Dental considerations and recommendations in Eisenmenger syndrome: A report of an unusual paediatric case.

BACKGROUND: Eisenmenger syndrome (ES) is a heart cyanotic condition characterised by elevated pulmonary vascular resistance and an intra-cardiac right-to-left shunting of blood through a systemic-to-pulmonary circulation connection. Affected children usually exhibit severe hypoxia, clubbing of fingers/toes, haemoptysis, anaemia, and organ damage. CASE REPORT: During autumn 2015, the patient and her parents arrived at the paediatric dentistry clinic. The patient presented with the main complaint of generalised inflamed gingival tissues, severely protruded upper incisors, and evident abnormal mouth breathing. TREATMENT: This was performed under local analgesia, rubber-dam isolation, and antimicrobial prophylaxis with amoxicillin (50 mg/kg). The patient's parents agreed to the treatment plan through a signed informed consent. This treatment consisted of the placement of pit and fissure sealants on the four permanent first molars (which included enamel preparation with fissurotomy burs), in-depth gingiva/dental frequent cleanings, local fluoride varnish applications, and an exhaustive programme of at-home oral hygiene (brushing, flossing, and chlorhexidine mouth rinses), including adequate nutrition. Gingivoplasty surgery to remove residual enlarged tissues was indicated for the near future. FOLLOW-UP: The child did not return to the clinic. When contacted, the parents reported that their daughter's systemic condition worsened significantly. She was confined to a bed at home under palliative care, with a life-span expectation of only a few months. CONCLUSION: Comprehensive dental care of children with ES requires careful consideration of their medical condition, and dental care delivery should be coordinated with the paediatric cardiologist. General analgesia should be considered only in strictly selected cases, due to the high peri-operative mortality reported.

Chitooligosaccharides as novel ingredients of fermented foods.

Chitooligosaccharides (COSs) have been clinically evaluated for their immunostimulating effects after oral intake. Similar to dietary supplements, prebiotics and biopreservatives, these water-soluble bioactives are easily incorporated into dairy products and beverages. Notwithstanding, the use of COS in fermented foods would be limited by its antimicrobial properties. In order to study the interaction with yoghurts as a model of fermented food, the effects of COS on chemical composition, viability, morphology and metabolism of lactic acid bacteria, fatty acid profiles and conjugated linoleic acid (CLA) were assessed over 28 days and after chemical digestion. There were no significant differences between the nutritional composition of controls and yoghurts supplemented with concentrations up to 0.1% w/w of COS. However, the acidification of milk decreased at 0.5% (p < 0.05) and the formation of yoghurt failed at 3.0%, without affecting viable counts. Lipid hydrolysis of yoghurts supplemented with 0.1% COS was not affected by chemical digestion. No significant differences were found between CLA percentages of controls and supplemented yoghurts after digestion. Although the nutritional composition, fatty acids and viable counts were not significantly modified after COS supplementation, the present study shows that COS diminishes bacterial acidification at concentrations higher than 0.1%, thus limiting the amounts that could be added to yoghurt.

Potential pitfall in parathyroid sestamibi imaging resulting from a cardiac pacemaker.

A 47-year-old woman with a history of end-stage renal disease and hyperparathyroidism after total parathyroidectomy had Tc-99m sestamibi imaging to identify possible ectopic parathyroid tissue. This study was prompted by increasing calcium and parathyroid hormone levels after several years of taking calcium supplements necessitated by a surgically induced hypoparathyroid state and end-stage renal disease. The scan showed persistent linear activity in the upper right mediastinum in delayed images, after washout of the thyroid had occurred. Because of the unusual configuration of this finding, investigation of the patient's clinical history and other imaging studies was undertaken. The authors concluded that the unusual mediastinal uptake was not hyperactive parathyroid tissue, but rather was attributed to the presence of central venous pacemaker wires. Thus, this case illustrates a potential pitfall in parathyroid sestamibi imaging, the uptake of which may increase in the presence of a cardiac pacemaker, and it emphasizes the importance of correlative imaging.

Changes in thyroid function in puppies fed a high iodine commercial diet.

Abnormally low(131)I uptakes were noticed in dogs fed with commercial diets at the University Animal Clinic in Buenos Aires, but the total iodine content of eight different commercial diets examined was found to provide an iodine intake above daily requirements. To investigate this anomaly, 18 dogs were distributed into three groups, fed either: (1) a home-prepared diet; (2) a commercial diet; (3) a home-prepared diet supplemented with potassium iodide equivalent to that found in the commercial diet. The(131)I uptake in dogs of groups B and C was significantly decreased, as was basal serum thyroxine (T(4)) and free thyroxine (FT(4)), whereas urinary iodide excretion and serum thyroid stimulating hormone (TSH), were increased. The thyroid releasing hormone (TRH)-TSH test showed an increased response in dogs from group B, while the TRH-T(4)test was inhibited in both groups B and C. The results demonstrate that the excessive amount of iodine present in some commercial diets in Argentina causes a significant impairment of thyroid function and hypothyroidism.

Commercial diet induced hypothyroidism due to high iodine. A histological and radiological analysis.

A number of puppies of the School Hospital of the Faculty of Veterinary Science-UBA showed bone changes. Measurement of the iodine content of the commercial diet showed a significant increase in its content. Iodine excess causes alterations in thyroid function and morphology, and its hormones have a direct action on bone formation. Three groups of puppies were fed on different diets: a home-prepared diet, a commercial diet (containing 5.6 mg potassium iodide/kg dry food), and a home-prepared diet supplemented with 5.6 mg potassium iodide/kg dry food. Groups B and C developed hypothyroidism. A significant decrease (p<0.05) in the styloid apophyseal surface was found in groups B and C vs. A, determined by radiography. Histologically, the hypertrophied cartilage was shorter in groups B and C than in group A (p<0.0001). The present results suggest that commercial diets with a high iodine content may cause hypothyroidism and changes in bone metabolism.

Nutritional assessment of seed proteins in rice bean [Vigna umbellata (Thumb.) Ohwi and Ohashi].

Seeds of three rice bean accessions had 17.26 to 21.42% protein, 3.46 to 4.03% fat, 61.09 to 64.73% carbohydrates 3.99 to 4.58% ash and 5.22 to 7.43% fiber (dry weight basis). The most limiting amino acids in the seed meal, albumin and globulin fractions, were methionine and cysteine with chemical scores of these fractions being 38% to 59%. The amino acid pattern of globulin and seed meal were similar. The in vitro protein digestibility (IVPD) ranged from 82 to 86% for the seed meal, 86 to 88.5% for the albumin and 75.9 to 83.3% for the globulin. Relative nutritive values (RNV) of raw mature seed of two accessions were 22.6% and 42.4% and increased to 55.6% to 79.4% after boiling and roasting.