Impact of parental attributes on the oral health-related quality of life of Brazilian preschool children

PURPOSE

Considering the importance of parental attitudes and their influence on children's oral health, it is important to know which characteristics may impact it. The aim of this population study was to evaluate the impact of the parental sociodemographic characteristics on the oral health-related quality of life (OHRQoL) of preschool children from southeastern Brazil.

METHODS

A population-based study was conducted with a sample of 321 children aged 2 to 5 years old who underwent a calibrated clinical oral examination to assess oral health status and their parents were asked to answer the two following questionnaires: (1) sociodemographic conditions and (2) Brazilian version of the Early Childhood Oral Health Impact Scale (B-ECOHIS). Descriptive analysis, Mann-Whitney and Kruskal-Wallis tests and adjusted Poisson regression models were used.

RESULTS

Younger mothers (RP: 1.47; 95% CI: 1.11-1.95), lower household income (RP: 1.47; 95% CI: 1.11-1.96) and the presence of dental caries (RP: 2.28; 95% CI: 1.74-3.0) were more likely to have a negative impact on the OHRQoL B-ECOHIS total scores (P < 0.01).

CONCLUSION

The characteristics of mothers, such as age, schooling and salary, influenced the mean B-ECOHIS total score; however, paternal attributes were not associated with a negative impact on the children's quality of life. Also, dental caries and household income influenced the children's oral health-related quality of life.

Conjugated linoleic acid trans-10, cis-12 increases the expression of genes from cell cycle progression and cis-9, trans-11 stimulates apoptotic genes in different mammary tumor explants of female dogs

BACKGROUND

The conjugated linoleic acid (CLA) isomer cis-9, trans-11 is an anticarcinogen that inhibits cell proliferation and/or induces apoptosis of tumor cells. The objective of this study was to evaluate the expression of genes responsible for cell cycle regulation and apoptosis in tumor explants of mammary anaplastic carcinoma (AC) and mammary tubulopapillary carcinoma (TC) cultured in vitro with the CLA isomers cis-9, trans-11 and trans-10, cis-12.

METHODS

In this study we used mammary explants from two adult female dogs that revealed two types of malignant tumors: (a) anaplastic mammary carcinoma (AC) and (b) mammary tubulopapillary carcinoma (TC). The explants (n = 6 per treatment) had an average weight of 80.0 ± 2.0 mg and were cultured for 24 h in 35 mm culture plates under the following treatments: (a) Control: Culture medium + fatty acid free bovine serum albumin (BSA); (b) Culture medium + cis-9, trans-11 CLA (75 µM) diluted with fatty acid free bovine serum albumin (BSA), and; (c) Culture medium + trans-10, cis-12 CLA (75 µM) diluted with fatty acid free bovine serum albumin (BSA). After that, total RNA was extracted, complementary DNA was synthesized (cDNA), and quantitative analysis by real-time polymerase chain reaction (RT-qPCR) was conducted. Data were analyzed using the MIXED procedure of SAS.

RESULTS

Compared with the Control, the CLA trans-10, cis-12 treatment decreased expression of the gene encoding the p53 by 20% (P = 0.02), Caspase-3 by 25% (P = 0.06) and Bax by 51% (P = 0.001) in AC. The CLA cis-9, trans-11 increased the gene expression of proapoptotic protein Bax in TC by 68% (P = 0.01), but increased the expression of the antiapoptotic Bcl2 gene in AC by 72% (P = 0.006).

CONCLUSION

The CLA cis-9, trans-11 stimulates apoptotic genes in mammary tubulopapillary carcinoma, but has a contrary effect on the anaplastic carcinoma, and the CLA trans-10, cis-12 stimulates cell cycle progression genes and may have an antiapoptotic effect, mainly in mammary anaplastic carcinoma.

Postoperative Endodontic Pain after Treatment Using XP-endo Finisher: A Randomized Clinical Trial

Introduction

This randomized clinical trial aimed to determine whether the XP-endo finisher combined with or without foraminal enlargement has any significant effect on the incidence and intensity of postoperative pain in necrotic pulps.

Materials and Methods

Clinical pain levels were measured after 6, 12, 24, 48, and 72 hours and at 7 postoperative days. All treatments were performed by an endodontist in a single visit. One hundred and twenty patients were included. All patients had a single tooth treated. The patients were divided into four groups: No FE (None Foraminal Enlargement) (n=30), FE (Foraminal Enlargement) (n=30), No FE+XPF (None Foraminal Enlargement+XP-endo Finisher) (n=30) and XPF+FE (XP-endo Finisher and Foraminal Enlargement) (n=30). The canals were irrigated with sodium hypochlorite, shaped using WaveOne Gold Medium file, and then filled by using a matching single cone and AH-Plus sealer. The cavity was filled using glass ionomer cement. Pain intensity was assessed using the visual analog scale. The data were analyzed with the ANOVA and Games-Howell test. The significance level was 5%.

Results

The XPF+FE group experienced a higher level of pain, being classified on the visual analog scale as moderate for 48 postoperative hours and mild for 7 postoperative days (P<0.05). In the other groups, the pain was mild, only with different time intervals (P>0.05).

Conclusions

Foraminal enlargement associated with XP-endo Finisher may cause moderate postoperative pain.

Sinonasal melanoma: a systematic review of the prognostic factors

The objective was to evaluate the available published data on sinonasal melanoma and analyse its clinical features, treatment modalities, and prognostic factors. An electronic search was undertaken in March 2018 in multiple databases. Eligibility criteria included publications with sufficient clinical, histological, and immunohistochemical information to confirm the diagnosis. Seventy-three publications (439 cases) were included. The lesion was more prevalent in females than in males. There was a higher prevalence in the seventh and eighth decades of life. The lesions mainly presented as epistaxis and commonly involved the nasal cavity. Age (>67.6 years; P=0.0012), primary location (middle turbinate; P=0.0112), disease stage (advanced disease stage; P=0.0026), treatment (radiotherapy; P=0.0111), recurrence (recurrence presented; P=0.0137), and distant metastasis (distant metastasis presented; P=0.0011) were independently associated with a lower survival rate. Recurrence was significantly correlated with age (>67.6 years; P=0.0021), sex (males tended to present a higher recurrence rate than females; P=0.0051), disease stage (stages III and IV presented a higher recurrence rate than stages I and II; P=0.0331), and histological type (amelanotic lesions presented a higher index of recurrence than melanotic lesions; P=0.0095). In conclusion, sinonasal melanoma is a neoplasm with a poor prognosis, presenting a 30.69% possibility of survival after 5 years.

Influence of Different Irrigation Solutions and Instrumentation Techniques on the Amount of Apically Extruded Debris

OBJECTIVE

The objective of the present study was to evaluate the influence of different irrigation solutions on the amount of extruded residues apically, varying the instrumentation technique in manual, continuous rotation, or reciprocation motions. The amounts of residue for each irrigation solution was also assessed.

METHODS

Two tests were performed. In the first test, 90 mandibular premolars were divided into nine groups (n=10). Each group was subjected to a different technique: ProTaper Universal, WaveOne Gold, or manual instruments, with different irrigation solutions [2.5% sodium hypochlorite (NaOCl), 2% chlorhexidine (CHX) gel, or distilled water]. During the preparation of the root canal, the apically extruded material was collected in previously weighed glass vials. In the second test, irrigation solutions were weighed separately with the same weighing method. Data were analyzed using the Kolmogorov-Smirnov, one-way and two-way ANOVA, Levene, Tukey, and Games-Howell tests.

RESULTS

Apically extruded debris was observed in all groups. ProTaper Universal with continuous rotation using 2% CHX gel resulted in the greatest amount of debris (P<0.001). There were significant differences in the amounts of residue among the different groups (P<0.001). Moreover, when the weighing of the irrigation solutions was tested, the 2.5% NaOCl solution produced the greatest amount of residues compared with other irrigation solutions.

CONCLUSION

Different irrigation solutions influenced the amount of apically extruded debris during the preparation of the canal among the different instrumentation techniques. The ProTaper technique using 2% CHX gel resulted in the greatest amount of apically extruded debris.

Methicillin-resistant Staphylococcus aureus in HIV patients: risk factors associated with colonization and/or infection and methods for characterization of isolates - a systematic review

Staphylococcus aureus is an important cause of infections and HIV-infected individuals are frequently susceptible to this pathogen. The aim of this study was to perform a systematic review to identify both the risk factors associated with colonization/infection by methicillin-resistant S. aureus in HIV patients and the methods used for characterization of isolates. An electronic search of articles published between January 2001 and December 2013 was first conducted. Among 116 studies categorized as being at a quality level of A, B or C, only 9 studies were considered to have high methodological quality (level A). The majority of these studies were retrospective (4/9 studies). The risk factors associated with colonization/infection by S. aureus were use of antimicrobials (4/9 studies), previous hospitalization (4/9 studies) and low CD4+ T lymphocyte counts (<200 cells/μl) (3/9 studies). Culture in mannitol salt agar (3/9 studies) and the latex agglutination test (5/9 studies) were the main methods used for bacterial phenotypic identification. Genotypic profiles were accessed by pulsed-field gel electrophoresis (6/9 studies) and USA300 was the most prevalent lineage (5/9 studies). Most isolates were resistant to erythromycin (3/9 studies) and susceptible to vancomycin (4/9 studies). Ultimately, use of antimicrobials and previous hospitalization were the main risk factors for colonization/infection by methicillin-resistant S. aureus in HIV-infected individuals. However, the numbers of evaluated patients, the exclusion and inclusion criteria and the characterization of the S. aureus isolates were not uniform, which made it difficult to establish the characteristics associated with HIV patients who are colonized/infected by S. aureus.

A PROMOÇÃO DO BRINCAR NO CONTEXTO DA HOSPITALIZAÇÃO INFANTIL COMO AÇÃO DE ENFERMAGEM: RELATO DE EXPERIÊNCIA

Trata-se de um relato de experiência de atividade realizada com alunos de graduação em Enfermagem, no período de setembro a dezembro de 2006, durante o estágio curricular. O objetivo foi discorrer sobre mudanças implantadas em uma unidade de cirurgia pediátrica de um hospital Universitário. Percebeu-se a necessidade de realizar algumas modificações no ambiente físico, afim de que as crianças pudessem passar pela internação com menos sofrimento, diminuindo os riscos de traumas decorrentes da hospitalização. Para isso dez salas da unidade foram remodeladas. Figuras adesivas e laváveis foram afixadas em vários locais, caixas foram encapadas, um painel colorido foi elaborado na parede de uma sala de procedimentos. No refeitório, estabeleceu-se a brinquedoteca. Nos intervalos das refeições, a sala transforma-se em uma brinquedoteca capaz de atender as crianças da unidade. O ambiente ficou mais colorido e alegre, colocando vida em paredes e objetos que fazem parte da rotina diária da criança hospitalizada.

Evaluation of the MRSA-Screen Test in detecting oxacillin resistance in community and hospital isolates of Staphylococcus aureus

The MRSA-Screen Test (Denka Seiken Co., Japan), a latex agglutination test to detect penicillin-binding protein 2a, was compared with PCR for the detection of oxacillin resistance in Staphylococcus aureus. A total of 77 oxacillin-sensitive and 269 oxacillin-resistant (ORSA) isolates were evaluated. Of the ORSA isolates, 186 were non-multiresistant (NORSA), defined as being resistant to two or fewer antibiotics other than beta-lactams. Eighty-three were multiresistant ORSA (MORSA) strains. If PCR is considered the gold standard test, then the sensitivity, specificity, positive and negative predictive values of the MRSA-Screen Test were 100, 99, 99 and 100%, respectively. The endpoint was hard to read with NORSA strains that took longer than 60 s to react. MORSA strains took a median 12 s (range 5-60 s) to give a positive reaction with the MRSA-Screen Test, whereas NORSA strains took a median 30 s (range 5-180 s), a difference which was significantly different (P < 0.0001, two-tailed Mann-Whitney unpaired two sample test). NORSA strains had an MIC50 of 128 mg/l and MIC90 of 256mg/l, whereas MORSA strains had an MIC50 and MIC90 of >256mg/l. The time that the MRSA-Screen Test took to agglutinate with ORSA strains correlated weakly with the MIC (r2 = 0.26). Detection of methicillin resistance cost AUD$9 per isolate with the MRSA-Screen Test, compared with AUD$13 per isolate with mecA PCR. The MRSA-Screen Test gave excellent sensitivity and specificity, and was quicker and cheaper than PCR. The full 3 min should be allowed to elapse before calling a test negative. Organisms giving indeterminate reactions should be tested for the mecA gene by PCR.

[Infective endocarditis in adolescents. Analysis of risk factors for hospital mortality]

PURPOSE

To study the epidemiological, clinical, therapeutic and evolutive aspects of endocarditis in a group of patients aging 12 to 20 years-old (mean 15.5).

METHODS

Thirty-three consecutive patients (14 males, 19 females) admitted with infective endocarditis were retrospectively studied.

RESULTS

Infective endocarditis mortality was 42%. Rheumatic heart disease was the predominant underlying condition in 63% of patients. Congenital heart disease (24%) and cardiac prosthesis (12%) were the other affections involved. The majority of patients (78%) were in functional class III and IV, with more deaths than the 22% who were in functional class I and II (p = 0.01). Staphylococcus aureus was the most frequently isolated agent (42% of the positive blood cultures, followed by Staphylococcus viridans, 21%). Multivariate analysis identified total leukocyte count above 10,000/mm3 and functional class, both at admission (p = 0.01 and p = 0.004, respectively), and the occurrence of embolic complications (p = 0.03) as independent predictors of in-hospital mortality.

CONCLUSION

Rheumatic heart disease remains, as in adults, the main predisposing factor for infective endocarditis in adolescents, and S. aureus is, like in children, the leading agent. Mortality is high and functional class at hospital admission, embolic complications and leukocytosis are independent predictors of in-hospital mortality.

Comparative recovery of 50-Hz and 100-Hz posttetanic twitch following profound neuromuscular block

STUDY OBJECTIVE

To determine if posttetanic twitch following 100-Hz tetanic stimulation enables titration of a nondepolarizing relaxant infusion to a greater depth of block than that achieved with posttetanic twitch following 50 Hz.

STUDY DESIGN

Prospective, observational study.

SETTING

Operating rooms of a university tertiary care center.

PATIENTS

10 ASA physical status II and III patients free of known neuromuscular disease and undergoing general endotracheal anesthesia for routine elective surgery.

INTERVENTIONS

Following induction of general anesthesia, neuromuscular block was maintained with a continuous intravenous vecuronium infusion. Depth of neuromuscular block was assessed by tactile evaluation of the evoked responses of the adductor pollicis muscle following supramaximal stimulation of the ulnar nerve via surface electrodes. The vecuronium infusion was titrated to loss of posttetanic twitch following 100-Hz tetanic stimulation, at which point the infusion was discontinued.

MEASUREMENTS AND MAIN RESULTS

100-Hz tetanic stimulation was repeated every two minutes until recovery of the first posttetanic twitch, at which point 50-Hz tetanic stimulation was repeated every two minutes until recovery of the first posttetanic twitch. The median time (interquartile range) from discontinuation of the vecuronium infusion to recovery of the first posttetanic twitch following 100-Hz tetanic stimulation was 27% faster than the corresponding time to recovery of the first posttetanic twitch following 50-Hz tetanic stimulation [19 (10 to 24) min and 26 (20 to 30) min respectively, p < 0.002].

CONCLUSIONS

Posttetanic twitch following 100-Hz tetanic stimulation enables titration of a vecuronium infusion to a greater depth of block than posttetanic twitch following 50-Hz tetanic stimulation. The present findings should enable more effective titration of this relaxant, thereby reducing the likelihood of unwanted patient movement or unduly prolonged recovery due to relaxant overdosing.

Parental presence during induction of anesthesia: the surgeon's perspective

Parental presence during induction of anesthesia (PPIA) remains controversial and little is known about surgeons' attitudes toward this clinical practice. A questionnaire was mailed to all the United States (US) members of the Surgical Section of the American Academy of Pediatrics and all members of the British Association of Paediatric Surgeons. Questions were asked about attitudes toward PPIA in the operating room and the prevalence of such practice. A total of 275 subjects, constituting 72.4% of the compared groups, responded after three mailings. Sixty percent of the US respondents and 95% of the Great Britain (GB) respondents said they disagree with the statement "parents should never be present during induction of anesthesia". Ninety-two percent of the GB respondents and 69% of the US respondents thought PPIA decreases anxiety (p = 0.001) and increases the cooperation of the child (86% GB, versus 53% US, p = 0.001). Most US respondents (72%) reported that PPIA occurs in less than 25% of their cases, but most GB respondents (80%) reported PPIA in more than 75% of their cases (p = 0.001). These differences in prevalence persisted after logistic-regression models were used to adjust for potential confounding demographic variables. We conclude that the attitudes and practice toward PPIA held by surgeons from the US and GB differ significantly. While a large percentage of the US sample agree that there are benefits in PPIA, only a minority report the routine use of PPIA in contrast to most respondents from GB who report PPIA as routine in their hospital.

[Beta-hemolytic streptococcus endocarditis in an adolescent with hypertrophic cardiomyopathy]

A 15 year-old male adolescent was hospitalized in a severe septic condition, due to infectious endocarditis which abided for 20 days. The admittance echocardiogram displayed a mitral valve vegetation in conjunction to a hypertrophic cardiomyopathy. In spite of applied antibiotics the patient expired. The authors emphasize the diagnostic difficulties of this compound entity and stress the need of antibiotic prophylaxis for patients who bear a hypertrophic cardiomyopathy, even in those with a non-obstructive disposition.