Participation, retention and uptake in a multicentre pre-exposure prophylaxis cohort using online, smartphone-compatible data collection.

OBJECTIVES: The aim of the study was to assess the feasibility of a national pre-exposure prophylaxis (PrEP) programme using smartphone-compatible data collection. METHODS: This was a multicentre cohort study (NCT03893188) enrolling individuals interested in PrEP in Switzerland. All centres participate in the SwissPrEPared programme, which uses smartphone-compatible data collection. Feasibility was assessed after centres had enrolled at least one participant. Participants were HIV-negative individuals presenting for PrEP counselling. Outcomes were participation (number enrolled/number eligible), enrolment rates (number enrolled per month), retention at first follow-up (number with first follow-up/number enrolled), and uptake (proportion attending first visit as scheduled). Participant characteristics were compared between those retained after baseline assessment and those who dropped out. RESULTS: Between April 2019 and January 2020, 987 individuals were assessed for eligibility, of whom 969 were enrolled (participation: 98.2%). The median enrolment rate was 86 per month [interquartile range (IQR) 52-137]. Retention at first follow-up and uptake were both 80.7% (782/969 and 532/659, respectively). At enrolment, the median age was 40 (IQR 33-47) years, 95% were men who have sex with men, 47% had a university degree, and 75.5% were already taking PrEP. Most reported multiple casual partners (89.2%), previous sexually transmitted infections (74%) and sexualized drug use (73.1%). At baseline, 25.5% tested positive for either syphilis, gonorrhoea or chlamydia. Participants who dropped out were at lower risk of HIV infection than those retained after baseline assessment. CONCLUSIONS: In a national PrEP programme using smartphone-compatible data collection, participation, retention and uptake were high. Participants retained after baseline assessment were at considerable risk of HIV infection. Younger, less educated individuals were underrepresented in the SwissPrEPared cohort.

[The post-exposure prophylaxis in all its forms]. / La prophylaxie postexposition dans tous ses états.

Every day physicians are confronted with situations that require evaluation concerning the indication for a post-exposition prophylaxis (PEP) for HIV or, less frequently, for hepatitis B (HBV). There is no specific prophylaxis for hepatitis C (HCV). In light of the experience gained in the domain of HIV in the last years, some international guidelines for PEP have been changed with regard to the choice of drugs and when to start PEP. This article attempts to resume the different factors contributing to the evaluation of PEP according to the local guidelines and to introduce the foreseen changes in the new Swiss-guidelines for PEP that will be released in autumn 2013.

Clinical relevance of cytomegalovirus viraemia(*,†).

BACKGROUND: Using new sensitive quantitative polymerase chain reaction (PCR) assays, cytomegalovirus (CMV) DNA is often detectable in the plasma of immunosuppressed patients. We investigated the prognostic value of a positive CMV DNA test for the development of CMV end-organ disease, other AIDS-defining events and mortality. METHODS: A survival analysis was performed, using the Kaplan-Meier method and Cox proportional hazards models, for patients prospectively followed in the Swiss HIV Cohort Study, from January 1996 to December 2007, who were CMV-seropositive, had a CD4 count of ≤ 100 cells/µL, and had a plasma sample available for the measurement of baseline CMV DNA with an ultrasensitive PCR. The outcome analysed was an AIDS-defining event, including CMV end-organ disease, or death. Variables analysed at the time of CMV measurement were demographic variables, CD4 cell counts, HIV-1 RNA loads, and use and type of highly active antiretroviral therapy (HAART). RESULTS: Of 1128 patients, 208 (18%) presented an AIDS-defining event and 246 (22%) died. A total of 368 patients (34% of samples) had detectable CMV DNA at baseline, with DNA concentrations of up to 38 800 copies/mL. In the multivariate analysis, CMV DNA predicted evolution not only towards CMV end-organ disease [hazard ratio (HR) 12.6; 95% confidence interval (CI) 4.27-37.41], but also towards other AIDS-defining events (HR 2.6; 95% CI 1.60-4.33) and death (HR 1.9; 95% CI 1.10-3.34). CONCLUSION: Quantitative CMV DNA detected in the plasma of HIV-infected patients with CD4 counts ≤ 100 cells/µL is a predictor for HIV disease progression, CMV disease and death. A single low value of 80 copies/mL identifies patients at low but significantly increased risk during the following months, after the measurement.

[PEP or no PEP? The rational of initiating postexposure prophylaxis]. / PEP ou pas PEP? Du rationnel de l'emploi des prophylaxies postexpositionnelles.

Every day, doctors are faced with the dilemma of starting a postexposure prophylaxis (PEP) against HIV, HBV and HCV. A 28 days course of highly active antiretroviral therapy, chosen on the basis of the source's HIV resistance profile, should be initiated, as soon as possible, to reduce the likelihood of HIV transmission. Complete vaccination against HBV (3 doses) is associated with a 100% seroprotection in children and 95% in adults. There is no specific prophylaxis against HCV. Because of the complexity of these situations, we have edited local guidelines, which take into account not only international and Swiss recommendations, but also our experts' opinions. It is important to stress that PEP does not replace standard precautions.

Influence of previous exposure to antibiotic therapy on the susceptibility pattern of Pseudomonas aeruginosa bacteremic isolates.

Many patients who present with Pseudomonas aeruginosa bacteremia have been previously exposed to antibiotics. To assess whether resistance of bacteremic strains to antipseudomonal antibiotics (piperacillin, ceftazidime, imipenem, ciprofloxacin, or aminoglycosides) is associated with previous exposure to these drugs, a case-control study including 267 cases of P. aeruginosa bacteremia was conducted. Twenty-five percent of the episodes had been preceded by the exposure to an antipseudomonal antibiotic. Eighty-one strains were resistant to at least 1 antibiotic; 186 were susceptible to all drugs. Via univariate analysis, the risks of resistance to ceftazidime and imipenem were found to be significantly associated with previous receipt of these agents. Using multivariate analysis, exposure to any antipseudomonal antibiotic as a monotherapy was found to be associated with an increased risk of subsequent resistance to itself (odds ratio, 2.5; P=.006). Therefore, clinicians should avoid readministering previously prescribed antibiotics when initiating empiric therapies for possible P. aeruginosa bacteremia, especially when they have been given as monotherapies.

Microleakage of composite resins in cavities of upper primary molars.

OBJECTIVE: To improve the quality of resin restorations, studies are necessary not only of the physical properties of materials but also of the cavity geometry. We have evaluated marginal microleakage for two types of photo-curing composite resin applied to cavities with different marginal structures. SAMPLE AND METHODS: The test materials were 91 extracted upper primary molars. The two composite resins used in this experiment were Liner Bond II (LBII) and Photo Clearfil A (PCA). A class I cavity was created in each tooth; the cavity configuration was a round bevel, a straight bevel and a butt joint. The tooth was then restored with each composite resin. Each tooth was exposed to thermal cycles, followed by immersion in 0.2% basic fuchsin solution. Three sections, through the mesial, central and distal areas of each tooth were taken. The penetration of the dye was examined with a stereoscopic microscope. The sites of observation for examination of microleakage were awarded scores of between 0 and 7. RESULTS: LBII-among the three marginal forms, absence of leakage was observed most frequently in the straight bevel group followed by the round bevel and the butt joint groups, in the mesial and distal sections. In the central section, the straight bevel did not show any scores of 0, 6 or 7. PCA-an absence of leakage in the mesial section occurred most frequently for the round bevel group. However, the absence of leakage in the central and distal sections was most frequent for the straight bevel group. Microleakage of the central section (with scores from 1 to 7) was frequently lower than that for the mesial and distal sections. Scores of 5 and above in the central section were observed only in the butt joint group. The frequency and mean score of leakage were clearly higher in LBII than in PCA, with one significant exception. For both composite resins, the butt joint group showed higher-mean scores of leakage than did either the round or straight bevel group, but for PCA, the mean score of the central section was lower than the other two sections in all groups. CONCLUSION: Our study shows that beveling does reduce marginal leakage. This leakage was more frequently observed with the use of LBII than with PCA. However, the amount of tooth ground away was greater for the bevel-treated cavity. In considering these features, special care is necessary in selecting the bur for treating a bevelled cavity.

New cavity forms in second deciduous molars which maximize dentin thickness between cavity and pulp chamber.

This study was designed to devise configuratively ideal cavity formations using 49 second deciduous molars, consisting of 25 extracted from the maxilla and 24 from the mandible. A cavity having at least 1 mm subcavitary (below the cavity) dentin thickness at any point of measurement and having an appropriately formed and positioned retention was defined as an ideal cavity. The same methods were used as in our previous study of first deciduous molars. The following results were obtained: 1. In upper second deciduous molars, the subcavitary dentin thickness was thin at the mesiobuccal side of the cavity; it measured 0.9 mm. In lower second deciduous molars, the subcavitary dentin thickness was thin at the mesiobuccal, distolingual sides of the cavity, and central fossa, where the retentional groove was provided; it measured 0.8-0.9 mm. The other measured values exceeded 1.0 mm. All thickness measurements were very close to the values considered as ideal. 2. In upper second deciduous molars, the margins of the cavity were positioned medially to the summits of respective cusps, 1.8-2.0 mm at the buccal side and 1.5 mm at the lingual side. The entire cavity was located lingually. 3. In lower second deciduous molars, the buccal margin of the cavity was positioned 1.7 mm medially to the summit of the distobuccal cusp and 1.2-1.3 mm medially to the summits of the other buccal cusps. The lingual margin was positioned 1.4-1.5 mm medially to the summits of respective cusps. medially to the summits of respective cusps. 4. The buccolingual width of the cavity amounted to 1/3 of the distance between the summits of the buccal and lingual cusps in both upper and lower second deciduous molars. 5. At the mesial side, the depth of cavity was 1.4 mm at the buccal wall and 1.5 mm at the lingual wall in upper second deciduous molars, and 1.4 mm at the buccal wall and 1.6 mm at the lingual wall in lower second deciduous molars. 6. The width of gingival wall in the proximal box measured 1.0 mm in both upper and lower second deciduous molars.

New cavity forms in first deciduous molars which maximize dentin thickness between cavity and pulp chamber.

Using a total of 60 human extracted first deciduous molars (30 upper molars and 30 lower molars), we contrived a variety of ideal cavities having dentin thicknesses below the cavity (subcavitary dentin) that measure approximately 1 mm in thickness from the pulp chamber at any point of measurement and also having a retentional groove prepared in such a way that detachment of a filling material is prevented. The transparent specimens prepared from the cavity-containing teeth were cut into serial sections of 93 microns. These sections were reconstructed using a personal computer. The thickness of dentin below the cavity was measured in randomly selected sections. Results obtained were as follows: 1. An ideal thickness of the subcavitary dentin was preserved for upper first deciduous molar by preparing a retentional groove lingually or by providing a dovetail-like shape to mesio-distolingual sides in the cavity; for lower first deciduous molar, any form of cavitation worked. 2. In the upper first deciduous molars, the margins of the cavity were displaced medially to the summits of the respective cusps 1.9 mm at the buccal side and 1.2 mm at the lingual side. In the lower first deciduous molars, the buccal margin medially measured 0.9 mm and the lingual margin measured 0.6 mm at the mesial side. At the distal side, the buccal and lingual margins measured 1.2 mm and 1.0 mm, respectively. 3. The ratio of cavity width to the distance between the summits of the buccal and lingual cusps was 1/3 in upper deciduous first molars and 2/5 in the lower first deciduous molars. 4. In the upper first deciduous molars, the depths of the buccal and lingual walls of the cavity at the center of the central groove were both 1.1 mm. In the lower first deciduous molars, the cavity formed with its center at the middle of the transverse ridge had a depth of 1.5 mm at the buccal wall and a depth of 1.7 mm at the lingual wall. The cavity formed with its center at the central fossa had a depth of 1.2 mm at the buccal wall and 1.1 mm at the lingual wall. 5. The width of the gingival wall in the proximal box measured 0.6-0.7 mm in upper and lower first deciduous molars.

[Frequency of the developmental disturbances of tooth structure].

In permanent and deciduous dentitions, the frequency of congenitally missing teeth, supernumerary teeth, conical teeth, fused teeth, germinate teeth, abnormal tubercles (basal ridge of incisor or canine, central cusps of molars, Carabelli's cusp, protostylid, and para-molar tubercles), and enamel hypoplasia (white spots, pigmentation, and enamel defects) were surveyed. Furthermore, mesio-distal and bucco-lingual dimensions of the crowns were measured and the relationship between developmental disturbances of dental hard tissue and tooth size was examined. For the deciduous dentition, the frequency of children with congenitally missing teeth, conical teeth and fused teeth was 7.2%, 1.1% and 5.3%, respectively. Enamel hypoplasia appears with the following frequency; white spots (16.0%), pigmentation (6.4%), and enamel defects (5.2%). Mesio-distal widths of the upper canine and lower lateral incisors of the children with congenitally missing teeth was significantly smaller than the standard values. For the permanent dentition, congenitally missing teeth, conical teeth and fused teeth were detected in 5.7%, 3.0%, and 0.5% of the children, respectively. The frequency of children with basal ridge, central cusps, Carabelli's cusp, protostylid, and para-molar tubercles was respectively, 1.1%, 2.6%, 7.1%, 0.3% and 1.3%. Children with central cusps or Carabelli's cusp tended to have larger crowns, while children with congenitally missing teeth or conical teeth tended to have smaller teeth. As for enamel hypoplasia, white spots were detected in 24.9% of the children, and pigmentation was in 8.1%, and enamel defects were in 9.2%. These results indicate that abnormality of tooth number and tooth morphology correlate with the tooth size and this tendency is more striking in permanent dentition than in deciduous dentition.

[Clinical study of enamel hypoplasia and its causes. 1. Primary teeth].

A nation-wide field survey was undertaken to examine clinical causes for hypoplasia of primary teeth in 141 children above 3 years of age with primary dentition having enamel hypoplasia. The survey was carried out by visual examination, photographic evaluation and questionnaire survey. The controls consisted of 120 children without enamel hypoplasia. The following results were obtained: 1. Hypoplastic teeth due to inflammation, trauma or radiation were not found. 2. Based on the configuration of the hypoplastic teeth, the place of birth and type of nursing, the teeth that developed enamel opacity could not necessarily be regarded as to mottled teeth. 3. No correlation was found between the unbalanced diet of the mothers during pregnancy and the occurrence of the hypoplastic teeth. 4. The development of enamel hypoplasia was estimated to have occurred from the neonatal to infantile stage for the primary canines and from the fetal stage to the early stage of birth or 6 months after birth for second primary molars. 5. Hypoplasia seemed to have begun from the stage of the matrix formation in many cases. 6. Among the mothers during embryogenesis, threatened abortion, severe hyperemesis gravidarum, anemia and drugs used in the treatment of these symptoms seemed to be responsible for the development of hypoplasia. Among the children, diseases occurring within one year after birth, exanthematous diseases such as exanthema submonia, common cold and pneumonia, Jaundice, intussusception and asthma seemed to be responsible. 7. The number of enamel-hypoplastic teeth per child increased, as the frequency of diseases in both mothers and children increased. 8. The kind of teeth susceptible to damage, the time of damage, the sensitivity of individuals, and the kind and severity of damage seemed to interact in the etiology of hypoplasia.

[Clinical study of enamel hypoplasia and its causes. 2. Permanent teeth].

A nation-wide field survey was carried out to investigate the etiology of enamel hypoplasia for permanent teeth in 286 subjects below 20 years of age with permanent dentition having enamel hypoplasia. Visual examination, photographic evaluation and questionnaire survey were used. The same questionnaire survey was also carried out in 111 subjects without hypoplastic teeth as controls. The following results were obtained. 1. The number of hypoplastic teeth ranged from 1 to 28 per subjects. 2. Upper central incisors were frequently involved, especially in subjects with few permanent teeth. Enamel hypoplasia in these teeth appeared symmetrically. 3. Only a few hypoplastic teeth seemed due to local causes. Hypoplastic teeth were not considered to be mottled teeth caused by fluoride. 4. Unbalanced diet (food liked and disliked) during pregnancy was not related to dental hypoplasia. 5. In subjects with many colored teeth, maternal diseases during embryogenesis and drugs administered for treatment were considered to be etiologically involved in the development of hypoplasia. 6. Viral infection during childhood seemed to be involved in the development of hypoplasia. 7. Many of the subjects with more than 7 hypoplastic teeth or colored teeth had contracted diseases during childhood. Moreover, the development of both viral infection and other disease was frequent. 8. The kind of teeth liable to damage, time of damage, sensitivity of individual subjects, multiple stimulation.

[Blood pressure changes in children during minor oral surgery].

The purpose of this study was to evaluate the influence of minor surgery conducted in the oral cavities of children. Changes in blood pressure and pulse during minor surgery were measured using a Pulse-Wave Korotokoff Sound Record Meter GP-303S (PARAMA). The subjects consisted of 28 children (15 boys and 13 girls) who underwent minor surgery at the pediatric dental clinic of Iwate Medical University. An examination of 16 of the 28 children to determine the relationship between their physique, personality, and blood pressure was made. The following results were obtained: 1) The maximum blood pressure formed a peak at the time of the impacted supernumerary teeth extraction. This was more conspicuous in boys than in girls. The pulse rose to the highest values with the infiltration of the anesthesia, the incision, and stripping. However, no significant values based on sex difference were demonstrated. 2) The maximum blood pressure changed more intensely during surgery in boys than in girls. This was distinctly observed during extraction of the impacted supernumerary tooth. 3) Both the maximum blood pressure and pulse increased with the progress of the surgery. After the surgery, it returned nearly to the presurgical level. With extraction of a supernumerary tooth and marsupialization, the return of the blood pressure to the preoperative level was more delayed in boys than in girls. 4. The changes in blood pressure and pulse seemed to be mostly induced by mental disquietude and stress such as anxiety and fear of surgery. 5. The physique and personality were related to the changes in blood pressure and pulse during minor surgery in the oral cavity.

[Effect of adhesive composite resin on pulp and capping of pulp with calcium hydroxide base (Dycal) in deciduous teeth of young dogs].

This study was designed to investigate the effect of adhesive composite resin (Clearfil SC Bond) on dental pulp and the effect of calcium hydroxide base (Dycal) on the protection of the pulp, using 66 deciduous teeth of young dogs. After forming a cavity (class 5) on the labial aspect in each tooth, the teeth were divided by the modes of plugging into 4 groups; stopping alone (Group S), stopping and capping with Dycal (Group D+S), capping with Dycal and resin (Group D+R) and capping with resin alone (Group R). After decalcification, the specimen was embedded in celloidin, sliced into thin sections and stained with hematoxylin and eosin for histopathological examination. Histological changes were examined at 3 days, 1 week, 2 weeks and 4 weeks. The following are the results obtained. 1. In Group S, slight histological changes were observed at 3 days and 1 week. However, the changes began to diminish after the 2nd week and disappeared in the 4th week. 2. In Group R, the severest histological changes persisted throughout the course of observation. The changes were not diminished even in the 4th week. Thus, the resin seemed to exert a strong and long-lasting stimulative effect against the pulp. 3. In Group D+S and D+R, the histological changes were more serve at 3 days and 1 week compared to those found in Group S, but these were diminished after the 2nd week. This seemed to suggest that the pulp was stimulated to a certain degree by Dycal but also, Dycal protected the pulp from stimulation of the resin. 4. Capping of the pulp seemed necessary in vital teeth with resin restoration.

[Clinical study of ectopic eruption of permanent incisors and first molars].

UNLABELLED: Using the X-ray films, plastic models and pathological photograph of 4824 patients seen at the Department of Pedodontics of Iwate Medical University, the patterns of ectopic eruptions of permanent incisors and first molars (restricted to these teeth in this study) were classified into 4 groups (I-IV) to investigate the conditions of its incidence, size of the teeth and dental arch, and conditions at the stage of the mixed and permanent dentitions. RESULTS: 1. The total frequency of ectopic eruptions was 5.6%. No difference based on sex was found. 2. By classification, ectopic eruptions of the upper and lower permanent central incisors (Group I) amounted to more than half of the total frequency. The incidence of ectopic eruptions of the upper and lower permanent first molars (Group III) was very low and amounted to only 4.6% of the total frequency. 3. In Groups I and III, the incidence was higher in the maxilla than in the mandible. 4. Based on sex, the incidence was higher in boys in Group III and in girls in group II. 5. Ectopia of the permanent central incisors was frequently bilateral and those of the lower permanent lateral incisors and upper permanent first molars were frequently unilateral. 6. The mesiodistal width of the ectopically erupted permanent teeth tended to be somewhat enlarged, but showed no significant differences from Ono's mean value. 7. In ectopic eruptions at the area of the incisors, the C-C distance was narrowed with an increase in the ectopically erupted permanent teeth. 8. In patients in whom the permanent dentition was formed without occlusal guidance, the basal arch length and dental arch length were large and basal arch width and dental arch width were small. 9. In cases which were followed from the deciduous dentitions to permanent dentitions, the anterior tooth area at the stage of the mixed dentition was frequently crowded. Occlusal guidance was carried out in more than half of these cases.

Failure of root development of human permanent teeth following irradiation.

Complete absence of root formation of the upper incisors, canine and first premolar was reported in a 27-year-old female who had received radiation therapy for a retinal glioma of the right eye at age of 3 years 1 month. Ground and decalcified sections showed no remarkable changes in enamel and dentin of the crowns, but the pulp floor was closed by irregular dentin deposit despite the absence of root formation. The outer surface of the irregular dentin was covered by acellular cementum, and the periodontal membrane was undeveloped. A slight degree of fibrosis was seen in the pulp, but the coronal part of the dentin was lined by odontoblasts. The theory that tooth eruption is caused by the growth of the root is not substantiated by the observation in this case.