Adjunctive efficacy of systemic metronidazole in the surgical treatment of periodontitis: a double-blind parallel randomized clinical trial.

OBJECTIVES: The purpose of this study was to evaluate the clinical and microbiological impact of adjunctive metronidazole to periodontal surgery. MATERIALS AND METHODS: Systemically healthy patients, with stages III-IV, grades B-C periodontitis, were randomly assigned to receive metronidazole or placebo adjunctive to periodontal surgery, after subgingival instrumentation. Clinical variables were recorded at the initial visit, 6 weeks after subgingival instrumentation, and 3, 6, and 12 months after surgery. Microbiological samples were taken at initial and final visits and analyzed by quantitative polymerase chain reaction. RESULTS: Our results showed no statistically significant differences in the reduction of probing depth between the initial and final (1 year) visits in the two treatment groups. Additionally, no statistically significant differences were observed between study groups when comparing the post-subgingival instrumentation and final visits. However, 3 months after surgery, probing depth (mean difference, MD = 0.31 mm, 95% confidence interval, CI [0.13; 0.49]; p = 0.001) and clinical attachment level (MD = 0.64 mm, 95% CI [0.02; 1.27]; p = 0.044) were significantly lower in the test group. CONCLUSIONS: The adjunctive use of systemic metronidazole to periodontal surgery has a limited clinical and microbiological impact in the present study, and therefore, its use is not recommended. CLINICAL RELEVANCE: There are no studies that have evaluated the clinical and microbiological impact of the adjunctive use of systemic metronidazole to periodontal surgery (step 3 of periodontal therapy). The results of the present study do not support the adjunctive use of systemic metronidazole to periodontal surgery.

Introducing the Body-QoL®: A New Patient-Reported Outcome Instrument for Measuring Body Satisfaction-Related Quality of Life in Aesthetic and Post-bariatric Body Contouring Patients.

OBJECTIVE: To develop a new patient-reported outcome instrument (PRO) to measure body-related satisfaction quality of life (QoL). METHODS: Standard 3-phase PRO design was followed; in the first phase, a qualitative design was used in 45 patients to develop a conceptual framework and to create preliminary scale domains and items. In phase 2, large-scale population testing on 1340 subjects was performed to reduce items and domains. In phase 3, final testing of the developed instrument on 34 patients was performed. Statistics used include Factor, RASCH, and multivariate regression analysis. Psychometric properties measured were internal reliability, item-rest, item-test, and test-retest correlations. RESULTS: The PRO-developed instrument is composed of four domains (satisfaction with the abdomen, sex life, self-esteem and social life, and physical symptoms) and 20 items in total. The score can range from 20 (worst) to 100 (best). Responsiveness was 100 %, internal reliability 93.3 %, and test-retest concordance 97.7 %. Body image-related QoL was superior in men than women (p < 0.001) and decreased with increasing age (p = 0.004) and BMI (p < 0.001). Post-bariatric body contouring patients score lower than cosmetic patients in all domains of the Body-QoL instrument (p < 0.001). After surgery, the score improves by on average 21.9 ± 16.9 (effect size 1.8, p < 0.001). CONCLUSIONS: Body satisfaction-related QoL can be measured reliably with the Body-QoL instrument. It can be used to quantify the improvement in cosmetic and post-bariatric patients including non- or minimally invasive procedures, suction assisted lipectomy, abdominoplasty, lipoabdominoplasty, and lower body lift and to give an evidence-based approach to standard practice. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

Soaking and extrusion effects on physicochemical parameters, phytic acid, nutrient content and mineral bio-accessibility of whole rice grain.

A combination of soaking and extrusion processes of whole rice grain was studied. The effects of temperature (35-55 °C) and time (24-48 h) of soaking treatment on phytic acid (PA), protein and ashes losses using a factorial design were evaluated. Taking into account ash, protein and PA losses, whole rice was soaked 24 h at 45 °C and extruded using a Brabender single screw extruder. Effects of extrusion temperature (160-190 °C) and moisture content (14-19 g/100 g) on product characteristics were evaluated using surface response methodology. Values corresponding to the different responses were: Expansion (1.64-3.28), Specific Volume (5.68-11.06 cm(3)/g), Water absorption (3.41-4.43 mL/g) and Solubility (45.44-66.20 g/100 g). The content of PA was reduced from 740.09 to 163.47 mg/100 g (77%) after both processes, resulting in a higher mineral bio-accessibility, and a 7.3% decrease of protein digestibility. Total soluble phenolics and trolox equivalent antioxidant capacity (TEAC) were affected according to the treatment. Both treatments were important to obtain a nutritionally improved whole grain product.

Chemical composition, nutritional and antioxidant properties of the red edible seaweed Porphyra columbina.

Proximate composition, fatty acids and amino acid profiles and nutritional (chemical score, protein digestibility, PDCAAS and mineral dialyzability) and antioxidant properties (TEAC, DPPH and power reduction) from Porphyra columbina were evaluated. Total dietary fiber (48.02 ± 1.13 g/100 g dry weight) and protein (24.61 ± 0.21 g/100 g dry weight) were the two most abundant components in this seaweed. The main saturated and unsaturated fatty acids were C16:0 and C20:5 (n-3), respectively. The limiting amino acid was tryptophan with a chemical score of 57%. Protein digestibility was 74.33 ± 3.0%. Porphyra columbina has high mineral content with good Na/K relationship and medium value of potential mineral accessibility (P, Ca and Zn dializability: 18.75 ± 0.01, 17.62 ± 0.16 and 16.70 ± 0.44, respectively). The highest antioxidant properties were obtained with an acetone/water extraction system. This work provides important information about chemical composition and nutraceutical new properties of P. columbina.

Effects of extrusion conditions on physical and nutritional properties of extruded whole grain red sorghum (sorghum spp).

In order to analyze the effects of extrusion temperature (T: 164, 182, 200 °C) and grits moisture content (g/100 g sample) (%M: 14, 16.5, 19) on textural and physicochemical properties of red sorghum extrudates, whole grain flour was extruded according to a factorial experimental design. The higher values for specific mechanical energy consumption (1006.98 J/g) and expansion (3.36) were obtained at 164 °C-14%M and for sensorial hardness at 164 °C-19%M. While for specific volume, the highest value (10.41 cm³/g) was obtained at 200 °C-14%M. Water solubility and water absorption were directly related with T and inversely with M. Microscopic observation of the samples indicates that the greatest cooking degree was obtained at 200 °C-4%M and the lowest at 164 °C-19%M. Extrusion at 182 °C-14%M allows obtaining an expanded product with good properties. Proximal composition did not show statistically significant differences with raw sample. Extruded sample showed a 25.4% reduction of available lysine and a 31% increase in protein digestibility.

Severe flea-borne typhus complicated by hemophagocytic lymphohistiocytosis: A case report and review of literature.

Flea-borne typhus (FBT), also known as murine typhus, is a zoonotic infection caused by R. typhi with world-wide distribution. In the United States, the infection is uncommon but remains endemic in some areas, including Los Angeles County. It typically manifests as a benign acute febrile illness but can be complicated in a minority of cases. Associated hemophagocytic lymphohistiocytosis (HLH) has been described in a limited number of cases. Here, we present a case of a patient with FBT complicated by HLH treated empirically with doxycycline with subsequent resolution of HLH. Also included is a review of the literature of other published cases.

Electrophysiologic diagnosis of narrow and wide complex tachyarrhythmias.

Establishing the precise mechanism of cardiac arrhythmias in the electrophysiology laboratory is one of the main requisites for a successful and safe ablation. This article provides an organized approach to the differential diagnosis of narrow and wide complex tachycardias based on the analysis of electrical activation patterns, followed by specific pacing maneuvers in each case.

[Electrical storm in Brugada syndrome successfully treated with isoproterenol. Report of a case]. / Tormenta eléctrica en síndrome de Brugada tratada exitosamente con infusión de isoproterenol.

We report a 22-year-old male who experienced several episodes of syncope within a timeframe of few hours. In the emergency room, multiple ventricular fibrillation episodes where documented along with a type 1 Brugada ECG pattern. Isoproterenol in continuous infusion was started, normalizing the ECG and avoiding further arrhythmia recurrences. The patient was implanted with an automated defibrillator and discharged 3 days after admission.

[Cardiac resynchronization therapy in patients with heart failure: a 10-year experience]. / Terapia de resincronización en pacientes con insuficiencia cardiaca: experiencia acumulada de 10 años.

BACKGROUND: Multiple randomized trials support the clinical benefits of cardiac resynchronization therapy (CRT) in patients with heart failure (HF) and ventricular dyssynchrony. Since the year 2000 this therapy has been increasingly used in Chile. AIM: To describe the clinical characteristics and follow-up of HF patients undergoing CRT in a single Chilean university hospital during the last 10 years. PATIENTS AND METHODS: All patients undergoing CRT between 2000 and 2010 in our university hospital were included. Clinical and echocardiographic data were extracted from medical records and mortality causes were obtained from the National Identification Service. RESULTS: A total of 252 patients underwent CRT during the study period. Seventy five percent were in New York Heart Associatin (NYHA) functional class III and mean ejection fraction was 29 ± 10%. Complete left bundle branch block was present in 55% and 20% had permanent atrial fibrillation (AF). Mean survival was 86% at 1 year and 82% of patients in NYHA class III-IV improved at least one functional class. Survival was poorer in patients with ischemic etiology (hazard ratio (HR) 1.48), functional class IV (HR 2.2), right bundle branch block (RBBB) (HR 3.1) and AF (HR 3.4). No survival differences were observed between patients with and without an implanted cardiodefibrillator. CONCLUSIONS: This series show good clinical outcomes, comparable to those reported in randomized trials. Predictors of worse survival included an ischemic etiology, functional class IV, RBBB and AF. Patients with a defibrillator had no better survival, which could be relevant in countries with limited health care resources.

The molecular profile of the inflammatory process differs among various neurodevelopmental disorders with or without cognitive component: A hypothesis of persistent systemic dysfunction and hyper-resolution.

Introduction: Challenges of diverse origin in childhood can alter the growth and development of the central nervous system, affecting structures and functions. As a consequence of the damage suffered during the perinatal period, long periods of dysfunctionality may occur, such as regulatory disorders, which may result in remaining in a process of low-grade inflammation. We previously found that perinatal risks and neurological signs are associated with long-term changes in circulating concentrations of molecules of the inflammatory process, findings that are consistent with the postulate that long periods of dysfunction may condition long-lasting low-grade inflammation or parainflammation. The aim of this study was to assess whether different expressions of neurological disorders show variations in their inflammatory molecule profiles or whether there is a common pattern. Methods: We included screening for (a) caregiver-perceived risk detection of regulatory disturbances, using the DeGangi instrument; (b) dysautonomia or asymmetries, through neurodevelopmental assessments; (c) cognitive developmental disturbances (using the Bailey instrument). We assessed protein molecules on a multiplex system, and lipid molecules by ELISA. Results: We found a similar, although not identical, pattern of cytokine profiles with the presence of risk of regulatory disturbances, dysautonomia and asymmetries; but an opposite inflammatory profile was associated with cognitive impairment. Discussion: Our results suggest that there are diverse, probably limited, molecular footprints associated with impaired function, and that these footprints may depend on the response requirements necessary to adjust to the altered internal environment. Here we propose a theoretical model that suggests possible scenarios for inflammatory outcomes associated with chronic challenges.

Less common clinical manifestations of atopic dermatitis: prevalence by age.

The common manifestations of atopic dermatitis (AD) appear sequentially with involvement of the cheeks in infancy, flexural extremities in childhood, and hands in adulthood. Although less common clinical manifestations are well described, they have not been the subject of epidemiologic studies to describe their prevalence in specific age groups. This observational, cross-sectional, comparative study included 131 children younger than 18 of both sexes with AD who attended the clinics of the Dermatology Department of the National Institute of Pediatrics in Mexico City. Patients were examined to determine the presence of infrequent clinical manifestations of AD during infancy, preschool and school age, and adolescence and stratified according to sex, age, and number of clinical signs. A chi-square test was used to detect differences according to age and sex. Logistic regression analysis was also performed. The main findings according to age were genital dermatitis and papular-lichenoid dermatitis variant in infants; atopic feet, prurigo-like, nummular pattern, and erythroderma in preschool and school-aged children; and eyelid eczema and nipple dermatitis in adolescents. The risk of development of nipple dermatitis and eyelid eczema increased with age, and the development of genital dermatitis decreased with age. The knowledge of the prevalence of less common clinical manifestations of AD according to age in different populations might be helpful in diagnosing incipient cases of AD.

Congenital cutaneous angioleiomyoma.

Congenital cutaneous angioleiomyoma is an extremely rare benign smooth muscle tumor. We present a case of a firm, painful subcutaneous mass noticed at birth on the left leg that on surgical excision proved to be an angioleiomyoma. Prognosis is good, and recurrences are uncommon. To our knowledge, this is the second report of a congenital angioleiomyoma.

[Iron and zinc in vitro potential availability in an infant diet with fortified bread with different iron sources or with the addition of different iron absorption promoters]. / Disponibilidad potencial in vitro de hierro y zinc en una dieta infantil con pan fortificado con distintas fuentes de hierro o con agregado de promotores de la absorción.

Home-made diets are the most frequently used complementary foods. In the present work we evaluated iron and zinc availability in a usually consumed infant diet containing either iron-fortified bread with different iron sources: ferrous sulfate, ferrous bisglycinate, NaFeEDTA. We also used non-fortified bread with absorption promoters: ascorbic acid, sodium citrate, Na2EDTA, combined with different beverages. The diet (potato, pumpkin, grits, bread, and apple) was combined with water, milk, tea, a soft drink and an orange-based artificial drink. Mineral dialyzability (D) as an indicator of potential availability was determined using an in vitro method. Statistical analysis was performed by ANOVA, and a posteriori Tukey test. There were no significant differences in FeD between diets with ferrous sulfate or ferrous bisglycinate fortified bread; in NaFeEDTA fortified bread it increased significantly (p<0.05). Iron D increase was greater in diets with bread containing absorption promoters than in those with fortified bread. The orange-based artificial drink increased FeD, while tea and milk decreased it significantly (p < 0.05). Zinc D increased significantly when the bread was fortified either with ferrous sulfate or NaFeEDTA, but remained unchanged in diets with ferrous bisglycinate fortified bread. The addition of tea or milk decreased ZnD while the orange-based artificial drink increased it significantly (p < 0.05). Regarding absorption promoters, the greater values both in FeD and ZnD were observed in diets with iron nonfortified bread containing Na2EDTA.

Pharmaceutical compound removal efficiency by a small constructed wetland located in south Brazil.

The fate of pharmaceuticals during the treatment of effluents is of major concern since they are not completely degraded and because of their persistence and mobility in environment. Indeed, even at low concentrations, they represent a risk to aquatic life and human health. In this work, fourteen pharmaceuticals were monitored in a constructed wetland wastewater treatment plants (WWTP) assessed in both influent and effluent samples. The basic water quality parameters were evaluated, and the removal efficiency of pharmaceutical, potential for bioaccumulation, and the impact of WWTP were assessed using Polar Organic Chemical Integrative Sampler (POCIS) and biofilms. The pharmaceutical compounds were quantified by High Performance Liquid chromatography coupled to mass spectrometry. The sampling campaign was carried out during winter (July/2018) and summer (January/2019). The WWTP performed well regarding the removal of TSS, COD, and BOD5 and succeeded to eliminate a significant part of the organic and inorganic pollution present in domestic wastewater but has low efficiency regarding the removal of pharmaceutical compounds. Biofilms were shown to interact with pharmaceuticals and were reported to play a role in their capture from water. The antibiotics were reported to display a high risk for aquatic organisms.

Iron and zinc availability and some physical characteristics from extruded products with added concentrate and hydrolysates from bovine hemoglobin.

Four hydrolysates were obtained from bovine hemoglobin concentrate (BHC) and used to fortify extruded maize products. Extrusion was carried out with a Brabender single-screw extruder. Physicochemical properties from extruded products were measured. The iron availability was estimated by the dializability method, which measures the mineral dialyzed after a double digestion simulating physiological processes. The physicochemical properties of the extruded products were not affected by fortification, with the exception of total soluble solids. The enzymic hydrolysis increased the iron dializability with respect to the substrate. The highest value of iron dializability corresponded to the more hydrolysated sample. Extruded products fortified with BHC hydrolysates showed higher iron dializability than those fortified with BHC. However, iron dializability corresponding to BHC is lower than that expected from heme iron. Therefore, heme-iron availability is low when it is determined in the absence of meat proteins, and hydrolysis could increase potential iron availability.

Endogenous Endophthalmitis Heralding Central Nervous System Involvement by Nocardia Farcinica.

Nocardiosis is an uncommon opportunistic infection caused by aerobic, gram-positive, weakly acid-fast, filamentous bacteria of the genus Nocardia that presents as a suppurative disease in immunocompromised hosts. Herein the authors describe the case of an elderly male with granulomatosis with polyangiitis (GPA) on chronic immunosuppressive therapy that presented initially with visual symptoms and developed focal neurological deficits. Nocardia should be considered as a potential pathogen in any immunosuppressed patient presenting with endogenous endophthalmitis and new-onset focal neurological deficits. Early recognition and treatment may prevent irrevocable neurological compromise stemming from misdiagnosis.

The Severity of Neurological Dysfunction in Preschool Children, Secondary to Damage Generated During the Perinatal Period, is Associated With a Pro-Inflammatory Pattern of Serum Molecules.

Disorders in the child's neurological development caused by perinatal risks can lead to long-term altered neurological signs that begin at an early age and involve persistent functional disorders. Recent data suggest that tissue dysfunction, not just acute damage, may initiate or perpetuate an inflammatory response. The aim of this study was to find out if any neurological dysfunction in preschool children secondary to damage generated during the perinatal period is associated with the magnitude of perinatal risks and long-term modifications in the serum concentrations of inflammatory molecules. The participants, aged 1-4 years, were on neurodevelopmental follow-up and rehabilitation therapy from the first three months of life and had no acute disease data. We classified the children into three groups according to the importance of their perinatal risks: low, medium, and high. The results show that 1) the magnitude of perinatal risks correlated with the severity of neurological dysfunction; 2) the greatest changes in the concentrations of the molecules of the inflammatory process were associated with the most altered neurological signs. This suggests that persistent nervous system dysfunction keeps inflammatory responses active even in the absence of an acute process of infection or damage.

Effect of extrusion conditions and lipoxygenase inactivation treatment on the physical and nutritional properties of corn/cowpea (Vigna unguiculata) blends.

The influence of lipoxygenase inactivation and extrusion cooking on the physical and nutritional properties of corn/cowpea (Vigna unguiculata) blends was studied. Corn was blended in an 80:15 proportion with cowpea flour treated to inactivate lipoxygenase (CI) or non-inactivated cowpea flour (CNI). Extrusion variables were temperature (150 degrees C, 165 degrees C and 180 degrees C) and moisture (15%, 17% and 19%). Based on their physical properties, the 165 degrees C/15% corn:CNI, and 165 degrees C/15% corn:CI, and 150 degrees C/15% corn:CI blends were chosen for nutritional quality analysis. Extrudate chemical composition indicated high crude protein levels compared with standard corn-based products. With the exception of lysine, essential amino acids content in the three treatments met FAO requirements. Extrusion and lipoxygenase inactivation are promising options for developing corn/cowpea extruded snack products with good physical properties and nutritional quality.

[Effect of the addition of soy flour and whey protein concentrate on bread quality and mineral dialyzability]. / Efecto de la adición de harina de soja y concentrado proteico de suero de queso sobre la calidad del pan y la dializabilidad de minerales.

The effects of the addition of soy flour and whey protein concentrate (WPC) on dough properties and mold bread quality were studied. Farinograph and alveograph were used to evaluate dough properties. Mold bread quality was evaluated by assessing sensory attributes using a trained panel and analyzing some nutritional characteristics, such as: protein chemical score, available lysine, and potential availability of fortified iron and also of the intrinsic calcium and zinc. Addition of soy flour and WPC caused significant changes on dough properties. Chemical score of bread was increased from 40.2 to 41.4 when 6% WPC was used, from 40.2 to 52.2 when 6% soy flour was added and up to 60.0 when substitution was made with 6% WPC plus 6% soy flour. This last improvement was obtained without impairing sensory attributes. The highest value of available lysine loss during baking, corresponded to the blend containing WPC, but it was reduced when WPC was used together with soy flour. WPC addition increased calcium content but reduced potential availability of iron and zinc. This negative effect on iron availability was overcome by adding mineral absorption promoters, being EDTA the most effective. On the other hand addition of 6% soy flour improved protein value without affecting mineral availability.

Lemierre's Syndrome Due to Methicillin-Resistant Staphylococcus aureus.

Lemierre's syndrome is an uncommon and potentially fatal complication of oropharyngeal and facial infections. It involves an associated septic thrombophlebitis, bacteremia, and septic emboli. Traditionally, compromise of the internal jugular vein has been described in conjunction with an infection caused by anaerobes, especially, Fusobacterium necrophorum. In recent years, however, variant forms have been appearing, including other vessel compromise and other etiologic agents. We present the case of Lemierre's syndrome in a 31-year-old male with facial vein thrombosis, septic emboli to the lungs, and bacteremia caused by methicillin-resistant Staphylococcus aureus. We hope that this case will raise awareness about variant presentations and promote a timely diagnosis and appropriate treatment of this potentially fatal infection.