Low-threshold SARS-CoV-2 testing facility for hospital staff: Prevention of COVID-19 outbreaks?

BACKGROUND: The ongoing global SARS-CoV-2 pandemic has caused over 4.7 million infections greatly challenging healthcare workers (HCW) and medical institutions worldwide. The SARS-CoV-2 pandemic has shown to significantly impact mental and physical health of HCW. Thus, implementation of testing facilities supporting HCW are urgently needed. METHODS: A low-threshold SARS-CoV-2 testing facility was introduced at the University Hospital Bonn, Germany, in March 2020. Irrespective of clinical symptoms employees were offered a voluntary and free SARS-CoV-2 test. Furthermore, employees returning from SARS-CoV-2 risk regions and employees after risk contact with SARS-CoV-2 infected patients or employees were tested for SARS-CoV-2 infection. Pharyngeal swabs were taken and reverse transcription polymerase chain reaction for detection of SARS-CoV-2 was performed, test results being available within 24 h. Profession, symptoms and reason for SARS-CoV-2 testing of employees were recorded. RESULTS: Between 9th March and April 30, 2020, a total of 1510 employees were tested for SARS-CoV-2 infection. 1185 employees took advantage of the low-threshold testing facility. One percent (n = 11) were tested positive for SARS-CoV-2 infection, 18% being asymptomatic, 36% showing mild and 36% moderate/severe symptoms (missing 10%). Furthermore, of 56 employees returning from SARS-CoV-2 risk regions, 18% (10/56) were tested SARS-CoV-2 positive. After risk contact tracking by the hospital hygiene 6 patient-to-employee transmissions were identified in 163 employees with contact to 55 SARS-CoV-2 positive patients. CONCLUSION: In the absence of easily accessible public SARS-CoV-2 testing facilities low-threshold SARS-CoV-2 testing facilities in hospitals with rapid testing resources help to identify SARS-CoV-2 infected employees with absent or mild symptoms, thus stopping the spread of infection in vulnerable hospital environments. High levels of professional infection prevention training and implementation of specialized wards as well as a perfectly working hospital hygiene network identifying and tracking risk contacts are of great importance in a pandemic setting.

[Lutetium-177-PSMA radioligand therapy : Consensus within the framework of GKV-funded care between the university hospitals in Aachen, Bonn, Düsseldorf, Essen, and Cologne and the MDK Nordrhein]. / Lutetium-177-PSMA-Radioligandentherapie : Konsensus im Rahmen der GKV-finanzierten Versorgung zwischen den Hochschulkliniken in Aachen, Bonn, Düsseldorf, Essen und Köln und dem MDK Nordrhein.

In the last 3 years, Lutetium-177 prostate-specific membrane antigen radioligand therapy (Lu-177-PSMA-RLT) has received increasing attention in nuclear medicine as a new form of treatment for castration-resistant metastatic prostate cancer. This therapy combines the radionuclide Lutetium-177, which has been therapeutically used in nuclear medicine for many years, with a molecular target of the transmembrane prostate-specific membrane antigen expressed by prostate cancer cells. Since there are no prospective randomized studies on Lu-177-PSMA-RLT and the question of reimbursement has repeatedly been the subject of review by the MDK Nordrhein (Medischenische Dienst der Krankenversicherung), there was a desire because of the increasing number of patients being treated to clarify under which circumstances Lu-177-PSMA-RLT can be reimbursed by German statutory health insurance. The goals of this article are to help treating physicians understand how this new therapy option works, to integrate it in the overall therapy concept for castration-resistant metastatic prostate cancer, and, above all, to use Lu-177-PSMA-RLT-based on the current data-at the right place in the therapy sequence of castration-resistant metastatic prostate cancer.

Oxytocin response to an experimental psychosocial challenge in adults exposed to traumatic experiences during childhood or adolescence.

Long-term implications of the exposure to traumatizing experiences during childhood or adolescence, such as sexual abuse, or cancer, have been documented, namely the subjects' response to an acute stress in adulthood. Several indicators of the stress response have been considered (e.g. cortisol, heart rate). Oxytocin (OT) response to an acute stress of individuals exposed to trauma has not been documented. Eighty subjects (n=26 women who had experienced episodes of child abuse, n=25 men and women healthy survivors of cancer in childhood or adolescence, and 29 controls) have been submitted to a laboratory session involving an experimental stress challenge, the Trier social stress test. Overall, there was a clear OT response to the psychosocial challenge. Subjects having experienced a childhood/adolescence life-threatening illness had higher mean levels of OT than both abused and control subjects. There was a moderate negative relationship between OT and salivary cortisol. It is suggested that an acute stress stimulates OT secretion, and that the exposure to enduring life-threatening experiences in childhood/adolescence has long-lasting consequences regarding the stress system and connected functions, namely the activation of OT secretion. Better knowledge of such long-term implications is important so that to prevent dysregulations of the stress responses, which have been shown to be associated to the individual's mental health.

Controlling invasive pneumococcal disease: is vaccination of at-risk groups sufficient?

Risk factors for invasive pneumococcal disease (IPD) include young and old age, comorbidities (such as splenic dysfunction, immunodeficiencies, chronic renal disease, chronic heart or lung disease or cerebral spinal fluid leak), crowded environments or poor socioeconomic conditions. Universal use of the 7-valent pneumococcal conjugate (7vPncCRM) vaccine for infants and young children has led to significant decreases in IPD in the vaccinated population (direct protection), and there has also been a decrease in the incidence of IPD among the nonvaccinated population (indirect immunity; herd protection). While 7vPncCRM vaccine is administered universally to children in USA, many countries of the European Union have chosen to target children with comorbidities. This review aims to highlight individual risk factors for IPD, describe studies that evaluated pneumococcal conjugate vaccines in at-risk groups and estimate the proportion of at-risk children who may have been vaccinated in the European Union since the 7vPncCRM vaccine was introduced, using UK as an example. Although immunisation targeting only children with comorbidities may achieve satisfactory results for a few, many otherwise healthy children at risk simply because of their age will be neglected, and herd protection might not be established.

Genioglossal advancement--a simple surgical procedure for sleep apnea. Case report and literature review.

Although the use of a standard nasal continuous positive airway pressure device to combat obstructive sleep apnea is often effective, it is neither curative nor universally well tolerated. Thus, surgical intervention is often inevitable. We describe a simple, conservative surgical procedure performed on a patient with profound mandibular retrognathia (dolichofacial type), accompanied by sleep apnea. The procedure resulted in a significant pharyngeal airway enlargement of 53 and 87% at the mandible angle and hyoid bone levels, respectively, increased oxygen saturation, reduction in the respiratory disturbance index by 50%, and improved sleep quality. We present a procedure for patients whose sleep apnea is due to extensive mandibular retrognathism with concomitant retrolingual narrowing and collapse.

The effect of secondary hyperparathyroidism and hemodialysis therapy on alveolar bone and periodontium.

BACKGROUND: Alveolar bone is particularly sensitive to increased levels of parathyroid hormone (PTH) from either primary or secondary hyperparathyroidism (HPT). The purpose of this study was to examine the effect of secondary HPT on the periodontium of patients on hemodialysis. METHODS: The experimental group consisted of 35 patients with secondary HPT, with chronic renal failure treated by hemodialysis (E group). A control group (C group) was formed from 35 healthy age- and gender-matched subjects attending the maxillofacial outpatient clinic for a variety of reasons. Blood samples were taken from the E group, and the biologically active intact parathormone molecule, PTH(1-84), was assayed using two-site immunoradiometric assay (IRMA). The time of onset and the duration since diagnosis of HPT was also recorded. In addition, for a subgroup of 25 matched pairs of patients, a clinical periodontal examination was performed, and the Ramfjord index teeth were recorded for: Plaque index (PI); Gingival index (GI); Probing depth (PD); and Clinical attachment level (CAL). A standardized panoramic X-ray was taken from all patients and computer-based linear measurements were used to assess alveolar bone loss (BL). Unpaired Student's t-test served to compare the two groups. Pearson's correlation coefficient test was used to study the association between PI, PTH level, disease duration and BL. RESULTS: Demographically, both groups were similar with no statistical difference. PI was also similar in the C and E group (2.03 +/- 0.13 and 1.76 +/- 0.17, respectively). GI, however, was slightly greater in the C group (1.28 +/- 0.09) compared to the E group (0.97 +/- 0.01). PD in the E group (2.92 +/- 0.14 mm) was almost identical to that of the C group (2.90 +/- 0.12 mm). Likewise, CAL in the E group (4.43 +/- 0.29 mm) did not differ from CAL in the C group (4.03 +/- 0.25 mm). Mean BL was also similar in the E and C groups (3.60 +/- 0.23 mm and 3.85 +/- 0.24 mm, respectively). PI showed a positive, significant correlation with BL (r = 0.457, P = 0.0008). CONCLUSION: From this study it can be concluded that secondary HPT does not have an appreciable effect on periodontal indices and radiographic bone height.

Enhancement of bone defect healing in old rats by TGF-beta and IGF-1.

Bone defects are often created in order to repair bone pathologies. In the aging population, the healing of such defects is very limited. Bone healing in aging depends on the availability of various hormone and growth factors. The ability of growth factors to enhance bone formation in femoral defects in old rats was tested. Bone defects were induced in femurs of old rats. A single dose of transforming growth factor-beta (TGF-beta), IGF-1, TGF-beta+IGF-1 or saline was inserted in the defect and bones were tested after 2 and 4 weeks. Radiology revealed that mineralization appeared in the 2 weeks group in defects treated with TGF-beta and in defects treated with TGF-beta, TGF-beta+IGF-1 in the 4 weeks groups. Computerized tomography (CT) coronal and axial images revealed that 4 weeks after treatment with TGF-beta+IGF-1, a complete bone bridge was observed. Morphology revealed that these defects were filled with trabecular bone. A less pronounced bone healing was observed after TGF-beta or IGF-1, while control specimens revealed partial healing of the bone defect. Biomechanical tests indicated that treatment with TGF-beta, IGF-1 or TGF-beta+IGF-1 resulted in a significant increase of bone bending rigidity compared to control in the 4 weeks group and that TGF-beta+IGF-1 was the most inductive in this respect. The ability to induce bone healing in aging by TGF-beta+IGF-1 is of a great clinical importance for restoration of bone strength and biomechanical properties of bone defects in aging.

Postlicensure evaluation of the effectiveness of seven valent pneumococcal conjugate vaccine.

OBJECTIVE: To evaluate the impact of the introduction and routine use of seven valent pneumococcal conjugate vaccine on the epidemiology of invasive pneumococcal disease within the Northern California Kaiser Permanente (KP) population. METHODS: Surveillance for invasive pneumococcal disease has been in place within KP since 1995. Isolates from normally sterile sites in children are routinely sent for serotyping. Cases of invasive disease are identified through review of automated microbiology records within KP. Incidence rates of invasive disease were compared for the period before and after routine use of pneumococcal conjugate vaccine in children. RESULTS: The incidence of invasive pneumococcal disease caused by vaccine serotypes before the licensure and routine use of pneumococcal conjugate vaccine ranged between 51.52 and 98.15 cases per 100 000 person years in children <1 year of age and fell to 9.35 after introduction of vaccine. The incidence in children <2 years of age was 81.67 to 113.80 before introduction and 38.22 cases per 100 000 person years after introduction of the vaccine into the general population. These reductions in disease rates exceeded the average vaccine coverage substantially in each age group. No increase in disease incidence was observed for possibly cross-reacting serotypes or nonvaccine serotypes. CONCLUSION: The introduction and routine use of pneumococcal conjugate vaccine in our population have been associated with a substantial reduction in invasive disease incidence in children <5 years of age.

[Vertical alveolar ridge augmentation using distraction osteogenesis].

Alveolar ridge atrophy can be acquired or congenital. Alveolar ridge augmentation can be performed using bone grafting but a donor site morbidity is unavoidable and some resorption of the grafted bone occurs. Distraction osteogenesis offers an alternative method for bone reconstruction without donor site morbidity and sufficient stability of the final results. In order to place implants, vertical alveolar augmentation using Distraction Osteogenesis has been applied to 14 patients aged 17 to 55 years old with edentulous alveolar ridge, 8 in the mandible and 6 in the maxilla. Vertical alveolar bone distraction was started by performing a segmental alveolar osteotomy followed by insertion of a central distraction device--Lead System (Endosseous alveolar distraction system, Leibinger). After three days of latency period, the distraction was started in a rate of 0.8 mm per day for 9 to 16 days as needed. The retention period for the new bone maturation was twice as long as the active distraction period. After removal of the device, 23 cylindrical threaded implants were inserted. The results revealed increase of the alveolar bone height with new bone formation that was observed radiographically and clinically at the removal of the distraction device. The amount of elevation was 7-13 mm. In follow-up of 6-14 months, failure of only one implant was noted, due to inadequate transported bone stability. The advantages of alveolar bone distraction are: Increase of the alveolar bone height with new bone formation, minimal resorption of bone without the bone graft disadvantages. A long term follow up after the bone height achieved and implant anchorage should be performed in the future.

Intraoral distraction osteogenesis of the mandible in hemifacial microsomia.

PURPOSE: Lengthening of the mandible by distraction osteogenesis is the preferred method for treatment of hemifacial microsomia in children. Use of an intraoral distraction technique and horizontal oblique ramus osteotomy in such patients is presented. PATIENTS AND METHODS: Mandibular ramus lengthening was performed in 11 patients aged 6 to 12 years with hemifacial microsomia. During the age of mixed dentition in hemifacial microsomia patients with a hypoplastic mandible, the unerupted molars buds are located high in the retromolar region and are in danger of being damaged by the osteotomy. Therefore, an intraoral approach exposing the mandibular ramus and angle was performed, and a horizontal oblique ramus osteotomy was made, preserving the inferior alveolar nerve. An intraoral device was placed along the ramus, and distraction was started on the third postoperative day at the rate of 1 mm/d and continued for 2 to 3 weeks or as long as necessary. The device was maintained for retention an additional 6 weeks and was then removed. RESULTS: Clinically, the face became more symmetric. The postdistraction posteroanterior cephalometric radiographs demonstrated elongation of the affected ramus and improvement in facial symmetry. CONCLUSIONS: The advantages of this method are that it allows device placement along the ramus, permitting the ramus elongation necessary in treatment of hemifacial microsomia, that it prevents damage to the tooth buds which, during the age of mixed dentition, are in a higher position in the retromolar area, and that it prevents injury of the inferior alveolar nerve.

The effect of low-dose interleukin-2-based immunotherapy on salivary function and composition in patients with metastatic renal cell carcinoma.

One of the side-effects accompanying low-dose recombinant interleukin-2 (rIL-2)-based immunotherapy is salivary hypofunction. We evaluated the functional and compositional whole salivary profile at both resting and stimulated conditions in 10 renal cell carcinoma patients who received prolonged low-dose rIL-2-based immunotherapy. Following the termination of 4 weeks of the combined administration of rIL-2 and recombinant interferon-alpha (rIFN-alpha), we found significant reductions of salivary flow rates at resting condition, accompanied by significant multiple compositional alterations, including increases in calcium, magnesium and phosphate concentrations, and significant reductions in total protein concentration. In contrast, no flow rate reduction was noted under stimulated condition, and the only significant altered compositional component was the phosphate. We recommend salivary-supporting therapies and anticariogenic treatments for patients undergoing low-dose rIL-2-based immunotherapy.

Invading basal cell carcinoma of the jaw: an under-evaluated complex entity.

Basal cell carcinoma (BCC) is a locally invasive neoplasm, rarely metastatic, yet capable of significant local destruction and disfigurement. Invasion into the bone is uncommon and only a few cases of invasion into facial bones, but never to the mandible or maxilla, have been described. We report three patients with BCC lesions invading their jaws, as a consequence of which either their mandible or maxilla had to be partially resected. This resulted in facial mutilation which required comprehensive multi-disciplinary therapy to restore function and esthetics. Such therapy requires a combination of modalities offered by both plastic and maxillofacial surgeons, as well as oral and dental rehabilitators.

[Secondary bone grafting in cleft lip and palate].

Results of reconstruction of residual alveolar bone defects in 52 patients operated between 1990-1998 were evaluated clinically and radiographically in a retrospective study. Ages ranged between 9-37; 30 were males. The donor site of bone grafts in all was particulate cancellous marrow from the anterior iliac crest. 32 had unilateral clefts and 20 bilateral. Total cleft sites treated was 72. Best results were achieved when bone grafting was carried out prior to the eruption of the canine tooth. The cleft space was closed and oro-nasal fistulas were eliminated in 42 (80%). Success rates in unilateral and bilateral cases were significantly different.

Amine fluoride/stannous fluoride and chlorhexidine mouthwashes as adjuncts to surgical periodontal therapy: a comparative study.

BACKGROUND: Postsurgical mouthwashes are routinely used in clinical studies and also in daily clinical practice. Chlorhexidine gluconate (CHX) has long been the gold standard for supra-gingival chemical plaque control regimens. Amine fluoride/stannous fluoride (AmF/SnF2) formulations have also been extensively studied and shown to have an antibacterial effect and be useful as antiplaque agents. The antibacterial effect of AmF/SnF2 and its minimal extrinsic tooth staining make it a possible alternative to CHX as an adjunct to periodontal surgical therapy. The aim of this double-blind, controlled clinical trial was to evaluate and compare the combined effect of an AmF/SnF2 or a CHX mouthwash and surgical periodontal therapy on periodontal parameters. METHODS: Thirty-two patients with at least 3 pockets > or =5 mm in the same quadrant were selected for this study, following a hygienic phase of therapy. They were randomized into 2 treatment groups: surgical flap debridement and a postsurgical CHX mouthwash or surgical flap debridement and an AmF/SnF2 postsurgical mouthwash, performed twice daily for 3 weeks. Clinical measurements were taken at baseline and 3 and 12 weeks postsurgery. RESULTS: Both treatment modalities resulted in significant improvements in probing depth and clinical attachment level. There was no significant difference between groups in any of the recorded parameters. Staining index at week 3 in the CHX group was significantly higher than in the AmF/SnF2 group (P<0.05). However these differences leveled down at 12 weeks. CONCLUSIONS: Our results support the alternative use of an AmF/SnF2 mouthwash in plaque control management of patients following flap debridement surgery.

Extraoral vs. intraoral distraction osteogenesis in the treatment of hemifacial microsomia.

During hemifacial microsomia (HMF), an important phase of the treatment is elongation of the hypoplastic mandible, mainly the ramus, at an early stage. Twenty-two patients with HFM were treated with distraction osteogenesis: 12 with an extraoral device (10 unidirectional and 2 multidirectional) and 10 with an intraoral device. The mean elongation with the extraoral device was 21 mm, and with the intraoral device was 17 mm, resulting in a more symmetrical facial appearance. The advantages and disadvantages of both methods are presented, based on the authors' experience and a review of the literature. The extraoral device permits elongation of a greater distance, enables extraoral control of the vector of elongation, and conserves the gonial angle by working in many directions. The main disadvantages of the extraoral device are the social inconvenience to the patient and the extraoral cutaneous scars. Conversely, the intraoral device is much more socially convenient to the patient and avoids residual scarring. However, in 2 patients treated with an intraoral device, an undesired contralateral open bite appeared as a result of reduced vector control. The intraoral method should always be considered first because of its previously mentioned advantages. However, in severely hypoplastic patients, when three-dimensional correction and gonial angle control are necessary, or when there is a limited space along the planned distracted bone, the extraoral device has an advantage over the intraoral device.

Enhancement of toluidine blue staining by transforming growth factor-beta, insulin-like growth factor and growth hormone in the temporomandibular joint of aged mice.

Osteoarthritic lesions appear in the articular cartilage of the temporomandibular joint of mice aged 7 months and older. Reduced rate of proteoglycan (PG) synthesis leading to destruction of the articular cartilage was observed in this joint. The purpose of the present study was to test the ability of transforming growth factor-beta1 (TGF-beta1), insulin-like growth factor-1 (IGF-1) and growth hormone (GH) to induce PG synthesis in joint cartilage of aged animals and to compare it with the effect of interleukin-1alpha (IL-1alpha). Mandibular condyle explants from 18-month-old mice were cultured up to 72 h in serum-free medium, supplemented with IL-1alpha (TGF-beta1 (0.1-5.0 ng/ml), TGF-beta1 (1.0 ng/ml) + IGF-1 (2 ng/ml) or GH (10 ng/ml). The incorporation of (35)S-SO(4) into sulfated PG was tested. Cartilage samples were processed for histomorphometry using sections stained with 0.1% toluidine blue (TB), pH 1.8. Results indicated that in cultures supplemented (48 h) with either TGF-beta, TGF-beta + IGF-1 or with GH, an increased height and area of TB-positive staining as well as increased incorporation of (35)S-SO(4) into sulfated PG were observed. In contrast, the cytokine IL-1alpha exerted an inhibitory effect on TB staining and on (35)S-SO(4) incorporation. The present study demonstrated that in vitro supplementation of IL-1alpha to mandibular condyle cartilage reduced the height and area of TB staining and incorporation of (35)S-SO(4), whereas TGF-beta1, TGF-beta1 + IGF-1 or GH increased the height and area of TB staining and increased incorporation of (35)S-SO(4). The two parameters used to identify increased PG synthesis were shown to reveal similar results and were useful for studying the dynamic events taking place in cartilage destruction and repair in osteoarthritis.

A possible otological complication due to maxillary expansion in a cleft lip and palate patient.

OBJECTIVE: We present a possible negative side effect of a sudden onset of secretory otitis media in a 12-year-old boy with unilateral cleft lip and palate who underwent maxillary expansion. The secretory otitis media caused a temporary hearing loss developed during the activation of the expander appliance. The possible causes for this complication are discussed. CONCLUSIONS: Clinicians should be aware of the possible association between maxillary expansion and secretory otitis media.