What evidence do economic evaluations in dental care provide? A scoping review.

OBJECTIVE: To collate the body of evidence in economic studies of different dental interventions. METHODS: Eligible English studies after 1980 were sourced from MEDLINE using MeSH terms and reviewed independently by 4 teams. Studies were grouped according to the type of dental intervention and their quality appraised using Drummond's Checklist. RESULTS: The number of dental economic studies increased from 1980 to 2016. A total of 91 studies were identified following the search strategy. Most studies were conducted in the United States (n=23), followed by Germany (n=14), Australia (n=10) and the United Kingdom (n=9). Preventative dental interventions comprised 37% of included studies (n=34), followed by restorative (n=14), prosthodontic (n=13) and periodontal interventions (n=12). Cost effectiveness analyses (n=68) comprise 75% of full economic evaluation (EE) studies, followed by cost-utility (n=17) and cost-benefit (n=6). Quality assessment checklists identified 60 studies as good, 23 as moderate and 8 as poor. Common methodological limitations were identified in EE studies. Comparison of studies identified trends and common findings within each dental intervention. CONCLUSION: High quality economic studies are important in directing resources and funding by policy makers. Standardisation of reporting outcome measures will improve the potential for interpretation and comparison between studies. Research adhering to recommended quality assessment checklists will improve the overall quality of evidence to better identify cost-effective treatments for different dental interventions.

Salivary epidermal growth factor correlates with hospitalization length in rotavirus infection.

BACKGROUND: The IFI27 interferon gene expression has been found to be largely increased in rotavirus (RV)-infected patients. IFI27 gene encodes for a protein of unknown function, very recently linked to epidermal proliferation and related to the epidermal growth factor (EGF) protein. The EGF is a low-molecular-weight polypeptide that is mainly produced by submandibular and parotid glands, and it plays an important physiological role in the maintenance of oro-esophageal and gastric tissue integrity. Our aim was to determine salivary EGF levels in RV-infected patients in order to establish its potential relationship with IFI27 increased expression and EGF-mediated mucosal protection in RV infection. METHODS: We conducted a prospective comparative study using saliva samples from 27 infants infected with RV (sampled at recruitment during hospital admission and at convalescence, i.e. at least 3 months after recovery) and from 36 healthy control children. RESULTS: Median (SD) EGF salivary concentration was 777 (529) pg/ml in RV-infected group at acute phase and 356 (242) pg/m at convalescence, while it was 337 (119) pg/ml in the healthy control group. A significant association was found between EGF levels and hospitalization length of stay (P-value = 0.022; r2 = -0.63). CONCLUSIONS: The salivary levels of EGF are significantly increased during the acute phase of natural RV infection, and relate to length of hospitalization. Further assessment of this non-invasive biomarker in RV disease is warranted.

[Long-term consequences of pediatric trauma requiring intensive care]. / Consecuencias a largo plazo de los traumatismos pediátricos que precisaron cuidados intensivos.

INTRODUCTION: Trauma is a major cause of pediatric morbidity. The aim of the present study was to determine the long-term effects of severe trauma in children and their families. PATIENTS AND METHODS: We performed an observational, cross sectional study of 209 children admitted to our pediatric intensive care unit due to trauma between 1999 and 2003. Family members and/or children were interviewed at least 2 years after the event. Functional situation was assessed by means of the Pediatric Overall Performance Category (POPC) scale and neurological status by means of the Pediatric Cerebral Performance Category (PCPC) scale. Subjective perception of quality of life was also evaluated. RESULTS: At assessment, patient age was 13+/-4 years. The causes of trauma were traffic accidents (42.6%), falls (30.1%), bicycle accidents (15.3%) and other causes (12%). The trauma affected the brain and cranium in 78.9%, skeleton in 20.2%, abdomen in 16.3% and other body regions in 15.3% of the patients. At assessment, 1.5 % of the patients were in a persistent vegetative state, 0.5% had severe disability, and 1% had moderate disability. A total of 9.5% had some type of persistent psychological disorder and 3.8 % needed some kind of help to perform daily activities. The median (range) score for self-estimated quality of life by the family was 3 (0-6) for the group of children with moderate or severe disability, while 12.9% of parents reported serious alterations of family dynamics related to the trauma event. CONCLUSIONS: Most children who survive after severe trauma achieve a good functional situation in the long term. Although the number of children with severe sequelae is small, these children have serious difficulties in achieving normal social adaptation and their quality of life is clearly impaired.

Suppression of a differentiation response in MC-3T3-E1 osteoblast-like cells by sustained, low-level, 30 Hz magnetic-field exposure.

Extremely low-frequency (ELF) magnetic fields have been reported to be capable of influencing both tissue remodeling and cell phenotypic expression in culture. However, whether the cells or tissues respond directly to the magnetic flux or to the electric field induced by the time-changing magnetic flux remains a controversial topic. To address this question, we developed an osteoblast cell assay based on the activity of alkaline phosphatase, an enzyme whose activity is up-regulated during the differentiation of bone cells. MC-3T3-E1 cells plated at a confluent density were allowed to proceed through the differentiation process for 3 days, after which they were exposed to a 30 Hz, 1.8-mT r.m.s. magnetic field inducing a spatially varying electric field with a maximum intensity of 0.9 mV/m r.m.s. In situ assays of alkaline phosphatase activity at 4, 8, 16 and 64 h demonstrated a progressive inhibition of enzyme activity, the pattern of which maps to the intensity of the induced electric field (R(2) = 0.5, P<0.001). We interpret these results to indicate that cells are capable of responding to ELF induced electric fields at intensities below 1 mV/m, and that the principal effect on cells is an inhibition of differentiation.

[T and B lymphocytes in hepatic diseases]. / Linfocitos T y B en afecciones hepáticas.

T and B. lymphocytes in peripheral blood were determined in 102 patients with several hepatic diseases: acute hepatitis, persistent and chronic active hepatitis and hepatic cirrhosis. Significant differences (p less than 0.05) were found between all groups of patients and controls. T lymphocytes were decreased (p less than 0.05) in patients with acute hepatitis that developed chronic disease in relation with those with good evolution. A remarkable decrease was found in cirrhotic patients with hepatic insufficiency. The prognostic value of these lymphocytes populations in hepatic diseases is enhanced.

[Study of lymphocyte subpopulations by means of monoclonal antibodies in acute hepatitis A and B]. / Estudio de sub-poblaciones linfocitarias mediante anticuerpos monoclonales en hepatitis aguda A y B.

We studied T3, T4 and T8 lymphocyte populations in peripheral blood by monoclonal antibodies in 40 patients with acute viral hepatitis (Type A 20; Type B 20) who underwent outcome to complete recovery. We compared the results with 20 healthy subjects (control group). We found a decrease in total lymphocytes measured by T3 monoclonal antibodies and a significant increase in T8 lymphocyte populations compared with control groups. In the early stage the T4/T8 ratio was decreased. Lymphocyte populations and T4/T8 ratio was normal in 3-6 month follow-up for the acute A hepatitis group and 3.6 month to a year follow-up for the B hepatitis group. Results were related to the humoral and clinical outcome.

Endoscopic versus direct vision for saphenous vein graft harvesting in coronary artery bypass surgery.

AIM: Recent reports have suggested harvesting of the greater saphenous vein for coronary artery bypass (CABG) using endoscopic techniques (endoscopic) results in early graft closure, higher rates of myocardial infarction (MI) and death. We explored the impact of this technique performed by experienced operators on postoperative morbidities, MI and death in our CABG patients. METHODS: All non-emergent patients presenting for first time CABG surgery from 2006 to June 2009 were included. Data pertaining to surgery, readmissions, cardiac catheterization and interventions during long term follow-up were extracted from our local STS and ACC registries. Linear and logistic regressions with clinical covariates were conducted to determine if vein harvest technique group predicted the major outcomes. Propensity score matching (PSM) was completed to simulate randomization and improve covariate balance across the endoscopic and direct vision groups. RESULTS: One thousand nine hundred and eighty-eight (N.=1988) patients were evaluated in this study (N.=1734 endoscopic group and N.=254 direct vision group). The perioperative major adverse outcomes (mortality within 30 days, stroke, reoperation for bleeding, prolonged ventilation and readmission within 30 days) were 17.8% in the endoscopic group and 25.2% in the direct vision group. The rate of leg infections was 0.3% for the endoscopic group and 1.6% for the direct vision group. After adjustment for covariates, the direct vision group had significantly greater risk for prolonged ventilation (P=0.03), MACE (P=0.02) and mortality within 30 days (P=0.01), but only marginally greater risk for leg infections (P=0.052). In the isolated CABG patients, operative death was 1% for the endoscopic group and 1.7% in the direct vision group (P=0.62). After PSM the endoscopic group was similar on all outcomes except for having fewer MACE (P=0.04). In a mean follow-up of 22.1±10.5 months, there were no significant differences in the overall rate and time to event for repeat revascularization, death and myocardial infarction. With maximum follow up of 39.6 months, 84 deaths were documented (N.=67 endoscopic and N.=17 direct vision). CONCLUSION: The outcomes captured by the number of postoperative morbidities, incidence of myocardial infarction and/or the rate of death for the endoscopic technique were comparable to patients in whom the open techniques was used. There was a trend towards a decrease in leg infections with the use of the endoscopic device. Based on this study we consider the device safe and effective with experienced operators.

Bloodless cardiac surgery and the pediatric patient: a case study.

Peri-operative transfusion of blood or blood products is associated with increased morbidity and mortality after cardiac surgery. However, excessive hemodilution as a result of avoiding the use of homologous blood products can also lead to decreased oxygen delivery to vital end organs and dilutional coagulopathy. This is particularly challenging in pediatric cardiac surgery where there is a large discrepancy between the patient circulating blood volume and the priming volume of the cardiopulmonary bypass (CPB) circuit. Strategies to avoid the use of homologous blood products during pediatric cardiac surgery must also incorporate miniaturization of the CPB circuit and other bypass techniques in order to avoid problems with excessive hemodilution. We report a 5.9 kg male infant who underwent successful surgical correction of a ventricular septal defect without the use of homologous blood transfusion. Our strategies included the pre-operative administration of erythropoietin and iron to increase red blood cell mass, acute normovolemic hemodilution (ANH) before the institution of CPB, retrograde autologous priming (RAP), cell salvage, continuous ultrafiltration, vacuum-assisted venous drainage to minimize the circuit size and priming volume, and the use of near infrared spectroscopy (NIRS) to monitor the patient during the entire procedure. The utilization of these strategies is now standard for our entire pediatric cardiac surgical population.

The role of class II molecules in Mls 1a recognition by CD4+ T cells is independent of the CD4 molecule.

The interpretation of previous antibody inhibition and cell depletion experiments was that major histocompatibility complex (MHC) class II molecules are involved in presentation of Mls molecules to T cell receptors. However, a possible conclusion of several subsequent studies was that T cell receptors may in fact recognize Mls molecules in a class II-unassociated manner. We considered that if this interpretation of the relevant data was correct, the earlier demonstrated role of MHC class II molecules on Mls 1a antigen presenting cells in the response of CD4+ T cells might be only to serve as a ligand for the CD4 molecule on the responder cells. To test the possibility that the inhibition of the anti-Mls 1a response by anti-class II antibodies solely reflected such a CD4:class II molecular interaction, we derived CD4- variants of two independent T cell receptor V beta 6-expressing, Mls 1a-responsive T hybrid clones. Since preliminary experiments to screen for responsiveness revealed that the CD4- variants of both T hybrid clones retained responsiveness to Mls 1a and the variants of one that was also responsive to staphylococcal enterotoxin B retained that responsiveness, we concluded that there is no qualitative dependency of the responses of V beta 6 T cells to these two superantigens on a CD4-mediated activity. More importantly, the responses of the CD4- variants of the two T hybrid clones to Mls 1a retain the same susceptibility to inhibition by antibodies to MHC class II molecules exhibited by the parental T hybrids. These results indicate that the blocking of responses of CD4+ T cells to Mls 1a by both anti-H-2A and anti-H-2E antibodies is not due only to disruption of interactions between CD4 and H-2A or H-2E molecules. The data are thus consistent with the class II molecule-dependent models of Mls 1a presentation to the T cell receptor which are discussed in the light of recent findings on the biochemical nature of the Mls 1a molecule.

Experimental intoxication of sheep and cattle with Wedelia glauca.

Wedelia glauca was administered experimentally to 11 sheep and 4 cattle. The minimum toxic dose for both species was of 4 to 5 g of fresh plant/kg bw. Clinical signs were depression, muscle fasciculations, increased respiratory and cardiac frequencies, opisthotonous, sternal or lateral recumbency and terminal paddling movements. Time of onset of signs ranged from 12 to 40 h after dosing. Serum AST, LDH and GGT were increased. Three cattle and 5 sheep died after clinical manifestation periods of 2 to 18 h, and 2 sheep survived after being affected for 14 and 46 h. Macroscopic and histologic lesions were similar in cattle and sheep; the liver was swollen and dark reddish, and the wall of the gall bladder was edematous. The cavities had yellowish fluid. Petechiae and echymoses were seen on serous membranes. Microscopically the liver had periacinar hemorrhagic necrosis. Two sheep dosed with 1 g/kg bw daily for 20 d and 1 dosed with 1 g/kg bw for 10 d were not affected. Six sheep were transferred from an area free of W glauca to an area where this plant was present. These animals ate small amounts of the plant and lost weight rapidly, but clinical intoxication did not occur. Two sheep were fed with lucerne hay containing 9% W glauca. They ingested 2.5 g/kg of the dry plant (corresponding to 10 g/kg bw of fresh plant) in 24 h, but did not show intoxication. Because the intoxication occurred in sheep and cattle administered 4 to 10 g/kg bw of the plant in a period of 1 to 2 h, the intoxication may only occur when animals ingest a single toxic dose in a short time.

Comparison between laparotomy and operative laparoscopy in the treatment of moderate and severe stages of endometriosis.

A retrospective study was designed to compare the results of treatment of moderate and severe stages of endometriosis by laparotomy and by laparoscopy. Patients were divided into three groups: the first consisted of 42 patients treated by laparotomy followed immediately with danazol treatment for 6-9 months; the second, 44 patients treated by operative laparoscopy followed immediately with danazol treatment for 4-6 months; and the third, 62 patients treated by operative laparoscopy followed immediately with danazol treatment for 6-10 weeks. The cumulative pregnancy rate in the laparoscopy groups was better than that of the laparotomy group. Most patients who failed to conceive underwent a second-look laparoscopy for reevaluation. Residual endometriosis and associated adhesions were noticed least in the third group. It is concluded that operative laparoscopy could be efficiently used for the treatment of moderate or even severe endometriosis.

Comparison of different modalities of treatment for minimal and mild endometriosis.

This is a retrospective study designed to compare the results of treatment of minimal and mild types of endometriosis with danazol alone, operative laparoscopy and danazol combined, and operative laparoscopy alone. The population consisted of 112 patients with minimal endometriosis and 126 patients with the mild type. Pregnancy rate and endometriosis resolution were lowest in patients who were treated with danazol alone and highest in patients treated with operative laparoscopy alone. It is concluded that in an infertile population with minimal to mild endometriosis danazol alone appears ineffective in improving the pregnancy rate or in achieving complete resolution of endometriosis. Laparoscopic surgery for the treatment of minimal to mild endometriosis seems to be a promising method of treatment.

[Study of lymphocyte subpopulations with monoclonal antibodies in acute hepatitis A and B]. / Estudio de sub-poblaciones linfocitarias mediante anticuerpos monoclonales en hepatitis aguda A y B.

Using monoclonal antibodies, it was determined the T3, T4 and T8 1ym phocyte populations in the blood samples of 40 patients with acute viral hepatitis (20 type A and 20 type B). al patients showed complete remission from it. The results of this study were compared with those of a control group of 20 healthy subjects. There was a non significant decreased of the total number of lymphocytes measured with the T3 monoclonal antibody in both types of hepatitis. The number of T8 lymphocytes was significantly increased (p less than 0.05) when the results were compared with those of the control group. The quotient T4/T8 was diminished in the initial phase of the disease (p less than 0.05). There were no other differences between hepatitis A and hepatitis B. In the follow up of the disease, the results tend to normal values in the whole group of patients.

Survival of Candida albicans in tropical marine and fresh waters.

A survey of Candida albicans indicated that the organism was present at all sites sampled in a rain forest stream and in near-shore coastal waters of Puerto Rico. In the rain forest watershed no relationship existed between densities of fecal coliforms and densities of C. albicans. At two pristine sites in the rain forest watershed both C. albicans and Escherichia coli survived in diffusion chambers for extended periods of time. In near-shore coastal waters C. albicans and E. coli survival times in diffusion chambers were enhanced by effluent from a rum distillery. The rum distillery effluent had a greater effect on E. coli than on C. albicans survival in the diffusion chambers. These studies show that neither E. coli nor C. albicans organisms are good indicators of recent fecal contamination in tropical waters. It further demonstrates that pristine freshwater environments and marine waters receiving organic loading in the tropics can support densities of C. albicans which may be a health hazard.

Actitud práctica diagnóstica y terapéutica ante la bronquiolitis aguda del lactante en Galicia (estudio Bronquio-Gal) / A practice approach to the diagnosis and treatment of infants with acute bronchiolitis in Galicia, Spain (Bronquio-Gal study)

Introducción: El diagnóstico y el tratamiento de la bronquiolitis aguda son controvertidos. Pretendemos conocer las actitudes prácticas diagnóstico-terapéuticas de los pediatras de Galicia en el contexto de la bronquiolitis aguda y analizar la influencia que puedan tener en la respuesta factures profesionales, como la base formativa, la experiencia práctica y el entorno laboral. Material y métodos: Estudio observacional transversal mediante encuesta postal que incluía un supuesto clínico de bronquiolitis aguda y 40 cuestiones relacionadas. La encuesta se envió a los pediatras miembros de la Sociedad de Pediatría de Galicia en mayo de 2004. Resultados: Untotoal de 103 encuestas fueron devueltas debidamente cumplimentadas. La mita de los participantes (50,5%) tenía una edad superior a los 45 años. El 87% eran pediatras especialistas y el 13% médicos residentes. El 58% de los facultativos desarrollaban su trabajo habitual en el ámbito de la atención primaria. En la mayoría de los casos, la actitud diagnóstica se adecuó a las recomendaciones vigentes, destacando la aplicación de escalas clínicas y la pulsiocimetría. Por el contrario, se indicaron tratamientos farmacológicos con más frecuencia de la recomendable, y algunos fármacos, como broncodilatadores o los corticoides, se empleban de forma casi generalizada. La experiencia práctica no tuvo influencia en las respuestas. El uso de pruebas de detección rápida del virus respiratorio sincitial fue más frecuente entre los médicos residentes (p<0.001). Los pediatras hospitalarios aplicaron con más frecuencia todas las exploraciones complementarias encuestadas (p<0,001), con la excepción de las escalas de valoración clínica, empleadas por igual en ambos grupos. En el ámbito hospitalario se indicaron con más frecuencia la oxigenoterapia y los broncodilatadores y, en particular, la adrenalina (p<0,001). Conclusiones: Hay grandes discrepancias entre la práctica habitual y las evidencias que la justifican. La realización de una conferencia de consenso nacional sobre el tratamientro de la bronquiolitis aguda podría ayudar a mejorar la atención a estos pacientes y racionalizar el consumo de recursos

Introduction: The diagnosis and treatment of acute bronchiolitis are controversial issues. We proposed to assess the practice patterns of pediatricians in Galicia (Northwest Spain) in the diagnosis and treatment of this disease, and to analyze the influence on the response of professional factors such as medical training, practical experience, and work setting. Material and methods: A total of 103 correctly completed surveys were returned. Half of the responders (50,5%) were over 45 years of age. Eighty-seven percent of them were pediatricians and 13% were pediatric residents. In all, 58% of the physicians worked, in the primary care setting. In most cases, the diagnostic approach followed the current international recommendations, with an especially widespread use of clinical scales and pulse oximetry. In contrast, pharmacological therapies were prescribed more frequently than is recommended,a nd the use of drugs such as bronchodilators or corticosteroids was nearly genralized. Practical experience did not influence the responses. Respiratory syncytial virus detection assays were more frequently indicated by medical residens (p<0.001). All the complementary tests included in the survey were requested more frequently by in-hospital pediatricians than by primary care pediatricians (p<0,001) , with the exception of clinical scales, which were employed to a similar extent in both groups. Oxygen therapy, bronchodilator therapy and, in particular, epinephrine were indicated more frequently in the hospital setting (p<0,001). Conclusions: There are considerable discrepancies between routine practice and the evidence justifying it. A national consensus conference on the management of acute bronchiolitis could help to improve patient care and to rationalize the use of resources