Experience, prevalence, need for treatment and cost of care for caries: A multicenter study in a developing country.

OBJECTIVE: To assess the experience, prevalence, need for treatment and economic impact of caries among students 6-12 years old in four cities in Mexico. BASIC RESEARCH DESIGN: Cross-sectional clinical study. SETTING: Elementary public schools. PARTICIPANTS: 500 schoolchildren aged 6 to 12 years. METHOD: Oral clinical examinations using WHO criteria for caries in the primary (dmft) and permanent (DMFT) dentitions. MAIN OUTCOME MEASURES: Indicators of caries in the primary and permanent dentitions: experience, prevalence, severity and the Significant Caries Index. In addition, we calculated the treatment needs, dental care rate and cost of care. RESULTS: dmft in the primary dentition was 2.59±2.83, and DMFT was 0.82±1.44 in the permanent dentition. Caries prevalence reached 67.7% in the primary and 34.1% in permanent dentition. The treatment needs index was 85.9% and 91.3% in the primary and permanent dentitions, respectively; the dental care index was 13.9% and 8.5%, respectively. The cost of care for caries in the primary dentition was estimated at $22.087 millions of international dollars (PPP US$) when amalgam was the restorative material used, and PPP US$19.107 millions for glass ionomer. For the permanent dentition, the cost was PPP US$7.431 millions when amalgam was used and PPP US$7.985 millions when resin/composite was used as restorative material. CONCLUSIONS: The prevalence and experience of caries in the primary dentition were 50% greater than those of other studies carried out in Mexico. In the permanent dentition they were less. There is considerable need for the treatment of caries and minimal experience with restorative care. The cost of care for caries may be assumed to be high for a health system such as Mexico's.

Retinol-binding protein 4 (RBP4), a potential biomarker of frailty in HIV-infected people on stable antiretroviral therapy.

OBJECTIVES: A quantitative biomarker for identification of pre-frail and frail persons is still lacking. This study aimed to identify biomarker predictors of frailty in HIV-infected patients. METHODS: A cross-sectional study of HIV-infected patients who had been on antiretroviral therapy (ART) for at least 1 year and who presented an undetectable viral load (< 50 HIV-1 RNA copies/mL) at baseline was carried out. For each frail patient, up to four pre-frail and robust patients were randomly selected. The frailty status assessment was based on the five-item criteria described by Fried et al. Sociodemographic, anthropometric, biochemical and HIV-related characteristics were evaluated. Multiple potential biomarkers of frailty and a biological age biomarker were analysed. RESULTS: A total of 73 HIV-infected patients on ART for at least 1 year were evaluated. The patients were categorized as robust (n = 33), pre-frail (n = 32) and frail (n = 8) using the Fried criteria. All patients were on ART, with 100% undetectable viral load (< 50 copies/mL) at baseline. No significant differences in demographic, clinical or analytical characteristics were observed among patients in the different categories based on Fried criteria, with the exception of the veterans aging cohort study index (VACS). Similarly, no differences were observed in HIV-related characteristics, although nucleoside reverse transcriptase inhibitor (NRTI) use was less common in frail persons. The distribution of biomarker values varied according to frailty status, with frail persons having higher levels of interleukin (IL)-8, IL-18, CXC chemokine ligand 10 (CXCL10) and retinol-binding protein 4 (RBP4). In multivariable analysis, the assocation of frailty with RBP4 showed a tendency to statistical significance (odds ratio 1.0; 95% confidence interval 0.99-1.00; P < 0.05). CONCLUSIONS: Differential biomarker expression was present according to Fried status. Longitudinal studies will clarify the utility of these biomarkers as targets for diagnostic or therapeutic intervention.

In vitro assessment of the acaricidal activity of computer-selected analogues of carvacrol and salicylic acid on Rhipicephalus (Boophilus) microplus.

Rhipicephalus (Boophilus) microplus is a tick that causes huge economic losses in cattle. The indiscriminate use of acaricides has generated resistance to most compounds present on the market. This makes further investigation on other potential acaricides necessary, the in silico assay being an alternative to the design of new compounds. In the present study a biosilico assay was performed using TOMOCOMD-CARDD (TOpological MOlecular COMputer Design-Computer-Aided Rational Drug Design) and WEKA (Waikato Environment for Knowledge Analysis) software. Two carvacrol and four salicylic acid derivatives, synthesized by conventional methods and evaluated with the larval packet test on larvae of R. (B.) microplus were selected. All evaluated compounds presented acaricidal activity; however, ethyl 2-methoxybenzoate (91.8 ± 1.7 % mortality) and ethyl 2,5-dihydroxybenzoate (89.1 ± 1.6 % mortality) showed greater activity than salicylic acid. With regard to the carvacrol analogues, carvacrol acetate (67.8 ± 2.1 % mortality) and carvacrol methyl ether (71.7 ± 1.6 % mortality) also showed greater activity than carvacrol (35.9 ± 3.2 % mortality). TOMOCOMD-CARDD and WEKA software were helpful tools in the search for alternative structures with potential acaricidal activity on R. (B.) microplus.

[Overnight extubation is not associated with extubation failure in pediatric intensive care unit patients: a retrospective cohort study]. / La extubación durante la noche no se asocia con su fracaso en pacientes pediátricos de Unidad de Cuidados Intensivos: Estudio de cohorte retrospectivo.

There is little known about the time of the day and the nature of it (business day/non-business day) at which extubation is performed, and whether it is safe during the night. OBJECTIVE: to describe the frequency of nocturnal extubation (NE) and non-business day extubation (nBDE). In addition, to determine the association between these and clinical outcomes. PATIENTS AND METHOD: Retrospective cohort study of patients under 18 years of age who received invasive mechanical ventilation (MV) and underwent an extubation attempt in a high complexity Pediatric Critical Patient Unit (PCPU) between 01/01/2018 to 12/31/2021. Primary exposure: NE, which was defined as that performed between 20:01 and 8:00 hours. Its association with extubation failure (EF), duration of invasive MV, and length of stay in the PCPU was evaluated. RESULTS: 146 patients were included [58.9% males, age 1.14 (0.25 - 5.5) years]. NE was performed in 17.8%. Nocturnal extubation was not associated with EF nor was the day of extubation. The EF was 3.8% in NE and 5% in daytime extubation (DE) (p = 0.80). Duration of invasive MV was shorter in NE than DE [48 (24-73.5) vs. 72 (48-96) h, p = 0.02]. CONCLUSIONS: NE was not associated with EF. Patients with NE had shorter duration of invasive MV, and the latter was associated with EF. Withdrawal of invasive MV should be considered at the first opportunity and be determined by clinical factors, rather than time of day.

Prevalence data of Rickettsia slovaca and other SFG Rickettsiae species in Dermacentor marginatus in the southeastern Iberian peninsula.

In southern Spain, Dermacentor marginatus ticks can be infected with several genospecies of spotted fever Group (SFG) Rickettsia. We developed a nested polymerase chain reaction assay by using a species-specific probe targeting the ompA gene to detect and differentiate between the two groups of rickettsiae previously described in D. marginatus. SFG rickettsia has been detected in 85.15% of ticks studied (26.7% of positives have been to R. slovaca, the causative agent of TIBOLA-DEBONEL, and 73.3% to SFG rickettsia closely related to strains RpA4-JL-02-DnS14-DnS28).

Rickettsia slovaca infection: DEBONEL/TIBOLA.

This study describes the epidemiological, clinical, and microbiological characteristics of a new tick-borne disease in Spain-Dermacentor-borne necrosis erythema lymphadenopathy (DEBONEL). The clinical presentations include an eschar at the site of the tick bite, surrounded by an erythema and painful regional lymphadenopathy. The disease appears during the colder months and its vector is Dermacentor marginatus (D. marginatus). From January 1990 to December 2004, 54 patients presented at Hospital of La Rioja with these clinical and epidemiological data. The ratio of females to males was 32/22. The average age was 37 years. In all cases tick bites were located on the upper body (90% on the scalp). The median incubation period was 4.7 days. Signs and symptoms were mild in all cases. Only a small number of patients presented mild and nonspecific abnormalities in a complete blood cell count and mild elevation of erythrocyte sedimentation rates and C-protein reactive and liver enzyme levels. Serological evidence of acute rickettsiosis was observed in 19 patients (61%). In 29% sera tested by polymerase chain reactions (PCRs) were positive. The sequence obtained from a PCR product revealed 98% identity with Rickettsia sp. strains RpA4, DnS14, and DnS28. All ticks removed from patients were PCR-positive. Sequencing showed 8 of them identified as R. slovaca and 2 as Rickettsia sp. strains RpA4, DnS14, and DnS28.

Prevalence of spotted fever group Rickettsia species detected in ticks in La Rioja, Spain.

Our objective was to learn the prevalence of spotted fever group (SFG) Rickettsia detected in ticks in La Rioja, in the north of Spain. From 2001 to 2005, 496 ticks representing 7 tick species were analysed at the Hospital de La Rioja. Ticks were removed from humans with or without rickettsial syndrome (n = 59) or collected from mammals (n = 371) or from vegetation by dragging (n = 66). The presence of SFG Rickettsia in these ticks was investigated by semi-nested PCR (ompA gene) and sequencing. A phylogenetic tree using Clustal method (neighbor-joining) was constructed with these data. Only 3 of 170 Hyalomma marginatum ticks carried SFG Rickettsia. Sequencing analysis demonstrated the presence of Rickettsia aeschlimannii (1.8%). Furthermore, Rickettsia massiliae and BAR29 were found in 3 of 120 Rhipicephalus sanguineus specimens (2.5%). In contrast, 81 of 83 tested Dermacentor marginatus ticks were PCR-positive (97%). Rickettsia slovaca (40.6%) and Rickettsia sp. strains RpA4, DnS14, DnS28 and JL-02 (59.3%) were found within this tick species. No SFG Rickettsia was detected using ompA primers when Ixodes ricinus, Rhipicephalus bursa, Rhipicephalus turanicus, Rhipicephalus eversti eversti, Hyalomma detritum scupense and Rhipicephalus sp. were analyzed. We detected 17.5% of ticks associated with different SFG Rickettsia: R. aeschlimannii, R. massiliae, BAR29, R. slovaca and Rickettsia sp. strains RpA4, DnS14, DnS28 and JL-02. Their presence has to be taken into account since most of them have been recognized as human pathogens.

Evaluation of IgG antibody response against Rickettsia conorii and Rickettsia slovaca in patients with DEBONEL/TIBOLA.

The aim of the study was to determine the IgG antibody response to spotted fever group Rickettsia (SFGR) R. conorii and R. slovaca, and its specificity and sensitivity in patients with DEBONEL/TIBOLA. A prospective study of 31 patients with DEBONEL was carried out from January 2001 to May 2004. The SFGR serology testing (IgG IFA) for the diagnosis of DEBONEL/TIBOLA showed 61% sensitivity and 100% specificity. The R. slovaca antigen allowed the diagnoses in 18 of the 31 patients (58%), and 17 patients (55%) were diagnosed with this disease using R. conorii antigen. Therefore, using R. slovaca as antigen did not improve the sensitivity of the assay.

Effect of antibiotic treatment in patients with DEBONEL/TIBOLA.

DEBONEL/TIBOLA is a tick-borne acute/sub-acute infection transmitted in our environment by Dermacentor marginatus and mainly caused by Rickettsia slovaca. The aim of our study was to know the effect of starting early treatment in the course of the DEBONEL/TIBOLA.

Detection of a non-pathogenic variant of Anaplasma phagocytophilum in Ixodes ricinus from La Rioja, Spain.

Our aim was to identify variants of Anaplasma phagocytophilum 16S rRNA gene sequences among products amplified from Ixodes ricinus collected in La Rioja, Spain. A. phagocytophilum AP-variant 1, reported as non-pathogenic, was detected in 12 samples (two adults and ten nymphs). This finding could justify the low incidence of human anaplasmosis in our area, despite the high prevalence of A. phagocytophilum in ticks.

Dermacentor-borne necrosis erythema and lymphadenopathy: clinical and epidemiological features of a new tick-borne disease.

This paper describes the epidemiological and clinical features of a tick-borne disease differing somewhat from other tick-borne diseases found previously in Spain. All patients were bitten by Dermacentor marginatus or a large tick. The clinical features include a crustaceous or necrotic lesion at the site of the tick's attachment, surrounded by an erythema (erythema migrans-like) and painful regional lymphadenopathies. The probable aetiological agent is Rickettsia slovaca. Similar cases have been reported in other European countries.

Incidence of pericardial effusion in pulmonary tuberculosis.

Tuberculosis (TB) is one cause of pericardial disease. In order to know the incidence of tuberculous pericardial effusion (TPE) in patients with pulmonary tuberculosis (PT), the factors associated with their presence and whether human immunodeficiency virus (HIV) patients have a higher risk, we analyzed different parameters and performed an echocardiography to evaluate the presence of TPE. The incidence of TPE was 14.1%, and the presence of pleural effusion was associated with TPE (OR 24.39). HIV patients do not have a higher risk of TPE, independently of immunosuppression. It is necessary to eliminate the presence of TPE in patients with PT, mainly in those with pleural effusion.

Assessment of the safety of intrauterine instillation of heated saline for endometrial ablation.

OBJECTIVE: To evaluate the safety of pressure, temperature-controlled, continuously circulating hot saline (EnAbl system, InnerDyne Medical, Sunnyvale, CA) for endometrial ablation using the in vivo human uterus. DESIGN: Clinical safety study. SETTING: An academic research environment. PATIENTS: Eleven women undergoing abdominal hysterectomy because of abnormal uterine bleeding. INTERVENTION: Before uterine removal, endometrial cavities were exposed to 15 minutes of recirculatory normal saline heated to 70-85 degrees C. MAIN OUTCOME MEASURE(S): The uteri were analyzed for extent of thermal damage using standard histopathological techniques and tissue viability histochemical staining. Intrauterine pressures and serosal and subserosal temperatures were continuously monitored by computer. RESULT(S): In each treated specimen, histochemical staining demonstrated a depth of necrosis that extended through the entire endometrium and approximately 1-2 mm into the myometrium. The control specimen showed no thermal or mechanical damage. There were no observed negative effects or related complications with this system. CONCLUSION(S): The computer-controlled system employing continuously circulating hot saline is an effective method to destroy the endometrium. In four cases with clearly patent tubes, no spill was observed. In all 11 patients, serosal and subserosal temperatures were within safe levels (mean temperature, 37 degrees C).

Serum androgen changes during meal-induced hyperinsulinemia and after acute sequential blockade and hyperstimulation of insulin release in women with polycystic ovary syndrome.

To investigate if acute changes in endogenous insulin release are associated with similar changes in serum androgen, 13 healthy ovulatory women (group 1) and six women with polycystic ovary syndrome (PCOS) and hyperinsulinemia, three with acanthosis nigricans (group 2) were studied. On day 1 all women ingested a 725 kilocalories breakfast between 7:30 and 8:00 A.M. The next day (day 2) only PCOS women had the breakfast and a simultaneous 90-min intravenous infusion of epinephrine (E, 6 micrograms/min) and propranolol (P, 80 micrograms/min). On both days serum glucose, insulin, cortisol, 17 alpha hydroxyprogesterone (17 OHP), dehydroepiandrosterone sulfate (DHEAS), free testosterone (free T), and androstenedione (A) were determined every 30 min for a period of 3 h. In group 1, glucose, insulin, free T, and DHEAS simultaneously rose (p < or = 0.026) while cortisol and 17 OHP fell (p < or = 0.020). Group 2 on day 1 had fasting and meal-stimulated hyperinsulinemia but all serum steroids progressively decreased. In only one woman free T rose. On day 2 during the E + P infusion, glucose increased yet fasting insulin remained constant and serum steroids decreased again. During the 90 min post-infusion, insulin sharply increased but no acute elevation in any steroid occurred. In conclusion, in PCOS women no parallel changes in serum androgen concentrations were seen in association with acute truly physiologic endogenous hyperinsulinemia or during the acute pharmacologically induced hypoinsulinemia and subsequent hyperinsulinemia.

Multistep carcinogenesis and genital papillomavirus infection. Implications for diagnosis and vaccines.

Activated cellular oncogenes (myc and ras, for example) and inactivated anti-oncogenes (p53 or Rb) participate in multistep carcinogenesis. In addition, some high risk human papillomaviruses (HPV) are also involved in uterine cervix carcinomas. Typification of HPV is important for clinical diagnosis. Unravelling the complexities of the immune system and understanding the biochemistry and molecular genetics of cellular oncogenes and tumor viruses have opened up new possibilities for vaccination.

Spine update. Clinical pathways.

Health care providers are becoming increasingly involved with the development of clinical pathways as they take on more of the responsibilities of quality management and resource use. Although clinical pathways that are developed at the national, regional, or specialty organization level provide a framework for reference, locally developed pathways tailor care to patients who are served within an agency or community. As multidisciplinary teams develop pathways for patients with back and spine disorders, they create tangible definitions of quality. Variance tracking systems used in conjunction with pathways provide feedback on patient progress and outcomes. These guidelines have significant potential for the future.

[Determination of antibodies against A-60 antigen for diagnosis of M. tuberculosis infection. A useful tool for rationalization of chemoprophylaxis in HIV patients]. / Determinación de anticuerpos frente al antígeno A-60 para el diagnóstico de la infección por M. tuberculosis. Una herramienta útil para la racionalización de la quimioprofilaxis en pacientes VIH.

OBJECTIVE: To identify M. tuberculosis infection in HIV patients by use of PPD and an ELISA test detecting the presence of antibodies against antigen A-60 of M. bovis. METHODS: 116 incoming HIV patients were classified according to the CDC. The status of M. tuberculosis infection was probed with PPD (RT-23) and the state of anergy was estimated by a Multitest CM1 (Multitext). The presence of circulating antibodies of the IgG class against antigen A-60 was analysed by an ELISA. The clinical course of the patients was followed for 24 month. RESULTS: A positive serology (A-60) was found in 52.58% of the patients, coinciding with 70.45% of the positive PPD (p < 0.003). This statical observation was found when we studied all of the individuals, and those with more than 500 CD4 lymphocytes. The Multitext was positive in 11.11% of the patients with PPD (-), all of them without antibodies against A-60. However, 42.2% of the patients who were PPD and Multitext (-), had circulating antibodies against A-60. The following up of the patients during 24 months allowed the detection of 7 news cases of pulmonary tuberculosis, 4 of them had a positive A-60 serology, and 4 were anergy. CONCLUSIONS: HIV patients with M. tuberculosis infection have circulating antibodies against A-60 antigen of M. bovis with independence of their immunity status. In anergic patients the presence of this antibodies can be an useful tool for rationalizing the prophylaxis against M. tuberculosis. A seropositivity (A-60) indicates as well as does PPD a previous contact with M. tuberculosis.

[Achromatic endometriosis]. / Endometriosis acromática.

Eleven patients with infertility of unknown cause and symptomatology suggestive of endometriosis were studied at the INPer. México from June 1, 1986 to December 15th, 1986. All these patients were subjected to a diagnostic laparoscopy, in 7/11 cases there were peritoneal lesions which were not classical of endometriosis in 2/11 there were typical endometriosical lesions and in the other 2/11 there was no evidence of lesion. Biopsies of nonpigmented endometriosis were obtained and in 7/11 endometriosis without hemosiderin were reported; in 2/11 endometriosis with hemosiderin and finally in 2/11 just an inflammatory process. We believe that the diagnosis of nonpigmented endometriosis must be suspected in all those patients with infertility of unknown cause who display endometriosic symptoms. When reorganizing nonpigmented lesions with histological evidence one must institute endometriosic therapy which will promote integral management of the problem: from the reproductive symptomatic aspects.

Septic shock in a patient infected with Rickettsia sibirica mongolitimonae, Spain.

In 1996, the first human case of infection by Rickettsia sibirica subsp. mongolitimonae was described in France. Subsequently, other human cases were reported in the same country. The acronym LAR (lymphangitis-associated rickettsiosis) has been proposed to designate this disease because lymphangitis is one of the main clinical manifestations. Later, a few more cases were described in Portugal, South Africa, Egypt, Greece and Spain. We report a case of R. sibirica mongolitimonae infection as a cause of septic shock in a Spanish patient living in La Rioja (northern Spain). In addition, the broad clinical spectrum of this tick-borne disease is discussed.