The NIH-led research response to COVID-19

Investment, collaboration, and coordination have been key.

Precision Health: Bringing Oral Health into the Context of Overall Health

Unprecedented advances in genomics, data science, and biotechnology have ushered in a new era of health care in which interventions are increasingly tailored to individual patients. Precision-based approaches extend to oral health, which is essential to overall health. Harnessing the full potential of precision oral health will depend on research to more fully understand the factors that underlie health and contribute to disease-including the human genome, microbiome, epigenome, proteome, and others.

An unusual radiographic finding in pulmonary parenchymal endometriosis: A case report

Thoracic endometriosis is an uncommon disorder. In most cases, the diagnosis is based on history alone and radiographic findings depend on the menstrual cycle. CT findings include ill-defined or well-defined opacities, nodular lesions, cavities, cystic changes and bullous formation. We report a case of pulmonary parenchymal endometriosis with an unusual radiographic finding.

The National Institute of Dental and Craniofacial Research: research for the practicing dentist

BACKGROUND AND OVERVIEW

Established in 1948, the National Institute of Dental and Craniofacial Research (NIDCR) has helped transform dentistry into a profession that is based firmly in prevention and technological innovation. This article introduces the new NIDCR initiative in general dentistry practice-based research. It also highlights research supported by the NIDCR and its implications for dental practice in restorative dentistry, oral and systemic disease, stem cell research, salivary diagnostics, gene transfer therapy and pain.

CLINICAL IMPLICATIONS

The NIDCR supports research that will help guide the practitioner in the delivery of patient care and have a direct impact on the practice of dentistry.

The value of labial biopsy in the differentiation of sarcoidosis from tuberculosis

BACKGROUND

Since the clinical features of sarcoidosis and tuberculosis may mimic each other, and that differentiation is not easy on clinical grounds, a histologic diagnosis may be mandatory in countries where the prevalence of tuberculosis is high or in populations with large numbers of immigrants from those countries. Previous studies have suggested the minor salivary gland biopsy as a useful method in the diagnosis of sarcoidosis. The present study was undertaken to evaluate the value of labial biopsy in the differentiation of sarcoidosis from tuberculosis in patients with enlarged hilar and paratracheal lymph nodes.

METHODS

Labial biopsy was performed in 50 consecutive patients with sarcoidosis, and in 35 consecutive patients with tuberculosis who had intrathoracic lympadenopathy. The files of all patients were reviewed for the clinical presentation, radiographic features, SACE levels, tuberculin skin test anergy, and the frequency of positive labial biopsy in each disease.

RESULTS

Noncaseating granulomas were present in labial biopsies obtained from 24 patients (48%) of 50 patients with sarcoidosis. Labial biopsies were positive in 4 of 6 patients who had an abnormality on eye examination and in 3 of 5 patients who had noncaseating granulomas on biopsy material from skin. In two of 4 patients who underwent mediastinoscopy, noncaseating granulomas were detected on labial biopsy. In contrast to the patients with sarcoidosis labial biopsies revealed normal minor salivary glands in all patients with tuberculosis.

CONCLUSIONS

Labial biopsy has a high discriminatory value as a diagnostic tool in the differentiation of sarcoidosis from tuberculosis. Although it has a rather lower diagnostic yield than transbronchial lung biopsy, labial biopsy should be considered as a first line approach prior to performing other more invasive procedures for the tissue confirmation of sarcoidosis.

Tuberculosis after renal transplantation: experience of one Turkish centre

BACKGROUND

In this study, renal transplant recipients with tuberculosis of different organs, were retrospectively analysed with respect to prevalence, outcome and drug toxicity.

PATIENTS AND METHODS

In 520 patients, 22 (4.2%) tuberculosis of various organs was diagnosed. The time interval between transplantation and diagnosis of tuberculosis was 44.4 +/- 33.5 (range 3-111) months. In 18 (82%) of the patients, tuberculosis was detected after the first year of transplantation. The most common form was pleuro/pulmonary tuberculosis (54%), and other localizations included jejunum, liver, bone, and urogenital tract.

RESULTS

Sixteen of the 22 patients responded favourably to the treatment and maintain excellent allograft function, whereas six patients (27.2%) died. Toxic hepatitis was seen in four (18%) patients, and one case was complicated with acute hepatocellular failure due to isoniazide (INH). However, of the 23 patients at risk of tuberculosis who had had INH prophylaxis for 1 year, neither tuberculosis, nor hepatotoxicity was observed.

CONCLUSION

Tuberculosis is a common infection of renal transplant recipients in developing countries. The peak incidence is after the first year of transplantation and mortality is considerable. Hepatoxicity is a considerable risk of treatment, possibly as a result of additive toxic effects of immunosuppressive drugs.

Bronchoalveolar lavage cytology and immunocytology in pulmonary tuberculosis

Limited data on the cellular and immunocytologic characteristics of bronchoalveolar lavage (BAL) fluid in pulmonary tuberculosis have been reported. We therefore studied 40 patients with active disease. BAL fluid differential cell counts and lymphocyte subsets were determined. The findings were compared with data from 47 patients with active sarcoidosis and 30 healthy control subjects. The proportion of lymphocytes was increased in both diseases (p < 0.001 versus control subjects) but with no difference compared to one another. The CD4/CD8 ratio was normal in 33 of 40 patients with pulmonary tuberculosis in contrast to sarcoidosis, with an increased ratio in 33 of 47 patients. HLA-DR+ T lymphocytes were significantly increased in both pulmonary tuberculosis and sarcoidosis (p < 0.05 versus control group). The proportion of CD57+ lymphocytes was normal in all study groups. We conclude that pulmonary tuberculosis and sarcoidosis are characterized by an increased percentage of lymphocytes in BAL fluid with a similar proportion of activated T cells. In contrast to active sarcoidosis, in which an elevated CD4/CD8 ratio is characteristic, in the majority of pulmonary tuberculosis patients the CD4/CD8 ratio is within the normal range.

Value of bronchoalveolar lavage in lipidoses with pulmonary involvement

Adult lipid storage disorders with pulmonary involvement are rare and usually diagnosed at autopsy. We report a patient with splenomegaly and reticulonodular pattern on lung computed tomography. Bronchoalveolar lavage was performed and revealed the presence of lipid-containing foamy cells, with the demonstration of both periodic acid-Schiff (PAS) and scharlach red stain positive vacuoles in the cytoplasm of alveolar macrophages. The same cells were found in bone marrow biopsy. As in other rare disorders, bronchoalveolar lavage may be of diagnostic value in lipid storage disorders with pulmonary involvement.

[Exogenous allergic alveolitis caused by mouldy hazel nut leaves]

A 62-year old farmer woman from the northeastern, very rainy part of Turkey has been collecting large amounts of green and brown involucral hazel-nut leaves for subsequent use as fuel. For the last 20 years she had been complaining of cough, respiratory distress and intermittent fever. In the course of years of continual antigen exposure she developed the clinical and x-ray signs of fibrosis of the lung. Bronchoalveolar lavage produced the typical cell pattern of chronic exogenous allergic alveolitis with predominant CD8 cells. Serum analysis yielded high titres of IgG antibodies against mould fungi partly obtained from hazel-nut husk cultures, as well as thermophilic actinomycetes.

MDL 17,043: short- and long-term cardiopulmonary and clinical effects in patients with heart failure

MDL 17,043, an inotropic and vasodilator drug, is believed to have beneficial effects in patients with heart failure. Its short- and long-term hemodynamic and cardiopulmonary effects were studied in 10 patients with New York Heart Association functional class III heart failure who were maintained on digitalis and diuretic drugs. Hemodynamics at baseline study and after 24 hours of oral therapy (four doses of 6 mg/kg) showed increased cardiac output (3.9 +/- 0.7 to 6.1 +/- 1.1 liters/min, p less than 0.05), increased stroke volume (42 +/- 12 to 60 +/- 15 ml, p less than 0.05), decreased systemic vascular resistance (1,564 +/- 326 to 1,009 +/- 296 dynes X s X cm-5, p less than 0.05) but no change in pulmonary capillary wedge pressure (31 +/- 6 to 25 +/- 13 mm Hg, p = NS). Only systemic vascular resistance and arteriovenous oxygen difference were significantly decreased during exercise. When restudied after 5 weeks of therapy, neither cardiac output nor stroke volume showed a sustained increase at rest or during exercise, and effects on systemic vascular resistance and arteriovenous oxygen difference were not sustained at exercise (p = NS). Peak oxygen uptake during exercise was 8.1 +/- 2.5 ml/kg per min at baseline and was not significantly increased either acutely (9.2 +/- 2.4 ml/kg per min, p = NS) or chronically (8.9 +/- 2.2 ml/kg per min, p = NS). Problems of increased ventricular arrhythmias and diarrhea were noted after therapy was begun.(ABSTRACT TRUNCATED AT 250 WORDS)

Alterations in lactoferrin in salivary gland disease

During the active phase of chronic recurrent parotitis there is a marked elevation in the parotid concentration of lactoferrin (Lf), and iron-binding glycoprotein with antibacterial properties. The Lf concentration decreases during the recovery period, but still remains above normal levels. The changes of Lf in parotitis parallel recent findings in mastitis and pancreatitis. Elevations in Lf were also noted in five of six subjects with Sjögren's disease, but not in subjects with sarcoidosis, diabetes or "dry mouth" without sialographic changes. The source of the Lf has not been determined; it could arise in part from disrupting polymorphonuclear leucocytes and in part from epithelial cells that synthesize Lf in the salivary glands. Inflammatory stimulation of Lf synthesis would suggest a basic protective mechanism in exocrine glands and should be fully explored.

Affinity chromatography of antiserum to a gram negative organism

An immunoadsorbent method is described for the purification of antibody directed against gram negative bacteria. Two anion exchange materials were compared for their ability to immobilize whole cells of Veillonella alcalescens, a gram negative oral bacterium. Purified antibody preparations were applied to the columns and subsequently eluted with various combinations of desorbing buffers. The quantity of recovered antibody was measured and its activity assayed, using a microagglutination technique. The highest levels of protein and specific antibody activity were recovered from Dowex-1-acetate columns desorbed by a combination of borate buffer pH 10 and 3 M KSCN pH 6, followed by levels of specific antibody activity obtained from a DEAE cellulose column desorbed by glycine--HC1, PBH 2.3.