Periodontal disease and stroke: a meta-analysis of cohort studies.

This review aimed to determine the association between periodontal disease and stroke incidence by a meta-analysis of cohort studies. Cohort studies that evaluated the incidence of stroke (fatal or non-fatal, ischaemic or haemorrhagic) and baseline periodontal status and calculated relative risk values were included. The quality of the included studies was assessed using an evaluation grid. The analyses were conducted separately for three outcomes: periodontitis, gingivitis and loss of teeth. Adjusted values of relative risk or of hazard ratio were used to assess risk values in each study. Random effects meta-analyses were conducted when data could be pooled. From the 743 references retrieved, only nine cohort studies were suitable for inclusion in this review. Quality scores of the studies varied greatly. Three prospective studies, which used reliable indicators of periodontal disease, obtained the highest scores. Conversely, three studies that used a subjective evaluation of stroke incidence or diagnosed stroke without imaging obtained the lowest score. The results of the meta-analyses varied depending on the outcome considered and the type of stroke. The risk of stroke was significantly increased by the presence of periodontitis [relative risk 1.63 (1.25, 2.00)]. Tooth loss was also a risk factor for stroke [relative risk 1.39 (1.13, 1.65)]. The risk of stroke did not vary significantly with the presence of gingivitis. This review shows that periodontitis and tooth loss are associated with the occurrence of stroke.

[Does persistent occiput posterior position increase the risk of severe perineal laceration?]. / Les présentations postérieures augmentent-elles le risque de déchirures périnéales sévères?

OBJECTIVE: To assess the risk of severe perineal lacerations (III and IV degrees) during vaginal deliveries in occiput posterior position. PATIENTS AND METHODS: We conducted a retrospective cohort study of 9097 vaginal deliveries in a teaching hospital's maternity between January 1st 2005 and December 31st 2008. Risk factors associated with tears of the 3rd or 4th degree were studied by a multivariate logistic regression. RESULTS: Severe perineal lacerations occurred in 1.69% of cases (n=152) and did not significantly vary between 2005 and 2008. Parity was a protective factor (OR 0.42; P<0.001; IC(95%) 0.29-0.60) whereas instrumental extraction was associated with an increased risk: vacuum (OR 3.95; P<0.001, IC(95%) 2.23-7.00) and forceps (OR 3.55; P<0.001, IC(95%) 2.33-5.42). macrosomia. Risks were also increased in fetal macrosomia and episiotomy did not protect the mother (respectively OR 1.41 P<0.001, IC(95%) 1.19-1.68 and OR 1.73; P<0.001, IC(95%) 1.16-2.57). Persistent occiput posterior position was not significantly associated with an anal sphincter injury (OR=1.70 P=0.059; IC(95%) 0.98-2.94). DISCUSSION AND CONCLUSION: In our series, occiput posterior position did not significantly impact the risk of severe perineal laceration. A manual rotation of the fetal head should be performed in case of associated risk factors.

Evolución de la incidencia de test de embarazo positivo en adolescentes atendidas en un servicio de urgencias / Trends in the incidence of positive pregnancy tests in adolescents seen in an emergency department

Introducción: El debate actual acerca del aborto y la edad en la que se considera la madurez suficiente para llevarlo a cabo sin el consentimiento paterno plantea la necesidad de saber la importancia real del embarazo adolescente en Urgencias. Objetivos: a) Determinar la variación de la incidencia de embarazos adolescentes diagnosticados en urgencias los últimos 12 años, y b) determinar las características de las adolescentes y cuál fue la evolución de los embarazos. Material y métodos: Estudio retrospectivo. Se incluye a las adolescentes con una prueba de embarazo positiva en urgencias entre el 1/7/1997 y el 30/6/2009. Se calcula la incidencia anual de embarazos por cada 1.000 visitas de mujeres adolescentes. Se divide el estudio en dos periodos: del 1/7/1997 al 30/6/2003 y del 1/7/2003 al 30/6/2009. Resultados: Se diagnosticaron 83 embarazos. La incidencia osciló entre 0,5 y 2,0, observándose una tendencia a aumentar en el segundo periodo. Los motivos de consulta más frecuentes fueron: metrorragia, dolor abdominal y vómitos. Sesenta y dos embarazos fueron evolutivos, 20 abortos y uno ectópico. Se conoce la evolución de 35 de las 62 gestaciones evolutivas, en 19 se llevó a cabo el parto, en 11 se produjo una interrupción voluntaria del embarazo, y en 4 un aborto espontáneo. Conclusiones: La incidencia de embarazos en adolescentes en urgencias es baja, pese a ello se observa una tendencia a incrementarse. Muchos motivos de consulta son inespecíficos constatándose la necesidad de interrogar sobre los hábitos sexuales en todas las adolescentes. Un elevado porcentaje de las gestaciones diagnosticadas no se llevan a término (AU)

Introduction: The current debate on induced abortion and the age when a young woman is considered mature to have this without parental consent, shows the need to know the real importance of adolescent pregnancy in the Emergency Department. Objectives: a) To determine the adolescent pregnancy rate variation in the Emergency Department during last 12years; b) to determine the characteristics of the pregnant adolescent and the outcome of their pregnancies. Material and methods: Retrospective study of pregnant adolescents diagnosed in the Emergency Department between July 1, 1997 and June 30, 2009. Pregnancy rates were calculated per 1000 annual female adolescent consultations. Two periods were considered: 1/from July 1, 1997 to June 30, 2003 and 2/from July 1, 2003 to June 30, 2009. Results: Eighty-three pregnancies were diagnosed in adolescents. Pregnancy rates varied from 0.5 to 2.0 per 1000 females; an increased trend in adolescent pregnancy rate was observed in the second period. Metrorrhagia, abdominal pain and vomiting were the most frequent complaints. There were 62 on-going pregnancies, 20 abortions and one ectopic pregnancy. Only 35 of the outcomes of the 62 on-going pregnancies were known: 19 ended in live birth, 11 in induced abortion and 4 in stillbirth. Conclusions: The adolescent pregnancy rate is low; nevertheless an increased trend is being observed in the last few years. Many adolescents diagnosed with pregnancy had nonspecific complaints, so it is important to ask about sexual habits in all adolescents. A high percentage of diagnosed pregnancies end in abortion (AU)

[Trends in the incidence of positive pregnancy tests in adolescents seen in an emergency department]. / Evolución de la incidencia de test de embarazo positivo en adolescentes atendidas en un servicio de urgencias.

INTRODUCTION: The current debate on induced abortion and the age when a young woman is considered mature to have this without parental consent, shows the need to know the real importance of adolescent pregnancy in the Emergency Department. OBJECTIVES: a) To determine the adolescent pregnancy rate variation in the Emergency Department during last 12 years; b) to determine the characteristics of the pregnant adolescent and the outcome of their pregnancies. MATERIAL AND METHODS: Retrospective study of pregnant adolescents diagnosed in the Emergency Department between July 1, 1997 and June 30, 2009. Pregnancy rates were calculated per 1000 annual female adolescent consultations. Two periods were considered: 1/from July 1, 1997 to June 30, 2003 and 2/from July 1, 2003 to June 30, 2009. RESULTS: Eighty-three pregnancies were diagnosed in adolescents. Pregnancy rates varied from 0.5 to 2.0 per 1000 females; an increased trend in adolescent pregnancy rate was observed in the second period. Metrorrhagia, abdominal pain and vomiting were the most frequent complaints. There were 62 on-going pregnancies, 20 abortions and one ectopic pregnancy. Only 35 of the outcomes of the 62 on-going pregnancies were known: 19 ended in live birth, 11 in induced abortion and 4 in stillbirth. CONCLUSIONS: The adolescent pregnancy rate is low; nevertheless an increased trend is being observed in the last few years. Many adolescents diagnosed with pregnancy had nonspecific complaints, so it is important to ask about sexual habits in all adolescents. A high percentage of diagnosed pregnancies end in abortion.

MYST opportunities for growth control: yeast genes illuminate human cancer gene functions.

The MYST family of histone acetyltransferases (HATs) was initially defined by human genes with disease connections and by yeast genes identified for their role in epigenetic transcriptional silencing. Since then, many new MYST genes have been discovered through genetic and genomic approaches. Characterization of the complexes through which MYST proteins act, regions of the genome to which they are targeted and biological consequences when they are disrupted, all deepen the connections of MYST proteins to development, growth control and human cancers. Many of the insights into MYST family function have come from studies in model organisms. Herein, we review functions of two of the founding MYST genes, yeast SAS2 and SAS3, and the essential yeast MYST ESA1. Analysis of these genes in yeast has defined roles for MYST proteins in transcriptional activation and silencing, and chromatin-mediated boundary formation. They have further roles in DNA damage repair and nuclear integrity. The observation that MYST protein complexes share subunits with other HATs, histone deacetylases and other key nuclear proteins, many with connections to human cancers, strengthens the idea that coordinating distinct chromatin modifications is critical for regulation.