Acute cervico-facial infection in Scotland 2010: patterns of presentation, patient demographics and recording of systemic involvement.

Acute bacterial cervicofacial infection is a common problem that is most often secondary to dental infection. Most cases present as localised abscesses but some may be associated with serious morbidity including scarring, embarrassment of the airway, SIRS (systemic inflammatory response syndrome), and sepsis syndrome. Fourteen oral surgery or maxillofacial surgery units in Scotland took part in a clinical audit of acute infection during two four-week cycles (August and November) in 2010. Information regarding the patients, signs and symptoms, and management was recorded. Training material was distributed between cycles with information on SIRS, sepsis, and the prescription of antibiotics. Overall, 140 patients presented with acute infection. There was an equal sex distribution and ages ranged from 5 to 87 years. There was an association with deprivation and 36% of patients were from the lowest socioeconomic quintile. Most infections were dental (n=120, 86%), and patients presented with pain and swelling (n=120, 86% and n=134, 96%, respectively) Twenty-three patients (16%) met the criteria for SIRS. A further 23 (16%) had at least one positive SIRS marker with incomplete recording of the remaining markers. Twenty-six patients (19%) had no recorded SIRS markers. Cervicofacial infection can be associated with serious morbidity and mortality, which may be better managed if the systemic signs and symptoms of sepsis are recognised and recorded at presentation. This study showed that the recording of signs of sepsis was variable even with training. Further training of junior staff to recognise severe acute bacterial infection may improve management.

Delivering alcohol screening and alcohol brief interventions within general dental practice: rationale and overview of the evidence.

Alcohol consumption and affordability in the UK has increased over the last 50 years and is associated with a range of adverse oral health outcomes, the most serious of which, oral cancer, is also increasing in incidence. Despite this, routine screening and intervention relating to alcohol consumption within general dental practice remains uncommon. This review of the literature describes the background and outlines the evidence base for undertaking alcohol screening and delivering brief interventions in general dental practice. Consideration will be given to the rationale for, and range of issues related to, introducing this into general dental practice.

Delivery of a brief motivational intervention to patients with alcohol-related facial injuries: role for a specialist nurse.

UNLABELLED: In this paper we focus on providing an alcohol screening and intervention service within maxillofacial surgery. Two trained nurses screened patients with alcohol-related facial injuries who attended maxillofacial outpatient clinics, and gave brief motivational interventions to those who had been drinking to a hazardous level. Patients were followed up at 3 and 12 months after the intervention. 195/249 patients (78%) drank to a hazardous level. One hundred and ninety-five patients received an intervention. Duration of intervention was between 5 and 65 minutes. Reasons for refusal to participate included lack of interest or time, and the main reason for exclusion was length of time since injury. The follow up rate was 103 (53%) at 3 months and 134 (69%) at 12 months. CONCLUSIONS: The high level of hazardous drinking among people with facial trauma suggests a clear need for alcohol screening and intervention. It is feasible for nursing staff to deliver brief interventions in a busy maxillofacial trauma clinic.

Nurse-delivered brief interventions for hazardous drinkers with alcohol-related facial trauma: a prospective randomised controlled trial.

AIMS: To assess the impact of two methods of brief nurse-delivered brief interventions in reducing drinking variables in hazardous drinkers with alcohol-related facial injuries. METHODS: A randomised controlled trial of two brief interventions involving hazardous drinkers with facial trauma in three Oral and Maxillofacial Surgery outpatient clinics in the West of Scotland; 194 patients were recruited and randomised to have either a nurse-led brief motivational intervention (intervention group) or a leaflet about alcohol misuse (control group). Patients were followed up at 3 and 12 months after the intervention and drinking variables reassessed. RESULTS: A brief motivational intervention for alcohol provided by a nurse was more effective than a leaflet in helping some patients with facial trauma to reduce their alcohol consumption 12 months after the intervention (p<0.05). CONCLUSIONS: Facial trauma in the West of Scotland is strongly associated with alcohol misuse and is a recurrent disease, particularly among those who drink heavily. A nurse-delivered brief motivational intervention is effective in helping patients with high scores in the Alcohol Use Disorders Identification Test to reduce their drinking, and this effect was apparent 12 months after the intervention.

Removal of third molars in Scottish oral and maxillofacial surgery units: a review of practice in 1995 and 2002.

We audited the practice of removal of third molars in Scottish oral and maxillofacial (OMFS) units in 1995 and in 2002. We collected data from anonymous structured postal questionnaires from 12 Scottish OMFS units about patients referred for removal of third molars in 1995 and 11 units in 2002. The percentage of patients who had no treatment increased from 11% in 1995 (102/928) to 16% in 2002 (66/412). The incidence of prophylactic removal of third molars decreased between the two periods. Removal of third molars under local anaesthesia with or without sedation increased from 35% (325/928) in 1995 to 54% (223/412) in 2002. Removal of third molars under general anaesthesia decreased from 54% in 1995 to 30% in 2002.

Raised CSF phospho-tau concentrations in variant Creutzfeldt-Jakob disease: diagnostic and pathological implications.

OBJECTIVE: To investigate whether phosphorylated tau protein (tau-pT181) is increased in variant Creutzfeldt-Jakob disease (vCJD) and if the tau-pT181/tau protein ratio is useful for distinguishing between patients with and without CJD. METHODS: CSF tau protein and tau-pT181 were measured in 50 patients with sporadic CJD (sCJD), 51 patients with vCJD, 46 sCJD controls, and 37 vCJD controls, using Innotest hTau and Innotest P-Thr181, Innogenetics. RESULTS: Concentrations of CSF tau protein were increased in sCJD (5120 v 367 pg/ml in controls, p < 0.001) and vCJD (952 v 106 pg/ml, p < 0.001); tau-pT181 was also raised in sCJD (61 v 35 pg/ml in controls, p = 0.002) and vCJD (114 v 33 pg/ml, p < 0.001). Median concentrations of tau-pT181 were higher in vCJD than in sCJD (p < 0.001). The tau-pT181/tau protein ratio was lower than in controls in both sCJD (12 v 128 (p < 0.001)) and vCJD (119 v 279 (p < 0.001)). Mean tau-pT181/tau protein ratio was 10-fold higher in vCJD than in sCJD. Raised CSF tau protein had the highest efficiency for distinguishing sCJD and vCJD from controls. CONCLUSIONS: CSF tau-pT181 concentrations are raised in vCJD and are higher than in sCJD. Measurement of CSF tau-pT181/tau protein ratio does not improve the diagnostic efficiency of CSF tau protein alone for either vCJD or sCJD. The higher concentration of CSF tau-pT181 found in vCJD suggests that unexplained pathogenic factors influence the phosphorylation of tau protein in vCJD patients.

Appropriate and inappropriate referrals to a unit of conservative dentistry.

Inappropriate referrals to secondary care are an unnecessary cost, notwithstanding the effect on waiting lists. It is essential therefore that only those patients whose referrals are appropriate are actually referred for secondary care. This project aimed to determine whether referrals to a unit of conservative dentistry are appropriate. The records of 120 consecutive new patient referrals who had been examined by one consultant in the unit of conservative dentistry at Glasgow Dental Hospital and School were obtained. A pro forma was designed on which synopses of the relevant clinical findings were written. These synopses were examined by four general dental practitioners (GDPs). A referral was considered appropriate if three or four of the GDPs considered it to be so, a referral was considered inappropriate if three or four of the GDPs concurred. Of the 120 cases examined, a majority of the GDP assessors agreed that 54 warranted referral, with 23 of these being referrals for toothwear. Agreement was not reached in 35 cases, while 31 referrals were considered inappropriate. Of the 31 cases which were considered inappropriate, 27 were thought to be within the scope of general practitioners. In conclusion, the results suggest that around one quarter of referrals to a unit of conservative dentistry are inappropriate. It would appear that a number of GDPs are unable or unwilling to treat a variety of simple conditions in practice and it may be that the development of referral guidelines is necessary to ensure that only those patients who merit a specialist opinion are referred for this service.

Calbindin-D9K gene expression in human myometrium during pregnancy and labor.

The 9-kilodalton vitamin D-dependent calcium-binding protein (CaBP9K) is expressed in the intestine and uterus of mammals. In this study, we demonstrated the intracellular location of CaBP9K and quantified its expression in human myometrial tissues from nonpregnant and pregnant women (before and after the onset of labor). By Western blot analysis, we found that antiserum raised against bovine intestinal CaBP9K was specific for CaBP9K in human myometrium. By Northern blot analysis, with an oligodeoxynucleotide probe specific for human CaBP9K, we identified a single 0.7-kilobase messenger ribonucleic acid (mRNA) species in myometrial tissues from pregnant women before and after the onset of labor. CaBP9K mRNA and immunoreactive protein were localized within myometrial smooth muscle cells by in situ hybridization and immunohistochemistry. The highest levels of CaBP9K mRNA and immunoreactive protein were found in myometrial tissues obtained from pregnant women at term before the onset of labor. CaBP9K mRNA and immunoreactive levels of CaBP9K were decreased significantly in myometrial tissues obtained after the onset of labor (2- and 8-fold, respectively). These findings demonstrated for the first time that CaBP9K was present in human myometrium and suggested that it may play a role in regulating uterine smooth muscle function during pregnancy.

Modulation of adhesion of lymphocytes to murine brain endothelial cells in vitro: relation to class II major histocompatibility complex expression.

Adhesion of lymphocytes to mouse brain endothelial cells was studied after treatment of the endothelium with 1000 U/ml gamma interferon (IFN-gamma) for 1 h to 2 days. Adhesion was not significantly different from controls after 1 h but at 4 h and thereafter, adhesion increased in a time-related manner. IFN-gamma also increased the expression of class II major histocompatibility complex (MHC) and murine intercellular adhesion molecule-1 (ICAM-1) molecules on the endothelial cells. The level of expression of class II MHC molecules was related to the length of exposure to IFN-gamma. MAb blocking studies suggested that class II molecules were responsible for the IFN-gamma-induced increase in lymphocyte-endothelial cell adhesion. Transfection of a murine lung endothelial cell line with cDNA for the class II MHC molecule also produced a significant increase in lymphocyte-endothelial cell adhesion, suggesting that the class II MHC molecule may have a role in adhesion which is distinct from antigen presentation.