Association between sense of coherence and oral clinical conditions in adults and the elderly: systematic review and meta-analysis.

OBJECTIVE: This study systematically reviews the evidence on the relationship between sense of coherence (SOC) and oral clinical conditions in adults and elderly people. METHODS: PubMed, Scopus, Web of Science, Latin American and Caribbean Literature in Health Sciences - Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Brazilian Dentistry Bibliography - Bibliografia Brasileira de Odontologia (BBO), Cochrane Library and grey literature were searched. Observational studies involving adults and elderly people that evaluated SOC with a valid instrument and investigated oral clinical measurements as outcomes were included. Two review authors independently assessed the studies for inclusion and extracted data. The quality of studies was assessed using the Downs and Black checklist. Meta-analysis used the random-effect inverse-variance method to obtain pooled odds ratios (OR) and 95% Confidence Intervals (CI) for each oral clinical condition. RESULTS: From a total of 872 identified studies, ten observational cross-sectional and one longitudinal study were included. Nine studies were judged of medium or high risk of bias. Meta-analyses showed that adults and elderly people with higher SOC were less likely to present dental caries (OR 0.84; 95%CI = 0.73-0.96), periodontal disease (OR 0.58; 95%CI = 0.30-0.85), gingivitis (OR 0.54; 95%CI = 0.18-0.90) or dental biofilm (OR 0.65; 95%CI = 0.43-0.86). CONCLUSIONS: Current evidence suggests that better SOC is positively related to better oral clinical status in adults and elderly people. Longitudinal and intervention studies are needed to confirm these findings.

Use of monitoring indicators in hospital management of antimicrobials.

BACKGROUND: According to the literature, 25% to 50% of antimicrobials prescribed in hospitals are unnecessary or inappropriate, directly impacting antimicrobial resistance. Thus, the present study aimed to evaluate the use of antimicrobials in a university hospital in Northeast Brazil, using days of therapy (DOT) and length of therapy (LOT) indicators in accordance with the latest national and international recommendations for monitoring the use of antimicrobials. METHODS: This is an observational, prospective analytical study conducted in a teaching hospital, with 94 active beds, distributed between the intensive care unit (ICU), the surgical clinic (SUR), the medical clinic (MED), the pneumology/infectology department (PNE/INF) and pediatrics (PED). The duration of the study was from the beginning of January to the end of December 2018. RESULTS: During the study period, a total of 11,634 patient-days were followed up and 50.4% of the patients were found to have received some antimicrobial, with a significant reduction in use of 1% per month throughout the year. Patients were receiving antimicrobial therapy for 376 days in every 1000 days of hospitalization (LOT = 376/1000pd). Overall, the 1st-generation cephalosporins and fluoroquinolones were the most used in respect of the number of prescriptions and the duration of therapy. The calculated global DOT/LOT ratio showed that each patient received an average of 1.5 antimicrobials during the hospital stay. The incidence of antimicrobial resistance, globally, for both methicillin-resistant Staphylococcus aureus (methicillin R), Carbapenem-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii (Carbapenem R), was 1 per 1000 patient-days. CONCLUSIONS: The results obtained from the analyses revealed that half of the patients admitted to the hospital who took part in the study were exposed to the use of antimicrobials at some point during their stay. Although moderate, it is noteworthy that there was a decline in the use of antimicrobials throughout the year. The indicators used in this study were found to be very effective for gathering data on the use of antimicrobials, and assessing the results of the initiatives taken as part of the Stewardship program.

Prevalence and sociobehavioural determinants of early childhood caries among 5-year-old Portuguese children: a longitudinal study.

PURPOSE: To assess the prevalence of early childhood caries (ECC) and associated factors among a 5-year-old cohort. METHODS: An observational longitudinal study was conducted with a sample of 142 preschoolers. A calibrated dentist performed intraoral examinations following International Caries Detection and Assessment System (ICDAS-II) criteria at baseline and after 6 months. A questionnaire on sociodemographic variables and oral health-related behaviours was answered by caregivers. Statistical analysis included descriptive statistics and computation of confidence intervals (95% confidence level). RESULTS: Baseline prevalence of ECC and severe ECC (S-ECC) were 40.1% and 11.3%, respectively. After 6 months ECC and S-ECC prevalence rates were 46.5%, and 13.2%, respectively. At both evaluations most caries lesions were untreated. Parental education and occupation were significantly associated with ECC. Behaviour variables found to be significantly associated with the disease comprised: establishing toothbrushing habits before the first year, toothbrushing twice daily and with parental assistance, frequency of dental visits, age at first dental visits, daily ingestion of sweets and number of daily meals. CONCLUSION: The prevalence of ECC was very high, with most of the lesions left untreated. ECC experience was associated with participants' socioeconomic background and several of the surveyed oral health-related behaviour variables.

A phenotypic screening bioassay for Escherichia coli stress and antibiotic responses based on Fourier-transform infrared (FTIR) spectroscopy and multivariate analysis.

AIMS: To develop and optimize a Fourier-transform infrared spectroscopy (FTIRS) phenotypic screening bioassay for stress responses, regarding the effect of nutrient content, bacterial growth phase and stress agent exposure time. METHODS AND RESULTS: A high-throughput FTIRS bioassay was developed to distinguish the stress responses of Escherichia coli to sodium hydroxide, hydrochloric acid, sodium chloride, sodium hypochlorite and ethanol. Principal component analysis and hierarchical clustering were used to quantify the effect of each parameter on bioassay performance, namely its reproducibility and metabolic resolution. Bioassay performance varied greatly, ranging from poor to very good. Spectra were partitioned into biologically relevant regions to evaluate their contributions to bioassay performance, but further improvements were not observed. Bioassay optimization was validated against empirical parameters, which confirmed a closer representation of known mechanisms on the antibiotic-induced stress responses. CONCLUSIONS: The optimized bioassay used standard nutrient content, cells in the late-stationary growth phase and a one-shift exposure duration. Only the optimized bioassay adequately and reproducibly distinguished the E. coli stress and antibiotic responses. The absence of performance improvements using partitioned spectra indicated that stress responses are imprinted on the whole-spectra metabolic signature. SIGNIFICANCE AND IMPACT OF THE STUDY: Highly optimized FTIRS bioassay parameters are vital in capturing whole-spectra metabolic signatures that can be used for satisfactory and reproducible phenotypic screening of stress and antibiotic responses.

Similarities and differences between doxycycline and minocycline: clinical and antimicrobial stewardship considerations.

Doxycycline and, to a lesser extent, minocycline, have been used for decades to treat various serious systemic infections, but many physicians remain unfamiliar with their spectrum, interpretation of susceptibility results, pharmacokinetic/pharmacodynamic (PK/PD) properties, optimal dosing regimens, and their activity against MRSA, VRE, and multidrug-resistant (MDR) Gram-negative bacilli, e.g., Acinetobacter sp. This article reviews the optimal use of doxycycline and minocycline to treat a variety of infections and when minocycline is preferred instead of doxycycline.

Nitrofurantoin safety and effectiveness in treating acute uncomplicated cystitis (AUC) in hospitalized adults with renal insufficiency: antibiotic stewardship implications.

Nitrofurantoin remains a key oral antibiotic stewardship program (ASP) option in the treatment of acute uncomplicated cystitis (AUC) due to multi-drug resistant (MDR) Gram negative bacilli (GNB). However, there have been concerns regarding decreased nitrofurantoin efficacy with renal insufficiency. In our experience over the past three decades, nitrofurantoin has been safe and effective in treating AUC in hospitalized adults with renal insufficiency. Accordingly, we retrospectively reviewed our recent experience treating AUC in hospitalized adults with decreased renal function (CrCl < 60 ml/min) with nitrofurantoin. Excluded were complicated urinary tract infections. Urinary isolated susceptibility testing was done by micro broth dilution (MBD). Treatment duration was 5-7 days. Cure was defined as eradication of the uropathogen and failure was defined as minimal/no decrease in urine colony counts. Of 26 evaluable patients with renal insufficiency (CrCl < 60 ml/min), nitrofurantoin eradicated the uropathogen in 18/26 (69%) of patients, and failed in 8/26 (31%). Of the eight failures, five were due to intrinsically resistant uropathogens, e.g., Proteus sp., and one failure was related to an alkaline urine. Of the treatment failures, only two were due to renal insufficiency, i.e., CrCl < 30 ml/min. Since there are few oral antibiotics available to treat AUC due to MDR GNB uropathogens, these results have important ASP implications. Currently, nitfurantoin is not recommended if CrCl < 60 ml/min. In our experience, used appropriately against susceptible uropathogens, nitrofurantoin was highly effective in nearly all patients with CrCl = 30-60 ml/min., and only failed in two patients due to renal insufficiency (CrCl < 30 ml/ml).

Viral influenza-like illnesses: dynamic interrelationships during the 2015-2016 influenza season in hospitalized patients.

In hospitalized children and adults, the temporal relationship of viruses causing influenza-like illnesses (ILIs) and influenza has not been well described. During the 2015-2016 influenza season at our hospital, the dynamic interrelationships between ILI viruses (human metapneumovirus, respiratory syncytial virus, human parainfluenza viruses 3 and 4, rhinoviruses/enteroviruses, and coronaviruses) and influenza A were characterized in 768 hospitalized children and adults.

Are atypical lymphocytes present with viral influenza-like illnesses (ILIs) in hospitalized adults?

The purpose of this investigation was to determine if atypical lymphocytes were of diagnostic value in viral influenza-like illnesses (ILIs) in hospitalized adults during the influenza season. Are atypical lymphocytes present with viral ILIs in hospitalized adults? During the influenza season, hospitals are inundated with influenza and viral ILIs, e.g., human parainfluenza virus-3 (HPIV-3). Without specific testing, clinically, it is difficult to differentiate influenza from ILIs, and surrogate influenza markers have been used for this purpose, e.g., relative lymphopenia. The diagnostic significance of atypical lymphocytes with ILIs is not known. We retrospectively reviewed the charts of 35 adults admitted with pneumonia due to viral ILI. The diagnosis of 14 patients was by respiratory virus polymerase chain reaction (PCR). During the 2015 influenza A season with ILIs, atypical lymphocytes were not present in influenza A (H3N2) patients but atypical lymphocytes were present in some ILIs, particularly HPIV-3. With viral ILIs, atypical lymphocytes should suggest a non-influenza viral diagnosis.

Predictors of ertapenem therapeutic efficacy in the treatment of urinary tract infections (UTIs) in hospitalized adults: the importance of renal insufficiency and urinary pH.

In hospitalized adults acute uncomplicated cystitis (AUC) and catheter associated bacteriuria (CAB) may be treated with oral antibiotics. With AUC or CAB due to extended spectrum ß-lactamase (ESBL) + Gram negative bacilli (GNB) physicians often use intravenous therapy, e.g., ertapenem. We reviewed our recent experience in hospitalized adults with AUC and CAB treated with ertapenem. Therapeutic efficacy of ertapenem was assessed by decreased pyuria/bacteriuria, and elimination of the uropathogen. The effectiveness of ertapenem in the presence of renal insufficiency (CrCl < 50 ml/min) and acid and alkaline urinary pH were evaluated. In addition, rapidity of eradication of bacteriuria was assessed by time to negative urine cultures (TTNC). In those with an acid urinary pH ertapenem was highly effective in eliminating bacteriuria (TTNC < 3 days). TTNC was prolonged ( >3 days) in patients with decreased renal function and alkaline urinary pH. We reviewed 45 hospitalized adults with AUC or CAB to determine if renal insufficiency and or alkaline urinary pH affected ertapenem efficacy. In the 33 adult hospitalized patients with AUC and 12 with CAB, we found that ertapenem was consistently effective in eliminating the GNB bacteriuria. In hospitalized adults, the presence of renal insufficiency and acid urine, bacteriuria was eliminated in < 3 days. However, in those with renal insufficiency and an alkaline urine pH, the rapidity of cure, i.e., time to negative cultures (TTNC) was prolonged, i.e., > 3 days which has not been previously reported.

The clinical usefulness of lymphocyte:monocyte ratios in differentiating influenza from viral non-influenza-like illnesses in hospitalized adults during the 2015 influenza A (H3N2) epidemic: the uniqueness of HPIV-3 mimicking influenza A.

During influenza epidemics, influenza-like illnesses (ILIs) viruses cocirculate with influenza strains. If positive, rapid influenza diagnostic tests (RIDTs) identify influenza A/B, but false-negative RIDTs require retesting by viral polymerase chain reaction (PCR). Patient volume limits testing during influenza epidemics, and non-specific laboratory findings have been used for presumptive diagnosis pending definitive viral testing. In adults, the most useful laboratory abnormalities in influenza include relative lymphopenia, monocytosis, and thrombocytopenia. Lymphocyte:monocyte (L:M) ratios may be even more useful. L:M ratios <2 have been used as a surrogate marker for influenza, but there are no longitudinal data on L:M ratios in hospitalized adults with viral ILIs. During the 2015 influenza A (H3N2) epidemic at our hospital, we reviewed our experience with L:M ratios in 37 hospitalized adults with non-influenza viral ILIs. In hospitalized adults with non-influenza A ILIs, the L:M ratios were >2 with human metapneumovirus (hMPV), rhinoviruses/enteroviruses (R/E), and respiratory syncytial virus (RSV), but not human parainfluenza virus type 3 (HPIV-3), which had L:M ratios <2. HPIV-3, like influenza, was accompanied by L:M ratios <2, mimicking influenza A (H3N2). In influenza A admitted adults, L:M ratios <2 did not continue for >3 days, whereas with HPIV-3, L:M ratios <2 persisted for >3 days of hospitalization.

BRAF overexpression is associated with BRAF V600E mutation in papillary thyroid carcinomas.

A common mutation in the BRAF gene, comprising the T1799A nucleotide transversion, which leads to the V600E amino acid substitution in the BRAF protein, has been observed in about 50% of papillary thyroid carcinomas (PTCs). However, BRAF protein expression has been rarely examined in such tumors. Clinical studies have shown important associations between BRAF mutation and clinical parameters in PTC, such as progression, invasion, and recurrence. The aim of this study was to evaluate the association between BRAF protein overexpression and the BRAF V600E mutation in a group of PTC patients. The study group included 116 patients with PTC from Araújo Jorge Hospital, Goiânia, Goiás, Brazil. Immunohistochemistry was utilized to analyze BRAF protein expression. Presence of the BRAF V600E mutation was determined by polymerase chain reaction amplification and restriction fragment length polymorphism, and confirmed by direct sequencing. The chi-square test with Yates correction and the Fisher exact test were used for statistical analysis. BRAF overexpression was detected in 55 patients with PTC (47.4%) and the BRAF V600E mutation was observed in 74 patients (63.8%). In the studied group, significant associations were observed between the BRAF V600E mutation and BRAF protein overexpression (P = 0.0115), and also between BRAF overexpression and extra-thyroid extension of the tumor (P = 0.0111). This study demonstrated a significant association between BRAF overexpression and the BRAF V600E mutation in PTC, highlighting the importance of these molecular events in the process of PTC carcinogenesis.

Unnecessary repeat Clostridium difficile PCR testing in hospitalized adults with C. difficile-negative diarrhea.

The aim of this study was to determine the extent and associated costs of repeat Clostridium difficile stool polymerase chain reaction (PCR) assays in patients with initially negative PCRs. C. difficile stool PCRs were done on adult hospitalized patients with diarrhea. The number/time course of repeat PCRs on initially negative PCR patients was determined. Of 5,027 C. difficile stool PCRs, 814 (16.2 %) were positive and 4,213 (83.8 %) were negative. Ninety-seven of the initially PCR-negative patients had >2 repeat tests 1-59 days after the initial negative stool PCR. Repeat negative PCR testing rarely resulted in a subsequent positive result (0.05 %). The unnecessary costs of 97 repeat PCRs was $32,658.00. Many of these patients were originally given empiric oral anti-C. difficile therapy, in spite of repeatedly negative PCRs.

Individuals with post-stroke hemiparesis are able to use additional sensory information to reduce postural sway.

The present study aimed to investigate whether stroke survivals are able to use the additional somatosensory information provided by the light touch to reduce their postural sway during the upright stance. Eight individuals, naturally right-handed pre-stroke, and eight healthy age-matched adults stood as quiet as possible on a force plate during 35s. Participants performed two trials for each visual condition (eyes open and closed) and somatosensory condition (with and without the right or left index fingertip touching an instrumented rigid and fixed bar). When participants touched the bar, they were asked to apply less than 1N of vertical force. The postural sway was assessed by the center of pressure (COP) displacement area, mean amplitude and velocity. In addition, the mean and standard deviation of the force vertically applied on the bar during the trials with touch were assessed. The averaged values of COP area, amplitude and velocity were greater for stroke individuals compared to healthy adults during all visual and somatosensory conditions. For both groups, the values of all variables increased when participants stood with eyes closed and reduced when they touched the bar regardless of the side of the touch. Overall, the results suggested that, as healthy individuals, persons with post-stroke hemiparesis are able to use the additional somatosensory information provided by the light touch to reduce the postural sway.

Fever of unknown origin (FUO) in an immunocompetent adult due to cytomegalovirus (CMV) with polyclonal gammopathy.

Fever of unknown origin (FUO) may be due to infection, malignancy, collagen vascular/inflammatory disorders, or other causes. Cytomegalovirus (CMV) infection is a rare cause of FUO in immunocompetent adults. We present a case of FUO due to CMV in an immunocompetent adult with polyclonal gammopathy on serum protein electrophoresis (SPEP).