Exposure to BTEX in buses: The influence of vehicle fuel type.

Diesel-fueled buses have been replaced by Compressed Natural Gas (CNG) to minimize the high level of emissions in urban areas. However, differences in indoor exposure levels to Benzene, Toluene, Ethylbenzene and Xylene (BTEX) in those vehicles have not been investigated so far. The primary aim of this study was to determine if passengers are exposed to different BTEX levels when using buses powered by CNG or by diesel, and further explore if indoor levels are influenced by external air quality. For this purpose, BTEX air concentrations were measured in bus cabins (CNG and diesel), parking stations and in a background urban area using passive air samplers. Results showed that BTEX concentrations inside vehicles were higher than outside, but no significant differences were found between buses powered by CNG or by diesel. In CNG vehicles, high and significant positive correlation was found between benzene and the number of journeys in the same route (rs = 0.786, p < 0.05), vehicle operating time (rs = 0.738, p < 0.05), exposure time (rs = 0.714, p < 0.05) and exposure index (rs = 0.738, p < 0.05), but this was not observed for diesel vehicles. Benzene in bus cabins was found to be significantly below reference value for human health protection. However, excepting p-xylene, all other aromatic pollutants have a mean concentration significantly above the lowest effect level (p ≤ 0.002 for all comparisons). Additionally, higher BTEX levels in cabin buses than in outdoor air suggest the presence of other emission sources in indoor cabins. These findings emphasize the need for further studies to fully characterize indoor emission sources in order to minimize the negative impact of BTEX exposure to human health.

Environmental and biological monitoring of benzene, toluene, ethylbenzene and xylene (BTEX) exposure in residents living near gas stations.

The volatile organic compounds benzene, toluene, ethylbenzene, and xylene (BTEX) are emitted into the atmosphere at gas stations (GS) leading to chronic exposure of nearby residents, which raises public health concerns. This study aimes at determining the contribution of GS emissions to BTEX exposure in nearby residents. Three Control and Exposed areas to BTEX emissions from GS were defined in a medium-sized European city (Porto, Portugal). BTEX atmospheric levels were determined in Control and Exposed areas using passive samplers deployed outdoors (n = 48) and indoors (n = 36), and human exposure was estimated for 119 non-smoking residents using the first urine of the day. Results showed that median BTEX outdoor and indoor concentrations were significantly higher for Exposed than Control areas, with exception of ethylbenzene and xylene indoor concentrations, where no marked differences were found. Comparison of urinary concentrations between Exposed and Control residents demonstrated no significant differences for benzene and ethylbenzene, whereas levels of toluene and xylene were significantly higher in Exposed residents. No marked correlation was obtained between atmospheric BTEX concentrations and urinary concentrations. Data indicate the potential impact on air quality of BTEX emissions from GS, which confirms the importance of these findings in urban planning in order to minimize the impact on health and well-being of surrounding populations.

How Effective Is the Quadruple Concomitant Helicobacter Pylori Eradication Therapy for Obese Patients Undergoing Gastric Bypass Surgery?

AIMS AND METHODS: Our aim was to assess, in obese patients undergoing Roux-en Y gastric bypass surgery, the quadruple concomitant HP eradication rates at first line treatment as proposed by the Maastricht IV consensus in areas of high clarithromycin resistance rates-proton pump inhibitor bid, clarithromycin 500 mg bid, amoxicillin 1000 mg bid, and metronidazole 500 mg bid. This is a single center prospective study over a 3-year period. Endoscopy and HP assessment (by histology or C13 urea breath) were performed at baseline, and post treatment HP status was assessed by C13 urea breath test 4-6 weeks after the end of therapy. RESULTS: The study cohort consisted of 600 adult obese HP positive patients [19 % male/81 % female, age 40.7 (±10.4) years] consecutively scheduled for HP concomitant therapy. HP was eradicated in 416 patients [69.3 % (95% CI 65.5-72.9 %)] and the eradication was independent of gender, age, endoscopic diagnosis, and smoking status (p > 0.05). CONCLUSIONS: Two weeks quadruple concomitant therapy did not achieve Maastricht recommended first line acceptable HP eradication rates (at least 80 %) in obese Portuguese patients undergoing GB.

A review of microbiological root canal sampling: updating an emerging picture / Uma revisão de amostragem microbiológica de canal radicular: atualizando um quadro emergente

The significance of microorganisms in root canals with regard to the aetiology of periapical infection and the need for crucial bacteria control during treatment are undeniable. In this study, we report and discuss a review of the literature on Microbiological Root Canal Sampling (MRS). The procedure is analyzed in detail, discussing its powers, limitations and the influence of sample collection procedures on the incidence of true and false positive results. Data sources: MEDLINE/PUBMED, B-On and library files of Oporto University were accessed. Selection: Papers were selected using the keywords: “root ca¬nal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. The references were selected under inclusion criteria such as English language, accessibility, relevance to the theme and scientific rigor. Conclusions: This review illustrated the absolute need to adhere to strict methodology procedures if valid samples are to be obtained. A combination of Culture and molecular identification approaches have confirmed the polymicrobial nature of endodontic infections with a predominance of anaerobic bacteria. Nucleic acid-based techniques provide significant additional information particularly regarding the not-yet-cultivable species of the microbial community, but greatly increase the budget of the procedure. Thus, assessment of the endodontic microflora, in the context of a polymicrobial biofilm ecosystem, and its relevance to endodontic treatments must rely in the complementariness of Culture and Metagenomics approaches as they are neither mutually exclusive nor competitive, but strongly complementary...

A importância de microrganismos em canais radiculares no que diz respeito à etiologia da infecção periapical e a necessidade de controlar bactérias durante o tratamento são incontestáveis. Neste estudo, relata-se e discute-se uma revisão da literatura sobre a amostragem microbiológica de canal radicular. O procedimento é analisado em detalhes, discutindo suas atribuições, limitações e influência de procedimentos de coleta de amostra sobre a incidência de verdadeiros e falsos resultados positivos. Fontes de dados: Foram usados MEDLINE/PubMed, B-On e arquivos da biblioteca da Universidade do Porto. Seleção: Os trabalhos foram selecionados utilizando as palavras-chave: “root canal sampling”; “apical periodontitis”; “endodontic pathogens”; “root canal infection”; “Culture”; “molecular biology”. As referências foram selecionadas de acordo com critérios de inclusão como o idioma inglês, acessibilidade, relevância para o tema e rigor científico. Conclusões: Esta revisão ilustrou a absoluta necessidade de aderir aos procedimentos metodológicos rigorosos se se pretende obter amostras válidas para análise. Uma combinação de cultura e abordagens de iden¬tificação molecular confirmaram a natureza polimicrobiana das infeções endodônticas com predominância de bactérias anaeróbias. Técnicas baseadas em ácidos nucleicos fornecem informação adicional significativa, particularmente em relação às espécies não cultiváveis da comunidade microbiana, mas aumentam muito o orçamento do procedimento. Assim, a avaliação da microflora endodôntica, no contexto de um ecossistema polimicrobiano em biofilme, e sua relevância para tratamentos endodônticos devem confiar na complementaridade entre a abordagem de cultura e de metagenômica, pois não são mutuamente exclusivas nem competitivas, mas fortemente complementares...

Periodontitis and atherosclerosis: an observational study.

BACKGROUND: Poor oral health has been related with cardiovascular diseases. Specifically, periodontitis has been implicated in the pathogenesis of atherosclerosis. Our aim was to evaluate the relationship between the degree of carotid atherosclerosis and severity of periodontitis in a patient cohort. METHODS: Fifty adult patients receiving carotid duplex scans in a cerebral hemodynamics lab were included in the study. Ultrasound protocol included measurement of carotid intima-media thickness (IMT), which is a marker of atherosclerosis, and characterization of any atherosclerotic plaques in the cervical common and internal carotid arteries. Patients were divided into two main groups: the test group had IMT ≥ 1 mm or the presence of any carotid atherosclerotic plaque, and the control group had IMT < 1 mm and absence of atherosclerotic plaques. Periodontal evaluation was performed in all the teeth and characterized according to the clinical attachment level, which between 1 mm and 2 mm was classified as slight, 3 mm and 4 mm as moderate and ≥5 mm as severe. RESULTS: The control group included 15 (30%), while the test group included 35 (70%) subjects. The most common diagnosis was severe periodontitis (40%); moderate and slight periodontitis were also frequent occurrences (32% and 28%, respectively). In the control group, 53.3% had slight, 33.3% had moderate and 13.3% had severe periodontitis. In the test group, those percentages were respectively 22.2%, 44.4% and 33.3%. Patients with atheroma plaque had the highest percentage of severe periodontitis (70.6%). More severe periodontitis was related to atherosclerosis (P = 0.007). CONCLUSION: This study showed an association between periodontitis severity and carotid atherosclerosis, suggesting that periodontal disease might be a risk indicator for atherosclerotic disease.

Cumulative Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery.

BACKGROUND: Our aim was to assess, in obese patients undergoing Roux-en Y gastric bypass surgery, the cumulative Helicobacter pylori (HP) eradication rates in two consecutive time spans (2006-2008 and 2009-2010). METHODS: The study adopted a 14-day clarithromycin-based triple therapy in first-line treatment as proposed by the Maastricht III consensus-proton pump inhibitor bid, clarithromycin 500 mg bid and amoxicillin 1,000 mg bid-and a 14-day second-line levofloxacin-based empirical regimen-proton pump inhibitor bid, amoxicillin 1,000 mg bid and levofloxacin 500 mg od. RESULTS: In 2006-2008, 253 patients received first-line therapy. HP was eradicated in 200 patients and 14 patients withdrew (intention to treat (ITT) = 79.1 %; per protocol (PP) = 83.7 %). In the remaining 39 patients, HP was eradicated in 22 patients and 8 patients withdrew (ITT = 56.4 % and PP = 71.0 %). Thus, out of 253 patients, HP was eradicated in 222 patients, 22 patients withdrew and 9 remained positive. In 2009-2010, 437 patients received first-line therapy. HP was eradicated in 256 patients and 30 patients withdrew (ITT = 58.6 %; PP = 62.9 %). In the remaining 151 patients, HP was eradicated in 80 and 6 patients withdrew (ITT = 53.0 % and PP = 55.1 %). These results give cumulative eradication rates of 87.7 % ITT and 96.1 % PP (2006-2008) and of 76.9 % ITT and 83.8 % PP (2009-2010). CONCLUSIONS: Cumulative HP eradication rates have fallen during 2006-2010 due to the fall of first-line eradication therapy rate, which was around 20 %. Therefore, the first-line clarithromycin-based Maastricht III consensus eradication is no longer effective in bariatric patients indicating the need to test new regimens.

Helicobacter pylori eradication therapy in obese patients undergoing gastric bypass surgery--fourteen days superior to seven days?

BACKGROUND: The high prevalence of Helicobacter pylori (HP) in our obese population undergoing Roux-en-Y bypass gastric surgery (69.4%) and the concern that it may exacerbate postoperative foregut symptoms and increase gastric cancer risk led us to adopt a policy of HP systematic eradication in this group of patients. Our aim, in obese patients undergoing bypass gastric surgery, was to compare effectivity of 7- and 14-days clarithromycin-based triple therapy as the first-line treatment for HP eradication. METHODS: Three hundred seventy-three patients [mean age 41.2 ± 10.3 years; 313 women (83.9%)] were HP positive determined by histology or urea breath test. In 2005, 94 patients (Group A) were treated with a 7-days triple therapy-proton pump inhibitor (PPI) b.i.d., clarithromycin (CL) 500 mg b.i.d., and amoxicillin (AMX) 1,000 mg b.i.d. Since 2006, 279 patients (Group B) were treated with a similar 14-days drug regimen-PPI b.i.d., CL 500 mg b.i.d., and AMX 1,000 mg b.i.d. Posttreatment HP status was assessed by C13 urea breath test 4-6 weeks after the end of therapy. RESULTS: The eradication rates were 67.0% (Group A) and 79.9% (Group B). The eradication rate achieved with 14-days triple therapy was significantly higher than with 7-days triple therapy (OR = 1.96; 95% CI: 1.16-3.30; p = 0.016). CONCLUSIONS: A 14-days triple therapy is more effective than 7-days triple therapy suggesting this regimen should be the first-line therapy for HP eradication in Portuguese obese patients undergoing bypass gastric surgery.

Dental erosion in alcoholic patients under addiction rehabilitation therapy

Objective: To determine the occurrence and severity of dental erosion in alcoholic patients undergoing detoxificationat the North Alcoholic Regional Centre (CRAN), Porto, Portugal, and to assess socioeconomic and behaviouralcovariates of dental erosion occurrence. Design: A cross-sectional descriptive study was carried out in onecentre (CRAN) for addiction rehabilitation therapy in the north of Portugal. A sample of 1064 teeth was examined.The condition of the dental erosion was classified by means of severity and anatomic location, according to theEccles and Jenkins dental erosion index, and a dichotomous outcome assessing the occurrence of dental erosion(severity dental erosion levels > 0 ). Dental erosion results were linked to data supplied by a questionnaire assessingsocio-demographic characteristics, behaviour related to alcohol and drug use, including a history of drugand alcohol abuse, and oral health promotion using logistic multivariate regression analysis. Results: Enameland/or dentine erosion lesions were present on 49.4% of the teeth. Among these, 36.9% of occlusal surfacespresented dental erosion with a severity level of 1, 11.4% with a severity level 2 and 1.1% with a severity level 3.The highest occurrence of severity level 3 was found to exist in palatal dental surfaces (1.9%). Dental erosion onteeth surfaces was found to be independently associated with intra oral location (by arch, tooth type), patients’socio-demographic characteristics, behaviour associated with a history of alcohol and drug abuse, and oral healthpromotion. Maxillary teeth, more so than mandibular teeth, presented moderate to higher severity erosion injuries(Wilcoxon test; p< 0.001); and significant differences in the severity of dental erosion were found betweenanterior and posterior teeth, in both the maxillary and the mandibular arches (Friedman test, p< 0.001). (..) (AU)

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Dental erosion in alcoholic patients under addiction rehabilitation therapy.

OBJECTIVE: To determine the occurrence and severity of dental erosion in alcoholic patients undergoing detoxification at the North Alcoholic Regional Centre (CRAN), Porto, Portugal, and to assess socioeconomic and behavioural covariates of dental erosion occurrence. DESIGN: A cross-sectional descriptive study was carried out in one centre (CRAN) for addiction rehabilitation therapy in the north of Portugal. A sample of 1064 teeth was examined. The condition of the dental erosion was classified by means of severity and anatomic location, according to the Eccles and Jenkins dental erosion index, and a dichotomous outcome assessing the occurrence of dental erosion (severity dental erosion levels > 0 ). Dental erosion results were linked to data supplied by a questionnaire assessing socio-demographic characteristics, behaviour related to alcohol and drug use, including a history of drug and alcohol abuse, and oral health promotion using logistic multivariate regression analysis. RESULTS: Enamel and/or dentine erosion lesions were present on 49.4% of the teeth. Among these, 36.9% of occlusal surfaces presented dental erosion with a severity level of 1, 11.4% with a severity level 2 and 1.1% with a severity level 3. The highest occurrence of severity level 3 was found to exist in palatal dental surfaces (1.9%). Dental erosion on teeth surfaces was found to be independently associated with intra oral location (by arch, tooth type), patients' socio-demographic characteristics, behaviour associated with a history of alcohol and drug abuse, and oral health promotion. Maxillary teeth, more so than mandibular teeth, presented moderate to higher severity erosion injuries (Wilcoxon test; p< 0.001); and significant differences in the severity of dental erosion were found between anterior and posterior teeth, in both the maxillary and the mandibular arches (Friedman test, p< 0.001). CONCLUSIONS: Alcohol-dependent patients undergoing a detoxification programme presented a high occurrence and a low severity of dental erosion lesions.The palatal surfaces of the anterior teeth, followed by incisive/occlusal surfaces in both anterior and posterior teeth, respectively, were most affected by erosion injuries.

Indications for upper gastrointestinal endoscopy. The accuracy of the American Society for Gastrointestinal Endoscopy guidelines in a Portuguese hospital.

INTRODUCTION: The appropriateness of the indications for upper gastro-intestinal endoscopy (EGD) is crucial in assessing quality in endoscopy units, improving cost-effectiveness and providing better patient care. Using the American Society for Gastrointestinal Endoscopy (ASGE) guidelines, the aim of this study was to evaluate the appropriate use of EGD and to measure the local accuracy of these guidelines. PATIENTS AND METHODS: Over a two year period information was gathered on 2305 consecutive patients--1146 (50% males)--of whom had an EGD performed at our unit. Patients were referred for EGD by other physicians of the hospital staff or through the gastroenterology out-patient clinic. The appropriateness, sensitivity, specificity and predictive value of the ASGE guidelines were established using EGD diagnosis as gold standard. Atrophic gastritis and hiatus hernia were considered irrelevant diagnosis. RESULTS: According to the ASGE guidelines the rate of inappropriateness was 20%. No lesions or irrelevant lesions were found in 30.6% EGD. Appropriately indicated endoscopies disclosed significantly more clinically relevant findings (71.3%) than endoscopies performed with indications that were not ASGE listed (61.7%) - p < 0.01, OR = 1.55, 95% CI (1.24-1.92) but no significant difference was found between appropriateness and inappropriateness in patients with a diagnosis of gastric cancer: p = 0.21, OR = 1.53, 95% CI (0.75-3.21). The sensitivity of the ASGE criteria was 82.1%, the specificity 25.2%, the positive predictive value 71% and the negative predictive value 38.1%. Gastric cancer was found in 10 (0.4%) of the patients not appropriately indicated. CONCLUSIONS: In this Portuguese population sample, the accuracy of the ASGE guidelines is too low to be confidently acceptable. This suggests that, in Portugal, a country with a high prevalence of gastric cancer, wider criteria must be applied, if useful local guidelines for appropriate referrals are expected.