Medical and Dental Electronic Health Record Reporting Discrepancies in Integrated Patient Care

Introduction:

Oral health mirrors systemic health; yet, few clinics worldwide provide dental care as part of primary medical care, nor are dental records commonly integrated with medical records.

Objectives:

To determine the degree to which misreporting of underlying health conditions poses problems for dental clinicians, we assessed misreporting of 2 common medical health conditions—hypertension and diabetes—at the time of dental examination and assessment.

Methods:

Using comparative chart analysis, we analyzed medical records of a diverse group of patients previously seen at the University of Texas Physician outpatient practice and then treated at the University of Texas Health Science Center at Houston School of Dentistry. Electronic health records of patients aged ≥18 y were extracted from 2 databases: Allscripts (University of Texas Physician) and axiUm (University of Texas Health Science Center at Houston). We identified 1,013 patients with the commonly occurring conditions of diabetes, hypertension, or both, with nonintegrated records contained in Allscripts and axiUm. We identified the percentage of those patients previously diagnosed with diabetes and/or hypertension by their physicians who failed to report these conditions to their dental clinicians.

Results:

Of those patients with diabetes, 15.1% misreported their diabetes condition to their dental clinicians, while 29.0% of patients with hypertension also misreported. There was no relationship between sex and misreporting of hypertension or diabetes, but age significantly affected reporting of hypertension, with misreporting decreasing with age.

Conclusions:

Because these conditions affect treatment planning in the dental clinic, misreporting of underlying medical conditions can have negative outcomes for dental patients. We conclude that policies that support the integration of medical and dental records would meaningfully increase the quality of health care delivered to patients, particularly those dental patients with underlying medical conditions.

Knowledge Transfer Statement:

Our study illustrates an urgent need for policy innovation within a currently fragmented health care delivery system. Dental clinicians rely on the accuracy of health information provided by patients, which we found was misreported in ~15% to 30% of dental patient records. An integrated health care system can close these misreporting gaps. Policies that support the integration of medical and dental records can improve the quality of health care delivered, particularly for dental patients with underlying medical conditions.

Pluto's Interaction With Energetic Heliospheric Ions

Pluto energies of a few kiloelectron volts and suprathermal ions with tens of kiloelectron volts and above. We measure this population using the Pluto Energetic Particle Spectrometer Science Investigation (PEPSSI) instrument on board the New Horizons spacecraft that flew by Pluto in 2015. Even though the measured ions have gyroradii larger than the size of Pluto and the cross section of its magnetosphere, we find that the boundary of the magnetosphere is depleting the energetic ion intensities by about an order of magnitude close to Pluto. The intensity is increasing exponentially with distance to Pluto and reaches nominal levels of the interplanetary medium at about 190R _P distance. Inside the wake of Pluto, we observe oscillations of the ion intensities with a periodicity of about 0.2 hr. We show that these can be quantitatively explained by the electric field of an ultralow-frequency wave and discuss possible physical drivers for such a field. We find no evidence for the presence of plutogenic ions in the considered energy range.

Fermented Dairy Foods: Impact on Intestinal Microbiota and Health-Linked Biomarkers

The intake of fermented foods is gaining increasing interest due to their health-promoting benefits. Among them, fermented dairy foods have been associated with obesity prevention, and reduction of the risk of metabolic disorders and immune-related pathologies. Fermented foods could lead to these health benefits by providing the consumer with both easily metabolizable nutrients and beneficial microorganisms. Our aim was to evaluate the relationship between the consumption of fermented dairy products and the intestinal microbiota, serum lipid profile, and the pro-oxidant/inflammatory status. 130 healthy adults were evaluated. Dietary fermented food intake was assessed by an annual food frequency questionnaire (FFQ), including 26 fermented dairy products. Levels of the major phylogenetic types of the intestinal microbiota were determined by qPCR, and concentration of fecal short chain fatty acids were assessed by gas chromatography. Serum glucose and lipid profile, as well as serum malondialdehyde (MDA), C-reactive protein (CRP), and leptin levels were determined by standardized protocols. Among fermented dairy foods, natural yogurt, sweetened yogurt and matured/semi-matured cheese were the most consumed. While natural yogurt consumers showed increased fecal levels of Akkermansia with respect to non-consumers, sweetened yogurt intake was associated to lower levels of Bacteroides. Serum levels of CRP were also significantly reduced in yogurt consumers. Our results underline the interest in exploring the potential effects of the different yogurt types and the role the microbiota may play in such effects.

Impact of probiotics on development and behaviour in Drosophila melanogaster - a potential in vivo model to assess probiotics

In vitro models are frequently used in probiotic research. However, such models often fail to predict in vivo functionality and efficacy. This fact complicates the screening process for selecting the most suitable strains, prior to accomplish expensive animal studies and clinical intervention trials. Therefore, additional sensitive, discriminating and cost-effective models are needed to conduct preliminary assays before undertaking human intervention studies definitely proving efficacy. With this purpose in mind, we explored the potential of axenic Drosophila melanogaster populations as well as of these axenic flies treated with probiotic microbial strains as a model to test the effects of probiotics on a subset of developmental and behavioural traits. An axenic D. melanogaster progeny from the wild-type Canton S strain was obtained and its eggs were further developed until pupae eclosion occurred in growth medium containing either of two probiotic strains: Bifidobacterium animalis subsp. lactis Bb12 or Lactobacillus rhamnosus GG. Whereas B. animalis Bb12 colonised the flies, the capacity of L. rhamnosus LGG to colonise was considerably lower in our experimental conditions. Regarding the influence of microbial load on the flies' development, the axenic condition caused a decrease in egg survival, and lowered adults' average weight with respect to wild-type flies. Both probiotics were able to counteract these effects. An earlier emergence of adults was observed from eggs treated with L. rhamnosus GG in comparison to the other fly populations. The axenic condition did not influence negative geotaxis behaviour in Drosophila; however, flies mono-associated with B. animalis Bb12 moved faster than wild-type. Our results suggest that the use of axenic/probiotic-treated D. melanogaster populations may be an affordable model for preliminary testing of the effects of probiotics on developmental or behavioural aspects.

Sleeve pneumonectomy and carinal resection for management of primary adenoid cystic tumor of the lung with carinal extension: Report of two cases

Adenoid cystic carcinoma is a rare tumor of low frequency, low grade malignancy and slow growth originating from the major and minor salivary glands. Its primary pulmonary presentation is very rare, it can manifest with central airway obstruction and extensive lung involvement. Although it is slow growing, it has a tendency to local recurrence and late hematogenous metastases. The cornerstone of management consists in the complete resection of the tumor. Radiotherapy and adjuvant chemotherapy have been used in a limited number of patients with unsatisfactory results. Therefore, clinical judgment is of vital importance for early diagnosis and adequate selection of patients for surgical management. We present two cases of patients with primary pulmonary adenoid cystic tumor with invasion of the carina treated with sleeve pneumonectomy and carinal resection with adequate response to the intervention.

Real-time monitoring of HT29 epithelial cells as an in vitro model for assessing functional differences among intestinal microbiotas from different human population groups

Several in vitro screening tests have been used for selecting probiotic strains; however they often show low predictive value and only a limited number of strains have demonstrated functionality in vivo. The most used in vitro tests represent a very simplified version of the gut environment, especially since they do not consider the accompanying microbiota. Therefore, there is a need to develop sensitive and discriminating in vitro models including the microbiota. Here we developed an in vitro model to discriminate among microbiotas/fecal waters from different population groups. To this end samples were obtained from seven healthy adults, five IBD-patients, ten full-term and ten preterm newborns. Fecal microbiotas were purified and their impact, as well as that of the fecal waters, on HT29 cells was continuously monitored for 22 h using a real-time cell analyzer (RTCA). The composition of the purified microbiotas was assessed by 16S rRNA gene profiling and qPCR and the levels of short chain fatty acids (SCFA) determined by gas chromatography. The microbiota fractions and SCFA concentrations obtained from IBD-patients, full-term and preterm babies, showed clear differences with regard to those of the control group (healthy adults). Moreover, the purified intestinal microbiotas and fecal waters also differed from the control group in the response induced on the HT29 cells assay developed. In short, we have developed a real-time, impedance-based in vitro model for assessing the functional response induced by purified microbiotas and fecal waters upon intestinal epithelial cells. The capability of the assay for discriminating the functional responses induced, by microbiotas or fecal waters from different human groups, promises to be of help on the search for compounds/strains to restore the functionality of the microbiota-host's interaction.

Resistance of Nonmelanoma Skin Cancer to Nonsurgical Treatments. Part II: Photodynamic Therapy, Vismodegib, Cetuximab, Intralesional Methotrexate, and Radiotherapy

A wide range of treatments is now available for nonmelanoma skin cancer, including 5-fluorouracil, ingenol mebutate, imiquimod, diclofenac, photodynamic therapy, methotrexate, cetuximab, vismodegib, and radiotherapy. All are associated with high clinical and histologic response rates. However, some tumors do not respond due to resistance, which may be primary or acquired. Study of the resistance processes is a broad area of research that aims to increase our understanding of the nature of each tumor and the biologic features that make it resistant, as well as to facilitate the design of new therapies directed against these tumors. In this second article, having covered the topical treatments of nonmelanoma skin cancer, we review resistance to other nonsurgical treatments, such as monoclonal antibodies against basal and squamous cell carcinomas, intralesional chemotherapy, photodynamic therapy, and radiotherapy.

The relationship between phenolic compounds from diet and microbiota: impact on human health

The human intestinal tract is home to a complex microbial community called microbiota.

Cryptomphalus aspersa mollusc eggs extract promotes migration and prevents cutaneous ageing in keratinocytes and dermal fibroblasts in vitro

BACKGROUND

The search of substances that minimize cutaneous ageing has increased in the last few years. Previous studies have described the regenerative properties of the secretion of the mollusc Cryptomphalus aspersa (C. aspersa) when applied topically.

OBJECTIVE

We evaluate the in vitro effects of a new product derived from the eggs of C. aspersa, IFC-CAF, on cell proliferation, migration, distribution of cytoskeletal proteins, production of extracellular components as well as its ability to prevent cutaneous ageing because of intrinsic or extrinsic factors (exposure to UVB) by determination of ageing markers.

METHODS

We have used the human keratinocyte cell line (HaCaT cells), primary dermal fibroblasts (HDF) and senescent dermal fibroblasts (SHDF). The effects of the compound on cell proliferation and on the cell cycle were determined by the MTT colorimetric assay, estimation of total protein and/or trypan blue test and by flow cytometry, respectively. We also studied cell migration using the wound-healing migration assay, whereas ELISA assays, Western Blot and immunofluorescence microscopy were carried out to test the expression of proteins related to cytoskeleton, extracellular matrix and with ageing.

RESULTS

We have found that IFC-CAF does not promote proliferation but induces migration of HaCaT, HDF and SHDF in a time- and dose-dependent manner; a better organization of cytoskeletal proteins (F-actin and vimentin) and promotes the production of extracellular components (fibronectin, collagen 1 and MMPs) and the adhesion to cell-substrate vinculin protein. IFC-CAF also prevents cutaneous ageing. The treatment decreases the expression of the ageing-related markers b-Gal, p53 and p16INK4 in SDDF cells, and improves cell survival after UVB irradiation and nuclear repair in HaCaT cells.

CONCLUSION

IFC-CAF has regenerative properties and protects against ageing factors being, therefore, a potential therapeutic agent for treating or preventing skin ageing.

Abstract P5-07-01: Defining the mechanism of breast cancer growth by chemokine receptor CXCR7 and Epidermal Growth Factor Receptor coupling interaction

Introduction: Breast cancer (BrCa) ranks second in both incidence and cancer deaths for women in the USA. Recent advances have revealed a significant contribution of chemokines and their receptors in tumor growth, survival after chemotherapy, and organ-specific metastasis. CXCR7 is the latest CXC-chemokine receptor implicated in BrCa growth. It is endogenously over expressed in BrCa, but its mechanism of tumor growth enhancement is still not clearly defined. CXCR7 heterodimerizes with CXCR4 and binds to SDF-1 (CXCL12) and CXCL11. No direct ligand mediated physiological action has been implicated for CXCR7 in BrCa other than facilitating CXCR4-mediated cell motility, however, studies in other cancers have implicated CXCR7 in cell proliferation, anti-apoptotic activity and cell-cell adhesion. The expression pattern of CXCR7 in BrCa tissues and its potential contribution in BrCa cell proliferation and survival were investigated in representative BrCa cell lines using knock down and knock-in experiments.

Results: CXCR7 was only expressed in ER-α positive BrCa cells (e.g., MCF-7) and was not found in BrCa cells with known metastatic potential (MDA-MB231 and SKBr3). Depletion of CXCR7 in MCF-7 BrCa cells by both siRNA and shRNA decreased cell proliferation and caused cell cycle arrest. Since CXCR7 is an atypical G-protein coupled receptor where ligand activation does not elicit conventional intracellular signaling, we hypothesized that CXCR7 regulates BrCa proliferation through interaction with EGFR or activating other potential targets of MAP-kinase activation. CXCR7 depletion reduced site-specific phosphorylation of EGFR at Tyrosine 1110 after EGF-stimulation. CXCR7 depletion also reduced phosphorylation of ERK-1/2, indicating a potentially direct interaction with mitogenic signaling in MCF-7 cells. We tested for direct interaction of CXCR7 with EGFR by co-immunoprecipitation and immunofluorescence studies. We found EGFR and CXCR7 co-immunoprecipitate and co-localize as demonstrated by confocal microscopy. Interestingly, our results also demonstrate CXCR7 and EGFR are co-localized before EGF stimulation. Further corroboration of CXCR7-EGFR interaction was established using the proximity ligation assay (PLA) technique that allowed us to visualize CXCR7-EGFR co-localization both in cell culture and in human normal and breast cancer tissue.

Conclusion: This data demonstrates an important role for CXCR7 in BrCa growth and explores the mechanism of action of direct coupling of EGFR with CXCR7.

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P5-07-01.

Exopolysaccharides produced by Lactobacillus and Bifidobacterium strains abrogate in vitro the cytotoxic effect of bacterial toxins on eukaryotic cells

AIMS

To evaluate the capability of the exopolysaccharides (EPS) produced by lactobacilli and bifidobacteria from human and dairy origin to antagonize the cytotoxic effect of bacterial toxins.

METHODS AND RESULTS

The cytotoxicity of Bacillus cereus extracellular factors on Caco-2 colonocytes in the presence/absence of the EPS was determined by measuring the integrity of the tissue monolayer and the damage to the cell membrane (extracellular lactate dehydrogenase activity). Additionally, the protective effect of EPS against the haemolytic activity of the streptolysin-O was evaluated on rabbit erythrocytes. The EPS produced by Bifidobacterium animalis ssp. lactis A1 and IPLA-R1, Bifidobacterium longum NB667 and Lactobacillus rhamnosus GG were able to counteract the toxic effect of bacterial toxins on the eukaryotic cells at 1mg ml(-1) EPS concentration. The EPS A1 was the most effective in counteracting the effect of B. cereus toxins on colonocytes, even at lower doses (0·5mg ml(-1) ), whereas EPS NB667 elicited the highest haemolysis reduction on erythrocytes.

CONCLUSIONS

The production of EPS by lactobacilli and bifidobacteria could antagonize the toxicity of bacterial pathogens, this effect being EPS and biological marker dependent.

SIGNIFICANCE AND IMPACT OF THE STUDY

This work allows gaining insight about the mechanisms that probiotics could exert to improve the host health.

[Distribution of capsular types and antimicrobial susceptibility of Streptococcus agalactiae causing infections in Argentina]

Streptococcus agalactiae is an endogenous bacterium that has emerged in the last 20 years as an etiological agent in both neonatal and perinatal infections, and in immunocompromised patients. The differentiation of the capsular polysaccharide, the presence of surface proteins c, X, R, and molecular methods allow classification in serotypes and genotypes. This identification is a useful tool for epidemiological purposes and virulence studies in this bacterium. The objective of this work was to study the serotypes and the antimicrobial susceptibility of isolates recovered from invasive diseases in different areas of Argentina. In the analyzed sample a fair predominance of Ia and III serotypes was recovered, followed by II and IV serotypes. All the isolates were found to be sensitive to penicillin. A 6% of resistance to erythromycin and a 4.5% to clindamycin were detected. In three of the isolates, constitutive MLS phenotype (resistance to macrolides, lincosamins and streptogramins) was founded, while in the remaining one, inducible MLS phenotype was detected. These results stress the importance of conducting a surveillance of the prevalent serotypes in our country with the goal of future prevention of this disease with an effective vaccine. The knowledge of the antimicrobial susceptibility profile will be also important to obtain therapeutic success in the treatment.

The situation of malaria along the Vietnam-Lao PDR border and some related factors

This was a descriptive cross sectional study. It was done in 4 communes along the Vietnam-Lao PDR border of two mountainous provinces: Sonla and Nghean. The cluster multistage sampling technique was applied to choose the study sites. The results of the study show: Among the 2,441 persons given blood tests to find malaria parasites, 0.7% of them carry malaria parasite, of whom 0.6% carry P. falciparum and 0.1% carry P. vivax. The malaria morbidity in the year was 6.9%. The mortality due to malaria is 1.59 per 100,000 population per year. Among the 106 hamlet motivators being interviewed, only 75.5% knew that malaria is transmitted by mosquitos, 71.7% knew that malaria patients are a source of transmission, over 50% of the motivators have mistaken understanding about the living environment of malaria mosquitos. Most of them have had mistakes in diagnosis, treatment of malaria, mosquito-killing spraying. Among the 729 adults being interviewed, 59.0% did not know about the causes of malaria, 30.7% did not take part in malaria control activities. Only 69.3% of the adults regularly sleep inside mosquito nets, 68% of adults buy medicine to cure malaria, 39.9% referred patients to health facilities for cure, and 25% use forest herbs to cure malaria. The factors that increased the malaria morbidity in communes along Vietnam-Lao PDR border have been identified.

IgA antibodies to Chlamydia trachomatis and seminal parameters in asymptomatic infertile males

Prevalence of IgA antibodies to Chlamydia trachomatis in semen samples from infertile men was estimated and its clinical meaning is discussed. The ejaculate of 102 infertile men without any symptom of genital infection was studied, and seminal alterations were classified according to WHO criteria. Antichlamydial IgA antibodies were detected using a solid-phase, enzyme-linked immunoassay (ImmunoComb II Chlamydia trachomatis monovalent IgA) and related to sperm count, motility and membrane integrity, seminal leucocyte count, and past history of sexually transmitted disease (STD). Prevalence of IgA antibodies to C. trachomatis was 23%. There was no relationship between IgA antibodies and the sperm variables or leucocyte count in semen. However, a strong association between antichlamydial IgA antibodies and the antecedent of STD was found (p < .005; OR = 6). IgA antibodies to C. trachomatis did not cause alterations in sperm function and they were not associated with inflammatory response. However, these antibodies in semen of asymptomatic infertile men would indicate a risk of C. trachomatis infection for the couples of those patients.

Malaria in tree crop plantations in south-eastern and western provinces of Thailand

During the past three decades almost half of the existing natural tropical forests in Thailand were destroyed and replaced by cash crops, rubber, coffee, fruit orchards (durian, rambutan, mangosteen) and other commercial plantations. In order to determine the proportion of malaria cases contracted from such commercial plantations, an epidemiological study was conducted between June 1996 to May 1997 in two districts, one in Pong Nam Ron, located in a south-eastern province near the Cambodian border and another in Sai Yok, in a western province along the Myanmar border. Data were collected by passive case detection from patients attending the existing malaria clinics and active case detection by monthly malariometric survey in selected villages. All malaria cases were thoroughly investigated and classified according to exposure to different ecotypes prior to onset of malaria symptoms in the preceding two weeks. Malaria cases acquired from commercial plantations accounted for 35.2% and 11.2% in Pong Nam Ron and in Sai Yok districts respectively. In such plantations, most of the malaria cases were contracted from fruit orchards and to a lesser extent from rubber and teak plantations. From this study it is evident that commercial plantations provide a significant site of malaria transmission in addition to the forest and foothills areas in Southeast Asia where efficient vectors such as An. dirus and An. minimus are prevalent and have adapted to such changed ecosystems.

Role of the SEAMEO TROPMED Network in health human resources development. Southeast Asian Ministers of Education Organization. Tropical Medicine and Public Health

The Southeast Asian Ministers of Education Organization (SEAMEO) is a chartered international organization for the promotion of regional cooperation in education, science, technology and culture. The Regional Tropical Medicine and Public Health Network (TROPMED) operates through four specialized Centers in Indonesia, Malaysia, the Philippines and Thailand, with a coordinating unit, the TROPMED Central Office in Bangkok, Thailand. In line with the overall mission of SEAMEO, the role of TROPMED is to promote health and to prevent or control disease, thus improving the quality of life of people in the Asia-Pacific Region. Toward this end, SEAMEO TROPMED serves to facilitate the strengthening of national and institutional capabilities in research and training through postgraduate academic programs; short-term training courses; scientific fora; publications and information dissemination and as such, has been in the mainstream of health human resources development since its inception in 1967. To date, a total of 3,353 TROPMED alumni have benefited from training in 26 regular course offerings; of these, 1,596 were females and 1,757, males. From 1991 to 1995, a total of 434 key health personnel have attended short-term training courses, with increasing attendance from Cambodia, Lao PDR and Vietnam. TROPMED's effectiveness comes from the collective strength of and the spirit of cooperation among its host institutions and partners. Faced with a health scenario of both developing and developed economies, SEAMEO TROPMED aims to further its role as an international forum for health development thus, addressing the need for effective strategies for health sector reform and advocacy of relevant health, environmental and development policies through its various programs and activities.

[Follow-up of partial seizure progression in an infant]

OBJECTIVE AND MATERIAL: We are carried out a retrospective study of 43 patients, 21 males and 22 women entered during the period of infancy in the Service of Neurology of our hospital and with diagnostic of any type of partial seizure, in an intent to correlate a series of clinical parameters, electroneurophysiologics and initial therapeutics with their factors follow-up periods.

RESULTS

They are a half age of 7.11 months (1-19), consecutive being controlled for a period of time of 40 months (6-96). We have settled down a relationship between the drugs utilized in the first seizure and that other that they remained in their last revision, the current state of the critical manifestations, and the existence or not of an agreement between the e diagnosis emitted to the discharge and the development of the illness.

CONCLUSION

After the present study, we thought that the current classification of the epileptic seizures is insufficient in the age of the infant, with presages much more complexes.

Autonomous replication sequences in an extrachromosomal element of a pathogenic Entamoeba histolytica

Entamoeba histolytica possesses a 24.5 kilobase plasmid-like molecule which encodes for the organism's ribosomal RNAs. Sequence analysis of this extrachromosomal element revealed the presence of AT rich sequences which show homology to the origin of replication of other lower eucaryotes. An 802 bp fragment containing these sequences was cloned into a yeast shuttle vector lacking the origin of replication and the construct tested for its ability to replicate autonomously in yeast. Mitotic stability tests as well as evidence for plasmid maintenance indicate that the transformed cells contained self-replicating episomes and not stably integrated molecules. The nucleotide sequence of this ARS-containing fragment is presented.