Assessing the impact of the presence of pharmacists in a clinical department of a Lebanese hospital.

BACKGROUND: Clinical pharmacy services are still in their very early implementation stages in Lebanon. The objective of this pilot study was to evaluate the impact of clinical pharmacist's presence at the infectious diseases department of Hôtel-Dieu de France University Hospital of Beirut (HDF) and to evaluate the acceptance of pharmacist's interventions by healthcare providers. MATERIAL AND METHODS: A 21-month prospective analysis was conducted, including 240 hospitalized patients in the infectious diseases department of HDF and 475 interventions performed by the pharmacist. A clinical pharmacist and pharmacy residents were present for 1 to 2hours/day in the ward. A pharmaceutical care plan was established and used to document patients' problems and pharmacist's interventions. Main criteria analyzed were: types and frequencies of pharmaceutical problems detected, types of pharmaceutical interventions performed, their acceptance by the prescribers and/or nurses, and factors affecting the interventions and their acceptance. RESULTS: The most frequent pharmaceutical problem detected was incorrect dosage and the three most frequent interventions performed by the pharmacist were stop/start/substitute a drug, change drug dosage/or daily distribution, and change administration time. The acceptance was the highest for I.TIM (change drug administration time) and the lowest for I.FOL (request a lab test/exam/clinical follow-up). DISCUSSION AND CONCLUSION: Even a short daily pharmacist's presence is an added value in inpatient care at the infectious diseases department of Hôtel-Dieu de France University Hospital. Areas of improvement are a better communication between the pharmacist and the prescribers, a direct contact between pharmacist and patient and a longer presence of the clinical pharmacist in the clinical department.

Analysis of induced sputum for the diagnosis of recurrent Pneumocystis carinii pneumonia.

We studied the sensitivity of ISA for diagnosis of second-episode PCP in AIDS patients. We induced sputum in 218 patients who had known or suspected AIDS and who had a presentation suggestive of PCP. All patients with negative sputum smear for PCP underwent BAL. Twenty-five patients were identified who had second-episode PCP at least 30 days after initial diagnosis. Chest roentgenographic infiltrate patterns for these 25 patients were blindly scored as normal, diffuse, upper lobe or focal non-upper lobe. The sensitivity of ISA was 72 percent for the first episode of PCP, 72 percent for the second episode of PCP, 72 percent for patients with second-episode PCP who had initial PCP detected by ISA and 71 percent for patients with second-episode PCP whose first episode of PCP was missed by ISA. Of the ten patients who were treated with AP, only one had a false-negative sputum analysis. A comparison of patients who had second-episode PCP diagnosed by ISA with those who had false-negative sputum analysis showed no difference in time to relapse, chest x-ray film pattern (all diffuse) or use of AP.

Pulmonary mucormycosis presenting as an endobronchial lesion.

A 56-year-old diabetic man presented with left upper lobe collapse and postobstructive pneumonitis. Fiberoptic bronchoscopy revealed an endobronchial mass obstructing the left mainstem bronchus. The lesion resembled a bronchial adenoma; however, cytologic and histologic examination revealed invasive mucormycosis. The patient was treated with intravenous amphotericin B followed by endoscopic laser surgery that relieved the obstruction.

The optimal number of pleural biopsy specimens for a diagnosis of tuberculous pleurisy.

STUDY OBJECTIVES: To determine the optimal number of pleural biopsy (PLBX) specimens for a diagnosis of tuberculous pleurisy. DESIGN: Retrospective review. SETTING: County hospital. METHODS: We reviewed all percutaneous needle biopsy specimens of the parietal pleura in 30 patients who had tuberculous pleurisy. Data are reported as mean+/-SEM and statistical comparisons are done with the Mann-Whitney test. We accepted p<0.05 as statistically significant. RESULTS: The number of biopsy specimens obtained from each patient ranged from 4 to 10 with 1 sample submitted for mycobacterial culture and the rest submitted for histologic study. Sixty percent of patients had pleural cultures positive for Mycobacterium tuberculosis and 80% had diagnostic histology. Overall pleural biopsy sensitivity (histology and culture) for tuberculous pleurisy was 87%. On average, 40.4%+/-4.7% of all PLBX specimens contained pleura. Diagnostic PLBX procedures compared to false-negative procedures produced more tissue specimens (7.1+/-0.3 vs 4.8+/-0.5, p=0.005) containing more pleural specimens (2.4+/-0.2 vs 0.8+/-0.5, p=0.01). If only PLBX procedures yielding more than six tissue specimens (n=18) or more than two pleural specimens (n=12) were analyzed, then the diagnostic sensitivity of PLBX for pleural tuberculosis was 100%. There seemed to be a direct relationship between the sensitivity of PLBX and the number of specimens submitted. CONCLUSIONS: The sensitivity of percutaneous needle biopsy for diagnosis of tuberculous pleurisy is highest when more than six specimens are obtained which, on average, contain more than two specimens of parietal pleura. There are no conclusive data indicating how many tissue specimens to submit for mycobacterial culture, but one specimen seems sufficient.

The effect of electrosurgery on alveolar bone.

The facial marginal alveolar bone of dogs was exposed with a full-thickness flap and touched by an activated electrosurgery electrode for periods of 0, 1, 5 and 10 seconds. Microscopic results were evaluated after periods ranging from 0 hours to 28 days. Various electrode exposure times produced similar changes in bone and periodontal ligament. The extent of the destruction was greater than that found in surgical areas not exposed to electrosurgery; healing and remodeling phases were also delayed in the electrosurgical sites.

Analysis of induced sputum in the diagnosis of Pneumocystis carinii pneumonia.

Sixty-two patients with possible AIDS-associated Pneumocystis carinii pneumonia (PCP) were studied to determine the diagnostic usefulness of sputum analysis and whether or not the results of sputum analysis are related to severity of disease. Induced sputum was stained with Gomori Methenamine silver and modified Wright Giemsa stains. Indicators of disease severity were: extent of chest roentgenographic infiltrate, serum lactic dehydrogenase activity, alveolar-arterial oxygen tension difference, and total blood lymphocyte count. All patients with sputum negative for Pneumocystis underwent bronchoscopy with bronchoalveolar lavage. Sputum analysis was 71% sensitive and 100% specific for the diagnosis of PCP. The negative predictive value of sputum analysis was 48%. There was no relationship between sputum results and the severity of PCP. This study led to the conclusions that sputum analysis is a sensitive, specific, rapid, and low-cost technique for the diagnosis of PCP, and that the sensitivity of sputum analysis for the detection of PCP is not affected by the severity of PCP.

Surgical reconstruction of the interdental papilla.

The traditional goal of disease elimination in the anterior region opens the interproximal spaces, causing flattening or cratering of the interdental papilla. Today's patients increasingly demand esthetic results in addition to periodontal treatment, and recent advances in periodontal plastic surgery have enhanced the periodontist's ability to address these concerns. Three case reports demonstrate a proposed surgical technique for the reconstruction of collapsed interdental papillae using a connective tissue graft under the buccal and palatal flaps.

Root coverage and papilla reconstruction in Class IV recession: a case report.

While root coverage is predictable for Miller Class I and II recessions, the surgical regeneration or reconstruction of a lost interdental papilla is more difficult to obtain. To date only a few successful case reports have been reported, and there are no studies that report a predictable technique to obtain papilla reconstruction or root coverage on Class IV recessions. This case report, which is part of a preliminary study, outlines a surgical technique to obtain simultaneous root coverage and papilla reconstruction.

Root coverage and papilla reconstruction using autogenous osseous and connective tissue grafts.

Previous studies have reported that the distance from the interdental crest of bone to the apical portion of the contact of the two approximating teeth must be 5 mm or less to support a stable interdental papilla. The reconstruction of a stable, long-term papilla for esthetic purposes must therefore consider interdental bone reconstruction. Autogenous osseous graft material was harvested from the tuberosity and augmented with a subperiosteal connective tissue graft for papilla reconstruction between the maxillary central incisors. Flap design, osseous graft fixation with a screw, connective tissue placement, wound closure, and suturing techniques are presented. To enhance the final result, porcelain veneers were bonded to the approximating central incisors. This case report demonstrates a surgical procedure that has not been reported to date for papilla reconstruction to enhance periodontal esthetics.

Experimental systemic cryptococcosis in SCID mice.

The susceptibility of severe combined immune deficiency (SCID) mice to experimental systemic cryptococcosis was studied. SCID mice were at least 16-fold more susceptible to lethal infection than were immunocompetent control mice (P < 0.001). Histological assessment showed that control mice responded with a granulomatous inflammatory response, whereas SCID mice showed no evidence of a cellular host response. In a therapeutic study, 5 mg kg-1 day-1 of fluconazole caused a significant reduction in the infectious burden in the spleen, liver, kidney and lungs of treated mice compared with no treatment. These results indicate that a model of systemic cryptococcosis with meningitis in SCID mice may have utility in the study of immunology and therapy of this disease in the severely immunocompromised host.

Sinusoidal hematolymphoid malignancy ("malignant histiocytosis") presenting as atypical sinusoidal proliferation. A study of nine cases.

A number of cases of sinusoidal hematolymphoid malignancy ("malignant histiocytosis") in which early lymph node biopsies have not allowed clear separation from benign histiocytic disorders have been observed. Nine such cases in which only a follow-up lymph node biopsy documented their malignant nature are reported. Seven of the nine patients were under 21 years of age; there was an even sex distribution. All had localized or generalized lymphadenopathy and three had hepatosplenomegaly at initial presentation. Histologically, the initial lymph node biopsy specimens showed an atypical sinusoidal proliferation, often with hemophagocytosis, but without sufficient atypia to allow a diagnosis of malignancy. The analysis of the follow-up biopsies, performed from 6 weeks to 5 years after the initial biopsy, showed a progression in histology with an increase in atypia, a greater tendency to efface lymph node architecture, and a decrease in hemophagocytosis. All patients were treated with chemotherapy. Six patients ultimately died; at autopsy, these patients showed a pattern of organ involvement typical of what has been described for malignant histiocytosis.

Comparative study of gingival retraction methods.

The effects of electrosurgery, retraction cord, and the rotary gingival curettage technique were tested clinically and histologically in dogs. Postoperative periods analyzed ranged from 6 hours to 14 days. All methods induced some kind of minor damage. Recession of clinical magnitude was induced only by rotary gingival curettage. Apical migration of the junctional epithelium was not seen.

[Oral pathology of pscyhosomatic origin. Review of the literature]. / Patologia orale di origine psicosomatica. Rassegna della letteratura.

Emotional stress is one of the etiologic or anyway predisposing factors involved in a lot of oral pathologies. In fact, relations between stress effects and frequent diseases such as gastric ulcer or ulcerous colitis are today wellknown by everyone. Theories about a relation between this kind of etiology and tumours are only reported by some Authors and are at the level of hypotheses. Mouth is very weak in these situations, owing to its great interest as primary erogenous zone, and for this reason we find frequently oral pathologies in relation with psychosomatic medicine. In this report we tried to give a good help to the study of these diseases and to find an easy classification to use (really it is an hard work to do due to the variety of this numerous illnesses).

Delayed hemolytic transfusion reaction associated with Rh antibody anti-f: first reported case.

A delayed hemolytic transfusion reaction (DHTR) occurring in a 30-year-old Caucasian man is described. His blood groups were B, CDe/cDE (R1R2, f-) K-, S-s+, Fy (a + b-), and Jk (a + b +). Eight days after receiving two units of packed red blood cells, his urine was strongly positive for hemoglobin; serum-free hemoglobin was 125 mg/dl. Serum contained a clearly reactive Rh antibody of anti-f specificity and a weakly reactive anti-Kell. The DHTR was probably caused by an anti-f alloantibody appearing as an anamnestic response to transfusion of seemingly compatible, but f-positive blood.

Murine model of paracoccidioidomycosis. Production of fatal acute pulmonary or chronic pulmonary and disseminated disease: immunological and pathological observations.

A model of fatal acute pulmonary or chronic pulmonary and disseminated paracoccidioidomycosis was developed by intranasal challenge of young (3-4-week-old) mice with high doses (2.5-10 X 10(7) units) or low doses (0.1-1 X 10(7)) of yeast-phase Paracoccidioides brasiliensis. Fatal acute paracoccidioidomycosis was dose dependent; 10, 5, and 2.5 X 10(7) viable units of P. brasiliensis produced 100%, 66%, and 17% mortality, respectively, within 11 days. The pathologic picture was that of consolidation with a neutrophil infiltrate. Infection of adult (7-8-week-old) mice with even 10 X 10(7) units did not produce acute fatal paracoccidioidomycosis. The model of fatal acute paracoccidioidomycosis lends itself well to studies of therapeutic intervention. Increasing degrees of chronic pulmonary-disseminated paracoccidioidomycosis were produced by pulmonary infection of young mice with 0.1-1 X 10(7) viable units of P. brasiliensis. Although mice in all groups appeared healthy, pathology in lungs, liver, and spleen was evident at 7 and 10 weeks postinfection. Histopathologic observation revealed acinonodular granulomatous inflammation. At 12 weeks postinfection, there was evidence of less pathology, and of clearing of abscesses. In contrast to the pathology produced by 0.1 X 10(7) P. brasiliensis in young mice, no pathology evident on gross examination was produced by a similar dose in adult mice. Immunological evaluations of mice with chronic pulmonary-disseminated disease showed that spleen cells, but not lymph node cells, had significantly depressed blastogenic responses to concanavalin A (ConA) early after infection. However, at 12 weeks postinfection, when pathological examination indicated beginning resolution of infection, spleen cell responses to ConA were normal. The model of chronic disease is of interest for further immunological studies as well.