyromonas gingivalis lipopolysaccharide on pregnancy in the rat

OBJECTIVE

Periodontitis, mostly associated with Porphyromonas gingivalis, has frequently been related to adverse pregnancy outcomes. We therefore investigated whether lipopolysaccharides of P. gingivalis (Pg-LPS) induced pregnancy complications in the rat.

METHODS

Experiment 1: pregnant rats (day 14) received increasing Pg-LPS doses (0.0-50.0 μg kg(-1) bw; n = 2/3 p per dose). Maternal intra-aortic blood pressure, urinary albumin excretion, placental and foetal weight and foetal resorptions were documented. Experiment 2: 10.0 μg kg(-1) bw (which induced the highest blood pressure together with decreased foetal weight in experiment 1) or saline was infused in pregnant and non-pregnant rats (n = 7/9 p per group). Parameters of experiment 1 and numbers of peripheral leucocytes as well as signs of inflammation in the kidney and placenta were evaluated.

RESULTS

Pg-LPS infusion in pregnant rats increased maternal systolic blood pressure, reduced placental weight (dose dependently) and decreased foetal weight and induced foetal resorptions. It, however, did not induce proteinuria or a generalised inflammatory response. No effects of Pg-LPS were seen in non-pregnant rats.

CONCLUSION

Pg-LPS increased maternal blood pressure, induced placental and foetal growth restriction, and increased foetal resorptions, without inducing proteinuria and inflammation. Pg-LPS may therefore play a role in pregnancy complications induced by periodontitis.

Evaluation of ethanolamine oleate sclerotherapy on the submandibular glands of canines as a potential therapy for sialorrhea

BACKGROUND

Sialorrhea can have major negative effects on the physical and social well-being. Sclerotherapy may be useful in patients with sialorrhea by decreasing the amount of saliva production. The aim of this study was to test the effect of ethanolamine oleate (EO) in an experimental model as a preliminary step for its application in humans.

METHODS

Histopathological and morphometric analysis of submandibular glands from thirteen dogs was preformed. A total of 25 glands were injected with 1ml of 2.5% EO (n=5), 1ml of 5% EO (n=5), 5ml of 2.5% EO (n=5) and 5ml of 5% EO (n=5). Five glands were used as control.

RESULTS

EO significantly induced a dose dependent scaring of the gland ending in lobular transformation (salivary gland cirrhosis). Morphometric measurements showed that 1ml of 2.5% or 5% EO significantly induced fibrosis compared to normal glands (p=0.014 and 0.021, respectively). Fibrosis significantly increased and was more apparent when a dose of 5ml of 2.5% EO or 5% EO were injected [by semi-quantitative evaluation (p=0.016 and 0.002, respectively) and morphometric measurements (p=0.016 and 0.008, respectively)]. This scarring effect was significantly associated with reduction of area of acinar cells when a dose of 1ml-5%, 5ml-2.5% or 5ml-5% EO were applied (p=0.03. 0.012 and 0.004, respectively). Moreover, ductal injury was only significant when a dose of 5ml of 5% EO was used (p=0.034). This dose and concentration (i.e. 5ml-5% EO) had a significant synergetic effect [p=0.0119].

CONCLUSION

In this model, treatment with EO proved to permanently reduce the acinar area through induction of progressive, irreversible and dose dependant scarring (medical sialoadenectomy).

Efficacy of irinotecan in combination with 5-fluorouracil (FOLFIRI) for metastatic gastric or gastroesophageal junction adenocarcinomas (MGA) treatment

OBJECTIVES

The most commonly used schedules are 5-FU in combination with CDDP with or without epirubicin (ECF) or docetaxel (TCF) in treatment of MGA patients (pts), independently of HER status. We evaluated the efficacy of FOLFIRI regimen in a large retrospective series of MGA pts.

METHODS

Two hundred and twelve pts from 13 French centers were treated with at least one cycle of FOLFIRI (irinotecan 180 mg/m2 intravenous (i.v.) over 90 minutes on day 1 with folinic acid (FA) 400mg/m2 i.v. over two hours followed by 5-FU 400mg/m2 i.v. bolus then 5- FU 2400 mg/m2 continuous infusion over 46 hours on day 1, repeated every 14 days). Primary tumour sites were 120 (58%) stomach and 92 (42%) gastroesophageal junction. FOLFIRI was administered as first-line in 137 (65%) pts and as later-line in 75 (35%) pts for MGA.

RESULTS

There was no difference between chemonaive and not chemonaive pts treated as firstline in terms of response rate 37% (95% CI: 25-50) vs 44% (95% CI: 21-69), median PFS, 6.7 (95% CI: 5.5-9.9) vs 5.3 months (95% CI: 3.6-6.9) (P = 0.25), and OS, 13.1 (95% CI: 11.7-18.7) vs 8.8 months (95% CI: 7.3—15.6) (P = 0.19), respectively. There was no difference between pts treated as second or later-line in terms of response rate 20% (95% CI: 8-39) vs 22% (95% CI: 6-48), median PFS, four months (95% CI: 2.8-5.4) vs 3.5 months (95% CI: 2.3-4.5) (P = 0.56), and OS, 10.4 months (95% CI: 5.4-14.4) vs 5.3 months (95% CI: 3.5-11.3) (P = 0.58), respectively. The global grade 3-4 toxicities were: diarrhea 11%, vomiting 9%, neutropenia 18%, febril neutropenia 4% (one toxic death).

CONCLUSIONS

This retrospective study confirms the activity and good tolerance of FOLFIRI regimen in MGA as first-line as well as later-line.

Hepatitis C virus induces nasal epithelial erosion and sub-epithelial rhinitis

BACKGROUND

Hepatitis C virus (HCV) affects extra-hepatic organs, but its effect on the nose is poorly defined.

OBJECTIVES

To investigate the histological changes in nasal tissue induced by HCV and whether the nasal mucosa harbors the virus for extrahepatic replication.

STUDY DESIGN

We investigated nasal biopsies from 20 patients with HCV infection, and from 10 control subjects. All biopsies were subjected to real time polymerase chain reaction (RT-PCR) as well as histology.

RESULTS

Our analyses showed that 60% of HCV positive samples showed nasal epithelial erosion, 95% showed subepithelial non-specific inflammation and/or fibrosis, while only 5% showed normal histology. However, none of the twenty PCR samples showed the presence of HCV nucleic acids sequences in the nasal tissues. On the other hand, all control subjects had normal histology and the absence of the viral m-RNA in the PCR (100%).

CONCLUSIONS

HCV induces histopathological rhinitis with nasal epithelial erosion. However, it does not seem that the nasal tissue harbors the virus.

[Pitfalls in diagnosis and treatment of periodontal diseases]

In the present article the complex aetiology of periodontal diseases is explained. Furthermore risk factors are identified for making mistakes in diagnosis and failing treatment of periodontal infections. This includes patient and treatment factors such as incomplete anamnesis, improper screening and documentation as well as insufficient plaque and smoking control, improper use of antibiotics and insufficient pocket-elimination and maintenance care. The use of a strict diagnostic and treatment protocol including evaluation is emphasized in order to obtain optimal treatment results. Patients should minimally expect to be regularly screened by their dentist or dental hygienist for periodontal diseases, to be informed about the further diagnostic steps and possible treatment options and to get periodontal care organised. Providers of oral health care can, in this way, reduce the risk of negligent practice and significantly limit their liability.

[Strength in numbers: illness-causing biofilms]

Microbial infections constitute an important reason for medical treatment, especially in dentistry. Ideas about the role played by bacteria in the development of diseases have changed steadily during the past centuries. At the present time much attention is being devoted to the role of biofilms due to their illness-causing influence with respect to stitches on hard tissue and on oral implants, knee-, hip-, and voice prostheses. In biofilms, bacteria function and communicate in organized extrapolymeric structures, attached to a surface. Biofilms provide bacteria with protection against the host's immune system and antibacterial chemicals. By gaining insights into the creation and functioning of biofilms, it will be possible to develop better antibacterial therapies.

Java project on periodontal diseases: a study on transmission of Porphyromonas gingivalis in a remote Indonesian population

AIM

To study transmission of Porphyromonas gingivalis in a population living in a remote area in Southern Java, Indonesia.

MATERIAL AND METHODS

Subgingival plaque samples from 167 subjects with varying degrees of periodontal breakdown were obtained and cultured for the presence of P. gingivalis. After extraction and purification of bacterial DNA, amplified fragment length polymorphism technique was applied to genotype the bacterial isolates. Computer-assisted analysis of the bacterial DNA profiles was used to study distribution of P. gingivalis genotypes within family units.

RESULTS

One hundred and five of the 167 (63%) subjects were culture positive for P. gingivalis. In total, 371 P. gingivalis isolates were obtained from the 105 subjects. Of the 105 subjects, 30 were siblings representing 13 families. In six of the 13 families (46%), identical P. gingivalis genotypes were found among siblings. In the study group of 105 subjects, 13 married couples were identified of which both spouses were culture positive for P. gingivalis. None of the 13 couples shared an identical P. gingivalis genotype. Twenty P. gingivalis-positive subjects had spouses that were culture negative for P. gingivalis.

CONCLUSIONS

In this study population, vertical transmission of P. gingivalis has occurred within family units, most likely from parents to children. Transmission of P. gingivalis between spouses could not be established.

Java project on periodontal diseases: the relationship between vitamin C and the severity of periodontitis

OBJECTIVE

To study the relationship between vitamin C and the severity of periodontitis.

MATERIAL AND METHODS

The study population consisted of subjects from the Malabar/Purbasari tea estate on West Java, Indonesia. In 2002, clinical measurements were performed in 128 subjects, including evaluation of plaque, bleeding on probing, pocket depth and attachment loss. In 2005, 123 out of 128 subjects could be retrieved who were present at the examination of 2002. Blood samples were taken to measure plasma vitamin C levels. Information about the subject's dietary habit was obtained by means of a personal interview guided by a questionnaire.

RESULTS

Plasma levels of vitamin C ranged from 0.02 to 34.45 mg/l with a mean of 7.90 mg/l (+/-5.35). The correlation coefficient between plasma vitamin C level and periodontal attachment loss was -0.199 (p<0.05); stepwise linear regression revealed that vitamin C levels explained 3.9% of the variance in periodontal attachment loss. Subjects with vitamin C deficiency (14.7% of the study population) had more attachment loss compared with those with depletion or normal plasma vitamin C values.

CONCLUSION

The negative association between plasma vitamin C levels and periodontal attachment loss suggests that vitamin C deficiency may contribute to the severity of periodontal breakdown.

Java project on periodontal diseases. The natural development of periodontitis: risk factors, risk predictors and risk determinants

OBJECTIVE

To identify risk factors, risk predictors and risk determinants for onset and progression of periodontitis.

MATERIAL AND METHODS

For this longitudinal, prospective study all subjects in the age range 15-25 years living in a village of approximately 2000 inhabitants at a tea estate on Western Java, Indonesia, were selected. Baseline examination was carried out in 1987 and follow-up examinations in 1994 and 2002. In 2002, 128 subjects could be retrieved from the original group of 255. Baseline examination included evaluation of plaque, bleeding on probing, calculus, pocket depth, attachment loss and presence of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, spirochetes and motile microorganisms.

RESULTS

The mean attachment loss increased from 0.33 mm in 1987 to 0.72 mm in 1994 and 1.97 mm in 2002. Analysis identified the amount of subgingival calculus and subgingival presence of A. actinomycetemcomitans as risk factors, and age as a risk determinant, for the onset of disease. Regarding disease progression, the number of sites with a probing depth > or = 5 mm and the number of sites with recession were identified as risk predictors and male gender as a risk determinant.

CONCLUSION

Screening of these parameters early in life could be helpful in the prevention of onset and progression of periodontal diseases.

[Links between periodontal disease and general health. 1. Pneumonia and cardiovascular disease]

The possible link between oral and general health is based on an old concept. This paper summarizes current ideas on the role of translocation of oral pathogens to other parts of the body in the development of systemic disease. It appears that colonisation of the oral cavity by respiratory pathogens is a risk factor in the development of pneumonia in institutionalised elderly and intensive care patients. Using a chloorhexidine oral rinse may reduce the risk of pneumonia. Furthermore, periodontal disease is associated with an increased risk of cardiovascular disease. Translocation of oral microorganisms and an increase in serum concentrations of inflammatory mediators are considered to play a role in the development of cardiovascular disease. Potentially, preventive oral health care and periodontal intervention could play a part in preventing cardiovascular disease.

[Incidence of cardiovascular events in giant cell arteritis: preliminary results of a prospective double cohort study (GRACG)]

Giant cell arteritis is the most frequent vasculitis. Cardiovascular events such as cerebrovascular accident or ischemic heart disease may occur in patients with giant cell arteritis. However, their real incidence, as well as their relative risk compared to the general population, remains unknown.

PURPOSE

To assess in a prospective, double cohort study, the incidence of cardiovascular events in giant cell arteritis patients compared to controls, after controlling for cardiovascular risk factors.

PATIENTS AND METHODS

We included on predefined criteria 432 newly diagnosed patients with giant cell arteritis, each assigned to sex- and age-matched controls randomly selected from the general population. Cardiovascular risk factors (high-blood pressure, diabetes, smoking, hypercholesterolemia and preexisting peripheral vascular disease) were collected at inclusion. During the 24-month follow-up, all cardiovascular events were collected. After stratification for cardiovascular risk factors, a log-rank test was performed to compare cases and controls. A parametric survival model was used for multivariate analysis.

RESULTS

Cardiovascular events all combined were significantly increased in patients with giant cell arteritis (RR = 2.15 [1.21-3.81], P = 0.009), and were mainly associated with age (P = 0.0001), past history of cardiovascular disease (P = 0.023) but also with giant cell arteritis (P = 0.009). However, each subset of cerebrovascular accident (RR = 2.42 [0.84-7]) or ischemic heart disease (RR = 1.67 [0.72-3.89]) increased but did not significantly.

CONCLUSION

Cardiovascular events incidence is increased in patients with giant cell arteritis, and prescription of preventive antiagregant treatment may be discussed.

The combined use of enamel matrix proteins and a tetracycline-coated expanded polytetrafluoroethylene barrier membrane in the treatment of intra-osseous defects

OBJECTIVES

The purpose of this split-mouth study was to evaluate the clinical response of enamel matrix proteins (EMPs, Emdogain Gel in intra-osseous defects with or without a combined application of a tetracycline-coated expanded polytetrafluoroethylene barrier membrane (e-PTFE, Gore-Tex).

METHODS

Twelve pairs of intra-osseous periodontal defects in 11 patients received the application of EMPs on the exposed root surface (EMP). One of the two defects received randomly, as an adjunct to EMP treatment, a tetracycline-coated e-PTFE membrane (MEMP). At baseline, 6- and 12-month probing pocket depth (PPD), clinical attachment level (CAL) and probing bone level (PBL) were measured.

RESULTS

After 12 months, the EMP defects showed a significant mean PPD reduction of 2.86+/-0.75 mm, a mean gain in CAL of 1.28+/-2.04 mm, a mean PBL gain of 1.63+/-1.21 mm and a mean increase of recession (REC) of 1.56+/-2.30 mm. The MEMP defects showed a significant mean PPD reduction of 3.02+/-1.55 mm, a mean gain in CAL of 1.65+/-1.29 mm, a mean PBL gain of 1.58+/-1.92 mm and a mean increase of REC of 1.38+/-1.63 mm. Except for significantly more post-operative discomfort at the MEMP sites, no significant differences were found between EMP and MEMP defects.

CONCLUSION

Within the limits of this study, it is concluded that in the treatment of intra-osseous defects with EMP, the adjunctive use of a tetracycline-coated e-PTFE membrane failed to show more gain of CAL and PBL.

[Impact of antibiotics on the indication for periodontal surgery]

The present paper describes the use of oral antibiotics in the treatment of severe periodontitis based on the composition of the subgingival flora. Antimicrobial therapy is applied within the concept of the three basic steps in periodontal treatment. It is demonstrated in the literature that the use of antibiotics based on clinical and microbiological parameters, can reduce the need of periodontal access surgery. Proper infection control is also related to favourable outcome of regenerative periodontal procedures and periodontal plastic surgery. Therefore, the proper use of antibiotics may result in a shift in indication for different modalities of periodontal surgery.

Role of estrogens in the secondary hormonal manipulation of hormone refractory prostate cancer

OBJECTIVE

To evaluate the role of Estrogens (Honvan) in the secondary hormonal manipulation of patients with hormone refractory prostate cancer (HRCP).

METHODS

Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days (Fosfestrol, a synthetic phosphorylated estrogen derivative), followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen (PSA) level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were recorded. The morbidity and mortality of the treatment was also recorded. A drop in PSA of > 50% was classified as major responder. The drop of < 50% was defined as minor responders. Treatment failure was defined as a rise in PSA > the level prior to the start of treatment.

RESULTS

The mean age at diagnosis of prostate cancer was 66.6 + 5.4 years (range 57-73). At the time of initial diagnosis only 3 patients (25%) had localized disease and 9 (75%) had metastatic prostate cancer. Six patients each opted for surgical or medical castration (LHRH analogs) as the mode of androgen ablation. The mean initial PSA at diagnosis was 340 + 728.1 ng/ml (range 4.1-2375, Median 94). After development of HRPC, six patients (50%) had major response, four (33%) had minor response to estrogen administration. Two patients (17%) did not respond to estrogens. The mean PSA before receiving Fosfestrol was 60.5 + 82 ng/ml (range 0.013-246). The PSA (nadir) after treatment was 24.3 +/- 33.2 ng/ml (range 0.9-81.3). One patient developed gynaecomastia and one had congestive cardiac failure. Two patients died of non cancer related deaths and one patient died of cancer related death.

CONCLUSION

Synthetic estrogens are well tolerated, in-expensive agents and could be considered for palliative use against hormone resistant prostate cancer.

The prevalence of silent kidney stones--an ultrasonographic screening study

OBJECTIVE

Silent and not yet discovered stones of the upper urinary tract are potentially dangerous, since in due course they may cause infection, obstruction and renal damage. The aim of this study was to determine the prevalence of such silent kidney stones in a representative Pakistani population of Karachi.

SUBJECTS AND METHODS

We studied 201 consecutive subjects at our hospital who underwent additional kidney screening whilst undergoing abdominal ultrasound. All these subjects did not have a history or symptoms of urolithiasis.

RESULT

We found silent kidney stones in 3% of subjects. All stone bearers were males. Most stones were in the left kidney. Notably, multiple stones and stones of a considerable size went unnoticed.

CONCLUSION

In addition to the usual figures of incidence and prevalence of stone disease drawn from patient data, there is a prevalence of 3% silent stones that may only be discovered incidentally or by screening. This is true for a "'stone country" like Pakistan. Figures for other regions have yet to be determined. Due to socioeconomic reasons, we believe that a general kidney screening for urolithiasis is, however, not indicated, at least in our country.

Health issues in ethnic minorities: awareness and action

A key issue in health provision is the approach to health inequalities. In the UK, black and ethnic minority populations are disadvantaged in this respect. We obtained annual/public health reports from 13 health authorities (HAs) and 22 primary care trusts/groups (PCT/Gs) serving conurbations with large black and ethnic minority populations, and examined them for mention of special health issues for these groups and the action being taken. 22 of the 35 reports referred to such issues but only 17 referred to special initiatives; the most frequently mentioned were diabetes and coronary heart disease. We recommend that HAs and PCT/Gs serving large black and ethnic minority populations state specifically in their annual reports their awareness of health-equality issues and the action being taken to address them.

Early surgical results with intent to treat by radical retropubic prostatectomy for clinically localized prostate cancer

AIMS

To evaluate the early cancer control rates, morbidity and mortality in men undergoing radical retropubic prostatectomy (RRP) for clinically localized adenocarcinoma prostate.

METHODS

Patient's characteristics, operative data, progressive-free survival rates, morbidity and mortality were analyzed for 23 men with clinical T1-2 prostate cancer who underwent surgery with an intent to treat by RRP between December 1997 to July 2001.

RESULTS

Patient's mean age was 63 +/- 6.2 years (range 51 to 76 years) with American Society of Anesthesiology (ASA) status I in 4%, II in 65% and III in 31%. Two third of the patients had lower urinary tract obstructive symptoms, followed by hematuria (9%) and back pain (4%). Clinical stages were T1b in 4%, T1c in 9%, T2a in 17%, T2b in 22% and T2c in 48% of the patients. Mean pre-operative serum prostate specific antigen (PSA) was 25 +/- 29 ng/ml (1.1 to 99.3). Bilateral pelvic lymphnode disection(PLND) and RRP was performed in 20 cases (nerve-sparing RRP 5 cases). In 3 cases with gross lymph node metastasis at frozen section, only bilateral orchidectomy was done. The mean operative time was 270 +/- 65 minutes and mean blood loss was 1097 +/- 654 mls. Packed cell transfusions were nil in 26%, 1-2 units in 44%, 3-4 units in 26% and 5 units in 4% of the patients who underwent RRP. The mean length of hospital stay was 10.2 +/- 1 days. Out of 20 patients who underwent RRP, 65% of tumors were confined to the specimen, 20% had seminal vesicle invasion and 15% had nodal metastasis. There was no peri-operative mortality while 2 patients developed epididymo-orchitis and 1 had myocardial ischemia (without infarction). Overall 87% of the patients were fully continent and 13% had mild to moderate stress urinary incontinence. The mean time of return of continence was 11.5 +/- 11.6 weeks. Two of the 3 patients (66%) with follow up information and having undergone nerve-sparing RRP are potent. At a mean follow up of 19.4 +/- 13 months (range 3-45 months), 20 of 23 total patients (87%) and 17 of 20 RRP patients (85%) remained free of disease recurrence with PSA < or = 0.4 ng/ml.

CONCLUSION

Our early results confirm the excellent potential for cancer control and low morbidity of radical prostatectomy for men with localized prostate cancer. These results are in conformity with the vast Western experience. Long-term results will be provided.