Treatment of impacted or retained second molars with the miniscrew-supported pole technique: a prospective follow-up study.

BACKGROUND: Eruption disturbances of permanent molars are uncommon; however, it is important to treat them as soon as they are diagnosed. The main objective was to analyze the effectiveness of the "miniscrew-supported pole technique," a surgically assisted orthodontic procedure to force the eruption of impacted/retained second molars (M2s) when there are indicators of complex molar inclusion. An observational prospective study was carried out during a 2-year period. Sociodemographic, clinical and low-dose scanner variables were taken at baseline (T0). Follow-up variables (T1) were the time between surgery and tooth eruption, radiographic measurements, debonding of buttons, failure rate of miniscrews and success rate of eruption. RESULTS: A total of 21 patients (mean age of 13.9 years) with 24 retained/impacted M2s were recruited; 13 molars were maxillary (54.2%) and 11 (45.8%) were mandibular. Six (25%) were impacted molars and 18 (75%) primarily retained. At T0, molar angulation was mesial in six molars (25%), distal in five molars (20.8%) and 13 molars were vertically positioned (54.2%). Infraocclusion degree was moderate in four (16.7%) molars and severe in 20 (83.3%). Only three (12.5%) third molars were removed due to lack of space. All M2s managed to erupt, achieving a success rate of 100%; however, two molars of the same patient did not achieve occlusion. The period of eruption after surgery was 126.8 (117.3) days. Anatomical radicular alteration was the only variable independently related to a longer time of treatment (p = 0.027). CONCLUSIONS: The pole technique, using one mesial miniscrew and simple orthodontic mechanics, applies forces that succeed in erupting complicated retained/impacted M2s in a short period of time and with a low failure rate.

Negative predictive value of procalcitonin to rule out bacterial respiratory co-infection in critical covid-19 patients.

BACKGROUND: Procalcitonin (PCT) and C-Reactive Protein (CRP) are useful biomarkers to differentiate bacterial from viral or fungal infections, although the association between them and co-infection or mortality in COVID-19 remains unclear. METHODS: The study represents a retrospective cohort study of patients admitted for COVID-19 pneumonia to 84 ICUs from ten countries between (March 2020-January 2021). Primary outcome was to determine whether PCT or CRP at admission could predict community-acquired bacterial respiratory co-infection (BC) and its added clinical value by determining the best discriminating cut-off values. Secondary outcome was to investigate its association with mortality. To evaluate the main outcome, a binary logistic regression was performed. The area under the curve evaluated diagnostic performance for BC prediction. RESULTS: 4635 patients were included, 7.6% fulfilled BC diagnosis. PCT (0.25[IQR 0.1-0.7] versus 0.20[IQR 0.1-0.5]ng/mL, p<0.001) and CRP (14.8[IQR 8.2-23.8] versus 13.3 [7-21.7]mg/dL, p=0.01) were higher in BC group. Neither PCT nor CRP were independently associated with BC and both had a poor ability to predict BC (AUC for PCT 0.56, for CRP 0.54). Baseline values of PCT<0.3ng/mL, could be helpful to rule out BC (negative predictive value 91.1%) and PCT≥0.50ng/mL was associated with ICU mortality (OR 1.5,p<0.001). CONCLUSIONS: These biomarkers at ICU admission led to a poor ability to predict BC among patients with COVID-19 pneumonia. Baseline values of PCT<0.3ng/mL may be useful to rule out BC, providing clinicians a valuable tool to guide antibiotic stewardship and allowing the unjustified overuse of antibiotics observed during the pandemic, additionally PCT≥0.50ng/mL might predict worsening outcomes.

Child Care Center Hand Hygiene Programs' Cost-Effectiveness in Preventing Respiratory Infections.

BACKGROUND: We previously demonstrated that a hand hygiene program, including hand sanitizer and educational measures, for day care center (DCC) staff, children, and parents was more effective than a soap-and-water program, with initial observation, in preventing respiratory infections (RIs) in children attending DCCs. We analyzed the cost-effectiveness of these programs in preventing RIs. METHODS: A cluster, randomized, controlled and open study of 911 children aged 0 to 3 years, attending 24 DCCs in Almeria. Two intervention groups of DCC-families performed educational measures and hand hygiene, one with soap-and-water (SWG) and another with hand sanitizer (HSG). The control group (CG) followed usual hand-washing procedures. RI episodes, including symptoms, treatments, medical contacts, complementary analyses, and DCC absenteeism days, were reported by parents. A Bayesian cost-effectiveness model was developed. RESULTS: There were 5201 RI episodes registered. The adjusted mean societal costs of RIs per child per study period were CG: €522.25 (95% confidence interval [CI]: 437.10 to 622.46); HSG: €374.53 (95% CI: 314.90 to 443.07); SWG: €494.51 (95% CI: 419.21 to 585.27). The indirect costs constituted between 35.7% to 43.6% of the total costs. Children belonging to the HSG had an average of 1.39 fewer RI episodes than the CG and 0.93 less than the SWG. It represents a saving of societal cost mean per child per study period of €147.72 and €119.15, respectively. The HSG intervention was dominant versus SWG and CG. CONCLUSIONS: Hand hygiene programs that include hand sanitizer and educational measures for DCC staff, children, and parents are more effective and cost less than a program with soap and water and initial observation in children attending DCCs.

Análisis de las intervenciones nutricionales en el proceso asistencial del paciente oncológico en Andalucía: el proyecto NOA / Analysis of nutritional interventions in the care process of oncological patients in Andalusia - The NOA project

Introducción: la desnutrición en los pacientes oncológicos puede conllevar una reducción de la calidad de vida del paciente y un aumento de la morbimortalidad y de los costes sanitarios asociados. Objetivos: analizar las intervenciones nutricionales en las diferentes fases del proceso oncológico, integrando las necesidades de los pacientes y las de los profesionales sanitarios. Material y métodos: se utilizaron técnicas de Design Thinking para abordar el análisis de la situación actual e identificar los aspectos clave. Participaron 13 profesionales de 8 centros sanitarios (endocrinología y nutrición, oncología médica y radioterápica, atención primaria (AP), enfermería y dietética) públicos de Andalucía. Resultados: no se realiza cribado nutricional de forma sistemática en las diferentes fases del proceso oncológico, y no existe consenso universal en los protocolos de actuación e intervención nutricional. Existe un cumplimiento generalizado de los circuitos y tiempos de derivación de los procesos seleccionados. En la fase terapéutica se dispone de la posibilidad de consultar a la Unidad de Nutrición Clínica y Dietética (UNCYD) y el 75 % disponen de protocolos específicos de derivación. La enfermera gestora de casos está presente en todos los hospitales y en AP. El acceso del paciente al psicólogo del centro era posible en el 87 % de los hospitales. Escasa participación de la UNCYD en los Comités de Tumores (solo en el 25 % de los centros). En todos los centros existe algún tipo de colaboración y apoyo de las asociaciones de pacientes y de la Escuela de Pacientes, especialmente en las fases terapéuticas y de control y seguimiento. Conclusiones: se observan variaciones entre los diferentes hospitales y territorios de Andalucía, tanto en la disposición de medios y estructuras como en las actividades y procedimientos. Se han seleccionado y priorizado puntos clave para mejorar la atención nutricional en oncología. (AU)

Introduction: malnutrition in cancer patients can lead to a reduction in patient quality of life, increased morbidity and mortality, and associated healthcare costs. Objective: to analyze nutritional interventions in the different phases of the oncological process, integrating the needs of patients and those of healthcare professionals. Material and methods: "Design Thinking" techniques were used to address the analysis of the current situation and identify key aspects. Thirteen professionals from 8 public health centers (endocrinology and nutrition, medical and radiotherapy oncology, primary care (PC), nursing and dietetics) participated in the study. Results: nutritional screening is not carried out in a systematic way in the different phases of the oncological process, and there is no universal consensus on the protocols for action and nutritional intervention. A wide compliance with the pathways and referral times of the selected processes has been observed. In the therapeutic phase, there is the possibility of consulting the Clinical Nutrition and Dietetics Unit (UNCYD) and 75 % have specific referral protocols. The nurse case manager is present in all hospitals and in PC. Patient access to the center psychologist was possible in 87 % of the hospitals. Participation of the UNCYD in Tumor Committees was low (only in 25 % of the centers). In all centers there is some kind of collaboration and support by patient associations and the School of Patients, especially in the therapeutic and the control and follow-up phases. Conclusions: variations are observed between the different hospitals and areas in Andalusia, both in terms of means and structures and in activities and procedures. Key points have been selected and prioritized to improve nutritional care in oncology. (AU)

Orthodontic management of severe iatrogenic biprotrusion and resorptions with miniscrews and corticotomies.

BACKGROUND: This case report describes a patient with severe iatrogenic dental biprotrusion who visited for a second assessment. The patient presented first premolar maxillary extractions, resorbed maxillary incisors and dehiscences in the anterior buccal and palatal cortical bone diagnosed with cone-beam computed tomography (CBCT). MATERIAL AND METHODS: At the beginning of treatment, fixed appliances were bonded on all teeth except on the upper incisors to prevent further root resorption. Mandibular first premolar extractions, miniscrews and corticotomies were scheduled for gaining distalization of the teeth in the four quadrants. When this was achieved, an occlusal splint was placed to extrude the posterior teeth with interarch elastics for increasing the vertical dimension. Next, brackets were placed on the maxillary incisors and a comprehensive orthodontic treatment was performed. RESULTS: After treatment, changes in incisor positioning were evident, varying the interincisal angle by 57.6 degrees. Nevertheless, slight root resorption of the upper incisors was observed. CONCLUSIONS: Correct diagnosis is necessary to design an adequate treatment plan and make orthodontists aware of possible severe unwanted tooth movements before they occur. In dental biprotrusion without overjet, the first objective should be to distalize mandibular teeth prior to maxillary teeth retraction.

[Analysis of nutritional interventions in the care process of oncological patients in Andalusia - The NOA project]. / Análisis de las intervenciones nutricionales en el proceso asistencial del paciente oncológico en Andalucía: el proyecto NOA.

INTRODUCTION: Introduction: malnutrition in cancer patients can lead to a reduction in patient quality of life, increased morbidity and mortality, and associated healthcare costs. Objective: to analyze nutritional interventions in the different phases of the oncological process, integrating the needs of patients and those of healthcare professionals. Material and methods: "Design Thinking" techniques were used to address the analysis of the current situation and identify key aspects. Thirteen professionals from 8 public health centers (endocrinology and nutrition, medical and radiotherapy oncology, primary care (PC), nursing and dietetics) participated in the study. Results: nutritional screening is not carried out in a systematic way in the different phases of the oncological process, and there is no universal consensus on the protocols for action and nutritional intervention. A wide compliance with the pathways and referral times of the selected processes has been observed. In the therapeutic phase, there is the possibility of consulting the Clinical Nutrition and Dietetics Unit (UNCYD) and 75 % have specific referral protocols. The nurse case manager is present in all hospitals and in PC. Patient access to the center psychologist was possible in 87 % of the hospitals. Participation of the UNCYD in Tumor Committees was low (only in 25 % of the centers). In all centers there is some kind of collaboration and support by patient associations and the School of Patients, especially in the therapeutic and the control and follow-up phases. Conclusions: variations are observed between the different hospitals and areas in Andalusia, both in terms of means and structures and in activities and procedures. Key points have been selected and prioritized to improve nutritional care in oncology.

INTRODUCCIÓN: Introducción: la desnutrición en los pacientes oncológicos puede conllevar una reducción de la calidad de vida del paciente y un aumento de la morbimortalidad y de los costes sanitarios asociados. Objetivos: analizar las intervenciones nutricionales en las diferentes fases del proceso oncológico, integrando las necesidades de los pacientes y las de los profesionales sanitarios. Material y métodos: se utilizaron técnicas de Design Thinking para abordar el análisis de la situación actual e identificar los aspectos clave. Participaron 13 profesionales de 8 centros sanitarios (endocrinología y nutrición, oncología médica y radioterápica, atención primaria (AP), enfermería y dietética) públicos de Andalucía. Resultados: no se realiza cribado nutricional de forma sistemática en las diferentes fases del proceso oncológico, y no existe consenso universal en los protocolos de actuación e intervención nutricional. Existe un cumplimiento generalizado de los circuitos y tiempos de derivación de los procesos seleccionados. En la fase terapéutica se dispone de la posibilidad de consultar a la Unidad de Nutrición Clínica y Dietética (UNCYD) y el 75 % disponen de protocolos específicos de derivación. La enfermera gestora de casos está presente en todos los hospitales y en AP. El acceso del paciente al psicólogo del centro era posible en el 87 % de los hospitales. Escasa participación de la UNCYD en los Comités de Tumores (solo en el 25 % de los centros). En todos los centros existe algún tipo de colaboración y apoyo de las asociaciones de pacientes y de la Escuela de Pacientes, especialmente en las fases terapéuticas y de control y seguimiento. Conclusiones: se observan variaciones entre los diferentes hospitales y territorios de Andalucía, tanto en la disposición de medios y estructuras como en las actividades y procedimientos. Se han seleccionado y priorizado puntos clave para mejorar la atención nutricional en oncología.

Miniscrew-supported pole technique: Surgical-orthodontic approach for impacted or retained second molars in adolescents.

BACKGROUND: Several treatment options have been proposed for the treatment of eruption disturbances of permanent molars. Despite being an infrequent condition, these disturbances should be solved as they can lead to important complications and play a relevant role in completing the occlusion. FINDINGS: The presented cases involved maxillary and mandibular included second molars (M2s) respectively. Both teeth erupted successfully after the application of the miniscrew-supported pole technique, and a functional occlusion was established. CONCLUSIONS: This technique is a surgically assisted orthodontic procedure performed to force the eruption of impacted/retained M2s. This device uses one mesial miniscrew which allows the application of relevant force to achieve the eruption of complicated retained/impacted M2s within a short period of time.

Orthodontic management of a complete and an incomplete maxillary canine-first premolar transposition.

Maxillary canine and first premolar transposition is a complicated dental anomaly to treat, especially if the clinician's goal is to orthodontically move the canine into its normal position. Early diagnosis with cone-beam computed tomography simplifies the treatment of this pathology. This case report describes a patient with bilateral transposition, one complete and the other incomplete, involving the maxillary canine and the first premolar (Mx.C.1P). The orthodontic treatment involved the correction of both transpositions. In the complete transposition, the traction was mesial and upward to move the canine into a more apical position with a wider dentoalveolar process for easier crown interchange.

Age- and Sex-Related Modifications of Hematology in Spanish Purebred Horse.

The purpose of this study was to test the hypothesis that age and sex significantly modulate the changes in hematological parameters of physiologically healthy Spanish Purebred horse, establishing the reference values. Blood samples were obtained on a total of 159 horses (n = 77 males and n = 82 females), classified in four age groups: group A (1-2 years; n = 39), group B (>2-3 years; n = 38), group C (>3-4 years; n = 41), and group D (>4-7 years; n = 41). By means ADVIA 2020i, red blood cell (RBC), hemoglobin concentration (HB), packed cell volume, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration, platelets (PLTs), as well as total and differential white blood cells (WBCs) were determined. Total plasma protein was determined by spectrophotometry. Results obtained showed that sex had a limited influence on these parameters, being the HB higher in males and WBC higher in females (P = .047). Age caused a reduction in RBC, with a compensatory increase of MCV and MCH, decrease in WBC, PLT, lymphocytes (LYMPs), as well as an increase of N/L ratio (P = .047). Interactions between age and sex showed higher RBC in males than in females of the group B, and higher HB and WBC in males than in females of the group D. According to hematological data, Spanish Purebred horse was classified as a warm- or cold-blooded horse. Decline of RBC, WBC, and PLT parameters is a natural condition of horse with the advance of age, indicating a decrease of the narrow bone response.

Effectiveness of a hand hygiene program to reduce acute gastroenteritis at child care centers: A cluster randomized trial.

We aimed to assess the effectiveness of an educational and hand hygiene program in daycare centers (DCCs) and homes on acute gastroenteritis (AGE) incidence in children attending DCCs. METHODS: A randomized, controlled, and open study of 911 children aged 0-3 years attending 24 DCCs in Almería (Spain) with an 8-month follow-up was employed. Two intervention groups of DCCs families performed educational and hand hygiene measures, 1 with soap and water (soap and water group; n = 274), another with hand sanitizer (hand sanitizer group [HSG]; n = 339), and the control group (CG; n = 298) followed usual handwashing procedures. We compared AGE episode rates with Poisson regression model. RESULTS: seven hundred fourteen AGE episodes were registered, significant differences between HSG and CG children were found during December and January. A multivariate model was applied and the adjusted incidence rate ratios by rotavirus vaccination found significant differences when children were previously vaccinated, the children in the soap and water group had a higher risk of AGE episodes (incidence rate ratio: 1.28, 95% confidence interval:1.0-1.64), compared with those in the HSG. CONCLUSIONS: This study demonstrated that hand hygiene programs that included hand sanitizer were most effective in the winter months. Further, the largest reduction of AGE episodes occurred in the children that followed hand hygiene programs including hand sanitizer and educational measures for DCC staff, parents, and children, and were vaccinated for rotavirus.

Quad-helix compression to decompensate molar inclination prior to skeletal expansion.

OBJECTIVES: To demonstrate that patients without posterior crossbite (PCB) but with maxillary transverse deficiency, not previously observed due to an increased curve of Wilson, can benefit from the same palatal expansion as patients with PCB, after correction of the buccal inclination. MATERIALS AND METHODS: A total of 41 patients presenting a maxillary skeletal transverse deficiency were treated: 26 without PCB and 15 with PCB. In the non-PCB group, quad-helix compression was followed by a Hyrax expander (QH+HY), whereas the PCB group only underwent Hyrax expander treatment (HY). The maxillary intercanine, interpremolar, intermolar widths (cusp tips and gingival level) and molar inclination were measured at baseline and at the end of treatment in both groups. RESULTS: No significant differences were found between groups at the end of treatment, and no PCBs remained. The same maxillary expansion was achieved in the QH+HY and HY groups in the region of the canines, at both the gingival (3.4 ± 2.0 vs. 3.4 ± 2.7 mm; P = 0.999) and cusp tip levels (4.5 ± 3.1 vs. 3.8 ± 2.2 mm; P = 0.981). The molar inclination in the QH+HY group decreased, while there was a slight increase in the HY group (-6.50° ± 5.34° vs. 2.3° ± 4.1°; P < 0.001). CONCLUSIONS: Some patients with maxillary transverse deficiency do not present with PCB, due to an increased curve of Wilson. However, these patients require skeletal expansion similar to that of patients with a bilateral PCB. The curve of Wilson should be flattened prior to expansion in order to increase the amount of maxillary skeletal expansion.

Surgical-orthodontic approach for facial rejuvenation based on a reverse facelift.

BACKGROUND: Orthodontic treatment combined with a maxillomandibular advancement (MMA) can be an effective option for patients who need not only corrected occlusion but also facial rejuvenation. In this case series, two patients underwent orthodontic treatment and bimaxillary orthognathic surgery involving MMA, one of them with a counterclockwise rotation of the occlusal plane (OP). FINDINGS: In both cases, the face was rejuvenated, a functional occlusion was established, and the posterior airway space (PAS) was widened. CONCLUSIONS: The facial mask ages three dimensionally. MMA should be offered to patients who have insufficient skeletal projection and are considering improving their facial appearance beyond just correcting a malocclusion problem. The reverse facelift provides more soft-tissue support, resulting in mid- and lower-face rejuvenation.

Management of Deeply Impacted Molars with the Miniscrew-Supported Pole Technique.

Impacted molars occur more often in the mandibular arch than in the maxillary arch, with an overall prevalence of .01-1.8%.(1-4) The most common type of impaction, a mesially inclined molar, is also the most successfully treated.(5) Even a horizontally impacted lower second molar can be uprighted. If a molar is diagnosed in a vertical position, however, its prognosis is more compromised and ankylosis should be suspected.(5,6).

Surgical and orthodontic management of maxillary canine-lateral incisor transpositions.

Transposition of the maxillary canine and the lateral incisor is a complex dental anomaly to treat. The difficulty increases if the treatment aims to correct the transposition. These case reports describe 2 patients with transposition of the maxillary lateral incisor and canine. The first case involves bilateral incomplete transpositions, and the second is a complete transposition. The radiographic appearance of the canine was similar in the 2 patients. However, the treatments were distinct because of the 3-dimensional positions of the teeth. The first case involved palatally placed lateral incisor roots. To prevent resorption of the lateral incisors, the canines were moved into position buccally. In the second case, the lateral incisor root had a buccal position, and the canine crown was tractioned palatally. The position of the lateral incisor root was critical when electing the correct treatment and mechanics for each patient.

Impacts of agricultural irrigation on nearby freshwater ecosystems: the seasonal influence of triazine herbicides in benthic algal communities.

A small hydrological basin (Lerma, NE Spain), transformed from its natural state (steppe) to rain-fed agriculture and recently to irrigation agriculture, has been monitored across four seasons of an agricultural year. The goal of this study was to assess how and whether agricultural activities impacted the nearby freshwater ecosystems via runoff. Specifically, we assessed the toxicity of three triazine herbicides, terbuthylazine, atrazine and simazine on the photosynthetic efficiency and structure of algal benthic biofilms (i.e., phototropic periphyton) in the small creek draining the basin. It was expected that the seasonal runoff of the herbicides in the creek affected the sensitivity of the periphyton in accord with the rationale of the Pollution Induced Community Tolerance (PICT): the exposure of the community to pollutants result in the replacement of sensitive species by more tolerant ones. In this way, PICT can serve to establish causal linkages between pollutants and the observed biological impacts. The periphyton presented significantly different sensitivities against terbuthylazine through the year in accord with the seasonal application of this herbicide in the crops nowadays. The sensitivity of already banned herbicides, atrazine and simazine does not display a clear seasonality. The different sensitivities to herbicides were in agreement with the expected exposures scenarios, according to the agricultural calendar, but not with the concentrations measured in water, which altogether indicates that the use of PICT approach may serve for long-term monitoring purposes. That will provide not only causal links between the occurrence of chemicals and their impacts on natural communities, but also information about the occurrence of chemicals that may escape from traditional sampling methods (water analysis). In addition, the EC50 and EC10 of periphyton for terbuthylazine or simazine are the first to be published and can be used for impact assessments.

Irrigation agriculture affects organic matter decomposition in semi-arid terrestrial and aquatic ecosystems.

Many dryland areas are being converted into intensively managed irrigation crops, what can disrupt the hydrological regime, degrade soil and water quality, enhance siltation, erosion and bank instability, and affect biological communities. Still, the impacts of irrigation schemes on the functioning of terrestrial and aquatic ecosystems are poorly understood. Here we assess the effects of irrigation agriculture on breakdown of coarse organic matter in soil and water. We measured breakdown rates of alder and holm oak leaves, and of poplar sticks in terrestrial and aquatic sites following a gradient of increasing irrigation agriculture in a semi-arid Mediterranean basin transformed into irrigation agriculture in 50% of its surface. Spatial patterns of stick breakdown paralleled those of leaf breakdown. In soil, stick breakdown rates were extremely low in non-irrigated sites (0.0001-0.0003 day(-1)), and increased with the intensity of agriculture (0.0018-0.0044 day(-1)). In water, stick breakdown rates ranged from 0.0005 to 0.001 day(-1), and increased with the area of the basin subject to irrigation agriculture. Results showed that irrigation agriculture affects functioning of both terrestrial and aquatic ecosystems, accelerating decomposition of organic matter, especially in soil. These changes can have important consequences for global carbon budgets.

Acute-phase inflammatory response in idiopathic sudden deafness: pathogenic implications.

The acute-phase inflammatory response in the peripheral bloodstream can be an expression of transient cerebral ischaemia in idiopathic sudden deafness. For this, a neurological and otorhinolaryngological examination of each patient, performing tests on audiometry, and tympanometry, haemogram, and cranial magnetic resonance were performed. The acute-phase inflammatory response manifests as an increased neutrophil/lymphocyte ratio that is detected 48-72 hours after the appearance of sudden deafness. This study shows that there is an acute-phase response in the peripheral bloodstream with an increased neutrophil/lymphocyte ratio as an expression of an inflammatory process that can be caused by transient cerebral ischaemia in sudden deafness. In addition, the increased neutrophil/lymphocyte ratio can rule out a viral origin of sudden deafness, since a viral infection lowers the neutrophil count and increases the lymphocyte count, thus reducing the neutrophil/lymphocyte ratio. These findings aid in understanding the pathogenic mechanisms involved in sudden deafness and offer better treatment to the patient.

Immunophenotype of dogs with subclinical ehrlichiosis.

The purpose of this study was the characterization of the different subsets of lymphocyte cells in dogs with subclinical ehrlichiosis in order to contribute to the knowledge of the immune response developed in the course of this disease. Thirty-eight dogs with subclinical ehrlichiosis and 15 unaffected dogs from two shelters in the area of Valencia (eastern Spain) were included in the study. The study of lymphocyte populations was made by flow cytometry. Monoclonal antibodies against CD3, CD4, CD8, and CD21 were used. Based on our results, the most common findings of the subclinical phase of canine ehrlichiosis were lymphocytosis, relative neutropenia, and a decrease in the neutrophil/lymphocyte ratio. Lymphocytosis in these dogs was from an increase of T lymphocyte counts. Tc cell counts in dogs with subclinical ehrlichiosis were higher than in healthy dogs. This rise in the number of Tc lymphocytes resulted in a reduced percentage of Th lymphocytes and in a decrease in the CD4/CD8 ratio.

Incidence, etiology, and outcome of nosocomial pneumonia in ICU patients requiring percutaneous tracheotomy for mechanical ventilation.

OBJECTIVE: To determine the epidemiology of pneumonia in patients with tracheotomy receiving short-term mechanical ventilation. DESIGN: Observational prospective study. SETTING: A 14-bed medical-surgical ICU. SUBJECTS: Ninety-nine critically ill acute patients requiring percutaneous dilatational tracheotomy for mechanical ventilation. INTERVENTIONS: Tracheal aspirate obtained 48 h before tracheotomy. MEASUREMENTS AND MAIN RESULTS: Eighteen patients (18.1%) acquired pneumonia (median of 7 days after tracheotomy). Pseudomonas aeruginosa was the most frequently identified pathogen, found in eight of the episodes (four not documented by prior tracheal colonization), followed by other Gram-negative bacilli. The development of ventilator-associated pneumonia (VAP) was not anticipated by any clinical variable. A positive tracheal aspirate (TA) culture result obtained before tracheotomy was associated with a risk of acquiring pneumonia of 19.7%, whereas sterile TA cultures were associated with a risk of 14.3% (p > 0.20). VAP prolonged ICU stay or the ventilation period for a median of 19 days and 15 days, respectively. Overall mortality was 34.3%, but the presence of VAP did not increase the mortality rate. CONCLUSIONS: Percutaneous tracheotomy in patients receiving short-term mechanical ventilation predisposes to pneumonia. Pneumonia was associated with prolonged ventilation and ICU stay, but was not associated with increased mortality. Pseudomonas is a common pathogen after tracheotomy, and this observation should be considered in selecting an antibiotic regimen, because TA obtained prior to the tracheotomy often failed to identify this pathogen.