Two novel Raoultella species associated with bleeding cankers of broadleaf hosts, Raoultella scottia sp. nov. and Raoultella lignicola sp. nov.

Seventeen Gram-negative, facultatively anaerobic bacterial strains were isolated from bleeding cankers of various broadleaf hosts and oak rhizosphere soil in Great Britain. The strains were tentatively identified as belonging to the genus Raoultella based on 16S rRNA gene sequencing. Multilocus sequence analysis (MLSA), based on four protein-encoding genes (fusA, leuS, pyrG, and rpoB), separated the strains into three clusters within the Raoultella genus clade. The majority of strains clustered with the type strain of Raoultella terrigena, with the remaining strains divided into two clusters with no known type strain. Whole genome sequencing comparisons confirmed these two clusters of strains as belonging to two novel Raoultella species which can be differentiated phenotypically from their current closest phylogenetic relatives. Therefore, two novel species are proposed: Raoultella scottia sp. nov. (type strain = BAC 10a-01-01T = LMG 33072T = CCUG 77096T) and Raoultella lignicola sp. nov. (type strain = TW_WC1a.1T = LMG 33073T = CCUG 77094T).

Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries.

OBJECTIVE: To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay. METHODS: Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only. RESULTS: The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment. CONCLUSIONS: Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.

Assessment of Patient Perspectives and Barriers to Self-Infusion of Augmentation Therapy for Alpha-1 Antitrypsin Deficiency During the COVID-19 Pandemic.

INTRODUCTION: Alpha-1 antitrypsin (AAT) deficiency is an autosomal co-dominant genetic condition that predisposes individuals to pulmonary and hepatic disease, and in severe cases is treated with augmentation by intravenous infusion. Our aim was to assess patient reluctance to transition to self-administered augmentation of alpha-1-antitrypsin, during the pandemic of SARS-CoV-2. METHODS: A phone questionnaire was administered to 22 patients with severe alpha-1-antitrypsin deficiency who were currently receiving AAT augmentation therapy. Inclusion criteria included patients [Formula: see text] 18 years old, diagnosed with AATD, and receiving intravenous AAT protein augmentation therapy. Information was gathered regarding demographics, perspectives on transitioning to self-administered treatment, and anxiety and depression prevalence. Results were collected anonymously using REDCap. Joint and marginal statistical analysis was done to quantify links between participants' willingness to transition to self-infusion and correlations with sex, age, years of therapy, anxiety, and depression. RESULTS: Of 22 patients, 14 were male and eight were female. Ages ranged from 36 to 79 years, with an average of 62.5. Genotypes were ZZ (14), MZ (3), and SZ (2) among others. Average length of intravenous augmentation was 9.5 years. The majority, 16 participants, were aware self-infusion was an option. Eight participants were willing to consider transitioning to self-infusion if trained and educated. Eight patients reported that fear of COVID-19 transmission influenced their decision-making. Above-normal anxiety, and depression scores, were found in four, and six patients, respectively. Neither sex, age, years of treatment, anxiety, or depression were found to be associated with willingness to consider self-infusion therapy. CONCLUSIONS: Although there are many reasons AATD patients may benefit from AAT self-infusion, including decreased exposure to SARS-CoV-2, the majority preferred home nurse-infused therapy.

Transfer of Erwinia toletana and Erwinia iniecta to a novel genus Winslowiella gen. nov. as Winslowiella toletana comb. nov. and Winslowiella iniecta comb. nov. and description of Winslowiella arboricola sp. nov., isolated from bleeding cankers on broadleaf hosts.

Following a screening campaign of bleeding cankers of broadleaf hosts in Great Britain, numerous bacterial strains were isolated, identified by 16S rRNA and protein-coding gene sequencing and ultimately classified. During the course of the study, several Gram-negative, facultatively anaerobic strains were isolated from bleeding Platanus x acerifolia (London plane) and Tilia x europaea (common lime) cankers that could not be assigned to an existing species. Partial 16S rRNA gene sequencing placed these strains in the genus Erwinia, as a close phylogenetic relative of Erwinia toletana. In an effort to determine the taxonomic position of the strains, a polyphasic approach was followed including genotypic, genomic, phenotypic, and chemotaxonomic assays. Multilocus sequence analysis based on four protein-coding genes (gyrB, rpoB, infB, and atpD) confirmed the phylogenetic position of the strains as a novel taxon of subgroup 3 of the genus Erwinia, along with E. toletana and E. iniecta, and furthermore, provided support for their reclassification in a novel genus. Whole genome comparisons allowed the delimitation of the novel species and also supported the proposed transfer of subgroup 3 species to a novel genus in the Erwiniaeae. Phenotypically the novel species could be differentiated from E. toletana and E. iniecta, and the novel genus could be differentiated from the closely related genera Erwinia and Mixta. Therefore, we propose (1) the reclassification of E. toletana and E. iniecta in a novel genus, Winslowiella gen. nov., as Winslowiella toletana comb. nov. and Winslowiella iniecta comb. nov., with W. toletana comb. nov. as the type species (type strain A37T = CFBP 6631T = ATCC 700880T = CECT 5263T), and (2) classification of the novel strains as Winslowiella arboricola sp. nov. (type strain BAC 15a-03bT = LMG 32576T = NCPPB 4696T).

Racial and Ethnic Disparities in the Research and Care of Hereditary Angioedema Patients in the United States.

BACKGROUND: Hereditary angioedema (HAE) affects all races and both sexes equally. Minority patients are underrepresented in clinical trials and may be at risk for additional disease burden. OBJECTIVES: To examine racial and ethnic disparities in the research and care of patients with HAE. METHODS: We conducted a retrospective population-based study using TriNetX Diamond Network. International Classification of Diseases, 10th Revision, Current Procedural Terminology, and RxNorm codes identified patients with HAE. The proportions of White, Black, and Hispanic patients with HAE were contrasted with racial and ethnic distributions of patients with HAE in clinical trials. Lifetime prevalence of mental health disorders and HAE treatments was contrasted among different racial and ethnic groups. RESULTS: A population-based search identified 2122 patients with HAE. The prevalence of HAE among Black patients (1.64/100,000 patients) mirrored that of White patients (1.47/100,000 patients), whereas there was a lower HAE prevalence among Hispanic patients (0.80/100,000 patients). The demographics of the 1274 patients with HAE included in phase 2/3 clinical trials differed significantly from population-based data with overrepresentation of White patients (89.9% vs 77.9%) and underrepresentation of Black patients (3.8% vs 13.6%) and Hispanic patients (1.3% vs 8.1%). Across the different racial and ethnic groups of patients with HAE, the prevalence of mental health disorders was comparatively higher than among patients without HAE. Whereas depression was equally prevalent across the different HAE racial and ethnic groups, anxiety was more prevalent among White patients. CONCLUSIONS: Clinical trials for Food and Drug Administration-approved HAE medications underrepresent minority patients. Hereditary angioedema remains underdiagnosed in Hispanic patients. Other than a lower prevalence of anxiety disorders among Black patients relative to White patients, the mental health impact of HAE is equally distributed across the different racial and ethnic groups.

Caregivers' satisfaction with pediatric dental care in a university clinical setting in North Philadelphia.

The aims of this study were twofold: to describe different aspects of caregiver satisfaction with pediatric dental treatment provided at a dental school clinic and to explore differences in satisfaction by caregivers' demographics and compliance with their children's appointments. A cross-sectional study was conducted in two phases. In Phase I, a convenience sample of caregivers (n=100) eighteen years of age and older whose children had been receiving dental care in Philadelphia, Pennsylvania, were invited to complete a self-administered dental satisfaction questionnaire. In Phase II, sociodemographic data and the child's reason for visit were extracted from axiUm. Descriptive analyses stratified by sociodemographic variables were conducted. Results indicated that almost half of the caregivers reported feeling concerned about pain at the dental office. Those with the lowest levels of education and income reported feeling the most concern about pain at the dental office, as well as sometimes avoiding bringing their child to the dentist because of their fear of pain and not complying with scheduled dental appointments for the child. Operational aspects related to access and motivational aspects such as fear of pain when seeking dental treatment were identified as barriers to treatment.

Non-surgical management methods of noncavitated carious lesions.

OBJECTIVE: To critically appraise all evidence related to the efficacy of nonsurgical caries preventive methods to arrest or reverse the progression of noncavitated carious lesions (NCCls). METHODS: A detailed search of Medline (via OVID), Cochrane Collaboration, Scielo, and EMBASE identified 625 publications. After title and abstract review, 103 publications were selected for further review, and 29 were finally included. The final publications evaluated the following therapies: fluorides (F) in varying vehicles (toothpaste, gel, varnish, mouthrinse, and combination), chlorhexidine (CHX) alone or in combination with F, resin infiltration (I), sealants (S), xylitol (X) in varying vehicles (lozenges, gum, or in combination with F and/or xylitol), casein phosphopeptide amorphous calcium phosphate (CPP-ACP) or in combination with calcium fluoride phosphate. All included studies were randomized clinical trials, were conducted with human subjects and natural NCCls, and reported findings that can yield outcomes measures such as caries incidence/increments, percentage of progression and/or arrest, odds ratio progression test to control, fluorescence loss/mean values, changes in lesion area/volume and lesion depth. Data were extracted from the selected studies and checked for errors. The quality of the studies was evaluated by three different methods (ADA, Cochrane, author's consensus). RESULTS: Sample size for these trials ranged between 15 and 3903 subjects, with a duration between 2 weeks and 4.02 years. More than half of the trials assessed had moderate to high risk of bias or may be categorized as 'poor'. The great majority (65.5%) did not use intention to treat analysis, 21% did not use any blinding techniques, and 41% reported concealment allocation procedures. Slightly more than half of the trials (55%) factored in background exposure to other fluoride sources, and only 41% properly adjusted for potential confounders. CONCLUSIONS: Fluoride interventions (varnishes, gels, and toothpaste) seem to have the most consistent benefit in decreasing the progression and incidence of NCCls. Studies using xylitol, CHX, and CPP-ACP vehicles alone or in combination with fluoride therapy are very limited in number and in the majority of the cases did not show a statistically significant reduction. Sealants and resin infiltration studies point to a potential consistent benefit in slowing the progression or reversing NCCls.

Amyand's hernia.

We report two children with Amyand's hernia, where the appendices along with caecum were found within the left hernial sac, which were operated for obstructed inguinal hernia.

Managing dental caries with atraumatic restorative treatment in children: successful experience in three Latin American countries / Control de la caries dental mediante tratamiento restaurador atraumático en niños: experiencia exitosa en tres países de América Latina

OBJECTIVE: To compare survival rates and cost differentials between the atraumatic restorative treatment (ART) technique and amalgams by type of dental personnel in Ecuador, Panama, and Uruguay. METHODS: Children 7 to 9 years of age in rural and urban schools with at least one lesion with initial cavitated enamel caries or a dentinal lesion on a first permanent molar were selected and randomized into the ART (intervention) or amalgam (control) group. Restoration failure was evaluated at 12 and 24 months. Cooperation and pain experienced during the procedures were measured. Cumulative and incident failure of restorations at 12 and 24 months was calculated for dentists who placed ART or amalgam restorations and auxiliaries who placed ART restorations at 12 months only. RESULTS: The total sample comprised 1 629 children. Study groups were similar by country, gender, and geographic location. Cumulative failure rate at 12 months varied by group: dentists' amalgam, 0.9% to 5.7%; dentists' ART, 2.0% to 10.5%; and auxiliaries' ART, 5.7% to 15.8%. At 24 months, higher cumulative failures were observed for the dentists' amalgam group compared with the dentists' ART group in Ecuador and Panama but not in Uruguay. Amalgam was least likely to have the best level of cooperation and an auxiliary using ART was associated with the least pain. The cost of using the ART approach for dental caries treatment, including retreatment, was roughly half that of using amalgam without retreatment. CONCLUSIONS: Having auxiliary personnel perform ART will lead to treatment survival that is expected to be lower than dentists using amalgam or ART. In spite of the greater risk of failure, the rate is not unacceptable and potential cost savings are substantial.

OBJETIVO: Comparar las tasas de supervivencia de las restauraciones y las diferencias en cuanto a costo según el tipo de profesional odontológico, entre la técnica de tratamiento restaurador atraumático (TRA) y las amalgamas en Ecuador, Panamá y Uruguay. MÉTODOS: Se seleccionaron niños de 7 a 9 años de edad, de escuelas rurales y urbanas, que presentaban como mínimo una lesión inicial cavitada de caries del esmalte o una lesión de la dentina en un primer molar permanente, y se distribuyeron aleatoriamente en el grupo sometido a TRA (intervención) o en el grupo tratado con amalgamas (control). Se evaluó el fracaso de la restauración a los 12 y 24 meses. Se midió el grado de cooperación y el dolor observados durante los procedimientos. Se calculó el fracaso acumulado e incidental de las restauraciones a los 12 y 24 meses para los dentistas que aplicaron restauraciones de tipo TRA o amalgamas, y únicamente a los 12 meses para el personal auxiliar que llevó a cabo restauraciones de tipo TRA. RESULTADOS: La muestra total incluyó a 1 629 niños. Los grupos de estudio fueron similares en cuanto a país, sexo y ubicación geográfica. La tasa de fracaso acumulado a los 12 meses varió según el grupo: fue de 0,9 a 5,7% para la amalgama aplicada por dentistas; de 2,0 a 10,5% para el TRA aplicado por dentistas; y de 5,7 a 15,8% para el TRA aplicado por personal auxiliar. A los 24 meses, se observaron mayores fracasos acumulados en el grupo de amalgamas aplicadas por dentistas en comparación con el grupo de TRA aplicado por dentistas en Ecuador y Panamá pero no en Uruguay. Fue menos probable que la aplicación de amalgama obtuviera el mejor grado de cooperación, y la aplicación de TRA por personal auxiliar se asoció con la menor intensidad de dolor. El costo de usar el método de TRA en el tratamiento de la caries dental, incluido el retratamiento, fue aproximadamente de la mitad del costo del empleo de amalgama sin retratamiento. CONCLUSIONES: La restauración mediante TRA llevado a cabo por personal auxiliar logrará una supervivencia presumiblemente inferior a la obtenida por la aplicación de amalgama o TRA por dentistas. A pesar del mayor riesgo de fracaso, la tasa es admisible y la potencial reducción de costos es importante.