RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS.

BACKGROUND: OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited. AIM: We assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them. METHODS: Data came from the "Dimensions of OHRQoL Project" and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions' summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions' domain scores or OHIP-5's items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment. RESULTS: Summary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91-0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively. CONCLUSION: Recommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.

Electrocortical spectral analysis and fractal methods for assessing the effects of unilateral brain injury on rat cerebellum.

We used electrocortical spectral analysis and fractal methods for assessing the effects of unilateral, single brain injury on cerebellum. Cerebellar electrocortical activity was recorded in control state (before the injury) and after a single brain injury of the cerebellar cortex in anesthetized rats. We noticed that the mean power in gamma high-frequency domain (32-128 Hz) of the cerebellum, was increased after the first brain injury, while after a two-week recovery, it was larger than before the injury. The unilateral brain injury induced a permanent increase of the mild gamma activity in both the left and the right side of cerebellum cortex, but there was no further increase after the lesion was repeated. Our recent electrophysiological study on the cerebellum (Culic et al., 2005) suggested that the mean power spectra of the cerebellar cortical activity in the gamma frequency range might be the indicator of acute single focal brain injury. However, there is insufficient information on the effects of the repeated brain injury on the cerebellar electrocortical activity and morphology. There was no significant difference between the absolute and the relative mean power of the left and the right paravermal cortical activity (before, as well as, after the injury), in each of the animals tested afterwards, but there were differences between the left and the right side of cerebellum in experimental animals. Repeated injury of the cerebellar cortical areas, is strengthened by morphological changes in the cerebellar hemisphere, and shows a decrease in delta and an increase in gamma range.

Vitamin C Depletion in Prenatal Guinea Pigs as a Model of Lissencephaly Type II.

Humans and guinea pigs are unable to produce vitamin C, with deficiency resulting in a well-known disorder of collagen synthesis. Pial basement membrane structure preservation is essential in the proper migration of neurons. In our study, intrauterine deprivation of vitamin C in guinea pig fetuses led to a collagen synthesis disorder, weakness, and finally a breach of pial basement membrane. We found excessive migration of the external germinal layer cells into the subarachnoid space of the cerebellum through defects in the pial basement membrane. The changes ranged from focal rupture of pial basement membranes to their complete disintegration. The loss of proper folia formation resulted in macroscopically visible flattening of the cerebellar surface. Different grades of dysplastic changes in the folia of the cerebellar cortex were observed in 2 experimental groups assigned different limits to mark the time of commencement and duration of vitamin C deprivation. The most severe form of dysplastic changes was characterized by marked irregularity of the cerebellar cortex similar to that in lissencephaly type II. Thus, prenatal vitamin C deficiency represents a novel animal model to study the effects of collagen synthesis on development of breaches in the pial basement membrane, disordered migration of neurons, dysplasia of cerebellar cortex, and the pathogenesis of lissencephaly.

Assessment of preschool psychopathology in Serbia.

The utility of the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5) and the Caregiver-Teacher Report Form (C-TRF) to the Serbian children is largely unknown and has not been studied. An aim of this study was to examine rates and distribution of emotional and behavioral problems among 4 to 6-year-old children in the Serbia. Country differences between our Serbian sample and the original U.S. sample, gender differences, and cross-informant agreement between teachers and parents were also to be examined. The CBCL/1.5-5 and the C-TRF was completed by parents and teachers respectively on 512 preschoolers in the city of Novi Sad, Serbia. Internal consistency of the scales was analyzed using Cronbach alpha (α). The comparison of behavioral/emotional syndromes raw scores was performed by t test. CBCL/1.5-5 prevalence rate of the Total Problems score in the clinical range was 13.4%, while the C-TRF prevalence rate for girls was 9.8% and for boys 8.8%. Our findings revealed that parent reported more problems than teachers on almost all scales across gender with the mean cross-informant correlation of 0.24. This study documents gender differences, with boys scoring significantly higher than girls on all externalizing related problem scales on both questionnaires, but with no gender differences on internalizing problems on either questionnaire. Results support the applicability of the Serbian version of the CBCL/1.5-5 and C-TRF and can be recommended for use in clinical and research settings.

Correlation analysis of alveolar macrophage cytochemical parameters in smoking and pulmonary oncology.

Cytochemical examination of alveolar macrophages (AM) obtained by bronchoalveolar lavage (BAL) was performed in healthy volunteers (11 non-smokers and 11 smokers) and in 9 patients with squamous lung carcinoma (all of them smokers or ex-smokers) in order to analyze its peculiarities related to the smoking habit and to lung malignancy. Assessment of non-specific esterases: alpha-naphthyl acetate esterase (ANAE) and butyrate esterase (BUT), chloroacetate esterase (CHL), acid phosphatase (AcP), intracellular glycogen (PAS reaction), lipids (Sudan black B reaction-SBB) and iron (Perl's reaction) was performed by a semiquantitative cytochemical method (1). A significant correlation was obtained between BUT and stage of squamous lung carcinoma (varying between I and IV) (r = 0.52, p < 0.05). There was a correlation between BUT and Perl's in healthy controls (r = 0.76, p < 0.05). The same type of correlation was observed in control smokers (r = 0.64, p < 0.05), in addition to a correlation between CHL and AcP (r = 0.69, p < 0.05). There was no significant BUT/Perl's correlation in patients with squamous cell lung carcinoma (r = 0.23, p > 0.05), but significant AcP/CHL correlation as was observed in control smokers (r = 0.73, p < 0.05), and a "new" type of correlation was shown to exist between ANAE and SBB (r = 0.77, p < 0.05). In spite of the unresolved nature of lung cancer, correlation analysis of cytochemical parameters in AM might have an important part in the analysis of their relative contribution to the development of smoking-related disorders and lung malignancies.

The importance of cytochemical analysis of alveolar macrophages in the evaluation of their biological properties.

Bronchoalveolar lavage (BAL) was performed in 48 subjects: 22 healthy controls, 13 patients with pulmonary sarcoidosis Stage I and 13 patients with lung cancer. All diagnoses were pathologically and clinically confirmed. Cytocentrifuge preparations were made, air-dried and stained for cytochemical examination of alveolar macrophages (AM) using indexing and scoring methods for the evaluation of esterase activity, intracellular amounts of glycogen, lipids and iron. Significant differences were found in the cytochemical examination of enzyme activity of AM and intracellular metabolic and ionic state, depending on pathological processes and smoking habits. There was a linear correlation between alpha naphthyl esterase activity and iron content in AM in patients with squamous cell lung carcinoma and in patients with pulmonary sarcoidosis, which makes it possible to assign individual patients to one of the groups. Cytochemical examination of BAL specimens might be of great significance for the prevention and early diagnosis of various malignant and non-malignant lung diseases.

A robotic dissolution system with on-line fiber-optic UV analysis.

An automated, robotic system has been developed with on-line UV fiber optics for real time dissolution analysis of solid dosage forms. The system is comprised of "off-the-shelf" hardware including a UV-Vis diode array spectrophotometer, fiber optic coupler, immersion probe, robot, and dissolution apparatus. The software system is modular with the functionalities of control, data acquisition, and spectral analysis separated into three Windows applications with communications performed via Dynamic Data Exchange (DDE). The fiber optic spectrophotometer collects a full spectrum over the range of 190-810 nm. Single wavelength UV analysis is performed on dosage forms in six dissolution vessels. The robotic system automates all facets of the analyses: measuring, degassing, and dispensing of the media; thermostating the media to physiologic temperature; dropping the dosage forms into the vessels; immersing the fiber optic probe at the appropriate time intervals; initiating the data acquisition, analyses, and reporting; and emptying and washing of the vessels prior to the next automated run. As a representative dosage form, 10 mg active tablets were selected and analyzed by this method. This fiber optic system has significantly improved the throughput of the robotic systems by eliminating the need for time consuming off-line HPLC or UV analyses. In addition, with the exception of system calibration, it is no longer necessary for laboratory personnel to come in contact with samples.

Automated system for the on-line monitoring of powder blending processes using near-infrared spectroscopy. Part II. Qualitative approaches to blend evaluation.

Near Infrared (NIR) spectroscopy is seen as a very powerful tool in a variety of applications involving powder characterisation. Here we deal with a typical pharmaceutical application of powder blend monitoring. A D-optimal experimental design is used to cover the 85-115% range of the target formulation which is comprised of the active component at 3.5% w/w, Microcrystalline Cellulose (Avicel PH102) at 62%, Dibasic Calcium Phosphate Anhydrous at 31.5%, Sodium Starch Glycolate (Explotab) at 2%, and 1% Magnesium Stearate. A miniature Flobin blender has been modified to enable the use of a fibre optic probe for on-line NIR spectral data collection. The experiments were successful in detecting spectral changes which eventually converged to constant variance. While the NIR spectrum of a powdered sample is rich in information which is representative of both the physical and chemical characteristics of the sample, it is at times difficult to select the appropriate mathematical treatments in order to extract the desired information. This article investigates several possible pre-treatments (including detrending (DT), standard normal variates (SNV), second derivatives, and the combination of SNV and DT) together with several ways in establishing blend homogeneity, which includes the running block standard deviation, dissimilarity calculations and principal components analysis (PCA). The focus of this work is to investigate qualitative tools of analysis for blend homogeneity determinations, while future work will focus on quantitative data interpretation.

Possible explanation of cephalic and noncephalic presentation during pregnancy: a theoretical approach.

This paper is based on fact that the fetus is exposed to gravity. The hypothesis is that from the 24th week of gestation an increasing percentage of fetuses occupies an exclusively cephalic presentation, since it allows an uncompromised posture in the caudal direction of body segments whose muscles are first affected by the occurrence and progressive increase of tone. Being in cephalic presentation, in a caudal direction, the fetus relieves body segments of the weight of the hypotonic-atonic part of the body in the cranial direction. In other words, cephalic presentation presents a body axis posture along the line of gravity. When the body axis posture along gravity is absent, the fetus simply fills the intrauterine cavity. In many such cases, the results are transverse lie, breech presentation and also cephalic presentation.

Polyhydramnios and bone development: an unexplored relationship.

Immersion of a humans and Macaca mulatta into a pool with fluid whose specific weight is equal to their specific weight cause bone demineralization. Also, in professional scuba divers, bone mineral density is reduced. Because of water immersion, the apparent weight of scuba divers represents 10% of their actual weight. The aim of this paper was to point out a previously unexplored aspect of fetal bone development in an environment lacking adequate mechanical stress on fetal bone, such as polyhydramnios. In the first part of gestation, the human fetus develops under conditions similar to neutral floating and has an apparent weight which is approximately 5% of its actual weight. During the last trimester of gestation, the fetus overgrows the intrauterine cavity and its apparent body weight is 60-80% of its actual weight. Polyhydramnios represents an excess of amniotic fluid in the uterus during gestation and it can reduce the apparent weight of the fetus to 10-20% of its actual weight. Reduction of the mechanical stress on fetal bone caused by polyhydramnios may significantly affect bone development and ossification during the last trimester of gestation. It is necessary to direct further studies towards examining bone development and mineralization in newborns from gestations complicated by polyhydramnios. A complete lack of data and studies on fetal bone development and bone mineralization in pregnancies complicated by polyhydramnios is not surprising. There is still a misleading opinion that the fetus is in weightlessness condition in the intrauterine environment throughout the second half of gestation regardless of the amount of amniotic fluid.

[Massive pneumonia with severe acute respiratory insufficiency after chicken pox in a female patient]. / Masivna pneumonija s teskom akutnom respiracionom insuficijencijom kod bolesnice posle prelezane varicele.

A female patient who developed massive bilateral pneumonia with severe respiratory insufficiency during recovery from varicella, is presented. Blood serologic analyses detected the cause of infection--Mycoplasma pneumoniae, while Streptococcus pneumoniae was isolated by bacteriological examination of the sputum. M. pneumoniae is a causative agent of acute upper and lower respiratory airway infections with a frequently mild clinical picture. This agent rarely provokes massive pneumonia with severe clinical appearance as described in the patient, who had immunodeficiency due to previous infection with Varicella zoster virus.

[Use of nuclear medicine technology (radionuclide venography) in detecting a case of suspected ileofemoral phlebothrombosis]. / Prikaz primene nuklearnomedicinske tehnologije (radionuklidne venografije) u razjasnjavanju slucaja suspektne ileofemoralne flebotromboze.

We reviewed a complex nuclear medical method's application for investigating venous circulation of lower extremities--radionuclide venography (RVG) in explaining a case of suspective ileofemoral thrombosis. Suffering from pain and swelling of the right leg, patient T.J. wanted a checkup. After the physical examination, vascular surgeon suspected phlebothrombosis of the right ileofemoral region and immediately sent her to have a radionuclide venography (RVG) (because by Doppler-ultrasonography certain data confirming presence of thrombus in the pelvic region couldn't be gained). On the basis of gathered results vascular surgeon can make a final diagnosis (phlebothrombosis of the right vein femoralis), so that in this case flebography was not necessary. Although performing RVG is complex and requires engagement of experts of different profiles, gathered data are valuable because they cover the shortage of existing diagnostic methods which are most often used in routine work (Doppler-ultrasonography and phlebography). Applying RVG phlebography can be avoided in all patients who are not expected to have operative treatment, and in cases where thrombosis is suspected in deep veins of pelvis, RVG can be performed right away, without Doppler ultrasonography.

Appearance of discontinuities in spectra transformed by the piecewise direct instrument standardization procedure.

Several years ago, we noted that spectra transformed by the piecewise direct standardization (PDS) method may contain discontinuities. Having noticed that the problem was a recurring one, we studied it and recently diagnosed its source. Our investigations suggest that this problem also occurs in applications of window factor analysis, evolving factor analysis, and any other procedure that uses piecewise principal component models. In this work, we report the source of the problem and illustrate it with one example. A procedure is presented for eliminating the problem that is effective in PDS pattern recognition applications. Further work is needed to develop modified algorithms suitable for calibration applications.

[Massive hemoptysis as a rare complication in a patient with cystic fibrosis]. / Masivne hemoptizije kao retka komplicacija kod bolesnika s sicticnom fibrozom.

A female patient, 28 years old, with massive haemoptysis as a complication of cystic fibrosis, is described. Cystic fibrosis is a systemic disease with common pulmonary manifestations. Chronic inflammatory process causes the proliferation of bronchial arteries, and their erosion is followed by bleeding. Transitory haemoptysis is common in patients with cystic fibrosis, but massive haemoptysis is a rare complication of this disease.

[Infections of the breast]. / Infekcija dojke.

The authors present their experiences of 45 female patients under the treatment of an acute purulent mastitis in five years period. From 45 treated female patients 8 (17.7%) were treated clinically, and 37 (82.2%) in the outpatient department. At the age to 35 years old, there were 87% of female patients from which 79.2% who bore the first child, and 21.7% of those who bore more than one child. From an acute lactic mastitis were treated 39 (86.6%) from which 2 (4.4%) were young girls, and 4 (8.8%) patients with already finished period of reproduction. Right-side localization of the pathological process was in 22 (48.8%) cases, left-side in 19 (42.2%) cases, and both-sides in 4 (8.8%) cases. In 15 (33.3%) female patients we have followed an immunological status. It is characteristic an immunological disbalance in acute phase. Following the immunological status, it can be useful for estimating and prognosis in treatment. In literature, there are quotation details of purulent diseases, among which breast infection takes a considerable place from 1.6 to 18%, and the death-rate is described in high percentage from 9.6 to 1.7%. Our attitude in the treatment of breast infection, especially when purulent process is present, as first we have to evacuate the suppuration, then to make good breast drainage, and separately to infiltrate the tissue because there are small abscesses in it, which bring to dissemination of pus within the breast. According to all mentioned above, we also give an antibiotic therapy.

On-line monitoring of powder blend homogeneity by near-infrared spectroscopy.

Near-infrared spectroscopy is evaluated as an on-line technique for monitoring the homogeneity of a pharmaceutical blend during the blending process. Blends containing 10% sodium benzoate (model active), which provided an aromatic functionality typical of many pharmaceutical compounds, 39% microcrystalline cellulose (Avicel PH102), 50% lactose, and 1% magnesium stearate were developed to mimic the properties of an actual pharmaceutical blend. A twin-shell V-blender was modified to allow installation of a diffuse reflectance fiber-optic probe at the axis of rotation, and spectra were collected during three experiments using a commercially available near-infrared spectrophotometer. In each experiment, blender control and spectral data collection were controlled by a compilation of software packages. The experiments detected spectral changes which eventually converged to a point of constant variance. Further analysis of the spectral data showed the blend is homogeneous long before a typical blending period is complete. Near-infrared spectroscopy has proven to be a feasible and effective method for the "real time" noninvasive determination of homogeneity in a pharmaceutical blend.