Healthy and Respectful Workplaces: The Experiences of Dental Hygienists in Canada.

INTRODUCTION: Like any health care practitioner, dental hygienists can experience mistreatment in the workplace. They can be subjected to harassment, bullying, abuse, and violence. These negative experiences can have adverse consequences on psychological and physical well-being and can lead to job dissatisfaction, depression, and burnout. The aim of this study was to describe dental hygienists' experiences related to healthy and respectful workplaces. METHODS: This was an online self-administered survey sent to all members of the Canadian Dental Hygienists Association. Respondents were asked to report the occurrence, frequency, and impact of different types of mistreatment as experienced over their career. RESULTS: In total, 3,780 dental hygienists responded to the survey (response rate = 22%). More than 70% of respondents experienced some form of mistreatment over their career from dentists, office managers, coworkers, and/or patients. Of those who experienced mistreatment, 67% reported losing the respect they felt for the offending person, 55% reported experiencing symptoms of depression, and 30% quit their job. CONCLUSIONS: Mistreatment toward dental hygienists can be prevalent in Canadian dental care settings, resulting in negative consequences to dental hygienists' well-being. KNOWLEDGE TRANSFER STATEMENT: The findings of this article suggest that measures are needed to support healthy and respectful workplaces in Canadian dental care settings. This includes but is not limited to 1) training and education for all members of the dental care team concerning mistreatment, 2) enacting policies in dental care settings to discourage these types of behaviors, and 3) providing help and support to individuals who experience these incidents.

Abundance and Annual Distribution of Freshwater Snails and Some Trematode Cercariae at Damietta Governorate, Egypt.

In addition to being a good food source, freshwater snails are considered one of the positively and negatively influencing invertebrates on the environment. Several biotic and abiotic factors are thought to affect the distribution and the dynamics of these snails. Freshwater snails are the most dominant and conspicuous individuals of the freshwater biota in Damietta Governorate. In this study, freshwater snails were collected monthly from 5 geographically and environmentally different sites at Damietta Governorate at the north of Egypt during June 2017-May 2018. Seven snail species; Lanistes carinatus, Lanistes varicus, Pila wernei, Segmentorbis angustus, Melanoides tuberculata, Biomphalaria alexandrina, and Gabbiella senoriansis, were identified. Lanistes carinatus was the most abundant species (56.4%) in the collection sites. Besides, Al-Inaniyyah village had the highest snail species abundance and variety. The abundance of the most recorded species varied seasonally; the highest abundance was recorded during summer while the lowest was during winter. The abundance of some snail species correlated positively or negatively with some physico-chemical parameters; water temperature, dissolved oxygen, conductivity, total dissolved salts, and electrical conductivity. Two types of trematode cercariae; gymnocephalus cercariae and xiphidiocercariae, were harvested from Lanistes carinatus. The highest prevalence of both cercarial types was detected during summer. The correlation between the prevalence of both cercarial types and the physico-chemical parameters were determined. Xiphidiocercariae were the most predominant cercarial type in Damietta Governorate. Our findings suggest that the invasion of some freshwater snails is likely to be the cause of the low prevalence or complete absence of some medically important intermediate snail hosts. We recommend further characterization of the distribution of freshwater snails and the interrelationships among them in Egypt, and suggest a controlled use of selected snail species to combat their medically important analogues.

Imaging of cerebral venous thrombosis.

The incidence of cerebral venous thrombosis (CVT) is increasing due to the widespread use of computed tomography (CT) and magnetic resonance imaging (MRI) for investigating patients with acute headaches and new onset of seizures. Alternatively referred to as cerebral venous sinus thrombosis (CVST) or dural venous sinus thrombosis (DVST), the terms encompass a broad spectrum of neurological pathologies. These include dural venous sinus thrombosis, cortical vein thrombosis, cavernous sinus thrombosis, venous infarction/haemorrhage, and the rare sequelae of intracranial hypertension or dural arteriovenous fistula. Timely and accurate diagnosis is critical; most patients are young adults and up to 15% will die in the acute phase of the condition. Imaging diagnosis using unenhanced CT or CT venography (CTV) can be readily achieved by the general radiologist. MRI or MRI venography (MRV) are powerful techniques, provided the radiologist is aware of critical diagnostic pitfalls. In selected cases, cerebral digital subtraction angiography (DSA) can facilitate both diagnosis and anticoagulant/transcatheter thrombolytic therapy improving clinical outcome. This article will outline the condition, highlighting cerebral venous anatomy, diagnostic techniques, and pitfalls pertinent to all practising radiologists.

Rapid pain relief using transdermal film forming polymeric solution of ketorolac.

CONTEXT: Ketorolac is one of the most potent nonsteroidal anti-inflammatory drugs and is an attractive alternative to opioids for pain management. OBJECTIVE: Development and evaluation of transdermal ketorolac film forming polymeric solution. MATERIALS AND METHODS: Eudragits(®) RLPO, RSPO and E100 as well as polyvinyl pyrrolidone K30 dissolved in ethanol were used as film forming solutions. In vitro experiments were conducted to optimize formulation parameters. Different permeation enhancers were monitored for potentiality of enhancing drug permeation across excised pigskin. RESULTS: The use of 10% oleic acid, Lauroglycol(®) 90 or Azone(®) with 5% Eudragit(®) RSPO, showed the highest enhancement effect on ketorolac skin permeation and showed faster analgesic effect compared to the ketorolac tablet. The formula comprising 5% Eudragit(®) RSPO and 10% Lauroglycol(®) 90 showed the greatest pharmacodynamic effect and thus was subjected to pharmacokinetic studies. The pharmacodynamic and pharmacokinetic results didn't run paralleled to each other, as the ketorolac tablets showed higher plasma concentrations compared to the selected ketorolac transdermal formulation. This might be due to the induction of analgesia by the available ethanol in the transdermal preparation. CONCLUSION: Optimized transdermal ketorolac formulation showed marked ability to ensure fast and augmented analgesic effect that is an essential request in pain management.

Optic disc detection from normalized digital fundus images by means of a vessels' direction matched filter.

Optic disc (OD) detection is a main step while developing automated screening systems for diabetic retinopathy. We present in this paper a method to automatically detect the position of the OD in digital retinal fundus images. The method starts by normalizing luminosity and contrast through out the image using illumination equalization and adaptive histogram equalization methods respectively. The OD detection algorithm is based on matching the expected directional pattern of the retinal blood vessels. Hence, a simple matched filter is proposed to roughly match the direction of the vessels at the OD vicinity. The retinal vessels are segmented using a simple and standard 2-D Gaussian matched filter. Consequently, a vessels direction map of the segmented retinal vessels is obtained using the same segmentation algorithm. The segmented vessels are then thinned, and filtered using local intensity, to represent finally the OD-center candidates. The difference between the proposed matched filter resized into four different sizes, and the vessels' directions at the surrounding area of each of the OD-center candidates is measured. The minimum difference provides an estimate of the OD-center coordinates. The proposed method was evaluated using a subset of the STARE project's dataset, containing 81 fundus images of both normal and diseased retinas, and initially used by literature OD detection methods. The OD-center was detected correctly in 80 out of the 81 images (98.77%). In addition, the OD-center was detected correctly in all of the 40 images (100%) using the publicly available DRIVE dataset.

Statistical analysis of the factors influencing the recurrence of urinary bladder cancer after radical cystectomy

Objective To evaluate the risk factors influencing the recurrence of urinary bladder cancer; and to predict the probability of recurrence within two years after radical cystectomy. Patients and Methods Between 1986 and 1994; 857 patients were admitted at the Urology and Nephrology Center of Mansoura University; Egypt; for treatment of bladder malignancy by radical cystectomy. The number of male patients was 682 (80) versus 175 females (20) with a mean age of 49 years (range 18 - 90 years). The median follow-up period was 38 months (range 0.03-138 months). Histopathology revealed squamous carcinoma in 440 patients (51); transitional carcinoma in 223 patients (26); adenocarcinoma in 94 patients (11) and mixed (two or more) types in 100 patients (11.7). Most of the patients presented with advanced-stage disease (defined as P3 or P4): 611 patients (71) had stage P3; 68 patients (6) stage P4. Bilharzial ova were seen in 80of the specimens; while regional lymph nodes were involved in 16of the cases. Results Cancer-related mortality was encountered in 199 patients (23.2) and mortality from unknown causes in 54 patients (6.3). Fifty-five patients (6.3) were alive with recurrence. Univariate and multivariate analysis of the survival rates showed that lymph node involvement (P = 0.0000); tumor grade (P = 0.0017); pathological stage (P = 0.0008); sex (P = 0.0005); urinary diversion (P=0.0080) and histopathology (P=0.0253) significantly influenced the recurrence-free survival after radical cystectomy. The 5-year survival rate was 61.7; and the 5-year hazard rate was 48.3. Using the logistic regression model for estimating and predicting the probability of recurrence within two years after radical cystectomy; we found that only one variable (lymph node involvement) had a significant effect on the prediction of the probability of recurrence. Conclusion These findings suggest that positive lymph nodes; tumor grade; stage; sex; urinary diversion and histopathology of tumor cells are independent predictors of survival in patients with bladder cancer. Positive lymph nodes are the most important indicators for recurrence in general and especially for predicting the probability of recurrence within two years after radical cystectomy

BAL neopterin : a novel marker for cell-mediated immunity in patients with pulmonary tuberculosis and lung cancer.

BACKGROUND: Neopterin is derived from guanosine triphosphate and is produced by stimulated macrophages under the influence of gamma-interferon of lymphocyte origin. It has been suggested that it is an excellent marker for the activation of the monocyte/macrophage axis in some clinical situations. However, to our knowledge, the relationship of BAL neopterin levels to disease states has not been studied. AIM: To assess the usefulness of BAL neopterin levels as an index of disease activity in patients with pulmonary tuberculosis and lung cancer. METHODS: BAL and serum neopterin levels were evaluated in 20 patients with pulmonary tuberculosis, 20 patients with bronchogenic carcinoma, and 10 healthy individuals. The concentration of neopterin was evaluated by radioimmunoassay technique. The BAL level of neopterin was standardized using the BAL urea level. RESULTS: The neopterin levels (mean +/- SD) in the BAL and serum of tuberculous patients (88.6 +/- 27.4 nmol/L epithelial lining fluid [ELF], 61.3 +/- 29.4 nmol/L, respectively) were significantly higher when compared with those in lung cancer patients (40.7 +/- 16.6 nmol/L ELF, 26.8 +/- 6.58 nmol/L, respectively, p < 0.001) and when compared with those in control subjects (26.3 +/- 11.3 nmol/L ELF, 6.8 +/- 2.7 nmol/L, respectively, p < 0.001). In the tuberculous group, BAL and serum neopterin levels in patients with far-advanced disease were significantly higher when compared with those in patients with moderately and minimally advanced diseases (p < 0.001). BAL and serum neopterin levels were significantly higher in patients with small cell carcinoma than in those with adenocarcinoma (p < 0.05). BAL neopterin levels were significantly (p < 0.001) higher than serum levels in all patients and control groups. In addition, there were significant positive correlations between BAL and serum neopterin levels in tuberculous (r = 0.92, p < 0.001), lung cancer (r = 0.62, p < 0.001), and control groups (r = 0.93, p < 0.001). CONCLUSIONS: The levels of neopterin in BAL fluid may reflect the degree of disease activity in pulmonary tuberculous patients. In addition, BAL neopterin levels are elevated in patients with lung cancer, especially the small-cell carcinoma type.

Effect of presence of 18-crown-6 on the response of 1-pyrrolidine dicarbodithioate-based lead selective electrode.

The lipophilic ammonium salt of 1-pyrrolidine dicarbodithioic acid (PCDT)[I] was introduced as a selective ionophore for a sensitive Pb-ion selective electrode. Also, the effect of immobilization of 18-crown-6 (CW), into the above membrane, on the electrode performance was discussed. The slope of the PCDT-based [I] electrode was (26-30 mV decade(-1)), while it was (29-30 mV decade(-1)) for (PCDT+CW)-based [II] electrode according to the doping time. The linear concentration ranges were (1x10(-6)-1x10(-1) M) and (5x10(-5)-1x10(-1) M) for electrode types [I] and [II] after one-day doping. The working pH ranges were (5.0-10.0) and (7.0-10.0) for electrode types [I] and [II], respectively. Most of the common cations were tested for the evaluation of the electrode selectivity with correlation to the ionic radii of the tested cations. Among them only Na(+), Ag(+) and Fe(3+) were the real interference. Application of using the electrode for the determination of lead in lubrication oil samples was performed with RSD (0.86-1.03%). The obtained results were compared to those of an atomic absorption spectrophotometric method.

PCR-RFLP typing of ureC from Helicobacter pylori isolated from gastric biopsies during a European multi-country clinical trial.

A multi-country clinical trial was conducted in ten European countries to determine the efficacy of clarithromycin-omeprazole dual therapy for treating Helicobacter pylori infection in peptic ulcers. Gastric biopsies were cultured for H. pylori before and after treatment. PCR-RFLP was used to determine the genetic heterogeneity of 100 H. pylori isolates from pretreatment and posttreatment biopsies. An 820 bp amplified fragment of the ureC gene was digested with the restriction enzymes Sau3A and Hhal. Fourteen different Sau3A patterns and 15 different Hhal patterns were identified among the pretreatment isolates. In combination, 42 different RFLP types were identified. Comparison of isolates before treatment with those after treatment showed that five of ten patients on clarithromycin-omeprazole dual therapy had the same RFLP type and that all 12 patients on omeprazole therapy alone had the same RFLP type. All isolates were susceptible to clarithromycin prior to treatment, while seven of ten patients on clarithromycin-omeprazole therapy had H. pylori that was resistant to clarithromycin after therapy and 11 of 12 patients on omeprazole therapy had isolates susceptible to clarithromycin after treatment. In addition to PCR-RFLP typing, the presence of the cytotoxin-associated gene (cagA) and the vacuolating gene (vacA) was determined; 79% of the isolates were cagA-positive and all were vacA-positive. The results of this study indicate that infection of H. pylori in Europe is not restricted to a few RFLP types.

A PCR-oligonucleotide ligation assay to determine the prevalence of 23S rRNA gene mutations in clarithromycin-resistant Helicobacter pylori.

We have developed a rapid PCR-oligonucleotide ligation assay that can discriminate single base substitutions that are associated with clarithromycin resistance in Helicobacter pylori. Susceptible isolates were wild type at positions 2143 and 2144 (cognate to 2058 and 2059 in Escherichia coli), while 93% of the resistant isolates contained A-to-G mutations at either position and 7% of the isolates contained A-to-C mutations at position 2143. In addition, the MIC for 86% of the resistant isolates with an A2143 mutation was > or = 64 micrograms per ml, and that for 89% of the resistant isolates with an A2144 mutation was < or = 32 micrograms per ml.

The value of serum IgG titres against Pseudomonas aeruginosa in the management of early pseudomonal infection in cystic fibrosis.

We report the results of a clinical trial. Patients enrolled had serum IgG titres against Pseudomonas aeruginosa above the control range. Assignment to the observation or treatment group was by minimisation. Significant signs or symptoms in any patient prompted antipseudomonal treatment. In addition, the treatment group received antipseudomonal treatment at intervals of four months until the serum IgG titre returned to the control range. P aeruginosa was isolated intermittently from patients in the main trial. Nineteen patients were enrolled (12 observation, seven treatment). After one year in the trial changes in parameters studied, including forced expiratory volume in one second, IgG titre, serum IgG concentrations, and frequency of P aeruginosa isolation had improved in the treated group and worsened in the observation group.

Aztreonam therapy in children with febrile neutropenia: a randomized trial of aztreonam plus flucloxacillin versus piperacillin plus gentamicin.

In a prospective, randomized trial in 100 febrile neutropenic children, aztreonam plus flucloxacillin was compared with piperacillin plus gentamicin. At the 72 h clinical assessment there was no statistically significant difference between the two groups. However, in microbiologically documented infections there was a higher response rate in the piperacillin/gentamicin group (57%) than in the aztreonam/flucoxacillin group (41%). This was contributed to by the poorer Gram-positive cover of the aztreonam/flucloxacillin combination. In clinically documented infections and unexplained fevers the response rate of the two antibiotic regimens was identical. There were two deaths; one early death (in the piperacillin/gentamicin arm) and one late death. At the final assessment a successful outcome was obtained in the remaining patients. In the aztreonam/flucloxacillin group 75% of the episodes required modification compared with 59% in the piperacillin/gentamicin group.

Monoclonal anti-CEA antibodies in the discrimination between primary pulmonary adenocarcinoma and colon carcinoma metastatic to the lung.

Lung metastases from colon adenocarcinoma are often difficult to differentiate from primary lung adenocarcinoma. We studied the diagnostic value of a polyclonal anti-CEA antiserum and two monoclonal anti-CEA antibodies (B18, D14) which define antigens overexpressed in colon carcinoma. Autopsy material from 20 patients with colon carcinoma and lung metastases and 20 specimens from patients with primary lung adenocarcinoma were retrieved, stained, and interpreted without knowledge of the origin of the lung tumor. Colon carcinomas, lung metastases and lung primaries stained positively with polyclonal anti-CEA in 90-100% of cases. D14 stained 75% of colonic metastases and 70% of primary lung adenocarcinomas, whereas 95% of colon primaries were positive. Sixty-five percent of colon primaries and 50% of their metastases were positive with B18, whereas 45% of lung primaries were positive. The frequency of B18 positivity was significantly greater in those colon primaries that were surgically derived (7/9, 78%) compared with their autopsy-derived lung metastases (2/9, 22%) (P less than 0.05). Similarly, D14 staining in surgically derived colon primaries (9/9, 100%) was significantly greater than their autopsy-derived lung metastases (5/9, 56%) (P less than 0.05). In surgical/biopsy-derived tissues 9/9 colonic primaries were D14-positive, whereas only 1 of 6 lung primaries was positive (P = 0.002). We conclude that D14 and polyclonal anti-CEA both stain the majority of colon adenocarcinomas and that changes associated with prolonged fixation may reduce the positivity rate with both B18 and D14 monoclonal antibodies. All three antibodies stain autopsy-derived tissue from primary lung cancer to a significant degree.(ABSTRACT TRUNCATED AT 250 WORDS)

Pseudomonas cepacia: a new pathogen in patients with cystic fibrosis referred to a large centre in the United Kingdom.

Pseudomonas cepacia infection has become increasingly common among patients with cystic fibrosis in North America. In a large cystic fibrosis centre in the United Kingdom 11 cases have been identified during the last six years, with a maximum prevalence of 7% in 1988. Three patients have died, two of whom deteriorated rapidly shortly after acquisition of the organism despite intensive treatment with appropriate antibiotics. Analysis of possible causes of the increase in P cepacia infection suggested that neither patient to patient transmission nor the use of nebulised antibiotics was associated with an increased risk of infection.

Serum IgA antibodies against Pseudomonas aeruginosa in cystic fibrosis.

Serum IgA antibodies to Pseudomonas aeruginosa cell surface antigens were estimated by ELISA. Titres in patients with and without cystic fibrosis and with no pseudomonal infection were low (less than 105 to less than 261). Titres in patients with cystic fibrosis who were chronically infected with P aeruginosa were very high (1200-163,000), and patients who grew the organism intermittently had intermediate titres. Longitudinal studies suggested increasing tissue invasion or involvement of the lower respiratory tract, or both, with increasing time of infection and identified patients with a good prognosis after the onset of pseudomonal infection. Detection of an increased serum IgA titre can give an earlier indication than measurement of the serum IgG titre of the presence of P aeruginosa in the respiratory tract in a proportion of patients. IgA measurement seems to be better than IgG measurement at predicting the reappearance of P aeruginosa after apparent eradication of early infection. These results suggest that this assay may be a valuable additional indicator of the presence of P aeruginosa at the beginning of infection, and of the reappearance of the organism after treatment in the early stages of infection.

An outbreak of acinetobacter septicaemia in a neonatal intensive care unit.

We describe an outbreak of Gram-negative septicaemia due to a rare, non-fermenting, aerobic organism, Acinetobacter calcoaceticus var. lwoffi. The outbreak occurred on a neonatal unit and was confined to babies who were receiving parenteral nutrition. Seven babies developed septicaemia within 24 hours. The source of the outbreak was never firmly established, but contamination of the parenteral nutrition fluid was considered most likely. All 7 babies recovered uneventfully after a week's course of intravenous ceftazidime. Thrombocytopenia was an unexpected feature of this infection.

An ELISA to detect antipseudomonal IgA antibodies in sera of patients with cystic fibrosis.

An enzyme linked immunosorbent assay (ELISA) to measure free serum IgA antibodies to Pseudomonas aeruginosa in patients with cystic fibrosis is described. Results were reproducible and there was no interference from crossreacting antibodies directed against other Gram negative bacteria. Titres were high in patients with Pseudomonas aeruginosa infection and differed according to the stage of the infection. These preliminary results suggest that this assay may be of value in assessing the state of Pseudomonas aeruginosa infection in patients with cystic fibrosis.

Prediction and diagnosis of early Pseudomonas aeruginosa infection in cystic fibrosis: a follow-up study.

Immunoglobulin G (IgG) antibodies to Pseudomonas aeruginosa surface antigens in serum were estimated by enzyme-linked immunosorbent assay for all patients from whom P. aeruginosa was isolated for the first time during a study period of 3 years (33 patients). The titer of IgG antibodies was greater than control values at or up to 24 months before the first isolation of P. aeruginosa in 24 patients. Another five patients had titers that were within the control range before isolation of P. aeruginosa but increased to above the control range within the following 2 months. In these 29 patients, continuing intermittent isolations of P. aeruginosa were accompanied by further increases in titer. The presence of a systemic immune response above the control range indicates tissue invasion and hence infection. Four patients were deemed to have no infection: one or two isolations of P. aeruginosa were accompanied by no increase in specific antibodies to above the control range throughout the entire study period. Fifteen patients received intravenous antipseudomonal chemotherapy. Eradication of the organism and a return of titer to control values, suggesting complete removal of the organisms, occurred in 5 patients, while continued isolations and only a partial decrease in titer occurred in 10 patients. The 15 patients who received treatment improved clinically, in contrast to untreated patients, whose clinical state worsened during the study period. Continuous steroid treatment, given to two patients, was accompanied by a dramatic decrease in both serum IgG concentration and titer, despite continuing intermittent isolations of P. aeruginosa. These results confirm and extend our earlier finding that this assay appears to detect P. aeruginosa infection at a very early stage and helps in differentiating between early infection and harmless colonization. It also appears to be a useful monitor of the progress of infection and the response to intravenous antibiotic treatment in these early stages of infection, before any clinical changes are sufficiently large to be detected, in patients who were not on continuous steroid therapy. The effect of steroid treatment on the immunological response and clinical outcome of patients with early P. aeruginosa infection requires further investigation.

Serum IgG antibodies in patients with cystic fibrosis with early Pseudomonas aeruginosa infection.

Serum IgG antibodies to Pseudomonas aeruginosa surface antigens were measured by enzyme linked immunosorbent assay in all patients with cystic fibrosis from whom P. aeruginosa was isolated for the first time during a study period of 18 months. In 15 patients the titre of serum IgG antibodies was greater than control values before or at the time of the first bacteriological isolation of P. aeruginosa. The presence of serum antibodies specific to P. aeruginosa suggests exposure to infection by that organism for some months before its isolation in significant numbers from the respiratory tract. In the other two patients serum titres were within the control range before isolation of P. aeruginosa but had increased to above the control range within the next month. Longitudinal studies on the entire group of patients showed further increases in titre concurrently with further isolations of P. aeruginosa. These results suggest that this assay may be an indicator of the beginning of pulmonary infection by P. aeruginosa and may prove to be a sensitive monitor of the progress of infection, and response to treatment, during the first months of infection by that organism.

Serum antibodies to Pseudomonas aeruginosa in cystic fibrosis.

Serum IgG antibodies to Pseudomonas aeruginosa cell surface antigens were determined by enzyme linked immunosorbent assay. Titres in patients without cystic fibrosis were low (140-235). Those in patients with cystic fibrosis who were chronically infected by P. aeruginosa were very high (1100-20,500), while patients who grew the organism intermittently had lower titres (160-4400). Longitudinal studies showed that raised titres were observed at a very early stage of infection. High titres were associated with a poor clinical state, while low titres were associated with a better clinical state in both chronic and intermittently infected patients with cystic fibrosis. These results suggest that this test is a specific and sensitive measure of the severity and progress of the different stages of pulmonary infection by P. aeruginosa in patients with cystic fibrosis.