Procalcitonin and white blood cells, combined predictors of infection in cardiac surgery patients.

BACKGROUND: Sepsis is strongly associated with an increased risk of postoperative mortality, longer length of hospital stay, and elevated health care costs. Early clinical symptoms overlap with those of systemic inflammatory response syndrome, a response that commonly occurs after cardiac surgery with cardiopulmonary bypass. Since a combination of biomarkers has been demonstrated to improve the prediction of postoperative infection, the objective of the present study was to test whether the combination of C-reactive protein (CRP), white blood cells (WBC), and procalcitonin (PCT) is able to predict postoperative infection in a large cohort of cardiac surgery patients. MATERIAL AND METHODS: Case-control study involving 423 patients who underwent cardiac surgery with cardiopulmonary bypass. Patients were retrospectively classified into two groups based on whether they developed severe sepsis or septic shock during the postoperative period. Blood samples for biological measurements (PCT, CRP, and WBC) were drawn on the first day in the intensive care unit, then once daily in the morning until the 10th postoperative day. RESULTS: CRP median values were similar in both groups. WBC and PCT median values were significantly higher in patients with infection than without during the first 10 postoperative days. With elevation cutoffs ≤3 times (OR: 4.058; 95% CI: 2.206-7.463; P = 0.001) and ≥4 times (OR: 10.274, 95% CI: 3.690-28.604; P < 0.001), the median value for PCT (1.7 ng/mL) and/or WBC (13,000 cells/mm3) on the second postoperative day was significantly associated with the development of infection. CONCLUSIONS: The goal of this study was to use a large cohort of cardiac surgery patients to ensure that the results were representative of this population. The combination of PCT and WBC levels over the first three postoperative days was able to predict postoperative infection within the 30 d following cardiac surgery.

Clinical Comparative Study of Shade Measurement Using Two Methods: Dental Guides and Spectrophotometry.

Tooth color is a determining factor in the fabrication of dental prostheses. The aim of the present study is to compare two measurement methods used in the field of dentistry: dental guides and spectrophotometry. A total of 2768 natural teeth were measured using the Vita Classical and Vita 3D-Master dental guides (Vita-Zahnfabrik, Bad Säckingen, Germany), as well as a Vita Easyshade Compact spectrophotometer (Vita-Zahnfabrik). The measurements were carried out by one operator under suitable illumination conditions at 5500 degrees Kelvin. The obtained results show that the measurements obtained with the Vita Classical dental guide classifies teeth into the A-B categories, while the spectrophotometer preferentially classifies teeth into the B-C categories. The correlation coefficients obtained with the dental guides ranged from -0.32 to -0.39 (p < 0.01), while those for the spectrophotometer ranged from -0.35 to -0.55 (p < 0.01). Therefore, we can conclude that the spectrophotometer is more reliable and reproducible in its measurements than the dental guides.

Changes in the Color and Brightness of White Spots Associated with Orthodontic Treatment 6 Months after the Application of Infiltrative Resins: Systematic Review and Meta-Analysis.

One of the risks that we find after orthodontic treatment is the secondary appearance of white spot lesions (WLS) after the removal of fixed multi-bracket appliances. Today, there are several treatment methods, resin infiltration being the most used in the most serious cases. The objective of this study is to carry out a systematic review and meta-analysis to determine the efficacy and stability in the variables of color and gloss, six months after resin infiltration. A comprehensive search was performed in the following databases: PubMed, Embase, Google Scholar, Scopus, Medline, and Web of Science. Articles published in the last 10 years were selected, including in vivo studies with a six-month follow-up. PRISMA guidelines were followed to carry out this systematic review. All studies where the application of resin was performed on carious lesions were discarded. Once the inclusion and exclusion criteria were applied, a final sample of four articles was obtained, on which the review and meta-analysis were carried out. Once examined, all authors considered that there was an immediate improvement in both variables. However, statistically significant differences were obtained in the color change outcome, but not in the brightness outcome in the subgroup analysis after six months of icon resin infiltration.

Influence of Serum Vitamin D Levels on Survival Rate and Marginal Bone Loss in Dental Implants: A Systematic Review.

This systematic literature review set out to investigate the relationship between serum vitamin D levels and dental implants in terms of survival rates, marginal bone loss, and associated complications. The review was conducted according to PRISMA guidelines, performing an electronic search in four databases (Pubmed, Web of Science, Cochrane, and Scopus), complemented by a manual search up to April 2022. Four articles were selected for analysis. The Newcastle-Ottawa Quality Assessment Scale tool was used to assess the quality of evidence of cohort studies, and the Cochrane bias assessment tool was used to assess the quality of evidence of randomized clinical trials. The study included 1089 patients restored with 1984 dental implants, with follow-up periods ranging from 20-240 months. Cases presenting lower serum vitamin D levels obtained slightly worse results in terms of marginal bone loss. Longer follow-up periods are needed in order to determine whether serum vitamin D levels affect implant survival rates and osseointegration over time.

Comparative Analysis of Periodontal Pain According to the Type of Precision Orthodontic Appliances: Vestibular, Lingual and Aligners. A Prospective Clinical Study.

The objective of this prospective clinical study was to analyze the pain (intensity, location and type) that patients presented after the placement of different types of orthodontic appliances: conventional, low friction, lingual and aligners. The sample consisted of 120 patients divided into four groups: conventional (CON), low friction (LF), lingual (LO) and aligners (INV). The participants were given the Short-Form McGill Pain Questionnaire (Ortho-SF-MPQ), where they had to record the pain intensity (no pain, mild, moderate or intense) and the periodontal location at different time points, from the first 4 h to 7 days after the start of treatment. In all the study groups, the most frequent location was both anterior arches, with maximum values between 56.7% (CON group at 24 h) and 30% (LO group at 4 h). The "whole mouth" and "complete lower arch" locations were indicated only by the patients in the lingual group. Regarding pain intensity, the patients reported a higher percentage of mild-moderate pain during the first 3 days of treatment (96.7% in LO at 4 h, 86.7% in CON, 83.3% in LF and 90% in INV at 24 h); later, the reported pain decreased to no pain/mild pain, especially in the lingual group, until reaching values close to zero at 7 days post-treatment. The most frequent type of pain was acute in the low friction and lingual groups (with maxima of 60% and 46.7% at 24 h, respectively). On the contrary, in the conventional (36.7% at 4 h) and Invisalign (40% at 24 h) groups, the sensitive type was the most frequent. There are differences regarding periodontal pain in its intensity, location and type according to the use of different orthodontic techniques.

Impact of nosocomial infections on patient mortality following cardiac surgery.

STUDY OBJECTIVE: To determine the rate of nosocomial infection among patients undergoing cardiac surgery and to identify risk factors and the impact of these infections on patient mortality. DESIGN: Prospective observational study. SETTING: Intensive Care Unit (ICU). PATIENTS: 1097 adult patients who underwent cardiac surgery at Hospital Clínico Universitario de Valladolid between January 2011 and January 2016. INTERVENTIONS: None. MEASUREMENTS: Preoperative, intraoperative and postoperative medical, surgical and anaesthetic variables. MAIN RESULTS: A total of 111 patients (10.1%) acquired a nosocomial infection in the postoperative period. Pneumonia was the most frequent (4.2%) nosocomial infection. Three independent risk factors for the development of a nosocomial infection were identified: cardiopulmonary bypass time, kidney failure and emergency surgery. The stay in the ICU was significantly higher in patients who developed a nosocomial infection (16.6 ±â€¯38.8 vs. 4.4 ±â€¯17.8, P < 0.001). The mortality rate of patients who acquired a nosocomial infection was significantly greater (18%) than that of patients who did not acquire a nosocomial infection (5%) (P < 0.001). The 90-day survival was greater in the group of patients without nosocomial infection (log rank 27.55, P < 0.001). The dynamic modelling of 90-day mortality revealed that in the first week, cardiopulmonary bypass time (HR = 1.00, 95% CI 1.00-1.02, P < 0.001) and emergency surgery (HR = 0.12, 95% CI 0.04-0.37, P < 0.001) were the most important risk factors for mortality, while after the first week, nosocomial infection (HR = 6.23, 95% CI 2.49-15.63, P < 0.001) was the main risk factor, followed by cardiopulmonary bypass time (HR = 1.01, 95% CI 1.00-1.01, P = 0.001) and EuroSCORE (HR = 1.03, 95% CI 1.00-1.06, P = 0.008). CONCLUSIONS: Nosocomial infections after cardiac surgery constitute the main independent risk factor for mortality after the first week of surgery. These data suggest that its prevention following cardiac surgery must be prioritised to improve patient outcomes.

Design and hygiene issues in sports facilities. A pilot study which investigates fitness centres by using a multidisciplinary tool.

INTRODUCTION: Awareness of the benefits of the physical activity on health by the general public has increased the number of people who is practicing it in the recent years. The gyms are the primary place - as the main indoor environment - for practicing physical activity. METHODS: A multidisciplinary tool was used primarily to investigate and analyse the general aspects of fitness centres then an assessment tool was created to evaluate a specific aspect such as the location, dimension, maintenance, etc. from the design, hygiene and safety points of view. Each section of the tool consisted of a series of questionnaires where the facility managers and the researches must have answered. DISCUSSION: The tool was tested on various cases by analysing the critical issues which affects the quality of spaces and end users' health. CONCLUSIONS: The critical points observed from the tool that has an impact on the design of the gyms will help to shape future of these facilities. Several design and management strategies were also highlighted to improve the hygiene and health issues of fitness centres.

Association of CD14 rs2569190 polymorphism with mortality in shock septic patients who underwent major cardiac or abdominal surgery: A retrospective study.

The aim of this study was to investigate the relationship between the CD14 rs2569190 polymorphism and death related to septic shock in white European patients who underwent major cardiac or abdominal surgery. We carried out a retrospective study in 205 septic shock patients. The septic shock diagnosis was established by international consensus definitions. The outcome variable was the death within 28, 60 and 90 days after septic shock diagnosis. The CD14 rs2569190 polymorphism was analyzed by Agena Bioscience's MassARRAY platform. For the genetic association analysis with survival was selected a recessive inheritance model (GG vs. AA/AG). One hundred thirteen out of 205 patients (55.1%) died with a survival median of 39 days (95%CI = 30.6; 47.4). Patients with rs2569190 GG genotype had shorter survival probability than rs2569190 AA/AG genotype at 60 days (62.3% vs 50%; p = 0.035), and 90 days (62.3% vs 52.6%; p = 0.046). The rs2569190 GG genotype was associated with increased risk of septic shock-related death in the first 60 days (adjusted hazard ratio (aHR) = 1.67; p = 0.016) and 90 days (aHR = 1.64; p = 0.020) compared to rs2569190 AA/AG genotype. In conclusion, the presence of CD14 rs2569190 GG genotype was associated with death in shock septic patients who underwent major surgery. Further studies with bigger sample size are required to verify this relationship.

Diagnosis of perioperative myocardial infarction after heart valve surgery with new cut-off point of high-sensitivity troponin T and new electrocardiogram or echocardiogram changes.

OBJECTIVE: Criteria for diagnosing myocardial infarction (MI) after heart valve surgery are not collected in the Third Universal Definition of MI. We aimed to define cut-offs for high-sensitivity cardiac troponin T (hs-cTnT) and creatine kinase-MB (CK-MB) for the diagnosis of perioperative MI after heart valve surgery according to perioperative MI determined by new alterations in electrocardiogram (ECG) and/or transthoracic echocardiogram (TTE). Secondary endpoints were incidence of perioperative MI, postoperative complications, 30-day mortality, and 2-year survival. METHODS: Heart valve surgery was performed in 805 patients (June 2012-January 2016). hs-cTnT and CK-MB were measured at intensive care unit (ICU) admission and 8, 16, 24, 48, and 72 hours after surgery. Blind to outcomes, we analyzed ECGs and TTEs before and after surgery. Patients were divided into 2 groups: with ECG and/or TTE criteria after surgery (following the consensus statement) and without these changes. We conducted receiver operating characteristic analyses for hs-cTnT and CK-MB in the group with ECG and/or TTE criteria. RESULTS: ECG and/or TTE criteria were observed in 88 patients. Receiver operating characteristic analyses in this group showed hs-cTnT levels of 732.3 pg/mL at ICU admission; 1008 pg/mL at 8 hours, 1057 pg/mL at 16 hours, and 958.3 pg/mL at 24 hours after surgery (P < .001) and CK-MB levels of 26.78 mg/dL at ICU admission, 54.88 mg/dL at 8 hours, 38.98 mg/dL at 16 hours, and 18.4 mg/dL at 24 hours after surgery (P < .001). CONCLUSIONS: Cut-offs for hs-cTnT and CK-MB to diagnose perioperative MI after heart valve surgery are well above upper reference limit. These findings update the Third Universal Definition providing cut-offs to diagnose perioperative MI after heart valve surgery.

Procalcitonin cannot be used as a biomarker of infection in heart surgery patients with acute kidney injury.

PURPOSE: We intended to assess how acute kidney injuy impacts on procalcitonin levels in cardiac surgery patients, with or without infection, and whether procalcitonin might be used as a biomarker of infection in acute kidney injuy. MATERIAL AND METHODS: A case-control study was designed which included patients that had had cardiac surgery between January 2011 and January 2015. Every patient developing severe sepsis or septic shock (n = 122; 5.5%) was enrolled. In addition, consecutive cardiac surgery patients during 2013 developing systemic inflammatory response syndrome (n = 318) were enrolled. Those recruited 440 patients were divided into 2 groups, according to renal function. RESULTS: Median procalcitonin levels were significantly higher during the 10 postoperative days in the acute kidney injury patients. Regression analysis showed that postoperatory day, creatinine, white blood cells and infection were significantly (P < .0001) associated to serum procalcitonin level. In patients with creatinine ≥2, median procalcitonin levels were similar in infected and non-infected patients. Only when creatinine was less than 2 mg/L, the median procalcitonin levels were significantly higher in patients with infection, as compared to those with no infection. CONCLUSIONS: In acute kidney injuy patients, high procalcitonin levels are a marker of acute kidney injuy but will not be able to differentiate infected from non-infected patients.

Predicting cardiac surgery-associated acute kidney injury: The CRATE score.

PURPOSE: Acute kidney injury (AKI) is a frequent complication after cardiac surgery and is associated with increased mortality. The aim was to design a nondialytic AKI score in patients with previously normal renal function undergoing cardiac surgery. METHODS: Data were collected on 909 patients who underwent cardiac surgery with cardiopulmonary bypass between 2012 and 2014. A total of 810 patients fulfilled the inclusion criteria. Patients were classified as having AKI based on the RIFLE criteria. Postoperative AKI occurred in 137 patients (16.9%). Several parameters were recorded preoperatively, intraoperatively, and at intensive care unit admission, looking for a univariate and multivariate association with AKI risk. A second data set of 741 patients, from 2 different hospitals, was recorded as a validation cohort. RESULTS: Four independent risk factors were included in the CRATE score: creatinine (odds ratio [OR], 9.66; 95% confidence interval [CI], 4.77-19.56; P < .001), EuroSCORE (OR, 1.40; CI, 1.29-1.52; P < .001), lactate (OR, 1.03; CI, 1.01-1.04; P < .001), and cardiopulmonary bypass time (OR, 1.01; CI, 1.01-1.02; P < .001). The accuracy of the model was good, with an area under the curve of 0.89 (CI, 0.85-0.92). The CRATE score retained good discrimination in validation cohort, with an area under the curve of 0.81 (95% CI, 0.78-0.85). CONCLUSIONS: CRATE score is an accurate and easy to calculate risk score that uses affordable and widely available variables in the routine care surgical patients.

Impact of ventilator-associated pneumonia on mortality and epidemiological features of patients with secondary peritonitis.

BACKGROUND: Despite the significant impact of nosocomial infections on the morbidity and mortality of patients staying in the intensive care unit (ICU), no study over the past 20 years has focused specifically on VAP following secondary peritonitis. The objective of the present study was to determine in-hospital mortality and epidemiological features attributed to ventilator-associated pneumonia (VAP) following secondary peritonitis. METHODS: Prospective observational study involved 418 consecutive patients admitted in the ICU. Univariate and multivariate analyses were performed to identify risk factors associated with mortality and development of VAP. RESULTS: The incidence of VAP following secondary peritonitis was 9.6 %. Risk factors associated with the development of VAP were hospital-acquired peritonitis, requiring >48 h of mechanical ventilation, and SOFA score. The onset of VAP was late in majority of patients. VAP was developed about 16.8 days after the initiation of the peritonitis. Etiological microorganisms responsible for the peritonitis were different than for VAP. The 90-day in-hospital mortality rate was 47.5 % of VAP patients. Independent factors associated with 30- to 90-day in-hospital mortality were VAP and SOFA. CONCLUSIONS: In light of the impact on morbidity and mortality in the ICU, more attention should be given to the concurrent features among VAP and secondary peritonitis.

Subsistema de vigilancia toxicológica para casos de intoxicaciones masivas y/o desastres químicos / Surveillance subsystem for mass poisonings and chemical disasters

Introducción: la Toxicovigilancia constituye un proceso activo de identificación y evaluación de riesgo y de las medidas adoptadas para reducirlos o eliminarlos. Desde 1998, el Centro Nacional de Toxicología ha realizado acciones de vigilancia, pero aún existen problemas en el conocimiento real en cuanto al comportamiento de las intoxicaciones en el país. Objetivo: diseñar un sistema integrado de toxicovigilancia, como herramienta fundamental para el desarrollo de la Toxicología en Cuba. Material y Métodos: Se realizó una investigación de desarrollo con el objetivo de establecer un sistema de vigilancia que permita la recolección, análisis e interpretación de la información de incidencia de brotes de intoxicaciones agudas y desastres químicos-radiológicos en el país. Se empleó la metodología de diseño para sistemas de vigilancia, utilizada en el Sistema Nacional de Salud Pública. Se diseñaron dos subsistemas de vigilancia: intoxicaciones masivas / desastres químicos e intoxicaciones agudas. Resultados: quedaron diseñados los 2 susbsitemas, en los cuales se describen: generalidades, objetos a vigilar, componentes y atributos del sistema, subsistemas y flujo de información. Conclusiones: se diseñó un sistema de Toxicovigilancia conformado por dos subsistemas (desastres químicos-radiológicos e intoxicaciones agudas), para ser implementado en la Red Nacional de Centros Antitóxicos del Ministerio de Salud Pública, como herramienta fundamental para el desarrollo de la Toxicología en Cuba.

Introduction: toxic surveillance is an active process for the identification and assessment of the risk as well as measures taken to reduce or eliminate such risks. Since 1988 surveillance actions have been carried out at CENATOX (National Center of Toxicology). Since 1988, CENATOX have done actions for surveillance but until there are real knowledge problems in relation to the behavior of poisonings in our country. Objective: to design an integrate system of toxic-surveillance like a fundamental tool for developing the Toxicology in Cuba. Material and Methods: a developing research with the aim to set a surveillance system that allows the collection, analysis and interpretation of outbreak acute poisonings and chemistry _ radiological disaster in our country. It was used the National Public Health Methodology to surveillance systems and were designed two sub systems of surveillance: Mass poisoning / chemical disaster and acute poisonings. Results: the two subsystems were designed in which are described: generalities, goals to surveillance, components and system´s attribute, sub system and information flow. Conclusions: a toxic _ surveillance subsystem was designed and are composed by two subsystem (chemical _ radiological disasters and acute poisonings) to be implemented in National network ofanti- toxic Centers belonging to the Public Health Ministry as a fundamental tool for developing the Toxicology in Cuba.

Intoxicaciones pediátricas atendidas por consultas telefónicas. Centro Nacional de Toxicología, 2000 / Pediatric poisonings seen at remote consultations by phone. National Center of Toxicology, 2000

Se realizó un estudio retrospectivo de las consultas telefónicas por eventos tóxicos en niños, durante el año 2000, con el objetivo de desarrollar medidas profilácticas. Se estudiaron las variables sexo, edad, agente y circunstancia en la cual ocurrió la intoxicación, así como la atención hospitalaria. Del total de consultas el 61,2 (por ciento) correspondió a intoxicados. El grupo de mayor riesgo lo formaron los pacientes de 0 a 4 años y del sexo masculino. Las intoxicaciones en el hogar (83,5 por ciento) fueron las más frecuentes. Las sustancias más involucradas resultaron ser los medicamentos (52,75 por ciento) y los productos químicos (17,63 por ciento). En el momento de la consulta, se le había realizado lavado gástrico al 26,8 (por ciento) de los niños. A partir de las situaciones detectadas, se sugieren medidas preventivas orientadas en 3 áreas fundamentales: educación sanitaria, capacitación del personal médico en la atención al niño intoxicado y promoción de los servicios que presta el Centro Nacional de Toxicología (CENATOX)

Eventos tóxicos en la infancia según consultas telefónicas atendidas en el centro nacional de toxicología (1994-1997) / Toxic events in childhood according to consultations made by phone at the National Center of Toxicology (1994-1997)

Se realizó un estudio retrospectivo de las consultas telefónicas por eventos tóxicos en niños, del período comprendido entre enero de 1994 y diciembre de 1997, con el objetivo de desarrollar medidas profilácticas. Se estudiaron las variables sexo, edad, agente y circunstancia en la cual ocurrió la intoxicación, así como la atención hospitalaria. Del total de consultas el 60,1 porciento correspondió a intoxicados. El grupo de mayor riesgo lo formaron los pacientes de 0 a 4 años del sexo masculino. Las intoxicaciones en el hogar (95 porciento) fueron las más frecuentes. Las sustancias involucradas resultaron ser los medicamentos (54,9 porciento) y los plaguicidas (21,9 porciento). En el momento de la consulta, se le había realizado lavado gástrico al 27,3 porciento de los niños. A partir de las situaciones detectadas, se sugieren medidas preventivas orientadas en 3 áreas fundamentales: educación sanitaria, capacitación del personal médico en la atención al niño intoxicado y distribución del jarabe de Ipecacuana en los policlínicos principales de urgencia