Relationship between fluoride exposure and count of Streptococcus mutans in supragingival biofilm of mexican scholar children.

BACKGROUND/PURPOSE: The use of fluoride is known to reduce the risk of dental caries. There is limited information on the relationship between Streptococcus mutans (S. mutans) and fluoride exposure. This study investigated the association between the count of S. mutans on supragingival biofilm and fluoride exposure of scholar children. MATERIALS AND METHODS: In this cross-sectional study, 56 children from 9 to 11 years of age were selected. Fluoride concentration in drinking water, urine and saliva of each participant were assessed. The count of S. mutans was estimated by calculating the DNA copy number through a quantitative real time polymerase chain reaction (qPCR) assay. Also, sociodemographic data, oral and general health information and variables related to caries risk were evaluated. A stepwise multiple linear regression was performed in all caries related predictor variables with the count of S. mutans as the dependent variable. RESULTS: The multiple linear regression analysis showed that the concentration of fluoride in saliva (ß = -3.029, p < 0.001) and urine (ß = -2.057, p = 0.017), time of last visit to the dentist (ß = 1.968, p = 0.001), plaque index (ß = 1.637, p = 0.006) and number of surfaces with codes 3-6 (D3-6MFS) of ICDAS II criteria (ß = 0.283, p = 0.076) were significantly associated with the count of S. mutans (Adjusted R square = 0.427, p < 0.001). CONCLUSION: Fluoride levels in urine and saliva were negatively associated with the count of S. mutans in supragingival biofilm. Plaque index, D3-6MFS and time of last visit to the dentist showed a positive association.

Bortezomib and thalidomide maintenance after stem cell transplantation for multiple myeloma: a PETHEMA/GEM trial.

The phase III trial GEM05MENOS65 randomized 390 patients 65 years old or younger with newly diagnosed symptomatic multiple myeloma (MM) to receive induction with thalidomide/dexamethasone, bortezomib/thalidomide/dexamethasone and Vincristine, BCNU, melphalan, cyclophosphamide, prednisone/vincristine, BCNU, doxorubicin, dexamethasone bortezomib (VBMCP/VBAD/B) followed by autologous stem cell transplantation (ASCT) with MEL-200. After ASCT, a second randomization was performed to compare thalidomide/bortezomib (TV), thalidomide (T) and alfa-2b interferon (alfa2-IFN). Maintenance treatment consisted of TV (thalidomide 100 mg daily plus one cycle of intravenous bortezomib at 1.3 mg/m2 on days 1, 4, 8 and 11 every 3 months) versus T (100 mg daily) versus alfa2-IFN (3 MU three times per week) for up to 3 years. A total of 271 patients were randomized (TV: 91; T: 88; alfa2-IFN: 92). The complete response (CR) rate with maintenance was improved by 21% with TV, 11% with T and 17% with alfa2-IFN (P, not significant). After a median follow-up of 58.6 months, the progression-free survival (PFS) was significantly longer with TV compared with T and alfa2-IFN (50.6 vs 40.3 vs 32.5 months, P=0.03). Overall survival was not significantly different among the three arms. Grade 2-3 peripheral neuropathy was observed in 48.8%, 34.4% and 1% of patients treated with TV, T and alfa2-IFN, respectively. In conclusion, bortezomib and thalidomide maintenance resulted in a significantly longer PFS when compared with thalidomide or alfa2-IFN. (no. EUDRA 2005-001110-41).

Direct laser writing of nanorough cell microbarriers on anatase/Si and graphite/Si.

The formation of hierarchical structures consisting of microstripe barriers decorated with nanorough ablated materials prepared by direct laser writing is described. Linear features of circa 25µm width and 12µm height are achieved on amorphous and crystalline titania and graphitic carbon films deposited on silicon. Ablated protrusions build up barriers decorated by nanoscale Si-film reconstructions, as indicated by EDX maps and micro-Raman spectroscopy. Wettability tests show a dramatic change in water contact angle, which leads to almost full wetting after irradiation, irrespective of the original film composition. Fluorescence microscopy images of human mesenchymal stem cells cultured on 1D and 2D structures demonstrate the short term biocompatibility of the ablated surfaces. It is shown that cells adhere, extend and polarize on feature edges, independently of the type of surface, thus suggesting that the created nanoroughness is at the origin of the antifouling behavior. In particular, irradiated anatase and graphite surfaces demonstrate an increased performance of crystalline films for the creation of cell guiding and trapping devices. The results suggest that such laser processing of films may serve as a time-and-cost-efficient method for the design of few-cells analytical surfaces.

Frequency of dental caries in active and inactive systemic lupus erythematous patients: salivary and bacterial factors.

OBJECTIVE: The objective of this study was to determine dental caries frequency and to analyze salivary and bacterial factors associated with active and inactive systemic lupus erythematous (SLE) patients. Also, a proposal to identify dental caries by a surface, teeth, and the patient was developed. MATERIAL AND METHODS: A cross-sectional, blinded study that included 60 SLE patients divided into two groups of 30 subjects each, according to the Activity Index for Diagnosis of Systemic Lupus Erythematous (SLEDAI). The decayed, missing, and filled teeth (DMFT) index and Integrative Dental Caries Index (IDCI) were used for analyzing dental caries. The saliva variables recorded were: flow, pH, and buffer capacity. The DNA copies of Streptococcus mutans and Streptococcus sobrinus were estimated by real-time PCR. RESULTS: The caries frequency was 85% for SLE subjects (73.3% for inactive systemic lupus erythematous (ISLE) and 100% for active systemic lupus erythematous (ASLE)); DMFT for the SLE group was 12.6 ± 5.7 and the IDCI was (9.8 ± 5.9). The ASLE group showed a salivary flow of 0.65 compared with 0.97 ml/1 min from the ISLE group; all variables mentioned above showed a statistical difference (p < 0.05). The salivary pH was 4.6 (6.06 for ISLE and 3.9 for ASLE). The DNA copies of S. mutans and S. sobrinus were high; all variables mentioned above show a significant statistical difference (p < 0.05) between groups. CONCLUSION: SLE patients had high DMFT and IDCI scores that were associated with a decrease in salivary flow, pH, and buffer capacity. There were high counts of S. sobrinus and S. mutans species, and IDCI is a useful tool to provide more detail about dental caries in epidemiological studies.

Molecular identification and antibiotic resistant bacteria isolated from primary dentition infections.

BACKGROUND: Bacterial resistance to antibiotics is a health problem in many parts of the world. The aim of this study was to identify bacteria from dental infections and determine bacterial resistance to antibiotics used in dental care in the primary dentition. METHODS: This cross-sectional study comprised 60 children who presented for dental treatment for active dental infections in the primary dentition. Samples from dental infections were collected and bacteria were identified by polymerase chain reaction (PCR) assay. Bacterial resistance to antibiotics was determined by colony forming units on agar plates containing amoxicillin, clindamycin and amoxillicin-clavulanic acid (A-CA) tested at 8 µg/ml or 16 µg/ml. RESULTS: Clindamycin in both concentrations tested (8 µg/ml and 16 µg/ml) showed the highest bacterial resistance (85.9%), followed by amoxicillin (43.7%) and A-CA (12.0%). All comparisons among the three antibiotics used in the study exhibited statistical significance (p = <0.05) in both concentrations tested (8 µg/ml and 16 µg/ml), and under aerobic and anaerobic conditions. The most prevalent resistant species identified by PCR in primary dentition infections were: Streptococcus oralis and Prevotella intermedia (75.0%); Treponema denticola and Porphyromonas gingivalis (48.3%); Streptococcus mutans (45.0%); Campylobacter rectus; and Streptococcus salivarius (40%). CONCLUSIONS: This study demonstrated that A-CA exhibited the lowest bacterial resistance for clinical isolates in primary dentition infections.

Characterization of periodontal biofilm in Down syndrome patients: a comparative study.

UNLABELLED: The aim of this study was to characterize the main periodontal bacterial species in Down syndrome (DS) patients with and without periodontitis. METHOD: This cross-sectional study involved 75 DS patients, 45 with and 30 without periodontitis. Informed consent, health and dental questionnaires and periodontitis diagnosis were performed PCR and LAMP assays were performed on subgingival dental plaque sample. RESULTS: Tannerella forsythia was the most frequent bacteria detected in the group with and without periodontitis (95.5 and 63.3%) followed by Treponema denticola (88.8 and 50%) and Porphyromonas gingivalis (53.3 and 25% respectively). There were statistical differences between groups (p < 0.05). Pg fimA type I was the most frequent Porphyromonas gingivalis genotype. Two different sets of primers (Aa-F/Aa-R and ltx3/ltx4) were used to detect Aggregatibacter actinomycetemcomitans and different frequencies were obtained, (68% and 14.6% respectively), they had a weak correlation (Cohen Kappa = 0.16). After sequencing of PCR products, ltx3/ltx4 showed more specificity. JP2 clone of A. actinomycetemcomitans was not detected in any sample. CONCLUSIONS: The composition of oral biofilm is fundamental for the development of periodontal disease independently of immunological alterations associated with DS. The frequency of detection of A. actinomycetemcomitans reported in the literature has a wide range, because the primers and probes applied

Placental FTO expression relates to fetal growth.

OBJECTIVE: The fat mass and obesity-associated gene (FTO) participates in the control of postnatal weight gain. We assessed whether FTO is expressed in human placenta and whether such expression relates to prenatal weight gain and to the rs9939609 single nucleotide polymorphism (SNP) in FTO. DESIGN AND SUBJECTS: In a birth cohort study, placentas from women (n = 147) with an uncomplicated, singleton, term pregnancy were weighed at delivery. Real-time PCR was used to study, in placental tissue, the expression of FTO and of housekeeping genes (TATA box binding protein and succinate dehydrogenase complex, subunit A) and to genotype the rs9939609 SNP in FTO. Weights and lengths of the newborns were measured; circulating insulin and insulin-like growth factor-I (IGF-I) were quantified in cord blood. RESULTS: FTO was highly expressed in placenta and was associated with increased fetal weight and length (P<0.001 to P<0.0001). Maternal parity showed an interaction (P<0.001) in the association between placental FTO expression and placental weight. Placental FTO mRNA expression was associated with increased fetal-to-placental weight ratio (P<0.005) in infants from primiparous women, and was associated with increased fetal weight and length and placental weight (P<0.001 to P<0.0001) in infants from nonprimiparous women. These associations were not explained by either cord insulin or IGF-I. Placental FTO expression was unrelated to placental FTO rs9939609 SNP. CONCLUSION: FTO is expressed in the human placenta. In a maternal parity-dependent manner, placental FTO may participate either in the control of fetal weight gain or in the partitioning between placental and fetal growth.

Utilización de analgésicos opioides mayores en dos áreas sanitarias de España durante 2005 / No disponible

Objetivo: describir y comparar la prescripción de analgésicos opioides mayores en dos áreas sanitarias de España durante 2005. Método: Diseño: estudio descriptivo ecológico. Ámbito: Servicio de Salud de Lleida y Área Sanitaria 3 de la Comunidad de Madrid (A3-Madrid). Medidas principales de resultado: los sistemas de información de atención primaria de los servicios de Salud de Madrid y Lleida proporcionaron los datos relativos a la prescripción de opioides mayores. Se utilizó la clasificación farmacológica ATC/DDD (Anatómica-Terapéutica-Clínica/Dosis Diaria Definida) con los datos en DDD por millón de habitantes y día (DHD). Resultados: la DHD de opioides mayores fue de 3.690 para Lleida y 2.140 para A3-Madrid. El fentanilo constituye el 88% de los opioides prescritos en A3-Madrid comparado con el 52% en Lleida. La buprenorfina representa el 45% de los opioides prescritos en Lleida comparado con el4% en A3-Madrid. Conclusiones: la utilización de morfina ha sido sustituida por fármacos opioides de más reciente comercialización, principalmente las formas transdérmicas de fentanilo y buprenorfina (AU)

Objective: to compare and to describe the prescription of strong opioid analgesics in two sanitary districts of Spain during 2005. Method: Design: an ecological descriptive study. Setting: Lleida Health Service and the Third Sanitary District in Madrid (3D-Madrid) Community. Main outcome measures: a primary healthcare database supplied information regarding the prescription of strong opioids. We used the ATC/DDD (Anathomical-Therapeutical-Clinical/Defined Daily Dose) drug classification. Data obtained are expressed as Defined Daily Dose per 1,000,000 inhabitants per day (DHD).Results: DHDs of 3,690 for Lleida and of 2,140 for the Third SanitaryDistrict in Madrid (3D-Madrid) were found. Fentanyl constitutes 88 percent of prescribed opioids in 3D-Madrid versus 52 percent in Lleida. Buprenorphine represents 44 percent of prescribed opioids in Lleida versus 4 percent in 3D-Madrid.Conclusions: morphine has been substituted for by other drugs, mainly the transdermic forms of fentanyl and buprenorphine (AU)

[Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality]. / Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores.

OBJECTIVE: To find the number of patients in terminal care in Madrid Health District 3. DESIGN: Ecological, descriptive study. SETTING: Eleven Health Districts. Madrid, Spain, 2002. MAIN MEASUREMENTS: Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. RESULTS: The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. CONCLUSIONS: There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved.

La automedicación responsable, la publicidad farmacéutica y su marco en la Atención Primaria / Responsible self-medication, over the counter drug publicity and its framework in Primary Care

La Organización Mundial de la Salud (OMS) ve en la automedicación responsable una fórmula válida de atención a la salud en las sociedades desarrolladas. Para ello se dispone de medicamentos clasificados como especialidades farmacéuticas publicitarias (EFP), que son las únicas de las que puede hacerse publicidad dirigida a la población, siempre bajo un control previo. La industria farmacéutica está demandando a la Administración un control menos estricto sobre las EFP para potenciar su desarrollo, sacar "marcas paraguas" o asumir directamente la responsabilidad de su publicidad ("autorregulación"); líneas éstas que el Ministerio de Sanidad y Consumo no considera prioritarias. En este artículo se revisan las ventajas e inconvenientes de las EFP, así como los requisitos que deberían darse para una automedicación responsable. Es clave la educación sanitaria de la población y la estrecha colaboración entre médicos y farmacéuticos. Los nuevos avances tecnológicos abren vías de colaboración para conseguir una automedicación responsable

The World Health Organization (WHO) considers responsible self-medication as a valid formula for health care in developed societies. For this, there are drugs classified as over the counter (OTC), which are the only ones that can use advertising aimed at the population, always under previous control. The pharmaceutical industry is demanding that the Administration control OTC drugs less strictly in order to potentiate their development, promote umbrella brands or directly assume responsibility for their publicity ("self-regulation"), lines which are not considered to be priority by the Ministry of Health and Consumer Affairs. This article reviews the advantages and disadvantages of the OTC and the requirements that should be used for responsible self-medication. Health care education of the population and strict collaboration between physicians and pharmacists are essential. The new technological advances open collaboration pathways to achieve responsible self-medication

Estimación de la población de enfermos en situación terminal a través de la utilización de analgésicos opioides y de la mortalidad por tumores / Calculation of the number of terminally ill patients through their use of opioid analgesics and tumor mortality

Objetivo. Conocer el número de pacientes en situación terminal del Área 3 de Madrid. Diseño. Estudio descriptivo, ecológico. Emplazamiento. Once áreas de salud. Comunidad de Madrid (CM). Año 2002. Mediciones principales. Se utilizan dos modelos para estimar a la población de pacientes en situación terminal y se comparan con los datos obtenidos en la cartera de servicios: ­ Modelo A. Consumo de opioides mayores (fentanilo y morfina). Se calcula el número de dosis diarias definidas (DDD) y la dosis diaria definida por 1.000 habitantes y día (DHD) para estos principios activos. Datos de prescripción: recetas facturadas por la Seguridad Social de médicos colegiados de la CM (atención primaria y especializada). ­ Modelo B. Mortalidad por tumores: número de defunciones por tumores del año 2000, publicado en 2004. Resultados. El número de pacientes en situación terminal estimado por los 2 modelos en 7 de las 11 áreas y en la CM es superior al obtenido en la cartera de servicios. La prescripción de opioides mayores se realiza fundamentalmente en atención primaria (96%) en la CM. Se produce un salto cuantitativo en la utilización de fentanilo entre 2001 y 2002, debido a la prescripción mayoritaria de fentanilo transdérmico. Conclusiones. Hay diferencias en la estimación de pacientes en situación terminal según los distintos modelos. Además, los modelos no presentan resultados coherentes entre las distintas áreas de salud. La utilización de fentanilo ha desplazado a la morfina en la CM. Es importante mejorar los registros y/o la captación de pacientes en situación terminal

Objective. To find the number of patients in terminal care in Madrid Health District 3. Design. Ecological, descriptive study. Setting. Eleven Health Districts. Madrid, Spain, 2002. Main measurements. Two models were used to calculate the number of patients in terminal care and were compared with data from the Primary Care Service Portfolio. Model A: consumption of morphine and fentanyl. The number of defined daily doses (DDD) of these active principles and the DDD per 1000 inhabitants and day (DID) were calculated. Prescription details: prescriptions charged to Social Security from registered doctors in Madrid (primary care and specialists). Model B: tumor mortality, i.e. the number of deaths due to tumors in the year 2000, published in 2004. Results. The number of terminal patients calculated by the 2 models in 7 of the 11 Health Districts and in the Community of Madrid is higher than in the Primary Care Service Portfolio. In the Community of Madrid, morphine and fentanyl are prescribed basically in primary care (96%). There was an important jump in fentanyl prescription from 2001 to 2002, due to the main fentanyl prescribed being transdermal. Conclusions. There are differences between the models in calculation of terminal patients. Moreover, the models offer heterogeneous results between health districts. Fentanyl consumption has become greater than morphine use in Madrid. The registers of terminal patients and/or their recruitment need to be improved

Mielitis transversa aguda. Diagnóstico desospecha en urgencias / Acute transverse myelitis. Suspicion in the emergency seeting

No disponible

Floating-Harbor syndrome. A neuropsychological approach.

We describe a six year old Mexican girl whose clinical picture (short stature with delayed bone age, language difficulties and triangular face with prominent nose) was compatible with the diagnosis of Floating-Harbor Syndrome (FHS). A neuropsychological evaluation disclosed a mild mental retardation, a constructive apraxia, a comprehensive and expressive language impairment. The analysis of the present case and sixteen patients previously described establishes that the FHS is mainly characterized by proportionate short stature with significantly delayed bone age, delayed expressive language and peculiar face.

[Acquired hemoglobin H disease associated with a myelodysplastic syndrome]. / Enfermedad de la hemoglobina H adquirida asociada a síndrome mielodisplásico.

Some patients found to have clonal panmyelopathies develop an acquired defect of haemoglobin synthesis clinically similar to haemoglobin H disease. A 58 year-old male diagnosed of simple refractory anaemia developed microcytosis and hypochromia. At the same time, his myelodysplastic syndrome became a refractory anaemia with excess of blasts. 33% of the red blood cells had "golf ball" inclusions after incubation with brilliant cresyl blue. Cellulose acetate electrophoresis revealed an haemoglobin H band. The globin chain synthesis alpha/beta ratio was 0.69. The molecular analysis demonstrated the integrity of both alpha genes in each chromosome. There were no familiar antecedent of haemoglobinopathy.

[Complete remission without marrow aplasia phase in a patient with acute promyelocytic leukosis treated with aggressive chemotherapy]. / Remisión completa sin fase de aplasia medular en un paciente con leucosis aguda promielocítica tratado con quimioterapia agresiva.

A patient diagnose of acute promyelocytic leukemia treated with chemotherapy schedule type VAPA. 2 weeks after the administration, there was no response this being the reason to administer a new induction course. 2 weeks after this, a new bone marrow aspiration was performed showing leukemic infiltration with 78% promyelocytes. The clinical situation of the patient did not recommend the addition of more chemotherapy. 10 days later complete remission in bone marrow and blood were demonstrated. The importance of this finding is discussed, complete remission without aplasia, as well as the diagnosis and therapeutic remarks of the case.